Dose Region Research Articles

Revision of orthovoltage chest wall treatment using Monte Carlo simulations.

Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. The results of the treatment study show that the optimized standard and mid sternum treatment for different chest wall thicknesses is with 50 cm FSD and zero (vertical) tube angle, while in large contour patients, it is with 100 cm FSD and zero tube angle. Finally, chest wall kilovoltage and electron therapies were compared, which revealed that electron therapy produces a better dose distribution than kilovoltage therapy.

TL and OSL dose response and stability properties of various commercially glass samples obtained from Turkey for dosimetric purposes in the UV emission spectral region

This paper reports Thermoluminescence (TL) and Optically Stimulated Luminescence (OSL) dose response characteristics of ten different commercial glass samples collected from Turkey. Nowadays, glass samples are widely used mostly in objects of everyday life. The study focuses to both TL and OSL dose responses, through a dose region within 1 and 512Gy. Lowest detectable dose limit (LDDL) as well as the respective linearity features of the corresponding dose response curves were studied for both TL and OSL. Moreover, signal reproducibility and fading behaviors have also been studied in detail. For specific samples, the lowest detectable dose was yielded at 2Gy, making thus these samples appropriate for retrospective dosimetry applications. Nevertheless, based on the features reported in the present study, the majority of the samples could be possibly used effectively for dosimetric applications of higher doses in the UV region emission.

Functional lung avoidance and response-adaptive escalation (FLARE) RT: Multimodality plan dosimetry of a precision radiation oncology strategy.

Nonsmall cell lung cancer (NSCLC) patient radiation therapy (RT) is planned without consideration of spatial heterogeneity in lung function or tumor response. We assessed the dosimetric and clinical feasibility of functional lung avoidance and response-adaptive escalation (FLARE) RT to reduce dose to [99m Tc]MAA-SPECT/CT perfused lung while redistributing an escalated boost dose within [18 F]FDG-PET/CT-defined biological target volumes (BTV). Eight stage IIB-IIIB NSCLC patients underwent FDG-PET/CT and MAA-SPECT/CT treatment planning scans. Perfused lung objectives were derived from scatter/collimator/attenuation-corrected MAA-SPECT uptake relative to ITV-subtracted lung to maintain <20Gy mean lung dose (MLD). Prescriptions included 60Gy to the planning target volume (PTV) and concomitant boost of 74Gy mean to biological target volumes (BTV=GTV+PET gradient segmentation) scaled to each BTV voxel by relative FDG-PET SUV. Dose-painting-by-numbers prescriptions were integrated into commercial treatment planning systems via uptake threshold discretization. Dose constraints for lung, heart, cord, and esophagus were defined. FLARE RT plans were optimized with volumetric modulated arc therapy (VMAT), proton pencil beam scanning (PBS) with 3%-3mm robust optimization, and combination of PBS (avoidance) plus VMAT (escalation). The high boost dose region was evaluated within a standardized SUVpeak structure. FLARE RT plans were compared to reference VMAT plans. Linear regression between radiation dose to BTV and normalized FDG PET SUV at every voxel was conducted, from which Pearson linear correlation coefficients and regression slopes were extracted. Spearman rank correlation coefficients were estimated between radiation dose to lung and normalized SPECT uptake. Dosimetric differences between treatment modalities were evaluated by Friedman nonparametric paired test with multiple sampling correction. No unacceptable violations of PTV and normal tissue objectives were observed in 24 FLARE RT plans. Compared to reference VMAT plans, FLARE VMAT plans achieved a higher mean dose to BTV (73.7Gy 98195. 61.3Gy), higher mean dose to SUVpeak (89.7Gy vs. 60.8Gy), and lower mean dose to highly perfused lung (7.3Gy vs. 14.9Gy). These dosimetric gains came at the expense of higher mean heart dose (9.4Gy vs. 5.8Gy) and higher maximum cord dose (50.1Gy vs. 44.6Gy) relative to the reference VMAT plans. Between FLARE plans, FLARE VMAT achieved higher dose to the SUVpeak ROI than FLARE PBS (89.7Gy vs. 79.2Gy, P=0.01), while FLARE PBS delivered lower dose to lung than FLARE VMAT (11.9Gy vs. 15.6Gy, P<0.001). Voxelwise linear dose redistribution slope between BTV dose and FDG PET uptake was higher in magnitude for FLARE PBS+VMAT (0.36Gy per %SUVmax ) compared to FLARE VMAT (0.27Gy per %SUVmax ) or FLARE PBS alone (0.17Gy per %SUVmax ). FLARE RT is clinically feasible with VMAT and PBS. A combination of PBS for functional lung avoidance and VMAT for FDG PET dose escalation balanced target and normal tissue objective tradeoffs. These results provide a technical platform for testing of FLARE RT safety and efficacy within a precision radiation oncology trial.

Intercenter validation of a knowledge based model for automated planning of volumetric modulated arc therapy for prostate cancer. The experience of the German RapidPlan Consortium

PurposeTo evaluate the performance of a model-based optimisation process for volumetric modulated arc therapy applied to prostate cancer in a multicentric cooperative group. The RapidPlan (RP) knowledge-based engine was tested for the planning of Volumetric modulated arc therapy with RapidArc on prostate cancer patients. The study was conducted in the frame of the German RapidPlan Consortium (GRC).Methods and materials43 patients from one institute of the GRC were used to build and train a RP model. This was further shared with all members of the GRC plus an external site from a different country to increase the heterogeneity of the patient’s sampling. An in silico multicentric validation of the model was performed at planning level by comparing RP against reference plans optimized according to institutional procedures. A total of 60 patients from 7 institutes were used.ResultsOn average, the automated RP based plans resulted fully consistent with the manually optimised set with a modest tendency to improvement in the medium-to-high dose region. A per-site stratification allowed to identify different patterns of performance of the model with some organs at risk resulting better spared with the manual or with the automated approach but in all cases the RP data fulfilled the clinical acceptability requirements. Discrepancies in the performance were due to different contouring protocols or to different emphasis put in the optimization of the manual cases.ConclusionsThe multicentric validation demonstrated that it was possible to satisfactorily optimize with the knowledge based model patients from all participating centres. In the presence of possibly significant differences in the contouring protocols, the automated plans, though acceptable and fulfilling the benchmark goals, might benefit from further fine tuning of the constraints. The study demonstrates that, at least for the case of prostate cancer patients, it is possibile to share models among different clinical institutes in a cooperative framework.

Spatial features of dose–surface maps from deformably-registered plans correlate with late gastrointestinal complications

This study investigates the associations between spatial distribution of dose to the rectal surface and observed gastrointestinal toxicities after deformably registering each phase of a combined external beam radiotherapy (EBRT)/high-dose-rate brachytherapy (HDRBT) prostate cancer treatment. The study contains data for 118 patients where the HDRBT CT was deformably-registered to the EBRT CT. The EBRT and registered HDRBT TG43 dose distributions in a reference 2 Gy/fraction were 3D-summed. Rectum dose–surface maps (DSMs) were obtained by virtually unfolding the rectum surface slice-by-slice. Associations with late peak gastrointestinal toxicities were investigated using voxel-wise DSM analysis as well as parameterised spatial patterns. The latter were obtained by thresholding DSMs from 1–80 Gy (increment = 1) and extracting inferior–superior extent, left–right extent, area, perimeter, compactness, circularity and ellipse fit parameters. Logistic regressions and Mann–Whitney U-tests were used to correlate features with toxicities. Rectal bleeding, stool frequency, diarrhoea and urgency/tenesmus were associated with greater lateral and/or longitudinal spread of the high doses near the anterior rectal surface. Rectal bleeding and stool frequency were also influenced by greater low-intermediate doses to the most inferior 20% of the rectum and greater low-intermediate-high doses to 40–80% of the rectum length respectively. Greater low-intermediate doses to the superior 20% and inferior 20% of the rectum length were associated with anorectal pain and urgency/tenesmus respectively. Diarrhoea, completeness of evacuation and proctitis were also related to greater low doses to the posterior side of the rectum. Spatial features for the intermediate-high dose regions such as area, perimeter, compactness, circularity, ellipse eccentricity and confinement to ellipse fits were strongly associated with toxicities other than anorectal pain. Consequently, toxicity is related to the shape of isodoses as well as dose coverage. The findings indicate spatial constraints on doses to certain sections of the rectum may be important for reducing toxicities and optimising dose.

Dosimetric Analysis of Randomized Proton and Photon Plans with Respect to Radiation Toxicity: The Importance of High Dose Regions in Lung and Esophagus

Dosimetric Analysis of Randomized Proton and Photon Plans with Respect to Radiation Toxicity: The Importance of High Dose Regions in Lung and Esophagus

Accuracy of the dose-shift approximation in estimating the delivered dose in SBRT of lung tumors considering setup errors and breathing motions

Introduction: Geometrical uncertainties can result in a delivered dose to the tumor different from that estimated in the static treatment plan. The purpose of this project was to investigate the accuracy of the dose calculated to the clinical target volume (CTV) with the dose-shift approximation, in stereotactic body radiation therapy (SBRT) of lung tumors considering setup errors and breathing motion. The dose-shift method was compared with a beam-shift method with dose recalculation.Material and methods: Included were 10 patients (10 tumors) selected to represent a variety of SBRT-treated lung tumors in terms of tumor location, CTV volume, and tumor density. An in-house developed toolkit within a treatment planning system allowed the shift of either the dose matrix or a shift of the beam isocenter with dose recalculation, to simulate setup errors and breathing motion. Setup shifts of different magnitudes (up to 10 mm) and directions as well as breathing with different peak-to-peak amplitudes (up to 10:5:5 mm) were modeled. The resulting dose–volume histograms (DVHs) were recorded and dose statistics were extracted.Results: Generally, both the dose-shift and beam-shift methods resulted in calculated doses lower than the static planned dose, although the minimum (D98%) dose exceeded the prescribed dose in all cases, for setup shifts up to 5 mm. The dose-shift method also generally underestimated the dose compared with the beam-shift method. For clinically realistic systematic displacements of less than 5 mm, the results demonstrated that in the minimum dose region within the CTV, the dose-shift method was accurate to 2% (root-mean-square error). Breathing motion only marginally degraded the dose distributions.Conclusions: Averaged over the patients and shift directions, the dose-shift approximation was determined to be accurate to approximately 2% (RMS) within the CTV, for clinically relevant geometrical uncertainties for SBRT of lung tumors.

Uncomplicated and Cancer-Free Control Probability (UCFCP): A new integral approach to treatment plan optimization in photon radiation therapy

PurposeBiological treatment plan evaluation does not currently consider second cancer induction from peripheral doses associated to photon radiotherapy. The aim is to propose a methodology to characterize the therapeutic window by means of an integral radiobiological approach, which considers not only Tumour Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) but also Secondary Cancer Probability (SCP). MethodsUncomplicated and Cancer-Free Control Probability (UCFCP) function has been proposed assuming a statistically uncorrelated response for tumour and normal tissues. The Poisson’s and Lyman’s models were chosen for TCP and NTCP calculations, respectively. SCP was modelled as the summation of risks associated to photon and neutron irradiation of radiosensitive organs. For the medium (>4Gy) and low dose regions, mechanistic and linear secondary cancer risks models were used, respectively. Two conformal and intensity-modulated prostate plans at 15MV (same prescription dose) were selected to illustrate the UCFCP features. ResultsUCFCP exhibits a bell-shaped behaviour with its maximum inside the therapeutic window. SCP values were not different for the plans analysed (∼2.4%) and agreed with published epidemiological results. Therefore, main differences in UCFCP came from differences in rectal NTCP (18% vs 9% for 3D-CRT and IMRT, respectively). According to UCFCP values, the evaluated IMRT plan ranked first. ConclusionsThe level of SCP was found to be similar to that of NTCP complications which reinforces the importance of considering second cancer risks as part of the possible late sequelae due to treatment. Previous concerns about the effect of peripheral radiation, especially neutrons, in the induction of secondary cancers can be evaluated by quantifying the UCFCP.

Dosimetric comparison of non-coplanar three-dimensional conformal radiation therapy (nc3DCRT) planning and radio biologically optimized partial arc volumetric modulated arc therapy (VMAT) planning of unilateral brain tumours � a retrospective study

Aim: To compare non-coplanar 3DCRT planning and partial arc VMAT planning dosimetrically for unilateral brain tumours.Introduction:Intensity modulated radiation therapyhas gainedwide popularity as a radiotherapy treatment of choice for many clinical sites. Volumetric modulated arc therapy is a kind of therapy in which rather than using multiple static fields at different gantry angles, one or multiple full or partial arcs are used for radiotherapy planning and treatment. Its ability to provide superior target coverage and better normal tissue sparing makes it a treatment of choice over conventional and 3DCRT radiotherapy planning techniques. But, on the same time volume of low dose region which can increase probability of secondary malignancy in VMAT planning is reported to be on the higher side. Our study compares various parameters of plan quality along with low dose volumes in the techniques under comparison.Materials and methods:10 anonymized patients with unilateral malignant brain tumours previously treated with nc3DCRT were selected for the study and planned with partial arc VMAT. Conformity Index, Homogeneity Index, Target Coverage, Doses to critical structures and normal brain were compared.Conclusion:In our study by using VMAT technique we were able to reduce doses to critical structures (Brainstem, optic nerves, and optic chiasm) significantly, got better target coverage along with lesser number of MUs per fraction and significant reduction in low dose volume and reduction in doses to contralateral normal structures including lesser amount of low dose volume.

Quantitative evaluation by measurement and modeling of the variations in dose distributions deposited in mobile targets.

The objective of this study is to quantitatively evaluate variations of dose distributions deposited in mobile target by measurement and modeling. The effects of variation in dose distribution induced by motion on tumor dose coverage and sparing of normal tissues were investigated quantitatively. The dose distributions with motion artifacts were modeled considering different motion patterns that include (a) motion with constant speed and (b) sinusoidal motion. The model predictions of the dose distributions with motion artifacts were verified with measurement where the dose distributions from various plans that included three-dimensional conformal and intensity-modulated fields were measured with a multiple-diode-array detector (MapCheck2), which was mounted on a mobile platform that moves with adjustable motion parameters. For each plan, the dose distributions were then measured with MapCHECK2 using different motion amplitudes from 0-25 mm. In addition, mathematical modeling was developed to predict the variations in the dose distributions and their dependence on the motion parameters that included amplitude, frequency and phase for sinusoidal motions. The dose distributions varied with motion and depended on the motion pattern particularly the sinusoidal motion, which spread out along the direction of motion. Study results showed that in the dose region between isocenter and the 50% isodose line, the dose profile decreased with increase of the motion amplitude. As the range of motion became larger than the field length along the direction of motion, the dose profiles changes overall including the central axis dose and 50% isodose line. If the total dose was delivered over a time much longer than the periodic time of motion, variations in motion frequency and phase do not affect the dose profiles. As a result, the motion dose modeling developed in this study provided quantitative characterization of variation in the dose distributions induced by motion, which can be employed in radiation therapy to quantitatively determine the margins needed for treatment planning considering dose spillage to normal tissue.

Finding of dose evaluation for organs at risk in intensity‐modulated radiation therapy for nasopharyngeal carcinoma using magnetic resonance imaging

AbstractA critical step in predicting and avoiding radiation injury of organs at risk in radiation therapy of nasopharyngeal carcinoma is to carry out an accurate dose evaluation in planning design. In the present study, we investigated the dose evaluation feature of organs at risk on magnetic resonance imaging (MRI) images in intensity‐modulated radiation therapy of nasopharyngeal carcinoma compared with computed tomography (CT) images. A total of 35 nasopharyngeal carcinoma patients were selected for this trial. CT simulation with non‐contrast and contrast‐enhanced scan, and MRI simulation with non‐contrast and contrast‐enhanced T1, T2, and diffusion weighted imaging were obtained sequentially. The organs at risk were contoured on the CT and MRI images after rigid registration, respectively. Nine‐beam intensity‐modulated radiation therapy plans with equal division angles were designed for every patient, and the prescription dose for the tumor target was set as 72 Gy (2.4Gy/fraction). The boundary display, volume, and dosimetric indices of each organ were compared between MRI and CT images. We found that MRI showed clearer boundary of the brainstem, spinal cord, deep lobe of the parotid gland, and the optical nerve in the canal compared with CT. MRI images increased the volume of the lens and optic nerve, while slightly reducing the volume of eye; the maximum dose of the lens, and the mean dose of the eyes and optic nerve increased to different extents, though no statistical differences were found. The left and right parotid gland volume on MRI increased by 7.07% and 8.13%, and the mean dose increased by 14.95% (4.01 Gy) and 18.76% (4.95 Gy), with a statistically significant difference (P &lt; 0.05). The brainstem volume reduced by 9.33% (P &lt; 0.05), and the dose of 0.1 cm3 volume reduced by a mean 8.46% (4.32 Gy), whereas the dose of 0.1 cm3 of the spinal cord increased by 1.5 Gy on MRI. The maximum dose region of the spinal cord was very close on CT and MRI images, and was similar to the brainstem. In conclusion, it is credible to evaluate the radiation dose of the lens, eye, brainstem, and the spinal cord by applying simulation CT; whereas MRI images are sometimes necessary to evaluate the dose of the parotid glands and the optical nerve.

Two Different Structures of the Oxygen-Evolving Complex in the Same Polypeptide Frameworks of Photosystem II.

The oxygen-evolving complex (OEC) forms the heart of photosystem II (PSII) in photosynthesis. The crystal structure of PSII from Thermosynechococcus vulcanus has been reported at a resolution of 1.9 Å and at an averaged X-ray dose of 0.43 MGy. The OEC structure is suggested to be partially reduced to Mn(II) by EXAFS and DFT computational studies. Recently, the "radiation-damage-free" structures have been published at 1.95 Å resolution using XFEL, but reports continued to appear that the OEC is reduced to the S0-state of the Kok cycle. To elucidate much more precise structure of the OEC, in this study two structures were determined at extremely low X-ray doses of 0.03 and 0.12 MGy using conventional synchrotron radiation source. The results indicated that the X-ray reduction effects on the OEC were very small in the low dose region below 0.12 MGy, that is, a threshold existed for the OEC structural changes caused by X-ray exposure. The OEC structures of the two identical monomers in the crystal were clearly different under the threshold of the radiation dose, although the surrounding polypeptide frameworks of PSII were the same. The assumption that the OECs in the crystal were in the dark-stable S1-state of the Kok cycle should be re-evaluated.

Patterns of failure after radiotherapy for pediatric patients with intracranial ependymoma

PurposeTo investigate the patterns of failure after radiotherapy for pediatric intracranial ependymoma and their correlation with dose parameters. MethodsBetween 2000 and 2013, 206 patients were treated in France. MRI scans at relapse were registered to the original planning CTs for topographic analysis of failure patterns. To compare relapse patients (RP) with non relapse patients (NRP), several dose parameters were derived from dose volume histograms. ResultsOver a median follow-up of 53.8months, 84 patients presented with relapse. Topographic analysis showed 50 patients with local relapse in the radiation field, 6 in the edge of field, 6 locoregional outside the field, 10 in the spine, 5 supratentorial and 7 local and distant. The median coverage, target coverage and homogeneity indices did not differ significantly between RP and NRP. The median volume of in-field relapse was 1.25cc [0.11, 27], with a median dose of 57.83Gy [50.04, 61.69]. ConclusionsLocal relapse in the tumor bed and the higher dose regions was the predominant pattern of failure. Improving coverage of the target volume and increasing the dose to the high radioresistant regions, taking into consideration other clinical and biological pronostic factors, may be an effective way of reducing local failures.

Quantification of confounding factors in MRI-based dose calculations as applied to prostate IMRT

Magnetic resonance (MR)-only radiotherapy treatment planning requires pseudo-CT (pCT) images to enable MR-based dose calculations. To verify the accuracy of MR-based dose calculations, institutions interested in introducing MR-only planning will have to compare pCT-based and computer tomography (CT)-based dose calculations. However, interpreting such comparison studies may be challenging, since potential differences arise from a range of confounding factors which are not necessarily specific to MR-only planning. Therefore, the aim of this study is to identify and quantify the contribution of factors confounding dosimetric accuracy estimation in comparison studies between CT and pCT. The following factors were distinguished: set-up and positioning differences between imaging sessions, MR-related geometric inaccuracy, pCT generation, use of specific calibration curves to convert pCT into electron density information, and registration errors.The study comprised fourteen prostate cancer patients who underwent CT/MRI-based treatment planning. To enable pCT generation, a commercial solution (MRCAT, Philips Healthcare, Vantaa, Finland) was adopted. IMRT plans were calculated on CT (gold standard) and pCTs. Dose difference maps in a high dose region (CTV) and in the body volume were evaluated, and the contribution to dose errors of possible confounding factors was individually quantified.We found that the largest confounding factor leading to dose difference was the use of different calibration curves to convert pCT and CT into electron density (0.7%). The second largest factor was the pCT generation which resulted in pCT stratified into a fixed number of tissue classes (0.16%). Inter-scan differences due to patient repositioning, MR-related geometric inaccuracy, and registration errors did not significantly contribute to dose differences (0.01%).The proposed approach successfully identified and quantified the factors confounding accurate MRI-based dose calculation in the prostate. This study will be valuable for institutions interested in introducing MR-only dose planning in their clinical practice.

Influence of daily imaging on plan quality and normal tissue toxicity for prostate cancer radiotherapy

BackgroundModern radiotherapy offers various possibilities for image guided verification of patient positioning. Different clinically relevant IGRT (image guided radiotherapy) scenarios were considered with regard to their influence on dosimetric plan quality and normal tissue complication probability (NTCP).MethodsThis study is based on treatment plans of 50 prostate patients. We evaluate the clinically performed IGRT and simulate the influence of different daily IGRT scenarios on plan quality. Imaging doses of planar and cone-beam-CT (CBCT) images for three different energies (6 MV, 1 MV and 121 kV) were added to the treatment plans. The plan quality of the different scenarios was assessed by a visual inspection of the dose distribution and dose-volume-histogram (DVH) and a statistical analysis of DVH criteria. In addition, an assessment of the normal tissue complication probability was performed.ResultsDaily 1MV-CBCTs result in undesirable high dose regions in the target volume. The DVH shows that the scenarios with actual imaging performed, daily kV-CBCT and daily 6MV imaging (1x CBCT, 4x planar images per week) do not differ exceedingly from the original plan; especially imaging with daily kV-CBCT has little influence to the sparing of organs at risk. In contrast, daily 1MV- CBCT entails an additional dose of up to two fraction doses. Due to the additional dose amount some DVH constraints for plan acceptability could no longer be satisfied, especially for the daily 1MV-CBCT scenario. This scenario also shows increased NTCP for the rectum.ConclusionDaily kV-CBCT has negligible influence on plan quality and is commendable for the clinical routine. If no kV-modality is available, a daily IGRT scenario with one CBCT per week and planar axial images on the other days should be preferred over daily MV-CBCT.

Enteric glial reactivity to systemic LPS administration: Changes in GFAP and S100B protein

Lipopolysaccharide (LPS) is used to induce inflammation and promotes nervous system activation. Different regions of the brain present heterogeneous glial responses; thus, in order to verify whether systemic LPS-induced inflammation affects the enteric glia differently across the intestinal segments, we evaluated the expressions of two glial activity markers, GFAP and S100B protein, in different intestine segments, at 1h, 24h and 7days after acute systemic LPS administration (0.25 or 2.5mgkg−1) in rats. Histological inflammatory analysis indicated that the cecum was most affected when compared to the duodenum and proximal colon at the highest doses of LPS. LPS induced an increased S100B content after 24h in all three regions, which decreased at 7days after the highest dose in all regions. Moreover, at 24h, this dose of LPS increased ex-vivo S100B secretion only in the cecum. The highest dose of LPS also increased GFAP in all regions at 24h, but earlier in the cecum, where LPS-induced enteric S100B and GFAP alterations were dependent on dose, time and intestine region. No associated changes in serum S100B were observed. Our results indicate heterogeneous enteric glial responses to inflammatory insult, as observed in distinct brain areas.

Evaluation of Dual-channel Compound Method for EBT3 Film Dosimetry

This study assessed the feasibility of a dual-channel (DC) compound method for film dosimetry. The red channel (RC) is usually used to ensure dosimetric quality using a conventional fraction dose because the RC is more accurate at low doses within 3 Gy than is the green channel (GC). However, the RC is prone to rapid degradation of sensitivity at high doses, while degradation of the GC is slow. In this study, the DC compound method combining the RC and GC was explored as a means of providing accurate film dosimetry for high doses. The DC compound method was evaluated at various dose distributions using EBT3 film inserted in a solid-water phantom. Measurements with 10×20 cm2 radiation field and 60° dynamic-wedge were done. Dose distributions acquired using the RC and GC were analyzed with root-mean-squares-error (RMSE) and gamma analyses. The DC compound method was used based on the RC after correcting the GC for high doses in the gamma analysis. The RC and GC produced comparatively more accurate RMSE values for low and high doses, respectively. Gamma passing rates with an acceptance criterion of 3%/3 mm revealed that the RC provided rapid reduction in the high dose region, while the GC displayed a gradual decrease. In the whole dose range, the DC compound method had the highest agreement (93%) compared with single channel method using either the RC (80%) or GC (85%). The findings indicate that the use of DC compound method is more appropriate in dosimetric quality assurance for radiotherapy using high doses.

Influence of computed tomography contrast agent on radiotherapy dose calculation for pancreatic carcinoma: A dosimetric study based on tomotherapy and volumetric-modulated arc therapy techniques

The main purpose of our investigation was to quantify the dosimetric influence of intravenous contrast agent for pancreatic cancer radiotherapy treatment. This study focused on complex modulated irradiation techniques of tomotherapy (TOMO) and volumetric-modulated arc therapy (VMAT) to investigate if novel conformal treatment methods could reduce the influence of contrast agent. In our study, patients with pancreatic cancer were enrolled to have 2 computed tomography (CT) scans in the same position without and with intravenous contrast agent for treatment planning. Then tumors and organ at risks were countered on contrast-enhanced CT (CECT) images. Each patient's CECT was assigned a TOMO plan and a VMAT plan. Then these plans were copied onto the non-CECT image and dose distribution was calculated with the same algorithm and structure sets. Finally, the dose distribution and the dose difference were analyzed for the target volume and organs at risk between the 2 sets of images. The statistic dosimetric result showed that for both TOMO and VMAT, no significant dose difference between CECT and non-CECT-based plan was observed. Dose difference was clinically negligible because the average relative percentage dose difference was 1% ± 1% for target volume, except a blurring effect at the higher dose region of the target volume. It implied that intravenous contrast agent will not affect dose calculation for pancreatic cancer radiotherapy significantly. Also the dose deviation based on TOMO showed no statistical difference compared with that on VMAT. For both superposition/conversation algorithm used by TOMO and Monte Carlo algorithm used by VMAT, the dosimetric difference was nonsignificant. A full analysis demonstrated a negligible dose difference of less than 1% between CECT-based plan and non-CECT-based plan. Therefore, contrast-enhanced CT image can be used directly for dose calculation of TOMO and VMAT plans for pancreatic cancer. It is unnecessary to scan twice then make a fusion of CECT and non-CECT, which would result to additional unnecessary radiation dose to patient and decrease work efficiency.

SC03.01 Advances in Stereotactic Body Radiotherapy

SC03.01 Advances in Stereotactic Body Radiotherapy

TL dosimetric characterization of gamma irradiated SrSO4:Eu phosphors

Thermoluminescence (TL) characteristics of SrSO4:Eu nanostructured phosphor under gamma excitation has been studied and their suitability for environmental radiation dosimetry applications is discussed. The dopant level is tuned for optimum TL response. The effect of radiation dose and heating rate were investigated. The phosphor preserves linearity in the low dose region, 0.1Gy to 20Gy. PL studies of irradiated and un-irradiated phosphors reveal that the dopant Eu exists in divalent state and are the luminescence emission centres in the material. The fading properties of SrSO4:Eu phosphor are observed to be better than that of the commercial dosimeters TLD-200 and TLD-400. The kinetic parameters are calculated using Chen's method and initial rise method and verified by Computerized Glow curve Deconvolution (CGCD). The sensitivity of the synthesized phosphor is found to be very high when compared with that of the commercial standard dosimeter CaSO4:Dy. The phosphor is found to be stable for short term radiation monitoring.