The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review.

BACKGROUND: Central nervous system (CNS) tumours account for around 25% of childhood neoplasms. With multi-modal therapy, 5-year survival is at around 75% in the UK. Conventional photon radiotherapy has made significant contributions to survival, but can be associated with long-term side effects. Proton beam radiotherapy (PBT) reduces the volume of irradiated tissue outside the tumour target volume which may potentially reduce toxicity. Our aim was to assess the effectiveness and safety of PBT and make recommendations for future research for this evolving treatment. METHODS: A systematic review assessing the effects of PBT for treating CNS tumours in children/young adults was undertaken using methods recommended by Cochrane and reported using PRISMA guidelines. Any study design was included where clinical and toxicity outcomes were reported. Searches were to May 2021, with a narrative synthesis employed. RESULTS: Thirty-one case series studies involving 1731 patients from 10 PBT centres were included. Eleven studies involved children with medulloblastoma / primitive neuroectodermal tumours (n = 712), five ependymoma (n = 398), four atypical teratoid/rhabdoid tumour (n = 72), six craniopharyngioma (n = 272), three low-grade gliomas (n = 233), one germ cell tumours (n = 22) and one pineoblastoma (n = 22). Clinical outcomes were the most frequently reported with overall survival values ranging from 100 to 28% depending on the tumour type. Endocrine outcomes were the most frequently reported toxicity outcomes with quality of life the least reported. CONCLUSIONS: This review highlights areas of uncertainty in this research area. A well-defined, well-funded research agenda is needed to best maximise the potential of PBT. SYSTEMATIC REVIEW REGISTRATION: PROSPERO-CRD42016036802.

Photon-beam-inducing synthesis of a tunable porous graphene/Ti3C2Txheterostructure for energy conversion-storage system.

Flexible electronic device requires a novel micro-supercapacitors (MSCs) energy conversion-storage system based on two-dimensional (2D) materials to solve the problems of stiffness and complexity. Herein, we report a novel catalytic introduction method of graphene with adjustable porosity by high-energy photon beam. The graphene/Ti3C2Txheterostructure was constructed by electrostatic self-assembly, has a high cycle life (98% after 8000 cycles), energy density (11.02 mWh cm-3), and demonstrate excellent flexible alternating current line-filtering performance. The phase angle of -79.8° at 120 Hz and a resistance-capacitance constant of 0.068 ms. Furthermore, the porous graphene/Ti3C2Txstructures produced by multiple catalytic inductions allowed ions to deeply penetrate the electrode, thereby increasing the stacking density. The special 'pore-layer nesting' graphene structure with adjustable pores effectively increased the specific surface area, and its superior matching with electrolyte solutions greatly improved surface-active site utilization. This work offers an alternative strategy for fabricating a 2D heterostructure for an MSC.

Characteristics of a plastic scintillation detector in photon beam dosimetry.

BACKGROUND: Plastic scintillating detectors (PSD) have gained popularity due to small size and are ideally suited in small-field dosimetry due to no correction needed and hence detector reading can be compared to dose. Likewise, these detectors are active and water equivalent. A new PSD from Blue Physics is characterized in photon beam. PURPOSE: Innovation in small-field dosimetry detector has led us to examine Blue Physics PSD (BP-PSD) for use in photon beams from linear accelerator. METHODS: BP-PSD was acquired and its characteristics were evaluated in photon beams from a Varian TrueBeam. Data were collected in a 3D water tank. Standard parameters; dose, dose rate, energy, angular dependence and temperature dependence were studied. Depth dose, profiles and output in a reference condition as well as small fields were measured. RESULTS: BP-PSD is versatile and provides data very similar to an ion chamber when Cerenkov radiation is properly accounted. This device measures data pulse by pulse which very few detectors can perform. The differences between ion chamber data and PSD are < 2% in most cases. The angular dependence is a bit pronounces to 1.5% which is due to PSD housing. Depth dose and profiles are comparable within < 1% to an ion chamber. For small fields this detector provides suitable field output factor compared to other detectors and Monte Carlo (MC) simulated data without any added correction factor. CONCLUSIONS: The characteristics of Blue Physics PSD is uniquely suitable in photon beam and more so in small fields. The data are reproducible compared to ion chamber for most parameters and ideally suitable for small-field dosimetry without any correction factor.

The investigation of dose rate and photon beam energy dependence of optimized PASSAG polymer gel dosimeter using magnetic resonance imaging.

OBJECTIVE: It seems that dose rate (DR) and photon beam energy (PBE) may influence the sensitivity and response of polymer gel dosimeters. In the current project, the sensitivity and response dependence of optimized PASSAG gel dosimeter (OPGD) on DR and PBE were assessed. MATERIALS AND METHODS: We fabricated the OPGD and the gel samples were irradiated with various DRs and PBEs. Then, the sensitivity and response (R2) of OPGD were obtained by MRI at various doses and post-irradiation times. RESULTS: Our analysis showed that the sensitivity and response of OPGD are not affected by the evaluated DRs and PBEs. It was also found that the dose resolution values of OPGD ranged from 9 to 33 cGy and 12 to 34 cGy for the evaluated DRs and PBEs, respectively. Additionally, the data demonstrated that the sensitivity and response dependence of OPGD on DR and PBE do not vary over various times after the irradiation. CONCLUSIONS: The findings of this research project revealed that the sensitivity and response dependence of OPGD are independent of DR and PBE.

Three-dimensional printers applied for the production of beam blocks in total body irradiation treatment.

PURPOSE: Total body irradiation (TBI) in extended source surface distance (SSD) is a common treatment technique before hematopoietic stem cell transplant. The lungs are organs at risk, which often are treated with a lower dose than the whole body. METHODS: This can be achieved by the application of blocks. Three-dimensional (3D) printers are a modern tool to be used in the production process of these blocks. RESULTS: We demonstrate the applicability of a specific printer and printing material, describe the process, and evaluate the accuracy of the product. CONCLUSION: The blocks and apertures were found to be applicable in clinical routine.

Stroke rate after external fractionated radiotherapy for benign meningioma.

PURPOSE: Patients with a benign meningioma often have a long survival following the treatment of their meningioma. Since radiotherapy is frequently part of the treatment, long-term side effects are of considerable concern. A controversial long-term side effect of radiotherapy is stroke. Due to its severity, it is important to know the frequency of this side effect. The aim of this study was to assess the stroke incidence and risk factors among patients receiving radiotherapy for their benign meningioma. METHODS: We performed a retrospective database study of patients who underwent primary or adjuvant radiotherapy for their benign meningioma at University Hospitals Leuven from January 2003 to December 2017. RESULTS: We included 169 patients with a median age of 51 years (range 22-84). Every patient received fractionated radiotherapy using photons with a median dose of 56 Gy (range 54-56) in fractions of 2 Gy (range 1.8-2). The median follow-up was 5.3 years (range 0.1-14). The cumulative stroke incidence function showed an incidence of 11.6% after 9 years of follow-up, translating to a stroke incidence per year of 1.29%. We found two significant risk factors for stroke: medically treated arterial hypertension (p = 0.005) and history of previous stroke or transient ischemic attack (p < 0.001). 5-year local control and overall survival rates were respectively 97.4% and 91.2%. Other late grade III/IV toxicities occurred in 16.0% (27/169) of patients. CONCLUSION: Our study shows a higher incidence of stroke in patients who received radiotherapy for their benign meningioma compared to the general population.

Radiosensitization effects by bismuth oxide nanorods of different sizes in megavoltage external beam radiotherapy.

BACKGROUND: Nanotechnology application has successfully reached numerous scientific breakthroughs including in radiotherapy. However, the clinical application of nanoparticles requires more diligent research primarily on the crucial parameters such as nanoparticle sizes. This study is aimed to investigate the influence of bismuth oxide nanorod (Bi2O3-NR) sizes on radiosensitization effects on MCF-7 and HeLa cell lines for megavoltage photon and electron beam radiotherapy. MATERIALS AND METHODS: MCF-7 and HeLa cells were treated with and without 0.5 µMol/L of Bi2O3-NR of varying sizes (60, 70, 80, and 90 nm). The samples, including the control groups, were exposed to different radiation doses (0-10 Gy), using photon (6 MV and 10 MV), and electron beam (6 MeV and 12 MeV) radiotherapy. Clonogenic assay was performed, and sensitization enhancement ratio (SER) was determined from linear quadratic based cell survival curves. RESULTS: The results depicted that 60 nm Bi2O3-NR yields the most excellent SER followed by 70 nm Bi2O3-NR. Meanwhile, the 80 and 90 nm Bi2O3-NR showed an insignificant difference between treated and untreated cell groups. This study also found that MCF-7 was subjected to more cell death compared to HeLa. CONCLUSION: 60 nm Bi2O3-NR was the optimal Bi2O3-NR size to induce radiosensitization effects for megavoltage external beam radiotherapy. The SER in photon beam radiotherapy marked the highest compared to electron beam radiotherapy due to decreased primary radiation energy from multiple radiation interaction and higher Compton scattering.

Radiobiological effects of the interruption time with Monte Carlo Simulation on multiple fields in photon beams.

PURPOSE: The interruption time is the irradiation interruption that occurs at sites and operations such as the gantry, collimator, couch rotation, and patient setup within the field in radiotherapy. However, the radiobiological effect of prolonging the treatment time by the interruption time for tumor cells is little evaluated. We investigated the effect of the interruption time on the radiobiological effectiveness with photon beams based on a modified microdosimetric kinetic (mMK) model. METHODS: The dose-mean lineal energy yD (keV/µm) of 6-MV photon beams was calculated by the particle and heavy ion transport system (PHITS). We set the absorbed dose to 2 or 8 Gy, and the interruption time (τ) was set to 1, 3, 5, 10, 30, and 60 min. The biological parameters such as α0, ß0, and DNA repair constant rate (a + c) values were acquired from a human non-small-cell lung cancer cell line (NCI-H460) for the mMK model. We used two-field and four-field irradiation with a constant dose rate (3 Gy/min); the photon beams were paused for interruption time τ. We calculated the relative biological effectiveness (RBE) to evaluate the interruption time's effect compared with no interrupted as a reference. RESULTS: The yD of 6-MV photon beams was 2.32 (keV/µm), and there was little effect by changing the water depth (standard deviation was 0.01). The RBE with four-field irradiation for 8 Gy was decreased to 0.997, 0.975, 0.900, and 0.836 τ = 1, 10, 30, 60 min, respectively. In addition, the RBE was affected by the repair constant rate (a + c) value, the greater the decrease in RBE with the longer the interruption time when the (a + c) value was large. CONCLUSION: The ~10-min interruption of 6-MV photon beams did not significantly impact the radiobiological effectiveness, since the RBE decrease was <3%. Nevertheless, the RBE's effect on tumor cells was decreased about 30% by increasing the 60 min interruption time at 8 Gy with four-field irradiation. It is thus necessary to make the interruption time as short as possible.

[Late complications following neo-/adjuvant radiotherapy and surgery for sarcomas of the extremities or pelvis/retroperitoneum : Preventative measures]. / Spätkomplikationen nach neo-/adjuvanter Strahlentherapie und Resektion von Sarkomen der Extremitäten oder des Beckens/Retroperitoneums : Ansätze zur Prävention.

Radiotherapy is one of the pillars in the multimodal therapy of sarcomas of the extremities or pelvis/retroperitoneum. It can be delivered prior to or following surgery. Novel radiation techniques, such as intensity-modulated radiotherapy using high-energy photons or protons, contribute to the reduction of acute and late toxicities. This review article summarizes these concepts.

Monte carlo model and output factors of elekta infinity™ 6 and 10 MV photon beam.

AIM: This study aimed to commission the Elekta Infinity™ working in 6 and 10 MV photon beam installed in Concord International Hospital, Singapore, and compare the OFs between MC simulation and measurement using PTW semiflex and microDiamond detector for small field sizes. MATERIAL AND METHODS: There are two main steps in this study: modelling of Linac 6 and 10 MV photon beam and analysis of the output factors for field size 2 × 2-10 × 10 cm2. The EGSnrc/BEAMnrc-DOSXYZnrc code was used to model and characterize the Linac and to calculate the dose distributions in a water phantom. The dose distribution and OFs were compared to the measurement data in the same condition. RESULTS: The commissioning process was only conducted for a 10 × 10 cm2 field size. The PDD obtained from MC simulation showed a good agreement with the measurement. The local dose difference of PDDs was less than 2% for 6 and 10 MV. The initial electron energy was 5.2 and 9.4 MeV for 6 and 10 MV photon beam, respectively. This Linac model can be used for dose calculation in other situations and different field sizes because this Linac has been commissioned and validated using Monte Carlo simulation. The 10 MV Linac produces higher electron contamination than that of 6 MV. CONCLUSIONS: The Linac model in this study was acceptable. The most important result in this work comes from OFs resulted from MC calculation. This value was more significant than the OFs from measurement using semiflex and microDiamond for all beam energy and field sizes because of the CPE phenomenon.

MCP-based detectors: calibration and first photon radiation measurements.

Detectors based on microchannel plates (MCPs) are used to detect radiation from free-electron lasers. Three MCP detectors have been developed by JINR for the European XFEL (SASE1, SASE2 and SASE3 lines). These detectors are designed to operate in a wide dynamic range from the level of spontaneous emission to the SASE saturation level (between a few nJ up to 25 mJ), in a wide wavelength range from 0.05 nm to 0.4 nm for SASE1 and SASE2, and from 0.4 nm to 4.43 nm for SASE3. The detectors measure photon pulse energies with an anode and a photodiode. The photon beam image is observed with an MCP imager with a phosphor screen. At present, the SASE1 and SASE3 MCP detectors are commissioned with XFEL beams. Calibration and first measurements of photon radiation in multibunch mode are performed with the SASE1 and SASE3 MCPs. The MCP detector for SASE2 and its electronics are installed in the XFEL tunnel, technically commissioned, and are now ready for acceptance tests with the X-ray beam.

Use of a commercial ion chamber detector array for the measurement of high spatial-resolution photon beam profiles.

Linear accelerator (linac) commissioning and quality assurance measurements are time-consuming tasks that often require a water tank scanning system to acquire profile scans for full characterization of dosimetric beam properties. To increase efficiency, a method is demonstrated to acquire variable resolution, photon beam profile data using a commercially available ion chamber array (0.5 cm detector spacing). Field sizes of 2 × 2, 5 × 5, 10 × 10, and 15 × 15 cm2 were acquired at depths in solid water of dmax , 5 cm, and 10 cm; additionally, beam profiles for field sizes of 25 × 25 and 40 × 40 cm2 were acquired at 5 cm depth in solid water at x-ray energies of 6 and 23 MV. 1D composite profiles were generated by combining discrete point measurements made at multiple couch positions. The 1D composite profile dataset was evaluated against a commissioning dataset acquired with a 3D water tank scan system utilizing (a) 0.125 cc ion chamber for 5 × 5, 10 × 10, 15 × 15, 25 × 25, and 40 × 40 field sizes and (b) a solid state detector for 2 × 2 cm2 field size. The two datasets were compared to the gamma criteria at 1%/1 mm and 2%/2 mm tolerance. Almost all pass rates exceeded 95% at 2%/2 mm except for the 6 MV 2 × 2 cm2 field size at dmax . Pass rates at 1%/1 mm ranged from 51% to 99%, with an average pass rate of 82%. A fourfold reduction in MU was achieved for scans larger than 15 × 15 cm2 using this method compared to the water tank scans. Further, dynamic wedge measurements acquired with the ion chamber array showed reasonable agreement with the treatment planning system. This method opens up new possibilities for rapid acquisition of variable resolution 2D-3D dosimetric data mitigating the need for acquiring all scan data with in-water measurements.

Application and advantages of monoenergetic reconstruction images for the reduction of metallic artifacts using dual-energy CT in knee and hip prostheses.

OBJECTIVE: The study aimed to assess image quality when using dual-energy CT (DECT) to reduce metal artifacts in subjects with knee and hip prostheses. METHODS: Twenty-two knee and 10 hip prostheses were examined in 31 patients using a DECT protocol (tube voltages 100 and 140 kVp). Monoenergetic reconstructions were extrapolated at 64, 69, 88, 105, 110, 120, 140, 170, and 190 kilo-electron volts (keV) and the optimal energy was manually selected. The B60-140 and Fast DE reconstructions were made by CT. The image quality and diagnostic value were subjectively and objectively determined. Double-blind qualitative assessment was performed by two radiologists using a Likert scale. For quantitative analysis, a circular region of interest (ROI) was placed by a third radiologist within the most evident streak artifacts on every image. Another ROI was placed in surrounding tissues without artifacts as a reference. RESULTS: The inter-reader agreement for the qualitative assessment was nearly 100%. The best overall image quality (37.8% rated "excellent") was the Fast DE Siemens reconstruction, followed by B60-140 and Opt KeV (20.5 and 10.2% rated excellent). On the other hand, DECT images at 64, 69 and 88 keV had the worse scores. The number of artifacts was significantly different between monoenergetic images. Nevertheless, because of the high number of pairwise comparisons, no differences were found in the post hoc analysis except for a trend toward statistical significance when comparing the 170 and 64 keV doses. CONCLUSIONS: DECT with specific post-processing may reduce metal artifacts and significantly enhance the image quality and diagnostic value when evaluating metallic implants.

Uncertainty in positioning ion chamber at reference depth for various water phantoms.

BACKGROUND: Uncertainty in the calibration of high-energy radiation sources is dependent on user and equipment type. AIM: We evaluated the uncertainty in the positioning of a cylindrical chamber at a reference depth for reference dosimetry of high-energy photon beams and the resulting uncertainty in the chamber readings for 6- and 10-MV photon beams. The aim was to investigate major contributions to the positioning uncertainty to reduce the uncertainty in calibration for external photon beam radiotherapy. MATERIALS AND METHODS: The following phantoms were used: DoseView 1D, WP1D, 1D SCANNER, and QWP-07 as one-dimensional (1D) phantoms for a vertical-beam geometry; GRI-7632 as a phantom for a fixed waterproofing sleeve; and PTW type 41023 and QWP-04 as 1D phantoms for a horizontal-beam geometry. The uncertainties were analyzed as per the Guide to the Expression of Uncertainty in Measurement. RESULTS: The positioning and resultant uncertainties in chamber readings ranged from 0.22 to 0.35 mm and 0.12-0.25%, respectively, among the phantoms (using a coverage factor k = 1 in both cases). The major contributions to positioning uncertainty are: definition of the origin for phantoms among users for the 1D phantoms for a vertical-beam geometry, water level adjustment among users for the phantom for a fixed waterproofing sleeve, phantom window deformation, and non-water material of the window for the 1D phantoms for a horizontal-beam geometry. CONCLUSION: The positioning and resultant uncertainties in chamber readings exhibited minor differences among the seven phantoms. The major components of these uncertainties differed among the phantom types investigated.

Comparison of the recommendations of the AAPM TG-51 and TG-51 addendum reference dosimetry protocols.

This work quantified differences between recommendations of the TG-51 and TG-51 addendum reference dosimetry protocols. Reference dosimetry was performed for flattened photon beams with nominal energies of 6, 10, 15, and 23 MV, as well as flattening-filter free (FFF) beam energies of 6 and 10 MV, following the recommendations of both the TG-51 and TG-51 addendum protocols using both a Farmer® ionization chamber and a scanning ionization chamber with calibration coefficients traceable to absorbed dose-to-water (Dw ) standards. Differences in Dw determined by the two protocols were 0.1%-0.3% for beam energies with a flattening filter, and up to 0.2% and 0.8% for FFF beams measured with the scanning and Farmer® ionization chambers, respectively, due to kQ determination, volume-averaging correction, and collimator jaw setting. Combined uncertainty was between 0.91% and 1.2% (k = 1), varying by protocol and detector.

Analysis and control of the photon beam position at PLS-II.

At third-generation light sources, the photon beam position stability is a critical issue for user experiments. In general, photon beam position monitors are developed to detect the real photon beam position, and the position is controlled by a feedback system in order to maintain the reference photon beam position. At Pohang Light Source II, a photon beam position stability of less than 1 µm r.m.s. was achieved for a user service period in the beamline, where the photon beam position monitor is installed. Nevertheless, a detailed analysis of the photon beam position data was necessary in order to ensure the performance of the photon beam position monitor, since it can suffer from various unknown types of noise, such as background contamination due to upstream or downstream dipole radiation, and undulator gap dependence. This paper reports the results of a start-to-end study of the photon beam position stability and a singular value decomposition analysis to confirm the reliability of the photon beam position data.

A surface energy spectral study on the bone heterogeneity and beam obliquity using the flattened and unflattened photon beams.

AIM: Using flattened and unflattened photon beams, this study investigated the spectral variations of surface photon energy and energy fluence in the bone heterogeneity and beam obliquity. BACKGROUND: Surface dose enhancement is a dosimetric concern when using unflattened photon beam in radiotherapy. It is because the unflattened photon beam contains more low-energy photons which are removed by the flattening filter of the flattened photon beam. MATERIALS AND METHODS: We used a water and bone heterogeneity phantom to study the distributions of energy, energy fluence and mean energy of the 6 MV flattened and unflattened photon beams (field size = 10 cm × 10 cm) produced by a Varian TrueBEAM linear accelerator. These elements were calculated at the phantom surfaces using Monte Carlo simulations. The photon energy and energy fluence calculations were repeated with the beam angle turned from 0° to 15°, 30° and 45° in the water and bone phantom. RESULTS: Spectral results at the phantom surfaces showed that the unflattened photon beams contained more photons concentrated mainly in the low-energy range (0-2 MeV) than the flattened beams associated with a flattening filter. With a bone layer of 1 cm under the phantom surface and within the build-up region of the 6 MV photon beam, it is found that both the flattened and unflattened beams had slightly less photons in the energy range <0.4 MeV compared to the water phantom. This shows that the presence of the bone decreased the low-energy photon backscatters to the phantom surface. When both the flattened and unflattened photon beams were rotated from 0° to 45°, the number of photon and mean photon energy increased. This indicates that both photon beams became more hardened or penetrate when the beam angle increased. In the presence of bone, the mean energies of both photon beams increased. This is due to the absorption of low-energy photons by the bone, resulting in more beam hardening. CONCLUSIONS: This study explores the spectral relationships of surface photon energy and energy fluence with bone heterogeneity and beam obliquity for the flattened and unflattened photon beams. The photon spectral information is important in studies on the patient's surface dose enhancement using unflattened photon beams in radiotherapy.

Upgrade of beamline BL08B at Taiwan Light Source from a photon-BPM to a double-grating SGM beamline.

During the last 20 years, beamline BL08B has been upgraded step by step from a photon beam-position monitor (BPM) to a testing beamline and a single-grating beamline that enables experiments to record X-ray photo-emission spectra (XPS) and X-ray absorption spectra (XAS) for research in solar physics, organic semiconductor materials and spinel oxides, with soft X-ray photon energies in the range 300-1000 eV. Demands for photon energy to extend to the extreme ultraviolet region for applications in nano-fabrication and topological thin films are increasing. The basic spherical-grating monochromator beamline was again upgraded by adding a second grating that delivers photons of energy from 80 to 420 eV. Four end-stations were designed for experiments with XPS, XAS, interstellar photoprocess systems (IPS) and extreme-ultraviolet lithography (EUVL) in the scheduled beam time. The data from these experiments show a large count rate in core levels probed and excellent statistics on background normalization in the L-edge adsorption spectrum.

An institutional experience of quality assurance of a treatment planning system on photon beam.

AIM: The purpose of the present study is to show the application of the IAEA TRS-430 QA procedures of Eclipse™v7.5 TPS for photon energies. In addition, the trends of the deviations found in the conducted tests were determined. BACKGROUND: In the past, the lack of complete TPS QA procedures led to some serious accidents. So, QA in the radiotherapy treatment planning process is essential for determination of accuracy in the radiotherapy process and avoidance of treatment errors. MATERIALS AND METHODS: The calculations of TPS and measurements of irradiations of the treatment device were compared in the study. As a result, the local dose deviation values (δ 1: central beam axis, δ 2: penumbra and build up region, δ 3: inside field, δ 4: outside beam edges, δ 50-90: beam fringe, RW50: radiological width) and their confidence limit values (including systematic and random errors) were obtained. RESULTS: The confidence limit values of δ 4 were detected to increase with expanding field size. The values of δ 1 and δ 3 of hard wedge were larger than open fields. The values of δ 2 and δ 50-90 of the inhomogeneity effect test were larger, especially than other tests of this study. The average deviation was showed to increase with the rise of the wedge angle. The values of δ 3 and δ 4 of lung irradiation were outside tolerance. CONCLUSIONS: The QA of TPS was done and it was found that there were no reservations in its use in patient treatment. The trend of the deviations is shown.