Superficial X-ray Research Articles

H02 Superficial X-rays and grenz rays for benign dermatoses: from saviour to pariah over the course of the 20th century – the story of the remarkable rise and slow decline of an entire therapeutic modality and its potential for revival

H02 Superficial X-rays and grenz rays for benign dermatoses: from saviour to pariah over the course of the 20th century – the story of the remarkable rise and slow decline of an entire therapeutic modality and its potential for revival

Measurements regarding a combined therapy concept for ophthalmic tumors consisting of brachytherapy and x-rays

Objective. We present a novel concept to treat ophthalmic tumors which combines brachytherapy and low-energy x-ray therapy. Brachytherapy with 106Ru applicators is inadequate for intraocular tumors with a height of 7 mm or more. This results from a steep dose gradient, and it is unfeasible to deliver the required dose at the tumor apex without exceeding the maximum tolerable sclera dose of usually 1000 Gy to 1500 Gy. Other modalities, such as irradiation with charged particles, may be individually contraindicated. A dose boost at the apex provided by a superficial x-ray therapy unit, performed simultaneously with the brachytherapy, results in a more homogeneous dose profile than brachytherapy alone. This avoids damage to organs at risk. The applicator may also serve as a beam stop for x-rays passing through the target volume, which reduces healthy tissue dosage. This study aims to investigate the suitability of the applicator to serve as a beam stop for the x-rays. Approach. A phantom with three detector types comprising a soft x-ray ionization chamber, radiochromic films, and a self-made scintillation detector was constructed to perform dosimetry. Measurements were performed using a conventional x-ray unit for superficial therapy to investigate the uncertainties of the phantom and the ability of the applicator to absorb x-rays. The manufacturer provided a dummy plaque to obtain x-ray dose profiles without noise from 106Ru decays. Results. The phantom is generally feasible to obtain dose profiles with three different detector types. The interaction of x-rays with the silver of the applicator leads to an increased dose rate in front of the applicator. The dose rate of the x-rays is reduced by up to 90% behind a 106Ru applicator. Therefore, a 106Ru applicator can be used as a beam stop in combined x-ray and brachytherapy treatment.

Superficial X-ray in the treatment of nonaggressive basal and squamous cell carcinoma in the elderly: A 22-year retrospective analysis

Superficial X-ray in the treatment of nonaggressive basal and squamous cell carcinoma in the elderly: A 22-year retrospective analysis

43821 Superficial X-Ray in the Treatment of Basal and Squamous Cell Carcinomas for Select Patients: The Second Decade

43821 Superficial X-Ray in the Treatment of Basal and Squamous Cell Carcinomas for Select Patients: The Second Decade

Tissue RNA Sequencing Reveals Novel Biomarkers Associated with Postoperative Keloid Recurrence.

Keloids can be resected through surgery, but they may still recur. The purpose of this study was to explore the biomarkers to predict the postoperative recurrence of keloids. Patients who underwent surgical treatment and postoperative superficial X-ray radiation between January 2019 and December 2020 were recruited with clinical data and keloid samples for RNA-seq. By screening differentially expressed genes (DEGs) between postoperative recurrent and non-recurrent sample groups and constructing a co-expression network via the weighted gene co-expression network analysis (WGCNA), an immunity-related module was chosen for subsequent analysis. By constructing a DEG co-expression network and using the Molecular Complex Detection (MCODE) algorithm, five hub genes were identified in the key module. Receiver Operating Characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the five combined hub genes was 0.776. The result of qRT-PCR showed that CHI3L1, IL1RN, MMP7, TNFAIP3, and TNFAIP6 were upregulated in the recurrent group with statistical significance (p < 0.05). Immune infiltration analysis showed that mast cells, macrophages, and T cells were the major components of the keloid immune microenvironment. This study provides potential biomarkers for predicting keloid recurrence and offers insights into genetic targets for recurrence prevention.

Machine characterization and central axis depth dose data of a superficial x-ray radiotherapy unit

Objectives. The purpose of this study is to present data from the clinical commissioning of an Xstrahl 150 x-ray unit used for superficial radiotherapy, Methods. Commissioning tasks included vendor acceptance tests, timer reproducibility, linearity and end-effect measurements, half-value layer (HVL) measurements, inverse square law verification, head-leakage measurements, and beam output calibration. In addition, percent depth dose (PDD) curves were determined for different combinations of filter/kV settings and applicators. Automated PDD water phantom scans were performed utilizing four contemporary detectors: a microDiamond detector, a microSilicon detector, an EDGE detector, and a PinPoint ionization chamber. The measured PDD data were compared to the published values in BJR Supplement 25, Results. The x-ray unit’s mechanical, safety, and radiation characteristics were within vendor-stated specifications. Across sixty commissioned x-ray beams, the PDDs determined in water using solid state detectors were in excellent agreement with the BJR 25 data. For the lower (<100 kVp) and medium-energy (≥100 kVp) superficial beams the average agreement was within [−3.6,+0.4]% and [−3.7,+1.4]% range, respectively. For the high-energy superficial (low-energy orthovoltage) x-rays at 150 kVp, the average difference for the largest 20 × 20 cm2 collimator was (−0.7 ± 1.0)%, Conclusions. This study presents machine characterization data collected for clinical use of a superficial x-ray unit. Special focus was placed on utilizing contemporary detectors and techniques for the relative PDD measurements using a motorized water phantom. The results in this study confirm that the aggregate values published in the BJR 25 report still serve as a valid benchmark when comparing data from site-specific measurements, or the reference data for clinical utilization without such measurements, Advances in knowledge. This paper presents comprehensive data from the acceptance and commissioning of a modern kilovoltage superficial x-ray radiotherapy machine. Comparisons between the PDD data measured in this study using different detectors and BJR 25 data are highlighted.

Use of a PLA sleeve to remove electron enhancement in superficial X-ray therapy.

A newly installed superficial X-ray unit was found to produce enhanced electron dose at the skin surface. The ACPSEM kilovoltage dosimetry recommendations suggest using nail varnish within the treatment cones as a method to reduce this dose. In this study, a 3D PLA sleeve was produced and used as an alternative to the nail varnish for energies between 55 and 100kV. Further, plastic wrap was also investigated as an alternative method to reduce dose. It was found that a 1mm printed sleeve, inserted into the treatment cone sufficiently reduced the enhanced dose as measured with a thin-window Exradin chamber to within 3.3% of the dose measured with a Farmer-type ionisation chamber. The use of plastic wrap also reduced the enhanced dose, but impracticalities in its use make it non-viable for routine clinical use.

Sports Bras Improve Chest Keloids but Outcomes Are Dependent on Breast Size: A Retrospective Analysis.

Our study is a retrospective medical record review performed on 95 female keloid patients with the standard therapy combining complete surgical excision with superficial X-ray radiation. We aimed to analyze the relationship between breast size and treatment outcomes as well as the benefits of sports bras in the postoperative management of keloids. The results showed that the keloid score of no sports bra group was significantly worse than the score of sports bra group at 1-year follow-up. In addition, the large breast size group showed more significant improvement of keloid score when wearing sports bras. Our study highlights that continuous wearing a sports bra effectively reduces the skin tension of the postoperative incision and promotes recovery, especially for patients with large breast size.

The efficacy and safety of topical Tretinoin combined with superficial X-ray therapy (SXRT) in treating periungual warts.

There are multiple treatment modalities for periungual warts (PWs), although most are destructive and painful, limiting their application. Radiotherapy is a non-invasive method suitable for treating PW patients with contraindications to invasive procedures. To investigate the efficacy and safety of topical Tretinoin combined with Superficial X-ray therapy (SXRT) in treating PWs. This study included patients with 65 PWs who underwent treatment and a 3-month follow-up. Twenty four PWs were subjected to SXRT alone (group A). The remaining 41 PWs were subjected to SXRT combined with the application of the Tretinoin cream from the first day (group B). The overall clinical response rate, recurrence rates, cosmetic outcomes, and adverse events were observed during the follow-up period. The complete clearance rate (75% vs. 92.7% in groups A and B, respectively) and healing times (19.9 vs. 16.0 days in groups A and B, respectively) between the two groups were significantly different (p< 0.046 and 0.04), indicating the combination treatment is more effective. Notably, there was no damaging or permanent deformation on the nail, and the other adverse effects were mild and bearable. Topical Tretinoin combined with SXRT therapy is an effective strategy for treating PWs, with minor side effects. It is painless and with excellent cosmetic outcomes.

ПАЦИЕНТОРИЕНТИРОВАННЫЙ АЛГОРИТМ РАБОТЫ РЕНТГЕНОТЕРАПЕВТИЧЕСКОГО КАБИНЕТА ОНКОЛОГИЧЕСКОГО ДИСПАНСЕРА

Results: IIntroduction: Superficial X-ray therapy is a common treatment of non-melanoma skin cancer with a high incidence worldwide. Interrupting the course of radiation therapy can negatively affect patient survival and treatment results. Low treatment adherence may be associated with a lack of a patient-centered approach and ineffective communications. The original study shows that patients undergoing X-ray therapy for cancer may have different needs. Based on the study results an algorithm for a patient-oriented approach has been developed for the X-ray cabinets.&#x0D; Purpose: To develop a patient-oriented algorithm of the X-ray therapy room to address the issues of increasing patient satisfaction and forming their adherence to treatment. The objectives of the study included studying and detailing the needs of the patients who passed the X-ray therapy and to develop the patient-oriented algorithm for the X-ray therapy room.&#x0D; Material and methods: The study of the patient's values was carried out from 2019 to 2020 by interviewing using open-ended questions to find out the deep motives and beliefs of patients. The study was based on Milton Rokich’s (2005) model of value orientations, which was adapted to the objectives of the study.&#x0D; Results: The study included 116 patients undergoing treatment with the X-ray therapy at the City Clinical Oncology Dispensary. As a result of the study, the following patient needs were identified: clinical outcome of the procedure 111 (96 %), safety of treatment and adverse reactions 106 (91 %), cosmetic outcome 53 (46 %), convenience of the treatment schedule 42 (36 %), painlessness of the procedure 39 (34 %), the ability to lead a normal lifestyle 27 (23 %), comfortable conditions for the procedure 16 (14 %), financial costs associated with treatment 10 (9 %), preservation of organ function 4 (3 %). On the basis of the data obtained, a patient-oriented algorithm for the X-ray therapy was developed, including a communication plan with the patient. The study results clearly demonstrate that even with the same disease and condition, patients may have different priorities hat need to be considered to improve patient experience and adherence to treatment.&#x0D; Conclusion: Radiation treatment decision-making based on the patients values is important for the development of the patient-centered management in oncology since this directly affects patients’ adherence to treatment. Exploring the values and needs of patients is an opportunity to influence and improve the metrics of the patient experience. Due to the mass incidence of non-melanoma skin cancer, the introduction of patient-centered approaches is an important part of patient satisfaction and increase of patients adherence to the treatment.

Adjuvant Radiotherapy for Keloids.

Radiotherapy is one of the therapeutic methods for keloids, and the irradiation technique has innovated from superficial X-ray to brachytherapy after decades of clinical practice. At present, the application of adjuvant radiotherapy has been widely accepted by clinicians, while the consensus of optimal adjuvant radiotherapy strategies for keloids has not been reached. Factors such as radiation timing, dose, fractions, and lesion locations may be associated with the clinical outcomes of patients with keloids after radiotherapy while a comprehensive review is lacking. Herein, this review summarized the published literature of adjuvant radiotherapy for keloids involving mechanism, timing, dose, fractions, and complications, etc., which may facilitate clinical decision making.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Short-term efficacy of superficial X-ray treatment for infantile maxillofacial hemangioma.

This study aimed to explore the short-term clinical efficacy and factors influencing low-dose superficial X-ray for treating infantile maxillofacial hemangioma. Retrospective analysis was conducted on 161 cases of infants with maxillofacial hemangioma treated with superficial X-ray in the Laser Center of Dermatology Department of Sichuan Provincial People's Hospital from January 2015 to December 2017. Clinical efficacy was analyzed by comparing the photos before and after treatment. Patients were further divided into groups according to different genders, age at the start of treatment, preterm birth or low birth weight, hemangioma site, longest diameter of hemangioma, and type of hemangioma to analyze whether differences existed in clinical efficacy and therapeutic dose between different groups. Twelve months after the end of treatment, the overall cure rate was 93.8%, and the significant efficiency was 97.5%. The clinical efficacy was related to the age of children at the beginning of treatment and the type of hemangioma (P<0.05). The clinical efficacy of children aged less than or equal to 12 months and superficial hemangioma group was better than that of children aged more than 12 months and deep subtype or mixed hemangioma group, respectively. Therapeutic doses associa-ted with hemangioma treatment with diameter, category, age (P<0.05), diameter greater than or equal to 4 cm hemangioma group, the mixed type or deep in the group, the children older than 12 months hemangioma group, respectively, the dia-meter is less than 4 cm hemangioma, superficial hemangioma group and age less than or equal to 12 months hemangioma total treatment group exposure dose is greater. Low-dose superficial X-ray is safe and effective for the treatment of infantile maxillofacial hemangioma. Age and type of hemangioma at the time of treatment are the factors influencing therapeutic dose and clinical efficacy.

PO-1496 Superficial X-Ray Therapy in Keloids after surgery: our experience

PO-1496 Superficial X-Ray Therapy in Keloids after surgery: our experience

Superficial X-ray-induced hyperpigmentation in postoperative keloid radiotherapy: A study of 70 keloids to identify clinical features and risk factors.

Postoperative radiation is one of the most effective treatments for keloid. Radiation-induced hyperpigmentation is, however, a concern for both patients and dermatologists. To identify clinical features and risk factors of superficial X-ray-induced hyperpigmentation in postoperative keloid radiotherapy. From November 2019 to November 2020, 70keloids in 55 patients were treated with superficial X-ray after surgery. Patient data and treatment-related parameters were collected. Follow-up photographs were taken one month after radiotherapy. Three independent dermatologists assessed photographs for pigmentation.The clinical characteristics and severity of pigmentation were summarized. Logistic regression was used to analyze the risk factors associated with occurrence and severity of hyperpigmentation. The pigmentation was a well-defined rectangular brown macule consistent with the unprotected area that involves normal skin, and 82.9% of keloids displayed pigmentation induced by superficial X-ray at one month after treatment. All keloids of trunk appeared to be mild-to-moderately hyperpigmented (100%); 92.89% of limb keloids displayed mainly severe pigmentation. Keloid location was an independent risk factor for the incidence and severity of pigmentation. Longer incision length was also predictive of increased hyperpigmentation severity. Superficial X-ray-induced hyperpigmentation was common and severe in postoperative keloid radiotherapy. The incidence and severity of pigmentation can be predicted by the location and incision length of the keloid.

Y2O3 Nanoparticles and X-ray Radiation-Induced Effects in Melanoma Cells.

The innovative strategy of using nanoparticles in radiotherapy has become an exciting topic due to the possibility of simultaneously improving local efficiency of radiation in tumors and real-time monitoring of the delivered doses. Yttrium oxide (Y2O3) nanoparticles (NPs) are used in material science to prepare phosphors for various applications including X-ray induced photodynamic therapy and in situ nano-dosimetry, but few available reports only addressed the effect induced in cells by combined exposure to different doses of superficial X-ray radiation and nanoparticles. Herein, we analyzed changes induced in melanoma cells by exposure to different doses of X-ray radiation and various concentrations of Y2O3 NPs. By evaluation of cell mitochondrial activity and production of intracellular reactive oxygen species (ROS), we estimated that 2, 4, and 6 Gy X-ray radiation doses are visibly altering the cells by inducing ROS production with increasing the dose while at 6 Gy the mitochondrial activity is also affected. Separately, high-concentrated solutions of 25, 50, and 100 µg/mL Y2O3 NPs were also found to affect the cells by inducing ROS production with the increase of concentration. Additionally, the colony-forming units assay evidenced a rather synergic effect of NPs and radiation. By adding the NPs to cells before irradiation, a decrease of the number of proliferating cell colonies was observed with increase of X-ray dose. DNA damage was evidenced by quantifying the γ-H2AX foci for cells treated with Y2O3 NPs and exposed to superficial X-ray radiation. Proteomic profile confirmed that a combined effect of 50 µg/mL Y2O3 NPs and 6 Gy X-ray dose induced mitochondria alterations and DNA changes in melanoma cells.

The intrinsic x-ray energy dependence of beryllium oxide (BeO) ceramic dosimeters

Beryllium oxide (BeO) ceramic is a radioluminescent and optically stimulated luminescent material which has been shown to be quite energy independent. However, BeO ceramic is a highly self-optically attenuating material. The aim of this study is to evaluate the effect self-optical attenuation has on the radioluminescence of the BeO ceramic, and how this effects the measured energy dependence. The energy dependence of a BeO ceramic fibre-coupled luminescent dosimeter was measured using a superficial x-ray unit with beams of 30–150 kVp. The energy dependence was measured with the dosimeter oriented parallel and perpendicular to the beam in order to enhance the effect of the self-optical attenuation from the BeO ceramic. From the measurements, energy dependence curves were generated showing the detector response in both orientations. The largest difference in response was >25% observed at the lowest energy.Monte-Carlo simulations of the dose distribution within the BeO ceramic were convolved with ray tracing modelling of the light collection from the BeO ceramic probe in order to simulate the total detector response. The light collection corrected the Monte Carlo simulation results, and the intrinsic energy dependence was obtained with the trends between the two orientations agreeing within 8%. Therefore, it can be concluded that the measured orientational energy dependence is due to the self-optical attenuation of the BeO ceramic.

Bismuth Oxide Films for X-ray shielding: Effects of particle size and structural morphology

Lead (Pb) as a traditional shielding material is limited due to its toxicity and heaviness. Recently, nanomaterials in different forms have attracted considerable attention for radiation shielding applications, due to their prominent chemical and physical properties. This work aims to evaluate the effects of size and morphology on the X-ray shielding performance. Both micro- and nano-sized Bi2O3 films with different morphologies (e.g. particles, wires, flowers) were synthesized via a ball milling process and a hydrothermal treatment, respectively. X-ray transmission tests were conducted using a superficial X-ray unit at energies of 30, 50 and 80 kVp (effective energies converted as 14, 24 and 29 keV), which were then compared with mass attenuation coefficient of Bi2O3 obtained from XCOM database. The results showed that the nanoflower (388 ± 30 nm) Bi2O3 film gave the best X-ray shielding performance among all three energies (60.49% improvement at 30 kVp, especially) compared to the bulk Bi2O3 film, indicating the synergy effects of both particle size and morphologies impact on low energies of X-ray attenuation. Moreover, the nanoparticle (830 ± 30 nm) Bi2O3 film enhanced the X-ray attenuation, up to 13.27% at 30 kVp relative to microparticle (1.21 ± 0.14 μm) films. However, the nanoflower (388 ± 30 nm) Bi2O3 film gave the best X-ray shielding performance (45.93% and 47.49% improvement at 30 kVp, respectively) compared to the microwire (1.30 ± 0.13 μm) and nanoparticle (830 ± 30 nm) Bi2O3 film, due to its large surface-to-volume ratio, showing that morphological variations can significantly impact the X-ray transmission to enhance the radiation shielding performance compared to the particle size. Theoretical data from XCOM database compared with experimental measurements showed the limitation of simulation as it can only calculate the ideal condition of regular distributions in materials with standardized geometry. This work concluded that the synergy effect of the particle size and morphology should be considered when designing effective radioprotective garments.

573 Improved effect on two cases of different subtypes of porokeratosis with superficial X-ray radiotherapy

573 Improved effect on two cases of different subtypes of porokeratosis with superficial X-ray radiotherapy

Treatment of keloids with a single dose of low-energy superficial X-ray radiation to prevent recurrence after surgical excision: An in vitro and in vivo study

Although keloids have been empirically treated with steroids and radiation, evidence-based radiation parameters for keloid therapy are lacking. To determine evidence-based radiation parameters for blocking keloid fibroblast proliferation invitro and apply them to patients. The effects of various radiation parameters and steroids on cell proliferation, cell death, and collagen production in keloid explants and fibroblasts were evaluated with standard assays. Effective radiation parameters were then tested on patients. No differences were observed between the effects of 50 and 320 kV radiation or between single and fractionated radiation doses on keloid fibroblasts. A 3 Gy, 50 kV dose inhibited keloid fibroblast proliferation in culture, whereas 9Gy completely blocked their outgrowth from explants by inducing multiple cell death pathways and reducing collagen levels. Thirteen of 14 keloids treated with a single 8 Gy, 50 kV dose of radiation did not recur, although 4 patients with 6 keloids were lost to follow-up. Seventy-five percent of patients received steroids for pruritus, whereas approximately 25% of patients were lost to follow-up. A single 8 Gy dose of superficial 50 kV radiation delivered an average of 34days after keloid excision maybe sufficient to minimize recurrence, including in individuals resistant to steroids. Higher radiation energies, doses, or fractions may be unnecessary for keloid therapy.

Cutaneous squamous cell carcinomas on special locations: perioral, periocular and genital area.

If tumours arise in special locations such as around the eyes, mouth or in the genital area, patients and physicians are challenged by the need for complete removal of the tumour with safety margins and high demands on function and aesthetic aspects. Treatment should be performed by specialized physicians including ophthalmologists, head and neck surgeons, surgical, medical and radiation oncologists. The first-line treatment for most cutaneous malignancies is surgical excision; however, in several situations, such as well-differentiated cutaneous squamous cell carcinomas (cSCC) in the periocular or anal region, radiotherapy is a very reasonable and sometimes treatment of first choice, especially in patients with advanced age. In periocular SCC, radiotherapy with superficial x-ray combined with eye shielding, while in anal SCC, radiotherapy combined with chemotherapy is recommended. However, after failure of local treatment options including surgery and radiotherapy, systemic medications are indicated in order to achieve tumour control or cure. Systemic therapies include immunotherapy, targeted therapy or chemotherapy. Preventive strategies are based on UV protection in facial, and vaccination in HPV associated anogenital SCCs.