Post-irradiation hyperamylasemia as a biological dosimeter.

Serum alpha-amylase was measured before and 24 h after either total body (31 patients) or localized irradiation including the salivary glands (40 patients) or the pancreatic area (22 patients). A significant increase in amylasemia was observed for doses to the parotid glands larger than 0.5 Gy. A sigmoid function of dose was fitted to the data and predicted a maximum amylasemia level for doses larger than 4 Gy and smaller than 10 Gy. The raw data from other published series were adequately described by the same model. However, the confidence limits of the parameters remained wide, because of a considerable interindividual variability. Post-irradiation hyperamylasemia appears to provide a good criterion for triage of accidentally irradiated patients: 24 h after a dose larger than 2 Gy to the parotid glands, 91% of the patients had an amylasemia level higher than 2.5-fold the upper normal value (sensitivity). Conversely, 96% had their serum amylasemia lower than 2.5-fold the upper normal value when dose was smaller than 2 Gy (specificity). However, a retrospective estimation of the absorbed dose (dosimetry) is not likely to be very precise because of the large interindividual variability.     

医科达磁共振加速器初步临床实践

目的:初步分析医科达磁共振加速器(Unity MR-Linac)摆位精度及流程时间等相关问题。方法:回顾Unity MR-Linac实验入组患者共14例,统计分析所有分次的治疗时间(包括摆位、扫描、重新制订计划和出束时间)和各个方向的摆位误差。随机选取常规加速器使用一体架固定的患者11例,统计摆位误差。成组 ...     

医科达iBeam evo碳纤维治疗床模型评价

目的:基于Monaco计划系统比较分析医科达iBeam evo Couchtop EP碳纤维治疗床及几何模型结构,评价其在放射治疗中对剂量衰减的影响。方法:CT扫描iBeam evo治疗床结构,与虚拟几何模型进行比较。基于Monaco计划系统建立衰减系数快速测试模型。比较治疗床延长附件、连接区域、主治疗床区域不同入射角度、不同能量条件下的衰减系数,确定内置虚拟治疗床模型最佳电子密度参数。结果:6 MV和10 MV射线条件下主治疗床衰减（2.89±1.40）%和（2.42±1.37）%,连接区域衰减（7.68±10.05）%和（6.52±8.64）%,延长附件衰减(2.00±1.01)%和（1.57±0.99）%。6 MV射线条件下治疗床模型碳纤维外壳及内部泡沫轮廓的最佳电子密度参数为0.3 g/cm3、0.1 g/cm3;10 MV射线条件下最佳电子密度参数为0.4 g/cm3、0.1 g/cm3。结论:放射治疗中治疗床对剂量衰减的影响不可忽略,且治疗床不同区域衰减存在差异。正确引入虚拟治疗床模型可以准确的模拟治疗床在放射治疗中的影响。     

Elekta Precise Table characteristics of IGRT remote table positioning

INTRODUCTION: Cone beam CT is a powerful tool to ensure an optimum patient positioning in radiotherapy. When cone beam CT scan of a patient is acquired, scan data of the patient are compared and evaluated against a reference image set and patient position offset is calculated. Via the linac control system, the patient is moved to correct for position offset and treatment starts. This procedure requires a reliable system for movement of patient. In this work we present a new method to characterize the reproducibility, linearity and accuracy in table positioning. The method applies to all treatment tables used in radiotherapy. MATERIAL AND METHODS: The table characteristics are investigated on our two recent Elekta Synergy Platforms equipped with Precise Table installed in a shallow pit concrete cavity. Remote positioning of the table uses the auto set-up (ASU) feature in the linac control system software Desktop Pro R6.1. The ASU is used clinically to correct for patient positioning offset calculated via cone beam CT (XVI)-software. High precision steel rulers and a USB-microscope has been used to detect the relative table position in vertical, lateral and longitudinal direction. The effect of patient is simulated by applying external load on the iBEAM table top. For each table position an image is exposed of the ruler and display values of actual table position in the linac control system is read out. The table is moved in full range in lateral direction (50 cm) and longitudinal direction (100 cm) while in vertical direction a limited range is used (40 cm). RESULTS AND DISCUSSION: Our results show a linear relation between linac control system read out and measured position. Effects of imperfect calibration are seen. A reproducibility within a standard deviation of 0.22 mm in lateral and longitudinal directions while within 0.43 mm in vertical direction has been observed. The usage of XVI requires knowledge of the characteristics of remote table positioning. It is our opinion that the method presented meets the requirements in high precision IGRT.     

放疗计划CT值的校准检测及其影响因素分析

背景与目的:放射治疗计划系统(treatmentplanningsystem,TPS)依赖CT扫描得到的CT值建立CT-密度转换曲线,并根据转换所得的组织密度(或电子密度)进行组织不均匀性剂量校正计算,从而得出放射治疗计划的剂量分布。同一组织在不同的扫描条件下得到的CT值可能产生相当大的差异,从而导致剂量计算的误差。本研究利用等效模体在不同条件下进行CT扫描,测量各因素对CT值影响的大小及分析各影响的相对严重程度。方法:用含有已知密度的不同组织替代材料组成的模体在不同的CT扫描条件下进行CT值测量,评价扫描参数、患者体形和CT床面等因素对CT值的影响。实验条件分为3组:(1)以不同的扫描电压、层厚及扫描方式(逐层/螺旋扫描)对相同模体进行CT扫描;(2)改变各不同密度的组织替代材料在模体中的位置和排列顺序,固定CT参数进行图像扫描;(3)扫描参数不变,分别将相同模体置于床面和悬空进行比较扫描和CT值测量。结果:扫描电压和床面分别对高密度组织和低密度组织的CT值影响较大,前者对皮质骨模型的CT值改变可达150Hu(12.7%),后者对水模的CT值改变达26.34%。模体几何位置对CT值的影响可以忽略(<3%)。结论:不同的CT扫描参数和定位条件可能使某一组织重建影像的CT值发生改变,从而造成TPS剂量计算误差。尤其以扫描电压和定位床面的散射对CT值的影响为甚。已知密度的不均匀体模可以用于放射治疗计划CT扫描的质量保证检测和CT值的校准。各放疗中心应根据实际测量和校准结果制定统一的CT定位扫描规范,对每一患者采用一致的扫描参数和定位条件,以保证治疗计划剂量计算的精度。     

Preparation and use of 131I magic gel as a dosimeter for targeted radionuclide therapy

Clinical interest in targeted radiotherapy is increasing, but accurate dosimetry studies are difficult to achieve. The aim of this study was to investigate the preparation and use of a "normoxic" polymer gel (with a tissue-equivalent density), known as MAGIC gel, and magnetic resonance imaging (MRI) for nonsealed source dosimetry. MAGIC gel samples were mixed with deionized water (MAGIC95) or a solution of 131I (131I-MAGIC95). By measuring the radioinduced variations of R2 values (relaxivity) of irradiated gels, we analyzed the response of MAGIC95 and MAGIC samples to external photon beam or 131I irradiation (131I-MAGIC95). MRI showed that a homogeneous dose distribution from 131I can be achieved if the MAGIC gel, at a temperature of approximately 35 degrees C, is mixed in 131I solution and the resulting mixture shaken gently for 30 minutes. It is important that the vials are completely filled, as residual air reduces polymerization and causes spontaneous polymerization stripes. Responses of MAGIC95 or MAGIC gels to external photon beam irradiation are similar. The variations of R2 values for 131I-MAGIC95 gel depend on the absorbed dose and not on the duration of the irradiation being reproducible from one batch of gel to another. MAGIC gel responses to 131I or external beam irradiation (EBI) are different. Our preliminary results suggest that radiolabeled "normoxic" polymer can be easily and safely produced. Radiolabeled MAGIC gel may, therefore, be suitable for the creation of phantoms dedicated to nonsealed source dosimetry.     

Technical evaluation of radiation dose delivered in prostate cancer patients as measured by an implantable MOSFET dosimeter

PURPOSE: To perform a comparison of the daily measured dose at depth in tissue with the predicted dose values from treatment plans for 29 prostate cancer patients involved in a clinical trial. METHODS AND MATERIALS: Patients from three clinical sites were implanted with one or two dosimeters in or near the prostatic capsule. The implantable device, known as the DVS, is based on a metal-oxide-semiconductor field effect transistor (MOSFET) detector. A portable telemetric readout system couples to the dosimeter antenna (visible on kilovoltage, computed tomography, and ultrasonography) for data transfer. The predicted dose values were determined by the location of the MOSFET on the treatment planning computed tomography scan. Serial computed tomography images were taken every 2 weeks to evaluate any migration of the device. The clinical protocol did not permit alteration of the treatment parameters using the dosimeter readings. For some patients, one of several image-guided radiotherapy (RT) modalities was used for target localization. RESULTS: The evaluation of dose discrepancy showed that in many patients the standard deviation exceeded the previous values obtained for the dosimeter in a phantom. In some patients, the cumulative dose disagreed with the planned dose by > or =5%. The data presented suggest that an implantable dosimeter can help identify dose discrepancies (random or systematic) for patients treated with external beam RT and could be used as a daily treatment verification tool for image-guided RT and adaptive RT. CONCLUSION: The results of our study have shown that knowledge of the dose delivered per fraction can potentially prevent over- or under-dosage to the treatment area and increase the accuracy of RT. The implantable dosimeter could also be used as a localizer for image-guided RT.     

Spatial resolution of a stacked radiochromic film dosimeter.

PURPOSE: The spatial resolution of stacked radiochromic film dosimeters, which have increased sensitivity from a single layer radiochromic film detector, has been studied. METHODS: A 5-layer film which can easily be constructed provided a 4.3-times increase in sensitivity over a single layer film at 670 nm readout wavelength which meant that doses as low as 0.6 Gy could be measured with an accuracy of +/-4% with the stacked dosimeter. The spatial resolution was tested by comparison of the 80%/20% penumbral widths of a 5 x 5 cm 6 MV X-ray field. RESULTS: The MD-55-2 film measured the penumbral width as 3.0 mm whereas the 5-layer stack dosimeter measured the same penumbra as 3.2 mm.Conclusion: The stack dosimeter can provide useful in vivo information such as the position of a diverging beam edge for treatments around critical structures such as eyes during the first fraction of treatment.     

Calibration of the LiF - thermoluminescent detectors used for personal dose equivalent Hp(3) assessment

AimsThe issue of exposure of eye lenses of employees exposed to ionizing radiation is an interesting topic not only from the point of view of deterministic effects related to the occurrence of cataracts, but also dosimetric aspects, in particular the calibration of detectors in units enabling the assessment of eye lens exposure or personal dose equivalent Hp(3). The paper presents the idea of calibrating thermoluminescent detectors designed for the Hp(3) values measurement of gamma radiation, which the source is the process of annihilation of positrons emitted by the deoxyglucose marker - ¹⁸F radionuclide.MethodsThe method was based on the value of air kerma Ka to Hp(3) conversion coefficients (Hp(3,0°)/Ka) developed as part of the ORAMED project. High-sensitivity thermoluminescent detectors (MCP-N) produced in Poland were used in the measurements. During the exposure of the detectors, a ¹³⁷Cs gamma radiation source (irradiator ¹³⁷Cs/⁶⁰Co) and a 20 cm diameter cylinder filled with water were used.Results & ConclusionsThe value of conversion coefficient Hp(3,0°)/Ka for energy 511 keV is 1.31 Sv/Gy and the calibration factor is (3.46 ± 0.03)·10^-4 mSv/N (N - number of counts). Verification of the value of the obtained coefficient carried out using a cylinder with a diameter of 20 cm showed a difference of less than 2% in relation to the value obtained by the method described in this paper.     

On-line aSi portal imaging of implanted fiducial markers for the reduction of interfraction error during conformal radiotherapy of prostate carcinoma

PURPOSE: An on-line system to ensure accuracy of daily setup and therapy of the prostate has been implemented with no equipment modification required. We report results and accuracy of patient setup using this system. METHODS AND MATERIALS: Radiopaque fiducial markers were implanted into the prostate before radiation therapy. Lateral digitally reconstructed radiographs (DRRs) were obtained from planning CT data. Before each treatment fraction, a lateral amorphous silicon (aSi) portal image was acquired and the position of the fiducial markers was compared to the DRRs using chamfer matching. Couch translation only was used to account for marker position displacements, followed by a second lateral portal image to verify isocenter position. Residual displacement data for the aSi and previous portal film systems were compared. RESULTS: This analysis includes a total of 239 portal images during treatment in 17 patients. Initial prostate center of mass (COM) displacements in the superior, inferior, anterior, and posterior directions were a maximum of 7 mm, 9 mm, 10 mm and 11 mm respectively. After identification and correction, prostate COM displacements were <3 mm in all directions. The therapists found it simple to match markers 88% of the time using this system. Treatment delivery times were in the order of 9 min for patients requiring isocenter adjustment and 6 min for those who did not. CONCLUSIONS: This system is technically possible to implement and use as part of an on-line correction protocol and does not require a longer than standard daily appointment time at our center with the current action limit of 3 mm. The system is commercially available and is more efficient and user-friendly than portal film analysis. It provides the opportunity to identify and accommodate interfraction organ motion and may also permit the use of smaller margins during conformal prostate radiotherapy. Further integration of the system such as remote table control would improve efficiency.     

TLD在肿瘤放疗中剂量测量基本特性研究

目的 研究LiF (Mg、Cu、P) TLD在肿瘤放疗中测量剂量的基本特性,为临床放疗热释光剂量测量提供可靠依据。方法 应用⁶⁰Coγ射线和6 MV X射线进行LiF热释光片的分散性、重复性、剂量响应等实验。根据临床放疗需要研究热释光计在肿瘤测量中随能量、剂量(50~600 cGy)、照射剂量率(50~600 MU/min)和加速器机架角度(0°~±90°)变化影响,分别求出校正因子。结果 LiF热释光计重复性和分散性的误差控制在±3%以内,一定剂量范围照射下的读出数值与照射剂量呈线性关系。用6 MV X射线照射,剂量率为300 MU/min,入射角度为0°,得到的读数值的相对偏差最小,为0.3%。结论 LiF热释光计具有重复性好、分散性小、稳定性高、线性相关性强等基本特性,符合国际推荐标准,可应用于肿瘤放疗中剂量的测定。     

Standardization of a reference dosimeter system for radiotherapy in Switzerland

The Swiss ordinance on radioprotection prescribes the periodic verification of the reference dosimeter systems for radiotherapy. The corresponding modalities were elaborated by an interdisciplinary collaboration of representatives of all concerned institutions. The modalities require in particular that the verifications are performed with the radiation qualities used in the hospitals. The verification concept is already realized for high energy photon radiation and for low and medium energy X-rays. The measurement capabilities for the verification with high energy electron beams are in preparation. The tasks to verify the reference dosimeter systems are divided between the Swiss Office of Metrology and Accreditation, METAS, and the Institut Universitaire de Radiophysique Appliquée, IRA. The corresponding metrological infrastructure and measurement capabilities of both institutes are presented. In particular, the traceability of the standards used for the verification to national and international primary standards and thus to the SI system of units is explained. The primary standards established and operated by METAS are briefly described.     

Levels of N7-(2-hydroxyethyl)guanine as a molecular dosimeter of drug delivery to human brain tumors

The level of N7-(2-hydroxyethyl)guanine (N7-HOEtG), one of the DNA alkylation products formed by 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) treatment, was measured in human brain tumor samples by high performance liquid chromatography with electrochemical detection. The tumors from 6 recurrent chemotherapy-naive patients with recurrent glioblastoma multiforme were analyzed as controls. The mean level of N7-HOEtG in DNA of these specimens was 0.42 pmol/mg DNA. Samples were also obtained from a patient with a recurrent glioblastoma multiforme after direct intratumoral therapy with BCNU in ethanol (DTI-015). The levels of N7-HOEtG in the samples distal, medial, and adjacent to the site of injection were 0.8, 2.6, and 369.5 pmol/mg DNA, respectively. Comparison of the level of N7-HOEtG detected in the distal sample after injection with BCNU in ethanol with the mean level of the untreated samples indicated that it was not sufficiently different to be ruled out as a chance occurrence. Comparison of the levels of N7-HOEtG in the medial and adjacent brain tumor samples with the mean level of the control samples showed values that were approximately 6- and 879-fold higher. These results demonstrate that intratumoral administration of BCNU in ethanol produces significant levels of DNA alkylation and suggest that DNA adduct measurements provide a unique molecular dosimeter to evaluate delivery of alkylating agents to brain tumors.     

Adverse effects of the humanized antibodies used as cancer therapeutics

PURPOSE OF REVIEW: Humanized monoclonal antibodies represent a recent and very significant addition to the anticancer armamentarium. With improved therapeutic strategies due to these agents, however, there are also various, sometimes unexpected, side effects. RECENT FINDINGS: Most of the monoclonal antibodies used in oncology share a risk of infusion-related manifestations, including the possibility of anaphylaxis; these reactions usually appear early on during the first administration. Hematological toxicity is also frequent, especially if the antibodies are associated with chemotherapy; the resulting neutropenia--and with some agents lymphopenia--is associated with an increased risk of infection. Cardiac failure and pulmonary complications have been reported with some of these agents, especially in patients with prior cardiac or pulmonary comorbidities. SUMMARY: Although consideration of these side effects is important in terms of prevention and therapy, overall they are relatively uncommon, making therapy with monoclonal antibodies quite safe in comparison with other therapeutic modalities used in cancer patients.