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To evaluate the dosimetric characteristics and applications of a dosimetry system composed of a flexible amorphous silicon thin-film solar cell and scintillator screen (STFSC-SS) for therapeutic X-rays.The real-time dosimetry system was composed of a flexible a-Si thin-film solar cell (0.2-mm thick), a scintillator screen to increase its efficiency, and an electrometer to measure the generated charge. The dosimetric characteristics of the developed system were evaluated including its energy dependence, dose linearity, and angular dependence. Calibration factors for the signal measured by the system and absorbed dose-to-water were obtained by setting reference conditions. The application and correction accuracy of the developed system were evaluated by comparing the absorbed dose-to-water measured using a patient treatment beam with that measured using the ion chamber.The responses of STFSC-SS to energy, field size, depth, and source-to-surface distance (SSD) were more dependent on measurement conditions than were the responses of the ion chamber, although the former dependence was due to the scintillator screen, not the solar cell. The signals of STFSC-SS were also dependent on dose rate, while the responses of solar cell alone and scintillator screen were not dependent on dose rate. The scintillator screen reduced the output of solar cell at 6 and 15 MV by 0.60 and 0.55%, respectively. The different absorbed dose-to-water measured using STFSC-SS for patient treatment beam differed by 0.4% compared to those measured using the ionization chamber. The uncertainties of the developed system for 6 and 15 MV photon beams were 1.8 and 1.7%, respectively, confirming the accuracy and applicability of this system.The thin-film solar cell-based detector developed in this study can accurately measure absorbed dose-to-water. The increased signal resulting from the use of the scintillator screen is advantageous for measuring low doses and stable signal output. In addition, this system is flexible, making it applicable to curved surfaces, such as a patient's body, and is cost-effective.

This study describes a simple method of inter-fractional photon beam monitoring to measure the entrance dose of radiation treatment using Gafchromic EBT3 film.The film was placed at the center of a 1-cm thick phantom shaped like a block tray and fixed on the accessory tray of the gantry. The entrance dose was measured following the placement of the film in the accessory tray. The dose distribution calculated with the treatment planning system was compared with the dose distribution on the irradiated EBT3 films. The effectiveness of this methodology, as determined by gamma passing rates, was evaluated for the 22 fields of eight three-dimensional conformal radiotherapy (3D-CRT) plans and the 41 fields of nine intensity-modulated radiotherapy (RT) plans. The plans for three-dimensional conformal RT included treatments of the rectum, liver, breast, and head and neck, whereas the plans for intensity-modulated RT included treatments of the liver, brain, and lung.The gamma passing rates for 3D-CRT ranged from 96.4% to 99.5%, with the mean gamma passing rate for 22 fields being 98.0%. The gamma passing rate for intensity-modulated RT ranged from 96.1% to 98.9%, with the mean gamma passing rate for 41 fields being 97.7%. All gamma indices were over the 95% tolerance level.The methodology described in this study, based on Gafchromic EBT3 film, can be utilized for inter-fractional entrance dose monitoring as quality assurance during RT. Clinical application of this method to patients can verify the accuracy of beam delivery in the treatment room.

Personal dosimeters are used to measure the amount of radiation exposure in individual radiation workers. We aimed to replace existing personal dosimeters and evaluate a real-time scintillator-based dosimeter by monitoring its radiation dose and checking the location exposed to radiation in the workspace. The developed dosimeter measured the radiation dose based on a scintillating fiber (SF) bundle, and comprised a silicon photomultiplier (SiPM), ultra-wide-band (UWB)-based location detecting system, and Bluetooth system. The SF bundle was exposed to radiation-emitted light, and the photons were amplified and converted to electrical signals through the SiPM. These signals were transferred to the user through the Bluetooth system and monitored. To evaluate the feasibility of this mechanism as a dosimeter, we performed characteristic tests, such as dose linearity, dependence on dose rate, energy, exposed angle, and location coordinate mapping. Also, the dose distribution formed in circles around the iso-center was measured to confirm the feasibility of monitoring the exposure dose and location and to enable the radiation worker to move freely in a workspace. We confirmed dose linearity, independence from energy and angle, and accuracy of location monitoring in our device. The user’s locations were measured with a difference of − 6 cm and − 4.8 cm on the x- and the y-axes, respectively. The measured doses on our developed dosimeter were 62.7, 32.3, 21.0, and 15.4 mSv at distances of 50, 100, 150, and 200 cm from the iso-center. In other words, all measured doses at several points showed an error within 5% as compared to doses provided by the conventional pocket dosimeter. These results show that the developed SF-based dosimeter is advantageous in monitoring the exposure dose and location in real time, and has significant potential as a new personal dosimeter for radiation workers.

Purpose The entrance beam fluence of therapeutic proton scanning beams can be monitored using a gantry-attachable plastic scintillating plate (GAPSP). This study evaluated the clinical application of the GAPSP using a method that measures intensity modulated proton therapy (IMPT) beams for patient treatment. Methods IMPT beams for the treatment of nine patients, at sites that included the spine, head and neck, pelvis, and lung, were measured using the GAPSP, composed of an EJ-212 plastic scintillator and a CMOS camera. All energy layers distinguished by the GAPSP were accumulated to determine the dose distribution of the treatment field. The evaluated fields were compared with reference dose maps verified by quality assurance. Results Comparison of dose distributions of evaluation treatment fields with reference dose distributions showed that the 3%/1 mm average gamma passing rate was 96.4%, independent of the treatment site, energy range and field size. When dose distributions were evaluated using the same criteria for each energy layer, the average gamma passing rate was 91.7%. Conclusions The GAPSP is a suitable, low-cost method for monitoring pencil beam scanning proton therapy, especially for non-spot scanning or additional collimation. The GAPSP can also estimate the treatment beam by the energy layer, a feature not common to other proton dosimetry tools.

Monte Carlo simulations can classify DNA damage into different types and predict the amount of energy deposited. Geant4-DNA was used to predict simple and complex DNA damage induced by irradiation ...

This study describes a method that uses a genetic algorithm to select optimal beam angles in proton therapy and evaluates the effectiveness of the proposed algorithm in actual patients. In the use of the genetic algorithm to select the optimal angle, a gene represents the angle of each field and a chromosome represents the combination of beam angles. The fitness of the genetic algorithm, which represents the suitability of the chromosome to the solution, was quantified by using the dose distribution. The weighting factors of the organs used for fitness were obtained from clinical data through logistic regression, reflecting the dose characteristics of actual patients. Genetic operations, such as selection, crossover, mutation, and replacement, were used to modify the population and were repeated until an evaluation based on fitness reached the termination criterion. The proposed genetic algorithm was tested by assessing its ability to select optimal beam angles in three patients with liver cancer. The optimal results for fitness, planning target volume (PTV), normal liver, and skin in the population were compared with the clinical treatment plans, a process that took an average of 36.8 minutes. The dose-volume histograms (DVHs) and the fitness of the genetic algorithm plans did not differ significantly from the actual treatment plans. These findings indicate that the proposed genetic algorithm can automatically generate proton treatment plans with the same quality as actual clinical treatment plans.

The amount of potentially lethal damage repair (PLDR) is a significant factor in the process of modeling the survival curves of cells irradiated with fractionated carbon beams. Because the amount of PLDR generally depends on the features of the cells and the linear energy transfer (LET), the amount of PLDR of cells irradiated with fractionated carbon beams shows distinct differences from that of cells irradiated with X-rays. This study considered a new parameter dependent on the correlation between the PLDR trait (T) of the cells over a time interval (Δ) at the fractionated carbon beam irradiation. The survival curves of the cells irradiated with fractionated carbon beams n times were predicted using the ζ and the Ψ values from the delay assay. This study aims to overcome the barriers of traditional methods by developing a new survival curve model with new parameters based on an analysis of the PLDR traits of cells over time interval in fractionated carbon beam irradiation and to suggest a model that produces results significantly closer to the experimental data.

This study describes the development of a simple method to assess inter-fractional deviations of delivered proton beams in treatment rooms. To monitor the treatment beam, we measured the field-by-field beam fluences by attaching the EBT3 film to the snout, followed by a simple constancy check based on comparisons between the reference beam fluences (acquired during the pre-treatment quality assurance process) and the test beam fluences (acquired during treatment). The feasibility of the proposed treatment beam-monitoring system was confirmed by evaluating 12 treatment fields for each of six patients (brain, liver, prostate, lung, cranial and spinal area, and head and neck). The constancy of the treatment beams was verified by using a gamma index analysis to compare three measurements per field with the reference beam fluence. On the basis of the 3%/3 mm criterion, the average gamma-index passing rates for all measurements were over 99.6%. These results suggest that the constancy of fractional proton beams delivered to patients in treatment rooms can be verified with EBT3 film-based proton-beam monitoring system that can be easily attached to the treatment nozzle and is cost effective.

Tumor-treating fields (TTFields) therapy is increasingly utilized clinically because of its demonstrated efficacy in cancer treatment. However, the risk of skin burns must still be reduced to improve patient safety and posttreatment quality of life.The purpose of this study was to evaluate the methods of constructing electrode arrays that reduce current density exceeding threshold values, which can cause skin burns during TTFields therapy.Electrode and body models were generated using COMSOL software. The body model had the dielectric properties of the scalp. The average current density beneath the central region of the electrode was maintained at ∼31 mA/cmWhile using a single circular electrode, adjustment of the ceramic thickness ratio, adjustment of the metal plate radius, and insertion of an insulator near the edge reduced the deviations of current density by 14.6%, 67.7%, and 75.3%, respectively. Similarly, while using circular electrode arrays, inserting an insulator at the edge of each electrode reduced the deviations of current density significantly, from 8.62 to 2.40 mA/cmInsertion of an insulator at the edge of each electrode was found to be the most effective method of attaining uniform current density distribution beneath the electrode, thereby lowering the risk of adverse effects of TTFields therapy.

Glioblastoma multiforme (GBM), the most common type of brain tumor, is a very aggressive and treatment-refractory cancer, with a 5-year survival rate of approximately 5%. Hyperthermia (HT) and tumor treating fields (TTF) therapy have been used to treat cancer, either alone or in combination with other treatment methods. Both treatments have been reported to increase the efficacy of other treatment techniques and to improve patient prognosis. The present study evaluated the therapeutic effects of combining HT and TTF on GBM cell lines. Cells were subjected to HT, TTF, HT+TTF, or neither treatment, followed by comparisons of cell proliferation, apoptosis, migration and invasiveness. Clonogenic assays showed that the two treatments had a synergistic effect. The levels of cleaved PARP and cleaved caspase-3 were higher and apoptosis was increased in cells treated with HT+TTF than in cells treated with HT or TTF alone. In addition, HT+TTF showed greater inhibition of GBM cell migration and invasiveness and greater downregulation of STAT3 than either HT or TTF alone. The stronger anticancer effect of HT+TTF suggested that this combination treatment can increase the survival rate of patients with difficult-to-treat cancers such as GBM.

Purpose To evaluate the quality of patient‐specific complicated treatment plans, including commercialized treatment planning systems (TPS) and commissioned beam data, we developed a process of quality assurance (QA) using a Monte Carlo (MC) platform. Specifically, we constructed an interface system that automatically converts treatment plan and dose matrix data in digital imaging and communications in medicine to an MC dose‐calculation engine. The clinical feasibility of the system was evaluated. Materials and Methods A dose‐calculation engine based on GATE v8.1 was embedded in our QA system and in a parallel computing system to significantly reduce the computation time. The QA system automatically converts parameters in volumetric‐modulated arc therapy (VMAT) plans to files for dose calculation using GATE. The system then calculates dose maps. Energies of 6 MV, 10 MV, 6 MV flattening filter free (FFF), and 10 MV FFF from a TrueBeam with HD120 were modeled and commissioned. To evaluate the beam models, percentage depth dose (PDD) values, MC calculation profiles, and measured beam data were compared at various depths (Dmax, 5 cm, 10 cm, and 20 cm), field sizes, and energies. To evaluate the feasibility of the QA system for clinical use, doses measured for clinical VMAT plans using films were compared to dose maps calculated using our MC‐based QA system. Results A LINAC QA system was analyzed by PDD and profile according to the secondary collimator and multileaf collimator (MLC). Values for MC calculations and TPS beam data obtained using CC13 ion chamber (IBA Dosimetry, Germany) were consistent within 1.0%. Clinical validation using a gamma index was performed for VMAT treatment plans using a solid water phantom and arbitrary patient data. The gamma evaluation results (with criteria of 3%/3 mm) were 98.1%, 99.1%, 99.2%, and 97.1% for energies of 6 MV, 10 MV, 6 MV FFF, and 10 MV FFF, respectively. Conclusions We constructed an MC‐based QA system for evaluating patient treatment plans and evaluated its feasibility in clinical practice. We observed robust agreement between dose calculations from our QA system and measurements for VMAT plans. Our QA system could be useful in other clinical settings, such as small‐field SRS procedures or analyses of secondary cancer risk, for which dose calculations using TPS are difficult to verify.

In chest radiography, a solitary pulmonary nodule, which may be a precursor of lung cancer, is a frequently detected finding. However, as the image quality is deteriorated owing to the increase in the noise, lung cancer screening studies revealed that the likelihood of finding a nodule is lower than those of other modalities. This study quantitatively evaluates three widely used filters (median, Wiener, and total variation) and a newly proposed filter (fast non-local means (FNLM)), which reduce image noise. Images of a phantom with lung nodules, obtained from a patient using the 3D printing technology, were acquired at the chest anterior–posterior, lateral, and posterior–anterior positions. To evaluate their denoising performance, normalized noise power spectrum, contrast to noise ratio and coefficient of variation were used. In the quantitative evaluation of the overall image, the proposed FNLM filter exhibited the best image performance. In the quantitative evaluation of the nodule image, the FNLM filter, which exhibits outstanding denoising performance and time efficiency, can be employed. Therefore, with the use of the FNLM filter in chest radiography, the detection probability of a nodule, which can be a precursor of lung cancer, is increased, and the cancer can be prevented even with a lower dose.

Background This study investigated the effect of accumulated doses on radio-photoluminescence glass dosimeters (RPLGDs) from measurements involving mega-voltage photons. Methods Forty-five commercially available RPLGDs were irradiated to estimate their dose responses. Photon beams of 6, 10, and 15 MV were irradiated onto the RPLGDs inside a phantom, which were divided into five groups with different doses and energies. Groups 1 and 2 were irradiated at 1, 5, 10, 50, and 100 Gy in a sequential manner; Group 3 was irradiated 10 times with a dose of 10 Gy; and Groups 4 and 5 followed the same method as that of Group 3, but with doses of 50 Gy and 100 Gy, respectively. Each device was subjected to a measurement reading procedure each time irradiation. Results For the annealed Group 1, RPLGD exhibited a linearity response with variance within 5%. For the non-annealed Group 2, readings demonstrated hyperlinearity at 6 MV and 10 MV, and linearity at 15 MV. Following the 100 Gy irradiation, the readings for Group 2 were 118.7 ± 1.9%, 112.2 ± 2.7%, and 101.5 ± 2.3% at 6, 10, and 15 MV, respectively. For Groups 3, 4, and 5, the responsiveness of the RPLGDs gradually decreased as the number of repeated irradiations increased. The percentage readings for the 10th beam irradiation with respect to the readings for the primary beam irradiation were 84.6 ± 1.9%, 87.5 ± 2.4%, and 93.0 ± 3.0% at 6 MV, 10 MV, and 15 MV, respectively. Conclusions The non-annealed RPLGD response to dose was hyperlinear for the 6 MV and 10 MV photon beams but not for the 15 MV photon beam. Additionally, the annealed RPLGD exhibited a fading phenomenon when the measurement was repeated several times and demonstrated a relatively large fading effect at low energies than at high energies.

Tumor-treating fields therapy involves placing pads onto the patient’s skin to create a low-intensity (1 - 3 V/cm), intermediate frequency (100 - 300 kHz), alternating electric field to treat cancerous tumors. This new treatment modality has been approved by the Food and Drug Administration in the USA to treat patients with both newly diagnosed and recurrent glioblastoma. To deliver the prescribed electric field intensity to the tumor while minimizing exposure of organs at risk, we developed an optimization method for the electric field distribution in the body and compared the electric field distribution in the body before and after application of this optimization algorithm. To determine the electric field distribution in the body before optimization, we applied the same electric potential to all pairs of electric pads located on opposite sides of models. We subsequently adjusted the intensity of the electric field to each pair of pads to optimize the electric field distribution in the body, resulting in the prescribed electric field intensity to the tumor while minimizing electric fields at organs at risk. A comparison of the electric field distribution within the body before and after optimization showed that application of the optimization algorithm delivered a therapeutically effective electric field to the tumor while minimizing the average and the maximum field strength applied to organs at risk. Use of this optimization algorithm when planning tumor-treating fields therapy should maintain or increase the intensity of the electric field applied to the tumor while minimizing the intensity of the electric field applied to organs at risk. This would enhance the effectiveness of tumor-treating fields therapy while reducing dangerous side effects.

We developed and evaluated an algorithm to calculate the target radiation dose in cancer patients by measuring the transmitted dose during 3D conformal radiation treatment (3D-CRT) treatment. The patient target doses were calculated from the transit dose, which was measured using a glass dosimeter positioned 150 cm from the source. The accuracy of the transit dose algorithm was evaluated using a solid water phantom for five patient treatment plans. We performed transit dose-based patient dose verification during the actual treatment of 34 patients who underwent 3D-CRT. These included 17 patients with breast cancer, 11 with pelvic cancer, and 6 with other cancers. In the solid water phantom study, the difference between the transit dosimetry algorithm with the treatment planning system (TPS) and the measurement was −0.10 ± 1.93%. In the clinical study, this difference was 0.94 ± 4.13% for the patients with 17 breast cancers, −0.11 ± 3.50% for the eight with rectal cancer, 0.51 ± 5.10% for the four with bone cancer, and 0.91 ± 3.69% for the other five. These results suggest that transit-dosimetry-based in-room patient dose verification is a useful application for 3D-CRT. We expect that this technique will be widely applicable for patient safety in the treatment room through improvements in the transit dosimetry algorithm for complicated treatment techniques (including intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT)).

Quality assurance (QA) is required when performing pencil-beam scanning proton therapy, but the efficiency of QA is degraded in proportion to the energy of the protons. We developed a method to assess the preferred energy range and distal fall-off by combining multiple Bragg peaks to increase the efficiency of QA. Beams of 70, 110, 150, 190, and 230 MeV for exposure were planned using a treatment planning system. The Bragg curves for therapeutic proton beams were modeled using three different fitting function models, allowing the feasibility of a simple modeling of the Bragg curve to be investigated. The planned beams were exposed and measured using a multi-layered ionization chamber. Software developed using a Python tool could detect five Bragg peaks from the integrated curves that were fitted based on polynomial, cubic spline and Landau distributions. This software could calculate the range and distal fall-off of the five fitted peaks. For the verification of the accuracy of this method, the calculated results were compared with the range and distal falloff obtained by exposing and analyzing five single-energy beams individually. Comparisons of the Bragg peaks for the five energies exposed individually with the results obtained by exposing them all at once showed that the ranges of the energy beams when using the polynomial fitting and the cubic spline modes were 0.16 mm and 0.10 mm longer, respectively, while the distal fall-offs were 0.14 mm and 0.06 mm shorter, respectively. When using the Landau distribution fitting, the range was 0.06 mm longer and the distal fall-off was 0.04 mm shorter. Analyses of the ranges and distal fall-offs of the five energy beams exposed at once with single-beam loading by using the method developed in this study showed no significant differences from the results obtained by exposing the energy beams individually. Thus, range verification QA by using the proposed method is not only suitable for single-proton beams with multiple energies but also reduces the measurement time.

PURPOSE Fabricate an acrylic disk radiation sensor (ADRS) and characterize the photoluminescence signal generated from the optical device as basis for the development and evaluation of a new dosimetry system for pencil beam proton therapy. METHODS Based on the characteristics of the proposed optical dosimetry sensor, we established the relation between the photoluminescence output and the applied dose using an ionization chamber. Then, we obtained the relative integral depth dose profiles using the photoluminescence signal generated by pencil beam irradiation at energies of 99.9 and 162.1 MeV, and compared the results with the curve measured using a Bragg peak ionization chamber. RESULTS The relation between the photoluminescence output and applied dose was linear. In addition, the ADRS was dose independent for beam currents up to 6 Gy/min, and the calibration factor for energy was close to 1. Hence, the energy dependence on the optical device can be disregarded. The integral depth dose profiles obtained for the ADRS suitable agreed with the curve measured in the Bragg peak ionization chamber without requiring correction. CONCLUSIONS These results suggest that the ADRS is suitable for dosimetry measurements in pencil beam scanning, and it will be employed as a low-cost and versatile dosimetry sensor in upcoming developments.

Radiotherapy for the treatment of cancer in companion animals is currently administered by using megavoltage X-ray machines. Because these machines are expensive, most animal hospitals do not perform radiotherapy. This study evaluated the ability of relatively inexpensive kilovoltage X-ray machines to treat companion animals. A simulation study based on a commercial treatment-planning system was performed for tumors of the brain (non-infectious meningoencephalitis), nasal cavity (malignant nasal tumors), forefoot (malignant muscular tumors), and abdomen (malignant intestinal tumors). The results of kilovoltage (300 kV and 450 kV) and megavoltage (6 MV) X-ray beams were compared. Whereas the 300 kV and 6 MV X-ray beams provided optimal radiation dose homogeneity and conformity, respectively, for brain tumors, the 6 MV X-rays provided optimal homogeneity and radiation conformity for nasal cavity, forefoot, and abdominal tumors. Although megavoltage X-ray beams provided better radiation dose distribution in most treated animals, the differences between megavoltage and kilovoltage X-ray beams were relatively small. The similar therapeutic effects of the kilovoltage and 6 MV X-ray beams suggest that kilovoltage X-ray beams may be effective alternatives to megavoltage X-ray beams in treating cancers in companion animals.

A moving phantom is manufactured for mimicking lung model to study the dose uncertainty from CT number-stopping power conversion and dose calculation in the soft tissue, light lung tissue and bone regions during passive proton irradiation with compensator smearing value. The phantom is scanned with a CT system, and a proton beam irradiation plan is carried out with the use of a treatment planning system (Eclipse). In the case of the moving phantom, a RPM system is used for respiratory gating. The uncertainties in the dose distribution between the measured data and the planned data are investigated by a gamma analysis with 3%-3 mm acceptance criteria. To investigate smearing effect, three smearing values (0.3 cm, 0.7 cm, 1.2 cm) are used to for fixed and moving phantom system. For both fixed and moving phantom, uncertainties in the light lung tissue are severe than those in soft tissue region in which the dose uncertainties are within clinically tolerable ranges. As the smearing value increases, the uncertainty in the proton dose distribution decreases.

During brachytherapy, confirming the dose delivered is very important in order to prevent radiation-associated side effects. Therefore, we aimed to confirm the accuracy of dose delivery near the source by inserting glass dosimeters within the applicator. We created an alternative pelvic phantom with the same shape and internal structures as the usual patient. In addition, we created a tandem for insertion of the glass dosimeters and measured the dose near the source by inserting the glass dosimeters into the tandem and evaluating the accuracy of the dwell position and time through the dose near the source. Errors between the values obtained from the five glass dosimeters and the values from the treatment planning system were −6.27, −2.1, −4.18, 6.31, and −0.39%, respectively. The mean error was 3.85%. This value was acceptable considering that the error of the glass dosimeter itself is approximately 3%. Even though a complement of the applicator and the error calibration is required in order to apply this technique clinically, we believe that radiation accidents and overdoses can be prevented through in-vivo dosimetry using a glass dosimeter for brachytherapy.

In the diagnostic radiology field, reducing the radiation dose for patient lead to increased noise in image. Since increases of noise decrease the diagnosis rate, to reduce the noise is necessary. In this study quantitatively evaluates the four widely used and newly verified filters which remove noise in image: median, Wiener, total variation, and fast non local means (FNLM). For that purpose, X-ray and computed tomography (CT) images are acquired using MATLAB simulation with 3D voxelized phantom. To evaluate image performance, normalized noise power spectrum (NNPS), contrast to noise ratio (CNR) and coefficient of variation (COV) were used. As a result, we can efficiently remove noise in X-ray image when FNLM filter was used compared with frequently used filters. In conclusion, our results demonstrated that our proposed FNLM filter shows superior denoising performance, which is expected to enhance the detection of diseases in clinical images with low dose.

We aimed to develop a beam monitoring system based on a fiber-optic radiation sensor (FORS), which can be used in real time in a beam control room, to monitor a beam in proton therapy, where patients are treated using a pencil beam scanning (PBS) mode, by measuring the beam spot width (BSW) and beam spot position (BSP) of the PBS. We developed two-dimensional detector arrays to monitor the PBS beam in the beam control room. We measured the BSW for five energies of the PBS beam and compared the measurements with those of Lynx and EBT3 film. In order to confirm the BSP, we compared the BSP values of the PBS calculated from radiation treatment planning (RTP), to five BSP values measured using FORS at 224.2 MeV. When comparing BSW values obtained using developed monitoring system to the measurements obtained using commercial EBT3 film, the average difference in BSW value of the PBS beam was 0.1 ± 0.1 mm. In the comparison of BSW values with the measurements obtained using Lynx, the average difference was 0.2 ± 0.1 mm. When comparing BSP measurements to the values calculated from RTP, the average difference was 0.4 ± 0.2 mm. The study results confirmed that the developed FORS-based beam monitoring system can monitor a PBS beam in real time in a beam control room, where proton beam is controlled for the patient.

The present study aims to verify patient doses by using a glass dosimeter to measure the radiation penetrating patients during radiation therapy and developing an algorithm based thereon that can simply and accurately calculate the internal doses reserved by the patients. In this study, we developed the algorithm and, as a feasibility study for a clinical test, we verified its accuracy by using a solid water phantom. We developed an algorithm that measured the scatter factor, which represents the correlation between the bottom of the phantoms and the transit-dose measurement unit and calculates the center doses of the phantoms by using the inverse square law and percentage depth dose data. Also, we used a glass dosimeter to measure the transit radiation of 14 patients’ 3D conformal radiation therapy cases and predicted the internal doses of the phantoms by using the results. By comparing these values and those of actual measurements obtained from an ion chamber, we evaluated the accuracy of the developed algorithm. When the developed algorithm was applied for patient dose verification based on the transit doses to 14 patients’ 3D-CRT treatment, as measured using the ion chamber, the average deviation from the measurement values for the phantoms was 0.33% (±0.57%). Based on this result, we confirmed that the algorithm is correct. When the patient doses obtained using a glass dosimeter were verified in the same way, the average deviation was −0.28% (±1.87%). The algorithm for calculating patients’ internal doses based on transit radiation measurements was found to be accurate and is expected to be capable of simply verifying patient doses even when measuring with a glass dosimeter, despite an increased error to a certain degree.

Tumor treating fields (TTF) therapy is a noninvasive method that uses alternating electric fields to treat various types of cancer. This study demonstrates the combined effect of TTF and radiotherapy (RT) in vitro on pancreatic cancer, which is known to be difficult to treat. In CFPAC-I and HPAF-II pancreatic cancer cell lines, the combined in vitro effect of TTF and RT was evaluated by measuring cell counts, markers of apoptosis, and clonogenic cell survival. The synergy effects were verified using the Valeriote and Carpentier equations. TTF and RT inhibited cancer cell growth more effectively than did monotherapy with TTF or RT. The combined treatment also enhanced apoptosis more than monotherapy, as shown by assays for cleaved poly (ADP-ribose) polymerase (PARP) and annexin V. In addition, on the survival curve, this treatment method has been shown to work synergistically. These results suggest that combined treatment with TTF and RT may be a good alternative treatment for patients with pancreatic cancer.

This study was aimed to evaluate the utility based on imaging quality of the fast non-local means (FNLM) filter in diagnosing lung nodules in pediatric chest computed tomography (CT).We retrospectively reviewed the chest CT reconstructed with both filtered back projection (FBP) and iterative reconstruction (IR) in pediatric patients with metastatic lung nodules. After applying FNLM filter with six h values (0.0001, 0.001, 0.01, 0.1, 1, and 10) to the FBP images, eight sets of images including FBP, IR, and FNLM were analyzed. The image quality of the lung nodules was evaluated objectively for coefficient of variation (COV), contrast to noise ratio (CNR), and point spread function (PSF), and subjectively for noise, sharpness, artifacts, and diagnostic acceptability.The COV was lowest in IR images and decreased according to increasing h values and highest with FBP images (P 0.001). The CNR was highest with IR images, increased according to increasing h values and lowest with FBP images (P 0.001). The PSF was lower only in FNLM filter with h value of 0.0001 or 0.001 than in IR images (P 0.001). In subjective analysis, only images of FNLM filter with h value of 0.0001 or 0.001 rarely showed unacceptable quality and had comparable results with IR images. There were less artifacts in FNLM images with h value of 0.0001 compared with IR images (p 0.001).FNLM filter with h values of 0.0001 allows comparable image quality with less artifacts compared with IR in diagnosing metastatic lung nodules in pediatric chest CT.

PURPOSE The purpose of this study was to describe a plastic scintillating plate-based gantry-attachable dosimetry system for pencil beam scanning proton therapy to monitor entrance proton beam fluence, and to evaluate the dosimetric characteristics of this system and its feasibility for clinical use. METHODS The dosimetry system, consisting of a plastic scintillating plate and a CMOS camera, was attached to a dedicated scanning nozzle and scintillation during proton beam irradiation was recorded. Dose distribution was calculated from the accumulated recorded frames. The dosimetric characteristics (energy dependency, dose linearity, dose rate dependency, and reproducibility) of the gantry-attachable dosimetry system for use with therapeutic proton beams were measured, and the feasibility of this system during clinical use was evaluated by determining selected quality assurance items at our institution. RESULTS The scintillating plate shortened the range of the proton beam by the water-equivalent thickness of the plate and broadened the spatial profile of the single proton spot by 11% at 70 MeV. The developed system functioned independently of the beam energy (

General x-ray images have a lower probability of nodule detection than other modalities. Especially in children, the probability of nodule detection can likely drop due to poor image quality from using low radiation dose. To demonstrate the effectiveness of fast non-local means (FNLM) filter to increase the probability of nodule detection in pediatric chest x-ray images and reduce radiation dose while maintaining image quality. Quantitative assessment of normalised noise power spectrum (NNPS), coefficient of variation (COV) and contrast to noise ratio (CNR) were performed after applying four filters (median, Wiener, total variation and FNLM) on a 1-year-old child phantom. A 3D-printed patient nodule phantom was inserted into the phantom. Assessment was performed on AP and LAT view images acquired with the tube voltage reduced to 38 and 27%, and tube current reduced to 84 and 61%, respectively. The results showed the lowest NNPS and COV values and the highest CNR value when the FNLM filter applied. Moreover, the AP view results showed 37% decrease in COV and 30% increase in CNR in images with the FNLM filter applied (images exposed with the tube voltage and current reduced to 29% and 50%, respectively). The LAT view results showed 5% decrease in COV and 36% increase in CNR in images with the FNLM filter applied (images exposed with the tube current reduced by 27%). By applying the FNLM filter, the probability of nodule detection could be increased by denoising and contrast enhancement. Moreover, using the FNLM filter could reduce cancer risk in pediatric patients by reducing radiation dose about 30% to 44%.

PurposeTo measure dosimetric characteristics for linear accelerator-based electron beams, which are applied through locally manufactured acrylic tubes for intraoral radiotherapy and to calculate the secondary cancer risk for organs at risk.Materials and methodsSix different acrylic tubes were exposed to a 6-MeV electron beam; they had tips with three angles (0°, 15° and 30°) and two diameters (2·5 and 3·0 cm). Gafchromic EBT2 film was horizontally and vertically inserted in a solid water phantom to measure the dose profiles and percentage depth doses (PDDs). The measured data from radio-photoluminescence glass dosimeters placed on the neck and both eyes were used to estimate the lifetime attributable risk of secondary cancer resulting from intraoral radiotherapy for tongue cancer.ResultsA total of 12 dose profiles were obtained from six different acrylic applicators at 0·5 and 1·28 cm depths. Circular shapes were obtained from 0° applicators, and oval shapes were obtained from 15° and 30° applicators. Absorbed doses at a 0·5 cm depth were higher than those at a 1·28 cm depth. PDD shapes for the six acrylic applicators were similar to those of a normal 6 MeV electron beam. Larger-diameter applicators showed higher PDD than smaller-diameter applicators with the same tip angle. According to our secondary cancer risk estimation, if 100,000 patients received intraoral radiotherapy at 30 years and lived until 80 years, 122 female and 22 male patients would develop secondary thyroid cancer, while 13 female and 18 male patients would develop secondary ocular melanoma or retinoblastoma.ConclusionsDosimetric characteristics for linear accelerator-based intraoperative radiotherapy treatment beam were confirmed. In addition, we found that 0·1% of tongue cancer patients would get secondary malignancies for both eyes and thyroid from this treatment.

This study was designed to estimate radiation‐induced secondary cancer risks from high‐dose‐rate (HDR) brachytherapy and external radiotherapy for patients with cervical cancer based on measurements of doses absorbed by various organs. Organ doses from HDR brachytherapy and external radiotherapy were measured using glass rod dosimeters. Doses to out‐of‐field organs were measured at various locations inside an anthropomorphic phantom. Brachytherapy‐associated organ doses were measured using a specialized phantom that enabled applicator insertion, with the pelvis portion of the existing anthropomorphic phantom replaced by this new phantom. Measured organ doses were used to calculate secondary cancer risk based on Biological Effects of Ionizing Radiation (BEIR) VII models. In both treatment modalities, organ doses per prescribed dose (PD) mostly depended on the distance between organs. The locations showing the highest and lowest doses were the right kidney (external radiotherapy: 215.2 mGy; brachytherapy: 655.17 mGy) and the brain (external radiotherapy: 15.82 mGy; brachytherapy: 2.49 mGy), respectively. Organ doses to nearby regions were higher for brachytherapy than for external beam therapy, whereas organ doses to distant regions were higher for external beam therapy. Organ doses to distant treatment regions in external radiotherapy were due primarily to out‐of‐field radiation resulting from scattering and leakage in the gantry head. For brachytherapy, the highest estimated lifetime attributable risk per 100,000 population was to the stomach (88.6), whereas the lowest risks were to the brain (0.4) and eye (0.4); for external radiotherapy, the highest and lowest risks were to the thyroid (305.1) and brain (2.4). These results may help provide a database on the impact of radiotherapy‐induced secondary cancer incidence during cervical cancer treatment, as well as suggest further research on strategies to counteract the risks of radiotherapy‐associated secondary malignancies. PACS number(s): 87.52.‐g, 87.52.Px, 87.53.Dq, 87.53.Jw

Alternating electric fields at an intermediate frequency (100~300 kHz), referred to as tumour-treating fields (TTF), are believed to interrupt the process of mitosis via apoptosis and to act as an inhibitor of cell proliferation. Although the existence of an antimitotic effect of TTF is widely known, the proposed apoptotic mechanism of TTF on cell function and the efficacy of TTF are controversial issues among medical experts. To resolve these controversial issues, a better understanding of the underlying molecular mechanisms of TTF on cell function and the differences between the effects of TTF alone and in combination with other treatment techniques is essential. Here, we report experimental evidence of TTF-induced apoptosis and the synergistic antimitotic effect of TTF in combination with ionizing radiation (IR). For these experiments, two human Glioblastoma multiforme (GBM) cells (U373 and U87) were treated either with TTF alone or with TTF followed by ionizing radiation (IR). Cell apoptosis, DNA damage, and mitotic abnormalities were quantified after the application of TTF, and their percentages were markedly increased when TTF was combined with IR. Our experimental results also suggested that TTF combined with IR synergistically suppressed both cell migration and invasion, based on the inhibition of MMP-9 and vimentin.

In this paper, we report the results of our investigation into whole brain radiotherapy (WBRT) using linear accelerator-based intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in lung cancer patients with a high risk of metastasis to the brain. Specifically, we assessed the absorbed dose and the rate of adverse effects for several organs at risk (OAR), including the hippocampus, according to the tilt of a patient's head. We arbitrarily selected five cases where measurements were made with the patients' heads tilted forward and five cases without such tilt. We set the entire brain as the planning target volume (PTV), and the hippocampi, the lenses, the eyes, and the cochleae as the main OAR, and formulated new plans for IMRT (coplanar, non-coplanar) and VMAT (coplanar, non-coplanar). Using the dose-volume histogram (DVH), we calculated and compared the effective uniform dose (EUD), normal tissue complication probability (NTCP) of the OAR and the mean and the maximum doses of hippocampus. As a result, if the patient tilted the head forward when receiving the Linac-based treatment, for the same treatment effect in the PTV, we confirmed that a lower dose entered the OAR, such as the hippocampus, eye, lens, and cochlea. Moreover, the damage to the hippocampus was expected to be the least when receiving coplanar VMAT with the head tilted forward. Accordingly, if patients tilt their heads forward when undergoing Linac-based WBRT, we anticipate that a smaller dose would be transmitted to the OAR, resulting in better quality of life following treatment.

This study was conducted for the purpose of establishing a quality-assurance (QA) system for brachytherapy that can ensure patient-specific QA by enhancing dosimetric accuracy for the patient’s therapy plan. To measure the point-absorbed dose and the 2D dose distribution for the patient’s therapy plan, we fabricated a solid phantom that allowed for the insertion of an applicator for patient-specific QA and used an ion chamber and a film as measuring devices. The patient treatment plan was exported to the QA dose-calculation software, which calculated the time weight of dwell position stored in the plan DICOM (Digital Imaging and Communications in Medicine) file to obtain an overall beam quality correction factor, and that correction was applied to the dose calculations. Experiments were conducted after importing the patient’s treatment planning source data for the fabricated phantom and inserting the applicator, ion chamber, and film into the phantom. On completion of dose delivery, the doses to the ion chamber and film were checked against the corresponding treatment plan to evaluate the dosimetric accuracy. For experimental purposes, five treatment plans were randomly selected. The beam quality correction factors for ovoid and tandem brachytherapy applicators were found to be 1.15 and 1.10 − 1.12, respectively. The beam quality correction factor in tandem fluctuated by approximately 2%, depending on the changes in the dwell position. The doses measured by using the ion chamber showed differences ranging from −2.4% to 0.6%, compared to the planned doses. As for the film, the passing rate was 90% or higher when assessed using a gamma value of the local dose difference of 3% and a distance to agreement of 3 mm. The results show that the self-fabricated phantom was suitable for QA in clinical settings. The proposed patient-specific QA for the treatment planning is expected to contribute to reduce dosimetric errors in brachytherapy and, thus, to enhancing treatment accuracy.

// Eun Young Han 1 , Nava Paudel 2 , Jiwon Sung 3 , Myonggeun Yoon 3 , Weon Kuu Chung 4 and Dong Wook Kim 4 1 Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 2 Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA 3 Department of Bio-Convergence Engineering, Korea University, Seoul, Korea 4 Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Korea Correspondence to: Dong Wook Kim, email: // Keywords : secondary malignancy, breast, IMRT, VMAT, TomoHDA Received : November 05, 2015 Accepted : March 18, 2016 Published : March 26, 2016 Abstract The risk of secondary cancer from radiation treatment remains a concern for long-term breast cancer survivors, especially those treated with radiation at the age younger than 45 years. Treatment modalities optimally maximize the dose delivery to the tumor while minimizing radiation doses to neighboring organs, which can lead to secondary cancers. A new TomoTherapy treatment machine, TomoHDA TM , can treat an entire breast with two static but intensity-modulated beams in a slice-by-slice fashion. This feature could reduce scattered and leakage radiation doses. We compared the plan quality and lifetime attributable risk (LAR) of a second malignancy among five treatment modalities: three-dimensional conformal radiation therapy, field-in-field forward-planned intensity-modulated radiation therapy, inverse-planned intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy, and TomoDirect mode on the TomoHDA system. Ten breast cancer patients were selected for retrospective analysis. Organ equivalent doses, plan characteristics, and LARs were compared. Out-of-field organ doses were measured with radio-photoluminescence glass dosimeters. Although the IMRT plan provided overall better plan quality, including the lowest probability of pneumonitis, it caused the second highest LAR. The TomoTherapy plan provided plan quality comparable to the IMRT plan and posed the lowest total LAR to neighboring organs. Therefore, it can be a better treatment modality for younger patients who have a longer life expectancy.

Tumor treating fields (TTFs) are a newly developed cancer therapy technology using an alternating electric field that may be a possible candidate for overcoming the limitations of conventional treatment methods currently used in cancer treatment. Although clinical results using TTFs appear promising, concerns regarding side effects must be clarified to demonstrate the effectiveness of this treatment method. To investigate the side effects of TTF treatment, the damage to normal cell lines and normal tissue of a mouse model was compared with the damage to tumor cells and tumors in a mouse model after TTF treatment. No serious damage was found in the normal cells and normal tissues of the mouse model, suggesting that the side effects of TTF treatment may not be serious. Our evidence based on in vitro and in vivo experiments suggests that TTF may cause selective damage to cancer cells, further demonstrating the potential of TTF as an attractive alternative to conventional cancer treatment modalities.

Tumor-treating fields (TTFs) - a type of electromagnetic field-based therapy using low-intensity electrical fields - has recently been characterized as a potential anticancer therapy for glioblastoma multiforme (GBM). However, the molecular mechanisms involved remain poorly understood. Our results show that the activation of autophagy contributes to the TTF-induced anti-GBM activity in vitro or in vivo and GBM patient stem cells or primary in vivo culture systems. TTF-treatment upregulated several autophagy-related genes (~2-fold) and induced cytomorphological changes. TTF-induced autophagy in GBM was associated with decreased Akt2 expression, not Akt1 or Akt3, via the mTOR/p70S6K pathway. An Affymetrix GeneChip miRNA 4.0 Array analysis revealed that TTFs altered the expression of many microRNAs (miRNAs). TTF-induced autophagy upregulated miR-29b, which subsequently suppressed the Akt signaling pathway. A luciferase reporter assay confirmed that TTFs induced miR-29b to target Akt2, negatively affecting Akt2 expression thereby triggering autophagy. TTF-induced autophagy suppressed tumor growth in GBM mouse models subjected to TTFs as determined by positron emission tomography and computed tomography (PET-CT). GBM patient stem cells and a primary in vivo culture system with high Akt2 levels also showed TTF-induced inhibition. Taken together, our results identified autophagy as a critical cell death pathway triggered by TTFs in GBM and indicate that TTF is a potential treatment option for GBM.

This study describes the development and evaluation of a new dosimetric system for proton therapy using an array of fiber-optic Cerenkov radiation sensors (AFCRS). The AFCRS was superior to a conventional, multi-layer ion chamber (MLIC) system in real-time data acquisition and cost effectiveness.

Beam delivery errors during intensity modulated radiotherapy (IMRT) were detected based on a simple constancy check of the transit dose by using an electronic portal imaging device (EPID). Twenty-one IMRT plans were selected from various treatment sites, and the transit doses during treatment were measured by using an EPID. Transit doses were measured 11 times for each course of treatment, and the constancy check was based on gamma index (3%/3 mm) comparisons between a reference dose map (the first measured transit dose) and test dose maps (the following ten measured dose maps). In a simulation using an anthropomorphic phantom, the average passing rate of the tested transit dose was 100% for three representative treatment sites (head & neck, chest, and pelvis), indicating that IMRT was highly constant for normal beam delivery. The average passing rate of the transit dose for 1224 IMRT fields from 21 actual patients was 97.6% ± 2.5%, with the lower rate possibly being due to inaccuracies of patient positioning or anatomic changes. An EPIDbased simple constancy check may provide information about IMRT beam delivery errors during treatment.

This study aimed to examine the feasibility of a portable respiratory monitoring system (PRMS) based on a micro-electro-mechanical system (MEMS). The performance of the PRMS was estimated by comparing the actual and the measured movements of the linear and the angular motions by using a one-dimensional motion phantom. The results indicated that differences between the actual and the measured movements ranged from −0.3% to −0.9% and from −7.07% to 2.93% for the periods and the amplitudes in linear motion and from −6.5% to 4.3% and from −9.5% to −5.2% for the periods and the amplitudes in angular motion. The PRMS reproduces a signal that is similar to the actual motion, and the uncertainty generated in the electronic error and the tilting movement was reduced when the velocities of movement were higher than 0.6 cm/s and 0.08 °/s. In this study, we found that the PRMS is applicable to respiratory motion training for relatively normal or fast respiratory cases and that with a more sensitive sensor, it can be the expanded to slower respiration cases.

This study estimated the planning quality of intensity-modulated radiotherapy in 42 lung cancer cases to provide preliminary data for the development of a planning quality assurance algorithm. Organs in or near the thoracic cavity (ipsilateral lung, contralateral lung, heart, liver, esophagus, spinal cord, and bronchus) were selected as organs at risk (OARs). Radiotherapy plans were compared by using the conformity index (CI), coverage index (CVI), and homogeneity index (HI) of the planning target volume (PTV), the OAR-PTV distance and the OAR-PTV overlap volume, and the V10Gy, V20Gy, and equivalent uniform dose (EUD) of the OARs. The CI, CVI, and HI of the PTV were 0.54–0.89 (0.77 ± 0.08), 0.90–1.00 (0.98 ± 0.02), and 0.11–0.41, (0.15 ± 0.05), respectively. The mean EUDs (V10Gy, V20Gy) of the ipsilateral lung, contralateral lung, esophagus, cord, liver, heart, and bronchus were 8.07 Gy (28.06, 13.17), 2.59 Gy (6.53, 1.18), 7.02 Gy (26.17, 12.32), 3.56 Gy (13.56, 4.48), 0.72 Gy (2.15, 0.91), 5.14 Gy (19.68, 8.62), and 10.56 Gy (36.08, 19.79), respectively. EUDs tended to decrease as the OAR-PTV distance increased and the OAR-PTV overlap volume decreased. Because the plans in this study were from a single department, relatively few people were involved in treatment planning. Differences in treatment results for a given patient would be much more pronounced if many departments were involved.