Predicted probabilities of brain injury after carbon ion radiotherapy for head and neck and skull base tumors in long-term survivors.

BACKGROUND AND PURPOSE: We aimed to determine the risk factors for radiation-induced brain injury (RIBI1) after carbon ion radiotherapy (CIRT) to predict their probabilities in long-term survivors. MATERIALS AND METHODS: We evaluated 104 patients with head, neck, and skull base tumors who underwent CIRT in a regimen of 32 fractions and were followed up for at least 24 months. RIBI was assessed using the Common Terminology Criteria for Adverse Events. RESULTS: The median follow-up period was 45.5 months; 19 (18.3 %) patients developed grade ≥2 RIBI. The maximal absolute dose covering 5 mL of the brain (D5ml) was the only significant risk factor for grade ≥2 RIBI in the multivariate logistic regression analysis (p = 0.001). The tolerance doses of D5ml for the 5% and 50% probabilities of developing grade ≥2 RIBI were estimated to be 55.4 Gy (relative biological effectiveness [RBE]) and 68.4 Gy (RBE) by a logistic model, respectively. CONCLUSION: D5ml was most significantly associated with grade ≥2 RIBI and may enable the prediction of its probability.

Estimation of identification limit for a small-type OSL dosimeter on the medical images by measurement of X-ray spectra.

Our aim in this study is to derive an identification limit on a dosimeter for not disturbing a medical image when patients wear a small-type optically stimulated luminescence (OSL) dosimeter on their bodies during X-ray diagnostic imaging. For evaluation of the detection limit based on an analysis of X-ray spectra, we propose a new quantitative identification method. We performed experiments for which we used diagnostic X-ray equipment, a soft-tissue-equivalent phantom (1-20 cm), and a CdTe X-ray spectrometer assuming one pixel of the X-ray imaging detector. Then, with the following two experimental settings, corresponding X-ray spectra were measured with 40-120 kVp and 0.5-1000 mAs at a source-to-detector distance of 100 cm: (1) X-rays penetrating a soft-tissue-equivalent phantom with the OSL dosimeter attached directly on the phantom, and (2) X-rays penetrating only the soft-tissue-equivalent phantom. Next, the energy fluence and errors in the fluence were calculated from the spectra. When the energy fluence with errors concerning these two experimental conditions was estimated to be indistinctive, we defined the condition as the OSL dosimeter not being identified on the X-ray image. Based on our analysis, we determined the identification limit of the dosimeter. We then compared our results with those for the general irradiation conditions used in clinics. We found that the OSL dosimeter could not be identified under the irradiation conditions of abdominal and chest radiography, namely, one can apply the OSL dosimeter to measurement of the exposure dose in the irradiation field of X-rays without disturbing medical images.

Practical method for determination of air kerma by use of an ionization chamber toward construction of a secondary X-ray field to be used in clinical examination rooms.

We propose a new practical method for the construction of an accurate secondary X-ray field using medical diagnostic X-ray equipment. For accurate measurement of the air kerma of an X-ray field, it is important to reduce and evaluate the contamination rate of scattered X-rays. To determine the rate quantitatively, we performed the following studies. First, we developed a shield box in which an ionization chamber could be set at an inner of the box to prevent detection of the X-rays scattered from the air. In addition, we made collimator plates which were placed near the X-ray source for estimation of the contamination rate by scattered X-rays from the movable diaphragm which is a component of the X-ray equipment. Then, we measured the exposure dose while changing the collimator plates, which had diameters of 25-90 mm(ϕ). The ideal value of the exposure dose was derived mathematically by extrapolation to 0 mm(ϕ). Tube voltages ranged from 40 to 130 kV. Under these irradiation conditions, we analyzed the contamination rate by the scattered X-rays. We found that the contamination rates were less than 1.7 and 2.3 %, caused by air and the movable diaphragm, respectively. The extrapolated value of the exposure dose has been determined to have an uncertainty of 0.7 %. The ionization chamber used in this study was calibrated with an accuracy of 5 %. Using this kind of ionization chamber, we can construct a secondary X-ray field with an uncertainty of 5 %.

Energy dependence measurement of small-type optically stimulated luminescence (OSL) dosimeter by means of characteristic X-rays induced with general diagnostic X-ray equipment.

For X-ray inspections by way of general X-ray equipment, it is important to measure an entrance-skin dose. Recently, a small optically stimulated luminescence (OSL) dosimeter was made commercially available by Landauer, Inc. The dosimeter does not interfere with the medical images; therefore, it is expected to be a convenient detector for measuring personal exposure doses. In an actual clinical situation, it is assumed that X-rays of different energies will be detected by a dosimeter. For evaluation of the exposure dose measured by a dosimeter, it is necessary to know the energy dependence of the dosimeter. Our aim in this study was to measure the energy dependence of the OSL dosimeter experimentally in the diagnostic X-ray region. Metal samples weighing several grams were irradiated and, in this way, characteristic X-rays having energies ranging from 8 to 85 keV were generated. Using these mono-energetic X-rays, the dosimeter was irradiated. Simultaneously, the fluence of the X-rays was determined with a CdTe detector. The energy-dependent efficiency of the dosimeter was derived from the measured value of the dosimeter and the fluence. Moreover, the energy-dependent efficiency was calculated by Monte-Carlo simulation. The efficiency obtained in the experiment was in good agreement with that of the simulation. In conclusion, our proposed method, in which characteristic X-rays are used, is valuable for measurement of the energy dependence of a small OSL dosimeter in the diagnostic X-ray region.

Practical calibration curve of small-type optically stimulated luminescence (OSL) dosimeter for evaluation of entrance skin dose in the diagnostic X-ray region.

For X-ray diagnosis, the proper management of the entrance skin dose (ESD) is important. Recently, a small-type optically stimulated luminescence dosimeter (nanoDot OSL dosimeter) was made commercially available by Landauer, and it is hoped that it will be used for ESD measurements in clinical settings. Our objectives in the present study were to propose a method for calibrating the ESD measured with the nanoDot OSL dosimeter and to evaluate its accuracy. The reference ESD is assumed to be based on an air kerma with consideration of a well-known back scatter factor. We examined the characteristics of the nanoDot OSL dosimeter using two experimental conditions: a free air irradiation to derive the air kerma, and a phantom experiment to determine the ESD. For evaluation of the ability to measure the ESD, a calibration curve for the nanoDot OSL dosimeter was determined in which the air kerma and/or the ESD measured with an ionization chamber were used as references. As a result, we found that the calibration curve for the air kerma was determined with an accuracy of 5 %. Furthermore, the calibration curve was applied to the ESD estimation. The accuracy of the ESD obtained was estimated to be 15 %. The origin of these uncertainties was examined based on published papers and Monte-Carlo simulation. Most of the uncertainties were caused by the systematic uncertainty of the reading system and the differences in efficiency corresponding to different X-ray energies.

[Fabrication of improved multi-slit equipment to obtain the input-output characteristics of computed radiography systems: correction of the heel effect, and application to high tube-voltage experiments].

Multi-slit equipment is a new experimental apparatus that can measure the input-output characteristics of a CR (computed radiography) system with limited influence of the fading effect. Kimoto et al. recently proposed a new type of multi-slit apparatus in which the multi-slit setup, the insertion region of the phosphor plate, and plate shielding are integrated to create a single handy-type item (an all-in-one type multi-slit apparatus). However, some problems remained unsolved. The aims of this study were to devise a setup for application to high tube voltage conditions, and to improve the all-in-one type multi-slit equipment so as to correct the heel effect. We examined the capabilities of our improved multi-slit equipment using diagnostic X-ray apparatus and found that it can obtain input-output characteristics with 5% accuracy for tube voltages of 40-140 kV and SID (source to image receptor distances) of 50-200 cm.

[Development of all-in-one multi-slit equipment for measurements of the input-output characteristic of a phosphor plate].

An input-output characteristic curve is an essential piece of information for analyzing medical images taken using a phosphor plate. In the multi-slit method, an actuator moves shields that have numerous slits during X-ray irradiation. Numerous data can be measured by one-time irradiation, so the fading effect is negligibly small. This method was recently proposed by Takegami et al., but their equipment consisted of large multiple compositions. The aim of this study was to fabricate a new handy type equipment that combines multiple productions into one small production. In this paper, we propose an idea for downscaling the size of the equipment, and report that the same input-output characteristic is obtained using our newly proposed method.