Radiation Quality Research Articles

Biological effects in normal human fibroblasts following chronic and acute irradiation with both low- and high-LET radiation

IntroductionRadiobiological studies at low dose rates allow us to improve our knowledge of the mechanisms by which radiation exerts its effects on biological systems following chronic exposures. Moreover, these studies can complement available epidemiological data on the biological effects of low doses and dose rates of ionizing radiation. Very few studies have simultaneously compared the biological effects of low- and high-LET radiations at the same dose rate for chronic irradiation.MethodsWe compared, for the first time in the same experiment, the effects of chronic (dose rates as low as ~18 and 5 mGy/h) and acute irradiations on clonogenicity and micronucleus formation in AG1522 normal human skin fibroblasts in the confluent state exposed to doses of low- and high-LET radiation (gamma rays and alpha particles) to investigate any differences due to the different radiation quality and different dose rate (in the dose range 0.006–0.9 Gy for alpha particles and 0.4–2.3 Gy for gamma rays).ResultsAs expected, alpha particles were more effective than gamma rays at inducing cytogenetic damage and reduced clonogenic cell survival. For gamma rays, the cytogenetic damage and the reduction of clonogenic cell survival were greater when the dose was delivered acutely instead of chronically. Instead, for the alpha particles, at the same dose, we found equal cytogenetic damage and reduction of clonogenic cell survival for both chronic and acute exposure (except for the highest doses of 0.4 and 0.9 Gy, where cytogenetic damage is greater at a low dose rate).ConclusionThe results of this study may have an impact on space and terrestrial radioprotection of humans at low doses and low dose rates, on biodosimetry, and on the use of ionizing radiation in medicine. These results also provide insights into understanding damage induction and cell reaction mechanisms following chronic exposure (at dose rates as low as 18 and 5 mGy/h) to low- and high-LET radiation.

Monte Carlo damage models of different complexity levels predict similar trends in radiation induced DNA damage.

Ion therapies have an increased relative biological effectiveness (RBE) compared to X-rays, but this remains poorly quantified across different radiation qualities. Mechanistic models that simulate DNA damage and repair after irradiation could be used to help better quantify RBE. However, there is large variation in model design with the simulation detail and number of parameters required to accurately predict key biological endpoints remaining unclear. This work investigated damage models with varying detail to determine how different model features impact the predicted DNA damage.

Methods: Damage models of reducing detail were designed in TOPAS-nBio and Medras investigating the inclusion of chemistry, realistic nuclear geometries, single strand break damage, and track structure. The nucleus models were irradiated with 1 Gy of protons across a range of linear energy transfers (LETs). Damage parameters in the models with reduced levels of simulation detail were fit to proton double strand break (DSB) yield predicted by the most detailed model. Irradiation of the optimised models with a range of radiation qualities was then simulated, before undergoing repair in the Medras biological response model.

Results: Simplified damage models optimised to proton exposures predicted similar trends in DNA damage across radiation qualities. On average across radiation qualities, the simplified models experienced an 8% variation in double strand break (DSB) yield but a larger 28% variation in chromosome aberrations. Aberration differences became more prominent at higher LETs, with model features having an increasing impact on the distribution and therefore misrepair of DSBs. However, overall trends remained similar with better agreement likely achievable through repair model optimisation. 

Conclusion: Several model simplifications could be made without compromising key damage yield predictions, although changes in damage complexity and distribution were observed. This suggests simpler, more efficient models may be sufficient for initial radiation damage comparisons, if validated against experimental data.&#xD.

Daily Light Integral and Far-Red Radiation Influence Morphology and Quality of Liners and Subsequent Flowering and Development of Petunia in Controlled Greenhouses

Petunia stands as the top-selling bedding plant in the U.S., and improved lighting control in greenhouses holds the potential to reduce crop production time and optimize crop quality. This study investigated the impact of four distinct daily light integral (DLI) conditions with and without supplemental far-red (FR) radiation on the growth of petunia liners and subsequent development of finish plants. Two experiments were conducted in spring (9 April to 18 June 2021) and winter (28 October 2021 to 6 January 2022). Petunia cuttings were rooted in a common environment and then transferred to four greenhouse sections with different DLI treatments: 6, 9, 12, and 15 mol·m−2·d−1 for four weeks. Within each DLI condition, half of the plants were exposed to 28 μmol·m−2·s−1 supplemental FR radiation for 16 h daily (equivalent to 1.61 mol·m−2·d−1 light integral). The number of flower buds and open flowers were tracked daily. Representative liners were destructively harvested and evaluated after four weeks of lighting treatments. The remaining plants were transplanted and moved to a common DLI condition of 15 mol·m−2·d−1 for an additional three weeks before being destructively harvested and evaluated as finish plants. The primary finding reveals the promoting effect of DLI on flowering, branching, morphology, and biomass accumulation of petunia liners, with many effects persisting into the finish stage. A threshold DLI of 9 mol·m−2·d−1 was identified, as lower DLI (6 mol·m−2·d−1) resulted in extensive stem elongation, rendering the plants unmarketable. Higher DLI levels were found to be optimal in terms of flowering and morphology. Supplemental FR accelerated flowering by up to three days in the summer experiment and up to 12 days in the winter experiment. However, FR had limited impact on the number of flower buds and open flowers, branching, and shoot and root weight of the finish plants. Interactions between DLI and FR were observed on some parameters, whereby FR effects were more pronounced under lower DLI. Overall, both higher DLI and supplemental FR exhibited beneficial effects, but DLI had a more pronounced effect. Thus, DLI during petunia liner production appears more important than adding FR. This study well simulated the commercial propagation and production of petunia plants, providing practical insights for decision-making regarding lighting strategies.

An SSDLs calibration method for the kerma-area product meter

The kerma-area product meter (KAP meter) is mainly used for quality assurance in medical imaging research, providing dose quality assessment or dose monitoring for patients. It can be calibrated either in the laboratory or on-site. The purpose of this study is to propose a method for calibrating the KAP meter using a plane-parallel transmission ionization chamber in the SSDLs. In the range of 50 kV–150 kV, under RQR (standard radiation qualities) and RQR additional filtering conditions of the KAP meter, the correction factor NQm of the transmission ionization chamber is calculated to select two types of KAP meters for the calibration of the transmitted beam. The collimators used to limit the size of the radiation field are respectively 50.07 mm in length, 30.03 mm in length, and 20.05 mm in radius. This method, with uncertainty not exceeding 3.0% while improving calibration efficiency, can replace the unit-specific correction of the laboratory method (Toroi et al., 2008).

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.

Well calculated is better than quickly calculated: Comparison of Pencil beam and Monte Carlo algorithms according to the number of lesions and fractionation in radiosurgery of multiple brain metastases

PurposeIn this work we compared pencil beam (PB) and Monte Carlo (MC) algorithms in single isocenter plans of multiple brain metastases radiosurgery (SIMM-SRS) plans using the quality indices reported for SRS. MethodThe plans were evaluated concerning the prescribed dose, fractions and the number of metastases. The quality indices studied were mean dose (Dmean), D95, Paddick conformity index (PCI), Radiation Therapy Oncology Group (RTOG) homogeneity (HIRTOG) and quality of coverage indices (QRTOG), gradient index (GI), efficiency index for targets (Gη12Gy) and organs at risk (OARη12Gy) and V12-V18 for brain. ResultsThe D95 for plans calculated with PB algorithm increased and differences were statistically significant (p < 0.001). For Dmean no differences were observed (p > 0.194). The PCI for the single-fraction cases showed statistical significant differences (p < 0.039). The PCI for the three-fraction cases did not show statistical significant difference (p < 0.569). However, the mean value of the index for all cases did not differ significantly between PB (0.84) and MC (0.81). The GI showed statistically significant differences, only for the plans with more than 10 metastases for a single-fraction (p = 0.0001). The Gη12Gy values reported are within the interval of 0.26–0.80, and for all cases, there were no statistically significant differences. ConclusionConsidering that MC is more accurate for small volumes and heterogeneities, and computational time is reasonable for clinical use, it should be selected in all cases for SIMM-SRS plans. We introduced the potential of novel indices as Gη12Gy, and OARη12Gy for clinical evaluation that potentially serve as optimization factor.

A multicenter study on deep learning for glioblastoma auto-segmentation with prior knowledge in multimodal imaging.

A precise radiotherapy plan is crucial to ensure accurate segmentation of glioblastomas (GBMs) for radiation therapy. However, the traditional manual segmentation process is labor-intensive and heavily reliant on the experience of radiation oncologists. In this retrospective study, a novel auto-segmentation method is proposed to address these problems. To assess the method's applicability across diverse scenarios, we conducted its development and evaluation using a cohort of 148 eligible patients drawn from four multicenter datasets and retrospective data collection including noncontrast CT, multisequence MRI scans, and corresponding medical records. All patients were diagnosed with histologically confirmed high-grade glioma (HGG). A deep learning-based method (PKMI-Net) for automatically segmenting gross tumor volume (GTV) and clinical target volumes (CTV1 and CTV2) of GBMs was proposed by leveraging prior knowledge from multimodal imaging. The proposed PKMI-Net demonstrated high accuracy in segmenting, respectively, GTV, CTV1, and CTV2 in an 11-patient test set, achieving Dice similarity coefficients (DSC) of 0.94, 0.95, and 0.92; 95% Hausdorff distances (HD95) of 2.07, 1.18, and 3.95 mm; average surface distances (ASD) of 0.69, 0.39, and 1.17 mm; and relative volume differences (RVD) of 5.50%, 9.68%, and 3.97%. Moreover, the vast majority of GTV, CTV1, and CTV2 produced by PKMI-Net are clinically acceptable and require no revision for clinical practice. In our multicenter evaluation, the PKMI-Net exhibited consistent and robust generalizability across the various datasets, demonstrating its effectiveness in automatically segmenting GBMs. The proposed method using prior knowledge in multimodal imaging can improve the contouring accuracy of GBMs, which holds the potential to improve the quality and efficiency of GBMs' radiotherapy.

Effects of minimum monitor unit per dynamic control point on intensity‐modulated radiotherapy planning for nasopharyngeal carcinoma: A retrospective study

The present study aimed to improve the dose distribution of radiotherapy planning for nasopharyngeal carcinoma (NPC) by comparing the effects of various minimum monitor units (MUs) per dynamic control point (MMCP) values on the quality and execution efficiency of dynamic intensity-modulated radiotherapy (IMRT) planning. Thirty-four clinically implemented dynamic IMRT plans for patients with NPC were retrospectively selected. In total, 170 plans were obtained by modifying only the MMCP values (set as 1, 3, 5, 7, and 9) in the treatment planning system's (TPS) optimization parameters. These plans were divided into 5 groups. Analyzing the effects of MMCP on the target and organ dose at risk (OAR), also the execution efficiency of the treatment plan in each group and using a quality score system, we conducted an objective quantitative study of the dose distribution and execution efficiency. The target dose evaluation indicators (target coverage (TC), homogeneity index (HI), and conformity index (CI)) of all IMRT plans showed a trend of variation with an increase in MMCP values, and the difference was statistically significant when MMCP values were 5, 7, 9, and 1 (p < 0.05). With an increase in MMCP, the dose to OAR slightly increased, but the difference was not statistically significant (p > 0.05). With an increase in MMCP, the average number of MUs per segment significantly increased (p < 0.01). The groups based on MMCP values of 1, 3, 5, 7, and 9 received quality score system of 1.188, 1.180, 1.171, 0.987, and 1.184, respectively, with the MMCP7 group achieving the lowest score, indicating that this plan had the highest overall quality. The MMCP value for dynamic IMRT planning in the Monaco TPS for patients with NPC should be set to 7 to achieve fewer segments, the best execution efficiency without significantly deteriorating the target and OAR dose.

Study of the Accuracy and Reliability of Dosimetric Measurements for X-ray Beams with Radiation Qualities N-40, N-100, N-200

Radiation dosimetry is a critical aspect of medical, industrial, and scientific applications involving ionizing radiation. Accurate measurements of radiation doses ensure the safety and effectiveness of radiological practices, which is essential for protecting patients in medical procedures, maintaining safety in industrial applications, and ensuring accuracy in scientific research. Leading international organizations conduct research aimed at improving measurement accuracy and the dissemination of measurement units. One of the methods contributing to this effort is various international projects. The National Scientific Centre “Institute of Metrology” has participated in one such international project. This international project, involving several National Metrology Institutes (NMIs), aimed to improve the accuracy and consistency of radiation dosimetry across Europe. By standardizing measurement and calibration procedures, the project seeks to create a unified system for measuring radiation doses, thereby improving the reliability of ionizing radiation dosimetry. This project is particularly significant given the continuous increase in radiation-based technologies across various fields. For example, precise measurements of ionizing quantities are crucial in the medical field, especially for radiotherapy, to ensure that patients receive the necessary dose with minimal exposure to surrounding healthy tissues. Similarly, in industrial radiography, accurate dosimetry is essential for meeting safety standards and preventing excessive radiation exposure to workers. The international project, with the Physikalisch-Technische Bundesanstalt (PTB) and the Central Office of Measures (GUM) as leading organizations, aims to improve key factors in ionizing radiation dosimetry. These include developing reliable calibration protocols for various types of radiation, establishing traceability chains to ensure measurement accuracy, and sharing best dosimetry practices among project participants. Preliminary comparisons were performed between NMIs, with two control participants serving as references while other NMIs participated anonymously (knowing only their number and the numbers of the reference participants). Each participant had the opportunity to compare their obtained values with the reference values and make adjustments for future measurements. The collaborative nature of such cooperation also promotes knowledge and experience exchange, fostering innovation and improvement in dosimetry techniques. The NSC “Institute of Metrology”, a leading organization in the field of the ionizing radiation metrology, has actively participated in this project as a representative from Ukraine. The paper presents the results of international comparisons for X-ray beams with the radiation qualities N-40, N-100, N-200.

Ablation of Supraventricular Arrhythmias With as Low as Reasonably Achievable X-Ray exposure (AALARA): Results of Prospective, Observational, Multicenter, Multinational, Open-Label Registry Study on Real World Data Using Routine Ensite 3D Mapping During SVT Ablation.

The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming the standard of care in many parts of the world. While observational studies in the United States and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and the generalizability of outcomes in other economic regions. The AALARA study is a prospective, observational, multicenter, and multinational open-label study. Patients were recruited from 13 countries across Central Eastern Europe, North and South Africa, the Middle East, and the CIS (Commonwealth of Independent States), with different levels of operator expertise using minimal fluoroscopic exposure techniques. Data on radiation exposure, procedural success, complications, recurrence, and quality of life changes were collected and analyzed. A total of 680 patients were enrolled and followed for 6 months. The majority were ablation naïve with the commonest arrhythmia ablated being typical AVNRT (58%) followed by Atrial Flutter (23%). Zero fluoroscopy exposure was observed in almost 90% of the cases. Fluoroscopy was most commonly used during the ablation phase of the procedure. We observed a high acute success rate (99%), a low complication rate (0.4%), and a 6-month recurrence rate of 3.8%. There was a significant improvement in the patient's symptoms and quality of life as measured by patient global assessment. The routine use of a 3D mapping system during right-sided ablation was associated with low radiation exposure and associated with high acute success rate, low complications, and recurrence rate along with significant improvement in quality of life. The data confirm the reproducibility of this approach in real-world settings across different healthcare systems, and operator experience supporting this approach to minimize radiation exposure without compromising efficacy and safety. NCT04716270.

56Fe-ion Exposure Increases the Incidence of Lung and Brain Tumors at a Similar Rate in Male and Female Mice.

The main deterrent to long-term space travel is the risk of Radiation Exposure Induced Death (REID). The National Aeronautics and Space Administration (NASA) has adopted Permissible Exposure Levels (PELs) to limit the probability of REID to 3% for the risk of death due to radiation-induced carcinogenesis. The most significant contributor to current REID estimates for astronauts is the risk of lung cancer. Recently updated lung cancer estimates from Japan's atomic bomb survivors showed that the excess relative risk of lung cancer by age 70 is roughly fourfold higher in females compared to males. However, whether sex differences may impact the risk of lung cancer due to exposure to high charge and energy (HZE) radiation is not well studied. Thus, to evaluate the impact of sex differences on the risk of solid cancer development after HZE radiation exposure, we irradiated Rbfl/fl, Trp53fl/+ male and female mice infected with Adeno-Cre with various doses of 320 kVp X rays or 600 MeV/n 56Fe ions and monitored them for any radiation-induced malignancies. We conducted complete necropsy and histopathology of major organs on 183 male and 157 female mice after following them for 350 days postirradiation. We observed that lung adenomas/carcinomas and esthesioneuroblastomas (ENBs) were the most common primary malignancies in mice exposed to X rays and 56Fe ions, respectively. In addition, 1 Gy 56Fe-ion exposure compared to X-ray exposure led to a significantly early incidence of lung adenomas/carcinomas (P = 0.02) and ENBs (P < 0.0001) in mice. However, we did not find a significantly higher incidence of any solid malignancies in female mice as compared to male mice, regardless of radiation quality. Furthermore, gene expression analysis of ENBs suggested a distinct gene expression pattern with similar hallmark pathways altered, such as MYC targets and MTORC1 signaling, in ENBs induced by X rays and 56Fe ions. Thus, our data revealed that 56Fe-ion exposure significantly accelerated the development of lung adenomas/carcinomas and ENBs compared to X rays, but the rate of solid malignancies was similar between male and female mice, regardless of radiation quality.

Exploring the LET dependence of DNA DSB repair kinetics using the DR DNA database.

The repair of DNA double-strand breaks is a crucial yet delicate process which is affected by a multitude of factors. In this study, our goal is to analyse the influence of the linear energy transfer (LET) on the DNA repair kinetics. By utilizing the database of repair of DNA and aggregating the results of 84 experiments, we conduct various model fits to evaluate and compare different hypothesis regarding the effect of LET on the rejoining of DNA ends. Despite the considerable research efforts dedicated to this topic over the past decades, our findings underscore the complexity of the relationship between LET and DNA repair kinetics. This study leverages big data analysis to capture overall trends that single experimental studies might miss, providing a valuable model for understanding how radiation quality impacts DNA damage and subsequent biological effects. Our results highlight the gaps in our current understanding, emphasizing the pressing need for further investigation into this phenomenon.

Significance and feasibility of air kerma length product and air kerma area product comparisons

Air kerma length product and air kerma area product are special quantities used in diagnostic radiology. They are measured using special measurement devices – CT-chambers and KAP-meters, in order to calculate quantities related to patient exposure. Appropriate calibration of all measurement devices is of vital importance, and comparisons between calibration laboratories are necessary to prove competence.It is usually considered adequate to participate in air kerma comparisons to prove capabilities for special quantities, but the literature shows that some problems in calibration procedure can remain unknown. The comparisons directly in terms of special quantities provide additional burden to laboratories, and require special transfer instruments, but they allow checking the whole calibration procedures.This paper describes a comparison between two calibration laboratories in terms of both air kerma length product and air kerma area product. Both laboratories achieved good results for all radiation qualities, considering the measurement uncertainty. Transfer instruments’ linearity, field size dependence and energy dependence were investigated. Even though the metrological properties of the transfer instruments are worse than the ionization chambers, they can be taken into account by introducing additional measurement uncertainty, performing appropriate corrections or choosing calibration points for the comparison for the values of influence quantities where the transfer instrument response is relatively flat. These comparisons provide additional value to calibration laboratories, but there are still several challenges related to their organization and execution.

Shaping the future of cancer treatment: The commitment of medical physicists

The incorporation of medical physics into the field of oncology has profoundly changed the ways in which cancer is diagnosed and treated. This article highlights the essential roles that medical physicists play in cancer care, demonstrating how principles from physics improve various aspects of oncology practices. Our analysis reveals that medical physics plays a fundamental role in optimizing various oncological procedures, thereby revolutionizing the management of cancer. Specifically, medical physicists are integral to critical areas such as radiation therapy planning, surgical navigation, and quality assurance, which collectively facilitate personalized and effective treatment strategies for patients. By working closely with healthcare professionals, medical physicists help ensure patients receive top-notch care while minimizing side effects associated with treatments. Their dedication to innovation and research is essential for improving both patient outcomes and quality of life throughout the cancer journey. The ongoing partnership between medical physicists and clinicians is instrumental in propelling advancements in oncology research and clinical practices, leveraging physics principles alongside state-of-the-art technologies to enhance cancer management. As medical physicists commit to excellence and patient-centered practices, they are at the forefront of transforming oncology care, promising improved hope and outcomes for those battling cancer. This collaborative effort ensures a bright future for cancer treatment, where the integration of physics not only optimizes therapeutic approaches but also fosters a comprehensive understanding of cancer care.

1225: Radiotherapy Quality Assurance over the course of time, a systematic literature review

1225: Radiotherapy Quality Assurance over the course of time, a systematic literature review

Commissioning and validation of a single photon beam model in RayStation for multiple matched Elekta Linacs.

A single treatment planning system (TPS) model for matched linacs provides flexible clinical workflows from patient treatment to intensity-modulated radiation therapy (IMRT) quality assurance (QA) measurement. Since general guidelines for building a single TPS model and its validation for matched linacs are not well established, we present our RayStation photon TPS modeling strategy for matched Elekta VersaHD linacs. The four linacs installed from 2013 to 2020 were matched in terms of Percent Depth Dose (PDD), profile, output factor and wedge factors for 6-MV, 10-MV, 15-MV, and 6-MV-FFF, and maintained following TG-142 recommendations until RayStation commissioning. The RayStation single model was built to represent all four linacs within the tolerance limits recommended by MPPG-5.a. The comprehensive validation tests were performed for one linac following MPPG-5.a and TG-119 guidelines, and spot checks for the other three. Our TPS modeling/validation method was evaluated by re-analyzing the previous 103 patient-specific IMRT/volumetric modulated arc therapy (VMAT) QA measurements with the calculated planar doses by the single model in comparison with the analysis results using four individual Pinnacle TPS models. For all energies, our single model PDDs were within 1% agreement of the four-linac commissioning measurements. The MPPG-5.a validation tests from 5.1 through 7.5 and all TG-119 measurements passed within the recommended tolerance limits. The IMRT QA results (mean±standard deviation) for RayStation single model versus Pinnacle individual models were 98.9%±1.3% and 98.0%±1.4% for 6-MV, 99.9%±0.1% and 99.1%±1.9% for 10-MV, and 98.2%±1.3% and 97.9%±1.8% for 6-MV-FFF, respectively. We successfully built and validated a single photon beam model in RayStation for four Elekta Linacs. The proposed new validation methods were proven to be both efficient and effective.

Comparison of directly and indirectly estimated entrance skin dose (ESD) for diagnostic radiation qualities (RQR, RQA and RQT) using water phantom and shadowfree diagnostic chamber (SFD)

BackgroundThe aim of this study was to find the entrance skin dose (ESD) for diagnostic radiation qualities RQRs, RQAs and RQTs given in IAEA technical report series No. 457 using direct and indirect methods of measurement. Measurements were done for 5 × 5, 10 × 10, 15 × 15, 20 × 20 and 25 × 25 cm2 field sizes and 70, 80, 90 and 100 cm source to surface distance (SSD) using shadow-free diagnostic (SFD) chamber and water phantom having dimension 30 × 30 × 30 cm3. ESD direct measurements were done by placing SFD chamber on the surface of water phantom, while in the case of indirect measurements, air kerma values were obtained.ResultsESD values for different selected radiation qualities RQR2, RQR5, RQR8, RQR10, RQA2, RQA5, RQA8, RQA10, RQT8, RQT9 and RQT10 were found to be in the range of 0.0045–5.11 mGy per examination.ConclusionsResults obtained were found to be comparable with ESD values published in the literature. The obtained results in this research would help in establishing the national diagnostic reference levels (DRLs) which would help in the optimization of diagnostic imaging procedures. It would also help the radiographers to optimize field sizes and SSDs in order to reduce dose to the patients thereby ensuring good radiological practices, and this would reduce the stochastic risk to the patients caused by the ionizing radiations.

Role of Oxidative Stress Signaling, Nrf2, on Survival and Stemness of Human Adipose-Derived Stem Cells Exposed to X-rays, Protons and Carbon Ions.

Some cancers have a poor prognosis and often lead to local recurrence because they are resistant to available treatments, e.g., glioblastoma. Attempts have been made to increase the sensitivity of resistant tumors by targeting pathways involved in the resistance and combining it, for example, with radiotherapy (RT). We have previously reported that treating glioblastoma stem cells with an Nrf2 inhibitor increases their radiosensitivity. Unfortunately, the application of drugs can also affect normal cells. In the present study, we aim to investigate the role of the Nrf2 pathway in the survival and differentiation of normal human adipose-derived stem cells (ADSCs) exposed to radiation. We treated ADSCs with an Nrf2 inhibitor and then exposed them to X-rays, protons or carbon ions. All three radiation qualities are used to treat cancer. The survival and differentiation abilities of the surviving ADSCs were studied. We found that the enhancing effect of Nrf2 inhibition on cell survival levels was radiation-quality-dependent (X-rays > proton > carbon ions). Furthermore, our results indicate that Nrf2 inhibition reduces stem cell differentiation by 35% and 28% for adipogenesis and osteogenesis, respectively, using all applied radiation qualities. Interestingly, the results show that the cells that survive proton and carbon ion irradiations have an increased ability, compared with X-rays, to differentiate into osteogenesis and adipogenesis lineages. Therefore, we can conclude that the use of carbon ions or protons can affect the stemness of irradiated ADSCs at lower levels than X-rays and is thus more beneficial for long-time cancer survivors, such as pediatric patients.

Microdosimetric measurements for LET monitoring in proton therapy. The development of engineered mini-TEPCs for clinical applications: First results

Innovative Treatment Planning Systems (TPS) in proton therapy based on a variable radiation quality with depth with respect to the conventional one with a fixed Relative Biological Effectiveness (RBE) of 1.1 are under study. Experimental methods are needed to verify the consistency between what is planned and what is delivered in terms of radiation quality. Microdosimetry studies the stochastics of the energy deposition process at micrometric and sub-micrometric level which is known to be related to the biological effectiveness of ionising radiation fields. For this reason, it is recognised by the scientific community that it is a useful tool to monitor the radiation quality of hadron therapy beams where the effectiveness varies with the penetration depth in patients. Detectors are needed to perform a microdosimetric characterization of a clinical beam and they need to satisfy specific requirements to enter the clinical practice as instruments for the Quality Assurance (QA). With this aim, at the Legnaro National Laboratories of the Italian National Institute for Nuclear Physics (LNL-INFN) a technological transfer project was carried out with the final goal of developing engineered miniaturized Tissue Equivalent Proportional Counters (mini-TEPCs) for clinical applications. This work presents the characterization performed on the new detectors and the results obtained in neutron and proton fields.

3D printed heterogeneous paediatric head and adult thorax phantoms for linear accelerator radiotherapy quality assurance: from fabrication to treatment delivery.

This study aims to design and fabricate a 3D printed heterogeneous paediatric head phantom and to customize a thorax phantom for radiotherapy dosimetry. &#xD;Approach: This study designed, fabricated, and tested 3D printed radiotherapy phantoms that can simulate soft tissue, lung, brain, and bone. Various polymers were considered in designing the phantoms. Polylactic acid+, nylon, and plaster were used in simulating different tissue equivalence. Dimensional accuracy, and CT number were investigated. The phantoms were subjected to a complete radiotherapy clinical workflow. Several treatment plans were delivered in both the head and the thorax phantom from a simple single 6 MV beam, parallel opposed beams, and five-field intensity modulated radiotherapy (IMRT) beams. Dose measurements using an ionization chamber and radiochromic films were compared with the calculated doses of the Varian Eclipse treatment planning system (TPS). &#xD;Main results: The fabricated heterogeneous phantoms represent paediatric human head and adult thorax based on its radiation attenuation and anatomy. The measured CT number ranges are within -786.23 ± 10.55, 0.98 ± 3.86, 129.51 ± 12.83, and 651.14 ± 47.76 HU for lung, water/brain, soft tissue, and bone, respectively. It has a good radiological imaging visual similarity relative to a real human head and thorax depicting soft tissue, lung, bone, and brain. The accumulated dose readings for both conformal radiotherapy and IMRT match with the TPS calculated dose within ±2% and ±4% for head and thorax phantom, respectively. The mean pass rate for all the plans delivered are above 90% for gamma analysis criterion of 3% / 3 mm.&#xD;Significance and conclusion: The fabricated heterogeneous paediatric head and thorax phantoms are useful in Linac end-to-end radiotherapy quality assurance based on its CT image and measured radiation dose. The manufacturing and dosimetry workflow of this study can be utilized by other institutions for dosimetry and trainings. &#xD.