Trade-off between breast dose and image quality using composite bismuth shields in computed tomography: A phantom study.

INTRODUCTION: Many researchers have suggested that bismuth composite shields (BCS) reduce breast dose remarkably; however, the level of this reduction and its impact on image quality has not been assessed. This study aimed to evaluate the efficiency of nano- and micro- BCS in reducing the dose and image quality during chest computed tomography (CT) scans. MATERIALS AND METHODS: Bismuth shields composed of 15 weighting percentage (wt%) and 20 wt% bismuth oxide (Bi2O3) nano- and micro-particles mixed in silicon rubber polymer were constructed in 1 and 1.5 mm thicknesses. The physical properties of nanoparticles were assessed using a scanning electron microscope (SEM), X-ray diffraction (XRD), and energy-dispersive X-ray (EDX). Breast radiation doses were measured experimentally during chest CT using PMMA standard dosimetry phantom (body phantom, 76-419-4150, Fluke Biomedical) in the presence of the shields. The image quality was assessed by calculating signal and noise values in different regions. RESULTS: The SEM images showed that the average size of Bi2O3 nano- and micro-particles was about 70 nm and 150 µm, respectively. The breast doses were reduced by increasing the shield thickness/bismuth weight percentage. The maximum dose reduction was related to the 20% weight of Bi2O3 nano-particles and a thickness of 1.5 mm. The minimum dose reduction was related to the 15% weight of Bi2O3 micro-particles with a thickness of 1 mm. The mean noise was higher in nano-particle bismuth shields than in micro-particles. CONCLUSION: Composite shields containing bismuth nano- and micro-particles can reduce the breast dose during chest CT examinations while negatively impacting diagnostic image quality. Several critical factors, such as bismuth concentration, particle size, and shield thickness, directly affect the efficiency.

Shielding performance of multi-metal nanoparticle composites for diagnostic radiology: an MCNPX and Geant4 study.

Lead-free polymer composite shields are used in diagnostic radiology to protect patients from unnecessary radiation exposure. This study aimed to examine and introduce the radiation-shielding properties of single- and multi-metal nanoparticle (NP)-based composites containing Bi, W, and Sn using Geant4, MCNPX, and XCom for radiological applications. The mass attenuation coefficients and effective atomic numbers of single- and multi-metal NP-loaded polymer composites were calculated using the Geant4 and MCNPX simulation codes for X-ray energies of 20-140 keV. The nano-sized fillers inside the polydimethylsiloxane (PDMS:C2H6SiO) matrix included W (K = 69.5 keV), Bi (K = 90.5 keV), and Sn (K = 29.20 keV). For single-metal shields, one filler was used, while in multi-metal shields, two fillers were required. The MCNPX and Geant4 simulation results were compared with the XCom results. The multi-metal NP composites exhibited higher attenuation over a larger energy range owing to their attenuation windows. In addition, Bi2O3 + WO3 NPs showed a 39% higher attenuation at 100-140 keV, and that of Bi2O3 + SnO2 NPs was higher at 40-60 keV. Meanwhile, the WO3 + SnO2 NPs exhibited lower attenuation. The difference between the results obtained using Geant4 and XCom was less than 2%, because these codes have similar simulation structures. The results show that the shielding performance of the Bi2O3 + WO3 filler is better than that of the other single- and multi-metal fillers. In addition, it was found that the Geant4 code was more accurate for simulating radiation composites.

Image Quality and Pulmonary Nodule Detectability at Low-dose Computed Tomography (low kVp and mAs): A phantom study.

Background: Nowadays, there has been a growing demand for low-dose computed tomography (LDCT) protocols. CT has a critical role in the management of the diagnosis chain of pulmonary disease, especially in lung cancer screening. There have been introduced several dose reduction methods, however, most of them are time-consuming, intricate, and vendor-based strategies that are hardly used in clinics routinely. This study aims to evaluate the image quality and pulmonary nodule detectability of LDCT protocols that are feasible and easy implemented. Image quality was analyzed in a general quality control phantom (Gammex) and then in a manmade lung phantom with nodules-equivalent objects. Methods: This study was designed in a two steps, in the first step, a feasible low-dose lung CT protocol was selected with quality assessment of accreditation phantom image. In the second step, the selected low-dose protocol with an appropriate image quality was performed on a manmade lung phantom in which there were objects equivalent to the pulmonary nodule. Finally, image quality parameters of the phantom at the appropriate scan protocol were compared with the standard protocol. Results: A reduction of about 17% of kVp and 46% in tube current leads to dose reduction by about 70%. The contrast-to-noise ratio in the low-dose protocol remained almost unchanged. The signal-to-noise ratio in the low-dose protocol decreased by approximately 32%, and the noise level has increased by about 1.5 times. However, this reduction method hardly affected the detectability of nodules in man-made pulmonary phantom. Conclusions: Here, we demonstrated that the LDCT scan has an insignificant effect on the perception of lung nodules. In this study, patient dose in lung CT was reduced by modifying of kVp and mAs about approximately 70%. Hence, to step in toward low-dose strategies in medical imaging clinics, using easy-implemented and feasible low-dose strategies may be helpful.

Predicting the Risk of Radiation Pneumonitis and Pulmonary Function Changes after Breast Cancer Radiotherapy.

BACKGROUND: Radiotherapy plays an important role in the treatment of breast cancer. In the process of radiotherapy, the underling lung tissue receives higher doses from treatment field, which led to incidence of radiation pneumonitis. OBJECTIVE: The present study aims to evaluate the predictive factors of radiation pneumonitis and related changes in pulmonary function after 3D-conformal radiotherapy of breast cancer. MATERIAL AND METHODS: In prospective basis study, thirty-two patients with breast cancer who received radiotherapy after surgery, were followed up to 6 months. Respiratory symptoms, lung radiologic changes and pulmonary function were evaluated. Radiation pneumonitis (RP) was graded according to common terminology criteria for adverse events (CTCAE) version 3.0. Dose-volume parameters, which included percentage of lung volume receiving dose of d Gy (V5-V50) and mean lung dose (MLD), were evaluated for RP prediction. Pulmonary function evaluated by spirometry test and changes of FEV1 and FVC parameters. RESULTS: Eight patients developed RP. Among the dose-volume parameters, V10 was associated to RP incidence. When V10<40% and V10≥40% the incidences of RP were 5.26% and 61.54%, respectively. The FEV1 and FVC had a reduction 3 and 6 months after radiotherapy, while only FEV1 showed significant reduction. The FEV1 had more reduction in the patients who developed RP than patients without RP (15.25±3.81 vs. 9.2±0.93). CONCLUSION: Pulmonary function parameters, especially FEV1, significantly decreased at 3 and 6 months after radiotherapy. Since most patients with breast cancer who developed RP did not show obvious clinical symptoms, so spirometry test is beneficial to identify patients with risk of radiation pneumonitis.

Evaluating the radioprotective effect of Cimetidine, IMOD, and hybrid radioprotectors agents: An in-vitro study.

INTRODUCTION: There are various radioprotective agents with different mechanisms that help to decrease ionizing radiation side effects. The radioprotective effect of Cimetidine and IMOD was assessed individually and compared with the hybrid radioprotectors agents (HRPAs-IMOD and Cimetidine) on human lymphocyte cells. METHODS: Twenty healthy volunteers (ten men and ten women) participated in the present study. About 75 mL peripheral blood lymphocytes from each individual were collected, and they were divided into 36 groups. Briefly, the blood samples were treated with different concentrations of Cimetidine (12.6 and 25.2 µg/mL) and IMOD (0.04, 0.08, and 0.12 mg/mL), and also a combination of these agents, namely hybrid radioprotectors agents (HRPAs). Besides, the irradiated groups were exposed to 2 and 4 Gy of Co-60 gamma irradiation. The amount of cellular damage was assessed using the micronucleus assay. The repeated measurements and paired T-test statistical analysis were used to compare the micronucleus frequencies in different groups. RESULTS: The micronucleus frequencies were significantly reduced (p < 0.05) in irradiated groups when the non-toxic concentrations of Cimetidine, IMOD, and HRPAs have been used. The reduction in micronucleus frequency was obtained 5-29% for Cimetidine and 40-51% for IMOD in peripheral blood lymphocytes irradiated with 2 Gy. This reduction in 4 Gy irradiation was 8-17% for Cimetidine and 27-37% for IMOD. The HRPAs resulted in a higher radioprotective effect, in a way that they cause up to 58% and 43% micronucleus frequency reduction in 2 and 4 Gy, respectively. CONCLUSION: In conclusion, the HRPAs showed the highest level of radioprotective. In addition, IMOD was remarkably higher radioprotective than Cimetidine, which may be related to its greater non-toxic concentrations.

Functional response difference between diabetic/normal cancerous patients to inflammatory cytokines and oxidative stresses after radiotherapy.

Diabetes, which is considered as a chronic metabolic disorder leads to an increase in inflammatory cytokines and oxidative stresses. Studies have shown several functional differences in the oxidative stress and inflammatory cytokines responses in diabetic/normal cancerous patients candidate for radiotherapy. Also, radiotherapy as a cancer treatment modality is known as a carcinogen due to oxidative damage via generation of reactive oxygen metabolites and also causing inflammation of the tissue by increasing the inflammatory cytokines. Therefore, the consequence of diabetes on oxidative stress and increased inflammatory factors and synergistic effects of radiotherapy on these factors cause complications in diabetics undergoing radiotherapy. It is considered as one of the most interesting objectives to control inflammation and oxidative stress in these patients. This review aims to concentrate on the influence of factors such as MPO, MDA, IL-1ß, and TNF-α in diabetic patients by emphasizing the effects related to radiation-induced toxicity and inflammation by proposing therapeutic approaches which could be helpful in reduction of the complications.

Influence of the size of nano- and microparticles and photon energy on mass attenuation coefficients of bismuth-silicon shields in diagnostic radiology.

Recent studies have shown that the particle size of the shielding material and photon energy has significant effects on the efficiency of radiation-shielding materials. The purpose of the current study was to investigate the shielding properties of the bismuth-silicon (Bi-Si) composite containing varying percentages of micro- and nano-sized Bi particles for low-energy X-rays. Radiation composite shields composed of nano- and micro-sized Bi particles in Si-based matrix were constructed. The mass attenuation coefficients of the designed shields were experimentally assessed for diagnostic radiology energy range. In addition, the mass attenuation coefficients of the composite were comprehensively investigated using the MCNPX Monte Carlo (MC) code and XCOM. The X-ray attenuation for two different micro-sized Bi composites of radii of 50 µm and 0.50 µm showed enhancement in the range of 37-79% and 5-24%, respectively, for mono-energy photons (60-150 keV). Furthermore, the experimental and MC results indicated that nano-structured composites had higher photon attenuation properties (approximately 11-18%) than those of micro-sized samples for poly-energy X-ray photons. The amount of radiation attenuation for lower energies was more than that of higher energies. Thus, it was found that the shielding properties of composites were considerably strengthened by adding Bi nano-particles for lower energy photons.

Interpretation of In-air Output Ratio of Wedged Fields in Different Measurement Conditions.

BACKGROUND: The collimator scatter factor (Sc) is one of the most important parameters in monitor unit (MU) calculation. There are several factors that impact Sc values, including head structures, backscatter in dose monitoring chambers, and wedges. The objective of this study was to investigate the variation of Sc with different buildup cap materials, wall thickness of buildup caps, source-to-chamber distances (SCDs), ionization chambers, and wedge angles in 6 MV photon beam. METHODS: In this study, copper and Perspex buildup caps were made with two different thicknesses for each buildup cap. Measurements were performed on an Elekta Compact medical linear accelerator (6 MV) using RK dosimeter with a sensitive volume of 0.120 cm3 and Farmer-type ion chamber with a sensitive volume of 0.65 cm3. In all measurements, buildup caps and ionization chambers were positioned such as to stand vertically to the beam central axis. It was also investigated the effect of internal wedge with different angles (30° and 60°) different SCDs on Sc. RESULTS: It was found in large field sizes, Sc values in Perspex buildup cap were higher than copper. Different SCDs and type of ion chamber and wall thickness of buildup caps had no significant influence on Sc values. The presence of wedge influenced Sc values significantly. Variation of Sc in wedged fields compared to open fields had a maximum deviation of 0.9% and 6.8% in 30° and 60° wedge angles, respectively. CONCLUSION: It was found that the presence of wedges had a significant influence on Sc and increases with wedge angles. As such, it should be taken into account in manual MU calculations.

Use of bismuth shield for protection of superficial radiosensitive organs in patients undergoing computed tomography: a literature review and meta-analysis.

The study aimed to assess the effect of bismuth (Bi) shielding on dose reduction and image quality in computed tomography (CT) through a literature review. A search was conducted in the following databases: Web of Science, PubMed, Google Scholar, and Scopus. Studies that reported estimated dose reduction with bismuth shielding during imaging of the eye, thyroid, and breast were included, and a meta-regression analysis was used to examine the influence of the CT scanner type on the dose reduction. The studies included a total of 237 patients and 34 pediatric and adult anthropomorphic phantoms for whom the radiation dose was reported. Bismuth shielding was recommended in 88.89% of the studies based on the maintenance of appropriate image quality under shielding. Noise associated with Bi shielding was 7.5%, 263%, and 23.5% for the eye, thyroid, and breast, respectively. The fixed-effects pooled estimate of dose reduction was 34% (95% CI: 13-55; p < 0.001) for the eye, 37% (95% CI 14-61; p < 0.001) for the thyroid, and 36% (95% CI 36-55; p < 0.001) for the breast. The image quality, usage of foams, CT scanner type, beam energies, and backscatter radiation were important factors that directly affected the efficacy of Bi shielding to reduce the radiation dose at the superficial radiosensitive organs.

Bismuth-Silicon and Bismuth-Polyurethane Composite Shields for Breast Protection in Chest Computed Tomography Examinations.

The article aims at constructing protective composite shields for breasts in chest computed tomography and investigating the effects of applying these new bismuth composites on dose and image quality. Polyurethane and silicon with 5% of bismuth were fabricated as a protective shield. At first, their efficiency in attenuating the X-ray beam was investigated by calculating the total attenuation coefficients at diagnostic energy range. Then, a physical chest phantom was scanned without and with these shields at tube voltage of 120 kVp, and image parameters together with dose values were studied. The results showed that these two shields have great effects on attenuating the X-ray beam, especially for lower energies (<40 kV), and in average, the attenuation coefficients of bismuth-polyurethane composite are higher in this energy range. The maximum relative differences between the average Hounsfield units (HUs) and noises of images without and with shield for both composites in 13 regions of interest were 4.5% and 15.7%, respectively. Moreover, primary investigation confirmed the ability of both shields (especially polyurethane-bismuth composite) in dose reduction. Comparing these two composites regarding the amount of dose reduction, the changes in HU and noise, and attenuation coefficients in diagnostic energy range, it seems that polyurethane composite is more useful for dose reduction, especially for higher tube voltages.

Near-Infrared Visual Differentiation in Normal and Abnormal Breast Using Hemoglobin Concentrations.

Introduction: Near-infrared (NIR) optical imaging is a non-ionizing modality that is emerging as a diagnostic/prognostic tool for breast cancer according to NIR differentiation of hemoglobin (Hb) concentration. Methods: The transmission values of LED-sourced light at 625 nm were measured by power meter to evaluate the optical properties of Hb in breast phantom containing major and minor vessels. For the simulation of blood variations in cancerous breast condition, we prepared 2 concentrations of pre-menopausal Hb and 4 concentrations of post-menopausal Hb and, for comparison with normal tissue, one concentration of Hb injected inside the phantom's vessels. Imaging procedure on the phantom was also conducted by LED source and CCD camera. The images from the experiments were compared with the results obtained from the images analyzed by MATLAB software. Finally, mammography of phantom including various concentration of Hb was prepared. Results: The transmitting intensities of NIR in blood containing 1, 2 and 4 concentrations of Hb in the major vessels were 52.83±2.85, 43.00±3.11 and 31.17±2.27 µW, respectively, and in minor vessels containing similar Hb concentrations were 73.50±2.43, 60.08±5.09 and 42.42±4.86 µW, respectively. The gray-scale levels on the major vessel were about 96, 124, 162 and on the minor vessel about 72, 100, 130 measured for 1, 2 and 4 Hb concentrations, respectively. The sensitivity and specificity of NIR imaging differentiation were 97.4% and 91.3%, respectively. Conclusion: Significant differences in transmitting intensity, optical imaging as well as software analysis of images were observed for 1, 2 and 4 concentrations of Hb in major and minor breast phantom vessels. Differentiation capability of minor vessels was higher than major vessels for Hb concentrations. Despite a good detection for location of vessels by mammography, it could not show differences between vessels with various concentrations. However, NIR optical imaging demonstrated a good image contrast for showing vessels in terms of concentration. This study recommends NIR optical imaging for prescreening breast cancer due to its potential for early diagnosis.

Estimating cancer induction risk from abdominopelvic scanning with 6- and 16-slice computed tomography.

PURPOSE: The biological effects of ionizing radiation (BEIR VII) report estimates that the risk of getting cancer from radiation is increased by about a third from current regulation risk levels. The propose of this study was to estimate cancer induction risk from abdominopelvic computed tomography (CT) scanning of adult patients using 6- and 16-slice CT scanners. MATERIALS AND METHODS: A cross-sectional study on 200 patients with abdominopelvic CT scan in 6- and 16-slice scanners was conducted. The dose-length product (DLP) and volume CT Dose Index (CTDIvol) values from the scanners as well as the effective dose values from the ImPACT CT patient dosimetry calculator with the biological effects of ionizing radiation (BEIR VII) method were used to estimate the cancer induction risk. RESULTS: The mean (and standard deviation) values of CTDIvol and DLP were 6.9 (±1.07) mGy and 306.44 (± 60.57) mGy.cm for 6-slice, and 5.19 (±0.91) mGy and 219.7 (±49.31) mGy.cm for 16-slice scanner, respectively. The range of effective dose in the 6-slice scanner was 2.61-8.15 mSv and, in the 16-slice scanner, it was 1.47-4.72 mSv. The mean and standard deviation values of total cancer induction risk in abdominopelvic examinations were 0.136 ± 0.059% for men and 0.135 ± 0.063% for women in the 6-slice CT scanner. The values were 0.126 ± 0.051% for men and 0.127 ± 0.056% for women in the 16-slice scanner. CONCLUSIONS: The cancer induction risk of abdominopelvic scanning was noticeable. Therefore, radiation dose should be minimized by optimizing the protocols and applying appropriate methods.

Assessing Absorption Coefficient of Hemoglobin in the Breast Phantom Using Near-Infrared Spectroscopy.

BACKGROUND: Blood concentrations and oxygen saturation levels are important biomarkers for breast cancer diagnosis. OBJECTIVES: In this study, the absorption coefficient of hemoglobin (Hb) was used to distinguish between normal and abnormal breast tissue. MATERIALS AND METHODS: A near-infrared source (637 nm) was transmitted from major and minor vessels of a breast phantom containing 2×, 4× concentrations of oxy- and deoxy-Hb. The absorption coefficients were determined from spectrometer (SM) and powermeter (PM) data. RESULTS: The absorption coefficients were 0.075 ± 0.026 cm-1 for oxygenated Hb (normal) in major vessels and 0.141 ± 0.023 cm-1 at 4× concentration (abnormal) with SM, whereas the breast absorption coefficients were 0.099 ± 0.017 cm-1 for oxygenated Hb (normal) in minor vessels and 0.171 ± 0.005 cm-1 at 4× concentrations with SM. A comparison of the data obtained using a SM and a PM was not significant statistically. CONCLUSION: The study of the absorption coefficient data of different concentrations of Hb in normal and abnormal breasts via the diffusion of near-infrared light is a valuable method and has the potential to aid in early detection of breast abnormalities with SM and PM in major and minor vessels.

Relation between Mammographic Parenchymal Patterns and Breast Cancer Risk: Considering BMI, Compressed Breast Thickness and Age of Women in Tabriz, Iran.

BACKGROUND: Mammographic density determined according paranchymal patterns is a risk factor for breast cancer and its relationships with body and other breast characteristics of women is important. The purpose of the present study was to correlate breast parenchymal patterns and mammography abnormality findings with women's BMI, compressed breast thickness (CBT) and age in Tabriz city, Iran. MATERIALS AND METHODS: From 1,100 mammograms interpreted by radiologists, breast parenchymal was classified into four categories from Types 1 (mostly fatty) through 4 (mostly fibroglandular tissue). Age, BMI, and CBT were recorded and their relation with risk for the development of breast abnormalities in mammograms was analyzed. RESULTS: In women with a mean age of 45.8±8.63 years 17.7% were in the high density group (Type 3 and 4). A comparison of four types of breast paranchymal with BMI, CBT and age showed inverse relations to breast density. Abnormal mammographic findings were 25.8% of all reported mammograms with a circular mass (12.7%) as the most common abnormality. About 21% abnormal cases were in less than 40 years. Increasing of BMI had significant relation with breast abnormality but in CBT was not observed. CONCLUSIONS: Measurement of women's body characteristics is useful for assistance in mammography diagnosis as well as selection of imaging instrument by high sensitivity for following patient in future. The effects of age, CBT and BMI groups on the breast paranchymal were significant.

Comparative Efficacy of Four Imaging Instruments for Breast Cancer Screening.

Sensitivity and specificity are the two most important indicators in selection of medical imaging devices for cancer screening. Breast images taken by conventional or digital mammography, ultrasound, MRI and optical mammography were collected from 2,143,852 patients. They were then studied and compared for sensitivity and specificity results. Optical mammography had the highest sensitivity (p<0.001 and p<0.006) except with MRI. Digital mammography had the highest specificity for breast cancer imaging. A comparison of specificity between digital mammography and optical mammography was significant (p<0.021). If two or more breast diagnostic imaging tests are requested the overall sensitivity and specificity will increase. In this literature review study patients at high-risk of breast cancer were studied beside normal or sensitive women. The image modality performance of each breast test was compared for each.

Evaluation of mean glandular dose in a full-field digital mammography unit in Tabriz, Iran.

This study was aimed at evaluating the mean glandular dose (MGD) and affecting factors during mammography examinations by a full-field digital mammography unit. An extensive quality control program was performed to assure that the unit is properly working. Required information including compressed breast thickness (CBT), breast parenchymal pattern and technical factors used for imaging were recorded. An entrance skin exposure measurement was also performed using slabs of polymethylmethacrylate with 2-8 cm thickness. On the basis of recorded information and measured data, the MGD was estimated for 1145 mammography examinations obtained from 298 patients. Mean CBTs of 4.9 and 5.8 cm and MGDs of 2 and 2.4 mGy were observed for craniocaudal and mediolateral oblique views, respectively. Significant correlation was seen between MGD and CBT, breast parenchymal pattern and applied kVp and mAs.

A study on the impact of operator experience on the patient radiation exposure in coronary angiography examinations.

The aim of the current study was to investigate the effect of cardiologists' experience on the patient received dose during coronary angiography. The exposure parameters including fluoroscopy time, total kerma-area product (KAP), total air-kerma, fluoroscopy and cine acquisition KAP and air-kerma for five senior cardiologists with the experience of 6-10 y were recorded. The range of values for fluoroscopy time and total KAP were 2.17- 4.19 min and 12.06-21.06 Gy cm(2), respectively, in our diagnostic coronary examinations, which was below the recommended reference values. The differences among cardiologists were analysed statistically using one-way ANOVA test. The fluoroscopy KAP and air-kerma results showed statistically significant differences between cardiologists. However, the experience of the cardiologists showed no relation with patient received dose. According to the results, training in radiation protection as a requisite for interventional cardiologists was recommended.

Comparison of radiation dose to patient and staff for two interventional cardiology units: a phantom study.

The purpose of this investigation was to measure the patient and staff dose during routine interventional cardiology procedures for an image intensifier-based and a flat detector system using a water phantom. The Integris BH3000 image intensifier-based (Philips) and the Axiom Artis flat detector-based (Siemens) angiography units were used in this study. The accuracy of tubes potential and irradiation timers and also internal dosimeters were verified and confirmed. A water phantom with a thickness of 18 cm was used for patient and staff dose measurements. For the Philips system, phantom entrance dose rates were 2.77 and 38.97 microGym(2) s(-1) during fluoroscopy and cineangiography. The respective dose rates for the Siemens were 1.98 and 13.46 microGym(2) s(-1). Phantom entrance dose rate was 28.5 and 65% higher for the Philips system during fluoroscopy and cineangiography, respectively. Comparing the scattered dose rates at the operator location showed that the flat detector-based Siemens system delivers five times lower dose to the operator in comparison with the image intensifier-based Philips unit. The results suggest that the decrease in received dose of the patient and staff is achievable using the flat detector system. In addition, application of lead curtain and glass is recommended to lower the cardiologist dose especially for the image intensifier-based Philips system.

Surface fluids effects on the bladder tissue characterisation using electrical impedance spectroscopy.

The electrical impedance of the human urinary bladder in both benign and malignant areas can be measured using an electrical impedance spectroscopy system (EIS). Glycine is usually used in the bladder surgery in the theatre to make an insulation medium for electro-surgery and the extension of the mucosa. In addition, a saline solution is usually used to wash the inside of the bladder after bladder surgery and it is used to extend the bladder tissue mucosa. Therefore, the effect of glycine and the saline solution that fills the bladder is important, because it was expected that the application of common surface fluids (air, saline solution and glycine solution) in the bladder epithelium would affect the measured electrical impedance of the urothelium, to differentiate the malignant area from the normal bladder tissue. In this study, bladders were removed from the patients' bodies and then were moved from theatre to the histopathology department immediately after excision. These bladder samples were then opened and pinned to a corkboard to take the impedance readings, using the impedance spectroscopy system. Following this, the bladder and corkboard were completely submerged in a saline solution and readings were taken at about 1cm from the sutures. Subsequently, this procedure was repeated with the bladder submerged in glycine and then air, respectively. According to the statistical work, these fluids were found to have a significant effect on the measured impedance of the bladder tissue in benign and malignant areas. Furthermore, the best fluid between air, glycine and saline, to measure the impedance of the urinary bladder, is air (P<0.0001).

Dosimetric properties of a flattening filter-free 6-MV photon beam: a Monte Carlo study.

PURPOSE: The dosimetric features of an unflattened 6-MV photon beam of an Elekta SL-25 linac was calculated by the Monte Carlo (MC) method. MATERIAL AND METHODS: The head of the Elekta SL-25 linac was simulated using the MCNP4C MC code. The accuracy of the model was evaluated using measured dosimetric features, including depth dose values and dose profiles in a water phantom. The flattening filter was then removed, and beam dosimetric properties were calculated by the MC method and compared with those of the flattened photon beam. RESULTS: Our results showed a significant (twofold) increase in the dose rate for all field sizes. Also, the photon beam spectra for an unflattened beam were softer, which led to a steeper reduction in depth doses. The decrease in the out-of-field dose and increase in the contamination electrons and a buildup region dose were the other consequences of removing the flattening filter. CONCLUSION: Our study revealed that, for recent radiotherapy techniques, the use of multileaf collimators for beam shaping removing the flattening filter could offer some advantages, including an increased dose rate and decreased out-of-field dose.