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W Enghardt

Publications and source records attributed to W Enghardt.

16 recordsLinked to original sources

In-beam PET at high-energy photon beams: a feasibility study.

For radiation therapy with carbon ion beams, either for the stable isotope (12)C or for the radioactive one (11)C, it has been demonstrated that the beta(+)-activity distribution created or deposited, respectively, within the irradiated volume can be visualized by means of positron emission tomography (PET). The PET images provide valuable information for quality assurance and precision improvement of ion therapy. Dedicated PET scanners have been integrated into treatment sites at the Heavy Ion Medical Accelerator at Chiba (HIMAC), Japan, and the Gesellschaft für Schwerionenforschung (GSI), Germany, to make PET imaging feasible during therapeutic irradiation (in-beam PET). A similar technique may be worthwhile for radiotherapy with high-energy bremsstrahlung. In addition to monitoring the dose delivery process which in-beam PET has been primarily developed for, it may be expected that radiation response of tissue can be detected by means of in-beam PET. We investigate the applicability of PET for treatment control in the case of using bremsstrahlung spectra produced by 15-50 MeV electrons. Target volume activation due to (gamma, n) reactions at energies above 20 MeV yields moderate beta(+)-activity levels, which can be employed for imaging. The radiation from positrons produced by pair production is not presently usable because the detectors are overloaded due to the low duty factor of medical electron linear accelerators. However, the degradation of images caused by positron motion between creation and annihilation seems to be tolerable.

Adipose Tissue↗

The FLUKA code: new developments and application to 1 GeV/n iron beams.

The modeling of ion transport and interactions in matter is a subject of growing interest, driven by the continuous increase of possible application fields. These include hadron therapy, dosimetry, and space missions, but there are also several issues involving fundamental research, accelerator physics, and cosmic ray physics, where a reliable description of heavy ion induced cascades is important. In the present work, the capabilities of the FLUKA code for ion beams will be briefly recalled and some recent developments presented. Applications of the code to the simulation of therapeutic carbon, nitrogen and oxygen ion beams, and of iron beams, which are of direct interest for space mission related experiments, will be also presented together with interesting consideration relative to the evaluation of dosimetric quantities. Both applications involve ion beams in the AGeV range.

Carbon↗

Dose quantification from in-beam positron emission tomography.

Positron emission tomography (PET) imaging of the radioactivity distributions induced by therapeutic irradiation is at present the only feasible method for an in situ and non-invasive monitoring of radiooncology treatments with ion beams. The clinical implementation of this imaging technology at the experimental carbon ion therapy facility at the Gesellschaft für Schwerionenforschung (GSI) at Darmstadt, Germany is outlined and an interactive approach for a PET guided quantification of local dose deviations with respect to the treatment plan is presented.

Humans↗

In-beam PET measurements of beta+ radioactivity induced by proton beams.

Our first in-beam PET measurements of the beta+ activation induced by proton irradiation are presented. Monoenergetic proton beams in the energy and intensity range suited for the treatment of deep-seated tumours were delivered by the synchrotron of the Gesellschaft für Schwerionenforschung Darmstadt (GSI). They were stopped in PMMA blocks placed in the centre of the field of view of the positron camera that is installed in the heavy ion tumour treatment facility at GSI. The beta+ activity signal was found to be three times larger than that produced by carbon ions at the same range and applied physical dose. The reconstructed spatial beta+ activity distributions were analysed and compared with the production of positron emitters predicted by a calculation based on experimental cross-sections and on the proton flux given by the FLUKA Monte Carlo code. The shape of the depth-activity profiles was well reproduced by the model and the correlation with the proton range and the depth-dose distributions was carefully investigated. Despite the non-trivial range determination from the beta+ activity distribution in the proton case, our experimental investigation supports the feasibility of an in situ proton therapy monitoring by means of in-beam PET, as already clinically implemented for the monitoring of carbon ion therapy at GSI Darmstadt.

Carbon↗

Radiobiological hypoxia, oxygen tension, interstitial fluid pressure and relative viable tumour area in two human squamous cell carcinomas in nude mice during fractionated radiotherapy.

Very little is known about the correlation between the radiobiological hypoxic fraction (rHF) and other measures of tumour oxygenation during fractionated irradiation. In the present study the rHF is determined in untreated human FaDu and GL squamous cell carcinoma in nude mice and in tumours irradiated with 10 fractions in 2 weeks and 20 fractions in 4 weeks, using tumour control as the experimental endpoint. The results were compared with measurements of the pO2, the interstitial fluid pressure (IFP) and the relative viable tumour area. In FaDu tumours the radiobiological hypoxic fractions (rHFs) before and during irradiation were not statistically different from 100%. Depending on the assumptions made for D0, the rHFs of GL tumours were between 0.2 and 4% or 30 and 53%. The median pO2 values were 2.8 mmHg for untreated FaDu tumours and 0.2 mmHg for GL tumours (p < 0.001). The median IFP values were 2.6 mmHg in FaDu and 5.3 mmHg in GL tumours (p = 0.01). No important changes in the pO2 and IFP values were observed during fractionated irradiation. The relative viable tumour area during irradiation decreased by 83% in FaDu tumours (p = 0.002) and by 54% in GL tumours (p = 0.003). It is concluded that differences in rHF exist between FaDu and GL tumours before and during fractionated irradiation and that these differences are not reflected by pO2 and IFP values and the relative viable tumour area.

Animals↗

[Carbon ion irradiation of skull base tumors at GSI. First clinical results and future perspectives].

BACKGROUND: Radiobiological and physical examinations suggest clinical advantages of heavy ion irradiation. We report the results of 23 women and 22 men (median age 48 years) with skull base tumors irradiated with carbon ion beams at the Gesellschaft für Schwerionenforschung (GSI), Darmstadt, from December 1997 until September 1999. PATIENTS AND METHODS: The study included patients with chordomas (17), chondrosarcomas (10) and other skull base tumors (Table 1). It is the first time that the intensity-controlled rasterscan-technique and the application of positron-emission tomography (PET) for quality assurance was used. All patients had computed tomography for three-dimensional-treatment planning (Figure 1). Patients with chordomas and chondrosarcomas underwent fractionated carbon ion irradiation in 20 consecutive days (median total dose 60 GyE). Other histologies were treated with a carbon ion boost of 15 to 18 GyE delivered to the macroscopic tumor after fractionated stereotactic radiotherapy (median total dose 63 GyE). RESULTS: Mean follow-up was 9 months. Irradiation was well tolerated by all patients. Partial tumor remission was seen in 7 patients (15.5%) (Figure 2). One-year local control rate was 94%. One patient (2.2%) deceased. No severe toxicity and no local recurrence within the treated volume were observed. CONCLUSION: Clinical effectiveness and technical feasibility of this therapy modality could clearly be demonstrated in our study. To evaluate the clinical relevance of the different beam modalities studies with larger patient numbers are necessary. To continue our project a new heavy ion accelerator exclusively for clinical use is planned to be constructed in Heidelberg.

Adolescent↗

Potential application of PET in quality assurance of proton therapy.

Our investigation supporting the feasibility of in situ PET monitoring in proton therapy is presented. We simulated by means of the FLUKA code the number and the spatial distribution of the main beta+ emitters created in PMMA targets by protons at typical therapeutic energies. The quantitative comparison with the activation induced by 12C ions of energies corresponding to the same range shows that the available signal at the same physical dose level should be up to twice as intense for protons than that actually successfully used for the control of carbon ion therapy at GSI Darmstadt. The spatial correlation between the activity and the dose profile for protons is poorer than for 12C nuclei. However, an important check of the particle range, dose localization and stability of the treatment during all the fractions seems to be possible.

Monte Carlo Method↗

The application of PET to quality assurance of heavy-ion tumor therapy.

At the new heavy ion tumor therapy facility of the Gesellschaft für Schwerionenforschung at Darmstadt positron emission tomography (PET) has been implemented for in-beam and in-situ therapy control, i.e. during the tumor irradiation. The components necessary for this dedicated PET-imaging and their integration into the framework of therapy planning and quality assurance of heavy ion cancer treatments are presented. Results of the first application of this PET-method to patient treatments are reported.

Germany↗

Response of pig lung to irradiation with accelerated 12C-ions.

The response of pig lungs to irradiation with 12C-ions was assessed in two experiments to validate the procedures for heavy ion therapy planning at the Gesellschaft für Schwerionenforschung (GSI) and to explore their range of applicability. In both experiments, the target volume (spread-out Bragg peak, SOBP) was planned to be a 4 cm long cylinder with a diameter of 4 cm. Doses in the SOBP were prescribed to be equivalent to 5x4 Gy, 5x5.5 Gy and 5x7 Gy of x-rays in the first experiment, and to 5 fractions of 7 Gy and 9 Gy in the second experiment. The lung response in the first experiment was less than expected on the basis of earlier experiments with photons. Pneumonitis reaction and chronic fibrotic changes were observed outside the prescribed high-dose region. In the second experiment, the effects were more pronounced than had been expected on the basis of the first experiment. Changes were most intense in the high-dose region, but were also seen throughout the lung along the beam channel. Moreover, significant skin reactions were observed at the beam entrance site in all animals and - less pronounced - at the beam exit site in 3 of the 6 animals. In conclusion, the complex irradiation geometry of the pig lung, the changes of body weight between the two experiments, and insufficient accounting for a change in the relative biological effectiveness (RBE) computation led to substantial deviations of the observed reactions from expectations, the reasons for which could be identified in a subsequent analysis. The less pronounced lung reaction in the first experiment was due to an overestimation of RBE in a preliminary version of the algorithm for its determination. The extension of the fibrotic reaction resulted from the smear-out of the high-dose region due to density variations in tissue structures, respiratory movement, and limited positioning accuracy. The skin reactions at the entrance port reflect the different treatment geometry in the two experiments. The one unexplained observation is the mild skin reaction that was observed in the second experiment at the beam exit site.

Animals↗

Acute response of pig skin to irradiation with 12C-ions or 200 kV X-rays.

The acute response of pig skin to treatment with high energy carbon ions (plateau region) at the Gesellschaft für Schwerionenforschung (GSI, Darmstadt, Germany) was compared with changes after 200 kV x-irradiation. Carbon doses isoeffective to the x-ray doses were computed with a recently established model for calculation of the biological effect of heavy ions. Clinical changes and physiological symptoms (blood flow, erythema, trans-epidermal water loss, skin hydration) were scored. The parameters analyzed were maximum and mean values of each symptom during days 24 to 70 after irradiation, and the quantal endpoints for the establishment of dose effect curves were the median values of these. With exception of the maximum change in the red blood cell concentration (p < 0.02) no significant differences could be found in the response to x-rays and RBE-corrected heavy ions. These results indicate that the model is valid for the calculation of biological effects of 12C-ions (plateau region) and may at least for epidermis be applied to treatment planning.

Animals↗

The investigation of different cameras for in-beam PET imaging.

In situ and in vivo treatment plan verification and beam monitoring as well as dose control during heavy-ion tumour therapy can be performed in principle by measurements of range distributions of beta(+)-emitting nuclei by means of PET techniques. For this purpose the performance of different types of positron camera as well as the results of in-beam PET experiments using beams of beta(+)-active heavy ions (15O, 17F and 19Ne with energies of 300-500 A MeV) are presented. Following the deduced performance requirements a PET scanner that is designed for clinical use in experimental heavy-ion therapy at GSI Darmstadt has been built. This limited angle tomograph consists of two large-area detector heads based on position sensitive BGO detectors and is predicted to perform the measurement of the end point of a beta(+)-emitting ion beam for the verification of a treatment plan with a precision better than 1 mm. The maximum dose applied in the patient thereby is of the magnitude of 10 mGy.

Beta Particles↗

Limited-angle 3D reconstruction of PET images for dose localization in light ion tumour therapy.

In vivo dose localization in light ion tumour therapy can be performed by measuring the range distributions of beta+ active ions in tissue employing positron emission tomographic techniques. For this purpose a multiplicative iteration scheme for reconstructing three-dimensional images from shift-variant, limited-angle data is presented. In the iterative correction steps the algorithm uses the geometric means of quotients calculated from the three-dimensional Radon transforms of the backprojected measured and approximated source distributions. When sources measured with poor statistics are reconstructed, an effective noise suppression is achieved.

Algorithms↗

Investigations of cerebral glucose utilization into the newborn brain: a [18F]-FDG positron emission tomography study using a high resolution multiwire proportional chamber detector device.

An experimental approach is presented, where for the first time positron emission tomography (PET, the most important method for in vivo measuring the key functions of brain physiology and metabolism) was applied together with other techniques for quantitative-topological estimation of key parameters such as rCMRGlu in normal and disturbed brain function states in the newborn period.

Animals↗