Porous photonic crystal external cavity laser biosensor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Qinglan; Peh, Jessie; Hergenrother, Paul J.

2016-08-15

We report the design, fabrication, and testing of a photonic crystal (PC) biosensor structure that incorporates a porous high refractive index TiO{sub 2} dielectric film that enables immobilization of capture proteins within an enhanced surface-area volume that spatially overlaps with the regions of resonant electromagnetic fields where biomolecular binding can produce the greatest shifts in photonic crystal resonant wavelength. Despite the nanoscale porosity of the sensor structure, the PC slab exhibits narrowband and high efficiency resonant reflection, enabling the structure to serve as a wavelength-tunable element of an external cavity laser. In the context of sensing small molecule interactions withmore » much larger immobilized proteins, we demonstrate that the porous structure provides 3.7× larger biosensor signals than an equivalent nonporous structure, while the external cavity laser (ECL) detection method provides capability for sensing picometer-scale shifts in the PC resonant wavelength caused by small molecule binding. The porous ECL achieves a record high figure of merit for label-free optical biosensors.« less

Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study.

PubMed

Nicolaisen, Marianne; Müller, Stig; Patel, Hitendra R H; Hanssen, Tove Aminda

2014-12-01

To assess patients' symptoms, quality of life and satisfaction with information three to four years after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy and to analyse differences between treatment groups and the relationship between disease-specific, health-related and overall quality of life and satisfaction with information. Radical prostate cancer treatments are associated with changes in quality of life. Differences between patients undergoing different treatments in symptoms and quality of life have been reported, but there are limited long-term data comparing radical prostatectomy with radical external beam radiotherapy and postoperative radiotherapy. A cross-sectional survey design was used. The study sample included 143 men treated with radical prostatectomy and/or radical external beam radiotherapy. Quality of life was measured using the 12-item Short Form Health Survey and the 50-item Expanded Prostate Cancer Index Composite Instrument. Questions assessing overall Quality of life and satisfaction with information were included. Descriptive statistics and interference statistical methods were applied to analyse the data. Radical external beam radiotherapy was associated with less urinary incontinence and better urinary function. There were no differences between the groups for disease-specific quality of life sum scores. Sexual quality of life was reported very low in all groups. Disease-specific quality of life and health-related quality of life were associated with overall quality of life. Patients having undergone surgery were more satisfied with information, and there was a positive correlation between quality of life and patient satisfaction. Pretreatment information and patient education lead to better quality of life and satisfaction. This study indicates a need for structured, pretreatment information and follow-up for all men going through radical prostate cancer treatment. Long-term quality of life

Investigation of photon beam models in heterogeneous media of modern radiotherapy.

PubMed

Ding, W; Johnston, P N; Wong, T P Y; Bubb, I F

2004-06-01

This study investigates the performance of photon beam models in dose calculations involving heterogeneous media in modern radiotherapy. Three dose calculation algorithms implemented in the CMS FOCUS treatment planning system have been assessed and validated using ionization chambers, thermoluminescent dosimeters (TLDs) and film. The algorithms include the multigrid superposition (MGS) algorithm, fast Fourier Transform Convolution (FFTC) algorithm and Clarkson algorithm. Heterogeneous phantoms used in the study consist of air cavities, lung analogue and an anthropomorphic phantom. Depth dose distributions along the central beam axis for 6 MV and 10 MV photon beams with field sizes of 5 cm x 5 cm and 10 cm x 10 cm were measured in the air cavity phantoms and lung analogue phantom. Point dose measurements were performed in the anthropomorphic phantom. Calculated results with three dose calculation algorithms were compared with measured results. In the air cavity phantoms, the maximum dose differences between the algorithms and the measurements were found at the distal surface of the air cavity with a 10 MV photon beam and a 5 cm x 5 cm field size. The differences were 3.8%. 24.9% and 27.7% for the MGS. FFTC and Clarkson algorithms. respectively. Experimental measurements of secondary electron build-up range beyond the air cavity showed an increase with decreasing field size, increasing energy and increasing air cavity thickness. The maximum dose differences in the lung analogue with 5 cm x 5 cm field size were found to be 0.3%. 4.9% and 6.9% for the MGS. FFTC and Clarkson algorithms with a 6 MV photon beam and 0.4%. 6.3% and 9.1% with a 10 MV photon beam, respectively. In the anthropomorphic phantom, the dose differences between calculations using the MGS algorithm and measurements with TLD rods were less than +/-4.5% for 6 MV and 10 MV photon beams with 10 cm x 10 cm field size and 6 MV photon beam with 5 cm x 5 cm field size, and within +/-7.5% for 10 MV with 5 cm

External Beam Radiotherapy for Prostate Cancer Patients on Anticoagulation Therapy: How Significant is the Bleeding Toxicity?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Choe, Kevin S.; Jani, Ashesh B.; Liauw, Stanley L., E-mail: sliauw@radonc.uchicago.ed

Purpose: To characterize the bleeding toxicity associated with external beam radiotherapy for prostate cancer patients receiving anticoagulation (AC) therapy. Methods and Materials: The study cohort consisted of 568 patients with adenocarcinoma of the prostate who were treated with definitive external beam radiotherapy. Of these men, 79 were receiving AC therapy with either warfarin or clopidogrel. All patients were treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Bleeding complications were recorded during treatment and subsequent follow-up visits. Results: With a median follow-up of 48 months, the 4-year actuarial risk of Grade 3 or worse bleeding toxicity was 15.5% for those receivingmore » AC therapy compared with 3.6% among those not receiving AC (p < .0001). On multivariate analysis, AC therapy was the only significant factor associated with Grade 3 or worse bleeding (p < .0001). For patients taking AC therapy, the crude rate of bleeding was 39.2%. Multivariate analysis within the AC group demonstrated that a higher radiotherapy dose (p = .0408), intensity-modulated radiotherapy (p = 0.0136), and previous transurethral resection of the prostate (p = .0001) were associated with Grade 2 or worse bleeding toxicity. Androgen deprivation therapy was protective against bleeding, with borderline significance (p = 0.0599). Dose-volume histogram analysis revealed that Grade 3 or worse bleeding was minimized if the percentage of the rectum receiving >=70 Gy was <10% or the rectum receiving >=50 Gy was <50%. Conclusion: Patients taking AC therapy have a substantial risk of bleeding toxicity from external beam radiotherapy. In this setting, dose escalation or intensity-modulated radiotherapy should be used judiciously. With adherence to strict dose-volume histogram criteria and minimizing hotspots, the risk of severe bleeding might be reduced.« less

Out-of-field neutron and leakage photon exposures and the associated risk of second cancers in high-energy photon radiotherapy: current status.

PubMed

Takam, R; Bezak, E; Marcu, L G; Yeoh, E

2011-10-01

Determination and understanding of out-of-field neutron and photon doses in accelerator-based radiotherapy is an important issue since linear accelerators operating at high energies (>10 MV) produce secondary radiations that irradiate parts of the patient's anatomy distal to the target region, potentially resulting in detrimental health effects. This paper provides a compilation of data (technical and clinical) reported in the literature on the measurement and Monte Carlo simulations of peripheral neutron and photon doses produced from high-energy medical linear accelerators and the reported risk and/or incidence of second primary cancer of tissues distal to the target volume. Information in the tables facilitates easier identification of (1) the various methods and measurement techniques used to determine the out-of-field neutron and photon radiations, (2) reported linac-dependent out-of-field doses, and (3) the risk/incidence of second cancers after radiotherapy due to classic and modern treatment methods. Regardless of the measurement technique and type of accelerator, the neutron dose equivalent per unit photon dose ranges from as low as 0.1 mSv/Gy to as high as 20.4 mSv/Gy. This radiation dose potentially contributes to the induction of second primary cancer in normal tissues outside the treated area.

Photonic water dynamically responsive to external stimuli

PubMed Central

Sano, Koki; Kim, Youn Soo; Ishida, Yasuhiro; Ebina, Yasuo; Sasaki, Takayoshi; Hikima, Takaaki; Aida, Takuzo

2016-01-01

Fluids that contain ordered nanostructures with periodic distances in the visible-wavelength range, anomalously exhibit structural colours that can be rapidly modulated by external stimuli. Indeed, some fish can dynamically change colour by modulating the periodic distance of crystalline guanine sheets cofacially oriented in their fluid cytoplasm. Here we report that a dilute aqueous colloidal dispersion of negatively charged titanate nanosheets exhibits structural colours. In this ‘photonic water', the nanosheets spontaneously adopt a cofacial geometry with an ultralong periodic distance of up to 675 nm due to a strong electrostatic repulsion. Consequently, the photonic water can even reflect near-infrared light up to 1,750 nm. The structural colour becomes more vivid in a magnetic flux that induces monodomain structural ordering of the colloidal dispersion. The reflective colour of the photonic water can be modulated over the entire visible region in response to appropriate physical or chemical stimuli. PMID:27572806

Influence of age on the pattern and outcome of external beam radiotherapy for clinically localized prostate cancer.

PubMed

Ogawa, Kazuhiko; Nakamura, Katsumasa; Onishi, Hiroshi; Koizumi, Masahiko; Sasaki, Tomonari; Araya, Masayuki; Miyabe, Yuuki; Otani, Yuuki; Teshima, Teruki

2006-01-01

The influence of age on the patterns and outcomes of external beam radiotherapy for clinically localized prostate cancer patients was examined. The Japanese Patterns of Care Study surveys were used to compare the processes and outcomes of radical external beam radiotherapy in 140 elderly patients (>75 years old) and 304 younger patients (<75 years old). Although the Karnofsky performance status was significantly different between elderly and younger patients, there were no significant differences in disease characteristics such as pretreatment PSA level, differentiation, Gleason combined score and clinical T stage. There were also no significant differences in the treatment characteristics such as CT-based treatment planning, conformal therapy, total radiation doses (both a median of 66.0 Gy) and hormonal therapy usage. Moreover, no significant differences in overall survival, biochemical relapse-free survival and late toxicity rates were observed between elderly and younger patients. Age did not influence the disease characteristics, patterns of external beam radiotherapy, survival and late toxicities for clinically localized prostate cancer patients. Therefore, radiotherapy could represent an important treatment modality for elderly patients as well as for younger ones.

Differentiated thyroid cancer. Impact of adjuvant external radiotherapy in patients with perithyroidal tumor infiltration (stage pT4).

PubMed

Farahati, J; Reiners, C; Stuschke, M; Müller, S P; Stüben, G; Sauerwein, W; Sack, H

1996-01-01

The role of adjuvant external radiotherapy in the survival of patients with differentiated thyroid cancer (DTC) is controversial. To our knowledge, no attempt has been undertaken thus far to assess the impact of this therapy with respect to the papillary and follicular types of thyroid cancer as separate entities. Between 1979 and 1992, 238 patients with differentiated papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) with Stage pT4 have been treated and followed in our clinic. One hundred sixty-nine patients free of metastases at the final staging, which was performed after the second radioiodine therapy, were included in this study. The standard treatment comprised total thyroidectomy, ablative radioiodine therapy, and thyroid-stimulating hormone-suppressive therapy with levothyroxin. Ninety-nine patients free of disease after the final staging received additional external radiotherapy to the neck (with a dose of 50-60 Gy), whereas the remaining 70 patients were treated with the standard treatment protocol only. Distributions of age, sex, and follow-up time were comparable in both irradiated and nonirradiated groups. Multivariate analysis of the influence of age, sex, histologic subtype, and lymph node status as well as of external radiotherapy on the time to first locoregional and distant failure (LDF), and the time to locoregional recurrence (LR), was accomplished using Cox's proportional hazard model. In patients with DTC, external radiotherapy was a predictive factor for improvement of both LR (P = 0.004) and locoregional and distant failure (P = 0.0003). When the time to first locoregional and distant failure was calculated separately for patients with PTC and FTC, there was a significant difference in the PTC group in favor of irradiated patients (P = 0.0001), whereas there was no effect of external radiotherapy in the FTC group (P = 0.38). Further analyses disclosed that this effect was significantly present only in patients with PTC and

Collective Evidence for Inverse Compton Emission from External Photons in High-Power Blazars

NASA Technical Reports Server (NTRS)

Meyer, Eileen T.; Fossati, Giovanni; Georganopoulos, Markos; Lister, Matthew L.

2012-01-01

We present the first collective evidence that Fermi-detected jets of high kinetic power (L(sub kin)) are dominated by inverse Compton emission from upscattered external photons. Using a sample with a broad range in orientation angle, including radio galaxies and blazars, we find that very high power sources (L(sub kin) > 10(exp 45.5) erg/s) show a significant increase in the ratio of inverse Compton to synchrotron power (Compton dominance) with decreasing orientation angle, as measured by the radio core dominance and confirmed by the distribution of superluminal speeds. This increase is consistent with beaming expectations for external Compton (EC) emission, but not for synchrotron self Compton (SSC) emission. For the lowest power jets (L(sub kin) < 10(exp 43.5) erg /s), no trend between Compton and radio core dominance is found, consistent with SSC. Importantly, the EC trend is not seen for moderately high power flat spectrum radio quasars with strong external photon fields. Coupled with the evidence that jet power is linked to the jet speed, this finding suggests that external photon fields become the dominant source of seed photons in the jet comoving frame only for the faster and therefore more powerful jets.

Clinical outcomes using carbon-ion radiotherapy and dose-volume histogram comparison between carbon-ion radiotherapy and photon therapy for T2b-4N0M0 non-small cell lung cancer-A pilot study.

PubMed

Shirai, Katsuyuki; Kawashima, Motohiro; Saitoh, Jun-Ichi; Abe, Takanori; Fukata, Kyohei; Shigeta, Yuka; Irie, Daisuke; Shiba, Shintaro; Okano, Naoko; Ohno, Tatsuya; Nakano, Takashi

2017-01-01

The safety and efficacy of carbon-ion radiotherapy for advanced non-small cell lung cancer have not been established. We evaluated the clinical outcomes and dose-volume histogram parameters of carbon-ion radiotherapy compared with photon therapy in T2b-4N0M0 non-small cell lung cancer. Twenty-three patients were treated with carbon-ion radiotherapy between May 2011 and December 2015. Seven, 14, and 2 patients had T2b, T3, and T4, respectively. The median age was 78 (range, 53-91) years, with 22 male patients. There were 12 adenocarcinomas, 8 squamous cell carcinomas, 1 non-small cell lung carcinoma, and 2 clinically diagnosed lung cancers. Eleven patients were operable, and 12 patients were inoperable. Most patients (91%) were treated with carbon-ion radiotherapy of 60.0 Gy relative biological effectiveness (RBE) in 4 fractions or 64.0 Gy (RBE) in 16 fractions. Local control and overall survival rates were calculated. Dose-volume histogram parameters of normal lung and tumor coverages were compared between carbon-ion radiotherapy and photon therapies, including three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). The median follow-up of surviving patients was 25 months. Three patients experienced local recurrence, and the 2-year local control rate was 81%. During follow-up, 5 patients died of lung cancer, and 1 died of intercurrent disease. The 2-year overall survival rate was 70%. Operable patients had a better overall survival rate compared with inoperable patients (100% vs. 43%; P = 0.04). There was no grade ≥2 radiation pneumonitis. In dose-volume histogram analysis, carbon-ion radiotherapy had a significantly lower dose to normal lung and greater tumor coverage compared with photon therapies. Carbon-ion radiotherapy was effectively and safely performed for T2b-4N0M0 non-small cell lung cancer, and the dose distribution was superior compared with those for photon therapies. A Japanese multi-institutional study is

Internal Motion Estimation by Internal-external Motion Modeling for Lung Cancer Radiotherapy.

PubMed

Chen, Haibin; Zhong, Zichun; Yang, Yiwei; Chen, Jiawei; Zhou, Linghong; Zhen, Xin; Gu, Xuejun

2018-02-27

The aim of this study is to develop an internal-external correlation model for internal motion estimation for lung cancer radiotherapy. Deformation vector fields that characterize the internal-external motion are obtained by respectively registering the internal organ meshes and external surface meshes from the 4DCT images via a recently developed local topology preserved non-rigid point matching algorithm. A composite matrix is constructed by combing the estimated internal phasic DVFs with external phasic and directional DVFs. Principle component analysis is then applied to the composite matrix to extract principal motion characteristics, and generate model parameters to correlate the internal-external motion. The proposed model is evaluated on a 4D NURBS-based cardiac-torso (NCAT) synthetic phantom and 4DCT images from five lung cancer patients. For tumor tracking, the center of mass errors of the tracked tumor are 0.8(±0.5)mm/0.8(±0.4)mm for synthetic data, and 1.3(±1.0)mm/1.2(±1.2)mm for patient data in the intra-fraction/inter-fraction tracking, respectively. For lung tracking, the percent errors of the tracked contours are 0.06(±0.02)/0.07(±0.03) for synthetic data, and 0.06(±0.02)/0.06(±0.02) for patient data in the intra-fraction/inter-fraction tracking, respectively. The extensive validations have demonstrated the effectiveness and reliability of the proposed model in motion tracking for both the tumor and the lung in lung cancer radiotherapy.

The influence of neutron contamination on dosimetry in external photon beam radiotherapy.

PubMed

Horst, Felix; Czarnecki, Damian; Zink, Klemens

2015-11-01

Photon fields with energies above ∼7 MeV are contaminated by neutrons due to photonuclear reactions. Their influence on dosimetry-although considered to be very low-is widely unexplored. In this work, Monte Carlo based investigations into this issue performed with fluka and egsnrc are presented. A typical Linac head in 18 MV-X mode was modeled equivalently within both codes. egsnrc was used for the photon and fluka for the neutron production and transport simulation. Water depth dose profiles and the response of different detectors (Farmer chamber, TLD-100, TLD-600H, and TLD-700H chip) in five representative depths were simulated and the neutrons' impact (neutron absorbed dose relative to photon absorbed dose) was calculated. To take account of the neutrons' influence, a theoretically required correction factor was defined and calculated for five representative water depths. The neutrons' impact on the absorbed dose to water was found to be below 0.1% for all depths and their impact on the response of the Farmer chamber and the TLD-700H chip was found to be even less. For the TLD-100 and the TLD-600H chip it was found to be up to 0.3% and 0.7%, respectively. The theoretical correction factors to be applied to absorbed dose to water values measured with these four detectors in a depth different from the reference/calibration depth were calculated and found to be below 0.05% for the Farmer chamber and the TLD-700H chip, but up to 0.15% and 0.35% for the TLD-100 and TLD-600H chips, respectively. In thermoluminescence dosimetry the neutrons' influence (and therefore the additional inaccuracy in measurement) was found to be higher for TLD materials whose 6Li fraction is high, such as TLD-100 and TLD-600H, resulting from the thermal neutron capture reaction on 6Li. The impact of photoneutrons on the absorbed dose to water and on the response of a typical ionization chamber as well as three different types of TLD chips was quantified and was as expected found to be very

Radiogenic Side Effects After Hypofractionated Stereotactic Photon Radiotherapy of Choroidal Melanoma in 212 Patients Treated Between 1997 and 2007

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dunavoelgyi, Roman; Dieckmann, Karin; Gleiss, Andreas

2012-05-01

Purpose: To evaluate side effects of hypofractionated stereotactic photon radiotherapy for patients with choroidal melanoma. Patients and Methods: Two hundred and twelve patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at the Medical University of Vienna between 1997 and 2007 with a Linac with 6-MV photon beams in five fractions with 10, 12, or 14 Gy per fraction. Examinations for radiogenic side effects were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and then once a year thereafter until 10 years after radiotherapy.more » Adverse side effects were assessed using slit-lamp examination, funduscopy, gonioscopy, tonometry, and, if necessary, fundus photography and fluorescein angiography. Evaluations of incidence of side effects are based on an actuarial analysis. Results: One hundred and eighty-nine (89.2%) and 168 (79.2%) of the tumors were within 3 mm of the macula and the optic disc, respectively. The five most common radiotherapy side effects were retinopathy and optic neuropathy (114 cases and 107 cases, respectively), cataract development (87 cases), neovascular glaucoma (46 cases), and corneal epithelium defects (41 cases). In total, 33.6%, 38.5%, 51.2%, 75.5%, and 77.6% of the patients were free of any radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, or corneal epithelium defects 5 years after radiotherapy, respectively. Conclusion: In centrally located choroidal melanoma hypofractionated stereotactic photon radiotherapy shows a low to moderate rate of adverse long-term side effects comparable with those after proton beam radiotherapy. Future fractionation schemes should seek to further reduce adverse side effects rate while maintaining excellent local tumor control.« less

The influence of neutron contamination on dosimetry in external photon beam radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Horst, Felix, E-mail: felix.ernst.horst@kmub.thm.de; Czarnecki, Damian; Zink, Klemens

Purpose: Photon fields with energies above ∼7 MeV are contaminated by neutrons due to photonuclear reactions. Their influence on dosimetry—although considered to be very low—is widely unexplored. Methods: In this work, Monte Carlo based investigations into this issue performed with FLUKA and EGSNRC are presented. A typical Linac head in 18 MV-X mode was modeled equivalently within both codes. EGSNRC was used for the photon and FLUKA for the neutron production and transport simulation. Water depth dose profiles and the response of different detectors (Farmer chamber, TLD-100, TLD-600H, and TLD-700H chip) in five representative depths were simulated and the neutrons’more » impact (neutron absorbed dose relative to photon absorbed dose) was calculated. To take account of the neutrons’ influence, a theoretically required correction factor was defined and calculated for five representative water depths. Results: The neutrons’ impact on the absorbed dose to water was found to be below 0.1% for all depths and their impact on the response of the Farmer chamber and the TLD-700H chip was found to be even less. For the TLD-100 and the TLD-600H chip it was found to be up to 0.3% and 0.7%, respectively. The theoretical correction factors to be applied to absorbed dose to water values measured with these four detectors in a depth different from the reference/calibration depth were calculated and found to be below 0.05% for the Farmer chamber and the TLD-700H chip, but up to 0.15% and 0.35% for the TLD-100 and TLD-600H chips, respectively. In thermoluminescence dosimetry the neutrons’ influence (and therefore the additional inaccuracy in measurement) was found to be higher for TLD materials whose {sup 6}Li fraction is high, such as TLD-100 and TLD-600H, resulting from the thermal neutron capture reaction on {sup 6}Li. Conclusions: The impact of photoneutrons on the absorbed dose to water and on the response of a typical ionization chamber as well as three

Results of a multicentric in silico clinical trial (ROCOCO): comparing radiotherapy with photons and protons for non-small cell lung cancer.

PubMed

Roelofs, Erik; Engelsman, Martijn; Rasch, Coen; Persoon, Lucas; Qamhiyeh, Sima; de Ruysscher, Dirk; Verhaegen, Frank; Pijls-Johannesma, Madelon; Lambin, Philippe

2012-01-01

This multicentric in silico trial compares photon and proton radiotherapy for non-small cell lung cancer patients. The hypothesis is that proton radiotherapy decreases the dose and the volume of irradiated normal tissues even when escalating to the maximum tolerable dose of one or more of the organs at risk (OAR). Twenty-five patients, stage IA-IIIB, were prospectively included. On 4D F18-labeled fluorodeoxyglucose-positron emission tomography-computed tomography scans, the gross tumor, clinical and planning target volumes, and OAR were delineated. Three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) photon and passive scattered conformal proton therapy (PSPT) plans were created to give 70 Gy to the tumor in 35 fractions. Dose (de-)escalation was performed by rescaling to the maximum tolerable dose. Protons resulted in the lowest dose to the OAR, while keeping the dose to the target at 70 Gy. The integral dose (ID) was higher for 3DCRT (59%) and IMRT (43%) than for PSPT. The mean lung dose reduced from 18.9 Gy for 3DCRT and 16.4 Gy for IMRT to 13.5 Gy for PSPT. For 10 patients, escalation to 87 Gy was possible for all 3 modalities. The mean lung dose and ID were 40 and 65% higher for photons than for protons, respectively. The treatment planning results of the Radiation Oncology Collaborative Comparison trial show a reduction of ID and the dose to the OAR when treating with protons instead of photons, even with dose escalation. This shows that PSPT is able to give a high tumor dose, while keeping the OAR dose lower than with the photon modalities.

Influence of an externally modulated photonic link on a microwave communications system

NASA Technical Reports Server (NTRS)

Yao, X. S.; Maleki, L.

1994-01-01

We analyze the influence of an externally modulated photonic link on the performance of a microwave communications system. From the analysis, we deduce limitations on the photocurrent, magnitude of the relaxation oscillation noise of the laser, third-order intercept point of the preamplifier, and other parameters in order for the photonic link to function according to the system specifications. Based on this, we outline a procedure for designing a photonic link that can be integrated in a system with minimal performance degradation.

In vivo dosimetry in external beam radiotherapy.

PubMed

Mijnheer, Ben; Beddar, Sam; Izewska, Joanna; Reft, Chester

2013-07-01

In vivo dosimetry (IVD) is in use in external beam radiotherapy (EBRT) to detect major errors, to assess clinically relevant differences between planned and delivered dose, to record dose received by individual patients, and to fulfill legal requirements. After discussing briefly the main characteristics of the most commonly applied IVD systems, the clinical experience of IVD during EBRT will be summarized. Advancement of the traditional aspects of in vivo dosimetry as well as the development of currently available and newly emerging noninterventional technologies are required for large-scale implementation of IVD in EBRT. These new technologies include the development of electronic portal imaging devices for 2D and 3D patient dosimetry during advanced treatment techniques, such as IMRT and VMAT, and the use of IVD in proton and ion radiotherapy by measuring the decay of radiation-induced radionuclides. In the final analysis, we will show in this Vision 20∕20 paper that in addition to regulatory compliance and reimbursement issues, the rationale for in vivo measurements is to provide an accurate and independent verification of the overall treatment procedure. It will enable the identification of potential errors in dose calculation, data transfer, dose delivery, patient setup, and changes in patient anatomy. It is the authors' opinion that all treatments with curative intent should be verified through in vivo dose measurements in combination with pretreatment checks.

Categorizing accident sequences in the external radiotherapy for risk analysis

PubMed Central

2013-01-01

Purpose This study identifies accident sequences from the past accidents in order to help the risk analysis application to the external radiotherapy. Materials and Methods This study reviews 59 accidental cases in two retrospective safety analyses that have collected the incidents in the external radiotherapy extensively. Two accident analysis reports that accumulated past incidents are investigated to identify accident sequences including initiating events, failure of safety measures, and consequences. This study classifies the accidents by the treatments stages and sources of errors for initiating events, types of failures in the safety measures, and types of undesirable consequences and the number of affected patients. Then, the accident sequences are grouped into several categories on the basis of similarity of progression. As a result, these cases can be categorized into 14 groups of accident sequence. Results The result indicates that risk analysis needs to pay attention to not only the planning stage, but also the calibration stage that is committed prior to the main treatment process. It also shows that human error is the largest contributor to initiating events as well as to the failure of safety measures. This study also illustrates an event tree analysis for an accident sequence initiated in the calibration. Conclusion This study is expected to provide sights into the accident sequences for the prospective risk analysis through the review of experiences. PMID:23865005

On-chip interference of single photons from an embedded quantum dot and an external laser

DOE Office of Scientific and Technical Information (OSTI.GOV)

Prtljaga, N., E-mail: n.prtljaga@sheffield.ac.uk; Bentham, C.; O'Hara, J.

2016-06-20

In this work, we demonstrate the on-chip two-photon interference between single photons emitted by a single self-assembled InGaAs quantum dot and an external laser. The quantum dot is embedded within one arm of an air-clad directional coupler which acts as a beam-splitter for incoming light. Photons originating from an attenuated external laser are coupled to the second arm of the beam-splitter and then combined with the quantum dot photons, giving rise to two-photon quantum interference between dissimilar sources. We verify the occurrence of on-chip Hong-Ou-Mandel interference by cross-correlating the optical signal from the separate output ports of the directional coupler.more » This experimental approach allows us to use a classical light source (laser) to assess in a single step the overall device performance in the quantum regime and probe quantum dot photon indistinguishability on application realistic time scales.« less

Dosimetric characterization of optically stimulated luminescence dosimeter with therapeutic photon beams for use in clinical radiotherapy measurements.

PubMed

Ponmalar, Retna; Manickam, Ravikumar; Ganesh, K M; Saminathan, Sathiyan; Raman, Arun; Godson, Henry Finlay

2017-01-01

The modern radiotherapy techniques impose new challenges for dosimetry systems with high precision and accuracy in in vivo and in phantom dosimetric measurements. The knowledge of the basic characterization of a dosimetric system before patient dose verification is crucial. This incites the investigation of the potential use of nanoDot optically stimulated luminescence dosimeter (OSLD) for application in radiotherapy with therapeutic photon beams. Measurements were carried out with nanoDot OSLDs to evaluate the dosimetric characteristics such as dose linearity, dependency on field size, dose rate, energy and source-to-surface distance (SSD), reproducibility, fading effect, reader stability, and signal depletion per read out with cobalt-60 (60 Co) beam, 6 and 18 MV therapeutic photon beams. The data acquired with OSLDs were validated with ionization chamber data where applicable. Good dose linearity was observed for doses up to 300 cGy and above which supralinear behavior. The standard uncertainty with field size observed was 1.10% ± 0.4%, 1.09% ± 0.34%, and 1.2% ± 0.26% for 6 MV, 18 MV, and 60 Co beam, respectively. The maximum difference with dose rate was 1.3% ± 0.4% for 6 MV and 1.4% ± 0.4% for 18 MV photon beams. The largest variation in SSD was 1.5% ± 1.2% for 60 Co, 1.5% ± 0.9% for 6 MV, and 1.5% ± 1.3% for 18 MV photon beams. The energy dependence of OSL response at 18 MV and 60 Co with 6 MV beam was 1.5% ± 0.7% and 1.7% ± 0.6%, respectively. In addition, good reproducibility, stability after the decay of transient signal, and predictable fading were observed. The results obtained in this study indicate the efficacy and suitability of nanoDot OSLD for dosimetric measurements in clinical radiotherapy.

Analysis of errors detected in external beam audit dosimetry program at Mexican radiotherapy centers

NASA Astrophysics Data System (ADS)

Álvarez-Romero, José T.; Tovar-Muñoz, Víctor M.

2012-10-01

Presented and analyzed are the causes of deviation observed in the pilot postal dosimetry audit program to verify the absorbed dose to water Dw in external beams of teletherapy 60Co and/or linear accelerators in Mexican radiotherapy centers, during the years 2007-2011.

Effect of external shielding for neutrons during radiotherapy for prostate cancer, considering the 2300 CD linear accelerator and voxel phantom

NASA Astrophysics Data System (ADS)

Thalhofer, J. L.; Roque, H. S.; Rebello, W. F.; Correa, S. A.; Silva, A. X.; Souza, E. M.; Batita, D. V. S.; Sandrini, E. S.

2014-02-01

Photoneutron production occurs when high energy photons, greater than 6.7 MeV, interact with linear accelerator head structures. In Brazil, the National Cancer Institute, one of the centers of reference in cancer treatment, uses radiation at 4 angles (0°, 90°, 180° and 270°) as treatment protocol for prostate cancer. With the objective of minimizing the dose deposited in the patient due to photoneutrons, this study simulated radiotherapy treatment using MCNPX, considering the most realistic environment; simulating the radiotherapy room, the Linac 2300 head, the MAX phantom and the treatment protocol with the accelerator operating at 18 MV. In an attempt to reduce the dose deposited by photoneutrons, an external shielding was added to the Linac 2300. Results show that the equivalent dose due to photoneutrons deposited in the patient diminished. The biggest reduction was seen in bone structures, such as the tibia and fibula, and mandible, at approximately 75%. Besides that, organs such as the brain, pancreas, small intestine, lungs and thyroid revealed a reduction of approximately 60%. It can be concluded that the shielding developed by our research group is efficient in neutron shielding, reducing the dose for the patient, and thus, the risk of secondary cancer, and increasing patient survival rates.

Intensity modulated neutron radiotherapy optimization by photon proxy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Snyder, Michael; Hammoud, Ahmad; Bossenberger, Todd

2012-08-15

Purpose: Introducing intensity modulation into neutron radiotherapy (IMNRT) planning has the potential to mitigate some normal tissue complications seen in past neutron trials. While the hardware to deliver IMNRT plans has been in use for several years, until recently the IMNRT planning process has been cumbersome and of lower fidelity than conventional photon plans. Our in-house planning system used to calculate neutron therapy plans allows beam weight optimization of forward planned segments, but does not provide inverse optimization capabilities. Commercial treatment planning systems provide inverse optimization capabilities, but currently cannot model our neutron beam. Methods: We have developed a methodologymore » and software suite to make use of the robust optimization in our commercial planning system while still using our in-house planning system to calculate final neutron dose distributions. Optimized multileaf collimator (MLC) leaf positions for segments designed in the commercial system using a 4 MV photon proxy beam are translated into static neutron ports that can be represented within our in-house treatment planning system. The true neutron dose distribution is calculated in the in-house system and then exported back through the MATLAB software into the commercial treatment planning system for evaluation. Results: The planning process produces optimized IMNRT plans that reduce dose to normal tissue structures as compared to 3D conformal plans using static MLC apertures. The process involves standard planning techniques using a commercially available treatment planning system, and is not significantly more complex than conventional IMRT planning. Using a photon proxy in a commercial optimization algorithm produces IMNRT plans that are more conformal than those previously designed at our center and take much less time to create. Conclusions: The planning process presented here allows for the optimization of IMNRT plans by a commercial treatment

Comparing the dosimetric impact of interfractional anatomical changes in photon, proton and carbon ion radiotherapy for pancreatic cancer patients

NASA Astrophysics Data System (ADS)

Houweling, Antonetta C.; Crama, Koen; Visser, Jorrit; Fukata, Kyohei; Rasch, Coen R. N.; Ohno, Tatsuya; Bel, Arjan; van der Horst, Astrid

2017-04-01

Radiotherapy using charged particles is characterized by a low dose to the surrounding healthy organs, while delivering a high dose to the tumor. However, interfractional anatomical changes can greatly affect the robustness of particle therapy. Therefore, we compared the dosimetric impact of interfractional anatomical changes (i.e. body contour differences and gastrointestinal gas volume changes) in photon, proton and carbon ion therapy for pancreatic cancer patients. In this retrospective planning study, photon, proton and carbon ion treatment plans were created for 9 patients. Fraction dose calculations were performed using daily cone-beam CT (CBCT) images. To this end, the planning CT was deformably registered to each CBCT; gastrointestinal gas volumes were delineated on the CBCTs and copied to the deformed CT. Fraction doses were accumulated rigidly. To compare planned and accumulated dose, dose-volume histogram (DVH) parameters of the planned and accumulated dose of the different radiotherapy modalities were determined for the internal gross tumor volume, internal clinical target volume (iCTV) and organs-at-risk (OARs; duodenum, stomach, kidneys, liver and spinal cord). Photon plans were highly robust against interfractional anatomical changes. The difference between the planned and accumulated DVH parameters for the photon plans was less than 0.5% for the target and OARs. In both proton and carbon ion therapy, however, coverage of the iCTV was considerably reduced for the accumulated dose compared with the planned dose. The near-minimum dose ({{D}98 % } ) of the iCTV reduced with 8% for proton therapy and with 10% for carbon ion therapy. The DVH parameters of the OARs differed less than 3% for both particle modalities. Fractionated radiotherapy using photons is highly robust against interfractional anatomical changes. In proton and carbon ion therapy, such changes can severely reduce the dose coverage of the target.

The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries.

PubMed

Yap, M L; Hanna, T P; Shafiq, J; Ferlay, J; Bray, F; Delaney, G P; Barton, M

2017-02-01

More than half of all cancer diagnoses worldwide occur in low- and middle-income countries (LMICs) and the incidence is projected to rise substantially within the next 20 years. Radiotherapy is a vital, cost-effective treatment for cancer; yet there is currently a huge deficit in radiotherapy services within these countries. The aim of this study was to estimate the potential outcome benefits if external beam radiotherapy was provided to all patients requiring such treatment in LMICs, according to the current evidence-based guidelines. Projected estimates of these benefits were calculated to 2035, obtained by applying the previously published Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) demand and outcome benefit estimates to cancer incidence and projection data from the GLOBOCAN 2012 data. The estimated optimal radiotherapy utilisation rate for all LMICs was 50%. There were about 4.0 million cancer patients in LMICs who required radiotherapy in 2012. This number is projected to increase by 78% by 2035, a far steeper increase than the 38% increase expected in high-income countries. National radiotherapy benefits varied widely, and were influenced by case mix. The 5 year population local control and survival benefits for all LMICs, if radiotherapy was delivered according to guidelines, were estimated to be 9.6% and 4.4%, respectively, compared with no radiotherapy use. This equates to about 1.3 million patients who would derive a local control benefit in 2035, whereas over 615 000 patients would derive a survival benefit if the demand for radiotherapy in LMICs was met. The potential outcome benefits were found to be higher in LMICs. These results further highlight the urgent need to reduce the gap between the supply of, and demand for, radiotherapy in LMICs. We must attempt to address this 'silent crisis' as a matter of priority and the approach must consider the complex societal challenges unique to LMICs. Copyright © 2016 The Royal College

External quantum efficiency enhancement by photon recycling with backscatter evasion.

PubMed

Nagano, Koji; Perreca, Antonio; Arai, Koji; Adhikari, Rana X

2018-05-01

The nonunity quantum efficiency (QE) in photodiodes (PD) causes deterioration of signal quality in quantum optical experiments due to photocurrent loss as well as the introduction of vacuum fluctuations into the measurement. In this paper, we report that the external QE enhancement of a PD was demonstrated by recycling the reflected photons. The external QE for an InGaAs PD was increased by 0.01-0.06 from 0.86-0.92 over a wide range of incident angles. Moreover, we confirmed that this technique does not increase backscattered light when the recycled beam is properly misaligned.

Methods and computer readable medium for improved radiotherapy dosimetry planning

DOEpatents

Wessol, Daniel E.; Frandsen, Michael W.; Wheeler, Floyd J.; Nigg, David W.

2005-11-15

Methods and computer readable media are disclosed for ultimately developing a dosimetry plan for a treatment volume irradiated during radiation therapy with a radiation source concentrated internally within a patient or incident from an external beam. The dosimetry plan is available in near "real-time" because of the novel geometric model construction of the treatment volume which in turn allows for rapid calculations to be performed for simulated movements of particles along particle tracks therethrough. The particles are exemplary representations of alpha, beta or gamma emissions emanating from an internal radiation source during various radiotherapies, such as brachytherapy or targeted radionuclide therapy, or they are exemplary representations of high-energy photons, electrons, protons or other ionizing particles incident on the treatment volume from an external source. In a preferred embodiment, a medical image of a treatment volume irradiated during radiotherapy having a plurality of pixels of information is obtained.

Radiobiological concepts for treatment planning of schemes that combines external beam radiotherapy and systemic targeted radiotherapy

NASA Astrophysics Data System (ADS)

Fabián Calderón Marín, Carlos; González González, Joaquín Jorge; Laguardia, Rodolfo Alfonso

2017-09-01

The combination of radiotherapy modalities with external bundles and systemic radiotherapy (CIERT) could be a reliable alternative for patients with multiple lesions or those where treatment planning maybe difficult because organ(s)-at-risk (OARs) constraints. Radiobiological models should have the capacity for predicting the biological irradiation response considering the differences in the temporal pattern of dose delivering in both modalities. Two CIERT scenarios were studied: sequential combination in which one modality is executed following the other one and concurrent combination when both modalities are running simultaneously. Expressions are provided for calculation of the dose-response magnitudes Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP). General results on radiobiological modeling using the linear-quadratic (LQ) model are also discussed. Inter-subject variation of radiosensitivity and volume irradiation effect in CIERT are studied. OARs should be under control during the planning in concurrent CIERT treatment as the administered activity is increased. The formulation presented here may be used for biological evaluation of prescriptions and biological treatment planning of CIERT schemes in clinical situation.

Sphere of equivalence--a novel target volume concept for intraoperative radiotherapy using low-energy X rays.

PubMed

Herskind, Carsten; Griebel, Jürgen; Kraus-Tiefenbacher, Uta; Wenz, Frederik

2008-12-01

Accelerated partial breast radiotherapy with low-energy photons from a miniature X-ray machine is undergoing a randomized clinical trial (Targeted Intra-operative Radiation Therapy [TARGIT]) in a selected subgroup of patients treated with breast-conserving surgery. The steep radial dose gradient implies reduced tumor cell control with increasing depth in the tumor bed. The purpose was to compare the expected risk of local recurrence in this nonuniform radiation field with that after conventional external beam radiotherapy. The relative biologic effectiveness of low-energy photons was modeled using the linear-quadratic formalism including repair of sublethal lesions during protracted irradiation. Doses of 50-kV X-rays (Intrabeam) were converted to equivalent fractionated doses, EQD2, as function of depth in the tumor bed. The probability of local control was estimated using a logistic dose-response relationship fitted to clinical data from fractionated radiotherapy. The model calculations show that, for a cohort of patients, the increase in local control in the high-dose region near the applicator partly compensates the reduction of local control at greater distances. Thus a "sphere of equivalence" exists within which the risk of recurrence is equal to that after external fractionated radiotherapy. The spatial distribution of recurrences inside this sphere will be different from that after conventional radiotherapy. A novel target volume concept is presented here. The incidence of recurrences arising in the tumor bed around the excised tumor will test the validity of this concept and the efficacy of the treatment. Recurrences elsewhere will have implications for the rationale of TARGIT.

Variation in Adherence to External Beam Radiotherapy Quality Measures Among Elderly Men With Localized Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bekelman, Justin E.; Zelefsky, Michael J.; Jang, Thomas L.

2007-12-01

Purpose: To characterize the variation in adherence to quality measures of external beam radiotherapy (EBRT) for localized prostate cancer and its relation to patient and provider characteristics in a population-based, representative sample of U.S. men. Methods and Materials: We evaluated EBRT quality measures proposed by a RAND expert panel of physicians among men aged {>=}65 years diagnosed between 2000 and 2002 with localized prostate cancer and treated with primary EBRT using data from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare program. We assessed the adherence to five EBRT quality measures that were amenable to analysis using SEER-Medicare data: (1)more » use of conformal RT planning; (2) use of high-energy (>10-MV) photons; (3) use of custom immobilization; (4) completion of two follow-up visits with a radiation oncologist in the year after therapy; and (5) radiation oncologist board certification. Results: Of the 11,674 patients, 85% had received conformal RT planning, 75% had received high-energy photons, and 97% had received custom immobilization. One-third of patients had completed two follow-up visits with a radiation oncologist, although 91% had at least one visit with a urologist or radiation oncologist. Most patients (85%) had been treated by a board-certified radiation oncologist. Conclusions: The overall high adherence to EBRT quality measures masked substantial variation in geography, socioeconomic status in the area of residence, and teaching affiliation of the RT facility. Future research should examine the reasons for the variations in these measures and whether the variation is associated with important clinical outcomes.« less

Patient safety in external beam radiotherapy, results of the ACCIRAD project: Recommendations for radiotherapy institutions and national authorities on assessing risks and analysing adverse error-events and near misses.

PubMed

Malicki, Julian; Bly, Ritva; Bulot, Mireille; Godet, Jean-Luc; Jahnen, Andreas; Krengli, Marco; Maingon, Philippe; Prieto Martin, Carlos; Skrobala, Agnieszka; Valero, Marc; Jarvinen, Hannu

2018-05-02

The ACCIRAD project, commissioned by the European Commission (EC) to develop guidelines for risk analysis of accidental and unintended exposures in external beam radiotherapy (EBRT), was completed in the year 2014. In 2015, the "General guidelines on risk management in external beam radiotherapy" were published as EC report Radiation Protection (RP)-181. The present document is the third and final report of the findings from the ACCIRAD project. The main aim of this paper is to describe the key features of the risk management process and to provide general guidelines for radiotherapy departments and national authorities on risk assessment and analysis of adverse error-events and near misses. The recommendations provided here and in EC report RP-181 are aimed at promoting the harmonisation of risk management systems across Europe, improving patient safety, and enabling more reliable inter-country comparisons. Copyright © 2018 Elsevier B.V. All rights reserved.

Interstitial and external radiotherapy in carcinoma of the soft palate and uvula

DOE Office of Scientific and Technical Information (OSTI.GOV)

Esche, B.A.; Haie, C.M.; Gerbaulet, A.P.

1988-09-01

Forty-three patients, all male, with limited epidermoid carcinoma of the soft palate and uvula were treated by interstitial implant usually associated with external radiotherapy. Most patients received 50 Gy external irradiation to the oropharynx and neck followed by 20-35 Gy by interstitial iridium-192 wires using either guide gutters or a plastic tube technique. Twelve primary tumors and two recurrences after external irradiation alone had implant only for 65-75 Gy. Total actuarial local control is 92% with no local failures in 34 T1 primary tumors. Only one serious complication was seen. Overall actuarial survival was 60% at 3 years and 37%more » at 5 years but cause-specific survivals were 81% and 64%. The leading cause of death was other aerodigestive cancer, with an actuarial rate of occurrence of 10% per year after treatment of a soft palate cancer. Interstitital brachytherapy alone or combined with external irradiation is safe, effective management for early carcinoma of the soft palate and uvula but second malignancy is a serious problem.« less

Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis.

PubMed

Blake, P; Swart, Ann Marie; Orton, J; Kitchener, H; Whelan, T; Lukka, H; Eisenhauer, E; Bacon, M; Tu, D; Parmar, M K B; Amos, C; Murray, C; Qian, W

2009-01-10

Early endometrial cancer with low-risk pathological features can be successfully treated by surgery alone. External beam radiotherapy added to surgery has been investigated in several small trials, which have mainly included women at intermediate risk of recurrence. In these trials, postoperative radiotherapy has been shown to reduce the risk of isolated local recurrence but there is no evidence that it improves recurrence-free or overall survival. We report the findings from the ASTEC and EN.5 trials, which investigated adjuvant external beam radiotherapy in women with early-stage disease and pathological features suggestive of intermediate or high risk of recurrence and death from endometrial cancer. Between July, 1996, and March, 2005, 905 (789 ASTEC, 116 EN.5) women with intermediate-risk or high-risk early-stage disease from 112 centres in seven countries (UK, Canada, Poland, Norway, New Zealand, Australia, USA) were randomly assigned after surgery to observation (453) or to external beam radiotherapy (452). A target dose of 40-46 Gy in 20-25 daily fractions to the pelvis, treating five times a week, was specified. Primary outcome measure was overall survival, and all analyses were by intention to treat. These trials were registered ISRCTN 16571884 (ASTEC) and NCT 00002807 (EN.5). After a median follow-up of 58 months, 135 women (68 observation, 67 external beam radiotherapy) had died. There was no evidence that overall survival with external beam radiotherapy was better than observation, hazard ratio 1.05 (95% CI 0.75-1.48; p=0.77). 5-year overall survival was 84% in both groups. Combining data from ASTEC and EN.5 in a meta-analysis of trials confirmed that there was no benefit in terms of overall survival (hazard ratio 1.04; 95% CI 0.84-1.29) and can reliably exclude an absolute benefit of external beam radiotherapy at 5 years of more than 3%. With brachytherapy used in 53% of women in ASTEC/EN.5, the local recurrence rate in the observation group at 5 years

Breast Cancer Patients’ Experience of External-Beam Radiotherapy

PubMed Central

Schnur, Julie B.; Ouellette, Suzanne C.; Bovbjerg, Dana H.; Montgomery, Guy H.

2013-01-01

Radiotherapy is a critical component of treatment for the majority of women with breast cancer, particularly those who receive breast conserving surgery. Although medically beneficial, radiotherapy can take a physical and psychological toll on patients. However, little is known about the specific thoughts and feelings experienced by women undergoing breast cancer radiotherapy. Therefore, the study aim was to use qualitative research methods to develop an understanding of these thoughts and feelings based on 180 diary entries, completed during radiotherapy by 15 women with Stage 0-III breast cancer. Thematic analysis identified four primary participant concerns: (a) a preoccupation with time; (b) fantasies (both optimistic and pessimistic) about life following radiotherapy; (c) the toll their side-effect experience takes on their self-esteem; and (d) feeling mystified by radiotherapy. These themes are consistent with previous literature on illness and identity. These findings have implications for the treatment and care of women undergoing breast cancer radiotherapy. PMID:19380502

Evaluation of surface and shallow depth dose reductions using a Superflab bolus during conventional and advanced external beam radiotherapy.

PubMed

Yoon, Jihyung; Xie, Yibo; Zhang, Rui

2018-03-01

The purpose of this study was to evaluate a methodology to reduce scatter and leakage radiations to patients' surface and shallow depths during conventional and advanced external beam radiotherapy. Superflab boluses of different thicknesses were placed on top of a stack of solid water phantoms, and the bolus effect on surface and shallow depth doses for both open and intensity-modulated radiotherapy (IMRT) beams was evaluated using thermoluminescent dosimeters and ion chamber measurements. Contralateral breast dose reduction caused by the bolus was evaluated by delivering clinical postmastectomy radiotherapy (PMRT) plans to an anthropomorphic phantom. For the solid water phantom measurements, surface dose reduction caused by the Superflab bolus was achieved only in out-of-field area and on the incident side of the beam, and the dose reduction increased with bolus thickness. The dose reduction caused by the bolus was more significant at closer distances from the beam. Most of the dose reductions occurred in the first 2-cm depth and stopped at 4-cm depth. For clinical PMRT treatment plans, surface dose reductions using a 1-cm Superflab bolus were up to 31% and 62% for volumetric-modulated arc therapy and 4-field IMRT, respectively, but there was no dose reduction for Tomotherapy. A Superflab bolus can be used to reduce surface and shallow depth doses during external beam radiotherapy when it is placed out of the beam and on the incident side of the beam. Although we only validated this dose reduction strategy for PMRT treatments, it is applicable to any external beam radiotherapy and can potentially reduce patients' risk of developing radiation-induced side effects. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis

PubMed Central

2009-01-01

Summary Background Early endometrial cancer with low-risk pathological features can be successfully treated by surgery alone. External beam radiotherapy added to surgery has been investigated in several small trials, which have mainly included women at intermediate risk of recurrence. In these trials, postoperative radiotherapy has been shown to reduce the risk of isolated local recurrence but there is no evidence that it improves recurrence-free or overall survival. We report the findings from the ASTEC and EN.5 trials, which investigated adjuvant external beam radiotherapy in women with early-stage disease and pathological features suggestive of intermediate or high risk of recurrence and death from endometrial cancer. Methods Between July, 1996, and March, 2005, 905 (789 ASTEC, 116 EN.5) women with intermediate-risk or high-risk early-stage disease from 112 centres in seven countries (UK, Canada, Poland, Norway, New Zealand, Australia, USA) were randomly assigned after surgery to observation (453) or to external beam radiotherapy (452). A target dose of 40–46 Gy in 20–25 daily fractions to the pelvis, treating five times a week, was specified. Primary outcome measure was overall survival, and all analyses were by intention to treat. These trials were registered ISRCTN 16571884 (ASTEC) and NCT 00002807 (EN.5). Findings After a median follow-up of 58 months, 135 women (68 observation, 67 external beam radiotherapy) had died. There was no evidence that overall survival with external beam radiotherapy was better than observation, hazard ratio 1·05 (95% CI 0·75–1·48; p=0·77). 5-year overall survival was 84% in both groups. Combining data from ASTEC and EN.5 in a meta-analysis of trials confirmed that there was no benefit in terms of overall survival (hazard ratio 1·04; 95% CI 0·84–1·29) and can reliably exclude an absolute benefit of external beam radiotherapy at 5 years of more than 3%. With brachytherapy used in 53% of women in ASTEC/EN.5, the local

Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement.

PubMed

Dröge, L H; Hinsche, T; Canis, M; Alt-Epping, B; Hess, C F; Wolff, H A

2014-02-01

Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting.

Respiratory gating for proton beam scanning versus photon 3D-CRT for breast cancer radiotherapy.

PubMed

Flejmer, Anna M; Edvardsson, Anneli; Dohlmar, Frida; Josefsson, Dan; Nilsson, Mats; Witt Nyström, Petra; Dasu, Alexandru

2016-05-01

Background Respiratory gating and proton therapy have both been proposed to reduce the cardiopulmonary burden in breast cancer radiotherapy. This study aims to investigate the additional benefit of proton radiotherapy for breast cancer with and without respiratory gating. Material and methods Twenty left-sided patients were planned on computed tomography (CT)-datasets acquired during enhanced inspiration gating (EIG) and free-breathing (FB), using photon three-dimensional conformal radiation therapy (3D-CRT) and scanned proton beams. Ten patients received treatment to the whole breast only (WBO) and 10 were treated to the breast and the regional lymph nodes (BRN). Dosimetric parameters characterizing the coverage of target volumes and the cardiopulmonary burden were compared using a paired, two-tailed Student's t-test. Results Protons ensured comparable or better target coverage than photons in all patients during both EIG and FB. The heterogeneity index decreased from 12% with photons to about 5% with protons. The mean dose to the ipsilateral lung was reduced in BRN patients from 12 Gy to 7 Gy  (RBE) in EIG and from 14 Gy to 6-7 Gy (RBE) in FB, while for WBO patients all values were about 5-6 Gy (RBE). The mean dose to heart decreased by a factor of four in WBO patients [from 1.1 Gy to 0.3 Gy (RBE) in EIG and from 2.1 Gy to 0.5 Gy (RBE) in FB] and 10 in BRN patients [from 2.1 Gy to 0.2 Gy (RBE) in EIG and from 3.4 Gy to 0.3 Gy (RBE) in FB]. Similarly, the mean and the near maximum dose to the left anterior descending artery (LAD) were significantly lower (p < 0.05) with protons in comparison with photons. Conclusion Proton spot scanning has a high potential to reduce the irradiation of organs at risk and other normal tissues for most patients, beyond what could be achieved with EIG and photon therapy. The largest dose sparing has been seen for BRN patients, both in terms of cardiopulmonary burden and integral dose.

External control of photonic bands in a magnetized cold plasma

NASA Astrophysics Data System (ADS)

Kumar, N.; Singh, P. P.; Suthar, B.; Kumar, A.; Thapa, K. B.

2018-05-01

In this analysis, the effect of external rectangle-wave-like periodic magnetic field, on photonic bandgaps (PBGs) exhibited by bulk cold plasma, has been illustrated. It is found that the forbidden gap for normal incidence decreases with a decrease in the thickness ratio for a constant magnetic field. A new gap appears for TM polarization at oblique incidence that is attributed to the Bragg's interference of plasma layers and this new gap width depends on the incident angle as well as the magnitude of the magnetic field. There is also a shifting in gap locations depending on the magnitude of the magnetic field. It is demonstrated that external parameters like magnetic field strength and the ratio of two parts of spatial period along with incident angle can tune the PBGs in a magnetized cold plasma.

Investigation of the optimum location of external markers for patient setup accuracy enhancement at external beam radiotherapy

PubMed Central

Torshabi, Ahmad Esmaili; Nankali, Saber

2016-01-01

In external beam radiotherapy, one of the most common and reliable methods for patient geometrical setup and/or predicting the tumor location is use of external markers. In this study, the main challenging issue is increasing the accuracy of patient setup by investigating external markers location. Since the location of each external marker may yield different patient setup accuracy, it is important to assess different locations of external markers using appropriate selective algorithms. To do this, two commercially available algorithms entitled a) canonical correlation analysis (CCA) and b) principal component analysis (PCA) were proposed as input selection algorithms. They work on the basis of maximum correlation coefficient and minimum variance between given datasets. The proposed input selection algorithms work in combination with an adaptive neuro‐fuzzy inference system (ANFIS) as a correlation model to give patient positioning information as output. Our proposed algorithms provide input file of ANFIS correlation model accurately. The required dataset for this study was prepared by means of a NURBS‐based 4D XCAT anthropomorphic phantom that can model the shape and structure of complex organs in human body along with motion information of dynamic organs. Moreover, a database of four real patients undergoing radiation therapy for lung cancers was utilized in this study for validation of proposed strategy. Final analyzed results demonstrate that input selection algorithms can reasonably select specific external markers from those areas of the thorax region where root mean square error (RMSE) of ANFIS model has minimum values at that given area. It is also found that the selected marker locations lie closely in those areas where surface point motion has a large amplitude and a high correlation. PACS number(s): 87.55.km, 87.55.N PMID:27929479

Modeling of the metallic port in breast tissue expanders for photon radiotherapy.

PubMed

Yoon, Jihyung; Xie, Yibo; Heins, David; Zhang, Rui

2018-03-30

The purpose of this study was to model the metallic port in breast tissue expanders and to improve the accuracy of dose calculations in a commercial photon treatment planning system (TPS). The density of the model was determined by comparing TPS calculations and ion chamber (IC) measurements. The model was further validated and compared with two widely used clinical models by using a simplified anthropomorphic phantom and thermoluminescent dosimeters (TLD) measurements. Dose perturbations and target coverage for a single postmastectomy radiotherapy (PMRT) patient were also evaluated. The dimensions of the metallic port model were determined to be 1.75 cm in diameter and 5 mm in thickness. The density of the port was adjusted to be 7.5 g/cm 3 which minimized the differences between IC measurements and TPS calculations. Using the simplified anthropomorphic phantom, we found the TPS calculated point doses based on the new model were in agreement with TLD measurements within 5.0% and were more accurate than doses calculated based on the clinical models. Based on the photon treatment plans for a real patient, we found that the metallic port has a negligible dosimetric impact on chest wall, while the port introduced significant dose shadow in skin area. The current clinical port models either overestimate or underestimate the attenuation from the metallic port, and the dose perturbation depends on the plan and the model in a complex way. TPS calculations based on our model of the metallic port showed good agreement with measurements for all cases. This new model could improve the accuracy of dose calculations for PMRT patients who have temporary tissue expanders implanted during radiotherapy and could potentially reduce the risk of complications after the treatment. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Measurement and properties of the dose-area product ratio in external small-beam radiotherapy.

PubMed

Niemelä, Jarkko; Partanen, Mari; Ojala, Jarkko; Sipilä, Petri; Björkqvist, Mikko; Kapanen, Mika; Keyriläinen, Jani

2017-06-21

In small-beam radiation therapy (RT) the measurement of the beam quality parameter, i.e. the tissue-phantom ratio or TPR 20,10 , using a conventional point detector is a challenge. To obtain reliable results, one has to consider potential sources of error, including volume averaging and adjustment of the point detector into the narrow beam. To overcome these challenges, a different type of beam quality parameter in small beams was studied, namely the dose-area product ratio, or DAPR 20,10 . With this method, the measurement of a dose-area product (DAP) using a large-area plane-parallel chamber (LAC) eliminates the uncertainties in detector positioning and volume averaging that are present when using a point detector. In this study, the properties of the DAPR 20,10 of a cone-collimated 6 MV photon beam were investigated using Monte Carlo (MC) calculations and the obtained values were compared to measurements obtained using two LAC detectors, PTW Type 34073 and PTW Type 34070. In addition, the possibility of determining the DAP using EBT3 film and a Razor diode detector was studied. The determination of the DAPR 20,10 value was found to be feasible in external small-beam radiotherapy using cone-collimated beams with diameters from 4-40 mm, based on the results of the two LACs, the MC calculations and the Razor diode. The measurements indicated a constant DAPR 20,10 value for fields 20-40 mm in diameter, with a maximum relative change of 0.6%, but an increase of 7.0% for fields from 20-4 mm in diameter for the PTW Type 34070 chamber. Simulations and measurements showed an increase of DAPR 20,10 with increasing LAC size or dose integral area for the studied 4-40 mm cone-collimated 6 MV photon beams. This has the consequence that there should be a reference to the size of the used LAC active area or the DAP integration area with the reported DAPR 20,10 value.

Effect of Gold Nanoparticles on Prostate Dose Distribution under Ir-192 Internal and 18 MV External Radiotherapy Procedures Using Gel Dosimetry and Monte Carlo Method.

PubMed

Khosravi, H; Hashemi, B; Mahdavi, S R; Hejazi, P

2015-03-01

Gel polymers are considered as new dosimeters for determining radiotherapy dose distribution in three dimensions. The ability of a new formulation of MAGIC-f polymer gel was assessed by experimental measurement and Monte Carlo (MC) method for studying the effect of gold nanoparticles (GNPs) in prostate dose distributions under the internal Ir-192 and external 18MV radiotherapy practices. A Plexiglas phantom was made representing human pelvis. The GNP shaving 15 nm in diameter and 0.1 mM concentration were synthesized using chemical reduction method. Then, a new formulation of MAGIC-f gel was synthesized. The fabricated gel was poured in the tubes located at the prostate (with and without the GNPs) and bladder locations of the phantom. The phantom was irradiated to an Ir-192 source and 18 MV beam of a Varian linac separately based on common radiotherapy procedures used for prostate cancer. After 24 hours, the irradiated gels were read using a Siemens 1.5 Tesla MRI scanner. The absolute doses at the reference points and isodose curves resulted from the experimental measurement of the gels and MC simulations following the internal and external radiotherapy practices were compared. The mean absorbed doses measured with the gel in the presence of the GNPs in prostate were 15% and 8 % higher than the corresponding values without the GNPs under the internal and external radiation therapies, respectively. MC simulations also indicated a dose increase of 14 % and 7 % due to presence of the GNPs, for the same experimental internal and external radiotherapy practices, respectively. There was a good agreement between the dose enhancement factors (DEFs) estimated with MC simulations and experiment gel measurements due to the GNPs. The results indicated that the polymer gel dosimetry method as developed and used in this study, can be recommended as a reliable method for investigating the DEF of GNPs in internal and external radiotherapy practices.

Quantum correlations and violation of the Bell inequality induced by an external field in a two-photon radiative cascade

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yuan Luqi; Das, Sumanta

2011-06-15

We study the polarization-dependent second-order correlation of a pair of photons emitted in a four-level radiative cascade driven by an external field. It is found that the quantum correlations of the emitted photons, degraded by the energy splitting of the intermediate levels in the radiative cascade, can be efficiently revived by a far-detuned external field. The physics of this revival is linked to an induced Stark shift and the formation of dressed states in the system by the nonresonant external field. Furthermore, we investigated the competition between the effect of the coherent external field and incoherent dephasing of the intermediatemore » levels. We find that the degradation of quantum correlations due to the incoherent dephasing can be contained for small dephasing with the external field. We also studied the nonlocality of the correlations by evaluating the Bell inequality in the linear polarization basis for the radiative cascade. We find that the Bell parameter decreases rapidly with increase in the intermediate-level energy splitting or incoherent dephasing rate to the extent that there is no violation. However, the presence of an external field leads to control over the degrading mechanisms and preservation of nonlocal correlation among the photons. This in turn can induce a violation of Bell's inequality in the radiative cascade for arbitrary intermediate-level splitting and small incoherent dephasing.« less

[Description of latest generation equipment in external radiotherapy].

PubMed

Pellejero, S; Lozares, S; Mañeru, F

2009-01-01

Both the planning systems and the form of administering radiotherapy have changed radically since the introduction of 3D planning. At present treatment planning based on computerised axial tomography (CAT) images is standard practice in radiotherapy services. In recent years lineal accelerators for medical use have incorporated technology capable of administering intensity modulated radiation beams (IMRT). With this mode distributions of conformed doses are generated that adjust to the three dimensional form of the white volume, providing appropriate coverage and a lower dose to nearby risk organs. The use of IMRT is rapidly spreading amongst radiotherapy centres throughout the world. This growing use of IMRT has focused attention on the need for greater control of the geometric uncertainties in positioning the patient and control of internal movements. To this end, both flat and volumetric image systems have been incorporated into the treatment equipment, making image-guided radiotherapy (IGRT) possible. This article offers a brief description of the latest advances included in the planning and administration of radiotherapy treatment.

SU-F-T-360: Dosimetric Impacts On the Mucosa and Bone in Radiotherapy with Unflattened Photon Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chow, J; Owrangi, A

Purpose: This study investigated the dosimetric impacts on the mucosa and bone when using the unflattened photon beams in radiotherapy. Dose calculations were carried out by Monte Carlo simulation. Methods: Heterogeneous phantoms containing water (soft tissue and mucosa), air and bone, with mucosa thicknesses varying from 0.5 – 3 mm were irradiated by the 6 MV unflattened and flattened photon beams (field size = 10 × 10 cm{sup 2}), produced by a Varian TrueBEAM linear accelerator. The photon energy spectra of the beams, mean bone and mucosal doses with different mucosa thicknesses were calculated using the EGSnrc Monte Carlo code.more » Results: It is found that the flattened photon beams had higher mean bone doses (1.3% and 2% for upper and lower bone regarding the phantom geometry, respectively) than the unflattened beams, and the mean bone doses of both beams did not vary significantly with the mucosa thickness. Similarly, flattened photon beams had higher mucosal dose (0.9% and 1.6% for upper and lower mucosa, respectively) than the unflattened beams. This is due to the larger slope of the depth dose for the unflattened photon beams compared to the flattened. The mucosal doses of both beams were found increased with the mucosa thickness. Moreover, the mucosal dose differences between the unflattened and flattened beams increased with the mucosa thickness. For photon energy spectra on the mucosal layers, it is found that the unflattened photon beams contained a larger portion of lowenergy photons than the flattened beams. The photon energy spectra did not change significantly with the mucosa thickness. Conclusion: It is concluded that the mucosal and bone dose for the unflattened photon beams were not more than 2% lower than the flattened beams, though the flattening filter free beams contained larger portion of low-energy photons than the flattened beams.« less

External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna.

PubMed

Esik, O; Seitz, W; Lövey, J; Knocke, T H; Gaudi, I; Németh, G; Pötter, R

1999-04-01

To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care. Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E. Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993,29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects between those of cases

Experimental and Monte Carlo measurements of dose perturbation around a non-radioactive brachytherapy seed in external beam radiotherapy

NASA Astrophysics Data System (ADS)

Steinman, James P.

limited to ~2 mm upstream and ~5 mm downstream with reference to the seed surface in relation to the incident photon beam. As with other heterogeneities in a human body, the dose perturbation due to I-125 seeds in external beam radiotherapy depends on incident beam energy, field size, and the composition of the seed. However, unlike other heterogeneities, no depth dependence of the seed in the material was noted. With multiple seeds spaced apart and multiple fields normally used in prostate treatment, the dose perturbation due to them may not be clinically significant.

SU-F-T-361: Dose Enhancement Due to Nanoparticle Addition in Skin Radiotherapy: A Monte Carlo Study Using Kilovoltage Photon Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zheng, X; Chow, J

Purpose: This study investigated the dose enhancement due to addition of nanoparticles with different types and concentrations in skin radiotherapy using kilovoltage photon beams. Methods: An inhomogeneous water phantom (15×15×10 cm{sup 3}) having the skin target layer (0.5–5 mm), added with different concentrations (3–40 mg/ml) of nanoparticles (Au, Pt, I, Ag and Fe{sub 2}O{sub 3}), was irradiated by the 105 and 220 kVp photon beams produced by a Gulmay D3225 Orthovoltage unit. The circular cone of 5-cm diameter and source-to-surface distance of 20 cm were used. Doses in the skin target layer with and without adding the nanoparticles were calculatedmore » using Monte Carlo simulation (the EGSnrc code) through the macroscopic approach. Dose enhancement ratio (DER), defined as the ratio of dose at the target with nanoparticle addition to the dose without addition, was calculated for each type and concentration of nanoparticle in different target thickness. Results: For Au nanoparticle, DER dependence on target thickness for the 220 kVp photon beams was not significant. However, DER for Au nanoparticle was found decreasing with an increase of target thickness when the nanoparticle concentration was increased from 18 to 40 mg/ml using the 105 kVp photon beams. For nanoparticle concentration of 40 mg/ml, DER variation with target thickness was not significant for the 220 kVp photon beams, but DEF was found decreasing with the target thickness when lower energy of photon beam (105 kVp) was used. DEF was found increasing with an increase of nanoparticle concentration. The higher the DEF increasing rate, the higher the atomic number of the nanoparticle except I and Ag for the same target thickness. Conclusion: It is concluded that nanoparticle addition can result in dose enhancement in kilovoltage skin radiotherapy. Moreover, the DER is related to the photon beam energy, target thickness, atomic number and concentration of nanoparticles.« less

SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoffman, D; Chung, E; Hess, C

2015-06-15

Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patientmore » treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements

Characterisation and novel applications of glass beads as dosimeters in radiotherapy

NASA Astrophysics Data System (ADS)

Jafari, Shakardokht

The intent of external beam radiotherapy is to deliver as high a radiation dose as possible to tumour volume whilst minimizing the dose to surrounding normal tissues. Recent development of techniques such as intensity modulated radiation therapy (IMRT) and stereotactic ablative body radiotherapy (SABR) aim to extend this capability. The main feature of these techniques is to use beams which often contain small fields and very steep dose gradients. These present several dosimetric challenges including loss of charge particle equilibrium (CPE), partial occlusion of the direct-beam source and steep fall-off in dose in the penumbra. Dosimeters which are small in size relative to the radiation field dimensions are recommended for such conditions. The particular glass beads studied herein have several potentially favourable physical characteristics; they are small in size (1 to 3 mm diameter), chemically inert, inexpensive, readily available and reusable. The dosimetric characterisation of glass beads has been obtained by irradiating them in various radiotherapy beams of kilo-voltage and mega-voltage photons, megavoltage electrons, protons and carbon ions. They exhibit minimal fading compared with commercial LiF thermo-luminescent (TL) dosimeters, have high TL light transparency, high sensitivity and a large dynamic dose range that remains linear from 1 cGy to 100 Gy They have also been shown to be independent of dose rate and beam incidence angle, as well as having a low variation in response with energy over a range of megavoltage photon and electron beams. The latter characteristic is of importance, where spectral changes may occur as a function of field size and off axis location and for the use of dosimeters in postal audit situations where each institution may have slightly different quality index (QI) for their respective photon energies thus ensuring that the calibration is still valid. These properties suggest their practical use as TL dosimeters for

Conversion coefficients for determination of dispersed photon dose during radiotherapy: NRUrad input code for MCNP.

PubMed

Shahmohammadi Beni, Mehrdad; Ng, C Y P; Krstic, D; Nikezic, D; Yu, K N

2017-01-01

Radiotherapy is a common cancer treatment module, where a certain amount of dose will be delivered to the targeted organ. This is achieved usually by photons generated by linear accelerator units. However, radiation scattering within the patient's body and the surrounding environment will lead to dose dispersion to healthy tissues which are not targets of the primary radiation. Determination of the dispersed dose would be important for assessing the risk and biological consequences in different organs or tissues. In the present work, the concept of conversion coefficient (F) of the dispersed dose was developed, in which F = (Dd/Dt), where Dd was the dispersed dose in a non-targeted tissue and Dt is the absorbed dose in the targeted tissue. To quantify Dd and Dt, a comprehensive model was developed using the Monte Carlo N-Particle (MCNP) package to simulate the linear accelerator head, the human phantom, the treatment couch and the radiotherapy treatment room. The present work also demonstrated the feasibility and power of parallel computing through the use of the Message Passing Interface (MPI) version of MCNP5.

Conversion coefficients for determination of dispersed photon dose during radiotherapy: NRUrad input code for MCNP

PubMed Central

Krstic, D.; Nikezic, D.

2017-01-01

Radiotherapy is a common cancer treatment module, where a certain amount of dose will be delivered to the targeted organ. This is achieved usually by photons generated by linear accelerator units. However, radiation scattering within the patient’s body and the surrounding environment will lead to dose dispersion to healthy tissues which are not targets of the primary radiation. Determination of the dispersed dose would be important for assessing the risk and biological consequences in different organs or tissues. In the present work, the concept of conversion coefficient (F) of the dispersed dose was developed, in which F = (Dd/Dt), where Dd was the dispersed dose in a non-targeted tissue and Dt is the absorbed dose in the targeted tissue. To quantify Dd and Dt, a comprehensive model was developed using the Monte Carlo N-Particle (MCNP) package to simulate the linear accelerator head, the human phantom, the treatment couch and the radiotherapy treatment room. The present work also demonstrated the feasibility and power of parallel computing through the use of the Message Passing Interface (MPI) version of MCNP5. PMID:28362837

Monte Carlo treatment planning for molecular targeted radiotherapy within the MINERVA system

NASA Astrophysics Data System (ADS)

Lehmann, Joerg; Hartmann Siantar, Christine; Wessol, Daniel E.; Wemple, Charles A.; Nigg, David; Cogliati, Josh; Daly, Tom; Descalle, Marie-Anne; Flickinger, Terry; Pletcher, David; DeNardo, Gerald

2005-03-01

The aim of this project is to extend accurate and patient-specific treatment planning to new treatment modalities, such as molecular targeted radiation therapy, incorporating previously crafted and proven Monte Carlo and deterministic computation methods. A flexible software environment is being created that allows planning radiation treatment for these new modalities and combining different forms of radiation treatment with consideration of biological effects. The system uses common input interfaces, medical image sets for definition of patient geometry and dose reporting protocols. Previously, the Idaho National Engineering and Environmental Laboratory (INEEL), Montana State University (MSU) and Lawrence Livermore National Laboratory (LLNL) had accrued experience in the development and application of Monte Carlo based, three-dimensional, computational dosimetry and treatment planning tools for radiotherapy in several specialized areas. In particular, INEEL and MSU have developed computational dosimetry systems for neutron radiotherapy and neutron capture therapy, while LLNL has developed the PEREGRINE computational system for external beam photon-electron therapy. Building on that experience, the INEEL and MSU are developing the MINERVA (modality inclusive environment for radiotherapeutic variable analysis) software system as a general framework for computational dosimetry and treatment planning for a variety of emerging forms of radiotherapy. In collaboration with this development, LLNL has extended its PEREGRINE code to accommodate internal sources for molecular targeted radiotherapy (MTR), and has interfaced it with the plugin architecture of MINERVA. Results from the extended PEREGRINE code have been compared to published data from other codes, and found to be in general agreement (EGS4—2%, MCNP—10%) (Descalle et al 2003 Cancer Biother. Radiopharm. 18 71-9). The code is currently being benchmarked against experimental data. The interpatient variability of

Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma.

PubMed

Takamura, Akio; Saito, Hiroya; Kamada, Tadashi; Hiramatsu, Kazuhide; Takeuchi, Shuhei; Hasegawa, Masakazu; Miyamoto, Noriyuki

2003-12-01

To evaluate the results of combined-modality therapy, including external beam radiotherapy, intraluminal (192)Ir, and biliary stenting for extrahepatic bile duct carcinoma. Between 1988 and 1998, 93 patients with unresectable extrahepatic bile duct carcinoma underwent definitive radiotherapy. The dose of external beam radiotherapy was 50 Gy in 25 fractions. Low-dose-rate (192)Ir was delivered at a dose of 27-50 Gy (mean 39.2) at 0.5 cm from the source. An expandable metallic endoprosthesis was used to establish an internal bile passage. The median survival was 12 months, with a 1-, 3-, and 5-year actuarial survival rate of 50%, 10%, and 4%, respectively. Tumor length, hepatic invasion, and distant metastasis significantly affected survival. Ninety-six percent of patients could successfully remove external drainage catheters. The actuarial biliary patency rate for these patients at 1, 3, and 5 years was 52%, 29%, and 18%, respectively. Tumor length, tumor diameter and T stage were significantly associated with the patency rate. Mild-to-severe gastroduodenal complications were observed in 32 patients and were significantly associated with the active length of (192)Ir and linear source activity. Eight patients had treatment-related biliary fistula. Our combined-modality therapy provided reasonable local control and improved the quality of life of patients with extrahepatic bile duct carcinoma. Because none of the treatment characteristics had any impact on survival or biliary patency, lower dose levels and/or a localized target volume are recommended to minimize morbidity.

Silicon photonic dynamic optical channel leveler with external feedback loop.

PubMed

Doylend, J K; Jessop, P E; Knights, A P

2010-06-21

We demonstrate a dynamic optical channel leveler composed of a variable optical attenuator (VOA) integrated monolithically with a defect-mediated photodiode in a silicon photonic waveguide device. An external feedback loop mimics an analog circuit such that the photodiode directly controls the VOA to provide blind channel leveling within +/-1 dB across a 7-10 dB dynamic range for wavelengths from 1530 nm to 1570 nm. The device consumes approximately 50 mW electrical power and occupies a 6 mm x 0.1 mm footprint per channel. Dynamic leveling is accomplished without tapping optical power from the output path to the photodiode and thus the loss penalty is minimized.

Partial breast radiotherapy with simple teletherapy techniques.

PubMed

Fekete, Gábor; Újhidy, Dóra; Együd, Zsófia; Kiscsatári, Laura; Marosi, Gusztáv; Kahán, Zsuzsanna; Varga, Zoltán

2015-01-01

A prospective pilot study of partial breast irradiation (PBI) with conventional vs hypofractionated schedules was set out. The study aimed to determine efficacy, acute and late side effects, and the preference of photon vs electron irradiation based on individual features. Patients were enrolled according to internationally accepted guidelines on PBI. Conformal radiotherapy plans were generated with both photon and electron beams, and the preferred technique based on dose homogeneity and the radiation exposure of healthy tissues was applied. For electron dose verification, a special phantom was constructed. Patients were randomized for fractionation schedules of 25 × 2 vs 13 × 3Gy. Skin and breast changes were registered at the time of and ≥1 year after the completion of radiotherapy. Dose homogeneity was better with photons. If the tumor bed was located in the inner quadrants, electron beam gave superior results regarding conformity and sparing of organ at risk (OAR). If the tumor was situated in the lateral quadrants, conformity was better with photons. A depth of the tumor bed ≥3.0cm predicted the superiority of photon irradiation (odds ratio [OR] = 23.6, 95% CI: 5.2 to 107.5, p < 0.001) with >90% sensitivity and specificity. After a median follow-up of 39 months, among 72 irradiated cases, 1 local relapse out of the tumor bed was detected. Acute radiodermatitis of grade I to II, hyperpigmentation, and telangiectasia developed ≥1 year after radiotherapy, exclusively after electron beam radiotherapy. The choice of electrons or photons for PBI should be based on tumor bed location; the used methods are efficient and feasible. Copyright © 2015 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Local Tumor Control, Visual Acuity, and Survival After Hypofractionated Stereotactic Photon Radiotherapy of Choroidal Melanoma in 212 Patients Treated Between 1997 and 2007

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dunavoelgyi, Roman; Dieckmann, Karin, E-mail: karin.dieckmann@meduniwien.ac.at; Gleiss, Andreas

2011-09-01

Purpose: To evaluate long-term local tumor control, visual acuity, and survival after hypofractionated linear accelerator-based stereotactic photon radiotherapy in patients with choroidal melanoma. Methods and Materials: Between 1997 and 2007, 212 patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at a linear accelerator with 6-MV photon beams at the Medical University of Vienna in five fractions over 7 days. Twenty-four patients received a total dose of 70 Gy (five fractions of 14 Gy), 158 a total dose of 60 Gy (five fractions of 12 Gy) and 30 patients a total dose of 50 Gymore » (five fractions of 10 Gy) applied on the 80% isodose. Ophthalmologic examinations were performed at baseline and every 3 months in the first 2 years, every 6 months until 5 years, and once a year thereafter until 10 years after radiotherapy. Assessment of visual acuity, routine ophthalmologic examinations, and measurement of tumor base dimension and height using standardized A-scan and B-scan echography were done at each visit. Funduscopy and fluorescein angiography were done when necessary to document tumor response. Results: Median tumor height and volume decreased from 4.8 mm and 270.7 mm{sup 3} at baseline to 2.6 mm and 86.6 mm{sup 3} at the last individual follow-up, respectively (p < 0.001, p < 0.001). Median visual acuity decreased from 0.55 at baseline to hand motion at the last individual follow-up (p < 0.001). Local tumor control was 95.9% after 5 years and 92.6% after 10 years. Thirty-two patients developed metastatic disease, and 22 of these patients died during the follow-up period. Conclusion: Hypofractionated stereotactic photon radiotherapy with 70 to 50 Gy delivered in five fractions in 7 days is sufficient to achieve excellent local tumor control in patients with malignant melanoma of the choroid. Disease outcome and vision are comparable to those achieved with proton beam radiotherapy

Wavelength-controlled external-cavity laser with a silicon photonic crystal resonant reflector

NASA Astrophysics Data System (ADS)

Gonzalez-Fernandez, A. A.; Liles, Alexandros A.; Persheyev, Saydulla; Debnath, Kapil; O'Faolain, Liam

2016-03-01

We report the experimental demonstration of an alternative design of external-cavity hybrid lasers consisting of a III-V Semiconductor Optical Amplifier with fiber reflector and a Photonic Crystal (PhC) based resonant reflector on SOI. The Silicon reflector comprises a polymer (SU8) bus waveguide vertically coupled to a PhC cavity and provides a wavelength-selective optical feedback to the laser cavity. This device exhibits milliwatt-level output power and sidemode suppression ratio of more than 25 dB.

Special cases for proton beam radiotherapy: re-irradiation, lymphoma, and breast cancer.

PubMed

Plastaras, John P; Berman, Abigail T; Freedman, Gary M

2014-12-01

The dose distributions that can be achieved with protons are usually superior to those of conventional photon external-beam radiation. There are special cases where proton therapy may offer a substantial potential benefit compared to photon treatments where toxicity concerns dominate. Re-irradiation may theoretically be made safer with proton therapy due to lower cumulative lifetime doses to sensitive tissues, such as the spinal cord. Proton therapy has been used in a limited number of patients with rectal, pancreatic, esophageal, and lung cancers. Chordomas and soft tissue sarcomas require particularly high radiation doses, posing additional challenges for re-irradiation. Lymphoma is another special case where proton therapy may be advantageous. Late toxicities from even relatively low radiation doses, including cardiac complications and second cancers, are of concern in lymphoma patients with high cure rates and long life expectancies. Proton therapy has begun to be used for consolidation after chemotherapy in patients with Hodgkin and non-Hodgkin lymphoma. Breast cancer is another emerging area of proton therapy development and use. Proton therapy may offer advantages compared to other techniques in the setting of breast boosts, accelerated partial breast irradiation, and post-mastectomy radiotherapy. In these settings, proton therapy may decrease toxicity associated with breast radiotherapy. As techniques are refined in proton therapy, we may be able to improve the therapeutic ratio by maintaining the benefits of radiotherapy while better minimizing the risks. Copyright © 2014 Elsevier Inc. All rights reserved.

Poster - 31: Predicting IQ and hearing loss following radiotherapy in pediatric brain tumors: proton vs photon

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fortin, Dominique; Ng, Angela; Tsang, Derek

Purpose: The increased sparing of normal tissues in intensity modulated proton therapy (IMPT) in pediatric brain tumor treatments should translate into improved neurocognitive outcomes. Models were used to estimate the intelligence quotient (IQ) and the risk of hearing loss 5 years post radiotherapy and to compare outcomes of proton against photon in pediatric brain tumors. Methods: Patients who had received intensity modulated radiotherapy (IMRT) were randomly selected from our retrospective database. The existing planning CT and contours were used to generate IMPT plans. The RBE-corrected dose was calculated for both IMPT and IMRT. For each patient, the IQ was estimatedmore » via a Monte Carlo technique, whereas the reported incidence of hearing loss as a function of cochlear dose was used to estimate the probability of occurrence. Results: The integrated brain dose was reduced in all IMPT plans, translating into a gain of 2 IQ points on average for protons for the whole cohort at 5 years post-treatment. In terms of specific diseases, the gains in IQ ranged from 0.8 points for medulloblastoma, to 2.7 points for craniopharyngioma. Hearing loss probability was evaluated on a per-ear-basis and was found to be systematically less for proton versus photon: overall 2.9% versus 7.2%. Conclusions: A method was developed to predict IQ and hearing outcomes in pediatric brain tumor patients on a case-by-case basis. A modest gain was systematically observed for proton in all patients. Given the uncertainties within the model used and our reinterpretation, these gains may be underestimated.« less

Dose-distance metric that predicts late rectal bleeding in patients receiving radical prostate external-beam radiotherapy

NASA Astrophysics Data System (ADS)

Lee, Richard; Chan, Elisa K.; Kosztyla, Robert; Liu, Mitchell; Moiseenko, Vitali

2012-12-01

The relationship between rectal dose distribution and the incidence of late rectal complications following external-beam radiotherapy has been previously studied using dose-volume histograms or dose-surface histograms. However, they do not account for the spatial dose distribution. This study proposes a metric based on both surface dose and distance that can predict the incidence of rectal bleeding in prostate cancer patients treated with radical radiotherapy. One hundred and forty-four patients treated with radical radiotherapy for prostate cancer were prospectively followed to record the incidence of grade ≥2 rectal bleeding. Radiotherapy plans were used to evaluate a dose-distance metric that accounts for the dose and its spatial distribution on the rectal surface, characterized by a logistic weighting function with slope a and inflection point d0. This was compared to the effective dose obtained from dose-surface histograms, characterized by the parameter n which describes sensitivity to hot spots. The log-rank test was used to determine statistically significant (p < 0.05) cut-off values for the dose-distance metric and effective dose that predict for the occurrence of rectal bleeding. For the dose-distance metric, only d0 = 25 and 30 mm combined with a > 5 led to statistical significant cut-offs. For the effective dose metric, only values of n in the range 0.07-0.35 led to statistically significant cut-offs. The proposed dose-distance metric is a predictor of rectal bleeding in prostate cancer patients treated with radiotherapy. Both the dose-distance metric and the effective dose metric indicate that the incidence of grade ≥2 rectal bleeding is sensitive to localized damage to the rectal surface.

Prognostic factors in prostate cancer patients treated by radical external beam radiotherapy.

PubMed

Garibaldi, Elisabetta; Gabriele, Domenico; Maggio, Angelo; Delmastro, Elena; Garibaldi, Monica; Russo, Filippo; Bresciani, Sara; Stasi, Michele; Gabriele, Pietro

2017-09-01

The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our Centre with external beam radiotherapy, the prognostic factors and their impact on the outcome in terms of cancer-specific survival (CSS), biochemical disease-free survival (BDFS) and clinical disease-free survival (CDFS). From October 1999 and March 2012, 1080 patients were treated with radiotherapy at our Institution: 87% of them were classified as ≤cT2, 83% had a Gleason Score (GS) ≤7, their mean of iPSA was 18 ng/mL, and the rate of clinical positive nodes was 1%. The mean follow-up was 81 months. The statistically significant prognostic factors for all groups of patients at both, univariate and multivariate analysis, were the GS and the iPSA. In intermediate- and high- or very-high-risk patients at multivariate analysis other prognostic factors for CSS were positive nodes on computed tomography (CT) scan and rectal preparation during the treatment; for BDFS, the prognostic factors were patient risk classification, positive lymph nodes on CT scan and rectal/bladder preparation; for CDFS, the prognostic factors were the number of positive core on biopsy (P=0.003), positive lymph nodes on CT scan, and radiotherapy (RT) dose. In high/very-high risk patient group at multivariate analysis other prognostic factors for CSS were clinical/radiological stage and RT dose, for BDFS they were adjuvant hormone therapy, clinical/radiological stage, and RT dose >77.7 Gy, and for CDFS they were clinical/radiological stage and RT dose >77.7 Gy. The results of this study confirm the prognostic factors described in the recent literature, with the addition of rectal/bladder preparation, generally known for its effect on toxicity but not yet on outcome.

Optimum location of external markers using feature selection algorithms for real-time tumor tracking in external-beam radiotherapy: a virtual phantom study.

PubMed

Nankali, Saber; Torshabi, Ahmad Esmaili; Miandoab, Payam Samadi; Baghizadeh, Amin

2016-01-08

In external-beam radiotherapy, using external markers is one of the most reliable tools to predict tumor position, in clinical applications. The main challenge in this approach is tumor motion tracking with highest accuracy that depends heavily on external markers location, and this issue is the objective of this study. Four commercially available feature selection algorithms entitled 1) Correlation-based Feature Selection, 2) Classifier, 3) Principal Components, and 4) Relief were proposed to find optimum location of external markers in combination with two "Genetic" and "Ranker" searching procedures. The performance of these algorithms has been evaluated using four-dimensional extended cardiac-torso anthropomorphic phantom. Six tumors in lung, three tumors in liver, and 49 points on the thorax surface were taken into account to simulate internal and external motions, respectively. The root mean square error of an adaptive neuro-fuzzy inference system (ANFIS) as prediction model was considered as metric for quantitatively evaluating the performance of proposed feature selection algorithms. To do this, the thorax surface region was divided into nine smaller segments and predefined tumors motion was predicted by ANFIS using external motion data of given markers at each small segment, separately. Our comparative results showed that all feature selection algorithms can reasonably select specific external markers from those segments where the root mean square error of the ANFIS model is minimum. Moreover, the performance accuracy of proposed feature selection algorithms was compared, separately. For this, each tumor motion was predicted using motion data of those external markers selected by each feature selection algorithm. Duncan statistical test, followed by F-test, on final results reflected that all proposed feature selection algorithms have the same performance accuracy for lung tumors. But for liver tumors, a correlation-based feature selection algorithm, in

Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report

PubMed Central

Giannelli, Flavio; Chiola, Ilaria; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

2017-01-01

Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 – PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects. PMID:29441103

Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report.

PubMed

Giannelli, Flavio; Chiola, Ilaria; Belgioia, Liliana; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

2017-12-01

Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 - PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D 90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

Potential for enhancing external beam radiotherapy for lung cancer using high-Z nanoparticles administered via inhalation

NASA Astrophysics Data System (ADS)

Hao, Yao; Altundal, Yucel; Moreau, Michele; Sajo, Erno; Kumar, Rajiv; Ngwa, Wilfred

2015-09-01

Nanoparticle-aided radiation therapy is emerging as a promising modality to enhance radiotherapy via the radiosensitizing action of high atomic number (Z) nanoparticles. However, the delivery of sufficiently potent concentrations of such nanoparticles to the tumor remain a challenge. This study investigates the dose enhancement to lung tumors due to high-Z nanoparticles (NPs) administered via inhalation during external beam radiotherapy. Here NPs investigated include: cisplatin nanoparticles (CNPs), carboplatin nanoparticles (CBNPs), and gold nanoparticles (GNPs). Using Monte Carlo-generated megavoltage energy spectra, a previously employed analytic method was used to estimate dose enhancement to lung tumors due to radiation-induced photoelectrons from the NPs administered via inhalation route (IR) in comparison to intravenous (IV) administration. Previous studies have indicated about 5% of FDA-approved cisplatin concentrations reach the lung via IV. Meanwhile recent experimental studies indicate that 3.5-14.6 times higher concentrations of NPs can reach the lung by IR compared to IV. Taking these into account, the dose enhancement factor (DEF) defined as the ratio of the radiotherapy dose with and without nanoparticles was calculated for a range of NPs concentrations and tumor sizes. The DEF for IR was then compared with that for IV. For IR with 3.5 times higher concentrations than IV, and 2 cm diameter tumor, clinically significant DEF values of up to 1.19, 1.26, and 1.51 were obtained for CNPs, CBNPs and GNPs. In comparison values of 1.06, 1.08, and 1.15 were obtained via IV administration. For IR with 14.6 times higher concentrations, even higher DEF values were obtained e.g. 1.81 for CNPs. Results also showed that the DEF increased with increasing field size or decreasing tumor volume, as expected. The results of this work indicate that IR administration of targeted high-Z CNPs/CBNPs/GNPs could enable clinically significant DEF to lung tumors compared to IV

Organ dose conversion coefficients based on a voxel mouse model and MCNP code for external photon irradiation.

PubMed

Zhang, Xiaomin; Xie, Xiangdong; Cheng, Jie; Ning, Jing; Yuan, Yong; Pan, Jie; Yang, Guoshan

2012-01-01

A set of conversion coefficients from kerma free-in-air to the organ absorbed dose for external photon beams from 10 keV to 10 MeV are presented based on a newly developed voxel mouse model, for the purpose of radiation effect evaluation. The voxel mouse model was developed from colour images of successive cryosections of a normal nude male mouse, in which 14 organs or tissues were segmented manually and filled with different colours, while each colour was tagged by a specific ID number for implementation of mouse model in Monte Carlo N-particle code (MCNP). Monte Carlo simulation with MCNP was carried out to obtain organ dose conversion coefficients for 22 external monoenergetic photon beams between 10 keV and 10 MeV under five different irradiation geometries conditions (left lateral, right lateral, dorsal-ventral, ventral-dorsal, and isotropic). Organ dose conversion coefficients were presented in tables and compared with the published data based on a rat model to investigate the effect of body size and weight on the organ dose. The calculated and comparison results show that the organ dose conversion coefficients varying the photon energy exhibits similar trend for most organs except for the bone and skin, and the organ dose is sensitive to body size and weight at a photon energy approximately <0.1 MeV.

Cobalt-60 Machines and Medical Linear Accelerators: Competing Technologies for External Beam Radiotherapy.

PubMed

Healy, B J; van der Merwe, D; Christaki, K E; Meghzifene, A

2017-02-01

Medical linear accelerators (linacs) and cobalt-60 machines are both mature technologies for external beam radiotherapy. A comparison is made between these two technologies in terms of infrastructure and maintenance, dosimetry, shielding requirements, staffing, costs, security, patient throughput and clinical use. Infrastructure and maintenance are more demanding for linacs due to the complex electric componentry. In dosimetry, a higher beam energy, modulated dose rate and smaller focal spot size mean that it is easier to create an optimised treatment with a linac for conformal dose coverage of the tumour while sparing healthy organs at risk. In shielding, the requirements for a concrete bunker are similar for cobalt-60 machines and linacs but extra shielding and protection from neutrons are required for linacs. Staffing levels can be higher for linacs and more staff training is required for linacs. Life cycle costs are higher for linacs, especially multi-energy linacs. Security is more complex for cobalt-60 machines because of the high activity radioactive source. Patient throughput can be affected by source decay for cobalt-60 machines but poor maintenance and breakdowns can severely affect patient throughput for linacs. In clinical use, more complex treatment techniques are easier to achieve with linacs, and the availability of electron beams on high-energy linacs can be useful for certain treatments. In summary, there is no simple answer to the question of the choice of either cobalt-60 machines or linacs for radiotherapy in low- and middle-income countries. In fact a radiotherapy department with a combination of technologies, including orthovoltage X-ray units, may be an option. Local needs, conditions and resources will have to be factored into any decision on technology taking into account the characteristics of both forms of teletherapy, with the primary goal being the sustainability of the radiotherapy service over the useful lifetime of the equipment

Whole-body dose and energy measurements in radiotherapy by a combination of LiF:Mg,Cu,P and LiF:Mg,Ti.

PubMed

Hauri, Pascal; Schneider, Uwe

2018-04-01

Long-term survivors of cancer who were treated with radiotherapy are at risk of a radiation-induced tumor. Hence, it is important to model the out-of-field dose resulting from a cancer treatment. These models have to be verified with measurements, due to the small size, the high sensitivity to ionizing radiation and the tissue-equivalent composition, LiF thermoluminescence dosimeters (TLD) are well-suited for out-of-field dose measurements. However, the photon energy variation of the stray dose leads to systematic dose errors caused by the variation in response with radiation energy of the TLDs. We present a dosimeter which automatically corrects for the energy variation of the measured photons by combining LiF:Mg,Ti (TLD100) and LiF:Mg,Cu,P (TLD100H) chips. The response with radiation energy of TLD100 and TLD100H compared to 60 Co was taken from the literature. For the measurement, a TLD100H was placed on top of a TLD100 chip. The dose ratio between the TLD100 and TLD100H, combined with the ratio of the response curves was used to determine the mean energy. With the energy, the individual correction factors for TLD100 and TLD100H could be found. The accuracy in determining the in- and out-of-field dose for a nominal beam energy of 6MV using the double-TLD unit was evaluated by an end-to-end measurement. Furthermore, published Monte Carlo (M.C.) simulations of the mean photon energy for brachytherapy sources, stray radiation of a treatment machine and cone beam CT (CBCT) were compared to the measured mean energies. Finally, the photon energy distribution in an Alderson phantom was measured for different treatment techniques applied with a linear accelerator. Additionally, a treatment plan was measured with a cobalt machine combined with an MRI. For external radiotherapy, the presented double-TLD unit showed a relative type A uncertainty in doses of -1%±2% at the two standard deviation level compared to an ionization chamber. The type A uncertainty in dose was in

Developing a mailed phantom to implement a local QA program in Egypt radiotherapy centers

NASA Astrophysics Data System (ADS)

Soliman, H. A.; Aletreby, M.

2016-07-01

In this work, a simple method that differs from the IAEA/WHO Thermoluminescent dosimeters (TLD) postal quality assurance (QA) program is developed. A small perspex; polymethyl methacrylate (PMMA), phantom measured 50 mm × 50 mm × 50 mm is constructed to be used for absorbed dose verification of high-energy photon beams in some major radiotherapy centers in Egypt. The phantom weighted only 140.7 g with two buildup covers weighted 14.8 and 43.19 g for the Cobalt-60 and the 6-MV X-ray beams, respectively. This phantom is aimed for use in the future's external audit/QA services in Egypt for the first time. TLD-700 chips are used for testing and investigating a convenient and national dosimetry QA program. Although the used methodology is comparable to previously introduced but new system; it has smaller size, less weight, and different more available material. Comparison with the previous similar designs is introduced. Theoretical calculations were done by the commercial Eclipse treatment planning system, implementing the pencil beam convolution algorithm to verify the accuracy of the experimental calculation of the dose conversion factor of water to the perspex phantom. The new constructed small phantom and methodology was applied in 10 participating radiotherapy centers. The absorbed dose was verified under the reference conditions for both 60Co and 6-MV high-energy photon beams. The checked beams were within the 5% limit except for four photon beams. There was an agreement of 0.2% between our experimental data and those previously published confirming the validity of the applied method in verifying radiotherapy absorbed dose.

SU-E-T-409: Evaluation of Tissue Composition Effect On Dose Distribution in Radiotherapy with 6 MV Photon Beam of a Medical Linac

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghorbani, M; Tabatabaei, Z; Noghreiyan, A Vejdani

Purpose: The aim of this study is to evaluate soft tissue composition effect on dose distribution for various soft tissues and various depths in radiotherapy with 6 MV photon beam of a medical linac. Methods: A phantom and Siemens Primus linear accelerator were simulated using MCNPX Monte Carlo code. In a homogeneous cubic phantom, six types of soft tissue and three types of tissue-equivalent materials were defined separately. The soft tissues were muscle (skeletal), adipose tissue, blood (whole), breast tissue, soft tissue (9-component) and soft tissue (4-component). The tissue-equivalent materials included: water, A-150 tissue-equivalent plastic and perspex. Photon dose relativemore » to dose in 9-component soft tissue at various depths on the beam’s central axis was determined for the 6 MV photon beam. The relative dose was also calculated and compared for various MCNPX tallies including,F8, F6 and,F4. Results: The results of the relative photon dose in various materials relative to dose in 9-component soft tissue and using different tallies are reported in the form of tabulated data. Minor differences between dose distributions in various soft tissues and tissue-equivalent materials were observed. The results from F6 and F4 were practically the same but different with,F8 tally. Conclusion: Based on the calculations performed, the differences in dose distributions in various soft tissues and tissue-equivalent materials are minor but they could be corrected in radiotherapy calculations to upgrade the accuracy of the dosimetric calculations.« less

Phase sensitivity of fundamental mode to external atmospheric pressure for hollow-core photonic bandgap fiber

NASA Astrophysics Data System (ADS)

Xu, Xiaobin; Liu, Yangqian; Gao, Fuyu; Song, Ningfang

2018-07-01

Hollow-core photonic bandgap fibers (HC-PBFs) are suitable for spaceborne fiber optical gyroscopes owing to their excellent environmental adaptability. However, hundreds of small holes full of air at one atmosphere of pressure can make the HC-PBF sensitive to external atmospheric pressure. In this study, we investigated the phase sensitivity of the fundamental mode to external atmospheric pressure for the HC-PBF, and the experimental result indicates that the phase sensitivity is approximately 1.6 × 10-5 ppm/Pa, which is mostly contributed by the change in the pressure-induced length. Through the choice of coating, the phase sensitivity to external atmospheric pressure can be reduced by about a factor of five compared to current HC-PBFs, and the excellent temperature performance can be maintained at the same time.

SU-F-T-551: Beam Hardening and Attenuation of Photon Beams Using Integral Quality Monitor in Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Casar, B; Carot, I Mendez; Peterlin, P

2016-06-15

Purpose: Aim of the multi-centre study was to analyse beam hardening effect of the Integral Quality Monitor (IQM) for high energy photon beams used in radiotherapy with linear accelerators. Generic values for attenuation coefficient k(IQM) of IQM system were additionally investigated. Methods: Beam hardening effect of the IQM system was studied for a set of standard nominal photon energies (6 MV–18 MV) and two flattening filter free (FFF) energies (6 MV FFF and 10 MV FFF). PDD curves were measured and analysed for various square radiation fields, with and without IQM in place. Differences between PDD curves were statistically analysedmore » through comparison of respective PDD-20,10 values. Attenuation coefficients k(IQM) were determined for the same range of photon energies. Results: Statistically significant differences in beam qualities for all evaluated high energy photon beams were found, comparing PDD-20,10 values derived from PDD curves with and without IQM in place. Significance of beam hardening effect was statistically proven with high confidence (p < 0,01) for all analysed photon beams except for 15 MV (p = 0,078), although relative differences in beam qualities were minimal, ranging from 0,1 % to 0,5 %. Attenuation of the IQM system showed negligible dependence on radiation field size. However, clinically important dependence of kIQM versus TPRs20,10 was found: 0,941 for 6 MV photon beams, to 0,959 for 18 MV photon beams, with highest uncertainty below 0,006. k(IQM) versus TPRs were tabulated and polynomial equation for the determination of k(IQM) is suggested for clinical use. Conclusion: There was no clinically relevant beam hardening, when IQM system was on linear accelerators. Consequently, no additional commissioning is needed for the IQM system regarding the determination of beam qualities. Generic values for k(IQM) are proposed and can be used as tray factors for complete range of examined photon beam energies.« less

Estimation of Risk of Normal-tissue Toxicity Following Gastric Cancer Radiotherapy with Photon- or Scanned Proton-beams.

PubMed

Mondlane, Gracinda; Ureba, Ana; Gubanski, Michael; Lind, Pehr A; Siegbahn, Albert

2018-05-01

Gastric cancer (GC) radiotherapy involves irradiation of large tumour volumes located in the proximities of critical structures. The advantageous dose distributions produced by scanned-proton beams could reduce the irradiated volumes of the organs at risk (OARs). However, treatment-induced side-effects may still appear. The aim of this study was to estimate the normal tissue complication probability (NTCP) following proton therapy of GC, compared to photon radiotherapy. Eight GC patients, previously treated with volumetric-modulated arc therapy (VMAT), were retrospectively planned with scanned proton beams carried out with the single-field uniform-dose (SFUD) method. A beam-specific planning target volume was used for spot positioning and a clinical target volume (CTV) based robust optimisation was performed considering setup- and range-uncertainties. The dosimetric and NTCP values obtained with the VMAT and SFUD plans were compared. With SFUD, lower or similar dose-volume values were obtained for OARs, compared to VMAT. NTCP values of 0% were determined with the VMAT and SFUD plans for all OARs (p>0.05), except for the left kidney (p<0.05), for which lower toxicity was estimated with SFUD. The NTCP reduction, determined for the left kidney with SFUD, can be of clinical relevance for preserving renal function after radiotherapy of GC. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Comparison of Local Recurrence Among Early Breast Cancer Patients Treated With Electron Intraoperative Radiotherapy vs Hypofractionated Photon Radiotherapy an Observational Study.

PubMed

Guenzi, Marina; Bonzano, Elisabetta; Corvò, Renzo; Merolla, Francesca; Pastorino, Alice; Cavagnetto, Francesca; Garelli, Stefania; Cutolo, Carlo Alberto; Friedman, Daniele; Belgioia, Liliana

2018-01-01

To evaluate local recurrence (LR) in women with early breast cancer (BC) who underwent intraoperative radiation therapy with electrons particles (IORT-E) or adjuvant hypofractionated external radiotherapy (HYPOFX). We retrospectively analyzed 470 patients with early BC treated at our center from September 2009 to December 2012. 235 women were treated with breast-conserving surgery and immediate IORT-E (21 Gy/1 fraction) while 235 patients underwent wide excision followed by hypofractionated whole-breast irradiation. Radiotherapy modality was chosen according to an individualized decision based on tumor features, stage, technical feasibility, age, and acceptance to be enrolled in the IORT-E group. After a median follow-up of 6 years, we observed 8 (3.4%) and 1 (0.42%) LR in the IORT-E and in the HYPOFX group ( p  = 0.02), respectively. The two groups differed in the prevalence of clinical characteristics ( p  < 0.05): age, tumor size, surgical margins, receptors, ki67, and histology. 4 and 1 woman in the IORT-E and HYPOFX group died of BC, respectively ( p  = 0.167). OS and DFS hazard ratio [HR] were 2.14 (95% IC, 1.10-4.15) and 2.09 (95% IC, 1.17-3.73), respectively. Our comparison showed that IORT-E and HYPOFX are two effective radiotherapy modalities after conservative surgery in early BC. However, at 6 years a significant higher rate of LR occurred in patients submitted to IORT-E with respect to HYPOFX. This finding may be correlated to some subsets of patients who, depending on the biological characteristics of the BC, may be less suitable to IORT-E.

Scattered radiation from dental metallic crowns in head and neck radiotherapy.

PubMed

Shimozato, T; Igarashi, Y; Itoh, Y; Yamamoto, N; Okudaira, K; Tabushi, K; Obata, Y; Komori, M; Naganawa, S; Ueda, M

2011-09-07

We aimed to estimate the scattered radiation from dental metallic crowns during head and neck radiotherapy by irradiating a jaw phantom with external photon beams. The phantom was composed of a dental metallic plate and hydroxyapatite embedded in polymethyl methacrylate. We used radiochromic film measurement and Monte Carlo simulation to calculate the radiation dose and dose distribution inside the phantom. To estimate dose variations in scattered radiation under different clinical situations, we altered the incident energy, field size, plate thickness, plate depth and plate material. The simulation results indicated that the dose at the incident side of the metallic dental plate was approximately 140% of that without the plate. The differences between dose distributions calculated with the radiation treatment-planning system (TPS) algorithms and the data simulation, except around the dental metallic plate, were 3% for a 4 MV photon beam. Therefore, we should carefully consider the dose distribution around dental metallic crowns determined by a TPS.

Scattered radiation from dental metallic crowns in head and neck radiotherapy

NASA Astrophysics Data System (ADS)

Shimozato, T.; Igarashi, Y.; Itoh, Y.; Yamamoto, N.; Okudaira, K.; Tabushi, K.; Obata, Y.; Komori, M.; Naganawa, S.; Ueda, M.

2011-09-01

We aimed to estimate the scattered radiation from dental metallic crowns during head and neck radiotherapy by irradiating a jaw phantom with external photon beams. The phantom was composed of a dental metallic plate and hydroxyapatite embedded in polymethyl methacrylate. We used radiochromic film measurement and Monte Carlo simulation to calculate the radiation dose and dose distribution inside the phantom. To estimate dose variations in scattered radiation under different clinical situations, we altered the incident energy, field size, plate thickness, plate depth and plate material. The simulation results indicated that the dose at the incident side of the metallic dental plate was approximately 140% of that without the plate. The differences between dose distributions calculated with the radiation treatment-planning system (TPS) algorithms and the data simulation, except around the dental metallic plate, were 3% for a 4 MV photon beam. Therefore, we should carefully consider the dose distribution around dental metallic crowns determined by a TPS.

Adjuvant radiotherapy for stage I endometrial cancer.

PubMed

Kong, A; Johnson, N; Cornes, P; Simera, I; Collingwood, M; Williams, C; Kitchener, H

2007-04-18

The role of adjuvant radiotherapy (both pelvic external beam radiotherapy and vaginal intracavity brachytherapy) in stage I endometrial cancer following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) remains unclear. To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CancerLit, Physician Data Query (PDQ) of National Cancer Institute. Handsearching was also carried out where appropriate. Randomised controlled trials (RCTs) which compared adjuvant radiotherapy versus no radiotherapy following surgery for patients with stage I endometrial cancer were included. Quality of the studies was assessed and data collected using a predefined data collection form. The primary endpoint was overall survival. Secondary endpoints were locoregional recurrence, distant recurrence and endometrial cancer death. Data on quality of life (QOL) and morbidity were also collected. A meta-analysis on included trials was performed using the Cochrane Collaboration Review Manager Software 4.2. The meta-analysis was performed on four trials (1770 patients). The addition of pelvic external beam radiotherapy to surgery reduced locoregional recurrence, a relative risk (RR) of 0.28 (95% confidence interval (CI) 0.17 to 0.44, p < 0.00001), which is a 72% reduction in the risk of pelvic relapse (95% CI 56% to 83%) and an absolute risk reduction of 6% (95% CI of 4 to 8%). The number needed to treat (NNT) to prevent one locoregional recurrence is 16.7 patients (95% CI 12.5 to 25). The reduction in the risk of locoregional recurrence did not translate into either a reduction in the risk of distant recurrence or death from all causes or endometrial cancer death. A subgroup analysis of women with multiple high risk factors (including stage 1c and grade 3) showed a trend toward the reduction in the risk of death from all causes and endometrial cancer

Poster - 52: Smoothing constraints in Modulated Photon Radiotherapy (XMRT) fluence map optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

McGeachy, Philip; Villarreal-Barajas, Jose Eduardo

Purpose: Modulated Photon Radiotherapy (XMRT), which simultaneously optimizes photon beamlet energy (6 and 18 MV) and fluence, has recently shown dosimetric improvement in comparison to conventional IMRT. That said, the degree of smoothness of resulting fluence maps (FMs) has yet to be investigated and could impact the deliverability of XMRT. This study looks at investigating FM smoothness and imposing smoothing constraint in the fluence map optimization. Methods: Smoothing constraints were modeled in the XMRT algorithm with the sum of positive gradient (SPG) technique. XMRT solutions, with and without SPG constraints, were generated for a clinical prostate scan using standard dosimetricmore » prescriptions, constraints, and a seven coplanar beam arrangement. The smoothness, with and without SPG constraints, was assessed by looking at the absolute and relative maximum SPG scores for each fluence map. Dose volume histograms were utilized when evaluating impact on the dose distribution. Results: Imposing SPG constraints reduced the absolute and relative maximum SPG values by factors of up to 5 and 2, respectively, when compared with their non-SPG constrained counterparts. This leads to a more seamless conversion of FMS to their respective MLC sequences. This improved smoothness resulted in an increase to organ at risk (OAR) dose, however the increase is not clinically significant. Conclusions: For a clinical prostate case, there was a noticeable improvement in the smoothness of the XMRT FMs when SPG constraints were applied with a minor increase in dose to OARs. This increase in OAR dose is not clinically meaningful.« less

On the direct acquisition of beam’s-eye-view images in MRI for integration with external beam radiotherapy

NASA Astrophysics Data System (ADS)

Wachowicz, K.; Murray, B.; Fallone, B. G.

2018-06-01

The recent interest in the integration of external beam radiotherapy with a magnetic resonance (MR) imaging unit offers the potential for real-time adaptive tumour tracking during radiation treatment. The tracking of large tumours which follow a rapid trajectory may best be served by the generation of a projection image from the perspective of the beam source, or ‘beam’s eye view’ (BEV). This type of image projection represents the path of the radiation beam, thus enabling rapid compensations for target translations, rotations and deformations, as well time-dependent critical structure avoidance. MR units have been traditionally incapable of this type of imaging except through lengthy 3D acquisitions and ray tracing procedures. This work investigates some changes to the traditional MR scanner architecture that would permit the direct acquisition of a BEV image suitable for integration with external beam radiotherapy. Based on the theory presented in this work, a phantom was imaged with nonlinear encoding-gradient field patterns to demonstrate the technique. The phantom was constructed with agarose gel tubes spaced two cm apart at their base and oriented to converge towards an imaginary beam source 100 cm away. A corresponding virtual phantom was also created and subjected to the same encoding technique as in the physical demonstration, allowing the method to be tested without hardware limitations. The experimentally acquired and simulated images indicate the feasibility of the technique, showing a substantial amount of blur reduction in a diverging phantom compared to the conventional imaging geometry, particularly with the nonlinear gradients ideally implemented. The theory is developed to demonstrate that the method can be adapted in a number of different configurations to accommodate all proposed integration schemes for MR units and radiotherapy sources. Depending on the configuration, the implementation of this technique will require between two and

The effect of aerobic exercise on treatment-related acute toxicity in men receiving radical external beam radiotherapy for localised prostate cancer.

PubMed

Kapur, G; Windsor, P M; McCowan, C

2010-09-01

We retrospectively analysed acute radiation toxicity data for patients who had participated in a randomised controlled study in our centre in order to assess the impact of aerobic exercise on acute rectal and bladder morbidity during treatment. Data from 65 of 66 patients were analysed: 33 allocated into a control group (standard advice) and 33 into an exercise group (aerobic walking for 30 min at least three times per week) during 4 weeks of external beam radiotherapy; one patient in the exercise group withdrew after randomisation before starting radiotherapy. There was a trend towards less severe acute rectal toxicity in the exercise group with a statistically significant difference in mean toxicity scores over the 4 weeks of radiotherapy (P=0.004), with no significant difference in bladder toxicity scores between the two groups (P=0.123). The lack of an association for severity of bladder toxicity could be attributed to the confounding effect of lower urinary tract symptoms from their prostate cancer. Keeping active and being asked to adhere to a well-defined exercise schedule appears to reduce the severity of rectal toxicity during radiotherapy to the prostate.

High dose chemoradiation for unresectable hilar cholangiocarcinomas using intensity modulated external beam radiotherapy: a single tertiary care centre experience

PubMed Central

Mehta, Shaesta; Kalyani, Nikhil; Chaudhari, Suresh; Dharia, Tejas; Shetty, Nitin; Chopra, Supriya; Goel, Mahesh; Kulkarni, Suyash; Shrivastava, Shyam Kishore

2017-01-01

Background We present results of patients diagnosed with unresectable hilar cholangiocarcinomas treated with high dose radiotherapy and concurrent chemotherapy. Methods From Aug 2005 to Dec 2012, 68 consecutive patients were treated. Fifty patients (group 1) presenting to us with obstructive jaundice were planned for endobiliary brachytherapy (EBBT 14 Gy) followed external beam radiotherapy (EBRT 45 Gy). Twenty-two patients (group 2) who had previously undergone biliary drainage underwent EBRT (57 Gy). All patients received injection Gemcitabine 300 mg/m2/weekly along with EBRT. Results Twenty-nine patients in group 1 and 22 patients in group 2 completed the treatment. Twenty-six (55%) patients achieved complete radiological response, 16 (64%) belonging to group 1 and 8 (44%) of group 2 (P=0.05). The median overall survival (MOS) was 17.5 and 16 months for group 1 and 2 respectively (P=0.07). The 1- and 2-year survival was 63%, and 18% for group I and 61% and 22% for group II respectively. The MOS was 5 months and 1 year survival was 14% for patients receiving EBBT only. MOS was significantly better after complete response (P=0.001). Conclusions Intensity modulated radiotherapy (IMRT) modulated high dose radiotherapy used either alone or with brachytherapy demonstrates potential to prolonged overall survival in unresectable hilar cholangiocarcinomas. PMID:28280622

The Influence of the External Signal Modulation Waveform and Frequency on the Performance of a Photonic Forced Oscillator.

PubMed

Sánchez-Castro, Noemi; Palomino-Ovando, Martha Alicia; Estrada-Wiese, Denise; Valladares, Nydia Xcaret; Del Río, Jesus Antonio; de la Mora, Maria Beatriz; Doti, Rafael; Faubert, Jocelyn; Lugo, Jesus Eduardo

2018-05-21

Photonic crystals have been an object of interest because of their properties to inhibit certain wavelengths and allow the transmission of others. Using these properties, we designed a photonic structure known as photodyne formed by two porous silicon one-dimensional photonic crystals with an air defect between them. When the photodyne is illuminated with appropriate light, it allows us to generate electromagnetic forces within the structure that can be maximized if the light becomes localized inside the defect region. These electromagnetic forces allow the microcavity to oscillate mechanically. In the experiment, a chopper was driven by a signal generator to modulate the laser light that was used. The driven frequency and the signal modulation waveform (rectangular, sinusoidal or triangular) were changed with the idea to find optimal conditions for the structure to oscillate. The microcavity displacement amplitude, velocity amplitude and Fourier spectrum of the latter and its frequency were measured by means of a vibrometer. The mechanical oscillations are modeled and compared with the experimental results and show good agreement. For external frequency values of 5 Hz and 10 Hz, the best option was a sinusoidal waveform, which gave higher photodyne displacements and velocity amplitudes. Nonetheless, for an external frequency of 15 Hz, the best option was the rectangular waveform.

The Influence of the External Signal Modulation Waveform and Frequency on the Performance of a Photonic Forced Oscillator

PubMed Central

Sánchez-Castro, Noemi; Palomino-Ovando, Martha Alicia; Estrada-Wiese, Denise; Valladares, Nydia Xcaret; del Río, Jesus Antonio; Doti, Rafael; Faubert, Jocelyn; Lugo, Jesus Eduardo

2018-01-01

Photonic crystals have been an object of interest because of their properties to inhibit certain wavelengths and allow the transmission of others. Using these properties, we designed a photonic structure known as photodyne formed by two porous silicon one-dimensional photonic crystals with an air defect between them. When the photodyne is illuminated with appropriate light, it allows us to generate electromagnetic forces within the structure that can be maximized if the light becomes localized inside the defect region. These electromagnetic forces allow the microcavity to oscillate mechanically. In the experiment, a chopper was driven by a signal generator to modulate the laser light that was used. The driven frequency and the signal modulation waveform (rectangular, sinusoidal or triangular) were changed with the idea to find optimal conditions for the structure to oscillate. The microcavity displacement amplitude, velocity amplitude and Fourier spectrum of the latter and its frequency were measured by means of a vibrometer. The mechanical oscillations are modeled and compared with the experimental results and show good agreement. For external frequency values of 5 Hz and 10 Hz, the best option was a sinusoidal waveform, which gave higher photodyne displacements and velocity amplitudes. Nonetheless, for an external frequency of 15 Hz, the best option was the rectangular waveform. PMID:29883393

[Radiation load on the skin using a silicone-coated polyamide wound dressing during photon and electron radiotherapy].

PubMed

Thilmann, C; Adamietz, I A; Ramm, U; Mose, S; Saran, F; Böttcher, H D

1996-05-01

Silicone-coated polyamide wound dressing is frequently used for the supportive treatment in patients with radiation induced skin lesions. The use of this kind of dressing during radiotherapy with high energy beams shifts the dose built-up effect towards the skin surface. Thus the dose delivered to the skin increases. The present work quantifies changes of the skin dose by a commercial silicon-coated polyamide wound dressing. The dependence on the beam quality and on different treatment techniques is investigated. Measurements were performed with photon (60Co, 6 MV, 42 MV) and electron (7 MeV, 20 MeV, 40 MeV) beams using thin LiF thermoluminescence dosimeters (TLD) in a perspex phantom. The beams were directed perpendicularly to the phantom surface. For 60Co and 6 MV photon beams the skin dose was evaluated in vivo at different beam arrangements and at a given reference dose. For 60Co, 6 MV and 42 MV photon beams wound dressing caused a dose increase on the surface of the perspex phantom by a factor of 1.65, 1.39 and 1.33 respectively. Using oblique or rotational techniques for 60Co and 6 MV photon irradiation the wound dressing increased the skin dose but less compared to perpendicular beam direction. For electron beams the skin dose is relatively high (from 84% to 92%) and an increase by a dressing has no clinical relevance (factor 1.03 to 1.05). The silicone-coated polyamide wound dressing causes no relevant skin dose increase during radiation treatment with electron beams and can be left on the skin during irradiation. During radiation treatment with photon beams like 60Co and 6 MV the protective procedure should be adapted to skin changes, in case of strong skin reactions a removal during the time of irradiation should be considered.

SU-E-T-66: A Prototype for Couch Based Real-Time Dosimetry in External Beam Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ramachandran, P

Purpose: The main purpose of this study is to design a prototype for couch-based based real time dosimetry system in external beam radiotherapy Methods: A prototype of 100 ionization chambers was designed on a printed circuit board by etching the copper layer and each ionization chamber was wired to a 50 pin connector. The signals from the two 50 pin connectors collected from the ionization chambers were then transferred to a PXI module from National Instruments. The PXI module houses a current amplifier that amplifies the charge collected from the ionization chamber. The amplified signal is then sent to amore » digital multimeter module for converting the analog signal to digital signal. A software was designed in labview to read and display the signals obtained from the PXI module. A couch attachment frame was designed to house the 100 ionization chamber module. The frame was fixed underneath the treatment couch for measuring the dose during treatment. Resutls: The ionization chamber based prototype dosimetry was tested for simple radiotherapy treatment fields and found to be a useful device for measuring real time dosimetry at the treatment couch plane. This information could be used to assess the delivered dose to a patient during radiotherapy. It could be used as an invivo dosimeter during radiotherapy. Conclusion: In this study, a prototype for couch based real time dosimetry system was designed and tested. The prototype forms a basis for the development of large scale couch based real time dosimetry system that could be used to perform morning QA prior to treatment, assess real time doses delivered to patient and as a device to monitor the output of the treatment beam. Peter MacCallum Cancer Foundation.« less

Effect of age-dependent bone electron density on the calculated dose distribution from kilovoltage and megavoltage photon and electron radiotherapy in paediatric MRI-only treatment planning.

PubMed

Zeinali-Rafsanjani, B; Faghihi, R; Mosleh-Shirazi, M A; Saeedi-Moghadam, M; Jalli, R; Sina, S

2018-01-01

MRI-only treatment planning (TP) can be advantageous in paediatric radiotherapy. However, electron density extraction is necessary for dose calculation. Normally, after bone segmentation, a bulk density is assigned. However, the variation of bone bulk density in patients makes the creation of pseudo CTs challenging. This study aims to assess the effects of bone density variations in children on radiation attenuation and dose calculation for MRI-only TP. Bone contents of <15-year-old children were calculated, and substituted in the Oak Ridge National Laboratory paediatric phantoms. The percentage depth dose and beam profile of 150 kVp and 6 MV photon and 6 MeV electron beams were then calculated using Xcom, MCNPX (Monte Carlo N-particle version X) and ORLN phantoms. Using 150 kVp X-rays, the difference in attenuation coefficient was almost 5% between an 11-year-old child and a newborn, and ~8% between an adult and a newborn. With megavoltage radiation, the differences were smaller but still important. For an 18 MV photon beam, the difference of radiation attenuation between an 11-year-old child and a newborn was 4% and ~7.4% between an adult and a newborn. For 6 MeV electrons, dose differences were observed up to the 2 cm depth. The percentage depth dose difference between 1 and 10-year-olds was 18.5%, and between 10 and 15-year-olds was 24%. The results suggest that for MRI-only TP of photon- or electron-beam radiotherapy, the bone densities of each age group should be defined separately for accurate dose calculation. Advances in knowledge: This study highlights the need for more age-specific determination of bone electron density for accurate dose calculations in paediatric MRI-only radiotherapy TP.

Low-energy photons in high-energy photon fields--Monte Carlo generated spectra and a new descriptive parameter.

PubMed

Chofor, Ndimofor; Harder, Dietrich; Willborn, Kay; Rühmann, Antje; Poppe, Björn

2011-09-01

The varying low-energy contribution to the photon spectra at points within and around radiotherapy photon fields is associated with variations in the responses of non-water equivalent dosimeters and in the water-to-material dose conversion factors for tissues such as the red bone marrow. In addition, the presence of low-energy photons in the photon spectrum enhances the RBE in general and in particular for the induction of second malignancies. The present study discusses the general rules valid for the low-energy spectral component of radiotherapeutic photon beams at points within and in the periphery of the treatment field, taking as an example the Siemens Primus linear accelerator at 6 MV and 15 MV. The photon spectra at these points and their typical variations due to the target system, attenuation, single and multiple Compton scattering, are described by the Monte Carlo method, using the code BEAMnrc/EGSnrc. A survey of the role of low energy photons in the spectra within and around radiotherapy fields is presented. In addition to the spectra, some data compression has proven useful to support the overview of the behaviour of the low-energy component. A characteristic indicator of the presence of low-energy photons is the dose fraction attributable to photons with energies not exceeding 200 keV, termed P(D)(200 keV). Its values are calculated for different depths and lateral positions within a water phantom. For a pencil beam of 6 or 15 MV primary photons in water, the radial distribution of P(D)(200 keV) is bellshaped, with a wide-ranging exponential tail of half value 6 to 7 cm. The P(D)(200 keV) value obtained on the central axis of a photon field shows an approximately proportional increase with field size. Out-of-field P(D)(200 keV) values are up to an order of magnitude higher than on the central axis for the same irradiation depth. The 2D pattern of P(D)(200 keV) for a radiotherapy field visualizes the regions, e.g. at the field margin, where changes of

DPM, a fast, accurate Monte Carlo code optimized for photon and electron radiotherapy treatment planning dose calculations

NASA Astrophysics Data System (ADS)

Sempau, Josep; Wilderman, Scott J.; Bielajew, Alex F.

2000-08-01

A new Monte Carlo (MC) algorithm, the `dose planning method' (DPM), and its associated computer program for simulating the transport of electrons and photons in radiotherapy class problems employing primary electron beams, is presented. DPM is intended to be a high-accuracy MC alternative to the current generation of treatment planning codes which rely on analytical algorithms based on an approximate solution of the photon/electron Boltzmann transport equation. For primary electron beams, DPM is capable of computing 3D dose distributions (in 1 mm3 voxels) which agree to within 1% in dose maximum with widely used and exhaustively benchmarked general-purpose public-domain MC codes in only a fraction of the CPU time. A representative problem, the simulation of 1 million 10 MeV electrons impinging upon a water phantom of 1283 voxels of 1 mm on a side, can be performed by DPM in roughly 3 min on a modern desktop workstation. DPM achieves this performance by employing transport mechanics and electron multiple scattering distribution functions which have been derived to permit long transport steps (of the order of 5 mm) which can cross heterogeneity boundaries. The underlying algorithm is a `mixed' class simulation scheme, with differential cross sections for hard inelastic collisions and bremsstrahlung events described in an approximate manner to simplify their sampling. The continuous energy loss approximation is employed for energy losses below some predefined thresholds, and photon transport (including Compton, photoelectric absorption and pair production) is simulated in an analogue manner. The δ-scattering method (Woodcock tracking) is adopted to minimize the computational costs of transporting photons across voxels.

Implementation of a software for REmote COMparison of PARticlE and photon treatment plans: ReCompare.

PubMed

Löck, Steffen; Roth, Klaus; Skripcak, Tomas; Worbs, Mario; Helmbrecht, Stephan; Jakobi, Annika; Just, Uwe; Krause, Mechthild; Baumann, Michael; Enghardt, Wolfgang; Lühr, Armin

2015-09-01

To guarantee equal access to optimal radiotherapy, a concept of patient assignment to photon or particle radiotherapy using remote treatment plan exchange and comparison - ReCompare - was proposed. We demonstrate the implementation of this concept and present its clinical applicability. The ReCompare concept was implemented using a client-server based software solution. A clinical workflow for the remote treatment plan exchange and comparison was defined. The steps required by the user and performed by the software for a complete plan transfer were described and an additional module for dose-response modeling was added. The ReCompare software was successfully tested in cooperation with three external partner clinics and worked meeting all required specifications. It was compatible with several standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. The ReCompare software can be applied to support non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by remote treatment plan exchange and comparison. Copyright © 2015. Published by Elsevier GmbH.

SU-F-T-116: Predicting IQ and the Risk of Hearing Loss Following Proton Versus Photon Radiotherapy for Pediatric Brain Tumor Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fortin, D; Sharpe, M; Laperriere, N

Purpose: The increased sparing of normal tissues in intensity modulated proton therapy (IMPT) compared to photon intensity modulated radiotherapy (IMRT) in brain tumor treatments should translate into improved neurocognitive outcomes. Models were used to estimate the intelligence quotient (IQ) and the risk of hearing loss 5 years post radiotherapy and to compare outcomes of proton against photon in pediatric brain tumors. Methods: Patients who had received radical IMRT were randomly selected from our retrospective database: 10 cases each of craniopharyngioma, ependymoma and medulloblastoma, and 20 cases of glioma. The existing planning CT and contours were used to generate IMPT plans.more » The RBE-corrected dose to brain structures and cochleas were calculated for both IMPT and IMRT. A model was applied to estimate IQ using a Markov chain Monte Carlo technique. The reported incidence of hearing loss as a function of cochlear dose was used to estimate the rate of occurrence. Results: The average brain dose was less in all IMPT plans compared to IMRT: ranging from a 6.7% reduction (P=0.003) in the case of medulloblastoma to 38% (P=0.007) for craniopharyngioma. This dose reduction translated into a gain in IQ of 1.9 points on average for protons vs photons for the whole cohort at 5 years post-treatment (P=0.011). In terms of specific diseases, the gains in IQ ranged from 0.8 points for medulloblastoma, to 2.7 points for craniopharyngioma. Hearing loss probability was evaluated on a per-ear-basis and was found to be systematically less for proton versus photon: overall 2.9% versus 7.2% (P < 0.001). Conclusion: A novel method was developed to predict neurocognitive outcomes in pediatric brain tumor patients on a case-by-case basis. A modest gain in IQ was systematically observed for proton in all patients. Given the uncertainties within the model used and our reinterpretation, these gains may be underestimated.« less

External Beam Radiotherapy Affects Serum Testosterone in Patients With Localized Prostate Cancer.

PubMed

Pompe, Raisa S; Karakiewicz, Pierre I; Zaffuto, Emanuele; Smith, Ariane; Bandini, Marco; Marchioni, Michele; Tian, Zhe; Leyh-Bannurah, Sami-Ramzi; Schiffmann, Jonas; Delouya, Guila; Lambert, Carole; Bahary, Jean-Paul; Beauchemin, Marie Claude; Barkati, Maroie; Ménard, Cynthia; Graefen, Markus; Saad, Fred; Tilki, Derya; Taussky, Daniel

2017-07-01

Previous studies have examined testosterone levels after external beam radiation (EBRT) monotherapy, but since 2002 only sparse contemporary data have been reported. To examine testosterone kinetics in a large series of contemporary patients after EBRT. The study was conducted in 425 patients who underwent definitive EBRT for localized prostate cancer from 2002 through 2014. Patients were enrolled in several phase II and III trials. Exclusion criteria were neoadjuvant or adjuvant androgen-deprivation therapy or missing data. Testosterone was recorded at baseline and then according to each study protocol (not mandatory in all protocols). Statistical analyses consisted of means and proportions, Kaplan-Meier plots, and logistic and Cox regression analyses. Testosterone kinetics after EBRT monotherapy and their influence on biochemical recurrence. Median follow-up of 248 assessable patients was 72 months. One hundred eighty-six patients (75.0%) showed a decrease in testosterone. Median time to first decrease was 6.4 months. Median percentage of decrease to the nadir was 30% and 112 (45.2%) developed biochemical hypogonadism (serum testosterone < 8 nmol/L). Of all patients with testosterone decrease, 117 (62.9%) recovered to at least 90% of baseline levels. Advanced age, increased body mass index, higher baseline testosterone level, and lower nadir level were associated with a lower chance of testosterone recovery. Subgroup analyses of 166 patients treated with intensity-modulated radiotherapy confirmed the results recorded for the entire cohort. In survival analyses, neither testosterone decrease nor recovery was predictive for biochemical recurrence. EBRT monotherapy influences testosterone kinetics, and although most patients will recover, approximately 45% will have biochemical hypogonadism. We report on the largest contemporary series of patients treated with EBRT monotherapy in whom testosterone kinetics were ascertained. Limitations are that testosterone follow

Phase II Trial of Combined High-Dose-Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hsu, I-Chow, E-mail: ihsu@radonc.ucsf.ed; Bae, Kyounghwa; Shinohara, Katsuto

2010-11-01

Purpose: To estimate the rate of late Grade 3 or greater genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) after treatment with external beam radiotherapy and prostate high-dose-rate (HDR) brachytherapy. Methods and Materials: Each participating institution submitted computed tomography-based HDR brachytherapy dosimetry data electronically for credentialing and for each study patient. Patients with locally confined Stage T1c-T3b prostate cancer were eligible for the present study. All patients were treated with 45 Gy in 25 fractions using external beam radiotherapy and one HDR implant delivering 19 Gy in two fractions. All AEs were graded according to the Common Terminology Criteria formore » Adverse Events, version 3.0. Late GU/GI AEs were defined as those occurring >9 months from the start of the protocol treatment, in patients with {>=}18 months of potential follow-up. Results: A total of 129 patients from 14 institutions were enrolled in the present study. Of the 129 patients, 125 were eligible, and AE data were available for 112 patients at analysis. The pretreatment characteristics of the patients were as follows: Stage T1c-T2c, 91%; Stage T3a-T3b, 9%; prostate-specific antigen level {<=}10 ng/mL, 70%; prostate-specific antigen level >10 but {<=}20 ng/mL, 30%; and Gleason score 2-6, 10%; Gleason score 7, 72%; and Gleason score 8-10, 18%. At a median follow-up of 29.6 months, three acute and four late Grade 3 GU/GI AEs were reported. The estimated rate of late Grade 3-5 GU and GI AEs at 18 months was 2.56%. Conclusion: This is the first prospective, multi-institutional trial of computed tomography-based HDR brachytherapy and external beam radiotherapy. The technique and doses used in the present study resulted in acceptable levels of AEs.« less

Towards a Clinical Decision Support System for External Beam Radiation Oncology Prostate Cancer Patients: Proton vs. Photon Radiotherapy? A Radiobiological Study of Robustness and Stability

PubMed Central

Walsh, Seán; Roelofs, Erik; Kuess, Peter; van Wijk, Yvonka; Lambin, Philippe; Jones, Bleddyn; Verhaegen, Frank

2018-01-01

We present a methodology which can be utilized to select proton or photon radiotherapy in prostate cancer patients. Four state-of-the-art competing treatment modalities were compared (by way of an in silico trial) for a cohort of 25 prostate cancer patients, with and without correction strategies for prostate displacements. Metrics measured from clinical image guidance systems were used. Three correction strategies were investigated; no-correction, extended-no-action-limit, and online-correction. Clinical efficacy was estimated via radiobiological models incorporating robustness (how probable a given treatment plan was delivered) and stability (the consistency between the probable best and worst delivered treatments at the 95% confidence limit). The results obtained at the cohort level enabled the determination of a threshold for likely clinical benefit at the individual level. Depending on the imaging system and correction strategy; 24%, 32% and 44% of patients were identified as suitable candidates for proton therapy. For the constraints of this study: Intensity-modulated proton therapy with online-correction was on average the most effective modality. Irrespective of the imaging system, each treatment modality is similar in terms of robustness, with and without the correction strategies. Conversely, there is substantial variation in stability between the treatment modalities, which is greatly reduced by correction strategies. This study provides a ‘proof-of-concept’ methodology to enable the prospective identification of individual patients that will most likely (above a certain threshold) benefit from proton therapy. PMID:29463018

Low dose out-of-field radiotherapy, part 2: Calculating the mean photon energy values for the out-of-field photon energy spectrum from scattered radiation using Monte Carlo methods.

PubMed

Skrobala, A; Adamczyk, S; Kruszyna-Mochalska, M; Skórska, M; Konefał, A; Suchorska, W; Zaleska, K; Kowalik, A; Jackowiak, W; Malicki, J

2017-08-01

During radiotherapy, leakage from the machine head and collimator expose patients to out-of-field irradiation doses, which may cause secondary cancers. To quantify the risks of secondary cancers due to out-of-field doses, it is first necessary to measure these doses. Since most dosimeters are energy-dependent, it is essential to first determine the type of photon energy spectrum in the out-of-field area. The aim of this study was to determine the mean photon energy values for the out-of-field photon energy spectrum for a 6 MV photon beam using the GEANT 4-Monte Carlo method. A specially-designed large water phantom was simulated with a static field at gantry 0°. The source-to-surface distance was 92cm for an open field size of 10×10cm2. The photon energy spectra were calculated at five unique positions (at depths of 0.5, 1.6, 4, 6, 8, and 10cm) along the central beam axis and at six different off-axis distances. Monte Carlo simulations showed that mean radiation energy levels drop rapidly beyond the edge of the 6 MV photon beam field: at a distance of 10cm, the mean energy level is close to 0.3MeV versus 1.5MeV at the central beam axis. In some cases, the energy level actually increased even as the distance from the field edge increased: at a depth of 1.6cm and 15cm off-axis, the mean energy level was 0.205MeV versus 0.252MeV at 20cm off-axis. The out-of-field energy spectra and dose distribution data obtained in this study with Monte Carlo methods can be used to calibrate dosimeters to measure out-of-field radiation from 6MV photons. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

A brachytherapy photon radiation quality index Q(BT) for probe-type dosimetry.

PubMed

Quast, Ulrich; Kaulich, Theodor W; Álvarez-Romero, José T; Carlsson Tedgren, Sa; Enger, Shirin A; Medich, David C; Mourtada, Firas; Perez-Calatayud, Jose; Rivard, Mark J; Zakaria, G Abu

2016-06-01

In photon brachytherapy (BT), experimental dosimetry is needed to verify treatment plans if planning algorithms neglect varying attenuation, absorption or scattering conditions. The detector's response is energy dependent, including the detector material to water dose ratio and the intrinsic mechanisms. The local mean photon energy E¯(r) must be known or another equivalent energy quality parameter used. We propose the brachytherapy photon radiation quality indexQ(BT)(E¯), to characterize the photon radiation quality in view of measurements of distributions of the absorbed dose to water, Dw, around BT sources. While the external photon beam radiotherapy (EBRT) radiation quality index Q(EBRT)(E¯)=TPR10(20)(E¯) is not applicable to BT, the authors have applied a novel energy dependent parameter, called brachytherapy photon radiation quality index, defined as Q(BT)(E¯)=Dprim(r=2cm,θ0=90°)/Dprim(r0=1cm,θ0=90°), utilizing precise primary absorbed dose data, Dprim, from source reference databases, without additional MC-calculations. For BT photon sources used clinically, Q(BT)(E¯) enables to determine the effective mean linear attenuation coefficient μ¯(E) and thus the effective energy of the primary photons Eprim(eff)(r0,θ0) at the TG-43 reference position Pref(r0=1cm,θ0=90°), being close to the mean total photon energy E¯tot(r0,θ0). If one has calibrated detectors, published E¯tot(r) and the BT radiation quality correction factor [Formula: see text] for different BT radiation qualities Q and Q0, the detector's response can be determined and Dw(r,θ) measured in the vicinity of BT photon sources. This novel brachytherapy photon radiation quality indexQ(BT) characterizes sufficiently accurate and precise the primary photon's penetration probability and scattering potential. Copyright © 2016. Published by Elsevier Ltd.

Concept for individualized patient allocation: ReCompare--remote comparison of particle and photon treatment plans.

PubMed

Lühr, Armin; Löck, Steffen; Roth, Klaus; Helmbrecht, Stephan; Jakobi, Annika; Petersen, Jørgen B; Just, Uwe; Krause, Mechthild; Enghardt, Wolfgang; Baumann, Michael

2014-02-18

Identifying those patients who have a higher chance to be cured with fewer side effects by particle beam therapy than by state-of-the-art photon therapy is essential to guarantee a fair and sufficient access to specialized radiotherapy. The individualized identification requires initiatives by particle as well as non-particle radiotherapy centers to form networks, to establish procedures for the decision process, and to implement means for the remote exchange of relevant patient information. In this work, we want to contribute a practical concept that addresses these requirements. We proposed a concept for individualized patient allocation to photon or particle beam therapy at a non-particle radiotherapy institution that bases on remote treatment plan comparison. We translated this concept into the web-based software tool ReCompare (REmote COMparison of PARticlE and photon treatment plans). We substantiated the feasibility of the proposed concept by demonstrating remote exchange of treatment plans between radiotherapy institutions and the direct comparison of photon and particle treatment plans in photon treatment planning systems. ReCompare worked with several tested standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. Our concept supports non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by providing expertise from a particle therapy center. The software tool ReCompare may help to improve and standardize this personalized treatment decision. It will be available from our website when proton therapy is operational at our facility.

Radiotherapy Dose Perturbation of Esophageal Stents Examined in an Experimental Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Atwood, Todd F.; Hsu, Annie; Ogara, Maydeen M.

2012-04-01

Purpose: To investigate the radiotherapy dose perturbations caused by esophageal stents in patients undergoing external beam treatments for esophageal cancer. Methods and Materials: Four esophageal stents were examined (three metallic stents: WallFlex, Ultraflex, and Alveolus; one nonmetallic stent with limited radiopaque markers for visualization: Polyflex). All experiments were performed in a liquid water phantom with a custom acrylic stent holder. Radiochromic film was used to measure the dose distributions adjacent to the stents at locations proximal and distal to the radiation source. The stents were placed in an air-filled cavity to simulate the esophagus. Treatment plans were created and deliveredmore » for photon energies of 6 and 15 MV, and data analysis was performed on uniform regions of interest, according to the size and geometric placement of the films, to quantify the dose perturbations. Results: The three metallic stents produced the largest dose perturbations with distinct patterns of 'hot' spots (increased dose) measured proximal to the radiation source (up to 15.4%) and both 'cold' (decreased dose) and hot spots measured distal to the radiation source (range, -6.1%-5.8%). The polymeric Polyflex stent produced similar dose perturbations when the radiopaque markers were examined (range, -7.6%-15.4%). However, when the radiopaque markers were excluded from the analysis, the Polyflex stent produced significantly smaller dose perturbations, with maximum hot spots of 7.3% and cold spots of -3.2%. Conclusions: The dose perturbations caused by esophageal stents during the treatment of esophageal cancer using external beam radiotherapy should be understood. These perturbations will result in hot and cold spots in the esophageal mucosa, with varying magnitudes depending on the stent. The nonmetallic Polyflex stent appears to be the most suitable for patients undergoing radiotherapy, but further studies are necessary to determine the clinical significance

Radiotherapy dose perturbation of esophageal stents examined in an experimental model.

PubMed

Atwood, Todd F; Hsu, Annie; Ogara, Maydeen M; Luba, Daniel G; Tamler, Bradley J; Disario, James A; Maxim, Peter G

2012-04-01

To investigate the radiotherapy dose perturbations caused by esophageal stents in patients undergoing external beam treatments for esophageal cancer. Four esophageal stents were examined (three metallic stents: WallFlex, Ultraflex, and Alveolus; one nonmetallic stent with limited radiopaque markers for visualization: Polyflex). All experiments were performed in a liquid water phantom with a custom acrylic stent holder. Radiochromic film was used to measure the dose distributions adjacent to the stents at locations proximal and distal to the radiation source. The stents were placed in an air-filled cavity to simulate the esophagus. Treatment plans were created and delivered for photon energies of 6 and 15 MV, and data analysis was performed on uniform regions of interest, according to the size and geometric placement of the films, to quantify the dose perturbations. The three metallic stents produced the largest dose perturbations with distinct patterns of "hot" spots (increased dose) measured proximal to the radiation source (up to 15.4%) and both "cold" (decreased dose) and hot spots measured distal to the radiation source (range, -6.1%-5.8%). The polymeric Polyflex stent produced similar dose perturbations when the radiopaque markers were examined (range, -7.6%-15.4%). However, when the radiopaque markers were excluded from the analysis, the Polyflex stent produced significantly smaller dose perturbations, with maximum hot spots of 7.3% and cold spots of -3.2%. The dose perturbations caused by esophageal stents during the treatment of esophageal cancer using external beam radiotherapy should be understood. These perturbations will result in hot and cold spots in the esophageal mucosa, with varying magnitudes depending on the stent. The nonmetallic Polyflex stent appears to be the most suitable for patients undergoing radiotherapy, but further studies are necessary to determine the clinical significance of the dose perturbations. Copyright © 2012 Elsevier Inc

SU-F-T-89: Investigation of Simultaneous Optimization of Photon and Electron Apertures for Mixed Beam Radiotherapy Based On An Academic Case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mueller, S; Joosten, A; Fix, MK

Purpose: To estimate the dosimetric potential of mixed beam radiotherapy (MBRT) by using a single process optimizing the shape and weight of photon and electron apertures simultaneously based on Monte Carlo beamlet dose distributions. Methods: A simulated annealing based direct aperture optimization capable to perform simultaneous optimization was developed to generate treatment plans for MERT, photon-IMRT and MBRT. Both photon and electron apertures are collimated with the photon-MLC and are delivered in a segmented manner. For dosimetric comparison and for investigating the dependency on the number of apertures, photon-IMRT, MERT and MBRT plans were generated for an academic case consistingmore » of a water phantom containing two shallow PTVs differing in the maximal depth of 5 and 7 cm, respectively and two OARs in distal and lateral direction to the PTVs. Results: For the superficial PTV, the dose homogeneity (V95%–V107%) and the mean dose (in percent of the prescribed dose) to the distal and the lateral OARs of the MBRT plan (94.9%, 16.9%, 17.8%) are superior or comparable to those for the MERT (74%, 18.4%, 15.4%) and the photon-IMRT plan (89.4%, 20.8%, 24.7%). For the enlarged PTV, the dosimetric superiority of MBRT compared to MERT and photon-IMRT is even more pronounced. Furthermore, an MBRT plan with 12 electron and 10 photon apertures lead to an objective function value 38% lower than that of a photon-IMRT plan with 40 apertures. Conclusion: The results of simultaneous optimization for MBRT are promising with regards to further OAR sparing and improved dose coverage to the PTV compared to photon-IMRT and MERT. Especially superficial targets with deeper subparts (>5 cm) could substantially benefit. Moreover, MBRT seems to be a possible solution of two downsides of photon-IMRT, namely the extended low dose bath and the requirement of numerous apertures. This work was supported by Varian Medical Systems. This work was supported by Varian Medical Systems.« less

Validating dose rate calibration of radiotherapy photon beams through IAEA/WHO postal audit dosimetry service.

PubMed

Jangda, Abdul Qadir; Hussein, Sherali

2012-05-01

In external beam radiation therapy (EBRT), the quality assurance (QA) of the radiation beam is crucial to the accurate delivery of the prescribed dose to the patient. One of the dosimetric parameters that require monitoring is the beam output, specified as the dose rate on the central axis under reference conditions. The aim of this project was to validate dose rate calibration of megavoltage photon beams using the International Atomic Energy Agency (IAEA)/World Health Organisation (WHO) postal audit dosimetry service. Three photon beams were audited: a 6 MV beam from the low-energy linac and 6 and 18 MV beams from a dual high-energy linac. The agreement between our stated doses and the IAEA results was within 1% for the two 6 MV beams and within 2% for the 18 MV beam. The IAEA/WHO postal audit dosimetry service provides an independent verification of dose rate calibration protocol by an international facility.

Gold nanoparticle induced vasculature damage in radiotherapy: Comparing protons, megavoltage photons, and kilovoltage photons.

PubMed

Lin, Yuting; Paganetti, Harald; McMahon, Stephen J; Schuemann, Jan

2015-10-01

The purpose of this work is to investigate the radiosensitizing effect of gold nanoparticle (GNP) induced vasculature damage for proton, megavoltage (MV) photon, and kilovoltage (kV) photon irradiation. Monte Carlo simulations were carried out using tool for particle simulation (TOPAS) to obtain the spatial dose distribution in close proximity up to 20 μm from the GNPs. The spatial dose distribution from GNPs was used as an input to calculate the dose deposited to the blood vessels. GNP induced vasculature damage was evaluated for three particle sources (a clinical spread out Bragg peak proton beam, a 6 MV photon beam, and two kV photon beams). For each particle source, various depths in tissue, GNP sizes (2, 10, and 20 nm diameter), and vessel diameters (8, 14, and 20 μm) were investigated. Two GNP distributions in lumen were considered, either homogeneously distributed in the vessel or attached to the inner wall of the vessel. Doses of 30 Gy and 2 Gy were considered, representing typical in vivo enhancement studies and conventional clinical fractionation, respectively. These simulations showed that for 20 Au-mg/g GNP blood concentration homogeneously distributed in the vessel, the additional dose at the inner vascular wall encircling the lumen was 43% of the prescribed dose at the depth of treatment for the 250 kVp photon source, 1% for the 6 MV photon source, and 0.1% for the proton beam. For kV photons, GNPs caused 15% more dose in the vascular wall for 150 kVp source than for 250 kVp. For 6 MV photons, GNPs caused 0.2% more dose in the vascular wall at 20 cm depth in water as compared to at depth of maximum dose (Dmax). For proton therapy, GNPs caused the same dose in the vascular wall for all depths across the spread out Bragg peak with 12.7 cm range and 7 cm modulation. For the same weight of GNPs in the vessel, 2 nm diameter GNPs caused three times more damage to the vessel than 20 nm diameter GNPs. When the GNPs were attached to the inner vascular wall

Gold nanoparticle induced vasculature damage in radiotherapy: Comparing protons, megavoltage photons, and kilovoltage photons

PubMed Central

Lin, Yuting; Paganetti, Harald; McMahon, Stephen J.; Schuemann, Jan

2015-01-01

Purpose: The purpose of this work is to investigate the radiosensitizing effect of gold nanoparticle (GNP) induced vasculature damage for proton, megavoltage (MV) photon, and kilovoltage (kV) photon irradiation. Methods: Monte Carlo simulations were carried out using tool for particle simulation (TOPAS) to obtain the spatial dose distribution in close proximity up to 20 μm from the GNPs. The spatial dose distribution from GNPs was used as an input to calculate the dose deposited to the blood vessels. GNP induced vasculature damage was evaluated for three particle sources (a clinical spread out Bragg peak proton beam, a 6 MV photon beam, and two kV photon beams). For each particle source, various depths in tissue, GNP sizes (2, 10, and 20 nm diameter), and vessel diameters (8, 14, and 20 μm) were investigated. Two GNP distributions in lumen were considered, either homogeneously distributed in the vessel or attached to the inner wall of the vessel. Doses of 30 Gy and 2 Gy were considered, representing typical in vivo enhancement studies and conventional clinical fractionation, respectively. Results: These simulations showed that for 20 Au-mg/g GNP blood concentration homogeneously distributed in the vessel, the additional dose at the inner vascular wall encircling the lumen was 43% of the prescribed dose at the depth of treatment for the 250 kVp photon source, 1% for the 6 MV photon source, and 0.1% for the proton beam. For kV photons, GNPs caused 15% more dose in the vascular wall for 150 kVp source than for 250 kVp. For 6 MV photons, GNPs caused 0.2% more dose in the vascular wall at 20 cm depth in water as compared to at depth of maximum dose (Dmax). For proton therapy, GNPs caused the same dose in the vascular wall for all depths across the spread out Bragg peak with 12.7 cm range and 7 cm modulation. For the same weight of GNPs in the vessel, 2 nm diameter GNPs caused three times more damage to the vessel than 20 nm diameter GNPs. When the GNPs were attached

Volumetric response of intracranial meningioma after photon or particle irradiation.

PubMed

Mozes, Petra; Dittmar, Jan Oliver; Habermehl, Daniel; Tonndorf-Martini, Eric; Hideghety, Katalin; Dittmar, Anne; Debus, Jürgen; Combs, Stephanie E

2017-03-01

Meningiomas are usually slow growing, well circumscribed intracranial tumors. In symptom-free cases observation with close follow-up imaging could be performed. Symptomatic meningiomas could be surgically removed and/or treated with radiotherapy. The study aimed to evaluate the volumetric response of intracranial meningiomas at different time points after photon, proton, and a mixed photon and carbon ion boost irradiation. In Group A 38 patients received proton therapy (median dose: 56 GyE in 1.8-2 GyE daily fractions) or a mixed photon/carbon ion therapy (50 Gy in 2 Gy daily fractions with intensity modulated radiotherapy (IMRT) and 18 GyE in 3 GyE daily dose carbon ion boost). Thirty-nine patients (Group B) were treated by photon therapy with IMRT or fractionated stereotactic radiotherapy technique (median dose: 56 Gy in 1.8-2 Gy daily fractions). The delineation of the tumor volume was based on the initial, one- and two-year follow-up magnetic resonance imaging and these volumes were compared to evaluate the volumetric tumor response. Significant tumor volume shrinkage was detected at one- and at two-year follow-up both after irradiation by particles and by photons. No significant difference in tumor volume change was observed between photon, proton or combined photon plus carbon ion boost treated patients. WHO grade and gender appear to be determining factors for tumor volume shrinkage. Significant volumetric shrinkage of meningiomas could be observed independently of the applied radiation modality. Long-term follow-up is recommended to evaluate further dynamic of size reduction and its correlation with outcome data.

Role of particle radiotherapy in the management of head and neck cancer.

PubMed

Laramore, George E

2009-05-01

Modern imaging techniques and powerful computers allow a radiation oncologist to design treatments delivering higher doses of radiation than previously possible. Dose distributions imposed by the physics of 'standard' photon and electron beams limit further dose escalation. Hadron radiotherapy offers advantages in either dose distribution and/or improved radiobiology that may significantly improve the treatment of certain head and neck malignancies. Clinical studies support the effectiveness of fast-neutron radiotherapy in the treatment of major and minor salivary gland tumors. Data show highly favorable outcomes with proton radiotherapy for skull-base malignancies and tumors near highly critical normal tissues compared with that expected with standard radiotherapy. Heavy-ion radiotherapy clinical studies are mainly being conducted with fully stripped carbon ions, and limited data seem to indicate a possible improvement over proton radiotherapy for the same subset of radioresistant tumors where neutrons show a benefit over photons. Fast-neutron radiotherapy has different radiobiological properties compared with standard radiotherapy but similar depth dose distributions. Its role in the treatment of head and neck cancer is currently limited to salivary gland malignancies and certain radioresistant tumors such as sarcomas. Protons have the same radiobiological properties as standard radiotherapy beams but more optimal depth dose distributions, making it particularly advantageous when treating tumors adjacent to highly critical structures. Heavy ions combine the radiobiological properties of fast neutrons with the physical dose distributions of protons, and preliminary data indicate their utility for radioresistant tumors adjacent to highly critical structures.

Gold nanoparticle induced vasculature damage in radiotherapy: Comparing protons, megavoltage photons, and kilovoltage photons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, Yuting, E-mail: yutingl188@gmail.com; Paganetti, Harald; Schuemann, Jan

2015-10-15

Purpose: The purpose of this work is to investigate the radiosensitizing effect of gold nanoparticle (GNP) induced vasculature damage for proton, megavoltage (MV) photon, and kilovoltage (kV) photon irradiation. Methods: Monte Carlo simulations were carried out using tool for particle simulation (TOPAS) to obtain the spatial dose distribution in close proximity up to 20 μm from the GNPs. The spatial dose distribution from GNPs was used as an input to calculate the dose deposited to the blood vessels. GNP induced vasculature damage was evaluated for three particle sources (a clinical spread out Bragg peak proton beam, a 6 MV photonmore » beam, and two kV photon beams). For each particle source, various depths in tissue, GNP sizes (2, 10, and 20 nm diameter), and vessel diameters (8, 14, and 20 μm) were investigated. Two GNP distributions in lumen were considered, either homogeneously distributed in the vessel or attached to the inner wall of the vessel. Doses of 30 Gy and 2 Gy were considered, representing typical in vivo enhancement studies and conventional clinical fractionation, respectively. Results: These simulations showed that for 20 Au-mg/g GNP blood concentration homogeneously distributed in the vessel, the additional dose at the inner vascular wall encircling the lumen was 43% of the prescribed dose at the depth of treatment for the 250 kVp photon source, 1% for the 6 MV photon source, and 0.1% for the proton beam. For kV photons, GNPs caused 15% more dose in the vascular wall for 150 kVp source than for 250 kVp. For 6 MV photons, GNPs caused 0.2% more dose in the vascular wall at 20 cm depth in water as compared to at depth of maximum dose (Dmax). For proton therapy, GNPs caused the same dose in the vascular wall for all depths across the spread out Bragg peak with 12.7 cm range and 7 cm modulation. For the same weight of GNPs in the vessel, 2 nm diameter GNPs caused three times more damage to the vessel than 20 nm diameter GNPs. When the GNPs were

Concept for individualized patient allocation: ReCompare—remote comparison of particle and photon treatment plans

PubMed Central

2014-01-01

Background Identifying those patients who have a higher chance to be cured with fewer side effects by particle beam therapy than by state-of-the-art photon therapy is essential to guarantee a fair and sufficient access to specialized radiotherapy. The individualized identification requires initiatives by particle as well as non-particle radiotherapy centers to form networks, to establish procedures for the decision process, and to implement means for the remote exchange of relevant patient information. In this work, we want to contribute a practical concept that addresses these requirements. Methods We proposed a concept for individualized patient allocation to photon or particle beam therapy at a non-particle radiotherapy institution that bases on remote treatment plan comparison. We translated this concept into the web-based software tool ReCompare (REmote COMparison of PARticlE and photon treatment plans). Results We substantiated the feasibility of the proposed concept by demonstrating remote exchange of treatment plans between radiotherapy institutions and the direct comparison of photon and particle treatment plans in photon treatment planning systems. ReCompare worked with several tested standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. Conclusions Our concept supports non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by providing expertise from a particle therapy center. The software tool ReCompare may help to improve and standardize this personalized treatment decision. It will be available from our website when proton therapy is operational at our facility. PMID:24548333

Melatonin prevents possible radiotherapy-induced thyroid injury.

PubMed

Arıcıgil, Mitat; Dündar, Mehmet Akif; Yücel, Abitter; Eryılmaz, Mehmet Akif; Aktan, Meryem; Alan, Mehmet Akif; Fındık, Sıdıka; Kılınç, İbrahim

2017-12-01

We aimed to investigate the protective effect of melatonin in radiotherapy-induced thyroid gland injury in an experimental rat model. Thirty-two rats were divided into four groups: the control group, melatonin treatment group, radiotherapy group and melatonin plus radiotherapy group. The neck region of each rat was defined by simulation and radiated with 2 Gray (Gy) per min with 6-MV photon beams, for a total dose of 18 Gy. Melatonin was administered at a dose of 50 mg/kg through intraperitoneal injection, 15 min prior to radiation exposure. Thirty days after the beginning of the study, rats were decapitated and analyses of blood and thyroid tissue were performed. Tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1β), thiobarbituric acid reactive substances (TBARS) and nitric oxide (NO) levels in the radiotherapy group were significantly higher than those in the melatonin plus radiotherapy group (p < .05), whereas interleukin-10 (IL-10) and glutathione (GSH) values were higher in the melatonin plus radiotherapy group (p < .05). The infiltration of inflammatory cells and percentage of apoptosis in the radiotherapy group were significantly higher than those in the melatonin plus radiotherapy group (p < .05). Melatonin helped protect thyroid gland structure against the undesired cytotoxic effects of radiotherapy in rats.

Endobiliary Stent Position Changes during External-beam Radiotherapy

PubMed Central

Chu, Kwun-Ye; Eccles, Cynthia L.; Brunner, Thomas B.

2015-01-01

Purpose Endobiliary stents can be used as surrogates for pancreatic localization when using cone-beam computed tomography (CBCT) during external-beam radiotherapy (EBRT). This work reports on interfraction stent position changes during EBRT for locally advanced pancreatic cancer (LAPC). Materials and Methods Six patients with endobiliary stents who underwent EBRT for LAPC were assessed. Measurements from the most superior aspect of the stent (sup stent) and the most inferior aspect of the stent (inf stent) to the most inferior, posterior aspect of the L1 vertebra central spinous process were determined from daily treatment CBCTs and compared with those determined from the planning computed tomography (CT) scan. Changes in stent-L1 measurements were interpreted as changes in relative stent position. Results Three patients showed mean interfraction stent position changes of ≥1 cm when treatment measurements were compared with planning measurements. The sup stent for patient A moved to the right (2.66 ± 2.77 cm) and inferiorly (3.0 ± 3.12 cm), and the inf stent moved to the right (1.92 ± 2.02 cm) inferiorly (3.23 ± 3.34 cm) and posteriorly (1.41 ± 1.43 cm). The inf stent for patient B moved superiorly (2.23 ± 0.49 cm) and posteriorly (1.72 ± 0.59 cm). The sup and inf stent for patient F moved inferiorly (0.98 ± 0.35 cm and 1.21 ± 0.38 cm, respectively). The remaining three patients C, D, and E showed interfraction position changes of <1 cm. Conclusion Endobiliary stent migration and deformation were observed in a small subset of patients. Further investigation is required before confirming their use as surrogates for LAPC target localization during image-guided EBRT. PMID:26090069

Conventional and conformal technique of external beam radiotherapy in locally advanced cervical cancer: Dose distribution, tumor response, and side effects

NASA Astrophysics Data System (ADS)

Mutrikah, N.; Winarno, H.; Amalia, T.; Djakaria, M.

2017-08-01

The objective of this study was to compare conventional and conformal techniques of external beam radiotherapy (EBRT) in terms of the dose distribution, tumor response, and side effects in the treatment of locally advanced cervical cancer patients. A retrospective cohort study was conducted on cervical cancer patients who underwent EBRT before brachytherapy in the Radiotherapy Department of Cipto Mangunkusumo Hospital. The prescribed dose distribution, tumor response, and acute side effects of EBRT using conventional and conformal techniques were investigated. In total, 51 patients who underwent EBRT using conventional techniques (25 cases using Cobalt-60 and 26 cases using a linear accelerator (LINAC)) and 29 patients who underwent EBRT using conformal techniques were included in the study. The distribution of the prescribed dose in the target had an impact on the patient’s final response to EBRT. The complete response rate of patients to conformal techniques was significantly greater (58%) than that of patients to conventional techniques (42%). No severe acute local side effects were seen in any of the patients (Radiation Therapy Oncology Group (RTOG) grades 3-4). The distribution of the dose and volume to the gastrointestinal tract affected the proportion of mild acute side effects (RTOG grades 1-2). The urinary bladder was significantly greater using conventional techniques (Cobalt-60/LINAC) than using conformal techniques at 72% and 78% compared to 28% and 22%, respectively. The use of conformal techniques in pelvic radiation therapy is suggested in radiotherapy centers with CT simulators and 3D Radiotherapy Treatment Planning Systems (RTPSs) to decrease some uncertainties in radiotherapy planning. The use of AP/PA pelvic radiation techniques with Cobalt-60 should be limited in body thicknesses equal to or less than 18 cm. When using conformal techniques, delineation should be applied in the small bowel, as it is considered a critical organ according to RTOG

Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk; Lewis, Joanne

2012-07-01

The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared inmore » terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.« less

Californium-252 Brachytherapy Combined With External-Beam Radiotherapy for Cervical Cancer: Long-Term Treatment Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lei Xin; Qian Chengyuan; Qing Yi

Purpose: To observe, by retrospective analysis, the curative effects and complications due to californium-252 ({sup 252}Cf) neutron intracavitary brachytherapy (ICBT) combined with external-beam radiotherapy (EBRT) in the treatment of cervical cancer. Methods and Materials: From February 1999 to December 2007, 696 patients with cervical cancer (Stages IB to IIIB) were treated with {sup 252}Cf-ICBT in combination of EBRT. Of all, 31 patients were at Stage IB, 104 at IIA, 363 at IIB, 64 at IIIA, and 134 at IIIB. Californium-252 ICBT was delivered at 7-12 Gy per insertion per week, with a total dose of 29-45 Gy to reference pointmore » A in three to five insertions. The whole pelvic cavity was treated with 8-MV X-ray external irradiation at 2 Gy per fraction, four times per week. After 16-38 Gy of external irradiation, the center of the whole pelvic field was blocked with a 4-cm-wide lead shield, with a total external irradiation dose of 44-56 Gy. The total treatment course was 5 to 6 weeks. Results: Overall survival rate at 3 and 5 years for all patients was 76.0% and 64.9%, respectively. Disease-free 3- and 5-year survival rates of patients were 71.2% and 58.4%, respectively. Late complications included vaginal contracture and adhesion, radiation proctitis, radiation cystitis, and inflammatory bowel, which accounted for 5.8%, 7.1%, 6.2%, and 4.9%, respectively. Univariate analysis results showed significant correlation of stage, age, histopathologic grade, and lymph node status with overall survival. Cox multiple regression analysis showed that the independent variables were stage, histopathologic grade, tumor size, and lymphatic metastasis in all patients. Conclusion: Results of this series suggest that the combined use of {sup 252}Cf-ICBT with EBRT is an effective method for treatment of cervical cancer.« less

WE-E-213AB-01: Medical Physics Challenges for Implementation of New Technologies in External Beam Radiotherapy.

PubMed

Boiras, C; Bourland, J; Gonzalez, L Brualla; Bulychkin, P; Ford, E; Kazantsev, P; Krylova, T; Medina, A Lopez; Prusova, M; Romanov, D; Ferrando, J Rosello; Willoughby, T; Yan, D; Yu, C; Zvereva, A

2012-06-01

The AAPM has signed two formal Educational Exchange Agreements with the Spanish (SEFM) and the Russian (AMPR) medical physics societies. While the primary purpose of the Agreements is to provide educational opportunities for young medical physicists, the Agreements also contemplate holding joint sessions at scientific congresses. The purpose of this professional AAPM/SEFM/AMPR Joint Symposium is to explore the challenges that medical physicists in the three countries face when new external beam radiotherapy technologies are introduced in their facilities and to suggest potential solutions to limitations in testing equipment and lack of familiarity with protocols. Speakers from the three societies will present reviews of the technical aspects of IMRT, Arc EVIRT (IMAT/VMAT/Rapid Arc), SRS/SRBT, and IGRT/Adaptive radiotherapy, and will describe the status of these technologies in their countries, including the challenges found in tasks such as developing anatomical and biological dose optimization techniques and implementing QA management, risk assessment and patient safety programs. The SEFM will offer AAPM and AMPR members the possibility to participate in collaborative proposals for future research bids in UE and USA based on an ongoing Spanish project for adaptive radiotherapy using functional imaging. A targeted discussion will debate three propositions: the cost/benefit ratio of IGRT, whether IMRT requires IGRT, and the use of non-ionizing radiation technologies for realtime monitoring of prostate IGRT. For these debates, each society has designated one speaker to present and defend either "For" or "Against" the proposition, followed by discussion by all participants. The Symposium presentations and the country-tailored recommendations drawn will be made available to each society for inclusion in their websites. The WGNIMP, the AAPM Work Group charged with executing the AAPM/SEFM and AAPM/AMPR Agreements, will follow up on the commitments made by the AAPM.Di Yan

Percentage of Cancer Volume in Biopsy Cores Is Prognostic for Prostate Cancer Death and Overall Survival in Patients Treated With Dose-Escalated External Beam Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vance, Sean M.; Stenmark, Matthew H.; Blas, Kevin

2012-07-01

Purpose: To investigate the prognostic utility of the percentage of cancer volume (PCV) in needle biopsy specimens for prostate cancer patients treated with dose-escalated external beam radiotherapy. Methods and Materials: The outcomes were analyzed for 599 men treated for localized prostate cancer with external beam radiotherapy to a minimal planning target volume dose of 75 Gy (range, 75-79.2). We assessed the effect of PCV and the pretreatment and treatment-related factors on the freedom from biochemical failure, freedom from metastasis, cause-specific survival, and overall survival. Results: The median number of biopsy cores was 7 (interquartile range, 6-12), median PCV was 10%more » (interquartile range, 2.5-25%), and median follow-up was 62 months. The PCV correlated with the National Comprehensive Cancer Network risk group and individual risk features, including T stage, prostate-specific antigen level, Gleason score, and percentage of positive biopsy cores. On log-rank analysis, the PCV stratified by quartile was prognostic for all endpoints, including overall survival. In addition, the PCV was a stronger prognostic factor than the percentage of positive biopsy cores when the two metrics were analyzed together. On multivariate analysis, the PCV predicted a worse outcome for all endpoints, including freedom from biochemical failure, (hazard ratio, 1.9; p = .0035), freedom from metastasis (hazard ratio, 1.7, p = .09), cause-specific survival (hazard ratio, 3.9, p = .014), and overall survival (hazard ratio, 1.8, p = .02). Conclusions: For patients treated with dose-escalated external beam radiotherapy, the volume of cancer in the biopsy specimen adds prognostic value for clinically relevant endpoints, particularly in intermediate- and high-risk patients. Although the PCV determination is more arduous than the percentage of positive biopsy cores, it provides superior risk stratification.« less

Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma

PubMed Central

2012-01-01

Background External beam radiotherapy (EBRT) is the treatment of choice for irresectable meningioma. Due to the strong expression of somatostatin receptors, peptide receptor radionuclide therapy (PRRT) has been used in advanced cases. We assessed the feasibility and tolerability of a combination of both treatment modalities in advanced symptomatic meningioma. Methods 10 patients with irresectable meningioma were treated with PRRT (177Lu-DOTA0,Tyr3 octreotate or - DOTA0,Tyr3 octreotide) followed by external beam radiotherapy (EBRT). EBRT performed after PRRT was continued over 5–6 weeks in IMRT technique (median dose: 53.0 Gy). All patients were assessed morphologically and by positron emission tomography (PET) before therapy and were restaged after 3–6 months. Side effects were evaluated according to CTCAE 4.0. Results Median tumor dose achieved by PRRT was 7.2 Gy. During PRRT and EBRT, no side effects > CTCAE grade 2 were noted. All patients reported stabilization or improvement of tumor-associated symptoms, no morphologic tumor progression was observed in MR-imaging (median follow-up: 13.4 months). The median pre-therapeutic SUVmax in the meningiomas was 14.2 (range: 4.3–68.7). All patients with a second PET after combined PRRT + EBRT showed an increase in SUVmax (median: 37%; range: 15%–46%) to a median value of 23.7 (range: 8.0–119.0; 7 patients) while PET-estimated volume generally decreased to 81 ± 21% of the initial volume. Conclusions The combination of PRRT and EBRT is feasible and well tolerated. This approach represents an attractive strategy for the treatment of recurring or progressive symptomatic meningioma, which should be further evaluated. PMID:22720902

Photonic band structures of two-dimensional magnetized plasma photonic crystals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qi, L.

By using modified plane wave method, photonic band structures of the transverse electric polarization for two types of two-dimensional magnetized plasma photonic crystals are obtained, and influences of the external magnetic field, plasma density, and dielectric materials on the dispersion curves are studied, respectively. Results show that two areas of flat bands appear in the dispersion curves due to the role of external magnetic field, and the higher frequencies of the up and down flat bands are corresponding to the right-circled and left-circled cutoff frequencies, respectively. Adjusting external magnetic field and plasma density can not only control positions of themore » flat bands, but also can control the location and width of the local gap; increasing relative dielectric constant of the dielectric materials makes omni-direction gaps appear.« less

Independent external validation of predictive models for urinary dysfunction following external beam radiotherapy of the prostate: Issues in model development and reporting.

PubMed

Yahya, Noorazrul; Ebert, Martin A; Bulsara, Max; Kennedy, Angel; Joseph, David J; Denham, James W

2016-08-01

Most predictive models are not sufficiently validated for prospective use. We performed independent external validation of published predictive models for urinary dysfunctions following radiotherapy of the prostate. Multivariable models developed to predict atomised and generalised urinary symptoms, both acute and late, were considered for validation using a dataset representing 754 participants from the TROG 03.04-RADAR trial. Endpoints and features were harmonised to match the predictive models. The overall performance, calibration and discrimination were assessed. 14 models from four publications were validated. The discrimination of the predictive models in an independent external validation cohort, measured using the area under the receiver operating characteristic (ROC) curve, ranged from 0.473 to 0.695, generally lower than in internal validation. 4 models had ROC >0.6. Shrinkage was required for all predictive models' coefficients ranging from -0.309 (prediction probability was inverse to observed proportion) to 0.823. Predictive models which include baseline symptoms as a feature produced the highest discrimination. Two models produced a predicted probability of 0 and 1 for all patients. Predictive models vary in performance and transferability illustrating the need for improvements in model development and reporting. Several models showed reasonable potential but efforts should be increased to improve performance. Baseline symptoms should always be considered as potential features for predictive models. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A neutron track etch detector for electron linear accelerators in radiotherapy

PubMed Central

Vukovic, Branko; Faj, Dario; Poje, Marina; Varga, Maja; Radolic, Vanja; Miklavcic, Igor; Ivkovic, Ana; Planinic, Josip

2010-01-01

Background Electron linear accelerators in medical radiotherapy have replaced cobalt and caesium sources of radiation. However, medical accelerators with photon energies over 10 MeV generate undesired fast neutron contamination in a therapeutic X-ray photon beam. Photons with energies above 10 MeV can interact with the atomic nucleus of a high-Z material, of which the target and the head of an accelerator consist, and lead to the neutron ejection. Results and conclusions. Our neutron dosimeter, composed of the LR-115 track etch detector and boron foil BN-1 converter, was calibrated on thermal neutrons generated in the nuclear reactor of the Josef Stefan Institute (Slovenia), and applied to dosimetry of undesirable neutrons in photon radiotherapy by the linear accelerator 15 MV Siemens Mevatron. Having considered a high dependence of a cross-section between neutron and boron on neutron energy, and broad neutron spectrum in a photon beam, as well as outside the entrance door to maze of the Mevatron, we developed a method for determining the effective neutron detector response. A neutron dose rate in the photon beam was measured to be 1.96 Sv/h. Outside the Mevatron room the neutron dose rate was 0.62 μSv/h. PACS: 87.52. Ga; 87.53.St; 29.40.Wk. PMID:22933893

Theory, simulation and experiments for precise deflection control of radiotherapy electron beams.

PubMed

Figueroa, R; Leiva, J; Moncada, R; Rojas, L; Santibáñez, M; Valente, M; Velásquez, J; Young, H; Zelada, G; Yáñez, R; Guillen, Y

2018-03-08

Conventional radiotherapy is mainly applied by linear accelerators. Although linear accelerators provide dual (electron/photon) radiation beam modalities, both of them are intrinsically produced by a megavoltage electron current. Modern radiotherapy treatment techniques are based on suitable devices inserted or attached to conventional linear accelerators. Thus, precise control of delivered beam becomes a main key issue. This work presents an integral description of electron beam deflection control as required for novel radiotherapy technique based on convergent photon beam production. Theoretical and Monte Carlo approaches were initially used for designing and optimizing device´s components. Then, dedicated instrumentation was developed for experimental verification of electron beam deflection due to the designed magnets. Both Monte Carlo simulations and experimental results support the reliability of electrodynamics models used to predict megavoltage electron beam control. Copyright © 2018 Elsevier Ltd. All rights reserved.

Development of a RadFET Linear Array for Intracavitary in vivo Dosimetry During External Beam Radiotherapy and Brachytherapy

NASA Astrophysics Data System (ADS)

Price, R. A.; Benson, C.; Joyce, M. J.; Rodgers, K.

2004-08-01

We present the details of a new linear array dosimeter consisting of a chain of semiconductors mounted on an ultra-thin (50 /spl mu/m thick) flexible substrate and housed in an intracavitary catheter. The semiconductors, manufactured by NMRC Cork, have not been packaging and incorporate a passivation layer that allows them to be mounted on the substrate using flip-chip-bonding. This paper reports, for the first time, the construction of a multiple (ten) detector array suited to in vivo dosimetry in the rectum, esophagus and vagina during external beam radiotherapy, as well as being adaptable to in vivo dosimetry during brachytherapy and diagnostic radiology.

Interferometer-Based Calorimetric Measurements of Absorbed Dose to Water in External Beam Radiotherapy

NASA Astrophysics Data System (ADS)

Flores-Martinez, Everardo

displacing a piezoelectric transducer. Measurements were compared with calculations to estimate the accuracy of the technique. The interferometer-based system was used to measure ADW in a water-filled glass phantom, irradiated with a 6MV photon beam. The estimated Type-A, (k = 1) uncertainty in the associated doses was about 0.3Gy, which is an order of magnitude lower than previously published interferometer-based ADW measurements. Additionally a comparative analysis was performed with the thermistor-based measurements, results for both techniques agreed within the uncertainty. This work presents the first absolute ADW measurements performed using interferometry in the dose range of linac-based radiotherapy and represents a significant step towards standards-level measurements using this technique.

Efficacy of patient-specific bolus created using three-dimensional printing technique in photon radiotherapy.

PubMed

Fujimoto, Koya; Shiinoki, Takehiro; Yuasa, Yuki; Hanazawa, Hideki; Shibuya, Keiko

2017-06-01

A commercially available bolus ("commercial-bolus") does not make complete contact with the irregularly shaped patient skin. This study aims to customise a patient-specific three-dimensional (3D) bolus using a 3D printing technique ("3D-bolus") and to evaluate its clinical feasibility for photon radiotherapy. The 3D-bolus was designed using a treatment planning system (TPS) in Digital Imaging and Communications in Medicine-Radiotherapy (DICOM-RT) format, and converted to stereolithographic format for printing. To evaluate its physical characteristics, treatment plans were created for water-equivalent phantoms that were bolus-free, or had a flat-form printed 3D-bolus, a TPS-designed bolus ("virtual-bolus"), or a commercial-bolus. These plans were compared based on the percentage depth dose (PDD) and target-volume dose volume histogram (DVH) measurements. To evaluate the clinical feasibility, treatment plans were created for head phantoms that were bolus-free or had a 3D-bolus, a virtual-bolus, or a commercial-bolus. These plans were compared based on the target volume DVH. In the physical evaluation, the 3D-bolus provided effective dose coverage in the build-up region, which was equivalent to the commercial-bolus. With regard to the clinical feasibility, the air gaps were lesser with the 3D-bolus when compared to the commercial-bolus. Furthermore, the prescription dose could be delivered appropriately to the target volume. The 3D-bolus has potential use for air-gap reduction compared to the commercial-bolus and facilitates target-volume dose coverage and homogeneity improvement. A 3D-bolus produced using a 3D printing technique is comparable to a commercial-bolus applied to an irregular-shaped skin surface. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Poster — Thur Eve — 48: Dosimetric dependence on bone backscatter in orthovoltage radiotherapy: A Monte Carlo photon fluence spectral study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chow, J; Grigor, G

This study investigated dosimetric impact due to the bone backscatter in orthovoltage radiotherapy. Monte Carlo simulations were used to calculate depth doses and photon fluence spectra using the EGSnrc-based code. Inhomogeneous bone phantom containing a thin water layer (1–3 mm) on top of a bone (1 cm) to mimic the treatment sites of forehead, chest wall and kneecap was irradiated by the 220 kVp photon beam produced by the Gulmay D3225 x-ray machine. Percentage depth doses and photon energy spectra were determined using Monte Carlo simulations. Results of percentage depth doses showed that the maximum bone dose was about 210–230%more » larger than the surface dose in the phantoms with different water thicknesses. Surface dose was found to be increased from 2.3 to 3.5%, when the distance between the phantom surface and bone was increased from 1 to 3 mm. This increase of surface dose on top of a bone was due to the increase of photon fluence intensity, resulting from the bone backscatter in the energy range of 30 – 120 keV, when the water thickness was increased. This was also supported by the increase of the intensity of the photon energy spectral curves at the phantom and bone surface as the water thickness was increased. It is concluded that if the bone inhomogeneity during the dose prescription in the sites of forehead, chest wall and kneecap with soft tissue thickness = 1–3 mm is not considered, there would be an uncertainty in the dose delivery.« less

Sexual function after external-beam radiotherapy for prostate cancer: what do we know?

PubMed

Incrocci, Luca

2006-02-01

Quality of life in general and sexual functioning in particular have become very important in cancer patients. Due to modern surgical techniques, improved quality of drugs for chemotherapy and very modern radiation techniques, more patients can be successfully treated without largely compromising sexual functioning. One can assume that because of the life-threatening nature of cancer, sexual activity is not important to patients and their partners, but this is not true. Prostate cancer has become the most common non-skin malignant neoplasm in older men in Western countries. In this paper, we discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. Data on the etiology of erectile dysfunction after external-beam radiotherapy for prostate cancer is reviewed, and the literature is been summarized. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices. Cancer affects quality of life and sexual function. The challenge for oncologists is to address this with compassion.

SU-E-T-368: Evaluating Dosimetric Outcome of Modulated Photon Radiotherapy (XMRT) Optimization for Head and Neck Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

McGeachy, P; Villarreal-Barajas, JE; Khan, R

2015-06-15

Purpose: The dosimetric outcome of optimized treatment plans obtained by modulating the photon beamlet energy and fluence on a small cohort of four Head and Neck (H and N) patients was investigated. This novel optimization technique is denoted XMRT for modulated photon radiotherapy. The dosimetric plans from XMRT for H and N treatment were compared to conventional, 6 MV intensity modulated radiotherapy (IMRT) optimization plans. Methods: An arrangement of two non-coplanar and five coplanar beams was used for all four H and N patients. Both XMRT and IMRT were subject to the same optimization algorithm, with XMRT optimization allowing bothmore » 6 and 18 MV beamlets while IMRT was restricted to 6 MV only. The optimization algorithm was based on a linear programming approach with partial-volume constraints implemented via the conditional value-at-risk method. H and N constraints were based off of those mentioned in the Radiation Therapy Oncology Group 1016 protocol. XMRT and IMRT solutions were assessed using metrics suggested by International Commission on Radiation Units and Measurements report 83. The Gurobi solver was used in conjunction with the CVX package to solve each optimization problem. Dose calculations and analysis were done in CERR using Monte Carlo dose calculation with VMC{sub ++}. Results: Both XMRT and IMRT solutions met all clinical criteria. Trade-offs were observed between improved dose uniformity to the primary target volume (PTV1) and increased dose to some of the surrounding healthy organs for XMRT compared to IMRT. On average, IMRT improved dose to the contralateral parotid gland and spinal cord while XMRT improved dose to the brainstem and mandible. Conclusion: Bi-energy XMRT optimization for H and N patients provides benefits in terms of improved dose uniformity to the primary target and reduced dose to some healthy structures, at the expense of increased dose to other healthy structures when compared with IMRT.« less

Hypofractionated stereotactic photon radiotherapy of posteriorly located choroidal melanoma with five fractions at ten Gy--clinical results after six years of experience.

PubMed

Dunavoelgyi, Roman; Zehetmayer, Martin; Gleiss, Andreas; Geitzenauer, Wolfgang; Kircher, Karl; Georg, Dietmar; Schmidt-Erfurth, Ursula; Poetter, Richard; Dieckmann, Karin

2013-08-01

To evaluate long-term safety and efficacy of hypofractionated stereotactic photon radiotherapy with 5 five fractions at 10 Gy each in patients with centrally located choroidal melanoma. Ninety-one patients with centrally located choroidal melanoma were treated stereotactically at a linear accelerator with 6 MV photon beams with 5 fractions at 10 Gy each. Examinations were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and yearly thereafter. Median follow-up was 37.8 months (IQR 19.2-49.9). They included visual acuity assessment, routine ophthalmological examinations with fundoscopy, echography for measurement of tumor dimensions, medical examinations and, if necessary, fluorescein angiography. Initial tumor base diameters, height and volume were 11.20mm (IQR 9.10-13.70), 9.80 mm (IQR 7.80-11.70), 4.53 mm (IQR 3.33-6.43) and 253.8mm(3) (IQR 127.5-477.0). Local tumor control and eye retention rates were 97.7% and 86.4% after 5 years, respectively. Eight patients developed metastatic disease and 3 of them died due to metastatic disease during the follow-up period. Median visual acuity decreased from 0.67 initially to 0.05 at the last individual follow-up (p<0.001). The most common toxicities (any grade) were radiation retinopathy (n=39), optic neuropathy (n=32), radiogenic cataract (n=21), neovascular glaucoma (n=15) and dry eye syndrome (n=10). The 5 year probabilities to remain free of these side effects (any grade) were 26.0%, 45.4%, 55.4%, 72.6% and 80.5%, respectively. The most important prognostic factors for toxicities were the largest tumor base diameter, tumor height and tumor distance to the optic disk. Hypofractionated stereotactic photon radiotherapy with a total dose of 50 Gy delivered in 5 fractions is a highly effective treatment option in patients with centrally located choroidal melanoma and has a moderate toxicity profile. Copyright © 2013. Published by Elsevier Ireland Ltd.

[Combined internal-external radiotherapy (CIERT) in a cell model].

PubMed

Oehme, Liane; Bartzsch, Thomas; Maucksch, Ute; Freudenberg, Robert; Wunderlich, Gerd; Kotzerke, Jörg

2018-06-01

Combined internal-external radiotherapy (CIERT) requires a unified assessment of biologic radiation effects in addition to the total dose. The concept of biological effective dose (BED) was evaluated in a cell model. The thyroid NIS-positive cell line FRTL-5 was irradiated with X-ray and the radiotracer Tc-99m pertechnetate either alone or in combination. The cellular uptake of the radionuclide during the incubation time of 24 h was controlled by the presence or absence of perchlorate. Dose calculation was performed based on measured uptake values. Cell specific radiobiologic parameters were derived from dose effect curves using the colony forming assay as biological endpoint. For the combination of the radiation qualities the sequence and time difference were varied. Cell survival was compared with the prediction of the BED model. The radiobiologic parameters from X-ray dose response were α = (0.22 ± 0.02) Gy -1 and β = (0.021 ± 0.001) Gy -2 . The half life for repair was (1.51 ± 0.21) h. These values could also explain the dose response curves for Tc-99m-irradiation with exponential decreasing dose rate. CIERT experiments showed no significant differences in cell survival regarding sequence and irradiation break. When the radionuclide uptake was not prevented the cell survival for the combination of X-ray and Tc-99m was lower than the prediction by BED calculations. The validity of the BED formalism for different dose rates and radiation qualities was verified. Supraaddive effects measured in the combination of X-ray and intracellular Tc-99m might be caused by Auger and conversion electrons, however further experiments are necessary. Schattauer GmbH.

Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Donovan, E. M.; James, H.; Bonora, M.

2012-10-15

Purpose: To compare organ specific cancer incidence risks for standard and complex external beam radiotherapy (including cone beam CT verification) following breast conservation surgery for early breast cancer.Method: Doses from breast radiotherapy and kilovoltage cone beam CT (CBCT) exposures were obtained from thermoluminescent dosimeter measurements in an anthropomorphic phantom in which the positions of radiosensitive organs were delineated. Five treatment deliveries were investigated: (i) conventional tangential field whole breast radiotherapy (WBRT), (ii) noncoplanar conformal delivery applicable to accelerated partial beast irradiation (APBI), (iii) two-volume simultaneous integrated boost (SIB) treatment, (iv) forward planned three-volume SIB, and (v) inverse-planned three volume SIB.more » Conformal and intensity modulated radiotherapy methods were used to plan the complex treatments. Techniques spanned the range from simple methods appropriate for patient cohorts with a low cancer recurrence risk to complex plans relevant to cohorts with high recurrence risk. Delineated organs at risk included brain, salivary glands, thyroid, contralateral breast, left and right lung, esophagus, stomach, liver, colon, and bladder. Biological Effects of Ionizing Radiation (BEIR) VII cancer incidence models were applied to the measured mean organ doses to determine lifetime attributable risk (LAR) for ages at exposure from 35 to 80 yr according to radiotherapy techniques, and included dose from the CBCT imaging. Results: All LAR decreased with age at exposure and were lowest for brain, thyroid, liver, and bladder (<0.1%). There was little dependence of LAR on radiotherapy technique for these organs and for colon and stomach. LAR values for the lungs for the three SIB techniques were two to three times those from WBRT and APBI. Uncertainties in the LAR models outweigh any differences in lung LAR between the SIB methods. Constraints in the planning of the SIB methods

Comparative sensitivities of functional MRI sequences in detection of local recurrence of prostate carcinoma after radical prostatectomy or external-beam radiotherapy.

PubMed

Roy, Catherine; Foudi, Fatah; Charton, Jeanne; Jung, Michel; Lang, Hervé; Saussine, Christian; Jacqmin, Didier

2013-04-01

The aim of this retrospective study was to determine the respective accuracies of three types of functional MRI sequences-diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI, and 3D (1)H-MR spectroscopy (MRS)-in the depiction of local prostate cancer recurrence after two different initial therapy options. From a cohort of 83 patients with suspicion of local recurrence based on prostate-specific antigen (PSA) kinetics who were imaged on a 3-T MRI unit using an identical protocol including the three functional sequences with an endorectal coil, we selected 60 patients (group A, 28 patients who underwent radical prostatectomy; group B, 32 patients who underwent external-beam radiation) who had local recurrence ascertained on the basis of a transrectal ultrasound-guided biopsy results and a reduction in PSA level after salvage therapy. All patients presented with a local relapse. Sensitivity with T2-weighted MRI and 3D (1)H-MRS sequences was 57% and 53%, respectively, for group A and 71% and 78%, respectively, for group B. DCE-MRI alone showed a sensitivity of 100% and 96%, respectively, for groups A and B. DWI alone had a higher sensitivity for group B (96%) than for group A (71%). The combination of T2-weighted imaging plus DWI plus DCE-MRI provided a sensitivity as high as 100% in group B. The performance of functional imaging sequences for detecting recurrence is different after radical prostatectomy and external-beam radiotherapy. DCE-MRI is a valid and efficient tool to detect prostate cancer recurrence in radical prostatectomy as well as in external-beam radiotherapy. The combination of DCE-MRI and DWI is highly efficient after radiation therapy. Three-dimensional (1)H-MRS needs to be improved. Even though it is not accurate enough, T2-weighted imaging remains essential for the morphologic analysis of the area.

Neutron spectral measurements in an intense photon field associated with a high-energy x-ray radiotherapy machine.

PubMed

Holeman, G R; Price, K W; Friedman, L F; Nath, R

1977-01-01

High-energy x-ray radiotherapy machines in the supermegavoltage region generate complex neutron energy spectra which make an exact evaluation of neutron shielding difficult. Fast neutrons resulting from photonuclear reactions in the x-ray target and collimators undergo successive collisions in the surrounding materials and are moderated by varying amounts. In order to examine the neutron radiation exposures quantitatively, the neutron energy spectra have been measured inside and outside the treatment room of a Sagittaire medical linear accelerator (25-MV x rays) located at Yale-New Haven Hospital. The measurements were made using a Bonner spectrometer consisting of 2-, 3-, 5-, 8-, 10- and 12-in.-diameter polyethylene spheres with 6Li and 7Li thermoluminescent dosimeter (TLD) chips at the centers, in addition to bare and cadmium-covered chips. The individual TLD chips were calibrated for neutron and photon response. The spectrometer was calibrated using a known PuBe spectrum Spectrometer measurements were made at Yale Electron Accelerator Laboratory and results compared with a neutron time-of-flight spectrometer and an activation technique. The agreement between the results from these independent methods is found to be good, except for the measurements in the direct photon beam. Quality factors have been inferred for the neutron fields inside and outside the treatment room. Values of the inferred quality factors fall primarily between 4 and 8, depending on location.

Comparing gold nano-particle enhanced radiotherapy with protons, megavoltage photons and kilovoltage photons: a Monte Carlo simulation.

PubMed

Lin, Yuting; McMahon, Stephen J; Scarpelli, Matthew; Paganetti, Harald; Schuemann, Jan

2014-12-21

Gold nanoparticles (GNPs) have shown potential to be used as a radiosensitizer for radiation therapy. Despite extensive research activity to study GNP radiosensitization using photon beams, only a few studies have been carried out using proton beams. In this work Monte Carlo simulations were used to assess the dose enhancement of GNPs for proton therapy. The enhancement effect was compared between a clinical proton spectrum, a clinical 6 MV photon spectrum, and a kilovoltage photon source similar to those used in many radiobiology lab settings. We showed that the mechanism by which GNPs can lead to dose enhancements in radiation therapy differs when comparing photon and proton radiation. The GNP dose enhancement using protons can be up to 14 and is independent of proton energy, while the dose enhancement is highly dependent on the photon energy used. For the same amount of energy absorbed in the GNP, interactions with protons, kVp photons and MV photons produce similar doses within several nanometers of the GNP surface, and differences are below 15% for the first 10 nm. However, secondary electrons produced by kilovoltage photons have the longest range in water as compared to protons and MV photons, e.g. they cause a dose enhancement 20 times higher than the one caused by protons 10 μm away from the GNP surface. We conclude that GNPs have the potential to enhance radiation therapy depending on the type of radiation source. Proton therapy can be enhanced significantly only if the GNPs are in close proximity to the biological target.

SU-E-T-577: Commissioning of a Deterministic Algorithm for External Photon Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhu, T; Finlay, J; Mesina, C

Purpose: We report commissioning results for a deterministic algorithm for external photon beam treatment planning. A deterministic algorithm solves the radiation transport equations directly using a finite difference method, thus improve the accuracy of dose calculation, particularly under heterogeneous conditions with results similar to that of Monte Carlo (MC) simulation. Methods: Commissioning data for photon energies 6 – 15 MV includes the percentage depth dose (PDD) measured at SSD = 90 cm and output ratio in water (Spc), both normalized to 10 cm depth, for field sizes between 2 and 40 cm and depths between 0 and 40 cm. Off-axismore » ratio (OAR) for the same set of field sizes was used at 5 depths (dmax, 5, 10, 20, 30 cm). The final model was compared with the commissioning data as well as additional benchmark data. The benchmark data includes dose per MU determined for 17 points for SSD between 80 and 110 cm, depth between 5 and 20 cm, and lateral offset of up to 16.5 cm. Relative comparisons were made in a heterogeneous phantom made of cork and solid water. Results: Compared to the commissioning beam data, the agreement are generally better than 2% with large errors (up to 13%) observed in the buildup regions of the FDD and penumbra regions of the OAR profiles. The overall mean standard deviation is 0.04% when all data are taken into account. Compared to the benchmark data, the agreements are generally better than 2%. Relative comparison in heterogeneous phantom is in general better than 4%. Conclusion: A commercial deterministic algorithm was commissioned for megavoltage photon beams. In a homogeneous medium, the agreement between the algorithm and measurement at the benchmark points is generally better than 2%. The dose accuracy for a deterministic algorithm is better than a convolution algorithm in heterogeneous medium.« less

Lithographic wavelength control of an external cavity laser with a silicon photonic crystal cavity-based resonant reflector.

PubMed

Liles, Alexandros A; Debnath, Kapil; O'Faolain, Liam

2016-03-01

We report the experimental demonstration of a new design for external cavity hybrid lasers consisting of a III-V semiconductor optical amplifier (SOA) with fiber reflector and a photonic crystal (PhC)-based resonant reflector on SOI. The silicon reflector is composed of an SU8 polymer bus waveguide vertically coupled to a PhC cavity and provides a wavelength-selective optical feedback to the laser cavity. This device exhibits milliwatt-level output power and side-mode suppression ratios of more than 25 dB.

In vivo dosimetry in UK external beam radiotherapy: current and future usage.

PubMed

MacDougall, Niall D; Graveling, Michael; Hansen, Vibeke N; Brownsword, Kevin; Morgan, Andrew

2017-04-01

Towards Safer Radiotherapy recommended that radiotherapy (RT) centres should have protocols in place for in vivo dosimetry (IVD) monitoring at the beginning of patient treatment courses (Donaldson S. Towards safer radiotherapy. R Coll Radiol 2008). This report determines IVD implementation in the UK in 2014, the methods used and makes recommendations on future use. Evidence from peer-reviewed journals was used in conjunction with the first survey of UK RT centre IVD practice since the publication of Towards Safer Radiotherapy. In March 2014, profession-specific questionnaires were sent to radiographer, clinical oncologist and physics staff groups in each of the 66 UK RT centres. Response rates from each group were 74%, 45% and 74%, respectively. 73% of RT centres indicated that they performed IVD. Diodes are the most popular IVD device. Thermoluminescent dosimeter (TLD) is still in use in a number of centres but not as a sole modality, being used in conjunction with diodes and/or electronic portal imaging device (EPID). The use of EPID dosimetry is increasing and is considered of most potential value for both geometric and dosimetric verification. Owing to technological advances, such as electronic data transfer, independent monitor unit checking and daily image-guided radiotherapy, the overall risk of adverse treatment events in RT has been substantially reduced. However, the use of IVD may prevent a serious radiation incident. Point dose IVD is not considered suited to the requirements of verifying advanced RT techniques, leaving EPID dosimetry as the current modality likely to be developed as a future standard. Advances in knowledge: An updated perspective on UK IVD use and provision of professional guidelines for future implementation.

In vivo dosimetry in UK external beam radiotherapy: current and future usage

PubMed Central

Graveling, Michael; Hansen, Vibeke N; Brownsword, Kevin; Morgan, Andrew

2017-01-01

Objective: Towards Safer Radiotherapy recommended that radiotherapy (RT) centres should have protocols in place for in vivo dosimetry (IVD) monitoring at the beginning of patient treatment courses (Donaldson S. Towards safer radiotherapy. R Coll Radiol 2008). This report determines IVD implementation in the UK in 2014, the methods used and makes recommendations on future use. Methods: Evidence from peer-reviewed journals was used in conjunction with the first survey of UK RT centre IVD practice since the publication of Towards Safer Radiotherapy. In March 2014, profession-specific questionnaires were sent to radiographer, clinical oncologist and physics staff groups in each of the 66 UK RT centres. Results: Response rates from each group were 74%, 45% and 74%, respectively. 73% of RT centres indicated that they performed IVD. Diodes are the most popular IVD device. Thermoluminescent dosimeter (TLD) is still in use in a number of centres but not as a sole modality, being used in conjunction with diodes and/or electronic portal imaging device (EPID). The use of EPID dosimetry is increasing and is considered of most potential value for both geometric and dosimetric verification. Conclusion: Owing to technological advances, such as electronic data transfer, independent monitor unit checking and daily image-guided radiotherapy, the overall risk of adverse treatment events in RT has been substantially reduced. However, the use of IVD may prevent a serious radiation incident. Point dose IVD is not considered suited to the requirements of verifying advanced RT techniques, leaving EPID dosimetry as the current modality likely to be developed as a future standard. Advances in knowledge: An updated perspective on UK IVD use and provision of professional guidelines for future implementation. PMID:28205452

Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riaz, Nadeem; Afaq, Asim; Akin, Oguz

Purpose: To investigate the utility of endorectal coil magenetic resonance imaging (eMRI) in predicting biochemical relapse in prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Methods and Materials: Between 2000 and 2008, 279 men with intermediate- or high-risk prostate cancer underwent eMRI of their prostate before receiving brachytherapy and supplemental intensity-modulated radiotherapy. Endorectal coil MRI was performed before treatment and retrospectively reviewed by two radiologists experienced in genitourinary MRI. Image-based variables, including tumor diameter, location, number of sextants involved, and the presence of extracapsular extension (ECE), were incorporated with other established clinical variables to predict biochemical control outcomes.more » The median follow-up was 49 months (range, 1-13 years). Results: The 5-year biochemical relapse-free survival for the cohort was 92%. Clinical findings predicting recurrence on univariate analysis included Gleason score (hazard ratio [HR] 3.6, p = 0.001), PSA (HR 1.04, p = 0.005), and National Comprehensive Cancer Network risk group (HR 4.1, p = 0.002). Clinical T stage and the use of androgen deprivation therapy were not correlated with biochemical failure. Imaging findings on univariate analysis associated with relapse included ECE on MRI (HR 3.79, p = 0.003), tumor size (HR 2.58, p = 0.04), and T stage (HR 1.71, p = 0.004). On multivariate analysis incorporating both clinical and imaging findings, only ECE on MRI and Gleason score were independent predictors of recurrence. Conclusions: Pretreatment eMRI findings predict for biochemical recurrence in intermediate- and high-risk prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Gleason score and the presence of ECE on MRI were the only significant predictors of biochemical relapse in this group of patients.« less

Astatine-211 imaging by a Compton camera for targeted radiotherapy.

PubMed

Nagao, Yuto; Yamaguchi, Mitsutaka; Watanabe, Shigeki; Ishioka, Noriko S; Kawachi, Naoki; Watabe, Hiroshi

2018-05-24

Astatine-211 is a promising radionuclide for targeted radiotherapy. It is required to image the distribution of targeted radiotherapeutic agents in a patient's body for optimization of treatment strategies. We proposed to image 211 At with high-energy photons to overcome some problems in conventional planar or single-photon emission computed tomography imaging. We performed an imaging experiment of a point-like 211 At source using a Compton camera, and demonstrated the capability of imaging 211 At with the high-energy photons for the first time. Copyright © 2018 Elsevier Ltd. All rights reserved.

Guidelines on the implementation of diode in vivo dosimetry programs for photon and electron external beam therapy.

PubMed

Alecu, R; Loomis, T; Alecu, J; Ochran, T

1999-01-01

Semiconductor diodes offer many advantages for clinical dosimetry: high sensitivity, real-time readout, simple instrumentation, robustness and air pressure independence. The feasibility and usefulness of in vivo dosimetry with diodes has been shown by numerous publications, but very few, if any, refer to the utilization of diodes in electron beam dosimetry. The purpose of this paper is to present our methods for implementing an effective IVD program for external beam therapy with photons and electrons and to evaluate a new type of diodes. Methods of deciding on reasonable action levels along with calibration procedures, established according to the type of measurements intended to be performed and the action limits, are discussed. Correction factors to account for nonreference clinical conditions for new types of diodes (designed for photon and electron beams) are presented and compared with those required by older models commercially available. The possibilities and limitations of each type of diode are presented, emphasizing the importance of using the appropriate diode for each task and energy range.

Evaluation of Al2O3:C optically stimulated luminescence (OSL) dosimeters for passive dosimetry of high-energy photon and electron beams in radiotherapy.

PubMed

Yukihara, E G; Mardirossian, G; Mirzasadeghi, M; Guduru, S; Ahmad, S

2008-01-01

This article investigates the performance of Al2O3: C optically stimulated luminescence dosimeters (OSLDs) for application in radiotherapy. Central-axis depth dose curves and optically stimulated luminescence (OSL) responses were obtained in a water phantom for 6 and 18 MV photons, and for 6, 9, 12, 16, and 20 MeV electron beams from a Varian 21EX linear accelerator. Single OSL measurements could be repeated with a precision of 0.7% (one standard deviation) and the differences between absorbed doses measured with OSLDs and an ionization chamber were within +/- 1% for photon beams. Similar results were obtained for electron beams in the low-gradient region after correction for a 1.9% photon-to-electron bias. The distance-to-agreement values were of the order of 0.5-1.0 mm for electrons in high dose gradient regions. Additional investigations also demonstrated that the OSL response dependence on dose rate, field size, and irradiation temperature is less than 1% in the conditions of the present study. Regarding the beam energy/quality dependence, the relative response of the OSLD for 18 MV was (0.51 +/- 0.48)% of the response for the 6 MV photon beam. The OSLD response for the electron beams relative to the 6 MV photon beam. The OSLD response for the electron beams relative to the 6 MV photon beam was in average 1.9% higher, but this result requires further confirmation. The relative response did not seem to vary with electron energy at dmax within the experimental uncertainties (0.5% in average) and, therefore, a fixed correction factor of 1.9% eliminated the energy dependence in our experimental conditions.

Chlorotoxin-Conjugated Multifunctional Dendrimers Labeled with Radionuclide 131I for Single Photon Emission Computed Tomography Imaging and Radiotherapy of Gliomas.

PubMed

Zhao, Lingzhou; Zhu, Jingyi; Cheng, Yongjun; Xiong, Zhijuan; Tang, Yueqin; Guo, Lilei; Shi, Xiangyang; Zhao, Jinhua

2015-09-09

Chlorotoxin-conjugated multifunctional dendrimers labeled with radionuclide 131I were synthesized and utilized for targeted single photon emission computed tomography (SPECT) imaging and radiotherapy of cancer. In this study, generation five amine-terminated poly(amidoamine) dendrimers were used as a platform to be sequentially conjugated with polyethylene glycol (PEG), targeting agent chlorotoxin (CTX), and 3-(4'-hydroxyphenyl)propionic acid-OSu (HPAO). This was followed by acetylation of the remaining dendrimer terminal amines and radiolabeling with 131I to form the targeted theranostic dendrimeric nanoplatform. We show that the dendrimer platform possessing approximately 7.7 CTX and 21.1 HPAO moieties on each dendrimer displays excellent cytocompatibility in a given concentration range (0-20 μM) and can specifically target cancer cells overexpressing matrix metallopeptidase 2 (MMP2) due to the attached CTX. With the attached HPAO moiety having the phenol group, the dendrimer platform can be effectively labeled with radioactive 131I with good stability and high radiochemical purity. Importantly, the 131I labeling renders the dendrimer platform with an ability to be used for targeted SPECT imaging and radiotherapy of an MMP2-overexpressing glioma model in vivo. The developed radiolabeled multifunctional dendrimeric nanoplatform may hold great promise to be used for targeted theranostics of human gliomas.

Reconstruction of organ dose for external radiotherapy patients in retrospective epidemiologic studies

NASA Astrophysics Data System (ADS)

Lee, Choonik; Jung, Jae Won; Pelletier, Christopher; Pyakuryal, Anil; Lamart, Stephanie; Kim, Jong Oh; Lee, Choonsik

2015-03-01

Organ dose estimation for retrospective epidemiological studies of late effects in radiotherapy patients involves two challenges: radiological images to represent patient anatomy are not usually available for patient cohorts who were treated years ago, and efficient dose reconstruction methods for large-scale patient cohorts are not well established. In the current study, we developed methods to reconstruct organ doses for radiotherapy patients by using a series of computational human phantoms coupled with a commercial treatment planning system (TPS) and a radiotherapy-dedicated Monte Carlo transport code, and performed illustrative dose calculations. First, we developed methods to convert the anatomy and organ contours of the pediatric and adult hybrid computational phantom series to Digital Imaging and Communications in Medicine (DICOM)-image and DICOM-structure files, respectively. The resulting DICOM files were imported to a commercial TPS for simulating radiotherapy and dose calculation for in-field organs. The conversion process was validated by comparing electron densities relative to water and organ volumes between the hybrid phantoms and the DICOM files imported in TPS, which showed agreements within 0.1 and 2%, respectively. Second, we developed a procedure to transfer DICOM-RT files generated from the TPS directly to a Monte Carlo transport code, x-ray Voxel Monte Carlo (XVMC) for more accurate dose calculations. Third, to illustrate the performance of the established methods, we simulated a whole brain treatment for the 10 year-old male phantom and a prostate treatment for the adult male phantom. Radiation doses to selected organs were calculated using the TPS and XVMC, and compared to each other. Organ average doses from the two methods matched within 7%, whereas maximum and minimum point doses differed up to 45%. The dosimetry methods and procedures established in this study will be useful for the reconstruction of organ dose to support

[Bladder-conserving treatment for bladder cancer: potential of and developments in radiotherapy].

PubMed

Hulshof, Maarten C C M; Pieters, Bradley R; Koning, Caro C E

2013-01-01

The standard treatment for muscle-invasive bladder cancer is surgical removal of the bladder and construction of a neobladder. Recently, important improvements have been made in the potential for bladder-conserving treatment using radiotherapy. External beam radiotherapy has undergone technological improvements, as a result of which it is possible to radiate the tumour more precisely while decreasing radiation to healthy tissue. Radiochemotherapy improves local recurrence-free and overall survival compared with radiotherapy alone. The results of this combined treatment are comparable with those of surgery. Additionally, Dutch radiotherapy departments have collected data in a national database of 1040 selected patients with confined bladder cancer. These patients were treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%. Bladder conserving treatment options for muscle-invasive bladder cancer should be discussed during the multidisciplinary meeting.

Potential hazard due to induced radioactivity secondary to radiotherapy: the report of task group 136 of the American Association of Physicists in Medicine.

PubMed

Thomadsen, Bruce; Nath, Ravinder; Bateman, Fred B; Farr, Jonathan; Glisson, Cal; Islam, Mohammad K; LaFrance, Terry; Moore, Mary E; George Xu, X; Yudelev, Mark

2014-11-01

External-beam radiation therapy mostly uses high-energy photons (x-rays) produced by medical accelerators, but many facilities now use proton beams, and a few use fast-neutron beams. High-energy photons offer several advantages over lower-energy photons in terms of better dose distributions for deep-seated tumors, lower skin dose, less sensitivity to tissue heterogeneities, etc. However, for beams operating at or above 10 MV, some of the materials in the accelerator room and the radiotherapy patient become radioactive due primarily to photonuclear reactions and neutron capture, exposing therapy staff and patients to unwanted radiation dose. Some recent advances in radiotherapy technology require treatments using a higher number of monitor units and monitor-unit rates for the same delivered dose, and compared to the conventional treatment techniques and fractionation schemes, the activation dose to personnel can be substantially higher. Radiotherapy treatments with proton and neutron beams all result in activated materials in the treatment room. In this report, the authors review critically the published literature on radiation exposures from induced radioactivity in radiotherapy. They conclude that the additional exposure to the patient due to induced radioactivity is negligible compared to the overall radiation exposure as a part of the treatment. The additional exposure to the staff due to induced activity from photon beams is small at an estimated level of about 1 to 2 mSv y. This is well below the allowed occupational exposure limits. Therefore, the potential hazard to staff from induced radioactivity in the use of high-energy x-rays is considered to be low, and no specific actions are considered necessary or mandatory. However, in the spirit of the "As Low as Reasonably Achievable (ALARA)" program, some reasonable steps are recommended that can be taken to reduce this small exposure to an even lower level. The dose reduction strategies suggested should be

Design and Shielding of Radiotherapy Treatment Facilities; IPEM Report 75, 2nd Edition

NASA Astrophysics Data System (ADS)

Horton, Patrick; Eaton, David

2017-07-01

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

[Cost comparison of three treatments for localized prostate cancer in Spain: radical prostatectomy, prostate brachytherapy and external 3D conformal radiotherapy].

PubMed

Becerra Bachino, Virginia; Cots, Francesc; Guedea, Ferran; Pera, Joan; Boladeras, Ana; Aguiló, Ferran; Suárez, José Francisco; Gallo, Pedro; Murgui, Lluis; Pont, Angels; Cunillera, Oriol; Pardo, Yolanda; Ferrer, Montserrat

2011-01-01

To compare the initial costs of the three most established treatments for clinically localized prostate cancer according to risk, age and comorbidity groups, from the healthcare provider's perspective. We carried out a cost comparison study in a sample of patients consecutively recruited between 2003 and 2005 from a functional unit for prostate cancer treatment in Catalonia (Spain). The use of services up to 6 months after the treatment start date was obtained from hospital databases and direct costs were estimated by micro-cost calculation. Information on the clinical characteristics of patients and treatments was collected prospectively. Costs were compared by using nonparametric tests comparing medians (Kruskall-Wallis) and a semi-logarithmic multiple regression model. Among the 398 patients included, the cost difference among treatments was statistically significant: medians were € 3,229.10, € 5,369.00 and € 6,265.60, respectively, for the groups of patients treated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy, (p<0.001). In the multivariate analysis (adjusted R(2)=0.8), the average costs of brachytherapy and external radiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729, respectively). Radical prostatectomy proved to be the most expensive treatment option. Overall, the estimated costs in our study were lower than those published elsewhere. Most of the costs were explained by the therapeutic option and neither comorbidity nor risk groups showed an effect on total costs independent of treatment. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Beyond D'Amico risk classes for predicting recurrence after external beam radiotherapy for prostate cancer: the Candiolo classifier.

PubMed

Gabriele, Domenico; Jereczek-Fossa, Barbara A; Krengli, Marco; Garibaldi, Elisabetta; Tessa, Maria; Moro, Gregorio; Girelli, Giuseppe; Gabriele, Pietro

2016-02-24

The aim of this work is to develop an algorithm to predict recurrence in prostate cancer patients treated with radical radiotherapy, getting up to a prognostic power higher than traditional D'Amico risk classification. Two thousand four hundred ninety-three men belonging to the EUREKA-2 retrospective multi-centric database on prostate cancer and treated with external-beam radiotherapy as primary treatment comprised the study population. A Cox regression time to PSA failure analysis was performed in univariate and multivariate settings, evaluating the predictive ability of age, pre-treatment PSA, clinical-radiological staging, Gleason score and percentage of positive cores at biopsy (%PC). The accuracy of this model was checked with bootstrapping statistics. Subgroups for all the variables' combinations were combined to classify patients into five different "Candiolo" risk-classes for biochemical Progression Free Survival (bPFS); thereafter, they were also applied to clinical PFS (cPFS), systemic PFS (sPFS) and Prostate Cancer Specific Survival (PCSS), and compared to D'Amico risk grouping performances. The Candiolo classifier splits patients in 5 risk-groups with the following 10-years bPFS, cPFS, sPFS and PCSS: for very-low-risk 90 %, 94 %, 100 % and 100 %; for low-risk 74 %, 88 %, 94 % and 98 %; for intermediate-risk 60 %, 82 %, 91 % and 92 %; for high-risk 43 %, 55 %, 80 % and 89 % and for very-high-risk 14 %, 38 %, 56 % and 70 %. Our classifier outperforms D'Amico risk classes for all the end-points evaluated, with concordance indexes of 71.5 %, 75.5 %, 80 % and 80.5 % versus 63 %, 65.5 %, 69.5 % and 69 %, respectively. Our classification tool, combining five clinical and easily available parameters, seems to better stratify patients in predicting prostate cancer recurrence after radiotherapy compared to the traditional D'Amico risk classes.

Venetoclax Synergizes with Radiotherapy for Treatment of B-cell Lymphomas.

PubMed

O'Steen, Shyril; Green, Damian J; Gopal, Ajay K; Orozco, Johnnie J; Kenoyer, Aimee L; Lin, Yukang; Wilbur, D Scott; Hamlin, Donald K; Fisher, Darrell R; Hylarides, Mark D; Gooley, Theodore A; Waltman, Amelia; Till, Brian G; Press, Oliver W

2017-07-15

Constitutive B-cell receptor signaling leads to overexpression of the antiapoptotic BCL-2 protein and is implicated in the pathogenesis of many types of B-cell non-Hodgkin lymphoma (B-NHL). The BCL-2 small-molecule inhibitor venetoclax shows promising clinical response rates in several lymphomas, but is not curative as monotherapy. Radiotherapy is a rational candidate for combining with BCL-2 inhibition, as DNA damage caused by radiotherapy increases the activity of pro-apoptotic BCL-2 pathway proteins, and lymphomas are exquisitely sensitive to radiation. We tested B-NHL responses to venetoclax combined with either external beam radiotherapy or radioimmunotherapy (RIT), which joins the selectivity of antibody targeting with the effectiveness of irradiation. We first tested cytotoxicity of cesium-137 irradiation plus venetoclax in 14 B-NHL cell lines representing five lymphoma subtypes. Combination treatment synergistically increased cell death in 10 of 14 lines. Lack of synergy was predicted by resistance to single-agent venetoclax and high BCL-XL expression. We then assessed the efficacy of external beam radiotherapy plus venetoclax in murine xenograft models of mantle cell (MCL), germinal-center diffuse large B-cell (GCB-DLBCL), and activated B-cell (ABC-DLBCL) lymphomas. In each model, external beam radiotherapy plus venetoclax synergistically increased mouse survival time, curing up to 10%. We finally combined venetoclax treatment of MCL and ABC-DLBCL xenografts with a pretargeted RIT (PRIT) system directed against the CD20 antigen. Optimal dosing of PRIT plus venetoclax cured 100% of mice with no detectable toxicity. Venetoclax combined with radiotherapy may be a promising treatment for a wide range of lymphomas Cancer Res; 77(14); 3885-93. ©2017 AACR . ©2017 American Association for Cancer Research.

Targeted Intraoperative Radiotherapy for Breast Cancer in Patients in Whom External Beam Radiation Is Not Possible

DOE Office of Scientific and Technical Information (OSTI.GOV)

Keshtgar, Mohammed R.S., E-mail: m.keshtgar@ucl.ac.u; Vaidya, Jayant S.; Tobias, Jeffrey S.

2011-05-01

Purpose: External beam radiation therapy (EBRT) following wide local excision of the primary tumor is the standard treatment in early breast cancer. In some circumstances this procedure is not possible or is contraindicated or difficult. The purpose of this study was to determine the safety and efficacy of targeted intraoperative radiotherapy (TARGIT) when EBRT is not feasible. Methods and Materials: We report our experience with TARGIT in three centers (Australia, Germany, and the United Kingdom) between 1999 and 2008. Patients at these centers received a single radiation dose of 20 Gy to the breast tissue in contact with the applicatormore » (or 6 Gy at 1-cm distance), as they could not be given EBRT and were keen to avoid mastectomy. Results: Eighty patients were treated with TARGIT. Reasons for using TARGIT were 21 patients had previously received EBRT, and 31 patients had clinical reasons such as systemic lupus erythematosus, motor neuron disease, Parkinson's disease, ankylosing spondylitis, morbid obesity, and cardiovascular or severe respiratory disease. Three of these patients received percutaneous radiotherapy without surgery; 28 patients were included for compelling personal reasons, usually on compassionate grounds. After a median follow-up of 38 months, only two local recurrences were observed, an annual local recurrence rate of 0.75% (95% confidence interval, 0.09%-2.70%). Conclusions: While we await the results of the randomized trial (over 2,000 patients have already been recruited), TARGIT is an acceptable option but only in highly selected cases that cannot be recruited in the trial and in whom EBRT is not feasible/possible.« less

Collimator-free photon tomography

DOEpatents

Dilmanian, F. Avraham; Barbour, Randall L.

1998-10-06

A method of uncollimated single photon emission computed tomography includes administering a radioisotope to a patient for producing gamma ray photons from a source inside the patient. Emissivity of the photons is measured externally of the patient with an uncollimated gamma camera at a plurality of measurement positions surrounding the patient for obtaining corresponding energy spectrums thereat. Photon emissivity at the plurality of measurement positions is predicted using an initial prediction of an image of the source. The predicted and measured photon emissivities are compared to obtain differences therebetween. Prediction and comparison is iterated by updating the image prediction until the differences are below a threshold for obtaining a final prediction of the source image.

Collimator-free photon tomography

DOEpatents

Dilmanian, F.A.; Barbour, R.L.

1998-10-06

A method of uncollimated single photon emission computed tomography includes administering a radioisotope to a patient for producing gamma ray photons from a source inside the patient. Emissivity of the photons is measured externally of the patient with an uncollimated gamma camera at a plurality of measurement positions surrounding the patient for obtaining corresponding energy spectrums thereat. Photon emissivity at the plurality of measurement positions is predicted using an initial prediction of an image of the source. The predicted and measured photon emissivities are compared to obtain differences therebetween. Prediction and comparison is iterated by updating the image prediction until the differences are below a threshold for obtaining a final prediction of the source image. 6 figs.

Carbon-ion radiotherapy for marginal lymph node recurrences of cervical cancer after definitive radiotherapy: a case report.

PubMed

Tamaki, Tomoaki; Ohno, Tatsuya; Kiyohara, Hiroki; Noda, Shin-ei; Ohkubo, Yu; Ando, Ken; Wakatsuki, Masaru; Kato, Shingo; Kamada, Tadashi; Nakano, Takashi

2013-04-05

Recurrences of cervical cancer after definitive radiotherapy often occur at common iliac or para-aortic lymph nodes as marginal lymph node recurrences. Patients with these recurrences have a chance of long-term survival by optimal re-treatment with radiotherapy. However, the re-irradiation often overlaps the initial and the secondary radiotherapy fields and can result in increased normal tissue toxicities in the bowels or the stomach. Carbon-ion radiotherapy, a form of particle beam radiotherapy using accelerated carbon ions, offers more conformal and sharp dose distribution than X-ray radiotherapy. Therefore, this approach enables the delivery of high radiation doses to the target while sparing its surrounding normal tissues. Marginal lymph node recurrences in common iliac lymph nodes after radiotherapy were treated successfully by carbon-ion radiotherapy in two patients. These two patients were initially treated with a combination of external beam radiotherapy and intracavitary and interstitial brachytherapy. However, the diseases recurred in the lymph nodes near the border of the initial radiotherapy fields after 22 months and 23 months. Because re-irradiation with X-ray radiotherapy may deliver high doses to a section of the bowels, carbon-ion radiotherapy was selected to treat the lymph node recurrences. A total dose of 48 Gy (RBE) in 12 fractions over 3 weeks was given to the lymph node recurrences, and the tumors disappeared completely with no severe acute toxicities. The two patients showed no evidence of disease for 75 months and 63 months after the initial radiotherapy and for 50 months and 37 months after the carbon-ion radiotherapy, respectively. No severe late adverse effects are observed in these patients. The two presented cases suggest that the highly conformal dose distribution of carbon-ion radiotherapy may be beneficial in the treatment of marginal lymph node recurrences after radiotherapy. In addition, the higher biological effect of carbon

Fatigue in prostate cancer patients treated with external beam radiotherapy: a prospective 5-year long-term patient-reported evaluation.

PubMed

Fransson, Per

2010-01-01

Limited information is available regarding the long-term effect of external beam radiotherapy (EBRT) on fatigue in individuals with prostate cancer (PC). Men with PC treated with EBRT from January 1992 to June 2003 were enrolled in a prospective study. The QLQ-C30 questionnaire was used to evaluate pre-treatment fatigue and up to 5 years post-treatment. 407 men with 5-year assessments were analyzed. Fatigue increased between pre-treatment (mean: 15.5; CI: 13.6-17.4) and 5-years post-treatment (mean: 22.8; CI: 20.5-25.1; P<0.001). Pre-treatment fatigue was absent in 206/407 (59%) patients and 5-year post-treatment was reported by 264/407 (66%). Sixteen of 407 patients (4%) reported severe fatigue after 5 years. Physical-, emotional-, cognitive function, and dyspnea were the factors that correlated most to higher level of fatigue 5-year post-treatment. Fatigue is a common symptom among patients with PC. A large percentage of patients reported pre-treatment fatigue. Fatigue increased over time, with the highest level seen at the end of EBRT. Severe fatigue was reported by 4% 5-year post-treatment. More work is needed in order to identify which patients are most susceptible to developing fatigue especially during radiotherapy.

PHASE II STUDY OF HIGH DOSE PHOTON/PROTON RADIOTHERAPY IN THE MANAGEMENT OF SPINE SARCOMAS

PubMed Central

DeLaney, Thomas F.; Liebsch, Norbert J.; Pedlow, Francis X.; Adams, Judith; Dean, Susan; Yeap, Beow Y.; McManus, Patricia; Rosenberg, Andrew E.; Nielsen, G. Petur; Harmon, David C.; Spiro, Ira J.; Raskin, Kevin A.; Suit, Herman D.; Yoon, Sam S.; Hornicek, Francis J.

2009-01-01

Purpose Radiotherapy (XRT) for spine sarcomas is constrained by spinal cord, nerve, and viscera tolerance. Negative surgical margins are uncommon; hence, doses of ≥ 66 Gy are recommended. A Phase II clinical trial evaluated high dose photon/proton XRT for spine sarcomas. Materials/Methods Eligible patients had non-metastatic, thoracic, lumbar, and/or sacral spine/paraspinal sarcomas. Treatment included pre- and/or post-op photon/proton XRT +/- radical resection; patients with osteosarcoma and Ewing's sarcoma received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (GyRBE) to subclinical disease, 70.2 GyRBE to microscopic disease in the tumor bed, and 77.4 GyRBE to gross disease at 1.8 GyRBE q.d. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when diabetes or autoimmune disease present. Spinal cord dose was limited to 63/54 GyRBE to surface/center. Intra-operative boost doses of 7.5-10 Gy could be given by dural plaque. Results 50 patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n=25) or subtotal (n=12) resection or biopsy (n=13). With 48 month median follow-up, five-year actuarial local control, recurrence-free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) patients treated for primary versus 7/14 (50%) for recurrent tumor developed local recurrence, p<0.001. Five patients developed late radiation-associated complications; no myelopathy developed but three sacral neuropathies appeared following 77.12-77.4 GyRBE. Conclusions Local control with this treatment is high in patients radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 GyRBE are at risk for late toxicity. PMID:19095372

Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeLaney, Thomas F.; Liebsch, Norbert J.; Pedlow, Francis X.

Purpose: Radiotherapy (XRT) for spine sarcomas is constrained by spinal cord, nerve, and viscera tolerance. Negative surgical margins are uncommon; hence, doses of {>=}66 Gy are recommended. A Phase II clinical trial evaluated high-dose photon/proton XRT for spine sarcomas. Methods and Materials: Eligible patients had nonmetastatic, thoracic, lumbar, and/or sacral spine/paraspinal sarcomas. Treatment included pre- and/or postoperative photon/proton XRT with or without radical resection; patients with osteosarcoma and Ewing's sarcoma received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (Gy RBE) to subclinical disease, 70.2 Gy RBE to microscopic disease in the tumor bed, and 77.4 Gy RBE to grossmore » disease at 1.8 Gy RBE qd. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when diabetes or autoimmune disease present. Spinal cord dose was limited to 63/54 Gy RBE to surface/center. Intraoperative boost doses of 7.5 to 10 Gy could be given by dural plaque. Results: A total of 50 patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). With 48 month median follow-up, 5-year actuarial local control, recurrence-free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) patients treated for primary versus 7/14 (50%) for recurrent tumor developed local recurrence (p < 0.001). Five patients developed late radiation-associated complications; no myelopathy developed but three sacral neuropathies appeared after 77.12 to 77.4 Gy RBE. Conclusions: Local control with this treatment is high in patients radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 Gy RBE are at risk for late toxicity.« less

Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions: experimental data from direct exposure at increasing doses.

PubMed

Zecchin, Massimo; Artico, Jessica; Morea, Gaetano; Severgnini, Mara; Bianco, Elisabetta; De Luca, Antonio; Fantasia, Anna Zorzin; Salvatore, Luca; Milan, Vittorino; Lucarelli, Matteo; Dissegna, Roberta; Cannatà, Antonio; Sinagra, Gianfranco

2018-04-01

During radiotherapy, in patients with implantable cardioverter-defibrillators (ICDs) malfunctions are considered more likely if doses more than 2 Gy reach the ICD site; however, most malfunctions occur with high-energy (>10 MV) radiations, and the risk is less defined using 6-MV linear accelerators. The purpose of the study is to experimentally evaluate the occurrence of malfunctions in ICDs radiated with a 6-MV linear accelerator at increasing photon doses. Thirty-two ICDs from all manufacturers (31 explanted and one demo) were evaluated; all devices with a sufficient battery charge underwent multiple radiations with a 6-MV photon beam reaching a cumulative dose at ICD site of 0.5, 1, 2, 3, 5 and 10 Gy and interrogated after every session. All antitachycardia therapies were left enabled; two ICDs were connected to a rhythm simulator (one simulating a complete atrioventricular block without ventricular activity) and visually monitored by external ECG and the ICD programmer during radiation. Thirteen ICDs were excluded before radiation because of battery depletion; after radiation up to the cumulative dose at the cardiac implantable electronic device site of 10 Gy, in the remaining 19 devices, programmation and battery charge remained unchanged and no switch to safety mode was observed; oversensing, pacing inhibition or inappropriate antitachycardia therapy were neither recorded nor visually observed during radiation. With a low-energy accelerator, neither malfunctions nor electromagnetic interferences were detected radiating the ICDs at doses usually reaching the ICD pocket during radiotherapy sessions. In this context, magnet application to avoid oversensing and inappropriate therapy seems, therefore, useless.

Considerations of MCNP Monte Carlo code to be used as a radiotherapy treatment planning tool.

PubMed

Juste, B; Miro, R; Gallardo, S; Verdu, G; Santos, A

2005-01-01

The present work has simulated the photon and electron transport in a Theratron 780® (MDS Nordion)⁶⁰Co radiotherapy unit, using the Monte Carlo transport code, MCNP (Monte Carlo N-Particle). This project explains mainly the different methodologies carried out to speedup calculations in order to apply this code efficiently in radiotherapy treatment planning.

Time of Decline in Sexual Function After External Beam Radiotherapy for Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Siglin, Joshua; Kubicek, Gregory J.; Leiby, Benjamin

Purpose: Erectile dysfunction is one of the most concerning toxicities for patients in the treatment of prostate cancer. The inconsistent evaluation of sexual function (SF) and limited follow-up data have necessitated additional study to clarify the rate and timing of erectile dysfunction after external beam radiotherapy (EBRT) for prostate cancer. Methods and Materials: A total of 143 men completed baseline data on SF before treatment and at the subsequent follow-up visits. A total of 1187 validated SF inventories were analyzed from the study participants. Multiple domains of SF (sex drive, erectile function, ejaculatory function, and overall satisfaction) were analyzed formore » <=8 years of follow-up. Results: The median follow-up was 4.03 years. The strongest predictor of SF after EBRT was SF before treatment. For all domains of SF, the only statistically significant decrease in function occurred in the first 24 months after EBRT. SF stabilized 2 years after treatment completion, with no statistically significant change in any area of SF >2 years after the end of EBRT. Conclusion: These data suggest that SF does not have a continuous decline after EBRT. Instead, SF decreases maximally within the first 24 months after EBRT, with no significant changes thereafter.« less

A longitudinal study on the radiation-induced thyroid gland changes after external beam radiotherapy of nasopharyngeal carcinoma.

PubMed

Lin, Zhixiong; Wu, Vincent Wing-Cheung; Lin, Jing; Feng, Huiting; Chen, Longhua

2011-01-01

Radiation-induced thyroid disorders have been reported in radiotherapy of head and neck cancers. This study evaluated the radiation-induced damages to thyroid gland in patients with nasopharyngeal carcinoma (NPC). Forty-five patients with NPC treated by radiotherapy underwent baseline thyroid hormones (free triiodothyronine, free thyroxine [fT4], and thyrotropin [TSH]) examination and CT scan before radiotherapy. The volume of the thyroid gland was calculated by delineating the structure in the corresponding CT slices using the radiotherapy treatment planning system. The thyroid doses were estimated using the treatment planning system. Subsequent CT scans were conducted at 6, 12, and 18 months after radiotherapy, whereas the hormone levels were assessed at 3, 6, 12, and 18 months after radiotherapy. Trend lines of the volume and hormone level changes against time were plotted. The relationship between the dose and the change of thyroid volume and hormone levels were evaluated using the Pearson correlation test. An average of 20% thyroid volume reduction in the first 6 months and a further 8% shrinkage at 12 months after radiotherapy were observed. The volume reduction was dependent on the mean thyroid doses at 6, 12, and 18 months after radiotherapy (r = -0.399, -0.472, and -0.417, respectively). Serum free triiodothyronine and fT4 levels showed mild changes of <2.5% at 6 months, started to drop by 8.8% and 11.3%, respectively, at 12 months, and became stable at 18 months. The mean serum TSH level increased mildly at 6 months after radiotherapy and more steeply after 18 months. At 18 months after radiotherapy, 12 patients had primary hypothyroidism with an elevated serum TSH, in which 4 of them also presented with low serum fT4. There was a significant difference (p = 0.014) in the mean thyroid doses between patients with hypothyroidism and normal thyroid function. Radiotherapy for patients with NPC caused radiation-induced changes of the thyroid gland. The

Safety and Efficacy of Thoracic External Beam Radiotherapy After Airway Stenting in Malignant Airway Obstruction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rochet, Nathalie, E-mail: nrochet@partners.org; Hauswald, Henrik; Schmaus, Martina

Purpose: We retrospectively evaluated the outcome and toxicity of external beam radiotherapy (EBRT) after airway stents were placed in patients treated for malignant airway obstruction. Methods and Materials: Between 2004 and 2009, we performed airway stenting followed by EBRT in 43 patients for symptomatic primary lung cancer (n = 31) or other thoracic malignancies (n = 12). The median time interval between stent placement and first irradiation was 14 days. A median total dose of 50 Gy was delivered. Sixty-seven percent of the patients had reduced performance status (Karnofsky performance score, {<=}70). Results: EBRT had to be stopped prematurely inmore » 16 patients (37%), at a median total dose of 17 Gy, for various reasons. In this group of patients, the survival was poor, with a median overall survival (OS) of only 21 days. Twenty-seven patients (63%) completed radiotherapy as planned, with a median OS of 8.4 months. Fourteen of 43 patients (33%) developed at least one Common Terminology Criteria for Adverse Event of grade 3 to 5. The most common event was a malignant restenosis of the stent leading to asphyxia (n = 7), followed by fistula formation (n = 4), necrosis (n = 3), mediastinitis with abscess (n = 1), secondary nonmalignant airway stenosis (n = 1), and hemoptysis (n = 1). With the exception of one event, all events were associated with a local progression of the tumor. Conclusions: Although the long-term prognosis for patients with malignant airway obstruction is poor, airway stenting combined with EBRT offers a possible therapeutic option, achieving fast relief of acute respiratory distress with an associated antitumor effect, resulting in a potential survival benefit. However, due to local advanced tumor growth, increased rates of adverse events are to be expected, necessitating careful monitoring.« less

Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ferrer, Montserrat; CIBER en Epidemiologia y Salud Publica; Suarez, Jose Francisco

Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Associationmore » Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel

Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy.

PubMed

Yeh, Jekwon; Lehrich, Brandon; Tran, Carolyn; Mesa, Albert; Baghdassarian, Ruben; Yoshida, Jeffrey; Torrey, Robert; Gazzaniga, Michael; Weinberg, Alan; Chalfin, Stuart; Ravera, John; Tokita, Kenneth

2016-01-01

To present rectal toxicity rates in patients administered a polyethylene glycol (PEG) hydrogel rectal spacer in conjunction with combination high-dose-rate brachytherapy and external beam radiotherapy. Between February 2010 and April 2015, 326 prostate carcinoma patients underwent combination high-dose-rate brachytherapy of 16 Gy (average dose 15.5 Gy; standard deviation [SD] = 1.6 Gy) and external beam radiotherapy of 59.4 Gy (average dose 60.2 Gy; SD = 2.9 Gy). In conjunction with the radiation therapy regimen, each patient was injected with 10 mL of a PEG hydrogel in the anterior perirectal fat space. The injectable spacer (rectal spacer) creates a gap between the prostate and the rectum. The rectum is displaced from the radiation field, and rectal dose is substantially reduced. The goal is a reduction in rectal radiation toxicity. Clinical efficacy was determined by measuring acute and chronic rectal toxicity using the National Cancer Center Institute Common Terminology Criteria for Adverse Events v4.0 grading scheme. Median followup was 16 months. The mean anterior-posterior separation achieved was 1.6 cm (SD = 0.4 cm). Rates of acute Grade 1 and 2 rectal toxicity were 37.4% and 2.8%, respectively. There were no acute Grade 3/4 toxicities. Rates of late Grade 1, 2, and 3 rectal toxicity were 12.7%, 1.4%, and 0.7%, respectively. There were no late Grade 4 toxicities. PEG rectal spacer implantation is safe and well tolerated. Acute and chronic rectal toxicities are low despite aggressive dose escalation. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

The prospect of carbon fiber implants in radiotherapy

PubMed Central

Xiao‐bin, Tang; Chang‐ran, Geng; Da, Chen

2012-01-01

Because of their superior characteristics, carbonaceous materials, which are still at their early stage of development, have garnered significant interest. Because of their low atomic number, carbonaceous orthopedic implants possess radiation properties similar to biological tissues and, therefore, they are more suitable to patients in need of radiotherapy. The effects of stainless steel, titanium, and carbon plates on radiation dose distributions were investigated in this work using Monte Carlo simulations and TLD measurements for 6 MV photon beams. It is found that carbon plates will neither increase the incident surface dose, nor lead to the decrease of exit surface dose (the effect of a second build‐up). Carbon fiber orthopedic implants have a good prospect for radiotherapy patients because they have minimal perturbation effects on the radiotherapy dose distribution. PACS number: 87.55.K‐,87.55.Gh, 87.55.ne PMID:22766953

Pelvic radiotherapy in the setting of rheumatoid arthritis: Refining the paradigm.

PubMed

Felefly, T; Mazeron, R; Huertas, A; Canova, C H; Maroun, P; Kordahi, M; Morice, P; Deutsch, É; Haie-Méder, C; Chargari, C

2017-04-01

Conflicting results concerning the toxicity of radiotherapy in the setting of rheumatoid arthritis were reported in literature. This work describes the toxicity profiles of patients with rheumatoid arthritis undergoing pelvic radiotherapy for gynecologic malignancies at our institution. Charts of patients with rheumatoid arthritis who underwent pelvic radiotherapy for cervical or endometrial cancer in a curative intent at the Gustave-Roussy Cancer Campus between 1990 and 2015 were reviewed for treatment-related toxicities. Acute and late effects were graded as per the Common Terminology Criteria for Adverse Events version 4.0 scoring system. Eight patients with cervical cancer and three with endometrial cancer were identified. Median follow-up was 56 months. Median external beam radiotherapy dose was 45Gy. All patients received a brachytherapy boost using either pulse- or low-dose rate technique. Concomitant chemotherapy was used in seven cases. Median time from rheumatoid arthritis diagnosis to external beam radiation therapy was 5 years. No severe acute gastrointestinal or genitourinary toxicity was reported. One patient had grade 3 dermatitis. Any late toxicity occurred in 7 /11 patients, and one patient experienced severe late toxicities. One patient with overt systemic rheumatoid arthritis symptoms at the time of external beam radiation therapy experienced late grade 3 ureteral stenosis, enterocolitis and lumbar myelitis. Pelvic radiotherapy, in the setting of rheumatoid arthritis, appears to be feasible, with potentially slight increase in low grade late events compared to other anatomic sites. Patients with overt systemic rheumatoid arthritis manifestation at the time of radiotherapy might be at risk of potential severe toxicities. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

[Salvage cryotherapy of prostate cancer after failed external radiotherapy and brachytherapy: Morbidity and mid-term oncological results].

PubMed

Gevorgyan, A; Hétet, J-F; Robert, M; Duchattelle-Dussaule, V; Corno, L; Boulay, I; Baumert, H

2018-04-01

To study the oncologic and functional results of salvage cryotherapy after failure of external radiotherapy and brachytherapy. Patients treated by total salvage cryotherapy (3rd generation) in 2 centers (Groupe Hospitalier Saint-Joseph in Paris and Clinique Jule-Verne Nantes) in between January 2008 and April 2016 were included. The biochemical recurrence-free survival (BRFS) was calculated using the Phoenix criteria (PSA>nadir+2ng/mL). The functional results were assessed clinically. Ninety-seven patients with an average follow up of 39.4months were evaluated retrospectively. The 5-year biochemical recurrence-free survival (5y-BRFS) among all patients was 58.1% (IC à 95% [45.9-68.5]). Low and intermediate risk patients (d'Amico classification) were less prone to biochemical recurrence than high risk (81.05% (IC à 95% [64.1-90.5]) 5y-BRFS as opposed to 35.09% (IC à 95% [20.1-50.4]) respectively) (P<0.0001). As were patients with a Gleason score≤7 75.35% (IC à 95% [59.7-85.6]) compared to 32.31% (IC à 95% [16.5-49.2]) for higher Gleason (>7 scores [P=0.0002]). A Gleason score>7 (OR=6.9; P=0.002), PSA nadir>1ng/mL (OR=25.8; P=0.0026) and peri-urethral invasion (OR=35.8; P<0.001) were major risk factors for local recurrence in univariate analysis. In multivariate analysis, only PSA nadir>1ng/mL (OR=12.9; P=0.042) and peri-urethral invasion (OR=21.6; P=0.0003) remain major risk factors for recurrence. About 13 (16.46%) patients were incontinent of which 3 (3.79%) required placement of an artificial urinary sphincter. Erectile dysfunction was present in 66 (83.5%) patients. Recto-urethral fistula was uncommon in 1 patient (1.27%). Salvage cryotherapy after failure of external radiotherapy and brachytherapy is a reliable and reproducible technique with promising oncological and functional results. Study of prognostic factors will help better select eligible patients in the future. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Self-assembled tunable photonic hyper-crystals

PubMed Central

Smolyaninova, Vera N.; Yost, Bradley; Lahneman, David; Narimanov, Evgenii E.; Smolyaninov, Igor I.

2014-01-01

We demonstrate a novel artificial optical material, the “photonic hyper-crystal”, which combines the most interesting features of hyperbolic metamaterials and photonic crystals. Similar to hyperbolic metamaterials, photonic hyper-crystals exhibit broadband divergence in their photonic density of states due to the lack of usual diffraction limit on the photon wave vector. On the other hand, similar to photonic crystals, hyperbolic dispersion law of extraordinary photons is modulated by forbidden gaps near the boundaries of photonic Brillouin zones. Three dimensional self-assembly of photonic hyper-crystals has been achieved by application of external magnetic field to a cobalt nanoparticle-based ferrofluid. Unique spectral properties of photonic hyper-crystals lead to extreme sensitivity of the material to monolayer coatings of cobalt nanoparticles, which should find numerous applications in biological and chemical sensing. PMID:25027947

Self-assembled tunable photonic hyper-crystals.

PubMed

Smolyaninova, Vera N; Yost, Bradley; Lahneman, David; Narimanov, Evgenii E; Smolyaninov, Igor I

2014-07-16

We demonstrate a novel artificial optical material, the "photonic hyper-crystal", which combines the most interesting features of hyperbolic metamaterials and photonic crystals. Similar to hyperbolic metamaterials, photonic hyper-crystals exhibit broadband divergence in their photonic density of states due to the lack of usual diffraction limit on the photon wave vector. On the other hand, similar to photonic crystals, hyperbolic dispersion law of extraordinary photons is modulated by forbidden gaps near the boundaries of photonic Brillouin zones. Three dimensional self-assembly of photonic hyper-crystals has been achieved by application of external magnetic field to a cobalt nanoparticle-based ferrofluid. Unique spectral properties of photonic hyper-crystals lead to extreme sensitivity of the material to monolayer coatings of cobalt nanoparticles, which should find numerous applications in biological and chemical sensing.

SU-E-T-238: Monte Carlo Estimation of Cerenkov Dose for Photo-Dynamic Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chibani, O; Price, R; Ma, C

Purpose: Estimation of Cerenkov dose from high-energy megavoltage photon and electron beams in tissue and its impact on the radiosensitization using Protoporphyrine IX (PpIX) for tumor targeting enhancement in radiotherapy. Methods: The GEPTS Monte Carlo code is used to generate dose distributions from 18MV Varian photon beam and generic high-energy (45-MV) photon and (45-MeV) electron beams in a voxel-based tissueequivalent phantom. In addition to calculating the ionization dose, the code scores Cerenkov energy released in the wavelength range 375–425 nm corresponding to the pick of the PpIX absorption spectrum (Fig. 1) using the Frank-Tamm formula. Results: The simulations shows thatmore » the produced Cerenkov dose suitable for activating PpIX is 4000 to 5500 times lower than the overall radiation dose for all considered beams (18MV, 45 MV and 45 MeV). These results were contradictory to the recent experimental studies by Axelsson et al. (Med. Phys. 38 (2011) p 4127), where Cerenkov dose was reported to be only two orders of magnitude lower than the radiation dose. Note that our simulation results can be corroborated by a simple model where the Frank and Tamm formula is applied for electrons with 2 MeV/cm stopping power generating Cerenkov photons in the 375–425 nm range and assuming these photons have less than 1mm penetration in tissue. Conclusion: The Cerenkov dose generated by high-energy photon and electron beams may produce minimal clinical effect in comparison with the photon fluence (or dose) commonly used for photo-dynamic therapy. At the present time, it is unclear whether Cerenkov radiation is a significant contributor to the recently observed tumor regression for patients receiving radiotherapy and PpIX versus patients receiving radiotherapy only. The ongoing study will include animal experimentation and investigation of dose rate effects on PpIX response.« less

Proton Radiotherapy for Solid Tumors of Childhood

PubMed Central

Cotter, Shane E.; McBride, Sean M.; Yock, Torunn I.

2012-01-01

The increasing efficacy of pediatric cancer therapy over the past four decades has produced many long-term survivors that now struggle with serious treatment related morbidities affecting their quality of life. Radiation therapy is responsible for a significant proportion of these late effects, but a relatively new and emerging modality, proton radiotherapy hold great promise to drastically reduce these treatment related late effects in long term survivors by sparing dose to normal tissues. Dosimetric studies of proton radiotherapy compared with best available photon based treatment show significant dose sparing to developing normal tissues. Furthermore, clinical data are now emerging that begin to quantify the benefit in decreased late treatment effects while maintaining excellent cancer control rates. PMID:22417062

Randomized control trial: evaluating aluminum-based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of Stage 0, I, and II breast cancer.

PubMed

Watson, Linda C; Gies, Donna; Thompson, Emmanuel; Thomas, Bejoy

2012-05-01

Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using antiperspirants during their treatment

[Radiotherapy in cancers of the oesophagus, the gastric cardia and the stomach].

PubMed

Créhange, G; Huguet, F; Quero, L; N'Guyen, T V; Mirabel, X; Lacornerie, T

2016-09-01

Localized oesophageal and gastric cancers have a poor prognosis. In oesophageal cancer, external radiotherapy combined with concomitant chemotherapy is accepted as part of the therapeutic armamentarium in a curative intent in the preoperative setting for resectable tumours; or without surgery in inoperable patients or non-resectable tumours due to wide local and/or regional extension. Data from the literature show conflicting results with no clinical evidence in favour of either a unique dose protocol or consensual target volume definition in the setting of exclusive chemoradiation. In the preoperative setting, chemoradiotherapy has become the standard in oesophageal cancer, even though there is no evidence that surgery may be beneficial in locally advanced tumours that respond to radiotherapy and chemotherapy. The main cause of failure after exclusive chemoradiotherapy in oesophageal cancer is locoregional relapse suggesting that doses and volumes usually considered may be inadequate. In gastric cancer, radiotherapy may be indicated postoperatively in patients with resected tumours that include less than D2 lymph node dissection or in the absence of perioperative chemotherapy. Preoperative chemoradiotherapy in gastric cancers is still under investigation. The evolving techniques of external radiotherapy, such as image-guided radiotherapy (IMRT) and volumetric modulated arctherapy (VMAT) have reduced the volume of lung and heart exposed to radiation, which seems to have diminished radiotherapy-related morbi-mortality rates. Given this, quality assurance for radiotherapy and protocols for radiotherapy delivery must be better standardized. This article on the indications for radiotherapy and the techniques used in oesophageal and gastric cancers is included in a special issue dedicated to national recommendations from the French society of radiation oncology (SFRO) on radiotherapy indications, planning, dose prescription, and techniques of radiotherapy delivery

Accelerated partial breast irradiation with external beam radiotherapy : First results of the German phase 2 trial.

PubMed

Ott, Oliver J; Strnad, Vratislav; Stillkrieg, Wilhelm; Uter, Wolfgang; Beckmann, Matthias W; Fietkau, Rainer

2017-01-01

To evaluate the feasibility and efficacy of external beam three-dimensional (3D) conformal accelerated partial breast irradiation (APBI) for selected patients with early breast cancer. Between 2011 and 2016, 72 patients were recruited for this prospective phase 2 trial. Patients were eligible for APBI if they had histologically confirmed breast cancer or pure ductal carcinoma in situ (DCIS), a tumor diameter ≤3 cm, clear resection margins ≥2 mm, no axillary lymph node involvement, no distant metastases, tumor bed clips, and were aged ≥50 years. Patients were excluded if mammography showed a multicentric invasive growth pattern, or if they had residual diffuse microcalcifications postoperatively, an extensive intraductal component, or vessel invasion. Patients received 3D conformal external beam APBI with a total dose of 38 Gy in 10 fractions in 1-2 weeks. The trial had been registered at the German Clinical Trials Register, DRKS-ID: DRKS00004417. Median follow-up was 25.5 months (range 1-61 months). Local control was maintained in 71 of 72 patients. The 3‑year local recurrence rate was 2.1% (95% confidence interval, CI: 0-6.1%). Early toxicity (grade 1 radiodermatitis) was seen in 34.7% (25/72). Late side effects ≥ grade 3 did not occur. Cosmetic results were rated as excellent/good in 96.7% (59/61). APBI with external beam radiotherapy techniques is feasible with low toxicity and, according to the results of the present and other studies, on the way to becoming a standard treatment option for a selected subgroup of patients.

Optical eye tracking system for real-time noninvasive tumor localization in external beam radiotherapy.

PubMed

Via, Riccardo; Fassi, Aurora; Fattori, Giovanni; Fontana, Giulia; Pella, Andrea; Tagaste, Barbara; Riboldi, Marco; Ciocca, Mario; Orecchia, Roberto; Baroni, Guido

2015-05-01

External beam radiotherapy currently represents an important therapeutic strategy for the treatment of intraocular tumors. Accurate target localization and efficient compensation of involuntary eye movements are crucial to avoid deviations in dose distribution with respect to the treatment plan. This paper describes an eye tracking system (ETS) based on noninvasive infrared video imaging. The system was designed for capturing the tridimensional (3D) ocular motion and provides an on-line estimation of intraocular lesions position based on a priori knowledge coming from volumetric imaging. Eye tracking is performed by localizing cornea and pupil centers on stereo images captured by two calibrated video cameras, exploiting eye reflections produced by infrared illumination. Additionally, torsional eye movements are detected by template matching in the iris region of eye images. This information allows estimating the 3D position and orientation of the eye by means of an eye local reference system. By combining ETS measurements with volumetric imaging for treatment planning [computed tomography (CT) and magnetic resonance (MR)], one is able to map the position of the lesion to be treated in local eye coordinates, thus enabling real-time tumor referencing during treatment setup and irradiation. Experimental tests on an eye phantom and seven healthy subjects were performed to assess ETS tracking accuracy. Measurements on phantom showed an overall median accuracy within 0.16 mm and 0.40° for translations and rotations, respectively. Torsional movements were affected by 0.28° median uncertainty. On healthy subjects, the gaze direction error ranged between 0.19° and 0.82° at a median working distance of 29 cm. The median processing time of the eye tracking algorithm was 18.60 ms, thus allowing eye monitoring up to 50 Hz. A noninvasive ETS prototype was designed to perform real-time target localization and eye movement monitoring during ocular radiotherapy treatments. The

Activation of hip prostheses in high energy radiotherapy and resultant dose to nearby tissue.

PubMed

Keehan, Stephanie; Smith, Ryan L; Millar, Jeremy; Esser, Max; Taylor, Michael L; Lonski, Peta; Kron, Tomas; Franich, Rick D

2017-03-01

High energy radiotherapy can produce contaminant neutrons through the photonuclear effect. Patients receiving external beam radiation therapy to the pelvis may have high-density hip prostheses. Metallic materials such as those in hip prostheses, often have high cross-sections for neutron interaction. In this study, Thackray (UK) prosthetic hips have been irradiated by 18 MV radiotherapy beams to evaluate the additional dose to patients from the activation products. Hips were irradiated in- and out-of field at various distances from the beam isocenter to assess activation caused in-field by photo-activation, and neutron activation which occurs both in and out-of-field. NaI(Tl) scintillator detectors were used to measure the subsequent gamma-ray emissions and their half-lives. High sensitivity Mg, Cu, P doped LiF thermoluminescence dosimeter chips (TLD-100H) were used to measure the subsequent dose at the surface of a prosthesis over the 12 h following an in-field irradiation of 10,000 MU to a hip prosthesis located at the beam isocenter in a water phantom. 53 Fe, 56 Mn, and 52 V were identified within the hip following irradiation by radiotherapy beams. The dose measured at the surface of a prosthesis following irradiation in a water phantom was 0.20 mGy over 12 h. The dose at the surface of prostheses irradiated to 200 MU was below the limit of detection (0.05 mGy) of the TLD100H. Prosthetic hips are activated by incident photons and neutrons in high energy radiotherapy, however, the dose resulting from activation is very small. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Poster — Thur Eve — 35: The impact of intensity- and energy-modulated photon radiotherapy (XMRT) optimization on a variety of organ geometries

DOE Office of Scientific and Technical Information (OSTI.GOV)

McGeachy, P.; Villarreal-Barajas, J. E.; Khan, R.

2014-08-15

We previously reported on a novel, modulated in both energy and intensity; photon radiotherapy (XMRT) optimization technique. The purpose of this investigation was to test this XMRT optimization against conventional intensity modulated radiotherapy (IMRT) optimization on four different organ test geometries. All geometries mimicked clinically relevant scenarios. Both IMRT and XMRT were based on a linear programming approach where the objective function was the mean dose to healthy organs and organ-specific linear dose-point constraints were used. For IMRT, the beam energy was fixed to 6 MV while XMRT optimized in terms of both 6 and 18 MV beams. All plansmore » consisted of a seven beam coplanar arrangement. All organ geometries were contoured on a 25cm diameter cylindrical water phantom in open source radiotherapy research software known as CERR. Solutions for both IMRT and XMRT were obtained for each geometry using a numerical solver Gurobi. Analyzing the quality of the solutions was done by comparing dose distributions and dose volume histograms calculated using CERR. For all four geometries, IMRT and XMRT solutions were comparable in terms of target coverage. For two of the geometries, IMRT provided an advantage in terms of reduced dose to the healthy structures. XMRT showed improved dose reduction to healthy organs for one geometry and a comparable dose distribution to IMRT for the remaining geometry. The inability to exploit the benefits of using multiple energies may be attributed to limited water phantom diameter and having the majority of the organs in close proximity to the transverse axis.« less

Combination of external-beam radiotherapy with intraoperative electron-beam therapy is effective in incompletely resected pediatric malignancies.

PubMed

Oertel, Susanne; Niethammer, Andreas G; Krempien, Robert; Roeder, Falk; Eble, Michael J; Baer, Claudia; Huber, Peter E; Kulozik, Andreas; Waag, Karl-Ludwig; Treiber, Martina; Debus, Juergen

2006-01-01

Intraoperative electron-beam radiotherapy (IOERT) has been applied for local dose escalation in over 1,400 patients in Heidelberg since 1991. Among these were 30 children, in 18 of whom IOERT was employed in radiation treatment with external-beam radiotherapy (EBRT) on account of incomplete resection. We address the question whether IOERT is able to compensate for microscopic or macroscopic tumor residue if employed in the overall radiation regimen. The data of the aforementioned 18 children were analyzed with regard to local recurrence, overall survival, and complication rates. All children suffered from either sarcomas or neuroblastomas. In all children, IOERT was employed for local dose escalation after or before EBRT. After a median follow-up of 60.5 months, 15 of the treated children are alive. One local failure has been observed. Six children show clinically significant late morbidity, including the loss of a treated limb (Radiation Therapy Oncology Group Grade 4 [RTOG 4]), a severe nerve lesion (RTOG 3), an orthopedic complication (RTOG 2), a ureteral stenosis (not clinically significant), and a kidney hypotrophy (not clinically significant). In 1 child a fracture due to radionecrosis (RTOG 4) was diagnosed; however, in the follow-up, local tumor relapse was diagnosed as another possible reason for the fracture. Regarding the low incidence of local failure, IOERT seems to be able to compensate incomplete tumor resection in childhood sarcoma and neuroblastoma patients. The incidence of late morbidity is low enough to justify the employment of IOERT as part of the radiation treatment regimen for pediatric patients.

Fast Neutron Radiotherapy for Locally Advanced Prostate Cancer: Update of a Past Trial and Future Research Directions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krieger, John N.; Krall, John M.; Laramore, George E.

1987-01-01

Between June, 1977 and April, 1983 the Radiation Therapy Oncology Group (RTOG) sponsored a Phase III study comparing fast neutron radiotherapy as part of a mixed beam (neutron/photon) regimen with conventional photon (x-ray) radiotherapy for patients with locally advanced (stages C and o1 ) adenocarcinoma of the prostate. A total of 91 analyzable patients were entered into the study with -the two treatment groups being balanced in regard to all major prognostic variables. The current analysis is for a median follow-up of 6.7 years (range 3.4-9.0). Actuarial curves are presented for local/regional control, overall survival and "determinantal" survival. The resultsmore » are statistically significant in favor of the mixed beam group for all of the above parameters. At 5 years the local control rate is 81% on the mixed beam arm compared to 60% on the photon arm. Histologic evidence of residual prostatic carcinoma was documented in six patients with no clinical evidence of disease on both treatment arms. The actuarial overall survival rate at S years is 70% on the mixed beam compared to 56% on the photon arm. The determinantal survival at 5 years was 82%. on the mixed beam arm compared to 61% on the photon arm. The type of therapy appeared to be the most important predictor of both local tumor control and patient survival in a step-wise Cox analysis. There was no difference in the treatment related morbidity for the two patient groups. Mixed beam therapy may be superior to standard photon radiotherapy for treatment of locally advanced prostate cancer.« less

Generation of synthetic CT using multi-scale and dual-contrast patches for brain MRI-only external beam radiotherapy.

PubMed

Aouadi, Souha; Vasic, Ana; Paloor, Satheesh; Torfeh, Tarraf; McGarry, Maeve; Petric, Primoz; Riyas, Mohamed; Hammoud, Rabih; Al-Hammadi, Noora

2017-10-01

To create a synthetic CT (sCT) from conventional brain MRI using a patch-based method for MRI-only radiotherapy planning and verification. Conventional T1 and T2-weighted MRI and CT datasets from 13 patients who underwent brain radiotherapy were included in a retrospective study whereas 6 patients were tested prospectively. A new contribution to the Non-local Means Patch-Based Method (NMPBM) framework was done with the use of novel multi-scale and dual-contrast patches. Furthermore, the training dataset was improved by pre-selecting the closest database patients to the target patient for computation time/accuracy balance. sCT and derived DRRs were assessed visually and quantitatively. VMAT planning was performed on CT and sCT for hypothetical PTVs in homogeneous and heterogeneous regions. Dosimetric analysis was done by comparing Dose Volume Histogram (DVH) parameters of PTVs and organs at risk (OARs). Positional accuracy of MRI-only image-guided radiation therapy based on CBCT or kV images was evaluated. The retrospective (respectively prospective) evaluation of the proposed Multi-scale and Dual-contrast Patch-Based Method (MDPBM) gave a mean absolute error MAE=99.69±11.07HU (98.95±8.35HU), and a Dice in bones DI bone =83±0.03 (0.82±0.03). Good agreement with conventional planning techniques was obtained; the highest percentage of DVH metric deviations was 0.43% (0.53%) for PTVs and 0.59% (0.75%) for OARs. The accuracy of sCT/CBCT or DRR sCT /kV images registration parameters was <2mm and <2°. Improvements with MDPBM, compared to NMPBM, were significant. We presented a novel method for sCT generation from T1 and T2-weighted MRI potentially suitable for MRI-only external beam radiotherapy in brain sites. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

A Simulation Study of a Radiofrequency Localization System for Tracking Patient Motion in Radiotherapy.

PubMed

Ostyn, Mark; Kim, Siyong; Yeo, Woon-Hong

2016-04-13

One of the most widely used tools in cancer treatment is external beam radiotherapy. However, the major risk involved in radiotherapy is excess radiation dose to healthy tissue, exacerbated by patient motion. Here, we present a simulation study of a potential radiofrequency (RF) localization system designed to track intrafraction motion (target motion during the radiation treatment). This system includes skin-wearable RF beacons and an external tracking system. We develop an analytical model for direction of arrival measurement with radio frequencies (GHz range) for use in a localization estimate. We use a Monte Carlo simulation to investigate the relationship between a localization estimate and angular resolution of sensors (signal receivers) in a simulated room. The results indicate that the external sensor needs an angular resolution of about 0.03 degrees to achieve millimeter-level localization accuracy in a treatment room. This fundamental study of a novel RF localization system offers the groundwork to design a radiotherapy-compatible patient positioning system for active motion compensation.

Evaluation of Al{sub 2}O{sub 3}:C optically stimulated luminescence (OSL) dosimeters for passive dosimetry of high-energy photon and electron beams in radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yukihara, E. G.; Mardirossian, G.; Mirzasadeghi, M.

This article investigates the performance of Al{sub 2}O{sub 3}:C optically stimulated luminescence dosimeters (OSLDs) for application in radiotherapy. Central-axis depth dose curves and optically stimulated luminescence (OSL) responses were obtained in a water phantom for 6 and 18 MV photons, and for 6, 9, 12, 16, and 20 MeV electron beams from a Varian 21EX linear accelerator. Single OSL measurements could be repeated with a precision of 0.7% (one standard deviation) and the differences between absorbed doses measured with OSLDs and an ionization chamber were within {+-}1% for photon beams. Similar results were obtained for electron beams in the low-gradientmore » region after correction for a 1.9% photon-to-electron bias. The distance-to-agreement values were of the order of 0.5-1.0 mm for electrons in high dose gradient regions. Additional investigations also demonstrated that the OSL response dependence on dose rate, field size, and irradiation temperature is less than 1% in the conditions of the present study. Regarding the beam energy/quality dependence, the relative response of the OSLD for 18 MV was (0.51{+-}0.48)% of the response for the 6 MV photon beam. The OSLD response for the electron beams relative to the 6 MV photon beam. The OSLD response for the electron beams relative to the 6 MV photon beam was in average 1.9% higher, but this result requires further confirmation. The relative response did not seem to vary with electron energy at d{sub max} within the experimental uncertainties (0.5% in average) and, therefore, a fixed correction factor of 1.9% eliminated the energy dependence in our experimental conditions.« less

Analysis of regional radiotherapy dosimetry audit data and recommendations for future audits

PubMed Central

Palmer, A; Mzenda, B; Kearton, J; Wills, R

2011-01-01

Objectives Regional interdepartmental dosimetry audits within the UK provide basic assurances of the dosimetric accuracy of radiotherapy treatments. Methods This work reviews several years of audit results from the South East Central audit group including megavoltage (MV) and kilovoltage (kV) photons, electrons and iodine-125 seeds. Results Apart from some minor systematic errors that were resolved, the results of all audits have been within protocol tolerances, confirming the long-term stability and agreement of basic radiation dosimetric parameters between centres in the audit region. There is some evidence of improvement in radiation dosimetry with the adoption of newer codes of practice. Conclusion The value of current audit methods and the limitations of peer-to-peer auditing is discussed, particularly the influence of the audit schedule on the results obtained, where no “gold standard” exists. Recommendations are made for future audits, including an essential requirement to maintain the monitoring of basic fundamental dosimetry, such as MV photon and electron output, but audits must also be developed to include new treatment technologies such as image-guided radiotherapy and address the most common sources of error in radiotherapy. PMID:21159805

Definitive treatment of androgen receptor-positive salivary duct carcinoma with androgen deprivation therapy and external beam radiotherapy.

PubMed

Soper, Margaret S; Iganej, Shawn; Thompson, Lester D R

2014-01-01

Salivary duct carcinoma (SDC) is an aggressive malignancy with high recurrence rates. Standard management includes surgical resection followed by adjuvant radiation. Androgen receptor positivity has been described to be present in 40% to 90% of SDCs, and a recent case series showed a benefit to androgen deprivation therapy (ADT) in recurrent or metastatic disease. We present the case of an 87-year-old woman with a locally advanced androgen receptor-positive parotid SDC treated definitively with ADT and external beam radiotherapy, a regimen modeled after the treatment of prostate cancer. She had a complete response on positron emission tomography (PET)/CT scan and had no evidence of disease 24 months after the completion of treatment. To our knowledge, this case report is the first to describe the use of ADT plus radiation to definitively treat SDC. This regimen could be considered in patients with androgen receptor-positive SDCs who are considered unresectable or who refuse surgery. Copyright © 2013 Wiley Periodicals, Inc.

Giant photonic Hall effect in magnetophotonic crystals.

PubMed

Merzlikin, A M; Vinogradov, A P; Inoue, M; Granovsky, A B

2005-10-01

We have considered a simple, square, two-dimensional (2D) PC built of a magneto-optic matrix with square holes. It is shown that using such a magnetophotonic crystal it is possible to deflect a light beam at very large angles by applying a nonzero external magnetic field. The effect is called the giant photonic Hall effect (GPHE) or the magnetic superprism effect. The GPHE is based on magneto-optical properties, as is the photonic Hall effect [B. A. van Tiggelen and G. L. J. A. Rikken, in, edited by V. M. Shalaev (Springer-Verlag, Berlin, 2002), p. 275]; however GPHE is not caused by asymmetrical light scattering but rather by the influence of an external magnetic field on the photonic band structure.

Real-time in vivo Cherenkoscopy imaging during external beam radiation therapy.

PubMed

Zhang, Rongxiao; Gladstone, David J; Jarvis, Lesley A; Strawbridge, Rendall R; Jack Hoopes, P; Friedman, Oscar D; Glaser, Adam K; Pogue, Brian W

2013-11-01

Cherenkov radiation is induced when charged particles travel through dielectric media (such as biological tissue) faster than the speed of light through that medium. Detection of this radiation or excited luminescence during megavoltage external beam radiotherapy (EBRT) can allow emergence of a new approach to superficial dose estimation, functional imaging, and quality assurance for radiation therapy dosimetry. In this letter, the first in vivo Cherenkov images of a real-time Cherenkoscopy during EBRT are presented. The imaging system consisted of a time-gated intensified charge coupled device (ICCD) coupled with a commercial lens. The ICCD was synchronized to the linear accelerator to detect Cherenkov photons only during the 3.25-μs radiation bursts. Images of a tissue phantom under irradiation show that the intensity of Cherenkov emission is directly proportional to radiation dose, and images can be acquired at 4.7 frames/s with SNR>30. Cherenkoscopy was obtained from the superficial regions of a canine oral tumor during planned, Institutional Animal Care and Use Committee approved, conventional (therapeutically appropriate) EBRT irradiation. Coregistration between photography and Cherenkoscopy validated that Cherenkov photons were detected from the planned treatment region. Real-time images correctly monitored the beam field changes corresponding to the planned dynamic wedge movement, with accurate extent of overall beam field, and expected cold and hot regions.

A practical implementation of physics quality assurance for photon adaptive radiotherapy.

PubMed

Cai, Bin; Green, Olga L; Kashani, Rojano; Rodriguez, Vivian L; Mutic, Sasa; Yang, Deshan

2018-03-14

The fast evolution of technology in radiotherapy (RT) enabled the realization of adaptive radiotherapy (ART). However, the new characteristics of ART pose unique challenges for efficiencies and effectiveness of quality assurance (QA) strategies. In this paper, we discuss the necessary QAs for ART and introduce a practical implementation. A previously published work on failure modes and effects analysis (FMEA) of ART is introduced first to explain the risks associated with ART sub-processes. After a brief discussion of QA challenges, we review the existing QA strategies and tools that might be suitable for each ART step. By introducing the MR-guided online ART QA processes developed at our institute, we demonstrate a practical implementation. The limitations and future works to develop more robust and efficient QA strategies are discussed at the end. Copyright © 2018. Published by Elsevier GmbH.

Dosimetric comparison of photon and proton treatment techniques for chondrosarcoma of thoracic spine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yadav, Poonam, E-mail: yadav@humonc.wisc.edu; Department of Medical Physics, University of Wisconsin, Madison, WI; University of Wisconsin Riverview Cancer Center, Wisconsin Rapids, WI

2013-10-01

Chondrosarcomas are relatively radiotherapy resistant, and also delivering high radiation doses is not feasible owing to anatomic constraints. In this study, the feasibility of helical tomotherapy for treatment of chondrosarcoma of thoracic spine is explored and compared with other available photon and proton radiotherapy techniques in the clinical setting. A patient was treated for high-grade chondrosarcoma of the thoracic spine using tomotherapy. Retrospectively, the tomotherapy plan was compared with intensity-modulated radiation therapy, dynamic arc photon therapy, and proton therapy. Two primary comparisons were made: (1) comparison of normal tissue sparing with comparable target volume coverage (plan-1), and (2) comparison ofmore » target volume coverage with a constrained maximum dose to the cord center (plan-2). With constrained target volume coverage, proton plans were found to yield lower mean doses for all organs at risk (spinal cord, esophagus, heart, and both lungs). Tomotherapy planning resulted in the lowest mean dose to all organs at risk amongst photon-based methods. For cord dose constrained plans, the static-field intensity-modulated radiation therapy and dynamic arc plans resulted target underdosing in 20% and 12% of planning target volume2 volumes, respectively, whereas both proton and tomotherapy plans provided clinically acceptable target volume coverage with no portion of planning target volume2 receiving less than 90% of the prescribed dose. Tomotherapy plans are comparable to proton plans and produce superior results compared with other photon modalities. This feasibility study suggests that tomotherapy is an attractive alternative to proton radiotherapy for delivering high doses to lesions in the thoracic spine.« less

On the Detectability of Acoustic Waves Induced Following Irradiation by a Radiotherapy Linear Accelerator.

PubMed

Hickling, Susannah; Leger, Pierre; El Naqa, Issam

2016-02-11

Irradiating an object with a megavoltage photon beam generated by a clinical radiotherapy linear accelerator (linac) induces acoustic waves through the photoacoustic effect. The detection and characterization of such acoustic waves has potential applications in radiation therapy dosimetry. The purpose of this work was to gain insight into the properties of such acoustic waves by simulating and experimentally detecting them in a well-defined system consisting of a metal block suspended in a water tank. A novel simulation workflow was developed by combining radiotherapy Monte Carlo and acoustic wave transport simulation techniques. Different set-up parameters such as photon beam energy, metal block depth, metal block width, and metal block material were varied, and the simulated and experimental acoustic waveforms showed the same relative amplitude trends and frequency variations for such setup changes. The simulation platform developed in this work can easily be extended to other irradiation situations, and will be an invaluable tool for developing a radiotherapy dosimetry system based on the detection of the acoustic waves induced following linear accelerator irradiation.

Qubit-qubit entanglement dynamics control via external classical pumping and Kerr nonlinearity mediated by a single detuned cavity field powered by two-photon processes

NASA Astrophysics Data System (ADS)

Ateto, M. S.

2017-11-01

The nonlinear time-dependent two-photon Hamiltonian of a couple of classically pumped independent qubits is analytically solved, and the corresponding time evolution unitary operator, in an exact form, is derived. Using the concurrence, entanglement dynamics between the qubits under the influence of a wide range of effective parameters are examined and, in detail, analyzed. Observations analysis is documented with aid of the field phase-space distribution Wigner function. A couple of initial qubit states is considered, namely similar excited states and a Bell-like pure state. It is demonstrated that an initial Bell-like pure state is as well typical initial qubits setting for robust, regular and a high degree of entanglement. Moreover, it is established that high-constant Kerr media represent an effective tool for generating periodical entanglement at fixed time cycles of maxima reach unity forever when qubits are initially in a Bell-like pure state. Further, it is showed that the medium strength of the classical pumping stimulates efficiently qubits entanglement, specially, when the interaction occurs off resonantly. However, the high-intensity pumping thermalizes the coherent distribution of photons, thus, the least photons number is used and, hence, the least minimum degree of qubits entanglement could be created. Furthermore, when the cavity field and external pumping are detuned, the external pumping acts like an auxiliary effective frequency for the cavity, as a result, the field Gaussian distribution acquires linear chirps, and consequently, more entanglement revivals appear in the same cycle during timescale.

Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lutz, Stephen, E-mail: slutz@bvha.or; Berk, Lawrence; Chang, Eric

2011-03-15

Purpose: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/ormore » prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. Conclusions: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its

Precision radiotherapy for cancer of the pancreas: technique and results. [Photons and electrons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dobelbower, R.R. Jr.; Borgelt, B.B.; Strubler, K.A.

1980-09-01

Forty patients with locally extensive, unresectable adenocarcinoma of the pancreas received precision high dose (PHD) radiation therapy with a 45 MeV betatron. PHD radiotherapy was generally well tolerated. During treatment, only 7 patients experienced significant nausea, vomiting, diarrhea or anorexia. Late gastrointestinal radiation reactions were observed in 7 patients. Twelve patients received adjuvant chemotherapy. The projected survival of patients with unresectable pancreatic cancer treated with PHD radiotherapy is comparable to that of patients with resectable disease operated on for cure. The projected one year survival rate is 49%.

Supervised physical therapy in women treated with radiotherapy for breast cancer 1

PubMed Central

Leal, Nara Fernanda Braz da Silva; de Oliveira, Harley Francisco; Carrara, Hélio Humberto Angotti

2016-01-01

ABSTRACT Objective: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. Methods: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. Results: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. Conclusion: the applied supervised physical therapy was effective in recovering the deficit in abduction after radiotherapy, and the deficits in flexion and external rotation were recovered within two months after the end of radiotherapy. Registration number of the clinical trial: NCT02198118. PMID:27533265

SU-E-T-332: Dosimetric Impact of Photon Energy and Treatment Technique When Knowledge Based Auto-Planning Is Implemented in Radiotherapy of Localized Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Z; Kennedy, A; Larsen, E

2015-06-15

Purpose: The aim of this study was to investigate the dosimetric impact of the combination of photon energy and treatment technique on radiotherapy of localized prostate cancer when knowledge based planning was used. Methods: A total of 16 patients with localized prostate cancer were retrospectively retrieved from database and used for this study. For each patient, four types of treatment plans with different combinations of photon energy (6X and 10X) and treatment techniques (7-field IMRT and 2-arc VMAT) were created using a prostate DVH estimation model in RapidPlan™ and Eclipse treatment planning system (Varian Medical System). For any beam arrangement,more » DVH objectives and weighting priorities were generated based on the geometric relationship between the OAR and PTV. Photon optimization algorithm was used for plan optimization and AAA algorithm was used for final dose calculation. Plans were evaluated in terms of the pre-defined dosimetric endpoints for PTV, rectum, bladder, penile bulb, and femur heads. A Student’s paired t-test was used for statistical analysis and p > 0.05 was considered statistically significant. Results: For PTV, V95 was statistically similar among all four types of plans, though the mean dose of 10X plans was higher than that of 6X plans. VMAT plans showed higher heterogeneity index than IMRT plans. No statistically significant difference in dosimetry metrics was observed for rectum, bladder, and penile bulb among plan types. For left and right femur, VMAT plans had a higher mean dose than IMRT plans regardless of photon energy, whereas the maximum dose was similar. Conclusion: Overall, the dosimetric endpoints were similar regardless of photon energy and treatment techniques when knowledge based auto planning was used. Given the similarity in dosimetry metrics of rectum, bladder, and penile bulb, the genitourinary and gastrointestinal toxicities should be comparable among the selections of photon energy and treatment

Evidence-based optimal number of radiotherapy fractions for cancer: A useful tool to estimate radiotherapy demand.

PubMed

Wong, Karen; Delaney, Geoff P; Barton, Michael B

2016-04-01

The recently updated optimal radiotherapy utilisation model estimated that 48.3% of all cancer patients should receive external beam radiotherapy at least once during their disease course. Adapting this model, we constructed an evidence-based model to estimate the optimal number of fractions for notifiable cancers in Australia to determine equipment and workload implications. The optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the evidence-based recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of variables on the model. Of the 27 cancer sites, the optimal number of fractions for the first course of radiotherapy ranged from 0 to 23.3 per cancer patient, and 1.5 to 29.1 per treatment course. Brain, prostate and head and neck cancers had the highest average number of fractions per course. Overall, the optimal number of fractions was 9.4 per cancer patient (range 8.7-10.0) and 19.4 per course (range 18.0-20.7). These results provide valuable data for radiotherapy services planning and comparison with actual practice. The model can be easily adapted by inserting population-specific epidemiological data thus making it applicable to other jurisdictions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Knowledge-based computer systems for radiotherapy planning.

PubMed

Kalet, I J; Paluszynski, W

1990-08-01

Radiation therapy is one of the first areas of clinical medicine to utilize computers in support of routine clinical decision making. The role of the computer has evolved from simple dose calculations to elaborate interactive graphic three-dimensional simulations. These simulations can combine external irradiation from megavoltage photons, electrons, and particle beams with interstitial and intracavitary sources. With the flexibility and power of modern radiotherapy equipment and the ability of computer programs that simulate anything the machinery can do, we now face a challenge to utilize this capability to design more effective radiation treatments. How can we manage the increased complexity of sophisticated treatment planning? A promising approach will be to use artificial intelligence techniques to systematize our present knowledge about design of treatment plans, and to provide a framework for developing new treatment strategies. Far from replacing the physician, physicist, or dosimetrist, artificial intelligence-based software tools can assist the treatment planning team in producing more powerful and effective treatment plans. Research in progress using knowledge-based (AI) programming in treatment planning already has indicated the usefulness of such concepts as rule-based reasoning, hierarchical organization of knowledge, and reasoning from prototypes. Problems to be solved include how to handle continuously varying parameters and how to evaluate plans in order to direct improvements.

Optical eye tracking system for real-time noninvasive tumor localization in external beam radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Via, Riccardo, E-mail: riccardo.via@polimi.it; Fassi, Aurora; Fattori, Giovanni

Purpose: External beam radiotherapy currently represents an important therapeutic strategy for the treatment of intraocular tumors. Accurate target localization and efficient compensation of involuntary eye movements are crucial to avoid deviations in dose distribution with respect to the treatment plan. This paper describes an eye tracking system (ETS) based on noninvasive infrared video imaging. The system was designed for capturing the tridimensional (3D) ocular motion and provides an on-line estimation of intraocular lesions position based on a priori knowledge coming from volumetric imaging. Methods: Eye tracking is performed by localizing cornea and pupil centers on stereo images captured by twomore » calibrated video cameras, exploiting eye reflections produced by infrared illumination. Additionally, torsional eye movements are detected by template matching in the iris region of eye images. This information allows estimating the 3D position and orientation of the eye by means of an eye local reference system. By combining ETS measurements with volumetric imaging for treatment planning [computed tomography (CT) and magnetic resonance (MR)], one is able to map the position of the lesion to be treated in local eye coordinates, thus enabling real-time tumor referencing during treatment setup and irradiation. Experimental tests on an eye phantom and seven healthy subjects were performed to assess ETS tracking accuracy. Results: Measurements on phantom showed an overall median accuracy within 0.16 mm and 0.40° for translations and rotations, respectively. Torsional movements were affected by 0.28° median uncertainty. On healthy subjects, the gaze direction error ranged between 0.19° and 0.82° at a median working distance of 29 cm. The median processing time of the eye tracking algorithm was 18.60 ms, thus allowing eye monitoring up to 50 Hz. Conclusions: A noninvasive ETS prototype was designed to perform real-time target localization and eye movement

Evolution of Carbon Ion Radiotherapy at the National Institute of Radiological Sciences in Japan

PubMed Central

Mohamad, Osama; Makishima, Hirokazu; Kamada, Tadashi

2018-01-01

Charged particles can achieve better dose distribution and higher biological effectiveness compared to photon radiotherapy. Carbon ions are considered an optimal candidate for cancer treatment using particles. The National Institute of Radiological Sciences (NIRS) in Chiba, Japan was the first radiotherapy hospital dedicated for carbon ion treatments in the world. Since its establishment in 1994, the NIRS has pioneered this therapy with more than 69 clinical trials so far, and hundreds of ancillary projects in physics and radiobiology. In this review, we will discuss the evolution of carbon ion radiotherapy at the NIRS and some of the current and future projects in the field. PMID:29509684

Evolution of Carbon Ion Radiotherapy at the National Institute of Radiological Sciences in Japan.

PubMed

Mohamad, Osama; Makishima, Hirokazu; Kamada, Tadashi

2018-03-06

Charged particles can achieve better dose distribution and higher biological effectiveness compared to photon radiotherapy. Carbon ions are considered an optimal candidate for cancer treatment using particles. The National Institute of Radiological Sciences (NIRS) in Chiba, Japan was the first radiotherapy hospital dedicated for carbon ion treatments in the world. Since its establishment in 1994, the NIRS has pioneered this therapy with more than 69 clinical trials so far, and hundreds of ancillary projects in physics and radiobiology. In this review, we will discuss the evolution of carbon ion radiotherapy at the NIRS and some of the current and future projects in the field.

Histological changes in the human prostate after radiotherapy and salvage high intensity focused ultrasound

PubMed Central

Chalasani, Venu; Martinez, Carlos H.; Williams, Andrew K.; Kwan, Kevin; Chin, Joseph L.

2010-01-01

The histological changes (both macroscopic and microscopic) in the prostate following the combination of external beam radiotherapy and salvage high intensity focused ultrasound (HIFU) have not been previously described. This article describes the case of a 65-year-old male who presented with recurrent localized prostate cancer after undergoing external beam radiotherapy for low-risk prostate cancer. He was treated with salvage HIFU, and 4 weeks later presented with symptoms and signs consistent with a prostatorectal fistula. During a period of conservative management, his serum prostate-specific antigen levels started rising after having reached a nadir. A radical cystoprostatectomy and repair of fistula were performed after conservative management failed. Histological changes of dense fibrosis were noted in the region where the prostate should have been located. A literature review of the histological findings in the prostate after HIFU is discussed in this article, as well as the available evidence for the management of patients with local failure after the combination of external beam radiotherapy and salvage HIFU. PMID:20694085

Monte Carlo treatment planning with modulated electron radiotherapy: framework development and application

NASA Astrophysics Data System (ADS)

Alexander, Andrew William

Within the field of medical physics, Monte Carlo radiation transport simulations are considered to be the most accurate method for the determination of dose distributions in patients. The McGill Monte Carlo treatment planning system (MMCTP), provides a flexible software environment to integrate Monte Carlo simulations with current and new treatment modalities. A developing treatment modality called energy and intensity modulated electron radiotherapy (MERT) is a promising modality, which has the fundamental capabilities to enhance the dosimetry of superficial targets. An objective of this work is to advance the research and development of MERT with the end goal of clinical use. To this end, we present the MMCTP system with an integrated toolkit for MERT planning and delivery of MERT fields. Delivery is achieved using an automated "few leaf electron collimator" (FLEC) and a controller. Aside from the MERT planning toolkit, the MMCTP system required numerous add-ons to perform the complex task of large-scale autonomous Monte Carlo simulations. The first was a DICOM import filter, followed by the implementation of DOSXYZnrc as a dose calculation engine and by logic methods for submitting and updating the status of Monte Carlo simulations. Within this work we validated the MMCTP system with a head and neck Monte Carlo recalculation study performed by a medical dosimetrist. The impact of MMCTP lies in the fact that it allows for systematic and platform independent large-scale Monte Carlo dose calculations for different treatment sites and treatment modalities. In addition to the MERT planning tools, various optimization algorithms were created external to MMCTP. The algorithms produced MERT treatment plans based on dose volume constraints that employ Monte Carlo pre-generated patient-specific kernels. The Monte Carlo kernels are generated from patient-specific Monte Carlo dose distributions within MMCTP. The structure of the MERT planning toolkit software and

[Head and neck adaptive radiotherapy].

PubMed

Graff, P; Huger, S; Kirby, N; Pouliot, J

2013-10-01

Onboard volumetric imaging systems can provide accurate data of the patient's anatomy during a course of head and neck radiotherapy making it possible to assess the actual delivered dose and to evaluate the dosimetric impact of complex daily positioning variations and gradual anatomic changes such as geometric variations of tumors and normal tissues or shrinkage of external contours. Adaptive radiotherapy is defined as the correction of a patient's treatment planning to adapt for individual variations observed during treatment. Strategies are developed to selectively identify patients that require replanning because of an intolerable dosimetric drift. Automated tools are designed to limit time consumption. Deformable image registration algorithms are the cornerstones of these strategies, but a better understanding of their limits of validity is required before adaptive radiotherapy can be safely introduced to daily practice. Moreover, strict evaluation of the clinical benefits is yet to be proven. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Self-assembled Tunable Photonic Hyper-crystals

DTIC Science & Technology

2014-07-16

a cobalt nanoparticle-based ferrofluid. Unique spectral properties of photonic hyper-crystals lead to extreme sensitivity of the material to...monolayer coatings of cobalt nanoparticles, which should find numerous applications in biological and chemical sensing. 2 Approved for public release...assembly of photonic hyper crystals has been achieved by application of external magnetic field to a cobalt nanoparticle based ferrofluid. Unique spectral

Optimum location of external markers using feature selection algorithms for real‐time tumor tracking in external‐beam radiotherapy: a virtual phantom study

PubMed Central

Nankali, Saber; Miandoab, Payam Samadi; Baghizadeh, Amin

2016-01-01

In external‐beam radiotherapy, using external markers is one of the most reliable tools to predict tumor position, in clinical applications. The main challenge in this approach is tumor motion tracking with highest accuracy that depends heavily on external markers location, and this issue is the objective of this study. Four commercially available feature selection algorithms entitled 1) Correlation‐based Feature Selection, 2) Classifier, 3) Principal Components, and 4) Relief were proposed to find optimum location of external markers in combination with two “Genetic” and “Ranker” searching procedures. The performance of these algorithms has been evaluated using four‐dimensional extended cardiac‐torso anthropomorphic phantom. Six tumors in lung, three tumors in liver, and 49 points on the thorax surface were taken into account to simulate internal and external motions, respectively. The root mean square error of an adaptive neuro‐fuzzy inference system (ANFIS) as prediction model was considered as metric for quantitatively evaluating the performance of proposed feature selection algorithms. To do this, the thorax surface region was divided into nine smaller segments and predefined tumors motion was predicted by ANFIS using external motion data of given markers at each small segment, separately. Our comparative results showed that all feature selection algorithms can reasonably select specific external markers from those segments where the root mean square error of the ANFIS model is minimum. Moreover, the performance accuracy of proposed feature selection algorithms was compared, separately. For this, each tumor motion was predicted using motion data of those external markers selected by each feature selection algorithm. Duncan statistical test, followed by F‐test, on final results reflected that all proposed feature selection algorithms have the same performance accuracy for lung tumors. But for liver tumors, a correlation‐based feature

Widely tunable eye-safe laser by a passively Q-switched photonic crystal fiber laser and an external-cavity optical parametric oscillator

NASA Astrophysics Data System (ADS)

Chang, H. L.; Zhuang, W. Z.; Huang, W. C.; Huang, J. Y.; Huang, K. F.; Chen, Y. F.

2011-09-01

We report on a widely tunable passively Q-switched photonic crystal fiber (PCF) laser with wavelength tuning range up to 80 nm. The PCF laser utilizes an AlGaInAs quantum well/barrier structure as a saturable absorber and incorporates an external-cavity optical parametric oscillator (OPO) to achieve wavelength conversion. Under a pump power of 13.1 W at 976 nm, the PCF laser generated 1029-nm radiation with maximum output energy of 750 μJ and was incident into an external-cavity OPO. The output energy and peak power of signal wave was found to be 138 μJ and 19 kW, respectively. By tuning the temperature of nonlinear crystal, periodically poled lithium niobate (PPLN), in the OPO, the signal wavelength in eye-safe regime from 1513 to 1593 nm was obtained.

External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society

PubMed Central

Kiess, Ana P.; Agrawal, Nishant; Brierley, James D.; Duvvuri, Umamaheswar; Ferris, Robert L.; Genden, Eric; Wong, Richard J.; Tuttle, R. Michael; Lee, Nancy Y.; Randolph, Gregory W.

2016-01-01

The use of external-beam radiotherapy (EBRT) in differentiated thyroid cancer (DTC) is debated because of a lack of prospective clinical data, but recent retrospective studies have reported benefits in selected patients. The Endocrine Surgery Committee of the American Head and Neck Society provides 4 recommendations regarding EBRT for locoregional control in DTC, based on review of literature and expert opinion of the authors. (1) EBRT is recommended for patients with gross residual or unresectable locoregional disease, except for patients <45 years old with limited gross disease that is radioactive iodine (RAI)-avid. (2) EBRT should not be routinely used as adjuvant therapy after complete resection of gross disease. (3) After complete resection, EBRT may be considered in select patients >45 years old with high likelihood of microscopic residual disease and low likelihood of responding to RAI. (4) Cervical lymph node involvement alone should not be an indication for adjuvant EBRT. PMID:26716601

Recent advances in intensity modulated radiotherapy and proton therapy for esophageal cancer.

PubMed

Xi, Mian; Lin, Steven H

2017-07-01

Radiotherapy is an important component of the standard of care for esophageal cancer. In the past decades, significant improvements in the planning and delivery of radiation techniques have led to better dose conformity to the target volume and improved normal tissue sparing. Areas covered: This review focuses on the advances in radiotherapy techniques and summarizes the availably dosimetric and clinical outcomes of intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy, proton therapy, and four-dimensional radiotherapy for esophageal cancer, and discusses the challenges and future development of proton therapy. Expert commentary: Although three-dimensional conformal radiotherapy is the standard radiotherapy technique in esophageal cancer, the retrospectively comparative studies strongly suggest that the dosimetric advantage of IMRT over three-dimensional conformal radiotherapy can translate into improved clinical outcomes, despite the lack of prospective randomized evidence. As a novel form of conventional IMRT technique, volumetric modulated arc therapy can produce equivalent or superior dosimetric quality with significantly higher treatment efficiency in esophageal cancer. Compared with photon therapy, proton therapy has the potential to achieve further clinical improvement due to their physical properties; however, prospective clinical data, long-term results, and cost-effectiveness are needed.

Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

PubMed Central

Johansson, Silvia; Åström, Lennart; Sandin, Fredrik; Isacsson, Ulf; Montelius, Anders; Turesson, Ingela

2012-01-01

Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT) of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT). The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU) and gastrointestinal (GI) toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity. PMID:22848840

Report of the AAPM Task Group No. 105: Issues associated with clinical implementation of Monte Carlo-based photon and electron external beam treatment planning.

PubMed

Chetty, Indrin J; Curran, Bruce; Cygler, Joanna E; DeMarco, John J; Ezzell, Gary; Faddegon, Bruce A; Kawrakow, Iwan; Keall, Paul J; Liu, Helen; Ma, C M Charlie; Rogers, D W O; Seuntjens, Jan; Sheikh-Bagheri, Daryoush; Siebers, Jeffrey V

2007-12-01

The Monte Carlo (MC) method has been shown through many research studies to calculate accurate dose distributions for clinical radiotherapy, particularly in heterogeneous patient tissues where the effects of electron transport cannot be accurately handled with conventional, deterministic dose algorithms. Despite its proven accuracy and the potential for improved dose distributions to influence treatment outcomes, the long calculation times previously associated with MC simulation rendered this method impractical for routine clinical treatment planning. However, the development of faster codes optimized for radiotherapy calculations and improvements in computer processor technology have substantially reduced calculation times to, in some instances, within minutes on a single processor. These advances have motivated several major treatment planning system vendors to embark upon the path of MC techniques. Several commercial vendors have already released or are currently in the process of releasing MC algorithms for photon and/or electron beam treatment planning. Consequently, the accessibility and use of MC treatment planning algorithms may well become widespread in the radiotherapy community. With MC simulation, dose is computed stochastically using first principles; this method is therefore quite different from conventional dose algorithms. Issues such as statistical uncertainties, the use of variance reduction techniques, the ability to account for geometric details in the accelerator treatment head simulation, and other features, are all unique components of a MC treatment planning algorithm. Successful implementation by the clinical physicist of such a system will require an understanding of the basic principles of MC techniques. The purpose of this report, while providing education and review on the use of MC simulation in radiotherapy planning, is to set out, for both users and developers, the salient issues associated with clinical implementation and

Magnetic assembly route to colloidal responsive photonic nanostructures.

PubMed

He, Le; Wang, Mingsheng; Ge, Jianping; Yin, Yadong

2012-09-18

Responsive photonic structures can respond to external stimuli by transmitting optical signals. Because of their important technological applications such as color signage and displays, biological and chemical sensors, security devices, ink and paints, military camouflage, and various optoelectronic devices, researchers have focused on developing these functional materials. Conventionally, self-assembled colloidal crystals containing periodically arranged dielectric materials have served as the predominant starting frameworks. Stimulus-responsive materials are incorporated into the periodic structures either as the initial building blocks or as the surrounding matrix so that the photonic properties can be tuned. Although researchers have proposed various versions of responsive photonic structures, the low efficiency of fabrication through self-assembly, narrow tunability, slow responses to the external stimuli, incomplete reversibility, and the challenge of integrating them into existing photonic devices have limited their practical application. In this Account, we describe how magnetic fields can guide the assembly of superparamagnetic colloidal building blocks into periodically arranged particle arrays and how the photonic properties of the resulting structures can be reversibly tuned by manipulating the external magnetic fields. The application of the external magnetic field instantly induces a strong magnetic dipole-dipole interparticle attraction within the dispersion of superparamagnetic particles, which creates one-dimensional chains that each contains a string of particles. The balance between the magnetic attraction and the interparticle repulsions, such as the electrostatic force, defines the interparticle separation. By employing uniform superparamagnetic particles of appropriate sizes and surface charges, we can create one-dimensional periodicity, which leads to strong optical diffraction. Acting remotely over a large distance, magnetic forces drove the

Evaluation of a mixed beam therapy for post-mastectomy breast cancer patients: bolus electron conformal therapy combined with intensity modulated photon radiotherapy and volumetric modulated photon arc therapy.

PubMed

Zhang, Rui; Heins, David; Sanders, Mary; Guo, Beibei; Hogstrom, Kenneth

2018-05-10

The purpose of this study was to assess the potential benefits and limitations of a mixed beam therapy, which combined bolus electron conformal therapy (BECT) with intensity modulated photon radiotherapy (IMRT) and volumetric modulated photon arc therapy (VMAT), for left-sided post-mastectomy breast cancer patients. Mixed beam treatment plans were produced for nine post-mastectomy radiotherapy (PMRT) patients previously treated at our clinic with VMAT alone. The mixed beam plans consisted of 40 Gy to the chest wall area using BECT, 40 Gy to the supraclavicular area using parallel opposed IMRT, and 10 Gy to the total planning target volume (PTV) by optimizing VMAT on top of the BECT+IMRT dose distribution. The treatment plans were created in a commercial treatment planning system (TPS), and all plans were evaluated based on PTV coverage, dose homogeneity index (DHI), conformity index (CI), dose to organs at risk (OARs), normal tissue complication probability (NTCP), and secondary cancer complication probability (SCCP). The standard VMAT alone planning technique was used as the reference for comparison. Both techniques produced clinically acceptable PMRT plans but with a few significant differences: VMAT showed significantly better CI (0.70 vs. 0.53, p < 0.001) and DHI (0.12 vs. 0.20, p < 0.001) over mixed beam therapy. For normal tissues, mixed beam therapy showed better OAR sparing and significantly reduced NTCP for cardiac mortality (0.23% vs. 0.80%, p = 0.01) and SCCP for contralateral breast (1.7% vs. 3.1% based on linear model, and 1.2% vs. 1.9% based on linear-exponential model, p < 0.001 in both cases), but showed significantly higher mean (50.8 Gy vs. 49.3 Gy, p < 0.001) and maximum skin doses (59.7 Gy vs. 53.3 Gy, p < 0.001) compared with VMAT. Patients with more tissue (minimum distance between the distal PTV surface and lung approximately > 0.5 cm and volume of tissue between the distal PTV surface and heart or lung approximately > 250 cm 3 ) between

[Radiotherapy of squamous cell carcinomas of the tongue--a statistical review].

PubMed

Kubo, K; Furukawa, S; Fuchihata, H; Nakamura, M; Shimizutani, K; Nishiyama, K; Ikeda, H; Masaki, N

1989-01-01

The cases of 36 patients referred for radiotherapy of the tongue after an excisional biopsy or after an inadequate excision of the tongue cancer have been reviewed. In 32 patients treated by radiotherapy, the actuarial survival rate at five years was 86%, and the local rate control, was 82%. The local control rate for those treated by interstitial radiotherapy (Int. RT) was successful in 12 out of 13 cases, and the rates for those treated by external radiotherapy (Ext. RT) followed by Int. RT, or by the intraoral cone technique with electron beams (Elec.), or by Ext. RT, or by Elec. followed by Int. RT, or by no additional therapy were 7 out of 9, 4 out of 5, 2 out of 4, 1 out of 1, and 2 out of 4, respectively. For such cases of cancer, subsequent interstitial radiotherapy is advisable to maintain local control.

Salvage low-dose-rate 125I partial prostate brachytherapy after dose-escalated external beam radiotherapy

PubMed Central

Chang, Lynn

2014-01-01

Purpose To report outcomes on 5 patients treated with salvage partial low-dose-rate (LDR) 125-iodine (125I) permanent prostate seed brachytherapy (BT) for biopsy-proven locally persistent prostate cancer, following failure of dose-escalated external beam radiotherapy (EBRT). Material and methods A retrospective review of the Fox Chase Cancer Center prostate cancer database identified five patients treated with salvage partial LDR 125I seed implant for locally persistent disease following dose-escalated EBRT to 76-84 Gy in 2 Gy per fraction equivalent. All patients had post-EBRT biopsies confirming unilateral locally persistent prostate cancer. Pre-treatment, EBRT and BT details, as well as post-treatment characteristics were documented and assessed. Results The median follow-up post-implant was 41 months. All five patients exhibited low acute genitourinary and gastrointestinal toxicities. Increased erectile dysfunction was noted in three patients. There were no biochemical failures following salvage LDR 125I seed BT to date, with a median post-salvage PSA of 0.4 ng/mL. Conclusions In carefully selected patients with local persistence of disease, partial LDR 125I permanent prostate seed implant appears to be a feasible option for salvage local therapy with an acceptable toxicity profile. Further study is needed to determine long-term results of this approach. PMID:25337135

Time-dependent photon heat transport through a mesoscopic Josephson device

NASA Astrophysics Data System (ADS)

Lu, Wen-Ting; Zhao, Hong-Kang

2017-02-01

The time-oscillating photon heat current through a dc voltage biased mesoscopic Josephson Junction (MJJ) has been investigated by employing the nonequilibrium Green's function approach. The Landauer-like formula of photon heat current has been derived in both of the Fourier space and its time-oscillating versions, where Coulomb interaction, self inductance, and magnetic flux take effective roles. Nonlinear behaviors are exhibited in the photon heat current due to the quantum nature of MJJ and applied external dc voltage. The magnitude of heat current decreases with increasing the external bias voltage, and subtle oscillation structures appear as the superposition of different photon heat branches. The overall period of heat current with respect to time is not affected by Coulomb interaction, however, the magnitude and phase of it vary considerably by changing the Coulomb interaction.

[Clinical evaluation of heavy-particle radiotherapy using dose volume histogram (DVH)].

PubMed

Terahara, A; Nakano, T; Tsujii, H

1998-01-01

Radiotherapy with heavy particles such as proton and heavy-charged particles is a promising modality for treatment of localized malignant tumors because of the good dose distribution. A dose calculation and radiotherapy planning system which is essential for this kind of treatment has been developed in recent years. It has the capability to compute the dose volume histogram (DVH) which contains dose-volume information for the target volume and other interesting volumes. Recently, DVH is commonly used to evaluate and compare dose distributions in radiotherapy with both photon and heavy particles, and it shows that a superior dose distribution is obtained in heavy particle radiotherapy. DVH is also utilized for the evaluation of dose distribution related to clinical outcomes. Besides models such as normal tissue complication probability (NTCP) and tumor control probability (TCP), which can be calculated from DVH are proposed by several authors, they are applied to evaluate dose distributions themselves and to evaluate them in relation to clinical results. DVH is now a useful and important tool, but further studies are needed to use DVH and these models practically for clinical evaluation of heavy-particle radiotherapy.

Residual tumour volumes and grey zones after external beam radiotherapy (with or without chemotherapy) in cervical cancer patients. A low-field MRI study.

PubMed

Schmid, M P; Mansmann, B; Federico, M; Dimopoulous, J C A; Georg, P; Fidarova, E; Dörr, W; Pötter, R

2013-03-01

Grey zones, which are defined as tissue with intermediate signal intensity in the area of primary hyperintense tumour extension, can be seen during radiation with or without chemotherapy on the T2-weighted MRI in patients with cervical cancer. The purpose of this study was to systematically measure the tumour volume at the time of diagnosis and the residual tumour volume at the time of brachytherapy without and with consideration of the grey zones and to estimate tumour regression during external beam radiotherapy (EBRT). T2-weighted MRI datasets of 175 patients with locally advanced cervical cancer (FIGO stage IB-IVA), who underwent combined external beam radiotherapy and brachytherapy with or without concomitant chemotherapy were available for this study. The gross tumour volume at the time of diagnosis (GTV(init)) and at the time of first brachytherapy without (GTV(res)) and with (GTV(res)+ GZ) consideration of grey zones were measured for each patient. A descriptive statistical analysis was performed and tumour regression rates without (R) and with consideration of grey zones (R(GZ)) were calculated. Further, the role of prognostic factors on GTV(init), GTV(res), GTV(res)+ GZ and tumour regression rates was investigated. The median GTV(init), GTV(res), GTV(res)+ GZ in all patients were 44.4 cm(3), 8.2 cm(3), 20.3 cm(3), respectively. The median R was 78.5% and the median R(GZ) was 50.1%. The histology and FIGO staging showed a significant impact on GTV(init), GTV(res) and GTV(res)+ GZ. Grey zones represent a substantial proportion of the residual tumour volume at the time of brachytherapy. Differentiation of high signal intensity mass and surrounding intermediate signal intensity grey zones may be reasonable.

A Dosimetric Comparison of Proton and Intensity-Modulated Photon Radiotherapy for Pediatric Parameningeal Rhabdomyosarcomas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kozak, Kevin R.; Adams, Judith; Krejcarek, Stephanie J.

Purpose: We compared tumor and normal tissue dosimetry of proton radiation therapy with intensity-modulated radiation therapy (IMRT) for pediatric parameningeal rhabdomyosarcomas (PRMS). Methods and Materials: To quantify dosimetric differences between contemporary proton and photon treatment for pediatric PRMS, proton beam plans were compared with IMRT plans. Ten patients treated with proton radiation therapy at Massachusetts General Hospital had IMRT plans generated. To facilitate dosimetric comparisons, clinical target volumes and normal tissue volumes were held constant. Plans were optimized for target volume coverage and normal tissue sparing. Results: Proton and IMRT plans provided acceptable and comparable target volume coverage, with atmore » least 99% of the CTV receiving 95% of the prescribed dose in all cases. Improved dose conformality provided by proton therapy resulted in significant sparing of all examined normal tissues except for ipsilateral cochlea and mastoid; ipsilateral parotid gland sparing was of borderline statistical significance (p = 0.05). More profound sparing of contralateral structures by protons resulted in greater dose asymmetry between ipsilateral and contralateral retina, optic nerves, cochlea, and mastoids; dose asymmetry between ipsilateral and contralateral parotids was of borderline statistical significance (p = 0.05). Conclusions: For pediatric PRMS, superior normal tissue sparing is achieved with proton radiation therapy compared with IMRT. Because of enhanced conformality, proton plans also demonstrate greater normal tissue dose distribution asymmetry. Longitudinal studies assessing the impact of proton radiotherapy and IMRT on normal tissue function and growth symmetry are necessary to define the clinical consequences of these differences.« less

Elastic scattering of virtual photons via a quark loop in the double-logarithmic approximation

NASA Astrophysics Data System (ADS)

Ermolaev, B. I.; Ivanov, D. Yu.; Troyan, S. I.

2018-04-01

We calculate the amplitude of elastic photon-photon scattering via a single quark loop in the double-logarithmic approximation, presuming all external photons to be off-shell and unpolarized. At the same time we account for the running coupling effects. We consider this process in the forward kinematics at arbitrary relations between t and the external photon virtualities. We obtain explicit expressions for the photon-photon scattering amplitudes in all double-logarithmic kinematic regions. Then we calculate the small-x asymptotics of the obtained amplitudes and compare them with the parent amplitudes, thereby fixing the applicability regions of the asymptotics, i.e., fixing the applicability region for the nonvacuum Reggeons. We find that these Reggeons should be used at x <10-8 only.

Magnetoresponsive discoidal photonic crystals toward active color pigments.

PubMed

Lee, Hye Soo; Kim, Ju Hyeon; Lee, Joon-Seok; Sim, Jae Young; Seo, Jung Yoon; Oh, You-Kwan; Yang, Seung-Man; Kim, Shin-Hyun

2014-09-03

Photonic microdisks with a multilayered structure are designed from photocurable suspensions by step-by-step photolithography. In each step of photolithography, either a colloidal photonic crystal or a magnetic-particle-laden layer is stacked over the windows of a photomask. Sequential photolithography enables the creation of multilayered photonic microdisks that have brilliant structural colors that can be switched by an external magnetic field. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Pilot Quality Control Program for Audit RT External Beams at Mexican Hospitals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alvarez R, J T; Tovar M, V M

2008-08-11

A pilot quality control program for audit 18 radiotherapy RT external beams at 13 Mexican hospitals is described--for eleven {sup 60}Co beams and seven photon beams of 6, 10 and 15 MV from accelerators. This program contains five parts: a) Preparation of the TLD-100 powder: washing, drying and annealing (one hour 400 deg. C plus 24 hrs 80 deg. C). b) Sending two IAEA type capsules to the hospitals for irradiation at the hospital to a nominal D{sub W} = 2 Gy{center_dot}c) Preparation at the SSDL of ten calibration curves CC in the range of 0.5 Gy to 6 Gymore » in terms of absorbed dose to water D{sub W} for {sup 60}Co with traceability to primary laboratory NRC (Canada), according to a window irradiation: 26/10/2007-7/12/2007. d) Reading all capsules that match their hospital time irradiation and the SSDL window irradiation. f) Evaluation of the Dw imparted by the hospitals.« less

Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study.

PubMed

Schnur, Julie B; Graff Zivin, Joshua; Mattson, David M K; Green, Sheryl; Jandorf, Lina H; Wernicke, A Gabriella; Montgomery, Guy H

2012-12-01

Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The secondary aims were to: (1) estimate nonmedical out-of-pocket costs, (2) examine the nature of the costs, (3) explore potential background predictors of costs, and (4) explore the relationship between patient-reported dermatologic quality of life and expenditures. A total of 50 patients (mean age = 54.88, Stage 0-III) undergoing external beam radiotherapy completed a demographics/medical history questionnaire as well as a seven-item Skin Toxicity Costs (STC) questionnaire and the Skindex-16 in week 5 of treatment. Mean skin toxicity costs were $131.64 (standard error [SE] = $23.68). Most frequently incurred expenditures were new undergarments and products to manage toxicity. Education was a significant unique predictor of spending, with more educated women spending more money. Greater functioning impairment was associated with greater costs. The STC proved to be a practical, brief measure which successfully indicated specific areas of patient expenditures and need. Results reveal the nonmedical, out-of-pocket costs associated with acute skin toxicity in the context of breast cancer radiotherapy. To our knowledge, this study is the first to quantify individual costs associated with this treatment side effect, as well as the first to present a scale specifically designed to assess such costs. In future research, the STC could be used as an outcome variable in skin toxicity prevention and control research, as a behavioral indicator of symptom burden, or as part of a needs assessment.

Photon buildup factors of some chemotherapy drugs.

PubMed

Kavaz, Esra; Ahmadishadbad, Nader; Özdemir, Yüksel

2015-02-01

Everyday more and more people are diagnosed with some form of cancer. Some are treatable with chemotherapy alone, while others need radiotherapy and occasionally surgery. Recently, concurrent administration of chemotherapy and radiotherapy has been increasingly used in cancer treatment, leading to improvements in survival as well as quality of life. Accordingly, interaction of chemotherapy drugs with radiation will be meaningful to examine. In the present study, gamma ray energy absorption and exposure of buildup factors were computed using the five-parameter geometric progression (G-P) fitting formula for some chemotherapy drugs in the energy range 0.015-15 MeV, and for penetration depths up to 40 mean free path (mfp). The generated energy absorption (EABF) and exposure buildup factors (EBF) of chemotherapy drugs have been studied as a function of penetration depth and incident photon energy. The significant variations in EABF and EBF for chemotherapy drugs have been observed at the moderate energy region. It has been concluded that the buildup of photons is less in azathioprine and is more in vinblastine compared with other drugs. Buildup factors investigated in the present work could be useful in radiation dosimetry and therapy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Adenoid cystic carcinoma of the external ear: a population based study.

PubMed

Green, Ross W; Megwalu, Uchechukwu C

2016-01-01

To determine the incidence of adenoid cystic carcinoma of the external ear in the United States, and to evaluate the clinical characteristics and survival outcomes associated with the disease. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with adenoid cystic carcinoma of the external ear from 1973 to 2012. The incidence of adenoid cystic carcinoma of the external ear was 0.004 per 100,000. The SEER database identified 66 patients meeting the inclusion criteria. Nodal metastasis was noted in 13.1% of patients, while 7.9% had distant metastasis. Distant metastasis was associated with worse overall survival (HR 10.18). However, nodal metastasis had no impact on overall survival (HR 0.15, p = 0.09). Surgery alone was associated with improved overall survival (HR 0.26), compared with combination surgery and radiotherapy, while radiotherapy alone was associated with worse overall survival (HR 20.12). Increasing age (HR 1.12) and black race (HR 6.83) were associated with worse overall survival, while female sex (HR 0.26) was associated with improved overall survival. ACC of the external ear is rare. Distant metastasis is a poor prognostic factor. However, nodal metastasis does not appear to impact survival. Advanced age, black race, and male sex are also poor prognostic factors. Surgical resection alone is associated with better survival than combination surgical resection and radiation, or radiotherapy alone. Copyright © 2016 Elsevier Inc. All rights reserved.

To analyze the impact of intracavitary brachytherapy as boost radiation after external beam radiotherapy in carcinoma of the external auditory canal and middle ear: a retrospective analysis.

PubMed

Badakh, Dinesh K; Grover, Amit H

2014-01-01

The purpose of this study was to analyze the impact of intra-cavitary brachytherapy (ICBT) as boost radiation after external beam radiotherapy (EBRT) in carcinoma of the external auditory canal and middle ear (EACMA): A retrospective analysis. A retrospective study of 18 patients with carcinoma of the EACMA who were treated with a curative intent from the year 1998 to 2010 was carried out. The age of the patients ranged from 25 years to 67 years. There were 11 male patients (61.1%) and 7 female patients (38.9%). A total of 15 (88.2%) patients were treated with curative radiation alone after a biopsy and two patients received post-operative radiation therapy. The patients were initially treated with EBRT with cobalt 60 machine up to 60-64 Gy. In our department, all the patients who were technically suitable for ICBT received an ICBT boost. The overall survival (OS) in these patients ranged from 7 months to 151 months (9 out of 17 patients, no evidence of disease 53%). The OS in patients treated with a combination of EBRT with ICBT was (8 out of 11) 72.7%, P value statistically significant (P value: 0.0024). The multivariate analysis shows statistically significant difference only for patients who got an ICBT boost (P Value: 0.020). ICBT as a boost after EBRT has got a positive impact on the OS. In conclusion, our results demonstrate that radical radiation therapy (EBRT and ICBT) is the treatment of choice for stage T2, carcinoma of EACMA.

Evaluation of the response of concurrent high dose rate intracavitary brachytherapy with external beam radiotherapy in management of early stage carcinoma cervix.

PubMed

Patidar, Arvind Kumar; Kumar, H S; Walke, Rahul V; Hirapara, Pushpendra H; Jakhar, Shankar Lal; Bardia, M R

2012-10-01

To evaluate local disease control and early complications of concomitant brachytherapy with external beam-radiotherapy in early stage carcinoma cervix. Fifty patients of early stage carcinoma cervix (FIGO-IB/IIA) were randomly divided into study group concomitant external beam irradiation (EBRT) and HDR-ICBT (intra-cavitary brachytherapy, xrt = 50 Gy/25 Fr, HDR 5.2 Gy*5 Fr) and the control group EBRT followed by HDR-ICBT (xrt = 50 Gy/25 Fr, HDR 7.5 Gy*3 Fr). Acute reactions and local disease response were compared between treatment and at 6-month follow up. Median overall treatment times were 38 and 61 days in the study and the control groups, respectively. Acute skin reactions and diarrhea were more in the study but manageable. At the completion of the study, there were 80 and 68 % complete responses, 16 and 20 % partial responses, 0 and 8 % stable diseases in the study group and the control group, respectively. Response was better in the study group but statistically insignificant. Larger number of patients and longer follow up are required to arrive at concrete conclusion.

SU-E-J-97: Evaluation of Multi-Modality (CT/MR/PET) Image Registration Accuracy in Radiotherapy Planning.

PubMed

Sethi, A; Rusu, I; Surucu, M; Halama, J

2012-06-01

Evaluate accuracy of multi-modality image registration in radiotherapy planning process. A water-filled anthropomorphic head phantom containing eight 'donut-shaped' fiducial markers (3 internal + 5 external) was selected for this study. Seven image sets (3CTs, 3MRs and PET) of phantom were acquired and fused in a commercial treatment planning system. First, a narrow slice (0.75mm) baseline CT scan was acquired (CT1). Subsequently, the phantom was re-scanned with a coarse slice width = 1.5mm (CT2) and after subjecting phantom to rotation/displacement (CT3). Next, the phantom was scanned in a 1.5 Tesla MR scanner and three MR image sets (axial T1, axial T2, coronal T1) were acquired at 2mm slice width. Finally, the phantom and center of fiducials were doped with 18F and a PET scan was performed with 2mm cubic voxels. All image scans (CT/MR/PET) were fused to the baseline (CT1) data using automated mutual-information based fusion algorithm. Difference between centroids of fiducial markers in various image modalities was used to assess image registration accuracy. CT/CT image registration was superior to CT/MR and CT/PET: average CT/CT fusion error was found to be 0.64 ± 0.14 mm. Corresponding values for CT/MR and CT/PET fusion were 1.33 ± 0.71mm and 1.11 ± 0.37mm. Internal markers near the center of phantom fused better than external markers placed on the phantom surface. This was particularly true for the CT/MR and CT/PET. The inferior quality of external marker fusion indicates possible distortion effects toward the edges of MR image. Peripheral targets in the PET scan may be subject to parallax error caused by depth of interaction of photons in detectors. Current widespread use of multimodality imaging in radiotherapy planning calls for periodic quality assurance of image registration process. Such studies may help improve safety and accuracy in treatment planning. © 2012 American Association of Physicists in Medicine.

Serendipity in dark photon searches

NASA Astrophysics Data System (ADS)

Ilten, Philip; Soreq, Yotam; Williams, Mike; Xue, Wei

2018-06-01

Searches for dark photons provide serendipitous discovery potential for other types of vector particles. We develop a framework for recasting dark photon searches to obtain constraints on more general theories, which includes a data-driven method for determining hadronic decay rates. We demonstrate our approach by deriving constraints on a vector that couples to the B-L current, a leptophobic B boson that couples directly to baryon number and to leptons via B- γ kinetic mixing, and on a vector that mediates a protophobic force. Our approach can easily be generalized to any massive gauge boson with vector couplings to the Standard Model fermions, and software to perform any such recasting is provided at <ExternalRef> https://gitlab.com/philten/darkcast ExternalRef>.

Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca; Loblaw, D. Andrew; Chung, Hans

Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domainmore » score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal

Active middle ear implant after lateral petrosectomy and radiotherapy for ear cancer.

PubMed

Cristalli, Giovanni; Sprinzl, Georg M; Wolf-Magele, Astrid; Marchesi, Paolo; Mercante, Giuseppe; Spriano, Giuseppe

2014-04-01

Tumor of the temporal bone is a rare disease with a very poor prognosis. Surgery and postoperative radiotherapy are usually the recommended treatments for squamous cell carcinoma (SCC) of the external and middle ear, which may cause conductive hearing loss. The purpose of this study was to evaluate the audiologic results and compliance of active middle ear implant (AMEI) and establish the feasibility of the procedure in a patient treated for middle ear cancer. A 73-year-old patient treated with lateral petrosectomy, neck dissection, reconstruction/obliteration by pedicled pectoralis major myocutaneous flap, and postoperative full dose radiotherapy for external and middle ear SCC was selected for AMEI. Preoperative audiometric and speech audiometry tests were performed on both ears before and after the activation. Pure tone free field audiometry. Binaural free field speech audiogram. Aided pure tone free field audiometry AMEI results show an increase in air conduction. Speech audiogram showed better discrimination scores in AMEI-aided situations. No complications were observed. AMEI after surgery followed by radiotherapy for middle ear cancer is feasible. Acoustic results in obliterated ear are satisfactory.

Commissioning of intensity modulated neutron radiotherapy (IMNRT).

PubMed

Burmeister, Jay; Spink, Robyn; Liang, Liang; Bossenberger, Todd; Halford, Robert; Brandon, John; Delauter, Jonathan; Snyder, Michael

2013-02-01

Intensity modulated neutron radiotherapy (IMNRT) has been developed using inhouse treatment planning and delivery systems at the Karmanos Cancer Center∕Wayne State University Fast Neutron Therapy facility. The process of commissioning IMNRT for clinical use is presented here. Results of commissioning tests are provided including validation measurements using representative patient plans as well as those from the TG-119 test suite. IMNRT plans were created using the Varian Eclipse optimization algorithm and an inhouse planning system for calculation of neutron dose distributions. Tissue equivalent ionization chambers and an ionization chamber array were used for point dose and planar dose distribution comparisons with calculated values. Validation plans were delivered to water and virtual water phantoms using TG-119 measurement points and evaluation techniques. Photon and neutron doses were evaluated both inside and outside the target volume for a typical IMNRT plan to determine effects of intensity modulation on the photon dose component. Monitor unit linearity and effects of beam current and gantry angle on output were investigated, and an independent validation of neutron dosimetry was obtained. While IMNRT plan quality is superior to conventional fast neutron therapy plans for clinical sites such as prostate and head and neck, it is inferior to photon IMRT for most TG-119 planning goals, particularly for complex cases. This results significantly from current limitations on the number of segments. Measured and calculated doses for 11 representative plans (six prostate∕five head and neck) agreed to within -0.8 ± 1.4% and 5.0 ± 6.0% within and outside the target, respectively. Nearly all (22∕24) ion chamber point measurements in the two phantom arrangements were within the respective confidence intervals for the quantity [(measured-planned)∕prescription dose] derived in TG-119. Mean differences for all measurements were 0.5% (max = 7.0%) and 1.4% (max = 4

18 F-FDG PET/CT for planning external beam radiotherapy alters therapy in 11% of 581 patients.

PubMed

Birk Christensen, Charlotte; Loft-Jakobsen, Annika; Munck Af Rosenschöld, Per; Højgaard, Liselotte; Roed, Henrik; Berthelsen, Anne K

2018-03-01

18 F-FDG PET/CT (FDG PET/CT) used in radiotherapy planning for extra-cerebral malignancy may reveal metastases to distant sites that may affect the choice of therapy. To investigate the role of FDG PET/CT on treatment strategy changes induced by the use of PET/CT as part of the radiotherapy planning. 'A major change of treatment strategy' was defined as either including more lesions in the gross tumour volume (GTV) distant from the primary tumour or a change in treatment modalities. The study includes 581 consecutive patients who underwent an FDG PET/CT scan for radiotherapy planning in our institution in the year 2008. All PET/CT scans were performed with the patient in treatment position with the use of immobilization devices according to the intended radiotherapy treatment. All scans were evaluated by a nuclear medicine physician together with a radiologist to delineate PET-positive GTV (GTV-PET). For 63 of the patients (11%), the PET/CT simulation scans resulted in a major change in treatment strategy because of the additional diagnostic information. Changes were most frequently observed in patients with lung cancer (20%) or upper gastrointestinal cancer (12%). In 65% of the patients for whom the PET/CT simulation scan revealed unexpected dissemination, radiotherapy was given - changed (n = 38) or unchanged (n = 13) according to the findings on the FDG PET/CT. Unexpected dissemination on the FDG PET/CT scanning performed for radiotherapy planning caused a change in treatment strategy in 11% of 581 patients. © 2017 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Organ-specific radiation-induced cancer risk estimates due to radiotherapy for benign pigmented villonodular synovitis

NASA Astrophysics Data System (ADS)

Mazonakis, Michalis; Tzedakis, Antonis; Lyraraki, Efrossyni; Damilakis, John

2016-09-01

Pigmented villonodular synovitis (PVNS) is a benign disease affecting synovial membranes of young and middle-aged adults. The aggressive treatment of this disorder often involves external-beam irradiation. This study was motivated by the lack of data relating to the radiation exposure of healthy tissues and radiotherapy-induced cancer risk. Monte Carlo methodology was employed to simulate a patient’s irradiation for PVNS in the knee and hip joints with a 6 MV photon beam. The average radiation dose received by twenty-two out-of-field critical organs of the human body was calculated. These calculations were combined with the appropriate organ-, age- and gender-specific risk coefficients of the BEIR-VII model to estimate the lifetime probability of cancer development. The risk for carcinogenesis to colon, which was partly included in the treatment fields used for hip irradiation, was determined with a non-linear mechanistic model and differential dose-volume histograms obtained by CT-based 3D radiotherapy planning. Risk assessments were compared with the nominal lifetime intrinsic risk (LIR) values. Knee irradiation to 36 Gy resulted in out-of-field organ doses of 0.2-24.6 mGy. The corresponding range from hip radiotherapy was 1.2-455.1 mGy whereas the organ equivalent dose for the colon was up to 654.9 mGy. The organ-specific cancer risks from knee irradiation for PVNS were found to be inconsequential since they were at least 161.5 times lower than the LIRs irrespective of the patient’s age and gender. The bladder and colon cancer risk from radiotherapy in the hip joint was up to 3.2 and 6.6 times smaller than the LIR, respectively. These cancer risks may slightly elevate the nominal incidence rates and they should not be ignored during the patient’s treatment planning and follow-up. The probabilities for developing any other solid tumor were more than 20 times lower than the LIRs and, therefore, they may be considered as small.

External beam radiotherapy for palliation of painful bone metastases: pooled data bioeffect dose response analysis of dose fractionation

NASA Astrophysics Data System (ADS)

Naveen, T.; Supe, Sanjay S.; Ganesh, K. M.; Samuel, Jacob

2009-01-01

Bone metastases develop in up to 70% of newly diagnosed cancer patients and result in immobility, anxiety, and depression, severely diminishing the patients quality of life. Radiotherapy is a frequently used modality for bone metastasis and has been shown to be effective in reducing metastatic bone pain and in some instances, causing tumor shrinkage or growth inhibition. There is controversy surrounding the optimal fractionation schedule and total dose of external beam radiotherapy, despite many randomized trials and overviews addressing the issue. This study was undertaken to apply BED to clinical fractionation data of radiotherapeutic management of bone metastases in order to arrive at optimum BED values for acceptable level of response rate. A computerised literature search was conducted to identify all prospective clinical studies that addressed the issue of fractionation for the treatment of bone metastasis. The results of these studies were pooled together to form the database for the analysis. A total of 4111 number of patients received radiation dose ranging from 4 to 40.5 Gy in 1 to 15 fractions with dose per fraction ranging from 2 to 10 Gy. Single fraction treatments were delivered in 2013 patients and the dose varied from 4 to 10 Gy. Multifraction treatments were delivered in 2098 patients and the dose varied from 15 to 40.5 Gy. The biological effective dose (BED) was evaluated for each fractionation schedule using the linear quadratic model and an α/β value of 10 Gy. Response rate increased significantly beyond a BED value of 14.4 Gy (p < 0.01). Based on our analysis and indications from the literature about higher retreatment and fracture rate of single fraction treatments, minimum BED value of 14.4 Gy is recommended.

Survey of Stereotactic Body Radiation Therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nagata, Yasushi; Hiraoka, Masahiro; Mizowaki, Takashi

2009-10-01

Purpose: To recognize the current status of stereotactic body radiotherapy (SBRT) in Japan, using a nationwide survey conducted by the Japan 3-D Conformal External Beam Radiotherapy Group. Methods and Materials: The questionnaire was sent by mail to 117 institutions. Ninety-four institutions (80%) responded by the end of November 2005. Fifty-three institutions indicated that they have already started SBRT, and 38 institutions had been reimbursed by insurance. Results: A total of 1111 patients with histologically confirmed lung cancer were treated. Among these patients, 637 had T1N0M0 and 272 had T2N0M0 lung cancer. Metastatic lung cancer was found in 702 and histologicallymore » unconfirmed lung tumor in 291 patients. Primary liver cancer was found in 207 and metastatic liver cancer in 76 patients. The most frequent schedule used for primary lung cancer was 48Gy in 4 fractions at 22 institutions (52%), followed by 50Gy in 5 fractions at 11 institutions (26%) and 60Gy in 8 fractions at 4 institutions (10%). The tendency was the same for metastatic lung cancer. The average number of personnel involved in SBRT was 1.8 radiation oncologists, including 1.1 certified radiation oncologists, 2.8 technologists, 0.7 nurses, and 0.6 certified quality assurance personnel and 0.3 physicists. The most frequent amount of time for treatment planning was 61-120min, for quality assurance was 50-60min, and for treatment was 30min. There were 14 (0.6% of all cases) reported Grade 5 complications: 11 cases of radiation pneumonitis, 2 cases of hemoptysis, and 1 case of radiation esophagitis. Conclusion: The current status of SBRT in Japan was surveyed.« less

[Implementation of "never events" checklists in a radiotherapy information system].

PubMed

Brusadin, G; Bour, M S; Deutsch, E; Kouchit, N; Corbin, S; Lefkopoulos, D

2017-10-01

In order to reduce the incidence of major accidents during external radiotherapy treatment, "never events" checklists have been incorporated into the "record and verify" system. This article details this process. Prospects for improvement are also proposed, including a peer-to-peer audit on the use of checklists and the availability of the radiotherapy information system manufacturer to collaborate in this process to secure the patients' journey. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Fractionated External Beam Radiotherapy as a Suitable Preparative Regimen for Hepatocyte Transplantation After Partial Hepatectomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krause, Petra; Wolff, Hendrik A.; Rave-Frank, Margret

2011-07-15

Purpose: Hepatocyte transplantation is strongly considered to be a promising option to correct chronic liver failure through repopulation of the diseased organ. We already reported on extensive liver repopulation by hepatocytes transplanted into rats preconditioned with 25-Gy single dose selective external beam irradiation (IR). Herein, we tested lower radiation doses and fractionated protocols, which would be applicable in clinical use. Methods and Material: Livers of dipeptidylpeptidase IV (DPPIV)-deficient rats were preconditioned with partial liver external beam single dose IR at 25 Gy, 8 Gy, or 5 Gy, or fractionated IR at 5 x 5 Gy or 5 x 2 Gy.more » Four days after completion of IR, a partial hepatectomy (PH) was performed to resect the untreated liver section. Subsequently, 12 million wild-type (DPPIV{sup +}) hepatocytes were transplanted via the spleen into the recipient livers. The degree of donor cell integration and liver repopulation was studied 16 weeks after transplantation by means of immunofluorescence and DPPIV-luminescence assay. Results: Donor hepatocyte integration and liver repopulation were more effective in the irradiated livers following pretreatment with the IR doses 1 x 25 Gy and 5 x 5 Gy (formation of large DPPIV-positive cell clusters) than single-dose irradiation at 8 Gy or 5 Gy (DPPIV-positive clusters noticeably smaller and less frequent). Quantitative analysis of extracted DPPIV revealed signals exceeding the control level in all transplanted animals treated with IR and PH. Compared with the standard treatment of 1 x 25 Gy, fractionation with 5 x 5 Gy was equally efficacious, the Mann-Whitney U test disclosing no statistically significant difference (p = 0.146). The lower doses of 1 x 5 Gy, 1 x 8 Gy, and 5 x 2 Gy were significantly less effective with p < 0.05. Conclusion: This study suggests that fractionated radiotherapy in combination with PH is a conceivable pretreatment approach to prime the host liver for hepatocyte

Dose enhancement in radiotherapy of small lung tumors using inline magnetic fields: A Monte Carlo based planning study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oborn, B. M., E-mail: brad.oborn@gmail.com; Ge, Y.; Hardcastle, N.

2016-01-15

Purpose: To report on significant dose enhancement effects caused by magnetic fields aligned parallel to 6 MV photon beam radiotherapy of small lung tumors. Findings are applicable to future inline MRI-guided radiotherapy systems. Methods: A total of eight clinical lung tumor cases were recalculated using Monte Carlo methods, and external magnetic fields of 0.5, 1.0, and 3 T were included to observe the impact on dose to the planning target volume (PTV) and gross tumor volume (GTV). Three plans were 6 MV 3D-CRT plans while 6 were 6 MV IMRT. The GTV’s ranged from 0.8 to 16 cm{sup 3}, whilemore » the PTV’s ranged from 1 to 59 cm{sup 3}. In addition, the dose changes in a 30 cm diameter cylindrical water phantom were investigated for small beams. The central 20 cm of this phantom contained either water or lung density insert. Results: For single beams, an inline magnetic field of 1 T has a small impact in lung dose distributions by reducing the lateral scatter of secondary electrons, resulting in a small dose increase along the beam. Superposition of multiple small beams leads to significant dose enhancements. Clinically, this process occurs in the lung tissue typically surrounding the GTV, resulting in increases to the D{sub 98%} (PTV). Two isolated tumors with very small PTVs (3 and 6 cm{sup 3}) showed increases in D{sub 98%} of 23% and 22%. Larger PTVs of 13, 26, and 59 cm{sup 3} had increases of 9%, 6%, and 4%, describing a natural fall-off in enhancement with increasing PTV size. However, three PTVs bounded to the lung wall showed no significant increase, due to lack of dose enhancement in the denser PTV volume. In general, at 0.5 T, the GTV mean dose enhancement is around 60% lower than that at 1 T, while at 3 T, it is 5%–60% higher than 1 T. Conclusions: Monte Carlo methods have described significant and predictable dose enhancement effects in small lung tumor plans for 6 MV radiotherapy when an external inline magnetic field is included. Results of

[Guidelines for external radiotherapy and brachytherapy: introduction to the 2nd edition. Société française de radiothérapie oncologique (SFRO)].

PubMed

Mahé, M-A; Barillot, I; Chauvet, B

2014-10-01

In 2007, a first edition was published with the objective to produce guidelines for optimization, harmonization and homogenization of practices in external radiation therapy in France. The second edition, including brachytherapy, has the same objective and takes into account recent technologic improvements (intensity modulation radiation therapy, stereotactic radiotherapy, and 3-dimension brachytherapy) and recent results of the literature. The first part is about daily use of general principles (quality, security, image-guided radiation therapy) and the second is to describe each step of treatment of main cancers. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Supplemental computational phantoms to estimate out-of-field absorbed dose in photon radiotherapy

NASA Astrophysics Data System (ADS)

Gallagher, Kyle J.; Tannous, Jaad; Nabha, Racile; Feghali, Joelle Ann; Ayoub, Zeina; Jalbout, Wassim; Youssef, Bassem; Taddei, Phillip J.

2018-01-01

The purpose of this study was to develop a straightforward method of supplementing patient anatomy and estimating out-of-field absorbed dose for a cohort of pediatric radiotherapy patients with limited recorded anatomy. A cohort of nine children, aged 2-14 years, who received 3D conformal radiotherapy for low-grade localized brain tumors (LBTs), were randomly selected for this study. The extent of these patients’ computed tomography simulation image sets were cranial only. To approximate their missing anatomy, we supplemented the LBT patients’ image sets with computed tomography images of patients in a previous study with larger extents of matched sex, height, and mass and for whom contours of organs at risk for radiogenic cancer had already been delineated. Rigid fusion was performed between the LBT patients’ data and that of the supplemental computational phantoms using commercial software and in-house codes. In-field dose was calculated with a clinically commissioned treatment planning system, and out-of-field dose was estimated with a previously developed analytical model that was re-fit with parameters based on new measurements for intracranial radiotherapy. Mean doses greater than 1 Gy were found in the red bone marrow, remainder, thyroid, and skin of the patients in this study. Mean organ doses between 150 mGy and 1 Gy were observed in the breast tissue of the girls and lungs of all patients. Distant organs, i.e. prostate, bladder, uterus, and colon, received mean organ doses less than 150 mGy. The mean organ doses of the younger, smaller LBT patients (0-4 years old) were a factor of 2.4 greater than those of the older, larger patients (8-12 years old). Our findings demonstrated the feasibility of a straightforward method of applying supplemental computational phantoms and dose-calculation models to estimate absorbed dose for a set of children of various ages who received radiotherapy and for whom anatomies were largely missing in their original

Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience.

PubMed

Tharavichitkul, Ekkasit; Chakrabandhu, Somvilai; Wanwilairat, Somsak; Tippanya, Damrongsak; Nobnop, Wannapha; Pukanhaphan, Nantaka; Galalae, Razvan M; Chitapanarux, Imjai

2013-07-01

To evaluate the outcomes of image-guided brachytherapy combined with 3D conformal or intensity modulated external beam radiotherapy (3D CRT/IMRT) in cervical cancer at Chiang Mai University. From 2008 to 2011, forty-seven patients with locally advanced cervical cancer were enrolled in this study. All patients received high-technology (3D CRT/IMRT) whole pelvic radiotherapy with a total dose of 45-46 Gy plus image-guided High-Dose-Rate intracavitary brachytherapy 6.5-7 Gy × 4 fractions to a High-Risk Clinical Target Volume (HR-CTV) according to GEC-ESTRO recommendations. The dose parameters of the HR-CTV for bladder, rectum and sigmoid colon were recorded, as well as toxicity profiles. In addition, the endpoints for local control, disease-free, metastasis-free survival and overall survival were calculated. At the median follow-up time of 26 months, the local control, disease-free survival, and overall survival rates were 97.9%, 85.1%, and 93.6%, respectively. The mean dose of HR-CTV, bladder, rectum and sigmoid were 93.1, 88.2, 69.6, and 72 Gy, respectively. In terms of late toxicity, the incidence of grade 3-4 bladder and rectum morbidity was 2.1% and 2.1%, respectively. A combination of image-guided brachytherapy and IMRT/3D CRT showed very promising results of local control, disease-free survival, metastasis-free survival and overall survival rates. It also caused a low incidence of grade 3-4 toxicity in treated study patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Time-dependent photon heat transport through a mesoscopic Josephson device

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, Wen-Ting; Zhao, Hong-Kang, E-mail: zhaohonk@bit.edu.cn

The time-oscillating photon heat current through a dc voltage biased mesoscopic Josephson Junction (MJJ) has been investigated by employing the nonequilibrium Green’s function approach. The Landauer-like formula of photon heat current has been derived in both of the Fourier space and its time-oscillating versions, where Coulomb interaction, self inductance, and magnetic flux take effective roles. Nonlinear behaviors are exhibited in the photon heat current due to the quantum nature of MJJ and applied external dc voltage. The magnitude of heat current decreases with increasing the external bias voltage, and subtle oscillation structures appear as the superposition of different photon heatmore » branches. The overall period of heat current with respect to time is not affected by Coulomb interaction, however, the magnitude and phase of it vary considerably by changing the Coulomb interaction. - Highlights: • The time-oscillating photon heat current through a mesoscopic Josephson Junction has been investigated. • The Landauer-like formula of photon heat current has been derived by the nonequilibrium Green’s function approach. • Nonlinear behaviors are exhibited in the photon heat current resulting from the self inductance and Coulomb interaction. • The oscillation structure of heat current is composed of the superposition of oscillations with different periods.« less

Tunability of temperature dependent THz photonic band gaps in 1-D photonic crystals composed of graded index materials and semiconductor InSb

NASA Astrophysics Data System (ADS)

Singh, Bipin K.; Pandey, Praveen C.; Rastogi, Vipul

2018-05-01

Tunable temperature dependent terahertz photonic band gaps (PBGs) in one-dimensional (1-D) photonic crystal composed of alternating layers of graded index and semiconductor materials are demonstrated. Results show the influence of temperature, geometrical parameters, grading profile and material damping factor on the PBGs. Number of PBG increases with increasing the layer thickness and their bandwidth can be tuned with external temperature and grading parameters. Lower order band gap is more sensitive to the temperature which shows increasing trend with temperature, and higher order PBGs can also be tuned by controlling the external temperature. Band edges of PBGs are shifted toward higher frequency side with increasing the temperature. Results show that the operational frequencies of PBGs are unaffected when loss involved. This work enables to design tunable Temperature dependent terahertz photonic devices such as reflectors, sensors and filters etc.

TH-CD-201-06: Experimental Characterization of Acoustic Signals Generated in Water Following Clinical Photon and Electron Beam Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hickling, S; El Naqa, I

Purpose: Previous work has demonstrated the detectability of acoustic waves induced following the irradiation of high density metals with radiotherapy linac photon beams. This work demonstrates the ability to experimentally detect such acoustic signals following both photon and electron irradiation in a more radiotherapy relevant material. The relationship between induced acoustic signal properties in water and the deposited dose distribution is explored, and the feasibility of exploiting such signals for radiotherapy dosimetry is demonstrated. Methods: Acoustic waves were experimentally induced in a water tank via the thermoacoustic effect following a single pulse of photon or electron irradiation produced by amore » clinical linac. An immersion ultrasound transducer was used to detect these acoustic waves in water and signals were read out on an oscilloscope. Results: Peaks and troughs in the detected acoustic signals were found to correspond to the location of gradients in the deposited dose distribution following both photon and electron irradiation. Signal amplitude was linearly related to the dose per pulse deposited by photon or electron beams at the depth of detection. Flattening filter free beams induced large acoustic signals, and signal amplitude decreased with depth after the depth of maximum dose. Varying the field size resulted in a temporal shift of the acoustic signal peaks and a change in the detected signal frequency. Conclusion: Acoustic waves can be detected in a water tank following irradiation by linac photon and electron beams with basic electronics, and have characteristics related to the deposited dose distribution. The physical location of dose gradients and the amount of dose deposited can be inferred from the location and magnitude of acoustic signal peaks. Thus, the detection of induced acoustic waves could be applied to photon and electron water tank and in vivo dosimetry. This work was supported in part by CIHR grants MOP-114910 and

External beam boost versus interstitial high-dose-rate brachytherapy boost in the adjuvant radiotherapy following breast-conserving therapy in early-stage breast cancer: a dosimetric comparison

PubMed Central

Melchert, Corinna; Kovács, György

2016-01-01

Purpose This study aims to compare the dosimetric data of local tumor's bed dose escalation (boost) with photon beams (external beam radiation therapy – EBRT) versus high-dose-rate interstitial brachytherapy (HDR-BT) after breast-conserving treatment in women with early-stage breast cancer. Material and methods We analyzed the treatment planning data of 136 irradiated patients, treated between 2006 and 2013, who underwent breast-conserving surgery and adjuvant whole breast irradiation (WBI; 50.4 Gy) and boost (HDR-BT: 10 Gy in one fraction [n = 36]; EBRT: 10 Gy in five fractions [n = 100]). Organs at risk (OAR; heart, ipsilateral lung, skin, most exposed rib segment) were delineated. Dosimetric parameters were calculated with the aid of dose-volume histograms (DVH). A non-parametric test was performed to compare the two different boost forms. Results There was no difference for left-sided cancers regarding the maximum dose to the heart (HDR-BT 29.8% vs. EBRT 29.95%, p = 0.34). The maximum doses to the other OAR were significantly lower for HDR-BT (Dmax lung 47.12% vs. 87.7%, p < 0.01; rib 61.17% vs. 98.5%, p < 0.01; skin 57.1% vs. 94.75%, p < 0.01; in the case of right-sided breast irradiation, dose of the heart 6.00% vs. 16.75%, p < 0.01). Conclusions Compared to EBRT, local dose escalation with HDR-BT presented a significant dose reduction to the investigated OAR. Only left-sided irradiation showed no difference regarding the maximum dose to the heart. Reducing irradiation exposure to OAR could result in a reduction of long-term side effects. Therefore, from a dosimetric point of view, an interstitial boost complementary to WBI via EBRT seems to be more advantageous in the adjuvant radiotherapy of breast cancer. PMID:27648082

Radiotherapy Improvements by Using Au Nanoparticles.

PubMed

Torrisi, Lorenzo

2015-01-01

Au nanoparticles can be prepared inside biological solutions and incorporated in special molecules for their transport through blood, drugs and proteins up to the tumour sites or directly injected in their volume when it is possible. The Au nanoparticles are biocompatible and can be accepted locally in the organism also at relatively high concentrations. The use of Au nanoparticles injected in the tumour site enhances significantly the effective atomic number of the medium, depending on the used concentration, and consequently the proton and electron energy loss and the X-ray absorption coefficient determining an increment of the local absorbed dose during radiotherapy. Traditional radiotherapy using electrons, X-rays and gamma rays, and innovative protontherapy can benefit the increment of the effective atomic number of the tissue in the presence of Au-nanoparticles embedded in the tumour volume with an adaptive up-take procedure. This method decreases the dose released to the healthy tissues permitting a better cantering of the irradiated targets and shielding the healthy tissue placed behind the tumour. The presented theoretical study approach permits to evaluate an enhancement of the radiotherapy dose of the order of 1 % using 60 MeV protons, of the order of 10% using 6 MeV electrons and of the order of 100 % using 100 keV X-ray photons. Here, we also disccused for patents relaed to the topic.

Photonic crystal microchip laser

NASA Astrophysics Data System (ADS)

Gailevicius, D.; Koliadenko, V.; Purlys, V.; Peckus, M.; Taranenko, V.; Staliunas, K.

2017-02-01

The microchip lasers, being sources of coherent light, suffer from one serious drawback: low spatial quality of the beam, strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here we propose that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. We experimentally show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M2 reducing it by factor of 2, and thus increase the brightness of radiation by a factor of 4. This comprises a new kind of laser, the "photonic crystal microchip laser", a very compact and efficient light source emitting high spatial high brightness radiation.

Peripheral dose measurement in high-energy photon radiotherapy with the implementation of MOSFET.

PubMed

Vlachopoulou, Vassiliki; Malatara, Georgia; Delis, Harry; Theodorou, Kiki; Kardamakis, Dimitrios; Panayiotakis, George

2010-11-28

To study the peripheral dose (PD) from high-energy photon beams in radiotherapy using the metal oxide semiconductor field effect transistor (MOSFET) dose verification system. The radiation dose absorbed by the MOSFET detector was calculated taking into account the manufacturer's Correction Factor, the Calibration Factor and the threshold voltage shift. PD measurements were carried out for three different field sizes (5 cm × 5 cm, 10 cm × 10 cm and 15 cm × 15 cm) and for various depths with the source to surface distance set at 100 cm. Dose measurements were realized on the central axis and then at distances (1 to 18 cm) parallel to the edge of the field, and were expressed as the percentage PD (% PD) with respect to the maximum dose (d(max)). The accuracy of the results was evaluated with respect to a calibrated 0.3 cm(3) ionization chamber. The reproducibility was expressed in terms of standard deviation (s) and coefficient of variation. % PD is higher near the phantom surface and drops to a minimum at the depth of d(max), and then tends to become constant with depth. Internal scatter radiation is the predominant source of PD and the depth dependence is determined by the attenuation of the primary photons. Closer to the field edge, where internal scatter from the phantom dominates, the % PD increases with depth because the ratio of the scatter to primary increases with depth. A few centimeters away from the field, where collimator scatter and leakage dominate, the % PD decreases with depth, due to attenuation by the water. The % PD decreases almost exponentially with the increase of distance from the field edge. The decrease of the % PD is more than 60% and can reach up to 90% as the measurement point departs from the edge of the field. For a given distance, the % PD is significantly higher for larger field sizes, due to the increase of the scattering volume. Finally, the measured PD obtained with MOSFET is higher than that obtained with an ionization chamber

Peripheral dose measurement in high-energy photon radiotherapy with the implementation of MOSFET

PubMed Central

Vlachopoulou, Vassiliki; Malatara, Georgia; Delis, Harry; Theodorou, Kiki; Kardamakis, Dimitrios; Panayiotakis, George

2010-01-01

AIM: To study the peripheral dose (PD) from high-energy photon beams in radiotherapy using the metal oxide semiconductor field effect transistor (MOSFET) dose verification system. METHODS: The radiation dose absorbed by the MOSFET detector was calculated taking into account the manufacturer’s Correction Factor, the Calibration Factor and the threshold voltage shift. PD measurements were carried out for three different field sizes (5 cm × 5 cm, 10 cm × 10 cm and 15 cm × 15 cm) and for various depths with the source to surface distance set at 100 cm. Dose measurements were realized on the central axis and then at distances (1 to 18 cm) parallel to the edge of the field, and were expressed as the percentage PD (% PD) with respect to the maximum dose (dmax). The accuracy of the results was evaluated with respect to a calibrated 0.3 cm3 ionization chamber. The reproducibility was expressed in terms of standard deviation (s) and coefficient of variation. RESULTS: % PD is higher near the phantom surface and drops to a minimum at the depth of dmax, and then tends to become constant with depth. Internal scatter radiation is the predominant source of PD and the depth dependence is determined by the attenuation of the primary photons. Closer to the field edge, where internal scatter from the phantom dominates, the % PD increases with depth because the ratio of the scatter to primary increases with depth. A few centimeters away from the field, where collimator scatter and leakage dominate, the % PD decreases with depth, due to attenuation by the water. The % PD decreases almost exponentially with the increase of distance from the field edge. The decrease of the % PD is more than 60% and can reach up to 90% as the measurement point departs from the edge of the field. For a given distance, the % PD is significantly higher for larger field sizes, due to the increase of the scattering volume. Finally, the measured PD obtained with MOSFET is higher than that obtained with an

Carbon Ion Radiotherapy: A Review of Clinical Experiences and Preclinical Research, with an Emphasis on DNA Damage/Repair

PubMed Central

Mohamad, Osama; Sishc, Brock J.; Saha, Janapriya; Pompos, Arnold; Rahimi, Asal; Story, Michael D.; Davis, Anthony J.; Kim, D.W. Nathan

2017-01-01

Compared to conventional photon-based external beam radiation (PhXRT), carbon ion radiotherapy (CIRT) has superior dose distribution, higher linear energy transfer (LET), and a higher relative biological effectiveness (RBE). This enhanced RBE is driven by a unique DNA damage signature characterized by clustered lesions that overwhelm the DNA repair capacity of malignant cells. These physical and radiobiological characteristics imbue heavy ions with potent tumoricidal capacity, while having the potential for simultaneously maximally sparing normal tissues. Thus, CIRT could potentially be used to treat some of the most difficult to treat tumors, including those that are hypoxic, radio-resistant, or deep-seated. Clinical data, mostly from Japan and Germany, are promising, with favorable oncologic outcomes and acceptable toxicity. In this manuscript, we review the physical and biological rationales for CIRT, with an emphasis on DNA damage and repair, as well as providing a comprehensive overview of the translational and clinical data using CIRT. PMID:28598362

Carbon Ion Radiotherapy: A Review of Clinical Experiences and Preclinical Research, with an Emphasis on DNA Damage/Repair.

PubMed

Mohamad, Osama; Sishc, Brock J; Saha, Janapriya; Pompos, Arnold; Rahimi, Asal; Story, Michael D; Davis, Anthony J; Kim, D W Nathan

2017-06-09

Compared to conventional photon-based external beam radiation (PhXRT), carbon ion radiotherapy (CIRT) has superior dose distribution, higher linear energy transfer (LET), and a higher relative biological effectiveness (RBE). This enhanced RBE is driven by a unique DNA damage signature characterized by clustered lesions that overwhelm the DNA repair capacity of malignant cells. These physical and radiobiological characteristics imbue heavy ions with potent tumoricidal capacity, while having the potential for simultaneously maximally sparing normal tissues. Thus, CIRT could potentially be used to treat some of the most difficult to treat tumors, including those that are hypoxic, radio-resistant, or deep-seated. Clinical data, mostly from Japan and Germany, are promising, with favorable oncologic outcomes and acceptable toxicity. In this manuscript, we review the physical and biological rationales for CIRT, with an emphasis on DNA damage and repair, as well as providing a comprehensive overview of the translational and clinical data using CIRT.

COTS Silicon diodes as radiation detectors in proton and heavy charged particle radiotherapy 1.

PubMed

Kaiser, Franz-Joachim; Bassler, Niels; Jäkel, Oliver

2010-08-01

Modern radiotherapy facilities for cancer treatment such as the Heavy Ion Therapy Center (HIT) in Heidelberg, Germany, allow for sub-millimeter precision in dose deposition. For measurement of such dose distributions and characterization of the particle beams, detectors with high spatial resolution are necessary. Here, a detector based on the commercially available COTS photodiode (BPW-34) is presented. When applied in hadronic beams of protons and carbon ions, the detector reproduces dose distribution well, but its response decreases rapidly by radiation damage. However, for MeV photon beams, the detector exhibits a similar behavior as found in diode detectors usually applied in radiotherapy.

Effect of beam arrangement on oral cavity dose in external beam radiotherapy of nasopharyngeal carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Vincent W.C.; Yang Zhining; Zhang Wuzhe

This study compared the oral cavity dose between the routine 7-beam intensity-modulated radiotherapy (IMRT) beam arrangement and 2 other 7-beam IMRT with the conventional radiotherapy beam arrangements in the treatment of nasopharyngeal carcinoma (NPC). Ten NPC patients treated by the 7-beam routine IMRT technique (IMRT-7R) between April 2009 and June 2009 were recruited. Using the same computed tomography data, target information, and dose constraints for all the contoured structures, 2 IMRT plans with alternative beam arrangements (IMRT-7M and IMRT-7P) by avoiding the anterior facial beam and 1 conventional radiotherapy plan (CONRT) were computed using the Pinnacle treatment planning system. Dose-volumemore » histograms were generated for the planning target volumes (PTVs) and oral cavity from which the dose parameters and the conformity index of the PTV were recorded for dosimetric comparisons among the plans with different beam arrangements. The dose distributions to the PTVs were similar among the 3 IMRT beam arrangements, whereas the differences were significant between IMRT-7R and CONRT plans. For the oral cavity dose, the 3 IMRT beam arrangements did not show significant difference. Compared with IMRT-7R, CONRT plan showed a significantly lower mean dose, V30 and V-40, whereas the V-60 was significantly higher. The 2 suggested alternative beam arrangements did not significantly reduce the oral cavity dose. The impact of varying the beam angles in IMRT of NPC did not give noticeable effect on the target and oral cavity. Compared with IMRT, the 2-D conventional radiotherapy irradiated a greater high-dose volume in the oral cavity.« less

The physics of small megavoltage photon beam dosimetry.

PubMed

Andreo, Pedro

2018-02-01

The increased interest during recent years in the use of small megavoltage photon beams in advanced radiotherapy techniques has led to the development of dosimetry recommendations by different national and international organizations. Their requirement of data suitable for the different clinical options available, regarding treatment units and dosimetry equipment, has generated a considerable amount of research by the scientific community during the last decade. The multiple publications in the field have led not only to the availability of new invaluable data, but have also contributed substantially to an improved understanding of the physics of their dosimetry. This work provides an overview of the most important aspects that govern the physics of small megavoltage photon beam dosimetry. Copyright © 2017 Elsevier B.V. All rights reserved.

Brushed permanent magnet DC MLC motor operation in an external magnetic field.

PubMed

Yun, J; St Aubin, J; Rathee, S; Fallone, B G

2010-05-01

Linac-MR systems for real-time image-guided radiotherapy will utilize the multileaf collimators (MLCs) to perform conformal radiotherapy and tumor tracking. The MLCs would be exposed to the external fringe magnetic fields of the linac-MR hybrid systems. Therefore, an experimental investigation of the effect of an external magnetic field on the brushed permanent magnet DC motors used in some MLC systems was performed. The changes in motor speed and current were measured for varying external magnetic field strengths up to 2000 G generated by an EEV electromagnet. These changes in motor characteristics were measured for three orientations of the motor in the external magnetic field, mimicking changes in motor orientations due to installation and/or collimator rotations. In addition, the functionality of the associated magnetic motor encoder was tested. The tested motors are used with the Varian 120 leaf Millennium MLC (Maxon Motor half leaf and full leaf motors) and the Varian 52 leaf MKII MLC (MicroMo Electronics leaf motor) including a carriage motor (MicroMo Electronics). In most cases, the magnetic encoder of the motors failed prior to any damage to the gearbox or the permanent magnet motor itself. This sets an upper limit of the external magnetic field strength on the motor function. The measured limits of the external magnetic fields were found to vary by the motor type. The leaf motor used with a Varian 52 leaf MKII MLC system tolerated up to 450 +/- 10 G. The carriage motor tolerated up to 2000 +/- 10 G field. The motors used with the Varian 120 leaf Millennium MLC system were found to tolerate a maximum of 600 +/- 10 G. The current Varian MLC system motors can be used for real-time image-guided radiotherapy coupled to a linac-MR system, provided the fringe magnetic fields at their locations are below the determined tolerance levels. With the fringe magnetic fields of linac-MR systems expected to be larger than the tolerance levels determined, some form of

Pain and mean absorbed dose to the pubic bone after radiotherapy among gynecological cancer survivors.

PubMed

Waldenström, Ann-Charlotte; Olsson, Caroline; Wilderäng, Ulrica; Dunberger, Gail; Lind, Helena; al-Abany, Massoud; Palm, Åsa; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

2011-07-15

To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses ≥ 52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer. Copyright © 2011 Elsevier Inc. All rights reserved.

Pain and Mean Absorbed Dose to the Pubic Bone After Radiotherapy Among Gynecological Cancer Survivors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Waldenstroem, Ann-Charlotte, E-mail: ann-charlotte.waldenstrom@oncology.gu.se; Department of Oncology, Sahlgrenska University Hospital, Gothenburg; Olsson, Caroline

Purpose: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. Methods and Materials: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. Results: We analyzed data from 650 survivors (participation rate 79%) with median follow-upmore » of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses {>=}52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Conclusions: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.« less

2D mapping of the MV photon fluence and 3D dose reconstruction in real time for quality assurance during radiotherapy treatment

NASA Astrophysics Data System (ADS)

Alrowaili, Z. A.; Lerch, M. L. F.; Carolan, M.; Fuduli, I.; Porumb, C.; Petasecca, M.; Metcalfe, P.; Rosenfeld, A. B.

2015-09-01

Summary: the photon irradiation response of a 2D solid state transmission detector array mounted in a linac block tray is used to reconstruct the projected 2D dose map in a homogenous phantom along rays that diverge from the X-ray source and pass through each of the 121 detector elements. A unique diode response-to-dose scaling factor, applied to all detectors, is utilised in the reconstruction to demonstrate that real time QA during radiotherapy treatment is feasible. Purpose: to quantitatively demonstrate reconstruction of the real time radiation dose from the irradiation response of the 11×11 silicon Magic Plate (MP) detector array operated in Transmission Mode (MPTM). Methods and Materials: in transmission mode the MP is positioned in the block tray of a linac so that the central detector of the array lies on the central axis of the radiation beam. This central detector is used to determine the conversion factor from measured irradiation response to reconstructed dose at any point on the central axis within a homogenous solid water phantom. The same unique conversion factor is used for all MP detector elements lying within the irradiation field. Using the two sets of data, the 2D or 3D dose map is able to be reconstructed in the homogenous phantom. The technique we have developed is illustrated here for different depths and irradiation field sizes, (5 × 5 cm2 to 40 × 40 cm2) as well as a highly non uniform irradiation field. Results: we find that the MPTM response is proportional to the projected 2D dose map measured at a specific phantom depth, the "sweet depth". A single factor, for several irradiation field sizes and depths, is derived to reconstruct the dose in the phantom along rays projected from the photon source through each MPTM detector element. We demonstrate that for all field sizes using the above method, the 2D reconstructed and measured doses agree to within ± 2.48% (2 standard deviation) for all in-field MP detector elements. Conclusions: a

Negative Avalanche Feedback Detectors for Photon-Counting Optical Communications

NASA Technical Reports Server (NTRS)

Farr, William H.

2009-01-01

Negative Avalanche Feedback photon counting detectors with near-infrared spectral sensitivity offer an alternative to conventional Geiger mode avalanche photodiode or phototube detectors for free space communications links at 1 and 1.55 microns. These devices demonstrate linear mode photon counting without requiring any external reset circuitry and may even be operated at room temperature. We have now characterized the detection efficiency, dark count rate, after-pulsing, and single photon jitter for three variants of this new detector class, as well as operated these uniquely simple to use devices in actual photon starved free space optical communications links.

Asymmetric photon transport in organic semiconductor nanowires through electrically controlled exciton diffusion

PubMed Central

Cui, Qiu Hong; Peng, Qian; Luo, Yi; Jiang, Yuqian; Yan, Yongli; Wei, Cong; Shuai, Zhigang; Sun, Cheng; Yao, Jiannian; Zhao, Yong Sheng

2018-01-01

The ability to steer the flow of light toward desired propagation directions is critically important for the realization of key functionalities in optical communication and information processing. Although various schemes have been proposed for this purpose, the lack of capability to incorporate an external electric field to effectively tune the light propagation has severely limited the on-chip integration of photonics and electronics. Because of the noninteractive nature of photons, it is only possible to electrically control the flow of light by modifying the refractive index of materials through the electro-optic effect. However, the weak optical effects need to be strongly amplified for practical applications in high-density photonic integrations. We show a new strategy that takes advantage of the strong exciton-photon coupling in active waveguides to effectively manipulate photon transport by controlling the interaction between excitons and the external electric field. Single-crystal organic semiconductor nanowires were used to generate highly stable Frenkel exciton polaritons with strong binding and diffusion abilities. By making use of directional exciton diffusion in an external electric field, we have realized an electrically driven asymmetric photon transport and thus directional light propagation in a single nanowire. With this new concept, we constructed a dual-output single wire–based device to build an electrically controlled single-pole double-throw optical switch with fast temporal response and high switching frequency. Our findings may lead to the innovation of concepts and device architectures for optical information processing. PMID:29556529

Ionizing radiation-induced acoustics for radiotherapy and diagnostic radiology applications.

PubMed

Hickling, Susannah; Xiang, Liangzhong; Jones, Kevin C; Parodi, Katia; Assmann, Walter; Avery, Stephen; Hobson, Maritza; El Naqa, Issam

2018-04-21

Acoustic waves are induced via the thermoacoustic effect in objects exposed to a pulsed beam of ionizing radiation. This phenomenon has interesting potential applications in both radiotherapy dosimetry and treatment guidance as well as low dose radiological imaging. After initial work in the field in the 1980s and early 1990s, little research was done until 2013 when interest was rejuvenated, spurred on by technological advances in ultrasound transducers and the increasing complexity of radiotherapy delivery systems. Since then, many studies have been conducted and published applying ionizing radiation-induced acoustic principles into three primary research areas: Linear accelerator photon beam dosimetry, proton therapy range verification, and radiological imaging. This review article introduces the theoretical background behind ionizing radiation-induced acoustic waves, summarizes recent advances in the field, and provides an outlook on how the detection of ionizing radiation-induced acoustic waves can be used for relative and in vivo dosimetry in photon therapy, localization of the Bragg peak in proton therapy, and as a low-dose medical imaging modality. Future prospects and challenges for clinical implementation of these techniques are discussed. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Contribution of FDOPA PET to radiotherapy planning for advanced glioma

NASA Astrophysics Data System (ADS)

Dowson, Nicholas; Fay, Michael; Thomas, Paul; Jeffree, Rosalind; McDowall, Robert; Winter, Craig; Coulthard, Alan; Smith, Jye; Gal, Yaniv; Bourgeat, Pierrick; Salvado, Olivier; Crozier, Stuart; Rose, Stephen

2014-03-01

Despite radical treatment with surgery, radiotherapy and chemotherapy, advanced gliomas recur within months. Geographic misses in radiotherapy planning may play a role in this seemingly ineluctable recurrence. Planning is typically performed on post-contrast MRIs, which are known to underreport tumour volume relative to FDOPA PET scans. FDOPA PET fused with contrast enhanced MRI has demonstrated greater sensitivity and specificity than MRI alone. One sign of potential misses would be differences between gross target volumes (GTVs) defined using MRI alone and when fused with PET. This work examined whether such a discrepancy may occur. Materials and Methods: For six patients, a 75 minute PET scan using 3,4-dihydroxy-6-18F-fluoro-L-phynel-alanine (18F-FDOPA) was taken within 2 days of gadolinium enhanced MRI scans. In addition to standard radiotherapy planning by an experienced radiotherapy oncologist, a second gross target volume (GTV) was defined by an experienced nuclear medicine specialist for fused PET and MRI, while blinded to the radiotherapy plans. The volumes from standard radiotherapy planning were compared to the PET defined GTV. Results: The comparison indicated radiotherapy planning would change in several cases if FDOPA PET data was available. PET-defined contours were external to 95% prescribed dose for several patients. However, due to the radiotherapy margins, the discrepancies were relatively small in size and all received a dose of 50 Gray or more. Conclusions: Given the limited size of the discrepancies it is uncertain that geographic misses played a major role in patient outcome. Even so, the existence of discrepancies indicates that FDOPA PET could assist in better defining margins when planning radiotherapy for advanced glioma, which could be important for highly conformal radiotherapy plans.

Radiotherapy access in Belgium: How far are we from evidence-based utilisation?

PubMed

Lievens, Y; De Schutter, H; Stellamans, K; Rosskamp, M; Van Eycken, L

2017-10-01

Underutilisation of radiotherapy has been observed worldwide. To evaluate the current situation in Belgium, optimal utilisation proportions (OUPs) adopted from the European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project were compared to actual utilisation proportions (AUPs) and with radiotherapy advised during the multidisciplinary cancer team (MDT) meetings. In addition, the impact of independent variables was analysed. AUPs and advised radiotherapy were calculated overall and by cancer type for 110,810 unique cancer diagnoses in 2009-2010. Radiotherapy utilisation was derived from reimbursement data and distinguished between palliative and curative intent external beam radiotherapy (EBRT) and/or brachytherapy (BT). Sensitivity analyses regarding the influence of the follow-up period, the survival length and patient's age were performed. Advised radiotherapy was calculated based on broad treatment categories as reported at MDT meetings. The overall AUP of 37% (39% including BT) was lower than the OUP of 53%, but in line with advised radiotherapy (35%). Large variations by tumour type were observed: in some tumours (e.g. lung and prostate cancer) AUP was considerably lower than OUP, whereas in others there was reasonable concordance (e.g. breast and rectal cancer). Overall, 84% of treatments started within 9 months following diagnosis. Survival time influenced AUP in a cancer type-dependent way. Elderly patients received less radiotherapy. Although the actually delivered radiotherapy in Belgium aligns well to MDT advices, it is lower than the evidence-based optimum. Further analysis of potential barriers is needed for radiotherapy forecasting and planning, and in order to promote adequate access to radiotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Non-rigid CT/CBCT to CBCT registration for online external beam radiotherapy guidance

NASA Astrophysics Data System (ADS)

Zachiu, Cornel; de Senneville, Baudouin Denis; Tijssen, Rob H. N.; Kotte, Alexis N. T. J.; Houweling, Antonetta C.; Kerkmeijer, Linda G. W.; Lagendijk, Jan J. W.; Moonen, Chrit T. W.; Ries, Mario

2018-01-01

Image-guided external beam radiotherapy (EBRT) allows radiation dose deposition with a high degree of accuracy and precision. Guidance is usually achieved by estimating the displacements, via image registration, between cone beam computed tomography (CBCT) and computed tomography (CT) images acquired at different stages of the therapy. The resulting displacements are then used to reposition the patient such that the location of the tumor at the time of treatment matches its position during planning. Moreover, ongoing research aims to use CBCT-CT image registration for online plan adaptation. However, CBCT images are usually acquired using a small number of x-ray projections and/or low beam intensities. This often leads to the images being subject to low contrast, low signal-to-noise ratio and artifacts, which ends-up hampering the image registration process. Previous studies addressed this by integrating additional image processing steps into the registration procedure. However, these steps are usually designed for particular image acquisition schemes, therefore limiting their use on a case-by-case basis. In the current study we address CT to CBCT and CBCT to CBCT registration by the means of the recently proposed EVolution registration algorithm. Contrary to previous approaches, EVolution does not require the integration of additional image processing steps in the registration scheme. Moreover, the algorithm requires a low number of input parameters, is easily parallelizable and provides an elastic deformation on a point-by-point basis. Results have shown that relative to a pure CT-based registration, the intrinsic artifacts present in typical CBCT images only have a sub-millimeter impact on the accuracy and precision of the estimated deformation. In addition, the algorithm has low computational requirements, which are compatible with online image-based guidance of EBRT treatments.

Tally and geometry definition influence on the computing time in radiotherapy treatment planning with MCNP Monte Carlo code.

PubMed

Juste, B; Miro, R; Gallardo, S; Santos, A; Verdu, G

2006-01-01

The present work has simulated the photon and electron transport in a Theratron 780 (MDS Nordion) (60)Co radiotherapy unit, using the Monte Carlo transport code, MCNP (Monte Carlo N-Particle), version 5. In order to become computationally more efficient in view of taking part in the practical field of radiotherapy treatment planning, this work is focused mainly on the analysis of dose results and on the required computing time of different tallies applied in the model to speed up calculations.

Photonic Crystal Microchip Laser.

PubMed

Gailevicius, Darius; Koliadenko, Volodymyr; Purlys, Vytautas; Peckus, Martynas; Taranenko, Victor; Staliunas, Kestutis

2016-09-29

The microchip lasers, being very compact and efficient sources of coherent light, suffer from one serious drawback: low spatial quality of the beam strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here it is proposed that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. Experiments show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M 2 reducing it by a factor of 2, and increase the brightness of radiation by a factor of 3. This comprises a new kind of laser, the "photonic crystal microchip laser", a very compact and efficient light source emitting high spatial quality high brightness radiation.

Photonic Crystal Microchip Laser

NASA Astrophysics Data System (ADS)

Gailevicius, Darius; Koliadenko, Volodymyr; Purlys, Vytautas; Peckus, Martynas; Taranenko, Victor; Staliunas, Kestutis

2016-09-01

The microchip lasers, being very compact and efficient sources of coherent light, suffer from one serious drawback: low spatial quality of the beam strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here it is proposed that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. Experiments show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M2 reducing it by a factor of 2, and increase the brightness of radiation by a factor of 3. This comprises a new kind of laser, the “photonic crystal microchip laser”, a very compact and efficient light source emitting high spatial quality high brightness radiation.

Photonic Crystal Microchip Laser

PubMed Central

Gailevicius, Darius; Koliadenko, Volodymyr; Purlys, Vytautas; Peckus, Martynas; Taranenko, Victor; Staliunas, Kestutis

2016-01-01

The microchip lasers, being very compact and efficient sources of coherent light, suffer from one serious drawback: low spatial quality of the beam strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here it is proposed that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. Experiments show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M2 reducing it by a factor of 2, and increase the brightness of radiation by a factor of 3. This comprises a new kind of laser, the “photonic crystal microchip laser”, a very compact and efficient light source emitting high spatial quality high brightness radiation. PMID:27683066

Fiducial marker guided prostate radiotherapy: a review

PubMed Central

Jain, Suneil; Hounsell, Alan R; O'Sullivan, Joe M

2016-01-01

Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced. PMID:27585736

High-Q microwave photonic filter with a tuned modulator.

PubMed

Capmany, J; Mora, J; Ortega, B; Pastor, D

2005-09-01

We propose the use of tuned electro-optic or electroabsorption external modulators to implement high-quality (high-Q) factor, single-bandpass photonic filters for microwave signals. Using this approach, we experimentally demonstrate a transversal finite impulse response with a Q factor of 237. This is to our knowledge the highest value ever reported for a passive finite impulse-response microwave photonic filter.

The feasibility and safety of high-intensity focused ultrasound combined with low-dose external beam radiotherapy as supplemental therapy for advanced prostate cancer following hormonal therapy.

PubMed

Wu, Rui-Yi; Wang, Guo-Min; Xu, Lei; Zhang, Bo-Heng; Xu, Ye-Qing; Zeng, Zhao-Chong; Chen, Bing

2011-05-01

The aim of this study was to investigate the feasibility and safety of high-intensity focused ultrasound (HIFU) combined with (+) low-dose external beam radiotherapy (LRT) as supplemental therapy for advanced prostate cancer (PCa) following hormonal therapy (HT). Our definition of HIFU+LRT refers to treating primary tumour lesions with HIFU in place of reduced field boost irradiation to the prostate, while retaining four-field box irradiation to the pelvis in conventional-dose external beam radiotherapy (CRT). We performed a prospective, controlled and non-randomized study on 120 patients with advanced PCa after HT who received HIFU, CRT, HIFU+LRT and HT alone, respectively. CT/MR imaging showed the primary tumours and pelvic lymph node metastases visibly shrank or even disappeared after HIFU+LRT treatment. There were significant differences among four groups with regard to overall survival (OS) and disease-specific survival (DSS) curves (P = 0.018 and 0.015). Further comparison between each pair of groups suggested that the long-term DSS of the HIFU+LRT group was higher than those of the other three groups, but there was no significant difference between the HIFU+LRT group and the CRT group. Multivariable Cox's proportional hazard model showed that both HIFU+LRT and CRT were independently associated with DSS (P = 0.001 and 0.035) and had protective effects with regard to the risk of death. Compared with CRT, HIFU+LRT significantly decreased incidences of radiation-related late gastrointestinal (GI) and genitourinary (GU) toxicity grade ≥ II. In conclusion, long-term survival of patients with advanced PCa benefited from strengthening local control of primary tumour and regional lymph node metastases after HT. As an alternative to CRT, HIFU+LRT showed good efficacy and better safety.

Target margins in radiotherapy of prostate cancer

PubMed Central

Bauman, Glenn

2016-01-01

We reviewed the literature on the use of margins in radiotherapy of patients with prostate cancer, focusing on different options for image guidance (IG) and technical issues. The search in PubMed database was limited to include studies that involved external beam radiotherapy of the intact prostate. Post-prostatectomy studies, brachytherapy and particle therapy were excluded. Each article was characterized according to the IG strategy used: positioning on external marks using room lasers, bone anatomy and soft tissue match, usage of fiducial markers, electromagnetic tracking and adapted delivery. A lack of uniformity in margin selection among institutions was evident from the review. In general, introduction of pre- and in-treatment IG was associated with smaller planning target volume (PTV) margins, but there was a lack of definitive experimental/clinical studies providing robust information on selection of exact PTV values. In addition, there is a lack of comparative research regarding the cost–benefit ratio of the different strategies: insertion of fiducial markers or electromagnetic transponders facilitates prostate gland localization but at a price of invasive procedure; frequent pre-treatment imaging increases patient in-room time, dose and labour; online plan adaptation should improve radiation delivery accuracy but requires fast and precise computation. Finally, optimal protocols for quality assurance procedures need to be established. PMID:27377353

Outcome analysis of salvage radiotherapy for occult cervical cancer found after simple hysterectomy.

PubMed

Koh, Hyeon Kang; Jeon, Wan; Kim, Hak Jae; Wu, Hong-Gyun; Kim, Kyubo; Chie, Eui Kyu; Ha, Sung W

2013-12-01

The objective was to analyze the outcomes of the patients, who received salvage radiotherapy for incidentally discovered cervical cancer following simple hysterectomy, and to identify the influence of intracavitary radiotherapy on treatment outcomes. Data from 117 patients with occult cervical cancer who underwent simple hysterectomy followed by salvage radiotherapy from September 1979 to November 2010 were collected. All the patients received external beam radiotherapy with (n = 45) or without (n = 72) intracavitary radiotherapy. Local control, disease-free survival, overall survival and treatment-related toxicity were investigated. The median follow-up time was 75 months. The 5- and 10-year local control/disease-free survival/overall survival rates were 93/87/87% and 90/84/83%, respectively. Among 98 patients who had no residual disease and negative resection margin on surgical specimens, 32 (33%) received intracavitary radiotherapy and 66 (67%) did not. There were no differences in patient and tumor characteristics between patients treated with and without intracavitary radiotherapy. The 5-year local control rate for the non-intracavitary radiotherapy group was 93 versus 94% for the intracavitary radiotherapy group (P = 0.564); the disease-free survival rate was 88 versus 94% (P = 0.894); the overall survival rate was 95 versus 85% (P = 0.106), respectively. Among all patients, there were 5% of Grade 3 or higher late toxicities. Patients with occult invasive cervical cancer discovered following simple hysterectomy could be treated safely and effectively with salvage radiotherapy. For patients with no residual disease and negative resection margin, intracavitary radiotherapy could be omitted.

Dosimetric verification of radiotherapy treatment planning systems in Serbia: national audit

PubMed Central

2012-01-01

Background Independent external audits play an important role in quality assurance programme in radiation oncology. The audit supported by the IAEA in Serbia was designed to review the whole chain of activities in 3D conformal radiotherapy (3D-CRT) workflow, from patient data acquisition to treatment planning and dose delivery. The audit was based on the IAEA recommendations and focused on dosimetry part of the treatment planning and delivery processes. Methods The audit was conducted in three radiotherapy departments of Serbia. An anthropomorphic phantom was scanned with a computed tomography unit (CT) and treatment plans for eight different test cases involving various beam configurations suggested by the IAEA were prepared on local treatment planning systems (TPSs). The phantom was irradiated following the treatment plans for these test cases and doses in specific points were measured with an ionization chamber. The differences between the measured and calculated doses were reported. Results The measurements were conducted for different photon beam energies and TPS calculation algorithms. The deviation between the measured and calculated values for all test cases made with advanced algorithms were within the agreement criteria, while the larger deviations were observed for simpler algorithms. The number of measurements with results outside the agreement criteria increased with the increase of the beam energy and decreased with TPS calculation algorithm sophistication. Also, a few errors in the basic dosimetry data in TPS were detected and corrected. Conclusions The audit helped the users to better understand the operational features and limitations of their TPSs and resulted in increased confidence in dose calculation accuracy using TPSs. The audit results indicated the shortcomings of simpler algorithms for the test cases performed and, therefore the transition to more advanced algorithms is highly desirable. PMID:22971539

Dosimetric verification of radiotherapy treatment planning systems in Serbia: national audit.

PubMed

Rutonjski, Laza; Petrović, Borislava; Baucal, Milutin; Teodorović, Milan; Cudić, Ozren; Gershkevitsh, Eduard; Izewska, Joanna

2012-09-12

Independent external audits play an important role in quality assurance programme in radiation oncology. The audit supported by the IAEA in Serbia was designed to review the whole chain of activities in 3D conformal radiotherapy (3D-CRT) workflow, from patient data acquisition to treatment planning and dose delivery. The audit was based on the IAEA recommendations and focused on dosimetry part of the treatment planning and delivery processes. The audit was conducted in three radiotherapy departments of Serbia. An anthropomorphic phantom was scanned with a computed tomography unit (CT) and treatment plans for eight different test cases involving various beam configurations suggested by the IAEA were prepared on local treatment planning systems (TPSs). The phantom was irradiated following the treatment plans for these test cases and doses in specific points were measured with an ionization chamber. The differences between the measured and calculated doses were reported. The measurements were conducted for different photon beam energies and TPS calculation algorithms. The deviation between the measured and calculated values for all test cases made with advanced algorithms were within the agreement criteria, while the larger deviations were observed for simpler algorithms. The number of measurements with results outside the agreement criteria increased with the increase of the beam energy and decreased with TPS calculation algorithm sophistication. Also, a few errors in the basic dosimetry data in TPS were detected and corrected. The audit helped the users to better understand the operational features and limitations of their TPSs and resulted in increased confidence in dose calculation accuracy using TPSs. The audit results indicated the shortcomings of simpler algorithms for the test cases performed and, therefore the transition to more advanced algorithms is highly desirable.

Low-Dose Radiotherapy in Indolent Lymphoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rossier, Christine; Schick, Ulrike; Miralbell, Raymond

Purpose: To assess the response rate, duration of response, and overall survival after low-dose involved-field radiotherapy in patients with recurrent low-grade lymphoma or chronic lymphocytic leukemia (CLL). Methods and Materials: Forty-three (24 women, 19 men) consecutive patients with indolent lymphoma or CLL were treated with a total dose of 4 Gy (2 x 2 Gy) using 6- 18-MV photons. The median age was 73 years (range, 39-88). Radiotherapy was given either after (n = 32; 75%) or before (n = 11; 25%) chemotherapy. The median time from diagnosis was 48 months (range, 1-249). The median follow-up period was 20 monthsmore » (range, 1-56). Results: The overall response rate was 90%. Twelve patients (28%) had a complete response, 15 (35%) had a partial response, 11 (26%) had stable disease, and 5 (11%) had progressive disease. The median overall survival for patients with a positive response (complete response/partial response/stable disease) was 41 months; for patients with progressive disease it was 6 months (p = 0.001). The median time to in-field progression was 21 months (range, 0-24), and the median time to out-field progression was 8 months (range, 0-40). The 3-year in-field control was 92% in patients with complete response (median was not reached). The median time to in-field progression was 9 months (range, 0.5-24) in patients with partial response and 6 months (range, 0.6-6) in those with stable disease (p < 0.05). Younger age, positive response to radiotherapy, and no previous chemotherapy were the best factors influencing the outcome. Conclusions: Low-dose involved-field radiotherapy is an effective treatment in the management of patients with recurrent low-grade lymphoma or CLL.« less

Calculation of conversion coefficients for clinical photon spectra using the MCNP code.

PubMed

Lima, M A F; Silva, A X; Crispim, V R

2004-01-01

In this work, the MCNP4B code has been employed to calculate conversion coefficients from air kerma to the ambient dose equivalent, H*(10)/Ka, for monoenergetic photon energies from 10 keV to 50 MeV, assuming the kerma approximation. Also estimated are the H*(10)/Ka for photon beams produced by linear accelerators, such as Clinac-4 and Clinac-2500, after transmission through primary barriers of radiotherapy treatment rooms. The results for the conversion coefficients for monoenergetic photon energies, with statistical uncertainty <2%, are compared with those in ICRP publication 74 and good agreements were obtained. The conversion coefficients calculated for real clinic spectra transmitted through walls of concrete of 1, 1.5 and 2 m thick, are in the range of 1.06-1.12 Sv Gy(-1).

RADRUE METHOD FOR RECONSTRUCTION OF EXTERNAL PHOTON DOSES TO CHERNOBYL LIQUIDATORS IN EPIDEMIOLOGICAL STUDIES

PubMed Central

Kryuchkov, Victor; Chumak, Vadim; Maceika, Evaldas; Anspaugh, Lynn R.; Cardis, Elisabeth; Bakhanova, Elena; Golovanov, Ivan; Drozdovitch, Vladimir; Luckyanov, Nickolas; Kesminiene, Ausrele; Voillequé, Paul; Bouville, André

2010-01-01

Between 1986 and 1990, several hundred thousand workers, called “liquidators” or “clean-up workers”, took part in decontamination and recovery activities within the 30-km zone around the Chernobyl nuclear power plant in Ukraine, where a major accident occurred in April 1986. The Chernobyl liquidators were mainly exposed to external ionizing radiation levels that depended primarily on their work locations and the time after the accident when the work was performed. Because individual doses were often monitored inadequately or were not monitored at all for the majority of liquidators, a new method of photon (i.e. gamma and x-rays) dose assessment, called “RADRUE” (Realistic Analytical Dose Reconstruction with Uncertainty Estimation) was developed to obtain unbiased and reasonably accurate estimates for use in three epidemiologic studies of hematological malignancies and thyroid cancer among liquidators. The RADRUE program implements a time-and-motion dose reconstruction method that is flexible and conceptually easy to understand. It includes a large exposure rate database and interpolation and extrapolation techniques to calculate exposure rates at places where liquidators lived and worked within ~70 km of the destroyed reactor. The RADRUE technique relies on data collected from subjects’ interviews conducted by trained interviewers, and on expert dosimetrists to interpret the information and provide supplementary information, when necessary, based upon their own Chernobyl experience. The RADRUE technique was used to estimate doses from external irradiation, as well as uncertainties, to the bone-marrow for 929 subjects and to the thyroid gland for 530 subjects enrolled in epidemiologic studies. Individual bone-marrow dose estimates were found to range from less than one μGy to 3,300 mGy, with an arithmetic mean of 71 mGy. Individual thyroid dose estimates were lower and ranged from 20 μGy to 507 mGy, with an arithmetic mean of 29 mGy. The

Dose conversion coefficients based on the Chinese mathematical phantom and MCNP code for external photon irradiation.

PubMed

Qiu, Rui; Li, Junli; Zhang, Zhan; Liu, Liye; Bi, Lei; Ren, Li

2009-02-01

A set of conversion coefficients from kerma free-in-air to the organ-absorbed dose are presented for external monoenergetic photon beams from 10 keV to 10 MeV based on the Chinese mathematical phantom, a whole-body mathematical phantom model. The model was developed based on the methods of the Oak Ridge National Laboratory mathematical phantom series and data from the Chinese Reference Man and the Reference Asian Man. This work is carried out to obtain the conversion coefficients based on this model, which represents the characteristics of the Chinese population, as the anatomical parameters of the Chinese are different from those of Caucasians. Monte Carlo simulation with MCNP code is carried out to calculate the organ dose conversion coefficients. Before the calculation, the effects from the physics model and tally type are investigated, considering both the calculation efficiency and precision. In the calculation irradiation conditions include anterior-posterior, posterior-anterior, right lateral, left lateral, rotational and isotropic geometries. Conversion coefficients from this study are compared with those recommended in the Publication 74 of International Commission on Radiological Protection (ICRP74) since both the sets of data are calculated with mathematical phantoms. Overall, consistency between the two sets of data is observed and the difference for more than 60% of the data is below 10%. However, significant deviations are also found, mainly for the superficial organs (up to 65.9%) and bone surface (up to 66%). The big difference of the dose conversion coefficients for the superficial organs at high photon energy could be ascribed to kerma approximation for the data in ICRP74. Both anatomical variations between races and the calculation method contribute to the difference of the data for bone surface.

Phase I/II Trial Evaluating Carbon Ion Radiotherapy for Salvaging Treatment of Locally Recurrent Nasopharyngeal Carcinoma.

PubMed

Kong, Lin; Hu, Jiyi; Guan, Xiyin; Gao, Jing; Lu, Rong; Lu, Jiade J

2016-01-01

Radiation therapy is the mainstay strategy for the treatment of nasopharyngeal cancer (NPC). Intensity-modulated X-ray therapy (IMXT) alone is the current standard for stage I and II NPC. For stage III and IV A/B diseases, concurrent chemotherapy should be provided in addition to IMXT. However, optimal treatment for locally recurrent NPC after previous definitive dose of radiotherapy is lacking. Various techniques including brachytherapy, IMXT, stereotactic radiosurgery or radiotherapy (SRS or SBRT) have been used in the management of locally recurrent NPC. Due to the inherent limitation of these techniques, i.e., limited range of irradiation or over-irradiation to surrounding normal tissues, moderate efficacy has been observed at the cost of severe toxicities. Carbon ion radiotherapy (CIRT) offers potential physical and biological advantages over photon and proton radiotherapy. Due to the inverted dose profile of particle beams and their greater energy deposition within the Bragg peak, precise dose delivery to the target volume(s) without exposing the surrounding organs at risk to extra doses is possible. In addition, CIRT provides an increased relative biological effectiveness (RBE) as compared to photon and proton radiotherapy. Such advantages may translate to improved outcomes after irradiation in terms of disease control in radio-resistant and previously treated, recurrent malignancies. It is therefore reasonable to postulate that recurrent NPC after high-dose radiotherapy could be more resistant to re-irradiation using photons. Reports on the treatment of radio-resistant malignancies in the head and neck region such as melanoma, sarcoma, and adenoid cystic carcinoma (ACC) have demonstrated superior local control rates from CIRT as compared to photon irradiation. Thus patients with recurrent NPC are likely to benefit from the enhanced biological effectiveness of carbon ions. As effective retreatment strategy is lacking for locally recurrent NPC, carbon ion

Genomic and Histopathological Tissue Biomarkers That Predict Radiotherapy Response in Localised Prostate Cancer

PubMed Central

Wilkins, Anna; Dearnaley, David; Somaiah, Navita

2015-01-01

Localised prostate cancer, in particular, intermediate risk disease, has varied survival outcomes that cannot be predicted accurately using current clinical risk factors. External beam radiotherapy (EBRT) is one of the standard curative treatment options for localised disease and its efficacy is related to wide ranging aspects of tumour biology. Histopathological techniques including immunohistochemistry and a variety of genomic assays have been used to identify biomarkers of tumour proliferation, cell cycle checkpoints, hypoxia, DNA repair, apoptosis, and androgen synthesis, which predict response to radiotherapy. Global measures of genomic instability also show exciting capacity to predict survival outcomes following EBRT. There is also an urgent clinical need for biomarkers to predict the radiotherapy fraction sensitivity of different prostate tumours and preclinical studies point to possible candidates. Finally, the increased resolution of next generation sequencing (NGS) is likely to enable yet more precise molecular predictions of radiotherapy response and fraction sensitivity. PMID:26504789

Radical External Beam Radiotherapy for Clinically Localized Prostate Cancer in Japan: Changing Trends in the Patterns of Care Process Survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ogawa, Kazuhiko, E-mail: kogawa@med.u-ryukyu.ac.jp; Nakamura, Katsumasa; Sasaki, Tomonari

2011-12-01

Purpose: To delineate changing trends in radical external beam radiotherapy (EBRT) for prostate cancer in Japan. Methods and Materials: Data from 841 patients with clinically localized prostate cancer treated with EBRT in the Japanese Patterns of Care Study (PCS) from 1996 to 2005 were analyzed. Results: Significant increases in the proportions of patients with stage T1 to T2 disease and decrease in prostate-specific antigen values were observed. Also, there were significant increases in the percentages of patients treated with radiotherapy by their own choice. Median radiation doses were 65.0 Gy and 68.4 Gy from 1996 to 1998 and from 1999more » to 2001, respectively, increasing to 70 Gy from 2003 to 2005. Moreover, conformal therapy was more frequently used from 2003 to 2005 (84.9%) than from 1996 to 1998 (49.1%) and from 1999 to 2001 (50.2%). On the other hand, the percentage of patients receiving hormone therapy from 2003 to 2005 (81.1%) was almost the same as that from 1996 to 1998 (86.3%) and from 1999 to 2001 (89.7%). Compared with the PCS in the United States, patient characteristics and patterns of treatments from 2003 to 2005 have become more similar to those in the United States than those from 1996 to 1998 and those from 1999 to 2001. Conclusions: This study indicates a trend toward increasing numbers of patients with early-stage disease and increasing proportions of patients treated with higher radiation doses with advanced equipment among Japanese prostate cancer patients treated with EBRT during 1996 to 2005 survey periods. Patterns of care for prostate cancer in Japan are becoming more similar to those in the United States.« less

Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020.

PubMed

Rodríguez, A; Algara, M; Monge, D; López-Torrecilla, J; Caballero, F; Morera, R; Escó, R; Pérez-Montero, H; Ferrer, C; Lara, P C

2018-03-01

Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS). The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old. The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate. Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

Clinical advantages of carbon-ion radiotherapy

NASA Astrophysics Data System (ADS)

Tsujii, Hirohiko; Kamada, Tadashi; Baba, Masayuki; Tsuji, Hiroshi; Kato, Hirotoshi; Kato, Shingo; Yamada, Shigeru; Yasuda, Shigeo; Yanagi, Takeshi; Kato, Hiroyuki; Hara, Ryusuke; Yamamoto, Naotaka; Mizoe, Junetsu

2008-07-01

Carbon-ion radiotherapy (C-ion RT) possesses physical and biological advantages. It was started at NIRS in 1994 using the Heavy Ion Medical Accelerator in Chiba (HIMAC); since then more than 50 protocol studies have been conducted on almost 4000 patients with a variety of tumors. Clinical experiences have demonstrated that C-ion RT is effective in such regions as the head and neck, skull base, lung, liver, prostate, bone and soft tissues, and pelvic recurrence of rectal cancer, as well as for histological types including adenocarcinoma, adenoid cystic carcinoma, malignant melanoma and various types of sarcomas, against which photon therapy could be less effective. Furthermore, when compared with photon and proton RT, a significant reduction of overall treatment time and fractions has been accomplished without enhancing toxicities. Currently, the number of irradiation sessions per patient averages 13 fractions spread over approximately three weeks. This means that in a carbon therapy facility a larger number of patients than is possible with other modalities can be treated over the same period of time.

Biomimetic Photonic Crystals based on Diatom Algae Frustules

NASA Astrophysics Data System (ADS)

Mishler, Jonathan; Alverson, Andrew; Herzog, Joseph

2015-03-01

Diatom algae are unicellular, photosynthetic microorganisms with a unique external shell known as a frustule. Frustules, which are composed of amorphous silica, exhibit a unique periodic nano-patterning, distinguishing diatoms from other types of phytoplankton. Diatoms have been studied for their distinctive optical properties due to their resemblance of photonic crystals. In this regard, diatoms are not only considered for their applications as photonic crystals, but also for their use as biomimetic templates for artificially fabricated photonic crystals. Through the examination and measurement of the physical characteristics of many scanning electron microscope (SEM) images of diatom frustules, a biomimetic photonic crystal derived from diatom frustules can be recreated and modeled with the finite element method. In this approach, the average geometries of the diatom frustules are used to recreate a 2-dimensional photonic crystal, after which the electric field distribution and optical transmission through the photonic crystal are both measured. The optical transmission is then compared to the transmission spectra of a regular hexagonal photonic crystal, revealing the effects of diatom geometry on their optical properties. Finally, the dimensions of the photonic crystal are parametrically swept, allowing for further control over the transmission of light through the photonic crystal.

NOTE: MMCTP: a radiotherapy research environment for Monte Carlo and patient-specific treatment planning

NASA Astrophysics Data System (ADS)

Alexander, A.; DeBlois, F.; Stroian, G.; Al-Yahya, K.; Heath, E.; Seuntjens, J.

2007-07-01

Radiotherapy research lacks a flexible computational research environment for Monte Carlo (MC) and patient-specific treatment planning. The purpose of this study was to develop a flexible software package on low-cost hardware with the aim of integrating new patient-specific treatment planning with MC dose calculations suitable for large-scale prospective and retrospective treatment planning studies. We designed the software package 'McGill Monte Carlo treatment planning' (MMCTP) for the research development of MC and patient-specific treatment planning. The MMCTP design consists of a graphical user interface (GUI), which runs on a simple workstation connected through standard secure-shell protocol to a cluster for lengthy MC calculations. Treatment planning information (e.g., images, structures, beam geometry properties and dose distributions) is converted into a convenient MMCTP local file storage format designated, the McGill RT format. MMCTP features include (a) DICOM_RT, RTOG and CADPlan CART format imports; (b) 2D and 3D visualization views for images, structure contours, and dose distributions; (c) contouring tools; (d) DVH analysis, and dose matrix comparison tools; (e) external beam editing; (f) MC transport calculation from beam source to patient geometry for photon and electron beams. The MC input files, which are prepared from the beam geometry properties and patient information (e.g., images and structure contours), are uploaded and run on a cluster using shell commands controlled from the MMCTP GUI. The visualization, dose matrix operation and DVH tools offer extensive options for plan analysis and comparison between MC plans and plans imported from commercial treatment planning systems. The MMCTP GUI provides a flexible research platform for the development of patient-specific MC treatment planning for photon and electron external beam radiation therapy. The impact of this tool lies in the fact that it allows for systematic, platform

Dosimetry of Al2O3 optically stimulated luminescent dosimeter at high energy photons and electrons

NASA Astrophysics Data System (ADS)

Yusof, M. F. Mohd; Joohari, N. A.; Abdullah, R.; Shukor, N. S. Abd; Kadir, A. B. Abd; Isa, N. Mohd

2018-01-01

The linearity of Al2O3 OSL dosimeters (OSLD) were evaluated for dosimetry works in clinical photons and electrons. The measurements were made at a reference depth of Zref according to IAEA TRS 398:2000 codes of practice at 6 and 10 MV photons and 6 and 9 MeV electrons. The measured dose was compared to the thermoluminescence dosimeters (TLD) and ionization chamber commonly used for dosimetry works for higher energy photons and electrons. The results showed that the measured dose in OSL dosimeters were in good agreement with the reported by the ionization chamber in both high energy photons and electrons. A reproducibility test also reported excellent consistency of readings with the OSL at similar energy levels. The overall results confirmed the suitability of OSL dosimeters for dosimetry works involving high energy photons and electrons in radiotherapy.

[Principles of radiotherapy of non-small cell lung cancer].

PubMed

Esik, Olga; Horváth, Akos; Bajcsay, András; Hideghéty, Katalin; Agócs, László; Pikó, Béla; Lengyel, Zsolt; Petrányi, Agota; Pisch, Julianna

2002-01-01

The long-term survival probability for Hungarian lung cancer patients is 10% worse than the best results published in the most highly developed countries (the mean 5-year survival probability in Hungary is 5%, in contrast with the 15% survival probability in the USA). On the basis of the international recommendations and personal experience, an attempt was made to formulate the guidelines for radiotherapy as one of the fundamental non-small cell lung cancer (NSCLC) treatment modalities for national use. An expert panel was set up comprising physicians from 6 radiotherapeutic centers (the National Institute of Oncology / Semmelweis University, Budapest; the Beth Israel Medical Center, New York; the University of Kaposvár; the University of Essen; the University of Debrecen; and the County Hospital of Gyula). Experts in two important medical fields closely related to radiotherapy (surgery and diagnostic imaging) were also engaged in the elaboration of the manuscript. Discussion of the most important principles of the radiotherapy and an overview of the prognostic factors was followed by a critical analysis of the protocols applied in the radiotherapy of Hungarian NSCLC patients during recent decades. The new guidelines suggested for the radiotherapy of NSCLC are presented separately for the postoperative period, marginally resectable tumors, and the aggressive or non-aggressive radiotherapy of inoperable tumors. Detailed accounts are given of the techniques of external irradiation and brachytherapy, and of the acute and late radiation-induced damage of normal tissues. The authors believe that this document may be instrumental in improving the survival index of Hungarian NSCLC patients in the near future.

A Review of Update Clinical Results of Carbon Ion Radiotherapy

PubMed Central

Tsujii, Hirohiko; Kamada, Tadashi

2012-01-01

Among various types of ion species, carbon ions are considered to have the most balanced, optimal properties in terms of possessing physically and biologically effective dose localization in the body. This is due to the fact that when compared with photon beams, carbon ion beams offer improved dose distribution, leading to the concentration of the sufficient dose within a target volume while minimizing the dose in the surrounding normal tissues. In addition, carbon ions, being heavier than protons, provide a higher biological effectiveness, which increases with depth, reaching the maximum at the end of the beam's range. This is practically an ideal property from the standpoint of cancer radiotherapy. Clinical studies have been carried out in the world to confirm the efficacy of carbon ions against a variety of tumors as well as to develop effective techniques for delivering an efficient dose to the tumor. Through clinical experiences of carbon ion radiotherapy at the National Institute of Radiological Sciences and Gesellschaft für Schwerionenforschung, a significant reduction in the overall treatment time with acceptable toxicities has been obtained in almost all types of tumors. This means that carbon ion radiotherapy has meanwhile achieved for itself a solid place in general practice. This review describes clinical results of carbon ion radiotherapy together with physical, biological and technological aspects of carbon ions. PMID:22798685

The contribution of bends and constrictions of a superconducting film to the photon detection by a single-photon superconducting detector

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zotova, A. N., E-mail: zotova@imp.sci-nnov.ru

2016-05-15

The contribution of bends and constrictions by a superconducting film to the detection by a single photon superconducting detector is investigated. It has been shown that, for currents smaller than the minimal detection current of a straight film, the detection efficiency of a film with a constriction attains saturation upon an increase in the current, which coincides qualitatively with the behavior of this dependence observed in the experiment. It has also been found that the effect of bends in the film and the external magnetic field on the detection efficiency for low-energy photons is essential, while for high-energy photons nomore » such influence is observed.« less

Single-Shot Quantum Nondemolition Detection of Individual Itinerant Microwave Photons

NASA Astrophysics Data System (ADS)

Besse, Jean-Claude; Gasparinetti, Simone; Collodo, Michele C.; Walter, Theo; Kurpiers, Philipp; Pechal, Marek; Eichler, Christopher; Wallraff, Andreas

2018-04-01

Single-photon detection is an essential component in many experiments in quantum optics, but it remains challenging in the microwave domain. We realize a quantum nondemolition detector for propagating microwave photons and characterize its performance using a single-photon source. To this aim, we implement a cavity-assisted conditional phase gate between the incoming photon and a superconducting artificial atom. By reading out the state of this atom in a single shot, we reach an external (internal) photon-detection fidelity of 50% (71%), limited by transmission efficiency between the source and the detector (75%) and the coherence properties of the qubit. By characterizing the coherence and average number of photons in the field reflected off the detector, we demonstrate its quantum nondemolition nature. We envisage applications in generating heralded remote entanglement between qubits and for realizing logic gates between propagating microwave photons.

Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey

PubMed Central

Zelefsky, Michael J.; Lee, W. Robert; Zietman, Anthony; Khalid, Najma; Crozier, Cheryl; Owen, Jean; Wilson, J. Frank

2012-01-01

Purpose To test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and non-academic US institutions. Methods and Materials 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures, such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. Results 167 patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16–23 MV. For intermediate- plus high-risk patients (n=181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n=9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85/354), weekly electronic portal imaging was obtained as verification films without daily target localization and the remaining 76% were treated with daily localization of the target using various methods. Conclusions Adherence to defined quality indicators was observed in a majority of patients. ≈90% of high-risk patients are treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients receive prescription doses >=75 Gy, consistent with the published results of randomized trials. PMID:23471563

Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey.

PubMed

Zelefsky, Michael J; Lee, W Robert; Zietman, Anthony; Khalid, Najma; Crozier, Cheryl; Owen, Jean; Wilson, J Frank

2013-01-01

To test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and non-academic US institutions. 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures, such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. 167 patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16-23 MV. For intermediate- plus high-risk patients (n=181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n=9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85/354), weekly electronic portal imaging was obtained as verification films without daily target localization and the remaining 76% were treated with daily localization of the target using various methods. Adherence to defined quality indicators was observed in a majority of patients. ≈90% of high-risk patients are treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients receive prescription doses >=75 Gy, consistent with the published results of randomized trials.

HIFU therapy for local recurrence of prostate cancer after external beam radiotherapy and radical prostatectomy - 5,5 years experience

NASA Astrophysics Data System (ADS)

Solovov, V. A.; Vozdvizhenskiy, M. O.; Matysh, Y. S.

2017-03-01

Objectives. To evaluate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) for local recurrence of prostate cancer after external beam radiotherapy (EBRT) and radical prostatectomy (RPE). Materials and Methods: During 2007-2013 years 47 patients with local recurrence of prostate cancer after EBRT and RPE undertook HIFU therapy on the system "Ablaterm» (EDAP, France). Relapse arose after an average of 2 years after EBRT and RPE. Median follow-up after HIFU therapy was 38 (12-60) months. The mean age was 68.5 ± 5.8 years. The median PSA level before HIFU - 15.4 (7-48) ng / mL. Results: In 34 patients (72.3%) at six months after treatment the median PSA was 0.4 (0-3.2) ng / mL, in 48 months - 0.9 (0.4-7.5) ng / mL. In 13 patients (27.7%) at 6 months was observed progression of the disease. In general, after a 5-year follow-up 72.3% of the patients had no data for the progression and recurrence. Conclusion: HIFU therapy in patients with local recurrence of prostate cancer after EBRT and RPE is minimally invasive and effective technology.

A TCP model for external beam treatment of intermediate-risk prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walsh, Sean; Putten, Wil van der

2013-03-15

Purpose: Biological models offer the ability to predict clinical outcomes. The authors describe a model to predict the clinical response of intermediate-risk prostate cancer to external beam radiotherapy for a variety of fractionation regimes. Methods: A fully heterogeneous population averaged tumor control probability model was fit to clinical outcome data for hyper, standard, and hypofractionated treatments. The tumor control probability model was then employed to predict the clinical outcome of extreme hypofractionation regimes, as utilized in stereotactic body radiotherapy. Results: The tumor control probability model achieves an excellent level of fit, R{sup 2} value of 0.93 and a root meanmore » squared error of 1.31%, to the clinical outcome data for hyper, standard, and hypofractionated treatments using realistic values for biological input parameters. Residuals Less-Than-Or-Slanted-Equal-To 1.0% are produced by the tumor control probability model when compared to clinical outcome data for stereotactic body radiotherapy. Conclusions: The authors conclude that this tumor control probability model, used with the optimized radiosensitivity values obtained from the fit, is an appropriate mechanistic model for the analysis and evaluation of external beam RT plans with regard to tumor control for these clinical conditions.« less

Influence of External Beam Radiotherapy on the Properties of Polymethyl Methacrylate-Versus Silicone-Induced Membranes in a Bilateral Segmental Bone Defect in Rats.

PubMed

Sagardoy, Thomas; Ehret, Camille; Bareille, Reine; Benoit, Jérôme; Amedee, Joëlle; De Mones, Erwan

2018-05-01

Standard care for malignant tumors arising next to a bone structure is surgical removal with safety margins, followed by external beam radiotherapy (EBRT). Complete tumor removal can result in large bone defects. A two-step bone reconstruction technique using the induced membrane (IM) technique has proven its efficacy to bridge gap nonunion. During the first step, a spacer is placed in the bone gap. The spacer then is removed and the IM around it is filled with autologous cancellous bone graft. However, the feasibility of this technique with the addition of adjuvant EBRT between the two reconstruction steps has not yet been studied. Polymethyl methacrylate (PMMA) used to be the standard spacer material for the first step. Silicone spacers could replace them owing to their good behavior when submitted to EBRT and their easier removal from the surgical site during the second step. The aim of this study was to evaluate the influence of EBRT on the histological and biochemical properties of IM induced using PMMA or silicone as spacer. The analyses were performed on PMMA- or silicone-IM with and without EBRT in a 6-mm bilateral femoral defect in 32 rats. Thickness and vessel content were measured in both groups. Bone morphogenetic protein 2 (BMP2) and vascular endothelial growth factor (VEGF) content in lysates of the crushed membranes were measured by enzyme immunoassay. Finally, alkaline phosphatase activity was analyzed in human bone marrow stromal cell cultures in contact with the same lysates. EBRT did not change the histological structure of the cellular internal layer or the fibrous outer layer. The nature of the spacer only influenced IM thickness, PMMA-IM with external radiotherapy being significantly thicker. EBRT decreased the vascular density of IM but was less effective on VEGF/BMP2 production. In vitro, IM could have an osteoinductive potential on human bone marrow stem cells. EBRT did not modify the histological properties of IMs but decreased their

A comparison between cobalt and linear accelerator-based treatment plans for conformal and intensity-modulated radiotherapy.

PubMed

Adams, E J; Warrington, A P

2008-04-01

The simplicity of cobalt units gives them the advantage of reduced maintenance, running costs and downtime when compared with linear accelerators. However, treatments carried out on such units are typically limited to simple techniques. This study has explored the use of cobalt beams for conformal and intensity-modulated radiotherapy (IMRT). Six patients, covering a range of treatment sites, were planned using both X-ray photons (6/10 MV) and cobalt-60 gamma rays (1.17 and 1.33 MeV). A range of conformal and IMRT techniques were considered, as appropriate. Conformal plans created using cobalt beams for small breast, meningioma and parotid cases were found to compare well with those created using X-ray photons. By using additional fields, acceptable conformal plans were also created for oesophagus and prostate cases. IMRT plans were found to be of comparable quality for meningioma, parotid and thyroid cases on the basis of dose-volume histogram analysis. We conclude that it is possible to plan high-quality radical radiotherapy treatments for cobalt units. A well-designed beam blocking/compensation system would be required to enable a practical and efficient alternative to multileaf collimator (MLC)-based linac treatments to be offered. If cobalt units were to have such features incorporated into them, they could offer considerable benefits to the radiotherapy community.

Photon beam dose distributions for patients with implanted temporary tissue expanders

NASA Astrophysics Data System (ADS)

Asena, A.; Kairn, T.; Crowe, S. B.; Trapp, J. V.

2015-01-01

This study examines the effects of temporary tissue expanders (TTEs) on the dose distributions of photon beams in breast cancer radiotherapy treatments. EBT2 radiochromic film and ion chamber measurements were taken to quantify the attenuation and backscatter effects of the inhomogeneity. Results illustrate that the internal magnetic port present in a tissue expander causes a dose reduction of approximately 25% in photon tangent fields immediately downstream of the implant. It was also shown that the silicone elastomer shell of the tissue expander reduced the dose to the target volume by as much as 8%. This work demonstrates the importance for an accurately modelled high-density implant in the treatment planning system for post-mastectomy breast cancer patients.

SU-G-TeP3-13: The Role of Nanoscale Energy Deposition in the Development of Gold Nanoparticle-Enhanced Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirkby, C; The University of Calgary, Calgary, AB; Koger, B

2016-06-15

Purpose: Gold nanoparticles (GNPs) can enhance radiotherapy effects. The high photoelectric cross section of gold relative to tissue, particularly at lower energies, leads to localized dose enhancement. However in a clinical context, photon energies must also be sufficient to reach a target volume at a given depth. These properties must be balanced to optimize such a therapy. Given that nanoscale energy deposition patterns around GNPs play a role in determining biological outcomes, in this work we seek to establish their role in this optimization process. Methods: The PENELOPE Monte Carlo code was used to generate spherical dose deposition kernels inmore » 1000 nm diameter spheres around 50 nm diameter GNPs in response to monoenergetic photons incident on the GNP. Induced “lesions” were estimated by either a local effect model (LEM) or a mean dose model (MDM). The ratio of these estimates was examined for a range of photon energies (10 keV to 2 MeV), for three sets of linear-quadratic parameters. Results: The models produce distinct differences in expected lesion values, the lower the alpha-beta ratio, the greater the difference. The ratio of expected lesion values remained constant within 5% for energies of 40 keV and above across all parameter sets and rose to a difference of 35% for lower energies only for the lowest alpha-beta ratio. Conclusion: Consistent with other work, these calculations suggest nanoscale energy deposition patterns matter in predicting biological response to GNP-enhanced radiotherapy. However the ratio of expected lesions between the different models is largely independent of energy, indicating that GNP-enhanced radiotherapy scenarios can be optimized in photon energy without consideration of the nanoscale patterns. Special attention may be warranted for energies of 20 keV or below and low alpha-beta ratios.« less

TH-D-BRC-00: Educational Point Counter/Point: Has Photon RT Hit the Limits?

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Interest in proton therapy has increased dramatically in the past couple of years, especially in the United States. There certainly is an important place for proton therapy in the arsenal of cancer treatments. Its dosimetric advantage and potential for low toxicity makes it the perfect partner for photons and other cancer treatment modalities. Often there is a belief that the new technology ought to be better but many believe that they should be widely adopted in the clinic only after evidence has shown that they are at least as safe and efficacious as existing technologies, which are often less expensive.more » This is the case for proton radiotherapy. This session being both educational and debate will provide a good review of basics and technological advancement as well as a comprehensive clinical update for both proton and photon therapy. Future technology developments and how they will impact the potential dosimetric advantage of proton therapy will be discussed. Particularly the debate will focus on whether these developments will close or widen the gap between photon and proton therapy. Learning Objectives: To review challenges, limitations, and recent and future developments in proton therapy. To review challenges, limitations, recent and future developments in photon radiotherapy. To review current clinical trials and challenging clinical cases. C. Yu, No company or organization that my presentation mentions provided me with financial support. I am the Founder and CEO of Xcision Medical Systems, LLC. However, my presentation will not mention any product or technology developed by Xcision.« less

3-DIMENSIONAL EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE CANCER INCREASES THE RISK OF HIP FRACTURE

PubMed Central

Elliott, Sean P.; Jarosek, Stephanie L.; Alanee, Shaheen R.; Konety, Badrinath R.; Dusenbery, Kathryn E.; Virnig, Beth A.

2011-01-01

Background Hip fracture is associated with high morbidity and mortality. Pelvic external beam radiotherapy (EBRT) is known to increase the risk of hip fractures in women but the effect in men is unknown. Methods 45,662 men aged ≥66 years, diagnosed with prostate cancer in 1992–2004 were identified from the SEER-Medicare database. Using Kaplan-Meier methods and Cox proportional hazards models, the primary outcome of hip fracture risk was compared among men who received radical prostatectomy (RP), EBRT, EBRT+androgen suppression therapy (AST) or AST alone, controlling for age, osteoporosis, race and other comorbidities. A secondary outcome was distal forearm fractures as an indicator of fragility fracture risk outside the radiation field. Results After controlling for covariates, EBRT increased the risk of hip fractures by 76% (HR 1.76, 95% CI 1.38–2.40) without increasing the risk of distal forearm fractures (HR 0.80, 95% CI 0.56–1.14). Combination therapy with EBRT+AST increased the risk of hip fracture 145% relative to RP (HR 2.45, 95% CI 1.88–3.19) and by 40% relative to EBRT (HR 1.40, 95% CI 1.17–1.68). EBRT+AST increased the risk of distal forearm fracture by 43% relative to RP (HR 1.43, 95% CI 0.97–2.10). The number needed to treat to result in 1 hip fracture through 10 years was 51 (95% CI 31–103). Conclusion In men with prostate cancer, pelvic 3-D conformal EBRT is associated with a 76% increased risk of hip fracture. This risk is slightly increased further by the addition of short-course AST to EBRT. This risk associated with EBRT is site-specific as there is no increase in the risk of fall-related fractures outside the radiation field. PMID:21412999

The potential of intensity-modulated proton radiotherapy to reduce swallowing dysfunction in the treatment of head and neck cancer: A planning comparative study.

PubMed

van der Laan, Hans Paul; van de Water, Tara A; van Herpt, Heleen E; Christianen, Miranda E M C; Bijl, Hendrik P; Korevaar, Erik W; Rasch, Coen R; van 't Veld, Aart A; van der Schaaf, Arjen; Schilstra, Cornelis; Langendijk, Johannes A

2013-04-01

Predictive models for swallowing dysfunction were developed previously and showed the potential of improved intensity-modulated radiotherapy to reduce the risk of swallowing dysfunction. Still the risk is high. The aim of this study was to determine the potential of swallowing-sparing (SW) intensity-modulated proton therapy (IMPT) in head and neck cancer (HNC) for reducing the risk of swallowing dysfunction relative to currently used photon therapy. Twenty-five patients with oropharyngeal (n = 21) and hypopharyngeal (n = 4) cancer received primary radiotherapy, including bilateral neck irradiation, using standard (ST) intensity-modulated photon therapy (IMRT). Prophylactic (54 Gy) and therapeutic (70 Gy) target volumes were defined. The dose to the parotid and submandibular glands was reduced as much as possible. Four additional radiotherapy plans were created for each patient: SW-IMRT, ST-IMPT, 3-beam SW-IMPT (3B-SW-IMPT) and 7-beam SW-IMPT (7B-SW-IMPT). All plans were optimized similarly, with additional attempts to spare the swallowing organs at risk (SWOARs) in the SW plans. Probabilities of swallowing dysfunction were calculated with recently developed predictive models. All plans complied with standard HNC radiotherapy objectives. The mean parotid gland doses were similar for the ST and SW photon plans, but clearly lower in all IMPT plans (ipsilateral parotid gland ST-IMRT: 46 Gy, 7B-SW-IMPT: 29 Gy). The mean dose in the SWOARs was lowest with SW-IMPT, in particular with 7B-SW-IMPT (supraglottic larynx ST-IMRT: 60 Gy, 7B-SW-IMPT: 40 Gy). The observed dose reductions to the SWOARs translated into substantial overall reductions in normal tissue complication risks for different swallowing dysfunction endpoints. Compared with ST-IMRT, the risk of physician-rated grade 2-4 swallowing dysfunction was reduced on average by 8.8% (95% CI 6.5-11.1%) with SW-IMRT, and by 17.2% (95% CI: 12.7-21.7%) with 7B-SW-IMPT. SWOAR-sparing with proton therapy has the potential to

Monte Carlo simulations of patient dose perturbations in rotational-type radiotherapy due to a transverse magnetic field: A tomotherapy investigation

PubMed Central

Yang, Y. M.; Geurts, M.; Smilowitz, J. B.; Sterpin, E.; Bednarz, B. P.

2015-01-01

Purpose: Several groups are exploring the integration of magnetic resonance (MR) image guidance with radiotherapy to reduce tumor position uncertainty during photon radiotherapy. The therapeutic gain from reducing tumor position uncertainty using intrafraction MR imaging during radiotherapy could be partially offset if the negative effects of magnetic field-induced dose perturbations are not appreciated or accounted for. The authors hypothesize that a more rotationally symmetric modality such as helical tomotherapy will permit a systematic mediation of these dose perturbations. This investigation offers a unique look at the dose perturbations due to homogeneous transverse magnetic field during the delivery of Tomotherapy® Treatment System plans under varying degrees of rotational beamlet symmetry. Methods: The authors accurately reproduced treatment plan beamlet and patient configurations using the Monte Carlo code geant4. This code has a thoroughly benchmarked electromagnetic particle transport physics package well-suited for the radiotherapy energy regime. The three approved clinical treatment plans for this study were for a prostate, head and neck, and lung treatment. The dose heterogeneity index metric was used to quantify the effect of the dose perturbations to the target volumes. Results: The authors demonstrate the ability to reproduce the clinical dose–volume histograms (DVH) to within 4% dose agreement at each DVH point for the target volumes and most planning structures, and therefore, are able to confidently examine the effects of transverse magnetic fields on the plans. The authors investigated field strengths of 0.35, 0.7, 1, 1.5, and 3 T. Changes to the dose heterogeneity index of 0.1% were seen in the prostate and head and neck case, reflecting negligible dose perturbations to the target volumes, a change from 5.5% to 20.1% was observed with the lung case. Conclusions: This study demonstrated that the effect of external magnetic fields can be

Assessing the risk of second malignancies after modern radiotherapy

PubMed Central

Newhauser, Wayne D.; Durante, Marco

2014-01-01

Recent advances in radiotherapy have enabled the use of different types of particles, such as protons and heavy ions, as well as refinements to the treatment of tumours with standard sources (photons). However, the risk of second cancers arising in long-term survivors continues to be a problem. The long-term risks from treatments such as particle therapy have not yet been determined and are unlikely to become apparent for many years. Therefore, there is a need to develop risk assessments based on our current knowledge of radiation-induced carcinogenesis. PMID:21593785

Definitive radiotherapy for primary vaginal cancer: correlation between treatment patterns and recurrence rate.

PubMed

Kanayama, Naoyuki; Isohashi, Fumiaki; Yoshioka, Yasuo; Baek, Sungjae; Chatani, Masashi; Kotsuma, Tadayuki; Tanaka, Eiichi; Yoshida, Ken; Seo, Yuji; Suzuki, Osamu; Mabuchi, Seiji; Shiki, Yasuhiko; Tatsumi, Keiji; Kimura, Tadashi; Teshima, Teruki; Ogawa, Kazuhiko

2015-03-01

The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1-169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III-IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Fiber transport of spatially entangled photons

NASA Astrophysics Data System (ADS)

Löffler, W.; Eliel, E. R.; Woerdman, J. P.; Euser, T. G.; Scharrer, M.; Russell, P.

2012-03-01

High-dimensional entangled photons pairs are interesting for quantum information and cryptography: Compared to the well-known 2D polarization case, the stronger non-local quantum correlations could improve noise resistance or security, and the larger amount of information per photon increases the available bandwidth. One implementation is to use entanglement in the spatial degree of freedom of twin photons created by spontaneous parametric down-conversion, which is equivalent to orbital angular momentum entanglement, this has been proven to be an excellent model system. The use of optical fiber technology for distribution of such photons has only very recently been practically demonstrated and is of fundamental and applied interest. It poses a big challenge compared to the established time and frequency domain methods: For spatially entangled photons, fiber transport requires the use of multimode fibers, and mode coupling and intermodal dispersion therein must be minimized not to destroy the spatial quantum correlations. We demonstrate that these shortcomings of conventional multimode fibers can be overcome by using a hollow-core photonic crystal fiber, which follows the paradigm to mimic free-space transport as good as possible, and are able to confirm entanglement of the fiber-transported photons. Fiber transport of spatially entangled photons is largely unexplored yet, therefore we discuss the main complications, the interplay of intermodal dispersion and mode mixing, the influence of external stress and core deformations, and consider the pros and cons of various fiber types.

Thermally Driven Photonic Actuator Based on Silica Opal Photonic Crystal with Liquid Crystal Elastomer.

PubMed

Xing, Huihui; Li, Jun; Shi, Yang; Guo, Jinbao; Wei, Jie

2016-04-13

We have developed a novel thermoresponsive photonic actuator based on three-dimensional SiO2 opal photonic crystals (PCs) together with liquid crystal elastomers (LCEs). In the process of fabrication of such a photonic actuator, the LCE precursor is infiltrated into the SiO2 opal PC followed by UV light-induced photopolymerization, thereby forming the SiO2 opal PC/LCE composite film with a bilayer structure. We find that this bilayer composite film simultaneously exhibits actuation behavior as well as the photonic band gap (PBG) response to external temperature variation. When the SiO2 opal PC/LCE composite film is heated, it exhibits a considerable bending deformation, and its PBG shifts to a shorter wavelength at the same time. In addition, this actuation is quite fast, reversible, and highly repeatable. The thermoresponsive behavior of the SiO2 opal PC/LCE composite films mainly derives from the thermal-driven change of nematic order of the LCE layer which leads to the asymmetric shrinkage/expansion of the bilayer structure. These results will be of interest in designing optical actuator systems for environment-temperature detection.

Role of Fractionated External Beam Radiotherapy in Hemangioblastoma of the Central Nervous System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koh, Eng-Siew; Nichol, Alan; Millar, Barbara-Ann

2007-12-01

Purpose: To assess the clinical outcomes and toxicity in patients receiving fractionated external beam radiotherapy (EBRT) for hemangioblastoma of the central nervous system, treated at two Canadian radiation oncology institutions. Methods and Materials: Between January 1980 and December 2004, the data of all patients receiving EBRT for central nervous system hemangioblastoma were retrospectively reviewed. The patient, tumor, and treatment characteristics were collected and overall survival, disease-free survival, and EBRT-related toxicities assessed. Results: A total of 18 cases, 5 associated with von Hippel-Lindau disease (VHL) and 13 sporadic (non-VHL), with a total 31 lesions, were documented. These were located in themore » cerebellum in 20 and spinal cord in 8 patients. EBRT was delivered for recurrence in 12, adjuvantly for residual disease in 4, and definitively in 2. The EBRT schedules ranged from 50.0 to 55.8 Gy in 1.8-2.0-Gy daily fractions (n = 17), typically with parallel-opposed fields to the cerebellar target volumes and direct posterior fields for spinal disease. At a median follow-up of 5.1 years (range, 0.1-14.5), the 5-year OS rate was 69% (95% confidence interval [CI], 50-96%), decreasing to 30% (95% CI, 10-87%) at 10 years. The disease-free survival rate at 5 and 10 years was 57% (95% CI, 37-87%) and 30% (95% CI, 11-83%), respectively. The outcomes differed according to VHL status. The 5-year OS rate was 100% for those with VHL compared with 55% (95% CI, 32-95%) for those with non-VHL disease (log-rank p = 0.003), and the 5-year disease-free survival rate was 80% (95% CI, 52-100%) with VHL compared with 48% (95% CI, 26-89%) without (log-rank p = 0.036). Conclusions: Fractionated EBRT has a role in the management of extensive intracranial and/or spinal cord disease, the adjuvant treatment of residual postoperative disease, and the treatment of recurrence. More favorable outcomes were reported for VHL-associated lesions than for sporadic cases.« less

Experiences with an application of industrial robotics for accurate patient positioning in proton radiotherapy.

PubMed

Allgower, C E; Schreuder, A N; Farr, J B; Mascia, A E

2007-03-01

Protons beams deliver targeted radiation doses with greater precision than is possible with electrons or megavoltage X-ray photons, but to retain this advantage, patient positioning systems at proton clinics must meet tighter accuracy requirements. For this and other reasons, robots were incorporated into the treatment room systems at MPRI. The Midwest Proton Radiotherapy Institute (MPRI) is the first radiotherapy facility in the United States to use commercial robots with six degrees of freedom for patient positioning, rather than a traditional bed with four degrees of freedom. This paper outlines the ways in which robots are used at MPRI and attempts to distil insights from the experience of treating over 200 radiotherapy patients with a robotic system from February 2004 to late 2006. The system has performed well, and with great reliability, but there is room for future improvement, especially in ease of use and in reducing the time to get patients into position. Copyright 2006 John Wiley & Sons, Ltd.

Intracranial meningiomas related to external cranial irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spallone, A.; Gagliardi, F.M.; Vagnozzi, R.

1979-08-01

Three cases are presented of meningiomas following small-dose external cranial irradiation in which several features clearly indicate a causal relationship between radiotherapy and tumor development. The length of the latent period separates meningiomas following high-dose irradiation from those which followed small-dose irradiation. Therefore the oncogenic mechanism seems to act differently in the two groups. This demonstration that multiple meningiomas can occur in patients irradiated for Tinea capitis should enable other similar cases to be recognized.

Photon pair source via two coupling single quantum emitters

NASA Astrophysics Data System (ADS)

Peng, Yong-Gang; Zheng, Yu-Jun

2015-10-01

We study the two coupling two-level single molecules driven by an external field as a photon pair source. The probability of emitting two photons, P2, is employed to describe the photon pair source quality in a short time, and the correlation coefficient RAB is employed to describe the photon pair source quality in a long time limit. The results demonstrate that the coupling single quantum emitters can be considered as a stable photon pair source. Project supported by the National Natural Science Foundation of China (Grand Nos. 91021009, 21073110, and 11374191), the Natural Science Foundation of Shandong Province, China (Grant No. ZR2013AQ020), the Postdoctoral Science Foundation of China (Grant No. 2013M531584), the Doctoral Program of Higher Education of China (Grant Nos. 20130131110005 and 20130131120006), and the Taishan Scholarship Project of Shandong Province, China.

A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma.

PubMed

Windsor, Phyllis M; Nicol, Kathleen F; Potter, Joan

2004-08-01

Advice to rest and take things easy if patients become fatigued during radiotherapy may be detrimental. Aerobic walking improves physical functioning and has been an intervention for chemotherapy-related fatigue. A prospective, randomized, controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma. Sixty-six men were randomized before they received radical radiotherapy for localized prostate carcinoma, with 33 men randomized to an exercise group and 33 men randomized to a control group. Outcome measures were fatigue and distance walked in a modified shuttle test before and after radiotherapy. There were no significant between group differences noted with regard to fatigue scores at baseline (P = 0.55) or after 4 weeks of radiotherapy (P = 0.18). Men in the control group had significant increases in fatigue scores from baseline to the end of radiotherapy (P = 0.013), with no significant increases observed in the exercise group (P = 0.203). A nonsignificant reduction (2.4%) in shuttle test distance at the end of radiotherapy was observed in the control group; however, in the exercise group, there was a significant increase (13.2%) in distance walked (P = 0.0003). Men who followed advice to rest and take things easy if they became fatigued demonstrated a slight deterioration in physical functioning and a significant increase in fatigue at the end of radiotherapy. Home-based, moderate-intensity walking produced a significant improvement in physical functioning with no significant increase in fatigue. Improved physical functioning may be necessary to combat radiation fatigue.

Transverse angular momentum in topological photonic crystals

NASA Astrophysics Data System (ADS)

Deng, Wei-Min; Chen, Xiao-Dong; Zhao, Fu-Li; Dong, Jian-Wen

2018-01-01

Engineering local angular momentum of structured light fields in real space enables applications in many fields, in particular, the realization of unidirectional robust transport in topological photonic crystals with a non-trivial Berry vortex in momentum space. Here, we show transverse angular momentum modes in silicon topological photonic crystals when considering transverse electric polarization. Excited by a chiral external source with either transverse spin angular momentum or transverse phase vortex, robust light flow propagating along opposite directions is observed in several kinds of sharp-turn interfaces between two topologically-distinct silicon photonic crystals. A transverse orbital angular momentum mode with alternating phase vortex exists at the boundary of two such photonic crystals. In addition, unidirectional transport is robust to the working frequency even when the ring size or location of the pseudo-spin source varies in a certain range, leading to the superiority of the broadband photonic device. These findings enable one to make use of transverse angular momentum, a kind of degree of freedom, to achieve unidirectional robust transport in the telecom region and other potential applications in integrated photonic circuits, such as on-chip robust delay lines.

Correlation between external and internal respiratory motion: a validation study.

PubMed

Ernst, Floris; Bruder, Ralf; Schlaefer, Alexander; Schweikard, Achim

2012-05-01

In motion-compensated image-guided radiotherapy, accurate tracking of the target region is required. This tracking process includes building a correlation model between external surrogate motion and the motion of the target region. A novel correlation method is presented and compared with the commonly used polynomial model. The CyberKnife system (Accuray, Inc., Sunnyvale/CA) uses a polynomial correlation model to relate externally measured surrogate data (optical fibres on the patient's chest emitting red light) to infrequently acquired internal measurements (X-ray data). A new correlation algorithm based on ɛ -Support Vector Regression (SVR) was developed. Validation and comparison testing were done with human volunteers using live 3D ultrasound and externally measured infrared light-emitting diodes (IR LEDs). Seven data sets (5:03-6:27 min long) were recorded from six volunteers. Polynomial correlation algorithms were compared to the SVR-based algorithm demonstrating an average increase in root mean square (RMS) accuracy of 21.3% (0.4 mm). For three signals, the increase was more than 29% and for one signal as much as 45.6% (corresponding to more than 1.5 mm RMS). Further analysis showed the improvement to be statistically significant. The new SVR-based correlation method outperforms traditional polynomial correlation methods for motion tracking. This method is suitable for clinical implementation and may improve the overall accuracy of targeted radiotherapy.

Multichannel tunable omnidirectional photonic band gaps of 1D ternary photonic crystal containing magnetized cold plasma

NASA Astrophysics Data System (ADS)

Awasthi, Suneet Kumar; Panda, Ranjita; Chauhan, Prashant Kumar; Shiveshwari, Laxmi

2018-05-01

By using the transfer matrix method, theoretical investigations have been carried out in the microwave region to study the reflection properties of multichannel tunable omnidirectional photonic bandgaps (OPBGs) based on the magneto-optic Faraday effect. The proposed one dimensional ternary plasma photonic crystal consists of alternate layers of quartz, magnetized cold plasma (MCP), and air. In the absence of an external magnetic field, the proposed structure possesses two OPBGs induced by Bragg scattering and is strongly dependent on the incident angle, the polarization of the incident light, and the lattice constant unlike to the single-negative gap and zero- n ¯ gap. Next, the reflection properties of OPBGs have been made tunable by the application of external magnetic field under right hand and left hand polarization configurations. The results of this manuscript may be utilized for the development of a new kind of tunable omnidirectional band stop filter with ability to completely stop single to multiple bands (called channels) of microwave frequencies in the presence of external static magnetic field under left-hand polarization and right-hand polarization configurations, respectively. Moreover, outcomes of this study open a promising way to design tunable magneto-optical devices, omnidirectional total reflectors, and planar waveguides of high Q microcavities as a result of evanescent fields in the MCP layer to allow propagation of light.

Proton or photon irradiation for hemangiomas of the choroid? A retrospective comparison

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoecht, Stefan; Wachtlin, Joachim; Bechrakis, Nikolaos E.

2006-10-01

Purpose: The aim of this study was to compare, on a retrospective basis, the results of therapy in patients with uveal hemangioma treated with photon or proton irradiation at a single center. Methods and Materials: From 1993 to 2002 a total of 44 patients were treated. Until 1998 radiotherapy was given with 6 MV photons in standard fractionation of 2.0 Gy 5 times per week. In 1998 proton therapy became available and was used since then. A dose of 20 to 22.5 Cobalt Gray Equivalent (CGE) 68 MeV protons was given on 4 consecutive days. Progressive symptoms or deterioration ofmore » vision were the indications for therapy. Results: Of the 44 patients treated, 36 had circumscribed choroidal hemangiomas and 8 had diffuse choroidal hemangiomas (DCH) and Sturge-Weber syndrome. Of the patients, 19 were treated with photons with a total dose in the range of 16 to 30 Gy. A total of 25 patients were irradiated with protons. All patients with DCH but 1 were treated with photons. Stabilization of visual acuity was achieved in 93.2% of all patients. Tumor thickness decreased in 95.4% and retinal detachment resolved in 92.9%. Late effects, although generally mild or moderate, were frequently detected. In all, 40.9% showed radiation-induced optic neuropathy, maximum Grade I. Retinopathy was found in 29.5% of cases, but only 1 patient experienced more than Grade II severity. Retinopathy and radiation-induced optic neuropathy were reversible in some of the patients and in some resolved completely. No differences could be detected between patients with circumscribed choroidal hemangiomas treated with protons and photons. Treatment was less effective in DCH patients (75%). Conclusions: Radiotherapy is effective in treating choroidal hemangiomas with respect to visual acuity and tumor thickness but a benefit of proton therapy could not be detected. Side effects are moderate but careful monitoring for side effects should be part of the follow-up procedures.« less

RF Photonic Technology in Optical Fiber Links

NASA Astrophysics Data System (ADS)

Chang, William S. C.

2007-06-01

List of contributors; Introduction and preface; 1. Figures of merit and performance analysis of photonic microwave links Charles Cox and William S. C. Chang; 2. RF subcarrier links in local access networks Xiaolin Lu; 3. Analog modulation of semiconductor lasers Joachim Piprek and John E. Bowers; 4. LiNbO3 external modulators and their use in high performance analog links Gary E. Betts; 5. Broadband traveling wave modulators in LiNbO3 Marta M. Howerton and William K. Burns; 6. Multiple quantum well electroabsorption modulators for RF photonic links William S. C. Chang; 7. Polymer modulators for RF photonics Timothy Van Eck; 8. Photodiodes for high performance analog links P. K. L. Yu and Ming C. Wu; 9. Opto-electronic oscillators X. Steve Yao; 10. Photonic link techniques for microwave frequency conversion Stephen A. Pappert, Roger Helkey and Ronald T. Logan Jr; 11. Antenna-coupled millimeter-wave electro-optical modulators William B. Bridges; 12. System design and performance of wideband photonic phased array antennas Greg L. Tangonan, Willie Ng, Daniel Yap and Ron Stephens; Acknowledgements; References; Index.

Multiple sclerosis, brain radiotherapy, and risk of neurotoxicity: The Mayo Clinic experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, Robert C.; Lachance, Daniel H.; Lucchinetti, Claudia F.

2006-11-15

Purpose: The aim of this study was a retrospective assessment of neurotoxicity in patients with multiple sclerosis (MS) receiving external beam radiotherapy (EBRT) to the brain. Methods and Materials: We studied 15 consecutively treated patients with MS who received brain EBRT. Neurologic toxicity was assessed with the Common Toxicity Criteria v.3.0. Results: Median follow-up for the 5 living patients was 6.0 years (range, 3.3-27.4 years). No exacerbation of MS occurred in any patient during EBRT. Five patients had Grade 4 neurologic toxicity and 1 had possible Grade 5 toxicity. Kaplan-Meier estimated risk of neurotoxicity greater than Grade 4 at 5more » years was 57% (95% confidence interval, 27%-82%). Toxicity occurred at 37.5 to 54.0 Gy at a median of 1.0 year (range, 0.2-4.3 years) after EBRT. Univariate analysis showed an association between opposed-field irradiation of the temporal lobes, central white matter, and brainstem and increased risk of neurotoxicity (p < 0.04). Three of 6 cases of toxicity occurred in patients treated before 1986. Conclusions: External beam radiotherapy of the brain in patients with MS may be associated with an increased risk of neurotoxicity compared with patients without demyelinating illnesses. However, this risk is associated with treatment techniques that may not be comparable to modern, conformal radiotherapy.« less

Customizable radiotherapy enhancement (CuRE) for prostate cancer using platinum based nanoparticles

NASA Astrophysics Data System (ADS)

Cifter, Gizem

New approach to prostate cancer (PCa) therapy titled "Customizable Radiotherapy Enhancement (CuRE)" employs cisplatin (C), carboplatin (Ca) and oxaliplatin (O) nanoparticles (CNPs, CaNPs and ONPs) as adjuvants to brachytherapy and external beam radiation therapy (EBRT), with the CNPs/CaNPs/ONPs released in situ from either brachytherapy spacers or fudicials loaded with the nanoparticles. The chemotherapy dose from the nanoparticles released in situ from within the prostate capsule, is enhanced by the physical dose due to photon interactions with the nanoparticles. The physical dose enhancement is due to low energy photons from the brachytherapy and EBRT sources interacting with the high-Z platinum component of the nanoparticles, causing emission of short-range photoelectrons to boost dose to the tumor. By varying the nanoparticle parameters, such as size, initial concentration, functionalization, location of spacer or fiducial, and intra-tumor biodistribution, the dose enhancement can be customized to maximize dose to tumor cells while minimizing toxicity to healthy cells. The hypothesis is that the CuRE approach will be a more efficacious method for concomitant cisplatin/carboplatin/oxaliplatin and radiotherapy treatment of localized prostate cancer due to significant dose boost to the PCa cells with minimal toxicity to healthy tissue. To investigate this hypothesis, microdosimetry calculations employing the energy loss formula of Cole were used to calculate the dose enhancement to the PCa cells from the CNPs/CaNPs/OPNs. The dose enhancement ratio (DEF) representing the ratio of the overall dose in the presence of CNPs/CaNPs/ONPs to the dose without CNPs/CaNPs/ONPs was determined for a range of CNP/CaNP/OPN concentrations up to their FDA approved limits. The dose enhancement to endothelial cells with (EDEF) with single concentration of cisplatin (42.8 mg/g) was found 2.6 with Pd-103. When EBRT source was used with single concentration of cisplatin, with 10cm x 10

Reconfigurable topological photonic crystal

NASA Astrophysics Data System (ADS)

Shalaev, Mikhail I.; Desnavi, Sameerah; Walasik, Wiktor; Litchinitser, Natalia M.

2018-02-01

Topological insulators are materials that conduct on the surface and insulate in their interior due to non-trivial topology of the band structure. The edge states on the interface between topological (non-trivial) and conventional (trivial) insulators are topologically protected from scattering due to structural defects and disorders. Recently, it was shown that photonic crystals (PCs) can serve as a platform for realizing a scatter-free propagation of light waves. In conventional PCs, imperfections, structural disorders, and surface roughness lead to significant losses. The breakthrough in overcoming these problems is likely to come from the synergy of the topological PCs and silicon-based photonics technology that enables high integration density, lossless propagation, and immunity to fabrication imperfections. For many applications, reconfigurability and capability to control the propagation of these non-trivial photonic edge states is essential. One way to facilitate such dynamic control is to use liquid crystals (LCs), which allow to modify the refractive index with external electric field. Here, we demonstrate dynamic control of topological edge states by modifying the refractive index of a LC background medium. Background index is changed depending on the orientation of a LC, while preserving the topology of the system. This results in a change of the spectral position of the photonic bandgap and the topological edge states. The proposed concept might be implemented using conventional semiconductor technology, and can be used for robust energy transport in integrated photonic devices, all-optical circuity, and optical communication systems.

Skeletal dosimetry in the MAX06 and the FAX06 phantoms for external exposure to photons based on vertebral 3D-microCT images

NASA Astrophysics Data System (ADS)

Kramer, R.; Khoury, H. J.; Vieira, J. W.; Kawrakow, I.

2006-12-01

3D-microCT images of vertebral bodies from three different individuals have been segmented into trabecular bone, bone marrow and bone surface cells (BSC), and then introduced into the spongiosa voxels of the MAX06 and the FAX06 phantoms, in order to calculate the equivalent dose to the red bone marrow (RBM) and the BSC in the marrow cavities of trabecular bone with the EGSnrc Monte Carlo code from whole-body exposure to external photon radiation. The MAX06 and the FAX06 phantoms consist of about 150 million 1.2 mm cubic voxels each, a part of which are spongiosa voxels surrounded by cortical bone. In order to use the segmented 3D-microCT images for skeletal dosimetry, spongiosa voxels in the MAX06 and the FAX06 phantom were replaced at runtime by so-called micro matrices representing segmented trabecular bone, marrow and BSC in 17.65, 30 and 60 µm cubic voxels. The 3D-microCT image-based RBM and BSC equivalent doses for external exposure to photons presented here for the first time for complete human skeletons are in agreement with the results calculated with the three correction factor method and the fluence-to-dose response functions for the same phantoms taking into account the conceptual differences between the different methods. Additionally the microCT image-based results have been compared with corresponding data from earlier studies for other human phantoms. This article is dedicated to Prof. Dr Guenter Drexler from the Laboratório de Ciências Radiológicas, State University of Rio de Janeiro, on the occasion of his 70th birthday.

On the Use of Optically Stimulated Luminescent Dosimeter for Surface Dose Measurement during Radiotherapy

PubMed Central

Yusof, Fasihah Hanum; Ung, Ngie Min; Wong, Jeannie Hsiu Ding; Jong, Wei Loong; Ath, Vannyat; Phua, Vincent Chee Ee; Heng, Siew Ping; Ng, Kwan Hoong

2015-01-01

This study was carried out to investigate the suitability of using the optically stimulated luminescence dosimeter (OSLD) in measuring surface dose during radiotherapy. The water equivalent depth (WED) of the OSLD was first determined by comparing the surface dose measured using the OSLD with the percentage depth dose at the buildup region measured using a Markus ionization chamber. Surface doses were measured on a solid water phantom using the OSLD and compared against the Markus ionization chamber and Gafchromic EBT3 film measurements. The effect of incident beam angles on surface dose was also studied. The OSLD was subsequently used to measure surface dose during tangential breast radiotherapy treatments in a phantom study and in the clinical measurement of 10 patients. Surface dose to the treated breast or chest wall, and on the contralateral breast were measured. The WED of the OSLD was found to be at 0.4 mm. For surface dose measurement on a solid water phantom, the Markus ionization chamber measured 15.95% for 6 MV photon beam and 12.64% for 10 MV photon beam followed by EBT3 film (23.79% and 17.14%) and OSLD (37.77% and 25.38%). Surface dose increased with the increase of the incident beam angle. For phantom and patient breast surface dose measurement, the response of the OSLD was higher than EBT3 film. The in-vivo measurements were also compared with the treatment planning system predicted dose. The OSLD measured higher dose values compared to dose at the surface (Hp(0.0)) by a factor of 2.37 for 6 MV and 2.01 for 10 MV photon beams, respectively. The measurement of absorbed dose at the skin depth of 0.4 mm by the OSLD can still be a useful tool to assess radiation effects on the skin dermis layer. This knowledge can be used to prevent and manage potential acute skin reaction and late skin toxicity from radiotherapy treatments. PMID:26052690

Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management

NASA Astrophysics Data System (ADS)

Fontanarosa, Davide; van der Meer, Skadi; Bamber, Jeffrey; Harris, Emma; O'Shea, Tuathan; Verhaegen, Frank

2015-02-01

In modern radiotherapy, verification of the treatment to ensure the target receives the prescribed dose and normal tissues are optimally spared has become essential. Several forms of image guidance are available for this purpose. The most commonly used forms of image guidance are based on kilovolt or megavolt x-ray imaging. Image guidance can also be performed with non-harmful ultrasound (US) waves. This increasingly used technique has the potential to offer both anatomical and functional information. This review presents an overview of the historical and current use of two-dimensional and three-dimensional US imaging for treatment verification in radiotherapy. The US technology and the implementation in the radiotherapy workflow are described. The use of US guidance in the treatment planning process is discussed. The role of US technology in inter-fraction motion monitoring and management is explained, and clinical studies of applications in areas such as the pelvis, abdomen and breast are reviewed. A companion review paper (O’Shea et al 2015 Phys. Med. Biol. submitted) will extensively discuss the use of US imaging for intra-fraction motion quantification and novel applications of US technology to RT.

Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management.

PubMed

Fontanarosa, Davide; van der Meer, Skadi; Bamber, Jeffrey; Harris, Emma; O'Shea, Tuathan; Verhaegen, Frank

2015-02-07

In modern radiotherapy, verification of the treatment to ensure the target receives the prescribed dose and normal tissues are optimally spared has become essential. Several forms of image guidance are available for this purpose. The most commonly used forms of image guidance are based on kilovolt or megavolt x-ray imaging. Image guidance can also be performed with non-harmful ultrasound (US) waves. This increasingly used technique has the potential to offer both anatomical and functional information.This review presents an overview of the historical and current use of two-dimensional and three-dimensional US imaging for treatment verification in radiotherapy. The US technology and the implementation in the radiotherapy workflow are described. The use of US guidance in the treatment planning process is discussed. The role of US technology in inter-fraction motion monitoring and management is explained, and clinical studies of applications in areas such as the pelvis, abdomen and breast are reviewed. A companion review paper (O'Shea et al 2015 Phys. Med. Biol. submitted) will extensively discuss the use of US imaging for intra-fraction motion quantification and novel applications of US technology to RT.

WE-G-BRE-06: New Potential for Enhancing External Beam Radiotherapy for Lung Cancer Using FDA-Approved Concentrations of Cisplatin Or Carboplatin Nanoparticles Administered Via Inhalation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hao, Y; Altundal, Y; Sajo, E

Purpose: This study investigates, for the first time, the dose enhancement to lung tumors due to cisplatin nanoparticles (CNPs) and carboplatin nanoparticles (CBNPs) administered via inhalation route (IR) during external beam radiotherapy. Methods: Using Monte Carlo generated 6 MV energy fluence spectra, a previously employed analytic method was used to estimate dose enhancement to lung tumor due to radiation-induced photoelectrons from CNPs administered via IR in comparison to intravenous (IV) administration. Previous studies have indicated about 5% of FDA-approved cisplatin concentrations reach the lung tumor via IV. Meanwhile recent experimental studies indicate that 3.5–14.6 times higher concentrations of CNPs canmore » reach the lung tumors by IR compared to IV. Taking these into account, the dose enhancement factor (DEF) defined as the ratio of the dose with and without CNPs was calculated for field size of 10 cm × 10 cm (sweeping gap), for a range of tumor depths and tumor sizes. Similar calculations were done for CBNPs. Results: For IR with 3.5 times higher concentrations than IV, and 2 cm diameter tumor, clinically significant DEF values of 1.19–1.30 were obtained for CNPs at 3–10 cm depth, respectively, in comparison to 1.06–1.09 for IV. For CBNPs, DEF values of 1.26–1.41 were obtained in comparison to 1.07–1.12 for IV. For IR with 14.6 times higher concentrations, higher DEF values were obtained e.g. 1.81–2.27 for CNPs. DEF increased with increasing field size or decreasing tumor size. Conclusions: Our preliminary results indicate that major dose enhancement to lung tumors can be achieved using CNPs/CBNPs administered via IR, in contrast to IV administration during external beam radiotherapy. These findings highlight a potential new approach for radiation boosting to lung tumors using CNPs/CBNPs administered via IR. This would, especially, be applicable during concomitant chemoradiotherapy, potentially allowing for dose enhancement while

The influence of bone density on the radiotherapy of cervix cancer

NASA Astrophysics Data System (ADS)

Soares, M. R.; Souza, D. N.

2011-10-01

Until the 1970s the irradiated region of a patient undergoing external beam radiotherapy was considered a homogeneous volume and a regular surface, with physical characteristics similar to water. With the improvement of medical imaging equipment, it has become possible to conduct planning in radiotherapy treatment that considers the heterogeneities and irregularities of a patient's anatomy. Consequently, such technological resources have brought greater accuracy to radiotherapy. In this study, we determined the variation in the average amount of absorbed dose on the target volume and at the point of prescription treatment by comparing the doses which were calculated in a planning system considering the patient both as a homogeneous, and as a heterogeneous medium. The results showed that when we take into account the volume of the upper vagina and cervix, and consider the pelvis as a heterogeneous medium, the calculated dose was under-estimated at some points in the studied volume with respect to the dose when this region was considered homogeneous.

Risk Factors of Developing Long-Lasting Breast Pain After Breast Cancer Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lundstedt, Dan, E-mail: dan.lundstedt@vgregion.se; Department of Oncology, Sahlgrenska University Hospital, Gothenburg; Gustafsson, Magnus

Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastasesmore » had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, loco-regional radiotherapy, axillary surgery, overweight, and smoking. Results: Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. Conclusions: Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long

Technologies for delivery of proton and ion beams for radiotherapy

NASA Astrophysics Data System (ADS)

Owen, Hywel; Holder, David; Alonso, Jose; Mackay, Ranald

2014-05-01

Recent developments for the delivery of proton and ion beam therapy have been significant, and a number of technological solutions now exist for the creation and utilisation of these particles for the treatment of cancer. In this paper we review the historical development of particle accelerators used for external beam radiotherapy and discuss the more recent progress towards more capable and cost-effective sources of particles.

Therapeutic and scintigraphic applications of polymeric micelles: combination of chemotherapy and radiotherapy in hepatocellular carcinoma

PubMed Central

Shih, Ying-Hsia; Peng, Cheng-Liang; Chiang, Ping-Fang; Lin, Wuu-Jyh; Luo, Tsai-Yueh; Shieh, Ming-Jium

2015-01-01

This study evaluated a multifunctional micelle simultaneously loaded with doxorubicin (Dox) and labeled with radionuclide rhenium-188 (188Re) as a combined radiotherapy and chemotherapy treatment for hepatocellular carcinoma. We investigated the single photon emission computed tomography, biodistribution, antitumor efficacy, and pathology of 188Re-Dox micelles in a murine orthotopic luciferase-transfected BNL tumor cells hepatocellular carcinoma model. The single photon emission computed tomography and computed tomography images showed high radioactivity in the liver and tumor, which was in agreement with the biodistribution measured by γ-counting. In vivo bioluminescence images showed the smallest size tumor (P<0.05) in mice treated with the combined micelles throughout the experimental period. In addition, the combined 188Re-Dox micelles group had significantly longer survival compared with the control, 188ReO4 alone (P<0.005), and Dox micelles alone (P<0.01) groups. Pathohistological analysis revealed that tumors treated with 188Re-Dox micelles had more necrotic features and decreased cell proliferation. Therefore, 188Re-Dox micelles may enable combined radiotherapy and chemotherapy to maximize the effectiveness of treatment for hepatocellular carcinoma. PMID:26719687

Mathematical modelling of radiotherapy strategies for early breast cancer.

PubMed

Enderling, Heiko; Anderson, Alexander R A; Chaplain, Mark A J; Munro, Alastair J; Vaidya, Jayant S

2006-07-07

Targeted intraoperative radiotherapy (Targit) is a new concept of partial breast irradiation where single fraction radiotherapy is delivered directly to the tumour bed. Apart from logistic advantages, this strategy minimizes the risk of missing the tumour bed and avoids delay between surgery and radiotherapy. It is presently being compared with the standard fractionated external beam radiotherapy (EBRT) in randomized trials. In this paper we present a mathematical model for the growth and invasion of a solid tumour into a domain of tissue (in this case breast tissue), and then a model for surgery and radiation treatment of this tumour. We use the established linear-quadratic (LQ) model to compute the survival probabilities for both tumour cells and irradiated breast tissue and then simulate the effects of conventional EBRT and Targit. True local recurrence of the tumour could arise either from stray tumour cells, or the tumour bed that harbours morphologically normal cells having a predisposition to genetic changes, such as a loss of heterozygosity (LOH) in genes that are crucial for tumourigenesis, e.g. tumour suppressor genes (TSGs). Our mathematical model predicts that the single high dose of radiotherapy delivered by Targit would result in eliminating all these sources of recurrence, whereas the fractionated EBRT would eliminate stray tumour cells, but allow (by virtue of its very schedule) the cells with LOH in TSGs or cell-cycle checkpoint genes to pass on low-dose radiation-induced DNA damage and consequently mutations that may favour the development of a new tumour. The mathematical model presented here is an initial attempt to model a biologically complex phenomenon that has until now received little attention in the literature and provides a 'proof of principle' that it is possible to produce clinically testable hypotheses on the effects of different approaches of radiotherapy for breast cancer.

Successful delivery of adjuvant external beam radiotherapy for ependymoma in a patient with Ondine's curse

DOE Office of Scientific and Technical Information (OSTI.GOV)

Choi, Mehee; Thoma, Miranda; Tolekidis, George

Ondine's curse is a rare, potentially life-threatening disorder characterized by loss of automatic breathing during sleep and preserved voluntary breathing. It is seldom encountered in the radiotherapy clinic but can pose significant technical challenges and safety concerns in the delivery of a prescribed radiation course. We report a unique case of successful delivery of radiotherapy for ependymoma in a patient with Ondine's curse. A 53-year-old gentleman presented with vertigo when lying down. Brain magnetic resonance imaging revealed an enhancing mass in the floor of the fourth ventricle. He underwent maximal safe resection. Pathology revealed ependymoma. The patient was referred formore » radiotherapy. Computed tomography simulation was performed in supine position with 3-point thermoplastic mask immobilization. Sequential TomoTherapy plans were developed. At first scheduled treatment, shortly after mask placement, his arms went limp and he was unresponsive. Vitals showed oxygen saturation 83%, pulse 127, and blood pressure 172/97 mm Hg. He was diagnosed with Ondine's curse thought secondary to previous brainstem damage; the combination of lying flat and pressure from the mask was causing him to go into respiratory arrest. As supine positioning did not seem clinically advisable, he was simulated in prone position. A RapidArc plan and a back-up conformal plan were developed. Prescriptions were modified to meet conservative organs-at-risk constraints. Several strategies were used to minimize uncertainties in set-up reproducibility associated with prone positioning. He tolerated prone RapidArc treatments well. The report highlights the importance of applying practical patient safety and treatment planning/delivery strategies in the management of this challenging case.« less

Commercial glass beads as TLDs in radiotherapy produced by different manufacturers

NASA Astrophysics Data System (ADS)

Jafari, S. M.; Bates, N. M.; Jupp, T.; Abdul Sani, S. F.; Nisbet, A.; Bradley, D. A.

2017-08-01

While commercial jewellery glass beads offer the basis of novel radiotherapy TL dosimetry (Jafari et al. 2014a,b,c, 2015a,b), detailed study of TL variation is required for the products from various manufacturers. Investigation is made for glass beads from four manufacturers from four countries: China (Rocaille), Japan (Mill Hill), Indonesia (TOHO™) and Czech Republic (Czech). Sample composition was determined using an energy-dispersive X-ray unit coupled to a scanning electron microscope. Values of mass attenuation coefficient, μ/ρ, as a function of photon energy were then calculated for photons of energy 1 keV to 10 MeV, using the National Institute of Standards and Technology XCOM program. Radiation and energy response were determined using X-rays generated at accelerating potentials from 80 kVp to 6 MV (TPR20/10=0.670). All bead types showed TL to be linear with dose (R2>0.999). Glow curve dosimetric peaks reached a maximum value at 300 °C for the Toho and 290 °C for the Czech and Mill Hill products but was between 200-250 °C for the Rocaille product. Radiation sensitivity following mass normalisation varied within an order of magnitude; Toho samples showed the greatest and Rocaille the least sensitivity. For the Toho, Czech, Rocaille and Mill Hill samples the energy responses at 80 kVp were 5.0, 4.0, 3.6 and 3.3 times that obtained at 6 MV. All four glass bead types offer potential use as TL dosimeters over doses commonly applied in radiotherapy. Energy response variation was <1% at 6 MV but significant variation was found for photon beam energies covering the kV range; careful characterisation is required if use at this range is intended.

Three-dimensional intrafractional internal target motions in accelerated partial breast irradiation using three-dimensional conformal external beam radiotherapy.

PubMed

Hirata, Kimiko; Yoshimura, Michio; Mukumoto, Nobutaka; Nakamura, Mitsuhiro; Inoue, Minoru; Sasaki, Makoto; Fujimoto, Takahiro; Yano, Shinsuke; Nakata, Manabu; Mizowaki, Takashi; Hiraoka, Masahiro

2017-07-01

We evaluated three-dimensional intrafractional target motion, divided into respiratory-induced motion and baseline drift, in accelerated partial breast irradiation (APBI). Paired fluoroscopic images were acquired simultaneously using orthogonal kV X-ray imaging systems at pre- and post-treatment for 23 patients who underwent APBI with external beam radiotherapy. The internal target motion was calculated from the surgical clips placed around the tumour cavity. The peak-to-peak respiratory-induced motions ranged from 0.6 to 1.5mm in all directions. A systematic baseline drift of 1.5mm towards the posterior direction and a random baseline drift of 0.3mm in the lateral-medial and cranial-caudal directions were observed. The baseline for an outer tumour cavity drifted towards the lateral and posterior directions, and that for an upper tumour cavity drifted towards the cranial direction. Moderate correlations were observed between the posterior baseline drift and the patients' physical characteristics. The posterior margin for intrafractional uncertainties was larger than 5mm in patients with greater fat thickness due to the baseline drift. The magnitude of the intrafractional motion was not uniform according to the direction, patients' physical characteristics, or tumour cavity location due to the baseline drift. Therefore, the intrafractional systematic movement should be properly managed. Copyright © 2017 Elsevier B.V. All rights reserved.

External beam radiotherapy synergizes 188Re-liposome against human esophageal cancer xenograft and modulates 188Re-liposome pharmacokinetics

PubMed Central

Chang, Chih-Hsien; Liu, Shin-Yi; Chi, Chih-Wen; Yu, Hsiang-Lin; Chang, Tsui-Jung; Tsai, Tung-Hu; Lee, Te-Wei; Chen, Yu-Jen

2015-01-01

External beam radiotherapy (EBRT) treats gross tumors and local microscopic diseases. Radionuclide therapy by radioisotopes can eradicate tumors systemically. Rhenium 188 (188Re)-liposome, a nanoparticle undergoing clinical trials, emits gamma rays for imaging validation and beta rays for therapy, with biodistribution profiles preferential to tumors. We designed a combinatory treatment and examined its effects on human esophageal cancer xenografts, a malignancy with potential treatment resistance and poor prognosis. Human esophageal cancer cell lines BE-3 (adenocarcinoma) and CE81T/VGH (squamous cell carcinoma) were implanted and compared. The radiochemical purity of 188Re-liposome exceeded 95%. Molecular imaging by NanoSPECT/CT showed that BE-3, but not CE81T/VGH, xenografts could uptake the 188Re-liposome. The combination of EBRT and 188Re-liposome inhibited tumor regrowth greater than each treatment alone, as the tumor growth inhibition rate was 30% with EBRT, 25% with 188Re-liposome, and 53% with the combination treatment at 21 days postinjection. Combinatory treatment had no additive adverse effects and significant biological toxicities on white blood cell counts, body weight, or liver and renal functions. EBRT significantly enhanced the excretion of 188Re-liposome into feces and urine. In conclusion, the combination of EBRT with 188Re-liposome might be a potential treatment modality for esophageal cancer. PMID:26056445

Optimization of combined electron and photon beams for breast cancer

NASA Astrophysics Data System (ADS)

Xiong, W.; Li, J.; Chen, L.; Price, R. A.; Freedman, G.; Ding, M.; Qin, L.; Yang, J.; Ma, C.-M.

2004-05-01

Recently, intensity-modulated radiation therapy and modulated electron radiotherapy have gathered a growing interest for the treatment of breast and head and neck tumours. In this work, we carried out a study to combine electron and photon beams to achieve differential dose distributions for multiple target volumes simultaneously. A Monte Carlo based treatment planning system was investigated, which consists of a set of software tools to perform accurate dose calculation, treatment optimization, leaf sequencing and plan analysis. We compared breast treatment plans generated using this home-grown optimization and dose calculation software for different treatment techniques. Five different planning techniques have been developed for this study based on a standard photon beam whole breast treatment and an electron beam tumour bed cone down. Technique 1 includes two 6 MV tangential wedged photon beams followed by an anterior boost electron field. Technique 2 includes two 6 MV tangential intensity-modulated photon beams and the same boost electron field. Technique 3 optimizes two intensity-modulated photon beams based on a boost electron field. Technique 4 optimizes two intensity-modulated photon beams and the weight of the boost electron field. Technique 5 combines two intensity-modulated photon beams with an intensity-modulated electron field. Our results show that technique 2 can reduce hot spots both in the breast and the tumour bed compared to technique 1 (dose inhomogeneity is reduced from 34% to 28% for the target). Techniques 3, 4 and 5 can deliver a more homogeneous dose distribution to the target (with dose inhomogeneities for the target of 22%, 20% and 9%, respectively). In many cases techniques 3, 4 and 5 can reduce the dose to the lung and heart. It is concluded that combined photon and electron beam therapy may be advantageous for treating breast cancer compared to conventional treatment techniques using tangential wedged photon beams followed by a boost

Silicon Photonics Transmitter with SOA and Semiconductor Mode-Locked Laser.

PubMed

Moscoso-Mártir, Alvaro; Müller, Juliana; Hauck, Johannes; Chimot, Nicolas; Setter, Rony; Badihi, Avner; Rasmussen, Daniel E; Garreau, Alexandre; Nielsen, Mads; Islamova, Elmira; Romero-García, Sebastián; Shen, Bin; Sandomirsky, Anna; Rockman, Sylvie; Li, Chao; Sharif Azadeh, Saeed; Lo, Guo-Qiang; Mentovich, Elad; Merget, Florian; Lelarge, François; Witzens, Jeremy

2017-10-24

We experimentally investigate an optical link relying on silicon photonics transmitter and receiver components as well as a single section semiconductor mode-locked laser as a light source and a semiconductor optical amplifier for signal amplification. A transmitter based on a silicon photonics resonant ring modulator, an external single section mode-locked laser and an external semiconductor optical amplifier operated together with a standard receiver reliably supports 14 Gbps on-off keying signaling with a signal quality factor better than 7 for 8 consecutive comb lines, as well as 25 Gbps signaling with a signal quality factor better than 7 for one isolated comb line, both without forward error correction. Resonant ring modulators and Germanium waveguide photodetectors are further hybridly integrated with chip scale driver and receiver electronics, and their co-operability tested. These experiments will serve as the basis for assessing the feasibility of a silicon photonics wavelength division multiplexed link relying on a single section mode-locked laser as a multi-carrier light source.

External-beam Co-60 radiotherapy for canine nasal tumors: a comparison of survival by treatment protocol.

PubMed

Yoon, J H; Feeney, D A; Jessen, C R; Walter, P A

2008-02-01

A retrospective analysis of survival times in dogs with intranasal tumors was performed comparing those treated using hypofractionated or full course Co-60 radiotherapy protocols alone or with surgical adjuvant therapy and those receiving no radiation treatment. One hundred thirty-nine dogs presented to the University of Minnesota Veterinary Medical Center for treatment of histologically-confirmed nasal neoplasia between July 1983 and October 2001 met the criteria for review. Statistically analyzed parameters included age at diagnosis, tumor histologic classification, fractionation schedule (number of treatments, and number of treatment days/week) (classified as hypofractionated if 2 or less treatments/week); calculated minimum tumor dose/fraction; calculated total minimum tumor dose (classified as hypofractionated if less than 37 Gy in six or fewer fractions); number of radiotherapy portals, a treatment gap of more than 7 days in a full course (3-5 treatments/week, 3-3.5 week treatment time) radiotherapy protocol, the influence of eye shields on survival following single portal DV fields, the survey radiographic extent of the disease, and the presence or absence of cytoreductive surgery. There was a significant relationship only between protocols using 3 or more treatments/week and at least 37 Gy cumulative minimum tumor dose and survival. However, there was no significant relationship between either total minimum tumor dose or dose/fraction and survival and there were no significant relationships between survival and any of the other variables analyzed including tumor histologic type.

Stereotactic fractionated radiotherapy for the treatment of benign meningiomas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Candish, Charles; McKenzie, Michael; Clark, Brenda G.

Purpose: To assess the use of stereotactic fractionated radiotherapy (SRT) for the treatment of meningiomas. Methods and Materials: Between April 1999 and October 2004, 38 patients underwent SRT. Of 34 patients (36 tumors) assessed, the median age was 53 years. The indication was primary treatment in 26 cases (no histology) and postoperative in 10 cases. The most common sites were cavernous sinus (17), optic nerve (6), and cerebellopontine angle (5). The median gross target volume and planning target volume were 8.9 cm{sup 3} and 18.9 cm{sup 3}, respectively. Stereotactic treatment was delivered with 6-MV photons with static conformal fields (custom-mademore » blocks, 9 patients, and micromultileaf collimator, 25 patients). Median number of fields was six. The median dose prescribed was 50 Gy (range, 45-50.4 Gy) in 28 fractions. The median homogeneity and conformality indices were 1.1 and 1.79, respectively. Results: Treatment was well tolerated. Median follow-up was 26 months with 100% progression-free survival. One patient developed an area of possible radionecrosis related to previous radiotherapy, and 2 men developed mild hypogonadism necessitating testosterone replacement. The vision of 5 of 6 patients with optic pathway meningiomas improved or remained static. Conclusions: Stereotactic fractionated radiotherapy for the treatment of meningiomas is practical, and with early follow-up, seems to be effective.« less

Dosimetric Comparison of Involved-Field Three-Dimensional Conformal Photon Radiotherapy and Breast-Sparing Proton Therapy for the Treatment of Hodgkin's Lymphoma in Female Pediatric Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andolino, David L., E-mail: dandolin@iupui.edu; Hoene, Ted; Xiao, Lu

2011-11-15

Purpose: To assess the potential reduction in breast dose for young girls with Hodgkin's lymphoma (HL) treated with breast-sparing proton therapy (BS-PT) as compared with three-dimensional conformal involved-field photon radiotherapy (3D-CRT). Methods and Materials: The Clarian Health Cancer Registry was queried for female pediatric patients with the diagnosis of HL who received radiotherapy at the Indiana University Simon Cancer Center during 2006-2009. The original CT simulation images were obtained, and 3D-CRT and BS-PT plans delivering 21 Gy or cobalt gray equivalent (CGE) in 14 fractions were created for each patient. Dose-volume histogram data were collected for both 3D-CRT and BS-PTmore » plans and compared by paired t test for correlated samples. Results: The cancer registry provided 10 female patients with Ann Arbor Stage II HL, aged 10-18 years at the time of treatment. Both mean and maximum breast dose were significantly less with BS-PT compared with 3D-CRT: 0.95 CGE vs. 4.70 Gy (p < 0.001) and 21.07 CGE vs. 23.11 Gy (p < 0.001), respectively. The volume of breast receiving 1.0 Gy/CGE and 5.0 Gy/CGE was also significantly less with BS-PT, 194 cm{sup 3} and 93 cm{sup 3}, respectively, compared with 790 cm{sup 3} and 360 cm{sup 3} with 3D-CRT (p = 0.009, 0.013). Conclusion: Breast-sparing proton therapy has the potential to reduce unnecessary breast dose in young girls with HL by as much as 80% relative to involved-field 3D-CRT.« less

Improved outcome of 131I-mIBG treatment through combination with external beam radiotherapy in the SK-N-SH mouse model of neuroblastoma.

PubMed

Corroyer-Dulmont, Aurélien; Falzone, Nadia; Kersemans, Veerle; Thompson, James; Allen, Danny P; Able, Sarah; Kartsonaki, Christiana; Malcolm, Javian; Kinchesh, Paul; Hill, Mark A; Vojnovic, Boris; Smart, Sean C; Gaze, Mark N; Vallis, Katherine A

2017-09-01

To assess the efficacy of different schedules for combining external beam radiotherapy (EBRT) with molecular radiotherapy (MRT) using 131 I-mIBG in the management of neuroblastoma. BALB/c nu/nu mice bearing SK-N-SH neuroblastoma xenografts were assigned to five treatment groups: 131 I-mIBG 24h after EBRT, EBRT 6days after 131 I-mIBG, EBRT alone, 131 I-mIBG alone and control (untreated). A total of 56 mice were assigned to 3 studies. Study 1: Vessel permeability was evaluated using dynamic contrast-enhanced (DCE)-MRI (n=3). Study 2: Tumour uptake of 131 I-mIBG in excised lesions was evaluated by γ-counting and autoradiography (n=28). Study 3: Tumour volume was assessed by longitudinal MR imaging and survival was analysed (n=25). Tumour dosimetry was performed using Monte Carlo simulations of absorbed fractions with the radiation transport code PENELOPE. Given alone, both 131 I-mIBG and EBRT resulted in a seven-day delay in tumour regrowth. Following EBRT, vessel permeability was evaluated by DCE-MRI and showed an increase at 24h post irradiation that correlated with an increase in 131 I-mIBG tumour uptake, absorbed dose and overall survival in the case of combined treatment. Similarly, EBRT administered seven days after MRT to coincide with tumour regrowth, significantly decreased the tumour volume and increased overall survival. This study demonstrates that combining EBRT and MRT has an enhanced therapeutic effect and emphasizes the importance of treatment scheduling according to pathophysiological criteria such as tumour vessel permeability and tumour growth kinetics. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Survival outcomes of radical prostatectomy and external beam radiotherapy in clinically localized high-risk prostate cancer: a population-based, propensity score matched study

PubMed Central

Gu, Xiaobin; Gao, Xianshu; Cui, Ming; Xie, Mu; Ma, Mingwei; Qin, Shangbin; Li, Xiaoying; Qi, Xin; Bai, Yun; Wang, Dian

2018-01-01

Objective This study was aimed to compare survival outcomes in high-risk prostate cancer (PCa) patients receiving external beam radiotherapy (EBRT) or radical prostatectomy (RP). Materials and methods The Surveillance, Epidemiology, and End Results (SEER) database was used to identify PCa patients with high-risk features who received RP alone or EBRT alone from 2004 to 2008. Propensity-score matching (PSM) was performed. Kaplan–Meier survival analysis was used to compare cancer-specific survival (CSS) and overall survival (OS). Multivariate Cox regression analysis was used to identify independent prognostic factors. Results A total of 24,293 patients were identified, 14,460 patients receiving RP and 9833 patients receiving EBRT. Through PSM, 3828 patients were identified in each group. The mean CSS was 128.6 and 126.7 months for RP and EBRT groups, respectively (P<0.001). The subgroup analyses showed that CSS of the RP group was better than that of the EBRT group for patients aged <65 years (P<0.001), White race (P<0.001), and married status (P<0.001). However, there was no significant difference in CSS for patients aged ≥65 years, Black race, other race, and unmarried status. Similar trends were observed for OS. Multivariate analysis showed that EBRT treatment modality, T3–T4 stage, Gleason score 8–10, and prostate-specific antigen >20 ng/mL were significant risk factors for both CSS and OS. Conclusion This study suggested that survival outcomes might be better with RP than EBRT in high-risk PCa patients aged <65 years; however, RP and EBRT provided equivalent survival outcomes in older patients, which argues for primary radiotherapy in this older cohort.

Laser modified processes: bremsstrahlung and inelastic photon atom scattering

NASA Astrophysics Data System (ADS)

Budriga, Olimpia; Dondera, Mihai; Florescu, Viorica

2007-08-01

We consider the influence of a low-frequency monochromatic external electromagnetic field (the laser) on two basic atomic processes: electron Coulomb bremsstrahlung and inelastic photon scattering on an electron bound in the ground state of a hydrogenic atom. We briefly describe the approximations adopted and illustrate in figures how the laser parameters modify the shape of the differential cross-sections and extend the energy domain for emitted electrons, due to simultaneous absorption or emission of a large number (hundreds) of laser photons.

Thermoluminescence Response of Ge-Doped Cylindrical-, Flat- and Photonic Crystal Silica-Fibres to Electron and Photon Radiation

PubMed Central

Entezam, A.; Khandaker, M. U.; Amin, Y. M.; Ung, N. M.; Bradley, D. A.; Maah, J.; Safari, M. J.; Moradi, F.

2016-01-01

Study has been made of the thermoluminescence (TL) response of silica-based Ge-doped cylindrical, flat and photonic crystal fibres (referred to herein as PCF-collapsed) to electron (6, 12 and 20 MeV) and photon (6, 10 MV) irradiation and 1.25 MeV γ-rays, for doses from 0.1 Gy to 100 Gy. The electron and photon irradiations were delivered through use of a Varian Model 2100C linear accelerator located at the University of Malaya Medical Centre and γ-rays delivered from a 60Co irradiator located at the Secondary Standard Dosimetry Laboratory (SSDL), Malaysian Nuclear Agency. Tailor-made to be of various dimensions and dopant concentrations (6–10% Ge), the fibres were observed to provide TL yield linear with radiation dose, reproducibility being within 1–5%, with insensitivity to energy and angular variation. The sensitivity dependency of both detectors with respect to field size follows the dependency of the output factors. For flat fibres exposed to 6 MV X-rays, the 6% Ge-doped fibre provided the greatest TL yield while PCF-collapsed showed a response 2.4 times greater than that of the 6% Ge-doped flat fibres. The response of cylindrical fibres increased with core size. The fibres offer uniform response, high spatial resolution and sensitivity, providing the basis of promising TL systems for radiotherapy applications. PMID:27149115

Feasibility of MR-only proton dose calculations for prostate cancer radiotherapy using a commercial pseudo-CT generation method

NASA Astrophysics Data System (ADS)

Maspero, Matteo; van den Berg, Cornelis A. T.; Landry, Guillaume; Belka, Claus; Parodi, Katia; Seevinck, Peter R.; Raaymakers, Bas W.; Kurz, Christopher

2017-12-01

A magnetic resonance (MR)-only radiotherapy workflow can reduce cost, radiation exposure and uncertainties introduced by CT-MRI registration. A crucial prerequisite is generating the so called pseudo-CT (pCT) images for accurate dose calculation and planning. Many pCT generation methods have been proposed in the scope of photon radiotherapy. This work aims at verifying for the first time whether a commercially available photon-oriented pCT generation method can be employed for accurate intensity-modulated proton therapy (IMPT) dose calculation. A retrospective study was conducted on ten prostate cancer patients. For pCT generation from MR images, a commercial solution for creating bulk-assigned pCTs, called MR for Attenuation Correction (MRCAT), was employed. The assigned pseudo-Hounsfield Unit (HU) values were adapted to yield an increased agreement to the reference CT in terms of proton range. Internal air cavities were copied from the CT to minimise inter-scan differences. CT- and MRCAT-based dose calculations for opposing beam IMPT plans were compared by gamma analysis and evaluation of clinically relevant target and organ at risk dose volume histogram (DVH) parameters. The proton range in beam’s eye view (BEV) was compared using single field uniform dose (SFUD) plans. On average, a (2%, 2 mm) gamma pass rate of 98.4% was obtained using a 10% dose threshold after adaptation of the pseudo-HU values. Mean differences between CT- and MRCAT-based dose in the DVH parameters were below 1 Gy (<1.5% ). The median proton range difference was 0.1 mm, with on average 96% of all BEV dose profiles showing a range agreement better than 3 mm. Results suggest that accurate MR-based proton dose calculation using an automatic commercial bulk-assignment pCT generation method, originally designed for photon radiotherapy, is feasible following adaptation of the assigned pseudo-HU values.

Periodically modulated single-photon transport in one-dimensional waveguide

NASA Astrophysics Data System (ADS)

Li, Xingmin; Wei, L. F.

2018-03-01

Single-photon transport along a one-dimension waveguide interacting with a quantum system (e.g., two-level atom) is a very useful and meaningful simplified model of the waveguide-based optical quantum devices. Thus, how to modulate the transport of the photons in the waveguide structures by adjusting certain external parameters should be particularly important. In this paper, we discuss how such a modulation could be implemented by periodically driving the energy splitting of the interacting atom and the atom-photon coupling strength. By generalizing the well developed time-independent full quantum mechanical theory in real space to the time-dependent one, we show that various sideband-transmission phenomena could be observed. This means that, with these modulations the photon has certain probabilities to transmit through the scattering atom in the other energy sidebands. Inversely, by controlling the sideband transmission the periodic modulations of the single photon waveguide devices could be designed for the future optical quantum information processing applications.

Quo vadis radiotherapy? Technological advances and the rising problems in cancer management.

PubMed

Allen, Barry J; Bezak, Eva; Marcu, Loredana G

2013-01-01

Despite the latest technological advances in radiotherapy, cancer control is still challenging for several tumour sites. The survival rates for the most deadly cancers, such as ovarian and pancreatic, have not changed over the last decades. The solution to the problem lies in the change of focus: from local treatment to systemic therapy. The aim of this paper is to present the current status as well as the gaps in radiotherapy and, at the same time, to look into potential solutions to improve cancer control and survival. The currently available advanced radiotherapy treatment techniques have been analysed and their cost-effectiveness discussed. The problem of systemic disease management was specifically targeted. Clinical studies show limited benefit in cancer control from hadron therapy. However, targeted therapies together with molecular imaging could improve treatment outcome for several tumour sites while controlling the systemic disease. The advances in photon therapy continue to be competitive with the much more expensive hadron therapy. To justify the cost effectiveness of proton/heavy ion therapy, there is a need for phase III randomised clinical trials. Furthermore, the success of systemic disease management lies in the fusion between radiation oncology technology and microbiology.

A novel surrogate to identify anatomical changes during radiotherapy of head and neck cancer patients.

PubMed

Gros, Sébastien A A; Xu, William; Roeske, John C; Choi, Mehe; Emami, Bahman; Surucu, Murat

2017-03-01

To develop a novel method to monitor external anatomical changes in head and neck cancer patients in order to triage possible adaptive radiotherapy needs. The presented approach aims to provide information on internal anatomical changes based on variations observed in external anatomy. Setup Cone Beam Computed Tomography (CBCT) images are processed to produce an accurate external contour of the patient's skin. After registering the CBCTs to the reference planning CT, the external contours from each CBCT are transferred to the initial - first week - CBCT. Contour radii, defined as the distances between an external contour and the isocenter projection in each CBCT slice, are calculated for each scan over the full 360 degrees. The changes in external anatomy are then quantified by the difference in radial distance between the external contours of any secondary CBCT relative to the initial CBCT. Finally, the radial difference is displayed in cylindrical coordinates as a 2D intensity map to highlight regions of interests with significant changes. Weekly CBCT scans from 15 head and neck patients were retrospectively analyzed to demonstrate the utility of this approach as a proof of principle. External changes suggested by the 2D radial difference map of an example patient after 23 fractions were then correlated with the changes in the gross tumor volumes and organs at risks. The resulting dosimetric effects were evaluated. An interactive standalone software application has been developed to facilitate the generation and the interpretation of the 2D intensity map. The 2D radial difference maps provided qualitative and quantitative information, such as the location and the magnitude of external contour changes and the rate at which these deviations occur. Out of the 15 patients, 10 presented clear evidence of general external volume shrinkage due to weight loss, and nine patients had at least one site of local shrinkage. Only two patients showed no signs of anatomical

Radiation-induced second primary cancer risks from modern external beam radiotherapy for early prostate cancer: impact of stereotactic ablative radiotherapy (SABR), volumetric modulated arc therapy (VMAT) and flattening filter free (FFF) radiotherapy

NASA Astrophysics Data System (ADS)

Murray, Louise J.; Thompson, Christopher M.; Lilley, John; Cosgrove, Vivian; Franks, Kevin; Sebag-Montefiore, David; Henry, Ann M.

2015-02-01

Risks of radiation-induced second primary cancer following prostate radiotherapy using 3D-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), flattening filter free (FFF) and stereotactic ablative radiotherapy (SABR) were evaluated. Prostate plans were created using 10 MV 3D-CRT (78 Gy in 39 fractions) and 6 MV 5-field IMRT (78 Gy in 39 fractions), VMAT (78 Gy in 39 fractions, with standard flattened and energy-matched FFF beams) and SABR (42.7 Gy in 7 fractions with standard flattened and energy-matched FFF beams). Dose-volume histograms from pelvic planning CT scans of three prostate patients, each planned using all 6 techniques, were used to calculate organ equivalent doses (OED) and excess absolute risks (EAR) of second rectal and bladder cancers, and pelvic bone and soft tissue sarcomas, using mechanistic, bell-shaped and plateau models. For organs distant to the treatment field, chamber measurements recorded in an anthropomorphic phantom were used to calculate OEDs and EARs using a linear model. Ratios of OED give relative radiation-induced second cancer risks. SABR resulted in lower second cancer risks at all sites relative to 3D-CRT. FFF resulted in lower second cancer risks in out-of-field tissues relative to equivalent flattened techniques, with increasing impact in organs at greater distances from the field. For example, FFF reduced second cancer risk by up to 20% in the stomach and up to 56% in the brain, relative to the equivalent flattened technique. Relative to 10 MV 3D-CRT, 6 MV IMRT or VMAT with flattening filter increased second cancer risks in several out-of-field organs, by up to 26% and 55%, respectively. For all techniques, EARs were consistently low. The observed large relative differences between techniques, in absolute terms, were very low, highlighting the importance of considering absolute risks alongside the corresponding relative risks, since when absolute

Palliative Radiotherapy in the Local Management of Stage IVB Esophageal Cancer: Factors Affecting Swallowing and Survival.

PubMed

Suzuki, Gen; Yamazaki, Hideya; Aibe, Norihiro; Masui, Koji; Tatekawa, Kotoha; Sasaki, Naomi; Kimoto, Takuya; Nishimura, Takeshi; Nakashima, Akihiro; Takenaka, Tadashi; Fujiwara, Hitoshi; Ishikawa, Takeshi; Yamada, Kei

2017-06-01

To clarify the role of external-beam radiotherapy in the local management of state IVB esophageal cancer. We reviewed records of 31 patients with histopathologically-proven squamous cell carcinoma who underwent radiotherapy for their primary lesion. The change in dysphagia score from before to after treatment was assessed. Nutritional support-free survival (NSFS) was also evaluated. The median overall survival was 6 months. The overall rate of improvement in dysphagia score was 73% (23/31). The median NSFS was 5 months. Age at presentation <67 years, tumor location in the middle thoracic esophagus, and tumor length <7 cm were associated with significant improvement in swallowing scores. Responders to radiotherapy had significantly longer NSFS than non-responders (p=0.04). Palliative radiotherapy in the local management of stage IVB esophageal cancer is an effective treatment option for dysphagia. Factors highly associated with improvement of swallowing are age, tumor location, and tumor length. Response to radiotherapy is the most important factor in improving NSFS. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Modelling the transport of optical photons in scintillation detectors for diagnostic and radiotherapy imaging

NASA Astrophysics Data System (ADS)

Roncali, Emilie; Mosleh-Shirazi, Mohammad Amin; Badano, Aldo

2017-10-01

Computational modelling of radiation transport can enhance the understanding of the relative importance of individual processes involved in imaging systems. Modelling is a powerful tool for improving detector designs in ways that are impractical or impossible to achieve through experimental measurements. Modelling of light transport in scintillation detectors used in radiology and radiotherapy imaging that rely on the detection of visible light plays an increasingly important role in detector design. Historically, researchers have invested heavily in modelling the transport of ionizing radiation while light transport is often ignored or coarsely modelled. Due to the complexity of existing light transport simulation tools and the breadth of custom codes developed by users, light transport studies are seldom fully exploited and have not reached their full potential. This topical review aims at providing an overview of the methods employed in freely available and other described optical Monte Carlo packages and analytical models and discussing their respective advantages and limitations. In particular, applications of optical transport modelling in nuclear medicine, diagnostic and radiotherapy imaging are described. A discussion on the evolution of these modelling tools into future developments and applications is presented. The authors declare equal leadership and contribution regarding this review.

Dose characteristics of in-house-built collimators for stereotactic radiotherapy with a linear accelerator.

PubMed

Norrgård, F S; Sipilä, P M; Kulmala, J A; Minn, H R

1998-06-01

Dose characteristics of a stereotactic radiotherapy unit based on a standard Varian Clinac 4/100 4 MV linear accelerator, in-house-built Lipowitz collimators and the SMART stereotactic radiotherapy treatment planning software have been determined. Beam collimation is constituted from the standard collimators of the linear accelerator and a tertiary collimation consisting of a replaceable divergent Lipowitz collimator. Four collimators with isocentre diameters of 15, 25, 35 and 45 mm, respectively, were constructed. Beam characteristics were measured in air, acrylic or water with ionization chamber, photon diode, electron diode, diamond detector and film. Monte Carlo simulation was also applied. The radiation leakage under the collimators was less than 1% at 50 mm depth in water. Specific beam characteristics for each collimator were imported to SMART and dose planning with five non-coplanar converging 140 degrees arcs separated by 36 degrees angles was performed for treatment of a RANDO phantom. Dose verification was made with TLD and radiochromic film. The in-house-built collimators were found to be suitable for stereotactic radiotherapy and patient treatments with this system are in progress.

Three-dimensional external beam radiotherapy for prostate cancer increases the risk of hip fracture.

PubMed

Elliott, Sean P; Jarosek, Stephanie L; Alanee, Shaheen R; Konety, Badrinath R; Dusenbery, Kathryn E; Virnig, Beth A

2011-10-01

Hip fracture is associated with high morbidity and mortality. Pelvic external beam radiotherapy (EBRT) is known to increase the risk of hip fractures in women, but the effect in men is unknown. From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, 45,662 men who were aged ≥66 years and diagnosed with prostate cancer in 1992-2004 were identified. By using Kaplan-Meier methods and Cox proportional hazards models, the primary outcome of hip fracture risk was compared among men who received radical prostatectomy (RP), EBRT, EBRT plus androgen suppression therapy (AST), or AST alone. Age, osteoporosis, race, and other comorbidities were statistically controlled. A secondary outcome was distal forearm fracture as an indicator of the risk of fall-related fracture outside the radiation field. After covariates were statistically controlled, the findings showed that EBRT increased the risk of hip fractures by 76% (hazards ratio [HR], 1.76; 95% confidence interval [CI], 1.38-2.40) without increasing the risk of distal forearm fractures (HR, 0.80; 95% CI, 0.56-1.14). Combination therapy with EBRT plus AST increased the risk of hip fracture 145% relative to RP alone (HR, 2.45; 95% CI, 1.88-3.19) and by 40% relative to EBRT alone (HR, 1.40; 95% CI, 1.17-1.68). EBRT plus AST increased the risk of distal forearm fracture by 43% relative to RP alone (HR, 1.43; 95% CI, 0.97-2.10). The number needed to treat to result in 1 hip fracture during a 10-year period was 51 patients (95% CI, 31-103). In men with prostate cancer, pelvic 3-D conformal EBRT was associated with a 76% increased risk of hip fracture. This risk was slightly increased further by the addition of short-course AST to EBRT. This risk associated with EBRT must be site-specific as there was no increase in the risk of fall-related fractures in bones that were outside the radiation field. Copyright © 2011 American Cancer Society.

Strategies to tackle the challenges of external beam radiotherapy for liver tumors.

PubMed

Lock, Michael I; Klein, Jonathan; Chung, Hans T; Herman, Joseph M; Kim, Edward Y; Small, William; Mayr, Nina A; Lo, Simon S

2017-05-18

Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity. Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis. However, the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment, management of motion and appropriate selection of dose regimen. This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines. Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation. Indeed, certain sub-populations, such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization, have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration. Implementing a liver radiation program requires three primary challenges to be addressed: (1) immobilization and motion management; (2) localization; and (3) dose regimen and constraint selection. Strategies to deal with motion include simple internal target volume (ITV) expansions, non-gated ITV reduction strategies, breath hold methods, and surrogate marker methods to enable gating or tracking. Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy, imaging modalities, and margin management. Finally, a dose response has been demonstrated and dose regimens appear to be converging. A more uniform approach to treatment in terms of technique, dose selection and patient selection will allow us to study liver radiation in larger and, hopefully, multicenter randomized

Strategies to tackle the challenges of external beam radiotherapy for liver tumors

PubMed Central

Lock, Michael I; Klein, Jonathan; Chung, Hans T; Herman, Joseph M; Kim, Edward Y; Small, William; Mayr, Nina A; Lo, Simon S

2017-01-01

Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity. Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis. However, the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment, management of motion and appropriate selection of dose regimen. This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines. Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation. Indeed, certain sub-populations, such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization, have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration. Implementing a liver radiation program requires three primary challenges to be addressed: (1) immobilization and motion management; (2) localization; and (3) dose regimen and constraint selection. Strategies to deal with motion include simple internal target volume (ITV) expansions, non-gated ITV reduction strategies, breath hold methods, and surrogate marker methods to enable gating or tracking. Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy, imaging modalities, and margin management. Finally, a dose response has been demonstrated and dose regimens appear to be converging. A more uniform approach to treatment in terms of technique, dose selection and patient selection will allow us to study liver radiation in larger and, hopefully, multicenter randomized

Unidirectional Wave Propagation in Low-Symmetric Colloidal Photonic-Crystal Heterostructures.

PubMed

Yannopapas, Vassilios

2015-03-19

We show theoretically that photonic crystals consisting of colloidal spheres exhibit unidirectional wave propagation and one-way frequency band gaps without breaking time-reversal symmetry via, e.g., the application of an external magnetic field or the use of nonlinear materials. Namely, photonic crystals with low symmetry such as the monoclinic crystal type considered here as well as with unit cells formed by the heterostructure of different photonic crystals show significant unidirectional electromagnetic response. In particular, we show that the use of scatterers with low refractive-index contrast favors the formation of unidirectional frequency gaps which is the optimal route for achieving unidirectional wave propagation.

Real-time dosimetry in radiotherapy using tailored optical fibers

NASA Astrophysics Data System (ADS)

Rahman, A. K. M. Mizanur; Zubair, H. T.; Begum, Mahfuza; Abdul-Rashid, H. A.; Yusoff, Z.; Omar, Nasr Y. M.; Ung, N. M.; Mat-Sharif, K. A.; Bradley, D. A.

2016-05-01

Real-time dosimetry plays an important role for accurate patient-dose measurement during radiotherapy. A tiny piece of laboratory fabricated Ge-doped optical fiber has been investigated as a radioluminescence (RL) sensor for real-time dosimetry over the dose range from 1 Gy to 8 Gy under 6 MV photon beam by LINAC. Fiber-coupled software-based RL prototype system was used to assess essential dosimetric characteristics including dose response linearity, dose rate dependency, sensitivity, repeatability and output dependence on field sizes. The consistency level of RL photon counts versus dose rate was also compared with that of standard Al2O3:C chips. Sensitivity of Ge-doped fiber were found to be sufficiently sensitive for practical use and also provided linear dose responses for various dose rates from 100 cGy/min to 600 cGy/min using both 6 MV photon and 6 MeV electron beams. SEM-EDX analysis was performed to identify Ge-dopant concentration level within the optical fiber RL material. Accumulated doses were also estimated using simple integral technique and the error was found to be around less than 1% under dissimilar dose rates or repeat measurements. The evaluation of the Ge-doped optical fiber based RL dosimeter system indicates its potential in medical dosimetry.

TU-D-201-03: Results of a Survey On the Implementation of the TG-51 Protocol and Associated Addendum On Reference Dosimetry of External Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, G; Muir, B; Culberson, W

Purpose: The working group on the review and extension of the TG-51 protocol (WGTG51) collected data from American Association of Physicists in Medicine (AAPM) members with respect to their current TG-51 and associated addendum usage in the interest of considering future protocol addenda and guidance on reference dosimetry best practices. This study reports an overview of this survey on dosimetry of external beams. Methods: Fourteen survey questions were developed by WGTG51 and released in November 2015. The questions collected information on reference dosimetry, beam quality specification, and ancillary calibration equipment. Results: Of the 190 submissions completed worldwide (U.S. 70%), 83%more » were AAPM members. Of the respondents, 33.5% implemented the TG-51 addendum, with the maximum calibration difference for any photon beam, with respect to the original TG-51 protocol, being <1% for 97.4% of responses. One major finding is that 81.8% of respondents used the same cylindrical ionization chamber for photon and electron dosimetry, implying that many clinics are foregoing the use of parallel-plate chambers. Other evidence suggests equivalent dosimetric results can be obtained with both cylindrical and parallel-plate chambers in electron beams. This, combined with users comfort with cylindrical chambers for electrons will likely impact recommendations put forward in an upcoming electron beam addendum to the TG-51 protocol. Data collected on ancillary equipment showed 58.2% (45.0%) of the thermometers (barometers) in use for beam calibration had NIST traceable calibration certificates, but 48.4% (42.7%) were never recalibrated. Conclusion: This survey provides a snapshot of TG-51 external beam reference dosimetry practice in radiotherapy centers. Findings demonstrate the rapid take-up of the TG-51 photon beam addendum and raise issues for the WGTG51 to focus on going forward, including guidelines on ancillary equipment and the choice of chamber for electron

Addressing as low as reasonably achievable (ALARA) issues: investigation of worker collective external and extremity dose data

DOE PAGES

Cournoyer, Michael Edward; Costigan, Stephen Andrew; Schreiber, Stephen Bruce

2017-03-17

Plutonium emits both neutrons and photons and when it is stored or handled inside a glovebox, both photons and neutrons are significant external radiation hazards. Doses to the extremities are usually dominated by gamma radiation in typical plutonium glovebox operations. Excess external dose can generates stochastic effects consisting of cancer and benign tumors in some organs. Direct doses from radiation sources external to the body are measured by thermoluminescent dosimeters (TLDs) placed on the glovebox worker between the neck and waist. Wrist dosimeters are used to assess externally penetrating radiation including neutrons and provide an estimate of neutron radiation exposuremore » to the extremities. Both TLDs and wrist dosimeters are processed monthly for most glovebox workers. Here, worker collective extremity and external dose data have been analyzed to prevent and mitigate external radiation events through the use of Lean Manufacturing and Six Sigma business practices (LSS). Employing LSS, statistically significant variations (trends) are identified in worker collective extremity and external dose data. Finally, the research results presented in this paper are pivotal to the ultimate focus of this program, which is to minimize external radiation events.« less

Addressing as low as reasonably achievable (ALARA) issues: investigation of worker collective external and extremity dose data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cournoyer, Michael Edward; Costigan, Stephen Andrew; Schreiber, Stephen Bruce

Plutonium emits both neutrons and photons and when it is stored or handled inside a glovebox, both photons and neutrons are significant external radiation hazards. Doses to the extremities are usually dominated by gamma radiation in typical plutonium glovebox operations. Excess external dose can generates stochastic effects consisting of cancer and benign tumors in some organs. Direct doses from radiation sources external to the body are measured by thermoluminescent dosimeters (TLDs) placed on the glovebox worker between the neck and waist. Wrist dosimeters are used to assess externally penetrating radiation including neutrons and provide an estimate of neutron radiation exposuremore » to the extremities. Both TLDs and wrist dosimeters are processed monthly for most glovebox workers. Here, worker collective extremity and external dose data have been analyzed to prevent and mitigate external radiation events through the use of Lean Manufacturing and Six Sigma business practices (LSS). Employing LSS, statistically significant variations (trends) are identified in worker collective extremity and external dose data. Finally, the research results presented in this paper are pivotal to the ultimate focus of this program, which is to minimize external radiation events.« less

The role of TRAIL in fatigue induced by repeated stress from radiotherapy.

PubMed

Feng, Li Rebekah; Suy, Simeng; Collins, Sean P; Saligan, Leorey N

2017-08-01

Fatigue is one of the most common and debilitating side effects of cancer and cancer treatment, and yet its etiology remains elusive. The goal of this study is to understand the role of chronic inflammation in fatigue following repeated stress from radiotherapy. Fatigue and non-fatigue categories were assessed using ≥ 3-point change in Functional Assessment of Cancer Therapy-Fatigue questionnaire (FACT-F) administered to participants at baseline/before radiotherapy and one year post-radiotherapy. Whole genome microarray and cytokine multiplex panel were used to examine fatigue-related transcriptome and serum cytokine changes, respectively. The study included 86 subjects (discovery phase n = 40, validation phase n = 46). The sample in the discovery phase included men with prostate cancer scheduled to receive external-beam radiotherapy. A panel of 48 cytokines were measured and the significantly changed cytokine found in the discovery phase was validated using sera from a separate cohort of men two years after completing radiotherapy for prostate cancer at a different institution. Effects of the significantly changed cytokine on cell viability was quantified using the MTT assay. During the discovery phase, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and TRAIL decoy receptor, TNFRSF10C (TRAIL-R3), were significantly upregulated in fatigued (≥3-point decrease from baseline to 1yr-post radiotherapy) subjects (n = 15). In the validation phase, TRAIL correlated with fatigue scores 2yrs post-radiotherapy. TRAIL caused selective cytotoxicity in neuronal cells, but not in microglial and muscle cells, in vitro. Late-onset inflammation directed by TRAIL may play a role in fatigue pathogenesis post-repeated stress from irradiation. Published by Elsevier Ltd.

Fast, noise-free memory for photon synchronization at room temperature.

PubMed

Finkelstein, Ran; Poem, Eilon; Michel, Ohad; Lahad, Ohr; Firstenberg, Ofer

2018-01-01

Future quantum photonic networks require coherent optical memories for synchronizing quantum sources and gates of probabilistic nature. We demonstrate a fast ladder memory (FLAME) mapping the optical field onto the superposition between electronic orbitals of rubidium vapor. Using a ladder-level system of orbital transitions with nearly degenerate frequencies simultaneously enables high bandwidth, low noise, and long memory lifetime. We store and retrieve 1.7-ns-long pulses, containing 0.5 photons on average, and observe short-time external efficiency of 25%, memory lifetime (1/ e ) of 86 ns, and below 10 -4 added noise photons. Consequently, coupling this memory to a probabilistic source would enhance the on-demand photon generation probability by a factor of 12, the highest number yet reported for a noise-free, room temperature memory. This paves the way toward the controlled production of large quantum states of light from probabilistic photon sources.

Intraoperative Radiotherapy for Parotid Cancer: A Single-Institution Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zeidan, Youssef H., E-mail: youssefzaidan@gmail.com; Shiue, Kevin; Weed, Daniel

2012-04-01

Purpose: Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland. Methods and Materials: Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component ofmore » definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years. Results: Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT. Conclusions: IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.« less

Survey of patient dosimetry for head and neck cancer patients undergoing external radiotherapy treatment: a study from northeastern hospitals of India.

PubMed

Sharma, Arunkumar B; Singh, Tomcha Th; Singh, Khelendra N; Gartia, R K

2009-01-01

To study dosimetry of patients during the external radiotherapy of head and neck cancers from different hospitals of the northeastern region (NER) of India. 35 confirmed cases of head and neck cancers reporting to three different hospitals in the NER of India who underwent radiation treatment were the materials for the study. Dosimetry was carried out at 8(eight) anatomical points to these patients, namely, target (entrance and exit points), forehead, chest, abdomen, gonad, arm, and leg respectively by thermoluminescence (TL) as well as optically stimulated luminescence (OSL) dosimeters. Unlike conventional appliances, we used common iodized salt as TL/OSL phosphor. Patient dosimetry was found to vary with an average of 1.17 +/- 0.39 Sv at forehead, 1.24 +/- 0.39 Sv at chest, 0.52 +/- 0.13 Sv at gonad to a minimum of 0.26 +/- 0.07 Sv at leg areas when exposed to a cumulative dose of 65 Sv at the target. Maximum dose received from a stray radiation is about 1.5 Sv at forehead/chest and dosimetry of patient among the three centers is not significantly different at the 5% level of probability.

pH Memory Effects of Tunable Block Copolymer Photonic Gels and Their Applications

NASA Astrophysics Data System (ADS)

Kang, Youngjong; Thomas, Edwin L.

2007-03-01

Materials with hysteresis, showing a bistable state to the external stimuli, have been widely investigated due to their potential applications. For example, they could be used as memory devices or optical switches when they have magnetic or optical hysteresis response to the external stimuli. Here we report pH tunable photonic gels which are spontaneously assembled from block copolymers. The general idea of this research is based on the selective swelling of block copolymer lamellar mesogels, where the solubility of one block is responsive to the change of pH. In this system, the domain spacing of the lamellar is varied with the extent of swelling. As a model system, we used protonated polystyrene-b-poly(2-vinly pyridine) (PS-b-P2VP) block copolymers forming lamellar structures. The photonic gel films prepared from protonated PS-b-P2VP show a strong reflectance in aqueous solution and the band position was varied with pH. Interestingly, a very strong optical hysteresis was observed while the reflection band of photonic gels was tuned by changing pH. We anticipate that pH tunable photonic gels with hysteresis can be applicable to novel applications such as a component of memory devices, photonic switches or drug delivery vehicles.

Finite element modeling of micromachined MEMS photon devices

NASA Astrophysics Data System (ADS)

Evans, Boyd M., III; Schonberger, D. W.; Datskos, Panos G.

1999-09-01

The technology of microelectronics that has evolved over the past half century is one of great power and sophistication and can now be extended to many applications (MEMS and MOEMS) other than electronics. An interesting application of MEMS quantum devices is the detection of electromagnetic radiation. The operation principle of MEMS quantum devices is based on the photoinduced stress in semiconductors, and the photon detection results from the measurement of the photoinduced bending. These devices can be described as micromechanical photon detectors. In this work, we have developed a technique for simulating electronic stresses using finite element analysis. We have used our technique to model the response of micromechanical photon devices to external stimuli and compared these results with experimental data. Material properties, geometry, and bimaterial design play an important role in the performance of micromechanical photon detectors. We have modeled these effects using finite element analysis and included the effects of bimaterial thickness coating, effective length of the device, width, and thickness.

Sexual (dys)function after radiotherapy for prostate cancer: a review.

PubMed

Incrocci, Luca; Slob, A Koos; Levendag, Peter C

2002-03-01

Prostate cancer has become the most common nonskin malignant neoplasm in older men in Western countries. As treatment efficacy has improved, issues related to posttherapy quality of life and sexual functioning have become more important. We discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. The etiologies of erectile dysfunction after external beam radiotherapy and brachytherapy for prostate cancer are also reviewed. The literature is summarized, and comparative studies of radiation and surgery are surveyed briefly. Rates of erectile dysfunction vary from 6 to 84% after external beam radiotherapy and from 0 to 51% after brachytherapy. In most of the studies, the analysis is retrospective, the definition of erectile dysfunction is not clear, only one question about sexual functioning is asked, and nonvalidated instruments are used. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood. Because erectile function is only one component of sexual function, it is necessary to assess sexual desire, satisfaction, frequency of intercourse, and other such factors when evaluating the effects of therapy. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices.

A Double-Blind Placebo-Controlled Randomized Clinical Trial With Magnesium Oxide to Reduce Intrafraction Prostate Motion for Prostate Cancer Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lips, Irene M., E-mail: i.m.lips@umcutrecht.nl; Gils, Carla H. van; Kotte, Alexis N.T.J.

2012-06-01

Purpose: To investigate whether magnesium oxide during external-beam radiotherapy for prostate cancer reduces intrafraction prostate motion in a double-blind, placebo-controlled randomized trial. Methods and Materials: At the Department of Radiotherapy, prostate cancer patients scheduled for intensity-modulated radiotherapy (77 Gy in 35 fractions) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide (500 mg twice a day) or placebo during radiotherapy. The primary outcome was the proportion of patients with clinically relevant intrafraction prostate motion, defined as the proportion of patients who demonstrated in {>=}50% of the fractions an intrafraction motion outside a range of 2 mm. Secondarymore » outcome measures included quality of life and acute toxicity. Results: In total, 46 patients per treatment arm were enrolled. The primary endpoint did not show a statistically significant difference between the treatment arms with a percentage of patients with clinically relevant intrafraction motion of 83% in the magnesium oxide arm as compared with 80% in the placebo arm (p = 1.00). Concerning the secondary endpoints, exploratory analyses demonstrated a trend towards worsened quality of life and slightly more toxicity in the magnesium oxide arm than in the placebo arm; however, these differences were not statistically significant. Conclusions: Magnesium oxide is not effective in reducing the intrafraction prostate motion during external-beam radiotherapy, and therefore there is no indication to use it in clinical practice for this purpose.« less

A methodology for TLD postal dosimetry audit of high-energy radiotherapy photon beams in non-reference conditions.

PubMed

Izewska, Joanna; Georg, Dietmar; Bera, Pranabes; Thwaites, David; Arib, Mehenna; Saravi, Margarita; Sergieva, Katia; Li, Kaibao; Yip, Fernando Garcia; Mahant, Ashok Kumar; Bulski, Wojciech

2007-07-01

A strategy for national TLD audit programmes has been developed by the International Atomic Energy Agency (IAEA). It involves progression through three sequential dosimetry audit steps. The first step audits are for the beam output in reference conditions for high-energy photon beams. The second step audits are for the dose in reference and non-reference conditions on the beam axis for photon and electron beams. The third step audits involve measurements of the dose in reference, and non-reference conditions off-axis for open and wedged symmetric and asymmetric fields for photon beams. Through a co-ordinated research project the IAEA developed the methodology to extend the scope of national TLD auditing activities to more complex audit measurements for regular fields. Based on the IAEA standard TLD holder for high-energy photon beams, a TLD holder was developed with horizontal arm to enable measurements 5cm off the central axis. Basic correction factors were determined for the holder in the energy range between Co-60 and 25MV photon beams. New procedures were developed for the TLD irradiation in hospitals. The off-axis measurement methodology for photon beams was tested in a multi-national pilot study. The statistical distribution of dosimetric parameters (off-axis ratios for open and wedge beam profiles, output factors, wedge transmission factors) checked in 146 measurements was 0.999+/-0.012. The methodology of TLD audits in non-reference conditions with a modified IAEA TLD holder has been shown to be feasible.

Surface dose investigation of the flattening filter-free photon beams.

PubMed

Wang, Yuenan; Khan, Mohammad K; Ting, Joseph Y; Easterling, Stephen B

2012-06-01

Flattening filter-free (FFF) x-rays can provide more efficient use of photons and a significant increase of dose rate compared with conventional flattened x-rays, features that are especially beneficial for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). The available data on the entrance doses of the FFF photon beams remain limited. The purpose of this study was to investigate the entrance dose of FFF photons in the buildup region and to compare it with that of conventional flattened photons. A Varian TrueBeam linear accelerator has been in full clinical operation with 6-MV and 10-MV FFF and flattened x-ray photons. Entrance dose at the surface was measured using a parallel plate ionization chamber in a solid water phantom with buildup depth = 0~15 mm for 6X and 0~25 mm for 10X. Different field size (FS) patterns were created in the Eclipse Treatment Planning System by multileaf collimator (MLC) rather than jaws (FS = 2 × 2, 3 × 3, 4 × 4, 6 × 6, and 10 × 10 cm(2) by MLC and jaw size = 2.2 × 2.2, 3.2 × 3.2, 4.2 × 4.2, 6 × 6, and 10 × 10 cm(2)). The smallest FS was about four times larger than the ion chamber dimension. All buildup dose measurements were normalized to FS = 10 × 10 cm(2) at the depth of dose maximum (dmax). Good repeatability was demonstrated and surface dose increased linearly with FS for both flattened and FFF photons. The entrance dose of the FFF photons was modestly larger than that of the corresponding flattened photons for both 6X and 10X for different FS ranging from 2 × 2 cm(2) to 10 × 10 cm(2). The FFF photons have a higher entrance dose than that of the corresponding flattened photons for FS smaller than 10 × 10 cm(2). However, the difference is not substantial and may be clinically insignificant. Published by Elsevier Inc.

The development and validation of a Monte Carlo model for calculating the out-of-field dose from radiotherapy treatments

NASA Astrophysics Data System (ADS)

Kry, Stephen

Introduction. External beam photon radiotherapy is a common treatment for many malignancies, but results in the exposure of the patient to radiation away from the treatment site. This out-of-field radiation irradiates healthy tissue and may lead to the induction of secondary malignancies. Out-of-field radiation is composed of photons and, at high treatment energies, neutrons. Measurement of this out-of-field dose is time consuming, often difficult, and is specific to the conditions of the measurements. Monte Carlo simulations may be a viable approach to determining the out-of-field dose quickly, accurately, and for arbitrary irradiation conditions. Methods. An accelerator head, gantry, and treatment vault were modeled with MCNPX and 6 MV and 18 MV beams were simulated. Photon doses were calculated in-field and compared to measurements made with an ion chamber in a water tank. Photon doses were also calculated out-of-field from static fields and compared to measurements made with thermoluminescent dosimeters in acrylic. Neutron fluences were calculated and compared to measurements made with gold foils. Finally, photon and neutron dose equivalents were calculated in an anthropomorphic phantom following intensity-modulated radiation therapy and compared to previously published dose equivalents. Results. The Monte Carlo model was able to accurately calculate the in-field dose. From static treatment fields, the model was also able to calculate the out-of-field photon dose within 16% at 6 MV and 17% at 18 MV and the neutron fluence within 19% on average. From the simulated IMRT treatments, the calculated out-of-field photon dose was within 14% of measurement at 6 MV and 13% at 18 MV on average. The calculated neutron dose equivalent was much lower than the measured value but is likely accurate because the measured neutron dose equivalent was based on an overestimated neutron energy. Based on the calculated out-of-field doses generated by the Monte Carlo model, it was

On the Correct Formulation of the Law of the External Photoelectric Effect

NASA Astrophysics Data System (ADS)

Kalanov, Temur Z.

2017-01-01

The critical and correct scientific analysis of the generally accepted theory of the external photoelectric effect is proposed. The methodological basis for the analysis is the unity of formal logic and of rational dialectics. It is shown that Einstein's formulation of the law of the photoelectric effect is not free from the following objection. The terms of Einstein's formula characterize the quantitative determinacy (i.e., energy) which belongs and is related to the different material objects: ``photon'', ``electron in metal'', and ``electron not in metal''. This signifies that Einstein's formula represents violation of the formal-logical laws of identity and absence (lack) of contradiction. The correct mathematical formulation of the law of the external photoelectric effect within the framework of the system approach is proposed. The correct formulation represents the proportion by relative increments of the energy of the incident photon and the energy of the emitted electron. The proportion describes the linear relationship between the energy of the incident photon and the energy of the emitted electron.

External audits of electron beams using mailed TLD dosimetry: preliminary results.

PubMed

Gomola, I; Van Dam, J; Isern-Verdum, J; Verstraete, J; Reymen, R; Dutreix, A; Davis, B; Huyskens, D

2001-02-01

A feasibility study has been performed to investigate the possibility of using mailed thermoluminescence dosimetry (TLD) for external audits of clinical electron beams in Europe. In the frame of the EC Network Project for Quality Assurance in Radiotherapy, instruction sheets and mailing procedures have been defined for mailed TLD dosimetry using the dedicated holder developed by a panel of experts of the International Atomic Energy Agency (IAEA). Three hundred and thirty electron beam set-ups have been checked in the reference centres and some local centres of the EC Network Project and in addition through the centres participating to the EORTC Radiotherapy Group trial 22922. The mean ratio of measured dose to stated dose is 0.2% and the standard deviation of measured dose to stated dose is 3.2%. In seven beam set-ups, deviations greater than 10% were observed (max. 66%), showing the usefulness of these checks. The results of this feasibility study (instruction sheets, mailing procedures, holder) are presently endorsed by the EQUAL-ESTRO structure in order to offer in the future to all ESTRO members the possibility to request external audits of clinical electron beams.

ORANGE: a Monte Carlo dose engine for radiotherapy.

PubMed

van der Zee, W; Hogenbirk, A; van der Marck, S C

2005-02-21

This study presents data for the verification of ORANGE, a fast MCNP-based dose engine for radiotherapy treatment planning. In order to verify the new algorithm, it has been benchmarked against DOSXYZ and against measurements. For the benchmarking, first calculations have been done using the ICCR-XIII benchmark. Next, calculations have been done with DOSXYZ and ORANGE in five different phantoms (one homogeneous, two with bone equivalent inserts and two with lung equivalent inserts). The calculations have been done with two mono-energetic photon beams (2 MeV and 6 MeV) and two mono-energetic electron beams (10 MeV and 20 MeV). Comparison of the calculated data (from DOSXYZ and ORANGE) against measurements was possible for a realistic 10 MV photon beam and a realistic 15 MeV electron beam in a homogeneous phantom only. For the comparison of the calculated dose distributions and dose distributions against measurements, the concept of the confidence limit (CL) has been used. This concept reduces the difference between two data sets to a single number, which gives the deviation for 90% of the dose distributions. Using this concept, it was found that ORANGE was always within the statistical bandwidth with DOSXYZ and the measurements. The ICCR-XIII benchmark showed that ORANGE is seven times faster than DOSXYZ, a result comparable with other accelerated Monte Carlo dose systems when no variance reduction is used. As shown for XVMC, using variance reduction techniques has the potential for further acceleration. Using modern computer hardware, this brings the total calculation time for a dose distribution with 1.5% (statistical) accuracy within the clinical range (less then 10 min). This means that ORANGE can be a candidate for a dose engine in radiotherapy treatment planning.

Skyshine photon doses from 6 and 10 MV medical linear accelerators.

PubMed

de Paiva, Eduardo; da Rosa, Luiz A R

2012-01-05

The skyshine radiation phenomenon consists of the scattering of primary photon beams in the atmosphere above the roof of a medical linear accelerator facility, generating an additional dose at ground level in the vicinity of the treatment room. Thus, with respect to radioprotection, this situation plays an important role when the roof is designed with little shielding and there are buildings next to the radiotherapy treatment room. In literature, there are few reported skyshine-measured doses and these contain poor agreement with empirical calculations. In this work, we carried out measurements of skyshine photon dose rates produced from eight different 6 and 10 MV medical accelerators. Each measurement was performed outside the room facility, with the beam positioned in the upward direction, at a horizontal distance from the target and for a 40 cm × 40 cm maximum photon field size at the accelerator isocenter. Measured dose-equivalent rates results were compared with calculations obtained by an empirical expression, and differences between them deviated in one or more order of magnitude.

Visibility of an iron-containing fiducial marker in magnetic resonance imaging for high-precision external beam prostate radiotherapy.

PubMed

Tanaka, Osamu; Komeda, Hisao; Hirose, Shigeki; Taniguchi, Takuya; Ono, Kousei; Matsuo, Masayuki

2017-11-29

Visualization of fiducial gold markers is critical for registration on computed tomography (CT) and magnetic resonance imaging (MRI) for imaging-guided radiotherapy. Although larger markers provide better visualization on MRI, they tend to generate artifacts on CT. MRI is strongly influenced by the presence of metals, such as iron, in the body. Here we compared efficacies of a 0.5% iron-containing gold marker (GM) and a traditional non-iron-containing marker. Twenty-seven patients underwent CT/MRI fusion-based intensity-modulated radiotherapy. Markers were placed by urologists under local anesthesia. Gold Anchor (GA; diameter: 0.28 mm; length: 10 mm), an iron-containing marker, was placed on the right side of the prostate using a 22-G needle and VISICOIL (VIS; diameter: 0.35 mm; length: 10 mm), a non-iron-containing marker, was placed on the left side using a 19-G needle. T2*-weighted images MRI sequences were obtained. Two radiation oncologists and a radiation technologist evaluated and assigned scores for visual quality on a five-point scale (1, poor; 5, best visibility). Artifact generation on CT was slightly greater with GA than with VIS. The mean marker visualization scores on MRI of all three observers were significantly superior for GA than for VIS (3.5 vs 3.2, 3.9 vs 3.2, and 4.0 vs 2.9). The actual size of the spherical GA was about 2 mm in diameter, but the signal void on MRI was approximately 5 mm. Although both markers were well visualized and can be recommended clinically, the results suggest that GA has some subtle advantages for quantitative visualization that could prove useful in certain situations of stereotactic body radiotherapy and intensity-modulated radiotherapy. © 2017 John Wiley & Sons Australia, Ltd.

Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease.

PubMed

Crook, Juanita

2016-11-01

Squamous cell cancer of the penis is a radiocurable malignancy all too often managed solely by partial or total penectomy. Effective management of the primary tumor while preserving penile morphology and function is a priority. External radiotherapy and brachytherapy have a role to play in the definitive management of the primary tumor. Surgical nodal staging remains a cornerstone of management because it is the strongest predictor of survival, and inguinal status determines pelvic management. Postoperative radiotherapy of the regional nodes for high-risk pathology is indicated. Chemoradiotherapy should be considered as neoadjuvant treatment for unresectable nodes or as definitive management. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of postoperative brachytherapy and external beam radiotherapy on functional outcomes of immediate facial nerve repair after radical parotidectomy.

PubMed

Hontanilla, Bernardo; Qiu, Shan-Shan; Marré, Diego

2014-01-01

There is much controversy regarding the effect of radiotherapy on facial nerve regeneration. However, the effect of brachytherapy has not been studied. Fifty-three patients underwent total parotidectomy of which 13 were radical with immediate facial nerve repair with sural nerve grafts. Six patients (group 1) did not receive adjuvant treatment whereas 7 patients (group 2) received postoperative brachytherapy plus radiotherapy. Functional outcomes were compared using Facial Clima. Mean percentage of blink recovery was 92.6 ± 4.2 for group 1 and 90.7 ± 5.2 for group 2 (p = .37). Mean percentage of commissural excursion restoration was 78.1 ± 3.5 for group 1 and 74.9 ± 5.9 for group 2 (p = .17). Mean time from surgery to first movement was 5.7 ± 0.9 months for group 1 and 6.3 ± 0.5 months for group 2 (p = .15). Brachytherapy plus radiotherapy does not affect the functional outcomes of immediate facial nerve repair with nerve grafts. Copyright © 2013 Wiley Periodicals, Inc.

Dosimetric characteristics of a new unshielded silicon diode and its application in clinical photon and electron beams.

PubMed

Griessbach, Irmgard; Lapp, Markus; Bohsung, Jörg; Gademann, Günther; Harder, Dietrich

2005-12-01

Shielded p-silicon diodes, frequently applied in general photon-beam dosimetry, show certain imperfections when applied in the small photon fields occurring in stereotactic or intensity modulated radiotherapy (IMRT), in electron beams and in the buildup region of photon beam dose distributions. Using as a study object the shielded p-silicon diode PTW 60008, well known for its reliable performance in general photon dosimetry, we have identified these imperfections as effects of electron scattering at the metallic parts of the shielding. In order to overcome these difficulties a new, unshielded diode PTW 60012 has been designed and manufactured by PTW Freiburg. By comparison with reference detectors, such as thimble and plane-parallel ionization chambers and a diamond detector, we could show the absence of these imperfections. An excellent performance of the new unshielded diode for the special dosimetric tasks in small photon fields, electron beams and build-up regions of photon beams has been observed. The new diode also has an improved angular response. However, due to its over-response to low-energy scattered photons, its recommended range of use does not include output factor measurements in large photon fields, although this effect can be compensated by a thin auxiliary lead shield.

Potential risk of alpha-glucosidase inhibitor administration in prostate cancer external radiotherapy by exceptional rectal gas production: a case report.

PubMed

Nishimura, Takuya; Yamazaki, Hideya; Iwama, Kazuki; Oota, Yoshitaka; Aibe, Norihiro; Nakamura, Satoaki; Yoshida, Ken; Okabe, Haruumi; Yamada, Kei

2014-05-05

Radiotherapy is a standard treatment for prostate cancer, and image-guided radiotherapy is increasingly being used to aid precision of dose delivery to targeted tissues. However, precision during radiotherapy cannot be maintained when unexpected intrafraction organ motion occurs. We report our experience of internal organ motion caused by persistent gas production in a patient taking an alpha-glucosidase inhibitor. A 68-year-old Japanese man with prostate cancer visited our institution for treatment with helical tomotherapy. He suffered from diabetes mellitus and took an alpha-glucosidase inhibitor. Routine treatment planning computed tomography showed a large volume of rectal gas; an enema was given to void the rectum. Subsequent treatment planning computed tomography again showed a large volume of gas. After exercise (walking) to remove the intestinal gas, a third scan was performed as a test scan without tight fixation, which showed a sufficiently empty rectum for planning. However, after only a few minutes, treatment planning computed tomography again showed extreme accumulation of gas. Therefore, we postponed treatment planning computed tomography and consulted his doctor to suspend the alpha-glucosidase inhibitor, which was the expected cause of his persistent gas. Four days after the alpha-glucosidase inhibitor regimen was suspended, we took a fourth treatment planning computed tomography and made a treatment plan without gas accumulation. Thereafter, the absence of rectal gas accumulation was confirmed using daily megavolt computed tomography before treatment, and the patient received 37 fractions of intensity-modified radiotherapy at 74 Gy without rectal gas complications. In this case study, the alpha-glucosidase inhibitor induced the accumulation of intestinal gas, which may have caused unexpected organ motion, untoward reactions, and insufficient doses to clinical targets. We suggest that patients who are taking an alpha-glucosidase inhibitor for

Quality management system in radiotherapy in the light of regulations applicable in Poland

PubMed Central

2012-01-01

The need to establish conditions for safe irradiation was noted in Poland back in 1986 in the Atomic Law, but for over 16 years no regulations regarding this aspect were passed. The radiological incident in Bialystok (Poland) in 2001 undeniably accelerated the implementation of new legal regulations. Nevertheless, in the absence of national guidelines until 2002, most health care institutions resorted to the quality management system (QMS) model proposed by the ISO norm 9001:2000. Eventually, practice proved the theory and the aforementioned model was also implemented into Polish acts of law defining basic requirements for QMS in radiotherapy. The aim of this work is to review current national regulations regarding QMS in radiotherapy, in particular those referring to standard procedures, the establishment of a commission for procedures and performance of external and internal clinical audits in oncological radiotherapy, as well as to present the process of their implementation into the practice of health care institutions. PMID:23788867

Dosimetric inter-institutional comparison in European radiotherapy centres: Results of IAEA supported treatment planning system audit.

PubMed

Gershkevitsh, Eduard; Pesznyak, Csilla; Petrovic, Borislava; Grezdo, Joseph; Chelminski, Krzysztof; do Carmo Lopes, Maria; Izewska, Joanna; Van Dyk, Jacob

2014-05-01

One of the newer audit modalities operated by the International Atomic Energy Agency (IAEA) involves audits of treatment planning systems (TPS) in radiotherapy. The main focus of the audit is the dosimetry verification of the delivery of a radiation treatment plan for three-dimensional (3D) conformal radiotherapy using high energy photon beams. The audit has been carried out in eight European countries - Estonia, Hungary, Latvia, Lithuania, Serbia, Slovakia, Poland and Portugal. The corresponding results are presented. The TPS audit reviews the dosimetry, treatment planning and radiotherapy delivery processes using the 'end-to-end' approach, i.e. following the pathway similar to that of the patient, through imaging, treatment planning and dose delivery. The audit is implemented at the national level with IAEA assistance. The national counterparts conduct the TPS audit at local radiotherapy centres through on-site visits. TPS calculated doses are compared with ion chamber measurements performed in an anthropomorphic phantom for eight test cases per algorithm/beam. A set of pre-defined agreement criteria is used to analyse the performance of TPSs. TPS audit was carried out in 60 radiotherapy centres. In total, 190 data sets (combination of algorithm and beam quality) have been collected and reviewed. Dosimetry problems requiring interventions were discovered in about 10% of datasets. In addition, suboptimal beam modelling in TPSs was discovered in a number of cases. The TPS audit project using the IAEA methodology has verified the treatment planning system calculations for 3D conformal radiotherapy in a group of radiotherapy centres in Europe. It contributed to achieving better understanding of the performance of TPSs and helped to resolve issues related to imaging, dosimetry and treatment planning.

Use of External Beam Radiotherapy Is Associated With Reduced Incidence of Second Primary Head and Neck Cancer: A SEER Database Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rusthoven, Kyle; Chen Changhu; Raben, David

2008-05-01

Purpose: Patients with head and neck cancer have a significant risk of developing a second primary cancer of the head and neck. We hypothesized that treatment with external beam radiotherapy (RT) might reduce this risk, because RT can eradicate occult foci of second head and neck cancer (HNCA). Methods and Materials: The data of patients with Surveillance, Epidemiology, and End Results Historic Stage A localized squamous cell carcinoma of the oral cavity, larynx, and pharynx were queried using the Surveillance, Epidemiology, and End Results database. For patients treated with or without RT, the incidence of second HNCA was determined andmore » compared using the log-rank method. Cox proportional hazards analysis was performed for each site, evaluating the influence of covariates on the risk of second HNCA. Results: Between 1973 and 1997, 27,985 patients were entered with localized HNCA. Of these patients, 44% had received RT and 56% had not. The 15-year incidence of second HNCA was 7.7% with RT vs. 10.5% without RT (hazard ratio 0.71, p <0.0001). The effect of RT was more profound in patients diagnosed between 1988 and 1997 (hazard ratio 0.53, p <0.0001) and those with pharynx primaries (hazard ratio 0.47, p <0.0001). On multivariate analysis, RT was associated with a reduced risk of second HNCA for pharynx (p <0.0001) and larynx (p = 0.04) tumors. For oral cavity primaries, RT was associated with an increased risk of second HNCA in patients treated before 1988 (p <0.001), but had no influence on patients treated between 1988 and 1997 (p = 0.91). Conclusion: For localized HNCA, RT is associated with a reduced incidence of second HNCA. These observations are consistent with the eradication of microscopic foci of second HNCA with external beam RT.« less

Regulatory aspects of low intensity photon emission.

PubMed

Van Wijk, R; Schamhart, D H

1988-07-15

Photon emission from unicellular and multicellular organisms has been a subject of study for many decennia. In contrast to the well-known phenomenon of bioluminescence originating in luciferin-luciferase reactions, low intensity emission in the visible region of the electromagnetic spectrum has been found in almost every species studied so far. At present, the nomenclature of this phenomenon has not crystallized and it is referred to by a variety of names, such as mitogenetic radiation 29, dark luminescence 7, low-level chemiluminescence 20,36, and biophotons 57. Particular attention has been focussed on the relationship between photon emission and the regulation of various aspects of cellular metabolism, although in many cases quantitative data are still lacking. Throughout the history of this field of research the question of a functional biological role of the low intensity emission has been repeatedly raised; this is reflected, for instance, in the heterogeneity of the terms used to describe it. The discussion concerns the possible participation of photons of low intensity in intra- and intercellular communication. This paper reviews literature on the metabolic regulation of low intensity emission, as well as the regulation of photon emission initiated by external light. Furthermore, recent data are discussed with respect to a possible biocommunicative function of low intensity photon emission.

[Anatomic foundation of the lateral portal for radiotherapy of nasopharyngeal cancer (NPC)].

PubMed

Wei, B Q; Feng, P B; Li, J Z

1987-05-01

Basing on 31 normal skulls, the lateral projections of some points relative to the bony structure near the nasopharynx were located under the simulator, followed by drawing it on a sheet of paper with the aid of geometry and trigonometry. Thus, the relation between external and internal structures is shown on the drawn projection, which can serve as the anatomic basis for designing the routine field and improving radiotherapy technique. In the light of data informed by this study and clinical experiences of the authors and others, it was found logical, in radiotherapy of NPC, that large opposing lateral pre-auriculo-cervical portals with their posterior margin extending beyond the external auditory meatus posteriorly be used in order to avoid geographic miss of the uppermost deep cervical lymph nodes usually involved beneath the jugular foramen and posterior portion of the nasopharynx. In addition, the upper margin of the lateral portal must be parallel but superior to the cantho-auditory line, on which the foramen ovale is projected. Actual locating the upper margin should depend on the extent of the intracranial invasion of the tumor as shown by the CT scan.

The role of radiotherapy in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline.

PubMed

Ryken, Timothy C; Parney, Ian; Buatti, John; Kalkanis, Steven N; Olson, Jeffrey J

2015-12-01

(1) What is the optimal role of external beam radiotherapy in the management of adult patients with newly diagnosed low-grade glioma (LGG) in terms of improving outcome (i.e., survival, complications, seizure control or other reported outcomes of interest)? (2) Which radiation strategies (dose, timing, fractionation, stereotactic radiation, brachytherapy, chemotherapy) improve outcomes compared to standard external beam radiation therapy in the initial management of low grade gliomas in adults? (3) Do specific factors (e.g., age, volume, extent of resection, genetic subtype) identify subgroups with better outcomes following radiation therapy than the general population of adults with newly diagnosed low-grade gliomas? These recommendations apply to adults with newly diagnosed diffuse LGG. OUTCOMES IN ADULT PATIENTS WITH NEWLY DIAGNOSED LOW GRADE GLIOMA TREATED WITH RADIOTHERAPY: Level I Radiotherapy is recommended in the management of newly diagnosed low-grade glioma in adults to prolong progression free survival, irrespective of extent of resection. Level II Radiotherapy is recommended in the management of newly diagnosed low grade glioma in adults as an equivalent alternative to observation in preserving cognitive function, irrespective of extent of resection. Level III Radiotherapy is recommended in the management of newly diagnosed low grade glioma in adults to improve seizure control in patients with epilepsy and subtotal resection. Level III Radiotherapy is recommended in the management of newly diagnosed low-grade glioma in adults to prolong overall survival in patients with subtotal resection. Level III Consideration of the risk of radiation induced morbidity, including cognitive decline, imaging abnormalities, metabolic dysfunction and malignant transformation, is recommended when the delivery of radiotherapy is selected in the management of newly diagnosed low-grade glioma in adults. STRATEGIES OF RADIOTHERAPY IN ADULT PATIENTS WITH NEWLY DIAGNOSED LOW

Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer.

PubMed

Kishan, Amar U; Cook, Ryan R; Ciezki, Jay P; Ross, Ashley E; Pomerantz, Mark M; Nguyen, Paul L; Shaikh, Talha; Tran, Phuoc T; Sandler, Kiri A; Stock, Richard G; Merrick, Gregory S; Demanes, D Jeffrey; Spratt, Daniel E; Abu-Isa, Eyad I; Wedde, Trude B; Lilleby, Wolfgang; Krauss, Daniel J; Shaw, Grace K; Alam, Ridwan; Reddy, Chandana A; Stephenson, Andrew J; Klein, Eric A; Song, Daniel Y; Tosoian, Jeffrey J; Hegde, John V; Yoo, Sun Mi; Fiano, Ryan; D'Amico, Anthony V; Nickols, Nicholas G; Aronson, William J; Sadeghi, Ahmad; Greco, Stephen; Deville, Curtiland; McNutt, Todd; DeWeese, Theodore L; Reiter, Robert E; Said, Johnathan W; Steinberg, Michael L; Horwitz, Eric M; Kupelian, Patrick A; King, Christopher R

2018-03-06

The optimal treatment for Gleason score 9-10 prostate cancer is unknown. To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy. The primary outcome was prostate cancer-specific mortality; distant metastasis-free survival and overall survival were secondary outcomes. Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer-specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No

Permanent Rabi oscillations in coupled exciton-photon systems with PT -symmetry

PubMed Central

Chestnov, Igor Yu.; Demirchyan, Sevak S.; Alodjants, Alexander P.; Rubo, Yuri G.; Kavokin, Alexey V.

2016-01-01

We propose a physical mechanism which enables permanent Rabi oscillations in driven-dissipative condensates of exciton-polaritons in semiconductor microcavities subjected to external magnetic fields. The method is based on stimulated scattering of excitons from the incoherent reservoir. We demonstrate that permanent non-decaying oscillations may appear due to the parity-time symmetry of the coupled exciton-photon system realized in a specific regime of pumping to the exciton state and depletion of the reservoir. At non-zero exciton-photon detuning, robust permanent Rabi oscillations occur with unequal amplitudes of exciton and photon components. Our predictions pave way to realization of integrated circuits based on exciton-polariton Rabi oscillators. PMID:26790534

Permanent Rabi oscillations in coupled exciton-photon systems with PT-symmetry.

PubMed

Chestnov, Igor Yu; Demirchyan, Sevak S; Alodjants, Alexander P; Rubo, Yuri G; Kavokin, Alexey V

2016-01-21

We propose a physical mechanism which enables permanent Rabi oscillations in driven-dissipative condensates of exciton-polaritons in semiconductor microcavities subjected to external magnetic fields. The method is based on stimulated scattering of excitons from the incoherent reservoir. We demonstrate that permanent non-decaying oscillations may appear due to the parity-time symmetry of the coupled exciton-photon system realized in a specific regime of pumping to the exciton state and depletion of the reservoir. At non-zero exciton-photon detuning, robust permanent Rabi oscillations occur with unequal amplitudes of exciton and photon components. Our predictions pave way to realization of integrated circuits based on exciton-polariton Rabi oscillators.

PEG spacer gel and adaptive planning vs single plan in external prostate radiotherapy—clinical dosimetry evaluation

PubMed Central

2015-01-01

Objective: Spacer gel is used to reduce the rectal dose in prostate radiotherapy. It is injected to increase the distance between the prostate and rectum. During the course of external radiotherapy treatment, physiological changes in rectal volume exist. When using polyethylene glycol material, such as DuraSeal® (Covidien, Mansfield, MA), gel resorption also occurs. Together, these factors alter the original dose plan distribution. Methods: External dose planning and calculations were simulated using images acquired from 10 patients who were treated with brachytherapy and gel. The CT series was taken relative to gel injection: pre 1 day, post 1 day, post 1 month and post 2 months. Adaptive planning was compared with a single plan. Results: Adaptive planning shows better results compared with the single plan used in the total treatment course; however, the effect is minor. Conclusion: Gel usage is clearly favourable to rectal DVH. Using adaptive planning with gel improves rectal DVH but is not necessary according to this study. Advances in knowledge: Spacer gel is used in prostate radiotherapy to increase distance between the prostate and the rectum, thus reducing the rectal doses. During the treatment course, gel resorption exists which affects the rectal doses. The usefulness of adaptive planning to compensate this resorption effect has not been studied before. PMID:26370300

Mild soaps and radiotherapy: a survey of the UK public to identify brands of soap considered mild and analysis of these to ascertain suitability for recommendation in radiotherapy departments.

PubMed

Robertson, K; Brown, P

2011-05-01

Cancer agencies recommend that patients use mild soap when undergoing external beam radiotherapy to minimise skin reactions. They define 'mild soap' as non-alkaline, lanolin free, unperfumed soap with a neutral pH. This study aimed to identify which soaps the UK public perceive as mild and ascertain if these were clinically mild and could potentially be recommended within radiotherapy departments. A survey of 237 participants identified eight top brands of mild soap, which were then tested for pH and analysed for potential irritants. All soaps were lanolin free and non-alkaline, with Simple and Johnson's the closest to pH 5.5. All contained fragrances except Simple and E45. Dove, Pears and Imperial Leather contained the highest concentration of fragrances. All soaps except E45 contained potential irritants. Only Simple and E45 fit the cancer agencies' definition of mild soap and could therefore be recommended for radiotherapy patients. Future research should identify current practices and recommendations in the UK as anecdotal evidence suggests large variations in skin care advice. Further scientific analysis could potentially identify cheaper brands that fit the definition of 'mild'. UK recommendations should be standardised and consistent with best practice to reduce skin reaction severity in radiotherapy patients. © 2010 Blackwell Publishing Ltd.

External beam techniques to boost cervical cancer when brachytherapy is not an option—theories and applications

PubMed Central

Kilic, Sarah; Khan, Atif J.; Beriwal, Sushil; Small, William

2017-01-01

The management of locally advanced cervical cancer relies on brachytherapy (BT) as an integral part of the radiotherapy delivery armamentarium. Occasionally, intracavitary BT is neither possible nor available. In these circumstances, post-external beam radiotherapy (EBRT) interstitial brachytherapy and/or hysterectomy may represent viable options that must be adequately executed in a timely manner. However, if these options are not applicable due to patient related or facility related reasons, a formal contingency plan should be in place. Innovative EBRT techniques such as intensity modulated and stereotactic radiotherapy may be considered for patients unable to undergo brachytherapy. Relying on provocative arguments and recent data, this review explores the rationale for and limitations of non-brachytherapy substitutes in that setting aiming to establish a formal process for the optimal execution of this alternative plan. PMID:28603722

[Task sharing with radiotherapy technicians in image-guided radiotherapy].

PubMed

Diaz, O; Lorchel, F; Revault, C; Mornex, F

2013-10-01

The development of accelerators with on-board imaging systems now allows better target volumes reset at the time of irradiation (image-guided radiotherapy [IGRT]). However, these technological advances in the control of repositioning led to a multiplication of tasks for each actor in radiotherapy and increase the time available for the treatment, whether for radiotherapy technicians or radiation oncologists. As there is currently no explicit regulatory framework governing the use of IGRT, some institutional experiments show that a transfer is possible between radiation oncologists and radiotherapy technicians for on-line verification of image positioning. Initial training for every technical and drafting procedures within institutions will improve audit quality by reducing interindividual variability. Copyright © 2013. Published by Elsevier SAS.

Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A.

PubMed

Welzel, Grit; Boch, Angela; Sperk, Elena; Hofmann, Frank; Kraus-Tiefenbacher, Uta; Gerhardt, Axel; Suetterlin, Marc; Wenz, Frederik

2013-01-07

Intraoperative radiotherapy (IORT) is a new treatment approach for early stage breast cancer. This study reports on the effects of IORT on radiation-related quality of life (QoL) parameters. Two hundred and thirty women with stage I-III breast cancer (age, 31 to 84 years) were entered into the study. A single-center subgroup of 87 women from the two arms of the randomized phase III trial TARGIT-A (TARGeted Intra-operative radioTherapy versus whole breast radiotherapy for breast cancer) was analyzed. Furthermore, results were compared to non-randomized control groups: n = 90 receiving IORT as a tumor bed boost followed by external beam whole breast radiotherapy (EBRT) outside of TARGIT-A (IORT-boost), and n = 53 treated with EBRT followed by an external-beam boost (EBRT-boost). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 (QLQ-C30) and BR23 (QLQ-BR23). The mean follow-up period in the TARGIT-A groups was 32 versus 39 months in the non-randomized control groups. Patients receiving IORT alone reported less general pain (21.3 points), breast (7.0 points) and arm (15.1 points) symptoms, and better role functioning (78.7 points) as patients receiving EBRT (40.9; 19.0; 32.8; and 60.5 points, respectively, P < 0.01). Patients receiving IORT alone also had fewer breast symptoms than TARGIT-A patients receiving IORT followed by EBRT for high risk features on final pathology (IORT-EBRT; 7.0 versus 29.7 points, P < 0.01). There were no significant differences between TARGIT-A patients receiving IORT-EBRT compared to non-randomized IORT-boost or EBRT-boost patients and patients receiving EBRT without a boost. In the randomized setting, important radiation-related QoL parameters after IORT were superior to EBRT. Non-randomized comparisons showed equivalent parameters in the IORT-EBRT group and the control groups.

Cost analysis of cetuximab (Erbitux) plus radiotherapy (ERT) versus concomitant cisplatin plus radiotherapy (CRT) within an NHS oncology unit (single institution): a pilot study.

PubMed

Caroline, Brammer; Sundus, Yahya; Dawn, Dawson; Carol, Glaister; Susan, Merrick

2016-12-01

The aim of this feasibility study is to define the resource effectiveness of cetuximab vs cisplatin given concomitantly with radiotherapy for squamous cell carcinoma within a National Health Service clinical oncology unit. 20 patients with Stage 3 or 4 head and neck squamous cell cancers were randomized to receive either cetuximab with radiotherapy (ERT) or cisplatin with radiotherapy concurrent with external beam radiotherapy 70 Gy in 35 fractions on a 1 : 1 basis over a 12-month duration. The study compared the resource utilization of ERT vs cisplatin with radiotherapy taking into account drug costs, clinical management and the costs of managing treatment-related toxicity from first fraction of radiotherapy to 6 months after the completion of therapy. Outcome measures were quality of life (recorded at the entry, end of radiotherapy, 6 weeks post treatment and 6 months post treatment), admissions to hospital, delays to radiotherapy, locoregional control and survival. Total drug costs including cost of nutritional supplements for patients treated with cetuximab were £7407.45 compared with £3959.07 for patients treated with cisplatin. Unscheduled admissions for toxicity management were significantly more common in the ERT arm. Healthcare personnel spent significantly more time delivering unscheduled outpatient care for patients receiving cisplatin than for those receiving cetuximab (p = 0.01). No significant difference in the quality of life was suggested at baseline, 6 weeks and 6 months. The mean time to removal of percutaneous gastrostomy (PEG) after completion of radiotherapy was 49.7 weeks in the cisplatin arm and 18.5 weeks in the cetuximab arm (p = 0.04). There was a statistically significant difference in patient-reported use of PEG between the cisplatin and cetuximab arms at 6 months following completion of treatment (p = 0.04). At 21 months, overall survival was 80% in the cisplatin arm vs 50% in the cetuximab (p = 0.332), with

Cost analysis of cetuximab (Erbitux) plus radiotherapy (ERT) versus concomitant cisplatin plus radiotherapy (CRT) within an NHS oncology unit (single institution): a pilot study

PubMed Central

Sundus, Yahya; Dawn, Dawson; Carol, Glaister; Susan, Merrick

2016-01-01

Objective: The aim of this feasibility study is to define the resource effectiveness of cetuximab vs cisplatin given concomitantly with radiotherapy for squamous cell carcinoma within a National Health Service clinical oncology unit. Methods: 20 patients with Stage 3 or 4 head and neck squamous cell cancers were randomized to receive either cetuximab with radiotherapy (ERT) or cisplatin with radiotherapy concurrent with external beam radiotherapy 70 Gy in 35 fractions on a 1 : 1 basis over a 12-month duration. The study compared the resource utilization of ERT vs cisplatin with radiotherapy taking into account drug costs, clinical management and the costs of managing treatment-related toxicity from first fraction of radiotherapy to 6 months after the completion of therapy. Outcome measures were quality of life (recorded at the entry, end of radiotherapy, 6 weeks post treatment and 6 months post treatment), admissions to hospital, delays to radiotherapy, locoregional control and survival. Results: Total drug costs including cost of nutritional supplements for patients treated with cetuximab were £7407.45 compared with £3959.07 for patients treated with cisplatin. Unscheduled admissions for toxicity management were significantly more common in the ERT arm. Healthcare personnel spent significantly more time delivering unscheduled outpatient care for patients receiving cisplatin than for those receiving cetuximab (p = 0.01). No significant difference in the quality of life was suggested at baseline, 6 weeks and 6 months. The mean time to removal of percutaneous gastrostomy (PEG) after completion of radiotherapy was 49.7 weeks in the cisplatin arm and 18.5 weeks in the cetuximab arm (p = 0.04). There was a statistically significant difference in patient-reported use of PEG between the cisplatin and cetuximab arms at 6 months following completion of treatment (p = 0.04). At 21 months, overall survival was 80% in the cisplatin arm vs 50% in the

Spin-dependent heat and thermoelectric currents in a Rashba ring coupled to a photon cavity

NASA Astrophysics Data System (ADS)

Abdullah, Nzar Rauf; Tang, Chi-Shung; Manolescu, Andrei; Gudmundsson, Vidar

2018-01-01

Spin-dependent heat and thermoelectric currents in a quantum ring with Rashba spin-orbit interaction placed in a photon cavity are theoretically calculated. The quantum ring is coupled to two external leads with different temperatures. In a resonant regime, with the ring structure in resonance with the photon field, the heat and the thermoelectric currents can be controlled by the Rashba spin-orbit interaction. The heat current is suppressed in the presence of the photon field due to contribution of the two-electron and photon replica states to the transport while the thermoelectric current is not sensitive to changes in parameters of the photon field. Our study opens a possibility to use the proposed interferometric device as a tunable heat current generator in the cavity photon field.

Testicular Doses in Image-Guided Radiotherapy of Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Deng Jun, E-mail: jun.deng@yale.edu; Chen Zhe; Yu, James B.

Purpose: To investigate testicular doses contributed by kilovoltage cone-beam computed tomography (kVCBCT) during image-guided radiotherapy (IGRT) of prostate cancer. Methods and Materials: An EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions from kVCBCT on 3 prostate cancer patients. Absorbed doses to various organs were compared between intensity-modulated radiotherapy (IMRT) treatments and kVCBCT scans. The impact of CBCT scanning mode, kilovoltage peak energy (kVp), and CBCT field span on dose deposition to testes and other organs was investigated. Results: In comparison with one 10-MV IMRT treatment, a 125-kV half-fan CBCT scan delivered 3.4, 3.8, 4.1, and 5.7 cGymore » to the prostate, rectum, bladder, and femoral heads, respectively, accounting for 1.7%, 3.2%, 3.2%, and 8.4% of megavoltage photon dose contributions. However, the testes received 2.9 cGy from the same CBCT scan, a threefold increase as compared with 0.7 cGy received during IMRT. With the same kVp, full-fan mode deposited much less dose to organs than half-fan mode, ranging from 9% less for prostate to 69% less for testes, except for rectum, where full-fan mode delivered 34% more dose. As photon beam energy increased from 60 to 125 kV, kVCBCT-contributed doses increased exponentially for all organs, irrespective of scanning mode. Reducing CBCT field span from 30 to 10 cm in the superior-inferior direction cut testicular doses from 5.7 to 0.2 cGy in half-fan mode and from 1.5 to 0.1 cGy in full-fan mode. Conclusions: Compared with IMRT, kVCBCT-contributed doses to the prostate, rectum, bladder, and femoral heads are clinically insignificant, whereas dose to the testes is threefold more. Full-fan CBCT usually deposits much less dose to organs (except for rectum) than half-fan mode in prostate patients. Kilovoltage CBCT-contributed doses increase exponentially with photon beam energy. Reducing CBCT field significantly cuts doses to testes and other organs.« less

Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirova, Youlia M., E-mail: youlia.kirova@curie.net; Menard, Jean; Chargari, Cyrus

2012-07-01

To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. Themore » dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.« less

In vivo dosimetry using a single diode for megavoltage photon beam radiotherapy: implementation and response characterization.

PubMed

Colussi, V C; Beddar, A S; Kinsella, T J; Sibata, C H

2001-01-01

The AAPM Task Group 40 reported that in vivo dosimetry can be used to identify major deviations in treatment delivery in radiation therapy. In this paper, we investigate the feasibility of using one single diode to perform in vivo dosimetry in the entire radiotherapeutic energy range regardless of its intrinsic buildup material. The only requirement on diode selection would be to choose a diode with the adequate build up to measure the highest beam energy. We have tested the new diodes from Sun Nuclear Corporation (called QED and ISORAD-p--both p-type) for low-, intermediate-, and high-energy range. We have clinically used both diode types to monitor entrance doses. In general, we found that the dose readings from the ISORAD (p-type) are closer of the dose expected than QED diodes in the clinical setting. In this paper we report on the response of these newly available ISORAD (p-type) diode detectors with respect to certain radiation field parameters such as source-to-surface distance, field size, wedge beam modifiers, as well as other parameters that affect detector characteristics (temperature and detector-beam orientation). We have characterized the response of the high-energy ISORAD (p-type) diode in the low- (1-4 MV), intermediate- (6-12 MV), and high-energy (15-25 MV) range. Our results showed that the total variation of the response of high-energy ISORAD (p-type) diodes to all the above parameters are within +/-5% in most encountered clinical patient treatment setups in the megavoltage photon beam radiotherapy. The usage of the high-energy buildup diode has the additional benefit of amplifying the response of the diode reading in case the wrong energy is used for patient treatment. In the light of these findings, we have since then switched to using only one single diode type, namely the "red" diode; manufacturer designation of the ISORAD (p-type) high-energy (15-25 MV) range diode, for all energies in our institution and satellites.

Finite Element Modeling of Micromachined MEMS Photon Devices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Datskos, P.G.; Evans, B.M.; Schonberger, D.

1999-09-20

The technology of microelectronics that has evolved over the past half century is one of great power and sophistication and can now be extended to many applications (MEMS and MOEMS) other than electronics. An interesting application of MEMS quantum devices is the detection of electromagnetic radiation. The operation principle of MEMS quantum devices is based on the photoinduced stress in semiconductors, and the photon detection results from the measurement of the photoinduced bending. These devices can be described as micromechanical photon detectors. In this work, we have developed a technique for simulating electronic stresses using finite element analysis. We havemore » used our technique to model the response of micromechanical photon devices to external stimuli and compared these results with experimental data. Material properties, geometry, and bimaterial design play an important role in the performance of micromechanical photon detectors. We have modeled these effects using finite element analysis and included the effects of bimaterial thickness coating, effective length of the device, width, and thickness.« less

VARIAN CLINAC 6 MeV Photon Spectra Unfolding using a Monte Carlo Meshed Model

NASA Astrophysics Data System (ADS)

Morató, S.; Juste, B.; Miró, R.; Verdú, G.

2017-09-01

Energy spectrum is the best descriptive function to determine photon beam quality of a Medical Linear Accelerator (LinAc). The use of realistic photon spectra in Monte Carlo simulations has a great importance to obtain precise dose calculations in Radiotherapy Treatment Planning (RTP). Reconstruction of photon spectra emitted by medical accelerators from measured depth dose distributions in a water cube is an important tool for commissioning a Monte Carlo treatment planning system. Regarding this, the reconstruction problem is an inverse radiation transport function which is ill conditioned and its solution may become unstable due to small perturbations in the input data. This paper presents a more stable spectral reconstruction method which can be used to provide an independent confirmation of source models for a given machine without any prior knowledge of the spectral distribution. Monte Carlo models used in this work are built with unstructured meshes to simulate with realism the linear accelerator head geometry.

Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy.

PubMed

He, Jian; Zeng, Zhao-Chong; Tang, Zhao-You; Fan, Jia; Zhou, Jian; Zeng, Meng-Su; Wang, Jian-Hua; Sun, Jing; Chen, Bing; Yang, Ping; Pan, Bai-Sheng

2009-06-15

The current study was performed to identify clinical features and independent predictors of survival in patients with bone metastases from hepatocellular carcinoma (HCC). Patients (n = 205) with bone metastases from HCC received external beam radiotherapy (EBRT) between 1997 and 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined before EBRT. The total radiation dose ranged from 32 to 66 grays (Gy) (median, 50 Gy) and was focused on the involved bone. In 80 of 205 (39.0%) patients with bone metastasis from HCC, tumors were characterized by osteolytic, expansile soft-tissue masses. Overall pain relief from EBRT occurred in 204 patients (99.5%). No consistent dose-response relation was found for palliation of bone metastases with doses between 32 and 66 Gy (P = .068), but the retreatment rate was higher in patients with expansile soft tissue. On univariate analysis, shorter survival was associated with poorer Karnofsky performance status (KPS), higher gamma-glutamyltransferase and alpha-fetoprotein levels, tumor size >5 cm, uncontrolled intrahepatic tumors, multifocal bone lesions, involvement of spinal vertebrae, extraosseous metastases, and a shorter disease-free interval after an initial diagnosis of HCC. On multivariate analysis, pretreatment-unfavorable predictors were associated with lower KPS, higher tumor markers, and uncontrolled intrahepatic tumor when KPS was considered. The median survival was 7.4 months. The results of the current study provide detailed information regarding clinical features, survival outcomes, and prognostic factors for HCC with bone metastases in a relatively large cohort of patients treated with EBRT. These prognostic factors will help in determining which dose and fraction are appropriate. (c) 2009 American Cancer Society.

Tumor Stage-Related Role of Radiotherapy in Patients with an External Auditory Canal and Middle Ear Carcinoma.

PubMed

Choi, Jinhyun; Kim, Se-Heon; Koh, Yoon Woo; Choi, Eun Chang; Lee, Chang Geol; Keum, Ki Chang

2017-01-01

The purpose of this study was to evaluate the clinical outcomes of patients treated with radiotherapy (RT) for a carcinoma of the external auditory canal (EAC) and middle ear. The records of 32 patients who received RT from 1990 to 2013 were reviewed retrospectively. The Pittsburgh classification was used to stage all the cancers (early stage, T1/T2 [n=12]; advanced stage, T3/T4 or N positive [n=20]). Twenty-one patients (65.6%) were treated with postoperative RT and 11 patients (34.4%) were treated with definitive RT. The median radiation doses for postoperative and definitive RT were 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered to seven patients (21.9%). The 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for the patients with early stage versus advanced stage carcinomawere 55.6% (5/9) and 50% (6/12) in the postoperative RT group and 66.7% (2/3) and 37.5% (3/8) in the definitive RT group, respectively. Overall, 15 cases (14 patients, 46.7%) experienced treatment failure; these failures were classified as local in four cases, regional in one case, and distant in 10 cases. The median follow-up period after RT was 51 months (range, 7 to 286 months). Patients with early stage carcinoma achieved better outcomes when definitive RT was used. Advanced stage carcinoma patients experienced better outcomes with postoperative RT. The high rate of distant failure after RT, with or without surgery, reflected the lack of a consensus regarding the best therapeutic approach for treating carcinoma of the EAC and middle ear.

Enraged about radiotherapy.

PubMed Central

Sikora, K.

1994-01-01

The use of radiotherapy in treating breast cancer has meant that many women are able to avoid mastectomy, which is both physically and psychologically damaging. The side effects of radiotherapy, however, are given little attention. Many women have developed brachial plexus injury after radiotherapy for breast cancer, often resulting in severe pain and loss of use of the arm. There is no effective treatment for this injury and little help can be offered. In addition, many of the women did not require radiotherapy of nodal areas. A pressure group has been formed to support these women, to establish the right to compensation, and to ensure that radiotherapy regimens given to future patients will not damage the brachial plexus. Images p188-a PMID:8312773

Optical and magneto-optical properties of one-dimensional magnetized coupled resonator plasma photonic crystals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hamidi, S. M.

2012-01-15

In this paper, the optical and magneto-optical properties of one-dimensional magnetized coupled resonator plasma photonic crystals have been investigated. We use transfer matrix method to solve our magnetized coupled resonator plasma photonic crystals consist of dielectric and magnetized plasma layers. The results of the change in the optical and magneto-optical properties of structure as a result of the alteration in the structural properties such as thickness, plasma frequency and collision frequency, plasma filling factor, number of resonators and dielectric constant of dielectric layers and external magnetic field have been reported. The main feature of this structure is a good magneto-opticalmore » rotation that takes place at the defect modes and the edge of photonic band gap of our proposed optical magnetized plasma waveguide. Our outcomes demonstrate the potential applications of the device for tunable and adjustable filters or reflectors and active magneto-optic in microwave devices under structural parameter and external magnetic field.« less

NOTE Thyroid volume measurement in external beam radiotherapy patients using CT imaging: correlation with clinical and anthropometric characteristics

NASA Astrophysics Data System (ADS)

Veres, C.; Garsi, J. P.; Rubino, C.; Pouzoulet, F.; Bidault, F.; Chavaudra, J.; Bridier, A.; Ricard, M.; Ferreira, I.; Lefkopoulos, D.; de Vathaire, F.; Diallo, I.

2010-11-01

The aim of this study is to define criteria for accurate representation of the thyroid in human models used to represent external beam radiotherapy (EBRT) patients and evaluate the relationship between the volume of this organ and clinical and anthropometric characteristics. From CT images, we segmented the thyroid gland and calculated its volume for a population of 188 EBRT patients of both sexes, with ages ranging from 1 to 89 years. To evaluate uncertainties linked to measured volumes, experimental studies on the Livermore anthropomorphic phantom were performed. For our population of EBRT patients, we observed that in children, thyroid volume increased rapidly with age, from about 3 cm3 at 2 years to about 16 cm3 at 20. In adults, the mean thyroid gland volume was 23.5 ± 9 cm3 for males and 17.5 ± 8 cm3 for females. According to anthropometric parameters, the best fit for children was obtained by modeling the log of thyroid volume as a linear function of body surface area (BSA) (p < 0.0001) and age (p = 0.04) and for adults, as a linear function of BSA (p < 0.0001) and gender (p = 0.01). This work enabled us to demonstrate that BSA was the best indicator of thyroid volume for both males and females. These results should be taken into account when modeling the volume of the thyroid in human models used to represent EBRT patients for dosimetry in retrospective studies of the relationship between the estimated dose to the thyroid and long-term follow-up data on EBRT patients.

Proton beam radiotherapy versus fractionated stereotactic radiotherapy for uveal melanomas: A comparative study.

PubMed

Weber, Damien C; Bogner, Joachim; Verwey, Jorn; Georg, Dietmar; Dieckmann, Karin; Escudé, Lluis; Caro, Monica; Pötter, Richard; Goitein, Gudrun; Lomax, Antony J; Miralbell, Raymond

2005-10-01

A comparative treatment planning study was undertaken between proton and photon therapy in uveal melanoma to assess the potential benefits and limitations of these treatment modalities. A fixed proton horizontal beam (OPTIS) and intensity-modulated spot-scanning proton therapy (IMPT), with multiple noncoplanar beam arrangements, was compared with linear accelerator-based stereotactic radiotherapy (SRT), using a static and a dynamic micromultileaf collimator and intensity-modulated RT (IMRS). A planning CT scan was performed on a brain metastasis patient, with a 3-mm acquisition slice spacing and the patient looking at a luminous spot with the eyes in three different positions (neutral and 25 degrees right and left). Four different gross tumor volumes were defined for each treatment technique. These target scenarios represented different locations (involving vs. not involving the macula and temporal vs. nasal) and volumes (10 x 6 mm vs. 16 x 10 mm) to challenge the proton and photon treatment techniques. The planning target volume was defined as the gross tumor volume plus 2 mm laterally and 3 mm craniocaudally for both modalities. A dose homogeneity of 95-99% of the planning target volume was used as the "goal" for all techniques. The dose constraint (maximum) for the organs at risk (OARs) for both the proton and the SRT photon plans was 27.5, 22.5, 20, and 9 CGE-Gy for the optic apparatus, retina, lacrimal gland, and lens, respectively. The dose to the planning target volume was 50 CGE-Gy in 10 CGE-Gy daily fractions. The plans for proton and photon therapy were computed using the Paul Scherrer Institute and BrainSCAN, version 5.2 (BrainLAB, Heimstetten, Germany) treatment planning systems, respectively. Tumor and OARs dose-volume histograms were calculated. The results were analyzed using the dose-volume histogram parameters, conformity index (CI(95%)), and inhomogeneity coefficient. Target coverage of all simulated uveal melanomas was equally conformal with the

Cellular automata in photonic cavity arrays.

PubMed

Li, Jing; Liew, T C H

2016-10-31

We propose theoretically a photonic Turing machine based on cellular automata in arrays of nonlinear cavities coupled with artificial gauge fields. The state of the system is recorded making use of the bistability of driven cavities, in which losses are fully compensated by an external continuous drive. The sequential update of the automaton layers is achieved automatically, by the local switching of bistable states, without requiring any additional synchronization or temporal control.

Experimental two-dimensional quantum walk on a photonic chip.

PubMed

Tang, Hao; Lin, Xiao-Feng; Feng, Zhen; Chen, Jing-Yuan; Gao, Jun; Sun, Ke; Wang, Chao-Yue; Lai, Peng-Cheng; Xu, Xiao-Yun; Wang, Yao; Qiao, Lu-Feng; Yang, Ai-Lin; Jin, Xian-Min

2018-05-01

Quantum walks, in virtue of the coherent superposition and quantum interference, have exponential superiority over their classical counterpart in applications of quantum searching and quantum simulation. The quantum-enhanced power is highly related to the state space of quantum walks, which can be expanded by enlarging the photon number and/or the dimensions of the evolution network, but the former is considerably challenging due to probabilistic generation of single photons and multiplicative loss. We demonstrate a two-dimensional continuous-time quantum walk by using the external geometry of photonic waveguide arrays, rather than the inner degree of freedoms of photons. Using femtosecond laser direct writing, we construct a large-scale three-dimensional structure that forms a two-dimensional lattice with up to 49 × 49 nodes on a photonic chip. We demonstrate spatial two-dimensional quantum walks using heralded single photons and single photon-level imaging. We analyze the quantum transport properties via observing the ballistic evolution pattern and the variance profile, which agree well with simulation results. We further reveal the transient nature that is the unique feature for quantum walks of beyond one dimension. An architecture that allows a quantum walk to freely evolve in all directions and at a large scale, combining with defect and disorder control, may bring up powerful and versatile quantum walk machines for classically intractable problems.

TU-AB-303-02: A Novel Surrogate to Identify Anatomical Changes During Radiotherapy of Head and Neck Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gros, S; Roeske, J; Surucu, M

Purpose: To develop a novel method to monitor external anatomical changes in head and neck cancer patients in order to help guide adaptive radiotherapy decisions. Methods: The method, developed in MATLAB, reveals internal anatomical changes based on variations observed in external anatomy. Weekly kV-CBCT scans from 11 Head and neck patients were retrospectively analyzed. The pre-processing step first corrects each CBCT for artifacts and removes pixels from the immobilization mask to produce an accurate external contour of the patient’s skin. After registering the CBCTs to the initial planning CT, the external contours from each CBCT (CBCTn) are transferred to themore » first week — reference — CBCT{sub 1}. Contour radii, defined as the distances between an external contour and the central pixel of each CBCT slice, are calculated for each scan at angular increments of 1 degree. The changes in external anatomy are then quantified by the difference in radial distance between the external contours of CBCT1 and CBCTn. The radial difference is finally displayed on a 2D intensity map (angle vs radial distance difference) in order to highlight regions of interests with significant changes. Results: The 2D radial difference maps provided qualitative and quantitative information, such as the location and the magnitude of external contour divergences and the rate at which these deviations occur. With this method, anatomical changes due to tumor volume shrinkage and patient weight loss were clearly identified and could be correlated with the under-dosage of targets or over-dosage of OARs. Conclusion: This novel method provides an efficient tool to visualize 3D external anatomical modification on a single 2D map. It quickly pinpoints the location of differences in anatomy during the course of radiotherapy, which can help determine if a treatment plan needs to be adapted.« less

Therapeutic value of lymphadenectomy and adjuvant radiotherapy in uterine corpus confined endometrioid-type cancer.

PubMed

Turan, Taner; Kimyon Comert, Gunsu; Turkmen, Osman; Ureyen, Isin; Fadiloglu, Erdem; Karalok, Alper; Tasci, Tolga; Tulunay, Gokhan; Basaran, Derman

2017-12-26

To determine the efficacy of lymphadenectomy and adjuvant radiotherapy in patients with endometrioid-type cancer confined to the uterine corpus. A total of 323 patients were evaluated. Patients were stratified according to depth of myometrial invasion (DMI) and tumor grade. Lymphadenectomy was performed in 83% of the entire cohort. Age (<60 vs. ≥60) and DMI affected disease-free survival. Addition of lymphadenectomy improved the disease-specific survival. The improved effect of lymphadenectomy was only observed in DMI ≥½ and grade 2 tumor (78.5% vs. 95.4%). However, that effect in this group was determined in patients with more than 50 removed lymph nodes. Performing adjuvant radiotherapy and the type of the radiotherapy (vaginal brachytherapy vs. external beam radiotherapy) were not significant for disease-free and disease-specific survival. In the entire cohort, loco-regional recurrence occurred in 3.1% and 4.4% of patients with or without adjuvant radiotherapy, respectively. However, these rates were 2.6% and 13.6% for patients with DMI ≥½ and grade 2 who were older than 60 years, respectively. Lymphadenectomy should be performed in patients with DMI ≥½ and grade 2 to improve survival. Adjuvant vaginal brachytherapy may only be given to patients who are older than 60 years old with moderate differentiation and deep myometrial invasion to reduce loco-regional recurrence. Copyright © 2017. Published by Elsevier Taiwan LLC.

Comparative Analysis of Neural Network Training Methods in Real-time Radiotherapy.

PubMed

Nouri, S; Hosseini Pooya, S M; Soltani Nabipour, J

2017-03-01

The motions of body and tumor in some regions such as chest during radiotherapy treatments are one of the major concerns protecting normal tissues against high doses. By using real-time radiotherapy technique, it is possible to increase the accuracy of delivered dose to the tumor region by means of tracing markers on the body of patients. This study evaluates the accuracy of some artificial intelligence methods including neural network and those of combination with genetic algorithm as well as particle swarm optimization (PSO) estimating tumor positions in real-time radiotherapy. One hundred recorded signals of three external markers were used as input data. The signals from 3 markers thorough 10 breathing cycles of a patient treated via a cyber-knife for a lung tumor were used as data input. Then, neural network method and its combination with genetic or PSO algorithms were applied determining the tumor locations using MATLAB© software program. The accuracies were obtained 0.8%, 12% and 14% in neural network, genetic and particle swarm optimization algorithms, respectively. The internal target volume (ITV) should be determined based on the applied neural network algorithm on training steps.

SU-E-J-198: Out-Of-Field Dose and Surface Dose Measurements of MRI-Guided Cobalt-60 Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lamb, J; Agazaryan, N; Cao, M

2015-06-15

Purpose: To measure quantities of dosimetric interest in an MRI-guided cobalt radiotherapy machine that was recently introduced to clinical use. Methods: Out-of-field dose due to photon scatter and leakage was measured using an ion chamber and solid water slabs mimicking a human body. Surface dose was measured by irradiating stacks of radiochromic film and extrapolating to zero thickness. Electron out-of-field dose was characterized using solid water slabs and radiochromic film. Results: For some phantom geometries, up to 50% of Dmax was observed up to 10 cm laterally from the edge of the beam. The maximum penetration was between 1 andmore » 2 mm in solid water, indicating an electron energy not greater than approximately 0.4 MeV. Out-of-field dose from photon scatter measured at 1 cm depth in solid water was found to fall to less than 10% of Dmax at a distance of 1.2 cm from the edge of a 10.5 × 10.5 cm field, and less that 1% of Dmax at a distance of 10 cm from field edge. Surface dose was measured to be 8% of Dmax. Conclusion: Surface dose and out-of-field dose from the MRIguided cobalt radiotherapy machine was measured and found to be within acceptable limits. Electron out-of-field dose, an effect unique to MRI-guided radiotherapy and presumed to arise from low-energy electrons trapped by the Lorentz force, was quantified. Dr. Low is a member of the scientific advisory board of ViewRay, Inc.« less

Experimental method of in-vivo dosimetry without build-up device on the skin for external beam radiotherapy

NASA Astrophysics Data System (ADS)

Jeon, Hosang; Nam, Jiho; Lee, Jayoung; Park, Dahl; Baek, Cheol-Ha; Kim, Wontaek; Ki, Yongkan; Kim, Dongwon

2015-06-01

Accurate dose delivery is crucial to the success of modern radiotherapy. To evaluate the dose actually delivered to patients, in-vivo dosimetry (IVD) is generally performed during radiotherapy to measure the entrance doses. In IVD, a build-up device should be placed on top of an in-vivo dosimeter to satisfy the electron equilibrium condition. However, a build-up device made of tissue-equivalent material or metal may perturb dose delivery to a patient, and requires an additional laborious and time-consuming process. We developed a novel IVD method using a look-up table of conversion ratios instead of a build-up device. We validated this method through a monte-carlo simulation and 31 clinical trials. The mean error of clinical IVD is 3.17% (standard deviation: 2.58%), which is comparable to that of conventional IVD methods. Moreover, the required time was greatly reduced so that the efficiency of IVD could be improved for both patients and therapists.

Magnetic assembly of nonmagnetic particles into photonic crystal structures.

PubMed

He, Le; Hu, Yongxing; Kim, Hyoki; Ge, Jianping; Kwon, Sunghoon; Yin, Yadong

2010-11-10

We report the rapid formation of photonic crystal structures by assembly of uniform nonmagnetic colloidal particles in ferrofluids using external magnetic fields. Magnetic manipulation of nonmagnetic particles with size down to a few hundred nanometers, suitable building blocks for producing photonic crystals with band gaps located in the visible regime, has been difficult due to their weak magnetic dipole moment. Increasing the dipole moment of magnetic holes has been limited by the instability of ferrofluids toward aggregation at high concentration or under strong magnetic field. By taking advantage of the superior stability of highly surface-charged magnetite nanocrystal-based ferrofluids, in this paper we have been able to successfully assemble 185 nm nonmagnetic polymer beads into photonic crystal structures, from 1D chains to 3D assemblies as determined by the interplay of magnetic dipole force and packing force. In a strong magnetic field with large field gradient, 3D photonic crystals with high reflectance (83%) in the visible range can be rapidly produced within several minutes, making this general strategy promising for fast creation of large-area photonic crystals using nonmagnetic particles as building blocks.

Characterizing a pulse-resolved dosimetry system for complex radiotherapy beams using organic scintillators.

PubMed

Beierholm, Anders R; Ottosson, Rickard O; Lindvold, Lars R; Behrens, Claus F; Andersen, Claus E

2011-05-21

A fast-readout dosimetry system based on fibre-coupled organic scintillators has been developed for the purpose of conducting point measurements of absorbed dose in radiotherapy beams involving high spatial and temporal dose gradients. The system measures the dose for each linac radiation pulse with millimetre spatial resolution. To demonstrate the applicability of the system in complex radiotherapy fields, output factors and per cent depth dose measurements were performed in solid water for a 6 MV photon beam and compared with Monte Carlo simulated doses for square fields down to 0.6 cm × 0.6 cm size. No significant differences between measurements and simulations were observed. The temporal resolution of the system was demonstrated by measuring dose per pulse, beam start-up transients and the quality factor for 6 MV. The precision of dose per pulse measurements was within 2.7% (1 SD) for a 10 cm × 10 cm field at 10 cm depth. The dose per pulse behaviour compared well with linac target current measurements and accumulated dose measurements, and the system was able to resolve transient dose delivery differences between two Varian linac builds. The system therefore shows promise for reference dosimetry and quality assurance of complex radiotherapy treatments.

Skyshine photon doses from 6 and 10 MV medical linear accelerators

PubMed Central

da Rosa, Luiz A. R.

2012-01-01

The skyshine radiation phenomenon consists of the scattering of primary photon beams in the atmosphere above the roof of a medical linear accelerator facility, generating an additional dose at ground level in the vicinity of the treatment room. Thus, with respect to radioprotection, this situation plays an important role when the roof is designed with little shielding and there are buildings next to the radiotherapy treatment room. In literature, there are few reported skyshine‐measured doses and these contain poor agreement with empirical calculations. In this work, we carried out measurements of skyshine photon dose rates produced from eight different 6 and 10 MV medical accelerators. Each measurement was performed outside the room facility, with the beam positioned in the upward direction, at a horizontal distance from the target and for a 40 cm×40 cm maximum photon field size at the accelerator isocenter. Measured dose‐equivalent rates results were compared with calculations obtained by an empirical expression, and differences between them deviated in one or more order of magnitude. PACS numbers: 87.53.‐j, 87.53.Bn PMID:22231219

High-resolution broadband spectroscopy using externally dispersed interferometry at the Hale telescope: part 2, photon noise theory

NASA Astrophysics Data System (ADS)

Erskine, David J.; Edelstein, Jerry; Wishnow, Edward; Sirk, Martin; Muirhead, Philip S.; Muterspaugh, Matthew W.; Lloyd, James P.

2016-10-01

High-resolution broadband spectroscopy at near-infrared (NIR) wavelengths (950 to 2450 nm) has been performed using externally dispersed interferometry (EDI) at the Hale telescope at Mt. Palomar, with the TEDI interferometer mounted within the central hole of the 200-in. primary mirror in series with the comounted TripleSpec NIR echelle spectrograph. These are the first multidelay EDI demonstrations on starlight. We demonstrated very high (10×) resolution boost and dramatic (20× or more) robustness to point spread function wavelength drifts in the native spectrograph. Data analysis, results, and instrument noise are described in a companion paper (part 1). This part 2 describes theoretical photon limited and readout noise limited behaviors, using simulated spectra and instrument model with noise added at the detector. We show that a single interferometer delay can be used to reduce the high frequency noise at the original resolution (1× boost case), and that except for delays much smaller than the native response peak half width, the fringing and nonfringing noises act uncorrelated and add in quadrature. This is due to the frequency shifting of the noise due to the heterodyning effect. We find a sum rule for the noise variance for multiple delays. The multiple delay EDI using a Gaussian distribution of exposure times has noise-to-signal ratio for photon-limited noise similar to a classical spectrograph with reduced slitwidth and reduced flux, proportional to the square root of resolution boost achieved, but without the focal spot limitation and pixel spacing Nyquist limitations. At low boost (˜1×) EDI has ˜1.4× smaller noise than conventional, and at >10× boost, EDI has ˜1.4× larger noise than conventional. Readout noise is minimized by the use of three or four steps instead of 10 of TEDI. Net noise grows as step phases change from symmetrical arrangement with wavenumber across the band. For three (or four) steps, we calculate a multiplicative bandwidth

High-resolution broadband spectroscopy using externally dispersed interferometry at the Hale telescope: Part 2, photon noise theory

DOE PAGES

Erskine, David J.; Edelstein, Jerry; Wishnow, Edward; ...

2016-10-01

High-resolution broadband spectroscopy at near-infrared (NIR) wavelengths (950 to 2450 nm) has been performed using externally dispersed interferometry (EDI) at the Hale telescope at Mt. Palomar, with the TEDI interferometer mounted within the central hole of the 200-in. primary mirror in series with the comounted TripleSpec NIR echelle spectrograph. These are the first multidelay EDI demonstrations on starlight. We demonstrated very high (10×) resolution boost and dramatic (20× or more) robustness to point spread function wavelength drifts in the native spectrograph. Data analysis, results, and instrument noise are described in a companion paper (part 1). This part 2 describes theoreticalmore » photon limited and readout noise limited behaviors, using simulated spectra and instrument model with noise added at the detector. We show that a single interferometer delay can be used to reduce the high frequency noise at the original resolution (1× boost case), and that except for delays much smaller than the native response peak half width, the fringing and nonfringing noises act uncorrelated and add in quadrature. This is due to the frequency shifting of the noise due to the heterodyning effect. We find a sum rule for the noise variance for multiple delays. The multiple delay EDI using a Gaussian distribution of exposure times has noise-to-signal ratio for photon-limited noise similar to a classical spectrograph with reduced slitwidth and reduced flux, proportional to the square root of resolution boost achieved, but without the focal spot limitation and pixel spacing Nyquist limitations. At low boost (~1×) EDI has ~1.4× smaller noise than conventional, and at >10× boost, EDI has ~1.4× larger noise than conventional. Readout noise is minimized by the use of three or four steps instead of 10 of TEDI. Net noise grows as step phases change from symmetrical arrangement with wavenumber across the band. As a result, for three (or four) steps, we calculate a

High-resolution broadband spectroscopy using externally dispersed interferometry at the Hale telescope: Part 2, photon noise theory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Erskine, David J.; Edelstein, Jerry; Wishnow, Edward

High-resolution broadband spectroscopy at near-infrared (NIR) wavelengths (950 to 2450 nm) has been performed using externally dispersed interferometry (EDI) at the Hale telescope at Mt. Palomar, with the TEDI interferometer mounted within the central hole of the 200-in. primary mirror in series with the comounted TripleSpec NIR echelle spectrograph. These are the first multidelay EDI demonstrations on starlight. We demonstrated very high (10×) resolution boost and dramatic (20× or more) robustness to point spread function wavelength drifts in the native spectrograph. Data analysis, results, and instrument noise are described in a companion paper (part 1). This part 2 describes theoreticalmore » photon limited and readout noise limited behaviors, using simulated spectra and instrument model with noise added at the detector. We show that a single interferometer delay can be used to reduce the high frequency noise at the original resolution (1× boost case), and that except for delays much smaller than the native response peak half width, the fringing and nonfringing noises act uncorrelated and add in quadrature. This is due to the frequency shifting of the noise due to the heterodyning effect. We find a sum rule for the noise variance for multiple delays. The multiple delay EDI using a Gaussian distribution of exposure times has noise-to-signal ratio for photon-limited noise similar to a classical spectrograph with reduced slitwidth and reduced flux, proportional to the square root of resolution boost achieved, but without the focal spot limitation and pixel spacing Nyquist limitations. At low boost (~1×) EDI has ~1.4× smaller noise than conventional, and at >10× boost, EDI has ~1.4× larger noise than conventional. Readout noise is minimized by the use of three or four steps instead of 10 of TEDI. Net noise grows as step phases change from symmetrical arrangement with wavenumber across the band. As a result, for three (or four) steps, we calculate a

Dosimetry audit simulation of treatment planning system in multicenters radiotherapy

NASA Astrophysics Data System (ADS)

Kasmuri, S.; Pawiro, S. A.

2017-07-01

Treatment Planning System (TPS) is an important modality that determines radiotherapy outcome. TPS requires input data obtained through commissioning and the potentially error occurred. Error in this stage may result in the systematic error. The aim of this study to verify the TPS dosimetry to know deviation range between calculated and measurement dose. This study used CIRS phantom 002LFC representing the human thorax and simulated all external beam radiotherapy stages. The phantom was scanned using CT Scanner and planned 8 test cases that were similar to those in clinical practice situation were made, tested in four radiotherapy centers. Dose measurement using 0.6 cc ionization chamber. The results of this study showed that generally, deviation of all test cases in four centers was within agreement criteria with average deviation about -0.17±1.59 %, -1.64±1.92 %, 0.34±1.34 % and 0.13±1.81 %. The conclusion of this study was all TPS involved in this study showed good performance. The superposition algorithm showed rather poor performance than either analytic anisotropic algorithm (AAA) and convolution algorithm with average deviation about -1.64±1.92 %, -0.17±1.59 % and -0.27±1.51 % respectively.

Enhancing photoluminescence yields in lead halide perovskites by photon recycling and light out-coupling.

PubMed

Richter, Johannes M; Abdi-Jalebi, Mojtaba; Sadhanala, Aditya; Tabachnyk, Maxim; Rivett, Jasmine P H; Pazos-Outón, Luis M; Gödel, Karl C; Price, Michael; Deschler, Felix; Friend, Richard H

2016-12-23

In lead halide perovskite solar cells, there is at least one recycling event of electron-hole pair to photon to electron-hole pair at open circuit under solar illumination. This can lead to a significant reduction in the external photoluminescence yield from the internal yield. Here we show that, for an internal yield of 70%, we measure external yields as low as 15% in planar films, where light out-coupling is inefficient, but observe values as high as 57% in films on textured substrates that enhance out-coupling. We analyse in detail how externally measured rate constants and photoluminescence efficiencies relate to internal recombination processes under photon recycling. For this, we study the photo-excited carrier dynamics and use a rate equation to relate radiative and non-radiative recombination events to measured photoluminescence efficiencies. We conclude that the use of textured active layers has the ability to improve power conversion efficiencies for both LEDs and solar cells.

Enhancing photoluminescence yields in lead halide perovskites by photon recycling and light out-coupling

PubMed Central

Richter, Johannes M.; Abdi-Jalebi, Mojtaba; Sadhanala, Aditya; Tabachnyk, Maxim; Rivett, Jasmine P.H.; Pazos-Outón, Luis M.; Gödel, Karl C.; Price, Michael; Deschler, Felix; Friend, Richard H.

2016-01-01

In lead halide perovskite solar cells, there is at least one recycling event of electron–hole pair to photon to electron–hole pair at open circuit under solar illumination. This can lead to a significant reduction in the external photoluminescence yield from the internal yield. Here we show that, for an internal yield of 70%, we measure external yields as low as 15% in planar films, where light out-coupling is inefficient, but observe values as high as 57% in films on textured substrates that enhance out-coupling. We analyse in detail how externally measured rate constants and photoluminescence efficiencies relate to internal recombination processes under photon recycling. For this, we study the photo-excited carrier dynamics and use a rate equation to relate radiative and non-radiative recombination events to measured photoluminescence efficiencies. We conclude that the use of textured active layers has the ability to improve power conversion efficiencies for both LEDs and solar cells. PMID:28008917

Malignant external otitis: early scintigraphic detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Strashun, A.M.; Nejatheim, M.; Goldsmith, S.J.

1984-02-01

Pseudomonas otitis externa in elderly diabetics may extend aggressively to adjacent bone, cranial nerves, meninges, and vessels, leading to a clinical diagnosis of ''malignant'' external otitis. Early diagnosis is necessary for successful treatment. This study compares the findings of initial radiographs, thin-section tomography of temporal bone, CT scans of head and neck, technetium-99m methylene diphosphonate (MDP) and gallium-67 citrate scintigraphy, and single-photon emission computed tomography (SPECT) for detection of temporal bone osteomylitis in ten patients fulfilling the clinical diagnostic criteria of malignant external otitis. Skull radiographs were negative in all of the eight patients studied. Thin-section tomography was positive inmore » one of the seven patients studied using this modality. CT scanning suggested osteomyelitis in three of nine patients. Both Tc-99m and Ga-67 citrate scintigraphy were positive in 10 of 10 patients. These results suggest that technetium and gallium scintigraphy are more sensitive than radiographs and CT scans for early detection of malignant external otitis.« less

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials.

PubMed

Clark, Catharine H; Aird, Edwin G A; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia A D; Thomas, Russell A S; Venables, Karen; Thwaites, David I

2015-01-01

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

PubMed Central

Aird, Edwin GA; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia AD; Thomas, Russell AS; Venables, Karen; Thwaites, David I

2015-01-01

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed. PMID:26329469

Tunable Amorphous Photonic Materials with Pigmentary Colloidal Nanostructures