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  1. Guyana: Energy Resources | Open Energy Information

    Open Energy Info (EERE)

    Country Profile Name Guyana Population 747,884 GDP 2,788,000,000 Energy Consumption 0.02 Quadrillion Btu 2-letter ISO code GY 3-letter ISO code GUY Numeric ISO...

  2. Preparing Guyana's REDD+ Participation: Developing Capacities...

    Open Energy Info (EERE)

    Workshop, Guidemanual Website http:unfccc.intfilesmethod Country Guyana UN Region Latin America and the Caribbean References Preparing Guyana's REDD+ Participation1...

  3. Guyana REDD+ Investment Fund (GRIF) | Open Energy Information

    Open Energy Info (EERE)

    Guyana REDD+ Investment Fund (GRIF) Jump to: navigation, search Name Guyana REDD+ Investment Fund (GRIF) AgencyCompany Organization Government of Norway, Government of Guyana...

  4. Guyana's Low Carbon Development Strategy | Open Energy Information

    Open Energy Info (EERE)

    Guyana's Low Carbon Development Strategy Jump to: navigation, search Tool Summary Name: Guyana's Low Carbon Development Strategy AgencyCompany Organization: Guyana Office of...

  5. Guyana-Caribbean Community (CARICOM) Sustainable Energy Roadmap...

    Open Energy Info (EERE)

    Guyana-Caribbean Community (CARICOM) Sustainable Energy Roadmap and Strategy Jump to: navigation, search Name Guyana-Caribbean Community (CARICOM) Sustainable Energy Roadmap and...

  6. Lesotho: Energy Resources | Open Energy Information

    Open Energy Info (EERE)

    Country Profile Name Lesotho Population 2,031,348 GDP 2,616,000,000 Energy Consumption 0.01 Quadrillion Btu 2-letter ISO code LS 3-letter ISO code LSO Numeric ISO...

  7. Guyana-ClimateWorks Low Carbon Growth Planning Support | Open...

    Open Energy Info (EERE)

    ClimateWorks Low Carbon Growth Planning Support Jump to: navigation, search Name Guyana-Low Carbon Growth Planning Support AgencyCompany Organization ClimateWorks, Project...

  8. RenGyS | Open Energy Information

    Open Energy Info (EERE)

    Energy Product: RenGyS is an independent renewable energy developer focused on the Chinese energy market. Coordinates: 31.247709, 121.472618 Show Map Loading map......

  9. MEMORANDUM GY

    Office of Legacy Management (LM)

    ... McKee Industrial Hygiene &.Safety Extrusion of Billets, Kaiser Aluminum Corporation, Dolton, Illinois C. S. McKee monitored the extrusion of three CP-5 type fuel elements on ...

  10. 70 Gy Versus 80 Gy in Localized Prostate Cancer: 5-Year Results of GETUG 06 Randomized Trial;Prostate cancer; Dose escalation; Conformal radiotherapy; Randomized trial

    SciTech Connect (OSTI)

    Beckendorf, Veronique; Guerif, Stephane; Le Prise, Elisabeth; Cosset, Jean-Marc; Bougnoux, Agnes; Chauvet, Bruno; Salem, Naji; Chapet, Olivier; Bourdain, Sylvain; Bachaud, Jean-Marc; Maingon, Philippe; Hannoun-Levi, Jean-Michel; Malissard, Luc; Simon, Jean-Marc; Pommier, Pascal; Hay, Men; Dubray, Bernard; Lagrange, Jean-Leon; Luporsi, Elisabeth; Bey, Pierre

    2011-07-15

    Purpose: To perform a randomized trial comparing 70 and 80 Gy radiotherapy for prostate cancer. Patients and Methods: A total of 306 patients with localized prostate cancer were randomized. No androgen deprivation was allowed. The primary endpoint was biochemical relapse according to the modified 1997-American Society for Therapeutic Radiology and Oncology and Phoenix definitions. Toxicity was graded using the Radiation Therapy Oncology Group 1991 criteria and the late effects on normal tissues-subjective, objective, management, analytic scales (LENT-SOMA) scales. The patients' quality of life was scored using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30-item cancer-specific and 25-item prostate-specific modules. Results: The median follow-up was 61 months. According to the 1997-American Society for Therapeutic Radiology and Oncology definition, the 5-year biochemical relapse rate was 39% and 28% in the 70- and 80-Gy arms, respectively (p = .036). Using the Phoenix definition, the 5-year biochemical relapse rate was 32% and 23.5%, respectively (p = .09). The subgroup analysis showed a better biochemical outcome for the higher dose group with an initial prostate-specific antigen level >15 ng/mL. At the last follow-up date, 26 patients had died, 10 of their disease and none of toxicity, with no differences between the two arms. According to the Radiation Therapy Oncology Group scale, the Grade 2 or greater rectal toxicity rate was 14% and 19.5% for the 70- and 80-Gy arms (p = .22), respectively. The Grade 2 or greater urinary toxicity was 10% at 70 Gy and 17.5% at 80 Gy (p = .046). Similar results were observed using the LENT-SOMA scale. Bladder toxicity was more frequent at 80 Gy than at 70 Gy (p = .039). The quality-of-life questionnaire results before and 5 years after treatment were available for 103 patients with no differences found between the 70- and 80-Gy arms. Conclusion: High-dose radiotherapy provided a better 5-year biochemical outcome with slightly greater toxicity.

  11. Low-Dose Radiation Therapy (2 Gy 2) in the Treatment of Orbital Lymphoma

    SciTech Connect (OSTI)

    Fasola, Carolina E.; Jones, Jennifer C.; Huang, Derek D.; Le, Quynh-Thu; Hoppe, Richard T.; Donaldson, Sarah S.

    2013-08-01

    Purpose: Low-dose radiation has become increasingly used in the management of indolent non-Hodgkin lymphoma (NHL), but has not been studied specifically for cases of ocular adnexal involvement. The objective of this study is to investigate the effectiveness of low-dose radiation in the treatment of NHL of the ocular adnexa. Methods and Materials: We reviewed the records of 20 NHL patients with 27 sites of ocular adnexal involvement treated with low-dose radiation consisting of 2 successive fractions of 2 Gy at our institution between 2005 and 2011. The primary endpoint of this study is freedom from local relapse (FFLR). Results: At a median follow-up time of 26 months (range 7-92), the overall response rate for the 27 treated sites was 96%, with a complete response (CR) rate of 85% (n=23) and a partial response rate of 11% (n=3). Among all treated sites with CR, the 2-year FFLR was 100%, with no in-treatment field relapses. The 2-year freedom from regional relapse rate was 96% with 1 case of relapse within the ipsilateral orbit (outside of the treatment field). This patient underwent additional treatment with low-dose radiation of 4 Gy to the area of relapse achieving a CR and no evidence of disease at an additional 42 months of follow-up. Orbital radiation was well tolerated with only mild acute side effects (dry eye, conjunctivitis, transient periorbital edema) in 30% of treated sites without any reports of long-term toxicity. Conclusions: Low-dose radiation with 2 Gy 2 is effective and well tolerated in the treatment of indolent NHL of the ocular adnexa with high response rates and durable local control with the option of reirradiation in the case of locoregional relapse.

  12. eGY-Africa: Addressing the Digital Divide for Science in Africa

    SciTech Connect (OSTI)

    Barton, C. E.

    2010-05-25

    Adoption of information and communication technologies and access to the Internet is expanding in Africa, but because of the rapid growth elsewhere, a Digital Divide between Africa and the rest of the world exists, and the gap is growing. In many sub-Saharan African countries, education and research sector suffer some of the worst deficiencies in access to the Internet, despite progress in development of NRENs National Research and Education (cyber) Networks. By contrast, it is widely acknowledged in policy statements from the African Union, the UN, and others that strength in this very sector provides the key to meeting and sustaining Millennium Development Goals. Developed countries with effective cyber-capabilities proclaim the benefits to rich and poor alike arising from the Information Revolution. This is but a dream for many scientists in African institutions. As the world of science becomes increasingly Internet-dependent, so they become increasingly isolated. eGY-Africa is a bottom-up initiative by African scientists and their collaborators to try to reduce this Digital Divide by a campaign of advocacy for better institutional facilities. Four approaches are being taken. The present status of Internet services, problems, and plans are being mapped via a combination of direct measurement of Internet performance (the PingER Project) and a questionnaire-based survey. Information is being gathered on policy statements and initiatives aimed at reducing the Digital Divide, which can be used for arguing the case for better Internet facilities. Groups of concerned scientists are being formed at the national, regional levels in Africa, building on existing networks as much as possible. Opinion in the international science community is being mobilized. Finally, and perhaps most important of all, eGY-Africa is seeking to engage with the many other programs, initiatives, and bodies that share the goal of reducing the Digital Divide either as a direct policy objective, or indirectly as a means to an end, such as the development of an indigenous capability in science and technology for national development. The expectation is that informed opinion from the scientific community at the institutional, national, and international levels can be used to influence the decision makers and donors who are in a position to deliver better Internet capabilities.

  13. eGY-Africa: Addressing the Digital Divide for Science in Africa

    SciTech Connect (OSTI)

    Barton, C.E.; Amory-Mazaudier, C.; Barry, B.; Chukwuma; Cottrell, R.L.; Kalim, U.; Mebrahtu, A.; Petitdidier, M.; Rabiu, B.; Reeves, C.; ,

    2010-06-16

    Adoption of information and communication technologies and access to the Internet is expanding in Africa, but because of the rapid growth elsewhere, a Digital Divide between Africa and the rest of the world exists, and the gap is growing. In many sub-Saharan African countries, education and research sector suffers some of the worst deficiencies in access to the Internet, despite progress in development of NRENs - National Research and Education (cyber) Networks. By contrast, it is widely acknowledged in policy statements from the African Union, the UN, and others that strength in this very sector provides the key to meeting and sustaining Millennium Development Goals. Developed countries with effective cyber-capabilities proclaim the benefits to rich and poor alike arising from the Information Revolution. This is but a dream for many scientists in African institutions. As the world of science becomes increasingly Internet-dependent, so they become increasingly isolated. eGY-Africa is a bottom-up initiative by African scientists and their collaborators to try to reduce this Digital Divide by a campaign of advocacy for better institutional facilities. Four approaches are being taken. The present status of Internet services, problems, and plans are being mapped via a combination of direct measurement of Internet performance (the PingER Project) and a questionnaire-based survey. Information is being gathered on policy statements and initiatives aimed at reducing the Digital Divide, which can be used for arguing the case for better Internet facilities. Groups of concerned scientists are being formed at the national, regional levels in Africa, building on existing networks as much as possible. Opinion in the international science community is being mobilized. Finally, and perhaps most important of all, eGY-Africa is seeking to engage with the many other programs, initiatives, and bodies that share the goal of reducing the Digital Divide - either as a direct policy objective, or indirectly as a means to an end, such as the development of an indigenous capability in science and technology for national development. The expectation is that informed opinion from the scientific community at the institutional, national, and international levels can be used to influence the decision makers and donors who are in a position to deliver better Internet capabilities.

  14. Phase 2 Trial of Accelerated, Hypofractionated Whole-Breast Irradiation of 39 Gy in 13 Fractions Followed by a Tumor Bed Boost Sequentially Delivering 9 Gy in 3 Fractions in Early-Stage Breast Cancer

    SciTech Connect (OSTI)

    Kim, Ja Young; Jung, So-Youn; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Park, In Hae; Lee, Keun Seok; Ro, Jungsil; Lee, Nam Kwon; Shin, Kyung Hwan

    2013-12-01

    Purpose: To report a phase 2 trial of accelerated, hypofractionated whole-breast irradiation (AH-WBI) delivered as a daily dose of 3 Gy to the whole breast followed by a tumor bed boost. Methods and Materials: Two hundred seventy-six patients diagnosed with breast cancer (pT1-2 and pN0-1a) who had undergone breast-conserving surgery in which the operative margins were negative were treated with AH-WBI delivered as 39 Gy in 13 fractions of 3 Gy to the whole breast once daily over 5 consecutive working days, and 9 Gy in 3 sequential fractions of 3 Gy to a lumpectomy cavity, all within 3.2 weeks. Results: After a median follow-up period of 57 months (range: 27-75 months), the rate of 5-year locoregional recurrence was 1.4% (n=4), whereas that of disease-free survival was 97.4%. No grade 3 skin toxicity was reported during the follow-up period. Qualitative physician cosmetic assessments of good or excellent were noted in 82% of the patients at 2 months after the completion of AH-WBI. The global cosmetic outcome did not worsen over time, and a good or excellent cosmetic outcome was reported in 82% of the patients at 3 years. The mean pretreatment percentage breast retraction assessment was 12.00 (95% confidence interval [CI]: 11.14-12.86). The mean value of percentage breast retraction assessment increased to 13.99 (95% CI: 12.17-15.96) after 1 year and decreased to 13.54 (95% CI: 11.84-15.46) after 3 years but was not significant (P>.05). Conclusions: AH-WBI consisting of 39 Gy in 13 fractions followed by a tumor bed boost sequentially delivering 9 Gy in 3 fractions can be delivered with excellent disease control and tolerable skin toxicity in patients with early-stage breast cancer after breast-conserving surgery.

  15. Thermoluminescence (TL) Analysis and Fading Studies of Naturally Occurring Salt Irradiated by 500 mGy Gamma Rays

    SciTech Connect (OSTI)

    Tiwari, Ramesh Chandra; Pau, Kham Suan

    2011-10-20

    The aim of the present study was to investigate the potential of the naturally occurring salt for the dosimetry purposes, using TL. The fine powder samples (20 mg) were irradiated by {gamma}- rays from 500 mGy to 2500 mGy by using Theratron-780C Cobalt-60 source, however, this paper discusses about 500 mGy only. The TL glow curve peak parameters were studied by using Chen's peak shape equation. TL glow curves were compared with fitted curves using glow curve deconvolution (GCD) method by using Kitis expression. The kinetic parameter values (E, b and s) so calculated, are in good agreement with those available in literature. The calculated energy values were also verified by using various heating rate (VHR) method. {chi}{sup 2} test and figure of merit (FOM) calculation was done to accept the goodness of fit between the curves. Fading studies of the sample showed a good fitting between the curves. The analysis suggests that natural salt should be considered for dosimetry purposes.

  16. QUARTER SH OR T-T ER M EN ER GY OU TL OO K QUAR TERL Y PROJ

    Gasoline and Diesel Fuel Update (EIA)

    1 2 QUARTER SH OR T-T ER M EN ER GY OU TL OO K QUAR TERL Y PROJ ECTIO NS ENERGY INFORMA TION ADMINIST RATION May 1991 This publication may be purchased from the Superintendent of Documents, U.S. Government Printing Office. Purchasing in formation for this or other Energy Information Administration (EIA) publications may be obtained from the Government Printing Office or ElA's National Energy Information Center. Questions on energy statistics should be directed to the Center by mail, telephone,

  17. Standard (60 Gy) or Short-Course (40 Gy) Irradiation Plus Concomitant and Adjuvant Temozolomide for Elderly Patients With Glioblastoma: A Propensity-Matched Analysis

    SciTech Connect (OSTI)

    Minniti, Giuseppe; Scaringi, Claudia; Lanzetta, Gaetano; Terrenato, Irene; Esposito, Vincenzo; Arcella, Antonella; Pace, Andrea; Giangaspero, Felice; Bozzao, Alessandro; Enrici, Riccardo Maurizi

    2015-01-01

    Purpose: To evaluate 2 specific radiation schedules, each combined with temozolomide (TMZ), assessing their efficacy and safety in patients aged ≥65 years with newly diagnosed glioblastoma (GBM). Methods and Materials: Patients aged ≥65 years with Karnofsky performance status (KPS) ≥60 who received either standard (60 Gy) or short-course (40 Gy) radiation therapy (RT) with concomitant and adjuvant TMZ between June 2004 and October 2013 were retrospectively analyzed. A propensity score analysis was executed for a balanced comparison of treatment outcomes. Results: A total of 127 patients received standard RT-TMZ, whereas 116 patients underwent short-course RT-TMZ. Median overall survival and progression-free survival times were similar: 12 months and 5.6 months for the standard RT-TMZ group and 12.5 months and 6.7 months for the short-course RT-TMZ group, respectively. Radiation schedule was associated with similar survival outcomes in either unadjusted or adjusted analysis. O{sup 6}-methylguanine-DNA methyltransferase promoter methylation was the most favorable prognostic factor (P=.0001). Standard RT-TMZ therapy was associated with a significant rise in grade 2 and 3 neurologic toxicity (P=.01), lowering of KPS scores during the study (P=.01), and higher posttreatment dosing of corticosteroid (P=.02). Conclusions: In older adults with GBM, survival outcomes of standard and short-course RT-TMZ were similar. An abbreviated course of RT plus TMZ may represent a reasonable therapeutic approach for these patients, without loss of survival benefit and acceptable toxicity.

  18. From nGy to MGy - New dosimetry with LiF:Mg,Cu,P thermoluminescence detectors

    SciTech Connect (OSTI)

    Obryk, Barbara

    2013-05-06

    One of the well known advantages of thermoluminescence (TL) detectors made of lithium fluoride doped with magnesium, copper and phosphorus (LiF:Mg,Cu,P) is their very high sensitivity to ionizing radiation. LiF:Mg,Cu,P detectors enable measurements of radiation doses from tens of nanograys up to a few kilograys, when the total saturation of the signal of the so-called main dosimetric peak occurs. Only recently, unprecedented high-temperature emission of LiF detectors heated to temperatures up to 600 Degree-Sign C, was observed after exposures to radiation doses ranging from 1 kGy to 1 MGy. For quantification of the glow-curve shape changes of LiF:Mg,Cu,P detectors in this range of doses and determination of the absorbed dose, the Ultra-High Temperature Ratio coefficient (UHTR) was defined. This newly established dosimetric method was tested in a range of radiation qualities, such as gamma radiation, electron and proton beams, thermal neutron fields and high-energy mixed fields around the SPS and PS accelerators at CERN. The new method for ultra-high dose range monitoring with a single LiF:Mg,Cu,P detector, which is capable of covering at least twelve orders of magnitude of doses, can be used for dosimetry at high energy accelerators, thermonuclear fusion technology facilities and has great potential for accident dosimetry in particular. A number of dosimetric sets with LiF:Mg,Cu,P detectors are currently installed around the LHC at CERN.

  19. Multidose Stereotactic Radiosurgery (9 Gy × 3) of the Postoperative Resection Cavity for Treatment of Large Brain Metastases

    SciTech Connect (OSTI)

    Minniti, Giuseppe; Department of Neurological Sciences, Scientific Institute IRCCS Neuromed, Pozzilli ; Esposito, Vincenzo; Clarke, Enrico; Scaringi, Claudia; Lanzetta, Gaetano; Salvati, Maurizio; Neurosurgery Unit, Umberto I Hospital, University “Sapienza,” Rome ; Raco, Antonino; Bozzao, Alessandro; Maurizi Enrici, Riccardo

    2013-07-15

    Purpose: To evaluate the clinical outcomes with linear accelerator-based multidose stereotactic radiosurgery (SRS) to large postoperative resection cavities in patients with large brain metastases. Methods and Materials: Between March 2005 to May 2012, 101 patients with a single brain metastasis were treated with surgery and multidose SRS (9 Gy × 3) for large resection cavities (>3 cm). The target volume was the resection cavity with the inclusion of a 2-mm margin. The median cavity volume was 17.5 cm{sup 3} (range, 12.6-35.7 cm{sup 3}). The primary endpoint was local control. Secondary endpoints were survival and distant failure rates, cause of death, performance measurements, and toxicity of treatment. Results: With a median follow-up of 16 months (range, 6-44 months), the 1-year and 2-year actuarial survival rates were 69% and 34%, respectively. The 1-year and 2-year local control rates were 93% and 84%, with respective incidences of new distant brain metastases of 50% and 66%. Local control was similar for radiosensitive (non-small cell lung cancer and breast cancer) and radioresistant (melanoma and renal cell cancer) brain metastases. On multivariate Cox analysis stable extracranial disease, breast cancer histology, and Karnofsky performance status >70 were associated with significant survival benefit. Brain radionecrosis occurred in 9 patients (9%), being symptomatic in 5 patients (5%). Conclusions: Adjuvant multidose SRS to resection cavity represents an effective treatment option that achieves excellent local control and defers the use of whole-brain radiation therapy in selected patients with large brain metastases.

  20. Low Dose Radiation Response Curves, Networks and Pathways in Human Lymphoblastoid Cells Exposed from 1 to 10 cGy of Acute Gamma Radiation

    SciTech Connect (OSTI)

    Wyrobek, A. J.; Manohar, C. F.; Nelson, D. O.; Furtado, M. R.; Bhattacharya, M. S.; Marchetti, F.; Coleman, M.A.

    2011-04-18

    We investigated the low dose dependency of the transcriptional response of human cells to characterize the shape and biological functions associated with the dose response curve and to identify common and conserved functions of low dose expressed genes across cells and tissues. Human lymphoblastoid (HL) cells from two unrelated individuals were exposed to graded doses of radiation spanning the range of 1-10 cGy were analyzed by transcriptome profiling, qPCR and bioinformatics, in comparison to sham irradiated samples. A set of {approx}80 genes showed consistent responses in both cell lines; these genes were associated with homeostasis mechanisms (e.g., membrane signaling, molecule transport), subcellular locations (e.g., Golgi, and endoplasmic reticulum), and involved diverse signal transduction pathways. The majority of radiation-modulated genes had plateau-like responses across 1-10 cGy, some with suggestive evidence that transcription was modulated at doses below 1 cGy. MYC, FOS and TP53 were the major network nodes of the low-dose response in HL cells. Comparison our low dose expression findings in HL cells with those of prior studies in mouse brain after whole body exposure, in human keratinocyte cultures, and in endothelial cells cultures, indicates that certain components of the low dose radiation response are broadly conserved across cell types and tissues, independent of proliferation status.

  1. MFISH Measurements of Chromosomal Aberrations Individuals Exposed in Utero to Gamma-ray Doses from 5 to 20 cGy

    SciTech Connect (OSTI)

    Brenner, David J.

    2009-11-17

    Our plan was to identify and obtain blood from 36 individuals from the Mayak-in-utero exposed cohort who were exposed in utero only to gamma ray does doses fro 5 to 20 cGy. Our goal is to do mFISH and in a new development, single-arm mFISH on these samples to measure stable chromosome aberrations in these now adult individuals. The results were compared with matched control individuals (same age, same gender) available from the large control population which we are studying in the context of our plutonium worker study. The long term goal was to assess the results both in terms of the sensitivity of the developing embryo/fetus to low doses of ionizing radiation, and in terms of different potential mechanisms (expanded clonal origin vs. induced instability) for an increased risk.

  2. Simvastatin mitigates increases in risk factors for and the occurrence of cardiac disease following 10 Gy total body irradiation

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Lenarczyk, Marek; Su, Jidong; Haworth, Steven T.; Komorowski, Richard; Fish, Brian L.; Migrino, Raymond Q.; Harmann, Leanne; Hopewell, John W.; Kronenberg, Amy; Patel, Shailendra; et al

    2015-06-01

    The ability of simvastatin to mitigate the increases in risk factors for and the occurrence of cardiac disease after 10 Gy total body irradiation (TBI) was determined. This radiation dose is relevant to conditioning for stem cell transplantation and threats from radiological terrorism. Male rats received single dose TBI of 10 Gy. Age-matched, sham-irradiated rats served as controls. Lipid profile, heart and liver morphology and cardiac mechanical function were determined for up to 120 days after irradiation. TBI resulted in a sustained increase in total- and LDL-cholesterol (low-density lipoprotein-cholesterol), and triglycerides. Simvastatin (10 mg/kg body weight/day) administered continuously from 9more » days after irradiation mitigated TBI-induced increases in total- and LDL-cholesterol and triglycerides, as well as liver injury. TBI resulted in cellular peri-arterial fibrosis, whereas control hearts had less collagen and fibrosis. Simvastatin mitigated these morphological injuries. TBI resulted in cardiac mechanical dysfunction. Simvastatin mitigated cardiac mechanical dysfunction 20–120 days following TBI. To determine whether simvastatin affects the ability of the heart to withstand stress after TBI, injury from myocardial ischemia/reperfusion was determined in vitro. TBI increased the severity of an induced myocardial infarction at 20 and 80 days after irradiation. Simvastatin mitigated the severity of this myocardial infarction at 20 and 80 days following TBI. It is concluded simvastatin mitigated the increases in risk factors for cardiac disease and the extent of cardiac disease following TBI. This statin may be developed as a medical countermeasure for the mitigation of radiation-induced cardiac disease.« less

  3. Simvastatin mitigates increases in risk factors for and the occurrence of cardiac disease following 10 Gy total body irradiation

    SciTech Connect (OSTI)

    Lenarczyk, Marek; Su, Jidong; Haworth, Steven T.; Komorowski, Richard; Fish, Brian L.; Migrino, Raymond Q.; Harmann, Leanne; Hopewell, John W.; Kronenberg, Amy; Patel, Shailendra; Moulder, John E.; Baker, John E.

    2015-06-01

    The ability of simvastatin to mitigate the increases in risk factors for and the occurrence of cardiac disease after 10 Gy total body irradiation (TBI) was determined. This radiation dose is relevant to conditioning for stem cell transplantation and threats from radiological terrorism. Male rats received single dose TBI of 10 Gy. Age-matched, sham-irradiated rats served as controls. Lipid profile, heart and liver morphology and cardiac mechanical function were determined for up to 120 days after irradiation. TBI resulted in a sustained increase in total- and LDL-cholesterol (low-density lipoprotein-cholesterol), and triglycerides. Simvastatin (10 mg/kg body weight/day) administered continuously from 9 days after irradiation mitigated TBI-induced increases in total- and LDL-cholesterol and triglycerides, as well as liver injury. TBI resulted in cellular peri-arterial fibrosis, whereas control hearts had less collagen and fibrosis. Simvastatin mitigated these morphological injuries. TBI resulted in cardiac mechanical dysfunction. Simvastatin mitigated cardiac mechanical dysfunction 20–120 days following TBI. To determine whether simvastatin affects the ability of the heart to withstand stress after TBI, injury from myocardial ischemia/reperfusion was determined in vitro. TBI increased the severity of an induced myocardial infarction at 20 and 80 days after irradiation. Simvastatin mitigated the severity of this myocardial infarction at 20 and 80 days following TBI. It is concluded simvastatin mitigated the increases in risk factors for cardiac disease and the extent of cardiac disease following TBI. This statin may be developed as a medical countermeasure for the mitigation of radiation-induced cardiac disease.

  4. Lesotho-National Adaptation Plan Global Support Programme (NAP...

    Open Energy Info (EERE)

    Global Environment Facility (GEF), United Nations Framework Convention on Climate Change (UNFCCC), Global Water Partnership (GWP), German Society for International Cooperation...

  5. OLADE-Latin American and Caribbean Energy Efficiency Seminar...

    Open Energy Info (EERE)

    Panama, Mexico, Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, Venezuela, Barbados, Cuba, Grenada, Haiti, Jamaica,...

  6. Energy-Economic Information System (SIEE) | Open Energy Information

    Open Energy Info (EERE)

    Panama, Mexico, Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, Venezuela, Barbados, Cuba, Grenada, Haiti, Jamaica,...

  7. OLADE Sustainable Energy Planning Manual | Open Energy Information

    Open Energy Info (EERE)

    Panama, Mexico, Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, Venezuela, Barbados, Cuba, Grenada, Haiti, Jamaica,...

  8. Legal Energy Information System (SIEL) Database | Open Energy...

    Open Energy Info (EERE)

    Panama, Mexico, Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, Venezuela, Barbados, Cuba, Grenada, Haiti, Jamaica,...

  9. National Action Programmes on Desertification | Open Energy Informatio...

    Open Energy Info (EERE)

    Faso, Burundi, Cameroon, Cape Verde, Chad, Democratic Republic of Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Kenya, Lesotho,...

  10. REDD+ Country Readiness Preparation Proposals | Open Energy Informatio...

    Open Energy Info (EERE)

    getting-ready Country: Democratic Republic of Congo, Ghana, Guyana, Indonesia, Madagascar, Mexico, Suriname, Panama Middle Africa, Western Africa, South America,...

  11. Voltalia Guyane | Open Energy Information

    Open Energy Info (EERE)

    Guyana Sector: Renewable Energy Product: French developer and operator of renewable plants References: Voltalia Guyane1 This article is a stub. You can help OpenEI by...

  12. A Review of the World Bank Forest Carbon Partnership Facility...

    Open Energy Info (EERE)

    submitted by Democratic Republic of Congo, Ghana, Guyana, Indonesia, Madagascar, Mexico, Panama and Suriname can be accessed online at: http:www.wri.orggfi ." To access...

  13. Category:LEDS Example | Open Energy Information

    Open Energy Info (EERE)

    on Climate Change (PNMC) C China's National Climate Change Programme G Guyana's Low Carbon Development Strategy I India National Action Plan on Climate Change Indonesia National...

  14. Category:Latin America Region | Open Energy Information

    Open Energy Info (EERE)

    Guatemala Guyana H Haiti Honduras J Jamaica M Martinique Mexico N Nicaragua P Panama Paraguay Peru S Saint Barthlemy Saint Kitts and Nevis Saint Lucia Saint Vincent and the...

  15. CRC handbook of agricultural energy potential of developing countries

    SciTech Connect (OSTI)

    Duke, J.A.

    1986-01-01

    The contents of this book are: Introduction; Kenya; Korea (Republic of); Lesotho; Liberia; Malagasy; Malawi; Mali; Mauritania; Mexico, Mozambique, Nepal; Nicaragua; Niger; Nigeria; Pakistan; Panama; Paraguay; Peru; Philippines; Rwanda; Senegal; Sierra Leone; Somalia; Sri Lanka; Sudana; Surinam; Swaziland; Tanzania; Thailand; Togo; Uganda; Uruguay; Venezuela; Zaire; Zambia; Appendix I. Conventional and Energetic Yields; Appendix II, Phytomass Files; and References.

  16. CRC handbook of agricultural energy potential of developing countries. Volume I

    SciTech Connect (OSTI)

    Duke, J.A.

    1986-01-01

    The contents of this book are: Introduction, Argentina, Bangladesh, Benin, Bolivia, Botswana, Bourkina (Upper Volta), Brazil, Burma, Burundi, Cameroon, Chad, Chile, Columbia, Costa Rica, Djibouti, Dominican Republic, Ecuador, El Salvador, Ethiopia, French Guiana, Gambia, Ghana, Guatemala, Guinea, Guyana, Haiti, Honduras, India, Indonesia, Jamaica, Appendix I. Conventional and Energetic Yields, Appendix II, Phytomass Files, and References.

  17. ORISE: Radiological Terms Quick Reference Guide

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    slight drop in lymphocytes later (near 1 Gy) > 100 rads, > 1 Gy Hematopoietic Anorexia, nausea, vomiting, initial granulocytosis and lymphocytopenia > 6-800 rads, >6-8 Gy...

  18. South America, Central America, the Caribbean, and Mexico

    SciTech Connect (OSTI)

    Deal, C.

    1981-10-01

    Summaries of oil and gas drillings, well completions, production, exploratory wells, exploration activity and wildcat drilling were given for South America, Central America, the Caribbean, and Mexico. The countries, islands, etc. included Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Jamaica, Leeward and Windward Islands, Mexico, Netherlands Antilles, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, El Salvador, Surinam, Trinidad and Venezuela. 16 figures, 120 tables. (DP)

  19. South America: everybody is drilling almost everywhere

    SciTech Connect (OSTI)

    Not Available

    1980-08-15

    A group of studies describes accomplishments in 1980 in South America drilling and producing. There may be 3285 wells drilled during 1980, with the majority in Venezuela, Argentina and Peru, compared with a 2934 total for all countries on the continent in 1979. Reserves at the end of 1979 in South America exceeded 27 billion bbl, and production averaged 3.8 million bpd. Individual country reports are given for Venezuela, Argentina, Brazil, Trinidad, Peru, Ecuador, Colombia, Chile, Bolivia, Paraguay, Urauguay, and Guyana.

  20. Energy resources in southern Africa: a select bibliography

    SciTech Connect (OSTI)

    Cavan, A.

    1981-01-01

    The aims, progress, and possibilities involved in Southern Africa's energy development are the subject of this 473-item bibliography. The primary items of information described in this document are relatively recent (1975-81), originate from both indigenous and international sources, and are mostly in English, although a few are in French and Portuguese. The presented information focuses on the African continent, the Southern African region, and the nations of Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, South Africa, Tanzania, Zambia, and Zimbabwe. The energy source topics include alcohol, coal, gas, oil, solar, uranium, water, wind, and wood; as well as a general energy-development category.

  1. Search for: All records | SciTech Connect

    Office of Scientific and Technical Information (OSTI)

    (RT) (54 Gy locally advanced and 45 Gy postsurgery) and concomitant continuous-infusion 5-fluorouracil (5FU) (200 mgmsup 2d throughout RT). After 4 weeks, patients...

  2. Bioenergy Technologies Office … Federal Partnerships

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    ... Company Location Feedstock Capacity Groundbreaking Off-Take Agreements Gulf Coast Fats and Greases 82 MM gy TBA TBD McCarran, NV MSW 10 MM gy SpringSummer of 2015 ...

  3. BETO Project Management Review

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Company Location Feedstock Capacity Groundbreaking Off-Take Agreements Gulf Coast Fats and Greases 82.0 MM gy TBA TBD McCarran, NV MSW 10.0 MM gy SpringSummer of 2015 ...

  4. Improved Technique of Hydrogen Content Analysis by Slow Neutron Scattering

    DOE R&D Accomplishments [OSTI]

    Rainwater, L. J.; Havens, W. W. Jr.

    1945-02-28

    A slow-neutron-transmission method fro determining the H content of fluorcarbons is described (G.Y.)

  5. Emissions Scenarios, Costs, and Implementation Considerations of REDD Programs

    SciTech Connect (OSTI)

    Sathaye, Jayant; Andrasko, Ken; Chan, Peter

    2011-04-11

    Greenhouse gas emissions from the forestry sector are estimated to be 8.4 GtCO2-eq./year or about 17percent of the global emissions. We estimate that the cost forreducing deforestation is low in Africa and several times higher in Latin America and Southeast Asia. These cost estimates are sensitive to the uncertainties of how muchunsustainable high-revenue logging occurs, little understood transaction and program implementation costs, and barriers to implementation including governance issues. Due to lack of capacity in the affected countries, achieving reduction or avoidance of carbon emissions will require extensive REDD-plus programs. Preliminary REDD-plus Readiness cost estimates and program descriptions for Indonesia, Democratic Republic of the Congo, Ghana, Guyana and Mexico show that roughly one-third of potential REDD-plus mitigation benefits might come from avoided deforestation and the rest from avoided forest degradation and other REDD-plus activities.

  6. Carbon Dioxide, Hydrographic, and Chemical Data Obtained During the R/V Maurice Ewing Cruise in the Atlantic Ocean (WOCE Section A17, 4 January - 21 March 1994)

    SciTech Connect (OSTI)

    Kozyr, Alex

    2005-06-30

    This documentation discusses the procedures and methods used to measure total carbon dioxide (TCO2), total alkalinity (TALK), and pH at hydrographic stations during the R/V Maurice Ewing cruise in the South Atlantic Ocean on the A17 WOCE section. Conducted as part of the World Ocean Circulation Experiment (WOCE), this cruise was also a part of the French WOCE program consisting of three expeditions (CITHER 1, 2, and 3) focused on the South Atlantic Ocean. The A17 section was occupied during the CITHER 2 expedition, which began in Montevideo, Uruguay, on January 4, 1994 and finished in Cayenne, French Guyana, on March 21, 1994. During this period the ship stopped in Salvador de Bahia and Recife, Brazil, to take on supplies and exchange personnel. Upon completion of the cruise the ship transited to Fort de France, Martinique. Instructions for accessing the data are provided.

  7. SU-E-T-315: The Change of Optically Stimulated Luminescent Dosimeters (OSLDs) Sensitivity by Accumulated Dose and High Dose

    SciTech Connect (OSTI)

    Han, S; Jung, H; Kim, M; Ji, Y; Kim, K [University of Science and Technology, Daejeon (Korea, Republic of); Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Choi, S; Park, S; Yoo, H [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Yi, C [Korea Research Institute of Standards and Science, Daejeon (Korea, Republic of)

    2014-06-01

    Purpose: The objective of this study is to evaluate radiation sensitivity of optical stimulated luminance dosimeters (OSLDs) by accumulated dose and high dose. Methods: This study was carried out in Co-60 unit (Theratron 780, AECL, and Canada) and used InLight MicroStar reader (Landauer, Inc., Glenwood, IL) for reading. We annealed for 30 min using optical annealing system which contained fluorescent lamps (Osram lumilux, 24 W, 280 ?780 nm). To evaluate change of OSLDs sensitivity by repeated irradiation, the dosimeters were repeatedly irradiated with 1 Gy. And whenever a repeated irradiation, we evaluated OSLDs sensitivity. To evaluate OSLDs sensitivity after accumulated dose with 5 Gy, We irradiated dose accumulatively (from 1 Gy to 5 Gy) without annealing. And OSLDs was also irradiated with 15, 20, 30 Gy to certify change of OSLDs sensitivity after high dose irradiation. After annealing them, they were irradiated with 1Gy, repeatedly. Results: The OSLDs sensitivity increased up to 3% during irradiating seven times and decreased continuously above 8 times. That dropped by about 0.35 Gy per an irradiation. Finally, after 30 times irradiation, OSLDs sensitivity decreased by about 7%. For accumulated dose from 1 Gy to 5 Gy, OSLDs sensitivity about 1 Gy increased until 4.4% after second times accumulated dose compared with before that. OSLDs sensitivity about 1 Gy decreased by 1.6% in five times irradiation. When OSLDs were irradiated ten times with 1Gy after irradiating high dose (10, 15, 20 Gy), OSLDs sensitivity decreased until 6%, 9%, 12% compared with it before high dose irradiation, respectively. Conclusion: This study certified OSLDs sensitivity by accumulated dose and high dose. When irradiated with 1Gy, repeatedly, OSLDs sensitivity decreased linearly and the reduction rate of OSLDs sensitivity after high dose irradiation had dependence on irradiated dose.

  8. IRAS sources associated with nebulosities resembling Herbig-Haro objects

    SciTech Connect (OSTI)

    Persi, P.; Ferrari-Toniolo, M.; Busso, M.; Robberto, M.; Scaltriti, F.

    1988-04-01

    The IRAS Survey has been used to search 22 nebulosities resembling Herbig-Haro objects for evidence of newly forming stars. Half the peculiar nebulae are found to have associated IRAS sources. From a study of the energy distributions, obtained from JHKL photometry and IRAS flux densities, the physical characteristics of the sources have been derived. The IRAS sources 04073 + 3800(GY 10), 05173-0555(GY 14), and 05439 + 3035(GY 18) have been identified as possible low-mass protostars, while the sources 03134 + 5958(GY 5) and 21004 + 7811(GY 21) are T Tauri stars with nebular disks and surrounding dust envelopes of residual infall. Finally, the IRAS source 04591-0856, associated with the nebula GY 13, could be in an evolutionary stage intermediate between a protostar in the pure infall phase and that of an obscured T Tauri. 26 references.

  9. Search results | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    gy-electricity-consumption-and-efficiency Current search Search found 1 item Water Remove Water filter Bioenergy Remove Bioenergy filter Filter by Resource Type All Results (1)...

  10. Washington, DC.20585

    Office of Legacy Management (LM)

    Department of ,En&gy Washington, DC.20585 , ' . The Honorable Thomas, Murphy : ,, 414 Grant.Street Pittsburgh, Pennsylvania 15219 Dear Rayor Murphy:. Secretary of Energy ...

  11. U.S. Department of Energy Fuel Cell Technologies Program

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    energy gy p proj jects efficiency * Double renewable energy * One million plug-in hybrid cars generation by 2012 Presidential on the road by 2015 Priorities * Weatherize one ...

  12. Guernsey Renewable Energy Commission GREC | Open Energy Information

    Open Energy Info (EERE)

    Renewable Energy Commission GREC Jump to: navigation, search Name: Guernsey Renewable Energy Commission (GREC) Place: St. Martin, Guernsey, Channel Islands, United Kingdom Zip: GY1...

  13. Alderney Renewable Energy ARE | Open Energy Information

    Open Energy Info (EERE)

    Alderney Renewable Energy ARE Jump to: navigation, search Name: Alderney Renewable Energy (ARE) Place: Alderney, Channel Islands, United Kingdom Zip: GY9 3XY Product: AREl develops...

  14. Search results | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    gy-electricity-consumption-and-efficiency Download Alternative Energy Sources- An Interdisciplinary Module for Energy Education Find activities focused on renewable energy sources...

  15. Shanghai, China: Energy Resources | Open Energy Information

    Open Energy Info (EERE)

    Energy Linde LienHwa LLH RenGyS Renaissance Carbon Investment Ltd SNERDI Shanghai Nuclear Engineering Research and Design Institute Shanghai TL Chemical Company References...

  16. Shikun Binui Arison Group | Open Energy Information

    Open Energy Info (EERE)

    Ramat Gan, Israel Zip: 55215 Product: String representation "Shikun & Binui ... gy and ecology." is too long. References: Shikun & Binui Arison Group1 This article is a stub. You...

  17. OF THE ADMINISTRATOR OF THE BONNEVILLE POWER ADMINISTRATION

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    public-owned distribution agencies, Government agencies and private utility enterprises. The ene1gy of the two great dams on the Columbia river-Grand Coulee and...

  18. SU-E-T-489: Plan Comparisons of Re-Irradiation Treatment of Three Intensity Modulated Techniques

    SciTech Connect (OSTI)

    Lian, J; Tang, X; Liu, R

    2014-06-01

    Purpose: There have been controversial reports on the comparison of dosimetric quality of TomoTherapy (Tomo), VMAT and IMRT. One of the main reasons is the sampled cases are often not dosimetrically challenging enough to test the limit of optimization/delivery modalities. We chose difficult re-irradiation cases when certain organ at risk (OAR) requires extremely low dose to examine the ability of OAR sparing of three main intensity modulated techniques. Methods: Three previous treated patients with disease site on head and neck (HN), brain and lung are planned for reirradiation treatment. The Tomo planning used jaw 2.5cm and pitch 0.3. VMAT and IMRT were planned on Pinnacle for a Varian 21iX Linac with MLC leaf width 5mm. VMAT plan used 2 Arcs and IMRT plan had beams 11–13. The dosimetric endpoints and treatment time were compared for each technique of each patient. Results: Plans of three techniques cover PTV similarly. The HN case requires PTV dose 60Gy but to limit dose of cord which is 8mm away <12Gy. The cord dose of Tomo, VMAT and IMRT plan is 11.6Gy, 11.3Gy and 11.0Gy, respectively. The brain case has PTV prescription 50.4 Gy while requiring the dose of brainstem < 28Gy. Tomo, VMAT and IMRT plan generate brainstem dose 27.6Gy, 27.6Gy and 27.1Gy respectively. For the lung case, PTV was prescribed 42.5Gy but cord dose constraint was 22.5Gy. The cord dose is optimized to 22.3Gy, 20.8Gy and 21.4Gy by Tomo, VMAT and IMRT, respectively. The delivery time if normalized to Tomo is 47.0%/145.6% (VMAT/IMRT), 33.3%/106.3% and 74.1%/245.4% for HN, brain and lung case, respectively. Conclusion: Difficult re-irradiation cases were used to test the limit of three intensity modulated techniques. Tomo, VMAT and IMRT show similar dosimetry while VMAT is the most efficient one and IMRT is the least.

  19. Whole Brain Irradiation With Hippocampal Sparing and Dose Escalation on Multiple Brain Metastases: A Planning Study on Treatment Concepts

    SciTech Connect (OSTI)

    Prokic, Vesna; Wiedenmann, Nicole; Fels, Franziska; Schmucker, Marianne; Nieder, Carsten; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromso, Tromso ; Grosu, Anca-Ligia

    2013-01-01

    Purpose: To develop a new treatment planning strategy in patients with multiple brain metastases. The goal was to perform whole brain irradiation (WBI) with hippocampal sparing and dose escalation on multiple brain metastases. Two treatment concepts were investigated: simultaneously integrated boost (SIB) and WBI followed by stereotactic fractionated radiation therapy sequential concept (SC). Methods and Materials: Treatment plans for both concepts were calculated for 10 patients with 2-8 brain metastases using volumetric modulated arc therapy. In the SIB concept, the prescribed dose was 30 Gy in 12 fractions to the whole brain and 51 Gy in 12 fractions to individual brain metastases. In the SC concept, the prescription was 30 Gy in 12 fractions to the whole brain followed by 18 Gy in 2 fractions to brain metastases. All plans were optimized for dose coverage of whole brain and lesions, simultaneously minimizing dose to the hippocampus. The treatment plans were evaluated on target coverage, homogeneity, and minimal dose to the hippocampus and organs at risk. Results: The SIB concept enabled more successful sparing of the hippocampus; the mean dose to the hippocampus was 7.55 {+-} 0.62 Gy and 6.29 {+-} 0.62 Gy, respectively, when 5-mm and 10-mm avoidance regions around the hippocampus were used, normalized to 2-Gy fractions. In the SC concept, the mean dose to hippocampus was 9.8 {+-} 1.75 Gy. The mean dose to the whole brain (excluding metastases) was 33.2 {+-} 0.7 Gy and 32.7 {+-} 0.96 Gy, respectively, in the SIB concept, for 5-mm and 10-mm hippocampus avoidance regions, and 37.23 {+-} 1.42 Gy in SC. Conclusions: Both concepts, SIB and SC, were able to achieve adequate whole brain coverage and radiosurgery-equivalent dose distributions to individual brain metastases. The SIB technique achieved better sparing of the hippocampus, especially when a10-mm hippocampal avoidance region was used.

  20. Integration of Functional MRI and White Matter Tractography in Stereotactic Radiosurgery Clinical Practice

    SciTech Connect (OSTI)

    Pantelis, Evaggelos; Papadakis, Nikolaos; Verigos, Kosmas; Stathochristopoulou, Irene; Antypas, Christos; Lekas, Leonidas; Tzouras, Argyrios; Georgiou, Evangelos; Salvaras, Nikolaos

    2010-09-01

    Purpose: To study the efficacy of the integration of functional magnetic resonance imaging (fMRI) and diffusion tensor imaging tractography data into stereotactic radiosurgery clinical practice. Methods and Materials: fMRI and tractography data sets were acquired and fused with corresponding anatomical MR and computed tomography images of patients with arteriovenous malformation (AVM), astrocytoma, brain metastasis, or hemangioma and referred for stereotactic radiosurgery. The acquired data sets were imported into a CyberKnife stereotactic radiosurgery system and used to delineate the target, organs at risk, and nearby functional structures and fiber tracts. Treatment plans with and without the incorporation of the functional structures and the fiber tracts into the optimization process were developed and compared. Results: The nearby functional structures and fiber tracts could receive doses of >50% of the maximum dose if they were excluded from the planning process. In the AVM case, the doses received by the Broadmann-17 structure and the optic tract were reduced to 700 cGy from 1,400 cGy and to 1,200 cGy from 2,000 cGy, respectively, upon inclusion into the optimization process. In the metastasis case, the motor cortex received 850 cGy instead of 1,400 cGy; and in the hemangioma case, the pyramidal tracts received 780 cGy instead of 990 cGy. In the astrocytoma case, the dose to the motor cortex bordering the lesion was reduced to 1,900 cGy from 2,100 cGy, and therefore, the biologically equivalent dose in three fractions was delivered instead. Conclusions: Functional structures and fiber tracts could receive high doses if they were not considered during treatment planning. With the aid of fMRI and tractography images, they can be delineated and spared.

  1. Shorter-Course Whole-Brain Radiotherapy for Brain Metastases in Elderly Patients

    SciTech Connect (OSTI)

    Rades, Dirk; Evers, Jasmin N.; Veninga, Theo; Stalpers, Lukas J.A.; Lohynska, Radka; Schild, Steven E.

    2011-11-15

    Purpose: Many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone. Using 10 Multiplication-Sign 3 Gy in 2 weeks is the standard regimen in most centers. Regarding the extraordinarily poor survival prognosis of elderly patients with multiple brain metastases, a shorter WBRT regimen would be preferable. This study compared 10 Multiplication-Sign 3 Gy with 5 Multiplication-Sign 4 Gy in elderly patients ({>=}65 years). Methods and Materials: Data from 455 elderly patients who received WBRT alone for brain metastases were retrospectively analyzed. Survival and local (= intracerebral) control of 293 patients receiving 10 Multiplication-Sign 3 Gy were compared with 162 patients receiving 5 Multiplication-Sign 4 Gy. Eight additional potential prognostic factors were investigated including age, gender, Karnofsky performance score (KPS), primary tumor, number of brain metastases, interval from tumor diagnosis to WBRT, extracerebral metastases, and recursive partitioning analysis (RPA) class. Results: The 6-month overall survival rates were 29% after 5 Multiplication-Sign 4 Gy and 21% after 10 Multiplication-Sign 3 Gy (p = 0.020). The 6-month local control rates were 12% and 10%, respectively (p = 0.32). On multivariate analysis, improved overall survival was associated with KPS {>=} 70 (p < 0.001), only one to three brain metastases (p = 0.029), no extracerebral metastasis (p = 0.012), and lower RPA class (p < 0.001). Improved local control was associated with KPS {>=} 70 (p < 0.001), breast cancer (p = 0.029), and lower RPA class (p < 0.001). Conclusions: Shorter-course WBRT with 5 Multiplication-Sign 4 Gy was not inferior to 10 Multiplication-Sign 3 Gy with respect to overall survival or local control in elderly patients. 5 Multiplication-Sign 4 Gy appears preferable for the majority of these patients.

  2. Is Intermediate Radiation Dose Escalation With Concurrent Chemotherapy for Stage III NonSmall-Cell Lung Cancer Beneficial? A Multi-Institutional Propensity Score MatchedAnalysis

    SciTech Connect (OSTI)

    Rodrigues, George; Oberije, Cary; Senan, Suresh; Tsujino, Kayoko; Wiersma, Terry; Moreno-Jimenez, Marta; Kim, Tae Hyun; Marks, Lawrence B.; Rengan, Ramesh; De Petris, Luigi; Ramella, Sara; DeRuyck, Kim; De Dios, Nria Rodriguez; Warner, Andrew; Bradley, Jeffrey D.; Palma, David A.

    2015-01-01

    Purpose: The clinical benefits and risks of dose escalation (DE) for stage III nonsmall-cell lung cancer (NSCLC) remain uncertain despite the results from Radiation Therapy Oncology Group (RTOG) protocol 0617. There is significant heterogeneity of practice, with many clinicians prescribing intermediate dose levels between the 0617 study arms of 60 and 74Gy. This study investigated whether this strategy is associated with any survival benefits/risks by analyzing a large multi-institutional database. Methods and Materials: An individual patient database of stage III NSCLC patients treated with radical intent concurrent chemoradiation therapy was created (13 institutions, n=1274 patients). Patients were divided into 2 groups based on tumor Biological Effective Dose at 10 Gy (BED 10): those receiving standard dose (SD; n=552), consisting of 72Gy?BED 10?76.8Gy (eg 60-64Gy/30-32 fractions [fr]), and those receiving intermediate dose (ID; n=497), consisting of 76.8GyGy (eg >64Gy/32 fr and <74Gy/37 fr), with lower-dose patients (n=225) excluded from consideration. Patients were then matched using propensity scores, leading to 2 matched groups of 196 patients. Outcomes were compared using various statistics including interquartile range (IQR), Kaplan-Meier curves, and adjusted Cox regression analysis. Results: Matched groups were found to be balanced except for N stage (more N3 disease in SD), median treatment year (SD in 2003; ID in 2007), platinum and taxane chemotherapy (SD in 28%; ID in 39%), and median follow-up (SD were 89months; ID were 40months). Median dose fractionation was 60Gy/30 fr in SD (BED 10 IQR: 72.0-75.5Gy) and 66Gy/33 fr (BED 10 IQR: 78.6-79.2Gy) in ID. Survival curves for SD and ID matched cohorts were statistically similar (P=.27); however, a nonstatistically significant trend toward better survival for ID was observed after 15months (median survival SD: 19.3months; ID: 21.0months). There was an increase in grades III to V lung toxicity associated with ID (13.0% vs 4.9%, respectively). Conclusions: No significant overall survival benefits were found with intermediate DE; however, more grade III or greater lung toxicity was observed. The separation of survival curves after 15months of follow-up suggests that a small overall survival improvement associated with intermediate DE cannot be excluded.

  3. Geothermal regime and thermal history of the Llanos Basin, Columbia

    SciTech Connect (OSTI)

    Bachu, S.; Underschultz, J.R.; Ramon, J.C.; Villegas, M.E.

    1995-01-01

    The Llanos basin is a siliciclastic foreland sub-Andean sedimentary basin located in Columbia between the Cordillera Oriental and the Guyana Precambrian shield. Data on bottom-hole temperature, lithology, porosity, and vitrinite reflectance from all 318 wells drilled in the central and southern parts of the basin were used to analyze its geothermal regime and thermal history. Average geothermal gradients in the Llanos basin decrease generally with depth and westward toward the fold and thrust belt. The geothermal regime is controlled by a moderate, generally westward-decreasing basement heat flow, by depositional and compaction factors, and, in places, by advection by formation waters. Compaction leads to increased thermal conductivity with depth, whereas westward downdip flow in deep sandstone formations may exert a cooling effect in the central-western part of the basin. Vitrinite reflectance variation with depth shows a major discontinuity at the pre-Cretaceous unconformity. Areally, vitrinite reflectance increases southwestward in Paleozoic strata and northwestward in post-Paleozoic strata. These patterns indicate that the thermal history of the basin probably includes three thermal events that led to peaks in oil generation: a Paleozoic event in the southwest, a failed Cretaceous rifting event in the west, and an early Tertiary back-arc event in the west. Rapid cooling since the last thermal event is possibly caused by subhorizontal subduction of cold oceanic lithospheric plate.

  4. SU-E-T-322: The Evaluation of the Gafchromic EBT3 Film in Low Dose 6 MV X-Ray Beams with Different Scanning Modes

    SciTech Connect (OSTI)

    Lee, H; Sung, J; Yoon, M; Kim, D; Chung, W

    2014-06-01

    Purpose: We have evaluated the response of the Gafchromic EBT3 film in low dose for 6 MV x-ray beams with two scanning modes, the reflection scanning mode and the transmission scanning mode. Methods: We irradiated the Gafcromic EBT3 film using a 60 degree enhanced dynamic wedge (EDW) with 6 MV x-ray beams from Clinac iX Linear accelerator (Varian Medical Systems, Palo Alto, CA). The irradiated Gafchromic EBT3 film was scanned with different scanning modes, the reflection scanning mode and the transmission scanning mode. The scanned Gafchromic EBT3 film was analyzed with MATLAB. Results: When 7.2 cGy was irradiated to the Gafchromic EBT3 film, the uncertainty was 0.54 cGy with reflection scanning mode and was 0.88 cGy with transmission scanning mode. When 24 cGy was irradiated to the Gafchromic EBT3 film, the uncertainty was similar to the case of 7.2 cGy irradiation showing 0.51 cGy of uncertainty with reflection scanning mode and 0.87 cGy of uncertainty with transmission scanning mode. The result suggests that the reflection mode should be used in Gafchromic EBT3 film for low irradiation. Conclusion: The result suggests that the reflection mode should be used in Gafchromic EBT3 film for low irradiation.

  5. Low Dose Suppression of Neoplastic Transformation in Vitro

    SciTech Connect (OSTI)

    John Leslie Redpath

    2012-05-01

    This grant was to study the low dose suppression of neoplastic transformation in vitro and the shape of the dose-response curve at low doses and dose-rates of ionizing radiation. Previous findings had indicated a suppression of transformation at dose <10cGy of low-LET radiation when delivered at high dose-rate. The present study indicates that such suppression extends out to doses in excess of 100cGy when the dose (from I-125 photons) is delivered at dose-rates as low as 0.2 mGy/min and out to in excess of {approx}25cGy the highest dose studied at the very low dose-rate of 0.5 mGy/day. We also examined dose-rate effects for high energy protons (which are a low-LET radiation) and suppression was evident below {approx}10cGy for high dose-rate delivery and at least out to 50cGy for low dose-rate (20cGy/h) delivery. Finally, we also examined the effect of low doses of 1 GeV/n iron ions (a high-LET radiation) delivered at high dose-rate on transformation at low doses and found a suppression below {approx}10cGy that could be attributable to an adaptive response in bystander cells induced by the associated low-LET delta rays. These results have implications for cancer risk assessment at low doses.

  6. Tropical Africa: Land use, biomass, and carbon estimates for 1980

    SciTech Connect (OSTI)

    Brown, S.; Gaston, G.; Daniels, R.C.

    1996-06-01

    This document describes the contents of a digital database containing maximum potential aboveground biomass, land use, and estimated biomass and carbon data for 1980 and describes a methodology that may be used to extend this data set to 1990 and beyond based on population and land cover data. The biomass data and carbon estimates are for woody vegetation in Tropical Africa. These data were collected to reduce the uncertainty associated with the possible magnitude of historical releases of carbon from land use change. Tropical Africa is defined here as encompassing 22.7 x 10{sup 6} km{sup 2} of the earth`s land surface and includes those countries that for the most part are located in Tropical Africa. Countries bordering the Mediterranean Sea and in southern Africa (i.e., Egypt, Libya, Tunisia, Algeria, Morocco, South Africa, Lesotho, Swaziland, and Western Sahara) have maximum potential biomass and land cover information but do not have biomass or carbon estimate. The database was developed using the GRID module in the ARC/INFO{sup TM} geographic information system. Source data were obtained from the Food and Agriculture Organization (FAO), the U.S. National Geophysical Data Center, and a limited number of biomass-carbon density case studies. These data were used to derive the maximum potential and actual (ca. 1980) aboveground biomass-carbon values at regional and country levels. The land-use data provided were derived from a vegetation map originally produced for the FAO by the International Institute of Vegetation Mapping, Toulouse, France.

  7. Low dose ionizing radiation detection using conjugated polymers

    SciTech Connect (OSTI)

    Silva, E.A.B.; Borin, J.F.; Nicolucci, P.; Graeff, C.F.O.; Netto, T. Ghilardi; Bianchi, R.F.

    2005-03-28

    In this work, the effect of gamma radiation on the optical properties of poly[2-methoxy-5-(2{sup '}-ethylhexyloxy)-p-phenylenevinylene] (MEH-PPV) is studied. The samples were irradiated at room temperature with different doses from 0 Gy to 152 Gy using a {sup 60}Co gamma ray source. For thin films, significant changes in the UV-visible spectra were only observed at high doses (>1 kGy). In solution, shifts in absorption peaks are observed at low doses (<10 Gy), linearly dependent on dose. The shifts are explained by conjugation reduction, and possible causes are discussed. Our results indicate that MEH-PPV solution can be used as a dosimeter adequate for medical applications.

  8. Search results | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    gy-electricity-consumption-and-efficiency Current search Search found 1 item Water Remove Water filter Homes Remove Homes filter Filter by Resource Type All Results (1) Lesson Plan...

  9. GAOH Offshore | Open Energy Information

    Open Energy Info (EERE)

    GAOH Offshore Jump to: navigation, search Name: GAOH Offshore Place: St Peter Port, United Kingdom Zip: GY1 4EE Sector: Wind energy Product: Intends to become the preferred...

  10. Property:Building/SPPurchasedEngyForPeriodMwhYrTotal | Open Energy...

    Open Energy Info (EERE)

    gyForPeriodMwhYrTotal" Showing 25 pages using this property. (previous 25) (next 25) S Sweden Building 05K0001 + 4228.0 + Sweden Building 05K0002 + 1501.1 + Sweden Building 05K0003...

  11. SECTION III: NUCLEAR THEORY

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    V. Crucill, M. Gulino, M. La Cognata, L. Lamia, F. Mud, R.G. Pizzone, S. Romano, M. L. Sergi, Z. Elekes, Z. Flp, G. Gyürky, G. Kiss, and E. Somorjai Are...

  12. GenDrive Limited | Open Energy Information

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    GenDrive Limited Jump to: navigation, search Name: GenDrive Limited Place: Cambridge, United Kingdom Zip: CB23 3GY Sector: Renewable Energy, Solar, Wind energy Product: Developing...

  13. doi:10.1016/j.jenvrad.2004.01.014

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    medaka (a small fish native to Asia) were chronically irradiated at the highest dose rate possible within the facility (350 150 mGy d 1 ). Irradiated fish produced fewer ...

  14. Summary - Preliminary TRA of the Calcine Disposition Project

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Assessment (TRA) is tric-based process a CDP y Office of E he Calci ar ssued ic with ste o on e and late For he ss gy nd in listed o be 4) * * * * * * * * Th am * * Sig ava rev ...

  15. Property:Building/SPPurchasedEngyForPeriodMwhYrNaturalGas | Open...

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    gyForPeriodMwhYrNaturalGas Jump to: navigation, search This is a property of type String. Natural gas Pages using the property "BuildingSPPurchasedEngyForPeriodMwhYrNaturalGas"...

  16. Individualized 3D Reconstruction of Normal Tissue Dose for Patients With Long-term Follow-up: A Step Toward Understanding Dose Risk for Late Toxicity

    SciTech Connect (OSTI)

    Ng, Angela; Brock, Kristy K.; Sharpe, Michael B.; Department of Radiation Oncology, University of Toronto, Toronto, Ontario ; Moseley, Joanne L.; Craig, Tim; Department of Radiation Oncology, University of Toronto, Toronto, Ontario ; Hodgson, David C.

    2012-11-15

    Purpose: Understanding the relationship between normal tissue dose and delayed radiation toxicity is an important component of developing more effective radiation therapy. Late outcome data are generally available only for patients who have undergone 2-dimensional (2D) treatment plans. The purpose of this study was to evaluate the accuracy of 3D normal tissue dosimetry derived from reconstructed 2D treatment plans in Hodgkin's lymphoma (HL) patients. Methods and Materials: Three-dimensional lung, heart, and breast volumes were reconstructed from 2D planning radiographs for HL patients who received mediastinal radiation therapy. For each organ, a reference 3D organ was modified with patient-specific structural information, using deformable image processing software. Radiation therapy plans were reconstructed by applying treatment parameters obtained from patient records to the reconstructed 3D volumes. For each reconstructed organ mean dose (D{sub mean}) and volumes covered by at least 5 Gy (V{sub 5}) and 20Gy (V{sub 20}) were calculated. This process was performed for 15 patients who had both 2D and 3D planning data available to compare the reconstructed normal tissue doses with those derived from the primary CT planning data and also for 10 historically treated patients with only 2D imaging available. Results: For patients with 3D planning data, the normal tissue doses could be reconstructed accurately using 2D planning data. Median differences in D{sub mean} between reconstructed and actual plans were 0.18 Gy (lungs), -0.15 Gy (heart), and 0.30 Gy (breasts). Median difference in V{sub 5} and V{sub 20} were less than 2% for each organ. Reconstructed 3D dosimetry was substantially higher in historical mantle-field treatments than contemporary involved-field mediastinal treatments: average D{sub mean} values were 15.2 Gy vs 10.6 Gy (lungs), 27.0 Gy vs 14.3 Gy (heart), and 8.0 Gy vs 3.2 Gy (breasts). Conclusions: Three-dimensional reconstruction of absorbed dose to organs at risk can be estimated accurately many years after exposure by using limited 2D data. Compared to contemporary involved-field treatments, normal tissue doses were significantly higher in historical mantle-field treatments. These methods build capacity to quantify the relationship between 3D normal tissue dose and observed late effects.

  17. Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost

    SciTech Connect (OSTI)

    Small, Katherine; Kelly, Chris; Beldham-Collins, Rachael; Gebski, Val

    2013-03-15

    A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans. CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions. CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy). IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.

  18. Phase I Three-Dimensional Conformal Radiation Dose Escalation Study in Newly Diagnosed Glioblastoma: Radiation Therapy Oncology Group Trial 98-03

    SciTech Connect (OSTI)

    Tsien, Christina Moughan, Jennifer; Michalski, Jeff M.; Gilbert, Mark R.; Purdy, James; Simpson, Joseph; Kresel, John J.; Curran, Walter J.; Diaz, Aidnag; Mehta, Minesh P.

    2009-03-01

    Purpose: To evaluate in a Phase I trial the feasibility and toxicity of dose-escalated three-dimensional conformal radiotherapy (3D-CRT) concurrent with chemotherapy in patients with primary supratentorial glioblastoma (GBM). Methods and Materials: A total of 209 patients were enrolled. All received 46 Gy in 2-Gy fractions to the first planning target volume (PTV{sub 1}), defined as the gross tumor volume (GTV) plus 1.8 cm. A subsequent boost was given to PTV{sub 2}, defined as GTV plus 0.3 cm. Patients were stratified into two groups (Group 1: PTV{sub 2} <75 cm{sup 3}; Group 2: PTV{sub 2} {>=}75 cm{sup 3}). Four RT dose levels were evaluated: 66, 72, 78, and 84 Gy. Carmustine 80 mg/m{sup 2} was given during RT, then every 8 weeks for 6 cycles. Pretreatment characteristics were well balanced. Results: Acute and late Grade 3/4 RT-related toxicities were no more frequent at higher RT dose or with larger tumors. There were no dose-limiting toxicities (acute Grade {>=}3 irreversible central nervous system toxicities) observed on any dose level in either group. On the basis of the absence of dose-limiting toxicities, dose was escalated to 84 Gy in both groups. Late RT necrosis was noted at 66 Gy (1 patient), 72 Gy (2 patients), 78 Gy (2 patients), and 84 Gy (3 patients) in Group 1. In Group 2, late RT necrosis was noted at 78 Gy (1 patient) and 84 Gy (2 patients). Median time to RT necrosis was 8.8 months (range, 5.1-12.5 months). Median survival in Group 1 was 11.6-19.3 months. Median survival in Group 2 was 8.2-13.9 months. Conclusions: Our study shows the feasibility of delivering higher than standard (60 Gy) RT dose with concurrent chemotherapy for primary GBM, with an acceptable risk of late central nervous system toxicity.

  19. A Treatment Planning Method for Sequentially Combining Radiopharmaceutical Therapy and External Radiation Therapy;External beam therapy; Radiopharmaceutical therapy; Three-dimensional dosimetry; Treatment planning

    SciTech Connect (OSTI)

    Hobbs, Robert F.; McNutt, Todd; Baechler, Sebastien; He Bin; Esaias, Caroline E.; Frey, Eric C.; Loeb, David M.; Wahl, Richard L.; Shokek, Ori; Sgouros, George

    2011-07-15

    Purpose: Effective cancer treatment generally requires combination therapy. The combination of external beam therapy (XRT) with radiopharmaceutical therapy (RPT) requires accurate three-dimensional dose calculations to avoid toxicity and evaluate efficacy. We have developed and tested a treatment planning method, using the patient-specific three-dimensional dosimetry package 3D-RD, for sequentially combined RPT/XRT therapy designed to limit toxicity to organs at risk. Methods and Materials: The biologic effective dose (BED) was used to translate voxelized RPT absorbed dose (D{sub RPT}) values into a normalized total dose (or equivalent 2-Gy-fraction XRT absorbed dose), NTD{sub RPT} map. The BED was calculated numerically using an algorithmic approach, which enabled a more accurate calculation of BED and NTD{sub RPT}. A treatment plan from the combined Samarium-153 and external beam was designed that would deliver a tumoricidal dose while delivering no more than 50 Gy of NTD{sub sum} to the spinal cord of a patient with a paraspinal tumor. Results: The average voxel NTD{sub RPT} to tumor from RPT was 22.6 Gy (range, 1-85 Gy); the maximum spinal cord voxel NTD{sub RPT} from RPT was 6.8 Gy. The combined therapy NTD{sub sum} to tumor was 71.5 Gy (range, 40-135 Gy) for a maximum voxel spinal cord NTD{sub sum} equal to the maximum tolerated dose of 50 Gy. Conclusions: A method that enables real-time treatment planning of combined RPT-XRT has been developed. By implementing a more generalized conversion between the dose values from the two modalities and an activity-based treatment of partial volume effects, the reliability of combination therapy treatment planning has been expanded.

  20. Strategic Energy Planning Project: Santa Ynez Chumash Environmental Office

    Energy Savers [EERE]

    TITLE Name of Presenter Str ategic Ener gy Planning Project Santa Ynez Chumash Environmental Office Cher lyn Ser uto J osh Simmons Ener gy Specialist Environmental Director Santa Ynez Band of Chumash Indians November 15, 2011 Step 1: Know Our Energy Use Casino Hotel Residences Tribal Hall and Health Clinic Employee Resource Center Restauraunt Gas Station Step 2: Envision our Energy Future Step 3: Assess our Options * Whole Building Energy Management Ø PG&E Integrated Energy Audit Ø Gas

  1. SU-E-T-371: Validation of Organ Doses Delivered During Craniospinal Irradiation with Helical Tomotherapy

    SciTech Connect (OSTI)

    Perez-Andujar, A; Chen, J; Garcia, A; Haas-Kogan, D

    2014-06-01

    Purpose: New techniques have been developed to deliver more conformal treatments to the craniospinal axis. One concern, however, is the widespread low dose delivered and implications for possible late effects. The purpose of this work is for the first time to validate the organ doses calculated by the treatment planning system (TPS), including out-of-field doses for a pediatric craniospinal treatment (CSI). Methods: A CSI plan prescribed to 23.4 Gy and a posterior fossa boost plan to 30.6 Gy (total dose 54.0 Gy) was developed for a pediatric anthropomorphic phantom representing a 13 yearold- child. For the CSI plan, the planning target volumes (PTV) consisted of the brain and spinal cord with 2 mm and 5 mm expansions, respectively. Organs at risk (OAR) were contoured and included in the plan optimization. The plans were delivered on a helical tomotherapy unit. Thermoluminescent dosimeters (TLDs) were used to measure the dose at 54 positions within the PTV and OARs. Results: For the CSI treatment, the mean percent difference between TPS dose calculations and measurements was 5% for the PTV and 10% for the OARs. For the boost, the average was 3% for the PTV. The percent difference for the OARs, which lie outside the field and received a small fraction of the prescription dose, varied from 15% to 200%. However in terms of absolute dose, the average difference between measurement and TPS per treatment Gy was 2 cGy/Gy and 3 mGy/Gy for the CSI and boost plans, respectively. Conclusion: There was good agreement between doses calculated by the TPS and measurements for the CSI treatment. Higher percent differences were observed for out-of-field doses in the boost plan, but absolute dose differences were very small compared to the prescription dose. These findings can help in the estimation of late effects after radiotherapy for pediatric patients.

  2. Poster — Thur Eve — 64: Preliminary investigation of arc configurations for optimal sparing of normal tissue in hypofractionated stereotactic radiotherapy (HF-SRT) of multiple brain metastases using a 5mm interdigitating micro-multileaf collimator

    SciTech Connect (OSTI)

    Leavens, C; Wronski, M; Lee, YK; Ruschin, M; Soliman, H; Sahgal, A

    2014-08-15

    Purpose: To evaluate normal tissue sparing in intra-cranial HF-SRT, comparing various arc configurations with the Synergy Beam Modulator (SynBM) and Agility linacs, the latter incorporating leaf interdigitation and backup jaws. Methods: Five patients with multiple brain metastases (BMs), (5 BMs (n=2), 3 BMs (n=3)) treated with HF-SRT using 25 Gy (n=2) or 30 Gy (n=3) in 5 fractions, were investigated. Clinical treatment plans used the SynBM. Each patient was retrospectively re-planned on Agility, employing three planning strategies: (A) one isocenter and dedicated arc for each BM; (B) a single isocenter, centrally placed with respect to BMs; (C) the isocenter and arc configuration used in the SynBM plan, where closely spaced (<5cm) BMs used a dedicated isocenter and arcs. Agility plans were normalized for PTV coverage and heterogeneity. Results and Conclusion: Strategy A obtained the greatest improvements over the SynBM plan, where the maximum OAR dose, and mean dose to normal brain (averaged for all patients) were reduced by 55cGy and 25cGy, respectively. Strategy B was limited by having a single isocenter, hence less jaw shielding and increased MLC leakage. The maximum OAR dose was reduced by 13cGy, however mean dose to normal brain increased by 84cGy. Strategy C reduced the maximum OAR dose and mean dose to normal brain by 32cGy and 9cGy, respectively. The results from this study indicate that, for intra-cranial HF-SRT of multiple BMs, Agility plans are equal or better than SynBM plans. Further planning is needed to investigate dose sparing using Strategy A and the SynBM.

  3. Sex-dependent Differences in Intestinal Tumorigenesis Induced in Apc1638N/+ Mice by Exposure to {gamma} Rays

    SciTech Connect (OSTI)

    Trani, Daniela; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia; Maastricht Radiation Oncology Lab, GROW-School for Oncology and Developmental Biology, University of Maastricht ; Moon, Bo-Hyun; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia ; Kallakury, Bhaskar; Hartmann, Dan P.; Datta, Kamal; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia ; Fornace, Albert J.

    2013-01-01

    Purpose: The purpose of the present study was to assess the effect of 1 and 5 Gy radiation doses and to investigate the interplay of gender and radiation with regard to intestinal tumorigenesis in an adenomatous polyposis coli (APC) mutant mouse model. Methods and Materials: Apc1638N/+ female and male mice were exposed whole body to either 1 Gy or 5 Gy of {gamma} rays and euthanized when most of the treated mice became moribund. Small and large intestines were processed to determine tumor burden, distribution, and grade. Expression of proliferation marker Ki-67 and estrogen receptor (ER)-{alpha} were also assessed by immunohistochemistry. Results: We observed that, with both 1 Gy and 5 Gy of {gamma} rays, females displayed reduced susceptibility to radiation-induced intestinal tumorigenesis compared with males. As for radiation effect on small intestinal tumor progression, although no substantial differences were found in the relative frequency and degree of dysplasia of adenomas in irradiated animals compared with controls, invasive carcinomas were found in 1-Gy- and 5-Gy-irradiated animals. Radiation exposure was also shown to induce an increase in protein levels of proliferation marker Ki-67 and sex-hormone receptor ER-{alpha} in both non tumor mucosa and intestinal tumors from irradiated male mice. Conclusions: We observed important sex-dependent differences in susceptibility to radiation-induced intestinal tumorigenesis in Apc1638N/+ mutants. Furthermore, our data provide evidence that exposure to radiation doses as low as 1 Gy can induce a significant increase in intestinal tumor multiplicity as well as enhance tumor progression in vivo.

  4. Microsoft PowerPoint - MartynJamesRTC-Revised DoETWG_082511.ppt [Compatibility Mode]

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Projects in Southern Nevada Transportation Projects in Southern Nevada U.S. Department of Energy U.S. Department of Energy p gy p gy Transportation Working Group Transportation Working Group August 25, 2011 August 25, 2011 August 25, 2011 August 25, 2011 Transportation Projects in Southern Nevada Transportation Projects in Southern Nevada RTC Responsibilities RTC Responsibilities * * Regional Regional transportation transportation planning planning * * Program Program projects projects for for

  5. Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy

    SciTech Connect (OSTI)

    Gondi, Vinai; Tolakanahalli, Ranjini; Mehta, Minesh P.; Tewatia, Dinesh; Rowley, Howard; Kuo, John S.; Khuntia, Deepak; Tome, Wolfgang A.

    2010-11-15

    Purpose: Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. Methods and Materials: Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy (IMRT) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. Results: On average, the hippocampal avoidance volume was 3.3 cm{sup 3}, occupying 2.1% of the whole-brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy{sub 2} using helical tomotherapy and by 81% to 0.73 Gy{sub 2} using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-off with helical tomotherapy. Conclusion: Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.

  6. Low-Dose, Ionizing Radiation and Age-Related Changes in Skeletal Microarchitecture

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Alwood, Joshua S.; Kumar, Akhilesh; Tran, Luan H.; Wang, Angela; Limoli, Charles L.; Globus, Ruth K.

    2012-01-01

    Osteoporosis can profoundly affect the aged as a consequence of progressive bone loss; high-dose ionizing radiation can cause similar changes, although less is known about lower doses (≤100 cGy). We hypothesized that exposure to relatively low doses of gamma radiation accelerates structural changes characteristic of skeletal aging. Mice (C57BL/6J-10 wk old, male) were irradiated (total body; 0-sham, 1, 10 or 100 cGy 137 Cs) and tissues harvested on the day of irradiation, 1 or 4 months later. Microcomputed tomography was used to quantify microarchitecture of high turnover, cancellous bone. Irradiation at 100 cGy caused transient microarchitectural changes over one month that were only evidentmore » at longer times in controls (4 months). Ex vivo bone cell differentiation from the marrow was unaffected by gamma radiation. In conclusion, acute ionizing gamma irradiation at 100 cGy (but not at 1 cGy or 10 cGy) exacerbated microarchitectural changes normally found during progressive, postpubertal aging prior to the onset of age-related osteoporosis.« less

  7. Predicting age of ovarian failure after radiation to a field that includes the ovaries

    SciTech Connect (OSTI)

    Wallace, W. Hamish B. . E-mail: Hamish.Wallace@ed.ac.uk; Thomson, Angela B.; Saran, Frank; Kelsey, Tom W.

    2005-07-01

    Purpose: To predict the age at which ovarian failure is likely to develop after radiation to a field that includes the ovary in women treated for cancer. Methods and Materials: Modern computed tomography radiotherapy planning allows determination of the effective dose of radiation received by the ovaries. Together with our recent assessment of the radiosensitivity of the human oocyte, the effective surviving fraction of primordial oocytes can be determined and the age of ovarian failure, with 95% confidence limits, predicted for any given dose of radiotherapy. Results: The effective sterilizing dose (ESD: dose of fractionated radiotherapy [Gy] at which premature ovarian failure occurs immediately after treatment in 97.5% of patients) decreases with increasing age at treatment. ESD at birth is 20.3 Gy; at 10 years 18.4 Gy, at 20 years 16.5 Gy, and at 30 years 14.3 Gy. We have calculated 95% confidence limits for age at premature ovarian failure for estimated radiation doses to the ovary from 1 Gy to the ESD from birth to 50 years. Conclusions: We report the first model to reliably predict the age of ovarian failure after treatment with a known dose of radiotherapy. Clinical application of this model will enable physicians to counsel women on their reproductive potential following successful treatment.

  8. SU-E-I-28: Evaluating the Organ Dose From Computed Tomography Using Monte Carlo Calculations

    SciTech Connect (OSTI)

    Ono, T; Araki, F

    2014-06-01

    Purpose: To evaluate organ doses from computed tomography (CT) using Monte Carlo (MC) calculations. Methods: A Philips Brilliance CT scanner (64 slice) was simulated using the GMctdospp (IMPS, Germany) based on the EGSnrc user code. The X-ray spectra and a bowtie filter for MC simulations were determined to coincide with measurements of half-value layer (HVL) and off-center ratio (OCR) profile in air. The MC dose was calibrated from absorbed dose measurements using a Farmer chamber and a cylindrical water phantom. The dose distribution from CT was calculated using patient CT images and organ doses were evaluated from dose volume histograms. Results: The HVLs of Al at 80, 100, and 120 kV were 6.3, 7.7, and 8.7 mm, respectively. The calculated HVLs agreed with measurements within 0.3%. The calculated and measured OCR profiles agreed within 3%. For adult head scans (CTDIvol) =51.4 mGy), mean doses for brain stem, eye, and eye lens were 23.2, 34.2, and 37.6 mGy, respectively. For pediatric head scans (CTDIvol =35.6 mGy), mean doses for brain stem, eye, and eye lens were 19.3, 24.5, and 26.8 mGy, respectively. For adult chest scans (CTDIvol=19.0 mGy), mean doses for lung, heart, and spinal cord were 21.1, 22.0, and 15.5 mGy, respectively. For adult abdominal scans (CTDIvol=14.4 mGy), the mean doses for kidney, liver, pancreas, spleen, and spinal cord were 17.4, 16.5, 16.8, 16.8, and 13.1 mGy, respectively. For pediatric abdominal scans (CTDIvol=6.76 mGy), mean doses for kidney, liver, pancreas, spleen, and spinal cord were 8.24, 8.90, 8.17, 8.31, and 6.73 mGy, respectively. In head scan, organ doses were considerably different from CTDIvol values. Conclusion: MC dose distributions calculated by using patient CT images are useful to evaluate organ doses absorbed to individual patients.

  9. SU-D-18A-04: Quantifying the Ability of Tumor Tracking to Spare Normal Tissue

    SciTech Connect (OSTI)

    Burger, A; Buzurovic, I; Hurwitz, M; Williams, C; Lewis, J; Mishra, P; Seco, J

    2014-06-01

    Purpose: Tumor tracking allows for smaller tissue volumes to be treated, potentially reducing normal tissue damage. However, tumor tracking is a more complex treatment and has little benefit in some scenarios. Here we quantify the benefit of tumor tracking for a range of patients by estimating the dose of radiation to organs at risk and the normal tissue complication probability (NTCP) for both standard and tracking treatment plans. This comparison is performed using both patient 4DCT data and extended Cardiac-Torso (XCAT) digital phantoms. Methods: We use 4DCT data for 10 patients. Additionally, we generate digital phantoms with motion derived from measured patient long tumor trajectories to compare standard and tracking treatment plans. The standard treatment is based on the average intensity projection (AIP) of 4DCT images taken over a breath cycle. The tracking treatment is based on doses calculated on images representing the anatomy at each time point. It is assumed that there are no errors in tracking the target. The NTCP values are calculated based on RTOG guidelines. Results: The mean reduction in the mean dose delivered was 5.5% to the lungs (from 7.3 Gy to 6.9 Gy) and 4.0% to the heart (from 12.5 Gy to 12.0 Gy). The mean reduction in the max dose delivered was 13% to the spinal cord (from 27.6 Gy to 24.0 Gy), 2.5% to the carina (from 31.7 Gy to 30.9 Gy), and 15% to the esophagus (from 69.6 Gy to 58.9 Gy). The mean reduction in the probability of 2nd degree radiation pneumonitis (RP) was 8.7% (3.1% to 2.8%) and the mean reduction in the effective volume was 6.8% (10.8% to 10.2%). Conclusions: Tumor tracking has the potential to reduce irradiation of organs at risk, and consequentially reduce the normal tissue complication probability. The benefits vary based on the clinical scenario. This study is supported by Varian Medical Systems, Inc.

  10. Indirect Tumor Cell Death After High-Dose Hypofractionated Irradiation: Implications for Stereotactic Body Radiation Therapy and Stereotactic Radiation Surgery

    SciTech Connect (OSTI)

    Song, Chang W.; Lee, Yoon-Jin; Griffin, Robert J.; Park, Inhwan; Koonce, Nathan A.; Hui, Susanta; Kim, Mi-Sook; Dusenbery, Kathryn E.; Sperduto, Paul W.; Cho, L. Chinsoo

    2015-09-01

    Purpose: The purpose of this study was to reveal the biological mechanisms underlying stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS). Methods and Materials: FSaII fibrosarcomas grown subcutaneously in the hind limbs of C3H mice were irradiated with 10 to 30 Gy of X rays in a single fraction, and the clonogenic cell survival was determined with in vivo–in vitro excision assay immediately or 2 to 5 days after irradiation. The effects of radiation on the intratumor microenvironment were studied using immunohistochemical methods. Results: After cells were irradiated with 15 or 20 Gy, cell survival in FSaII tumors declined for 2 to 3 days and began to recover thereafter in some but not all tumors. After irradiation with 30 Gy, cell survival declined continuously for 5 days. Cell survival in some tumors 5 days after 20 to 30 Gy irradiation was 2 to 3 logs less than that immediately after irradiation. Irradiation with 20 Gy markedly reduced blood perfusion, upregulated HIF-1α, and increased carbonic anhydrase-9 expression, indicating that irradiation increased tumor hypoxia. In addition, expression of VEGF also increased in the tumor tissue after 20 Gy irradiation, probably due to the increase in HIF-1α activity. Conclusions: Irradiation of FSaII tumors with 15 to 30 Gy in a single dose caused dose-dependent secondary cell death, most likely by causing vascular damage accompanied by deterioration of intratumor microenvironment. Such indirect tumor cell death may play a crucial role in the control of human tumors with SBRT and SRS.

  11. SU-E-I-49: The Evaluation of Usability of Multileaf Collimator for Diagnostic Radiation in Cephalometric Exposure

    SciTech Connect (OSTI)

    Han, S; Kim, K; Jung, H; Kim, M; Ji, Y; Park, S; Choi, S

    2014-06-01

    Purpose: This study evaluated usability of Multileaf collimator (MLC) for diagnostic radiation in cephalometric exposure using optical stimulated luminance dosimeters (OSLDs) Methods: The MLC material was made alloy tool steel (SKD-11) and the density of it is 7.89g/m3 that is similar to it of steel (Fe, 7.85 g/m3) and the MLC was attached to general radiography unit (Rex-650R, Listem Inc, Korea) for cephalometric exposure. The OSLDs that used were nanoDotTM Dosimeter (Landauer Inc, Glenwood, USA) and we read out OSLDs with micro star system (Landauer Inc, Glenwood, USA). The Optical annealing system contained fluorescent lamps (Osram lumilux, 24 W, 280 ?780 nm). To measure absorbed dose using OSLDs, was carried out dosimetric characteristics of OSLDs. Based on these, we evaluated dose reduction of critical organ (Eyes, Thyroids) with MLC in cephalometric exposure Results: The dosimetric characteristics were following that batch homogeneity was 1.21% and reproducibility was 0.96% of the coefficient of variation The linearity was that the correlation of between dose and count was fitted by linear function (dose,mGy = 0.00029 Count, R2 =0.997). The range of angular dependence was from ?3.6% to 3.7% variation when each degree was normalized by zero degree. The organ dose of Rt. eye, Lt eye, thyroids were 77.8 ?Gy, 337.0 ?Gy, 323.1?Gy, respectively in open field and the dose reduction of organ dose was 10.6%(8.3?Gy), 12.4 %(42 ?Gy), 87.1%(281.4?Gy) with MLC Conclusion: We certified dose reduction of organ dose in cephalometric exposure. The dose reduction of Eye was 11% because of reduction of field size and it of thyroids was 87% by primary beam shielding.

  12. Kilovoltage cone-beam CT imaging dose during breast radiotherapy: A dose comparison between a left and right breast setup

    SciTech Connect (OSTI)

    Quinn, Alexandra; Holloway, Lois; Begg, Jarrad; Nelson, Vinod; Metcalfe, Peter

    2014-07-01

    The purpose of this study was to investigate the delivered dose from a kilovoltage cone-beam computed tomography (kV-CBCT) acquired in breast treatment position for a left and right breast setup. The dose was measured with thermoluminescent dosimeters positioned within a female anthropomorphic phantom at organ locations. Imaging was performed on an Elekta Synergy XVI system with the phantom setup on a breast board. The image protocol involved 120 kVp, 140 mAs, and a 270 arc rotation clockwise 0 to 270 for the left breast setup and 270 to 180 for the right breast setup (maximum arc rotations possible). The dose delivered to the left breast, right breast, and heart was 5.1 mGy, 3.9 mGy, and 4.0 mGy for the left breast setup kV-CBCT, and 6.4 mGy, 6.0 mGy, and 4.8 mGy for the right breast setup kV-CBCT, respectively. The rotation arc of the kV-CBCT influenced the dose delivered, with the right breast setup kV-CBCT found to deliver a dose of up to 4 mGy or 105% higher to the treated breast?s surface in comparison with the left breast setup. This is attributed to the kV-CBCT source being more proximal to the anterior of the phantom for a right breast setup, whereas the source is more proximal to the posterior of the patient for a left-side scan.

  13. Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma

    SciTech Connect (OSTI)

    Yang, Joanna C.; Dharmarajan, Kavita V.; Wexler, Leonard H.; La Quaglia, Michael P.; Happersett, Laura; Wolden, Suzanne L.

    2012-11-01

    Purpose: To examine local control and patterns of failure in rhabdomyosarcoma patients treated with intensity modulated radiation therapy (RT) with dose painting (DP-IMRT). Patients and Methods: A total of 41 patients underwent DP-IMRT with chemotherapy for definitive treatment. Nineteen also underwent surgery with or without intraoperative RT. Fifty-six percent had alveolar histologic features. The median interval from beginning chemotherapy to RT was 17 weeks (range, 4-25). Very young children who underwent second-look procedures with or without intraoperative RT received reduced doses of 24-36 Gy in 1.4-1.8-Gy fractions. Young adults received 50.4 Gy to the primary tumor and lower doses of 36 Gy in 1.8-Gy fractions to at-risk lymph node chains. Results: With 22 months of median follow-up, the actuarial local control rate was 90%. Patients aged {<=}7 years who received reduced overall and fractional doses had 100% local control, and young adults had 79% (P=.07) local control. Three local failures were identified in young adults whose primary target volumes had received 50.4 Gy in 1.8-Gy fractions. Conclusions: DP-IMRT with lower fractional and cumulative doses is feasible for very young children after second-look procedures with or without intraoperative RT. DP-IMRT is also feasible in adolescents and young adults with aggressive disease who would benefit from prophylactic RT to high-risk lymph node chains, although dose escalation might be warranted for improved local control. With limited follow-up, it appears that DP-IMRT produces local control rates comparable to those of sequential IMRT in patients with rhabdomyosarcoma.

  14. Critical Combinations of Radiation Dose and Volume Predict Intelligence Quotient and Academic Achievement Scores After Craniospinal Irradiation in Children With Medulloblastoma

    SciTech Connect (OSTI)

    Merchant, Thomas E.; Schreiber, Jane E.; Wu, Shengjie; Lukose, Renin; Xiong, Xiaoping; Gajjar, Amar

    2014-11-01

    Purpose: To prospectively follow children treated with craniospinal irradiation to determine critical combinations of radiation dose and volume that would predict for cognitive effects. Methods and Materials: Between 1996 and 2003, 58 patients (median age 8.14 years, range 3.99-20.11 years) with medulloblastoma received risk-adapted craniospinal irradiation followed by dose-intense chemotherapy and were followed longitudinally with multiple cognitive evaluations (through 5 years after treatment) that included intelligence quotient (estimated intelligence quotient, full-scale, verbal, and performance) and academic achievement (math, reading, spelling) tests. Craniospinal irradiation consisted of 23.4 Gy for average-risk patients (nonmetastatic) and 36-39.6 Gy for high-risk patients (metastatic or residual disease >1.5 cm{sup 2}). The primary site was treated using conformal or intensity modulated radiation therapy using a 2-cm clinical target volume margin. The effect of clinical variables and radiation dose to different brain volumes were modeled to estimate cognitive scores after treatment. Results: A decline with time for all test scores was observed for the entire cohort. Sex, race, and cerebrospinal fluid shunt status had a significant impact on baseline scores. Age and mean radiation dose to specific brain volumes, including the temporal lobes and hippocampi, had a significant impact on longitudinal scores. Dichotomized dose distributions at 25 Gy, 35 Gy, 45 Gy, and 55 Gy were modeled to show the impact of the high-dose volume on longitudinal test scores. The 50% risk of a below-normal cognitive test score was calculated according to mean dose and dose intervals between 25 Gy and 55 Gy at 10-Gy increments according to brain volume and age. Conclusions: The ability to predict cognitive outcomes in children with medulloblastoma using dose-effects models for different brain subvolumes will improve treatment planning, guide intervention, and help estimate the value of newer methods of irradiation.

  15. Single-Fraction Versus 5-Fraction Radiation Therapy for Metastatic Epidural Spinal Cord Compression in Patients With Limited Survival Prognoses: Results of a Matched-Pair Analysis

    SciTech Connect (OSTI)

    Rades, Dirk; Huttenlocher, Stefan; Šegedin, Barbara; Perpar, Ana; Conde, Antonio J.; Garcia, Raquel; Veninga, Theo; Stalpers, Lukas J.A.; Cacicedo, Jon; Rudat, Volker; Schild, Steven E.

    2015-10-01

    Purpose: This study compared single-fraction to multi-fraction short-course radiation therapy (RT) for symptomatic metastatic epidural spinal cord compression (MESCC) in patients with limited survival prognosis. Methods and Materials: A total of 121 patients who received 8 Gy × 1 fraction were matched (1:1) to 121 patients treated with 4 Gy × 5 fractions for 10 factors including age, sex, performance status, primary tumor type, number of involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, pre-RT ambulatory status, and time developing motor deficits prior to RT. Endpoints included in-field repeated RT (reRT) for MESCC, overall survival (OS), and impact of RT on motor function. Univariate analyses were performed with the Kaplan-Meier method and log-rank test for in-field reRT for MESCC and OS and with the ordered-logit model for effect of RT on motor function. Results: Doses of 8 Gy × 1 fraction and 4 Gy × 5 fractions were not significantly different with respect to the need for in-field reRT for MESCC (P=.11) at 6 months (18% vs 9%, respectively) and 12 months (30% vs 22%, respectively). The RT regimen also had no significant impact on OS (P=.65) and post-RT motor function (P=.21). OS rates at 6 and 12 months were 24% and 9%, respectively, after 8 Gy × 1 fraction versus 25% and 13%, respectively, after 4 Gy × 5 fractions. Improvement of motor function was observed in 17% of patients after 8 Gy × 1 fraction and 23% after 4 Gy × 5 fractions, respectively. Conclusions: There were no significant differences with respect to need for in-field reRT for MESCC, OS, and motor function by dose fractionation regimen. Thus, 8 Gy × 1 fraction may be a reasonable option for patients with survival prognosis of a few months.

  16. SU-E-T-129: Dosimetric Evaluation of the Impact of Density Correction On Dose Calculation of Breast Cancer Treatment: A Study Based On RTOG 1005 Cases

    SciTech Connect (OSTI)

    Li, J; Yu, Y

    2014-06-01

    Purpose: RTOG 1005 requires density correction in the dose calculation of breast cancer radiation treatment. The aim of the study was to evaluate the impact of density correction on the dose calculation. Methods: Eight cases were studied, which were planned on an XiO treatment planning system with pixel-by-pixel density correction using a superposition algorithm, following RTOG 1005 protocol requirements. Four were protocol Arm 1 (standard whole breast irradiation with sequential boost) cases and four were Arm 2 (hypofractionated whole breast irradiation with concurrent boost) cases. The plans were recalculated with the same monitor units without density correction. Dose calculations with and without density correction were compared. Results: Results of Arm 1 and Arm 2 cases showed similar trends in the comparison. The average differences between the calculations with and without density correction (difference = Without - With) among all the cases were: -0.82 Gy (range: -2.65??0.18 Gy) in breast PTV Eval D95, ?0.75 Gy (range: ?1.23?0.26 Gy) in breast PTV Eval D90, ?1.00 Gy (range: ?2.46??0.29 Gy) in lumpectomy PTV Eval D95, ?0.78 Gy (range: ?1.30?0.11 Gy) in lumpectomy PTV Eval D90, ?0.43% (range: ?0.95??0.14%) in ipsilateral lung V20, ?0.81% (range: ?1.62??0.26%) in V16, ?1.95% (range: ?4.13??0.84%) in V10, ?2.64% (?5.55??1.04%) in V8, ?4.19% (range: ?6.92??1.81%) in V5, and ?4.95% (range: ?7.49??2.01%) in V4, respectively. The differences in other normal tissues were minimal. Conclusion: The effect of density correction was observed in breast target doses (an average increase of ?1 Gy in D95 and D90, compared to the calculation without density correction) and exposed ipsilateral lung volumes in low dose region (average increases of ?4% and ?5% in V5 and V4, respectively)

  17. Oxidative Stress and Skeletal Health with Low-Dose, Low-LET (Linear Energy Transfer) Ionizing Radiation

    SciTech Connect (OSTI)

    Globus, Ruth K.

    2014-11-03

    We performed in vivo and in vitro experiments to accomplish the following specific aims of this project: 1) determine if low dose, low LET radiation affects skeletal remodeling at structural, cellular and molecular levels and 2) determine if low dose, low LET radiation modulates skeletal health during aging via oxidative mechanisms. A third aim is supported by NASA supplement to this DOE grant focusing on the influence of high LET radiation on bone. A series of experiments were conducted at the NASA Space Radiation Laboratory at Brookhaven, NSRL-BNL, using iron (56Fe) or a sequential exposure to protons / iron / protons, and separate experiments at NASA Ames Research Center (ARC) using 137Cs. The following provides a summary of key findings. (1) Exposure of nine-week old female mice to priming doses of gamma radiation (10cGy x 5) did not significantly affect bone volume/total volume (BV/TV) or microarchitecture as analyzed by 3D microcomputed tomography. As expected, exposure to the challenge dose of 2 Gy gamma irradiation resulted in significant decreases in BV/TV. The priming dose combined with the 2Gy challenge dose had no further effect on BV/TV compared to challenge dose alone, with the sole exception of the Structural Model Index (SMI). SMI reflects the ratio of rods-to-plates in cancellous bone tissue, such that higher SMI values indicate a tendency toward a weaker structure compared to lower SMI values. Mice treated with both priming and challenge dose had 25% higher SMI values compared to sham-irradiated controls and 7% higher values compared to mice treated with the challenge dose alone. Thus, although this priming regimen had relatively modest effects on cancellous tissue, the difference in SMI suggests this fractionated priming doses have adverse, rather than beneficial, effects on bone structure. (2) In 10-week old male mice, a single exposure to 100cGy of 137Cs reduces trabecular bone number and connectivity density by 20% and 36% respectively one month after irradiation (IR). At four months post-IR, these animals were comparable to sham-treated controls with regards to the abovementioned structural parameters. Irradation at 1 or 10 cGy did not result in any significant changes in bone structural parameters. (3) Irradiation of 16-wk old male mice with high doses of 56Fe or proton (50 or 200cGy), but not at low doses (5 or 10cGy), showed a similar loss of cancellous BV/TV and trabecular number at five weeks post-IR. (4) Age-related bone loss overtook acute radiation-induced decrements in bone structure within four months post-IR with 100 cGy gamma and 12 months post-IR with 200 cGy iron. Transgenic mice globally overexpressing human catalase gene in mitochondria did not exhibit cancellous bone loss as assessed at four month post-IR with 10 cGy proton, 50 cGy iron, or in combination. (5) The cellular and molecular mechanisms responsible for loss of bone with radiation are mediated primarily through increased osteoclastogenesis. Our data provide evidence that there are increases in gene expression of TNF alpha and MCP1 in the bone marrow cells 24 hours post-IR and of osteoclastogenic differentiation factor RANKL by day 3. These cytokines in the marrow may stimulate mature osteoclasts or drive osteoclastogenesis from precursors. (6) Osteoblastogenesis from marrow progenitors evaluated ex vivo decreased following whole body 56Fe irradiation at a dose threshold between 20 and 50 cGy whereas osteoclastogenesis ex vivo increased with doses as low as 10cGy two days post-IR of mice. However, the latter finding was not observed in more than a single experiment. (7) Gamma irradiation of cells in vitro requires relatively high doses (200cGy) to disturb normal osteoblastogenesis and osteoclastogenesis as evidenced by decrements in mineralized nodule formation, osteoclast counts, and expression of osteoblast related genes such as runx2, col1a1. (8) We also investigated the effect of antioxidants on osteoblastogenesis following low dose in vitro gamma irradiation (15cGy) on day four bone marrow stromal cell cultures. Superoxide dismutase (SOD) was added to the cell culture medium for 2 or 3 days post-irradiation and cell colonies were counted on days 7 and 10. SOD treatment increased cell growth as measured by DNA content and colony forming units (CFU) in both irradiated cells and 0 cGy control groups. However, low dose radiation of 15cGy abolished SOD stimulatory effects on cell growth and CFU number. These results suggest that exogenous SOD increases osteoblast cell growth and colony formation and that low-dose radiation (15cGy) can interfere with the antioxidant effects. In summary, our findings indicate that acute, whole body irradiation at high doses (50-200 cGy) results in prompt tissue degradation and bone loss. Lower doses (<50 cGy) do not cause bone structural deterioration but may deplete stem/progenitor cell pools in the bone marrow.

  18. High and Low Doses of Ionizing Radiation Induce Different Secretome Profiles in a Human Skin Model

    SciTech Connect (OSTI)

    Zhang, Qibin; Matzke, Melissa M.; Schepmoes, Athena A.; Moore, Ronald J.; Webb-Robertson, Bobbie-Jo M.; Hu, Zeping; Monroe, Matthew E.; Qian, Weijun; Smith, Richard D.; Morgan, William F.

    2014-03-18

    It is postulated that secreted soluble factors are important contributors of bystander effect and adaptive responses observed in low dose ionizing radiation. Using multidimensional liquid chromatography-mass spectrometry based proteomics, we quantified the changes of skin tissue secretome the proteins secreted from a full thickness, reconstituted 3-dimensional skin tissue model 48 hr after exposure to 3, 10 and 200 cGy of X-rays. Overall, 135 proteins showed statistical significant difference between the sham (0 cGy) and any of the irradiated groups (3, 10 or 200 cGy) on the basis of Dunnett adjusted t-test; among these, 97 proteins showed a trend of downregulation and 9 proteins showed a trend of upregulation with increasing radiation dose. In addition, there were 21 and 8 proteins observed to have irregular trends with the 10 cGy irradiated group either having the highest or the lowest level among all three radiated doses. Moreover, two proteins, carboxypeptidase E and ubiquitin carboxyl-terminal hydrolase isozyme L1 were sensitive to ionizing radiation, but relatively independent of radiation dose. Conversely, proteasome activator complex subunit 2 protein appeared to be sensitive to the dose of radiation, as rapid upregulation of this protein was observed when radiation doses were increased from 3, to 10 or 200 cGy. These results suggest that different mechanisms of action exist at the secretome level for low and high doses of ionizing radiation.

  19. Comparison of the calculated absorbed dose using the Cadplan™ treatment planning software and Tld-100 measurements in an Alderson-Rando phantom for a bronchogenic treatment

    SciTech Connect (OSTI)

    Gutiérrez Castillo, J. G.; Álvarez Romero, J. T. E-mail: fisarmandotorres@gmail.com Calderón, A. Torres E-mail: fisarmandotorres@gmail.com M, V. Tovar E-mail: fisarmandotorres@gmail.com

    2014-11-07

    To verify the accuracy of the absorbed doses D calculated by a TPS Cadplan for a bronchogenic treatment (in an Alderson-Rando phantom) are chosen ten points with the following D's and localizations. Point 1, posterior position on the left edge with 136.4 Gy. Points: 2, 3 and 4 in the left lung with 104.9, 104.3 and 105.8 Gy, respectively; points 5 and 6 at the mediastinum with 192.4 and 173.5 Gy; points 7, 8 and 9 in the right lung with 105.8, 104.2 and 104.7 Gy, and 10 at posterior position on right edge with 143.7 Gy. IAEA type capsules with TLD 100 powder are placed, planned and irradiated. The evaluation of the absorbed dose is carried out a curve of calibration for the LiF response (nC) {sup vs} {sup DW}, to several cavity theories. The traceability for the DW is obtained with a secondary standard calibrated at the NRC (Canada). The dosimetric properties for the materials considered are determined from the Hounsfield numbers reported by the TPS. The stopping power ratios are calculated for nominal spectrum to 6 MV photons. The percent variations among the planned and determined D in all the cases they are < ± 3%.

  20. SU-E-T-309: Tangential Modulated Arc Therapy: A Novel Technique for the Treatment of Superficial Disease

    SciTech Connect (OSTI)

    Hadsell, M; Chin, E; Li, R; Xing, L; Bush, K

    2014-06-01

    Purpose: We propose a new type of treatment that employs a modulated and sliding tangential photon field to provide superior coverage of superficial targets when compared to other commonly employed methods while drastically reducing dose to the underlying sensitive structures often present in these cases. Methods: Modulated treatment plans were formulated for a set of three representative cases. The first was a revised treatment of a scalp sarcoma, while the second was a treatment of a right posterior chest wall sarcoma. For these cases, asymmetric jaw placement, angular limitations, and central isocenter placements were used to force the optimization algorithm into finding solutions with beamlines that were not perpendicular to the body surface. The final case targeted the chest wall of a breast cancer patient, in which standard treatments were compared to the use of modulated fields with multiple isocenters along the chest wall. Results: When compared with unrestricted modulated arcs, the tangential arc scalp treatment reduced the max and mean doses delivered to the brain by 33Gy (from 55 to 22Gy) and 6Gy (from 14Gy to 8Gy), respectively. In the right posterior chest wall case, the V10 in the ipsilateral lung was kept below 5% while retaining a Rx dose (45Gy) target coverage of over 97%. For the breast case, the modulated plan achieved reductions in high dose to the ipsilateral lung and heart by a factor of 23 when compared to classic laterally opposed tangents and reduced the V5 by 40% when compared to standard modulated arcs. Conclusion: Tangential modulated arc therapy has outperformed the conventional modalities of treatment for superficial lesions used in our clinic. We hope that with the advent of digitally controlled linear accelerators, we can uncover further benefits of this new technique and extend its applicability to a wider section of the patient population.

  1. WE-D-BRE-03: Late Toxicity Following Photon Or Proton Radiotherapy in Patients with Brain Tumors

    SciTech Connect (OSTI)

    Munbodh, R; Ding, X; Yin, L; Anamalayil, S; Dorsey, J; Lustig, R; Alonso-Basanta, M

    2014-06-15

    Purpose: To identify indicators of Late Grade 3 (LG3) toxicity, late vision and hearing changes in patients treated for primary brain tumors with photon (XRT) or proton radiotherapy (PRT). Methods: We retrospectively reviewed 102 patients who received brain XRT or PRT to doses of 54 or 59.6 Gy in daily fractions of 1.8–2 Gy. Of the 80 patients (34 XRT, 39 PRT and 7 both modalities) reviewed for indicators of LG3 toxicity, 25 developed LG3 toxicity 90 to 500 days after radiotherapy completion. 55 patients had less than LG3 toxicity > 500 days after treatment. In that time, late vision and hearing changes were seen in 44 of 75 and 25 of 78 patients, respectively. The correlation between late toxicity and prescription dose, planning target volume (PTV) size, and doses to the brainstem, brain, optic chiasm, optic nerves, eyes and cochlea was evaluated. A two-tailed Fisher's exact test and Wilcoxon rank sum test were used for the statistical analysis for XRT, PRT and all patients combined. Results: Exceeding the 54 Gy-5% dose-volume brainstem constraint, but not the optic structure constraints, was significantly correlated (p < 0.05) with late vision changes in all three groups. Exceeding maximum and mean cochlear doses of 45 and 30 Gy, respectively, was a significant indicator of hearing changes (p < 0.05) in PRT patients and all patients combined. In a sub-group of 52 patients in whom the brain was contoured, the absolute brain volume receiving ≤ 50 Gy and > 60 Gy was significantly larger in patients with LG3 toxicity for all patients combined (p < 0.05). Prescription dose, brainstem dose and PTV volume were not correlated to LG3 toxicity. Conclusion: Our results indicate the importance of minimizing the brain volume irradiated, and brainstem and cochlea doses to reduce the risk of late toxicities following brain radiotherapy.

  2. Outcomes and Acute Toxicities of Proton Therapy for Pediatric Atypical Teratoid/Rhabdoid Tumor of the Central Nervous System

    SciTech Connect (OSTI)

    McGovern, Susan L.; Okcu, M. Fatih; Munsell, Mark F.; Kumbalasseriyil, Nancy; Grosshans, David R.; McAleer, Mary F.; Chintagumpala, Murali; Khatua, Soumen; Mahajan, Anita

    2014-12-01

    Purpose: Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system is a rare cancer primarily affecting children younger than 5 years old. Because patients are young and receive intensive chemotherapy, there is concern regarding late radiation toxicity, particularly as survival rates improve. Therefore, there is interest in using proton therapy to treat these tumors. This study was undertaken to investigate outcomes and acute toxicities associated with proton therapy for AT/RT. Methods and Materials: The records of 31 patients with AT/RT treated with proton radiation from October 2008 to August 2013 were reviewed. Demographics, treatment characteristics, and outcomes were recorded and analyzed. Results: Median age at diagnosis was 19 months (range, 4-55 months), with a median age at radiation start of 24 months (range, 6-62 months). Seventeen patients received local radiation with a median dose of 50.4 GyRBE (range, 9-54 GyRBE). Fourteen patients received craniospinal radiation; half received 24 GyRBE or less, and half received 30.6 GyRBE or more. For patients receiving craniospinal radiation, the median tumor dose was 54 GyRBE (range, 43.2-55.8 GyRBE). Twenty-seven patients (87%) completed the planned radiation. With median follow-up of 24 months for all patients (range, 3-53 months), median progression-free survival was 20.8 months and median overall survival was 34.3 months. Five patients (16%) developed clinical findings and imaging changes in the brainstem 1 to 4 months after radiation, consistent with radiation reaction; all cases resolved with steroids or bevacizumab. Conclusions: This is the largest report of children with AT/RT treated with proton therapy. Preliminary survival outcomes in this young pediatric population are encouraging compared to historic results, but further study is warranted.

  3. SU-E-I-09: Application of LiF:Mg,Cu (TLD-100H) Dosimeters for in Diagnostic Radiology

    SciTech Connect (OSTI)

    Sina, S; Zeinali, B; Karimipourfard, M; Lotfalizadeh, F; Sadeghi, M; Faghihi, R

    2014-06-01

    Purpose: Accurate dosimetery is very essential in diagnostic radiology. The goal of this study is to verify the application of LiF:Mg,Cu,P (TLD100H) in obtaining the Entrance skin dose (ESD) of patients undergoing diagnostic radiology. The results of dosimetry performed by TLD-100H, were compared with those obtained by TLD100, which is a common dosimeter in diagnostic radiology. Methods: In this study the ESD values were measured using two types of Thermoluminescence dosimeters (TLD-100, and TLD-100H) for 16 patients undergoing diagnostic radiology (lumbar spine imaging). The ESD values were also obtained by putting the two types of TLDs at the surface of Rando phantom for different imaging techniques and different views (AP, and lateral). The TLD chips were annealed with a standard procedure, and the ECC values for each TLD was obtained by exposing the chips to equal amount of radiation. Each time three TLD chips were covered by thin dark plastic covers, and were put at the surface of the phantom or the patient. The average reading of the three chips was used for obtaining the dose. Results: The results show a close agreement between the dose measuered by the two dosimeters.According to the results of this study, the TLD-100H dosimeters have higher sensitivities (i.e.signal(nc)/dose) than TLD-100.The ESD values varied between 2.71 mGy and 26.29 mGy with the average of 11.89 mGy for TLD-100, and between 2.55 mGy and 27.41 mGy with the average of 12.32 mGy for measurements. Conclusion: The TLD-100H dosimeters are suggested as effective dosimeters for dosimetry in low dose fields because of their higher sensitivities.

  4. Osteoradionecrosis and Radiation Dose to the Mandible in Patients With Oropharyngeal Cancer

    SciTech Connect (OSTI)

    Tsai, Chiaojung Jillian; Hofstede, Theresa M.; Sturgis, Erich M.; Garden, Adam S.; Lindberg, Mary E.; Wei Qingyi; Tucker, Susan L.; Dong Lei

    2013-02-01

    Purpose: To determine the association between radiation doses delivered to the mandible and the occurrence of osteoradionecrosis (ORN). Methods and Materials: We reviewed the records of 402 oropharyngeal cancer patients with stage T1 or T2 disease treated with definitive radiation between January 2000 and October 2008 for the occurrence of ORN. Demographic and treatment variables were compared between patients with ORN and those without. To examine the dosimetric relationship further, a nested case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by age, sex, radiation type, treatment year, and cancer subsite. Detailed radiation treatment plans for the ORN cases and matched controls were reviewed. Mann-Whitney test and conditional logistic regression were used to compare relative volumes of the mandible exposed to doses ranging from 10 Gy-60 Gy in 10-Gy increments. Results: In 30 patients (7.5%), ORN developed during a median follow-up time of 31 months, including 6 patients with grade 4 ORN that required major surgery. The median time to develop ORN was 8 months (range, 0-71 months). Detailed radiation treatment plans were available for 25 of the 30 ORN patients and 40 matched ORN-free patients. In the matched case-control analysis, there was a statistically significant difference between the volumes of mandible in the 2 groups receiving doses between 50 Gy (V50) and 60 Gy (V60). The most notable difference was seen at V50, with a P value of .02 in the multivariate model after adjustment for the matching variables and dental status (dentate or with extraction). Conclusions: V50 and V60 saw the most significant differences between the ORN group and the comparison group. Minimizing the percent mandibular volume exposed to 50 Gy may reduce ORN risk.

  5. Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study

    SciTech Connect (OSTI)

    Feddock, Jonathan; Arnold, Susanne M.; Department of Medical Oncology, University of Kentucky, Lexington, Kentucky ; Shelton, Brent J.; Sinha, Partha; Conrad, Gary; Chen, Li; Rinehart, John; McGarry, Ronald C.

    2013-04-01

    Purpose: To report the results of a prospective, single-institution study evaluating the feasibility of conventional chemoradiation (CRT) followed by stereotactic body radiation therapy (SBRT) as a means of dose escalation for patients with stage II-III non-small cell lung cancer (NSCLC) with residual disease. Methods and Materials: Patients without metastatic disease and with radiologic evidence of limited residual disease (?5 cm) within the site of the primary tumor and good or complete nodal responses after standard CRT to a target dose of 60 Gy were considered eligible. The SBRT boost was done to achieve a total combined dose biological equivalent dose >100 Gy to the residual primary tumor, consisting of 10 Gy 2 fractions (20 Gy total) for peripheral tumors, and 6.5 Gy 3 fractions (19.5 Gy total) for medial tumors using the Radiation Therapy Oncology Group protocol 0813 definitions. The primary endpoint was the development of grade ?3 radiation pneumonitis (RP). Results: After a median follow-up of 13 months, 4 patients developed acute grade 3 RP, and 1 (2.9%) developed late and persistent grade 3 RP. No patients developed grade 4 or 5 RP. Mean lung dose, V2.5, V5, V10, and V20 values were calculated for the SBRT boost, and none were found to significantly predict for RP. Only advancing age (P=.0147), previous smoking status (P=.0505), and high CRT mean lung dose (P=.0295) were significantly associated with RP development. At the time of analysis, the actuarial local control rate at the primary tumor site was 82.9%, with only 6 patients demonstrating recurrence. Conclusions: Linear accelerator-based SBRT for dose escalation of limited residual NSCLC after definitive CRT was feasible and did not increase the risk for toxicity above that for standard radiation therapy.

  6. Radiation Dose to the Esophagus From Breast Cancer Radiation Therapy, 1943-1996: An International Population-Based Study of 414 Patients

    SciTech Connect (OSTI)

    Lamart, Stephanie; Stovall, Marilyn; Simon, Steven L.; Smith, Susan A.; Weathers, Rita E.; Howell, Rebecca M.; Curtis, Rochelle E.; Aleman, Berthe M.P.; Travis, Lois; Kwon, Deukwoo; Morton, Lindsay M.

    2013-07-15

    Purpose: To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. Methods and Materials: We abstracted the radiation therapy treatment parameters from each patients radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were {sup 60}Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Results: Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Conclusions: Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses.

  7. SU-E-T-426: Dose Delivery Accuracy in Breast Field Junction for Free Breath and Deep Inspiration Breath Hold Techniques

    SciTech Connect (OSTI)

    Epstein, D; Shekel, E; Levin, D

    2014-06-01

    Purpose: The purpose of this work was to verify the accuracy of the dose distribution along the field junction in a half beam irradiation technique for breast cancer patients receiving radiation to the breast or chest wall (CW) and the supraclavicular LN region for both free breathing and deep inspiration breath hold (DIBH) technique. Methods: We performed in vivo measurements for nine breast cancer patients receiving radiation to the breast/CW and to the supraclavicular LN region. Six patients were treated to the left breast/CW using DIBH technique and three patients were treated to the right breast/CW in free breath. We used five microMOSFET dosimeters: three located along the field junction, one located 1 cm above the junction and the fifth microMOSFET located 1 cm below the junction. We performed consecutive measurements over several days for each patient and compared the measurements to the TPS calculation (Eclipse, Varian). Results: The calculated and measured doses along the junction were 0.970.08 Gy and 1.020.14 Gy, respectively. Above the junction calculated and measured doses were 0.910.08 Gy and 0.980.09 Gy respectively, and below the junction calculated and measured doses were 1.700.15 Gy and 1.610.09 Gy, respectively. All differences were not statistically significant. When comparing calculated and measured doses for DIBH patients only, there was still no statistically significant difference between values for all dosimeter locations. Analysis was done using the Mann-Whitney Rank-Sum Test. Conclusion: We found excellent correlation between calculated doses from the TPS and measured skin doses at the junction of several half beam fields. Even for the DIBH technique, where there is more potential for variance due to depth of breath, there is no over or underdose along the field junction. This correlation validates the TPS, as well an accurate, reproducible patient setup.

  8. SU-E-T-125: Dosimetric Comparison of Intensity Modulated Radiation Therapy Using Robotic Versus Traditional Linac Platform in Prostate Cancer

    SciTech Connect (OSTI)

    Hayes, T; Rella, J; Yang, J; Sims, C; Fung, C

    2014-06-01

    Purpose: Recent development of an MLC for robotic external beam radiotherapy has the potential of new clinical application in conventionally fractionated radiation therapy. This study offers a dosimetric comparison of IMRT plans using Cyberknife with MLC versus conventional linac plans. Methods: Ten prostate cancer patients treated on a traditional linac with IMRT to 7920cGy at 180cGy/fraction were randomly selected. GTVs were defined as prostate plus proximal seminal vesicles. PTVs were defined as GTV+8mm in all directions except 5mm posteriorly. Conventional IMRT planning was performed on Philips Pinnacle and delivered on a standard linac with CBCT and 10mm collimator leaf width. For each case a Cyberknife plan was created using Accuray Multiplan with same CT data set, contours, and dose constraints. All dosimetric data was transferred to third party software for independent computation of contour volumes and DVH. Delivery efficiency was evaluated using total MU, treatment time, number of beams, and number of segments. Results: Evaluation criteria including percent target coverage, homogeneity index, and conformity index were found to be comparable. All dose constraints from QUANTEC were found to be statistically similar except rectum V50Gy and bladder V65Gy. Average rectum V50Gy was lower for robotic IMRT (30.07%±6.57) versus traditional (34.73%±3.62, p=0.0130). Average bladder V65Gy was lower for robotic (17.87%±12.74) versus traditional (21.03%±11.93, p=0.0405). Linac plans utilized 9 coplanar beams, 48.9±3.8 segments, and 19381±2399MU. Robotic plans utilized 38.4±9.0 non-coplanar beams, 85.5±21.0 segments and 42554.71±16381.54 MU. The average treatment was 15.02±0.60 minutes for traditional versus 20.90±2.51 for robotic. Conclusion: The robotic IMRT plans were comparable to the traditional IMRT plans in meeting the target volume dose objectives. Critical structure dose constraints were largely comparable although statistically significant differences were found in favor of the robotic platform in terms of rectum V50Gy and bladder V65Gy at a cost of 25% longer treatment time.

  9. Assessment of dedicated low-dose cardiac micro-CT reconstruction algorithms using the left ventricular volume of small rodents as a performance measure

    SciTech Connect (OSTI)

    Maier, Joscha; Sawall, Stefan; Kachelrie, Marc

    2014-05-15

    Purpose: Phase-correlated microcomputed tomography (micro-CT) imaging plays an important role in the assessment of mouse models of cardiovascular diseases and the determination of functional parameters as the left ventricular volume. As the current gold standard, the phase-correlated Feldkamp reconstruction (PCF), shows poor performance in case of low dose scans, more sophisticated reconstruction algorithms have been proposed to enable low-dose imaging. In this study, the authors focus on the McKinnon-Bates (MKB) algorithm, the low dose phase-correlated (LDPC) reconstruction, and the high-dimensional total variation minimization reconstruction (HDTV) and investigate their potential to accurately determine the left ventricular volume at different dose levels from 50 to 500 mGy. The results were verified in phantom studies of a five-dimensional (5D) mathematical mouse phantom. Methods: Micro-CT data of eight mice, each administered with an x-ray dose of 500 mGy, were acquired, retrospectively gated for cardiac and respiratory motion and reconstructed using PCF, MKB, LDPC, and HDTV. Dose levels down to 50 mGy were simulated by using only a fraction of the projections. Contrast-to-noise ratio (CNR) was evaluated as a measure of image quality. Left ventricular volume was determined using different segmentation algorithms (Otsu, level sets, region growing). Forward projections of the 5D mouse phantom were performed to simulate a micro-CT scan. The simulated data were processed the same way as the real mouse data sets. Results: Compared to the conventional PCF reconstruction, the MKB, LDPC, and HDTV algorithm yield images of increased quality in terms of CNR. While the MKB reconstruction only provides small improvements, a significant increase of the CNR is observed in LDPC and HDTV reconstructions. The phantom studies demonstrate that left ventricular volumes can be determined accurately at 500 mGy. For lower dose levels which were simulated for real mouse data sets, the HDTV algorithm shows the best performance. At 50 mGy, the deviation from the reference obtained at 500 mGy were less than 4%. Also the LDPC algorithm provides reasonable results with deviation less than 10% at 50 mGy while PCF and MKB reconstruction show larger deviations even at higher dose levels. Conclusions: LDPC and HDTV increase CNR and allow for quantitative evaluations even at dose levels as low as 50 mGy. The left ventricular volumes exemplarily illustrate that cardiac parameters can be accurately estimated at lowest dose levels if sophisticated algorithms are used. This allows to reduce dose by a factor of 10 compared to today's gold standard and opens new options for longitudinal studies of the heart.

  10. A dosimetric comparison of 3D-CRT, IMRT, and static tomotherapy with an SIB for large and small breast volumes

    SciTech Connect (OSTI)

    Michalski, Andrea; Atyeo, John; Cox, Jennifer; Rinks, Marianne; Morgia, Marita; Lamoury, Gillian

    2014-07-01

    Radiation therapy to the breast is a complex task, with many different techniques that can be employed to ensure adequate dose target coverage while minimizing doses to the organs at risk. This study compares the dose planning outcomes of 3 radiation treatment modalities, 3 dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and static tomotherapy, for left-sided whole-breast radiation treatment with a simultaneous integrated boost (SIB). Overall, 20 patients with left-sided breast cancer were separated into 2 cohorts, small and large, based on breast volume. Dose plans were produced for each patient using 3D-CRT, IMRT, and static tomotherapy. All patients were prescribed a dose of 45 Gy in 20 fractions to the breast with an SIB of 56 Gy in 20 fractions to the tumor bed and normalized so that D{sub 98%} > 95% of the prescription dose. Dosimetric comparisons were made between the 3 modalities and the interaction of patient size. All 3 modalities offered adequate planning target volume (PTV) coverage with D{sub 98%} > 95% and D{sub 2%} < 107%. Static tomotherapy offered significantly improved (p = 0.006) dose homogeneity to the PTV{sub boost} {sub eval} (0.079 0.011) and breast minus the SIB volume (Breast{sub SIB}) (p < 0.001, 0.15 0.03) compared with the PTV{sub boost} {sub eval} (0.085 0.008, 0.088 0.12) and Breast{sub SIB} (0.22 0.05, 0.23 0.03) for IMRT and 3D-CRT, respectively. Static tomotherapy also offered statistically significant reductions (p < 0.001) in doses to the ipsilateral lung mean dose of 6.79 2.11 Gy compared with 7.75 2.54 Gy and 8.29 2.76 Gy for IMRT and 3D-CRT, respectively, and significantly (p < 0.001) reduced heart doses (mean = 2.83 1.26 Gy) compared to both IMRT and 3D-CRT (mean = 3.70 1.44 Gy and 3.91 1.58 Gy). Static tomotherapy is the dosimetrically superior modality for the whole breast with an SIB compared with IMRT and 3D-CRT. IMRT is superior to 3D-CRT in both PTV dose conformity and reduction of mean doses to the ipsilateral lung.

  11. Threshold Doses for Focal Liver Reaction After Stereotactic Ablative Body Radiation Therapy for Small Hepatocellular Carcinoma Depend on Liver Function: Evaluation on Magnetic Resonance Imaging With Gd-EOB-DTPA

    SciTech Connect (OSTI)

    Sanuki, Naoko; Takeda, Atsuya; Oku, Yohei; Eriguchi, Takahisa; Nishimura, Shuichi; Aoki, Yosuke; Mizuno, Tomikazu; Iwabuchi, Shogo; Kunieda, Etsuo

    2014-02-01

    Purpose: Focal liver reaction (FLR) appears on radiographic images after stereotactic ablative body radiation therapy (SABR) in patients with hepatocellular carcinoma (HCC) and chronic liver disease. We investigated the threshold dose (TD) of FLR and possible factors affecting the TD on gadoxetate acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). Methods and Materials: In 50 patients who were treated with SABR for small HCC and followed up by MRI for >6 months, FLR, seen as a hypointense area, was evaluated on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. The follow-up MRI with the largest extent of FLR was fused to the planning computed tomography (CT) image, and patients with good image fusion concordance were eligible. After delineating the border of the FLR manually, a dosevolume histogram was used to identify the TD for the FLR. Clinical and volumetric factors were analyzed for correlation with the TD. Results: A total of 45 patients were eligible for analysis with a median image fusion concordance of 84.9% (range, 71.6-95.4%). The median duration between SABR and subsequent hepatobiliary phase MRI with the largest extent of FLR was 3 months (range, 1-6 months). The median TD for FLR was 28.0 Gy (range, 22.3-36.4 Gy). On univariate analysis, pre-treatment Child-Pugh (CP) score and platelet count were significantly correlated with the TD. On multiple linear regression analysis, CP score was the only parameter that predicted TD. Median TDs were 30.5 Gy (range, 26.2.3-36.4 Gy) and 25.2 Gy (range, 22.3-27.5 Gy) for patients with CP-A and CP-B disease, respectively. Conclusion: The TD was significantly correlated with baseline liver function. We propose 30 Gy for CP-A disease and 25 Gy for CP-B disease in 5 fractions as TDs for FLR after SABR for patients with HCC and chronic liver disease. Use of these TDs will help to predict potential loss of liver tissue after SABR.

  12. SU-C-12A-05: Radiation Dose in High-Pitch Pediatric Cardiac CTA: Correlation Between Lung Dose and CTDIvol, DLP, and Size Specific Dose Estimates (SSDE)

    SciTech Connect (OSTI)

    Wang, J; Kino, A; Newman, B; Chan, F

    2014-06-01

    Purpose: To investigate the radiation dose for pediatric high pitch cardiac CTA Methods: A total of 14 cases were included in this study, with mean age of 6.2 years (ranges from 2 months to 15 years). Cardiac CTA was performed using a dual-source CT system (Definition Flash, Siemens). Tube voltage (70, 80 and 100kV) was chosen based on patient weight. All patients were scanned using a high-pitch spiral mode (pitch ranges from 2.5 to 3) with tube current modulation technique (CareDose4D, Siemens). For each case, the three dimensional dose distributions were calculated using a Monte Carlo software package (IMPACT-MC, CT Image GmbH). Scanning parameters of each exam, including tube voltage, tube current, beamshaping filters, beam collimation, were defined in the Monte Carlo calculation. Tube current profile along projection angles was obtained from projection data of each tube, which included data within the over-scanning range along z direction. The volume of lungs was segmented out with CT images (3DSlicer). Lung doses of all patients were calculated and compared with CTDIvol, DLP, and SSDE. Results: The average (range) of CTDIvol, DLP and SSDE of all patients was 1.19 mGy (0.58 to 3.12mGy), 31.54 mGy*cm (12.56 to 99 mGy*cm), 2.26 mGy (1.19 to 6.24 mGy), respectively. Radiation dose to the lungs ranged from 0.83 to 4.18 mGy. Lung doses correlated with CTDIvol, DLP and SSDE with correlation coefficients(k) at 0.98, 0.93, and 0.99. However, for the cases with CTDIvol less than 1mGy, only SSDE preserved a strong correlation with lung doses (k=0.83), while much weaker correlations were found for CTDIvol (k=0.29) and DLP (k=-0.47). Conclusion: Lung doses to pediatric patients during Cardiac CTA were estimated. SSDE showed the most robust correlation with lung doses in contrast to CTDIvol and DLP.

  13. 131I-Tositumomab Myeloablative Radioimmunotherapy for Non-Hodgkin's Lymphoma: Radiation Dose to the Testes

    SciTech Connect (OSTI)

    Hattori, Naoya; Gopal, Ajay K.; Shields, Andrew T.; Fisher, Darrell R.; Gooley, Ted; Pagel, John M.; Press, Oliver W.; Rajendran, Joseph G.

    2012-12-01

    To investigate radiation dose to testes delivered by radiolabeled anti-CD20 antibody and its effects on male sex hormone levels. METHODS: We evaluated dosimetry results for 67 male patients (54 ± 11 years old) with non-Hodgkin lymphoma who underwent myeloablative radioimmunotherapy (RIT) using 131I-tositumomab. In a subset of patients, male sex hormones were measured before and one year after the therapy. RESULTS: Absorbed dose to testes showed greater variability (range = 4.4 to 70.2 Gy) than did dose to lungs (9.5 to 28.4 Gy, p < 0.0001) or liver (6.5 to 27.2 Gy, p < 0.0001). Absorbed dose to the testes per 131I administered (1.18 ± 0.59 mGy/MBq) was not significantly different from that to the liver (1.03 ± 0.29 mGy/MBq, p = 0.08), or to the lungs (1.19 ± 0.50 mGy/MBq, p = 0.889). Pre-therapy levels of total testosterone were below the lower limit of the reference range, and post-therapy evaluation demonstrated further reduction (4.6 ± 1.8 nmol/L (pre-RIT) vs. 3.8 ± 2.9 nmol/L (post-RIT), p < 0.05). Patients receiving higher radiation doses to the testes (≥ 25 Gy) showed a greater reduction (4.7 ± 1.6 nmol/L (pre RIT) vs. 3.3 ± 2.7 nmol/L (post-RIT), p < 0.05) than did patients receiving lower doses (< 25 Gy), who showed no significant change in total testosterone levels. CONCLUSION: The testicular radiation absorbed dose varied highly among individual patients. Patients receiving higher doses to testes were more likely to show post-RIT suppression of testosterone levels. Key Words: 131I-tositumomab, follicular lymphoma, radioimmunotherapy, radiation dosimetry, male sex hormones.  

  14. Variation of carrier concentration and interface trap density in 8MeV electron irradiated c-Si solar cells

    SciTech Connect (OSTI)

    Bhat, Sathyanarayana Rao, Asha; Krishnan, Sheeja; Sanjeev, Ganesh; Suresh, E. P.

    2014-04-24

    The capacitance and conductance measurements were carried out for c-Si solar cells, irradiated with 8 MeV electrons with doses ranging from 5kGy 100kGy in order to investigate the anomalous degradation of the cells in the radiation harsh environments. Capacitance Voltage measurements indicate that there is a slight reduction in the carrier concentration upon electron irradiation due to the creation of radiation induced defects. The conductance measurement results reveal that the interface state densities and the trap time constant increases with electron dose due to displacement damages in c-Si solar cells.

  15. SU-E-P-06: A Novel Hybrid Planning Approach to Allow More Patients Benefited by the Intensity Modulated Proton Therapy

    SciTech Connect (OSTI)

    Jiang, S; Liao, L; Li, Y; Wang, X; Sahoo, N; Liao, Z; Grosshans, D; Frank, S; Li, H; Zhu, X; Chang, J; Zhang, X; Gillin, M; Hojo, Y; Sun, J

    2014-06-01

    Purpose: We report a hybrid scattering and scanning beam delivery approach, termed as (HimpsPT), which demonstrated that majority IMPT delivery can be potentially replaced with hybrid IMPT and PSPT delivery with similar or better plan quality. Methods: Three representative clinical cases, including head and neck (HN), skull base chordoma (CNS) and lung cancer, treated in MDACC Proton Therapy Center with IMPT were retrospectively redesigned using HimpsPT. The PSPT plans are designed with the same prescriptions as those of IMPT plans. The whole treatment can be delivered by either alternating or sequential PSPT and IMPT delivery. The dosimetric data and dose distributions of HimpsPT plans are compared with those of IMPT plans. We also performed a worst-case robust analysis for all plans. Results: The target coverages for all cases are comparable. For the HN case, the mean dose of esophagus larynx, left parotid and right submandibular, oral cavity V20, the max dose of cord is 18.0, 36.1, 23.6, 47.2, 0.1, 31.7 Gy in HimpsPT plan, and 25.5, 33.8, 24.9, 49.1, 0.2, 33.8 Gy in IMPT plan. For the lung case, the lung V5, V20, V30, mean lung dose, heart V40, esophagus V70, cord maximum dose are 50.5%, 37.0%, 31.7%, 21.3 Gy, 7.2%, 4.9%, 35.5 Gy in HimpsPT plan, and 55.4%, 36.7%, 30.1%, 21.3 Gy, 7.7%, 8.4%, 36.8Gy in IMPT plans. For the CNS case, brainstem maximum dose is 50.5 Gy in HimpsPT plan and 55.4 Gy in IMPT plan due to sharp penumbra offered by the aperture of the PSPT plan in HimpsPT technique. Conclusion: For majority disease sites, the dosimetric advantage of IMPT technique can be achieved by the hybrid PSPT and IMPT technique, which enables the centers equipped with both scattering and scanning beam facilities to treat more patients which can be benefited by the scanning beam.

  16. Petroleum Marketing Monthly

    U.S. Energy Information Administration (EIA) Indexed Site

    Petroleum Product Sales Report." So o our ur ur urce c c c : U. U S. S E Ene nerg rg g g gy y In Info fo o o orm rmat at t t tio ion n Ad Ad A A A mi mini ni n n st stra rati ti ...

  17. Predictors of Rectal Tolerance Observed in a Dose-Escalated Phase 1-2 Trial of Stereotactic Body Radiation Therapy for Prostate Cancer

    SciTech Connect (OSTI)

    Kim, D.W. Nathan; Cho, L. Chinsoo; Straka, Christopher; Christie, Alana; Lotan, Yair; Pistenmaa, David; Kavanagh, Brian D.; Nanda, Akash; Kueplian, Patrick; Brindle, Jeffrey; Cooley, Susan; Perkins, Alida; Raben, David; Xie, Xian-Jin; Timmerman, Robert D.

    2014-07-01

    Purpose: To convey the occurrence of isolated cases of severe rectal toxicity at the highest dose level tested in 5-fraction stereotactic body radiation therapy (SBRT) for localized prostate cancer; and to rationally test potential causal mechanisms to guide future studies and experiments to aid in mitigating or altogether avoiding such severe bowel injury. Methods and Materials: Clinical and treatment planning data were analyzed from 91 patients enrolled from 2006 to 2011 on a dose-escalation (45, 47.5, and 50 Gy in 5 fractions) phase 1/2 clinical study of SBRT for localized prostate cancer. Results: At the highest dose level, 6.6% of patients treated (6 of 91) developed high-grade rectal toxicity, 5 of whom required colostomy. Grade 3+ delayed rectal toxicity was strongly correlated with volume of rectal wall receiving 50 Gy >3 cm{sup 3} (P<.0001), and treatment of >35% circumference of rectal wall to 39 Gy (P=.003). Grade 2+ acute rectal toxicity was significantly correlated with treatment of >50% circumference of rectal wall to 24 Gy (P=.010). Conclusion: Caution is advised when considering high-dose SBRT for treatment of tumors near bowel structures, including prostate cancer. Threshold dose constraints developed from physiologic principles are defined, and if respected can minimize risk of severe rectal toxicity.

  18. 2014_Q1.indd

    Energy Savers [EERE]

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  19. High energy electron beam curing of epoxy resin systems incorporating cationic photoinitiators

    DOE Patents [OSTI]

    Janke, C.J.; Lopata, V.J.; Havens, S.J.; Dorsey, G.F.; Moulton, R.J.

    1999-03-02

    A mixture of epoxy resins such as a semi-solid triglycidyl ether of tris (hydroxyphenyl) methane and a low viscosity bisphenol A glycidyl ether and a cationic photoinitiator such as a diaryliodonium salt is cured by irradiating with a dosage of electron beams from about 50 to about 150 kGy, forming a cross-linked epoxy resin polymer.

  20. Thermoluminescence of Eu activated LiF nanophosphors

    SciTech Connect (OSTI)

    Kumar, Satinder; Sharma, A. K.; Lochab, S. P.; Kumar, Ravi

    2012-06-05

    Nanocrystalline lithium fluoride (LiF) phosphors prepared by the chemical co-precipitation method at 8.00 pH value have been activated with Eu (0.01, 0.03, 0.07 and 0.1%nt;) as single dopants. The formation of nanocrystalline structure has been confirmed by X-ray diffraction. Thermolumniscence (TL) properties of LiF: Eu nano-phosphors irradiated with gamma rays at different doses of 100 Gy - 10 kGy have been further studied. There is only one main glow peak at around 122 deg. C; which shifts to higher temperature with an increase in doping concentration at all studied irradiation doses. However, the glow peak shifts to lower temperature with an increase in irradiation dose from 100 Gy to 10 kGy. The LiF nano-crystallites synthesized at 8.00 pH and activated with 0.03%nt; Eu are found to have maximum TL sensitivity at studied gamma doses.

  1. Property:Building/SPPurchasedEngyPerAreaKwhM2Pellets | Open Energy...

    Open Energy Info (EERE)

    gyPerAreaKwhM2Pellets" Showing 25 pages using this property. (previous 25) (next 25) S Sweden Building 05K0001 + 0.0 + Sweden Building 05K0002 + 0.0 + Sweden Building 05K0003 + 0.0...

  2. Property:Building/SPPurchasedEngyForPeriodMwhYrOther | Open Energy...

    Open Energy Info (EERE)

    gyForPeriodMwhYrOther" Showing 25 pages using this property. (previous 25) (next 25) S Sweden Building 05K0001 + 0.0 + Sweden Building 05K0002 + 0.0 + Sweden Building 05K0003 + 0.0...

  3. A study of normoxic polymer gel using monomer 2-hydroxyethyl methacrylate (HEMA)

    SciTech Connect (OSTI)

    Ishak, Siti Atiqah; Mustafa, Iskandar Shahrim; Rahman, Azhar Abdul; Moktar, Mohd; Min, Ung Ngie

    2015-04-24

    The aim of this study is to determine the sensitivity of HEMA-polymer gel mixture consist of monomer 2-hydroxyethyl methacrylate (HEMA) with different types of composition. Several composition of HEMA-polymer gel were fabricated and the gels were irradiated with radiation dose between 10 cGy to 100cGy by using x-ray machine and 100 cGy to 1400 cGy by using 6 MV photon beam energy of linear accelerator. The degree of polymerization was evaluated by using magnetic resonance imaging (MRI) with dependence of R2-dose response. Polymer gel consists of cross-linker, anti-oxidant Tetrakis(Hydroxymethyl)phosphonium chloride solution (THPC) and oxygen scavenger hydroquinone shows a stable sensitivity with highest dose dependency. Besides, the results shows the stage polymerization consist of induction, propagation, termination, and chain transfer were dependence with type of chemical mixture and radiation dose. Thus, normoxic HEMA-polymer gel with the different gel formulations can have a better dose resolution and an appropriate recipe must be selected to increase of the sensitivity required and the stability of the dosimeter.

  4. Radiosensitivity study and radiation effects on morphology characterization of grey oyster mushroom Pleurotus sajor-caju

    SciTech Connect (OSTI)

    Rashid, Rosnani Abdul; Awang, Mat Rasol; Mohamad, Azhar; Mutaat, Hassan Hamdani; Maskom, Mohd Meswan; Daud, Fauzi; Senafi, Sahidan

    2014-09-03

    Radiosensitive dosage and morphology characterization of irradiated grey oyster mushroom Pleurotus sajor-caju by gamma rays was investigated due to effects of irradiation. In order to establish the effect, mycelium of P. sajor-caju was irradiated by gamma rays at dose 0.1 to 8.0 kGy with dose rate 0.227 Gy sec{sup ?1}. The irradiation of mycelia was carried out at the radiation facility in Malaysian Nuclear Agency. The radiosensitivity study was performed by evaluating the percentage of survival irradiated mycelia. The lethal dose of the mycelium P. sajor-caju was determined at 4.0 kGy and LD{sub 50} to be equal at 2.2 kGy. The radiation effects on morphology were evaluated based on growth rate of irradiated mycelia, mycelia types, colonization period on substrate, morphology of fruit bodies and yields. The results shown growth rate of irradiated mycelium was slightly lower than the control and decreased as the dose increased. Irradiation was found can induced the primordia formation on PDA and the BE of irradiated seed is higher than to control. The irradiation is proven to be useful for generating new varieties of mushroom with commercial value to the industry.

  5. High energy electron beam curing of epoxy resin systems incorporating cationic photoinitiators

    DOE Patents [OSTI]

    Janke, Christopher J.; Lopata, Vincent J.; Havens, Stephen J.; Dorsey, George F.; Moulton, Richard J.

    1999-01-01

    A mixture of epoxy resins such as a semi-solid triglycidyl ether of tris (hydroxyphenyl) methane and a low viscosity bisphenol A glycidyl ether and a cationic photoinitiator such as a diaryliodonium salt is cured by irradiating with a dosage of electron beams from about 50 to about 150 kGy, forming a cross-linked epoxy resin polymer.

  6. Measurement of radiation damage of water-based liquid scintillator and liquid scintillator

    SciTech Connect (OSTI)

    Bignell, L. J.; Diwan, M. V.; Hans, S.; Jaffe, D. E.; Rosero, R.; Vigdor, S.; Viren, B.; Worcester, E.; Yeh, M.; Zhang, C.

    2015-10-19

    Liquid scintillating phantoms have been proposed as a means to perform real-time 3D dosimetry for proton therapy treatment plan verification. We have studied what effect radiation damage to the scintillator will have upon this application. We have performed measurements of the degradation of the light yield and optical attenuation length of liquid scintillator and water-based liquid scintillator after irradiation by 201 MeV proton beams that deposited doses of approximately 52 Gy, 300 Gy, and 800 Gy in the scintillator. Liquid scintillator and water-based liquid scintillator (composed of 5% scintillating phase) exhibit light yield reductions of 1.74 ± 0.55 % and 1.31 ± 0.59 % after ≈ 800 Gy of proton dose, respectively. Some increased optical attenuation was observed in the irradiated samples, the measured reduction to the light yield is also due to damage to the scintillation light production. Based on our results and conservative estimates of the expected dose in a clinical context, a scintillating phantom used for proton therapy treatment plan verification would exhibit a systematic light yield reduction of approximately 0.1% after a year of operation.

  7. EERE Fiscal Year 2013 Website Annual Report

    Broader source: Energy.gov (indexed) [DOE]

    Saver facebook 29 Videos 32 Widgets 35 WEB HOSTING AND CONTENT mANAGEmENT SYSTEmS 28 ... EErE total EnErGy SavEr nEWS Social mEdia multimEdia WEb HoStinG and contEnt manaGEmEnt ...

  8. Transforming PV Installations Toward Dispatchable, Schedulable...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    PV insTallaTions Toward disPaTchable, schedulable energy soluTions MIChAEl MIllS-PrICE, SEGIS-AC ProGrAM MAnAGEr, AE SolAr EnErGy A B C N SATCON518kw1 B2+2 Cap Bank ...

  9. Measurement of radiation damage of water-based liquid scintillator and liquid scintillator

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Bignell, L. J.; Diwan, M. V.; Hans, S.; Jaffe, D. E.; Rosero, R.; Vigdor, S.; Viren, B.; Worcester, E.; Yeh, M.; Zhang, C.

    2015-10-19

    Liquid scintillating phantoms have been proposed as a means to perform real-time 3D dosimetry for proton therapy treatment plan verification. We have studied what effect radiation damage to the scintillator will have upon this application. We have performed measurements of the degradation of the light yield and optical attenuation length of liquid scintillator and water-based liquid scintillator after irradiation by 201 MeV proton beams that deposited doses of approximately 52 Gy, 300 Gy, and 800 Gy in the scintillator. Liquid scintillator and water-based liquid scintillator (composed of 5% scintillating phase) exhibit light yield reductions of 1.74 ± 0.55 % andmore » 1.31 ± 0.59 % after ≈ 800 Gy of proton dose, respectively. Some increased optical attenuation was observed in the irradiated samples, the measured reduction to the light yield is also due to damage to the scintillation light production. Based on our results and conservative estimates of the expected dose in a clinical context, a scintillating phantom used for proton therapy treatment plan verification would exhibit a systematic light yield reduction of approximately 0.1% after a year of operation.« less

  10. SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

    SciTech Connect (OSTI)

    Acar, H; Altinok, A; Kucukmorkoc, E; Kucuk, N; Caglar, H

    2014-06-01

    Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of the planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is superior to 7 field IMRT technique in terms of both spinal cord sparing and better conformity and gradient indexes.

  11. Neoadjuvant Chemoradiation for Distal Rectal Cancer: 5-Year Updated Results of a Randomized Phase 2 Study of Neoadjuvant Combined Modality Chemoradiation for Distal Rectal Cancer

    SciTech Connect (OSTI)

    Mohiuddin, Mohammed, E-mail: asemuddin@gmail.com [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia)] [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia); Paulus, Rebecca [RTOG Statistical Department, Philadelphia, Pennsylvania (United States)] [RTOG Statistical Department, Philadelphia, Pennsylvania (United States); Mitchell, Edith [Thomas Jefferson University, Philadelphia, Pennsylvania (United States)] [Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Hanna, Nader [Department of Surgical Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States)] [Department of Surgical Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States); Yuen, Albert [Reading Hospital and Medical Center, Reading, Pennsylvania (United States)] [Reading Hospital and Medical Center, Reading, Pennsylvania (United States); Nichols, Romaine [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States)] [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Yalavarthi, Salochna [Ingalls Memorial Hospital, Harvey, Illinois (United States)] [Ingalls Memorial Hospital, Harvey, Illinois (United States); Hayostek, Cherie [Santa Fe Cancer Center, Santa Fe, New Mexico (United States)] [Santa Fe Cancer Center, Santa Fe, New Mexico (United States); Willett, Christopher [Duke University Medical Center, Durham, North Carolina (United States)] [Duke University Medical Center, Durham, North Carolina (United States)

    2013-07-01

    Purpose: To assess the efficacy of 2 different approaches to neoadjuvant chemoradiation for distal rectal cancers. Methods and Materials: One hundred six patients with T3/T4 distal rectal cancers were randomized in a phase 2 study. Patients received either continuous venous infusion (CVI) of 5-Fluorouracil (5-FU), 225 mg/m{sup 2} per day, 7 days per week plus pelvic hyperfractionated radiation (HRT), 45.6 Gy at 1.2 Gy twice daily plus a boost of 9.6 to 14.4 Gy for T3 or T4 cancers (Arm 1), or CVI of 5-FU, 225 mg/m{sup 2} per day, Monday to Friday, plus irinotecan, 50 mg/m{sup 2} once weekly 4, plus pelvic radiation therapy (RT), 45 Gy at 1.8 Gy per day and a boost of 5.4 Gy for T3 and 9 Gy for T4 cancers (Arm 2). Surgery was performed 4 to 10 weeks later. Results: All eligible patients (n=103) are included in this analysis; 2 ineligible patients were excluded, and 1 patient withdrew consent. Ninety-eight of 103 patients (95%) underwent resection. Four patients did not undergo surgery for either disease progression or patient refusal, and 1 patient died during induction chemotherapy. The median time of follow-up was 6.4 years in Arm 1 and 7.0 years in Arm 2. The pathological complete response (pCR) rates were 30% in Arm 1 and 26% in Arm 2. Locoregional recurrence rates were 16% in Arm 1 and 17% in Arm 2. Five-year survival rates were 61% and 75% and Disease-specific survival rates were 78% and 85% for Arm1 and Arm 2, respectively. Five second primaries occurred in patients on Arm 1, and 1 second primary occurred in Arm 2. Conclusions: High rates of disease-specific survival were seen in each arm. Overall survival appears affected by the development of unrelated second cancers. The high pCR rates with 5-FU and higher dose radiation in T4 cancers provide opportunity for increased R0 resections and improved survival.

  12. SU-E-T-11: A Dosimetric Comparison of Robotic Prostatic Radiosugery Using Multi- Leaf Collimation Vs Circular Collimators

    SciTech Connect (OSTI)

    Feng, J; Yang, J; Lamond, J; Lavere, N; Laciano, R; Ding, W; Arrigo, S; Brady, L

    2014-06-01

    Purpose: The study compared the dosimetry plans of Stereotatic Body Radiotherapy (SBRT) prostate cancer patients using the M6 Cyberknife with Multi-leaf Collimation (MLC) compared with the plans using G4 Cyberknife with circular collimators. Methods: Eight previously treated prostate cancer patients' SBRT plans using circular collimators, designed with Multiplan v3.5.3, were used as a benchmark. The CT, contours and the optimization scripts were imported into Multiplan v5.0 system and replanned with MLC. The same planning objectives were used: more than 95% of PTV received 36.25Gy, 90% of prostate received 40Gy and maximum dose <45Gy, in five fractions. For organs at risk, less than 1cc of rectum received 36Gy and less than 10cc of bladder received 37Gy. Plans were evaluated on parameters derived from dose volume. The beam number, MU and delivery time were recorded to compare the treatment efficiency. Results: The mean CTV volume was 41.3cc (27.5?57.6cc) and mean PTV volume was 76.77cc (59.1?99.7cc). The mean PTV coverage was comparable between MLC (98.87%) and cone (98.74%). MLC plans had a slightly more favorable homogeneity index (1.22) and conformity index (1.17), than the cone (1.24 and 1.15). The mean rectum volume of 36 Gy (0.52cc) of MLC plans was slightly larger than cone (0.38cc) and the mean bladder volume of 37 Gy was smaller in MLC (1.82cc) than in cone plans (3.09cc). The mean number of nodes and beams were 65.9 and 80.5 in MLC vs 65.9 and 203.6 in cone. The mean MUs were significantly less for MLC plans (24,228MUs) than cone (32,347MUs). The total delivery time (which included 5 minutes for setup) was less, 29.6min (26?32min) for MLC vs 45min (35?55min) for cone. Conclusion: While the differences in the dosimetry between the MLC and circular collimator plans were rather minor, the MLC plans were much more efficient and required significantly less treatment time.

  13. Uterine Artery Embolization for Leiomyomata: Optimization of the Radiation Dose to the Patient Using a Flat-Panel Detector Angiographic Suite

    SciTech Connect (OSTI)

    Sapoval, Marc Pellerin, Olivier; Rehel, Jean-Luc; Houdoux, Nicolas; Rahmoune, Ghizlaine; Aubert, Bernard; Fitton, Isabelle

    2010-10-15

    The purpose of this study was to assess the ability of low-dose/low-frame fluoroscopy/angiography with a flat-panel detector angiographic suite to reduce the dose delivered to patients during uterine fibroid embolization (UFE). A two-step prospective dosimetric study was conducted, with a flat-panel detector angiography suite (Siemens Axiom Artis) integrating automatic exposure control (AEC), during 20 consecutive UFEs. Patient dosimetry was performed using calibrated thermoluminescent dosimeters placed on the lower posterior pelvis skin. The first step (10 patients; group A) consisted in UFE (bilateral embolization, calibrated microspheres) performed using the following parameters: standard fluoroscopy (15 pulses/s) and angiography (3 frames/s). The second step (next consecutive 10 patients; group B) used low-dose/low-frame fluoroscopy (7.5 pulses/s for catheterization and 3 pulses/s for embolization) and angiography (1 frame/s). We also recorded the total dose-area product (DAP) delivered to the patient and the fluoroscopy time as reported by the manufacturer's dosimetry report. The mean peak skin dose decreased from 2.4 {+-} 1.3 to 0.4 {+-} 0.3 Gy (P = 0.001) for groups A and B, respectively. The DAP values decreased from 43,113 {+-} 27,207 {mu}Gy m{sup 2} for group A to 9,515 {+-} 4,520 {mu}Gy m{sup 2} for group B (P = 0.003). The dose to ovaries and uterus decreased from 378 {+-} 238 mGy (group A) to 83 {+-} 41 mGy (group B) and from 388 {+-} 246 mGy (group A) to 85 {+-} 39 mGy (group B), respectively. Effective doses decreased from 112 {+-} 71 mSv (group A) to 24 {+-} 12 mSv (group B) (P = 0.003). In conclusion, the use of low-dose/low-frame fluoroscopy/angiography, based on a good understanding of the AEC system and also on the technique during uterine fibroid embolization, allows a significant decrease in the dose exposure to the patient.

  14. Biologically Effective Dose (BED) Correlation With Biochemical Control After Low-Dose Rate Prostate Brachytherapy for Clinically Low-Risk Prostate Cancer

    SciTech Connect (OSTI)

    Miles, Edward F.; Nelson, John W.; Alkaissi, Ali K.; Das, Shiva; Clough, Robert W.; Broadwater, Gloria; Anscher, Mitchell S.; Chino, Junzo P.; Oleson, James R.

    2010-05-01

    Purpose: To assess the correlation of postimplant dosimetric quantifiers with biochemical control of prostate cancer after low-dose rate brachytherapy. Methods and Materials: The biologically effective dose (BED), dose in Gray (Gy) to 90% of prostate (D{sub 90}), and percent volume of the prostate receiving 100% of the prescription dose (V{sub 100}) were calculated from the postimplant dose-volume histogram for 140 patients undergoing low-dose rate prostate brachytherapy from 1997 to 2003 at Durham Regional Hospital and the Durham VA Medical Center (Durham, NC). Results: The median follow-up was 50 months. There was a 7% biochemical failure rate (10 of 140), and 91% of patients (127 of 140) were alive at last clinical follow-up. The median BED was 148 Gy (range, 46-218 Gy). The median D{sub 90} was 139 Gy (range, 45-203 Gy). The median V{sub 100} was 85% (range, 44-100%). The overall 5-year biochemical relapse-free survival (bRFS) rate was 90.1%. On univariate Cox proportional hazards modeling, no pretreatment characteristic (Gleason score sum, age, baseline prostate-specific antigen, or clinical stage) was predictive of bRFS. The BED, D{sub 90}, and V{sub 100} were all highly correlated (Pearson coefficients >92%), and all were strongly correlated with bRFS. Using the Youden method, we identified the following cut points for predicting freedom from biochemical failure: D{sub 90} >= 110 Gy, V{sub 100} >= 74%, and BED >= 115 Gy. None of the covariates significantly predicted overall survival. Conclusions: We observed significant correlation between BED, D{sub 90}, and V{sub 100} with bRFS. The BED is at least as predictive of bRFS as D{sub 90} or V{sub 100}. Dosimetric quantifiers that account for heterogeneity in tumor location and dose distribution, tumor repopulation, and survival probability of tumor clonogens should be investigated.

  15. SU-E-T-199: How Number of Control Points Influences the Dynamic IMRT Plan Quality and Deliverability

    SciTech Connect (OSTI)

    Sharma, S; Manigandan, D; Chander, S; Subramani, V; Julka, P; Rath, G

    2014-06-01

    Purpose: To study the influence of number of control points on plan quality and deliverability. Methods: Five previously treated patients of carcinoma of rectum were selected. Planning target volume (PTV) and organs at risk (OARs) i.e. bladder and bowel were contoured. Dynamic IMRT plans (6MV, 7-fields, 45Gy/25 fractions and prescribed at 95% isodose) were created in Eclipse (Varian medical system, Palo Alto, CA) treatment planning system (TPS) for Varian CL2300C/D linear-accelerator. Base plan was calculated with 166 control points, variable mode (Eclipse Default). For generating other plans, all parameters were kept constant, only number of control points (Fixed mode) was varied as follows: 100, 166 and 200. Then, plan quality was analyzed in terms of maximum and mean dose received by the PTV and OARs. For plan deliverability, TPS calculated fluence was verified with ImatriXX (IBA Dosimetry, Germany) array and compared with TPS dose-plane using gamma index criteria of 3% dose difference and 3mm distance to agreement (DTA). Total number of monitor units (MU) required to deliver a plan was also noted. Results: The maximum variation for the PTV maximum with respect to eclipse default control point (166) was 0.28% (0.14Gy). Similarly, PTV mean varied only up to 0.22 %( 0.11Gy). Bladder maximum and bladder mean varied up to 0.51% (0.24Gy) and 0.16% (0.06Gy). The variation for the bowel maximum and bowel mean was also only 0.39% (0.19Gy) and 0.33% (0.04Gy). Total MU was within 0.32 % (4MU). Average gamma pass rate using different control points for five patients are 98.750.33%, 99.370.09%, 99.290.12%, 98.140.13% and 99.250.14% respectively. Conclusion: Slight variation (<1%) in PTV and OARs maximum and mean doses was observed with varying number of control points. Monitor unit was also not varied much. Reducing number of control points did not showed any comprise in plan deliverability in terms of gamma index pass rate.

  16. SU-E-T-629: Feasibility Study of Treating Multiple Brain Tumors with Large Number of Noncoplanar IMRT Beams

    SciTech Connect (OSTI)

    Dong, P; Ma, L

    2014-06-15

    Purpose: To study the feasibility of treating multiple brain tumors withlarge number of noncoplanar IMRT beams. Methods: Thirty beams are selected from 390 deliverable beams separated by six degree in 4pi space. Beam selection optimization is based on a column generation algorithm. MLC leaf size is 2 mm. Dose matrices are calculated with collapsed cone convolution and superposition method in a 2 mm by 2mm by 2 mm grid. Twelve brain tumors of various shapes, sizes and locations are used to generate four plans treating 3, 6, 9 and 12 tumors. The radiation dose was 20 Gy prescribed to the 100% isodose line. Dose Volume Histograms for tumor and brain were compared. Results: All results are based on a 2 mm by 2 mm by 2 mm CT grid. For 3, 6, 9 and 12 tumor plans, minimum tumor doses are all 20 Gy. Mean tumor dose are 20.0, 20.1, 20.1 and 20.1 Gy. Maximum tumor dose are 23.3, 23.6, 25.4 and 25.4 Gy. Mean ventricles dose are 0.7, 1.7, 2.4 and 3.1 Gy.Mean subventricular zone dose are 0.8, 1.3, 2.2 and 3.2 Gy. Average Equivalent uniform dose (gEUD) values for tumor are 20.1, 20.1, 20.2 and 20.2 Gy. The conformity index (CI) values are close to 1 for all 4 plans. The gradient index (GI) values are 2.50, 2.05, 2.09 and 2.19. Conclusion: Compared with published Gamma Knife treatment studies, noncoplanar IMRT treatment plan is superior in terms of dose conformity. Due to maximum limit of beams per plan, Gamma knife has to treat multiple tumors separately in different plans. Noncoplanar IMRT plans theoretically can be delivered in a single plan on any modern linac with an automated couch and image guidance. This warrants further study of using noncoplanar IMRT as a viable treatment solution for multiple brain tumors.

  17. Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

    SciTech Connect (OSTI)

    Bishop, Andrew J.; Tao, Randa; Rebueno, Neal C.; Christensen, Eva N.; Allen, Pamela K.; Wang, Xin A.; Amini, Behrang; Tannir, Nizar M.; Tatsui, Claudio E.; Rhines, Laurence D.; Li, Jing; Chang, Eric L.; Brown, Paul D.; Ghia, Amol J.

    2015-08-01

    Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy. Methods and Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months). Endpoints were overall survival and local control (LC); recurrences were classified as either in-field or marginal. Results: The 1-year actuarial LC and overall survival rates were 88% and 64%, respectively. Patients with local relapses had poorer dosimetric coverage of the gross tumor volume (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin ≥33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared with patients with a lower GTV BED Dmin; this factor was the only significant variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 0.29, 95% confidence interval 0.14-0.60) and also was the only variable significant in a separate competing risk multivariate model (P=.001, hazard ratio 0.30, 95% confidence interval 0.15-0.62). Conclusions: Stereotactic body radiation therapy offers durable control for spinal metastases, but there is a subset of patients that recur locally. Patients with local relapse had significantly poorer tumor coverage, which was likely attributable to treatment planning directives that prioritized the spinal cord constraints over tumor coverage. When possible, we recommend maintaining a GTV Dmin above 14 Gy in 1 fraction and 21 Gy in 3 fractions.

  18. Volumetric-modulated arc radiotherapy for pancreatic malignancies: Dosimetric comparison with sliding-window intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy

    SciTech Connect (OSTI)

    Nabavizadeh, Nima Simeonova, Anna O.; Waller, Joseph G.; Romer, Jeanna L.; Monaco, Debra L.; Elliott, David A.; Tanyi, James A.; Fuss, Martin; Thomas, Charles R.; Holland, John M.

    2014-10-01

    Volumetric-modulated arc radiotherapy (VMAT) is an iteration of intensity-modulated radiotherapy (IMRT), both of which deliver highly conformal dose distributions. Studies have shown the superiority of VMAT and IMRT in comparison with 3-dimensional conformal radiotherapy (3D-CRT) in planning target volume (PTV) coverage and organs-at-risk (OARs) sparing. This is the first study examining the benefits of VMAT in pancreatic cancer for doses more than 55.8 Gy. A planning study comparing 3D-CRT, IMRT, and VMAT was performed in 20 patients with pancreatic cancer. Treatments were planned for a 25-fraction delivery of 45 Gy to a large field followed by a reduced-volume 8-fraction external beam boost to 59.4 Gy in total. OARs and PTV doses, conformality index (CI) deviations from 1.0, monitor units (MUs) delivered, and isodose volumes were compared. IMRT and VMAT CI deviations from 1.0 for the large-field and the boost plans were equivalent (large field: 0.032 and 0.046, respectively; boost: 0.042 and 0.037, respectively; p > 0.05 for all comparisons). Both IMRT and VMAT CI deviations from 1.0 were statistically superior to 3D-CRT (large field: 0.217, boost: 0.177; p < 0.05 for all comparisons). VMAT showed reduction of the mean dose to the boost PTV (VMAT: 61.4 Gy, IMRT: 62.4 Gy, and 3D-CRT: 62.3 Gy; p < 0.05). The mean number of MUs per fraction was significantly lower for VMAT for both the large-field and the boost plans. VMAT delivery time was less than 3 minutes compared with 8 minutes for IMRT. Although no statistically significant dose reduction to the OARs was identified when comparing VMAT with IMRT, VMAT showed a reduction in the volumes of the 100% isodose line for the large-field plans. Dose escalation to 59.4 Gy in pancreatic cancer is dosimetrically feasible with shorter treatment times, fewer MUs delivered, and comparable CIs for VMAT when compared with IMRT.

  19. Dosimetric and Late Radiation Toxicity Comparison Between Iodine-125 Brachytherapy and Stereotactic Radiation Therapy for Juxtapapillary Choroidal Melanoma

    SciTech Connect (OSTI)

    Krema, Hatem

    2013-07-01

    Purpose: To compare the dose distributions and late radiation toxicities for {sup 125}I brachytherapy (IBT) and stereotactic radiation therapy (SRT) in the treatment of juxtapapillary choroidal melanoma. Methods: Ninety-four consecutive patients with juxtapapillary melanoma were reviewed: 30 have been treated with IBT and 64 with SRT. Iodine-125 brachytherapy cases were modeled with plaque simulator software for dosimetric analysis. The SRT dosimetric data were obtained from the Radionics XKnife RT3 software. Mean doses at predetermined intraocular points were calculated. Kaplan-Meier estimates determined the actuarial rates of late toxicities, and the logrank test compared the estimates. Results: The median follow-up was 46 months in both cohorts. The 2 cohorts were balanced with respect to pretreatment clinical and tumor characteristics. Comparisons of radiation toxicity rates between the IBT and SRT cohorts yielded actuarial rates at 50 months for cataracts of 62% and 75% (P=.1), for neovascular glaucoma 8% and 47% (P=.002), for radiation retinopathy 59% and 89% (P=.0001), and for radiation papillopathy 39% and 74% (P=.003), respectively. Dosimetric comparisons between the IBT and SRT cohorts yielded mean doses of 12.8 and 14.1 Gy (P=.56) for the lens center, 17.6 and 19.7 Gy (P=.44) for the lens posterior pole, 13.9 and 10.8 Gy (P=.30) for the ciliary body, 61.9 and 69.7 Gy (P=.03) for optic disc center, and 48.9 and 60.1 Gy (P<.0001) for retina at 5-mm distance from tumor margin, respectively. Conclusions: Late radiation-induced toxicities were greater with SRT, which is secondary to the high-dose exposure inherent to the technique as compared with IBT. When technically feasible, IBT is preferred to treat juxtapapillary choroidal melanoma.

  20. Phase II Trial of Hyperfractionated Intensity-Modulated Radiation Therapy and Concurrent Weekly Cisplatin for Stage III and IVa Head-and-Neck Cancer

    SciTech Connect (OSTI)

    Maguire, Patrick D.; Papagikos, Michael; Hamann, Sue; Neal, Charles; Meyerson, Martin; Hayes, Neil; Ungaro, Peter; Kotz, Kenneth; Couch, Marion; Pollock, Hoke; Tepper, Joel

    2011-03-15

    Purpose: To investigate a novel chemoradiation regimen designed to maximize locoregional control (LRC) and minimize toxicity for patients with advanced head-and-neck squamous cell carcinoma (HNSCC). Methods and Materials: Patients received hyperfractionated intensity modulated radiation therapy (HIMRT) in 1.25-Gy fractions b.i.d. to 70 Gy to high-risk planning target volume (PTV). Intermediate and low-risk PTVs received 60 Gy and 50 Gy, at 1.07, and 0.89 Gy per fraction, respectively. Concurrent cisplatin 33 mg/m{sup 2}/week was started Week 1. Patients completed the Quality of Life Radiation Therapy Instrument pretreatment (PRE), at end of treatment (EOT), and at 1, 3, 6, 9, and 12 months. Overall survival (OS), progression-free (PFS), LRC, and toxicities were assessed. Results: Of 39 patients, 30 (77%) were alive without disease at median follow-up of 37.5 months. Actuarial 3-year OS, PFS, and LRC were 80%, 82%, and 87%, respectively. No failures occurred in the electively irradiated neck and there were no isolated neck failures. Head and neck QOL was significantly worse in 18 of 35 patients (51%): mean 7.8 PRE vs. 3.9 EOT. By month 1, H and N QOL returned near baseline (mean 6.2, SD = 1.7). The most common acute Grade 3+ toxicities were mucositis (38%), fatigue (28%), dysphagia (28%), and leukopenia (26%). Conclusions: Hyperfractionated IMRT with low-dose weekly cisplatin resulted in good LRC with acceptable toxicity and QOL. Lack of elective nodal failures despite very low dose per fraction has led to an attempt to further minimize toxicity by reducing elective nodal doses in our subsequent protocol.

  1. Five-year Local Control in a Phase II Study of Hypofractionated Intensity Modulated Radiation Therapy With an Incorporated Boost for Early Stage Breast Cancer

    SciTech Connect (OSTI)

    Freedman, Gary M.; Anderson, Penny R.; Bleicher, Richard J.; Litwin, Samuel; Li Tianyu; Swaby, Ramona F.; Ma, Chang-Ming Charlie; Li Jinsheng; Sigurdson, Elin R.; Watkins-Bruner, Deborah; Morrow, Monica; Goldstein, Lori J.

    2012-11-15

    Purpose: Conventional radiation fractionation of 1.8-2 Gy per day for early stage breast cancer requires daily treatment for 6-7 weeks. We report the 5-year results of a phase II study of intensity modulated radiation therapy (IMRT), hypofractionation, and incorporated boost that shortened treatment time to 4 weeks. Methods and Materials: The study design was phase II with a planned accrual of 75 patients. Eligibility included patients aged {>=}18 years, Tis-T2, stage 0-II, and breast conservation. Photon IMRT and an incorporated boost was used, and the whole breast received 2.25 Gy per fraction for a total of 45 Gy, and the tumor bed received 2.8 Gy per fraction for a total of 56 Gy in 20 treatments over 4 weeks. Patients were followed every 6 months for 5 years. Results: Seventy-five patients were treated from December 2003 to November 2005. The median follow-up was 69 months. Median age was 52 years (range, 31-81). Median tumor size was 1.4 cm (range, 0.1-3.5). Eighty percent of tumors were node negative; 93% of patients had negative margins, and 7% of patients had close (>0 and <2 mm) margins; 76% of cancers were invasive ductal type: 15% were ductal carcinoma in situ, 5% were lobular, and 4% were other histology types. Twenty-nine percent of patients 29% had grade 3 carcinoma, and 20% of patients had extensive in situ carcinoma; 11% of patients received chemotherapy, 36% received endocrine therapy, 33% received both, and 20% received neither. There were 3 instances of local recurrence for a 5-year actuarial rate of 2.7%. Conclusions: This 4-week course of hypofractionated radiation with incorporated boost was associated with excellent local control, comparable to historical results of 6-7 weeks of conventional whole-breast fractionation with sequential boost.

  2. Outcomes of Patients With Revised Stage I Clear Cell Sarcoma of Kidney Treated in National Wilms Tumor Studies 1-5

    SciTech Connect (OSTI)

    Kalapurakal, John A., E-mail: j-kalapurakal@northwestern.edu [Northwestern University, Chicago, Illinois (United States); Perlman, Elizabeth J. [Northwestern University, Chicago, Illinois (United States)] [Northwestern University, Chicago, Illinois (United States); Seibel, Nita L. [Cancer Therapy and Evaluation Program, Bethesda, Maryland (United States)] [Cancer Therapy and Evaluation Program, Bethesda, Maryland (United States); Ritchey, Michael [Phoenix Children's Hospital, Phoenix, Arizona (United States)] [Phoenix Children's Hospital, Phoenix, Arizona (United States); Dome, Jeffrey S. [Children's National Medical Center, Washington, District of Columbia (United States)] [Children's National Medical Center, Washington, District of Columbia (United States); Grundy, Paul E. [University of Alberta, Edmonton, AB (Canada)] [University of Alberta, Edmonton, AB (Canada)

    2013-02-01

    Purpose: To report the clinical outcomes of children with revised stage I clear cell sarcoma of the kidney (CCSK) using the National Wilms Tumor Study Group (NWTS)-5 staging criteria after multimodality treatment on NWTS 1-5 protocols. Methods and Materials: All CCSK patients enrolled in the National Wilms Tumor Study Group protocols had their pathology slides reviewed, and only those determined to have revised stage I tumors according to the NWTS-5 staging criteria were included in the present analysis. All patients were treated with multimodality therapy according to the NWTS 1-5 protocols. Results: A total of 53 children were identified as having stage I CCSK. All patients underwent primary surgery with radical nephrectomy. The chemotherapy regimens used were as follows: regimen A, C, F, or EE in 4 children (8%); regimen DD or DD4A in 33 children (62%); regimen J in 4 children (8%); and regimen I in 12 children (22%). Forty-six patients (87%) received flank radiation therapy (RT). Seven children (13%) did not receive flank RT. The median delay between surgery and the initiation of RT was 9 days (range, 3-61). The median RT dose was 10.8 Gy (range, 10-36). The flank RT doses were as follows: 10.5 or 10.8 Gy in 25 patients (47%), 11-19.9 Gy in 2 patients (4%), 20-29.9 Gy in 9 patients (17%), and 30-40 Gy in 10 patients (19%). The median follow-up for the entire group was 17 years (range, 2-36). The relapse-free and cancer-specific survival rate was 100% at the last follow-up examination. Conclusions: The present results have demonstrated that children with revised stage I CCSK using the NWTS-5 staging criteria have excellent survival rates despite the use of varying RT doses and chemotherapy regimens in the NWTS 1-5 protocols.

  3. Volumetric tumor burden and its effect on brachial plexus dosimetry in head and neck intensity-modulated radiotherapy

    SciTech Connect (OSTI)

    Romesser, Paul B.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Truong, Minh Tam

    2014-07-01

    To determine the effect of gross tumor volume of the primary (GTV-P) and nodal (GTV-N) disease on planned radiation dose to the brachial plexus (BP) in head and neck intensity-modulated radiotherapy (IMRT). Overall, 75 patients underwent definitive IMRT to a median total dose of 69.96 Gy in 33 fractions. The right BP and left BP were prospectively contoured as separate organs at risk. The GTV was related to BP dose using the unpaired t-test. Receiver operating characteristics curves were constructed to determine optimized volumetric thresholds of GTV-P and GTV-N corresponding to a maximum BP dose cutoff of > 66 Gy. Multivariate analyses were performed to account for factors associated with a higher maximal BP dose. A higher maximum BP dose (> 66 vs ? 66 Gy) correlated with a greater mean GTV-P (79.5 vs 30.8 cc; p = 0.001) and ipsilateral GTV-N (60.6 vs 19.8 cc; p = 0.014). When dichotomized by the optimized nodal volume, patients with an ipsilateral GTV-N ? 4.9 vs < 4.9 cc had a significant difference in maximum BP dose (64.2 vs 59.4 Gy; p = 0.001). Multivariate analysis confirmed that an ipsilateral GTV-N ? 4.9 cc was an independent predictor for the BP to receive a maximal dose of > 66 Gy when adjusted individually for BP volume, GTV-P, the use of a low anterior neck field technique, total planned radiation dose, and tumor category. Although both the primary and the nodal tumor volumes affected the BP maximal dose, the ipsilateral nodal tumor volume (GTV-N ? 4.9 cc) was an independent predictor for high maximal BP dose constraints in head and neck IMRT.

  4. Stereotactic, Single-Dose Irradiation of Lung Tumors: A Comparison of Absolute Dose and Dose Distribution Between Pencil Beam and Monte Carlo Algorithms Based on Actual Patient CT Scans

    SciTech Connect (OSTI)

    Chen Huixiao; Lohr, Frank; Fritz, Peter; Wenz, Frederik; Dobler, Barbara; Lorenz, Friedlieb; Muehlnickel, Werner

    2010-11-01

    Purpose: Dose calculation based on pencil beam (PB) algorithms has its shortcomings predicting dose in tissue heterogeneities. The aim of this study was to compare dose distributions of clinically applied non-intensity-modulated radiotherapy 15-MV plans for stereotactic body radiotherapy between voxel Monte Carlo (XVMC) calculation and PB calculation for lung lesions. Methods and Materials: To validate XVMC, one treatment plan was verified in an inhomogeneous thorax phantom with EDR2 film (Eastman Kodak, Rochester, NY). Both measured and calculated (PB and XVMC) dose distributions were compared regarding profiles and isodoses. Then, 35 lung plans originally created for clinical treatment by PB calculation with the Eclipse planning system (Varian Medical Systems, Palo Alto, CA) were recalculated by XVMC (investigational implementation in PrecisePLAN [Elekta AB, Stockholm, Sweden]). Clinically relevant dose-volume parameters for target and lung tissue were compared and analyzed statistically. Results: The XVMC calculation agreed well with film measurements (<1% difference in lateral profile), whereas the deviation between PB calculation and film measurements was up to +15%. On analysis of 35 clinical cases, the mean dose, minimal dose and coverage dose value for 95% volume of gross tumor volume were 1.14 {+-} 1.72 Gy, 1.68 {+-} 1.47 Gy, and 1.24 {+-} 1.04 Gy lower by XVMC compared with PB, respectively (prescription dose, 30 Gy). The volume covered by the 9 Gy isodose of lung was 2.73% {+-} 3.12% higher when calculated by XVMC compared with PB. The largest differences were observed for small lesions circumferentially encompassed by lung tissue. Conclusions: Pencil beam dose calculation overestimates dose to the tumor and underestimates lung volumes exposed to a given dose consistently for 15-MV photons. The degree of difference between XVMC and PB is tumor size and location dependent. Therefore XVMC calculation is helpful to further optimize treatment planning.

  5. Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy

    SciTech Connect (OSTI)

    Narayan, Samir Lehmann, Joerg; Coleman, Matthew A.; Vaughan, Andrew; Yang, Claus Chunli; Enepekides, Danny; Farwell, Gregory; Purdy, James A.; Laredo, Grace; Nolan, Kerry A.S.; Pearson, Francesca S.; Vijayakumar, Srinivasan

    2008-11-01

    Purpose: We conducted a clinical study to correlate oral cavity dose with clinical mucositis, perform in vivo dosimetry, and determine the feasibility of obtaining buccal mucosal cell samples in patients undergoing head-and-neck radiation therapy. The main objective is to establish a quantitative dose response for clinical oral mucositis. Methods and Materials: Twelve patients undergoing radiation therapy for head-and-neck cancer were prospectively studied. Four points were chosen in separate quadrants of the oral cavity. Calculated dose distributions were generated by using AcQPlan and Eclipse treatment planning systems. MOSFET dosimeters were used to measure dose at each sampled point. Each patient underwent buccal sampling for future RNA analysis before and after the first radiation treatment at the four selected points. Clinical and functional mucositis were assessed weekly according to National Cancer Institute Common Toxicity Criteria, Version 3. Results: Maximum and average doses for sampled sites ranged from 7.4-62.3 and 3.0-54.3 Gy, respectively. A cumulative point dose of 39.1 Gy resulted in mucositis for 3 weeks or longer. Mild severity (Grade {<=} 1) and short duration ({<=}1 week) of mucositis were found at cumulative point doses less than 32 Gy. Polymerase chain reaction consistently was able to detect basal levels of two known radiation responsive genes. Conclusions: In our sample, cumulative doses to the oral cavity of less than 32 Gy were associated with minimal acute mucositis. A dose greater than 39 Gy was associated with longer duration of mucositis. Our technique for sampling buccal mucosa yielded sufficient cells for RNA analysis using polymerase chain reaction.

  6. Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer

    SciTech Connect (OSTI)

    McMillan, Matthew T.; Ojerholm, Eric; Roses, Robert E.; Plastaras, John P.; Metz, James M.; Mamtani, Ronac; Stripp, Diana; Ben-Josef, Edgar; Datta, Jashodeep

    2015-10-01

    Purpose: Prolonged radiation therapy treatment time (RTT) is associated with worse survival in several tumor types. This study investigated whether delays during adjuvant radiation therapy impact overall survival (OS) in gastric cancer. Methods and Materials: The National Cancer Data Base was queried for patients with resected gastric cancer who received adjuvant radiation therapy with National Comprehensive Cancer Network–recommended doses (45 or 50.4 Gy) between 1998 and 2006. RTT was classified as standard (45 Gy: 33-36 days, 50.4 Gy: 38-41 days) or prolonged (45 Gy: >36 days, 50.4 Gy: >41 days). Cox proportional hazards models evaluated the association between the following factors and OS: RTT, interval from surgery to radiation therapy initiation, interval from surgery to radiation therapy completion, radiation therapy dose, demographic/pathologic and operative factors, and other elements of adjuvant multimodality therapy. Results: Of 1591 patients, RTT was delayed in 732 (46%). Factors associated with prolonged RTT were non-private health insurance (OR 1.3, P=.005) and treatment at non-academic facilities (OR 1.2, P=.045). Median OS and 5-year actuarial survival were significantly worse in patients with prolonged RTT compared with standard RTT (36 vs 51 months, P=.001; 39 vs 47%, P=.005); OS worsened with each cumulative week of delay (P<.0004). On multivariable analysis, prolonged RTT was associated with inferior OS (hazard ratio 1.2, P=.002); the intervals from surgery to radiation therapy initiation or completion were not. Prolonged RTT was particularly detrimental in patients with node positivity, inadequate nodal staging (<15 nodes examined), and those undergoing a cycle of chemotherapy before chemoradiation therapy. Conclusions: Delays during adjuvant radiation therapy appear to negatively impact survival in gastric cancer. Efforts to minimize cumulative interruptions to <7 days should be considered.

  7. Clinical and Dosimetric Predictors of Acute Severe Lymphopenia During Radiation Therapy and Concurrent Temozolomide for High-Grade Glioma

    SciTech Connect (OSTI)

    Huang, Jiayi; DeWees, Todd A.; Badiyan, Shahed N.; Speirs, Christina K.; Mullen, Daniel F.; Fergus, Sandra; Tran, David D.; Linette, Gerry; Campian, Jian L.; Chicoine, Michael R.; Kim, Albert H.; Dunn, Gavin; Simpson, Joseph R.; Robinson, Clifford G.

    2015-08-01

    Purpose: Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters. Methods and Materials: From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL. Results: Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V{sub 25Gy}) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V{sub 25Gy} <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006). Conclusions: Female sex, older age, lower baseline TLC, and higher brain V{sub 25Gy} are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V{sub 25Gy} of brain below 56% may reduce the risk of ASL.

  8. Second Solid Cancers After Radiation Therapy: A Systematic Review of the Epidemiologic Studies of the Radiation Dose-Response Relationship

    SciTech Connect (OSTI)

    Berrington de Gonzalez, Amy; Gilbert, Ethel; Curtis, Rochelle; Inskip, Peter; Kleinerman, Ruth; Morton, Lindsay; Rajaraman, Preetha; Little, Mark P.

    2013-06-01

    Rapid innovations in radiation therapy techniques have resulted in an urgent need for risk projection models for second cancer risks from high-dose radiation exposure, because direct observation of the late effects of newer treatments will require patient follow-up for a decade or more. However, the patterns of cancer risk after fractionated high-dose radiation are much less well understood than those after lower-dose exposures (0.1-5 Gy). In particular, there is uncertainty about the shape of the dose-response curve at high doses and about the magnitude of the second cancer risk per unit dose. We reviewed the available evidence from epidemiologic studies of second solid cancers in organs that received high-dose exposure (>5 Gy) from radiation therapy where dose-response curves were estimated from individual organ-specific doses. We included 28 eligible studies with 3434 second cancer patients across 11 second solid cancers. Overall, there was little evidence that the dose-response curve was nonlinear in the direction of a downturn in risk, even at organ doses of ≥60 Gy. Thyroid cancer was the only exception, with evidence of a downturn after 20 Gy. Generally the excess relative risk per Gray, taking account of age and sex, was 5 to 10 times lower than the risk from acute exposures of <2 Gy among the Japanese atomic bomb survivors. However, the magnitude of the reduction in risk varied according to the second cancer. The results of our review provide insights into radiation carcinogenesis from fractionated high-dose exposures and are generally consistent with current theoretical models. The results can be used to refine the development of second solid cancer risk projection models for novel radiation therapy techniques.

  9. Individualized Radical Radiotherapy of Non-Small-Cell Lung Cancer Based on Normal Tissue Dose Constraints: A Feasibility Study

    SciTech Connect (OSTI)

    Baardwijk, Angela van Bosmans, Geert; Boersma, Liesbeth; Wanders, Stofferinus; Dekker, Andre; Dingemans, Anne Marie C.; Bootsma, Gerben; Geraedts, Wiel; Pitz, Cordula; Simons, Jean; Lambin, Philippe; Ruysscher, Dirk de

    2008-08-01

    Purpose: Local recurrence is a major problem after (chemo-)radiation for non-small-cell lung cancer. We hypothesized that for each individual patient, the highest therapeutic ratio could be achieved by increasing total tumor dose (TTD) to the limits of normal tissues, delivered within 5 weeks. We report first results of a prospective feasibility trial. Methods and Materials: Twenty-eight patients with medically inoperable or locally advanced non-small-cell lung cancer, World Health Organization performance score of 0-1, and reasonable lung function (forced expiratory volume in 1 second > 50%) were analyzed. All patients underwent irradiation using an individualized prescribed TTD based on normal tissue dose constraints (mean lung dose, 19 Gy; maximal spinal cord dose, 54 Gy) up to a maximal TTD of 79.2 Gy in 1.8-Gy fractions twice daily. No concurrent chemoradiation was administered. Toxicity was scored using the Common Terminology Criteria for Adverse Events criteria. An {sup 18}F-fluoro-2-deoxy-glucose-positron emission tomography-computed tomography scan was performed to evaluate (metabolic) response 3 months after treatment. Results: Mean delivered dose was 63.0 {+-} 9.8 Gy. The TTD was most often limited by the mean lung dose (32.1%) or spinal cord (28.6%). Acute toxicity generally was mild; only 1 patient experienced Grade 3 cough and 1 patient experienced Grade 3 dysphagia. One patient (3.6%) died of pneumonitis. For late toxicity, 2 patients (7.7%) had Grade 3 cough or dyspnea; none had severe dysphagia. Complete metabolic response was obtained in 44% (11 of 26 patients). With a median follow-up of 13 months, median overall survival was 19.6 months, with a 1-year survival rate of 57.1%. Conclusions: Individualized maximal tolerable dose irradiation based on normal tissue dose constraints is feasible, and initial results are promising.

  10. Effects of radioactive hot particles on pig skin

    SciTech Connect (OSTI)

    Kaurin, D.G.; Baum, J.W.; Schaefer, C.W. [and others

    1997-06-01

    The purpose of these studies was to determine the incidence and severity of lesions resulting from very localized deposition of dose to skin from small (< 0.5 mm) discrete radioactive particles as produced in the work environments of nuclear reactors. Hanford mini-pigs were exposed, both on a slightly off the skin, to localized replicate doses from 0.31 to 64 Gy (averaged over 1 cm{sup 2} at 70 {mu}m depth unless noted otherwise) using Sc-46, Yb-175, Tm-170, and fissioned UC{sub 2} isotopes having maximum beta-particle energies from about 0.3 to 3 MeV. Erythema and scabs (indicating ulceration) were scored for up to 71 days post-irradiation. The responses followed normal cumulative probability distributions, and therefore, no true threshold could be defined. Hence, 10 and 50% scab incidence rates were deduced using probit analyses. The lowest dose which produced 10% incidence was about 1 Gy for Yb-175 (0.5 MeV maximum energy) beta particle exposures, and about 3 to 9 Gy for other isotopes. The histopathology of lesions was determined at several doses. Single exposures to doses as large as 1,790 Gy were also given, and results were observed for up to 144 days post-exposure. Severity of detriment was estimated by analyzing the results in terms of lesion diameter, persistence, and infection. Over 1,100 sites were exposed. Only two exposed sites became infected after doses near 5000 Gy; the lesions healed quickly on treatment. 105 refs., 145 figs., 47 tabs.

  11. Quantification of incidental mediastinal and hilar irradiation delivered during definitive stereotactic body radiation therapy for peripheral non-small cell lung cancer

    SciTech Connect (OSTI)

    Martin, Kate L.; Gomez, Jorge; Nazareth, Daryl P.; Warren, Graham W.; Singh, Anurag K.

    2012-07-01

    To determine the amount of incidental radiation dose received by the mediastinal and hilar nodes for patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Fifty consecutive patients with NSCLC, treated using an SBRT technique, were identified. Of these patients, 38 had a prescription dose of 60 Gy in 20-Gy fractions and were eligible for analysis. For each patient, ipsilateral upper (level 2) and lower (level 4) paratracheal, and hilar (level 10) nodal regions were contoured on the planning computed tomography (CT) images. Using the clinical treatment plan, dose and volume calculations were performed retrospectively for each nodal region. SBRT to upper lobe tumors resulted in an average total ipsilateral mean dose of between 5.2 and 7.8 Gy for the most proximal paratracheal nodal stations (2R and 4R for right upper lobe lesions, 2L and 4L for left upper lobe lesions). SBRT to lower lobe tumors resulted in an average total ipsilateral mean dose of between 15.6 and 21.5 Gy for the most proximal hilar nodal stations (10R for right lower lobe lesions, 10 l for left lower lobe lesions). Doses to more distal nodes were substantially lower than 5 Gy. The often substantial incidental irradiation, delivered during SBRT for peripheral NSCLC of the lower lobes to the most proximal hilar lymph nodes may be therapeutic for low-volume, subclinical nodal disease. Treatment of peripheral upper lobe lung tumors delivers less incidental irradiation to the paratracheal lymph nodes with lower likelihood of therapeutic benefit.

  12. Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer

    SciTech Connect (OSTI)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Swanick, Cameron; Alvarado, Tina; Komaki, Ritsuko; Cox, James D.; Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-15

    Background: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. Methods and Materials: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. Results: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. Conclusion: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.

  13. Dermatofibrosarcoma Protuberans: Long-term Outcomes of 53 Patients Treated With Conservative Surgery and Radiation Therapy

    SciTech Connect (OSTI)

    Castle, Katherine O. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Guadagnolo, B. Ashleigh, E-mail: aguadagn@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tsai, C. Jillian [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Feig, Barry W. [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zagars, Gunar K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-01

    Purpose: To evaluate outcomes of conservative surgery and radiation therapy (RT) treatment in patients with dermatofibrosarcoma protuberans. Methods and Materials: We retrospectively reviewed the medical records of 53 consecutive dermatofibrosarcoma protuberans patients treated with surgery and preoperative or postoperative radiation therapy between 1972 and 2010. Median tumor size was 4 cm (range, 1-25 cm). Seven patients (13%) were treated with preoperative RT (50-50.4 Gy) and 46 patients (87%) with postoperative RT (60-66 Gy). Of the 46 patients receiving postoperative radiation, 3 (7%) had gross disease, 14 (30%) positive margins, 26 (57%) negative margins, and 3 (7%) uncertain margin status. Radiation dose ranged from 50 to 66 Gy (median dose, 60 Gy). Results: At a median follow-up time of 6.5 years (range, 0.5 months-23.5 years), 2 patients (4%) had disease recurrence, and 3 patients (6%) had died. Actuarial overall survival was 98% at both 5 and 10 years. Local control was 98% and 93% at 5 and 10 years, respectively. Disease-free survival was 98% and 93% at 5 and 10 years, respectively. The presence of fibrosarcomatous change was not associated with increased risk of local or distant relapse (P=.43). One of the patients with a local recurrence had gross residual disease at the time of RT and despite RT to 65 Gy developed both an in-field recurrence and a nodal and distant recurrence 3 months after RT. The other patient with local recurrence was found to have in-field recurrence 10 years after initial treatment. Thirteen percent of patients had an RT complication at 5 and 10 years, and 9% had a moderate or severe complication at 5 and 10 years. Conclusions: Dermatofibrosarcoma protuberans is a radioresponsive disease with excellent local control after conservative surgery and radiation therapy. Adjuvant RT should be considered for patients with large or recurrent tumors or when attempts at wide surgical margins would result in significant morbidity.

  14. Clinical Application of High-Dose, Image-Guided Intensity-Modulated Radiotherapy in High-Risk Prostate Cancer

    SciTech Connect (OSTI)

    Bayley, Andrew, E-mail: Andrew.Bayley@rmp.uhn.on.c [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Rosewall, Tara; Craig, Tim; Bristow, Rob; Chung, Peter; Gospodarowicz, Mary; Menard, Cynthia; Milosevic, Michael; Warde, Padraig; Catton, Charles [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

    2010-06-01

    Purpose: To report the feasibility and early toxicity of dose-escalated image-guided IMRT to the pelvic lymph nodes (LN), prostate (P), and seminal vesicles (SV). Methods and Materials: A total of 103 high-risk prostate cancer patients received two-phase, dose-escalated, image-guided IMRT with 3 years of androgen deprivation therapy. Clinical target volumes (CTVs) were delineated using computed tomography/magnetic resonance co-registration and included the prostate, portions of the SV, and the LN. Planning target volume margins (PTV) used were as follows: P (10 mm, 7 mm posteriorly), SV (10 mm), and LN (5 mm). Organs at risk (OaR) were the rectal and bladder walls, femoral heads, and large and small bowel. The IMRT was planned with an intended dose of 55.1 Gy in 29 fractions to all CTVs (Phase 1), with P+SV consecutive boost of 24.7 Gy in 13 fractions. Daily online image guidance was performed using bony landmarks and intraprostatic markers. Feasibility criteria included delivery of intended doses in 80% of patients, 95% of CTV displacements incorporated within PTV during Phase 1, and acute toxicity rate comparable to that of lower-dose pelvic techniques. Results: A total of 91 patients (88%) received the total prescription dose. All patients received at least 72 Gy. In Phase 1, 63 patients (61%) received the intended 55.1 Gy, whereas 87% of patients received at least 50 Gy. Dose reductions were caused by small bowel and rectal wall constraints. All CTVs received the planned dose in >95% of treatment fractions. There were no Radiation Therapy Oncology Group acute toxicities greater than Grade 3, although there were five incidences equivalent to Grade 3 within a median follow-up of 23 months. Conclusion: These results suggest that dose escalation to the PLN+P+SV using IMRT is feasible, with acceptable rates of acute toxicity.

  15. Optimization of leaf margins for lung stereotactic body radiotherapy using a flattening filter-free beam

    SciTech Connect (OSTI)

    Wakai, Nobuhide; Sumida, Iori; Otani, Yuki; Suzuki, Osamu; Seo, Yuji; Isohashi, Fumiaki; Yoshioka, Yasuo; Ogawa, Kazuhiko; Hasegawa, Masatoshi

    2015-05-15

    Purpose: The authors sought to determine the optimal collimator leaf margins which minimize normal tissue dose while achieving high conformity and to evaluate differences between the use of a flattening filter-free (FFF) beam and a flattening-filtered (FF) beam. Methods: Sixteen lung cancer patients scheduled for stereotactic body radiotherapy underwent treatment planning for a 7 MV FFF and a 6 MV FF beams to the planning target volume (PTV) with a range of leaf margins (?3 to 3 mm). Forty grays per four fractions were prescribed as a PTV D95. For PTV, the heterogeneity index (HI), conformity index, modified gradient index (GI), defined as the 50% isodose volume divided by target volume, maximum dose (Dmax), and mean dose (Dmean) were calculated. Mean lung dose (MLD), V20 Gy, and V5 Gy for the lung (defined as the volumes of lung receiving at least 20 and 5 Gy), mean heart dose, and Dmax to the spinal cord were measured as doses to organs at risk (OARs). Paired t-tests were used for statistical analysis. Results: HI was inversely related to changes in leaf margin. Conformity index and modified GI initially decreased as leaf margin width increased. After reaching a minimum, the two values then increased as leaf margin increased (V shape). The optimal leaf margins for conformity index and modified GI were ?1.1 0.3 mm (mean 1 SD) and ?0.2 0.9 mm, respectively, for 7 MV FFF compared to ?1.0 0.4 and ?0.3 0.9 mm, respectively, for 6 MV FF. Dmax and Dmean for 7 MV FFF were higher than those for 6 MV FF by 3.6% and 1.7%, respectively. There was a positive correlation between the ratios of HI, Dmax, and Dmean for 7 MV FFF to those for 6 MV FF and PTV size (R = 0.767, 0.809, and 0.643, respectively). The differences in MLD, V20 Gy, and V5 Gy for lung between FFF and FF beams were negligible. The optimal leaf margins for MLD, V20 Gy, and V5 Gy for lung were ?0.9 0.6, ?1.1 0.8, and ?2.1 1.2 mm, respectively, for 7 MV FFF compared to ?0.9 0.6, ?1.1 0.8, and ?2.2 1.3 mm, respectively, for 6 MV FF. With the heart inside the radiation field, the mean heart dose showed a V-shaped relationship with leaf margins. The optimal leaf margins were ?1.0 0.6 mm for both beams. Dmax to the spinal cord showed no clear trend for changes in leaf margin. Conclusions: The differences in doses to OARs between FFF and FF beams were negligible. Conformity index, modified GI, MLD, lung V20 Gy, lung V5 Gy, and mean heart dose showed a V-shaped relationship with leaf margins. There were no significant differences in optimal leaf margins to minimize these parameters between both FFF and FF beams. The authors results suggest that a leaf margin of ?1 mm achieves high conformity and minimizes doses to OARs for both FFF and FF beams.

  16. 3D inpatient dose reconstruction from the PET-CT imaging of {sup 90}Y microspheres for metastatic cancer to the liver: Feasibility study

    SciTech Connect (OSTI)

    Fourkal, E.; Veltchev, I.; Lin, M.; Meyer, J.; Koren, S.; Doss, M.; Yu, J. Q.

    2013-08-15

    Purpose: The introduction of radioembolization with microspheres represents a significant step forward in the treatment of patients with metastatic disease to the liver. This technique uses semiempirical formulae based on body surface area or liver and target volumes to calculate the required total activity for a given patient. However, this treatment modality lacks extremely important information, which is the three-dimensional (3D) dose delivered by microspheres to different organs after their administration. The absence of this information dramatically limits the clinical efficacy of this modality, specifically the predictive power of the treatment. Therefore, the aim of this study is to develop a 3D dose calculation technique that is based on the PET imaging of the infused microspheres.Methods: The Fluka Monte Carlo code was used to calculate the voxel dose kernel for {sup 90}Y source with voxel size equal to that of the PET scan. The measured PET activity distribution was converted to total activity distribution for the subsequent convolution with the voxel dose kernel to obtain the 3D dose distribution. In addition, dose-volume histograms were generated to analyze the dose to the tumor and critical structures.Results: The 3D inpatient dose distribution can be reconstructed from the PET data of a patient scanned after the infusion of microspheres. A total of seven patients have been analyzed so far using the proposed reconstruction method. Four patients underwent treatment with SIR-Spheres for liver metastases from colorectal cancer and three patients were treated with Therasphere for hepatocellular cancer. A total of 14 target tumors were contoured on post-treatment PET-CT scans for dosimetric evaluation. Mean prescription activity was 1.7 GBq (range: 0.583.8 GBq). The resulting mean maximum measured dose to targets was 167 Gy (range: 71311 Gy). Mean minimum dose to 70% of target (D70) was 68 Gy (range: 25155 Gy). Mean minimum dose to 90% of target (D90) was 53 Gy (range: 13125 Gy).Conclusions: A three-dimensional inpatient dose reconstruction method has been developed that is based on the PET/CT data of a patient treated with {sup 90}Y microspheres. It allows for a complete description of the absorbed dose by the tumor and critical structures. It represents the first step in building predictive models for treatment outcomes for patients receiving this therapeutic modality as well as it allows for better analysis of patients' dose response and will ultimately improve future treatment administration.

  17. Modeling Local Control After Hypofractionated Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Report From the Elekta Collaborative Lung Research Group

    SciTech Connect (OSTI)

    Ohri, Nitin; Werner-Wasik, Maria; Grills, Inga S.; Belderbos, Jose; Hope, Andrew; Yan Di; Kestin, Larry L.; Guckenberger, Matthias; Sonke, Jan-Jakob; Bissonnette, Jean-Pierre; Xiao, Ying

    2012-11-01

    Purpose: Hypofractionated stereotactic body radiation therapy (SBRT) has emerged as an effective treatment option for early-stage non-small cell lung cancer (NSCLC). Using data collected by the Elekta Lung Research Group, we generated a tumor control probability (TCP) model that predicts 2-year local control after SBRT as a function of biologically effective dose (BED) and tumor size. Methods and Materials: We formulated our TCP model as follows: TCP = e{sup [BED10-c Asterisk-Operator L-TCD50]/k} Division-Sign (1 + e{sup [BED10-c Asterisk-Operator L-TCD50]/k}), where BED10 is the biologically effective SBRT dose, c is a constant, L is the maximal tumor diameter, and TCD50 and k are parameters that define the shape of the TCP curve. Least-squares optimization with a bootstrap resampling approach was used to identify the values of c, TCD50, and k that provided the best fit with observed actuarial 2-year local control rates. Results: Data from 504 NSCLC tumors treated with a variety of SBRT schedules were available. The mean follow-up time was 18.4 months, and 26 local recurrences were observed. The optimal values for c, TCD50, and k were 10 Gy/cm, 0 Gy, and 31 Gy, respectively. Thus, size-adjusted BED (sBED) may be defined as BED minus 10 times the tumor diameter (in centimeters). Our TCP model indicates that sBED values of 44 Gy, 69 Gy, and 93 Gy provide 80%, 90%, and 95% chances of tumor control at 2 years, respectively. When patients were grouped by sBED, the model accurately characterized the relationship between sBED and actuarial 2-year local control (r=0.847, P=.008). Conclusion: We have developed a TCP model that predicts 2-year local control rate after hypofractionated SBRT for early-stage NSCLC as a function of biologically effective dose and tumor diameter. Further testing of this model with additional datasets is warranted.

  18. Early-Stage Breast Cancer Treated With 3-Week Accelerated Whole-Breast Radiation Therapy and Concomitant Boost

    SciTech Connect (OSTI)

    Chadha, Manjeet; Woode, Rudolph; Sillanpaa, Jussi; Lucido, David; Boolbol, Susan K.; Kirstein, Laurie; Osborne, Michael P.; Feldman, Sheldon; Harrison, Louis B.

    2013-05-01

    Purpose: To report early outcomes of accelerated whole-breast radiation therapy with concomitant boost. Methods and Materials: This is a prospective, institutional review board-approved study. Eligibility included stage TisN0, T1N0, and T2N0 breast cancer. Patients receiving adjuvant chemotherapy were ineligible. The whole breast received 40.5 Gy in 2.7-Gy fractions with a concomitant lumpectomy boost of 4.5 Gy in 0.3-Gy fractions. Total dose to the lumpectomy site was 45 Gy in 15 fractions over 19 days. Results: Between October 2004 and December 2010, 160 patients were treated; stage distribution was as follows: TisN0, n=63; T1N0, n=88; and T2N0, n=9. With a median follow-up of 3.5 years (range, 1.5-7.8 years) the 5-year overall survival and disease-free survival rates were 90% (95% confidence interval [CI] 0.84-0.94) and 97% (95% CI 0.93-0.99), respectively. Five-year local relapse-free survival was 99% (95% CI 0.96-0.99). Acute National Cancer Institute/Common Toxicity Criteria grade 1 and 2 skin toxicity was observed in 70% and 5%, respectively. Among the patients with ?2-year follow-up no toxicity higher than grade 2 on the Late Effects in Normal TissuesSubjective, Objective, Management, and Analytic scale was observed. Review of the radiation therapy dosevolume histogram noted that ?95% of the prescribed dose encompassed the lumpectomy target volume in >95% of plans. The median dose received by the heart D{sub 05} was 215 cGy, and median lung V{sub 20} was 7.6%. Conclusions: The prescribed accelerated schedule of whole-breast radiation therapy with concomitant boost can be administered, achieving acceptable dose distribution. With follow-up to date, the results are encouraging and suggest minimal side effects and excellent local control.

  19. Precision Hypofractionated Radiation Therapy in Poor Performing Patients With Non-Small Cell Lung Cancer: Phase 1 Dose Escalation Trial

    SciTech Connect (OSTI)

    Westover, Kenneth D.; Loo, Billy W.; Gerber, David E.; Iyengar, Puneeth; Choy, Hak; Diehn, Maximilian; Hughes, Randy; Schiller, Joan; Dowell, Jonathan; Wardak, Zabi; Sher, David; Christie, Alana; Xie, Xian-Jin; Corona, Irma; Sharma, Akanksha; Wadsworth, Margaret E.; Timmerman, Robert

    2015-09-01

    Purpose: Treatment regimens for locally advanced non-small cell lung cancer (NSCLC) give suboptimal clinical outcomes. Technological advancements such as radiation therapy, the backbone of most treatment regimens, may enable more potent and effective therapies. The objective of this study was to escalate radiation therapy to a tumoricidal hypofractionated dose without exceeding the maximally tolerated dose (MTD) in patients with locally advanced NSCLC. Methods and Materials: Patients with stage II to IV or recurrent NSCLC and Eastern Cooperative Oncology Group performance status of 2 or greater and not candidates for surgical resection, stereotactic radiation, or concurrent chemoradiation were eligible. Highly conformal radiation therapy was given to treat intrathoracic disease in 15 fractions to a total of 50, 55, or 60 Gy. Results: Fifty-five patients were enrolled: 15 at the 50-Gy, 21 at the 55-Gy, and 19 at the 60-Gy dose levels. A 90-day follow-up was completed in each group without exceeding the MTD. With a median follow-up of 12.5 months, there were 93 grade ≥3 adverse events (AEs), including 39 deaths, although most AEs were considered related to factors other than radiation therapy. One patient from the 55- and 60-Gy dose groups developed grade ≥3 esophagitis, and 5, 4, and 4 patients in the respective dose groups experienced grade ≥3 dyspnea, but only 2 of these AEs were considered likely related to therapy. There was no association between fraction size and toxicity (P=.24). The median overall survival was 6 months with no significant differences between dose levels (P=.59). Conclusions: Precision hypofractionated radiation therapy consisting of 60 Gy in 15 fractions for locally advanced NSCLC is generally well tolerated. This treatment regimen could provide patients with poor performance status a potent alternative to chemoradiation. This study has implications for the cost effectiveness of lung cancer therapy. Additional studies of long-term safety and efficacy of this therapy are warranted.

  20. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

    SciTech Connect (OSTI)

    Pak, Daniel; Vineberg, Karen A.; Griffith, Kent A.; Sabolch, Aaron; Chugh, Rashmi; Biermann, Janet Sybil; Feng, Mary

    2012-07-15

    Purpose: We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). Methods and Materials: We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V{sub d}) receiving specified doses ({>=}30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Results: Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 {+-} 8.9 Gy, V30 of 14.5 {+-} 2.3 cc, V45 of 11.8 {+-} 1.1 cc, and V60 of 7.2 {+-} 2.2 cc at the femoral neck compared with 22.9 {+-} 20.8 Gy, 4.8 {+-} 5.6 cc, 2.5 {+-} 3.9 cc, and 0.8 {+-} 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. Conclusions: These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients.

  1. A protocol for EBT3 radiochromic film dosimetry using reflection scanning

    SciTech Connect (OSTI)

    Papaconstadopoulos, Pavlos Hegyi, Gyorgy; Seuntjens, Jan; Devic, Slobodan

    2014-12-15

    Purpose: To evaluate the performance of the EBT3 radiochromic film dosimetry system using reflection measurements and to suggest a calibration protocol for precise and accurate reflection film dosimetry. Methods: A set of 14 Gafchromic EBT3 film pieces were irradiated to various doses ranging from 0 to 8 Gy and subsequently scanned using both the reflection and transmission mode. Scanning resolution varied from 50 to 508 dpi (0.50.05 mm/pixel). Both the red and green color channels of scanned images were used to relate the film response to the dose. A sensitivity, uncertainty, and accuracy analysis was performed for all scanning modes and color channels. The total uncertainty, along with the fitting and experimental uncertainty components, was identified and analyzed. A microscope resolution target was used to evaluate possible resolution losses under reflection scanning. The calibration range was optimized for reflection scanning in the low (<2 Gy) and high (>2 Gy) dose regions based on the reported results. Results: Reflection scanning using the red channel exhibited the highest sensitivity among all modes, being up to 150% higher than transmission mode in the red channel for the lowest dose level. Furthermore, there was no apparent loss in resolution between the two modes. However, higher uncertainties and reduced accuracy were observed for the red channel under reflection mode, especially at dose levels higher than 2 Gy. These uncertainties were mainly attributed to saturation effects which were translated in poor fitting results. By restricting the calibration to the 02 Gy dose range, the situation is reversed and the red reflection mode was superior to the transmission mode. For higher doses, the green channel in reflection mode presented comparable results to the red transmission. Conclusions: A two-color reflection scanning protocol can be suggested for EBT3 radiochromic film dosimetry using the red channel for doses less than 2 Gy and the green channel for higher doses. The precision and accuracy are significantly improved in the low dose region following such a protocol.

  2. Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant

    SciTech Connect (OSTI)

    Faraci, Maura; Cohen, Amnon; Lanino, Edoardo; Sacco, Oliviero; Cabria, Manlio; De Marco, Riccardo; Stella, Gilberto; Dallorso, Sandro; Vitale, Vito; Dini, Giorgio

    2005-12-01

    Purpose: To describe long-term late consequences in children who received total body irradiation (TBI) for hematopoietic stem cell transplantation 10 years earlier. Methods and Materials: A cohort of 42 children treated with TBI between 1985 and 1993, still alive at least 10 years after fractionated TBI (FTBI), was evaluated. Twenty-five patients received FTBI at 330 cGy/day for 3 days (total dose 990 cGy), whereas 17 children were administered fractions of 200 cGy twice daily for 3 days (total dose 1200 cGy). Twenty-seven patients received autologous and 16 allogeneic hematopoietic stem cell transplantation. Median age at TBI was 6.3 years, and 18.4 years at most recent follow-up. Results: Cataract was diagnosed in 78% of patients after a median of 5.7 years. Hypothyroidism was detected in 12%, whereas thyroid nodules were observed in 60% of our population after a median interval of 10.2 years. Patients treated with 990 cGy developed thyroid nodules more frequently than those treated with 1200 cGy (p = 0.0002). Thyroid carcinoma was diagnosed in 14% of the total population. Females who received FTBI after menarche more frequently developed temporary ovarian dysfunction than those treated before menarche, but cases of persistent ovarian dysfunction did not differ between the two groups. Indirect signs of germinal testicular dysfunction were detected in 87% of males. Restrictive pulmonary disease was observed in 74% of patients. Osteochondroma was found in 29% of patients after a median interval of 9.2 years. This latter complication appeared more frequently in patients irradiated before the age of 3 years (p < 0.001). Conclusions: This study shows that late effects that are likely permanent, although not fatal, are frequent in survivors 10 years after TBI. However, some of the side effects observed shortly after TBI either disappeared or remained unchanged without signs of evolution. Monitoring is recommended to pursue secondary prevention strategies and counseling on family planning.

  3. Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

    SciTech Connect (OSTI)

    Klopp, Ann H.; Moughan, Jennifer; Portelance, Lorraine; Miller, Brigitte E.; Salehpour, Mohammad R.; Hildebrandt, Evangeline; Nuanjing, Jenny; D'Souza, David; Souhami, Luis; Small, William; Gaur, Rakesh; Jhingran, Anuja

    2013-05-01

    Purpose: Intensity modulated radiation therapy (IMRT), compared with conventional 4-field treatment, can reduce the volume of bone marrow irradiated. Pelvic bone marrow sparing has produced a clinically significant reduction in hematologic toxicity (HT). This analysis investigated HT in Radiation Therapy Oncology Group (RTOG) 0418, a prospective study to test the feasibility of delivering postoperative IMRT for cervical and endometrial cancer in a multiinstitutional setting. Methods and Materials: Patients in the RTOG 0418 study were treated with postoperative IMRT to 50.4 Gy to the pelvic lymphatics and vagina. Endometrial cancer patients received IMRT alone, whereas patients with cervical cancer received IMRT and weekly cisplatin (40 mg/m{sup 2}). Pelvic bone marrow was defined within the treatment field by using a computed tomography density-based autocontouring algorithm. The volume of bone marrow receiving 10, 20, 30, and 40 Gy and the median dose to bone marrow were correlated with HT, graded by Common Terminology Criteria for Adverse Events, version 3.0, criteria. Results: Eighty-three patients were eligible for analysis (43 with endometrial cancer and 40 with cervical cancer). Patients with cervical cancer treated with weekly cisplatin and pelvic IMRT had grades 1-5 HT (23%, 33%, 25%, 0%, and 0% of patients, respectively). Among patients with cervical cancer, 83% received 5 or more cycles of cisplatin, and 90% received at least 4 cycles of cisplatin. The median percentage volume of bone marrow receiving 10, 20, 30, and 40 Gy in all 83 patients, respectively, was 96%, 84%, 61%, and 37%. Among cervical cancer patients with a V40 >37%, 75% had grade 2 or higher HT compared with 40% of patients with a V40 less than or equal to 37% (P =.025). Cervical cancer patients with a median bone marrow dose of >34.2 Gy also had higher rates of grade ?2 HT than did those with a dose of ?34.2 Gy (74% vs 43%, P=.049). Conclusions: Pelvic IMRT with weekly cisplatin is associated with low rates of HT and high rates of weekly cisplatin use. The volume of bone marrow receiving 40 Gy and the median dose to bone marrow correlated with higher rates of grade ?2 toxicity among patients receiving weekly cisplatin (cervical cancer patients). Evaluation and limitation of the volume of bone marrow treated with pelvic IMRT is warranted in patients receiving concurrent chemotherapy.

  4. Thermal, tensile and rheological properties of high density polyethylene (HDPE) processed and irradiated by gamma-ray in different atmospheres

    SciTech Connect (OSTI)

    Ferreto, H. F. R. E-mail: ana-feitoza@yahoo.com.br; Oliveira, A. C. F. E-mail: ana-feitoza@yahoo.com.br; Parra, D. F. E-mail: ablugao@ipen.br; Lugo, A. B. E-mail: ablugao@ipen.br; Gaia, R.

    2014-05-15

    The aim of this paper is to investigate structural changes of high density polyethylene (HDPE) modified by ionizing radiation (gamma rays) in different atmospheres. The gamma radiation process for modification of commercial polymers is a widely applied technique to promote new physical-chemical and mechanical properties. Gamma irradiation originates free radicals which can induce chain scission or recombination, providing its annihilation, branching or crosslinking. This polymer was irradiated with gamma source of {sup 60}Co at doses of 5, 10, 20, 50 or 100 kGy at a dose rate of 5 kGy/h. The changes in molecular structure of HDPE, after gamma irradiations were evaluated using thermogravimetric analysis (TGA) and tensile machine and oscillatory rheology. The results showed the variations of the properties depending on the dose at each atmosphere.

  5. Poly [1,1'-bis(ethynyl)-4,4'-biphenyl(bis-tributylphosphine)Pt(II)] solutions used as low dose ionizing radiation dosimeter

    SciTech Connect (OSTI)

    Bronze-Uhle, E. S.; Graeff, C. F. O.; Batagin-Neto, A.; Fernandes, D. M.; Fratoddi, I.; Russo, M. V.

    2013-06-17

    In this work, the effect of gamma radiation on the optical properties of polymetallayne poly[1,1'-bis(ethynyl)-4,4'-biphenyl(bis-tributylphosphine)Pt(II)] (Pt-DEBP) in chloroform solution is studied. The samples were irradiated at room temperature with doses from 0.01 Gy to 1 Gy using a {sup 60}Co gamma ray source. A new band at 420 nm is observed in the emission spectra, in superposition to the emission maximum at 398 nm, linearly dependent on dose. We propose to use the ratio of the emission amplitude bands as the dosimetric parameter. This method proved to be robust, accurate, and can be used as a dosimeter in medical applications.

  6. Flat Ge-doped optical fibres for food irradiation dosimetry

    SciTech Connect (OSTI)

    Noor, N. Mohd; Jusoh, M. A.; Razis, A. F. Abdull; Alawiah, A.; Bradley, D. A.

    2015-04-24

    Exposing food to radiation can improve hygiene quality, germination control, retard sprouting, and enhance physical attributes of the food product. To provide for food safety, radiation dosimetry in irradiated food is required. Herein, fabricated germanium doped (Ge-doped) optical fibres have been used. The fibres have been irradiated using a gamma source irradiator, doses in the range 1 kGy to 10 kGy being delivered. Using Ge-doped optical fibres of variable size, type and dopant concentration, study has been made of linearity, reproducibility, and fading. The thermoluminescence (TL) yield of the fibres were obtained and compared. The fibres exhibit a linear dose response over the investigated range of doses, with mean reproducibility to within 2.69 % to 8.77 %, exceeding the dose range of all commercial dosimeters used in evaluating high doses for the food irradiation industry. TL fading of the Ge-doped flat fibres has been found to be < 13%.

  7. Pure LiF nanophosphors for high exposures of gamma-rays

    SciTech Connect (OSTI)

    Sharma, A. K.; Kumar, Satinder; Dogra, R.; Lochab, S. P.; Kumar, Ravi

    2012-06-05

    Nanocrystalline lithium fluoride (LiF) phosphors have been prepared by the chemical co-precipitation method at different pH values (7.0, 8.0, 9.0 and 10.00). The formation of nanocrystalline structure has been confirmed by X-ray diffraction and transmission electron microscope. Thermoluminescence (TL) properties of LiF phosphors irradiated with gamma rays at different doses of 10 Gy - 70 kGy have been further studied. The analysis of TL glow curve revealed the existence of three well resolved glow peaks, first low temperature peak at around 82 deg. C, second at 125 deg. C and third one at higher temperature around 303 deg. C. The LiF nano-crystallites synthesized at 8.00 pH with maximum TL sensitivity at studied gamma doses ranging from threshold to high exposures are potential candidate for dosimetry applications.

  8. Thermoluminescence Characteristics of Nanocrystalline LiF Phosphors Synthesized at Different pH Values

    SciTech Connect (OSTI)

    Sharma, A. K.; Dogra, R.; Kumar, Shalendra; Mishra, S. K.; Lochab, S. P.; Kumar, Ravi

    2011-07-15

    Nanocrystalline lithium fluoride (LiF) phosphors have been prepared by the chemical co-precipitation method at different pH values (7.0, 8.0, 9.0). The formation of nanocrystalline structure has been confirmed by X-ray diffraction and transmission electron microscope. The thermolumniscence (TL) properties of LiF phosphors irradiated with gamma rays at different doses have been studied. The analysis of TL glow curve has revealed the existence of two well resolved glow peaks, one low temperature peak at around 145 deg. C and other one at higher temperature around 375 deg. C. The LiF nano-crystallites synthesized at 8.00 pH have been found to show maximum TL intensity at studied gamma doses (0.1 Gy-15 Gy).

  9. TLD linearity vs. beam energy and modality

    SciTech Connect (OSTI)

    Troncalli, Andrew J.; Chapman, Jane

    2002-12-31

    Thermoluminescent dosimetry (TLD) is considered to be a valuable dosimetric tool in determining patient dose. Lithium fluoride doped with magnesium and titanium (TLD-100) is widely used, as it does not display widely divergent energy dependence. For many years, we have known that TLD-100 shows supralinearity to dose. In a radiotherapy clinic, there are multiple energies and modality beams. This work investigates whether individual linearity corrections must be used for each beam or whether a single correction can be applied to all beams. The response of TLD as a function of dose was measured from 25 cGy to 1000 cGy on both electrons and photons from 6 to 18 MeV. This work shows that, within our measurement uncertainty, TLD-100 exhibits supralinearity at all megavoltage energies and modalities.

  10. Non-Targeted Effects Induced by Ionizing Radiation: Mechanisms and Potential Impact on Radiation Induced Health Effects

    SciTech Connect (OSTI)

    Morgan, William F.; Sowa, Marianne B.

    2015-01-01

    Not-targeted effects represent a paradigm shift from the "DNA centric" view that ionizing radiation only elicits biological effects and subsequent health consequences as a result of an energy deposition event in the cell nucleus. While this is likely true at higher radiation doses (> 1Gy), at low doses (< 100mGy) non-targeted effects associated with radiation exposure might play a significant role. Here definitions of non-targeted effects are presented, the potential mechanisms for the communication of signals and signaling networks from irradiated cells/tissues are proposed, and the various effects of this intra- and intercellular signaling are described. We conclude with speculation on how these observations might lead to and impact long-term human health outcomes.

  11. Development of high-voltage pulse-slicer unit with variable pulse duration for pulse radiolysis system

    SciTech Connect (OSTI)

    Upadhyay, J.; Sharma, M. L.; Navathe, C. P.; Toley, M. A.; Shinde, S. J.; Nadkarni, S. A.; Sarkar, S. K.

    2012-02-15

    A high-voltage pulse-slicer unit with variable pulse duration has been developed and integrated with a 7 MeV linear electron accelerator (LINAC) for pulse radiolysis investigation. The pulse-slicer unit provides switching voltage from 1 kV to 10 kV with rise time better than 5 ns. Two MOSFET based 10 kV switches were configured in differential mode to get variable duration pulses. The high-voltage pulse has been applied to the deflecting plates of the LINAC for slicing of electron beam of 2 {mu}s duration. The duration of the electron beam has been varied from 30 ns to 2 {mu}s with the optimized pulse amplitude of 7 kV to get corresponding radiation doses from 6 Gy to 167 Gy.

  12. Dose rate dependence of the speciation of neptunium in irradiated solutions of nitric acid

    SciTech Connect (OSTI)

    Precek, M.; Paulenova, A.; Mincher, B.J.; Mezyk, S.P.

    2013-07-01

    The effects of radiation on the redox speciation of neptunium are of interest due to their impact on the performance of separation of neptunium from highly radioactive solutions of dissolved used nuclear fuel. In this study, the influence of dose rate change from 0.4 kGy/h to 6 kGy/h was examined during irradiation of solutions of initially hexavalent 2.0-2.5 mM neptunium in nitric acid of two different concentrations (0.5 and 1 M). Results indicate that the immediate radiolytic steady-state concentration of neptunium(V) were depressed and its initial radiolytic yield was up to 2-times lower (in 1 M HNO{sub 3} solutions)during irradiations with the higher dose rate. The finding is explained on the basis of the enhancement of the role of oxidizing radicals during the radiolytic process. (authors)

  13. Microsoft PowerPoint - Indian Energy Forum v1 (2).pptx

    Energy Savers [EERE]

    Rebecca Kujawa Vice President gy Solutions from Clean Coal Vice President Business Development Indian Energy Forum March 1, 2012 Sustainable Energy Solutions from Clean Coal C l M k t Key Discussion Points Key Discussion Points ●Coal Markets ●Clean Coal Technologies ●Clean Coal Technologies ●Sustainable Partnerships 2 Coal is the Power Energizing the World Our Energy Needs in Perspective: In Just One Day... Our Energy Needs in Perspective: In Just One Day... Global Population Will

  14. Iii;.} An Ann

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Iii;.} An Ann otated Bibli ography of the Red - Coc kaded Woodpecker bv * Jerom e A. Jack son A Publi cati on of the Sava nnah River Plonl Notional En... ironmentol Research Pork PrOQ rom United Stales Dep ortment of Ene r gy An Annotated Bibliography of the Red-Cockaded Woodpecker, Picoides borealis Jerome A. Jackson Department of Biological Sciences Mississippi State University Mississippi State, Mississippi A Publication of the Savannah River National Environmental Research Park Prepared

  15. SU-E-I-98: Dose Comparison for Pulmonary Embolism CT Studies: Single Energy Vs. Dual Energy

    SciTech Connect (OSTI)

    Mahmood, U; Erdi, Y

    2014-06-01

    Purpose: The purpose of this study was to assess and compare the size specific dose estimate (SSDE), dose length product (DLP) and noise relationship for pulmonary embolism studies evaluated by single source dual energy computed tomography (DECT) against conventional CT (CCT) studies in a busy cancer center and to determine the dose savings provided by DECT. Methods: An IRB-approved retrospective study was performed to determine the CTDIvol and DLP from a subset of patients scanned with both DECT and CCT over the past five years. We were able to identify 30 breast cancer patients (6 male, 24 female, age range 24 to 81) who had both DECT and CCT studies performed. DECT scans were performed with a GE HD 750 scanner (140/80 kVp, 480 mAs and 40 mm) and CCT scans were performed with a GE Lightspeed 16 slice scanner (120 kVp, 352 mAs, 20 mm). Image noise was measured by placing an ROI and recording the standard deviation of the mean HU along the descending aorta. Results: The average DECT patient size specific dose estimate was to be 14.2 1.7 mGy as compared to 22.4 2.7 mGy from CCT PE studies, which is a 37% reduction in the SSDE. The average DECT DLP was 721.8 84.6 mGy-cm as compared to 981.8 106.1 mGy-cm for CCT, which is a 26% decrease. Compared to CCT the image noise was found to decrease by 19% when using DECT for PE studies. Conclusion: DECT SSDE and DLP measurements indicate dose savings and image noise reduction when compared to CCT. In an environment that heavily debates CT patient doses, this study confirms the effectiveness of DECT in PE imaging.

  16. Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors

    SciTech Connect (OSTI)

    Cunha, Marcelo V.R.; Al-Omair, Ameen; Atenafu, Eshetu G.; Masucci, Giuseppina Laura; Letourneau, Daniel; Korol, Renee; Yu, Eugene; Howard, Peter; Lochray, Fiona; Costa, Leodante B. da; Fehlings, Michael G.; Sahgal, Arjun; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario

    2012-11-01

    Purpose: Vertebral compression fractures (VCFs) are increasingly observed after spine stereotactic body radiation therapy (SBRT). The aim of this study was to determine the risk of VCF after spine SBRT and identify clinical and dosimetric factors predictive for VCF. The analysis incorporated the recently described Spinal Instability Neoplastic Score (SINS) criteria. Methods and Materials: The primary endpoint of this study was the development of a de novo VCF (ie, new endplate fracture or collapse deformity) or fracture progression based on an existing fracture at the site of treatment after SBRT. We retrospectively scored 167 spinal segments in 90 patients treated with spine SBRT according to each of the 6 SINS criteria. We also evaluated the presence of paraspinal extension, prior radiation, various dosimetric parameters including dose per fraction ({>=}20 Gy vs <20 Gy), age, and histology. Results: The median follow-up was 7.4 months. We identified 19 fractures (11%): 12 de novo fractures (63%) and 7 cases of fracture progression (37%). The mean time to fracture after SBRT was 3.3 months (range, 0.5-21.6 months). The 1-year fracture-free probability was 87.3%. Multivariate analysis confirmed that alignment (P=.0003), lytic lesions (P=.007), lung (P=.03) and hepatocellular (P<.0001) primary histologies, and dose per fraction of 20 Gy or greater (P=.004) were significant predictors of VCF. Conclusions: The presence of kyphotic/scoliotic deformity and the presence of lytic tumor were the only predictive factors of VCF based on the original 6 SINS criteria. We also report that patients with lung and hepatocellular tumors and treatment with SBRT of 20 Gy or greater in a single fraction are at a higher risk of VCF.

  17. Gamma irradiation effects in W films

    SciTech Connect (OSTI)

    Claro, Luiz H.; Santos, Ingrid A.; Silva, Cassia F.

    2013-05-06

    Using the van Der Pauw methodology, the surface resistivity of irradiated tungsten films deposited on Silicon substrate was measured. The films were exposed to {gamma} radiation using a isotopic {sup 60}Co source in three irradiation stages attaining 40.35 kGy in total dose. The obtained results for superficial resistivity display a time annealing features and their values are proportional to the total dose.

  18. Decomposition of PCBs in Oils Using Gamma Radiolysis A Treatability Study - Final Report

    SciTech Connect (OSTI)

    B. J. Mincher; R. E. Arbon

    1996-08-01

    Several legacy hydraulic oil waste streams contaminated with Aroclor 1260 and small amounts of Cesium-137 have been in storage at the Idaho National Engineering Laboratory (INEL) due to the lack of appropriate treatment facilities. The goal of this study was to demonstrate that polychlorinated biphenyls (PCBs) could be selectively decomposed in the oils. Removal of the PCB component to less than the 2 mg/L treatment standard should result in a waste oil that is not regulated by the Toxic Substances Control Act. Irradiation of the oils with high gamma-ray doses produces free electrons in the solution that react with PCBs. The reaction results in dechlorination of the PCBs to produce biphenyl. The gamma-ray source was spent reactor fuel stored in the Advanced Test Reactor canal at the INEL. A dry tube extends into the canal which allowed for positioning of samples in the proximity of the fuel. The gamma-ray dose rates at the samples varied from 10 to 30 kGy/h. This was measured using commercially available FWT-60 dosimeters. Irradiation of samples in a series of progressively increasing absorbed doses allowed the generation of rate constants used to predict absorbed doses necessary to meet the 2 mg/kg treatment standard. Three separate irradiation experiments were performed. The first irradiation used a maximum absorbed dose of 183 kGy. This experiment demonstrated that the PCB concentration decreased and allowed calculation of preliminary rate constants. The second irradiation used a maximum absorbed dose of 760 kGy. From this experiment, accurate rate constants were calculated, and the necessary absorbed dose to achieve the treatment standard was calculated. In the third irradiation of 2,242 kGy, all three waste streams were adequately decontaminated.

  19. Intensity-Modulated Radiotherapy as Primary Therapy for Prostate Cancer: Report on Acute Toxicity After Dose Escalation With Simultaneous Integrated Boost to Intraprostatic Lesion

    SciTech Connect (OSTI)

    Fonteyne, Valerie Villeirs, Geert; Speleers, Bruno; Neve, Wilfried de; Wagter, Carlos de; Lumen, Nicolas; Meerleer, Gert de

    2008-11-01

    Purpose: To report on the acute toxicity of a third escalation level using intensity-modulated radiotherapy for prostate cancer (PCa) and the acute toxicity resulting from delivery of a simultaneous integrated boost (SIB) to an intraprostatic lesion (IPL) detected on magnetic resonance imaging (MRI), with or without spectroscopy. Methods and Materials: Between January 2002 and March 2007, we treated 230 patients with intensity-modulated radiotherapy to a third escalation level as primary therapy for prostate cancer. If an IPL (defined by MRI or MRI plus spectroscopy) was present, a SIB was delivered to the IPL. To report on acute toxicity, patients were seen weekly during treatment and 1 and 3 months after treatment. Toxicity was scored using the Radiation Therapy Oncology Group toxicity scale, supplemented by an in-house-developed scoring system. Results: The median dose to the planning target volume was 78 Gy. An IPL was found in 118 patients. The median dose to the MRI-detected IPL and MRI plus spectroscopy-detected IPL was 81 Gy and 82 Gy, respectively. No Grade 3 or 4 acute gastrointestinal toxicity developed. Grade 2 acute gastrointestinal toxicity was present in 26 patients (11%). Grade 3 genitourinary toxicity was present in 15 patients (7%), and 95 patients developed Grade 2 acute genitourinary toxicity (41%). No statistically significant increase was found in Grade 2-3 acute gastrointestinal or genitourinary toxicity after a SIB to an IPL. Conclusion: The results of our study have shown that treatment-induced acute toxicity remains low when intensity-modulated radiotherapy to 80 Gy as primary therapy for prostate cancer is used. In addition, a SIB to an IPL did not increase the severity or incidence of acute toxicity.

  20. SU-E-T-580: Comparison of Cervical Carcinoma IMRT Plans From Four Commercial Treatment Planning Systems (TPS)

    SciTech Connect (OSTI)

    Cao, Y; Li, R; Chi, Z; Zhu, S

    2014-06-01

    Purpose: Different treatment planning systems (TPS) use different treatment optimization and leaf sequencing algorithms. This work compares cervical carcinoma IMRT plans optimized with four commercial TPSs to investigate the plan quality in terms of target conformity and delivery efficiency. Methods: Five cervical carcinoma cases were planned with the Corvus, Monaco, Pinnacle and Xio TPSs by experienced planners using appropriate optimization parameters and dose constraints to meet the clinical acceptance criteria. Plans were normalized for at least 95% of PTV to receive the prescription dose (Dp). Dose-volume histograms and isodose distributions were compared. Other quantities such as Dmin(the minimum dose received by 99% of GTV/PTV), Dmax(the maximum dose received by 1% of GTV/PTV), D100, D95, D90, V110%, V105%, V100% (the volume of GTV/PTV receiving 110%, 105%, 100% of Dp), conformity index(CI), homogeneity index (HI), the volume of receiving 40Gy and 50 Gy to rectum (V40,V50) ; the volume of receiving 30Gy and 50 Gy to bladder (V30,V50) were evaluated. Total segments and MUs were also compared. Results: While all plans meet target dose specifications and normal tissue constraints, the maximum GTVCI of Pinnacle plans was up to 0.74 and the minimum of Corvus plans was only 0.21, these four TPSs PTVCI had significant difference. The GTVHI and PTVHI of Pinnacle plans are all very low and show a very good dose distribution. Corvus plans received the higer dose of normal tissue. The Monaco plans require significantly less segments and MUs to deliver than the other plans. Conclusion: To deliver on a Varian linear-accelerator, the Pinnacle plans show a very good dose distribution. Corvus plans received the higer dose of normal tissue. The Monaco plans have faster beam delivery.

  1. RIngle-crystal lithium fluoride detectors

    SciTech Connect (OSTI)

    Nepomnyashchikh, A.I.; Afonin, G.P.; Mironenko, S.N.; Selyauko, A.I.

    1985-10-01

    The use of lithium fluoride as detectors for thermoluminescence dosimetry is discussed. The principal characteristics of detectors of diameters 3, 8, and 10 mm are discussed, including: lower limit of detectable dose, repeated use of detectors, dependence of the thermally stimulated luminescence yield on the radiation dose, and loss of accumulated light sum during storage of the detectors. The detector preserves its characteristics to within + or - 15% after irradiation with a dose of 5 . 10/sup 4/ cGy.

  2. Multi-level effects of low dose rate ionizing radiation on southern toad, Anaxyrus [Bufo] terrestris

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Stark, Karolina; Scott, David E.; Tsyusko, Olga; Coughlin, Daniel P.; Hinton, Thomas G.; Amendola, Roberto

    2015-04-30

    Despite their potential vulnerability to contaminants from exposure at multiple life stages, amphibians are one of the least studied groups of vertebrates in ecotoxicology, and research on radiation effects in amphibians is scarce. We used multiple endpoints to assess the radiosensitivity of the southern toad (Anaxyrus [Bufo] terrestris) during its pre-terrestrial stages of development –embryonic, larval, and metamorphic. Toads were exposed, from several hours after oviposition through metamorphosis (up to 77 days later), to four low dose rates of ¹³⁷Cs at 0.13, 2.4, 21, and 222 mGy d⁻¹, resulting in total doses up to 15.8 Gy. Radiation treatments did notmore » affect hatching success of embryos, larval survival, or the length of the larval period. The individual family variation in hatching success of embryos was larger than the radiation response. In contrast, newly metamorphosed individuals from the higher dose-rate treatments had higher mass and mass/length body indices, a measure which may relate to higher post-metamorphic survival. The increased mass and index at higher dose rates may indicate that the chronic, low dose rate radiation exposures triggered secondary responses. Additionally, the increases in growth were linked to a decrease in DNA damage (as measured by the Comet Assay) in red blood cells at a dose rate of 21mGy d⁻¹ and a total dose of 1.1 Gy. In conclusion, the complex effects of low dose rates of ionizing radiation may trigger growth and cellular repair mechanisms in amphibian larvae.« less

  3. Analysis of Dose at the Site of Second Tumor Formation After Radiotherapy to the Central Nervous System

    SciTech Connect (OSTI)

    Galloway, Thomas J.; Indelicato, Daniel J.; Amdur, Robert J.; Morris, Christopher G.; Swanson, Erika L.; Marcus, Robert B.

    2012-01-01

    Purpose: Second tumors are an uncommon complication of multimodality treatment of childhood cancer. The present analysis attempted to correlate the dose received as a component of primary treatment and the site of the eventual development of a second tumor. Methods and Materials: We retrospectively identified 16 patients who had received radiotherapy to sites in the craniospinal axis and subsequently developed a second tumor. We compared the historical fields and port films of the primary treatment with the modern imaging of the second tumor locations. We classified the location of the second tumors as follows: in the boost field; marginal to the boost field, but in a whole-brain field; in a whole-brain field; marginal to the whole brain/primary treatment field; and distant to the field. We divided the dose received into 3 broad categories: high dose (>45 Gy), moderate dose (20-36 Gy), and low dose (<20 Gy). Results: The most common location of the second tumor was in the whole brain field (57%) and in the moderate-dose range (81%). Conclusions: Our data contradict previous publications that suggested that most second tumors develop in tissues that receive a low radiation dose. Almost all the second tumors in our series occurred in tissue within a target volume in the cranium that had received a moderate dose (20-36 Gy). These findings suggest that a major decrease in the brain volume that receives a moderate radiation dose is the only way to substantially decrease the second tumor rate after central nervous system radiotherapy.

  4. Partial oxidation of landfill leachate in supercritical water: Optimization by response surface methodology

    SciTech Connect (OSTI)

    Gong, Yanmeng; Wang, Shuzhong; Xu, Haidong; Guo, Yang; Tang, Xingying

    2015-09-15

    Highlights: • Partial oxidation of landfill leachate in supercritical water was investigated. • The process was optimized by Box–Behnken design and response surface methodology. • GY{sub H2}, TRE and CR could exhibit up to 14.32 mmol·gTOC{sup −1}, 82.54% and 94.56%. • Small amounts of oxidant can decrease the generation of tar and char. - Abstract: To achieve the maximum H{sub 2} yield (GY{sub H2}), TOC removal rate (TRE) and carbon recovery rate (CR), response surface methodology was applied to optimize the process parameters for supercritical water partial oxidation (SWPO) of landfill leachate in a batch reactor. Quadratic polynomial models for GY{sub H2}, CR and TRE were established with Box–Behnken design. GY{sub H2}, CR and TRE reached up to 14.32 mmol·gTOC{sup −1}, 82.54% and 94.56% under optimum conditions, respectively. TRE was invariably above 91.87%. In contrast, TC removal rate (TR) only changed from 8.76% to 32.98%. Furthermore, carbonate and bicarbonate were the most abundant carbonaceous substances in product, whereas CO{sub 2} and H{sub 2} were the most abundant gaseous products. As a product of nitrogen-containing organics, NH{sub 3} has an important effect on gas composition. The carbon balance cannot be reached duo to the formation of tar and char. CR increased with the increase of temperature and oxidation coefficient.

  5. Definitive Chemoradiation Therapy Following Surgical Resection or Radiosurgery Plus Whole-Brain Radiation Therapy in Non-Small Cell Lung Cancer Patients With Synchronous Solitary Brain Metastasis: A Curative Approach

    SciTech Connect (OSTI)

    Parlak, Cem; Mertsoylu, Hüseyin; Güler, Ozan Cem; Onal, Cem; Topkan, Erkan

    2014-03-15

    Purpose/Objectives: The aim of this study was to evaluate the impact of definitive thoracic chemoradiation therapy following surgery or stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT) on the outcomes of patients with non-small cell lung cancer (NSCLC) with synchronous solitary brain metastasis (SSBM). Methods and Materials: A total of 63 NSCLC patients with SSBM were retrospectively evaluated. Patients were staged using positron emission tomography-computed tomography in addition to conventional staging tools. Thoracic radiation therapy (TRT) with a total dose of 66 Gy in 2 Gy fractions was delivered along with 2 cycles of cisplatin-based chemotherapy following either surgery plus 30 Gy of WBRT (n=33) or SRS plus 30 Gy of WBRT (n=30) for BM. Results: Overall, the treatment was well tolerated. All patients received planned TRT, and 57 patients (90.5%) were also able to receive 2 cycles of chemotherapy. At a median follow-up of 25.3 months (7.1-52.1 months), the median months of overall, locoregional progression-free, neurological progression-free, and progression-free survival were 28.6, 17.7, 26.4, and 14.6, respectively. Both univariate and multivariate analyses revealed that patients with a T1-T2 thoracic disease burden (P=.001), a nodal stage of N0-N1 (P=.003), and no weight loss (P=.008) exhibited superior survival. Conclusions: In the present series, surgical and radiosurgical treatments directed toward SSBM in NSCLC patients were equally effective. The similarities between the present survival outcomes and those reported in other studies for locally advanced NSCLC patients indicate the potentially curative role of definitive chemoradiation therapy for highly selected patients with SSBM.

  6. Final Technical Report

    SciTech Connect (OSTI)

    W. C. Griffith

    2007-01-01

    In this project we provide an example of how to develop multi-tiered models to go across levels of biological organization to provide a framework for relating results of studies of low doses of ionizing radiation. This framework allows us to better understand how to extrapolate laboratory results to policy decisions, and to identify future studies that will increase confidence in policy decisions. In our application of the conceptual Model we were able to move across multiple levels of biological assessment for rodents going from molecular to organism level for in vitro and in vivo endpoints and to relate these to human in vivo organism level effects. We used the rich literature on the effects of ionizing radiation on the developing brain in our models. The focus of this report is on disrupted neuronal migration due to radiation exposure and the structural and functional implications of these early biological effects. The cellular mechanisms resulting in pathogenesis are most likely due to a combination of the three mechanisms mentioned. For the purposes of a computational model, quantitative studies of low dose radiation effects on migration of neuronal progenitor cells in the cerebral mantle of experimental animals were used. In this project we were able to show now results from studies of low doses of radiation can be used in a multidimensional framework to construct linked models of neurodevelopment using molecular, cellular, tissue, and organ level studies conducted both in vitro and in vivo in rodents. These models could also be linked to behavioral endpoints in rodents which can be compared to available results in humans. The available data supported modeling to 10 cGy with limited data available at 5 cGy. We observed gradual but non-linear changes as the doses decreased. For neurodevelopment it appears that the slope of the dose response decreases from 25 cGy to 10 cGy. Future studies of neurodevelopment should be able to better define the dose response in this range.

  7. World Watch Institute Feed | Open Energy Information

    Open Energy Info (EERE)

    in more than a dozen languages. For more information, visitGyQ98itsQ5wXa9eKtj6nN7ZSxBHVW5O2QwJEbFEUl8j0zopxW...

  8. Treatment Planning Constraints to Avoid Xerostomia in Head-and-Neck Radiotherapy: An Independent Test of QUANTEC Criteria Using a Prospectively Collected Dataset

    SciTech Connect (OSTI)

    Moiseenko, Vitali, E-mail: vmoiseenko@bccancer.bc.ca [Department of Medical Physics, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Wu, Jonn [Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Hovan, Allan [Department of Oral Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Saleh, Ziad; Apte, Aditya; Deasy, Joseph O. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Harrow, Stephen [Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Rabuka, Carman; Muggli, Adam [Department of Oral Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Thompson, Anna [Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada)

    2012-03-01

    Purpose: The severe reduction of salivary function (xerostomia) is a common complication after radiation therapy for head-and-neck cancer. Consequently, guidelines to ensure adequate function based on parotid gland tolerance dose-volume parameters have been suggested by the QUANTEC group and by Ortholan et al. We perform a validation test of these guidelines against a prospectively collected dataset and compared with a previously published dataset. Methods and Materials: Whole-mouth stimulated salivary flow data from 66 head-and-neck cancer patients treated with radiotherapy at the British Columbia Cancer Agency (BCCA) were measured, and treatment planning data were abstracted. Flow measurements were collected from 50 patients at 3 months, and 60 patients at 12-month follow-up. Previously published data from a second institution, Washington University in St. Louis (WUSTL), were used for comparison. A logistic model was used to describe the incidence of Grade 4 xerostomia as a function of the mean dose of the spared parotid gland. The rate of correctly predicting the lack of xerostomia (negative predictive value [NPV]) was computed for both the QUANTEC constraints and Ortholan et al. recommendation to constrain the total volume of both glands receiving more than 40 Gy to less than 33%. Results: Both datasets showed a rate of xerostomia of less than 20% when the mean dose to the least-irradiated parotid gland is kept to less than 20 Gy. Logistic model parameters for the incidence of xerostomia at 12 months after therapy, based on the least-irradiated gland, were D{sub 50} = 32.4 Gy and and {gamma} = 0.97. NPVs for QUANTEC guideline were 94% (BCCA data), and 90% (WUSTL data). For Ortholan et al. guideline NPVs were 85% (BCCA) and 86% (WUSTL). Conclusion: These data confirm that the QUANTEC guideline effectively avoids xerostomia, and this is somewhat more effective than constraints on the volume receiving more than 40 Gy.

  9. Early Clinical Outcomes Demonstrate Preserved Cognitive Function in Children With Average-Risk Medulloblastoma When Treated With Hyperfractionated Radiation Therapy

    SciTech Connect (OSTI)

    Gupta, Tejpal; Jalali, Rakesh; Goswami, Savita; Nair, Vimoj; Moiyadi, Aliasgar; Epari, Sridhar; Sarin, Rajiv

    2012-08-01

    Purpose: To report on acute toxicity, longitudinal cognitive function, and early clinical outcomes in children with average-risk medulloblastoma. Methods and Materials: Twenty children {>=}5 years of age classified as having average-risk medulloblastoma were accrued on a prospective protocol of hyperfractionated radiation therapy (HFRT) alone. Radiotherapy was delivered with two daily fractions (1 Gy/fraction, 6 to 8 hours apart, 5 days/week), initially to the neuraxis (36 Gy/36 fractions), followed by conformal tumor bed boost (32 Gy/32 fractions) for a total tumor bed dose of 68 Gy/68 fractions over 6 to 7 weeks. Cognitive function was prospectively assessed longitudinally (pretreatment and at specified posttreatment follow-up visits) with the Wechsler Intelligence Scale for Children to give verbal quotient, performance quotient, and full-scale intelligence quotient (FSIQ). Results: The median age of the study cohort was 8 years (range, 5-14 years), representing a slightly older cohort. Acute hematologic toxicity was mild and self-limiting. Eight (40%) children had subnormal intelligence (FSIQ <85), including 3 (15%) with mild mental retardation (FSIQ 56-70) even before radiotherapy. Cognitive functioning for all tested domains was preserved in children evaluable at 3 months, 1 year, and 2 years after completion of HFRT, with no significant decline over time. Age at diagnosis or baseline FSIQ did not have a significant impact on longitudinal cognitive function. At a median follow-up time of 33 months (range, 16-58 months), 3 patients had died (2 of relapse and 1 of accidental burns), resulting in 3-year relapse-free survival and overall survival of 83.5% and 83.2%, respectively. Conclusion: HFRT without upfront chemotherapy has an acceptable acute toxicity profile, without an unduly increased risk of relapse, with preserved cognitive functioning in children with average-risk medulloblastoma.

  10. Evaluation of the dosimetric impact of applying flattening filter-free beams in intensity-modulated radiotherapy for early-stage upper thoracic carcinoma of oesophagus

    SciTech Connect (OSTI)

    Zhang, Wuzhe; Lin, Zhixiong; Yang, Zhining; Fang, Weisheng; Lai, Peibo; Lu, Jiayang; Wu, Vincent WC

    2015-06-15

    Flattening filter-free (FFF) radiation beams have recently become clinically available on modern linear accelerators in radiation therapy. This study aimed to evaluate the dosimetric impact of using FFF beams in intensity-modulated radiotherapy (IMRT) for early-stage upper thoracic oesophageal cancer. Eleven patients with primary stage upper thoracic oesophageal cancer were recruited. For each patient, two IMRT plans were computed using conventional beams (Con-P) and FFF beams (FFF-P), respectively. Both plans employed a five-beam arrangement and were prescribed with 64 Gy to (planning target volume) PTV1 and 54 Gy to PTV2 in 32 fractions using 6 MV photons. The dose parameters of the target volumes and organs at risks (OARs), and treatment parameters including the monitor units (MU) and treatment time (TT) for Con-P and FFF-P were recorded and compared. The mean D{sub 5} of PTV1 and PTV2 were higher in FFF-P than Con-P by 0.4 Gy and 0.3 Gy, respectively. For the OARs, all the dose parameters did not show significant difference between the two plans except the mean V{sub 5} and V{sub 10} of the lung in which the FFF-P was lower (46.7% vs. 47.3% and 39.1% vs. 39.6%, respectively). FFF-P required 54% more MU but 18.4% less irradiation time when compared to Con-P. The target volume and OARs dose distributions between the two plans were comparable. However, FFF-P was more effective in sparing the lung from low dose and reduced the mean TT compared with Con-P. Long-term clinical studies are suggested to evaluate the radiobiological effects of FFF beams.

  11. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    SciTech Connect (OSTI)

    Venkatramani, Rajkumar; Kamath, Sunil; Wong, Kenneth; Malvar, Jemily; Sposto, Richard; Goodarzian, Fariba; Freyer, David R.; Keens, Thomas G.; and others

    2013-08-01

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V{sub 22} (volume of lung exposed to a radiation dose ≥22 Gy) and V{sub 30} (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and V{sub dose} (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed dose should be used to perform risk stratification of patients receiving lung irradiation.

  12. Fully Automated Simultaneous Integrated Boosted-Intensity Modulated Radiation Therapy Treatment Planning Is Feasible for Head-and-Neck Cancer: A Prospective Clinical Study

    SciTech Connect (OSTI)

    Wu Binbin; McNutt, Todd; Zahurak, Marianna; Simari, Patricio; Pang, Dalong; Taylor, Russell; Sanguineti, Giuseppe

    2012-12-01

    Purpose: To prospectively determine whether overlap volume histogram (OVH)-driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics. Methods and Materials: A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison. Results: Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases. Conclusions: The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.

  13. Mitigation and Treatment of Radiation-Induced Thoracic Injury With a Cyclooxygenase-2 Inhibitor, Celecoxib

    SciTech Connect (OSTI)

    Hunter, Nancy R.; Valdecanas, David [Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao Zhongxing [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Milas, Luka [Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Thames, Howard D. [Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mason, Kathy A., E-mail: kmason@mdanderson.org [Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-02-01

    Purpose: To test whether a cyclooxygenase-2 inhibitor (celecoxib) could reduce mortality resulting from radiation-induced pneumonitis. Methods and Materials: Celecoxib was given to mice twice daily for 40 consecutive days starting on the day of local thoracic irradiation (LTI) or 40 or 80 days later. C3Hf/KamLaw mice were observed for morbidity, and time to death was determined. Results were analyzed using the Cox proportional hazards model. Results: Timing of celecoxib relative to LTI determined efficacy. A significant reduction in time to death was achieved only when celecoxib was started 80 days after LTI, corresponding to the time when pneumonitis is expressed. For these mice the reduction in mortality was quantified as a hazard ratio for mortality of treated vs untreated of 0.36 (95% confidence interval [CI] 0.24-0.53), thus significantly less than 1.0. Correspondingly, the median lethal dose for treated mice (12.9 Gy; 95% CI 12.55-13.25 Gy) was significantly (P=.026) higher than for untreated mice (12.4 Gy; 95% CI 12.2-12.65 Gy). Conclusions: Celecoxib significantly reduced lung toxicity when administered months after LTI when the deleterious effects of radiation were expressed. The schedule-dependent reduction in fatal pneumonitis suggests that celecoxib could be clinically useful by reintroduction of treatment months after completion of radiation therapy. These findings may be important for designing clinical trials using cyclooxygenase-2 inhibitors to treat radiation-induced lung toxicity as a complement to concurrent radiation therapy of lung cancers.

  14. Multi-level effects of low dose rate ionizing radiation on southern toad, Anaxyrus [Bufo] terrestris

    SciTech Connect (OSTI)

    Stark, Karolina; Scott, David E.; Tsyusko, Olga; Coughlin, Daniel P.; Hinton, Thomas G.; Amendola, Roberto

    2015-04-30

    Despite their potential vulnerability to contaminants from exposure at multiple life stages, amphibians are one of the least studied groups of vertebrates in ecotoxicology, and research on radiation effects in amphibians is scarce. We used multiple endpoints to assess the radiosensitivity of the southern toad (Anaxyrus [Bufo] terrestris) during its pre-terrestrial stages of development –embryonic, larval, and metamorphic. Toads were exposed, from several hours after oviposition through metamorphosis (up to 77 days later), to four low dose rates of ¹³⁷Cs at 0.13, 2.4, 21, and 222 mGy d⁻¹, resulting in total doses up to 15.8 Gy. Radiation treatments did not affect hatching success of embryos, larval survival, or the length of the larval period. The individual family variation in hatching success of embryos was larger than the radiation response. In contrast, newly metamorphosed individuals from the higher dose-rate treatments had higher mass and mass/length body indices, a measure which may relate to higher post-metamorphic survival. The increased mass and index at higher dose rates may indicate that the chronic, low dose rate radiation exposures triggered secondary responses. Additionally, the increases in growth were linked to a decrease in DNA damage (as measured by the Comet Assay) in red blood cells at a dose rate of 21mGy d⁻¹ and a total dose of 1.1 Gy. In conclusion, the complex effects of low dose rates of ionizing radiation may trigger growth and cellular repair mechanisms in amphibian larvae.

  15. HEALTH AND ENVIRONMENTAL SCIENCE

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    7/82 HEALTH AND ENVIRONMENTAL SCIENCE A B rie f Review I . INTRODUCTION AND SU M M AR Y I I . ORIGINS O F HEALTH AND ENVIRONMENTAL RESEARCH: PROBLEM S AND OPPORTUNITIES I I I . ADDRESSING THE PROBLEMS: BIOLOGY AND ECO LO GY IV. EXPLOITING THE OPPORTUNITIES: NUCLEAR MEDICINE V. REFINING THE TECHNIQUES: INSTRUMENTATION VI. N E W CHALLENGES AND FRESH OPPORTUNITIES DISCLAIMER Portions of this document may be illegible in electronic image products. Images are produced from the best available original

  16. Radiation Dose and Subsequent Risk for Stomach Cancer in Long-term Survivors of Cervical Cancer

    SciTech Connect (OSTI)

    Kleinerman, Ruth A.; Smith, Susan A.; Holowaty, Eric; Hall, Per; Pukkala, Eero; Vaalavirta, Leila; Stovall, Marilyn; Weathers, Rita; Gilbert, Ethel; Aleman, Berthe M.P.; Kaijser, Magnus; Andersson, Michael; Storm, Hans; Joensuu, Heikki; Lynch, Charles F.; and others

    2013-08-01

    Purpose: To assess the doseresponse relationship for stomach cancer after radiation therapy for cervical cancer. Methods and Materials: We conducted a nested, matched casecontrol study of 201 cases and 378 controls among 53,547 5-year survivors of cervical cancer diagnosed from 1943 to 1995, from 5 international, population-based cancer registries. We estimated individual radiation doses to the site of the stomach cancer for all cases and to corresponding sites for the matched controls (overall mean stomach tumor dose, 2.56 Gy, range 0.03-46.1 and after parallel opposed pelvic fields, 1.63 Gy, range 0.12-6.3). Results: More than 90% of women received radiation therapy, mostly with external beam therapy in combination with brachytherapy. Stomach cancer risk was nonsignificantly increased (odds ratio 1.27-2.28) for women receiving between 0.5 and 4.9 Gy to the stomach cancer site and significantly increased at doses ?5 Gy (odds ratio 4.20, 95% confidence interval 1.41-13.4, P{sub trend}=.047) compared with nonirradiated women. A highly significant radiation doseresponse relationship was evident when analyses were restricted to the 131 cases (251 controls) whose stomach cancer was located in the middle and lower portions of the stomach (P{sub trend}=.003), whereas there was no indication of increasing risk with increasing dose for 30 cases (57 controls) whose cancer was located in the upper stomach (P{sub trend}=.23). Conclusions: Our findings show for the first time a significant linear doseresponse relationship for risk of stomach cancer in long-term survivors of cervical cancer.

  17. Poster Thur Eve 57: Evaluation of laryngeal mucosal dose with conventional linac and TomoTherapy

    SciTech Connect (OSTI)

    Nusrat, H; Lekx, K; Eapen, L

    2014-08-15

    The purpose of this study was to examine whether or not underdosing occurs in the mucosal layer during treatment of glottis cancer. A larynx phantom was produced and regions at risk of recurrence due to suspected underdosing were identified and wells drilled into the phantom for flush placement of TLDs. Seven interest points were chosen. CT simulation was completed prior to the wells being drilled, and again afterwards with the TLD locations indicated using BBs. Treatment plans created for this investigation included: 3DCRT using Elekta-XiO (n=9) and VMAT created using Elekta-Monaco (n=9), both delivered on an Elekta linac; standard TomoTherapy plan (n=11) and a directionally blocked TomoTherapy plan to approximate a 3D-conformal approach (n=5). Imaging dose during TomoTherapy deliveries was accounted for. The average TLD result at each interest point was compared to the planned value using a paired t-test. There was no significant difference between the planned and measured 3DCRT dose (268.9 vs. 267.0 cGy, respectively; p>0.05). Similarly, the planned and measured TomoTherapy treatment did not show any significant differences (271.7 vs 269.7 cGy; p>0.05). In the blocked TomoTherapy plan, significant overdosing was seen (274.5 vs 294.9 cGy; p<0.05) and underdosing was not seen in the VMAT treatment (303.5 vs 321.8 cGy; p>0.05). Further investigation is ongoing to ensure appropriate normalization of results and to investigate the overdosing noted with the blocked TomoTherapy plan. Results from this study suggest that significant underdosing does not occur in the conventional treatment of early glottic cancer using 6MV photons.

  18. The Effects of Low Dose Irradiation on Inflammatory Response Proteins in a 3D Reconstituted Human Skin Tissue Model

    SciTech Connect (OSTI)

    Varnum, Susan M.; Springer, David L.; Chaffee, Mary E.; Lien, Katie A.; Webb-Robertson, Bobbie-Jo M.; Waters, Katrina M.; Sacksteder, Colette A.

    2012-12-01

    Skin responses to moderate and high doses of ionizing radiation include the induction of DNA repair, apoptosis, and stress response pathways. Additionally, numerous studies indicate that radiation exposure leads to inflammatory responses in skin cells and tissue. However, the inflammatory response of skin tissue to low dose radiation (<10 cGy) is poorly understood. In order to address this, we have utilized a reconstituted human skin tissue model (MatTek EpiDerm FT) and assessed changes in 23 cytokines twenty-four and forty eight hours following treatment of skin with either 3 or 10 cGy low-dose of radiation. Three cytokines, IFN-?, IL-2, MIP-1?, were significantly altered in response to low dose radiation. In contrast, seven cytokines were significantly altered in response to a high radiation dose of 200 cGy (IL-2, IL-10, IL-13, IFN-?, MIP-1?, TNF ?, and VEGF) or the tumor promoter 12-O-tetradecanoylphorbol 13-acetate (G-CSF, GM-CSF, IL-1?, IL-8, MIP-1?, MIP-1?, RANTES). Additionally, radiation induced inflammation appears to have a distinct cytokine response relative to the non-radiation induced stressor, TPA. Overall, these results indicate that there are subtle changes in the inflammatory protein levels following exposure to low dose radiation and this response is a sub-set of what is seen following a high dose in a human skin tissue model.

  19. Low dose radiation hypersensitivity and clustered DNA damages in human fibroblasts exposed to low dose and dose rate protons or 137CS y-rays

    SciTech Connect (OSTI)

    Bennett P. V.; Bennett, P.V.; Keszenman, D.J.; Johnson, A.M.; Sutherland, B.M.; Wilson, P.F.

    2013-05-14

    Effective radioprotection for human space travelers hinges upon understanding the individual properties of charged particles. A significant fraction of particle radiation astronauts will encounter in space exploratory missions will come from high energy protons in galactic cosmic radiation (GCR) and/or possible exposures to lower energy proton flux from solar particle events (SPEs). These potential exposures present major concerns for NASA and others, in planning and executing long term space exploratory missions. We recently reported cell survival and transformation (acquisition of anchorage-independent growth in soft agar) frequencies in apparently normal NFF-28 primary human fibroblasts exposed to 0-30 cGy of 50MeV, 100MeV (SPE-like), or 1000 MeV (GCR-like) monoenergetic protons. These were modeled after 1989 SPE energies at an SPE-like low dose-rate (LDR) of 1.65 cGy/min or high dose rate (HDR) of 33.3 cGy/min delivered at the NASA Space Radiation Laboratory (NSRL) at BNL.

  20. Primary explants of human uroepithelium show an unusual response to low-dose irradiation with cobalt-60 gamma rays

    SciTech Connect (OSTI)

    Mothersill, C.; Seymour, C.B.; Harney, J.; Parsons, K.; Lyng, F.; Cottell, D.; Murphy, D.M.

    1995-05-01

    Recent results using very low doses of radiation have suggested that there is a hypersensitive region where cultures show an enhanced level of cell killing leading to a non-monotonic survival curve. This effect has been observed at doses below 2 Gy in mammalian systems and at much higher doses in insect cells. In this paper we report observation of the effect in primary human uroepithelial cell cultures. The effect was measured using a postirradiation proliferation assay where irradiated explants of standard size were allowed to proliferate for 14 days after exposure to {sup 60}Co{gamma} irradiation. By 14 days the majority of cultures derived from explants irradiated with 2-5 Gy showed little evidence of growth inhibition and cell numbers approached or even exceeded those obtained in the controls. There was, however, a significant reduction in cell number and growth rate in all cultures exposed to doses lower than 1 Gy. Oncoprotein and EGFR expression were also measured in these cultures and were significantly increased. Morphological evidence of apoptosis was present in all irradiated cultures at 4 h after exposure, but this persisted for longer periods in cultures exposed to low doses. 18 refs., 2 figs., 4 tabs.

  1. Dosimetric comparison of {sup 90}Y, {sup 32}P, and {sup 186}Re radiocolloids in craniopharyngioma treatments

    SciTech Connect (OSTI)

    Sadeghi, Mahdi; Karimi, Elham; Hosseini, S. Hamed

    2009-11-15

    Purpose: In the radionuclide treatment of some forms of brain tumors such as craniopharyngiomas, the selection of the appropriate radionuclide for therapy is a key element in treatment planning. The aim was to study the influence by considering the beta-emitter radionuclide dose rate in an intracranial cyst. Methods: Dosimetry was performed using the MCNP4C radiation transport code. Analytical dosimetry was additionally performed using the Loevinger and the Berger formulas in the MATLAB software. Each result was compared under identical conditions. The advantages and disadvantages of using {sup 90}Y versus {sup 32}P and {sup 186}Re were investigated. Results: The dose rate at the inner surface of the cyst wall was estimated to be 400 mGy/h for a 1 MBq/ml concentration of {sup 90}Y. Under identical conditions of treatment, the corresponding dose rates were 300 mGy/h for {sup 32}P and 160 mGy/h for {sup 186}Re. For a well-defined cyst radius and identical wall thickness, higher dose rates resulted for {sup 90}Y. Conclusions: To achieve the same radiological burden, the required amount of physical activity of injectable solution is lower for {sup 32}P. This is found to be a consequence of both the radionuclide physical half-life and the pattern of energy deposition from the emitted radiation. According to the half-life and dose-rate results, {sup 90}Y would be a good substitute for {sup 32}P.

  2. Dosimetry of an In-Line Kilovoltage Imaging System and Implementation in Treatment Planning

    SciTech Connect (OSTI)

    Dzierma, Yvonne; Alaei, Parham; Licht, Norbert; Rübe, Christian

    2014-03-15

    Purpose: To present the beam properties of the Siemens 70-kV and 121-kV linear accelerator-mounted imaging modalities and commissioning of the 121-kV beam in the Philips Pinnacle treatment planning system (TPS); measurements in an Alderson phantom were performed for verification of the model and to estimate the cone-beam CT (CBCT) imaging dose in the head and neck, thorax, and pelvis. Methods and Materials: The beam profiles and depth–dose curve were measured in an acrylic phantom using thermoluminescent dosimeters and a soft x-ray ionization chamber. Measurements were imported into the TPS, modeled, and verified by phantom measurements. Results: Modeling of the profiles and the depth–dose curve can be achieved with good quality. Comparison with the measurements in the Alderson phantom is generally good; only very close to bony structures is the dose underestimated by the TPS. For a 200° arc CBCT of the head and neck, a maximum dose of 7 mGy is measured; the thorax and pelvis 360° CBCTs give doses of 4-10 mGy and 7-15 mGy, respectively. Conclusions: Dosimetric characteristics of the Siemens kVision imaging modalities are presented and modeled in the Pinnacle TPS. Thermoluminescent dosimeter measurements in the Alderson phantom agree well with the calculated TPS dose, validating the model and providing an estimate of the imaging dose for different protocols.

  3. A study of radiolytic stability of 25,27-bis(2-propyloxy) calix[4]-26,28-crown-6 (iPR-C[4]C-6)

    SciTech Connect (OSTI)

    Jianchen, Wang; Chongli, Song

    2008-07-01

    The radiolytic stability of 25,27-bis(2-propyloxy)calix[4] arene -26,28-crown-6 (iPr-C[4]C-6) was studied. {sup 60}co was used as a radiation source. Its dose rate was 437 Gy/min., and the total absorbed dose of the iPr-C[4]C-6 was from 10{sup 4} to 10{sup 6} Gy. The iPr-C[4]C-6 solid and 0.025 mol/L iPr-C[4]C-6/n-octanol which were pre-equilibrated with 0.01 mol/L and 3 mol/L nitric acid, respectively, were given different doses, and their extraction performance was researched. Their degradation mechanism was investigated by mass spectrometry (MS) and infrared spectroscopy (IR). The results show that radiolytic stability of the iPr-C[4]C-6 solid and 0.025 mol/L iPr-C[4]C-6/n-octanol are good when their absorbed dose is less than 10{sup 6} Gy. The extracting system of iPr-C[4]C-6/n-octanol is promising for separating cesium from high-level liquid waste(HLLW)

  4. Radiation bronchitis and stenosis secondary to high dose rate endobronchial irradiation

    SciTech Connect (OSTI)

    Speiser, B.L. ); Spratling, L.

    1993-03-15

    The purpose of the study was to describe a new clinical entity observed in follow-up bronchoscopies in patients who were treated with high dose rate and medium dose rate remote afterloading brachytherapy of the tracheobronchial tree. Patients were treated by protocol with medium dose rate, 47 patients receiving 1000 cGy at a 5 mm depth times three fractions, high dose rate 144 patients receiving 1000 cGy at a 10 mm depth for three fractions and high dose rate 151 patients receiving cGy at a 10 mm depth for three fractions followed by bronchoscopy. Incidence of this entity was 9% for the first group, 12% for the second, and 13% for the third group. Reactions were grade 1 consisting of mild inflammatory response with a partial whitish circumferential membrane in an asymptomatic patient; grade 2, thicker complete white circumferential membrane with cough and/or obstructive problems requiring intervention; grade 3, severe inflammatory response with marked membranous exudate and mild fibrotic reaction; and grade 4 a predominant fibrotic reaction with progressive stenosis. Variables associated with a slightly increased incidence of radiation bronchitis and stenosis included: large cell carcinoma histology, curative intent, prior laser photoresection, and/or concurrent external radiation. Survival was the strongest predictor of the reaction. Radiation bronchitis and stenosis is a new clinical entity that must be identified in bronchial brachytherapy patients and treated appropriately. 23 refs., 3 figs., 7 tabs.

  5. Patterns of Practice of Palliative Radiotherapy in Africa, Part 1: Bone and Brain Metastases

    SciTech Connect (OSTI)

    Sharma, Vinay Gaye, Papa Macoumba M.Med.; Wahab, Sherif Abdel; Ndlovu, Ntokozo; Ngoma, Twalib; Vanderpuye, Verna; Sowunmi, Anthonia; Kigula-Mugambe, Joseph; Jeremic, Branislav

    2008-03-15

    Purpose: To provide data on the pattern of practice of palliative radiotherapy (RT) on the African continent. Methods and Materials: A questionnaire was distributed to participants in a regional training course of the International Atomic Energy Agency in palliative cancer care and sent by e-mail to other institutions in Africa. Requested information included both infrastructure and human resources available and the pattern of RT practice for metastatic and locally advanced cancers. Results: Of 35 centers contacted, 24 (68%) completed the questionnaire. Although RT is used by most centers for most metastatic cancers, liver and lung metastases are treated with chemotherapy. Of 23 centers, 14 (61%) had a single RT regimen as an institutional policy for treating painful bone metastases, but only 5 centers (23%) of 23 used 8 Gy in 1 fraction. Brain metastases were being treated by RT to the whole brain to 30 Gy in 10 fractions, either exclusively (n = 13, 56%) or in addition to the use of 20 Gy in 5 fractions (n = 3, 14%). Conclusion: Radiotherapy is a major component of treatment of cancer patients in African countries. There is consensus among few centers for treatment schedules for almost all sites regarding time and dose-fractionation characteristics of RT regimens used and/or indications for the use of RT in this setting.

  6. Prognostic Impact of Radiation Therapy to the Primary Tumor in Patients With Non-small Cell Lung Cancer and Oligometastasis at Diagnosis

    SciTech Connect (OSTI)

    Lopez Guerra, Jose Luis [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States) [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Gomez, Daniel, E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhuang, Yan; Hong, David S. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Heymach, John V. [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swisher, Stephen G. [Department of Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Komaki, Ritsuko; Cox, James D.; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-09-01

    Purpose: We investigated prognostic factors associated with survival in patients with non-small cell lung cancer (NSCLC) and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis. Methods and Materials: From January 2000 through June 2011, 78 consecutive patients with oligometastatic NSCLC (<5 metastases) at diagnosis underwent definitive chemoradiation therapy ({>=}45 Gy) to the primary site. Forty-four of these patients also received definitive local treatment for the oligometastases. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Univariate Cox proportional hazard analysis revealed better overall survival (OS) for those patients who received at least 63 Gy of radiation to the primary site (P=.002), received definitive local treatment for oligometastasis (P=.041), had a Karnofsky performance status (KPS) score >80 (P=.007), had a gross tumor volume {<=}124 cm{sup 3} (P=.002), had adenocarcinoma histology (P=.002), or had no history of respiratory disease (P=.016). On multivariate analysis, radiation dose, performance status, and tumor volume retained significance (P=.004, P=.006, and P<.001, respectively). The radiation dose also maintained significance when patients with and without brain metastases were analyzed separately. Conclusions: Tumor volume, KPS, and receipt of at least 63 Gy to the primary tumor are associated with improved OS in patients with oligometastatic NSCLC at diagnosis. Our results suggest that a subset of such patients may benefit from definitive local therapy.

  7. SU-E-T-617: A Feasibility Study of Navigation Based Multi Criteria Optimization for Advanced Cervical Cancer IMRT Planning

    SciTech Connect (OSTI)

    Ma, C

    2014-06-01

    Purpose: This study aims to validate multi-criteria optimization (MCO) against standard intensity modulated radiation therapy (IMRT) optimization for advanced cervical cancer in RayStation (v2.4, RaySearch Laboratories, Sweden). Methods: 10 advanced cervical cancer patients IMRT plans were randomly selected, these plans were designed with step and shoot optimization, new plans were then designed with MCO based on these plans,while keeping optimization conditions unchanged,comparison was made between both kinds of plans including the dose volume histogram parameters of PTV and OAR,and were analysed by pairing-t test. Results: We normalize the plan so that 95% volume of PTV achieved the prescribed dose(50Gy). The volume of radiation 10, 20, 30, and 40 Gy of the rectum were reduced by 14.7%,26.8%,21.1%,10.5% respectively(P?0.05). The mean dose of rectum were reduced by 7.2Gy(P?0.05). There were no significant differences for the dosimetric parameters for the bladder. Conclusion: In comparision with standard IMRT optimization, MCO reduces the dose of organs at risk with the same PTV coverage,but the result needs further clinical evalution.

  8. Dose Response and Post-irradiation Characteristics of the Sunna 535-nm Photo-Fluorescent Film Dosimeter

    SciTech Connect (OSTI)

    Murphy, Mark K.; Kovacs, Andras; Miller, Steven D.; Mclaughlin, William L.

    2003-06-09

    Results of characterization studies on one of the first versions of the Sunna photo-fluorescent dosimeter ? have previously been reported, and describe the performance of the red fluorescence component. This present paper describes dose response and post-irradiation characteristics of the green fluorescence component from the same dosimeter film (Sunna Model ?), which is manufactured using the injection molding technique. This production method may supply batch sizes on the order of 1 million dosimeter film elements while maintaining a signal precision (1?) on the order of ?1% without the need to correct for variability of film thickness. The dosimeter is a 1-cm by 3-cm polymeric film of 0.5-mm thickness that emits green fluorescence at intensities increasing almost linearly with dose. The data presented include dose response, post-irradiation growth, heat treatment, dosimeter aging, dose rate dependence, energy dependence, dose fractionation, variation of response within a batch, and the stability of the fluorimeter response. The results indicate that, as a routine dosimeter, the green signal provides a broad range of response at food irradiation (0.3 to 5 kGy), medical sterilization (5 to 40 kGy), and polymer cross-linking (40 to 250 kGy) dose levels.

  9. Decreased Risk of Radiation Pneumonitis With Incidental Concurrent Use of Angiotensin-Converting Enzyme Inhibitors and Thoracic Radiation Therapy

    SciTech Connect (OSTI)

    Kharofa, Jordan; Cohen, Eric P.; Tomic, Rade; Xiang Qun; Gore, Elizabeth

    2012-09-01

    Purpose: Angiotensin-converting enzyme (ACE) inhibitors have been shown to mitigate radiation-induced lung injury in preclinical models. The aim of this study was to evaluate whether ACE inhibitors decrease the risk of radiation pneumonitis in lung cancer patients receiving thoracic irradiation. Methods and Materials: Patients with Stage I through III small-cell and non-small-cell lung cancer treated definitively with radiation from 2004-2009 at the Clement J. Zablocki Veterans Affairs Medical Center were retrospectively reviewed. Acute pulmonary toxicity was quantified within 6 months of completion of treatment according to the Common Terminology Criteria for Adverse Events version 4. The use of ACE inhibitors, nonsteroidal anti-inflammatory drugs, inhaled glucocorticosteroids, statins, and angiotensin receptor blockers; dose-volume histogram parameters; and patient factors were assessed for association with Grade 2 or higher pneumonitis. Results: A total of 162 patients met the criteria for inclusion. The majority of patients had Stage III disease (64%) and received concurrent chemotherapy (61%). Sixty-two patients were identified as ACE inhibitor users (38%). All patients had acceptable radiation plans based on dose-volume histogram constraints (V20 [volume of lung receiving at least 20 Gy] {<=}37% and mean lung dose {<=}20 Gy) with the exception of 2 patients who did not meet both criteria. Grade 2 or higher pulmonary toxicity occurred in 12 patients (7.4%). The rate of Grade 2 or higher pneumonitis was lower in ACE inhibitor users vs. nonusers (2% vs. 11%, p = 0.032). Rates of Grade 2 or higher pneumonitis were significantly increased in patients aged greater than 70 years (16% vs. 2%, p = 0.005) or in whom V5 (volume of lung receiving at least 5 Gy) was 50% or greater (13% vs. 4%, p = 0.04). V10 (volume of lung receiving at least 10 Gy), V20, V30 (volume of lung receiving at least 30 Gy), and mean lung dose were not independently associated with Grade 2 or higher pneumonitis. Conclusion: ACE inhibitors may decrease the incidence of radiation pneumonitis in patients receiving thoracic radiation for lung cancer. These findings are consistent with preclinical evidence and should be prospectively evaluated.

  10. Brain Tumor Therapy-Induced Changes in Normal-Appearing Brainstem Measured With Longitudinal Diffusion Tensor Imaging

    SciTech Connect (OSTI)

    Hua Chiaho; Merchant, Thomas E.; Gajjar, Amar; Broniscer, Alberto; Zhang, Yong; Li Yimei; Glenn, George R.; Kun, Larry E.; Ogg, Robert J.

    2012-04-01

    Purpose: To characterize therapy-induced changes in normal-appearing brainstems of childhood brain tumor patients by serial diffusion tensor imaging (DTI). Methods and Materials: We analyzed 109 DTI studies from 20 brain tumor patients, aged 4 to 23 years, with normal-appearing brainstems included in the treatment fields. Those with medulloblastomas, supratentorial primitive neuroectodermal tumors, and atypical teratoid rhabdoid tumors (n = 10) received postoperative craniospinal irradiation (23.4-39.6 Gy) and a cumulative dose of 55.8 Gy to the primary site, followed by four cycles of high-dose chemotherapy. Patients with high-grade gliomas (n = 10) received erlotinib during and after irradiation (54-59.4 Gy). Parametric maps of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed and spatially registered to three-dimensional radiation dose data. Volumes of interest included corticospinal tracts, medial lemnisci, and the pons. Serving as an age-related benchmark for comparison, 37 DTI studies from 20 healthy volunteers, aged 6 to 25 years, were included in the analysis. Results: The median DTI follow-up time was 3.5 years (range, 1.6-5.0 years). The median mean dose to the pons was 56 Gy (range, 7-59 Gy). Three patterns were seen in longitudinal FA and apparent diffusion coefficient changes: (1) a stable or normal developing time trend, (2) initial deviation from normal with subsequent recovery, and (3) progressive deviation without evidence of complete recovery. The maximal decline in FA often occurred 1.5 to 3.5 years after the start of radiation therapy. A full recovery time trend could be observed within 4 years. Patients with incomplete recovery often had a larger decline in FA within the first year. Radiation dose alone did not predict long-term recovery patterns. Conclusions: Variations existed among individual patients after therapy in longitudinal evolution of brainstem white matter injury and recovery. Early response in brainstem anisotropy may serve as an indicator of the recovery time trend over 5 years after radiation therapy.

  11. Predicting objective function weights from patient anatomy in prostate IMRT treatment planning

    SciTech Connect (OSTI)

    Lee, Taewoo Hammad, Muhannad; Chan, Timothy C. Y.; Techna Institute for the Advancement of Technology for Health, 124-100 College Street, Toronto, Ontario M5G 1P5 ; Craig, Tim; Department of Radiation Oncology, University of Toronto, 148-150 College Street, Toronto, Ontario M5S 3S2 ; Sharpe, Michael B.; Department of Radiation Oncology, University of Toronto, 148-150 College Street, Toronto, Ontario M5S 3S2; Techna Institute for the Advancement of Technology for Health, 124-100 College Street Toronto, Ontario M5G 1P5

    2013-12-15

    Purpose: Intensity-modulated radiation therapy (IMRT) treatment planning typically combines multiple criteria into a single objective function by taking a weighted sum. The authors propose a statistical model that predicts objective function weights from patient anatomy for prostate IMRT treatment planning. This study provides a proof of concept for geometry-driven weight determination. Methods: A previously developed inverse optimization method (IOM) was used to generate optimal objective function weights for 24 patients using their historical treatment plans (i.e., dose distributions). These IOM weights were around 1% for each of the femoral heads, while bladder and rectum weights varied greatly between patients. A regression model was developed to predict a patient's rectum weight using the ratio of the overlap volume of the rectum and bladder with the planning target volume at a 1 cm expansion as the independent variable. The femoral head weights were fixed to 1% each and the bladder weight was calculated as one minus the rectum and femoral head weights. The model was validated using leave-one-out cross validation. Objective values and dose distributions generated through inverse planning using the predicted weights were compared to those generated using the original IOM weights, as well as an average of the IOM weights across all patients. Results: The IOM weight vectors were on average six times closer to the predicted weight vectors than to the average weight vector, usingl{sub 2} distance. Likewise, the bladder and rectum objective values achieved by the predicted weights were more similar to the objective values achieved by the IOM weights. The difference in objective value performance between the predicted and average weights was statistically significant according to a one-sided sign test. For all patients, the difference in rectum V54.3 Gy, rectum V70.0 Gy, bladder V54.3 Gy, and bladder V70.0 Gy values between the dose distributions generated by the predicted weights and IOM weights was less than 5 percentage points. Similarly, the difference in femoral head V54.3 Gy values between the two dose distributions was less than 5 percentage points for all but one patient. Conclusions: This study demonstrates a proof of concept that patient anatomy can be used to predict appropriate objective function weights for treatment planning. In the long term, such geometry-driven weights may serve as a starting point for iterative treatment plan design or may provide information about the most clinically relevant region of the Pareto surface to explore.

  12. Risk Factors of Developing Long-Lasting Breast Pain After Breast Cancer Radiotherapy

    SciTech Connect (OSTI)

    Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Malmstroem, Per; Alsadius, David; Sundberg, Agnetha; Wilderaeng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

    2012-05-01

    Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, loco-regional radiotherapy, axillary surgery, overweight, and smoking. Results: Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. Conclusions: Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long-lasting breast pain compared to older women. Time since treatment may decrease the occurrence of pain.

  13. Five-Year Outcomes, Cosmesis, and Toxicity With 3-Dimensional Conformal External Beam Radiation Therapy to Deliver Accelerated Partial Breast Irradiation

    SciTech Connect (OSTI)

    Rodrguez, Nria; Sanz, Xavier; Dengra, Josefa; Foro, Palmira; Membrive, Ismael; Reig, Anna; Quera, Jaume; Fernndez-Velilla, Enric; Pera, scar; Lio, Jackson; Lozano, Joan; Algara, Manuel

    2013-12-01

    Purpose: To report the interim results from a study comparing the efficacy, toxicity, and cosmesis of breast-conserving treatment with accelerated partial breast irradiation (APBI) or whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy (3D-CRT). Methods and Materials: 102 patients with early-stage breast cancer who underwent breast-conserving surgery were randomized to receive either WBI (n=51) or APBI (n=51). In the WBI arm, 48 Gy was delivered to the whole breast in daily fractions of 2 Gy, with or without additional 10 Gy to the tumor bed. In the APBI arm, patients received 37.5 Gy in 3.75 Gy per fraction delivered twice daily. Toxicity results were scored according to the Radiation Therapy Oncology Group Common Toxicity Criteria. Skin elasticity was measured using a dedicated device (Multi-Skin-Test-Center MC-750-B2, CKelectronic-GmbH). Cosmetic results were assessed by the physician and the patients as good/excellent, regular, or poor. Results: The median follow-up time was 5 years. No local recurrences were observed. No significant differences in survival rates were found. APBI reduced acute side effects and radiation doses to healthy tissues compared with WBI (P<.01). Late skin toxicity was no worse than grade 2 in either group, without significant differences between the 2 groups. In the ipsilateral breast, the areas that received the highest doses (ie, the boost or quadrant) showed the greatest loss of elasticity. WBI resulted in a greater loss of elasticity in the high-dose area compared with APBI (P<.05). Physician assessment showed that >75% of patients in the APBI arm had excellent or good cosmesis, and these outcomes appear to be stable over time. The percentage of patients with excellent/good cosmetic results was similar in both groups. Conclusions: APBI delivered by 3D-CRT to the tumor bed for a selected group of early-stage breast cancer patients produces 5-year results similar to those achieved with conventional WBI.

  14. SU-E-T-183: Feasibility of Extreme Dose Escalation for Glioblastoma Multiforme Using 4? Radiotherapy

    SciTech Connect (OSTI)

    Nguyen, D; Rwigema, J; Yu, V; Kaprealian, T; Kupelian, P; Selch, M; Low, D; Sheng, K

    2014-06-01

    Purpose: GBM recurrence primarily occurs inside or near the high-dose radiation field of original tumor site requiring greater than 100 Gy to significantly improve local control. We utilize 4? non-coplanar radiotherapy to test the feasibility of planning target volume (PTV) margin expansions or extreme dose escalations without incurring additional radiation toxicities. Methods: 11 GBM patients treated with VMAT to a prescription dose of 59.4 Gy or 60 Gy were replanned with 4?. Original VMAT plans were created with 2 to 4 coplanar or non-coplanar arcs using 3 mm hi-res MLC. The 4? optimization, using 5 mm MLC, selected and inverse optimized 30 beams from a candidate pool of 1162 beams evenly distributed through 4? steradians. 4? plans were first compared to clinical plans using the same prescription dose. Two more studies were then performed to respectively escalate the GTV and PTV doses to 100 Gy, followed by a fourth plan expanding the PTV by 5 mm and maintaining the prescription dose. Results: The standard 4? plan significantly reduced (p<0.01) max and mean doses to critical structures by a range of 47.098.4% and 61.099.2%, respectively. The high dose PTV/high dose GTV/expanded PTV studies showed a reduction (p<0.05) or unchanged* (p>0.05) maximum dose of 72.1%/86.7%/77.1% (chiasm), 7.2%*/27.7%*/30.7% (brainstem), 39.8%*/84.2%/51.9%* (spinal cord), 69.0%/87.0%/66.9% (L eye), 76.2%/88.1%/84.1% (R eye), 95.0%/98.6%/97.5% (L lens), 93.9%/98.8%/97.6% (R lens), 74.3%/88.5%/72.4% (L optical nerve), 80.4%/91.3%/75.7% (R optical nerve), 64.8%/84.2%/44.9%* (L cochlea), and 85.2%/93.0%/78.0% (R cochlea), respectively. V30 and V36 for both brain and (brain - PTV) were reduced for all cases except the high dose PTV plan. PTV dose coverage increased for all 4? plans. Conclusion: Extreme dose escalation or further margin expansion is achievable using 4?, maintaining or reducing OAR doses. This study indicates that clinical trials employing 4? delivery using prescription doses up to 100 Gy are feasible. Funding support partially contributed by Varian.

  15. Dose impact in radiographic lung injury following lung SBRT: Statistical analysis and geometric interpretation

    SciTech Connect (OSTI)

    Yu, Victoria; Kishan, Amar U.; Cao, Minsong; Low, Daniel; Lee, Percy; Ruan, Dan

    2014-03-15

    Purpose: To demonstrate a new method of evaluating dose response of treatment-induced lung radiographic injury post-SBRT (stereotactic body radiotherapy) treatment and the discovery of bimodal dose behavior within clinically identified injury volumes. Methods: Follow-up CT scans at 3, 6, and 12 months were acquired from 24 patients treated with SBRT for stage-1 primary lung cancers or oligometastic lesions. Injury regions in these scans were propagated to the planning CT coordinates by performing deformable registration of the follow-ups to the planning CTs. A bimodal behavior was repeatedly observed from the probability distribution for dose values within the deformed injury regions. Based on a mixture-Gaussian assumption, an Expectation-Maximization (EM) algorithm was used to obtain characteristic parameters for such distribution. Geometric analysis was performed to interpret such parameters and infer the critical dose level that is potentially inductive of post-SBRT lung injury. Results: The Gaussian mixture obtained from the EM algorithm closely approximates the empirical dose histogram within the injury volume with good consistency. The average Kullback-Leibler divergence values between the empirical differential dose volume histogram and the EM-obtained Gaussian mixture distribution were calculated to be 0.069, 0.063, and 0.092 for the 3, 6, and 12 month follow-up groups, respectively. The lower Gaussian component was located at approximately 70% prescription dose (35 Gy) for all three follow-up time points. The higher Gaussian component, contributed by the dose received by planning target volume, was located at around 107% of the prescription dose. Geometrical analysis suggests the mean of the lower Gaussian component, located at 35 Gy, as a possible indicator for a critical dose that induces lung injury after SBRT. Conclusions: An innovative and improved method for analyzing the correspondence between lung radiographic injury and SBRT treatment dose has been demonstrated. Bimodal behavior was observed in the dose distribution of lung injury after SBRT. Novel statistical and geometrical analysis has shown that the systematically quantified low-dose peak at approximately 35 Gy, or 70% prescription dose, is a good indication of a critical dose for injury. The determined critical dose of 35 Gy resembles the critical dose volume limit of 30 Gy for ipsilateral bronchus in RTOG 0618 and results from previous studies. The authors seek to further extend this improved analysis method to a larger cohort to better understand the interpatient variation in radiographic lung injury dose response post-SBRT.

  16. Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases

    SciTech Connect (OSTI)

    Thibault, Isabelle; Campbell, Mikki; Tseng, Chia-Lin; Atenafu, Eshetu G.; Letourneau, Daniel; Yu, Eugene; Cho, B.C. John; Lee, Young K.; Fehlings, Michael G.; Sahgal, Arjun

    2015-10-01

    Purpose: We report our experience in salvaging spinal metastases initially irradiated with stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression, and were re-irradiated with a salvage second SBRT course to the same level. Methods and Materials: From a prospective database, 56 metastatic spinal segments in 40 patients were identified as having been irradiated with a salvage second SBRT course to the same level. In addition, 24 of 56 (42.9%) segments had initially been irradiated with conventional external beam radiation therapy before the first course of SBRT. Local control (LC) was defined as no progression on magnetic resonance imaging at the treated segment, and calculated according to the competing risk model. Overall survival (OS) was evaluated for each patient treated by use of the Kaplan-Meier method. Results: The median salvage second SBRT total dose and number of fractions was 30 Gy in 4 fractions (range, 20-35 Gy in 2-5 fractions), and for the first course of SBRT was 24 Gy in 2 fractions (range, 20-35 Gy in 1-5 fractions). The median follow-up time after salvage second SBRT was 6.8 months (range, 0.9-39 months), the median OS was 10.0 months, and the 1-year OS rate was 48%. A longer time interval between the first and second SBRT courses predicted for better OS (P=.02). The crude LC was 77% (43/56), the 1-year LC rate was 81%, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Of the 13 local failures, 85% (11/13) and 46% (6/13) showed progression within the epidural space and paraspinal soft tissues, respectively. Absence of baseline paraspinal disease predicted for better LC (P<.01). No radiation-induced vertebral compression fractures or cases of myelopathy were observed. Conclusion: A second course of spine SBRT, most often with 30 Gy in 4 fractions, for spinal metastases that failed initial SBRT is a feasible and efficacious salvage treatment option.

  17. Predictors of Grade 3 or Higher Late Bowel Toxicity in Patients Undergoing Pelvic Radiation for Cervical Cancer: Results From a Prospective Study

    SciTech Connect (OSTI)

    Chopra, Supriya; Dora, Tapas; Chinnachamy, Anand N.; Thomas, Biji; Kannan, Sadhna; Engineer, Reena; Mahantshetty, Umesh; Phurailatpam, Reena; Paul, Siji N.; Shrivastava, Shyam Kishore

    2014-03-01

    Purpose: The present study investigates relationship between dosevolume parameters and severe bowel toxicity after postoperative radiation treatment (PORT) for cervical cancer. Methods and Materials: From June 2010 to December 2012, a total of 71 patients undergoing PORT were included. Small bowel (SB) and large bowel (LB) loops were contoured 2cm above the target volume. The volume of SB and LB that received 15Gy, 30Gy, and 40Gy was calculated (V15 SB, V15 LB, V30 SB, V30 LB, V40 SB, V 40 LB). On follow-up, bowel toxicity was scored using Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. A reciever operating characteristic (ROC) curve identified volume thresholds that predicted for grade 3 or higher toxicity with highest specificity. All data was dichotomized across these identified cut-off values. Univariate and multivariate analysis was performed using SPSS, version15. Results: The median patient age was 47years (range, 35-65years). Of the 71 patients, 46 received image-guided intensity modulated radiation therapy, and 25 received conformal radiation (50Gy in 25 fractions for 5weeks). Overall, 63 of 71 patients received concurrent chemotherapy. On a median follow-up of 18months (range, 8-29months), grade 2 or higher bowel toxicity was seen in 22 of 71 patients (30.9%) and grade 3 or higher bowel toxicity was seen in 9 patients (12.6%). On univariate analysis, V15 SB <275 cc (P=.01), V30 SB <190 cc (P=.02), V40 SB <150 cc (P=.01), and V15 LB <250 cc (P=.03), and V40 LB <90 cc (P=.04) predicted for absence of grade 3 or higher toxicity. No other patient- or treatment-related factors were statistically significant. On multivariate analysis, only V15 SB (P=.002) and V15 LB (P=.03) were statistically significant. Conclusions: V 15Gy SB and LB are independent predictors of late grade 3 or higher toxicity. Restricting V15 SB and V15 LB to <275 cc and <250 cc can reduce grade 3 or higher toxicity to less than 5%.

  18. Imprinted genes and transpositions: epigenomic targets for low dose radiation effects. Final report

    SciTech Connect (OSTI)

    Jirtle, Randy L.

    2012-10-11

    The overall hypothesis of this grant application is that low dose ionizing radiation (LDIR) elicits adaptive responses in part by causing heritable DNA methylation changes in the epigenome. This novel postulate was tested by determining if the level of DNA methylation at the Agouti viable yellow (A{sup vy}) metastable locus is altered, in a dose-dependent manner, by low dose radiation exposure (<10 cGy) during early gestation. This information is particularly important to ascertain given the increased use of CT scans in disease diagnosis, increased number of people predicted to live and work in space, and the present concern about radiological terrorism. We showed for the first time that LDIR significantly increased DNA methylation at the A{sup vy} locus in a sex-specific manner (p=0.004). Average DNA methylation was significantly increased in male offspring exposed to doses between 0.7 cGy and 7.6 cGy with maximum effects at 1.4 cGy and 3.0 cGy (p<0.01). Offspring coat color was concomitantly shifted towards pseudoagouti (p<0.01). Maternal dietary antioxidant supplementation mitigated both the DNA methylation changes and coat color shift in the irradiated offspring (p<0.05). Thus, LDIR exposure during gestation elicits epigenetic alterations that lead to positive adaptive phenotypic changes that are negated with antioxidants, indicating they are mediated in part by oxidative stress. These findings provide evidence that in the isogenic Avy mouse model epigenetic alterations resulting from LDIR play a role in radiation hormesis, bringing into question the assumption that every dose of radiation is harmful. Our findings not only have significant implications concerning the mechanism of hormesis, but they also emphasize the potential importance of this phenomenon in determining human risk at low radiation doses. Since the epigenetic regulation of genes varies markedly between species, the effect of LDIR on other epigenetically labile genes (e.g. imprinted genes) in animals and humans needs to be defined.

  19. Estimating pediatric entrance skin dose from digital radiography examination using DICOM metadata: A quality assurance tool

    SciTech Connect (OSTI)

    Brady, S. L. Kaufman, R. A.

    2015-05-15

    Purpose: To develop an automated methodology to estimate patient examination dose in digital radiography (DR) imaging using DICOM metadata as a quality assurance (QA) tool. Methods: Patient examination and demographical information were gathered from metadata analysis of DICOM header data. The x-ray system radiation output (i.e., air KERMA) was characterized for all filter combinations used for patient examinations. Average patient thicknesses were measured for head, chest, abdomen, knees, and hands using volumetric images from CT. Backscatter factors (BSFs) were calculated from examination kVp. Patient entrance skin air KERMA (ESAK) was calculated by (1) looking up examination technique factors taken from DICOM header metadata (i.e., kVp and mA s) to derive an air KERMA (k{sub air}) value based on an x-ray characteristic radiation output curve; (2) scaling k{sub air} with a BSF value; and (3) correcting k{sub air} for patient thickness. Finally, patient entrance skin dose (ESD) was calculated by multiplying a massenergy attenuation coefficient ratio by ESAK. Patient ESD calculations were computed for common DR examinations at our institution: dual view chest, anteroposterior (AP) abdomen, lateral (LAT) skull, dual view knee, and bone age (left hand only) examinations. Results: ESD was calculated for a total of 3794 patients; mean age was 11 8 yr (range: 2 months to 55 yr). The mean ESD range was 0.190.42 mGy for dual view chest, 0.281.2 mGy for AP abdomen, 0.180.65 mGy for LAT view skull, 0.150.63 mGy for dual view knee, and 0.100.12 mGy for bone age (left hand) examinations. Conclusions: A methodology combining DICOM header metadata and basic x-ray tube characterization curves was demonstrated. In a regulatory era where patient dose reporting has become increasingly in demand, this methodology will allow a knowledgeable user the means to establish an automatable dose reporting program for DR and perform patient dose related QA testing for digital x-ray imaging.

  20. Monte Carlo evaluation of CTDI{sub {infinity}} in infinitely long cylinders of water, polyethylene and PMMA with diameters from 10 mm to 500 mm

    SciTech Connect (OSTI)

    Zhou Hong; Boone, John M.

    2008-06-15

    Monte Carlo simulations were used to evaluate the radiation dose to infinitely long cylinders of water, polyethylene, and poly(methylmethacrylate) (PMMA) from 10 to 500 mm in diameter. Radiation doses were computed by simulating a 10 mm divergent primary beam striking the cylinder at z=0, and the scattered radiation in the -z and +z directions was integrated out to infinity. Doses were assessed using the total energy deposited divided by the mass of the 10-mm-thick volume of material in the primary beam. This approach is consistent with the notion of the computed tomography dose index (CTDI) integrated over infinite z, which is equivalent to the dose near the center of an infinitely long CT scan. Monoenergetic x-ray beams were studied from 5 to 140 keV, allowing polyenergetic x-ray spectra to be evaluated using a weighted average. The radiation dose for a 10-mm-thick CT slice was assessed at the center, edge, and over the entire diameter of the phantom. The geometry of a commercial CT scanner was simulated, and the computed results were in good agreement with measured doses. The absorbed dose in water for 120 kVp x-ray spectrum with no bow tie filter for a 50 mm cylinder diameter was about 1.2 mGy per mGy air kerma at isocenter for both the peripheral and center regions, and dropped to 0.84 mGy/mGy for a 500-mm-diam water phantom at the periphery, where the corresponding value for the center location was 0.19 mGy/mGy. The influence of phantom composition was studied. For a diameter of 100 mm, the dose coefficients were 1.23 for water, 1.02 for PMMA, and 0.94 for polyethylene (at 120 kVp). For larger diameter phantoms, the order changed--for a 400 mm phantom, the dose coefficient of polyethylene (0.25) was greater than water (0.21) and PMMA (0.16). The influence of the head and body bow tie filters was also studied. For the peripheral location, the dose coefficients when no bow tie filter was used were high (e.g., for a water phantom at 120 kVp at a diameter of 300 mm, the dose coefficient was 0.97). The body bow tie filter reduces this value to 0.62, and the head bow tie filter (which is not actually designed to be used for a 300 mm object) reduces the dose coefficient to 0.42. The dose in CT is delivered both by the absorption of primary and scattered x-ray photons, and at the center of a water cylinder the ratio of scatter to primary (SPR) doses increased steadily with cylinder diameter. For water, a 120 kVp spectrum and a cylinder diameter of 200 mm, the SPR was 4, and this value grew to 9 for a diameter of 350 mm and to over 16 for a 500-mm-diam cylinder. A freely available spreadsheet was developed to allow the computation of radiation dose as a function of object diameter (10-500 mm), composition (water, polyethylene, PMMA), and beam energy (10-140 keV, 40-140 kVp)

  1. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    SciTech Connect (OSTI)

    Nakamura, Naoki; Shikama, Naoto; Wada, Hitoshi; Harada, Hideyuki; Nozaki, Miwako; Nagakura, Hisayasu; Tago, Masao; Oguchi, Masahiko; Uchida, Nobue

    2012-05-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: 'time until first increase in pain' (85%), 'incidence of spinal cord compression' (50%), and 'incidence of pathologic fractures' (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  2. Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis

    SciTech Connect (OSTI)

    Machtay, Mitchell; Moughan, Jennifer; Farach, Andrew; University of Texas Health Science Center Martin-O'Meara, Elizabeth; Galvin, James; Thomas Jefferson University, Philadelphia, Pennsylvania ; Garden, Adam S.; Weber, Randal S.; Cooper, Jay S.; Forastiere, Arlene; Ang, K. Kian

    2012-11-15

    Purpose: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. Methods and Materials: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube {>=}2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. Results: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving {<=}60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. Conclusions: Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.

  3. Brachial Plexopathy in Apical Non-Small Cell Lung Cancer Treated With Definitive Radiation: Dosimetric Analysis and Clinical Implications

    SciTech Connect (OSTI)

    Eblan, Michael J.; Corradetti, Michael N.; Lukens, J. Nicholas; Xanthopoulos, Eric; Mitra, Nandita; Christodouleas, John P.; Grover, Surbhi; Fernandes, Annemarie T.; Langer, Corey J.; Evans, Tracey L.; Stevenson, James; Rengan, Ramesh; Apisarnthanarax, Smith

    2013-01-01

    Purpose: Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients. Methods and Materials: Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received {>=}50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines. Results: Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received {<=}78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving {>=}1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively. Conclusions: RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of patients.

  4. Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

    SciTech Connect (OSTI)

    Kemmerer, Eric; Hernandez, Enrique; Ferriss, James S.; Valakh, Vladimir; Miyamoto, Curtis; Li, Shidong; Micaily, Bizhan

    2013-01-01

    Purpose: Retrospective analysis of patients with invasive endometrial neoplasia who were treated with external beam radiation therapy followed by stereotactic body radiation therapy (SBRT) boost because of the inability to undergo surgery or brachytherapy. Methods and Materials: We identified 11 women with stage I-III endometrial cancer with a median age of 78 years that were not candidates for hysterectomy or intracavitary brachytherapy secondary to comorbidities (91%) or refusal (9%). Eight patients were American Joint Committee on Cancer (AJCC) stage I (3 stage IA, 5 stage IB), and 3 patients were AJCC stage III. Patients were treated to a median of 4500 cGy at 180 cGy per fraction followed by SBRT boost (600 cGy per fraction Multiplication-Sign 5). Results: The most common side effect was acute grade 1 gastrointestinal toxicity in 73% of patients, with no late toxicities observed. With a median follow-up of 10 months since SBRT, 5 patients (45%) experienced locoregional disease progression, with 3 patients (27%) succumbing to their malignancy. At 12 and 18 months from SBRT, the overall freedom from progression was 68% and 41%, respectively. Overall freedom from progression (FFP) was 100% for all patients with AJCC stage IA endometrial carcinoma, whereas it was 33% for stage IB at 18 months. The overall FFP was 100% for International Federation of Obstetrics and Gynecology grade 1 disease. The estimated overall survival was 57% at 18 months from diagnosis. Conclusion: In this study, SBRT boost to the intact uterus was feasible, with encouragingly low rates of acute and late toxicity, and favorable disease control in patients with early-stage disease. Additional studies are needed to provide better insight into the best management of these clinically challenging cases.

  5. MO-F-16A-04: Case Study: Estimation of Peak Skin Dose Following a Physician Reported “High Dose” Case and Sentinel Event Considerations

    SciTech Connect (OSTI)

    Supanich, M; Chu, J; Wehmeyer, A

    2014-06-15

    Purpose: This work offers as a teaching example a reported high dose fluoroscopy case and the workflow the institution followed to self-report a radiation overdose sentinel event to the Joint Commission. Methods: Following the completion of a clinical case in a hybrid OR room with a reported air kerma of >18 Gy at the Interventional Reference Point (IRP) the physicians involved in the case referred study to the institution's Radiation Safety Committee (RSC) for review. The RSC assigned a Diagnostic Medical Physicist (DMP) to estimate the patient's Peak Skin Dose (PSD) and analyze the case. Following the DMP's analysis and estimate of a PSD of >15 Gy the institution's adverse event committee was convened to discuss the case and to self-report the case as a radiation overdose sentinel event to the Joint Commission. The committee assigned a subgroup to perform the root cause analysis and develop institutional responses to the event. Results: The self-reporting of the sentinel event and the associated root cause analysis resulted in several institutional action items that are designed to improve process and safety. A formal reporting and analysis mechanism was adopted to review fluoroscopy cases with air kerma greater than 6 Gy at the IRP. An improved and formalized radiation safety training program for physicians using fluoroscopy equipment was implemented. Additionally efforts already under way to monitor radiation exposure in the Radiology department were expanded to include all fluoroscopy equipment capable of automated dose reporting. Conclusion: The adverse event review process and the root cause analysis following the self-reporting of the sentinel event resulted in policies and procedures that are expected to improve the quality and safe usage of fluoroscopy throughout the institution.

  6. TH-C-19A-10: Systematic Evaluation of Photodetectors Performances for Plastic Scintillation Dosimetry

    SciTech Connect (OSTI)

    Boivin, J; Beaulieu, L; Beddar, S; Guillemette, M

    2014-06-15

    Purpose: To assess and compare the performance of different photodetectors likely to be used in a plastic scintillation detector (PSD). Methods: The PSD consists of a 1 mm diameter, 10 mm long plastic scintillation fiber (BCF-60) which is optically coupled to a clear 10 m long optical fiber of the same diameter. A light-tight plastic sheath covers both fibers and the scintillator end is sealed. The clear fiber end is connected to one of the following six studied photodetectors: two polychromatic cameras (one with an optical lens and one with a fiber optic taper replacing the lens); a monochromatic camera with the same optical lens; a PIN photodiode; an avalanche photodiode (APD); and a photomultiplier tube (PMT). Each PSD is exposed to both low energy beams (120, 180, and 220 kVp) from an orthovoltage unit, and high energy beams (6 MV and 23 MV) from a linear accelerator. Various dose rates are explored to identify the photodetectors operating ranges and accuracy. Results: For all photodetectors, the relative uncertainty remains under 5 % for dose rates over 3 mGy/s. The taper camera collects four times more signal than the optical lens camera, although its standard deviation is higher since it could not be cooled. The PIN, APD and PMT have higher sensitivity, suitable for low dose rate and out-of-field dose monitoring. PMT's relative uncertainty remains under 1 % at the lowest dose rate achievable (50 ?Gy/s), suggesting optimal use for live dosimetry. Conclusion: A set of 6 photodetectors have been studied over a broad dose rate range at various energies. For dose rate above 3 mGy/s, the PIN diode is the most effective photodetector in term of performance/cost ratio. For lower dose rate, such as those seen in interventional radiology, PMTs are the optimal choice. FQRNT Doctoral Research Scholarship.

  7. SU-E-J-52: Dosimetric Benefit of Adaptive Re-Planning in Lung Cancer Stereotactic Body Radiotherapy (SBRT)

    SciTech Connect (OSTI)

    Jia, J; Tian, Z; Gu, X; Yan, H; Jiang, S; Jia, X

    2014-06-01

    Purpose: To investigate the dosimetric benefit of adaptive re-planning for lung stereotactic body radiotherapy(SBRT). Methods: Five lung cancer patients with SBRT treatment were retrospectively investigated. Our in-house supercomputing online re-planning environment (SCORE) was used to realize the re-planning process. First a deformable image registration was carried out to transfer contours from treatment planning CT to each treatment CBCT. Then an automatic re-planning using original plan DVH guided fluence-map optimization is performed to get a new plan for the up-to-date patient geometry. We compared the re-optimized plan to the original plan projected on the up-to-date patient geometry in critical dosimetric parameters, such as PTV coverage, spinal cord maximum and volumetric constraint dose, esophagus maximum and volumetric constraint dose. Results: The average volume of PTV covered by prescription dose for all patients was improved by 7.56% after the adaptive re-planning. The volume of the spinal cord receiving 14.5Gy and 23Gy (V14.5, V23) decreased by 1.48% and 0.68%, respectively. For the esophagus, the volume receiving 19.5Gy (V19.5) reduced by 1.37%. Meanwhile, the maximum dose dropped off by 2.87% for spinal cord and 4.80% for esophagus. Conclusion: Our experimental results demonstrate that adaptive re-planning for lung SBRT has the potential to minimize the dosimetric effect of inter-fraction deformation and thus improve target coverage while reducing the risk of toxicity to nearby normal tissues.

  8. SU-E-J-33: Cardiac Movement in Deep Inspiration Breath-Hold for Left-Breast Cancer Radiotherapy

    SciTech Connect (OSTI)

    Kim, M; Lee, S; Suh, T

    2014-06-01

    Purpose: The present study was designed to investigate the displacement of heart using Deep Inspiration Breath Hold (DIBH) CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Methods: Treatment planning was performed on the computed tomography (CT) datasets of 20 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ? 95% of the prescribed dose and that the volume inside the CTV receiving > 107% of the prescribed dose should be minimized. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. Results: The maximum and minimum left-right (LR) displacements of heart were 8.9 mm and 3 mm, respectively. The heart moved > 4 mm in the LR direction in 17 of the 20 patients. The distances between the heart and left breast ranged from 8.0217.68 mm (mean, 12.23 mm) and 7.8512.98 mm (mean, 8.97 mm) with DIBH CT and FB CT, respectively. The maximum doses to the heart were 3115 cGy and 4652 cGy for the DIBH and FB CT dataset, respectively. Conclusion: The present study has demonstrated that the DIBH technique could help to reduce the risk of radiation dose-induced cardiac toxicity by using movement of cardiac; away from radiation field. The DIBH technique could be used in an actual treatment room for a few minutes and could effectively reduce the cardiac dose when used with a sub-device or image acquisition standard to maintain consistent respiratory motion.

  9. Quantification of Contralateral Breast Dose and Risk Estimate of Radiation-Induced Contralateral Breast Cancer Among Young Women Using Tangential Fields and Different Modes of Breathing

    SciTech Connect (OSTI)

    Zurl, Brigitte; Stranzl, Heidi; Winkler, Peter; Kapp, Karin Sigrid

    2013-02-01

    Purpose: Whole breast irradiation with deep-inspiration breath-hold (DIBH) technique among left-sided breast cancer patients significantly reduces cardiac irradiation; however, a potential disadvantage is increased incidental irradiation of the contralateral breast. Methods and Materials: Contralateral breast dose (CBD) was calculated by comparing 400 treatment plans of 200 left-sided breast cancer patients whose tangential fields had been planned on gated and nongated CT data sets. Various anatomic and field parameters were analyzed for their impact on CBD. For a subgroup of patients (aged {<=}45 years) second cancer risk in the contralateral breast (CB) was modeled by applying the linear quadratic model, compound models, and compound models considering dose-volume information (DVH). Results: The mean CBD was significantly higher in DIBH with 0.69 Gy compared with 0.65 Gy in normal breathing (P=.01). The greatest impact on CBD was due to a shift of the inner field margin toward the CB in DIBH (mean 0.4 cm; range, 0-2), followed by field size in magnitude. Calculation with different risk models for CBC revealed values of excess relative risk/Gy ranging from 0.48-0.65 vs 0.46-0.61 for DIBH vs normal breathing, respectively. Conclusion: Contralateral breast dose, although within a low dose range, was mildly but significantly increased in 200 treatment plans generated under gated conditions, predominately due to a shift in the medial field margin. Risk modeling for CBC among women aged {<=}45 years also pointed to a higher risk when comparing DIBH with normal breathing. This risk, however, was substantially lower in the model considering DVH information. We think that clinical decisions should not be affected by this small increase in CBD with DIBH because DIBH is effective in reducing the dose to the heart in all patients.

  10. SU-E-T-275: Radiobiological Evaluation of Intensity Modulated Radiotherapy Treatment for Locally Advanced Head and Neck Squamous Cell Carcinomas

    SciTech Connect (OSTI)

    Rekha Reddy, B.; Ravikumar, M.; Tanvir Pasha, C.R; Anil Kumar, M.R; Varatharaj, C.; Pyakuryal, A; Narayanasamy, Ganesh

    2014-06-01

    Purpose: To evaluate the radiobiological outcome of Intensity Modulated Radiotherapy Treatment (IMRT) for locally advanced head and neck squamous cell carcinomas using HART (Histogram Analysis in Radiation Therapy; J Appl Clin Med Phys 11(1): 137157, 2010) program and compare with the clinical outcomes. Methods: We have treated 20 patients of stage III and IV HNSCC Oropharynx and hypopharynx with accelerated IMRT technique and concurrent chemotherapy. Delineation of tumor and normal tissues were done using Danish Head and Neck Cancer Group (DAHANCA) contouring guidelines and radiotherapy was delivered to a dose of 70Gy in 35 fractions to the primary and involved lymph nodes, 63Gy to intermediate risk areas and 56 Gy to lower risk areas, Monday to Saturday, 6 Days/week using 6 MV Photons with an expected overall treatment time of 6 weeks. The TCP and NTCP's were calculated from the dose-volume histogram (DVH) statistics using the Poisson Statistics (PS) and JT Lyman models respectively and the Resultwas correlated with clinical outcomes of the patients with mean follow up of 24 months. Results: Using HART program, the TCP (0.89 0.01) of primary tumor and the NTCP for parotids (0.200.12), spinal cord (0.050.01), esophagus (0.300.2), mandible (0.350.21), Oral cavity (0.370.18), Larynx (0.300.15) were estimated and correlated with clinical outcome of the patients. Conclusion: Accelerated IMRT with Chemotherapy is a clinical feasible option in the treatment of locally advanced HNSCC with encouraging initial tumour response and acceptable acute toxicities. The correlation between the clinical outcomes and radiobiological model estimated parameters using HART programs are found to be satisfactory.

  11. SU-E-J-190: Characterization of Radiation Induced CT Number Changes in Tumor and Normal Lung During Radiation Therapy for Lung Cancer

    SciTech Connect (OSTI)

    Yang, C; Liu, F; Tai, A; Gore, E; Johnstone, C; Li, X

    2014-06-01

    Purpose: To measure CT number (CTN) changes in tumor and normal lung as a function of radiation therapy (RT) dose during the course of RT delivery for lung cancer using daily IGRT CT images and single respiration phase CT images. Methods: 4D CT acquired during planning simulation and daily 3D CT acquired during daily IGRT for 10 lung cancer cases randomly selected in terms of age, caner type and stage, were analyzed using an in-house developed software tool. All patients were treated in 2 Gy fractions to primary tumors and involved nodal regions. Regions enclosed by a series of isodose surfaces in normal lung were delineated. The obtained contours along with target contours (GTVs) were populated to each singlephase planning CT and daily CT. CTN in term of Hounsfield Unit (HU) of each voxel in these delineated regions were collectively analyzed using histogram, mean, mode and linear correlation. Results: Respiration induced normal lung CTN change, as analyzed from single-phase planning CTs, ranged from 9 to 23 (2) HU for the patients studied. Normal lung CTN change was as large as 50 (12) HU over the entire treatment course, was dose and patient dependent and was measurable with dose changes as low as 1.5 Gy. For patients with obvious tumor volume regression, CTN within the GTV drops monotonically as much as 10 (1) HU during the early fractions with a total dose of 20 Gy delivered. The GTV and CTN reductions are significantly correlated with correlation coefficient >0.95. Conclusion: Significant RT dose induced CTN changes in lung tissue and tumor region can be observed during even the early phase of RT delivery, and may potentially be used for early prediction of radiation response. Single respiration phase CT images have dramatically reduced statistical noise in ROIs, making daily dose response evaluation possible.

  12. SU-E-T-602: Beryllium Seeds Implant for Photo-Neutron Yield Using External Beam Therapy

    SciTech Connect (OSTI)

    Koren, S; Veltchev, I; Furhang, E

    2014-06-01

    Purpose: To evaluate the Neutron yield obtained during prostate external beam irradiation. Methods: Neutrons, that are commonly a radiation safety concern for photon beams with energy above 10 MV, are induced inside a PTV from Beryllium implemented seeds. A high megavoltage photon beam delivered to a prostate will yield neutrons via the reaction Be-9(?,n)2?. Beryllium was chosen for its low gamma,n reaction cross-section threshold (1.67 MeV) to be combined with a high feasible 25 MV photon beam. This beam spectra has a most probable photon energy of 2.5 to 3.0 MeV and an average photon energy of about 5.8 MeV. For this feasibility study we simulated a Beryllium-made common seed dimension (0.1 cm diameter and 0.5 cm height) without taking into account encapsulation. We created a 0.5 cm grid loading pattern excluding the Urethra, using Variseed (Varian inc.) A total of 156 seeds were exported to a 4cm diameter prostate sphere, created in Fluka, a particle transport Monte Carlo Code. Two opposed 25 MV beams were simulated. The evaluation of the neutron dose was done by adjusting the simulated photon dose to a common prostate delivery (e.g. 7560 cGy in 42 fractions) and finding the corresponding neutron dose yield from the simulation. A variance reduction technique was conducted for the neutrons yield and transported. Results: An effective dose of 3.65 cGy due to neutrons was found in the prostate volume. The dose to central areas of the prostate was found to be about 10 cGy. Conclusion: The neutron dose yielded does not justify a clinical implant of Beryllium seeds. Nevertheless, one should investigate the Neutron dose obtained when a larger Beryllium loading is combined with commercially available 40 MeV Linacs.

  13. SU-D-16A-06: Modeling Biological Effects of Residual Uncertainties For Stereotactic Radiosurgery

    SciTech Connect (OSTI)

    Ma, L; Larson, D; McDermott, M; Sneed, P; Sahgal, A

    2014-06-01

    Purpose: Residual uncertainties on the order of 1-2 mm are frequently observed when delivering stereotactic radiosurgery via on-line imaging guidance with a relocatable frame. In this study, a predictive model was developed to evalute potentiral late radiation effects associated with such uncertainties. Methods: A mathematical model was first developed to correlate the peripherial isodose volume with the internal and/or setup margins for a radiosurgical target. Such a model was then integrated with a previoulsy published logistic regression normal tissue complication model for determining the symptomatic radiation necrosis rate at various target sizes and prescription dose levels. The model was tested on a cohort of 15 brain tumor and tumor resection cavity patient cases and model predicted results were compared with the clinical results reported in the literature. Results: A normalized target diameter (D{sub 0}) in term of D{sub 0} = 6V/S, where V is the volume of a radiosurgical target and S is the surface of the target, was found to correlate excellently with the peripheral isodose volume for a radiosurgical delivery (logarithmic regression R{sup 2} > 0.99). The peripheral isodose volumes were found increase rapidly with increasing uncertainties levels. In general, a 1-mm residual uncertainties as calculated to result in approximately 0.5%, 1%, and 3% increases in the symptomatic radiation necrosis rate for D{sub 0} = 1 cm, 2 cm, and 3 cm based on the prescription guideline of RTOG 9005, i.e., 21 Gy to a lesion of 1 cm in diameter, 18 Gy to a lesion 2 cm in diameter, and 15 Gy to a lesion 3 cm in diameter respectively. Conclusion: The results of study suggest more stringent criteria on residual uncertainties are needed when treating a large target such as D{sub 0}≤ 3 cm with stereotactic radiosurgery. Dr. Ma and Dr. Sahgal are currently serving on the board of international society of stereotactic radiosurgery (ISRS)

  14. Quantifying the Impact of Immediate Reconstruction in Postmastectomy Radiation: A Large, Dose-Volume Histogram-Based Analysis

    SciTech Connect (OSTI)

    Ohri, Nisha; Cordeiro, Peter G.; Keam, Jennifer; Ballangrud, Ase; Shi Weiji; Zhang Zhigang; Nerbun, Claire T.; Woch, Katherine M.; Stein, Nicholas F.; Zhou Ying; McCormick, Beryl; Powell, Simon N.; Ho, Alice Y.

    2012-10-01

    Purpose: To assess the impact of immediate breast reconstruction on postmastectomy radiation (PMRT) using dose-volume histogram (DVH) data. Methods and Materials: Two hundred forty-seven women underwent PMRT at our center, 196 with implant reconstruction and 51 without reconstruction. Patients with reconstruction were treated with tangential photons, and patients without reconstruction were treated with en-face electron fields and customized bolus. Twenty percent of patients received internal mammary node (IMN) treatment. The DVH data were compared between groups. Ipsilateral lung parameters included V20 (% volume receiving 20 Gy), V40 (% volume receiving 40 Gy), mean dose, and maximum dose. Heart parameters included V25 (% volume receiving 25 Gy), mean dose, and maximum dose. IMN coverage was assessed when applicable. Chest wall coverage was assessed in patients with reconstruction. Propensity-matched analysis adjusted for potential confounders of laterality and IMN treatment. Results: Reconstruction was associated with lower lung V20, mean dose, and maximum dose compared with no reconstruction (all P<.0001). These associations persisted on propensity-matched analysis (all P<.0001). Heart doses were similar between groups (P=NS). Ninety percent of patients with reconstruction had excellent chest wall coverage (D95 >98%). IMN coverage was superior in patients with reconstruction (D95 >92.0 vs 75.7%, P<.001). IMN treatment significantly increased lung and heart parameters in patients with reconstruction (all P<.05) but minimally affected those without reconstruction (all P>.05). Among IMN-treated patients, only lower lung V20 in those without reconstruction persisted (P=.022), and mean and maximum heart doses were higher than in patients without reconstruction (P=.006, P=.015, respectively). Conclusions: Implant reconstruction does not compromise the technical quality of PMRT when the IMNs are untreated. Treatment technique, not reconstruction, is the primary determinant of target coverage and normal tissue doses.

  15. Measurement of relative output factors for the 8 and 4 mm collimators of Leksell Gamma Knife Perfexion by film dosimetry

    SciTech Connect (OSTI)

    Novotny, Josef Jr.; Bhatnagar, Jagdish P.; Quader, Mubina A.; Bednarz, Greg; Lunsford, L. Dade; Huq, M. Saiful

    2009-05-15

    Three types of films, Kodak EDR2, Gafchromic EBT, and Gafchromic MD-V2-55, were used to measure relative output factors of 4 and 8 mm collimators of the Leksell Gamma Knife Perfexion. The optical density to dose calibration curve for each of the film types was obtained by exposing the films to a range of known doses. Ten data points were acquired for each of the calibration curves in the dose ranges from 0 to 4 Gy, 0 to 8 Gy, and 0 to 80 Gy for Kodak EDR2, Gafchromic EBT, and Gafchromic MD-V2-55 films, respectively. For the measurement of relative output factors, five films of each film type were exposed to a known dose. All films were scanned using EPSON EXPRESSION 10000 XL scanner with 200 dpi resolution in 16 bit gray scale for EDR2 film and 48 bit color scale for Gafchromic films. The scanned images were imported in the red channel for both Gafchromic films. The background corrections from an unexposed film were applied to all films. The output factors obtained from film measurements were in a close agreement both with the Monte Carlo calculated values of 0.924 and 0.805 for 8 and 4 mm collimators, respectively. These values are provided by the vendor and used as default values in the vendor's treatment planning system. The largest differences were noted for the Kodak EDR 2 films (-2.1% and -4.5% for 8 and 4 mm collimators, respectively). The best agreement observed was for EBT Gafchromic film (-0.8% and +0.6% differences for 8 and 4 mm collimators, respectively). Based on the present values, no changes in the default relative output factor values were made in the treatment planning system.

  16. SU-E-T-500: Dose Escalation Strategy for Lung Cancer Patients Using a Biologically- Guided Target Definition

    SciTech Connect (OSTI)

    Shusharina, N; Khan, F; Choi, N; Sharp, G

    2014-06-01

    Purpose: Dose escalation strategy for lung cancer patients can lead to late symptoms such as pneumonitis and cardiac injury. We propose a strategy to increase radiation dose for improving local tumor control while simultaneously striving to minimize the injury of organs at risk (OAR). Our strategy is based on defining a small, biologically-guided target volume for receiving additional radiation dose. Methods: 106 patients with lung cancer treated with radiotherapy were selected for patients diagnosed with stage II and III disease. Previous research has shown that 50% of the maximum SUV threshold in FDG-PET imaging is appropriate for delineation of the most aggressive part of a tumor. After PET- and CT-derived targets were contoured, an IMRT treatment plan was designed to deliver 60 Gy to the GTV as delineated on a 4D CT (Plan 1). A second plan was designed with additional dose of 18 Gy to the PET-derived volume (Plan 2). A composite plan was generated by the addition of Plan 1 and Plan 2. Results: Plan 1 was compared to the composite plan and increases in OAR dose were assessed. For seven patients on average, lung V5 was increased by 1.4% and V20 by 4.2% for ipsilateral lung and by 13.5% and 7% for contralateral lung. For total lung, V5 and V20 were increased by 4.5% and 4.8% respectively. Mean lung dose was increased by 9.7% for the total lung. The maximum dose to the spinal cord increased by 16% on average. For the heart, V20 increased by 4.2% and V40 by 5.2%. Conclusion: It seems feasible that an additional 18 Gy of radiation dose can be delivered to FDG PET-derived subvolume of the CT-based GTV of the primary tumor without significant increase in total dose to the critical organs such as lungs, spinal cord and heart.

  17. Gamma Knife irradiation method based on dosimetric controls to target small areas in rat brains

    SciTech Connect (OSTI)

    Constanzo, Julie; Paquette, Benoit; Charest, Gabriel; Masson-Côté, Laurence; Guillot, Mathieu

    2015-05-15

    Purpose: Targeted and whole-brain irradiation in humans can result in significant side effects causing decreased patient quality of life. To adequately investigate structural and functional alterations after stereotactic radiosurgery, preclinical studies are needed. The purpose of this work is to establish a robust standardized method of targeted irradiation on small regions of the rat brain. Methods: Euthanized male Fischer rats were imaged in a stereotactic bed, by computed tomography (CT), to estimate positioning variations relative to the bregma skull reference point. Using a rat brain atlas and the stereotactic bregma coordinates obtained from CT images, different regions of the brain were delimited and a treatment plan was generated. A single isocenter treatment plan delivering ≥100 Gy in 100% of the target volume was produced by Leksell GammaPlan using the 4 mm diameter collimator of sectors 4, 5, 7, and 8 of the Gamma Knife unit. Impact of positioning deviations of the rat brain on dose deposition was simulated by GammaPlan and validated with dosimetric measurements. Results: The authors’ results showed that 90% of the target volume received 100 ± 8 Gy and the maximum of deposited dose was 125 ± 0.7 Gy, which corresponds to an excellent relative standard deviation of 0.6%. This dose deposition calculated with GammaPlan was validated with dosimetric films resulting in a dose-profile agreement within 5%, both in X- and Z-axes. Conclusions: The authors’ results demonstrate the feasibility of standardizing the irradiation procedure of a small volume in the rat brain using a Gamma Knife.

  18. Toward Dose Optimization for Fractionated Stereotactic Radiotherapy for Acoustic Neuromas: Comparison of Two Dose Cohorts

    SciTech Connect (OSTI)

    Andrews, David W. Werner-Wasik, Maria; Den, Robert B.; Paek, Sun Ha; Downes-Phillips, Beverly; Willcox, Thomas O.; Bednarz, Greg; Maltenfort, Mitchel; Evans, James J.; Curran, Walter J.

    2009-06-01

    Purpose: To describe our initial experience of fractionated stereotactic radiotherapy dose reduction comparing two dose cohorts with examination of tumor control rates and serviceable hearing preservation rates. Methods and Materials: After institutional review board approval, we initiated a retrospective chart review to study the hearing outcomes and tumor control rates. All data were entered into a JMP, version 7.01, statistical spreadsheet for analysis. Results: A total of 89 patients with serviceable hearing had complete serial audiometric data available for analysis. The higher dose cohort included 43 patients treated to 50.4 Gy with a median follow-up (latest audiogram) of 53 weeks and the lower dose cohort included 46 patients treated to 46.8 Gy with a median follow-up of 65 weeks. The tumor control rate was 100% in both cohorts, and the pure tone average was significantly improved in the low-dose cohort (33 dB vs. 40 dB, p = 0.023, chi-square). When the patient data were analyzed at comparable follow-up points, the actuarial hearing preservation rate was significantly longer for the low-dose cohort than for the high-dose cohort (165 weeks vs. 79 weeks, p = .0318, log-rank). Multivariate analysis revealed the dose cohort (p = 0.0282) and pretreatment Gardner-Robertson class (p = 0.0215) to be highly significant variables affecting the hearing outcome. Conclusion: A lower total dose at 46.8 Gy was associated with a 100% local control tumor rate and a greater hearing preservation rate. An additional dose reduction is justified to achieve the optimal dose that will yield the greatest hearing preservation rate without compromising tumor control for these patients.

  19. Pattern of Failure After Limited Margin Radiotherapy and Temozolomide for Glioblastoma

    SciTech Connect (OSTI)

    McDonald, Mark W.; Shu, Hui-Kuo G.; Curran, Walter J.; Crocker, Ian R.

    2011-01-01

    Purpose: To evaluate the pattern of failure after limited margin radiotherapy for glioblastoma. Methods and Materials: We analyzed 62 consecutive patients with newly diagnosed glioblastoma treated between 2006 and 2008 with standard fractionation to a total dose of 60Gy with concurrent temozolomide (97%) or arsenic trioxide (3%). The initial clinical target volume included postoperative T2 abnormality with a median margin of 0.7cm. The boost clinical target volume included residual T1-enhancing tumor and resection cavity with a median margin of 0.5cm. Planning target volumes added a 0.3- or 0.5-cm margin to clinical target volumes. The total boost planning target volume (PTV{sub boost}) margin was 1cm or less in 92% of patients. The volume of recurrent tumor (new T1 enhancement) was categorized by the percent within the 60-Gy isodose line as central (>95%), infield (81-95%), marginal (20-80%), or distant (<20%). For comparison, an initial planning target volume with a 2-cm margin and PTV{sub boost} with a 2.5-cm margin were created for each patient. Results: With a median follow-up of 12 months, radiographic tumor progression developed in 43 of 62 patients. Imaging was available for analysis in 41: 38 (93%) had central or infield failure, 2 (5%) had marginal failure, and 1 (2%) had distant failure relative to the 60-Gy isodose line. The treated PTV{sub boost} (median, 140cm{sup 3}) was, on average, 70% less than the PTV{sub boost} with a 2.5-cm margin (median, 477cm{sup 3}) (p < 0.001). Conclusions: A PTV{sub boost} margin of 1cm or less did not appear to increase the risk of marginal and/or distant tumor failures compared with other published series. With careful radiation planning and delivery, it appears that treatment margins for glioblastoma can be reduced.

  20. Incidence, Risks, and Sequelae of Posterior Fossa Syndrome in Pediatric Medulloblastoma

    SciTech Connect (OSTI)

    Korah, Mariam P.; Esiashvili, Natia; Mazewski, Claire M.; Hudgins, Roger J.; Tighiouart, Mourad; Janss, Anna J.; Schwaibold, Frederick P.; Crocker, Ian R.; Curran, Walter J.; Marcus, Robert B.

    2010-05-01

    Purpose: To investigate the incidence, risks, severity, and sequelae of posterior fossa syndrome (PFS) in children with medulloblastoma. Methods and Materials: Between 1990 and 2007, 63 children with medulloblastoma at Emory University and Children's Healthcare of Atlanta were treated with craniectomy followed by radiation. Fifty-one patients were assigned to a standard-risk group, and 12 patients were assigned to a high-risk group. Five patients had <1.5-cm{sup 2} residual tumor, 4 had >=1.5-cm{sup 2} residual tumor, and the remainder had no residual tumor. Eleven patients had disseminated disease. Patients received craniospinal irradiation at a typical dose of 23.4 Gy or 36 Gy for standard- or high-risk disease, respectively. The posterior fossa was given a total dose of 54 or 55.8 Gy. Nearly all patients received chemotherapy following cooperative group protocols. Results: Median follow-up was 7 years. PFS developed in 18 patients (29%). On univariate analysis, brainstem invasion, midline tumor location, younger age, and the absence of radiographic residual tumor were found to be predictors of PFS; the last two variables remained significant on multivariate analysis. From 1990 to 2000 and from 2001 to 2007, the proportions of patients with no radiographic residual tumor were 77% and 94%, respectively. During the same eras, the proportions of patients with PFS were 17% and 39%. Only 4 patients had complete recovery at last follow-up. Conclusions: The incidence of PFS increased in the latter study period and is proportional to more aggressive surgery. Children with midline tumors exhibiting brainstem invasion are at increased risk. With the increased incidence of PFS and the permanent morbidity in many patients, the risks and benefits of complete tumor removal in all patients need to be reexamined.

  1. Long-term low-dose ?-particle enhanced the potential of malignant transformation in human bronchial epithelial cells through MAPK/Akt pathway

    SciTech Connect (OSTI)

    Liu, Weili; Xiao, Linlin; Dong, Chen; He, Mingyuan; Pan, Yan; Xie, Yuexia; Tu, Wenzhi; Fu, Jiamei; Shao, Chunlin

    2014-05-09

    Highlights: Multi-exposures of 25 mGy ?-ray enhanced cell proliferation, adhesion, and invasion. MAPK/Akt but not JNK/P66 was positively correlated with cell invasive phenotypes. LDR of ?-irradiation triggers cell malignant transformation through MAPK/Akt. - Abstract: Since the wide usage of ionizing radiation, the cancer risk of low dose radiation (LDR) (<0.1 Gy) has become attractive for a long time. However, most results are derived from epidemiologic studies on atomic-bomb survivors and nuclear accidents surrounding population, and the molecular mechanism of this risk is elusive. To explore the potential of a long-term LDR-induced malignant transformation, human bronchial epithelial cells Beas-2B were fractionally irradiated with 0.025 Gy ?-particles for 8 times in total and then further cultured for 12 months. It was found that the cell proliferation, the abilities of adhesion and invasion, and the protein expressions of p-ERK, p-Akt, especially p-P38 were not only increased in the multiply-irradiated cells but also in their offspring 12 months after the final exposure, indicating high potentiality of cell malignant transformation. On opposite, the expressions of p-JNK and p-P66 were diminished in the subcultures of irradiated cells and thus may play a role of negative regulation in canceration. When the cells were transferred with p38 siRNA, the LDR-induced enhancements of cell adhesion and invasion were significantly reduced. These findings suggest that long-term LDR of ?-particles could enhance the potential of malignant transformation incidence in human bronchial epithelial cells through MAPK/Akt pathway.

  2. Dosimetric verification of stereotactic radiosurgery/stereotactic radiotherapy dose distributions using Gafchromic EBT3

    SciTech Connect (OSTI)

    Cusumano, Davide; Fumagalli, Maria L.; Marchetti, Marcello; Fariselli, Laura; De Martin, Elena

    2015-10-01

    Aim of this study is to examine the feasibility of using the new Gafchromic EBT3 film in a high-dose stereotactic radiosurgery and radiotherapy quality assurance procedure. Owing to the reduced dimensions of the involved lesions, the feasibility of scanning plan verification films on the scanner plate area with the best uniformity rather than using a correction mask was evaluated. For this purpose, signal values dispersion and reproducibility of film scans were investigated. Uniformity was then quantified in the selected area and was found to be within 1.5% for doses up to 8 Gy. A high-dose threshold level for analyses using this procedure was established evaluating the sensitivity of the irradiated films. Sensitivity was found to be of the order of centiGray for doses up to 6.2 Gy and decreasing for higher doses. The obtained results were used to implement a procedure comparing dose distributions delivered with a CyberKnife system to planned ones. The procedure was validated through single beam irradiation on a Gafchromic film. The agreement between dose distributions was then evaluated for 13 patients (brain lesions, 5 Gy/die prescription isodose ~80%) using gamma analysis. Results obtained using Gamma test criteria of 5%/1 mm show a pass rate of 94.3%. Gamma frequency parameters calculation for EBT3 films showed to strongly depend on subtraction of unexposed film pixel values from irradiated ones. In the framework of the described dosimetric procedure, EBT3 films proved to be effective in the verification of high doses delivered to lesions with complex shapes and adjacent to organs at risk.

  3. Quality of Life Assessment After Concurrent Chemoradiation for Invasive Bladder Cancer: Results of a Multicenter Prospective Study (GETUG 97-015)

    SciTech Connect (OSTI)

    Lagrange, Jean-Leon; Bascoul-Mollevi, Caroline; Geoffrois, Lionnel; Beckendorf, Veronique; Ferrero, Jean-Marc; Joly, Florence; Allouache, Nedjila; Bachaud, Jean-Marc; Chevreau, Christine; Kramar, Andrew; Chauvet, Bruno

    2011-01-01

    Purpose: To evaluate bladder preservation and functional quality after concurrent chemoradiotherapy for muscle-invasive cancer in 53 patients included in a Phase II trial. Patient and Methods: Pelvic irradiation delivered 45Gy, followed by an 18-Gy boost. Concurrent chemotherapy with cisplatin and 5-fluorouracil by continuous infusion was performed at Weeks 1, 4, and 7 during radiotherapy. Patients initially suitable for surgery were evaluated with macroscopically complete transurethral resection after 45Gy, followed by radical cystectomy in case of incomplete response. The European Organization for Research and Treatment of Cancer quality of life questionnaire QLQ-C30, specific items on bladder function, and the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic (LENT-SOMA) symptoms scale were used to evaluate quality of life before treatment and 6, 12, 24, and 36 months after treatment. Results: Median age was 68 years for 51 evaluable patients. Thirty-two percent of patients had T2a tumors, 46% T2b, 16% T3, and 6% T4. A visibly complete transurethral resection was possible in 66%. Median follow-up was 8 years. Bladder was preserved in 67% (95% confidence interval, 52-79%) of patients. Overall survival was 36% (95% confidence interval, 23-49%) at 8 years for all patients, and 45% (28-61%) for the 36 patients suitable for surgery. Satisfactory bladder function, according to LENT-SOMA, was reported for 100% of patients with preserved bladder and locally controlled disease 6-36 months after the beginning of treatment. Satisfactory bladder function was reported for 35% of patients before treatment and for 43%, 57%, and 29%, respectively, at 6, 18, and 36 months. Conclusions: Concurrent chemoradiation therapy allowed bladder preservation with tumor control for 67% patients at 8 years. Quality of life and quality of bladder function were satisfactory for 67% of patients.

  4. Multi-Institutional Phase II Clinical Study of Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer in East and Southeast Asia

    SciTech Connect (OSTI)

    Kato, Shingo; Ohno, Tatsuya; Thephamongkhol, Kullathorn; Chansilpa, Yaowalak

    2010-07-01

    Purpose: To evaluate the toxicity and efficacy of concurrent chemoradiotherapy using weekly cisplatin for patients with locally advanced cervical cancer in East and Southeast Asia, a multi-institutional Phase II clinical study was conducted among eight Asian countries. Methods and Materials: Between April 2003 and March 2006, 120 patients (60 with bulky Stage IIB and 60 with Stage IIIB) with previously untreated squamous cell carcinoma of the cervix were enrolled in the present study. Radiotherapy consisted of pelvic external beam radiotherapy (total dose, 50 Gy) and either high-dose-rate or low-dose-rate intracavitary brachytherapy according to institutional practice. The planned Point A dose was 24-28 Gy in four fractions for high-dose-rate-intracavitary brachytherapy and 40-45 Gy in one to two fractions for low-dose-rate-intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m{sup 2}) were administered during the radiotherapy course. Results: All patients were eligible for the study. The median follow-up was 27.3 months. Of the 120 patients, 100 (83%) received four or five cycles of chemotherapy. Acute Grade 3 leukopenia was observed in 21% of the patients, and Grade 3 gastrointestinal toxicity was observed in 6%. No patient failed to complete the radiotherapy course because of toxicity. The 2-year local control and overall survival rate for all patients was 87.1% and 79.6%, respectively. The 2-year major late rectal and bladder complication rate was 2.5% and 0%, respectively. Conclusion: The results have suggested that concurrent chemoradiotherapy using weekly cisplatin is feasible and effective for patients with locally advanced cervical cancer in East and Southeast Asia.

  5. Intra-Arterial Rhenium-188 Lipiodol in the Treatment of Inoperable Hepatocellular Carcinoma: Results of an IAEA-Sponsored Multination Study

    SciTech Connect (OSTI)

    Bernal, Patricia; Raoul, Jean-Luc Vidmar, Gaj; Sereegotov, Erdenechimeg; Sundram, Felix X.; Kumar, Ajay; Jeong, Jae Min; Pusuwan, Pawana; Divgi, Chaitanya; Zanzonico, Pat; Stare, Janez; Buscombe, John; Chau Trinh Thi Minh; Saw, Maung Maung; Chen Shaoliang; Ogbac, Ruben; Padhy, Ajit K.

    2007-12-01

    Purpose: Intra-arterial injections (IAI) of 131I-lipiodol is effective in treating hepatocellular carcinoma patients, but is expensive and requires a 7-day hospitalization in a radioprotection room. 188Re is inexpensive, requires no patient isolation, and can be used with lipiodol. Methods and Materials: This International Atomic Energy Agency-sponsored phase II trial aimed to assess the safety and the efficacy of a radioconjugate 188Re + lipiodol (188Re-Lip) in a large cohort of hepatocellular carcinoma patients from developing countries. A scout dose is used to determine the maximal tolerated dose (lungs <12 Gy, normal liver <30 Gy, bone marrow <1.5 Gy) and then the delivery of the calculated activity. Efficacy was assessed using response evaluation criteria in solid tumor (RECIST) and alpha-feto-protein ({alpha}FP) levels and severe adverse events were graded using the Common Toxicity Criteria of the National Cancer Institute scale v2.0. Results: The trial included 185 patients from eight countries. The procedure was feasible in all participating centers. One treatment was given to 134 patients; 42, 8, and 1 received two, three, and four injections, respectively. The injected activity during the first treatment was 100 mCi. Tolerance was excellent. We observed three complete responses and 19 partial responses (22% of evaluable patients, 95% confidence interval 16-35%); 1- and 2-year survivals were 46% and 23%. Some factors affected survival: country of origin, existence of a cirrhosis, Cancer of the Liver Italian Program score, tumor dose, absence of progression, and posttreatment decrease in {alpha}FP level. Conclusions: IAI of 188Re-Lip in developing countries is feasible, safe, cost-effective, and deserves a phase III trial.

  6. Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

    SciTech Connect (OSTI)

    Batumalai, Vikneswary; Quinn, Alexandra; Jameson, Michael; Delaney, Geoff; Holloway, Lois

    2015-03-15

    Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). The mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account.

  7. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    SciTech Connect (OSTI)

    Lewis, Lorraine; Cox, Jennifer; Morgia, Marita; Atyeo, John; Lamoury, Gillian

    2015-09-15

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm{sup 3} (4–118) and CT2ch: median 16 cm{sup 3}, (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.

  8. On the effect of x-ray irradiation on the deformation and fracture behavior of human cortical bone

    SciTech Connect (OSTI)

    Barth, Holly D.; Launey, Maximilien E.; McDowell, Alastair A.; Ager III, Joel W.; Ritchie, Robert O.

    2010-01-10

    In situ mechanical testing coupled with imaging using high-energy synchrotron x-ray diffraction or tomography imaging is gaining in popularity as a technique to investigate micrometer and even sub-micrometer deformation and fracture mechanisms in mineralized tissues, such as bone and teeth. However, the role of the irradiation in affecting the nature and properties of the tissue is not always taken into account. Accordingly, we examine here the effect of x-ray synchrotron-source irradiation on the mechanistic aspects of deformation and fracture in human cortical bone. Specifically, the strength, ductility and fracture resistance (both work-of-fracture and resistance-curve fracture toughness) of human femoral bone in the transverse (breaking) orientation were evaluated following exposures to 0.05, 70, 210 and 630 kGy irradiation. Our results show that the radiation typically used in tomography imaging can have a major and deleterious impact on the strength, post-yield behavior and fracture toughness of cortical bone, with the severity of the effect progressively increasing with higher doses of radiation. Plasticity was essentially suppressed after as little as 70 kGy of radiation; the fracture toughness was decreased by a factor of five after 210 kGy of radiation. Mechanistically, the irradiation was found to alter the salient toughening mechanisms, manifest by the progressive elimination of the bone's capacity for plastic deformation which restricts the intrinsic toughening from the formation 'plastic zones' around crack-like defects. Deep-ultraviolet Raman spectroscopy indicated that this behavior could be related to degradation in the collagen integrity.

  9. Poster — Thur Eve — 42: Radiochromic film calibration for low-energy seed brachytherapy dose measurement

    SciTech Connect (OSTI)

    Morrison, H; Menon, G; Sloboda, R

    2014-08-15

    The purpose of this study was to investigate the accuracy of radiochromic film calibration procedures used in external beam radiotherapy when applied to I-125 brachytherapy sources delivering higher doses, and to determine any necessary modifications to achieve similar accuracy in absolute dose measurements. GafChromic EBT3 film was used to measure radiation doses upwards of 35 Gy from 6 MV, 75 kVp and (∼28 keV) I-125 photon sources. A custom phantom was used for the I-125 irradiations to obtain a larger film area with nearly constant dose to reduce the effects of film heterogeneities on the optical density (OD) measurements. RGB transmission images were obtained with an Epson 10000XL flatbed scanner, and calibration curves relating OD and dose using a rational function were determined for each colour channel and at each energy using a non-linear least square minimization method. Differences found between the 6 MV calibration curve and those for the lower energy sources are large enough that 6 MV beams should not be used to calibrate film for low-energy sources. However, differences between the 75 kVp and I-125 calibration curves were quite small; indicating that 75 kVp is a good choice. Compared with I-125 irradiation, this gives the advantages of lower type B uncertainties and markedly reduced irradiation time. To obtain high accuracy calibration for the dose range up to 35 Gy, two-segment piece-wise fitting was required. This yielded absolute dose measurement accuracy above 1 Gy of ∼2% for 75 kVp and ∼5% for I-125 seed exposures.

  10. Reverse-Contrast Imaging and Targeted Radiation Therapy of Advanced Pancreatic Cancer Models

    SciTech Connect (OSTI)

    Thorek, Daniel L.J.; Kramer, Robin M.; Chen, Qing; Jeong, Jeho; Lupu, Mihaela E.; Lee, Alycia M.; Moynahan, Mary E.; Lowery, Maeve; Ulmert, David; Zanzonico, Pat; Deasy, Joseph O.; Humm, John L.; Russell, James

    2015-10-01

    Purpose: To evaluate the feasibility of delivering experimental radiation therapy to tumors in the mouse pancreas. Imaging and treatment were performed using combined CT (computed tomography)/orthovoltage treatment with a rotating gantry. Methods and Materials: After intraperitoneal administration of radiopaque iodinated contrast, abdominal organ delineation was performed by x-ray CT. With this technique we delineated the pancreas and both orthotopic xenografts and genetically engineered disease. Computed tomographic imaging was validated by comparison with magnetic resonance imaging. Therapeutic radiation was delivered via a 1-cm diameter field. Selective x-ray radiation therapy of the noninvasively defined orthotopic mass was confirmed using γH2AX staining. Mice could tolerate a dose of 15 Gy when the field was centered on the pancreas tail, and treatment was delivered as a continuous 360° arc. This strategy was then used for radiation therapy planning for selective delivery of therapeutic x-ray radiation therapy to orthotopic tumors. Results: Tumor growth delay after 15 Gy was monitored, using CT and ultrasound to determine the tumor volume at various times after treatment. Our strategy enables the use of clinical radiation oncology approaches to treat experimental tumors in the pancreas of small animals for the first time. We demonstrate that delivery of 15 Gy from a rotating gantry minimizes background healthy tissue damage and significantly retards tumor growth. Conclusions: This advance permits evaluation of radiation planning and dosing parameters. Accurate noninvasive longitudinal imaging and monitoring of tumor progression and therapeutic response in preclinical models is now possible and can be expected to more effectively evaluate pancreatic cancer disease and therapeutic response.

  11. Decision Regret in Men Undergoing Dose-Escalated Radiation Therapy for Prostate Cancer

    SciTech Connect (OSTI)

    Steer, Anna N.; Aherne, Noel J.; Gorzynska, Karen; Hoffman, Matthew; Last, Andrew; Hill, Jacques; Shakespeare, Thomas P.; Rural Clinical School Faculty of Medicine, University of New South Wales, Coffs Harbour

    2013-07-15

    Purpose: Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT. Methods and Materials: We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire. Results: There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01). Conclusion: Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery.

  12. Relative Importance of Hip and Sacral Pain Among Long-Term Gynecological Cancer Survivors Treated With Pelvic Radiotherapy and Their Relationships to Mean Absorbed Doses

    SciTech Connect (OSTI)

    Waldenstroem, Ann-Charlotte; Department of Oncology, Sahlgrenska University Hospital, Gothenburg ; Olsson, Caroline; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg ; Wilderaeng, Ulrica; Dunberger, Gail; Lind, Helena; Alevronta, Eleftheria; Al-Abany, Massoud; Department of Hospital Physics, Karolinska University Hospital, Stockholm ; Tucker, Susan; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar; Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm

    2012-10-01

    Purpose: To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs. Methods and Materials: We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors. Results: Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy. Conclusions: Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.

  13. A Fully Automated Method for CT-on-Rails-Guided Online Adaptive Planning for Prostate Cancer Intensity Modulated Radiation Therapy

    SciTech Connect (OSTI)

    Li, Xiaoqiang; Quan, Enzhuo M.; Li, Yupeng; Pan, Xiaoning; Zhou, Yin; Wang, Xiaochun; Du, Weiliang; Kudchadker, Rajat J.; Johnson, Jennifer L.; Kuban, Deborah A.; Lee, Andrew K.; Zhang, Xiaodong

    2013-08-01

    Purpose: This study was designed to validate a fully automated adaptive planning (AAP) method which integrates automated recontouring and automated replanning to account for interfractional anatomical changes in prostate cancer patients receiving adaptive intensity modulated radiation therapy (IMRT) based on daily repeated computed tomography (CT)-on-rails images. Methods and Materials: Nine prostate cancer patients treated at our institution were randomly selected. For the AAP method, contours on each repeat CT image were automatically generated by mapping the contours from the simulation CT image using deformable image registration. An in-house automated planning tool incorporated into the Pinnacle treatment planning system was used to generate the original and the adapted IMRT plans. The cumulative dosevolume histograms (DVHs) of the target and critical structures were calculated based on the manual contours for all plans and compared with those of plans generated by the conventional method, that is, shifting the isocenters by aligning the images based on the center of the volume (COV) of prostate (prostate COV-aligned). Results: The target coverage from our AAP method for every patient was acceptable, while 1 of the 9 patients showed target underdosing from prostate COV-aligned plans. The normalized volume receiving at least 70 Gy (V{sub 70}), and the mean dose of the rectum and bladder were reduced by 8.9%, 6.4 Gy and 4.3%, 5.3 Gy, respectively, for the AAP method compared with the values obtained from prostate COV-aligned plans. Conclusions: The AAP method, which is fully automated, is effective for online replanning to compensate for target dose deficits and critical organ overdosing caused by interfractional anatomical changes in prostate cancer.

  14. Risk Factors Associated With Secondary Sarcomas in Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study

    SciTech Connect (OSTI)

    Henderson, Tara O.; Rajaraman, Preetha; Stovall, Marilyn; Constine, Louis S.; Olive, Aliza; Smith, Susan A.; Mertens, Ann; Meadows, Anna; Neglia, Joseph P.; Hammond, Sue; Whitton, John; Inskip, Peter D.; Robison, Leslie L.; Diller, Lisa

    2012-09-01

    Purpose: Childhood cancer survivors have an increased risk of secondary sarcomas. To better identify those at risk, the relationship between therapeutic dose of chemotherapy and radiation and secondary sarcoma should be quantified. Methods and Materials: We conducted a nested case-control study of secondary sarcomas (105 cases, 422 matched controls) in a cohort of 14,372 childhood cancer survivors. Radiation dose at the second malignant neoplasm (SMN) site and use of chemotherapy were estimated from detailed review of medical records. Odds ratios (ORs) and 95% confidence intervals were estimated by conditional logistic regression. Excess odds ratio (EOR) was modeled as a function of radiation dose, chemotherapy, and host factors. Results: Sarcomas occurred a median of 11.8 years (range, 5.3-31.3 years) from original diagnosis. Any exposure to radiation was associated with increased risk of secondary sarcoma (OR = 4.1, 95% CI = 1.8-9.5). A dose-response relation was observed, with elevated risks at doses between 10 and 29.9 Gy (OR = 15.6, 95% CI = 4.5-53.9), 30-49.9 Gy (OR = 16.0, 95% CI 3.8-67.8) and >50 Gy (OR = 114.1, 95% CI 13.5-964.8). Anthracycline exposure was associated with sarcoma risk (OR = 3.5, 95% CI = 1.6-7.7) adjusting for radiation dose, other chemotherapy, and primary cancer. Adjusting for treatment, survivors with a first diagnosis of Hodgkin lymphoma (OR = 10.7, 95% CI = 3.1-37.4) or primary sarcoma (OR = 8.4, 95% CI = 3.2-22.3) were more likely to develop a sarcoma. Conclusions: Of the risk factors evaluated, radiation exposure was the most important for secondary sarcoma development in childhood cancer survivors; anthracycline chemotherapy exposure was also associated with increased risk.

  15. The potential benefits of nicaraven to protect against radiation-induced injury in hematopoietic stem/progenitor cells with relative low dose exposures

    SciTech Connect (OSTI)

    Ali, Haytham; Galal, Omima; Urata, Yoshishige; Goto, Shinji; Guo, Chang-Ying; Luo, Lan; Abdelrahim, Eman; Ono, Yusuke; Mostafa, Emtethal; Li, Tao-Sheng

    2014-09-26

    Highlights: Nicaraven mitigated the radiation-induced reduction of c-kit{sup +} stem cells. Nicaraven enhanced the function of hematopoietic stem/progenitor cells. Complex mechanisms involved in the protection of nicaraven to radiation injury. - Abstract: Nicaraven, a hydroxyl radical-specific scavenger has been demonstrated to attenuate radiation injury in hematopoietic stem cells with 5 Gy ?-ray exposures. We explored the effect and related mechanisms of nicaraven for protecting radiation injury induced by sequential exposures to a relatively lower dose ?-ray. C57BL/6 mice were given nicaraven or placebo within 30 min before exposure to 50 mGy ?-ray daily for 30 days in sequences (cumulative dose of 1.5 Gy). Mice were victimized 24 h after the last radiation exposure, and the number, function and oxidative stress of hematopoietic stem cells were quantitatively estimated. We also compared the gene expression in these purified stem cells from mice received nicaraven and placebo treatment. Nicaraven increased the number of c-kit{sup +} stem/progenitor cells in bone marrow and peripheral blood, with a recovery rate around 6090% of age-matched non-irradiated healthy mice. The potency of colony forming from hematopoietic stem/progenitor cells as indicator of function was completely protected with nicaraven treatment. Furthermore, nicaraven treatment changed the expression of many genes associated to DNA repair, inflammatory response, and immunomodulation in c-kit{sup +} stem/progenitor cells. Nicaraven effectively protected against damages of hematopoietic stem/progenitor cells induced by sequential exposures to a relatively low dose radiation, via complex mechanisms.

  16. Long-term Outcomes in Treatment of Invasive Bladder Cancer With Concomitant Boost and Accelerated Hyperfractionated Radiation Therapy

    SciTech Connect (OSTI)

    Canyilmaz, Emine; Yavuz, Melek Nur; Serdar, Lasif; Uslu, Gonca Hanedan; Zengin, Ahmet Yasar; Aynaci, Ozlem; Haciislamoglu, Emel; Bahat, Zumrut; Yoney, Adnan

    2014-11-01

    Purpose: The aim of this study was to evaluate the long-term clinical efficacy and toxicity of concomitant boost and accelerated hyperfractionated radiation therapy (CBAHRT) in patients with invasive bladder cancer. Methods and Materials: Between October 1997 and September 2012, 334 patients with diagnoses of invasive bladder cancer were selected. These patients received CBAHRT as a bladder-conserving approach. The treatment consisted of a dose of 45Gy/1.8Gy to the whole pelvis with a daily concomitant boost of 1.5Gy to the tumor. Total dose was 67.5Gy in 5weeks. A total of 32 patients (10.3%) had a diagnosis of stage T1, 202 (64.3%) were at stage T2, 46 (14.6%) were at stage T3a, 22 (7%) were at stage T3b, and 12 (3.8%) were at stage T4a. Results: The follow-up period was 33.1months (range, 4.3-223.3months). Grade 3 late intestinal toxicity was observed in 9 patients (2.9%), whereas grade 3 late urinary toxicity was observed in 8 patients (2.5%). The median overall survival (OS) was 26.3months (95% confidence interval [CI]: 21.4-31.2). The 5-, 10, and 15-year OS rates were 32.1% (standard error [SE], 0.027), 17.9% (SE, 0.025) and 12.5% (SE, 0.028), respectively. The median cause-specific survival (CSS) was 42.1months (95% CI: 28.7-55.5). The 5-, 10-, and 15-year CSS rates were 43.2% (SE, 0.03), 30.3% (SE, 0.03), and 28% (SE, 0.04), respectively. The median relapse-free survival (RFS) was 111.8months (95% CI: 99.6-124). The 5-, 10-, and 15-year RFS rates were 61.9% (SE, 0.03), 57.6% (SE, 0.04), and 48.2% (SE, 0.07), respectively. Conclusions: The CBAHRT technique demonstrated acceptable toxicity and local control rates in patients with invasive bladder cancer, and this therapy facilitated bladder conservation. In selected patients, the CBAHRT technique is a practical alternative treatment option with acceptable5-, 10-, and 15-year results in patients undergoing cystectomy as well as concurrent chemoradiation therapy.

  17. Improved rubber nanofillers (Program Document) | SciTech Connect

    Office of Scientific and Technical Information (OSTI)

    Program Document: Improved rubber nanofillers Citation Details In-Document Search Title: Improved rubber nanofillers During this task, Silane functionalized TiO2 and HK3Ti4O4(SiO4)3 were sent to Goodyear (GY) for testing. These materials were characterized based on their interaction with the model elastomer, squalene. The Van der Waals interactions and Hamaker Constants for ZnO particles in squalene and rubber materials were characterized and it was determined that a 10-20 nm spacing was

  18. WE-D-BRE-01: A Sr-90 Irradiation Device for the Study of Cutaneous Radiation Injury

    SciTech Connect (OSTI)

    Dorand, JE; Bourland, JD; Burnett, LR; Tytell, M

    2014-06-15

    Purpose: To determine dosimetric character for a custom-built Sr-90 beta irradiator designed for the study of Cutaneous Radiation Injury (CRI) in a porcine animal model. In the event of a radiological accident or terrorist event, Sr-90, a fission by-product, will likely be produced. CRI is a main concern due to the low energy and superficial penetration in tissue of beta particles from Sr-90. Seven 100 mCi plaque Sr-90 radiation sources within a custom-built irradiation device create a 40 mm diameter region of radiation-induced skin injury as part of a larger project to study the efficacy of a topical keratin-based product in CRI healing. Methods: A custom-built mobile irradiation device was designed and implemented for in vivo irradiations. Gafchromic™ EBT3 radiochromic film and a PTW Markus chamber type 23343 were utilized for dosimetric characterization of the beta fluence at the surface produced by this device. Films were used to assess 2-dimensional dose distribution and percent depth dose characteristics of the radiation field. Ion chamber measurements provided dose rate data within the field. Results: The radiation field produced by the irradiation device is homogeneous with high uniformity (∼5%) and symmetry (∼3%) with a steep dose fall-off with depth from the surface. Dose rates were determined to be 3.8 Gy/min and 3.3 Gy/min for film and ion chamber measurements, respectively. A dose rate of 3.4 Gy/min was used to calculate irradiation times for in vivo irradiations. Conclusion: The custom-built irradiation device enables the use of seven Sr-90 beta sources in an array to deliver a 40 mm diameter area of homogeneous skin dose with a dose rate that is useful for research purposes and clinically relevant for the induction of CRI. Doses of 36 and 42 Gy successfully produce Grade III CRI and are used in the study of the efficacy of KeraStat™. This project has been funded in whole or in part with Federal funds from the Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, under Contract No. HHSO100201200007C.

  19. OneTouch 4.0 Scanned Documents

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    eo SRQ-NERP- 15 FLORA OF THE SAVANNAH RIVER PLANT An Inventory of the Vascular Plants on the Savannah River Plant, South Carolina WADE T. BATSON JEANNINE S. ANGERMAN J. THOMAS JONES A Publication of the S.vann.h River PI.nt National Environm.nta. R****rch Park Program FLORA OF TIlE SAVANNAH RIVER PLANT An Inveneory of ehe Vascular Planes of ehe Savannah Ri ver Plane , U. S. Deparemene of Ener gy Aiken, Soueh Carol ina by WADE T. BATSON Deparemene of Biology, Univers ity of Soueh Carolina

  20. Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience

    SciTech Connect (OSTI)

    Keller, Lanea M.M.; Sopka, Dennis M.; Li Tianyu; Klayton, Tracy; Li Jinsheng; Anderson, Penny R.; Bleicher, Richard J.; Sigurdson, Elin R.; Freedman, Gary M.

    2012-11-15

    Purpose: To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. Methods and Materials: A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. Results: With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered 'excellent', 33% 'good', and <1.5% 'fair/poor'. For physician-reported cosmesis, boost doses {>=}16 Gy, breast size >900 cc, or boost volumes >34 cc were significantly associated with a 'fair/poor' cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with 'fair/poor' physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported 'excellent', 'good', and 'fair/poor' cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with 'fair/poor' outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose {>=}16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy. Conclusions: Whole-breast IMRT is associated with very low rates of local recurrence at 5 years, 83%-98% 'good/excellent' cosmetic outcomes, and minimal chronic toxicity, including late fibrosis.

  1. SU-E-T-361: Clinical Benefit of Automatic Beam Gating Mixed with Breath Hold in Radiation Therapy of Left Breast

    SciTech Connect (OSTI)

    Wu, J; Hill, G; Spiegel, J; Ye, J; Mehta, V

    2014-06-01

    Purpose: To investigate the clinical and dosimetric benefits of automatic gating of left breast mixed with breath-hold technique. Methods: Two Active Breathing Control systems, ABC2.0 and ABC3.0, were used during simulation and treatment delivery. The two systems are different such that ABC2.0 is a breath-hold system without beam control capability, while ABC3.0 has capability in both breath-hold and beam gating. At simulation, each patient was scanned twice: one with free breathing (FB) and one with breath hold through ABC. Treatment plan was generated on the CT with ABC. The same plan was also recalculated on the CT with FB. These two plans were compared to assess plan quality. For treatments with ABC2.0, beams with MU > 55 were manually split into multiple subfields. All subfields were identical and shared the total MU. For treatment with ABC3.0, beam splitting was unnecessary. Instead, treatment was delivered in gating mode mixed with breath-hold technique. Treatment delivery efficiency using the two systems was compared. Results: The prescribed dose was 50.4Gy at 1.8Gy/fraction. The maximum heart dose averaged over 10 patients was 46.02.5Gy and 24.512.2Gy for treatments with FB and with ABC respectively. The corresponding heart V10 was 13.23.6% and 1.01.6% respectively. The averaged MUs were 99.87.5 for LMT, 99.29.4 for LLT. For treatment with ABC2.0, normally the original beam was split into 2 subfields. The averaged total time to delivery all beams was 4.30.4min for treatments with ABC2.0 and 3.30.6min for treatments with ABC3.0 in gating mode. Conclusion: Treatment with ABC tremendously reduced heart dose. Compared to treatments with ABC2.0, gating with ABC3.0 reduced the total treatment time by 23%. Use of ABC3.0 improved the delivery efficiency, and eliminated the possibility of mistreatments. The latter may happen with ABC2.0 where beam is not terminated when breath signal falls outside of the treatment window.

  2. Fulvestrant radiosensitizes human estrogen receptor-positive breast cancer cells

    SciTech Connect (OSTI)

    Wang, Jing; Department of Oncology, Affiliated Hospital of Qingdao University Medical College, Shandong Province ; Yang, Qifeng; Haffty, Bruce G.; Li, Xiaoyan; Moran, Meena S.

    2013-02-08

    Highlights: ? Fulvestrant radiosensitizes MCF-7 cells. ? Fulvestrant increases G1 arrest and decreases S phase in MCF-7 cells. ? Fulvestrant down-regulates DNA-PKcs and RAD51 in MCF-7 cells. -- Abstract: The optimal sequencing for hormonal therapy and radiation are yet to be determined. We utilized fulvestrant, which is showing promise as an alternative to other agents in the clinical setting of hormonal therapy, to assess the cellular effects of concomitant anti-estrogen therapy (fulvestrant) with radiation (F + RT). This study was conducted to assess the effects of fulvestrant alone vs. F + RT on hormone-receptor positive breast cancer to determine if any positive or negative combined effects exist. The effects of F + RT on human breast cancer cells were assessed using MCF-7 clonogenic and tetrazolium salt colorimetric (MTT) assays. The assays were irradiated with a dose of 0, 2, 4, 6 Gy fulvestrant. The effects of F + RT vs. single adjuvant treatment alone on cell-cycle distribution were assessed using flow cytometry; relative expression of repair proteins (Ku70, Ku80, DNA-PKcs, Rad51) was assessed using Western Blot analysis. Cell growth for radiation alone vs. F + RT was 0.885 0.013 vs. 0.622 0.029 @2 Gy, 0.599 0.045 vs. 0.475 0.054 @4 Gy, and 0.472 0.021 vs. 0.380 0.018 @6 Gy RT (p = 0.003). While irradiation alone induced G2/M cell cycle arrest, the combination of F + RT induced cell redistribution in the G1 phase and produced a significant decrease in the proportion of cells in G2 phase arrest and in the S phase in breast cancer cells (p < 0.01). Furthermore, levels of repair proteins DNA-PKcs and Rad51 were significantly decreased in the cells treated with F + RT compared with irradiation alone. F + RT leads to a decrease in the surviving fraction, increased cell cycle arrest, down regulating of nonhomologous repair protein DNA-PKcs and homologous recombination repair protein RAD51. Thus, our findings suggest that F + RT increases breast cancer cell radiosensitivity compared with radiation alone. These findings have salient implications for designing clinical trials using fulvestrant and radiation therapy.

  3. Strain-dependent Damage in Mouse Lung After Carbon Ion Irradiation

    SciTech Connect (OSTI)

    Moritake, Takashi; Proton Medical Research Center, University of Tsukuba, Tsukuba ; Fujita, Hidetoshi; Yanagisawa, Mitsuru; Nakawatari, Miyako; Imadome, Kaori; Nakamura, Etsuko; Iwakawa, Mayumi; Imai, Takashi

    2012-09-01

    Purpose: To examine whether inherent factors produce differences in lung morbidity in response to carbon ion (C-ion) irradiation, and to identify the molecules that have a key role in strain-dependent adverse effects in the lung. Methods and Materials: Three strains of female mice (C3H/He Slc, C57BL/6J Jms Slc, and A/J Jms Slc) were locally irradiated in the thorax with either C-ion beams (290 MeV/n, in 6 cm spread-out Bragg peak) or with {sup 137}Cs {gamma}-rays as a reference beam. We performed survival assays and histologic examination of the lung with hematoxylin-eosin and Masson's trichrome staining. In addition, we performed immunohistochemical staining for hyaluronic acid (HA), CD44, and Mac3 and assayed for gene expression. Results: The survival data in mice showed a between-strain variance after C-ion irradiation with 10 Gy. The median survival time of C3H/He was significantly shortened after C-ion irradiation at the higher dose of 12.5 Gy. Histologic examination revealed early-phase hemorrhagic pneumonitis in C3H/He and late-phase focal fibrotic lesions in C57BL/6J after C-ion irradiation with 10 Gy. Pleural effusion was apparent in C57BL/6J and A/J mice, 168 days after C-ion irradiation with 10 Gy. Microarray analysis of irradiated lung tissue in the three mouse strains identified differential expression changes in growth differentiation factor 15 (Gdf15), which regulates macrophage function, and hyaluronan synthase 1 (Has1), which plays a role in HA metabolism. Immunohistochemistry showed that the number of CD44-positive cells, a surrogate marker for HA accumulation, and Mac3-positive cells, a marker for macrophage infiltration in irradiated lung, varied significantly among the three mouse strains during the early phase. Conclusions: This study demonstrated a strain-dependent differential response in mice to C-ion thoracic irradiation. Our findings identified candidate molecules that could be implicated in the between-strain variance to early hemorrhagic pneumonitis after C-ion irradiation.

  4. WE-D-17A-05: Measurement of Stray Radiation Within An Active Scanning Proton Therapy Facility: EURADOS WG9 Intercomparison Exercise of Active Dosimetry Systems

    SciTech Connect (OSTI)

    Farah, J; Trompier, F; Stolarczyk, L; Klodowska, M; Liszka, M; Olko, P; Algranati, C; Fellin, F; Schwarz, M; Domingo, C; Romero-Exposito, M; Dufek, V; Frojdh, E; George, S; Harrison, R; Kubancak, J; Ploc, O; Knezevic, Z; Majer, M; Miljanic, S; and others

    2014-06-15

    Purpose: Intercomparison of active dosemeters in the measurement of stray radiation at the Trento active-scanning proton therapy facility. Methods: EURADOS WG9 carried out a large intercomparison exercise to test different dosemeters while measuring secondary neutrons within a 230 MeV scanned proton therapy facility. Detectors included two Bonner Sphere Spectrometers (BSS), three tissue equivalent proportional counters (TEPCHawk) and six rem-counters (Wendi II, Berthold, RadEye, a regular and an extended-range Anderson and Braun NM2B counters). Measurements of neutron ambient dose equivalents, H*(10), were done at several positions inside (8 positions) and outside (3 positions) the treatment room while irradiating a water tank phantom with a 10 10 10 cc field. Results: A generally good agreement on H*(10) values was observed for the tested detectors. At distance of 2.25 m and angles 45, 90 and 180 with respect to the beam axis, BSS and proportional counters agreed within 30%. Higher differences (up to 60%) were observed at the closest and farthest distances, i.e. at positions where detectors sensitivity, energy, fluence and angular response are highly dependent on neutron spectra (flux and energy). The highest neutron H*(10) value, ?60 microSv/Gy, was measured at 1.15 m along the beam axis. H*(10) decreased significantly with the distance from the isocenter dropping to 1.1 microSv/Gy at 4.25 m and 90 from beam axis, ?2 nanoSv/Gy at the entrance of the maze, 0.2 nanoSv/Gy at the door outside the room and below detection limit in the gantry control room and at an adjacent room. These values remain considerately lower than those of passively scattered proton beams. BSS and Hawk unfolded spectra provide valuable inputs when studying the response of each detector. Conclusion: TEPCs and BSS enable accurate measurements of stray neutrons while other rem-meters also give satisfactory results but require further improvements to reduce uncertainties.

  5. TU-F-17A-08: The Relative Accuracy of 4D Dose Accumulation for Lung Radiotherapy Using Rigid Dose Projection Versus Dose Recalculation On Every Breathing Phase

    SciTech Connect (OSTI)

    Lamb, J; Lee, C; Tee, S; Lee, P; Iwamoto, K; Low, D; Valdes, G; Robinson, C

    2014-06-15

    Purpose: To investigate the accuracy of 4D dose accumulation using projection of dose calculated on the end-exhalation, mid-ventilation, or average intensity breathing phase CT scan, versus dose accumulation performed using full Monte Carlo dose recalculation on every breathing phase. Methods: Radiotherapy plans were analyzed for 10 patients with stage I-II lung cancer planned using 4D-CT. SBRT plans were optimized using the dose calculated by a commercially-available Monte Carlo algorithm on the end-exhalation 4D-CT phase. 4D dose accumulations using deformable registration were performed with a commercially available tool that projected the planned dose onto every breathing phase without recalculation, as well as with a Monte Carlo recalculation of the dose on all breathing phases. The 3D planned dose (3D-EX), the 3D dose calculated on the average intensity image (3D-AVE), and the 4D accumulations of the dose calculated on the end-exhalation phase CT (4D-PR-EX), the mid-ventilation phase CT (4D-PR-MID), and the average intensity image (4D-PR-AVE), respectively, were compared against the accumulation of the Monte Carlo dose recalculated on every phase. Plan evaluation metrics relating to target volumes and critical structures relevant for lung SBRT were analyzed. Results: Plan evaluation metrics tabulated using 4D-PR-EX, 4D-PR-MID, and 4D-PR-AVE differed from those tabulated using Monte Carlo recalculation on every phase by an average of 0.140.70 Gy, - 0.110.51 Gy, and 0.000.62 Gy, respectively. Deviations of between 8 and 13 Gy were observed between the 4D-MC calculations and both 3D methods for the proximal bronchial trees of 3 patients. Conclusions: 4D dose accumulation using projection without re-calculation may be sufficiently accurate compared to 4D dose accumulated from Monte Carlo recalculation on every phase, depending on institutional protocols. Use of 4D dose accumulation should be considered when evaluating normal tissue complication probabilities as well as in clinical situations where target volumes are directly inferior to mobile critical structures.

  6. SU-E-T-34: An in Vivo Study On Pulsed Low Dose-Rate Radiotherapy for Prostate Cancer

    SciTech Connect (OSTI)

    Wang, B; Cvetkovic, D; Chen, L; Ma, C; Chen, X; Zhang, P; Zhang, C

    2014-06-01

    Purpose: Re-irradiation with conventional radiotherapy techniques (CRT) may pose significant risks due to high accumulative radiation doses. Pulsed low dose-rate radiotherapy (PLDR) has been used in clinical trials for recurrent cancer treatment. In our previous studies, PLDR irradiation showed significantly lower toxicity than CRT, resulting in much longer survival of mice after PLDR total body irradiation (TBI) than conventional TBI. The purpose of this study was to investigate tumor control efficacy of PLDR treatment for prostate cancer with an animal model of prostate cancer LNCaP. Methods: We used an orthotopic murine model of LNCaP cell line for this study. LNCaP cells were implanted into immune-suppressed male nude mice via surgery. We monitored the tumor growth with MRI. The tumor-bearing mice were allocated into a PLDR(n=9), CRT(n=7), and control group(n=7) randomly. The mice in the PLDR and CRT groups were irradiated with 2Gy dose for one time. For the CRT treatment, the mice received 2Gy at a dose-rate of 300 MU/minute. For the PLDR treatment, the 2Gy dose was further divided into ten pulses of 0.2Gy at the same dose-rate with an interval of 3 minutes between the pulses. Results: Sizable tumor growth delays were observed for the PLDR and CRT groups through weekly MRI scans. The mean values of the normalized tumor volumes ( standard deviation of the mean) were 1.530.07, 1.530.14, and 1.810.09 at one week after treatment, 2.280.13, 2.190.16, and 3.040.25 at two weeks after treatment, and 3.310.23, 3.140.24 and 4.620.49 at three weeks after treatment, for the PLDR, CRT, and control groups, respectively. Conclusion: The PLDR and CRT treatments showed comparable tumor control rates in this study. Our in vivo results indicate that PLDR may be a viable option for treating recurrent prostate cancer due to its equivalent tumor control but low normal tissue toxocities.

  7. A dosimetric evaluation of dose escalation for the radical treatment of locally advanced vulvar cancer by intensity-modulated radiation therapy

    SciTech Connect (OSTI)

    Bloemers, Monique C.W.M.; Portelance, Lorraine; Ruo, Russell; Parker, William; Souhami, Luis

    2012-10-01

    The purpose of this planning study was to determine whether intensity-modulated radiation therapy (IMRT) reduces the radiation dose to organs at risk (OAR) when compared with 3D conventional radiation therapy (3D-CRT) in patients with vulvar cancer treated by irradiation. This study also investigated the use of sequential IMRT boost (seq-IMRT) and simultaneous integrated boost (SIB-IMRT) for dose escalation in the treatment of locally advanced vulvar cancer. Five vulvar cancer patients treated in the postoperative setting and 5 patients treated with definitive intent (def-group) were evaluated. For the postoperative group, 3D-CRT and IMRT plans to a total dose (TD) of 45 Gy were generated. For the def-group, 4 plans were generated: a 3D-CRT and an IMRT plan to a TD of 56.4 Gy, a SIB-IMRT plan to a TD of 56 Gy, and a SIB-IMRT with dose escalation (SIB-IMRT-esc): TD of 67.2 Gy. Mean dose and dose-volume histograms were compared using Student's t-test. IMRT significantly (all p < 0.05) reduced the D{sub mean}, V30, and V40 for all OAR in the adjuvant setting. The V45 was also significantly reduced for all OAR except the bladder. For patients treated in the def-group, all IMRT techniques significantly reduced the D{sub mean}, V40, and V45 for all OAR. The mean femur doses with SIB-IMRT and SIB-IMRT-esc were 47% and 49% lower compared with 3D-CRT. SIB-IMRT-esc reduced the doses to the OAR compared with seq-3D-CRT but increased the D{sub max.} for the small bowel, rectum, and bladder. IMRT reduces the dose to the OAR compared with 3D-CRT in patients with vulvar cancer receiving irradiation to a volume covering the vulvar region and nodal areas without compromising the dosimetric coverage of the target volume. IMRT for vulvar cancer is feasible and an attractive option for dose escalation studies.

  8. Impact of Millimeter-Level Margins on Peripheral Normal Brain Sparing for Gamma Knife Radiosurgery

    SciTech Connect (OSTI)

    Ma, Lijun; Sahgal, Arjun; Larson, David A.; Pinnaduwage, Dilini; Fogh, Shannon; Barani, Igor; Nakamura, Jean; McDermott, Michael; Sneed, Penny

    2014-05-01

    Purpose: To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. Methods and Materials: A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. Results: Confirmatory correlation between the nominal target radius (ie, R{sub T}) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/R{sub T}, where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R{sup 2} >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/R{sub T} values for the target. Conclusions: Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets.

  9. Pulmonary Function After Treatment for Embryonal Brain Tumors on SJMB03 That Included Craniospinal Irradiation

    SciTech Connect (OSTI)

    Green, Daniel M.; Merchant, Thomas E.; Billups, Catherine A.; Stokes, Dennis C.; Broniscer, Alberto; Bartels, Ute; Chintagumpala, Murali; Hassall, Timothy E.; Gururangan, Sridharan; McCowage, Geoffrey B.; Heath, John A.; Cohn, Richard J.; Fisher, Michael J.; Srinivasan, Ashok; Robinson, Giles W.; Gajjar, Amar

    2015-09-01

    Purpose: The treatment of children with embryonal brain tumors (EBT) includes craniospinal irradiation (CSI). There are limited data regarding the effect of CSI on pulmonary function. Methods: Protocol SJMB03 enrolled patients 3 to 21 years of age with EBT. Pulmonary function tests (PFTs) (forced expiratory volume in 1 second [FEV{sub 1}] and forced vital capacity [FVC] by spirometry, total lung capacity [TLC] by nitrogen washout or plethysmography, and diffusing capacity of the lung for carbon monoxide corrected for hemoglobin [DLCO{sub corr}]) were obtained. Differences between PFTs obtained immediately after the completion of CSI and 24 or 60 months after the completion of treatment (ACT) were compared using exact Wilcoxon signed-rank tests and repeated-measures models. Results: Between June 24, 2003, and March 1, 2010, 303 eligible patients (spine dose: ≤2345 cGy, 201; >2345 cGy, 102; proton beam, 20) were enrolled, 260 of whom had at least 1 PFT. The median age at diagnosis was 8.9 years (range, 3.1-20.4 years). The median thoracic spinal radiation dose was 23.4 Gy (interquartile range [IQR], 23.4-36.0 Gy). The median cyclophosphamide dose was 16.0 g/m{sup 2} (IQR, 15.7-16.0 g/m{sup 2}). At 24 and 60 months ACT, DLCO{sub corr} was <75% predicted in 23% (27/118) and 25% (21/84) of patients, FEV{sub 1} was <80% predicted in 20% (34/170) and 29% (32/109) of patients, FVC was <80% predicted in 27% (46/172) and 28% (30/108) of patients, and TLC was <75% predicted in 9% (13/138) and 11% (10/92) of patients. DLCO{sub corr} was significantly decreased 24 months ACT (median difference [MD] in % predicted, 3.00%; P=.028) and 60 months ACT (MD in % predicted, 6.00%; P=.033) compared with the end of radiation therapy. These significant decreases in DLCO{sub corr} were also observed in repeated-measures models (P=.011 and P=.032 at 24 and 60 months ACT, respectively). Conclusions: A significant minority of EBT survivors experience PFT deficits after CSI. Continued monitoring of this cohort is planned.

  10. Chemoradiation With Concomitant Boosts Followed by Radical Surgery in Locally Advanced Cervical Cancer: Long-term Results of the ROMA-2 Prospective Phase 2 Study

    SciTech Connect (OSTI)

    Ferrandina, Gabriella; Gambacorta, Antonietta; Gallotta, Valerio; Smaniotto, Daniela; Fagotti, Anna; Tagliaferri, Luca; Foti, Elvira; Fanfani, Francesco; Autorino, Rosa; Scambia, Giovanni; Valentini, Vincenzo

    2014-11-15

    Purpose: This prospective, phase 2 study aimed at assessing the efficacy of accelerated fractionation radiation therapy by concomitant boosts (CBs) associated with chemoradiation therapy (CRT) of the whole pelvis, in improving the rate of pathological complete response (pCR) to treatment in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2-IVA locally advanced cervical cancer. Methods and Materials: Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6Gy (1.8cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8Gy administered with CBs (0.9cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20mg/m{sup 2}, days 1-4 and 26-30 of treatment), and capecitabine (1300mg/m{sup 2}/daily, orally) during the first 2 and the last 2weeks of treatment. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8weeks from CRT. Toxicity was recorded according to Radiation Therapy Oncology Group toxicity criteria and Chassagne grading system. Based on the Simon design, 103 cases were required, and the regimen would be considered active if>45 pCR were registered (? error = 0.05; ? error = 0.1). Results: pCR was documented in 51 cases (50.5%), and the regimen was considered active, according to the planned statistical assumptions. At median follow-up of 36months (range: 7-85months), the 3-year local failure rate was 7%, whereas the 3-year disease-free and overall survival rates were 73.0% and 86.1%, respectively. Grade 3 leukopenia and neutropenia were reported in only 1 and 2 cases, respectively. Gastrointestinal toxicity was always grade 1 or2. Conclusions: Addition of CBs in the accelerated fractionation modality to the whole pelvis chemoradiation followed by radical surgery results in a high rate of pathologically assessed complete response to CRT and a very encouraging local control rate, with acceptable toxicity.

  11. AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

    National Nuclear Security Administration (NNSA)

    AMENDMENT/MODIFICATION NO . 3. EFFECTIVE DATE 0232 See Block 16C 6. ISSUED BY CODE 05003 NNSA/Los Al amos Si t e Office U. S . Dep a rtme nt of Ene r gy Los Alamo s Sit e Off i ce 3747 We st Jemez Road Los Al a mos NM 87544 8. NAME AND ADDRESS OF CONTRACTOR (No. , street, county, State and ZIP Code) L A OS ALAMOS NAT I ONAL SECURI TY, ttn : STEVE K. SHOOK P.O . BOX 1663 , M S P222 L OS ALAMOS NM 875450001 CODE 175252894 LLC FACILITY CODE 11 . CONTRACT ID CODE I PAGE OF PAGES 1 I 2 4.

  12. Measurements of neutron dose equivalent for a proton therapy center using uniform scanning proton beams

    SciTech Connect (OSTI)

    Zheng Yuanshui; Liu Yaxi; Zeidan, Omar; Schreuder, Andries Niek; Keole, Sameer

    2012-06-15

    Purpose: Neutron exposure is of concern in proton therapy, and varies with beam delivery technique, nozzle design, and treatment conditions. Uniform scanning is an emerging treatment technique in proton therapy, but neutron exposure for this technique has not been fully studied. The purpose of this study is to investigate the neutron dose equivalent per therapeutic dose, H/D, under various treatment conditions for uniform scanning beams employed at our proton therapy center. Methods: Using a wide energy neutron dose equivalent detector (SWENDI-II, ThermoScientific, MA), the authors measured H/D at 50 cm lateral to the isocenter as a function of proton range, modulation width, beam scanning area, collimated field size, and snout position. They also studied the influence of other factors on neutron dose equivalent, such as aperture material, the presence of a compensator, and measurement locations. They measured H/D for various treatment sites using patient-specific treatment parameters. Finally, they compared H/D values for various beam delivery techniques at various facilities under similar conditions. Results: H/D increased rapidly with proton range and modulation width, varying from about 0.2 mSv/Gy for a 5 cm range and 2 cm modulation width beam to 2.7 mSv/Gy for a 30 cm range and 30 cm modulation width beam when 18 Multiplication-Sign 18 cm{sup 2} uniform scanning beams were used. H/D increased linearly with the beam scanning area, and decreased slowly with aperture size and snout retraction. The presence of a compensator reduced the H/D slightly compared with that without a compensator present. Aperture material and compensator material also have an influence on neutron dose equivalent, but the influence is relatively small. H/D varied from about 0.5 mSv/Gy for a brain tumor treatment to about 3.5 mSv/Gy for a pelvic case. Conclusions: This study presents H/D as a function of various treatment parameters for uniform scanning proton beams. For similar treatment conditions, the H/D value per uncollimated beam size for uniform scanning beams was slightly lower than that from a passive scattering beam and higher than that from a pencil beam scanning beam, within a factor of 2. Minimizing beam scanning area could effectively reduce neutron dose equivalent for uniform scanning beams, down to the level close to pencil beam scanning.

  13. SU-E-CAMPUS-T-05: Preliminary Results On a 2D Dosimetry System Based On the Optically Stimulated Luminescence of Al2O3

    SciTech Connect (OSTI)

    Ahmed, M; Eller, S; Yukihara, E; Schnell, E; Ahmad, S; Akselrod, M; Hanson, O

    2014-06-15

    Purpose: To develop a precise 2D dose mapping technique based on the optically stimulated luminescence (OSL) from Al{sub 2}O{sub 3} films for medical applications. Methods: A 2D laser scanning reader was developed using fast F{sup +}-center (lifetime of <7 ns) and slow F-center (lifetime of 35 ms) OSL emission from newly developed Al{sub 2}O{sub 3} films (Landauer Inc.). An algorithm was developed to correct images for both material and system properties. Since greater contribution of the F??-center emission in the recorded signal increases the readout efficiency and robustness of image corrections, Al{sub 2}O{sub 3}:C,Mg film samples are being investigated in addition to Al{sub 2}O{sub 3}:C samples. Preliminary investigations include exposure of the films to a 6 MV photon beam at 10 cm depth in solid water phantom with an SSD of 100 cm, using a 10 cm × 10 cm flat field or a 4 cm × 4 cm field with a 60° wedge filter. Kodak EDR2 radiographic film and EBT2 Gafchromic film were also exposed for comparison. Results: The results indicate that the algorithm is able to correct images and calculate 2D dose. For the wedge field irradiation, the calculated dose at the center of the field was 0.9 Gy for Al{sub 2}O{sub 3}:C and 0.87 Gy for Al{sub 2}O{sub 3}:C,Mg, whereas, the delivered dose was 0.95 Gy. A good qualitative agreement of the dose profiles was obtained between the OSL films and EDR2 and EBT2 films. Laboratory tests using a beta source suggest that a large dynamic range (10{sup −2}−10{sup 2} Gy) can be achieved using this technique. Conclusion: A 2D dosimetry system and an in-house image correction algorithm were developed for 2D film dosimetry in medical applications. The system is in the preliminary stage of development, but the data demonstrates the feasibility of this approach. This work was supported by Landauer, Inc.

  14. Benefit of Consolidative Radiation Therapy for Primary Bone Diffuse Large B-Cell Lymphoma

    SciTech Connect (OSTI)

    Tao, Randa; Allen, Pamela K.; Rodriguez, Alma; Shihadeh, Ferial; Pinnix, Chelsea C.; Arzu, Isadora; Reed, Valerie K.; Oki, Yasuhiro; Westin, Jason R.; Fayad, Luis E.; Medeiros, L. Jeffrey; Dabaja, Bouthaina

    2015-05-01

    Purpose: Outcomes for patients with diffuse large B-cell lymphoma (DLBCL) differ according to the site of presentation. With effective chemotherapy, the need for consolidative radiation therapy (RT) is controversial. We investigated the influence of primary bone presentation and receipt of consolidative RT on progression-free survival (PFS) and overall survival (OS) in patients with DLBCL. Methods and Materials: We identified 102 patients with primary bone DLBCL treated consecutively from 1988 through 2013 and extracted clinical, pathologic, and treatment characteristics from the medical records. Survival outcomes were calculated by the Kaplan-Meier method, with factors affecting survival determined by log-rank tests. Univariate and multivariate analyses were done with a Cox regression model. Results: The median age was 55 years (range, 16-87 years). The most common site of presentation was in the long bones. Sixty-five patients (63%) received R-CHOP–based chemotherapy, and 74 (72%) received rituximab. RT was given to 67 patients (66%), 47 with stage I to II and 20 with stage III to IV disease. The median RT dose was 44 Gy (range, 24.5-50 Gy). At a median follow-up time of 82 months, the 5-year PFS and OS rates were 80% and 82%, respectively. Receipt of RT was associated with improved 5-year PFS (88% RT vs 63% no RT, P=.0069) and OS (91% vs 68%, P=.0064). On multivariate analysis, the addition of RT significantly improved PFS (hazard ratio [HR] = 0.14, P=.014) with a trend toward an OS benefit (HR=0.30, P=.053). No significant difference in PFS or OS was found between patients treated with 30 to 35 Gy versus ≥36 Gy (P=.71 PFS and P=.31 OS). Conclusion: Patients with primary bone lymphoma treated with standard chemotherapy followed by RT can have excellent outcomes. The use of consolidative RT was associated with significant benefits in both PFS and OS.

  15. Wood-Polymer composites obtained by gamma irradiation

    SciTech Connect (OSTI)

    Gago, J.; Lopez, A.; Rodriguez, J.; Santiago, J.; Acevedo, M.

    2007-10-26

    In this work we impregnate three Peruvian woods (Calycophy spruceanum Be, Aniba amazonica Meiz and Hura crepitans L) with styrene-polyester resin and methyl methacrylate. The polymerization of the system was promoted by gamma radiation and the experimental optimal condition was obtained with styrene-polyester 1:1 and 15 kGy. The obtained composites show reduced water absorption and better mechanical properties compared to the original wood. The structure of the wood-polymer composites was studied by light microscopy. Water absorption and hardness were also obtained.

  16. SU-D-9A-07: Imaging Dose and Cancer Risk in Image-Guided Radiotherapy of Cancers

    SciTech Connect (OSTI)

    Zhou, L; Bai, S; Zhang, Y; Ming, X; Zhang, Y; Deng, J

    2014-06-01

    Purpose: To systematically evaluate the imaging doses and cancer risks associated with various imaging procedures involving ionizing radiation during image-guided radiotherapy of an increasingly large number of cancer patients. Methods: 141 patients (52 brain cases, 47 thoracic cases, 42 abdominal cases, aged 3 to 91 years old) treated between October 2009 and March 2010 were included in this IRB-approved retrospective study. During the whole radiotherapy course, each patient underwent at least one type of imaging procedures, i.e., kV portal, MV portal and kVCBCT, besides CT simulations. Based on Monte Carlo modeling and particle transport in human anatomy of various dimensions, the correlations between the radiation doses to the various organs-at-risk (OARs) at the head, the thoracic and the abdominal regions and one's weight, circumference, scan mAs and kVp have been obtained and used to estimate the radiation dose from a specific imaging procedure. The radiation-induced excess relative risk (ERR) was then estimated with BEIR VII formulism based on one's gender, age and radiation dose. 1+ ERR was reported in this study as relative cancer risk. Results: For the whole cohort of 141 patients, the mean imaging doses from various imaging procedures were 8.3 cGy to the brain, 10.5 cGy to the lungs and 19.2 cGy to the red bone marrow, respectively. Accordingly, the cancer risks were 1.140, 1.369 and 2.671, respectively. In comparison, MV portal deposited largest doses to the lungs while kVCBCT delivered the highest doses to the red bone marrow. Conclusion: The compiled imaging doses to a patient during his/her treatment course were patient-specific and site-dependent, varying from 1.2 to 263.5 cGy on average, which were clinically significant and should be included in the treatment planning and overall decision-making. Our results indicated the necessity of personalized imaging to maximize its clinical benefits while reducing the associated cancer risks. Sichuan University Scholarship.

  17. SU-E-T-215: Interactive Dose Shaping: Proof of Concept Study for Six Prostate Patients

    SciTech Connect (OSTI)

    Kamerling, CP [The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London (United Kingdom); German Cancer Research Center (DKFZ), Heidelberg (Germany); Ziegenhein, P; Oelfke, U [The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London (United Kingdom); Sterzing, F [German Cancer Research Center (DKFZ), Heidelberg (Germany)

    2014-06-01

    Purpose: To provide a proof of concept study for IMRT treatment planning through interactive dose shaping (IDS) by utilising the respective tools to create IMRT treatment plans for six prostate patients. Methods: The IDS planning paradigm aims to perform interactive local dose adaptations of an IMRT plan without compromising already established valuable dose features in real-time. Various IDS tools are available in our in-house treatment planning software Dynaplan and were utilised to create IMRT treatment plans for six patients with an adeno-carcinoma of the prostate. The sequenced IDS treatment plans were compared to conventionally optimised clinically approved plans (9 beams, co-planar). The starting point consisted of open fields. The IDS tools were utilised to sculpt dose out of the rectum and bladder. For each patient, several IDS plans were created, with different trade-offs between organ sparing and target coverage. The reference dose distributions were imported into Dynaplan. For each patient, the IDS treatment plan with a similar or better trade-off between target coverage and OAR sparing was selected for plan evaluation, guided by a physician. Pencil beam dose calculation was performed on a grid with a voxel size of 1.951.952.0 mm{sup 3}. D98%, D2%, mean dose and dose-volume indicators as specified by Quantec were calculated for plan evaluation. Results: It was possible to utilise the software prototype to generate treatment plans for prostate patient geometries in 1545 minutes. Individual local dose adaptations could be performed in less than one second. The average differences compared to the reference plans were for the mean dose: 0.0 Gy (boost) and 1.2 Gy (CTV), for D98%: ?1.1 Gy and for D2%: 1.1 Gy (both target volumes). The dose-volume quality indicators were well below the Quantec constraints. Conclusion: Real-time treatment planning utilising IDS is feasible and has the potential to be implemented clinically. Research at The Institute of Cancer Research is supported by Cancer Research UK under Programme C46/A10588.

  18. Investigations of DNA damage induction and repair resulting from cellular exposure to high dose-rate pulsed proton beams

    SciTech Connect (OSTI)

    Renis, M.; Malfa, G.; Tomasello, B.; Borghesi, M.; Schettino, G.; Favetta, M.; Romano, F.; Cirrone, G. A. P.; Manti, L.

    2013-07-26

    Studies regarding the radiobiological effects of low dose radiation, microbeam irradiation services have been developed in the world and today laser acceleration of protons and heavy ions may be used in radiation therapy. The application of different facilities is essential for studying bystander effects and relating signalling phenomena in different cells or tissues. In particular the use of ion beams results advantageous in cancer radiotherapy compared to more commonly used X-rays, since the ability of ions in delivering lethal amount of doses into the target tumour avoiding or limiting damage to the contiguous healthy tissues. At the INFN-LNS in Catania, a multidisciplinary radiobiology group is strategically structured aimed to develop radiobiological research, finalised to therapeutic applications, compatible with the use of high dose laser-driven ion beams. The characteristic non-continuous dose rates with several orders of magnitude of laser-driven ion beams makes this facility very interesting in the cellular systems' response to ultra-high dose rates with non-conventional pulse time intervals cellular studies. Our group have projected to examine the effect of high dose laser-driven ion beams on two cellular types: foetal fibroblasts (normal control cells) and DU145 (prostate cancer cells), studying the modulation of some different bio-molecular parameters, in particular cell proliferation and viability, DNA damage, redox cellular status, morphological alterations of both the cytoskeleton components and some cell organelles and the possible presence of apoptotic or necrotic cell death. Our group performed preliminary experiments with high energy (60 MeV), dose rate of 10 Gy/min, doses of 1, 2, 3 Gy and LET 1 keV/?m on human foetal fibroblasts (control cells). We observed that cell viability was not influenced by the characteristics of the beam, the irradiation conditions or the analysis time. Conversely, DNA damage was present at time 0, immediately following irradiation in a dose-dependent manner. The analysis of repair capability showed that the cells irradiated with 1 and 2 Gy almost completely recovered from the damage, but not, however, 3 Gy treated cells in which DNA damage was not recovered. In addition, the results indicate the importance of the use of an appropriate control in radiobiological in vitro analysis.

  19. Technical Note: Measuring contrast- and noise-dependent spatial resolution of an iterative reconstruction method in CT using ensemble averaging

    SciTech Connect (OSTI)

    Yu, Lifeng Vrieze, Thomas J.; Leng, Shuai; Fletcher, Joel G.; McCollough, Cynthia H.

    2015-05-15

    Purpose: The spatial resolution of iterative reconstruction (IR) in computed tomography (CT) is contrast- and noise-dependent because of the nonlinear regularization. Due to the severe noise contamination, it is challenging to perform precise spatial-resolution measurements at very low-contrast levels. The purpose of this study was to measure the spatial resolution of a commercially available IR method using ensemble-averaged images acquired from repeated scans. Methods: A low-contrast phantom containing three rods (7, 14, and 21 HU below background) was scanned on a 128-slice CT scanner at three dose levels (CTDI{sub vol} = 16, 8, and 4 mGy). Images were reconstructed using two filtered-backprojection (FBP) kernels (B40 and B20) and a commercial IR method (sinogram affirmed iterative reconstruction, SAFIRE, Siemens Healthcare) with two strength settings (I40-3 and I40-5). The same scan was repeated 100 times at each dose level. The modulation transfer function (MTF) was calculated based on the edge profile measured on the ensemble-averaged images. Results: The spatial resolution of the two FBP kernels, B40 and B20, remained relatively constant across contrast and dose levels. However, the spatial resolution of the two IR kernels degraded relative to FBP as contrast or dose level decreased. For a given dose level at 16 mGy, the MTF{sub 50%} value normalized to the B40 kernel decreased from 98.4% at 21 HU to 88.5% at 7 HU for I40-3 and from 97.6% to 82.1% for I40-5. At 21 HU, the relative MTF{sub 50%} value decreased from 98.4% at 16 mGy to 90.7% at 4 mGy for I40-3 and from 97.6% to 85.6% for I40-5. Conclusions: A simple technique using ensemble averaging from repeated CT scans can be used to measure the spatial resolution of IR techniques in CT at very low contrast levels. The evaluated IR method degraded the spatial resolution at low contrast and high noise levels.

  20. A Dosimetric Comparison of Tomotherapy and Volumetric Modulated Arc Therapy in the Treatment of High-Risk Prostate Cancer With Pelvic Nodal Radiation Therapy

    SciTech Connect (OSTI)

    Pasquier, David; Universite Lille Nord de France, Lille; Centre Galilee, Clinique de la Louviere, Lille ; Cavillon, Fabrice; Faculte Libre de Medecine, Lille ; Lacornerie, Thomas; Universite Lille Nord de France, Lille ; Touzeau, Claire; Tresch, Emmanuelle; Lartigau, Eric; Universite Lille Nord de France, Lille

    2013-02-01

    Purpose: To compare the dosimetric results of volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy. Methods and Materials: Plans were generated for 10 consecutive patients treated for high-risk prostate cancer with prophylactic whole pelvic radiation therapy (WPRT) using VMAT and HT. After WPRT, a sequential boost was delivered to the prostate. Plan quality was assessed according to the criteria of the International Commission on Radiation Units and Measurements 83 report: the near-minimal (D98%), near-maximal (D2%), and median (D50%) doses; the homogeneity index (HI); and the Dice similarity coefficient (DSC). Beam-on time, integral dose, and several organs at risk (OAR) dosimetric indexes were also compared. Results: For WPRT, HT was able to provide a higher D98% than VMAT (44.3 {+-} 0.3 Gy and 43.9 {+-} 0.5 Gy, respectively; P=.032) and a lower D2% than VMAT (47.3 {+-} 0.3 Gy and 49.1 {+-} 0.7 Gy, respectively; P=.005), leading to a better HI. The DSC was better for WPRT with HT (0.89 {+-} 0.009) than with VMAT (0.80 {+-} 0.02; P=.002). The dosimetric indexes for the prostate boost did not differ significantly. VMAT provided better rectum wall sparing at higher doses (V70, V75, D2%). Conversely, HT provided better bladder wall sparing (V50, V60, V70), except at lower doses (V20). The beam-on times for WPRT and prostate boost were shorter with VMAT than with HT (3.1 {+-} 0.1 vs 7.4 {+-} 0.6 min, respectively; P=.002, and 1.5 {+-} 0.05 vs 3.7 {+-} 0.3 min, respectively; P=.002). The integral dose was slightly lower for VMAT. Conclusion: VMAT and HT provided very similar and highly conformal plans that complied well with OAR dose-volume constraints. Although some dosimetric differences were statistically significant, they remained small. HT provided a more homogeneous dose distribution, whereas VMAT enabled a shorter delivery time.

  1. Microsoft PowerPoint - MACRUC Smart Grid School_rev 2A_NETL.pptx

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    School MACRUC 15 th Annual Education Conference Joe Miller - Smart Grid Implementation Strategy Team Lead June 28-29, 2010 This material is based upon work supported by the Department of Energy under Award Number p gy DE-AC26-04NT41817 This presentation was prepared as an account of work sponsored by an f th U it d St t G t N ith th U it d St t agency of the United States Government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty,

  2. G I A. J. Brcslill, Director halt:: Protection Ci&ieerirG Divisio:l

    Office of Legacy Management (LM)

    G I A. J. Brcslill, Director halt:: Protection Ci&ieerirG Divisio:l H. Glauberrrrr: iiealt;: Protection &;'ineeri::i: Division SURVEY OF IIOOD BUILDING DECO~iTX.fIi~ATIO.:i . 'L. KSH: 3G I viz&Led t.:e Hood Buildiiig on July 3, 1763 wit:. Lr. R. C;iamberli!: axd NY. F. M!sce of the &scac..zetts Institute of Teci:;iolozy, Occupational Medical Service, Mr. R. Hoxell, Massac::usetIs Insti.t.ule of Tec:fioloGy, Btlilding Maintenance, and NE. P. Russo of Cx-Rad, to perform a fhal

  3. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    SciTech Connect (OSTI)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Poenisch, Falk [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pinnix, Chelsea C. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sheu, Tommy [Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Memon, Nada [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rozner, Marc A. [Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dougherty, Anne H. [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely.

  4. Radiation Exposure During Uterine Artery Embolization: Effective Measures to Minimize Dose to the Patient

    SciTech Connect (OSTI)

    Scheurig-Muenkler, Christian; Powerski, Maciej J.; Mueller, Johann-Christoph; Kroencke, Thomas J.

    2015-06-15

    PurposeEvaluation of patient radiation exposure during uterine artery embolization (UAE) and literature review to identify techniques minimizing required dose.MethodsA total of 224 of all included 286 (78 %) women underwent UAE according to a standard UAE-protocol (bilateral UAE from unilateral approach using a Rösch inferior mesenteric and a microcatheter, no aortography, no ovarian artery catheterization or embolization) and were analyzed for radiation exposure. Treatment was performed on three different generations of angiography systems: (I) new generation flat-panel detector (N = 108/151); (II) classical image amplifier and pulsed fluoroscopy (N = 79/98); (III) classical image amplifier and continuous fluoroscopy (N = 37/37). Fluoroscopy time (FT) and dose-area product (DAP) were documented. Whenever possible, the following dose-saving measures were applied: optimized source-object, source-image, and object-image distances, pulsed fluoroscopy, angiographic runs in posterior-anterior direction with 0.5 frames per second, no magnification, tight collimation, no additional aortography.ResultsIn a standard bilateral UAE, the use of the new generation flat-panel detector in group I led to a significantly lower DAP of 3,156 cGy × cm{sup 2} (544–45,980) compared with 4,000 cGy × cm{sup 2} (1,400–13,000) in group II (P = 0.033). Both doses were significantly lower than those of group III with 8,547 cGy × cm{sup 2} (3,324–35,729; P < 0.001). Other reasons for dose escalation were longer FT due to difficult anatomy or a large leiomyoma load, additional angiographic runs, supplementary ovarian artery embolization, and obesity.ConclusionsThe use of modern angiographic units with flat panel detectors and strict application of methods of radiation reduction lead to a significantly lower radiation exposure. Target DAP for UAE should be kept below 5,000 cGy × cm{sup 2}.

  5. Microsoft PowerPoint - Interface_Levin

    Office of Environmental Management (EM)

    Energy Rebecca Kujawa Vice President gy Solutions from Clean Coal Vice President Business Development Indian Energy Forum March 1, 2012 Sustainable Energy Solutions from Clean Coal C l M k t Key Discussion Points Key Discussion Points ●Coal Markets ●Clean Coal Technologies ●Clean Coal Technologies ●Sustainable Partnerships 2 Coal is the Power Energizing the World Our Energy Needs in Perspective: In Just One Day... Our Energy Needs in Perspective: In Just One Day... Global Population Will

  6. Stereotactic Body Radiation Therapy for Locally Advanced and Borderline Resectable Pancreatic Cancer Is Effective and Well Tolerated

    SciTech Connect (OSTI)

    Chuong, Michael D.; Springett, Gregory M.; Freilich, Jessica M.; Park, Catherine K.; Weber, Jill M.; Mellon, Eric A.; Hodul, Pamela J.; Malafa, Mokenge P.; Meredith, Kenneth L.; Hoffe, Sarah E.; Shridhar, Ravi

    2013-07-01

    Purpose: Stereotactic body radiation therapy (SBRT) provides high rates of local control (LC) and margin-negative (R0) resections for locally advanced pancreatic cancer (LAPC) and borderline resectable pancreatic cancer (BRPC), respectively, with minimal toxicity. Methods and Materials: A single-institution retrospective review was performed for patients with nonmetastatic pancreatic cancer treated with induction chemotherapy followed by SBRT. SBRT was delivered over 5 consecutive fractions using a dose painting technique including 7-10 Gy/fraction to the region of vessel abutment or encasement and 5-6 Gy/fraction to the remainder of the tumor. Restaging scans were performed at 4 weeks, and resectable patients were considered for resection. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Results: Seventy-three patients were evaluated, with a median follow-up time of 10.5 months. Median doses of 35 Gy and 25 Gy were delivered to the region of vessel involvement and the remainder of the tumor, respectively. Thirty-two BRPC patients (56.1%) underwent surgery, with 31 undergoing an R0 resection (96.9%). The median OS, 1-year OS, median PFS, and 1-year PFS for BRPC versus LAPC patients was 16.4 months versus 15 months, 72.2% versus 68.1%, 9.7 versus 9.8 months, and 42.8% versus 41%, respectively (all P>.10). BRPC patients who underwent R0 resection had improved median OS (19.3 vs 12.3 months; P=.03), 1-year OS (84.2% vs 58.3%; P=.03), and 1-year PFS (56.5% vs 25.0%; P<.0001), respectively, compared with all nonsurgical patients. The 1-year LC in nonsurgical patients was 81%. We did not observe acute grade ?3 toxicity, and late grade ?3 toxicity was minimal (5.3%). Conclusions: SBRT safely facilitates margin-negative resection in patients with BRPC pancreatic cancer while maintaining a high rate of LC in unresectable patients. These data support the expanded implementation of SBRT for pancreatic cancer.

  7. Investigation of Radiation and Chemical Resistance of Flexible HLW Transfer Hose

    SciTech Connect (OSTI)

    E. Skidmore; Billings, K.; Hubbard, M.

    2010-03-24

    A chemical transfer hose constructed of an EPDM (ethylene-propylene diene monomer) outer covering with a modified cross-linked polyethylene (XLPE) lining was evaluated for use in high level radioactive waste transfer applications. Laboratory analysis involved characterization of the hose liner after irradiation to doses of 50 to 300 Mrad and subsequent exposure to 25% NaOH solution at 93 C for 30 days, simulating 6 months intermittent service. The XLPE liner mechanical and structural properties were characterized at varying dose levels. Burst testing of irradiated hose assemblies was also performed. Literature review and test results suggest that radiation effects below doses of 100 kGy are minimal, with acceptable property changes to 500 kGy. Higher doses may be feasible. At a bounding dose of 2.5 MGy, the burst pressure is reduced to the working pressure (1.38 MPa) at room temperature. Radiation exposure slightly reduces liner tensile strength, with more significant decrease in liner elongation. Subsequent exposure to caustic solutions at elevated temperature slightly increases elongation, suggesting an immersion/hydrolytic effect or possible thermal annealing of radiation damage. This paper summarizes the laboratory results and recommendations for field deployment.

  8. The influence of TRP53 in the dose response of radiation-induced apoptosis, DNA repair and genomic stability in murine haematopoietic cells

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Lemon, Jennifer A.; Taylor, Kristina; Verdecchia, Kyle; Phan, Nghi; Boreham, Douglas R.

    2014-01-01

    Apoptotic and DNA damage endpoints are frequently used as surrogate markers of cancer risk, and have been well-studied in the Trp53+/- mouse model. We report the effect of differing Trp53 gene status on the dose response of ionizing radiation exposures (0.01-2 Gy), with the unique perspective of determining if effects of gene status remain at extended time points. Here we report no difference in the dose response for radiation-induced DNA double-strand breaks in bone marrow and genomic instability (MN-RET levels) in peripheral blood, between wild-type (Trp53+/+) and heterozygous (Trp53+/-) mice. The dose response for Trp53+/+ mice showed higher initial levelsmore » of radiation-induced lymphocyte apoptosis relative to Trp53+/- between 0 and 1 Gy. Although this trend was observed up to 12 hours post-irradiation, both genotypes ultimately reached the same level of apoptosis at 14 hours, suggesting the importance of late-onset p53-independent apoptotic responses in this mouse model. Expected radiation-induced G1 cell cycle delay was observed in Trp53+/+ but not Trp53+/-. Although p53 has an important role in cancer risk, we have shown its influence on radiation dose response can be temporally variable. This research highlights the importance of caution when using haematopoietic endpoints as surrogates to extrapolate radiation-induced cancer risk estimation.« less

  9. CHRONIC IRRADIATION OF SCOTS PINE TREES (PINUS SYLVESTRIS) IN THE CHERNOBYL EXCLUSION ZONE: DOSIMETRY AND RADIOBIOLOGICAL EFFECTS

    SciTech Connect (OSTI)

    Farfan, E.; Jannik, T.

    2011-10-01

    To identify effects of chronic internal and external radiation exposure for components of terrestrial ecosystems, a comprehensive study of Scots pine trees in the Chernobyl Exclusion Zone was performed. The experimental plan included over 1,100 young trees (up to 20 years old) selected from areas with varying levels of radioactive contamination. These pine trees were planted after the 1986 Chernobyl Nuclear Power Plant accident mainly to prevent radionuclide resuspension and soil erosion. For each tree, the major morphological parameters and radioactive contamination values were identified. Cytological analyses were performed for selected trees representing all dose rate ranges. A specially developed dosimetric model capable of taking into account radiation from the incorporated radionuclides in the trees was developed for the apical meristem. The calculated dose rates for the trees in the study varied within three orders of magnitude, from close to background values in the control area (about 5 mGy y{sup -1}) to approximately 7 Gy y{sup -1} in the Red Forest area located in the immediate vicinity of the Chernobyl Nuclear Power Plant site. Dose rate/effect relationships for morphological changes and cytogenetic defects were identified and correlations for radiation effects occurring on the morphological and cellular level were established.

  10. Hyperfractionated Accelerated Radiotherapy (HART) for Anaplastic Thyroid Carcinoma: Toxicity and Survival Analysis

    SciTech Connect (OSTI)

    Dandekar, Prasad; Rhys-Evans, Peter; Harrington, Kevin; Nutting, Christopher; Newbold, Kate

    2009-06-01

    Purpose: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive cancers, and the current protocol of hyperfractionated accelerated radiotherapy was initiated to improve survival while limiting toxicities. Methods and Materials: All patients with ATC from 1991 to 2002 were accrued and received megavoltage radiotherapy from the mastoid processes to the carina up to 60 Gy in twice-daily fractions of 1.8 and 2 Gy, 6 hours apart. Results: Thirty-one patients were accrued with a median age of 69 years, and 55% were women. Debulking was performed in 26%, and total thyroidectomy, in 6%, whereas 68% received radical radiotherapy alone. Local control data were available for 27 patients: 22% had a complete response, 26% had a partial response, 15% showed progressive disease, and 37% showed static disease. Median overall survival for all 31 patients was 70 days (95% confidence interval, 40-99). There was no significant difference in median survival between patients younger (70 days) and older than 70 years (42 days), between men (70 days) and women (49days), and between patients receiving postoperative radiotherapy (77 days) and radical radiotherapy alone (35 days). Grade III or higher skin erythema was seen in 56% patients; desquamation in 21%; dysphagia in 74%; and esophagitis in 79%. Conclusion: The current protocol failed to offer a significant survival benefit, was associated with severe toxicities, and thus was discontinued. There is a suggestion that younger patients with operable disease have longer survival, but this would require a larger study to confirm it.

  11. Evaluation of GafChromic EBT prototype B for external beam dose verification

    SciTech Connect (OSTI)

    Todorovic, M.; Fischer, M.; Cremers, F.; Thom, E.; Schmidt, R.

    2006-05-15

    The capability of the new GafChromic EBT prototype B for external beam dose verification is investigated in this paper. First the general characteristics of this film (dose response, postirradiation coloration, influence of calibration field size) were derived using a flat-bed scanner. In the dose range from 0.1 to 8 Gy, the sensitivity of the EBT prototype B film is ten times higher than the response of the GafChromic HS, which so far was the GafChromic film with the highest sensitivity. Compared with the Kodak EDR2 film, the response of the EBT is higher by a factor of 3 in the dose range from 0.1 to 8 Gy. The GafChromic EBT almost does not show a temporal growth of the optical density and there is no influence of the chosen calibration field size on the dose response curve obtained from this data. A MatLab program was written to evaluate the two-dimensional dose distributions from treatment planning systems and GafChromic EBT film measurements. Verification of external beam therapy (SRT, IMRT) using the above-mentioned approach resulted in very small differences between the planned and the applied dose. The GafChromic EBT prototype B together with the flat-bed scanner and MatLab is a successful approach for making the advantages of the GafChromic films applicable for verification of external beam therapy.

  12. Low-energy X-ray dosimetry studies (6 to 16 keV) at SSRL beamline 1-5

    SciTech Connect (OSTI)

    Ipe, N.E.; Chatterji, S.; Fasso, A.; Kase, K.R.; Seefred, R.; Olko, P.; Bilski, P.; Soares, C.

    1997-06-01

    Synchrotron radiation facilities provide a unique opportunity for low-energy x-ray dosimetry studies because of the availability of monochromatic x-ray beams. Results of such studies performed at the Stanford Synchrotron Radiation Laboratory (SSRL) are described. Polish lithium fluoride thermoluminescent dosemeters (TLDs), MTS-N(LiF:Mg, Ti-0.4 mm thick), MCP-N(LiF:Mg, Cu, P-0.4 mm thick) were exposed free in air to monochromatic x-rays (6--16 keV). These exposures were monitored with an SSRL ionization chamber. The responses (counts/Gy) of MTS-N and MCP-N were generally found to increase with increasing energy. The response at 16 keV is about 3 and 4 times higher than the response at 6 keV for MTS-N and MCP-N, respectively. Irradiation at 6 keV indicates a fairly linear dose response for both types of TLDs over a dose range of 0.01 to 0.4 Gy. In addition there appears to be no significant difference in responses between irradiating the TLDs from the front and the back sides. The energy response of the PTW ionization chamber type 23342 relative to the SSRL ionization chamber is within {+-}4.5% between 6 and 16 keV. Both the TLDs and the PTW ionization chamber can also be used for beam dosimetry.

  13. Low-energy x-ray dosimetry studies (6 to 16 keV) at SSRL beamline 1-5

    SciTech Connect (OSTI)

    Ipe, N. E.; Chatterji, S.; Fasso, A.; Kase, K. R.; Seefred, R.; Olko, P.; Bilski, P.; Soares, C.

    1997-07-01

    Synchrotron radiation facilities provide a unique opportunity for low-energy x-ray dosimetry studies because of the availability of monochromatic x-ray beams. Results of such studies performed at the Stanford Synchrotron Radiation Laboratory (SSRL) are described. Polish lithium fluoride thermoluminescent dosemeters (TLDs), MTS-N(LiF:Mg, Ti- 0.4 mm thick), MCP-N (LiF:Mg, Cu, P - 0.4 mm thick) were exposed free in air to monochromatic x-rays (6-16 keV). These exposures were monitored with an SSRL ionization chamber. The responses (counts/Gy) of MTS-N and MCP-N were generally found to increase with increasing energy. The response at 16 keV is about 3 and 4 times higher than the response at 6 keV for MTS-N and MCP-N, respectively. Irradiation at 6 keV indicates a fairly linear dose response for both type of TLDs over a dose range of 0.01 to 0.4 Gy. In addition there appears to be no significant difference in responses between irradiating the TLDs from the front and the back sides. The energy response of the PTW ionization chamber type 23342 relative to the SSRL ionization chamber is within {+-}4.5% between 6 and 16 keV. Both the TLDs and the PTW ionization chamber can also be used for beam dosimetry.

  14. Primary Radiation Therapy for Head-and-Neck Cancer in the Setting of Human Immunodeficiency Virus

    SciTech Connect (OSTI)

    Klein, Emily A.; Guiou, Michael; Farwell, D. Gregory; Luu, Quang; Lau, Derick H.; Stuart, Kerri; Vaughan, Andrew; Vijayakumar, Srinivasan; Chen, Allen M.

    2011-01-01

    Purpose: To analyze outcomes after radiation therapy for head-and-neck cancer among a cohort of patients with human immunodeficiency virus (HIV). Methods and Materials: The medical records of 12 patients with serologic evidence of HIV who subsequently underwent radiation therapy to a median dose of 68 Gy (range, 64-72 Gy) for newly diagnosed squamous cell carcinoma of the head and neck were reviewed. Six patients (50%) received concurrent chemotherapy. Intensity-modulated radiotherapy was used in 6 cases (50%). All patients had a Karnofsky performance status of 80 or 90. Nine patients (75%) were receiving antiretroviral therapies at the time of treatment, and the median CD4 count was 460 (range, 266-800). Toxicity was graded according to the Radiation Therapy Oncology Group / European Organization for the Treatment of Cancer toxicity criteria. Results: The 3-year estimates of overall survival and local-regional control were 78% and 92%, respectively. Acute Grade 3+ toxicity occurred in 7 patients (58%), the most common being confluent mucositis (5 patients) and moist skin desquamation (4 patients). Two patients experienced greater than 10% weight loss, and none experienced more than 15% weight loss from baseline. Five patients (42%) experienced treatment breaks in excess of 10 cumulative days, although none required hospitalization. There were no treatment-related fatalities. Conclusions: Radiation therapy for head-and-neck cancer seems to be relatively well tolerated among appropriately selected patients with HIV. The observed rates of toxicity were comparable to historical controls without HIV.

  15. Impact of x-ray dose on the response of CR-39 to 1–5.5 MeV alphas

    SciTech Connect (OSTI)

    Rojas-Herrera, J. Rinderknecht, H. G.; Zylstra, A. B.; Gatu Johnson, M.; Orozco, D.; Rosenberg, M. J.; Sio, H.; Seguin, F. H.; Frenje, J. A.; Li, C. K.; Petrasso, R. D.

    2015-03-15

    The CR-39 nuclear track detector is used in many nuclear diagnostics fielded at inertial confinement fusion (ICF) facilities. Large x-ray fluences generated by ICF experiments may impact the CR-39 response to incident charged particles. To determine the impact of x-ray exposure on the CR-39 response to alpha particles, a thick-target bremsstrahlung x-ray generator was used to expose CR-39 to various doses of 8 keV Cu-K{sub α} and K{sub β} x-rays. The CR-39 detectors were then exposed to 1–5.5 MeV alphas from an Am-241 source. The regions of the CR-39 exposed to x-rays showed a smaller track diameter than those not exposed to x-rays: for example, a dose of 3.0 ± 0.1 Gy causes a decrease of (19 ± 2)% in the track diameter of a 5.5 MeV alpha particle, while a dose of 60.0 ± 1.3 Gy results in a decrease of (45 ± 5)% in the track diameter. The reduced track diameters were found to be predominantly caused by a comparable reduction in the bulk etch rate of the CR-39 with x-ray dose. A residual effect depending on alpha particle energy is characterized using an empirical formula.

  16. Outcomes of High-Dose-Rate Interstitial Brachytherapy in the Treatment of Locally Advanced Cervical Cancer: Long-term Results

    SciTech Connect (OSTI)

    Pinn-Bingham, Melva; Puthawala, Ajmel A.; Syed, A.M. Nisar; Sharma, Anil; DiSaia, Philip; Berman, Michael; Tewari, Krishnansu S.; Randall-Whitis, Leslie; Mahmood, Usama; Ramsinghani, Nilam; Kuo, Jeffrey; Chen, Wen-Pin; McLaren, Christine E.

    2013-03-01

    Purpose: The purpose of this study was to determine locoregional control (LRC), disease-free survival (DFS), and toxicity of high-dose-rate interstitial brachytherapy (HDR-ISBT) in the treatment of locally advanced cervical cancer. Methods and Materials: Between March 1996 and May 2009, 116 patients with cervical cancer were treated. Of these, 106 (91%) patients had advanced disease (International Federation of Gynecology and Obstetrics stage IIB-IVA). Ten patients had stage IB, 48 had stage II, 51 had stage III, and 7 had stage IVA disease. All patients were treated with a combination of external beam radiation therapy (EBRT) to the pelvis (5040 cGy) and 2 applications of HDR-ISBT to a dose of 3600 cGy to the implanted volume. Sixty-one percent of patients also received interstitial hyperthermia, and 94 (81%) patients received chemotherapy. Results: Clinical LRC was achieved in 99 (85.3%) patients. Three-year DFS rates were 59%, 67%, 71%, and 57% for patients with stage IB, II, III, and IVA disease, respectively. The 5-year DFS and overall survival rates for the entire group were 60% and 44%, respectively. Acute and late toxicities were within acceptable limits. Conclusions: Locally advanced cervical cancer patients for whom intracavitary BT is unsuitable can achieve excellent LRC and OS with a combination of EBRT and HDR-ISBT.

  17. Motexafin-Gadolinium and Involved Field Radiation Therapy for Intrinsic Pontine Glioma of Childhood: A Children's Oncology Group Phase 2 Study

    SciTech Connect (OSTI)

    Bradley, Kristin A.; Zhou Tianni; McNall-Knapp, Rene Y.; Jakacki, Regina I.; Pollack, Ian F.

    2013-01-01

    Purpose: To evaluate the effects on 1-year event-free survival (EFS) and overall survival (OS) of combining motexafin and gadolinium (MGd), a potent radiosensitizer, with daily fractionated radiation therapy in children with newly diagnosed intrinsic pontine gliomas. Methods and Materials: Patients with newly diagnosed intrinsic pontine glioma were treated with MGd daily for 5 consecutive days each week, for a total of 30 doses. Patients received a 5- to 10-min intravenous bolus of MGd, 4.4 mg/kg/day, given 2 to 5 h prior to standard dose irradiation. Radiation therapy was administered at a daily dose of 1.8 Gy for 30 treatments over 6 weeks. The total dose was 54 Gy. Results: Sixty eligible children received MGd daily, concurrent with 6 weeks of radiation therapy. The estimated 1-year EFS was 18% {+-} 5%, and the estimated 1-year OS was 53% {+-} 6.5%. The most common grade 3 to 4 toxicities were lymphopenia, transient elevation of liver transaminases, and hypertension. Conclusions: Compared to historical controls, the addition of MGd to a standard 6-week course of radiation did not improve the survival of pediatric patients with newly diagnosed intrinsic pontine gliomas.

  18. Physiological and molecular characterization of the enhanced salt tolerance induced by low-dose gamma irradiation in Arabidopsis seedlings

    SciTech Connect (OSTI)

    Qi, Wencai; Zhang, Liang; Xu, Hangbo; Wang, Lin; Jiao, Zhen

    2014-07-25

    Highlights: 50-Gy gamma irradiation markedly promotes the seedling growth under salt stress in Arabidopsis. The contents of H{sub 2}O{sub 2} and MDA are obviously reduced by low-dose gamma irradiation under salt stress. Low-dose gamma irradiation stimulates the activities of antioxidant enzymes under salt stress. Proline accumulation is required for the low-gamma-ray-induced salt tolerance. Low gamma rays differentially regulate the expression of genes related to salt stress. - Abstract: It has been established that gamma rays at low doses stimulate the tolerance to salt stress in plants. However, our knowledge regarding the molecular mechanism underlying the enhanced salt tolerance remains limited. In this study, we found that 50-Gy gamma irradiation presented maximal beneficial effects on germination index and root length in response to salt stress in Arabidopsis seedlings. The contents of H{sub 2}O{sub 2} and MDA in irradiated seedlings under salt stress were significantly lower than those of controls. The activities of antioxidant enzymes and proline levels in the irradiated seedlings were markedly increased compared with the controls. Furthermore, transcriptional expression analysis of selected genes revealed that some components of salt stress signaling pathways were stimulated by low-dose gamma irradiation under salt stress. Our results suggest that gamma irradiation at low doses alleviates the salt stress probably by modulating the physiological responses as well as stimulating the stress signal transduction in Arabidopsis seedlings.

  19. Dried plum diet protects from bone loss caused by ionizing radiation

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Schreurs, A. -S.; Shirazi-Fard, Y.; Shahnazari, M.; Alwood, J. S.; Truong, T. A.; Tahimic, C. G. T.; Limoli, C. L.; Turner, N. D.; Halloran, B.; Globus, R. K.

    2016-02-11

    Bone loss caused by ionizing radiation is a potential health concern for radiotherapy patients, radiation workers and astronauts. In animal studies, exposure to ionizing radiation increases oxidative damage in skeletal tissues, and results in an imbalance in bone remodeling initiated by increased bone-resorbing osteoclasts. Therefore, we evaluated various candidate interventions with antioxidant or antiinflammatory activities (antioxidant cocktail, dihydrolipoic acid, ibuprofen, dried plum) both for their ability to blunt the expression of resorption-related genes in marrow cells after irradiation with either gamma rays (photons, 2 Gy) or simulated space radiation (protons and heavy ions, 1 Gy) and to prevent bone loss.more » Dried plum was most effective in reducing the expression of genes related to bone resorption (Nfe2l2, Rankl, Mcp1, Opg, TNF-α) and also preventing later cancellous bone decrements caused by irradiation with either photons or heavy ions. Furthermore, dietary supplementation with DP may prevent the skeletal effects of radiation exposures either in space or on Earth.« less

  20. The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

    SciTech Connect (OSTI)

    Smyth, Lloyd M; Knight, Kellie A; Aarons, Yolanda K; Wasiak, Jason

    2015-03-15

    Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.

  1. Impact of x-ray dose on the response of CR-39 to 1–5.5 MeV alphas

    SciTech Connect (OSTI)

    Rojas-Herrera, J.; Rinderknecht, H. G.; Zylstra, A. B.; Gatu Johnson, M.; Orozco, D.; Rosenberg, M. J.; Sio, H.; Seguin, F. H.; Frenje, J. A.; Li, C. K.; Petrasso, R. D.

    2015-03-01

    The CR-39 nuclear track detector is used in many nuclear diagnostics fielded at inertial confinement fusion (ICF) facilities. Large x-ray uences generated by ICF experiments may impact the CR-39 response to incident charged particles. To determine the impact of x-ray exposure on the CR-39 response to alpha particles, a thick-target bremsstrahlung x-ray generator was used to expose CR-39 to various doses of 8 keV Cu-Kα and Kβ x-rays. The CR-39 detectors were then exposed to 1-5.5 MeV alphas from an Am-241 source. The regions of the CR-39 exposed to x-rays showed a smaller track diameter than those not exposed to x-rays: for example, a dose of 3.0 ± 0.1 Gy causes a decrease of (19 ± 2)% in the track diameter of a 5.5 MeV alpha particle, while a dose of 60.0 ± 1.3 Gy results in a decrease of (45 ± 5)% in the track diameter. The reduced track diameters were found to be predominantly caused by a comparable reduction in the bulk etch rate of the CR-39 with x-ray dose. A residual effect depending on alpha particle energy is characterized using an empirical formula.

  2. Poster Thur Eve 10: Partial kV CBCT, complete kV CBCT and EPID in breast treatment: a dose comparison study for skin, breasts, heart and lungs

    SciTech Connect (OSTI)

    Roussin, E; Archambault, L K; Wierzbicki, W

    2014-08-15

    The advantages of kilovoltage cone beam CT (kV CBCT) imaging over electronic portal imaging device (EPID) such as accurate 3D anatomy, soft tissue visualization, fast rigid registration and enhanced precision on patient positioning has lead to its increasing use in clinics. The benefits of this imaging technique are at the cost of increasing the dose to healthy surrounding organs. Our center has moved toward the use of daily partial rotation kV CBCT to restrict the dose to healthy tissues. This study aims to better quantify radiation doses from different image-guidance techniques such as tangential EPID, complete and partial kV CBCT for breast treatments. Cross-calibrated ionization chambers and kV calibrated Gafchromic films were used to measure the dose to the heart, lungs, breasts and skin. It was found that performing partial kV CBCT decreases the heart dose by about 36%, the lungs dose by 31%, the contralateral breast dose by 41% and the ipsilateral breast dose by 43% when compared to a full rotation CBCT. The skin dose measured for a full rotation CBCT was about 0.8 cGy for the contralateral breast and about 0.3 cGy for the ipsilateral breast. The study is still ongoing and results on skin doses for partial rotation kV CBCT as well as for tangential EPID images are upcoming.

  3. Chromosome Damage and Cell Proliferation Rates in In Vitro Irradiated Whole Blood as Markers of Late Radiation Toxicity After Radiation Therapy to the Prostate

    SciTech Connect (OSTI)

    Beaton, Lindsay A.; Ferrarotto, Catherine; Marro, Leonora; Samiee, Sara; Malone, Shawn; Grimes, Scott; Malone, Kyle; Wilkins, Ruth C.

    2013-04-01

    Purpose: In vitro irradiated blood samples from prostate cancer patients showing late normal tissue damage were examined for lymphocyte response by measuring chromosomal aberrations and proliferation rate. Methods and Materials: Patients were selected from a randomized trial evaluating the optimal timing of dose-escalated radiation and short-course androgen deprivation therapy. Of 438 patients, 3% experienced grade 3 late radiation proctitis and were considered to be radiosensitive. Blood samples were taken from 10 of these patients along with 20 matched samples from patients with grade 0 proctitis. The samples were irradiated at 6 Gy and, along with control samples, were analyzed for dicentric chromosomes and excess fragments per cell. Cells in first and second metaphase were also enumerated to determine the lymphocyte proliferation rate. Results: At 6 Gy, there were statistically significant differences between the radiosensitive and control cohorts for 3 endpoints: the mean number of dicentric chromosomes per cell (3.26 0.31, 2.91 0.32; P=.0258), the mean number of excess fragments per cell (2.27 0.23, 1.43 0.37; P<.0001), and the proportion of cells in second metaphase (0.27 0.10, 0.46 0.09; P=.0007). Conclusions: These results may be a valuable indicator for identifying radiosensitive patients and for tailoring radiation therapy.

  4. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

    SciTech Connect (OSTI)

    Crowhurst, James A; Whitby, Mark; Thiele, David; Halligan, Toni; Westerink, Adam; Crown, Suzanne; Milne, Jillian

    2014-09-15

    Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.36.1). Median K{sub AR} = 581 mGy (374876). Median P{sub KA} = 3908 uGym{sup 2} (24895865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.717.4). Median K{sub AR} = 1501 mGy (9282224). Median P{sub KA} = 8736 uGym{sup 2} (544912,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

  5. Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix: Results of a phase II study

    SciTech Connect (OSTI)

    Vrdoljak, Eduard . E-mail: eduard.vrdoljak@st.hinet.hr; Prskalo, Tomislav; Omrcen, Tomislav; Situm, Kristina; Boraska, Tihana; Frleta Ilic, Nives; Jankovic, Stjepan; Hamm, Wolfgang

    2005-03-01

    Purpose: To evaluate the efficacy and toxicity of ifosfamide and cisplatin administered concomitantly with low-dose-rate brachytherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell cervical carcinoma (LASCC). Methods and materials: Forty-four patients with biopsy-proven LASCC were enrolled. FIGO Stages IB2 bulky to IVA were entered into this study. Patients were assigned to receive external radiotherapy (50 Gy in 25 fractions); then ifosfamide 2 g/m{sup 2} plus cisplatin 75 mg/m{sup 2} was applied during two low-dose-rate brachytherapy applications, and 4 cycles of consolidation chemotherapy with the same drug combination were given after completion of radiotherapy. The planned dose to point A was 85 Gy. Results: All patients received both courses of concomitant chemobrachytherapy and at least 1 cycle of consolidation chemotherapy. The average duration of radiation was 45.1 days. The clinical complete response rate was 100%. Grade 3 and 4 leukopenia occurred in 25% and 11% of the cycles, respectively. After a median follow-up of 34 months (range, 20-54 months), the recurrence-free and the overall survival rates were 84% and 91%, respectively. Major delayed local complications occurred in 7 cases (16%). Conclusions: These results indicate that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin is a feasible combination for patients with LASCC of the cervix uteri. A randomized trial is planned.

  6. Effects of estrogen and gender on cataractogenesis induced by high-LET radiation

    SciTech Connect (OSTI)

    Henderson, M.A.; Rusek, A.; Valluri, S.; Garrett, J.; Lopez, J.; Caperell-Grant, A.; Mendonca, M.; Bigsby, R.; Dynlacht, J.

    2010-02-01

    Planning for long-duration manned lunar and interplanetary missions requires an understanding of radiation-induced cataractogenesis. Previously, it was demonstrated that low-linear energy transfer (LET) irradiation with 10 Gy of {sup 60}Co {gamma} rays resulted in an increased incidence of cataracts in male rats compared to female rats. This gender difference was not due to differences in estrogen, since male rats treated with the major secreted estrogen 17-{beta}-estradiol (E2) showed an identical increase compared to untreated males. We now compare the incidence and rate of progression of cataracts induced by high-LET radiation in male and female Sprague-Dawley rats. Rats received a single dose of 1 Gy of 600 MeV {sup 56}Fe ions. Lens opacification was measured at 2-4 week intervals with a slit lamp. The incidence and rate of progression of radiation-induced cataracts was significantly increased in the animals in which estrogen was available from endogenous or exogenous sources. Male rats with E2 capsules implanted had significantly higher rates of progression compared to male rats with empty capsules implanted (P = 0.025) but not compared to the intact female rats. These results contrast with data obtained after low-LET irradiation and suggest the possibility that the different types of damage caused by high- and low-LET radiation may be influenced differentially by steroid sex hormones.

  7. Sexual Function After Three-Dimensional Conformal Radiotherapy for Prostate Cancer: Results From a Dose-Escalation Trial

    SciTech Connect (OSTI)

    Wielen, Gerard J. van der [Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)]. E-mail: g.vanderwielen@erasmusmc.nl; Putten, Wim van [Department of Biostatistics, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Incrocci, Luca [Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2007-06-01

    Purpose: The purpose of this study is to provide information about sexual function (SF) after three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer while taking important factors into account that influence SF. Methods and Materials: Between June 1997 and February 2003, a total of 268 patients from a randomized dose-escalation trial comparing 68 Gy and 78 Gy agreed to participate in an additional part of the trial that evaluated SF. Results: At baseline 28% of patients had erectile dysfunction (ED). After 1 year, 27% of the pretreatment potent patients had developed ED. After 2 years this percentage had increased to 36%. After 3 years it almost stabilized at 38%. Satisfaction with sexual life was significantly correlated with ED. After 2 years one third of the pre-treatment potent patients still had considerable to very much sexual desire and found sex (very) important. No significant differences were found between the two dose-arms. Potency aids were used on a regular base by 14% of the patients. Conclusion: By taking adjuvant hormonal therapy (HT), HT during follow-up and potency aids into account, we found a lower percentage of ED after 3D-CRT than reported in previous prospective studies. A large group of patients still had sexual desire, considered sex important and 14% used potency aids after 3D-CRT.

  8. Impact of x-ray dose on the response of CR-39 to 1–5.5 MeV alphas

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Rojas-Herrera, J.; Rinderknecht, H. G.; Zylstra, A. B.; Gatu Johnson, M.; Orozco, D.; Rosenberg, M. J.; Sio, H.; Seguin, F. H.; Frenje, J. A.; Li, C. K.; et al

    2015-03-01

    The CR-39 nuclear track detector is used in many nuclear diagnostics fielded at inertial confinement fusion (ICF) facilities. Large x-ray uences generated by ICF experiments may impact the CR-39 response to incident charged particles. To determine the impact of x-ray exposure on the CR-39 response to alpha particles, a thick-target bremsstrahlung x-ray generator was used to expose CR-39 to various doses of 8 keV Cu-Kα and Kβ x-rays. The CR-39 detectors were then exposed to 1-5.5 MeV alphas from an Am-241 source. The regions of the CR-39 exposed to x-rays showed a smaller track diameter than those not exposed tomore » x-rays: for example, a dose of 3.0 ± 0.1 Gy causes a decrease of (19 ± 2)% in the track diameter of a 5.5 MeV alpha particle, while a dose of 60.0 ± 1.3 Gy results in a decrease of (45 ± 5)% in the track diameter. The reduced track diameters were found to be predominantly caused by a comparable reduction in the bulk etch rate of the CR-39 with x-ray dose. A residual effect depending on alpha particle energy is characterized using an empirical formula.« less

  9. Prospective Study of Local Control and Late Radiation Toxicity After Intraoperative Radiation Therapy Boost for Early Breast Cancer

    SciTech Connect (OSTI)

    Chang, David W.; Marvelde, Luc te; Chua, Boon H.

    2014-01-01

    Purpose: To report the local recurrence rate and late toxicity of intraoperative radiation therapy (IORT) boost to the tumor bed using the Intrabeam System followed by external-beam whole-breast irradiation (WBI) in women with early-stage breast cancer in a prospective single-institution study. Methods and Materials: Women with breast cancer ?3 cm were recruited between February 2003 and May 2005. After breast-conserving surgery, a single dose of 5 Gy IORT boost was delivered using 50-kV x-rays to a depth of 10 mm from the applicator surface. This was followed by WBI to a total dose of 50 Gy in 25 fractions. Patients were reviewed at regular, predefined intervals. Late toxicities were recorded using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring systems. Results: Fifty-five patients completed both IORT boost and external-beam WBI. Median follow-up was 3.3 years (range, 1.4-4.1 years). There was no reported locoregional recurrence or death. One patient developed distant metastases. Grade 2 and 3 subcutaneous fibrosis was detected in 29 (53%) and 8 patients (15%), respectively. Conclusions: The use of IORT as a tumor bed boost using kV x-rays in breast-conserving therapy was associated with good local control but a clinically significant rate of grade 2 and 3 subcutaneous fibrosis.

  10. Impact of x-ray dose on the response of CR-39 to 15.5 MeV alphas

    SciTech Connect (OSTI)

    Rojas-Herrera, J.; Rinderknecht, H. G.; Zylstra, A. B.; Gatu Johnson, M.; Orozco, D.; Rosenberg, M. J.; Sio, H.; Seguin, F. H.; Frenje, J. A.; Li, C. K.; Petrasso, R. D.

    2015-03-01

    The CR-39 nuclear track detector is used in many nuclear diagnostics #12;fielded at inertial con#12;nement fusion (ICF) facilities. Large x-ray uences generated by ICF experiments may impact the CR-39 response to incident charged particles. To determine the impact of x-ray exposure on the CR-39 response to alpha particles, a thick-target bremsstrahlung x-ray generator was used to expose CR-39 to various doses of 8 keV Cu-K?#11; and K#12;? x-rays. The CR-39 detectors were then exposed to 1-5.5 MeV alphas from an Am-241 source. The regions of the CR-39 exposed to x-rays showed a smaller track diameter than those not exposed to x-rays: for example, a dose of 3.0#6; 0.1 Gy causes a decrease of (19 #6;2)% in the track diameter of a 5.5 MeV alpha particle, while a dose of 60.0 #6;1.3 Gy results in a decrease of (45 #6;5)% in the track diameter. The reduced track diameters were found to be predominantly caused by a comparable reduction in the bulk etch rate of the CR-39 with x-ray dose. A residual eff#11;ect depending on alpha particle energy is characterized using an empirical formula.

  11. Radiation-induced refraction artifacts in the optical CT readout of polymer gel dosimeters

    SciTech Connect (OSTI)

    Campbell, Warren G.; Jirasek, Andrew; Wells, Derek M.

    2014-11-01

    Purpose: The objective of this work is to demonstrate imaging artifacts that can occur during the optical computed tomography (CT) scanning of polymer gel dosimeters due to radiation-induced refractive index (RI) changes in polyacrylamide gels. Methods: A 1 L cylindrical polyacrylamide gel dosimeter was irradiated with 3 3 cm{sup 2} square beams of 6 MV photons. A prototype fan-beam optical CT scanner was used to image the dosimeter. Investigative optical CT scans were performed to examine two types of rayline bending: (i) bending within the plane of the fan-beam and (ii) bending out the plane of the fan-beam. To address structured errors, an iterative SavitzkyGolay (ISG) filtering routine was designed to filter 2D projections in sinogram space. For comparison, 2D projections were alternatively filtered using an adaptive-mean (AM) filter. Results: In-plane rayline bending was most notably observed in optical CT projections where rays of the fan-beam confronted a sustained dose gradient that was perpendicular to their trajectory but within the fan-beam plane. These errors caused distinct streaking artifacts in image reconstructions due to the refraction of higher intensity rays toward more opaque regions of the dosimeter. Out-of-plane rayline bending was observed in slices of the dosimeter that featured dose gradients perpendicular to the plane of the fan-beam. These errors caused widespread, severe overestimations of dose in image reconstructions due to the higher-than-actual opacity that is perceived by the scanner when light is bent off of the detector array. The ISG filtering routine outperformed AM filtering for both in-plane and out-of-plane rayline errors caused by radiation-induced RI changes. For in-plane rayline errors, streaks in an irradiated region (>7 Gy) were as high as 49% for unfiltered data, 14% for AM, and 6% for ISG. For out-of-plane rayline errors, overestimations of dose in a low-dose region (?50 cGy) were as high as 13 Gy for unfiltered data, 10 Gy for AM, and 3.1 Gy for ISG. The ISG routine also addressed unrelated artifacts that previously needed to be manually removed in sinogram space. However, the ISG routine blurred reconstructions, causing losses in spatial resolution of ?5 mm in the plane of the fan-beam and ?8 mm perpendicular to the fan-beam. Conclusions: This paper reveals a new category of imaging artifacts that can affect the optical CT readout of polyacrylamide gel dosimeters. Investigative scans show that radiation-induced RI changes can cause significant rayline errors when rays confront a prolonged dose gradient that runs perpendicular to their trajectory. In fan-beam optical CT, these errors manifested in two ways: (1) distinct streaking artifacts caused by in-plane rayline bending and (2) severe overestimations of opacity caused by rays bending out of the fan-beam plane and missing the detector array. Although the ISG filtering routine mitigated these errors better than an adaptive-mean filtering routine, it caused unacceptable losses in spatial resolution.

  12. TU-C-17A-05: Dose Domain Optimization of MLC Leaf Patterns for Highly Complicated 4Ï€ IMRT Plans

    SciTech Connect (OSTI)

    Nguyen, D; Yu, V; Ruan, D; Semwal, H; Cao, M; Low, D; Sheng, K; O’Connor, D

    2014-06-15

    Purpose: Highly conformal non-coplanar 4π radiotherapy plans typically require more than 20 intensity-modulated fields to deliver. A novel method to calculate multileaf collimator (MLC) leaf patterns is introduced to maximize delivery efficiency, accuracy and plan quality. Methods: 4 GBM patients, with a prescription dose of 59.4 Gy or 60 Gy, were evaluated using the 4π algorithm using 20 beams. The MLC calculation utilized a least square minimization of the dose distribution, with an anisotropic total variation regularization term to encourage piecewise continuity in the fluence maps. Transforming the fluence to the dose domain required multiplying the fluence with a sparse matrix. Exploiting this property made it feasible to solve the problem using CVX, a MATLAB-based convex modeling framework. The fluence was stratified into even step sizes, and the MLC segments, limited to 300, were calculated. The patients studied were replanned using Eclipse with the same beam angles. Results: Compared to the original 4π plan, the stratified 4π plan increased the maximum/mean dose for, in Gy, by 1.0/0.0 (brainstem), 0.5/0.2 (chiasm), 0.0/0.0 (spinal cord), 1.9/0.3 (L eye), 0.7/0.2 (R eye), 0.4/0.4 (L lens), 0.3/0.3 (R lens), 1.0/0.8 (L Optical Nerve), 0.5/0.3 (R Optical Nerve), 0.3/0.2 (L Cochlea), 0.1/0.1 (R Cochlea), 4.6/0.2 (brain), 2.4/0.1 (brain-PTV), 5.1/0.9 (PTV). Compared to Eclipse, which generated an average of 607 segments, the stratified plan reduced (−) or increased (+) the maximum/mean dose, in Gy, by −10.2/−4.1 (brainstem), −10.5/−8.9 (chiasm), +0.0/−0.1 (spinal cord), −4.9/−3.4 (L eye), −4.1/−2.5 (R eye), −2.8/−2.7 (L lens), −2.1/−1.9 (R lens), −7.6/−6.5 (L Optical Nerve), −8.9/−6.1 (R Optical Nerve), −1.3/−1.9 (L Cochlea), −1.8/−1.8 (R Cochlea), +1.7/−2.1 (brain), +3.2/−2.6 (brain-PTV), +1.8/+0.3 Gy (PTV. The stratified plan was also more homogeneous in the PTV. Conclusion: This novel solver can transform complicated fluence maps into significantly fewer deliverable MLC segments than the commercial system while achieving superior dosimetry. Funding support partially contributed by Varian.

  13. Oral Mucositis Prevention By Low-Level Laser Therapy in Head-and-Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy: A Phase III Randomized Study

    SciTech Connect (OSTI)

    Gouvea de Lima, Aline; Villar, Rosangela Correa; Castro, Gilberto de; Antequera, Reynaldo; Gil, Erlon; Rosalmeida, Mauro Cabral; Federico, Miriam Hatsue Honda; Snitcovsky, Igor Moises Longo

    2012-01-01

    Purpose: Oral mucositis is a major complication of concurrent chemoradiotherapy (CRT) in head-and-neck cancer patients. Low-level laser (LLL) therapy is a promising preventive therapy. We aimed to evaluate the efficacy of LLL therapy to decrease severe oral mucositis and its effect on RT interruptions. Methods and Materials: In the present randomized, double-blind, Phase III study, patients received either gallium-aluminum-arsenide LLL therapy 2.5 J/cm{sup 2} or placebo laser, before each radiation fraction. Eligible patients had to have been diagnosed with squamous cell carcinoma or undifferentiated carcinoma of the oral cavity, pharynx, larynx, or metastases to the neck with an unknown primary site. They were treated with adjuvant or definitive CRT, consisting of conventional RT 60-70 Gy (range, 1.8-2.0 Gy/d, 5 times/wk) and concurrent cisplatin. The primary endpoints were the oral mucositis severity in Weeks 2, 4, and 6 and the number of RT interruptions because of mucositis. The secondary endpoints included patient-reported pain scores. To detect a decrease in the incidence of Grade 3 or 4 oral mucositis from 80% to 50%, we planned to enroll 74 patients. Results: A total of 75 patients were included, and 37 patients received preventive LLL therapy. The mean delivered radiation dose was greater in the patients treated with LLL (69.4 vs. 67.9 Gy, p = .03). During CRT, the number of patients diagnosed with Grade 3 or 4 oral mucositis treated with LLL vs. placebo was 4 vs. 5 (Week 2, p = 1.0), 4 vs. 12 (Week 4, p = .08), and 8 vs. 9 (Week 6, p = 1.0), respectively. More of the patients treated with placebo had RT interruptions because of mucositis (6 vs. 0, p = .02). No difference was detected between the treatment arms in the incidence of severe pain. Conclusions: LLL therapy was not effective in reducing severe oral mucositis, although a marginal benefit could not be excluded. It reduced RT interruptions in these head-and-neck cancer patients, which might translate into improved CRT efficacy.

  14. Larynx-sparing techniques using intensity-modulated radiation therapy for oropharyngeal cancer

    SciTech Connect (OSTI)

    Bar Ad, Voichita; Lin, Haibo; Hwang, Wei-Ting; Deville, Curtiland; Dutta, Pinaki R.; Tochner, Zelig; Both, Stefan

    2012-01-01

    The purpose of the current study was to explore whether the laryngeal dose can be reduced by using 2 intensity-modulated radiation therapy (IMRT) techniques: whole-neck field IMRT technique (WF-IMRT) vs. junctioned IMRT (J-IMRT). The effect on planning target volumes (PTVs) coverage and laryngeal sparing was evaluated. WF-IMRT technique consisted of a single IMRT plan, including the primary tumor and the superior and inferior neck to the level of the clavicular heads. The larynx was defined as an organ at risk extending superiorly to cover the arytenoid cartilages and inferiorly to include the cricoid cartilage. The J-IMRT technique consisted of an IMRT plan for the primary tumor and the superior neck, matched to conventional antero-posterior opposing lower neck fields at the level of the thyroid notch. A central block was used for the anterior lower neck field at the level of the larynx to restrict the dose to the larynx. Ten oropharyngeal cancer cases were analyzed. Both the primary site and bilateral regional lymphatics were included in the radiotherapy targets. The averaged V95 for the PTV57.6 was 99.2% for the WF-IMRT technique compared with 97.4% (p = 0.02) for J-IMRT. The averaged V95 for the PTV64 was 99.9% for the WF-IMRT technique compared with 98.9% (p = 0.02) for J-IMRT and the averaged V95 for the PT70 was 100.0% for WF-IMRT technique compared with 99.5% (p = 0.04) for J-IMRT. The averaged mean laryngeal dose was 18 Gy with both techniques. The averaged mean doses within the matchline volumes were 69.3 Gy for WF-MRT and 66.2 Gy for J-IMRT (p = 0.03). The WF-IMRT technique appears to offer an optimal coverage of the target volumes and a mean dose to the larynx similar with J-IMRT and should be further evaluated in clinical trials.

  15. SU-E-J-97: Pretreatment Test and Post-Treatment Evaluation for Iso-NTCP Dose Guided Adapive Radiotherapy (DGART), Experience with Prostate Cancer Patients Treated with Rectal Balloons

    SciTech Connect (OSTI)

    Yu, J; Hardcastle, N; Bender, E; Jeong, K; Tome', M

    2014-06-01

    Purpose: To explore the feasibility of pretreatment test for iso-NTCP DGART and to compare the pretreatment test results with post-treatment evaluations. Methods: NTCP here refers to late rectal wall toxicity only and is calculated with the ring rectal wall DVH. Simulation for one time iso- NTCP DGART starts after half of the total dose was done for 10 patients to investigate if TCP gains could be achieved. Six patients were treated using a 12-fraction 4.3Gy technique and four using 16-fraction 3.63Gy technique. For each of the 12-fraction cases a VMAT plan was generated in Pinnacle3 using the daily CT obtained prior to the 6th fraction. A pretreatment simulation was performed using only the first 6 daily CTs. The idea is to add the 6 original plan delivered doses with 6 DGART plan delivered doses by deformable dose accumulation (DDA) on each of the first 6 CTs, resulting in 6 rectal wall doses (RWDs) and NTCPs. The 95% confidence interval (95%CI) for the 6 NTCPs were computed.The posttreatment evaluation was done by: a) copy the DGART plan to 6 CTs for fraction 712 and calculate the 6 actual DGART delivered fractional doses; b) sum the 6 actual DGART doses with the 6 original plan delivered doses by DDA on each of the 12 CTs resulting in 12 post-treatment RWDs and NTCPs; c) boxplot the 12 post-treatment NTCPs. Results: Target dose gain is 0.761.93 Gy. The 95%CI widths of the pretreatment tests NTCPs were 1.12.7%. For 5 patients, the planned NTCP fell within the 95%CI. For 4 patients, the planned NTCP was lower than the 95%CI lines. Post-treatment results show that for 7 patients, the upper quartile was within the 95%CI; for 2 patients, the upper quartile were higher than the 95%CI. Conclusion: The pretreatment test yields conservative prediction of the actual delivered NTCP.

  16. Postmastectomy Hypofractionated and Accelerated Radiation Therapy With (and Without) Subcutaneous Amifostine Cytoprotection

    SciTech Connect (OSTI)

    Koukourakis, Michael I.

    2013-01-01

    Purpose: Postmastectomy radiation therapy (PMRT) provides major local control and survival benefits. More aggressive radiation therapy schemes may, however, be necessary in specific subgroups, provided they are safely administered. We report the tolerance and efficacy of a highly accelerated and hypofractionated regimen (HypoARC). Methods and Materials: One hundred twelve high-risk patients who had undergone mastectomy received 10 consecutive fractions of 3.5 Gy in 12 days (thoracic wall and axillary/supraclavicular areas). Two consecutive additional fractions of 4 Gy were given to the surgical scar area (electrons 8-10 MeV) and 1 3.5-Gy fraction to the axilla (in cases with extensive nodal involvement). A minimum follow-up of 24 months (median, 44 months) was allowed before analysis. Of 112 patients, 21 (18.7%) refused to receive amifostine, the remaining receiving tolerance-based individualized doses (500-1000 mg/day subcutaneously). Results: By use of a dose individualization algorithm, 68.1%, 11%, and 18.7% of patients received 1000 mg, 750 mg, and 500 mg/day of amifostine. Patchy moist skin desquamation outside and inside the booster fields was noted in 14 of 112 (12.5%) and 26 of 112 (23.2%) patients, respectively. No case of acute pneumonitis was recorded. High amifostine dose offered a significant skin protection. Within a median follow-up time of 44 months, moderate subcutaneous edema outside and within the booster thoracic area was noted in 5 of 112 (4.4%) and 8 of 112 (7.1%) cases, respectively. Intense asymptomatic radiographic findings of in field lung fibrosis were noted in 4 of 112 (3.6%) patients. Amifostine showed a significant protection against lung and soft tissue fibrosis. A 97% projected 5-year local relapse free survival and 84% 5-year disease-specific survival were recorded. Lack of steroid receptor expression, simple human epidermal growth factor 2 positivity, or triple negative phenotype defined higher metastasis rates but had no effect on local control. Conclusions: PMRT with HypoARC showed an excellent early and short-term late toxicity profile, and amifostine further reduced early and late radiation sequelae. Encouraging local control rates are obtained in high-risk subgroups.

  17. Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty

    SciTech Connect (OSTI)

    Mazonakis, Michalis; Berris, Theoharris; Damilakis, John; Lyraraki, Efrossyni

    2013-10-15

    Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 10{sup ?5} to 837.4 10{sup ?5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2541.0) 10{sup ?5}. The probability of bladder cancer development was more than 113.7 10{sup ?5} and 110.3 10{sup ?5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.00368.5) 10{sup ?5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the treatment parameters, organ site in respect to treatment volume and patient's gender and age. The presented risk estimates may be useful in the follow-up studies of irradiated patients.

  18. SU-E-T-481: Dosimetric Comparison of Acuros XB and Anisotropic Analytic Algorithm with Commercial Monte Carlo Based Dose Calculation Algorithm for Stereotactic Body Radiation Therapy of Lung Cancer

    SciTech Connect (OSTI)

    Cao, M; Tenn, S; Lee, C; Yang, Y; Lamb, J; Agazaryan, N; Lee, P; Low, D

    2014-06-01

    Purpose: To evaluate performance of three commercially available treatment planning systems for stereotactic body radiation therapy (SBRT) of lung cancer using the following algorithms: Boltzmann transport equation based algorithm (AcurosXB AXB), convolution based algorithm Anisotropic Analytic Algorithm (AAA); and Monte Carlo based algorithm (XVMC). Methods: A total of 10 patients with early stage non-small cell peripheral lung cancer were included. The initial clinical plans were generated using the XVMC based treatment planning system with a prescription of 54Gy in 3 fractions following RTOG0613 protocol. The plans were recalculated with the same beam parameters and monitor units using AAA and AXB algorithms. A calculation grid size of 2mm was used for all algorithms. The dose distribution, conformity, and dosimetric parameters for the targets and organs at risk (OAR) are compared between the algorithms. Results: The average PTV volume was 19.6mL (range 4.247.2mL). The volume of PTV covered by the prescribed dose (PTV-V100) were 93.972.00%, 95.072.07% and 95.102.97% for XVMC, AXB and AAA algorithms, respectively. There was no significant difference in high dose conformity index; however, XVMC predicted slightly higher values (p=0.04) for the ratio of 50% prescription isodose volume to PTV (R50%). The percentage volume of total lungs receiving dose >20Gy (LungV20Gy) were 4.032.26%, 3.862.22% and 3.852.21% for XVMC, AXB and AAA algorithms. Examination of dose volume histograms (DVH) revealed small differences in targets and OARs for most patients. However, the AAA algorithm was found to predict considerable higher PTV coverage compared with AXB and XVMC algorithms in two cases. The dose difference was found to be primarily located at the periphery region of the target. Conclusion: For clinical SBRT lung treatment planning, the dosimetric differences between three commercially available algorithms are generally small except at target periphery. XVMC and AXB algorithms are recommended for accurate dose estimation at tissue boundaries.

  19. SU-F-BRD-05: Dosimetric Comparison of Protocol-Based SBRT Lung Treatment Modalities: Statistically Significant VMAT Advantages Over Fixed- Beam IMRT

    SciTech Connect (OSTI)

    Best, R; Harrell, A; Geesey, C; Libby, B; Wijesooriya, K

    2014-06-15

    Purpose: The purpose of this study is to inter-compare and find statistically significant differences between flattened field fixed-beam (FB) IMRT with flattening-filter free (FFF) volumetric modulated arc therapy (VMAT) for stereotactic body radiation therapy SBRT. Methods: SBRT plans using FB IMRT and FFF VMAT were generated for fifteen SBRT lung patients using 6 MV beams. For each patient, both IMRT and VMAT plans were created for comparison. Plans were generated utilizing RTOG 0915 (peripheral, 10 patients) and RTOG 0813 (medial, 5 patients) lung protocols. Target dose, critical structure dose, and treatment time were compared and tested for statistical significance. Parameters of interest included prescription isodose surface coverage, target dose heterogeneity, high dose spillage (location and volume), low dose spillage (location and volume), lung dose spillage, and critical structure maximum- and volumetric-dose limits. Results: For all criteria, we found equivalent or higher conformality with VMAT plans as well as reduced critical structure doses. Several differences passed a Student's t-test of significance: VMAT reduced the high dose spillage, evaluated with conformality index (CI), by an average of 9.4%15.1% (p=0.030) compared to IMRT. VMAT plans reduced the lung volume receiving 20 Gy by 16.2%15.0% (p=0.016) compared with IMRT. For the RTOG 0915 peripheral lesions, the volumes of lung receiving 12.4 Gy and 11.6 Gy were reduced by 27.0%13.8% and 27.5%12.6% (for both, p<0.001) in VMAT plans. Of the 26 protocol pass/fail criteria, VMAT plans were able to achieve an average of 0.20.7 (p=0.026) more constraints than the IMRT plans. Conclusions: FFF VMAT has dosimetric advantages over fixed beam IMRT for lung SBRT. Significant advantages included increased dose conformity, and reduced organs-at-risk doses. The overall improvements in terms of protocol pass/fail criteria were more modest and will require more patient data to establish difference trends of more statistical significance.

  20. Implications of CT noise and artifacts for quantitative {sup 99m}Tc SPECT/CT imaging

    SciTech Connect (OSTI)

    Hulme, K. W.; Kappadath, S. C.

    2014-04-15

    Purpose: This paper evaluates the effects of computed tomography (CT) image noise and artifacts on quantitative single-photon emission computed-tomography (SPECT) imaging, with the aim of establishing an appropriate range of CT acquisition parameters for low-dose protocols with respect to accurate SPECT attenuation correction (AC). Methods: SPECT images of two geometric and one anthropomorphic phantom were reconstructed iteratively using CT scans acquired at a range of dose levels (CTDI{sub vol} = 0.4 to 46 mGy). Resultant SPECT image quality was evaluated by comparing mean signal, background noise, and artifacts to SPECT images reconstructed using the highest dose CT for AC. Noise injection was performed on linear-attenuation (?) maps to determine the CT noise threshold for accurate AC. Results: High levels of CT noise (? ? 200400 HU) resulted in low ?-maps noise (? ? 1%3%). Noise levels greater than ?10% in 140 keV ?-maps were required to produce visibly perceptible increases of ?15% in {sup 99m}Tc SPECT images. These noise levels would be achieved at low CT dose levels (CTDI{sub vol} = 4 ?Gy) that are over 2 orders of magnitude lower than the minimum dose for diagnostic CT scanners. CT noise could also lower (bias) the expected ? values. The relative error in reconstructed SPECT signal trended linearly with the relative shift in ?. SPECT signal was, on average, underestimated in regions corresponding with beam-hardening artifacts in CT images. Any process that has the potential to change the CT number of a region by ?100 HU (e.g., misregistration between CT images and SPECT images due to motion, the presence of contrast in CT images) could introduce errors in ?{sub 140} {sub keV} on the order of 10%, that in turn, could introduce errors on the order of ?10% into the reconstructed {sup 99m}Tc SPECT image. Conclusions: The impact of CT noise on SPECT noise was demonstrated to be negligible for clinically achievable CT parameters. Because CT dose levels that affect SPECT quantification is low (CTDI{sub vol} ? 4 ?Gy), the low dose limit for the CT exam as part of SPECT/CT will be guided by CT image quality requirements for anatomical localization and artifact reduction. A CT technique with higher kVp in combination with lower mAs is recommended when low-dose CT images are used for AC to minimize beam-hardening artifacts.

  1. Tissue pO{sub 2} of Orthotopic 9L and C6 Gliomas and Tumor-Specific Response to Radiotherapy and Hyperoxygenation

    SciTech Connect (OSTI)

    Khan, Nadeem Li Hongbin; Hou, Huagang; Lariviere, Jean P.; Gladstone, David J.; Demidenko, Eugene; Swartz, Harold M.

    2009-03-01

    Purpose: Tumor hypoxia is a well-known therapeutic problem; however, a lack of methods for repeated measurements of glioma partial pressure of oxygen (pO{sub 2}) limits the ability to optimize the therapeutic approaches. We report the effects of 9.3 Gy of radiation and carbogen inhalation on orthotopic 9L and C6 gliomas and on the contralateral brain pO{sub 2} in rats using a new and potentially widely useful method, multisite in vivo electron paramagnetic resonance oximetry. Methods and Materials: Intracerebral 9L and C6 tumors were established in the left hemisphere of syngeneic rats, and electron paramagnetic resonance oximetry was successfully used for repeated tissue pO{sub 2} measurements after 9.3 Gy of radiation and during carbogen breathing for 5 consecutive days. Results: Intracerebral 9L gliomas had a pO{sub 2} of 30-32 mm Hg and C6 gliomas were relatively hypoxic, with a pO{sub 2} of 12-14 mm Hg (p < 0.05). The tissue pO{sub 2} of the contralateral brain was 40-45 mm Hg in rats with either 9L or C6 gliomas. Irradiation resulted in a significant increase in pO{sub 2} of the 9L gliomas only. A significant increase in the pO{sub 2} of the 9L and C6 gliomas was observed in rats breathing carbogen, but this effect decreased during 5 days of repeated experiments in the 9L gliomas. Conclusion: These results highlight the tumor-specific effect of radiation (9.3.Gy) on tissue pO{sub 2} and the different responses to carbogen inhalation. The ability of electron paramagnetic resonance oximetry to provide direct repeated measurements of tissue pO{sub 2} could have a vital role in understanding the dynamics of hypoxia during therapy that could then be optimized by scheduling doses at times of improved tumor oxygenation.

  2. SU-E-T-625: Use and Choice of Ionization Chambers for the Commissioning of Flattened and Flattening-Filter-Free Photon Beams: Determination of Recombination Correction Factor (ks)

    SciTech Connect (OSTI)

    Stucchi, C; Mongioj, V; Carrara, M; Pignoli, E; Bonfantini, F; Bresolin, A

    2014-06-15

    Purpose: To evaluate the recombination effect for some ionization chambers to be used for linacs commissioning for Flattened Filter (FF) and Flattening Filter Free (FFF) photon beams. Methods: A Varian TrueBeam linac with five photon beams was used: 6, 10 and 15 MV FF and 6 and 10 MV FFF. Measurements were performed in a water tank and in a plastic water phantom with different chambers: a mini-ion chamber (IC CC01, IBA), a plane-parallel ion chamber (IC PPC05, IBA) and two Farmer chambers (NE2581 and FPC05-IBA). Measurement conditions were Source- Surface Distance of 100 cm, two field sizes (10x10 and 40x40 cm2) and five depths (1cm, maximum buildup, 5cm, 10cm and 20cm). The ion recombination factors (kS), obtained from the Jaffe's plots (voltage interval 50-400 V), were evaluated at the recommended operating voltage of +300V. Results: Dose Per Pulse (DPP) at dmax was 0.4 mGy/pulse for FF beams, 1.0 mGy/pulse and 1.9 mGy/pulse for 6MV and 10 MV FFF beams respectively. For all measurement conditions, kS ranged between 0.996 and 0.999 for IC PPC05, 0.997 and 1.008 for IC CC01. For the FPC05 IBA Farmer IC, kS varied from 1.001 to 1.011 for FF beams, from 1.004 to 1.015 for 6 MV FFF and from 1.009 to 1.025 for 10 MV FFF. Whereas, for NE2581 IC the values ranged from 1.002 to 1.009 for all energy beams and measurement conditions. Conclusion: kS depends on the chamber volume and the DPP, which in turn depends on energy beam but is independent of dose rate. Ion chambers with small active volume can be reliably used for dosimetry of FF and FFF beams even without kS correction. On the contrary, for absolute dosimetry of FFF beams by Farmer ICs it is necessary to evaluate and apply the kS correction. Partially supported by Lega Italiana Lotta contro i Tumori (LILT)

  3. Feasibility of RACT for 3D dose measurement and range verification in a water phantom

    SciTech Connect (OSTI)

    Alsanea, Fahed; Moskvin, Vadim; Stantz, Keith M.

    2015-02-15

    Purpose: The objective of this study is to establish the feasibility of using radiation-induced acoustics to measure the range and Bragg peak dose from a pulsed proton beam. Simulation studies implementing a prototype scanner design based on computed tomographic methods were performed to investigate the sensitivity to proton range and integral dose. Methods: Derived from thermodynamic wave equation, the pressure signals generated from the dose deposited from a pulsed proton beam with a 1 cm lateral beam width and a range of 16, 20, and 27 cm in water using Monte Carlo methods were simulated. The resulting dosimetric images were reconstructed implementing a 3D filtered backprojection algorithm and the pressure signals acquired from a 71-transducer array with a cylindrical geometry (30 40 cm) rotated over 2? about its central axis. Dependencies on the detector bandwidth and proton beam pulse width were performed, after which, different noise levels were added to the detector signals (using 1 ?s pulse width and a 0.5 MHz cutoff frequency/hydrophone) to investigate the statistical and systematic errors in the proton range (at 20 cm) and Bragg peak dose (of 1 cGy). Results: The reconstructed radioacoustic computed tomographic image intensity was shown to be linearly correlated to the dose within the Bragg peak. And, based on noise dependent studies, a detector sensitivity of 38 mPa was necessary to determine the proton range to within 1.0 mm (full-width at half-maximum) (systematic error < 150 ?m) for a 1 cGy Bragg peak dose, where the integral dose within the Bragg peak was measured to within 2%. For existing hydrophone detector sensitivities, a Bragg peak dose of 1.6 cGy is possible. Conclusions: This study demonstrates that computed tomographic scanner based on ionizing radiation-induced acoustics can be used to verify dose distribution and proton range with centi-Gray sensitivity. Realizing this technology into the clinic has the potential to significantly impact beam commissioning, treatment verification during particle beam therapy and image guided techniques.

  4. Long-term Survival and Toxicity in Patients Treated With High-Dose Intensity Modulated Radiation Therapy for Localized Prostate Cancer

    SciTech Connect (OSTI)

    Spratt, Daniel E.; Pei, Xin; Yamada, Josh; Kollmeier, Marisa A.; Cox, Brett; Zelefsky, Michael J.

    2013-03-01

    Purpose: To report long-term survival and toxicity outcomes with the use of high-dose intensity modulated radiation therapy (IMRT) to 86.4 Gy for patients with localized prostate cancer. Methods and Materials: Between August 1997 and December 2008, 1002 patients were treated to a dose of 86.4 Gy using a 5-7 field IMRT technique. Patients were stratified by prognostic risk group based on National Comprehensive Cancer Network risk classification criteria. A total of 587 patients (59%) were treated with neoadjuvant and concurrent androgen deprivation therapy. The median follow-up for the entire cohort was 5.5 years (range, 1-14 years). Results: For low-, intermediate-, and high-risk groups, 7-year biochemical relapse-free survival outcomes were 98.8%, 85.6%, and 67.9%, respectively (P<.001), and distant metastasis-free survival rates were 99.4%, 94.1%, and 82.0% (P<.001), respectively. On multivariate analysis, T stage (P<.001), Gleason score (P<.001), and >50% of initial biopsy positive core (P=.001) were predictive for distant mestastases. No prostate cancer-related deaths were observed in the low-risk group. The 7-year prostate cancer-specific mortality (PCSM) rates, using competing risk analysis for intermediate- and high-risk groups, were 3.3% and 8.1%, respectively (P=.008). On multivariate analysis, Gleason score (P=.004), percentage of biopsy core positivity (P=.003), and T-stage (P=.033) were predictive for PCSM. Actuarial 7-year grade 2 or higher late gastrointestinal and genitourinary toxicities were 4.4% and 21.1%, respectively. Late grade 3 gastrointestinal and genitourinary toxicity was experienced by 7 patients (0.7%) and 22 patients (2.2%), respectively. Of the 427 men with full potency at baseline, 317 men (74%) retained sexual function at time of last follow-up. Conclusions: This study represents the largest cohort of patients treated with high-dose radiation to 86.4 Gy, using IMRT for localized prostate cancer, with the longest follow-up to date. Our findings indicate that this treatment results in excellent clinical outcomes with acceptable toxicity.

  5. SU-E-T-415: An Ionization Chamber Array with High Spatial Resolution for External Beam Radiotherapy

    SciTech Connect (OSTI)

    Togno, M; Wilkens, J; Menichelli, D

    2014-06-01

    Purpose: To characterize an ionization chamber array technology with high spatial resolution and high charge collection efficiency for external beam radiotherapy. Methods: The prototype under test is a linear array of air vented ionization chambers developed by IBA Dosimetry, consisting of 80 pixels with 3.5mm spatial resolution and 4mm{sup 3} sensitive volume. The detector was characterized in a plastic phantom with {sup 60} Co radiation and MV X-rays from an ELEKTA Agility LINAC (with flattened and unflattened beam qualities). Bias voltage was varied in order to evaluate charge collection efficiency. A commercial array of ionization chambers (MatriXX Evolution, IBA Dosimetry) and an amorphous silicon flat panel in direct conversion configuration were used as references. Results: Repeatability (0.4%) and stability under continuous gamma irradiation (0.3%) are very good, in spite of low active volume and sensitivity (?200pC/Gy). Charge collection efficiency is higher than 99% already at 150V with ?2mGy dose per pulse, leading to a 1.1% sensitivity change with dose per pulse in the range 0.09-2mGy (covering all flattened and unflattened applications). Measured dose profiles are in agreement with MatriXX for fields larger than 22cm{sup 2}, in which case the linear array offers a much better characterization of the penumbra region. Down to 11cm{sup 2}, measured profiles are in very good agreement with the flat panel. Conclusion: The array represents a valuable tool for the characterization of treatment fields in which high spatial resolution is required, together with the dosimetric performance of air vented ionization chambers. Such a technology would be particularly valuable in association with advanced treatment modalities such as rotational radiotherapy, stereotactic treatments (even with unflattened beam qualities) and proton therapy, due to the insensitivity of the chambers on dose per pulse. In the future, a two dimensional prototype based on this technology will be developed and tested. This research project has been supported by a Marie Curie Early Initial Training Network Fellowship of the European Community's Seventh Framework Programme under contract number (PITN-GA-2011-289198-.

  6. Defining the Optimal Planning Target Volume in Image-Guided Stereotactic Radiosurgery of Brain Metastases: Results of a Randomized Trial

    SciTech Connect (OSTI)

    Kirkpatrick, John P.; Wang, Zhiheng; Sampson, John H.; McSherry, Frances; Herndon, James E.; Allen, Karen J.; Duffy, Eileen; Hoang, Jenny K.; Chang, Zheng; Yoo, David S.; Kelsey, Chris R.; Yin, Fang-Fang

    2015-01-01

    Purpose: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. Methods and Materials: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board–approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator–based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). Results: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non–small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in neurocognition or quality of life was observed. Conclusions: SRS was well tolerated, with low rates of LR and RN in both cohorts. However, given the higher potential risk of RN with a 3-mm margin, a 1-mm GTV expansion is more appropriate.

  7. SU-E-T-198: Hippocampal-Sparing Radiotherapy (HSRT) for Patients with Head and Neck Cancer (HNC) Using Intensity-Modulated Radiation Therapy (IMRT)

    SciTech Connect (OSTI)

    Dunlop, A; Welsh, L; Nutting, C; Harrington, K; Bhide, S; Newbold, K

    2014-06-01

    Purpose: There is increasing evidence that decline in cognitive function following brain radiotherapy (RT) is related to the radiation dose delivered to the hippocampi. In this work we evaluate the feasibility of using IMRT to generate HSRT plans in HNC. Methods: A planning study was undertaken for ten representative patients with HNC previously treated with radical (chemo)-RT using standard IMRT techniques. The hippocampi were delineated according to the RTOG hippocampal contouring atlas, on a T1w- MRI scan that was registered with the RT planning CT. LINAC-based, clinically acceptable, HSRT plans were generated and assessed using the Pinnacle3 treatment planning system. Results: Using a VMAT technique, a reduction in hippocampal dose was achievable in six cases. For these cases, the EQD2-D40% of the bilateral hippocampi was significantly reduced by HSRT (p = 0.006) from a median of 18.8Gy (range 14.4–34.6) to 6.5 Gy (4.2–9.5) for the delivered and HSRT plans respectively. Plans were also generated using a fixed-field IMRT technique with non-coplanar beams that were designed to avoid the bilateral hippocampi, resulting in a median EQD2-D40% of 11.2Gy (8.0–14.5). Both HSRT techniques also resulted in lower doses to the whole brain, brain stem, and cerebellum. The HSRT plans resulted in higher doses to some regions of non-contoured normaltissue, but the magnitude of these dose differences is unlikely to be of clinical significance in terms of acute and late toxicity. Conclusion: This study has demonstrated that it is possible, in many cases, to adapt treatment plans for HNC to significantly reduce dose to the hippocampi. This reduction in dose would be predicted to Resultin a significant reduction in the probability of subsequent decline in cognitive function following RT. Our results point towards the need for the collection of prospective data on cognitive outcomes for the HNC patient population treated with radical (chemo)-RT.

  8. Volumetric-modulated arc therapy vs conventional fixed-field intensity-modulated radiotherapy in a whole-ventricular irradiation: A planning comparison study

    SciTech Connect (OSTI)

    Sakanaka, Katsuyuki; Mizowaki, Takashi; Sato, Sayaka; Ogura, Kengo; Hiraoka, Masahiro

    2013-07-01

    This study evaluated the dosimetric difference between volumetric-modulated arc therapy (VMAT) and conventional fixed-field intensity-modulated radiotherapy (cIMRT) in whole-ventricular irradiation. Computed tomography simulation data for 13 patients were acquired to create plans for VMAT and cIMRT. In both plans, the same median dose (100% = 24 Gy) was prescribed to the planning target volume (PTV), which comprised a tumor bed and whole ventricles. During optimization, doses to the normal brain and body were reduced, provided that the dose constraints of the target coverage were satisfied. The dose-volume indices of the PTV, normal brain, and body as well as monitor units were compared between the 2 techniques by using paired t-tests. The results showed no significant difference in the homogeneity index (0.064 vs 0.065; p = 0.824) of the PTV and conformation number (0.78 vs 0.77; p = 0.065) between the 2 techniques. In the normal brain and body, the dose-volume indices showed no significant difference between the 2 techniques, except for an increase in the volume receiving a low dose in VMAT; the absolute volume of the normal brain and body receiving 1 Gy of radiation significantly increased in VMAT by 1.6% and 8.3%, respectively, compared with that in cIMRT (1044 vs 1028 mL for the normal brain and 3079.2 vs 2823.3 mL for the body; p<0.001). The number of monitor units to deliver a 2.0-Gy fraction was significantly reduced in VMAT compared with that in cIMRT (354 vs 873, respectively; p<0.001). In conclusion, VMAT delivers IMRT to complex target volumes such as whole ventricles with fewer monitor units, while maintaining target coverage and conformal isodose distribution comparable to cIMRT; however, in addition to those characteristics, the fact that the volume of the normal brain and body receiving a low dose would increase in VMAT should be considered.

  9. Phase I Trial Using Patupilone (Epothilone B) and Concurrent Radiotherapy for Central Nervous System Malignancies

    SciTech Connect (OSTI)

    Fogh, Shannon; Machtay, Mitchell; Werner-Wasik, Maria; Curran, Walter J.; Bonanni, Roseann; Axelrod, Rita; Andrews, David; Dicker, Adam P.

    2010-07-15

    Purpose: Based on preclinical data indicating the radiosensitizing potential of epothilone B, the present study was designed to evaluate the toxicity and response rate of patupilone, an epothilone B, with concurrent radiotherapy (RT) for the treatment of central nervous system malignancies. Methods and Materials: The present Phase I study evaluated the toxicities associated with patupilone combined with RT to establish the maximal tolerated dose. Eligible patients had recurrent gliomas (n = 10) primary (n = 5) or metastatic (n = 17) brain tumors. Dose escalation occurred if no dose-limiting toxicities, defined as any Grade 4-5 toxicity or Grade 3 toxicity requiring hospitalization, occurred during treatment. Results: Of 14 patients, 5 were treated with weekly patupilone at 1.5 mg/m{sup 2}, 4 at 2.0 mg/m{sup 2}, 4 at 2.5 mg/m{sup 2}, and 1 at 4 mg/m{sup 2}. Of 18 patients, 7 were treated in the 6-mg/m{sup 2} group, 6 in the 8-mg/m{sup 2} group, and 5 in the 10-mg/m{sup 2} group. Primary central nervous system malignancies received RT to a median dose of 60 Gy. Central nervous system metastases received whole brain RT to a median dose of 37.4 Gy, and patients with recurrent gliomas underwent stereotactic RT to a median dose of 37.5 Gy. One dose-limiting toxicity (pneumonia) was observed in group receiving 8-mg/m{sup 2} every 3 weeks. At the subsequent dose level (10 mg/m{sup 2}), two Grade 4 dose-limiting toxicities occurred (renal failure and pulmonary hemorrhage); thus, 8 mg/m{sup 2} every 3 weeks was the maximal tolerated dose and the recommended Phase II dose. Conclusion: Combined with a variety of radiation doses and fractionation schedules, concurrent patupilone was well tolerated and safe, with a maximal tolerated dose of 8 mg/m{sup 2} every 3 weeks.

  10. Phase II Study of Accelerated High-Dose Radiotherapy With Concurrent Chemotherapy for Patients With Limited Small-Cell Lung Cancer: Radiation Therapy Oncology Group Protocol 0239

    SciTech Connect (OSTI)

    Komaki, Ritsuko; Paulus, Rebecca; Ettinger, David S.; Videtic, Gregory M.M.; Bradley, Jeffrey D.; Glisson, Bonnie S.; Sause, William T.; Curran, Walter J.; Choy, Hak

    2012-07-15

    Purpose: To investigate whether high-dose thoracic radiation given twice daily during cisplatin-etoposide chemotherapy for limited small-cell lung cancer (LSCLC) improves survival, acute esophagitis, and local control rates relative to findings from Intergroup trial 0096 (47%, 27%, and 64%). Patients and Methods: Patients were accrued over a 3-year period from 22 US and Canadian institutions. Patients with LSCLC and good performance status were given thoracic radiation to 61.2 Gy over 5 weeks (daily 1.8-Gy fractions on days 1-22, then twice-daily 1.8-Gy fractions on days 23-33). Cisplatin (60 mg/m{sup 2} IV) was given on day 1 and etoposide (120 mg/m{sup 2} IV) on days 1-3 and days 22-24, followed by 2 cycles of cisplatin plus etoposide alone. Patients who achieved complete response were offered prophylactic cranial irradiation. Endpoints included overall and progression-free survival; severe esophagitis (Common Toxicity Criteria v 2.0) and treatment-related fatalities; response (Response Evaluation Criteria in Solid Tumors); and local control. Results: Seventy-two patients were accrued from June 2003 through May 2006; 71 were evaluable (median age 63 years; 52% female; 58% Zubrod 0). Median survival time was 19 months; at 2 years, the overall survival rate was 36.6% (95% confidence interval [CI] 25.6%-47.7%), and progression-free survival 19.7% (95% CI 11.4%-29.6%). Thirteen patients (18%) experienced severe acute esophagitis, and 2 (3%) died of treatment-related causes; 41% achieved complete response, 39% partial response, 10% stable disease, and 6% progressive disease. The local control rate was 73%. Forty-three patients (61%) received prophylactic cranial irradiation. Conclusions: The overall survival rate did not reach the projected goal; however, rates of esophagitis were lower, and local control higher, than projected. This treatment strategy is now one of three arms of a prospective trial of chemoradiation for LSCLC (Radiation Therapy Oncology Group 0538/Cancer and Leukemia Group B 30610).

  11. SU-F-BRE-02: Characterization of a New Commercial Single Crystal Diamond Detector in Photon, Electron and Proton Beams

    SciTech Connect (OSTI)

    Akino, Y; Das, I

    2014-06-15

    Purpose: Diamond detectors even with superior characteristics have become obsolete due to poor design, selection of crystal and cost. Recently, microDiamond using synthetic single crystal diamond detector (SCDD) is commercially available which is characterized in various radiation beams in this study. Methods: The characteristics of a commercial SCDD model 60019 (PTW) to a 6- and 15-MV photon beams, 6- and 20-MeV electron beams, and 208 MeV proton beams were investigated and compared to the pre-characterized detectors: TN31010 (0.125 cm{sup 3}) and TN30006 (pinpoint) ionization chambers (PTW), EDGE detector (Sun Nuclear Corp), and SFD Stereotactic Dosimetry Diode Detector (IBA). The depth-dose and profiles data were collected for various field sizes and depths. The dose linearity and dose rate dependency were also evaluated. To evaluate the effects of the preirradiation, the diamond detector which had not been irradiated on the day was set up in the water tank and the response to 100 MU was measured every 20 s. The temperature dependency was tested for the range of 4–60 °C. Angular dependency was evaluated in water phantom by rotating the SCDD. Results: For all radiation types and field sizes, the depth-dose data of the diamond chamber showed identical curve to those of ionization chambers. The profile of the diamond detector was very similar to those of the Edge and SFD detectors, although the 0.125 cm{sup 3} and pinpoint chambers showed averaging effects in the penumbrae region. The temperature dependency was within 0.7% in the range of 4–41°C. A dose of 900 cGy and 1200 cGy were needed to stabilize the chamber to the level within 0.5% and 0.2%, respectively. Conclusion: The type 60019 SCDD detector showed suitable characteristics for depth-dose and profile measurements for wide range of field sizes. However, at least 1000 cGy of pre-irradiation is needed for accurate measurements.

  12. SU-E-T-428: Dosimetric Impact of Multileaf Collimator Leaf Width On Single and multiple Isocenter Stereotactic IMRT Treatment Plans for multiple Brain Tumors

    SciTech Connect (OSTI)

    Giem, J; Algan, O; Ahmad, S; Ali, I; Young, J; Hossain, S

    2014-06-01

    Purpose: To assess the impacts that multileaf collimator (MLC) leaf width has on the dose conformity and normal brain tissue doses of single and multiple isocenter stereotactic IMRT (SRT) plans for multiple intracranial tumors. Methods: Fourteen patients with 2–3 targets were studied retrospectively. Patients treated with multiple isocenter treatment plans using 9 to 12 non-coplanar beams per lesion underwent repeat planning using single isocenter and 10 to 12 non-coplanar beams with 2.5mm, 3mm and 5mm MLC leaf widths. Brainlab iPlan treatment planning system for delivery with the 2.5mm MLC served as reference. Identical contour sets and dose-volume constraints were applied. The prescribed dose to each target was 25 Gy to be delivered over 5 fractions with a minimum of 99% dose to cover ≥ 95% of the target volume. Results: The lesions and normal brains ranged in size from 0.11 to 51.67cc (median, 2.75cc) and 1090 to 1641cc (median, 1401cc), respectively. The Paddick conformity index for single and multiple isocenter (2.5mm vs. 3mm and 5mm MLCs) was (0.79±0.08 vs. 0.79±0.07 and 0.77±0.08) and (0.79±0.09 vs. 0.77±0.09 and 0.76±0.08), respectively. The average normal brain volumes receiving 15 Gy for single and multiple isocenter (2.5mm vs. 3mm and 5mm MLCs) were (3.65% vs. 3.95% and 4.09%) and (2.89% vs. 2.91% and 2.92%), respectively. Conclusion: The average dose conformity observed for the different leaf width for single and multiple isocenter plans were similar, throughout. However, the average normal brain volumes receiving 2.5 to 15 Gy were consistently lower for the 2.5mm MLC leaf width, especially for single isocenter plans. The clinical consequences of these integral normal brain tissue doses are still unknown, but employing the use of the 2.5mm MLC option is desirable at sparing normal brain tissue for both single and multiple isocenter cases.

  13. Spot Scanning Proton Therapy for Malignancies of the Base of Skull: Treatment Planning, Acute Toxicities, and Preliminary Clinical Outcomes

    SciTech Connect (OSTI)

    Grosshans, David R.; Zhu, X. Ronald; Melancon, Adam; Allen, Pamela K.; Poenisch, Falk; Palmer, Matthew; McAleer, Mary Frances; McGovern, Susan L.; Gillin, Michael; DeMonte, Franco; Chang, Eric L.; Brown, Paul D.; Mahajan, Anita

    2014-11-01

    Purpose: To describe treatment planning techniques and early clinical outcomes in patients treated with spot scanning proton therapy for chordoma or chondrosarcoma of the skull base. Methods and Materials: From June 2010 through August 2011, 15 patients were treated with spot scanning proton therapy for chordoma (n=10) or chondrosarcoma (n=5) at a single institution. Toxicity was prospectively evaluated and scored weekly and at all follow-up visits according to Common Terminology Criteria for Adverse Events, version 3.0. Treatment planning techniques and dosimetric data were recorded and compared with those of passive scattering plans created with clinically applicable dose constraints. Results: Ten patients were treated with single-field-optimized scanning beam plans and 5 with multifield-optimized intensity modulated proton therapy. All but 2 patients received a simultaneous integrated boost as well. The mean prescribed radiation doses were 69.8 Gy (relative biological effectiveness [RBE]; range, 68-70 Gy [RBE]) for chordoma and 68.4 Gy (RBE) (range, 66-70) for chondrosarcoma. In comparison with passive scattering plans, spot scanning plans demonstrated improved high-dose conformality and sparing of temporal lobes and brainstem. Clinically, the most common acute toxicities included fatigue (grade 2 for 2 patients, grade 1 for 8 patients) and nausea (grade 2 for 2 patients, grade 1 for 6 patients). No toxicities of grades 3 to 5 were recorded. At a median follow-up time of 27 months (range, 13-42 months), 1 patient had experienced local recurrence and a second developed distant metastatic disease. Two patients had magnetic resonance imaging-documented temporal lobe changes, and a third patient developed facial numbness. No other subacute or late effects were recorded. Conclusions: In comparison to passive scattering, treatment plans for spot scanning proton therapy displayed improved high-dose conformality. Clinically, the treatment was well tolerated, and with short-term follow-up, disease control rates and toxicity profiles were favorable.

  14. Normal Tissue Complication Probability Modeling of Radiation-Induced Hypothyroidism After Head-and-Neck Radiation Therapy

    SciTech Connect (OSTI)

    Bakhshandeh, Mohsen; Hashemi, Bijan; Mahdavi, Seied Rabi Mehdi; Nikoofar, Alireza; Vasheghani, Maryam; Kazemnejad, Anoshirvan

    2013-02-01

    Purpose: To determine the dose-response relationship of the thyroid for radiation-induced hypothyroidism in head-and-neck radiation therapy, according to 6 normal tissue complication probability models, and to find the best-fit parameters of the models. Methods and Materials: Sixty-five patients treated with primary or postoperative radiation therapy for various cancers in the head-and-neck region were prospectively evaluated. Patient serum samples (tri-iodothyronine, thyroxine, thyroid-stimulating hormone [TSH], free tri-iodothyronine, and free thyroxine) were measured before and at regular time intervals until 1 year after the completion of radiation therapy. Dose-volume histograms (DVHs) of the patients' thyroid gland were derived from their computed tomography (CT)-based treatment planning data. Hypothyroidism was defined as increased TSH (subclinical hypothyroidism) or increased TSH in combination with decreased free thyroxine and thyroxine (clinical hypothyroidism). Thyroid DVHs were converted to 2 Gy/fraction equivalent doses using the linear-quadratic formula with {alpha}/{beta} = 3 Gy. The evaluated models included the following: Lyman with the DVH reduced to the equivalent uniform dose (EUD), known as LEUD; Logit-EUD; mean dose; relative seriality; individual critical volume; and population critical volume models. The parameters of the models were obtained by fitting the patients' data using a maximum likelihood analysis method. The goodness of fit of the models was determined by the 2-sample Kolmogorov-Smirnov test. Ranking of the models was made according to Akaike's information criterion. Results: Twenty-nine patients (44.6%) experienced hypothyroidism. None of the models was rejected according to the evaluation of the goodness of fit. The mean dose model was ranked as the best model on the basis of its Akaike's information criterion value. The D{sub 50} estimated from the models was approximately 44 Gy. Conclusions: The implemented normal tissue complication probability models showed a parallel architecture for the thyroid. The mean dose model can be used as the best model to describe the dose-response relationship for hypothyroidism complication.

  15. MO-C-17A-06: Online Adaptive Re-Planning to Account for Independent Motions Between Multiple Targets During Radiotherapy of Lung Cancer

    SciTech Connect (OSTI)

    Liu, F; Tai, A; Ahunbay, E; Gore, E; Johnstone, C; Li, X

    2014-06-15

    Purpose: To quantify interfractional independent motions between multiple targets in radiotherapy (RT) of lung cancer, and to study the dosimetric benefits of an online adaptive replanning method to account for these variations. Methods: Ninety five diagnostic-quality daily CTs acquired for 9 lung cancer patients treated with IGRT using an in-room CT (CTVision, Siemens) were analyzed. On each daily CT set, contours of the targets (GTV, CTV, or involved nodes) and organs at risk were generated by populating the planning contours using an auto-segmentation tool (ABAS, Elekta) with manual editing. For each patient, an IMRT plan was generated based on the planning CT with a prescription dose of 60 Gy in 2Gy fractions. Three plans were generated and compared for each daily CT set: an IGRT (repositioning) plan by copying the original plan with the required shifts, an online adaptive plan by rapidly modifying the aperture shapes and segment weights of the original plan to conform to the daily anatomy, and a new fully re-optimized plan based on the daily CT using a planning system (Panther, Prowess). Results: The daily deviations of the distance between centers of masses of the targets from the plans varied daily from -10 to 8 mm with an average −0.9±4.1 mm (one standard deviation). The average CTV V100 are 99.0±0.7%, 97.9±2.8%, 99.0±0.6%, and 99.1±0.6%, and the lung V20 Gy 928±332 cc, 944±315 cc, 917±300 cc, and 891±295 cc for the original, repositioning, adaptive, and re-optimized plans, respectively. Wilcoxon signed-rank tests show that the adaptive plans are statistically significantly better than the repositioning plans and comparable with the reoptimized plans. Conclusion: There exist unpredictable, interfractional, relative volume changes and independent motions between multiple targets during lung cancer RT which cannot be accounted for by the current IGRT repositioning but can be corrected by the online adaptive replanning method.

  16. TH-C-18A-12: Evaluation of the Impact of Body Size and Tube Output Limits in the Optimization of Fast Scanning with High-Pitch Dual Source CT

    SciTech Connect (OSTI)

    Ramirez Giraldo, J; Mileto, A.; Hurwitz, L.; Marin, D.

    2014-06-15

    Purpose: To evaluate the impact of body size and tube power limits in the optimization of fast scanning with high-pitch dual source CT (DSCT). Methods: A previously validated MERCURY phantom, made of polyethylene, with circular cross-section of diameters 16, 23, 30 and 37cm, and connected through tapered sections, was scanned using a second generation DSCT system. The DSCT operates with two independently controlled x-ray tube generators offering up to 200 kW power reserve (100 kW per tube). The entire length of the phantom (42cm) was scanned with two protocols using: A)Standard single-source CT (SSCT) protocol with pitch of 0.8, and B) DSCT protocol with high-pitch values ranging from 1.6 to 3.2 (0.2 steps). All scans used 120 kVp with 150 quality reference mAs using automatic exposure control. Scanner radiation output (CTDIvol) and effective mAs values were extracted retrospectively from DICOM files for each slice. Image noise was recorded. All variables were assessed relative to phantom diameter. Results: With standard-pitch SSCT, the scanner radiation output (and tube-current) were progressively adapted with increasing size, from 6 mGy (120 mAs) up to 15 mGy (270 mAs) from the thinnest (16cm) to the thickest diameter (37 cm), respectively. By comparison, using high-pitch (3.2), the scanner output was bounded at about 8 mGy (140 mAs), independent of phantom diameter. Although relative to standard-pitch, the high-pitch led to lower radiation output for the same scan, the image noise was higher, particularly for larger diameters. To match the radiation output adaptation of standard-pitch, a high-pitch mode of 1.6 was needed, with the advantage of scanning twice as fast. Conclusion: To maximize the benefits of fast scanning with high-pitch DSCT, the body size and tube power limits of the system need to be considered such that a good balance between speed of acquisition and image quality are warranted. JCRG is an employee of Siemens Medical Solutions USA Inc.

  17. TH-E-BRF-03: A Multivariate Interaction Model for Assessment of Hippocampal Vascular Dose-Response and Early Prediction of Radiation-Induced Neurocognitive Dysfunction

    SciTech Connect (OSTI)

    Farjam, R; Pramanik, P; Srinivasan, A; Chapman, C; Tsien, C; Lawrence, T; Cao, Y

    2014-06-15

    Purpose: Vascular injury could be a cause of hippocampal dysfunction leading to late neurocognitive decline in patients receiving brain radiotherapy (RT). Hence, our aim was to develop a multivariate interaction model for characterization of hippocampal vascular dose-response and early prediction of radiation-induced late neurocognitive impairments. Methods: 27 patients (17 males and 10 females, age 31–80 years) were enrolled in an IRB-approved prospective longitudinal study. All patients were diagnosed with a low-grade glioma or benign tumor and treated by 3-D conformal or intensity-modulated RT with a median dose of 54 Gy (50.4–59.4 Gy in 1.8− Gy fractions). Six DCE-MRI scans were performed from pre-RT to 18 months post-RT. DCE data were fitted to the modified Toft model to obtain the transfer constant of gadolinium influx from the intravascular space into the extravascular extracellular space, Ktrans, and the fraction of blood plasma volume, Vp. The hippocampus vascular property alterations after starting RT were characterized by changes in the hippocampal mean values of, μh(Ktrans)τ and μh(Vp)τ. The dose-response, Δμh(Ktrans/Vp)pre->τ, was modeled using a multivariate linear regression considering integrations of doses with age, sex, hippocampal laterality and presence of tumor/edema near a hippocampus. Finally, the early vascular dose-response in hippocampus was correlated with neurocognitive decline 6 and 18 months post-RT. Results: The μh(Ktrans) increased significantly from pre-RT to 1 month post-RT (p<0.0004). The multivariate model showed that the dose effect on Δμh(Ktrans)pre->1M post-RT was interacted with sex (p<0.0007) and age (p<0.00004), with the dose-response more pronounced in older females. Also, the vascular dose-response in the left hippocampus of females was significantly correlated with memory function decline at 6 (r = − 0.95, p<0.0006) and 18 (r = −0.88, p<0.02) months post-RT. Conclusion: The hippocampal vascular response to radiation could be sex and age dependent. The early hippocampal vascular dose-response could predict late neurocognitive dysfunction. (Support: NIH-RO1NS064973)

  18. TU-F-17A-06: Motion Stability and Dosimetric Impact of Spirometer-Based DIBH-RT of Left-Sided Breast Cancer

    SciTech Connect (OSTI)

    McKenzie, E; Yang, W; Burnison, M; Mirhadi, A; Hakimian, B; Stephen, S; Robert, R; Yue, Y; Sandler, H; Fraass, B

    2014-06-15

    Purpose: Patients undergoing radiotherapy (RT) for left-sided breast cancer have increased risk of coronary artery disease. Deep Inhalation Breath Hold assisted RT (DIBH-RT) is shown to increase the geometric separation of the target area and heart, reducing cardiac radiation dose. The purposes of this study are to use Cine MV portal images to determine the stability of spirometer-guided DIBH-RT and examine the dosimetric cardiopulmonary impact of this technique. Methods: Twenty consecutive patients with left-sided breast cancer were recruited to the IRB-approved study. Free-breathing (FB) and DIBH-CT's were acquired at simulation. Rigid registration of the FB-CT and DIBH-CT was performed using primarily breast tissue. Treatment plans were created for each FB-CT and DIBH-CT using identical paired tangent fields with field-in-field or electronic compensation techniques. Dosimetric evaluation included mean and maximum (Dmax) doses for the left anterior descending artery (LAD), mean heart dose, and left lung V20. Cine MV portal images were acquired for medial and lateral fields during treatment. Analysis of Cine images involved chest wall segmentation using an algorithm developed in-house. Intra- and inter-fractional chest wall motion were determined through affine registration to the first frame of each Cine. Results: Dose to each cardiac structure evaluated was significantly (p<0.001) reduced with the DIBH plans. Mean heart dose decreased from 2.9(0.96.6) to 1.6(0.65.3) Gy; mean LAD dose from 16.6(343.6) to 7.4(1.732.7) Gy; and LAD Dmax from 35.4 (6.153) to 18.4(2.551.2) Gy. No statistically significant reduction was found for the left lung V20. Average AP and SI median chest wall motion (intrafractional) was 0.1 (SD=0.9) and 0.5 (SD=1.1) mm, respectively. Average AP inter-fractional chest wall motion was 2.0 (SD=1.4) mm. Conclusion: Spirometer-based DIBH treatments of the left breast are reproducible both inter- and intra-fractionally, and provide a statistically and potentially clinically useful dosimetric advantage to cardiac structures.

  19. From iron(III) precursor to magnetite and vice versa

    SciTech Connect (OSTI)

    Gotic, M.; Jurkin, T.; Music, S.

    2009-10-15

    The syntheses of nanosize magnetite particles by wet-chemical oxidation of Fe{sup 2+} have been extensively investigated. In the present investigation the nanosize magnetite particles were synthesised without using the Fe(II) precursor. This was achieved by {gamma}-irradiation of water-in-oil microemulsion containing only the Fe(III) precursor. The corresponding phase transformations were monitored. Microemulsions (pH {approx} 12.5) were {gamma}-irradiated at a relatively high dose rate of {approx}22 kGy/h. Upon 1 h of {gamma}-irradiation the XRD pattern of the precipitate showed goethite and unidentified low-intensity peaks. Upon 6 h of {gamma}-irradiation, reductive conditions were achieved and substoichiometric magnetite ({approx}Fe{sub 2.71}O{sub 4}) particles with insignificant amount of goethite particles found in the precipitate. Hydrated electrons (e{sub aq}{sup -}), organic radicals and hydrogen gas as radiolytic products were responsible for the reductive dissolution of iron oxide in the microemulsion and the reduction Fe{sup 3+} {yields} Fe{sup 2+}. Upon 18 h of {gamma}-irradiation the precipitate exhibited dual behaviour, it was a more oxidised product than the precipitate obtained after 6 h of {gamma}-irradiation, but it contained magnetite particles in a more reduced form ({approx}Fe{sub 2.93}O{sub 4}). It was presumed that the reduction and oxidation processes existed as concurrent competitive processes in the microemulsion. After 18 h of {gamma}-irradiation the pH of the medium shifted from the alkaline to the acidic range. The high dose rate of {approx}22 kGy/h was directly responsible for this shift to the acidic range. At a slightly acidic pH a further reduction of Fe{sup 3+} {yields} Fe{sup 2+} resulted in the formation of more stoichiometric magnetite particles, whereas the oxidation conditions in the acidic medium permitted the oxidation Fe{sup 2+} {yields} Fe{sup 3+}. The Fe{sup 3+} was much less soluble in the acidic medium and it hydrolysed and recrystallised as goethite. The {gamma}-irradiation of the microemulsion for 25 h at a lower dose rate of 16 kGy/h produced pure substoichiometric nanosize magnetite particles of about 25 nm in size and with the stoichiometry of Fe{sub 2.83}O{sub 4}.

  20. SU-E-T-121: Dosimetric Characterization of Gafchromic Film EBT3 Using Vidar DosimetryPro Advantage RED and EPSON Expression 10000XL Scanners

    SciTech Connect (OSTI)

    Medina, L; Adrada, A; Filipuzzi, M; Garrigo, E; Venencia, C

    2014-06-01

    Purpose: The purpose of this paper is to characterize EBT3 using two types of scanner, analyzing the factors of influence of each dosimetry system. Methods: The film used in this study was GAFCHROMIC EBT3, the films were exposed at a dose range between 0Gy a 9Gy in a solid water phantom, SSD=100cm, 5cm depth and perpendicularly to the 6MV photon beam generated by a Novalis TX linear accelerator equipped with an HDMLC. A Farmer type ion chamber TN30013 (PTW) was used to determine the dose delivered to the film. The films were digitized with a scanner EPSON expression 10000XL and the VIDAR DosimetryPro Adventage RED. Software RIT113v6.1 was used for construction of the calibration curve and analysis. The film characteristics investigated were: response at different dose levels, sensitivity to orientation and side and resolution through the results of the spatial response function by analyzing a step pattern. Additionally, 20 IMRT treatment fields were measured with both scanner and compared with calculated dose using gamma index analysis (3%-3mm). Results: The OD obtained for dose level 2Gy in the orientation portrait of the film on the scanner EPSON is (0,2220,19) and for Vidar RED (0,2520,10) and landscape is for EPSON (0,2110,25) and for Vidar RED (0,2500,11) . The orientation dependence with respect to film side is about 0,09% for EPSON and about 0.03% for VIDAR. The spatial response function increase in response to the Gaussian function FWHM EPSON scanner (0.18mm) compared with VIDAR scanner function (less than 0.06mm) was observed. We analyzed 20 total plan dose distributions the number of pixels with gamma>1 (3%-3mm) was 0.7%1.2 [0.1%; 2.82%] for EBT3-VIDAR y 2%2.9 [0.2%; 3.5%] for EBT3-EPSON. Conclusion: VIDAR scanner shows better sensitivity. EBT3 film shows a different response between portrait and landscape orientation. Step pattern is better reproduce by VIDAR scanner.

  1. ANALYSIS OF EPR AND FISH STUDIES OF RADIATION DOSES IN PERSONS WHO LIVED IN THE UPPER REACHES OF THE TECHA RIVER

    SciTech Connect (OSTI)

    Degteva, M. O.; Shagina, N. B.; Shishkina, Elena A.; Vozilova, Alexandra; Volchkova, A. Y.; Vorobiova, M. I.; Wieser, Albrecht; Fattibene, Paola; Della Monaca, S.; Ainsbury, E.; Moquet, J.; Anspaugh, L. R.; Napier, Bruce A.

    2015-07-24

    Waterborne radioactive releases into the Techa River from the Mayak Production Association in Russia during 1949–1956 resulted in significant doses to about 30,000 persons who lived in downstream settlements. The residents were exposed to internal and external radiation. Two methods for reconstruction of the external dose are considered in this paper, electron paramagnetic resonance (EPR) measurements of teeth and fluorescence in situ hybridization (FISH) measurements of chromosome translocations in circulating lymphocytes. The main issue in the application of the EPR and FISH methods for reconstruction of the external dose for the Techa Riverside residents was strontium radioisotopes incorporated in teeth and bones that served as a source of confounding local exposures. In order to estimate and subtract doses from incorporated 89,90Sr, the EPR and FISH assays were supported by measurements of 90Sr-body burdens and estimates of 90Sr concentrations in dental tissues by the luminescence method. The resulting dose estimates derived from EPR and FISH measurements for residents of the upper Techa River were found to be consistent: the mean values vary from 510 – 550 mGy for the villages located close to the site of radioactive release to 130 – 160 mGy for the more distant villages. The upper bound of individual estimates for both methods is equal to 2.2 – 2.3 Gy. The EPR- and FISH-based dose estimates were compared with the doses calculated for the donors using the Techa River Dosimetry System (TRDS). The TRDS external dose assessments were based on the data on contamination of the Techa River floodplain, simulation of ai r kerma above the contaminated soil, age-dependent life-styles and individual residence histories. For correct comparison TRDS-based doses were calculated from two sources: external exposure from the contaminated environment and internal exposure from 137Cs incorporated in donors’ soft tissues. The TRDS-based absorbed doses in tooth enamel and muscle were in agreement with with EPR- and FISH-based estimates within uncertainty bounds. Basically, the agreement between the estimates has confirmed the validity of external doses calculated with the Techa River Dosimetry System.

  2. Dosimetric Predictors of Duodenal Toxicity After Intensity Modulated Radiation Therapy for Treatment of the Para-aortic Nodes in Gynecologic Cancer

    SciTech Connect (OSTI)

    Verma, Jonathan [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Sulman, Erik P.; Jhingran, Anuja [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rauch, Gaiane M. [Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eifel, Patricia J. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Klopp, Ann H., E-mail: aklopp@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-02-01

    Purpose: To determine the incidence of duodenal toxicity in patients receiving intensity modulated radiation therapy (IMRT) for treatment of para-aortic nodes and to identify dosimetric parameters predictive of late duodenal toxicity. Methods and Materials: We identified 105 eligible patients with gynecologic malignancies who were treated with IMRT for gross metastatic disease in the para-aortic nodes from January 1, 2005, through December 31, 2009. Patients were treated to a nodal clinical target volume to 45 to 50.4 Gy with a boost to 60 to 66 Gy. The duodenum was contoured, and dosimetric data were exported for analysis. Duodenal toxicity was scored according to Radiation Therapy Oncology Group criteria. Univariate Cox proportional hazards analysis and recursive partitioning analysis were used to determine associations between dosimetric variables and time to toxicity and to identify the optimal threshold that separated patients according to risk of toxicity. Results: Nine of the 105 patients experienced grade 2 to grade 5 duodenal toxicity, confirmed by endoscopy in all cases. The 3-year actuarial rate of any duodenal toxicity was 11.7%. A larger volume of the duodenum receiving 55 Gy (V55) was associated with higher rates of duodenal toxicity. The 3-year actuarial rates of duodenal toxicity with V55 above and below 15 cm{sup 3} were 48.6% and 7.4%, respectively (P<.01). In Cox univariate analysis of dosimetric variables, V55 was associated with duodenal toxicity (P=.029). In recursive partitioning analysis, V55 less than 13.94% segregated all patients with duodenal toxicity. Conclusions: Dose-escalated IMRT can safely and effectively treat para-aortic nodal disease in gynecologic malignancies, provided that care is taken to limit the dose to the duodenum to reduce the risk of late duodenal toxicity. Limiting V55 to below 15 cm{sup 3} may reduce the risk of duodenal complications. In cases where the treatment cannot be delivered within these constraints, consideration should be given to other treatment approaches such as resection or initial chemotherapy.

  3. Technology on In-Situ Gas Generation to Recover Residual Oil Reserves

    SciTech Connect (OSTI)

    Sayavur Bakhtiyarov

    2008-02-29

    This final technical report covers the period October 1, 1995 to February 29, 2008. This chapter begins with an overview of the history of Enhanced Oil Recovery techniques and specifically, CO2 flood. Subsequent chapters conform to the manner consistent with the Activities, Tasks, and Sub-tasks of the project as originally provided in Exhibit C1 in the Project Management Plan dated September 20, 1995. These chapters summarize the objectives, status and conclusions of the major project activities performed during the project period. The report concludes by describing technology transfer activities stemming from the project and providing a reference list of all publications of original research work generated by the project team or by others regarding this project. The overall objective of this project was a final research and development in the United States a technology that was developed at the Institute for Geology and Development of Fossil Fuels in Moscow, Russia. Before the technology can be convincingly adopted by United States oil and gas producers, the laboratory research was conducted at Mew Mexico Institute of Mining and Technology. The experimental studies were conducted to measure the volume and the pressure of the CO{sub 2} gas generated according to the new Russian technology. Two experimental devices were designed, built and used at New Mexico Tech facilities for these purposes. The designed setup allowed initiating and controlling the reaction between the 'gas-yielding' (GY) and 'gas-forming' (GF) agents proposed by Russian technology. The temperature was controlled, and the generated gas pressure and volume were recorded during the reaction process. Additionally, the effect of surfactant addition on the effectiveness of the process was studied. An alternative GY reactant was tested in order to increase the efficiency of the CO2 gas generation process. The slim tube and the core flood experimental studies were conducted to define the sweep efficiency of the in-situ generated CO{sub 2} gas. A set of core flood experiments were conducted to define effect of surfactant on recovery efficiency. The results demonstrated obvious advantages of the foamy system over the brine solution in order to achieve higher sweep efficiency and recovery coefficient. It is shown that a slug injection is not an efficient method for mixing GY and GF solutions and it can't generate considerable gas inside the slim-tube.

  4. SU-E-J-214: Comparative Assessment On IGRT On Partial Bladder Cancer Treatment Between CT-On-Rails (CTOR) and KV Cone Beam CT (CBCT)

    SciTech Connect (OSTI)

    Lin, T; Ma, C

    2014-06-01

    Purpose: Image-Guided radiation therapy(IGRT) depends on reliable online patient-specific anatomy information to address random and progressive anatomy changes. Large margins have been suggested to bladder cancer treatment due to large daily bladder anatomy variation. KV Cone beam CT(CBCT) has been used in IGRT localization prevalently; however, its lack of soft tissue contrast makes clinicians hesitate to perform daily soft tissue alignment with CBCT for partial bladder cancer treatment. This study compares the localization uncertainties of bladder cancer IGRT using CTon- Rails(CTOR) and CBCT. Methods: Three T2N0M0 bladder cancer patients (total of 66 Gy to partial bladder alone) were localized daily with either CTOR or CBCT for their entire treatment course. A total of 71 sets of CTOR and 22 sets of CBCT images were acquired and registered with original planning CT scans by radiation therapists and approved by radiation oncologists for the daily treatment. CTOR scanning entailed 2mm slice thickness, 0.98mm axial voxel size, 120kVp and 240mAs. CBCT used a half fan pelvis protocol from Varian OBI system with 2mm slice thickness, 0.98axial voxel size, 125kVp, and 680mAs. Daily localization distribution was compared. Accuracy of CTOR and CBCT on partial bladder alignment was also evaluated by comparing bladder PTV coverage. Results: 1cm all around PTV margins were used in every patient except target superior limit margin to 0mm due to bowel constraint. Daily shifts on CTOR averaged to 0.48, 0.24, 0.19 mms(SI,Lat,AP directions); CBCT averaged to 0.43, 0.09, 0.19 mms(SI,Lat,AP directions). The CTOR daily localization showed superior results of V100% of PTV(102% CTOR vs. 89% CBCT) and bowel(Dmax 69.5Gy vs. 78Gy CBCT). CTOR images showed much higher contrast on bladder PTV alignment. Conclusion: CTOR daily localization for IGRT is more dosimetrically beneficial for partial bladder cancer treatment than kV CBCT localization and provided better soft tissue PTV identification.

  5. Direct 2-Arm Comparison Shows Benefit of High-Dose-Rate Brachytherapy Boost vs External Beam Radiation Therapy Alone for Prostate Cancer

    SciTech Connect (OSTI)

    Khor, Richard; Duchesne, Gillian; Monash University, Melbourne ; Tai, Keen-Hun; Foroudi, Farshad; Chander, Sarat; Van Dyk, Sylvia; Garth, Margaret; Williams, Scott

    2013-03-01

    Purpose: To evaluate the outcomes of patients treated for intermediate- and high-risk prostate cancer with a single schedule of either external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDRB) boost or EBRT alone. Methods and Materials: From 2001-2006, 344 patients received EBRT with HDRB boost for definitive treatment of intermediate- or high-risk prostate cancer. The prescribed EBRT dose was 46 Gy in 23 fractions, with a HDR boost of 19.5 Gy in 3 fractions. This cohort was compared to a contemporaneously treated cohort who received EBRT to 74 Gy in 37 fractions, using a matched pair analysis. Three-dimensional conformal EBRT was used. Matching was performed using a propensity score matching technique. High-risk patients constituted 41% of the matched cohorts. Five-year clinical and biochemical outcomes were analyzed. Results: Initial significant differences in prognostic indicators between the unmatched treatment cohorts were rendered negligible after matching, providing a total of 688 patients. Median biochemical follow-up was 60.5 months. The 5-year freedom from biochemical failure was 79.8% (95% confidence interval [CI], 74.3%-85.0%) and 70.9% (95% CI, 65.4%-76.0%) for the HDRB and EBRT groups, respectively, equating to a hazard ratio of 0.59 (95% CI, 0.43-0.81, P=.0011). Interaction analyses showed no alteration in HDR efficacy when planned androgen deprivation therapy was administered (P=.95), but a strong trend toward reduced efficacy was shown compared to EBRT in high-risk cases (P=.06). Rates of grade 3 urethral stricture were 0.3% (95% CI, 0%-0.9%) and 11.8% (95% CI, 8.1%-16.5%) for EBRT and HDRB, respectively (P<.0001). No differences in clinical outcomes were observed. Conclusions: This comparison of 2 individual contemporaneously treated HDRB and EBRT approaches showed improved freedom from biochemical progression with the HDR approach. The benefit was more pronounced in intermediate- risk patients but needs to be weighed against an increased risk of urethral toxicity.

  6. TU-F-12A-04: Differential Radiation Avoidance of Functional Liver Regions Defined by 99mTc-Sulfur Colloid SPECT/CT with Proton Therapy

    SciTech Connect (OSTI)

    Bowen, S; Miyaoka, R; Kinahan, P; Sandison, G; Vesselle, H; Nyflot, M; Apisarnthanarax, S; Saini, J; Wong, T

    2014-06-15

    Purpose: Radiotherapy for hepatocellular carcinoma patients is conventionally planned without consideration of spatial heterogeneity in hepatic function, which may increase risk of radiation-induced liver disease. Pencil beam scanning (PBS) proton radiotherapy (pRT) plans were generated to differentially decrease dose to functional liver volumes (FLV) defined on [{sup 99m}Tc]sulfur colloid (SC) SPECT/CT images (functional avoidance plans) and compared against conventional pRT plans. Methods: Three HCC patients underwent SC SPECT/CT scans for pRT planning acquired 15 min post injection over 24 min. Images were reconstructed with OSEM following scatter, collimator, and exhale CT attenuation correction. Functional liver volumes (FLV) were defined by liver:spleen uptake ratio thresholds (43% to 90% maximum). Planning objectives to FLV were based on mean SC SPECT uptake ratio relative to GTV-subtracted liver and inversely scaled to mean liver dose of 20 Gy. PTV target coverage (V{sub 95}) was matched between conventional and functional avoidance plans. PBS pRT plans were optimized in RayStation for single field uniform dose (SFUD) and systematically perturbed to verify robustness to uncertainty in range, setup, and motion. Relative differences in FLV DVH and target dose heterogeneity (D{sub 2}-D{sub 98})/D50 were assessed. Results: For similar liver dose between functional avoidance and conventional PBS pRT plans (D{sub mean}?5% difference, V{sub 18Gy}?1% difference), dose to functional liver volumes were lower in avoidance plans but varied in magnitude across patients (FLV{sub 70%max} D{sub mean}?26% difference, V{sub 18Gy}?8% difference). Higher PTV dose heterogeneity in avoidance plans was associated with lower functional liver dose, particularly for the largest lesion [(D{sub 2}-D{sub 98})/D{sub 50}=13%, FLV{sub 90%max}=50% difference]. Conclusion: Differential avoidance of functional liver regions defined on sulfur colloid SPECT/CT is feasible with proton therapy. The magnitude of benefit appears to be patient specific and dependent on tumor location, size, and proximity to functional volumes. Further investigation in a larger cohort of patients may validate the clinical utility of functional avoidance planning of HCC radiotherapy.

  7. First Evaluation of the Biologic Effectiveness Factors of Boron Neutron Capture Therapy (BNCT) in a Human Colon Carcinoma Cell Line

    SciTech Connect (OSTI)

    Dagrosa, Maria Alejandra; Crivello, Martin; Perona, Marina; Thorp, Silvia; Santa Cruz, Gustavo Alberto; Pozzi, Emiliano; Casal, Mariana; Thomasz, Lisa; Cabrini, Romulo; Kahl, Steven; Juvenal, Guillermo Juan; Pisarev, Mario Alberto

    2011-01-01

    Purpose: DNA lesions produced by boron neutron capture therapy (BNCT) and those produced by gamma radiation in a colon carcinoma cell line were analyzed. We have also derived the relative biologic effectiveness factor (RBE) of the neutron beam of the RA-3- Argentine nuclear reactor, and the compound biologic effectiveness (CBE) values for p-boronophenylalanine ({sup 10}BPA) and for 2,4-bis ({alpha},{beta}-dihydroxyethyl)-deutero-porphyrin IX ({sup 10}BOPP). Methods and Materials: Exponentially growing human colon carcinoma cells (ARO81-1) were distributed into the following groups: (1) BPA (10 ppm {sup 10}B) + neutrons, (2) BOPP (10 ppm {sup 10}B) + neutrons, (3) neutrons alone, and (4) gamma rays ({sup 60}Co source at 1 Gy/min dose-rate). Different irradiation times were used to obtain total absorbed doses between 0.3 and 5 Gy ({+-}10%) (thermal neutrons flux = 7.5 10{sup 9} n/cm{sup 2} sec). Results: The frequency of micronucleated binucleated cells and the number of micronuclei per micronucleated binucleated cells showed a dose-dependent increase until approximately 2 Gy. The response to gamma rays was significantly lower than the response to the other treatments (p < 0.05). The irradiations with neutrons alone and neutrons + BOPP showed curves that did not differ significantly from, and showed less DNA damage than, irradiation with neutrons + BPA. A decrease in the surviving fraction measured by 3-(4,5-dimetiltiazol-2-il)-2,5-difeniltetrazolium bromide (MTT) assay as a function of the absorbed dose was observed for all the treatments. The RBE and CBE factors calculated from cytokinesis block micronucleus (CBMN) and MTT assays were, respectively, the following: beam RBE: 4.4 {+-} 1.1 and 2.4 {+-} 0.6; CBE for BOPP: 8.0 {+-} 2.2 and 2.0 {+-} 1; CBE for BPA: 19.6 {+-} 3.7 and 3.5 {+-} 1.3. Conclusions: BNCT and gamma irradiations showed different genotoxic patterns. To our knowledge, these values represent the first experimental ones obtained for the RA-3 in a biologic model and could be useful for future experimental studies for the application of BNCT to colon carcinoma.

  8. Probability of double-strand breaks in genome-sized DNA by {gamma}-ray decreases markedly as the DNA concentration increases

    SciTech Connect (OSTI)

    Shimobayashi, Shunsuke F.; Iwaki, Takafumi; Mori, Toshiaki; Yoshikawa, Kenichi

    2013-05-07

    By use of the single-molecule observation, we count the number of DNA double-strand breaks caused by {gamma}-ray irradiation with genome-sized DNA molecules (166 kbp). We find that P{sub 1}, the number of double-strand breaks (DSBs) per base pair per unit Gy, is nearly inversely proportional to the DNA concentration above a certain threshold DNA concentration. The inverse relationship implies that the total number of DSBs remains essentially constant. We give a theoretical interpretation of our experimental results in terms of attack of reactive species upon DNA molecules, indicating the significance of the characteristics of genome-sized giant DNA as semiflexible polymers for the efficiency of DSBs.

  9. Neutron and gamma irradiation damage to organic materials.

    SciTech Connect (OSTI)

    White, Gregory Von, II; Bernstein, Robert

    2012-04-01

    This document discusses open literature reports which investigate the damage effects of neutron and gamma irradiation on polymers and/or epoxies - damage refers to reduced physical chemical, and electrical properties. Based on the literature, correlations are made for an SNL developed epoxy (Epon 828-1031/DDS) with an expected total fast-neutron fluence of {approx}10{sup 12} n/cm{sup 2} and a {gamma} dosage of {approx}500 Gy received over {approx}30 years at < 200 C. In short, there are no gamma and neutron irradiation concerns for Epon 828-1031/DDS. To enhance the fidelity of our hypotheses, in regards to radiation damage, we propose future work consisting of simultaneous thermal/irradiation (neutron and gamma) experiments that will help elucidate any damage concerns at these specified environmental conditions.

  10. Image

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

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  11. Plasma induced DNA damage: Comparison with the effects of ionizing radiation

    SciTech Connect (OSTI)

    Lazovi?, S.; Maleti?, D.; Pua?, N.; Malovi?, G.; Petrovi?, Z. Lj.; Leskovac, A.; Filipovi?, J.; Joksi?, G.

    2014-09-22

    We use human primary fibroblasts for comparing plasma and gamma rays induced DNA damage. In both cases, DNA strand breaks occur, but of fundamentally different nature. Unlike gamma exposure, contact with plasma predominantly leads to single strand breaks and base-damages, while double strand breaks are mainly consequence of the cell repair mechanisms. Different cell signaling mechanisms are detected confirming this (ataxia telangiectasia mutated - ATM and ataxia telangiectasia and Rad3 related - ATR, respectively). The effective plasma doses can be tuned to match the typical therapeutic doses of 2?Gy. Tailoring the effective dose through plasma power and duration of the treatment enables safety precautions mainly by inducing apoptosis and consequently reduced frequency of micronuclei.

  12. Fat to muscle ratio measurements with dual energy x-ray absorbtiometry

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Chen, A.; Luo, J.; Wang, A.; Broadbent, C.; Zhong, J.; Dilmanian, F. A.; Zafonte, F.; Zhong, Z.

    2015-03-14

    Accurate measurement of the fat-to-muscle ratio in animal model is important for obesity research. In addition, an efficient way to measure the fat to muscle ratio in animal model using dual-energy absorptiometry is presented in this paper. A radioactive source exciting x-ray fluorescence from a target material is used to provide the two x-ray energies needed. The x-rays, after transmitting through the sample, are measured with an energy-sensitive Ge detector. Phantoms and specimens were measured. The results showed that the method was sensitive to the fat to muscle ratios with good linearity. A standard deviation of a few percent inmore » the fat to muscle ratio could be observed with the x-ray dose of 0.001 mGy.« less

  13. The increase in animal mortality risk following exposure to sparsely ionizing radiation is not linear quadratic with dose

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Haley, Benjamin M.; Paunesku, Tatjana; Grdina, David J.; Woloschak, Gayle E.; Aravindan, Natarajan

    2015-12-09

    The US government regulates allowable radiation exposures relying, in large part, on the seventh report from the committee to estimate the Biological Effect of Ionizing Radiation (BEIR VII), which estimated that most contemporary exposures- protracted or low-dose, carry 1.5 fold less risk of carcinogenesis and mortality per Gy than acute exposures of atomic bomb survivors. This correction is known as the dose and dose rate effectiveness factor for the life span study of atomic bomb survivors (DDREFLSS). As a result, it was calculated by applying a linear-quadratic dose response model to data from Japanese atomic bomb survivors and a limitedmore » number of animal studies.« less

  14. DOE

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    /E/A- 0202( 83//Q J Sh or t-T er m En er gy O ut lo ok a to m Quar terly Proje ction s Febru ary 1983 Ene rgy Info rma tion Adm inist ratio n Was hing ton, D.C. t rt jrt .or t lor t lor t .lor t- ior t- ior t <.o rt ort . m .er m -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -T erm -T erm -T erm Nrm ue rgy En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg

  15. NATIONAL GEOTHERMAL DATA SYSTEM (NGDS) GEOTHERMAL DATA DOMAIN: ASSESSMENT OF GEOTHERMAL COMMUNITY DATA NEEDS

    SciTech Connect (OSTI)

    Anderson, Arlene; Blackwell, David; Chickering, Cathy; Boyd, Toni; Horne, Roland; MacKenzie, Matthew; Moore, Joseph; Nickull, Duane; Richard, Stephen; Shevenell, Lisa A.

    2013-01-01

    To satisfy the critical need for geothermal data to ad- vance geothermal energy as a viable renewable ener- gy contender, the U.S. Department of Energy is in- vesting in the development of the National Geother- mal Data System (NGDS). This paper outlines efforts among geothermal data providers nationwide to sup- ply cutting edge geo-informatics. NGDS geothermal data acquisition, delivery, and methodology are dis- cussed. In particular, this paper addresses the various types of data required to effectively assess geother- mal energy potential and why simple links to existing data are insufficient. To create a platform for ready access by all geothermal stakeholders, the NGDS in- cludes a work plan that addresses data assets and re- sources of interest to users, a survey of data provid- ers, data content models, and how data will be ex- changed and promoted, as well as lessons learned within the geothermal community.

  16. Total skin electron beam therapy using an inclinable couch on motorized table and a compensating filter

    SciTech Connect (OSTI)

    Fuse, H.; Suzuki, K.; Shida, K.; Takahashi, H.; Kobayashi, D.; Seki, M.; Mori, Y.; Sakae, T.; Isobe, T.; Okumura, T.; Sakurai, H.

    2014-06-15

    Total skin electron beam is a specialized technique that involves irradiating the entire skin from the skin surface to only a few millimetres in depth. In the Stanford technique, the patient is in a standing position and six different directional positions are used during treatment. Our technique uses large electron beams in six directions with an inclinable couch on motorized table and a compensating filter was also used to spread the electron beam and move its intensity peak. Dose uniformity measurements were performed using Gafchromic films which indicated that the surface dose was 2.04 0.05 Gy. This technique can ensure the dose reproducibility because the patient is fixed in place using an inclinable couch on a motorized table.

  17. A survey of films for use as dosimeters in interventional radiology

    SciTech Connect (OSTI)

    Fajardo, L.C.; Geise, R.A.; Ritenour, E.R.

    1995-04-01

    Analysis of radiation doses in interventional radiological procedures that can lead to deterministic radiation effects such as erythema and epilation would assist physicians in planning patient care after exposure and in reducing doses. Photographic films used to measure skin exposure in the past are too sensitive for the high doses involved in interventional procedures. Seventeen different types of films, many of which are generally available in hospitals, were surveyed to see if any would meet the demands of interventional radiology. Sensitometric curves obtained demonstrate that most films are inappropriate for high dose procedures. Using Kodak Fine Grain Positive and Deupont duplicating films and automatic processing, doses as high as 2.8 Gy could be measured with reasonable accuracy. Similar results can be obtained by manually processing Kodak XV-2 verification film at room temperature.

  18. Transient Radiation Darkening Features in VISAR Window

    SciTech Connect (OSTI)

    G. D. Stevens; K. J. Moy

    2001-06-01

    We have studied and characterized radiation-induced changes in the index of refraction of materials used in Z experiments. Interferometric measurements of the radiation-induced change in the real part, n, of the complex index of refraction, N = n + iK, have been made in lithium fluoride (LiF), sapphire, and fused silica samples. Our results indicate that the index changes are small, with {delta}n/n {approx} 1 x 10{sup -5}/kGy. In addition, we have characterized the dose dependence of the radiation-induced transient radiation darkening (TRD) of these materials, which is related to K, the imaginary part of the refractive index. We have also measured time-resolved spectral profiles of TRD in LiF and sapphire, and have examined the results in terms of known color centers and possible colloid aggregation.

  19. Characterization of TLD-100 micro-cubes for use in small field dosimetry

    SciTech Connect (OSTI)

    Peña-Jiménez, Salvador Gamboa-deBuen, Isabel; Lárraga-Gutiérrez, José Manuel E-mail: amanda.garcia.g@gmail.com; García-Garduño, Olivia Amanda E-mail: amanda.garcia.g@gmail.com

    2014-11-07

    At present there are no international regulations for the management of millimeter scale fields and there are no suggestions for a reference detector to perform the characterization and dose determination for unconventional radiation beams (small fields) so that the dosimetry of small fields remains an open research field worldwide because these fields are used in radiotherapy treatments. Sensitivity factors and reproducibility of TLD-100 micro-cubes (1×1×1 mm3) were determinate irradiating the dosimeters with a 6 MV beam in a linear accelerator dedicated to radiosurgery at the Instituto Nacional de Neurología y Neurocirugía (INNN). Thermoluminescent response as a function of dose was determined for doses in water between 0.5 and 3 Gy and two field sizes (2×2 cm2 and 10×10 cm2). It was found that the response is linear over the dose range studied and it does not depend on field size.

  20. Mechanisms underlying cellular responses of cells from haemopoietic tissue to low

    SciTech Connect (OSTI)

    Kadhim, Munira A

    2012-08-22

    The above studies will provide fundamental mechanistic information relating genetic predisposition to important low dose phenomena, and will aid in the development of Department of Energy policy, as well as radiation risk policy for the public and the workplace. We believe the proposed studies accurately reflect the goals of the DOE low dose program. To accurately define the risks associated with human exposure to relevant environmental doses of low LET ionizing radiation, it is necessary to completely understand the biological effects at very low doses (i.e. less than 0.1 Gy), including the lowest possible dose, that of a single electron track traversal. At such low doses, a range of studies have shown responses in biological systems which are not related to the direct interaction of radiation tracks with DNA. The role of these "œnon-targeted" responses in critical tissues is poorly understood and little is known regarding the underlying mechanisms. Although critical for dosimetry and risk assessment, the role of individual genetic susceptibility in radiation risk is not satisfactorily defined at present. The aim of the proposed grant is to critically evaluate non-targeted effects of ionizing radiation with a focus on the induction of genomic instability (GI) in key stem cell populations from haemopoietic tissue. Using stem cells from two mouse strains (CBA/CaH and C57BL/6J) known to differ in their susceptibility to radiation effects, we plan to carefully dissect the role of genetic predisposition in these models on genomic instability. We will specifically focus on the effects of low doses of low LET radiation, down to the dose of 10mGy (0.01Gy) X-rays. Using conventional X-ray and we will be able to assess the role of genetic variation under various conditions at a range of doses down to the very low dose of 0.01Gy. Irradiations will be carried out using facilities in routine operation for such studies. Mechanistic studies of instability in different cell lineages will include the role of cytokines which have been shown to be in the initiation of instability. These studies also aim to uncover the possible mechanism of the initiation, perpetuation and delayed pathways of the instability response using relevant biological endpoints i.e. chromosomal instability, apoptosis induction, cytokine and gene array analysis. Integral to these studies will be an assessment of the role of genetic susceptibility in these responses, using CBA/CaH and C57BL/6J mice. The overall results suggest that low dose low LET X-irradiation induced delayed GI in both CBA/CaH and C57BL/6J haemopoeitic tissue. Using several biological approaches, some key strain and dose-specific differences have been identified in radiation-induced signalling in the initiation and perpetuation of the instability process. Furthermore, the induction of non-targeted radiation effects and genetic dependency may be linked to the use of alternative signalling pathways and mechanisms which have potential implications on evaluation of non-targeted effects in radiation risk assessment.

  1. Evaluating iterative reconstruction performance in computed tomography

    SciTech Connect (OSTI)

    Chen, Baiyu Solomon, Justin; Ramirez Giraldo, Juan Carlos; Samei, Ehsan

    2014-12-15

    Purpose: Iterative reconstruction (IR) offers notable advantages in computed tomography (CT). However, its performance characterization is complicated by its potentially nonlinear behavior, impacting performance in terms of specific tasks. This study aimed to evaluate the performance of IR with both task-specific and task-generic strategies. Methods: The performance of IR in CT was mathematically assessed with an observer model that predicted the detection accuracy in terms of the detectability index (d′). d′ was calculated based on the properties of the image noise and resolution, the observer, and the detection task. The characterizations of image noise and resolution were extended to accommodate the nonlinearity of IR. A library of tasks was mathematically modeled at a range of sizes (radius 1–4 mm), contrast levels (10–100 HU), and edge profiles (sharp and soft). Unique d′ values were calculated for each task with respect to five radiation exposure levels (volume CT dose index, CTDI{sub vol}: 3.4–64.8 mGy) and four reconstruction algorithms (filtered backprojection reconstruction, FBP; iterative reconstruction in imaging space, IRIS; and sinogram affirmed iterative reconstruction with strengths of 3 and 5, SAFIRE3 and SAFIRE5; all provided by Siemens Healthcare, Forchheim, Germany). The d′ values were translated into the areas under the receiver operating characteristic curve (AUC) to represent human observer performance. For each task and reconstruction algorithm, a threshold dose was derived as the minimum dose required to achieve a threshold AUC of 0.9. A task-specific dose reduction potential of IR was calculated as the difference between the threshold doses for IR and FBP. A task-generic comparison was further made between IR and FBP in terms of the percent of all tasks yielding an AUC higher than the threshold. Results: IR required less dose than FBP to achieve the threshold AUC. In general, SAFIRE5 showed the most significant dose reduction potentials (11–54 mGy, 77%–84%), followed by SAFIRE3 (7–36 mGy, 50%–61%) and IRIS (6–26 mGy, 37%–50%). The dose reduction potentials highly depended on task size and task contrast, with tasks of lower contrasts and smaller sizes, i.e., more challenging tasks, indicating higher dose reductions. Softer edge profile showed higher dose reduction potentials with SAFIRE3 and SAFIRE5, but not with IRIS. The task-generic comparison between IR and FBP demonstrated the overall superiority of IR performance, as IR allowed a larger percent of tasks to exceed the threshold AUC: IRIS, 8%–12%; SAFIRE3, 10%–16%; and SAFIRE5, 20%–33%. The improvement with IR was generally more pronounced at lower dose levels. Conclusions: Expanding beyond traditional contrast and noise based assessments of IR, we performed both task-specific and task-generic evaluations of IR performance. The task-specific evaluation demonstrated the dependency of IR’s dose reduction potential on task attributes, which can be employed to optimize IR for clinical indications with specific range of size and contrast. The task-generic evaluation demonstrated IR’s overall superiority over FBP in terms of the range of tasks exceeding a threshold performance level, which can be employed for general comparisons between algorithms.

  2. Radiation calculations for the ILC cryomodule

    SciTech Connect (OSTI)

    Nakao, N.; Mokhov, N.V.; Klebaner, A.; /Fermilab

    2007-04-01

    The MARS15 radiation simulations were performed for the ILC cryomodule. The model assumes a uniform beam loss intensity of 1 W/m of 750-MeV and 250-GeV electron along the inner surface of the beam pipe and the cavity iris of the 12-m cryomodule. Two-dimensional distributions of radiation dose in the module were obtained. Absorbed dose rate and energy spectra of electrons, photons, neutrons and protons were also obtained at the three cryogenic thermometers locations by filling with silicon material in the appropriate locations, and radiation hardness of the thermometers was discussed. From the obtained results, maximum absorbed dose of thermometers at the cooling pipe is 0.85mGy/sec (85 mRad/sec), that is 0.31 MGy (31 MRad) for 20 years.

  3. The radiation chemistry of CCD-PEG, a solvent-extraction process for Cs and Sr from dissolved nuclear fuel

    SciTech Connect (OSTI)

    Mincher, B.J.; Herbst, R.S.; Tillotson, R.D.; Mezyk, S.P.

    2008-07-01

    Cobalt dicarbollide and polyethylene glycol in phenyl-trifluoromethyl sulfone (HCCD/PEG in FS- 13) is currently under consideration for use in the process-scale selective extraction of fission- product cesium and strontium from dissolved nuclear fuel. This solvent will be exposed to high radiation doses during use and has not been adequately investigated for radiation stability. Here, HCCD/PEG was y-irradiated to various absorbed doses, to a maximum of 432 kGy, using {sup 60}Co. Irradiations were performed for the neat organic phase and also for the organic phase in contact with 1 M-nitric acid mixed by air sparging. Post-irradiation solvent-extraction measurements showed that Cs distribution ratios were unaffected; however, Sr extraction efficiency decreased with absorbed dose under both conditions and was greater when in contact with the aqueous phase. Stripping performance was not affected. A mechanism, initiated by direct radiolysis of the sulfone diluent, is proposed. (authors)

  4. The Radiolysis of AmVI Solutions

    SciTech Connect (OSTI)

    Bruce J. Mincher

    2013-06-01

    The reduction of bismuthate-produced AmVI by 60Co gamma-rays was measured using post-irradiation UV/Vis spectroscopy. The reduction of AmVI by radiolysis was rapid, producing AmV as the sole product. Relatively low absorbed doses in the ~0.3 kGy range quantitatively reduced a solution of 2.5 x 10-4 M AmVI. The addition of bismuthate to samples during irradiation did not appear to protect AmVI from radiolytic reduction during these experiments. It was also shown here that AmV is very stable toward radiation. The quantitative reduction of the AmVI concentration here corresponds to 1.4 hours of exposure to a process solution, however the actual americium concentrations will be higher and the expected contact times short when using centrifugal contactors. Thus, the reduction rate found in these initial experiments may not be excessive.

  5. Effect of irradiation on bone remodelling and the structural integrity of the vertebral column. Doctoral thesis

    SciTech Connect (OSTI)

    Swenson, K.N.

    1990-01-01

    The effects of therapeutic levels of radiation on the axial properties of the primate vertebral column were studied. Seven male rhesus monkeys (Macaca mulatta) were irradiated with a single does of 1300 cGy to the specific lumbar vertebrae of L2, L3, and L4. Three additional animals served as controls. Radiographs were taken before the radiation treatment and just prior to sacrifice to determine density changes in the bone. The animal subjects were sacrificed 105 days following the radiation exposure. Biomechanical testing was completed on lumbar levels 2 and 3 to identify changes in strength characteristics following radiation treatment. Histomorphometric analysis of lumbar vertebrae level 4 was completed to identify volume and surface density changes as well as cellular changes. Tetracycline, dicarbomethylaminomethyl fluorescein (DCAF), and xylenol orange were used as bone labeling agents to aid in the histomorphometry and to obtain dynamic parameter changes.

  6. Detection of irradiated spices using photo-stimulated luminescence technique (PSL)

    SciTech Connect (OSTI)

    Ramli, Ros Anita Ahmad; Yasir, Muhamad Samudi; Othman, Zainon; Abdullah, Wan Saffiey Wan

    2014-09-03

    Photo-stimulated luminescence (PSL) technique was applied to detect irradiated black pepper (Piper nigrum), cinnamon (Cinnamomum verum) and turmeric (Curcuma longa) after dark storage for 1 day, 3 and 6 months. Using screening and calibrated PSL, all samples were correctly discriminated between non-irradiated and spices irradiated with doses 1, 5 and 10 kGy. The PSL photon counts (PCs) of irradiated spices increased with increasing dose, with turmeric showing highest sensitivity index to irradiation compared to black pepper and cinnamon. The differences in response are possibly attributed to the varying quantity and quality of silicate minerals present in each spice sample. PSL signals of all irradiated samples reduced after 3 and 6 months storage. The results of this study provide a useful database on the applicability of PSL technique for the detection of Malaysian irradiated spices.

  7. Identifying irradiated flours by photo-stimulated luminescence technique

    SciTech Connect (OSTI)

    Ramli, Ros Anita Ahmad; Yasir, Muhamad Samudi; Othman, Zainon; Abdullah, Wan Saffiey Wan

    2014-02-12

    Photo-stimulated luminescence (PSL) technique was used in this study to detect gamma irradiation treatment of five types of flours (corn, rice, tapioca, wheat and glutinous rice) at four different doses 0, 0.2, .05 and 1kGy. The signal level was compared with two threshold values (700 and 5000). With the exception of glutinous rice, all irradiated samples produced a strong signal above the upper threshold (5000 counts/60s). All control samples produced negative result with the signals below the lower threshold (700 counts/60s) suggesting that the samples have not been irradiated. Irradiated glutinous rice samples produced intermediate signals (700 - 5000 counts/60s) which were subsequently confirmed using calibrated PSL. The PSL signals remained stable after 90 days of storage. The findings of this study will be useful to facilitate control of food irradiation application in Malaysia.

  8. The increase in animal mortality risk following exposure to sparsely ionizing radiation is not linear quadratic with dose

    SciTech Connect (OSTI)

    Haley, Benjamin M.; Paunesku, Tatjana; Grdina, David J.; Woloschak, Gayle E.; Aravindan, Natarajan

    2015-12-09

    The US government regulates allowable radiation exposures relying, in large part, on the seventh report from the committee to estimate the Biological Effect of Ionizing Radiation (BEIR VII), which estimated that most contemporary exposures- protracted or low-dose, carry 1.5 fold less risk of carcinogenesis and mortality per Gy than acute exposures of atomic bomb survivors. This correction is known as the dose and dose rate effectiveness factor for the life span study of atomic bomb survivors (DDREFLSS). As a result, it was calculated by applying a linear-quadratic dose response model to data from Japanese atomic bomb survivors and a limited number of animal studies.

  9. DOE

    Gasoline and Diesel Fuel Update (EIA)

    DOE /E/A- 0202( 83//Q J Sh or t-T er m En er gy O ut lo ok a to m Quar terly Proje ction s Febru ary 1983 Ene rgy Info rma tion Adm inist ratio n Was hing ton, D.C. t rt jrt .or t lor t lor t .lor t- ior t- ior t <.o rt ort . m .er m -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -Te rm -T erm -T erm -T erm Nrm ue rgy En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En erg y En

  10. Effect of MPG on radiation-induced odontogenic tissue metaplasia

    SciTech Connect (OSTI)

    Geist, J.R.; Kafrawy, A.H.; Shupe, R.E.

    1988-01-01

    This investigation monitored the effect of 2-mercaptopropionylglycine (MPG) in reducing radiation damage to the tooth-forming tissues. Fifty rats were exposed to x-ray doses of between 3 and 19 Gy directed toward the maxillary incisor germinal centers. Half of the animals were given an injection of MPG before irradiation, while the other rats were injected with saline solution. Administration of MPG did not significantly reduce the frequency of dentinal niche formation relative to the control teeth. The average lengths and percentage depths of the apicoincisal niches were statistically smaller in the groups treated with MPG. Although statistically significant, the mild protective effect of MPG was not clinically important because damage to the irradiated teeth was still extensive.

  11. Changes in gene expression following EMF exposure

    SciTech Connect (OSTI)

    Woloschak, G.E.; Paunesku, T.; Chang-Liu, C.M.; Loberg, L.; Gauger, J.; McCormick, D.

    1997-10-01

    Experiments were designed to examine the effects of electromagnetic field (EMF) exposure on specific gene expression, an effect that can be deleterious, beneficial, or neutral, depending on the long-term consequences; however, the proof of a reproducible, quantitative biological effect (such as change in gene expression) will lead to latter experiments aimed at determining the relative contribution of these changes to cellular consequences. Past work by ourselves and by others has shown that measures of gene expression are extremely sensitive indicators of the cellular and biological effects of ionizing radiation, with transcriptional changes being detected by exposure of cells to doses of {gamma}-rays as low as 0.01 cGy that have no pronounced cellular consequences. On the basis of this work, the authors hypothesized that measures of gene expression will be equally sensitive to EMF effects on cells.

  12. SU-E-T-593: Clinical Evaluation of Direct Aperture Optimization in Head/Neck and Prostate IMRT Treatment

    SciTech Connect (OSTI)

    Hosini, M; GALAL, M; Emam, I; Kamal, G; Algohary, M

    2014-06-01

    Purpose: To investigate the planning and dosimetric advantages of direct aperture optimization (DAO) over beam-let optimization in IMRT treatment of head and neck (H/N) and prostate cancers. Methods: Five Head and Neck as well as five prostate patients were planned using the beamlet optimizer in Elekta-Xio ver 4.6 IMRT treatment planning system. Based on our experience in beamlet IMRT optimization, PTVs in H/N plans were prescribed to 70 Gy delivered by 7 fields. While prostate PTVs were prescribed to 76 Gy with 9 fields. In all plans, fields were set to be equally spaced. All cases were re-planed using Direct Aperture optimizer in Prowess Panther ver 5.01 IMRT planning system at same configurations and dose constraints. Plans were evaluated according to ICRU criteria, number of segments, number of monitor units and planning time. Results: For H/N plans, the near maximum dose (D2) and the dose that covers 95% D95 of PTV has improved by 4% in DAO. For organs at risk (OAR), DAO reduced the volume covered by 30% (V30) in spinal cord, right parotid, and left parotid by 60%, 54%, and 53% respectively. This considerable dosimetric quality improvement achieved using 25% less planning time and lower number of segments and monitor units by 46% and 51% respectively. In DAO prostate plans, Both D2 and D95 for the PTV were improved by only 2%. The V30 of the right femur, left femur and bladder were improved by 35%, 15% and 3% respectively. On the contrary, the rectum V30 got even worse by 9%. However, number of monitor units, and number of segments decreased by 20% and 25% respectively. Moreover the planning time reduced significantly too. Conclusion: DAO introduces considerable advantages over the beamlet optimization in regards to organs at risk sparing. However, no significant improvement occurred in most studied PTVs.

  13. Once-Daily Radiation Therapy for Inflammatory Breast Cancer

    SciTech Connect (OSTI)

    Brown, Lindsay; Harmsen, William; Blanchard, Miran; Goetz, Matthew; Jakub, James; Mutter, Robert; Petersen, Ivy; Rooney, Jessica; Stauder, Michael; Yan, Elizabeth; Laack, Nadia

    2014-08-01

    Purpose: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer variant treated with multimodality therapy. A variety of approaches intended to escalate the intensity and efficacy of radiation therapy have been reported, including twice-daily radiation therapy, dose escalation, and aggressive use of bolus. Herein, we examine our outcomes for patients treated with once-daily radiation therapy with aggressive bolus utilization, focusing on treatment technique. Methods and Materials: A retrospective review of patients with nonmetastatic IBC treated from January 1, 2000, through December 31, 2010, was performed. Locoregional control (LRC), disease-free survival (DFS), overall survival (OS) and predictors thereof were assessed. Results: Fifty-two women with IBC were identified, 49 (94%) of whom were treated with neoadjuvant chemotherapy. All underwent mastectomy followed by adjuvant radiation therapy. Radiation was delivered in once-daily fractions of 1.8 to 2.25 Gy (median, 2 Gy). Patients were typically treated with daily 1-cm bolus throughout treatment, and 33 (63%) received a subsequent boost to the mastectomy scar. Five-year Kaplan Meier survival estimates for LRC, DFS, and OS were 81%, 56%, and 64%, respectively. Locoregional recurrence was associated with poorer OS (P<.001; hazard ratio [HR], 4.1). Extracapsular extension was associated with worse LRC (P=.02), DFS (P=.007), and OS (P=.002). Age greater than 50 years was associated with better DFS (P=.03). Pathologic complete response was associated with a trend toward improved LRC (P=.06). Conclusions: Once-daily radiation therapy with aggressive use of bolus for IBC results in outcomes consistent with previous reports using various intensified radiation therapy regimens. LRC remains a challenge despite modern systemic therapy. Extracapsular extension, age ≤50 years, and lack of complete response to chemotherapy appear to be associated with worse outcomes. Novel strategies are needed in IBC, particularly among these subsets of patients.

  14. Management of Pediatric Myxopapillary Ependymoma: The Role of Adjuvant Radiation

    SciTech Connect (OSTI)

    Agbahiwe, Harold C.; Wharam, Moody; Batra, Sachin; Cohen, Kenneth; Terezakis, Stephanie A.

    2013-02-01

    Introduction: Myxopapillary ependymoma (MPE) is a rare tumor in children. The primary treatment is gross total resection (GTR), with no clearly defined role for adjuvant radiation therapy (RT). Published reports, however, suggest that children with MPE present with a more aggressive disease course. The goal of this study was to assess the role of adjuvant RT in pediatric patients with MPE. Methods: Sixteen patients with MPE seen at Johns Hopkins Hospital (JHH) between November 1984 and December 2010 were retrospectively reviewed. Fifteen of the patients were evaluable with a mean age of 16.8 years (range, 12-21 years). Kaplan-Meier curves and descriptive statistics were used for analysis. Results: All patients received surgery as the initial treatment modality. Surgery consisted of either a GTR or a subtotal resection (STR). The median dose of adjuvant RT was 50.4 Gy (range, 45-54 Gy). All patients receiving RT were treated at the involved site. After a median follow-up of 7.2 years (range, 0.75-26.4 years), all patients were alive with stable disease. Local control at 5 and 10 years was 62.5% and 30%, respectively, for surgery alone versus 100% at both time points for surgery and adjuvant RT. Fifty percent of the patients receiving surgery alone had local failure. All patients receiving STR alone had local failure compared to 33% of patients receiving GTR alone. One patient in the surgery and adjuvant RT group developed a distant site of recurrence 1 year from diagnosis. No late toxicity was reported at last follow-up, and neurologic symptoms either improved or remained stable following surgery with or without RT. Conclusions: Adjuvant RT improved local control compared to surgery alone and should be considered after surgical resection in pediatric patients with MPE.

  15. SU-E-J-233: A Facility for Radiobiological Experiments in a Large Magnetic Field

    SciTech Connect (OSTI)

    Carlone, M; Heaton, R; Keller, H; Wouters, B; Jaffray, D

    2014-06-01

    Purpose: There is considerable interest in developing medical linear accelerators with integrated image guidance by MRI. Less work has been done on the fundamental biology of cell survival in the presence of a strong magnetic field. The purpose of this work is to describe an experimental system capable of measuring cell survival response in the types of MRI-linac systems currently under development. Methods: We have integrated a cobalt irradiator with a solenoid magnet. The solenoid magnet has inner diameter of 10 cm. To enable measurement of the biological effects as a function of depth, we are utilizing the sliced gel technique, in which cells are embedded and fixed within a gelatin matrix. Irradiated cells at defined positions (sub mm resolution) can subsequently be recovered and assessed for cell survival or other biological effects. Results: The magnetic field profile in the solenoid has a peak magnetic field 36 cm below the top edge of the magnet bore and can be placed at and SAD of 100 cm. At a solenoid current of 35 A, the peak magnetic field is 0.25 T. The dose rate of the cobalt irradiator is 16 cGy/min at 100 cm SAD. EBT3 film was used to demonstrate the system functionality. It was irradiated at 1 cm depth at 100 cm SSD with a 44 field to 1.5 Gy in a 0.25 T magnetic field. The dose profile was similar between this film and the control exposure without magnetic field. Conclusion: Integrating a cobalt irradiator with a high field magnet is demonstrated. The magnetic field at the cobalt defining head was minimal and did not interfere with the functioning of this unit. Cell survival experiments can be reproduced exactly in the presence or absence of a magnetic field since a resistive magnet is used.

  16. Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases

    SciTech Connect (OSTI)

    Ebinu, Julius O.; Lwu, Shelly; Monsalves, Eric; Arayee, Mandana; Chung, Caroline; Laperriere, Normand J.; Kulkarni, Abhaya V.; Goetz, Pablo; Zadeh, Gelareh

    2013-03-01

    Purpose: To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. Methods: We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. Results: A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRT (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. Conclusions: This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates.

  17. A Phase I Study of the Combination of Sorafenib With Temozolomide and Radiation Therapy for the Treatment of Primary and Recurrent High-Grade Gliomas

    SciTech Connect (OSTI)

    Den, Robert B.; Kamrava, Mitchell; Sheng, Zhi; Werner-Wasik, Maria; Dougherty, Erin; Marinucchi, Michelle; Lawrence, Yaacov R.; Center for Translational Research in Radiation Oncology, Sheba Medical Center ; Hegarty, Sarah; Hyslop, Terry; Andrews, David W.; Glass, Jon; Friedman, David P.; Green, Michael R.; Camphausen, Kevin; Dicker, Adam P.

    2013-02-01

    Purpose: Despite recent advances in the management of high-grade and recurrent gliomas, survival remains poor. Antiangiogenic therapy has been shown to be efficacious in the treatment of high-grade gliomas both in preclinical models and in clinical trials. We sought to determine the safety and maximum tolerated dose of sorafenib when combined with both radiation and temozolomide in the primary setting or radiation alone in the recurrent setting. Methods and Materials: This was a preclinical study and an open-label phase I dose escalation trial. Multiple glioma cell lines were analyzed for viability after treatment with radiation, temozolomide, or sorafenib or combinations of them. For patients with primary disease, sorafenib was given concurrently with temozolomide (75 mg/m{sup 2}) and 60 Gy radiation, for 30 days after completion of radiation. For patients with recurrent disease, sorafenib was combined with a hypofractionated course of radiation (35 Gy in 10 fractions). Results: Cell viability was significantly reduced with the combination of radiation, temozolomide, and sorafenib or radiation and sorafenib. Eighteen patients (11 in the primary cohort, 7 in the recurrent cohort) were enrolled onto this trial approved by the institutional review board. All patients completed the planned course of radiation therapy. The most common toxicities were hematologic, fatigue, and rash. There were 18 grade 3 or higher toxicities. The median overall survival was 18 months for the entire population. Conclusions: Sorafenib can be safely combined with radiation and temozolomide in patients with high-grade glioma and with radiation alone in patients with recurrent glioma. The recommended phase II dose of sorafenib is 200 mg twice daily when combined with temozolomide and radiation and 400 mg with radiation alone. To our knowledge, this is the first publication of concurrent sorafenib with radiation monotherapy or combined with radiation and temozolomide.

  18. A Phase 3 Trial of Whole Brain Radiation Therapy and Stereotactic Radiosurgery Alone Versus WBRT and SRS With Temozolomide or Erlotinib for Non-Small Cell Lung Cancer and 1 to 3 Brain Metastases: Radiation Therapy Oncology Group 0320

    SciTech Connect (OSTI)

    Sperduto, Paul W.; Wang, Meihua; Robins, H. Ian; Schell, Michael C.; Werner-Wasik, Maria; Komaki, Ritsuko; Souhami, Luis; Buyyounouski, Mark K.; Khuntia, Deepak; Demas, William; Shah, Sunjay A.; Nedzi, Lucien A.; Perry, Gad; Suh, John H.; Mehta, Minesh P.

    2013-04-01

    Background: A phase 3 Radiation Therapy Oncology Group (RTOG) study subset analysis demonstrated improved overall survival (OS) with the addition of stereotactic radiosurgery (SRS) to whole brain radiation therapy (WBRT) in non-small cell lung cancer (NSCLC) patients with 1 to 3 brain metastases. Because temozolomide (TMZ) and erlotinib (ETN) cross the blood-brain barrier and have documented activity in NSCLC, a phase 3 study was designed to test whether these drugs would improve the OS associated with WBRT + SRS. Methods and Materials: NSCLC patients with 1 to 3 brain metastases were randomized to receive WBRT (2.5 Gy 15 to 37.5 Gy) and SRS alone, versus WBRT + SRS + TMZ (75 mg/m{sup 2}/day 21 days) or ETN (150 mg/day). ETN (150 mg/day) or TMZ (150-200 mg/m{sup 2}/day 5 days/month) could be continued for as long as 6 months after WBRT + SRS. The primary endpoint was OS. Results: After 126 patients were enrolled, the study closed because of accrual limitations. The median survival times (MST) for WBRT + SRS, WBRT + SRS + TMZ, and WBRT + SRS + ETN were qualitatively different (13.4, 6.3, and 6.1 months, respectively), although the differences were not statistically significant. Time to central nervous system progression and performance status at 6 months were better in the WBRT + SRS arm. Grade 3 to 5 toxicity was 11%, 41%, and 49% in arms 1, 2, and 3, respectively (P<.001). Conclusion: The addition of TMZ or ETN to WBRT + SRS in NSCLC patients with 1 to 3 brain metastases did not improve survival and possibly had a deleterious effect. Because the analysis is underpowered, these data suggest but do not prove that increased toxicity was the cause of inferior survival in the drug arms.

  19. Dosimetric comparison of volumetric modulated Arc therapy, step-and-shoot, and sliding window IMRT for prostate cancer

    SciTech Connect (OSTI)

    Schnell, Erich; De La Fuente Herman, Tania; Young, Julie; Hildebrand, Kim; Algan, Ozer; Syzek, Elizabeth; Herman, Terence; Ahmad, Salahuddin

    2012-10-23

    This study aims to evaluate treatment plans generated by Step-and-Shoot (SS), Sliding Window (SW) and Volumetric Modulated Arc Therapy (VMAT) in order to assess the differences in dose volume histograms of planning target volume (PTV) and organs at risk (OAR), conformity indices, radiobiological evaluations, and plan quality for prostate cancer cases. Six prostate cancer patients treated in our center were selected for this retrospective study. Treatment plans were generated with Eclipse version 8.9 using 10 MV photon beams. For VMAT, Varian Rapid Arc with 1 or 2 arcs, and for SS and SW IMRT, 7-9 fields were used. Each plan had three PTVs with prescription doses of 81, 59.4, and 45 Gy to prostate, to prostate and lymph nodes, and to pelvis, respectively. Doses to PTV and OAR and the conformal indices (COIN) were compared among three techniques. The equivalent uniform dose (EUD), tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated and compared. The mean doses to the PTV prostate on average were 83 Gy and the percent differences of mean dose among all techniques were below 0.28. For bladder and rectum, the percent differences of mean dose among all techniques were below 2.2. The COIN did not favour any particular delivery method over the other. The TCP was higher with SS and SW for four patients and higher with VMAT for two patients. The NTCP for the rectum was the lowest with VMAT in five out of the six patients. The results show similar target coverage in general.

  20. Utility of the Amplatzer Vascular Plug in Splenic Artery Embolization: A Comparison Study with Conventional Coil Technique

    SciTech Connect (OSTI)

    Zhu Xiaoli; Tam, Matthew D. B. S.; Pierce, Gregory; McLennan, Gordon; Sands, Mark J.; Lieber, Michael S.; Wang Weiping

    2011-06-15

    Purpose: To retrospectively evaluate the role of the Amplatzer Vascular Plug (AVP) in proximal splenic artery embolization (SAE) compared with coils. Materials and Methods: Forty patients had proximal SAE performed with AVP(s) or coils as the primary embolic agent for splenic artery steal syndrome (n = 23), trauma (n = 5), portal hypertension (n = 5), bleeding due to pancreatic pathology (n = 4), and pre-splenectomy (n = 3). Comparisons were made of occlusion and procedure time, cost, and radiation dose. Results: Eighteen proximal SAE procedures were successfully performed with AVP. Twenty-two procedures were performed with coils, including one failed AVP attempt, which was completed with coils. Precise deployment without migration was achieved in all 18 AVP cases. Seven of 22 (31.8%) coil procedures had distal migration without consequence. There was no statistically significant difference in mean occlusion time (24.4 min for AVP vs. 31.5 min for coils, P = 0.13), procedure time (43.7 min for AVP vs. 53.8 min for coils, P = 0.16), or cost ($1474.13 for AVP vs. $1722.51 for coils, P = 0.69). There was significant difference in radiation dose (842 mGy for AVP vs. 1,309 mGy for coils, P = 0.04). Fourteen of the 18 (78%) AVP devices required additional embolic material. Conclusions: AVP with additional embolic agents is a useful alternative for proximal SAE because of precise deployment, resistance to migration, and radiation reduction. AVP use may be limited by vessel tortuosity. The occlusion time, procedure time, and cost were reduced but this was not statistically significant due to the need for additional embolic material.

  1. A Systems Genetic Approach to Identify Low Dose Radiation-Induced Lymphoma Susceptibility/DOE2013FinalReport

    SciTech Connect (OSTI)

    Balmain, Allan; Song, Ihn Young

    2013-05-15

    The ultimate goal of this project is to identify the combinations of genetic variants that confer an individual's susceptibility to the effects of low dose (0.1 Gy) gamma-radiation, in particular with regard to tumor development. In contrast to the known effects of high dose radiation in cancer induction, the responses to low dose radiation (defined as 0.1 Gy or less) are much less well understood, and have been proposed to involve a protective anti-tumor effect in some in vivo scientific models. These conflicting results confound attempts to develop predictive models of the risk of exposure to low dose radiation, particularly when combined with the strong effects of inherited genetic variants on both radiation effects and cancer susceptibility. We have used a ??Systems Genetics approach in mice that combines genetic background analysis with responses to low and high dose radiation, in order to develop insights that will allow us to reconcile these disparate observations. Using this comprehensive approach we have analyzed normal tissue gene expression (in this case the skin and thymus), together with the changes that take place in this gene expression architecture a) in response to low or high- dose radiation and b) during tumor development. Additionally, we have demonstrated that using our expression analysis approach in our genetically heterogeneous/defined radiation-induced tumor mouse models can uniquely identify genes and pathways relevant to human T-ALL, and uncover interactions between common genetic variants of genes which may lead to tumor susceptibility.

  2. The influence of TRP53 in the dose response of radiation-induced apoptosis, DNA repair and genomic stability in murine haematopoietic cells

    SciTech Connect (OSTI)

    Lemon, Jennifer A.; Taylor, Kristina; Verdecchia, Kyle; Phan, Nghi; Boreham, Douglas R.

    2014-01-01

    Apoptotic and DNA damage endpoints are frequently used as surrogate markers of cancer risk, and have been well-studied in the Trp53+/- mouse model. We report the effect of differing Trp53 gene status on the dose response of ionizing radiation exposures (0.01-2 Gy), with the unique perspective of determining if effects of gene status remain at extended time points. Here we report no difference in the dose response for radiation-induced DNA double-strand breaks in bone marrow and genomic instability (MN-RET levels) in peripheral blood, between wild-type (Trp53+/+) and heterozygous (Trp53+/-) mice. The dose response for Trp53+/+ mice showed higher initial levels of radiation-induced lymphocyte apoptosis relative to Trp53+/- between 0 and 1 Gy. Although this trend was observed up to 12 hours post-irradiation, both genotypes ultimately reached the same level of apoptosis at 14 hours, suggesting the importance of late-onset p53-independent apoptotic responses in this mouse model. Expected radiation-induced G1 cell cycle delay was observed in Trp53+/+ but not Trp53+/-. Although p53 has an important role in cancer risk, we have shown its influence on radiation dose response can be temporally variable. This research highlights the importance of caution when using haematopoietic endpoints as surrogates to extrapolate radiation-induced cancer risk estimation.

  3. Implications of Intercellular Signaling for Radiation Therapy: A Theoretical Dose-Planning Study

    SciTech Connect (OSTI)

    McMahon, Stephen J.; McGarry, Conor K.; Butterworth, Karl T.; O'Sullivan, Joe M.; Hounsell, Alan R.; Prise, Kevin M.

    2013-12-01

    Purpose: Recent in vitro results have shown significant contributions to cell killing from signaling effects at doses that are typically used in radiation therapy. This study investigates whether these in vitro observations can be reconciled with in vivo knowledge and how signaling may have an impact on future developments in radiation therapy. Methods and Materials: Prostate cancer treatment plans were generated for a series of 10 patients using 3-dimensional conformal therapy, intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy techniques. These plans were evaluated using mathematical models of survival following modulated radiation exposures that were developed from in vitro observations and incorporate the effects of intercellular signaling. The impact on dosevolume histograms and mean doses were evaluated by converting these survival levels into signaling-adjusted doses for comparison. Results: Inclusion of intercellular communication leads to significant differences between the signalling-adjusted and physical doses across a large volume. Organs in low-dose regions near target volumes see the largest increases, with mean signaling-adjusted bladder doses increasing from 23 to 33 Gy in IMRT plans. By contrast, in high-dose regions, there is a small decrease in signaling-adjusted dose due to reduced contributions from neighboring cells, with planning target volume mean doses falling from 74 to 71 Gy in IMRT. Overall, however, the dose distributions remain broadly similar, and comparisons between the treatment modalities are largely unchanged whether physical or signaling-adjusted dose is compared. Conclusions: Although incorporating cellular signaling significantly affects cell killing in low-dose regions and suggests a different interpretation for many phenomena, their effect in high-dose regions for typical planning techniques is comparatively small. This indicates that the significant signaling effects observed in vitro are not contradicted by comparison with clinical observations. Future investigations are needed to validate these effects in vivo and to quantify their ranges and potential impact on more advanced radiation therapy techniques.

  4. Clinical Utility of the Modified Segmental Boost Technique for Treatment of the Pelvis and Inguinal Nodes

    SciTech Connect (OSTI)

    Moran, M.S.; Castrucci, W.A.; Ahmad, M.; Song, H.; Lund, M.W.; Mani, S.; Chamberlain, Daniel; Higgins, S.A.

    2010-03-15

    Purpose: Low-lying pelvic malignancies often require simultaneous radiation to pelvis and inguinal nodes. We previously reported improved homogeneity with the modified segmental boost technique (MSBT) compared to that with traditional methods, using phantom models. Here we report our institutional clinical experience with MSBT. Methods and Materials: MSBT patients from May 2001 to March 2007 were evaluated. Parameters analyzed included isocenter/multileaf collimation shifts, time per fraction (four fields), monitor units (MU)/fraction, femoral doses, maximal dose relative to body mass index, and inguinal node depth. In addition, a dosimetric comparison of the MSBT versus intensity modulated radiation therapy (IMRT) was conducted. Results: Of the 37 MSBT patients identified, 32 were evaluable. Port film adjustments were required in 6% of films. Median values for each analyzed parameter were as follows: MU/fraction, 298 (range, 226-348); delivery time, 4 minutes; inguinal depth, 4.5 cm; volume receiving 45 Gy (V45), 7%; V27.5, 87%; body mass index, 25 (range, 16.0-33.8). Inguinal dose was 100% in all cases; in-field inhomogeneity ranged from 111% to 118%. IMRT resulted in significantly decreased dose to normal tissue but required more time for treatment planning and a higher number of MUs (1,184 vs. 313 MU). Conclusions: In our clinical experience, the mono-isocentric MSBT provides a high degree of accuracy, improved homogeneity compared with traditional techniques, ease of simulation, treatment planning, treatment delivery, and acceptable femoral doses for pelvic/inguinal radiation fields requiring 45 to 50.4 Gy. In addition, the MSBT delivers a relatively uniform dose distribution throughout the treatment volume, despite varying body habitus. Clinical scenarios for the use of MSBT vs. intensity-modulated radiation therapy are discussed. To our knowledge, this is the first study reporting the utility of MSBT in the clinical setting.

  5. Long-term Survival Outcomes Following Internal Mammary Node Irradiation in Stage II-III Breast Cancer: Results of a Large Retrospective Study With 12-Year Follow-up

    SciTech Connect (OSTI)

    Chang, Jee Suk; Park, Won; Kim, Yong Bae; Lee, Ik Jae; Keum, Ki Chang; Lee, Chang Geol; Choi, Doo Ho; Suh, Chang-Ok; Huh, Seung Jae

    2013-08-01

    Purpose: To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials: Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results: The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions: Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy.

  6. A Phase II Study of Radiotherapy and Concurrent Paclitaxel Chemotherapy in Breast-Conserving Treatment for Node-Positive Breast Cancer

    SciTech Connect (OSTI)

    Chen, William C.; Kim, Janice; Kim, Edward; Silverman, Paula; Overmoyer, Beth; Cooper, Brenda W.; Anthony, Sue; Shenk, Robert; Leeming, Rosemary; Hanks, Shelli H.; Lyons, Janice A.

    2012-01-01

    Purpose: Administering adjuvant chemotherapy before breast radiotherapy decreases the risk of systemic recurrence, but delays in radiotherapy could yield higher local failure. We assessed the feasibility and efficacy of placing radiotherapy earlier in the breast-conserving treatment course for lymph node-positive breast cancer. Methods and Materials: Between June 2000 and December 2004, 44 women with node-positive Stage II and III breast cancer were entered into this trial. Breast-conserving surgery and 4 cycles of doxorubicin (60 mg/m{sup 2})/cyclophosphamide (600 mg/m{sup 2}) were followed by 4 cycles of paclitaxel (175 mg/m{sup 2}) delivered every 3 weeks. Radiotherapy was concurrent with the first 2 cycles of paclitaxel. The breast received 39.6 Gy in 22 fractions with a tumor bed boost of 14 Gy in 7 fractions. Regional lymphatics were included when indicated. Functional lung volume was assessed by use of the diffusing capacity for carbon monoxide as a proxy. Breast cosmesis was evaluated with the Harvard criteria. Results: The 5-year actuarial rate of disease-free survival is 88%, and overall survival is 93%. There have been no local failures. Median follow-up is 75 months. No cases of radiation pneumonitis developed. There was no significant change in the diffusing capacity for carbon monoxide either immediately after radiotherapy (p = 0.51) or with extended follow-up (p = 0.63). Volume of irradiated breast tissue correlated with acute cosmesis, and acute Grade 3 skin toxicity developed in 2 patients. Late cosmesis was not adversely affected. Conclusions: Concurrent paclitaxel chemotherapy and radiotherapy after breast-conserving surgery shortened total treatment time, provided excellent local control, and was well tolerated.

  7. SU-E-J-263: Dosimetric Analysis On Breast Brachytherapy Based On Deformable Image Registration

    SciTech Connect (OSTI)

    Chen, T; Nie, K; Narra, V; Zou, J; Zhang, M; Khan, A; Haffty, B; Yue, N

    2014-06-01

    Purpose: To quantitatively compare and evaluate the dosimetry difference between breast brachytherapy protocols with different fractionation using deformable image registration. Methods: The accumulative dose distribution for multiple breast brachytherapy patients using four different applicators: Contura, Mammosite, Savi, and interstitial catheters, under two treatment protocols: 340cGy by 10 fractions in 5 days and 825cGy by 3 fractions in 2days has been reconstructed using a two stage deformable image registration approach. For all patients, daily CT was acquired with the same slice thickness (2.5mm). In the first stage, the daily CT images were rigidly registered to the initial planning CT using the registration module in Eclipse (Varian) to align the applicators. In the second stage, the tissues surrounding the applicator in the rigidly registered daily CT image were non-rigidly registered to the initial CT using a combination of image force and the local constraint that enforce zero normal motion on the surface of the applicator, using a software developed in house. We calculated the dose distribution in the daily CTs and deformed them using the final registration to convert into the image domain of the initial planning CT. The accumulative dose distributions were evaluated by dosimetry parameters including D90, V150 and V200, as well as DVH. Results: Dose reconstruction results showed that the two day treatment has a significant dosimetry improvement over the five day protocols. An average daily drop of D90 at 1.3% of the prescription dose has been observed on multiple brachytherapy patients. There is no significant difference on V150 and V200 between those two protocols. Conclusion: Brachytherapy with higher fractional dose and less fractions has an improved performance on being conformal to the dose distribution in the initial plan. Elongated brachytherapy treatments need to consider the dose uncertainty caused by the temporal changes of the soft tissue.

  8. Five-Year Analysis of Treatment Efficacy and Cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in Patients Treated With Accelerated Partial Breast Irradiation

    SciTech Connect (OSTI)

    Vicini, Frank; Beitsch, Peter; Quiet, Coral; Gittleman, Mark; Zannis, Vic; Fine, Ricky; Whitworth, Pat; Kuerer, Henry; Haffty, Bruce; Lyden, Maureen

    2011-03-01

    Purpose: To present 5-year data on treatment efficacy, cosmetic results, and toxicities for patients enrolled on the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Methods and Materials: A total of 1440 patients (1449 cases) with early-stage breast cancer receiving breast-conserving therapy were treated with the MammoSite device to deliver accelerated partial-breast irradiation (APBI) (34 Gy in 3.4-Gy fractions). Of 1449 cases, 1255 (87%) had invasive breast cancer (IBC) (median size, 10 mm) and 194 (13%) had ductal carcinoma in situ (DCIS) (median size, 8 mm). Median follow-up was 54 months. Results: Thirty-seven cases (2.6%) developed an ipsilateral breast tumor recurrence (IBTR), for a 5-year actuarial rate of 3.80% (3.86% for IBC and 3.39% for DCIS). Negative estrogen receptor status (p = 0.0011) was the only clinical, pathologic, or treatment-related variable associated with IBTR for patients with IBC and young age (<50 years; p = 0.0096) and positive margin status (p = 0.0126) in those with DCIS. The percentage of breasts with good/excellent cosmetic results at 60 months (n = 371) was 90.6%. Symptomatic breast seromas were reported in 13.0% of cases, and 2.3% developed fat necrosis. A subset analysis of the first 400 consecutive cases enrolled was performed (352 with IBC, 48 DCIS). With a median follow-up of 60.5 months, the 5-year actuarial rate of IBTR was 3.04%. Conclusion: Treatment efficacy, cosmesis, and toxicity 5 years after treatment with APBI using the MammoSite device are good and similar to those reported with other forms of APBI with similar follow-up.

  9. Can We Predict Plan Quality for External Beam Partial Breast Irradiation: Results of a Multicenter Feasibility Study (Trans Tasman Radiation Oncology Group Study 06.02)

    SciTech Connect (OSTI)

    Kron, Tomas; Willis, David; Link, Emma; Lehman, Margot; Campbell, Gillian; O'Brien, Peter; Chua, Boon

    2013-11-15

    Purpose: Partial breast irradiation (PBI) after lumpectomy may be an option for selected patients with early breast cancer. A feasibility study of accelerated PBI delivered using external beam 3-dimensional conformal radiation therapy (RT) was undertaken at 8 Australasian centers. The present study evaluated the impact of patient, tumor, and RT technique-related factors on the quality of RT plans as determined by the dosevolume parameters of organs at risk. Methods and Materials: Forty-eight patients were enrolled in the study. All RT plans were centrally reviewed using predefined dosimetric criteria before commencement and after completion of protocol therapy. The RT plans of 47 patients met the dosevolume constraints, and all 47 patients received PBI to a prescribed dose of 38.5 Gy in 10 fractions. The RT plan quality was determined by volumes of the ipsilateral whole breast, lung, and heart that received 50% and 95%; 30%; and 5% of the prescribed dose, respectively. Patient, tumor, and RT technique-related factors were investigated for association with the parameters of RT plan quality. Results: The ratio of the planning target volume to the ipsilateral whole-breast volume was significantly associated with the ipsilateral breast doses on multiple variable analyses. The distance of the postlumpectomy surgical cavity from the heart and lung were predictive for heart and lung doses, respectively. A distance between surgical cavity and heart of >4 cm typically resulted in <1% of the heart volume receiving 5 Gy or less. It was more difficult to meet the heart dose constraint for left-sided and medially located tumors. Conclusions: Partial breast irradiation using 3-dimensional conformal RT was feasible within the study constraints. The ratio of planning target volume to ipsilateral whole-breast volume and the distance of surgical cavity from the heart were significant predictors of the quality of treatment plan for external beam PBI.

  10. Hysterosalpingography using a flat panel unit: Evaluation and optimization of ovarian radiation dose

    SciTech Connect (OSTI)

    Messaris, Gerasimos A. T.; Abatzis, Ilias; Kagadis, George C.; Samartzis, Alexandros P.; Athanasopoulou, Panagiota; Christeas, Nikolaos; Katsanos, Konstantinos; Karnabatidis, Dimitrios; Nikiforidis, George C.

    2012-07-15

    Purpose: The aim of the present study was the evaluation and optimization of radiation dose to the ovaries (D) in hysterosalpingography (HSG). Methods: The study included a phantom study and a clinical one. In the phantom study, we evaluated imaging results for different geometrical setups and irradiation conditions. In the clinical study, 34 women were assigned into three different fluoroscopy modes and D was estimated with direct cervical TLD measurements. Results: In the phantom study, we used a source-to-image-distance (SID) of 110 cm and a field diagonal of 48 cm, and thus decreased air KERMA rate (KR) by 19% and 70%, respectively, for beam filtration: 4 mm Al and 0.9 mm Cu (Low dose). The least radiation exposure was accomplished by using the 3.75 pps fluoroscopy mode in conjunction with beam filtration: Low dose. In the clinical study, D normalized to 50 s of fluoroscopy time with a 3.75 pps fluoroscopy mode reached a value of 0.45 {+-} 0.04 mGy. Observers' evaluation of diagnostic image quality did not significantly differ for the three different modes of acquisition that were compared. Conclusions: Digital spot radiographs could be omitted in modern flat panel systems during HSG. Fluoroscopy image acquisitions in a modern flat panel unit at 3.75 pps and a beam filtration of 4 mm Al and 0.9 mm Cu demonstrate acceptable image quality with an average D equal to 0.45 mGy. This value is lower compared to the studied literature. For these reasons, the proposed method may be recommended for routine HSG examination in order to limit radiation exposure to the ovaries.

  11. Linear Accelerator-Based Radiosurgery Alone for Arteriovenous Malformation: More Than 12 Years of Observation

    SciTech Connect (OSTI)

    Matsuo, Takayuki Kamada, Kensaku; Izumo, Tsuyoshi; Hayashi, Nobuyuki; Nagata, Izumi

    2014-07-01

    Purpose: Although radiosurgery is an accepted treatment method for intracranial arteriovenous malformations (AVMs), its long-term therapeutic effects have not been sufficiently evaluated, and many reports of long-term observations are from gamma-knife facilities. Furthermore, there are few reported results of treatment using only linear accelerator (LINAC)-based radiosurgery (LBRS). Methods and Materials: Over a period of more than 12 years, we followed the long-term results of LBRS treatment performed in 51 AVM patients. Results: The actuarial obliteration rates, after a single radiosurgery session, at 3, 5, 10, and 15 years were 46.9%, 54.0%, 64.4%, and 68.0%, respectively; when subsequent radiosurgeries were included, the rates were 46.9%, 61.3%, 74.2%, and 90.3%, respectively. Obliteration rates were significantly related to target volumes ≥4 cm{sup 3}, marginal doses ≥12 Gy, Spetzler-Martin grades (1 vs other), and AVM scores ≥1.5; multivariate analyses revealed a significant difference for target volumes ≥4 cm{sup 3}. The postprocedural actuarial symptomatic radiation injury rates, after a single radiation surgery session, at 5, 10, and 15 years were 12.3%, 16.8%, and 19.1%, respectively. Volumes ≥4 cm{sup 3}, location (lobular or other), AVM scores ≥1.5, and the number of radiosurgery were related to radiation injury incidence; multivariate analyses revealed significant differences associated with volumes ≥4 cm{sup 3} and location (lobular or other). Conclusions: Positive results can be obtained with LBRS when performed with a target volume ≤4 cm{sup 3}, an AVM score ≤1.5, and ≥12 Gy radiation. Bleeding and radiation injuries may appear even 10 years after treatment, necessitating long-term observation.

  12. Effects of Irradiation on Brain Vasculature Using an In Situ Tumor Model

    SciTech Connect (OSTI)

    Zawaski, Janice A.; Gaber, M. Waleed; Sabek, Omaima M.; Wilson, Christy M.; Duntsch, Christopher D.; Merchant, Thomas E.

    2012-03-01

    Purpose: Damage to normal tissue is a limiting factor in clinical radiotherapy (RT). We tested the hypothesis that the presence of tumor alters the response of normal tissues to irradiation using a rat in situ brain tumor model. Methods and Materials: Intravital microscopy was used with a rat cranial window to assess the in situ effect of rat C6 glioma on peritumoral tissue with and without RT. The RT regimen included 40 Gy at 8 Gy/day starting Day 5 after tumor implant. Endpoints included blood-brain barrier permeability, clearance index, leukocyte-endothelial interactions and staining for vascular endothelial growth factor (VEGF) glial fibrillary acidic protein, and apoptosis. To characterize the system response to RT, animal survival and tumor surface area and volume were measured. Sham experiments were performed on similar animals implanted with basement membrane matrix absent of tumor cells. Results: The presence of tumor alone increases permeability but has little effect on leukocyte-endothelial interactions and astrogliosis. Radiation alone increases tissue permeability, leukocyte-endothelial interactions, and astrogliosis. The highest levels of permeability and cell adhesion were seen in the model that combined tumor and irradiation; however, the presence of tumor appeared to reduce the volume of rolling leukocytes. Unirradiated tumor and peritumoral tissue had poor clearance. Irradiated tumor and peritumoral tissue had a similar clearance index to irradiated and unirradiated sham-implanted animals. Radiation reduces the presence of VEGF in peritumoral normal tissues but did not affect the amount of apoptosis in the normal tissue. Apoptosis was identified in the tumor tissue with and without radiation. Conclusions: We developed a novel approach to demonstrate that the presence of the tumor in a rat intracranial model alters the response of normal tissues to irradiation.

  13. Poster Thur Eve 36: Implementation of constant dose rate and gantry speed arc therapy(CDR-CAS-IMAT) for thoracic esophageal carcinoma on Varian 23EX

    SciTech Connect (OSTI)

    Zhang, Ruohui; Fan, Xiaomei; Bai, Wenwen; Han, Chun

    2014-08-15

    Objective: The purpose of this study is to propose an alternative planning approach for VMAT using constant dose rate and gantry speed arc therapy(CDR-CAS-IMAT) implementation on conventional Linac Varian 23EX and used IMRT as a benchmark to evaluate the performance. Methods and materials: Eighteen patients with thoracic esophageal carcinoma who were previously treated with IMRT on Varian 23EX were retrospectively planned for CDR-CAS-IMAT plans. Dose prescription was set to 60 Gy to PTVs in 30 fractions. The planning objectives for PTVs and OAR were corresponding with the IMRT plans. Dose to the PTVs and OAR were compared to IMRT with respect to plan quality, MU, treatment time and delivery accuracy. Results: CDR-CAS-IMAT plans led to equivalent or superior plan quality as compared to IMRT, PTV's CI relative increased 16.2%, while small deviations were observed on minimum dose for PTV. Volumes in the cord receiving 40Gy were increased from 3.6% with IMRT to 7.0%. Treatment times were reduced significantly with CDR-CAS-IMAT(mean 85.7s vs. 232.1s, p < .05), however, MU increased by a factor of 1.3 and lung V10/5/3.5/aver were relative increase 6.7%,12%,17.9%,4.2%, respectively. And increased the E-P low dose area volume decreased the hight dose area. There were no significant difference in Delta4 measurements results between both planning techniques. Conclusion: CDR-CAS-IMAT plans can be implemented smoothly and quickly into a busy cancer center, which improved PTV CI and reduces treatment time but increased the MU and low dose irradiated area. An evaluation of weight loss must be performed during treatment for CDR-CAS-IMAT patients.

  14. A dosimetric comparison of proton and photon therapy in unresectable cancers of the head of pancreas

    SciTech Connect (OSTI)

    Thompson, Reid F.; Zhai, Huifang; Both, Stefan; Metz, James M.; Plastaras, John P.; Ben-Josef, Edgar; Mayekar, Sonal U.; Apisarnthanarax, Smith

    2014-08-15

    Purpose: Uncontrolled local growth is the cause of death in ?30% of patients with unresectable pancreatic cancers. The addition of standard-dose radiotherapy to gemcitabine has been shown to confer a modest survival benefit in this population. Radiation dose escalation with three-dimensional planning is not feasible, but high-dose intensity-modulated radiation therapy (IMRT) has been shown to improve local control. Still, dose-escalation remains limited by gastrointestinal toxicity. In this study, the authors investigate the potential use of double scattering (DS) and pencil beam scanning (PBS) proton therapy in limiting dose to critical organs at risk. Methods: The authors compared DS, PBS, and IMRT plans in 13 patients with unresectable cancer of the pancreatic head, paying particular attention to duodenum, small intestine, stomach, liver, kidney, and cord constraints in addition to target volume coverage. All plans were calculated to 5500 cGy in 25 fractions with equivalent constraints and normalized to prescription dose. All statistics were by two-tailed paired t-test. Results: Both DS and PBS decreased stomach, duodenum, and small bowel dose in low-dose regions compared to IMRT (p < 0.01). However, protons yielded increased doses in the mid to high dose regions (e.g., 23.653.8 and 34.952.4 Gy for duodenum using DS and PBS, respectively; p < 0.05). Protons also increased generalized equivalent uniform dose to duodenum and stomach, however these differences were small (<5% and 10%, respectively; p < 0.01). Doses to other organs-at-risk were within institutional constraints and placed no obvious limitations on treatment planning. Conclusions: Proton therapy does not appear to reduce OAR volumes receiving high dose. Protons are able to reduce the treated volume receiving low-intermediate doses, however the clinical significance of this remains to be determined in future investigations.

  15. SU-E-I-10: Automatic Monitoring of Accumulated Dose Indices From DICOM RDSR to Improve Radiation Safety in X-Ray Angiography

    SciTech Connect (OSTI)

    Omar, A; Bujila, R; Nowik, P; Karambatsakidou, A

    2014-06-01

    Purpose: To investigate the potential benefits of automatic monitoring of accumulated patient and staff dose indicators, i.e., CAK and KAP, from DICOM Radiation Dose Structured Reports (RDSR) in x-ray angiography (XA). Methods: Recently RDSR has enabled the convenient aggregation of dose indices and technique parameters for XA procedures. The information contained in RDSR objects for three XA systems, dedicated to different types of clinical procedures, has been collected and aggregated in a database for over one year using a system developed with open-source software at the Karolinska University Hospital. Patient weight was complemented to the RDSR data via an interface with the Hospital Information System (HIS). Results: The linearly approximated trend in KAP over a time period of a year for cerebrovascular, pelvic/peripheral vascular, and cardiovascular procedures showed a decrease of 12%, 20%, and 14%, respectively. The decrease was mainly due to hardware/software upgrades and new low-dose imaging protocols, and partially due to ongoing systematic radiation safety education of the clinical staff. The CAK was in excess of 3 Gy for 15 procedures, and exceeded 5 Gy for 3 procedures. The dose indices have also shown a significant dependence on patient weight for cardiovascular and pelvic/peripheral vascular procedures; a 10 kg shift in mean patient weight can result in a dose index increase of 25%. Conclusion: Automatic monitoring of accumulated dose indices can be utilized to notify the clinical staff and medical physicists when the dose index has exceeded a predetermined action level. This allows for convenient and systematic follow-up of patients in risk of developing deterministic skin injuries. Furthermore, trend analyses of dose indices over time is a valuable resource for the identification of potential positive or negative effects (dose increase/decrease) from changes in hardware, software, and clinical work habits.

  16. SU-E-J-243: Possibility of Exposure Dose Reduction of Cone-Beam Computed Tomography in An Image Guided Patient Positioning System by Using Various Noise Suppression Filters

    SciTech Connect (OSTI)

    Kamezawa, H; Arimura, H; Ohki, M; Shirieda, K; Kameda, N

    2014-06-01

    Purpose: To investigate the possibility of exposure dose reduction of the cone-beam computed tomography (CBCT) in an image guided patient positioning system by using 6 noise suppression filters. Methods: First, a reference dose (RD) and low-dose (LD)-CBCT (X-ray volume imaging system, Elekta Co.) images were acquired with a reference dose of 86.2 mGy (weighted CT dose index: CTDIw) and various low doses of 1.4 to 43.1 mGy, respectively. Second, an automated rigid registration for three axes was performed for estimating setup errors between a planning CT image and the LD-CBCT images, which were processed by 6 noise suppression filters, i.e., averaging filter (AF), median filter (MF), Gaussian filter (GF), bilateral filter (BF), edge preserving smoothing filter (EPF) and adaptive partial median filter (AMF). Third, residual errors representing the patient positioning accuracy were calculated as an Euclidean distance between the setup error vectors estimated using the LD-CBCT image and RD-CBCT image. Finally, the relationships between the residual error and CTDIw were obtained for 6 noise suppression filters, and then the CTDIw for LD-CBCT images processed by the noise suppression filters were measured at the same residual error, which was obtained with the RD-CBCT. This approach was applied to an anthropomorphic pelvic phantom and two cancer patients. Results: For the phantom, the exposure dose could be reduced from 61% (GF) to 78% (AMF) by applying the noise suppression filters to the CBCT images. The exposure dose in a prostate cancer case could be reduced from 8% (AF) to 61% (AMF), and the exposure dose in a lung cancer case could be reduced from 9% (AF) to 37% (AMF). Conclusion: Using noise suppression filters, particularly an adaptive partial median filter, could be feasible to decrease the additional exposure dose to patients in image guided patient positioning systems.

  17. HSPB1 Gene Polymorphisms Predict Risk of Mortality for US Patients After Radio(chemo)therapy for Non-Small Cell Lung Cancer

    SciTech Connect (OSTI)

    Xu Ting; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas ; Wei Qingyi; Lopez Guerra, Jose Luis; Department of Radiation Oncology, Instituto Madrileno de Oncologia Wang Lie; Liu Zhensheng; Gomez, Daniel; O'Reilly, Michael; Lin, Steven Hsesheng; Zhuang Yan; Levy, Lawrence B.; Mohan, Radhe; Zhou Honghao; Liao Zhongxing

    2012-10-01

    Purpose: We investigated potential associations between single-nucleotide polymorphisms (SNPs) in the heat shock protein beta-1 (HSPB1) gene and overall survival in US patients with non-small cell lung cancer (NSCLC). Methods and Materials: Using available genomic DNA samples from 224 patients with NSCLC treated with definitive radio(chemo)therapy, we genotyped 2 SNPs of HSPB1 (NCBI SNP nos. rs2868370 and rs2868371). We used both Kaplan-Meier cumulative probability and Cox proportional hazards analyses to evaluate the effect of HSPB1 genotypes on survival. Results: Our cohort consisted of 117 men and 107 women, mostly white (79.5%), with a median age of 70 years. The median radiation dose was 66 Gy (range, 63-87.5 Gy), and 183 patients (82%) received concurrent platinum-based chemotherapy. The most common genotype of the rs2868371 SNP was CC (61%). Univariate and multivariate analyses showed that this genotype was associated with poorer survival than CG and GG genotypes (univariate hazard ratio [HR] = 1.39, 95% confidence interval [CI], 1.02-1.90; P=.037; multivariate HR = 1.39; 95% CI, 1.01-1.92; P=.045). Conclusions: Our results showed that the CC genotype of HSPB1 rs2868371 was associated with poorer overall survival in patients with NSCLC after radio(chemo)therapy, findings that contradict those of a previous study of Chinese patients. Validation of our findings with larger numbers of similar patients is needed, as are mechanical and clinical studies to determine the mechanism underlying these associations.

  18. SU-E-T-568: Improving Normal Brain Sparing with Increasing Number of Arc Beams for Volume Modulated Arc Beam Radiosurgery of Multiple Brain Metastases

    SciTech Connect (OSTI)

    Hossain, S; Hildebrand, K; Ahmad, S; Larson, D; Ma, L; Sahgal, A

    2014-06-01

    Purpose: Intensity modulated arc beams have been newly reported for treating multiple brain metastases. The purpose of this study was to determine the variations in the normal brain doses with increasing number of arc beams for multiple brain metastases treatments via the TrueBeam Rapidarc system (Varian Oncology, Palo Alto, CA). Methods: A patient case with 12 metastatic brain lesions previously treated on the Leksell Gamma Knife Perfexion (GK) was used for the study. All lesions and organs at risk were contoured by a senior radiation oncologist and treatment plans for a subset of 3, 6, 9 and all 12 targets were developed for the TrueBeam Rapidarc system via 3 to 7 intensity modulated arc-beams with each target covered by at least 99% of the prescribed dose of 20 Gy. The peripheral normal brain isodose volumes as well as the total beam-on time were analyzed with increasing number of arc beams for these targets. Results: All intensisty modulated arc-beam plans produced efficient treatment delivery with the beam-on time averaging 0.6–1.5 min per lesion at an output of 1200 MU/min. With increasing number of arc beams, the peripheral normal brain isodose volumes such as the 12-Gy isodose line enclosed normal brain tissue volumes were on average decreased by 6%, 11%, 18%, and 28% for the 3-, 6-, 9-, 12-target treatment plans respectively. The lowest normal brain isodose volumes were consistently found for the 7-arc treatment plans for all the cases. Conclusion: With nearly identical beam-on times, the peripheral normal brain dose was notably decreased when the total number of intensity modulated arc beams was increased when treating multiple brain metastases. Dr Sahgal and Dr Ma are currently serving on the board of international society of stereotactic radiosurgery.

  19. SU-E-J-179: Prediction of Pelvic Nodal Coverage Using Mutual Information Between Cone-Beam and Planning CTs

    SciTech Connect (OSTI)

    Jani, S; Kishan, A; O'Connell, D; King, C; Steinberg, M; Low, D; Lamb, J

    2014-06-01

    Purpose: To investigate if pelvic nodal coverage for prostate patients undergoing intensity modulated radiotherapy (IMRT) can be predicted using mutual image information computed between planning and cone-beam CTs (CBCTs). Methods: Four patients with high-risk prostate adenocarcinoma were treated with IMRT on a Varian TrueBeam. Plans were designed such that 95% of the nodal planning target volume (PTV) received the prescription dose of 45 Gy (N=1) or 50.4 Gy (N=3). Weekly CBCTs (N=25) were acquired and the nodal clinical target volumes and organs at risk were contoured by a physician. The percent nodal volume receiving prescription dose was recorded as a ground truth. Using the recorded shifts performed by the radiation therapists at the time of image acquisition, CBCTs were aligned with the planning kVCT. Mutual image information (MI) was calculated between the CBCT and the aligned planning CT within the contour of the nodal PTV. Due to variable CBCT fields-of-view, CBCT images covering less than 90% of the nodal volume were excluded from the analysis, resulting in the removal of eight CBCTs. Results: A correlation coefficient of 0.40 was observed between the MI metric and the percent of the nodal target volume receiving the prescription dose. One patient's CBCTs had clear outliers from the rest of the patients. Upon further investigation, we discovered image artifacts that were present only in that patient's images. When those four images were excluded, the correlation improved to 0.81. Conclusion: This pilot study shows the potential of predicting pelvic nodal dosimetry by computing the mutual image information between planning CTs and patient setup CBCTs. Importantly, this technique does not involve manual or automatic contouring of the CBCT images. Additional patients and more robust exclusion criteria will help validate our findings.

  20. The variations in long term TLD measurements of environmental background radiation at locations in southeastern New York state and northern New Jersey

    SciTech Connect (OSTI)

    Maiello, M.L.

    1997-06-01

    The variations of the measured dose rate in air should be recognized especially where background radiation is used as a comparative benchmark to assess radiation surveillance and environmental remediation work. In this note, the natural variations of the combined gamma and cosmic-ray background air-dose rate as measured by lithium fluoride thermoluminescence dosimeters are reported. The dosimeters were deployed monthly at locations within 150 km of the Environmental Measurements Laboratory in New York City. Urban and suburban stations were established with simultaneous indoor and outdoor measurements at some locations. Measurements were obtained over 10 to 18 years. The mean air-dose rates from the six outdoor and four indoor stations vary from 50.8 to 123.1 nGy h{sup -1}. The range of the annual dose rates expressed as a percent-difference of the minimum and maximum is 5.3 to 18.0%. Commonly, 1-mo deviations from the long term mean of about {+-}10 to {+-}25% are observed. An abrupt decrease in the annual dose rate at one of the measurement sites was attributed to a minor relocation of a dosimeter. Structural shielding factors for the first and second floors of a residence are reported. The ground level location of a dosimeter inside another residence apparently resulted in a very high shielding factor. Finally, a gradual decrease of the dose rate at most of the stations is shown to exist (approximately -0.3 nGy h{sup -1} y{sup -1} for the outdoor stations). Plausible causes of this trend are briefly discussed. 24 refs., 6 figs., 2 tabs.

  1. Minibeam radiation therapy for the management of osteosarcomas: A Monte Carlo study

    SciTech Connect (OSTI)

    Martnez-Rovira, I.; Prezado, Y.

    2014-06-15

    Purpose: Minibeam radiation therapy (MBRT) exploits the well-established tissue-sparing effect provided by the combination of submillimetric field sizes and a spatial fractionation of the dose. The aim of this work is to evaluate the feasibility and potential therapeutic gain of MBRT, in comparison with conventional radiotherapy, for osteosarcoma treatments. Methods: Monte Carlo simulations (PENELOPE/PENEASY code) were used as a method to study the dose distributions resulting from MBRT irradiations of a rat femur and a realistic human femur phantoms. As a figure of merit, peak and valley doses and peak-to-valley dose ratios (PVDR) were assessed. Conversion of absorbed dose to normalized total dose (NTD) was performed in the human case. Several field sizes and irradiation geometries were evaluated. Results: It is feasible to deliver a uniform dose distribution in the target while the healthy tissue benefits from a spatial fractionation of the dose. Very high PVDR values (?20) were achieved in the entrance beam path in the rat case. PVDR values ranged from 2 to 9 in the human phantom. NTD{sub 2.0} of 87 Gy might be reached in the tumor in the human femur while the healthy tissues might receive valley NTD{sub 2.0} lower than 20 Gy. The doses in the tumor and healthy tissues might be significantly higher and lower than the ones commonly delivered used in conventional radiotherapy. Conclusions: The obtained dose distributions indicate that a gain in normal tissue sparing might be expected. This would allow the use of higher (and potentially curative) doses in the tumor. Biological experiments are warranted.

  2. Multicolor flow cytometry analysis of blood cell subsets in patients given total body irradiation before bone marrow transplantation

    SciTech Connect (OSTI)

    Clave, E.; Socie, G.; Carosella, E.

    1995-11-01

    Bone marrow transplantation has often been closely linked with accidental or intentional therapeutical irradiation. In both situations, study of the radiosensitivity of human blood cell subsets is of interest. Using one-color flow cytometry analysis of B lymphocytes, T cell subsets, and natural killer cells, we previously reported that lymphocyte subsets exhibit equal radiosensitivity. Taking advantage of recent developments in the knowledge of leukocyte differentiation antigens and flow cytometry technology we undertook a study of blood cell subsets to search for rare populations exhibiting different radiosensitivity. Thirty patients, who were delivered a 12 Gy fractionated total body irradiation as part of their conditioning regimen before transplantation for malignant disorders, were studied using multicolor flow cytometry. T and B lymphocytes showed a sharp, radiation-induced decrease, with the B lymphocytes (cluster of differentiation (CD) 19+) being the most sensitive. When analyzed by multicolor flow cytometry all major lymphocyte subsets appeared equally sensitive to the in vivo irradiation. Therefore, all major lymphocyte subsets sharing the helper phenotype (naive or memory) and the cytotoxic phenotype appeared equally sensitive to in vivo whole body irradiation. In parallel, the CD34+ cell subset remained basically unchanged after whole body irradiation. Finally, the CD3{minus}, 56+, 16+ natural killer cell subset was relatively radioresistant (91 and 74% of its initial value, after 2 and 4 Gy, respectively) as compared to other lymphocyte subsets. Our study provides evidence that T and B cell subsets seem to be highly radiosensitive in vivo. The CD34+ progenitor/stem cells and NK cells seem to be more radioresistant. This latter result might provide clues to the understanding of the pathophysiogeny of radiation-induced aplasia and of the engrafment/rejection process following bone marrow transplantation. 20 refs., 3 figs., 1 tab.

  3. Stereotactic Body Radiotherapy: A Promising Treatment Option for the Boost of Oropharyngeal Cancers Not Suitable for Brachytherapy: A Single-Institutional Experience

    SciTech Connect (OSTI)

    Al-Mamgani, Abrahim; Tans, Lisa; Teguh, David N.; Rooij, Peter van; Zwijnenburg, Ellen M.; Levendag, Peter C.

    2012-03-15

    Purpose: To prospectively assess the outcome and toxicity of frameless stereotactic body radiotherapy (SBRT) as a treatment option for boosting primary oropharyngeal cancers (OPC) in patients who not suitable for the standard brachytherapy boost (BTB). Methods and Materials: Between 2005 and 2010, 51 patients with Stage I to IV biopsy-proven OPC who were not suitable for BTB received boosts by means of SBRT (3 times 5.5 Gy, prescribed to the 80% isodose line), after 46 Gy of IMRT to the primary tumor and neck (when indicated). Endpoints of the study were local control (LC), disease-free survival (DFS), overall survival (OS), and acute and late toxicity. Results: After a median follow-up of 18 months (range, 6-65 months), the 2-year actuarial rates of LC, DFS, and OS were 86%, 80%, and 82%, respectively, and the 3-year rates were 70%, 66%, and 54%, respectively. The treatment was well tolerated, as there were no treatment breaks and no Grade 4 or 5 toxicity reported, either acute or chronic. The overall 2-year cumulative incidence of Grade {>=}2 late toxicity was 28%. Of the patients with 2 years with no evidence of disease (n = 20), only 1 patient was still feeding tube dependent and 2 patients had Grade 3 xerostomia. Conclusions: According to our knowledge, this study is the first report of patients with primary OPC who received boosts by means of SBRT. Patients with OPC who are not suitable for the standard BTB can safely and effectively receive boosts by SBRT. With this radiation technique, an excellent outcome was achieved. Furthermore, the SBRT boost did not have a negative impact regarding acute and late side effects.

  4. Simplified field-in-field technique for a large-scale implementation in breast radiation treatment

    SciTech Connect (OSTI)

    Fournier-Bidoz, Nathalie; Kirova, Youlia M.; Campana, Francois; Dendale, Remi; Fourquet, Alain

    2012-07-01

    We wanted to evaluate a simplified 'field-in-field' technique (SFF) that was implemented in our department of Radiation Oncology for breast treatment. This study evaluated 15 consecutive patients treated with a simplified field in field technique after breast-conserving surgery for early-stage breast cancer. Radiotherapy consisted of whole-breast irradiation to the total dose of 50 Gy in 25 fractions, and a boost of 16 Gy in 8 fractions to the tumor bed. We compared dosimetric outcomes of SFF to state-of-the-art electronic surface compensation (ESC) with dynamic leaves. An analysis of early skin toxicity of a population of 15 patients was performed. The median volume receiving at least 95% of the prescribed dose was 763 mL (range, 347-1472) for SFF vs. 779 mL (range, 349-1494) for ESC. The median residual 107% isodose was 0.1 mL (range, 0-63) for SFF and 1.9 mL (range, 0-57) for ESC. Monitor units were on average 25% higher in ESC plans compared with SFF. No patient treated with SFF had acute side effects superior to grade 1-NCI scale. SFF created homogenous 3D dose distributions equivalent to electronic surface compensation with dynamic leaves. It allowed the integration of a forward planned concomitant tumor bed boost as an additional multileaf collimator subfield of the tangential fields. Compared with electronic surface compensation with dynamic leaves, shorter treatment times allowed better radiation protection to the patient. Low-grade acute toxicity evaluated weekly during treatment and 2 months after treatment completion justified the pursuit of this technique for all breast patients in our department.

  5. Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy

    SciTech Connect (OSTI)

    Weksberg, David C.; Palmer, Matthew B.; Vu, Khoi N.; Rebueno, Neal C.; Sharp, Hadley J.; Luo, Dershan; Yang, James N.; Shiu, Almon S.; Rhines, Laurence D.; McAleer, Mary Frances; Brown, Paul D.; Chang, Eric L.

    2012-11-01

    Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V{sub 4Gy}) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by {approx}20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.

  6. Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck

    SciTech Connect (OSTI)

    Sher, David J.; Balboni, Tracy A.; Haddad, Robert I.; Norris, Charles M.; Posner, Marshall R.; Wirth, Lori J.; Goguen, Laura A.; Annino, Donald; Tishler, Roy B.

    2011-08-01

    Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. Patients and Materials: A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. Results: A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. Conclusion: In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.

  7. X-ray irradiation induced changes in electron transport in stabilized a-Se photoconductors

    SciTech Connect (OSTI)

    Walornyj, M.; Kasap, S. O.

    2013-12-07

    We have examined the effect of high-dose x-ray irradiation on electron transport in stabilized amorphous selenium (a-Se) x-ray photoconductive films (of the type used in x-ray image detectors) by measuring the electron lifetime ?{sub e} through interrupted-field time-of-flight experiments. X-ray induced effects have been examined through two types of experiments. In recovery experiments, the a-Se was preirradiated with and without an applied field (5 V/?m) during irradiation with sufficient dose (typically ?20 Gy at 21 C) to significantly reduce the electron lifetime by ?50%, and then the recovery of the lifetime was monitored as a function of time at three different temperatures, 10 C, 21 C, and 35 C. The lifetime recovery kinetics was exponential with a relaxation time ?{sub r} that is thermally activated with an activation energy of 1.66 eV. ?{sub r} is a few hours at 21 C and only a few minutes at 35 C. In experiments examining the irradiation induced effects, the a-Se film was repeatedly exposed to x-ray radiation and the changes in the drift mobility and lifetime were monitored as a function of accumulated dose D. There was no observable change in the drift mobility. At 21 C, the concentration of x-ray induced deep traps (or capture centers), N{sub d}, increases linearly with D (N{sub d} ? D) whereas at 35 C, the recovery process prevents a linear increase in N{sub d} with D, and N{sub d} saturates. In all cases, even under high dose irradiation (?50 Gy), the lifetime was recoverable to its original equilibrium (pre-exposure) value within a few relaxation times.

  8. Gamma Knife Stereotactic Radiosurgery as Salvage Therapy After Failure of Whole-Brain Radiotherapy in Patients With Small-Cell Lung Cancer

    SciTech Connect (OSTI)

    Harris, Sunit; Chan, Michael D.; Lovato, James F.; Ellis, Thomas L.; Tatter, Stephen B.; Bourland, J. Daniel; Munley, Michael T.; Guzman, Allan F. de; Shaw, Edward G.; Urbanic, James J.; McMullen, Kevin P.

    2012-05-01

    Purpose: Radiosurgery has been successfully used in selected cases to avoid repeat whole-brain irradiation (WBI) in patients with multiple brain metastases of most solid tumor histological findings. Few data are available for the use of radiosurgery for small-cell lung cancer (SCLC). Methods and Materials: Between November 1999 and June 2009, 51 patients with SCLC and previous WBI and new brain metastases were treated with GammaKnife stereotactic radiosurgery (GKSRS). A median dose of 18 Gy (range, 10-24 Gy) was prescribed to the margin of each metastasis. Patients were followed with serial imaging. Patient electronic records were reviewed to determine disease-related factors and clinical outcomes after GKSRS. Local and distant brain failure rates, overall survival, and likelihood of neurologic death were determined based on imaging results. The Kaplan-Meier method was used to determine survival and local and distant brain control. Cox proportional hazard regression was performed to determine strength of association between disease-related factors and survival. Results: Median survival time for the entire cohort was 5.9 months. Local control rates at 1 and 2 years were 57% and 34%, respectively. Distant brain failure rates at 1 and 2 years were 58% and 75%, respectively. Fifty-three percent of patients ultimately died of neurologic death. On multivariate analysis, patients with stable (hazard ratio [HR] = 2.89) or progressive (HR = 6.98) extracranial disease (ECD) had worse overall survival than patients without evidence of ECD (p = 0.00002). Concurrent chemotherapy improved local control (HR = 89; p = 0.006). Conclusions: GKSRS represents a feasible salvage option in patients with SCLC and brain metastases for whom previous WBI has failed. The status of patients' ECD is a dominant factor predictive of overall survival. Local control may be inferior to that seen with other cancer histological results, although the use of concurrent chemotherapy may help to improve this.

  9. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    SciTech Connect (OSTI)

    Chen, Allen M.; Hall, William H.; Li, Judy; Beckett, Laurel; Farwell, D. Gregory; Lau, Derick H.; Purdy, James A.

    2012-09-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

  10. Evaluating the Role of Prophylactic Gastrostomy Tube Placement Prior to Definitive Chemoradiotherapy for Head and Neck Cancer

    SciTech Connect (OSTI)

    Chen, Allen M.; Li Baoqing; Lau, Derick H.; Farwell, D. Gregory; Luu, Quang; Stuart, Kerri; Newman, Kathleen; Purdy, James A.; Vijayakumar, Srinivasan M.D.

    2010-11-15

    Purpose: To determine the effect of prophylactic gastrostomy tube (GT) placement on acute and long-term outcome for patients treated with definitive chemoradiotherapy for locally advanced head and neck cancer. Methods and Materials: One hundred twenty consecutive patients were treated with chemoradiotherapy for Stage III/IV head and neck cancer to a median dose of 70 Gy (range, 64-74 Gy). The most common primary site was the oropharynx (66 patients). Sixty-seven patients (56%) were treated using intensity-modulated radiotherapy (IMRT). Seventy patients (58%) received prophylactic GT placement at the discretion of the physician before initiation of chemoradiotherapy. Results: Prophylactic GT placement significantly reduced weight loss during radiation therapy from 43 pounds (range, 0 to 76 pounds) to 19 pounds (range, 0 to 51 pounds), which corresponded to a net change of -14% (range, 0% to -30%) and -8% (range, +1% to -22%) from baseline, respectively (p < 0.001). However, the proportion of patients who were GT-dependent at 6- and 12-months after treatment was 41% and 21%, respectively, compared with 8% and 0%, respectively, for those with and without prophylactic GT (p < 0.001). Additionally, prophylactic GT was associated with a significantly higher incidence of late esophageal stricture compared with those who did not have prophylactic GT (30% vs. 6%, p < 0.001). Conclusions: Although prophylactic GT placement was effective at preventing acute weight loss and the need for intravenous hydration, it was also associated with significantly higher rates of late esophageal toxicity. The benefits of this strategy must be balanced with the risks.

  11. DoseVolume Modeling of Brachial Plexus-Associated Neuropathy After Radiation Therapy for Head-and-Neck Cancer: Findings From a Prospective Screening Protocol

    SciTech Connect (OSTI)

    Chen, Allen M.; Wang, Pin-Chieh; Daly, Megan E.; Cui, Jing; Hall, William H.; Vijayakumar, Srinivasan; Phillips, Theodore L.; Farwell, D. Gregory; Purdy, James A.

    2014-03-15

    Purpose: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. Methods and Materials: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. Results: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms withthe most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dosevolume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). Conclusions: Dosevolume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.

  12. Prospective Trial of High-Dose Reirradiation Using Daily Image Guidance With Intensity-Modulated Radiotherapy for Recurrent and Second Primary Head-and-Neck Cancer

    SciTech Connect (OSTI)

    Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Cheng, Suzan; Donald, Paul J.; Purdy, James A.

    2011-07-01

    Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 {+-} 1.25 mm, 1.79 {+-} 1.45 mm, and 1.98 {+-} 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.

  13. SU-D-204-06: Dose and Image Quality Evaluation of a Low-Dose Slot-Scanning X-Ray System for Pediatric Orthopedic Studies

    SciTech Connect (OSTI)

    Liu, Z; Hoerner, M; Lamoureux, R; Rill, L; Arreola, M

    2015-06-15

    Purpose: Children in early teens with scoliosis require repeated radiographic exams over a number of years. The EOS (EOS imaging S.A., Paris, France) is a novel low-dose slot-scanning digital radiographic system designed to produce full-spine images of a free-standing patient. The radiation dose and image quality characteristics of the EOS were evaluated relative to those of a Computed Radiography (CR) system for scoliosis imaging. Methods: For dose evaluation, a full-torso anthropomorphic phantom was scanned five times using the default standard clinical protocols for both the EOS and a CR system, which include both posteroanterior and lateral full-spine views. Optically stimulated luminescent dosimeters (OSLDs), also known as nanoDots™ (Landauer, Inc., Glenwood, IL), were placed on the phantom’s surface to measure entrance skin dose. To assess image quality, MTF curves were generated from sampling the noise levels within the high-contrast regions of a line-pair phantom. Vertical and horizontal distortions were measured for the square line-pair phantom with the EOS system to evaluate the effects of geometric magnification and misalignment with the indicated imaging plane. Results: The entrance skin dose was measured to be 0.4 to 1.1 mGy for the EOS, and 0.7 to 3.6 mGy for the CR study. MTF comparison shows that CR greatly outperforms the EOS, despite both systems having a limiting resolution at 1.8 line-pairs per mm. Vertical distortion was unaffected by phantom positioning, because of the EOS slot-scanning geometry. Horizontal distortion increased linearly with miscentering distance. Conclusion: The EOS system resulted in approximately 70% lower radiation dose than CR for full-spine images. Image quality was found to be inferior to CR. Further investigation is required to see if EOS system is an acceptable modality for performing clinically diagnostic scoliosis examinations.

  14. SU-E-J-91: Novel Epitaxial Silicon Array for Quality Assurance in Photon and Proton Therapy

    SciTech Connect (OSTI)

    Talamonti, C; Zani, M; Scaringella, M; Bruzzi, M; Bucciolini, M; Menichelli, D; Friedl, F

    2014-06-01

    Purpose: to demonstrate suitability of a novel silicon array for measuring the dose properties of highly conformal photon and proton beams. Methods: prototype under test is a 24cm long linear array prototype, although the underlying technology is suitable to construct 2D arrays as well. It is based on a 64pixels monolithic sensor with 1mm pixel pitch, made of epitaxial ptype silicon. Thanks to design modularity, more sensors can be placed side by side without breaking pixel pitch. Flattened and unflattened photon beams, as well as proton radiation from a cyclotron in pencil beam scanning mode, were considered. Measurements of beam characteristics as percentage depth doses, dose profiles, output factors and energy response, which are necessary to deliver radiation with high precision and reliability, were performed. Results: Dose rate independence with photons was verified in the dose per pulse range 0.03 to 2mGy. Results clearly indicate nondependence of the detector sensitivity both for flattened and unflattened beams, with a variation of at most 0.5percentage. OFs were obtained for field with a lateral size ranging from 0.8cm to 16cm and the results are in good agreement with ion chamber A1SL, max difference less than 1.5percentage. Field sizes and beam penumbra were measured and compared to EBT film results. Concerning proton beams, sensitivity independence on dose rate was verified by changing the beam current in the interval 2-130Gy/s. Field sizes and beam penumbra measurements are in agreement with data taken with a scintillating 2D array with 0.5mm resolution IBA Lynx, and a better penumbra definition than an array of ionization chambers IBA MatriXX is reached. Conclusion: The device is a novel and valuable tool for QA both for photon and proton dose delivery. All measurements demonstrated its capability to measure with high spatial resolution many crucial properties of the RT beam.

  15. SU-E-T-501: Normal Tissue Toxicities of Pulsed Low Dose Rate Radiotherapy and Conventional Radiotherapy: An in Vivo Total Body Irradiation Study

    SciTech Connect (OSTI)

    Cvetkovic, D; Zhang, P; Wang, B; Chen, L; Ma, C

    2014-06-01

    Purpose: Pulsed low dose rate radiotherapy (PLDR) is a re-irradiation technique for therapy of recurrent cancers. We have previously shown a significant difference in the weight and survival time between the mice treated with conventional radiotherapy (CRT) and PLDR using total body irradiation (TBI). The purpose of this study was to investigate the in vivo effects of PLDR on normal mouse tissues.Materials and Methods: Twenty two male BALB/c nude mice, 4 months of age, were randomly assigned into a PLDR group (n=10), a CRT group (n=10), and a non-irradiated control group (n=2). The Siemens Artiste accelerator with 6 MV photon beams was used. The mice received a total of 18Gy in 3 fractions with a 20day interval. The CRT group received the 6Gy dose continuously at a dose rate of 300 MU/min. The PLDR group was irradiated with 0.2Gyx20 pulses with a 3min interval between the pulses. The mice were weighed thrice weekly and sacrificed 2 weeks after the last treatment. Brain, heart, lung, liver, spleen, gastrointestinal, urinary and reproductive organs, and sternal bone marrow were removed, formalin-fixed, paraffin-embedded and stained with H and E. Morphological changes were observed under a microscope. Results: Histopathological examination revealed atrophy in several irradiated organs. The degree of atrophy was mild to moderate in the PLDR group, but severe in the CRT group. The most pronounced morphological abnormalities were in the immune and hematopoietic systems, namely spleen and bone marrow. Brain hemorrhage was seen in the CRT group, but not in the PLDR group. Conclusions: Our results showed that PLDR induced less toxicity in the normal mouse tissues than conventional radiotherapy for the same dose and regimen. Considering that PLDR produces equivalent tumor control as conventional radiotherapy, it would be a good modality for treatment of recurrent cancers.

  16. TH-A-BRF-09: Integration of High-Resolution MRSI Into Glioblastoma Treatment Planning

    SciTech Connect (OSTI)

    Schreibmann, E; Cordova, J; Shu, H; Crocker, I; Curran, W; Holder, C; Shim, H

    2014-06-15

    Purpose: Identification of a metabolite signature that shows significant tumor cell infiltration into normal brain in regions that do not appear abnormal on standard MRI scans would be extremely useful for radiation oncologists to choose optimal regions of brain to treat, and to quantify response beyond the MacDonald criteria. We report on integration of high-resolution magnetic resonance spectroscopic imaging (HR-MRSI) with radiation dose escalation treatment planning to define and target regions at high risk for recurrence. Methods: We propose to supplement standard MRI with a special technique performed on an MRI scanner to measure the metabolite levels within defined volumes. Metabolite imaging was acquired using an advanced MRSI technique combining 3D echo-planar spectroscopic imaging (EPSI) with parallel acquisition (GRAPPA) using a multichannel head coil that allows acquisition of whole brain metabolite maps with 108 μl resolution in 12 minutes implemented on a 3T MR scanner. Elevation in the ratio of two metabolites, choline (Cho, elevated in proliferating high-grade gliomas) and N-acetyl aspartate (NAA, a normal neuronal metabolite), was used to image infiltrating high-grade glioma cells in vivo. Results: The metabolite images were co-registered with standard contrast-enhanced T1-weighted MR images using in-house registration software and imported into the treatment-planning system. Regions with tumor infiltration are identified on the metabolic images and used to create adaptive IMRT plans that deliver a standard dose of 60 Gy to the standard target volume and an escalated dose of 75 Gy (or higher) to the most suspicious regions, identified as areas with elevated Cho/NAA ratio. Conclusion: We have implemented a state-of-the-art HR-MRSI technology that can generate metabolite maps of the entire brain in a clinically acceptable scan time, coupled with introduction of an imaging co-registration/ analysis program that combines MRSI data with standard imaging studies in a clinically useful fashion.

  17. A planning study of simultaneous integrated boost with forward IMRT for multiple brain metastases

    SciTech Connect (OSTI)

    Liang, Xiaodong; Ni, Lingqin; Hu, Wei; Chen, Weijun; Ying, Shenpeng; Gong, Qiangjun; Liu, Yanmei

    2013-07-01

    The objective of this study was to evaluate the dose conformity and feasibility of whole-brain radiotherapy with a simultaneous integrated boost by forward intensity-modulated radiation therapy in patients with 1 to 3 brain metastases. Forward intensity-modulated radiation therapy plans were generated for 10 patients with 1 to 3 brain metastases on Pinnacle 6.2 Treatment Planning System. The prescribed dose was 30 Gy to the whole brain (planning target volume [PTV]{sub wbrt}) and 40 Gy to individual brain metastases (PTV{sub boost}) simultaneously, and both doses were given in 10 fractions. The maximum diameters of individual brain metastases ranged from 1.6 to 6 cm, and the summated PTVs per patient ranged from 1.62 to 69.81 cm{sup 3}. Conformity and feasibility were evaluated regarding conformation number and treatment delivery time. One hundred percent volume of the PTV{sub boost} received at least 95% of the prescribed dose in all cases. The maximum doses were less than 110% of the prescribed dose to the PTV{sub boost}, and all of the hot spots were within the PTV{sub boost}. The volume of the PTV{sub wbrt} that received at least 95% of the prescribed dose ranged from 99.2% to 100%. The mean values of conformation number were 0.682. The mean treatment delivery time was 2.79 minutes. Ten beams were used on an average in these plans. Whole-brain radiotherapy with a simultaneous integrated boost by forward intensity-modulated radiation therapy in 1 to 3 brain metastases is feasible, and treatment delivery time is short.

  18. SU-E-T-340: Use of Intensity Modulated Proton Therapy (IMPT) for Reducing the Dose to Cochlea in Craniospinal Irradiation (CSI) of Pediatric Patients

    SciTech Connect (OSTI)

    Dormer, J; Kassaee, A; Lin, H; Ding, X; Lustig, R

    2014-06-01

    Purpose: To evaluate use of intensity modulated proton therapy (IMPT) and number of beams for sparing cochlea in treatment of whole brain for pediatric medulloblastoma patients. Methods: In our institution, craniospinal irradiation patients are treated in supine position on our proton gantries using pencil beam scanning with each beam uniformly covering the target volume (SFUD). Each treatment plan consists of two opposed lateral whole brain fields and one or two spinal fields. For sparing the cochlea for the whole brain treatment, we created three different plans using IMPT for five pediatric patients. The first plan consisted of two lateral fields, the second two lateral fields and a superior-inferior field, and the third two lateral fields and two superior oblique fields. Optimization was performed with heavy weights applied to the eye, lens and cochlea while maintaining a dose prescription of 36 Gy to the whole brain. Results: IMPT plans reduce the dose to the cochlea. Increasing the number of treatment fields was found to lower the average dose to the cochlea: 15.0, 14.5 and 12.5 Gy for the two-field, three-field, and four-field plans respectively. The D95 for the two-field plan was 98.2%, compared to 100.0% for both the three-field and four-field plan. Coverage in the mid-brain was noticeably better in the three- and four-field plans, with more dose conformality surrounding the cochlea. Conclusion: IMPT plans for CSI and the whole brain irradiations are capable of sparing cochlea and reduce the dose considerably without compromising treating brain tissues. The reduction in average dose increases with three and four field plans as compared to traditional two lateral beam plans.

  19. Irradiation Alters MMP-2/TIMP-2 System and Collagen Type IV Degradation in Brain

    SciTech Connect (OSTI)

    Lee, Won Hee; Warrington, Junie P.; Sonntag, William E.; Lee, Yong Woo

    2012-04-01

    Purpose: Blood-brain barrier (BBB) disruption is one of the major consequences of radiation-induced normal tissue injury in the central nervous system. We examined the effects of whole-brain irradiation on matrix metalloproteinases (MMPs)/tissue inhibitors of metalloproteinases (TIMPs) and extracellular matrix (ECM) degradation in the brain. Methods and Materials: Animals received either whole-brain irradiation (a single dose of 10 Gy {gamma}-rays or a fractionated dose of 40 Gy {gamma}-rays, total) or sham-irradiation and were maintained for 4, 8, and 24 h following irradiation. mRNA expression levels of MMPs and TIMPs in the brain were analyzed by real-time reverse transcriptase-polymerase chain reaction (PCR). The functional activity of MMPs was measured by in situ zymography, and degradation of ECM was visualized by collagen type IV immunofluorescent staining. Results: A significant increase in mRNA expression levels of MMP-2, MMP-9, and TIMP-1 was observed in irradiated brains compared to that in sham-irradiated controls. In situ zymography revealed a strong gelatinolytic activity in the brain 24 h postirradiation, and the enhanced gelatinolytic activity mediated by irradiation was significantly attenuated in the presence of anti-MMP-2 antibody. A significant reduction in collagen type IV immunoreactivity was also detected in the brain at 24 h after irradiation. In contrast, the levels of collagen type IV were not significantly changed at 4 and 8 h after irradiation compared with the sham-irradiated controls. Conclusions: The present study demonstrates for the first time that radiation induces an imbalance between MMP-2 and TIMP-2 levels and suggests that degradation of collagen type IV, a major ECM component of BBB basement membrane, may have a role in the pathogenesis of brain injury.

  20. Valvular Abnormalities Detected by Echocardiography in 5-Year Survivors of Childhood Cancer: A Long-Term Follow-Up Study

    SciTech Connect (OSTI)

    Pal, Helena J. van der; Caron, Huib N.; Kremer, Leontien C.; Dalen, Elvira C. van

    2015-01-01

    Purpose: To determine the prevalence of valvular abnormalities after radiation therapy involving the heart region and/or treatment with anthracyclines and to identify associated risk factors in a large cohort of 5-year childhood cancer survivors (CCS). Methods and Materials: The study cohort consisted of all 626 eligible 5-year CCS diagnosed with childhood cancer in the Emma Children's Hospital/Academic Medical Center between 1966 and 1996 and treated with radiation therapy involving the heart region and/or anthracyclines. We determined the presence of valvular abnormalities according to echocardiograms. Physical radiation dose was converted into the equivalent dose in 2-Gy fractions (EQD{sub 2}). Using multivariable logistic regression analyses, we examined the associations between cancer treatment and valvular abnormalities. Results: We identified 225 mainly mild echocardiographic valvular abnormalities in 169 of 545 CCS (31%) with a cardiac assessment (median follow-up time, 14.9years [range, 5.1-36.8years]; median attained age 22.0years [range, 7.0-49.7years]). Twenty-four CCS (4.4%) had 31 moderate or higher-graded abnormalities. Most common abnormalities were tricuspid valve disorders (n=119; 21.8%) and mitral valve disorders (n=73; 13.4%). The risk of valvular abnormalities was associated with increasing radiation dose (using EQD{sub 2}) involving the heart region (odds ratio 1.33 per 10Gy) and the presence of congenital heart disease (odds ratio 3.43). We found no statistically significant evidence that anthracyclines increase the risk. Conclusions: Almost one-third of CCS treated with potentially cardiotoxic therapy had 1 or more asymptomatic, mostly mild valvular abnormalities after a median follow-up of nearly 15years. The most important risk factors are higher EQD{sub 2} to the heart region and congenital heart disease. Studies with longer follow-up are necessary to investigate the clinical course of asymptomatic valvular abnormalities in CCS.

  1. Current Dosing Paradigm for Stereotactic Radiosurgery Alone After Surgical Resection of Brain Metastases Needs to Be Optimized for Improved Local Control

    SciTech Connect (OSTI)

    Prabhu, Roshan; Shu, Hui-Kuo; Hadjipanayis, Constantinos; Dhabaan, Anees; Hall, William; Raore, Bethwel; Olson, Jeffrey; Curran, Walter; Oyesiku, Nelson; Crocker, Ian

    2012-05-01

    Purpose: To describe the use of radiosurgery (RS) alone to the resection cavity after resection of brain metastases as an alternative to adjuvant whole-brain radiotherapy (WBRT). Methods and Materials: Sixty-two patients with 64 cavities were treated with linear accelerator-based RS alone to the resection cavity after surgical removal of brain metastases between March 2007 and August 2010. Fifty-two patients (81%) had a gross total resection. Median cavity volume was 8.5 cm{sup 3}. Forty-four patients (71%) had a single metastasis. Median marginal and maximum doses were 18 Gy and 20.4 Gy, respectively. Sixty-one cavities (95%) had gross tumor volume to planning target volume expansion of {>=}1 mm. Results: Six-month and 1-year actuarial local recurrence rates were 14% and 22%, respectively, with a median follow-up period of 9.7 months. Six-month and 1-year actuarial distant brain recurrence, total intracranial recurrence, and freedom from WBRT rates were 31% and 51%, 41% and 63%, and 91% and 74%, respectively. The symptomatic cavity radiation necrosis rate was 8%, with 2 patients (3%) undergoing surgery. Of the 11 local failures, 8 were in-field, 1 was marginal, and 2 were both (defined as in-field if {>=}90% of recurrence within the prescription isodose and marginal if {>=}90% outside of the prescription isodose). Conclusions: The high rate of in-field cavity failure suggests that geographic misses with highly conformal RS are not a major contributor to local recurrence. The current dosing regimen derived from Radiation Therapy Oncology Group protocol 90-05 should be optimized in this patient population before any direct comparison with WBRT.

  2. Improvements in dose calculation accuracy for small off-axis targets in high dose per fraction tomotherapy

    SciTech Connect (OSTI)

    Hardcastle, Nicholas; Bayliss, Adam; Wong, Jeannie Hsiu Ding; Rosenfeld, Anatoly B.; Tome, Wolfgang A.

    2012-08-15

    Purpose: A recent field safety notice from TomoTherapy detailed the underdosing of small, off-axis targets when receiving high doses per fraction. This is due to angular undersampling in the dose calculation gantry angles. This study evaluates a correction method to reduce the underdosing, to be implemented in the current version (v4.1) of the TomoTherapy treatment planning software. Methods: The correction method, termed 'Super Sampling' involved the tripling of the number of gantry angles from which the dose is calculated during optimization and dose calculation. Radiochromic film was used to measure the dose to small targets at various off-axis distances receiving a minimum of 21 Gy in one fraction. Measurements were also performed for single small targets at the center of the Lucy phantom, using radiochromic film and the dose magnifying glass (DMG). Results: Without super sampling, the peak dose deficit increased from 0% to 18% for a 10 mm target and 0% to 30% for a 5 mm target as off-axis target distances increased from 0 to 16.5 cm. When super sampling was turned on, the dose deficit trend was removed and all peak doses were within 5% of the planned dose. For measurements in the Lucy phantom at 9.7 cm off-axis, the positional and dose magnitude accuracy using super sampling was verified using radiochromic film and the DMG. Conclusions: A correction method implemented in the TomoTherapy treatment planning system which triples the angular sampling of the gantry angles used during optimization and dose calculation removes the underdosing for targets as small as 5 mm diameter, up to 16.5 cm off-axis receiving up to 21 Gy.

  3. SU-E-T-445: Lateral Optical Density Variation in Flatbed Scanners in Combination with Gafchromic Film

    SciTech Connect (OSTI)

    Battum, LJ van; Heukelom, S

    2014-06-01

    Purpose This study investigates the origin of lateral optical density (OD) variation for Gafchromic film (EBT and EBT2) scanned in transmission mode with Epson flatbed scanners (1680 Expression Pro and 10000XL). Effects investigated are: cross talk, optical path length and polarization. Methods Cross talk has been examined with triangular shaped light-transmission sheets with OD ranging from 0 to opaque. Optical path length has been studied with absorptive and reflective OD-filters (OD range 0.2 to 2.0). Dependency on light-polarization on the scanner read out has been investigated using linear polarizer sheets. All experiments have been performed at centre scanner position (norm point) and at several lateral scan positions, without and with (un)irradiated EBT-film. Dose values used ranged between 0.2 to 9 Gy, yielding an OD-range between 0.25 to 1.1. Results The lateral OD variation is dose dependent and increases up to 14% at most lateral position for dose up to 9 Gy. Cross talk effect contributes to 0.5% in clinical used OD ranges but equals 2% for extreme high dose gradients. Film induced optical path length will effect the lateral OD variation up to 3% at most lateral points. Light polarization is inherent present in these scanners due to multiple reflection on mirrors. In addition film induced polarization is the most important effect generating the observed lateral OD variation. Both Gafchromic film base and sensitive layer have polarizing capabilities; for the sensitive layer its influence is dose dependent. Conclusions Lateral OD variation origins from optical physics (i.e. polarization and reflection) related to scanner and film construction. Cross talk can be ignored in film dosimetry for clinical used dose values and gradients. Therefore it is recommended to determine the lateral OD variation per film type and scanner.

  4. Acquired Tumor Cell Radiation Resistance at the Treatment Site Is Mediated Through Radiation-Orchestrated Intercellular Communication

    SciTech Connect (OSTI)

    Aravindan, Natarajan; Aravindan, Sheeja; Pandian, Vijayabaskar; Khan, Faizan H.; Ramraj, Satish Kumar; Natt, Praveen; Natarajan, Mohan

    2014-03-01

    Purpose: Radiation resistance induced in cancer cells that survive after radiation therapy (RT) could be associated with increased radiation protection, limiting the therapeutic benefit of radiation. Herein we investigated the sequential mechanistic molecular orchestration involved in radiation-induced radiation protection in tumor cells. Results: Radiation, both in the low-dose irradiation (LDIR) range (10, 50, or 100 cGy) or at a higher, challenge dose IR (CDIR), 4 Gy, induced dose-dependent and sustained NFκB-DNA binding activity. However, a robust and consistent increase was seen in CDIR-induced NFκB activity, decreased DNA fragmentation, apoptosis, and cytotoxicity and attenuation of CDIR-inhibited clonal expansion when the cells were primed with LDIR prior to challenge dose. Furthermore, NFκB manipulation studies with small interfering RNA (siRNA) silencing or p50/p65 overexpression unveiled the influence of LDIR-activated NFκB in regulating CDIR-induced DNA fragmentation and apoptosis. LDIR significantly increased the transactivation/translation of the radiation-responsive factors tumor necrosis factor-α (TNF-α), interleukin-1α (IL-1α), cMYC, and SOD2. Coculture experiments exhibit LDIR-influenced radiation protection and increases in cellular expression, secretion, and activation of radiation-responsive molecules in bystander cells. Individual gene-silencing approach with siRNAs coupled with coculture studies showed the influence of LDIR-modulated TNF-α, IL-1α, cMYC, and SOD2 in induced radiation protection in bystander cells. NFκB inhibition/overexpression studies coupled with coculture experiments demonstrated that TNF-α, IL-1α, cMYC, and SOD2 are selectively regulated by LDIR-induced NFκB. Conclusions: Together, these data strongly suggest that scattered LDIR-induced NFκB-dependent TNF-α, IL-1α, cMYC, and SOD2 mediate radiation protection to the subsequent challenge dose in tumor cells.

  5. The Efficacy of Radiotherapy in the Treatment of Orbital Pseudotumor

    SciTech Connect (OSTI)

    Matthiesen, Chance; Bogardus, Carl; Thompson, J. Spencer; Farris, Bradley; Hildebrand, Lloyd; Wilkes, Byron; Syzek, Elizabeth; Algan, Ozer; Ahmad, Salahuddin; Herman, Terence

    2011-04-01

    Purpose: To review institutional outcomes for patients treated with external-beam radiotherapy (EBRT) for orbital pseudotumor. Methods and Materials: This is a single-institution retrospective review of 20 orbits in 16 patients diagnosed with orbital pseudotumor that received EBRT at the University of Oklahoma, Department of Radiation Oncology. Treated patients had a median follow-up of 16.5 months. Results: Fifteen patients (93.7%) were initially treated with corticosteroids. Eight had recurrence after steroid cessation, six were unable to taper corticosteroids completely or partially, and one experienced progression of symptoms despite corticosteroid therapy. Fourteen patients (87.5%) initially responded to radiotherapy indicated by clinical improvement of preradiation symptoms and/or tapering of corticosteroid dose. Mean EBRT dose was 20 Gy (range, 14-30 Gy). Thirteen patients (81.2%) continued to improve after radiation therapy. Patient outcomes were complete cessation of corticosteroid therapy in nine patients (56.3%) and reduced corticosteroid dose in four patients (25%). Radiotherapy did not achieve long-term control for three patients (18.7%), who still required preradiation corticosteroid dosages. Three patients received retreatment(s) of four orbits, of which two patients achieved long-term symptom control without corticosteroid dependence. One patient received retreatment to an orbit three times, achieving long-term control without corticosteroid dependence. No significant late effects have been observed in retreated patients. Conclusions: Radiotherapy is an effective treatment for acute symptomatic improvement and long-term control of orbital pseudotumor. Orbital retreatment can be of clinical benefit, without apparent increase in morbidity, when initial irradiation fails to achieve complete response.

  6. SU-E-T-304: Study of Secondary Neutrons From Uniform Scanning Proton Beams

    SciTech Connect (OSTI)

    Islam, M; Zheng, Y; Benton, E

    2014-06-01

    Purpose: Secondary neutrons are unwanted byproducts from proton therapy and exposure from secondary radiation during treatment could increase risk of developing a secondary cancer later in a patient's lifetime. The purpose of this study is to investigate secondary neutrons from uniform scanning proton beams under various beam conditions using both measurements and Monte Carlo simulations. Methods: CR-39 Plastic Track Nuclear Detectors (PNTD) were used for the measurement. CR-39 PNTD has tissue like sensitivity to the secondary neutrons but insensitive to the therapeutic protons. In this study, we devised two experimental conditions: a) hollow-phantom; phantom is bored with a hollow cylinder along the direction of the beam so that the primary proton passes through the phantom without interacting with the phantom material, b) cylindrical-phantom; a solid cylinder of diameter close to the beam diameter is placed along the beam path. CR-39 PNTDs were placed laterally inside a 60X20X35 cm3 phantom (hollow-phantom) and in air (cylindrical-phantom) at various angles with respect to the primary beam axis. We studied for three different proton energies (78 MeV, 162 MeV and 226 MeV), using a 4 cm modulation width and 5cm diameter brass aperture for the entire experiment and simulation. A comparison of the experiment was performed using the Monte Carlo code FLUKA. Results: The measured secondary neutron dose equivalent per therapeutic primary proton dose (H/D) ranges from 2.1 ± 0.2 to 25.42 ± 2.3 mSv/Gy for the hollow phantom study, and 2.7 ± 0.3 to 46.4 ± 3.4 mSv/Gy for the cylindrical phantom study. Monte Carlo simulations predicated neutron dose equivalent from measurements within a factor of 5. Conclusion: The study suggests that the production of external neutrons is significantly higher than the production of internal neutrons.

  7. Impact of 1p/19q Codeletion and Histology on Outcomes of Anaplastic Gliomas Treated With Radiation Therapy and Temozolomide

    SciTech Connect (OSTI)

    Speirs, Christina K.; Simpson, Joseph R.; Robinson, Clifford G.; DeWees, Todd A.; Tran, David D.; Linette, Gerry; Chicoine, Michael R.; Dacey, Ralph G.; Rich, Keith M.; Dowling, Joshua L.; Leuthardt, Eric C.; Zipfel, Gregory J.; Kim, Albert H.; Huang, Jiayi

    2015-02-01

    Purpose: Anaplastic gliomas represent a heterogeneous group of primary high-grade brain tumors, and the optimal postoperative treatment remains controversial. In this report, we present our institutional data on the clinical outcomes of radiation therapy (RT) plus temozolomide (RT + TMZ) for anaplastic gliomas, stratified by histology and 1p/19q codeletion. Methods and Materials: A single-institution retrospective review was conducted of patients with supratentorial anaplastic oligodendroglioma (AO), mixed anaplastic oligoastrocytoma (AOA), and anaplastic astrocytoma (AA). After surgery, RT was delivered at a median total dose of 60 Gy (range, 31.6-63 Gy) in daily fractions. All patients received standard concurrent TMZ, with or without adjuvant TMZ. Histological/molecular subtypes were defined as codeleted AO/AOA, non-codeleted AO/AOA, and AA. Results: From 2000 to 2012, 111 cases met study criteria and were evaluable. Codeleted AO/AOA had superior overall survival (OS) to non-codeleted AO/AOA (91% vs 68% at 5 years, respectively, P=.02), whereas progression-free survival (PFS) was not significantly different (70% vs 46% at 5 years, respectively, P=.10). AA had inferior OS to non-codeleted AO/AOA (37% vs 68% at 5 years, respectively, P=.007) and inferior PFS (27% vs 46%, respectively, P=.03). On multivariate analysis, age, performance status, and histological or molecular subtype were independent predictors for both PFS and OS. Compared to historical controls, RT + TMZ provided comparable OS to RT with procarbazine, lomustine, and vincristine (RT + PCV) for codeleted AO/AOA, superior OS to RT alone for non-codeleted AO/AOA, and similar OS to RT alone for AA. Conclusions: RT + TMZ may be a promising treatment for both codeleted and non-codeleted AO/AOA, but its role for AA remains unclear.

  8. Pulmonary Artery Invasion, High-Dose Radiation, and Overall Survival in Patients With Non-Small Cell Lung Cancer

    SciTech Connect (OSTI)

    Han, Cheng-Bo; Wang, Wei-Li; Quint, Leslie; Xue, Jian-Xin; Matuszak, Martha; Ten Haken, Randall; Kong, Feng-Ming

    2014-06-01

    Purpose: To investigate whether high-dose radiation to the pulmonary artery (PA) affects overall survival (OS) in patients with non-small cell lung cancer (NSCLC). Methods and Materials: Patients with medically inoperable/unresectable NSCLC treated with definitive radiation therapy in prospective studies were eligible for this study. Pulmonary artery involvement was defined on the basis of pretreatment chest CT and positron emission tomography/CT fusion. Pulmonary artery was contoured according to the Radiation Therapy Oncology Group protocol 1106 atlas, and dose-volume histograms were generated. Results: A total of 100 patients with a minimum follow-up of 1 year for surviving patients were enrolled: 82.0% underwent concurrent chemoradiation therapy. Radiation dose ranged from 60 to 85.5 Gy in 30-37 fractions. Patients with PA invasion of grade ≤2, 3, 4, and 5 had 1-year OS and median survival of 67% and 25.4 months (95% confidence interval [CI] 15.7-35.1), 62% and 22.2 months (95% CI 5.8-38.6), 90% and 35.8 months (95% CI 28.4-43.2), and 50% and 7.0 months, respectively (P=.601). Two of the 4 patients with grade 5 PA invasion died suddenly from massive hemorrhage at 3 and 4.5 months after completion of radiation therapy. Maximum and mean doses to PA were not significantly associated with OS. The V45, V50, V55, and V60 of PA were correlated significantly with a worse OS (P<.05). Patients with V45 >70% or V60 >37% had significantly worse OS (13.3 vs 37.9 months, P<.001, and 13.8 vs 37.9 months, P=.04, respectively). Conclusions: Grade 5 PA invasion and PA volume receiving more than 45-60 Gy may be associated with inferior OS in patients with advanced NSCLC treated with concurrent chemoradiation.

  9. Colorectal Histology Is Associated With an Increased Risk of Local Failure in Lung Metastases Treated With Stereotactic Ablative Radiation Therapy

    SciTech Connect (OSTI)

    Binkley, Michael S.; Trakul, Nicholas; Jacobs, Lisa Rose; Eyben, Rie von; Le, Quynh-Thu; Maxim, Peter G.; Loo, Billy W.; Shultz, David Benjamin; Diehn, Maximilian

    2015-08-01

    Purpose: Stereotactic ablative radiation therapy (SABR) is increasingly used to treat lung oligometastases. We set out to determine the safety and efficacy of this approach and to identify factors associated with outcomes. Methods and Materials: We conducted a retrospective study of patients treated with SABR for metastatic lung tumors at our institution from 2003 to 2014. We assessed the association between various patient and treatment factors with local failure (LF), progression, subsequent treatment, systemic treatment, and overall survival (OS), using univariate and multivariate analyses. Results: We identified 122 tumors in 77 patients meeting inclusion criteria for this study. Median follow-up was 22 months. The 12- and 24-month cumulative incidence rates of LF were 8.7% and 16.2%, respectively; the 24-month cumulative incidence rates of progression, subsequent treatment, and subsequent systemic treatment were 75.2%, 64.5%, and 35.1%, respectively. Twenty-four-month OS was 74.6%, and median OS was 36 months. Colorectal metastases had a significantly higher cumulative incidence of LF at 12 and 24 months (25.5% and 42.2%, respectively), than all other histologies (4.4% and 9.9%, respectively; P<.0004). The 24-month cumulative incidences of LF for colorectal metastases treated with a biologically effective dose at α/β = 10 (BED{sub 10}) of <100 Gy versus BED{sub 10} of ≥100 Gy were 62.5% and 16.7%, respectively (P=.08). Toxicity was minimal, with only a single grade 3 or higher event observed. Conclusions: SABR for metastatic lung tumors appears to be safe and effective with excellent local control, treatment-free intervals, and OS. An exception is metastases from colorectal cancer, which have a high LF rate consistent with a radioresistant phenotype, suggesting a potential role for dose escalation.

  10. Radiation Therapy Planning for Early-Stage Hodgkin Lymphoma: Experience of the International Lymphoma Radiation Oncology Group

    SciTech Connect (OSTI)

    Maraldo, Maja V.; Dabaja, Bouthaina S.; Filippi, Andrea R.; Illidge, Tim; Tsang, Richard; Ricardi, Umberto; Petersen, Peter M.; Schut, Deborah A.; Garcia, John; Headley, Jayne; Parent, Amy; Guibord, Benoit; Ragona, Riccardo; Specht, Lena

    2015-05-01

    Purpose: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs). Methods: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013. Results: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient. Conclusions: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.

  11. {sup 18}F-Choline Positron Emission Tomography/Computed Tomography–Driven High-Dose Salvage Radiation Therapy in Patients With Biochemical Progression After Radical Prostatectomy: Feasibility Study in 60 Patients

    SciTech Connect (OSTI)

    D'Angelillo, Rolando M.; Sciuto, Rosa; Ramella, Sara; Papalia, Rocco; Jereczek-Fossa, Barbara A.; Trodella, Luca E.; Fiore, Michele; Gallucci, Michele; Maini, Carlo L.; Trodella, Lucio

    2014-10-01

    Purpose: To retrospectively review data of a cohort of patients with biochemical progression after radical prostatectomy, treated according to a uniform institutional treatment policy, to evaluate toxicity and feasibility of high-dose salvage radiation therapy (80 Gy). Methods and Materials: Data on 60 patients with biochemical progression after radical prostatectomy between January 2009 and September 2011 were reviewed. The median value of prostate-specific antigen before radiation therapy was 0.9 ng/mL. All patients at time of diagnosis of biochemical recurrence underwent dynamic {sup 18}F-choline positron emission tomography/computed tomography (PET/CT), which revealed in all cases a local recurrence. High-dose salvage radiation therapy was delivered up to total dose of 80 Gy to 18F-choline PET/CT-positive area. Toxicity was recorded according to the Common Terminology Criteria for Adverse Events, version 3.0, scale. Results: Treatment was generally well tolerated: 54 patients (90%) completed salvage radiation therapy without any interruption. Gastrointestinal grade ≥2 acute toxicity was recorded in 6 patients (10%), whereas no patient experienced a grade ≥2 genitourinary toxicity. No grade 4 acute toxicity events were recorded. Only 1 patient (1.7%) experienced a grade 2 gastrointestinal late toxicity. With a mean follow-up of 31.2 months, 46 of 60 patients (76.6%) were free of recurrence. The 3-year biochemical progression-free survival rate was 72.5%. Conclusions: At early follow-up, {sup 18}F-choline PET/CT-driven high-dose salvage radiation therapy seems to be feasible and well tolerated, with a low rate of toxicity.

  12. Evaluation of Thyroid Disorders During Head-and-Neck Radiotherapy by Using Functional Analysis and Ultrasonography

    SciTech Connect (OSTI)

    Bakhshandeh, Mohsen; Hashemi, Bijan; Mahdavi, Seyed Rabie; Nikoofar, Alireza; Edraki, Hamid Reza; Kazemnejad, Anoshirvan

    2012-05-01

    Purpose: To evaluate thyroid function and vascular changes during radiotherapy for patients with head and neck cancer. Methods and Materials: Fifty patients treated with primary or postoperative radiotherapy for various cancers in the head and neck region were prospectively evaluated. The serum samples (triiodothyronine [T3], thyroxine [T4], thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]), the echo level of the thyroid gland, and color Doppler ultrasonography (CDU) parameters of the right inferior thyroid artery (RITA) of the patients were measured before and at regular intervals during radiotherapy. The thyroid gland dose-volume histograms of the patients were derived from their computed tomography-based treatment plans. Results: There was a significant fall in TSH level (p < 0.0001) but an increase in FT4 (p < 0.0001) and T4 (p < 0.022) levels during the radiotherapy course. The threshold dose required to produce significant changes was 12 Gy (Biologically Effective Dose in 2-Gy fractions, BED{sub 2}). There were significant rises in the patients' pulsatility index, resistive index, peak systolic velocity, blood volume flow levels, and RITA diameter (p < 0.0001), as detected by CDU during radiotherapy, compared to those parameters measured before the treatment. Hypoechogenicity and irregular echo patterns (p < 0.0001) were seen during radiotherapy compared to those before treatment. There was significant Pearson's correlation between the CDU parameters and T4, FT4, and TSH levels. Conclusions: Radiation-induced thyroiditis is regarded as primary damage to the thyroid gland. Thyroiditis can subsequently result in hypothyroidism or hyperthyroidism. Our results demonstrated that changes in thyroid vessels occur during radiotherapy delivered to patients. Vessel changes also can be attributed to the late effect of radiation on the thyroid gland. The hypoechogenicity and irregular echo patterns observed in patients may result from the increase in intrathyroidal flow.

  13. A Multicenter Retrospective Analysis of Survival Outcome Following Postoperative Chemoradiotherapy in Non-Small-Cell Lung Cancer Patients With N2 Nodal Disease

    SciTech Connect (OSTI)

    Zou Bingwen; Xu Yong; Li Tao; Li Wenhui; Tang Bangxian; Zhou Lin; Li Lu; Liu Yongmei; Zhu Jiang; Huang Meijuan; Wang Jin; Ren Li; Gong Youlin; Che Guowei; Liu Lunxu; Hou Mei; Lu You

    2010-06-01

    Purpose: To retrospectively evaluate the role of postoperative chemoradiotherapy (POCRT) in patients with completely resected non-small-cell lung cancer (NSCLC) with N2 lymph node involvement. Methods and Materials: This study included 183 patients from four centers in southwest China who underwent radical section of Stage III-N2 NSCLC without any preoperative therapy. One hundred and four were treated with POCRT and 79 with postoperative chemotherapy (POCT) alone. The median radiation dose to clinical target volume (CTV) was 50 Gy (varying between 48 and 54 Gy), whereas the cycles of platinum-based chemotherapy ranged from two to six with a median of four. Results: The median duration of follow-up was 72 months. The 5-year overall survival rate (OS) was 30.5% in the POCRT group, and 14.4% in the POCT group (p = 0.007). The 5-year disease-free survival rate (DFS) was 22.2% in POCRT group and 9.3% in POCT group (p = 0.003). In a multivariate analysis, N1 nodal involvement (N1+/N2+) was associated with significantly worse OS (HR = 1.454, 95% CI, 1.012-2.087, p = 0.043) and DFS (HR = 1.685, 95% CI, 1.196-2.372, p = 0.003). Absence of radiotherapy and treatment with fewer than three cycles of chemotherapy both were poor prognostic factors for both OS and DFS. Conclusions: As compared with chemotherapy alone, adjuvant treatment with both radiotherapy and chemotherapy improves survival in patients with completely resected Stage III-N2 nodal disease in NSCLC. Future study of treatment modality with radiotherapy and chemotherapy is warranted, especially focusing on both N1 and N2 nodal status.

  14. SU-E-T-381: Radio-Dynamic Therapy (RDT) for the Treatment of Late-Stage Cancers

    SciTech Connect (OSTI)

    Ma, C; Chen, L; Price, R [Fox Chase Cancer Center, Philadelphia, PA (United States); Zhang, Q [Wu Xi Yi Ren Tumor Hosiptal, Wuxi, Jiangsu (China); Zeng, J; Xu, K; Sun, Q [Wuxi Yiren Cancer Hospital, Wuxi, Jiangsu (China)

    2014-06-01

    Purpose: Photo-dynamic therapy (PDT) is an effective treatment modality because of the preferential absorption of photosensitizing agent in tumor cells than in surrounding normal tissues. A limitation of PDT for cancer therapy is the finite penetration of laser light to activate the targeting agent in deep-seated tumors. Radio-dynamic therapy (RDT) is designed to overcome this problem by the combination of high-energy (up to 45MV) photon beams and photo/radio-sensitizers. This work investigates the feasibility of PDT for late-stage cancer patients who are no longer respond to conventional therapies available. Methods: The high-energy photon beams are generated using a LA45 RaceTrack Microtron (Top Grade Medical, Beijing, China). The targeting agent investigated is 5- aminolevulinic acid (5-ALA). Both in vitro cell lines and in vivo animal models have been used to investigate the mechanisms of RDT and its therapeutic effects and normal tissue toxicities. Oral 5-ALA (30-60 mg/kg) was administered 4-6 hours before the radiation treatment and the total radiation dose varied between 0.1-4.0Gy in 1-4 fractions. Clinical trials are initiated in China for late-stage cancer patients targeting both primary tumors utilizing localized therapies such as 3DCRT/IMRT and metastases using TBI. Results: There is clear correlation between the cell death and the 5-ALA concentration/radiation dose. The therapeutic effect of RDT is demonstrated using an animal model where the volume of parotid tumors for the RT only group continued to grow after 3Gy irradiation while the RDT group showed a complete response with the same radiation dose. The preliminary clinical results showed encouraging clinical outcome. Conclusion: RDT is a novel treatment technique that may be developed into an effective cancer treatment modality. Further studies on the mechanisms of RDT and its potential clinical applications are warranted.

  15. Exposure to Ionizing Radiation Causes Long-Term Increase in Serum Estradiol and Activation of PI3K-Akt Signaling Pathway in Mouse Mammary Gland

    SciTech Connect (OSTI)

    Suman, Shubhankar; Johnson, Michael D.; Fornace, Albert J.; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC ; Datta, Kamal

    2012-10-01

    Purpose: Exposure to ionizing radiation is an established risk factor for breast cancer. Radiation exposure during infancy, childhood, and adolescence confers the highest risk. Although radiation is a proven mammary carcinogen, it remains unclear where it acts in the complex multistage process of breast cancer development. In this study, we investigated the long-term pathophysiologic effects of ionizing radiation at a dose (2 Gy) relevant to fractionated radiotherapy. Methods and Materials: Adolescent (6-8 weeks old; n = 10) female C57BL/6J mice were exposed to 2 Gy total body {gamma}-radiation, the mammary glands were surgically removed, and serum and urine samples were collected 2 and 12 months after exposure. Molecular pathways involving estrogen receptor-{alpha} (ER{alpha}) and phosphatidylinositol-3-OH kinase (PI3K)-Akt signaling were investigated by immunohistochemistry and Western blot. Results: Serum estrogen and urinary levels of the oncogenic estrogen metabolite (16{alpha}OHE1) were significantly increased in irradiated animals. Immunostaining for the cellular proliferative marker Ki-67 and cyclin-D1 showed increased nuclear accumulation in sections of mammary glands from irradiated vs. control mice. Marked increase in p85{alpha}, a regulatory sub-unit of the PI3K was associated with increase in Akt, phospho-Akt, phospho-BAD, phospho-mTOR, and c-Myc in irradiated samples. Persistent increase in nuclear ER{alpha} in mammary tissues 2 and 12 months after radiation exposure was also observed. Conclusions: Taken together, our data not only support epidemiologic observations associating radiation and breast cancer but also, specify molecular events that could be involved in radiation-induced breast cancer.

  16. F-18-FDG-PET Confined Radiotherapy of Locally Advanced NSCLC With Concomitant Chemotherapy: Results of the PET-PLAN Pilot Trial

    SciTech Connect (OSTI)

    Fleckenstein, Jochen; Hellwig, Dirk; Kremp, Stephanie; Grgic, Aleksandar; Groeschel, Andreas; Kirsch, Carl-Martin; Nestle, Ursula; Ruebe, Christian

    2011-11-15

    Purpose: The integration of fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) in the process of radiotherapy (RT) planning of locally advanced non-small-cell lung cancer (NSCLC) may improve diagnostic accuracy and minimize interobserver variability compared with target volume definition solely based on computed tomography. Furthermore, irradiating only FDG-PET-positive findings and omitting elective nodal regions may allow dose escalation by treating smaller volumes. The aim of this prospective pilot trial was to evaluate the therapeutic safety of FDG-PET-based RT treatment planning with an autocontour-derived delineation of the primary tumor. Methods and Materials: Eligible patients had Stages II-III inoperable NSCLC, and simultaneous, platinum-based radiochemotherapy was indicated. FDG-PET and computed tomography acquisitions in RT treatment planning position were coregistered. The clinical target volume (CTV) included the FDG-PET-defined primary tumor, which was autodelineated with a source-to-background algorithm, plus FDG-PET-positive lymph node stations. Limited by dose restrictions for normal tissues, prescribed total doses were in the range of 66.6 to 73.8 Gy. The primary endpoint was the rate of out-of-field isolated nodal recurrences (INR). Results: As per intent to treat, 32 patients received radiochemotherapy. In 15 of these patients, dose escalation above 66.6 Gy was achieved. No Grade 4 toxicities occurred. After a median follow-up time of 27.2 months, the estimated median survival time was 19.3 months. During the observation period, one INR was observed in 23 evaluable patients. Conclusions: FDG-PET-confined target volume definition in radiochemotherapy of NSCLC, based on a contrast-oriented source-to-background algorithm, was associated with a low risk of INR. It might provide improved tumor control because of dose escalation.

  17. Quality Assurance of Multifractionated Pelvic Interstitial Brachytherapy for Postoperative Recurrences of Cervical Cancers: A Prospective Study

    SciTech Connect (OSTI)

    Shukla, Pragya; Chopra, Supriya; Engineer, Reena; Mahantshetty, Umesh; Paul, Siji Nojin; Phurailatpam, Reena; SV, Jamema; Shrivastava, Shyam K.

    2012-03-15

    Purpose: To evaluate three-dimensional needle displacements during multifractionated interstitial brachytherapy (BT) for cervical cancers. Methods and Materials: Patients scheduled to undergo pelvic interstitial BT for postoperative and or postradiation vault recurrences were included from November 2009 to December 2010. All procedures were performed under spinal anesthesia. Postprocedure BT planning CT scans were obtained with patients in supine position with arms on the chest (interslice thickness of 3 mm). Thereafter, verification CT was repeated at every alternate fraction. Needle displacements were measured in reference to a relocatable bony point. The mean cranial, caudal, anteroposterior, and mediolateral displacements were recorded. Statistical significance of mean interfraction displacements was evaluated with Wilcoxon Test. Results: Twenty patients were included. Seventeen received boost BT (20 Gy/5 fractions/3 days) after external radiation, three received radical BT alone (36 Gy/9 fractions/5-8 days). An average of three scans (range, 2-3) were available per patient, and 357 needle displacements were analyzed. For the entire study cohort, the average of mean needle displacement was 2.5 mm (range, 0-7.4), 17.4 mm (range, 0-27.9), 1.7 mm (range, 0-6.7), 2.1 mm (range, 0-9.5), 1.7 mm (range, 0-9.3), and 0.6 mm (range, 0-7.8) in cranial, caudal, anterior, posterior, right, and left directions, respectively. The mean displacement in the caudal direction was higher between Days 1 and 2 than that between Days 2 and 3 (13.4 mm vs. 3.8 mm; p = 0.01). The average caudal displacements were no different between reirradiation and boost cohort (15.2 vs. 17.8 mm). Conclusions: Clinically significant caudal displacements occur during multifractionated pelvic brachytherapy. Optimal margins need to be incorporated while preplanning brachytherapy to account for interfraction displacements.

  18. Second Malignant Neoplasms in Digestive Organs After Childhood Cancer: A Cohort-Nested Case-Control Study

    SciTech Connect (OSTI)

    Tukenova, Markhaba; Diallo, Ibrahima; Anderson, Harald; Hawkins, Mike; Garwicz, Stanislaw; Sankila, Risto; El Fayech, Chiraz; Winter, Dave; Rubino, Carole; Adjadj, Elisabeth; Haddy, Nadia; Oberlin, Odile; Moller, Torgil; Langmark, Froydis; and others

    2012-03-01

    Purpose: Cancers of the digestive system constitute a major risk for childhood cancer survivors treated with radiotherapy once they reach adulthood. The aim of this study was to determine therapy-related risk factors for the development of a second malignancy in the digestive organs (SMDO) after a childhood cancer. Methods and Materials: Among 4,568 2-year survivors of a childhood solid cancer diagnosed before 17 years of age at eight French and British centers, and among 25,120 patients diagnosed as having a malignant neoplasm before the age of 20 years, whose data were extracted from the Nordic Cancer Registries, we matched 58 case patients (41 men and 17 women) of SMDO and 167 controls, in their respective cohort, for sex, age at first cancer, calendar year of occurrence of the first cancer, and duration of follow-up. The radiation dose received at the site of each second malignancy and at the corresponding site of its matched control was estimated. Results: The risk of developing a SMDO was 9.7-fold higher in relation to the general populations in France and the United Kingdom. In the case-control study, a strong dose-response relationship was estimated, compared with that in survivors who had not received radiotherapy; the odds ratio was 5.2 (95% CI, 1.7-16.0) for local radiation doses between 10 and 29 Gy and 9.6 (95% CI, 2.6-35.2) for doses equal to or greater than 30 Gy. Chemotherapy was also found to increase the risk of developing SMDO. Conclusions: This study confirms that childhood cancer treatments strongly increase the risk of SMDO, which occur only after a very long latency period.

  19. Impact of Four-Dimensional Computed Tomography Pulmonary Ventilation Imaging-Based Functional Avoidance for Lung Cancer Radiotherapy

    SciTech Connect (OSTI)

    Yamamoto, Tokihiro; Kabus, Sven; Berg, Jens von; Lorenz, Cristian; Keall, Paul J.

    2011-01-01

    Purpose: To quantify the dosimetric impact of four-dimensional computed tomography (4D-CT) pulmonary ventilation imaging-based functional treatment planning that avoids high-functional lung regions. Methods and Materials: 4D-CT ventilation images were created from 15 non-small-cell lung cancer patients using deformable image registration and quantitative analysis of the resultant displacement vector field. For each patient, anatomic and functional plans were created for intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). Consistent beam angles and dose-volume constraints were used for all cases. The plans with Radiation Therapy Oncology Group (RTOG) 0617-defined major deviations were modified until clinically acceptable. Functional planning spared the high-functional lung, and anatomic planning treated the lungs as uniformly functional. We quantified the impact of functional planning compared with anatomic planning using the two- or one-tailed t test. Results: Functional planning led to significant reductions in the high-functional lung dose, without significantly increasing other critical organ doses, but at the expense of significantly degraded the planning target volume (PTV) conformity and homogeneity. The average reduction in the high-functional lung mean dose was 1.8 Gy for IMRT (p < .001) and 2.0 Gy for VMAT (p < .001). Significantly larger changes occurred in the metrics for patients with a larger amount of high-functional lung adjacent to the PTV. Conclusion: The results of the present study have demonstrated the impact of 4D-CT ventilation imaging-based functional planning for IMRT and VMAT for the first time. Our findings indicate the potential of functional planning in lung functional avoidance for both IMRT and VMAT, particularly for patients who have high-functional lung adjacent to the PTV.

  20. Poster — Thur Eve — 77: Implanted Brachythearpy Seed Movement due to Transrectal Ultrasound Probe-Induced Prostate Deformation

    SciTech Connect (OSTI)

    Liu, D; Usmani, N; Sloboda, R; Meyer, T; Husain, S; Angyalfi, S; Kay, I

    2014-08-15

    The study investigated the movement of implanted brachytherapy seeds upon transrectal US probe removal, providing insight into the underlying prostate deformation and an estimate of the impact on prostate dosimetry. Implanted seed distributions, one obtained with the prostate under probe compression and another with the probe removed, were reconstructed using C-arm fluoroscopy imaging. The prostate, delineated on ultrasound images, was registered to the fluoroscopy images using seeds and needle tracks identified on ultrasound. A deformation tensor and shearing model was developed to correlate probe-induced seed movement with position. Changes in prostate TG-43 dosimetry were calculated. The model was used to infer the underlying prostate deformation and to estimate the location of the prostate surface in the absence of probe compression. Seed movement patterns upon probe removal reflected elastic decompression, lateral shearing, and rectal bending. Elastic decompression was characterized by expansion in the anterior-posterior direction and contraction in the superior-inferior and lateral directions. Lateral shearing resulted in large anterior movement for extra-prostatic seeds in the lateral peripheral region. Whole prostate D90 increased up to 8 Gy, mainly due to the small but systematic seed movement associated with elastic decompression. For selected patients, lateral shearing movement increased prostate D90 by 4 Gy, due to increased dose coverage in the anterior-lateral region at the expense of the posterior-lateral region. The effect of shearing movement on whole prostate D90 was small compared to elastic decompression due to the subset of peripheral seeds involved, but is expected to have greater consequences for local dose coverage.

  1. Digital holographic interferometry: A novel optical calorimetry technique for radiation dosimetry

    SciTech Connect (OSTI)

    Cavan, Alicia; Meyer, Juergen

    2014-02-15

    Purpose: To develop and demonstrate the proof-of-principle of a novel optical calorimetry method to determine radiation absorbed dose in a transparent medium. Methods: The calorimetric property of water is measured during irradiation by means of an interferometer, which detects temperature-induced changes in the refractive index that can be mathematically related to absorbed dose. The proposed method uses a technique called digital holographic interferometry (DHI), which comprises an optical laser interferometer setup and consecutive physical reconstruction of the recorded wave fronts by means of the Fresnel transform. This paper describes the conceptual framework and provides the mathematical basis for DHI dosimetry. Dose distributions from a high dose rate Brachytherapy source were measured by a prototype optical setup to demonstrate the feasibility of the approach. Results: The developed DHI dosimeter successfully determined absorbed dose distributions in water in the region adjacent to a high dose rate Brachytherapy source. A temperature change of 0.0381 K across a distance of 6.8 mm near the source was measured, corresponding to a dose of 159.3 Gy. The standard deviation in a typical measurement set was ±3.45 Gy (corresponding to an uncertainty in the temperature value of ±8.3 × 10{sup −4} K). The relative dose fall off was in agreement with treatment planning system modeled data. Conclusions: First results with a prototype optical setup and a Brachytherapy source demonstrate the proof-of-principle of the approach. The prototype achieves high spatial resolution of approximately 3 × 10{sup −5} m. The general approach is fundamentally independent of the radiation type and energy. The sensitivity range determined indicates that the method is predominantly suitable for high dose rate applications. Further work is required to determine absolute dose in all three dimensions.

  2. Localized Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy: A Long-Term Outcome in 86 Patients With 104 Treated Eyes

    SciTech Connect (OSTI)

    Harada, Ken; Murakami, Naoya; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Sumi, Minako; Suzuki, Shigenobu; Tobinai, Kensei; Uno, Takashi; Itami, Jun

    2014-03-01

    Purpose: To evaluate the natural history, behavior of progression, prognostic factors, and treatment-related adverse effects of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML). Methods and Materials: Eighty-six patients with histologically proven stage I POAML treated with radiation therapy at National Cancer Center Hospital, Tokyo between 1990 and 2010 were retrospectively reviewed. The median age was 56years (range, 18-85years). The median dose administered was 30Gy (range, 30-46Gy). Seventy-seven patients (90%) were treated by radiation therapy alone. Results: The median follow-up duration was 9years (range, 0.9-22years). The 5- and 10-year overall survival (OS) rates were 97.6% and 93.5%, respectively, and no patients died of lymphoma. Patients with tumor sizes ?4cm showed a greater risk of contralateral relapse (P=.012). Six patients with contralateral relapse were seen and treated by radiation therapy alone, and all the lesions were controlled well, with follow-up times of 3 to 12years. There was 1 case of local relapse after radiation therapy alone, and 3 cases of relapse occurred in a distant site. Cataracts developed in 36 of the 65 eyes treated without lens shielding and in 12 of the 39 patients with lens shielding (P=.037). Conclusions: The majority of patients with POAML showed behavior consistent with that of localized, indolent diseases. Thirty gray of local irradiation seems to be quite effective. The initial bilateral involvement and contralateral orbital relapses can be also controlled with radiation therapy alone. Lens shielding reduces the risk of cataract.

  3. WE-E-BRE-06: High-Dose Microbeam Radiation Induces Different Responses in Tumor Microenvironment Compared to Conventional Seamless Radiation in Window Chamber Tumor Models

    SciTech Connect (OSTI)

    Chang, S; Zhang, J; Hadsell, M; Fontanella, A; Schroeder, T; Palmer, G; Dewhirst, M; Boss, M; Berman, K

    2014-06-15

    Purpose: Microbeam radiation therapy and GRID therapy are different forms of Spatially-Fractioned Radiation Therapy (SFRT) that is fundamentally different from the conventional seamless and temporally fractionated radiation therapy. SFRT is characterized by a ultra-high dose (10s –100s Gy) dose single treatment with drastic inhomogeneity pattern of given spatial frequencies. Preclinical and limited clinical studies have shown that the SFRT treatments may offer significant improvements in reducing treatment toxicity, especially for those patients who have not benefited from the state-of-the-art radiation therapy approaches. This preliminary study aims to elucidate the underlying working mechanisms of SFRT, which currently remains poorly understood. Methods: A genetically engineered 4T1 murine mammary carcinoma cell line and nude mice skin fold window chamber were used. A nanotechnology-based 160kV x-ray irradiator delivered 50Gy (entrance dose) single treatments of microbeam or seamless radiation. Animals were in 3 groups: mock, seamless radiation, and 300μm microbeam radiation. The windows were imaged using a hyperspectral system to capture total hemoglobin/saturation, GFP fluorescence emission, RFP fluorescence emission, and vessel density at 9 time points up to 7 days post radiation. Results: We found unique physiologic changes in different tumor/normal tissue regions and differential effects between seamless and microbeam treatments. They include 1) compared to microbeam and mock radiation seamless radiation damaged more microvasculature in tumor-surrounding normal tissue, 2) a pronounced angiogenic effect was observed with vascular proliferation in the microbeam irradiated portion of the tumor days post treatment (no such effect observed in seamless and mock groups), and 3) a notable change in tumor vascular orientation was observed where vessels initially oriented parallel to the beam length were replaced by vessels running perpendicular to the irradiation portion of the tumor. Conclusion: Our preliminary study indicated that microbeam radiation modified tumor microenvironment in ways significantly different than of the conventional seamless radiation.

  4. Characterization of the effects of x-ray irradiation on the hierarchical structure and mechanical properties of human cortical bone

    SciTech Connect (OSTI)

    Barth, Holly; Zimmermann, Elizabeth; Schaible, Eric; Tang, Simon; Alliston, Tamara; Ritchie, Robert

    2011-08-19

    Bone comprises a complex structure of primarily collagen, hydroxyapatite and water, where each hierarchical structural level contributes to its strength, ductility and toughness. These properties, however, are degraded by irradiation, arising from medical therapy or bone-allograft sterilization. We provide here a mechanistic framework for how irradiation affects the nature and properties of human cortical bone over a range of characteristic (nano to macro) length-scales, following x-ray exposures up to 630 kGy. Macroscopically, bone strength, ductility and fracture resistance are seen to be progressively degraded with increasing irradiation levels. At the micron-scale, fracture properties, evaluated using in-situ scanning electron microscopy and synchrotron x-ray computed micro-tomography, provide mechanistic information on how cracks interact with the bone-matrix structure. At sub-micron scales, strength properties are evaluated with in-situ tensile tests in the synchrotron using small-/wide-angle x-ray scattering/diffraction, where strains are simultaneously measured in the macroscopic tissue, collagen fibrils and mineral. Compared to healthy bone, results show that the fibrillar strain is decreased by ~40% following 70 kGy exposures, consistent with significant stiffening and degradation of the collagen. We attribute the irradiation-induced deterioration in mechanical properties to mechanisms at multiple length-scales, including changes in crack paths at micron-scales, loss of plasticity from suppressed fibrillar sliding at sub-micron scales, and the loss and damage of collagen at the nano-scales, the latter being assessed using Raman and Fourier-Transform-Infrared spectroscopy and a fluorometric assay.

  5. L-Boronophenylalanine-Mediated Boron Neutron Capture Therapy for Malignant Glioma Progressing After External Beam Radiation Therapy: A Phase I Study

    SciTech Connect (OSTI)

    Kankaanranta, Leena; Seppaelae, Tiina; Koivunoro, Hanna; Vaelimaeki, Petteri; Beule, Annette; Collan, Juhani; Kortesniemi, Mika; Uusi-Simola, Jouni; Kotiluoto, Petri; Auterinen, Iiro; Seren, Tom; Paetau, Anders; Saarilahti, Kauko; Savolainen, Sauli; Joensuu, Heikki

    2011-06-01

    Purpose: To investigate the safety of boronophenylalanine-mediated boron neutron capture therapy (BNCT) in the treatment of malignant gliomas that progress after surgery and conventional external beam radiation therapy. Methods and Materials: Adult patients who had histologically confirmed malignant glioma that had progressed after surgery and external beam radiotherapy were eligible for this Phase I study, provided that >6 months had elapsed from the last date of radiation therapy. The first 10 patients received a fixed dose, 290 mg/kg, of L-boronophenylalanine-fructose (L-BPA-F) as a 2-hour infusion before neutron irradiation, and the remaining patients were treated with escalating doses of L-BPA-F, either 350 mg/kg, 400 mg/kg, or 450 mg/kg, using 3 patients on each dose level. Adverse effects were assessed using National Cancer Institute Common Toxicity Criteria version 2.0. Results: Twenty-two patients entered the study. Twenty subjects had glioblastoma, and 2 patients had anaplastic astrocytoma, and the median cumulative dose of prior external beam radiotherapy was 59.4 Gy. The maximally tolerated L-BPA-F dose was reached at the 450 mg/kg level, where 4 of 6 patients treated had a grade 3 adverse event. Patients who were given >290 mg/kg of L-BPA-F received a higher estimated average planning target volume dose than those who received 290 mg/kg (median, 36 vs. 31 Gy [W, i.e., a weighted dose]; p = 0.018). The median survival time following BNCT was 7 months. Conclusions: BNCT administered with an L-BPA-F dose of up to 400 mg/kg as a 2-hour infusion is feasible in the treatment of malignant gliomas that recur after conventional radiation therapy.

  6. Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

    SciTech Connect (OSTI)

    Aaltonen, Leena-Maija; Rautiainen, Noora; Sellman, Jaana; Saarilahti, Kauko; Mkitie, Antti; Rihkanen, Heikki; Laranne, Jussi; Kleemola, Leenamaija; Wigren, Tuija; Sala, Eeva; Lindholm, Paula; Grenman, Reidar; Joensuu, Heikki

    2014-10-01

    Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Methods and Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO{sub 2} laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66Gy in 2-Gy daily fractions over 6.5weeks. Voice quality was assessed at baseline and 6 and 24months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2years after treatment. Three patients in each group had local cancer recurrence within 2years from randomization. Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.

  7. SU-E-T-510: Mathematical Analysis of Approximate Biological Effective Dose (BED) Calculation for Multi-Phase Radiotherapy Treatment Plans

    SciTech Connect (OSTI)

    Kauweloa, K; Gutierrez, A; Bergamo, A; Stathakis, S; Papanikolaou, N; Mavroidis, P

    2014-06-01

    Purpose: There is growing interest about biological effective dose (BED) and its application in treatment plan evaluation due to its stronger correlation with treatment outcome. An approximate biological effective dose (BEDA) equation was introduced to simplify BED calculations by treatment planning systems in multi-phase treatments. The purpose of this work is to reveal its mathematical properties relative to the true, multi-phase BED (BEDT) equation. Methods: The BEDT equation was derived and used to reveal the mathematical properties of BEDA. MATLAB (MathWorks, Natick, MA) was used to simulate and analyze common and extreme clinical multi-phase cases. In those cases, percent error (Perror) and Bland-Altman analysis were used to study the significance of the inaccuracies of BEDA for different combinations of total doses, numbers of fractions, doses per fractions and ? over ? values. All the calculations were performed on a voxel-basis in order to study how dose distributions would affect the accuracy of BEDA. Results: When the voxel dose-per-fractions (DPF) delivered by both phases are equal, BEDA and BEDT are equal. In heterogeneous dose distributions, which significantly vary between the phases, there are fewer occurrences of equal DPFs and hence the imprecision of BEDA is greater. It was shown that as the ? over ? ratio increased the accuracy of BEDA would improve. Examining twenty-four cases, it was shown that the range of DPF ratios for a 3 Perror varied from 0.32 to 7.50Gy, whereas for Perror of 1 the range varied from 0.50 to 2.96Gy. Conclusion: The DPF between the different phases should be equal in order to render BEDA accurate. OARs typically receive heterogeneous dose distributions hence the probability of equal DPFs is low. Consequently, the BEDA equation should only be used for targets or OARs that receive uniform or very similar dose distributions by the different treatment phases.

  8. Optimized Volumetric Modulated Arc Therapy Versus 3D-CRT for Early Stage Mediastinal Hodgkin Lymphoma Without Axillary Involvement: A Comparison of Second Cancers and Heart Disease Risk

    SciTech Connect (OSTI)

    Filippi, Andrea Riccardo; Ragona, Riccardo; Piva, Cristina; Scafa, Davide; Fiandra, Christian; Fusella, Marco; Giglioli, Francesca Romana; Lohr, Frank; Ricardi, Umberto

    2015-05-01

    Purpose: The purpose of this study was to evaluate the risks of second cancers and cardiovascular diseases associated with an optimized volumetric modulated arc therapy (VMAT) planning solution in a selected cohort of stage I/II Hodgkin lymphoma (HL) patients treated with either involved-node or involved-site radiation therapy in comparison with 3-dimensional conformal radiation therapy (3D-CRT). Methods and Materials: Thirty-eight patients (13 males and 25 females) were included. Disease extent was mediastinum alone (n=8, 21.1%); mediastinum plus unilateral neck (n=19, 50%); mediastinum plus bilateral neck (n=11, 29.9%). Prescription dose was 30 Gy in 2-Gy fractions. Only 5 patients had mediastinal bulky disease at diagnosis (13.1%). Anteroposterior 3D-CRT was compared with a multiarc optimized VMAT solution. Lung, breast, and thyroid cancer risks were estimated by calculating a lifetime attributable risk (LAR), with a LAR ratio (LAR{sub VMAT}-to-LAR{sub 3D-CRT}) as a comparative measure. Cardiac toxicity risks were estimated by calculating absolute excess risk (AER). Results: The LAR ratio favored 3D-CRT for lung cancer induction risk in mediastinal alone (P=.004) and mediastinal plus unilateral neck (P=.02) presentations. LAR ratio for breast cancer was lower for VMAT in mediastinal plus bilateral neck presentations (P=.02), without differences for other sites. For thyroid cancer, no significant differences were observed, regardless of anatomical presentation. A significantly lower AER of cardiac (P=.038) and valvular diseases (P<.0001) was observed for VMAT regardless of disease extent. Conclusions: In a cohort of patients with favorable characteristics in terms of disease extent at diagnosis (large prevalence of nonbulky presentations without axillary involvement), optimized VMAT reduced heart disease risk with comparable risks of thyroid and breast cancer, with an increase in lung cancer induction probability. The results are however strongly influenced by the different anatomical presentations, supporting an individualized approach.

  9. INTRINSIC DOSIMETRY: PROPERTIES AND MECHANISMS OF THERMOLUMINESCENCE IN COMMERCIAL BOROSILICATE GLASS

    SciTech Connect (OSTI)

    Clark, Richard A.

    2012-10-24

    Intrinsic dosimetry is the method of measuring total absorbed dose received by the walls of a container holding radioactive material. By considering the total absorbed dose received by a container in tandem with the physical characteristics of the radioactive material housed within that container, this method has the potential to provide enhanced pathway information regarding the history of the container and its radioactive contents. The latest in a series of experiments designed to validate and demonstrate this newly developed tool are reported. Thermoluminescence (TL) dosimetry was used to measure dose effects on raw stock borosilicate container glass up to 70 days after gamma ray, x-ray, beta particle or ultraviolet irradiations at doses from 0.15 to 20 Gy. The TL glow curve when irradiated with 60Co was separated into five peaks: two relatively unstable peaks centered near 120 and 165°C, and three relatively stable peaks centered near 225, 285, and 360°C. Depending on the borosilicate glass source, the minimum measurable dose using this technique is 0.15-0.5 Gy, which is roughly equivalent to a 24 hr irradiation at 1 cm from a 50-165 ng source of 60Co. Differences in TL glow curve shape and intensity were observed for the glasses from different geographical origins. These differences can be explained by changes in the intensities of the five peaks. Electron paramagnetic resonance (EPR) and multivariate statistical methods were used to relate the TL intensity and peaks to electron/hole traps and compositional variations.

  10. Radiation-Induced Micro-RNA Expression Changes in Peripheral Blood Cells of Radiotherapy Patients

    SciTech Connect (OSTI)

    Templin, Thomas; Paul, Sunirmal; Amundson, Sally A.; Young, Erik F.; Barker, Christopher A.; Wolden, Suzanne L.; Smilenov, Lubomir B.

    2011-06-01

    Purpose: MicroRNAs (miRNAs), a class of noncoding small RNAs that regulate gene expression, are involved in numerous physiologic processes in normal and malignant cells. Our in vivo study measured miRNA and gene expression changes in human blood cells in response to ionizing radiation, to develop miRNA signatures that can be used as biomarkers for radiation exposure. Methods and Materials: Blood from 8 radiotherapy patients in complete remission 1 or 2 was collected immediately before and 4 hours after total body irradiation with 1.25 Gy x-rays. Both miRNA and gene expression changes were measured by means of quantitative polymerase chain reaction and microarray hybridization, respectively. Hierarchic clustering, multidimensional scaling, class prediction, and gene ontology analysis were performed to investigate the potential of miRNAs to serve as radiation biomarkers and to elucidate their likely physiologic roles in the radiation response. Results: The expression levels of 45 miRNAs were statistically significantly upregulated 4 hours after irradiation with 1.25 Gy x-rays, 27 of them in every patient. Nonirradiated and irradiated samples form separate clusters in hierarchic clustering and multidimensional scaling. Out of 223 differentially expressed genes, 37 were both downregulated and predicted targets of the upregulated miRNAs. Paired and unpaired miRNA-based classifiers that we developed can predict the class membership of a sample with unknown irradiation status, with accuracies of 100% when all 45 upregulated miRNAs are included. Both miRNA control of and gene involvement in biologic processes such as hemopoiesis and the immune response are increased after irradiation, whereas metabolic processes are underrepresented among all differentially expressed genes and the genes controlled by miRNAs. Conclusions: Exposure to ionizing radiation leads to the upregulation of the expression of a considerable proportion of the human miRNAome of peripheral blood cells. These miRNA expression signatures can be used as biomarkers of radiation exposure.

  11. Do Angiotensin-Converting Enzyme Inhibitors Reduce the Risk of Symptomatic Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer After Definitive Radiation Therapy? Analysis of a Single-Institution Database

    SciTech Connect (OSTI)

    Wang, Hongmei [Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, P.R. of China (China); Liao, Zhongxing, E-mail: zliao@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhuang, Yan; Xu, Ting; Nguyen, Quynh-Nhu; Levy, Lawrence B.; O'Reilly, Michael [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gold, Kathryn A. [Department of Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-12-01

    Purpose: Preclinical studies have suggested that angiotensin-converting enzyme inhibitors (ACEIs) can mitigate radiation-induced lung injury. We sought here to investigate possible associations between ACEI use and the risk of symptomatic radiation pneumonitis (RP) among patients undergoing radiation therapy (RT) for nonsmall cell lung cancer (NSCLC). Methods and Materials: We retrospectively identified patients who received definitive radiation therapy for stages I to III NSCLC between 2004 and 2010 at a single tertiary cancer center. Patients must have received a radiation dose of at least 60 Gy for a single primary lung tumor and have had imaging and dosimetric data available for analysis. RP was quantified according to Common Terminology Criteria for Adverse Events, version 3.0. A Cox proportional hazard model was used to assess potential associations between ACEI use and risk of symptomatic RP. Results: Of 413 patients analyzed, 65 were using ACEIs during RT. In univariate analysis, the rate of RP grade ?2 seemed lower in ACEI users than in nonusers (34% vs 46%), but this apparent difference was not statistically significant (P=.06). In multivariate analysis of all patients, ACEI use was not associated with the risk of symptomatic RP (hazard ratio [HR] = 0.66; P=.07) after adjustment for sex, smoking status, mean lung dose (MLD), and concurrent carboplatin and paclitaxel chemotherapy. Subgroup analysis showed that ACEI use did have a protective effect from RP grade ?2 among patients who received a low (?20-Gy) MLD (P<.01) or were male (P=.04). Conclusions: A trend toward reduction in symptomatic RP among patients taking ACEIs during RT for NSCLC was not statistically significant on univariate or multivariate analyses, although certain subgroups may benefit from use (ie, male patients and those receiving low MLD). The evidence at this point is insufficient to establish whether the use of ACEIs does or does not reduce the risk of RP.

  12. Sexual Function After Stereotactic Body Radiotherapy for Prostate Cancer: Results of a Prospective Clinical Trial

    SciTech Connect (OSTI)

    Wiegner, Ellen A. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); King, Christopher R., E-mail: crking@stanford.ed [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States)

    2010-10-01

    Purpose: To study the sexual quality of life for prostate cancer patients after stereotactic body radiotherapy (SBRT). Methods and Materials: Using the Expanded Prostate Cancer Index Composite (EPIC)-validated quality-of-life questionnaire, the sexual function of 32 consecutive patients who received prostate SBRT in a prospective Phase II clinical trial were analyzed at baseline, and at median times of 4, 12, 20, and 50 months after treatment. SBRT consisted of 36.25 Gy in five fractions of 7.25 Gy using the Cyberknife. No androgen deprivation therapy was given. The use of erectile dysfunction (ED) medications was monitored. A comprehensive literature review for radiotherapy-alone modalities based on patient self-reported questionnaires served as historical comparison. Results: Median age at treatment was 67.5 years, and median follow-up was 35.5 months (minimum 12 months). The mean EPIC sexual domain summary score, sexual function score, and sexual bother score decreased by 45%, 49%, and 25% respectively at 50 months follow-up. These differences reached clinical relevance by 20 months after treatment. Baseline ED rate was 38% and increased to 71% after treatment (p = 0.024). Use of ED medications was 3% at baseline and progressed to 25%. For patients aged <70 years at follow-up, 60% maintained satisfactory erectile function after treatment compared with only 12% aged {>=}70 years (p = 0.008). Penile bulb dose was not associated with ED. Conclusions: The rates of ED after treatment appear comparable to those reported for other modalities of radiotherapy. Given the modest size of this study and the uncertainties in the physiology of radiotherapy-related ED, these resu