Multi-scaled Monte Carlo calculation for radon-induced cellular damage in the bronchial airway epithelium.

Radon is a leading cause of lung cancer in indoor public and mining workers. Inhaled radon progeny releases alpha particles, which can damage cells in the airway epithelium. The extent and complexity of cellular damage vary depending on the alpha particle's kinetic energy and cell characteristics. We developed a framework to quantitate the cellular damage on the nanometer and micrometer scales at different intensities of exposure to radon progenies Po-218 and Po-214. Energy depositions along the tracks of alpha particles that were slowing down were simulated on a nanometer scale using the Monte Carlo code Geant4-DNA. The nano-scaled track histories in a 5 µm radius and 1 µm-thick cylindrical volume were integrated into the tracking scheme of alpha trajectories in a micron-scale bronchial epithelium segment in the user-written SNU-CDS program. Damage distribution in cellular DNA was estimated for six cell types in the epithelium. Deep-sited cell nuclei in the epithelium would have less chance of being hit, but DNA damage from a single hit would be more serious, because low-energy alpha particles of high LET would hit the nuclei. The greater damage in deep-sited nuclei was due to the 7.69 MeV alpha particles emitted from Po-214. From daily work under 1 WL of radon concentration, basal cells would respond with the highest portion of complex DSBs among the suspected progenitor cells in the most exposed regions of the lung epithelium.

Automated Instead of Manual Treatment Planning? A Plan Comparison Based on Dose-Volume Statistics and Clinical Preference.

PURPOSE: Automated planning aims to speed up treatment planning and improve plan quality. We compared manual planning with automated planning for lung stereotactic body radiation therapy based on dose-volume histogram statistics and clinical preference. METHODS AND MATERIALS: Manual and automated intensity modulated radiation therapy plans were generated for 56 patients by use of software developed in-house and Pinnacle 9.10 Auto-Planning, respectively. Optimization times were measured in 10 patients, and the impact of the automated plan (AP) on the total treatment cost was estimated. For the remaining 46 patients, each plan was checked against our clinical objectives, and a pair-wise dose-volume histogram comparison was performed. Three experienced radiation oncologists evaluated each plan and indicated their preference. RESULTS: APs reduced the average optimization time by 77.3% but only affected the total treatment cost by 3.6%. Three APs and 0 manual plans failed our clinical objectives, and 13 APs and 9 manual plans showed a minor deviation. APs significantly reduced D2% (2% of the volume receives a dose of at least D2%) for the spinal cord, esophagus, heart, aorta, and main stem bronchus (P < .05) while preserving target coverage. The radiation oncologists found >75% of the APs clinically acceptable without any further fine-tuning. CONCLUSIONS: APs may help to create satisfactory treatment plans quickly and effectively. Because critical appraisal by qualified professionals remains necessary, there is no such thing as "fully automated" planning yet.

Establishment of detailed respiratory tract model and Monte Carlo simulation of radon progeny caused dose.

As radon is one of the most important natural radiation sources, its radiation hazard has always been a concern. α and ß particles emitted by short-lived radioactive radon progeny nuclides could result in a high local dose and induce radiation damage to the respiratory tract. A detailed respiratory tract model needs to be built and dose distribution in the respiratory tract should be studied to reflect the characteristics of energy deposition caused by radon and its progeny. Therefore, in the present work, a dosimetric study was conducted on the respiratory tract and non-uniform dose distribution in the bronchial region was studied. First, a detailed voxel respiratory tract model was established based on the anatomic bronchial parameters of an adult Chinese male. The dimensional parameters of the tracheo-bronchial tree of an adult male adopted in ICRP Publication 66 (ICRP 1994 Human Respiratory Tract Model for Radiological Protection ICRP Publication 66 (Oxford: Pergamon)), featured by consecutive 16 generations of bronchi structures to express the irregular structure of the respiratory tract and the radiosensitive tissues in the bronchial region, were also built for dosimetric study. Then the deposition and clearance models recommended by ICRP were used to analyse the regional deposition and transfer in the respiratory tract, and a fluid dynamic simulation was used to obtain 3D distribution of radon progeny aerosol particles in the bronchial region. The result showed that the highest deposition fraction density occurs at the first and second generations of bronchi. Furthermore, the detailed voxel respiratory tract model along with the Monte Carlo method were used to obtain dose distribution in the BB region. It was found that the dose distribution in the respiratory tract is very non-uniform and the maximum voxel dose is about 30 times higher than the average voxel dose. The dose conversion factor (DCF) for lung in the home environment derived with the dosimetry method in the present work is 9.86 mSv·WLM-1. Sensitivity analysis was performed for the parameters involved in the DCF calculation and it was found that the unattached fraction and breathing rate influence the DCF the most.

Normal Tissue Complication Probability Modeling of Pulmonary Toxicity After Stereotactic and Hypofractionated Radiation Therapy for Central Lung Tumors.

PURPOSE: To evaluate clinical pulmonary and radiographic bronchial toxicity after stereotactic ablative radiation therapy and hypofractionated radiation therapy for central lung tumors, and perform normal tissue complication probability modeling and multivariable analyses to identify predictors for toxicity. METHODS AND MATERIALS: A pooled analysis was performed of patients with a central lung tumor treated using ≤12 fractions at 2 centers between 2006 and 2015. Airways were manually contoured on planning computed tomography scans, and doses were recalculated to an equivalent dose of 2 Gy per fraction with an α/ß ratio of 3. Grade ≥3 (≥G3) clinical pulmonary toxicity was evaluated by 2 or more physicians. Radiographic toxicity was defined as a stenosis or an occlusion with or without atelectasis using follow-up computed tomography scans. Logistic regression analyses were used for statistical analyses. RESULTS: A total of 585 bronchial structures were studied in 195 patients who were mainly treated using 5 or 8 fractions (60%). Median patient survival was 27.9 months (95% confidence interval 22.3-33.6 months). Clinical ≥G3 toxicity was observed in 24 patients (12%) and radiographic bronchial toxicity in 55 patients (28%), both mainly manifesting ≤12 months after treatment. All analyzed dosimetric parameters correlated with clinical and lobar bronchial radiographic toxicity, with V130Gy,EQD having the highest odds ratio. Normal tissue complication probability modeling showed a volume dependency for the development of both clinical and radiographic toxicity. On multivariate analyses, significant predictors for ≥G3 toxicity were a planning target volume overlapping the trachea or main stem bronchus (P = .005), chronic obstructive pulmonary disease (P = .034), and the total V130Gy,EQD (P = .012). Radiographic bronchial toxicity did not significantly correlate with clinical toxicity (P = .663). CONCLUSIONS: We identified patient and dosimetric factors associated with clinical and radiographic toxicity after high-dose radiation therapy for central lung tumors. Additional data from prospective studies are needed to validate these findings.

Dosimetric impact of an air passage on intraluminal brachytherapy for bronchus cancer.

The brachytherapy dose calculations used in treatment planning systems (TPSs) have conventionally been performed assuming homogeneous water. Using measurements and a Monte Carlo simulation, we evaluated the dosimetric impact of an air passage on brachytherapy for bronchus cancer. To obtain the geometrical characteristics of an air passage, we analyzed the anatomical information from CT images of patients who underwent intraluminal brachytherapy using a high-dose-rate 192Ir source (MicroSelectron V2r®, Nucletron). Using an ionization chamber, we developed a measurement system capable of measuring the peripheral dose with or without an air cavity surrounding the catheter. Air cavities of five different radii (0.3, 0.5, 0.75, 1.25 and 1.5 cm) were modeled by cylindrical tubes surrounding the catheter. A Monte Carlo code (GEANT4) was also used to evaluate the dosimetric impact of the air cavity. Compared with dose calculations in homogeneous water, the measurements and GEANT4 indicated a maximum overdose of 5-8% near the surface of the air cavity (with the maximum radius of 1.5 cm). Conversely, they indicated a minimum overdose of ~1% in the region 3-5 cm from the cavity surface for the smallest radius of 0.3 cm. The dosimetric impact depended on the size and the distance of the air passage, as well as the length of the treatment region. Based on dose calculations in water, the TPS for intraluminal brachytherapy for bronchus cancer had an unexpected overdose of 3-5% for a mean radius of 0.75 cm. This study indicates the need for improvement in dose calculation accuracy with respect to intraluminal brachytherapy for bronchus cancer.

Radon induced hyperplasia: effective adaptation reducing the local doses in the bronchial epithelium.

There is experimental and histological evidence that chronic irritation and cell death may cause hyperplasia in the exposed tissue. As the heterogeneous deposition of inhaled radon progeny results in high local doses at the peak of the bronchial bifurcations, it was proposed earlier that hyperplasia occurs in these deposition hot spots upon chronic radon exposure. The objective of the present study is to quantify how the induction of basal cell hyperplasia modulates the microdosimetric consequences of a given radon exposure. For this purpose, computational epithelium models were constructed with spherical cell nuclei of six different cell types based on histological data. Basal cell hyperplasia was modelled by epithelium models with additional basal cells and increased epithelium thickness. Microdosimetry for alpha-particles was performed by an own-developed Monte-Carlo code. Results show that the average tissue dose, and the average hit number and dose of basal cells decrease by the increase of the measure of hyperplasia. Hit and dose distribution reveal that the induction of hyperplasia may result in a basal cell pool which is shielded from alpha-radiation. It highlights that the exposure history affects the microdosimetric consequences of a present exposure, while the biological and health effects may also depend on previous exposures. The induction of hyperplasia can be considered as a radioadaptive response at the tissue level. Such an adaptation of the tissue challenges the validity of the application of the dose and dose rate effectiveness factor from a mechanistic point of view. As the location of radiosensitive target cells may change due to previous exposures, dosimetry models considering the tissue geometry characteristic of normal conditions may be inappropriate for dose estimation in case of protracted exposures. As internal exposures are frequently chronic, such changes in tissue geometry may be highly relevant for other incorporated radionuclides.

Stochastic rat lung dosimetry for inhaled radon progeny: a surrogate for the human lung for lung cancer risk assessment.

Laboratory rats are frequently used in inhalation studies as a surrogate for human exposures. The objective of the present study was therefore to develop a stochastic dosimetry model for inhaled radon progeny in the rat lung, to predict bronchial dose distributions and to compare them with corresponding dose distributions in the human lung. The most significant difference between human and rat lungs is the branching structure of the bronchial tree, which is relatively symmetric in the human lung, but monopodial in the rat lung. Radon progeny aerosol characteristics used in the present study encompass conditions typical for PNNL and COGEMA rat inhalation studies, as well as uranium miners and human indoor exposure conditions. It is shown here that depending on exposure conditions and modeling assumptions, average bronchial doses in the rat lung ranged from 5.4 to 7.3 mGy WLM(-1). If plotted as a function of airway generation, bronchial dose distributions exhibit a significant maximum in large bronchial airways. If, however, plotted as a function of airway diameter, then bronchial doses are much more uniformly distributed throughout the bronchial tree. Comparisons between human and rat exposures indicate that rat bronchial doses are slightly higher than human bronchial doses by about a factor of 1.3, while lung doses, averaged over the bronchial (BB), bronchiolar (bb) and alveolar-interstitial (AI) regions, are higher by about a factor of about 1.6. This supports the current view that the rat lung is indeed an appropriate surrogate for the human lung in case of radon-induced lung cancers. Furthermore, airway diameter seems to be a more appropriate morphometric parameter than airway generations to relate bronchial doses to bronchial carcinomas.

Split exponential track length estimator for Monte-Carlo simulations of small-animal radiation therapy.

We propose the split exponential track length estimator (seTLE), a new kerma-based method combining the exponential variant of the TLE and a splitting strategy to speed up Monte Carlo (MC) dose computation for low energy photon beams. The splitting strategy is applied to both the primary and the secondary emitted photons, triggered by either the MC events generator for primaries or the photon interactions generator for secondaries. Split photons are replaced by virtual particles for fast dose calculation using the exponential TLE. Virtual particles are propagated by ray-tracing in voxelized volumes and by conventional MC navigation elsewhere. Hence, the contribution of volumes such as collimators, treatment couch and holding devices can be taken into account in the dose calculation.We evaluated and analysed the seTLE method for two realistic small animal radiotherapy treatment plans. The effect of the kerma approximation, i.e. the complete deactivation of electron transport, was investigated. The efficiency of seTLE against splitting multiplicities was also studied. A benchmark with analog MC and TLE was carried out in terms of dose convergence and efficiency.The results showed that the deactivation of electrons impacts the dose at the water/bone interface in high dose regions. The maximum and mean dose differences normalized to the dose at the isocenter were, respectively of 14% and 2% . Optimal splitting multiplicities were found to be around 300. In all situations, discrepancies in integral dose were below 0.5% and 99.8% of the voxels fulfilled a 1%/0.3 mm gamma index criterion. Efficiency gains of seTLE varied from 3.2 × 10(5) to 7.7 × 10(5) compared to analog MC and from 13 to 15 compared to conventional TLE.In conclusion, seTLE provides results similar to the TLE while increasing the efficiency by a factor between 13 and 15, which makes it particularly well-suited to typical small animal radiation therapy applications.

3D-modelling of radon-induced cellular radiobiological effects in bronchial airway bifurcations: direct versus bystander effects.

PURPOSE: The primary objective of this paper was to investigate the distribution of radiation doses and the related biological responses in cells of a central airway bifurcation of the human lung of a hypothetical worker of the New Mexico uranium mines during approximately 12 hours of exposure to short-lived radon progenies. MATERIALS AND METHODS: State-of-the-art computational modelling techniques were applied to simulate the relevant biophysical and biological processes in a central human airway bifurcation. RESULTS: The non-uniform deposition pattern of inhaled radon daughters caused a non-uniform distribution of energy deposition among cells, and of related cell inactivation and cell transformation probabilities. When damage propagation via bystander signalling was assessed, it produced more cell killing and cell transformation events than did direct effects. If bystander signalling was considered, variations of the average probabilities of cell killing and cell transformation were supra-linear over time. CONCLUSIONS: Our results are very sensitive to the radiobiological parameters, derived from in vitro experiments (e.g., range of bystander signalling), applied in this work and suggest that these parameters may not be directly applicable to realistic three-dimensional (3D) epithelium models.

Bronchial thermoplasty.

Even with the use of maximum pharmacological treatment, asthma still remains uncontrolled in some cases. For such cases of uncontrolled asthma, a novel therapy--Bronchial Thermoplasty (BT)--has shown some promising results over the past few years. BT is application of controlled radiofrequency heat via catheter inserted through a flexible bronchoscope, to the bronchial walls. It reduces the smooth muscle mass in bronchial wall and thus results in decreased contractility. Three major trials of BT show that it does not cause any improvement in FEV1. However, BT causes improvement the quality of life and decreases the future exacerbations and emergency hospital visits due to asthma. But the benefit observed was too small to be clinically significant. Follow up (two to five years) results of these BT trials did not show any significant long-term adverse event related to BT. However, further independent large randomized controlled trials and results of application of BT in real hospital settings are needed to define its role in asthma management.

Modelling the effect of non-uniform radon progeny activities on transformation frequencies in human bronchial airways.

The effects of radiological and morphological source heterogeneities in straight and Y-shaped bronchial airways on hit frequencies and microdosimetric quantities in epithelial cells have been investigated previously. The goal of the present study is to relate these physical quantities to transformation frequencies in sensitive target cells and to radon-induced lung cancer risk. Based on an effect-specific track length model, computed linear energy transfer (LET) spectra were converted to corresponding transformation frequencies for different activity distributions and source-target configurations. Average transformation probabilities were considerably enhanced for radon progeny accumulations and target cells at the carinal ridge, relative to uniform activity distributions and target cells located along the curved and straight airway portions at the same exposure level. Although uncorrelated transformation probabilities produce a linear dose-effect relationship, correlated transformations first increase depending on the LET, but then decrease significantly when exceeding a defined number of hits or cumulative exposure level.

Assessment and prevention of radioactive risk due to 222Radon on University Premises in Genoa, Italy.

From October 2004 to September 2005, Radon222 activity in high-risk indoor spaces used by employees and students at the University of Genoa was measured with CR-39 nuclear track detectors. The mean concentration in winter (78.9 Bq/m3 +/- 74.92 S.D.) was low in relation to the microenvironment considered. When data were broken down by type and location of the spaces, no significant differences were found, despite the fact that the Genoa conurbation lies on soil of variable geological composition. The dose absorbed by employees was 0.42 mSv/year, with a relative risk of 4.2/1000 cases of Radon-related lung cancer. The dose absorbed by students was 0.28 mSv/year, with a relative risk of 2.5/1000 cases of Radon-related lung cancer. The level of radon activity detected never exceeded the limit of 500 Bq/m3 established by Italian law. Nevertheless, the value of the compound uncertainty index suggested that the real level of Radon contamination could have exceeded 400 Bq/m3 in selected spaces, a value requiring annual concentration tests.

Microdosimetry of radon progeny alpha particles in bronchial airway bifurcations.

A Monte Carlo code, initially developed for the calculation of microdosimetric spectra for alpha particles in cylindrical airways, has been extended to allow the computation of microdosimetric parameters for multiple source-target configurations in bronchial airway bifurcations. The objective of the present study was to investigate the effects of uniform and non-uniform radon progeny surface activity distributions in symmetric and asymmetric bronchial airway bifurcations on absorbed dose, hit frequency, lineal energy, single hit specific energy and LET spectra. In order to assess the effects of multiple hits, dose-dependent specific energy spectra were calculated by solving the compound Poisson process by iterative convolution. While the simulations showed significant differences of cellular dose quantities at different cell locations for uniformly distributed surface activities, even higher variations, as high as several orders of magnitude, were observed for non-uniform surface activity distributions, depending on the location of the cell and the local activity distribution.

Interaction of alpha particles at the cellular level--implications for the radiation weighting factor.

Since low dose effects of alpha particles are produced by cellular hits in a relatively small fraction of exposed cells, the present study focuses on alpha particle interactions in bronchial epithelial cells following exposure to inhaled radon progeny. A computer code was developed for the calculation of microdosimetric spectra, dose and hit probabilities for alpha particles emitted from uniform and non-uniform source distributions in cylindrical and Y-shaped bronchial airway geometries. Activity accumulations at the dividing spur of bronchial airway bifurcations produce hot spots of cellular hits, indicating that a small fraction of cells located at such sites may receive substantially higher doses. While presently available data on in vitro transformation frequencies suggest that the relative biological effectiveness for alpha particles ranges from about 3 to 10, the effect of inhomogeneous activity distributions of radon progeny may slightly increase the radiation weighting factor relative to a uniform distribution. Thus a radiation weighting factor of about 10 may be more realistic than the current value of 20, at least for lung cancer risk following inhalation of short-lived radon progeny.

Absorbed fraction of radon progeny in human bronchial airways with bifurcation geometry.

PURPOSE: The absorbed fraction, defined as the portion of the initial particle energy which is absorbed in the tissue of interest, was calculated, under bifurcation geometry of the airway tubes, for alpha-particles emitted from radon progeny in the human respiratory tract. The results are given for all branching generations and compared with the data obtained for the commonly used infinite straight cylinders adopted by the International Commission on Radiological Protection (ICRP) Report 66. MATERIALS AND METHODS: A model was created to calculate the absorbed fraction of alpha-particle energy in the human lung using bifurcation geometry. Monte Carlo simulations of alpha-particle propagation in tissue and air were performed. The stopping powers of alpha-particles were adopted from the International Commission of Radiation Units and Measurements (ICRU) Report 49. RESULTS: The absorbed fractions for the bifurcation geometry are given for the 15 generations in the tracheobronchial tree for alpha-particle energies of 6 and 7.69 MeV. The sources were assumed to be the fast and slow moving mucus. CONCLUSIONS: Comparisons with ICRP66 data reveal that the assumption of long, straight cylinders was appropriate in some cases, but not in all. Adoption of the absorbed fractions obtained from the bifurcation model instead of the ICRP66 data caused 'redistribution' of doses in the bronchial (BB) and bronchiolar (bb) regions.

Monte Carlo code for microdosimetry of inhaled alpha emitters.

A Monte Carlo code has been developed to calculate the local energy deposited by alpha emitters deposited on the inner surface in the lung airway. Developed to deal further with airway bifurcations, this code has been as a first step validated in a cylindrical airway configuration by comparison with well-established analytical codes in the case of contamination of bronchiolar airways with actinides. The code has then been applied to the study of uniform and non-uniform contamination of cylindrical bronchial airways by radon progeny in indoor and mine exposure conditions. In addition to the microdosimetric spectra, the average microdosimetric parameters (zp, n, z) have been evaluated. The work currently in progress consists in adapting this developed Monte Carlo code to the configuration of an airway bifurcation with realistic particles deposition.

Distributions of specific energy in sensitive layers of the human respiratory tract.

The purpose of the present work was to calculate the specific energy distribution in sensitive cells of the human lung. Specific energy distributions were calculated by applying Monte Carlo methods and the ICRP 66 model of the human respiratory tract. Specific energies were calculated at various depths in the epithelium and combined according to the relative cell abundance. Distributions are given for various combinations of sources, alpha-particle energies, targets and regions of the lung. The chord length does not follow the triangular distribution when the particle range is comparable to the diameter of the target. The notion of "effective volume" is introduced and defined, which is needed for estimation of hit frequency in some particular targets. It has been shown that basal cells are subjected to a larger proportion of alpha-particle hits with small energy transfer than secretory cells. Small energy transfer events that lead to minor damage of the DNA are more efficient in cancer induction than are hits with large energy deposition that lead to cell killing.

Monte Carlo simulations for EndoBronchial Photodynamic Therapy: the influence of variations in optical and geometrical properties and of realistic and eccentric light sources.

BACKGROUND AND OBJECTIVE: Light dosimetry for endobronchial photodynamic therapy is not very advanced to date. This study investigates the dependency of the fluence rate distribution in the bronchial wall on several parameters. STUDY DESIGN/MATERIALS AND METHODS: A Monte Carlo model is employed for the illumination of a cylindrical cavity by a linear diffuser to compute the fluence rate distribution in the tissue. The influence of optical and geometrical properties (e.g., the absorption coefficient of the bronchial mucosa and the diameter of the treated lumen) have been investigated, as well as the consequences of varying output characteristics of the diffusers. The optical properties used are those of ex vivo pig bronchial mucosa. RESULTS: With on-axis linear diffusers that can be modelled as a row of isotropic point sources, a constant fluence rate buildup factor can be employed for varying diffuser lengths and lumen diameters. Extreme off-axis placement of the diffuser causes a highly variable, considerable increase in the maximum fluence rate as well as a highly asymmetrical fluence rate profile on the circumference of the illuminated lumen. The fluence rate profiles resulting from illumination with realistic diffusers can be evaluated by implementing the measured radiance profiles of these diffusers in the model. The changes in fluence rate caused by variations in the optical properties of the bronchial mucosa could be accounted for by diffusion theory. This relationship can be used to extrapolate the ex vivo results to the clinical situation. CONCLUSION: A set of practical rules of thumb is presented that can help to estimate fluence rate distributions in clinical practice.

Ex vivo light dosimetry and Monte Carlo simulations for endobronchial photodynamic therapy.

The light distribution during photodynamic therapy of the bronchial tree has been estimated by measuring the fluence rate in ex vivo experiments on dissected pig bronchi. The trachea was illuminated (630 nm) with a cylindrical diffuser and the fluence rate was measured with a fibre optic isotropic probe. The experiment with the diffuser on the central axis was also simulated with Monte Carlo techniques using the optical properties that were determined with a double-integrating-sphere set-up. The results from ex vivo experiments and the Monte Carlo simulations were found to agree within the error of measurement (15%), indicating that the Monte Carlo technique can be used to estimate the light distribution for varying geometries and optical properties. The results showed that the light fluence rate in the mucosa of the tracheal tract may increase by a factor of six compared to the fluence rate in air (in the absence of tissue). This is due to the scattering properties of the tissue and the multiple reflections within the cavity. Further ex vivo experiments showed that the positioning of the diffuser is critical for the fluence rate in the lesion to be treated. When the position of the diffuser was changed from the central axis to near the lesion, the fluence rate in the mucosa increased significantly by several orders of magnitude as compared to the initial (central) illumination. The inter- and intraspecimen variations in this increase were large (+/- 35%) because of variations in optical and geometrical properties and light source positioning, respectively. These variations might cause under- or overdosage resulting in either insufficient tumour necrosis or excessive normal tissue damage.