Validation of the Elekta iBEAM Evo couchtop modeling in the Monaco treatment planning system.

Recently, carbon fiber (CF) has prevailed as the primary material used in radiotherapy couchtops. Modern couchtops incorporate the CF sandwich design, in which 2 thin CF plates sandwich an air-equivalent polymeric foam. Developments in radiotherapy necessitate irradiation from posterior angles through the couchtop. However, the presence of the couchtop needs proper modeling in the treatment planning system (TPS) due to attenuation; otherwise, the tumor dose is reduced. In the current study, an effort was made with the intent of finding the optimum electron density (ED) values for Elekta's iBEAM Evo couchtop components (CF and Foam Core (FC)) for its proper modeling in Monaco TPS. Also, the attenuation of the beam due to the couchtop's presence was investigated. A cylindrical phantom with an ionization chamber positioned at the isocenter was utilized for the measurements. The phantom was placed centrally on the iBEAM Evo couchtop and was irradiated with an Elekta Infinity linear accelerator's 6, 10, and 15 MV photon beams. The gantry angle was set at 0o and from 120o to 180o with an increment of 10o. The same procedure was designed and followed in Monaco TPS. Measured and calculated dose values were compared by calculating percentage deviation (PD). Attenuation has also been calculated using the measurements of the experimental setup and the Monaco calculations. The values of ED that provided the optimum agreement between measured and Monaco-calculated dose values while minimizing PD were 0.55 g/cm3 for CF, and 0.1 g/cm3 for FC. The maximum values of PD for the beams of 6, 10, and 15 MV were -0.62%, +1,78%, and +2.35%, respectively, for a 5 × 5 cm2 field size. Furthermore, Monaco predicted attenuation from 1.83% to 6.26% (calculated values), while from the measurements, an attenuation from 1.44% to 5.75% (measured values) regarding the posterior angles was found. Thus, good agreement was verified between the TPS calculations and experimental measurements. Elekta's iBEAM Evo couchtop modeling was successfully validated in Monaco TPS. The couchtop's presence alters the patient's dose regarding irradiation from the posterior angles. Due to the attenuation of the beam, proper incorporation, modeling, and validation of the couchtop are necessary to improve the radiotherapy outcome and ensure that each patient receives the optimal treatment.

Estimation of the risk of secondary cancer in the thyroid gland and the breast outside the treated volume in patients undergoing brain, mediastinum and breast radiotherapy.

The purpose of this study was to measure the peripheral dose which is the absorbed dose in organs located outside the treatment volume such as the thyroid gland and the breast in patients undergoing radiotherapy, utilising the MOSFET dosemeters, as well as to estimate the probability of secondary cancer. The thyroid gland doses, expressed as a percentage of the prescribed dose (%TD), were measured to be 2.0±0.3 %, in whole brain irradiation, 10.0±8.0 % in mediastinum treatment and 8.0±2.0 and 2.0±0.8 % in breast treatment, with and without the supraclavicular irradiation, respectively, with a corresponding risk of 0.2, 2.0, 1.0 and 0.3 %. The dose to the breast was 7.0±2.0 %, in the mediastinum treatment, and 4.0±1.0 and 2.0±0.8 %, in the breast treatment, with and without supraclavicular irradiation, respectively, with a corresponding risk of 4.0, 2.0 and 1.0 %. Although the results indicate that the risk is not negligible, its significance should be considered in conjunction with the existing pathology and age of the patients.

Ionizing radiation affects epidermal growth factor receptor signalling and metalloproteinase secretion in glioma cells.

BACKGROUND: The effect of different doses of X(-)rays on apoptosis, proliferation, epidermal growth factor receptor (EGFR) and matrix metalloproteinase (MMP-2) expression was investigated in a human glioblastoma cell line. MATERIALS AND METHODS: The cell line LN18 was irradiated at room temperature with doses ranging from 0.5 to 15 Gy using 6 MV X(-)rays. Apoptosis was assessed using the annexin V binding assay, proliferation by the methyl tetrazolium (MTT) assay and MMP-2 secretion with zymography. The levels of phosphorylated (pEGFR) were estimated using a commercially available ELISA kit. RESULTS: Cell proliferation decreased in a dose-dependent manner, while apoptosis was increased after radiation. Doses below 2 Gy did not affect proliferation or apoptosis. MMP-2 levels were increased 48 h after radiation in a dose-dependent manner. In contrast, EGFR signaling was significantly activated 15 min after radiation in a dose-dependent manner. CONCLUSION: Ionizing radiation activates EGFR signalling and enhances MMP-2 secretion, suggesting that the molecular pathways involved may contribute to the invasiveness and malignant behaviour of glioma cells and help to explain the response of gliomas to ionizing radiation.

Peripheral dose measurement in high-energy photon radiotherapy with the implementation of MOSFET.

AIM: To study the peripheral dose (PD) from high-energy photon beams in radiotherapy using the metal oxide semiconductor field effect transistor (MOSFET) dose verification system. METHODS: The radiation dose absorbed by the MOSFET detector was calculated taking into account the manufacturer's Correction Factor, the Calibration Factor and the threshold voltage shift. PD measurements were carried out for three different field sizes (5 cm × 5 cm, 10 cm × 10 cm and 15 cm × 15 cm) and for various depths with the source to surface distance set at 100 cm. Dose measurements were realized on the central axis and then at distances (1 to 18 cm) parallel to the edge of the field, and were expressed as the percentage PD (% PD) with respect to the maximum dose (d(max)). The accuracy of the results was evaluated with respect to a calibrated 0.3 cm(3) ionization chamber. The reproducibility was expressed in terms of standard deviation (s) and coefficient of variation. RESULTS: % PD is higher near the phantom surface and drops to a minimum at the depth of d(max), and then tends to become constant with depth. Internal scatter radiation is the predominant source of PD and the depth dependence is determined by the attenuation of the primary photons. Closer to the field edge, where internal scatter from the phantom dominates, the % PD increases with depth because the ratio of the scatter to primary increases with depth. A few centimeters away from the field, where collimator scatter and leakage dominate, the % PD decreases with depth, due to attenuation by the water. The % PD decreases almost exponentially with the increase of distance from the field edge. The decrease of the % PD is more than 60% and can reach up to 90% as the measurement point departs from the edge of the field. For a given distance, the % PD is significantly higher for larger field sizes, due to the increase of the scattering volume. Finally, the measured PD obtained with MOSFET is higher than that obtained with an ionization chamber with percentage differences being from 0.6% to 34.0%. However, when normalized to the central d(max) this difference is less than 1%. The MOSFET system, in the early stage of its life, has a dose measurement reproducibility of within 1.8%, 2.7%, 8.9% and 13.6% for 22.8, 11.3, 3.5 and 1.3 cGy dose assessments, respectively. In the late stage of MOSFET life the corresponding values change to 1.5%, 4.8%, 11.1% and 29.9% for 21.8, 2.9, 1.6 and 1.0 cGy, respectively. CONCLUSION: Comparative results acquired with the MOSFET and with an ionization chamber show fair agreement, supporting the suitability of this measurement for clinical in vivo dosimetry.

External beam radiation therapy reduces the rate of re-stenosis in patients treated with femoral stenting: results of a randomised study.

BACKGROUND AND PURPOSE: To evaluate the feasibility and efficacy of external beam irradiation (EBI) for the prevention of re-stenosis due to neointimal hyperplasia, after percutaneous transluminal angioplasty (PTA) and stent placement of the superficial femoral artery. PATIENTS AND METHODS: A total of 60 patients with the diagnosis of superficial femoral artery stenoses or occlusions due to peripheral arterial obstructive disease underwent PTA and implantation of a self-expandable stent at their superficial femoral artery. After the procedure, patients were randomised and 30 of them received EBI (6 MV photons, total dose 24 Gy in six fractions in 2 weeks), while the rest 30 received no radiation therapy. RESULTS: EBI was technically feasible in all patients, without serious radiation related side effects. Overall, a statistically significant difference was observed in stenosis categories between the two groups at 6 months follow-up (P=0.04). More specifically, significantly more patients in the control group presented with stenosis greater or equal than 70% [EBI group 30% (9/30); control group 66.7% (20/30); P=0.009]. This difference in the percentage of re-stenosis had as a consequence significantly lower re-intervention rates among the patients of the irradiated group [17% (5/30) versus 47% (14/30); P=0.025] during the 6 months follow-up period. We also observed that the irradiated patients had re-stenosis at the stent ends, while the non-irradiated had re-stenosis at the stent ends and the lumen. Three of the irradiated patients, who discontinued the anti-platelet treatment, have shown thrombosis of the irradiated artery during the first month from the completion of the treatment. CONCLUSIONS: It is our belief that EBI is a feasible, safe and effective method for the prevention of neointimal hyperplasia at the superficial femoral artery. Further studies are deemed necessary to optimise the radiotherapy schedule.