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PubMed1983

Calculation of doses in intracavitary therapy.

The computer simulation of the gamma-energy spectrum of four radionuclides usually used in intracavitary therapy was performed. A Monte Carlo method was used for simulation of the decay schemes. The emerging gamma-energy spectra of the radioactive source assemblies were obtained as the result of the interaction of emitted source radiation with the protective stainless steel sheath and the radioactive material itself.

Brachytherapy↗
PubMed2001

The use of cylindrical coordinates for treatment planning parameters of an elongated 192Ir source.

PURPOSE: The doses given to the intima, media, and adventitia are very crucial quantities in intravascular brachytherapy. To facilitate accurate computerized treatment planning calculations, we have determined dose distributions in away-and-along table format around an 192Ir wire source and developed pertinent dosimetric parameters in cylindrical coordinates. METHODS AND MATERIALS: The Monte Carlo method (MCNP4C code) was used to calculate the dose distributions for the AngioRad 192Ir wire source (model SL-77HS, Interventional Therapies). The calculations were carried out for photon, beta, and electron (conversion and Auger) contributions for radial distances from 0.03 to 2.0 cm with 0.01-cm increments, and up to 2.24 cm from the source center in the longitudinal direction with 0.04-cm resolution. Dose rate values are determined in away-and-along format (cylindrical coordinates) and then converted to spherical coordinate format. Dosimetric parameters, such as the geometry factor, G(r, theta), and anisotropy function, F(r, theta), are generated in both cylindrical (R, Z, phi) and spherical (r, theta, phi) coordinates. The use of a cylindrical coordinate system for treatment planning parameters is proposed as a more suitable approach for accurate calculations. RESULTS: The photon contribution to dose varies nearly inversely with radial distance (from the source center) along the perpendicular bisector with 0.199 x 10(-3) cGy U(-1) s(-1) (0.802 cGy Ci(-1) s(-1)) at 1 cm. The beta and electron contributions start at very high values of about 35.5 x 10(-3) cGy U(-1) s(-1) and 11.0 x 10(-3) cGy U(-1) s(-1), respectively, at 0.03 cm and fall off exponentially to negligible amount near 0.2 cm. The total dose rate at 0.2 cm is 1.428 x 10(-3) cGy U(-1) s(-1) (5.754 cGy Ci(-1) s(-1)). The radial dose function, g(R), is nearly unity between 0.2 cm and 2 cm. Due to the beta and electron dose contributions, g(R) increases steeply to 5.5 as radial distance decreases from 0.2 cm down to 0.03 cm. The F(R, Z) values are close to unity for the majority of the region of interest. In contrast, F(r, theta) experiences a steep rise as shallow angles are approached (closer to the source), related to the beta dose contributions. Accurate treatment planning calculations would be possible with linear interpolation of F(R, Z), but difficult with F(r, theta) in the spherical coordinate system and the original normalization point as recommended in the American Association of Physicists in Medicine Task Group 60 (AAPM TG-60) formalism. CONCLUSION: The AngioRad 192Ir wire source, model SL-77HS, was completely characterized dosimetrically using Monte Carlo methods. The use of cylindrical coordinates and a modified anisotropy function normalization point for dosimetric parameters of an elongated 192Ir source is more suitable for accurate computerized treatment planning calculations in intravascular brachytherapy.

Algorithms↗
PubMed1998

Prevention of vascular restenosis with radiation.

Recently, ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. The Scripps Coronary Radiation to Inhibit Proliferation Post-Stenting (SCRIPPS) trial was a double-blind, placebo-controlled, randomized trial to test this new treatment modality in restenotic stented human coronary arteries. Patients with previous restenosis and stent implantation were randomized to receive catheter-based radiation with Iridium-192 or a placebo using a catheter-based delivery system. Fifty-five patients were enrolled; 26 were assigned to Iridium-192 and 29 to the placebo. Follow-up angiography was obtained in 96% of patients. Restenosis was observed in 53.6% of placebo patients compared with only 16.7% of treated patients (P = 0.025). Late luminal loss was also significantly lower in the Iridium-192 group (0.38 +/- 1.06 mm vs 1.03 +/- 0.97 mm, P = 0.009). Clinical outcome also revealed a significant reduction in the need for target lesion revascularization in the Iridium-192 group (44.8% vs 11.5%, P = 0.008). In this preliminary study, catheter-based intracoronary radiotherapy substantially reduced the rate of subsequent restenosis. Clinical trials using gamma emitters, beta emitters, and beta-emitting radioactive stents are ongoing.

Brachytherapy↗
PubMed1986

Induction of lung tumors by radioactive isotopes implanted in the rat lung.

Squamous cell carcinomas were induced in the lungs of male WAG/Rij inbred rats by radiation emitted from the isotopes iridium-192 or iodine-125. These isotopes were implanted by a surgical procedure in the lungs of young rats. Forty rats received implants of 192Ir wires and 20 animals, of 125I seeds. In a 14-month observation period, 30 of the 40 animals with implants of 192Ir wires developed tumors. Malignant hemangioendotheliomas occurred with the highest frequency (50%). From the lungs of 12 rats, squamous cell carcinomas were found. In the observation period of 17 months, 3 rats with implants of 125I seeds developed tumors, among which 1 squamous cell carcinoma could be identified. Tumor fragments were transplanted in syngeneic hosts for propagation of the tumors. Histologic appearances of tumors remained constant in subsequent passages. Responses of transplanted tumors growing in the flanks of syngeneic hosts to doses of radiation, methotrexate, or vinblastine were determined. Although the histologic appearances of the 5 squamous cell carcinomas were similar, tumor-doubling times and responses to irradiation and chemotherapeutic drugs were different. Small cell or large cell carcinomas were not observed.

Animals↗
PubMed1985

Radioactive iodine-125 implantation for cancer of the prostate.

Localized cancer of the prostate can be treated by radical prostatectomy, external beam irradiation, or radioactive implantation with similar survival results. Radical prostatectomy, however, almost universally results in impotency, although a new, nerve-sparing procedure may preserve potency in B1 patients. External beam irradiation radiates a large volume of tissue with significant rectal and bladder morbidity, 23-47% risk of impotency, and requires prolonged treatment (6-8 weeks). Radioactive implantation may be done suprapubically or transperineally using iodine-125, gold-198, or radon-222 permanent implantation techniques and iridium-192 or radium-226 removable implantation techniques. Interstitial iodine-125 implantation is frequently employed since it is a short procedure and limits the morbidity to a 7% incidence of impotency, 20% urinary complications, and 5% rectal complications. The overall 5-year survival of patients with iodine-125 is 79%, the survival rate decreasing with increasing T or N stage or increasing grade of tumor.

Brachytherapy↗
PubMed2000

Mathematical methods in biological dosimetry: the 1996 Iranian accident.

PURPOSE: To report 18 months of cytogenetic follow-up for an Iranian worker accidentally overexposed to 192Ir, the mathematical extrapolation and comparison with clinical data. MATERIAL AND METHODS: Unstable chromosome aberrations were measured using conventional cytogenetic tests by French and Iranian biological dosimetry laboratories on five occasions after the exposure. The decrease in dicentrics over time was analysed mathematically. In addition, Dolphin and Qdr extrapolations were applied to the data to check the exposure estimates. FISH determination of translocation yields was performed twice by the French laboratory and the results compared with the Dolphin and Qdr corrected values. RESULTS: Dose estimates based on dicentrics decreased from 3.1 +/- 0.4 Gy at 5 days after the accident to 0.8 +/- 0.2 Gy at 529 days. This could be fitted by double-exponential regression with an inflexion point between rapid and slow decrease of dicentrics after about 40 days. Dose estimates of 3.4 +/- 0.4 Gy for the Qdr model and 3.6 +/- 0.5 Gy for the Dolphin model were calculated during the post-exposure period and were remarkably stable. FISH translocation data at 26 and 61 days appeared consistent with the Dolphin and Qdr estimates. CONCLUSION: Dose correction by the Qdr and Dolphin models and translocation scoring appeared consistent with the clinical data and provided better information about the radiation injury than did crude estimates from dicentric scoring alone. Estimation by the Dolphin model of the irradiated fraction of the body seemed unreliable: it correlated better with the fraction of originally irradiated lymphocytes.

Biometry↗
PubMed2002

"High specific activity" radiotracers for metallo-toxicological studies: cyclotron and nuclear reactor production, radiochemical separation and "quality control": platinum, iridium, gold, copper and gallium.

Very High Specific Activity RadioNuclides, HSARN, are a powerful tool to label a wide variety of chemical elements and compounds present in the biosphere in ultra-trace amounts. Medium and high Z radionuclides, can be produced by irradiation in light-ions accelerator and sometimes nuclear reactor. If the nuclear reaction product has atomic number different from irradiated target, it is possible separating the radioactive nuclide from irradiated target, without addition of isotopic carrier. These kinds of radionuclides are named No Carrier Added, NCA, and their specific activity is very high and can reach values close to the theoretical Carrier Free one. The true specific activity must be determined by use of very sensitive radioanalytical techniques. If a low isotopic dilution factor is obtained, these radiotracers are used to label inorganic species and complexes of elements, which are presently introduced into the echo-systems by human activities. New production methods for NCA Pt, Ir, Au, Cu and Ga radiotracers are presented, with some details on radiochemistry and quality controls.

Copper↗
PubMed2002

[Accidents in radiotherapy: historical account].

Radiotherapy accidents are exceedingly rare. However, they may have major negative consequences: for health (and sometimes life) of victims as well as for the trust that patients put in radiotherapy and radiation oncologists. Each accident must be pointed out, analysed and reported, in order to allow preventive actions, avoiding repetitive accidents. Through examples of majors accidents occurred all over the world in the last decades, affecting professionals, public or patients themselves, the necessity of transparency is demonstrated. The International Commission of Radiobiological Protection has drawn positive lessons from such accidents and insists on following recommendations: necessity of sufficient number and competent professionals, importance of continuous and initial education, information of professionals and, in general, a strict Quality Assurance program. It is clear that each radiotherapy center remains at risk for errors. It is essential to develop preventive procedures to avoid transformation of errors into accidents. In that context, complete and detailed description and reports of each anomaly or incident must be encouraged as it is done for sectors of aviation or nuclear industry. Radiation oncology must develop such a culture of transparency and of systematic report of all incidents.

Accidents, Occupational↗
PubMed2002

Cytogenic investigations of serious overexposures to an industrial gamma radiography source.

This paper describes the sequence of events, medical aspects and dose estimations for two radiographers and their driver who were seriously exposed to an iridium-192 industrial radiography source that became detached from its wind-out cable. The men came to medical attention about 1 month later by which time all three were severely leucopenic and one had skin burns on both hands. Doses were estimated by (i) physics calculations combined with their accounts of the event. (ii) the levels of depression of their blood neutrophils, (iii) electron spin resonance on tooth enamel and (iv) blood lymphocyte chromosomal analyses by the conventional dicentric and the fluorescence in situ hybridisation methods. Intercomparison of these methods for estimating doses showed a good level of agreement. In brief, the averaged whole body dose for the most seriously exposed man was about 2.5-3.0 Gy and for the others it was 1.0-2.0 Gy.

Acute Disease↗
PubMed1997

[Combined iridium 192 afterloading therapy of prostate carcinoma].

The goal of radiation therapy is to deliver a high dose to the tumor while preserving normal surrounding tissue. For early-stage prostate cancer, the ultimate conformal irradiation is to place radioactive sources directly into the gland as permanent or temporary seeds. Contemporary prostate brachytherapy incorporates advances in computer analysis, imaging technology, and delivery apparatus, allowing exact and reproducible results. Accurate comparison of brachytherapy to surgery and external beam irradiation requires a randomized study. Comparisons of retrospective studies are fraught with the problems of the heterogeneous nature of early-stage prostate cancer. Pretreatment PSA and grade appear to be more sensitive variables than stage in predicting failure after irradiation. The treatment results based on biopsy are promising for the first two years. Brachytherapy may be considered as a therapeutic option: as monotherapy for early-stage disease and also as a boost following moderate doses of external beam irradiation for locally advanced disease.

Brachytherapy↗