International Commission On Radiation Units And Measurements Research Articles

New operational quantities (RBE × D p lens/Φ) for eye lens neutron dosimetry as a function of energy and angle of incidence in the ICRU 95 formalism

This paper is a continuation of a study published recently by the authors. It presents and discusses computed personal absorbed dose in the lens of the eye (D p lens/Φ), and a relative biological effectiveness (RBE)-weighted absorbed dose (in terms of an newly proposed operational quantity RBE × D p lens/Φ), conversion coefficients for the lens of the eye for neutron exposure at incident energies from thermal to ∼20 MeV and at angles of incidence from 0° to 90° in 15° increments, at 180° and for rotational incidence irradiation geometry (from 0° to 360° in 5° increments). These conversion coefficients were obtained from a simulation model developed for this study that contains the stylised eye model, embedded in the adult UF-ORNL mathematical phantom, whereby the previously stated RBE-weighted absorbed dose was obtained using the proposed RBE versus neutron energy distribution compiled in a previous paper by the authors. The simulations carried out for this study using the Monte Carlo N-Particle transport code version 6.2, were conducted in a realistic human eye model, for the left and right sensitive and whole volume of the lens of the eye, considering the recent proposed redefinition of the operational quantities for external radiation exposure in International Commission on Radiation Units and Measurements (ICRU) report 95. A comprehensive set of tabulated data for neutron fluence-to-dose conversion coefficients (D p lens/Φ in pGy cm2) and RBE-weighted absorbed dose (RBE × D p lens/Φ in pGy cm2) conversion coefficients is included in this paper as a function of incident neutron energy and angle of incidence. Data for D p lens/Φ (pGy cm2) are compared to similar data from the literature for validation of our model. Data for RBE × D p lens/Φ (in pGy cm2), were also compared to the equivalent operational quantity H p(3,α)/Φ (in pSv cm2) conversion coefficients calculated at 3 mm depth in a cylindrical phantom for different incident neutron energies and angles of incidence from 0° to 75° in 15° increments to demonstrate the relevance of this newly proposed operational quantity for doses resulting in tissue reactions (deterministic effects) which should be quoted in Gray (RBE-weighted absorbed dose, RBE × D (Gy)), rather than Sievert (Sv) which is reserved for stochastic effects. The current neutron weighted absorbed dose (RBE × D p lens) is proposed for the tissue reactions in the eye-lens for neutron radiation as per National Council on Radiation Protection and Measurements report 180 and in line with the recent proposal for the review and revision of the System of Radiological Protection to Keeping the International Commission on Radiological Protection (ICRP) recommendations fit for purpose. This method would bring better alignment between the dose limits in ICRP 118 and the new operational quantity consistent with the units of the new eye-lens dose limits without being overly conservative. The utilization of the proposed new operational quantities, as outlined in ICRU 95, has the potential to address the ongoing challenge in enforcing regulatory limits for neutron eye dose, specifically the use of Gy instead of Sv. It should be noted that the applicability of this will vary from country to country as in many countries the legislation is likely to mandate the use of H p(3) until the regulation is amended. This approach can serve as an interim solution while awaiting the issuance of the new ICRP general recommendations, which is expected to take several years. Implementing the new operational quantities can contribute to enhancing the accuracy and effectiveness of neutron eye dose limit enforcement.

Heavy-ions shielding data for hadrontherapy application with Monte Carlo methods.

In hadrontherapy centers, ion beams are accelerated by a cyclotron or synchrotron through electric and magnetic fields and, once the treatment energy is reached, ions interact with the patient. The interaction of the beam with magnets, other elements of particle accelerator or with the patient generates secondary radiation and the calculation for the design of the shielding is required. A first assessment of the shielding, generally made by concrete, can be performed by using Monte Carlo simulations, in which neutron yields and the ambient dose equivalent, H*(10), spatial distribution are obtained. The aim of this work is to evaluate, with a Monte Carlo approach, ambient dose equivalent values at various concrete depths generated by the secondary radiation. Simulations are performed considering helium, lithium, carbon, oxygen and iron primary beams. For existing facilities that already accelerates carbon ion, an equivalent carbon ratio is introduced to estimate the ion currents to get, in a given point, the same ambient dose equivalent as a carbon ion. Numerical results have been obtained simulating an ion beam that impinges on a thick iron or international commission on radiation units and measurements (ICRU) tissue, respectively, representing magnets and patient. The secondary radiation is transported through a large concrete shielding where ambient dose equivalent values are calculated as function of concrete thickness.

Planning Target Volume Margin Determination for Volumetric Modulated Arc Therapy Planning in Cervix Cancers Using an Empty Bladder Protocol

OBJECTIVE To evaluate the planning target volume (PTV) margin and bladder volume variation of volumetric modulated arc therapy (VMAT) in cervical cancer using an empty bladder protocol. METHODS Ten patients with cervical cancer who had indications to receive whole pelvic radiotherapy and who had been identified to receive whole pelvic irradiation with a dose of 46-55.2 Gy in 23 fractions planned by VMAT were included. International Commission on Radiation Units and Measurements (ICRU) Report 83 was used to report plan parameters. The empty bladder protocol is designed for use with all patients before simulation and irradiation. From June 2020 to February 2021, 215 fractions from the 10 patients were evaluated. The ‘all fraction’ set-up errors were recorded using cone-beam computed tomography (CBCT) and were interpreted as error margins using the Van Herk Formula. RESULTS The calculated PTV margins were 0.75, 0.84, and 0.98 cm on the X, Y, and Z-axes, respectively. The median volume of the bladder before irradiation was 40.6 cc, with an interquartile range of 31.9 to 59.2 cc. The average change in bladder volume from the planning volume was 23.56%. CONCLUSIONS Using the empty bladder protocol, the clinical target volume (CTV) to PTV margin was 1 cm following the Van Herk formula. No patients experienced side effects of grade 3 or greater. The empty bladder protocol is a method which can reduce target placement error and reduce patient discomfort without causing serious side effects. KEYWORDS PTV margin, VMAT, IGRT, Cervix cancer, Empty bladder

Prompt gamma ray activation analysis for determining chemical composition of 3D printing and casting materials used in biomedical applications.

Three-dimensional printing and casting materials were analyzed by prompt gamma-ray activation analysis (PGAA) to determine their suitability as human tissue surrogates for the fabrication of phantoms for medical imaging and radiation dosimetry applications. Measured elemental compositions and densities of five surrogate materials simulating soft tissue and bone were used to determine radiological properties (x-ray mass attenuation coefficient and electron stopping power). When compared with radiological properties of International Commission on Radiation Units and Measurements (ICRU) materials, it was determined that urethane rubber and PLA plastic yielded the best match for soft tissue, while silicone rubber and urethane resin best simulated the properties of bone.

Heterogeneous breast phantom for computed tomography and magnetic resonance imaging.

In this article, a heterogeneous multimodal anthropomorphic breast phantom with carcinoma is introduced to meet the response of the natural breast tissue when imaged using ionizing and non-ionizing machines. The skin, adipose, fibroglandular, pectoral muscle, and carcinoma tissue were mimicked. A T1-weighted breast magnetic resonance image with BI-RADS I tissue segmentation was used for molds creation. The tissue-mimicking materials (TMMs) were tailored in terms of their elemental composition weight fractions and their response to ionization radiation parameters. These are the mass attenuation coefficient (MAC), electron density (ne) and effective atomic number (Zeff). The behaviour of the TMMs, when exposed to a wide range of ionization radiation energy, was investigated analytically and numerically using X-COM. The achieved results showed an excellent agreement with the corresponding properties of the natural breast elemental compositions as reported by the International Commission on Radiation Units and Measurements (ICRU). The MAC of the TMMs and the ICRU-based breast tissue were found to be consistent. The maximum percentage of error in ne and Zeff amounts to only 2.93% and 5.76%, respectively. For non-ionizing imaging, the TMMs were characterized in term of T1 and T2 relaxation times. Using our preclinical MRI unit, the TMMs relaxation times were measured and compared to the natural tissue. The fabricated phantom was validated experimentally using CT, MRI, and Mammographic machines. The achieved images of the TMMs were in alignment with the real tissue in terms of CT HU values and grayscale colors. T1W and T2W images on MRI revealed the expected contrast between TMMs as in natural tissue.

Impact of the implementation of the new radiation quantities recommended by ICRU/ICRP for practical use in interventional radiology: a Monte Carlo study

The International Commission on Radiation Units and Measurements (ICRU) proposed a new set of operational quantities for radiation protection for external radiation in its Report Committee 26 (ICRU 95). The new proposal aims to improve the coherence between the operational quantities and the definitions of the protection quantities in the recommendations of the International Commission on Radiological Protection set out in 2007 (Ann. ICRP 37). It is expected that this change in operational quantities will impact current dosimeter designs. Although for many photon energies, the conversion coefficients from physical field quantities to the new operational quantities will change relatively little, for radiation fields with low energy photon components, such as medical x-ray applications, there will be a significant decrease in the values of the conversion coefficients. This means that the numerical values of the new operational quantities will be much lower for the same radiation field. These values will be closer to the effective dose, but this change can still cause confusion for medical staff. It is important to examine the effect of the new set of dose conversion coefficients on the personal dose in realistic radiation fields. We performed a study to assess the effect of changing the definition of the operational quantity, personal dose equivalent (), in realistic radiation fields in interventional radiology (IR) workplaces. The x-ray tube kilovoltage peak (kVp) in IR ranges between 60 and 120 kV. The medical staff is exposed to the scattered photons which have a wide range of energies depending on the beam configuration and the patient size. The objective of this study is to ‘quantitatively’ estimate the impact of implementing the new ICRU quantities of Report 95 in IR radiation fields using Monte Carlo simulations. Simulations of 560 different configurations in IR were performed using MCNPX to calculate fluence binned per energy and angle of incidence. and were then calculated for each configuration using dose conversion coefficients from fluence given by ICRU Reports 95 and 57, respectively. The results show that the mean of the ratio, , is 1.6 for all simulated scenarios. This reduction will correct the current overestimation of the effective dose and should result in better compliance with the dose limits in IR. However, it may also have negative consequences on the safety culture among the medical staff. Special care will be needed when interpreting these lower doses.

On the perturbation effect and LET dependence of beam quality correction factors in carbon ion beams.

In a recent study, we reported beam quality correction factors, fQ , in carbon ion beams using Monte Carlo (MC) methods for a cylindrical and a parallel-plate ionization chamber (IC). A non-negligible perturbation effect was observed; however, the magnitude of the perturbation correction due to the specific IC subcomponents was not included. Furthermore, the stopping power data presented in the International Commission on Radiation Units and Measurements (ICRU) report 73 were used, whereas the latest stopping power data have been reported in the ICRU report 90. The aim of this study was to extend our previous work by computing fQ correction factors using the ICRU 90 stopping power data and by reporting IC-specific perturbation correction factors. Possible energy or linear energy transfer (LET) dependence of the fQ correction factor was investigated by simulating both pristine beams and spread-out Bragg peaks (SOBPs). The TOol for PArticle Simulation (TOPAS)/GEANT4 MC code was used in this study. A 30 × 30 × 50 cm3 water phantom was simulated with a uniform 10 × 10 cm2 parallel beam incident on the surface. A Farmer-type cylindrical IC (Exradin A12) and two parallel-plate ICs (Exradin P11 and A11) were simulated in TOPAS using the manufacturer-provided geometrical drawings. The fQ correction factor was calculated in pristine carbon ion beams in the 150-450 MeV/u energy range at 2 cm depth and in the middle of the flat region of four SOBPs. The kQ correction factor was calculated by simulating the fQo correction factor in a 60 Co beam at 5 cm depth. The perturbation correction factors due to the presence of the individual IC subcomponents, such as the displacement effect in the air cavity, collecting electrode, chamber wall, and chamber stem, were calculated at 2 cm depth for monoenergetic beams only. Additionally, the mean dose-averaged and track-averaged LET was calculated at the depths at which the fQ was calculated. The ICRU 90 fQ correction factors were reported. The pdis correction factor was found to be significant for the cylindrical IC with magnitudes up to 1.70%. The individual perturbation corrections for the parallel-plate ICs were <1.0% except for the A11 pcel correction at the lowest energy. The fQ correction for the P11 IC exhibited an energy dependence of >1.00% and displayed differences up to 0.87% between pristine beams and SOBPs. Conversely, the fQ for A11 and A12 displayed a minimal energy dependence of <0.50%. The energy dependence was found to manifest in the LET dependence for the P11 IC. A statistically significant LET dependence was found only for the P11 IC in pristine beams only with a magnitude of <1.10%. The perturbation and kQ correction factor should be calculated for the specific IC to be used in carbon ion beam reference dosimetry as a function of beam quality.

ANALYSIS OF OPTIC CHIASM RADIATION DOSE FOR NASOPHARYNGEAL CANCER (NPC) PATIENTS WITH INTENSITY MODULATED RADIOTHERAPY (IMRT) TECHNIQUE BASED ON DOSE VOLUME HISTOGRAM (DVH) GRAPH FOR THERAPY USING LINAC

Motivation/Background: Radiotherapy is the standard therapy that uses ionizing rays for the treatment of malignancies. However, in some cases of nasopharyngeal cancer (NPC), the location of the tumor pushes to the base of the brain until it reaches the optic chiasma. The optic chiasm as part of a healthy organ around the target irradiation becomes a dangerous organ or a risk organ (OAR) so it needs to be considered in the case of radiation therapy for NPC. This study aims to consider dosing in patients to fulfill radiation protection. IMRT technique is believed to maximize the success of therapy in cases of NPC.Method: In this study, secondary data was used by looking at the DVH (Dose Volume Histogram) graph from the results of radiation planning for NPC patients using the IMRT (Intensity Modulated Radiotherapy) technique. Data analysis was carried out on PTV and OAR dose values NPC patients at Ken Saras Hospital on the DVH chart that was adjusted to the wishes used, namely The International Commission on Radiation Units and Measurements (ICRU) Report 62 (1999) for PTV doses and QUANTEC for doses OAR.Results: The results of the analysis showed that of the 15 patient data analyzed, there were 10 patients with a percentage of 66.67% who received radiation doses that were in accordance with the ICRU Report 62 reference (95-107%) while patients who received less than optimal doses (&lt; 95%) there were 5 people with a percentage of 33.33% while the maximum dose received by OAR for the optic chiasm in NPC patients who had complied with QUANTEC rules overall there were 7 patients with a percentage of 46.67% while there were 8 patients who received doses exceeding the QUANTEC limit with a percentage of 53 ,33% risk of receiving radiation side effects by 7-20%..Conclusions: there were patients who received doses exceeding QUANTEC as much as 53.33%

Quality Assurance in Clinical Trials Requiring Radiation Therapy in Sub-Saharan Africa

Given the increasing availability of radiation therapy in sub-Saharan Africa, clinical trials that include radiation therapy are likely to grow. Ensuring appropriate delivery of radiation therapy through rigorous quality assurance is an important component of clinical trial execution. We reviewed the process for credentialing radiation therapy sites and radiation therapy quality assurance through the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center for AIDS Malignancy Consortium (AMC)-081, a multicenter study of cisplatin and radiation therapy for women with locally advanced cervical cancer living with HIV, conducted by the AIDS Malignancy Consortium at 2 sites in South Africa and Zimbabwe. Women living with HIV with newly diagnosed stage IB2, IIA (>4 cm), IIB-IVA cervical carcinoma (per the 2009 International Federation of Gynecology and Obstetrics [FIGO] staging classifications) were enrolled in AMC-081. They received 3-dimensional conformal external beam radiation therapy (EBRT) to the pelvis (41.4-45 Gy) using a linear accelerator, high-dose-rate brachytherapy (6-9 Gy to point A with each fraction and up to 4 fractions), and concurrent weekly cisplatin (40 mg/m2). IROC reviewed EBRT and brachytherapy quality assurance records after treatment. All of the 38 women enrolled in AMC-081 received ±5% of the protocol-specified prescribed dose of EBRT. Geometry of brachytherapy applicator placement was scored as per protocol in all implants. Doses to points A and B, International Commission on Radiation Units and Measurements (ICRU) bladder, or ICRU rectum required correction by IROC in >50% of the implants. In the final evaluation, 58% of participants (n=22) were treated per protocol, 40% (n=15) had minor protocol deviations, and 3% (n=1) had major protocol deviations. No records were received within 60 days of treatment completion as requested in the protocol. Major radiation therapy deviations were low, but timely submission of radiation therapy data did not occur. Future studies, especially those that include specialized radiation therapy techniques such as stereotactic or intensity-modulated radiation therapy, will require pathways to ensure timely and adequate quality assurance.

On the operational quantity for eye lens neutron dosimetry considering ICRU 95 report

For planned occupational exposure situations, the International Commission on Radiological Protection (ICRP) publication 118 recommends an equivalent dose limit for the lens of the eye of 20 mSv yr−1 averaged over 5 yr with no single year exceeding 50 mSv. Regulatory authorities of various jurisdictions worldwide followed some or all, of the ICRP recommendations and implemented reduced occupational lens of eye dose limits in their legislation. As compliance with the eye-lens dose limit will be based on the summation of doses received from all types of radiation, applicable to a variety of workplaces, the contribution of neutrons to eye lens dose will be important where it contributes a significant fraction of the total dose to the eye lens. This work presents and discusses computed personal absorbed dose (D lens/Φ), and personal dose equivalent (H p(3)/Φ) as well as a newly proposed relative biological effectiveness (RBE)-weighted absorbed dose (RBE × D lens/Φ) conversion coefficients for the lens of the eye for neutron exposure at incident energies from thermal to ∼20 MeV. The D lens/Φ coefficients were obtained from a simulation model developed for this study that contains the stylised eye model embedded in the adult UF-ORNL mathematical phantom. The modelling techniques used in these simulations were also used to calculate H p(3)/Φ for the International Commission on Radiation Units and Measurements (ICRU) slab and cylinder phantoms. All simulations carried out for this study utilised the Monte Carlo N-Particle (MCNP) series of codes. The results are compared with the related published data. The issue of compliance with the current equivalent dose limit for the lens of the eye is addressed from a neutron perspective considering the recent proposed redefinition of the operational quantities for external radiation exposure in ICRU report 95. The use of a radiation weighted absorbed dose (RBE × D lens, in Gy) is proposed for the tissue reactions in the eye-lens for neutron radiation as per the National Council on Radiation Protection and Measurements report 180, and in line with the recent review and revision of the System of Radiological Protection To Keeping the ICRP Recommendations Fit for Purpose, which states that RBE weighted dose should be used for high-Linear energy transfer (LET) radiations such as neutrons. This confirms the earlier statement in ICRP publication 92, paragraph 297 and reiterated in the Executive summary, paragraph (q) of ICRP publication 118. The proposed approach would provide an operational quantity consistent with the units of the new eye-lens dose limits without being overly conservative.

Dosimetric characteristics of fabricated germanium doped optical fibres for a postal audit of therapy electron beams

The dosimetric characteristics of germanium (Ge) doped optical fibres are investigated as a potential dosimetric alternative for electron beam therapy postal audits. The dosimetric characteristics of 6 mol% Ge-doped optical fibres fabricated as cylindrical fibres (CF) and flat fibres (FF) are established in terms of signal fading, linearity of dose-response, beam energy- and dose rate dependence. Pilot electron beam therapy audit study irradiations are made with a linear accelerator located at the Royal Surrey County Hospital, applying International Atomic Energy Agency (IAEA) standard irradiation procedures for reference and non-reference conditions. Results for the CF and FF show fading of 26% and 20% respectively at 120 days post-irradiation. For a 6 MeV electron beam the dose-response is observed to be linear over the dose range 1–3 Gy, the least determination coefficient, R2, being 0.985. The results of the electron beam therapy audit are within the tolerance limit of 5% recommended by the International Commission on Radiation Units and Measurements (ICRU) Report No. 24, with a maximum deviation of 4% for FF at a 6 MeV electron beam under non-reference conditions. In conclusion, the fabricated Ge-doped optical fibres are seen to offer suitability for use as an alternative dosimeter to TLD-100 in electron beam therapy postal audit.

Description of a novel technique for ultrasound-based planning for gynaecological 3D brachytherapy and comparison between plans of this technique and 2D with fluoroscopy.

With the purpose of implementing a way to obtain volumes from ultrasound axial images, a novel method for 3D gynaecologic brachytherapy was assessed, with a 3D-printed attachment for a commercial stepper (for prostate brachytherapy). It allowed the acquisition of a transabdominal axial image series by ultrasound; these images were uploaded to a treatment planning system where high-risk clinical tumour volume (HR-CTV) and risk organs were contoured. A dose administration plan was developed with orthogonal X-ray images (0° and 270° incidences), using International Commission on Radiation Units and Measurements (ICRU) 38 points. The same plan was applied in the ultrasound images’ sequence and their respective volumes; differences were noted. In the 20 cases analysed, with a given point A dose, its corresponding dose delivered to 90% of HR-CTV percentage was highly variable (mean = 104.2, SD = 26.01). There is a significant variation of this percentage when point A falls outside the HR-CTV than when it falls inside (p < 0.00001). There is a significant correlation in terms of the bladder point dose ICRU 38 and the Maximum dose to 2cc of organ or target volume (D2cc) bladder (p = 0.021); however, there is no such correlation when we relate the rectum point dose ICRU 38 to the D2cc rectum (p = 0.327). There was a negative correlation between HR-CTV and D2cc bladder and D2cc rectum; both were statistically significant. There were significant differences comparing ICRU points and dose to prescription and organ at risk volumes, pointing out that there is room for optimisation of plans using the latter technique. So, it is proposed to further test this image modality and compare it to other imaging techniques that allow the creation of volumes, such as computed tomography or magnetic resonance imaging.

Dosimetry of absolute dose to water from elekta synergy platform linear accelerator using clinical electron beam

The use of electron beams in external beam radiation therapy started in 1930 but was limited to very few medical centers due to manual calculations of dose. The development of Van de Graaff generators, Betatrons, and various generations of commercial linear accelerators led to Elekta Synergy platform linear accelerators which were capable of performing dose calculations using computer software. In the present paper, we present a study on dose calculations for electron energies in the range of 4-15 MeV. This study was pursued following the recommendations of the International Commission on Radiation Units and Measurements (ICRU) and International Atomic Energy Agency (IAEA) reports and protocols of the international code of practice TRS-381. It is based on an experimental setup using a radiation field analyzer (RFA). This comprises of PTW-Freiburg Parallel plate ionization chamber (waterproof with cap, Model TM 23343) with a sensitive volume of 0.055 cm3 and a semi-flex chamber (waterproof with cap, Model TM 30010) with a sensitive volume of 0.125 cm3 both coupled with a digital electrometer (PTW UNIDOSE). The measurements were performed on a linear accelerator (Make &amp; Model: ELEKTA, Synergy Platform).

Evaluation of Microscopic Tumour Extension in Localized Stage Non-Small-Cell Lung Cancer for Stereotactic Radiotherapy Planning.

Simple SummaryStereotactic radiotherapy for localised stage non-small-cell lung carcinoma is an alternative indication for patients who are inoperable or refuse surgery. A study showed that the microscopic tumour extension of non-small-cell lung carcinoma varied according to the histological type, which allowed us to deduce adapted margins for the clinical target volume. The objectives of our retrospective study are. The objective of our study is to measure the microscopic tumour extension of T1N0 or T2aN0 primary lung tumors who underwent surgery. The margin required to cover the microscopic tumour extension with a 95% probability is 4.4 mm and 2.9 mm for squamous cell carcinoma and adenocarcinoma, respectively. Multivariate analysis showed a statistically significant relationship between the maximum microextension distance and size with the shrinkage coefficient.Background: Stereotactic radiotherapy for localised stage non-small-cell lung carcinoma (NSCLC) is an alternative indication for patients who are inoperable or refuse surgery. A study showed that the microscopic tumour extension (ME) of NSCLC varied according to the histological type, which allowed us to deduce adapted margins for the clinical target volume (CTV). However, to date, no study has been able to define the most relevant margins for patients with stage 1 tumours. Methods: We performed a retrospective analysis including patients with adenocarcinoma (ADC) or squamous cell carcinoma (SCC) of localised stage T1N0 or T2aN0 who underwent surgery. The ME was measured from this boundary. The profile of the type of tumour spread was also evaluated. Results: The margin required to cover the ME of a localised NSCLC with a 95% probability is 4.4 mm and 2.9 mm for SCC and ADC, respectively. A significant difference in the maximum distance of the ME between the tumour-infiltrating lymphocytes (TILs), 0–10% and 50–90% (p < 0.05), was noted for SCC. There was a significant difference in the maximum ME distance based on whether the patient had chronic obstructive pulmonary disease (COPD) (p = 0.011) for ADC. Multivariate analysis showed a statistically significant relationship between the maximum microextension distance and size with the shrinkage coefficient. Conclusion: This study definitively demonstrated that the ME depends on the pathology subtype of NSCLC. According to International Commission on Radiation Units and Measurements (ICRU) reports, 50, 62 and 83 CTV margins, proposed by these results, should be added to the GTV (Gross tumour volume). When stereotactic body radiation therapy is used, this approach should be considered in conjunction with the dataset and other margins to be applied.

Development of a quasi-humanoid phantom to perform dosimetric and radiobiological measurements for out-of-field doses from external beam radiation therapy.

Our understanding of low dose, out‐of‐field radiation and their radiobiological effects are limited, in part due to the rapid technological advances in external beam radiotherapy, especially for non‐coplanar and dynamic techniques. Reliable comparisons of out‐of‐field doses produced by advanced radiotherapy techniques are difficult due to the limitations of commercially available phantoms. There is a clear need for a functional phantom to accurately measure the dosimetric and radiobiological characteristics of out‐of‐field doses, which would in turn allow clinicians and medical physicists to optimize treatment parameters. We designed, manufactured, and tested the performance of a quasi‐humanoid (Q‐H) adult phantom. To test the physics parameters, we used computed tomography (CT) scans of assembled Q‐H phantom. Static open field and dynamic techniques were measured both in‐ and out‐of‐field with ionization chambers and radiochromic films for two configurations (full solid and with water‐filled containers). In the areas simulating soft tissues, lung, and bones, median Hounsfield units and densities were, respectively: 129.8, ‐738.7, 920.8 HU and 1.110, 0.215, 1.669 g/cm3. Comparison of the measured to treatment planning systems (TPS) in‐field dose values for the sample volumetric arc therapy (VMAT) (6 MV flattening filter‐free (FFF)) plan, 96.4% of analyzed points passed the gamma evaluation criteria (L2%/2 mm, threshold (TH) 10%) and less than 1.50% for point dose verification. In the two phantom configurations: full poly(methyl) methacrylate (PMMA) and with water container, the off‐axis median doses for open field, relative to the central axis of the beam (CAX) were similar, respectively: 0.900% versus 0.907% (15 cm distance to CAX); 0.096% versus 0.120% (35 cm); 0.018% versus 0.018% (52 cm); 0.009% versus 0.008% (74 cm). For VMAT 6 MV FFF, doses relative the CAX were, respectively: 0.667% (15 cm), 0.062% (35 cm), 0.019% (52 cm), 0.016% (74 cm). The Q‐H phantom meets the International Commission on Radiation Units and Measurements (ICRU) and American Association of Physicists in Medicine (AAPM) recommended phantom criteria, providing medical physicists with a reliable, comprehensive system to perform dose calculation and measurements and to assess the impact on radiobiological response and on the risk of secondary tumor induction.

Conversion coefficients from total air kerma to the newly proposed ICRU/ICRP operational quantities for radiation protection for photon reference radiation qualities

The International Commission on Radiation Units and Measurements (ICRU) has recently proposed a set of new operational quantities for radiation protection. ICRU supplied conversion coefficients for mono-energetic photons but not for photon reference radiation qualities defined by the International Organization for Standardization (ISO) in ISO 4037 and by the International Electrotechnical Commission (IEC) in IEC 61267. Therefore, in this work, conversion coefficients from total air kerma to the newly proposed operational quantities are averaged for photon reference radiation qualities. Also, parameters necessary to determine the influence of the air density on the conversion coefficients are determined. Finally, the impact of the newly proposed quantities upon the response of dosemeters is investigated.

A mathematical model to predict the different isodose volumes using TRAK value in HDR intracavitary brachytherapy for revised Manchester and ICRU-89 based Point A plans using computer tomography images

To find out the simple relationship between Total Reference Air Kerma (TRAK) and various isodose volumes. Calculated isodose volumes were compared with experimental data for revised Manchester and International Commission on Radiation Units and measurements (ICRU)-89 Point A-based treatment plans. The accuracy of the formula was compared with the results of other relationships available in the literature. Dosimetric data from 62 intracavitary brachytherapy (ICBT) treatment plans of 31 patients with cervical cancer were studied. Each patient had treatment plans normalized to revised Manchester and ICRU-89 Points A (Aflange and Aicru89). For each treatment plan, TRAK values, V350, V700, V1050, and V1400 were obtained. The modeling curve was plotted between Isodose volume (Vd) and the ratio of d/TRAK obtained from Aflange plans to get a mathematical relation. The results of this formula were compared with the experimental data and outcomes of other formulas available in the literature. A paired-sample t-test was performed to assess the statistical significance. In the case of revised Manchester-based Aflange normalization plans, the mean isodose volume of V350, V700, V1050, and V1400 were 285.98 ± 32.3 cm3, 101.96 ± 10.63 cm3, 52.71 ± 4.72 cm3, and 31.44 ± 2.33 cm3 respectively. Likewise, for ICRU-89 based Aicru89 normalization plans, the mean isodose volumes of V350, V700, V1050, and V1400 were 304.11 ± 26.17 cm3, 108.88 ± 8.29 cm3, 56.62 ± 3.69 cm3 and 34 ± 2.23 cm3 respectively. The mean difference was significant. The Mathematical relationship developed was [INLINE:1]. No correlation was found between TRAK and D0.1cm3,D2cm3 for organs at risk. The developed formula calculated isodose volumes within the accuracy of ± 3% in ICBT plans.

A retrospective study to establish recommendations for plan quality metrics in Lung SBRT.

The increased use of Stereotactic body radiation therapy (SBRT) has warranted a new method of plan evaluation. The crucial component of SBRT is the precise, conformal delivery of radiation dose to the target with rapid dose fall-off in the surrounding normal tissues.In this study, we retrospectively evaluated plan quality in lung SBRT patients by calculating conformity, homogeneity, and gradient parameters using an in-house script. The goal of this study was to establish achievable, size-dependent recommendations for these plan quality metrics such that they may be used as a guideline in our clinic. Seventy-three patients treated with lung SBRT at The University of Toledo Medical Center during the period 2017-2020 were retrospectively reviewed for this study. Plans were evaluated using dosimetric indices from respective The Radiation Therapy Oncology Group (RTOG) and International Commission on Radiation Units and Measurements (ICRU) protocols. Average values for each of the following indices were calculated: RTOG conformity index = 1.12 ± 0.13; Paddick conformity index = 0.82 ± 0.07; gradient index = 4.63 ± 0.71; and Homogeneity index = 0.3 ± 0.07, for all studied lung lesions with a mean volume of 23.2 cc. Our final recommendations are based on clinically approved plans, after having removed statistical outliers that we may not have approved had the metrics been calculated. Additionally, we observed that a sharper dose fall-off and a more homogeneous plan were found using 6 FFF compared to 10 FFF energy. Comparison between our results and RTOG0915 data shows no deviation or minor deviation for the RTOG conformity index and the ratio of 50% prescription isodose volume to the target volume. Furthermore, no statistically significant correlation between RTOG conformity index and target volume was observed which is in agreement with RTOG0915. Using various dosimetric indices to characterize dose distributions in lung SBRT is a powerful tool to assess plan quality. We recommend that these values be calculated for all plans, utilizing a script or program so as to improve clinical workflow.

Evaluation of Dose Distribution Indices by using RapidArc Technique for the Treatment of Gynecological Cancer

Introduction: This study describes the distribution of radiation doses to investigate the planned target volume (PTV) of gynecological cancers using the RapidArc technique. The optimal treatment plan options are developed by involvement of different dosimetric parameters including Homogeneity index (HI), Conformity index (HI), Uniformity index (UI), Radical dose homogeneity index (rDHI) and Moderate dose homogeneity index (mDHI).&#x0D; Method: Thirteen patients diagnosed with gynecological cancer were treated through RapidArc on DHX Varian linear accelerator with 6MV and 15MV photon beams. This therapy was carried out with linac.&#x0D; Result: The calculated dosimetric parameters for planning target volume were found in the ranges; HI (1.08 to 1.20), CI (0.985 to 0.997 in RTOG), CI (1.003 to 1.005 in ICRU), UI (1.05 to 1.13), rDHI (0.57 to 0.75) and mDHI (0.88 to 0.93).&#x0D; Conclusion: It has been concluded that all the calculated indices are within the range specified by radiation therapy oncology group (RTOG; 1993), International Commission on Radiation Units and Measurements (ICRU) and OLIVER; except in rare cases may be due to complex geometry, tumor volume range, and low radiation dose.This treatment can be further added to calculate other dose indices by using higher energy beams and different prescription doses for different fractions.

Conversion coefficients from absorbed dose to tissue to the newly proposed ICRU/ICRP operational quantities for radiation protection for beta reference radiation qualities

The International Commission on Radiation Units and Measurements (ICRU) has, jointly with the International Commission on Radiological Protection (ICRP), recently proposed a set of new operational quantities for radiation protection in ICRU report 95. ICRU/ICRP supplied conversion coefficients for mono-energetic betas but not for beta reference radiation qualities defined by the International Organization for Standardization (ISO) in ISO 6980. Therefore, in this work, conversion coefficients from absorbed dose to tissue at a depth of 0.07 mm in a slab phantom to the newly proposed operational quantities are determined for beta reference radiation qualities. Finally, the impact of the newly proposed quantities on primary and calibration laboratories and on users and manufacturers of dosemeters is investigated, the latter by having a close look at the expected change of the response of dosemeters.