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Subject: Comparison of computed tomography and magnetic resonance based target volume in brain tumors Prabhakar R, Haresh KP, Ganesh T, Joshi RC, Julka PK, Rath GK - J Can Res Ther
Date: Sat, 17 Nov 2007 11:14:58 +0100
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BACKGROUND-COLOR: #ffffff
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.pageHead {
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.other {
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}
.sTitle {
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.ref {
	FONT-SIZE: 10px; COLOR: #cc6601; FONT-FAMILY: Arial, Verdana, =
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.empty {
	PADDING-LEFT: 1px; COLOR: #000000; PADDING-TOP: 1px; BACKGROUND-COLOR: =
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}
.footer {
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}
.menu {
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BORDER-LEFT: #a1a1a1 10px solid; BORDER-BOTTOM: #a1a1a1 10px solid
}
.sj {
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FONT-SIZE: 10px; BORDER-LEFT: #d2d2da 1px solid; COLOR: #000000; =
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.menutable {
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.Footertab {
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.leftnavcelltop {
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.spl {
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	CURSOR: pointer
}
.bl {
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Kruti Dev 050; src: =
url(http://www.cancerjournal.net/templates/krutide0.eot)
}

------=_NextPart_000_003A_01C8290B.1728FB80
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://www.cancerjournal.net/templates/layer.js

var link=3Dnew Array()
var delay_hide=3D500
var menuobj;
var menu;
var default_menu_item;


function lib_bwcheck(){ //Browsercheck (needed)
	this.ver=3Dnavigator.appVersion
	this.agent=3Dnavigator.userAgent
	this.dom=3Ddocument.getElementById?1:0
	this.opera5=3Dthis.agent.indexOf("Opera 5")>-1
	this.ie5=3D(this.ver.indexOf("MSIE 5")>-1 && this.dom && =
!this.opera5)?1:0;=20
	this.ie6=3D(this.ver.indexOf("MSIE 6")>-1 && this.dom && =
!this.opera5)?1:0;
	this.ie4=3D(document.all && !this.dom && !this.opera5)?1:0;
	this.ie=3Dthis.ie4||this.ie5||this.ie6
	this.mac=3Dthis.agent.indexOf("Mac")>-1
	this.ns6=3D(this.dom && parseInt(this.ver) >=3D 5) ?1:0;=20
	this.ns4=3D(document.layers && !this.dom)?1:0;
	this.bw=3D(this.ie6 || this.ie5 || this.ie4 || this.ns4 || this.ns6 || =
this.opera5)
	return this
}
var bw=3Dnew lib_bwcheck();

function  (obj,visible)
{	this.evnt=3Dbw.dom? 	=
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
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	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
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	this.css.visibility =3D visible;
	this.css.width=3D'100%';

}

function showHideLayer(obj,visible){							=09
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document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
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	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
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	this.css.visibility =3D visible;
	this.css.top=3D'94px';
	bw.ns4||bw.ns6?this.css.left=3D'-8px':
	this.css.left=3D'0px';
	this.css.width=3D'100%';
	this.css.position=3D"absolute";
}


function writeSubmenu(obj,item){							=09
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document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
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	if(!this.evnt) return false
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	thecontent=3D(item=3D=3D-1)? "" : link[item]
	this.wref.innerHTML=3Dthecontent;*/

}


function clearContent(obj){=09
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document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
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	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
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	thecontent=3D(item=3D=3D-1)? "" : link[item]
	this.wref.innerHTML=3D"";

}


function clear_delayhide()
{
	alert("asdASD");
	if (window.delayhide)
	{onlpgld(default_menu_item)
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}
}

function contains_ns6(a, b)=20
{
	while (b.parentNode)
	if ((b =3D b.parentNode) =3D=3D a)
		return true;
	return false;
}



////


function navleftMouseOver(src)
{=20

	src.className=3D"leftnavcellover"
}=20



function navleftMouseOut(src)
{=20
	src.className=3D"leftnavcell"
}

function navtabMouseOver(src)
{=20

		src.className=3D"buttonCell"
}=20



function navtabMouseOut(src)
{=20
	src.className=3D"topBand1"
}

////



function navMouseOver(src,item)
{=20

	src.className=3D"topBand1MO"
	//writeSubmenu("submenu",item);
	//showHideLayer("submenu","visible");=09
=09

}=20



function navMouseOut(src,lyr)
{=20
	src.className=3D"topBand1";
//	onlpgld(default_menu_item);
=09
}

function onload(item)
{
	writeSubmenu("submenu",item);
	showHideLayer("submenu","visible");
	=09
}

function onlpgld(item)
{
	/*default_menu_item=3Ditem;=09
	writeSubmenu("submenu",item);
	showHideLayer("submenu","visible");*/

	=09
}

function navMouseOversUB(src)
{=20
	src.className=3D"topBand2MO"

}=20
function navMouseOutsUB(src)
{=20
	src.className=3D"topBand2"
}
function navMouseBotOut(src)
{
	src.className=3D"leftnavcell"
}
function navMouseBotOver(src)
{
	src.className=3D"leftnavcellover"
}

function loadMenu(index)
{
	writeMenu("menu",item);
	showHideLayer("menu","visible");=09
	if (index >=3D 0)
	{
		onload(index)	=09
	}
}


function showMenu(e,f)
{
	var ie4=3Ddocument.all&&navigator.userAgent.indexOf("Opera")=3D=3D-1
	var ns6=3Ddocument.getElementById&&!document.all
	var ns4=3Ddocument.layers
	eventX=3Die4? event.clientX : ns6? e.clientX : e.x
	eventY=3Die4? event.clientY : ns6? e.clientY : e.y
	var rightedge=3Die4? document.body.clientWidth-eventX : =
window.innerWidth-eventX
	var bottomedge=3Die4? document.body.clientHeight-eventY : =
window.innerHeight-eventY

	var obj=3D"floatmenu";
	this.evnt=3Dbw.dom? 	=
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;
	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	this.css.visibility =3D "visible";
	this.css.left=3Die4? document.body.scrollLeft+eventX : ns6? =
window.pageXOffset+eventX : eventX
	 if (bottomedge<this.css.contentheight)
		this.css.top=3Die4? =
document.body.scrollTop+eventY-this.css.contentheight : ns6? =
window.pageYOffset+eventY-this.css.contentheight : =
eventY-this.css.contentheight;
	 else
		 this.css.top=3Die4? document.body.scrollTop+event.clientY : ns6? =
window.pageYOffset+eventY : eventY=20

	this.css.visibility=3D"visible";
	this.css.top=3DeventX;

	alert(eventX);

}


function writeMenu(obj,item)
{
  	this.evnt=3Dbw.dom? =
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;
	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	thecontent=3D(item=3D=3D-1)? "" : menu;
	this.wref.innerHTML=3Dthecontent;

}

function setCSS(typ)
{=20
	var i, a, main;
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	{

	    if(a.getAttribute("rel").indexOf("style") !=3D -1 && 	=
a.getAttribute("title")) {
      	    a.disabled =3D true;
            if(a.getAttribute("title") =3D=3D typ) a.disabled =3D false;
    }
  }
=09
}



function getActiveStyleSheet() {
  var i, a;
  for(i=3D0; (a =3D document.getElementsByTagName("link")[i]); i++) {
    if(a.getAttribute("rel").indexOf("style") !=3D -1 && =
a.getAttribute("title") && !a.disabled) return a.getAttribute("title");
  }
  return null;
}

function openWin(pg)
{

if (pg.indexOf('special') >=3D 0 )
{
var attributes =3D 'toolbar=3D0,location=3D0,directories=3D0,status=3D0, =
menubar=3D0,scrollbars=3D1,resizable=3D1,width=3D800,height=3D600,left=3D=
0,top=3D0';
}
else
{
var attributes =3D 'toolbar=3D0,location=3D0,directories=3D0,status=3D0, =
menubar=3D0,scrollbars=3D1,resizable=3D1,width=3D600,height=3D400,left=3D=
0,top=3D0';
}

sealWin=3Dwindow.open(pg ,'',attributes);=20
self.name =3D pg;=20
}


function valfld(field)
{

	var valid =3D "0123456789"; // these are allowed values
	var ok =3D "yes";
	var temp;
	if (field.value.length =3D=3D 0 )
	{
		//alert("Invalid entry! please enter number");
		field.value =3D ""
		field.focus();
		field.select();
		return false;=09
	}
	for (var i=3D0; i<field.value.length; i++)
	{
		temp =3D "" + field.value.substring(i, i+1);
		if (valid.indexOf(temp) =3D=3D "-1")=20
		ok =3D "no";
	}
	if (ok =3D=3D "no")=20
	{
		alert("Invalid entry! Only numbers are allowed!");
		field.value =3D ""
		field.focus();
		field.select();

		return false;
	}
	else
		return true;
	}


function chkvldemail(email_address)
   {
         //Assumes that valid email addresses consist of =
user_name@domain.tld
         at =3D email_address.indexOf('@');
         dot =3D email_address.indexOf('.');
        =20
         if(at =3D=3D -1 ||=20
            dot =3D=3D -1 ||        =20
            dot =3D=3D 0 )
		{=09
			alert("Please enter valid email address 1.");
            return(false);
		}
           =20
         user_name =3D email_address.substr(0, at);
         domain_name =3D email_address.substr(at + 1, =
email_address.length);                 =20

         if(Validate_String(user_name) =3D=3D=3D false || =
Validate_String(domain_name) =3D=3D=3D false)
		{=09
			alert("Please enter valid email address.");
	            return(false);=20
                }
         else
		 return(true);
}

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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" =
"http://www.w3c.org/TR/1999/REC-html401-19991224/loose.dtd">
<HTML><HEAD><TITLE>Comparison of computed tomography and magnetic =
resonance based target volume in brain tumors Prabhakar R, Haresh KP, =
Ganesh T, Joshi RC, Julka PK, Rath GK - J Can Res Ther</TITLE>
<META http-equiv=3DContent-Type content=3D"text/html; =
charset=3Dwindows-1252">
<META=20
content=3D"Journal of Cancer Research and Therapeutics, full-text, =
online, electronic, e-journal, free access, open access, online =
submission"=20
name=3Dkeywords>
<META=20
content=3D"Official publication of Association of Radiation Oncology of =
India (AROI)"=20
name=3Ddescription><!--DC META DATA START-->
<META=20
content=3D"Comparison of computed tomography and magnetic resonance =
based target volume in brain tumors"=20
name=3DDC.Title><LINK =
href=3D"http://purl.org/metadata/dublin_core_elements#title"=20
rel=3DSCHEMA.dc>
<META content=3DPrabhakar name=3DDC.Creator><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#creator" =
rel=3DSCHEMA.dc>
<META content=3Dprabhakar_smr@hotmail.com =
name=3DDC.Creator.Address><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#creator" =
rel=3DSCHEMA.dc>
<META content=3D"Brain tumor, computed tomography, magnetic resonance =
imaging"=20
name=3DDC.Subject>
<META=20
content=3D"<b>Purpose</b> : This study was mainly framed to study the =
difference in tumor volumes as seen on computed tomography (CT) and =
magnetic resonance (MR) and their significance in =
planning.<br><b>Materials and Methods</b> : Twenty-five patients with =
brain tumor of different diagnoses who underwent stereotactic =
radiotherapy were included in this study. CT and MR imaging was done for =
all the patients with 2.5 mm slice thickness. The CT tumor volume and MR =
tumor volume were measured and compared with each other. The center of =
mass (CM) of the tumor volume delineated on CT and MR were computed and =
the shift between the two CMs was determined.<br><b>Results</b> : The =
mean and median volume of the tumor as measured from MR scans was 19.67 =
cc =B1 13.73 and 16.13 cc (range: 3.25 cc - 50.37 cc). Similarly, the =
mean and median volume of the tumor as measured from CT scans was 15.05 =
cc =B1 10.13 and 11.63 cc (range: 3.0 cc - 36.25 cc) respectively. The =
mean and median CM shift between CT and MR was 5.47 mm and 5.21 mm =
respectively.<br><b>Conclusion</b> : The study demonstrates that MR is =
an indispensable imaging modality in radiotherapy for planning brain =
tumors."=20
name=3DDC.Description><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#description" =
rel=3DSCHEMA.dc>
<META content=3D"Medknow Publications" name=3DDC.Publisher><LINK=20
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<META=20
content=3D"Prabhakar  R, Haresh  KP, Ganesh  T, Joshi  RC, Julka  PK, =
Rath  GK"=20
name=3DDC.Contributor.PersonalName><LINK=20
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2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar=20
name=3DDC.Identifier><LINK=20
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                <TD width=3D"100%" colSpan=3D3><FONT =
class=3DtocAT><B>BRIEF=20
                  REPORT</B></FONT></TD></TR>
              <TR>
                <TD width=3D"33%" height=3D5></TD>
                <TD width=3D"33%" height=3D5></TD>
                <TD width=3D"34%" height=3D5></TD></TR>
              <TR>
                <TD class=3Dother width=3D"100%" colSpan=3D3><B>Year =
</B>:=20
                  2007&nbsp; |&nbsp; <B>Volume</B> : 3&nbsp; |&nbsp;=20
                  <B>Issue</B> : 2&nbsp; |&nbsp; <B>Page</B> : =
121-123</TD></TR>
              <TR>
                <TD class=3Dother width=3D"100%"=20
            colSpan=3D3>&nbsp;</TD></TR></TBODY></TABLE>
            <P><FONT class=3DsTitle>Comparison of computed tomography =
and magnetic=20
            resonance based target volume in brain =
tumors</FONT><BR><BR><FONT=20
            class=3DarticleAuthor>Prabhakar R, Haresh KP, Ganesh T, =
Joshi RC,=20
            Julka PK, Rath GK</FONT><BR><FONT =
class=3DAuthorAff>&nbsp;Department=20
            of Radiation Oncology, Institute Rotary Cancer Hospital, All =
India=20
            Institute of Medical Sciences, New Delhi - 110 029,=20
            India<BR></FONT><BR></P>
            <P><FONT class=3DCorrsAdd><B>Correspondence =
Address</B>:<BR>Prabhakar=20
            R <BR>Department of Radiation Oncology, Insitute Rotary =
Cancer=20
            Hospital, All India Institute of Medical Sciences, New Delhi =
- 110=20
            029 <BR>India<BR>prabhakar_smr@hotmail.com</FONT> </P>
            <TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" =
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              <TBODY>
              <TR>
                <TD class=3DinsideLine width=3D"100%"=20
            height=3D1></TD></TR></TBODY></TABLE>&nbsp;<BR>
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            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub width=3D"85%" =
height=3D15>&nbsp;&gt;<A=20
                  name=3DAbstract></A>&nbsp;Abstract</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD width=3D"15%" height=3D15></TD></TR></TBODY></TABLE>
            <P><B>Purpose</B> : This study was mainly framed to study =
the=20
            difference in tumor volumes as seen on computed tomography =
(CT) and=20
            magnetic resonance (MR) and their significance in=20
            planning.<BR><B>Materials and Methods</B> : Twenty-five =
patients=20
            with brain tumor of different diagnoses who underwent =
stereotactic=20
            radiotherapy were included in this study. CT and MR imaging =
was done=20
            for all the patients with 2.5 mm slice thickness. The CT =
tumor=20
            volume and MR tumor volume were measured and compared with =
each=20
            other. The center of mass (CM) of the tumor volume =
delineated on CT=20
            and MR were computed and the shift between the two CMs was=20
            determined.<BR><B>Results</B> : The mean and median volume =
of the=20
            tumor as measured from MR scans was 19.67 cc =B1 13.73 and =
16.13 cc=20
            (range: 3.25 cc - 50.37 cc). Similarly, the mean and median =
volume=20
            of the tumor as measured from CT scans was 15.05 cc =B1 =
10.13 and=20
            11.63 cc (range: 3.0 cc - 36.25 cc) respectively. The mean =
and=20
            median CM shift between CT and MR was 5.47 mm and 5.21 mm=20
            respectively.<BR><B>Conclusion</B> : The study demonstrates =
that MR=20
            is an indispensable imaging modality in radiotherapy for =
planning=20
            brain tumors.</P><BR>
            <P class=3Dkyds><B>Keywords:</B>&nbsp;Brain tumor, computed=20
            tomography, magnetic resonance imaging</P><BR>
            <TABLE class=3Dsitethis width=3D"100%" border=3D0>
              <TBODY>
              <TR>
                <TD class=3Dother><B>How to cite this =
article:</B><BR>Prabhakar=20
                  R, Haresh KP, Ganesh T, Joshi RC, Julka PK, Rath GK.=20
                  Comparison of computed tomography and magnetic =
resonance based=20
                  target volume in brain tumors. J Can Res Ther=20
              2007;3:121-3</TD></TR></TBODY></TABLE><BR>
            <TABLE class=3Dsitethis width=3D"100%" border=3D0>
              <TBODY>
              <TR>
                <TD class=3Dother><B>How to cite this =
URL:</B><BR>Prabhakar R,=20
                  Haresh KP, Ganesh T, Joshi RC, Julka PK, Rath GK. =
Comparison=20
                  of computed tomography and magnetic resonance based =
target=20
                  volume in brain tumors. J Can Res Ther [serial online] =
2007=20
                  [cited&nbsp;2007 Nov 17];3:121-3. Available =
from:&nbsp;<A=20
                  =
href=3D"http://www.cancerjournal.net/text.asp?2007/3/2/121/34694">http://=
www.cancerjournal.net/text.asp?2007/3/2/121/34694</A></TD></TR></TBODY></=
TABLE><BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  =
name=3DIntroduction></A>&nbsp;&gt;&nbsp;Introduction</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  =
border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>Computed tomography=20
            (CT) has made a dramatic impact in radiotherapy treatment =
planning.=20
            Although, CT provides geometrically precise scans, it gives =
less=20
            information about the soft tissues, in comparison to =
magnetic=20
            resonance imaging (MR). The high sensitivity of MR to =
variations in=20
            tissue proton density and in T<SUB> 1</SUB> and T<SUB> =
2</SUB>=20
            relaxation times can be of value for radiotherapy imaging in =
central=20
            nervous system lesions. Magnetic resonance imaging (MRI) =
provides=20
            excellent contrast resolution, easy multiplanar imaging and =
absence=20
            of artifacts. Because of the absence of bone artifacts, as =
seen on=20
            CT, MRI is superior for imaging the lesions at the vertex, =
in the=20
            posterior fossa, near the walls of the middle fossa and at =
the base=20
            of the skull<B> .</B> CT is superior to MRI for detecting =
meningioma=20
            but requires contrast enhancement. Both MRI and =
contrast-enhanced CT=20
            are effective in defining pituitary tumors, but MRI may =
provide more=20
            information about the precise extent of the lesions and =
their effect=20
            on adjacent structures. In many instances, the sensitivity =
of MRI=20
            exceeds that of CT. Though CT <B>-</B> MR fusion is the =
standard=20
            imaging technique for radiotherapy treatment planning for =
brain=20
            tumors, many centers still use CT alone. This study was =
mainly=20
            framed to study the difference in tumor volumes as seen on =
CT and MR=20
            and their significance in planning. <BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3D"Materials and =
Methods"></A>&nbsp;&gt;&nbsp;Materials and=20
                  Methods</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  =
border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>Twenty-five patients=20
            with brain tumor of different diagnoses who underwent =
stereotactic=20
            radiotherapy were included in this study. The diagnoses =
include=20
            pituitary adenoma, glioma, craniopharyngioma, meningioma and =
brain=20
            metastasis. Immobilization was done with a relocatable frame =

            (Gill-Thomas Cosman). Using the sequential scanning mode, 60 =
to 80=20
            slices were taken for each patient. Contrast enhanced CT =
scan was=20
            done with CT localizer frame placed over the GTC frame for =
2.5 mm=20
            slice thickness (Siemens Volume Zoom CT<SUP> TM</SUP> ). =
Similarly,=20
            contrast enhanced MR imaging was performed with MR localizer =
frame=20
            for 2.5 mm slice thickness (Sonata<SUP> TM</SUP> ). Both the =
image=20
            data sets were transferred to the Xknife-RT<SUP> TM</SUP> =
treatment=20
            planning system. Both the CT and MR datasets were registered =
using=20
            the MR and CT localizer rods attached to the patient frame. =
Tumor=20
            volume was marked separately on CT and MR image datasets. =
The CT=20
            tumor volume and MR tumor volume were measured and compared =
with=20
            each other. The center of mass of the tumor volume =
delineated on CT=20
            and MR were computed and the shift between the two CMs was=20
            determined with the distance formula. Statistical analysis =
was done=20
            with SPSS ver.10.0 software. The CT and MR volume comparison =
was=20
            done by paired t-test.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                name=3DResults></A>&nbsp;&gt;&nbsp;Results</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>The =
tumor volume=20
            delineated on CT and MR datasets along with the CM is shown =
in <A=20
            class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_1.jpg"=20
            target=3D_blank>[Table - 1]</A>. The mean and median volume =
of the=20
            tumor as measured from the MR scans was 19.67 cc =B1 13.73 =
and 16.13=20
            cc (range: 3.25 cc - 50.37 cc). Similarly, the mean and =
median=20
            volume of the tumor as measured from CT scans was 15.05 cc =
=B1 10.13=20
            and 11.63 cc (range: 3.0 cc - 36.25 cc) respectively. The =
mean and=20
            median CM shift between CT and MR was 5.47 mm and 5.21 mm=20
            respectively. There is a linear relationship between MRI and =
CT=20
            volume with a good correlation coefficient of r=3D 0.94 and =
MRI shows=20
            1.27 times more volume when compared to CT volume <A =
class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_2.jpg"=20
            target=3D_blank>[Figure - 1]</A>. <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_3.jpg"=20
            target=3D_blank>[Figure - 2]</A> shows the Bland-Altman test =
for CT=20
            and MR tumor volumes. It shows that MRI volume is larger =
than CT=20
            volume in most of the studied cases. Statistical analysis =
using=20
            paired sample t-test for the difference in CT and MR tumor =
volume=20
            was highly significant (<I> P</I> &lt;0.0001). <A =
class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_4.jpg"=20
            target=3D_blank>[Figure - 3]</A> shows the relationship =
between CM=20
            shift and MRI volume. It shows that the CM shift (Planning =
isocenter=20
            shift) decreases with increase in tumor volume.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3DDiscussion></A>&nbsp;&gt;&nbsp;Discussion</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  =
border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>CT-based planning in=20
            brain tumor without the use of MRI will lead to under-dosage =
to the=20
            tumor. In our study, except in the case of meningiomas in =
more than=20
            44% of the patients, MRI showed more than 40% increase in =
the tumor=20
            volume. The statistics clearly show that MRI plays a very =
important=20
            role for tumor delineation for brain tumors and MRI should=20
            compulsorily be incorporated for radiotherapy treatment =
planning.=20
            Our results clearly show that CT underestimates the tumor =
volume in=20
            brain tumors and the isocenter shift also indicates a =
possible tumor=20
            under-dosage when CT alone is used for planning. The fact =
that MRI=20
            shows larger tumor volume compared to CT is well in accord =
with the=20
            published results.<SUP> <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref1=
"=20
            name=3Dft1>[1]</A>,<A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref2=
"=20
            name=3Dft2>[2]</A></SUP> The relationship between isocenter =
shift and=20
            MRI volume reveals that isocenter shift decreases with =
increase in=20
            tumor volume. It shows that there may be geometric miss in =
small=20
            tumors especially if CT alone is used for treatment =
planning. It is=20
            also evident from these figures that small tumor may get =
under-dosed=20
            if CT alone is used for planning.<BR><BR>It was reported =
about a=20
            decade ago that on using MRI for radiation treatment =
planning in=20
            brain tumors, there was a mean reduction of 30% in field =
size from=20
            the purely CT defined one.<SUP> <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref3=
"=20
            name=3Dft3>[3]</A></SUP> However, two other groups have =
reported an=20
            increased MRI defined target volume with a greater volume =
seen on=20
            MRI alone as opposed to CT only.<SUP> <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref1=
"=20
            name=3Dft1>[1]</A>,<A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref4=
"=20
            name=3Dft4>[4]</A></SUP> It can therefore be concluded that =
there is=20
            an increased sensitivity of MRI in defining target volumes. =
This=20
            will in turn lead to better dose delivery to the tumor as =
well as=20
            more sparing of normal tissues.<SUP> <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref5=
"=20
            name=3Dft5>[5]</A></SUP> Although CT scanning provides =
geometrically=20
            precise scans, it gives less detailed tumor and normal =
tissue=20
            anatomic definition, in comparison to MRI.<SUP> <A =
class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ref6=
"=20
            name=3Dft6>[6]</A></SUP><BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3DConclusion></A>&nbsp;&gt;&nbsp;Conclusion</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>The =
study=20
            demonstrates that MR is an indispensable imaging modality in =

            radiotherapy for planning brain tumors.<BR><BR>&nbsp;
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub height=3D15><A=20
                  name=3DReference></A>&nbsp;&gt;&nbsp;References</TD>
                <TD class=3Dinthis align=3Dright height=3D15>&nbsp;</TD>
                <TD align=3Dright width=3D"15%" height=3D15><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR>
            <TABLE class=3Dbody cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
              border=3D0><TBODY>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft1"=
=20
                  name=3Dref1>1.</A></TD>
                <TD>Ten Haken RK, Thornton AF Jr, Sandler HM, LaVigne =
ML,=20
                  Quint DJ, Fraass BA, <I>et al.</I> A quantitative =
assessment=20
                  of the addition of MRI to CT-based, 3-D treatment =
planning of=20
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href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft1"=
><IMG=20
                  alt=3D"Back to cited text no. 1"=20
                  =
src=3D"http://www.cancerjournal.net/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
db=3DPubMed&amp;list_uids=3D1332134&amp;dopt=3DAbstract"=20
                  target=3D_blank><FONT=20
              class=3Dref>PUBMED</FONT></A>]&nbsp;&nbsp;</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft2"=
=20
                  name=3Dref2>2.</A></TD>
                <TD>Thornton AF Jr, Sandler HM, Ten Haken RK, McShan DL, =

                  Fraass BA, La Vigne ML, <I>et al.</I> The clinical =
utility of=20
                  magnetic resonance imaging in 3-dimensional treatment =
planning=20
                  of brain neoplasms. Int J Radiat Oncol Biol Phys=20
                  1992;24:767-75.&nbsp;&nbsp;<A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft2"=
><IMG=20
                  alt=3D"Back to cited text no. 2"=20
                  =
src=3D"http://www.cancerjournal.net/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
db=3DPubMed&amp;list_uids=3D1429103&amp;dopt=3DAbstract"=20
                  target=3D_blank><FONT=20
              class=3Dref>PUBMED</FONT></A>]&nbsp;&nbsp;</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft3"=
=20
                  name=3Dref3>3.</A></TD>
                <TD>Websy G, Adamis MK, Edelmann RR. Artifacts in MRI:=20
                  Description, causes and solutions. <I>In</I> : =
Edelmann RR,=20
                  Hesselink JK, Zlatkin MB, editors. Clinical Magnetic =
Resonance=20
                  Imaging. Saunders: Philadelphia, Pa; 1996. p. 88-144.=20
                  &nbsp;&nbsp;<A=20
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href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft3"=
><IMG=20
                  alt=3D"Back to cited text no. 3"=20
                  =
src=3D"http://www.cancerjournal.net/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft4"=
=20
                  name=3Dref4>4.</A></TD>
                <TD>Khoo VS, Dearnaley DP, Finnigan DJ, Padhani A, =
Tanner SF,=20
                  Leach MO. Magnetic resonance imaging (MRI): =
Considerations and=20
                  applications in radiotherapy treatment planning. =
Radiother=20
                  Oncol 1997;42:1-15.&nbsp;&nbsp;<A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft4"=
><IMG=20
                  alt=3D"Back to cited text no. 4"=20
                  =
src=3D"http://www.cancerjournal.net/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
db=3DPubMed&amp;list_uids=3D9132820&amp;dopt=3DAbstract"=20
                  target=3D_blank><FONT=20
                  class=3Dref>PUBMED</FONT></A>]&nbsp;&nbsp;[<A=20
                  =
href=3D"http://linkinghub.elsevier.com/retrieve/pii/S016781409601866X"=20
                  target=3D_blank><FONT =
class=3Dref>FULLTEXT</FONT></A>]</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft5"=
=20
                  name=3Dref5>5.</A></TD>
                <TD>Kessler ML, Ten Haken R, Fraas B, McShan D. =
Expanding the=20
                  use and Effectiveness of dose volume histograms for 3D =

                  treatment planning. Med Phys =
1991;18:611.&nbsp;&nbsp;<A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft5"=
><IMG=20
                  alt=3D"Back to cited text no. 5"=20
                  =
src=3D"http://www.cancerjournal.net/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft6"=
=20
                  name=3Dref6>6.</A></TD>
                <TD>Kent DL, Haynor DR, Longstreth WT, Larson EB. The =
clinical=20
                  efficacy of magnetic resonance imaging in =
neuroimaging. Ann=20
                  Intern Med 1994;15;120:856-71.&nbsp;&nbsp;<A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#ft6"=
><IMG=20
                  alt=3D"Back to cited text no. 6"=20
                  =
src=3D"http://www.cancerjournal.net/images/ref_top.gif"=20
                  =
border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR></TBODY></TABLE><BR><BR>=

            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub>&nbsp;&nbsp;&nbsp;&nbsp;<A=20
                  =
name=3Dafigs></A>Figures</TD></TR></TBODY></TABLE><BR>&nbsp; <A=20
            class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_2.jpg"=20
            target=3D_blank>[Figure - 1]</A>, <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_3.jpg"=20
            target=3D_blank>[Figure - 2]</A>, <A class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_4.jpg"=20
            target=3D_blank>[Figure - 3]</A><BR>&nbsp;<BR>&nbsp;
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub>&nbsp;&nbsp;&nbsp;&nbsp;<A=20
                  =
name=3Databs></A>Tables</TD></TR></TBODY></TABLE><BR>&nbsp; <A=20
            class=3Dref=20
            =
href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
_3_2_121_34694_1.jpg"=20
            target=3D_blank>[Table - 1]</A>=20
            <TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" =
border=3D0>
              <TBODY>
              <TR>
                <TD width=3D"100%">
                  <P align=3Dcenter><BR>
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                <TD align=3Dright width=3D"100%"><A=20
                  =
href=3D"http://www.cancerjournal.net/article.asp?issn=3D0973-1482;year=3D=
2007;volume=3D3;issue=3D2;spage=3D121;epage=3D123;aulast=3DPrabhakar#top"=
><IMG=20
                  height=3D13 alt=3DTop=20
                  =
src=3D"http://www.cancerjournal.net/images/arrow_top.gif"=20
                  width=3D13 border=3D0></A></TD></TR></TBODY></TABLE>
            <TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" =
border=3D0>
              <TBODY>
              <TR>
                <TD vAlign=3Dbottom rowSpan=3D2><A=20
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2007_3_2_121_34694_2.jpg"=20
width=3D150></A><BR><FONT class=3Dadlink>Figure 1: Relationship=20
between...</FONT></P>
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_3_2_121_34694_3.jpg"=20
target=3D_blank><IMG=20
style=3D"BORDER-RIGHT: #cccccc 1px solid; BORDER-TOP: #cccccc 1px solid; =
BORDER-LEFT: #cccccc 1px solid; BORDER-BOTTOM: #cccccc 1px solid"=20
alt=3D""=20
src=3D"http://www.cancerjournal.net/articles/2007/3/2/images/JCanResTher_=
2007_3_2_121_34694_3.jpg"=20
width=3D150></A><BR><FONT class=3Dadlink>Figure 2: Bland-Altman test=20
fo...</FONT></P>
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style=3D"BORDER-RIGHT: #cccccc 1px solid; BORDER-TOP: #cccccc 1px solid; =
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alt=3D""=20
src=3D"http://www.cancerjournal.net/articles/2007/3/2/images/JCanResTher_=
2007_3_2_121_34694_4.jpg"=20
width=3D150></A><BR><FONT class=3Dadlink>Figure 3: Relationship=20
between...</FONT></P>
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href=3D"http://www.cancerjournal.net/viewimage.asp?img=3DJCanResTher_2007=
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BORDER-LEFT: #cccccc 1px solid; BORDER-BOTTOM: #cccccc 1px solid"=20
height=3D150 alt=3D""=20
src=3D"http://www.cancerjournal.net/articles/2007/3/2/images/JCanResTher_=
2007_3_2_121_34694_1.jpg"></A><BR><FONT=20
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 if (_ufsc) s+=3D_uBInfo();=0A=
 if (_uctm) s+=3D_uCInfo();=0A=
 if (_utitle && _ubd.title && _ubd.title!=3D"") =
s+=3D"&utmdt=3D"+_uES(_ubd.title);=0A=
 if (_udl.hostname && _udl.hostname!=3D"") =
s+=3D"&utmhn=3D"+_uES(_udl.hostname);=0A=
 s+=3D"&utmr=3D"+_ur;=0A=
 s+=3D"&utmp=3D"+pg;=0A=
 if ((_userv=3D=3D0 || _userv=3D=3D2) && _uSP()) {=0A=
  var i=3Dnew Image(1,1);=0A=
  i.src=3D_ugifpath+"?"+"utmwv=3D"+_uwv+s;=0A=
  i.onload=3Dfunction() {_uVoid();}=0A=
 }=0A=
 if ((_userv=3D=3D1 || _userv=3D=3D2) && _uSP()) {=0A=
  var i2=3Dnew Image(1,1);=0A=
  =
i2.src=3D_ugifpath2+"?"+"utmwv=3D"+_uwv+s+"&utmac=3D"+_uacct+"&utmcc=3D"+=
_uGCS();=0A=
  i2.onload=3Dfunction() { _uVoid(); }=0A=
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 return;=0A=
}=0A=
function _uVoid() { return; }=0A=
function _uCInfo() {=0A=
 if (!_ucto || _ucto=3D=3D"") { _ucto=3D"15768000"; }=0A=
 if (!_uVG()) return;=0A=
 var =
c=3D"",t=3D"-",t2=3D"-",t3=3D"-",o=3D0,cs=3D0,cn=3D0,i=3D0,z=3D"-",s=3D""=
;=0A=
 if (_uanchor && _udlh && _udlh!=3D"") s=3D_udlh+"&";=0A=
 s+=3D_udl.search;=0A=
 var x=3Dnew Date(_udt.getTime()+(_ucto*1000));=0A=
 var dc=3D_ubd.cookie;=0A=
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 if (_ulink && !_ubl) {=0A=
  z=3D_uUES(_uGC(s,"__utmz=3D","&"));=0A=
  if (z!=3D"-" && z.indexOf(";")=3D=3D-1) { =
_ubd.cookie=3D"__utmz=3D"+z+"; path=3D"+_utcp+";"+x+_udo; return ""; }=0A=
 }=0A=
 z=3Ddc.indexOf("__utmz=3D"+_udh);=0A=
 if (z>-1) { z=3D_uGC(dc,"__utmz=3D"+_udh,";"); }=0A=
 else { z=3D"-"; }=0A=
 t=3D_uGC(s,_ucid+"=3D","&");=0A=
 t2=3D_uGC(s,_ucsr+"=3D","&");=0A=
 t3=3D_uGC(s,"gclid=3D","&");=0A=
 if ((t!=3D"-" && t!=3D"") || (t2!=3D"-" && t2!=3D"") || (t3!=3D"-" && =
t3!=3D"")) {=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"utmcid=3D"+_uEC(t);=0A=
  if (t2!=3D"-" && t2!=3D"") { if (c !=3D "") c+=3D"|"; =
c+=3D"utmcsr=3D"+_uEC(t2); }=0A=
  if (t3!=3D"-" && t3!=3D"") { if (c !=3D "") c+=3D"|"; =
c+=3D"utmgclid=3D"+_uEC(t3); }=0A=
  t=3D_uGC(s,_uccn+"=3D","&");=0A=
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  t=3D_uGC(s,_ucmd+"=3D","&");=0A=
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  else  c+=3D"|utmcmd=3D(not+set)";=0A=
  t=3D_uGC(s,_uctr+"=3D","&");=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"|utmctr=3D"+_uEC(t);=0A=
  else { t=3D_uOrg(1); if (t!=3D"-" && t!=3D"") =
c+=3D"|utmctr=3D"+_uEC(t); }=0A=
  t=3D_uGC(s,_ucct+"=3D","&");=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"|utmcct=3D"+_uEC(t);=0A=
  t=3D_uGC(s,_ucno+"=3D","&");=0A=
  if (t=3D=3D"1") o=3D1;=0A=
  if (z!=3D"-" && o=3D=3D1) return "";=0A=
 }=0A=
 if (c=3D=3D"-" || c=3D=3D"") { c=3D_uOrg(); if (z!=3D"-" && =
_ufno=3D=3D1)  return ""; }=0A=
 if (c=3D=3D"-" || c=3D=3D"") { if (_ufns=3D=3D1)  c=3D_uRef(); if =
(z!=3D"-" && _ufno=3D=3D1)  return ""; }=0A=
 if (c=3D=3D"-" || c=3D=3D"") {=0A=
  if (z=3D=3D"-" && _ufns=3D=3D1) { =
c=3D"utmccn=3D(direct)|utmcsr=3D(direct)|utmcmd=3D(none)"; }=0A=
  if (c=3D=3D"-" || c=3D=3D"") return "";=0A=
 }=0A=
 if (z!=3D"-") {=0A=
  i=3Dz.indexOf(".");=0A=
  if (i>-1) i=3Dz.indexOf(".",i+1);=0A=
  if (i>-1) i=3Dz.indexOf(".",i+1);=0A=
  if (i>-1) i=3Dz.indexOf(".",i+1);=0A=
  t=3Dz.substring(i+1,z.length);=0A=
  if (t.toLowerCase()=3D=3Dc.toLowerCase()) cs=3D1;=0A=
  t=3Dz.substring(0,i);=0A=
  if ((i=3Dt.lastIndexOf(".")) > -1) {=0A=
   t=3Dt.substring(i+1,t.length);=0A=
   cn=3D(t*1);=0A=
  }=0A=
 }=0A=
 if (cs=3D=3D0 || _ufns=3D=3D1) {=0A=
  t=3D_uGC(dc,"__utma=3D"+_udh,";");=0A=
  if ((i=3Dt.lastIndexOf(".")) > 9) {=0A=
   _uns=3Dt.substring(i+1,t.length);=0A=
   _uns=3D(_uns*1);=0A=
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  cn++;=0A=
  if (_uns=3D=3D0) _uns=3D1;=0A=
  _ubd.cookie=3D"__utmz=3D"+_udh+"."+_ust+"."+_uns+"."+cn+"."+c+"; =
path=3D"+_utcp+"; "+x+_udo;=0A=
 }=0A=
 if (cs=3D=3D0 || _ufns=3D=3D1) return "&utmcn=3D1";=0A=
 else return "&utmcr=3D1";=0A=
}=0A=
function _uRef() {=0A=
 if (_ur=3D=3D"0" || _ur=3D=3D"" || _ur=3D=3D"-") return "";=0A=
 var i=3D0,h,k,n;=0A=
 if ((i=3D_ur.indexOf("://"))<0) return "";=0A=
 h=3D_ur.substring(i+3,_ur.length);=0A=
 if (h.indexOf("/") > -1) {=0A=
  k=3Dh.substring(h.indexOf("/"),h.length);=0A=
  if (k.indexOf("?") > -1) k=3Dk.substring(0,k.indexOf("?"));=0A=
  h=3Dh.substring(0,h.indexOf("/"));=0A=
 }=0A=
 h=3Dh.toLowerCase();=0A=
 n=3Dh;=0A=
 if ((i=3Dn.indexOf(":")) > -1) n=3Dn.substring(0,i);=0A=
 for (var ii=3D0;ii<_uRno.length;ii++) {=0A=
  if ((i=3Dn.indexOf(_uRno[ii].toLowerCase())) > -1 && =
n.length=3D=3D(i+_uRno[ii].length)) { _ufno=3D1; break; }=0A=
 }=0A=
 if (h.indexOf("www.")=3D=3D0) h=3Dh.substring(4,h.length);=0A=
 return =
"utmccn=3D(referral)|utmcsr=3D"+_uEC(h)+"|"+"utmcct=3D"+_uEC(k)+"|utmcmd=3D=
referral";=0A=
}=0A=
function _uOrg(t) {=0A=
 if (_ur=3D=3D"0" || _ur=3D=3D"" || _ur=3D=3D"-") return "";=0A=
 var i=3D0,h,k;=0A=
 if ((i=3D_ur.indexOf("://")) < 0) return "";=0A=
 h=3D_ur.substring(i+3,_ur.length);=0A=
 if (h.indexOf("/") > -1) {=0A=
  h=3Dh.substring(0,h.indexOf("/"));=0A=
 }=0A=
 for (var ii=3D0;ii<_uOsr.length;ii++) {=0A=
  if (h.toLowerCase().indexOf(_uOsr[ii].toLowerCase()) > -1) {=0A=
   if ((i=3D_ur.indexOf("?"+_uOkw[ii]+"=3D")) > -1 || =
(i=3D_ur.indexOf("&"+_uOkw[ii]+"=3D")) > -1) {=0A=
    k=3D_ur.substring(i+_uOkw[ii].length+2,_ur.length);=0A=
    if ((i=3Dk.indexOf("&")) > -1) k=3Dk.substring(0,i);=0A=
    for (var yy=3D0;yy<_uOno.length;yy++) {=0A=
     if (_uOno[yy].toLowerCase()=3D=3Dk.toLowerCase()) { _ufno=3D1; =
break; }=0A=
    }=0A=
    if (t) return _uEC(k);=0A=
    else return =
"utmccn=3D(organic)|utmcsr=3D"+_uEC(_uOsr[ii])+"|"+"utmctr=3D"+_uEC(k)+"|=
utmcmd=3Dorganic";=0A=
   }=0A=
  }=0A=
 }=0A=
 return "";=0A=
}=0A=
function _uBInfo() {=0A=
 var sr=3D"-",sc=3D"-",ul=3D"-",fl=3D"-",cs=3D"-",je=3D1;=0A=
 var n=3Dnavigator;=0A=
 if (self.screen) {=0A=
  sr=3Dscreen.width+"x"+screen.height;=0A=
  sc=3Dscreen.colorDepth+"-bit";=0A=
 } else if (self.java) {=0A=
  var j=3Djava.awt.Toolkit.getDefaultToolkit();=0A=
  var s=3Dj.getScreenSize();=0A=
  sr=3Ds.width+"x"+s.height;=0A=
 }=0A=
 if (n.language) { ul=3Dn.language.toLowerCase(); }=0A=
 else if (n.browserLanguage) { ul=3Dn.browserLanguage.toLowerCase(); }=0A=
 je=3Dn.javaEnabled()?1:0;=0A=
 if (_uflash) fl=3D_uFlash();=0A=
 if (_ubd.characterSet) cs=3D_uES(_ubd.characterSet);=0A=
 else if (_ubd.charset) cs=3D_uES(_ubd.charset);=0A=
 return =
"&utmcs=3D"+cs+"&utmsr=3D"+sr+"&utmsc=3D"+sc+"&utmul=3D"+ul+"&utmje=3D"+j=
e+"&utmfl=3D"+fl;=0A=
}=0A=
function __utmSetTrans() {=0A=
 var e;=0A=
 if (_ubd.getElementById) e=3D_ubd.getElementById("utmtrans");=0A=
 else if (_ubd.utmform && _ubd.utmform.utmtrans) =
e=3D_ubd.utmform.utmtrans;=0A=
 if (!e) return;=0A=
 var l=3De.value.split("UTM:");=0A=
 var i,i2,c;=0A=
 if (_userv=3D=3D0 || _userv=3D=3D2) i=3Dnew Array();=0A=
 if (_userv=3D=3D1 || _userv=3D=3D2) { i2=3Dnew Array(); c=3D_uGCS(); }=0A=
=0A=
 for (var ii=3D0;ii<l.length;ii++) {=0A=
  l[ii]=3D_uTrim(l[ii]);=0A=
  if (l[ii].charAt(0)!=3D'T' && l[ii].charAt(0)!=3D'I') continue;=0A=
  var r=3DMath.round(Math.random()*2147483647);=0A=
  if (!_utsp || _utsp=3D=3D"") _utsp=3D"|";=0A=
  var f=3Dl[ii].split(_utsp),s=3D"";=0A=
  if (f[0].charAt(0)=3D=3D'T') {=0A=
   s=3D"&utmt=3Dtran"+"&utmn=3D"+r;=0A=
   f[1]=3D_uTrim(f[1]); if(f[1]&&f[1]!=3D"") =
s+=3D"&utmtid=3D"+_uES(f[1]);=0A=
   f[2]=3D_uTrim(f[2]); if(f[2]&&f[2]!=3D"") =
s+=3D"&utmtst=3D"+_uES(f[2]);=0A=
   f[3]=3D_uTrim(f[3]); if(f[3]&&f[3]!=3D"") =
s+=3D"&utmtto=3D"+_uES(f[3]);=0A=
   f[4]=3D_uTrim(f[4]); if(f[4]&&f[4]!=3D"") =
s+=3D"&utmttx=3D"+_uES(f[4]);=0A=
   f[5]=3D_uTrim(f[5]); if(f[5]&&f[5]!=3D"") =
s+=3D"&utmtsp=3D"+_uES(f[5]);=0A=
   f[6]=3D_uTrim(f[6]); if(f[6]&&f[6]!=3D"") =
s+=3D"&utmtci=3D"+_uES(f[6]);=0A=
   f[7]=3D_uTrim(f[7]); if(f[7]&&f[7]!=3D"") =
s+=3D"&utmtrg=3D"+_uES(f[7]);=0A=
   f[8]=3D_uTrim(f[8]); if(f[8]&&f[8]!=3D"") =
s+=3D"&utmtco=3D"+_uES(f[8]);=0A=
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   s=3D"&utmt=3Ditem"+"&utmn=3D"+r;=0A=
   f[1]=3D_uTrim(f[1]); if(f[1]&&f[1]!=3D"") =
s+=3D"&utmtid=3D"+_uES(f[1]);=0A=
   f[2]=3D_uTrim(f[2]); if(f[2]&&f[2]!=3D"") =
s+=3D"&utmipc=3D"+_uES(f[2]);=0A=
   f[3]=3D_uTrim(f[3]); if(f[3]&&f[3]!=3D"") =
s+=3D"&utmipn=3D"+_uES(f[3]);=0A=
   f[4]=3D_uTrim(f[4]); if(f[4]&&f[4]!=3D"") =
s+=3D"&utmiva=3D"+_uES(f[4]);=0A=
   f[5]=3D_uTrim(f[5]); if(f[5]&&f[5]!=3D"") =
s+=3D"&utmipr=3D"+_uES(f[5]);=0A=
   f[6]=3D_uTrim(f[6]); if(f[6]&&f[6]!=3D"") =
s+=3D"&utmiqt=3D"+_uES(f[6]);=0A=
  }=0A=
  if ((_userv=3D=3D0 || _userv=3D=3D2) && _uSP()) {=0A=
   i[ii]=3Dnew Image(1,1);=0A=
   i[ii].src=3D_ugifpath+"?"+"utmwv=3D"+_uwv+s;=0A=
   i[ii].onload=3Dfunction() { _uVoid(); }=0A=
  }=0A=
  if ((_userv=3D=3D1 || _userv=3D=3D2) && _uSP()) {=0A=
   i2[ii]=3Dnew Image(1,1);=0A=
   =
i2[ii].src=3D_ugifpath2+"?"+"utmwv=3D"+_uwv+s+"&utmac=3D"+_uacct+"&utmcc=3D=
"+c;=0A=
   i2[ii].onload=3Dfunction() { _uVoid(); }=0A=
  }=0A=
 }=0A=
 return;=0A=
}=0A=
function _uFlash() {=0A=
 var f=3D"-",n=3Dnavigator;=0A=
 if (n.plugins && n.plugins.length) {=0A=
  for (var ii=3D0;ii<n.plugins.length;ii++) {=0A=
   if (n.plugins[ii].name.indexOf('Shockwave Flash')!=3D-1) {=0A=
    f=3Dn.plugins[ii].description.split('Shockwave Flash ')[1];=0A=
    break;=0A=
   }=0A=
  }=0A=
 } else if (window.ActiveXObject) {=0A=
  for (var ii=3D10;ii>=3D2;ii--) {=0A=
   try {=0A=
    var fl=3Deval("new =
ActiveXObject('ShockwaveFlash.ShockwaveFlash."+ii+"');");=0A=
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   }=0A=
   catch(e) {}=0A=
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 }=0A=
 return f;=0A=
}=0A=
function __utmLinker(l,h) {=0A=
 if (!_ulink) return;=0A=
 var p,k,a=3D"-",b=3D"-",c=3D"-",x=3D"-",z=3D"-",v=3D"-";=0A=
 var dc=3D_ubd.cookie;=0A=
 if (!l || l=3D=3D"") return;=0A=
 var iq =3D l.indexOf("?"); =0A=
 var ih =3D l.indexOf("#"); =0A=
 if (dc) {=0A=
  a=3D_uES(_uGC(dc,"__utma=3D"+_udh,";"));=0A=
  b=3D_uES(_uGC(dc,"__utmb=3D"+_udh,";"));=0A=
  c=3D_uES(_uGC(dc,"__utmc=3D"+_udh,";"));=0A=
  x=3D_uES(_uGC(dc,"__utmx=3D"+_udh,";"));=0A=
  z=3D_uES(_uGC(dc,"__utmz=3D"+_udh,";"));=0A=
  v=3D_uES(_uGC(dc,"__utmv=3D"+_udh,";"));=0A=
  k=3D(_uHash(a+b+c+x+z+v)*1)+(_udh*1);=0A=
  =
p=3D"__utma=3D"+a+"&__utmb=3D"+b+"&__utmc=3D"+c+"&__utmx=3D"+x+"&__utmz=3D=
"+z+"&__utmv=3D"+v+"&__utmk=3D"+k;=0A=
 }=0A=
 if (p) {=0A=
  if (h && ih>-1) return;=0A=
  if (h) { _udl.href=3Dl+"#"+p; }=0A=
  else {=0A=
   if (iq=3D=3D-1 && ih=3D=3D-1) _udl.href=3Dl+"?"+p;=0A=
   else if (ih=3D=3D-1) _udl.href=3Dl+"&"+p;=0A=
   else if (iq=3D=3D-1) =
_udl.href=3Dl.substring(0,ih-1)+"?"+p+l.substring(ih);=0A=
   else _udl.href=3Dl.substring(0,ih-1)+"&"+p+l.substring(ih);=0A=
  }=0A=
 } else { _udl.href=3Dl; }=0A=
}=0A=
function __utmLinkPost(f,h) {=0A=
 if (!_ulink) return;=0A=
 var p,k,a=3D"-",b=3D"-",c=3D"-",x=3D"-",z=3D"-",v=3D"-";=0A=
 var dc=3D_ubd.cookie;=0A=
 if (!f || !f.action) return;=0A=
 var iq =3D f.action.indexOf("?"); =0A=
 var ih =3D f.action.indexOf("#"); =0A=
 if (dc) {=0A=
  a=3D_uES(_uGC(dc,"__utma=3D"+_udh,";"));=0A=
  b=3D_uES(_uGC(dc,"__utmb=3D"+_udh,";"));=0A=
  c=3D_uES(_uGC(dc,"__utmc=3D"+_udh,";"));=0A=
  x=3D_uES(_uGC(dc,"__utmx=3D"+_udh,";"));=0A=
  z=3D_uES(_uGC(dc,"__utmz=3D"+_udh,";"));=0A=
  v=3D_uES(_uGC(dc,"__utmv=3D"+_udh,";"));=0A=
  k=3D(_uHash(a+b+c+x+z+v)*1)+(_udh*1);=0A=
  =
p=3D"__utma=3D"+a+"&__utmb=3D"+b+"&__utmc=3D"+c+"&__utmx=3D"+x+"&__utmz=3D=
"+z+"&__utmv=3D"+v+"&__utmk=3D"+k;=0A=
 }=0A=
 if (p) {=0A=
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  if (h) { f.action+=3D"#"+p; }=0A=
  else {=0A=
   if (iq=3D=3D-1 && ih=3D=3D-1) f.action+=3D"?"+p;=0A=
   else if (ih=3D=3D-1) f.action+=3D"&"+p;=0A=
   else if (iq=3D=3D-1) =
f.action=3Df.action.substring(0,ih-1)+"?"+p+f.action.substring(ih);=0A=
   else =
f.action=3Df.action.substring(0,ih-1)+"&"+p+f.action.substring(ih);=0A=
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 }=0A=
 return;=0A=
}=0A=
function __utmSetVar(v) {=0A=
 if (!v || v=3D=3D"") return;=0A=
 if (!_udo || _udo =3D=3D "") {=0A=
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 if (!_uVG()) return;=0A=
 var r=3DMath.round(Math.random() * 2147483647);=0A=
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expires=3D"+_uNx()+";"+_udo;=0A=
 var s=3D"&utmt=3Dvar&utmn=3D"+r;=0A=
 if ((_userv=3D=3D0 || _userv=3D=3D2) && _uSP()) {=0A=
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 if ((_userv=3D=3D1 || _userv=3D=3D2) && _uSP()) {=0A=
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i2.src=3D_ugifpath2+"?"+"utmwv=3D"+_uwv+s+"&utmac=3D"+_uacct+"&utmcc=3D"+=
_uGCS();=0A=
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}=0A=
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