Internal dosimetry of [99m Tc]NTP15-5 radiotracer for cartilage imaging in preclinical and clinical models using the GATE Monte Carlo platform

PURPOSE

This study aims to perform dosimetry for [^99m Tc]NTP15-5 radiotracer used in imaging of articular cartilage in rabbits and humans. The radiotracer (covered by a world patent WO 01/00621 A1) has been proposed in the previous years for the study of cartilage in osteoarthritis diseases. A sensitive imaging approach is essential to quantify osteoarthritis progression and monitor response to new therapies. [^99m Tc]NTP15-5 binds to cartilage proteoglycans whose decreased content is associated to a loss of biomedical function of cartilage. We have implemented the whole dosimetry study concerning this new radiotracer for rabbits and humans using the GATE Monte Carlo platform.

MATERIALS AND METHODS

Absorbed doses to critical organs are determined using the MIRD formalism. Biodistribution data are obtained by organ sampling, measuring the activity in organs for three rabbits sacrificed at various times postadministration, and by SPECT/CT imaging at different times after injection. Most important sources are cartilages (in knees and intervertebral discs), due to localization together with the liver and kidneys due to excretion of the agent. S-values are calculated from rabbit's CT scan and human CT scan using the GATE v8.0 Monte Carlo platform. Cumulated activity in humans is extrapolated from animals using the %kg-dose/g method. Particular attention is given to dose calculation in bones, bone marrow and organs at risk.

RESULTS

The dosimetry performed in rabbits shows highest absorbed doses for liver and kidneys with respectively 22.5 and 43.8 µGy per MBq of injected activity. In humans, we found absorbed doses for a maximum injected activity of 15 MBq/kg, that is, 1050 MBq for an adult of 70 kgs of 9.03 mGy for kidneys and 4.16 mGy for knee cartilages. Effective dose is 2.69 µSv/MBq.

CONCLUSIONS

The dosimetry profile of [^99m Tc]NTP15-5 in the context of preclinical trials is of major importance in order to make sure that organs at risk are not overexposed. GATE provides all the capability needed to calculate dose profiles for internal dosimetry. The extrapolation of the dose for a human model is a first step towards clinical trials.

Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT

PURPOSE

To determine the optimal dose-volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck.

MATERIALS AND METHODS

Thirty patients with stage II-IVA oropharynx cancers received definitive radiotherapy with split-field IMRT (SF-IMRT) to the bilateral neck between 2008 and 2013. Each case was re-planned using whole-field IMRT (WF-IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage.

RESULTS

Target coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF-IMRT than SF-IMRT (22.1 vs 25.8 Gy; P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF-IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy; P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy; P < 0.01).

CONCLUSIONS

Modern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers.

SUMMARY

We evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split-field IMRT (SF-IMRT), whole-field IMRT (WF-IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non-laryngeal organs at risk among techniques.

Radiation Dosimetry of 99mTc-PSMA I&S: A Single-Center Prospective Study

^99mTc-PSMA I&S is a prostate-specific membrane antigen (PSMA) tracer that can be used for planar and SPECT/CT γ-imaging and radioguided surgery. The primary aim of this study was to estimate the dosimetry of ^99mTc-PSMA I&S using a hybrid method (sequential γ-planar imaging and 1 single SPECT/CT) in healthy volunteers. The secondary aim was to depict the tracer biodistribution and tumor-to-background ratios (TBRs) in patients with prostate cancer (PCa). Methods: Dosimetry of ^99mTc-PSMA I&S was investigated in 4 healthy volunteers. Whole-body planar imaging was acquired at 1, 2, 3, 6, and 24 h and SPECT/CT at 6 h after tracer injection. Contours of organs were drawn on all acquisitions to determine organ activity at each time point. Absorbed dose was estimated using 2 methods: independent curve-fitting manual method (Levenberg-Marquardt-based algorithm using dose factors from RAdiation Dose Assessment Resource [RADAR] website) and OLINDA/EXM software (version 2.0; HERMES Medical Solutions). Biodistribution of ^99mTc-PSMA I&S was assessed in 10 patients with PCa on SPECT/CT images at 6 h. Tumor uptake (SUV_max), and TBR (tumor SUV_max/background organ SUV_mean) using muscle (T/M), bladder (T/B), and intestine (T/I) as background organs were determined. Results: The mean injected activity of ^99mTc-PSMA I&S was 717 MBq (range: 562-828 MBq). No adverse events related to the injection of ^99mTc-PSMA I&S were reported. The average radiation effective dose was 0.0055 mSv/MBq with the RADAR manual method and 0.0052 mSv/MBq with OLINDA/EXM. Total body effective dose ranged between 3.33-4.42 and 3.11-4.23 mSv, respectively. All PCa patients showed high tracer uptake in primary and metastatic lesions with T/M, T/B, and T/I ranging from 5.29-110, 0.11-7.02, and 0.96-16.30, respectively. Conclusion: Effective doses of ^99mTc-PSMA I&S were comparable to those known for most of the ^99mTc tracers and was lower than for the ⁶⁸Ga-labeled and ¹⁸F-labeled agents. ^99mTc-PSMA I&S SPECT/CT showed high TBR in PCa patients. This study can provide required data for translation and approval of ^99mTc-PSMA I&S by regulatory agencies.

Refining complex re-irradiation dosimetry through feasibility benchmarking and analysis for informed treatment planning

PURPOSE/OBJECTIVES

The purpose of this study is to dually evaluate the effectiveness of PlanIQ in predicting the viability and outcome of dosimetric planning in cases of complex re-irradiation as well as generating an equivalent plan through Pinnacle integration. The study also postulates that a possible strength of PlanIQ lies in mitigating pre-optimization uncertainties tied directly to dose overlap regions where re-irradiation is necessary.

METHODS

A retrospective patient selection (n = 20) included a diverse range of re-irradiation cases to be planned using Pinnacle auto-planning with PlanIQ integration. A consistent planning template was developed and applied across all cases. Direct plan comparisons of manual plans against feasibility-produced plans were performed by physician(s) with dosimetry recording relevant proximal OAR and planning timeline data.

RESULTS AND DISCUSSION

All re-irradiation cases were successfully predicted to be achievable per PlanIQ analyses with three cases (3/20) necessitating 95% target coverage conditions, previously exhibited in the manually planned counterparts, and determined acceptable under institutional standards. At the same time, PlanIQ consistently produced plans of equal or greater quality to the previously manually planned re-irradiation across all (20/20) trials (P = 0.05). Proximal OAR exhibited similar to slightly improved maximum point doses from feasibility-based planning with the largest advantages gained found within the subset of cranial and spine overlap cases, where improvements upward of 10.9% were observed. Mean doses to proximal tissues were found to be a statistically significant (P < 0.05) 5.0% improvement across the entire study. Documented planning times were markedly less than or equal to the time contributed to manual planning across all cases.

CONCLUSION

Initial findings indicate that PlanIQ effectively provides the user clear feasibility feedback capable of facilitating decision-making on whether re-irradiation dose objectives and prescription dose coverage are possible at the onset of treatment planning thus eliminating possible trial and error associated with some manual planning. Introducing model-based prediction tools into planning of complex re-irradiation cases yielded positive outcomes on the final treatment plans.

Ambulatory Phonation Monitoring With Wireless Microphones Based on the Speech Energy Envelope: Algorithm Development and Validation

Background

Voice disorders mainly result from chronic overuse or abuse, particularly in occupational voice users such as teachers. Previous studies proposed a contact microphone attached to the anterior neck for ambulatory voice monitoring; however, the inconvenience associated with taping and wiring, along with the lack of real-time processing, has limited its clinical application.

Objective

This study aims to (1) propose an automatic speech detection system using wireless microphones for real-time ambulatory voice monitoring, (2) examine the detection accuracy under controlled environment and noisy conditions, and (3) report the results of the phonation ratio in practical scenarios.

Methods

We designed an adaptive threshold function to detect the presence of speech based on the energy envelope. We invited 10 teachers to participate in this study and tested the performance of the proposed automatic speech detection system regarding detection accuracy and phonation ratio. Moreover, we investigated whether the unsupervised noise reduction algorithm (ie, log minimum mean square error) can overcome the influence of environmental noise in the proposed system.

Results

The proposed system exhibited an average accuracy of speech detection of 89.9%, ranging from 81.0% (67,357/83,157 frames) to 95.0% (199,201/209,685 frames). Subsequent analyses revealed a phonation ratio between 44.0% (33,019/75,044 frames) and 78.0% (68,785/88,186 frames) during teaching sessions of 40-60 minutes; the durations of most of the phonation segments were less than 10 seconds. The presence of background noise reduced the accuracy of the automatic speech detection system, and an adjuvant noise reduction function could effectively improve the accuracy, especially under stable noise conditions.

Conclusions

This study demonstrated an average detection accuracy of 89.9% in the proposed automatic speech detection system with wireless microphones. The preliminary results for the phonation ratio were comparable to those of previous studies. Although the wireless microphones are susceptible to background noise, an additional noise reduction function can alleviate this limitation. These results indicate that the proposed system can be applied for ambulatory voice monitoring in occupational voice users.

VHEE beam dosimetry at CERN Linear Electron Accelerator for Research under ultra-high dose rate conditions

The aim of this work is the dosimetric characterization of a plane parallel ionization chamber under defined beam setups at the CERN Linear Electron Accelerator for Research (CLEAR). A laser driven electron beam with energy of 200 MeV at two different field sizes of approximately 3.5 mm FWHM and approximately 7 mm FWHM were used at different pulse structures. Thereby the dose-per-pulse range varied between approximately 0.2 and 12 Gy per pulse. This range represents approximately conventional dose rate range beam conditions up to ultra-high dose rate (UHDR) beam conditions. The experiment was based on a water phantom which was integrated into the horizontal beamline and radiochromic films and an Advanced Markus ionization chamber was positioned in the water phantom. In addition, the experimental setup were modelled in the Monte Carlo simulation environment FLUKA. In a first step the radiochromic film measurements were used to verify the beamline setup. Depth dose distributions and dose profiles measured by radiochromic film were compared with Monte Carlo simulations to verify the experimental conditions. Second, the radiochromic films were used for reference dosimetry to characterize the ionization chamber. In particular, polarity effects and the ion collection efficiency of the ionization chamber were investigated for both field sizes and the complete dose rate range. As a result of the study, significant polarity effects and recombination loss of the ionization chamber were shown and characterized. However, the work shows that the behavior of the ionization chamber at the laser driven beam line at the CLEAR facility is comparable to classical high dose-per-pulse electron beams. This allows the use of ionization chambers on the CLEAR system and thus enables active dose measurement during the experiment. Compared to passive dose measurement with film, this is an important step forward in the experimental equipment of the facility.

Dosimetric impact of commercial CT metal artifact reduction algorithms and a novel in-house algorithm for proton therapy of head and neck cancer

PURPOSE

To compare the dosimetric impact of all major commercial vendors' metal artifact reduction (MAR) algorithms to one another, as well as to a novel in-house technique (AMPP) using an anthropomorphic head phantom.

MATERIALS AND METHODS

The phantom was an Alderson phantom, modified to allow for artifact-filled and baseline (no artifacts) computed tomography (CT) scans using teeth capsules made with metal amalgams or bone-equivalent materials. It also included a cylindrical insert that was accessible from the bottom of the neck and designed to introduce soft tissue features into the phantom that were used in the analysis. The phantom was scanned with the metal teeth in place using each respective vendor's MAR algorithm: OMAR (Philips), iMAR (Siemens), SEMAR (Canon), and SmartMAR (GE); the AMPP algorithm was designed in-house. Uncorrected and baseline (bone-equivalent teeth) image sets were also acquired using a Siemens scanner. Proton spot scanning treatment plans were designed on the baseline image set for five targets in the phantom. Once optimized, the proton beams were copied onto the different artifact-corrected image sets, with no reoptimization of the beams' parameters, to evaluate dose distribution differences in the different MAR-corrected and -uncorrected image sets. Dose distribution differences were evaluated by comparing dose-volume histogram (DVH) metrics, including planning target volume D95 and clinical target volume D99 coverages, V100, D0.03cc, and heterogeneity indexes, along with a qualitative and water equivalent thickness (WET) analysis.

RESULTS

Uncorrected CT metal artifacts and commercial MAR algorithms negatively impacted the proton dose distributions of all five target shapes and locations in an inconsistent manner, sometimes overdosing by as much as 11.1% (D0.03) or underdosing by as much as 11.7% (V100) the planning target volumes. The AMPP-corrected images, however, provided dose distributions that consistently agreed with the baseline dose distribution. The dosimetry results also suggest that the commercial MAR algorithms' performances varied more with target location and less with target shape. Once relocated further from the metal, the target showed dose distributions that agreed more with the baseline for all commercial solutions, improving the overdosing by as much as 6%, implying inadequate HU correction from commercial MAR algorithms. In comparison to the baseline, HU profile shapes were considerably altered by commercial algorithms and reference values showed differences that represent stopping power percentage differences of 2.7-10%. The AMPP algorithm plans showed the smallest WET differences with the baseline (0.06 cm on average), while the commercial image sets created differences that ranged from 0.11 to 0.54 cm.

CONCLUSIONS

Computed tomography metal artifacts negatively impacted proton dose distributions on all five targets analyzed. The commercial MAR solutions performed inconsistently throughout all targets compared to the metal-free baseline. A lack of CTV coverage and an increased number of hotspots were observed throughout all commercial solutions. Dose distribution errors were related to the proximity to the artifacts, demonstrating the inability of commercial techniques to adequately correct severe artifacts. In contrast, AMPP consistently showed dose distributions that best matched the baseline, likely because it makes use of accurate HU information, as opposed to interpolated data like commercial algorithms.

Experimentally determined and Monte Carlo-calculated energy dependence of NaCl pellets read by optically stimulated luminescence for photon beams in the energy range 30 keV to 1.25 MeV

Ordinary salt, NaCl, has many properties suitable for dosimetry and has been suggested for both retrospective and prospective optically stimulated luminescence (OSL) dosimetry. Lately, the focus has been on NaCl that is compressed into solid pellets, as this improves both its handling and dosimetric properties. In this project, the energy dependence of NaCl pellets produced in-house was investigated for photon energies between 30 and 1.25 MeV. The NaCl pellets were first exposed to free-in-air conditions, and the estimated absorbed dose to the NaCl pellets was compared to the air kerma,K_air, at the point of exposure. Second, a backscatter medium of polymethyl methacrylate (PMMA) was added, and NaCl pellets were exposed when positioned on a ISO slab phantom to relate the response in the NaCl to the personal dose equivalent,H_p(10). The results show a significant energy dependence for exposure to low-energy photons with a peak over-response compared toK_airandH_p(10) of up to 18. Comparisons with Monte Carlo simulations show good agreement, even though the simulations cannot account for properties related to the intrinsic luminescence effects of the NaCl pellets or the readout and calibration process. The finite thickness of the NaCl pellet makes it an imperfect Bragg-Grey cavity, which complicates the behaviour of the energy dependence. The results presented here may serve as an important basis for further experimental and theoretical modelling of a build-up layer and filters in efforts to develop a passive personal dosemeter based on NaCl.

Feasibility of dosimetric measurements using Al2O3:C OSL dosimeter during fluoroscopy-guided procedures

This study investigated the feasibility of dosimetric measurements using Al2O3:C optically stimulated luminescence (OSL) dosimeters during fluoroscopy-guided procedures. The linearity and energy dependence of Al2O3:C OSL dosimeters were evaluated, and the air kerma rate at the operator's position was measured. The response of Al2O3:C OSL dosimeters to short, repetitive irradiations was compared to that of long uninterrupted irradiation. The change in response of the Al2O3:C OSL dosimeter under automatic exposure rate control (AERC) was evaluated with the use of various thicknesses of polymethyl-methacrylate (PMMA) plates (15-30 cm). The Al2O3:C OSL dosimeters could detect 5µGy and showed good linearity in doses of ≥10µGy (R²: 0.997-0.999,p< 0.001). The relative response of the Al2O3:C OSL dosimeter normalised to that of 36.8 keV was 0.828-1.101 at the energies investigated (30.6-46.0 keV). The air kerma rate at the operator's position was estimated to be 2.61-7.17µGy min^-1depending on the heights representing different body parts. Repetitive short irradiations had no significant impact on the relative response of the Al2O3:C OSL dosimeters (p> 0.05). Despite a high energy dependence on the low energy beam used in fluoroscopy, the change in relative response of the Al2O3:C OSL dosimeter under AERC was within 5.7% depending on the thickness of the PMMA plates. Dosimetric measurement using Al2O3:C OSL dosimeters for patients and operators is feasible. However, one should be cautious about high standard deviations when measuring small doses of ≤20µGy using Al2O3:C OSL dosimeters. It is essential to perform intensive bleaching before measuring very small doses to minimise pre-irradiation counts.

Monte Carlo simulations of EBT3 film dose deposition for percentage depth dose (PDD) curve evaluation

Purpose

To use Monte Carlo (MC) calculations to evaluate the effects of Gafchromic EBT3 film orientation on percentage depth dose (PDD) curves.

Methods

Dose deposition in films placed in a water phantom, and oriented either parallel or perpendicular with respect to beam axis, were simulated with MC and compared to PDDs scored in a homogenous water phantom. The effects of introducing 0.01–1.00 mm air gaps on each side of the film as well as a small 1°‐3° tilt for film placed in parallel orientation were studied. PDDs scored based on two published EBT3 film compositions were compared. Three photon beam energies of 120 kVp, 220 kVp, and 6 MV and three field sizes between 1 × 1 and 5 × 5 cm² were considered. Experimental PDDs for a 6‐MV 3 × 3 cm² beam were acquired.

Results

PDD curves for films in perpendicular orientation more closely agreed to water PDDs than films placed in parallel orientation. The maximum difference between film and water PDD for films in parallel orientation was −12.9% for the 220 kVp beam. For the perpendicular film orientation, the maximum difference decreased to 5.7% for the 120 kVp beam. The inclusion of an air gap had the largest effect on the 6‐MV 1 × 1 cm² beam, for which the dose in the buildup region was underestimated by 21.2% compared to the simulation with no air gap. A 2° film tilt decreased the difference between the parallel film and homogeneous water phantom PDDs from −5.0% to −0.5% for the 6 MV 3 × 3 cm² beam. The “newer” EBT3 film composition resulted in larger PDD discrepancies than the previous composition. Experimental film data qualitatively agreed with MC simulations.

Conclusions

PDD measurements with films should either be performed with film in perpendicular orientation to the beam axis or in parallel orientation with a ~ 2º tilt and no air gaps.

Targeted Alpha Therapy in mCRPC (Metastatic Castration-Resistant Prostate Cancer) Patients: Predictive Dosimetry and Toxicity Modeling of 225Ac-PSMA (Prostate-Specific Membrane Antigen)

Radioligand therapy is a type of internal radiotherapy combining a short-range radioisotope labeled to a carrier with a high affinity for a specific receptor expressed on tumor cells. Targeted alpha therapy (TAT) combines a high-linear energy transfer (LET) emitter (²²⁵Ac) with a prostate-specific membrane antigen (PSMA) carrier, specifically binding tumor cells in patients with metastatic castration-resistant prostate cancer. Although the antitumor activity of ²²⁵Ac-PSMA is well-documented, this treatment is nowadays only used as salvage therapy because the high incidence of xerostomia limits the therapeutic window. Thus, methods to reduce salivary toxicity and models able to describe xerostomia incidence are needed. We recently studied the efficacy of salivary gland protectors administered in combination with ¹⁷⁷Lu-PSMA therapy. Starting from these data, we performed a predictive dosimetric evaluation of ²²⁵Ac-PSMA to assess the impact of salivary gland protectors in TAT. ²²⁵Ac-PSMA predictive dosimetry was performed in 13 patients treated with ¹⁷⁷Lu-PSMA. Sequential whole-body planar images were acquired 0.5–1, 16–24, 36–48, and 120 h post-injection. ¹⁷⁷Lu time-activity curves were corrected for ²²⁵Ac physical decay and assumed in equilibrium for all daughters. The OLINDA/EXM spherical model was used for dose estimation of the parotid and submandibular glands. The dose for each daughter was calculated and summed for the total dose estimation. The biologically effective dose formalism was extended to high-LET emitters. For the total biologically effective dose formalism extended to high-LET emitters, including the contribution of all daughter isotopes, the brachytherapy formalism for a mixture of radionuclides was implemented. Equivalent doses in 2 Gy/fraction (EQD2) were then calculated and compared with the normal tissue complication probability model derived from external beam radiotherapy for grade ≥2 xerostomia induction. Median predictive doses were 0.86 Bd_RBE5/MBq for parotid glands and 1.05 Bd_RBE5/MBq for submandibular glands, with a 53% reduction compared with previously published data. The results show that the radiobiological model implemented is conservative, as it overestimates the complication rate with respect to the clinical data. Our data shows the possibility of reducing salivary gland uptake in TAT with the coadministration of organ protectors, but these results should be confirmed for TAT with ²²⁵Ac-PSMA by carrying out prospective trials with defined toxicity endpoints and dosimetry procedures.

Dosimetric Impact of the Positional Imaging Frequency for Hypofractionated Prostate Radiotherapy - A Voxel-by-Voxel Analysis

Background

To investigate deviations between planned and applied treatment doses for hypofractionated prostate radiotherapy and to quantify dosimetric accuracy in dependence of the image guidance frequency.

Methods

Daily diagnostic in-room CTs were carried out in 10 patients in treatment position as image guidance for hypofractionated prostate radiotherapy. Fraction doses were mapped to the planning CTs and recalculated, and applied doses were accumulated voxel-wise using deformable registration. Non-daily imaging schedules were simulated by deriving position correction vectors from individual scans and used to rigidly register the following scans until the next repositioning before dose recalculation and accumulation. Planned and applied doses were compared regarding dose-volume indices and TCP and NTCP values in dependence of the imaging and repositioning frequency.

Results

Daily image-guided repositioning was associated with only negligible deviations of analyzed dose-volume parameters and conformity/homogeneity indices for the prostate, bladder and rectum. Average CTV T did not significantly deviate from the plan values, and rectum NTCPs were highly comparable, while bladder NTCPs were reduced. For non-daily image-guided repositioning, there were significant deviations in the high-dose range from the planned values. Similarly, CTV dose conformity and homogeneity were reduced. While TCPs and rectal NTCPs did not significantly deteriorate for non-daily repositioning, bladder NTCPs appeared falsely diminished in dependence of the imaging frequency.

Conclusion

Using voxel-by-voxel dose accumulation, we showed for the first time that daily image-guided repositioning resulted in only negligible dosimetric deviations for hypofractionated prostate radiotherapy. Regarding dosimetric aberrations for non-daily imaging, daily imaging is required to adequately deliver treatment.

Feasibility of Single-Time-Point Dosimetry for Radiopharmaceutical Therapies

Because of challenges in performing routine personalized dosimetry in radiopharmaceutical therapies, interest in single-time-point (STP) dosimetry, particularly using only a single SPECT scan, is on the rise. Meanwhile, there are questions about the reliability of STP dosimetry, with limited independent validations. In the present work, we analyzed 2 STP dosimetry methods and evaluated dose errors for several radiopharmaceuticals based on effective half-life distributions. Methods: We first challenged the common assumption that radiopharmaceutical effective half-lives across the population are gaussian-distributed (i.e., follow a normal distribution). Then, dose accuracy was estimated using 2 STP dosimetry methods for a wide range of potential post injection (p.i.) scan time points for different radiopharmaceuticals applied to neuroendocrine tumors and prostate cancer. The accuracy and limitations of each of the STP methods were discussed. Results: A lognormal distribution was more appropriate for capturing effective half-life distributions. The STP framework was promising for dosimetry of ¹⁷⁷Lu-DOTATATE and for kidney dosimetry of different radiopharmaceuticals (errors < 30%). Meanwhile, for some radiopharmaceuticals, STP accuracy was compromised (e.g., in bone marrow and tumors for ¹⁷⁷-labeled prostate-specific membrane antigen [PSMA])). The optimal SPECT scanning time for ¹⁷⁷Lu-DOTATATE was approximately 72 h p.i., whereas 48 h p.i. was better for ¹⁷⁷Lu-PSMA. Conclusion: Simplified STP dosimetry methods may compromise the accuracy of dose estimates, with some exceptions, such as for ¹⁷⁷Lu-DOTATATE and for kidney dosimetry in different radiopharmaceuticals. Simplified personalized dosimetry in the clinic continues to be challenging. On the basis of our results, we make suggestions and recommendations for improved personalized dosimetry using simplified imaging schemes.

Analysis of Geometric Performance and Dosimetric Impact of Using Automatic Contour Segmentation for Radiotherapy Planning

Purpose: To analyze geometric discrepancy and dosimetric impact in using contours generated by auto-segmentation (AS) against manually segmented (MS) clinical contours. Methods: A 48-subject prostate atlas was created and another 15 patients were used for testing. Contours were generated using a commercial atlas-based segmentation tool and compared to their clinical MS counterparts. The geometric correlation was evaluated using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). Dosimetric relevance was evaluated for a subset of patients by assessing the DVH differences derived by optimizing plan dose using the AS and MS contours, respectively, and evaluating with respect to each. A paired t-test was employed for statistical comparison. The discrepancy in plan quality with respect to clinical dosimetric endpoints was evaluated. The analysis was repeated for head/neck (HN) with a 31-subject atlas and 15 test cases. Results: Dice agreement between AS and MS differed significantly across structures: from (L:0.92/R: 0.91) for the femoral heads to seminal vesical of 0.38 in the prostate cohort, and from 0.98 for the brain, to 0.36 for the chiasm of the HN group. Despite the geometric disagreement, the paired t-tests showed the lack of statistical evidence for systematic differences in dosimetric plan quality yielded by the AS and MS approach for the prostate cohort. In HN cases, statistically significant differences in dosimetric endpoints were observed in structures with small volumes or elongated shapes such as cord (p = 0.01) and esophagus (p = 0.04). The largest absolute dose difference of 11 Gy was seen in the mean pharynx dose. Conclusion: Varying AS performance among structures suggests a differential approach of using AS on a subset of structures and focus MS on the rest. The discrepancy between geometric and dosimetric-end-point driven evaluation also indicates the clinical utility of AS contours in optimization and evaluating plan quality despite of suboptimal geometrical accuracy.

Dosimetry in vitro - exploring the sensitivity of deposited dose predictions vs. affinity, polydispersity, freeze-thawing, and analytical methods

Dose-response by in vitro testing is only valid if the fraction of the particle dose that deposits onto adherent cells is known. Modeling tools such as the 'distorted grid' (DG) code are common practices to predict that fraction. As another challenge, workflow efficiency depends on parallelized sample preparation, for which freeze-thaw protocols have been explored earlier, but not their implications on dosimetry. Here we assess the sensitivity of the DG code toward freeze-thaw protocols and variations in user-defined parameters, including the estimation of particle-cell affinity and determination of agglomerate size, which we measure by DLS or AUC. We challenge the sensitivity by materials of varying composition, surface functionalization, and size (TiO₂, CeO₂, BaSO₄, 2x Ag, 3x SiO₂). We found that the average effective density is robust, but the dose predictions by different approaches varied typically 2-fold and up to 10-fold; this uncertainty translates directly into the uncertainty of no-effect-concentrations. The use of standardized dispersion protocols increases the uncertainty in doses. The choice of a measurement method and minor details of the particle size distribution strongly influence the modeled dosimetry. Uncertainty is high for very well dispersed nanomaterials; since then, the assumed affinity of particles to cells has a decisive influence. Against this background, the modulation of deposited dose by freeze-thaw protocols is a minor factor that can be controlled by aligning the protocols of sample preparation. However, even then, the uncertainty of deposited doses must be considered when comparing the in vitro toxicity of different nanomaterials.

Personalisation of Molecular Radiotherapy through Optimisation of Theragnostics

Molecular radiotherapy, or targeted radionuclide therapy, uses systemically administered drugs bearing a suitable radioactive isotope, typically a beta emitter. These are delivered via metabolic or other physiological pathways to cancer cells in greater concentrations than to normal tissues. The absorbed radiation dose in tumour deposits causes chromosomal damage and cell death. A partner radiopharmaceutical, most commonly the same vector labelled with a different radioactive atom, with emissions suitable for gamma camera or positron emission tomography imaging, is used to select patients for treatment and to assess response. The use of these pairs of radio-labelled drugs, one optimised for therapy, the other for diagnostic purposes, is referred to as theragnostics. Theragnostics is increasingly moving away from a fixed number of defined activity administrations, to a much more individualised or personalised approach, with the aim of improving treatment outcomes, and minimising toxicity. There is, however, still significant scope for further progress in that direction. The main tools for personalisation are the following: imaging biomarkers for better patient selection; predictive and post-therapy dosimetry to maximise the radiation dose to the tumour while keeping organs at risk within tolerance limits; imaging for assessment of treatment response; individualised decision making and communication about radiation protection, adjustments for toxicity, inpatient and outpatient care.

Recent developments in phosphate materials for their thermoluminescence dosimeter (TLD) applications

The use of phosphate-based thermoluminescence dosimeter (TLD) materials in current scenarios is presented here, particularly for the field of low dosimetry. TLD materials are currently researched for their use in for example environmental dosimetry, personal dosimetry, and medical dosimetry. There are several TLD materials available such as: sulphates, borates, fluorides, and sulphides, including some metal oxides and perovskites, which are the most used and have been widely explored. In the present scenario, new interest is being focused on the need for thermoluminescent materials for application in material science and radiation dosimetry for low-dose dosimetry. These doped TLDs are prepared using different techniques including solid-state reaction methods, combustion methods, wet chemical methods, and sol gel methods. Therefore, among the above stated TLDs, phosphates have opened a new door in radiation dosimetry, particularly in low-dose dosimetry over the last few years. This paper mainly deals with a review of various phosphate-based TLD materials and recent advancements in phosphates for TL dosimetry.

Thermoluminescence dosimetry properties and kinetic analysis of K3 Ca2 (SO4 )3 F:Dy3+ phosphor

A trivalent Dy³⁺ -activated K₃ Ca₂ (SO₄ )₃ F fluoride-based phosphor was synthesized using a solid-state reaction method and characterized for its thermoluminescence (TL) application. The crystal structure and surface morphology of the as-synthesized material was analyzed using X-ray diffraction and scanning electron microscopy. A series of the K₃ Ca₂ (SO₄ )₃ F:Dy³⁺ phosphor was irradiated using γ-rays from a ⁶⁰ Co source and TL glow curves were recorded using a Nucleonix 1009I TL reader. The glow curve of the prepared phosphor showed a prominent single peak at 278°C. TL characteristics were maximum intensity at 1 mol% of Dy³⁺ ion with a single TL glow peak. The TL glow curve revealed linearity with increase in exposure dose range from 0.1 kGy to 3.0 kGy. Theoretical analysis of the TL glow curve of the γ-ray-irradiated sample was carried out using a computerized glow curve deconvolution method and trapping parameters such as activation energy and frequency factor were calculated using the initial rise method and Ilich's method. The synthesized Dy³⁺ -doped K₃ Ca₂ (SO₄ )₃ phosphor revealed excellent TL properties and was found to be a potential candidate for dosimetric applications.

Dosimetry and Calorimetry Performance of a Scientific CMOS Camera for Environmental Monitoring

This paper explores the prospect of CMOS devices to assay lead in drinking water, using calorimetry. Lead occurs together with traces of radioisotopes, e.g., 210Pb, producing g-emissions with energies ranging from 10 keV to several 100 keV when they decay; this range is detectable in silicon sensors. In this paper we test a CMOS camera (OXFORD INSTRUMENTS Neo 5.5) for its general performance as a detector of X-rays and low energy g-rays and assess its sensitivity relative to the World Health Organization upper limit on lead in drinking water. Energies from 6 keV to 60 keV are examined. The CMOS camera has a linear energy response over this range and its energy resolution is for the most part slightly better than 2%. The Neo sCMOS is not sensitive to X-rays with energies below ~10 keV. The smallest detectable rate is 40 ± 3 mHz, corresponding to an incident activity on the chip of 7 ± 4 Bq. The estimation of the incident activity sensitivity from the detected activity relies on geometric acceptance and the measured efficiency vs. energy. We report the efficiency measurement, which is 0.08(2)% (0.0011(2)%) at 26.3 keV (59.5 keV). Taking calorimetric information into account we measure a minimal detectable rate of 4 ± 1 mHz (1.5 ± 0.1 mHz) for 26.3 keV (59.5 keV) g-rays, which corresponds to an incident activity of 1.0 ± 0.6 Bq (57 ± 33 Bq). Toy Monte Carlo and Geant4 simulations agree with these results. These results show this CMOS sensor is well-suited as a g- and X-ray detector with sensitivity at the few to 100 ppb level for 210Pb in a sample.

Impact of tumor volume enlargement after induction chemotherapy on subsequent radiotherapy in locally advanced nasopharyngeal carcinoma: A propensity-score matching analysis

A small proportion of nasopharyngeal carcinoma (NPC) patients show resistance to induction chemotherapy (IC). This study sought to investigate the impact of tumor volume enlargement after IC on the dosimetric parameters of subsequent radiotherapy. The records of a total of 240 locally advanced NPC patients who received IC followed by concurrent chemoradiotherapy were retrospectively reviewed. Patients with a tumor volume enlargement of ≥10% and patients with a tumor volume reduction of ≥10% after induction chemotherapy were classified as the enlargement group and the control group, respectively. The dosimetric parameters of the planning target volumes (PTVs) and the organs at risk (OARs) were compared between the matched groups after propensity score matching (PSM). For the gross tumor volume of nasopharynx (GTVnx), 21 patients and 127 patients were classified as the enlargement group and the control group, respectively. After matching, 20 sub-pairs of 40 patients were generated in the post-PSM cohort. The GTVnx enlargement group exhibited no significant disadvantages in all of the dosimetric parameters, except in the planning organ-at-risk volume (PRV) of contralateral lens (Dmax, 722 cGy vs. 634 cGy, p = 0.041). For the gross tumor volume of lymph nodes (GTVnd), 44 patients and 144 patients were classified as the enlargement group and the control group, respectively. After matching, 39 sub-pairs of 78 patients were generated in the post-PSM cohort. The GTVnd enlargement group exhibited no significant disadvantages in all of the dosimetric parameters. Univariate and multivariate analyses showed that the enlargement of GTVnx and the enlargement of GTVnd were not independently associated with any of the dosimetric parameters. A tumor volume enlargement of ≥10% in GTVnx or GTVnd after induction chemotherapy has no significant impact on the dosimetric parameters of subsequent radiotherapy in locally advanced NPC.

Suitability of the microDiamond detector for experimental determination of the anisotropy function of High Dose Rate 192 Ir brachytherapy sources

PURPOSE

To investigate the suitability of the microDiamond detector (mDD) type 60019 (PTW-Freiburg, Germany) to measure the anisotropy function F(r,θ) of High Dose Rate (HDR) ¹⁹² Ir brachytherapy sources.

METHODS

The HDR ¹⁹² Ir brachytherapy source, model mHDR-v2r (Elekta AB, Sweden), was placed inside a water tank within a 4F plastic needle. Four mDDs (mDD1, mDD2, mDD3, and mDD4) were investigated. Each mDD was placed laterally with respect to the source, and measurements were performed at radial distances r = 1 cm, 3 and 5 cm, and polar angles θ from 0° to 168°. The Monte Carlo (MC) system EGSnrc was used to simulate the measurements and to calculate phantom effect, energy dependence and volume-averaging correction factors. F(r,θ) was determined according to TG-43 formalism from the detector reading corrected with the MC-based factors and compared to the consensus anisotropy function _CON F(r,θ).

RESULTS

At 1 cm, the differences between measurements and MC simulations ranged from -0.8% to +0.8% for θ = 0° and from -2.1% to + 2.3% for θ ≠ 0°. At 3 and 5 cm, the differences ranged from +1.4% to +3.9% for θ = 0°, and from -0.4% to +2.9% for θ ≠ 0°. All differences were within the uncertainties (k = 2). At small angles, the phantom effect correction was up to -1.9%. This effect was mainly caused by the air between source and needle tip. The energy correction was angle-independent everywhere. For small angles at 1 cm, the volume-averaging correction was up to -2.9% and became less important for larger angles and distances. The differences of the measured F(r,θ) corrected with the MC-based factors to _CON F(r,θ) ranged from -1.0% to +3.4% for mDD1, -2.2% to +4.2% for mDD2, -2.5% to +4.0% for mDD3, and -2.6% to +3.4% for mDD4. All differences were within the uncertainties (k = 2) except one at (3 cm, 0°). For all the mDDs, F(r,0°) was always higher than _CON F(r,0°), with average differences of +3.1% (1 cm), +3.6% (3 cm), and +1.9% (5 cm). The inter-detector variability was within 2.9% (1 cm), 1.8% (3 cm), and 3.4% (5 cm).

CONCLUSIONS

A reproducible method and experimental setup were presented for measuring and validating F(r,θ) of an HDR ¹⁹² Ir brachytherapy source in a water phantom using the mDD. The phantom effect and the volume-averaging need to be taken into account, especially for the smaller distances and angles. Good agreement to _CON F(r,θ) was obtained. The discrepancies at (1 cm, 0°), accurately predicted by the MC results, may suggest a reconsideration of _CON F(r,θ), at least for this position. The slight overestimations at (3 cm,0°) and (5 cm,0°), both in comparison to _CON F(r,θ) and MC results, may be due to an underestimation of the air volume between source and needle tip, dark current, intrinsic over-response of the mDDs, or radiation-induced charge imbalance in the detector's components. The results indicate that the mDD is a valuable tool for measurements with HDR ¹⁹² Ir brachytherapy sources and support its employment for the determination and validation of TG-43 parameters of such sources.

Study logistics that can impact medical countermeasure efficacy testing in mouse models of radiation injury

PURPOSE

To address confounding issues that have been noted in planning and conducting studies to identify biomarkers of radiation injury, develop animal models to simulate these injuries, and test potential medical countermeasures to mitigate/treat damage caused by radiation exposure.

METHODS

The authors completed an intensive literature search to address several key areas that should be considered before embarking on studies to assess efficacy of medical countermeasure approaches in mouse models of radiation injury. These considerations include: (1) study variables; (2) animal selection criteria; (3) animal husbandry; (4) medical management; and (5) radiation attributes.

RESULTS

It is important to select mouse strains that are capable of responding to the selected radiation exposure (e.g. genetic predispositions might influence radiation sensitivity and proclivity to certain phenotypes of radiation injury), and that also react in a manner similar to humans. Gender, vendor, age, weight, and even seasonal variations are all important factors to consider. In addition, the housing and husbandry of the animals (i.e. feed, environment, handling, time of day of irradiation and animal restraint), as well as the medical management provided (e.g. use of acidified water, antibiotics, routes of administration of drugs, consideration of animal numbers, and euthanasia criteria) should all be addressed. Finally, the radiation exposure itself should be tightly controlled, by ensuring a full understanding and reporting of the radiation source, dose and dose rate, shielding and geometry of exposure, while also providing accurate dosimetry. It is important to understand how all the above factors contribute to the development of radiation dose response curves for a given animal facility with a well-defined murine model.

CONCLUSIONS

Many potential confounders that could impact the outcomes of studies to assess efficacy of a medical countermeasure for radiation-induced injuries are addressed, and recommendations are made to assist investigators in carrying out research that is robust, reproducible, and accurate.

Quantitative Performance Characterization of Radiation Dose for the Carestream CS9600 Cone-Beam Computed Tomography Machine

INTRODUCTION

Cone-beam computed tomography (CBCT) machines produce relatively low levels of harmful ionizing radiation, as compared with the computed tomography devices used in medical practices. The Carestream CS9600 CBCT imaging device has been recently introduced into the marketplace, and the manufacturer reports the use of an increased x-ray tube voltage (120 kVp) for the device, along with a reduced patient dose that is achieved using added filtration. Independent dosimetry studies are performed to ensure appropriate radiation exposure dose levels are within recommended safety guidelines.The purpose of this study is to independently evaluate and measure the radiation exposure dose performance parameters of the CS9600 CBCT, including its multiple field of view, exposure settings, and filtration options.

METHODS

A thimble ionization chamber and PMMA phantom were used to characterize dose index using the established SEDENTEXTCT evaluation method.

RESULTS

The phantom-obtained radiation dose index measures ranged from 0.128782-13.848 milligrays (mGy) for the various scanning options evaluated. The field of view, type of filter used, and phantom size all had a direct impact on the relationship between the experimentally obtained dose index measures and the dose area product values reported by the manufacturer.

CONCLUSIONS

A strong linear correlation was observed between the experimentally obtained dose index measures and the manufacturer-reported dose area product values. The 0.7 mm Cu filter that has been added to the CS9600 reduced the exposure dose index measures even with the x-ray tube kilovoltage peak (kVp) being increased to 120 kVp, as compared with the 0.15 mm Cu filter at 90 kVp.

Absorbed dose distributions from beta-decaying radionuclides: Experimental validation of Monte Carlo tools for radiopharmaceutical dosimetry

PURPOSE

This study aims to experimentally validate the Monte Carlo generated absorbed doses from the beta particles emitted by ⁹⁰ Y and ¹⁷⁷ Lu using radiochromic EBT3 film-based dosimetry.

METHODS

Line sources of ⁹⁰ Y and ¹⁷⁷ Lu were inserted longitudinally through blocks of low-density polyethylene and tissue-equivalent slabs of cortical bone and lung equivalent plastics. Radiochromic film (Gafchromic EBT3) was laser cut to accommodate orthogonal line sources of radioactivity, and the film was sandwiched intimately between the rectangular blocks to achieve charged particle equilibrium. Line sources consisted of plastic capillary tube of length (13 ± 0.1) cm, with 0.42-mm inner diameter and a wall thickness of 0.21 mm. ⁹⁰ Y line sources were prepared from a solution of dissolved ⁹⁰ Y resin microspheres. ¹⁷⁷ Lu line sources were prepared from an aliquot of ¹⁷⁷ Lu-DOTATATE. Film exposures were conducted for durations ranging from 10 min to 38 h. Radiochromic film calibration was performed by irradiation with 6-MV-bremsstrahlung x rays from a calibrated linear accelerator, in accordance with literature recommendations. Experimental geometries were precisely simulated within the GATE Monte Carlo toolkit, which has previously been used for the generation of dose point kernels.

RESULTS

The mean percentage difference between measured and simulated absorbed doses were 5.04% and 7.21% for ⁹⁰ Y and ¹⁷⁷ Lu beta absorbed dose in the range of (0.1-10) Gy. Additionally, 1D gamma analysis using a local 10%/1 mm gamma criterion was performed to compare the absorbed dose distributions. The percentage of measurement points passing the gamma criterion, averaged over all tests, was 93.5%.

CONCLUSIONS

We report the experimental validation of Monte Carlo derived beta absorbed dose distributions for ⁹⁰ Y and ¹⁷⁷ Lu, solidifying the validity of using Monte Carlo-based methods for estimating absorbed dose from beta emitters. Overall, excellent agreement was observed between the experimental beta absorbed doses in the linear region of the radiochromic film and the GATE Monte Carlo simulations demonstrating that radiochromic film dosimetry has sufficient sensitivity and spatial resolution to be used as a tool for measuring beta decay absorbed dose distributions.