International Journal of Cancer Therapy and Oncology
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Gamma Putty shielding effect in megavoltage photon beam
Get PDFPurpose: Traditionally, lead and Cerrobend have been employed for field shaping in radiation therapy. Lately, another shielding material called Gamma Putty has emerged. The objective of this report is to examine its dosimetric and shielding characteristics in megavoltage photon beam.Methods: All measurements were carried out in a dual energy linac. Data were collected using a calibrated ionization chamber. Percent transmission, linear attenuation, and field size dependence were evaluated for open square fields (4 × 4 cm2 to 10 × 10 cm2) defined by collimator jaws and for different Gamma Putty thicknesses (t = 0, 0.3, 0.5, 1.0, 1.5, 2.0, and 2.5 cm) at 6 and 18 MV photon beams. The measurements were performed both in air using appropriate acrylic buildup cap and in solid water.Results: The Gamma Putty tray factor (GPTF) increased steadily with field size for both 6 and 18 MV. It was characterized by a half value thickness (HVT) of 2.513 ± 0.101 and 2.855 ± 0.024 cm for 6 and 18 MV, respectively. The reduction in surface dose was about 6%, 14.5%, 22%, 36.37%, and 54% for 6 MV and 2.75 %, 9.36 %, 16.25 %, 28.95 %, and 44.47 % for 18 MV for Gamma Putty thicknesses of 0.3, 0.5, 1.0, 1.5, 2.0, and 2.5 cm.Conclusion: The result of Gamma Putty shielding on the photon beam output increases with thickness, beam energy, and field size. Therefore, clinical use of Gamma Putty tray factors should be tailored for all thicknesses, beam energies, and field sizes.
Evaluation of ArcCHECK SNC Machine QA tool for Modern Linear Accelerator
Get PDFPurpose: ArcCHECK SNC Machine QA tool is used to test geometric and delivery aspects of linear accelerator.Methods: In this study we evaluated the performance of this tool. For each item analyzed by the tool, wherever possible, tests across the same time period using portal dosimetry were also evaluated. Machine QA feature allows user to perform quality assurance tests using ArcCHECK phantom. Following tests can be performed 1) Gantry Speed, Rotation and Angle 2) MLC/Collimator 3) Beam Profile Flatness and Symmetry. Data was collected on true BEAM STx for a year. All plans were created for 6 and 10 MV beams as per the SNC patient user manual in Eclipse v.13.Results: The Gantry speed was 3.9 deg/sec with speed maximum deviation around 0.3 deg/sec. The Gantry Isocenter for arc delivery was 0.9 mm and static delivery was 0.4 mm which was well consistent with MPC (0.4 mm). The average maximum percent positive and negative diff was found to be 1.9%, -0.25% and average maximum distance positive and negative diff was 0.4 mm, -0.3 mm for MLC/Collimator QA. The average gamma error at 1% 1 mm criteria was 1.4% using portal Dosimetry for 6 MV. The Flatness for Arc delivery was 1.8% and Symmetry for Y was 0.8% and X was 1.8%.Conclusion: ArcCHECK SNC Machine QA tool is useful for quality assurance of modern linear accelerators as it tests both geometric and delivery aspects. This test can be incorporated in the regular quality assurance protocol for VMAT delivery
Stability assessment of radiation isocenter with the gimbaled linac system
Get PDFPurpose: We report the results of our year-long radiation isocenter accuracy verification for daily quality assurance (QA) implementation on a Vero4DRT system. Methods: The radiation isocenter was calculated using a cube phantom with a steel ball of diameter 10 mm fixed to the center of the phantom. A single photon beam was set with a field size of 100 × 100 mm2. Coincidence of the centroid of the steel ball at kiloVolt X-ray imaging isocenter and megaVolt beam radiation isocenter at each gantry and ring angle was tested. This procedure was performed for gantry angles of 0°, 90°, 180°, and 270°, and ring angles of 0°, 20°, and 340°. The centroid of the steel ball and the center of the radiation field were calculated to analyze the radiation isocenter error. This analysis was automatically calculated using the Daily Check tool in the Vero4DRT system. This QA was implemented between 24 August 2015 and 23 August 2016.Results: The average and standard deviation for pan and tilt directions were 0.12 ± 0.10 mm and -0.20 ± 0.13 mm, respectively. The maximum radiation isocenter accuracy error was 0.50 mm in both directions. Conclusion: The radiation isocenter alignment for the one year duration of the experiment was performed with high accuracy
The bootstrap method to improve statistical analysis of dosimetric data for radiotherapy outcomes
Get PDFPurpose: The purpose of this study is to validate a new technique in radiotherapy, the medical physicist needs to evaluate the dosimetric benefit and the risk of toxicity before integrating it in the clinical use.Methods: We validate a sound decision tool based on bootstrap method to help the radio oncologist and the medical physicist to usefully analyze the dosimetric data obtained from small-sized samples, with few patients. Statistical investigation principles are presented in the framework of a clinical example based on 36 patients with 6 different cancer sites treated with radiotherapy. For each patient, two treatment plans were generated. In plan 1, the dose was calculated using Modified Batho's (MB) density correction method integrated with pencil beam convolution (PBC) as type (a) algorithm. In plan 2, the dose was calculated using Anisotropic Analytical Algorithm (AAA) as type (b) algorithm. The delivered doses in monitor units (MUs) were compared using the two plans. Then, the bootstrap method was applied to the original data set to assess the dose differences and evaluate the impact of sample size on the 95% confidence interval (95%.CI). Shapiro-Wilks and Wilcoxon signed-rank tests were used to assess the normality of the data and determine the p-value. In addition, Spearman’s rank test was used to calculate the correlation coefficient between the doses calculated with both algorithms.Results: A significant difference was observed between AAA and MB for all tested radiation sites. Spearman’s test indicated a good correlation between the doses calculated with both methods. The bootstrap simulation with 1000 random samplings can be used for small populations with n = 10 and provides a true estimation.Conclusion: one must be cautious when implementing this method for radiotherapy: the data should be representative of the real variations of the cases and the cases should be as homogeneous as possible to avoid bias of over/under estimation of the results
The advantages of collimator optimization for intensity modulated radiation therapy
Get PDFPurpose: The goal of this study was to improve dosimetry for pelvic, head and neck and other cancers with aspherical planning target volumes (PTV) using collimator optimization for intensity modulated radiation therapy (IMRT).Methods: A retroactive study on the effects of collimator optimization of 20 patients was done by comparing collimator angles from optimized plans in Eclipse version 11.0. Keeping all other parameters equal, plans were created with four collimator techniques: CA0, all fields have collimators set to 0°, CAE, using the Eclipse collimator optimization, CAA, minimizing the area of the jaws around the PTV, and CAX, minimizing the x-jaw gap. The minimum area and the minimum x-jaw angles were found by evaluating each field beam’s eye view of the PTV with ImageJ and finding the desired parameters with a custom script. The evaluation of the plans included the monitor units (MU), the maximum dose of the plan, the maximum dose to organs at risk (OAR), the conformity index (CI) and the number of split fields. Results: Compared to the CA0 plans, the monitor units decreased on average by 6% for the CAX with a p-value of 0.01 from an ANOVA test. The average maximum dose stayed within 1.1% between all four methods with the lowest being CAX. The maximum dose to the most at risk organ was best spared by the CAA, which decreased by 0.62% from the CA0. Minimizing the x-jaws significantly reduced the number of split field from 61 to 37.Conclusion: In every field tested the CAX optimization produced as good or superior results than the other three techniques. For aspherical PTVs, CAX on average reduced the number of split fields, the maximum dose, minimized the dose to the surrounding OAR, and reduced the MU all while achieving the same control of the PTV
Multileaf-collimator daily quality assurance of Vero4DRT system: our one-year experience
Get PDFPurpose: We assessed the daily quality assurance (QA) of multi-leaf collimator (MLC) using the Vero4DRT system. Methods: As part of daily MLC QA, the irradiation field was set to 100 × 150 mm2 with a gantry angle of 0 º. Only the leaf positioning error values only were displayed. We developed an in-house program to easily acquire these values using an open source optical character recognition engine. This test was implemented between 24 August 2015 and 23 August 2016. Results: The maximum leaf positioning error was 0.40 mm in both banks. In addition, the maximum deviation was 0.10 mm in both banks. The average and standard deviation for left and right banks were 0.19 mm ± 0.11 mm and 0.15 mm ± 0.09 mm, respectively. In our one-year measurement, the leaf positioning error was less than 0.50 mm. Therefore, if the leaf position error for daily MLC QA exceeded 0.50 mm, then an external intervention is required.Conclusion: The daily MLC QA of our one-year evaluation of the Vero4DRT system demonstrates an excellent leaf accuracy and reproducibility, thereby giving confidence in the quality of the treatment
The efficacy of the quercetin analogue LY294002 in immortalized cancer cell lines is related to the oxygenic and metabolic status of cells
Get PDFPurpose: LY294002, a promising drug for chemotherapy, suppresses the activity of Phosphatidylinositol 3-Kinase (PI3K) which is pivotal to a number of processes such as proliferation, metabolism, and apoptosis. The compound has, however, been seen to have very variable efficacy in vivo.Methods: Proliferation and viability of two immortalized cells with divergent bioenergetic profiles was determined using crystal violet staining, and the 3-(4, 5-dimethylthiazol-2yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay. Oxygen consumption rates were determined using MitoXpress-Xtra probes, and lactate generation was assessed with pH-Xtra probe and BM-lactate strips. Immunoblotting was performed with phospho-Akt-Ser 473 and Akt-pan primary antibodies.Results: U87 cells were shown to have a glycolytic metabolism, whereas RD cells exhibited a more aerobic metabolism. In both lines, hypoxia was shown to increase lactate production, and LY294002 reduced lactate production. The drug decreased cell proliferation and viability under all conditions, but the effect was greatest in U87 cells under normoxic conditions.Conclusion: Metabolic analysis showed a link between a glycolytic cell status and LY294002 induced cell death. However, in both cell lines the drug was also less effective under hypoxic conditions, as would be found in a tumour in vivo. Furthermore, in the presence of LY294002 the phosphorylation status of Akt, a target of PI3K, was found to be related to both the mechanism of cell respiration, and the oxygenic status of the cells
Management of Multiple Primary Cancers: What is the Priority?
No full textMultiple primary cancers are known entity due to the propensity of cancer survivors to develop additional malignancies both from genetic predisposition and exogenous influences. However, the development of triple or quadruple primary cancers, especially presenting simultaneously, presents challenging diagnostic and treatment dilemmas. We report here a patient who presented initially with neurological symptoms. Extensive evaluation and pathologic workup revealed that the patient actually has an intra-medullary vascular neoplasm at the level of upper thoracic spine, mucinous adenocarcinoma of the right lower lobe, poorly differentiated adenocarcinoma of the stomach near the gastro-esophageal (GE) junction, and conventional type adenocarcinoma of the hepatic flexure of the colon. The patient underwent neoadjuvant chemo-radiation for the GE junction carcinoma followed by surgical resection of the three different adenocarcinomas simultaneously as definitive management. This case illustrates the utility of immuno-histochemistry in delineating the site of origin for primary tumors, and the challenges posed when dealing with multiple primary neoplasms concurrently
Preferred treatment position between supine and prone for pelvic radiation therapy; quantification of the intrafractional body motion component by 3D surface imaging system
Get PDFPurpose: We investigated the preferred treatment position between supine and prone during pelvic radiation treatment using real time tracking data from AlignRT. Our findings will provide valuable information regarding the role of intrafractional body motion in answering the question of prone versus supine position for pelvis radiation. Methods: Ten patients receiving pelvic radiation were enrolled in this study. For each patient, two simulation helical CT scans were performed, one in supine and one in prone position. Body surface contours were automatically generated and then exported to the AlignRT system as reference images. AlignRT continuous patient body motion tracking (1.5 to 2 minutes) was performed for both positions for each patient once per week for five weeks. The equivalent patient body motion along three principle directions was calculated from the six degree of freedom real time patient displacements data. The maximum and the standard deviation (STD) of equivalent patient body motion were calculated, so as the average of maximum and STD of equivalent patient motion over five fractions. These were then compared between supine and prone orientations. Results: A correlation was observed between the intrafractional body motion and large BMI. For overweight/obese patients, the intrafractional body motion was smaller for the supine position in both vertical and longitudinal directions. For normal range BMI patients, we observed no clear advantage for either supine or prone position in both vertical and longitudinal directions. In lateral direction, the intrafractional motion did not have statistically difference between two positions. Conclusion: Our study shows that the amount of intrafractional body motion between supine and prone orientation is correlated with patient BMI. Overweight/obese patients experienced significantly less overall body motion in supine orientation. The preferred treatment position for normal BMI patients was seen to be individually variable
Investigation the impact of maximum control point on dose calculation in Eclipse treatment planning system for lung SBRT
Get PDFPurpose: Choosing an appropriate parameter on the computerized treatment planning systems (TPSs) influences on the accuracy of dose calculation. Several dosimetric parameters have been studied to achieve a more accurate dose and qualitative plan. The purpose of this study was to determine the impact of maximum control point on the dose calculation on Eclipse TPSs for lung Stereotactic Body Radiation Therapy (SBRT) considering the plan quality, the computation time and the treatment file size.Methods: Dose distributions for the 8 lung SBRT plans with varying maximum control point of 64, 166, and 320 were calculated by Eclipse TPSs with flattening filter free (FFF) beam. The treatment dose was prescribed at 85% isodose level of 54 Gy to the planning target volume (PTV). The dosimetric impact can be evaluated from target coverage, conformity index (CI), homogeneity index (HI), and organ at risk (OAR) doses, while the computation time and the file storage space were compared with the recommended number of control point.Results: The use of 64 control points per subfields tended to increase the dose at PTV and OARs comparing with the 166 and 320 control point plans, while the HI and CI values were similar. The average increases of OARs doses including the spinal cord, heart, esophagus and total lung depended on the photon beam energy. The higher average control point (AVG) number leaded to increase the computation time and the file size for both 6X-FFF and 10X-FFF photon beams. The correlations between AVG and plan storaage space were observed in the same ratio as the computation time.Conclusion: Using the minimal number of control point, the quantitative analysis in the PTV and OARs showed no clinically significant variation in dose, therefore choosing an optimal number of fixed control points leaded to balance the plan quality, the computation time and the file size