The geometric and dosimetric accuracy of kilovoltage cone beam computed tomography images for adaptive treatment: a systematic review.

Objectives: To provide an overview and meta-analysis of different techniques adopted to accomplish kVCBCT for dose calculation and automated segmentation. Methods: A systematic review and meta-analysis were performed on eligible studies demonstrating kVCBCT-based dose calculation and automated contouring of different tumor features. Meta-analysis of the performance was accomplished on the reported γ analysis and dice similarity coefficient (DSC) score of both collected results as three subgroups (head and neck, chest, and abdomen). Results: After the literature scrutinization (n = 1008), 52 papers were recognized for the systematic review. Nine studies of dosimtric studies and eleven studies of geometric analysis were suitable for inclusion in meta-analysis. Using kVCBCT for treatment replanning depends on a method used. Deformable Image Registration (DIR) methods yielded small dosimetric error (≤2%), γ pass rate (≥90%) and DSC (≥0.8). Hounsfield Unit (HU) override and calibration curve-based methods also achieved satisfactory yielded small dosimetric error (≤2%) and γ pass rate ((≥90%), but they are prone to error due to their sensitivity to a vendor-specific variation in kVCBCT image quality. Conclusions: Large cohorts of patients ought to be undertaken to validate methods achieving low levels of dosimetric and geometric errors. Quality guidelines should be established when reporting on kVCBCT, which include agreed metrics for reporting on the quality of corrected kVCBCT and defines protocols of new site-specific standardized imaging used when obtaining kVCBCT images for adaptive radiotherapy. Advances in knowledge: This review gives useful knowledge about methods making kVCBCT feasible for kVCBCT-based adaptive radiotherapy, simplifying patient pathway and reducing concomitant imaging dose to the patient.

Synthesis and evaluation of thermoluminescence properties of ZrO2:Mg for radiotherapy dosimetry.

This study aimed to investigate the thermoluminescent properties of ZrO2:Mg irradiated with a 6 MV X-ray beam and its potential application in radiotherapy dosimetry. ZrO2 powder was synthesized using the sol-gel method and Mg was used as a dopant. Irradiations were performed with ZrO2:Mg chips located at the center of a 10 × 10 cm2 radiation field at a source surface distance of 100 cm, below a stack of solid water slabs, at the depth of maximum absorbed dose. The investigated characteristics of the material included linearity with radiation dose, reproducibility, accuracy, sensitivity and fading. Regarding the intrinsic difference of the samples, the glow curves of the investigated ZrO2:Mg chips exposed to 1 Gy of 6 MV X-rays exhibited three or four peaks. The ZrO2:Mg samples showed a 47% fading at 24 h after irradiation, and the reproducibility of the thermoluminescence reading of ZrO2:Mg for equal irradiation conditions was ± 21%. The thermoluminescence response of the investigated ZrO2:Mg samples to various absorbed doses from 0.5 to 2.5 Gy showed a gentle increase of the thermoluminescence intensity with increasing absorbed dose. The obtained results show that ZrO2:Mg is not an appropriate candidate for X-ray photons in radiotherapy, due to low thermoluminescence peak temperature, low reproducibility, low sensitivity to various absorbed doses and significant fading.

Enhanced cytotoxic and genotoxic effects of gadolinium-doped ZnO nanoparticles on irradiated lung cancer cells at megavoltage radiation energies.

The purpose of this study was to investigate the radiation dose enhancement effects of gadolinium-doped zinc oxide nanoparticles (Gd-doped ZnO NPs) under the megavoltage (MV) X-ray irradiation. ZnO NPs have preferred photocatalytic properties under UV light for cancer killing. UV light has limited applications in cancer treatment and it is necessary to use X-ray photons with MV energies. In order to increase the absorption of radiation and also to enhance the imaging visualization capabilities of ZnO NPs, gadolinium (Gd) as a high atomic number element was selected for doping into the structure of ZnO NPs. Gd-doped ZnO NPs were synthesized by a chemical precipitation method and characterized by transmission electron microscopy, powder X-ray diffraction, ultraviolet-visible spectroscopy, and energy-dispersive X-ray techniques. Cellular uptake was assessed by TEM and inductively coupled plasma mass spectrometry. NPs cytotoxicity was analyzed by MTT assay and radiation dose enhancement was measured by clonogenic survival assay. Apoptosis induction, cell cycle progression, micronucleus formation and expression of DNA double-strand break repair genes of XRCC2 and XRCC4 were determined by flow cytometry, micronucleus assay, and quantitative real-time polymerase chain reaction. CT and MR imaging were used to analyze the image visualization capabilities of NPs. NPs characterization showed that highly pure crystalline Gd-doped ZnO NPs with a narrow size distribution and grain size of 9 nm were synthesized. Gd-doped ZnO NPs were distributed in the cells and showed dose-dependent toxicity. Combination of Gd-doped ZnO NPs with 6 MV X-rays induced dose-dependent radiosensitivity with sensitizer enhancement ratios (SER) of 1.47 and 1.61 for 10 and 20 µg/mL NPs concentrations. Cancer cells blocked in G1, apoptosis rates, and micronuclei formation was enhanced and inversely, the DNA repair efficiency was impaired by down regulation of the mRNA levels of XRCC2 and XRCC4 genes. Gd-doped ZnO NPs enhanced the contrasts of CT and MR images of cancer cells. Overall, the results of this study provide detailed biological insights on the dose enhancement of Gd-doped ZnO NPs at MV radiations, which would contribute to the further development of this potent theranostic platform for clinical applications.

Multi-parametric Improvements in the CCD Camera-based EPID for Portal Dosimetry.

Dosimetric verification of radiation treatment has recently been extended by the introduction of electronic portal imaging devices (EPIDs). Detailed dose response specifications of EPID should be addressed prior to any dosimetric application. The present study evaluates improvements of dosimetric properties of the low elbow camera-based EPID Theraview (Cablon Medical, Leusden, The Netherlands) equipped with a cooled charge coupled device (CCD) for portal dosimetry. The dose response, warm-up behavior, stability over long- and short-term scales (throughout a day) were studied. The field size dependency of the EPID response was also investigated and compared with ion chamber measurements under the same conditions. The EPID response without saturation for doses up to 2 Gy was linear for both beam qualities (6 and 15 MV). There was no evident warm-up characteristic. The detector sensitivity showed excellent stability in short term [standard deviation (SD) 0.38%]. In long-term stability (over a period of approximately 3 months), a negligible linear decline of 0.01% per day was observed. It was concluded that the cooled CCD camera-based EPID could be used for portal dosimetry, after accurate corrections for the field size dependency and sensitivity loss.

Enhancement of radiosensitivity of melanoma cells by pegylated gold nanoparticles under irradiation of megavoltage electrons.

PURPOSE: Gold nanoparticles (GNP) have significant potential as radiosensitizer agents due to their distinctive properties. Several studies have shown that the surface modification of nanoparticles with methyl polyethylene glycol (mPEG) can increase their biocompatibility. However, the present study investigated the radiosensitization effects of mPEG-coated GNP (mPEG-GNP) in B16F10 murine melanoma cells under irradiation of 6 MeV Electron beam. MATERIALS AND METHODS: The synthesized GNP were characterized by UV-Visible spectroscopy, dynamic light scattering, transmission electron microscopy, and zeta potential. Enhancement of radiosensitization was evaluated by the clonogenic assay at different radiation doses of megavoltage electron beams. RESULTS: It was observed that mPEG-GNP with a hydrodynamic size of approximately 50 nm are almost spherical and cellular uptake occurred at all concentrations. Both proliferation efficiency and survival fraction decreased with increasing mPEG-GNP concentration. Furthermore, significant GNP sensitization occurred with a maximum dose enhancement factor of 1.22 at a concentration of 30 µM. CONCLUSIONS: Pegylated-GNP are taken up by B16F10 cancer cells and cause radiosensitization in the presence of 6 MeV electrons. The radiosensitization effects of GNP may probably be due to biological processes. Therefore, the underlying biological mechanisms beyond the physical dose enhancement need to be further clarified.