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A Longitudinal Study of clinical Benefits with Implementation of the Deep Inspiration Breath-Hold Technique in Post-Operative radiotherapy for Left-Sided Breast Cancer

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2019年第3期8卷 151-162页

作者： Chunhui Han Nayana Vora Sean Zhang An Liu Jeffrey Y. C. Wong department of Radiation oncology City of Hope National Medical Center Duarte CA USA

Purpose/Objectives: We aimed to report clinical effects on critical organ dose and cardiac toxicity from implementation of the deep inspiration breath-hold (DIBH) technique in post-operative extern-beam radiotherapy of patients with left-sided breast cancer, using longitudinal clinical data. Materials/Methods: We retrieved three groups of patients who received post-operative radiotherapy of left-sided breast cancer in our institution in recent years: Groups A and B consist of patients whose treatment did not include internal mammary nodes (IMN) and who were treated with the free breathing technique and with the DIBH technique, respectively, and Group C consists of patients whose radiotherapy included internal mammary nodes with the DIBH technique. Dose parameters for the heart and left lung were retrieved from the treatment plans. Radiation-induced cardiac risks were estimated using existing risk models. Results: The average heart dose was 2.65 ± 0.98 Gy, 1.10 ± 0.29 Gy, and 1.26 ± 0.25 Gy in Groups A, B, and C, respectively. The average heart volumes receiving at least 25 Gy were 7.10 ± 9.79 cc in Group A, 0.07 ± 0.22 cc in Group B, and 0.03 ± 0.08 cc in Group C. On average, the excessive risk of having ischemic heart disease was estimated to be 19.6%, 8.1%, and 9.3% in Groups A, B, and C, respectively. The mean left lung doses were 5.73 ± 1.86 Gy, 5.93 ± 1.55 Gy, and 9.13 ± 1.57 Gy in Groups A, B, and C, respectively. Conclusion: Implementation of the DIBH technique significantly lowered heart dose and decreased the ischemic heart disease risk in patients receiving post-operative radiotherapy for left-sided breast cancer, without significant increase in left lung dose.

关键词： Breast Cancer Heart Toxicity Breath Hold Extern-Beam radiotherapy

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The Verification of iPlan Commissioning by Radiochromic EBT2 Films

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2012年第1期1卷 1-7页

作者： Maria F. Chan Qinghui Zhang Jingdong Li Preeti Parhar Karen Schupak Chandra Burman department of Radiation oncology Memorial Sloan-Kettering Cancer Center Basking Ridge USA

Purpose: To evaluate the measured dose distributions using radiochromic EBT2 films for small fields in iPlan (BrainLab) commissioning. Methods: Radiochromic EBT2 films were irradiated with 6 MV photons on a Varian Trilogy linac using polystyrene phantoms. The measurements included dose profiles and depth doses for field sizes of 1 × 1, 2 × 2, 3 × 3, 4 × 4, and 10 × 10 cm2 etc. The dose profile measurements were taken at the depth of 5 cm. The calibration films were irradiated at dmax(1.4 cm) for doses up to 6 Gy. Films were scanned using an Epson 10,000 XL flatbed scanner with 72 dpi resolution. Pixel values were converted to doses using the established calibration-curve. The 2D dose distributions were generated from the film data analysis. In-house software was utilized to compare the measured doses from films with the treatment planning data. In addition, selected patients’ SRS fields were also measured with the EBT2 films for comparison with iPlan. An EDGETM detector was also used to check the centralaxis doses for the SRS patients’ measurements. Results and Discussion: The measured planar dose distributions achieved more than 98% and 95% passing rates with a set of 2%/2 mm dose and DTA criteria for all square fields and all patient treatment fields (2), respectively. Agreement with measurement data with the EDGETM detector at the central axis (±1%) was found with the plan data. This is the first report for SRS small photon-field measurement using the latest radiochromic film, EBT2. The results shown in this work indicate that the use of EBT2 film provides accurate dosimetry measure-ments for small photon beams. The measurements show excellent agreement with the iPlan TP commissioning data. Conclusions: The patient-specific EBT2 film QA for iPlan SRS patients showed good results. The EBT2 films could potentially be a useful dosimeter in verification of commissioning as well as patient-specific QA for SRS cases.

关键词： Radiochromic Film Dosimetry Radiosurgery Commissioning radiotherapy

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Radiation-Associated Cardiotoxicity during Breast Cancer Treatment with Ionizing Radiation

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2023年第1期12卷 28-36页

作者： Besim Xhafa Fesal Selimi Doriana Berberi Paloji Ylli Kaçiu Blerim Rrakaqi Alma Mater Rezonanca Campus College “Rezonanca” Prishtina Kosovo University clinical Center of Kosovo Prishtina Kosovo

Introduction: Breast cancer is the most common cancer in women. The treatment of breast carcinoma has advanced in the last decade and nowadays there are treatment protocols for all stages of the disease. Depending on the histopathology and stage breast cancer is treated with surgery, chemotherapy and radiotherapy. Regarding radiation, the field of irradiation includes the chest wall in patients with mastectomy, or the breast glandular tissue in patients with conserving surgical approaches. It is often treated with radiation therapy with two opposing tangential fields, and when indicated supraclavicular lymph nodes have to be irradiated. In this case an additional anterior field is applied. The tangential as well as the other radiation beams have a potential damaging effect on the healthy surrounding tissues, particularly over the heart in the left breast irradiation and in the lungs as well. Material and Methods: The study included 25 patients with left breast carcinoma, all post surgery, treated with radiation therapy, with the Elekta accelerator at our department. For academic purpose the treatment plans were generated following two methods. The first one with two tangential opposite beams plus a supraclavicular beam. In this method the angles of the tangential internal and external create an angle that is equal to 180˚{310˚& 130˚};no further changes were made to the beam geometry. Even though this is not the best option from the dose distribution point of view, it is still the most applied method, probably because of the semplicity of it. For each patient, a second plan was generated using two opposite tangential beams plus the supraclavicular beam. The angles of the internal and external beam were changed from 1˚to 3˚, depending on the surface of the body, so that the resulting angle was 180˚± 3˚{310˚± 3˚& 130˚± 3˚} with the aim to adapt the beam geometry as much as possible to the shape of the thoracic wall

关键词： Radiation Dose Brest Cancer Heart Gentry Angle

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Evaluation of Delivery Analysis to Detect Intrafractional Motion during Tomotherapy

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2019年第4期8卷 225-235页

作者： Kazuo Tarutani Masao Tanooka Keisuke Sano Okada Wataru Masayuki Fujiwara Koichiro Yamakado department of Radiology Hyogo College of Medicine Nishinomiya Japan Japan Organization of Occupational Health and Safety Kansai Rousai Hospital Amagasaki Japan department of radiotherapy Takarazuka City Hospital Takarazuka Japan

The purpose of this study was to investigate the ability of a management system (Delivery Analysis: DA) to detect intrafractional motion during intensity-modulated radiation therapy (IMRT) in tomotherapy mode. Tomotherapy has made it possible to manage internal movements during treatment using software DA, which quantifies using the information of the passing dose obtained during the radiation treatment of patients. First, three treatment plans for the test were created (lumbar spine, prostate, and femur). Second, a pelvis phantom was moved in the X, Y, and Z directions, and a sinogram was acquired. The magnitudes of the movements were 3 mm, 5 mm, and 10 mm, respectively. Finally, the ability of DA to detect the motion was evaluated by comparing the sinogram obtained by moving the phantom with a reference sinogram obtained without movement. The sensitivity of DA could be detected with a shift amount of 3 mm (gamma analysis tolerance 0.3 mm/0.3%). The average gamma analysis of each direction at 0.3 mm/0.3% tolerance at each treatment site was 96.1% for the prostate, 93.5% for the lumbar spine, and 94.4% for the femur. Additionally, the average gamma pass rate results for the pelvic phantom in the X, Y, Z directions for a 10 mm shift were 96.2%, 96.3%, and 95.9%, respectively. DA is a powerful tool with high detection sensitivity and ability to detect body movement during treatment.

关键词： Delivery Analysis (DA) Tomotherapy Sinogram Intra-Fraction Motion Quality Assurance (QA)

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Evaluation of Excitation Functions of Reactions Used in Production of Some Medical Radioisotopes

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2017年第3期6卷 290-303页

作者： Idris Ahmad Yahya Ibrahim Yola Fatima Salman Koki department of physics Bayero University Kano Kano Nigeria

In this work, reaction cross-sections were calculated and Excitation Functions were evaluated for productions of 208Bi, 212,211,210At, 211,210Po isotopes using EXIFON code in the energy range from 0 MeV to 30 MeV. The code is based on an analytical model for statistical multistep direct and multistep compound reactions (SMD/SMC model). This work also investigates the shell structure effect on the reaction cross-section, the results obtained show that the cross-sections of (a, na) reaction for both with shell correction and without shell correction are zeros at energies range considered, this shows that the energy of the incident particle is below the threshold of this reaction due to the present of coulomb repulsive force between the projectile and target nucleus.

关键词： Nuclear Reaction Cross-section Excitation Function Radioisotope Nuclear Model

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The Application of Image Guided radiotherapy on the Precision of Intensity Modulated radiotherapy in Patients with Locally Advanced Rectal Cancer

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2018年第4期7卷 479-490页

作者： Chengtao Wang Zhenyu Wang Mengzhen Min Xiaobi Yu Jun Dong Bixiu Wen department of Radiation oncology The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

Objective: To investigate the effect of onboard image (OBI) system-based image guided radiotherapy (IGRT) on the precision of fractionated intensity modulated radiotherapy (IMRT) for patients with locally advanced rectal cancer. Methods: The IGRT validation images of the 12 patients with rectal cancer were obtained after initial setup by the OBI system of Varian Novalis TX linear accelerator, and registered to the planning CT image system. Subsequently, the setup deviations on three translational directions [ventral-dorsal direction (VD), cranial-caudal direction (CD) and lateral direction (LD)] for the three-validation phase including Pre-treatment (Pre-RT1), repositioning (Pre-RT2) and Post-treatment (Post-RT) were obtained and comparatively analyzed. Results: The frequency of setup deviation of ≤2.0 mm in the lateral, cephalocaudal and ventral direction was 83.01%, 65.71%, and 68.91%, respectively for Pre-RT1;100%, 98.72% and 100%, respectively for Pre-RT2;100%, 97.76%, and 99.68%, respectively for Post-RT. Compared with the Pre-RT1 phase, the ranges of setup deviation on Pre-RT2 and Post-RT phases possessed a significant contraction trend. The absolute values of setup deviations on the three translation directions between the Pre-RT1 and Pre-RT2 or Post-RT were statistically significant (p < 0.05). Through positioning adjustment based on IGRT based on the OBI system, the setup deviations on the three translational directions decreased significantly. Conclusion: Application of OBI-based daily IGRT may help improve the precise delivery of fractionated IMRT by decreasing the inter- and intra-fractionated setup deviation in the ventral-dorsal direction, cranial-caudal direction and lateral direction for patients with locally advanced rectal cancer.

关键词： Rectal Cancer IMRT IGRT OBI Setup Deviation

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Proton Therapy Results in the Treatment of Hepatocellular Carcinoma According to the Barcelona-Clinic Liver Cancer (BCLC) Staging System

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2015年第2期4卷 96-103页

作者： Francesco Dionisi Maurizio Amichetti Protontherapy Unit Department of Oncology Azienda Provinciale per i Servizi Sanitari Trento Italy

Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.

关键词： Proton Therapy HCC BCLC Staging System

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The Dosimetric Characteristics and Potential Limitation in clinical Application of a Low Energy Photon Intra-Operative radiotherapy System

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2015年第2期4卷 184-195页

作者： Zhenhua Xiao Ouyang Bin Zhenyu Wang Botian Huang Bixiu Wen department of Radiation oncology The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.

关键词： Intra-Operative radiotherapy Low Energy Photon Dosimetry Isotropy Limitation

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Visual Analysis of the Daily QA Results of Photon and Electron Beams of a Trilogy Linac over a Five-Year Period

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International Journal of Medical physics, clinical Engineering and Radiation oncology 2015年第4期4卷 290-299页

作者： Maria F. Chan Qiongge Li Xiaoli Tang Xiang Li Jingdong Li Grace Tang Margie A. Hunt Joseph O. Deasy department of Medical physics Memorial Sloan Kettering Cancer Center New York USA department of physics The City University of New York New York USA

Data visualization technique was applied to analyze the daily QA results of photon and electron beams. Special attention was paid to any trend the beams might display. A Varian Trilogy Linac equipped with dual photon energies and five electron energies was commissioned in early 2010. Daily Linac QA tests including the output constancy, beam flatness and symmetry (radial and transverse directions) were performed with an ionization chamber array device (QA Beam Checker Plus, Standard Imaging). The data of five years were collected and analyzed. For each energy, the measured data were exported and processed for visual trending using an in-house Matlab program. These daily data were cross-correlated with the monthly QA and annual QA results, as well as the preventive maintenance records. Majority of the output were within 1% of variation, with a consistent positive/upward drift for all seven energies (^+0.25% per month). The baseline of daily device is reset annually right after the TG-51 calibration. This results in a sudden drop of the output. On the other hand, the large amount of data using the same baseline exhibits a sinusoidal behavior (period = 12 months;amplitude = 0.8%, 0.5% for photons, electrons, respectively) on symmetry and flatness when normalization of baselines is accounted for. The well known phenomenon of new Linac output drift was clearly displayed. This output drift was a result of the air leakage of the over-pressurized sealed monitor chambers for the specific vendor. Data visualization is a new trend in the era of big data in radiation oncology research. It allows the data to be displayed visually and therefore more intuitive. Based on the visual display from the past, the physicist might predict the trend of the Linac and take actions proactively. It also makes comparisons, alerts failures, and potentially identifies causalities.

关键词： Linac QA Data Visualization Daily Output radiotherapy

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外照射配合肝动脉栓塞治疗不能手术切除的原发性肝癌的临床研究(英文)

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The Chinese-German Journal of clinical oncology 2008年第2期7卷 64-68页

作者： Ling Cai Mengzhong Liu Xiushen Wang Mofa Gu Hui Liu Qun Li Nianji Cui Guohui Li Jinqing Li department of Radiation oncology and Medical physics The Cancer Center of Sun Yat-Sen University Guangzhou 510060 China Deparment of Hepatobiliary Tumor The Cancer Center of Sun Yat-Sen University Guangzhou 510060 China

Objective: This study evaluated the therapeutic effect of external beam radiotherapy (RT) combined with trans- catheter arterial chemoembolization (TACE) on the patients with unresectable hepatocellular carcinoma (HCC). Methods: From June 1994 to April 2002, 114 patients with unresectable HCC were nonrandomized prospectively stepped into our study. All patients received TACE as initial therapy, except 54 also received combination therapy with external beam therapy. Sur- vival failure patterns were analyzed and compared between the two groups. Results: Overall survival rates in the patients in the radiotherapy group were 65%, 47%, 38% at 1, 2, 3 years, respectively, improved over the non-radiotherapy group rates of 54%, 36.5%, 18% at 1, 2, 3 years, respectively. There was significant difference between two groups (P < 0.05). The survival rates correlated with tumor size, number of tumors, and portal vein embolus. Conclusion: TACE combined with RT is a more effective treatment than TACE alone in patients with unresectable HCC.

关键词：外照射治疗肝动脉栓塞手术切除原发性肝癌

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