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A fourier analysis on the maximum acceptable grid size for discrete proton beam dose calculation.

We developed an analytical method for determining the maximum acceptable grid size for discrete dose calculation in proton therapy treatment plan optimization, so that the accuracy of the optimized dose distribution is guaranteed in the phase of dose sampling and the superfluous computational work is avoided. The accuracy of dose sampling was judged by the criterion that the continuous dose distribution could be reconstructed from the discrete dose within a 2% error limit. To keep the error caused by the discrete dose sampling under a 2% limit, the dose grid size cannot exceed a maximum acceptable value. The method was based on Fourier analysis and the Shannon-Nyquist sampling theorem as an extension of our previous analysis for photon beam intensity modulated radiation therapy [J. F. Dempsey, H. E. Romeijn, J. G. Li, D. A. Low, and J. R. Palta, Med. Phys. 32, 380-388 (2005)]. The proton beam model used for the analysis was a near monoenergetic (of width about 1% the incident energy) and monodirectional infinitesimal (nonintegrated) pencil beam in water medium. By monodirection, we mean that the proton particles are in the same direction before entering the water medium and the various scattering prior to entrance to water is not taken into account. In intensity modulated proton therapy, the elementary intensity modulation entity for proton therapy is either an infinitesimal or finite sized beamlet. Since a finite sized beamlet is the superposition of infinitesimal pencil beams, the result of the maximum acceptable grid size obtained with infinitesimal pencil beam also applies to finite sized beamlet. The analytic Bragg curve function proposed by Bortfeld [T. Bortfeld, Med. Phys. 24, 2024-2033 (1997)] was employed. The lateral profile was approximated by a depth dependent Gaussian distribution. The model included the spreads of the Bragg peak and the lateral profiles due to multiple Coulomb scattering. The dependence of the maximum acceptable dose grid size on the orientation of the beam with respect to the dose grid was also investigated. The maximum acceptable dose grid size depends on the gradient of dose profile and in turn the range of proton beam. In the case that only the phantom scattering was considered and that the beam was aligned with the dose grid, grid sizes from 0.4 to 6.8 mm were required for proton beams with ranges from 2 to 30 cm for 2% error limit at the Bragg peak point. A near linear relation between the maximum acceptable grid size and beam range was observed. For this analysis model, the resolution requirement was not significantly related to the orientation of the beam with respect to the grid.

Algorithms↗

Chromosome translocations: a biomarker for retrospective biodosimetry.

We discuss here the results from our studies demonstrating that simple translocations detected by chromosome painting can be used to reconstruct radiation doses for workers exposed within the dose limits and for individuals with past exposure. To be useful, a biomarker for exposure and risk assessment should employ an end point that is highly quantitative, stable over time, and relevant to human risk. Recent advances in chromosome staining using fluorescence in situ hybridization facilitate fast and reliable measurement of simple translocations, a type of DNA damage linked both to prior clastogenic exposure and to risk. In contrast to other biomarkers available, the frequency of simple translocations in individuals exposed to whole-body radiation is stable over time postexposure, has little interindividual variability, and can be measured accurately at low frequencies.

Animals↗

Post-Chornobyl thyroid cancers in Ukraine. Report 1: estimation of thyroid doses.

About 1.8 EBq of 131I was released into the atmosphere during the Chornobyl accident that occurred in Ukraine on April 26, 1986. More than 10% of this activity was deposited on the territory of Ukraine. Beginning 4-5 years after the accident, an increase in the incidence of thyroid cancer among children, believed to be caused in part by exposure to 131I, has been observed in different regions of Ukraine. A three-level system of thyroid dose estimation was developed for the reconstruction of thyroid doses from 131I for the entire population of Ukrainian children aged 1 to 18 at the time of accident: (1) At the first level, individual doses were estimated for the approximately 99,000 children and adolescents with direct measurements of radioactivity in the thyroid (so-called direct thyroid measurements) performed in May-June of 1986; (2) at the second level, group doses by year of age and by gender were estimated for the population of 748 localities (with 208,400 children aged 1-18 in 1986) where direct thyroid measurements of good quality were performed on some of the residents; and (3) at the third level, group doses by age and by gender were estimated for the population of the localities where no thyroid measurements were made in 1986. The third-level doses were then aggregated over the population of each oblast. Data, models and procedures required for each level of thyroid dose estimation are described in the paper. At the first level, individual doses were found to range up to 27,000 mGy, with geometric and arithmetic means of 100 and 300 mGy, respectively. At the second level, group doses were found to be highest for the younger children (aged 1 to 4 years); doses for the older children (aged 16 to 18 years) were 3.5 times smaller. At the third level, average population-weighted doses were found to exceed 35 mGy in the five northern oblasts closer to the Chornobyl reactor site; to be in the 14- to 34-mGy range in seven other oblasts, Kyiv city and Crimea; and to be less than 13 mGy in all other oblasts.

Adolescent↗

Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique.

We developed a method for the estimation of three-dimensional acetabular coverage of the femoral head with use of only an anteroposterior radiograph of the hip. This technique also allows recalculation of the corrected value for coverage at neutral pelvic tilt. Provided that the acetabulum and femoral head are spherical and congruent, the results are as accurate as those obtained with computerized tomographic reconstruction, the dose of radiation is much lower, and much less time is required for calculation. The hips of 286 normal subjects showed increases with age in both anterior and posterior coverage and backward tilt of the pelvis, along with a decrease in the anterior-posterior ratio of coverage. The proportion of anterior acetabular coverage in female subjects was smaller than that in male subjects. There was more backward tilt of the pelvis and the anterior-posterior ratio of coverage was smaller when the subjects were standing than when they were supine.

Acetabulum↗

Angiotensin II and renal hypertension in dog, rat and man: effect of converting enzyme inhibition.

The role of the renin-angiotensin system in the pathogenesis of one-clip, two-kidney hypertension has been studied in man, dog and rat. Particular attention has been paid to peripheral plasma concentrations of angiotensin II in different circumstances; angiotensin II infusion has been combined with radioimmunoassay to construct angiotensin II/blood pressure dose-response curves. The effect of converting enzyme inhibitors has been studied, precautions being taken to avoid obtaining falsely high values for plasma angiotensin II because of cross-reaction with angiotensin I in these circumstances. The initial phase of one-clip, two-kidney hypertension is attributable to the direct pressor effect of the immediate rise in plasma angiotensin II. Subsequently, plasma angiotensin II is relatively lower, although blood pressure remains high. This upward resetting of the plasma angiotensin II/blood pressure relationship can be mimicked by infusing angiotensin II chronically at low dose. After reconstruction of a stenosed renal artery, or excision of a post-stenotic kidney, the angiotensin II/blood pressure relationship returns slowly to normal. In this second phase of one-clip, two-kidney hypertension, the long-term administration of saralasin, or of converting enzyme inhibitor, can also return arterial pressure to normal; brief administration of these drugs is less effective or ineffective. The results are compatible with, although they do not conclusively establish, an important slow pressor action of the renin-angiotensin system in the second phase of one-clip, two-kidney hypertension. This provides a rational basis for the use of captopril clinically in this condition.

Adult↗

Issues in cytogenetic biological dosimetry: emphasis on radiation environments in space.

Issues central to the reliability of cytogenetic biodosimetry are presented. Although it now appears that cytogenetic biodosimetry can be used reliably to reconstruct radiation dose after acute, uniform whole-body exposure (albeit within certain dose ranges), additional data are required to fully validate cytogenetic biodosimetry for the protracted and complex exposure conditions in space. Approaches are presented that could be used to obtain the data necessary for validation. It also appears that the use of dicentric aberrations for biodosimetry on missions lasting several months or more may not be reliable because of the large variability observed among individuals in the rate of loss of cells with dicentrics, making back-extrapolations uncertain. This may be testable, however, by comparing the results for dicentrics and translocations obtained by biodosimetry with the radiation dosimetry obtained on board the spacecraft. In addition to these and several other issues, estimates are provided of the current limitations of detection of dicentrics and reciprocal translocations.

Aerospace Medicine↗

[Evaluation of ultra-low-dose thoracic multi-detector-row CT using different reconstruction kernels and new reconstruction algorithms].

CT has great advantages in detecting early-stage small lung cancer and is becoming common in lung cancer screening. Multi-detector-row CT (MDCT) can provide thin-slice images with low radiation exposure. In this study, ultra-low-dose (5 mAs: 10 mAs, 0.5 sec/rot) thoracic MDCT images were evaluated. We describe the differences in image quality and quantity between the different reconstruction kernels. We also propose a new reconstruction algorithm (ultra-low-dose reconstruction algorithm: ULR) for ultra-low-dose thoracic CT, to reduce noise and streak artifacts. We are convinced of the usefulness and possibility of ultra-low-dose thoracic MDCT with ULR algorithms for lung cancer screening.

Algorithms↗

Developing historical food production and consumption data for 131I dose estimates: the Hanford experience.

This paper describes the methods used to reconstruct the movement of commercial foods in and through the study area of the Hanford Environmental Dose Reconstruction Project. The most dose-relevant radionuclide released from Hanford separations plants was 131I via the atmospheric pathway. As a result of atmospheric deposition of 131I, commercial food supplies may have been contaminated. Because the half-life of 131I is relatively short, foods consumed soon after production, such as milk and produce, presented the highest risk. For that reason, this paper deals primarily with the reconstruction of milk and produce production, marketing, and consumption from 1945-1951, the period with the highest known 131I releases. The reconstructed food production and consumption information was used as input to radiation dose estimates for representative individuals and as default values for real individuals who may not remember where they obtained food or how much they consumed during that period. Specific methods for tracing the movement of commercial milk and produce back from the point of human consumption, through commercial markets, to original production are presented. Results include the characteristics of food consumption exhibited by representative individuals, examples of commercial milk and produce market structures, and a review of commercial milk production and processing practices from 1945-1951.

Air Pollutants, Radioactive↗

Biomarkers of exposure, sensitivity and disease.

PURPOSE: This review is to evaluate the use of biomarkers as an indication of past exposure to radiation or other environmental insults, individual sensitivity and risk for the development of late occurring disease. OVERVIEW: Biomarkers can be subdivided depending on their applications. Markers of exposure and dose can be used to reconstruct and predict past accidental or occupational exposures when limited or no physical measurements were available. Markers of risk or susceptibility can help identify sensitivity individuals that are at increased risk for development of spontaneous disease and may help predict the increased risk in sensitive individuals associated with environmental or therapeutic radiation exposures. Markers of disease represent the initial cellular or molecular changes that occur during disease development. Each of these types of biomarkers serves a unique purpose. OUTLINE: This paper concentrates on biomarkers of dose and exposure and provides a brief review of biomarkers of sensitivity and disease. The review of biomarkers of dose and exposure will demonstrate the usefulness of biomarkers in evaluation of physical factors associated with radiation exposure, such as LET, doserate and dose distribution. It will also evaluate the use of biomarkers to establish relationships that exist between exposure parameters such as energy deposition, environmental concentration of radioactive materials, alpha traversals and dose. In addition, the importance of biological factors on the magnitude of the biomarker response will be reviewed. Some of the factors evaluated will be the influence of species, tissue, cell types and genetic background. The review will demonstrate that markers of sensitivity and disease often have little usefulness in dose-reconstruction and, by the same token, many markers of dose or exposure may not be applicable for prediction of sensitivity or risk.

Animals↗

Low-molecular-weight heparin in arterial reconstructive surgery: a double-blind, randomized dose-finding trial.

Periprocedural and postprocedural anticoagulation during arterial reconstructive surgery (ARS) with intravenous heparin is standard of care. The general use and correct dosage of low-molecular-weight heparin, however, are still under debate. A prospective, randomized, double-blind trial was performed with a parallel group comparison of four dose regimen of a low-molecular-weight heparin, reviparin sodium, in patients undergoing major ARS. Sixty-five patients were randomly allocated to receive twice-daily subcutaneous injections of reviparin, 3500 (group A, n=17), 4200 (group B, n=16), 5950 (group C, n=16), and 7000 (group D, n=16) anti-Xa IU per day. Patients were eligible for the trial if they had angiographically proven peripheral arterial obstructive disease with a planned arterial reconstruction of the infrarenal aorta, iliaca artery, or femoralis artery. Fifty-nine patients completed the trial. The goal was to determine the optimal dose of the low-molecular-weight heparin to achieve a minimum of early vascular events (less than 12%) with a minimum of major bleeding events (less than 10%) during a short-term follow-up of up to 8 postoperative days. There was no reocclusion in the entire population. Patients randomized into the two lower dose groups (A and B), however, experienced a relatively high incidence of restenosis, whereas patients enrolled in group D, receiving the highest dose of reviparin, experienced an unacceptably high rate of bleeding events (all bleeds, 43%; major bleeding, 14.3%). Thus, the optimal dose of reviparin sodium to be administered in patients undergoing major ARS is half the therapeutic dose: 5950 to 6300 anti Xa IU (75-85 anti Xa IU/kg body weight per day). Patients included in group C had no major bleeding event (95% confidence interval, 0% to 6.6%), a significant improvement of the doppler ankle-brachial systolic pressure index (difference of 0.46 +/- 0.29, P=.017), and a higher rate of responders with regard to the puls status measured at the tibialis posterior arteries (66.7%) compared to groups A and B (46.7% and 54.5%, respectively, P=.086). The efficacy and safety of this dosage regimen in comparison to standard of care should be further substantiated in larger trials.

Aged↗

[Gastrocystoplasty for severely contracted bladder following high dose pelvic irradiation: a case report].

A 24-year-old female who had received hysterectomy and adnexectomy of bilateral appendages for yolk sac tumor at the age of 12 years, followed by repeated surgery and pelvic irradiation over a total of 100 Gy for relapse of tumor, suffered from a severely contracted bladder and renal dysfunction of serum creatinine level over 2.0 mg/dl. The diagnosis was radiation-induced contracted bladder with renal dysfunction due to vesicoureteral reflux. Since the small intestine was not considered suitable after high dose irradiation, the stomach was used to reconstruct the bladder. The vesical pressure, which was 70 cmH2O at the capacity of 30 ml, was decreased to 22 cmH2O at the capacity of 100 ml, 5 weeks after surgery. The renal function was stable with a serum creatinine level below 1.4 mg/dl and the bladder capacity was 200 ml, 15 months after surgery. This method using the stomach was considered valuable for bladder reconstruction after large dose pelvic irradiation.

Adult↗

Cardiovascular and neuromuscular responses to high-dose pancuronium-metocurine in pediatric burned and reconstructive patients.

The efficacy of the combined use of pancuronium and metocurine (Pm-MTC) in high doses to produce rapid-onset muscle paralysis was evaluated in 15 patients with acute burns and 18 recovered burned patients scheduled for reconstructive surgery. Two and three times the previously determined ED95 of the combination for each group was used. (ED95 for Pm-MTC combination is 0.032/0.129 mg/kg for acute burns and 0.013/0.051 mg/kg for reconstructive patients.) Doubling ED95 produced 95% paralysis in 3.1 +/- 0.9 min in acutely burned children and in 4.3 +/- 0.7 min in reconstructive children (mean +/- SEM). These onset times were not significantly different from each other. Tripling the ED95 of the combination in burned children reduced the onset time to 1.3 +/- 0.14 min, but this was not significantly different from 2 X ED95 onset time in burned patients. The administration of 3 X ED95 to the reconstructive group, however, resulted in a significantly more rapid onset time of 1.8 +/- 0.4 min compared with 2 X ED95 in the same population. With 3 X ED95 the onset times between burn and reconstructive patients were not significantly different. Time for recovery of twitch to 25% of control twitch height (75% twitch depression) was significantly prolonged in burned patients compared with reconstructive patients for equipotent doses administered. Although the occasional patient showed prominent changes in heart rate and blood pressure, overall cardiovascular stability was impressive.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗

Verification of IMRT dose distributions using a water beam imaging system.

A water beam imaging system (WBIS) has been developed and used to verify dose distributions for intensity modulated radiotherapy using dynamic multileaf collimator. This system consisted of a water container, a scintillator screen, a charge-coupled device camera, and a portable personal computer. The scintillation image was captured by the camera. The pixel value in this image indicated the dose value in the scintillation screen. Images of radiation fields of known spatial distributions were used to calibrate the device. The verification was performed by comparing the image acquired from the measurement with a dose distribution from the IMRT plan. Because of light scattering in the scintillator screen, the image was blurred. A correction for this was developed by recognizing that the blur function could be fitted to a multiple Gaussian. The blur function was computed using the measured image of a 10 cm x 10 cm x-ray beam and the result of the dose distribution calculated using the Monte Carlo method. Based on the blur function derived using this method, an iterative reconstruction algorithm was applied to recover the dose distribution for an IMRT plan from the measured WBIS image. The reconstructed dose distribution was compared with Monte Carlo simulation result. Reasonable agreement was obtained from the comparison. The proposed approach makes it possible to carry out a real-time comparison of the dose distribution in a transverse plane between the measurement and the reference when we do an IMRT dose verification.

Calibration↗

[Reconstruction of I-131 in milk and exposure doses to the thyroid gland of cattle after the Chernobyl AES].

Suggestions are made concerning the restoration of 131I content in cow milk of six districts in the Gomel region based on radiometric measurements of the overall activity of milk samples in the iodine period of the Chernobyl NPP accident, reconstruction of doses to thyroid of cattle and calculation of dose distribution among the live-stock by separation the function of activity changes in milk samples in time into the basic components formed by the contribution of 131I, 134Cs and 137Cs. The best approximation to the description of the function of milk activity variations was found to be achieved by the representation of forage activity changes as a sum of exponents with the half-life periods of 5 and 30 day with a partial contribution of 0.8 and 0.2. The calculations showed, that the average absorbed doses to the thyroid varied between 10 and 40 Gy.

Animal Feed↗

[Historical evolution of the treatment of esophageal cancer at the Hospital A. C. Camargo, São Paulo, Brazil].

OBJECTIVES: From 1947-1986 we reviewed a historical series of 1,900 cases of esophageal cancers registered at the A.C. Camargo Hospital, São Paulo, Brazil. Two hundred and thirty four cases were submitted to surgical resection. During these 4 decades the treatment philosophy of these tumors has changed. METHOD: Five different historical groups were identified and the results are presented. RESULTS: The first group (1947-60) consisted of 47 cases only submitted to surgical resection. The second group (1961-70) of 56 cases had pre and pos surgery radiotherapy in low doses and the reconstruction was made using subcutaneous colon. From 1971-75 the same approach was used except with high dose preoperative radiotherapy (31 cases). In the 4th group (1976-82) of 68 cases preoperative radiotherapy (high dose) and chemotherapy were used. In the last group (1983-86) composed of 32 cases the treatment was preoperative chemotherapy, surgical resection with gastric reconstruction followed with high doses radiotherapy in the surgical bed and chemotherapy. The only significant prognostic factors in the statistical analysis were tumor size and involvement peri-esophageal lymph nodes. CONCLUSION: A five year survival from 3.7% to 9.0% was obtained through the use of the fifth group treatment planning.

Adult↗

A comparison of dose calculations at points around an intracavitary cervix applicator.

An intercomparison was made between dose-rate calculations performed in 10 institute in The Netherlands for intracavitary applications with the Selectron-LDR remote afterloading machine. The results of 11 computer planning systems of five different manufacturers were compared with reference dose-rate calculations. The difference in clinically relevant dose-points like rectum and bladder, were less than 2% if the values of the coordinates of source and dose-points were given, except for one type of planning system, that showed differences up to 10%. The errors observed for the latter system were probably due to a coarse calculation grid, which becomes important in regions with a high dose gradient. If the reconstruction process of source and dose-point positions from radiographs was included as it usually is in practice, then the accuracy became worse and the planning system that showed large errors before, gave unacceptable errors of 30% to 40% in the rectal area. This is due to additional errors introduced in the reconstruction. The intercomparison showed that it is very important that computer treatment planning systems for brachytherapy calculations are tested before clinical use. The reconstruction technique for source and dose-point positions should be part of this test. Radiographs should be made of a phantom that simulates the cervix application, and the radiography technique should be similar to the one that is clinically employed.

Brachytherapy↗

Contribution of different foodstuffs to the internal exposure of rural inhabitants in Russia after the Chernobyl accident.

In a large village, Veprin of the Bryansk region of Russia contaminated with radionuclides as a result of the Chernobyl accident, 137Cs concentration in food products of agricultural produce and natural origin was regularly measured, local inhabitants were polled on the composition of their diet, and the 137Cs content in their bodies was measured at the same time. These results were used as the basis for calculation of annual effective doses of internal exposure to inhabitants and for reconstruction of the dose during the entire period after the accident (1986-1996). The efficiency of countermeasures performed for reduction of the internal dose was assessed. The internal dose in inhabitants during the 10 years after the accident was shown to be reduced by countermeasures by a factor of 2, namely down to 35 mSv instead of the expected 70 mSv. The dose of external gamma radiation during the same time period is close to the obtained dose of internal exposure. The presence of peat and water-meadow soils in the vicinity of this village that are characterised by high transfer factors for radionuclides from soil to vegetation causes a high contribution of internal exposure to the total dose of population exposure. The contribution of natural products to the internal dose increased from 6% in 1987 increased to 25% in 1996. The individual content of 137Cs in the body of inhabitants reliably correlates with consumption of milk in the initial period after the accident and with consumption of forest mushrooms in the subsequent period.

Adult↗

[Biological properties of reconstructed mouse hematopoiesis with hematopoietic stem cells transfected by bcl-2 gene].

OBJECTIVE: To observe resistance to radiochemical agents in the mice reconstructed hematopoiesis with hematopoietic stem cells transfected by bcl-2 gene. METHODS: The plasmid containing bcl-2 cDNA retrovirus vector was transfected to PA317 cells with Lipofecaine kite. A PA317 cell clone(D3) with high virus titer was obtained through G418 selection. The virus supernatant of D3 clone cells was used to transfect mouse embryo-liver hematopoietic stem cells. Hematopoiesis in the mice treated with lethal dose irradiation was reconstructed by hematopoietic stem cells transfected with bcl-2 gene. The resistance to radiochemical agents in the mice with reconstructed hematopoiesis was evaluated according to the number of WBC of periphereal blood and mononuclear cells of bone marrow, CFU-S and CFU-S regeneration. RESULTS: The expression of bcl-2 protein was increased in the hematopoietic cells transfected by bcl-2 gene. The mice reconstructed hematopoiesis by stem cells transfected bcl-2 gene can tolerate high dose combined with chemotherapy and radiation of middle dose. The mice reconstructed hematopoiesis with stem cells transfected bcl-2 gene survived over one year, no tumors were found. CONCLUSION: The mice with reconstructed hematopoiesis by stem cells carried bcl-2 gene possess the ability of resistance to radiochemical agents, even only part of hematopoietic stem cells were transfected with bcl-2 gene.

Animals↗