Using machine learning to predict gamma passing rate in volumetric-modulated arc therapy treatment plans.

PURPOSE: This study aims to develop an algorithm to predict gamma passing rate (GPR) in the volumetric-modulated arc therapy (VMAT) technique. MATERIALS AND METHODS: A total of 118 clinical VMAT plans, including 28 mediastina, 25 head and neck, 40 brains intensity-modulated radiosurgery, and 25 prostate cases, were created in RayStation treatment planning system for Edge and TrueBeam linacs. In-house scripts were developed to compute Modulation indices such as plan-averaged beam area (PA), plan-averaged beam irregularity (PI), total monitor unit (MU), leaf travel/arc length, mean dose rate variation, and mean gantry speed variation. Pretreatment verifications were performed on ArcCHECK phantom with SNC software. GPR was calculated with 3%/2 mm and 10% threshold. The dataset was randomly split into a training (70%) and a test (30%) dataset. A random forest regression (RFR) model and support vector regression (SVR) with linear kernel were trained to predict GPR using the complexity metrics as input. The prediction performance was evaluated by calculating the mean absolute error (MAE), R2 , and root mean square error (RMSE). RESULTS: RMSEs at γ 3%/2 mm for RFR and SVR were 1.407 ± 0.103 and 1.447 ± 0.121, respectively. MAE was 1.14 ± 0.084 for RFR and 1.101 ± 0.09 for SVR. R2 was equal to 0.703 ± 0.027 and 0.689 ± 0.053 for RFR and SVR, respectively. GPR of 3%/2 mm with a 10% threshold can be predicted with an error smaller than 3% for 94% of plans using RFR and SVR models. The most important metrics that had the greatest impact on how accurately GPR can be predicted were determined to be the PA, PI, and total MU. CONCLUSION: In terms of its prediction values and errors, SVR (linear) appeared to be comparable with RFR for this dataset. Based on our results, the PA, PI, and total MU calculations may be useful in guiding VMAT plan evaluation and ultimately reducing uncertainties in planning and radiation delivery.

Evaluation of parameters affecting gamma passing rate in patient-specific QAs for multiple brain lesions IMRS treatments using ray-station treatment planning system.

PURPOSE: Using intensity-modulated radiosurgery (IMRS) with single isocenter for the treatment of multiple brain lesions has gained acceptance in recent years. One of the challenges of this technique is conducting a patient-specific quality assurance (QA), involving accurate gamma passing rate (GPR) calculations for small and wide spread-out targets. We evaluated effects of parameters such as dose grid and energy on GPR using our clinical IMRS plans. METHODS: Ten patients with total of 40 volumetric modulated arc therapy (VMAT) plans were created in Raystation (V.8A) treatment planning system (TPS) for the Varian Edge Linac using 6 and 10 flattening filter-free (FFF) beams and planned dose grids of 1 mm and 2 mm resulting in four plans with 6-10 targets per patient. All parameters and objectives except dose grid and energy were kept the same in all plans. Next, patient-specific QAs were measured evaluating GPR with 10% threshold, 3%/3 mm objective, and an acceptance criterion of 95%. Modulation factors (MF) and confidence intervals were calculated. Two modes of measurements, standard density (SD) and high density (HD), were used. RESULTS: Generally, plans computed with 1 mm dose grid have higher GPRs than those with 2 mm dose grid for both energies used. The GPRs of 6 FFF plans were higher than those of 10 FFF plans. GPR showed no noticeable difference between HD and SD measurements. Negative correlation between MF and GPR was observed. The HD pass rates fall within the confidence interval of SD. CONCLUSION: Calculated dose grid should be less than or equal to one-third of distance to agreement, thus 1 mm planned dose grid is recommended to reduce artifacts in gamma calculation. GPR of SD and HD measurement modes is almost the same, which indicates that SD mode is clinically preferable for performing patient-specific QAs. According to our results, using 6 FFF beams with 1 mm planned dose grid is more accurate and reliable for dose calculation of IMRS plans.

A novel and innovative device to retract rectum during radiation therapy of pelvic tumors.

An effective radiotherapy treatment entails maximizing radiation dose to the tumor while sparing the surrounding and normal tissues. With the advent of SBRT with extreme hypo-fractionation in treating tumors including prostate where ablative dose is delivered in smaller number of fractions, rectum remains a dose-limiting organ and at the risk of rectal toxicity or secondary cancer. The same limitation of rectal toxicity exists for high-dose rate (HDR) treatments of cervical, endometrial, or prostate cancer when creating even a short distance between the anterior rectal wall and field of radiation is ideal in delivering ablative dose to the target. An effective solution to such problem is to physically displace rectum as the organ at risk. This research presents an organ retractor device that is designed to displace the rectum away from the path of radiation beam employing a Nitinol shape memory alloy that is designed for displacing the rectum upon actuation. A control system regulates the motion in a reproducible and safe manner by creating the desirable shape in moving the anterior rectal wall. The study finds the novel organ retractor device to be a promising tool that can be applied in a clinical setting for minimizing dose to the rectum during treatment of pelvic tumors, and creating the potential to deliver an ablative dose to tumor volume or to escalate the dose when needed.

Dosimetric comparison of VMAT with integrated skin flash to 3D field-in-field tangents for left breast irradiation.

Volumetric modulated arc therapy (VMAT) has been implemented for left breast irradiation to reduce prescription dose to the heart and improve dose homogeneity across the targeted breast. Our in-house method requires application of a bolus during the optimization process with a target outside of the body, then removing the bolus during the final calculation in order to incorporate skin flash in VMAT plans. To quantify the dosimetric trade-offs between traditional 3D field-in-field tangents and VMAT with integrated skin flash for these patients, we compared nine consecutive patients who recently received radiation to their entire left breast but not their regional lymphatics. Tangent plans used non-divergent tangents of mixed energies and VMAT plans utilized four 6 MV arcs of roughly 260°. Mean dose to the heart, contralateral lung, and contralateral breast and their volume receiving 5%, 10%, and 20% of the prescription dose were higher in all nine VMAT plans than in the static tangential beam plans. For all critical structures, the mean VMAT DVH was higher in the low-dose region and crossed the 3D field-in-field DVH between 23.13% and 34.18% of the prescription dose (984.75-1454.70 cGy). However, the volume of the contralateral breast and heart receiving the prescription dose was slightly lower in the VMAT plans, but not statistically significant. VMAT provided superior homogeneity, with a mean homogeneity index of 9.41 ± 1.64 compared to 11.05 ± 1.82 for 3D tangents. Results indicate that VMAT spares the heart, contralateral lung, and contralateral breast from prescription dose at the cost of increasing their mean and low-dose volume and delivers a more homogenous dose distribution to the breast. For these reasons, VMAT is selectively applied at the request of the physician for left breast radiation without respiratory gating to spare the heart from prescription dose in cases of poor anatomical geometry.

Thin-film CdTe detector for microdosimetric study of radiation dose enhancement at gold-tissue interface.

Presence of interfaces between high and low atomic number (Z) materials, often encountered in diagnostic imaging and radiation therapy, leads to radiation dose perturbation. It is characterized by a very narrow region of sharp dose enhancement at the interface. A rapid falloff of dose enhancement over a very short distance from the interface makes the experimental dosimetry nontrivial. We use an in-house-built inexpensive thin-film Cadmium Telluride (CdTe) photodetector to study this effect at the gold-tissue interface and verify our experimental results with Monte Carlo (MC) modeling. Three-micron thick thin-film CdTe photodetectors were fabricated in our lab. One-, ten- or one hundred-micron thick gold foils placed in a tissue-equivalent-phantom were irradiated with a clinical Ir-192 high-dose-rate (HDR) source and current measured with a CdTe detector in each case was compared with the current measured for all uniform tissue-equivalent phantom. Percentage signal enhancement (PSE) due to each gold foil was then compared against MC modeled percentage dose enhancement (PDE), obtained from the geometry mimicking the experimental setup. The experimental PSEs due to 1, 10, and 100 µm thick gold foils at the closest measured distance of 12.5µm from the interface were 42.6 ± 10.8 , 137.0 ± 11.9, and 203.0 ± 15.4, respectively. The corresponding MC modeled PDEs were 38.1 ± 1, 164 ± 1, and 249 ± 1, respectively. The experimental and MC modeled values showed a closer agreement at the larger distances from the interface. The dose enhancement in the vicinity of gold-tissue interface was successfully measured using an in-house-built, high-resolution CdTe-based photodetector and validated with MC simulations. A close agreement between experimental and the MC modeled results shows that CdTe detector can be utilized for mapping interface dose distribution encountered in the application of ionizing radiation.

Optimization and experimental characterization of the innovative thermo-brachytherapy seed for prostate cancer treatment.

BACKGROUND: Adjuvant administration of hyperthermia (HT) with radiation therapy in the treatment of cancer has been extensively studied in the past five decades. Concurrent use of the two modalities leads to both complementary and synergetic enhancements in tumor management, but presents a practical challenge. Their simultaneous administration using the same implantable thermo-brachytherapy (TB) seed source has been established theoretically through magnetically mediated heat induction with ferromagnetic materials. Careful consideration, however, showed that regular ferromagnetic alloys lack the required conductivity to generate enough power through eddy current to overcome heat dissipation due to blood perfusion at clinically measured rates. PURPOSE: We characterized the TB implant that combines a sealed radioactive source with a ferrimagnetic ceramic (ferrite) core, serving as a self-regulating HT source when placed in an alternating electromagnetic field. To increase the heat production and uniformity of temperature distribution the empty spacers between radioisotope seeds were replaced by hyperthermia-only (HT-only) seeds. METHODS: The heat generation due to eddy currents circulating in the seed's thin metal shell, surrounding the core, depends drastically on the core permeability. We identified a soft ferrite material ( MnZnFe 2 O 4 $\rm MnZnFe_2O_4$ ) as the best candidate for the core, owing to its high permeability, the HT-range Curie temperature, adjustable through material composition, and a sharp Curie transition, leading to heat self-regulation, with no invasive thermometry required. The core permeability as a function of temperature was calculated based on measured resistor-inductor (RL) circuit parameters and material B-H curves. The thickness of the shell was optimized separately for TB and HT-only seeds, having slightly different dimensions. Heat generation was calculated using the power versus temperature approximation. Finally, the temperature distribution for a realistic prostate LDR brachytherapy plan was modeled with COMSOL Multiphysics for a set of blood perfusion rates found in the literature. RESULTS: The small size of the investigated ferrite core samples resulted in demagnetization significantly decreasing the relative permeability from its intrinsic value of ∼5000 to about 11 in the range of magnetic field amplitude and frequency values relevant to HT. The power generated by the seed dropped sharply as the shell thickness deviated from the optimal value. The optimized TB and HT-only seeds generated 45 and 267 mW power, respectively, providing a HT source sufficient for >90% volume coverage even for the highest blood perfusion rates. The toxicity of the surrounding normal tissues was minimal due to the rapid temperature fall off within a few millimeters distance from a seed. CONCLUSIONS: The investigated TB and HT-only seed prototypes were shown to provide sufficient power for the concurrent administration of radiation and HT. In addition to being used as a source for both radiation and heat at the onset of cancer therapy, these implanted seeds would be available for treatment intensification in the setting of salvage brachytherapy for locally radiorecurrent disease, possibly as a sensitizer to systemic therapies or as a modulator of the immune response, without another invasive procedure. Experimentally determined parameters of the ferrite material cores provided in this study establish a mechanistic foundation for future pre-clinical and clinical validation studies.

Differentiating Radiation Necrosis and Metastatic Progression in Brain Tumors Using Radiomics and Machine Learning.

OBJECTIVES: Distinguishing between radiation necrosis (RN) and metastatic progression is extremely challenging due to their similarity in conventional imaging. This is crucial from a therapeutic point of view as this determines the outcome of the treatment. This study aims to establish an automated technique to differentiate RN from brain metastasis progression using radiomics with machine learning. METHODS: Eighty-six patients with brain metastasis after they underwent stereotactic radiosurgery as primary treatment were selected. Discrete wavelets transform, Laplacian-of-Gaussian, Gradient, and Square were applied to magnetic resonance post-contrast T1-weighted images to extract radiomics features. After feature selection, dataset was randomly split into train/test (80%/20%) datasets. Random forest classification, logistic regression, and support vector classification were trained and subsequently validated using test set. The classification performance was measured by area under the curve (AUC) value of receiver operating characteristic curve, accuracy, sensitivity, and specificity. RESULTS: The best performance was achieved using random forest classification with a Gradient filter (AUC=0.910±0.047, accuracy 0.8±0.071, sensitivity=0.796±0.055, specificity=0.922±0.059). For, support vector classification the best result obtains using wavelet_HHH with a high AUC of 0.890±0.89, accuracy of 0.777±0.062, sensitivity=0.701±0.084, and specificity=0.85±0.112. Logistic regression using wavelet_HHH provides a poor result with AUC=0.882±0.051, accuracy of 0.753±0.08, sensitivity=0.717±0.208, and specificity=0.816±0.123. CONCLUSION: This type of machine-learning approach can help accurately distinguish RN from recurrence in magnetic resonance imaging, without the need for biopsy. This has the potential to improve the therapeutic outcome.

Dosimetric and thermal properties of a newly developed thermobrachytherapy seed with ferromagnetic core for treatment of solid tumors.

PURPOSE: Studies of the curative effects of hyperthermia and radiation therapy on treatment of cancer show a strong evidence of a synergistic enhancement when both radiation and hyperthermia modalities are applied simultaneously. Varieties of tissue heating approaches developed up to date still fail to overcome such essential limitations as an inadequate temperature control, temperature nonuniformity, and prolonged time delay between hyperthermia and radiation treatments. The authors propose a new self-regulating thermobrachytherapy seed, which serves as a source of both radiation and heat for concurrent administration of brachytherapy and hyperthermia. METHODS: The proposed seed is based on the BEST Medical, Inc., Seed Model 2301-I(125), where tungsten marker core and the air gap are replaced with a ferromagnetic material. The ferromagnetic core produces heat when subjected to alternating electromagnetic (EM) field and effectively shuts off after reaching the Curie temperature (T(C)) of the ferromagnetic material thus realizing the temperature self-regulation. The authors present a Monte Carlo study of the dose rate constant and other TG-43 factors for the proposed seed. For the thermal characteristics, the authors studied a model consisting of 16 seeds placed in the central region of a cylindrical water phantom using a finite-element partial differential equation solver package "COMSOL Multiphysics." RESULTS: The modification of the internal structure of the seed slightly changes dose rate and other TG-43 factors characterizing radiation distribution. The thermal modeling results show that the temperature of the thermoseed surface rises rapidly and stays constant around T(C) of the ferromagnetic material. The amount of heat produced by the ferromagnetic core is sufficient to raise the temperature of the surrounding phantom to the therapeutic range. The phantom volume reaching the therapeutic temperature range increases with increase in frequency or magnetic field strength. CONCLUSIONS: An isothermal distribution matching with the radiation isodose distribution can be achieved within a target volume by tuning frequency and intensity of the alternating magnetic field. The proposed combination seed model has a potential for implementation of concurrent brachytherapy and hyperthermia.

Radiation Exposure Perturbs IL-17RA-Mediated Immunity Leading to Changes in Neutrophil Responses That Increase Susceptibility to Oropharyngeal Candidiasis.

Fungal infections caused by Candida albicans are a serious problem for immunocompromised individuals, including those undergoing radiotherapy for head and neck cancers. Targeted irradiation causes inflammatory dysregulation and damage to the oral mucosa that can be exacerbated by candidiasis. Post-irradiation the cytokine interleukin-17 (IL-17) protects the oral mucosae by promoting oral epithelial regeneration and balancing the oral immune cell populations, which leads to the eventual healing of the tissue. IL-17 signaling is also critical for the antifungal response during oropharyngeal candidiasis (OPC). Yet, the benefit of IL-17 during other forms of candidiasis, such as vulvovaginal candidiasis, is not straightforward. Therefore, it was important to determine the role of IL-17 during OPC associated with radiation-induced inflammatory damage. To answer this question, we exposed Il17ra-/- and wild-type mice to head-neck irradiation (HNI) and OPC to determine if the IL-17 signaling pathway was still protective against C. albicans. HNI increased susceptibility to OPC, and in Il17ra-/- mice, the mucosal damage and fungal burden were elevated compared to control mice. Intriguingly, neutrophil influx was increased in Il17ra-/- mice, yet these cells had reduced capacity to phagocytose C. albicans and failed to clear OPC compared to immunocompetent mice. These findings suggest that radiotherapy not only causes physical damage to the oral cavity but also skews immune mediators, leading to increased susceptibility to oropharyngeal candidiasis.

Tissue Damage in Radiation-Induced Oral Mucositis Is Mitigated by IL-17 Receptor Signaling.

Oral mucositis (OM) is a treatment-limiting adverse side effect of radiation and chemotherapy. Approximately 80% of patients undergoing radiotherapy (RT) for head and neck cancers (HNC) develop OM, representing a major unmet medical condition. Our understanding of the immunopathogenesis of OM is limited, due in part to the surprising paucity of information regarding healing mechanisms in the oral mucosa. RNAseq of oral tissue in a murine model that closely mimics human OM, showed elevated expression of IL-17 and related immune pathways in response to head and neck irradiation (HNI). Strikingly, mice lacking the IL-17 receptor (IL-17RA) exhibited markedly more severe OM. Restoration of the oral mucosa was compromised in Il17ra-/- mice and components associated with healing, including matrix metalloproteinase 3, 10 and IL-24 were diminished. IL-17 is typically associated with recruitment of neutrophils to mucosal sites following oral infections. Unexpectedly, in OM the absence of IL-17RA resulted in excessive neutrophil recruitment and immunopathology. Instead, neutrophil activation was IL-1R-driven in Il17ra-/- mice. Blockade of IL-1R and depletion of neutrophils lessened the severity of damage in these mice. Overall, we show IL-17 is protective in OM through multiple mechanisms including restoration of the damaged epithelia and control of the neutrophil response. We also present a clinically relevant murine model of human OM to improve mechanistic understanding and develop rational translational therapeutics.

Design and optimization of large area thin-film CdTe detector for radiation therapy imaging applications.

PURPOSE: The authors investigate performance of thin-film cadmium telluride (CdTe) in detecting high-energy (6 MV) x rays. The utilization of this material has become technologically feasible only in recent years due to significant development in large area photovoltaic applications. METHODS: The CdTe film is combined with a metal plate, facilitating conversion of incoming photons into secondary electrons. The system modeling is based on the Monte Carlo simulations performed to determine the optimized CdTe layer thickness in combination with various converter materials. RESULTS: The authors establish a range of optimal parameters producing the highest DQE due to energy absorption, as well as signal and noise spatial spreading. The authors also analyze the influence of the patient scatter on image formation for a set of detector configurations. The results of absorbed energy simulation are used in device operation modeling to predict the detector output signal. Finally, the authors verify modeling results experimentally for the lowest considered device thickness. CONCLUSIONS: The proposed CdTe-based large area thin-film detector has a potential of becoming an efficient low-cost electronic portal imaging device for radiation therapy applications.

A quantitative three-dimensional dose attenuation analysis around Fletcher-Suit-Delclos due to stainless steel tube for high-dose-rate brachytherapy by Monte Carlo calculations.

PURPOSE: The commercially available brachytherapy treatment-planning systems today, usually neglects the attenuation effect from stainless steel (SS) tube when Fletcher-Suit-Delclos (FSD) is used in treatment of cervical and endometrial cancers. This could lead to potential inaccuracies in computing dwell times and dose distribution. A more accurate analysis quantifying the level of attenuation for high-dose-rate (HDR) iridium 192 radionuclide ((192)Ir) source is presented through Monte Carlo simulation verified by measurement. METHODS AND MATERIALS: In this investigation a general Monte Carlo N-Particles (MCNP) transport code was used to construct a typical geometry of FSD through simulation and compare the doses delivered to point A in Manchester System with and without the SS tubing. A quantitative assessment of inaccuracies in delivered dose vs. the computed dose is presented. In addition, this investigation expanded to examine the attenuation-corrected radial and anisotropy dose functions in a form parallel to the updated AAPM Task Group No. 43 Report (AAPM TG-43) formalism. This will delineate quantitatively the inaccuracies in dose distributions in three-dimensional space. The changes in dose deposition and distribution caused by increased attenuation coefficient resulted from presence of SS are quantified using MCNP Monte Carlo simulations in coupled photon/electron transport. The source geometry was that of the Vari Source wire model VS2000. The FSD was that of the Varian medical system. In this model, the bending angles of tandem and colpostats are 15 degrees and 120 degrees , respectively. We assigned 10 dwell positions to the tandem and 4 dwell positions to right and left colpostats or ovoids to represent a typical treatment case. Typical dose delivered to point A was determined according to Manchester dosimetry system. RESULTS AND CONCLUSIONS: Based on our computations, the reduction of dose to point A was shown to be at least 3%. So this effect presented by SS-FSD systems on patient dose is of concern.

Dose optimization of breast balloon brachytherapy using a stepping 192Ir HDR source.

There is a considerable underdosage (11%-13%) of PTV due to anisotropy of a stationary source in breast balloon brachytherapy. We improved the PTV coverage by varying multiple dwell positions and weights. We assumed that the diameter of spherical balloons varied from 4.0 cm to 5.0 cm, that the PTV was a 1-cm thick spherical shell over the balloon (reduced by the small portion occupied by the catheter path), and that the number of dwell positions varied from 2 to 13 with 0.25-cm steps, oriented symmetrically with respect to the balloon center. By assuming that the perfect PTV coverage can be achieved by spherical dose distributions from an isotropic source, we developed an optimization program to minimize two objective functions defined as: (1) the number of PTV-voxels having more than 10% difference between optimized doses and spherical doses, and (2) the difference between optimized doses and spherical doses per PTV-voxel. The optimal PTV coverage occurred when applying 8-11 dwell positions with weights determined by the optimization scheme. Since the optimization yields ellipsoidal isodose distributions along the catheter, there is relative skin sparing for cases with source movement approximately tangent to the skin. We also verified the optimization in CT-based treatment planning systems. Our volumetric dose optimization for PTV coverage showed close agreement to linear or multiple-points optimization results from the literature. The optimization scheme provides a simple and practical solution applicable to the clinic.

Three-dimensional quantitative dose reduction analysis in MammoSite balloon by Monte Carlo calculations.

Current treatment planning systems (TPSs) for partial breast irradiation using the MammoSite brachytherapy applicator (Cytyc Corporation, Marlborough, MA) often neglect the effect of inhomogeneity, leading to potential inaccuracies in dose distributions. Previous publications either have studied only a planar dose perturbation along the bisector of the source or have paid little attention to the anisotropy effect of the system. In the present study, we investigated the attenuation-corrected radial dose and anisotropy functions in a form parallel to the updated American Association of Physicists in Medicine TG-43 formalism. This work quantitatively delineates the inaccuracies in dose distributions in three-dimensional space. Monte Carlo N-particle transport code simulations in coupled photon-electron transport were used to quantify the changes in dose deposition and distribution caused by the increased attenuation coefficient of iodine-based contrast solution. The source geometry was that of the VariSource wire model VS2000 (Varian Medical Systems, Palo Alto, CA). The concentration of the iodine-based solution was varied from 5% to 25% by volume, a range recommended by the balloon's manufacturer. Balloon diameters of 4, 5, and 6 cm were simulated. Dose rates at the typical prescription line (1 cm away from the balloon surface) were determined for various polar angles. The computations showed that the dose rate reduction throughout the entire region of interest ranged from 0.64% for the smallest balloon diameter and contrast concentration to 6.17% for the largest balloon diameter and contrast concentration. The corrected radial dose function has a predominant influence on dose reduction, but the corrected anisotropy functions explain only the effect at the MammoSite system poles. By applying the corrected radial dose and anisotropy functions to TPSs, the attenuation effect can be reduced to the minimum.

A novel property of gold nanoparticles: Free radical generation under microwave irradiation.

PURPOSE: Gold nanoparticles (GNPs) are known to be effective mediators in microwave hyperthermia. Interaction with an electromagnetic field, large surface to volume ratio, and size quantization of nanoparticles (NPs) can lead to increased cell killing beyond pure heating effects. The purpose of this study is to explore the possibility of free radical generation by GNPs in aqueous media when they are exposed to a microwave field. METHODS: A number of samples with 500 mM 5,5-dimethyl-1-pyrroline N-oxide (DMPO) in 20 ppm GNP colloidal suspensions were scanned with an electron paramagnetic resonance (EPR)/electron spin resonance spectrometer to generate and detect free radicals. A fixed (9.68 GHz) frequency microwave from the spectrometer has served for both generation and detection of radicals. EPR spectra obtained as first derivatives of intensity with the spectrometer were double integrated to get the free radical signal intensities. Power dependence of radical intensity was studied by applying various levels of microwave power (12.5, 49.7, and 125 mW) while keeping all other scan parameters the same. Free radical signal intensities from initial and final scans, acquired at the same power levels, were compared. RESULTS: Hydroxyl radical (OH⋅) signal was found to be generated due to the exposure of GNP-DMPO colloidal samples to a microwave field. Intensity of OH⋅ signal thus generated at 12.5 mW microwave power for 2.8 min was close to the intensity of OH⋅ signal obtained from a water-DMPO sample exposed to 1.5 Gy ionizing radiation dose. For repeated scans, higher OH⋅ intensities were observed in the final scan for higher power levels applied between the initial and the final scans. Final intensities were higher also for a shorter time interval between the initial and the final scans. CONCLUSIONS: Our results observed for the first time demonstrate that GNPs generate OH⋅ radicals in aqueous media when they are exposed to a microwave field. If OH⋅ radicals can be generated close to deoxyribonucleic acid of cells by proper localization of NPs, NP-aided microwave hyperthermia can yield cell killing via both elevated temperature and free radical generation.

Use of novel thermobrachytherapy seeds for realistic prostate seed implant treatments.

PURPOSE: A practical means of delivering both therapeutic radiation and hyperthermia to a deep-seated target has been identified in the literature as highly desirable, provided it is capable of generating sufficient temperatures over the defined target volume. The authors present continued development of a dual-modality thermobrachytherapy (TB) seed, investigating its capabilities in delivering prescribed hyperthermia to realistic deep-seated targets. METHODS: The TB seed is based on the ubiquitous low dose-rate (LDR) brachytherapy permanent implant. Heat is generated by incorporating a ferromagnetic core within the seed and placing the patient in an oscillating external magnetic field, producing eddy currents within the core and hence Joule heating. A strategically selected Curie temperature results in thermal self-regulation. The magnetic and thermal properties of the TB seed were studied experimentally by means of seed prototypes placed in a tissue-mimicking phantom and heated with an industrial induction heater, as well as computationally in the finite element analysis solver COMSOL Multiphysics. Patient-specific seed distributions derived from LDR permanent prostate implants previously conducted at their institution were modeled in COMSOL to evaluate their ability to adequately cover a defined target volume and to overcome the loss of heat due to blood perfusion within tissue. The calculated temperature distributions were analyzed by generating temperature-volume histograms, which were used to quantify coverage and temperature homogeneity for varied blood perfusion rates, seed Curie temperatures, and thermal power production rates. Use of additional hyperthermia-only (HT-only) seeds in unused spots within the implantation needles was investigated, as was an increase in these seeds' core size to increase their power. The impact of the interseed attenuation and scatter (ISA) effect on radiation dose distributions of this seed was also quantified by Monte Carlo studies in the software package Monte Carlo N-Particle Version 5. RESULTS: Increasing the power production of the seeds, as well as increasing their Curie point, would increase the maximum blood perfusion rate that a given seed distribution could overcome to obtain an acceptable temperature distribution. However, this would also increase the maximum temperatures generated at the seed surfaces. Auxiliary HT-only seeds serve to improve the temperature uniformity within the target, as well as decrease the seed power generation requirements. Both an increase in their core size and an increase in both seed types' Curie temperatures enhance the resulting temperature coverage. The interseed and scatter effect caused by both the TB and HT-only seeds was found to reduce the dose to 90% of the target volume (D90) by a factor of 1.10 ± 0.02. CONCLUSIONS: A systematic approach of combining LDR prostate brachytherapy with hyperthermia is described, and its ability to provide sufficient and uniform temperature distributions in realistic patient-specific implants evaluated. A combination of TB and HT-only seeds may be used to produce a uniform temperature distribution in a defined target. Various modeled changes to their design, such as optimization of their Curie temperature, improve their ability to overcome the thermal effects of blood perfusion. The enhanced ISA of the TB and HT-only seeds must be taken into account for dose calculations, but is manageable.

AAPM Task Group 103 report on peer review in clinical radiation oncology physics.

This report provides guidelines for a peer review process between two clinical radiation oncology physicists. While the Task Group's work was primarily focused on ensuring timely and productive independent reviews for physicists in solo practice, these guidelines may also be appropriate for physicists in a group setting, particularly when dispersed over multiple separate clinic locations. To ensure that such reviews enable a collegial exchange of professional ideas and productive critique of the entire clinical physics program, the reviews should not be used as an employee evaluation instrument by the employer. Such use is neither intended nor supported by this Task Group. Detailed guidelines are presented on the minimum content of such reviews, as well as a recommended format for reporting the findings of a review. In consideration of the full schedules faced by most clinical physicists, the process outlined herein was designed to be completed in one working day.

Correction factor measurements for multiple detectors used in small field dosimetry on the Varian Edge radiosurgery system.

PURPOSE: Accurate dosimetry of small fields remains a challenge to the clinical physicist. Choosing the appropriate detector and determination of kQclin,Qmsr (fclin,fmsr) factors continue to be an area of active research. The purpose of this study is to evaluate the output factors for a dedicated stereotactic accelerator using multiple dosimeters designed for use in small fields and evaluate published kQclin,Qmsr (fclin,fmsr) factors relative to measured values using a commercial scintillating fiber. METHODS: Four microionization chambers, a commercial plastic scintillation detector, and a semiconducting diode were used to measure output factors for a linear accelerator. Field sizes ranging from 6 × 6 to 0.6 × 0.6 cm(2) were measured in a water phantom at 10 cm depth for 100 cm SSD. All microionization chambers were mounted in both vertical and horizontal configurations. Fields were normalized to the output at 5 × 5 cm(2). Output correction factors, kQclin,Qmsr (fclin,fmsr), were calculated as the ratio of a detector response relative to the scintillating fiber response for a given clinical field size, fclin. RESULTS: Ionization chambers consistently under-responded for small fields relative to the scintillating fiber. Variations in response between horizontal and vertical mounting were most notable for the microchambers, with the vertical mounting which reduced the magnitude of the necessary correction factor, kQclin,Qmsr (fclin,fmsr), for the microionization chambers ranging from 1.1 to 1.2 for the smallest field size at all energies. The semiconducting diode over-responded by 7% for the smallest field size across all energies, resulting in a kQclin,Qmsr (fclin,fmsr) of ∼ 0.93. CONCLUSIONS: The commercial scintillating fiber, which produces accurate and consistent ratios of dose to water for nonstandard fields, can be used to measure correction factors for various detectors used in a clinical setting. This can allow for comparison of measured correction factors to previously published values.

Technical Note: Influence of Compton currents on profile measurements in small-volume ion chambers.

PURPOSE: This work is to evaluate the effects of Compton current generation in three small-volume ionization chambers on measured beam characteristics for electron fields. METHODS: Beam scans were performed using Exradin A16, A26, and PTW 31014 microchambers. Scans with varying chamber components shielded were performed. Static point measurements, output factors, and cable only irradiations were performed to determine the contribution of Compton currents to various components of the chamber. Monte Carlo simulations were performed to evaluate why one microchamber showed a significant reduction in Compton current generation. RESULTS: Beam profiles demonstrated significant distortion for two of the three chambers when scanned parallel to the chamber axis, produced by electron deposition within the wire. Measurements of ionization produced within the cable identified Compton current generation as the cause of these distortions. The size of the central collecting wire was found to have the greatest influence on the magnitude of Compton current generation. CONCLUSIONS: Microchambers can demonstrate significant (>5%) deviations from properties as measured with larger volume chambers (0.125 cm(3) and above). These deviations can be substantially reduced by averaging measurements conducted at opposite polarities.