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Background: Electronic portal imaging devices (EPIDs) are applied to measure the dose and verify patients’ position.Objective: The present study aims to evaluate the performance of EPID for measuring dosimetric parameters in small photon fields.Material and Methods: In this experimental study, the output factors and beam profiles were obtained using the amorphous silicon (a-Si) EPID for square field sizes ranging from 1×1 to 10×10 cm2 at energies 6 and 18 mega-voltage (MV). For comparison, the dosimetric parameters were measured with the pinpoint, diode, and Semiflex dosimeters. Additionally, the Monaco treatment planning system was selected to calculate the output factors and beam profiles.Results: There was a significant difference between the output factors measured using the EPID and that measured with the other dosimeters for field sizes lower than 8×8 cm2. In the energy of 6 MV, the gamma passing rates (3%/3 mm) between EPID and diode profile were 98%, 98%, 95%, 94%, 93%, and 94% for 1×1, 2×2, 3×3, 4×4, 5×5, and 10×10 cm2, respectively. The measured penumbra width with EPID was higher compared to that measured by the diode dosimeter for both energies. Conclusion: The EPID can measure the dosimetric parameters in small photon fields, especially for beam profiles and penumbra measurements.

Abstract Background Radiation induced acute skin toxicity (AST) is considered as a common side effect of breast radiation therapy. The goal of this study was to design dosiomics-based machine learning (ML) models for prediction of AST, to enable creating optimized treatment plans for high-risk individuals. Methods Dosiomics features extracted using Pyradiomics tool (v3.0.1), along with treatment plan-derived dose volume histograms (DVHs), and patient-specific treatment-related (PTR) data of breast cancer patients were used for modeling. Clinical scoring was done using the Common Terminology Criteria for Adverse Events (CTCAE) V4.0 criteria for skin-specific symptoms. The 52 breast cancer patients were grouped into AST 2 + (CTCAE ≥ 2) and AST 2 − (CTCAE

Background: Radiomic feature reproducibility assessment is critical in radiomics-based image biomarker discovery. This study aims to evaluate the impact of preprocessing parameters on the reproducibility of magnetic resonance image (MRI) radiomic features extracted from gross tumor volume (GTV) and high-risk clinical tumor volume (HR-CTV) in cervical cancer (CC) patients. Methods: This study included 99 patients with pathologically confirmed cervical cancer who underwent an MRI prior to receiving brachytherapy. The GTV and HR-CTV were delineated on T2-weighted MRI and inputted into 3D Slicer for radiomic analysis. Before feature extraction, all images were preprocessed to a combination of several parameters of Laplacian of Gaussian (1 and 2), resampling (0.5 and 1), and bin width (5, 10, 25, and 50). The reproducibility of radiomic features was analyzed using the intra-class correlation coefficient (ICC). Results: Almost all shapes and first-order features had ICC values > 0.95. Most second-order texture features were not reproducible (ICC < 0.95) in GTV and HR-CTV. Furthermore, 20% of all neighboring gray-tone difference matrix texture features had ICC > 0.90 in both GTV and HR-CTV. Conclusion: The results presented here showed that MRI radiomic features are vulnerable to changes in preprocessing, and this issue must be understood and applied before any clinical decision-making. Features with ICC > 0.90 were considered the most reproducible features. Shape and first-order radiomic features were the most reproducible features in both GTV and HR-CTV. Our results also showed that GTV and HR-CTV radiomic features had similar changes against preprocessing sets.

Background and purpose: Radiation therapy is one of the most important methods in treatment of cancer. Targeted metal nanoparticles (NPs) play an effective role in reducing ionizing radiation side effects through increasing the effect of ionizing radiation on cancer cells and controlling the harmful effect of radiation on healthy cells. The purpose of this study was to investigate the effect of targeted folic acid gold NPs (GNPs) using linker bovine serum albumin in the absorption and sensitivity of gold NPs in HeLa cervical cancer cells compared to non-targeted gold NPs. Materials and methods: In this study, GNPs were conjugated with folic acid by bovine serum albumin as the linker. The binding of bovine serum albumin and folic acid to GNPs was investigated by infrared (IR) spectroscopy. Toxicity was measured by the MTT method and based on the results, the GNPs’ non-toxic concentration was determined. The effect of targeted synthesized GNPs on their absorption and sensitivity were evaluated on HeLa cells. Results: The non-toxic concentration of GNPs was 12 μg/ml. Incubation of the cells with this concentration was performed for 2, 4, and 24 hours and it was observed that in 4 hours, the absorption rate of targeted GNPs was about 4 times higher than that of non-targeted GNPs. The radiosensitization ratios of targeted and non-targeted GNPs in the studied cancer cells relative to the control group (without NPs) exposed to 6 MV photon radiation were 1.32±0.02 and 1.19±0.02, respectively. Conclusion: The use of bovine serum albumin linker to target GNPs has a significant effect on increasing the absorption of GNPs and the effect of ionizing radiation on HeLa cells under 6 MV photon beams.

Abstract Background As a radiosensitizing agent in magnetic resonance imaging (MRI), gadolinium is disadvantageous in that it confers a rather high toxicity and low longitudinal comfort time (r1). We hypothesized that gadolinium when combined with gold-coated iron oxide nanoparticles (NPs), might deliver better radiosensitization in MRI-based cancer theranostics. After being synthesized ligand/receptor RGD@Fe3O4-Au/Gd nanoparticles, they were characterized via some methods, such as visible–ultraviolet spectroscopy (UV–VIS), Fourier transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), and transmission electron microscope (TEM). Using relaxometry, the parameters of contrast change in T1-weighted MRI and the rate of radiation sensitivity on cancerous (MCF-7, SK-BR-3 and MDA-MB-231 (and reference (MCF-10a) breast cell lines were investigated. Results The presence of ultra-small iron oxide, gold, gadolinium, and RGD peptide as components of the RGD@Fe3O4-Au/Gd nanocomplex was confirmed by UV–visible, FTIR, EDX and XRD tests. With a size ranging from 4.124 nm (DLS) to 15 nm (TEM), these NPs exhibited a surface charge of –45.7 mV and a magnetic saturation of 3 emu/g. The concentrations of iron, gadolinium and gold samples in the nanocomplex were 1000, 1171 and 400 parts per million (ppm), respectively. In the relaxometry test, the rates of r2/r1 and r1 NPs were 1.56 and 23.5 mM−1 s−1. The dose increase factor for targeted (RGD@Fe3O4-Au/Gd) and non-targeted (Fe3O4-Au/Gd) NPs at 6 MV and 2 Gy was 89.1 and 59.1, respectively. Conclusion Owing to an enhanced signal-to-noise ratio (SNR), as confirmed by the MRI of RGD receptor-expressing MDA-MB-231 cells, RGD@Fe3O4-Au/Gd NPs were found to confer higher radiosensitization and an overall better performance as a novel radiosensitizer for MRI-based breast cancer theranostics than Fe3O4-Au/Gd nanocomplex. Graphical Abstract

Introduction: In intensity-modulated radiation therapy (IMRT) techniques, although the dose conformity increases, the out-of-field doses would not decrease. This study aimed to assess the dose error calculated by the treatment planning system (TPS) in the out-of-field regions using the dynamic IMRT (D-IMRT) method in nasopharyngeal cancer (NPC) patients. Methods: The out-of-field doses were measured for the chiasm and parotid organs using the D-IMRT technique (6 MV energy) with Monaco TPS. Computed tomography (CT) images of 10 NPC patients (54–77 years, mean: 61.6 ± 12.2 years) were considered and countered using 7-field and 11-field methods. The OCTAVIUS 4D phantom was utilized for dose assessment. Results: According to the OCTAVIUS measurements, the Monaco TPS dose errors ranged from −58.8 to 105.5%. The average dose error for optic chiasm and parotid organs was −25% and 8.5%, respectively, with several cases falling within tolerance (±5%). Conclusion: There were considerable dose calculation errors by Monaco TPS for organs located in out-of-field regions (optic chiasm and parotid) during IMRT for NPC patients. Therefore, accurate dose estimation in the out-of-field regions should be considered in clinical practices.

Chordoma is a bone tumor that is resistant to radiotherapy, and few studies have been published on the concomitant use of radiotherapy in combination with hyperthermia in its treatment. We reported a chordoma patient treated with both radiotherapy and hyperthermia. The patient was a 74-year-old man with chordoma who underwent radiotherapy combined with hyperthermia due to his unwillingness to undergo surgery and responded very well clinically and imaging-wise without increasing in complications. Radiotherapy combined with hyperthermia improves the response to treatment (both clinically and in imaging) and does not increase the complications.

Background: Laryngeal damages after chemoradiation therapy (RT) in nonlaryngeal head-and-neck cancers (HNCs) can cause voice disorders and finally reduce the patient's quality of life (QOL). The aim of this study was to evaluate voice and predict laryngeal damages using statistical binary logistic regression (BLR) models in patients with nonlaryngeal HNCs. Methods: This cross-section experimental study was performed on seventy patients (46 males, 24 females) with an average age of 50.43 ± 16.54 years, with nonlaryngeal HNCs and eighty individuals with assumed normal voices. Subjective and objective voice assessment was carried out in three stages including before, at the end, and 6 months after treatment. Eventually, the Enter method of the BLR was used to measure the odds ratio of independent variables. Results: In objective evaluation, the acoustic parameters except for F0 increased significantly (P < 0.001) at the end treatment stage and decreased 6 months after treatment. The same trend can be seen in the subjective evaluations, whereas none of the values returned to pretreatment levels. Statistical models of BLR showed that chemotherapy (P < 0.05), mean laryngeal dose (P < 0.05), V50 Gy (P = 0.002), and gender (P = 0.008) had the greatest effect on incidence laryngeal damages. The model based on acoustic analysis had the highest percentage accuracy of 84.3%, sensitivity of 87.2%, and the area under the curve of 0.927. Conclusions: Voice evaluation and the use of BLR models to determine important factors were the optimum methods to reduce laryngeal damages and maintain the patient's QOL.

Radiotherapy as a standard method for cancer treatment faces tumor recurrence and antitumoral unresponsiveness. Suppressive tumor microenvironment (TME) and hypoxia are significant challenges affecting efficacy of radiotherapy. Herein, a versatile method is introduced for the preparation of pH-sensitive catalase-gold cross-linked nanoaggregate (Au@CAT) having acceptable stability and selective activity in tumor microenvironment. Combining Au@CAT with low-dose radiotherapy enhanced radiotherapy effects via polarizing protumoral immune cells to the antitumoral landscape. This therapeutic approach also attenuated hypoxia, confirmed by downregulating hypoxia hallmarks, such as hypoxia-inducible factor α-subunits (HIF-α), vascular endothelial growth factor (VEGF), and EGF. Catalase stability against protease digestion was improved significantly in Au@CAT compared to the free catalase. Moreover, minimal toxicity of Au@CAT on normal cells and increased reactive oxygen species (ROS) were confirmed in vitro compared with radiotherapy. Using the nanoaggregates combined with radiotherapy led to a significant reduction of immunosuppressive infiltrating cells such as myeloid-derived suppressor cells (MDSCs) and regulatory T cells (T-regs) compared to the other groups. While, this combined therapy could significantly increase the frequency of CD8+ cells as well as M1 to M2 macrophages (MQs) ratio. The combination therapy also reduced the tumor size and increased survival rate in mice models of colorectal cancer (CRC). Our results indicate that this innovative nanocomposite could be an excellent system for catalase delivery, manipulating the TME and providing a potential therapeutic strategy for treating CRC.

Introduction: In this study, Radiomic features analysis of CT scan images of the irradiated breast compared to the contralateral breast after a 12 Gy boost radiation dose in IOERT was conducted to obtain radiation-sensitive indicators (parameters) biological markers or biological dosimeters.Material and Methods: 35 contrast chest CT scans (with unilateral ductal carcinoma in situ (DCIS) who had undergone boost IOERT) were used in this study. The total number of 259 CT radiomic features (first-order, textural, gradient, and autoregressive model-based features) were extracted using Mazda software. The features that were significantly different in the two breasts were selected. A score was assigned to each of the features and the highest scores were characterized (according to the level of significant differences). The feature selection process was performed using the hybrid feature selection method.Results: CT Texture analysis indicated that radiation dose causes significant changes in some radiomic features of the breast tissue. Conclusion: With more research in the future, we can fit the Delta-Radiomics values with the received radiation dose and achieve a biological dosimeter to detect low-dose radiation.

Background: This study evaluated the performances of neural networks in terms of denoizing metal artifacts in computed tomography (CT) images to improve diagnosis based on the CT images of patients. Methods: First, head-and-neck phantoms were simulated (with and without dental implants), and CT images of the phantoms were captured. Six types of neural networks were evaluated for their abilities to reduce the number of metal artifacts. In addition, 40 CT patients' images with head-and-neck cancer (with and without teeth artifacts) were captured, and mouth slides were segmented. Finally, simulated noisy and noise-free patient images were generated to provide more input numbers (for training and validating the generative adversarial neural network [GAN]). Results: Results showed that the proposed GAN network was successful in denoizing artifacts caused by dental implants, whereas more than 84% improvement was achieved for images with two dental implants after metal artifact reduction (MAR) in patient images. Conclusion: The quality of images was affected by the positions and numbers of dental implants. The image quality metrics of all GANs were improved following MAR comparison with other networks.

Background: Respiratory movement and the motion range of the diaphragm can affect the quality and quantity of prostate images.Objective: This study aimed to investigate the magnitude of respiratory-induced errors to determine Dominant Intra- prostatic Lesions (DILs) in positron emission tomography (PET) images.Material and Methods: In this simulation study, we employed the 4D NURBS-based cardiac-torso (4D-NCAT) phantom with a realistic breathing model to simulate the respiratory cycles of a patient to assess the displacement, volume, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), signal to noise ratio (SNR), and the contrast of DILs in frames within the respiratory cycle.Results: Respiration in a diaphragm motion resulted in the maximum superior-inferior displacement of 3.9 and 6.1 mm, and the diaphragm motion amplitudes of 20 and 35 mm. In a no-motion image, the volume measurement of DILs had the smallest percentage of errors. Compared with the no-motion method, the percentages of errors in the average method in 20 and 35 mm- diaphragm motion were 25% and 105%, respectively. The motion effect was significantly reduced in terms of the values of SUVmax and SUVmean in comparison with the values of SUVmax and SUVmean in no- motion images. The contrast values in respiratory cycle frames were at a range of 3.3-19.2 mm and 6.5-46 for diaphragm movements’ amplitudes of 20 and 35 mm. Conclusion: The respiratory movement errors in quantification and delineation of DILs were highly dependent on the range of motion, while the average method was not suitable to precisely delineate DILs in PET/CT in the dose-painting technique.

Purpose: The goal of this research was to investigate the bystander effect in the A-375 cell line under the spatially fractionated radiation therapy (GRID therapy technique). In GRID therapy, due to direct and indirect cell damage after high-dose radiation, evaluation of Radiation-Induced Bystander Effects (RIBE) is of the most importance for investigating the risk of therapy. Materials and Methods: The potential role of RIBE was evaluated with different doses of 6 MeV electron radiation and different incubation times after irradiation using two methods; GRID therapy and medium transfer. Colony Formation Assay (CFA) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) test were used to detect the mentioned effects. Alpha and beta parameters were calculated from the cell survival curve by the quadratic-linear model. Results: The result showed that the survival fraction significantly decreases by increasing the radiation dose for both bystander and irradiated cells. However, a decrease in the number of colony-forming cells caused by electron radiation greater than 4MeV to target cells was significantly increased compared with bystander cells (P < 0.05). While increasing the incubation time after exposure to an electron beam, it had no significant effect on cell survival fraction (P > 0.05). Furthermore, the RIBE level in non-target cells increased up to a dose of 4Gy, but decreased significantly at doses higher than 4Gy. This result in high doses confirmed that a negative feedback mechanism was responsible for reducing the RIBE response. Conclusion: Based on the results, we can state there are classic radiation-induced bystander effects in A-375 monolayer exposed by GRID therapy and medium transfer technique, which can play an important role in pre-clinical and clinical studies.

Background: Patients diagnosed with dominant intraprostatic lesions (DIL) may need radiation doses over than 80 Gy. Dose-painting by contours (DPC) is a useful technique which helps the patients. Dose-painting approach need to be evaluated. Objective: To evaluate the DCP technique in the case of boosting the DILs by radiobiological parameters, tumor control probability (TCP), and normal tissue complication probability (NTCP) via PET/CT images traced by 68Ga-PSMA.Material and Methods: In this analytical study, 68Ga-PSMA PET/CT images were obtained from patients with DILs that were delineated using the Fuzzy c-mean (FCM) algorithm and thresholding methods. The protocol of therapy included two phases; at the first phase (ph1), a total dose of 72 Gy in 36 fractions were delivered to the planning target volume (PTV1); the seconds phase consisted of the application of variable doses to the PTV2. Moreover, two concepts were also considered to calculate the TCP using the Zaider-Minerbo model. Results: The lowest volume in DILs belonged to the DIL1 extracted by the FCM method. According to dose-volume parameters of the rectum and bladder, by the increase in the PTV dose higher than 92 Gy, the amounts of rectum and bladder doses are increased. There was no difference between the TCPs of DILs at doses higher than 86 Gy and 100 Gy for ordinary and high clone density, respectively. Conclusion: Consequently, our dose-painting approach for DILs, extracted by the FCM method via PET/CT images, can reduce the total dose for prostate radiation with 100% tumor control and less normal tissue complications.

Androgen deprivation therapy (ADT) remains the cornerstone of advanced prostate cancer treatment. However, the progression towards castration-resistant prostate cancer is inevitable, as the cancer cells reactivate androgen receptor signaling and adapt to the castrate state through autoregulation of the androgen receptor. Additionally, the upfront use of novel hormonal agents such as enzalutamide and abiraterone acetate may result in long-term toxicities and may trigger the selection of AR-independent cells through “Darwinian” treatment-induced pressure. Therefore, it is crucial to develop new strategies to overcome these challenges. Bipolar androgen therapy (BAT) is one such approach that has been devised based on studies demonstrating the paradoxical inhibitory effects of supraphysiologic testosterone on prostate cancer growth, achieved through a variety of mechanisms acting in concert. BAT involves rapidly alternating testosterone levels between supraphysiological and near-castrate levels over a period of a month, achieved through monthly intramuscular injections of testosterone plus concurrent ADT. BAT is effective and well-tolerated, improving quality of life and potentially re-sensitizing patients to previous hormonal therapies after progression. By exploring the mechanisms and clinical evidence for BAT, this review seeks to shed light on its potential as a promising new approach to prostate cancer treatment.

Breast cancer is considered as one of the main causes of cancer death in women. Early diagnosis and treatment, especially by modern technologies play major roles in management of breast cancer. Radiation therapy is known as one of the main treatment options for breast cancer. Nowadays, 3D printing technology is also used to rapidly construct objects with high quality. Many studies have shown the positive effects of this technology on the results of cancer radiation therapy. The aim of this study was to review the application of 3D printing technology in treatment of breast cancer by mega voltage electron and photon beams, including bolus, applicators, immobilizer devices, and compensators. Creating personalized treatment devices by 3D printing technology reduces treatment errors, therefore, the prescribed dose is increased in the treatment area and subsequently improves treatment outcomes. In spite of the valuable benefits of this technology, there are some disadvantages such as size limitations and the number of materials used for printing. Indeed, recent studies are trying to fix the shortcomings of 3D printing technologies in clinical applications.

Abstract Background Intraoperative electron radiotherapy (IOERT) followed by hypofractionated whole breast irradiation (HWBI) provides the shortest possible time of adjuvant breast irradiation. The efficacy of either method has been described in previous reports; however, to our knowledge, the efficacy of combined therapy has not been reported. Aim To compare the toxicity and cosmetic outcome of IOERT as a tumor bed boost followed by HWBI with conventional whole breast irradiation (CWBI) followed by external electron tumor bed boost (EETBB) after breast conserving surgery (BCS) in patients with invasive breast cancer. Methods In 2019, a prospective noninferiority trial (IRCT20180919041070N2) was started. After BCS, early‐stage breast cancer patients were treated by IOERT (10 Gy) and HWBI (42.56 Gy in 16 fractions) or CWBI (50 Gy in 25 fraction) and EETBB (10 Gy in 5) in a double‐arm design. Acute/late toxicity and cosmetic outcome were evaluated by common toxicity criteria (CTC) after 1‐year follow‐up (FUP) at the level of p

Abstract Using a rectal retractor (RR) during salvage radiotherapy after radical prostatectomy is a promising approach for reducing dose to the rectum. The patient well tolerated the daily RR insertion. This area of research encourages researchers for a comprehensive evaluation of the role of the RR in postprostatectomy radiotherapy.

Objectives: Metal artifacts are one of the major issues encountered in computed tomography (CT) images since they may make distinguishing healthy and tumor organs and computing dose distribution through radiotherapy very difficult. Accordingly, designing generative adversarial neural networks (GANs) will help reduce metal artifacts. Methods: Training and validating images with and without metal artifacts were simulated in MATLAB. Then, these images were used as the input data for the GAN, while CT images of 30 patients with head and neck cancer were used as testing data for the GAN. Finally, the quality metrics of denoised images were compared with those of the noisy images. Results: The images of patients with one dental implant have shown more improvement in the oral cavity area (16.81%), which is very important in treatment planning. Simulated images were used for the validation of the GAN's ability for metal artifact reduction. Moreover, the GAN was affected by the density and position of the metal artifacts in the CT images. Conclusions: Corrected images allow us to improve the quality of the CT images of patients with metal artifacts.

Background. The standard treatment for breast cancer is breast-conserving surgery (BCS) with radiotherapy. If external beam radiation therapy (EBRT) can be safely replaced with intraoperative radiotherapy (IORT), it will help patients to save their breast and to have equivocal or better results in DFS and overall survival (OS). Methods. A total of 2022 patients with breast cancer treated during 6 years were enrolled in the current study. A total of 657, 376, and 989 patients received EBRT, radical, and boost dose by IORT, respectively, according to the IRIORT consensus protocol. The primary endpoint was recurrence and death. The secondary endpoint was the role of variables in recurrence and death. Results. With a mean follow-up of 34.5 and 40.18 months for the IORT and EBRT groups, respectively, there was a significant difference in DFS between electron boost and X-ray boost groups (P=0.037) and the electron radical group compared with EBRT (P=0.025), but there was no significant difference between other boost and radical groups in DFS and OS. Conclusions. IORT can be a preferred treatment modality because of its noninferior outcomes, and in some special conditions, it has superior outcomes compared to EBRT, particularly in delivering radical dose with IORT.

Introduction: Environmental and occupational human exposure from neutron source can lead to the serious biologic effects. The aim of this study is to evaluate the cancer incidence risk for various human organs at different neutron dose levels due to exposure from an Americium-241/Beryllium (Am-241/Be), a standard neutron source for calibration purposes. Material and Methods: We measured ambient dose equivalent H*(10) at different distances from Am-241/Be mixed neutron source by Berthold LB 6411 detector and determined cancer incidence risk for different organs of both male and female subjects at different neutron exposure levels by BEIR VII model. Results: Exposure age had a reverse impact on cancer incidence risk of different organs. We found that as H*(10) increases, cancer incidence risk increments as well. Colon (for men) and bladder (for women) had the highest sensitivity to neutron exposure, while prostate and uterus showed the lowest risk of cancer incidence among male and female subjects, respectively. Conclusion: Older exposed persons are at a lower risk of cancer incidence. The risk of cancer incidence for various organs is considerably associated with gender, such that radiation sensitivity of female organs was higher at all the measured neutron dose levels.

Objective This study evaluated enhanced induced DNA damages and apoptosis of a spheroid culture of DU145 prostate cancer cells treated by a combination of radiofrequency hyperthermia (RF HT) with radiation treatment (RT) from an external radiotherapy machine compared to RT alone. Materials and Methods In this experimental study, DU145 cells were cultured as spheroids until they reached 300 µm in diameter. We exposed these cultures to either: RF HT for 90 minutes at 43˚C originated from a Celsius TCS system, RF HT followed by RT at doses of 2 Gy or 4 Gy (15 MV energy) with 15-minute interval, or RT alone at the above mentioned doses. The trypan blue exclusion assay, alkaline comet assay, and annexin V/PI flow cytometry were performed to measure cell viability, the amount of DNA damage in an individual cell as the tail moment, and percentage of induced cell apoptosis in response to treatments explained. Results We calculated the thermal enhancement factor (TEF) for the combined treatment regime. RF HT followed by the 4 Gy dose of RT resulted in minimum viability (85.33 ± 1.30%), the highest tail moment (1.98 ± 0.18), and highest percentage of apoptotic cells (64.48 ± 3.40%) compared to the other treatments. The results of the TEF assay were 2.54 from the comet assay and 2.33 according to flow cytometry. Conclusion The present data suggest that combined treatment of mega voltage X-rays and RF HT can result in significant radiosensitization of prostate cancer cells.

Introduction Interaluminal brachytherapy is one of the important methods of esophageal cancer treatment. The effect of applicator attenuation is not considered in dose calculation method released by AAPM-TG43. In this study, the effect of High-Dose Rate (HDR) brachytherapy esophageal applicator on dose distribution was surveyed in HDR brachytherapy. Materials and Methods A cylindrical PMMA phantom was built in order to be inserted by various sizes of esophageal applicators. EDR2 films were placed at 33 mm from Ir-192 source and irradiated with 1.5 Gy after planning using treatment planning system for all applicators. Results The results of film dosimetry in reference point for 6, 8, 10, and 20 mm applicators were 1.54, 1.53, 1.48, and 1.50 Gy, respectively. The difference between practical and treatment planning system results was 0.023 Gy (

Introduction Dosimetric accuracy is a major issue in the quality assurance (QA) program for treatment planning systems (TPS). An important contribution to this process has been a proper dosimetry method to guarantee the accuracy of delivered dose to the tumor. In brachytherapy (BT) of gynecological (Gyn) cancer it is usual to insert a combination of tandem and ovoid applicators with a complicated geometry which makes their dosimetry verification difficult and important. Therefore, evaluation and verification of dose distribution is necessary for accurate dose delivery to the patients. Materials and Methods The solid phantom was made from Perspex slabs as a tool for intracavitary brachytherapy dosimetric QA. Film dosimetry (EDR2) was done for a combination of ovoid and tandem applicators introduced by Flexitron brachytherapy system. Treatment planning was also done with Flexiplan 3D-TPS to irradiate films sandwiched between phantom slabs. Isodose curves obtained from treatment planning system and the films were compared with each other in 2D and 3D manners. Results The brachytherapy solid phantom was constructed with slabs. It was possible to insert tandems and ovoids loaded with radioactive source of Ir-192 subsequently. Relative error was 3-8.6% and average relative error was 5.08% in comparison with the films and TPS isodose curves. Conclusion Our results showed that the difference between TPS and the measurements is well within the acceptable boundaries and below the action level according to AAPM TG.45. Our findings showed that this phantom after minor corrections can be used as a method of choice for inter-comparison analysis of TPS and to fill the existing gap for accurate QA program in intracavitary brachytherapy. The constructed phantom also showed that it can be a valuable tool for verification of accurate dose delivery to the patients as well as training for brachytherapy residents and physics students.

Introduction Bolus is a soft and resilient material which is used for increasing skin dose or to even out the irregular patient contour. The main property of various materials used presently as bolus is the water-equivalent electron density. Ethyl methacrylate is used as a soft-liner in dentistry and its physical and chemical properties are proved to be nontoxic for human body. The goal of this study was to assess the feasibility of using this material as bolus in radiotherapy and also evaluating some parameters such as mass, electron densities, and transmission factors. Materials and Methods Computed tomography data from the sample material were acquired to assess mass and electron densities with various techniques (mA and kVp). Circular ROIs were delineated on CT DICOM images and densities were calculated using CT numbers. Transmission factors were calculated for 6 and 18 MV. Results Evaluation of our results are evident that showed that mass and electron densities of ethyl methacrylate are similar to those of water and soft tissue. Furthermore, transmission factors are close to those of water. Conclusion According to the results of this study and other properties such as flexibility and harmlessness, it seems that ethyl methacrylate is a suitable material to be used as bolus in radiotherapy.