Hybrid planning techniques for hypofractionated whole-breast irradiation using flattening filter-free beams.

OBJECTIVE: The aim of this study was to assess the feasibility of flattening filter-free (FFF) photon beams in hybrid intensity-modulated radiation therapy (H-IMRT) and hybrid volumetric modulated arc therapy (H-VMAT) for left-sided whole-breast radiation therapy with a boost volume (RT) using a hypofractionated dose regimen. PATIENTS AND METHODS: RT plans of 25 patients with left-sided early-stage breast cancer were created with H­IMRT and H­VMAT techniques under breath-hold conditions using 6­MV FFF beams. In hybrid techniques, three-dimensional conformal radiotherapy (3DCRT) plans were kept as base-dose plans for the VMAT and IMRT plans. In addition, H­IMRT in step-and-shoot mode was also calculated to assess its achievability with FFF beams. RESULTS: All hybrid plans achieved the expected target coverage. H­VMAT showed better coverage and homogeneity index results for the boost target (p < 0.002), while H­IMRT presented better results for the whole-breast target (p < 0.001). Mean doses to normal tissues were comparable between both plans, while H­IMRT reduced the low-dose levels to heart and ipsilateral lung (p < 0.05). H­VMAT revealed significantly better results with regard to monitor units (MU) and treatment time (p < 0.001). CONCLUSION: The 6­MV FFF beam technique is feasible for large-field 3DCRT-based hybrid planning in whole-breast and boost planning target volume irradiation. For breath-hold patients, the H­VMAT plan is superior to H­IMRT for hypofractionated dose regimens, with reduced MU and treatment delivery time.

Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs.

PURPOSE: To find an optimal arc design for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left-sided whole breast radiation therapy. METHODS AND MATERIALS: A total of 26 left-sided early-stage breast cancer patients were selected for this study. To find the superior plan, H-VMAT with three different arc designs including, two partial arcs (2A), four partial arcs (4A) and four tangential arcs (TA) were created for each study case by combining 3DCRT and VMAT with 75% 3DCRT/25% VMAT dose proportion of prescription dose. RESULTS: All H-VMAT plans achieved the expected target coverage. A higher conformity index and homogeneity index were achieved for 2A and 4A H-VMAT plans and significantly differ from TA H-VMAT (p < 0.003). The heart and ipsilateral lung dose parameters were comparable among all plans except heart V40Gy which was significantly less in 4A H-VMAT plan (p < 0.05). The contralateral lung, contralateral breast, spinal cord, normal tissue doses and MU were significantly less in TA H-VMAT (p < 0.03). The beam-on time was significantly less in 2A H-VMAT (p < 0.0001). CONCLUSION: 2A and 4A H-VMAT techniques are effective in improving the PTV dosimetric parameters as well as reducing the OAR doses. Further, 2A H-VMAT delivers less MU and beam-on time compared to 4A H-VMAT.

Bilateral Breast Irradiation Using Hybrid Volumetric Modulated Arc Therapy (h-VMAT) Technique: A Planning Case Report.

The purpose of this planning case report is to share the perceived dosimetric benefits of innovative hybrid volumetric modulated arc therapy (h-VMAT) for bilateral breast cancer radiotherapy in two patients with synchronous bilateral breast cancer. Two patients with early bilateral breast cancer after breast conservation surgery and adjuvant chemotherapy were planned for bilateral breast radiotherapy. On the planning computed tomography (CT) dataset, bilateral breast planning treatment volume (PTV) and organs at risk (OARs) were delineated using standard guidelines. Using the same structure set, volumetric modulated arc therapy (VMAT) and h-VMAT plans were generated and compared dosimetrically. The h-VMAT showed comparable target coverage, conformity and homogeneity while sparing of both lungs and heart were better. The dose to heart was reduced with h-VMAT, with a V25Gy and V5Gy of 3.2 & 22.3% for h-VMAT versus 11.6 & 84.9% for the VMAT plan. Similarly, the dose to the total lung was better in h-VMAT with a V20Gy and V5Gy of 12.1 & 46.2 versus 19.9 & 83.3% for VMAT. Overall the results indicate a better sparing of lung and heart at low doses with h-VMAT. Long-term clinical follow-up will give us more insight about the dosimetric benefits of these innovative techniques.

Influence of cathode on the electro-generation of peroxydisulfuric acid oxidant and its application for effective removal of SO2 by room temperature electro-scrubbing process.

Peroxydisulfuric acid oxidant (H2S2O8) was electro-generated using boron doped diamond (BDD) anode in an undivided electrolytic cell under the optimized conditions and used for the oxidative removal of gaseous SO2. The influence of the nature of cathode material on the formation yield of H2S2O8 was investigated with Ti, Pt, Zr and DSA electrodes in a flow type electrolytic cell under batch recirculation mode. Among the various cathodes employed Ti exhibited a good performance and the formation yield was nearly doubled (0.19 M) compared to the reported value of 0.07 M. The optimization of electrode area ratio between the anode and cathode brought out the fact that for nearly 8 times smaller Ti cathode (8.75:1) the achieved yield was ∼65% higher than the 1:1 ratio of anode and cathode. The highest concentration of 6.8% (0.48 M) H2S2O8 was seen for 35 cm(2) BDD anode with 4 cm(2) Ti at 20 °C with the measured redox potential value of +1200 mV. The oxidative removal of SO2 in an electro-scrubbing column attached to the online production of peroxydisulfuric acid under the optimized conditions of cell parameters shows that SO2 removal efficiency was nearly 100% for 25 and 50 ppm inlet concentrations and 96% for 100 ppm at the room temperature of 25 °C.

Dosimetric comparison of Linac-based (BrainLAB®) and robotic radiosurgery (CyberKnife ®) stereotactic system plans for acoustic schwannoma.

A dosimetric comparison of linear accelerator (LA)-based (BrainLAB) and robotic radiosurgery (RS) (CyberKnife) systems for acoustic schwannoma (Acoustic neuroma, AN) was carried out. Seven patients with radiologically confirmed unilateral AN were planned with both an LA-based (BrainLAB) and robotic RS (CyberKnife) system using the same computed tomography (CT) dataset and contours. Gross tumour volume (GTV) was contoured on post-contrast magnetic resonance imaging (MRI) scan [planning target volume (PTV) margin 2 mm]. Planning and calculation were done with appropriate calculation algorithms. The prescribed isodose in both systems was considered adequate to cover at least 95% of the contoured target. Plan evaluations were done by examining the target coverage by the prescribed isodose line, and high- and low-dose volumes. Isodose plans and dose volume histograms generated by the two systems were compared. There was no statistically significant difference between the contoured volumes between the systems. Tumour volumes ranged from 380 to 3,100 mm(3). Dose prescription was 13-15 Gy in single fraction (median prescribed isodose 85%). There were no significant differences in conformity index (CI) (0.53 versus 0.58; P = 0.225), maximum brainstem dose (4.9 versus 4.7 Gy; P = 0.935), 2.5-Gy volume (39.9 versus 52.3 cc; P = 0.238) or 5-Gy volume (11.8 versus 16.8 cc; P = 0.129) between BrainLAB and CyberKnife system plans. There were statistically significant differences in organs at risk (OAR) doses, such as mean cochlear dose (6.9 versus 5.4 Gy; P = 0.001), mean mesial temporal dose (2.6 versus 1.7 Gy; P = 0.07) and high-dose (10 Gy) volume (3.2 versus 5.2 cc; P = 0.017). AN patients planned with the CyberKnife system had superior OAR (cochlea and mesial temporal lobe) sparing compared with those planned with the Linac-based system. Further evaluation of these findings in prospective studies with clinical correlation will provide actual clinical benefit from the dosimetric superiority of CyberKnife.

Destruction of commercial pesticides by cerium redox couple mediated electrochemical oxidation process in continuous feed mode.

Mediated electrochemical oxidation was carried out for the destruction of commercial pesticide formulations using cerium(IV) in nitric acid as the mediator electrolyte solution in a bench scale set up. The mediator oxidant was regenerated in situ using an electrochemical cell. The real application of this sustainable process for toxic organic pollutant destruction lies in its ability for long term continuous operation with continuous organic feeding and oxidant regeneration with feed water removal. In this report we present the results of fully integrated MEO system. The task of operating the continuous feed MEO system for a long time was made possible by continuously removing the feed water using an evaporator set up. The rate of Ce(IV) regeneration in the electrochemical cell and the consumption for the pesticide destruction was matched based on carbon content of the pesticides. It was found that under the optimized experimental conditions for Ce(III) oxidation, organic addition and water removal destruction efficiency of ca. 99% was obtained for all pesticides studied. It was observed that the Ce(IV) concentration was maintained nearly the same throughout the experiment. The stable operation for 6h proved that the process can be used for real applications and for possible scale up for the destruction of larger volumes of toxic organic wastes.

Destruction of organic pollutants by cerium(IV) MEO process: a study on the influence of process conditions for EDTA mineralization.

The mediated electrochemical oxidation (MEO) process with cerium(IV) and nitric acid as the oxidizing medium was employed for the destruction of various model organic pollutants in continuous organic feeding mode. A near complete destruction was observed for all the organics studied. The effects of various experimental conditions were evaluated with respect to EDTA mineralization. The key parameters varied in the process were concentration of EDTA (67-268 mM), temperature (70, 80 and 95 degrees C), concentrations of Ce(IV) (0.7, 0.8 and 0.95 M), nitric acid (2, 3 and 4M) and duration of organic addition (30 and 120 min). Under the experimental conditions of 80 degrees C and 0.95 M Ce(IV) in 3 M nitric acid, nearly 90% destruction was achieved based on CO(2) production and 95% based on TOC analyses for all the organic compounds studied. The in situ regeneration of mediator ion by the electrochemical cell was found to be good during the organic destruction within the range of experimental conditions studied. In the case of long term organic feeding (120 min) the destruction was calculated after the CO(2) evolution attained the steady state and under this condition the destruction efficiency was found to be 85% based on CO(2) evolution.

Mineralization of phenol by Ce(IV)-mediated electrochemical oxidation in methanesulphonic acid medium: a preliminary study.

The mediated electrochemical oxidation (MEO) process using cerium(IV) in methanesulphonic acid (MSA) as the oxidizing medium was employed for the mineralization of phenol in batch and continuous feeding modes. Although nitric acid was an extensively studied electrolyte for organic mineralization reactions in MEO processes it does possess the problem of NO(x) gas production during the reduction of nitric acid in the cathode compartment of the electrochemical cell. This problem could be circumvented by proper choice of the electrolyte medium such as MSA. The mediator cerium in MSA solution was first oxidized to higher oxidation state using an electrochemical cell. The produced Ce(IV) oxidant was then used for the destruction of phenol. It was found that phenol could be mineralized to CO2 by Ce(IV) in MSA. The evolved CO2 was continuously measured and used for the calculation of destruction efficiency. The destruction efficiency was observed to be 85% based on CO2 evolution for 1000 ppm phenol solution at 80 degrees C in continuous feed mode.

Destruction of EDTA using Ce(IV) mediated electrochemical oxidation: a simple modeling study and experimental verification.

Mediated electrochemical oxidation (MEO) is a recent development in the environmental research field for the complete destruction of organic pollutants. This study presents the destruction of EDTA by cerium(IV) MEO process in nitric acid medium. The destruction reaction was carried out in a continuous stirred tank reactor under various conditions. A simple kinetic model was developed to analyze and simulate the organic destruction in the MEO process. The model was based on the calculation of the total mass balance, the component mass balance, and the energy balance in the reactor and also in the heating jacket. The sensitivity to key operating conditions such as the initial EDTA concentration (50-200 mM), EDTA feeding time (30-180 min), reaction temperature (323-363 K), and the rate laws corresponding to zero-, first-, second-, and third-order reaction were analyzed. It was found that the model simulated agreed well with the experimental data for EDTA oxidation. The results obtained showed the suitability of the MEO process for the effective mineralization of high concentrations of EDTA.

Application of several advanced oxidation processes for the destruction of terephthalic acid (TPA).

Terephthalic acid (TPA) is widely applied as a raw material in making polyester fiber, polyethylene terephthalate (PET) bottles, polyester films, etc. TPA is toxic and is known to act as endocrine disruptor. TPA wastewater is traditionally treated by biological process and this study aims to evaluate the effectiveness of several advanced oxidation processes on TPA removal. The oxidation processes studied were: UV-TiO(2), UV-H(2)O(2), UV-H(2)O(2)-Fe, O(3), O(3)/Fe, O(3)/TiO(2), UV-O(3)-H(2)O(2)-Fe and UV-O(3)-H(2)O(2)-Fe-TiO(2). The results indicate that the time required for the complete destruction of 50 ppm of TPA can be minimized from 10h using UV-TiO(2) system, to less than 10 min by UV-H(2)O(2)-Fe-O(3) system. Some of the likely organic intermediates identified during TPA destruction include, benzoquinone, benzene, maleic acid and oxalic acid. Possible destruction pathway of TPA has been proposed. TPA degradation by various systems was also analyzed based on the reaction kinetics and operating costs.