Estimating the skin dose near to the applicator and acute toxicity in breast cancer patients: An intraoperative electron radiotherapy technique.

Introduction: Intraoperative electron radiation therapy (IOERT) is one of the most recently popular therapeutic methods for breast cancer. This study aimed to measure the skin dose near the applicator during IOERT of breast cancer patients, as well as, the incidence of acute toxicity after surgery. Materials and Methods: Thirty-six female patients participated in the current study with the prescribed dose of 21 and 12 Gy for IOERT as full and boost, respectively. The skin dose was investigated based on different applicator sizes, tumor bed thicknesses, and monitor units (MUs). The energy was chosen 8 MeV, and EBT3 film was used for the dosimetric process. In addition, the acute toxicity included healing time for the surgical wound, scaling of the skin, itching, necrosis, redness as well as seroma formation for 1 week and 1 month were recorded. The results were compared to those of 22 patients who underwent the surgery without IOERT. Results: The highest skin dose for the patients was obtained 2.09 Gy, which is lower than the threshold dose (6 Gy). Furthermore, the findings showed that the average skin dose was higher in bigger applicator sizes and MU and lower tumor bed thicknesses. The average of wound healing for the patient underwent IOERT and without the use of IOERT (as the control group) was 19.32 and 11.67 days, respectively. One month after surgery, the volume of aspirated seroma was higher in the patients who performed IOERT compared to the control group (250 ml vs. 200 ml). It is notable that there were not observed any redness, itching, scaling, and necrosis in both investigated groups. Conclusion: Owing to the results, the skin dose during IOERT was lower than the recommended level. The dose of IOERT as a full was higher than boost which can be related to the lower number of the patients in full method; however, there was a well-tolerated without severe acute complication, especially seroma formation and wound healing time in both full and boost methods.

Can leaded glasses protect the eye lens in patients undergoing neck computed tomography?

BACKGROUND AND AIMS: Computed tomography (CT) is one of the main sources using ionizing radiation. Considering the toxicity from this radiation, any technique that could reduce the radiosensitive organs' doses without affecting the image diagnostic quality must be considered in routine practice. In this study, the amount of eye lens dose reduction in the presence of radioprotective glasses was evaluated in neck CT examinations. METHODS: Thirty adult patients (15 men and 15 women) with a mean age of 44.6 years undergoing neck CT examination participated in this study. For each patient, six thermoluminescent dosimeters (TLDs-100) were attached above the eye lens glasses surface, and another six under the glasses to assess the radioprotective effect of the glasses. The TLDs were readout and converted to Hp (3) as an indicator of eye lens dose. The obtained results from the TLD readouts as eye lens dose were compared using a paired t-test. RESULTS: The TLD measurements showed the mean±standard deviation values of 2.97±0.61 mGy and 1.04±0.16 mGy for TLDs above and under the radioprotective glasses, respectively. The radioprotective glasses significantly decreased the eye lens dose by about 64.9% (P=0.001). CONCLUSIONS: Due to the results, wearing radioprotective glasses for patients during neck CT scans could significantly reduce the eye lens doses. RELEVANCE FOR PATIENTS: The outcome of this research shows that leaded glasses can decrease the received dose significantly in patient during neck CT scans.

Therapeutic effect of cold atmospheric plasma and its combination with radiation as a novel approach on inhibiting cervical cancer cell growth (HeLa cells).

Cervical cancer is one of the important cancers in women. Research on novel treatment approach can reduce the mortality and burden. Although radiotherapy is a common treatment, its negative side effects have concerned physician. In our study, we studied impact of cold atmospheric pressure plasma on the Hela cancer cells, as an alternative treatment. The effect of three different types of such plasma; dielectric barrier discharge (DBD), plasma jet, and afterglow plasma, on the cancer cells were studied. Moreover, some effective operating parameters such as exposure time, applied voltage, composition of working gas in plasma treatment were investigated on the survival of the afterglow plasma. Finally, treatments by the afterglow plasma, gamma radiation (1 Gy), and combination of both were compared. Analysis showed that DBD and plasma jet (direct exposure) effectively killed the cancer cells, even by a minimum applied voltage. But a fraction of the cells survived after the exposure of indirect diffused afterglow plasma. In the case of this plasma, we realized that higher applied voltage and exposure time led to less cell viability. Fewer fractions of survival cells were detected in the case of argon afterglow plasma comparing to oxygen afterglow. Cold atmospheric plasma and its combination with radiation therapy showed a significant decrease in viability of the cells, comparing to the radiation alone. Our research showed that plasma and its combination with radiation therapy have superiority over radiation therapy.

Dosimetric comparison of artificial walls of bladder and rectum with real walls in common prostate IMRT techniques: Patient and Monte Carlo study.

BACKGROUND: Rectum and bladder are hallow structures and considered as critical organs in prostate cancer intensity modulated radiotherapy (IMRT). Therefore, dose received by these organ walls must be considered for prediction of radiobiological effects. Contouring the real organ walls is quite difficult and time consuming in CT/MRI images, so the easy contouring artificial walls with uniform thickness could be appropriated alternatives. OBJECTIVE: To compare reconstructed artificial walls with real walls of bladder and rectum in common prostate IMRT techniques based on dose volume-histograms (DVHs) derived from artificial and real walls. METHODS: Artificial walls were reconstructed with 2-10 mm and 2-8 mm thicknesses for bladder and rectum, respectively. Four common IMRT techniques were applied to each patient. Spearman correlation was used to find the relation between the DVHs of true walls with artificial walls and whole organs. Monte Carlo (MC) simulations of the IMRT techniques and dosimetric comparison were also performed on a standard patient data. RESULTS: The 2 mm thickness artificial walls showed the minimum differences with the true bladder and rectum walls based on absolute evaluations (the maximum difference < 10cc and standard deviation < 15cc). However, relative evaluations showed that all the artificial walls had high correlations with real walls for selecting dose volume parameters. There was also good agreement between the treatment planning system and MC simulations results. CONCLUSION: The DVH of whole organs was not a good surrogate of the true wall. The 2 mm artificial walls can be regarded as good alternatives for both of rectum and bladder. However, in relative dose evaluations all studied artificial walls were appropriate.

Evaluation of Dose Rate and Photon Energy Dependence of Gafchromic EBT3 Film Irradiating with 6 MV and Co-60 Photon Beams.

Gafchromic films are utilized for two-dimensional dose distribution measurements, especially in radiotherapy. In this study, we investigated a close connection between energy and dose rate of Gafchromic EBT3 films irradiating with 6 MV and Co-60 photon beams over a broad dose range. EBT3 films were exposed to 6 MV and Co-60 photon beams using 4 and 2 Gy/min dose rates over a 10-400 cGy dose range. The films were scanned in red, green, and blue channels to obtain the optical density (OD)-dose curves. The OD-dose curves resulted from three-color scans for different photon energies and dose rates were compared by statistical independent t-test. For the radiations of Co-60 and 6 MV photon beams, the highest correlation was obtained between the 2 and 4 Gy/min dose rates with red and green channels, respectively. Moreover, the red channel had a greater OD response per dose value, following the green and blue channels. There was no significant difference between different photon energies' (Co-60 and 6 MV) and dose rates' (2 and 4 Gy/min) dependence on OD-dose response of EBT3 films over a broad domain of radiation dose, except for different photon energies in the blue channel. Our results revealed that the OD-dose response of EBT3 films is independent on photon energies (Co-60 and 6 MV) and dose rate (2 and 4 Gy/min) in the evaluated dose range (10-400 cGy). Therefore, the EBT3 films are suitable, consistent, and reliable instruments for dose measurements in radiotherapy.

The expression of MLH1 and MSH2 genes among inhabitants of high background radiation area of Ramsar, Iran.

Previous studies evidenced the critical role of the mismatch repair system in DNA damage recognition, cell cycle arrest, apoptosis and DNA repair. MLH1 and MSH2 genes belong to repairing complexes of mismatch repair system. The side effects of ionizing radiation on the human health were proved, but researches on the inhabitants of high background radiation areas, with extra-ordinary radiation exposure, showed that the prevalence of cancer or radiation-related diseases is not significantly higher than normal background areas. The city of Ramsar, in northern Iran, has the highest level of natural background radiation in the world and in this study, we aimed to evaluate the expression of MLH1 and MSH2 genes among the inhabitants of high background radiation areas of Ramsar compared to normal background radiation areas. In the present study, 60 blood sample from high and normal background inhabitants were collected and we MLH1, and MSH2 genes expressions in residents of high background radiation area compared with normal background radiation area were evaluated by Quantitative Real-Time PCR. Our results showed a significant upregulation of MLH1 in residents of high background radiation area. Also, there is a significant association between MLH1 and MSH2 gene expression in both sexes. Also, the increased expression of MLH1 in HBRA is notable. There is an increased expression of MLH1 in age above 50 and a decreased expression of MSH2 in ages under 50 years (P < 0.0001). These findings are suggesting the triggering of Mismatch Repair system in response to high-level of natural background radiation.

The assessment of radio-adaptive response in graves' hyperthyroidism patients following radioactive iodine uptake.

Low doses of radiation affect the response of cells to higher doses; this phenomenon is called radio-adaptive response, which leads to increased resistance to subsequent higher doses. We have investigated the adaptive response using 0.37 MBq priming dose of I-131 followed by 296-444 MBq challenging dose in peripheral human lymphocyte cells. The study was performed on 42 patients with Graves' disease and 29 healthy adult persons as a control group. The patients were divided into two groups. In the first group, patients were referred for radioactive iodine therapy with a specific dose, and iodine was given to them on the day of referral. In the second group, patients were referred for radioactive iodine uptake and radioactive iodine therapy, and iodine uptake was initially performed, then 24 h later, iodine therapy was done. In both groups, 1 month after treatment, blood samples were taken to cytokinesis-block micronucleus (MN) assay. The number of MN in binuclear lymphocyte cells was counted as an end point test. The mean frequency of MN in first, second, and control groups was 75.86 ± 12.68, 71.45 ± 12.56, and 20.06 ± 7.30, respectively. Our results showed that the frequency of total chromosome aberration in both radiation groups was higher than controls. However, in the first group was higher than another group, but their difference was not statistically significant. According to the results, we cannot approve the hypothesis that 0.37 MBq I-131 administration before iodine therapy could induce a radio-adaptive response in lymphocytes of Graves' patients.