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Sample records for 192ir high dose

  1. High-Dose-Rate 192Ir Brachytherapy Dose Verification: A Phantom Study

    PubMed Central

    Nikoofar, Alireza; Hoseinpour, Zohreh; Rabi Mahdavi, Seied; Hasanzadeh, Hadi; Rezaei Tavirani, Mostafa

    2015-01-01

    Background: The high-dose-rate (HDR) brachytherapy might be an effective tool for palliation of dysphagia. Because of some concerns about adverse effects due to absorbed radiation dose, it is important to estimate absorbed dose in risky organs during this treatment. Objectives: This study aimed to measure the absorbed dose in the parotid, thyroid, and submandibular gland, eye, trachea, spinal cord, and manubrium of sternum in brachytherapy in an anthropomorphic phantom. Materials and Methods: To measure radiation dose, eye, parotid, thyroid, and submandibular gland, spine, and sternum, an anthropomorphic phantom was considered with applicators to set thermoluminescence dosimeters (TLDs). A specific target volume of about 23 cm3 in the upper thoracic esophagus was considered as target, and phantom planned computed tomography (CT) for HDR brachytherapy, then with a micro-Selectron HDR (192Ir) remote after-loading unit. Results: Absorbed doses were measured with calibrated TLDs and were expressed in centi-Gray (cGy). In regions far from target (≥ 16 cm) such as submandibular, parotid and thyroid glands, mean measured dose ranged from 1.65 to 5.5 cGy. In closer regions (≤ 16 cm), the absorbed dose might be as high as 113 cGy. Conclusions: Our study showed similar depth and surface doses; in closer regions, the surface and depth doses differed significantly due to the role of primary radiation that had imposed a high-dose gradient and difference between the plan and measurement, which was more severe because of simplifications in tissue inhomogeneity, considered in TPS relative to phantom. PMID:26413250

  2. Dosimetry of indigenously developed (192)Ir high-dose rate brachytherapy source: An EGSnrc Monte Carlo study.

    PubMed

    Sahoo, Sridhar; Selvam, T Palani; Sharma, S D; Das, Trupti; Dey, A C; Patil, B N; Sastri, K V S

    2016-01-01

    Clinical application using high-dose rate (HDR) (192)Ir sources in remote afterloading technique is a well-established treatment method. In this direction, Board of Radiation and Isotope Technology (BRIT) and Bhabha Atomic Research Centre, India, jointly indigenously developed a remote afterloading machine and (192)Ir HDR source. The two-dimensional (2D) dose distribution and dosimetric parameters of the BRIT (192)Ir HDR source are generated using EGSnrc Monte Carlo code system in a 40 cm dia × 40 cm height cylindrical water phantom. The values of air-kerma strength and dose rate constant for BRIT (192)Ir HDR source are 9.894 × 10(-8) ± 0.06% UBq(-1) and 1.112 ± 0.11% cGyh(-1)U(-1), respectively. The values of radial dose function (gL(r)) of this source compare well with the corresponding values of BEBIG, Flexisource, and GammaMed 12i source models. This is because of identical active lengths of the sources (3.5 mm) and the comparable phantom dimensions. A comparison of gL(r) values of BRIT source with microSelectron-v1 show differences about 2% at r = 6 cm and up to 13% at r = 12 cm, which is due to differences in phantom dimensions involved in the calculations. The anisotropy function of BRIT (192)Ir HDR source is comparable with the corresponding values of microSelectron-v1 (classic) HDR source. PMID:27217623

  3. Dosimetry of indigenously developed 192Ir high-dose rate brachytherapy source: An EGSnrc Monte Carlo study

    PubMed Central

    Sahoo, Sridhar; Selvam, T. Palani; Sharma, S. D.; Das, Trupti; Dey, A. C.; Patil, B. N.; Sastri, K.V.S.

    2016-01-01

    Clinical application using high-dose rate (HDR) 192Ir sources in remote afterloading technique is a well-established treatment method. In this direction, Board of Radiation and Isotope Technology (BRIT) and Bhabha Atomic Research Centre, India, jointly indigenously developed a remote afterloading machine and 192Ir HDR source. The two-dimensional (2D) dose distribution and dosimetric parameters of the BRIT 192Ir HDR source are generated using EGSnrc Monte Carlo code system in a 40 cm dia × 40 cm height cylindrical water phantom. The values of air-kerma strength and dose rate constant for BRIT 192Ir HDR source are 9.894 × 10−8 ± 0.06% UBq−1 and 1.112 ± 0.11% cGyh−1U−1, respectively. The values of radial dose function (gL(r)) of this source compare well with the corresponding values of BEBIG, Flexisource, and GammaMed 12i source models. This is because of identical active lengths of the sources (3.5 mm) and the comparable phantom dimensions. A comparison of gL(r) values of BRIT source with microSelectron-v1 show differences about 2% at r = 6 cm and up to 13% at r = 12 cm, which is due to differences in phantom dimensions involved in the calculations. The anisotropy function of BRIT 192Ir HDR source is comparable with the corresponding values of microSelectron-v1 (classic) HDR source. PMID:27217623

  4. Comparison of Axxent-Xoft, 192Ir and 60Co high-dose-rate brachytherapy sources for image-guided brachytherapy treatment planning for cervical cancer

    PubMed Central

    Packianathan, S; He, R; Yang, C C

    2015-01-01

    Objective: To evaluate the dosimetric differences and similarities between treatment plans generated with Axxent-Xoft electronic brachytherapy source (Xoft-EBS), 192Ir and 60Co for tandem and ovoids (T&O) applicators. Methods: In this retrospective study, we replanned 10 patients previously treated with 192Ir high-dose-rate brachytherapy. Prescription was 7 Gy × 4 fractions to Point A. For each original plan, we created two additional plans with Xoft-EBS and 60Co. The dose to each organ at risk (OAR) was evaluated in terms of V35% and V50%, the percentage volume receiving 35% and 50% of the prescription dose, respectively, and D2cc, highest dose to a 2 cm3 volume of an OAR. Results: There was no difference between plans generated by 192Ir and 60Co, but the plans generated using Xoft-EBS showed a reduction of up to 50% in V35%, V50% and D2cc. The volumes of the 200% and 150% isodose lines, however, were 74% and 34% greater than the comparable volumes generated with the 192Ir source. Point B dose was on average only 16% of the Point A dose for plans generated with Xoft-EBS compared with 30% for plans generated with 192Ir or 60Co. Conclusion: The Xoft-EBS can potentially replace either 192Ir or 60Co in T&O treatments. Xoft-EBS offers either better sparing of the OARs compared with 192Ir or 60Co or at least similar sparing. Xoft-EBS-generated plans had higher doses within the target volume than 192Ir- or 60Co-generated ones. Advances in knowledge: This work presents newer knowledge in dosimetric comparison between Xoft-EBS, 192Ir or 60Co sources for T&O implants. PMID:25996576

  5. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part II. High dose rate {sup 192}Ir sources

    SciTech Connect

    Fulkerson, Regina K. Micka, John A.; DeWerd, Larry A.

    2014-02-15

    Purpose: Historically, treatment of malignant surface lesions has been achieved with linear accelerator based electron beams or superficial x-ray beams. Recent developments in the field of brachytherapy now allow for the treatment of surface lesions with specialized conical applicators placed directly on the lesion. Applicators are available for use with high dose rate (HDR){sup 192}Ir sources, as well as electronic brachytherapy sources. Part I of this paper discussed the applicators used with electronic brachytherapy sources. Part II will discuss those used with HDR {sup 192}Ir sources. Although the use of these applicators has gained in popularity, the dosimetric characteristics have not been independently verified. Additionally, there is no recognized method of output verification for quality assurance procedures with applicators like these. Methods: This work aims to create a cohesive method of output verification that can be used to determine the dose at the treatment surface as part of a quality assurance/commissioning process for surface applicators used with HDR electronic brachytherapy sources (Part I) and{sup 192}Ir sources (Part II). Air-kerma rate measurements for the {sup 192}Ir sources were completed with several models of small-volume ionization chambers to obtain an air-kerma rate at the treatment surface for each applicator. Correction factors were calculated using MCNP5 and EGSnrc Monte Carlo codes in order to determine an applicator-specific absorbed dose to water at the treatment surface from the measured air-kerma rate. Additionally, relative dose measurements of the surface dose distributions and characteristic depth dose curves were completed in-phantom. Results: Theoretical dose distributions and depth dose curves were generated for each applicator and agreed well with the measured values. A method of output verification was created that allows users to determine the applicator-specific dose to water at the treatment surface based on a

  6. Dosimetric characterization of a novel intracavitary mold applicator for 192Ir high dose rate endorectal brachytherapy treatment.

    PubMed

    Poon, Emily; Reniers, Brigitte; Devic, Slobodan; Vuong, Té; Verhaegen, Frank

    2006-12-01

    The dosimetric properties of a novel intracavitary mold applicator for 192Ir high dose rate (HDR) endorectal cancer treatment have been investigated using Monte Carlo (MC) simulations and experimental methods. The 28 cm long applicator has a flexible structure made of silicone rubber for easy passage into cavities with deep-seated tumors. It consists of eight source catheters arranged around a central cavity for shielding insertion, and is compatible for use with an endocavitary balloon. A phase space model of the HDR source has been validated for dose calculations using the GEANT4 MC code. GAFCHROMIC EBT model film was used to measure dose distributions in water around shielded and unshielded applicators with two loading configurations, and to quantify the shielding effect of a balloon injected with an iodine solution (300 mg I/mL). The film calibration procedure was performed in water using an 192Ir HDR source. Ionization chamber measurements in a Lucite phantom show that placing a tungsten rod in the applicator attenuates the dose in the shielded region by up to 85%. Inserting the shielded applicator into a water-filled balloon pushes the neighboring tissues away from the radiation source, and the resulting geometric displacement reduces the dose by up to 53%; another 8% dose reduction can be achieved when the balloon is injected with an iodine solution. All experimental results agree with the GEANT4 calculations within measurement uncertainties. PMID:17278803

  7. Dosimetric characterization of a novel intracavitary mold applicator for {sup 192}Ir high dose rate endorectal brachytherapy treatment

    SciTech Connect

    Poon, Emily; Reniers, Brigitte; Devic, Slobodan; Vuong, Te; Verhaegen, Frank

    2006-12-15

    The dosimetric properties of a novel intracavitary mold applicator for {sup 192}Ir high dose rate (HDR) endorectal cancer treatment have been investigated using Monte Carlo (MC) simulations and experimental methods. The 28 cm long applicator has a flexible structure made of silicone rubber for easy passage into cavities with deep-seated tumors. It consists of eight source catheters arranged around a central cavity for shielding insertion, and is compatible for use with an endocavitary balloon. A phase space model of the HDR source has been validated for dose calculations using the GEANT4 MC code. GAFCHROMIC trade mark sign EBT model film was used to measure dose distributions in water around shielded and unshielded applicators with two loading configurations, and to quantify the shielding effect of a balloon injected with an iodine solution (300 mg I/mL). The film calibration procedure was performed in water using an {sup 192}Ir HDR source. Ionization chamber measurements in a Lucite phantom show that placing a tungsten rod in the applicator attenuates the dose in the shielded region by up to 85%. Inserting the shielded applicator into a water-filled balloon pushes the neighboring tissues away from the radiation source, and the resulting geometric displacement reduces the dose by up to 53%; another 8% dose reduction can be achieved when the balloon is injected with an iodine solution. All experimental results agree with the GEANT4 calculations within measurement uncertainties.

  8. Usefulness of direct-conversion flat-panel detector system as a quality assurance tool for high-dose-rate 192Ir source.

    PubMed

    Miyahara, Yoshinori; Kitagaki, Hajime; Nishimura, Tomonori; Itakura, Kanae; Takahashi, Shinobu; Yokokawa, Masaki; Uchida, Nobue; Inomata, Taisuke

    2015-01-01

    The routine quality assurance (QA) procedure for a high-dose-rate (HDR) 192Ir radioactive source is an important task to provide appropriate brachytherapy. Traditionally, it has been difficult to obtain good quality images using the 192Ir source due to irradiation from the high-energy gamma rays. However, a direct-conversion flat-panel detector (d-FPD) has made it possible to confirm the localization and configuration of the 192Ir source. The purpose of the present study was to evaluate positional and temporal accuracy of the 192Ir source using a d-FPD system, and the usefulness of d-FPD as a QA tool. As a weekly verification of source positional accuracy test, we obtained 192Ir core imaging by single-shot radiography for three different positions (1300/1400/1500 mm) of a check ruler. To acquire images for measurement of the 192Ir source movement distance with varying interval steps (2.5/5.0/10.0 mm) and temporal accuracy, we used the high-speed image acquisition technique and digital subtraction. For accuracy of the 192Ir source dwell time, sequential images were obtained using various dwell times ranging from 0.5 to 30.0 sec, and the acquired number of image frames was assessed. Analysis of the data was performed using the measurement analysis function of the d-FPD system. Although there were slight weekly variations in source positional accuracy, the measured positional errors were less than 1.0 mm. For source temporal accuracy, the temporal errors were less than 1.0%, and the correlation between acquired frames and programmed time showed excellent linearity (R2 = 1). All 192Ir core images were acquired clearly without image halation, and the data were obtained quantitatively. All data were successfully stored in the picture archiving and communication system (PACS) for time-series analysis. The d-FPD is considered useful as the QA tool for the 192Ir source. PMID:25679163

  9. Determination of the tissue attenuation factor along two major axes of a high dose rate (HDR) 192Ir source.

    PubMed

    Cho, S H; Muller-Runkel, R; Hanson, W F

    1999-08-01

    Quantitative information on photon scattering around brachytherapy sources is needed to develop dose calculation formalisms capable of predicting dosimetric parameters with minimal empiricism. Photon absorption and scatter around brachytherapy sources can be characterized using the tissue attenuation factor, defined as the ratio of dose in water to water kerma in free space. In this study, the tissue attenuation factor along two major axes of a high dose rate (HDR) 192Ir source was determined by TLD measurements and MCNP Monte Carlo calculations. A calculational method is also suggested to derive the tissue attenuation factor along the longitudinal source axis from the factor along the transverse axis, using published anisotropy data as input. TLD and Monte Carlo results agreed with each other for both source axes within the statistical uncertainty (approximately +/- 5%) of Monte Carlo calculations. Comparison with published data, available only for the transverse source axis, also showed good agreement within +/- 5%. The shape and magnitude of the tissue attenuation factor are found to be remarkably different between the two axes. The tissue attenuation factor reaches a maximum value of about 1.4 at 8 cm from the source along the longitudinal source axis, while a maximum value of about 1.04 occurs at 3-4 cm from the source along the transverse axis. The calculated tissue attenuation factor along the longitudinal source axis generally reproduced the TLD and Monte Carlo results within +/- 5% at most radial distances. PMID:10501048

  10. On the use of a single-fiber multipoint plastic scintillation detector for 192Ir high-dose-rate brachytherapy

    PubMed Central

    Therriault-Proulx, François; Beddar, Sam; Beaulieu, Luc

    2013-01-01

    Purpose: The goal of this study was to prove the feasibility of using a single-fiber multipoint plastic scintillation detector (mPSD) as an in vivo verification tool during 192Ir high-dose-rate brachytherapy treatments. Methods: A three-point detector was built and inserted inside a catheter-positioning template placed in a water phantom. A hyperspectral approach was implemented to discriminate the different optical signals composing the light output at the exit of the single collection optical fiber. The mPSD was tested with different source-to-detector positions, ranging from 1 to 5 cm radially and over 10.5 cm along the longitudinal axis of the detector, and with various integration times. Several strategies for improving the accuracy of the detector were investigated. The device's accuracy in detecting source position was also tested. Results: Good agreement with the expected doses was obtained for all of the scintillating elements, with average relative differences from the expected values of 3.4 ± 2.1%, 3.0 ± 0.7%, and 4.5 ± 1.0% for scintillating elements from the distal to the proximal. A dose threshold of 3 cGy improved the general accuracy of the detector. An integration time of 3 s offered a good trade-off between precision and temporal resolution. Finally, the mPSD measured the radioactive source positioning uncertainty to be no more than 0.32 ± 0.06 mm. The accuracy and precision of the detector were improved by a dose-weighted function combining the three measurement points and known details about the geometry of the detector construction. Conclusions: The use of a mPSD for high-dose-rate brachytherapy dosimetry is feasible. This detector shows great promise for development of in vivo applications for real-time verification of treatment delivery. PMID:23718599

  11. Calibration of 192Ir high dose rate brachytherapy source using different calibration procedures

    PubMed Central

    Bondel, Shwetha; Ravikumar, Manickham; Supe, Sanjay Sudhakar; Reddy, Buchuppudi Rekha

    2013-01-01

    Aim To calibrate Ir-192 high dose rate (HDR) brachytherapy source using different calibration methods and to determine the accuracy and suitability of each method for routine calibrations. Background The source calibration is an essential part of the quality assurance programme for dosimetry of brachytherapy sources. The clinical use of brachytherapy source requires an independent measurement of the air kerma strength according to the recommendations of medical physics societies. Materials and methods The Ir-192 HDR brachytherapy source from Gammamed plus machine (Varian Medical Systems, Palo Alto, CA) was calibrated using three different procedures, one using the well-type ionization chamber, second by the in-air calibration method and third using solid water phantoms. The reference air kerma rate (RAKR) of the source was determined using Deutsche Gesellschaft fur Medizinische Physik (DGMP) recommendations. Results The RAKR determined using different calibration methods are in good agreement with the manufacturer stated value. The mean percentage variations of 0.21, −0.94, −0.62 and 0.58 in RAKR values with respect to the manufacturer quoted values were observed with the well-type chamber, in-air calibration, cylindrical phantom and slab phantom measurements, respectively. Conclusion Measurements with a well-type chamber are relatively simple to perform. For in-air measurements, the indigenously designed calibration jig provides an accurate positioning of the source and chamber with minimum scatter contribution. The slab phantom system has an advantage that no additional phantom and chamber are required other than those used for external beam therapy dosimetry. All the methods of calibration discussed in this study are effective to be used for routine calibration purposes. PMID:24944818

  12. Dosimetric modeling of the microselectron high-dose rate 192Ir source by the multigroup discrete ordinates method.

    PubMed

    Daskalov, G M; Baker, R S; Rogers, D W; Williamson, J F

    2000-10-01

    The DANTSYS multigroup discrete ordinates computer code is applied to quantitatively estimate the absorbed dose rate distributions in the vicinity of a microSelectron 192Ir high-dose-rate (HDR) source in two-dimensional cylindrical R-Z geometry. The source is modeled in a cylindrical water phantom of diameter 20 cm and height 20 cm. The results are also used for evaluation of the Task Group 43 (TG-43) dosimetric quantities. The DANTSYS accuracy is estimated by direct comparisons with corresponding Monte Carlo results. Our 210-group photon cross section library developed previously, together with angular quadratures consisting of 36 (S16) to 210 (S40) directions and associated weights per octant, are used in the DANTSYS simulations. Strong ray effects are observed but are significantly mitigated through the use of DANTSYS's stochastic ray-tracing first collision source algorithm. The DANTSYS simulations closely approximate Monte Carlo estimates of both direct dose calculations and TG-43 dosimetric quantities. The discrepancies with S20 angular quadrature (55 directions and weights per octant) or higher are shown to be less than +/- 5% (about 2.5 standard deviations of Monte Carlo calculations) everywhere except for limited regions along the Z axis of rotational symmetry, where technical limitations in the DANTSYS first collision source implementation makes adequate suppression of ray effects difficult to achieve. The efficiency of DANTSYS simulations is compared with that of the EGS4 Monte Carlo code. It is demonstrated that even with the 210-group cross section library, DANTSYS achieves two-fold efficiency gains using the the S20 quadrature set. The potential of discrete ordinates method for further efficiency improvements is also discussed. PMID:11099199

  13. Dose specification for 192Ir high dose rate brachytherapy in terms of dose-to-water-in-medium and dose-to-medium-in-medium

    NASA Astrophysics Data System (ADS)

    Paiva Fonseca, Gabriel; Carlsson Tedgren, Åsa; Reniers, Brigitte; Nilsson, Josef; Persson, Maria; Yoriyaz, Hélio; Verhaegen, Frank

    2015-06-01

    Dose calculation in high dose rate brachytherapy with 192Ir is usually based on the TG-43U1 protocol where all media are considered to be water. Several dose calculation algorithms have been developed that are capable of handling heterogeneities with two possibilities to report dose: dose-to-medium-in-medium (Dm,m) and dose-to-water-in-medium (Dw,m). The relation between Dm,m and Dw,m for 192Ir is the main goal of this study, in particular the dependence of Dw,m on the dose calculation approach using either large cavity theory (LCT) or small cavity theory (SCT). A head and neck case was selected due to the presence of media with a large range of atomic numbers relevant to tissues and mass densities such as air, soft tissues and bone interfaces. This case was simulated using a Monte Carlo (MC) code to score: Dm,m, Dw,m (LCT), mean photon energy and photon fluence. Dw,m (SCT) was derived from MC simulations using the ratio between the unrestricted collisional stopping power of the actual medium and water. Differences between Dm,m and Dw,m (SCT or LCT) can be negligible (<1%) for some tissues e.g. muscle and significant for other tissues with differences of up to 14% for bone. Using SCT or LCT approaches leads to differences between Dw,m (SCT) and Dw,m (LCT) up to 29% for bone and 36% for teeth. The mean photon energy distribution ranges from 222 keV up to 356 keV. However, results obtained using mean photon energies are not equivalent to the ones obtained using the full, local photon spectrum. This work concludes that it is essential that brachytherapy studies clearly report the dose quantity. It further shows that while differences between Dm,m and Dw,m (SCT) mainly depend on tissue type, differences between Dm,m and Dw,m (LCT) are, in addition, significantly dependent on the local photon energy fluence spectrum which varies with distance to implanted sources.

  14. A generic high-dose rate {sup 192}Ir brachytherapy source for evaluation of model-based dose calculations beyond the TG-43 formalism

    SciTech Connect

    Ballester, Facundo; Carlsson Tedgren, Åsa; Granero, Domingo; Haworth, Annette; Mourtada, Firas; Fonseca, Gabriel Paiva; Rivard, Mark J.; Siebert, Frank-André; Sloboda, Ron S.; and others

    2015-06-15

    Purpose: In order to facilitate a smooth transition for brachytherapy dose calculations from the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) formalism to model-based dose calculation algorithms (MBDCAs), treatment planning systems (TPSs) using a MBDCA require a set of well-defined test case plans characterized by Monte Carlo (MC) methods. This also permits direct dose comparison to TG-43 reference data. Such test case plans should be made available for use in the software commissioning process performed by clinical end users. To this end, a hypothetical, generic high-dose rate (HDR) {sup 192}Ir source and a virtual water phantom were designed, which can be imported into a TPS. Methods: A hypothetical, generic HDR {sup 192}Ir source was designed based on commercially available sources as well as a virtual, cubic water phantom that can be imported into any TPS in DICOM format. The dose distribution of the generic {sup 192}Ir source when placed at the center of the cubic phantom, and away from the center under altered scatter conditions, was evaluated using two commercial MBDCAs [Oncentra{sup ®} Brachy with advanced collapsed-cone engine (ACE) and BrachyVision ACUROS{sup TM}]. Dose comparisons were performed using state-of-the-art MC codes for radiation transport, including ALGEBRA, BrachyDose, GEANT4, MCNP5, MCNP6, and PENELOPE2008. The methodologies adhered to recommendations in the AAPM TG-229 report on high-energy brachytherapy source dosimetry. TG-43 dosimetry parameters, an along-away dose-rate table, and primary and scatter separated (PSS) data were obtained. The virtual water phantom of (201){sup 3} voxels (1 mm sides) was used to evaluate the calculated dose distributions. Two test case plans involving a single position of the generic HDR {sup 192}Ir source in this phantom were prepared: (i) source centered in the phantom and (ii) source displaced 7 cm laterally from the center. Datasets were independently produced by

  15. Optimization of deterministic transport parameters for the calculation of the dose distribution around a high dose-rate 192Ir brachytherapy source.

    PubMed

    Gifford, Kent A; Price, Michael J; Horton, John L; Wareing, Todd A; Mourtada, Firas

    2008-06-01

    The goal of this work was to calculate the dose distribution around a high dose-rate 192Ir brachytherapy source using a multi-group discrete ordinates code and then to compare the results with a Monte Carlo calculated dose distribution. The unstructured tetrahedral mesh discrete ordinates code Attila version 6.1.1 was used to calculate the photon kerma rate distribution in water around the Nucletron microSelectron mHDRv2 source. MCNPX 2.5.c was used to compute the Monte Carlo water photon kerma rate distribution. Two hundred million histories were simulated, resulting in standard errors of the mean of less than 3% overall. The number of energy groups, S(n) (angular order), P(n) (scattering order), and mesh elements were varied in addition to the method of analytic ray tracing to assess their effects on the deterministic solution. Water photon kerma rate matrices were exported from both codes into an in-house data analysis software. This software quantified the percent dose difference distribution, the number of points within +/- 3% and +/- 5%, and the mean percent difference between the two codes. The data demonstrated that a 5 energy-group cross-section set calculated results to within 0.5% of a 15 group cross-section set. S12 was sufficient to resolve the solution in angle. P2 expansion of the scattering cross-section was necessary to compute accurate distributions. A computational mesh with 55 064 tetrahedral elements in a 30 cm diameter phantom resolved the solution spatially. An efficiency factor of 110 with the above parameters was realized in comparison to MC methods. The Attila code provided an accurate and efficient solution of the Boltzmann transport equation for the mHDRv2 source. PMID:18649459

  16. Optimization of deterministic transport parameters for the calculation of the dose distribution around a high dose-rate {sup 192}Ir brachytherapy source

    SciTech Connect

    Gifford, Kent A.; Price, Michael J.; Horton, John L. Jr.; Wareing, Todd A.; Mourtada, Firas

    2008-06-15

    The goal of this work was to calculate the dose distribution around a high dose-rate {sup 192}Ir brachytherapy source using a multi-group discrete ordinates code and then to compare the results with a Monte Carlo calculated dose distribution. The unstructured tetrahedral mesh discrete ordinates code Attila version 6.1.1 was used to calculate the photon kerma rate distribution in water around the Nucletron microSelectron mHDRv2 source. MCNPX 2.5.c was used to compute the Monte Carlo water photon kerma rate distribution. Two hundred million histories were simulated, resulting in standard errors of the mean of less than 3% overall. The number of energy groups, S{sub n} (angular order), P{sub n} (scattering order), and mesh elements were varied in addition to the method of analytic ray tracing to assess their effects on the deterministic solution. Water photon kerma rate matrices were exported from both codes into an in-house data analysis software. This software quantified the percent dose difference distribution, the number of points within {+-}3% and {+-}5%, and the mean percent difference between the two codes. The data demonstrated that a 5 energy-group cross-section set calculated results to within 0.5% of a 15 group cross-section set. S{sub 12} was sufficient to resolve the solution in angle. P{sub 2} expansion of the scattering cross-section was necessary to compute accurate distributions. A computational mesh with 55 064 tetrahedral elements in a 30 cm diameter phantom resolved the solution spatially. An efficiency factor of 110 with the above parameters was realized in comparison to MC methods. The Attila code provided an accurate and efficient solution of the Boltzmann transport equation for the mHDRv2 source.

  17. Dose error from deviation of dwell time and source position for high dose-rate 192Ir in remote afterloading system

    PubMed Central

    Okamoto, Hiroyuki; Aikawa, Ako; Wakita, Akihisa; Yoshio, Kotaro; Murakami, Naoya; Nakamura, Satoshi; Hamada, Minoru; Abe, Yoshihisa; Itami, Jun

    2014-01-01

    The influence of deviations in dwell times and source positions for 192Ir HDR-RALS was investigated. The potential dose errors for various kinds of brachytherapy procedures were evaluated. The deviations of dwell time ΔT of a 192Ir HDR source for the various dwell times were measured with a well-type ionization chamber. The deviations of source position ΔP were measured with two methods. One is to measure actual source position using a check ruler device. The other is to analyze peak distances from radiographic film irradiated with 20 mm gap between the dwell positions. The composite dose errors were calculated using Gaussian distribution with ΔT and ΔP as 1σ of the measurements. Dose errors depend on dwell time and distance from the point of interest to the dwell position. To evaluate the dose error in clinical practice, dwell times and point of interest distances were obtained from actual treatment plans involving cylinder, tandem-ovoid, tandem-ovoid with interstitial needles, multiple interstitial needles, and surface-mold applicators. The ΔT and ΔP were 32 ms (maximum for various dwell times) and 0.12 mm (ruler), 0.11 mm (radiographic film). The multiple interstitial needles represent the highest dose error of 2%, while the others represent less than approximately 1%. Potential dose error due to dwell time and source position deviation can depend on kinds of brachytherapy techniques. In all cases, the multiple interstitial needles is most susceptible. PMID:24566719

  18. Application of a pelvic phantom in brachytherapy dosimetry for high-dose-rate (HDR) 192Ir source based on Monte Carlo simulations

    NASA Astrophysics Data System (ADS)

    Ahn, Woo Sang; Choi, Wonsik; Shin, Seong Soo; Jung, Jinhong

    2014-08-01

    In this study, we evaluate how the radial dose function is influenced by the source position as well as the phantom size and shape. A pelvic water phantom similar to the pelvic shape of a human body was designed by averaging dimensions obtained from computed tomography (CT) images of patients treated with brachytherapy for cervical cancer. Furthermore, for the study of the effects of source position on the dose distribution, the position of the source in the water phantom was determined by using the center of mass of the gross target volume (GTV) in the CT images. To obtain the dosimetric parameter of a high-dose-rate (HDR) 192Ir source, we performed Monte Carlo simulations by using the Monte Carlo n-particle extended code (MCNPX). The radial dose functions obtained using the pelvic water phantom were compared with those of spherical phantom with different sizes, including the Monte Carlo (MC) results of Williamson and Li. Differences between the radial dose functions from this study and the data in the literature increased with the radial distances. The largest differences appeared for spherical phantom with the smallest size. In contrast to the published MC results, the radial dose function of the pelvic water phantom significantly decreased with radial distance in the vertical direction because full scattering was not possible. When the source was located in posterior position 2 cm from the center in the pelvic water phantom, the differences between the radial dose functions rapidly decreased with the radial distance in the lower vertical direction. If the International Commission on Radiation Units and Measurements bladder and rectum points are considered, doses to these reference points could be underestimated by up to 1%-2% at a distance of 3 to 6 cm. Our simulation results provide a valid clinical reference data and can used to improve the accuracy of the doses delivered during brachytherapy applied to patients with cervical cancer.

  19. On the use of a single-fiber multipoint plastic scintillation detector for {sup 192}Ir high-dose-rate brachytherapy

    SciTech Connect

    Therriault-Proulx, Francois; Beddar, Sam; Beaulieu, Luc

    2013-06-15

    Purpose: The goal of this study was to prove the feasibility of using a single-fiber multipoint plastic scintillation detector (mPSD) as an in vivo verification tool during {sup 192}Ir high-dose-rate brachytherapy treatments.Methods: A three-point detector was built and inserted inside a catheter-positioning template placed in a water phantom. A hyperspectral approach was implemented to discriminate the different optical signals composing the light output at the exit of the single collection optical fiber. The mPSD was tested with different source-to-detector positions, ranging from 1 to 5 cm radially and over 10.5 cm along the longitudinal axis of the detector, and with various integration times. Several strategies for improving the accuracy of the detector were investigated. The device's accuracy in detecting source position was also tested.Results: Good agreement with the expected doses was obtained for all of the scintillating elements, with average relative differences from the expected values of 3.4 {+-} 2.1%, 3.0 {+-} 0.7%, and 4.5 {+-} 1.0% for scintillating elements from the distal to the proximal. A dose threshold of 3 cGy improved the general accuracy of the detector. An integration time of 3 s offered a good trade-off between precision and temporal resolution. Finally, the mPSD measured the radioactive source positioning uncertainty to be no more than 0.32 {+-} 0.06 mm. The accuracy and precision of the detector were improved by a dose-weighted function combining the three measurement points and known details about the geometry of the detector construction.Conclusions: The use of a mPSD for high-dose-rate brachytherapy dosimetry is feasible. This detector shows great promise for development of in vivo applications for real-time verification of treatment delivery.

  20. Experimental determination of the radial dose distribution in high gradient regions around {sup 192}Ir wires: Comparison of electron paramagnetic resonance imaging, films, and Monte Carlo simulations

    SciTech Connect

    Kolbun, N.; Leveque, Ph.; Abboud, F.; Bol, A.; Vynckier, S.; Gallez, B.

    2010-10-15

    Purpose: The experimental determination of doses at proximal distances from radioactive sources is difficult because of the steepness of the dose gradient. The goal of this study was to determine the relative radial dose distribution for a low dose rate {sup 192}Ir wire source using electron paramagnetic resonance imaging (EPRI) and to compare the results to those obtained using Gafchromic EBT film dosimetry and Monte Carlo (MC) simulations. Methods: Lithium formate and ammonium formate were chosen as the EPR dosimetric materials and were used to form cylindrical phantoms. The dose distribution of the stable radiation-induced free radicals in the lithium formate and ammonium formate phantoms was assessed by EPRI. EBT films were also inserted inside in ammonium formate phantoms for comparison. MC simulation was performed using the MCNP4C2 software code. Results: The radical signal in irradiated ammonium formate is contained in a single narrow EPR line, with an EPR peak-to-peak linewidth narrower than that of lithium formate ({approx}0.64 and 1.4 mT, respectively). The spatial resolution of EPR images was enhanced by a factor of 2.3 using ammonium formate compared to lithium formate because its linewidth is about 0.75 mT narrower than that of lithium formate. The EPRI results were consistent to within 1% with those of Gafchromic EBT films and MC simulations at distances from 1.0 to 2.9 mm. The radial dose values obtained by EPRI were about 4% lower at distances from 2.9 to 4.0 mm than those determined by MC simulation and EBT film dosimetry. Conclusions: Ammonium formate is a suitable material under certain conditions for use in brachytherapy dosimetry using EPRI. In this study, the authors demonstrated that the EPRI technique allows the estimation of the relative radial dose distribution at short distances for a {sup 192}Ir wire source.

  1. A Feasibility Study of Fricke Dosimetry as an Absorbed Dose to Water Standard for 192Ir HDR Sources

    PubMed Central

    deAlmeida, Carlos Eduardo; Ochoa, Ricardo; de Lima, Marilene Coelho; David, Mariano Gazineu; Pires, Evandro Jesus; Peixoto, José Guilherme; Salata, Camila; Bernal, Mario Antônio

    2014-01-01

    High dose rate brachytherapy (HDR) using 192Ir sources is well accepted as an important treatment option and thus requires an accurate dosimetry standard. However, a dosimetry standard for the direct measurement of the absolute dose to water for this particular source type is currently not available. An improved standard for the absorbed dose to water based on Fricke dosimetry of HDR 192Ir brachytherapy sources is presented in this study. The main goal of this paper is to demonstrate the potential usefulness of the Fricke dosimetry technique for the standardization of the quantity absorbed dose to water for 192Ir sources. A molded, double-walled, spherical vessel for water containing the Fricke solution was constructed based on the Fricke system. The authors measured the absorbed dose to water and compared it with the doses calculated using the AAPM TG-43 report. The overall combined uncertainty associated with the measurements using Fricke dosimetry was 1.4% for k = 1, which is better than the uncertainties reported in previous studies. These results are promising; hence, the use of Fricke dosimetry to measure the absorbed dose to water as a standard for HDR 192Ir may be possible in the future. PMID:25521914

  2. A Monte Carlo study on dose distribution evaluation of Flexisource 192Ir brachytherapy source

    PubMed Central

    Alizadeh, Majid; Ghorbani, Mahdi; Haghparast, Abbas; Zare, Naser; Ahmadi Moghaddas, Toktam

    2015-01-01

    Aim The aim of this study is to evaluate the dose distribution of the Flexisource 192Ir source. Background Dosimetric evaluation of brachytherapy sources is recommended by task group number 43 (TG. 43) of American Association of Physicists in Medicine (AAPM). Materials and methods MCNPX code was used to simulate Flexisource 192Ir source. Dose rate constant and radial dose function were obtained for water and soft tissue phantoms and compared with previous data on this source. Furthermore, dose rate along the transverse axis was obtained by simulation of the Flexisource and a point source and the obtained data were compared with those from Flexiplan treatment planning system (TPS). Results The values of dose rate constant obtained for water and soft tissue phantoms were equal to 1.108 and 1.106, respectively. The values of the radial dose function are listed in the form of tabulated data. The values of dose rate (cGy/s) obtained are shown in the form of tabulated data and figures. The maximum difference between TPS and Monte Carlo (MC) dose rate values was 11% in a water phantom at 6.0 cm from the source. Conclusion Based on dosimetric parameter comparisons with values previously published, the accuracy of our simulation of Flexisource 192Ir was verified. The results of dose rate constant and radial dose function in water and soft tissue phantoms were the same for Flexisource and point sources. For Flexisource 192Ir source, the results of TPS calculations in a water phantom were in agreement with the simulations within the calculation uncertainties. Furthermore, the results from the TPS calculation for Flexisource and MC calculation for a point source were practically equal within the calculation uncertainties. PMID:25949224

  3. Monte Carlo estimation of dose difference in lung from 192Ir brachytherapy due to tissue inhomogeneity.

    PubMed

    Gialousis, G; Dimitriadis, A; Yakoumakis, E

    2011-09-01

    Lung brachytherapy using high-dose rate (192)Ir technique is a well-established technique of radiation therapy. However, many commercial treatment planning systems do not have the ability to consider the inhomogeneity of lung in relation to normal tissue. Under such circumstances dose calculations for tissues and organs at risk close to the target are inaccurate. The purpose of the current study was to estimate the dose difference due to tissue inhomogeneity using the Monte Carlo simulation code MCNP-5. Results showed that there was a relative sub dosage by treatment planning systems calculations in neighbouring tissues around the radioactive source due to inhomogeneity ignorance. The presence of lung instead of normal tissue resulted in an increase in relative dose, which approached 8 % at 4-cm distance from the source. Additionally, the relative increase was small for the lung (2.1 %) and larger for organs at risk such as the heart (6.8 %) and bone marrow (7.6 %). PMID:21831865

  4. The contribution from transit dose for 192Ir HDR brachytherapy treatments

    NASA Astrophysics Data System (ADS)

    Fonseca, G. P.; Landry, G.; Reniers, B.; Hoffmann, A.; Rubo, R. A.; Antunes, P. C. G.; Yoriyaz, H.; Verhaegen, F.

    2014-04-01

    Brachytherapy treatment planning systems that use model-based dose calculation algorithms employ a more accurate approach that replaces the TG43-U1 water dose formalism and adopt the TG-186 recommendations regarding composition and geometry of patients and other relevant effects. However, no recommendations were provided on the transit dose due to the source traveling inside the patient. This study describes a methodology to calculate the transit dose using information from the treatment planning system (TPS) and considering the source's instantaneous and average speed for two prostate and two gynecological cases. The trajectory of the 192Ir HDR source was defined by importing applicator contour points and dwell positions from the TPS. The transit dose distribution was calculated using the maximum speed, the average speed and uniform accelerations obtained from the literature to obtain an approximate continuous source distribution simulated with a Monte Carlo code. The transit component can be negligible or significant depending on the speed profile adopted, which is not clearly reported in the literature. The significance of the transit dose can also be due to the treatment modality; in our study interstitial treatments exhibited the largest effects. Considering the worst case scenario the transit dose can reach 3% of the prescribed dose in a gynecological case with four catheters and up to 11.1% when comparing the average prostate dose for a case with 16 catheters. The transit dose component increases by increasing the number of catheters used for HDR brachytherapy, reducing the total dwell time per catheter or increasing the number of dwell positions with low dwell times. This contribution may become significant (>5%) if it is not corrected appropriately. The transit dose cannot be completely compensated using simple dwell time corrections since it may have a non-uniform distribution. An accurate measurement of the source acceleration and maximum speed should be

  5. HDR {sup 192}Ir source speed measurements using a high speed video camera

    SciTech Connect

    Fonseca, Gabriel P.; Rubo, Rodrigo A.; Sales, Camila P. de; Verhaegen, Frank

    2015-01-15

    Purpose: The dose delivered with a HDR {sup 192}Ir afterloader can be separated into a dwell component, and a transit component resulting from the source movement. The transit component is directly dependent on the source speed profile and it is the goal of this study to measure accurate source speed profiles. Methods: A high speed video camera was used to record the movement of a {sup 192}Ir source (Nucletron, an Elekta company, Stockholm, Sweden) for interdwell distances of 0.25–5 cm with dwell times of 0.1, 1, and 2 s. Transit dose distributions were calculated using a Monte Carlo code simulating the source movement. Results: The source stops at each dwell position oscillating around the desired position for a duration up to (0.026 ± 0.005) s. The source speed profile shows variations between 0 and 81 cm/s with average speed of ∼33 cm/s for most of the interdwell distances. The source stops for up to (0.005 ± 0.001) s at nonprogrammed positions in between two programmed dwell positions. The dwell time correction applied by the manufacturer compensates the transit dose between the dwell positions leading to a maximum overdose of 41 mGy for the considered cases and assuming an air-kerma strength of 48 000 U. The transit dose component is not uniformly distributed leading to over and underdoses, which is within 1.4% for commonly prescribed doses (3–10 Gy). Conclusions: The source maintains its speed even for the short interdwell distances. Dose variations due to the transit dose component are much lower than the prescribed treatment doses for brachytherapy, although transit dose component should be evaluated individually for clinical cases.

  6. Evaluation of Wall Correction Factor of INER's Air-Kerma Primary Standard Chamber and Dose Variation by Source Displacement for HDR 192Ir Brachytherapy

    PubMed Central

    Lee, J. H.; Wang, J. N.; Huang, T. T.; Su, S. H.; Chang, B. J.; Su, C. H.; Hsu, S. M.

    2013-01-01

    The aim of the present study was to estimate the wall effect of the self-made spherical graphite-walled cavity chamber with the Monte Carlo method for establishing the air-kerma primary standard of high-dose-rate (HDR) 192Ir brachytherapy sources at the Institute of Nuclear Energy Research (INER, Taiwan). The Monte Carlo method established in this paper was also employed to respectively simulate wall correction factors of the 192Ir air-kerma standard chambers used at the National Institute of Standards and Technology (NIST, USA) and the National Physical Laboratory (NPL, UK) for comparisons and verification. The chamber wall correction calculation results will be incorporated into INER's HDR 192Ir primary standard in the future. For the brachytherapy treatment in the esophagus or in the bronchi, the position of the isotope may have displacement in the cavity. Thus the delivered dose would differ from the prescribed dose in the treatment plan. We also tried assessing dose distribution due to the position displacement of HDR 192Ir brachytherapy source in a phantom with a central cavity by the Monte Carlo method. The calculated results could offer a clinical reference for the brachytherapy within the human organs with cavity. PMID:24222907

  7. Development of a water calorimetry-based standard for absorbed dose to water in HDR {sup 192}Ir brachytherapy

    SciTech Connect

    Sarfehnia, Arman; Seuntjens, Jan

    2010-04-15

    Purpose: The aim of this article is to develop and evaluate a primary standard for HDR {sup 192}Ir brachytherapy based on 4 deg. C stagnant water calorimetry. Methods: The absolute absorbed dose to water was directly measured for several different Nucletron microSelectron {sup 192}Ir sources of air kerma strength ranging between 21 000 and 38 000 U and for source-to-detector separations ranging between 25 and 70 mm. The COMSOL MULTIPHYSICS software was used to accurately calculate the heat transport in a detailed model geometry. Through a coupling of the ''conduction and convection'' module with the ''Navier-Stokes incompressible fluid'' module in the software, both the conductive and convective effects were modeled. Results: A detailed uncertainty analysis resulted in an overall uncertainty in the absorbed dose of 1.90%(1{sigma}). However, this includes a 1.5% uncertainty associated with a nonlinear predrift correction which can be substantially reduced if sufficient time is provided for the system to come to a new equilibrium in between successive calorimetric runs, an opportunity not available to the authors in their clinical setting due to time constraints on the machine. An average normalized dose rate of 361{+-}7 {mu}Gy/(h U) at a source-to-detector separation of 55 mm was measured for the microSelectron {sup 192}Ir source based on water calorimetry. The measured absorbed dose per air kerma strength agreed to better than 0.8%(1{sigma}) with independent ionization chamber and EBT-1 Gafchromic film reference dosimetry as well as with the currently accepted AAPM TG-43 protocol measurements. Conclusions: This work paves the way toward a primary absorbed dose to water standard in {sup 192}Ir brachytherapy.

  8. Using LiF:Mg,Cu,P TLDs to estimate the absorbed dose to water in liquid water around an {sup 192}Ir brachytherapy source

    SciTech Connect

    Lucas, P. Avilés Aubineau-Lanièce, I.; Lourenço, V.; Vermesse, D.; Cutarella, D.

    2014-01-15

    Purpose: The absorbed dose to water is the fundamental reference quantity for brachytherapy treatment planning systems and thermoluminescence dosimeters (TLDs) have been recognized as the most validated detectors for measurement of such a dosimetric descriptor. The detector response in a wide energy spectrum as that of an{sup 192}Ir brachytherapy source as well as the specific measurement medium which surrounds the TLD need to be accounted for when estimating the absorbed dose. This paper develops a methodology based on highly sensitive LiF:Mg,Cu,P TLDs to directly estimate the absorbed dose to water in liquid water around a high dose rate {sup 192}Ir brachytherapy source. Methods: Different experimental designs in liquid water and air were constructed to study the response of LiF:Mg,Cu,P TLDs when irradiated in several standard photon beams of the LNE-LNHB (French national metrology laboratory for ionizing radiation). Measurement strategies and Monte Carlo techniques were developed to calibrate the LiF:Mg,Cu,P detectors in the energy interval characteristic of that found when TLDs are immersed in water around an{sup 192}Ir source. Finally, an experimental system was designed to irradiate TLDs at different angles between 1 and 11 cm away from an {sup 192}Ir source in liquid water. Monte Carlo simulations were performed to correct measured results to provide estimates of the absorbed dose to water in water around the {sup 192}Ir source. Results: The dose response dependence of LiF:Mg,Cu,P TLDs with the linear energy transfer of secondary electrons followed the same variations as those of published results. The calibration strategy which used TLDs in air exposed to a standard N-250 ISO x-ray beam and TLDs in water irradiated with a standard{sup 137}Cs beam provided an estimated mean uncertainty of 2.8% (k = 1) in the TLD calibration coefficient for irradiations by the {sup 192}Ir source in water. The 3D TLD measurements performed in liquid water were obtained with a

  9. An absorbed dose to water standard for HDR 192Ir brachytherapy sources based on water calorimetry: numerical and experimental proof-of-principle.

    PubMed

    Sarfehnia, Arman; Stewart, Kristin; Seuntjens, Jan

    2007-12-01

    Water calorimetry is an established technique for absorbed dose to water measurements in external beams. In this paper, the feasibility of direct absorbed dose measurements for high dose rate (HDR) iridium-192 (192Ir) sources using water calorimetry is established. Feasibility is determined primarily by a balance between the need to obtain sufficient signal to perform a reproducible measurement, the effect of heat loss on the measured signal, and the positioning uncertainty affecting the source-detector distance. The heat conduction pattern generated in water by the Nucletron microSelectron-HDR 192Ir brachytherapy source was simulated using COMSOL MULTIPHYSICS software. Source heating due to radiation self-absorption was calculated using EGSnrcMP. A heat-loss correction k(c) was calculated as the ratio of the temperature rise under ideal conditions to temperature rise under realistic conditions. The calorimeter setup used a parallel-plate calorimeter vessel of 79 mm diameter and 1.12 mm thick front and rear glass windows located 24 mm apart. Absorbed dose was measured with two sources with nominal air kerma strengths of 38 000 and 21 000 U, at source-detector separations ranging from 24.7 to 27.6 mm and irradiation times of 36.0 to 80.0 s. The preliminary measured dose rate per unit air kerma strength of (0.502 +/- 0.007) microGy/(s U) compares well with the TG-43 derived 0.505 microGy/(s U). This work shows that combined dose uncertainties of significantly less than 5% can be achieved with only modest modifications of current water calorimetry techniques and instruments. This work forms the basis of a potential future absolute dose to water standard for HDR 192Ir brachytherapy. PMID:18196821

  10. An absorbed dose to water standard for HDR {sup 192}Ir brachytherapy sources based on water calorimetry: Numerical and experimental proof-of-principle

    SciTech Connect

    Sarfehnia, Arman; Stewart, Kristin; Seuntjens, Jan

    2007-12-15

    Water calorimetry is an established technique for absorbed dose to water measurements in external beams. In this paper, the feasibility of direct absorbed dose measurements for high dose rate (HDR) iridium-192 ({sup 192}Ir) sources using water calorimetry is established. Feasibility is determined primarily by a balance between the need to obtain sufficient signal to perform a reproducible measurement, the effect of heat loss on the measured signal, and the positioning uncertainty affecting the source-detector distance. The heat conduction pattern generated in water by the Nucletron microSelectron-HDR {sup 192}Ir brachytherapy source was simulated using COMSOL MULTIPHYSICSTM software. Source heating due to radiation self-absorption was calculated using EGSnrcMP. A heat-loss correction k{sub c} was calculated as the ratio of the temperature rise under ideal conditions to temperature rise under realistic conditions. The calorimeter setup used a parallel-plate calorimeter vessel of 79 mm diameter and 1.12 mm thick front and rear glass windows located 24 mm apart. Absorbed dose was measured with two sources with nominal air kerma strengths of 38 000 and 21 000 U, at source-detector separations ranging from 24.7 to 27.6 mm and irradiation times of 36.0 to 80.0 s. The preliminary measured dose rate per unit air kerma strength of (0.502{+-}0.007) {mu}Gy/(s U) compares well with the TG-43 derived 0.505 {mu}Gy/(s U). This work shows that combined dose uncertainties of significantly less than 5% can be achieved with only modest modifications of current water calorimetry techniques and instruments. This work forms the basis of a potential future absolute dose to water standard for HDR {sup 192}Ir brachytherapy.

  11. Determination of air-kerma strength for the {sup 192}Ir GammaMedplus iX pulsed-dose-rate brachytherapy source

    SciTech Connect

    Riley, A. D.; Pike, T. L.; Micka, J. A.; Fulkerson, R. K.; DeWerd, L. A.

    2013-07-15

    Purpose: Pulsed-dose-rate (PDR) brachytherapy was originally proposed to combine the therapeutic advantages of high-dose-rate (HDR) and low-dose-rate brachytherapy. Though uncommon in the United States, several facilities employ pulsed-dose-rate brachytherapy in Europe and Canada. Currently, there is no air-kerma strength standard for PDR brachytherapy {sup 192}Ir sources traceable to the National Institute of Standards and Technology. Discrepancies in clinical measurements of the air-kerma strength of the PDR brachytherapy sources using HDR source-calibrated well chambers warrant further investigation.Methods: In this research, the air-kerma strength for an {sup 192}Ir PDR brachytherapy source was compared with the University of Wisconsin Accredited Dosimetry Calibration Laboratory transfer standard well chambers, the seven-distance technique [B. E. Rasmussen et al., 'The air-kerma strength standard for 192Ir HDR sources,' Med. Phys. 38, 6721-6729 (2011)], and the manufacturer's stated value. Radiochromic film and Monte Carlo techniques were also employed for comparison to the results of the measurements.Results: While the measurements using the seven-distance technique were within + 0.44% from the manufacturer's determination, there was a + 3.10% difference between the transfer standard well chamber measurements and the manufacturer's stated value. Results showed that the PDR brachytherapy source has geometric and thus radiological qualities that exhibit behaviors similar to a point source model in contrast to a conventional line source model.Conclusions: The resulting effect of the pointlike characteristics of the PDR brachytherapy source likely account for the differences observed between well chamber and in-air measurements.

  12. Evaluation of a lithium formate EPR dosimetry system for dose measurements around {sup 192}Ir brachytherapy sources

    SciTech Connect

    Antonovic, Laura; Gustafsson, Haakan; Alm Carlsson, Gudrun; Carlsson Tedgren, Aasa

    2009-06-15

    A dosimetry system using lithium formate monohydrate (HCO{sub 2}Li{center_dot}H{sub 2}O) as detector material and electron paramagnetic resonance (EPR) spectroscopy for readout has been used to measure absorbed dose distributions around clinical {sup 192}Ir sources. Cylindrical tablets with diameter of 4.5 mm, height of 4.8 mm, and density of 1.26 g/cm{sup 3} were manufactured. Homogeneity test and calibration of the dosimeters were performed in a 6 MV photon beam. {sup 192}Ir irradiations were performed in a PMMA phantom using two different source models, the GammaMed Plus HDR and the microSelectron PDR-v1 model. Measured absorbed doses to water in the PMMA phantom were converted to the corresponding absorbed doses to water in water phantoms of dimensions used by the treatment planning systems (TPSs) using correction factors explicitly derived for this experiment. Experimentally determined absorbed doses agreed with the absorbed doses to water calculated by the TPS to within {+-}2.9%. Relative standard uncertainties in the experimentally determined absorbed doses were estimated to be within the range of 1.7%-1.3% depending on the radial distance from the source, the type of source (HDR or PDR), and the particular absorbed doses used. This work shows that a lithium formate dosimetry system is well suited for measurements of absorbed dose to water around clinical HDR and PDR {sup 192}Ir sources. Being less energy dependent than the commonly used thermoluminescent lithium fluoride (LiF) dosimeters, lithium formate monohydrate dosimeters are well suited to measure absorbed doses in situations where the energy dependence cannot easily be accounted for such as in multiple-source irradiations to verify treatment plans. Their wide dynamic range and linear dose response over the dose interval of 0.2-1000 Gy make them suitable for measurements on sources of the strengths used in clinical applications. The dosimeter size needs, however, to be reduced for application to

  13. Determination of absorbed dose to water around a clinical HDR {sup 192}Ir source using LiF:Mg,Ti TLDs demonstrates an LET dependence of detector response

    SciTech Connect

    Carlsson Tedgren, Aasa; Elia, Rouba; Hedtjaern, Haakan; Olsson, Sara; Alm Carlsson, Gudrun

    2012-02-15

    Purpose: Experimental radiation dosimetry with thermoluminescent dosimeters (TLDs), calibrated in a {sup 60}Co or megavoltage (MV) photon beam, is recommended by AAPM TG-43U1for verification of Monte Carlo calculated absorbed doses around brachytherapy sources. However, it has been shown by Carlsson Tedgren et al.[Med. Phys. 38, 5539-5550 (2011)] that for TLDs of LiF:Mg,Ti, detector response was 4% higher in a {sup 137}Cs beam than in a {sup 60}Co one. The aim of this work was to investigate if similar over-response exists when measuring absorbed dose to water around {sup 192}Ir sources, using LiF:Mg,Ti dosimeters calibrated in a 6 MV photon beam. Methods: LiF dosimeters were calibrated to measure absorbed dose to water in a 6 MV photon beam and used to measure absorbed dose to water at distances of 3, 5, and 7 cm from a clinical high dose rate (HDR) {sup 192}Ir source in a polymethylmethacrylate (PMMA) phantom. Measured values were compared to values of absorbed dose to water calculated using a treatment planning system (TPS) including corrections for the difference in energy absorption properties between calibration quality and the quality in the users'{sup 192}Ir beam and for the use of a PMMA phantom instead of the water phantom underlying dose calculations in the TPS. Results: Measured absorbed doses to water around the {sup 192}Ir source were overestimated by 5% compared to those calculated by the TPS. Corresponding absorbed doses to water measured in a previous work with lithium formate electron paramagnetic resonance (EPR) dosimeters by Antonovic et al. [Med. Phys. 36, 2236-2247 (2009)], using the same irradiation setup and calibration procedure as in this work, were 2% lower than those calculated by the TPS. The results obtained in the measurements in this work and those obtained using the EPR lithium formate dosimeters were, within the expanded (k = 2) uncertainty, in agreement with the values derived by the TPS. The discrepancy between the results using

  14. Establishment of in vitro 192Ir γ-ray dose-response relationship for dose assessment by the lymphocyte dicentric assay

    NASA Astrophysics Data System (ADS)

    Kowalska, Maria; Meronka, Katarzyna; Szewczak, Kamil

    2012-03-01

    In vitro dose-response relationships are used to describe the relation between dicentric chromosomes and radiation dose for human peripheral blood lymphocytes. The dicentric yield depends on both the dose and the radiation quality. Thus, for reliable dose estimation in vitro dose responses must be determined for different radiation qualities. This paper reports the work for setting up the relationship for the dicentric production in the lymphocytes exposed in vitro to 192Ir g-rays at Central Laboratory for Radiological Protection (CLOR). In a case of a radiation accident in industrial radiography using 192Ir sealed sources, this will be the basis for the indirect evaluation of the g-ray dose to which an accidental victim was exposed.

  15. Absolute depth-dose-rate measurements for an {sup 192}Ir HDR brachytherapy source in water using MOSFET detectors

    SciTech Connect

    Zilio, Valery Olivier; Joneja, Om Parkash; Popowski, Youri; Rosenfeld, Anatoly; Chawla, Rakesh

    2006-06-15

    Reported MOSFET measurements concern mostly external radiotherapy and in vivo dosimetry. In this paper, we apply the technique for absolute dosimetry in the context of HDR brachytherapy using an {sup 192}Ir source. Measured radial dose rate distributions in water for different planes perpendicular to the source axis are presented and special attention is paid to the calibration of the R and K type detectors, and to the determination of appropriate correction factors for the sensitivity variation with the increase of the threshold voltage and the energy dependence. The experimental results are compared with Monte Carlo simulated dose rate distributions. The experimental results show a good agreement with the Monte Carlo simulations: the discrepancy between experimental and Monte Carlo results being within 5% for 82% of the points and within 10% for 95% of the points. Moreover, all points except two are found to lie within the experimental uncertainties, confirming thereby the quality of the results obtained.

  16. Measurement of absorbed dose-to-water for an HDR {sup 192}Ir source with ionization chambers in a sandwich setup

    SciTech Connect

    Araki, Fujio; Kouno, Tomohiro; Ohno, Takeshi; Kakei, Kiyotaka; Yoshiyama, Fumiaki; Kawamura, Shinji

    2013-09-15

    Purpose: In this study, a dedicated device for ion chamber measurements of absorbed dose-to-water for a Nucletron microSelectron-v2 HDR {sup 192}Ir brachytherapy source is presented. The device uses two ionization chambers in a so-called sandwich assembly. Using this setup and by taking the average reading of the two chambers, any dose error due to difficulties in absolute positioning (centering) of the source in between the chambers is cancelled to first order. The method's accuracy was examined by comparing measurements with absorbed dose-to-water determination based on the AAPM TG-43 protocol.Methods: The optimal source-to-chamber distance (SCD) for {sup 192}Ir dosimetry was determined from ion chamber measurements in a water phantom. The {sup 192}Ir source was sandwiched between two Exradin A1SL chambers (0.057 cm{sup 3}) at the optimal SCD separation. The measured ionization was converted to the absorbed dose-to-water using a {sup 60}Co calibration factor and a Monte Carlo-calculated beam quality conversion factor, k{sub Q}, for {sup 60}Co to {sup 192}Ir. An uncertainty estimate of the proposed method was determined based on reproducibility of measurements at different institutions for the same type of source.Results: The optimal distance for the A1SL chamber measurements was determined to be 5 cm from the {sup 192}Ir source center, considering the depth dependency of k{sub Q} for {sup 60}Co to {sup 192}Ir and the chamber positioning. The absorbed dose to water measured at (5 cm, 90°) on the transverse axis was 1.3% lower than TG-43 values and its reproducibility and overall uncertainty were 0.8% and 1.7%, respectively. The measurement doses at anisotropic points agreed within 1.5% with TG-43 values.Conclusions: The ion chamber measurement of absorbed dose-to-water with a sandwich method for the {sup 192}Ir source provides a more accurate, direct, and reference dose compared to the dose-to-water determination based on air-kerma strength in the TG-43 protocol

  17. Computation of relative dose distribution and effective transmission around a shielded vaginal cylinder with {sup 192}Ir HDR source using MCNP4B

    SciTech Connect

    Sureka, Chandra Sekaran; Aruna, Prakasarao; Ganesan, Singaravelu; Sunny, Chirayath Sunil; Subbaiah, Kamatam Venkata

    2006-06-15

    The present work is primarily focused on the estimation of relative dose distribution and effective transmission around a shielded vaginal cylinder with an {sup 192}Ir source using the Monte Carlo technique. The MCNP4B code was used to evaluate the dose distribution around a tungsten shielded vaginal cylinder as a function of thickness and angular shielding. The dose distribution and effective transmission of {sup 192}Ir by 0.8 cm thickness tungsten were also compared with that for gold and lead. Dose distributions were evaluated for different distances starting from 1.35 cm to 10.15 cm from the center of the cylinder. Dose distributions were also evaluated sequentially from 0 deg.to 180 deg.for every 5 deg.interval. Studies show that all the shielding material at 0.8 cm thickness contribute tolerable doses to normal tissues and also protect the critical organs such as the rectum and bladder. However, the computed dose values are in good agreement with the reported experimental values. It was also inferred that the higher the shielding angles, the more the protection of the surrounding tissues. Among the three shielding materials, gold has been observed to have the highest attenuation and hence contribute lowest transmission in the shielded region. Depending upon the shielding angle and thickness, it is possible to predict the dose distribution using the MCNP4B code. In order to deliver the higher dose to the unshielded region, lead may be considered as the shielding material and further it is highly economic over other materials.

  18. Determination of transit dose profile for a {sup 192}Ir HDR source

    SciTech Connect

    Fonseca, G. P.; Antunes, P. C. G.; Yoriyaz, H.

    2013-05-15

    Purpose: Several studies have reported methodologies to calculate and correct the transit dose component of the moving radiation source for high dose rate (HDR) brachytherapy planning systems. However, most of these works employ the average source speed, which varies significantly with the measurement technique used, and does not represent a realistic speed profile, therefore, providing an inaccurate dose determination. In this work, the authors quantified the transit dose component of a HDR unit based on the measurement of the instantaneous source speed to produce more accurate dose values. Methods: The Nucletron microSelectron-HDR Ir-192 source was characterized considering the Task Group 43 (TG-43U1) specifications. The transit dose component was considered through the calculation of the dose distribution using a Monte Carlo particle transport code, MCNP5, for each source position and correcting it by the source speed. The instantaneous source speed measurements were performed in a previous work using two optical fibers connected to a photomultiplier and an oscilloscope. Calculated doses were validated by comparing relative dose profiles with those obtained experimentally using radiochromic films. Results: TG-43U1 source parameters were calculated to validate the Monte Carlo simulations. These agreed with the literature, with differences below 1% for the majority of the points. Calculated dose profiles without transit dose were also validated by comparison with ONCENTRA{sup Registered-Sign} Brachy v. 3.3 dose values, yielding differences within 1.5%. Dose profiles obtained with MCNP5 corrected using the instantaneous source speed profile showed differences near dwell positions of up to 800% in comparison to values corrected using the average source speed, but they are in good agreement with the experimental data, showing a maximum discrepancy of approximately 3% of the maximum dose. Near a dwell position the transit dose is about 22% of the dwell dose delivered

  19. Comparison of 3D dose distributions for HDR 192Ir brachytherapy sources with normoxic polymer gel dosimetry and treatment planning system.

    PubMed

    Senkesen, Oznur; Tezcanli, Evrim; Buyuksarac, Bora; Ozbay, Ismail

    2014-01-01

    Radiation fluence changes caused by the dosimeter itself and poor spatial resolution may lead to lack of 3-dimensional (3D) information depending on the features of the dosimeter and quality assurance of dose distributions for high-dose rate (HDR) iridium-192 ((192)Ir) brachytherapy sources is challenging and experimental dosimetry methods used for brachytherapy sources are limited. In this study, we investigated 3D dose distributions of (192)Ir brachytherapy sources for irradiation with single and multiple dwell positions using a normoxic gel dosimeter and compared them with treatment planning system (TPS) calculations. For dose calibration purposes, 100-mL gel-containing vials were irradiated at predefined doses and then scanned in an magnetic resonance (MR) imaging unit. Gel phantoms prepared in 2 spherical glasses were irradiated with (192)Ir for the calculated dwell positions, and MR scans of the phantoms were obtained. The images were analyzed with MATLAB software. Dose distributions and profiles derived with 1-mm resolution were compared with TPS calculations. Linearity was observed between the delivered dose and the reciprocal of the T2 relaxation time constant of the gel. The x-, y-, and z-axes were defined as the sagittal, coronal, and axial planes, respectively, the sagittal and axial planes were defined parallel to the long axis of the source while the coronal plane was defined horizontally to the long axis of the source. The differences between measured and calculated profile widths of 3-cm source length and point source for 70%, 50%, and 30% isodose lines were evaluated at 3 dose levels using 18 profiles of comparison. The calculations for 3-cm source length revealed a difference of > 3mm in 1 coordinate at 50% profile width on the sagittal plane and 3 coordinates at 70% profile width and 2 coordinates at 50% and 30% profile widths on the axial plane. Calculations on the coronal plane for 3-cm source length showed > 3-mm difference in 1 coordinate at

  20. Comparison of 3D dose distributions for HDR {sup 192}Ir brachytherapy sources with normoxic polymer gel dosimetry and treatment planning system

    SciTech Connect

    Senkesen, Oznur; Tezcanli, Evrim; Buyuksarac, Bora; Ozbay, Ismail

    2014-10-01

    coordinate at 50% and 70% and 2 coordinates at 30% profile widths. The point source measurements and calculations for 50% profile widths revealed a difference > 3 mm in 1 coordinate on the sagittal plane and 2 coordinates on the axial plane. The doses of 3 coordinates on the sagittal plane and 4 coordinates on the axial plane could not be evaluated in 30% profile width because of low doses. There was good agreement between the gel dosimetry and TPS results. Gel dosimetry provides dose distributions in all 3 planes at the same time, which enables us to define the dose distributions in any plane with high resolution. It can be used to obtain 3D dose distributions for HDR {sup 192}Ir brachytherapy sources and 3D dose verification of TPS.

  1. Comparison of TLD calibration methods for 192Ir dosimetry.

    PubMed

    Haworth, Annette; Butler, Duncan J; Wilfert, Lisa; Ebert, Martin A; Todd, Stephen P; Hayton, Anna J M; Kron, Tomas

    2013-01-01

    For the purpose of dose measurement using a high-dose rate (192)Ir source, four methods of thermoluminescent dosimeter (TLD) calibration were investigated. Three of the four calibration methods used the (192)Ir source. Dwell times were calculated to deliver 1 Gy to the TLDs irradiated either in air or water. Dwell time calculations were confirmed by direct measurement using an ionization chamber. The fourth method of calibration used 6 MV photons from a medical linear accelerator, and an energy correction factor was applied to account for the difference in sensitivity of the TLDs in (192)Ir and 6 MV. The results of the four TLD calibration methods are presented in terms of the results of a brachytherapy audit where seven Australian centers irradiated three sets of TLDs in a water phantom. The results were in agreement within estimated uncertainties when the TLDs were calibrated with the (192)Ir source. Calibrating TLDs in a phantom similar to that used for the audit proved to be the most practical method and provided the greatest confidence in measured dose. When calibrated using 6 MV photons, the TLD results were consistently higher than the (192)Ir-calibrated TLDs, suggesting this method does not fully correct for the response of the TLDs when irradiated in the audit phantom. PMID:23318392

  2. Comparison of organ doses for patients undergoing balloon brachytherapy of the breast with HDR 192Ir or electronic sources using Monte Carlo simulations in a heterogeneous human phantom1

    PubMed Central

    Mille, Matthew M.; Xu, X. George; Rivard, Mark J.

    2010-01-01

    Purpose: Accelerated partial breast irradiation via interstitial balloon brachytherapy is a fast and effective treatment method for certain early stage breast cancers. The radiation can be delivered using a conventional high-dose rate (HDR) 192Ir gamma-emitting source or a novel electronic brachytherapy (eBx) source which uses lower energy x rays that do not penetrate as far within the patient. A previous study [A. Dickler, M. C. Kirk, N. Seif, K. Griem, K. Dowlatshahi, D. Francescatti, and R. A. Abrams, “A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy,” Brachytherapy 6, 164–168 (2007)] showed that the target dose is similar for HDR 192Ir and eBx. This study compares these sources based on the dose received by healthy organs and tissues away from the treatment site. Methods: A virtual patient with left breast cancer was represented by a whole-body, tissue-heterogeneous female voxel phantom. Monte Carlo methods were used to calculate the dose to healthy organs in a virtual patient undergoing balloon brachytherapy of the left breast with HDR 192Ir or eBx sources. The dose-volume histograms for a few organs which received large doses were also calculated. Additional simulations were performed with all tissues in the phantom defined as water to study the effect of tissue inhomogeneities. Results: For both HDR 192Ir and eBx, the largest mean organ doses were received by the ribs, thymus gland, left lung, heart, and sternum which were close to the brachytherapy source in the left breast. eBx yielded mean healthy organ doses that were more than a factor of ∼1.4 smaller than for HDR 192Ir for all organs considered, except for the three closest ribs. Excluding these ribs, the average and median dose-reduction factors were ∼28 and ∼11, respectively. The volume distribution of doses in nearby soft tissue organs that were outside the PTV were also improved with eBx. However, the maximum dose to the closest

  3. Comparison of organ doses for patients undergoing balloon brachytherapy of the breast with HDR {sup 192}Ir or electronic sources using Monte Carlo simulations in a heterogeneous human phantom

    SciTech Connect

    Mille, Matthew M.; Xu, X. George; Rivard, Mark J.

    2010-02-15

    Purpose: Accelerated partial breast irradiation via interstitial balloon brachytherapy is a fast and effective treatment method for certain early stage breast cancers. The radiation can be delivered using a conventional high-dose rate (HDR) {sup 192}Ir gamma-emitting source or a novel electronic brachytherapy (eBx) source which uses lower energy x rays that do not penetrate as far within the patient. A previous study [A. Dickler, M. C. Kirk, N. Seif, K. Griem, K. Dowlatshahi, D. Francescatti, and R. A. Abrams, ''A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy,'' Brachytherapy 6, 164-168 (2007)] showed that the target dose is similar for HDR {sup 192}Ir and eBx. This study compares these sources based on the dose received by healthy organs and tissues away from the treatment site. Methods: A virtual patient with left breast cancer was represented by a whole-body, tissue-heterogeneous female voxel phantom. Monte Carlo methods were used to calculate the dose to healthy organs in a virtual patient undergoing balloon brachytherapy of the left breast with HDR {sup 192}Ir or eBx sources. The dose-volume histograms for a few organs which received large doses were also calculated. Additional simulations were performed with all tissues in the phantom defined as water to study the effect of tissue inhomogeneities. Results: For both HDR {sup 192}Ir and eBx, the largest mean organ doses were received by the ribs, thymus gland, left lung, heart, and sternum which were close to the brachytherapy source in the left breast. eBx yielded mean healthy organ doses that were more than a factor of {approx}1.4 smaller than for HDR {sup 192}Ir for all organs considered, except for the three closest ribs. Excluding these ribs, the average and median dose-reduction factors were {approx}28 and {approx}11, respectively. The volume distribution of doses in nearby soft tissue organs that were outside the PTV were also improved with e

  4. SU-F-19A-10: Recalculation and Reporting Clinical HDR 192-Ir Head and Neck Dose Distributions Using Model Based Dose Calculation

    SciTech Connect

    Carlsson Tedgren, A; Persson, M; Nilsson, J

    2014-06-15

    Purpose: To retrospectively re-calculate dose distributions for selected head and neck cancer patients, earlier treated with HDR 192Ir brachytherapy, using Monte Carlo (MC) simulations and compare results to distributions from the planning system derived using TG43 formalism. To study differences between dose to medium (as obtained with the MC code) and dose to water in medium as obtained through (1) ratios of stopping powers and (2) ratios of mass energy absorption coefficients between water and medium. Methods: The MC code Algebra was used to calculate dose distributions according to earlier actual treatment plans using anonymized plan data and CT images in DICOM format. Ratios of stopping power and mass energy absorption coefficients for water with various media obtained from 192-Ir spectra were used in toggling between dose to water and dose to media. Results: Differences between initial planned TG43 dose distributions and the doses to media calculated by MC are insignificant in the target volume. Differences are moderate (within 4–5 % at distances of 3–4 cm) but increase with distance and are most notable in bone and at the patient surface. Differences between dose to water and dose to medium are within 1-2% when using mass energy absorption coefficients to toggle between the two quantities but increase to above 10% for bone using stopping power ratios. Conclusion: MC predicts target doses for head and neck cancer patients in close agreement with TG43. MC yields improved dose estimations outside the target where a larger fraction of dose is from scattered photons. It is important with awareness and a clear reporting of absorbed dose values in using model based algorithms. Differences in bone media can exceed 10% depending on how dose to water in medium is defined.

  5. An overexposure in industrial radiography using an 192Ir radionuclide.

    PubMed

    Jalil, A; Molla, M A

    1989-07-01

    An industrial radiographer was accidentally exposed to a high dose of ionizing radiation from an 192Ir source during radiography of weldjoints in gas pipelines. Some symptoms of high radiation exposure occurred immediately after the incident. The clinical effect of skin erythema developed within 7 d, leading to progressive tissue deterioration. The dose to the body was estimated to be about 2-3 Gy, and the dose to the fingertips was approximately 24 Gy. PMID:2526106

  6. SU-E-T-102: Determination of Dose Distributions and Water-Equivalence of MAGIC-F Polymer Gel for 60Co and 192Ir Brachytherapy Sources

    SciTech Connect

    Quevedo, A; Nicolucci, P

    2014-06-01

    Purpose: Analyse the water-equivalence of MAGIC-f polymer gel for {sup 60}Co and {sup 192}Ir clinical brachytherapy sources, through dose distributions simulated with PENELOPE Monte Carlo code. Methods: The real geometry of {sup 60} (BEBIG, modelo Co0.A86) and {sup 192}192Ir (Varian, model GammaMed Plus) clinical brachytherapy sources were modelled on PENELOPE Monte Carlo simulation code. The most probable emission lines of photons were used for both sources: 17 emission lines for {sup 192}Ir and 12 lines for {sup 60}. The dose distributions were obtained in a cubic water or gel homogeneous phantom (30 × 30 × 30 cm{sup 3}), with the source positioned in the middle of the phantom. In all cases the number of simulation showers remained constant at 10{sup 9} particles. A specific material for gel was constructed in PENELOPE using weight fraction components of MAGIC-f: wH = 0,1062, wC = 0,0751, wN = 0,0139, wO = 0,8021, wS = 2,58×10{sup −6} e wCu = 5,08 × 10{sup −6}. The voxel size in the dose distributions was 0.6 mm. Dose distribution maps on the longitudinal and radial direction through the centre of the source were used to analyse the water-equivalence of MAGIC-f. Results: For the {sup 60} source, the maximum diferences in relative doses obtained in the gel and water were 0,65% and 1,90%, for radial and longitudinal direction, respectively. For {sup 192}Ir, the maximum difereces in relative doses were 0,30% and 1,05%, for radial and longitudinal direction, respectively. The materials equivalence can also be verified through the effective atomic number and density of each material: Zef-MAGIC-f = 7,07 e .MAGIC-f = 1,060 g/cm{sup 3} and Zef-water = 7,22. Conclusion: The results showed that MAGIC-f is water equivalent, consequently being suitable to simulate soft tissue, for Cobalt and Iridium energies. Hence, gel can be used as a dosimeter in clinical applications. Further investigation to its use in a clinical protocol is needed.

  7. Determination of absorbed dose in water at the reference point D(r{sub 0},{theta}{sub 0}) for an {sup 192}Ir HDR brachytherapy source using a Fricke system

    SciTech Connect

    Austerlitz, C.; Mota, H. C.; Sempau, J.; Benhabib, S. M.; Campos, D.; Allison, R.; Almeida, C. E. de; Zhu, D.; Sibata, C. H.

    2008-12-15

    A ring-shaped Fricke device was developed to measure the absolute dose on the transverse bisector of a {sup 192}Ir high dose rate (HDR) source at 1 cm from its center in water, D(r{sub 0},{theta}{sub 0}). It consists of a polymethylmethacrylate (PMMA) rod (axial axis) with a cylindrical cavity at its center to insert the {sup 192}Ir radioactive source. A ring cavity around the source with 1.5 mm thickness and 5 mm height is centered at 1 cm from the central axis of the source. This ring cavity is etched in a disk shaped base with 2.65 cm diameter and 0.90 cm thickness. The cavity has a wall around it 0.25 cm thick. This ring is filled with Fricke solution, sealed, and the whole assembly is immersed in water during irradiations. The device takes advantage of the cylindrical geometry to measure D(r{sub 0},{theta}{sub 0}). Irradiations were performed with a Nucletron microselectron HDR unit loaded with an {sup 192}Ir Alpha Omega radioactive source. A Spectronic 1001 spectrophotometer was used to measure the optical absorbance using a 1 mL quartz cuvette with 1.00 cm light pathlength. The PENELOPE Monte Carlo code (MC) was utilized to simulate the Fricke device and the {sup 192}Ir Alpha Omega source in detail to calculate the perturbation introduced by the PMMA material. A NIST traceable calibrated well type ionization chamber was used to determine the air-kerma strength, and a published dose-rate constant was used to determine the dose rate at the reference point. The time to deliver 30.00 Gy to the reference point was calculated. This absorbed dose was then compared to the absorbed dose measured by the Fricke solution. Based on MC simulation, the PMMA of the Fricke device increases the D(r{sub 0},{theta}{sub 0}) by 2.0%. Applying the corresponding correction factor, the D(r{sub 0},{theta}{sub 0}) value assessed with the Fricke device agrees within 2.0% with the expected value with a total combined uncertainty of 3.43%(k=1). The Fricke device provides a promising

  8. Direct measurement of absorbed dose to water in HDR {sup 192}Ir brachytherapy: Water calorimetry, ionization chamber, Gafchromic film, and TG-43

    SciTech Connect

    Sarfehnia, Arman; Kawrakow, Iwan; Seuntjens, Jan

    2010-04-15

    Purpose: Gafchromic film and ionometric calibration procedures for HDR {sup 192}Ir brachytherapy sources in terms of dose rate to water are presented and the experimental results are compared to the TG-43 protocol as well as with the absolute dose measurement results from a water calorimetry-based primary standard. Methods: EBT-1 Gafchromic films, an A1SL Exradin miniature Shonka thimble type chamber, and an SI HDR 1000 Plus well-type chamber (Standard Imaging, Inc., Middleton, WI) with an ADCL traceable S{sub k} calibration coefficient (following the AAPM TG-43 protocol) were used. The Farmer chamber and Gafchromic film measurements were performed directly in water. All results were compared to direct and absolute absorbed dose to water measurements from a 4 deg. C stagnant water calorimeter. Results: Based on water calorimetry, the authors measured the dose rate to water to be 361{+-}7 {mu}Gy/(h U) at a 55 mm source-to-detector separation. The dose rate normalized to air-kerma strength for all the techniques agree with the water calorimetry results to within 0.83%. The overall 1-sigma uncertainty on water calorimetry, ionization chamber, Gafchromic film, and TG-43 dose rate measurement amounts to 1.90%, 1.44%, 1.78%, and 2.50%, respectively. Conclusions: This work allows us to build a more realistic uncertainty estimate for absorbed dose to water determination using the TG-43 protocol. Furthermore, it provides the framework necessary for a shift from indirect HDR {sup 192}Ir brachytherapy dosimetry to a more accurate, direct, and absolute measurement of absorbed dose to water.

  9. Source geometry factors for HDR 192Ir brachytherapy secondary standard well-type ionization chamber calibrations

    NASA Astrophysics Data System (ADS)

    Shipley, D. R.; Sander, T.; Nutbrown, R. F.

    2015-03-01

    Well-type ionization chambers are used for measuring the source strength of radioactive brachytherapy sources before clinical use. Initially, the well chambers are calibrated against a suitable national standard. For high dose rate (HDR) 192Ir, this calibration is usually a two-step process. Firstly, the calibration source is traceably calibrated against an air kerma primary standard in terms of either reference air kerma rate or air kerma strength. The calibrated 192Ir source is then used to calibrate the secondary standard well-type ionization chamber. Calibration laboratories are usually only equipped with one type of HDR 192Ir source. If the clinical source type is different from that used for the calibration of the well chamber at the standards laboratory, a source geometry factor, ksg, is required to correct the calibration coefficient for any change of the well chamber response due to geometric differences between the sources. In this work we present source geometry factors for six different HDR 192Ir brachytherapy sources which have been determined using Monte Carlo techniques for a specific ionization chamber, the Standard Imaging HDR 1000 Plus well chamber with a type 70010 HDR iridium source holder. The calculated correction factors were normalized to the old and new type of calibration source used at the National Physical Laboratory. With the old Nucletron microSelectron-v1 (classic) HDR 192Ir calibration source, ksg was found to be in the range 0.983 to 0.999 and with the new Isodose Control HDR 192Ir Flexisource ksg was found to be in the range 0.987 to 1.004 with a relative uncertainty of 0.4% (k = 2). Source geometry factors for different combinations of calibration sources, clinical sources, well chambers and associated source holders, can be calculated with the formalism discussed in this paper.

  10. An overexposure in industrial radiography using an /sup 192/Ir radionuclide

    SciTech Connect

    Jalil, A.; Molla, M.A.

    1989-07-01

    An industrial radiographer was accidentally exposed to a high dose of ionizing radiation from an /sup 192/Ir source during radiography of weldjoints in gas pipelines. Some symptoms of high radiation exposure occurred immediately after the incident. The clinical effect of skin erythema developed within 7 d, leading to progressive tissue deterioration. The dose to the body was estimated to be about 2-3 Gy, and the dose to the fingertips was approximately 24 Gy.

  11. Qualification tests for 192Ir sealed sources

    NASA Astrophysics Data System (ADS)

    Iancso, Georgeta; Iliescu, Elena; Iancu, Rodica

    2013-12-01

    This paper describes the results of qualification tests for 192Ir sealed sources, available in Testing and Nuclear Expertise Laboratory of National Institute for Physics and Nuclear Engineering "Horia Hulubei" (I.F.I.N.-HH), Romania. These sources had to be produced in I.F.I.N.-HH and were tested in order to obtain the authorization from The National Commission for Nuclear Activities Control (CNCAN). The sources are used for gammagraphy procedures or in gammadefectoscopy equipments. Tests, measurement methods and equipments used, comply with CNCAN, AIEA and International Quality Standards and regulations. The qualification tests are: 1. Radiological tests and measurements: dose equivalent rate at 1 m; tightness; dose equivalent rate at the surface of the transport and storage container; external unfixed contamination of the container surface. 2. Mechanical and climatic tests: thermal shock; external pressure; mechanic shock; vibrations; boring; thermal conditions for storage and transportation. Passing all tests, it was obtained the Radiological Security Authorization for producing the 192Ir sealed sources. Now IFIN-HH can meet many demands for this sealed sources, as the only manufacturer in Romania.

  12. Balloon-based adjuvant radiotherapy in breast cancer: comparison between 99mTc and HDR 192Ir*

    PubMed Central

    de Campos, Tarcísio Passos Ribeiro; de Lima, Carla Flavia; Cuperschmid, Ethel Mizrahy

    2016-01-01

    Objective To perform a comparative dosimetric analysis, based on computer simulations, of temporary balloon implants with 99mTc and balloon brachytherapy with high-dose-rate (HDR) 192Ir, as boosts to radiotherapy. We hypothesized that the two techniques would produce equivalent doses under pre-established conditions of activity and exposure time. Materials and Methods Simulations of implants with 99mTc-filled and HDR 192Ir-filled balloons were performed with the Siscodes/MCNP5, modeling in voxels a magnetic resonance imaging set related to a young female. Spatial dose rate distributions were determined. In the dosimetric analysis of the protocols, the exposure time and the level of activity required were specified. Results The 99mTc balloon presented a weighted dose rate in the tumor bed of 0.428 cGy.h-1.mCi-1 and 0.190 cGyh-1.mCi-1 at the balloon surface and at 8-10 mm from the surface, respectively, compared with 0.499 and 0.150 cGyh-1.mCi-1, respectively, for the HDR 192Ir balloon. An exposure time of 24 hours was required for the 99mTc balloon to produce a boost of 10.14 Gy with 1.0 Ci, whereas only 24 minutes with 10.0 Ci segments were required for the HDR 192Ir balloon to produce a boost of 5.14 Gy at the same reference point, or 10.28 Gy in two 24-minutes fractions. Conclusion Temporary 99mTc balloon implantation is an attractive option for adjuvant radiotherapy in breast cancer, because of its availability, economic viability, and similar dosimetry in comparison with the use of HDR 192Ir balloon implantation, which is the current standard in clinical practice. PMID:27141131

  13. Comparison of 60Co and 192Ir sources in HDR brachytherapy

    PubMed Central

    Zwierzchowski, Grzegorz

    2011-01-01

    This paper compares the isotopes 60Co and 192Ir as radiation sources for high-dose-rate (HDR) afterloading brachytherapy. The smaller size of 192Ir sources made it the preferred radionuclide for temporary brachytherapy treatments. Recently also 60Co sources have been made available with identical geometrical dimensions. This paper compares the characteristics of both nuclides in different fields of brachytherapy based on scientific literature. In an additional part of this paper reports from medical physicists of several radiation therapy institutes are discussed. The purpose of this work is to investigate the advantages or disadvantages of both radionuclides for HDR brachytherapy due to their physical differences. The motivation is to provide useful information to support decision-making procedures in the selection of equipment for brachytherapy treatment rooms. The results of this work show that no advantages or disadvantages exist for 60Co sources compared to 192Ir sources with regard to clinical aspects. Nevertheless, there are potential logistical advantages of 60Co sources due to its longer half-life (5.3 years vs. 74 days), making it an interesting alternative especially in developing countries. PMID:23346129

  14. Dose specification and quality assurance of RTOG protocol 95-17; a cooperative group study of 192Ir breast implants as sole therapy

    PubMed Central

    Ibbott, Geoffrey S.; Hanson, W.F.; Martin, Elizabeth; Kuske, Robert R.; Arthur, Douglas; Rabinovitch, Rachel; White, Julia; Wilenzick, Raymond M.; Harris, Irene; Tailor, Ramesh C.

    2007-01-01

    Purpose RTOG protocol 95-17 was a phase I/II trial to evaluate multi-catheter brachytherapy as the sole method of adjuvant breast radiotherapy for stage I/II breast carcinoma following breast conserving surgery. Low or high dose rate sources were allowed. Dose prescription and treatment evaluation were based on recommendations in ICRU Report 58, and included the parameters mean central dose (MCD), average peripheral dose, dose homogeneity index (DHI), and the dimensions of the low and high dose regions. Methods and Materials Three levels of quality assurance were implemented: (1) Credentialing of institutions was required prior to entering patients onto the study. (2) Rapid review of each treatment plan was conducted prior to treatment, and (3) Retrospective review was performed by the Radiological Physics Center in conjunction with the study chairman and RTOG dosimetry staff. Results Credentialing focused on the accuracy of dose calculation algorithm and compliance with protocol guidelines. Rapid review was designed to identify and correct deviations from the protocol prior to treatment. The retrospective review involved recalculation of dosimetry parameters and review of dose distributions to evaluate the treatment. Specifying both central and peripheral doses resulted in uniform dose distributions, with a mean dose homogeneity index of 0.83 ±0.06. Conclusions Vigorous quality assurance resulted in a high-quality study with few deviations; only 4 of 100 patients were judged as minor variations from protocol and no patient was judged a major deviation. This study should be considered a model for quality assurance of future trials. PMID:18035213

  15. Water equivalent phantom materials for (192)Ir brachytherapy.

    PubMed

    Schoenfeld, Andreas A; Harder, Dietrich; Poppe, Björn; Chofor, Ndimofor

    2015-12-21

    Several solid phantom materials have been tested regarding their suitability as water substitutes for dosimetric measurements in brachytherapy with (192)Ir as a typical high energy photon emitter. The radial variations of the spectral photon fluence, of the total, primary and scattered photon fluence and of the absorbed dose to water in the transversal plane of the tested cylindrical phantoms surrounding a centric and coaxially arranged Varian GammaMed afterloading (192)Ir brachytherapy source were Monte-Carlo simulated in EGSnrc. The degree of water equivalence of a phantom material was evaluated by comparing the radial dose-to-water profile in the phantom material with that in water. The phantom size was varied over a large range since it influences the dose contribution by scattered photons with energies diminished by single and multiple Compton scattering. Phantom axis distances up to 10 cm were considered as clinically relevant. Scattered photons with energies reaching down into the 25 keV region dominate the photon fluence at source distances exceeding 3.5 cm.The tested phantom materials showed significant differences in the degree of water equivalence. In phantoms with radii up to 10 cm, RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR phantoms show excellent water equivalence with dose deviations from a water phantom not exceeding 0.8%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene show deviations up to 2.6%. For larger phantom radii up to 30 cm, the deviations for RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR remain below 1.4%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene produce deviations up to 8.1%. PMMA plays a separate role, with deviations up to 4.3% for radii not exceeding 10 cm, but below 1% for radii up to 30 cm.As suggested

  16. Water equivalent phantom materials for 192Ir brachytherapy

    NASA Astrophysics Data System (ADS)

    Schoenfeld, Andreas A.; Harder, Dietrich; Poppe, Björn; Chofor, Ndimofor

    2015-12-01

    Several solid phantom materials have been tested regarding their suitability as water substitutes for dosimetric measurements in brachytherapy with 192Ir as a typical high energy photon emitter. The radial variations of the spectral photon fluence, of the total, primary and scattered photon fluence and of the absorbed dose to water in the transversal plane of the tested cylindrical phantoms surrounding a centric and coaxially arranged Varian GammaMed afterloading 192Ir brachytherapy source were Monte-Carlo simulated in EGSnrc. The degree of water equivalence of a phantom material was evaluated by comparing the radial dose-to-water profile in the phantom material with that in water. The phantom size was varied over a large range since it influences the dose contribution by scattered photons with energies diminished by single and multiple Compton scattering. Phantom axis distances up to 10 cm were considered as clinically relevant. Scattered photons with energies reaching down into the 25 keV region dominate the photon fluence at source distances exceeding 3.5 cm. The tested phantom materials showed significant differences in the degree of water equivalence. In phantoms with radii up to 10 cm, RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR phantoms show excellent water equivalence with dose deviations from a water phantom not exceeding 0.8%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene show deviations up to 2.6%. For larger phantom radii up to 30 cm, the deviations for RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR remain below 1.4%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene produce deviations up to 8.1%. PMMA plays a separate role, with deviations up to 4.3% for radii not exceeding 10 cm, but below 1% for radii up to 30 cm. As suggested by

  17. Dosimetric study of a brachytherapy treatment of esophagus with Brazilian 192Ir sources using an anthropomorphic phantom

    NASA Astrophysics Data System (ADS)

    Neves, Lucio P.; Santos, William S.; Gorski, Ronan; Perini, Ana P.; Maia, Ana F.; Caldas, Linda V. E.; Orengo, Gilberto

    2014-11-01

    Several radioisotopes are produced at Instituto de Pesquisas Energéticas e Nucleares for the use in medical treatments, including the activation of 192Ir sources. These sources are suitable for brachytherapy treatments, due to their low or high activity, depending on the concentration of 192Ir, easiness to manufacture, small size, stable daughter products and the possibility of re-utilization. They may be used for the treatment of prostate, cervix, head and neck, skin, breast, gallbladder, uterus, vagina, lung, rectum, and eye cancer treatment. In this work, the use of some 192Ir sources was studied for the treatment of esophagus cancer, especially the dose determination of important structures, such as those on the mediastinum. This was carried out utilizing a FASH anthropomorphic phantom and the MCNP5 Monte Carlo code to transport the radiation through matter. It was possible to observe that the doses at lungs, breast, esophagus, thyroid and heart were the highest, which was expected due to their proximity to the source. Therefore, the data are useful to assess the representative dose specific to brachytherapy treatments on the esophagus for radiation protection purposes. The use of brachytherapy sources was studied for the treatment of esophagus cancer. FASH anthropomorphic phantom and MCNP5 Monte Carlo code were employed. The doses at lungs, breast, esophagus, thyroid and heart were the highest. The data is useful to assess the representative doses of treatments on the esophagus.

  18. Characterization of a fiber-coupled Al{sub 2}O{sub 3}:C luminescence dosimetry system for online in vivo dose verification during {sup 192}Ir brachytherapy

    SciTech Connect

    Andersen, Claus E.; Nielsen, Soeren Kynde; Greilich, Steffen; Helt-Hansen, Jakob; Lindegaard, Jacob Christian; Tanderup, Kari

    2009-03-15

    A prototype of a new dose-verification system has been developed to facilitate prevention and identification of dose delivery errors in remotely afterloaded brachytherapy. The system allows for automatic online in vivo dosimetry directly in the tumor region using small passive detector probes that fit into applicators such as standard needles or catheters. The system measures the absorbed dose rate (0.1 s time resolution) and total absorbed dose on the basis of radioluminescence (RL) and optically stimulated luminescence (OSL) from aluminum oxide crystals attached to optical fiber cables (1 mm outer diameter). The system was tested in the range from 0 to 4 Gy using a solid-water phantom, a Varian GammaMed Plus {sup 192}Ir PDR afterloader, and dosimetry probes inserted into stainless-steel brachytherapy needles. The calibrated system was found to be linear in the tested dose range. The reproducibility (one standard deviation) for RL and OSL measurements was 1.3%. The measured depth-dose profiles agreed well with the theoretical expectations computed with the EGSNRC Monte Carlo code, suggesting that the energy dependence for the dosimeter probes (relative to water) is less than 6% for source-to-probe distances in the range of 2-50 mm. Under certain conditions, the RL signal could be greatly disturbed by the so-called stem signal (i.e., unwanted light generated in the fiber cable upon irradiation). The OSL signal is not subject to this source of error. The tested system appears to be adequate for in vivo brachytherapy dosimetry.

  19. A study of 192Ir production conditions at an electron accelerator

    NASA Astrophysics Data System (ADS)

    Dovbnya, A. N.; Rogov, Yu. V.; Shevchenko, V. A.; Shramenko, B. I.; Tenishev, A. Eh.; Torgovkin, A. V.; Uvarov, V. L.

    2014-09-01

    This communication deals with the conditions of 192Ir isotope production under a nonreactor technology via the 193Ir(γ, n)192Ir reaction. It can be carried out by irradiation of a target from natural iridium with the high-energy X-ray of an electron accelerator. The possibility of increasing the photonuclear yield of the target isotope by addition of the 191Ir( n, γ)192Ir reaction induced by moderated photoneutrons has been shown. For this, an X-ray converter and a target were placed inside a neutron moderator. Data on the 192Ir and admixture yields for the techniques using the moderator and without it have been obtained by computer simulation and experimentally.

  20. Qualification tests for {sup 192}Ir sealed sources

    SciTech Connect

    Iancso, Georgeta Iliescu, Elena Iancu, Rodica

    2013-12-16

    This paper describes the results of qualification tests for {sup 192}Ir sealed sources, available in Testing and Nuclear Expertise Laboratory of National Institute for Physics and Nuclear Engineering 'Horia Hulubei' (I.F.I.N.-HH), Romania. These sources had to be produced in I.F.I.N.-HH and were tested in order to obtain the authorization from The National Commission for Nuclear Activities Control (CNCAN). The sources are used for gammagraphy procedures or in gammadefectoscopy equipments. Tests, measurement methods and equipments used, comply with CNCAN, AIEA and International Quality Standards and regulations. The qualification tests are: 1. Radiological tests and measurements: dose equivalent rate at 1 m; tightness; dose equivalent rate at the surface of the transport and storage container; external unfixed contamination of the container surface. 2. Mechanical and climatic tests: thermal shock; external pressure; mechanic shock; vibrations; boring; thermal conditions for storage and transportation. Passing all tests, it was obtained the Radiological Security Authorization for producing the {sup 192}Ir sealed sources. Now IFIN-HH can meet many demands for this sealed sources, as the only manufacturer in Romania.

  1. Dosimetry revisited for the HDR {sup 192}Ir brachytherapy source model mHDR-v2

    SciTech Connect

    Granero, Domingo; Vijande, Javier; Ballester, Facundo; Rivard, Mark J.

    2011-01-15

    Purpose: Recently, the manufacturer of the HDR {sup 192}Ir mHDR-v2 brachytherapy source reported small design changes (referred to herein as mHDR-v2r) that are within the manufacturing tolerances but may alter the existing dosimetric data for this source. This study aimed to (1) check whether these changes affect the existing dosimetric data published for this source; (2) obtain new dosimetric data in close proximity to the source, including the contributions from {sup 192}Ir electrons and considering the absence of electronic equilibrium; and (3) obtain scatter dose components for collapsed cone treatment planning system implementation. Methods: Three different Monte Carlo (MC) radiation transport codes were used: MCNP5, PENELOPE2008, and GEANT4. The source was centrally positioned in a 40 cm radius water phantom. Absorbed dose and collision kerma were obtained using 0.1 mm (0.5 mm) thick voxels to provide high-resolution dosimetry near (far from) the source. Dose-rate distributions obtained with the three MC codes were compared. Results: Simulations of mHDR-v2 and mHDR-v2r designs performed with three radiation transport codes showed agreement typically within 0.2% for r{>=}0.25 cm. Dosimetric contributions from source electrons were significant for r<0.25 cm. The dose-rate constant and radial dose function were similar to those from previous MC studies of the mHDR-v2 design. The 2D anisotropy function also coincided with that of the mHDR-v2 design for r{>=}0.25 cm. Detailed results of dose distributions and scatter components are presented for the modified source design. Conclusions: Comparison of these results to prior MC studies showed agreement typically within 0.5% for r{>=}0.25 cm. If dosimetric data for r<0.25 cm are not needed, dosimetric results from the prior MC studies will be adequate.

  2. Comparison of air-kerma strength determinations for HDR {sup 192}Ir sources

    SciTech Connect

    Rasmussen, Brian E.; Davis, Stephen D.; Schmidt, Cal R.; Micka, John A.; DeWerd, Larry A.

    2011-12-15

    Purpose: To perform a comparison of the interim air-kerma strength standard for high dose rate (HDR) {sup 192}Ir brachytherapy sources maintained by University of Wisconsin Accredited Dosimetry Calibration Laboratory (UWADCL) with measurements of the various source models using modified techniques from the literature. The current interim standard was established by Goetsch et al. in 1991 and has remained unchanged to date. Methods: The improved, laser-aligned seven-distance apparatus of University of Wisconsin Medical Radiation Research Center (UWMRRC) was used to perform air-kerma strength measurements of five different HDR {sup 192}Ir source models. The results of these measurements were compared with those from well chambers traceable to the original standard. Alternative methodologies for interpolating the {sup 192}Ir air-kerma calibration coefficient from the NIST air-kerma standards at {sup 137}Cs and 250 kVp x rays (M250) were investigated and intercompared. As part of the interpolation method comparison, the Monte Carlo code EGSnrc was used to calculate updated values of A{sub wall} for the Exradin A3 chamber used for air-kerma strength measurements. The effects of air attenuation and scatter, room scatter, as well as the solution method were investigated in detail. Results: The average measurements when using the inverse N{sub K} interpolation method for the Classic Nucletron, Nucletron microSelectron, VariSource VS2000, GammaMed Plus, and Flexisource were found to be 0.47%, -0.10%, -1.13%, -0.20%, and 0.89% different than the existing standard, respectively. A further investigation of the differences observed between the sources was performed using MCNP5 Monte Carlo simulations of each source model inside a full model of an HDR 1000 Plus well chamber. Conclusions: Although the differences between the source models were found to be statistically significant, the equally weighted average difference between the seven-distance measurements and the well

  3. Estimation of distance error by fuzzy set theory required for strength determination of HDR 192Ir brachytherapy sources

    PubMed Central

    Kumar, Sudhir; Datta, D.; Sharma, S. D.; Chourasiya, G.; Babu, D. A. R.; Sharma, D. N.

    2014-01-01

    Verification of the strength of high dose rate (HDR) 192Ir brachytherapy sources on receipt from the vendor is an important component of institutional quality assurance program. Either reference air-kerma rate (RAKR) or air-kerma strength (AKS) is the recommended quantity to specify the strength of gamma-emitting brachytherapy sources. The use of Farmer-type cylindrical ionization chamber of sensitive volume 0.6 cm3 is one of the recommended methods for measuring RAKR of HDR 192Ir brachytherapy sources. While using the cylindrical chamber method, it is required to determine the positioning error of the ionization chamber with respect to the source which is called the distance error. An attempt has been made to apply the fuzzy set theory to estimate the subjective uncertainty associated with the distance error. A simplified approach of applying this fuzzy set theory has been proposed in the quantification of uncertainty associated with the distance error. In order to express the uncertainty in the framework of fuzzy sets, the uncertainty index was estimated and was found to be within 2.5%, which further indicates that the possibility of error in measuring such distance may be of this order. It is observed that the relative distance li estimated by analytical method and fuzzy set theoretic approach are consistent with each other. The crisp values of li estimated using analytical method lie within the bounds computed using fuzzy set theory. This indicates that li values estimated using analytical methods are within 2.5% uncertainty. This value of uncertainty in distance measurement should be incorporated in the uncertainty budget, while estimating the expanded uncertainty in HDR 192Ir source strength measurement. PMID:24872605

  4. Response of an implantable MOSFET dosimeter to 192Ir HDR radiation.

    PubMed

    Fagerstrom, Jessica M; Micka, John A; DeWerd, Larry A

    2008-12-01

    New in vivo dosimetry methods would be useful for clinical HDR brachytherapy. An implantable MOSFET Dose Verification System designed by Sicel Technologies, Inc. was examined for use with 192Ir HDR applications. This investigation demonstrated that varying the dose rate from 22 to 84 cGy/min did not change detector response. The detectors exhibited a higher sensitivity to 192Ir energies than 60Co energies. A nonlinear accumulated dose effect was characterized by three third-order polynomials fit to data from detectors placed at three different distances from the source. The detectors were found to have minimal rotational angular dependence. A strong longitudinal angular dependence was found when the detector's copper coil and electronics assembly were aligned between the MOSFETs and incident radiation. This orientation showed a 16% decrease in response relative to other orientations tested. PMID:19175130

  5. Enhancement and validation of Geant4 Brachytherapy application on clinical HDR 192Ir source

    NASA Astrophysics Data System (ADS)

    Ababneh, Eshraq; Dababneh, Saed; Qatarneh, Sharif; Wadi-Ramahi, Shada

    2014-10-01

    The Geant4 Monte Carlo MC associated Brachytherapy example was adapted, enhanced and several analysis techniques have been developed. The simulation studies the isodose distribution of the total, primary and scattered doses around a Nucletron microSelectron 192Ir source. Different phantom materials were used (water, tissue and bone) and the calculation was conducted at various depths and planes. The work provides an early estimate of the required number of primary events to ultimately achieve a given uncertainty at a given distance, in the otherwise CPU and time consuming clinical MC calculation. The adaptation of the Geant4 toolkit and the enhancements introduced to the code are all validated including the comprehensive decay of the 192Ir source, the materials used to build the geometry, the geometry itself and the calculated scatter to primary dose ratio. The simulation quantitatively illustrates that the scattered dose in the bone medium is larger than its value in water and tissue. As the distance away from the source increases, scatter contribution to dose becomes more significant as the primary dose decreases. The developed code could be viewed as a platform that contains detailed dose calculation model for clinical application of HDR 192Ir in Brachytherapy.

  6. Comparison of 192Ir air kerma calibration coefficients derived at ARPANSA using the interpolation method and at the National Physical Laboratory using a direct measurement.

    PubMed

    Butler, D; Haworth, A; Sander, T; Todd, S

    2008-12-01

    The reference air kerma rate from 192Ir High Dose Rate (HDR) brachytherapy sources can be measured using a suitably calibrated Farmer chamber and an appropriate in-air calibration jig. When a primary standard for 192Ir gamma rays is available, a calibration coefficient for the chamber and jig combination can be determined directly. In Australia, due to the absence of such a standard, the chamber must be calibrated by interpolation of the response in 60Co and in a kilovoltage x-ray beam. Corrections for the effect of the jig, scatter and beam non-uniformity must then be measured or calculated before the reference air kerma rate can be determined. We compare the air-kerma calibration coefficient of a PTW 30010 PMMA/A1 Farmer chamber (referred to as Farmer chamber throughout this report) obtained from the 192Ir primary standard at the National Physical Laboratory in the UK with the corresponding coefficient obtained by interpolating Australian calibrations using 60Co and 250 kV x-rays and determining suitable correction factors. The resulting chamber/jig calibration coefficients differ by 0.2% which is well within the combined standard uncertainties of 1.2% and 0.6% reported by ARPANSA and NPL respectively. PMID:19239060

  7. Design and characterization of an economical 192Ir hemi-brain small animal irradiator

    PubMed Central

    Sio, Terence T.; Beltran, Chris J.; Tryggestad, Erik J.; Gupta, Shiv K.; Blackwell, Charles R.; McCollough, Kevin P.; Sarkaria, Jann N.; Furutani, Keith M.

    2015-01-01

    Purpose To describe the design and dosimetric characterization of a simple and economical small animal irradiator. Materials and methods A high dose rate (HDR) 192Ir brachytherapy source from a commercially available afterloader was used with a 1.3 cm thick tungsten collimator to provide sharp beam penumbra suitable for hemi-brain irradiation of mice. The unit was equipped with continuous gas anesthesia to allow robust animal immobilization. Dosimetric characterization of the device was performed with Gafchromic film measurements. Results The tungsten collimator provided a sharp penumbra suitable for hemi-brain irradiation, and dose rates on the order of 200 cGy/minute were achieved. The sharpness of the penumbra attainable with this device compares favorably to those measured experimentally for 6 MV photons, and 6 and 20 MeV electron beams from a linear accelerator, and was comparable to those measured for a 300 kVp orthovoltage beam and a Monte Carlo simulated 90 MeV proton beam. Conclusions Due to its simplicity and low cost, the apparatus described is an attractive alternative for small animal irradiation experiments requiring steep dose gradients. PMID:24844370

  8. Multi-species prostate implant treatment plans incorporating {sup 192}Ir and {sup 125}I using a Greedy Heuristic based 3D optimization algorithm

    SciTech Connect

    Chaswal, V.; Yoo, S.; Thomadsen, B. R.; Henderson, D. L.

    2007-02-15

    The goals of interstitial implant brachytherapy include delivery of the target dose in a uniform manner while sparing sensitive structures, and minimizing the number of needles and sources. We investigated the use of a multi-species source arrangement ({sup 192}Ir with {sup 125}I) for treatment in interstitial prostate brachytherapy. The algorithm utilizes an 'adjoint ratio', which provides a means of ranking source positions and is the criterion for the Greedy Heuristic optimization. Three cases were compared, each using 0.4 mCi {sup 125}I seeds: case I is the base case using {sup 125}I alone, case II uses 0.12 mCi {sup 192}Ir seeds mixed with {sup 125}I, and case III uses 0.25 mCi {sup 192}Ir mixed with {sup 125}I. Both multi-species cases result in lower exposure of the urethra and central prostate region. Compared with the base case, the exposure to the rectum and normal tissue increases by a significant amount for case III as compared with the increase in case II, signifying the effect of slower dose falloff rate of higher energy gammas of {sup 192}Ir in the tissue. The number of seeds and needles decreases in both multi-species cases, with case III requiring fewer seeds and needles than case II. Further, the effect of {sup 192}Ir on uniformity was investigated using the 0.12 mCi {sup 192}Ir seeds in multi-species implants. An increase in uniformity was observed with an increase in the number of 0.12 mCi {sup 192}Ir seeds implanted. The effects of prostate size on the evaluation parameters for multi-species implants were investigated using 0.12 mCi {sup 192}Ir and 0.4 mCi {sup 125}I, and an acceptable treatment plan with increased uniformity was obtained.

  9. Limitations of the TG-43 formalism for skin high-dose-rate brachytherapy dose calculations

    SciTech Connect

    Granero, Domingo; Perez-Calatayud, Jose; Vijande, Javier; Ballester, Facundo; Rivard, Mark J.

    2014-02-15

    Purpose: In skin high-dose-rate (HDR) brachytherapy, sources are located outside, in contact with, or implanted at some depth below the skin surface. Most treatment planning systems use the TG-43 formalism, which is based on single-source dose superposition within an infinite water medium without accounting for the true geometry in which conditions for scattered radiation are altered by the presence of air. The purpose of this study is to evaluate the dosimetric limitations of the TG-43 formalism in HDR skin brachytherapy and the potential clinical impact. Methods: Dose rate distributions of typical configurations used in skin brachytherapy were obtained: a 5 cm × 5 cm superficial mould; a source inside a catheter located at the skin surface with and without backscatter bolus; and a typical interstitial implant consisting of an HDR source in a catheter located at a depth of 0.5 cm. Commercially available HDR{sup 60}Co and {sup 192}Ir sources and a hypothetical {sup 169}Yb source were considered. The Geant4 Monte Carlo radiation transport code was used to estimate dose rate distributions for the configurations considered. These results were then compared to those obtained with the TG-43 dose calculation formalism. In particular, the influence of adding bolus material over the implant was studied. Results: For a 5 cm × 5 cm{sup 192}Ir superficial mould and 0.5 cm prescription depth, dose differences in comparison to the TG-43 method were about −3%. When the source was positioned at the skin surface, dose differences were smaller than −1% for {sup 60}Co and {sup 192}Ir, yet −3% for {sup 169}Yb. For the interstitial implant, dose differences at the skin surface were −7% for {sup 60}Co, −0.6% for {sup 192}Ir, and −2.5% for {sup 169}Yb. Conclusions: This study indicates the following: (i) for the superficial mould, no bolus is needed; (ii) when the source is in contact with the skin surface, no bolus is needed for either {sup 60}Co and {sup 192}Ir. For

  10. The air-kerma rate constant of 192Ir.

    PubMed

    Ninković, M M; Raiĉevìć, J J

    1993-01-01

    The air-kerma rate constant gamma delta (and its precursors), as one of the basic radiation characteristics of 192Ir, was determined by many authors. Analysis of accessible data on this quantity led us to the conclusion that published data strongly disagree. That is the reason we calculated this quantity on the basis of our and many other authors' gamma-ray spectral data and the latest data for mass energy-transfer coefficients for air. In this way, a value was obtained for gamma delta of 30.0 +/- 0.9 a Gy m2 s-1 Bq-1 for an unshielded 192Ir source and 27.8 +/- 0.9 a Gy m2s -1Bq-1 for a standard packaged radioactive source taking into account attenuation of gamma rays in the platinum source wall. PMID:8416220

  11. Dosimetric comparison between the microSelectron HDR 192Ir v2 source and the BEBIG 60Co source for HDR brachytherapy using the EGSnrc Monte Carlo transport code

    PubMed Central

    Islam, M. Anwarul; Akramuzzaman, M. M.; Zakaria, G. A.

    2012-01-01

    Manufacturing of miniaturized high activity 192Ir sources have been made a market preference in modern brachytherapy. The smaller dimensions of the sources are flexible for smaller diameter of the applicators and it is also suitable for interstitial implants. Presently, miniaturized 60Co HDR sources have been made available with identical dimensions to those of 192Ir sources. 60Co sources have an advantage of longer half life while comparing with 192Ir source. High dose rate brachytherapy sources with longer half life are logically pragmatic solution for developing country in economic point of view. This study is aimed to compare the TG-43U1 dosimetric parameters for new BEBIG 60Co HDR and new microSelectron 192Ir HDR sources. Dosimetric parameters are calculated using EGSnrc-based Monte Carlo simulation code accordance with the AAPM TG-43 formalism for microSlectron HDR 192Ir v2 and new BEBIG 60Co HDR sources. Air-kerma strength per unit source activity, calculated in dry air are 9.698×10-8 ± 0.55% U Bq-1 and 3.039×10-7 ± 0.41% U Bq-1 for the above mentioned two sources, respectively. The calculated dose rate constants per unit air-kerma strength in water medium are 1.116±0.12% cGy h-1U-1 and 1.097±0.12% cGy h-1U-1, respectively, for the two sources. The values of radial dose function for distances up to 1 cm and more than 22 cm for BEBIG 60Co HDR source are higher than that of other source. The anisotropic values are sharply increased to the longitudinal sides of the BEBIG 60Co source and the rise is comparatively sharper than that of the other source. Tissue dependence of the absorbed dose has been investigated with vacuum phantom for breast, compact bone, blood, lung, thyroid, soft tissue, testis, and muscle. No significant variation is noted at 5 cm of radial distance in this regard while comparing the two sources except for lung tissues. The true dose rates are calculated with considering photon as well as electron transport using appropriate cut

  12. Evaluation of high-energy brachytherapy source electronic disequilibrium and dose from emitted electrons

    SciTech Connect

    Ballester, Facundo; Granero, Domingo; Perez-Calatayud, Jose; Melhus, Christopher S.; Rivard, Mark J.

    2009-09-15

    Purpose: The region of electronic disequilibrium near photon-emitting brachytherapy sources of high-energy radionuclides ({sup 60}Co, {sup 137}Cs, {sup 192}Ir, and {sup 169}Yb) and contributions to total dose from emitted electrons were studied using the GEANT4 and PENELOPE Monte Carlo codes. Methods: Hypothetical sources with active and capsule materials mimicking those of actual sources but with spherical shape were examined. Dose contributions due to source photons, x rays, and bremsstrahlung; source {beta}{sup -}, Auger electrons, and internal conversion electrons; and water collisional kerma were scored. To determine if conclusions obtained for electronic equilibrium conditions and electron dose contribution to total dose for the representative spherical sources could be applied to actual sources, the {sup 192}Ir mHDR-v2 source model (Nucletron B.V., Veenendaal, The Netherlands) was simulated for comparison to spherical source results and to published data. Results: Electronic equilibrium within 1% is reached for {sup 60}Co, {sup 137}Cs, {sup 192}Ir, and {sup 169}Yb at distances greater than 7, 3.5, 2, and 1 mm from the source center, respectively, in agreement with other published studies. At 1 mm from the source center, the electron contributions to total dose are 1.9% and 9.4% for {sup 60}Co and {sup 192}Ir, respectively. Electron emissions become important (i.e., >0.5%) within 3.3 mm of {sup 60}Co and 1.7 mm of {sup 192}Ir sources, yet are negligible over all distances for {sup 137}Cs and {sup 169}Yb. Electronic equilibrium conditions along the transversal source axis for the mHDR-v2 source are comparable to those of the spherical sources while electron dose to total dose contribution are quite different. Conclusions: Electronic equilibrium conditions obtained for spherical sources could be generalized to actual sources while electron contribution to total dose depends strongly on source dimensions, material composition, and electron spectra.

  13. A statistical approach to infer the minimum setup distance of a well chamber to the wall or to the floor for {sup 192}Ir HDR calibration

    SciTech Connect

    Chang Liyun; Ho, S.-Y.; Chui, C.-S.; Lee, J.-H.; Du Yichun; Chen Tainsong

    2008-06-15

    We propose a new method based on statistical analysis technique to determine the minimum setup distance of a well chamber used in the calibration of {sup 192}Ir high dose rate (HDR). The chamber should be placed at least this distance away from any wall or from the floor in order to mitigate the effect of scatter. Three different chambers were included in this study, namely, Sun Nuclear Corporation, Nucletron, and Standard Imaging. The results from this study indicated that the minimum setup distance varies depending on the particular chamber and the room architecture in which the chamber was used. Our result differs from that of a previous study by Podgorsak et al. [Med. Phys. 19, 1311-1314 (1992)], in which 25 cm was suggested, and also differs from that of the International Atomic Energy Agency (IAEA)-TECDOC-1079 report, which suggested 30 cm. The new method proposed in this study may be considered as an alternative approach to determine the minimum setup distance of a well-type chamber used in the calibration of {sup 192}Ir HDR.

  14. Influence of phantom material and dimensions on experimental {sup 192}Ir dosimetry

    SciTech Connect

    Tedgren, Aasa Carlsson; Carlsson, Gudrun Alm

    2009-06-15

    In treatment planning of brachytherapy, absorbed dose is calculated by superposing predetermined distributions of absorbed dose to water in water for the single source according to the irradiation pattern [i.e., placement of the source(s) or dwelling position(s)]. Single-source reference water data are derived from Monte Carlo (MC) simulations and/or experiments. For reasons of positional accuracy, experimental brachytherapy dosimetry is most often performed in plastic phantoms. This work investigates the water equivalence of phantoms made from polystyrene, PMMA, and solid water for {sup 192}Ir dosimetry. The EGSnrc MC code is used to simulate radial absorbed dose distributions in cylindrical phantoms of dimensions ranging in size from diameter and height of 20 cm to diameter and height of 40 cm. Water equivalence prevails if the absorbed dose to water in the plastic phantom is the same as the absorbed dose to water in a water phantom at equal distances from the source. It is shown that water equivalence at a specified distance from the source depends not only on the size of the plastic phantom but also on the size of the water phantom used for comparison. Compared to equally sized water phantoms, phantoms of polystyrene are less water equivalent than phantoms of PMMA and solid water but compared to larger water phantoms they are the most water equivalent. Although phantom dimension is the most important single factor influencing the dose distributions around {sup 192}Ir sources, the effect of material properties is non-negligible and becomes increasingly important as phantom dimensions increase. The importance of knowing the size of the water phantom whose data underlies treatment planning systems, when using such data as a reference in, e.g., detector evaluation studies, is discussed. To achieve the highest possible accuracy in experimental dosimetry, phantom-specific correction factors should be used.

  15. Dose characterization in the near-source region for two high dose rate brachytherapy sources.

    PubMed

    Wang, Ruqing; Li, X Allen

    2002-08-01

    High dose rate (HDR) 192Ir sources are currently used in intravascular brachytherapy (IVB) for the peripheral arterial system. This poses a demand on evaluating accurate dose parameters in the near-source region for such sources. The purpose of this work is to calculate the dose parameters for the old VariSource HDR 192Ir source and the new microSelectron HDR 192Ir source, using Monte Carlo electron and photon transport simulation. The two-dimensional (2D) dose rate distributions and the air kerma strengths for the two HDR sources were calculated by EGSnrc and EGS4 Monte Carlo codes. Based on these data, the dose parameters proposed in the AAPM TG-60 protocol were derived. The dose rate constants obtained are 13.119+/-0.028 cGy h(-1) U(-1) for the old VariSource source, and 22.751+/-0.031 cGy h(-1) U(-1) for the new microSelectron source at the reference point (r0 = 2 mm, theta = pi/2). The 2D dose rate distributions, the radial dose functions, and the anisotropy functions presented for the two sources cover radial distances ranging from 0.5 to 10 mm. In the near-source region on the transverse plane, the dose effects of the charged particle nonequilibrium and the beta-particle dose contribution were studied. It is found that at radial distances ranging from 0.5 to 2 mm, these effects increase the calculated dose rates by up to 29% for the old VariSource source, and by up to 12% for the new microSelectron source, which, in turn, change values of the radial dose function and the anisotropy function. The present dose parameters, which account for the charged particle nonequilibrium and the beta particle contribution, may be used for accurate IVB dose calculation. PMID:12201413

  16. Dosimetric impact of an {sup 192}Ir brachytherapy source cable length modeled using a grid-based Boltzmann transport equation solver

    SciTech Connect

    Mikell, Justin K.; Mourtada, Firas

    2010-09-15

    Purpose: To evaluate the dose distributions of an {sup 192}Ir source (model VS2000) in homogeneous water geometry calculated using a deterministic grid-based Boltzmann transport equation solver (GBBS) in the commercial treatment planning system (TPS) (BRACHYVISION-ACUROS v8.8). Methods: Using percent dose differences (%{Delta}D), the GBBS (BV-ACUROS) was compared to the (1) published TG-43 data, (2) MCNPX Monte Carlo (MC) simulations of the {sup 192}Ir source centered in a 15 cm radius water sphere, and (3) TG-43 output from the TPS using vendor supplied (BV-TG43-vendor) and user extended (BV-TG43-extended) 2D anisotropy functions F(r,{theta}). BV-ACUROS assumes 1 mm of NiTi cable, while the TPS TG-43 algorithm uses data based on a 15 cm cable. MC models of various cable lengths were simulated. Results: The MC simulations resulted in >20% dose deviations along the cable for 1, 2, and 3 mm cable lengths relative to 15 cm. BV-ACUROS comparisons with BV-TG43-vendor and BV-TG43-extended yielded magnitude of differences, consistent with those seen in MC simulations. However, differences >20% extended further ({theta}{<=}10 deg.) when using the vendor supplied anisotropy function F{sub ven}(r,{theta}). These differences were also seen in comparisons of F(r,{theta}) derived from the TPS output. Conclusions: The results suggest that %{Delta}D near the cable region is larger than previously estimated. The spatial distribution of the dose deviation is highly dependent on the reference TG-43 data used to compare to GBBS. The differences observed, while important to realize, should not have an impact on clinical dosimetry in homogeneous water.

  17. Dosimetric characterizations of GZP6 60Co high dose rate brachytherapy sources: application of superimposition method

    PubMed Central

    Bahreyni Toossi, Mohammad Taghi; Ghorbani, Mahdi; Mowlavi, Ali Asghar; Meigooni, Ali Soleimani

    2012-01-01

    Background Dosimetric characteristics of a high dose rate (HDR) GZP6 Co-60 brachytherapy source have been evaluated following American Association of Physicists in MedicineTask Group 43U1 (AAPM TG-43U1) recommendations for their clinical applications. Materials and methods MCNP-4C and MCNPX Monte Carlo codes were utilized to calculate dose rate constant, two dimensional (2D) dose distribution, radial dose function and 2D anisotropy function of the source. These parameters of this source are compared with the available data for Ralstron 60Co and microSelectron192Ir sources. Besides, a superimposition method was developed to extend the obtained results for the GZP6 source No. 3 to other GZP6 sources. Results The simulated value for dose rate constant for GZP6 source was 1.104±0.03 cGyh-1U-1. The graphical and tabulated radial dose function and 2D anisotropy function of this source are presented here. The results of these investigations show that the dosimetric parameters of GZP6 source are comparable to those for the Ralstron source. While dose rate constant for the two 60Co sources are similar to that for the microSelectron192Ir source, there are differences between radial dose function and anisotropy functions. Radial dose function of the 192Ir source is less steep than both 60Co source models. In addition, the 60Co sources are showing more isotropic dose distribution than the 192Ir source. Conclusions The superimposition method is applicable to produce dose distributions for other source arrangements from the dose distribution of a single source. The calculated dosimetric quantities of this new source can be introduced as input data to the GZP6 treatment planning system (TPS) and to validate the performance of the TPS. PMID:23077455

  18. The Application of Elliptic Cylindrical Phantom in Brachytherapy Dosimetric Study of HDR 192Ir Source

    NASA Astrophysics Data System (ADS)

    Ahn, Woo Sang; Park, Sung Ho; Jung, Sang Hoon; Choi, Wonsik; Do Ahn, Seung; Shin, Seong Soo

    2014-06-01

    The purpose of this study is to determine the radial dose function of HDR 192Ir source based on Monte Carlo simulation using elliptic cylindrical phantom, similar to realistic shape of pelvis, in brachytherapy dosimetric study. The elliptic phantom size and shape was determined by analysis of dimensions of pelvis on CT images of 20 patients treated with brachytherapy for cervical cancer. The radial dose function obtained using the elliptic cylindrical water phantom was compared with radial dose functions for different spherical phantom sizes, including the Williamsion's data loaded into conventional planning system. The differences in the radial dose function for the different spherical water phantoms increase with radial distance, r, and the largest differences in the radial dose function appear for the smallest phantom size. The radial dose function of the elliptic cylindrical phantom significantly decreased with radial distance in the vertical direction due to different scatter condition in comparison with the Williamson's data. Considering doses to ICRU rectum and bladder points, doses to reference points can be underestimated up to 1-2% at the distance from 3 to 6 cm. The radial dose function in this study could be used as realistic data for calculating the brachytherapy dosimetry for cervical cancer.

  19. Approaches to calculating AAPM TG-43 brachytherapy dosimetry parameters for 137Cs, 125I, 192Ir, 103Pd, and 169Yb sources.

    PubMed

    Melhus, Christopher S; Rivard, Mark J

    2006-06-01

    Underlying characteristics in brachytherapy dosimetry parameters for medical radionuclides 137Cs, 125I, 192Ir, 103Pd, and 169Yb were examined using Monte Carlo methods. Sources were modeled as unencapsulated point or line sources in liquid water to negate variations due to materials and construction. Importance of phantom size, mode of radiation transport physics--i.e., photon transport only or coupled photon:electron transport, phantom material, volume averaging, and Monte Carlo tally type were studied. For noninfinite media, g(r) was found to degrade as r approached R, the phantom radius. MCNP5 results were in agreement with those published using GEANT4. Brachytherapy dosimetry parameters calculated using coupled photon:electron radiation transport simulations did not differ significantly from those using photon transport only. Dose distributions from low-energy photon-emitting radionuclides 125I and 103Pd were sensitive to phantom material by upto a factor of 1.4 and 2.0, respectively, between tissue-equivalent materials and water at r =9 cm. In comparison, high-energy photons from 137Cs, 192Ir, and 169Yb demonstrated +/- 5% differences in dose distributions between water and tissue substitutes at r=20 cm. Similarly, volume-averaging effects were found to be more significant for low-energy radionuclides. When modeling line sources with L < or = 0.5 cm, the two-dimensional anisotropy function was largely within +/- 0.5% of unity for 137Cs, 125I, and 192Ir. However, an energy and geometry effect was noted for 103Pd and 169Yb, with Pd-103F(0.5,0 degrees)=l.05 and yb-169F(0.5,0 degrees)=0.98 for L=0.5 cm. Simulations of monoenergetic photons for L=0.5 cm produced energy-dependent variations in F(r, theta) having a maximum value at 10 keV, minimum at 50 keV, and approximately 1.0 for higher-energy photons up to 750 keV. Both the F6 cell heating and *F4 track-length estimators were employed to determine brachytherapy dosimetry parameters. F6 was found to be necessary

  20. Approaches to calculating AAPM TG-43 brachytherapy dosimetry parameters for {sup 137}Cs, {sup 125}I, {sup 192}Ir, {sup 103}Pd, and {sup 169}Yb sources

    SciTech Connect

    Melhus, Christopher S.; Rivard, Mark J.

    2006-06-15

    Underlying characteristics in brachytherapy dosimetry parameters for medical radionuclides {sup 137}Cs, {sup 125}I, {sup 192}Ir, {sup 103}Pd, and {sup 169}Yb were examined using Monte Carlo methods. Sources were modeled as unencapsulated point or line sources in liquid water to negate variations due to materials and construction. Importance of phantom size, mode of radiation transport physics--i.e., photon transport only or coupled photon:electron transport, phantom material, volume averaging, and Monte Carlo tally type were studied. For noninfinite media, g(r) was found to degrade as r approached R, the phantom radius. MCNP5 results were in agreement with those published using GEANT4. Brachytherapy dosimetry parameters calculated using coupled photon:electron radiation transport simulations did not differ significantly from those using photon transport only. Dose distributions from low-energy photon-emitting radionuclides {sup 125}I and {sup 103}Pd were sensitive to phantom material by upto a factor of 1.4 and 2.0, respectively, between tissue-equivalent materials and water at r=9 cm. In comparison, high-energy photons from {sup 137}Cs, {sup 192}Ir, and {sup 169}Yb demonstrated {+-}5% differences in dose distributions between water and tissue substitutes at r=20 cm. Similarly, volume-averaging effects were found to be more significant for low-energy radionuclides. When modeling line sources with L{<=}0.5 cm, the two-dimensional anisotropy function was largely within {+-}0.5% of unity for {sup 137}Cs, {sup 125}I, and {sup 192}Ir. However, an energy and geometry effect was noted for {sup 103}Pd and {sup 169}Yb, with {sub Pd-103}F(0.5,0 deg.)=1.05 and {sub Yb-169}F(0.5,0 deg.)=0.98 for L=0.5 cm. Simulations of monoenergetic photons for L=0.5 cm produced energy-dependent variations in F(r,{theta}) having a maximum value at 10 keV, minimum at 50 keV, and {approx}1.0 for higher-energy photons up to 750 keV. Both the F6 cell heating and track-length estimators were

  1. On source models for (192)Ir HDR brachytherapy dosimetry using model based algorithms.

    PubMed

    Pantelis, Evaggelos; Zourari, Kyveli; Zoros, Emmanouil; Lahanas, Vasileios; Karaiskos, Pantelis; Papagiannis, Panagiotis

    2016-06-01

    A source model is a prerequisite of all model based dose calculation algorithms. Besides direct simulation, the use of pre-calculated phase space files (phsp source models) and parameterized phsp source models has been proposed for Monte Carlo (MC) to promote efficiency and ease of implementation in obtaining photon energy, position and direction. In this work, a phsp file for a generic (192)Ir source design (Ballester et al 2015) is obtained from MC simulation. This is used to configure a parameterized phsp source model comprising appropriate probability density functions (PDFs) and a sampling procedure. According to phsp data analysis 15.6% of the generated photons are absorbed within the source, and 90.4% of the emergent photons are primary. The PDFs for sampling photon energy and direction relative to the source long axis, depend on the position of photon emergence. Photons emerge mainly from the cylindrical source surface with a constant probability over  ±0.1 cm from the center of the 0.35 cm long source core, and only 1.7% and 0.2% emerge from the source tip and drive wire, respectively. Based on these findings, an analytical parameterized source model is prepared for the calculation of the PDFs from data of source geometry and materials, without the need for a phsp file. The PDFs from the analytical parameterized source model are in close agreement with those employed in the parameterized phsp source model. This agreement prompted the proposal of a purely analytical source model based on isotropic emission of photons generated homogeneously within the source core with energy sampled from the (192)Ir spectrum, and the assignment of a weight according to attenuation within the source. Comparison of single source dosimetry data obtained from detailed MC simulation and the proposed analytical source model show agreement better than 2% except for points lying close to the source longitudinal axis. PMID:27191179

  2. On source models for 192Ir HDR brachytherapy dosimetry using model based algorithms

    NASA Astrophysics Data System (ADS)

    Pantelis, Evaggelos; Zourari, Kyveli; Zoros, Emmanouil; Lahanas, Vasileios; Karaiskos, Pantelis; Papagiannis, Panagiotis

    2016-06-01

    A source model is a prerequisite of all model based dose calculation algorithms. Besides direct simulation, the use of pre-calculated phase space files (phsp source models) and parameterized phsp source models has been proposed for Monte Carlo (MC) to promote efficiency and ease of implementation in obtaining photon energy, position and direction. In this work, a phsp file for a generic 192Ir source design (Ballester et al 2015) is obtained from MC simulation. This is used to configure a parameterized phsp source model comprising appropriate probability density functions (PDFs) and a sampling procedure. According to phsp data analysis 15.6% of the generated photons are absorbed within the source, and 90.4% of the emergent photons are primary. The PDFs for sampling photon energy and direction relative to the source long axis, depend on the position of photon emergence. Photons emerge mainly from the cylindrical source surface with a constant probability over  ±0.1 cm from the center of the 0.35 cm long source core, and only 1.7% and 0.2% emerge from the source tip and drive wire, respectively. Based on these findings, an analytical parameterized source model is prepared for the calculation of the PDFs from data of source geometry and materials, without the need for a phsp file. The PDFs from the analytical parameterized source model are in close agreement with those employed in the parameterized phsp source model. This agreement prompted the proposal of a purely analytical source model based on isotropic emission of photons generated homogeneously within the source core with energy sampled from the 192Ir spectrum, and the assignment of a weight according to attenuation within the source. Comparison of single source dosimetry data obtained from detailed MC simulation and the proposed analytical source model show agreement better than 2% except for points lying close to the source longitudinal axis.

  3. Levels of two-particle and gamma bands in 192Ir

    NASA Astrophysics Data System (ADS)

    Balodis, M.; Krasta, T.

    2015-01-01

    Level scheme of the transitional doubly odd nucleus 192Ir is analysed in detail up to about 530 keV energy using earlier published experimental data of neutron capture and particle transfer reactions. A number of new levels are proposed. Obtained 192Ir level scheme is interpreted in terms of particle-plus-rotor coupling model. It is shown that the long-lived 241 year isomer of 192Ir has spin-parity 11-, just like the analogous states in neighbouring 190,194Ir.

  4. SU-E-T-457: Design and Characterization of An Economical 192Ir Hemi-Brain Small Animal Irradiator

    SciTech Connect

    Grams, M; Wilson, Z; Sio, T; Beltran, C; Tryggestad, E; Gupta, S; Blackwell, C; McCollough, K; Sarkaria, J; Furutani, K

    2014-06-01

    Purpose: To describe the design and dosimetric characterization of a simple and economical small animal irradiator. Methods: A high dose rate 192Ir brachytherapy source from a commercially available afterloader was used with a 1.3 centimeter thick tungsten collimator to provide sharp beam penumbra suitable for hemi-brain irradiation of mice. The unit is equipped with continuous gas anesthesia to allow robust animal immobilization. Dosimetric characterization of the device was performed with Gafchromic film. The penumbra from the small animal irradiator was compared under similar collimating conditions to the penumbra from 6 MV photons, 6 MeV electrons, and 20 MeV electrons from a linear accelerator as well as 300 kVp photons from an orthovoltage unit and Monte Carlo simulated 90 MeV protons. Results: The tungsten collimator provides a sharp penumbra suitable for hemi-brain irradiation, and dose rates on the order of 200 cGy/minute were achieved. The sharpness of the penumbra attainable with this device compares favorably to those measured experimentally for 6 MV photons, and 6 and 20 MeV electron beams from a linear accelerator. Additionally, the penumbra was comparable to those measured for a 300 kVp orthovoltage beam and a Monte Carlo simulated 90 MeV proton beam. Conclusions: The small animal irradiator described here can be built for under $1,000 and used in conjunction with any commercial brachytherapy afterloader to provide a convenient and cost-effective option for small animal irradiation experiments. The unit offers high dose rate delivery and sharp penumbra, which is ideal for hemi-brain irradiation of mice. With slight modifications to the design, irradiation of sites other than the brain could be accomplished easily. Due to its simplicity and low cost, the apparatus described is an attractive alternative for small animal irradiation experiments requiring a sharp penumbra.

  5. Evaluation of PC-ISO for customized, 3D Printed, gynecologic 192-Ir HDR brachytherapy applicators.

    PubMed

    Cunha, J Adam M; Mellis, Katherine; Sethi, Rajni; Siauw, Timmy; Sudhyadhom, Atchar; Garg, Animesh; Goldberg, Ken; Hsu, I-Chow; Pouliot, Jean

    2015-01-01

    The purpose of this study was to evaluate the radiation attenuation properties of PC-ISO, a commercially available, biocompatible, sterilizable 3D printing material, and its suitability for customized, single-use gynecologic (GYN) brachytherapy applicators that have the potential for accurate guiding of seeds through linear and curved internal channels. A custom radiochromic film dosimetry apparatus was 3D-printed in PC-ISO with a single catheter channel and a slit to hold a film segment. The apparatus was designed specifically to test geometry pertinent for use of this material in a clinical setting. A brachytherapy dose plan was computed to deliver a cylindrical dose distribution to the film. The dose plan used an 192Ir source and was normalized to 1500 cGy at 1 cm from the channel. The material was evaluated by comparing the film exposure to an identical test done in water. The Hounsfield unit (HU) distributions were computed from a CT scan of the apparatus and compared to the HU distribution of water and the HU distribution of a commercial GYN cylinder applicator. The dose depth curve of PC-ISO as measured by the radiochromic film was within 1% of water between 1 cm and 6 cm from the channel. The mean HU was -10 for PC-ISO and -1 for water. As expected, the honeycombed structure of the PC-ISO 3D printing process created a moderate spread of HU values, but the mean was comparable to water. PC-ISO is sufficiently water-equivalent to be compatible with our HDR brachytherapy planning system and clinical workflow and, therefore, it is suitable for creating custom GYN brachytherapy applicators. Our current clinical practice includes the use of custom GYN applicators made of commercially available PC-ISO when doing so can improve the patient's treatment.  PMID:25679174

  6. A Case Report: Cytogenetic Dosimetry after Accidental Radiation Exposure during (192)Ir Industrial Radiography Testing.

    PubMed

    Beinke, C; Ben-Shlomo, A; Abend, M; Port, M

    2015-07-01

    The accidental gamma radiation exposure of an industrial radiography worker and the cytogenetic examination of the worker's blood lymphocytes are described here. The exposure of the worker was due to a malfunction at the entrance into the depleted uranium-shielding device of a (192)Ir source during operation. Because the source was sealed no additional beta radiation exposure was assumed. The worker's thermoluminescent dosimeter indicated an absorbed dose of 0.078 Sv, which presumably took place in December 2013. No clinical symptoms were reported in the case history after the potential exposure to radiation. Four months after the incident it was decided that biological dosimetry using dicentric chromosome and micronucleus analysis would be performed to follow radiation protection aspects and to clarify the radiation dose uncertainties for the exposed worker. Micronucleus frequency was not increased above the laboratory's control value of micronucleus background frequency of unexposed individuals. However, the observed dicentric frequency (0.003 dicentric/cell) differs significantly from the laboratory's background level of dicentric chromosomes in unexposed individuals (0.0007 dicentric/cell). Dicentric analysis in 2,048 metaphase cells resulted in an estimated dose of no more than 0.181 Gy (95% upper confidence level), not less than 0.014 Gy (95% lower confidence level) and a mean dose of 0.066 Gy (photon-equivalent whole-body exposure) based on interpolation from the laboratory's calibration curve for (60)Co gamma radiation. Since overdispersion of dicentric chromosomes (u = 9.78) indicated a heterogeneous (partial-body) exposure, we applied the Dolphin method and estimated an exposure of 2.1 Sv affecting 21% of the body volume. Because the overdispersion of dicentric chromosomes was caused by only one heavily damaged cell containing two dicentrics, it is possible that this was an incidental finding. In summary, a radiation overexposure of the radiography worker

  7. Patient-specific dose calculation methods for high-dose-rate iridium-192 brachytherapy

    NASA Astrophysics Data System (ADS)

    Poon, Emily S.

    In high-dose-rate 192Ir brachytherapy, the radiation dose received by the patient is calculated according to the AAPM Task Group 43 (TG-43) formalism. This table-based dose superposition method uses dosimetry parameters derived with the radioactive 192Ir source centered in a water phantom. It neglects the dose perturbations caused by inhomogeneities, such as the patient anatomy, applicators, shielding, and radiographic contrast solution. In this work, we evaluated the dosimetric characteristics of a shielded rectal applicator with an endocavitary balloon injected with contrast solution. The dose distributions around this applicator were calculated by the GEANT4 Monte Carlo (MC) code and measured by ionization chamber and GAFCHROMIC EBT film. A patient-specific dose calculation study was then carried out for 40 rectal treatment plans. The PTRAN_CT MC code was used to calculate the dose based on computed tomography (CT) images. This study involved the development of BrachyGUI, an integrated treatment planning tool that can process DICOM-RT data and create PTRAN_CT input initialization files. BrachyGUI also comes with dose calculation and evaluation capabilities. We proposed a novel scatter correction method to account for the reduction in backscatter radiation near tissue-air interfaces. The first step requires calculating the doses contributed by primary and scattered photons separately, assuming a full scatter environment. The scatter dose in the patient is subsequently adjusted using a factor derived by MC calculations, which depends on the distances between the point of interest, the 192Ir source, and the body contour. The method was validated for multicatheter breast brachytherapy, in which the target and skin doses for 18 patient plans agreed with PTRAN_CT calculations better than 1%. Finally, we developed a CT-based analytical dose calculation method. It corrects for the photon attenuation and scatter based upon the radiological paths determined by ray tracing

  8. Influence of brachytherapy ( sup 192 Ir afterloading) on cell-mediated immune reactions in patients with stage I endometrial cancer

    SciTech Connect

    Gerstner, G.J.; Kucera, H.; Kudlacek, S.; Micksche, M. )

    1989-11-01

    The influence of radiation therapy on cell-mediated immune reactions in cancer patients seems to depend on source, dose, and area of irradiation, as well as on the variables reflected by the patient population investigated. In the present study we demonstrated that brachytherapy ({sup 192}Ir afterloading), applied to patients with inoperable stage I endometrial cancer, has no immediate or sustained effect on lymphocyte function. Both lymphocyte mitogen response and natural killer cell (NK) activity are not significantly changed in terms of baseline values compared with test results during and after therapy. Brachytherapy, as used in this study, has no influence on cell-mediated immunity in patients with endometrial cancer stage I.

  9. Dosimetric accuracy of a deterministic radiation transport based {sup 192}Ir brachytherapy treatment planning system. Part II: Monte Carlo and experimental verification of a multiple source dwell position plan employing a shielded applicator

    SciTech Connect

    Petrokokkinos, L.; Zourari, K.; Pantelis, E.; Moutsatsos, A.; Karaiskos, P.; Sakelliou, L.; Seimenis, I.; Georgiou, E.; Papagiannis, P.

    2011-04-15

    Purpose: The aim of this work is the dosimetric validation of a deterministic radiation transport based treatment planning system (BRACHYVISION v. 8.8, referred to as TPS in the following) for multiple {sup 192}Ir source dwell position brachytherapy applications employing a shielded applicator in homogeneous water geometries. Methods: TPS calculations for an irradiation plan employing seven VS2000 {sup 192}Ir high dose rate (HDR) source dwell positions and a partially shielded applicator (GM11004380) were compared to corresponding Monte Carlo (MC) simulation results, as well as experimental results obtained using the VIP polymer gel-magnetic resonance imaging three-dimensional dosimetry method with a custom made phantom. Results: TPS and MC dose distributions were found in agreement which is mainly within {+-}2%. Considerable differences between TPS and MC results (greater than 2%) were observed at points in the penumbra of the shields (i.e., close to the edges of the ''shielded'' segment of the geometries). These differences were experimentally verified and therefore attributed to the TPS. Apart from these regions, experimental and TPS dose distributions were found in agreement within 2 mm distance to agreement and 5% dose difference criteria. As shown in this work, these results mark a significant improvement relative to dosimetry algorithms that disregard the presence of the shielded applicator since the use of the latter leads to dosimetry errors on the order of 20%-30% at the edge of the ''unshielded'' segment of the geometry and even 2%-6% at points corresponding to the potential location of the target volume in clinical applications using the applicator (points in the unshielded segment at short distances from the applicator). Conclusions: Results of this work attest the capability of the TPS to accurately account for the scatter conditions and the increased attenuation involved in HDR brachytherapy applications employing multiple source dwell positions and

  10. Measurement of dosimetric parameters for the Alpha-Omega high-dose-rate Iridium-192 source

    SciTech Connect

    Muller-Runkel, R. . E-mail: renate.muller@ssfhs.org

    2005-09-30

    Thermoluminescent (TLD) measurements of dose-rate constant, anisotropy function, and radial dose function are reported for the Alpha-Omega high dose rate (HDR) Iridium-192 ({sup 192}Ir) source, which has been available since 1998 for use in the MicroSelectron HDR afterloader manufactured by the Nucletron Corporation. Measurement results are compared with published or available Monte Carlo calculations for both sources. They are found in good agreement, and, within experimental accuracy, no difference is seen in the dosimetric parameters of both sources.

  11. 192Ir pharyngoepiglottic fold interstitial implants. The key to successful treatment of base tongue carcinoma by radiation therapy.

    PubMed

    Goffinet, D R; Fee, W E; Wells, J; Austin-Seymour, M; Clarke, D; Mariscal, J M; Goode, R L

    1985-03-01

    Twenty-eight patients with squamous carcinomas of the base tongue were seen and evaluated in a conjoint Head and Neck Tumor Board at Stanford between 1976 and 1982. Fourteen patients were treated by combined external beam and interstitial irradiation, 11 of whom had Stage III and IV carcinomas (American Joint Committee). An initial dose of 5000 to 5500 rad was first delivered by external beam irradiation in 5 to 5.5 weeks, followed approximately 3 weeks later by an iridium 192 (192Ir) interstitial implant boost by the trocar and loop technique. The key to successful treatment of these neoplasms was found to be the use of a lateral percutaneous cervical technique, which placed horizontal loops through the oropharyngeal wall above and below the hyoid bone; the superior loop included the pharyngoepiglottic fold and the tonsilloglossal groove. Standard multiple loop implants (submentally inserted) of the base tongue from the vallecula anteriorly to the circumvallate papillae were also used routinely. This approach has been successful, since 10 of the 14 patients (71%) remain without evidence of disease (mean follow-up, 32 months). There have been only two local recurrences, both on the pharyngoepiglottic fold in patients who did not receive the now standard pharyngoepiglottic fold/lateral pharyngeal wall implants. No patients have relapsed after 18 months. The other 14 patients were treated prospectively during the same period by combining initial resection, radical neck dissection, and postoperative irradiation. In this group, there were more locoregional failures compared to the group treated with radiation therapy alone (5 tongue recurrences and 7 neck relapses); in addition, more severe complications were noted in these 14 patients who received surgery and postoperative irradiation. The authors believe that combined external beam and interstitial irradiation is effective treatment for base tongue carcinomas, especially when the high-dose distribution includes the

  12. An investigation into the accuracy of Acuros(TM) BV in heterogeneous phantoms for a (192)Ir HDR source using LiF TLDs.

    PubMed

    Manning, Siobhan; Nyathi, Thulani

    2014-09-01

    The aim of this study was to evaluate the accuracy of the new Acuros(TM) BV algorithm using well characterized LiF:Mg,Ti TLD 100 in heterogeneous phantoms. TLDs were calibrated using an (192)Ir source and the AAPM TG-43 calculated dose. The Tölli and Johansson Large Cavity principle and Modified Bragg Gray principle methods confirm the dose calculated by TG-43 at a distance of 5 cm from the source to within 4 %. These calibrated TLDs were used to measure the dose in heterogeneous phantoms containing air, stainless steel, bone and titanium. The TLD results were compared with the AAPM TG-43 calculated dose and the Acuros calculated dose. Previous studies by other authors have shown a change in TLD response with depth when irradiated with an (192)Ir source. This TLD depth dependence was assessed by performing measurements at different depths in a water phantom with an (192)Ir source. The variation in the TLD response with depth in a water phantom was not found to be statistically significant for the distances investigated. The TLDs agreed with Acuros(TM) BV within 1.4 % in the air phantom, 3.2 % in the stainless steel phantom, 3 % in the bone phantom and 5.1 % in the titanium phantom. The TLDs showed a larger discrepancy when compared to TG-43 with a maximum deviation of 9.3 % in the air phantom, -11.1 % in the stainless steel phantom, -14.6 % in the bone phantom and -24.6 % in the titanium phantom. The results have shown that Acuros accounts for the heterogeneities investigated with a maximum deviation of -5.1 %. The uncertainty associated with the TLDs calibrated in the PMMA phantom is ±8.2 % (2SD). PMID:24866931

  13. Dosimetric perturbations of a lead shield for surface and interstitial high-dose-rate brachytherapy.

    PubMed

    Candela-Juan, Cristian; Granero, Domingo; Vijande, Javier; Ballester, Facundo; Perez-Calatayud, Jose; Rivard, Mark J

    2014-06-01

    In surface and interstitial high-dose-rate brachytherapy with either (60)Co, (192)Ir, or (169)Yb sources, some radiosensitive organs near the surface may be exposed to high absorbed doses. This may be reduced by covering the implants with a lead shield on the body surface, which results in dosimetric perturbations. Monte Carlo simulations in Geant4 were performed for the three radionuclides placed at a single dwell position. Four different shield thicknesses (0, 3, 6, and 10 mm) and three different source depths (0, 5, and 10 mm) in water were considered, with the lead shield placed at the phantom surface. Backscatter dose enhancement and transmission data were obtained for the lead shields. Results were corrected to account for a realistic clinical case with multiple dwell positions. The range of the high backscatter dose enhancement in water is 3 mm for (60)Co and 1 mm for both (192)Ir and (169)Yb. Transmission data for (60)Co and (192)Ir are smaller than those reported by Papagiannis et al (2008 Med. Phys. 35 4898-4906) for brachytherapy facility shielding; for (169)Yb, the difference is negligible. In conclusion, the backscatter overdose produced by the lead shield can be avoided by just adding a few millimetres of bolus. Transmission data provided in this work as a function of lead thickness can be used to estimate healthy organ equivalent dose saving. Use of a lead shield is justified. PMID:24705066

  14. Retreatment of recurrent carcinoma of the head and neck by afterloading interstitial 192Ir implant

    SciTech Connect

    Emami, B.; Marks, J.E.

    1983-10-01

    From January 1975 to December 1980, 25 patients with persistent or recurrent carcinomas of the head and neck were retreated for palliation at the Division of Radiation Oncology, Mallinckrodt Institute of Radiology. These patients had all undergone extensive previous treatment by surgery and/or radiation. All were retreated with 192Ir interstitial implant with or without external radiation and/or surgical excision. Of 25 patients, 13 had complete response (CR) and 6 had partial response for a follow-up period of 1 to 7 years. Of 13 patients with CR, 6 are alive with no evidence of disease (NED) and two died NED. Detailed results are presented and the new strategy for such patients is discussed.

  15. Effect of air cavities on the dose delivered to the lung during high-dose brachytherapy.

    PubMed

    Ambrosi, R M; Watterson, J I; Nam, T; Keddy, R J

    1999-01-01

    In the treatment of lung cancer using the radiotherapy technique of intracavitary brachytherapy with an 192Ir source, the lung is normally assumed to be entirely composed of a homogeneous mass of soft tissue. The aim of this study is to investigate whether there is the possibility that the air cavities in the lung influence the dose delivered to the lung at a prescribed distance from the source. The Monte Carlo code MCNP-4A was used to model the dose delivered by both 192Ir and 198Au as a function of treatment medium, density and composition, photon energy, and distance from the source. The suitability of MCNP-4A for this study was tested by producing depth-dose profiles for photons in water and comparing these to calculated profiles produced using well-documented methods. PMID:10676526

  16. A Monte Carlo dosimetry study of vaginal {sup 192}Ir brachytherapy applications with a shielded cylindrical applicator set

    SciTech Connect

    Lymperopoulou, G.; Pantelis, E.; Papagiannis, P.; Rozaki-Mavrouli, H.; Sakelliou, L.; Baltas, D.; Karaiskos, P.

    2004-11-01

    A durable recommendation for brachytherapy treatment planning systems to account for the effect of tissue, applicator and shielding material heterogeneities exists. As different proposed approaches have not been integrated in clinical treatment planning routine yet, currently utilized systems disregard or, most commonly, do not fully account for the aforementioned effects. Therefore, it is of interest to evaluate the efficacy of current treatment planning in clinical applications susceptible to errors due to heterogeneities. In this work the effect of the internal structure as well as the shielding used with a commercially available cylindrical shielded applicator set (Nucletron part no. 084.320) for vaginal and rectum treatments is studied using three-dimensional Monte Carlo simulation for a clinical treatment plan involving seven source dwell positions of the classic microSelectron HDR {sup 192}Ir source. Results are compared to calculations of a treatment planning system (Plato BPS v.14.2.7), which assumes homogeneous water medium and applies a constant, multiplicative transmission factor only at points lying in the shadow of the shield. It is found that the internal structure of the applicator (which includes stainless steel, air and plastic materials) with no shield loaded does not affect the dose distribution relative to homogeneous water. In the unshielded side of the applicator with a 90 deg., 180 deg., or 270 deg. tungsten alloy shield loaded, an overestimation of treatment planning system calculations relative to Monte Carlo results was observed which is both shield and position dependent. While significant (up to 15%) at increased distances, which are not of major clinical importance, this overestimation does not affect dose prescription distances by more than 3%. The inverse effect of approx. 3% dose increase at dose prescription distances is observed for stainless steel shields. Regarding the shielded side of the applicator, it is shown that the

  17. Development and implementation of a remote audit tool for high dose rate (HDR) Ir-192 brachytherapy using optically stimulated luminescence dosimetry

    PubMed Central

    Casey, Kevin E.; Alvarez, Paola; Kry, Stephen F.; Howell, Rebecca M.; Lawyer, Ann; Followill, David

    2013-01-01

    Purpose: The aim of this work was to create a mailable phantom with measurement accuracy suitable for Radiological Physics Center (RPC) audits of high dose-rate (HDR) brachytherapy sources at institutions participating in National Cancer Institute-funded cooperative clinical trials. Optically stimulated luminescence dosimeters (OSLDs) were chosen as the dosimeter to be used with the phantom. Methods: The authors designed and built an 8 × 8 × 10 cm3 prototype phantom that had two slots capable of holding Al2O3:C OSLDs (nanoDots; Landauer, Glenwood, IL) and a single channel capable of accepting all 192Ir HDR brachytherapy sources in current clinical use in the United States. The authors irradiated the phantom with Nucletron and Varian 192Ir HDR sources in order to determine correction factors for linearity with dose and the combined effects of irradiation energy and phantom characteristics. The phantom was then sent to eight institutions which volunteered to perform trial remote audits. Results: The linearity correction factor was kL = (−9.43 × 10−5 × dose) + 1.009, where dose is in cGy, which differed from that determined by the RPC for the same batch of dosimeters using 60Co irradiation. Separate block correction factors were determined for current versions of both Nucletron and Varian 192Ir HDR sources and these vendor-specific correction factors differed by almost 2.6%. For the Nucletron source, the correction factor was 1.026 [95% confidence interval (CI) = 1.023–1.028], and for the Varian source, it was 1.000 (95% CI = 0.995–1.005). Variations in lateral source positioning up to 0.8 mm and distal/proximal source positioning up to 10 mm had minimal effect on dose measurement accuracy. The overall dose measurement uncertainty of the system was estimated to be 2.4% and 2.5% for the Nucletron and Varian sources, respectively (95% CI). This uncertainty was sufficient to establish a ±5% acceptance criterion for source strength audits under a formal RPC

  18. Development and implementation of a remote audit tool for high dose rate (HDR) Ir-192 brachytherapy using optically stimulated luminescence dosimetry

    SciTech Connect

    Casey, Kevin E.; Kry, Stephen F.; Howell, Rebecca M.; Followill, David; Alvarez, Paola; Lawyer, Ann

    2013-11-15

    Purpose: The aim of this work was to create a mailable phantom with measurement accuracy suitable for Radiological Physics Center (RPC) audits of high dose-rate (HDR) brachytherapy sources at institutions participating in National Cancer Institute-funded cooperative clinical trials. Optically stimulated luminescence dosimeters (OSLDs) were chosen as the dosimeter to be used with the phantom.Methods: The authors designed and built an 8 × 8 × 10 cm{sup 3} prototype phantom that had two slots capable of holding Al{sub 2}O{sub 3}:C OSLDs (nanoDots; Landauer, Glenwood, IL) and a single channel capable of accepting all {sup 192}Ir HDR brachytherapy sources in current clinical use in the United States. The authors irradiated the phantom with Nucletron and Varian {sup 192}Ir HDR sources in order to determine correction factors for linearity with dose and the combined effects of irradiation energy and phantom characteristics. The phantom was then sent to eight institutions which volunteered to perform trial remote audits.Results: The linearity correction factor was k{sub L}= (−9.43 × 10{sup −5}× dose) + 1.009, where dose is in cGy, which differed from that determined by the RPC for the same batch of dosimeters using {sup 60}Co irradiation. Separate block correction factors were determined for current versions of both Nucletron and Varian {sup 192}Ir HDR sources and these vendor-specific correction factors differed by almost 2.6%. For the Nucletron source, the correction factor was 1.026 [95% confidence interval (CI) = 1.023–1.028], and for the Varian source, it was 1.000 (95% CI = 0.995–1.005). Variations in lateral source positioning up to 0.8 mm and distal/proximal source positioning up to 10 mm had minimal effect on dose measurement accuracy. The overall dose measurement uncertainty of the system was estimated to be 2.4% and 2.5% for the Nucletron and Varian sources, respectively (95% CI). This uncertainty was sufficient to establish a ±5% acceptance

  19. Cluster pattern analysis of energy deposition sites for the brachytherapy sources 103Pd, 125I, 192Ir, 137Cs, and 60Co

    NASA Astrophysics Data System (ADS)

    Villegas, Fernanda; Tilly, Nina; Bäckström, Gloria; Ahnesjö, Anders

    2014-09-01

    Analysing the pattern of energy depositions may help elucidate differences in the severity of radiation-induced DNA strand breakage for different radiation qualities. It is often claimed that energy deposition (ED) sites from photon radiation form a uniform random pattern, but there is indication of differences in RBE values among different photon sources used in brachytherapy. The aim of this work is to analyse the spatial patterns of EDs from 103Pd, 125I, 192Ir, 137Cs sources commonly used in brachytherapy and a 60Co source as a reference radiation. The results suggest that there is both a non-uniform and a uniform random component to the frequency distribution of distances to the nearest neighbour ED. The closest neighbouring EDs show high spatial correlation for all investigated radiation qualities, whilst the uniform random component dominates for neighbours with longer distances for the three higher mean photon energy sources (192Ir, 137Cs, and 60Co). The two lower energy photon emitters (103Pd and 125I) present a very small uniform random component. The ratio of frequencies of clusters with respect to 60Co differs up to 15% for the lower energy sources and less than 2% for the higher energy sources when the maximum distance between each pair of EDs is 2 nm. At distances relevant to DNA damage, cluster patterns can be differentiated between the lower and higher energy sources. This may be part of the explanation to the reported difference in RBE values with initial DSB yields as an endpoint for these brachytherapy sources.

  20. Verification of the plan dosimetry for high dose rate brachytherapy using metal-oxide-semiconductor field effect transistor detectors

    SciTech Connect

    Qi Zhenyu; Deng Xiaowu; Huang Shaomin; Lu Jie; Lerch, Michael; Cutajar, Dean; Rosenfeld, Anatoly

    2007-06-15

    The feasibility of a recently designed metal-oxide-semiconductor field effect transistor (MOSFET) dosimetry system for dose verification of high dose rate (HDR) brachytherapy treatment planning was investigated. MOSFET detectors were calibrated with a 0.6 cm{sup 3} NE-2571 Farmer-type ionization chamber in water. Key characteristics of the MOSFET detectors, such as the energy dependence, that will affect phantom measurements with HDR {sup 192}Ir sources were measured. The MOSFET detector was then applied to verify the dosimetric accuracy of HDR brachytherapy treatments in a custom-made water phantom. Three MOSFET detectors were calibrated independently, with the calibration factors ranging from 0.187 to 0.215 cGy/mV. A distance dependent energy response was observed, significant within 2 cm from the source. The new MOSFET detector has a good reproducibility (<3%), small angular effect (<2%), and good dose linearity (R{sup 2}=1). It was observed that the MOSFET detectors had a linear response to dose until the threshold voltage reached approximately 24 V for {sup 192}Ir source measurements. Further comparison of phantom measurements using MOSFET detectors with dose calculations by a commercial treatment planning system for computed tomography-based brachytherapy treatment plans showed that the mean relative deviation was 2.2{+-}0.2% for dose points 1 cm away from the source and 2.0{+-}0.1% for dose points located 2 cm away. The percentage deviations between the measured doses and the planned doses were below 5% for all the measurements. The MOSFET detector, with its advantages of small physical size and ease of use, is a reliable tool for quality assurance of HDR brachytherapy. The phantom verification method described here is universal and can be applied to other HDR brachytherapy treatments.

  1. Monte Carlo Dosimetry of the 60Co BEBIG High Dose Rate for Brachytherapy

    PubMed Central

    Campos, Luciana Tourinho; de Almeida, Carlos Eduardo Veloso

    2015-01-01

    Introduction The use of high-dose-rate brachytherapy is currently a widespread practice worldwide. The most common isotope source is 192Ir, but 60Co is also becoming available for HDR. One of main advantages of 60Co compared to 192Ir is the economic and practical benefit because of its longer half-live, which is 5.27 years. Recently, Eckert & Ziegler BEBIG, Germany, introduced a new afterloading brachytherapy machine (MultiSource®); it has the option to use either the 60Co or 192Ir HDR source. The source for the Monte Carlo calculations is the new 60Co source (model Co0.A86), which is referred to as the new BEBIG 60Co HDR source and is a modified version of the 60Co source (model GK60M21), which is also from BEBIG. Objective and Methods The purpose of this work is to obtain the dosimetry parameters in accordance with the AAPM TG-43U1 formalism with Monte Carlo calculations regarding the BEBIG 60Co high-dose-rate brachytherapy to investigate the required treatment-planning parameters. The geometric design and material details of the source was provided by the manufacturer and was used to define the Monte Carlo geometry. To validate the source geometry, a few dosimetry parameters had to be calculated according to the AAPM TG-43U1 formalism. The dosimetry studies included the calculation of the air kerma strength Sk, collision kerma in water along the transverse axis with an unbounded phantom, dose rate constant and radial dose function. The Monte Carlo code system that was used was EGSnrc with a new cavity code, which is a part of EGS++ that allows calculating the radial dose function around the source. The spectrum to simulate 60Co was composed of two photon energies, 1.17 and 1.33 MeV. Only the gamma part of the spectrum was used; the contribution of the electrons to the dose is negligible because of the full absorption by the stainless-steel wall around the metallic 60Co. The XCOM photon cross-section library was used in subsequent simulations, and the

  2. Determination of the tissue inhomogeneity correction in high dose rate Brachytherapy for Iridium-192 source

    PubMed Central

    Ravikumar, Barlanka; Lakshminarayana, S.

    2012-01-01

    In Brachytherapy treatment planning, the effects of tissue heterogeneities are commonly neglected due to lack of accurate, general and fast three-dimensional (3D) dose-computational algorithms. In performing dose calculations, it is assumed that the tumor and surrounding tissues constitute a uniform, homogeneous medium equivalent to water. In the recent past, three-dimensional computed tomography (3D-CT) based treatment planning for Brachytherapy applications has been popularly adopted. However, most of the current commercially available planning systems do not provide the heterogeneity corrections for Brachytherapy dosimetry. In the present study, we have measured and quantified the impact of inhomogeneity caused by different tissues with a 0.015 cc ion chamber. Measurements were carried out in wax phantom which was employed to measure the heterogeneity. Iridium-192 (192Ir) source from high dose rate (HDR) Brachytherapy machine was used as the radiation source. The reduction of dose due to tissue inhomogeneity was measured as the ratio of dose measured with different types of inhomogeneity (bone, spleen, liver, muscle and lung) to dose measured with homogeneous medium for different distances. It was observed that different tissues attenuate differently, with bone tissue showing maximum attenuation value and lung tissue resulting minimum value and rest of the tissues giving values lying in between those of bone and lung. It was also found that inhomogeneity at short distance is considerably more than that at larger distances. PMID:22363109

  3. Dosimetric characterization of surface applicators for use with high dose rate Iridium-192 and electronic brachytherapy sources

    NASA Astrophysics Data System (ADS)

    Fulkerson, Regina Kennedy

    Historically, treatment of malignant surface lesions has been achieved with linear accelerator based electron beams or superficial x-ray beams. Recent developments in the field of brachytherapy now allow for the treatment of surface lesions with specialized conical applicators placed directly on the lesion. Applicators are available for use with high dose rate 192Ir sources, as well as electronic brachytherapy sources. Although use of these applicators has gained in popularity, the dosimetric characteristics including depth dose and surface dose distributions have not been independently verified. Additionally, there is no recognized method of output verification for quality assurance procedures with applicators like these. Existing dosimetry protocols available from the American Association of Physicists in Medicine (AAPM) bookend the cross-over characteristics of a traditional brachytherapy source (as described by Task Group 43) being implemented as a low-energy superficial x-ray beam (as described by Task Group 61) as observed with the surface applicators of interest. This thesis work aims to create a cohesive method of output verification that can be used to determine the dose at the treatment surface as part of a quality assurance/commissioning process for surface applicators used with high dose rate 192Ir and electronic brachytherapy sources. Air-kerma rate measurements were completed with an Attix Free-Air Chamber, as well as several models of small-volume ionization chambers to obtain an air-kerma rate at the treatment surface for each applicator. Correction factors were calculated using MCNP5 and EGSnrc Monte Carlo codes in order to determine an applicator-specific absorbed dose to water at the treatment surface from the measured air-kerma rate. Additionally, relative dose measurements of the surface dose distributions and characteristic depth dose curves were completed in-phantom and in-water. Theoretical dose distributions and depth dose curves were

  4. SU-E-T-580: On the Significance of Model Based Dosimetry for Breast and Head and Neck 192Ir HDR Brachytherapy

    SciTech Connect

    Peppa, V; Pappas, E; Pantelis, E; Papagiannis, P; Major, T; Polgar, C

    2015-06-15

    Purpose: To assess the dosimetric and radiobiological differences between TG43-based and model-based dosimetry in the treatment planning of {sup 192}Ir HDR brachytherapy for breast and head and neck cancer. Methods: Two cohorts of 57 Accelerated Partial Breast Irradiation (APBI) and 22 head and neck (H&N) patients with oral cavity carcinoma were studied. Dosimetry for the treatment plans was performed using the TG43 algorithm of the Oncentra Brachy v4.4 treatment planning system (TPS). Corresponding Monte Carlo (MC) simulations were performed using MCNP6 with input files automatically prepared by the BrachyGuide software tool from DICOM RT plan data. TG43 and MC data were compared in terms of % dose differences, Dose Volume Histograms (DVHs) and related indices of clinical interest for the Planning Target Volume (PTV) and the Organs-At-Risk (OARs). A radiobiological analysis was also performed using the Equivalent Uniform Dose (EUD), mean survival fraction (S) and Tumor Control Probability (TCP) for the PTV, and the Normal Tissue Control Probability (N TCP) and the generalized EUD (gEUD) for the OARs. Significance testing of the observed differences performed using the Wilcoxon paired sample test. Results: Differences between TG43 and MC DVH indices, associated with the increased corresponding local % dose differences observed, were statistically significant. This is mainly attributed to their consistency however, since TG43 agrees closely with MC for the majority of DVH and radiobiological parameters in both patient cohorts. Differences varied considerably among patients only for the ipsilateral lung and ribs in the APBI cohort, with a strong correlation to target location. Conclusion: While the consistency and magnitude of differences in the majority of clinically relevant DVH indices imply that no change is needed in the treatment planning practice, individualized dosimetry improves accuracy and addresses instances of inter-patient variability observed. Research

  5. Improved 192,194,195,196Pt(n,γ) and 192Ir(n,γ) astrophysical reaction rates

    NASA Astrophysics Data System (ADS)

    Koehler, P. E.; Guber, K. H.

    2013-09-01

    192Pt is produced solely by the slow neutron capture (s) nucleosynthesis process and hence an accurate (n,γ) reaction rate for this nuclide would allow its use as an important calibration point near the termination of the s-process nucleosynthesis flow. For this reason, we have measured neutron capture and total cross sections for 192,194,195,196,natPt in the energy range from 10 eV to several hundred keV at the Oak Ridge Electron Linear Accelerator. Measurements on the other Pt isotopes were, in part, necessitated by the fact that only a relatively small 192Pt sample of modest enrichment was available. Astrophysical 192,194,195,196Pt(n,γ) reaction rates, accurate to approximately 3%-5%, were calculated from these data. No accurate reaction rates have been published previously for any of these isotopes. At s-process temperatures, previously recommended rates are larger (by as much as 35%) and have significantly different shapes as functions of temperature than our new rates. We used our new Pt results, together with 191,193Ir(n,γ) data, to calibrate nuclear statistical model calculations and hence obtain an improved rate for the unmeasured s-process branching-point isotope 192Ir.

  6. Comparison BIPM.RI(I)-K8 of high dose-rate Ir-192 brachytherapy standards for reference air kerma rate of the PTB and the BIPM

    NASA Astrophysics Data System (ADS)

    Kessler, C.; Allisy-Roberts, P. J.; Selbach, H. J.

    2015-01-01

    An indirect comparison of the standards for reference air kerma rate (RAKR) for 192Ir high dose rate (HDR) brachytherapy sources of the Physikalisch-Technische Bundesanstalt (PTB), Germany, and of the Bureau International des Poids et Mesures (BIPM) was carried out at the PTB in September 2011. The comparison result, based on the calibration coefficients for a transfer standard and expressed as a ratio of the PTB and the BIPM standards for reference air kerma rate, is 1.0003 with a combined standard uncertainty of 0.0099. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

  7. Comparison BIPM.RI(I)-K8 of high dose-rate Ir-192 brachytherapy standards for reference air kerma rate of the NRC and the BIPM

    NASA Astrophysics Data System (ADS)

    Kessler, C.; Downton, B.; Mainegra-Hing, E.

    2015-01-01

    An indirect comparison of the standards for reference air kerma rate for 192Ir high dose rate (HDR) brachytherapy sources of the National Research Council (NRC), Canada, and of the Bureau International des Poids et Mesures (BIPM) was carried out at the NRC in August 2014. The comparison result, based on the calibration coefficients for a transfer standard and expressed as a ratio of the NRC and the BIPM standards for reference air kerma rate, is 0.9966 with a combined standard uncertainty of 0.0050. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

  8. Comparison BIPM.RI(I)-K8 of high dose-rate Ir-192 brachytherapy standards for reference air kerma rate of the NMIJ and the BIPM

    NASA Astrophysics Data System (ADS)

    Kessler, C.; Kurosawa, T.; Mikamoto, T.

    2016-01-01

    An indirect comparison of the standards for reference air kerma rate for 192Ir high dose rate (HDR) brachytherapy sources of the National Metrology Institute of Japan (AIST-NMIJ), Japan, and of the Bureau International des Poids et Mesures (BIPM) was carried out at the Japan Radioisotope Association (JRIA) in April 2015. The comparison result, based on the calibration coefficients for a transfer standard and expressed as a ratio of the NMIJ and the BIPM standards for reference air kerma rate, is 1.0036 with a combined standard uncertainty of 0.0054. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

  9. Determination of the Sensibility Factors for TLD-100 Powder on the Energy of X-Ray of 50, 250 kVp; 192Ir, 137Cs and 60Co

    SciTech Connect

    Loaiza, Sandra P.; Alvarez, Jose T.

    2006-09-08

    TLD-100 powder is calibrated in terms of absorbed dose to water Dw, using the protocols AAPM TG61, AAPM TG43 and IAEA-TRS 398, for the energy of RX 50, 250 kVp, 137Cs and 60Co respectively. The calibration curves, TLD Response R versus Dw, are fitted by weighted least square by a quadratic polynomials; which are validated with the lack of fit and the Anderson-Darling normality test. The slope of these curves corresponds to the sensibility factor: Fs R/DW, [Fs] = nC Gy-1. The expanded uncertainties U's for these factors are obtained from the ANOVA tables. Later, the Fs' values are interpolated using the effective energy hvefec for the 192Ir. The SSDL sent a set of capsules with powder TLD-100 for two Hospitals. These irradiated them a nominal dose of Dw = 2 Gy. The results determined at SSDL are: for the Hospital A the Dw is overestimated in order to 4.8% and the Hospital B underestimates it in the range from -1.4% to -17.5%.

  10. Sci—Fri AM: Mountain — 03: Current status of the NRC primary standard for {sup 192}Ir HDR brachytherapy sources

    SciTech Connect

    Mainegra-Hing, E; Downton, Brad

    2014-08-15

    The Canadian primary standard for {sup 192}Ir HDR brachytherapy sources has been recently revised in a more accurate manner allowing for more realistic uncertainty estimation. Air-kerma strength S{sub k} is derived from measurements of the source's output using a graphite-walled spherical ionization chamber (2S) at several distances. Traceability to NRC primary standards for the {sup 192}Ir calibration coefficient N{sub k} is insured by estimating it as the inverse arithmetic mean of the inverse of the calibration coefficients for a {sup 137}Cs beam and the medium energy x-ray beam quality N250, both of which are traceable to NRC primary standards. The multiple-distance method is combined with a non-linear least squares fit to determine St, while at the same time removing the effects of room scatter and position offset. The previously used shadow-cone method for directly measuring the room scatter is found to be inadequate due to the increased scatter contribution from the lead cone itself, especially at short source-detector distances. Rather than including the reported 1% difference in source strength for {sup 192}Ir HDR sources of different construction into the total uncertainty, users are cautioned that the calibration coefficient provided by NRC is only valid for a microSelectron V2 model. A comprehensive uncertainty budged shows that the total one sigma uncertainty of the standard is actually 0.6% rather than the previously assumed 1.2%. NRC measured S{sub k} agrees within 0.03% of the manufacturer's value.

  11. The collapsed cone algorithm for 192Ir dosimetry using phantom-size adaptive multiple-scatter point kernels

    NASA Astrophysics Data System (ADS)

    Carlsson Tedgren, Åsa; Plamondon, Mathieu; Beaulieu, Luc

    2015-07-01

    The aim of this work was to investigate how dose distributions calculated with the collapsed cone (CC) algorithm depend on the size of the water phantom used in deriving the point kernel for multiple scatter. A research version of the CC algorithm equipped with a set of selectable point kernels for multiple-scatter dose that had initially been derived in water phantoms of various dimensions was used. The new point kernels were generated using EGSnrc in spherical water phantoms of radii 5 cm, 7.5 cm, 10 cm, 15 cm, 20 cm, 30 cm and 50 cm. Dose distributions derived with CC in water phantoms of different dimensions and in a CT-based clinical breast geometry were compared to Monte Carlo (MC) simulations using the Geant4-based brachytherapy specific MC code Algebra. Agreement with MC within 1% was obtained when the dimensions of the phantom used to derive the multiple-scatter kernel were similar to those of the calculation phantom. Doses are overestimated at phantom edges when kernels are derived in larger phantoms and underestimated when derived in smaller phantoms (by around 2% to 7% depending on distance from source and phantom dimensions). CC agrees well with MC in the high dose region of a breast implant and is superior to TG43 in determining skin doses for all multiple-scatter point kernel sizes. Increased agreement between CC and MC is achieved when the point kernel is comparable to breast dimensions. The investigated approximation in multiple scatter dose depends on the choice of point kernel in relation to phantom size and yields a significant fraction of the total dose only at distances of several centimeters from a source/implant which correspond to volumes of low doses. The current implementation of the CC algorithm utilizes a point kernel derived in a comparatively large (radius 20 cm) water phantom. A fixed point kernel leads to predictable behaviour of the algorithm with the worst case being a source/implant located well within a patient

  12. The collapsed cone algorithm for (192)Ir dosimetry using phantom-size adaptive multiple-scatter point kernels.

    PubMed

    Tedgren, Åsa Carlsson; Plamondon, Mathieu; Beaulieu, Luc

    2015-07-01

    The aim of this work was to investigate how dose distributions calculated with the collapsed cone (CC) algorithm depend on the size of the water phantom used in deriving the point kernel for multiple scatter. A research version of the CC algorithm equipped with a set of selectable point kernels for multiple-scatter dose that had initially been derived in water phantoms of various dimensions was used. The new point kernels were generated using EGSnrc in spherical water phantoms of radii 5 cm, 7.5 cm, 10 cm, 15 cm, 20 cm, 30 cm and 50 cm. Dose distributions derived with CC in water phantoms of different dimensions and in a CT-based clinical breast geometry were compared to Monte Carlo (MC) simulations using the Geant4-based brachytherapy specific MC code Algebra. Agreement with MC within 1% was obtained when the dimensions of the phantom used to derive the multiple-scatter kernel were similar to those of the calculation phantom. Doses are overestimated at phantom edges when kernels are derived in larger phantoms and underestimated when derived in smaller phantoms (by around 2% to 7% depending on distance from source and phantom dimensions). CC agrees well with MC in the high dose region of a breast implant and is superior to TG43 in determining skin doses for all multiple-scatter point kernel sizes. Increased agreement between CC and MC is achieved when the point kernel is comparable to breast dimensions. The investigated approximation in multiple scatter dose depends on the choice of point kernel in relation to phantom size and yields a significant fraction of the total dose only at distances of several centimeters from a source/implant which correspond to volumes of low doses. The current implementation of the CC algorithm utilizes a point kernel derived in a comparatively large (radius 20 cm) water phantom. A fixed point kernel leads to predictable behaviour of the algorithm with the worst case being a source/implant located well within a patient

  13. Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma

    SciTech Connect

    Candela-Juan, Cristian; Perez-Calatayud, Jose; Ballester, Facundo; Rivard, Mark J.

    2013-03-15

    Purpose: The aim of this study was to obtain equivalent doses in radiosensitive organs (aside from the bladder and rectum) when applying high-dose-rate (HDR) brachytherapy to a localized prostate carcinoma using {sup 60}Co or {sup 192}Ir sources. These data are compared with results in a water phantom and with expected values in an infinite water medium. A comparison with reported values from proton therapy and intensity-modulated radiation therapy (IMRT) is also provided. Methods: Monte Carlo simulations in Geant4 were performed using a voxelized phantom described in International Commission on Radiological Protection (ICRP) Publication 110, which reproduces masses and shapes from an adult reference man defined in ICRP Publication 89. Point sources of {sup 60}Co or {sup 192}Ir with photon energy spectra corresponding to those exiting their capsules were placed in the center of the prostate, and equivalent doses per clinical absorbed dose in this target organ were obtained in several radiosensitive organs. Values were corrected to account for clinical circumstances with the source located at various positions with differing dwell times throughout the prostate. This was repeated for a homogeneous water phantom. Results: For the nearest organs considered (bladder, rectum, testes, small intestine, and colon), equivalent doses given by {sup 60}Co source were smaller (8%-19%) than from {sup 192}Ir. However, as the distance increases, the more penetrating gamma rays produced by {sup 60}Co deliver higher organ equivalent doses. The overall result is that effective dose per clinical absorbed dose from a {sup 60}Co source (11.1 mSv/Gy) is lower than from a {sup 192}Ir source (13.2 mSv/Gy). On the other hand, equivalent doses were the same in the tissue and the homogeneous water phantom for those soft tissues closer to the prostate than about 30 cm. As the distance increased, the differences of photoelectric effect in water and soft tissue, and appearance of other materials

  14. HDRMC, an accelerated Monte Carlo dose calculator for high dose rate brachytherapy with CT-compatible applicators

    SciTech Connect

    Chibani, Omar C-M Ma, Charlie

    2014-05-15

    Purpose: To present a new accelerated Monte Carlo code for CT-based dose calculations in high dose rate (HDR) brachytherapy. The new code (HDRMC) accounts for both tissue and nontissue heterogeneities (applicator and contrast medium). Methods: HDRMC uses a fast ray-tracing technique and detailed physics algorithms to transport photons through a 3D mesh of voxels representing the patient anatomy with applicator and contrast medium included. A precalculated phase space file for the{sup 192}Ir source is used as source term. HDRM is calibrated to calculated absolute dose for real plans. A postprocessing technique is used to include the exact density and composition of nontissue heterogeneities in the 3D phantom. Dwell positions and angular orientations of the source are reconstructed using data from the treatment planning system (TPS). Structure contours are also imported from the TPS to recalculate dose-volume histograms. Results: HDRMC was first benchmarked against the MCNP5 code for a single source in homogenous water and for a loaded gynecologic applicator in water. The accuracy of the voxel-based applicator model used in HDRMC was also verified by comparing 3D dose distributions and dose-volume parameters obtained using 1-mm{sup 3} versus 2-mm{sup 3} phantom resolutions. HDRMC can calculate the 3D dose distribution for a typical HDR cervix case with 2-mm resolution in 5 min on a single CPU. Examples of heterogeneity effects for two clinical cases (cervix and esophagus) were demonstrated using HDRMC. The neglect of tissue heterogeneity for the esophageal case leads to the overestimate of CTV D90, CTV D100, and spinal cord maximum dose by 3.2%, 3.9%, and 3.6%, respectively. Conclusions: A fast Monte Carlo code for CT-based dose calculations which does not require a prebuilt applicator model is developed for those HDR brachytherapy treatments that use CT-compatible applicators. Tissue and nontissue heterogeneities should be taken into account in modern HDR

  15. Dose perturbation due to the polysulfone cap surrounding a Fletcher-Williamson colpostat.

    PubMed

    Price, Michael J; Kry, Stephen F; Eifel, Patricia J; Salehpour, Mohammad; Mourtada, Firas

    2010-01-01

    We conducted a metrological evaluation of the dosimetric impact due to the polysulfone cap used with the Fletcher-Williamson (FW) colpostat for 192Ir high-dose rate and pulsed-dose rate intracavitary brachytherapy using Monte Carlo simulations. Polysulfone caps with diameter of 30 mm, 25 mm, 20 mm, and 16 mm (mini-ovoid) were simulated and the absorbed dose rate in the surrounding water was calculated and compared to the dose rate for a bare 192Ir source in water. The dose perturbation depended on the cap diameter, distance away from the cap surface, and angular position around the cap. The largest dose rate reductions were found to be in the direction of the tumor bed where the cap is thickest. The range of perturbation over all depths and cap diameters was +2.8% (dose enhancement) to -6.8% (dose reduction). The FW colpostat cap's material composition should be modified to reduce this dosimetric effect or brachytherapy treatment planning dose algorithms should be improved to account for this perturbation. PMID:20160700

  16. High-dose-rate (HDR) brachytherapy for the treatment of benign obstructive endobronchial granulation tissue

    SciTech Connect

    Madu, Chika N. . E-mail: chikam@xrt.upenn.edu; Machuzak, Michael S.; Sterman, Daniel H.; Musani, Ali; Ahya, Vivek; McDonough, James; Metz, James M.

    2006-12-01

    Background: Severe airway obstruction can occur in the setting of benign granulation tissue forming at bronchial anastomotic sites after lung transplantation in up to 20% of patients. Many of these benign lesions respond to stent placement, laser ablation, or balloon bronchoplasty. However, in certain cases, proliferation of granulation tissue may persist despite all therapeutic attempts. This study describes a series of refractory patients treated with high-dose-rate (HDR) brachytherapy for benign proliferation of granulation tissue, causing airway compromise. Methods and Materials: Between April 2002 and June 2005, 5 patients with significant airway compromise from recurrent granulation tissue were treated with HDR brachytherapy. All patients had previously failed to maintain a patent airway despite multiple bronchoscopic interventions. Treatment was delivered using an HDR brachytherapy afterloader with {sup 192}Ir. Dose prescription was to a depth of 1 cm. All patients were treated weekly, with total doses ranging from 10 Gy to 21 Gy in two to three fractions. Results: The median follow-up was 12 months. All patients experienced a reduction in therapeutic bronchoscopic procedures after HDR brachytherapy compared with the pretreatment period. With the exception of possible radiation-induced bronchitis in 1 patient, there were no other treatment related complications. At the time of this report, 2 patients have died and the other 3 are alive with marked symptomatic improvement and reduced bronchoscopic procedures. Conclusion: High-dose-rate brachytherapy is an effective treatment for benign proliferation of granulation tissue causing airway obstruction. The early response to therapy is encouraging and further follow-up is necessary to determine long-term durability and late effects.

  17. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: Treatment description and preliminary results of a phase I/II clinical trial

    SciTech Connect

    Stromberg, J.; Martinez, A.; Edmundson, G.

    1995-08-30

    To improve results for locally advanced prostate cancer, a prospective clinical trial of concurrent external beam irradiation and fractionated iridium-192 (IR-192) high dose rate (HDR) conformal boost brachytherapy was initiated. This technique of concurrent external pelvic irradiation and conformal HDR brachytherapy was well tolerated. No significant intraoperative or perioperative complications occurred. Three patients (9%) experienced Grade 3 acute toxicity (two dysuria and one diarrhea). All toxicities were otherwise Grades 1 or 2 and were primarily as expected from pelvic external irradiation. Persistent implant-related toxicities included Grades 1-2 perineal pain (12%) and hematospermia (15%). Median follow-up time was 13 months. Serum prostatic-specific antigen (PSA) levels normalized in 91% of patients (29 out of 32) within 1-14 months (median 2.8 months) after irradiation. PSA levels were progressively decreasing in the other three patients at last measurement. Prospectively planned prostatic rebiopsies done at 18 months in the first 10 patients were negative in 9 out of 10 (90%). Acute toxicity has been acceptable with this unique approach using conformal high dose rate IR-192 boost brachytherapy with concurrent external irradiation. The initial tumor response as assessed by serial PSA measurement and rebiopsy is extremely encouraging. Dose escalation will proceed in accordance with the protocol guidelines. Further patient accrual and longer follow-up will allow comparison to other techniques. 58 refs., 5 figs., 4 tabs.

  18. Dosimetric characteristics of the Leipzig surface applicators used in the high dose rate brachy radiotherapy

    SciTech Connect

    Niu Hongquan; Hsi, Wen C.; Chu, James C.H.; Kirk, Michael C.; Kouwenhoven, Erik

    2004-12-01

    The nucletron Leipzig applicator is designed for (HDR) {sup 192}Ir brachy radiotherapy of surface lesions. The dosimetric characteristics of this applicator were investigated using simulation method based on Monte Carlo N-particle (MCNP) code and phantom measurements. The simulation method was validated by comparing calculated dose rate distributions of nucletron microSelectron HDR {sup 192}Ir source against published data. Radiochromic films and metal-oxide-semiconductor field-effect transistor (MOSFET) detectors were used for phantom measurements. The double exposure technique, correcting the nonuniform film sensitivity, was applied in the film dosimetry. The linear fit of multiple readings with different irradiation times performed for each MOSFET detector measurement was used to obtain the dose rate of each measurement and to correct the source transit-time error. The film and MOSFET measurements have uncertainties of 3%-7% and 3%-5%, respectively. The dose rate distributions of the Leipzig applicator with 30 mm opening calculated by the validated MC method were verified by measurements of film and MOSFET detectors. Calculated two-dimensional planar dose rate distributions show similar patterns as the film measurement. MC calculated dose rate at a reference point defined at depth 5 mm on the applicator's central axis is 7% lower than the film and 3% higher than the MOSFET measurements. The dose rate of a Leipzig applicator with 30 mm opening at reference point is 0.241{+-}3% cGy h{sup -1} U{sup -1}. The MC calculated depth dose rates and profiles were tabulated for clinic use.

  19. The feasibility study and characterization of a two-dimensional diode array in “magic phantom” for high dose rate brachytherapy quality assurance

    SciTech Connect

    Espinoza, A.; Beeksma, B.; Petasecca, M.; Fuduli, I.; Porumb, C.; Cutajar, D.; Lerch, M. L. F.; Rosenfeld, A. B.; Corde, S.; Jackson, M.

    2013-11-15

    Purpose: High dose rate (HDR) brachytherapy is a radiation treatment technique capable of delivering large dose rates to the tumor. Radiation is delivered using remote afterloaders to drive highly active sources (commonly {sup 192}Ir with an air KERMA strength range between 20 000 and 40 000 U, where 1 U = 1 μGy m{sup 2}/h in air) through applicators directly into the patient's prescribed region of treatment. Due to the obvious ramifications of incorrect treatment while using such an active source, it is essential that there are methods for quality assurance (QA) that can directly and accurately verify the treatment plan and the functionality of the remote afterloader. This paper describes the feasibility study of a QA system for HDR brachytherapy using a phantom based two-dimensional 11 × 11 epitaxial diode array, named “magic phantom.”Methods: The HDR brachytherapy treatment plan is translated to the phantom with two rows of 10 (20 in total) HDR source flexible catheters, arranged above and below the diode array “magic plate” (MP). Four-dimensional source tracking in each catheter is based upon a developed fast iterative algorithm, utilizing the response of the diodes in close proximity to the {sup 192}Ir source, sampled at 100 ms intervals by a fast data acquisition (DAQ) system. Using a {sup 192}Ir source in a solid water phantom, the angular response of the developed epitaxial diodes utilized in the MP and also the variation of the MP response as a function of the source-to-detector distance (SDD) were investigated. These response data are then used by an iterative algorithm for source dwelling position determination. A measurement of the average transit speed between dwell positions was performed using the diodes and a fast DAQ.Results: The angular response of the epitaxial diode showed a variation of 15% within 360°, with two flat regions above and below the detector face with less than 5% variation. For SDD distances of between 5 and 30 mm the

  20. The mean photon energy ĒF at the point of measurement determines the detector-specific radiation quality correction factor kQ,M in (192)Ir brachytherapy dosimetry.

    PubMed

    Chofor, Ndimofor; Harder, Dietrich; Selbach, Hans-Joachim; Poppe, Björn

    2016-09-01

    The application of various radiation detectors for brachytherapy dosimetry has motivated this study of the energy dependence of radiation quality correction factor kQ,M, the quotient of the detector responses under calibration conditions at a (60)Co unit and under the given non-reference conditions at the point of measurement, M, occurring in photon brachytherapy. The investigated detectors comprise TLD, radiochromic film, ESR, Si diode, plastic scintillator and diamond crystal detectors as well as ionization chambers of various sizes, whose measured response-energy relationships, taken from the literature, served as input data. Brachytherapy photon fields were Monte-Carlo simulated for an ideal isotropic (192)Ir point source, a model spherical (192)Ir source with steel encapsulation and a commercial HDR GammaMed Plus source. The radial source distance was varied within cylindrical water phantoms with outer radii ranging from 10 to 30cm and heights from 20 to 60cm. By application of this semiempirical method - originally developed for teletherapy dosimetry - it has been shown that factor kQ,M is closely correlated with a single variable, the fluence-weighted mean photon energy ĒF at the point of measurement. The radial profiles of ĒF obtained with either the commercial (192)Ir source or the two simplified source variants show little variation. The observed correlations between parameters kQ,M and ĒF are represented by fitting formulae for all investigated detectors, and further variation of the detector type is foreseen. The herewith established close correlation of radiation quality correction factor kQ,M with local mean photon energy ĒF can be regarded as a simple regularity, facilitating the practical application of correction factor kQ,M for in-phantom dosimetry around (192)Ir brachytherapy sources. ĒF values can be assessed by Monte Carlo simulation or measurement. A technique describing the local measurement of ĒF will be published separately. PMID

  1. Limitations of current dosimetry for intracavitary accelerated partial breast irradiation with high dose rate iridium-192 and electronic brachytherapy sources

    NASA Astrophysics Data System (ADS)

    Raffi, Julie A.

    Intracavitary accelerated partial breast irradiation (APBI) is a method of treating early stage breast cancer using a high dose rate (HDR) brachytherapy source positioned within the lumpectomy cavity. An expandable applicator stretches the surrounding tissue into a roughly spherical or elliptical shape and the dose is prescribed to 1 cm beyond the edge of the cavity. Currently, dosimetry for these treatments is most often performed using the American Association of Physicists in Medicine Task Group No. 43 (TG-43) formalism. The TG-43 dose-rate equation determines the dose delivered to a homogeneous water medium by scaling the measured source strength with standardized parameters that describe the radial and angular features of the dose distribution. Since TG-43 parameters for each source model are measured or calculated in a homogeneous water medium, the dosimetric effects of the patient's dimensions and composition are not accounted for. Therefore, the accuracy of TG-43 calculations for intracavitary APBI is limited by the presence of inhomogeneities in and around the target volume. Specifically, the breast is smaller than the phantoms used to determine TG-43 parameters and is surrounded by air, ribs, and lung tissue. Also, the composition of the breast tissue itself can affect the dose distribution. This dissertation is focused on investigating the limitations of TG-43 dosimetry for intracavitary APBI for two HDR brachytherapy sources: the VariSource TM VS2000 192Ir source and the AxxentRTM miniature x-ray source. The dose for various conditions was determined using thermoluminescent dosimeters (TLDs) and Monte Carlo (MC) calculations. Accurate measurements and calculations were achieved through the implementation of new measurement and simulation techniques and a novel breast phantom was developed to enable anthropomorphic phantom measurements. Measured and calculated doses for phantom and patient geometries were compared with TG-43 calculated doses to

  2. Direction-Modulated Brachytherapy for High-Dose-Rate Treatment of Cervical Cancer. I: Theoretical Design

    SciTech Connect

    Han, Dae Yup; Webster, Matthew J.; Scanderbeg, Daniel J.; Yashar, Catheryn; Choi, Dongju; Song, Bongyong; Devic, Slobodan; Ravi, Ananth; Song, William Y.

    2014-07-01

    Purpose: To demonstrate that utilization of the direction-modulated brachytherapy (DMBT) concept can significantly improve treatment plan quality in the setting of high-dose-rate (HDR) brachytherapy for cervical cancer. Methods and Materials: The new, MRI-compatible, tandem design has 6 peripheral holes of 1.3-mm diameter, grooved along a nonmagnetic tungsten-alloy rod (ρ = 18.0 g/cm{sup 3}), enclosed in Delrin tubing (polyoxymethylene, ρ = 1.41 g/cm{sup 3}), with a total thickness of 6.4 mm. The Monte Carlo N-Particle code was used to calculate the anisotropic {sup 192}Ir dose distributions. An in-house-developed inverse planning platform, geared with simulated annealing and constrained-gradient optimization algorithms, was used to replan 15 patient cases (total 75 plans) treated with a conventional tandem and ovoids (T and O) applicator. Prescription dose was 6 Gy. For replanning, we replaced the conventional tandem with that of the new DMBT tandem for optimization but left the ovoids in place and kept the dwell positions as originally planned. All DMBT plans were normalized to match the high-risk clinical target volume V100 coverage of the T and O plans. Results: In general there were marked improvements in plan quality for the DMBT plans. On average, D2cc for the bladder, rectum, and sigmoid were reduced by 0.59 ± 0.87 Gy (8.5% ± 28.7%), 0.48 ± 0.55 Gy (21.1% ± 27.2%), and 0.10 ± 0.38 Gy (40.6% ± 214.9%) among the 75 plans, with best single-plan reductions of 3.20 Gy (40.8%), 2.38 Gy (40.07%), and 1.26 Gy (27.5%), respectively. The high-risk clinical target volume D90 was similar, with 6.55 ± 0.96 Gy and 6.59 ± 1.06 Gy for T and O and DMBT, respectively. Conclusions: Application of the DMBT concept to cervical cancer allowed for improved organ at risk sparing while achieving similar target coverage on a sizeable patient population, as intended, by maximally utilizing the anatomic information contained in 3-dimensional

  3. Development of a phantom to validate high-dose-rate brachytherapy treatment planning systems with heterogeneous algorithms

    SciTech Connect

    Moura, Eduardo S.; Rostelato, Maria Elisa C. M.; Zeituni, Carlos A.

    2015-04-15

    Purpose: This work presents the development of a phantom to verify the treatment planning system (TPS) algorithms used for high-dose-rate (HDR) brachytherapy. It is designed to measure the relative dose in a heterogeneous media. The experimental details used, simulation methods, and comparisons with a commercial TPS are also provided. Methods: To simulate heterogeneous conditions, four materials were used: Virtual Water™ (VM), BR50/50™, cork, and aluminum. The materials were arranged in 11 heterogeneity configurations. Three dosimeters were used to measure the relative response from a HDR {sup 192}Ir source: TLD-100™, Gafchromic{sup ®} EBT3 film, and an Exradin™ A1SL ionization chamber. To compare the results from the experimental measurements, the various configurations were modeled in the PENELOPE/penEasy Monte Carlo code. Images of each setup geometry were acquired from a CT scanner and imported into BrachyVision™ TPS software, which includes a grid-based Boltzmann solver Acuros™. The results of the measurements performed in the heterogeneous setups were normalized to the dose values measured in the homogeneous Virtual Water™ setup and the respective differences due to the heterogeneities were considered. Additionally, dose values calculated based on the American Association of Physicists in Medicine-Task Group 43 formalism were compared to dose values calculated with the Acuros™ algorithm in the phantom. Calculated doses were compared at the same points, where measurements have been performed. Results: Differences in the relative response as high as 11.5% were found from the homogeneous setup when the heterogeneous materials were inserted into the experimental phantom. The aluminum and cork materials produced larger differences than the plastic materials, with the BR50/50™ material producing results similar to the Virtual Water™ results. Our experimental methods agree with the PENELOPE/penEasy simulations for most setups and dosimeters. The

  4. The Influence of Prostate Volume on Outcome After High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer

    SciTech Connect

    Le, Hien Rojas, Ana; Alonzi, Roberto; Hughes, Robert; Ostler, Peter; Lowe, Gerry; Bryant, Linda; Hoskin, Peter

    2013-10-01

    Objective: To determine whether late genitourinary toxicity, biochemical control of prostate cancer, and dosimetric parameters in patients with large prostate glands is different from those variables in men with smaller glands after treatment with high-dose-rate brachytherapy alone (HDR-BT). Methods: From November 2003 to July 2009, 164 patients with locally advanced prostate carcinoma were sequentially enrolled and treated with 34 or 36 Gy in 4 fractions and 31.5 Gy in 3 fractions of {sup 192}Ir HDR-BT alone. The median follow-up time was 71 months. Gland size was not considered in the selection criteria for this study. Estimates of freedom from biochemical relapse (FFbR) and late morbidity, stratified by median clinical target volume (CTV), were obtained, and differences were compared. Results: The median CTV volume was 60 cc (range, 15-208 cc). Dose–volume parameters D90 and V100 (ie, minimum dose to 90% of the prostate volume and volume receiving 100% of the prescribed isodose) achieved in patients with glands ≥60 cc were not significantly different from those with glands <60 cc (P≥.2). Nonetheless, biochemical control in patients with larger CTV was significantly higher (91% vs 78% at 6 years; P=.004). In univariate and multivariate analysis, CTV was a significant predictor for risk of biochemical relapse. This was not at the expense of an increase in either moderate (P=.6) or severe (P=.3) late genitourinary toxicity. The use of hormonal therapy was 17% lower in the large gland group (P=.01). Conclusions: Prostate gland size does not affect dosimetric parameters in HDR-BT assessed by D90 and V100. In patients with larger glands, a significantly higher biochemical control of disease was observed, with no difference in late toxicity. This improvement cannot be attributed to differences in dosimetry. Gland size should not be considered in the selection of patients for HDR-BT.

  5. Computed organ doses to an Indian reference adult during brachytherapy treatment of esophagus, breast, and neck cancers

    PubMed Central

    Keshavkumar, Biju

    2012-01-01

    This study aims to generate the normalized mean organ dose factors (mGy min-1 GBq-1) to healthy organs during brachytherapy treatment of esophagus, breast, and neck cancers specific to the patient population in India. This study is in continuation to the earlier published studies on the estimation of organ doses during uterus brachytherapy treatments. The results are obtained by Monte Carlo simulation of radiation transport through MIRD type anthropomorphic mathematical phantom representing reference Indian adult with 192Ir and 60Co high dose rate sources in the esophagus, breast, and neck of the phantom. The result of this study is compared with a published computational study using voxel-based phantom model. The variation in the organ dose of this study to the published values is within 50%. PMID:22973082

  6. Stem effect of a Ce3+ doped SiO2 optical dosimeter irradiated with a 192Ir HDR brachytherapy source

    NASA Astrophysics Data System (ADS)

    Carrara, Mauro; Tenconi, Chiara; Guilizzoni, Roberta; Borroni, Marta; Cavatorta, Claudia; Cerrotta, Annamaria; Fallai, Carlo; Gambarini, Grazia; Vedda, Anna; Pignoli, Emanuele

    2014-11-01

    Fiber-optic-coupled scintillation dosimeters are characterized by their small active volume if compared to other existing systems. However, they potentially show a greater stem effect, especially in external beam radiotherapy where the Cerenkov effect is not negligible. In brachytherapy, due to the lower energies and the shorter high dose range of the employed sources, the impact of the stem effect to the detector accuracy might be low. In this work, the stem effect of a Ce3+ doped SiO2 scintillation detector coupled to a SiO2 optical fiber was studied for high dose rate brachytherapy applications. Measurements were performed in a water phantom at changing source-detector mutual positions. The same irradiations were performed with a passive optical fiber, which doesn't have the dosimeter at its end. The relative contribution of the passive fiber with respect to the uncorrected readings of the detector in each one of the investigated source dwell positions was evaluated. Furthermore, the dosimeter was calibrated both neglecting and correcting its response for the passive fiber readings. The obtained absolute dose measurements were then compared to the dose calculations resulting from the treatment planning system. Dosimeter uncertainties with and without taking into account the passive fiber readings were generally below 2.8% and 4.3%, respectively. However, a particular exception results when the source is positioned near to the optical fiber, where the detector underestimates the dose (-8%) or at source-detector longitudinal distances higher than 3 cm. The obtained results show that the proposed dosimeter might be adopted in high dose rate prostate brachytherapy with satisfactory accuracy, without the need for any stem effect correction. However, accuracy further improves by subtraction of the noise signal produced by the passive optical fiber.

  7. Dosimetric Considerations to Determine the Optimal Technique for Localized Prostate Cancer Among External Photon, Proton, or Carbon-Ion Therapy and High-Dose-Rate or Low-Dose-Rate Brachytherapy

    SciTech Connect

    Georg, Dietmar

    2014-03-01

    Purpose: To assess the dosimetric differences among volumetric modulated arc therapy (VMAT), scanned proton therapy (intensity-modulated proton therapy, IMPT), scanned carbon-ion therapy (intensity-modulated carbon-ion therapy, IMIT), and low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy (BT) treatment of localized prostate cancer. Methods and Materials: Ten patients were considered for this planning study. For external beam radiation therapy (EBRT), planning target volume was created by adding a margin of 5 mm (lateral/anterior–posterior) and 8 mm (superior–inferior) to the clinical target volume. Bladder wall (BW), rectal wall (RW), femoral heads, urethra, and pelvic tissue were considered as organs at risk. For VMAT and IMPT, 78 Gy(relative biological effectiveness, RBE)/2 Gy were prescribed. The IMIT was based on 66 Gy(RBE)/20 fractions. The clinical target volume planning aims for HDR-BT ({sup 192}Ir) and LDR-BT ({sup 125}I) were D{sub 90%} ≥34 Gy in 8.5 Gy per fraction and D{sub 90%} ≥145 Gy. Both physical and RBE-weighted dose distributions for protons and carbon-ions were converted to dose distributions based on 2-Gy(IsoE) fractions. From these dose distributions various dose and dose–volume parameters were extracted. Results: Rectal wall exposure 30-70 Gy(IsoE) was reduced for IMIT, LDR-BT, and HDR-BT when compared with VMAT and IMPT. The high-dose region of the BW dose–volume histogram above 50 Gy(IsoE) of IMPT resembled the VMAT shape, whereas all other techniques showed a significantly lower high-dose region. For all 3 EBRT techniques similar urethra D{sub mean} around 74 Gy(IsoE) were obtained. The LDR-BT results were approximately 30 Gy(IsoE) higher, HDR-BT 10 Gy(IsoE) lower. Normal tissue and femoral head sparing was best with BT. Conclusion: Despite the different EBRT prescription and fractionation schemes, the high-dose regions of BW and RW expressed in Gy(IsoE) were on the same order of magnitude. Brachytherapy techniques

  8. SU-E-T-223: Investigation of the Accuracy of Two-Dimensional Dose Distributions Measurement From High-Dose-Rate Brachytherapy Ir-192 Source Using Multiple-Diode-Array Detector (MapCheck2)

    SciTech Connect

    Taguenang, J; De La Fuente, T Herman; Ahmad, S; Ali, I

    2014-06-01

    Purpose: To investigate the dosimetric accuracy of multiple-diode-array detector (Mapcheck2) for high-dose-rate brachytherapy Ir-192 source. The two-dimensional (2D) dose distributions measured with MapCheck2 were validated with EBT2 Gafchromic film measurement and AAPM task-group- 43 (TG-43) modeling. Methods: 2D-dose distributions from Ir-192 source were measured with MapCheck2 and EBT2-films. MapCheck2 response was corrected for effects: directional dependence, diode and phantom heterogeneity. Optical density growth of the film was controlled by synchronized scanning of the film exposed to Ir-192 and calibration films exposed to 6 MV linac beams. Similarly, MapCheck2 response was calibrated to dose using 6 MV beams. An empirical model was developed for the dose distributions measured with Mapcheck2 that considered directional, diode and phantom heterogeneity corrections. The dose deposited in solid-state-detectors was modeled using a cavity theory model for the diode. This model was then validated with measurements using EBT2-films and calculations with TG-43. Results: The response of MapCheck2 has been corrected for different effects including: (a) directional dependence of 0–20% over angular range 0o–90o, (b) phantom heterogeneity (3%) and (c) diode heterogeneity (9%). The corrected dose distributions measured with MapCheck2 agreed well with the measured dose distributions from EBT2-film and with calculations using TG-43 within 5% over a wide range of dose levels and rates. The advantages of MapCheck2 include less noisy, linear and stable response compared with film. The response of MapCheck2 exposed to 192Ir-source showed no energy dependence similar to its response to MV energy beam. Detection spatial-resolution of individual diodes was 0.8×0.8 mm2, however, 2DMapCheck2 resolution is limited by distance between diodes (7.07 mm). Conclusion: The dose distribution measured with MapCheck2 agreed well within 5% with that measured using EBT2-films; and

  9. High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

    PubMed Central

    Ishiyama, Hiromichi; Satoh, Takefumi; Kitano, Masashi; Tabata, Ken-ichi; Komori, Shouko; Ikeda, Masaomi; Soda, Itaru; Kurosaka, Shinji; Sekiguchi, Akane; Kimura, Masaki; Kawakami, Shogo; Iwamura, Masatsugu; Hayakawa, Kazushige

    2014-01-01

    The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent 192Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ≥6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25–94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach. PMID:24222312

  10. A Prospective Cohort Study to Compare Treatment Results Between 2 Fractionation Schedules of High-Dose-Rate Intracavitary Brachytherapy (HDR-ICBT) in Patients With Cervical Cancer

    SciTech Connect

    Huang, Eng-Yen; Sun, Li-Min; Lin, Hao; Lan, Jen-Hong; Chanchien, Chan-Chao; Huang, Yu-Jie; Wang, Chang-Yu; Wang, Chong-Jong

    2013-01-01

    Purpose: To compare the treatment results of 2 fractionation schedules for high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Methods and Materials: From June 2001 through January 2008, 267 patients with stage IB-IVA cervical cancer were enrolled in the study. All patients underwent 4-field pelvic irradiation and HDR-ICBT. The median central and parametrial doses were 39.6 Gy and 45 Gy, respectively. Patient underwent either 6 Gy Multiplication-Sign 4 (HDR-4) (n=144) or 4.5 Gy Multiplication-Sign 6 (HDR-6) (n=123) to point A of ICBT using {sup 192}Ir isotope twice weekly. The rates of overall survival, locoregional failure, distant metastasis, proctitis, cystitis, and enterocolitis were compared between HDR-4 and HDR-6. Results: There were no significant differences in the demographic data between HDR-4 and HDR-6 except for total treatment time. The 5-year proctitis rates were 23.0% and 21.5% in HDR-4 and HDR-6 (P=.399), respectively. The corresponding rates of grade 2-4 proctitis were 18.7% and 9.6% (P=.060). The corresponding rates of grades 3-4 proctitis were 5.2% and 1.3% (P=.231). Subgroup analysis revealed that HDR-4 significantly increased grade 2-4 proctitis in patients aged {>=}62 years old (P=.012) but not in patients aged <62 years (P=.976). The rates of overall survival, locoregional failure, distant metastasis, cystitis, and enterocolitis were not significantly different between HDR-4 and HDR-6 schedules. Conclusion: The small fraction size of HDR-ICBT is associated with grade 2 proctitis without compromise of prognosis in elderly patients. This schedule is suggested for patients who tolerate an additional 2 applications of HDR-ICBT.

  11. Retrospective dosimetric comparison of low-dose-rate and pulsed-dose-rate intracavitary brachytherapy using a tandem and mini-ovoids.

    PubMed

    Mourtada, Firas; Gifford, Kent A; Berner, Paula A; Horton, John L; Price, Michael J; Lawyer, Ann A; Eifel, Patricia J

    2007-01-01

    The purpose of this study was to compare the dose distribution of Iridium-192 ((192)Ir) pulsed-dose-rate (PDR) brachytherapy to that of Cesium-137 ((137)Cs) low-dose-rate (LDR) brachytherapy around mini-ovoids and an intrauterine tandem. Ten patient treatment plans were selected from our clinical database, all of which used mini-ovoids and an intrauterine tandem. A commercial treatment planning system using AAPM TG43 formalism was used to calculate the dose in water for both the (137)Cs and (192)Ir sources. For equivalent system loadings, we compared the dose distributions in relevant clinical planes, points A and B, and to the ICRU bladder and rectal reference points. The mean PDR doses to points A and B were 3% +/- 1% and 6% +/- 1% higher than the LDR doses, respectively. For the rectum point, the PDR dose was 4% +/- 3% lower than the LDR dose, mainly because of the (192)Ir PDR source anisotropy. For the bladder point, the PDR dose was 1% +/- 4% higher than the LDR dose. We conclude that the PDR and LDR dose distributions are equivalent for intracavitary brachytherapy with a tandem and mini-ovoids. These findings will aid in the transfer from the current practice of LDR intracavitary brachytherapy to PDR for the treatment of gynecologic cancers. PMID:17707197

  12. Retrospective Dosimetric Comparison of Low-Dose-Rate and Pulsed-Dose-Rate Intracavitary Brachytherapy Using a Tandem and Mini-Ovoids

    SciTech Connect

    Mourtada, Firas Gifford, Kent A.; Berner, Paula A.; Horton, John L.; Price, Michael J.; Lawyer, Ann A.; Eifel, Patricia J.

    2007-10-01

    The purpose of this study was to compare the dose distribution of Iridium-192 ({sup 192}Ir) pulsed-dose-rate (PDR) brachytherapy to that of Cesium-137 ({sup 137}Cs) low-dose-rate (LDR) brachytherapy around mini-ovoids and an intrauterine tandem. Ten patient treatment plans were selected from our clinical database, all of which used mini-ovoids and an intrauterine tandem. A commercial treatment planning system using AAPM TG43 formalism was used to calculate the dose in water for both the {sup 137}Cs and {sup 192}Ir sources. For equivalent system loadings, we compared the dose distributions in relevant clinical planes, points A and B, and to the ICRU bladder and rectal reference points. The mean PDR doses to points A and B were 3% {+-} 1% and 6% {+-} 1% higher than the LDR doses, respectively. For the rectum point, the PDR dose was 4% {+-} 3% lower than the LDR dose, mainly because of the {sup 192}Ir PDR source anisotropy. For the bladder point, the PDR dose was 1% {+-} 4% higher than the LDR dose. We conclude that the PDR and LDR dose distributions are equivalent for intracavitary brachytherapy with a tandem and mini-ovoids. These findings will aid in the transfer from the current practice of LDR intracavitary brachytherapy to PDR for the treatment of gynecologic cancers.

  13. Comparison of dose calculation algorithms for colorectal cancer brachytherapy treatment with a shielded applicator

    SciTech Connect

    Yan Xiangsheng; Poon, Emily; Reniers, Brigitte; Vuong, Te; Verhaegen, Frank

    2008-11-15

    Colorectal cancer patients are treated at our hospital with {sup 192}Ir high dose rate (HDR) brachytherapy using an applicator that allows the introduction of a lead or tungsten shielding rod to reduce the dose to healthy tissue. The clinical dose planning calculations are, however, currently performed without taking the shielding into account. To study the dose distributions in shielded cases, three techniques were employed. The first technique was to adapt a shielding algorithm which is part of the Nucletron PLATO HDR treatment planning system. The isodose pattern exhibited unexpected features but was found to be a reasonable approximation. The second technique employed a ray tracing algorithm that assigns a constant dose ratio with/without shielding behind the shielding along a radial line originating from the source. The dose calculation results were similar to the results from the first technique but with improved accuracy. The third and most accurate technique used a dose-matrix-superposition algorithm, based on Monte Carlo calculations. The results from the latter technique showed quantitatively that the dose to healthy tissue is reduced significantly in the presence of shielding. However, it was also found that the dose to the tumor may be affected by the presence of shielding; for about a quarter of the patients treated the volume covered by the 100% isodose lines was reduced by more than 5%, leading to potential tumor cold spots. Use of any of the three shielding algorithms results in improved dose estimates to healthy tissue and the tumor.

  14. Application of optical methods for dose evaluation in normoxic polyacrylamide gels irradiated at two different geometries

    NASA Astrophysics Data System (ADS)

    Adliene, D.; Jakstas, K.; Vaiciunaite, N.

    2014-03-01

    Normoxic gels are frequently used in clinical praxis for dose assessment or 3-D dose imaging in radiotherapy due to their relative simple manufacturing process under normal atmospheric conditions, spatial stability and well expressed modification feature of physical properties which is related to radiation induced polymerization of gels. In this work we have investigated radiation induced modification of the optical properties of home prepared normoxic polyacrylamide gels (nPAG) in relation to polymerization processes that occur in irradiated gels. Two irradiation geometries were used for irradiation of gel samples: broad beam irradiation geometry of teletherapy unit ROKUS-M with a 60Co source and point source irradiation geometry using 192Ir source of high dose rate afterloading brachytherapy unit MicroSelectron v2 which was inserted into gel via 6 Fr (2 mm thick) catheter. Verification of optical methods: UV-VIS spectrometry, spectrophotometry, Raman spectroscopy for dose assessment in irradiated gels has been performed. Aspects of their application for dose evaluation in gels irradiated using different geometries are discussed. Simple pixel-dose based photometry method also has been proposed and evaluated as a potential method for dose evaluation in catheter based interstitial high dose rate brachytherapy.

  15. Dosimetric accuracy of a deterministic radiation transport based {sup 192}Ir brachytherapy treatment planning system. Part III. Comparison to Monte Carlo simulation in voxelized anatomical computational models

    SciTech Connect

    Zourari, K.; Pantelis, E.; Moutsatsos, A.; Sakelliou, L.; Georgiou, E.; Karaiskos, P.; Papagiannis, P.

    2013-01-15

    Purpose: To compare TG43-based and Acuros deterministic radiation transport-based calculations of the BrachyVision treatment planning system (TPS) with corresponding Monte Carlo (MC) simulation results in heterogeneous patient geometries, in order to validate Acuros and quantify the accuracy improvement it marks relative to TG43. Methods: Dosimetric comparisons in the form of isodose lines, percentage dose difference maps, and dose volume histogram results were performed for two voxelized mathematical models resembling an esophageal and a breast brachytherapy patient, as well as an actual breast brachytherapy patient model. The mathematical models were converted to digital imaging and communications in medicine (DICOM) image series for input to the TPS. The MCNP5 v.1.40 general-purpose simulation code input files for each model were prepared using information derived from the corresponding DICOM RT exports from the TPS. Results: Comparisons of MC and TG43 results in all models showed significant differences, as reported previously in the literature and expected from the inability of the TG43 based algorithm to account for heterogeneities and model specific scatter conditions. A close agreement was observed between MC and Acuros results in all models except for a limited number of points that lay in the penumbra of perfectly shaped structures in the esophageal model, or at distances very close to the catheters in all models. Conclusions: Acuros marks a significant dosimetry improvement relative to TG43. The assessment of the clinical significance of this accuracy improvement requires further work. Mathematical patient equivalent models and models prepared from actual patient CT series are useful complementary tools in the methodology outlined in this series of works for the benchmarking of any advanced dose calculation algorithm beyond TG43.

  16. Intracavitary dosimetry of a high-activity remote loading device with oscillating source.

    PubMed

    Arcovito, G; Piermattei, A; D'Abramo, G; Bassi, F A

    1984-12-01

    Dosimetric experiments have been carried out in order to obtain the dose distribution in water around a Fletcher applicator loaded by a Buchler system containing two 137Cs 148 GBq (4 Ci) sources and one 192Ir 740 GBq (20 Ci) source. The mechanical system which controls the movement of the 192Ir source and the resulting motion of the source are described. The dose distribution around the sources was measured photographically and by a PWT Normal 0.22 cm3 ionisation chamber. The absolute dose rate was measured along the lateral axes of the sources. The measurements of exposure in water near the sources were corrected for the effect due to the finite volume of the chamber. The "quantisation method" described by Cassell (1983) was utilised to calculate the variation of the dose rate along the lateral axes of the sources. The dose distribution around both 192Ir and 137Cs sources was found to be spherical for angles greater than 40 degrees from the longitudinal axes of the sources. A simple algorithm fitting the data for the moving 192Ir source is proposed. A program written in FORTRAN IV and run on a Univac 1100/80 computer has been used to plot dose distributions on anatomical data obtained from CT images. The uncertainties of the measurements and calculations have been examined and the greatest error has been found to be 5.5%. The clinical significance of the treatment method is discussed. PMID:6509290

  17. HDR Brachytherapy Dose Distribution is Influenced by the Metal Material of the Applicator

    PubMed Central

    Wu, Chin-Hui; Liao, Yi-Jen; Shiau, An-Cheng; Lin, Hsin-Yu; Hsueh Liu, Yen-Wan; Hsu, Shih-Ming

    2015-01-01

    Applicators containing metal have been widely used in recent years when applying brachytherapy to patients with cervical cancer. However, the high dose rate (HDR) treatment-planning system (TPS) that is currently used in brachytherapy still assumes that the treatment environment constitutes a homogeneous water medium and does not include a dose correction for the metal material of the applicator. The primary purpose of this study was to evaluate the HDR 192Ir dose distribution in cervical cancer patients when performing brachytherapy using a metal-containing applicator. Thermoluminescent dosimeter (TLD) measurements and Monte Carlo N-Particle eXtended (MCNPX) code were used to explore the doses to the rectum and bladder when using a Henschke applicator containing metal during brachytherapy. When the applicator was assumed to be present, the absolute dose difference between the TLD measurement and MCNPX simulation values was within approximately 5%. A comparison of the MCNPX simulation and TPS calculation values revealed that the TPS overestimated the International Commission of Radiation Units and Measurement (ICRU) rectum and bladder reference doses by 57.78% and 49.59%, respectively. We therefore suggest that the TPS should be modified to account for the shielding effects of the applicator to ensure the accuracy of the delivered doses. PMID:26658746

  18. HDR Brachytherapy Dose Distribution is Influenced by the Metal Material of the Applicator.

    PubMed

    Wu, Chin-Hui; Liao, Yi-Jen; Shiau, An-Cheng; Lin, Hsin-Yu; Hsueh Liu, Yen-Wan; Hsu, Shih-Ming

    2015-01-01

    Applicators containing metal have been widely used in recent years when applying brachytherapy to patients with cervical cancer. However, the high dose rate (HDR) treatment-planning system (TPS) that is currently used in brachytherapy still assumes that the treatment environment constitutes a homogeneous water medium and does not include a dose correction for the metal material of the applicator. The primary purpose of this study was to evaluate the HDR (192)Ir dose distribution in cervical cancer patients when performing brachytherapy using a metal-containing applicator. Thermoluminescent dosimeter (TLD) measurements and Monte Carlo N-Particle eXtended (MCNPX) code were used to explore the doses to the rectum and bladder when using a Henschke applicator containing metal during brachytherapy. When the applicator was assumed to be present, the absolute dose difference between the TLD measurement and MCNPX simulation values was within approximately 5%. A comparison of the MCNPX simulation and TPS calculation values revealed that the TPS overestimated the International Commission of Radiation Units and Measurement (ICRU) rectum and bladder reference doses by 57.78% and 49.59%, respectively. We therefore suggest that the TPS should be modified to account for the shielding effects of the applicator to ensure the accuracy of the delivered doses. PMID:26658746

  19. Radiation control in the intensive care unit for high intensity iridium-192 brain implants

    SciTech Connect

    Sewchand, W.; Drzymala, R.E.; Amin, P.P.; Salcman, M.; Salazar, O.M.

    1987-04-01

    A bedside lead cubicle was designed to minimize the radiation exposure of intensive care unit staff during routine interstitial brain irradiation by removable, high intensity iridium-192. The cubicle shields the patient without restricting intensive care routines. The design specifications were confirmed by exposure measurements around the shield with an implanted anthropomorphic phantom simulating the patient situation. The cubicle reduces the exposure rate around an implant patient by as much as 90%, with the exposure level not exceeding 0.1 mR/hour/mg of radium-equivalent /sup 192/Ir. Evaluation of data accumulated for the past 3 years has shown that the exposure levels of individual attending nurses are 0.12 to 0.36 mR/mg of radium-equivalent /sup 192/Ir per 12-hour shift. The corresponding range for entire nursing teams varies between 0.18 and 0.26. A radiation control index (exposure per mg of radium-equivalent /sup 192/Ir per nurse-hour) is thus defined for individual nurses and nursing teams; this index is a significant guide to the planning of nurse rotations for brain implant patients with various /sup 192/Ir loads. The bedside shield reduces exposure from /sup 192/Ir implants by a factor of about 20, as expected, and the exposure from the lower energy radioisotope iodine-125 is barely detectable.

  20. High-dose gallium imaging in lymphoma

    SciTech Connect

    Anderson, K.C.; Leonard, R.C.; Canellos, G.P.; Skarin, A.T.; Kaplan, W.D.

    1983-08-01

    The role of gallium-67 imaging in the management of patients with lymphoma, traditionally assessed using low tracer doses and the rectilinear scanner, was assessed when using larger doses (7 to 10 mCi) and a triple-peak Anger camera. Gallium scan results in 51 patients with non-Hodgkin's lymphoma and 21 patients with Hodgkin's disease were compared with simultaneous radiologic, clinical, and histopathologic reports. Subsequent disease course was also evaluated in light of radionuclide findings. Sensitivity and specificity of the scans were 0.90 or greater for both non-Hodgkin's lymphoma and Hodgkin's disease, and overall accuracy by site was 96 percent. Although there are insufficient numbers of pretreatment scans to allow any conclusions, our data suggest that newer approaches to gallium scanning in treated patients are (1) highly specific in all lymphomas and most sensitive in high-grade non-Hodgkin's lymphoma and Hodgkin's disease; (2) valuable in assessing the mediastinum in both non-Hodgkin's lymphoma and Hodgkin's disease; and (3) helpful adjuncts to computed tomographic scanning and ultrasonography in assessing abdominal node disease.

  1. Modern trends and development in high-dose luminescent measurements

    NASA Astrophysics Data System (ADS)

    Kortov, V.

    2014-11-01

    Main application areas of high-dose dosimetry are described. The requirements to the materials for high-dose luminescent detectors are set. The examples of successful high-dose measurements using radiation-resistant phosphors are given. Viability of using materials with deep traps to detect intensive radiation flows is grounded. Characteristics of high-dose measurements using highly sensitive detectors TLD-500 (Al2O3:C) and LiF:Mg,Cu,P are discussed.

  2. Dose rate in brachytherapy using after-loading machine: pulsed or high-dose rate?

    PubMed

    Hannoun-Lévi, J-M; Peiffert, D

    2014-10-01

    Since February 2014, it is no longer possible to use low-dose rate 192 iridium wires due to the end of industrial production of IRF1 and IRF2 sources. The Brachytherapy Group of the French society of radiation oncology (GC-SFRO) has recommended switching from iridium wires to after-loading machines. Two types of after-loading machines are currently available, based on the dose rate used: pulsed-dose rate or high-dose rate. In this article, we propose a comparative analysis between pulsed-dose rate and high-dose rate brachytherapy, based on biological, technological, organizational and financial considerations. PMID:25195117

  3. High-dose naloxone in tardive dyskinesia.

    PubMed

    Lindenmayer, J P; Gardner, E; Goldberg, E; Opler, L A; Kay, S R; van Praag, H M; Weiner, M; Zukin, S

    1988-10-01

    Tardive dyskinesia (TD) is thought to result from nigrostriatal dopaminergic supersensitivity secondary to prolonged neuroleptic exposure. Preclinical studies have demonstrated that the opiate antagonist naloxone can acutely reverse a haloperidol-induced hyperdopaminergic state. In a trial of high-dose naloxone, 20 patients with TD received i.v. naloxone (20 mg, 40 mg, and placebo) under double-blind conditions. At baseline and at regular postdrug intervals, patients were evaluated using a battery of motor, clinical, and neuropsychological measures to study effects on neurological, behavioral, and cognitive functions. There was a significant improvement in involuntary movements at 30 min postnaloxone, together with improvement in clinical ratings at that time point, as well as some cognitive changes. The implications of these findings for the putative functional relationship between dopaminergic and enkephalinergic systems in the nigrostriatal area are discussed. PMID:3070611

  4. [High-dose intravenous immunoglobulin treatment].

    PubMed

    Taneichi, Hiromichi; Miyawaki, Toshio

    2011-03-01

    Intravenous immunoglobulin treatment was introduced as replacement therapy for patients with congenital agammaglobulinemia. For the last three decades, high-dose intravenous immunoglobulin (HD-IVIg) has been used for autoimmune diseases and systemic inflammatory diseases, such as idiopathic thrombocytopenic purpura, Kawasaki disease, myasthenia gravis and Guillain-Barré/syndrome. Although the immunomodulatory mechanisms of HD-IVIg remains unclear. Its use in many other diseases have been expected. Acute encephalitis/encephalopathy is a complex neurological syndrome associated with significant morbidity and mortality. The pathogenicity of brain dysfunction is still unknown. This review provides an overview and discussion of mechanisms that may be responsible for HD-IVIg effects in acute encephalitis/encephalopathy. PMID:21400848

  5. Chick development and high dose of bendiocarb.

    PubMed

    Petrovova, Eva; Sedmera, David; Luptakova, Lenka; Mazensky, David; Danko, Jan

    2012-01-01

    Developmental data of carbamate pesticides are scarce although they generally possess low toxicity for vertebrates. The aim of the study was to investigate the toxicity of bendiocarb to liver and central nervous system of chick embryos. Bendiocarb (1600 μg/egg) was administered to the embryo through membrana papyracea on embryonic day 3 and 10. In the liver and central nervous system we observed no macroscopic or microscopic changes. These organs were also investigated for caspase activity in regard to application of bendiocarb and no differences in the caspase immunopositivity were observed in comparison with the control. The embryolethality after bendiocarb respective dose was high (94 %) on the embryonic day 3, though following results indicated no toxicity to investigated organs and no increase in the number of apoptotic cells in survived chick embryos on both the early (day 3 of incubation) and the later (day 10 of incubation) developmental stage. PMID:22540656

  6. Evaluation of Rectal Dose During High-Dose-Rate Intracavitary Brachytherapy for Cervical Carcinoma

    SciTech Connect

    Sha, Rajib Lochan; Reddy, Palreddy Yadagiri; Rao, Ramakrishna; Muralidhar, Kanaparthy R.; Kudchadker, Rajat J.

    2011-01-01

    High-dose-rate intracavitary brachytherapy (HDR-ICBT) for carcinoma of the uterine cervix often results in high doses being delivered to surrounding organs at risk (OARs) such as the rectum and bladder. Therefore, it is important to accurately determine and closely monitor the dose delivered to these OARs. In this study, we measured the dose delivered to the rectum by intracavitary applications and compared this measured dose to the International Commission on Radiation Units and Measurements rectal reference point dose calculated by the treatment planning system (TPS). To measure the dose, we inserted a miniature (0.1 cm{sup 3}) ionization chamber into the rectum of 86 patients undergoing radiation therapy for cervical carcinoma. The response of the miniature chamber modified by 3 thin lead marker rings for identification purposes during imaging was also characterized. The difference between the TPS-calculated maximum dose and the measured dose was <5% in 52 patients, 5-10% in 26 patients, and 10-14% in 8 patients. The TPS-calculated maximum dose was typically higher than the measured dose. Our study indicates that it is possible to measure the rectal dose for cervical carcinoma patients undergoing HDR-ICBT. We also conclude that the dose delivered to the rectum can be reasonably predicted by the TPS-calculated dose.

  7. ELDRS Characterization for a Very High Dose Mission

    NASA Technical Reports Server (NTRS)

    Harris, Richard D.; McClure, Steven S.; Rax, Bernard G.; Kenna, Aaron J.; Thorbourn, Dennis O.; Clark, Karla B.; Yan, Tsun-Yee

    2010-01-01

    Evaluation of bipolar linear parts which may have Enhanced Low Dose Rate Sensitivity (ELDRS) is problematic for missions that have very high dose radiation requirements. The accepted standards for evaluating parts that display ELDRS require testing at a very low dose rate which could be prohibitively long for very high dose missions. In this work, a methodology for ELDRS characterization of bipolar parts for mission doses up to 1 Mrad(Si) is evaluated. The procedure employs an initial dose rate of 0.01 rad(Si)/s to a total dose of 50 krad(Si) and then changes to 0.04 rad(Si)/s to a total dose of 1 Mrad(Si). This procedure appears to work well. No change in rate of degradation with dose has been observed when the dose rate is changed from 0.01 to 0.04 rad(Si)/s. This is taken as an indication that the degradation due to the higher dose rate is equivalent to that at the lower dose rate at the higher dose levels, at least for the parts studied to date. In several cases, significant parameter degradation or functional failure not observed at HDR was observed at fairly high total doses (50 to 250 krad(Si)) at LDR. This behavior calls into question the use of dose rate trend data and enhancement factors to predict LDR performance.

  8. Influence of photon energy spectra from brachytherapy sources on Monte Carlo simulations of kerma and dose rates in water and air

    SciTech Connect

    Rivard, Mark J.; Granero, Domingo; Perez-Calatayud, Jose; Ballester, Facundo

    2010-02-15

    Purpose: For a given radionuclide, there are several photon spectrum choices available to dosimetry investigators for simulating the radiation emissions from brachytherapy sources. This study examines the dosimetric influence of selecting the spectra for {sup 192}Ir, {sup 125}I, and {sup 103}Pd on the final estimations of kerma and dose. Methods: For {sup 192}Ir, {sup 125}I, and {sup 103}Pd, the authors considered from two to five published spectra. Spherical sources approximating common brachytherapy sources were assessed. Kerma and dose results from GEANT4, MCNP5, and PENELOPE-2008 were compared for water and air. The dosimetric influence of {sup 192}Ir, {sup 125}I, and {sup 103}Pd spectral choice was determined. Results: For the spectra considered, there were no statistically significant differences between kerma or dose results based on Monte Carlo code choice when using the same spectrum. Water-kerma differences of about 2%, 2%, and 0.7% were observed due to spectrum choice for {sup 192}Ir, {sup 125}I, and {sup 103}Pd, respectively (independent of radial distance), when accounting for photon yield per Bq. Similar differences were observed for air-kerma rate. However, their ratio (as used in the dose-rate constant) did not significantly change when the various photon spectra were selected because the differences compensated each other when dividing dose rate by air-kerma strength. Conclusions: Given the standardization of radionuclide data available from the National Nuclear Data Center (NNDC) and the rigorous infrastructure for performing and maintaining the data set evaluations, NNDC spectra are suggested for brachytherapy simulations in medical physics applications.

  9. Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO

    SciTech Connect

    Perez-Calatayud, Jose; Ballester, Facundo; Das, Rupak K.; DeWerd, Larry A.; Ibbott, Geoffrey S.; Meigooni, Ali S.; Ouhib, Zoubir; Rivard, Mark J.; Sloboda, Ron S.; Williamson, Jeffrey F.

    2012-05-15

    Purpose: Recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO) on dose calculations for high-energy (average energy higher than 50 keV) photon-emitting brachytherapy sources are presented, including the physical characteristics of specific {sup 192}Ir, {sup 137}Cs, and {sup 60}Co source models. Methods: This report has been prepared by the High Energy Brachytherapy Source Dosimetry (HEBD) Working Group. This report includes considerations in the application of the TG-43U1 formalism to high-energy photon-emitting sources with particular attention to phantom size effects, interpolation accuracy dependence on dose calculation grid size, and dosimetry parameter dependence on source active length. Results: Consensus datasets for commercially available high-energy photon sources are provided, along with recommended methods for evaluating these datasets. Recommendations on dosimetry characterization methods, mainly using experimental procedures and Monte Carlo, are established and discussed. Also included are methodological recommendations on detector choice, detector energy response characterization and phantom materials, and measurement specification methodology. Uncertainty analyses are discussed and recommendations for high-energy sources without consensus datasets are given. Conclusions: Recommended consensus datasets for high-energy sources have been derived for sources that were commercially available as of January 2010. Data are presented according to the AAPM TG-43U1 formalism, with modified interpolation and extrapolation techniques of the AAPM TG-43U1S1 report for the 2D anisotropy function and radial dose function.

  10. In vivo TLD dose measurements in catheter-based high-dose-rate brachytherapy.

    PubMed

    Adlienė, Diana; Jakštas, Karolis; Urbonavičius, Benas Gabrielis

    2015-07-01

    Routine in vivo dosimetry is well established in external beam radiotherapy; however, it is restricted mainly to detection of gross errors in high-dose-rate (HDR) brachytherapy due to complicated measurements in the field of steep dose gradients in the vicinity of radioactive source and high uncertainties. The results of in vivo dose measurements using TLD 100 mini rods and TLD 'pin worms' in catheter-based HDR brachytherapy are provided in this paper alongside with their comparison with corresponding dose values obtained using calculation algorithm of the treatment planning system. Possibility to perform independent verification of treatment delivery in HDR brachytherapy using TLDs is discussed. PMID:25809111

  11. Radiation dose enhancement at tissue-tungsten interfaces in HDR brachytherapy

    NASA Astrophysics Data System (ADS)

    Han, Z.; Safavi-Naeini, M.; Alnaghy, S.; Cutajar, DL; Guatelli, S.; Petasecca, M.; Franklin, DR; Malaroda, A.; Carrara, M.; Bucci, J.; Zaider, M.; Lerch, MLF; Rosenfeld, AB

    2014-11-01

    HDR BrachyView is a novel in-body dosimetric imaging system for real-time monitoring and verification of the source position in high dose rate (HDR) prostate brachytherapy treatment. It is based on a high-resolution pixelated detector array with a semi-cylindrical multi-pinhole tungsten collimator and is designed to fit inside a compact rectal probe, and is able to resolve the 3D position of the source with a maximum error of 1.5 mm. This paper presents an evaluation of the additional dose that will be delivered to the patient as a result of backscatter radiation from the collimator. Monte Carlo simulations of planar and cylindrical collimators embedded in a tissue-equivalent phantom were performed using Geant4, with an 192Ir source placed at two different source-collimator distances. The planar configuration was replicated experimentally to validate the simulations, with a MOSkin dosimetry probe used to measure dose at three distances from the collimator. For the cylindrical collimator simulation, backscatter dose enhancement was calculated as a function of axial and azimuthal displacement, and dose distribution maps were generated at three distances from the collimator surface. Although significant backscatter dose enhancement was observed for both geometries immediately adjacent to the collimator, simulations and experiments indicate that backscatter dose is negligible at distances beyond 1 mm from the collimator. Since HDR BrachyView is enclosed within a 1 mm thick tissue-equivalent plastic shell, all backscatter radiation resulting from its use will therefore be absorbed before reaching the rectal wall or other tissues. dosimetry, brachytherapy, HDR

  12. Radiation dose enhancement at tissue-tungsten interfaces in HDR brachytherapy.

    PubMed

    Han, Z; Safavi-Naeini, M; Alnaghy, S; Cutajar, D L; Guatelli, S; Petasecca, M; Franklin, D R; Malaroda, A; Carrara, M; Bucci, J; Zaider, M; Lerch, M L F; Rosenfeld, A B

    2014-11-01

    HDR BrachyView is a novel in-body dosimetric imaging system for real-time monitoring and verification of the source position in high dose rate (HDR) prostate brachytherapy treatment. It is based on a high-resolution pixelated detector array with a semi-cylindrical multi-pinhole tungsten collimator and is designed to fit inside a compact rectal probe, and is able to resolve the 3D position of the source with a maximum error of 1.5 mm. This paper presents an evaluation of the additional dose that will be delivered to the patient as a result of backscatter radiation from the collimator. Monte Carlo simulations of planar and cylindrical collimators embedded in a tissue-equivalent phantom were performed using Geant4, with an (192)Ir source placed at two different source-collimator distances. The planar configuration was replicated experimentally to validate the simulations, with a MOSkin dosimetry probe used to measure dose at three distances from the collimator. For the cylindrical collimator simulation, backscatter dose enhancement was calculated as a function of axial and azimuthal displacement, and dose distribution maps were generated at three distances from the collimator surface. Although significant backscatter dose enhancement was observed for both geometries immediately adjacent to the collimator, simulations and experiments indicate that backscatter dose is negligible at distances beyond 1 mm from the collimator. Since HDR BrachyView is enclosed within a 1 mm thick tissue-equivalent plastic shell, all backscatter radiation resulting from its use will therefore be absorbed before reaching the rectal wall or other tissues. dosimetry, brachytherapy, HDR. PMID:25325249

  13. Analysis of bipolar linear circuit response mechanisms for high and low dose rate total dose irradiations

    SciTech Connect

    Barnaby, H.; Tausch, H.J.; Turfler, R.; Cole, P.; Baker, P.; Pease, R.L.

    1996-12-01

    A methodology is presented for the identification of circuit total dose response mechanisms in bipolar linear microcircuits irradiated at high and low dose rates. This methodology includes manual circuit analysis, circuit simulations with SPICE using extracted device parameters, and selective irradiations of portions of the circuit using a scanning electron microscope.

  14. Relative safety profiles of high dose statin regimens

    PubMed Central

    Escobar, Carlos; Echarri, Rocio; Barrios, Vivencio

    2008-01-01

    Recent clinical trials recommend achieving a low-density lipoprotein cholesterol level of <100 mg/dl in high-risk and <70 mg/dl in very high risk patients. To attain these goals, however, many patients will need statins at high doses. The most frequent side effects related to the use of statins, myopathy, rhabdomyolysis, and increased levels of transaminases, are unusual. Although low and moderate doses show a favourable profile, there is concern about the tolerability of higher doses. During recent years, numerous trials to analyze the efficacy and tolerability of high doses of statins have been published. This paper updates the published data on the safety of statins at high doses. PMID:18827903

  15. Calculation of dose, dose equivalent, and relative biological effectiveness for high charge and energy ion beams

    NASA Technical Reports Server (NTRS)

    Wilson, J. W.; Chun, S. Y.; Reginatto, M.; Hajnal, F.

    1995-01-01

    The Green's function for the transport of ions of high charge and energy is utilized with a nuclear fragmentation database to evaluate dose, dose equivalent, and RBE for C3H10T1/2 cell survival and neo-plastic transformation as function of depth in soft tissue. Such evaluations are useful to estimates of biological risk for high altitude aircraft, space operations, accelerator operations, and biomedical application.

  16. Dosimetric investigation of high dose rate, gated IMRT

    SciTech Connect

    Lin, Teh; Chen Yan; Hossain, Murshed; Li, Jinsheng; Ma, C.-M.

    2008-11-15

    Increasing the dose rate offers time saving for IMRT delivery but the dosimetric accuracy is a concern, especially in the case of treating a moving target. The objective of this work is to determine the effect of dose rate associated with organ motion and gated treatment using step-and-shoot IMRT delivery. Both measurements and analytical simulation on clinical plans are performed to study the dosimetric differences between high dose rate and low dose rate gated IMRT step-and-shoot delivery. Various sites of IMRT plans for liver, lung, pancreas, and breast cancers were delivered to a custom-made motorized phantom, which simulated sinusoidal movement. Repeated measurements were taken for gated and nongated delivery with different gating settings and three dose rates, 100, 500, and 1000 MU/min using ion chambers and extended dose range films. For the study of the residual motion effect for individual segment dose and composite dose of IMRT plans, our measurements with 30%-60% phase gating and without gating for various dose rates were compared. A small but clinically acceptable difference in delivered dose was observed between 1000, 500, and 100 MU/min at 30%-60% phase gating. A simulation is presented, which can be used for predicting dose profiles for patient cases in the presence of motion and gating to confirm that IMRT step-and-shoot delivery with gating for 1000 MU/min are not much different from 500 MU/min. Based on the authors sample plan analyses, our preliminary results suggest that using 1000 MU/Min dose rate is dosimetrically accurate and efficient for IMRT treatment delivery with gating. Nonetheless, for the concern of patient care and safety, a patient specific QA should be performed as usual for IMRT plans for high dose rate deliveries.

  17. High total dose effects on CMOS/SOI technology

    SciTech Connect

    Flament, O.; Dupont-Nivet, E.; Leray, J.L.; Pere, J.F.; Delagnes, E. ); Auberton-Herve, A.J.; Giffard, B. ); Borel, G.; Ouisse, T. )

    1992-06-01

    This paper reports that, CMOS silicon on insulator technology has shown its ability to process hardened components which remain functional after irradiation with a total dose of several tens of Megarads. New tests on elementary transistors and 29101 microprocessor have been made at doses up to 100 Mrad (SiO{sub 2}) and above. Results of irradiation at these total doses are presented for different biases, together with the post-irradiation behavior of the components. All the observations show that new parameters must be taken into account for hardness insurance at a high level of total dose.

  18. Impact of Surface Curvature on Dose Delivery in Intraoperative High-Dose-Rate Brachytherapy

    SciTech Connect

    Oh, Moonseong Wang Zhou; Malhotra, Harish K.; Jaggernauth, Wainwright; Podgorsak, Matthew B.

    2009-04-01

    In intraoperative high-dose-rate (IOHDR) brachytherapy, a 2-dimensional (2D) geometry is typically used for treatment planning. The assumption of planar geometry may cause serious errors in dose delivery for target surfaces that are, in reality, curved. A study to evaluate the magnitude of these errors in clinical practice was undertaken. Cylindrical phantoms with 6 radii (range: 1.35-12.5 cm) were used to simulate curved treatment geometries. Treatment plans were developed for various planar geometries and were delivered to the cylindrical phantoms using catheters inserted into Freiburg applicators of varying dimension. Dose distributions were measured using radiographic film. In comparison to the treatment plan (for a planar geometry), the doses delivered to prescription points were higher on the concave side of the geometry, up to 15% for the phantom with the smallest radius. On the convex side of the applicator, delivered doses were up to 10% lower for small treated areas ({<=} 5 catheters) but, interestingly, the dose error was negligible for large treated areas (>5 catheters). Our measurements have shown inaccuracy in dose delivery when the original planar treatment plan is delivered with a curved applicator. Dose delivery errors arising from the use of planar treatment plans with curved applicators may be significant.

  19. Using matrix summation method for three dimensional dose calculation in brachytherapy

    PubMed Central

    Zibandeh-Gorji, Mahmoud; Mowlavi, Ali Asghar; Mohammadi, Saeed

    2012-01-01

    Aim The purpose of this study is to calculate radiation dose around a brachytherapy source in a water phantom for different seed locations or rotation the sources by the matrix summation method. Background Monte Carlo based codes like MCNP are widely used for performing radiation transport calculations and dose evaluation in brachytherapy. But for complicated situations, like using more than one source, moving or rotating the source, the routine Monte Carlo method for dose calculation needs a long time running. Materials and methods The MCNPX code has been used to calculate radiation dose around a 192Ir brachytherapy source and saved in a 3D matrix. Then, we used this matrix to evaluate the absorbed dose in any point due to some sources or a source which shifted or rotated in some places by the matrix summation method. Results Three dimensional (3D) dose results and isodose curves were presented for 192Ir source in a water cube phantom shifted for 10 steps and rotated for 45 and 90° based on the matrix summation method. Also, we applied this method for some arrays of sources. Conclusion The matrix summation method can be used for 3D dose calculations for any brachytherapy source which has moved or rotated. This simple method is very fast compared to routine Monte Carlo based methods. In addition, it can be applied for dose optimization study. PMID:24377009

  20. The use of tetrahedral mesh geometries in Monte Carlo simulation of applicator based brachytherapy dose distributions.

    PubMed

    Fonseca, Gabriel Paiva; Landry, Guillaume; White, Shane; D'Amours, Michel; Yoriyaz, Hélio; Beaulieu, Luc; Reniers, Brigitte; Verhaegen, Frank

    2014-10-01

    Accounting for brachytherapy applicator attenuation is part of the recommendations from the recent report of AAPM Task Group 186. To do so, model based dose calculation algorithms require accurate modelling of the applicator geometry. This can be non-trivial in the case of irregularly shaped applicators such as the Fletcher Williamson gynaecological applicator or balloon applicators with possibly irregular shapes employed in accelerated partial breast irradiation (APBI) performed using electronic brachytherapy sources (EBS). While many of these applicators can be modelled using constructive solid geometry (CSG), the latter may be difficult and time-consuming. Alternatively, these complex geometries can be modelled using tessellated geometries such as tetrahedral meshes (mesh geometries (MG)). Recent versions of Monte Carlo (MC) codes Geant4 and MCNP6 allow for the use of MG. The goal of this work was to model a series of applicators relevant to brachytherapy using MG. Applicators designed for (192)Ir sources and 50 kV EBS were studied; a shielded vaginal applicator, a shielded Fletcher Williamson applicator and an APBI balloon applicator. All applicators were modelled in Geant4 and MCNP6 using MG and CSG for dose calculations. CSG derived dose distributions were considered as reference and used to validate MG models by comparing dose distribution ratios. In general agreement within 1% for the dose calculations was observed for all applicators between MG and CSG and between codes when considering volumes inside the 25% isodose surface. When compared to CSG, MG required longer computation times by a factor of at least 2 for MC simulations using the same code. MCNP6 calculation times were more than ten times shorter than Geant4 in some cases. In conclusion we presented methods allowing for high fidelity modelling with results equivalent to CSG. To the best of our knowledge MG offers the most accurate representation of an irregular APBI balloon applicator. PMID

  1. The use of tetrahedral mesh geometries in Monte Carlo simulation of applicator based brachytherapy dose distributions

    NASA Astrophysics Data System (ADS)

    Paiva Fonseca, Gabriel; Landry, Guillaume; White, Shane; D'Amours, Michel; Yoriyaz, Hélio; Beaulieu, Luc; Reniers, Brigitte; Verhaegen, Frank

    2014-10-01

    Accounting for brachytherapy applicator attenuation is part of the recommendations from the recent report of AAPM Task Group 186. To do so, model based dose calculation algorithms require accurate modelling of the applicator geometry. This can be non-trivial in the case of irregularly shaped applicators such as the Fletcher Williamson gynaecological applicator or balloon applicators with possibly irregular shapes employed in accelerated partial breast irradiation (APBI) performed using electronic brachytherapy sources (EBS). While many of these applicators can be modelled using constructive solid geometry (CSG), the latter may be difficult and time-consuming. Alternatively, these complex geometries can be modelled using tessellated geometries such as tetrahedral meshes (mesh geometries (MG)). Recent versions of Monte Carlo (MC) codes Geant4 and MCNP6 allow for the use of MG. The goal of this work was to model a series of applicators relevant to brachytherapy using MG. Applicators designed for 192Ir sources and 50 kV EBS were studied; a shielded vaginal applicator, a shielded Fletcher Williamson applicator and an APBI balloon applicator. All applicators were modelled in Geant4 and MCNP6 using MG and CSG for dose calculations. CSG derived dose distributions were considered as reference and used to validate MG models by comparing dose distribution ratios. In general agreement within 1% for the dose calculations was observed for all applicators between MG and CSG and between codes when considering volumes inside the 25% isodose surface. When compared to CSG, MG required longer computation times by a factor of at least 2 for MC simulations using the same code. MCNP6 calculation times were more than ten times shorter than Geant4 in some cases. In conclusion we presented methods allowing for high fidelity modelling with results equivalent to CSG. To the best of our knowledge MG offers the most accurate representation of an irregular APBI balloon applicator.

  2. Interaction of 2-Gy Equivalent Dose and Margin Status in Perioperative High-Dose-Rate Brachytherapy

    SciTech Connect

    Martinez-Monge, Rafael; Cambeiro, Mauricio; Moreno, Marta; Gaztanaga, Miren; San Julian, Mikel; Alcalde, Juan; Jurado, Matias

    2011-03-15

    Purpose: To determine patient, tumor, and treatment factors predictive of local control (LC) in a series of patients treated with either perioperative high-dose-rate brachytherapy (PHDRB) alone (Group 1) or with PHDRB combined with external-beam radiotherapy (EBRT) (Group 2). Patient and Methods: Patients (n = 312) enrolled in several PHDRB prospective Phase I-II studies conducted at the Clinica Universidad de Navarra were analyzed. Treatment with PHDRB alone, mainly because of prior irradiation, was used in 126 patients to total doses of 32 Gy/8 b.i.d. or 40 Gy/10 b.i.d. treatments after R0 or R1 resections. Treatment with PHDRB plus EBRT was used in 186 patients to total doses of 16 Gy/4 b.i.d. or 24 Gy/6 b.i.d. treatments after R0 or R1 resections along with 45 Gy of EBRT with or without concomitant chemotherapy. Results: No dose-margin interaction was observed in Group 1 patients. In Group 2 patients there was a significant interaction between margin status and 2-Gy equivalent (Eq2Gy) dose (p = 0.002): (1) patients with negative margins had 9-year LC of 95.7% at Eq2Gy = 62.9Gy; (2) patients with close margins of >1 mm had 9-year LC of 92.4% at Eq2Gy = 72.2Gy, and (3) patients with positive/close <1-mm margins had 9-year LC of 68.0% at Eq2Gy = 72.2Gy. Conclusions: Two-gray equivalent doses {>=}70 Gy may compensate the effect of close margins {>=}1 mm but do not counterbalance the detrimental effect of unfavorable (positive/close <1 mm) resection margins. No dose-margin interaction is observed in patients treated at lower Eq2Gy doses {<=}50 Gy with PHDRB alone.

  3. Chromosomal Aberrations in Normal and AT Cells Exposed to High Dose of Low Dose Rate Irradiation

    NASA Technical Reports Server (NTRS)

    Kawata, T.; Shigematsu, N.; Kawaguchi, O.; Liu, C.; Furusawa, Y.; Hirayama, R.; George, K.; Cucinotta, F.

    2011-01-01

    Ataxia telangiectasia (A-T) is a human autosomally recessive syndrome characterized by cerebellar ataxia, telangiectases, immune dysfunction, and genomic instability, and high rate of cancer incidence. A-T cell lines are abnormally sensitive to agents that induce DNA double strand breaks, including ionizing radiation. The diverse clinical features in individuals affected by A-T and the complex cellular phenotypes are all linked to the functional inactivation of a single gene (AT mutated). It is well known that cells deficient in ATM show increased yields of both simple and complex chromosomal aberrations after high-dose-rate irradiation, but, less is known on how cells respond to low-dose-rate irradiation. It has been shown that AT cells contain a large number of unrejoined breaks after both low-dose-rate irradiation and high-dose-rate irradiation, however sensitivity for chromosomal aberrations at low-dose-rate are less often studied. To study how AT cells respond to low-dose-rate irradiation, we exposed confluent normal and AT fibroblast cells to up to 3 Gy of gamma-irradiation at a dose rate of 0.5 Gy/day and analyzed chromosomal aberrations in G0 using fusion PCC (Premature Chromosomal Condensation) technique. Giemsa staining showed that 1 Gy induces around 0.36 unrejoined fragments per cell in normal cells and around 1.35 fragments in AT cells, whereas 3Gy induces around 0.65 fragments in normal cells and around 3.3 fragments in AT cells. This result indicates that AT cells can rejoin breaks less effectively in G0 phase of the cell cycle? compared to normal cells. We also analyzed chromosomal exchanges in normal and AT cells after exposure to 3 Gy of low-dose-rate rays using a combination of G0 PCC and FISH techniques. Misrejoining was detected in the AT cells only? When cells irradiated with 3 Gy were subcultured and G2 chromosomal aberrations were analyzed using calyculin-A induced PCC technique, the yield of unrejoined breaks decreased in both normal and AT

  4. Assessments for High Dose Radionuclide Therapy Treatment Planning

    SciTech Connect

    Fisher, Darrell R.

    2003-10-01

    Advances in the biotechnology of cell-specific targeting of cancer, and the increased number of clinical trials involving treatment of cancer patients with radiolabeled antibodies, peptides, and similar delivery vehicles have led to an increase in the number of high-dose radionuclide therapy procedures. Optimized radionuclide therapy for cancer treatment is based on the concept of absorbed dose to the dose-limiting normal organ or tissue. The limiting normal tissue is often the red marrow, but it may sometimes be lungs, liver, intestinal tract, or kidneys. Appropriate treatment planning requires assessment of radiation dose to several internal organs and tissues, and usually involves biodistribution studies in the patient using a tracer amount of radionuclide bound to the targeting agent and imaged at sequential time points using a planar gamma camera. Time-activity curves are developed from the imaging data for the major organs tissues of concern, for the whole body, and sometimes for selected tumors. Patient-specific factors often require that dose estimates be customized for each patient. The Food and Drug Administration regulates the experimental use of investigational new drugs and requires reasonable calculation of radiation absorbed dose to the whole body and to critical organs using methods prescribed by the Medical Internal Radiation Dose (MIRD) Committee of the Society of Nuclear Medicine. Review of high-dose studies in the U.S. and elsewhere shows that 1) some studies are conducted with minimal dosimetry, 2) the marrow dose is difficult to establish and is subject to large uncertainties, and 3) despite the general availability of MIRD software, internal dosimetry methods are often inconsistent from one clinical center to another.

  5. Pharmacokinetics of high-dose busulfan in children.

    PubMed

    Vassal, G; Gouyette, A; Hartmann, O; Pico, J L; Lemerle, J

    1989-01-01

    The pharmacokinetics of high-dose busulfan given orally at 1 mg/kg every 6 h over 4 days (total dose, 16 mg/kg) in combined chemotherapy followed by autologous bone marrow transplantation was studied in 12 children with a mean age of 7 years (range, 4-14 years). Busulfan levels in biological fluids were measured by a gas chromatographic assay with mass fragmentographic detection, using a deuterated analogue as the internal standard. In a high-dose regimen, busulfan followed one-compartment model kinetics with zero-order absorption. A mean maximal concentration of 803 +/- 228 ng/ml was achieved at 92-255 min after dosing. The mean elimination half-life was 2.33 h, and the mean total clearance was 119 +/- 54 ml/min per m2, with an apparent distribution volume of 27.10 +/- 11.50 l/m2. A mean trough level of 370 ng/ml was found throughout the 4 days of the chemotherapy course. There were no significant variations in pharmacokinetic parameters measured after the first and last doses. Busulfan was monitored in the CSF of nine children at 3.25-7 h after the last dose and was detected in all patients, with a mean CSF-to-plasma concentration ratio of 0.95 (range, 0.5-1.4). PMID:2791192

  6. Spectroscopic gamma camera for use in high dose environments

    NASA Astrophysics Data System (ADS)

    Ueno, Yuichiro; Takahashi, Isao; Ishitsu, Takafumi; Tadokoro, Takahiro; Okada, Koichi; Nagumo, Yasushi; Fujishima, Yasutake; Kometani, Yutaka; Suzuki, Yasuhiko; Umegaki, Kikuo

    2016-06-01

    We developed a pinhole gamma camera to measure distributions of radioactive material contaminants and to identify radionuclides in extraordinarily high dose regions (1000 mSv/h). The developed gamma camera is characterized by: (1) tolerance for high dose rate environments; (2) high spatial and spectral resolution for identifying unknown contaminating sources; and (3) good usability for being carried on a robot and remotely controlled. These are achieved by using a compact pixelated detector module with CdTe semiconductors, efficient shielding, and a fine resolution pinhole collimator. The gamma camera weighs less than 100 kg, and its field of view is an 8 m square in the case of a distance of 10 m and its image is divided into 256 (16×16) pixels. From the laboratory test, we found the energy resolution at the 662 keV photopeak was 2.3% FWHM, which is enough to identify the radionuclides. We found that the count rate per background dose rate was 220 cps h/mSv and the maximum count rate was 300 kcps, so the maximum dose rate of the environment where the gamma camera can be operated was calculated as 1400 mSv/h. We investigated the reactor building of Unit 1 at the Fukushima Dai-ichi Nuclear Power Plant using the gamma camera and could identify the unknown contaminating source in the dose rate environment that was as high as 659 mSv/h.

  7. Ocular toxicity following high dose chemotherapy and autologous transplant.

    PubMed

    Rubin, P; Hulette, C; Khawly, J A; Elkordy, M; Hussein, A; Vredenburgh, J J; Jaffe, G J; Peters, W P

    1996-07-01

    A 49-year-old woman received an autologous transplant for breast cancer. Six weeks later she noticed visual disturbance of the left eye which correlated with a visual field abnormality. There was a milder degree of visual disturbance in the right eye. Treatment with high-dose steroids partially stabilized the problem, which was felt to be an ischemic optic neuropathy. She ultimately died of respiratory failure. Pathology of the optic nerves revealed demyelination. Visual disturbances following high-dose chemotherapy are uncommon; the pathology to date has not been elucidated. Steroid therapy may be useful. PMID:8832031

  8. Monte Carlo Study of Radiation Dose Enhancement by Gadolinium in Megavoltage and High Dose Rate Radiotherapy

    PubMed Central

    Zhang, Daniel G.; Feygelman, Vladimir; Moros, Eduardo G.; Latifi, Kujtim; Zhang, Geoffrey G.

    2014-01-01

    MRI is often used in tumor localization for radiotherapy treatment planning, with gadolinium (Gd)-containing materials often introduced as a contrast agent. Motexafin gadolinium is a novel radiosensitizer currently being studied in clinical trials. The nanoparticle technologies can target tumors with high concentration of high-Z materials. This Monte Carlo study is the first detailed quantitative investigation of high-Z material Gd-induced dose enhancement in megavoltage external beam photon therapy. BEAMnrc, a radiotherapy Monte Carlo simulation package, was used to calculate dose enhancement as a function of Gd concentration. Published phase space files for the TrueBeam flattening filter free (FFF) and conventional flattened 6MV photon beams were used. High dose rate (HDR) brachytherapy with Ir-192 source was also investigated as a reference. The energy spectra difference caused a dose enhancement difference between the two beams. Since the Ir-192 photons have lower energy yet, the photoelectric effect in the presence of Gd leads to even higher dose enhancement in HDR. At depth of 1.8 cm, the percent mean dose enhancement for the FFF beam was 0.38±0.12, 1.39±0.21, 2.51±0.34, 3.59±0.26, and 4.59±0.34 for Gd concentrations of 1, 5, 10, 15, and 20 mg/mL, respectively. The corresponding values for the flattened beam were 0.09±0.14, 0.50±0.28, 1.19±0.29, 1.68±0.39, and 2.34±0.24. For Ir-192 with direct contact, the enhanced were 0.50±0.14, 2.79±0.17, 5.49±0.12, 8.19±0.14, and 10.80±0.13. Gd-containing materials used in MRI as contrast agents can also potentially serve as radiosensitizers in radiotherapy. This study demonstrates that Gd can be used to enhance radiation dose in target volumes not only in HDR brachytherapy, but also in 6 MV FFF external beam radiotherapy, but higher than the currently used clinical concentration (>5 mg/mL) would be needed. PMID:25275550

  9. High-dose chemotherapy in small-cell lung cancer.

    PubMed

    Pasini, F; Durante, E; De Manzoni, D; Rosti, G; Pelosi, G

    2002-01-01

    Small cell lung cancer (SCLC) is highly sensitive both to radiotherapy and chemotherapy. Given its high chemo sensitivity, even two decades ago, SCLC was one of the first malignancies deemed suitable for maximising the dose and dose intensity with the support of autologous bone marrow (ABMT). On the whole, results were disappointing and the procedure was practically abandoned. Nowadays some interest is again emerging due to improvements in supportive care, such as the availability of hematopoietic growth factors and the peripheral blood progenitor cells (PBPC). Data of 505 patients included in 26 studies were reviewed. About two thirds of these patients had LD (limited disease). Late intensification protocols were used in 311 patients who, however, represented only the 30% of the population initially given conventional chemotherapy. Of the patients not achieving complete remission (CR) after induction, high-dose induced a CR in 39% of the cases. The use of early intensification was reported in 8 studies including 194 patients. The CR rate was 51.5%. Overall, the probability of achieving the CR was 2-3 times higher in LD than in ED (extensive disease). Relapses occurred at the site of the primary in more than half of the cases, showing that the course of the disease was not modified by the use of high-dose chemotherapy. Toxic deaths occurred in 7% of the treated patients, without difference in the two treatment methods. Though the schedules were too variable to draw firm conclusions, the ICE (ifosfamide, carboplatin, etoposide) and the CBP (cyclophosphamide, cisplatin, carmustine) regimens apparently provided better results, with a 2-year survival rate of 30-50% in the LD subset. An european multicenter randomized trial is ongoing. At the present time high-dose chemotherapy is still to be considered experimental treatment, since major problems such as the selection of the patients, doses and timing of chemotherapy and radiotherapy remain unsolved. PMID:12552940

  10. Reporting small bowel dose in cervix cancer high-dose-rate brachytherapy.

    PubMed

    Liao, Yixiang; Dandekar, Virag; Chu, James C H; Turian, Julius; Bernard, Damian; Kiel, Krystyna

    2016-01-01

    Small bowel (SB) is an organ at risk (OAR) that may potentially develop toxicity after radiotherapy for cervix cancer. However, its dose from brachytherapy (BT) is not systematically reported as in other OARs, even with image-guided brachytherapy (IGBT). This study aims to introduce consideration of quantified objectives for SB in BT plan optimization and to evaluate the feasibility of sparing SB while maintaining adequate target coverage. In all, 13 patients were included in this retrospective study. All patients were treated with external beam radiotherapy (EBRT) 45Gy in 25 fractions followed by high dose rate (HDR)-BT boost of 28Gy in 4 fractions using tandem/ring applicator. Magnetic resonance imaging (MRI) and computed tomographic (CT) images were obtained to define the gross tumor volume (GTV), high-risk clinical target volume (HR-CTV) and OARs (rectum, bladder, sigmoid colon, and SB). Treatment plans were generated for each patient using GEC-ESTRO recommendations based on the first CT/MRI. Treatment plans were revised to reduce SB dose when the [Formula: see text] dose to SB was > 5Gy, while maintaining other OAR constraints. For the 7 patients with 2 sets of CT and MRI studies, the interfraction variation of the most exposed SB was analyzed. Plan revisions were done in 6 of 13 cases owing to high [Formula: see text] of SB. An average reduction of 19% in [Formula: see text] was achieved. Meeting SB and other OAR constraints resulted in less than optimal target coverage in 2 patients (D90 of HR-CTV < 77Gyαβ10). The highest interfraction variation was observed for SB at 16 ± 59%, as opposed to 28 ± 27% for rectum and 21 ± 16% for bladder. Prospective reporting of SB dose could provide data required to establish a potential correlation with radiation-induced late complication for SB. PMID:26235549

  11. Finnish spectrolite as high-dose gamma detector

    NASA Astrophysics Data System (ADS)

    Antonio, Patrícia L.; Caldas, Linda V. E.

    2015-11-01

    A natural material called spectrolite, from Finland, was studied in this work. The purpose was to test it in gamma radiation beams to verify its performance as a high-dose detector. From this material, pellets were manufactured with two different concentrations of Teflon and spectrolite, and their responses were verified using two luminescent techniques: thermoluminescence (TL) and optically stimulated luminescence (OSL). The TL and OSL signals were evaluated by means of characterization tests of the material response, after exposure to a nominal absorbed dose interval of 5 Gy to 10 kGy. The results obtained, for both concentrations, showed a good performance of this material in beams of high-dose gamma radiation. Both techniques were utilized in order to investigate the properties of the spectrolite+Teflon samples for different applications.

  12. Low-dose high-resolution CT of lung parenchyma

    SciTech Connect

    Zwirewich, C.V.; Mayo, J.R.; Mueller, N.L. )

    1991-08-01

    To evaluate the efficacy of low-dose high-resolution computed tomography (HRCT) in the assessment of lung parenchyma, three observers reviewed the scans of 31 patients. The 1.5-mm-collimation, 2-second, 120-kVp scans were obtained at 20 and 200 mA at selected identical levels in the chest. The observers evaluated the visualization of normal pulmonary anatomy, various parenchymal abnormalities and their distribution, and artifacts. The low-dose and conventional scans were equivalent in the evaluation of vessels, lobar and segmental bronchi, and anatomy of secondary pulmonary lobules, and in characterizing the extent and distribution of reticulation, honeycomb cysts, and thickened interlobular septa. The low-dose technique failed to demonstrate ground-glass opacity in two of 10 cases (20%) and emphysema in one of nine cases (11%), in which they were evident but subtle on the high-dose scans. These differences were not statistically significant. Linear streak artifact was more prominent on images acquired with the low-dose technique, but the two techniques were judged equally diagnostic in 97% of cases. The authors conclude that HRCT images acquired at 20 mA yield anatomic information equivalent to that obtained with 200-mA scans in the majority of patients, without significant loss of spatial resolution or image degradation due to linear streak artifact.

  13. High-dose Helical Tomotherapy With Concurrent Full-dose Chemotherapy for Locally Advanced Pancreatic Cancer

    SciTech Connect

    Chang, Jee Suk; Wang, Michael L.C.; Koom, Woong Sub; Yoon, Hong In; Chung, Yoonsun; Song, Si Young; Seong, Jinsil

    2012-08-01

    Purpose: To improve poor therapeutic outcome of current practice of chemoradiotherapy (CRT), high-dose helical tomotherapy (HT) with concurrent full-dose chemotherapy has been performed on patients with locally advanced pancreatic cancer (LAPC), and the results were analyzed. Methods and Materials: We retrospectively reviewed 39 patients with LAPC treated with radiotherapy using HT (median, 58.4 Gy; range, 50.8-59.9 Gy) and concomitant chemotherapy between 2006 and 2009. Radiotherapy was directed to the primary tumor with a 0.5-cm margin without prophylactic nodal coverage. Twenty-nine patients (79%) received full-dose (1000 mg/m{sup 2}) gemcitabine-based chemotherapy during HT. After completion of CRT, maintenance chemotherapy was administered to 37 patients (95%). Results: The median follow-up was 15.5 months (range, 3.4-43.9) for the entire cohort, and 22.5 months (range, 12.0-43.9) for the surviving patients. The 1- and 2-year local progression-free survival rates were 82.1% and 77.3%, respectively. Eight patients (21%) were converted to resectable status, including 1 with a pathological complete response. The median overall survival and progression-free survival were 21.2 and 14.0 months, respectively. Acute toxicities were acceptable with no gastrointestinal (GI) toxicity higher than Grade 3. Severe late GI toxicity ({>=}Grade 3) occurred in 10 patients (26%); 1 treatment-related death from GI bleeding was observed. Conclusion: High-dose helical tomotherapy with concurrent full-dose chemotherapy resulted in improved local control and long-term survival in patients with LAPC. Future studies are needed to widen the therapeutic window by minimizing late GI toxicity.

  14. High-dose-rate prostate brachytherapy inverse planning on dose-volume criteria by simulated annealing

    NASA Astrophysics Data System (ADS)

    Deist, T. M.; Gorissen, B. L.

    2016-02-01

    High-dose-rate brachytherapy is a tumor treatment method where a highly radioactive source is brought in close proximity to the tumor. In this paper we develop a simulated annealing algorithm to optimize the dwell times at preselected dwell positions to maximize tumor coverage under dose-volume constraints on the organs at risk. Compared to existing algorithms, our algorithm has advantages in terms of speed and objective value and does not require an expensive general purpose solver. Its success mainly depends on exploiting the efficiency of matrix multiplication and a careful selection of the neighboring states. In this paper we outline its details and make an in-depth comparison with existing methods using real patient data.

  15. High-dose-rate prostate brachytherapy inverse planning on dose-volume criteria by simulated annealing.

    PubMed

    Deist, T M; Gorissen, B L

    2016-02-01

    High-dose-rate brachytherapy is a tumor treatment method where a highly radioactive source is brought in close proximity to the tumor. In this paper we develop a simulated annealing algorithm to optimize the dwell times at preselected dwell positions to maximize tumor coverage under dose-volume constraints on the organs at risk. Compared to existing algorithms, our algorithm has advantages in terms of speed and objective value and does not require an expensive general purpose solver. Its success mainly depends on exploiting the efficiency of matrix multiplication and a careful selection of the neighboring states. In this paper we outline its details and make an in-depth comparison with existing methods using real patient data. PMID:26760757

  16. Ketobemidone may alter busulfan pharmacokinetics during high-dose therapy.

    PubMed

    Hassan, M; Svensson, J O; Nilsson, C; Hentschke, P; Al-Shurbaji, A; Aschan, J; Ljungman, P; Ringdén, O

    2000-08-01

    The authors report a possible interaction between ketobemidone and busulfan during myeloablative treatment of a patient with acute myeloid leukemia. At the time of admission, the patient was receiving ketobemidone 1,000 mg/d as analgesic for a rectal fissure. The patient started conditioning prior to bone marrow transplantation with busulfan (1 mg/kg x 4 for 4 days). High busulfan plasma concentrations were observed after the first dose and the next doses were reduced to 0.7 mg/kg. The kinetics of both drugs revealed that an increase in ketobemidone concentration was followed by an increase in busulfan levels. Substituting ketobemidone with morphine resulted in a decrease in busulfan concentration despite increasing the dose once more to 1 mg/kg. PMID:10942175

  17. Precision, high dose radiotherapy: helium ion treatment of uveal melanoma

    SciTech Connect

    Saunders, W.M.; Char, D.H.; Quivey, J.M.; Castro, J.R.; Chen, G.T.Y.; Collier, J.M.; Cartigny, A.; Blakely, E.A.; Lyman, J.T.; Zink, S.R.

    1985-02-01

    The authors report on 75 patients with uveal melanoma who were treated by placing the Bragg peak of a helium ion beam over the tumor volume. The technique localizes the high dose region very tightly around the tumor volume. This allows critical structures, such as the optic disc and the macula, to be excluded from the high dose region as long as they are 3 to 4 mm away from the edge of the tumor. Careful attention to tumor localization, treatment planning, patient immobilization and treatment verification is required. With a mean follow-up of 22 months (3 to 60 months) the authors have had only five patients with a local recurrence, all of whom were salvaged with another treatment. Pretreatment visual acuity has generally been preserved as long as the tumor edge is at least 4 mm away from the macula and optic disc. The only serious complication to date has been an 18% incidence of neovascular glaucoma in the patients treated at our highest dose level. Clinical results and details of the technique are presented to illustrate potential clinical precision in administering high dose radiotherapy with charged particles such as helium ions or protons.

  18. Radiation Dose Testing on Juno High Voltage Cables

    NASA Technical Reports Server (NTRS)

    Green, Nelson W.; Kirkham, Harold; Kim, Wousik; McAlpine, Bill

    2008-01-01

    The Juno mission to Jupiter will have a highly elliptical orbit taking the spacecraft through the radiation belts surrounding the planet. During these passes through the radiation belts, the spacecraft will be subject to high doses of radiation from energetic electrons and protons with energies ranging from 10 keV to 1 GeV. While shielding within the spacecraft main body will reduce the total absorbed dose to much of the spacecraft electronics, instruments and cables on the outside of the spacecraft will receive much higher levels of absorbed dose. In order to estimate the amount of degradation to two such cables, testing has been performed on two coaxial cables intended to provide high voltages to three of the instruments on Juno. Both cables were placed in a vacuum of 5x10(exp -6) torr and cooled to -50(deg)C prior to exposure to the radiation sources. Measurements of the coaxial capacitance per unit length and partial discharge noise floor indicate that increasing levels of radiation make measurable but acceptably small changes to the F EP Teflon utilized in the construction of these cables. In addition to the radiation dose testing, observations were made on the internal electrostatic charging characteristics of these cables and multiple discharges were recorded.

  19. Radiation Dose Testing on Juno High Voltage Cables

    NASA Technical Reports Server (NTRS)

    Green, Nelson W.; Kirkham, Harold; Kim, Wousik; McAlpine, Bill

    2008-01-01

    The Juno mission to Jupiter will have a highly elliptical orbit taking the spacecraft through the radiation belts surrounding the planet. During these passes through the radiation belts, the spacecraft will be subject to high doses of radiation from energetic electrons and protons with energies ranging from 10 keV to 1 GeV. While shielding within the spacecraft main body will reduce the total absorbed dose to much of the spacecraft electronics, instruments and cables on the outside of the spacecraft will receive much higher levels of absorbed dose. In order to estimate the amount of degradation to two such cables, testing has been performed on two coaxial cables intended to provide high voltages to three of the instruments on Juno. Both cables were placed in a vacuum of 5x10-6 torr and cooled to -50 C prior to exposure to the radiation sources. Measurements of the coaxial capacitance per unit length and partial discharge noise floor indicate that increasing levels of radiation make measurable but acceptably small changes to the F EP Teflon utilized in the construction of these cables. In addition to the radiation dose testing, observations were made on the internal electrostatic charging characteristics of these cables and multiple discharges were recorded.

  20. The Acute Gastrointestinal Syndrome in High-Dose Irradiated Mice

    PubMed Central

    Booth, Catherine; Tudor, Gregory; Tudor, Julie; Katz, Barry P; MacVittie, Thomas

    2012-01-01

    The most detailed reports of the response of the gastrointestinal system to high dose acute radiation have focused mainly on understanding the histopathology. However, to enable medical countermeasure assessment under the animal rule criteria, it is necessary to have a robust model in which the relationship between radiation dose and intestinal radiation syndrome incidence, timing and severity are established and correlated with histopathology. Although many mortality studies have been published, they have used a variety of mouse strains, ages, radiation sources and husbandry conditions, all of which influence the dose response. Further, it is clear that the level of bone marrow irradiation and supportive care can influence endpoints. In order to create robust baseline data we have generated dose response data in adult male mice, maintained under identical conditions, and exposed to either total or partial-body irradiation. Partial-body irradiation includes both extensive (40%) and minimal (5%) bone marrow sparing models, the latter designed to correlate with an established primate model and allow assessment of effects of any medical countermeasure on all three major radiation syndromes (intestinal, bone marrow and lung) in the surviving mice. Lethal dose (LD30, LD50 and LD70) data are described in the various models, along with the impact of enteric flora and response to supportive care. Correlation with diarrhea severity and histopathology are also described. This data can be used to aid the design of good laboratory practice (GLP) compliant Animal Rule studies that are reflective of the conditions following accidental radiation exposure. PMID:23091876

  1. High dose calibrations at the pacific northwest laboratory

    NASA Astrophysics Data System (ADS)

    McDonald, J. C.; Fox, R. A.

    1989-04-01

    he need is increasing for both high radiation exposures and calibration measurements that provide traceability of such exposures to national standards. The applications of high exposures include: electronic component damage studies, sterilization of medical products and food irradiation. Accurate high exposure measurements are difficult to obtain and cannot, in general, be carried out with a single dose measurement system or technique because of the wide range of doses and the variety of materials involved. This paper describes the dosimetric measurement and calibration techniques used at the Pacific Northwest Laboratory (PNL) that make use of radiochromic dye films, thermoluminescence dosimeters (TLDs), ionization chambers and calorimetric dosimeters. The methods used to demonstrate the consistency of PNL calibrations with national standards will also be discussed.

  2. Hardening electronic devices against very high total dose radiation environments

    NASA Technical Reports Server (NTRS)

    Buchanan, B.; Shedd, W.; Roosild, S.; Dolan, R.

    1972-01-01

    The possibilities and limitations of hardening silicon semiconductor devices to the high neutron and gamma radiation levels and greater than 10 to the eighth power rads required for the NERVA nuclear engine development are discussed. A comparison is made of the high dose neutron and gamma hardening potential of bipolar, metal insulator semiconductors and junction field effect transistors. Experimental data is presented on device degradation for the high neutron and gamma doses. Previous data and comparisons indicate that the JFET is much more immune to the combined neutron displacement and gamma ionizing effects than other transistor types. Experimental evidence is also presented which indicates that p channel MOS devices may be able to meet the requirements.

  3. Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe

    PubMed Central

    Garcia, Maristela Magnavita Oliveira; Varela, Carolina Garcez; Silva, Patricia Fontes; Lima, Paulo Roberto Passos; Góes, Paulo Meira; Rodrigues, Marilia Galeffi; Silva, Maria de Lourdes Lima Souza e; Ladeia, Ana Marice Teixeira; Guimarães, Armênio Costa; Correia, Luis Claudio Lemos

    2016-01-01

    Background The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. Objective To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. Methods Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. Results The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. Conclusion The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms. PMID:27142792

  4. High-dose secondary calibration laboratory accreditation program

    SciTech Connect

    Humphreys, J.C.

    1993-12-31

    There is a need for high-dose secondary calibration laboratories to serve the multi-billion dollar radiation processing industry. This need is driven by the desires of industry for less costly calibrations and faster calibration-cycle response time. Services needed include calibration irradiations of routine processing dosimeters and the supply of reference standard transfer dosimeters for irradiation in the production processing facility. In order to provide measurement quality assurance and to demonstrate consistency with national standards, the high-dose secondary laboratories would be accredited by means of an expansion of an existing National Voluntary Laboratory Accreditation Program. A laboratory performance criteria document is under development to implement the new program.

  5. High-dose thiamine as initial treatment for Parkinson's disease

    PubMed Central

    Costantini, Antonio; Pala, Maria Immacolata; Compagnoni, Laura; Colangeli, Marco

    2013-01-01

    Parkinson's disease (PD) is a systemic disease with motor and non-motor deficits. We recruited three patients with newly diagnosed PD. They were not under anti-Parkinson's therapy. Plasmatic thiamine was within healthy reference range. We performed the Unified Parkinson's Disease Rating Scale (UPDRS) and started a parenteral therapy with high doses of thiamine. The therapy led to a considerable improvement in the motor part of the UPDRS ranging from 31.3% to 77.3%. From this clinical observation, it is reasonable to infer that a focal, severe thiamine deficiency due to a dysfunction of thiamine metabolism could cause a selective neuronal damage in the centres that are typically hit in this disease. Injection of high doses of thiamine was effective in reversing the symptoms, suggesting that the abnormalities in thiamine-dependent processes could be overcome by diffusion-mediated transport at supranormal thiamine concentrations. PMID:23986125

  6. PLUTONIUM/HIGH-LEVEL VITRIFIED WASTE BDBE DOSE CALCULATION

    SciTech Connect

    J.A. Ziegler

    2000-11-20

    The purpose of this calculation is to provide a dose consequence analysis of high-level waste (HLW) consisting of plutonium immobilized in vitrified HLW to be handled at the proposed Monitored Geologic Repository at Yucca Mountain for a beyond design basis event (BDBE) under expected conditions using best estimate values for each calculation parameter. In addition to the dose calculation, a plutonium respirable particle size for dose calculation use is derived. The current concept for this waste form is plutonium disks enclosed in cans immobilized in canisters of vitrified HLW (i.e., glass). The plutonium inventory at risk used for this calculation is selected from Plutonium Immobilization Project Input for Yucca Mountain Total Systems Performance Assessment (Shaw 1999). The BDBE examined in this calculation is a nonmechanistic initiating event and the sequence of events that follow to cause a radiological release. This analysis will provide the radiological releases and dose consequences for a postulated BDBE. Results may be considered in other analyses to determine or modify the safety classification and quality assurance level of repository structures, systems, and components. This calculation uses best available technical information because the BDBE frequency is very low (i.e., less than 1.0E-6 events/year) and is not required for License Application for the Monitored Geologic Repository. The results of this calculation will not be used as part of a licensing or design basis.

  7. High-dose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high.

    PubMed

    Hernández-Vanegas, Laura E; Jara-Prado, Aurelio; Ochoa, Adriana; Rodríguez Y Rodríguez, Nayelli; Durón, Reyna M; Crail-Meléndez, Daniel; Alonso, Ma Elisa; Delgado-Escueta, Antonio V; Martínez-Juárez, Iris E

    2016-08-01

    Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy accounting for 3-12% of adult cases of epilepsy. Valproate has proven to be the first-choice drug in JME for controlling the most common seizure types: myoclonic, absence, and generalized tonic-clonic (GTC). In this retrospective study, we analyzed seizure outcome in patients with JME using valproate monotherapy for a minimum period of one year. Low valproate dose was considered to be 1000mg/day or lower, while serum levels were considered to be low if they were at or below 50mcg/dl. One hundred three patients met the inclusion criteria. Fifty-six patients (54.4%) were female. The current average age was 28.4±7.4years, while the age of epilepsy onset was 13.6±2.9years. Most patients corresponded to the subsyndrome of classic JME. Forty-six (44.7%) patients were free from all seizure types, and 76 (73.7%) patients were free from GTC seizures. No significant difference was found in seizure freedom among patients using a low dose of valproate versus a high dose (p=0.535) or among patients with low blood levels versus high blood levels (p=0.69). In patients with JME, it seems appropriate to use low doses of valproate (500mg to 1000mg) for initial treatment and then to determine if freedom from seizures was attained. PMID:27300146

  8. High-Dose Intravenous Corticosteroids for Ocular Inflammatory Diseases

    PubMed Central

    Charkoudian, Leon D.; Ying, Gui-shuang; Pujari, Siddharth S.; Gangaputra, Sapna; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Kempen, John H.

    2011-01-01

    Purpose To evaluate the effectiveness and risk of complications of high-dose intravenous pulsed corticosteroids for non-infectious ocular inflammatory diseases. Methods Retrospective cohort study. One hundred four eyes of seventy patients who received high-dose intravenous corticosteroids for treatment of active ocular inflammation were identified from five centers. The main outcome measures were control of inflammation and occurrence of ocular or systemic complications within one month after treatment. Results Within ≤1 month of starting treatment, 57% of eyes achieved complete control of inflammation (95% confidence interval (CI): 33-83%), improving to 82% when near-complete control was included (95% CI: 61-96%). Most eyes (85%; 95% CI: 70-95%) gained clinically significant improvement in anterior chamber inflammation. One patient developed a colon perforation during treatment. No other major complications were recorded. Conclusions Treatment of ocular inflammation with high-dose intravenous corticosteroids resulted in substantial clinical improvement for most cases within one month. Complications of therapy were infrequent. PMID:22409561

  9. Measurement of absorbed dose to water around an electronic brachytherapy source. Comparison of two dosimetry systems: lithium formate EPR dosimeters and radiochromic EBT2 film

    NASA Astrophysics Data System (ADS)

    Adolfsson, Emelie; White, Shane; Landry, Guillaume; Lund, Eva; Gustafsson, Håkan; Verhaegen, Frank; Reniers, Brigitte; Carlsson Tedgren, Åsa; Alm Carlsson, Gudrun

    2015-05-01

    Interest in high dose rate (HDR) electronic brachytherapy operating at 50 kV is increasing. For quality assurance it is important to identify dosimetry systems that can measure the absorbed doses in absolute terms which is difficult in this energy region. In this work a comparison is made between two dosimetry systems, EPR lithium formate dosimeters and radiochromic EBT2 film. Both types of dosimeters were irradiated simultaneously in a PMMA phantom using the Axxent EBS. Absorbed dose to water was determined at distances of 10 mm, 30 mm and 50 mm from the EBS. Results were traceable to different primary standards as regards to absorbed dose to water (EPR) and air kerma (EBT2). Monte Carlo simulations were used in absolute terms as a third estimate of absorbed dose to water. Agreement within the estimated expanded (k = 2) uncertainties (5% (EPR), 7% (EBT2)) was found between the results at 30 mm and 50 mm from the x-ray source. The same result was obtained in 4 repetitions of irradiation, indicating high precision in the measurements with both systems. At all distances, agreement between EPR and Monte Carlo simulations was shown as was also the case for the film measurements at 30mm and 50mm. At 10mm the geometry for the film measurements caused too large uncertainty in measured values depending on the exact position (within sub-mm distances) of the EBS and the 10 mm film results were exculded from comparison. This work has demonstrated good performance of the lithium formate EPR dosimetry system in accordance with earlier experiments at higher photon energies (192Ir HDR brachytherapy). It was also highlighted that there might be issues regarding the energy dependence and intrinsic efficiency of the EBT2 film that need to be considered for measurements using low energy sources.

  10. SU-E-T-315: The Change of Optically Stimulated Luminescent Dosimeters (OSLDs) Sensitivity by Accumulated Dose and High Dose

    SciTech Connect

    Han, S; Jung, H; Kim, M; Ji, Y; Kim, K; Choi, S; Park, S; Yoo, H; Yi, C

    2014-06-01

    Purpose: The objective of this study is to evaluate radiation sensitivity of optical stimulated luminance dosimeters (OSLDs) by accumulated dose and high dose. Methods: This study was carried out in Co-60 unit (Theratron 780, AECL, and Canada) and used InLight MicroStar reader (Landauer, Inc., Glenwood, IL) for reading. We annealed for 30 min using optical annealing system which contained fluorescent lamps (Osram lumilux, 24 W, 280 ∼780 nm). To evaluate change of OSLDs sensitivity by repeated irradiation, the dosimeters were repeatedly irradiated with 1 Gy. And whenever a repeated irradiation, we evaluated OSLDs sensitivity. To evaluate OSLDs sensitivity after accumulated dose with 5 Gy, We irradiated dose accumulatively (from 1 Gy to 5 Gy) without annealing. And OSLDs was also irradiated with 15, 20, 30 Gy to certify change of OSLDs sensitivity after high dose irradiation. After annealing them, they were irradiated with 1Gy, repeatedly. Results: The OSLDs sensitivity increased up to 3% during irradiating seven times and decreased continuously above 8 times. That dropped by about 0.35 Gy per an irradiation. Finally, after 30 times irradiation, OSLDs sensitivity decreased by about 7%. For accumulated dose from 1 Gy to 5 Gy, OSLDs sensitivity about 1 Gy increased until 4.4% after second times accumulated dose compared with before that. OSLDs sensitivity about 1 Gy decreased by 1.6% in five times irradiation. When OSLDs were irradiated ten times with 1Gy after irradiating high dose (10, 15, 20 Gy), OSLDs sensitivity decreased until 6%, 9%, 12% compared with it before high dose irradiation, respectively. Conclusion: This study certified OSLDs sensitivity by accumulated dose and high dose. When irradiated with 1Gy, repeatedly, OSLDs sensitivity decreased linearly and the reduction rate of OSLDs sensitivity after high dose irradiation had dependence on irradiated dose.

  11. The estimation of low-dose hazards by extrapolation from high doses.

    PubMed

    Rossi, H H

    1981-01-01

    Empirical information on the effects of low doses of ionizing radiation is beset by severe limitations. Theoretical considerations of biophysics can guide the analysis of epidemiological data by indicating certain dose-response relations or eliminating others. Thus, it can be shown that at low doses there must be proportionality between dose and effect on non-interacting cells and that one must anticipate different dose-effect relations upon exposure to markedly different types of radiation. PMID:7336764

  12. High-dose neutron irradiation performance of dielectric mirrors

    SciTech Connect

    Nimishakavi Anantha Phani Kiran Kumar; Leonard, Keith J.; Jellison, Jr., Gerald Earle; Snead, Lance Lewis

    2015-05-01

    The study presents the high-dose behavior of dielectric mirrors specifically engineered for radiation-tolerance: alternating layers of Al2O3/SiO2 and HfO2/SiO2 were grown on sapphire substrates and exposed to neutron doses of 1 and 4 dpa at 458 10K in the High Flux Isotope Reactor (HFIR). In comparison to previously reported results, these higher doses of 1 and 4 dpa results in a drastic drop in optical reflectance, caused by a failure of the multilayer coating. HfO2/SiO2 mirrors failed completely when exposed to 1 dpa, whereas the reflectance of Al2O3/SiO2 mirrors reduced to 44%, eventually failing at 4 dpa. Transmission electron microscopy (TEM) observation of the Al2O3/SiO2 specimens showed SiO2 layer defects which increases size with irradiation dose. The typical size of each defect was 8 nm in 1 dpa and 42 nm in 4 dpa specimens. Buckling type delamination of the interface between the substrate and first layer was typically observed in both 1 and 4 dpa HfO2/SiO2 specimens. Composition changes across the layers were measured in high resolution scanning-TEM mode using energy dispersive spectroscopy. A significant interdiffusion between the film layers was observed in Al2O3/SiO2 mirror, though less evident in HfO2/SiO2 system. Lastly, the ultimate goal of this work is the provide insight into the radiation-induced failure mechanisms of these mirrors.

  13. High-dose neutron irradiation performance of dielectric mirrors

    DOE PAGESBeta

    Nimishakavi Anantha Phani Kiran Kumar; Leonard, Keith J.; Jellison, Jr., Gerald Earle; Snead, Lance Lewis

    2015-05-01

    The study presents the high-dose behavior of dielectric mirrors specifically engineered for radiation-tolerance: alternating layers of Al2O3/SiO2 and HfO2/SiO2 were grown on sapphire substrates and exposed to neutron doses of 1 and 4 dpa at 458 10K in the High Flux Isotope Reactor (HFIR). In comparison to previously reported results, these higher doses of 1 and 4 dpa results in a drastic drop in optical reflectance, caused by a failure of the multilayer coating. HfO2/SiO2 mirrors failed completely when exposed to 1 dpa, whereas the reflectance of Al2O3/SiO2 mirrors reduced to 44%, eventually failing at 4 dpa. Transmission electron microscopymore » (TEM) observation of the Al2O3/SiO2 specimens showed SiO2 layer defects which increases size with irradiation dose. The typical size of each defect was 8 nm in 1 dpa and 42 nm in 4 dpa specimens. Buckling type delamination of the interface between the substrate and first layer was typically observed in both 1 and 4 dpa HfO2/SiO2 specimens. Composition changes across the layers were measured in high resolution scanning-TEM mode using energy dispersive spectroscopy. A significant interdiffusion between the film layers was observed in Al2O3/SiO2 mirror, though less evident in HfO2/SiO2 system. Lastly, the ultimate goal of this work is the provide insight into the radiation-induced failure mechanisms of these mirrors.« less

  14. High dose rate intraluminal irradiation in recurrent endobronchial carcinoma

    SciTech Connect

    Seagren, S.L.; Harrell, J.H.; Horn, R.A.

    1985-12-01

    Palliative therapy for previously irradiated patients with symptomatic recurrent endobronchial malignancy is a difficult problem. We have had the opportunity to treat 20 such patients with high dose rate (50-100 rad/min) endobronchial brachytherapy. Eligible patients had received previous high dose thoracic irradiation (TDF greater than or equal to 90), a performance status of greater than or equal to 50, and symptoms caused by a bronchoscopically defined and implantable lesion. The radiation is produced by a small cobalt-60 source (0.7 Ci) remotely afterloaded by cable control. The source is fed into a 4 mm diameter catheter which is placed with bronchoscopic guidance; it may oscillate if necessary to cover the lesion. A dose of 1,000 rad at 1 cm from the source is delivered. We have performed 22 procedures in 20 patients, four following YAG laser debulking. Most had cough, some with hemoptysis. Eight had dyspnea secondary to obstruction and three had obstructive pneumonitis. In 12, symptoms recurred with a mean time to recurrence of 4.3 months (range 1-9 months). Eighteen patients were followed-up and reexamined via bronchoscope 1-2.5 months following the procedure; two were lost to follow-up. All had at least 50 percent clearance of tumor, and six had complete clearance; most regressions were documented on film or videotape. In six, the palliation was durable. The procedure has been well tolerated with no toxicity. We conclude that palliative endobronchial high dose rate brachytherapy is a useful palliative modality in patients with recurrent endobronchial symptomatic carcinoma.

  15. Mortality risk coefficients for radiation-induced cancer at high doses and dose-rates, and extrapolation to the low dose domain.

    PubMed

    Liniecki, J

    1989-01-01

    Risk coefficients for life-long excessive mortality due to radiation-induced cancers are presented, as derived in 1988 by the U.N. Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), principally on the basis of follow-up from A-bomb survivors in Japan, over the period from 1950 through 1985. The data are based on the new, revised dosimetry (DS 86) in the two cities, and reflect the effects of high and intermediate doses of basically low LET radiation delivered instantaneously. The author presents arguments relevant to the extrapolation of the risk to the low dose (dose rate) domain, as outlined by UNSCEAR in its 1986, and the NCRP (USA) in its 1980, (no 64), reports. The arguments are based on models and dose-response relationships for radiation action, derived from data on cellular radiobiology, animal experiments on radiation-induced cancers and life shortening, as well as the available limited human epidemiological evidence. The available information points to the lower effectiveness of sparsely ionizing radiation at low doses and low dose-rates, as compared with that observed for high, acutely delivered doses. The possible range of the reduction values (DREF) is presented. For high LET radiations, the evidence is less extensive and sometimes contradictory; however, it does not point to a reduction of the effectiveness at low doses/dose-rates, relative to the high dose domain. Practical consequences of these facts are considered. PMID:2489419

  16. Toward high-contrast breast CT at low radiation dose.

    PubMed

    Keyriläinen, Jani; Fernández, Manuel; Karjalainen-Lindsberg, Marja-Liisa; Virkkunen, Pekka; Leidenius, Marjut; von Smitten, Karl; Sipilä, Petri; Fiedler, Stefan; Suhonen, Heikki; Suortti, Pekka; Bravin, Alberto

    2008-10-01

    This study was approved by the local research ethics committee, and patient informed consent was obtained. The purpose of this study was to demonstrate that high-spatial-resolution low-dose analyzer-based x-ray computed tomography (CT) can substantially improve the radiographic contrast of breast tissue in vitro when compared with that attained by using diagnostic mammography and CT. An excised human breast tumor was examined by using analyzer-based x-ray imaging with synchrotron radiation. The correspondence between analyzer-based x-ray images and diagnostic mammograms, CT images, and histopathologic findings was determined. Calcifications and fine details of soft tissue, which are at the contrast detection limit on diagnostic mammograms, are clearly visible on planar analyzer-based x-ray images. Analyzer-based x-ray CT yields high contrast from smoothly varying internal structures, such as tumorous mass lesions, corresponding to information on actual structures seen at histopathologic analysis. The mean glandular dose of 1.9 mGy in analyzer-based x-ray CT is approximately equivalent to the dose administered during single-view screening mammography. The improved visibility of mammographically indistinguishable lesions in vitro suggests that analyzer-based x-ray CT may be a valuable method in radiographic evaluation of the breast, thereby justifying further investigations. PMID:18796684

  17. Evaluation of High Performance Converters Under Low Dose Rate Total Ionizing Dose (TID) Testing for NASA Programs

    NASA Technical Reports Server (NTRS)

    Sharma, Ashok K.; Sahu, Kusum

    1998-01-01

    This paper reports the results of low dose rate (0.01-0.18 rads(Si)/sec) total ionizing dose (TID) tests performed on several types of high performance converters. The parts used in this evaluation represented devices such as a high speed flash converter, a 16-bit ADC and a voltage-to-frequency converter.

  18. High doses of corticosteroids in the treatment of septic shock.

    PubMed

    Hellman, A; Alestig, K

    1985-01-01

    High doses of corticosteroids are reported to be beneficial in the treatment of septic shock in many animal species, e.g. dog, rat and rabbit. Recent findings in baboons subjected to E. coli shock indicate that early treatment with a combination of antibiotics and steroids strongly enhance survival rate. In clinical studies the protective effects of steroids are more ambiguous, however. In part this may be explained by variations in the amount of steroids used or by the fact that in some studies the steroid is administered late in shock. The dose recommended, 30 mg/kg bw of methylprednisolone or an equivalent amount of another glucocorticoid given once or twice, is based on animal as well as clinical documentation. PMID:3911703

  19. High dose bystander effects in spatially fractionated radiation therapy

    PubMed Central

    Asur, Rajalakshmi; Butterworth, Karl T.; Penagaricano, Jose A.; Prise, Kevin M.; Griffin, Robert J.

    2014-01-01

    Traditional radiotherapy of bulky tumors has certain limitations. Spatially fractionated radiation therapy (GRID) and intensity modulated radiotherapy (IMRT) are examples of advanced modulated beam therapies that help in significant reductions in normal tissue damage. GRID refers to the delivery of a single high dose of radiation to a large treatment area that is divided into several smaller fields, while IMRT allows improved dose conformity to the tumor target compared to conventional three-dimensional conformal radiotherapy. In this review, we consider spatially fractionated radiotherapy approaches focusing on GRID and IMRT, and present complementary evidence from different studies which support the role of radiation induced signaling effects in the overall radiobiological rationale for these treatments. PMID:24246848

  20. Effect of tissue composition on dose distribution in brachytherapy with various photon emitting sources

    PubMed Central

    Ghorbani, Mahdi; Salahshour, Fateme; Haghparast, Abbas; Knaup, Courtney

    2014-01-01

    Purpose The aim of this study is to compare the dose in various soft tissues in brachytherapy with photon emitting sources. Material and methods 103Pd, 125I, 169Yb, 192Ir brachytherapy sources were simulated with MCNPX Monte Carlo code, and their dose rate constant and radial dose function were compared with the published data. A spherical phantom with 50 cm radius was simulated and the dose at various radial distances in adipose tissue, breast tissue, 4-component soft tissue, brain (grey/white matter), muscle (skeletal), lung tissue, blood (whole), 9-component soft tissue, and water were calculated. The absolute dose and relative dose difference with respect to 9-component soft tissue was obtained for various materials, sources, and distances. Results There was good agreement between the dosimetric parameters of the sources and the published data. Adipose tissue, breast tissue, 4-component soft tissue, and water showed the greatest difference in dose relative to the dose to the 9-component soft tissue. The other soft tissues showed lower dose differences. The dose difference was also higher for 103Pd source than for 125I, 169Yb, and 192Ir sources. Furthermore, greater distances from the source had higher relative dose differences and the effect can be justified due to the change in photon spectrum (softening or hardening) as photons traverse the phantom material. Conclusions The ignorance of soft tissue characteristics (density, composition, etc.) by treatment planning systems incorporates a significant error in dose delivery to the patient in brachytherapy with photon sources. The error depends on the type of soft tissue, brachytherapy source, as well as the distance from the source. PMID:24790623

  1. Time-resolved in vivo luminescence dosimetry for online error detection in pulsed dose-rate brachytherapy

    SciTech Connect

    Andersen, Claus E.; Nielsen, Soeren Kynde; Lindegaard, Jacob Christian; Tanderup, Kari

    2009-11-15

    Purpose: The purpose of this study is to present and evaluate a dose-verification protocol for pulsed dose-rate (PDR) brachytherapy based on in vivo time-resolved (1 s time resolution) fiber-coupled luminescence dosimetry. Methods: Five cervix cancer patients undergoing PDR brachytherapy (Varian GammaMed Plus with {sup 192}Ir) were monitored. The treatments comprised from 10 to 50 pulses (1 pulse/h) delivered by intracavitary/interstitial applicators (tandem-ring systems and/or needles). For each patient, one or two dosimetry probes were placed directly in or close to the tumor region using stainless steel or titanium needles. Each dosimeter probe consisted of a small aluminum oxide crystal attached to an optical fiber cable (1 mm outer diameter) that could guide radioluminescence (RL) and optically stimulated luminescence (OSL) from the crystal to special readout instrumentation. Positioning uncertainty and hypothetical dose-delivery errors (interchanged guide tubes or applicator movements from {+-}5 to {+-}15 mm) were simulated in software in order to assess the ability of the system to detect errors. Results: For three of the patients, the authors found no significant differences (P>0.01) for comparisons between in vivo measurements and calculated reference values at the level of dose per dwell position, dose per applicator, or total dose per pulse. The standard deviations of the dose per pulse were less than 3%, indicating a stable dose delivery and a highly stable geometry of applicators and dosimeter probes during the treatments. For the two other patients, the authors noted significant deviations for three individual pulses and for one dosimeter probe. These deviations could have been due to applicator movement during the treatment and one incorrectly positioned dosimeter probe, respectively. Computer simulations showed that the likelihood of detecting a pair of interchanged guide tubes increased by a factor of 10 or more for the considered patients when

  2. High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review

    PubMed Central

    Das, Rashmi Ranjan; Sankar, Jhuma; Dev, Nishanth

    2015-01-01

    Though snake antivenom (SAV) is the mainstay of therapy for poisonous snake bites, there is no universally accepted standard regimen regarding the optimum dose (low vs. high). We therefore, undertook this systematic review to address this important research question. We searched all the published literature through the major electronic databases till August 2014. Randomized clinical trials (RCTs) were included. Eligible trials compared low versus high dose SAV in poisonous snake bite. The review has been registered at PROSPERO (Registration number: CRD42014009700). Of 36 citations retrieved, a total of 5 RCTs (n = 473) were included in the final analyses. Three trials were open-label, 4 conducted in Indian sub-continent and 1 in Brazil. The doses of SAV varied in the high dose group from 40 ml to 550 ml, and in the low dose group from 20 ml to 220 ml. There was no significant difference between the two groups for any of the outcomes except duration of hospital stay, which was lower in the low dose group. The GRADE evidence generated was of “very low quality.” Low-dose SAV is equivalent or may be superior to high-dose SAV in management of poisonous snake bite. Low dose is also highly cost-effective as compared to the high dose. But the GRADE evidence generated was of “very low quality” as most were open label trials. Further trials are needed to make definitive recommendations regarding the dose and these should also include children <9 years of age. PMID:26195860

  3. High-dose enzyme replacement therapy in murine Hurler syndrome.

    PubMed

    Ou, Li; Herzog, Tyler; Koniar, Brenda L; Gunther, Roland; Whitley, Chester B

    2014-02-01

    Mucopolysaccharidosis type I (MPS I) is an autosomal recessive disease that is systemic, including progressive neurodegeneration, mental retardation and death before the age of 10 years. MPS I results from deficiency of α-L-iduronidase (IDUA) in lysosomes and subsequent accumulation of glycosaminoglycans (GAG). Clinical enzyme replacement therapy (ERT) with intravenous laronidase reverses some aspects of MPS I disease (e.g., hepatomegaly, splenomegaly, glycosaminoglycanuria) and ameliorates others (e.g., pulmonary function, cardiac disease, arthropathy, exercise tolerance). However, neurologic benefits are thought to be negligible because the blood-brain barrier (BBB) blocks enzyme from reaching the central nervous system (CNS). We considered the possibility that a very high dose of intravenous laronidase might be able to traverse the BBB in small quantities, and provide some metabolic correction in the brain. To address this question, high-dose laronidase was administered (11.6 mg/kg, once per week, 4 weeks) to adult MPS I mice. IDUA enzyme activity in the cortex of treated mice increased to 97% of that in wild type mice (p<0.01). GAG levels in cortex were reduced by 63% of that from untreated MPS I mice (p<0.05). Further, immunohistochemical analysis showed that treatment reduced secondary GM3-ganglioside accumulation in treated MPS I mice. Water T-maze tests showed that the learning abnormality in MPS I mice was reduced (p<0.0001). In summary, repeated, high-dose ERT facilitated laronidase transit across the BBB, reduced GAG accumulation within the CNS, and rescued cognitive impairment. PMID:24100243

  4. On carbon nitride synthesis at high-dose ion implantation

    NASA Astrophysics Data System (ADS)

    Romanovsky, E. A.; Bespalova, O. V.; Borisov, A. M.; Goryaga, N. G.; Kulikauskas, V. S.; Sukharev, V. G.; Zatekin, V. V.

    1998-04-01

    Rutherford backscattering spectrometry was used for the study of high dose 35 keV nitrogen ions implantation into graphites and glassy carbon. Quantitative data on depth profiles and its dependencies on irradiation fluence and ion beam density were obtained. The stationary dome-shaped depth profile with maximum nitrogen concentration 22-27 at.% and half-width more than twice exceeding projected range of ions is reached at fluence Φ ˜10 18 cm -2. The dependence of the maximum concentration in the profile on ion current density was studied. The largest concentration was obtained at reduced ion current density.

  5. Cation disorder in high-dose, neutron-irradiated spinel

    SciTech Connect

    Sickafus, K.E.; Larson, A.C.; Yu, N.

    1995-04-01

    The objective of this effort is to determine whether MgAl{sub 2}O{sub 4} spinel is a suitable ceramic for fusion applications. The crystal structures of MgAl{sub 2}O{sub 4} spinel single crystals irradiated to high neutron fluences [>5{times}10{sup 26} n/m{sup 2} (E{sub n}>0.1 MeV)] were examined by neutron diffraction. Crystal structure refinement of the highese dose sample indicated that the average scattering strength of the tetrahedral crystal sites decreased by {approx}20% while increasing by {approx}8% on octahedral sites.

  6. High dose calcitriol may reduce thrombosis in cancer patients.

    PubMed

    Beer, Tomasz M; Venner, Peter M; Ryan, Christopher W; Petrylak, Daniel P; Chatta, Gurkamal; Dean Ruether, J; Chi, Kim N; Curd, John G; DeLoughery, Thomas G

    2006-11-01

    The incidence of venous and arterial thrombosis in a placebo-controlled randomised trial of DN-101 (high dose calcitriol) with docetaxel versus docetaxel was compared. Of the 13 thrombotic events observed in the 250 patients enroled in this study, two occurred in DN-101 and 11 in placebo-treated patients (P = 0.01). This difference remained significant after adjustment for baseline history of thrombosis, atrial fibrillation and use of anti-thrombotic agents. In vitro and vitamin D receptor (VDR) knockout mouse studies predict that nanomolar concentrations of calcitriol may act as an antithrombotic agent. We report the first clinical observation that supports this hypothesis in humans. PMID:16984385

  7. Pharmacokinetic interaction between high-dose methotrexate and oxacillin.

    PubMed

    Titier, Karine; Lagrange, Fabrice; Péhourcq, Fabienne; Moore, Nicholas; Molimard, Mathieu

    2002-08-01

    An 18-year-old man received two high-dose methotrexate cycles for the treatment of an osteosarcoma. Fifteen grams of methotrexate were infused over 6 hours. During the second cycle, co-administration of oxacillin (1g/8h) resulted in prolonged and marked elevation of methotrexate plasma concentrations. The patient experienced acute toxicity with renal failure, myelosuppression, mucitis, fever, and dermatologic abnormalities. After an initial improvement with folinic acid rescue and hemodialysis, the patient died. Oxacillin may thus inhibit the elimination of methotrexate. PMID:12142645

  8. Effects of moderate-dose versus high-dose trimethoprim on serum creatinine and creatinine clearance and adverse reactions.

    PubMed Central

    Naderer, O; Nafziger, A N; Bertino, J S

    1997-01-01

    The effects of a 10-day course of moderate-dose (10 mg/kg/day) or high-dose (20 mg/kg/day) trimethoprim therapy on serum creatinine, measured creatinine clearance, urinary creatinine excretion, and serum folate were studied in 20 healthy volunteers. Serum creatinine concentrations increased significantly during trimethoprim therapy, began to decrease near day 10, and returned to baseline during the washout phase at both dosage levels. At the same time, measured creatinine clearance and urine creatinine changed in the opposite direction. No clinical or statistical differences were noted between changes in the moderate- versus the high-dose phases. Serum folate concentration decreases during high-dose trimethoprim therapy were statistically significant. Adverse drug reactions in the two groups were statistically different during the first study period, with the high-dose group having a 75% incidence rate and the moderate-dose group having an 11% incidence rate (P < 0.02). Serum creatinine, measured creatinine clearance, and urinary creatinine excretion demonstrated statistically, but not clinically, significant changes during trimethoprim therapy. In addition, high-dose trimethoprim caused significantly more adverse drug reactions than moderate-dose trimethoprim in normal volunteers. PMID:9371351

  9. Characterization of power transistors as high dose dosimeters

    NASA Astrophysics Data System (ADS)

    Fuochi, P. G.; Lavalle, M.; Corda, U.; Kovacs, A.; Peimel-Stuglik, Z.; Gombia, E.

    2009-02-01

    A bipolar transistor, previously investigated as a possible radiation dosimeter and tested under industrial irradiation conditions in high-activity gamma and high-energy, high-power electron beam facilities has been subjected to stability test in order to understand its behaviour and help to improve its performances. Charge carrier lifetime was measured for several sets of transistors which were then irradiated with various doses (3-60 kGy): seven sets with 60Co gamma rays and eight with a 10 MeV electron beam. After irradiation all the transistors were measured and each set was divided into three groups: one group was left untreated, the second group was heated at 100 °C for 30 minutes and the third group was heated at 150 °C for 30 minutes, for testing the stability of the lifetime. Our data showed that heat treatment quite successfully eliminates post-irradiation changes in the response. Response measurements of the irradiated transistors, heat-treated and untreated, were carried out at room temperature over several weeks after irradiation to establish post-irradiation stability and assess if these transistors could be used for recording dose history. Calibration curves in the range 3-60 kGy for the thermally treated and untreated devices are presented. Dependence of the response of the transistors on the temperature of the measurements in the range 20-50 °C is reported.

  10. The susceptibility of TaOx-based memristors to high dose rate ionizing radiation and total ionizing dose

    DOE PAGESBeta

    McLain, Michael Lee; Sheridan, Timothy J.; Hjalmarson, Harold Paul; Mickel, Patrick R.; Hanson, Donald J.; McDonald, Joseph K.; Hughart, David Russell; Marinella, Matthew J.

    2014-11-11

    This paper investigates the effects of high dose rate ionizing radiation and total ionizing dose (TID) on tantalum oxide (TaOx) memristors. Transient data were obtained during the pulsed exposures for dose rates ranging from approximately 5.0 ×107 rad(Si)/s to 4.7 ×108 rad(Si)/s and for pulse widths ranging from 50 ns to 50 μs. The cumulative dose in these tests did not appear to impact the observed dose rate response. Static dose rate upset tests were also performed at a dose rate of ~3.0 ×108 rad(Si)/s. This is the first dose rate study on any type of memristive memory technology. Inmore » addition to assessing the tolerance of TaOx memristors to high dose rate ionizing radiation, we also evaluated their susceptibility to TID. The data indicate that it is possible for the devices to switch from a high resistance off-state to a low resistance on-state in both dose rate and TID environments. The observed radiation-induced switching is dependent on the irradiation conditions and bias configuration. Furthermore, the dose rate or ionizing dose level at which a device switches resistance states varies from device to device; the enhanced susceptibility observed in some devices is still under investigation. As a result, numerical simulations are used to qualitatively capture the observed transient radiation response and provide insight into the physics of the induced current/voltages.« less

  11. Anti-angiogenic effect of high doses of ascorbic acid

    PubMed Central

    Mikirova, Nina A; Ichim, Thomas E; Riordan, Neil H

    2008-01-01

    Pharmaceutical doses of ascorbic acid (AA, vitamin C, or its salts) have been reported to exert anticancer activity in vitro and in vivo. One proposed mechanism involves direct cytotoxicity mediated by accumulation of ascorbic acid radicals and hydrogen peroxide in the extracellular environment of tumor cells. However, therapeutic effects have been reported at concentrations insufficient to induce direct tumor cell death. We hypothesized that AA may exert anti-angiogenic effects. To test this, we expanded endothelial progenitor cells (EPCs) from peripheral blood and assessed, whether or not high dose AA would inhibit EPC ability to migrate, change energy metabolism, and tube formation ability. We also evaluated the effects of high dose AA on angiogenic activities of HUVECs (human umbilical vein endothelial cells) and HUAECs (human umbilical arterial endothelial cells). According to our data, concentrations of AA higher than 100 mg/dl suppressed capillary-like tube formation on Matrigel for all cells tested and the effect was more pronounced for progenitor cells in comparison with mature cells. Co-culture of differentiated endothelial cells with progenitor cells showed that there was incorporation of EPCs in vessels formed by HUVECs and HUAECs. Cell migration was assessed using an in vitro wound healing model. The results of these experiments showed an inverse correlation between AA concentrations relative to both cell migration and gap filling capacity. Suppression of NO (nitric oxide) generation appeared to be one of the mechanisms by which AA mediated angiostatic effects. This study supports further investigation into non-cytotoxic antitumor activities of AA. PMID:18789157

  12. [Clinical trials of ultra-high-dose methylcobalamin in ALS].

    PubMed

    Izumi, Yuishin; Kaji, Ryuji

    2007-10-01

    Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder affecting both upper and lower motor neurons. Weakness may begin in the legs, hands, proximal arms, or pharynx. The course is relentless and progressive without remissions, relapses, or even stable plateaus. There is no effective drug therapy for ALS, although riluzole has been shown to prolong life in sufferers, without tracheostomy. A vitamin B12 analog, methylcobalamin, has a protective effect on cultured cortical neurons against glutamate-induced cytotoxicity. We have shown the ultra-high-dose methylcobalamin (25 mg/day i.m.) slows down the progressive reduction of the CMAP (compound muscle action potential) amplitudes in ALS in the short term (4 weeks). The latencies of SSR (sympathetic skin response) were shorter after treatment (50 mg/day i.v., 2 weeks). In the long-term effect of methylcobalamin (50 mg/day i.m., twice a week), the survival time (or the period to become respirator-bound) was significantly longer in the treated group than in the untreated. Larger-scale randomized double blind trial was started in Japan in order to evaluate the long-term efficacy and the safety of ultra-high-dose methylcobalamin for sporadic or familial cases of ALS. PMID:17969354

  13. Total rod ERG suppression with high dose compassionate Fenretinide usage.

    PubMed

    Marmor, Michael F; Jain, Atul; Moshfeghi, Darius

    2008-11-01

    Fenretinide is a synthetic retinoid that interferes with the attachment of retinol to retinol binding protein. It may inhibit accumulation of A2E and lipofuscin, and is proposed as therapy for Stargardt disease. It is currently used for cancer therapy, and mild depression of rod function and dark adaptation is a side effect at standard dosage. We studied two youngsters (aged between 12 and 13) receiving high doses as compassionate treatment for neuroblastoma: 800 mg daily for 1 out of every 3 weeks, for roughly 2 years. Goldmann-Weekers dark adaptometry, ISCEV standard ERG and mfERG were performed, and blood was analyzed for vitamin A. Neither child complained of night blindness or showed retinal fundus abnormalities. On initial exam, dark adaptation thresholds were elevated by 3 log units, and there were no detectable rod ERG responses. However, cone responses and mfERG were normal. Retesting one subject 3 months after stopping the drug revealed normal rod thresholds (slightly delayed) and low normal rod ERG responses. Serum vitamin A levels were normal from both subjects, but there is no record of whether the samples were drawn during cycles on or off drug. Our study demonstrates that high dose Fenretinide can suppress rod function quite completely, although serum vitamin A and rod function apparently return to normal or near normal levels rapidly once the drug is stopped. It is intriguing that cone function and access to vitamin A seems largely independent of Fenretinide effects on retinol availability. PMID:18523815

  14. High Dose-Rate Versus Low Dose-Rate Brachytherapy for Lip Cancer

    SciTech Connect

    Ghadjar, Pirus; Bojaxhiu, Beat; Simcock, Mathew; Terribilini, Dario; Isaak, Bernhard; Gut, Philipp; Wolfensberger, Patrick; Broemme, Jens O.; Geretschlaeger, Andreas; Behrensmeier, Frank; Pica, Alessia; Aebersold, Daniel M.

    2012-07-15

    Purpose: To analyze the outcome after low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy for lip cancer. Methods and Materials: One hundred and three patients with newly diagnosed squamous cell carcinoma of the lip were treated between March 1985 and June 2009 either by HDR (n = 33) or LDR brachytherapy (n = 70). Sixty-eight patients received brachytherapy alone, and 35 received tumor excision followed by brachytherapy because of positive resection margins. Acute and late toxicity was assessed according to the Common Terminology Criteria for Adverse Events 3.0. Results: Median follow-up was 3.1 years (range, 0.3-23 years). Clinical and pathological variables did not differ significantly between groups. At 5 years, local recurrence-free survival, regional recurrence-free survival, and overall survival rates were 93%, 90%, and 77%. There was no significant difference for these endpoints when HDR was compared with LDR brachytherapy. Forty-two of 103 patients (41%) experienced acute Grade 2 and 57 of 103 patients (55%) experienced acute Grade 3 toxicity. Late Grade 1 toxicity was experienced by 34 of 103 patients (33%), and 5 of 103 patients (5%) experienced late Grade 2 toxicity; no Grade 3 late toxicity was observed. Acute and late toxicity rates were not significantly different between HDR and LDR brachytherapy. Conclusions: As treatment for lip cancer, HDR and LDR brachytherapy have comparable locoregional control and acute and late toxicity rates. HDR brachytherapy for lip cancer seems to be an effective treatment with acceptable toxicity.

  15. High-dose processing and application to Korean space foods

    NASA Astrophysics Data System (ADS)

    Song, Beom-Seok; Park, Jin-Gyu; Park, Jae-Nam; Han, In-Jun; Choi, Jong-il; Kim, Jae-Hun; Byun, Myung-Woo; Kang, Sang-Wook; Choi, Gi-Hyuk; Lee, Ju-Woon

    2009-07-01

    Nutrition bar, Ramen (ready-to-cook noodle), and two Korean traditional foods ( Kimchi, fermented vegetable; Sujeonggwa, cinnamon beverage) have been developed as space foods using high-dose gamma irradiation. Addition of calcium lactate and vitamin C, a mild heating, deep-freezing, and gamma irradiation at 25 kGy were conducted to prepare Kimchi as a ready-to-eat space food. Sterilization of Space Kimchi (SK) was confirmed by a microbiological test. The hardness of the Space Kimchi was lower than the untreated Kimchi (CON), but higher than the irradiated only Kimchi. Sensory attributes of the SK were similar to CON, and maintained during preservation at 35 °C for 30 days. The optimal doses for eliminating the contaminated microbes and maintaining the qualities of the Nutrition bars, Ramen, and Sujeonggwa were determined at 15, 10 and 6 kGy, respectively. All the Korean space food were certificated for use in space flight conditions of 30 days by the Russian Institute for Biomedical Problems.

  16. High dose intravenous ciprofloxacin in febrile neutropenic patients.

    PubMed

    Johnson, P R; Yin, J A; Tooth, J A

    1990-12-01

    We have evaluated the use of high-dose intravenous ciprofloxacin as monotherapy in the empirical therapy of febrile episodes in neutropenic patients during the course of a randomized trial comparing ciprofloxacin with a standard combination regimen. Sixty-four episodes of fever were studied in a high risk population of 42 patients mostly undergoing intensive chemotherapy for leukaemia. Ciprofloxacin achieved clinical responses as follows: completely successful in 39%, partially successful in 20%, and unsuccessful in 41%. Infections were microbiologically documented in 37 (58%), with Gram-positive bacteria (of which 37% were coagulase negative staphylococci and 34% were streptococci) accounting for 81% of all organisms cultured. Responses in documented infections were as follows; completely successful in 32%, partially successful in 27%, and unsuccessful in 41%. One infection-related death occurred 30 h after starting ciprofloxacin, and a further three patients died before the resolution of neutropenia. The early death was caused by fulminant infection with a ciprofloxacin-resistant Pseudomonas aeruginosa. No other ciprofloxacin resistance was seen amongst eight Gram-negative isolates. There was no evidence of emerging ciprofloxacin resistance during the course of the study. Ciprofloxacin was associated with a low incidence of adverse events with skin rash (five cases) and nausea (one case) being reported as possibly or probably related to ciprofloxacin. We conclude that high-dose intravenous ciprofloxacin may be safely employed as monotherapy in the empirical treatment of febrile episodes in neutropenic patients. It has the additional advantages of twice daily administration, the availability of intravenous and oral presentations, and absence of cross-allergy in beta-lactam antibiotic hypersensitive patients. PMID:2292537

  17. Correlation of Point B and Lymph Node Dose in 3D-Planned High-Dose-Rate Cervical Cancer Brachytherapy

    SciTech Connect

    Lee, Larissa J.; Sadow, Cheryl A.; Russell, Anthony; Viswanathan, Akila N.

    2009-11-01

    Purpose: To compare high dose rate (HDR) point B to pelvic lymph node dose using three-dimensional-planned brachytherapy for cervical cancer. Methods and Materials: Patients with FIGO Stage IB-IIIB cervical cancer received 70 tandem HDR applications using CT-based treatment planning. The obturator, external, and internal iliac lymph nodes (LN) were contoured. Per fraction (PF) and combined fraction (CF) right (R), left (L), and bilateral (Bil) nodal doses were analyzed. Point B dose was compared with LN dose-volume histogram (DVH) parameters by paired t test and Pearson correlation coefficients. Results: Mean PF and CF doses to point B were R 1.40 Gy +- 0.14 (CF: 7 Gy), L 1.43 +- 0.15 (CF: 7.15 Gy), and Bil 1.41 +- 0.15 (CF: 7.05 Gy). The correlation coefficients between point B and the D100, D90, D50, D2cc, D1cc, and D0.1cc LN were all less than 0.7. Only the D2cc to the obturator and the D0.1cc to the external iliac nodes were not significantly different from the point B dose. Significant differences between R and L nodal DVHs were seen, likely related to tandem deviation from irregular tumor anatomy. Conclusions: With HDR brachytherapy for cervical cancer, per fraction nodal dose approximates a dose equivalent to teletherapy. Point B is a poor surrogate for dose to specific nodal groups. Three-dimensional defined nodal contours during brachytherapy provide a more accurate reflection of delivered dose and should be part of comprehensive planning of the total dose to the pelvic nodes, particularly when there is evidence of pathologic involvement.

  18. Improvements in dose calculation accuracy for small off-axis targets in high dose per fraction tomotherapy

    SciTech Connect

    Hardcastle, Nicholas; Bayliss, Adam; Wong, Jeannie Hsiu Ding; Rosenfeld, Anatoly B.; Tome, Wolfgang A.

    2012-08-15

    Purpose: A recent field safety notice from TomoTherapy detailed the underdosing of small, off-axis targets when receiving high doses per fraction. This is due to angular undersampling in the dose calculation gantry angles. This study evaluates a correction method to reduce the underdosing, to be implemented in the current version (v4.1) of the TomoTherapy treatment planning software. Methods: The correction method, termed 'Super Sampling' involved the tripling of the number of gantry angles from which the dose is calculated during optimization and dose calculation. Radiochromic film was used to measure the dose to small targets at various off-axis distances receiving a minimum of 21 Gy in one fraction. Measurements were also performed for single small targets at the center of the Lucy phantom, using radiochromic film and the dose magnifying glass (DMG). Results: Without super sampling, the peak dose deficit increased from 0% to 18% for a 10 mm target and 0% to 30% for a 5 mm target as off-axis target distances increased from 0 to 16.5 cm. When super sampling was turned on, the dose deficit trend was removed and all peak doses were within 5% of the planned dose. For measurements in the Lucy phantom at 9.7 cm off-axis, the positional and dose magnitude accuracy using super sampling was verified using radiochromic film and the DMG. Conclusions: A correction method implemented in the TomoTherapy treatment planning system which triples the angular sampling of the gantry angles used during optimization and dose calculation removes the underdosing for targets as small as 5 mm diameter, up to 16.5 cm off-axis receiving up to 21 Gy.

  19. High-Dose Atomoxetine Treatment of ADHD in Youths with Limited Response to Standard Doses

    ERIC Educational Resources Information Center

    Kratochvil, Christopher J.; Michelson, David; Newcorn, Jeffrey H.; Weiss, Margaret D.; Busner, Joan; Moore, Rodney J.; Ruff, Dustin D.; Ramsey, Janet; Dickson, Ruth; Turgay, Atilla; Saylor, Keith E.; Luber, Stephen; Vaughan, Brigette; Allen, Albert J.

    2007-01-01

    Objective: To assess the utility and tolerability of higher than standard atomoxetine doses to treat attention-deficit/hyperactivity disorder (ADHD). Method: Two randomized, double-blind trials of atomoxetine nonresponders ages 6 to 16 years were conducted comparing continued treatment with same-dose atomoxetine to treatment using greater than…

  20. High-dose thiamine improves the symptoms of fibromyalgia.

    PubMed

    Costantini, Antonio; Pala, Maria Immacolata; Tundo, Silvia; Matteucci, Pietro

    2013-01-01

    Living with fibromyalgia means living with chronic pain, fatigue, sleep disorders and other associated key symptoms. To date, pharmacotherapy generally produces modest benefits. Some observations indicate that the large majority of symptoms of fibromyalgia could be the clinical manifestation of a mild thiamine deficiency due to a dysfunction of the active transport of thiamine from the blood to the mitochondria or to enzymatic abnormalities. Between June and July 2011, we recruited three female patients affected by fibromyalgia. We proceeded with the study of the patients' history, a physical examination, an evaluation of chronic widespread pain using the Visual Numeric Scale and an evaluation of the fatigue using the Fatigue Severity Scale were also performed. The levels of thiamine and thiamine pyrophosphate in the blood were determined. After the therapy with high doses of thiamine, in the patients, there was an appreciable improvement of the symptoms. PMID:23696141

  1. High-dose thiamine improves the symptoms of Friedreich's ataxia

    PubMed Central

    Costantini, Antonio; Giorgi, Rafaela; D'Agostino, Sonia; Pala, Maria Immacolata

    2013-01-01

    Friedreich's ataxia (FRDA) is an autosomal recessive inherited disorder characterised by progressive gait and limb ataxia, dysarthria, areflexia, loss of position sense and a progressive motor weakness of central origin. Some observations indicate that all symptoms of FRDA ataxia could be the manifestation of a thiamine deficiency because of enzymatic abnormalities. Two patients with FRDA were under rehabilitative treatment from February 2012 to February 2013. The scale for assessment and rating of ataxia was performed. The patient began an intramuscular therapy with 100 mg of thiamine every 3–5  days. Injection of high-dose thiamine was effective in reversing the motor failure. From this clinical observation, it is reasonable to infer that a thiamine deficiency due to enzymatic abnormalities could cause a selective neuronal damage in the centres that are typically affected by this disease. PMID:23704441

  2. High dose thiamine improves fatigue in multiple sclerosis

    PubMed Central

    Costantini, Antonio; Nappo, Agostino; Pala, Maria Immacolata; Zappone, Antonietta

    2013-01-01

    The majority of the patients with multiple sclerosis (MS) experience fatigue. Some observations indicate that fatigue and related manifestations concomitant with MS could be associated with an intracellular mild thiamine deficiency. We recruited 15 patients with MS who also experience fatigue and assessed the severity of the fatigue using the Fatigue Severity Scale. Although blood thiamine and thiamine pyrophosphate levels were within normal limit in all the patients, high-dose thiamine therapy administered orally or parenterally led to an appreciable improvement of the fatigue. The absence of apparent decrease in blood thiamine despite the presence of symptoms referable to a mild thiamine deficiency suggests that these patients may have a dysfunction of the mechanisms of intracellular transport or structural enzymatic abnormalities. The administration of large quantities of thiamine was effective in reversing the fatigue in MS, suggesting that the abnormalities in thiamine-dependent processes could be overcome by diffusion-mediated transport at supranormal thiamine concentrations. PMID:23861280

  3. High-dose thiamine improves the symptoms of fibromyalgia

    PubMed Central

    Costantini, Antonio; Pala, Maria Immacolata; Tundo, Silvia; Matteucci, Pietro

    2013-01-01

    Living with fibromyalgia means living with chronic pain, fatigue, sleep disorders and other associated key symptoms. To date, pharmacotherapy generally produces modest benefits. Some observations indicate that the large majority of symptoms of fibromyalgia could be the clinical manifestation of a mild thiamine deficiency due to a dysfunction of the active transport of thiamine from the blood to the mitochondria or to enzymatic abnormalities. Between June and July 2011, we recruited three female patients affected by fibromyalgia. We proceeded with the study of the patients’ history, a physical examination, an evaluation of chronic widespread pain using the Visual Numeric Scale and an evaluation of the fatigue using the Fatigue Severity Scale were also performed. The levels of thiamine and thiamine pyrophosphate in the blood were determined. After the therapy with high doses of thiamine, in the patients, there was an appreciable improvement of the symptoms. PMID:23696141

  4. Oxidation of silicon implanted with high-dose aluminum

    SciTech Connect

    Yang, Zunde; Du, Honghua; Withrow, S.P.

    1994-12-31

    Si(100) wafers were implanted with Al at 500 C to high doses at multi-energies and were oxidized in 1 atm flowing oxygen at 1000-1200 C. Morphology, structure, and oxidation behavior of the implanted and oxidized Si were studied using optical microscopy, atomic force microscopy, and cross-sectional transmission electron microscopy in conjunction with selected area electron diffraction and energy dispersive x-ray analysis. Large Al precipitates were formed and embedded near the surface region of the implanted Si. Oxidation rate of the Al-implanted Si wafers was lower than that of virgin Si. The unique morphology of the implanted Si results from rpaid Al diffusion and segregation promoted by hot implantation. Reduction of the oxidation rate of Si by Al implantation is attributed to preferential oxidation of Al and formation of a continuous diffusion barrier of Al{sub 2}O{sub 3}.

  5. Dose Response for Chromosome Aberrations in Human Lymphocytes and Fibroblasts After Exposure to Very Low Dose of High Let Radiation

    NASA Technical Reports Server (NTRS)

    Hada, M.; George, K.; Chappell, L.; Cucinotta, F. A.

    2011-01-01

    The relationship between biological effects and low doses of absorbed radiation is still uncertain, especially for high LET radiation exposure. Estimates of risks from low-dose and low-dose-rates are often extrapolated using data from Japanese atomic bomb survivor with either linear or linear quadratic models of fit. In this study, chromosome aberrations were measured in human peripheral blood lymphocytes and normal skin fibroblasts cells after exposure to very low dose (0.01 - 0.20 Gy) of 170 MeV/u Si-28 ions or 600 MeV/u Fe-56 ions, including doses where on average less than one direct ion traversal per cell nucleus occurs. Chromosomes were analyzed using the whole-chromosome fluorescence in situ hybridization (FISH) technique during the first cell division after irradiation, and chromosome aberrations were identified as either simple exchanges (translocations and dicentrics) or complex exchanges (involving >2 breaks in 2 or more chromosomes). The responses for doses above 0.1 Gy (more than one ion traverses a cell) showed linear dose responses. However, for doses less than 0.1 Gy, both Si-28 ions and Fe-56 ions showed a dose independent response above background chromosome aberrations frequencies. Possible explanations for our results are non-targeted effects due to aberrant cell signaling [1], or delta-ray dose fluctuations [2] where a fraction of cells receive significant delta-ray doses due to the contributions of multiple ion tracks that do not directly traverse cell nuclei where chromosome aberrations are scored.

  6. Absorbed dose simulations in near-surface regions using high dose rate Iridium-192 sources applied for brachytherapy

    NASA Astrophysics Data System (ADS)

    Moura, E. S.; Zeituni, C. A.; Sakuraba, R. K.; Gonçalves, V. D.; Cruz, J. C.; Júnior, D. K.; Souza, C. D.; Rostelato, M. E. C. M.

    2014-02-01

    Brachytherapy treatment with Iridium-192 high dose rate (HDR) sources is widely used for various tumours and it could be developed in many anatomic regions. Iridium-192 sources are inserted inside or close to the region that will be treated. Usually, the treatment is performed in prostate, gynaecological, lung, breast and oral cavity regions for a better clinical dose coverage compared with other techniques, such as, high energy photons and Cobalt-60 machines. This work will evaluate absorbed dose distributions in near-surface regions around Ir-192 HDR sources. Near-surface dose measurements are a complex task, due to the contribution of beta particles in the near-surface regions. These dose distributions should be useful for non-tumour treatments, such as keloids, and other non-intracavitary technique. For the absorbed dose distribution simulations the Monte Carlo code PENELOPE with the general code penEasy was used. Ir-192 source geometry and a Polymethylmethacrylate (PMMA) tube, for beta particles shield were modelled to yield the percentage depth dose (PDD) on a cubic water phantom. Absorbed dose simulations were realized at the central axis to yield the Ir-192 dose fall-off along central axis. The results showed that more than 99.2% of the absorbed doses (relative to the surface) are deposited in 5 cm depth but with slower rate at higher distances. Near-surface treatments with Ir-192 HDR sources yields achievable measurements and with proper clinical technique and accessories should apply as an alternative for treatment of lesions where only beta sources were used.

  7. Volumetric (3D) bladder dose parameters are more reproducible than point (2D) dose parameters in vaginal vault high-dose-rate brachytherapy

    PubMed Central

    Sapienza, Lucas Gomes; Flosi, Adriana; Aiza, Antonio; de Assis Pellizzon, Antonio Cassio; Chojniak, Rubens; Baiocchi, Glauco

    2016-01-01

    There is no consensus on the use of computed tomography in vaginal cuff brachytherapy (VCB) planning. The purpose of this study was to prospectively determine the reproducibility of point bladder dose parameters (DICRU and maximum dose), compared with volumetric-based parameters. Twenty-two patients who were treated with high-dose-rate (HDR) VCB underwent simulation by computed tomography (CT-scan) with a Foley catheter at standard tension (position A) and extra tension (position B). CT-scan determined the bladder ICRU dose point in both positions and compared the displacement and recorded dose. Volumetric parameters (D0.1cc, D1.0cc, D2.0cc, D4.0cc and D50%) and point dose parameters were compared. The average spatial shift in ICRU dose point in the vertical, longitudinal and lateral directions was 2.91 mm (range: 0.10–9.00), 12.04 mm (range: 4.50–24.50) and 2.65 mm (range: 0.60–8.80), respectively. The DICRU ratio for positions A and B was 1.64 (p < 0.001). Moreover, a decrease in Dmax was observed (p = 0.016). Tension level of the urinary catheter did not affect the volumetric parameters. Our data suggest that point parameters (DICRU and Dmax) are not reproducible and are not the ideal choice for dose reporting. PMID:27296459

  8. 'In vivo' Dose Measurements in High-Dose-Rate Brachytherapy Treatments for Cervical Cancer: A Project Proposal

    SciTech Connect

    Reynoso Mejia, C. A.; Buenfil Burgos, A. E.; Ruiz Trejo, C.; Mota Garcia, A.; Trejo Duran, E.; Rodriguez Ponce, M.; Gamboa de Buen, I.

    2010-12-07

    The aim of this thesis project is to compare doses calculated from the treatment planning system using computed tomography images, with those measured 'in vivo' by using thermoluminescent dosimeters placed at different regions of the rectum and bladder of a patient during high-dose-rate intracavitary brachytherapy treatment of uterine cervical carcinoma. The experimental dosimeters characterisation and calibration have concluded and the protocol to carry out the 'in vivo' measurements has been established. In this work, the calibration curves of two types of thermoluminescent dosimeters (rods and chips) are presented, and the proposed protocol to measure the 'in vivo' dose is fully described.

  9. Formation of vanadium silicide by high dose ion implantation

    NASA Astrophysics Data System (ADS)

    Salvi, V. P.; Narsale, A. M.; Vidwans, S. V.; Rangwala, A. A.; Guzman, L.; Dapor, M.; Giunta, G.; Calliari, L.; Marchetti, F.

    1987-10-01

    The vanadium silicide system has been found to be of increasing interest because one of the silicide phases viz. V 3Si with the A-15 structure is often accompanied by a high temperature superconductivity. We have studied the formation of vanadium silicide layers by high dose ion implantation. 30 keV 51V + ions were implanted at room temperature onto thermally evaporated a-Si films on thermally grown SiO 2 substrates. The samples were annealed in vacuum to study the possible evolution of V-Si phases. Both Seeman-Bohlin X-ray diffraction and Auger/sputter profiling techniques were used to analyse these samples. The observed Auger depth profile of the annealed samples shows a more uniform vanadium distribution as compared to the vanadium distribution in as-implanted samples, along with the changes in the Si L 2,3VV lineshape. The X-ray diffraction results show the formation of V 3Si, V 5Si 3 and VSi 2 phases. After annealing the sample in vacuum, a more ordered growth of V 3Si phase is found to be accompanied by an increase in VSi 2 phase. This has been related to the possible changes ocurring in the a-Si layers due to annealing of the sample.

  10. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

    PubMed Central

    McHugh, Stephen M; Kolarczyk, Lavinia; Lang, Robert S; Wei, Lawrence M; Jose, Marquez; Subramaniam, Kathirvel

    2016-01-01

    Background and Aims: Tranexamic acid (TA) is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG) surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB) via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit) and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit) groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05) between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB. PMID:27013747

  11. Dose-dependent high-resolution electron ptychography

    NASA Astrophysics Data System (ADS)

    D'Alfonso, A. J.; Allen, L. J.; Sawada, H.; Kirkland, A. I.

    2016-02-01

    Recent reports of electron ptychography at atomic resolution have ushered in a new era of coherent diffractive imaging in the context of electron microscopy. We report and discuss electron ptychography under variable electron dose conditions, exploring the prospects of an approach which has considerable potential for imaging where low dose is needed.

  12. SU-E-T-636: Investigation of Dose Variation in High Dose Radiation Brachytherapy

    SciTech Connect

    Hyvarinen, M; Leventouri, T; Casey, C; Long, S; Pella, S; Dumitru, N; Herrera, R

    2014-06-15

    Purpose: The purpose of this study is to revise most of the HDR types of treatments with their applicators and their localization challenges. Since every millimeter of misplacement counts the study will look into the necessity of increasing the immobilization for several types of applicators Methods: The study took over 136 plans generated by the treatment planning system (TPS) looking into the applicator's placement in regard to the organs at risk (OR) and simulated the three possible displacements at the hottest dose point on the critical organ for several accessories to evaluate the variation of the delivered dose at the point due to the displacement. Results: Significant dose variation was obtained for the Contura, Savi, MLM and Prostate applicators. Conclusion: This study data indicates that an improvement of the immobilization devices for HDR is absolutely necessary. Better applicator fixation devices are required too. Developing new immobilization devices for all the applicators is recommended. Florida Atlantic University may provide Travel reimbursements.

  13. Dose Response for Chromosome Aberrations in Human Lymphocytes and Fibroblasts after Exposure to Very Low Doses of High LET Radiation

    NASA Technical Reports Server (NTRS)

    Hada, M.; George, Kerry; Cucinotta, Francis A.

    2011-01-01

    The relationship between biological effects and low doses of absorbed radiation is still uncertain, especially for high LET radiation exposure. Estimates of risks from low-dose and low-dose-rates are often extrapolated using data from Japanese atomic bomb survivors with either linear or linear quadratic models of fit. In this study, chromosome aberrations were measured in human peripheral blood lymphocytes and normal skin fibroblasts cells after exposure to very low dose (1-20 cGy) of 170 MeV/u Si-28- ions or 600 MeV/u Fe-56-ions. Chromosomes were analyzed using the whole chromosome fluorescence in situ hybridization (FISH) technique during the first cell division after irradiation, and chromosome aberrations were identified as either simple exchanges (translocations and dicentrics) or complex exchanges (involving greater than 2 breaks in 2 or more chromosomes). The curves for doses above 10 cGy were fitted with linear or linear-quadratic functions. For Si-28- ions no dose response was observed in the 2-10 cGy dose range, suggesting a non-target effect in this range.

  14. Efficacy of a single high dose versus multiple low doses of LLLT on wounded skin fibroblasts

    NASA Astrophysics Data System (ADS)

    Hawkins, Denise H.; Abrahamse, Heidi

    2007-07-01

    Background/purpose: In vivo studies have demonstrated that phototherapy accelerates wound healing in the clinical environment; however the exact mechanism is still not completely understood. The main focus of this study was to use in vitro laboratory results to establish an effective treatment regimen that may be practical and applicable to the clinical environment. This in vitro study aimed to compare the cellular responses of wounded fibroblasts following a single exposure of 5 J/cm2 or multiple exposures of low doses (2.5 J/cm2 or 5 J/cm2) on one day of the week to a single application of a higher dose (16 J/cm2) on day 1 and day 4. Methodology: Cellular responses to Helium-Neon (632.8 nm) laser irradiation were evaluated by measuring changes in cell morphology, cell viability, cell proliferation, membrane integrity and DNA damage. Results: Wounded cells exposed to 5 J/cm2 on day 1 and day 4 showed an increase in cell viability, increase in the release of bFGF, increase in cell density, decrease in ALP enzyme activity and decrease in caspase 3/7 activity indicating a stimulatory effect. Wounded cells exposed to three doses of 5 J/cm2 on day 1 showed a decrease in cell viability and cell proliferation and an increase in LDH cytotoxicity and DNA damage indicating an inhibitory effect. Conclusion: Results indicate that cellular responses are influenced by the combination of dose administered, number of exposures and time between exposures. Single doses administered with sufficient time between exposures is more beneficial to restoring cell function than multiple doses within a short period. Although this work confirms previous reports on the cumulative effect of laser irradiation it provides essential information for the initiation of in vivo clinical studies.

  15. Age-specific inhalation radiation dose commitment factors for selected radionuclides

    SciTech Connect

    Strenge, D.L.; Peloquin, R.A.; Baker, D.A.

    1982-08-01

    Inhalation dose commitment factors are presented for selected radionuclides for exposure of individuals in four age groups: infant, child, teen and adult. Radionuclides considered are /sup 35/S, /sup 36/Cl, /sup 45/Ca, /sup 67/Ga, /sup 75/Se, /sup 85/Sr, /sup 109/Cd, /sup 113/Sn, /sup 125/I, /sup 133/Ba, /sup 170/Tm, /sup 169/Yb, /sup 182/Ta, /sup 192/Ir, /sup 198/Au, /sup 201/Tl, /sup 204/Tl, and /sup 236/Pu. The calculational method is based on the human metabolic model of ICRP as defined in Publication 2 (ICRP 1959) and as used in previous age-specific dose factor calculations by Hoenes and Soldat (1977). Dose commitment factors are presented for the following organs of reference: total body, bone, liver, kidney, thyroid, lung and lower large intestine.

  16. High Doses of Fish Oil Might Help Healing After Heart Attack

    MedlinePlus

    ... Doses of Fish Oil Might Help Healing After Heart Attack Study found improved heart function, less scarring To ... 2, 2016 MONDAY, Aug. 1, 2016 (HealthDay News) -- Heart attack patients who took high doses of fish oil ...

  17. Efficacy and Safety of Single and Double Doses of Ivermectin versus 7-Day High Dose Albendazole for Chronic Strongyloidiasis

    PubMed Central

    Suputtamongkol, Yupin; Premasathian, Nalinee; Bhumimuang, Kid; Waywa, Duangdao; Nilganuwong, Surasak; Karuphong, Ekkapun; Anekthananon, Thanomsak; Wanachiwanawin, Darawan; Silpasakorn, Saowaluk

    2011-01-01

    , and double doses of oral ivermectin respectively (P = 0.006) in modified intention to treat analysis. No serious adverse event associated with treatment was found in any of the groups. Conclusion/Significance This study confirms that both a single, and a double dose of oral ivermectin taken two weeks apart, is more effective than a 7-day course of high dose albendazole for patients with chronic infection due to S. stercoralis. Double dose of ivermectin, taken two weeks apart, might be more effective than a single dose in patients with concomitant illness. Trial Registration ClinicalTrials.gov NCT00765024 PMID:21572981

  18. Treatment of myasthenia gravis with high-dose intravenous immunoglobulin.

    PubMed

    Cosi, V; Lombardi, M; Piccolo, G; Erbetta, A

    1991-08-01

    We treated 37 patients affected by autoimmune generalized myasthenia gravis (MG) with high-dose intravenous gammaglobulin (HDIVIg), 400 mg/kg per day on 5 consecutive days. A one-degree improvement of Oosterhuis global clinical classification of myasthenic severity (OGCCMS), the disappearance of bulbar involvement or both were recorded 12 days after the beginning of the treatment in 70.3% of the patients and persisted up to 60 days in 58.7%. A two-degree improvement of OGCCMS was recorded in 54.1% of the patients and it was maintained up to 60 days in 37.8%. The percentage of improvement did not significantly differ between patients entering the treatment in a long-standing, drug-refractory stationary phase of the illness (n = 26) and patients who received HDIVIg in an acute phase of MG (n = 11). None of the patients experienced side effects. Our data indicates that HDIVIg is an interesting, virtually riskless therapeutic choice for MG patients, and allows the planning of a controlled trial versus plasma-exchange. PMID:1950455

  19. High-Dose Resveratrol Supplementation in Obese Men

    PubMed Central

    Poulsen, Morten M.; Vestergaard, Poul F.; Clasen, Berthil F.; Radko, Yulia; Christensen, Lars P.; Stødkilde-Jørgensen, Hans; Møller, Niels; Jessen, Niels; Pedersen, Steen B.; Jørgensen, Jens Otto L.

    2013-01-01

    Obesity, diabetes, hypertension, and hyperlipidemia constitute risk factors for morbidity and premature mortality. Based on animal and in vitro studies, resveratrol reverts these risk factors via stimulation of silent mating type information regulation 2 homolog 1 (SIRT1), but data in human subjects are scarce. The objective of this study was to examine the metabolic effects of high-dose resveratrol in obese human subjects. In a randomized, placebo-controlled, double-blinded, and parallel-group design, 24 obese but otherwise healthy men were randomly assigned to 4 weeks of resveratrol or placebo treatment. Extensive metabolic examinations including assessment of glucose turnover and insulin sensitivity (hyperinsulinemic euglycemic clamp) were performed before and after the treatment. Insulin sensitivity, the primary outcome measure, deteriorated insignificantly in both groups. Endogenous glucose production and the turnover and oxidation rates of glucose remained unchanged. Resveratrol supplementation also had no effect on blood pressure; resting energy expenditure; oxidation rates of lipid; ectopic or visceral fat content; or inflammatory and metabolic biomarkers. The lack of effect disagrees with persuasive data obtained from rodent models and raises doubt about the justification of resveratrol as a human nutritional supplement in metabolic disorders. PMID:23193181

  20. Wernicke's encephalopathy in a child with high dose thiamine therapy

    PubMed Central

    Park, So Won; Yi, Yoon Young; Han, Jung Woo; Kim, Heung Dong; Lee, Joon Soo

    2014-01-01

    Wernicke's encephalopathy is an acute neurological disorder characterized by mental confusion, oculomotor dysfunction, and ataxia. It has been reported in individuals with alcohol dependence, hyperemesis gravidarum, and prolonged parenteral nutrition without vitamin supplementation. Here we present the case of a 13-year-old male patient with neuroblastoma and a history of poor oral intake and nausea for 3 months. After admission, he showed gait disturbances, nystagmus, and excessive dizziness; his mental state, however, indicated he was alert, which did not fit the classical triad of Wernicke's encephalopathy. A diagnosis of Wernicke's encephalopathy was made only after brain magnetic resonance imaging and serum thiamine level analyses were performed. The patient's symptoms remained after 5 days of treatment with 100-mg thiamine once daily; thus, we increased the dosage to 500 mg 3 times daily, 1,500 mg per day. His symptoms then improved after 20 days of replacement therapy. This case report describes a pediatric patient who was promptly diagnosed with Wernicke's encephalopathy, despite only 2 suspicious symptoms, and who completely recovered after high doses of thiamine were given intravenously. PMID:25550705

  1. The application of high dose food irradiation in South Africa

    NASA Astrophysics Data System (ADS)

    de Bruyn, Ingrid Nine

    2000-03-01

    During the 1950s to the end of the 1970s the United States Army developed the basic methodology to produce shelf-stable irradiated meat, seafood and poultry products. These products are normally packed without gravy, sauce or brine, as liquid is not required to sterilize the product as in the canning process. This leads to the distinctive "dried cooked" taste normally associated with roasts opposed to the casserole taste usually associated with tinned meats. The Biogam group at the Atomic Energy Corporation of South Africa is currently producing shelf-stable irradiated meats on a commercial basis. The meats are cooked, chilled, portioned, vacuum packed and irradiated to the required minimum dose of 45 kGy at a temperature of between -20 and -40°C to ensure absolute sterility even under tropical conditions. The product is packaged in a high quality four layer laminate pouch and will therefore not rust or burst even under adverse weather conditions and can be guaranteed for more than two years as long as the integrity of the packaging is maintained. Safari operators in remote parts of Africa, mountaineers, yachtsmen, canoeists and geological survey teams currently use shelf-stable irradiated meat products produced in South Africa.

  2. High-Dose Rifapentine with Moxifloxacin for Pulmonary Tuberculosis

    PubMed Central

    Jindani, Amina; Harrison, Thomas S.; Nunn, Andrew J.; Phillips, Patrick P.J.; Churchyard, Gavin J.; Charalambous, Salome; Hatherill, Mark; Geldenhuys, Hennie; McIlleron, Helen M.; Zvada, Simbarashe P.; Mungofa, Stanley; Shah, Nasir A.; Zizhou, Simukai; Magweta, Lloyd; Shepherd, James; Nyirenda, Sambayawo; van Dijk, Janneke H.; Clouting, Heather E.; Coleman, David; Bateson, Anna L.E.; McHugh, Timothy D.; Butcher, Philip D.; Mitchison, Denny A.

    2014-01-01

    BACKGROUND Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are needed. METHODS We randomly assigned patients with newly diagnosed, smear-positive, drug-sensitive tuberculosis to one of three regimens: a control regimen that included 2 months of ethambutol, isoniazid, rifampicin, and pyrazinamide administered daily followed by 4 months of daily isoniazid and rifampicin; a 4-month regimen in which the isoniazid in the control regimen was replaced by moxifloxacin administered daily for 2 months followed by moxifloxacin and 900 mg of rifapentine administered twice weekly for 2 months; or a 6-month regimen in which isoniazid was replaced by daily moxifloxacin for 2 months followed by one weekly dose of both moxifloxacin and 1200 mg of rifapentine for 4 months. Sputum specimens were examined on microscopy and after culture at regular intervals. The primary end point was a composite treatment failure and relapse, with noninferiority based on a margin of 6 percentage points and 90% confidence intervals. RESULTS We enrolled a total of 827 patients from South Africa, Zimbabwe, Botswana, and Zambia; 28% of patients were coinfected with the human immunodefiency virus. In the per-protocol analysis, the proportion of patients with an unfavorable response was 4.9% in the control group, 3.2% in the 6-month group (adjusted difference from control, −1.8 percentage points; 90% confidence interval [CI], −6.1 to 2.4), and 18.2% in the 4-month group (adjusted difference from control, 13.6 percentage points; 90% CI, 8.1 to 19.1). In the modified intention-to-treat analysis these proportions were 14.4% in the control group, 13.7% in the 6-month group (adjusted difference from control, 0.4 percentage points; 90% CI, −4.7 to 5.6), and 26.9% in the 4-month group (adjusted difference from control, 13.1 percentage points; 90% CI, 6.8 to 19.4). CONCLUSIONS The 6-month regimen that included weekly administration of high-dose rifapentine and

  3. High-dose methotrexate: pharmacokinetics in children and young adults.

    PubMed

    Raude, E; Oellerich, M; Weinel, P; Freund, M; Schrappe, M; Riehm, H; Poliwoda, H

    1988-07-01

    Pharmacokinetics of methotrexate (MTX) was studied in 34 patients (age 1-25 years, median 12 years) predominantly with primary brain tumors and osteosarcoma, who received a total of 64 high-dose infusions (12 g/m2/4 h, maximum dose 20 g), followed by leucovorin rescue (COSS 82). Serum samples were collected over a period of at least 72 h after the end of infusion and MTX was measured by enzyme immunoassay (EMIT). The data were fitted to a biexponential equation using a nonlinear regression analysis. The concentration-time decay of MTX in serum observed in 29/34 patients receiving 4 x 15 mg/m2/d p.o. leucovorin up to 5 days was biphasic with mean half-lives (+/- SD) of 2.42 +/- 0.45 h for t1/2 alpha and 19.9 +/- 7.6 h for t1/2 beta. The steady-state volume of distribution (Vss) was 0.56 +/- 0.18 l/kg and the total body clearance (CL) 71 +/- 20 ml/min/m2 (mean +/- SD). Peak serum concentrations ranged from 674-1778 mumol/l (mean +/- SD, 1201 +/- 293 mumol/l). In 5/34 patients who received a prolonged leucovorin rescue due to a delayed MTX elimination t1/2 alpha was greater than 3.1 h. The data of this study suggest that patients with MTX serum concentrations of less than or equal to 6.3 mumol/l at 24 h, less than or equal to 0.77 mumol/l at 48 h, and less than or equal to 0.33 mumol/l at 72 h after the end of infusion, and a t1/2 alpha of less than or equal to 3.1 h (97.5th percentiles) are at low risk of toxicity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3209285

  4. Suitability of laser stimulated TLD arrays as patient dose monitors in high dose x-ray imaging.

    PubMed

    Geise, R A; Schueler, B A; Lien, W; Jones, S C

    1997-10-01

    Skin entrance doses of patients undergoing interventional x-ray procedures are capable of causing skin damage and should be monitored routinely. Single TLD chips are not suitable because the location of maximum skin exposure cannot be predicted. Most photographic films are too sensitive at diagnostic x-ray energies for dosimetry, exhibit temporal changes in response, and require special packaging by the user. We have investigated the suitability of laser heated MgB4O7 TLDs in a polyimide binder in the range of 0.2-20 Gy. These are available in radioluscent arrays up to 30 x 30 cm for direct measurement of patient skin dose. Dose response was compared with a calibrated ion chamber dosimeter. Exposures were made at 60, 90, and 120 kVp, at low (fluoroscopy) and high (DSA) dose rates, and at different beam incidence angles. Longitudinal reproducibility and response to temperature changes during exposure were also checked. The dose response is linear below approximately 6 Gy where the slope starts to increase 2% per Gy. Errors were less than +/- 2% over a 0-80 degrees range of beam incidence angles; less than +/- 3% for both dose rate variations and kVp differences between 70 and 120 kVp. The response was unaffected by temperature changes between 20 and 37 degrees C. Reproducibility is current +/- 7%. MgB4O7 TLD arrays are suitable for patient dosimetry in high dose fluoroscopy procedures if appropriate calibrations are used. Uncertainty in skin dose measurement is less than 10%, which is substantially better than film dosimetry. PMID:9350720

  5. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer

    PubMed Central

    2014-01-01

    Background In this study, high risk clinical target volumes (HR-CTVs) according to GEC-ESTRO guideline were contoured retrospectively based on CT images taken at the time of high-dose rate intracavitary brachytherapy (HDR-ICBT) and correlation between clinical outcome and dose of HR-CTV were analyzed. Methods Our study population consists of 51 patients with cervical cancer (Stages IB-IVA) treated with 50 Gy external beam radiotherapy (EBRT) using central shield combined with 2–5 times of 6 Gy HDR-ICBT with or without weekly cisplatin. Dose calculation was based on Manchester system and prescribed dose of 6 Gy were delivered for point A. CT images taken at the time of each HDR-ICBT were reviewed and HR-CTVs were contoured. Doses were converted to the equivalent dose in 2 Gy (EQD2) by applying the linear quadratic model (α/β = 10 Gy). Results Three-year overall survival, Progression-free survival, and local control rate was 82.4%, 85.3% and 91.7%, respectively. Median cumulative dose of HR-CTV D90 was 65.0 Gy (52.7-101.7 Gy). Median length from tandem to the most lateral edge of HR-CTV at the first ICBT was 29.2 mm (range, 18.0-51.9 mm). On univariate analysis, both LCR and PFS was significantly favorable in those patients D90 for HR-CTV was 60 Gy or greater (p = 0.001 and 0.03, respectively). PFS was significantly favorable in those patients maximum length from tandem to edge of HR-CTV at first ICBT was shorter than 3.5 cm (p = 0.042). Conclusion Volume-dose showed a relationship to the clinical outcome in CT based brachytherapy for cervical carcinoma. PMID:24938757

  6. High-dose-rate brachytherapy in uterine cervical carcinoma

    SciTech Connect

    Patel, Firuza D. . E-mail: patelfd@glide.net.in; Rai, Bhavana; Mallick, Indranil; Sharma, Suresh C.

    2005-05-01

    Purpose: High-dose-rate (HDR) brachytherapy is in wide use for curative treatment of cervical cancer. The American Brachytherapy Society has recommended that the individual fraction size be <7.5 Gy and the range of fractions should be four to eight; however, many fractionation schedules, varying from institution to institution, are in use. We use 9 Gy/fraction of HDR in two to five fractions in patients with carcinoma of the uterine cervix. We found that our results and toxicity were comparable to those reported in the literature and hereby present our experience with this fractionation schedule. Methods and Materials: A total of 121 patients with Stage I-III carcinoma of the uterine cervix were treated with HDR brachytherapy between 1996 and 2000. The total number of patients analyzed was 113. The median patient age was 53 years, and the histopathologic type was squamous cell carcinoma in 93% of patients. The patients were subdivided into Groups 1 and 2. In Group 1, 18 patients with Stage Ib-IIb disease, tumor size <4 cm, and preserved cervical anatomy underwent simultaneous external beam radiotherapy to the pelvis to a dose of 40 Gy in 20 fractions within 4 weeks with central shielding and HDR brachytherapy of 9 Gy/fraction, given weekly, and interdigitated with external beam radiotherapy. The 95 patients in Group 2, who had Stage IIb-IIIb disease underwent external beam radiotherapy to the pelvis to a dose of 46 Gy in 23 fractions within 4.5 weeks followed by two sessions of HDR intracavitary brachytherapy of 9 Gy each given 1 week apart. The follow-up range was 3-7 years (median, 36.4 months). Late toxicity was graded according to the Radiation Therapy Oncology Group criteria. Results: The 5-year actuarial local control and disease-free survival rate was 74.5% and 62.0%, respectively. The actuarial local control rate at 5 years was 100% for Stage I, 80% for Stage II, and 67.2% for Stage III patients. The 5-year actuarial disease-free survival rate was 88.8% for

  7. High dose intravenous immunoglobulin in autoimmune rheumatic disorders.

    PubMed

    Zeuner, R A; Euler, H H; Schroeder, J O

    1997-11-01

    Since the effectiveness of high dose intravenous immunoglobulin (IVIg) was first demonstrated in autoimmune thrombocytopenia, IVIg has been investigated in the treatment of various autoimmune rheumatic disorders. Controlled randomised studies have established the efficacy of IVIg in Kawasaki's syndrome, for which combined IVIg and aspirin (acetylsalicylic acid) now constitutes the standard treatment. Another controlled study has demonstrated the benefit of IVIg in dermatomyositis. IVIg treatment in juvenile rheumatoid arthritis has produced contradictory results. Uncontrolled studies and case reports on the application of IVIg in systemic lupus erythematosus, ANCA-associated vasculitides and adult rheumatoid arthritis generally describe short term positive effects. Various mechanisms are thought to underlie the effect of IVIg on autoimmune rheumatic diseases, such as: blockade of Fc receptors;immunomodulation via anti-idiotypic interactions;inhibition of complement-mediated tissue damage;modulation of cytokine expression by leucocytes and endothelial cells; andinhibition of superantigen-mediated T cell activation. IVIg is considered to be a low-risk form of treatment. Reported adverse effects include headache, aseptic meningitis and transient impairment of renal function. Haemolysis and anaphylactic reactions are rare. The effect profile of IVIg makes it a relevant, although still experimental, form of treatment in autoimmune rheumatic disorders, but its high cost renders it unsuitable as a first-line treatment. Because IVIg does not weaken patients' resistance to infection, it might serve as a therapeutic option in bridging clinical situations where immunosuppressive or cytotoxic approaches are contraindicated in patients with autoimmune disorders, such as intercurrent infection or in the period immediately before and after surgery. PMID:18020527

  8. Molecular Mechanisms Linking High Dose Medroxyprogesterone with HIV-1 Risk

    PubMed Central

    Irvin, Susan C.; Herold, Betsy C.

    2015-01-01

    Background Epidemiological studies suggest that medroxyprogesterone acetate (MPA) may increase the risk of HIV-1. The current studies were designed to identify potential underlying biological mechanisms. Methods Human vaginal epithelial (VK2/E6E7), peripheral blood mononuclear (PBMC), and polarized endometrial (HEC-1-A) cells were treated with a range of concentrations of MPA (0.015-150 μg/ml) and the impact on gene expression, protein secretion, and HIV infection was evaluated. Results Treatment of VK2/E6E7 cells with high doses (>15μg/ml] of MPA significantly upregulated proinflammatory cytokines, which resulted in a significant increase in HIV p24 levels secreted by latently infected U1 cells following exposure to culture supernatants harvested from MPA compared to mock-treated cells. MPA also increased syndecan expression by VK2/E6E7 cells and cells treated with 15 μg/ml of MPA bound and transferred more HIV-1 to T cells compared to mock-treated cells. Moreover, MPA treatment of epithelial cells and PBMC significantly decreased cell proliferation resulting in disruption of the epithelial barrier and decreased cytokine responses to phytohaemagglutinin, respectively. Conclusion We identified several molecular mechanisms that could contribute to an association between DMPA and HIV including proinflammatory cytokine and chemokine responses that could activate the HIV promoter and recruit immune targets, increased expression of syndecans to facilitate the transfer of virus from epithelial to immune cells and decreased cell proliferation. The latter could impede the ability to maintain an effective epithelial barrier and adversely impact immune cell function. However, these responses were observed primarily following exposure to high (15-150 μg/ml) MPA concentrations. Clinical correlation is needed to determine whether the prolonged MPA exposure associated with contraception activates these mechanisms in vivo. PMID:25798593

  9. Conventional High-Dose-Rate Brachytherapy With Concomitant Complementary IMRT Boost: A Novel Approach for Improving Cervical Tumor Dose Coverage

    SciTech Connect

    Duan, Jun; Kim, Robert Y. Elassal, Shaaban; Lin Huiyi; Shen Sui

    2008-07-01

    Purpose: To investigate the feasibility of combining conventional high-dose-rate (HDR) brachytherapy with a concomitant complementary intensity-modulated radiotherapy (IMRT) boost for improved target coverage in cervical cancers. Methods and Materials: Six patients with cervical cancer underwent conventional HDR (C-HDR) treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) scans were acquired with a CT/MRI-compatible applicator in place. The clinical target volumes (CTVs), defined as the gross target volume with a 3-mm margin and the uterus, were delineated on the CT scans, along with the organs at risk (OARs). The IMRT plans were optimized to generate dose distributions complementing those of C-HDR to cover the CTV while maintaining low doses to the OARs (IMRT-HDR). For comparison, dwell-weight optimized HDR (O-HDR) plans were also generated to cover the CTV and spare the OARs. The three treatment techniques (C-HDR, O-HDR, and IMRT-HDR) were compared. The percentage of volume receiving 95% of the prescription dose (V{sub 95}) was used to evaluate dose coverage to the CTV, and the minimal doses in the 2.0-cm{sup 3} volume receiving the greatest dose were calculated to compare the doses to the OARs. Results: The C-HDR technique provided very poor CTV coverage in 5 cases (V{sub 95} <62%). Although O-HDR provided excellent gross tumor volume coverage (V{sub 95} {>=}96.9%), it resulted in unacceptably high doses to the OARs in all 6 cases and unsatisfactory coverage to the whole CTV in 3 cases. IMRT-HDR not only yielded substantially improved CTV coverage (average V{sub 95} = 95.3%), but also kept the doses to the bladder and rectum reasonably low. Conclusion: Compared with C-HDR and O-HDR, concomitant IMRT boost complementary to C-HDR not only provided excellent CTV coverage, but also maintained reasonably low doses to the OARs.

  10. Enhanced Interaction between Warfarin and High-Dose Ketoconazole: A Case Report

    PubMed Central

    Jackevicius, Cynthia A.; Ton, Mannhu N.

    2009-01-01

    This case describes the increased anticoagulation effect associated with the use of high-dose ketoconazole. A 59-year-old man treated with warfarin for aortic valve replacement was prescribed high-dose ketoconazole and hydrocortisone for the treatment of prostate cancer. Despite lowering the warfarin dosage by 35% during the start of high dose ketoconazole, an additional dose reduction was required subsequently when the INR rose from 2.62 to 3.82 within nine days. After a total dose reduction of 43%, the INR returned to therapeutic range within two weeks. The Naranjo probability scale revealed a probable adverse reaction of increased anticoagulant effect associated with high dose ketoconazole. Due to the inhibition of warfarin metabolism by ketoconazole, patients taking high dose ketoconazole concomitantly with warfarin may need their warfarin dosage reduced by more than is currently recommended, as well as receive more frequent INR monitoring to avoid over anticoagulation. PMID:20029646

  11. Extrapolation of the dna fragment-size distribution after high-dose irradiation to predict effects at low doses

    NASA Technical Reports Server (NTRS)

    Ponomarev, A. L.; Cucinotta, F. A.; Sachs, R. K.; Brenner, D. J.; Peterson, L. E.

    2001-01-01

    The patterns of DSBs induced in the genome are different for sparsely and densely ionizing radiations: In the former case, the patterns are well described by a random-breakage model; in the latter, a more sophisticated tool is needed. We used a Monte Carlo algorithm with a random-walk geometry of chromatin, and a track structure defined by the radial distribution of energy deposition from an incident ion, to fit the PFGE data for fragment-size distribution after high-dose irradiation. These fits determined the unknown parameters of the model, enabling the extrapolation of data for high-dose irradiation to the low doses that are relevant for NASA space radiation research. The randomly-located-clusters formalism was used to speed the simulations. It was shown that only one adjustable parameter, Q, the track efficiency parameter, was necessary to predict DNA fragment sizes for wide ranges of doses. This parameter was determined for a variety of radiations and LETs and was used to predict the DSB patterns at the HPRT locus of the human X chromosome after low-dose irradiation. It was found that high-LET radiation would be more likely than low-LET radiation to induce additional DSBs within the HPRT gene if this gene already contained one DSB.

  12. High versus Low-Dose Rate Brachytherapy for Cervical Cancer

    PubMed Central

    Patankar, Sonali S.; Tergas, Ana I.; Deutsch, Israel; Burke, William M.; Hou, June Y.; Ananth, Cande V.; Huang, Yongmei; Neugut, Alfred I.; Hershman, Dawn L.; Wright, Jason D.

    2015-01-01

    Objectives Brachytherapy plays an important role in the treatment of cervical cancer. While small trials have shown comparable survival outcomes between high (HDR) and low-dose rate (LDR) brachytherapy, little data is available in the US. We examined the utilization of HDR brachytherapy and analyzed the impact of type of brachytherapy on survival for cervical cancer. Methods Women with stage IB2–IVA cervical cancer treated with primary (external beam and brachytherapy) radiotherapy between 2003–2011 and recorded in the National Cancer Database (NCDB) were analyzed. Generalized linear mixed models and Cox proportional hazards regression were used to examine predictors of HDR brachytherapy use and the association between HDR use and survival. Results A total of 10,564 women including 2681 (25.4%) who received LDR and 7883 (74.6%) that received HDR were identified. Use of HDR increased from 50.2% in 2003 to 83.9% in 2011 (P<0.0001). In a multivariable model, year of diagnosis was the strongest predictor of use of HDR. While patients in the Northeast were more likely to receive HDR therapy, there were no other clinical or socioeconomic characteristics associated with receipt of HDR. In a multivariable Cox model, survival was similar between the HDR and LDR groups (HR=0.93; 95% 0.83–1.03). Similar findings were noted in analyses stratified by stage and histology. Kaplan-Meier analyses demonstrated no difference in survival based on type of brachytherapy for stage IIB (P=0.68), IIIB (P=0.17), or IVA (P=0.16) tumors. Conclusions The use of HDR therapy has increased rapidly. Overall survival is similar for LDR and HDR brachytherapy. PMID:25575481

  13. Discussion on the usefulness of dose dynamic multi-leaf collimator-based plan to overcome dose limit of spinal cord in high-dose radiotherapy

    NASA Astrophysics Data System (ADS)

    Kim, E. C.; Cho, J. H.; Park, C. S.; Kim, D. H.; Choi, C. W.

    2014-03-01

    In this study, the conventional plan was compared with the plan that was based on a dose dynamic multi-leaf collimator (MLC), and a dose dynamic MLC was used to evaluate its usefulness. Then, this study examined if it was possible to perform a high-dose radiation therapy by adjusting the dose limit of the spinal cord when the dose dynamic MLC-based plan was used. First of all, linear accelerator was used to compare the conventional plan with the dose dynamic MLC-based plan. Then, the study was conducted in two methods in order to examine the proper range of the shield for the spinal cord when the dose dynamic MLC was used to adjust the dose of the spinal cord. In the first method, X-omat film was used to perform film dosimetry. In the second method, radiation treatment planning (RTP) system was used to find out the proper range among 0, 3, 6, and 9 mm. When film scan was performed in the each range, respectively, from the spinal cord and under the same conditions, it was confirmed to be appropriate to use the range of 3 mm. When the RTP system was used to perform planning in the shield range of each range, respectively, from the spinal cord, dose-volume histogram (DVH) was a slight difference could be found in the region from 25% to 35%. On the contrary, no radiation exposure was found in the region of 35% or higher for all of the each range. Consequently, if MLC is selected in consideration of the planning target volume (PTV), the most proper value can be obtained by selecting the range of 3 mm. Next, the DVH was compared to examine the relationship in PTV when the each range was used for planning. All of the ranges showed the same pattern up to the point of 90%. However, the results were different in the region of higher than 90% because the dose was low for the spinal cord, and a relatively useful dose was used for PTV when the range was 3 mm.

  14. High-Dose-Rate Prostate Brachytherapy Consistently Results in High Quality Dosimetry

    SciTech Connect

    White, Evan C.; Kamrava, Mitchell R.; Demarco, John; Park, Sang-June; Wang, Pin-Chieh; Kayode, Oluwatosin; Steinberg, Michael L.; Demanes, D. Jeffrey

    2013-02-01

    Purpose: We performed a dosimetry analysis to determine how well the goals for clinical target volume coverage, dose homogeneity, and normal tissue dose constraints were achieved with high-dose-rate (HDR) prostate brachytherapy. Methods and Materials: Cumulative dose-volume histograms for 208 consecutively treated HDR prostate brachytherapy implants were analyzed. Planning was based on ultrasound-guided catheter insertion and postoperative CT imaging; the contoured clinical target volume (CTV) was the prostate, a small margin, and the proximal seminal vesicles. Dosimetric parameters analyzed for the CTV were D90, V90, V100, V150, and V200. Dose to the urethra, bladder, bladder balloon, and rectum were evaluated by the dose to 0.1 cm{sup 3}, 1 cm{sup 3}, and 2 cm{sup 3} of each organ, expressed as a percentage of the prescribed dose. Analysis was stratified according to prostate size. Results: The mean prostate ultrasound volume was 38.7 {+-} 13.4 cm{sup 3} (range: 11.7-108.6 cm{sup 3}). The mean CTV was 75.1 {+-} 20.6 cm{sup 3} (range: 33.4-156.5 cm{sup 3}). The mean D90 was 109.2% {+-} 2.6% (range: 102.3%-118.4%). Ninety-three percent of observed D90 values were between 105 and 115%. The mean V90, V100, V150, and V200 were 99.9% {+-} 0.05%, 99.5% {+-} 0.8%, 25.4% {+-} 4.2%, and 7.8% {+-} 1.4%. The mean dose to 0.1 cm{sup 3}, 1 cm{sup 3}, and 2 cm{sup 3} for organs at risk were: Urethra: 107.3% {+-} 3.0%, 101.1% {+-} 14.6%, and 47.9% {+-} 34.8%; bladder wall: 79.5% {+-} 5.1%, 69.8% {+-} 4.9%, and 64.3% {+-} 5.0%; bladder balloon: 70.3% {+-} 6.8%, 59.1% {+-} 6.6%, and 52.3% {+-} 6.2%; rectum: 76.3% {+-} 2.5%, 70.2% {+-} 3.3%, and 66.3% {+-} 3.8%. There was no significant difference between D90 and V100 when stratified by prostate size. Conclusions: HDR brachytherapy allows the physician to consistently achieve complete prostate target coverage and maintain normal tissue dose constraints for organs at risk over a wide range of target volumes.

  15. 'In Vivo' Dosimetry in High Dose Rate Brachytherapy for Cervical Cancer Treatments

    SciTech Connect

    Gonzalez-Azcorra, S. A.; Ruiz-Trejo, C.; Buenfil, A. E.; Mota-Garcia, A.; Poitevin-Chacon, M. A.; Santamaria-Torruco, B. J.; Rodriguez-Ponce, M.; Herrera-Martinez, F. P.; Gamboa de Buen, I.

    2008-08-11

    In this prospective study, rectal dose was measured 'in vivo' using TLD-100 crystals (3x3x1 mm{sup 3}), and it has been compared to the prescribed dose. Measurements were performed in patients with cervical cancer classified in FIGO stages IB-IIIB and treated with high dose rate brachytherapy (HDR BT) at the Instituto Nacional de Cancerologia (INCan)

  16. Clinical Characteristics of Veterans Prescribed High Doses of Opioid Medications for Chronic Non-Cancer Pain

    PubMed Central

    Morasco, Benjamin J.; Duckart, Jonathan P.; Carr, Thomas P.; Deyo, Richard A.; Dobscha, Steven K.

    2010-01-01

    Little is known about patients prescribed high doses of opioids to treat chronic non-cancer pain, though these patients may be at higher risk for medication-related complications. We describe the prevalence of high-dose opioid use and associated demographic and clinical characteristics among veterans treated in a VA regional healthcare network. Veterans with chronic non-cancer pain prescribed high doses of opioids (>=180 mg/day morphine equivalent; n=478) for 90+ consecutive days were compared to two groups with chronic pain: Traditional-dose (5–179 mg/day; n=500) or no opioid (n=500). High-dose opioid use occurred in 2.4% of all chronic pain patients and in 3.4% of all chronic pain patients prescribed opioids long-term. The average dose in the high-dose group was 324.9 (SD=285.1) mg/day. The only significant demographic difference among groups was race (p=0.03) with black veterans less likely to receive high doses. High-dose patients were more likely to have four or more pain diagnoses and the highest rates of medical, psychiatric, and substance use disorders. After controlling for demographic factors and VA facility, neuropathy, low back pain, and nicotine dependence diagnoses were associated with increased likelihood of high-dose prescriptions. High-dose patients frequently did not receive care consistent with treatment guidelines: there was frequent use of short-acting opioids, urine drug screens were administered to only 40.8% of patients in the prior year, and 32.0% received concurrent benzodiazepine prescriptions, which may increase risk for overdose and death. Further study is needed to identify better predictors of high-dose usage, as well as the efficacy and safety of such dosing. PMID:20801580

  17. Population pharmacokinetics of high dose ibuprofen in cystic fibrosis

    PubMed Central

    Arranz, I; Martin-Suarez, A; Lanao, J; Mora, F; Vazquez, C; Escribano, A; Juste, M; Mercader, J; Ripoll, E

    2003-01-01

    Methods: Blood samples were collected during routine clinical care; serum ibuprofen concentrations were determined by HPLC. Fitting of the concentration/time data to a one compartment kinetic population model was performed by a non-linear mixed effect regression method. Results: Body weight, dose, and ibuprofen dosage form (lysinate salt or the free acid form), for elimination clearance (CL/F); and body weight, dose, and fasting status for the apparent distribution volume (Vd/F) proved to be the covariates with influence in the model. The four factors identified helped to explain part of the interindividual variability observed, but the remaining unexplained variability made therapeutic drug monitoring absolutely essential. PMID:14670788

  18. SU-C-12A-05: Radiation Dose in High-Pitch Pediatric Cardiac CTA: Correlation Between Lung Dose and CTDIvol, DLP, and Size Specific Dose Estimates (SSDE)

    SciTech Connect

    Wang, J; Kino, A; Newman, B; Chan, F

    2014-06-01

    Purpose: To investigate the radiation dose for pediatric high pitch cardiac CTA Methods: A total of 14 cases were included in this study, with mean age of 6.2 years (ranges from 2 months to 15 years). Cardiac CTA was performed using a dual-source CT system (Definition Flash, Siemens). Tube voltage (70, 80 and 100kV) was chosen based on patient weight. All patients were scanned using a high-pitch spiral mode (pitch ranges from 2.5 to 3) with tube current modulation technique (CareDose4D, Siemens). For each case, the three dimensional dose distributions were calculated using a Monte Carlo software package (IMPACT-MC, CT Image GmbH). Scanning parameters of each exam, including tube voltage, tube current, beamshaping filters, beam collimation, were defined in the Monte Carlo calculation. Tube current profile along projection angles was obtained from projection data of each tube, which included data within the over-scanning range along z direction. The volume of lungs was segmented out with CT images (3DSlicer). Lung doses of all patients were calculated and compared with CTDIvol, DLP, and SSDE. Results: The average (range) of CTDIvol, DLP and SSDE of all patients was 1.19 mGy (0.58 to 3.12mGy), 31.54 mGy*cm (12.56 to 99 mGy*cm), 2.26 mGy (1.19 to 6.24 mGy), respectively. Radiation dose to the lungs ranged from 0.83 to 4.18 mGy. Lung doses correlated with CTDIvol, DLP and SSDE with correlation coefficients(k) at 0.98, 0.93, and 0.99. However, for the cases with CTDIvol less than 1mGy, only SSDE preserved a strong correlation with lung doses (k=0.83), while much weaker correlations were found for CTDIvol (k=0.29) and DLP (k=-0.47). Conclusion: Lung doses to pediatric patients during Cardiac CTA were estimated. SSDE showed the most robust correlation with lung doses in contrast to CTDIvol and DLP.

  19. High dose medroxyprogesterone acetate (MPA) treatment in metastatic carcinoma of the breast: a dose-response evaluation.

    PubMed

    Cuna, G R; Calciati, A; Strada, M R; Bumma, C; Campio, L

    1978-04-30

    The results of controlled clinical trial that used high doses of medroxyprogesterone acetate (MPA) in the treatment of metastatic breast cancer are reported. Two treatment reigmens were used: regimen A, 500 mg daily with a total dose of 30 g; regimen B, 1,000 mg daily with a total dose of 60 g. The overall response rates were similar, with no statistically significant difference between the two treated groups. Regimen A (lower dosage group) reached a remission rate of 44%, whereas regimen B (higher dosage group) had a remission rate of 41%. The mean duration of response was 8 months with regimen A and 9 months with regimen B. The advantages of the lower dosage regimen as opposed to the higher dosage regimen of MPA in the treatment of advanced breast cancer are discussed. PMID:354147

  20. An Absorbed-Dose/Dose-Rate Dependence for the Alanine-EPR Dosimetry System and Its Implications in High-Dose Ionizing Radiation Metrology

    PubMed Central

    Desrosiers, M. F.; Puhl, J. M.; Cooper, S. L.

    2008-01-01

    NIST developed the alanine dosimetry system in the early 1990s to replace radiochromic dye film dosimeters. Later in the decade the alanine system was firmly established as a transfer service for high-dose radiation dosimetry and an integral part of the internal calibration scheme supporting these services. Over the course of the last decade, routine monitoring of the system revealed a small but significant observation that, after examination, led to the characterization of a previously unknown absorbed-dose-dependent, dose-rate effect for the alanine system. Though the potential impact of this effect is anticipated to be extremely limited for NIST’s customer-based transfer dosimetry service, much greater implications may be realized for international measurement comparisons between National Measurement Institutes. PMID:27096113

  1. Irradiation dose and temperature dependence of fracture toughness in high dose HT9 steel from the fuel duct of FFTF

    SciTech Connect

    Byun, Thak Sang; Toloczko, M; Maloy, S

    2013-01-01

    Static fracture toughness tests have been performed for high dose HT9 steel using miniature disk compact tension (DCT) specimens to expand the knowledge base for fast reactor core materials. The HT9 steel DCT specimens were from the ACO-3 duct of the Fast Flux Test Facility (FFTF), which achieved high doses in the range of 3 148 dpa at 378 504oC. The static fracture resistance (J-R) tests have been performed in a servohydraulic testing machine in vacuum at selected temperatures including room temperature, 200 C, and each irradiation temperature. Brittle fracture with a low toughness less than 50 MPa m occurred in room temperature tests when irradiation temperature was below 400 C, while ductile fracture with stable crack growth was observed in all tests at higher irradiation temperatures. No fracture toughness less than 100 MPa m was measured when the irradiation temperature was above 430 C. It was shown that the influence of irradiation temperature was dominant in fracture toughness while the irradiation dose has only limited influence over the dose range 3 148 dpa. A post upper-shelf behavior was observed for the non-irradiated and high temperature (>430 C) irradiation cases, which indicates that the ductile-brittle transition temperatures (DBTTs) in those conditions are lower than room temperature. A comparison with the collection of existing data confirmed the dominance of irradiation temperature in the fracture toughness of HT9 steels.

  2. Irradiation dose and temperature dependence of fracture toughness in high dose HT9 steel from the fuel duct of FFTF

    SciTech Connect

    Byun, Thak Sang; Toloczko, Mychailo B.; Saleh, Tarik A.; Maloy, Stuart A.

    2013-01-14

    To expand the knowledge base for fast reactor core materials, fracture toughness has been evaluated for high dose HT9 steel using miniature disk compact tension (DCT) specimens. The HT9 steel DCT specimens were machined from the ACO-3 fuel duct of the Fast Flux Test Facility (FFTF), which achieved high doses in the range of 3–148 dpa at 378–504 C. The static fracture resistance (J-R) tests have been performed in a servohydraulic testing machine in vacuum at selected temperatures including room temperature, 200 C, and each irradiation temperature. Brittle fracture with a low toughness less than 50 MPa pm occurred in room temperature tests when irradiation temperature was below 400 C, while ductile fracture with stable crack growth was observed when irradiation temperature was higher. No fracture toughness less than 100 MPa pm was measured when the irradiation temperature was above 430 C. It was shown that the influence of irradiation temperature was dominant in fracture toughness while the irradiation dose has only limited influence over the wide dose range 3–148 dpa. A slow decrease of fracture toughness with test temperature above room temperature was observed for the nonirradiated and high temperature (>430 *C) irradiation cases, which indicates that the ductile–brittle transition temperatures (DBTTs) in those conditions are lower than room temperature. A comparison with the collection of existing data confirmed the dominance of irradiation temperature in the fracture toughness of HT9 steels.

  3. Inhalation and external doses in coastal villages of high background radiation area in Kollam, India.

    PubMed

    Ben Byju, S; Koya, P K M; Sahoo, B K; Jojo, P J; Chougaonkar, M P; Mayya, Y S

    2012-11-01

    The observational evidence for radiation-induced health effects in humans comes largely from the exposures to high doses received over short periods of time. The rate of induction of any health risk at low doses and dose rates is estimated by extrapolation from observations at high doses. Effects of low dose/low dose rate could be done by the study of populations that have been exposed to slightly above-average natural radiation doses. Southwest coastal line of the Kerala state in India is one such region known to have elevated levels of background radioactivity mainly due to the mineral-rich sand available with high abundance of thorium. In the present work, a study was conducted to investigate the inhalation and external radiation doses to human beings in the high background radiation area along the southwest coast of Kerala. Five hundred dwellings were selected for the study. All the selected houses were at least 10 y old with similar construction. Long-term integrated indoor measurements of the external gamma dose using thermoluminescent dosemeters (TLDs) and the inhalation dose with the SSNTD-based twin-cup dosemeters were carried out in the dwellings simultaneously. Ambient gamma dose measurements were also made with a GM tube-based survey meter while deploying and retrieving the dosemeters. The data show a high degree of heterogeneity. The inhalation dose was found to vary from 0.1 to 3.53 mSv y(-1) and the external dose rates had a range of 383-11419 µGy y(-1). The external doses measured by the survey meter and TLDs showed an excellent correlation. PMID:22961502

  4. Dose distribution under external eye shields for high energy electrons

    SciTech Connect

    Rustgi, S.N.

    1986-01-01

    Effectiveness of eye shields in reducing the dose to the eye lens from 6 and 9 MeV electron beams from a linear accelerator has been evaluated. The thickness of the shields made from cerrobend was such that only bremsstrahlung photons were transmitted. A shield with a diameter of 1.3 cm and thickness of 1 cm was adequate for the 9 MeV electron beam. The optimum shield to phantom surface distance was 1 cm or less. The same shield with a thickness of 0.5 cm was found to be ineffective with a 6 MeV electron beam. The dose under the shield is greater than predicted by transmission measurements because of the contribution of phantom and electron cone generated scattered electrons.

  5. PLUTONIUM/HIGH LEVEL VITRIFIED WASTE - DBE OFFSITE DOSE CALCULATION

    SciTech Connect

    S. O. Bader

    1999-09-20

    The purpose of this calculation is to provide a bounding dose consequence analysis of the immobilized plutonium (can-in-canister) waste form to be handled at the Monitored Geologic Repository (MGR) at Yucca Mountain. The current concept for the Plutonium Can-in-Canister waste form is provided in Attachment III. A typical design basis event (DBE) defines a scenario that generally includes an initiating event and the sequences of events that follow. This analysis will provide (1) radiological releases and dose consequences for a postulated, bounding DBE and (2) design-related assumptions on which the calculated dose consequences are based. This analysis is part of the safety design basis for the repository. Results will be used in other analyses to determine or modify the safety classification and quality assurance level of repository structures, systems, and components (SSCs). The Quality Assurance (QA) program applies to this calculation. The work reported in this document is part of the analysis of MGR DBEs and is performed using AP-3.12Q, Calculations. The work done for this analysis was evaluated according to QAP-2-0, Control of Activities. This evaluation determined that such activities are subject to DOE/RW/0333PY Quality Assurance Requirements and Description (DOE 1998), requirements. This calculation is quality affecting because the results may be used to support analyses of repository SSCs per QAP-2-3, Classification of Permanent Items.

  6. A computer simulation method for low-dose CT images by use of real high-dose images: a phantom study.

    PubMed

    Takenaga, Tomomi; Katsuragawa, Shigehiko; Goto, Makoto; Hatemura, Masahiro; Uchiyama, Yoshikazu; Shiraishi, Junji

    2016-01-01

    Practical simulations of low-dose CT images have a possibility of being helpful means for optimization of the CT exposure dose. Because current methods reported by several researchers are limited to specific vendor platforms and generally rely on raw sinogram data that are difficult to access, we have developed a new computerized scheme for producing simulated low-dose CT images from real high-dose images without use of raw sinogram data or of a particular phantom. Our computerized scheme for low-dose CT simulation was based on the addition of a simulated noise image to a real high-dose CT image reconstructed by the filtered back-projection algorithm. First, a sinogram was generated from the forward projection of a high-dose CT image. Then, an additional noise sinogram resulting from use of a reduced exposure dose was estimated from a predetermined noise model. Finally, a noise CT image was reconstructed with a predetermined filter and was added to the real high-dose CT image to create a simulated low-dose CT image. The noise power spectrum and modulation transfer function of the simulated low-dose images were very close to those of the real low-dose images. In order to confirm the feasibility of our method, we applied this method to clinical cases which were examined with the high dose initially and then followed with a low-dose CT. In conclusion, our proposed method could simulate the low-dose CT images from their real high-dose images with sufficient accuracy and could be used for determining the optimal dose setting for various clinical CT examinations. PMID:26290269

  7. MOSFET sensitivity dependence on integrated dose from high-energy photon beams.

    PubMed

    Tanyi, James A; Krafft, Shane P; Hagio, Tomoe; Fuss, Martin; Salter, Bill J

    2008-01-01

    The ability of a commercially available dual bias, dual MOSFET dosimetry system to measure therapeutic doses reproducibly throughout its vendor-defined dose-based lifetime has been evaluated by characterizing its sensitivity variation to integrated/cumulative doses from,high-energy (6 and 15 MV) photon radiotherapy beams. The variation of sensitivity as a function of total integrated dose was studied for three different dose-per-fraction levels; namely, 50, 200, and 1200 cGy/fraction. In standard sensitivity mode (i.e., measurements involving dose-per-fraction levels > or =100 cGy), the response of the MOSFET system to identical irradiations increased with integrated dose for both energies investigated. Dose measurement reproducibility for the low (i.e., 50 cGy) dose fractions was within 2.1% (if the system was calibrated before each in-phantom measurement) and 3.1% [if the system was calibrated prior to first use, with no intermediate calibration(s)]. Similarly, dose measurement reproducibility was between 2.2% and 6.6% for the conventional (i.e., 200 cGy) dose fractions and between 1.8% and 7.9% for escalated (i.e., 1200 cGy) dose fractions. The results of this study suggest that, due to the progressively increasing sensitivity resulting from the dual-MOSFET design, frequent calibrations are required to achieve measurement accuracy of < or =3% (within one standard deviation). PMID:18293559

  8. Dose-Rate Dependence of High-Dose Health Effects in Humans from Photon Radiation with Application to Radiological Terrorism

    SciTech Connect

    Strom, Daniel J.

    2005-01-14

    In 1981, as part of a symposium entitled ''The Control of Exposure of the Public to Ionizing Radiation in the Event of Accident or Attack,'' Lushbaugh, H?bner, and Fry published a paper examining ''radiation tolerance'' of various human health endpoints as a function of dose rate. This paper may not have received the notice it warrants. The health endpoints examined by Lushbaugh et al. were the lethal dose that will kill 50% of people within 60 days of exposure without medical care (LD50/60); severe bone marrow damage in healthy men; severe bone marrow damage in leukemia patients; temporary sterility (azoospermia); reduced male fertility; and late effects such as cancer. Their analysis was grounded in extensive clinical experience and anchored to a few selected data points, and based on the 1968 dose-rate dependence theory of J.L. Bateman. The Lushbaugh et al. paper did not give predictive equations for the relationships, although they were implied in the text, and the relationships were presented in a non-intuitive way. This work derives the parameters needed in Bateman's equation for each health endpoint, tabulates the results, and plots them in a more conventional manner on logarithmic scales. The results give a quantitative indication of how the human organism can tolerate more radiation dose when it is delivered at lower dose rates. For example, the LD50/60 increases from about 3 grays (300 rads) when given at very high dose rates to over 10 grays (1,000 rads) when given at much lower dose rates over periods of several months. The latter figure is borne out by the case of an individual who survived for at least 19 years after receiving doses in the range of 9 to 17 grays (900-1700 rads) over 106 days. The Lushbaugh et al. work shows the importance of sheltering when confronted with long-term exposure to radiological contamination such as would be expected from a radiological dispersion event, reactor accident, or ground-level nuclear explosion.

  9. Characterization of Radiation Hardened Bipolar Linear Devices for High Total Dose Missions

    NASA Technical Reports Server (NTRS)

    McClure, Steven S.; Harris, Richard D.; Rax, Bernard G.; Thorbourn, Dennis O.

    2012-01-01

    Radiation hardened linear devices are characterized for performance in combined total dose and displacement damage environments for a mission scenario with a high radiation level. Performance at low and high dose rate for both biased and unbiased conditions is compared and the impact to hardness assurance methodology is discussed.

  10. Nursing care of patients receiving high-dose, continuous-infusion interleukin-2 with pulse dose and famotidine.

    PubMed

    Tyre, Charley Cowan; Quan, Walter

    2007-08-01

    High-dose, continuous-infusion interleukin-2 (IL-2) followed by pulse dose and concurrent administration of famotidine has demonstrated response rates of 64% and 33% in patients with metastatic melanoma and metastatic renal cell carcinoma, respectively. Currently, no information is available concerning the nursing care of patients receiving that IL-2 regimen. Given the high response rates of patients on the treatment, attention by the nursing profession is warranted. Effective nursing care of patients receiving IL-2 is essential to the regimen's success. Recognition and prompt treatment of common side effects lead to better patient outcomes. This article provides nurses with an overview of the treatment regimen, expected side effects, psycho-social considerations, and discharge instructions for patients receiving continuous-infusion plus pulse IL-2 and famotidine. PMID:17723964

  11. Comparison of high-dose-rate and low-dose-rate brachytherapy in the treatment of endometrial carcinoma

    SciTech Connect

    Fayed, Alaa; Mutch, David G.; Rader, Janet S.; Gibb, Randall K. |; Powell, Matthew A. |; Wright, Jason D.; El Naqa, Issam; Zoberi, Imran |; Grigsby, Perry W. |||. E-mail: pgrigsby@wustl.edu

    2007-02-01

    Purpose: To compare the outcomes for endometrial carcinoma patients treated with either high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy. Methods and Materials: This study included 1,179 patients divided into LDR (1,004) and HDR groups (175). Patients with International Federation of Gynecology and Obstetrics (FIGO) surgical Stages I-III were included. All patients were treated with postoperative irradiation. In the LDR group, the postoperative dose applied to the vaginal cuff was 60-70 Gy surface doses to the vaginal mucosa. The HDR brachytherapy prescription was 6 fractions of 2 Gy each to a depth of 0.5 cm from the surface of the vaginal mucosa. Overall survival, disease-free survival, local control, and complications were endpoints. Results: For all stages combined, the overall survival, disease-free survival, and local control at 5 years in the LDR group were 70%, 69%, and 81%, respectively. For all stages combined, the overall survival, disease-free survival, and local control at 5 years in the HDR group were 68%, 62%, and 78%, respectively. There were no significant differences in early or late Grade III and IV complications in the HDR or LDR groups. Conclusion: Survival outcomes, pelvic tumor control, and Grade III and IV complications were not significantly different in the LDR brachytherapy group compared with the HDR group.

  12. Ceramic Matrix Composites Performances Under High Gamma Radiation Doses

    NASA Astrophysics Data System (ADS)

    Cemmi, A.; Baccaro, S.; Fiore, S.; Gislon, P.; Serra, E.; Fassina, S.; Ferrari, E.; Ghisolfi, E.

    2014-06-01

    Ceramic matrix composites reinforced by continuous ceramic fibers (CMCs) represent a class of advanced materials developed for applications in automotive, aerospace, nuclear fusion reactors and in other specific systems for harsh environments. In the present work, the silicon carbide/silicon carbide (SiCf/SiC) composites, manufactured by Chemical Vapour Infiltration process at FN S.p.A. plant, have been evaluated in term of gamma radiation hardness at three different absorbed doses (up to around 3MGy). Samples behavior has been investigated before and after irradiation by means of mechanical tests (flexural strength) and by surface and structural analyses (X-ray diffraction, SEM, FTIR-ATR, EPR).

  13. TLD efficiency of 7LiF for doses deposited by high-LET particles

    NASA Technical Reports Server (NTRS)

    Benton, E. R.; Frank, A. L.; Benton, E. V.

    2000-01-01

    The efficiency of 7 LiF TLDs (TLD-700) in registering dose from high-LET (> or = 10 keV/micrometers) charged particles (relative to 137Cs gamma rays) has been measured for a number of accelerated heavy ions at various particle accelerator facilities. These measured efficiency values have been compared with similar results obtained from the open literature and a dose efficiency function has been fitted to the combined data set. While it was found that the dose efficiency is not only a function of LET, but also of the charge of the incident particle, the fitted function can be used to correct the undermeasured value of dose from exposures made in mixed radiation fields where LET information is available. This LET-dependent dose efficiency function is used in our laboratory in determining total absorbed dose and dose equivalent from combined TLD and CR-39 plastic nuclear track detector measurements.

  14. Irradiation dose and temperature dependence of fracture toughness in high dose HT9 steel from the fuel duct of FFTF

    NASA Astrophysics Data System (ADS)

    Byun, Thak Sang; Toloczko, Mychailo B.; Saleh, Tarik A.; Maloy, Stuart A.

    2013-01-01

    To expand the knowledge base for fast reactor core materials, fracture toughness has been evaluated for high dose HT9 steel using miniature disk compact tension (DCT) specimens. The HT9 steel DCT specimens were machined from the ACO-3 fuel duct of the Fast Flux Test Facility (FFTF), which achieved high doses in the range of 3-148 dpa at 378-504 °C. The static fracture resistance (J-R) tests have been performed in a servohydraulic testing machine in vacuum at selected temperatures including room temperature, 200 °C, and each irradiation temperature. Brittle fracture with a low toughness less than 50 MPa √m occurred in room temperature tests when irradiation temperature was below 400 °C, while ductile fracture with stable crack growth was observed when irradiation temperature was higher. No fracture toughness less than 100 MPa √m was measured when the irradiation temperature was above 430 °C. It was shown that the influence of irradiation temperature was dominant in fracture toughness while the irradiation dose has only limited influence over the wide dose range 3-148 dpa. A slow decrease of fracture toughness with test temperature above room temperature was observed for the nonirradiated and high temperature (>430 °C) irradiation cases, which indicates that the ductile-brittle transition temperatures (DBTTs) in those conditions are lower than room temperature. A comparison with the collection of existing data confirmed the dominance of irradiation temperature in the fracture toughness of HT9 steels.

  15. Pharmacokinetics of high-dose oral thiamine hydrochloride in healthy subjects

    PubMed Central

    2012-01-01

    Background High dose oral thiamine may have a role in treating diabetes, heart failure, and hypermetabolic states. The purpose of this study was to determine the pharmacokinetic profile of oral thiamine hydrochloride at 100 mg, 500 mg and 1500 mg doses in healthy subjects. Methods This was a randomized, double-blind, single-dose, 4-way crossover study. Pharmacokinetic measures were calculated. Results The AUC0-10 hr and Cmax values increased nonlinearly between100 mg and 1500 mg. The slope of the AUC0-10 hr vs dose, as well as the Cmax vs dose, plots are steepest at the lowest thiamine doses. Conclusion Our study demonstrates that high blood levels of thiamine can be achieved rapidly with oral thiamine hydrochloride. Thiamine is absorbed by both an active and nonsaturable passive process. Trial Registration ClinicalTrials.gov: NCT00981877 PMID:22305197

  16. Effect of high doses of gamma radiation on the functional characteristics of amniotic membrane

    NASA Astrophysics Data System (ADS)

    Singh, Rita; Purohit, Sumita; Chacharkar, M. P.

    2007-06-01

    The effect of different doses of gamma radiation viz. 25, 36 and 50 kGy on the chemical and functional characteristics of the amniotic membrane was studied. The change in the chemical structure of amniotic membranes at high doses of gamma irradiation was evaluated by means of Infrared (IR) Spectroscopy. The degradation of amnion on irradiation with gamma rays could produce a relative variation in IR absorption troughs. This kind of variation was absent in the samples irradiated to doses of 25, 36 and 50 kGy indicating no qualitative change in the material property of amnion. No significant differences in the water absorption capacity and water vapour transmission rate of amniotic membranes irradiated to different doses were observed. Impermeability of the amniotic membranes to different microorganisms was also not affected at high doses of gamma radiation. Gamma irradiation at doses of 25-50 kGy did not evoke undesirable changes in the functional properties of the amniotic membrane.

  17. Gene expression profiling in undifferentiated thyroid carcinoma induced by high-dose radiation.

    PubMed

    Bang, Hyun Soon; Choi, Moo Hyun; Kim, Cha Soon; Choi, Seung Jin

    2016-06-01

    Published gene expression studies for radiation-induced thyroid carcinogenesis have used various methodologies. In this study, we identified differential gene expression in a human thyroid epithelial cell line after exposure to high-dose γ-radiation. HTori-3 cells were exposed to 5 or 10 Gy of ionizing radiation using two dose rates (high-dose rate: 4.68 Gy/min, and low-dose rate: 40 mGy/h) and then implanted into the backs of BALB/c nude mice after 4 (10 Gy) or 5 weeks (5 Gy). Decreases in cell viability, increases in giant cell frequency, anchorage-independent growth in vitro, and tumorigenicity in vivo were observed. Particularly, the cells irradiated with 5 Gy at the high-dose rate or 10 Gy at the low-dose rate demonstrated more prominent tumorigenicity. Gene expression profiling was analyzed via microarray. Numerous genes that were significantly altered by a fold-change of >50% following irradiation were identified in each group. Gene expression analysis identified six commonly misregulated genes, including CRYAB, IL-18, ZNF845, CYP24A1, OR4N4 and VN1R4, at all doses. These genes involve apoptosis, the immune response, regulation of transcription, and receptor signaling pathways. Overall, the altered genes in high-dose rate (HDR) 5 Gy and low-dose rate (LDR) 10 Gy were more than those of LDR 5 Gy and HDR 10 Gy. Thus, we investigated genes associated with aggressive tumor development using the two dosage treatments. In this study, the identified gene expression profiles reflect the molecular response following high doses of external radiation exposure and may provide helpful information about radiation-induced thyroid tumors in the high-dose range. PMID:27006382

  18. Gene expression profiling in undifferentiated thyroid carcinoma induced by high-dose radiation

    PubMed Central

    Bang, Hyun Soon; Choi, Moo Hyun; Kim, Cha Soon; Choi, Seung Jin

    2016-01-01

    Published gene expression studies for radiation-induced thyroid carcinogenesis have used various methodologies. In this study, we identified differential gene expression in a human thyroid epithelial cell line after exposure to high-dose γ-radiation. HTori-3 cells were exposed to 5 or 10 Gy of ionizing radiation using two dose rates (high-dose rate: 4.68 Gy/min, and low-dose rate: 40 mGy/h) and then implanted into the backs of BALB/c nude mice after 4 (10 Gy) or 5 weeks (5 Gy). Decreases in cell viability, increases in giant cell frequency, anchorage-independent growth in vitro, and tumorigenicity in vivo were observed. Particularly, the cells irradiated with 5 Gy at the high-dose rate or 10 Gy at the low-dose rate demonstrated more prominent tumorigenicity. Gene expression profiling was analyzed via microarray. Numerous genes that were significantly altered by a fold-change of >50% following irradiation were identified in each group. Gene expression analysis identified six commonly misregulated genes, including CRYAB, IL-18, ZNF845, CYP24A1, OR4N4 and VN1R4, at all doses. These genes involve apoptosis, the immune response, regulation of transcription, and receptor signaling pathways. Overall, the altered genes in high-dose rate (HDR) 5 Gy and low-dose rate (LDR) 10 Gy were more than those of LDR 5 Gy and HDR 10 Gy. Thus, we investigated genes associated with aggressive tumor development using the two dosage treatments. In this study, the identified gene expression profiles reflect the molecular response following high doses of external radiation exposure and may provide helpful information about radiation-induced thyroid tumors in the high-dose range. PMID:27006382

  19. TMPyP4 promotes cancer cell migration at low doses, but induces cell death at high doses

    PubMed Central

    Zheng, Xiao-Hui; Nie, Xin; Liu, Hai-Ying; Fang, Yi-Ming; Zhao, Yong; Xia, Li-Xin

    2016-01-01

    TMPyP4 is widely considered as a potential photosensitizer in photodynamic therapy and a G-quadruplex stabilizer for telomerase-based cancer therapeutics. However, its biological effects including a possible adverse-effect are poorly understood. In this study, whole genome RNA-seq analysis was used to explore the alteration in gene expression induced by TMPyP4. Unexpectedly, we find that 27.67% of changed genes were functionally related to cell adhesion. Experimental evidences from cell adhesion assay, scratch-wound and transwell assay indicate that TMPyP4 at conventional doses (≤0.5 μM) increases cell-matrix adhesion and promotes the migration of tumor cells. In contrast, a high dose of TMPyP4 (≥2 μM) inhibits cell proliferation and induces cell death. The unintended “side-effect” of TMPyP4 on promoting cell migration suggests that a relative high dose of TMPyP4 is preferred for therapeutic purpose. These findings contribute to better understanding of biological effects induced by TMPyP4 and provide a new insight into the complexity and implication for TMPyP4 based cancer therapy. PMID:27221067

  20. TMPyP4 promotes cancer cell migration at low doses, but induces cell death at high doses.

    PubMed

    Zheng, Xiao-Hui; Nie, Xin; Liu, Hai-Ying; Fang, Yi-Ming; Zhao, Yong; Xia, Li-Xin

    2016-01-01

    TMPyP4 is widely considered as a potential photosensitizer in photodynamic therapy and a G-quadruplex stabilizer for telomerase-based cancer therapeutics. However, its biological effects including a possible adverse-effect are poorly understood. In this study, whole genome RNA-seq analysis was used to explore the alteration in gene expression induced by TMPyP4. Unexpectedly, we find that 27.67% of changed genes were functionally related to cell adhesion. Experimental evidences from cell adhesion assay, scratch-wound and transwell assay indicate that TMPyP4 at conventional doses (≤0.5 μM) increases cell-matrix adhesion and promotes the migration of tumor cells. In contrast, a high dose of TMPyP4 (≥2 μM) inhibits cell proliferation and induces cell death. The unintended "side-effect" of TMPyP4 on promoting cell migration suggests that a relative high dose of TMPyP4 is preferred for therapeutic purpose. These findings contribute to better understanding of biological effects induced by TMPyP4 and provide a new insight into the complexity and implication for TMPyP4 based cancer therapy. PMID:27221067

  1. Is High Dose Therapy Superior to Conventional Dose Therapy as Initial Treatment for Relapsed Germ Cell Tumors? The TIGER Trial

    PubMed Central

    Feldman, Darren R.; Huddart, Robert; Hall, Emma; Beyer, Jörg; Powles, Thomas

    2011-01-01

    Metastatic germ cell tumours (GCTs) are usually cured with cisplatin based chemotherapy and standard treatment algorithms are established. However when this treatment fails and the disease relapses, standard treatment is much more uncertain. Both conventional dose therapy (CDT) and high dose therapy (HDT) are widely used, due to the lack of conclusive data supporting one specific approach. A recent retrospective analysis focusing on this population suggested a significant benefit for HDT. Retrospective analyses are prone to bias, and therefore while this data is provocative it is by no mean conclusive. For this reason the international community is supporting a prospective randomised trial in this area comparing CDT(TIP) with sequential HDT (TICE). The planned open labelled randomised phase III study (TIGER) is due to open in 2011 and will recruit 390 patients to detect a 13% difference in 2 year progression free survival (primary endpoint). It is hoped that this large study will conclusively resolve the uncertainty which currently exists. PMID:21750688

  2. Absorbed dose-to-water protocol applied to synchrotron-generated x-rays at very high dose rates.

    PubMed

    Fournier, P; Crosbie, J C; Cornelius, I; Berkvens, P; Donzelli, M; Clavel, A H; Rosenfeld, A B; Petasecca, M; Lerch, M L F; Bräuer-Krisch, E

    2016-07-21

    Microbeam radiation therapy (MRT) is a new radiation treatment modality in the pre-clinical stage of development at the ID17 Biomedical Beamline of the European synchrotron radiation facility (ESRF) in Grenoble, France. MRT exploits the dose volume effect that is made possible through the spatial fractionation of the high dose rate synchrotron-generated x-ray beam into an array of microbeams. As an important step towards the development of a dosimetry protocol for MRT, we have applied the International Atomic Energy Agency's TRS 398 absorbed dose-to-water protocol to the synchrotron x-ray beam in the case of the broad beam irradiation geometry (i.e. prior to spatial fractionation into microbeams). The very high dose rates observed here mean the ion recombination correction factor, k s , is the most challenging to quantify of all the necessary corrections to apply for ionization chamber based absolute dosimetry. In the course of this study, we have developed a new method, the so called 'current ramping' method, to determine k s for the specific irradiation and filtering conditions typically utilized throughout the development of MRT. Using the new approach we deduced an ion recombination correction factor of 1.047 for the maximum ESRF storage ring current (200 mA) under typical beam spectral filtering conditions in MRT. MRT trials are currently underway with veterinary patients at the ESRF that require additional filtering, and we have estimated a correction factor of 1.025 for these filtration conditions for the same ESRF storage ring current. The protocol described herein provides reference dosimetry data for the associated Treatment Planning System utilized in the current veterinary trials and anticipated future human clinical trials. PMID:27366861

  3. Absorbed dose-to-water protocol applied to synchrotron-generated x-rays at very high dose rates

    NASA Astrophysics Data System (ADS)

    Fournier, P.; Crosbie, J. C.; Cornelius, I.; Berkvens, P.; Donzelli, M.; Clavel, A. H.; Rosenfeld, A. B.; Petasecca, M.; Lerch, M. L. F.; Bräuer-Krisch, E.

    2016-07-01

    Microbeam radiation therapy (MRT) is a new radiation treatment modality in the pre-clinical stage of development at the ID17 Biomedical Beamline of the European synchrotron radiation facility (ESRF) in Grenoble, France. MRT exploits the dose volume effect that is made possible through the spatial fractionation of the high dose rate synchrotron-generated x-ray beam into an array of microbeams. As an important step towards the development of a dosimetry protocol for MRT, we have applied the International Atomic Energy Agency’s TRS 398 absorbed dose-to-water protocol to the synchrotron x-ray beam in the case of the broad beam irradiation geometry (i.e. prior to spatial fractionation into microbeams). The very high dose rates observed here mean the ion recombination correction factor, k s , is the most challenging to quantify of all the necessary corrections to apply for ionization chamber based absolute dosimetry. In the course of this study, we have developed a new method, the so called ‘current ramping’ method, to determine k s for the specific irradiation and filtering conditions typically utilized throughout the development of MRT. Using the new approach we deduced an ion recombination correction factor of 1.047 for the maximum ESRF storage ring current (200 mA) under typical beam spectral filtering conditions in MRT. MRT trials are currently underway with veterinary patients at the ESRF that require additional filtering, and we have estimated a correction factor of 1.025 for these filtration conditions for the same ESRF storage ring current. The protocol described herein provides reference dosimetry data for the associated Treatment Planning System utilized in the current veterinary trials and anticipated future human clinical trials.

  4. High dose rate sources in remote afterloading brachytherapy: Implications for intracavitary and interstitial treatment of carcinoma

    SciTech Connect

    Syzek, E.J.; Bogardus, C.R. Jr. )

    1990-11-01

    Remote afterloading brachytherapy provides effective cancer treatment with zero personnel radiation exposure compared to conventional low dose rate systems requiring inpatient use of iridium, radium, or cesium sources. Clinical use of high dose rate brachytherapy is broadened to encompass curative treatment of cervical, endometrial, endobronchial, head and neck, esophageal, rectal, and prostatic carcinomas as well as palliation of intra-abdominal metastasis intraoperatively. Complications encountered with high dose rate sources will be compared to those of low dose rate systems commonly used in conjunction with external beam irradiation. Radiobiological effectiveness and economic benefits will be addressed to provide support for use of remote afterloading using high dose rate brachytherapy in palliative and curative treatment of selected carcinoma. 36 refs.

  5. Estimating Toxicity Pathway Activating Doses for High Throughput Chemical Risk Assessments

    EPA Science Inventory

    Estimating a Toxicity Pathway Activating Dose (TPAD) from in vitro assays as an analog to a reference dose (RfD) derived from in vivo toxicity tests would facilitate high throughput risk assessments of thousands of data-poor environmental chemicals. Estimating a TPAD requires def...

  6. A New Model of Biodosimetry to Integrate Low and High Doses

    PubMed Central

    Pujol, Mònica; Barquinero, Joan-Francesc; Puig, Pedro; Puig, Roser; Caballín, María Rosa; Barrios, Leonardo

    2014-01-01

    Biological dosimetry, that is the estimation of the dose of an exposure to ionizing radiation by a biological parameter, is a very important tool in cases of radiation accidents. The score of dicentric chromosomes, considered to be the most accurate method for biological dosimetry, for low LET radiation and up to 5 Gy, fits very well to a linear-quadratic model of dose-effect curve assuming the Poisson distribution. The accuracy of this estimation raises difficulties for doses over 5 Gy, the highest dose of the majority of dose-effect curves used in biological dosimetry. At doses over 5 Gy most cells show difficulties in reaching mitosis and cannot be used to score dicentric chromosomes. In the present study with the treatment of lymphocyte cultures with caffeine and the standardization of the culture time, metaphases for doses up to 25 Gy have been analyzed. Here we present a new model for biological dosimetry, which includes a Gompertz-type function as the dose response, and also takes into account the underdispersion of aberration-among-cell distribution. The new model allows the estimation of doses of exposures to ionizing radiation of up to 25 Gy. Moreover, the model is more effective in estimating whole and partial body exposures than the classical method based on linear and linear-quadratic functions, suggesting their effectiveness and great potential to be used after high dose exposures of radiation. PMID:25461738

  7. [High-dose buprenorphine for outpatient palliative pain therapy].

    PubMed

    Gastmeier, K; Freye, E

    2009-04-01

    The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. Under this medication a sufficient pain reduction (median NRS 2-3) over a period of 135 days could be achieved. At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family.If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care. PMID:19066981

  8. Dose rate dependence of the PTW 60019 microDiamond detector in high dose-per-pulse pulsed beams

    NASA Astrophysics Data System (ADS)

    Brualla-González, Luis; Gómez, Faustino; Pombar, Miguel; Pardo-Montero, Juan

    2016-01-01

    Recombination effects can affect the detectors used for the dosimetry of radiotherapy fields. They are important when using ionization chambers, especially in liquid-filled ionization chambers, and should be corrected for. The introduction of flattening-filter-free accelerators increases the typical dose-per-pulse used in radiotherapy beams, which leads to more important recombination effects. Diamond detectors provide a good solution for the dosimetry and quality assurance of small radiotherapy fields, due to their low energy dependence and small volume. The group of Università di Roma Tor Vergata has developed a synthetic diamond detector, which is commercialized by PTW as microDiamond detector type 60019. In this work we present an experimental characterization of the collection efficiency of the microDiamond detector, focusing on high dose-per-pulse FFF beams. The collection efficiency decreases with dose-per-pulse, down to 0.978 at 2.2 mGy/pulse, following a Fowler-Attix-like curve. On the other hand, we have found no significant dependence of the collection efficiency on the pulse repetition frequency (or pulse period).

  9. Sputtering of HOPG under high-dose ion irradiation

    NASA Astrophysics Data System (ADS)

    Borisov, A. M.; Mashkova, E. S.; Nemov, A. S.; Virgiliev, Yu. S.

    2007-03-01

    The dependences of sputtering yield Y of highly oriented pyrolytic graphite under high fluences (1018-1019 ion/cm2) 30 keV N2+ irradiation at ion incidence angles from θ = 0 (normal incidence) to θ = 80° at room temperature (RT) and T = 400 °C have been measured to trace the radiation damage influence on angular behavior of sputtering yield. A difference has been found between angular dependences of sputtering yields at RT, when the irradiation leads to a high degree of disorder, and at temperatures, larger than the temperature Ta responsible for annealing the radiation damage at continuous ion bombardment.

  10. Acute cognitive effects of high doses of dextromethorphan relative to triazolam in humans

    PubMed Central

    Carter, Lawrence P.; Reissig, Chad J.; Johnson, Matthew W.; Klinedinst, Margaret A.; Griffiths, Roland R.

    2012-01-01

    BACKGROUND Although concerns surrounding high-dose dextromethorphan (DXM) abuse have recently increased, few studies have examined the acute cognitive effects of high doses of DXM. The aim of this study was to compare the cognitive effects of DXM with those of triazolam and placebo. METHODS Single, acute, oral doses of DXM (100, 200, 300, 400, 500, 600, 700, 800 mg/70 kg), triazolam (0.25, 0.5 mg /70 kg), and placebo were administered p.o. to twelve healthy volunteers with histories of hallucinogen use, under double-blind conditions, using an ascending dose run-up design. Effects on cognitive performance were examined at baseline and after drug administration for up to 6 hours. RESULTS Both triazolam and DXM produced acute impairments in attention, working memory, episodic memory, and metacognition. Impairments observed following doses of 100-300 mg/70 kg DXM were generally smaller in magnitude than those observed after 0.5 mg/70 kg triazolam. Doses of DXM that impaired performance to the same extent as triazolam were in excess of 10-30 times the therapeutic dose of DXM. CONCLUSION The magnitude of the doses required for these effects and the absence of effects on some tasks within the 100-300 mg/70 kg dose range of DXM, speak to the relatively broad therapeutic window of over-the-counter DXM preparations when used appropriately. However, the administration of supratherapeutic doses of DXM resulted in acute cognitive impairments on all tasks that were examined. These findings are likely relevant to cases of high-dose DXM abuse. PMID:22989498

  11. Measurement of the Space Radiation Dose for the Flight Aircrew at High-Altitude

    NASA Astrophysics Data System (ADS)

    Lee, Jaewon; Park, Inchun; Kim, Junsik; Lee, Jaejin; Hwang, Junga; Kim, Young-chul

    2014-03-01

    This paper describes an experimental approach to evaluate the effective doses of space radiations at high-altitude by combining the measured data from the Liulin-6K spectrometer loaded onto the air-borne RC-800 cockpit and the calculated data from CARI-6M code developed by FAA. In this paper, 15 exposed dose experiments for the flight missions at a highaltitude above 10 km and 3 experiments at a normal altitude below 4 km were executed over the Korean Peninsula in 2012. The results from the high-altitude flight measurements show a dramatic change in the exposed doses as the altitude increases. The effective dose levels (an average of 15.27 mSv) of aircrew at the high-altitude are an order of magnitude larger than those (an average of 0.30 mSv) of the normal altitude flight. The comparison was made between the measure dose levels and the calculated dose levels and those were similar each other. It indicates that the annual dose levels of the aircrew boarding RC- 800 could be above 1 mSv. These results suggest that a proper procedure to manage the exposed dose of aircrew is required for ROK Air Force.

  12. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning.

    PubMed

    Engebretsen, Kristin M; Kaczmarek, Kathleen M; Morgan, Jenifer; Holger, Joel S

    2011-04-01

    INTRODUCTION. High-dose insulin therapy, along with glucose supplementation, has emerged as an effective treatment for severe beta-blocker and calcium channel-blocker poisoning. We review the experimental data and clinical experience that suggests high-dose insulin is superior to conventional therapies for these poisonings. PRESENTATION AND GENERAL MANAGEMENT. Hypotension, bradycardia, decreased systemic vascular resistance (SVR), and cardiogenic shock are characteristic features of beta-blocker and calcium-channel blocker poisoning. Initial treatment is primarily supportive and includes saline fluid resuscitation which is essential to correct vasodilation and low cardiac filling pressures. Conventional therapies such as atropine, glucagon and calcium often fail to improve hemodynamic status in severely poisoned patients. Catecholamines can increase blood pressure and heart rate, but they also increase SVR which may result in decreases in cardiac output and perfusion of vascular beds. The increased myocardial oxygen demand that results from catecholamines and vasopressors may be deleterious in the setting of hypotension and decreased coronary perfusion. METHODS. The Medline, Embase, Toxnet, and Google Scholar databases were searched for the years 1975-2010 using the terms: high-dose insulin, hyperinsulinemia-euglycemia, beta-blocker, calcium-channel blocker, toxicology, poisoning, antidote, toxin-induced cardiovascular shock, and overdose. In addition, a manual search of the Abstracts of the North American Congress of Clinical Toxicology and the Congress of the European Association of Poisons Centres and Clinical Toxicologists published in Clinical Toxicology for the years 1996-2010 was undertaken. These searches identified 485 articles of which 72 were considered relevant. MECHANISMS OF HIGH-DOSE INSULIN BENEFIT. There are three main mechanisms of benefit: increased inotropy, increased intracellular glucose transport, and vascular dilatation. EFFICACY OF HIGH-DOSE

  13. The OVLT initiates the fall in arterial pressure evoked by high dose lipopolysaccharide: evidence that dichotomous, dose-related mechanisms mediate endotoxic hypotension.

    PubMed

    Feleder, Carlos; Sertac Yilmaz, M; Peng, Jianya; Göktalay, Gökhan; Millington, William R

    2015-08-15

    This study tested the hypothesis that lipopolysaccharide (LPS) lowers arterial pressure through two different mechanisms depending on the dose. Previously, we found that a low hypotensive dose of LPS (1mg/kg) lowers arterial pressure by activating vagus nerve afferents. Here we report that hypotension evoked by high dose LPS (15mg/kg) can be prevented by injecting lidocaine into the OVLT but not by vagotomy or inactivation of the NTS. The hypotension produced by both LPS doses was correlated with elevated extracellular norepinephrine concentrations in the POA and prevented by blocking alpha-adrenergic receptors. Thus, initiation of endotoxic hypotension is dose-related, mechanistically. PMID:26198924

  14. Cumulative high doses of inhaled formoterol have less systemic effects in asthmatic children 6–11 years-old than cumulative high doses of inhaled terbutaline

    PubMed Central

    Kaae, Rikke; Agertoft, Lone; Pedersen, Sören; Nordvall, S Lennart; Pedroletti, Christophe; Bengtsson, Thomas; Johannes-Hellberg, Ingegerd; Rosenborg, Johan

    2004-01-01

    Objectives To evaluate high dose tolerability and relative systemic dose potency between inhaled clinically equipotent dose increments of formoterol and terbutaline in children. Methods Twenty boys and girls (6–11 years-old) with asthma and normal ECGs were studied. Ten doses of formoterol (Oxis®) 4.5 µg (F4.5) or terbutaline (Bricanyl®) 500 µg (T500) were inhaled cumulatively via a dry powder inhaler (Turbuhaler®) over 1 h (three patients) or 2.5 h (17 patients) and compared to a day of no treatment, in a randomised, double-blind (active treatments only), crossover trial. Blood pressure (BP), ECG, plasma potassium, glucose, lactate, and adverse events were monitored up to 10 h to assess tolerability and relative systemic dose potency. Results Formoterol and terbutaline had significant β2-adrenergic effects on most outcomes. Apart from the effect on systolic BP, QRS duration and PR interval, the systemic effects were significantly more pronounced with terbutaline than with formoterol. Thus, mean minimum plasma potassium, was suppressed from 3.56 (95% confidence interval, CI: 3.48–3.65) mmol l−1 on the day of no treatment to 2.98 (CI: 2.90–3.08) after 10 × F4.5 and 2.70 (CI: 2.61–2.78) mmol l−1 after 10 × T500, and maximum Q-Tc (heart rate corrected Q-T interval [Bazett's formula]) was prolonged from 429 (CI: 422–435) ms on the day of no treatment, to 455 (CI: 448–462) ms after 10 × F4.5 and 470 (CI: 463–476) ms after 10 × T500. Estimates of relative dose potency indicated that F4.5 µg had the same systemic activity as the clinically less effective dose of 250 µg terbutaline. The duration of systemic effects differed marginally between treatments. Spontaneously reported adverse events (most frequently tremor) were fewer with formoterol (78% of the children) than with terbutaline (95%). A serious adverse event occurred after inhalation of 45 µg formoterol over the 1 h dosing time, that prompted the extension of dosing time to 2.5 h

  15. An Alternative to the Use of High-Dose Estrogens for Postcoital Contraception.

    ERIC Educational Resources Information Center

    Schilling, Lee H.

    1979-01-01

    Research is reported on the use of ethinyl estradiol and norgestrel for contraception after intercourse. This treatment is offered as an alternative to high doses of estrogen and appears to be successful in preventing unwanted pregnancies. (JMF)

  16. Spatially resolved measurement of high doses in microbeam radiation therapy using samarium doped fluorophosphate glasses

    SciTech Connect

    Okada, Go; Morrell, Brian; Koughia, Cyril; Kasap, Safa; Edgar, Andy; Varoy, Chris; Belev, George; Wysokinski, Tomasz; Chapman, Dean

    2011-09-19

    The measurement of spatially resolved high doses in microbeam radiation therapy has always been a challenging task, where a combination of high dose response and high spatial resolution (microns) is required for synchrotron radiation peaked around 50 keV. The x-ray induced Sm{sup 3+}{yields} Sm{sup 2+} valence conversion in Sm{sup 3+} doped fluorophosphates glasses has been tested for use in x-ray dosimetry for microbeam radiation therapy. The conversion efficiency depends almost linearly on the dose of irradiation up to {approx}5 Gy and saturates at doses exceeding {approx}80 Gy. The conversion shows strong correlation with x-ray induced absorbance of the glass which is related to the formation of phosphorus-oxygen hole centers. When irradiated through a microslit collimator, a good spatial resolution and high ''peak-to-valley'' contrast have been observed by means of confocal photoluminescence microscopy.

  17. High-Dose Induced Thermoluminescence of Light-Colored Lithology in Chelyabinsk Meteorite

    NASA Astrophysics Data System (ADS)

    Weinstein, I. A.; Vokhmintsev, A. S.; Ishchenko, A. V.; Grokhovsky, V. I.

    2015-07-01

    This work presents the study results of high-dose irradiation effects on the laboratory TL parameters in Chelyabinsk LL5 chondrite fragments with light-colored lithology. Obtained data are analyzed in terms of the general order kinetic formalism.

  18. Evaluation of a deterministic grid-based Boltzmann solver (GBBS) for voxel-level absorbed dose calculations in nuclear medicine

    NASA Astrophysics Data System (ADS)

    Mikell, Justin; Cheenu Kappadath, S.; Wareing, Todd; Erwin, William D.; Titt, Uwe; Mourtada, Firas

    2016-06-01

    To evaluate the 3D Grid-based Boltzmann Solver (GBBS) code ATTILA ® for coupled electron and photon transport in the nuclear medicine energy regime for electron (beta, Auger and internal conversion electrons) and photon (gamma, x-ray) sources. Codes rewritten based on ATTILA are used clinically for both high-energy photon teletherapy and 192Ir sealed source brachytherapy; little information exists for using the GBBS to calculate voxel-level absorbed doses in nuclear medicine. We compared DOSXYZnrc Monte Carlo (MC) with published voxel-S-values to establish MC as truth. GBBS was investigated for mono-energetic 1.0, 0.1, and 0.01 MeV electron and photon sources as well as 131I and 90Y radionuclides. We investigated convergence of GBBS by analyzing different meshes ({{M}0},{{M}1},{{M}2} ), energy group structures ({{E}0},{{E}1},{{E}2} ) for each radionuclide component, angular quadrature orders (≤ft. {{S}4},{{S}8},{{S}16}\\right) , and scattering order expansions ({{P}0} –{{P}6} ); higher indices imply finer discretization. We compared GBBS to MC in (1) voxel-S-value geometry for soft tissue, lung, and bone, and (2) a source at the interface between combinations of lung, soft tissue, and bone. Excluding Auger and conversion electrons, MC agreed within  ≈5% of published source voxel absorbed doses. For the finest discretization, most GBBS absorbed doses in the source voxel changed by less than 1% compared to the next finest discretization along each phase space variable indicating sufficient convergence. For the finest discretization, agreement with MC in the source voxel ranged from  ‑3% to  ‑20% with larger differences at lower energies (‑3% for 1 MeV electron in lung to  ‑20% for 0.01 MeV photon in bone); similar agreement was found for the interface geometries. Differences between GBBS and MC in the source voxel for 90Y and 131I were  ‑6%. The GBBS ATTILA was benchmarked against MC in the nuclear medicine regime. GBBS can be a

  19. Evaluation of a deterministic grid-based Boltzmann solver (GBBS) for voxel-level absorbed dose calculations in nuclear medicine.

    PubMed

    Mikell, Justin; Cheenu Kappadath, S; Wareing, Todd; Erwin, William D; Titt, Uwe; Mourtada, Firas

    2016-06-21

    To evaluate the 3D Grid-based Boltzmann Solver (GBBS) code ATTILA (®) for coupled electron and photon transport in the nuclear medicine energy regime for electron (beta, Auger and internal conversion electrons) and photon (gamma, x-ray) sources. Codes rewritten based on ATTILA are used clinically for both high-energy photon teletherapy and (192)Ir sealed source brachytherapy; little information exists for using the GBBS to calculate voxel-level absorbed doses in nuclear medicine. We compared DOSXYZnrc Monte Carlo (MC) with published voxel-S-values to establish MC as truth. GBBS was investigated for mono-energetic 1.0, 0.1, and 0.01 MeV electron and photon sources as well as (131)I and (90)Y radionuclides. We investigated convergence of GBBS by analyzing different meshes ([Formula: see text]), energy group structures ([Formula: see text]) for each radionuclide component, angular quadrature orders ([Formula: see text], and scattering order expansions ([Formula: see text]-[Formula: see text]); higher indices imply finer discretization. We compared GBBS to MC in (1) voxel-S-value geometry for soft tissue, lung, and bone, and (2) a source at the interface between combinations of lung, soft tissue, and bone. Excluding Auger and conversion electrons, MC agreed within  ≈5% of published source voxel absorbed doses. For the finest discretization, most GBBS absorbed doses in the source voxel changed by less than 1% compared to the next finest discretization along each phase space variable indicating sufficient convergence. For the finest discretization, agreement with MC in the source voxel ranged from  -3% to  -20% with larger differences at lower energies (-3% for 1 MeV electron in lung to  -20% for 0.01 MeV photon in bone); similar agreement was found for the interface geometries. Differences between GBBS and MC in the source voxel for (90)Y and (131)I were  -6%. The GBBS ATTILA was benchmarked against MC in the nuclear medicine regime. GBBS can be a

  20. Anti-Inflammatory Properties of Low and High Doxycycline Doses: An In Vitro Study

    PubMed Central

    Di Caprio, Roberta; Di Costanzo, Luisa; Monfrecola, Giuseppe

    2015-01-01

    Doxycycline is used to treat infective diseases because of its broadspectrum efficacy. High dose administration (100 or 200 mg/day) is often responsible for development of bacterial resistances and endogenous flora alterations, whereas low doses (20–40 mg/day) do not alter bacteria susceptibility to antibiotics and exert anti-inflammatory activities. In this study, we wanted to assess the efficacy of both low and high doxycycline doses in modulating IL-8, TNF-α, and IL-6 gene expression in HaCaT cells stimulated with LPS. Three experimental settings were used, differing in the timing of doxycycline treatment in respect to the insult induced by LPS: pretreatment, concomitant, and posttreatment. Low doses were more effective than high doses in modulating gene expression of LPS-induced proinflammatory cytokines (IL-8, TNF-α, and IL-6), when added before (pretreatment) or after (posttreatment) LPS stimulation. This effect was not appreciated when LPS and doxycycline were simultaneously added to cell cultures: in this case high doses were more effective. In conclusion, our in vitro study suggests that low doxycycline doses could be safely used in chronic or acute skin diseases in which the inflammatory process, either constantly in progress or periodically recurring, has to be prevented or controlled. PMID:25977597

  1. High-dose MVCT image guidance for stereotactic body radiation therapy

    SciTech Connect

    Westerly, David C.; Schefter, Tracey E.; Kavanagh, Brian D.; Chao, Edward; Lucas, Dan; Flynn, Ryan T.; Miften, Moyed

    2012-08-15

    Purpose: Stereotactic body radiation therapy (SBRT) is a potent treatment for early stage primary and limited metastatic disease. Accurate tumor localization is essential to administer SBRT safely and effectively. Tomotherapy combines helical IMRT with onboard megavoltage CT (MVCT) imaging and is well suited for SBRT; however, MVCT results in reduced soft tissue contrast and increased image noise compared with kilovoltage CT. The goal of this work was to investigate the use of increased imaging doses on a clinical tomotherapy machine to improve image quality for SBRT image guidance. Methods: Two nonstandard, high-dose imaging modes were created on a tomotherapy machine by increasing the linear accelerator (LINAC) pulse rate from the nominal setting of 80 Hz, to 160 Hz and 300 Hz, respectively. Weighted CT dose indexes (wCTDIs) were measured for the standard, medium, and high-dose modes in a 30 cm solid water phantom using a calibrated A1SL ion chamber. Image quality was assessed from scans of a customized image quality phantom. Metrics evaluated include: contrast-to-noise ratios (CNRs), high-contrast spatial resolution, image uniformity, and percent image noise. In addition, two patients receiving SBRT were localized using high-dose MVCT scans. Raw detector data collected after each scan were used to reconstruct standard-dose images for comparison. Results: MVCT scans acquired using a pitch of 1.0 resulted in wCTDI values of 2.2, 4.7, and 8.5 cGy for the standard, medium, and high-dose modes respectively. CNR values for both low and high-contrast materials were found to increase with the square root of dose. Axial high-contrast spatial resolution was comparable for all imaging modes at 0.5 lp/mm. Image uniformity was improved and percent noise decreased as the imaging dose increased. Similar improvements in image quality were observed in patient images, with decreases in image noise being the most notable. Conclusions: High-dose imaging modes are made possible on a

  2. Absolute dose measurements by means of a small cylindrical ionization chamber for very high dose per pulse high energy electron beams

    SciTech Connect

    Karaj, E.; Righi, S.; Di Martino, F.

    2007-03-15

    Very high dose per pulse (3-13 cGy/pulse) high energy electron beams are currently produced by special linear accelerators (linac) dedicated to Intra Operative Radiation Therapy (IORT). The electron beams produced by such linacs are collimated by special Perspex applicators of various size and cylindrically shaped. The biggest problems from the dosimetric point of view are caused by the high dose-per-pulse values and the use of inclined applicators. In this work measurements of absolute dose for the inclined applicators were done by using a small cylindrical ionization chamber, type CC01 (Wellhofer), a parallel plane ionization chamber type Markus (PTW 23343) and radiochromic films type EBT. We show a method which allows calculating the quality correction factors for CC01 chamber with an uncertainty of 1% and the absolute dose value for the inclined applicators using CC01 with an uncertainty of 3.1% for electron beams of energy of 6 and 7 MeV produced by the linac dedicated to IORT Novac7.

  3. Focal takotsubo cardiomyopathy with high-dose interleukin-2 therapy for malignant melanoma.

    PubMed

    Damodaran, Senthil; Mrozek, Ewa; Liebner, David; Kendra, Kari

    2014-12-01

    High-dose interleukin-2 (IL-2) is an available treatment option for patients with metastatic melanoma or renal cell carcinoma, and is associated with sustained complete and partial responses in a subset of patients. IL-2, however, is not devoid of toxicities, most of which involve the cardiovascular system and manifest as hypotension, arrhythmias, and cardiomyopathy. This report describes an unusual presentation of takotsubo cardiomyopathy in a postmenopausal woman receiving high-dose IL-2 for metastatic melanoma. PMID:25505207

  4. Early supradiaphragmatic Hodgkin's disease. High-dose gallium scanning obviates the need for staging laparotomy

    SciTech Connect

    Blackwell, E.A.; Joshua, D.E.; McLaughlin, A.F.; Green, D.; Kronenberg, H.; May, J.

    1986-08-15

    Experience with 16 sequential patients with Stage IA/IIA supradiaphragmatic Hodgkin's disease who had no evidence of intra-abdominal disease using high-dose gallium and computerized tomography scanning is reported. Subsequent staging laparotomy also was negative in all these patients and did not alter management decisions. It is suggested that high-dose, whole-body gallium scanning and other noninvasive staging procedures give reliable data for therapeutic decisions.

  5. Salvage high-dose-rate interstitial brachytherapy for locally recurrent rectal cancer*

    PubMed Central

    Pellizzon, Antônio Cássio Assis

    2016-01-01

    For tumors of the lower third of the rectum, the only safe surgical procedure is abdominal-perineal resection. High-dose-rate interstitial brachytherapy is a promising treatment for local recurrence of previously irradiated lower rectal cancer, due to the extremely high concentrated dose delivered to the tumor and the sparing of normal tissue, when compared with a course of external beam radiation therapy. PMID:27403021

  6. SU-E-J-93: Parametrisation of Dose to the Mucosa of the Anterior Rectal Wall in Transrectal Ultrasound Guided High-Dose-Rate Brachytherapy of the Prostate

    SciTech Connect

    Aitkenhead, A; Hamlett, L; Wood, D; Choudhury, A

    2014-06-01

    Purpose: In high-dose-rate (HDR) brachytherapy of the prostate, radiation is delivered from a number of radioactive sources which are inserted via catheter into the target volume. The rectal mucosa also receives dose during the treatment, which may lead to late toxicity effects. To allow possible links between rectal dose and toxicity to be investigated, suitable methods of parametrising the rectal dose are needed. Methods: During treatment of a series of 95 patients, anatomy and catheter locations were monitored by transrectal ultrasound, and target volume positions were contoured on the ultrasound scan by the therapist. The anterior rectal mucosal wall was identified by contouring the transrectal ultrasound balloon within the ultrasound scan. Source positions and dwell times, along with the dose delivered to the patient were computed using the Oncentra Prostate treatment planning system (TPS). Data for the series of patients were exported from the TPS in Dicom format, and a series of parametrisation methods were developed in a Matlab environment to assess the rectal dose. Results: Contours of the anterior rectal mucosa were voxelised within Matlab to allow the dose to the rectal mucosa to be analysed directly from the 3D dose grid. Dose parametrisations based on dose-surface (DSH) and dose-line (DLH) histograms were obtained. Both lateral and longitudinal extents of the mucosal dose were parametrised using dose-line histograms in the relevant directions. Conclusion: We have developed a series of dose parametrisations for quantifying the dose to the rectal mucosa during HDR prostate brachytherapy which are suitable for future studies investigating potential associations between mucosal dose and late toxicity effects. The geometry of the transrectal probe standardises the rectal anatomy, making this treatment technique particularly suited to studies of this nature.

  7. Evaluation of High Ipsilateral Subventricular Zone Radiation Therapy Dose in Glioblastoma: A Pooled Analysis

    SciTech Connect

    Lee, Percy; Eppinga, Wietse; Lagerwaard, Frank; Cloughesy, Timothy; Slotman, Benjamin; Nghiemphu, Phioanh L.; Wang, Pin-Chieh; Kupelian, Patrick; Agazaryan, Nzhde; Demarco, John; Selch, Michael T.; Steinberg, Michael; Kang, Jung Julie

    2013-07-15

    Purpose: Cancer stem cells (CSCs) may play a role in the recurrence of glioblastoma. They are believed to originate from neural stem cells in the subventricular zone (SVZ). Because of their radioresistance, we hypothesized that high doses of radiation (>59.4 Gy) to the SVZ are necessary to control CSCs and improve progression-free survival (PFS) or overall survival (OS) in glioblastoma. Methods and Materials: 173 patients with glioblastoma pooled from 2 academic centers were treated with resection followed by chemoradiation therapy. The SVZ was segmented on computed tomography to calculate radiation doses delivered to the presumptive CSC niches. The relationships between high SVZ doses and PFS and OS were examined using Cox proportional hazards models. Five covariates were included to estimate their impact on PFS or OS: ipsilateral and contralateral SVZ doses, clinical target volume dose, age, and extent of resection. Results: Median PFS and OS were 10.4 and 19.6 months for the cohort. The mean ipsilateral SVZ, contralateral SVZ, and clinical target volume doses were 49.2, 35.2, and 60.1 Gy, respectively. Twenty-one patients who received high ipsilateral SVZ dose (>59.4 Gy) had significantly longer median PFS (12.6 vs 9.9 months, P=.042) and longer OS (25.8 vs 19.2 months, P=.173). On multivariate analysis, high radiation therapy doses to ipsilateral SVZ remained a statistically significant independent predictor of improved PFS but not of OS. The extent of surgery affected both PFS and OS on multivariate analysis. Conclusion: High radiation therapy doses to ipsilateral CSC niches are associated with improved PFS in glioblastoma.

  8. High-dose simultaneously integrated breast boost using intensity-modulated radiotherapy and inverse optimization

    SciTech Connect

    Hurkmans, Coen W. . E-mail: coen.hurkmans@cze.nl; Meijer, Gert J.; Vliet-Vroegindeweij, Corine van; Cassee, Jorien

    2006-11-01

    Purpose: Recently a Phase III randomized trial has started comparing a boost of 16 Gy as part of whole-breast irradiation to a high boost of 26 Gy in young women. Our main aim was to develop an efficient simultaneously integrated boost (SIB) technique for the high-dose arm of the trial. Methods and Materials: Treatment planning was performed for 5 left-sided and 5 right-sided tumors. A tangential field intensity-modulated radiotherapy technique added to a sequentially planned 3-field boost (SEQ) was compared with a simultaneously planned technique (SIB) using inverse optimization. Normalized total dose (NTD)-corrected dose volume histogram parameters were calculated and compared. Results: The intended NTD was produced by 31 fractions of 1.66 Gy to the whole breast and 2.38 Gy to the boost volume. The average volume of the PTV-breast and PTV-boost receiving more than 95% of the prescribed dose was 97% or more for both techniques. Also, the mean lung dose and mean heart dose did not differ much between the techniques, with on average 3.5 Gy and 2.6 Gy for the SEQ and 3.8 Gy and 2.6 Gy for the SIB, respectively. However, the SIB resulted in a significantly more conformal irradiation of the PTV-boost. The volume of the PTV-breast, excluding the PTV-boost, receiving a dose higher than 95% of the boost dose could be reduced considerably using the SIB as compared with the SEQ from 129 cc (range, 48-262 cc) to 58 cc (range, 30-102 cc). Conclusions: A high-dose simultaneously integrated breast boost technique has been developed. The unwanted excessive dose to the breast was significantly reduced.

  9. Dose Control System in the Optima XE Single Wafer High Energy Ion Implanter

    SciTech Connect

    Satoh, Shu; Yoon, Jongyoon; David, Jonathan

    2011-01-07

    Photoresist outgassing can significantly compromise accurate dosimetry of high energy implants. High energy implant even at a modest beam current produces high beam powers which create significantly worse outgassing than low and medium energy implants and the outgassing continues throughout the implant due to the low dose in typical high energy implant recipes. In the previous generation of high energy implanters, dose correction by monitoring of process chamber pressure during photoresist outgassing has been used. However, as applications diversify and requirements change, the need arises for a more versatile photoresist correction system to match the versatility of a single wafer high energy ion implanter. We have successfully developed a new dosimetry system for the Optima XE single wafer high energy ion implanter which does not require any form of compensation due to the implant conditions. This paper describes the principles and performance of this new dose system.

  10. Dose Control System in the Optima XE Single Wafer High Energy Ion Implanter

    NASA Astrophysics Data System (ADS)

    Satoh, Shu; Yoon, Jongyoon; David, Jonathan

    2011-01-01

    Photoresist outgassing can significantly compromise accurate dosimetry of high energy implants. High energy implant even at a modest beam current produces high beam powers which create significantly worse outgassing than low and medium energy implants and the outgassing continues throughout the implant due to the low dose in typical high energy implant recipes. In the previous generation of high energy implanters, dose correction by monitoring of process chamber pressure during photoresist outgassing has been used. However, as applications diversify and requirements change, the need arises for a more versatile photoresist correction system to match the versatility of a single wafer high energy ion implanter. We have successfully developed a new dosimetry system for the Optima XE single wafer high energy ion implanter which does not require any form of compensation due to the implant conditions. This paper describes the principles and performance of this new dose system.

  11. Peripheral blood progenitor cell transplantation in multiple myeloma following high-dose melphalan-based therapy.

    PubMed

    Goldschmidt, H; Hegenbart, U; Wallmeier, M; Hohaus, S; Engenhart, R; Wannenmacher, M; Haas, R

    1998-01-01

    The objective of our study was to evaluate the efficacy and toxicity of a high-dose melphalan-based therapy with or without total body irradiation (TBI) followed by peripheral blood progenitor cell (PBPC) transplantation in patients with multiple myeloma. Between June 1992 and June 1996, 104 patients (71 male, 33 female) with a median age of 51 years (range 30-65 years) underwent transplantation at our center. PBPC were mobilized using high-dose chemotherapy followed by treatment with G-CSF. Fifty patients were treated with TBI+melphalan 140 mg/m2 while 54 patients received melphalan 200 mg/m2. Following PBPC autografting, the median time to attainment of platelets > or = 20 x 10(9)/l and neutrophils > or = 0.5 x 10(9)/l was 11 and 14 days, with no difference between the treatment groups. In the TBI group significantly longer periods of total parenteral nutrition were required due to the occurrence of severe mucositis. Two patients from the TBI group died of transplantation-related complications. Following high-dose treatment, remission state improved in 43 out of 102 patients. No statistically significant advantage in reaching complete or partial remission was observed with TBI+high-dose melphalan compared to the treatment with high-dose melphalan alone. The optimal high-dose treatment, with particular reference to the inclusion or omission of TBI, should be prospectively investigated. PMID:9304704

  12. Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage therapies

    PubMed Central

    Leyvraz, S; Herrmann, R; Guillou, L; Honegger, H P; Christinat, A; Fey, M F; Sessa, C; Wernli, M; Cerny, T; Dietrich, D; Pestalozzi, B

    2006-01-01

    Having determined in a phase I study the maximum tolerated dose of high-dose ifosfamide combined with high-dose doxorubicin, we now report the long-term results of a phase II trial in advanced soft-tissue sarcomas. Forty-six patients with locally advanced or metastatic soft-tissue sarcomas were included, with age <60 years and all except one in good performance status (0 or 1). The chemotherapy treatment consisted of ifosfamide 10 g m−2 (continuous infusion for 5 days), doxorubicin 30 mg m−2 day−1 × 3 (total dose 90 mg m−2), mesna and granulocyte-colony stimulating factor. Cycles were repeated every 21 days. A median of 4 (1–6) cycles per patient was administered. Twenty-two patients responded to therapy, including three complete responders and 19 partial responders for an overall response rate of 48% (95% CI: 33–63%). The response rate was not different between localised and metastatic diseases or between histological types, but was higher in grade 3 tumours. Median overall survival was 19 months. Salvage therapies (surgery and/or radiotherapy) were performed in 43% of patients and found to be the most significant predictor for favourable survival (exploratory multivariate analysis). Haematological toxicity was severe, including grade ⩾3 neutropenia in 59%, thrombopenia in 39% and anaemia in 27% of cycles. Three patients experienced grade 3 neurotoxicity and one patient died of septic shock. This high-dose regimen is toxic but nonetheless feasible in multicentre settings in non elderly patients with good performance status. A high response rate was obtained. Prolonged survival was mainly a function of salvage therapies. PMID:17031396

  13. Effectiveness of once-daily high-dose ACTH for infantile spasms.

    PubMed

    Hodgeman, Ryan M; Kapur, Kush; Paris, Ann; Marti, Candice; Can, Afra; Kimia, Amir; Loddenkemper, Tobias; Bergin, Ann; Poduri, Annapurna; Libenson, Mark; Lamb, Nathan; Jafarpour, Saba; Harini, Chellamani

    2016-06-01

    There is insufficient evidence to recommend a specific protocol for treatment of infantile spasms (IS) and a lack of standardization among, and even within, institutions. Twice-daily dosing (for the first two weeks) of high-dose natural ACTH for IS is used by many centers and recommended by the National Infantile Spasms Consortium (NISC). Conversely, it is our practice to use once-daily dosing of high-dose natural ACTH for IS. In order to determine the effectiveness of our center's practice, we retrospectively reviewed 57 cases over the past four years at Boston Children's Hospital (BCH). We found that 70% of infants were spasm-free at 14days from ACTH initiation and 54% continued to be spasm-free at 3-month follow-up. Electroencephalogram showed resolution of hypsarrhythmia (when present on the pretreatment EEG) in all responders. Additionally, once-daily dosing of ACTH was well tolerated. We performed a meta-analysis to compare our results against the reports of published literature using twice-daily high-dose ACTH for treatment of IS. The meta-analysis revealed that our results were comparable to previously published outcomes using twice-daily ACTH administration for IS treatment. Our experience shows that once-daily dosing of ACTH is effective for treatment of IS. If larger prospective trials can confirm our findings, it would obviate the need for additional painful injections, simplify the schedule, and support a universal standardized protocol. PMID:27084976

  14. High doses of cobalt induce optic and auditory neuropathy.

    PubMed

    Apostoli, Pietro; Catalani, Simona; Zaghini, Anna; Mariotti, Andrea; Poliani, Pietro Luigi; Vielmi, Valentina; Semeraro, Francesco; Duse, Sarah; Porzionato, Andrea; Macchi, Veronica; Padovani, Alessandro; Rizzetti, Maria Cristina; De Caro, Raffaele

    2013-09-01

    The adverse biological effects of continuous exposure to cobalt and chromium have been well defined. In the past, this toxicity was largely an industrial issue concerning workers exposed in occupational setting. Nevertheless, recent reports have described a specific toxicity mediated by the high levels of cobalt and chromium released by metallic prostheses, particularly in patients who had received hip implants. Clinical symptoms, including blindness, deafness and peripheral neuropathy, suggest a specific neurotropism. However, little is known about the neuropathological basis of this process, and experimental evidence is still lacking. We have investigated this issue in an experimental setting using New Zealand White rabbits treated with repeated intravenous injections of cobalt and chromium, alone or in combination. No evident clinical or pathological alterations were associated after chromium administration alone, despite its high levels in blood and tissue while cobalt-chromium and cobalt-treated rabbits showed clinical signs indicative of auditory and optic system toxicity. On histopathological examination, the animals showed severe retinal and cochlear ganglion cell depletion along with optic nerve damage and loss of sensory cochlear hair cells. Interestingly, the severity of the alterations was related to dosages and time of exposure. These data confirmed our previous observation of severe auditory and optic nerve toxicity in patients exposed to an abnormal release of cobalt and chromium from damaged hip prostheses. Moreover, we have identified the major element mediating neurotoxicity to be cobalt, although the molecular mechanisms mediating this toxicity still have to be defined. PMID:23069009

  15. High and low dose radiation effects on mammary adenocarcinoma cells – an epigenetic connection

    PubMed Central

    Luzhna, Lidia; Filkowski, Jody; Kovalchuk, Olga

    2016-01-01

    The successful treatment of cancer, including breast cancer, depends largely on radiation therapy and proper diagnostics. The effect of ionizing radiation on cells and tissues depends on the radiation dose and energy level, but there is insufficient evidence concerning how tumor cells respond to the low and high doses of radiation that are often used in medical diagnostic and treatment modalities. The purpose of this study was to investigate radiation-induced gene expression changes in the MCF-7 breast adenocarcinoma cell line. Using microarray technology tools, we were able to screen the differential gene expressions profiles between various radiation doses applied to MCF-7 cells. Here, we report the substantial alteration in the expression level of genes after high-dose treatment. In contrast, no dramatic gene expression alterations were noticed after the application of low and medium doses of radiation. In response to a high radiation dose, MCF-7 cells exhibited down-regulation of biological pathways such as cell cycle, DNA replication, and DNA repair and activation of the p53 pathway. Similar dose-dependent responses were seen on the epigenetic level, which was tested by a microRNA expression analysis. MicroRNA analysis showed dose-dependent radiation-induced microRNA expression alterations that were associated with cell cycle arrest and cell death. An increased rate of apoptosis was determined by an Annexin V assay. The results of this study showed that high doses of radiation affect gene expression genetically and epigenetically, leading to alterations in cell cycle, DNA replication, and apoptosis. PMID:27226982

  16. Elastic stability of high dose neutron irradiated spinel

    SciTech Connect

    Li, Z.; Chan, S.K.; Garner, F.A.

    1995-04-01

    The objective of this effort is to identify ceramic materials that are suitable for fusion reactor applications. Elastic constants (C{sub 11}, C{sub 12}, and C{sub 44}) of spinel (MgAl{sub 2}O{sub 4}) single crystals irradiated to very high neutron fluences have geen measured by an ultrasonic technique. Although results of a neutron diffraction study show that cation occupation sites are significantly changed in the irradiated samples, no measurable differences occurred in their elastic properties. In order to understand such behavior, the elastic properties of a variety of materials with either normal or inverse spinel structures were studied. The cation valence and cation distribution appear to have little influence on the elastic properties of spinel materials.

  17. Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock

    PubMed Central

    Bassi, Estevão; Park, Marcelo; Azevedo, Luciano Cesar Pontes

    2013-01-01

    There is no consensual definition of refractory shock. The use of more than 0.5 mcg/kg/min of norepinephrine or epinephrine to maintain target blood pressure is often used in clinical trials as a threshold. Nearly 6% of critically ill patients will develop refractory shock, which accounts for 18% of deaths in intensive care unit. Mortality rates are usually greater than 50%. The assessment of fluid responsiveness and cardiac function can help to guide therapy, and inotropes may be used if hypoperfusion signs persist after initial resuscitation. Arginine vasopressin is frequently used in refractory shock, although definite evidence to support this practice is still missing. Its associations with corticosteroids improved outcome in observational studies and are therefore promising alternatives. Other rescue therapies such as terlipressin, methylene blue, and high-volume isovolemic hemofiltration await more evidence before use in routine practice. PMID:24151551

  18. Neutron spectra and dose equivalents calculated in tissue for high-energy radiation therapy

    SciTech Connect

    Kry, Stephen F.; Howell, Rebecca M.; Salehpour, Mohammad; Followill, David S.

    2009-04-15

    Neutrons are by-products of high-energy radiation therapy and a source of dose to normal tissues. Thus, the presence of neutrons increases a patient's risk of radiation-induced secondary cancer. Although neutrons have been thoroughly studied in air, little research has been focused on neutrons at depths in the patient where radiosensitive structures may exist, resulting in wide variations in neutron dose equivalents between studies. In this study, we characterized properties of neutrons produced during high-energy radiation therapy as a function of their depth in tissue and for different field sizes and different source-to-surface distances (SSD). We used a previously developed Monte Carlo model of an accelerator operated at 18 MV to calculate the neutron fluences, energy spectra, quality factors, and dose equivalents in air and in tissue at depths ranging from 0.1 to 25 cm. In conjunction with the sharply decreasing dose equivalent with increased depth in tissue, the authors found that the neutron energy spectrum changed drastically as a function of depth in tissue. The neutron fluence decreased gradually as the depth increased, while the average neutron energy decreased sharply with increasing depth until a depth of approximately 7.5 cm in tissue, after which it remained nearly constant. There was minimal variation in the quality factor as a function of depth. At a given depth in tissue, the neutron dose equivalent increased slightly with increasing field size and decreasing SSD; however, the percentage depth-dose equivalent curve remained constant outside the primary photon field. Because the neutron dose equivalent, fluence, and energy spectrum changed substantially with depth in tissue, we concluded that when the neutron dose equivalent is being determined at a depth within a patient, the spectrum and quality factor used should be appropriate for depth rather than for in-air conditions. Alternately, an appropriate percent depth-dose equivalent curve should be

  19. X-ray storage performance of KCl:Eu2+ with high cumulated dose

    NASA Astrophysics Data System (ADS)

    Hansel, Rachael A.; Xiao, Zhiyan; Zhang, Lei; Li, H. Harold

    2014-05-01

    The effects of high cumulative radiation dose on the luminescence properties of KCl:Eu2+ are investigated. Pellet samples of KCl:Eu2+ were given doses of up to 200 kGy at the Louisiana State University Synchrotron facility. After synchrotron irradiation, samples were optically bleached and given a clinical dose of 2 Gy from a 6 MV medical linear accelerator. Optical properties were evaluated using photostimulated luminescence (PSL), photoluminescence (PL), and temperature-dependent PSL measurements. For a cumulated dose of up to 5-10 kGy, the PSL emission intensity increased by 15% compared to the PSL signal with no radiation history. For doses higher than 10 kGy, the PSL emission intensity retained at least 70% of the original intensity. Spatial correlation of the charge storage centers increased for doses up to 5 kGy and then decreased for higher cumulative doses. Emission band at 975 nm was attributed to transitions of Eu1+. PL spectra showed an intense peak centered at 420 nm for all cumulative doses. The results of this work show that KCl:Eu2+ storage phosphors are excellent reusable materials for radiation therapy dosimetry.

  20. A novel triple therapy for ITP using high-dose dexamethasone, low-dose rituximab, and cyclosporine (TT4)

    PubMed Central

    Choi, Philip Young-Ill; Roncolato, Fernando; Badoux, Xavier; Ramanathan, Sundra; Ho, Shir-Jing

    2015-01-01

    Promising reports of combination immunosuppression with high-dose dexamethasone and rituximab for the treatment of primary immune thrombocytopenia (ITP) have recently emerged. They suggest a potential to further optimize the efficacy of therapy. We investigate the use of a novel combination of conventional therapies in ITP given over 4 weeks. From 2011 to 2014, 20 patients were prospectively enrolled onto a single-arm phase 2b study to describe the safety, efficacy, and tolerability of oral dexamethasone 40 mg for days 1 to 4, oral cyclosporine 2.5 to 3 mg/kg daily for day 1 to 28, and intravenous low-dose rituximab 100 mg for days 7, 14, 21, and 28. There were no therapy-related serious adverse side effects, 6-month response rate was 60%, and treatment was well tolerated. Responders enjoyed relapse-free survivals of 92% and 76%, respectively, at 12 and 24 months. This study highlights the possibility of achieving an enduring remission from 4 weeks of therapy. This study is registered at www.anzctr.org.au (#ANZCTRN12611000015943). PMID:25972158

  1. Albuminuria after renal transplantation: maintenance with sirolimus/low-dose tacrolimus vs. mycophenolate mofetil/high-dose tacrolimus.

    PubMed

    Miles, Clifford D; Skorupa, Jill Y; Sandoz, John P; Rigley, Theodore H; Nielsen, Kathleen J; Stevens, R Brian

    2011-01-01

    Maintenance immunosuppression with sirolimus (SRL) in renal transplantation has been associated with proteinuria. We report long-term outcomes of kidney transplant recipients maintained on steroid-free regimens, either SRL with low-dose tacrolimus (SRL/L-Tac) or mycophenolate mofetil (MMF) with high-dose tacrolimus (MMF/H-Tac). We conducted a case-matched study of 50 patients receiving MMF/H-Tac, matched 1:2 with 100 patients maintained on SRL/L-Tac. All patients were induced with rabbit antithymocyte globulin followed by early steroid withdrawal. Comparisons were made of patient and graft survival, graft function, acute rejection, and albuminuria. There were no significant differences between the SRL/L-Tac and MMF/H-Tac groups for patient survival, graft survival, occurrence of acute rejection, or graft function. There was no difference in the proportion of patients with albumin/creatinine ratio (ACR) ≥300 μg/mg (19% vs. 20%), but more patients in the SRL group were receiving renin-angiotensin system blocking agents (72% vs. 53%, p = 0.04). Only flushing the donor kidney with histidine-tryptophan-ketoglutarate solution (vs. UW solution) was predictive of albuminuria. Long-term outcomes are similar at our center for kidney transplant patients receiving either SRL/L-Tac or MMF/H-Tac. Although the occurrence of albuminuria was not different, significantly more SRL-treated patients were receiving antiproteinuric medications. PMID:21077952

  2. Effects of prescription depth, cylinder size, treatment length, tip space, and curved end on doses in high-dose-rate vaginal brachytherapy

    SciTech Connect

    Li Shidong . E-mail: sli1@hfhs.org; Aref, Ibrahim; Walker, Eleanor; Movsas, Benjamin

    2007-03-15

    Purpose: To determine the effects of the prescription depth, cylinder size, treatment length, tip space, and curved end on high-dose-rate vaginal brachytherapy (HDR-VBT) of endometrial cancer. Methods and Materials: Treatment plans were prescribed and optimized based on points at the cylinder surface or at 0.5-cm depth. Cylinder sizes ranging from 2 to 4 cm in diameter, and treatment lengths ranging from 3 to 8 cm were used. Dose points in various depths were precisely defined along the cylinder dome. The given dose and dose uniformity to a depth of interest were measured by the mean dose (MD) and standard deviation (SD), respectively, among the dose points belonging to the depth. Dose fall-off beyond the 0.5 cm treatment depth was determined by the ratio of MD at 0.75-cm depth to MD at 0.5-cm depth. Results: Dose distribution varies significantly with different prescriptions. The surface prescription provides more uniform doses at all depths in the target volume, whereas the 0.5-cm depth prescription creates larger dose variations at the cylinder surface. Dosimetric uncertainty increases significantly (>30%) with shorter tip space. Extreme hot (>150%) and cold spots (<60%) occur if no optimization points were placed at the curved end. Conclusions: Instead of prescribing to a depth of 0.5 cm, increasing the dose per fraction and prescribing to the surface with the exact surface points around the cylinder dome appears to be the optimal approach.

  3. Gene interaction network analysis suggests differences between high and low doses of acetaminophen

    SciTech Connect

    Toyoshiba, Hiroyoshi . E-mail: toyoshiba.hiroyoshi@nies.go.jp; Sone, Hideko; Yamanaka, Takeharu; Parham, Frederick M.; Irwin, Richard D.; Boorman, Gary A.; Portier, Christopher J.

    2006-09-15

    Bayesian networks for quantifying linkages between genes were applied to detect differences in gene expression interaction networks between multiple doses of acetaminophen at multiple time points. Seventeen (17) genes were selected from the gene expression profiles from livers of rats orally exposed to 50, 150 and 1500 mg/kg acetaminophen (APAP) at 6, 24 and 48 h after exposure using a variety of statistical and bioinformatics approaches. The selected genes are related to three biological categories: apoptosis, oxidative stress and other. Gene interaction networks between all 17 genes were identified for the nine dose-time observation points by the TAO-Gen algorithm. Using k-means clustering analysis, the estimated nine networks could be clustered into two consensus networks, the first consisting of the low and middle dose groups, and the second consisting of the high dose. The analysis suggests that the networks could be segregated by doses and were consistent in structure over time of observation within grouped doses. The consensus networks were quantified to calculate the probability distribution for the strength of the linkage between genes connected in the networks. The quantifying analysis showed that, at lower doses, the genes related to the oxidative stress signaling pathway did not interact with the apoptosis-related genes. In contrast, the high-dose network demonstrated significant interactions between the oxidative stress genes and the apoptosis genes and also demonstrated a different network between genes in the oxidative stress pathway. The approaches shown here could provide predictive information to understand high- versus low-dose mechanisms of toxicity.

  4. Can we avoid high levels of dose escalation for high-risk prostate cancer in the setting of androgen deprivation?

    PubMed Central

    Shakespeare, Thomas P; Wilcox, Shea W; Aherne, Noel J

    2016-01-01

    Aim Both dose-escalated external beam radiotherapy (DE-EBRT) and androgen deprivation therapy (ADT) improve outcomes in patients with high-risk prostate cancer. However, there is little evidence specifically evaluating DE-EBRT for patients with high-risk prostate cancer receiving ADT, particularly for EBRT doses >74 Gy. We aimed to determine whether DE-EBRT >74 Gy improves outcomes for patients with high-risk prostate cancer receiving long-term ADT. Patients and methods Patients with high-risk prostate cancer were treated on an institutional protocol prescribing 3–6 months neoadjuvant ADT and DE-EBRT, followed by 2 years of adjuvant ADT. Between 2006 and 2012, EBRT doses were escalated from 74 Gy to 76 Gy and then to 78 Gy. We interrogated our electronic medical record to identify these patients and analyzed our results by comparing dose levels. Results In all, 479 patients were treated with a 68-month median follow-up. The 5-year biochemical disease-free survivals for the 74 Gy, 76 Gy, and 78 Gy groups were 87.8%, 86.9%, and 91.6%, respectively. The metastasis-free survivals were 95.5%, 94.5%, and 93.9%, respectively, and the prostate cancer-specific survivals were 100%, 94.4%, and 98.1%, respectively. Dose escalation had no impact on any outcome in either univariate or multivariate analysis. Conclusion There was no benefit of DE-EBRT >74 Gy in our cohort of high-risk prostate patients treated with long-term ADT. As dose escalation has higher risks of radiotherapy-induced toxicity, it may be feasible to omit dose escalation beyond 74 Gy in this group of patients. Randomized studies evaluating dose escalation for high-risk patients receiving ADT should be considered. PMID:27274277

  5. PLUTONIUM/HIGH-LEVEL VITRIFIED WASTE BDBE DOSE CALCULATION

    SciTech Connect

    D.C. Richardson

    2003-03-19

    In accordance with the Nuclear Waste Policy Amendments Act of 1987, Yucca Mountain was designated as the site to be investigated as a potential repository for the disposal of high-level radioactive waste. The Yucca Mountain site is an undeveloped area located on the southwestern edge of the Nevada Test Site (NTS), about 100 miles northwest of Las Vegas. The site currently lacks rail service or an existing right-of-way. If the Yucca Mountain site is found suitable for the repository, rail service is desirable to the Office of Civilian Waste Management (OCRWM) Program because of the potential of rail transportation to reduce costs and to reduce the number of shipments relative to highway transportation. A Preliminary Rail Access Study evaluated 13 potential rail spur options. Alternative routes within the major options were also developed. Each of these options was then evaluated for potential land use conflicts and access to regional rail carriers. Three potential routes having few land use conflicts and having access to regional carriers were recommended for further investigation. Figure 1-1 shows these three routes. The Jean route is estimated to be about 120 miles long, the Carlin route to be about 365 miles long, and Caliente route to be about 365 miles long. The remaining ten routes continue to be monitored and should any of the present conflicts change, a re-evaluation of that route will be made. Complete details of the evaluation of the 13 routes can be found in the previous study. The DOE has not identified any preferred route and recognizes that the transportation issues need a full and open treatment under the National Environmental Policy Act. The issue of transportation will be included in public hearings to support development of the Environmental Impact Statement (EIS) proceedings for either the Monitored Retrievable Storage Facility or the Yucca Mountain Project or both.

  6. High- and low-dose allergen challenges in asthmatic patients using inhaled corticosteroids

    PubMed Central

    Lee, Wha-Yong; Southworth, Thomas; Booth, Steven; Singh, Dave

    2015-01-01

    Aims The inhaled allergen challenge model has been used previously to investigate the effects of novel anti-inflammatory drugs in inhaled corticosteroid (ICS)-naïve asthmatics. The aim of this study was to characterize high- and low-dose allergen challenges in asthmatic patients using ICS. Methods Twenty-eight asthmatic patients taking ICS (beclomethasone equivalent <1000 μg day−1) were recruited for high-dose allergen challenge, of whom 10 subsequently also had a repeat low-dose challenge comprising seven allergen challenges. Induced sputum was collected for measurements of cell counts and supernatant biomarkers. Results The high-dose allergen challenge caused an early and late asthmatic response in 19 of 28 patients; the mean maximal fall in the forced expiratory volume in 1 s (FEV1) was 29.1% (SD 6.2%) and 25.1% (SD 9.6%), respectively. There was also an increase in sputum eosinophils of 6.2% (P = 0.0004), as well as supernatant eosinophil cationic protein levels. The low-dose allergen challenge caused an acute fall in FEV1, but had no effect on FEV1 at 24 h after challenge or sputum measurements. Conclusions The high-dose allergen challenge in asthmatics using ICS induces a late asthmatic response associated with an increase in eosinophilic airway inflammation. This may be a suitable model for studying the effects of novel anti-inflammatory drugs added to maintenance ICS treatment. PMID:25214200

  7. Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma.

    PubMed

    Weisel, Katja C; Dimopoulos, Meletios A; Moreau, Philippe; Lacy, Martha Q; Song, Kevin W; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Banos, Anne; Oriol, Albert; Alegre, Adrian; Chen, Christine; Cavo, Michele; Garderet, Laurent; Ivanova, Valentina; Martinez-Lopez, Joaquin; Knop, Stefan; Yu, Xin; Hong, Kevin; Sternas, Lars; Jacques, Christian; Zaki, Mohamed H; San Miguel, Jesus

    2016-07-01

    Pomalidomide + low-dose dexamethasone is effective and well tolerated for refractory or relapsed and refractory multiple myeloma after bortezomib and lenalidomide failure. The phase III trial MM-003 compared pomalidomide + low-dose dexamethasone with high-dose dexamethasone. This subanalysis grouped patients by baseline creatinine clearance ≥ 30 - < 60 mL/min (n=93, pomalidomide + low-dose dexamethasone; n=56, high-dose dexamethasone) or ≥ 60 mL/min (n=205, pomalidomide + low-dose dexamethasone; n=93, high-dose dexamethasone). Median progression-free survival was similar for both subgroups and favored pomalidomide + low-dose dexamethasone versus high-dose dexamethasone: 4.0 versus 1.9 months in the group with baseline creatinine clearance ≥ 30 - < 60 mL/min (P<0.001) and 4.0 versus 2.0 months in the group with baseline creatinine clearance ≥ 60 mL/min (P<0.001). Median overall survival for pomalidomide + low-dose dexamethasone versus high-dose dexamethasone was 10.4 versus 4.9 months (P=0.030) and 15.5 versus 9.2 months (P=0.133), respectively. Improved renal function, defined as an increase in creatinine clearance from < 60 to ≥ 60 mL/min, was similar in pomalidomide + low-dose dexamethasone and high-dose dexamethasone patients (42% and 47%, respectively). Improvement in progression-free and overall survival in these patients was comparable with that in patients without renal impairment. There was no increase in discontinuations of therapy, dose modifications, and adverse events in patients with moderate renal impairment. Pomalidomide at a starting dose of 4 mg + low-dose dexamethasone is well tolerated in patients with refractory or relapsed and refractory multiple myeloma, and of comparable efficacy if moderate renal impairment is present. This trial was registered with clinicaltrials.gov identifier 01311687 and EudraCT identifier 2010-019820-30. PMID:27081177

  8. Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma

    PubMed Central

    Weisel, Katja C.; Dimopoulos, Meletios A.; Moreau, Philippe; Lacy, Martha Q.; Song, Kevin W.; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Banos, Anne; Oriol, Albert; Alegre, Adrian; Chen, Christine; Cavo, Michele; Garderet, Laurent; Ivanova, Valentina; Martinez-Lopez, Joaquin; Knop, Stefan; Yu, Xin; Hong, Kevin; Sternas, Lars; Jacques, Christian; Zaki, Mohamed H.; Miguel, Jesus San

    2016-01-01

    Pomalidomide + low-dose dexamethasone is effective and well tolerated for refractory or relapsed and refractory multiple myeloma after bortezomib and lenalidomide failure. The phase III trial MM-003 compared pomalidomide + low-dose dexamethasone with high-dose dexamethasone. This subanalysis grouped patients by baseline creatinine clearance ≥ 30 − < 60 mL/min (n=93, pomalidomide + low-dose dexamethasone; n=56, high-dose dexamethasone) or ≥ 60 mL/min (n=205, pomalidomide + low-dose dexamethasone; n=93, high-dose dexamethasone). Median progression-free survival was similar for both subgroups and favored pomalidomide + low-dose dexamethasone versus high-dose dexamethasone: 4.0 versus 1.9 months in the group with baseline creatinine clearance ≥ 30 − < 60 mL/min (P<0.001) and 4.0 versus 2.0 months in the group with baseline creatinine clearance ≥ 60 mL/min (P<0.001). Median overall survival for pomalidomide + low-dose dexamethasone versus high-dose dexamethasone was 10.4 versus 4.9 months (P=0.030) and 15.5 versus 9.2 months (P=0.133), respectively. Improved renal function, defined as an increase in creatinine clearance from < 60 to ≥ 60 mL/min, was similar in pomalidomide + low-dose dexamethasone and high-dose dexamethasone patients (42% and 47%, respectively). Improvement in progression-free and overall survival in these patients was comparable with that in patients without renal impairment. There was no increase in discontinuations of therapy, dose modifications, and adverse events in patients with moderate renal impairment. Pomalidomide at a starting dose of 4 mg + low-dose dexamethasone is well tolerated in patients with refractory or relapsed and refractory multiple myeloma, and of comparable efficacy if moderate renal impairment is present. This trial was registered with clinicaltrials.gov identifier 01311687 and EudraCT identifier 2010-019820-30. PMID:27081177

  9. Image-guided high-dose-rate brachytherapy in inoperable endometrial cancer

    PubMed Central

    Petsuksiri, J; Chansilpa, Y; Hoskin, P J

    2014-01-01

    Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brachytherapy has been used instead of low-dose-rate brachytherapy. Image-guided brachytherapy enables sufficient coverage of tumour and reduction of dose to the organs at risk, thus increasing the therapeutic ratio of treatment. Local control rates with three-dimensional brachytherapy appear better than with conventional techniques (about 90–100% and 70–90%, respectively). PMID:24807067

  10. A dosimetric study on the Ir-192 high dose rate flexisource.

    PubMed

    Granero, D; Pérez-Calatayud, J; Casal, E; Ballester, F; Venselaar, J

    2006-12-01

    In this work, the dose rate distribution of a new Ir-192 high dose rate source (Flexisource used in the afterloading Flexitron system, Isodose Control, Veenendaal, The Netherlands) is studied by means of Monte Carlo techniques using the GEANT4 code. The dosimetric parameters of the Task Group No. 43 Report (TG43) formalism and two-dimensional rectangular look-up tables have been obtained. PMID:17278809

  11. A dosimetric study on the Ir-192 high dose rate Flexisource

    SciTech Connect

    Granero, D.; Perez-Calatayud, J.; Casal, E.; Ballester, F.; Venselaar, J.

    2006-12-15

    In this work, the dose rate distribution of a new Ir-192 high dose rate source (Flexisource used in the afterloading Flexitron system, Isodose Control, Veenendaal, The Netherlands) is studied by means of Monte Carlo techniques using the GEANT4 code. The dosimetric parameters of the Task Group No. 43 Report (TG43) formalism and two-dimensional rectangular look-up tables have been obtained.

  12. Transmission and dose perturbations with high-Z materials in clinical electron beams.

    PubMed

    Das, Indra J; Cheng, Chee-Wai; Mitra, Raj K; Kassaee, Alireza; Tochner, Zelig; Solin, Lawrence J

    2004-12-01

    High density and atomic number (Z) materials used in various prostheses, eye shielding, and beam modifiers produce dose enhancements on the backscatter side in electron beams and is well documented. However, on the transmission side the dose perturbation is given very little clinical importance, which is investigated in this study. A simple and accurate method for dose perturbation at metallic interfaces with soft tissues and transmission through these materials is required for all clinical electron beams. Measurements were taken with thin-window parallel plate ion chambers for various high-Z materials (Al, Ti, Cu, and Pb) on a Varian and a Siemens accelerator in the energy range of 5-20 MeV. The dose enhancement on both sides of the metallic sheet is due to increased electron fluence that is dependent on the beam energy and Z. On the transmission side, the magnitude of dose enhancement depends on the thickness of the high-Z material. With increasing thickness, dose perturbation reduces to the electron transmission. The thickness of material to reduce 100% (range of dose perturbation), 50% and 10% transmission is linear with the beam energy. The slope (mm/MeV) of the transmission curve varies exponentially with Z. A nonlinear regression expression (t=E[alpha+beta exp(-0.1Z)]) is derived to calculate the thickness at a given transmission, namely 100%, 50%, and 10% for electron energy, E, which is simple, accurate and well suited for a quick estimation in clinical use. Caution should be given to clinicians for the selection of thickness of high-Z materials when used to shield critical structures as small thickness increases dose significantly at interfaces. PMID:15651605

  13. Transmission and dose perturbations with high-Z materials in clinical electron beams

    SciTech Connect

    Das, Indra J.; Cheng, C.-W.; Mitra, Raj K.; Kassaee, Alireza; Tochner, Zelig; Solin, Lawrence J.

    2004-12-01

    High density and atomic number (Z) materials used in various prostheses, eye shielding, and beam modifiers produce dose enhancements on the backscatter side in electron beams and is well documented. However, on the transmission side the dose perturbation is given very little clinical importance, which is investigated in this study. A simple and accurate method for dose perturbation at metallic interfaces with soft tissues and transmission through these materials is required for all clinical electron beams. Measurements were taken with thin-window parallel plate ion chambers for various high-Z materials (Al, Ti, Cu, and Pb) on a Varian and a Siemens accelerator in the energy range of 5-20 MeV. The dose enhancement on both sides of the metallic sheet is due to increased electron fluence that is dependent on the beam energy and Z. On the transmission side, the magnitude of dose enhancement depends on the thickness of the high-Z material. With increasing thickness, dose perturbation reduces to the electron transmission. The thickness of material to reduce 100% (range of dose perturbation), 50% and 10% transmission is linear with the beam energy. The slope (mm/MeV) of the transmission curve varies exponentially with Z. A nonlinear regression expression {l_brace}t=E[{alpha}+{beta} exp(-0.1Z)]{r_brace} is derived to calculate the thickness at a given transmission, namely 100%, 50%, and 10% for electron energy, E, which is simple, accurate and well suited for a quick estimation in clinical use. Caution should be given to clinicians for the selection of thickness of high-Z materials when used to shield critical structures as small thickness increases dose significantly at interfaces.

  14. Assessment of simulated high-dose partial-body irradiation by PCC-R assay

    PubMed Central

    Romero, Ivonne; García, Omar; Lamadrid, Ana I.; Gregoire, Eric; González, Jorge E.; Morales, Wilfredo; Martin, Cécile; Barquinero, Joan-Francesc; Voisin, Philippe

    2013-01-01

    The estimation of the dose and the irradiated fraction of the body is important information in the primary medical response in case of a radiological accident. The PCC-R assay has been developed for high-dose estimations, but little attention has been given to its applicability for partial-body irradiations. In the present work we estimated the doses and the percentage of the irradiated fraction in simulated partial-body radiation exposures at high doses using the PCC-R assay. Peripheral whole blood of three healthy donors was exposed to doses from 0–20 Gy, with 60Co gamma radiation. To simulate partial body irradiations, irradiated and non-irradiated blood was mixed to obtain proportions of irradiated blood from 10–90%. Lymphocyte cultures were treated with Colcemid and Calyculin-A before harvest. Conventional and triage scores were performed for each dose, proportion of irradiated blood and donor. The Papworth's u test was used to evaluate the PCC-R distribution per cell. A dose-response relationship was fitted according to the maximum likelihood method using the frequencies of PCC-R obtained from 100% irradiated blood. The dose to the partially irradiated blood was estimated using the Contaminated Poisson method. A new D0 value of 10.9 Gy was calculated and used to estimate the initial fraction of irradiated cells. The results presented here indicate that by PCC-R it is possible to distinguish between simulated partial- and whole-body irradiations by the u-test, and to accurately estimate the dose from 10–20 Gy, and the initial fraction of irradiated cells in the interval from 10–90%. PMID:23596200

  15. The susceptibility of TaOx-based memristors to high dose rate ionizing radiation and total ionizing dose

    SciTech Connect

    McLain, Michael Lee; Sheridan, Timothy J.; Hjalmarson, Harold Paul; Mickel, Patrick R.; Hanson, Donald J.; McDonald, Joseph K.; Hughart, David Russell; Marinella, Matthew J.

    2014-11-11

    This paper investigates the effects of high dose rate ionizing radiation and total ionizing dose (TID) on tantalum oxide (TaOx) memristors. Transient data were obtained during the pulsed exposures for dose rates ranging from approximately 5.0 ×107 rad(Si)/s to 4.7 ×108 rad(Si)/s and for pulse widths ranging from 50 ns to 50 μs. The cumulative dose in these tests did not appear to impact the observed dose rate response. Static dose rate upset tests were also performed at a dose rate of ~3.0 ×108 rad(Si)/s. This is the first dose rate study on any type of memristive memory technology. In addition to assessing the tolerance of TaOx memristors to high dose rate ionizing radiation, we also evaluated their susceptibility to TID. The data indicate that it is possible for the devices to switch from a high resistance off-state to a low resistance on-state in both dose rate and TID environments. The observed radiation-induced switching is dependent on the irradiation conditions and bias configuration. Furthermore, the dose rate or ionizing dose level at which a device switches resistance states varies from device to device; the enhanced susceptibility observed in some devices is still under investigation. As a result, numerical simulations are used to qualitatively capture the observed transient radiation response and provide insight into the physics of the induced current/voltages.

  16. No Salvage Using High-Dose Chemotherapy Plus/Minus Reirradiation for Relapsing Previously Irradiated Medulloblastoma

    SciTech Connect

    Massimino, Maura Gandola, Lorenza; Spreafico, Filippo; Biassoni, Veronica; Luksch, Roberto; Collini, Paola; Solero, Carlo N.; Simonetti, Fabio; Pignoli, Emanuele; Cefalo, Graziella; Poggi, Geraldina; Modena, Piergiorgio Ph.D.; Mariani, Luigi; Potepan, Paolo; Podda, Marta; Casanova, Michela; Pecori, Emilia; Acerno, Stefania; Ferrari, Andrea; Terenziani, Monica

    2009-04-01

    Purpose: Myeloablative regimens were frequently used for medulloblastoma relapsing after craniospinal irradiation (CSI): in 1997-2002, we used repeated surgery, standard-dose and myeloablative chemotherapy, and reirradiation. Methods and Materials: In 10 patients, reinduction included sequential high-dose etoposide, high-dose cyclophosphamide/vincristine, and high-dose carboplatin/vincristine, then two myeloablative courses with high-dose thiotepa ({+-} carboplatin); 6 other patients received two of four courses of cisplatin/etoposide. Hematopoietic precursor mobilization followed high-dose etoposide or high-dose cyclophosphamide or cisplatin/etoposide therapy. After the overall chemotherapy program, reirradiation was prescribed when possible. Results: Seventeen patients were treated: previous treatment included CSI of 19.5-36 Gy with posterior fossa/tumor boost and chemotherapy in 16 patients. Fifteen patients were in their first and 2 in their second and third relapses, respectively. First progression-free survival had lasted a median of 26 months. Relapse sites included leptomeninges in 9 patients, spine in 4 patients, posterior fossa in 3 patients, and brain in 1 patient. Three patients underwent complete resection of recurrence, and 10 underwent reirradiation. Twelve of 14 patients with assessable tumor had an objective response after reinduction; 2 experienced progression and were not given the myeloablative courses. Remission lasted a median of 16 months. Additional relapses appeared in 13 patients continuing the treatment. Fifteen patients died of progression and 1 died of pneumonia 13 months after relapse. The only survivor at 93 months had a single spinal metastasis that was excised and irradiated. Survival for the series as a whole was 11-93 months, with a median of 41 months. Conclusions: Despite responses being obtained and ample use of surgery and reirradiation, second-line therapy with myeloablative schedules was not curative, barring a few

  17. Does High-Dose Antimicrobial Chemotherapy Prevent the Evolution of Resistance?

    PubMed Central

    Day, Troy; Read, Andrew F.

    2016-01-01

    High-dose chemotherapy has long been advocated as a means of controlling drug resistance in infectious diseases but recent empirical studies have begun to challenge this view. We develop a very general framework for modeling and understanding resistance emergence based on principles from evolutionary biology. We use this framework to show how high-dose chemotherapy engenders opposing evolutionary processes involving the mutational input of resistant strains and their release from ecological competition. Whether such therapy provides the best approach for controlling resistance therefore depends on the relative strengths of these processes. These opposing processes typically lead to a unimodal relationship between drug pressure and resistance emergence. As a result, the optimal drug dose lies at either end of the therapeutic window of clinically acceptable concentrations. We illustrate our findings with a simple model that shows how a seemingly minor change in parameter values can alter the outcome from one where high-dose chemotherapy is optimal to one where using the smallest clinically effective dose is best. A review of the available empirical evidence provides broad support for these general conclusions. Our analysis opens up treatment options not currently considered as resistance management strategies, and it also simplifies the experiments required to determine the drug doses which best retard resistance emergence in patients. PMID:26820986

  18. Psychiatric side effects of acute high-dose corticosteroid therapy in neurological conditions.

    PubMed

    Lotan, Itay; Fireman, Liora; Benninger, Felix; Weizman, Abraham; Steiner, Israel

    2016-07-01

    It has been implied that high-dose corticosteroids (CSs) commonly cause psychiatric side effects. Here, we examined the rate and risk factors of psychiatric side effects during high-dose CS treatment in patients with neurological disorders. Patients treated with high-dose intravenous CSs for neurological disorders were evaluated for depression, mania, and psychosis using the Beck Depression Inventory, the Geriatric Depression Scale, the Young Mania Rating Scale, and the Brief Psychiatric Rating Scale before CS treatment, immediately after, and 1 month following treatment. Forty-nine consecutive patients were monitored. There was a reduction in the Beck Depression Inventory and Geriatric Depression Scale scores as well as in the Brief Psychiatric Rating Scale scores throughout the study period and a transitory increase in the Young Mania Rating Scale score immediately after CS administration. Thus, a tendency to develop transient mild euphoria during high-dose CS treatment exists, but is reversible at 1 month, whereas a reduction in depressive symptoms tended to persist. Overall, our data indicate that high-dose CS treatment for neurological diseases is relatively safe with respect to psychiatric complications. PMID:26938038

  19. High dose zinc supplementation induces hippocampal zinc deficiency and memory impairment with inhibition of BDNF signaling.

    PubMed

    Yang, Yang; Jing, Xiao-Peng; Zhang, Shou-Peng; Gu, Run-Xia; Tang, Fang-Xu; Wang, Xiu-Lian; Xiong, Yan; Qiu, Mei; Sun, Xu-Ying; Ke, Dan; Wang, Jian-Zhi; Liu, Rong

    2013-01-01

    Zinc ions highly concentrate in hippocampus and play a key role in modulating spatial learning and memory. At a time when dietary fortification and supplementation of zinc have increased the zinc consuming level especially in the youth, the toxicity of zinc overdose on brain function was underestimated. In the present study, weaning ICR mice were given water supplemented with 15 ppm Zn (low dose), 60 ppm Zn (high dose) or normal lab water for 3 months, the behavior and brain zinc homeostasis were tested. Mice fed high dose of zinc showed hippocampus-dependent memory impairment. Unexpectedly, zinc deficiency, but not zinc overload was observed in hippocampus, especially in the mossy fiber-CA3 pyramid synapse. The expression levels of learning and memory related receptors and synaptic proteins such as NMDA-NR2A, NR2B, AMPA-GluR1, PSD-93 and PSD-95 were significantly decreased in hippocampus, with significant loss of dendritic spines. In keeping with these findings, high dose intake of zinc resulted in decreased hippocampal BDNF level and TrkB neurotrophic signaling. At last, increasing the brain zinc level directly by brain zinc injection induced BDNF expression, which was reversed by zinc chelating in vivo. These results indicate that zinc plays an important role in hippocampus-dependent learning and memory and BDNF expression, high dose supplementation of zinc induces specific zinc deficiency in hippocampus, which further impair learning and memory due to decreased availability of synaptic zinc and BDNF deficit. PMID:23383172

  20. Comparison of Two High-Dose Magnesium Infusion Regimens in the Treatment of Status Asthmaticus

    PubMed Central

    Vaiyani, Danish

    2016-01-01

    OBJECTIVES: To determine the feasibility and safety of a simplified high-dose magnesium sulfate infusion (sHDMI) for the treatment of status asthmaticus. METHODS: We retrospectively compared 2 different high-dose magnesium sulfate infusion regimens, as adjunctive treatment in status asthmatics, using data that were preciously collected. The initial high-dose, prolonged magnesium infusion (HDMI) regimen consisted of a loading dose of 75 mg/kg (weight ≤ 30 kg) or 50 mg/kg (weight > 30 kg) over a period of 30 to 45 minutes followed by a continuous infusion of 40 mg/kg/hr for an additional 4 hours. This was compared to the sHDMI regimen that consisted of 50 mg/kg/hr for 5 hours. No loading dose was given to the patients in the sHDMI arm. Obese patients were dosed by using ideal body weight. Physiologic parameters (i.e., heart rate, blood pressure, respiratory rate, oxygen saturation) and serum magnesium (SrMg) concentrations were monitored during administration of magnesium sulfate. RESULTS: Nineteen patients receiving the initial HDMI regimen were compared with 10 patients who received the sHDMI regimen. There was no significant difference in SrMg concentrations or physiologic parameters between the 2 dose regimens. CONCLUSIONS: The HDMI and sHDMI regimens both produced SrMg concentrations that are associated with bronchodilation. The safety profile was also similar for the 2 regimens. The unambiguity of sHDMI has the potential to reduce medication errors that are associated with calculation of the loading dose, product preparation, and ultimate administration. PMID:27453701

  1. Comparison of low and high dose ionising radiation using topological analysis of gene coexpression networks

    PubMed Central

    2012-01-01

    Background The growing use of imaging procedures in medicine has raised concerns about exposure to low-dose ionising radiation (LDIR). While the disastrous effects of high dose ionising radiation (HDIR) is well documented, the detrimental effects of LDIR is not well understood and has been a topic of much debate. Since little is known about the effects of LDIR, various kinds of wet-lab and computational analyses are required to advance knowledge in this domain. In this paper we carry out an “upside-down pyramid” form of systems biology analysis of microarray data. We characterised the global genomic response following 10 cGy (low dose) and 100 cGy (high dose) doses of X-ray ionising radiation at four time points by analysing the topology of gene coexpression networks. This study includes a rich experimental design and state-of-the-art computational systems biology methods of analysis to study the differences in the transcriptional response of skin cells exposed to low and high doses of radiation. Results Using this method we found important genes that have been linked to immune response, cell survival and apoptosis. Furthermore, we also were able to identify genes such as BRCA1, ABCA1, TNFRSF1B, MLLT11 that have been associated with various types of cancers. We were also able to detect many genes known to be associated with various medical conditions. Conclusions Our method of applying network topological differences can aid in identifying the differences among similar (eg: radiation effect) yet very different biological conditions (eg: different dose and time) to generate testable hypotheses. This is the first study where a network level analysis was performed across two different radiation doses at various time points, thereby illustrating changes in the cellular response over time. PMID:22594378

  2. High-dose statin therapy and risk of intracerebral hemorrhage: a meta-analysis.

    PubMed

    Pandit, A K; Kumar, P; Kumar, A; Chakravarty, K; Misra, S; Prasad, K

    2016-07-01

    Statin plays a major role in the primary and secondary prevention of cardiovascular disease (CVD). Inconsistent findings in the studies have been observed toward the risk of intracerebral hemorrhage (ICH) using higher dose of statin. To examine this issue, we performed a meta-analysis of randomized controlled trials (RCTs) to assess the association between higher dose of various statins and risk of ICH among patients with CVD. Literature was searched for studies published before June 10, 2015, using electronic database 'PubMed', 'EMBASE', and 'Google Scholar' as well as from many trial databases. The following search terms were used: 'Statin therapy' AND 'Cardiovascular Disease', AND 'Dose' AND 'Intracerebral hemorrhage', AND 'Randomized Controlled Trials' AND 'High Dose Statin'. High dose of statins was defined as atorvastatin 80 mg, simvastatin 80 mg, pravastatin 40 mg, rosuvastatin 20 mg per day. Fixed-effect model was used to estimate the risk ratio (RR) and 95% confidence interval (CI) if heterogeneity was <50%; otherwise, random-effect model was used. Begg's funnel plot was used to assess the publication bias. Seven RCTs involving 31,099 subjects receiving high-dose statin and 31,105 subjects receiving placebo were analyzed in our meta-analysis. A significant risk of ICH was observed in subjects with higher dose of statin (RR = 1.53; 95% CI: 1.16-2.01; P = 0.002). There was no difference in all-cause mortality between the two groups (RR = 0.95; 95% CI: 0.86-1.06; P = 0.36). No publication bias was observed through Begg's funnel plot. Higher dose of statins was found to be associated with the risk of ICH. Future studies are needed to confirm these findings. PMID:26647879

  3. Three Patients Needing High Doses of Valproic Acid to Get Therapeutic Concentrations

    PubMed Central

    Jackson, James; McCollum, Betsy; Ognibene, Judy; Diaz, Francisco J.; de Leon, Jose

    2015-01-01

    Valproic acid (VPA) can autoinduce its own metabolism. Cases requiring VPA doses >4000 mg/day to obtain therapeutic plasma concentrations, such as these 3 cases, have never been published. Case 1 received VPA for seizures and schizophrenia and had >50 VPA concentrations in 4 years. A high dose of 5,250 mg/day of VPA concentrate was prescribed for years but this dose led to an intoxication when switched to the enterocoated divalproex sodium formulation, requiring a normal dose of 2000 mg/day. VPA metabolic capacity was significantly higher (t = −9.6; df = 6.3, p < 0.001) during the VPA concentrate therapy, possibly due to autoinduction in that formulation. Case 2 had VPA for schizoaffective psychosis with 10 VPA concentrations during an 8-week admission. To maintain a VPA level ≥50 μg/mL, VPA doses increased from 1500 to 4000 mg/day. Case 3 had tuberous sclerosis and epilepsy and was followed up for >4 years with 137 VPA concentrations. To maintain VPA concentrations ≥50 μg/mL, VPA doses increased from 3,375 to 10,500 mg/day. In Cases 2 and 3, the duration of admission and the VPA dose were strongly correlated (r around 0.90; p < 0.001) with almost no change after controlling for VPA concentrations, indicating progressive autoinduction that increased with time. PMID:26000191

  4. High and Low Doses of Ionizing Radiation Induce Different Secretome Profiles in a Human Skin Model

    SciTech Connect

    Zhang, Qibin; Matzke, Melissa M.; Schepmoes, Athena A.; Moore, Ronald J.; Webb-Robertson, Bobbie-Jo M.; Hu, Zeping; Monroe, Matthew E.; Qian, Weijun; Smith, Richard D.; Morgan, William F.

    2014-03-18

    It is postulated that secreted soluble factors are important contributors of bystander effect and adaptive responses observed in low dose ionizing radiation. Using multidimensional liquid chromatography-mass spectrometry based proteomics, we quantified the changes of skin tissue secretome – the proteins secreted from a full thickness, reconstituted 3-dimensional skin tissue model 48 hr after exposure to 3, 10 and 200 cGy of X-rays. Overall, 135 proteins showed statistical significant difference between the sham (0 cGy) and any of the irradiated groups (3, 10 or 200 cGy) on the basis of Dunnett adjusted t-test; among these, 97 proteins showed a trend of downregulation and 9 proteins showed a trend of upregulation with increasing radiation dose. In addition, there were 21 and 8 proteins observed to have irregular trends with the 10 cGy irradiated group either having the highest or the lowest level among all three radiated doses. Moreover, two proteins, carboxypeptidase E and ubiquitin carboxyl-terminal hydrolase isozyme L1 were sensitive to ionizing radiation, but relatively independent of radiation dose. Conversely, proteasome activator complex subunit 2 protein appeared to be sensitive to the dose of radiation, as rapid upregulation of this protein was observed when radiation doses were increased from 3, to 10 or 200 cGy. These results suggest that different mechanisms of action exist at the secretome level for low and high doses of ionizing radiation.

  5. Monitor units are not predictive of neutron dose for high-energy IMRT

    PubMed Central

    2012-01-01

    Background Due to the substantial increase in beam-on time of high energy intensity-modulated radiotherapy (>10 MV) techniques to deliver the same target dose compared to conventional treatment techniques, an increased dose of scatter radiation, including neutrons, is delivered to the patient. As a consequence, an increase in second malignancies may be expected in the future with the application of intensity-modulated radiotherapy. It is commonly assumed that the neutron dose equivalent scales with the number of monitor units. Methods Measurements of neutron dose equivalent were performed for an open and an intensity-modulated field at four positions: inside and outside of the treatment field at 0.2 cm and 15 cm depth, respectively. Results It was shown that the neutron dose equivalent, which a patient receives during an intensity-modulated radiotherapy treatment, does not scale with the ratio of applied monitor units relative to an open field irradiation. Outside the treatment volume at larger depth 35% less neutron dose equivalent is delivered than expected. Conclusions The predicted increase of second cancer induction rates from intensity-modulated treatment techniques can be overestimated when the neutron dose is simply scaled with monitor units. PMID:22883384

  6. Dose Contribution from High Level Waste Uranium and Plutonium. Revision 1

    SciTech Connect

    Chandler, M.C.; Gray, P.L.; d`Entremont, P.D.; Marra, J.E.; Monahon, T.M.

    1994-10-07

    Radiological source terms for safety analyses traditionally have been curie lists of radionuclides. Converting the source term to dose values allows each radionuclide to be evaluated for its impact on dose, which is the purpose of the source term. This report is one in a series of reports establishing source terms for High Level Waste (HLW) by evaluating the dose impact of each radionuclide. These reports will be used in establishing the source terms to be used in HLW Safety Analysis Reports. The purpose of this report is to document the bounding element dose impact of uranium and plutonium in HLW. This technique (use of dose rather than curies) demonstrates vividly the relative importance of these nuclides in accident analyses. A large amount of available data permitted dose values to be established for uranium and plutonium; therefore, these two elements were evaluated independent of other nuclides. Solubility and adsorption data, available for these elements, allow bounding conditions to be established for their contribution to dose for various HLW processes.

  7. Mapping of dose distribution from IMRT onto MRI-guided high dose rate brachytherapy using deformable image registration for cervical cancer treatments: preliminary study with commercially available software

    PubMed Central

    Huq, M. Saiful; Houser, Chris; Beriwal, Sushil; Michalski, Dariusz

    2014-01-01

    Purpose For patients undergoing external beam radiation therapy (EBRT) and brachytherapy, recommendations for target doses and constraints are based on calculation of the equivalent dose in 2 Gy fractions (EQD2) from each phase. At present, the EBRT dose distribution is assumed to be uniform throughout the pelvis. We performed a preliminary study to determine whether deformable dose distribution mapping from the EBRT onto magnetic resonance (MR) images for the brachytherapy would yield differences in doses for organs at risk (OARs) and high-risk clinical target volume (HR-CTV). Material and methods Nine cervical cancer patients were treated to a total dose of 45 Gy in 25 fractions using intensity-modulated radiation therapy (IMRT), followed by MRI-based 3D high dose rate (HDR) brachytherapy. Retrospectively, the IMRT planning CT images were fused with the MR image for each fraction of brachytherapy using deformable image registration. The deformed IMRT dose onto MR images were converted to EQD2 and compared to the uniform dose assumption. Results For all patients, the EQD2 from the EBRT phase was significantly higher with deformable registration than with the conventional uniform dose distribution assumption. The mean EQD2 ± SD for HR-CTV D90 was 45.7 ± 0.7 Gy vs. 44.3 Gy for deformable vs. uniform dose distribution, respectively (p < 0.001). The dose to 2 cc of the bladder, rectum, and sigmoid was 46.4 ± 1.2 Gy, 46.2 ± 1.0 Gy, and 48.0 ± 2.5 Gy, respectively with deformable dose distribution, and was significantly higher than with uniform dose distribution (43.2 Gy for all OAR, p < 0.001). Conclusions This study reveals that deformed EBRT dose distribution to HR-CTV and OARs in MR images for brachytherapy is technically feasible, and achieves differences compared to a uniform dose distribution. Therefore, the assumption that EBRT contributes the same dose value may need to be carefully investigated further based on deformable image registration. PMID:25097559

  8. Dose rate constant and energy spectrum of interstitial brachytherapy sources.

    PubMed

    Chen, Z; Nath, R

    2001-01-01

    In the past two years, several new manufacturers have begun to market low-energy interstitial brachytherapy seeds containing 125I and 103Pd. Parallel to this development, the National Institute of Standards and Technology (NIST) has implemented a modification to the air-kerma strength (S(K)) standard for 125I seeds and has also established an S(K) standard for 103Pd seeds. These events have generated a considerable number of investigations on the determination of the dose rate constants (inverted V) of interstitial brachytherapy seeds. The aim of this work is to study the general properties underlying the determination of dose rate constant and to develop a simple method for a quick and accurate estimation of dose rate constant. As the dose rate constant of clinical seeds is defined at a fixed reference point, we postulated that dose rate constant may be calculated by treating the seed as an effective point source when the seed's source strength is specified in S(K) and its source characteristics are specified by the photon energy spectrum measured in air at the reference point. Using a semi-analytic approach, an analytic expression for dose rate constant was derived for point sources with known photon energy spectra. This approach enabled a systematic study of dose rate constant as a function of energy. Using the measured energy spectra, the calculated dose rate constant for 125I model 6711 and 6702 seeds and for 192Ir seed agreed with the AAPM recommended values within +/-1%. For the 103Pd model 200 seed, the agreement was 5% with a recently measured value (within the +/-7% experimental uncertainty) and was within 1% with the Monte Carlo simulations. The analytic expression for dose rate constant proposed here can be evaluated using a programmable calculator or a simple spreadsheet and it provides an efficient method for checking the measured dose rate constant for any interstitial brachytherapy seed once the energy spectrum of the seed is known. PMID:11213926

  9. A Monte Carlo Study for Photoneutron Dose Estimations around the High-Energy Linacs

    PubMed Central

    Mohammadi, N; Miri-Hakimabad, S H; Rafat-Motavalli, L

    2014-01-01

    Background: High-energy linear accelerator (linac) is a valuable tool and the most commonly used device for external beam radiation treatments in cancer patients. In the linac head, high-energy photons with energies above the threshold of (γ,n) interaction produce photoneutrons. These photoneutrons deliver the extra dose to the patients undergoing radiation treatment and increase the risk of secondary cancer. Objective: In this study, a simplified model of the linac head was simulated and photoneutron dose equivalent was calculated at the isocenter and maze in the sphere detector. In addition, the absorbed and equivalent dose of photoneutron were estimated in the some organs of the phantom. Methods: The simulations were made using the Monte Carlo code. The ICRP reference adult male voxel phantom was used as the human body model for dosimetry calculations. Results: The results of dose calculations at the isocenter and maze showed that photoneutron dose decreases as the function of distance from the isocenter and increases with increasing the distance from the entrance maze. Conclusion: It is concluded that the simplified model of linac head is a useful and reliable method in dosimetry calculations. Calculations illustrated that the photoneutron dose is not negligible and duo to its harmful biological effects on body, it should be considered in the treatment plans. PMID:25599059

  10. Bladder–Rectum Spacer Balloon in High-Dose-Rate Brachytherapy in Cervix Carcinoma

    SciTech Connect

    Rai, Bhavana; Patel, Firuza D.; Chakraborty, Santam; Sharma, Suresh C.; Kapoor, Rakesh; Aprem, Abi Santhosh

    2013-04-01

    Purpose: To compare bladder and rectum doses with the use of a bladder–rectum spacer balloon (BRSB) versus standard gauze packing in the same patient receiving 2 high-dose-rate intracavitary brachytherapy fractions. Methods and Materials: This was a randomized study to compare the reduction in bladder and rectum doses with the use of a BRSB compared with standard gauze packing in patients with carcinoma of the cervix being treated with high-dose-rate intracavitary brachytherapy. The patients were randomized between 2 arms. In arm A, vaginal packing was done with standard gauze packing in the first application, and BRSB was used in the second application. Arm B was the reverse of arm A. The International Commission for Radiation Units and Measurement (ICRU) point doses and doses to 0.1-cm{sup 3}, 1-cm{sup 3}, 2-cm{sup 3}, 5-cm{sup 3}, and 10-cm{sup 3} volumes of bladder and rectum were compared. The patients were also subjectively assessed for the ease of application and the time taken for application. Statistical analysis was done using the paired t test. Results: A total of 43 patients were enrolled; however, 3 patients had to be excluded because the BRSB could not be inserted owing to unfavorable local anatomy. Thus 40 patients (80 plans) were evaluated. The application was difficult in 3 patients with BRSB, and in 2 patients with BRSB the application time was prolonged. There was no significant difference in bladder doses to 0.1 cm{sup 3}, 1 cm{sup 3}, 2 cm{sup 3}, 5 cm{sup 3}, and 10 cm{sup 3} and ICRU bladder point. Statistically significant dose reductions to 0.1-cm{sup 3}, 1-cm{sup 3}, and 2-cm{sup 3} volumes for rectum were observed with the BRSB. No significant differences in 5-cm{sup 3} and 10-cm{sup 3} volumes and ICRU rectum point were observed. Conclusion: A statistically significant dose reduction was observed for small high-dose volumes in rectum with the BRSB. The doses to bladder were comparable for BRSB and gauze packing. Transparent balloons of

  11. [Changes in the rat liver after exposure to high doses of bromex].

    PubMed

    Krustev, L; Kaloianova-Simeonova, F

    1982-01-01

    Experiments were carried out with male albino rats treated with the phosphorous-organic compound--bromex. The pesticide was perorally administered to one of the experimental groups--a single dose of 1/2 LD50. The same quantity bromex was administered to the other experimental group after a previous 20-day treatment with the same preparation but with a dose of 1/20 LD50. The changes, not particularly well manifested, progressing the organelles of the liver cells were followed up. The changes were established (in mitochondria, endoplasmatic reticulum, lysozoymes and some other organelles) to be better manifested in the group under a single effect of bromex. In this case they are interpreted as manifestation of one initial alterative process. In the group with the 20-day low doses, followed up by one high dose, the changes were gradual, lighter and considered a manifestation of a sort of adaptation or a form of subcellular liver regeneration. PMID:7178067

  12. Dosimetric evaluation of two treatment planning systems for high dose rate brachytherapy applications

    SciTech Connect

    Shwetha, Bondel; Ravikumar, Manickam; Supe, Sanjay S.; Sathiyan, Saminathan; Lokesh, Vishwanath; Keshava, Subbarao L.

    2012-04-01

    Various treatment planning systems are used to design plans for the treatment of cervical cancer using high-dose-rate brachytherapy. The purpose of this study was to make a dosimetric comparison of the 2 treatment planning systems from Varian medical systems, namely ABACUS and BrachyVision. The dose distribution of Ir-192 source generated with a single dwell position was compared using ABACUS (version 3.1) and BrachyVision (version 6.5) planning systems. Ten patients with intracavitary applications were planned on both systems using orthogonal radiographs. Doses were calculated at the prescription points (point A, right and left) and reference points RU, LU, RM, LM, bladder, and rectum. For single dwell position, little difference was observed in the doses to points along the perpendicular bisector. The mean difference between ABACUS and BrachyVision for these points was 1.88%. The mean difference in the dose calculated toward the distal end of the cable by ABACUS and BrachyVision was 3.78%, whereas along the proximal end the difference was 19.82%. For the patient case there was approximately 2% difference between ABACUS and BrachyVision planning for dose to the prescription points. The dose difference for the reference points ranged from 0.4-1.5%. For bladder and rectum, the differences were 5.2% and 13.5%, respectively. The dose difference between the rectum points was statistically significant. There is considerable difference between the dose calculations performed by the 2 treatment planning systems. It is seen that these discrepancies are caused by the differences in the calculation methodology adopted by the 2 systems.

  13. Pharmacokinetic study of low- versus high-dose medroxyprogesterone acetate (MPA) in women.

    PubMed

    Ohtsu, T; Fujii, H; Wakita, H; Igarashi, T; Itoh, K; Imoto, S; Kohagura, M; Sasaki, Y

    1998-01-01

    The present study was conducted to compare the pharmacokinetics (PK) of low-dose versus high-dose medroxyprogesterone (MPA) as a once-daily oral administration. Of 32 patients, all women, enrolled in this PK study, 18 received 600 mg MPA daily and 14 received 1200 mg daily. Detailed PK data were obtained on day 1 and after more than 4 weeks of MPA treatment. In addition, multiple data for the minimum steady-state concentration (Css min) were analyzed. The MPA serum concentrations were measured by high-performance liquid chromatography. Wide interpatient variability was found in the PK parameters obtained both on day 1 and after more than 4 weeks. There were no clear relationships between the oral dose and the MPA peak concentration (Cmax), area under the time versus concentration curve (AUC), or mean Css min. Weight gains of 10% or more were demonstrated more frequently in the high-dose group (P < 0.01). Liver dysfunction (n = 5) did not influence the PK of MPA. Five patients demonstrated extremely low AUC and Cmax (< 10 ng/ml) values on day 1. Phenobarbital, dexamethasone and betamethasone were being taken concomitantly with the MPA each by one patient. The serum MPA concentrations were markedly increased after the discontinuation of phenobarbital in that patient, suggesting a drug interaction. At present we cannot recommend the high dose of MPA, except in clinical studies, from a PK or a pharmacodynamic points of view. PMID:9619751

  14. The EORTC GI group experience with high-dose infusional 5-FU in colorectal cancer.

    PubMed

    Blijham, G H

    1996-01-01

    The EORTC Gastrointestinal Tract Cancer Cooperative Group has conducted a randomized trial of high-dose infusional 5-fluorouracil (FU) with or without Methotrexate (MTX). FU was given as a 48-horus infusion of 60 mg/kg every week x 4, biweekly x 4, and subsequently every 3 weeks. Half of the patients also received 40 mg/m2 MTX as a bolus injection just prior to the FU infusion. A total of 312 patients were randomized. High-dose infusional FU was very well tolerated with virtually no haematological, renal, hepatic or cutaneous toxicity. Nausea and vomiting occurred in 35% and diarrhea in 24% of patients but was almost never severe. Cardiac toxicity and ataxia were seen in less than 5% of patients. Methotrexate lead to a significantly higher incidence of stomatitis, which was severe in 10% of patients. Eleven percent of the high-dose infusional FU patients showed an objective response with stabilization in an additional 35%; median survival was 9.3 months. With the addition of methotrexate a 23% response rate was seen (p = 0.025) and survival was 12.5 months (n.s.). We demonstrated the favorable therapeutic index tolaribility of high-dose (60 mg/kg), short-term (48 hours), frequent (weekly-biweekly) infusional FU and the ability of low-dose MTX to positivity modulate this FU treatment. PMID:9229320

  15. High-dose short-term administration of naringin did not alter talinolol pharmacokinetics in humans.

    PubMed

    Nguyen, M A; Staubach, P; Tamai, I; Langguth, P

    2015-02-20

    Naringin is considered the major causative ingredient of the inhibition of intestinal drug uptake by grapefruit juice. Moreover, it is contained in highly dosed nutraceuticals available on the market. A controlled, open, randomized, crossover study was performed in 10 healthy volunteers to investigate the effect of high-dose naringin on the bioavailability of talinolol, a substrate of intestinal organic anion-transporting polypeptide (OATP)-mediated uptake. Following 6-day supplementation with 3 capsules of 350 mg naringin daily, 100mg talinolol were administered orally with 3 capsules of the same dietary supplement (1050 mg naringin) on the seventh day. This test treatment was compared to 100mg talinolol only (control). The results showed that short-term high-dose naringin supplementation did not significantly affect talinolol pharmacokinetics. Geometric mean ratios of test versus control ranged between 0.90 and 0.98 for talinolol c(max), AUC(0-48 h), AUC(0-∞), t(1/2) and A(e(0-48 h)). The high dose may provoke inhibition of the efflux transporter P-glycoprotein (P-gp) which counteracts the uptake inhibition. As disintegration and dissolution processes are required for the solid dosage form, dissolved naringin may arrive at the site of interaction after talinolol is already absorbed. In conclusion, the effect of nutraceuticals on drug pharmacokinetics can deviate from that observed when administered as food component due to the different dose and dosage form. PMID:25486333

  16. High-temperature thermoluminescence of anion-deficient alumina and possibilities of its application in high-dose dosimetry

    NASA Astrophysics Data System (ADS)

    Surdo, A. I.; Milman, I. I.; Abashev, R. M.; Vlasov, M. I.

    2014-12-01

    Results of studies of the thermoluminescence (TL) of anion-deficient alumina (α-Al2O3 - δ) single crystals and based on them TLD-500 detectors exposed to pulsed X-ray and electron radiation in a wide range of doses D, pulsed dose rates P p , and temperatures are described. The TL responses of α-Al2O3 - δ for continuous and pulsed X-ray irradiation at D = 0.05-150 Gy are compared. Unlike continuous irradiation, in the case of pulsed irradiation at P p ≥ 6 × 106 Gy/s, a linear increase in the TL response as a function of D is registered in the main and "chromium" peaks at 450 and 580 K, respectively, with a decrease in the slope of the dose dependence at D > 2 Gy for the peak at 450 K. It is found that high-dose irradiation (>60 Gy) leads to the formation of a new TL peak at 830 K and the preferential redistribution of the stored light sums into this peak. The dose dependence for the TL peak at 830 K is studied. It is established that it is linear in a super-high dose range of 104 to 6 × 106 Gy at P p = 2.6 × 1011 Gy/s.

  17. Clinical Application of High-Dose, Image-Guided Intensity-Modulated Radiotherapy in High-Risk Prostate Cancer

    SciTech Connect

    Bayley, Andrew; Rosewall, Tara; Craig, Tim; Bristow, Rob; Chung, Peter; Gospodarowicz, Mary; Menard, Cynthia; Milosevic, Michael; Warde, Padraig; Catton, Charles

    2010-06-01

    Purpose: To report the feasibility and early toxicity of dose-escalated image-guided IMRT to the pelvic lymph nodes (LN), prostate (P), and seminal vesicles (SV). Methods and Materials: A total of 103 high-risk prostate cancer patients received two-phase, dose-escalated, image-guided IMRT with 3 years of androgen deprivation therapy. Clinical target volumes (CTVs) were delineated using computed tomography/magnetic resonance co-registration and included the prostate, portions of the SV, and the LN. Planning target volume margins (PTV) used were as follows: P (10 mm, 7 mm posteriorly), SV (10 mm), and LN (5 mm). Organs at risk (OaR) were the rectal and bladder walls, femoral heads, and large and small bowel. The IMRT was planned with an intended dose of 55.1 Gy in 29 fractions to all CTVs (Phase 1), with P+SV consecutive boost of 24.7 Gy in 13 fractions. Daily online image guidance was performed using bony landmarks and intraprostatic markers. Feasibility criteria included delivery of intended doses in 80% of patients, 95% of CTV displacements incorporated within PTV during Phase 1, and acute toxicity rate comparable to that of lower-dose pelvic techniques. Results: A total of 91 patients (88%) received the total prescription dose. All patients received at least 72 Gy. In Phase 1, 63 patients (61%) received the intended 55.1 Gy, whereas 87% of patients received at least 50 Gy. Dose reductions were caused by small bowel and rectal wall constraints. All CTVs received the planned dose in >95% of treatment fractions. There were no Radiation Therapy Oncology Group acute toxicities greater than Grade 3, although there were five incidences equivalent to Grade 3 within a median follow-up of 23 months. Conclusion: These results suggest that dose escalation to the PLN+P+SV using IMRT is feasible, with acceptable rates of acute toxicity.

  18. Nebuhaler or nebulizer for high dose bronchodilator therapy in chronic bronchitis: a comparison.

    PubMed

    Allen, M B; Pugh, J; Wilson, R S

    1988-10-01

    We have compared the clinical efficacy of high dose terbutaline sulphate (10 mg four times daily) delivered by either a Nebuhaler or jet nebulizer in 13 patients with chronic bronchitis in a 2-week, open, crossover study. Both treatment regimens improved run-in symptom scores but no significant changes were recorded in peak flow and spirometry. Side-effects were more common with the Nebuhaler and more patients preferred the nebulizer. However, the Nebuhaler is an alternative therapeutic option for delivery of high doses of bronchodilators in patients with chronic bronchitis. PMID:3076792

  19. High-dose neuroleptics: uncontrolled clinical practice confirms controlled clinical trials.

    PubMed

    Bollini, P; Andreani, A; Colombo, F; Bellantuono, C; Beretta, P; Arduini, A; Galli, T; Tognoni, G

    1984-01-01

    The strategy of high-dose intramuscular haloperidol as routinely applied in a general hospital psychiatric ward to 74 successive patients, 33 of whom stayed only up to seven days, and a further 34 up to 15 days, led to a complete recovery in only six, and complete lack of change in 23. Adverse reactions were recorded in 42, severe enough to stop treatment in eight; there were three deaths. In view of this risk-benefit analysis, systematic application of this high dose strategy to get a more rapid turnover of patients is unjustified. PMID:6692073

  20. Efficacy of High-Dose Baclofen for Alcohol Use Disorder and Comorbid Bulimia: A Case Report.

    PubMed

    Weibel, Sébastien; Lalanne, Laurence; Riegert, Myriam; Bertschy, Gilles

    2015-01-01

    High-dose baclofen is a promising treatment for alcohol use disorder, with a specific action on craving. A more general action on craving in other addictive disorders has been suggested based on the hypothesis of a common neurobiological pathway in addictions. We report the case of a woman with both alcohol use disorder and bulimia nervosa. There was a positive response to high-dose baclofen on alcohol craving, but no response on food craving. The case illustrates that craving could be differentially responsive to anti-craving drugs. PMID:26457456

  1. Vitamin E ameliorates high dose trans-dehydrocrotonin-associated hepatic damage in mice.

    PubMed

    Rabelo, Alana Fontales Lima; Guedes, Marjorie Moreira; Tomé, Adriana da Rocha; Lima, Patricia Rodrigues; Maciel, Maria Aparecida; Lira, Silveria Regina de Sousa; Carvalho, Ana Carla da Silva; Santos, Flávia Almeida; Rao, Vietla Satyanarayana

    2010-04-01

    trans-Dehydrocrotonin (t-DCTN), the diterpenoid from Croton cajucara Bentham, exhibits hypoglycemic and hypolipidemic activities, but in high doses is associated with a discrete hepatotoxicity. In the search for measures to mitigate this, pretreatment with the antioxidants N-acetylcysteine and vitamin E has been examined. Mice that received a high dose t-DCTN (100 mg/kg) manifested hepatic damage, as evidenced by significant elevations in serum ALT and AST, and hepatic GSH, and histological alterations, which could be obliterated by pretreatment with vitamin E, but not with N-acetylcysteine, possibly by creating an effective antioxidant balance. PMID:20433064

  2. Direct absorbed dose to water determination based on water calorimetry in scanning proton beam delivery

    SciTech Connect

    Sarfehnia, A.; Clasie, B.; Chung, E.; Lu, H. M.; Flanz, J.; Cascio, E.; Engelsman, M.; Paganetti, H.; Seuntjens, J.

    2010-07-15

    Purpose: The aim of this manuscript is to describe the direct measurement of absolute absorbed dose to water in a scanned proton radiotherapy beam using a water calorimeter primary standard. Methods: The McGill water calorimeter, which has been validated in photon and electron beams as well as in HDR {sup 192}Ir brachytherapy, was used to measure the absorbed dose to water in double scattering and scanning proton irradiations. The measurements were made at the Massachusetts General Hospital proton radiotherapy facility. The correction factors in water calorimetry were numerically calculated and various parameters affecting their magnitude and uncertainty were studied. The absorbed dose to water was compared to that obtained using an Exradin T1 Chamber based on the IAEA TRS-398 protocol. Results: The overall 1-sigma uncertainty on absorbed dose to water amounts to 0.4% and 0.6% in scattered and scanned proton water calorimetry, respectively. This compares to an overall uncertainty of 1.9% for currently accepted IAEA TRS-398 reference absorbed dose measurement protocol. The absorbed dose from water calorimetry agrees with the results from TRS-398 well to within 1-sigma uncertainty. Conclusions: This work demonstrates that a primary absorbed dose standard based on water calorimetry is feasible in scattered and scanned proton beams.

  3. High-Dose Oral Ibuprofen in Treatment of Patent Ductus Arteriosus in Full-Term Neonates

    PubMed Central

    Pourarian, Shahnaz; Rezaie, Mehrdad; Amoozgar, Hamid; Shakiba, Ali-Mohammad; Edraki, Mohammad-Reza; Mehdizadegan, Nima

    2015-01-01

    Background: Patent ductus arteriosus (PDA) is an important risk for heart failure due to left to right shunt in term neonates. Objectives: In this study, we evaluated the effect of high dose ibuprofen in closure of PDA in term neonates. Patients and Methods: We used double dose ibuprofen (20 mg/kg, 10 mg/kg, and 10 mg/kg) for 3 - 30 day old term neonates with PDA who were admitted in the neonatal wards of Shiraz University of Medical Sciences. The results of this study were compared to the data of the previous study in our center which used the low dose of ibuprofen (10 mg/kg, 5 mg/kg, and 5 mg/kg). Results: 29 full term neonates received high-dose ibuprofen, in 18 neonates, PDA was closed after 4 days (62.1% versus 43.3% for the standard dose and 4.7% for the control group in the previous study) (P = 0.001). The results showed no significant correlation between the closure rate and gestational age, postnatal age, sex, and weight. In the 4th day of treatment, size of the pulmonic end of ductus arteriosus decreased from 2.09 mm to 0.77 mm compared to 1.68 mm to 0.81 mm in the standard dose of oral ibuprofen and 2.1 mm to 1.4 mm in the control group (P = 0.046). Conclusions: This study indicated that high-dose oral ibuprofen was more effective in closing or decreasing the size of PDA. PMID:26396694

  4. Low or High Fractionation Dose {beta}-Radiotherapy for Pterygium? A Randomized Clinical Trial

    SciTech Connect

    Viani, Gustavo Arruda; De Fendi, Ligia Issa; Fonseca, Ellen Carrara; Stefano, Eduardo Jose

    2012-02-01

    Purpose: Postoperative adjuvant treatment using {beta}-radiotherapy (RT) is a proven technique for reducing the recurrence of pterygium. A randomized trial was conducted to determine whether a low fractionation dose of 2 Gy within 10 fractions would provide local control similar to that after a high fractionation dose of 5 Gy within 7 fractions for surgically resected pterygium. Methods: A randomized trial was conducted in 200 patients (216 pterygia) between February 2006 and July 2007. Only patients with fresh pterygium resected using a bare sclera method and given RT within 3 days were included. Postoperative RT was delivered using a strontium-90 eye applicator. The pterygia were randomly treated using either 5 Gy within 7 fractions (Group 1) or 2 Gy within 10 fractions (Group 2). The local control rate was calculated from the date of surgery. Results: Of the 216 pterygia included, 112 were allocated to Group 1 and 104 to Group 2. The 3-year local control rate for Groups 1 and 2 was 93.8% and 92.3%, respectively (p = .616). A statistically significant difference for cosmetic effect (p = .034), photophobia (p = .02), irritation (p = .001), and scleromalacia (p = .017) was noted in favor of Group 2. Conclusions: No better local control rate for postoperative pterygium was obtained using high-dose fractionation vs. low-dose fractionation. However, a low-dose fractionation schedule produced better cosmetic effects and resulted in fewer symptoms than high-dose fractionation. Moreover, pterygia can be safely treated in terms of local recurrence using RT schedules with a biologic effective dose of 24-52.5 Gy{sub 10.}.

  5. Radiation bronchitis and stenosis secondary to high dose rate endobronchial irradiation

    SciTech Connect

    Speiser, B.L. ); Spratling, L.

    1993-03-15

    The purpose of the study was to describe a new clinical entity observed in follow-up bronchoscopies in patients who were treated with high dose rate and medium dose rate remote afterloading brachytherapy of the tracheobronchial tree. Patients were treated by protocol with medium dose rate, 47 patients receiving 1000 cGy at a 5 mm depth times three fractions, high dose rate 144 patients receiving 1000 cGy at a 10 mm depth for three fractions and high dose rate 151 patients receiving cGy at a 10 mm depth for three fractions followed by bronchoscopy. Incidence of this entity was 9% for the first group, 12% for the second, and 13% for the third group. Reactions were grade 1 consisting of mild inflammatory response with a partial whitish circumferential membrane in an asymptomatic patient; grade 2, thicker complete white circumferential membrane with cough and/or obstructive problems requiring intervention; grade 3, severe inflammatory response with marked membranous exudate and mild fibrotic reaction; and grade 4 a predominant fibrotic reaction with progressive stenosis. Variables associated with a slightly increased incidence of radiation bronchitis and stenosis included: large cell carcinoma histology, curative intent, prior laser photoresection, and/or concurrent external radiation. Survival was the strongest predictor of the reaction. Radiation bronchitis and stenosis is a new clinical entity that must be identified in bronchial brachytherapy patients and treated appropriately. 23 refs., 3 figs., 7 tabs.

  6. Delayed activation of human microglial cells by high dose ionizing radiation.

    PubMed

    Chen, Hongxin; Chong, Zhao Zhong; De Toledo, Sonia M; Azzam, Edouard I; Elkabes, Stella; Souayah, Nizar

    2016-09-01

    Recent studies have shown that microglia affects the fate of neural stem cells in response to ionizing radiation, which suggests a role for microglia in radiation-induced degenerative outcomes. We therefore investigated the effects of γ-irradiation on cell survival, proliferation, and activation of microglia and explored associated mechanisms. Specifically, we evaluated cellular and molecular changes associated with exposure of human microglial cells (CHME5) to low and high doses of acute cesium-137 γ rays. Twenty-four hours after irradiation, cell cycle analyses revealed dose-dependent decreases in the fraction of cells in S and G2/M phase, which correlated with significant oxidative stress. By one week after irradiation, 20-30% of the cells exposed to high doses of γ rays underwent apoptosis, which correlated with significant concomitant decrease in metabolic activity as assessed by the MTT assay, and microglial activation as judged by both morphological changes and increased expression of Glut-5 and CR43. These changes were associated with increases in the mRNA levels for IL-1α, IL-10 and TNFα. Together, the results show that human CHME5 microglia are relatively resistant to low and moderate doses of γ rays, but are sensitive to acute high doses, and that CHME5 cells are a useful tool for in vitro study of human microglia. PMID:27265419

  7. Dosimetric Effects of Magnetic Resonance Imaging-assisted Radiotherapy Planning: Dose Optimization for Target Volumes at High Risk and Analytic Radiobiological Dose Evaluation.

    PubMed

    Park, Ji-Yeon; Suh, Tae Suk; Lee, Jeong-Woo; Ahn, Kook-Jin; Park, Hae-Jin; Choe, Bo-Young; Hong, Semie

    2015-10-01

    Based on the assumption that apparent diffusion coefficients (ADCs) define high-risk clinical target volume (aCTVHR) in high-grade glioma in a cellularity-dependent manner, the dosimetric effects of aCTVHR-targeted dose optimization were evaluated in two intensity-modulated radiation therapy (IMRT) plans. Diffusion-weighted magnetic resonance (MR) images and ADC maps were analyzed qualitatively and quantitatively to determine aCTVHR in a high-grade glioma with high cellularity. After confirming tumor malignancy using the average and minimum ADCs and ADC ratios, the aCTVHR with double- or triple-restricted water diffusion was defined on computed tomography images through image registration. Doses to the aCTVHR and CTV defined on T1-weighted MR images were optimized using a simultaneous integrated boost technique. The dosimetric benefits for CTVs and organs at risk (OARs) were compared using dose volume histograms and various biophysical indices in an ADC map-based IMRT (IMRTADC) plan and a conventional IMRT (IMRTconv) plan. The IMRTADC plan improved dose conformity up to 15 times, compared to the IMRTconv plan. It reduced the equivalent uniform doses in the visual system and brain stem by more than 10% and 16%, respectively. The ADC-based target differentiation and dose optimization may facilitate conformal dose distribution to the aCTVHR and OAR sparing in an IMRT plan. PMID:26425053

  8. High-Dose versus Low-Dose Vitamin D Supplementation and Arterial Stiffness among Individuals with Prehypertension and Vitamin D Deficiency

    PubMed Central

    Zaleski, Amanda; Panza, Gregory; Swales, Heather; Arora, Pankaj; Newton-Cheh, Christopher; Wang, Thomas; Thompson, Paul D.; Taylor, Beth

    2015-01-01

    Introduction. Vitamin D deficiency is associated with the onset and progression of hypertension and cardiovascular disease (CVD). However, mechanisms underlying vitamin D deficiency-mediated increased risk of CVD remain unknown. We sought to examine the differential effect of high-dose versus low-dose vitamin D supplementation on markers of arterial stiffness among ~40 vitamin D deficient adults with prehypertension. Methods. Participants were randomized to high-dose (4000 IU/d) versus low-dose (400 IU/d) oral vitamin D3 for 6 months. 24 hr ambulatory blood pressure (BP), carotid-femoral pulse wave velocity, and pulse wave analyses were obtained at baseline and after 6 months of vitamin D supplementation. Results. There were no changes in resting BP or pulse wave velocity over 6 mo regardless of vitamin D dose (all p > 0.202). High-dose vitamin D decreased augmentation index and pressure by 12.3 ± 5.3% (p = 0.047) and 4.0 ± 1.5 mmHg (p = 0.02), respectively. However, these decreases in arterial stiffness were not associated with increases in serum 25-hydroxyvitamin D over 6 mo (p = 0.425). Conclusion. High-dose vitamin D supplementation appears to lower surrogate measures of arterial stiffness but not indices of central pulse wave velocity. Clinical Trial Registration. This trial is registered with www.clinicaltrials.gov (Unique Identifier: NCT01240512). PMID:26451070

  9. Influence of adjacent low-dose fields on tolerance to high doses of protons in rat cervical spinal cord

    SciTech Connect

    Bijl, Hendrik P. . E-mail: h.p.bijl@rt.umcg.nl; Luijk, Peter van; Coppes, Rob P.; Schippers, Jacobus M.; Konings, Antonius W.T.; Kogel, Albert J. van der

    2006-03-15

    Purpose: The dose-response relationship for a relatively short length (4 mm) of rat spinal cord has been shown to be significantly modified by adjacent low-dose fields. In an additional series of experiments, we have now established the dose-volume dependence of this effect. Methods and Materials: Wistar rats were irradiated on the cervical spinal cord with single doses of unmodulated protons (150 MeV) to obtain sharp lateral penumbras, by use of the shoot-through technique, which employs the plateau of the depth-dose profile rather than the Bragg peak. Three types of inhomogeneous dose distributions were administered: Twenty millimeters of cervical spinal cord were irradiated with variable subthreshold (= bath) doses (4 and 18 Gy). At the center of the 20-mm segment, a short segment of 2 mm or 8 mm (= shower) was irradiated with variable single doses. These inhomogeneous dose distributions are referred to as symmetrical bath-and-shower experiments. An asymmetrical dose distribution was arranged by irradiation of 12 mm (= bath) of spinal cord with a dose of 4 Gy. The caudal 2 mm (= shower) of the 12-mm bath was additionally irradiated with variable single doses. This arrangement of inhomogeneous dose distribution is referred to as asymmetrical bath-and-shower experiment. The endpoint for estimation of the dose-response relationships was paralysis of the fore limbs or hind limbs and confirmation by histology. Results: The 2-mm bath-and-shower experiments with a 4-Gy bath dose showed a large shift of the dose-response curves compared with the 2-mm single field, which give lower ED{sub 5} values of 61.2 Gy and 68.6 Gy for the symmetrical and asymmetrical arrangement, respectively, compared with an ED{sub 5} of 87.8 Gy after irradiation of a 2-mm field only. If the bath dose is increased to 18 Gy, the ED{sub 5} value is decreased further to 30.9 Gy. For an 8-mm field, addition of a 4-Gy bath dose did not modify the ED{sub 5} obtained for an 8-mm field only (23.2 and 23

  10. Influence of prophylactic anticonvulsant therapy on high-dose busulphan kinetics.

    PubMed

    Hassan, M; Oberg, G; Björkholm, M; Wallin, I; Lindgren, M

    1993-01-01

    The pharmacokinetics of high-dose busulphan was studied in 17 patients during conditioning prior to bone marrow transplantation using deuterium-labeled busulphan (d8-BU). About 50% of busulphan doses 1 and 16 was replaced with d8-BU. Patients were treated with phenytoin or diazepam as prophylactic anticonvulsant therapy. Patients who received phenytoin demonstrated significantly higher clearance (mean +/- SD, 3.32 +/- 0.99 ml min-1 kg-1), a lower area under the concentration-time curve (AUC, 5,412 +/- 1,534 ng h ml-1; corrected for dose/kilogram) and a shorter elimination half-life (3.03 +/- 0.57 h) for the last dose of d8-BU (dose 16) as compared with the first dose (2.80 +/- 0.78 ml min-1 kg-1, 6,475 +/- 2,223 ng h ml-1 and 3.94 +/- 1.10 h, respectively). No difference in the above mentioned pharmacokinetic parameters was seen in patients treated with diazepam. Moreover, a continuous decrease in the steady-state level of busulphan was observed in four of seven patients in the phenytoin-treated group, whereas in the diazepam group, such a decrease was seen in only one of eight patients. We conclude that phenytoin used as prophylactic anticonvulsant therapy alters busulphan pharmacokinetics and, most probably, its pharmacodynamics. For adequate prophylactic therapy, anticonvulsants with fewer enzyme-inductive properties than phenytoin should be used. PMID:8269597

  11. Relative Efficiency of TLD-100 to High Linear Energy Transfer Radiation: Correction to Astronaut Absorbed Dose

    NASA Technical Reports Server (NTRS)

    Badhwar, G. D.; Cash, B. L.; Semones, E. J.; Yasuda, H.; Fujitaka, K.

    1999-01-01

    Response of thermoluminescent detectors (TLD-100) to high linear energy transfer (LET) particles has been studied using helium, carbon, silicon, and iron ions from the Heavy Ion Medical Accelerator at Chiba (Japan), iron ions from the Brookhaven National Laboratory (NY) Alternate Gradient Synchrotron, and 53, 134, 185, and 232 MeV protons from the Loma Linda accelerator. Using the measured relative (to 137Cs) dose efficiency, and measured LET spectra from a tissue equivalent proportional counter (TEPC) on 20 Space Shuttle flights, and 7 Mir flights, the underestimation of absorbed dose by these detectors has been evaluated. The dose underestimation is between 15-20% depending upon the flight inclination and shielding location. This has been confirmed by direct correlation of measured dose by TEPC and TLD-100 at a low shielded location in the Shuttle mid-deck. A comparison of efficiency- LET data with a compilation of similar data from TLD-700, shows that shapes of the two curves are nearly identical, but that the TLD-100 curve is systematically lower by about 13%, and is the major cause of dose underestimation. These results strongly suggest that TLDs used for crew dose estimation be regularly calibrated using heavy ions.

  12. A BrachyPhantom for verification of dose calculation of HDR brachytherapy planning system

    SciTech Connect

    Austerlitz, C.; Campos, C. A. T.

    2013-11-15

    Purpose: To develop a calibration phantom for {sup 192}Ir high dose rate (HDR) brachytherapy units that renders possible the direct measurement of absorbed dose to water and verification of treatment planning system.Methods: A phantom, herein designated BrachyPhantom, consists of a Solid Water™ 8-cm high cylinder with a diameter of 14 cm cavity in its axis that allows the positioning of an A1SL ionization chamber with its reference measuring point at the midheight of the cylinder's axis. Inside the BrachyPhantom, at a 3-cm radial distance from the chamber's reference measuring point, there is a circular channel connected to a cylindrical-guide cavity that allows the insertion of a 6-French flexible plastic catheter from the BrachyPhantom surface. The PENELOPE Monte Carlo code was used to calculate a factor, P{sub sw}{sup lw}, to correct the reading of the ionization chamber to a full scatter condition in liquid water. The verification of dose calculation of a HDR brachytherapy treatment planning system was performed by inserting a catheter with a dummy source in the phantom channel and scanning it with a CT. The CT scan was then transferred to the HDR computer program in which a multiple treatment plan was programmed to deliver a total dose of 150 cGy to the ionization chamber. The instrument reading was then converted to absorbed dose to water using the N{sub gas} formalism and the P{sub sw}{sup lw} factor. Likewise, the absorbed dose to water was calculated using the source strength, S{sub k}, values provided by 15 institutions visited in this work.Results: A value of 1.020 (0.09%, k= 2) was found for P{sub sw}{sup lw}. The expanded uncertainty in the absorbed dose assessed with the BrachyPhantom was found to be 2.12% (k= 1). To an associated S{sub k} of 27.8 cGy m{sup 2} h{sup −1}, the total irradiation time to deliver 150 cGy to the ionization chamber point of reference was 161.0 s. The deviation between the absorbed doses to water assessed with the Brachy

  13. In vivo real-time dosimetric verification in high dose rate prostate brachytherapy

    SciTech Connect

    Seymour, Erin L.; Downes, Simon J.; Fogarty, Gerald B.; Izard, Michael A.; Metcalfe, Peter

    2011-08-15

    Purpose: To evaluate the performance of a diode array in the routine verification of planned dose to points inside the rectum from prostate high dose rate (HDR) brachytherapy using a real-time planning system. Methods: A dosimetric study involving 28 patients was undertaken where measured doses received during treatment were compared to those calculated by the treatment planning system (TPS). After the ultrasound imaging required for treatment planning had been recorded, the ultrasound probe was replaced with a geometric replica that contained an 8 mm diameter cylindrical cavity in which a PTW diode array type 9112 was placed. The replica probe was then positioned inside the rectum with the individual diode positions determined using fluoroscopy. Dose was then recorded during the patients' treatment and compared to associated coordinates in the planning system. Results: Factors influencing diode response and experimental uncertainty were initially investigated to estimate the overall uncertainty involved in dose measurements, which was determined to be {+-}10%. Data was acquired for 28 patients' first fractions, 11 patients' second fractions, and 13 patients' third fractions with collection dependent upon circumstances. Deviations between the diode measurements and predicted values ranged from -42% to +35% with 71% of measurements experiencing less than a 10% deviation from the predicted values. If the {+-}10% measurement uncertainty was combined with a tolerated dose discrepancy of {+-}10% then over 95% of the diode results exhibited agreement with the calculated data to within {+-}20%. It must also be noted that when large dose discrepancies were apparent they did not necessarily occur for all five diodes in the one measurement. Conclusions: This technique provided a method that could be utilized to detect gross errors in dose delivery of a real-time prostate HDR plan. Limitations in the detection system used must be well understood if meaningful results are to

  14. CT of multiple sclerosis: reassessment of delayed scanning with high doses of contrast material

    SciTech Connect

    Spiegel, S.M.; Vinuela, F.; Fox, A.J.; Pelz, D.M.

    1985-09-01

    A prospective study involving 87 patients was carried out to evaluate the necessity for a high dose of contrast material in addition to delayed computed tomographic (CT) scanning for optimal detection of the lesions of multiple sclerosis in the brain. In patients with either clinically definite multiple sclerosis or laboratory-supported definite multiple sclerosis, CT scans were obtained with a uniform protocol. Lesions consistent with multiple sclerosis were demonstrated on the second scan in 54 patients. In 36 of these 54 patients, the high-dose delayed scan added information. These results are quite similar to those of a previous study from this institution using different patients, in whom the second scan was obtained immediately after the bolus injection of contrast material containing 40 g of organically bound iodine. The lack of real difference in the results of the two studies indicate that the increased dose, not just the delay in scanning, is necessary for a proper study.

  15. [A comparative study between low-dose and high-dose medroxyprogesterone acetate (MPA) in the treatment of advanced and recurrent breast cancer--in relation to dose, serum concentration and response. Osaka Breast Cancer Research Group].

    PubMed

    Furukawa, J; Yayoi, E; Takatsuka, Y; Aikawa, T; Maeura, Y; Kobayashi, T; Miyauchi, K; Kotsuma, Y

    1997-05-01

    A prospective randomized study was carried out to evaluate the effectiveness of MPA in the treatment of breast cancer by comparing low dose (600 mg/day) with high dose (1,200 mg/day) of MPA. In 35 evaluable cases, the response rate to treatment was 40.0% (8/20) with low dose MPA and 26.7% (4/15) with high dose MPA. There was no significant difference between the two groups. The serum MPA concentration measured by high-performance liquid chromatography (HPLC) assay was 23.2 +/- 17.6 ng/ml in the low-dose group and 89.5 +/- 56.7 ng/ml in the high-dose group. Intrapatient variability in serum MPA concentration was relatively stable, but interpatient variability was large. No correlation was found between the response rate and serum MPA concentration. The above results indicate that a low dose of MPA (600 mg/day) is a useful treatment with high effectiveness and safety in advanced and recurrent breast cancer patients. Though no exact data on the optimal serum concentration could not be obtained, it was obvious that a successful response cannot be expected from a serum MPA concentration of less than 17 ng/ml, which was the average serum concentration in NC and PD patients of the low-dose group. PMID:9170519

  16. SU-F-BRF-11: Dose Rearrangement in High Dose Locally Advanced Lung Patients Based On Perfusion Imaging

    SciTech Connect

    Matrosic, C; Jarema, D; Kong, F; McShan, D; Stenmark, M; Owen, D; Ten Haken, R; Matuszak, M

    2014-06-15

    Purpose: The use of mean lung dose (MLD) limits allows individualization of lung patient tumor doses at safe levels. However, MLD does not account for local lung function differences between patients, leading to toxicity variability at the same MLD. We investigated dose rearrangement to minimize dose to functional lung, as measured by perfusion SPECT, while maintaining target coverage and conventional MLD limits. Methods: Retrospective plans were optimized for 15 locally advanced NSCLC patients enrolled in a prospective imaging trial. A priority-based optimization system was used. The baseline priorities were (1) meet OAR dose constraints, (2) maximize target gEUD, and (3) minimize physical MLD. As a final step, normal tissue doses were minimized. To determine the benefit of rearranging dose using perfusion SPECT, plans were reoptimized to minimize functional lung gEUD as the 4th priority. Results: When only minimizing physical MLD, the functional lung gEUD was 10.8+/−5.0 Gy (4.3–19.8 Gy). Only 3/15 cases showed a decrease in functional lung gEUD of ≥4% when rearranging dose to minimize functional gEUD in the cost function (10.5+/−5.0 Gy range 4.3−19.7). Although OAR constraints were respected, the dose rearrangement resulted in ≥10% increases in gEUD to an OAR in 4/15 cases. Only slight reductions in functional lung gEUD were noted when omitting the minimization of physical MLD, suggesting that constraining the target gEUD minimizes the potential to redistribute dose. Conclusion: Prioritydriven optimization permits the generation of plans that respect traditional OAR limits and target coverage, but with the ability to rearrange dose based on functional imaging. The latter appears to be limited due to the decreased solution space when constraining target coverage. Since dose rearrangement may increase dose to other OARs, it is also worthwhile to investigate global biomarkers of lung toxicity to further individualize treatment in this population

  17. Loudness perception affected by high doses of salicylate--a behavioral model of hyperacusis.

    PubMed

    Zhang, Chao; Flowers, Elizabeth; Li, Jun-Xu; Wang, Qiuju; Sun, Wei

    2014-09-01

    The major side-effects of high doses of salicylate include sensorial hearing loss and tinnitus. Although salicylate decreases cochlear output, it enhances the evoked potentials recorded from the central auditory system (CAS), suggesting an increase to sound sensitivity. However, the loudness change after salicylate administration has not yet been directly measured. In this study, we established an operant conditioning based behavioral task in rats and measured their loudness perception changes before and after high doses of salicylate injection (250 mg/kg, i.p.). We found that high doses of salicylate induced a significant increase to loudness response in 40% of the rats (out of 20 rats), suggesting a hyperacusis behavior. In another 40% of rats, a rapid increase of loudness response was detected, suggesting loudness recruitment. The reaction time of the rats was also measured during the loudness tests before and after salicylate exposure. The reaction time level functions are highly correlated to the loudness response functions. Our studies confirmed that increased sound sensitivity, which is commonly seen in patients with tinnitus and hyperacusis, can be induced by high doses of salicylate. This loudness change induced by salicylate may be related with hypersensitivity in the CAS. PMID:24882611

  18. Specification of absorbed dose to water using model-based dose calculation algorithms for treatment planning in brachytherapy

    NASA Astrophysics Data System (ADS)

    Carlsson Tedgren, Åsa; Alm Carlsson, Gudrun

    2013-04-01

    Model-based dose calculation algorithms (MBDCAs), recently introduced in treatment planning systems (TPS) for brachytherapy, calculate tissue absorbed doses. In the TPS framework, doses have hereto been reported as dose to water and water may still be preferred as a dose specification medium. Dose to tissue medium Dmed then needs to be converted into dose to water in tissue Dw,med. Methods to calculate absorbed dose to differently sized water compartments/cavities inside tissue, infinitesimal (used for definition of absorbed dose), small, large or intermediate, are reviewed. Burlin theory is applied to estimate photon energies at which cavity sizes in the range 1 nm-10 mm can be considered small or large. Photon and electron energy spectra are calculated at 1 cm distance from the central axis in cylindrical phantoms of bone, muscle and adipose tissue for 20, 50, 300 keV photons and photons from 125I, 169Yb and 192Ir sources; ratios of mass-collision-stopping powers and mass energy absorption coefficients are calculated as applicable to convert Dmed into Dw,med for small and large cavities. Results show that 1-10 nm sized cavities are small at all investigated photon energies; 100 µm cavities are large only at photon energies <20 keV. A choice of an appropriate conversion coefficient Dw, med/Dmed is discussed in terms of the cavity size in relation to the size of important cellular targets. Free radicals from DNA bound water of nanometre dimensions contribute to DNA damage and cell killing and may be the most important water compartment in cells implying use of ratios of mass-collision-stopping powers for converting Dmed into Dw,med.

  19. High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens

    PubMed Central

    Carter, Lawrence P.; Johnson, Matthew W.; Mintzer, Miriam Z.; Klinedinst, Margaret A.; Griffiths, Roland R.

    2013-01-01

    Rationale Although reports of dextromethorphan (DXM) abuse have increased recently, few studies have examined the effects of high doses of DXM. Objective This study in humans evaluated the effects of supratherapeutic doses of DXM and triazolam. Methods Single, acute, oral doses of DXM (100, 200, 300, 400, 500, 600, 700, 800 mg/70 kg), triazolam (0.25, 0.5 mg/70kg), and placebo were administered to twelve healthy volunteers with histories of hallucinogen use, under double-blind conditions, using an ascending dose run-up design. Subjective, behavioral, and physiological effects were assessed repeatedly after drug administration for 6 hours. Results Triazolam produced dose-related increases in subject-rated sedation, observer-rated sedation, and behavioral impairment. DXM produced a profile of dose-related physiological and subjective effects differing from triazolam. DXM effects included increases in blood pressure, heart rate, and emesis, increases in observer-rated effects typical of classic hallucinogens (e.g. distance from reality, visual effects with eyes open and closed, joy, anxiety), and participant ratings of stimulation (e.g. jittery, nervous), somatic effects (e.g. tingling, headache), perceptual changes, end-of-session drug liking, and mystical-type experience. After 400 mg/70kg DXM, 11 of 12 participants indicated on a pharmacological class questionnaire that they thought they had received a classic hallucinogen (e.g. psilocybin). Drug effects resolved without significant adverse effects by the end of the session. In a 1-month follow up volunteers attributed increased spirituality and positive changes in attitudes, moods, and behavior to the session experiences. Conclusions High doses of DXM produced effects distinct from triazolam and had characteristics that were similar to the classic hallucinogen psilocybin. PMID:22526529

  20. High doses of pseudoephedrine hydrochloride accelerate onset of CNS oxygen toxicity seizures in unanesthetized rats.

    PubMed

    Pilla, R; Held, H E; Landon, C S; Dean, J B

    2013-08-29

    Pseudoephedrine (PSE) salts (hydrochloride and sulfate) are commonly used as nasal and paranasal decongestants by scuba divers. Anecdotal reports from the Divers Alert Network suggest that taking PSE prior to diving while breathing pure O₂ increases the risk for CNS oxygen toxicity (CNS-OT), which manifests as seizures. We hypothesized that high doses of PSE reduce the latency time to seizure (LS) in unanesthetized rats breathing 5 atmospheres absolute (ATA) of hyperbaric oxygen. Sixty-three male rats were implanted with radio-transmitters that recorded electroencephalogram activity and body temperature. After ≥7-day recovery, and 2 h before "diving", each rat was administered either saline solution (control) or PSE hydrochloride intragastrically at the following doses (mg PSE/kg): 0, 40, 80, 100, 120, 160, and 320. Rats breathed pure O₂ and were dived to 5ATA until the onset of behavioral seizures coincident with neurological seizures. LS was the time elapsed between reaching 5ATA and exhibiting seizures. We observed a significant dose-dependent decrease in the LS at doses of 100-320 mg/kg, whereas no significant differences in LS from control value were observed at doses ≤80 mg/kg. Our findings showed that high doses of PSE accelerate the onset of CNS-OT seizures in unanesthetized rats breathing 5ATA of poikilocapnic hyperoxia. Extrapolating our findings to humans, we conclude that the recommended daily dose of PSE should not be abused prior to diving with oxygen-enriched gas mixes or pure O₂. PMID:23624060

  1. Single high-dose vs. fractionated radiotherapy: Effects on plant growth rates

    PubMed Central

    Guedea, Marc; Castel, Antoni; Arnalte, Marc; Mollera, Alex; Muñoz, Victor; Guedea, Ferran

    2013-01-01

    Aim To evaluate the differential effects of fractionated vs. high-dose radiotherapy on plant growth. Background Interest in hypofractionated radiotherapy has increased substantially in recent years as tumours (especially of the lung, prostate, and liver) can be irradiated with ever greater accuracy due to technological improvements. The effects of low-dose ionizing radiation on plant growth have been studied extensively, yet few studies have investigated the effect of high-dose, hypofractionated radiotherapy on plant growth development. Materials and methods A total of 150 plants from the genus Capsicum annuum were randomized to receive fractionated radiotherapy (5 doses of 10 Gy each), single high-dose (SHD) radiotherapy (single 50 Gy dose), or no radiotherapy (control group). Irradiation was delivered via linear accelerator and all samples were followed daily for 26 days to assess and compare daily growth. Results On day 26, plants in the control, fractionated, and SHD groups had grown to a mean height of 7.55 cm, 4.32 cm, and 2.94 cm, respectively. These differences in overall growth were highly significant (P = 0.005). The SHD group showed the least amount of growth. Conclusions SHD effectively stunts plant growth and development. Despite the evident differences between plant and animal cells, ionizing radiation is believed to work in a similar manner in all biological cells. These findings highlight the need to continue investigating the use of hypofractionated schemes in humans to improve cancer treatment outcomes. PMID:24416565

  2. The effect of high and low ultraviolet-B dose exposure on the degree of hairless mouse skin wrinkling.

    PubMed

    Kiss, I; Chen, S; Tramposch, K M

    1991-01-01

    Chronic exposure of hairless mice to ultraviolet light (UVB 290-320 nm) causes degradative changes in the dermal matrix and wrinkle production. We compared the effects of two different UVB dosing regimens on wrinkle production and dermal damage in female Skh:HR-1 hairless mice using a bank of unfiltered FS-40 lamps. One group of mice, the low dose group, was exposed to a sub-erythemal UVB dose of 12 mJ/cm2 (1 MED = 14 mJ/cm2), 3 times per week for 20 weeks (total dose = 0.72 J/cm2). A second group, the high dose group, was exposed also 3 times per week for 15 weeks to a UVB dose which started with the sub-erythemal dose of 12 mJ/cm2 at Week 1, and 1 MED at week 2. The dose was then increased weekly by 1 MED until reaching 4 MED at week 5. The animals were then dosed at 4 MED for 10 additional weeks (total dose = 2.1 J/cm2). Visual results indicate that, as expected, within the same group, the degree of wrinkling was generally dependent on the total UVB dose administered. However, comparison between the low dose and high dose groups shows that equal cumulative UVB doses did not always result in identical wrinkle grades. For example, at a cumulative dose of 0.5 J/cm2, the mean wrinkle grade for the low dose group was 1.75 compared to that of 1.2 for the high dose group (age-matched = 0). This observation may suggest that there are other factors in addition to total cumulative dose which are important for the appearance of wrinkling in this model. PMID:2027899

  3. In vivo measurements for high dose rate brachytherapy with optically stimulated luminescent dosimeters

    SciTech Connect

    Sharma, Renu; Jursinic, Paul A.

    2013-07-15

    Purpose: To show the feasibility of clinical implementation of OSLDs for high dose-rate (HDR) in vivo dosimetry for gynecological and breast patients. To discuss how the OSLDs were characterized for an Ir-192 source, taking into account low gamma energy and high dose gradients. To describe differences caused by the dose calculation formalism of treatment planning systems.Methods: OSLD irradiations were made using the GammaMedplus iX Ir-192 HDR, Varian Medical Systems, Milpitas, CA. BrachyVision versions 8.9 and 10.0, Varian Medical Systems, Milpitas, CA, were used for calculations. Version 8.9 used the TG-43 algorithm and version 10.0 used the Acuros algorithm. The OSLDs (InLight Nanodots) were characterized for Ir-192. Various phantoms were created to assess calculated and measured doses and the angular dependence and self-absorption of the Nanodots. Following successful phantom measurements, patient measurements for gynecological patients and breast cancer patients were made and compared to calculated doses.Results: The OSLD sensitivity to Ir-192 compared to 6 MV is between 1.10 and 1.25, is unique to each detector, and changes with accumulated dose. The measured doses were compared to those predicted by the treatment planning system and found to be in agreement for the gynecological patients to within measurement uncertainty. The range of differences between the measured and Acuros calculated doses was -10%-14%. For the breast patients, there was a discrepancy of -4.4% to +6.5% between the measured and calculated doses at the skin surface when the Acuros algorithm was used. These differences were within experimental uncertainty due to (random) error in the location of the detector with respect to the treatment catheter.Conclusions: OSLDs can be successfully used for HDR in vivo dosimetry. However, for the measurements to be meaningful one must account for the angular dependence, volume-averaging, and the greater sensitivity to Ir-192 gamma rays than to 6 MV x

  4. The impact of low-Z and high-Z metal implants in IMRT: A Monte Carlo study of dose inaccuracies in commercial dose algorithms

    SciTech Connect

    Spadea, Maria Francesca; Verburg, Joost Mathias; Seco, Joao; Baroni, Guido

    2014-01-15

    Purpose: The aim of the study was to evaluate the dosimetric impact of low-Z and high-Z metallic implants on IMRT plans. Methods: Computed tomography (CT) scans of three patients were analyzed to study effects due to the presence of Titanium (low-Z), Platinum and Gold (high-Z) inserts. To eliminate artifacts in CT images, a sinogram-based metal artifact reduction algorithm was applied. IMRT dose calculations were performed on both the uncorrected and corrected images using a commercial planning system (convolution/superposition algorithm) and an in-house Monte Carlo platform. Dose differences between uncorrected and corrected datasets were computed and analyzed using gamma index (Pγ{sub <1}) and setting 2 mm and 2% as distance to agreement and dose difference criteria, respectively. Beam specific depth dose profiles across the metal were also examined. Results: Dose discrepancies between corrected and uncorrected datasets were not significant for low-Z material. High-Z materials caused under-dosage of 20%–25% in the region surrounding the metal and over dosage of 10%–15% downstream of the hardware. Gamma index test yielded Pγ{sub <1}>99% for all low-Z cases; while for high-Z cases it returned 91% < Pγ{sub <1}< 99%. Analysis of the depth dose curve of a single beam for low-Z cases revealed that, although the dose attenuation is altered inside the metal, it does not differ downstream of the insert. However, for high-Z metal implants the dose is increased up to 10%–12% around the insert. In addition, Monte Carlo method was more sensitive to the presence of metal inserts than superposition/convolution algorithm. Conclusions: The reduction in terms of dose of metal artifacts in CT images is relevant for high-Z implants. In this case, dose distribution should be calculated using Monte Carlo algorithms, given their superior accuracy in dose modeling in and around the metal. In addition, the knowledge of the composition of metal inserts improves the accuracy of

  5. Not too little, not too much-just right! (Better ways to give high dose melphalan).

    PubMed

    Shaw, P J; Nath, C E; Lazarus, H M

    2014-12-01

    Of the 13 286 autologous haematopoietic cell transplant procedures reported in the US in 2010-2012 for plasma cell disorders, 10 557 used single agent, high-dose melphalan. Despite 30 years of clinical and pharmacokinetic (PK) experience with high-dose melphalan, and its continuing central role as cytoreductive therapy for large numbers of patients with myeloma, the pharmacodynamics and pharmacogenomics of melphalan are still in their infancy. The addition of protectant agents such as amifostine and palifermin allows dose escalation to 280 mg/m(2), but at these doses it is cardiac, rather than gut, toxicity that is dose-limiting. Although combination with additional alkylating agents is feasible, the additional TRM may not be justified when so many post-consolidation therapies are available for myeloma patients. Current research should optimise the delivery of this single-agent chemotherapy. This includes the use of newer formulations and real-time PKs. These strategies may allow a safe and effective platform for adding synergistic novel therapies and provide a window of lymphodepletion for the addition of immunotherapies. PMID:25133893

  6. Effect of particle size in the TL response of natural quartz sensitized with high gamma dose

    NASA Astrophysics Data System (ADS)

    Carvalho, A. B., Jr.; Guzzo, P. L.; Sullasi, H. L.; Khoury, H. J.

    2010-11-01

    The aim of this study is to investigate the effect of particle size in the thermoluminescence (TL) response of natural quartz sensitized with high gamma dose. For this, fragments of a single crystal taken from the Solonópole district (Brazil) were crushed and classified into ten size fractions ranging from 38 μm to 5 mm. Aliquots of each size fraction were sensitized with 25 kGy of gamma dose of 60Co and heat-treated in a muffle furnace at 400oC. The non-sensitized samples were exposed to test doses between 50 Gy and 5 kGy and the sensitized samples were exposed to a unique test dose equal to 50 mGy. For non-sensitized samples, the TL peak near 325 °C increases with the particle size decreasing. However, in the case of sensitized samples, the TL output near 280 °C increases with the increasing of particle size up to mean grain size equal to 308 μm. Above 308 μm, an abrupt reduction in the TL intensity was noticed. These effects are discussed in relation to the specific surface area and the different interaction of high gamma doses with fine and coarse particles of quartz.

  7. A Software App for Radiotherapy with In-situ Dose-painting using high Z nanoparticles

    PubMed Central

    Jermoumi, M; Yucel, A; Hao, Y; Cifter, G; Sajo, E; Ngwa, W

    2016-01-01

    The purpose of this work is to develop an user friendly and free-to-download application software that can be employed for modeling Radiotherapy with In-situ Dose-painting (RAID) using high-Z nanoparticles (HZNPs). The RAID APP is software program written in Matlab (Mathworks, Natick, MA, USA) based on deterministic code developed to simulate the space-time intra-tumor HZNPs biodistribution within the tumor, and the corresponding dose enhancement in response to low dose rate (LDR) brachytherapy of I-125, Pd-102, Cs-131 and kilovoltage x-rays such as 50 keV and 100 keV. Through the GUI of RAID APP, the user will be directed to different features to compute various parameters related to the dose enhancement and the biodistribution of NPs within high risk tumor sub-volumes. The software was developed as tool for research purposes with potential for subsequent development to guide dose-painting treatment planning using radiosensitizers such as gold (Au) and platinum (Pt).

  8. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer.

    PubMed

    Yang, Ruijie; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-01-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D90 of 34Gy in 8.5Gy per fraction, and 145Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2Gy per fraction, EQD2) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The Dmean (EQD2) of rectum decreased 22.36Gy in HDR and 17.01Gy in LDR from 30.24Gy in VMAT, respectively. The Dmean (EQD2) of bladder decreased 6.91Gy in HDR and 2.53Gy in LDR from 13.46Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD2) was 80.26, 70.23, and 104.91Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR. PMID:27400663

  9. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria

    PubMed Central

    2014-01-01

    Introduction The high incidence of multidrug-resistant (MDR) bacteria among patients admitted to ICUs has determined an increase of tigecycline (TGC) use for the treatment of severe infections. Many concerns have been raised about the efficacy of this molecule and increased dosages have been proposed. Our purpose is to investigate TGC safety and efficacy at higher than standard doses. Methods We conducted a retrospective study of prospectively collected data in the ICU of a teaching hospital in Rome. Data from all patients treated with TGC for a microbiologically confirmed infection were analyzed. The safety profile and efficacy of high dosing regimen use were investigated. Results Over the study period, 54 patients (pts) received TGC at a standard dose (SD group: 50 mg every 12 hours) and 46 at a high dose (HD group: 100 mg every 12 hours). Carbapenem-resistant Acinetobacter.baumannii (blaOXA-58 and blaOXA-23 genes) and Klebsiella pneumoniae (blaKPC-3 gene) were the main isolated pathogens (n = 79). There were no patients requiring TGC discontinuation or dose reduction because of adverse events. In the ventilation-associated pneumonia population (VAP) subgroup (63 patients: 30 received SD and 33 HD), the only independent predictor of clinical cure was the use of high tigecycline dose (odds ratio (OR) 6.25; 95% confidence interval (CI) 1.59 to 24.57; P = 0.009) whilst initial inadequate antimicrobial treatment (IIAT) (OR 0.18; 95% CI 0.05 to 0.68; P = 0.01) and higher Sequential Organ Failure Assessment (SOFA) score (OR 0.66; 95% CI 0.51 to 0.87; P = 0.003) were independently associated with clinical failure. Conclusions TGC was well tolerated at a higher than standard dose in a cohort of critically ill patients with severe infections. In the VAP subgroup the high-dose regimen was associated with better outcomes than conventional administration due to Gram-negative MDR bacteria. PMID:24887101

  10. AS03-Adjuvanted, Very-Low-Dose Influenza Vaccines Induce Distinctive Immune Responses Compared to Unadjuvanted High-Dose Vaccines in BALB/c Mice

    PubMed Central

    Yam, Karen K.; Gupta, Jyotsana; Winter, Kaitlin; Allen, Elizabeth; Brewer, Angela; Beaulieu, Édith; Mallett, Corey P.; Burt, David S.; Ward, Brian J.

    2015-01-01

    During the 2009–2010 influenza pandemic, an adjuvanted, dose-sparing vaccine was recommended for most Canadians. We hypothesize that differences exist in the responses to AS03-adjuvanted, low antigen (Ag) dose versus unadjuvanted, full-dose vaccines. We investigated the relationship between Ag dose and the oil-in-water emulsion Adjuvant System AS03. BALB/c mice received two IM doses of AS03A or AS03B with exaggerated dilutions of A/Uruguay/716/2007 H3N2 split virion vaccine Ag. Immune responses were assessed 3 weeks after the booster. Unadjuvanted “high” (3 μg) and low-dose (0.03–0.003 μg) vaccines generated similar serum antibody titers and cytokine secretion patterns in restimulated splenocytes. Compared to unadjuvanted “high-dose” vaccination, both AS03A and AS03B-adjuvanted low-dose vaccines tended to elicit higher serum antibody titers, broader induction of cytokine secretion and generated more influenza-specific antibody secreting cells and cytokine-secreting CD4 and CD8 T cells in splenocytes. We show that varying Ag and/or AS03 dose in this influenza vaccination mouse model can strongly influence both the magnitude and pattern of the immune response elicited. These findings are highly relevant given the likelihood of expanded use of adjuvanted, dose-sparing vaccines and raise questions about the use of “standard” doses of vaccines in pre-clinical vaccine studies. PMID:25972874

  11. Review of high-dose intravenous vitamin C as an anticancer agent.

    PubMed

    Wilson, Michelle K; Baguley, Bruce C; Wall, Clare; Jameson, Michael B; Findlay, Michael P

    2014-03-01

    In the 1970s, Pauling and Cameron reported increased survival of patients with advanced cancer treated with high-dose intravenous (IV) vitamin C (L-ascorbate, ascorbic acid). These studies were criticized for their retrospective nature and lack of standardization of key prognostic factors including performance status. Subsequently, several well-designed randomized controlled trials failed to demonstrate a significant survival benefit, although these trials used high-dose oral vitamin C. Marked differences are now recognized in the pharmacokinetics of vitamin C with oral and IV administration, opening the issue of therapeutic efficacy to question. In vitro evidence suggests that vitamin C functions at low concentrations as an antioxidant but may have pro-oxidant activity at high concentrations. The mechanism of its pro-oxidant action is not fully understood, and both intra- and extracellular mechanisms that generate hydrogen peroxide have been proposed. It remains to be proven whether vitamin C-induced reactive oxygen species occur in vivo and, if so, whether this will translate to a clinical benefit. Current clinical evidence for a therapeutic effect of high-dose IV vitamin C is ambiguous, being based on case series. The interpretation and validation of these studies is hindered by limited correlation of plasma vitamin C concentrations with response. The methodology exists to determine if there is a role for high-dose IV vitamin C in the treatment of cancer, but the limited understanding of its pharmacodynamic properties makes this challenging. Currently, the use of high-dose IV vitamin C cannot be recommended outside of a clinical trial. PMID:24571058

  12. Efficacy of high-dose methylprednisolone pulse therapy in the treatment of enterovirus 71 encephalitis.

    PubMed

    Zhang, Guangyou; Wang, Jiwen; Yao, Guo; Shi, Baohai

    2016-07-01

    To investigate the efficacy of high-dose methylprednisolone pulse therapy in the treatment of Enterovirus 71 (EV71) encephalitis. To determine whether high-dose methylprednisolone pulse therapy should be used, 80 cases of pediatric patients with EV71 encephalitis were randomly divided into steroid pulse therapy group and non-steroid pulse therapy group and their clinical information was compared using statistic analysis. There was no statistical difference in the duration of fever, duration of nervous system involvement, duration of hospital stay, blood pressure, and cure rates between the two groups (p>0.05). The heart rate, respiratory rate, white blood cell counts and blood glucose of the steroid pulse therapy group were significantly higher than those of the non-steroid pulse therapy group (p<0.05). High-dose steroid pulse therapy to treat EV71 encephalitis can't shorten the course or improve the prognosis of the disease. In contrast, it has side effects and might aggravate disease condition or interfere with disease diagnosis. Our study suggested that there is no beneficial effect to use high-dose steroid pulse therapy for the treatment of EV71 encephalitis. PMID:27592493

  13. Administration of high-dose interleukin-2 in a 2-year-old with metastatic melanoma.

    PubMed

    Bernhardt, M Brooke; Hicks, M John; Pappo, Alberto S

    2009-12-15

    Malignant melanoma is rare in pediatrics, and therapies for patients with disseminated disease have not been well studied. This report describes our experience with the use of high-dose interleukin 2 (aldesleukin, IL-2) in a 2-year-old child with metastatic melanoma and describes our approach for the administration of this agent to young patients. PMID:19731326

  14. HUMAN ACTIVITIES THAT MAY LEAD TO HIGH INHALED INTAKE DOSES IN CHILDREN AGED 6-13

    EPA Science Inventory

    The paper focuses on possible activities of children aged 6-13 that may make them susceptible to high hourly intake doses of ozone (O3) air pollution. Data from an O3 exposure modeling exercise indicates that a relatively few hours can account for a significant amount of the t...

  15. [High-dose chemotherapy and residual tumor resection in male germ cell tumors].

    PubMed

    Lorch, A; Albers, P; Winter, C; Beyer, J

    2011-09-01

    As a consequence of the unsatisfactory results of conventional dose salvage regimens, in particular for patients with poor prognostic features at the time of relapse or in patients with refractory disease, high-dose chemotherapy (HDCT) was introduced into clinical practice in the late 1980s. The combination of carboplatin and etoposide (CE) still remains the backbone of most high-dose regimens. Multiple modifications with more dose escalations or addition of further drugs have been explored, most often with increased toxicity. With improved expertise in supportive care and the use of peripheral blood stem cells, hematopoetic recovery has been significantly shortened and the initial high treatment-related mortality reduced from more than 10% to about 3%. Since the incorporation of HDCT, even patients with unfavorable prognostic features or patients with second or subsequent relapses can achieve long-term remission. Following HDCT residual tumor resection plays a major role in achieving these long-term results. The proportion of vital residual tumor after HDCT is much higher than in patients after conventional chemotherapy. The role of HDCT remains controversial particularly as a first-line treatment and less so in the first salvage setting. As these patients are rare HDCT and residual tumor resection should only be be provided by high-volume centers with sufficient expertise in performing these complex procedures. PMID:21845425

  16. Monthly high dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Importance: Vitamin D deficiency has been associated with poor physical performance. Objective: To determine the effectiveness of high dose vitamin D in lowering the risk of functional decline. Design, Setting, and Participants: One-year double-blind, randomized clinical trial conducted in Zurich,...

  17. Pregnancy outcomes following the administration of high doses of dexamethasone in early pregnancy

    PubMed Central

    Kayvan Jafari, Sabah; Nezafat Firizi, Maryam; Abbaspour, Ali Reza; Ghafoori Gharib, Fahime; Ghobadi, Yusef; Gholizadeh, Samira

    2016-01-01

    Objective In the present study, we aimed to evaluate the effects of high doses of dexamethasone (DEX) in early pregnancy on pregnancy outcomes. Methods Pregnant BALB/c mice were treated with high-dose DEX in the experimental group or saline in the control group on gestational days (GDs) 0.5 to 4.5. Pregnant mice were sacrificed on GDs 7.5, 13.5, or 18.5 and their peripheral blood, placentas, fetuses, and uterine tissue were collected. Decidual and placenta cell supernatants were examined to evaluate the effect of DEX on the proliferation of mononuclear cells, the quantity of uterine macrophages and uterine natural killer (uNK) cells, and levels of progesterone and 17β-estradiol, as determined by an 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide assay, immunohistochemistry, and enzyme-linked immunosorbent assay, respectively. We also were measured fetal and placental growth parameters on GD 18.5. Results We found that high doses of DEX were associated with an increased abortion rate, enhancement of the immunosuppressive effect of the decidua, alterations in placental growth parameters, decreased progesterone and 17β-estradiol levels, and a reduced frequency of macrophages and uNK cells. Conclusion Our data suggest that the high-dose administration of DEX during early pregnancy negatively affected pregnancy outcomes. PMID:27104153

  18. Transient radiation effects following high dose I-131 therapy for differentiated thyroid cancer (DTC)

    SciTech Connect

    Khan, S.; Waxman, A.; Ramanna, L.

    1994-05-01

    There is limited information regarding the incidence of post-I-131 therapeutic side effects in pts. undergoing high-dose I-131 therapy for DTC. The purpose of the current study is to characterize side effects experienced by patients following 150 mCi.

  19. Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy

    PubMed Central

    Zeiler, F. A.; Silvaggio, J.

    2015-01-01

    Background. Treatment of symptomatic delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult. Recent studies suggest intravenous (IV) high dose milrinone as a potential therapy. The timing to angiographic response with this is unclear. Methods. We reviewed the chart of one patient admitted for SAH who developed symptomatic DCI and was treated with high dose IV milrinone. Results. A 66-year-old female was admitted with a Hunt and Hess clinical grade 4, World Federation of Neurological Surgeons (WFNS) clinical grade 4, and SAH secondary to a left anterior choroidal artery aneurysm which was clipped. After bleed day 6, the patient developed symptomatic DCI. We planned for angioplasty of the proximal segments. We administered high dose IV milrinone bolus followed by continuous infusion which led to clinical improvement prior to angiography. The angiogram performed 1.5 hours after milrinone administration displayed resolution of the CT angiogram and MRI based cerebral vasospasm such that further intra-arterial therapy was aborted. She completed 6 days of continuous IV milrinone therapy, was transferred to the ward, and subsequently rehabilitated. Conclusions. High dose IV milrinone therapy for symptomatic DCI after SAH can lead to rapid neurological improvement with dramatic early angiographic improvement of cerebral vasospasm. PMID:26457209

  20. Monitoring performance of the cameras under the high dose-rate gamma ray environments.

    PubMed

    Cho, Jai Wan; Choi, Young Soo; Jeong, Kyung Min

    2014-05-01

    CCD/CMOS cameras, loaded on a robot system, are generally used as the eye of the robot and monitoring unit. A major problem that arises when dealing with images provided by CCD/CMOS cameras under severe accident situations of a nuclear power plant is the presence of speckles owing to the high dose-rate gamma irradiation fields. To use a CCD/CMOS camera as a monitoring unit in a high radiation area, the legibility of the camera image in such intense gamma-radiation fields should therefore be defined. In this paper, the authors describe the monitoring index as a figure of merit of the camera's legibleness under a high dose-rate gamma ray irradiation environment. From a low dose-rate (10 Gy h) to a high dose-rate (200 Gy h) level, the legible performances of the cameras owing to the speckles are evaluated. The numbers of speckles generated by gamma ray irradiation in the camera image are calculated by an image processing technique. The legibility of the sensor indicator (thermo/hygrometer) owing to the number of speckles is also presented. PMID:24667385

  1. Nalbuphine Sedation in a Patient with Long Term, High Dose Chemotherapeutically Controlled Psychosis

    PubMed Central

    Kelly, Maureen; Howell, Robert M.

    1985-01-01

    Consideration of which pharmacologic agent to use when a patient requires sedation prior to an oral surgery procedure entails a number of factors, including past medical history, current medications and dose level, duration of administration, pharmacologic interactions, and the dental needs of the patient. The case described in this report illustrates the importance of consideration of these factors in a patient who required sedation prior to oral surgery while taking 800 mg chlorpromazine, 300 mg amantadine hydrochloride, and 900 mg of cimetidine daily. The possible pharmacologic interactions which could occur from concomitantly administering either diazepam or a narcotic in the presence of these agents are numerous and significant. The choice of sedative agent was further complicated by the fact that the patient was prescribed chlorpromazine and amantadine in doses which far exceeded the usual therapeutic levels and had been maintained for an extended period of time, over 8 months. Consequently, any adverse reactions that may have resulted when sedating a patient taking chlorapromazine and amantadine hydrochloride in lower doses for a shorter duration would be more likely to occur with greater speed and severity in a patient receiving such high-dose, long-term therapy. Also, unusual reactions which have not been reported with usual therapeutic dose levels might also occur since these high doses approach toxic levels for some patients. Additionally, a sedative agent had to be used which would not interfere with the antipsychotic effects of chlorpromazine since the patient's psychiatric condition required maintenance of these unusually high therapeutic levels. The following case report gives the rationale and outcome of utilizing nalbuphine for obtunding pain and producing sedation during an oral surgery procedure under such complex therapeutic conditions. PMID:3866505

  2. Nalbuphine sedation in a patient with long-term, high-dose chemotherapeutically controlled psychosis.

    PubMed

    Kelly, M; Howell, R M

    1985-01-01

    Consideration of which pharmacologic agent to use when a patient requires sedation prior to an oral surgery procedure entails a number of factors, including past medical history, current medications and dose level, duration of administration, pharmacologic interactions, and the dental needs of the patient. The case described in this report illustrates the importance of consideration of these factors in a patient who required sedation prior to oral surgery while taking 800 mg chlorpromazine, 300 mg amantadine hydrochloride, and 900 mg of cimetidine daily. The possible pharmacologic interactions which could occur from concomitantly administering either diazepam or a narcotic in the presence of these agents are numerous and significant. The choice of sedative agent was further complicated by the fact that the patient was prescribed chlorpromazine and amantadine in doses which far exceeded the usual therapeutic levels and had been maintained for an extended period of time, over 8 months. Consequently, any adverse reactions that may have resulted when sedating a patient taking chlorapromazine and amantadine hydrochloride in lower doses for a shorter duration would be more likely to occur with greater speed and severity in a patient receiving such high-dose, long-term therapy. Also, unusual reactions which have not been reported with usual therapeutic dose levels might also occur since these high doses approach toxic levels for some patients. Additionally, a sedative agent had to be used which would not interfere with the antipsychotic effects of chlorpromazine since the patient's psychiatric condition required maintenance of these unusually high therapeutic levels. The following case report gives the rationale and outcome of utilizing nalbuphine for obtunding pain and producing sedation during an oral surgery procedure under such complex therapeutic conditions. PMID:3866505

  3. Effects of high dose intraperitoneal cytosine arabinoside on the radiation tolerance of the rat spinal cord

    SciTech Connect

    Menten, J.; Landuyt, W.; van der Kogel, A.J.; Ang, K.K.; van der Schueren, E.

    1989-07-01

    The effect of intraperitoneal high dose (9 g/kg) cytosine arabinoside (Ara-C) on the early delayed radiation response of the rat cervical spinal cord has been studied. When given 2 hrs before irradiation, systemically administered Ara-C significantly reduces the isoeffect doses for the induction of paralysis due to white matter necrosis by a factor of approximately 1.2 for both a single irradiation treatment and for a two fraction irradiation with 24 hr interval. No effect on the latency time to develop paralysis was recorded.

  4. Cation disorder determined by MAS {sup 27}Al NMR in high dose neutron irradiated spinel

    SciTech Connect

    Cooper, E.A.; Sickafus, K.E.; Hughes, C.D.; Earl, W.L.; Hollenberg, G.W.; Garner, F.A.; Bradt, R.C.

    1995-12-31

    Spinel (MgAl{sub 2}O{sub 4}) single crystals which had been neutron irradiated to high doses (53-250 dpa) were examined using {sup 27}Al magic angle spinning (MAS) nuclear magnetic resonance (NMR). The sensitivity of this procedure to a specific cation (Al) residing in different crystallographic environments allowed one to determine the distribution of the Al between the two cation sites in the spinel structure. The samples were irradiated at two different temperatures (400 and 750{degrees}C) and various doses. These results indicate that the Al was nearly fully disordered over the two lattice sites after irradiation.

  5. Novel application of high-dose rate brachytherapy for severe, recalcitrant palmoplantar pustulosis.

    PubMed

    Timerman, D; Devlin, P M; Nambudiri, V E; Wright, N A; Vleugels, R A; Clark, R A; Kupper, T S; Merola, J F; Patel, M

    2016-07-01

    Palmoplantar pustulosis (PPP) is a chronic pustular dermatitis of the palms and soles, which is frequently associated with significant pruritus and pain, often limiting daily activities. We present the case of a 36-year-old man with severe PPP who had treatment failure with multiple medical therapies but showed marked improvement with high-dose rate brachytherapy. Brachytherapy has the advantage of providing a conformal dose distribution over complex curved surfaces, such as the foot and ankle. Our observations suggest that brachytherapy may be a well-tolerated treatment option for patients with severe, refractory PPP. PMID:26848819

  6. Adequacy of high-dose cefepime regimen in febrile neutropenic patients with hematological malignancies.

    PubMed

    Sime, Fekade Bruck; Roberts, Michael S; Tiong, Ing Soo; Gardner, Julia H; Lehman, Sheila; Peake, Sandra L; Hahn, Uwe; Warner, Morgyn S; Roberts, Jason A

    2015-09-01

    While guidelines recommend empirical cefepime therapy in febrile neutropenia, the mortality benefit of cefepime has been controversial. In light of this, recent reports on pharmacokinetic changes for several antibiotics in febrile neutropenia and the consequent suboptimal exposure call for a pharmacokinetic/pharmacodynamic evaluation of current dosing. This study aimed to assess pharmacokinetic/pharmacodynamic target attainment from a 2-g intravenous (i.v.) every 8 h (q8h) cefepime regimen in febrile neutropenic patients with hematological malignancies. Cefepime plasma concentrations were measured in the 3rd, 6th, and 9th dosing intervals at 60% of the interval and/or trough point. The selected pharmacokinetic/pharmacodynamic targets were the proportion of the dosing interval (60% and 100%) for which the free drug concentration remains above the MIC (fT>MIC). Target attainment was assessed in reference to the MIC of isolated organisms if available or empirical breakpoints if not. The percentage of fT>MIC was also estimated by log-linear regression analysis. All patients achieved >60% fT>MIC in the 3rd and 6th dosing intervals. A 100% fT>MIC was not attained in 6/12, 4/10, and 4/9 patients in the 3rd, 6th, and 9th dose intervals, respectively, or in 14/31 (45%) of the dosing intervals investigated. On the other hand, 29/31 (94%) of trough concentrations were at or above 4 mg/liter. In conclusion, for patients with normal renal function, a high-dose 2-g i.v. q8h cefepime regimen appears to provide appropriate exposure if the MIC of the organism is ≤4 mg/liter but may fail to cover less susceptible organisms. PMID:26124158

  7. Adequacy of High-Dose Cefepime Regimen in Febrile Neutropenic Patients with Hematological Malignancies

    PubMed Central

    Roberts, Michael S.; Tiong, Ing Soo; Gardner, Julia H.; Lehman, Sheila; Peake, Sandra L.; Hahn, Uwe; Warner, Morgyn S.; Roberts, Jason A.

    2015-01-01

    While guidelines recommend empirical cefepime therapy in febrile neutropenia, the mortality benefit of cefepime has been controversial. In light of this, recent reports on pharmacokinetic changes for several antibiotics in febrile neutropenia and the consequent suboptimal exposure call for a pharmacokinetic/pharmacodynamic evaluation of current dosing. This study aimed to assess pharmacokinetic/pharmacodynamic target attainment from a 2-g intravenous (i.v.) every 8 h (q8h) cefepime regimen in febrile neutropenic patients with hematological malignancies. Cefepime plasma concentrations were measured in the 3rd, 6th, and 9th dosing intervals at 60% of the interval and/or trough point. The selected pharmacokinetic/pharmacodynamic targets were the proportion of the dosing interval (60% and 100%) for which the free drug concentration remains above the MIC (fT>MIC). Target attainment was assessed in reference to the MIC of isolated organisms if available or empirical breakpoints if not. The percentage of fT>MIC was also estimated by log-linear regression analysis. All patients achieved >60% fT>MIC in the 3rd and 6th dosing intervals. A 100% fT>MIC was not attained in 6/12, 4/10, and 4/9 patients in the 3rd, 6th, and 9th dose intervals, respectively, or in 14/31 (45%) of the dosing intervals investigated. On the other hand, 29/31 (94%) of trough concentrations were at or above 4 mg/liter. In conclusion, for patients with normal renal function, a high-dose 2-g i.v. q8h cefepime regimen appears to provide appropriate exposure if the MIC of the organism is ≤4 mg/liter but may fail to cover less susceptible organisms. PMID:26124158

  8. Dose Distribution Calculation in Skin Cancer Treatment Using Leipzig Applicator

    NASA Astrophysics Data System (ADS)

    Mowlawi, Ali Asghar; Yazdani, Majed

    The combination of 192Ir seed with the Leipzig applicators is used in a considerable number of clinical trials for skin cancer treatment. As is known, the beneficial effects of ionizing radiation for tumor treatment depends on the dosimetry accuracy. Nowadays, dosimetry calculations are supported by the characteristics provided by the manufacturer, which have been obtained from measurements with an ionization chamber in a phantom. Despite their benefit, the experimental data involves errors related to the positioning, energy, and angular dependence of the detectors. Thus, in order to get a detailed and more accurate dosimetry, the Monte Carlo code MCNP4C2 — Monte Carlo Neutron Particle, 4C2 version — has been employed to analyze the dose distribution in depth and at the surface in the skin cancer treatment using Leipzig applicators. On the other hand, some different measurements have been taken to validate the method and compare results. The results for this material of phantom (the skin with 0.5 cm thick over infinite soft tissue) can be used in treatment planning systems and also for computation of model dependent parameters like anisotropy dose function.

  9. [Proton Pump Inhibitor and High-dose Methotrexate: Two Cases Reports].

    PubMed

    Evrard, Julien; Farnier, Elodie; Carcel, Corine; Lachenal, Florence; Vial, Thierry; Pont, Emmanuelle

    2015-01-01

    Methotrexate (MTX) is a cytotoxic agent prescribed at high dose in treatment of malignancy. Association of MTX to proton pump inhibitor (PPI) is not recommended if doses are more than 20 mg per weeks and only to take into account for smaller doses. Review relate some cases of delayed elimination of methotrexate in patients taking PPI, which increase risk of toxic event. However, currently there is no status quo on interaction between PPI and MTX according to available data. We report two clinical cases illustrating one more time a toxic event to MTX in presence of PPI. In absence of risk/benefit ratio set correctly, an assessment of appropriateness of PPI prescription before MTX therapy can limit an iatrogenic risk. PMID:26242498

  10. Long-Term High-dose Oral Morphine in Phantom Limb Pain with No Addiction Risk

    PubMed Central

    Kumar, Vinod; Garg, Rakesh; Bharati, Sachidanand Jee; Gupta, Nishkarsh; Bhatanagar, Sushma; Mishra, Seema; Balhara, Yatan Pal Singh

    2015-01-01

    Chronic phantom limb pain (PLP) is a type of neuropathic pain, which is located in the missing/amputated limb. Phantom pain is difficult to treat as the exact basis of pain mechanism is still unknown. Various methods of treatment for PLP have been described, including pharmacological (NSAIDs, opioids, antiepileptic, antidepressants) and non-pharmacological (TENS, sympathectomy, deep brain stimulation and motor cortex stimulation). Opioids are used for the treatment of neuropathic pain and dose of opioid is determined based on its effect and thus there is no defined ceiling dose for opioids. We report a case where a patient receiving high-dose oral morphine for chronic cancer pain did not demonstrate signs of addiction. PMID:25709194

  11. Long-Term High-dose Oral Morphine in Phantom Limb Pain with No Addiction Risk.

    PubMed

    Kumar, Vinod; Garg, Rakesh; Bharati, Sachidanand Jee; Gupta, Nishkarsh; Bhatanagar, Sushma; Mishra, Seema; Balhara, Yatan Pal Singh

    2015-01-01

    Chronic phantom limb pain (PLP) is a type of neuropathic pain, which is located in the missing/amputated limb. Phantom pain is difficult to treat as the exact basis of pain mechanism is still unknown. Various methods of treatment for PLP have been described, including pharmacological (NSAIDs, opioids, antiepileptic, antidepressants) and non-pharmacological (TENS, sympathectomy, deep brain stimulation and motor cortex stimulation). Opioids are used for the treatment of neuropathic pain and dose of opioid is determined based on its effect and thus there is no defined ceiling dose for opioids. We report a case where a patient receiving high-dose oral morphine for chronic cancer pain did not demonstrate signs of addiction. PMID:25709194

  12. Radiation dose in the high background radiation area in Kerala, India.

    PubMed

    Christa, E P; Jojo, P J; Vaidyan, V K; Anilkumar, S; Eappen, K P

    2012-03-01

    A systematic radiological survey has been carried out in the region of high-background radiation area in Kollam district of Kerala to define the natural gamma-radiation levels. One hundred and forty seven soil samples from high-background radiation areas and five samples from normal background region were collected as per standard sampling procedures and were analysed for (238)U, (232)Th and (40)K by gamma-ray spectroscopy. External gamma dose rates at all sampling locations were also measured using a survey meter. The activities of (238)U, (232)Th and (40)K was found to vary from 17 to 3081 Bq kg(-1), 54 to 11976 Bq kg(-1) and BDL (67.4 Bq kg(-1)) to 216 Bq kg(-1), respectively, in the study area. Such heterogeneous distribution of radionuclides in the region may be attributed to the deposition phenomenon of beach sand soil in the region. Radium equivalent activities were found high in several locations. External gamma dose rates estimated from the levels of radionuclides in soil had a range from 49 to 9244 nGy h(-1). The result of gamma dose rate measured at the sampling sites using survey meter showed an excellent correlation with dose rates computed from the natural radionuclides estimated from the soil samples. PMID:21515614

  13. Amorphous and crystalline optical materials used as instruments for high gamma radiation doses estimations

    NASA Astrophysics Data System (ADS)

    Ioan, M.-R.

    2016-06-01

    Nuclear radiation induce some changes to the structure of exposed materials. The main effect of ionizing radiation when interacting with optical materials is the occurrence of color centers, which are quantitatively proportional to the up-taken doses. In this paper, a relation between browning effect magnitude and dose values was found. Using this relation, the estimation of a gamma radiation dose can be done. By using two types of laser wavelengths (532 nm and 633 nm), the optical powers transmitted thru glass samples irradiated to different doses between 0 and 59.1 kGy, were measured and the associated optical browning densities were determined. The use of laser light gives the opportunity of using its particularities: monochromaticity, directionality and coherence. Polarized light was also used for enhancing measurements quality. These preliminary results bring the opportunity of using glasses as detectors for the estimation of the dose in a certain point in space and for certain energy, especially in particles accelerators experiments, where the occurred nuclear reactions are involving the presence of high gamma rays fields.

  14. Rotational IMRT delivery using a digital linear accelerator in very high dose rate 'burst mode'.

    PubMed

    Salter, Bill J; Sarkar, Vikren; Wang, Brian; Shukla, Himanshu; Szegedi, Martin; Rassiah-Szegedi, Prema

    2011-04-01

    Recently, there has been a resurgence of interest in arc-based IMRT, through the use of 'conventional' multileaf collimator (MLC) systems that can treat large tumor volumes in a single, or very few pass(es) of the gantry. Here we present a novel 'burst mode' modulated arc delivery approach, wherein 2000 monitor units per minute (MU min(-1)) high dose rate bursts of dose are facilitated by a flattening-filter-free treatment beam on a Siemens Artiste (Oncology Care Systems, Siemens Medical Solutions, Concord, CA, USA) digital linear accelerator in a non-clinical configuration. Burst mode delivery differs from continuous mode delivery, used by Elekta's VMAT (Elekta Ltd, Crawley, UK) and Varian's RapidArc (Varian Medical Systems, Palo Alto, CA, USA) implementations, in that dose is not delivered while MLC leaves are moving. Instead, dose is delivered in bursts over very short arc angles and only after an MLC segment shape has been completely formed and verified by the controller. The new system was confirmed to be capable of delivering a wide array of clinically relevant treatment plans, without machine fault or other delivery anomalies. Dosimetric accuracy of the modulated arc platform, as well as the Prowess (Prowess Inc., Concord, CA, USA) prototype treatment planning version utilized here, was quantified and confirmed, and delivery times were measured as significantly brief, even with large hypofractionated doses. The burst mode modulated arc approach evaluated here appears to represent a capable, accurate and efficient delivery approach. PMID:21364260

  15. A Comprehensive Analysis of Cardiac Dose in Balloon-Based High-Dose-Rate Brachytherapy for Left-Sided Breast Cancer

    SciTech Connect

    Valakh, Vladimir; Kim, Yongbok; Werts, E. Day; Trombetta, Mark G.

    2012-04-01

    Purpose: To investigate radiation dose to the heart in 60 patients with left-sided breast cancer who were treated with balloon-based high-dose-rate brachytherapy using MammoSite or Contura applicators. Methods and Materials: We studied 60 consecutive women with breast cancer who were treated with 34 Gy in 10 twice-daily fractions using MammoSite (n = 37) or Contura (n = 23) applicators. The whole heart and the left and right ventricles were retrospectively delineated, and dose-volume histograms were analyzed. Multiple dosimetrics were reported, such as mean dose (D{sub mean}); relative volume receiving 1.7, 5, 10, and 20 Gy (V1.7, V5, V10, and V20, respectively); dose to 1 cc (D{sub 1cc}); and maximum point dose (D{sub max}). Biologic metrics, biologically effective dose and generalized equivalent uniform dose were computed. The impact of lumpectomy cavity location on cardiac dose was investigated. Results: The average {+-} standard deviation of D{sub mean} was 2.45 {+-} 0.94 Gy (range, 0.56-4.68) and 3.29 {+-} 1.28 Gy (range, 0.77-6.35) for the heart and the ventricles, respectively. The average whole heart V5 and V10 values were 10.2% and 1.3%, respectively, and the heart D{sub max} was >20 Gy in 7 of 60 (11.7%) patients and >25 Gy in 3 of 60 (5%) patients. No cardiac tissue received {>=}30 Gy. The V1.7, V5, V10, V20, and D{sub mean} values were all higher for the ventricles than for the whole heart. For balloons located in the upper inner quadrant of the breast, the average whole heart D{sub mean} was highest. The D{sub mean}, biologically effective dose, and generalized equivalent uniform dose values for heart and ventricles decreased with increasing minimal distance from the surface of the balloon. Conclusions: On the basis of these comprehensive cardiac dosimetric data, we recommend that cardiac dose be routinely reported and kept as low as possible in balloon-based high-dose-rate brachytherapy treatment planning for patients with left-sided breast cancer so

  16. Is Heparin Effective for the Controlled Delivery of High-Dose Bone Morphogenetic Protein-2?

    PubMed

    Kim, Ri Youn; Lee, Beomseok; Park, Si-Nae; Ko, Jae-Hyung; Kim, In Sook; Hwang, Soon Jung

    2016-05-01

    Sustained release of bone morphogenetic protein (BMP)-2 by heparin-contained biomaterials is advantageous for bone tissue regeneration using low-dose BMP-2. However, its effect with high-dose BMP-2 is still unclear and should be clarified considering the clinical use of a high dose of BMP-2 in spine and oral surgery. This study aimed to evaluate the efficacy of a heparin-conjugated collagen sponge (HCS) with high-dose BMP-2 delivery by investigating in vivo initial osteogenic regulation and bone healing over 12 weeks in comparison with that of an absorbable collagen sponge (ACS). The in vitro BMP-2 release profile in the HCS exhibited a lower burst followed by a sustained release of BMP-2, whereas that of the ACS showed an initial burst phase only. As a result of a lower burst, the HCS-BMP group showed higher expression of bone-forming/resorbing markers and enhanced activation of osteoclasts than the ACS-BMP group within the scaffold of defect after 7 days, which is presumed to be because of retention of relatively higher amounts of BMP-2. However, the surrounding calvariae were less resorbed in the HCS-BMP group, compared with the aggressive resorptive response in the ACS-BMP group. Microcomputed tomography and histology revealed that HCS-BMP guided more effective bone regeneration of central defect over time inducing minor ossification at the defect exterior, whereas ACS-BMP exhibited excessive ossification at the defect exterior. These results showed that HCS-mediated BMP-2 delivery at a high dose has advantages over ACS, including less early resorption of surrounding bone tissue and higher efficacy in compact bone regeneration over a longer period, highlighting a clinical feasibility of this technology. PMID:27098389

  17. Magnetic Resonance Lymphography-Guided Selective High-Dose Lymph Node Irradiation in Prostate Cancer

    SciTech Connect

    Meijer, Hanneke J.M.; Debats, Oscar A.; Kunze-Busch, Martina; Kollenburg, Peter van; Leer, Jan Willem; Witjes, J. Alfred; Kaanders, Johannes H.A.M.; Barentsz, Jelle O.; Lin, Emile N.J.Th. van

    2012-01-01

    Purpose: To demonstrate the feasibility of magnetic resonance lymphography (MRL) -guided delineation of a boost volume and an elective target volume for pelvic lymph node irradiation in patients with prostate cancer. The feasibility of irradiating these volumes with a high-dose boost to the MRL-positive lymph nodes in conjunction with irradiation of the prostate using intensity-modulated radiotherapy (IMRT) was also investigated. Methods and Materials: In 4 prostate cancer patients with a high risk of lymph node involvement but no enlarged lymph nodes on CT and/or MRI, MRL detected pathological lymph nodes in the pelvis. These lymph nodes were identified and delineated on a radiotherapy planning CT to create a boost volume. Based on the location of the MRL-positive lymph nodes, the standard elective pelvic target volume was individualized. An IMRT plan with a simultaneous integrated boost (SIB) was created with dose prescriptions of 42 Gy to the pelvic target volume, a boost to 60 Gy to the MRL-positive lymph nodes, and 72 Gy to the prostate. Results: All MRL-positive lymph nodes could be identified on the planning CT. This information could be used to delineate a boost volume and to individualize the pelvic target volume for elective irradiation. IMRT planning delivered highly acceptable radiotherapy plans with regard to the prescribed dose levels and the dose to the organs at risk (OARs). Conclusion: MRL can be used to select patients with limited lymph node involvement for pelvic radiotherapy. MRL-guided delineation of a boost volume and an elective pelvic target volume for selective high-dose lymph node irradiation with IMRT is feasible. Whether this approach will result in improved outcome for these patients needs to be investigated in further clinical studies.

  18. Factors for Predicting Rectal Dose of High-Dose-Rate Intracavitary Brachytherapy After Pelvic Irradiation in Patients With Cervical Cancer: A Retrospective Study With Radiography-Based Dosimetry

    SciTech Connect

    Huang Engyen; Wang Chongjong; Lan Jenhong; Chen Huichun; Fang Fumin; Hsu, H.-C.; Huang Yujie; Wang Changyu; Wang Yuming

    2010-02-01

    Purpose: To evaluate the predictive factors for rectal dose of the first fraction of high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Methods and Materials: From March 1993 through February 2008, 946 patients undergoing pelvic irradiation and HDR-ICBT were analyzed. Examination under anesthesia (EUA) at the first implantation of the applicator was usually performed in the early period. Rectal point was determined radiographically according to the 38th Report of the International Commission of Radiation Units and Measurements (ICRU). The ICRU rectal dose (PRD) as a percentage of point A dose was calculated; multiple linear regression models were used to predict PRD. Results: Factors influencing successful rectal dose calculation were EUA (p < 0.001) and absence of diabetes (p = 0.047). Age (p < 0.001), body weight (p = 0.002), diabetes (p = 0.020), and EUA (p < 0.001) were independent factors for the PRD. The predictive equation derived from the regression model was PRD (%) = 57.002 + 0.443 x age (years) - 0.257 x body weight (kg) + 6.028 x diabetes (no: 0; yes: 1) - 8.325 x EUA (no: 0; yes: 1) Conclusion: Rectal dose at the first fraction of HDR-ICBT is positively influenced by age and diabetes, and negatively correlated with EUA and body weight. A small fraction size at point A may be considered in patients with a potentially high rectal dose to reduce the biologically effective dose if the ICRU rectal dose has not been immediately obtained in the first fraction of HDR-ICBT.

  19. Effect of high dose isoflurane on cerebral blood flow in macaque monkeys

    PubMed Central

    Li, Chun-Xia; Patel, Sudeep; Wang, Danny JJ; Zhang, Xiaodong

    2014-01-01

    The effect of high dose isoflurane on cerebral blood flow (CBF) was investigated in adult macaque monkeys receiving 1% to 2% isoflurane with the pseudo continuous arterial-spin-labeling (pCASL) MRI technique. High concentration (2%) of isoflurane resulted in significant increase in the mean CBF of the global, cortical, subcortical regions and the regional CBF in all subcortical structures and most cortical structures (such as motor cortex, anterior cingulate cortex, but not media prefrontal cortex). In addition, the changes of regional CBF in the affected regions correlated linearly with increasing isoflurane concentrations. The study demonstrates region specific CBF abnormal increase in adult macaque monkeys under high dose (2%) isoflurane and suggests the brain functionality in corresponding structures may be affected and need to be taken consideration in either human or non-human primate neuroimaging studies. PMID:24890304

  20. Precipitate behavior in self-ion irradiated stainless steels at high doses

    NASA Astrophysics Data System (ADS)

    Jiao, Z.; Was, G. S.

    2014-06-01

    To study radiation-induced precipitation at high doses, solution annealed 304L SS and cold worked 316 SS were irradiated to 46 and 260 dpa at 380 °C using 5 MeV Fe++ and the radiation-induced precipitates were examined using atom probe tomography. Ni/Si-rich clusters were observed in all examined conditions. G-phase precipitates were observed in 316 SS at 46 dpa but only appeared in 304L SS at 260 dpa. Using the neutron irradiation to 46 dpa at 320 °C as a reference, the temperature shift for cold worked 316 SS appeared to be smaller than that of solution annealed 304L SS, probably due to the high density of dislocations, which served as defect sinks and mitigated the effect of high dose rate.

  1. Image quality and dose efficiency of high energy phase sensitive x-ray imaging: Phantom studies

    PubMed Central

    Wong, Molly Donovan; Wu, Xizeng; Liu, Hong

    2014-01-01

    The goal of this preliminary study was to perform an image quality comparison of high energy phase sensitive imaging with low energy conventional imaging at similar radiation doses. The comparison was performed with the following phantoms: American College of Radiology (ACR), contrast-detail (CD), acrylic edge and tissue-equivalent. Visual comparison of the phantom images indicated comparable or improved image quality for all phantoms. Quantitative comparisons were performed through ACR and CD observer studies, both of which indicated higher image quality in the high energy phase sensitive images. The results of this study demonstrate the ability of high energy phase sensitive imaging to overcome existing challenges with the clinical implementation of phase contrast imaging and improve the image quality for a similar radiation dose as compared to conventional imaging near typical mammography energies. In addition, the results illustrate the capability of phase sensitive imaging to sustain the image quality improvement at high x-ray energies and for – breast – simulating phantoms, both of which indicate the potential to benefit fields such as mammography. Future studies will continue to investigate the potential for dose reduction and image quality improvement provided by high energy phase sensitive contrast imaging. PMID:24865208

  2. Exploring {sup 57}Co as a new isotope for brachytherapy applications

    SciTech Connect

    Enger, Shirin A.; Lundqvist, Hans; D'Amours, Michel; Beaulieu, Luc

    2012-05-15

    Purpose: The characteristics of the radionuclide {sup 57}Co make it interesting for use as a brachytherapy source. {sup 57}Co combines a possible high specific activity with the emission of relatively low-energy photons and a half-life (272 days) suitable for regular source exchanges in an afterloader. {sup 57}Co decays by electron capture to the stable {sup 57}Fe with emission of 136 and 122 keV photons. Methods: A hypothetical {sup 57}Co source based on the Flexisource brachytherapy encapsulation with the active core set as a pure cobalt cylinder (length 3.5 mm and diameter 0.6 mm) covered with a cylindrical stainless-steel capsule (length 5 mm and thickness 0.125 mm) was simulated using Geant4 Monte Carlo (MC) code version 9.4. The radial dose function, g(r), and anisotropy function F(r,{theta}), for the line source approximation were calculated following the TG-43U1 formalism. The results were compared to well-known {sup 192}Ir and {sup 125}I radionuclides, representing the higher and the lower energy end of brachytherapy, respectively. Results: The mean energy of photons in water, after passing through the core and the encapsulation material was 123 keV. This hypothetical {sup 57}Co source has an increasing g(r) due to multiple scatter of low-energy photons, which results in a more uniform dose distribution than {sup 192}Ir. Conclusions: {sup 57}Co has many advantages compared to {sup 192}Ir due to its low-energy gamma emissions without any electron contamination. {sup 57}Co has an increasing g(r) that results in a more uniform dose distribution than {sup 192}Ir due to its multiple scattered photons. The anisotropy of the {sup 57}Co source is comparable to that of {sup 192}Ir. Furthermore, {sup 57}Co has lower shielding requirements than {sup 192}Ir.

  3. Pharmacokinetic Properties of Single-Dose Primaquine in Papua New Guinean Children: Feasibility of Abbreviated High-Dose Regimens for Radical Cure of Vivax Malaria

    PubMed Central

    Moore, Brioni R.; Salman, Sam; Benjamin, John; Page-Sharp, Madhu; Robinson, Leanne J.; Waita, Elizabeth; Batty, Kevin T.; Siba, Peter; Mueller, Ivo; Betuela, Inoni

    2014-01-01

    Since conventional 14-day primaquine (PMQ) radical cure of vivax malaria is associated with poor compliance, and as total dose, not therapy duration, determines efficacy, a preliminary pharmacokinetic study of two doses (0.5 and 1.0 mg/kg of body weight) was conducted in 28 healthy glucose-6-phosphate dehydrogenase-normal Papua New Guinean children, aged 5 to 12 years, to facilitate development of abbreviated high-dose regimens. Dosing was with food and was directly observed, and venous blood samples were drawn during a 168-h postdose period. Detailed safety monitoring was performed for hepatorenal function and hemoglobin and methemoglobin concentrations. Plasma concentrations of PMQ and its metabolite carboxyprimaquine (CPMQ) were determined by liquid chromatography-mass spectrometry and analyzed using population pharmacokinetic methods. The derived models were used in simulations. Both single-dose regimens were well tolerated with no changes in safety parameters. The mean PMQ central volume of distribution and clearance relative to bioavailability (200 liters/70 kg and 24.6 liters/h/70 kg) were within published ranges for adults. The median predicted maximal concentrations (Cmax) for both PMQ and CPMQ after the last dose of a 1.0 mg/kg 7-day PMQ regimen were approximately double those at the end of 14 days of 0.5 mg/kg daily, while a regimen of 1.0 mg/kg twice daily resulted in a 2.38 and 3.33 times higher Cmax for PMQ and CPMQ, respectively. All predicted median Cmax concentrations were within ranges for adult high-dose studies that also showed acceptable safety and tolerability. The present pharmacokinetic data, the first for PMQ in children, show that further studies of abbreviated high-dose regimens are feasible in this age group. PMID:24189254

  4. High-dose continuous infusion plus pulse interleukin-2 and famotidine in melanoma.

    PubMed

    Quan, Walter; Ramirez, Maria; Taylor, W Chris; Vinogradov, Mikhail; Khan, Nawazish; Jackson, Shawn

    2004-12-01

    High-dose, continuous infusion interleukin-2 (IL-2) regimens generate greater Lymphokine Activated Killer cell (LAK) cytotoxicity in vitro and a higher rebound lymphocytosis in vivo than do bolus IL-2 regimens. Lymphocytes initially activated by continuous infusion IL-2 then subsequently pulsed with IL-2 have increased cytotoxicity against cancer cells. Famotidine may enhance the lysis of tumors by cytotoxic lymphocytes. Fourteen patients with melanoma were treated with famotidine 20 mg intravenously twice per day and continuous infusion IL-2 (18 MIU/sq m/24 hours) for 72 hours, followed by a 24-hour rest, then IL-2 18 MIU/sq m over 15-30 minutes for 1 dose (12 patients) or daily for 3 doses (2 patients). Most common toxicities were fever, nausea/emesis, hypophosphatemia, hypomagnesemia, and rigors. Nine partial responses (64% response rate; 95% Confidence Interval: 39%-84%) have been seen. Median survival has not been reached at greater than 10 months. Two patients responding to therapy showed an increase in detectable CD 56(+) cells in serial subcutaneous or lymph node biopsies, while 1 patient undergoing progression of disease had no such infiltrate. High-dose, 72-hour continuous infusion plus pulse interleukin-2 with famotidine has activity in melanoma. CD 56(+) cells may play a role in responding patients. PMID:15665626

  5. High-dose Daptomycin Therapy for Staphylococcal Endocarditis and When to Apply It

    PubMed Central

    Smith, Jordan R.; Claeys, Kimberly; Barber, Katie E.; Rybak, Michael J.

    2014-01-01

    Infective endocarditis (IE) continues to present a large burden to the healthcare system. Staphylococcus aureus, the leading pathogen associated with the disease, has always proven difficult to treat. Increasing numbers of S. aureus isolates are demonstrating reduced susceptibility to vancomycin, and therapeutic options are limited. Daptomycin is frequently employed when vancomycin therapy proves unsuccessful or when vancomycin MIC values rise above 1 mg/L. Currently, daptomycin is FDA-approved at a dose of 6 mg/kg/day for the treatment of S. aureus bacteremia and associated right-sided endocarditis. However, numerous in vitro and clinical studies suggest that daptomycin doses up to 12 mg/kg/day may provide improved efficacy and resistance prevention. Additionally, high-dose daptomycin has demonstrated excellent safety. Together, these data suggest a role for high-dose daptomycin in staphylococcal IE patients who are severely ill, previously failed therapy with vancomycin, or possess a S. aureus isolate with an elevated vancomycin MIC. PMID:25165017

  6. Postoperative vaginal irradiation with high dose rate afterloading technique in endometrial carcinoma stage I

    SciTech Connect

    Sorbe, B.G.; Smeds, A.C. )

    1990-02-01

    A high dose rate ({sup 60}Co) afterloading technique was used for postoperative prophylactic vaginal irradiation in a series of 404 women with endometrial carcinoma Stage I. The total recurrence rate was 3.7% with 0.7% vaginal deposits. The crude 5-year survival rate for the complete series was 91.8% compared to 13.3% for those with recurrences. Depth of myometrial infiltration (greater than 1/3 of the uterine wall) and nuclear grade were the most important prognostic factors. Clinically significant late radiation reactions (bladder and/or rectum) were recorded in 6.9%. Dose per fraction and the size of the target volume were highly significantly related to the occurrence of both early and late radiation reactions. Vaginal shortening is closely related to the dose per fraction, length of the reference isodose, and the applicator diameter. The shape of the vaginal applicator versus the isodoses and the importance of the source train geometry and relative activity for dose gradient inhomogeneities within the target volume are discussed. Cumulative radiation effect (CRE) and linear-quadratic (LQ) calculations have been performed and related to tissue reactions within the target volume and in the risk organs. An alpha-beta quotient of 8.8 for vaginal shrinkage effect and 2.0 for late rectal complications are suggested on the basis of calculations using a maximum likelihood method for quantal radiation data.

  7. Are high doses of carbidopa a concern? A randomized, clinical trial in Parkinson's disease.

    PubMed

    Brod, Lissa S; Aldred, Jason L; Nutt, John G

    2012-05-01

    Recommended doses of carbidopa are 75-200 mg/day. Higher doses could inhibit brain aromatic amino-acid decarboxylase and reduce clinical effects. We compared 4-week outpatient treatments with carbidopa (75 and 450 mg/day) administered with L-dopa on the subjects' normal schedule. After each treatment phase, subjects had two 2-hour L-dopa infusions. The first infusion examined the effects of carbidopa doses administered the preceding 4 weeks, and the second infusion determined the acute effects of the two dosages of carbidopa. The antiparkinsonian effects and L-dopa and carbidopa plasma concentrations were monitored during the infusions. Twelve subjects completed the study. Carbidopa concentrations were eight times higher after the high-carbidopa phase. Area under the curve (AUC) for clinical ratings did not differ for the four L-dopa infusions, although AUC for plasma L-dopa was modestly increased with 450 mg of carbidopa. Nine subjects reported that the high-carbidopa outpatient phase was associated with greater response to L-dopa. Doses of 450 mg/day of carbidopa did not reduce the responses to L-dopa infusion, extending the safe range of carbidopa to 450 mg/day. PMID:22508376

  8. The use of small fraction numbers in high dose-rate gynaecological afterloading: some radiobiological considerations.

    PubMed

    Dale, R G

    1990-04-01

    Using commonly assumed alpha/beta ratios for tumours and late-reacting tissues, the linear-quadratic (LQ) model has been used to compare low dose-rate (LDR) gynaecological treatment with high dose-rate (HDR) techniques given in small fraction numbers. Even in the absence of relatively favourable tissue recovery constants (mu values) it is shown that, provided a modest extra amount of geometrical sparing of critical tissues is available (by means of spacing or shielding), HDR treatment in a small number of fractions may be used in place of an LDR regime without loss of therapeutic ratio. This general result, although not universally true, does indicate that HDR treatment delivered in a small number of fractions may be more feasible than is sometimes thought. These findings do not contradict currently accepted radiobiological philosophy, which cautions against the use of small numbers of high-dose fractions. Primarily they serve to emphasize the importance of the recommendations of the ICRU (1985), which stress the need to consider the complete time-dose pattern of radiation delivery to all the critical tissues in an intracavitary treatment. PMID:2346867

  9. SU-E-T-244: Motion Control Challenges in High Dose Rate Brachytherapy

    SciTech Connect

    Hyvarinen, M; Leventouri, T; Pella, S; Dumitru, N

    2014-06-01

    Purpose: High dose rate (HDR) brachytherapy dose distribution is highly localized and has a very sharp fall-off. Thus the one of the most important part of the treatment is the localization and immobilization of the applicator from the implantation to the setup verification to the treatment delivery. The smallest motions of the patient can induce a small rotation, tilt, or translational movement of the applicator that can convert into miss of a significant part of the tumor or to over irradiating a nearby critical organ.The purpose of this study is to revise most of the HDR types of treatments with their applicators and their localization challenges. Since every millimeter of misplacement counts the study will look into the necessity of increasing the immobilization for several types of applicators. Methods: The study took over 136 plans generated by the treatment planning system (TPS) looking into the applicator placement in regard to the organs at risk (OR) and simulated the three possible displacements at the hottest dose point on the critical organ for several accessories to evaluate the variation of the delivered dose at the point due to the displacement. Results: Many of the present immobilization devices produced for external radiotherapy can be used to improve the localization of HDR applicators during transportation of the patient and during treatment. Conclusion: This study data indicates that an improvement of the immobilization devices for HDR is absolutely necessary. Better applicator fixation devices are required too. Developing new immobilization devices for all the applicators is recommended.

  10. Comparison of efficacy and adverse effect profile of high dose versus standard dose atorvastatin in acute ST elevation myocardial infarction patients

    PubMed Central

    Sebastian, Gailin B; Anoop, T M; Thomas, Joby K; George, Raju

    2011-01-01

    Objective To compare the efficacy and adverse effects of high and standard dose atorvastatin in ST elevation myocardial infarction (STEMI) patients. Design A prospective, single-centre, randomised, double blind study. Setting A tertiary care centre in Kerala, India, from January to June 2009. Patients 121 consecutive acute STEMI patients eligible for thrombolytic therapy. Interventions Pharmacological thrombolysis and atorvastatin therapy. Main outcome measures Primary end points were mean change in low density lipoprotein and total cholesterol, serum glutamic pyruvic transaminase (SGPT), creatine phosphokinase (CPK) at 3 months of high dose (80 mg) and standard dose (20 mg) of atorvastatin. Results There was no significant difference in the mean cholesterol levels at 3 months of therapy (mean reduction in total cholesterol and low density lipoprotein cholesterol were 48 mg%, 49 mg% in the 20 mg group compared with 54 mg% and 53 mg%, respectively, in the 80 mg group; p 0.39 and 0.4). There was a significant increase in SGPT at 1 week in the 80 mg group and atorvastatin was stopped in a significantly higher number of patients due to the increase in SGPT and CPK at 1 week in the high dose group (12% and 7% of patients; (p=0.04 and p=0.06, respectively). Conclusion In acute STEMI patients treated with pharmacological thrombolysis, standard dose atorvastatin is equally effective as high dose atorvastatin in terms of reduction in cholesterol, with higher and earlier incidence of asymptomatic SGPT and CPK elevation in the high dose group.

  11. "Effects of recombinant human erythropoietin high mimicking abuse doses on oxidative stress processes in rats".

    PubMed

    Bianchi, Sara; Fusi, Jonathan; Franzoni, Ferdinando; Giovannini, Luca; Galetta, Fabio; Mannari, Claudio; Guidotti, Emanuele; Tocchini, Leonardo; Santoro, Gino

    2016-08-01

    Although many studies highlight how long-term moderate dose of Recombinant Human Erythropoietin (rHuEPO) treatments result in beneficial and antioxidants effects, few studies take into account the effects that short-term high doses of rHuEPO (mimicking abuse conditions) might have on the oxidative stress processes. Thus, the aim of this study was to investigate the in vivo antioxidant activity of rHuEPO, administered for a short time and at high doses to mimic its sports abuse as doping. Male Wistar healthy rats (n=36) were recruited for the study and were treated with three different concentrations of rHuEPO: 7.5, 15, 30μg/kg. Plasma concentrations of erythropoietin, 8-epi Prostaglandin F2α, plasma and urinary concentrations of NOx were evaluated with specific assay kit, while hematocrit levels were analyzed with an automated cell counter. Antioxidant activity of rHuEPO was assessed analyzing the possible variation of the plasma scavenger capacity against hydroxylic and peroxylic radicals by TOSC (Total Oxyradical Scavenging Capacity) assay. Statistical analyses showed higher hematocrit values, confirmed by a statistically significant increase of plasmatic EPO concentration. An increase in plasma scavenging capacity against peroxyl and hydroxyl radicals, in 8-isoprostane plasmatic concentrations and in plasmatic and urinary levels of NOX were also found in all the treated animals, though not always statistically significant. Our results confirm the literature data regarding the antioxidant action of erythropoietin administered at low doses and for short times, whereas they showed an opposite incremental oxidative stress action when erythropoietin is administered at high doses. PMID:27470373

  12. Patients treated with high-dose intravenous immunoglobulin show selective activation of regulatory T cells

    PubMed Central

    Tjon, A S W; Tha-In, T; Metselaar, H J; van Gent, R; van der Laan, L J W; Groothuismink, Z M A; te Boekhorst, P A W; van Hagen, P M; Kwekkeboom, J

    2013-01-01

    Intravenous immunoglobulin (IVIg) is used to treat autoimmune and systemic inflammatory diseases caused by derailment of humoral and cellular immunity. In this study we investigated whether IVIg treatment can modulate regulatory T cells (Tregs) in humans in vivo. Blood was collected from IVIg-treated patients with immunodeficiency or autoimmune disease who were treated with low-dose (n = 12) or high-dose (n = 15) IVIg before, immediately after and at 7 days after treatment. Percentages and activation status of circulating CD4+CD25+forkhead box protein 3 (FoxP3+) Tregs and of conventional CD4+FoxP3− T-helper cells (Tconv) were measured. The suppressive capacity of Tregs purified from blood collected at the time-points indicated was determined in an ex-vivo assay. High-dose, but not low-dose, IVIg treatment enhanced the activation status of circulating Tregs, as shown by increased FoxP3 and human leucocyte antigen D-related (HLA-DR) expression, while numbers of circulating Tregs remained unchanged. The enhanced activation was sustained for at least 7 days after infusion, and the suppressive capacity of purified Tregs was increased from 41 to 70% at day 7 after IVIg treatment. The activation status of Tconv was not affected by IVIg. We conclude that high-dose IVIg treatment activates Tregs selectively and enhances their suppressive function in humans in vivo. This effect may be one of the mechanisms by which IVIg restores imbalanced immune homeostasis in patients with autoimmune and systemic inflammatory disorders. PMID:23607448

  13. The Effect of High Dose Radioiodine Therapy on Formation of Radiation Retinopathy During Thyroid Cancer Treatment

    PubMed Central

    Kaçar Güveli, Tülay; Özkan, Sezer; Öner Tamam, Müge; Uyanık, Ercan; Ediz, Nurcan; Mülazımoğlu, Mehmet; Özpaçacı, Tevfik

    2014-01-01

    Objective: Non-thyroidal complication of high-dose radioiodine therapy for thyroid carcinoma might cause salivary and lacrimal gland dysfunction, which may be transient or permanent in a dose-dependent manner. However, radiation retinopathy complicating 131I therapy, has not been previously well characterized. The aim of this study was to evaluate the extent of retinal damage among patients who had received high doses of radioiodine treatment. Methods: Forty eyes of 20 patients (3 male, 17 female) who received 250-1000 mCi during 131I therapy and on ophthalmological follow up for a year after the last treatment were included in the study. Mean age of the study group was 50 years (range 25-70 years). In ophthalmologic examination, visual acuity was measured in order to determine visual loss. Intraocular pressure was measured in all the patients. Then lens examination was carried out with slit lamp biomicroscopy in order to investigate cataract or partial lens opacities. Fundus observation was carried out through the dilated pupil with slit lamp biomicroscopy using 90 D noncontact lens. Result: The best corrected visual aquity with Snellen chart was found as 1.0 in 36 eyes (90%) and between 0.6 and 0.9 (10%) in 4 eyes (10%). At the biomicroscopic fundus examination, retinal hemorrhage consistent with radiation retinopathy, microaneurysm, microinfarction, edema or exudation, vitreus hemorrhage, partial or total optical disc pallor indicating papillopathy in the optic disc were not observed in any of the eyes. Conclusion: This result indicates that there is not any significant correlation between repeated high-dose radioiodine therapy and radiation retinopathy in differentiated thyroid carcinomas. Even though there is not a significant restriction in use of higher doses of radioiodine therapy in differentiated thyroid carcinoma, more extensive studies are needed in order to obtain more accurate data on possible occurrence of retinopathy. PMID:25541931

  14. Cardiovascular Safety Profile and Clinical Experience With High-Dose Domperidone Therapy for Nausea and Vomiting

    PubMed Central

    Ortiz, Arleen; Cooper, Chad J.; Alvarez, Alicia; Gomez, Yvette; Sarosiek, Irene

    2015-01-01

    Abstract: Introduction: Domperidone is a dopamine receptor antagonist with peripheral prokinetic and central antiemetic properties. Prolongation of the QTc interval with chronic use of oral domperidone in standard doses has been reported in the literature. Our goal was to investigate cardiac toxicity in patients receiving 2-fold greater doses than in previous reports. Methods: A retrospective chart review was conducted of patients with nausea (N) and vomiting (V) receiving domperidone from 2009 to 2013 under an Investigational New Drug (IND) protocol. Patient demographics, indications for therapy, clinical outcomes, cardiac symptoms and electrocardiogram tracings were reviewed. Prolonged QTc was verified if >470 milliseconds in females (F) and >450 milliseconds in males (M). Results: A total of 64 patients, 44 female (37% Hispanic, 60% white, 3% African American), were taking domperidone for diabetic gastroparesis 45%; idiopathic gastroparesis 36%; chronic N&V 8%; dumping syndrome 5%; cyclic vomiting 5% and conditioned vomiting 1%. Mean duration of therapy was 8 months (range, 3 months to 4 years). Doses ranged from 40 to 120 mg/d with 90% receiving 80 to 120 mg compared with the standard dose of 40 mg. Of note, 73% of subjects benefited from treatment with reduced nausea and vomiting. Thirty-seven patients had follow-up electrocardiograms available, and they showed that the mean QTc at baseline was 424 milliseconds ± 28.4 (SD) compared with 435 milliseconds ± 27.2 (SD) at follow-up (not significant). Ten of these patients had prolonged QTc at F/U ranging from 453 to 509 milliseconds, without any cardiovascular complaints. There was no relationship between prolonged QTc and daily dose of domperidone, body mass index or age. Conclusions: Our data indicate that at very high dosing, the prokinetic/antiemetic agent domperidone has a low risk of adverse cardiovascular events while exhibiting good clinical efficacy. PMID:25828198

  15. The Use of Very High-Doses of Baclofen for the Treatment of Alcohol-Dependence: A Case Series

    PubMed Central

    de Beaurepaire, Renaud

    2014-01-01

    Baclofen, particularly high-dose baclofen, has recently emerged as a treatment of major interest for alcohol-dependence. However, baclofen has many potentially dangerous side effects, and the maximal dose of baclofen that may be used is a matter of discussion. Here, the author analyses the medical charts of the last 100 patients seen in his clinic, 17 of whom have been taking a very high dose of baclofen, which is to say, more than 300 mg/day. The analysis of the charts shows that the very high-doses baclofen were justified in almost all the cases. Side effects are analyzed. PMID:25346700

  16. Remote distributed optical fibre dose measuring of high gamma-irradiation with highly sensitive Al- and P-doped fibres

    NASA Astrophysics Data System (ADS)

    Faustov, A. V.; Gusarov, A.; Wuilpart, M.; Fotiadi, A.; Liokumivich, L. B.; Zolotovskiy, I. O.; Tomashuk, A. L.; de Schoutheete, T.; Mégret, P.

    2013-05-01

    We present our results on measuring distributed Radiation-Induced Absorption (RIA) by means of a commercially available Optical Frequency Domain Reflectometry (OFDR) system. We also compare distributed OFDR RIA measurements with spatially integrated spectral transmission detection using an Optical Spectra Analyser (OSA). We have chosen four different highly gamma-radiation sensitive fibres, two of which were doped with Al and two with P. The dose rate during irradiations was about 590 Gy/h. The irradiations were conducted at temperatures of 30°C and 80°C. Different temperatures were needed for studying the temperature dependence of the annealing speed of RIA. All four fibres demonstrated a strong saturation-like increase of RIA with the dose accumulation up to several tens of dB/m as detected by the OSA. In case of the OFDR measurements the change of the absorption in an optical fibre resulted in a clear change of the slope of the corresponding Rayleigh backscattering trace. The RIA dependences measured with the OFDR were in a reasonable agreement with the measurements obtained with the OSA. This allows us to use the RIA dependences on absorption dose obtained by means of OSA for the distributed dose reconstruction based on the OFDR technique. We also irradiated different lengths of one of the P-doped fibers to see if it influences accuracy of the distributed dose detection and to find out the minimal possible length of the probe. The results of the presented experiments provide a basis for a dose estimation model based on RIA in which temperature oscillations are taken into account.

  17. Effects of high-dose selegiline on morphine reinforcement and precipitated withdrawal in dependent rats.

    PubMed

    Grasing, K; He, S

    2005-02-01

    Selegiline is an irreversible inhibitor of monoamine oxidase (MAO) with psychostimulant and neuroprotective effects. Several lines of evidence suggest that treatment with selegiline at doses that exceed levels required for inhibition of MAO can produce distinct pharmacologic effects. The purpose of this study was to evaluate the effects of chronic treatment with high-dose selegiline on extinction responding, cue-induced reinstatement, morphine reinforcement and naloxone-precipitated withdrawal. After pretreatment with noncontingent morphine to establish opiate dependence, rats acquired self-administration of 3.2 mg/kg per injection of morphine under a progressive ratio schedule. Daily treatment with saline or 6.4 mg/kg per day of selegiline was then administered over extinction, reinstatement and re-acquisition of morphine self-administration. To enhance or diminish the potential for psychostimulant effects, selegiline was administered either immediately prior to (pre-session) or 1 h following (post-session) extinction, reinstatement and self-administration sessions. Pre-session selegiline decreased the number of ratios completed on days 2, 3 and 4 of extinction, and decreased morphine self-administration during all four re-acquisition sessions. When administered at the same dose level, post-session selegiline decreased responding on the fourth extinction session, and was ineffective in modifying re-acquisition of self-administration. Selegiline administered by either schedule did not modify cue-induced reinstatement. Daily treatment with 6.4 mg/kg per day of selegiline did not modify self-administration of food under a progressive ratio schedule. Acute treatment with single, 6.4 mg/kg doses of selegiline attenuated naloxone-induced increases in ptosis and global withdrawal score, but did not modify any other sign of withdrawal or global withdrawal score calculated without ratings of ptosis. In conclusion, high-dose selegiline can attenuate extinction responding

  18. Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock

    PubMed Central

    Zabet, Mohadeseh Hosseini; Mohammadi, Mostafa; Ramezani, Masoud; Khalili, Hossein

    2016-01-01

    Objective: Effects of ascorbic acid on hemodynamic parameters of septic shock were evaluated in nonsurgical critically ill patients in limited previous studies. In this study, the effect of high-dose ascorbic acid on vasopressor drug requirement was evaluated in surgical critically ill patients with septic shock. Methods: Patients with septic shock who required a vasopressor drug to maintain mean arterial pressure >65 mmHg were assigned to receive either 25 mg/kg intravenous ascorbic acid every 6 h or matching placebo for 72 h. Vasopressor dose and duration were considered as the primary outcomes. Duration of Intensive Care Unit (ICU) stay and 28-day mortality has been defined as secondary outcomes. Findings: During the study period, 28 patients (14 in each group) completed the trial. Mean dose of norepinephrine during the study period (7.44 ± 3.65 vs. 13.79 ± 6.48 mcg/min, P = 0.004) and duration of norepinephrine administration (49.64 ± 25.67 vs. 71.57 ± 1.60 h, P = 0.007) were significantly lower in the ascorbic acid than the placebo group. No statistically significant difference was detected between the groups regarding the length of ICU stay. However, 28-day mortality was significantly lower in the ascorbic acid than the placebo group (14.28% vs. 64.28%, respectively; P = 0.009). Conclusion: High-dose ascorbic acid may be considered as an effective and safe adjuvant therapy in surgical critically ill patients with septic shock. The most effective dose of ascorbic acid and the best time for its administration should be determined in future studies. PMID:27162802

  19. High-Dose-Rate Monotherapy: Safe and Effective Brachytherapy for Patients With Localized Prostate Cancer

    SciTech Connect

    Demanes, D. Jeffrey; Martinez, Alvaro A.; Ghilezan, Michel; Hill, Dennis R.; Schour, Lionel; Brandt, David; Gustafson, Gary

    2011-12-01

    Purpose: High-dose-rate (HDR) brachytherapy used as the only treatment (monotherapy) for early prostate cancer is consistent with current concepts in prostate radiobiology, and the dose is reliably delivered in a prospectively defined anatomic distribution that meets all the requirements for safe and effective therapy. We report the disease control and toxicity of HDR monotherapy from California Endocurietherapy (CET) and William Beaumont Hospital (WBH) in low- and intermediate-risk prostate cancer patients. Methods and Materials: There were 298 patients with localized prostate cancer treated with HDR monotherapy between 1996 and 2005. Two biologically equivalent hypofractionation protocols were used. At CET the dose was 42 Gy in six fractions (two implantations 1 week apart) delivered to a computed tomography-defined planning treatment volume. At WBH the dose was 38 Gy in four fractions (one implantation) based on intraoperative transrectal ultrasound real-time treatment planning. The bladder, urethral, and rectal dose constraints were similar. Toxicity was scored with the National Cancer Institute Common Toxicity Criteria for Adverse Events version 3. Results: The median follow-up time was 5.2 years. The median age of the patients was 63 years, and the median value of the pretreatment prostate-specific antigen was 6.0 ng/mL. The 8-year results were 99% local control, 97% biochemical control (nadir +2), 99% distant metastasis-free survival, 99% cause-specific survival, and 95% overall survival. Toxicity was scored per event, meaning that an individual patient with more than one symptom was represented repeatedly in the morbidity data table. Genitourinary toxicity consisted of 10% transient Grade 2 urinary frequency or urgency and 3% Grade 3 episode of urinary retention. Gastrointestinal toxicity was <1%. Conclusions: High disease control rates and low morbidity demonstrate that HDR monotherapy is safe and effective for patients with localized prostate cancer.

  20. High Doses of Bone Morphogenetic Protein 2 Induce Structurally Abnormal Bone and Inflammation In Vivo

    PubMed Central

    Zara, Janette N.; Siu, Ronald K.; Zhang, Xinli; Shen, Jia; Ngo, Richard; Lee, Min; Li, Weiming; Chiang, Michael; Chung, Jonguk; Kwak, Jinny; Wu, Benjamin M.; Ting, Kang

    2011-01-01

    The major Food and Drug Association–approved osteoinductive factors in wide clinical use are bone morphogenetic proteins (BMPs). Although BMPs can promote robust bone formation, they also induce adverse clinical effects, including cyst-like bone formation and significant soft tissue swelling. In this study, we evaluated multiple BMP2 doses in a rat femoral segmental defect model and in a minimally traumatic rat femoral onlay model to determine its dose-dependent effects. Results of our femoral segmental defect model established a low BMP2 concentration range (5 and 10 μg/mL, total dose 0.375 and 0.75 μg in 75 μg total volume) unable to induce defect fusion, a mid-range BMP2 concentration range able to fuse the defect without adverse effects (30 μg/mL, total dose 2.25 μg in 75 μg total volume), and a high BMP2 concentration range (150, 300, and 600 μg/mL, total dose 11.25, 22.5, and 45 μg in 75 μg total volume) able to fuse the defect, but with formation of cyst-like bony shells filled with histologically confirmed adipose tissue. In addition, compared to control, 4 mg/mL BMP2 also induced significant tissue inflammatory infiltrates and exudates in the femoral onlay model that was accompanied by increased numbers of osteoclast-like cells at 3, 7, and 14 days. Overall, we consistently reproduced BMP2 side effects of cyst-like bone and soft tissue swelling using high BMP2 concentration approaching the typical human 1500 μg/mL. PMID:21247344

  1. High doses of bone morphogenetic protein 2 induce structurally abnormal bone and inflammation in vivo.

    PubMed

    Zara, Janette N; Siu, Ronald K; Zhang, Xinli; Shen, Jia; Ngo, Richard; Lee, Min; Li, Weiming; Chiang, Michael; Chung, Jonguk; Kwak, Jinny; Wu, Benjamin M; Ting, Kang; Soo, Chia

    2011-05-01

    The major Food and Drug Association-approved osteoinductive factors in wide clinical use are bone morphogenetic proteins (BMPs). Although BMPs can promote robust bone formation, they also induce adverse clinical effects, including cyst-like bone formation and significant soft tissue swelling. In this study, we evaluated multiple BMP2 doses in a rat femoral segmental defect model and in a minimally traumatic rat femoral onlay model to determine its dose-dependent effects. Results of our femoral segmental defect model established a low BMP2 concentration range (5 and 10 μg/mL, total dose 0.375 and 0.75 μg in 75 μg total volume) unable to induce defect fusion, a mid-range BMP2 concentration range able to fuse the defect without adverse effects (30 μg/mL, total dose 2.25 μg in 75 μg total volume), and a high BMP2 concentration range (150, 300, and 600 μg/mL, total