Dose Delivery System Research Articles

Probiotics, prebiotics, and microencapsulation: A review

ABSTRACTThe development of a suitable technology for the production of probiotics is a key research for industrial production, which should take into account the viability and the stability of the organisms involved. Microbial criteria, stress tolerance during processing, and storage of the product constitute the basis for the production of probiotics. Generally, the bacteria belonging to the genera Lactobacillus and Bifidobacterium have been used as probiotics. Based on their positive qualities, probiotic bacteria are widely used in the production of food. Interest in the incorporation of the probiotic bacteria into other products apart from dairy products has been increasing and represents a great challenge. The recognition of dose delivery systems for probiotic bacteria has also resulted in research efforts aimed at developing probiotic food outside the dairy sector. Producing probiotic juices has been considered more in the recent years, due to an increased concern in personal health of consumers. This review focuses on probiotics, prebiotics, and the microencapsulation of living cells.

The CNAO dose delivery system for modulated scanning ion beam radiotherapy.

This paper describes the system for the dose delivery currently used at the Centro Nazionale di Adroterapia Oncologica (CNAO) for ion beam modulated scanning radiotherapy. CNAO Foundation, Istituto Nazionale di Fisica Nucleare and University of Torino have designed, built, and commissioned a dose delivery system (DDS) to monitor and guide ion beams accelerated by a dedicated synchrotron and to distribute the dose with a full 3D scanning technique. Protons and carbon ions are provided for a wide range of energies in order to cover a sizable span of treatment depths. The target volume, segmented in several layers orthogonally to the beam direction, is irradiated by thousands of pencil beams which must be steered and held to the prescribed positions until the prescribed number of particles has been delivered. For the CNAO beam lines, these operations are performed by the DDS. The main components of this system are two independent beam monitoring detectors, called BOX1 and BOX2, interfaced with two control systems performing the tasks of real-time fast and slow control, and connected to the scanning magnets and the beam chopper. As a reaction to any condition leading to a potential hazard, a DDS interlock signal is sent to the patient interlock system which immediately stops the irradiation. The essential tasks and operations performed by the DDS are described following the data flow from the treatment planning system through the end of the treatment delivery. The ability of the DDS to guarantee a safe and accurate treatment was validated during the commissioning phase by means of checks of the charge collection efficiency, gain uniformity of the chambers, and 2D dose distribution homogeneity and stability. A high level of reliability and robustness has been proven by three years of system activity needing rarely more than regular maintenance and working with 100% uptime. Four identical and independent DDS devices have been tested showing comparable performances and are presently in use on the CNAO beam lines for clinical activity. The dose delivery system described in this paper is one among the few worldwide existing systems to operate ion beam for modulated scanning radiotherapy. At the time of writing, it has been used to treat more than 350 patients and it has proven to guide and control the therapeutic pencil beams reaching performances well above clinical requirements. In particular, in terms of dose accuracy and stability, daily quality assurance measurements have shown dose deviations always lower than the acceptance threshold of 5% and 2.5%, respectively.

Sci-Fri PM: Topics - 07: Monte Carlo Simulation of Primary Dose and PET Isotope Production for the TRIUMF Proton Therapy Facility

Uveal melanoma is a rare and deadly tumour of the eye with primary metastases in the liver resulting in an 8% 2-year survival rate upon detection. Large growths, or those in close proximity to the optic nerve, pose a particular challenge to the commonly employed eye-sparing technique of eye-plaque brachytherapy. In these cases external beam charged particle therapy offers improved odds in avoiding catastrophic side effects such as neuropathy or blindness. Since 1995, the British Columbia Cancer Agency in partnership with the TRIUMF national laboratory have offered proton therapy in the treatment of difficult ocular tumors. Having seen 175 patients, yielding 80% globe preservation and 82% metastasis free survival as of 2010, this modality has proven to be highly effective. Despite this success, there have been few studies into the use of the world's largest cyclotron in patient care. Here we describe first efforts of modeling the TRIUMF dose delivery system using the FLUKA Monte Carlo package. Details on geometry, estimating beam parameters, measurement of primary dose and simulation of PET isotope production are discussed. Proton depth dose in both modulated and pristine beams is successfully simulated to sub-millimeter precision in range (within limits of measurement) and 2% agreement to measurement within in a treatment volume. With the goal of using PET signals for in vivo dosimetry (alignment), a first look at PET isotope depth distribution is presented — comparing favourably to a naive method of approximating simulated PET slice activity in a Lucite phantom.

SU-E-T-107: Development of a GPU-Based Dose Delivery System for Adaptive Pencil Beam Scanning

Purpose: A description of a GPU-based dose delivery system (G-DDS) to integrate a fast forward planning implementing in real-time the prescribed sequence of pencil beams. The system, which is under development, is designed to evaluate the dose distribution deviations due to range variations and interplay effects affecting mobile tumors treatments. Methods: The Dose Delivery System (DDS) in use at the Italian Centro Nazionale di Adroterapia Oncologica (CNAO), is the starting point for the presented system. A fast and partial forward planning (FP) tool has been developed to evaluate in few seconds the delivered dose distributions using the DDS data (on-line measurements of spot properties, i.e. number of particles and positions). The computation is performed during the intervals between synchrotron spills and, made available at the end of each spill. In the interval between two spills, the G-DDS will evaluate the delivered dose distributions taking into account the real-time target positions measured by a tracking system. The sequence of prescribed pencil beams for the following spill will be adapted taking into account the variations with respect to the original plan due to the target motion. In order to speed up the computation required to modify pencil beams distribution (up to 400more » times has been reached), the Graphics Processing Units (GPUs) and advanced Field Programmable Gate Arrays (FPGAs) are used. Results: An existing offline forward planning is going to be optimized for the CUDA architecture: the gain in time will be presented. The preliminary performances of the developed GPU-based FP algorithms will be shown. Conclusion: A prototype of a GPU-based dose delivery system is under development and will be presented. The system workflow will be illustrated together with the approach adopted to integrate the three main systems, i.e. CNAO dose delivery system, fast forward planning, and tumor tracking system.« less

59: Dose Delivery System of CNAO: a new medical device

Since September 2011 CNAO Foundation has been using the active Dose Delivery System (DDS) developed by CNAO and INFN. The evolution toward a CE marked medical device with the involvement of industrial partners is presented. The DDS is composed by: two independent beam monitors (with strip and integral ionization chambers each) with an active area larger than 200x200 mm and a total water equivalent thickness along the beam path of about 0.9 mm; data transmission system to carry signals away from the treatment room; data acquisition system based on real-time software and designed to manage hadrontherapy treatment, beam measurements and check of the dosimetric parameters. Ancillaries: power supplies of the detection system, gas distribution system, delivered dose recovery (DDR) and interfaces towards patient interlock system, chopper magnet (beam stopper) and scanning magnets. The acceptance tests to verify the performance of the system and the tests required to demonstrate the compliance with the technical rules related to the 93/42/EEC are described and showed. The DDS has been produced following the Medical Devices Directive 93/42/EEC ISO 13485 medical requirements.

Local confidence limits for IMRT and VMAT techniques: a study based on TG119 test suite

The aim of this study was to generate a local confidence limit (CL) for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques used at Waikato Regional Cancer Centre. This work was carried out based on the American Association of Physicists in Medicine (AAPM) Task Group (TG) 119 report. The AAPM TG 119 report recommends CLs as a bench mark for IMRT commissioning and delivery based on its multiple institutions planning and dosimetry comparisons. In this study the locally obtained CLs were compared to TG119 benchmarks. Furthermore, the same bench mark was used to test the capabilities and quality of the VMAT technique in our clinic. The TG 119 test suite consists of two primary and four clinical tests for evaluating the accuracy of IMRT planning and dose delivery systems. Pre defined structure sets contoured on computed tomography images were downloaded from AAPM website and were transferred to a locally designed phantom. For each test case two plans were generated using IMRT and VMAT optimisation. Dose prescriptions and planning objectives recommended by TG119 report were followed to generate the test plans in Eclipse Treatment Planning System. For each plan the point dose measurements were done using an ion chamber at high dose and low dose regions. The planar dose distribution was analysed for percentage of points passing the gamma criteria of 3%/3 mm, for both the composite plan and individual fields of each plan. The CLs were generated based on the results from the gamma analysis and point dose measurements. For IMRT plans, the CLs obtained were (1) from point dose measurements: 2.49% at high dose region and 2.95% for the low dose region (2) from gamma analysis: 2.12% for individual fields and 5.9% for the composite plan. For VMAT plans, the CLs obtained were (1) from point dose measurements: 2.56% at high dose region and 2.6% for the low dose region (2) from gamma analysis: 1.46% for individual fields and 0.8% for the composite plan. All these CLs were well within the TG119 recommended bench marks. Based on these analysis which were performed in line with the TG119 recommendations, it is evident that the local clinic has commissioned IMRT and VMAT techniques with adequate accuracy. These results compliment our clinical confidence of using IMRT and VMAT routinely and expanding to different clinical sites.

Evaluating IMRT and VMAT dose accuracy: Practical examples of failure to detect systematic errors when applying a commonly used metric and action levels

This study (1) examines a variety of real-world cases where systematic errors were not detected by widely accepted methods for IMRT/VMAT dosimetric accuracy evaluation, and (2) drills-down to identify failure modes and their corresponding means for detection, diagnosis, and mitigation. The primary goal of detailing these case studies is to explore different, more sensitive methods and metrics that could be used more effectively for evaluating accuracy of dose algorithms, delivery systems, and QA devices. The authors present seven real-world case studies representing a variety of combinations of the treatment planning system (TPS), linac, delivery modality, and systematic error type. These case studies are typical to what might be used as part of an IMRT or VMAT commissioning test suite, varying in complexity. Each case study is analyzed according to TG-119 instructions for gamma passing rates and action levels for per-beam and/or composite plan dosimetric QA. Then, each case study is analyzed in-depth with advanced diagnostic methods (dose profile examination, EPID-based measurements, dose difference pattern analysis, 3D measurement-guided dose reconstruction, and dose grid inspection) and more sensitive metrics (2% local normalization/2 mm DTA and estimated DVH comparisons). For these case studies, the conventional 3%/3 mm gamma passing rates exceeded 99% for IMRT per-beam analyses and ranged from 93.9% to 100% for composite plan dose analysis, well above the TG-119 action levels of 90% and 88%, respectively. However, all cases had systematic errors that were detected only by using advanced diagnostic techniques and more sensitive metrics. The systematic errors caused variable but noteworthy impact, including estimated target dose coverage loss of up to 5.5% and local dose deviations up to 31.5%. Types of errors included TPS model settings, algorithm limitations, and modeling and alignment of QA phantoms in the TPS. Most of the errors were correctable after detection and diagnosis, and the uncorrectable errors provided useful information about system limitations, which is another key element of system commissioning. Many forms of relevant systematic errors can go undetected when the currently prevalent metrics for IMRT∕VMAT commissioning are used. If alternative methods and metrics are used instead of (or in addition to) the conventional metrics, these errors are more likely to be detected, and only once they are detected can they be properly diagnosed and rooted out of the system. Removing systematic errors should be a goal not only of commissioning by the end users but also product validation by the manufacturers. For any systematic errors that cannot be removed, detecting and quantifying them is important as it will help the physicist understand the limits of the system and work with the manufacturer on improvements. In summary, IMRT and VMAT commissioning, along with product validation, would benefit from the retirement of the 3%/3 mm passing rates as a primary metric of performance, and the adoption instead of tighter tolerances, more diligent diagnostics, and more thorough analysis.

Dosimetry of MammoSite® applicator: Comparison between Monte Carlo simulation, measurements, and treatment planning calculation

To investigate the dosimetric characteristics of accelerated partial breast irradiation technique by MammoSite® applicator using thermoluminescent dosimeter (TLD) and Monte Carlo simulation to comparing them with treatment planning system calculation for planning target volume (PTV) and organs at risk such as skin, lung and chest wall. The Monte Carlo MCNP-5 code was used to simulate dose rate in the PTV that is a MammoSite® balloon with 1 cm margin around it. Experimental dosimetry was carried out within a female-equivalent chest phantom with TLD dosimeter after insertion of 192 Ir source into the MammoSite® applicator. Three dimensional planning (TP) was done for dose delivery to the specific points within the phantom by means of FlexiPlan software. Statistical comparisons were done between TP calculation, Monte Carlo simulation and TLD. Our results showed good agreement for surface doses between simulation and measurement. The mean skin dose for the simulation and TLD result was 61.7% and 56.8% of prescription dose, respectively. The maximum dose to the chest wall for Monte Carlo and TLD were 114.4% and 111.8% of prescription dose, respectively. The maximum dose to the lung for Monte Carlo and TLD results were 28.4% and 27.3% of prescription dose, respectively. Using Monte Carlo simulation and an average female chest phantom, it was possible to demonstrate the accuracy on the calculated dose rate in the PTV of a MammoSite® dose delivery system with 192 Ir HDR sources. The results showed acceptable agreement between simulation, treatment planning, and experimental dosimetry results.

Single-dose and multi-dose delivery systems for intranasal fentanyl spray are bioequivalent as demonstrated in a replicate pharmacokinetic study

Intranasal fentanyl spray (INFS, Instanyl®) was developed to treat cancer patients with Breakthrough Pain (BTP). INFS is delivered via a multi-dose delivery system (MDS) that is available in various dose strengths. The aim of this study was to demonstrate the pharmacokinetic bioequivalence of INFS single dose delivery system (SDS) in relation to the currently marketed MDS device. In a randomized, single-center, single-dose, open label, comparative, four-period, two-sequence, replicate cross-over study, 48 healthy subjects (24 male and 24 female, mean age of 28.1 years, mean bodyweight 69.8 kg) received 200 μg/100 μl fentanyl administered via SDS and via MDS in one of two alternating treatment sequences. Naltrexone was given to all subjects to prevent potential fentanyl adverse drug reactions. Blood samples were frequently taken up to 72 hours post INFS administration and analyzed by liquid chromatography with tandem mass spectrometric detection. Primary pharmacokinetic parameters were area under the curve extrapolated to infinity (AUC0-∞) and peak plasma concentration (Cmax). Statistical analyses of the primary pharmacokinetic parameters were performed using a linear mixed effect model applied to the natural log-transformed data. Healthy subjects showed very similar plasma concentration over time profiles for both delivery systems. The mean fentanyl Cmax and AUC0-∞ values for SDS and MDS were 948 pg/ml, 949 pg/ml and 4,439 pg×h/ml, 4,489 pg×h/ml. respectively. Point estimates (and 90% confidence intervals) for AUC and Cmax were 0.97 (0.93 - 1.02) and 1.00 (0.92 - 1.09) and therefore in the bioequivalence range of 0.80 - 1.25. Results of this study show that SDS and MDS met the pre-defined regulatory criteria for bioequivalence. Safety profiles were consistent between both devices and no safety concerns were identified with INFS administered in combination with oral naltrexone.

Validation of a new protocol for 18F-FDG infusion using an automatic combined dispenser and injector system

In nuclear medicine, radiopharmaceuticals are usually administered in unit doses partitioned from multi-dose vials. The partitioning typically takes place in a radiopharmacy, depending on local practice. Automatic, as opposed to manual, partitioning and administration should reduce radiation exposure of the personnel involved, improve the accuracy of the administration and mitigate contamination. This study set out to verify and validate the (18)F-fluorodeoxyglucose (FDG) administration procedure performed using Intego (MEDRAD, Inc., Warrendale, PA, USA), a combined dispenser and injector system. We considered maintenance of sterility and the system's potential to improve, with respect to the manual procedure, the accuracy of net administered (18)F-FDG radioactivity in patients and the radiation protection of operators. A media-fill procedure was used to assess whether sterility is maintained during use of the Intego system. Simulating a typical working day's setup and use of the system, we investigated the accuracy of the net administered (18)F-FDG activity obtained with Intego versus the manual dose delivery system. We also measured personnel radiation exposure during use of Intego and during manual administration and recorded and compared environmental doses in the two conditions. The radiopharmaceutical remained sterile in all the tests performed. The accuracy of the net (18)F-FDG activity delivered to the patients was found to be within 3 % points, as required by European Association of Nuclear Medicine (EANM) guidelines on (18)F-FDG imaging procedures. With Intego, the residual radioactivity in the tubing was 0.20 MBq, corresponding to approximately 0.07 % of the mean activity delivered. With manual injection, the residual radioactivity in the syringe averaged 7.37 MBq, corresponding to a mean error of 2.9 % in the delivered dose. During the injection step of the positron emission tomography (PET) procedure, whole-body and extremity radiation exposures were significantly reduced with Intego by 38 and by 94 %, respectively, compared to the levels associated with manual administration (p < 0.05). Integoaccurately partitions and administers sterile doses of (18)F-FDG from multi-dose vials. Compared with standard manual (18)F-FDG administration, the new procedure with an automatic dispensing and injection system greatly reduces the extremity dose to the operator involved in the administration of the radiopharmaceutical.

SU-E-T-298: Evaluation of the CNAO Spot Scanning Technique Based on the First Clinical Deliveries.

The first Italian hospital-based facility for hadrontherapy is the Centro Nazionale di Adroterapia Oncologica (CNAO) which started the clinical activity on September 2011 with protons beams. The control of the treatment is performed online by the Dose Delivery (DD) system which guides the whole treatment by measuring beam characteristics as number of delivered particles and beam position. The author will present the comparison between the required and delivered quantities. The CNAO facility is based on a synchrotron designed to accelerate and deliver proton and carbon ion beams in the clinical ranges. Unlike most of the proton-therapy centres, the delivery technique adopted at CNAO is the "quasi-discrete" active scanning where dedicated magnets are used to drive a pencil beam through the target and the beam is normally not switched off during the transition between adjacent spots. These operations are performed by the DD system which, based on the treatment planning and the online analysis of dedicated beam monitor chambers, drives the scanning magnets. Spot by spot the DD records data which allow the comparison between the measured number of particles and position and the prescription. The data collected by the dose delivery during the treatments were analyzed in detail, each treatment consisting in more than 30 identical fractions. This allows checking the stability and the accuracy of the CNAO delivery over identical spot sequences. The comparison between the measured number of particles, the measured position of each spot, and the corresponding prescribed quantities will be presented in detail. Critical points will be discussed together with the proposed improvement of the system. The results confirm the good performance of the CNAO beam delivery obtained during the commissioning phase.

A review on the technical and dosimetric aspects of stereotactic body radiation therapy (SBRT)

Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy is currently enjoying much popularity due to its favorable outcomes. This treatment option had been derived from stereotactic radiosurgery (SRS) which uses focus irradiation technique to deliver a very high dose to a small intracranial target. The focus irradiation technique is performed using multiple collimated beams directed at the target from around the patient. Advancement in technology has provided similar tools on tomotherapy, modern medical linear accelerators, and dedicated system such as the Cyberknife to perform SBRT. Such tools include immobilization systems, 3D treatment planning systems, image-guidance system for precise localization, and accurate dose delivery systems. Each of these systems is being briefly reviewed. While the technical specifications of the equipment for SBRT are favorable, the dosimetric aspects need attention when performing treatment planning and managing target/organ motion. Because of the delivery of high doses in one or few fractions, special considerations must be given to transient doses through neighboring structures to avoid or reduce radiation toxicities for SBRT. Like SRS, direct involvement of medical physicists is essential for both the quality assurance and clinical procedures.

Modeling of tumor growth undergoing virotherapy

Tumor growth models subject to virotherapy treatment are analyzed and compared in this paper. Tumor growth conditions are obtained for each model type based on the virus infection rate and immune suppressive drug delivery. Equilibrium conditions resulted into quadratic functions for which the tumor radius remained constant during virotherapy. An irrigation tumor model for virotherapy treatment was also proposed. This model consists of irrigation layers distributed radially along the tumor and attached to a common blood circulation compartment. The irrigation model has similar dynamic and steady state characteristics to the diffusion model, which has been supported by experimental results. The irrigation model considers the immune system cell generation and consumption outside the tumor boundary but inside the blood circulation compartment. These characteristics provide a great potential for advanced cancer treatment applications because therapy dose delivery and immune system measurements can be made at the blood compartment level of the irrigation model.

Present challenges in hadrontherapy techniques

Hadrontherapy is a high-precision technique in cancer radiation therapy, which allows obtaining a superior conformal treatment with respect to photons used in conventional radiation therapy. To reach this ambitious goal without reducing the patient throughput needed in a hospital-based environment, the physical and radiobiological properties of charged hadrons, protons and carbon ions in particular, have to be exploited at best, making use of the most modern technologies issued from research in nuclear and particle physics. In the present days, we are assisting to a continuous technological challenge, leading to the conception and to the development of innovative methods and instruments. In this paper, the most relevant challenges in dose delivery systems, gantries, imaging, quality assurance and particle accelerators are reviewed.

Effects of breast‐air and breast‐lung interfaces on the dose rate at the planning target volume of a MammoSite® catheter for Yb‐169 and Ir‐192 HDR sources

To study the effects of the breast-air and breast-lung interfaces on the absorbed dose within the planning target volume (PTV) of a MammoSite balloon dose delivery system as well as the effect of contrast material on the dose rate in the PTV. The Monte Carlo MCNP5 code was used to simulate dose rate in the PTV of a 2 cm radius MammoSite balloon dose delivery system. The simulations were carried out using an average female chest phantom (AFCP) and a semi-infinite water phantom for both Yb-169 and Ir-192 high dose rate sources for brachytherapy application. Gastrografin was introduced at varying concentrations to study the effect of contrast material on the dose rate in the PTV. The effect of the density of the materials surrounding the MammoSite balloon containing 0% contrast material on the calculated dose rate at different radial distances in the PTV was demonstrated. Within the PTV, the ratio of the calculated dose rate for the AFCP and the semi-infinite water phantom for the point closest to the breast-air interface (90 degrees) is less than that for the point closest to the breast-lung interface (270 degrees) by 11.4% and 4% for the HDR sources of Yb-169 and Ir-192, respectively. When contrast material was introduced into the 2 cm radius MammoSite balloon at varying concentrations, (5%, 10%, 15%, and 20%), the dose rate in the AFCP at 3.0 cm radial distance at 90 degrees was decreased by as much as 14.8% and 6.2% for Yb-169 and Ir-192, respectively, when compared to that of the semi-infinite water phantom with contrast concentrations of 5%, 10%, 15%, and 20%, respectively. Commercially available software used to calculate dose rate in the PTV of a MammoSite balloon needs to account for patient anatomy and density of surrounding materials in the dosimetry analyses in order to avoid patient underdose.

Performances of the scanning system for the CNAO center of oncological hadron therapy

In hadron therapy one of the most advanced methods for beam delivery is the active scanning technique which uses fast scanning magnets to drive a narrow particle beam across the target. The Centro Nazionale di Adroterapia Oncologica (CNAO) will treat tumours with this technique. The CNAO scanning system includes two identical dipole magnets for horizontal and vertical beam deflection, each one connected to a fast power supply. The dose delivery system exploits a set of monitor chambers to measure the fluence and position of the beam and drives the beam during the treatment by controlling the sequence of currents set by the power supplies. A test of the dynamic performance of the scanning system has been performed using a Hall probe to measure the field inside the magnet and the results are presented in this paper.

SU‐FF‐T‐308: Output Factor Measurements and Aperture Size Dependence of Dose Distributions for Scanned Proton Beams at MPRI

Purpose: Prior to a patient's proton beam treatment at MPRI, the Quality Assurance program entails measurement of the specific output factor for each field with its associated hardware in place. As a basis for comparison to patient specific measurements, and to characterize our dose delivery and monitoring system, we have measured a standard set of output factors (10 cm diameter aperture without compensator) over the energy range of clinical interest for all spread‐out Bragg peaks (SOBPs) commissioned for delivery. We have also made detailed measurements of on‐axis depth‐dose distributions as a function of aperture diameter from 10 cm to 2 cm for representative scanned‐beam fields to further characterize our system. Method and Materials: Single point output factor measurements were made in a water phantom using a Markus ionization chamber. Additionally, depth‐dose distributions were acquired with a multi‐layer ionization chamber (MLIC) array, which provides 122 depth channels spaced approximately every 0.18 cm. Lastly, beam profiles were measured with a commercial array of ionization chambers (MatriXX, IBA). Results: The results show the systematic decrease in dose along the SOBP plateau, and the increase of the SOBP entrance dose relative to the plateau dose, as a function of aperture size and treatment range. The need to carefully plan and deliver fields less than 5 cm diameter is obvious. Additionally, the application of the standard output factor measurements to predicting patient specific output factors for prostate patients has been verified with ±0.8% accuracy. Conclusions: Given the similarity of prostate fields and our ability to model the output factors within ±0.8%, we no longer measure patient specific output factors for prostate patients treated with opposed laterals. But, we do make these output factor measurements for other treatment fields while utilizing the MLIC to characterize depth‐dose distributions for fields smaller than 5 cm diameter.

Technical aspects of quality assurance in radiation oncology

The technical aspects of quality assurance (QA) in radiation oncology as practice in the United States will be reviewed and updated in the spirit of offering the experience to the radiation oncology communities in the Asia-Pacific region. The word “technical” is used to express the organisational components or processes and not the materials within the QA program. A comprehensive QA program in radiation oncology will have an official statement declaring the quality plan for effective patient care services it provides in a document. The QA program will include all aspects of patient care: physical, clinical, and medical aspects of the services. The document will describe the organisational structure, responsibilities, checks and procedures, and resources allocated to ensure the successful implementation of the quality of patient management. Regulatory guidelines and guidelines from accreditation agencies should be incorporated in the QA program to ensure compliance. The organisational structure will have a multidisciplinary QA committee that has the authority to evaluate continuously the effectiveness of the QA program to provide prompt corrective recommendations and to request feedback as needed to monitor the response. The continuous monitoring aspects require meetings to be held at regular intervals with the minutes of the meetings officially recorded and documented. To ensure that a QA program is effective, the program itself should be audited for quality at regular intervals at least annually. It has been recognised that the current QA program has not kept abreast with the rapid implementation of new and advanced radiation therapy technologies with the most recent in image-based radiation therapy technology. The societal bodies (ASTRO and AAPM) and federal agency (NCI) acknowledge this inadequacy and have held workshops to address this issue. The challenges for the societal bodies and federal agency are numerous that include (a) the prescriptive methodology used may not be appropriate for currently implemented new technologies, (b) resources are becoming scarce, (c) advanced radiation therapy technologies have been introduced too rapidly, (d) advances in radiation therapy technologies have become too sophisticated and specialised with each therapy modality having its own separate set of equipment, for example its own dose planning software, computer system and dose delivery systems requiring individualised QA procedures. At the present time, industrial engineers are being recruited to assist in devising a methodology that is broad-based and more process-oriented risk-based formulation of QA in radiation oncology.

TH-D-352-06: An Overview of Comprehensive Proton Machine Quality Assurance at the University of Texas M.D. Anderson Cancer Center

Purpose: Since the publication of ICRU‐59, there has not been any dedicated report constitute to proton therapy machine quality assurance (QA). We present a comprehensive machine QA program that is implemented at the proton therapy center in Houston (PTC‐H). Method and Materials: PTC‐H uses a Hitachi proton therapy machine for treatment of cancer patients. The machine consists of a synchrotron accelerator that delivers proton beams in range of 70–250 MeV to three gantries and one fixed beam rooms. The majority of the QA procedures are based on the AAPM TG‐40. Specific tests include mechanical, beam quality, dose delivery system, imaging system tests, safety interlock checks and information flow to the Electronic Medical Record. Frequency of these tests depends on many factors such as safety requirements, availability of the treatment rooms, state regulations, consistency, and reproducibility. Results: Analysis of our results for many tests for a period of one year will be presented. The dose outputs remained stable within 1%, Spread Out Bragg Peaks widths and proton ranges were consistently within 1‐mm, the flatness/symmetry remained stable within 2%, gantry/treatment couch isocentricity were found to be within 1°, and mechanical limits were within 1‐mm. Periodic issues with information flow have been discovered. Conclusion: We have developed a comprehensive machine QA program at PTC‐H. The QA program was gradually and cautiously developed at the beginning with numerous frequencies. It is hoped that by sharing our experiences in developing such a QA program, we will provide an insight to upcoming new facilities for proton therapy to establish their program.

Comparison of ciprofloxacin hydrochloride‐loaded protein, lipid, and chitosan nanoparticles for drug delivery

The aim of the present study was to develop single dose delivery systems based on nanotechnology for prolonged antibiotic release in a controlled manner. Five different drug-carrier ratios of ciprofloxacin hydrochloride-loaded nanoparticles of albumin, gelatin, chitosan (CS), and lipid [solid lipid nanoparticles (SLNs)] were prepared and characterized. Average particle size was found to be in the range of 73 +/- 2 to 98 +/- 44 nm for SLNs, 140 +/- 7 to 175 +/- 24 nm for albumin nanoparticles, 143 +/- 18 to 184 +/- 27 nm for gelatin nanoparticles, and 247 +/- 48 to 322 +/- 52 nm for CS nanoparticles. A drug-to-carrier ratio of 0.5:1 was preferred for CS nanoparticles having zeta potential of >20 mV and drug encapsulation of 35.01% +/- 2.66%. Similarly, 0.6:1 ratio was preferred for albumin nanoparticles with zeta potential >16 mV and drug encapsulation 48.20% +/- 3.01%. Zeta potentials of gelatin nanoparticles loaded with ciprofloxacin suggested that they were unstable and prone to flocculation. SLN with 0.25:1 drug carrier ratio showed 38.71% +/- 2.38% drug entrapment and -28 +/- 1 mV surface charge. All the nanoparticles showed sustained drug release avoiding "burst effect" of the free drugs for up to 120 h for albumin nanoparticles, 96 h for CS and gelatin nanoparticles, and 80 h for SLNs. The drug release profiles followed Higuchi model. Results suggest that CS nanoparticles and SLNs can act as promising carriers for sustained ciprofloxacin release in infective conditions.