BACKGROUND Zika virus (ZIKV) has spread in the Americas, including parts of the southern United States, and infection can be associated with serious complications, including congenital brain abnormalities. Probable transfusion transmission of ZIKV has been documented in Brazil. STUDY DESIGN AND METHODS Preemptive testing of blood donations for ZIKV RNA was implemented in southern US states at risk of local transmission using a test approved under a Food and Drug Administration (FDA) investigational new drug application, cobas Zika. Screening was expanded after issuance of an updated FDA guidance. Donations reactive on initial screening were further tested by nucleic acid and antibody tests to determine the donor status. RESULTS Of 358,786 donations from US states screened by individual donation testing, 23 were initially reactive on cobas Zika. Fourteen of these represented probable ZIKV infection based on reactivity on additional nucleic acid testing or anti‐Zika immunoglobulin M. Ten of the 14 donors reported travel to an identified ZIKV‐active area within 90 days before donation (median time from end of travel to donation, 25 days; range, 6‐71 days). Three donors with travel history also had a potential sexual exposure. Only seven of the 14 donations with probable ZIKV infection were detectable upon 1:6 dilution to simulate minipool testing. The estimated specificity of the cobas Zika test was 99.997%. CONCLUSION Screening of donations for ZIKV RNA can interdict ZIKV‐infected donors. Donor risk factors include travel more than 4 weeks before donation and sexual exposure. Minipool screening would have detected only 50% of the RNA‐positive donations.

Although phosphorus-31 (³¹P) magnetic resonance spectroscopy holds potential as noninvasive tool to monitor treatment response of liver malignancies, the lack of appropriate coils has so far restricted its use to liver lesions close to the surface. A novel eight-channel phased-array dual-tuned ³¹P/¹H coil that can assess ³¹P metabolism in deeper liver tissue as well is presented in this article. Analysis of its performance demonstrates that this coil can provide good sensitivity across a width of 20 cm, thereby enabling magnetic resonance spectroscopic imaging (MRSI) scans that can fully cover axial views of the abdomen in lean subjects. In vivo results and reproducibility of ³¹P MRSI at 3 T of axial slices covering the full depth of the liver are shown in healthy volunteers. To minimize intrasubject and intersubject data variability, spectra are corrected for coil sensitivities. Methods to maximize the reproducibility of coil placement and spectroscopic planning are discussed. The phosphomonoesters/phosphodiesters ratio calculated in healthy volunteers has an average intrasubject variation of 23% averaged over voxels selected from the entire liver. Finally, the feasibility of using the coil in the clinic is shown by preliminary ³¹P liver MRSI data obtained from a patient with hepatocellular carcinoma.

IntroductionThe magnitude of intra- and inter-fractional variation in the set up of breast cancer patients treated with tangential megavoltage photon beams was investigated using an electronic portal imaging device (EPID).MethodsDaily cine-EPID images were captured during delivery of the tangential fields for ten breast cancer patients treated in the supine position. Measurements collected from each image included the central lung distance (CLD), central flash distance (CFD), superior axial measurement (SAM) and the inferior axial measurement (IAM). The variation of motion within a fraction (intra-fraction) and the variation between fractions (inter-fraction) was analysed to quantify set up variation and motion due to respiration.ResultsAltogether 3775 EPID images were collected from 10 patients. The effect of respiratory motion during treatment was <0.1 cm standard deviation (SD) in the anterior–posterior (AP) direction. The inter-fraction movement caused by variations in daily set up was larger at 0.28 cm SD in the AP direction. Superior–inferior (SI) variation was more difficult to summarise and proved unreliable as the measurements were taken to an ambiguous point on the images. It was difficult to discern true SI movement from that implicated by AP movement.ConclusionThere is minimal intra-fractional chest wall motion due to respiration during treatment. Inter-fractional variation was larger, however, on average it remained within departmental tolerance (0.5 cm) for set up variations. This review of our current breast technique provides confidence in the feasibility of utilising advanced treatment techniques (field-in-field, intensity modulated radiotherapy or volumetric modulated arc therapy) following a review of the current imaging protocol.

This study demonstrated the use of a novel 3-dimensional marker as a safe and effective method for delineating the tumor bed with a significant utility for RT planning. With routine use of the device, an increased use of hypofractionation with a resultant 25 % cost savings was noted.