Dosimetric Quality Assurance for Intensity–Modulated Radiotherapy

PURPOSE: Test and comparison of various 2-D real-time detectors for dosimetric quality assurance (QA) of intensity-modulated radiotherapy (IMRT) with the vision to replace radiographic films for 2-D dosimetry. MATERIAL AND METHODS: All IMRT treatment plans were created with the Konrad software (Siemens OCS). The final dose calculation was also carried out in Konrad. A Mevatron Primus (Siemens OCS) linear accelerator which provides 6-MV and 15-MV highenergy photon beams was used for the delivery of segmented multileaf-modulated IMRT. Three different 2-D detectors, each based on a different physical (interaction) principle, were tested for the field-related IMRT verification: (1) the MapCheck diode system (Sun Nuclear), (2) the I'mRT QA scintillation detector (Scanditronix/Wellh?fer), and the Seven29 ionization chamber array (PTW). The performance of these detector arrays was evaluated against IMRT dose distributions created and calculated with Konrad and the results obtained were compared with film measurements performed with radiographic films (EDR2, Kodak). Additionally, measurements were performed with point detectors, such as diamond, diodes (PTW) and ionization chambers (PTW, Scanditronics/ Wellh?fer) and radiochromic films (GafChromic film MD55, ISP). RESULTS: The results obtained with all three 2-D detector systems were in good agreement with calculations performed with the treatment-planning system and with the standard dosimetric tools, i.e., films or various point dose detectors. It could be shown that all three systems offer dosimetric characteristics required for performing field-related IMRT QA with relative dose measurements. The accuracy of the 2-D detectors was mostly +/- 3% normalized to dose maximum for a wide dynamic range. The maximum deviations did not exceed +/- 5% even in regions with a steep dose gradient. The main differences between the detector systems were the spatial resolution, the maximal field size, and the ability to perform absolute dosimetric measurements. CONCLUSION: Commercial 2-D detectors have the potential to replace films as an "area detector" for field-related verification of IMRT. The on-line information provided by the respective systems can even improve the efficiency of the QA procedures.     

Surgery for MSK tumors: 1971–2011

Since 1971 surgical management of musculoskeletal tumors has changed dramatically. In 1971 less than one-fourth of patients with a malignant tumor had limb salvage surgery, the remainder having an amputation. Amputations were also sometimes done for recurrent benign tumors. Since then amputation has become unusual for malignant disease and is virtually never done for benign tumors. The changes have been made possible because of advances in anesthesiology, surgery, radiology, medical oncology, and radiation oncology.     

Supply and demand for radiographers in Lithuania: A prognosis for 2012–2030

Background

This is the first ever study on the planning of the supply and demand for radiographers in Lithuania. The aim of this study was to analyze the supply and demand for radiographers in the labor market with respect to their number, structure, and services, and to provide a prognosis for the period of 2012–2030.

Materials and methods

Supply was calculated using two scenarios with differing duration of studies, annual student drop-out rates, rates of failure to start working, the annual number of new entrants into the labor market, and emigration rates. Annual mortality rates, the number of first-year students, and retirement rates were evaluated equally in both scenarios.Two projections of the demand for radiographers, based on the population's differing (by age and gender), need for outpatient radiology services, computed tomography, and magnetic resonance scans. Subsequently, the supply and demand scenarios were compared.

Results

Evaluation of the perspective supply and demand scenarios – which are the most probable – revealed a gap forming during the analyzed period, the predicted specialist shortage will reach 0.13 full-time equivalents per 10,000 population, and in 2030—0.37 full-time equivalents per 10,000 population.

Conclusions

Considering the changes in education of radiographers, the socio-demographic characteristics of the staff, and the increasing need for radiographers’ services, the supply of radiographers during the next two decades will be insufficient. To meet the forecasted demand for radiographers in the perspective scenario, the number of students choosing this specialty from 2013 on should increase by up to 30%.     

Chest Radiograph–based Algorithm for Managing Malfunctioning Ports

PurposeTo evaluate a chest x-ray–based algorithm for managing malfunctioning ports.Materials and MethodsA review of interventional radiology procedures on malfunctioning ports during the period 2000–2012 was performed. Events were divided into two periods: before and after implementation of an algorithm beginning with tip position evaluation using a chest x-ray. Time to return to usability, frequency of interventions to restore function, and frequency of malfunctioning ports remaining in use after the procedure were calculated.ResultsThe review included 303 procedures before implementation of the algorithm on 237 access sites in 227 patients (mean age, 56 y; 38% male) and 155 procedures after implementation of the algorithm on 131 access sites in 130 patients (mean age, 55 y; 35% male). Implementation of the algorithm was associated with significantly fewer repeat checks on the same access (27% before algorithm, 9% after algorithm, P < .001) and reduced frequency of a malfunctioning port remaining in use after the interventional radiology procedure (43% before algorithm to 14% after algorithm, P < .001). Median time from consultation to revision was significantly less after implementing the algorithm (13 days before algorithm, 1 day after algorithm, P < .001). Median time from consultation to port usability was also less after implementing the algorithm (2.7 days before algorithm, 1 day after algorithm, P < .001).ConclusionsImplementation of the algorithm was associated with significantly less frequent repeat procedures on the same port and a lower frequency of malfunctioning ports remaining in place. Use of the algorithm was associated with significantly reduced time from consultation to revision and to return to usability. These findings suggest the algorithm allows triage of patients with malfunctioning ports to the appropriate intervention before undergoing a procedure.     

Radiofrequency Ablation for Ground-Glass Opacity–Dominant Lung Adenocarcinoma

PurposeTo evaluate retrospectively the clinical utility of lung radiofrequency (RF) ablation for the treatment of ground-glass opacity (GGO)–dominant lung adenocarcinoma.Materials and MethodsFrom August 2004 through May 2012, 33 consecutive patients (14 men and 19 women; mean age, 71.1 y; age range, 46–84 y) with 42 lung tumors having ≥ 50% GGO component received lung RF ablation. The mean maximum tumor diameter was 1.6 cm ± 0.9 (range, 0.7–4.0 cm). Feasibility, safety, local tumor progression, and survival were evaluated.ResultsFor the 42 RF sessions, after RF electrodes were placed in each target tumor, planned ablation protocols were completed in all sessions (100%; 42 of 42). No deaths related to the RF procedure occurred. Major and minor complication rates were 4.8% and 23.8%, respectively. Local tumor progression developed in 6 tumors (14.3%; 6 of 42) during a mean follow-up of 42 months ± 23 (range, 5–92 mo). Four of six tumors with local progression were controlled by repeated RF ablation. No evidence of disease was achieved in 31 of 33 patients (93.9%) at the end of the follow-up period. All but one patient (who died of brain hemorrhage) are alive today. Overall and cancer-specific survival rates were 100% and 100% at 1 year, 96.4% (95% confidence interval [CI], 77.5%–99.5%) and 100% at 3 years, and 96.4% (95% CI, 77.5%–99.5%) and 100% at 5 years, respectively.ConclusionsLung RF ablation is a feasible, safe, and useful therapeutic option to control GGO-dominant lung adenocarcinoma.     

ACR–ABS–ASTRO practice parameter for the performance of radionuclide-based high-dose-rate brachytherapy

purposeThis practice parameter aims to detail the processes, qualifications of personnel, patient selection, equipment, patient and personnel safety, documentation, and quality control and improvement necessary for an HDR brachytherapy program.Methods and MaterialsThis practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO).ResultsBrachytherapy is a radiotherapeutic modality in which radionuclide or electronic sources are used to deliver a radiation dose at a distance of up to a few centimeters by surface, intracavitary, intraluminal, or interstitial application. Brachytherapy alone or combined with external beam radiotherapy plays an important role in the management and treatment of patients with cancer. High-dose-rate (HDR) brachytherapy uses radionuclides, such as iridium-192, at dose rates of ≥12 Gy/hr to a designated target point or volume, and it is an important treatment for a variety of malignant and benign conditions. Its use allows for application of high doses of radiation to defined target volumes with relative sparing of adjacent critical structures.ConclusionsHDR brachytherapy requires detailed attention to personnel, equipment, patient and personnel safety, and continuing staff education. Coordination between the radiation oncologist and treatment planning staff and effective quality assurance procedures are important components of successful HDR brachytherapy programs.     

Equipment for neutron measurements at VR–1 Sparrow training reactor

The VR-1 sparrow reactor is an experimental nuclear facility for training, student education and teaching purposes. The sparrow reactor is an educational platform for the basic experiments at the reactor physic and dosimetry. The aim of this article is to describe the new experimental equipment EMK310 features and possibilities for neutron detection by different gas filled detectors at VR-1 reactor. Among the EMK310 equipment typical attributes belong precise set-up, simple control, resistance to electromagnetic interference, high throughput (counting rate), versatility and remote controllability. The methods for non-linearity correction of pulse neutron detection system and reactimeter application are presented.     

Population data for 30 insertion–deletion markers in a Korean population

This study reports on the forensic parameters of 30 insertion–deletion polymorphisms (Indels) (Investigator DIPplex® kit) in 100 individuals from a Korean population. The match probability ranged from 0.353 to 0.789, and the combined power of discrimination reached 0.99999999995. The DIPplex® kit is more discriminative in Koreans than six COfiler® short tandem repeats (STRs), but less discriminative than nine Profiler Plus® STRs. This study further demonstrated that some Indels in the DIPplex® kit could be used as Asian ancestry informative markers through a comparison with other population data.     

Hypofractionated accelerated computed tomography–guided interstitial high-dose-rate brachytherapy for liver malignancies

PurposeTo report our results of computed tomography (CT)–guided interstitial high-dose-rate (HDR) brachytherapy (BRT) in the local treatment of inoperable primary and secondary liver malignancies.Methods and MaterialsBetween 2000 and 2009, 31 patients underwent a total of 42 BRT procedures for 36 hepatic lesions exceeding 4 cm and located adjacent to the liver hilum and bile duct bifurcation. The median tumor volume was 99 cm³ (range, 46–1348 cm³). The median age was 64 years (range, 27–85 years). The HDR-BRT delivered a median total physical dose of 13.0 Gy (range, 7.0–32.0 Gy) in twice daily fractions of median 7.0 Gy (range, 4.0–10.0 Gy) in 14 patients and in once daily fractions of median 8.0 Gy (range, 7.0–14.0 Gy) in 17 patients.ResultsThe median followup was 13.3 months with an overall survival rate of 66% at 1 year. The local control rate for patients with metastatic lesions was 79%, 59%, and 59%, and for the subgroup with primary hepatic tumors 88%, 50%, and 50% at 1, 2, and 3 years, respectively. Severe side effects occurred in 4.7% of BRT procedures with no treatment-related deaths.ConclusionsOur results confirm CT–guided interstitial HDR-BRT to be a safe procedure for the local treatment of inoperable liver malignancies unsuitable for thermal ablation.     

Predicting adherence of dose–volume constraints for personalized partial-breast irradiation technique

PurposeMulticatheter interstitial brachytherapy (MIB) and external-beam (EB) radiotherapy are established partial-breast irradiation (PBI) techniques. Although EB-PBI is widely available, it requires extra irradiated margins for target uncertainties. We examined the impact of EB-PBI on dose–volume constraints as compared to MIB-PBI.Methods and MaterialsAmong 653 patients receiving MIB-PBI between October 2008 and April 2020, consequent 159 patients after September 2018 were examined. Clinical target volume (CTV) included the lumpectomy cavity plus 1.0 cm. Planning target volume (PTV) for EB-PBI was defined as CTV with 1.0-cm expansion. Because the ratio of PTV to breast volume (RPB) was related to cosmesis, <25% of RPB was defined as suitable for the ipsilateral breast constraints. Preoperative breast size was classified as very small (<350 cm³), small (350–699 cm³), and medium or large (≥700 cm³). According to each category, the dose–volume constraints of the organs at risk were compared between the two PBI techniques.ResultsPatients including 84 very small, 59 small, and 16 moderate to large breasts were examined. Although RPB was suitable in all patients receiving MIB-PBI, it was achieved in 74 patients (46.5%) receiving EB-PBI (p < 0.0001). The suitable RPB in patients with very small, small, and moderate to large breast was 32.1%, 55.9%, and 100%, respectively (p < 0.0001). Normal-tissue constraints for the other organs could be satisfied in patients with moderate to large breasts.ConclusionAlthough EB-PBI may be an appropriate option for patients with moderate to large breasts, MIB-PBI could still be a crucial technique, especially for patients with small breasts.     

An Analysis of Cancer Center–Provided Rideshare Utilization for Radiation Therapy

ObjectivesThe potential of rideshare services to facilitate timely radiation therapy (RT), especially for resource-limited patients, is understudied.MethodsPatients (n = 63) who received 73 courses of RT (1,513 fractions) and utilized free hospital-provided rideshare service (537 rides) were included in this retrospective study. A multidimensional analysis was conducted including a comparison of demographic, disease characteristics, and treatment completion data; a revenue analysis to evaluate the financial impact of rideshare services; and a geospatial analysis to evaluate community-level characteristics of patients.ResultsMedian age was 59; most were female (56%) and self-identified as Black or African American (56%), not working (91%), not partnered (83%), high school educated or less (78%), and insured with Medicaid (51%). Geospatial analysis revealed that patients lived in communities with significantly higher rates of resource deprivation. Median rideshare distance was 6.4 miles (interquartile range 3.4-11.2) with a median cost of $13.04 per rideshare (interquartile range 9-19). Of the rideshare-facilitated treatments, 100% were completed, with an overall course completion rate of 97.3% compared with 85.4% for those who did not use rideshare (P = .001); two patients discontinued RT for reasons unrelated to transportation. High rideshare utilization (n = 32), defined as utilization ≥ 45% of the treatment course, was associated with significantly shorter treatment courses and lower radiation doses compared with low rideshare utilization (P = .04). Total rideshare cost for high utilizers and whole cohort was $11,589 and $16,895, facilitating an estimated revenue of $401,952 and $1,175,119, respectively.ConclusionsFree hospital-provided rideshare service is economically feasible and associated with high RT completion rates. It may help enhance quality radiation care for those who come from resource-limited communities.     

Thermal analysis of titanium drive-in target for D–D neutron generation

Thermal analysis was performed for a titanium drive-in target of a D–D neutron generator. Computational fluid dynamics code CFX-5 was used in this study. To define the heat flux term for the thermal analysis, beam current profile was measured. Temperature of the target was calculated at some of the operating conditions. The cooling performance of the target was evaluated by means of the comparison of the calculated maximum target temperature and the critical temperature of titanium.     

MR Imaging–Guided Percutaneous Cryotherapy for Lung Tumors: Initial Experience

PurposeTo evaluate prospectively the initial clinical experience of magnetic resonance (MR) imaging–guided percutaneous cryotherapy of lung tumors.Materials and MethodsMR imaging–guided percutaneous cryotherapy was performed in 21 patients with biopsy-proven lung tumors (12 men, 9 women; age range, 39–79 y). Follow-up consisted of contrast-enhanced chest computed tomography (CT) scan performed at 3-month intervals to assess tumor control; CT scanning was carried out for 12 months or until death.ResultsCryotherapy procedures were successfully completed in all 21 patients. Pneumothorax occurred in 7 (33.3%) of 21 patients. Chest tube placement was required in one (4.8%) case. Hemoptysis was exhibited by 11 (52.4%) patients, and pleural effusion occurred in 6 (28.6%) patients. Other complications were observed in 14 (66.7%) patients. The mean follow-up period was 10.5 months (range, 9–12 mo) in patients who died. At month 12 of follow-up, 7 (33.3%) patients had a complete response to therapy, and 10 (47.6%) patients showed a partial response. In addition, two patients had stable disease, and two patients developed progressive disease; one patient developed a tumor in the liver, and the other developed a tumor in the brain. The 1-year local control rate was 81%, and 1-year survival rate was 90.5%.ConclusionsMR imaging–guided percutaneous cryotherapy appears feasible, effective, and minimally invasive for lung tumors.     

Reference data for the Thiemann–Nitz method of assessing skeletal age for the purpose of forensic age estimation

The aim of this study was to determine the statistical parameters of deviation in the Thiemann–Nitz method for use in forensic age diagnostics. To this effect, 402 hand radiograms, originally taken in two large German cities between 1983 and 2002 for the purpose of diagnosing trauma, were analyzed. At the time of examination, the patients were aged between 10 and 18 years. The study presents the mean, standard deviation, and median, with lower and upper quartiles, for the skeletal ages of 11.0 through 18.0 years. The simple standard deviations range between 0.2 and 1.2 years. To increase the accuracy of age estimates and improve the identification of age-relevant developmental disorders in forensic age estimation practice, the methods for determining skeletal age should always be combined with a physical and dental examination. In addition, the expert opinion should pay attention to the issue of different modernization levels in relevant populations.     

Quantitative real-time PCR (qPCR) assay for human–dog–cat species identification and nuclear DNA quantification

In the United States, human forensic evidence collected from crime scenes is usually comingled with biomaterial of canine and feline origins. Knowledge of the concentration of nuclear DNA extracted from a crime scene biological sample and the species from which the sample originated is essential for DNA profiling. The ability to accurately detect and quantify target DNA in mixed-species samples is crucial when target DNA may be overwhelmed by non-target DNA.We have designed and evaluated a species-specific (human, dog and cat) nuclear DNA identification assay based on the TaqMan^® quantitative real-time PCR (qPCR) technology that can simultaneously detect and measure minute quantities of DNA specific to either humans, dogs and/or cats. The fluorogenic triplex assay employs primers and hydrolysis probes that target the human TH01 locus as well as the dog and cat Melanocortin 1 Receptor (MC1R) sequences in a species-specific manner. We also demonstrate that the assay is a highly sensitive, reliable and robust method for identifying and quantifying mixed-species templates of human–dog–cat origin with as little as 0.4 pg of human and cat nuclear DNA, respectively, and 4.0 pg of dog nuclear DNA.