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We assessed the effect of beam size on plan robustness for intensity-modulated proton therapy (IMPT) of head and neck cancer (HNC) and compared the plan quality including robustness with that of intensity-modulated radiation therapy (IMRT). IMPT plans were generated for six HNC patients using six beam sizes (air-sigma 3–17 mm at isocenter for a 70–230 MeV) and two optimization methods for planning target volume-based non-robust optimization (NRO) and clinical target volume (CTV)-based robust optimization (RO). Worst-case dosimetric parameters and plan robustness for CTV and organs-at-risk (OARs) were assessed under different scenarios, assuming a ± 1–5 mm setup error and a ± 3% range error. Statistical comparisons of NRO-IMPT, RO-IMPT and IMRT plans were performed. In regard to CTV-D99%, RO-IMPT with smaller beam size was more robust than RO-IMPT with larger beam sizes, whereas NRO-IMPT showed the opposite (P  < 0.05). There was no significant difference in the robustness of the CTV-D99% and CTV-D95% between RO-IMPT and IMRT. The worst-case CTV coverage of IMRT (±5 mm/3%) for all patients was 96.0% ± 1.4% (D99%) and 97.9% ± 0.3% (D95%). For four out of six patients, the worst-case CTV-D95% for RO-IMPT (±1–5 mm/3%) were higher than those for IMRT. Compared with IMRT, RO-IMPT with smaller beam sizes achieved lower worst-case doses to OARs. In HNC treatment, utilizing smaller beam sizes in RO-IMPT improves plan robustness compared to larger beam sizes, achieving comparable target robustness and lower worst-case OARs doses compared to IMRT. [ABSTRACT FROM AUTHOR]

In recent years, eye lens exposure among radiation workers has become a serious concern in medical X-ray fluoroscopy and interventional radiology (IVR), highlighting the need for radiation protection education and training. This study presents a method that can maintain high accuracy when calculating spatial dose distributions obtained via Monte Carlo simulation and establishes another method to three-dimensionally visualize radiation using the obtained calculation results for contributing to effective radiation-protection education in X-ray fluoroscopy and IVR. The Monte Carlo particle and heavy ion transport code system (PHITS, Ver. 3.24) was used for calculating the spatial dose distribution generated by an angiography device. We determined the peak X-ray tube voltage and half value layer using Raysafe X2 to define the X-ray spectrum from the source and calculated the X-ray spectrum from the measured results using an approximation formula developed by Tucker et al. Further, we performed measurements using the "jungle-gym" method under the same conditions as the Monte Carlo calculations for verifying the accuracy of the latter. An optically stimulated luminescence dosimeter (nanoDot dosimeter) was used as the measuring instrument. In addition, we attempted to visualize radiation using ParaView (version 5.12.0-RC2) using the spatial dose distribution confirmed by the above calculations. A comparison of the measured and Monte Carlo calculated spatial dose distributions revealed that some areas showed large errors (12.3 and 24.2%) between the two values. These errors could be attributed to the scattering and absorption of X-rays caused by the jungle gym method, which led to uncertain measurements, and (2) the angular and energy dependencies of the nanoDot dosimetry. These two causes explain the errors in the actual values, and thus, the Monte Carlo calculations proposed in this study can be considered to have high-quality X-ray spectra and high accuracy. We successfully visualized the three-dimensional spatial dose distribution for direct and scattered X-rays separately using the obtained spatial dose distribution. We established a method to verify the accuracy of Monte Carlo calculations performed through the procedures considered in this study. Various three-dimensional spatial dose distributions were obtained with assured accuracy by applying the Monte Carlo calculation (e.g., changing the irradiation angle and adding a protective plate). Effective radiation-protection education can be realized by combining the present method with highly reliable software to visualize dose distributions. [ABSTRACT FROM AUTHOR]

Background: Coincidence of the treatment and imaging isocenter coordinates is required to safely perform small‐margin treatments, such as stereotactic radiosurgery of multiple brain metastases. A comprehensive and direct methodology for verifying concordance of kilovoltage cone‐beam computed tomography (kV‐CBCT) and treatment coordinates using an x‐ray CT‐based polymer gel dosimeter (dGEL) and onboard kV‐CBCT was previously reported. Using this methodology, we tested the ability of a new commercially available x‐ray CT‐based polymer dGEL with a rapid response to provide efficient quality assurance (QA). Purpose: The aim of this study was to evaluate the robustness of the three‐dimensional geometric QA methodology using dGEL. Methods: The dGEL were commercially manufactured. The prescribed dose for each field was determined by visually identifying the 5, 10, and 20 Gy isodose lines. A linear accelerator was used to irradiate the gels with seven non‐coplanar beams. An in‐house analysis program was used to identify the beam axes and treatment isocenter in kV‐CBCT coordinates by processing the pre‐ and post‐irradiation CBCT images. The impact of the radiation dose on the test reproducibility was examined, and the detectability of an intentional geometric error was assessed. Results: The treatment isocenter was within 0.4 mm of the imaging isocenter for all radiation doses. The residual error of the test with the intentional error was within 0.2 mm. The analysis and image quality variations for a single dGEL introduced displacement errors less than 0.3 mm. Conclusions: The test assessed the coincidence of treatment and kV‐CBCT isocenter coordinates and detected errors with high robustness. Even for a 10 Gy dose, the test yielded results comparable with those obtained using higher radiation doses owing to the rapid response of the dGEL dosimeter. [ABSTRACT FROM AUTHOR]

Background: Administration of external radiation therapy via proton therapy systems carries a risk of occasional collisions between the patient's body and gantry, which is increased by the snout placed near the patient for better dose distribution. Although treatment planning software (TPS) can simulate controlled collisions, the computed tomography (CT) data used for treatment planning are insufficient given that collisions can occur outside the CT imaging region. Thus, imaging the three‐dimensional (3D) surface outside the CT range and combining the data with those obtained by CT are essential for avoiding collisions. Purpose: To construct a prototype for 3D surface imaging and an end‐to‐end framework for preventing collisions between the patient's body and the gantry. Methods: We obtained 3D surface data using a light sectioning method (LSM). By installing only cameras in front of the CT, we achieved LSM using the CT couch motion and preinstalled patient‐positioning lasers. The camera image contained both sagittal and coronal lines, which are unnecessary for LSM and were removed by deep learning. We combined LSM 3D surface data and original CT data to create synthetic Digital Imaging and Communications in Medicine (DICOM) data. Subsequently, we compared the TPS snout auto‐optimization using the original CT data with the synthetic DICOM data. Results: The mean positional error for LSM of the arms and head was 0.7 ± 0.8 and 0.8 ± 0.8 mm for axial and sagittal imaging, respectively. The TPS snout auto‐optimization indicated that the original CT data would cause collisions; however, the synthetic DICOM data prevented these collisions. Conclusions: The prototype system's acquisition accuracy for 3D surface data was approximately 1 mm, which was sufficient for the collision simulation. The use of a TPS with collision avoidance can help optimize the snout position using synthetic DICOM data. Our proposed method requires no external software for collision simulation and can be integrated into the clinical workflow to improve treatment planning efficiency. [ABSTRACT FROM AUTHOR]

Recently, progress in technology for accelerator-based neutron sources has increased attention regarding boron neutron capture therapy (BNCT). BNCT is a type of radiotherapy that combines neutrons and boron drugs and is expected to be used in the treatment of refractory and recurrent cancers. Owing to the need for high-intensity neutrons in treatment, compact accelerator-based neutron sources applicable to BNCT are being developed worldwide. These current projects utilize cyclotrons, linear accelerators, and electrostatic accelerators as accelerators for BNCT devices. Beryllium and lithium are the main target materials for neutron generation. The accelerators for BNCT device are required to accelerate charged particles with an average current ranging from a few milliamperes to a few tens of milliamperes in order to generate neutrons of sufficient intensity for the treatment. Moreover, the target systems require technologies and mechanisms that can withstand the large heat load produced by high-power beam irradiation and prevent blistering. This review outlines and explains the accelerator neutron sources for BNCT and the requirements for the components of each device, such as the accelerator, target material, and beam shaping assembly. In addition, various development projects for accelerator-based BNCT devices worldwide are introduced. [ABSTRACT FROM AUTHOR]

Background: Volumetric modulated arc therapy (VMAT) for locally advanced rectal cancer (LARC) has emerged as a promising technique, but the planning process can be time-consuming and dependent on planner expertise. We aimed to develop a fully automated VMAT planning program for LARC and evaluate its feasibility and efficiency. Methods: A total of 26 LARC patients who received VMAT treatment and the computed tomography (CT) scans were included in this study. Clinical target volumes and organs at risk were contoured by radiation oncologists. The automatic planning program, developed within the Raystation treatment planning system, used scripting capabilities and a Python environment to automate the entire planning process. The automated VMAT plan (auto-VMAT) was created by our automated planning program with the 26 CT scans used in the manual VMAT plan (manual-VMAT) and their regions of interests. Dosimetric parameters and time efficiency were compared between the auto-VMAT and the manual-VMAT created by experienced planners. All results were analyzed using the Wilcoxon signed-rank sum test. Results: The auto-VMAT achieved comparable coverage of the target volume while demonstrating improved dose conformity and uniformity compared with the manual-VMAT. V30 and V40 in the small bowel were significantly lower in the auto-VMAT compared with those in the manual-VMAT (p < 0.001 and < 0.001, respectively); the mean dose of the bladder was also significantly reduced in the auto-VMAT (p < 0.001). Furthermore, auto-VMAT plans were consistently generated with less variability in quality. In terms of efficiency, the auto-VMAT markedly reduced the time required for planning and expedited plan approval, with 93% of cases approved within one day. Conclusion: We developed a fully automatic feasible VMAT plan creation program for LARC. The auto-VMAT maintained target coverage while providing organs at risk dose reduction. The developed program dramatically reduced the time to approval. [ABSTRACT FROM AUTHOR]

This study aims to provide a model that compounds historically proposed ideas regarding cell survival irradiated with X rays or particles. The parameters used in this model have simple meanings and are closely related to cell death-related phenomena. The model is adaptable to a wide range of doses and dose rates and thus can consistently explain previously published cell survival data. The formulas of the model were derived by using five basic ideas: 1. "Poisson's law"; 2. "DNA affected damage"; 3. "repair"; 4. "clustered affected damage"; and 5. "saturation of reparability". The concept of affected damage is close to but not the same as the effect caused by the double-strand break (DSB). The parameters used in the formula are related to seven phenomena: 1. "linear coefficient of radiation dose"; 2. "probability of making affected damage"; 3. "cell-specific repairability", 4. "irreparable damage by adjacent affected damage"; 5. "recovery of temporally changed repairability"; 6. "recovery of simple damage which will make the affected damage"; 7. "cell division". By using the second parameter, this model includes cases where a single hit results in repairable–lethal and double-hit results in repairable–lethal. The fitting performance of the model for the experimental data was evaluated based on the Akaike information criterion, and practical results were obtained for the published experiments irradiated with a wide range of doses (up to several 10 Gy) and dose rates (0.17 Gy/h to 55.8 Gy/h). The direct association of parameters with cell death-related phenomena has made it possible to systematically fit survival data of different cell types and different radiation types by using crossover parameters. [ABSTRACT FROM AUTHOR]

Introduction: Despite the development of DOSIRIS™, an eye lens dosimeter, the characteristics of DOSIRIS™ in the area of radiotherapy have not been investigated. The purpose of this study was to evaluate the basic characteristics of the 3‐mm dose equivalent measuring instrument DOSIRIS™ in radiotherapy. Methods: Dose linearity and energy dependence were evaluated for the irradiation system based on the calibration method of the monitor dosimeter. The angle dependence was measured by irradiating from a total of 18 directions. Interdevice variation was repeated three times by simultaneously irradiating five dosimeters. The measurement accuracy was based on the absorbed dose measured by the monitor dosimeter of the radiotherapy equipment. Absorbed doses were converted to 3‐mm dose equivalents and compared with DOSIRIS™ measurements. Results: Dose linearity was evaluated using the determination coefficient (R2) R2 = 0.9998 and 0.9996 at 6 and 10 MV, respectively. For energy dependence, although the therapeutic photons evaluated in this study had higher energies than in the previous studies and had a continuous spectrum, the response was equivalent to 0.2–1.25 MeV, well below the IEC 62387 limits. The maximum error at all angles was 15% (angle of 140°) and the coefficient of variation at all angles was 4.70%, which satisfies the standard of the thermoluminescent dosimeter measuring instrument. Accuracy of measurement was determined in terms of the measurement errors for DOSIRIS™ (3.2% and 4.3% at 6 and 10 MV, respectively,) using the 3‐mm dose equivalent obtained from the theoretical value as a reference. The DOSIRIS™ measurements met the IEC standard which defines the measurement error of ±30% of the irradiance value in IEC 62387. Conclusions: We found that the characteristics of the 3‐mm dose equivalent dosimeter in a high‐energy radiation satisfy the IEC standards and have the same measurement accuracy as diagnostic areas such as Interventional Radiology. [ABSTRACT FROM AUTHOR]

Background: We reported the concept of patient‐specific deep learning (DL) for real‐time markerless tumor segmentation in image‐guided radiotherapy (IGRT). The method was aimed to control the attention of convolutional neural networks (CNNs) by artificial differences in co‐occurrence probability (CoOCP) in training datasets, that is, focusing CNN attention on soft tissues while ignoring bones. However, the effectiveness of this attention‐based data augmentation has not been confirmed by explainable techniques. Furthermore, compared to reasonable ground truths, the feasibility of tumor segmentation in clinical kilovolt (kV) X‐ray fluoroscopic (XF) images has not been confirmed. Purpose: The first aim of this paper was to present evidence that the proposed method provides an explanation and control of DL behavior. The second purpose was to validate the real‐time lung tumor segmentation in clinical kV XF images for IGRT. Methods: This retrospective study included 10 patients with lung cancer. Patient‐specific and XF angle‐specific image pairs comprising digitally reconstructed radiographs (DRRs) and projected‐clinical‐target‐volume (pCTV) images were calculated from four‐dimensional computer tomographic data and treatment planning information. The training datasets were primarily augmented by random overlay (RO) and noise injection (NI): RO aims to differentiate positional CoOCP in soft tissues and bones, and NI aims to make a difference in the frequency of occurrence of local and global image features. The CNNs for each patient‐and‐angle were automatically optimized in the DL training stage to transform the training DRRs into pCTV images. In the inference stage, the trained CNNs transformed the test XF images into pCTV images, thus identifying target positions and shapes. Results: The visual analysis of DL attention heatmaps for a test image demonstrated that our method focused CNN attention on soft tissue and global image features rather than bones and local features. The processing time for each patient‐and‐angle‐specific dataset in the training stage was ∼30 min, whereas that in the inference stage was 8 ms/frame. The estimated three‐dimensional 95 percentile tracking error, Jaccard index, and Hausdorff distance for 10 patients were 1.3–3.9 mm, 0.85–0.94, and 0.6–4.9 mm, respectively. Conclusions: The proposed attention‐based data augmentation with both RO and NI made the CNN behavior more explainable and more controllable. The results obtained demonstrated the feasibility of real‐time markerless lung tumor segmentation in kV XF images for IGRT. [ABSTRACT FROM AUTHOR]

Light flash and odor during radiotherapy are well-known phenomena. Two prospective observational studies have indicated that 55% of patients observed a light flash during irradiation of the retina and 27% of patients sensed an odor during radiotherapy for the nasal cavity. A prospective observational study was performed in all patients at our hospital who received total body irradiation (TBI) between January 2019 to October 2021. Light flash and odor during TBI were examined using the same method as that used in previous studies. A total of 32 patients received TBI during the study period. The patients had a median age of 41 (18–60) years, and included 20 males and 12 females. A survey checklist showed that 14 patients (44%) sensed light and 14 patients (44%) sensed odor during TBI,. The color of the light during irradiation was yellow in six cases, white in four cases, and blue in four cases. The intensity of the light was 2–5 (median 3, 1 is very weak, 5 is very strong) and the time over which the light flash was felt was 4–60 s (median 10 s). Two patients each sensed smells of plastic, ozone and bleach, and others sensed one smell each. The intensity of the odor was 1–4 (median 3, 1 is very weak, 5 is very strong) and the time over which the odor was sensed was 1–25 s (median 3 s). We conclude that light flashes and odors are each sensed by 44% of patients during TBI. Various types of light flashes and odors were reported in this study. [ABSTRACT FROM AUTHOR]

The iBNCT project aims to develop "iBNCT001," a demonstration device of the linac-based neutron irradiation facility for boron neutron capture therapy (BNCT) application. iBNCT001 generates an epithermal neutron beam by irradiating 8 MeV protons accelerated by a linac onto a beryllium target. Currently, the linac can drive an average proton current of 2.1 mA. Several experiments were performed using a water phantom to confirm the main physical characteristics of the neutron beam produced at the irradiation position. The measurement results demonstrated that the maximum thermal neutron flux achievable in the phantom volume was approximately 1.36 × 10 9 cm − 2 s − 1 when a normal beam collimator with a 120 mm diameter was used. This neutron beam intensity was sufficient to complete the irradiation within 30 min using the BNCT approach. In addition to normal beam collimators, extended collimators that protrude 100 mm from the wall were developed. By using an extended collimator, it is possible to prevent interference of the patient's body with the wall when irradiating head and neck cancers. The measurement results for the extended collimator demonstrated that irradiation with the collimator could be completed within 1 h when the neutron beam is generated with an average proton current of 2.1 mA. [ABSTRACT FROM AUTHOR]

Purpose: To develop a system for detecting anatomical changes using two‐dimensional (2D) x‐ray images. Methods: Ten patients with head and neck cancer were retrospectively analyzed using 2D x‐ray and cone‐beam computed tomography (CBCT) images. The 2D x‐ray images were acquired daily, whereas the CBCT images were acquired weekly during the treatment period. The developed system imported the 2D x‐ray images obtained on the initial treatment day and on another day, and thereafter converted them into the water equivalent thickness (WET) using the conversion table. The difference between the WET images for the first and other treatment days (ΔWET) was calculated as the quantitative value for anatomical changes and visualized to recognize the anatomical change location. We compared ΔWET and the difference in the lateral neck distance (ΔLND) on the corresponding CBCT images. ΔLND was used as the ground truth for anatomical changes. ΔWET and ΔLND were measured at the first cervical vertebra (C1) and the tumor center (TC). C1 and TC were selected to observe the volume changes in the parotid gland and tumor, respectively. Sensitivity and specificity were calculated to evaluate the performance of the 2D‐WET system. The cut‐off values of WET and LND were set to 2–10 mm. Furthermore, intensity‐modulated proton therapy (IMPT) plans for six patients with rescan CT images were generated. The IMPT plans on the rescan CT images were compared to the original plans on simulation CT using the dosimetric parameters for the target and the organs at risk. Results: The mean differences between ΔWET and ΔLND for C1 and TC were −0.62 ± 1.66 mm and −0.93 ± 1.28 mm (mean ± 1 SD), respectively. ΔWET in the proposed system was in good agreement with ΔLND using the CBCT images. In the sensitivity and specificity results for C1 and TC with cut‐off values from 2 to 10 mm, the sensitivity was >85% for all cut‐off values, while the specificity was >90% at 5–10 mm and <90% at less than 5 mm. The average ΔWET at the time of replanning was 12.8 mm which resulted in maximum dose increase in the spinal cord D1cc by 8.4 Gy, the parotid gland D50 by 26.6 Gy, and the oral cavity D50 by 23.2 Gy. Conclusions: We developed a new system for detecting anatomical changes using 2D x‐ray images. The developed system with ΔWET showed an agreement with ΔLND at C1 and TC with an average difference of less than 1 mm. ΔWET detected anatomical changes with high sensitivity and specificity with a cut‐off value of 5–10 mm. This system can monitor daily anatomical changes without causing high exposure to patients and requiring any inefficient work, and it can be applied to daily online adaptive proton beam therapy and triggered adaptive radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: The accuracy of the CyberKnife Synchrony Respiratory Tracking System is dependent on the breathing pattern of a patient. Therefore, the tracking error in each patient must be determined. Support vector regression (SVR) can be used to easily identify the tracking error in each patient. This study aimed to develop a system with SVR that can predict tracking error according to a patient's respiratory waveform. Methods: Datasets of the respiratory waveforms of 93 patients were obtained. The feature variables were variation in respiration amplitude, tumor velocity, and phase shift between tumor and the chest wall, and the target variable was tracking error. A learning model was evaluated with tenfold cross-validation. We documented the difference between the predicted and actual tracking errors and assessed the correlation coefficient and coefficient of determination. Results: The average difference and maximum difference between the actual and predicted tracking errors were 0.57 ± 0.63 mm and 2.1 mm, respectively. The correlation coefficient and coefficient of determination were 0.86 and 0.74, respectively. Conclusion: We developed a system for obtaining tracking error by using SVR. The accuracy of such a system is clinically useful. Moreover, the system can easily evaluate tracking error. [ABSTRACT FROM AUTHOR]

Unirradiated liver volume (ULV) preservation rate is an important factor associated with radiation-induced liver disease (RILD) in patients with hepatocellular carcinoma (HCC) undergoing proton beam therapy (PBT). The purpose of this study is to identify the predictors for ULV preservation and quantify the capacity of proton beams in normal liver sparing during PBT. We reviewed planning data of 92 patients with single intrahepatic HCC tumors undergoing PBT. The potential clinical and planning factors that may affect ULV preservation were involved in multiple linear regression for ULV preservation rate. The significant factors were determined to be predictors and their influences were quantified. The median ULV preservation rate was 62.08%. All the assessed clinical factors showed significant effects on ULV preservation rate: clinical target volume (CTV), P  < 0.001; portal vein tumor thrombosis (PVTT), P  = 0.010; left lobe tumor, P  = 0.010. In contrast, none of the planning factors demonstrated significance. The coefficients of significant factors in multiple linear regression were 60.85 for intercept, −0.02 for CTV, −9.01 for PVTT and 8.31 for left lobe tumors. The capacity of proton beams to spare normal liver tissue during PBT for HCC is mainly affected by clinical factors. The baseline of the ULV preservation rate is 60.85%, decreasing 0.02% with each milliliter of CTV increase and 9.01% for tumors with PVTT, and increasing 8.31% for tumors limited to the left lobe. Further clinical studies should be carried out to correlate our dosimetric findings with clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Maintaining a good level of physical fitness from engaging in regular exercise is important for the treatment and prevention of metabolic syndrome (MetS). However, which components constitutive of physical fitness confer the greatest influence remains controversial. This retrospective cross-sectional study aimed to investigate the association between MetS and physical fitness components including cardiorespiratory fitness, muscle strength, flexibility, and agility and to identify which physical fitness components have the largest influence on MetS. Methods: A total of 168 Japanese adult males aged 25–64 years were allocated into non-MetS, pre-MetS, and MetS groups according to the criteria recommended by the Japanese Society of Internal Medicine. Anthropometric measurement of body composition by whole-body dual-energy X-ray absorptiometry and measures related to MetS, including waist circumference, triglyceride level, high-density lipoprotein cholesterol level, blood pressure, glucose level, and physical fitness components, were assessed. For evaluation of cardiorespiratory fitness, muscle strength, flexibility, agility, and balance, maximal oxygen consumption (VO2peak) and oxygen uptake at anaerobic threshold (VO2AnT), handgrip strength and vertical jumping, trunk extension and flexion, stepping side to side, and single-leg balance task with the eyes closed were assessed, respectively. Results: A progressive tendency of increasing body weight, body mass index, whole-body lean and fat mass, percentage of whole-body fat mass, trunk lean and fat mass, percentage of trunk fat mass, arm fat mass, waist circumference, triglyceride level, systolic and diastolic blood pressure, and blood glucose level from the non-MetS group to the MetS group was significant (P < 0.05). Conversely, the cardiorespiratory endurance parameters VO2peak and VO2AnT and the high-density lipoprotein cholesterol level showed a progressively decreasing tendency across the groups (P < 0.01). In addition, a VO2peak below 29.84 ml·kg·min−1 (P = 0.028) and VO2AnT below 15.89 ml·kg·min−1 (P = 0.011) were significant risk components for pre-MetS and MetS. However, there was no significant tendency with respect to muscle strength, agility, and flexibility. Conclusion: Cardiorespiratory fitness is strongly linked to metabolic syndrome among physical fitness components [ABSTRACT FROM AUTHOR]

In proton therapy, the Bragg peak of a proton beam reportedly deteriorates when passing though heterogeneous structures such as human lungs. Previous studies have used heterogeneous random voxel phantoms, in which soft tissues and air are randomly allotted to render the phantoms the same density as human lungs, for conducting Monte Carlo (MC) simulations. However, measurements of these phantoms are complicated owing to their difficult‐to‐manufacture shape. In the present study, we used Voronoi tessellation to design a phantom that can be manufactured, and prepared a Voronoi lung phantom for which both measurement and MC calculations are possible. Our aim was to evaluate the effectiveness of this phantom as a new lung phantom for investigating proton beam Bragg peak deterioration. For this purpose, we measured and calculated the percentage depth dose and the distal falloff widths (DFW) passing through the phantom. For the 155 MeV beam, the measured and calculated DFW values with the Voronoi lung phantom were 0.40 and 0.39 cm, respectively. For the 200 MeV beam, the measured and calculated DFW values with the Voronoi lung phantom were both 0.48 cm. Our results indicate that both the measurements and MC calculations exhibited high reproducibility with plastinated lung sample from human body in previous studies. We found that better results were obtained using the Voronoi lung phantom than using other previous phantoms. The designed phantom may contribute significantly to the improvement of measurement precision. This study suggests that the Voronoi lung phantom is useful for simulating the effects of the heterogeneous structure of lungs on proton beam deterioration. [ABSTRACT FROM AUTHOR]

Fractionated proton beam radiotherapy is spreading worldwide these days. However, biological data of sub-lethal damage recovery (SLDR) after proton irradiation is not known yet. We here conducted split-dose experiments (20–360 min intervals) to clarify SLDR kinetics, and also compared the kinetics between cells with different repairability of DNA double-strand breaks. CHO and 51D1 cell lines but not V3 cell line showed significant SLDR, which reached plateau in 4–6 h. The recovery rates and recovery halftime of SLDR after X-rays were significantly higher and shorter than proton beams for CHO and 51D1 cells, respectively. Additionally, the frequency of remaining gamma-H2AX foci after two fractions was remarkably higher for X-rays than proton beams. These data suggest that there is a difference between proton beam and X-rays in SLDR and the retained DNA double-strand breaks after split-dose irradiation. [ABSTRACT FROM AUTHOR]

The effective utilization of various biomolecules for creating a series of mesoporous boehmite (γ‐AlOOH) and gamma‐alumina (γ‐Al2O3) nanosheets with unique hierarchical multilayered structures is demonstrated. The nature and concentration of the biomolecules strongly influence the degree of the crystallinity, the morphology, and the textural properties of the resulting γ‐AlOOH and γ‐Al2O3 nanosheets, allowing for easy tuning. The hierarchical γ‐AlOOH and γ‐Al2O3 multilayered nanosheets synthesized by using biomolecules exhibit enhanced crystallinity, improved particle separation, and well‐defined multilayered structures compared to those obtained without biomolecules. More impressively, these γ‐AlOOH and γ‐Al2O3 nanosheets possess high surface areas up to 425 and 371 m2 g−1, respectively, due to their mesoporous nature and hierarchical multilayered structure. When employed for molybdenum adsorption toward medical radioisotope production, the hierarchical γ‐Al2O3 multilayered nanosheets exhibit Mo adsorption capacities of 33.1–40.8 mg g−1. The Mo adsorption performance of these materials is influenced by the synergistic combination of the crystallinity, the surface area, and the pore volume. It is expected that the proposed biomolecule‐assisted strategy may be expanded for the creation of other 3D mesoporous oxides in the future. Biomolecular influencer: Mesoporous γ‐Al2O3 nanosheets with unique hierarchical multilayered structures have been fabricated in the presence of biomolecules (see figure). They exhibit high molybdenum adsorption capacities up to 40.8 mg g−1. [ABSTRACT FROM AUTHOR]

To establish boron neutron capture therapy (BNCT), the University of Tsukuba is developing a treatment device and peripheral devices required in BNCT, such as a treatment planning system. We are developing a new multimodal Monte Carlo based treatment planning system (developing code: Tsukuba Plan). Tsukuba Plan allows for dose estimation in proton therapy, X-ray therapy and heavy ion therapy in addition to BNCT because the system employs PHITS as the Monte Carlo dose calculation engine. Regarding BNCT, several verifications of the system are being carried out for its practical usage. The verification results demonstrate that Tsukuba Plan allows for accurate estimation of thermal neutron flux and gamma-ray dose as fundamental radiations of dosimetry in BNCT. In addition to the practical use of Tsukuba Plan in BNCT, we are investigating its application to other radiation therapies. [ABSTRACT FROM AUTHOR]

Robustness to obstacles is the most important factor necessary to achieve accurate tumor tracking without fiducial markers. Some high-density structures, such as bone, are enhanced on X-ray fluoroscopic images, which cause tumor mistracking. Tumor tracking should be performed by controlling “importance recognition”: the understanding that soft-tissue is an important tracking feature and bone structure is unimportant. We propose a new real-time tumor-contouring method that uses deep learning with importance recognition control. The novelty of the proposed method is the combination of the devised random overlay method and supervised deep learning to induce the recognition of structures in tumor contouring as important or unimportant. This method can be used for tumor contouring because it uses deep learning to perform image segmentation. Our results from a simulated fluoroscopy model showed accurate tracking of a low-visibility tumor with an error of approximately 1 mm, even if enhanced bone structure acted as an obstacle. A high similarity of approximately 0.95 on the Jaccard index was observed between the segmented and ground truth tumor regions. A short processing time of 25 ms was achieved. The results of this simulated fluoroscopy model support the feasibility of robust real-time tumor contouring with fluoroscopy. Further studies using clinical fluoroscopy are highly anticipated. [ABSTRACT FROM AUTHOR]

Suberoylanilide hydroxamic acid (SAHA) is a histone deacetylase inhibitor, which has been widely utilized throughout the cancer research field. SAHA-induced radiosensitization in normal human fibroblasts AG1522 and lung carcinoma cells A549 were evaluated with a combination of γ-rays, proton, and carbon ion exposure. Growth delay was observed in both cell lines during SAHA treatment; 2 μM SAHA treatment decreased clonogenicity and induced cell cycle block in G1 phase but 0.2 μM SAHA treatment did not show either of them. Low LET (Linear Energy Transfer) irradiated A549 cells showed radiosensitization effects on cell killing in cycling and G1 phase with 0.2 or 2 μM SAHA pretreatment. In contrast, minimal sensitization was observed in normal human cells after low and high LET radiation exposure. The potentially lethal damage repair was not affected by SAHA treatment. SAHA treatment reduced the rate of γ-H2AX foci disappearance and suppressed RAD51 and RPA (Replication Protein A) focus formation. Suppression of DNA double strand break repair by SAHA did not result in the differences of SAHA-induced radiosensitization between human cancer cells and normal cells. In conclusion, our results suggest SAHA treatment will sensitize cancer cells to low and high LET radiation with minimum effects to normal cells. [ABSTRACT FROM AUTHOR]

BackgroundThe control of patient position, posture and respiratory movements during radiotherapy is important for effective and specific treatment of malignancy. We have developed an infrared (IR) interactive patient position guidance and acquisition control system for clinical use, comprising IR cameras, IR markers and dedicated software.Materials and methodsWe evaluated the system with ten healthy volunteers and ten experienced operators. IR markers were placed on the body surface. Their positions were calculated using vectors of three translational and three rotational parameters, and the intrafractional error for each marker was acquired with and without respiratory motion. The inclusion of multiple positioning markers allowed for real-time visualisation of the patient posture, with feedback on misalignment and required postural adjustments.ResultsThe positioning time was 73 seconds (with a minimum period of 39 seconds), which was significantly shorter than for conventional line alignment. A comparison of positioning reproducibility between conventional line alignment and this system was <3·5 mm and was not patient dependent or operator dependent. An intrafractional error of displacement of up to 10·0 mm was found in the right iliac crest.ConclusionsThis IR interactive system was shown to be high utility and suitable for monitoring patient position, posture and respiratory movements during radiotherapy. [ABSTRACT FROM PUBLISHER]

Purpose Hypo-fractionated proton beam therapy (PBT) is an approach that has been increasingly explored over the past decade. It requires high geometric accuracy for targeting of the PBT beams. However, image-guided PBT is currently commonly performed with kV X-ray images of bony anatomy. A dynamic adaptive passive scattering PBT system using computed tomography-based three-dimensional image guidance was developed, and its effectiveness was then evaluated retrospectively in patients with nonsmall cell lung cancer (NSCLC). Methods The dynamic adaptive PBT system consisted of computed tomography-based image registration and proton dose calculation using a simplified Monte Carlo algorithm, with a range adaptation system that could adjust the range shifter thickness to alter the dose distribution. Three patients were retrospectively analyzed. All plans, which each had a total dose of 60 Gy (relative biological effectiveness; RBE), were generated using two fields (Gantry angles: 270 degree and 180 degree) in a passive scattering method. Three dose distributions were generated for each patient according to the following different registrations: bone registration, tumor registration, and tumor registration with range adaptation. The following dosimetric parameters were compared with the original plan: target dose coverage at D95% for the clinical target volume (CTV), homogeneity of D5% to D95% for the CTV, and dose distributions in normal tissue (Dmax of Spinal cord and V20 Gy of lung). Results For the bone registration method, the average D95% and D5% to D95% for the CTV showed average differences from the original plan of −3.7 ± 4.1 Gy (mean ± 1SD; RBE) and 3.6 ± 3.9 Gy (RBE) respectively. The tumor registration method achieved better coverage than the bone registration method, although the dosimetric parameters for coverage and homogeneity still showed average differences in −2.0 ± 2.3 Gy (RBE) and 1.9 ± 2.2 Gy (RBE) respectively. The range adaptive plan showed comparable coverage and homogeneity [D95%: −1.0 ± 1.3 Gy (RBE) and D5% to D95%: 0.9 ± 1.0 Gy (RBE) on average] to the original plan, as well as demonstrating similar normal tissue sparing. The approach could be completed in less than 10 min, including CT acquisition, image registration, dose recalculation with range optimization, and the operator's visual verification. Conclusions The tumor dose coverage in patients with NSCLC may deteriorate as a result of respiratory or body movement if daily proton range adaptation is not performed. Our approach may provide higher geometric accuracy for localization of the tumor, and the dynamic range adaptation enables us to achieve the planned dose distribution for hypo-fractionated PBT in the lung. [ABSTRACT FROM AUTHOR]

Although there are several two-dimensional (2D) dose-distribution measurement methods using proton beam therapy, they all have drawbacks; hence, there is no standard method established worldwide. The purpose of this study was to develop a simple, high-precision 2D distribution measurement method for proton beam therapy that uses an imaging plate and EBT3. First, we expanded the maximum readable dose (saturation dose) in the imaging plate. The method involves (i) the control of the fading phenomenon by an annealing process and (ii) the control of the photostimulated luminescence (PSL) phenomenon using a longpass filter (LPF). In method (i), upon heating at 80 °C, the PSL became 0.485 times the room temperature, and in method (ii), we attenuated the PSL by a factor of 0.245 using an LPF. Thus, by combining methods (i) and (ii), we expanded the saturation dose to 2 Gy. Thus, it was possible to measure the imaging plate and EBT3 in the same dose range. We simultaneously measured the percent depth dose using imaging plate and EBT3. We defined a correction factor to match the measured values-which had a reduced sensitivity because of the linear energy transfer (LET) dependence of the imaging plate and EBT3-with reference data and developed a correction factor function. Subsequently, by defining the relative LET dependence of imaging plate and EBT3 as the relative sensitivity and converting the relationship imaging plate between the relative sensitivity and correction factor into a function, we obtained a sensitivity-correction function. By employing this function, measurements with the same accuracy as the reference data were performed using the imaging plate and EBT3. [ABSTRACT FROM AUTHOR]

Purpose: To develop a multilayer ionization chamber (MLIC) and a correction technique that suppresses differences between the MLIC and water phantom measurements in order to achieve fast and accurate depth dose measurements in pencil beam scanning proton therapy. Methods: The authors distinguish between a calibration procedure and an additional correction: 1--the calibration for variations in the air gap thickness and the electrometer gains is addressed without involving measurements in water; 2--the correction is addressed to suppress the difference between depth dose profiles in water and in the MLIC materials due to the nuclear interaction cross sections by a semiempirical model tuned by using measurements in water. In the correction technique, raw MLIC data are obtained for each energy layer and integrated after multiplying them by the correction factor because the correction factor depends on incident energy. The MLIC described here has been designed especially for pencil beam scanning proton therapy. This MLIC is called a dual ring multilayer ionization chamber (DRMLIC). The shape of the electrodes allows the DRMLIC to measure both the percentage depth dose (PDD) and integrated depth dose (IDD) because ionization electrons are collected from inner and outer air gaps independently. Results: IDDs for which the beam energies were 71.6, 120.6, 159, 180.6, and 221.4 MeV were measured and compared with water phantom results. Furthermore, the measured PDDs along the central axis of the proton field with a nominal field size of 10×10 cm² were compared. The spread out Bragg peak was 20 cm for fields with a range of 30.6 and 3 cm for fields with a range of 6.9 cm. The IDDs measured with the DRMLIC using the correction technique were consistent with those that of the water phantom; except for the beam energy of 71.6 MeV, all of the points satisfied the 1% dose/1 mm distance to agreement criterion of the gamma index. The 71.6 MeV depth dose profile showed slight differences in the shallow region, but 94.5% of the points satisfied the 1%/1 mm criterion. The 90% ranges, defined at the 90% dose position in distal fall off, were in good agreement with those in the water phantom, and the range differences from the water phantom were less than ±0.3 mm. The PDDs measured with the DRMLIC were also consistent with those that of the water phantom; 97% of the points passed the 1%/1 mm criterion. Conclusions: It was demonstrated that the new correction technique suppresses the difference between the depth dose profiles obtained with the MLIC and those obtained from a water phantom, and a DRMLIC enabling fast measurements of both IDD and PDD was developed. The IDDs and PDDs measured with the DRMLIC and using the correction technique were in good agreement with those that of the water phantom, and it was concluded that the correction technique and DRMLIC are useful for depth dose profile measurements in pencil beam scanning proton therapy. [ABSTRACT FROM AUTHOR]

Dose evaluation for out-of-field organs during radiotherapy has gained interest in recent years. A team led by University of Tsukuba is currently implementing a project for advancing boron neutron capture therapy (BNCT), along with a radiation treatment planning system (RTPS). In this study, the authors used the RTPS (the ‘Tsukuba-Plan’) to evaluate the dose to out-of-field organs during BNCT. Computed tomography images of a whole-body phantom were imported into the RTPS, and a voxel model was constructed for the Monte Carlo calculations, which used the Particle and Heavy Ion Transport Code System. The results indicate that the thoracoabdominal organ dose during BNCT for a brain tumour and maxillary sinus tumour was 50–360 and 120–1160 mGy-Eq, respectively. These calculations required ∼29.6 h of computational time. This system can evaluate the outof- field organ dose for BNCT irradiation during treatment planning with patient-specific irradiation conditions. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prediction error and required internal margin provided for irregular respiratory movements. Materials and methods: Twenty-eight patterns of irregular movement were prepared using a moving phantom. For irregular cycle movement, a cycle of 2.0-5.0 s was inserted into the baseline movement data (3.5-s cycle, 6-mm amplitude) every four cycles. In addition, a cycle of 2.5-4.5 s was further inserted into one of the irregular data points every four cycles to produce more complicated irregularity. For irregular amplitude movement, an amplitude of 3.0-9.0 mm was inserted into the baseline respiratory movement data. In addition, an amplitude of 4.0-8.0 mm was further inserted into one of the irregular data points every four cycles to produce more complicated irregularity. Images of the moving target were acquired using a real-time position management (RPM) and four-dimensional CT (4DCT) system. The displacement from the baseline image and required margin to compensate for irregular movement were calculated. Results: Amplitude irregularity tended to lose stable placement and need larger margins to compensate for the reduction of image reproducibility than cycle irregularity. There was a large displacement and required margin when the target moved with more complicated irregular amplitude. Conclusion: The RPM and 4DCT system has a risk of prediction error, which may result from the complicated amplitude irregularity of respiratory movement. [ABSTRACT FROM AUTHOR]

Background and Aim Treatment for unresectable intrahepatic cholangiocarcinoma ( ICC) has not been established. The aim of the study was to evaluate the outcome of proton beam therapy ( PBT) for patients with unresectable ICC. Methods Up to 2010, 20 patients (11 males, 9 females, median age 63 years old) with unresectable ICC (two, seven, seven, and four in stages II, IIIA, IIIC, and IV, respectively) were treated with PBT. The largest dimensions of the tumors ranged from 15 to 140 mm (median: 50 mm). The intrahepatic region and lymph nodes received median total proton doses of 72.6 GyE in 22 fractions and 56.1 GyE in 17 fractions, respectively. Four patients received concurrent chemotherapy (tegafur, gimeracil, and oteracil; TS-1) during PBT. Twelve patients were treated curatively, and eight were treated palliatively because tumors were present outside the irradiation field. Results In the curative group, nine tumors within the irradiated field were controlled in follow-up of 8.6-62.6 months (median: 20.8 months). Median survival rates in the curative and palliative groups were 27.5 and 9.6 months, respectively, and overall 1- and 3-year survival rates were 82% and 38%, and 50% and 0%, respectively. Eight patients survived for > 2 years, and there was no distant metastasis in five of these patients after 2 years. No severe side-effects occurred. Conclusions The results suggest that long-term survival can be achieved using PBT for patients with unresectable ICC without distant metastasis. Further studies are required to determine the optimal treatment schedule and best combination of PBT and chemotherapy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify the roles of non-homologous end-joining (NHEJ) or homologous recombination (HR) pathways in repairing DNA double-strand breaks (DSBs) induced by exposure to high-energy protons and carbon ions (C ions) versus gamma rays in Chinese hamster cells. Two Chinese hamster cell lines, ovary AA8 and lung fibroblast V79, as well as various mutant sublines lacking DNA-PKcs (V3), X-ray repair cross-complementing protein-4 [XRCC4 (XR1), XRCC3 (irs1SF) and XRCC2 (irs1)] were exposed to gamma rays (137Cs), protons (200 MeV; 2.2 keV/μm) and C ions (290 MeV; 50 keV/μm). V3 and XR1 cells lack the NHEJ pathway, whereas irs1 and irs1SF cells lack the HR pathway. After each exposure, survival was measured using a clonogenic survival assay, in situ DSB induction was evaluated by immunocytochemical analysis of histone H2AX phosphorylation at serine 139 (γ-H2AX foci) and chromosome aberrations were examined using solid staining. The findings from this study showed that clonogenic survival clearly depended on the NHEJ and HR pathway statuses, and that the DNA-PKcs-/- cells (V3) were the most sensitive to all radiation types. While protons and γ rays yielded almost the same biological effects, C-ion exposure greatly enhanced the sensitivity of wild-type and HR-deficient cells. However, no significant enhancement of sensitivity in cell killing was seen after C-ion irradiation of NHEJ deficient cells. Decreases in the number of γ-H2AX foci after irradiation occurred more slowly in the NHEJ deficient cells. In particular, V3 cells had the highest number of residual γ-H2AX foci at 24 h after C-ion irradiation. Chromosomal aberrations were significantly higher in both the NHEJ- and HR-deficient cell lines than in wild-type cell lines in response to all radiation types. Protons and gamma rays induced the same aberration levels in each cell line, whereas C ions introduced higher but not significantly different aberration levels. Our results suggest that the NHEJ pathway plays an important role in repairing DSBs induced by both clinical proton and C-ion beams. Furthermore, in C ions the HR pathway appears to be involved in the repair of DSBs to a greater extent compared to gamma rays and protons. [ABSTRACT FROM AUTHOR]

Background. Radiation-induced rib fracture has been reported as a late complication after external radiotherapy to the chest. The purpose of this study was to clarify the characteristics and risk factors of rib fracture after hypofractionated proton beam therapy (PBT). Material and methods. The retrospective study comprised 67 patients with hepatocellular carcinoma who were treated using PBT of 66 Cobalt-Gray-equivalents [Gy (RBE)] in 10 fractions. We analyzed the patients' characteristics and determined dose-volume histograms (DVHs) for the irradiated ribs, and then estimated relationships between risk of fracture and several dose-volume parameters. An irradiated rib was defined to be any rib included in the area irradiated by PBT as determined by treatment-planning computed tomography. Results. Among the 67 patients, a total of 310 ribs were identified as irradiated ribs. Twenty-seven (8.7%) of the irradiated ribs developed fractures in 11 patients (16.4%). No significant relationships were seen between incidence of fracture and characteristics of patients, including sex, age, tumor size, tumor site, and follow-up period (p ≥ 0.05). The results of receiver operating characteristic curve analysis using DVH parameters demonstrated that the largest area under the curve (AUC) was observed for the volume of rib receiving a biologically effective dose of more than 60 Gy3 (RBE) (V60) [The equivalent dose in 2 Gy fractions (EQD2); 36 Gy3] and the AUCs of V30 to V120 (EQD2; 18-72 Gy3) and Dmax to D10cm3 were similar to that of V60. No significant relationships were seen for DVH parameters and intervals from PBT to incidence of fracture. Conclusion. DVH parameters are useful in predicting late adverse events of rib irradiation. This study identified that V60 was a most statistically significant parameter, and V30 to V120 and Dmax to D10cm3 were also significant and clinically useful for estimating the risk of rib fracture after hypofractionated PBT. [ABSTRACT FROM AUTHOR]

Purpose: To determine the oxidative capabilities of proton beams compared to X-rays based on lineal energy ( y). Materials and methods: Microdosimetry was used to determine y-values of 155 MeV protons. Salmon testes deoxyribonucleic acid (ST-DNA) in solution and human tumor cells (MOLT-4) were irradiated with 200 kV X-rays ( X) or 155 MeV protons at their plateau ( P) and near their Bragg-peak ( B). 8-Hydroxydeoxyguanosine (8-OHdG) production was determined by high performance liquid chromatography. Double-strand breaks (DSB) in ST-DNA were evaluated by agarose gel electrophoresis and DSB in cell nuclei were evaluated by immunocytochemical analysis of phosphorylated histone H2AX (γH2AX) foci. Edaravone was used as a radical scavenger. Results: 8-OHdG yields in ST-DNA were significantly higher with X than with P or B, and they were significantly higher with P than with B. DSB yields in ST-DNA were higher with P than with B or X, although not statistically significant, and were nearly equal with B and X. Although γH2AX foci formation in MOLT-4 cells after each irradiation type was nearly identical, the addition of edaravone significantly inhibited foci formation only with X. Conclusions: Our results indicated that radical-induced indirect DNA damage was significantly lower with proton beams than with X-rays. [ABSTRACT FROM AUTHOR]

The radioactivation of linear accelerator components for radiation therapy is interest for radiation protection in general, and particularly, when decommissioning these structures. The energy spectra of gamma rays emitted from the heads of two accelerator models, EXL-15SP and Clinac iX, after 10-MeV X-ray irradiation, were measured using a high-purity germanium semiconductor survey meter. After spectrum analyses, activities of 24Na, 28Al, 54Mn, 56Mn, 57Ni, 58Co, 60Co, 64Cu, 65Zn, 122Sb, 124Sb, 181W, 187W, 196Au, and 198Au were detected. One centimetre deep dose-equivalent rate of the heads of the linear accelerator was measured using the survey meter. The dose rate decreased to ∼10 % of its initial rate after 1 week. Long-term activations were few, the radioactivity level was low, and a cooling time of several days was effective for reducing dose rate to an acceptable level for decommissioning. [ABSTRACT FROM PUBLISHER]

Background: Proton-beam therapy (PBT) provides therapeutic advantages over conformal x-ray therapy in sparing organs at risk when treating esophageal cancer because of the fundamental physical dose distribution of the proton-beam. However, cases with extended esophageal lesions are difficult to treat with conventional PBT with a single isocentric field, as the length of the planning target volume (PTV) is longer than the available PBT field size in many facilities. In this study, the feasibility of a practical technique to effectively match PBT fields for esophageal cancer with a larger regional field beyond the available PBT field size was investigated. Methods: Twenty esophageal cancer patients with a larger regional field than the available PBT single-field size (15 cm in our facility) were analyzed. The PTV was divided into two sections to be covered by a single PBT field. Subsequently, each PTV isocenter was aligned in a cranial-caudal (CC) axis to rule out any influence by the movement of the treatment couch in anterior-posterior and left-right directions. To obtain the appropriate dose distributions, a designed-seamless irradiation technique (D-SLIT) was proposed. This technique requires the following two adjustments: (A) blocking a part of the PTV by multi-leaf collimator(s) (MLCs); and (B) fine-tuning the isocenter distance by the half-width of the MLC leaf (2.5 mm in our facility). After these steps, the inferior border of the cranial field was designed to match the superior border of the caudal field. Dose distributions along the CC axis around the field junction were evaluated by the treatment-planning system. Dose profiles were validated with imaging plates in all cases. Results: The average and standard deviation of minimum dose, maximum dose, and dose range between maximum and minimum doses around the field junction by the treatment-planning system were 95.9 ± 3.2%, 105.3 ± 4.1%, and 9.4 ± 5.2%. The dose profile validated by the imaging plate correlated with the results of the treatment-planning system in each case, with an error range within 4.3%. Conclusions: Dose distributions around the field junction were applied using D-SLIT. D-SLIT can be a useful treatment strategy for PBT of extended esophageal cancer. [ABSTRACT FROM AUTHOR]

In current radiotherapy, neutrons are produced in a photonuclear reaction when incident photon energy is higher than the threshold. In the present study, a method of discriminating the neutron component was investigated using an imaging plate (IP) in the neutron–gamma-ray mixed field. Two types of IP were used: a conventional IP for beta- and gamma rays, and an IP doped with Gd for detecting neutrons. IPs were irradiated in the mixed field, and the photo-stimulated luminescence (PSL) intensity of the thermal neutron component was discriminated using an expression proposed herein. The PSL intensity of the thermal neutron component was proportional to thermal neutron fluence. When additional irradiation of photons was added to constant neutron irradiation, the PSL intensity of the thermal neutron component was not affected. The uncertainty of PSL intensities was approximately 11.4 %. This method provides a simple and effective means of discriminating the neutron component in a mixed field. [ABSTRACT FROM PUBLISHER]

Purpose: To clarify the properties of clinical high-energy protons by comparing with clinical high-energy X-rays. Materials and methods: Human tumor cell lines, ONS76 and MOLT4, were irradiated with 200 MeV protons or 10 MV X-rays. In situ DNA double-strand breaks (DDSB) induction was evaluated by immunocytochemical staining of phosphorylated histone H2AX (γ-H2AX). Apoptosis was measured by flow-cytometry after staining with Annexin V. The relative biological effectiveness (RBE) was obtained by clonogenic survival assay. Results: DDSB induction was significantly higher for protons than X-rays with average ratios of 1.28 (ONS76) and 1.59 (MOLT4) at 30 min after irradiation. However the differences became insignificant at 6 h. Also, apoptosis induction in MOLT4 cells was significantly higher for protons than X-rays with an average ratio of 2.13 at 12 h. However, the difference became insignificant at 20 h. RBE values of protons to X-rays at 10% survival were 1.06 ± 0.04 and 1.02 ± 0.15 for ONS76 and MOLT4, respectively. Conclusions: Cell inactivation may differ according to different timings and/or endpoints. Proton beams demonstrated higher cell inactivation than X-rays in the early phases. These data may facilitate the understanding of the biological properties of clinical proton beams. [ABSTRACT FROM AUTHOR]

Organ absorbed doses in computed tomography (CT) scans can be measured with anatomical phantoms but not inside the human body. In this study, a straightforward method was investigated to estimate organ doses in clinical CT using the radiation treatment planning system (RTPS) and compared them with experimental results of photoluminescence dosemeters (PLD). In a heterogeneous phantom, the average difference between PLD and RTPS values were −5.0 % for the body and 7.1 % for the lung. Using CT data, organ doses in 30 clinical cases were then calculated. There was a significant inverse correlation between the calculated values of organ doses and body mass index (BMI, correlation coefficients (r)=−0.69 (whole body), −0.80 (right lung), −0.81 (left lung), −0.76 (spinal cord), −0.74 (vertebra bone), −0.74 (heart), and −0.79 (oesophagus), all p < 0.01). An RTPS can be a simple and useful tool for estimating equivalent doses inside the human body, during whole-body CT scans. [ABSTRACT FROM PUBLISHER]

Purpose: To investigate technical feasibilities of noncoplanar proton-beam therapy (PBT) on dose reduction to critical organs.Material and Methods: The degree of mechanical precision, rotational limitations of the gantry and the treatment couch were evaluated, and dose-volume histograms were compared for noncoplanar and coplanar PBT. Following these studies, three patients with tumors proximal to the optic nerve underwent noncoplanar PBT.Results: Noncoplanar PBT offered advantage in dose reduction to the optic nerve when compared to coplanar therapy. This advantage was more significant if the tumor reduced in size during treatment. None experienced radiation injury to the optic nerve during a short follow-up time of 7-12 months.Conclusion: Noncoplanar PBT appears to reduce doses to organs at risk. [ABSTRACT FROM AUTHOR]

In this study, the organ doses were measured using a human- body phantom simulating a medical staff member, and we considered an effective method for decreasing exposure to staff in positron emission tomography examinations. A fluorescence glass dosimeter was arranged for measurements in various organs. Regarding exposure, the average ratio of the dose at 100 cm from the source to the dose at 30 cm was 0.35. The ratio of the dose at 100 cm with a 3 cm lead shield to the dose at 100 cm with no shielding device was 0.01. To reduce the radiation exposure effectively, medical staff members should inform the patient of the details of the examination in advance, reduce the contact time with the patient during the examination, and maximize their distance from the patient when contact is necessary. [ABSTRACT FROM AUTHOR]

In this study, the nuclear medicine staff wore one finger dosimeter placed at the base of the index finger of the working hand. When a physician injected radioisotope drugs, the finger dose was 22.4 µSv, that for radiological technologists handling 99mTc was 29.6 µSv/day (consultation period 20 days), that for a physician injecting 18F-FDG-PET drugs was 51.3 µSv (right finger 53.9 µSv, left finger 47.2 µSv), that for pharmacists’ assay of FDG was 31.5 µSv, and that for radiological technologists positioning patients was 1.9 µSv. The largest value (94.1 µSv) was observed in physicians in the case of aspiration of a delivered drug. The finger dosimeter provides an effective solution for radiation protection procedures and follow-up. All the above staff members are on rotation and do not constantly handle radioactivity throughout the year. [ABSTRACT FROM AUTHOR]

A medical compact cyclotron produces about 1015 neutrons per day along with 100 GBq of 18F. Therefore, it is important to establish radiation safety guidelines on residual radioactivity for routine operation, maintenance work, and decommissioning. Thus, we developed a simple method for measuring the thermal neutrons in a cyclotron room. In order to verify the feasibility of our proposed method, we measured the thermal neutron distribution around a cyclotron by using the activation of 23Na in salt. We installed 78 salt dosimeters in the cyclotron room with a 50 cm mesh. The photopeak of 24Na was measured, and the neutron flux distribution was estimated. Monitoring the neutron flux distribution in a cyclotron room appears to be useful for not only obtaining an accurate estimate of the distribution of induced radioactivity, but also optimizing the shield design for radiation safety in preparation for the decommissioning process. [ABSTRACT FROM AUTHOR]

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Secondary neutron ambient dose equivalents per the treatment absorbed dose in passive carbon-ion and proton radiotherapies were measured using a rem meter, WENDI-II at two carbon-ion radiotherapy facilities and four proton radiotherapy facilities in Japan. Our measured results showed that (1) neutron ambient dose equivalent in carbon-ion radiotherapy is lower than that in proton radiotherapy, and (2) the difference to the measured neutron ambient dose equivalents among the facilities is within a factor of 3 depending on the operational beam setting used at the facility and the arrangement of the beam line, regardless of the method for making a laterally uniform irradiation field: the double scattering method or the single-ring wobbling method. The reoptimization of the beam line in passive particle radiotherapy is an effective way to reduce the risk of secondary cancer because installing an adjustable precollimator and designing the beam line devices with consideration of their material, thickness and location, etc., can significantly reduce the neutron exposure. It was also found that the neutron ambient dose equivalent in passive particle radiotherapy is equal to or less than that in the photon radiotherapy. This result means that not only scanning particle radiotherapy but also passive particle radiotherapy can provide reduced exposure to normal tissues around the target volume without an accompanied increase in total body dose. [ABSTRACT FROM AUTHOR]