A 10-year follow-up study of yearly indoor radon measurements in homes, review of other studies and implications on lung cancer risk estimates.

Uncertainty on long-term average radon concentration has a large impact on lung cancer risk assessment in epidemiological studies. The uncertainty can be estimated by year-to-year radon concentration variability, however few data are available. In Italy a study has been planned and conducted to evaluate year-to-year radon variability over several years in normally inhabited dwellings, mainly located in Rome. This is the longest study of this kind in Europe; repeat radon measurements are carried out for 10 years using LR-115 radon detectors in the same home in consecutive years. The study includes 84 dwellings with long-term average radon concentration ranging from 28 to 636 Bq/m3. The result shows that year-to-year variability of repeated measurements made in the same home in different years is low, with an overall coefficient of variation of 17%. This is smaller than most of those observed in studies from other European countries and USA, ranging from 15% to 62%. Influencing factors that may explain the differences between this study and other studies have been discussed. Due to the low yearly variability estimated in the present 10-year study, a negligible impact on lung cancer risk estimate for the Italian epidemiological study is expected.

Effects of Transcranial Ultrasound Stimulation on Trigeminal Blink Reflex Excitability.

Recent evidence indicates that transcranial ultrasound stimulation (TUS) modulates sensorimotor cortex excitability. However, no study has assessed possible TUS effects on the excitability of deeper brain areas, such as the brainstem. In this study, we investigated whether TUS delivered on the substantia nigra, superior colliculus, and nucleus raphe magnus modulates the excitability of trigeminal blink reflex, a reliable neurophysiological technique to assess brainstem functions in humans. The recovery cycle of the trigeminal blink reflex (interstimulus intervals of 250 and 500 ms) was tested before (T0), and 3 (T1) and 30 min (T2) after TUS. The effects of substantia nigra-TUS, superior colliculus-TUS, nucleus raphe magnus-TUS and sham-TUS were assessed in separate and randomized sessions. In the superior colliculus-TUS session, the conditioned R2 area increased at T1 compared with T0, while T2 and T0 values did not differ. Results were independent of the interstimulus intervals tested and were not related to trigeminal blink reflex baseline (T0) excitability. Conversely, the conditioned R2 area was comparable at T0, T1, and T2 in the nucleus raphe magnus-TUS and substantia nigra-TUS sessions. Our findings demonstrate that the excitability of brainstem circuits, as evaluated by testing the recovery cycle of the trigeminal blink reflex, can be increased by TUS. This result may reflect the modulation of inhibitory interneurons within the superior colliculus.

EURADOS intercomparison exercise on Monte Carlo modelling of a medical linear accelerator.

BACKGROUND: In radiotherapy, Monte Carlo (MC) methods are considered a gold standard to calculate accurate dose distributions, particularly in heterogeneous tissues. EURADOS organized an international comparison with six participants applying different MC models to a real medical linear accelerator and to one homogeneous and four heterogeneous dosimetric phantoms. AIMS: The aim of this exercise was to identify, by comparison of different MC models with a complete experimental dataset, critical aspects useful for MC users to build and calibrate a simulation and perform a dosimetric analysis. RESULTS: Results show on average a good agreement between simulated and experimental data. However, some significant differences have been observed especially in presence of heterogeneities. Moreover, the results are critically dependent on the different choices of the initial electron source parameters. CONCLUSIONS: This intercomparison allowed the participants to identify some critical issues in MC modelling of a medical linear accelerator. Therefore, the complete experimental dataset assembled for this intercomparison will be available to all the MC users, thus providing them an opportunity to build and calibrate a model for a real medical linear accelerator.

A computational tool for evaluating HIFU safety.

BACKGROUND: High Intensity Focused Ultrasound (HIFU) is a noninvasive treatment for therapeutic applications, in particular the treatment of either benign or malignant tumor lesions. HIFU treatment is based on the power of a focused ultrasound beam to locally heat biological tissues over a necrotic level with minimal impact on the surrounding tissues. Therapies based on HIFU are becoming widely spread in the panorama of options offered by the Health Care System. Consequently, there is an ever increasing need to standardise quality assurance protocols and to develop computational tools to evaluate the output of clinical HIFU devices and ensuring safe delivery of HIFU treatment. AIMS: Goal of this study is the development of a computational tool for HIFU ablation therapy to assure safety of the patient and effectiveness of the treatment. RESULTS: The simulated results provide information about the behaviour of the focalized ultrasound in their interaction with different biological tissues. CONCLUSIONS: Numerical simulation represents a useful approach to predict the heath deposition and, consequently, to assess the safety and effectiveness of HIFU devices.

Fast and high temperature hyperthermia coupled with radiotherapy as a possible new treatment for glioblastoma.

BACKGROUND: A new transcranial focused ultrasound device has been developed that can induce hyperthermia in a large tissue volume. The purpose of this work is to investigate theoretically how glioblastoma multiforme (GBM) can be effectively treated by combining the fast hyperthermia generated by this focused ultrasound device with external beam radiotherapy. METHODS/DESIGN: To investigate the effect of tumor growth, we have developed a mathematical description of GBM proliferation and diffusion in the context of reaction-diffusion theory. In addition, we have formulated equations describing the impact of radiotherapy and heat on GBM in the reaction-diffusion equation, including tumor regrowth by stem cells. This formulation has been used to predict the effectiveness of the combination treatment for a realistic focused ultrasound heating scenario. Our results show that patient survival could be significantly improved by this combined treatment modality. DISCUSSION: High priority should be given to experiments to validate the therapeutic benefit predicted by our model.

IMRT optimization: variability of solutions and its radiobiological impact.

We aim at (1) defining and measuring a "complexity" index for the optimization process of an intensity modulated radiation therapy treatment plan (IMRT TP), (2) devising an efficient approximate optimization strategy, and (3) evaluating the impact of the complexity of the optimization process on the radiobiological quality of the treatment. In this work, for a prostate therapy case, the IMRT TP optimization problem has been formulated in terms of dose-volume constraints. The cost function has been minimized in order to achieve the optimal solution, by means of an iterative procedure, which is repeated for many initial modulation profiles, and for each of them the final optimal solution is recorded. To explore the complexity of the space of such solutions we have chosen to minimize the cost function with an algorithm that is unable to avoid local minima. The size of the (sub)optimal solutions distribution is taken as an indicator of the complexity of the optimization problem. The impact of the estimated complexity on the probability of success of the therapy is evaluated using radiobiological indicators (Poissonian TCP model [S. Webb and A. E. Nahum, Phys. Med. Biol. 38(6), 653-666 (1993)] and NTCP relative seriality model [Kallman et al., Int. J. Radiat. Biol. 62(2), 249-262 (1992)]). We find in the examined prostate case a nontrivial distribution of local minima, which has symmetry properties allowing a good estimate of near-optimal solutions with a moderate computational load. We finally demonstrate that reducing the a priori uncertainty in the optimal solution results in a significant improvement of the probability of success of the TP, based on TCP and NTCP estimates.

MedLinac2: a GEANT4 based software package for radiotherapy.

Dose distribution evaluation in oncological radiotherapy treatments is an outstanding problem that requires sophisticated computing technologies to optimize the clinical results (i.e. increase the dose to the tumour and reduce the dose to the healthy tissues). Nowdays, dose calculation algorithms based on the Monte Carlo method are generally regarded as the most accurate tools for radiotherapy. The flexibility of the GEANT4 (GEometry ANd Tracking) Monte Carlo particle transport simulation code allows a wide range of applications, from high-energy to medical physics. In order to disseminate and encourage the use of Monte Carlo method in oncological radiotherapy, a software package based on the GEANT4 Monte Carlo toolkit has been developed. The developed package (MedLinac2) allows to simulate in an adequate flexible way a linear accelerator for radiotherapy and to evaluate the dose distributions.