Development of a hydrated electron dosimeter for radiotherapy applications: A proof of concept.

BACKGROUND: Hydrated electrons, which are short-lived products of radiolysis in water, increase the optical absorption of water, providing a pathway toward near-tissue-equivalent clinical radiation dosimeters. This has been demonstrated in high-dose-per-pulse radiochemistry research, but, owing to the weak absorption signal, its application in existing low-dose-per-pulse radiotherapy provided by clinical linear accelerators (linacs) has yet to be investigated. PURPOSE: The aims of this study were to measure the optical absorption associated with hydrated electrons produced by clinical linacs and to assess the suitability of the technique for radiotherapy (⩽ 1 cGy per pulse) applications. METHODS: 40 mW of 660-nm laser light was sent five passes through deionized water contained in a 10 × 4 × $\times 4\times$ 2 cm3 glass-walled cavity by using four broadband dielectric mirrors, two on each side of the cavity. The light was collected with a biased silicon photodetector. The water cavity was then irradiated by a Varian TrueBeam linac with both photon (10 MV FFF, 6 MV FFF, 6 MV) and electron beams (6 MeV) while monitoring the transmitted laser power for absorption transients. Radiochromic EBT3 film measurements were also performed for comparison. RESULTS: Examination of the absorbance profiles showed clear absorption changes in the water when radiation pulses were delivered. Both the amplitude and the decay time of the signal appeared consistent with the absorbed dose and the characteristics of the hydrated electrons. By using literature value for the hydrated electron radiation chemical yield (3.0±0.3), we inferred doses of 2.1±0.2 mGy (10 MV FFF), 1.3±0.1 mGy (6 MV FFF), 0.45±0.06 mGy (6 MV) for photons, and 0.47±0.05 mGy (6 MeV) for electrons, which differed from EBT3 film measurements by 0.6%, 0.8%, 10%, and 15.7%, respectively. The half-life of the hydrated electrons in the solution was ∼ 24 µ $\umu$ s. CONCLUSIONS: By measuring 660-nm laser light transmitted through a cm-scale, multi-pass water cavity, we observed absorption transients consistent with hydrated electrons generated by clinical linac radiation. The agreement between our inferred dose and EBT3 film measurements suggests this proof-of-concept system represents a viable pathway toward tissue-equivalent dosimeters for clinical radiotherapy applications.

Design and modeling of a Laue lens for radiation therapy with hard x-ray photons.

We have designed and modeled a novel optical system composed of a Laue lens coupled to an x-ray tube that produces a focused beam in an energy range near 100 keV (λ= 12.4 picometer). One application of this system is radiation therapy where it could enable treatment units that are considerably simpler and lower in cost than present technologies relying on linear accelerators. The Laue lens is made of Silicon Laue components which exploit the silicon pore optics technology. The lens concentrates photons to a small region thus allowing high dose rates at the focal area with very much lower dose rates at the skin and superficial regions. Monte Carlo simulations with Geant4 indicate a dose deposition rate of 0.2 Gy min-1in a cylindrical volume of 0.7 mm diameter and 10 mm length, and a dose ratio of 72 at the surface (skin) compared to the focus placed 10 cm within a water phantom. Work is ongoing to newer generation crystal technologies to increase dose rate.

NIR multiphoton ablation of cancer cells, fluorescence quenching and cellular uptake of dansyl-glutathione-coated gold nanoparticles.

Theranostics based on two-photon excitation of therapeutics in the NIR region is an emerging and powerful tool in cancer therapy since this radiation deeply penetrates healthy biological tissues and produces selective cell death. Aggregates of gold nanoparticles coated with glutathione corona functionalized with the dansyl chromophore (a-DG-AuNPs) were synthesized and found efficient nanodevice for applications in photothermal therapy (PTT). Actually the nanoparticle aggregation enhances the quenching of radiative excitation and the consequent conversion into heat. The a-DG-AuNPs are readily internalized in Hep G2 where the chromophore acts as both antenna and transducer of the NIR radiation under two-photons excitation, determining efficient cell ablation via photothermal effect.

IPEM code of practice for high-energy photon therapy dosimetry based on the NPL absorbed dose calibration service.

The 1990 code of practice (COP), produced by the IPSM (now the Institute of Physics and Engineering in Medicine, IPEM) and the UK National Physical Laboratory (NPL), gave instructions for determining absorbed dose to water for megavoltage photon (MV) radiotherapy beams (Lillicrap et al 1990). The simplicity and clarity of the 1990 COP led to widespread uptake and high levels of consistency in external dosimetry audits. An addendum was published in 2014 to include the non-conventional conditions in Tomotherapy units. However, the 1990 COP lacked detailed recommendations for calibration conditions, and the corresponding nomenclature, to account for modern treatment units with different reference fields, including small fields as described in IAEA TRS483 (International Atomic Energy Agency (IAEA) 2017, Vienna). This updated COP recommends the irradiation geometries, the choice of ionisation chambers, appropriate correction factors and the derivation of absorbed dose to water calibration coefficients, for carrying out reference dosimetry measurements on MV external beam radiotherapy machines. It also includes worked examples of application to different conditions. The strengths of the 1990 COP are retained: recommending the NPL2611 chamber type as secondary standard; the use of tissue phantom ratio (TPR) as the beam quality specifier; and NPL-provided direct calibration coefficients for the user's chamber in a range of beam qualities similar to those in clinical use. In addition, the formalism is now extended to units that cannot achieve the standard reference field size of 10 cm × 10 cm, and recommendations are given for measuring dose in non-reference conditions. This COP is designed around the service that NPL provides and thus it does not require the range of different options presented in TRS483, such as generic correction factors for beam quality. This approach results in a significantly simpler, more concise and easier to follow protocol.

A simple approximation for the evaluation of the photon iso-effective dose in Boron Neutron Capture Therapy based on dose-independent weighting factors.

The current methodology for determining the biological effect of Boron Neutron Capture Therapy (BNCT) has recently been questioned, and a more accurate framework based in the photon iso-effective dose has been proposed. In this work we derive a first order approximation to this quantity. The new approach removes the main drawbacks of the current method, being based on new weighting factors which are true constants (dose independent) but which can be evaluated from published data on the existing (dose-dependent) weighting factors. In addition to this, we apply the formalism to allow the comparison to a fractionated conventional radiotherapy treatment, for which there is a lot of knowledge from clinical practice. As an application, the photon iso-effective dose of a BNCT treatment for a brain tumor is estimated. An excel sheet used for these calculations is also provided as supplementary material and can be used also with user-provided input data for the estimation of the photon iso-effective dose for comparison with conventional radiotherapy, both to single and fractionated treatments.

Calculated beam quality correction factors for ionization chambers in MV photon beams.

The beam quality correction factor, [Formula: see text], which corrects for the difference in the ionization chamber response between the reference and clinical beam quality, is an integral part of radiation therapy dosimetry. The uncertainty of [Formula: see text] is one of the most significant sources of uncertainty in the dose determination. To improve the accuracy of available [Formula: see text] data, four partners calculated [Formula: see text] factors for 10 ionization chamber models in linear accelerator beams with accelerator voltages ranging from 6 MV to 25 MV, including flattening-filter-free (FFF) beams. The software used in the calculations were EGSnrc and PENELOPE, and the ICRU report 90 cross section data for water and graphite were included in the simulations. Volume averaging correction factors were calculated to correct for the dose averaging in the chamber cavities. A comparison calculation between partners showed a good agreement, as did comparison with literature. The [Formula: see text] values from TRS-398 were higher than our values for each chamber where data was available. The [Formula: see text] values for the FFF beams did not follow the same [Formula: see text], [Formula: see text] relation as beams with flattening filter (values for 10 MV FFF beams were below fits made to other data on average by 0.3%), although our FFF sources were only for Varian linacs.

Absolute dosimetry of a 1.5 T MR-guided accelerator-based high-energy photon beam in water and solid phantoms using Aerrow.

PURPOSE: In this work, the fabrication, operation, and evaluation of a probe-format graphite calorimeter - herein referred to as Aerrow - as an absolute clinical dosimeter of high-energy photon beams while in the presence of a B = 1.5 T magnetic field is described. Comparable to a cylindrical ionization chamber (IC) in terms of utility and usability, Aerrow has been developed for the purpose of accurately measuring absorbed dose to water in the clinic with a minimum disruption to the existing clinical workflow. To our knowledge, this is the first reported application of graphite calorimetry to magnetic resonance imaging (MRI)-guided radiotherapy. METHODS: Based on a previously numerically optimized and experimentally validated design, an Aerrow prototype capable of isothermal operation was constructed in-house. Graphite-to-water dose conversions as well as magnetic field perturbation factors were calculated using Monte Carlo, while heat transfer and mass impurity corrections and uncertainties were assessed analytically. Reference dose measurements were performed in the absence and presence of a B = 1.5 T magnetic field using Aerrow in the 7 MV FFF photon beam of an Elekta MRI-linac and were directly compared to the results obtained using two calibrated reference-class IC types. The feasibility of performing solid phantom-based dosimetry with Aerrow and the possible influence of clearance gaps is also investigated by performing reference-type dosimetry measurements for multiple rotational positions of the detector and comparing the results to those obtained in water. RESULTS: In the absence of the B-field, as well as in the parallel orientation while in the presence of the B-field, the absorbed dose to water measured using Aerrow was found to agree within combined uncertainties with those derived from TG-51 using calibrated reference-class ICs. Statistically significant differences on the order of (2-4)%, however, were observed when measuring absorbed dose to water using the ICs in the perpendicular orientation in the presence of the B-field. Aerrow had a peak-to-peak response of about 0.5% when rotated within the solid phantom regardless of whether the B-field was present or not. CONCLUSIONS: This work describes the successful use of Aerrow as a straightforward means of measuring absolute dose to water for large high-energy photon fields in the presence of a 1.5 T B-field to a greater accuracy than currently achievable with ICs. The detector-phantom air gap does not appear to significantly influence the response of Aerrow in absolute terms, nor does it contribute to its rotational dependence. This work suggests that the accurate use of solid phantoms for absolute point dose measurement is possible with Aerrow.

Dose to water versus dose to medium from cavity theory applied to small animal irradiation with kilovolt x-rays.

Dose reporting is a matter of concern in the preclinical field as the different dose descriptors dose-to-water-in-medium [Formula: see text] and dose-to-medium-in-medium [Formula: see text] coexist. For kV photons differences between both quantities are expected to be amplified due to photon energy absorption coefficients differences for different media, and could represent a limiting factor for accurate translation of pre-clinical research into clinical trials. The main goal of this study was to analyse the relationship between [Formula: see text] and [Formula: see text] for kV irradiation of small animals, using different flavours of the intermediate cavity theory (ICT). Irradiations of mathematical phantoms and a mouse CT scan, both with different voxel sizes and materials, were investigated. A modified version of the Monte Carlo code DOSXYZnrc was used to derive [Formula: see text] and convert to [Formula: see text] using ICT. Local photon spectra were generated in different regions of the mouse. Depending on energy and cavity size, which we equate to the voxel size, [Formula: see text] ranged from 0.68 to 4.37 times [Formula: see text]. Higher kV energy combined with very small cavity sizes yielded decreased [Formula: see text] in comparison to [Formula: see text]; this behaviour was reversed for larger cavities combined with lower kV energies. Hence, the impact of the cavity dimensions on estimated [Formula: see text] is significant on pre-clinical kV beams. [Formula: see text] and [Formula: see text] in the ex vivo male mouse were found to differ by -29% to 286%. Caution is advised when using the ICT due to a lack of consensus on weighting factor (d-parameter) deriving methods; for the same irradiation conditions, different d-values affected [Formula: see text] up to 20%. Pre-clinically, such divergence between dose descriptors could enable biological damage. The abiding debate over which quantity to favour is foreseen to linger while it is unclear which quantity correlates better with the biological effects of ionizing irradiation: preclinical radiotherapy might represent an ideal platform for measurement-based studies to settle this fundamental question. Finally, dose distribution comparisons require caution and should use the same reporting quantity.

Hyperthermic chest wall re-irradiation in recurrent breast cancer: a prospective observational study.

PURPOSE: To prospectively investigate the role of re-irradiation (re-RT) combined with hyperthermia (HT) in a contemporary cohort of patients affected by recurrent breast cancer (RBC). METHODS: Within the prospective registry HT03, patients with resected RBC and previous irradiation were included. Re-RT was applied to the recurrence region with doses of 50-50.4 Gy, with a boost up to 60-60.4 Gy to the microscopically or macroscopically positive resection margins (R1/R2) region. Concurrent HT was performed at 40-42 ℃. Primary endpoint was LC. Acute and late toxicity, overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) were also evaluated. RESULTS: 20 patients and 21 RBC were analyzed. Median re-RT dose was 50.4 Gy and a median of 11 HT fractions were applied. Re-RT+HT was well tolerated, with three patients who experienced a grade (G) 3 acute skin toxicity and no cases of ≥G3 late toxicity. With a median follow up of 24.7 months, two local relapses occurred. Ten patients experienced regional and/or distant disease progression. Five patients died, four of them from breast cancer. PFS was favorable in patients treated with re-RT+HT for the first recurrence with doses of 60 Gy. A trend towards better CSS was found in patients with negative or close margins and after doses of 60 Gy. CONCLUSION: Full-dose re-RT+HT for RBC is well tolerated, provides good LC, and seems to be more effective when applied at the time of the first relapse and after doses of 60 Gy. The registry will be continued for validation in a larger cohort and with longer follow-up.

Broadband light treatment using static operation and constant motion techniques for skin tightening in Asian patients.

BACKGROUND: Broadband light (BBL) devices irradiate photons of different wavelength to induce photothermal reactions on various aging-related chromophores. OBJECTIVES: To evaluate three BBL treatment settings for skin tightening in Asian patients. METHODS: A total of 27 patients underwent three sessions of BBL treatment via (1) an 800-nm cutoff filter using a static operation technique and a 695-nm cutoff filter using a constant motion technique (group 1, N = 9), (2) an 800-nm cutoff filter using a constant motion technique (group 2, N = 9), and (3) a 590-nm cutoff filter using a constant motion technique (group 3, N = 9). RESULTS: The patients in group 1 presented marked clinical improvements in zygomatic wrinkles, nasolabial folds, and marionette lines, with a median overall global aesthetic improvement scale (GAIS) score of 3. Meanwhile, patients in group 2 exhibited noticeable improvements in zygomatic wrinkles, nasolabial folds, perioral expression wrinkles at the cheek, and marionette lines, with a median GAIS score of 3. Patients in group 3 experienced improvement in skin tone and texture, zygomatic wrinkles, nasolabial folds, and marionette lines, with a median GAIS score of 2. CONCLUSIONS: Our data demonstrated that BBL treatment for nonablative, noninvasive skin tightening elicits satisfactory clinical outcomes.

Technical Note: On maximizing Cherenkov emissions from medical linear accelerators.

PURPOSE: Cherenkov light during MV radiotherapy has recently found imaging and therapeutic applications but is challenged by relatively low fluence. Our purpose is to investigate the feasibility of increasing Cherenkov light production during MV radiotherapy by increasing photon energy and applying specialized beam-hardening filtration. METHODS: GAMOS 5.0.0, a GEANT4-based framework for Monte Carlo simulations, was used to model standard clinical linear accelerator primary photon beams. The photon source was incident upon a 17.8 cm3 cubic water phantom with a 94 cm source to surface distance. Dose and Cherenkov production was determined at depths of 3-9 cm. Filtration was simulated 15 cm below the photon beam source. Filter materials included aluminum, iron, and copper with thicknesses of 2-20 cm. Histories used depended on the level of attenuation from the filter, ranging from 100 million to 2 billion. Comparing average dose per history also allowed for evaluation of dose-rate reduction for different filters. RESULTS: Overall, increasing photon beam energy is more effective at improving Cherenkov production per unit dose than is filtration, with a standard 18 MV beam yielding 3.3-4.0× more photons than 6 MV. Introducing an aluminum filter into an unfiltered 2400 cGy/min 10 MV beam increases the Cherenkov production by 1.6-1.7×, while maintaining a clinical dose rate of 300 cGy/min, compared to increases of ~1.5× for iron and copper. Aluminum was also more effective than the standard flattening filter, with the increase over the unfiltered beam being 1.4-1.5× (maintaining 600 cGy/min dose rate) vs 1.3-1.4× for the standard flattening filter. Applying a 10 cm aluminum filter to a standard 18 MV, photon beam increased the Cherenkov production per unit dose to 3.9-4.3× beyond that of 6 MV (vs 3.3-4.0× for 18 MV with no aluminum filter). CONCLUSIONS: Through a combination of increasing photon energy and applying specialized beam-hardening filtration, the amount of Cherenkov photons per unit radiotherapy dose can be increased substantially.

Learning from clinical phenotypes: Low-dose biophotonics therapies in oral diseases.

This narrative review on the use of biophotonics therapies for management of oral diseases is written as a tribute to Prof. Crispian Scully. His seminal contributions to the field are highlighted by the detailed, comprehensive description of clinical presentations of oral diseases. This has enabled a more thorough, fundamental understanding of many of these pathologies by research from his group as well as inspired mechanistic investigations in many groups globally. In the same vein, a major emphasis of this narrative review is to focus on the evidence from human case reports rather than in vitro or in vivo animal studies that showcases the growing and broad impact of biophotonics therapies. The similarities and differences between two distinct forms of low-dose biophotonics treatments namely photodynamic therapy and photobiomodulation therapy are discussed. As evident in this review, a majority of these reports provide promising evidence for their clinical efficacy. However, a lack of adequate technical details, precise biological rationale, and limited outcome measures limits the current utility of these treatments. Future investigations should attempt to address these shortcomings and develop better designed, rigorous, controlled studies to fully harness the tremendous potential of low-dose biophotonics therapies.

Feasibility of using a dose-area product ratio as beam quality specifier for photon beams with small field sizes.

PURPOSE: To investigate the feasibility of using the ratio of dose-area product at 20 cm and 10 cm water depths (DAPR20,10) as a beam quality specifier for radiotherapy photon beams with field diameter below 2 cm. METHODS: Dose-area product was determined as the integral of absorbed dose to water (Dw) over a surface larger than the beam size. 6 MV and 10 MV photon beams with field diameters from 0.75 cm to 2 cm were considered. Monte Carlo (MC) simulations were performed to calculate energy-dependent dosimetric parameters and to study the DAPR20,10 properties. Aspects relevant to DAPR20,10 measurement were explored using large-area plane-parallel ionization chambers with different diameters. RESULTS: DAPR20,10 was nearly independent of field size in line with the small differences among the corresponding mean beam energies. Both MC and experimental results showed a dependence of DAPR20,10 on the measurement setup and the surface over which Dw is integrated. For a given setup, DAPR20,10 values obtained using ionization chambers with different air-cavity diameters agreed with one another within 0.4%, after the application of MC correction factors accounting for effects due to the chamber size. DAPR20,10 differences among the small field sizes were within 1% and sensitivity to the beam energy resulted similar to that of established beam quality specifiers based on the point measurement of Dw. CONCLUSIONS: For a specific measurement setup and integration area, DAPR20,10 proved suitable to specify the beam quality of small photon beams for the selection of energy-dependent dosimetric parameters.

Small field depth dose profile of 6 MV photon beam in a simple air-water heterogeneity combination: A comparison between anisotropic analytical algorithm dose estimation with thermoluminescent dosimeter dose measurement.

AIM OF STUDY: To establish trends of estimation error of dose calculation by anisotropic analytical algorithm (AAA) with respect to dose measured by thermoluminescent dosimeters (TLDs) in air-water heterogeneity for small field size photon. MATERIALS AND METHODS: TLDs were irradiated along the central axis of the photon beam in four different solid water phantom geometries using three small field size single beams. The depth dose profiles were estimated using AAA calculation model for each field sizes. The estimated and measured depth dose profiles were compared. RESULTS: The over estimation (OE) within air cavity were dependent on field size (f) and distance (x) from solid water-air interface and formulated as OE = - (0.63 f + 9.40) x2+ (-2.73 f + 58.11) x + (0.06 f2 - 1.42 f + 15.67). In postcavity adjacent point and distal points from the interface have dependence on field size (f) and equations are OE = 0.42 f2 - 8.17 f + 71.63, OE = 0.84 f2 - 1.56 f + 17.57, respectively. CONCLUSION: The trend of estimation error of AAA dose calculation algorithm with respect to measured value have been formulated throughout the radiation path length along the central axis of 6 MV photon beam in air-water heterogeneity combination for small field size photon beam generated from a 6 MV linear accelerator.

Monte Carlo and experimental determination of correction factors for gamma knife perfexion small field dosimetry measurements.

Detector-, field size- and machine-specific correction factors are required for precise dosimetry measurements in small and non-standard photon fields. In this work, Monte Carlo (MC) simulation techniques were used to calculate the [Formula: see text] and [Formula: see text] correction factors for a series of ionization chambers, a synthetic microDiamond and diode dosimeters, used for reference and/or output factor (OF) measurements in the Gamma Knife Perfexion photon fields. Calculations were performed for the solid water (SW) and ABS plastic phantoms, as well as for a water phantom of the same geometry. MC calculations for the [Formula: see text] correction factors in SW were compared against corresponding experimental results for a subset of ionization chambers and diode detectors. Reference experimental OF data were obtained through the weighted average of corresponding measurements using TLDs, EBT-2 films and alanine pellets. [Formula: see text] values close to unity (within 1%) were calculated for most of ionization chambers in water. Greater corrections of up to 6.0% were observed for chambers with relatively large air-cavity dimensions and steel central electrode. A phantom correction of 1.006 and 1.024 (breaking down to 1.014 from the ABS sphere and 1.010 from the accompanying ABS phantom adapter) were calculated for the SW and ABS phantoms, respectively, adding up to [Formula: see text] corrections in water. Both measurements and MC calculations for the diode and microDiamond detectors resulted in lower than unit [Formula: see text] correction factors, due to their denser sensitive volume and encapsulation materials. In comparison, higher than unit [Formula: see text] results for the ionization chambers suggested field size depended dose underestimations (being significant for the 4 mm field), with magnitude depending on the combination of contradicting phenomena associated with volume averaging and electron fluence perturbations. Finally, the presence of 0.5 mm air-gap between the diodes' frontal surface and their phantom-inserts may considerably influence OF measurements, reaching 4.6% for the Razor diode.

Study on dependence of dose enhancement on cluster morphology of gold nanoparticles in radiation therapy using a body-centred cubic model.

Gold nanoparticles (GNPs) injected in a body for dose enhancement in radiation therapy are known to form clusters. We investigated the dependence of dose enhancement on the GNP morphology using Monte-Carlo simulations and compared the model predictions with experimental data. The cluster morphology was approximated as a body-centred cubic (BCC) structure by placing GNPs at the 8 corners and the centre of a cube with an edge length of 0.22-1.03 µm in a 4 × 4 × 4 µm3 water-filled phantom. We computed the dose enhancement ratio (DER) for 50 and 260 kVp photons as a function of the distance from the cube centre for 12 different cube sizes. A 10 nm-wide concentric shell shaped detector was placed up to 100 nm away from a GNP at the cube centre. For model validation, simulations based on BCC and nanoparticle random distribution (NRD) models were performed using parameters that corresponded to the experimental conditions, which measured increases in the relative biological effect due to GNPs. We employed the linear quadratic model to compute cell surviving fraction (SF) and sensitizer enhancement ratio (SER). The DER is inversely proportional to the distance to the GNPs. The largest DERs were 1.97 and 1.80 for 50 kVp and 260 kVp photons, respectively. The SF predicted by the BCC model agreed with the experimental value within 10%, up to a 5 Gy dose, while the NRD model showed a deviation larger than 10%. The SERs were 1.21 ± 0.13, 1.16 ± 0.11, and 1.08 ± 0.11 according to the experiment, BCC, and NRD models, respectively. We most accurately predicted the GNP radiosensitization effect using the BCC approximation and suggest that the BCC model is effective for use in nanoparticle dosimetry.

Efficacy of Photon-induced Photoacoustic Streaming in the Reduction of Enterococcus faecalis within the Root Canal: Different Settings and Different Sodium Hypochlorite Concentrations.

INTRODUCTION: The purpose of this study was to determine the effectiveness of laser-activated irrigation by photon-induced photoacoustic streaming (PIPS) in the reduction of Enterococcus faecalis in root canal disinfection, varying laser energy output, and sodium hypochlorite (NaOCl) concentration. For effective removal of the smear layer, the sequence and resting time of the final irrigation steps were modified compared with the standard PIPS protocol. METHODS: Eighty-six extracted single-rooted teeth were mechanically prepared, sterilized, and inoculated with E. faecalis for 4 weeks. Teeth were divided into 9 groups and treated with an Er:YAG laser using a PIPS 600/9 tip at the following parameters: 10 mJ or 20 mJ, 15 Hz, and a 50-microsecond pulse duration at 0.15 W or 0.3 W average power, respectively. Root canals were irrigated with different concentrations of NaOCl (ie, 1%, 3%, and 5% and activated using the adjusted PIPS protocol). The bacterial count was performed immediately after and 48 hours after decontamination and new incubation on an agar plate. RESULTS: A statistically significant difference in bacterial counts (P < .05) was detected in all groups before and directly after the treatment and in groups treated with 5% NaOCl 48 hours after treatment. Scanning electron microscopic imaging showed an absence of bacteria and biofilm in the scanned areas after treatment with 5% NaOCl. CONCLUSIONS: Laser-activated irrigation using 5% NaOCl and a modified PIPS protocol resulted in effective eradication of the bacterial biofilm and removal of the smear layer.

High performance modelling of the transport of energetic particles for photon radiotherapy.

This work consists of the validation of a new Grid Based Boltzmann Solver (GBBS) conceived for the description of the transport and energy deposition by energetic particles for radiotherapy purposes. The entropic closure and a compact mathematical formulation allow our code (M1) to calculate the delivered dose with an accuracy comparable to the Monte-Carlo (MC) codes with a computational time that is reduced to the order of few minutes without any special processing power requirement. A validation protocol with heterogeneity inserts has been defined for different photon sources. The comparison with the MC calculated depth-dose curves and transverse profiles of the beam at different depths shows an excellent accuracy of the M1 model.

Collision-kerma conversion between dose-to-tissue and dose-to-water by photon energy-fluence corrections in low-energy brachytherapy.

The AAPM TG-43 brachytherapy dosimetry formalism, introduced in 1995, has become a standard for brachytherapy dosimetry worldwide; it implicitly assumes that charged-particle equilibrium (CPE) exists for the determination of absorbed dose to water at different locations, except in the vicinity of the source capsule. Subsequent dosimetry developments, based on Monte Carlo calculations or analytical solutions of transport equations, do not rely on the CPE assumption and determine directly the dose to different tissues. At the time of relating dose to tissue and dose to water, or vice versa, it is usually assumed that the photon fluence in water and in tissues are practically identical, so that the absorbed dose in the two media can be related by their ratio of mass energy-absorption coefficients. In this work, an efficient way to correlate absorbed dose to water and absorbed dose to tissue in brachytherapy calculations at clinically relevant distances for low-energy photon emitting seeds is proposed. A correction is introduced that is based on the ratio of the water-to-tissue photon energy-fluences. State-of-the art Monte Carlo calculations are used to score photon fluence differential in energy in water and in various human tissues (muscle, adipose and bone), which in all cases include a realistic modelling of low-energy brachytherapy sources in order to benchmark the formalism proposed. The energy-fluence based corrections given in this work are able to correlate absorbed dose to tissue and absorbed dose to water with an accuracy better than 0.5% in the most critical cases (e.g. bone tissue).

The energy dependence of the lateral dose response functions of detectors with various densities in photon-beam dosimetry.

The lateral dose response function is a general characteristic of the volume effect of a detector used for photon dosimetry in a water phantom. It serves as the convolution kernel transforming the true absorbed dose to water profile, which would be produced within the undisturbed water phantom, into the detector-measured signal profile. The shape of the lateral dose response function characterizes (i) the volume averaging attributable to the detector's size and (ii) the disturbance of the secondary electron field associated with the deviation of the electron density of the detector material from the surrounding water. In previous work, the characteristic dependence of the shape of the lateral dose response function upon the electron density of the detector material was studied for 6 MV photons by Monte Carlo simulation of a wall-less voxel-sized detector (Looe et al 2015 Phys. Med. Biol. 60 6585-07). This study is here continued for 60Co gamma rays and 15 MV photons in comparison with 6 MV photons. It is found (1) that throughout these photon spectra the shapes of the lateral dose response functions are retaining their characteristic dependence on the detector's electron density, and (2) that their energy-dependent changes are only moderate. This appears as a practical advantage because the lateral dose response function can then be treated as practically invariant across a clinical photon beam in spite of the known changes of the photon spectrum with increasing distance from the beam axis.