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Biomedical subjects

Kari Tanderup

Publications and source records attributed to Kari Tanderup.

6 recordsLinked to original sources
PubMed2006

Dose optimisation in single plane interstitial brachytherapy.

BACKGROUND AND PURPOSE: Brachytherapy dose distributions can be optimised by modulation of source dwell times. In this study dose optimisation in single planar interstitial implants was evaluated in order to quantify the potential benefit in patients. MATERIAL AND METHODS: In 14 patients, treated for recurrent rectal and cervical cancer, flexible catheters were sutured intra-operatively to the tumour bed in areas with compromised surgical margin. Both non-optimised, geometrically and graphically optimised CT -based dose plans were made. The overdose index (OI), homogeneity index (HI), conformal index (COIN), minimum target dose, and high dose volumes were evaluated. The dependence of OI, HI, and COIN on target volume and implant regularity was evaluated. In addition, 12 theoretical implant configurations were analyzed. RESULTS: Geometrical and graphical optimisation improved the dose plans significantly with graphical optimisation being superior. Graphically optimised dose plans showed a significant decrease of 18%+/-9% in high dose volume (p<0.001). HI, COIN, and OI were significantly improved from 0.50+/-0.05 to 0.60+/-0.05, from 0.65+/-0.04 to 0.71+/-0.04, and from 0.19+/-0.03 to 0.15+/-0.03, respectively (p<0.001 for all). Moreover, minimum target dose increased significantly from 71%+/-5% to 80%+/-5% (p<0.001). The improvement in OI and HI obtained by optimisation depended on the regularity of the implant, such that the benefit of optimisation was larger for irregular implants. OI and HI correlated strongly with target volume limiting the usability of these parameters for comparison of dose plans between patients. CONCLUSIONS: Dwell time optimisation significantly improved the dose distribution regarding homogeneity, conformity, minimum target dose, and size of high dose volumes. Graphical optimisation is fast, reproducible and superior to geometric optimisation.

Brachytherapy↗
PubMed2006

Geometric stability of intracavitary pulsed dose rate brachytherapy monitored by in vivo rectal dosimetry.

BACKGROUND AND PURPOSE: To evaluate geometric stability of applicator and rectum during pulsed dose rate (PDR) intracavitary brachytherapy. PATIENTS AND METHODS: A total of 14 patients with cervical cancer (stages IIB-IVA) were analysed retrospectively. A dose of 10 Gy to point A was prescribed per brachytherapy session, and PDR was given with 1 Gy/pulse, 1 pulse/h, using a ring applicator (Varian). A rectal dosimeter consisting of five diodes spaced by 1.5 cm was routinely placed in the rectum. The diodes detected the progression of each pulse of radiation, as the stepping source was advanced through the applicator. A mathematical model has been developed for spatial analysis of the pattern of the dose readings. The model transforms dose measurement into a quantification of the geometric relationship between rectum diodes and applicator. RESULTS: The model could be used for all treatment sessions, and the relative positions of diodes and applicator were calculated for each pulse of radiation. The SD of displacements during the treatment was below 2.8mm in all directions for all patients. The mean SD in lateral, longitudinal and anterior-posterior directions were 1.2 +/- 0.7, 1.2 +/- 0.7 and 0.9 +/- 0.6 mm, respectively. The mean measurement uncertainty was below 0.8 +/- 0.5 mm in all directions. CONCLUSIONS: A new mathematical method has been developed, enabling us to quantitate and monitor relative positions of applicator and rectal diodes during a PDR treatment. The spatial relation between rectal dosimeter and applicator was very stable during extended PDR treatments suggesting that the geometric stability of PDR treatment is at the same level as the stability reported for HDR brachytherapy.

Algorithms↗
PubMed2005

[Beta-radiation as adjuvant treatment of in-stent restenosis in coronary vessels].

INTRODUCTION: The purpose of this study was to describe our initial "real-world" experience with vascular b-radiation for in-stent restenosis using a simple angioplasty approach without stent implantation. MATERIALS AND METHODS: Thirty-five consecutive patients with in-stent restenosis were treated with balloon angioplasty (n = 28), cutting balloon angioplasty (n = 3), or angioplasty plus stent implantation (only in case of significant dissection: n = 4), followed by catheter-based beta-radiation. Angiographic follow-up was performed after 6 to 10 months. RESULTS: One patient experienced a left main stem occlusion immediately after beta-radiation, which necessitated an acute coronary bypass operation. No other complications related to the radiation procedure were observed. In-stent restenosis recurred in 6 of the 34 patients (18%). DISCUSSION: Our results indicate that catheter-based radiation can be safely introduced at centres without previous experience with this treatment modality. Furthermore, the in-stent restenosis recurrence rates after catheter-based radiation which have been obtained in randomised trials can be reproduced in consecutive patients.

Angioplasty, Balloon, Coronary↗
PubMed2004

Multi-channel intracavitary vaginal brachytherapy using three-dimensional optimization of source geometry.

BACKGROUND AND PURPOSE: A new multi-channel vaginal cylinder has been constructed. The dose distribution is compared to that of a central channel cylinder. PATIENTS AND METHODS: The source channels of the multi-channel cylinder are placed close to the treatment volume, which means that the dose gradient in the radial direction is steep. Therefore the dose is enhanced close to the cylinder surface and lowered at larger distances as compared to the central channel cylinder. Three patients were each CT-scanned twice with a vaginal cylinder in situ. CT-based 3D dose-planning studies were used to calculate the dose distribution. Dose-volume histograms (DVHs) were generated for rectum and bladder, and a quantification of high dose volumes was calculated from the DVHs. Dose to the vaginal mucosa was calculated. RESULTS: The dose to the critical organs depends on the depth of normalization. When the dose is normalized on the cylinder surface the hot spot dose to bladder and rectum is reduced by 16 and 17%, respectively, whereas mucosal dose remains the same. When the dose is normalized at 5 mm depth the hot spot dose to bladder and rectum is reduced by 1 and 3%, respectively, whereas mucosal dose is enhanced by 17%. CONCLUSIONS: The multi-channel cylinder makes it possible to spare the rectum and the bladder at the expense of enhanced mucosal dose.

Brachytherapy↗
PubMed2003

Catheter-based 32P beta-radiation after stent implantation in porcine coronary arteries: role of source-centering and geographical miss.

The present study examined the role of source-centering and geographical miss in vascular brachytherapy. After implantation of 13 mm long stents, 38 coronary arteries in 13 pigs were randomly assigned to centered brachytherapy (n = 13), eccentric brachytherapy (n = 13), or no radiation (n = 12). Geographical miss was avoided by careful placement of a 27 mm (32)P beta-radiation source. Restenosis was quantified by angiography, histomorphometry, and intravascular ultrasound at 28 days. Source-centering led to a significant (P < 0.001) reduction of in-stent area stenosis (centered radiation, 12% +/- 5%; eccentric radiation, 37% +/- 21%; control arteries, 41% +/- 13%). Despite 7 mm coverage of the edge segments, radiation was found to induce edge stenosis due to neointima formation and constrictive vascular remodeling. We conclude that centered radiation was superior to eccentric radiation in reducing in-stent luminal narrowing while radiation-induced edge stenosis was still observed despite extension of the radiation zone to 7 mm beyond the stent edges.

Animals↗