Dosimetry Protocols Research Articles

Post-irradiation darkening model for EBT-3 films characterized using a single lot calibration approach

Objective.In this study, we present a model to correct the progressive post-irradiation darkening of EBT3 films. The model allows for a clinical use of EBT3 using application and calibration films scanned with different post-irradiation times.Approach.The model is a post-irradiation time- and dose-dependent power-law function, projecting the scanned transmittance of application films to the transmittance matching the same post-irradiation time of calibration films. The model was characterized for two EBT3 production lots within the dose range 0.1-12.8 Gy. A first characterization was performed utilizing calibration films scanned repeatedly for 54 d post-irradiation (lot 1), while a fast re-characterization of a second lot used three post-irradiation times (lot 2). For a long-term validation of the model, 16 film strips were irradiated at 2 Gy on different time points starting from the day of film calibration up to 43 d afterwards (lot 1). For the multiple-dose validation of the model, 8 strips were irradiated with dose levels ranging 0-12 Gy deposited 25 d after the calibration (lot 2). As a proof of principle, the model was applied to four clinical patient-specific quality assurance film measurements with prescribed dose/fraction ranging 2.66 Gy-8 Gy.Main results. The post-irradiation transmittance decreased for higher doses up to -2.5% at 12.8 Gy, and 54 d post-irradiation. With a lot-specific model correction, the mean dose accuracy of validation strips that ranged from initial -3.4% (triple-channel) and -9.90% (blue-channel) reduced to within 3.0% (all colour channels) for doses above 1 Gy. The median dose difference with the planned dose improved from -3.5% to -1.1%, and the 3%/2 mm local gamma ranged from (48.5-92.5)% to (81.2-99.2)%.Significance.A film darkening model corrects the transmittance of EBT3 films and increases the flexibility of existing dosimetry protocols. The correction ensures dose accuracies within 3%.

Relative biological effectiveness of clinically relevant photon energies for the survival of human colorectal, cervical, and prostate cancer cell lines

Objective.Relative biological effectiveness (RBE) differs between radiation qualities. However, an RBE of 1.0 has been established for photons regardless of the wide range of photon energies used clinically, the lack of reproducibility in radiobiological studies, and outdated reference energies used in the experimental literature. Moreover, due to intrinsic radiosensitivity, different cancer types have different responses to radiation. This study aimed to characterize the RBE of clinically relevant high and low photon energiesin vitrofor three human cancer cell lines: HCT116 (colon), HeLa (cervix), and PC3 (prostate).Approach.Experiments were conducted following dosimetry protocols provided by the American Association of Physicists in Medicine. Cells were irradiated with 6 MV x-rays, an192Ir brachytherapy source, 225 kVp and 50 kVp x-rays. Cell survival post-irradiation was assessed using the clonogenic assay. Survival fractions were fitted using the linear quadratic model, and survival curves were generated for RBE calculations.Main results.Cell killing was more efficient with decreasing photon energy. Using 225 kVp x-rays as the reference, the HCT116 RBESF0.1for 6 MV x-rays,192Ir, and 50 kVp x-rays were 0.89 ± 0.03, 0.95 ± 0.03, and 1.24 ± 0.04; the HeLa RBESF0.1were 0.95 ± 0.04, 0.97 ± 0.05, and 1.09 ± 0.03, and the PC3 RBESF0.1were 0.84 ± 0.01, 0.84 ± 0.01, and 1.13 ± 0.02, respectively. HeLa and PC3 cells had varying radiosensitivity when irradiated with 225 and 50 kVp x-rays.Significance.This difference supports the notion that RBE may not be 1.0 for all photons through experimental investigations that employed precise dosimetry. It highlights that different cancer types may not have identical responses to the same irradiation quality. Additionally, the RBE of clinically relevant photons was updated to the reference energy of 225 kVp x-rays.

Regenerative Retinal Laser and Light Therapies (RELITE): Proposal of a New Nomenclature, Categorization, and Trial Reporting Standard.

Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements. A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns. The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose "regenerative retinal laser and light therapies (RELITE)" as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT). Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability: Pattern-Dosimetry-Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength-Subcategory-Category. Regenerative retinal laser and light therapies are widely used for different diseases and may become valuable in the future. A precise nomenclature system and strict reporting standards are needed to allow for a better understanding, reproduceable and comparable clinical trials, and overall acceptance. We defined categories for a systematic therapeutic goal-based nomenclature to facilitate future research in this field.

A Systematic Review of Laser Photobiomodulation Dosimetry and Treatment Protocols in the Management of Medications-Related Osteonecrosis of the Jaws: A Rationalised Consensus for Future Randomised Controlled Clinical Trials.

Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating adverse effect of bisphosphates, antiresorptive therapy or antiangiogenic agents that can potentially increase oxidative stress, leading to progressive osteonecrosis of the jaws. Despite the large number of published systematic reviews, there is a lack of potential MRONJ treatment protocols utilising photobiomodulation (PBM) as a single or adjunct therapy for preventive or therapeutic oncology or non-oncology cohort. Hence, this systematic review aimed to evaluate PBM laser efficacy and its dosimetry as a monotherapy or combined with the standard treatments for preventive or therapeutic approach in MRONJ management. The objectives of the review were as follows: (1) to establish PBM dosimetry and treatment protocols for preventive, therapeutic or combined approaches in MRONJ management; (2) to highlight and bridge the literature gaps in MRONJ diagnostics and management; and (3) to suggest rationalised consensus recommendations for future randomised controlled trials (RCTs) through the available evidence-based literature. This review was conducted according to the PRISMA guidelines, and the protocol was registered at PROSPERO under the ID CRD42021238175. A multi-database search was performed to identify articles of clinical studies published from their earliest records until 15 December 2023. The data were extracted from the relevant papers and analysed according to the outcomes selected in this review. In total, 12 out of 126 studies met the eligibility criteria. The striking inconsistent conclusions made by the various authors of the included studies were due to the heterogeneity in the methodology, diagnostic criteria and assessment tools, as well as in the reported outcomes, made it impossible to conduct a meta-analysis. PBM as a single or adjunct treatment modality is effective for MRONJ preventive or therapeutic management, but it was inconclusive to establish a standardised and replicable protocol due to the high risk of bias in a majority of the studies, but it was possible to extrapolate the PBM dosimetry of two studies that were close to the WALT recommended parameters. In conclusion, the authors established suggested rationalised consensus recommendations for future well-designed robust RCTs, utilising PBM as a monotherapy or an adjunct in preventive or therapeutic approach of MRONJ in an oncology and non-oncology cohort. This would pave the path for standardised PBM dosimetry and treatment protocols in MRONJ management.

Organ and tumor dosimetry including method simplification for [177Lu]Lu-PSMA-I&T for treatment of metastatic castration resistant prostate cancer

BackgroundInternal dosimetry in individual patients is essential for safe and effective radioligand therapy. Multiple time point imaging for accurate dosimetry is time consuming and hence can be demanding for nuclear medicine departments as well as patients. The objectives of this study were (1) to assess absorbed doses to organs at risk and tumor lesions for [177Lu]Lu-PSMA-I&T using whole body SPECT imaging and (2) to investigate possible simplified dosimetry protocols.MethodsThis study included 16 patients each treated with 4 cycles of [177Lu]Lu-PSMA-I&T. They underwent quantitative whole body SPECT/CT imaging (3 bed positions) at four time points (TP) comprising 2 h, 24 h, 48 h and 72–168 h post-injection (p.i.). Full 3D dosimetry (reference method) was performed for all patients and dose cycles for organs at risk (kidneys, parotid glands and submandibular glands) and up to ten tumor lesions per patient (resulting in 90 lesions overall). The simplified dosimetry methods (SM) included (1) generating time activity curves for subsequent cycles using a single TP of imaging applying the kinetics of dose cycle 1, and for organs at risk also (2) simple extrapolation from dose cycle 1 and (3) from both, dose cycle 1 and 2.ResultsNormalized absorbed doses were 0.71 ± 0.32 mGy/MBq, 0.28 ± 0.12 mGy/MBq and 0.22 ± 0.08 mGy/MBq for kidneys, parotid glands and submandibular glands, respectively. Tumor doses decreased from 3.86 ± 3.38 mGy/MBq in dose cycle 1 to 2.01 ± 2.65 mGy/MBq in dose cycle 4. Compared to the full dosimetry approach the SM 1 using single TP imaging at 48 h p.i. resulted in the most accurate and precise results for the organs at risk in terms of absorbed doses per cycle and total cumulated dose. For tumor lesions better results were achieved using the fourth TP (≥ 72 h p.i.).ConclusionSimplification of safety dosimetry protocols is possible for [177Lu]Lu-PSMA-I&T therapy. If tumor dosimetry is of interest a later imaging TP (≥ 72 h p.i.) should be used/added to account for the slower kinetics of tumors compared to organs at risk.

AAPM WGTG51 Report 385: Addendum to the AAPM's TG-51 protocol for clinical reference dosimetry of high-energy electron beams.

An Addendum to the AAPM's TG-51 protocol for the determination of absorbed dose to water is presented for electron beams with energies between 4MeV and 22MeV ( ). This updated formalism allows simplified calibration procedures, including the use of calibrated cylindrical ionization chambers in all electron beams without the use of a gradient correction. New data are provided for electron beams based on Monte Carlo simulations. Implementation guidance is provided. Components of the uncertainty budget in determining absorbed dose to water at the reference depth are discussed. Specifications for a reference-class chamber in electron beams include chamber stability, settling, ion recombination behavior, and polarity dependence. Progress in electron beam reference dosimetry is reviewed. Although this report introduces some major changes (e.g., gradient corrections are implicitly included in the electron beam quality conversion factors), they serve to simplify the calibration procedure. Results for absorbed dose per linac monitor unit are expected to be up to approximately 2% higher using this Addendum compared to using the original TG-51protocol.

Internal dosimetry and biodistribution of indigenously prepared 177Lu-DOTA-rituximab in lymphoma and other hematological malignancies treated with rituximab.

The aim of this study was to evaluate the biodistribution and dosimetry of lutetium-177-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (177Lu-DOTA)-rituximab in CD20+ non-Hodgkin's lymphoma and other hematological malignancies treated with rituximab. The standard dosimetry protocol was used, with cold rituximab infusion, then a diagnostic activity of 177Lu-DOTA-rituximab. Planar images were acquired at multiple time points. Normal organs and tumor dosimetry were performed by using organ and tumor-specific regions of interest and whole-body counts were obtained serially after pixel matched, background, scatter, and attenuation correction. The mean radiation absorbed doses were obtained from OLINDA/EXM v2.1.1 and ORIGIN software. A total of 22 patients were included in this study. Prolonged blood pool clearance of 177Lu-DOTA-rituximab with long residence time in the blood pool and normal organs were observed. The whole body effective half-life was 104.5 ± 22 h. The mean total body radiation absorbed dose was 0.208 ± 0.03 mGy/MBq and the mean total body effective dose was 0.196 ± 0.05 mGy/MBq of 177Lu-DOTA-rituximab. The mean radiation absorbed doses of 0.613 ± 0.21, 1.68 ± 2, 1.01 ± 0.42, and 0.136 ± 0.02mGy/MBq were seen for the liver, spleen, kidneys, and bone marrow, respectively. Tumor lesion uptake was noticed in two patients with tumor radiation absorbed doses were 0.842 mGy/MBq in one and 9.9 mGy/MBq in the other patient. A strong correlation was obtained between the cumulative activities of radiation-absorbed doses derived from ORIGIN and OLINDA software methods at a significant P value less than 0.001. The results of our study demonstrated favorable biodistribution and dosimetry of indigenously produced 177Lu-DOTA-rituximab in patients with CD20+ lymphoma. These results can be used for future studies of radioimmunotherapy employing 177Lu-DOTA-rituximab.

Quantitative evaluation of 90Y-PET/CT and 90Y-SPECT/CT-based dosimetry following Yttrium-90 radioembolization.

Following yttrium-90 radioembolization (90Y-RE), 90Y-PET/CT and 90Y-SPECT/CT imaging provide the means to calculate the voxelized absorbed dose distribution. Given the widespread use of the two imaging modalities and lack of well-established standardized dosimetry protocols for 90Y-RE, there is a clinical need to systematically investigate and evaluate differences in the performance of voxel-based dosimetry between 90Y-PET/CT and 90Y-SPECT/CT. To quantitatively analyze and compare 90Y-PET/CT and 90Y-SPECT/CT-based dosimetry following 90Y-RE. 90Y-PET/CT and90Y-SPECT/CT imaging was acquired for 35 patients following 90Y-RE with TheraSphere for the treatment of unresectable hepatocellular carcinoma. Dosimetry was performed using the local deposition method with known activity and the mean dose (Dmean) was calculated for perfused liver volumes (PV), tumors (T), and perfused normal livers (NL). Additionally, the absorbed dose to x% of the volume (Dx, x [5%, 10%, …, 90%, 95%]) and the volume receiving y Gy (Vy, y [10Gy, 20Gy, …, 190Gy, 200Gy]) were calculated for T and NL, respectively. Dose metrics were compared using linear regression, Bland-Altman analysis, and statistical testing. Both 90Y-SPECT/CT and 90Y-PET/CT-based tumor Dmean were strongly correlated (R2 ≥ 0.90) with Dx, excluding metrics on the extrema. Intra-modality comparisons of various Dx and Vy metrics yielded statistically significant differences (ANOVA, p<0.001) for both90Y-PET/CT and90Y-SPECT/CT. Based on statistical testing, only Dx metrics separated by greater than 20%-30% coverage, and only Vy metrics separated by greater than 40-70Gy, reported significant differences. For PV, there was a strong correlation (R2 ≥ 0.99) between Dmean derived separately from 90Y-PET/CT and 90Y-SPECT/CT imaging. The strength of the correlation was slightly reduced for T and NL with R2=0.91 and R2=0.95, respectively. For PV, the mean bias±standard error (SE) and 95% limits of agreement (LOA) between Dmean from the two modalities was effectively zero with -0.8±0.4% (±2.5%). For T and NL, the mean bias±SE (±LOA) was -14.5±3.7% (±24%) and 9.4±4.7% (±27%), respectively. The strong correlation between Dmean and Dx suggests information from multiple dose metrics (e.g., D70 and Dmean) is largely redundant when establishing dose-response relationships in 90Y-RE. Dmean is highly correlated between 90Y-PET/CT and 90Y-SPECT/CT-based dosimetry, for all liver VOIs. Relative to 90Y-SPECT/CT, 90Y-PET/CT, on average, yielded higher Dmean to tumors (14%) and lower Dmean to perfused normal livers (9%). Absorbed dose differences for perfused liver volumes between 90Y-SPECT/CT and 90Y-PET/CT were negligible.

Investigation of dosimetric characteristics of radiochromic film in response to alpha particles emitted from Americium-241.

In radiotherapy, it is essential to deliver prescribed doses to tumors while minimizing damage to surrounding healthy tissue. Accurate measurements of absorbed dose are required for this purpose. Gafchromic® external beam therapy (EBT) radiochromic films have been widely used in radiotherapy. While the dosimetric characteristics of the EBT3 model film have been extensively studied for photon and charged particle beams (protons, electrons, and carbon ions), little research has been done on -particle dosimetry. -emitting radionuclides have gained popularity in cancer treatment due to their high linear energy transfer, short range in tissue, and ability to spare surrounding organs at risk, thereby delivering a more localized dose distribution to the tumor. Therefore, a dose-calibration film protocol for -particles isrequired. This study aimed to develop a dose-calibration protocol for the -particle emitting radionuclide 241Am, using Monte Carlo (MC) simulations and measurements with unlaminated EBT3films. In this study, a MC-based user code was developed using the Geant4 simulation toolkit to model and simulate an 241Am source and an unlaminated EBT3 film. Two simulations were performed: one with voxelized geometries of the EBT3 active volume composition and the other using water. The dose rate was calculated within a region of interest in the voxelized geometries. Unlaminated EBT3 film pieces were irradiated with the 241Am source at various exposure times inside a black box. Film irradiations were compared to a 6-MV photon beam from a Varian TrueBeam machine. The simulated dose rate was used to convert the exposure times into absorbed doses to water, describing a radiochromic-film-based reference dosimetry protocol for -particles. The irradiated films were scanned and through an in-house Python script, the normalized pixel values from the green-color channel of scanned film images wereanalyzed. The 241Am energy spectra obtained from the simulations were in good agreement with IAEA and NIST databases, having differences 0.516% for the emitted -rays and produced characteristic x-rays and 0.006% for the -particles. Due to the short range of -particles, there was no energy deposition in the voxels outside the active 241Am source region projected onto the film surface. Thus, the total dose rate within the voxels covering the source was 0.847 0.003 Gy/min within the sensitive layer of the film (LiPCDA) and 0.847 0.004 Gy/min in water, indicating that the active volume can be considered water equivalent for the 241Am beam quality. A novel approach was employed in -film dosimetry using an exponential fit for the green channel, which showed promising results by reducing the uncertainty in dose estimation within 5%. Although the statistical analysis did not reveal significant differences between the 6-MV photon beam and the calibration curves, the dose-response curves exhibited the expected behavior. The developed MC user code simulated the experimental setup for -dosimetry using radiochromic film with acceptable uncertainty. Unlaminated EBT3 film is suitable for the dosimetry of -radiation at low doses and can be used in conjunction with other unlaminated GafChromic® films for quality assurance and researchpurposes.

Synchrotron x-ray spectra characterisation for radiation therapy applications at the ESRF - ID17 biomedical beamline

Objective. Radiation therapy requires reliable dosimetry protocols to deliver successful treatments with high accuracy and precision. In this context, accurate knowledge of the beam’s energy spectra is mandatory. The goal of this study was to validate the synchrotron x-ray spectrum of the ID17 beamline at the European Synchrotron Radiation Facility (ESRF). The modification of the synchrotron storage ring and beamline in recent years necessitates a new characterisation of the radiation spectra of the ID17 beamline. The validated spectra will be a starting point for possible future clinical applications. Approach. The half value layer method was used to measure the attenuation of the x-ray spectrum in Al and Cu. Experimental data was validated against theoretical data produced using OASYS; an in-house developed software for calculating beamline spectra. Two different spectral configurations, ‘conventional’ and ‘clinical’, were investigated. The characterised spectra were used to perform dosimetric validation of depth dose profiles measured in a water-equivalent phantom. The dose profile was measured using two different detectors and compared with calculations generated using two different Monte Carlo algorithms. Main results. The results showed good agreement between measured and predicted half value layers, with differences of less than 1% in most cases. Excellent dosimetric agreement to within 3% was obtained, an agreement that satisfies the requirements in conventional radiotherapy for approvable treatment planning. Significance. Accurate spectra have been defined and validated for the ESRF—ID17 Biomedical beamline. The validated spectra can be used as input for future dosimetric studies and treatment planning systems in the context of preclinical studies and possible future clinical trials.

Characterizing the voxel-based approaches in radioembolization dosimetry with reDoseMC.

Yttrium-90 ( ) represents the primary radioisotope used in radioembolization procedures, while holmium-166 ( ) is hypothesized to serve as a viable substitute for due to its comparable therapeutic potential and improved quantitative imaging. Voxel-based dosimetry for these radioisotopes relies on activity images obtained through PET or SPECT and dosimetry methods, including the voxel S-value (VSV) and the local deposition method (LDM). However, the evaluation of the accuracy of absorbed dose calculations has been limited by the use of non-ideal reference standards and investigations restricted to the liver. The objective of this study was to expand upon these dosimetry characterizations by investigating the impact of image resolutions, voxel sizes, target volumes, and tissue materials on the accuracy of and dosimetry techniques. A specialized radiopharmaceutical dosimetry software called reDoseMC was developed using the Geant4 Monte Carlo toolkit and validated by benchmarking the generated kernels with published data. The decay spectra of both and were also compared. Multiple VSV kernels were generated for the liver, lungs, soft tissue, and bone for isotropic voxel sizes of 1 mm, 2 mm, and 4 mm. Three theoretical phantom setups were created with 20 or 40mm activity and mass density inserts for the same three voxel sizes. To replicate the limited spatial resolutions present in PET and SPECT images, image resolutions were modeled using a 3D Gaussian kernel with a Full Width at Half Maximum (FWHM) ranging from 0 to 16mm and with no added noise. The VSV and LDM dosimetry methods were evaluated by characterizing their respective kernels and analyzing their absorbed dose estimates calculated on theoretical phantoms. The ground truth for these estimations was calculated usingreDoseMC. The decay spectra obtained through reDoseMC showed less than a 1% difference when compared to previously published experimental data for energies below 1.9MeV in the case of and less than 1% for energies below 1.5MeV for . Additionally, the validation kernels for VSV exhibited results similar to those found in published Monte Carlo codes, with source dose depositions having less than a 3% error margin. Resolution thresholds ( ), defined as resolutions that resulted in similar dose estimates between the LDM and VSV methods, were observed for . They were 1.5mm for bone, 2.5 mm for soft tissue and liver, and 8.5 mm for lungs. For , the accuracy of absorbed dose deposition was found to be dependent on the contributions of absorbed dose from photons. Volume errors due to variations in voxel size impacted the final dose estimates. Larger target volumes yielded more accurate mean doses than smaller volumes. For both radioisotopes, the radial dose profiles for the VSV and LDM approximated but never matched the referencestandard. reDoseMC was developed and validated for radiopharmaceutical dosimetry. The accuracy of voxel-based dosimetry was found to vary widely with changes in image resolutions, voxel sizes, chosen target volumes, and tissue material; hence, the standardization of dosimetry protocols was found to be of great importance for comparable dosimetryanalysis.

Minimum phantom size for megavoltage photon beam reference dosimetry.

Water phantoms are required to perform reference dosimetry and beam quality measurements but there are no published studies about the size requirements for suchphantoms. To investigate, using Monte Carlo techniques, the size requirements for water phantoms used in reference dosimetry and/or to measure the beam quality specifiers and . The EGSnrc application DOSXYZnrc is used to calculate , the dose per incident fluence at 10cm depth in a water phantom irradiated by incident beams of or 6MV photons. The water phantom dimensions are varied from to and occasionally smaller. The and values are also calculated with care being taken to distinguish results when using Method A (changing depth of water in phantom) and Method B (moving entire phantom). Typical statistical uncertainties are 0.03%. Phantom dimensions have only minor effects for phantoms larger than . A table of corrections to the dose at 10cm depth in beams of or 6MV photons are provided and range from no correction to 0.75% for a beam incident on a phantom. There can be distinct differences in the values measured using Method A or Method B, especially for smaller phantoms. It is explicitly demonstrated that, within 0.15%, values for a phantom measured using Method A or B are independent of source detector distance between 40 and200cm. The phantom sizes recommended in the TG-51 and IAEA TRS-398 reference dosimetry protocols are adequate for accurate reference dosimetry and in some cases are even conservative. Correction factors are necessary for accurate measurement of the dose at 10cm depth in smaller phantoms and these factors are provided. Very accurate beam quality specifiers are not required for reference dosimetry itself, but for specifying beam stability and characteristics it is important to specify phantom sizes and also the method used for measurements.

Computational evaluation of the bucky components influence on the estimation of normalized glandular dose in digital mammography

The mean glandular dose (MGD) is the most suitable dosimetric quantity used in mammography to describe the absorbed dose by the breast, although it cannot be directly acquired. Studies have provided conversion factors widely implemented in international dosimetry protocols to estimate MGD, such as normalized glandular dose (DgN). Over time, the DgN estimation was refined by considering geometric models that approach a real clinical environment, such as new anode/filter combinations, compression plate and breast models. However, there is no detailed study of how the bucky (support plate, antiscatter grid and detector) can affect the DgN estimation. A modified PENELOPE Monte Carlo code was used for DgN estimation. The irradiation geometric model was built as a complete digital mammography system, considering a homogeneous breast and different typical bucky models in commercial mammography units. Simulations were carried out for mono and polyenergetic beams considering different imaging geometries. Studies with monoenergetic beams showed that the bucky presence affected DgN mainly for higher beam energies and thinner breasts. The breast support plate was the bucky component that most affected the DgN, followed by the antis-scatter grid and finally, the image detector. Studies with polyenergetic conventional (low-energy) spectra showed that the bucky exerted a minimal influence on DgN values (less than 1.0%). For high-energy spectra, mainly employed in modalities such as contrast-enhanced digital mammography, the DgN values were more affected by the bucky, increasing by 4.8% the DgN values for a 2 cm thick breast and a W/Cu 50 kV spectrum. Bucky inclusion in computer simulations is highly recommended mainly for thinner breasts and high-energy spectra. To simplify the simulations, we confirm that a homogeneous carbon fibre block support, with thickness between 3.9 and 4.1 mm, can be used as a good substitute for a complete bucky model.

Characterization of a commercial PIN diode for radiotherapy photon beam dosimetry

The dosimetric characterization of a commercial diode (BPW-34) was performed using a True Beam accelerator (Varian), with flattening filter (FF) photon beams of 6 and 15 MV and flattening filter free (FFF) of 6 MVFFF. The main performance characteristics, namely dose response, energy and dose rate dependence, field output factor, and percentage depth dose profile (PDD), were compared with those available in the literature and, whenever possible, benchmarked against the Varian Eclipse treatment planning system (TPS) predictions. Regardless of the energy, the results showed that the dose response curves are linear (R2 = 1) with nonlinearity parameters less than 0.1% and 0.3% of repeatability. Furthermore, the average dose rate effect (0.7%) is almost negligible within the range of 20–600 MU/min (6 MV, 15 MV) and 400–1400 MU/min (6 MVFFF). Despite these good results, the charge sensitivity measurements evidenced that the diode response depends slightly on the energy, being within 5% for 6 MV–15 MV. It is important to underline that all these results adhere to the standard radiotherapy dosimetry protocols. Moreover, the general output field factor measurements and the percentage depth dose profiles, which are in excellent agreement with the Eclipse TPS calculations, also demonstrated that the diode BPW-34 is a low-budget alternative radiotherapy photon beam dosimeter.

Use of a dosimetry-based RAI protocol for treatment of benign hyperthyroidism optimises response while minimising exposure to ionising radiation.

The optimal treatment strategy for radioiodine (RAI) treatment protocols for benign hyperthyroidism remains elusive. Although individualised activities are recommended in European Law, many centres continue to provide fixed activities. Our institution implemented a dosimetry protocol in 2016 following years of fixed dosing which facilitates the calculation of individualised activities based on thyroid volume and radioiodine uptake. This was a retrospective study comparing success rates using a dosimetry protocol targeting an absorbed dose of 150 Gy for Graves' disease (GD) and 125 Gy for Toxic Multinodular Goiter (TMNG) with fixed dosing (200MBq for GD and 400MBq for TMNG) among 204 patients with hyperthyroidism. Success was defined as a non-hyperthyroid state at 1 year for both disease states. Results were analysed for disease specific or patient specific modulators of response. This study included 204 patients; 74% (n = 151) received fixed activities and 26% (n = 53) of activities administered were calculated using dosimetry. A dosimetry-based protocol was successful in 80.5% of patients with GD and 100% of patients with TMNG. Differences in success rates and median activity administered between the fixed (204Mbq) and dosimetry (246MBq) cohort were not statistically significant (p = .64) however 44% of patients with GD and 70% of patients with TMNG received lower activities following treatment with dosimetry as opposed to fixed activities. Use of dosimetry resulted in successful treatment and reduced RAI exposure for 36% of patients with GD, 70% of patients with TMNG, and 44% of patients overall. This retrospective clinical study demonstrated that treatment with a dosimetry-based protocol for TMNG and GD achieved comparable success rates to fixed protocols while reducing RAI exposure for over a third of patients with GD and most patients with TMNG. This study also highlighted that RAI can successfully treat hyperthyroidism for some patients with activities lower than commonplace in clinical practise. No patient or disease specific modulators of treatment response were established in this study; however, the data supports a future prospective trial which further scrutinises the individual patient factors governing treatment response to RAI.

Beam monitor chamber calibration of a synchro-cyclotron high dose rate per pulse pulsed scanned proton beam

Objective. Ionization chambers, mostly used for beam calibration and for reference dosimetry, can show high recombination effects in pulsed high dose rate proton beams. The aims of this paper are: first, to characterize the linearity response of newly designed asymmetrical beam monitor chambers (ABMC) in a 100–226 MeV pulsed high dose rate per pulse scanned proton beam; and secondly, to calibrate the ABMC with a PPC05 (IBA Dosimetry) plane parallel ionization chamber and compare to calibration with a home-made Faraday cup (FC). Approach. The ABMC response linearity was evaluated with both the FC and a PTW 60019 microDiamond detector. Regarding ionometry-based ABMC calibration, recombination factors were evaluated theoretically, then numerically, and finally experimentally measured in water for a plane parallel ionization chamber PPC05 (IBA Dosimetry) through k s saturation curves. Finally, ABMC calibration was also achieved with FC and compared to the ionometry method for 7 energies. Main results. Linearity measurements showed that recombination losses in the new ABMC design were well taken into account for the whole range of the machine dose rates. The two-voltage-method was not suitable for recombination correction, but Jaffé’s plots analysis was needed, emphasizing the current IAEA TRS-398 reference protocol limitations. Concerning ABMC calibration, FC based absorbed dose estimation and PPC05-based absorbed dose estimation differ by less than 6.3% for the investigated energies. Significance. So far, no update on reference dosimetry protocols is available to estimate the absorbed dose in ionization chambers for clinical high dose rate per pulse pulsed scanned proton beams. This work proposes a validation of the new ABMC design, a method to take into account the recombination effect for ionometry-based ABMC calibration and a comparison with FC dose estimation in this type of proton beams.

Interstitial and Intraluminal Photodynamic Therapy – The Munich Experiences

Different clinical aspects of photodynamic therapy (PDT), like treatment planning, treatment and dosimetry protocols, spectral on-line-monitoring (SOM) as well as follow-up evaluation of clinical outcome, are of interest regarding further iPDT developments. For three specific applications, interstitial PDT (iPDT) for prostate cancer in urology, intraluminal PDT for cholangiocarcinoma in gastroenterology and stereotactic iPDT for glioblastoma in neurosurgery, the clinical scenario is described. If all information arising around a PDT intervention is combined, as shown on the example iPDT for glioblastoma, further insight about the involved processes and mechanisms can be derived and utilized to develop the therapeutic approach further as a whole.

Evaluation of Ion Recombination Correction for Indigenously Developed Farmer Ion Chamber in Flattening Filter-Free Photon Beams.

Modern generation linear accelerator (linac) either generates X-rays with a flattening filter (WFF beam) or without flattening filter free (FFF beam). The FFF beams are associated with a significantly higher dose per pulse compared to WFF beams due to the absence of a flattening filter and the corresponding attenuation caused by it. This results in increased ion recombination and a larger saturation correction factor (ks). In accordance with the IAEA TRS 398 dosimetry protocol, ks is necessary for the accurate measurement of absorbed dose at a point in water. The objective of this study was to evaluate the ks for the indigenous FAR 65-GB ion chamber (IC) for the FFF X-rays. The study was carried out on TrueBeam linac (Varian, A Siemens Healthineers company) which offers 6 MV WFF, 6 MV FFF, 10 MV WFF and 10 MV FFF beams. The two-voltage method was employed to measure ks in a solid water phantom at a depth of 10 cm for a FAR 65-GB and SNC 600c and 0.6cc PTW 30013 Farmer chambers at 100 cm and 150 cm source-to-chamber distances for a 10 cm × 10 cm field size. The ks values for the FAR 65-GB, PTW 30,013, and SNC 600c were 1.0055 (1.0113), 1.0051 (1.0071), and 1.0033 (1.0066) for the 6 MV WFF (FFF) beams, respectively, and 1.0066 (1.0178), 1.0061 (1.0137), and 1.0035 (1.0119) for the 10MV WFF (FFF) beams, respectively. The ks values calculated by two-voltage method matches with ks values obtained from Jaffe's plot. The chamber exhibited a linear dose-response up to 3000 cGy, beyond which a saturation effect was observed. Our study reveals that this chamber is suitable for the reference dosimetry for the FFF beams.

A Novel Therapeutic Approach of 980 nm Photobiomodulation Delivered with Flattop Beam Profile in Management of Recurrent Aphthous Stomatitis in Paediatrics and Adolescents-A Case Series with 3-Month Follow-Up.

Background/Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and a very debilitating lesion, especially in paediatric and adolescent patients. The current pharmacotherapy offers a pain relief but not without side effects, and therefore photobiomodulation (PBM) can be an alternative therapy. To the authors' best knowledge, no published study has explored the efficacy of λ 980 nm laser PBM in the management of all RAS subtypes in paediatric and adolescent patients, and therefore, this prospective observational clinical study was conducted to bridge this gap by evaluating λ 980 nm laser PBM efficacy in symptomatic RAS management in paediatric and adolescent patients. The objectives were to evaluate (1) pain intensity alleviation; (2) wound healing rate; (3) wound size closure; (4) a complete resolution; (5) evidence of recurrence; and (6) patients' treatment satisfaction. Methods: The study's variables were assessed at the following timepoints: T0: pre-treatment; T1: immediately after first PBM session; T2: 5 hours (h) post first PBM session (via telephone call); T3: immediately after second PBM session (three days post first PBM session); T4: three-day follow-up (after complete PBM treatments); T5: two-week follow-up; and T6: three-month follow-up. The following PBM dosimetry and treatment protocols were employed: λ 980 nm; 300 mW; 60 s; 18 J; CW; flattop beam profile of 1 cm2 spot size; 18 J/cm2; and twice-a-week irradiation (72 h interval). Results: At T1, significant immediate pain intensity relief was reported. 33.33% recorded "4" and 66.67% reported "5" on the quantitative numeric pain intensity scale (NPIS), and this continued to improve significantly (83.33%) at T2. All the subjects reported "0" on the NPIS at T3, T4, T5 and T6. There was a significant reduction in the lesion surface area (>50% complete healing) at T3 compared to T0. Complete healing (100%) with no evidence of scarring and lesion recurrence observed at T4, T5 and T6. Very good patients' satisfaction was reported at all timepoints. Conclusions: This is the first report demonstrating λ980 nm efficacy in all RAS subtype management in paediatric and adolescent patients with a 3-month follow-up, whereby its PBM dosimetry and treatment protocols were effective from scientific and practical standpoints, and hence multicentre RCTs with large data are warranted to validate its reproducibility and to enrich the knowledge of PBM application in all RAS subtypes.

Grid/lattice therapy: consideration of small field dosimetry.

Small-field dosimetry used in special procedures such as gamma knife, Cyberknife, Tomotherapy, IMRT, and VMAT has been in evolution after several radiation incidences with very significant (70%) errors due to poor understanding of the dosimetry. IAEA-TRS-483 and AAPM-TG-155 have provided comprehensive information on small-fields dosimetry in terms of code of practice and relative dosimetry. Data for various detectors and conditions have been elaborated. It turns out that with a suitable detectors dose measurement accuracy can be reasonably (±3%) achieved for 6 MV beams for fields >1×1cm2. For grid therapy, even though the treatment is performed with small fields created by either customized blocks, multileaf collimator (MLC), or specialized devices, it is multiple small fields that creates combined treatment. Hence understanding the dosimetry in collection of holes of small field is a separate challenge that needs to be addressed. It is more critical to understand the scattering conditions from multiple holes that form the treatment grid fields. Scattering changes the beam energy (softer) and hence dosimetry protocol needs to be properly examined for having suitable dosimetric parameters. In lieu of beam parameter unavailability in physical grid devices, MLC-based forward and inverse planning is an alternative path for bulky tumours. Selection of detectors in small field measurement is critical and it is more critical in mixed beams created by scattering condition. Ramification of small field concept used in grid therapy along with major consideration of scattering condition is explored. Even though this review article is focussed mainly for dosimetry for low-energy megavoltage photon beam (6 MV) but similar procedures could be adopted for high energy beams. To eliminate small field issues, lattice therapy with the help of MLC is a preferrable choice.