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   Table of Contents - Current issue
October-December 2017
Volume 42 | Issue 4
Page Nos. 199-280

Online since Tuesday, December 5, 2017

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Assessment of volumetric-modulated arc therapy for constant and variable dose rates Highly accessed article p. 199
Mariluz De Ornelas-Couto, Ivaylo Mihaylov, Nesrin Dogan
DOI:10.4103/jmp.JMP_65_17  PMID:29296033
Purpose: The aim of this study is to compare the effects of dose rate on volumetric-modulated arc therapy plans to determine optimal dose rates for prostate and head and neck (HN) cases. Materials and Methods: Ten prostate and ten HN cases were retrospectively studied. For each case, seven plans were generated: one variable dose rate (VDR) and six constant dose rate (CDR) (100–600 monitor units [MUs]/min) plans. Prescription doses were: 80 Gy to planning target volume (PTV) for the prostate cases, and 70, 60, and 54 Gy to PTV1, PTV2, and PTV3, respectively, for HN cases. Plans were normalized to 95% of the PTV and PTV1, respectively, with the prescription dose. Plans were assessed using Dose-Volume-Histogram metrics, homogeneity index, conformity index, MUs, and delivery time. Results: For the prostate cases, significant differences were found for rectum D35 between VDR and all CDR plans, except CDR500. Furthermore, VDR was significantly different than CDR100 and 200 for bladder D50. Delivery time for all CDR plans and MUs for CDR400–600 were significantly higher when compared to VDR. HN cases showed significant differences between VDR and CDR100, 500 and 600 for D2 to the cord and brainstem. Significant differences were found for delivery time and MUs for all CDR plans, except CDR100 for number of MUs. Conclusion: The most significant differences were observed in delivery time and number of MUs. All-in-all, the best CDR for prostate cases was found to be 300 MUs/min and 200 or 300 MUs/min for HN cases. However, VDR plans are still the choice in terms of MU efficiency and plan quality.
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The impact of dose rate on the accuracy of step-and-shoot intensity-modulated radiation therapy quality assurance using varian 2300CD p. 206
Christopher F Njeh, Howard W Salmon, Claire Schiller
DOI:10.4103/jmp.JMP_18_17  PMID:29296034
Introduction: Intensity-modulated radiation therapy (IMRT) delivery using “step-and-shoot” technique on Varian C-Series linear accelerator (linac) is influenced by the communication frequency between the multileaf collimator and linac controllers. Hence, the dose delivery accuracy is affected by the dose rate. Aim: Our aim was to quantify the impact of using two dose rates on plan quality assurance (QA). Materials and Methods: Twenty IMRT patients were selected for this study. The plan QA was measured at two different dose rates. A gamma analysis was performed, and the degree of plan modulation on the QA pass rate was also evaluated in terms of average monitor unit per segment (MU/segment) and the total number of segments. Results: The mean percentage gamma pass rate of 94.9% and 93.5% for 300 MU/min and 600 MU/min dose rate, respectively, was observed. There was a significant (P = 0.001) decrease in percentage gamma pass rate when the dose rate was increased from 300 MU/min to 600 MU/min. There was a weak, but significant association between the percentage pass rate at both dose rate and total number of segments. The total number of MU was significantly correlated to the total number of segments (r = 0.59). We found a positive correlation between the percentage pass rate and mean MU/segment, r = 0.52 and r = 0.57 for 300 MU/min and 600 MU/min, respectively. Conclusion: IMRT delivery using step-and-shoot technique on Varian 2300CD is impacted by the dose rate and the total amount of segments.
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Grid block design based on monte carlo simulated dosimetry, the linear quadratic and Hug–Kellerer radiobiological models p. 213
Somayeh Gholami, Hassan Ali Nedaie, Francesco Longo, Mohammad Reza Ay, Sharifeh A Dini, Ali S Meigooni
DOI:10.4103/jmp.JMP_38_17  PMID:29296035
Purpose: The clinical efficacy of Grid therapy has been examined by several investigators. In this project, the hole diameter and hole spacing in Grid blocks were examined to determine the optimum parameters that give a therapeutic advantage. Methods: The evaluations were performed using Monte Carlo (MC) simulation and commonly used radiobiological models. The Geant4 MC code was used to simulate the dose distributions for 25 different Grid blocks with different hole diameters and center-to-center spacing. The therapeutic parameters of these blocks, namely, the therapeutic ratio (TR) and geometrical sparing factor (GSF) were calculated using two different radiobiological models, including the linear quadratic and Hug–Kellerer models. In addition, the ratio of the open to blocked area (ROTBA) is also used as a geometrical parameter for each block design. Comparisons of the TR, GSF, and ROTBA for all of the blocks were used to derive the parameters for an optimum Grid block with the maximum TR, minimum GSF, and optimal ROTBA. A sample of the optimum Grid block was fabricated at our institution. Dosimetric characteristics of this Grid block were measured using an ionization chamber in water phantom, Gafchromic film, and thermoluminescent dosimeters in Solid WaterTM phantom materials. Results: The results of these investigations indicated that Grid blocks with hole diameters between 1.00 and 1.25 cm and spacing of 1.7 or 1.8 cm have optimal therapeutic parameters (TR > 1.3 and GSF~0.90). The measured dosimetric characteristics of the optimum Grid blocks including dose profiles, percentage depth dose, dose output factor (cGy/MU), and valley-to-peak ratio were in good agreement (±5%) with the simulated data. Conclusion: In summary, using MC-based dosimetry, two radiobiological models, and previously published clinical data, we have introduced a method to design a Grid block with optimum therapeutic response. The simulated data were reproduced by experimental data.
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A unified dose response relationship to predict high dose fractionation response in the lung cancer stereotactic body radiation therapy p. 222
Than S Kehwar, Kashmiri L Chopra, Durg V Rai
DOI:10.4103/jmp.JMP_36_17  PMID:29296036
Aim: This study is designed to investigate the superiority and applicability of the model among the linear-quadratic (LQ), linear-quadratic-linear (LQ-L) and universal-survival-curve (USC) models by fitting published radiation cell survival data of lung cancer cell lines. Materials and Method: The radiation cell survival data for small cell (SC) and non-small cell (NSC) lung cancer cell lines were obtained from published reports, and were used to determine the LQ and cell survival curve parameters, which ultimately were used in the curve fitting of the LQ, LQ-L and USC models. Results: The results of this study demonstrate that the LQ-L(Dt-mt) model, compared with the LQ and USC models, provides best fit with smooth and gradual transition to the linear portion of the curve at transition dose Dt-mt, where the LQ model loses its validity, and the LQ-L(Dt-2α/β) and USC(Dt-mt) models do not transition smoothly to the linear portion of the survival curve. Conclusion: The LQ-L(Dt-mt) model is able to fit wide variety of cell survival data over a very wide dose range, and retains the strength of the LQ model in the low-dose range.
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Estimating second malignancy risk in intensity-modulated radiotherapy and volumetric-modulated arc therapy using a mechanistic radiobiological model in radiotherapy for carcinoma of left breast p. 234
Vasanthan Sakthivel, Ganesh Kadirampatti Mani, Sunil Mani, Raghavendiran Boopathy, Jothybasu Selvaraj
DOI:10.4103/jmp.JMP_89_17  PMID:29296037
Objectives: The aim of this study is to estimate second cancer risk (SCR) in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) using a mechanistic radiobiological model. The model also takes into account patient age at exposure and the gender-specific correction factors of SCR. Materials and Methods: Fifty IMRT and VMAT plans were selected for the study. Monte Carlo-based dose calculation engine was used for dose calculation. Appropriate model parameters were taken from the literature for the mechanistic model to calculate excess absolute risk (EAR), lifetime attributable risk, integral dose and relative risk (RR) for lungs, contralateral breast, heart, and spinal cord. Results: The mean monitor unit (MU) in IMRT and VMAT plans were 751.1 ± 133.3 and 1004.8 ± 180, respectively, for IMRT and VMAT. The mean EAR values with age correction were 44.6 ± 11.9, 11.2 ± 6.4, 5.4 ± 4.0, 1.4 ± 0.5, and 0.3 ± 0.2 for left lung, right lung, contralateral breast, heart, and spinal cord, respectively, for the IMRT treatments and 54.6 ± 20.6, 30.2 ± 12.0, 13.8 ± 8.6, 1.6 ± 0.6, and 0.9 ± 0.5 for the VMAT treatments in units of 10,000 PY. The RR of 6.7% and 9.1%, respectively, for IMRT and VMAT found in our study using computational models is in close comparison with the value reported in a large epidemiological breast cancer study. Conclusions: VMAT plans had a higher risk of developing second malignancy in lung, contralateral breast, heart, and cord compared to IMRT plans. However, the increase in risk was found to be marginal compared to IMRT. Incorporating the age correction factor decreased the risk of contralateral breast SCR. No strong correlation was found between EAR and MU.
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Melatonin ameliorates radiation-induced oxidative stress at targeted and nontargeted lung tissue p. 241
Alireza Ghobadi, Alireza Shirazi, Masoud Najafi, Masoud Heidari Kahkesh, Saeed Rezapoor
DOI:10.4103/jmp.JMP_60_17  PMID:29296038
Purpose: Radiation causes damage to irradiated tissues and also tissues that do not receive direct irradiation through a phenomenon called out-of-field effects. This damage through signals such as inflammatory responses can be transmitted to unirradiated cells/tissues and causes many effects such as oxidative damage. The radioprotective and anti-inflammatory effects of melatonin have been demonstrated in various studies. The aim of this study was to evaluate the effect of pretreatment with melatonin on oxidative damage caused by direct irradiation and out-of-field effects on the lung tissue after pelvic irradiation in rats. Materials and Methods: In this experimental study, 42 adult male Wistar albino rats were divided into seven groups (six rats per group) including control, melatonin treatment, localized irradiation to the pelvis (out-of-field group), whole-body scatter group (which gave radiation dose equal to the amount of radiation that the lung had received from the localized pelvic irradiation), direct irradiation to lung, melatonin administration before localized radiation to the pelvis, and melatonin administration before localized radiation to the lung. A 100 mg/kg of melatonin 30 min before irradiation with 5 Gy γ-rays in a local (3.75 cm × 3.75 cm) field to the lower abdomen was administered to the rats, and after 24 h, all rats were sacrificed and their lungs were excised to measure the biochemical parameters including malondialdehyde (MDA), glutathione peroxidase (GPx), and superoxide dismutase (SOD). Results: The results showed that localized irradiation to the lung or pelvis caused an increase in the MDA level. Moreover, pelvis and lung irradiation increased the GPx and SOD activity in the lungs. Pretreatment with melatonin before irradiation reduced the GPx and MDA levels in both targeted and nontargeted lung tissues and reduced the SOD activity after lung irradiation. Conclusion: Although pretreatment with melatonin did not increase the activity of SOD and GPx in comparison to the radiation groups, this study showed that preadministration of melatonin can ameliorate the oxidative damage induced by ionizing radiation.
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Modulation of radiation-induced base excision repair pathway gene expression by melatonin p. 245
Saeed Rezapoor, Alireza Shirazi, Sakineh Abbasi, Javad Tavakkoly Bazzaz, Pantea Izadi, Hamed Rezaeejam, Majid Valizadeh, Farid Soleimani-Mohammadi, Masoud Najafi
DOI:10.4103/jmp.JMP_9_17  PMID:29296039
Objective: Approximately 70% of all cancer patients receive radiotherapy. Although radiotherapy is effective in killing cancer cells, it has adverse effects on normal cells as well. Melatonin (MLT) as a potent antioxidant and anti-inflammatory agent has been proposed to stimulate DNA repair capacity. We investigated the capability of MLT in the modification of radiation-induced DNA damage in rat peripheral blood cells. Materials and Methods: In this experimental study, male rats (n = 162) were divided into 27 groups (n = 6 in each group) including: irradiation only, vehicle only, vehicle with irradiation, 100 mg/kg MLT alone, 100 mg/kg MLT plus irradiation in 3 different time points, and control. Subsequently, they were irradiated with a single whole-body X-ray radiation dose of 2 and 8 Gy at a dose rate of 200 MU/min. Rats were given an intraperitoneal injection of MLT or the same volume of vehicle alone 1 h prior to irradiation. Blood samples were also taken 8, 24, and 48 h postirradiation, in order to measure the 8-oxoguanine glycosylase1 (Ogg1), Apex1, and Xrcc1 expression using quantitative real-time-polymerase chain reaction. Results: Exposing to the ionizing radiation resulted in downregulation of Ogg1, Apex1, and Xrcc1 gene expression. The most obvious suppression was observed in 8 h after exposure. Pretreatments with MLT were able to upregulate these genes when compared to the irradiation-only and vehicle plus irradiation groups (P < 0.05) in all time points. Conclusion: Our results suggested that MLT in mentioned dose may result in modulation of Ogg1, Apex1, and Xrcc1 gene expression in peripheral blood cells to reduce X-ray irradiation-induced DNA damage. Therefore, administration of MLT may increase the normal tissue tolerance to radiation through enhancing the cell DNA repair capacity. We believed that MLT could play a radiation toxicity reduction role in patients who have undergone radiation treatment as a part of cancer radiotherapy.
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Evaluation and performance of arccheck and film using gamma criteria in pre-treatment quality assurance of stereotactic ablative radiotherapy p. 251
Prabhakar Ramachandran, Abdulrahman Tajaldeen, David Taylor, Derrick Wanigaratne, Karl Roozen, Moshi Geso
DOI:10.4103/jmp.JMP_132_16  PMID:29296040
Aim: The aim of this study is to assess the use of ArcCHECK (AC) as an alternative method to replace film dosimetry for pre-treatment quality assurance (QA) of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) stereotactic ablative radiotherapy (SABR) treatment plans. Materials and Methods: Twenty-five patients with a varied diagnosis of lung, spine, sacrum, sternum, ribs, scapula, and femur undergoing SABR were selected for this study. Pre-treatment QA was performed for all the patients using ionization chamber and film dosimetry. Measurements were also carried out on an AC phantom. The planned and measured doses from the AC device and EBT3 films were compared using four different gamma criteria: 2%/2 mm, 3%/2 mm, 3%/1 mm, and 3%/3 mm. Results: The mean gamma passing rates at 3%/3 mm for all non-spine SABR cases were 98.79 ± 0.96 and 99.27 ± 1.03 with AC and films, respectively. The mean passing rates at 3%/2 mm for AC and films were 98.76 ± 0.42 and 99.43 ± 0.27 respectively for spine VMAT SABR, and 87.15 ± 2.45 and 99.79 ± 0.14 respectively for spine IMRT SABR. In the case of spine tumors, the gamma criterion was tightened due to the proximity of spinal cord to the planning target volume. Our results show that AC provides good results for all VMAT SABR plans. Conclusion: The AC results at 3%/3 mm were in good agreement with film dosimetry for most cases. We observed a significant reduction in QA time on using AC for SABR QA. This study showed that AC results are comparable to film dosimetry for all studied sites except for spine IMRT SABR.
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Verification of dosimetric commissioning accuracy of intensity modulated radiation therapy and volumetric modulated arc therapy delivery using task Group-119 guidelines p. 258
Karunakaran Kaviarasu, N Arunai Nambi Raj, Misba Hamid, A Ananda Giri Babu, Lingampally Sreenivas, Kammari Krishna Murthy
DOI:10.4103/jmp.JMP_16_17  PMID:29296041
Aim: The purpose of this study is to verify the accuracy of the commissioning of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) based on the recommendation of the American Association of Physicists in Medicine Task Group 119 (TG-119). Materials and Methods: TG-119 proposes a set of clinical test cases to verify the accuracy of IMRT planning and delivery system. For these test cases, we generated two sets of treatment plans, the first plan using 7–9 IMRT fields and a second plan utilizing two-arc VMAT technique for both 6 MV and 15 MV photon beams. The template plans of TG-119 were optimized and calculated by Varian Eclipse Treatment Planning System (version 13.5). Dose prescription and planning objectives were set according to the TG-119 goals. The point dose (mean dose to the contoured chamber volume) at the specified positions/locations was measured using compact (CC-13) ion chamber. The composite planar dose was measured with IMatriXX Evaluation 2D array with OmniPro IMRT Software (version 1.7b). The per-field relative gamma was measured using electronic portal imaging device in a way similar to the routine pretreatment patient-specific quality assurance. Results: Our planning results are compared with the TG-119 data. Point dose and fluence comparison data where within the acceptable confident limit. Conclusion: From the obtained data in this study, we conclude that the commissioning of IMRT and VMAT delivery were found within the limits of TG-119.
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A study to determine whether the volume-weighted computed tomography dose index gives reasonable estimates of organ doses for thai patients undergoing abdomen and pelvis computed tomography examinations p. 266
Supawitoo Sookpeng, Colin J Martin, Chitsanupong Butdee
DOI:10.4103/jmp.JMP_91_17  PMID:29296042
Introduction: Values for the CTDIvol, which is displayed on scanner consoles, give doses relative to a phantom much larger than most Thai patients, and the CTDIvoldoes not take account of differences in patient size, which affect organ doses. Objective: The purpose of this study was to evaluate relationships for size specific dose estimate (SSDE) and volume weighted computed tomography (CT) dose index (CTDIvol) with patient size for CT scanners operating under automatic tube current modulation (ATCM). Methods: Retrospective data from 244 patients who had undergone abdomen and pelvis examination on GE and Siemens CT scanners were included in this study. The combination of anteroposterior (AP) and lateral dimensions at the level of the first lumbar vertebra (L1) was used to represent patient size. Image noise within the liver was measured, and values of the absorbed dose for organs covered by the primary beam such as the liver, stomach and kidney were calculated using methods described in the literature. Values of CTDIvolwere recorded and SSDE calculated according to the American Association of Physics in Medicine (AAPM) Report No.204. Linear regression models were used to evaluate the relationship between SSDE, CTDIvol, image noise and patient size. Results: SSDE is 20%-50% larger than the CTDIvol, with values for larger patients being more representative. Both the CTDIvoland image noise decreased with patient size for Siemens scanners, but the decline in SSDE was less significant. For the GE scanner, the CTDIvolwas a factor of 3-4 lower in small patients compared to larger ones, while the SSDE only decreased by a factor of two. Noise actually decreased slightly with patient size. Conclusion: Values of SSDE were similar to the doses calculated for the liver, stomach and kidney, which are covered by the primary beam, confirming that it provides a good estimate of organ-absorbed dose.
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Evaluation of radiation shielding properties of the polyvinyl alcohol/iron oxide polymer composite p. 273
K Srinivasan, E James Jabaseelan Samuel
DOI:10.4103/jmp.JMP_54_17  PMID:29296043
Context: Lead is the conventional shielding material against gamma/X-rays. It has some limitations such as toxic, high density, nonflexibility, and also bremsstrahlung production during electron interaction. It may affect the accuracy of radiotherapy outcome. Aims: To theoretically analyze the radiation shielding properties of flexible polyvinyl alcohol/iron oxide polymer composite with five different concentrations of magnetite over the energy range of 15 KeV–20 MeV. Subjects and Methods: Radiological properties were calculated based on the published literature. Attenuation coefficients of pure elements are generated with the help of WinXCOM database. Results: Effective atomic numbers and electron density are increased with the concentration of magnetite. On the other hand, the number of electrons per gram decreased. Mass attenuation coefficient (μ/ϼ) and linear attenuation coefficients (μ) are higher in the lower energy <100 KeV, and their values decreased when the energy increased. Computed tomography numbers (CT) show the significant variation between the concentrations in <60 KeV. Half-value layer and tenth-value layers are directly proportional to the energy and indirectly proportional to the concentration of magnetite. Transmission curve, relaxation length (ƛ), kinetic energy released in the matter, and elemental weight fraction are also calculated and the results are discussed. Conclusions: 0.5% of the magnetite gives superior shielding properties compared with other concentrations. It may be due to the presence of 0.3617% of Fe. Elemental weight fraction, atomic number, photon energy, and mass densities are the important parameters to understand the shielding behavior of any material.
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Comments on “radiological risk assessment of cosmic radiation at aviation altitudes (A trip from houston intercontinental airport to lagos international airport)” p. 279
Munish Kumar, D Datta
DOI:10.4103/jmp.JMP_55_17  PMID:29296044
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