Imaging Role in Diagnosis, Prognosis, and Treatment Response Prediction Associated with High-grade Glioma.

Background: Glioma is one of the most drug and radiation-resistant tumors. Gliomas suffer from inter- and intratumor heterogeneity which makes the outcome of similar treatment protocols vary from patient to patient. This article is aimed to overview the potential imaging markers for individual diagnosis, prognosis, and treatment response prediction in malignant glioma. Furthermore, the correlation between imaging findings and biological and clinical information of glioma patients is reviewed. Materials and Methods: The search strategy in this study is to select related studies from scientific websites such as PubMed, Scopus, Google Scholar, and Web of Science published until 2022. It comprised a combination of keywords such as Biomarkers, Diagnosis, Prognosis, Imaging techniques, and malignant glioma, according to Medical Subject Headings. Results: Some imaging parameters that are effective in glioma management include: ADC, FA, Ktrans, regional cerebral blood volume (rCBV), cerebral blood flow (CBF), ve, Cho/NAA and lactate/lipid ratios, intratumoral uptake of 18F-FET (for diagnostic application), RD, ADC, ve, vp, Ktrans, CBFT1, rCBV, tumor blood flow, Cho/NAA, lactate/lipid, MI/Cho, uptakes of 18F-FET, 11C-MET, and 18F-FLT (for prognostic and predictive application). Cerebral blood volume and Ktrans are related to molecular markers such as vascular endothelial growth factor (VEGF). Preoperative ADCmin value of GBM tumors is associated with O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. 2-hydroxyglutarate metabolite and dynamic 18F-FDOPA positron emission tomography uptake are related to isocitrate dehydrogenase (IDH) mutations. Conclusion: Parameters including ADC, RD, FA, rCBV, Ktrans, vp, and uptake of 18F-FET are useful for diagnosis, prognosis, and treatment response prediction in glioma. A significant correlation between molecular markers such as VEGF, MGMT, and IDH mutations with some diffusion and perfusion imaging parameters has been identified.

Prospective Prediction of Treatment Response in High-Grade Glioma Patients using Pre-Treatment Tumor ADC Value and miR-222 and miR-205 Expression Levels in Plasma.

Background: Treatment response in High-grade Glioma (HGG) patients changes based on their genetic and biological characteristics. MiRNAs, as important regulators of drug and radiation resistance, and the Apparent Diffusion Coefficients (ADC) value of tumor can be used as a prognostic predictor for glioma. Objective: This study aimed to identify some of the pre-treatment individual patient features for predicting the treatment response in HGG patients. Material and Methods: In this prospective study, 18 HGG patients, who were candidated for chemo-radiation treatment, participated after informed consent of the patients. The investigated features were the expression level of miR-222 and miR-205 in plasma, the ADC value of tumor, Body Mass Index (BMI), and age. Treatment response was assessed, and Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to obtain a model to predict the treatment response. Mann-Whitney U test was also applied to select the variables with a significant relationship with patients' treatment response. Results: The LASSO coefficients for miR-205, miR-222, tumor's mean ADC value, BMI, and age were 3.611, -1.683, 2.468, -0.184, and -0.024, respectively. Mann-Whitney U test results showed miR-205 and tumor's mean ADC significantly related to treatment response (P-value<0.05). Conclusion: The miR-205 expression level of the patient in plasma and tumor's mean ADC value has the potential for prognostic predictors in HGG.

Dosiomics-based detection of dose distribution variations in helical tomotherapy for prostate cancer patients: influence of treatment plan parameters.

The stability of dosiomics features (DFs) and dose-volume histogram (DVH) parameters for detecting disparities in helical tomotherapy planned dose distributions was assessed. Treatment plans of 18 prostate patients were recalculated using the followings: field width (WF) (2.5 vs. 5), pitch factor (PF) (0.433 vs. 0.444), and modulation factor (MF) (2.5 vs. 3). From each of the eight plans per patient, ninety-three original and 744 wavelet-based DFs were extracted, using 3D-Slicer software, across six regions including: target volume (PTV), pelvic lymph nodes (PTV-LN), PTV + PTV-LN (PTV-All), one cm rind around PTV-All (PTV-Ring), rectum, and bladder. For the resulting DFs and DVH parameters, the coefficient of variation (CV) was calculated, and using hierarchical clustering, the features were classified into low/high variability. The significance of parameters on instability was analyzed by a three-way analysis of variance. All DF's were stable in PTV, PTV-LN, and PTV-Ring (average CV ( CV ¯ )  ≤ 0.36). Only one feature in the bladder ( CV ¯  = 0.9), rectum ( CV ¯  = 0.4), and PTV-All ( CV ¯  = 0.37) were considered unstable due to change in MF in the bladder and WF in the PTV-All. The value of CV ¯ for the wavelet features was much higher than that for the original features. Out of 225 unstable wavelet features, 84 features had CV ¯  ≥ 1. The CVs for all the DVHs remained very small ( CV ¯ < 0.06). This study highlights that the sensitivity of DFs to changes in tomotherapy planning parameters is influenced by the region and the DFs, particularly wavelet features, surpassing the effectiveness of DVHs.

Sensitivity Analysis of a 6 MeV Photon Beam Monte Carlo Model.

Background: This study aimed to optimize efficiency in Monte Carlo (MC) simulation using sensitivity analysis of a beam model. Methods: The BEAMnrc-based model of 6 MV beam of a Siemens Primus linac was developed. For sensitivity analysis, the effect of the electron source, treatment head, and virtual phantom specifications on calculated percent depth dose (PDD) and lateral dose profiles was evaluated. Results: The optimum mean energy (E) and the full width at half maximum (FWHM) of the intensity distribution of the electron beam were calculated as 6.7 MeV and 3 mm, respectively. Increasing E from 6.1 to 6.7 MeV, increased the PDD in the fall-off region by 4.70% and decreased the lateral profile by 8.76%. Changing the FWHM had a significant effect on the buildup region of PDD and the horns and out-of-field regions of the lateral profile. Increasing the collimators opening by 0.5 mm, PDD increased by 2.13% and the central and penumbra regions of profiles decreased by 1.98% and 11.40% respectively. Collimator properties such as thickness and density were effective in changing the penumbra (11.32% for 0.25 cm increment) and the out-of-field (22.82% for 3 g/cm3) regions of the lateral profiles. Conclusion: Analysis of a 6 MV model showed that PDD profiles were more sensitive to changes in energy than to FWHM of the electron source. The lateral profiles were sensitive to E, FWHM, and collimator opening. The density of the collimator affected only the out-of-field region of lateral profiles. The findings of this study may be used to make benchmarking of an MC beam model more efficient.

Prediction of Normal Tissue Complication Probability (NTCP) After Radiation Therapy Using Imaging and Molecular Biomarkers and Multivariate Modelling.

The aim of this study was to design a predictive radiobiological model of normal brain tissue in low-grade glioma following radiotherapy based on imaging and molecular biomarkers. Fifteen patients with primary brain tumors prospectively participated in this study and underwent radiation therapy. Magnetic resonance imaging (MRI) was obtained from the patients, including T1- and T2-weighted imaging and diffusion tensor imaging (DTI), and a generalized equivalent dose (gEUD) was calculated. The radiobiological model of the normal tissue complication probability (NTCP) was performed using the variables gEUD; axial diffusivity (AD) and radial diffusivity (RD) of the corpus callosum; and serum protein S100B by univariate and multivariate logistic regression XLIIIrd Sir Peter Freyer Memorial Lecture and Surgical Symposium (2018). Changes in AD, RD, and S100B from baseline up to the 6 months after treatment had an increasing trend and were significant in some time points (P-value < 0.05). The model resulting from RD changes in the 6 months after treatment was significantly more predictable of necrosis than other univariate models. The bivariate model combining RD changes in Gy40 dose-volume and gEUD, as well as the trivariate model obtained using gEUD, RD, and S100B, had a higher predictive value among multivariate models at the sixth month of the treatment. Changes in RD diffusion indices and in serum protein S100B value were used in the early-delayed stage as reliable biomarkers for predicting late-delayed damage (necrosis) caused by radiation in the corpus callosum. Current findings could pave the way for intervention therapies to delay the severity of damage to white matter structures, minimize cognitive impairment, and improve the quality of life of patients with low-grade glioma.

Early Detection of Radiation-Induced Injury and Prediction of Cognitive Deficit by MRS Metabolites in Radiotherapy of Low-Grade Glioma.

PURPOSE: To compare the sensitivity of MRS metabolites and MoCA and ACE-R cognitive tests in the detection of radiation-induced injury in low grade glioma (LGG) patients in early and early delayed postradiation stages. METHODS: MRS metabolite ratios of NAA/Cr and Cho/Cr, ACE-R and MoCA cognitive tests, and dosimetric parameters in corpus callosum were analyzed during RT and up to 6-month post-RT for ten LGG patients. RESULTS: Compared to pre RT baseline, a significant decline in both NAA/Cr and Cho/Cr in the corpus callosum was seen at the 4th week of RT, 1, 3, and 6-month post-RT. These declines were detected at least 3 months before the detection of declines in cognitive functions by ACE-R and MoCA tools. Moreover, NAA/Cr alterations at 4th week of RT and 1-month post-RT were significantly negatively correlated with the mean dose received by the corpus callosum, as well as the corpus callosum 40 Gy dose volume, i.e., the volume of the corpus callosum receiving a dose greater than 40 Gy. CONCLUSION: MRS-based biomarkers may be more sensitive than the state-of-the-art cognitive tests in the prediction of postradiation cognitive impairments. They would be utilized in treatment planning and dose sparing protocols, with a specific focus on the corpus callosum in the radiation therapy of LGG patients.

Improvement of metallic artifacts in computed tomography in the absence of artifact reduction algorithms for spinal treatment planning applications.

AIM OF STUDY: The goal of this research was to investigate if application of optimized imaging parameters, recommended in literature, would be effective in producing the image quality required for treatment planning of spinal radiation fields with metallic implants. MATERIALS AND METHODS: CT images from an anthropomorphic torso phantom with and without spinal implants were acquired using different imaging protocols: raising kVp and mAs, reducing the pitch and applying an extended CT scale (ECTS) technique. Profiles of CT number (CT#) were produced using DICOM data of each image. The effect of artifact on dose calculation accuracy was investigated using the image data in the absence of implant as a reference and the recommended electron density tolerance levels (Δρe). RESULTS: Raising the kVp was the only method that produced improvement to some degree in CT# in artifact regions. Application of ECTS improved CT# values only for metal. CONCLUSIONS: Although raising the kVp was effective in reducing metallic artifact, the significance of this effect on Δρe values in corrected images depends on the required tolerance for treatment planning dose calculation accuracy. ECTS method was only successful in correcting the CT number range in the metal. Although, application of ECTS method did not have any effect on artifact regions, its use is necessary in order to improve delineation of metal and accuracy of attenuation calculations in metal, provided that the treatment planning system can use an extended CT# calibration curve. Also, for Monte Carlo calculations using patient's images, ECTS-post-processed-CT images improve dose calculation accuracy for impure metals.

Determination of Gamma Camera's Calibration Factors for Quantitation of Diagnostic Radionuclides in Simultaneous Scattering and Attenuation Correction.

OBJECTIVE: The characterization of cancerous tissue and bone metastasis can be distinguished by accurate assessment of accumulated uptake and activity from different radioisotopes. The various parameters and phenomena such as calibration factor, Compton scattering, attenuation and penetration intrinsicallyinfluence calibration equation, and the qualification of images as well. METHODS: The camera calibration factor (CF) translates reconstructed count map into absolute activity map, which is determined by both planar and tomographic scans using different phantom geometries. In this study, the CF for radionuclides of Tc-99m and Sm-153 in soft tissue and bone was simulated by the Monte Carlo method, and experimental results were obtained in equivalent tissue and bone phantoms. It may be employed for the simultaneous correction of the scattering and attenuation rays interacted with the camera, leading to corrected counts. Also, the target depth (d) may be estimated by a combination of scattering and photoelectric functions, which we have published before. RESULTS: The calibrated equations for soft tissue phantom for the radionuclides were obtained by RTc = - 10d+ 300 and RSm = -8d + 100, and the relative errors between the simulated and experimental results were 4.5% and 3.1%, respectively. The equations for bone phantom were RTc = -30d + 300 and RSm = - 10d + 100, and the relative errors were 5.4% and 5.6%. The R and d are in terms of cpm/mCi and cm. Besides, the collimators' impact was evaluated on the camera response, and the relevant equations were obtained by the Monte Carlo method. The calibrated equations as a function of various radiation angles on the center of camera's cells without using collimator indicated that both sources have the same quadratic coefficient by -2E-08 and same vertical width from the origin by 8E-05. CONCLUSION: The presented procedure may help determine the absorbed dose in the target and likewise optimize treatment planning.

A protocol for irradiation of cell lines cultured in multi-well plates: effect of air inhomogeneity on irradiated cell survival.

Introduction: In multi-well cell culture plates, wells are bordered by air cavities. The air cavity inhomogeneities can reduce the amount of delivered dose. In this study, the effect of these cavities on cell survival was investigated.Materials and methods: A special phantom was designed to house the plates and air cavities were filled by water equivalent materials. Cultured melanoma cells were irradiated using 6MV photon for 200 cGy. MTT and clonogenic assay tests were used to evaluate cell survival.Results: Results of MTT assay showed mean survival percentage for irradiated cells in the first group, i.e. plates with air cavities, was 18.9% higher than the second group with air cavities filled with paraffin. Clonogenic assay results showed a maximum of 37% difference in the mean of number of colonies between the first group and the second group (p value < .05).Conclusions: The presence of air cavities in multi-well cell culture plates reduced radiation cell kill by up to 37%. To ensure the accuracy of delivered dose, it is necessary to replace the air cavities as well as the air surrounding the plates by a water equivalent material.

Measurement of photoneutron dose produced by wedge filters of a high energy linac using polycarbonate films.

Radiotherapy represents the most widely spread technique to control and treat cancer. To increase the treatment efficiency, high energy linacs are used. However, applying high energy photon beams leads to a non-negligible dose of neutrons contaminating therapeutic beams. In addition, using conventional linacs necessitates applying wedge filters in some clinical conditions. However, there is not enough information on the effect of these filters on the photoneutrons produced. The aim of this study was to investigate the change of photoneutron dose equivalent due to the use of linac wedge filters. A high energy (18 MV) linear accelerator (Elekta SL 75/25) was studied. Polycarbonate films were used to measure the dose equivalent of photoneutrons. After electrochemical etching of the films, the neutron dose equivalent was calculated using Hp(10) factor, and its variation on the patient plane at 0, 5, 10, 50 and 100 cm from the center of the X-ray beam was determined. By increasing the distance from the center of the X-ray beam towards the periphery, the photoneutron dose equivalent decreased rapidly for the open and wedged fields. Increasing of the field size increased the photoneutron dose equivalent. The use of wedge filter increased the proportion of the neutron dose equivalent. The increase can be accounted for by the selective absorption of the high energy photons by the wedge filter.

The effect of field modifier blocks on the fast photoneutron dose equivalent from two high-energy medical linear accelerators.

High-energy linear accelerators (linacs) have several advantages, including low skin doses and high dose rates at deep-seated tumours. But, at energies more than 8 MeV, photonuclear reactions produce neutron contamination around the therapeutic beam, which may induce secondary malignancies. In spite of improvements achieved in medical linac designs, many countries still use conventional (non-intensity-modulated radiotherapy) linacs. Hence, in these conventional machines, fitting the beam over the treatment volume may require using blocks. Therefore, the effect of these devices on neutron production of linacs needs to be studied. The aim of this study was to investigate the effect of field shaping blocks on photoneutron dose in the treatment plane for two high-energy medical linacs. Two medical linacs, a Saturn 43 (25 MeV) and an Elekta SL 75/25 (18 MeV), were studied. Polycarbonate (PC) films were used to measure the fluence of photoneutrons produced by these linacs. After electrochemical etching of the PC films, the neutron dose equivalent was calculated at the isocentre and 50 cm away from the isocentre. It was noted that by increasing the distance from the centre of the X-ray beam towards the periphery, the photoneutron dose equivalent decreases rapidly for both the open and blocked fields. Increasing the energy of the photons causes an increase in the amount of photoneutron dose equivalent. At 25 MeV photon energy, the lead blocks cause a meaningful increase in the dose equivalent of photoneutrons. In this research, a 30% increase was seen in neutron dose contribution to central axis dose at the isocentre of a 25 MeV irregular field shaped by lead blocks. It is concluded that lead blocks must be considered as a source of photoneutron production when treating irregular fields with high-energy photons.

Evaluation of the photon dose calculation accuracy in radiation therapy of malignant pleural mesothelioma.

BACKGROUND: Photon dose distribution of malignant pleural mesothelioma (MPM) in matched photon-electron technique is influenced by media inhomogeneity, lateral electronic disequilibrium at interfaces and narrow field. These may influence the dose calculation accuracy, calculated by treatment planning systems (TPS). This study aimed to evaluate the dose calculation accuracy of TiGRT TPS in radiation therapy of MPM. MATERIALS AND METHODS: 18 MV photon beams of ONCOR Siemens linear accelerator was simulated using EGSnrc Monte Carlo (MC) code. Data of four patients were used to compare TPS and MC results in different regions included: Open and in-field, under shied and out of field regions. RESULTS: Compared to MC results, the TPS overestimated the pleura dose coverage (90% of prescribed dose) about 3-12 mm, and also it overestimated the dose in under the shielded regions of lung (4-74%). While the TPS underestimated the dose profile width about 1-16 mm in low dose region (<50% prescribed dose) as well as the out of field region dose (4-100%). CONCLUSIONS: Results showed that TPS underestimated the dose in out of field and overestimated the dose in under the shielded regions. Unlike MC measurements, TPS calculation showed adequate pleural dose coverage. Based on the results, MC calculation can be used in matched photon-electron beam radiation therapy of MPM to modify the TPS photon dose calculations in the presence of heterogeneity, interfaces, and shield in MPM radiotherapy.

Evaluation of the Effects of Prostate Radiation Therapy on Occludin Expression and Ultrasonography Characteristics of the Bladder.

PURPOSE: To evaluate the effects of radiation dose in prostate radiation therapy (RT) on occludin expression and ultrasonography characteristics of the bladder. METHODS AND MATERIALS: Urine samples of 64 prostate RT patients were collected before, at regular intervals during, and 3 months after RT. Occludin expression analysis was performed, and bladder wall echogenicity and echotexture were investigated by ultrasound and the gray-scale histogram analysis method. The bladder equivalent uniform dose (EUD) was derived from individually produced dose treatment plan for each patient. Clinical scoring for bladder-specific symptoms was done using the Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Criteria Scale. RESULTS: Thirty patients (47%) experienced at least 1 of the studied bladder symptoms (grade ≥1 endpoints), including urinary pain, frequency, urgency, straining, incontinence, hematuria, dysuria, and nocturia. For these patients there were significant changes in urine occludin levels after starting the treatment compared with the baseline urine samples (P=.023). The mean bladder EUD that caused a significant change in occludin level, which occurred after the 15th RT session, was 26.9 Gy (range, 13.2-36.5 Gy, P=.020). In all patients a significant reduction in bladder echogenicity (P=.0137) and a significant change in its echotexture (P=.047) was found after the 10th RT session, after which the EUD to the bladder reached 17.9 Gy (range, 8.8-24.3 Gy). CONCLUSIONS: Significant changes in occludin expression level and bladder wall echogenicity and echotexture occurred during prostate RT. Our findings suggest that a significant reduction in bladder echogenicity and increase in occludin expression during treatment can be associated with acute urinary complications.

First macro Monte Carlo based commercial dose calculation module for electron beam treatment planning--new issues for clinical consideration.

The purpose of this study is to present our experience of commissioning, testing and use of the first commercial macro Monte Carlo based dose calculation algorithm for electron beam treatment planning and to investigate new issues regarding dose reporting (dose-to-water versus dose-to-medium) as well as statistical uncertainties for the calculations arising when Monte Carlo based systems are used in patient dose calculations. All phantoms studied were obtained by CT scan. The calculated dose distributions and monitor units were validated against measurements with film and ionization chambers in phantoms containing two-dimensional (2D) and three-dimensional (3D) type low- and high-density inhomogeneities at different source-to-surface distances. Beam energies ranged from 6 to 18 MeV. New required experimental input data for commissioning are presented. The result of validation shows an excellent agreement between calculated and measured dose distributions. The calculated monitor units were within 2% of measured values except in the case of a 6 MeV beam and small cutout fields at extended SSDs (>110 cm). The investigation on the new issue of dose reporting demonstrates the differences up to 4% for lung and 12% for bone when 'dose-to-medium' is calculated and reported instead of 'dose-to-water' as done in a conventional system. The accuracy of the Monte Carlo calculation is shown to be clinically acceptable even for very complex 3D-type inhomogeneities. As Monte Carlo based treatment planning systems begin to enter clinical practice, new issues, such as dose reporting and statistical variations, may be clinically significant. Therefore it is imperative that a consistent approach to dose reporting is used.

Assessment of a 2D electronic portal imaging devices-based dosimetry algorithm for pretreatment and in-vivo midplane dose verification.

BACKGROUND: The use of electronic portal imaging devices (EPIDs) is a method for the dosimetric verification of radiotherapy plans, both pretreatment and in vivo. The aim of this study is to test a 2D EPID-based dosimetry algorithm for dose verification of some plans inside a homogenous and anthropomorphic phantom and in vivo as well. MATERIALS AND METHODS: Dose distributions were reconstructed from EPID images using a 2D EPID dosimetry algorithm inside a homogenous slab phantom for a simple 10 × 10 cm2 box technique, 3D conformal (prostate, head-and-neck, and lung), and intensity-modulated radiation therapy (IMRT) prostate plans inside an anthropomorphic (Alderson) phantom and in the patients (one fraction in vivo) for 3D conformal plans (prostate, head-and-neck and lung). RESULTS: The planned and EPID dose difference at the isocenter, on an average, was 1.7% for pretreatment verification and less than 3% for all in vivo plans, except for head-and-neck, which was 3.6%. The mean γ values for a seven-field prostate IMRT plan delivered to the Alderson phantom varied from 0.28 to 0.65. For 3D conformal plans applied for the Alderson phantom, all γ1% values were within the tolerance level for all plans and in both anteroposterior and posteroanterior (AP-PA) beams. CONCLUSION: The 2D EPID-based dosimetry algorithm provides an accurate method to verify the dose of a simple 10 × 10 cm2 field, in two dimensions, inside a homogenous slab phantom and an IMRT prostate plan, as well as in 3D conformal plans (prostate, head-and-neck, and lung plans) applied using an anthropomorphic phantom and in vivo. However, further investigation to improve the 2D EPID dosimetry algorithm for a head-and-neck case, is necessary.

Effect of Temporal Pattern of Radiation in Intensity Modulated Radiotherapy on Cell Cycle Progression and Apoptosis of ACHN Renal Cell Carcinoma Cell Line.

BACKGROUND AND OBJECTIVE: The existence of a hypersensitive radiation response to doses below 1 Gy is well established for many normal and tumor cell lines. The aim of this study was to ascertain the impact of temporal pattern modeling IMRT on survival, cell cycle and apoptosis of human RCC cell line ACHN, so as to provide radiobiological basis for optimizing IMRT plans for this disease. MATERIALS AND METHODS: The ACHN renal cell carcinoma cell line was used in this study. Impact of the triangle, V, small-large or large-small temporal patterns in the presence and absence of threshold dose of hyper-radiosensitivity at the beginning of patterns were studied using soft agarclonogenic assays. Cell cycle and apoptosis analysis were performed after irradiation with the temporal patterns. RESULTS: For triangle and small-large dose sequences, survival fraction was significantly reduced after irradiation with or without threshold dose of hyper-radiosensitivity at the beginning of the patterns. In all of the dose patterns, cell cycle distributions and the percentage of apoptotic cells at 24 h after irradiation with or without priming dose of hyper-radiosensitivity showed no significant difference. However, apoptotic cells were increased when beams with the smallest dose applied at the beginning of dose pattern like triangle and small-large dose sequence. CONCLUSION: These data show that the biologic effects of single fraction may differ in clinical settings depending on the size and sequence of the partial fractions. Doses at the beginning but not at the end of sequences may change cytotoxicity effects of radiation.

Evaluation of various energy windows at different radionuclides for scatter and attenuation correction in nuclear medicine.

OBJECTIVE: Improving signal to noise ratio (SNR) and qualified images by the various methods is very important for detecting the abnormalities at the body organs. Scatter and attenuation of photons by the organs lead to errors in radiopharmaceutical estimation as well as degradation of images. The choice of suitable energy window and the radionuclide have a key role in nuclear medicine which appearing the lowest scatter fraction as well as having a nearly constant linear attenuation coefficient as a function of phantom thickness. METHODS: The energy windows of symmetrical window (SW), asymmetric window (ASW), high window (WH) and low window (WL) using Tc-99m and Sm-153 radionuclide with solid water slab phantom (RW3) and Teflon bone phantoms have been compared, and Matlab software and Monte Carlo N-Particle (MCNP4C) code were modified to simulate these methods and obtaining the amounts of FWHM and full width at tenth maximum (FWTM) using line spread functions (LSFs). The experimental data were obtained from the Orbiter Scintron gamma camera. RESULTS: Based on the results of the simulation as well as experimental work, the performance of WH and ASW display of the results, lowest scatter fraction as well as constant linear attenuation coefficient as a function of phantom thickness. WH and ASW were optimal windows in nuclear medicine imaging for Tc-99m in RW3 phantom and Sm-153 in Teflon bone phantom. Attenuation correction was done for WH and ASW optimal windows and for these radionuclides using filtered back projection algorithm. Results of simulation and experimental show that very good agreement between the set of experimental with simulation as well as theoretical values with simulation data were obtained which was nominally less than 7.07 % for Tc-99m and less than 8.00 % for Sm-153. Corrected counts were not affected by the thickness of scattering material. The Simulated results of Line Spread Function (LSF) for Sm-153 and Tc-99m in phantom based on four windows and TEW method were indicated that the FWHM and FWTM values were approximately the same in TEW method and WH and ASW, but the sensitivity at the optimal window was more than that of the other one. CONCLUSIONS: The suitable determination of energy window width on the energy spectra can be useful in optimal design to improve efficiency and contrast. It is found that the WH is preferred to the ASW and the ASW is preferred to the SW.

Monte Carlo Study of Fetal Dosimetry Parameters for 6 MV Photon Beam.

Because of the adverse effects of ionizing radiation on fetuses, prior to radiotherapy of pregnant patients, fetal dose should be estimated. Fetal dose has been studied by several authors in different depths in phantoms with various abdomen thicknesses (ATs). In this study, the effect of maternal AT and depth in fetal dosimetry was investigated, using peripheral dose (PD) distribution evaluations. A BEAMnrc model of Oncor linac using out of beam components was used for dose calculations in out of field border. A 6 MV photon beam was used to irradiate a chest phantom. Measurements were done using EBT2 radiochromic film in a RW3 phantom as abdomen. The followings were measured for different ATs: Depth PD profiles at two distances from the field's edge, and in-plane PD profiles at two depths. The results of this study show that PD is depth dependent near the field's edge. The increase in AT does not change PD depth of maximum and its distribution as a function of distance from the field's edge. It is concluded that estimating the maximum fetal dose, using a flat phantom, i.e., without taking into account the AT, is possible. Furthermore, an in-plane profile measured at any depth can represent the dose variation as a function of distance. However, in order to estimate the maximum PD the depth of D max in out of field should be used for in-plane profile measurement.

A novel approach in electron beam radiation therapy of lips carcinoma: a Monte Carlo study.

PURPOSE: Squamous cell carcinoma (SCC) is commonly treated by electron beam radiotherapy (EBRT) followed by a boost via brachytherapy. Considering the limitations associated with brachytherapy, in this study, a novel boosting technique in EBRT of lip carcinoma using an internal shield as an internal dose enhancer tool (IDET) was evaluated. An IDET is referred to a partially covered internal shield located behind the lip. It was intended to show that while the backscattered electrons are absorbed in the portion covered with a low atomic number material, they will enhance the target dose in the uncovered area. METHODS: Monte-Carlo models of 6 and 8 MeV electron beams were developed using BEAMnrc code and were validated against experimental measurements. Using the developed models, dose distributions in a lip phantom were calculated and the effect of an IDET on target dose enhancement was evaluated. Typical lip thicknesses of 1.5 and 2.0 cm were considered. A 5 × 5 cm(2) of lead covered by 0.5 cm of polystyrene was used as an internal shield, while a 4 × 4 cm(2) uncovered area of the shield was used as the dose enhancer. RESULTS: Using the IDET, the maximum dose enhancement as a percentage of dose at dmax of the unshielded field was 157.6% and 136.1% for 6 and 8 MeV beams, respectively. The best outcome was achieved for lip thickness of 1.5 cm and target thickness of less than 0.8 cm. For lateral dose coverage of planning target volume, the 80% isodose curve at the lip-IDET interface showed a 1.2 cm expansion, compared to the unshielded field. CONCLUSIONS: This study showed that a boost concomitant EBRT of lip is possible by modifying an internal shield into an IDET. This boosting method is especially applicable to cases in which brachytherapy faces limitations, such as small thicknesses of lips and targets located at the buccal surface of the lip.

Monte Carlo and experimental characterization of the first AMIRS 103Pd brachytherapy source.

TG-43U1 dosimetric parameters of a new brachytherapy (103)Pd source, including dose-rate constant, radial dose function, 2D anisotropy function, 1D anisotropy function and anisotropy constant, have been determined using MCNP4C code and have been verified by measurements in Perspex phantoms, using TLD-100 dosimeters calibrated in (60)Co radiation field. The comparison of calculated and measured dosimetric parameters showed the validity of Monte Carlo calculations and experimental results. The anisotropy constant was calculated as 0.87 in water and 0.88 in Perspex; and measured as 0.92 in Perspex. Comparing dosimetric parameters of the new source with other source models showed acceptable agreement.