Dosimetry Protocols Research Articles

Monte Carlo simulation for proton dosimetry in magnetic fields: Fano test and magnetic field correction factorskBfor Farmer-type ionization chambers.

Objective. In this contribution we present a special Fano test for charged particles in presence of magnetic fields in the MC code TOol for PArticle Simulation (TOPAS), as well as the determination of magnetic field correction factorskBfor Farmer-type ionization chambers using proton beams.Approach. Customized C++ extensions for TOPAS were implemented to model the special Fano tests in presence of magnetic fields for electrons and protons. The Geant4-specific transport parameters,DRoverRandfinalRange,were investigated to optimize passing rate and computation time. ThekBwas determined for the Farmer-type PTW 30013 ionization chamber, and 5 custom built ionization chambers with same geometry but varying inner radius, testing magnetic flux density ranging from 0 to 1.0 T and two proton beam energies of 157.43 and 221.05 MeV.Main results. Using the investigated parameters, TOPAS passed the Fano test within 0.39 ± 0.15% and 0.82 ± 0.42%, respectively for electrons and protons. The chamber response (kB,M,Q) gives a maximum at different magnetic flux densities depending of the chamber size, 1.0043 at 1.0 T for the smallest chamber and 1.0051 at 0.2 T for the largest chamber. The local dose differencecBremained ≤ 0.1% for both tested energies. The magnetic field correction factorkB, for the chamber PTW 30013, varied from 0.9946 to 1.0036 for both tested energies.Significance. The developed extension for the special Fano test in TOPAS MC code with the adjusted transport parameters, can accurately transport electron and proton particles in magnetic field. This makes TOPAS a valuable tool for the determination ofkB. The ionization chambers we tested showed thatkBremains small (≤0.72%). To the best of our knowledge, this is the first calculations ofkBfor proton beams. This work represents a significant step forward in the development of MRgPT and protocols for proton dosimetry in presence of magnetic field.

Efficacy of Combined Photobiomodulation Therapy with Supplements versus Supplements alone in Restoring Thyroid Gland Homeostasis in Hashimoto Thyroiditis: A Clinical Feasibility Parallel Trial with 6-Months Follow-Up.

Hashimoto thyroiditis (HT) is a thyroid-specific autoimmune disorder, triggering hypothyroidism in a population with an adequate dietary intake. Despite the current conventional treatment focuses on the permanent replacement of levothyroxine (LT4) deficiency, it appears that thyroid autoimmunity remains the cause of persistent symptoms in patients with HT, even when they achieve to be euthyroid from a biochemical standpoint. Photobiomodulation (PBM) showed to be an effective therapy in the management of autoimmune diseases, but with limited evidence. Hence, our study was conducted to appraise the efficacy of PBM therapy with supplements in restoring thyroid gland homeostasis in patients with HT compared with supplements alone. Seventy-four female subjects aged between 20 and 50 years old were recruited and divided equally into two groups: PBM and supplements group (group 1); and supplements alone group (group 2). The PBM dosimetry and treatment protocols were as follows: wavelength, 820 nm; power output, 200 mW; continuous emission mode; irradiating time, 20 s per point; fluence, 32 J/cm2 per point; treatment frequency, twice a week (excluding weekends); and treatment duration, three consecutive weeks. Whereas, the supplements protocol for both groups was the same, as follows: subjects with a serum level of vitamin D3 <40 ng/dL, who received replacement according to their serum levels, and all the subjects had a daily intake of 100 µg of oral selenium. The biochemical (FT3, FT4, antiTPO and antiTG) and anthropometric measurements were evaluated. Our findings showed significant improvement in group 1 parameters (PBM+ supplements) compared with group 2 (supplements only) in terms of weight loss and reduction in the following parameters: BMI, hip and waist circumference, waist/hip ratio, TSH, antiTPO, antiTG and treatment dose of LT4 (p < 0.05). Our results, for the first time, demonstrated an efficacy of PBM delivered at a lower fluence with supplements in restoring thyroid function, anthropometric parameters and lifestyle factors in patients with HT. Hence, extensive studies with a longer follow-up period are warranted.

Applicability evaluation of the TRS-483 protocol for the determination of small-field output factors using different multi-leaf collimator and field-shaping types

PurposeTo evaluate the applicability of TRS-483 output correction factors (CFs) for small-field output factors (OFs) using different multi-leaf collimators (MLC) and field-shaping types. MethodsAll measurements were performed on TrueBeam, TrueBeam STx, and Halcyon using 6 MV flattening filter-free energy. Four detectors, including CC01, CC04, microDiamond, and EDGE, were used. Nominal field sizes ranging from 1 × 1 to 4 × 4, and 10 × 10 cm2 were used to measure small-field OFs at source-to-axis distance of 100 cm with a 0° gantry angle in a 3D water phantom. Further, the field-shaping types were defined using jaw collimator or MLC (five different configurations). A field size of 10 × 10 cm2 was used as the reference for calculation of OFs obtained as ratio of detector readings (OFdet). The percentage difference and coefficient of variation of OFdet and OFdet corrected by applying CF were compared for each field size and configuration. ResultsFor OFdet corrected by applying CF, the ranges of percentage difference and coefficient of variation in all configurations for ≥ 2 × 2 cm2 fields were reduced from 1.2–2.2 to 0.8–1.3 percentage points (%pt) and from 0.5–1.0 to 0.4–0.7%, respectively. For 1 × 1 cm2 field, the ranges of percentage difference and coefficient of variation were reduced from 3.3–5.7 to 1.2–2.2 %pt and from 2.2–3.7 to 0.8–1.1%, respectively. ConclusionsThe CFs described in TRS-483 dosimetry protocol have broad applicability in reducing OF variations between detectors under different MLC and field-shaping types.

Establishment and validation of a calibration curve for dicentric chromosome induced by 6MV X-ray.

Radiation during radiotherapy and nuclear accidents is currently one of the biggest concerns for the international community. Biological dosimetry examines the amount of damage caused by radiation at the cellular level by quantifying a radiation biomarker. In particular, the dicentric chromosome assay is a biodosimetric technique that can quantify radiation damage by correlating radiation dose exposure with the frequency of dicentric chromosomes in the peripheral lymphocytes extracted from exposed individuals. This study aims to present of the reference dose-response calibration curve for biodosimetry laboratory of Mashhad University of Medical Sciences (north-east of Iran). In all, 40 samples of peripheral blood from four healthy volunteers were irradiated at doses of 0-5 Gray in a customised water phantom using a 6MV X-rays at dose rate of 2Gy/min from a linear accelerator. The irradiated samples were cultured and analysed according to the International Atomic Energy Agency Cytogenetic Dosimetry Protocol (2011) with some modifications. Linear-quadratic model curve fitting and further statistical analysis were done using Chromosome Aberration Calculation Software Version 2.0 and Dose Estimate (Version 5.2). The curve equation obtained was ${Y}_{dic}=0.0533{D}^2+0.0231D+0.0001$ and was in the range of other studies. Validation of the calibration curve was done by estimating the dose of blind samples.

Investigation of TL and OSL detectors in ultra-high dose rate electron beams

Objective. This work aims at investigating the response of various thermally stimulated luminescence detectors (TLDs) and optically stimulated luminescence detectors (OSLDs) for dosimetry of ultra-high dose rate electron beams. The study was driven by the challenges of dosimetry at ultra-high dose rates and the importance of dosimetry for FLASH radiotherapy and radiobiology experiments. Approach. Three types of TLDs (LiF:Mg,Ti; LiF:Mg,Cu,P; CaF2:Tm) and one type of OSLD (Al2O3:C) were irradiated in a 15 MeV electron beam with instantaneous dose rates in the (1–324) kGy s−1 range. Reference dosimetry was carried out with an integrating current transformer, which was calibrated in absorbed dose to water against a reference ionization chamber. Additionally, dose rate independent BeO OSLDs were employed as a reference. Beam non-uniformity was addressed using a matrix of TLDs/OSLDs. Main results. The investigated TLDs were shown to be dose rate independent within the experimental uncertainties, which take into account the uncertainty of the dosimetry protocol and the irradiation uncertainty. The relative deviation between the TLDs and the reference dose was lower than 4 % for all dose rates. A decreasing response with the dose rate was observed for Al2O3:C OSLDs, but still within 10 % from the reference dose. Significance. The precision of the investigated luminescence detectors make them suitable for dosimetry of ultra-high dose rate electron beams. Specifically, the dose rate independence of the TLDs can support the investigation of the beam uniformity as a function of the dose rate, which is one of the challenges of the employed beam. Al2O3:C OSLDs provided high precision measurements, but the decreasing response with the dose rate needs to be confirmed by additional experiments.

Analysis of different protocols using an Exradin A12 cylindrical chamber for electron beam reference dosimetry

The Technical Report Series 398 (TRS-398), Electron Dosimetry Working Party (EWDP), and Task Group 51 (TG 51) are the most important protocols for reference dosimetry. In the case of electron beam reference dosimetry, these protocols recommend using parallel-plate ionization chambers for beams with R50 values below specific thresholds. However, recent papers suggested using cylindrical chambers for reference dosimetry of all electron beam energies. Here we compared different protocols using a cylindrical chamber with the recommendations of using a parallel-plate chamber and the TRS-398 formalism for the dosimetry of several electron beam energies. We employed electron beams with nominal energies of 4, 6, 9, 12, and 15 MeV of a Varian 2100C linear accelerator, an Exradin A12, and an Exradin P11 chamber for the analysis. The results showed differences below 3% when comparing the cylindrical chamber and alternative protocols with the parallel-plate chamber and the TRS-398 formalism for electron beams reference dosimetry. These results can bring confidence in using a cylindrical chamber for reference electron beam dosimetry, which can make the electron beam dosimetry procedure simpler and faster.

Normal organ dosimetry for thyroid cancer patients treated with radioiodine as part of the multi-centre multi-national Horizon 2020 MEDIRAD project

PurposeDosimetry is rarely performed for the treatment of differentiated thyroid cancer patients with Na[131I]I (radioiodine), and information regarding absorbed doses delivered is limited. Collection of dosimetry data in a multi-centre setting requires standardised quantitative imaging and dosimetry. A multi-national, multi-centre clinical study was performed to assess absorbed doses delivered to normal organs for differentiated thyroid cancer patients treated with Na[131I]I.MethodsPatients were enrolled in four centres and administered fixed activities of 1.1 or 3.7 GBq of Na[131I]I using rhTSH stimulation or under thyroid hormone withdrawal according to local protocols. Patients were imaged using SPECT(/CT) at variable imaging time-points following standardised acquisition and reconstruction protocols. Whole-body retention data were collected. Dosimetry for normal organs was performed at two dosimetry centres and results collated.ResultsOne hundred and five patients were recruited. Median absorbed doses per unit administered activity of 0.44, 0.14, 0.05 and 0.16 mGy/MBq were determined for the salivary glands of patients treated at centre 1, 2, 3 and 4, respectively. Median whole-body absorbed doses for 1.1 and 3.7 GBq were 0.05 Gy and 0.16 Gy, respectively. Median whole-body absorbed doses per unit administered activity of 0.04, 0.05, 0.04 and 0.04 mGy/MBq were calculated for centre 1, 2, 3 and 4, respectively.ConclusionsA wide range of normal organ doses were observed for differentiated thyroid cancer patients treated with Na[131I]I, highlighting the necessity for individualised dosimetry. The results show that data may be collated from multiple centres if minimum standards for the acquisition and dosimetry protocols can be achieved.

Evaluation of Dosimetry Formalisms in Intraoperative Radiation Therapy of Glioblastoma

The intraoperative radiotherapy in newly diagnosed glioblastoma multiforme (INTRAGO) clinical trial assesses survival in patients with glioblastoma treated with intraoperative radiation therapy (IORT) using the INTRABEAM. Treatment planning for INTRABEAM relies on vendor-provided in-water depth dose curves obtained according to the TARGeted Intraoperative radioTherapy (TARGIT) dosimetry protocol. However, recent studies have shown discrepancies between the estimated TARGIT and delivered doses. This work evaluates the effect of the choice of dosimetry formalism on organs at risk (OAR) doses. A treatment planning framework for INTRABEAM was developed to retrospectively calculate the IORT dose in 8 INTRAGO patients. These patients received an IORT prescription dose of 20 to 30 Gy in addition to external beam radiation therapy. The IORT dose was obtained using (1) the TARGIT method; (2) the manufacturer's V4.0 method; (3) the CQ method, which uses an ionization chamber Monte Carlo (MC) calculated factor; (4) MC dose-to-water; and (5) MC dose-to-tissue. The IORT dose was converted to 2 Gy fractions equivalent dose. According to the TARGIT method, the OAR dose constraints were respected in all cases. However, the other formalisms estimated a higher mean dose to OARs and revealed 1 case where the constraint for the brain stem was exceeded. The addition of the external beam radiation therapy and TARGIT IORT doses resulted in 10 cases of OARs exceeding the dose constraints. The more accurate MC calculation of dose-to-tissue led to the highest dosimetric differences, with 3, 3, 2, and 2 cases (out of 8) exceeding the dose constraint to the brain stem, optic chiasm, optic nerves, and lenses, respectively. Moreover, the mean cumulative dose to brain stem exceeded its constraint of 66 Gy with the MC dose-to-tissue method, which was not evident with the current INTRAGO clinical practice. The current clinical approach of calculating the IORT dose with the TARGIT method may considerably underestimate doses to nearby OARs. In practice, OAR dose constraints may have been exceeded, as revealed by more accurate methods.

PO-1763 New protocol for small fields dosimetry in tomotherapy: an inter-department validation

PO-1763 New protocol for small fields dosimetry in tomotherapy: an inter-department validation

Comparison of derived correction factors for effects of ion recombination and photon beam quality index following TG-51 and TRS-398 dosimetry protocols

In this study, ion recombination correction factor (kS) and beam quality conversion factor (kQ,Q0) values were extracted following the recommendations of the TRS-398 and TG-51 dosimetry protocols for widely used cylindrical ionization chambers for high energy photon beam dosimetry to quantify the agreement between the instructions for these two protocols for absolute dosimetry inside water. Four different types of cylindrical ionization chambers comprising Farmer (TM30013), Semiflex 0.125 cm3 (TM31010), Semiflex 0.3 cm3 (TM31013), and PinPoint (TM31016) were considered, and kS and kQ,Q0 values were determined at photon energies of 6 MV and 15 MV. The maximum difference between the measured kS values according to the instructions in the TRS-398 and TG-51 protocols was 0.03%. The kS data measured with both protocols agreed well with those measured by using the Jaffe-plot approach, where the maximum difference was about 0.33%. The observed differences between the kQ,Q0 factors measured by using the TRS-398 and TG-51 dosimetry protocols at photon energies of 6 MV and 15 MV were 0.37% and 0.55%, respectively. The kQ,Q0 values measured using the TG-51 dosimetry protocols were slightly closer to those measured by a reference ionization chamber dosimeter. We conclude that the maximum differences were about 0.4% and 0.6% in the absorbed dose measurements according to the TRS-398 and TG-51 instructions at photon energies of 6 MV and 15 MV, respectively. The type of ionization chamber employed also affected the differences, where the maximum and minimum dose differences were found using the Farmer and PinPoint chambers, respectively.

Technical note: Consistency of IAEA's TRS‐483 and AAPM's extended TG‐51 protocols for clinical reference dosimetry of the CyberKnife M6 machine

While IAEA's TRS-483 code of practice is adapted for the calibration of CyberKnife machines, AAPM's TG-51 is still the protocol recommended by the manufacturer for their calibration. The differences between both protocols could lead to differences in absorbed dose to water during the calibrationprocess. The aims of this work are to evaluate the difference resulting from the application of TG-51 (including the manufacturer's adaptations) and TRS-483 in terms of absorbed dose to water for a CyberKnife M6, and to evaluate the consistency ofTRS-483. Measurements are performed on a CyberKnife M6 unit under machine-specific reference conditions using a calibrated Exradin A12 ionization chamber. Monte Carlo (MC) simulations are performed to estimate and using a fully modeled detector and an optimized CyberKnife M6 beam model. The latter is also estimated experimentally. Differences between the adapted TG-51 and TRS-483 protocols are identified and their impact isquantified. When using an in-house experimentally-evaluated volume averaging correction factor, a difference of 0.11% in terms of absorbed dose to water per monitor unit is observed when applying both protocols. This disparity is solely associated to the difference in beam quality correction factor. If a generic volume averaging correction factor is used during the application of TRS-483, the difference in calibration increases to 0.14%. In both cases, the disparity is not statistically significant according to TRS-483's reported uncertainties on their beam quality correction factor (i.e., 1%). MC results lead to and . Results illustrate that the generic beam quality correction factor provided in the TRS-483 might be overestimated by 0.36% compared to our specific model and that this overestimation could be due to the volume averagingcomponent. For clinical reference dosimetry of the CyberKnife M6, the application of TRS-483 is found to be consistent withTG-51.

Proton beam dosimetry in the presence of magnetic fields using Farmer-type ionization chambers of different radii.

Magnetic resonance-guided proton therapy is promising, as it combines high-contrast imaging of soft tissue with highly conformal dose delivery. However, proton dosimetry in magnetic fields using ionization chambers is challenging since the dose distribution as well as the detector response are perturbed. This work investigates the effect of the magnetic field on the ionization chamber response, and on the polarity and ion recombination correction factors, which are essential for the implementation of a proton beam dosimetry protocol in the presence of magnetic fields. Three Farmer-type cylindrical ionization chambers, the 30013 with 3mm inner radius (PTW, Freiburg, Germany) and two custom built chambers "R1" and "R6" with 1 and 6mm inner radii respectively were placed at the center of an experimental electromagnet (Schwarzbeck Mess - Elektronik, Germany) 2cm depth of an in-house developed 3D printed water phantom. The detector response was measured for a 3×10cm2 field of mono-energetic protons 221.05MeV/u for the three chambers, and with an additional proton beam of 157.43MeV/u for the chamber PTW 30013. The magnetic flux density was varied between 0.1 and 1.0Tesla in steps of 0.1Tesla. At both energies, the ionization chamber PTW 30013 showed a non-linear response as a function of the magnetic field strength, with a decrease of the ionization chamber response of up to 0.27%±0.06% (1 SD) at 0.2Tesla, followed by a smaller effect at higher magnetic field strength. For the chamber R1, the response decreased slightly with the magnetic field strength up to 0.45%±0.12% at 1Tesla, and for the chamber R6, the response decreased up to 0.54%±0.13% at 0.1Tesla, followed by a plateau up to 0.3Tesla, and a weaker effect at higher magnetic field strength. The dependence of the polarity and recombination correction factor on the magnetic field was ⩽0.1% for the chamber PTW 30013. The magnetic field has a small but significant effect on the chamber response in the low magnetic field region for the chamber PTW 30013 and for R6, and in the high magnetic field region for the chamber R1. Corrections may be necessary for ionization chamber measurements, depending on both the chamber volume and the magnetic flux density. No significant effect of the magnetic field on the polarity and recombination correction factor was detected in this work for the ionization chamber PTW 30013.

On the field size definition and field output factors in small field dosimetry.

There is a major conceptual difference between small-field and large field dosimetry that is, different definition of the field size. The dosimetry protocol IAEA TRS-483 recommends the use of the field size defined by measured dose profiles (full-width half maximum, FWHM) that is significantly different from conventional field size definition by the geometric field opening of MLC/Jaw at the isocenter. The application of the effective field size concept, Sclin , was introduced by Cranmer-Sargison etal. (DOI:10.1016/j.radonc.2013.10.002) as a reporting mechanism for field output factors of rectangular fields. The study by Das etal. (DOI:10.1002/mp.15624) indicated the limitations of obtaining the field size by experimentally measuring FWHM, for example, the measured FWHM is smaller than beam geometric size, which is contradictory to what is expected as a result of partial occlusion of the primary photon source by the collimating devices. Cranmer-Sargison etal. and Das et al suggested that additional investigations are needed to evaluate its limitations. This study investigates the validity of the field size definition by FWHM and by MLC/Jaw opening and finds the pros and cons between these two methods to resolve the controversial issue. The FWHM can be obtained by measuring or calculating dose profiles. Using Monte Carlo simulations this study compares the field size obtained by FWHM and by field geometric field opening. The EGSnrc system is used to simulate 6 MV beam to generate square and rectangular fields from 5-30mm with every possible permutation (keeping one jaw fixed and varying other jaw from 5 to 30mm). The calculated FWHM and output factors are compared with measurements obtained by a microSilicon detector. The results show that field width (FWHM) derived from MC calculations generally agrees with machine geometric field width within 0.5mm for square or rectangular fields with a minimum field width of ≥8mm. For the extremely small fields with a minimum field width of 5mm the discrepancies are up to 1.6mm. The field width (FWHM) obtained by measuring dose profiles are unreliable for small fields due to the measurement uncertainties for an extremely small field. The effect of partial occlusion of the primary photon source by the jaws on the beam axis is clearly observed in the calculated dose profiles. For the extremely small field width of 5mm, Monte Carlo predicted up to 10% exchange factor differences which are confirmed by the measurements. The field size defined by the geometric opening of the beam-defining system, is still valid for small fields. The field size defined by geometric opening is independent of measurement uncertainties, independent of machine design, and highly reproducible. It is feasible to accurately tabulate the output factors as a function of geometric field opening thus eliminating user and detector choice for FWHM measurements. The field output factor of a small rectangular field cannot be related to an equivalent field size without considering the exchange factor due to partial occlusion of the photon source.

Investigation of image-based lesion and kidney dosimetry protocols for 177Lu-PSMA-I&T therapy with and without a late SPECT/CT acquisition

Background177Lu-PSMA therapy has been successfully used to prolong the survival of patients with metastatic castration-resistant prostate cancer. Patient-specific dosimetry based on serial quantitative SPECT/CT imaging can support the understanding of dose–effect relationships. However, multiple SPECT/CT measurements can be challenging for patients, which motivates the investigation of efficient sampling schedules and their impact on dosimetry. In this study, different time samplings with respect to the number and timing of SPECT/CT acquisitions with and without a late measurement were investigated.Materials and methodsIn total, 43 lesions and 10 kidneys of 5 patients receiving 177Lu-PSMA-I&T therapy were investigated. Whole-body SPECT/CT measurements were performed at 1, 2, 3 and 7 days post-injection. For both lesions (isocontour-based segmentation) and kidneys (CT-based segmentation), a reference model was employed including all four time points. To identify the best-matching fit function out of a pre-defined set of models, visual inspection, coefficients of variation and sum of squared errors were considered as goodness-of-fit criteria. Biologically effective doses (BEDs) calculated with different time samplings (days 1, 2, 3/1, 2, 7/1, 3, 7/2, 3, 7 and 1, 2/1, 3/1, 7) were compared to the reference.ResultsThe best-fit function was found to be a mono-exponential model for lesions and a bi-exponential model with a population-based parameter and two free parameters for kidneys. The BEDs calculated with the time sampling 1, 3, 7 days showed the lowest deviations from the reference for lesions with 4 ± 5%. Without day 7, still 86% of all lesions showed deviations from the reference < 10%. The outlier deviations showed a positive correlation with the effective half-life of the respective lesions. For kidneys, including days 1, 2, 3 achieved the best results with 0 ± 1%. Generally, deviations for kidneys were found to be small for all time samplings (max. 13%).ConclusionsFor combined optimization of the SPECT/CT time sampling for kidney and lesion dosimetry during 177Lu-PSMA-I&T therapy, the sampling with days 1, 3, 7 showed the smallest deviation from the reference. Without a late acquisition, using the schedule with days 1, 2, 3 is likewise feasible.

Optimization of the radiation dosimetry protocol in Lutetium-177-PSMA therapy: toward clinical implementation

BackgroundDosimetry in [177Lu]Lu-PSMA therapy is a valuable tool to assess treatment efficacy and toxicity. This study aims to develop a clinically implementable protocol to determine the absorbed dose in organs and tumor lesions after [177Lu]Lu-PSMA-617 therapy, by reducing the imaging time points and utilizing population-based kinetics with a single scan, with evaluation of its influence on the uncertainty in absorbed dose.MethodsTen patients with metastatic hormone-sensitive prostate cancer received two cycles of [177Lu]Lu-PSMA-617. Post-treatment imaging was performed at 1 h, 24 h, 48 h, 72 h and 168 h, consisting of three-bed positions SPECT/CT and a whole-body planar scan. Five-time point SPECT dosimetry was performed for lesions and organs with physiological uptake (kidneys, liver and salivary glands) and used as the reference standard. Absorbed dose values for various simplified protocols were compared to the reference standard.ResultsAccurate lesion dosimetry is possible using one-time point SPECT imaging at 168 h, with an increase in uncertainty (20% vs. 14% for the reference standard). By including a second time point, uncertainty was comparable to the reference standard (13%). Organ dosimetry can be performed using a single SPECT at 24 h or 48 h. Dosimetry based on planar scans did not provide accurate dose estimations.ConclusionAccurate lesion dosimetry in [177Lu]Lu-PSMA therapy can be performed using a one- or two-time point protocol, making dosimetry assessments more suitable for routine clinical implementation, although dosimetry based om multiple time points is more accurate.Clinical trial registration This study was approved by the Medical Review Ethics Committee Region Arnhem-Nijmegen on January 23, 2018 and was registered on clinicaltrials.gov (NCT03828838).

A comparison of simplified protocols of personalized dosimetry in NEN patients treated by radioligand therapy (RLT) with [177Lu]Lu-DOTATATE to favor its use in clinical practice

The role of internal dosimetry is usually proposed for investigational purposes in patients treated by RLT, even if its application is not yet the standard method in clinical practice. This limited use is partially justified by several concomitant factors that make calculations a complex process. Therefore, simplified dosimetry protocols are required.MethodsIn our study, dosimetric evaluations were performed in thirty patients with NENs who underwent RLT with [177Lu]Lu-DOTATATE. The reference method (M0) calculated the cumulative absorbed dose performing dosimetry after each of the four cycles. Obtained data were employed to assess the feasibility of simplified protocols: defining the dosimetry only after the first cycle (M1) and after the first and last one (M2).ResultsThe mean differences of the cumulative absorbed doses between M1 and M0 were – 10% for kidney, – 5% for spleen, + 34% for liver, + 13% for red marrow, and + 37% for tumor lesions. Conversely, differences lower than ± 10% were measured between M2 and M0.ConclusionCumulative absorbed doses obtained with the M2 protocol resembled the doses calculated by M0, while the M1 protocol overestimated the absorbed doses in all organs at risk, except for the spleen.

Kidney absorbed radiation doses for [ 177 Lu]Lu-PSMA-617 and [ 177 Lu]Lu-PSMA-I&T determined by 3D clinical dosimetry.

For prostate-specific membrane antigen-directed radioligand therapy (PSMA-RLT), [ 177 Lu]Lu-PSMA-617 and [ 177 Lu]Lu-PSMA-I&T are the currently preferred compounds. Recent preclinical studies suggested ~30x higher kidney absorbed dose for [ 177 Lu]Lu-PSMA-I&T compared to [ 177 Lu]Lu-PSMA-617, which may lead to an increased risk of kidney toxicity. We performed two single-centre, prospective dosimetry studies with either [ 177 Lu]Lu-PSMA-617 or [ 177 Lu]Lu-PSMA-I&T, using an identical dosimetry protocol. We evaluated the absorbed doses of both 177 Lu-labelled radioligands in human kidneys. 3D SPECT/computed tomography (CT) imaging of the kidneys was performed after PSMA-RLT in cancer patients with PSMA-positive disease and an adequate glomerular filtration rate (≥50 mL/min). Ten metastatic hormone-sensitive prostate cancer patients (mHSPC) were treated with [ 177 Lu]Lu-PSMA-617 and 10 advanced salivary gland cancer (SGC) patients were treated with [ 177 Lu]Lu-PSMA-I&T. SPECT/CT imaging was performed at five timepoints (1 h, 24 h, 48 h, 72 h, and 168 h post-injection). In mHSPC patients, SPECT/CT imaging was performed after cycles 1 and 2 (cumulative activity: 9 GBq) and in SGC patients only after cycle 1 (activity: 7.4 GBq). Kidney absorbed dose was calculated using organ-based dosimetry. The median kidney absorbed dose was 0.49 Gy/GBq (range: 0.34-0.66) and 0.73 Gy/GBq (range: 0.42-1.31) for [ 177 Lu]Lu-PSMA-617 and [ 177 Lu]Lu-PSMA-I&T, respectively (independent samples t test; P = 0.010). This study shows that the kidney absorbed dose for [ 177 Lu]Lu-PSMA-617 and [ 177 Lu]Lu-PSMA-I&T differs, with a ~1.5x higher median kidney absorbed dose for [ 177 Lu]Lu-PSMA-I&T. This difference in the clinical setting is considerably smaller than observed in preclinical studies and may not hamper treatments with [ 177 Lu]Lu-PSMA-I&T.

Transition of Standard Dosimetry of Absorbed Dose to Water in External Beam Radiotherapy [Part 1]

The radiotherapy is performed with the aim of delivering the optimal dose to the target volume with minimal side effect of surrounding normal tissue. For this purpose, quality assurance is essential to ensure that the target volume is correctly irradiated in the optimal geometrical arrangement, and the absorbed dose evaluation is essential to ensure that the prescribed dose is correctly delivered. The absorbed doses are generally evaluated using a small cavity ionization chamber that utilizes gas ionization. For the evaluation of absorbed dose to water using ionization chambers, the national dose and charge standards, ionization chambers and electrometer calibration systems are required. And it is also required standard dosimetry protocol that recommend conditions such as fields, depths, and optimal ionization chambers for the measurement, as well as reliable physical data. This manuscript reviews the transition of standard dosimetry of absorbed dose to water in external beam radiotherapy, including the background of dose standards, ionization chamber calibration systems, units, and physical constants.

Measuring and Determining the Output Factor of 6 and 10 MV WFF Photon Beams in Small Square and Rectangular Fields using Semiflex TM 31010 and Pintpoint TM 31014 Ionization Chamber

Research has been carried out on Measuring and Determining the Output Factors of 6 and 10 MV WFF photon beams in Small Square and Rectangular fields using Semiflex TM 31010 and PintPoint TM 31014 Ionization Chamber. This study aims to determine the value of the small field output factor. Measurements were carried out in a water phantom at a depth of 10 cm with a 100 cm SSD technique. The area of ​​the irradiation field used is (2 × 2; 3 × 3; 4 × 4; 2.5 × 1.6; 3.6 × 2.5; 4.5 × 2; and 5 × 3.2) cm2. Field output factor calculations were performed using the IAEA TRS. 483 dosimetry protocol. The results of measurements and calculations obtained for the two detectors used show that a decrease in the value of the output factor occurs when the field size is getting smaller. The output factor value in a small rectangular field looks smaller when compared to the output factor value in a small square field.

Protocol determination for OSL in vivo measurements of absorbed dose in the oral mucosa in oral cancer patients: A pilot study

Radiation-induced oral mucositis (RIOM) is one of the major oral complications caused by radiotherapy (RT), and can lead a negative impact on patients’ quality of life. Considering that there is no specific radiation therapy dose constraint for oral mucosa, the need to study the correlation between absorbed dose and effect in this area is crucial. This pilot study aims to report in vivo OSL dosimetry protocol to investigate the dose distribution in the oral mucosa in patients with oral cancer using Intraoral customised Stent (IOS). For measurements, aluminium oxide nanoDot dosimeters and a microStar ii OSL reader from Landauer Inc. were used. The OSL dosimetry system was calibrated with a 6 MV photon beam using an Elekta Synergy linear accelerator and solid water phantoms following the recommendations of the AAPM TG 191 protocol. The dose distribution in the oral mucosa using seven OSL dosimeters fixed on the intraoral stent was evaluated and compared with the dose distribution available from the RT planning for the patient. Our experimental results showed the expected linearity response of the nanoDot dosimeters from 20 to 200 cGy. The repeatability of readings was better than 1.0% in all commissioning measurements. The uncertainty budget of the commissioning analysis resulted in an overall type An uncertainty of ∼3.4% at the 1-sigma level for dose calculation, compatible with the TG 191 protocol. The dose distribution in the oral mucosa was assessed and dose deviations up to 35% can be found in high dose gradient regions of the treatment planning. This type of deviation may impact on the development and progression of RIOM, as analysed in this protocol. It is feasible to establish this procedure in vivo dosimetry for a patient undergoing RT using a multidisciplinary approach. Additionally, intraoral customised stents can decrease radiation doses in the oral mucosa, and the understanding of the dose distribution in the oral mucosa may help to minimise damages from radiation.