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Biomedical subjects

F Ballester

Publications and source records attributed to F Ballester.

At least 19 recordsLinked to original sources

Technique for routine output verification of Leipzig applicators with a well chamber.

The H-type Leipzig applicators are accessories of the microSelectron-HDR system (Nucletron, Veenendaal, The Netherlands) for treatment of superficial malignancies. Recently, the dose rate distributions in liquid water for the whole set of applicators using both source models available for the microSelectron-HDR afterloaders have been obtained by means of the experimentally validated Monte Carlo (MC) code GEANT4. Also an output table (cGy/hU) at 3 mm depth on the applicator central axis was provided. The output verification of these applicators by the user, prior to their clinical use, present practical problems: small detectors such as thermoluminescent dosimeters or parallel-plate ionization chambers are not easily used for verification in a clinical environment as they require a rigid setup with the Leipzig applicator and a phantom. In contrast, well-type ionization chambers are readily available in radiotherapy departments. This study presents a technique based on the HDR1000Plus well chamber (Standar Imaging) measurements with a special insert, which allows the output verification of the H-type Leipzig applicators on a routine basis. This technique defines correspondence factors (CF) between the in water dose rate output of the Leipzig applicators (cGy/hU) obtained with MC and the reading on the well chamber with the special insert, normalized to the HDR calibration factor with the HDR insert and to the source strength. To commission the applicators (with the well chamber and the special insert used), the physicist should check if the CF value agrees with its tabulated values presented in this work. If the differences are within 5% the tabulated output values can be used in clinical dosimetry. This technique allows the output validation of the Leipzig applicators with a well chamber widely used for HDR Ir-192 source strength measurements. It can easily be adapted to other types of well chambers for HDR source output verification.

Brachytherapy↗

Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project.

OBJECTIVE: To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities METHODS: The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed. RESULTS: Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0-1), except in the case of ozone where there was a more delayed relation (lag 2-3). For combined estimates an increase of 10 microg/m3 in the PM10 levels in lag 0-1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2-3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m3 in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models CONCLUSIONS: A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.

Aged↗

Monte Carlo dosimetric study of the BEBIG Co-60 HDR source.

Although not as widespread as Ir-192, Co-60 is also available on afterloading equipment devoted to high dose rate brachytherapy, mainly addressed to the treatment of gynaecological lesions. The purpose of this study is to obtain the dosimetric parameters of the Co-60 source used by the BEBIG MultiSource remote afterloader (BEBIG GmbH, Germany) for which there are no dosimetric data available in the literature. The Monte Carlo code GEANT4 has been used to obtain the TG43 parameters and the 2D dose rate table in Cartesian coordinates of the BEBIG Co-60 HDR source. The dose rate constant, radial dose function and anisotropy function have been calculated and are presented in a tabular form as well as a detailed 2D dose rate table in Cartesian coordinates. These dosimetric datasets can be used as input data and to validate the treatment planning system calculations.

Anisotropy↗

Monte Carlo and experimental derivation of TG43 dosimetric parameters for CSM-type Cs-137 sources.

In this study, complete dosimetric datasets for the CSM2 and CSM3 Cs-137 sources were obtained using the Monte Carlo GEANT4 code. The application of this calculation method was experimentally validated with thermoluminescent dosimetry (TLD). Functions and parameters following the TG43 formalism are presented: the dose rate constant, the radial dose functional, and the anisotropy function. In addition, to aid the quality control process on treatment planning systems, a two-dimensional (2D) rectangular dose rate table (the traditional along-away table), coherent with the TG43 dose calculation formalism, is given. The data given in this study complement existing information for both sources on the following aspects: (i) the source asymmetries were considered explicitly in the Monte Carlo calculations, (ii) TG43 data were derived directly from Monte Carlo calculations, (iii) the radial range of the different tables was increased as well as the angular resolution in the anisotropy function, including angles close to the longitudinal source axis. The CSM2 source TG-43 data of Liu et al. [Med. Phys. 31, 477-483 (2004)] are not consistent with the Williamson 2D along-away data [Int. J. Radiat. Oncol., Biol., Phys. 15, 227-237 (1988)] at distances closer than approximately 2 cm from the source. The data presented here for this source are consistent with this 2D along-away table, and are suitable for use in clinical practice.

Anisotropy↗

Technical note: Monte Carlo derivation of TG-43 dosimetric parameters for radiation therapy resources and 3M Cs-137 sources.

In clinical brachytherapy dosimetry, a detailed dose rate distribution of the radioactive source in water is needed in order to plan for quality treatment. Two Cs-137 sources are considered in this study; the Radiation Therapy Resources 67-800 source (Radiation Therapy Resources Inc., Valencia, CA) and the 3M model 6500/6D6C source. A complete dosimetric dataset for both sources has been obtained by means of the Monte Carlo GEANT4 code. Dose rate distributions are presented in two different ways; following the TG43 formalism and in a 2D rectangular dose rate table. This 2D dose rate table is helpful for the TPS quality control and is fully consistent with the TG43 dose calculation formalism. In this work, several improvements to the previously published data for these sources have been included: the source asymmetries were taken explicitly into account in the MC calculations, TG43 data were derived directly from MC calculations, the data radial range was increased, the angular grid in the anisotropy function was increased, and TG43 data is now consistent with the along and away dose rate table as recommended by the TG43 update.

Algorithms↗

Association between tonsillectomy, adenoidectomy, and appendicitis.

INTRODUCTION: Tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. OBJECTIVE: To examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. MATERIAL AND METHOD: A cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy) was tested. RESULTS: The 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28) than in men (OR: 1.74; 95% CI: 0.90-3.39). CONCLUSIONS: A clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.

Adenoidectomy↗

Monte Carlo evaluation of kerma in an HDR brachytherapy bunker.

In recent years, the use of high dose rate (HDR) after-loader machines has greatly increased due to the shift from traditional Cs-137/Ir-192 low dose rate (LDR) to HDR brachytherapy. The method used to calculate the required concrete and, where appropriate, lead shielding in the door is based on analytical methods provided by documents published by the ICRP, the IAEA and the NCRP. The purpose of this study is to perform a more realistic kerma evaluation at the entrance maze door of an HDR bunker using the Monte Carlo code GEANT4. The Monte Carlo results were validated experimentally. The spectrum at the maze entrance door, obtained with Monte Carlo, has an average energy of about 110 keV, maintaining a similar value along the length of the maze. The comparison of results from the aforementioned values with the Monte Carlo ones shows that results obtained using the albedo coefficient from the ICRP document more closely match those given by the Monte Carlo method, although the maximum value given by MC calculations is 30% greater.

Brachytherapy↗

Monte Carlo dosimetric characterization of the Cs-137 selectron/LDR source: evaluation of applicator attenuation and superposition approximation effects.

The purpose of this study is to calculate the dose rate distribution for the Amersham Cs-137 pellet source used in brachytherapy with the Selectron low-dose-rate remote afterloading system in gynaecological applications using the Monte Carlo code GEANT4. The absolute dose rate distribution for the pellet source was obtained and presented as a one-dimensional absolute dose rate table as well as in the Task Group 43 dose-calculation formalism. In this study, excellent agreement was found between the point source theoretical model using fitted polynomial values and Monte Carlo calculations of the dose rate distribution for the pellet source. A comparison study was also made between the dose rate distribution obtained from a complete Monte Carlo simulation (Cs-137 pellet sources + remote afterloading system plastic guide tube + gynaecological applicator) and that calculated by applying the superposition principle to Monte Carlo data of the individual pellet sources. The data were obtained for a portion of uterine tandem of typical train source configurations. Significant differences with a strong dependence on polar angle have been found that must be kept in mind for clinical dosimetry.

Brachytherapy↗

Phantom size in brachytherapy source dosimetric studies.

An important point to consider in a brachytherapy dosimetry study is the phantom size involved in calculations or experimental measurements. As pointed out by Williamson [Med. Phys. 18, 776-786 (1991)] this topic has a relevant influence on final dosimetric results. Presently, one-dimensional (1-D) algorithms and newly-developed 3-D correction algorithms are based on physics data that are obtained under full scatter conditions, i.e., assumed infinite phantom size. One can then assume that reference dose distributions in source dosimetry for photon brachytherapy should use an unbounded phantom size rather than phantom-like dimensions. Our aim in this paper is to study the effect of phantom size on brachytherapy for radionuclide 137Cs, 192Ir, 125I and 103Pd, mainly used for clinical purposes. Using the GEANT4 Monte Carlo code, we can ascertain effects on derived dosimetry parameters and functions to establish a distance dependent difference due to the absence of full scatter conditions. We have found that for 137Cs and 192Ir, a spherical phantom with a 40 cm radius is the equivalent of an unbounded phantom up to a distance of 20 cm from the source, as this size ensures full scatter conditions at this distance. For 125I and 103Pd, the required radius for the spherical phantom in order to ensure full scatter conditions at 10 cm from the source is R = 15 cm. A simple expression based on fits of the dose distributions for various phantom sizes has been developed for 137Cs and 192Ir in order to compare the dose rate distributions published for different phantom sizes. Using these relations it is possible to obtain radial dose functions for unbounded medium from bounded phantom ones.

Algorithms↗

Dosimetric study of the 15 mm ROPES eye plaque.

The main aim of this paper is to make a study of dose-rate distributions obtained around the 15 mm, radiation oncology physics and engineering services, Australia (ROPES) eye plaque loaded with 125I model 6711 radioactive seeds. In this study, we have carried out a comparison of the dose-rate distributions obtained by the algorithm used by the Plaque Simulator (PS) (BEBIG GmbH, Berlin, Germany) treatment planning system with those obtained by means of the Monte Carlo method for the ROPES eye plaque. A simple method to obtain the dose-rate distributions in a treatment planning system via the superposition of the dose-rate distributions of a seed placed in the eye plaque has been developed. The method uses eye plaque located in a simplified geometry of the head anatomy and distributions obtained by means of the Monte Carlo code GEANT4. The favorable results obtained in the development of this method suggest that it could be implemented on a treatment planning system to improve dose-rate calculations. We have also found that the dose-rate falls sharply along the eye and that outside the eye the dose-rate is very low. Furthermore, the lack of backscatter photons from the air located outside the eye-head phantom produces a dose reduction negligible for distances from the eye-plaque r<1 cm but reaches up to 20% near the air-eye interface. Results showed that the treatment planning system lacks accuracy around the border of the eye (in the sclera and the surrounding area) due to the simplicity of the algorithm used. The BEBIG treatment planning system uses a global attenuation factor that takes into account the effect of the eye plaque seed carrier and the lack of backscatter photons caused by the metallic cover, which in the case of a ROPES eye plaque has a default value of T= 1 (no correction). In the present study, a global attenuation factor T=0.96 and an air-interface correction factor which improve on treatment planning system calculations were obtained.

Brachytherapy↗

Monte Carlo dosimetric study of best industries and Alpha Omega Ir-192 brachytherapy seeds.

Ir-192 seeds are widely used in the USA for low dose rate interstitial brachytherapy. There are two commercially available models: those manufactured by Best Industries filtered with stainless steel, and those manufactured by Alpha-Omega seeds filtered with Pt. Newly developed 3D correction algorithms for brachytherapy are based on dosimetry data obtained on unbounded phantom size, allowing corrections for heterogeneities and actual tissue boundaries. Published dosimetric datasets for both seeds have been obtained under bounded conditions. The aim of the present study is to obtain dosimetric datasets for these seeds under full scatter conditions. The Monte Carlo GEANT4 code has been used to estimate air-kerma strength and dose rate in water around the Ir-192 seeds. Functions and parameters following the TG43 formalism are obtained and presented in tabular forms: the dose rate constant, the radial dose function, and the anisotropy function. Tables for the anisotropy factor have been obtained in order to apply punctual approximation. Differences between dose rate distributions for both seeds show that specific dataset must be used for each type of seed in clinical dosimetry. The data in the present study improve on published data in the following aspects: (i) dosimetric data were obtained under full scatter conditions, which affect dose values at distances greater than 4-5 cm from the source; (ii) the dose rate tables are given at greater distances from the source; and (iii) the spatial resolution in high dose gradient areas, such as those near the longitudinal source axis, has been improved.

Body Burden↗

Apheis: public health impact of PM10 in 19 European cities.

STUDY OBJECTIVE: Apheis is a public health surveillance system that aims to provide European, national, regional, and local decision makers, environmental health professionals, and the general public with up to date and easy to use information on air pollution and public health. This study presents the health impact assessment done in 19 cities of Western and Eastern European countries. DESIGN: Apheis developed guidelines for gathering and analysing data on air pollution and the impact on public health. Apheis has analysed the acute and chronic effects of fine particles on premature mortality using the estimates developed by Aphea2 study and two American cohort studies. This health impact assessment was performed for different scenarios on the health benefits of reducing levels of particles less than 10 microm in size (PM(10)). MAIN RESULTS: PM(10) concentrations were measured in 19 cities (range: 14-73 microg/m(3)). The population covered in this health impact assessment includes nearly 32 million inhabitants. The age standardised mortality rates (per 100 000 people) range from 456 in Toulouse to 1127 in Bucharest. Reducing long term exposure to PM(10) concentrations by 5 microg/m(3) would have "prevented" between 3300 and 7700 early deaths annually, 500 to 1000 of which are associated with short term exposure. CONCLUSIONS: Apheis shows that current levels of air pollution in urban Europe have a non-negligible impact on public health, and that preventive measures could reduce this impact, even in cities with low levels of air pollution.

Air Pollutants↗

Influence of the non-homogeneity of Ir-192 wires in calibration of well chambers.

All international recommendations point out as necessary the calibration or verification of the reference air kerma rate (RAKR) for brachytherapy sources (independent of manufacturer established value) prior to their clinical use. The most common procedure for RAKR measurement in iridium wires is based on the use of well chambers with specific inserts that set the wire in a fixed position; previously, the electrometer plus well chamber with insert (EWI) was calibrated by using a source obtained from an accredited laboratory for which the RKAR was established precisely, called the 'reference' source. The distribution of Ir-192 material in the wire could be not perfectly homogeneous all along its length, and in this case the influence of these inhomogeneities in the calibration process should be studied. This paper focuses on the evaluation of this topic and an analytical and experimental study is presented taking into account the non-homogeneity of Ir-192 material along the wire for both the reference source (of length 14 cm) and a wire of unknown RAKR. This study is based on measurements with a 1 cm iridium wire on a rectilinear insert considering either of the two available reference sources (1 or 14 cm length), and has been experimentally evaluated using two typical well chambers. The main conclusion of the study is that if the non-homogeneity of the wires is lower than 5% the effect of non-homogeneity on RAKR measurements is negligible for rectilinear inserts even for short well chambers.

Algorithms↗

Technical note: fitted dosimetric parameters of high dose-rate 192Ir sources according to the AAPM TG43 formalism.

Functional fits for the anisotrophy function and the radial dose function, have been studied, in a previous work, in order to characterize dose-rate distributions around some of the high-intensity 192Ir sources. The purpose of the present work is to complete the previous one in order to include all the existing HDR and PDR 192Ir sources. The sources addressed here are: the Buchler source from Amersham, the 12i and Plus PDR sources and the 12i and Plus HDR sources from GammaMed, and the new VariSource HDR source wire model VS2000 from Varian Oncology Systems.

Anisotropy↗

Respiratory effects of sulphur dioxide: a hierarchical multicity analysis in the APHEA 2 study.

BACKGROUND: Sulphur dioxide (SO(2)) was associated with hospital admissions for asthma in children in the original APHEA study, but not with other respiratory admissions. AIMS: To assess the association between daily levels of SO(2) and daily levels of respiratory admissions in a larger and more recent study. METHODS: Time series of daily counts of hospital emergency admissions were constructed for asthma at ages 0-14 years and 15-64 years, COPD and asthma, and all respiratory admissions at ages 65+ years in the cities of Birmingham, London, Milan, Paris, Rome, Stockholm, and in the Netherlands for periods of varying duration between the years 1988 and 1997. A two stage hierarchical modelling approach was used. In the first stage generalised additive Poisson regression models were fitted in each city controlling for weather and season. These results were then combined across cities in a second stage ecological regression that looked at potential effect modifiers. RESULTS: For an increase of 10 micro g/m(3) of SO(2) the daily number of admissions for asthma in children increased 1.3% (95% CI 0.4% to 2.2%). Effect modification among cities by levels of other air pollutants or temperature was not found. The SO(2) effect disappeared after controlling for PM(10) or CO, but correlation among these pollutants was very high. Other respiratory admissions were not associated with SO(2). CONCLUSION: SO(2) is associated with asthma admissions in children, indicating that reduction in current air pollution levels could lead to a decrease in the number of asthma admissions in children in Europe.

Adolescent↗