CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk.

Background: The purpose of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation with special focus on dose to organs at risk (OARs). Materials and methods: Treatment plans of thirty-one patients treated with MIBT were selected and additional CK plans were created on the same CT images. The OARs included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left sided cases. The fractionation was identical (4 × 6.25 Gy). Dose-volume parameters were calculated for both techniques and compared. Results: The D90 of the PTV for MIBT and CK were similar (102.4% vs. 103.6%, p = 0.0654), but in COIN the MIBT achieved lower value (0.75 vs. 0.91, p < 0.001). Regarding the V100 parameter of non-target breast CK performed slightly better than MIBT (V100: 1.1% vs. 1.6%), but for V90, V50 and V25 MIBT resulted in less dose. Every examined parameter of ipsilateral lung, skin, ribs and contralateral lung was significantly smaller for MIBT than for CK. Protection of the heart was slightly better with MIBT, but only the difference of D2cm3 was statistically significant (17.3% vs. 20.4%, p = 0.0311). There were no significant differences among the dose-volume parameters of the contralateral breast. Conclusion: The target volume can be properly irradiated by both techniques with high conformity and similar dose to the OARs. MIBT provides more advantageous plans than CK, except for dose conformity and the dosimetry of the heart and contralateral breast. More studies are needed to analyze whether these dosimetrical findings have clinical significance.

Normal tissue sparing using different techniques for prostate irradiation.

AIM: The aim of this study was to investigate normal tissue sparing through dosimetric parameters of normal tissue volumes using different irradiation techniques for conventional (CFRT) and simultaneously integrated boost (SIB) schedules. BACKGROUND: Several dose-escalation studies for localized prostate cancer (PCa) have shown advanced biochemical relapse-free (bRFS) rates and also better local control for higher total doses using either CFRT or SIB schedules. Besides the most important organs-at-risk, absorbed dose reduction of other surrounding normal tissues are also preferable. In order to analyse the normal tissue sparing, dosimetric parameters of different normal tissue volumes were examined. MATERIALS AND METHODS: Treatment plans for 15 high risk prostate cancer patients were created using RapidArc (RA), Sliding Window (SW) IMRT and 4-field box (3D-CRT) technique. In order to evaluate normal tissue sparing, the volume of pelvic region was divided into six normal tissue cylinders with 1 cm wall thickness, located in each other. RESULTS: All plans met the criteria of target coverage (V95%>95%). All techniques provided the same results for OARs except 3D-CRT for rectum and bilateral femoral heads. The values of V5, V10 and V15 increased in cases which included RapidArc technique and decreased for V20 and V30. CONCLUSIONS: The dosimetric parameters for the cylindrical normal tissue volumes show that using RapidArc technique gives equal or slightly better normal tissue sparing and SIB provided the same normal tissue sparing as CFRT planned with RapidArc.

Medical physics in Europe following recommendations of the International Atomic Energy Agency.

BACKGROUND: Medical physics is a health profession where principles of applied physics are mostly directed towards the application of ionizing radiation in medicine. The key role of the medical physics expert in safe and effective use of ionizing radiation in medicine was widely recognized in recent European reference documents like the European Union Council Directive 2013/59/EURATOM (2014), and European Commission Radiation Protection No. 174, European Guidelines on Medical Physics Expert (2014). Also the International Atomic Energy Agency (IAEA) has been outspoken in supporting and fostering the status of medical physics in radiation medicine through multiple initiatives as technical and cooperation projects and important documents like IAEA Human Health Series No. 25, Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (2013) and the International Basic Safety Standards, General Safety Requirements Part 3 (2014). The significance of these documents and the recognition of the present insufficient fulfilment of the requirements and recommendations in many European countries have led the IAEA to organize in 2015 the Regional Meeting on Medical Physics in Europe, where major issues in medical physics in Europe were discussed. Most important outcomes of the meeting were the recommendations addressed to European member states and the survey on medical physics status in Europe conducted by the IAEA and European Federation of Organizations for Medical Physics. CONCLUSIONS: Published recommendations of IAEA Regional Meeting on Medical Physics in Europe shall be followed and enforced in all European states. Appropriate qualification framework including education, clinical specialization, certification and registration of medical physicists shall be established and international recommendation regarding staffing levels in the field of medical physics shall be fulfilled in particular. European states have clear legal and moral responsibility to effectively transpose Basic Safety Standards into national legislation in order to ensure high quality and safety in patient healthcare.

[Dosimetric comparison of different techniques for external beam accelerated partial breast irradiation]. / Modern besugárzási technikák dozimetriai összehasonlítása gyorsított részleges külsõ emlõbesugárzásnál.

The aim of this article is to evaluate and compare four different radiotherapy techniques of accelerated partial breast irradiation (APBI) considering planning quality, dosimetric and practical aspects. The investigated techniques are three dimensional conformal radiotherapy (3D-CRT), "step and shoot" (SS) and "sliding window" (SW) intensity-modulated radiotherapy, intensity-modulated arc therapy (RA). CT scans of 10 patients previously treated with APBI were selected for the study. Surgical clips were placed on the borders of the tumour bed during breast conserving surgery. Target volume (PTV) was defined as enlarged CTV, which was created from the tumour bed through volume expansion using individual margins. Planning objectives were set up according to the international recommendations. Non-coplanar fields were used only for the 3D-CRT plans. For each plan homogeneity, conformity and plan quality indices were calculated from volumetric and dosimetric parameters of target volumes and organs at risk. The total monitor units and feasibility were also investigated. There was no significant difference in the coverage of the target volume by the prescribed dose between the techniques. SW plans were significantly more homogeneous (HI=0.033) than the 3D-CRT (HI=0.057) and the RA (HI=0.073) plans. The homogeneity of the SS technique (HI=0.053) did not differ significantly compared to others. The conformity of the 3D-CRT technique was significantly worse (CN=0.62) than that of SS (CN=0.85), SW (CN=0.85) and RA (CN=0.86) plans. There was a significant difference between RA (29.4%) and 3D-CRT (44.1%) and SW (35.6%) plans in the V50% of the ipsilateral breast. Mean V10% of the ipsilateral lung in 3D-CRT (10.1%) plans was significantly lower than in SS (34.3%), SW (34.3%) and RA (35.3%) plans. 3D-CRT technique provided the best heart protection. The shortest treatment times were achieved with RA technique. Good target volume coverage and tolerable dose to the organs at risk are achievable with all four techniques. Taking into account all the aspects, we recommend the sliding window IMRT technique for accelerated partial breast irradiation.

[Investigating the clinical applicability of EBT2 self-developing films]. / Az EBT2 önhívó filmek sugárterápiás klinikai alkalmazhatóságának vizsgálata.

The purpose of the study was to investigate the physical properties of the EBT2 radiochromic films and define the conditions of its clinical applicability. We irradiated the films with different treatment techniques 3D conformal (3DCRT), intensity-modulated (IMRT) and stereotactic body radiotherapy with arc therapy (SBRT), and then compared the data with the dose distribution exported from the treatment planning system (Eclipse). Two film analysis softwares were investigated for the comparison: PTW Mephysto and FilmQA Pro. The comparisons of dose distributions were performed with gamma analysis, and the gamma criterion was 3%, 3mm, and 2%, 2mm. The gamma analysis results by the two programs were the following, (PTW/FilmQA Pro) with 3%, 3mm gamma criterion: 3DCRT (95,5/100%), IMRT (97/99,9%), SBRT (99,7/100%). In case of 2%, 2mm the results were: 3DCRT (87,1/98,9%), IMRT (92/98,5%), SBRT (96,7/97,9%). Based on the results it can be stated that during proper use, the features of the scanner do not affect the results. Both evaluation softwares are suitable for calibrating and evaluating films, moreover, performing the gamma analysis. The EBT2 film is suitable for the two-dimensional controlling of radiation therapy plans.

Moving gantry method for electron beam dose profile measurement at extended source-to-surface distances.

A novel method has been put forward for very large electron beam profile measurement. With this method, absorbed dose profiles can be measured at any depth in a solid phantom for total skin electron therapy. Electron beam dose profiles were collected with two different methods. Profile measurements were performed at 0.2 and 1.2 cm depths with a parallel plate and a thimble chamber, respectively. 108cm × 108 cm and 45 cm × 45 cm projected size electron beams were scanned by vertically moving phantom and detector at 300 cm source-to-surface distance with 90° and 270° gantry angles. The profiles collected this way were used as reference. Afterwards, the phantom was fixed on the central axis and the gantry was rotated with certain angular steps. After applying correction for the different source-to-detector distances and incidence of angle, the profiles measured in the two different setups were compared. Correction formalism has been developed. The agreement between the cross profiles taken at the depth of maximum dose with the 'classical' scanning and with the new moving gantry method was better than 0.5 % in the measuring range from zero to 71.9 cm. Inverse square and attenuation corrections had to be applied. The profiles measured with the parallel plate chamber agree better than 1%, except for the penumbra region, where the maximum difference is 1.5%. With the moving gantry method, very large electron field profiles can be measured at any depth in a solid phantom with high accuracy and reproducibility and with much less time per step. No special instrumentation is needed. The method can be used for commissioning of very large electron beams for computer-assisted treatment planning, for designing beam modifiers to improve dose uniformity, and for verification of computed dose profiles.

[Dosimetry analysis of intensity-modulated and conformal radiation therapy for head and neck tumors]. / Intenzitásmodulált és konformális besugárzási tervek dozimetriai elemzése fej-nyak tumorok külsõ besugárzásánál.

The aim of the study was to compare different treatment plans - intensity-modulated and conformal - for head and neck cancer patients. Treatment plans were developed for ten head and neck cancer patients by applying four different techniques: two conventional 3D conformal plans (forward treatment planning, with two opposing fields 90o-270o and one asymmetric anterior field, matching in isocenter /Conv/, conformal parotis sparing plans /ConPas/), 3D conformal plans with inverse treatment planning techniques /INVCRT/ and intensity-modulated radiation therapy plans /IMRT/. The plans were made for the same target volumes PTV50 (elective) and PTV66 (boost-16 Gy). The cumulative dose was 66 Gy, and the Philips Pinnacle3 v8.0m TPS was used for treatment planning. The organs at risk (OAR) were as follows: spinal cord, brain stem, left and right parotis and oral cavity. The dose constrains and conditions for optimization were determined for IMRT techniques with 7 fields. During the optimization we applied two different protocols: in one case the plans were made by 40 segments for "step and shoot" IMRT techniques and by 14 segments for INVCRT, which were converted into static fields. The homogeneity (HI) and conformity (COIN) indices were calculated for planning target volumes and the comparisons were assessed on several dosimetric parameters for OARs. The IMRT, INVCRT, Conv and ConPas techniques for PTV50 planning target volume gave the following values for homogeneity index: 0.13, 0.18, 0.22, 0.19, and for conformity index: 0.76, 0.68, 0.13, 0.09. The spinal cord received a maximum of 38 Gy, 42 Gy, 45 Gy and 44 Gy for the PTV66. Mean doses of the oral cavity outside the target volume were 33 Gy, 36 Gy, 30 Gy and 48 Gy. When the 16 Gy boost treatment was applied on one side only, the mean dose for the parotis on the contralateral side was 28 Gy, 31 Gy, 49 Gy and 43 Gy, while 39 Gy, 41 Gy, 59 Gy and 53 Gy on the same side. The objectives of adequate target coverage and sparing of critical structures were fulfilled only with IMRT technique. Although the sparing of the oral cavity was the most effectively provided by the traditional technique - due to the arrangement of the fields - it gave the worst results regarding the parotis and the target volume. The highest dose for the oral cavity was given by the ConPas technique, which can cause serious early and late side effects. By increasing the number of segments for IMRT at a reasonable level, the dose for OARs can be reduced.

[Imaging protocols for the management of respiratory motions in the radiotherapy planning for early stage lung cancer patients]. / Légzomozgást figyelembe vevo képalkotó protokollok alkalmazása korai stádiumú tüdodaganatos betegek besugárzástervezésénél.

The aim of our work is to present the imaging techniques used at the National Institute of Oncology for taking into consideration the breathing motion at radiation therapy treatment planning. Internationally recommended imaging techniques, such as 4D CT, respiratory gating and ITV (Internal Target Volume) definition were examined. The different imaging techniques were analysed regarding the delivered dose during imaging, the required time to adapt the technique, and the necessary equipment. The differences in size of PTVs (Planning Target Volume) due to diverse volume defining methods were compared in 5 cases. For 4D CT breath monitoring is crucial, which requires special equipment. To decrease the relatively high exposure of 4D CT it is possible to scan only a few predefined breathing phases. The possible positions of the tumour can be well approximated with CT scans taken in the inhale maximum, the exhale maximum and in intermediate phase. The intermediate phase can be exchanged with an ordinary CT image set, and the extreme phase CT images can be ensured by given verbal instructions for the patient. This way special gating equipment is not required. Based on these 3 breathing phases an ITV can be defined. Using this ITV definition method the margin between the CTV (Clinical Target Volume) and the PTV can be reduced by 1 cm. Using this imaging protocol PTV can be reduced by 30%. A further 10% PTV reduction can be achieved with respiratory gating. In the routine clinical practice respiratory motion management with a 3-phase CT-imaging protocol the PTV for early-stage lung cancer can be significantly reduced without the use of 4D CT and/or respiratory gating. For special, high precision treatment techniques 4D CT is recommended.

[Intraoperative and post-implant dosimetry in patients treated with permanent prostate implant brachytherapy]. / Intraoperatív és posztimplantációs dozimetria összehasonlítása permanens implantációs prosztata-brachyterápiával kezelt betegeknél.

The purpose of our work was to compare intraoperative and four-week post-implant dosimetry for loose and stranded seed implants for permanent prostate implant brachytherapy. In our institute low-dose-rate (LDR) prostate brachytherapy is performed with encapsulated I-125 isotopes (seeds) using transrectal ultrasound guidance and metal needles. The SPOT PRO 3.1 (Elekta, Sweden) system is used for treatment planning. In this study the first 79 patients were treated with loose seed (LS) technique, the consecutive patients were treated with stranded seed (SS) technique. During intraoperative planning the dose constraints were the same for both techniques. All LSs were placed inside the prostate capsule, while with SS a 2 mm margin around the prostate was allowed for seed positioning. The prescribed dose for the prostate was 145 Gy. This study investigated prostate dose coverage in 30-30 randomly selected patients with LS and SS. Four weeks after the implantation native CT and MRI were done and CT/MRI image fusion was performed. The target was contoured on MRI and the plan was prepared on CT data. To assess the treatment plan dose-volume histograms were used. For the target coverage V100, V90, D90, D100, for the dose inhomogeneity V150, V200, and the dose-homogeneity index (DHI), for dose conformality the conformal index (COIN) were calculated. Intraoperative and postimplant plans were compared. The mean V100 values decreased at four-week plan for SS (97% vs. 84%) and for LS (96% vs. 80%) technique, as well. Decrease was observed for all parameters except for the DHI value. The DHI increased for SS (0.38 vs. 0.41) and for LS (0.38 vs. 0.47) technique, as well. The COIN decreased for both techniques at four-week plan (SS: 0.63 vs. 0.57; LS: 0.67 vs. 0.50). All differences were significant except for the DHI value at SS technique. The percentage changes were not significant, except the COIN value. The dose coverage of the target decreased significantly at four-week plans for both techniques. The decrease was larger for LS technique, but the difference between techniques was not significant at this patient number. The dose distribution was more homogenous, but the conformality was worse at four-week plans.

Dosimetric inter-institutional comparison in European radiotherapy centres: Results of IAEA supported treatment planning system audit.

BACKGROUND AND PURPOSE: One of the newer audit modalities operated by the International Atomic Energy Agency (IAEA) involves audits of treatment planning systems (TPS) in radiotherapy. The main focus of the audit is the dosimetry verification of the delivery of a radiation treatment plan for three-dimensional (3D) conformal radiotherapy using high energy photon beams. The audit has been carried out in eight European countries - Estonia, Hungary, Latvia, Lithuania, Serbia, Slovakia, Poland and Portugal. The corresponding results are presented. MATERIAL AND METHODS: The TPS audit reviews the dosimetry, treatment planning and radiotherapy delivery processes using the 'end-to-end' approach, i.e. following the pathway similar to that of the patient, through imaging, treatment planning and dose delivery. The audit is implemented at the national level with IAEA assistance. The national counterparts conduct the TPS audit at local radiotherapy centres through on-site visits. TPS calculated doses are compared with ion chamber measurements performed in an anthropomorphic phantom for eight test cases per algorithm/beam. A set of pre-defined agreement criteria is used to analyse the performance of TPSs. RESULTS: TPS audit was carried out in 60 radiotherapy centres. In total, 190 data sets (combination of algorithm and beam quality) have been collected and reviewed. Dosimetry problems requiring interventions were discovered in about 10% of datasets. In addition, suboptimal beam modelling in TPSs was discovered in a number of cases. CONCLUSIONS: The TPS audit project using the IAEA methodology has verified the treatment planning system calculations for 3D conformal radiotherapy in a group of radiotherapy centres in Europe. It contributed to achieving better understanding of the performance of TPSs and helped to resolve issues related to imaging, dosimetry and treatment planning.

On dosimetric characteristics of detectors for relative dosimetry in small fields: a multicenter experimental study.

Objective. In this multicentric collaborative study, we aimed to verify whether the selected radiation detectors satisfy the requirements of TRS-483 Code of Practice for relative small field dosimetry in megavoltage photon beams used in radiotherapy, by investigating four dosimetric characteristics. Furthermore, we intended to analyze and complement the recommendations given in TRS-483.Approach. Short-term stability, dose linearity, dose-rate dependence, and leakage were determined for 17 models of detectors considered suitable for small field dosimetry. Altogether, 47 detectors were used in this study across ten institutions. Photon beams with 6 and 10 MV, with and without flattening filters, generated by Elekta Versa HDTMor Varian TrueBeamTMlinear accelerators, were used.Main results. The tolerance level of 0.1% for stability was fulfilled by 70% of the data points. For the determination of dose linearity, two methods were considered. Results from the use of a stricter method show that the guideline of 0.1% for dose linearity is not attainable for most of the detectors used in the study. Following the second approach (squared Pearson's correlation coefficientr2), it was found that 100% of the data fulfill the criteriar2> 0.999 (0.1% guideline for tolerance). Less than 50% of all data points satisfied the published tolerance of 0.1% for dose-rate dependence. Almost all data points (98.2%) satisfied the 0.1% criterion for leakage.Significance. For short-term stability (repeatability), it was found that the 0.1% guideline could not be met. Therefore, a less rigorous criterion of 0.25% is proposed. For dose linearity, our recommendation is to adopt a simple and clear methodology and to define an achievable tolerance based on the experimental data. For dose-rate dependence, a realistic criterion of 1% is proposed instead of the present 0.1%. Agreement was found with published guidelines for background signal (leakage).

Dose indices of kilovoltage cone beam computed tomography for various image guided radiotherapy protocols.

Varian Halcyon (HA) linear accelerators (LINAC) require kilovoltage cone-beam computed tomography (CT) acquisition for all patients before all treatment fractions. The aim of this study is to compare dose indices of various available protocols with different calculation and measurement methods. CT dose index (CTDI) in mGy is a measure of the radiation dose output of a CT scanner. A pencil ionisation chamber was used to measure dose index free air and in a standard CTDI phantom for different imaging protocols of HA and TrueBeam LINACs. For the point measurements, we found large deviations between displayed and calculated low CTDI values: 26.6 and 27.1% at Head low dose and Breast protocol, respectively. The calculated values were always larger than the displayed ones for all protocols and measurement setups. For the point measurements similar results were found as in the international literature, where the displayed values the measured CTDIs.

EFOMP policy statement 18: Medical physics education for the non-physics healthcare professions.

Although Medical Physics educators have historically contributed to the education of the non-physics healthcare professions, their role was not studied in a systematic manner. In 2009, EFOMP set up a group to research the issue. In their first paper, the group carried out an extensive literature review regarding physics teaching for the non-physics healthcare professions. Their second paper reported the results of a pan-European survey of physics curricula delivered to the healthcare professions and a Strengths-Weaknesses-Opportunities-Threats (SWOT) audit of the role. The group's third paper presented a strategic development model for the role, based on the SWOT data. A comprehensive curriculum development model was subsequently published, whilst plans were laid to develop the present policy statement. This policy statement presents mission and vision statements for Medical Physicists teaching non-physics users of medical devices and physical agents, best practices for teaching non-physics healthcare professionals, a stepwise process for curriculum development (content, method of delivery and assessment), and summary recommendations based on the aforementioned research studies.

Verification of an optimizer algorithm by the beam delivery evaluation of intensity-modulated arc therapy plans.

BACKGROUND: In the case of dynamic radiotherapy plans, the fractionation schemes can have dosimetric effects. Our goal was to define the effect of the fraction dose on the plan quality and the beam delivery. MATERIALS AND METHODS: Treatment plans were created for 5 early-stage lung cancer patients with different dose schedules. The planned total dose was 60 Gy, fraction dose was 2 Gy, 3 Gy, 5 Gy, 12 Gy and 20 Gy. Additionally renormalized plans were created by changing the prescribed fraction dose after optimization. The dosimetric parameters and the beam delivery parameters were collected to define the plan quality and the complexity of the treatment plans. The accuracy of dose delivery was verified with dose measurements using electronic portal imaging device (EPID). RESULTS: The plan quality was independent from the used fractionation scheme. The fraction dose could be changed safely after the optimization, the delivery accuracy of the treatment plans with changed prescribed dose was not lower. According to EPID based measurements, the high fraction dose and dose rate caused the saturation of the detector, which lowered the gamma passing rate. The aperture complexity score, the gantry speed and the dose rate changes were not predicting factors for the gamma passing rate values. CONCLUSIONS: The plan quality and the delivery accuracy are independent from the fraction dose, moreover the fraction dose can be changed safely after the dose optimization. The saturation effect of the EPID has to be considered when the action limits of the quality assurance system are defined.

[Dosimetric analysis of LINAC based stereotactic irradiation of brain tumours in CIRS SHANE phantom]. / Lineáris gyorsítóval végzett agyi sztereotaxiás besugárzások terveinek dozimetriai elemzése CIRS SHANE fantomban.

The aim of the study was to compare the different stereotactic treatment plans and dose calculation algorithms for small targets with film dosimetry in anthropomorphic phantom. Treatment plans were prepared for multiple targets with single setup isocenter. Plans for three different irradiation techniques were generated using conformal arc with four non-coplanar arcs, RapidArc with two coplanar full arcs and RapidArc with four non-coplanar arcs in the Varian Eclipse v13.7.16 TPS. Conformal arc and RapidArc plans were calculated using AAA, Acuros XBDm and XBDw algorithms. Conformity index, gradient index and dose maximum were calculated for all PTVs. All measurements were made on the Varian TrueBeam linear accelerator. Comparison between computed and measured dose distributions was performed with gamma evaluation criteria of 3%, 3 mm; 3%, 1 mm and 2%, 2 mm. According to our results, the Eclipse AAA and AXB algorithms provide accurate dose distributions for homogeneous cranial irradiation.

[Biological dose estimation for photons of different qualities in radiation therapy]. / Biológiai dózisbecslés a sugárterápiában alkalmazott különbözo sugárminoségu fotonnyaláboknál.

Flattening filter free mode (FFF) has been introduced in radiotherapy during the past decades, however, not much has been reported on its radiobiological effect. The purpose of our study was to compare the radiobiological effects of flattening filter and flattening filter free photon beams on chromosomal aberrations in peripheral blood lymphocytes. In our study the blood of the same healthy donor was irradiated with linear accelerator using both conventional flattening filter (FF) and FFF photon beams at dose rate of 3.57-23.08 Gy/min, using 6 or 10 MV. The dose-response calibration curves for dicentric + ring chromosomes induced by irradiation were fitted with linear-quadratic model. CABAS (Chromosomal Aberration Calculation Software) was used to prepare the curves. The coefficients and equations of the curves were calculated and compared with the results of other authors. We found significant differences in the number of aberrations at different irradiation parameters. Based on our results, FFF mode has a 10-20% higher biological effect than FF mode. These results can be used during radiotherapy or to estimate the biological doses in case of an accidental exposure to radiation.

Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk.

BACKGROUND: The aim of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation (APBI) especially concerning the dose of organs at risk (OAR-s). PATIENTS AND METHODS: Treatment plans of thirty-two MIBT and CK patients were compared. The OAR-s included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left-sided cases. The fractionation was identical (4 x 6.25 Gy) in both treatment groups. The relative volumes (e.g. V100, V90) receiving a given relative dose (100%, 90%), and the relative doses (e.g. D0.1cm3, D1cm3) delivered to the most exposed small volumes (0.1 cm3, 1 cm3) were calculated from dose-volume histograms. All dose values were related to the prescribed dose (25 Gy). RESULTS: Regarding non-target breast CK performed slightly better than MIBT (V100: 0.7% vs. 1.6%, V50: 10.5% vs. 12.9%). The mean dose of the ipsilateral lung was the same for both techniques (4.9%), but doses irradiated to volume of 1 cm3 were lower with MIBT (36.1% vs. 45.4%). Protection of skin and rib was better with MIBT. There were no significant differences between the dose-volume parameters of the heart, but with MIBT, slightly larger volumes were irradiated by 5% dose (V5: 29.9% vs. 21.2%). Contralateral breast and lung received a somewhat higher dose with MIBT (D1cm3: 2.6% vs. 1.8% and 3.6% vs. 2.5%). CONCLUSIONS: The target volume can be properly irradiated by both techniques with similar dose distributions and high dose conformity. Regarding the dose to the non-target breast, heart, and contralateral organs the CK was superior, but the nearby organs (skin, ribs, ipsilateral lung) received less dose with MIBT. The observed dosimetric differences were small but significant in a few parameters at the examined patient number. More studies are needed to explore whether these dosimetric findings have clinical significance.

Influence of sample preparation optimization on the accuracy of dose assessment of an automatic non-fluorescent MN scoring system.

PURPOSE: Automatizing the scoring of the cytokinesis-blocked micronucleus assay spares a lot of valuable time. The dose-effect relationship can be applied reliably for dose estimation if the quality of the slides is the same from the perspective of the used image processing algorithm. This aspect brings in additional requirements against the quality of the slides compared to the conventional visual scoring. MATERIALS AND METHODS: An add-in software was created to the non-fluorescent RS-MN automatic MN scoring system which is capable of measuring quantitatively the degree of typical anomalies. The image processing is less reliable when the presence of these anomalies is more frequent. The behavior of the designed sample quality parameters (SQPs) was tested on in vitro irradiated peripheral blood samples (0, 1, and 2 Gy) obtained from a healthy donor and also on samples from patients undergoing low dose-rate brachytherapy. RESULTS: We examined 20 different SQPs and identified two that are independent and correlate significantly with the error of the fully automatic MN frequency. One is related to the size of the cells and the other reflects the homogeneity of the environment. An equation was established which presents a connection between the error of the auto MN frequency and the SQPs. By adding a fourth cleaning step to the conventional sample preparation and changing the pre-dripping temperature of the slide, the SQP can be modified, and consequently, the sample quality can be improved. The gain in accuracy is 54 ± 10 MN per 1000 binucleated cells, which corresponds to the effects of 0.5 Gy. Around the lowest limit of detection (<0.5 Gy), it means a 50-100% drop in the error of dose, which is significant. With sample quality harmonization, the positive predictive value was raised to 80-93% depending on the dose. CONCLUSIONS: With the technique described in this paper, the suitability for automated scoring of a micronucleus slide can be tested quantitatively and objectively. A method is presented with which in some cases the uncertainty of the assessed doses due to variance in sample quality can be decreased or if it is not possible its bias can be predicted. The proposed protocol leads to more reliable estimation of dose. The SQPs are designed in a way that they have the potential to be adapted to similar systems.

Relationship between biodosimetric parameters and treatment volumes in three types of prostate radiotherapy.

Brachytherapy (BT) and external beam radiotherapy (EBRT) apply different dose rates, overall treatment times, energies and fractionation. However, the overall impact of these variables on the biological dose of blood is neglected. As the size of the irradiated volume influences the biological effect as well, we studied chromosome aberrations (CAs) as biodosimetric parameters, and explored the relationship of isodose surface volumes (ISVs: V1%, V1Gy, V10%, V10Gy, V100%, V150%) and CAs of both irradiation modalities. We performed extended dicentrics assay of lymphocytes from 102 prostate radiotherapy patients three-monthly for a year. Aberration frequency was the highest after EBRT treatment. It increased after the therapy and did not decrease significantly during the first follow-up year. We showed that various types of CAs 9 months after LDR BT, 3 months after HDR BT and in a long time-range (even up to 1 year) after EBRT positively correlated with ISVs. Regression analysis confirmed these relationships in the case of HDR BT and EBRT. The observed differences in the time points and aberration types are discussed. The ISVs irradiated by EBRT showed stronger correlation and regression relationships with CAs than the ISVs of brachytherapy.

A scanning and image processing system with integrated design for automated micronucleus scoring.

Purpose: Our aim was to design a compact and cost-effective optical microscopic system for automated non-fluorescent micronucleus (MN) scoring whose performance can reach the accuracy of visual scoring with the help of minimal user interaction and also gives an option for fully automatic scoring with an accuracy suitable for triage purposes.Materials and methods: The concept of Radometer MN-Series (RS-MN) microscopic system designed by Radosys was to develop hardware and software layers in parallel in order to optimize the performance in automated MN scoring. A MN assay slide is automatically scanned by the RS-MN then the binucleated cells and micronuclei are automatically identified. Processing 1000 cells takes 10-60 minutes by automatic scoring (scanning plus image processing) depending on sample quality and required accuracy. The manual revision of the cell gallery takes an extra 10 minutes per sample. Dose response curves are determined for manual, automatic and semi-automatic scoring methods.Results: The combination of object-sensitive autofocusing method and the multi-layer image acquisition is able to reduce the minimum resolvable dose by 14%. The MN yields obtained from the manual, semi-automatic and automatic scoring methods are well correlating (Pearson's correlation coefficients are between 0.977 and 0.998). In order to compare the reliability of the results of visual and automatic scoring, an extended analysis on uncertainty contributors was performed. For a dose of 1 Gy, the estimated relative uncertainty from the Poisson characteristics of MN yield is 17-19% for the manual and 20-38% for the automated scoring. Other uncertainty factors (differences in donor radiosensitivity, scorer performance, and sample preparations) can contribute to this error fall within a similar range: 3-16%. Taking into account all of the possible uncertainties, the minimum resolvable dose for the manual (0.48 Gy) is the two-thirds of that of the automatic scoring (0.61 Gy).Conclusions: The results verify that the fully automatic mode of RS-MN is suitable for triage purposes. The performance of the user interacted semi-automatic mode is comparable with the reference manual scoring. Its performance reaches up to other non-fluorescent automatic systems and offers a compact and cost-effective alternative.