Radiation Therapy Applications Research Articles

Current uses and applications of stereotactic body radiation therapy.

Stereotactic body radiation therapy (SBRT) is a modality that delivers high doses of radiation to a well-defined tumor target in a single or a few fractions and with high precision, which significantly reduces the dose received by surrounding normal tissues. SBRT is indicated for inoperable, early stage (T1 and T2) primary non-small cell lung cancer, lung metastases with a controlled primary tumor, prostate tumors and oligometastatic disease. Despite the lack of long-term or phase III studies, efficacy results in local control are higher than 90%, with similar toxicity to that reported with conventional fractionated radiotherapy. This article describes SBRT technology and technique, along with clinical applications, indications and limitations of this therapeutic modality.

SynthRAD2023 Grand Challenge dataset: Generating synthetic CT for radiotherapy.

Medical imaging has become increasingly important in diagnosing and treating oncological patients, particularly in radiotherapy. Recent advances in synthetic computed tomography (sCT) generation have increased interest in public challenges to provide data and evaluation metrics for comparing different approaches openly. This paper describes a dataset of brain and pelvis computed tomography (CT) images with rigidly registered cone-beam CT(CBCT) and magnetic resonance imaging (MRI) images to facilitate the development and evaluation of sCT generation for radiotherapy planning. The dataset consists of CT, CBCT, and MRI of 540 brains and 540 pelvic radiotherapy patients from three Dutch university medical centers. Subjects' ages ranged from 3 to 93 years, with a mean age of 60. Various scanner models and acquisition settings were used across patients from the three data-providing centers. Details are available in a comma separated value files provided with the datasets. The data is available on Zenodo (https://doi.org/10.5281/zenodo.7260704, https://doi.org/10.5281/zenodo.7868168) under the SynthRAD2023 collection. The images for each subject are available in nifti format. This dataset will enable the evaluation and development of image synthesis algorithms for radiotherapy purposes on a realistic multi-center dataset with varying acquisition protocols. Synthetic CT generation has numerous applications in radiation therapy, including diagnosis, treatment planning, treatment monitoring, and surgical planning.

Harnessing the abscopal effect for gastrointestinal malignancies in the era of immunotherapy.

Gastrointestinal (GI) cancers are among the leading causes of cancer-related mortality and have traditionally been treated using a combination of surgical resection and chemoradiotherapy (CRT). While the introduction of immunotherapies over the last decade have dramatically changed the treatment landscape for some GI malignancies, including esophageal, gastric, and colorectal cancer, treatment resistance remains a major unaddressed obstacle for many patients. There has thus been emerging interest in determining the optimal treatment strategy for the delivery of immunotherapy in combination with traditional therapies. In this regard, a growing number of preclinical and clinical studies have suggested that combining radiation therapy (RT) with immunotherapy may work synergistically to improve treatment response through amplification of the abscopal effect. In this review, we discuss the rationale for RT in combination with immunotherapy. We further discuss how this knowledge may lead to a paradigm shift in the application of RT and highlight remaining issues pertaining to the delivery of combination therapy.

Integrated Small Animal PET/CT/RT with Onboard PET/CT Image Guidance for Preclinical Radiation Oncology Research.

We have integrated a compact and lightweight PET with an existing CT image-guided small animal irradiator to enable practical onboard PET/CT image-guided preclinical radiation therapy (RT) research. The PET with a stationary and full-ring detectors has ~1.1 mm uniform spatial resolution over its imaging field-of-view of 8.0 cm diameter and 3.5 cm axial length and was mechanically installed inside the irradiator in a tandem configuration with CT and radiation unit. A common animal bed was used for acquiring sequential dual functional and anatomical images with independent PET and CT control and acquisition systems. The reconstructed dual images were co-registered based on standard multi-modality image calibration and registration processes. Phantom studies were conducted to evaluate the integrated system and dual imaging performance. The measured mean PET/CT image registration error was ~0.3 mm. With one-bed and three-bed acquisitions, initial tumor focused and whole-body [18F]FDG animal images were acquired to test the capability of onboard PET/CT image guidance for preclinical RT research. Overall, the results have shown that integrated PET/CT/RT can provide advantageous and practical onboard PET/CT image to significantly enhance the accuracy of tumor delineation and radiation targeting that should enhance the existing and enable new and potentially breakthrough preclinical RT research and applications.

A robust collision source method for rank adaptive dynamical low-rank approximation in radiation therapy

Deterministic models for radiation transport describe the density of radiation particles moving through a background material. In radiation therapy applications, the phase space of this density is composed of energy, spatial position and direction of flight. The resulting six-dimensional phase space prohibits fine numerical discretizations, which are essential for the construction of accurate and reliable treatment plans. In this work, we tackle the high dimensional phase space through a dynamical low-rank approximation of the particle density. Dynamical low-rank approximation (DLRA) evolves the solution on a low-rank manifold in time. Interpreting the energy variable as a pseudo-time lets us employ the DLRA framework to represent the solution of the radiation transport equation on a low-rank manifold for every energy. Stiff scattering terms are treated through an efficient implicit energy discretization and a rank adaptive integrator is chosen to dynamically adapt the rank in energy. To facilitate the use of boundary conditions and reduce the overall rank, the radiation transport equation is split into collided and uncollided particles through a collision source method. Uncollided particles are described by a directed quadrature set guaranteeing low computational costs, whereas collided particles are represented by a low-rank solution. It can be shown that the presented method is L2-stable under a time step restriction which does not depend on stiff scattering terms. Moreover, the implicit treatment of scattering does not require numerical inversions of matrices. Numerical results for radiation therapy configurations as well as the line source benchmark underline the efficiency of the proposed method.

Free-electron-driven X-ray caustics from strained van der Waals materials

Tunable control of X-ray waves remains an open challenge of critical importance for applications in high-resolution X-ray spectroscopy, medical imaging, and radiation therapy. Unlike in the X-ray regime, control over light waves in the visible and IR regimes is ubiquitous in a vast range of applications, and typically relies on widely available optical components. However, analogous optical elements for X-rays are usually inefficient and challenging to fabricate. Here, we propose a method for shaping X-ray waves directly at the source, using the interaction of free electrons with crystalline materials. Specifically, by inducing strain on van der Waals materials, we control their interaction with free electrons in a manner that tunes the emissions of the X-rays and forms caustic X-ray beams. The development of wave-shaping concepts like caustics generation in the X-ray spectral range could benefit from achievements in this field in the optical range and may help bypass the noted limits of current X-ray optics technology. Looking forward, shaping the interference of X-rays at the atomic scale could enable further developments in high-resolution X-ray science.

Image-based scatter correction for cone-beam CT using flip swin transformer U-shape network.

Cone beam computed tomography (CBCT) plays an increasingly important role in image-guided radiation therapy. However, the image quality of CBCT is severely degraded by excessive scatter contamination, especially in the abdominal region, hindering its further applications in radiation therapy. To restore low-quality CBCT images contaminated by scatter signals, a scatter correction algorithm combining the advantages of convolutional neural networks (CNN) and Swin Transformer is proposed. In this paper a scatter correction model for CBCT image, the Flip Swin Transformer U-shape network (FSTUNet) model, is proposed. In this model, the advantages of CNN in texture detail and Swin Transformer in global correlation are used to accurately extract shallow and deep features, respectively. Instead of using the original Swin Transformer tandem structure, we build the Flip Swin Transformer Block to achieve a more powerful inter-window association extraction. The validity and clinical relevance of the method is demonstrated through extensive experiments on a Monte Carlo (MC) simulation dataset and frequency split dataset generated by a validated method, respectively. Experimental results on the MC simulated dataset show that the root mean square error of images corrected by the method is reduced from over 100 HU to about 7 HU. Both the structural similarity index measure (SSIM) and the universal quality index (UQI) are close to 1. Experimental results on the frequency split dataset demonstrate that the method not only corrects shading artifacts but also exhibits a high degree of structural consistency. In addition, comparison experiments show that FSTUNet outperforms UNet, Deep Residual Convolutional Neural Network (DRCNN), DSENet, Pix2pixGAN, and 3DUnet methods in both qualitative and quantitative metrics. Accurately capturing the features at different levels is greatly beneficial for reconstructing high-quality scatter-free images. The proposed FSTUNet method is an effective solution to CBCT scatter correction and has the potential to improve the accuracy of CBCT image-guided radiation therapy.

Single High-Dose Irradiation-Induced iRhom2 Upregulation Promotes Macrophage Antitumor Activity Through cGAS/STING Signaling

The clinical application of stereotactic body radiation therapy (SBRT) allows a high dose of radiation to be safely delivered to extracranial targets within the body; however, a high dose per fraction (hypofractionation) has opened the radiation oncology field to new questions on a variety of dose-fractionation schedules, especially the immunomodulatory effects of radiation therapy, which can change after various dose-fractionation schedules. We investigated the immunomodulatory effects of different fractionation schedules. We established a subcutaneous tumor model in wild-type C57BL/6J mice and STING (stimulator of interferon genes)-deficient mice. We then compared the tumor control efficacy of 3 different fractionation schedules: 2 Gy×8, 4.5 Gy×3, and 10 Gy×1, which are similar biologically effective doses. We found the fractionation schedule of 10 Gy×1 had a significantly higher antitumor effect, suggesting that a single high dose induced enhanced antitumor immunity compared with conventional fractionation (2 Gy×8) and moderate hypofractionation (4.5 Gy×3). However, in STING-deficient mice, differential tumor control was not observed among the 3 dose-fractionation schedules, suggesting that cGAS (cyclic GMP-AMP synthase)/STING signaling is involved in the antitumor immune effects of single high-dose schedules. Mechanistically, we found that conventional fractionation induced apoptosis; by comparison, a single high dose was more attuned to induced necroptosis, leading to the release of intracellular irradiation-induced double-stranded DNA (dsDNA) due to the loss of plasma membrane integrity, which then activated the dsDNA sensing signaling cGAS/STING in the recruited macrophage. Furthermore, iRhom2, a member of the conserved family of inhibitory rhomboid-like pseudoproteases, was upregulated in infiltrated macrophages in the single high-dose irradiation microenvironment. Therefore, iRhom2 positively regulates STING and directly promotes tumor necrosis factor α secretion. This exacerbates necroptosis of irradiated tumor cells, leading to continuous dsDNA release and enhancement of cGAS/STING signaling antitumor immunity in a positive feedback loop. iRhom2 amplifies antitumor signaling in a positive feedback loop mediated by cGAS/STING signaling and tumor necrosis factor-driven necroptosis after single high-dose radiation.

An unsupervised image registration method employing chest computed tomography images and deep neural networks

BackgroundDeformable image registration is crucial for multiple radiation therapy applications. Fast registration of computed tomography (CT) lung images is challenging because of the large and nonlinear deformation between inspiration and expiration. With advancements in deep learning techniques, learning-based registration methods are considered efficient alternatives to traditional methods in terms of accuracy and computational cost. MethodIn this study, an unsupervised lung registration network (LRN) with cycle-consistent training is proposed to align two acquired CT-derived lung datasets during breath-holds at inspiratory and expiratory levels without utilizing any ground-truth registration results. Generally, the LRN model uses three loss functions: image similarity, regularization, and Jacobian determinant. Here, LRN was trained on the CT datasets of 705 subjects and tested using 10 pairs of public CT DIR-Lab datasets. Furthermore, to evaluate the effectiveness of the registration technique, target registration errors (TREs) of the LRN model were compared with those of the conventional algorithm (sum of squared tissue volume difference; SSTVD) and a state-of-the-art unsupervised registration method (VoxelMorph). ResultsThe results showed that the LRN with an average TRE of 1.78 ± 1.56 mm outperformed VoxelMorph with an average TRE of 2.43 ± 2.43 mm, which is comparable to that of SSTVD with an average TRE of 1.66 ± 1.49 mm. In addition, estimating the displacement vector field without any folding voxel consumed less than 2 s, demonstrating the superiority of the learning-based method with respect to fiducial marker tracking and the overall soft tissue alignment with a nearly real-time speed. ConclusionsTherefore, this proposed method shows significant potential for use in time-sensitive pulmonary studies, such as lung motion tracking and image-guided surgery.

Investigation of the Cross-Sections for the Production of Bromine Isotopes Using Proton-Induced Reactions

We have considered the production of bromine isotopes by studying the cross-sections of nuclear reactions in the selenium enriched target. This is of importance due to the applications in nuclear medicine and radiation therapy. Eight channels are observed in the production of bromine isotopes: 7634Se(p, 2n) 7535Br, 7734Se(p, 3n) 7535Br, 7634Se(p, n) 7635Br, 7734Se(p, 2n) 7635Br, 7734Se(p, n) 7735Br, 7834Se(p, 2n) 7735Br, 8034Se(p, 4n) 7735Br, and 8034Se(p, n) 8035mBr. The energy of the interacting protons ranging from the threshold is 2.20–84.20 MeV and is calculated by using an activation technique. For the proton-induced production of bromine isotopes from selenium target atoms, the stopping power and the yield have been calculated. The Zeigler formula was applied to investigate the cross-sections and to determine the yield for each reaction over the stopping power range. The total energy of each reaction and the corresponding crosssections are statistically analyzed. These energies are reproduced by the incident proton energy with acceptable errors at 0.01 MeV intervals. One of the most significant results of the current calculations is the stopping power of targets evaluated within the Ziegler and SRIM approaches.

Camera-based radiotherapy dosimetry using dual-material 3D printed scintillator arrays.

To describe a methodology for the dual-material fused deposition modeling (FDM) 3D printing of plastic scintillator arrays, to characterize their light output under irradiation using an sCMOS camera, and to establish a methodology for the dosimetric calibration of planar array geometries. We have published an investigation into the fabrication and characterization of single element FDM printed scintillators intending to produce customizable dosimeters for radiation therapy applications. 1 This work builds on previous investigations by extending the concept to the production of a high-resolution (scintillating element size 3×3×3mm3 ) planar scintillator array. The array was fabricated using a BCN3D Epsilon W27 3D printer and composed of polylactic acid (PLA) filament and BCF-10 plastic scintillator. The array's response was initially characterized using a 20×20cm2 6 MV photon field with a source-to-surface (SSD) distance of 100cm and the beam incident on the top of the array. The light signals emitted under irradiation were imaged using 200ms exposures from a sCMOS camera positioned at the foot of the treatment couch (210cm from the array). The collected images were then processed using a purpose-built software to correct known optical artefacts and determine the light output for each scintillating element. The light output was then corrected for element sensitivity and calibrated to dose using Monte Carlo simulations of the array and irradiation geometry based on the array's digital 3D print model. To assess the accuracy of the array calibration both a 3D beam and a clinical VMAT plan were delivered. Dose measurements using the calibrated array were then compared to EBT3 GAFChromic film and OSLD measurements, as well as Monte Carlo simulations and TPS calculations. Our results establish the feasibility of dual-material 3D printing for the fabrication of custom plastic scintillator arrays. Assessment of the 3D printed scintillators response across each row of the array demonstrated a nonuniform response with an average percentage deviation from the mean of 2.1%±2.8%. This remains consistent with our previous work on individual 3D printed scintillators which showed an average difference of 2.3% and a maximum of 4.0% between identically printed scintillators.1 Array dose measurements performed following calibration indicate difficulty in differentiating the scintillator response from ambient background light contamination at low doses (<20-25cGy) and dose rates (≤100 MU/min). However, when analysis was restricted to exclude dose values less than 10% of the Monte Carlo simulated max dose the average absolute percentage dose difference between Monte Carlo simulation and array measurement was 5.3%±4.8% for the fixed beam delivery and 5.4%±5.2% for the VMAT delivery CONCLUSION: In this study, we developed and characterized a 3D printed array of plastic scintillators and demonstrated a methodology for the dosimetric calibration of a simple array geometry.

Dosimetric Characterization of DSF/NaOH/IA-PAE/R. spp. Phantom Material for Radiation Therapy

Background: Different compositions of DSF/NaOH/IA-PAE/R. spp. composite particleboard phantoms were constructed. Methods: Photon attenuation characteristics were ascertained using gamma rays from 137Cs and 60Co. Absorbed doses at the location of an ionization chamber and Gafchromic EBT3 radiochromic films were calculated for high-energy photons (6 and 10 MV) and electrons (6, 9, 12, and 15 MeV). Results: The calculated TPR20,10 values indicate that the percentage discrepancy for 6 and 10 MV was in the range of 0.29-0.72% and 0.26-0.65%. It was also found that the relative difference in the dmax to water and solid water phantoms was between 1.08-1.28% and 5.42-6.70%. The discrepancies in the determination of PDD curves with 6, 9, 12, and 15 MeV, and those of water and solid water phantoms, ranged from 2.40-4.84%. Comparable results were found using the EBT3 films with variations of 2.0-7.0% for 6 and 10 MV photons. Likewise, the discrepancies for 6, 9, 12, and 15 MeV electrons were within an acceptable range of 2.0-4.5%. Conclusions: On the basis of these findings, the DSF/NaOH/IA-PAE/R. spp. particleboard phantoms with 15 wt% IA-PAE addition level can be effectively used as alternative tissue-equivalent phantom material for radiation therapy applications.

Changing trends in the management of ductal carcinoma in situ in Republic of Korea: a comprehensive analysis using Health Insurance Review and Assessment data [2009-2020

Increasing rates of diagnosis of ductal carcinoma in situ (DCIS), given the widespread use of mammography, is a global trend. Various attempts have been made in the selection of surgical methods and application of radiation therapy (RT), and the prevalence of infectious diseases has also affected these attempts. This study aimed to investigate evolving treatment patterns and trends in the management of DCIS in South Korea. We conducted a comprehensive search of the Korean Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database and selected patients who underwent breast surgery following a DCIS diagnosis between 2009 and 2020. Based on this sample, the analyses were weighted according to the Korean population. We examined annual variations in mastectomy types, reconstructive procedures, and RT utilization from a multidisciplinary perspective. In our weighted sample, 43,780 patients with DCIS underwent surgery, with a consistent annual increase of 10%. The proportion of lumpectomy procedures increased from 56.7% to 65.4%, showing a greater growth rate than that of total mastectomies (TMs). Following the availability of reconstruction data in 2015, shifts have emerged toward a preference for implant-based autologous tissue reconstruction. As we transitioned to the latter part of our study, the trend was marked by the increasing adoption of hypofractionated RT and omission of RT. Of the patients who underwent lumpectomy in 2020, 25.6% adopted hypofractionated RT and 53.8% omitted RT. This transformation was particularly evident among older patients, individuals treated in metropolitan areas, and those treated in small-sized healthcare facilities. Our study sheds light on the changing landscape of DCIS treatment in South Korea incorporating perspectives from surgeons, plastic surgeons, and radiation oncologists. We observed an increase in the rates of lumpectomy and implant-based reconstruction. Adoption of hypofractionated RT and omission of RT showed increasing trends.

Response assessment by positron emission tomography-computed tomography as compared with contrast-enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low- and middle-income countries.

The InPOG-HL-15-01, a multicentric prospective study, used a risk-stratified and response-based approach with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) backbone to treat children and adolescents with newly diagnosed Hodgkin lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after two cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast-enhanced computed tomography (CECT) and PET-CT on treatment decisions and outcomes. 396 patients were enrolled and 382 had an ERA at the assigned time point. Satisfactory response was defined as Deauville score 3 or less for patients undergoing PET-CT and complete response (CR)/very good partial response (VGPR) for patients undergoing CECT. Outcomes of interest incorporate 5 year event-free survival (EFS), EFS including abandonment (EFSa), and overall survival (OS). At ERA, satisfactory response was documented in 277 out of 382 (72.5%) participants and this was significantly higher in PET-CT (151 out of 186, 81.2%) as compared with CECT-based assessments (126 out of 196, 64.3%) respectively (p value<.001). Amongst the 203 patients with nonbulky disease (wherein the indication for RT was entirely dependent on ERA), 96 out of 114 (84.2%) and 61 out of 89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value=.008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year OS of both groups, ERA based on CECT (91.8%) versus PET-CT (94.1%) was comparable (p value=.391) and so was the 5 year EFS (86.7vs. 85.5%, p value=.724). Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared with CECT and thereby decreases the need for RT in response-based treatment algorithm for HL-afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.

Effects of different types of radiation therapy on cardiac-specific death in patients with thyroid malignancy.

Radiation therapy (RT) is one of the common and widely used treatment method for thyroid tumors. Considering that the thyroid is located close to the heart, the radiation generated during the treatment of thyroid tumors may have an adverse greater impact on the heart. This study is to explore the influencing factors, especially additional effects of RT, on cardiac-specific death among patients with malignant thyroid tumors. Collecting information from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database using SEER*Stat. Patients with malignant thyroid tumors were searched, whether receiving RT or not. Ultimately, 201, 346 eligible patients were included. Propensity Score Matching (PSM) was used to minimize bias of baseline characteristics by adjusting for confounding factors. COX (proportional hazards) and fine-gray (competing risk) model regression analysis were used to explore the effects of various influencing factors on cardiac-specific death. The present analysis showed that, compared with non-RT, RT based upon radioactive implants and beam radiation were associated with lower risk of cardiac-specific death in patients with thyroid malignancy, beam radiation therapy may had a similar effect. Besides, the remaining RT methods did not significantly increase the risk of cardiac-specific death. In addition, Asian or Pacific Islander ethnicity, female sex, marital status, combined summary stage (localized, regional, and distant), high-income, and later year of diagnosis were associated with lower risk of cardiac-specific death. While older age of diagnosis, African ethnicity, non-Hispanic ancestry, and derived AJCC stage (IV) were risk factors for cardiac-specific death. These results help to identify the factors influencing cardiac-specific death among patients with thyroid malignancies. Furthermore, it may helps to improve the clinical application of RT without too much concern about adverse cardiac effects.

Spatial‐temporal modulation in radiation therapy

Spatial‐temporal modulation in radiation therapy

Early and late radiation complications after application of preoperative radiation therapy in complex treatment of cancer recti

Objective. To study and assess the rates and degree of severity of early and late radiation complications in patients after application of preoperative radiation therapy in complex treatment of the patients, suffering cancer recti.&#x0D; Materials and methods. Analysis of the treatment results in 113 patients, suffering locally–advanced (сT3с–4N1–2M0) cancer recti, who have obtained preoperative oncotherapy in 2019–2022 yrs in the Department of Radiation Therapy of Zakarpattya Antitumoral Centre, was performed.&#x0D; Results. Most frequent early radiation affection was rectitis, which have occurred – in 86 (76,1%) patients of 113. Early radiation affections of the reproductive system organs were noted in 5 (4,4%) patients. Late radiation affections were registered in 9 (7,9%) patients, mostly frequent in the gut system – in 5 (4,4%) patients.&#x0D; Conclusion. Аnalysis of the complex treatment results, performed in 113 patients with cancer recti, have shown, that preoperative radiation therapy do not enhance the rate of occurrence of early radiation complications and hematological toxicity. The rate of early radiation affections was 76,1%, and of the late – 7,9%.

The future of MRI in radiation therapy: Challenges and opportunities for the MR community.

Radiation therapy is a major component of cancer treatment pathways worldwide. The main aim of this treatment is to achieve tumor control through the delivery of ionizing radiation while preserving healthy tissues for minimal radiation toxicity. Because radiation therapy relies on accurate localization of the target and surrounding tissues, imaging plays a crucial role throughout the treatment chain. In the treatment planning phase, radiological images are essential for defining target volumes and organs-at-risk, as well as providing elemental composition (e.g., electron density) information for radiation dose calculations. At treatment, onboard imaging informs patient setup and could be used to guide radiation dose placement for sites affected by motion. Imaging is also an important tool for treatment response assessment and treatment plan adaptation. MRI, with its excellent soft tissue contrast and capacity to probe functional tissue properties, holds great untapped potential for transforming treatment paradigms in radiation therapy. The MR in Radiation Therapy ISMRM Study Group was established to provide a forum within the MR community to discuss the unmet needs and fuel opportunities for further advancement of MRI for radiation therapy applications. During the summer of 2021, the study group organized its first virtual workshop, attended by a diverse international group of clinicians, scientists, and clinical physicists, to explore our predictions for the future of MRI in radiation therapy for the next 25 years. This article reviews the main findings from the event and considers the opportunities and challenges of reaching our vision for the future in this expanding field.

Experimental investigation of skin toxicity after immune checkpoint inhibition in combination with radiation therapy

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. However, structured knowledge to mitigate a patient's specific risk of developing adverse events are limited. Nevertheless, there is an exponential growth of clinical studies combining conventional therapies such as radiation therapy (RT) with ICIs. Cutaneous reactions are among the most common adverse events after monotherapy with either ICIs or RT. So far, little is known about interindividual differences for the risk of developing severe tissue toxicity after the combination of RT with ICIs, and the underlying biological mechanisms are ill defined. We used experimental models of RT-induced skin injury to analyze skin toxicity after simultaneous application of ICIs. We compared different RT regimens such as fractionated or stereotactic RT with varying dose intensity. Strikingly, we found that simultaneous application of RT and ICIs did not significantly aggravate acute skin injury in two different mouse strains. Detailed examination of long-term tissue damage of the skin revealed similar signs of epidermal hyperplasia, dermal fibrosis, and adnexal atrophy. In summary, we here present the first experimental study demonstrating the excellent safety profiles of concurrent treatment with RT and ICIs. These findings will help to interpret the development of adverse events of the skin after radioimmunotherapy and guide the design of new clinical trials and clinical decision-making in individual cases. © 2022 The Authors. The Journal of Pathology published by John Wiley &amp; Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Characterization of ion chambers set for different metrological applications

In this work, the standard dosimeters for radiotherapy, protection and X-ray dosimetry of the National Institute of Standards (NIS)-Egypt were standardized for metrological application. A set of standard dosimeters composed of 0.3, 0.6 and 30 cm3 ion chambers and NPL, Unidose electrometer was used for charge collection within the used chambers. Different beam qualities such as 60Co, 137Cs and X-ray machines were used as reference beams. The ion chambers and electrometers are traceable to SI units through the calibration at the BIPM every five years. The calibration factor drift of each chamber in air and water was determined and the full uncertainty budget of gamma doses at the reference condition was reported in accordance with the international protocols. Commissioning of the 60Co machine was performed and a comparison between the measured doses and the calculated doses was obtained for one half-life of 60Co. The data showed the high performance of the secondary standard dosimeter of NIS for calibration and metrological application in radiation therapy, protection and the X-ray range. The drift in the ion chamber calibration factor over the course of 2 decades is 0.12, 0.001 and 0.11 respectively, which extracted a ratio of 20%, 0.12% and 10.6% from the combined uncertainty.