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Biomedical subjects

J G Kereiakes

Publications and source records attributed to J G Kereiakes.

At least 19 recordsLinked to original sources

The modification of specific absorption rates in interstitial microwave hyperthermia via tissue-equivalent material bolus.

Patterns of specific absorption rates generated by interstitial, microwave antenna arrays must be experimentally ascertained and quantified to facilitate their clinical incorporation. Phantom studies involved the use of four single-gap, coaxial antennas oriented in a 2 cm square array. These dipoles were driven in phase by a microwave generator at a frequency of 915 MHz. The inherent limitations in modifying the specific absorption rate patterns were addressed with the addition of bolus to the phantom. These additions of Guy's muscle tissue-equivalent material were made either proximal or distal to the phantom proper. Experiments conducted in the presence and absence of tissue-equivalent material bolus showed the ability to achieve broader bands of 50% power deposition in certain bolus conditions. These heating patterns were sufficiently reproducible and predictable to warrant clinical application of the bolus addition. A through-and-through method of catheter implantation allowed for bolus addition when deemed necessary. Treatments with veterinary and human patients using the bolus method to modify heating patterns yielded augmented patterns of power deposition. The effective length of the antennas that would radiate efficiently was essentially broadened via introduction of a microwave-interacting medium. As a result of the tissue equivalent material's ability to absorb microwave power, it was necessary to interpose minimally-interactive styrofoam spacers to limit heat transfer effects at the tissue-bolus interfaces.

Aged

Adjustable portal film cassette holder for radiation therapy.

An adjustable portal film cassette holder has been designed and constructed. The holder provides for: holding portal film perpendicular to and centered with the central axis of the beam film-to-patient distance to minimize magnification; angling (swivel) film to match collimator angle; and ease of correct repositioning of arrangement when frequent filming is required. This device has now been in use for several months with good results.

Radiotherapy

Nuclear medicine from Becquerel to the present.

During a period of a little over ninety years, the use of radioactive materials has moved from the discovery of natural radioactivity by Becquerel to the use of highly sophisticated equipment for in-house production of biologically important molecules labeled with radionuclides, for the measurement of body functions. Radiation detectors have progressed from photographic plates and the gold leaf electroscope to the routine use of improved scintillation detectors for imaging the three-dimensional distribution of radioactive materials in the body as a function of space and time. It is expected that future improvements will be along the line of instruments with better spatial resolution, contrast, and sensitivity. Advances in hardware and software will be more than matched by developments in radiopharmaceuticals, including the use of monoclonal antibodies and receptor mapping agents which promise the exquisite specificity and sensitivity of radioimmunoassay procedures.

Europe

Radiotherapeutic agents: properties, dosimetry, and radiobiologic considerations.

Radioactive nuclides for treatment have occupied an important but somewhat diminishing role in the total practice of nuclear medicine. Although theoretically they should have important potentialities, particularly in the treatment of various forms of cancer, their development in this field has not kept pace with the progress in other treatment modalities in radiation oncology. Indications for the selection of appropriate isotopes for therapy revolve about the emission of beta particles of sufficient energy, which are administered in a chemical form that reaches the tumor. Methods of calculation of doses delivered to sites of deposition are discussed in the text. Radiobiologic considerations include the possibility of early deleterious effects from overdosage, and consideration of chromosomal changes of circulating lymphocytes and their implications. Late effects that have been of great public concern are confined almost solely to possible carcinogenesis, and this effect has been minimal in patients receiving therapeutic levels of radioactive drugs. Genetic and developmental effects, also, have been negligible. Complications encountered more frequently have been leukemia after extensive therapy of thyroid carcinoma, and local fibrosis after direct injection of radioactive colloids into tumor tissue.

Adolescent

Dose to the liver and spleen in pediatric patients undergoing technetium-99m sulfur colloid scans.

Quantitative conjugate view external counting techniques were applied to determine radiation dose to the liver and spleen in pediatric patients undergoing 99mTc-sulfur colloid (Tc-SC) liver scans. The effective half-life of 99mTc-SC was 5.8 +/- 0.23 hours and 5.2 +/- 0.68 hours in the liver and spleen, respectively. Dose per administered activity ranged from 0.34 to 0.63 rad/mCi (92 to 170 muGy/MBq) for the liver and 0.35 to 1.96 rad/mCi (95.0 to 530.0 muGy/MBq) for the spleen. The spleen to liver dose ratio ranged from 1.0 to 4.9. These values are compared with results extrapolated from published adult data to the pediatric population.

Adolescent

Intracranial blood clot volume and geometric parameters determined from CT images.

A method of determining intracranial blood vlot volumes from CT images data is presented. This technique avoids dependence on regular geometric volume approximations. Studies are presented on phantoms of known volume (ranging from 3.5 to 108 cm3) but with varying size, shape, and density relative to the surrounding medium. For a wide range of differential densities across the boundary, these phantom results indicate that volumes may be calculated to an accuracy generally better than +/- 2 cm3. A series of clinical cases, principally hypertensive intracranial hemorrhages, have been studied to demonstrate the technique. Three-dimensional axes, which allow clot localization relative to cerebral anatomy, are defined using the anterior/posterior falx attachment points and the dorsum sellae. Clot volume, center of mass, vector of clot expansion, and shift of anatomical structures are determined. Correlation of these data with clinical outcome and surgery is discussed.

Cerebral Hemorrhage

Dose to the metaphyseal growth complexes in children undergoing 99mTc-EHDP bone scans.

The spatial temporal distribution of radionuclides in children may differ greatly from that accepted for adults. Following injection of a bone-seeking agent (99mTc-EHDP), radioactivity in the metaphyseal growth complexes of the distal femur and proximal tibia was quantitated in a series of children 4 to 16 years of age, using a gamma camera/computer system. The dose to the growth plate was fount to range from 0.8 to 4.7 rads when adjusted to an administered activity of 200 muCi/kg, compared to approximately 0.6 rad to the adult skeleton for a corresponding study.

Adolescent

Generation of iso-TDF maps: considerations for radiation therapy planning.

The NSD (nominal standard dose) concept has been useful in therapy for comparing various radiation treatment schedules. More recently, TDF (time, dose, and fractionation) factors were introduced. By incorporating treatment schedules (time and fractionation) with isodose summations, TDFs can be determined throughout the patient contour, including tissue in and outside the tumor volume. For this purpose an isodose summation program was modified to generate iso-TDF maps based on the treatment schedule. For schedules in which all fields are not treated every day, recovery is not inhibited throughout the total treatment volume. It was necessary to reevaluate the concept of "recovery time" for tissues outside the tumor volume and to introduce a "threshold to inhibit recovery" model. Clinical examples assuming this recovery model are presented.

Cobalt Radioisotopes

Ionizing irradiation and the induction of clinically significant disease in the human thyroid gland.

Because of increasing concern over continuing medical and potential nonmedical exposure of the thyroid to radiation, risk estimates have been developed for acute thyroiditis, hypothyroidism, and both benign and malignant thyroid nodules following exposure of the human thyroid to external and internal sources of ionizing radiation. These estimates are unique in that they are based entirely on data in human subjects are included corrections for the spontaneous occurrence of thyroid disease in human populations not subjected to radiation whenever possible.

Adolescent

Quantitative external counting techniques enabling improved diagnostic and therapeutic decisions in patients with well-differentiated thyroid cancer.

A quantitative technique is described which allows the physician to predict more accurately whether a recurrent or metastatic well-differentiated thyroid carcinoma is amenable to radioiodine-131 therapy or is better treated by other means. A calibrated uptake probe and scaler system is used to obtain conjugate view (i.e., diametrically opposed) counting rates for both the whole body and for any areas of abnormal uptake (lesion) at 24,48 annd 72 hours following the administration of 2 mCi 131l. Quantitative calculations accounting for patient attenuation, lesion size and geometrical factors then provide a determination of the lesion uptake as well as the effective half-life of 131l in the lesion. The radiation dose which would be delivered to the lesion by a given therapeutic amount of 131l may then be calculated to help determine the desirability of 131l treatment. The results of patient studies indicate the potential benefit of such quantitative evaluation.

Half-Life

The use of photogrammetry in tissue compensator design. Part I: photogrammetric determination of patient topography.

The surface topography of a patient can be determined by photogrammetry before beginning radiotherapy. The source light of the therapy unit or simulator is used to project a grid pattern onto the patient, and this is then photographed together with control points consisting of miniature light bulbs mounted on a frame suspended from the wedge slot of the therapy machine. When the photograph is projected onto a graphics terminal for data entry into a computer, the three-dimensional topography of the patient's surface can be reconstructed as a two-dimensional matrix of discrete points. A computer algorithm can then design a tissue compensator to fit the individual patient.

Humans

The use of photogrammetry in tissue compensator design. Part II: experimental verification of compensator design.

A computer algorithm for designing sheet lead tissue compensators is described. Corrections are made for scatter within the radiation field as well as the shape of the patient for the mantle fields used in treating Hodgkin's disease. The method was tested experimentally with a phantom and found to be clinically acceptable. The advantages of employing this technique with parallel opposed fields are emphasized.

Hodgkin Disease

Transport calculations of gamma ray flux density and dose rate about implantable californium-252 sources.

Gamma flux density and dose rate distributions have been calculated about implantable californium-252 sources for an infinite tissue medium. Point source flux densities as a function of energy and position were obtained from a discrete-ordinates calculation, and the flux densities were multiplied by their corresponding kerma factors and added to obtain point source dose rates. The point dose rates were integrated over the line source to obtain line source dose rates. Container attenuation was accounted for by evaluating the point dose rate as a function of platinum thickness. Both primary and secondary flux densities and dose rates are presented. The agreement with an independent Monte Carlo calculation was excellent. The data presented should be useful for the design of new source configurations.

Californium

Cystourethrography procedures in children. Evaluation of benefits versus dose.

Cystourethrography was used by the referring physician in 53 children with urinary tract disease. The benefits of this technique were evaluated using Bayesian methods. Prior and subsequent odds of the accuracy of the clinical diagnosis being affected by the radiological procedure were estimated. Marked benefits were found in 12 cases, which were used as the basis for the most conservative estimate of benefits. The genetic benefit-risk ratio is 140 for boys and 8.3 for girls. The somatic benefit-risk ratio is 10,000 for boys and 4,200 for girls.

Child

Quantitative assessment of field uniformity for gamma cameras.

Objective criteria for judging the uniformity of field floods are developed and the effects of the energy window and scatter material on uniformity are examined. There is a highly significant correlation (p = 0.99) between a 14% difference in average count among adjacent photomultiplier tube regions and observer detection of detuned areas. Similarly, a 10% average count difference is not significantly recognized as a nonuniform area. Results indicate that there is a complex interaction between uniformity, energy window (15-30% symmetrical) and 0-7.6 cm of tissue-equivalent scatter medium interposed between the flood source and the collimator. Quantitation of the flood should be performed to indicate which regions need retuning.

Radionuclide Imaging