A dose-volume-based tool for evaluating and ranking IMRT treatment plans

External beam radiotherapy is commonly used for patients with cancer. While tumor shrinkage and palliation are frequently achieved, local control and cure remain elusive for many cancers. With regard to local control, the fundamental problem is that radiotherapy‐induced normal tissue injury limits the dose that can be delivered to the tumor. While intensity‐modulated radiation therapy (IMRT) allows for the delivery of higher tumor doses and the sparing of proximal critical structures, multiple competing plans can be generated based on dosimetric and/or biological constraints that need to be considered/compared. In this work, an IMRT treatment plan evaluation and ranking tool, based on dosimetric criteria, is presented. The treatment plan with the highest uncomplicated target conformity index (TCI+) is ranked at the top. The TCI+ is a dose‐volume‐based index that considers both a target conformity index (TCI) and a normal tissue‐sparing index (NTSI). TCI+ is designed to assist in the process of judging the merit of a clinical treatment plan. To demonstrate the utility of this tool, several competing lung and prostate IMRT treatment plans are compared. Results show that the plan with the highest TCI+ values accomplished the competing goals of tumor coverage and critical structures sparing best, among rival treatment plans for both treatment sites. The study demonstrates, first, that dose‐volume‐based indices, which summarize complex dose distributions through a single index, can be used to automatically select the optimal plan among competing plans, and second, that this dose‐volume‐based index may be appropriate for ranking IMRT dose distributions.

PACS numbers: 87.53.‐j, 87.53.Tf

Lead accumulation in woodchucks (Marmota monax) at small arms and skeet ranges

Increasing concern regarding the stewardship of US Army lands requires a proactive program to evaluate sites of potential risk. Small arms and upland skeet ranges are a potentially significant source of lead exposure for burrowing mammals. Woodchucks (Marmota monax) were evaluated for lead exposure in a previously used upland skeet range and a small arms range, respective to animals collected at two nearby reference locations. Soil lead concentrations collected at burrow entrances on the firing ranges were compared with blood, bone, kidney, liver, and fecal concentrations of woodchucks collected from the reference areas. No statistical differences were found in the lead concentrations in tissue between woodchucks in reference and firing ranges; concentrations of lead in liver and kidney were below detection limits. Levels in bone, blood, and feces suggest the bioavailability of lead at these various sites, although other factors (e.g., differences in foraging areas, age structure, habitat preferences, and environmental conditions) were also likely to influence exposure. Blood levels were below that which suggests toxicity. Further analysis of other ranges with higher lead concentrations and of small mammal species with smaller home ranges is recommended to further elucidate trends that could be extrapolated to other sites.

Application of the narcosis target lipid model to algal toxicity and deriving predicted-no-effect concentrations

The narcosis target lipid model (TLM) was developed to predict the toxicity of chemicals to aquatic organisms that act via narcosis. It is based on the hypothesis that target lipid is the site of toxic action within the organism, that octanol is the appropriate surrogate, and that target lipid has the same physical-chemical properties in all organisms. Here the TLM is extended to available freshwater green algal toxicity data to support a narcosis toxic mode-of-action (TMoA) effect assessment. For each species, significant linear relationships were observed between log(median effective concentration [EC50]) and log(Kow) of the test chemicals. The slope of the log-log relationship statistically was similar to the universal narcosis slope of -0.945 that was derived from an earlier analysis of the TLM to nonalgal species. Critical target lipid body burdens (CTLBB), C(L)* were estimated for each algal species from the intercepts of the regressions and found to be within the range (43-398 micromol/g octanol) reported previously, indicating that algae exhibit a similar sensitivity distribution relative to other aquatic species. The TLM is used to derive the predicted-no-effect concentrations (PNECs) using the hazardous concentration to 5% species (HC5) statistical extrapolation procedure. This calculation requires an analysis of the variability of the universal slope, the C(L)*, and the acute-to-chronic ratio. The PNECs derived using this procedure were consistent with chronic-no-effect concentrations reported for narcotic chemicals. This is in contrast to PNECs derived from limited chemical-specific toxicity data and default application factors. It is concluded that coupling the TLM to the HC5 extrapolation procedure allows optimal use of available toxicity data for deriving environmental quality criteria with a narcotic TMoA.

Comparison of dose calculation algorithms in phantoms with lung equivalent heterogeneities under conditions of lateral electronic disequilibrium

An extensive set of benchmark measurement of PDDs and beam profiles was performed in a heterogeneous layer phantom, including a lung equivalent heterogeneity, by means of several detectors and compared against the predicted dose values by different calculation algorithms in two treatment planning systems. PDDs were measured with TLDs, plane parallel and cylindrical ionization chambers and beam profiles with films. Additionally, Monte Carlo simulations by means of the PENELOPE code were performed. Four different field sizes (10 x 10, 5 x 5, 2 x 2, and 1 x 1 cm2) and two lung equivalent materials (CIRS, p(w)e=0.195 and St. Bartholomew Hospital, London, p(w)e=0.244-0.322) were studied. The performance of four correction-based algorithms and one based on convolution-superposition was analyzed. The correction-based algorithms were the Batho, the Modified Batho, and the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system and the TMS Pencil Beam from the Helax-TMS (Nucletron) treatment planning system. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. The only studied calculation methods that correlated successfully with the measured values with a 2% average inside all media were the Collapsed Cone and the Monte Carlo simulation. The biggest difference between the predicted and the delivered dose in the beam axis was found for the EqTAR algorithm inside the CIRS lung equivalent material in a 2 x 2 cm2 18 MV x-ray beam. In these conditions, average and maximum difference against the TLD measurements were 32% and 39%, respectively. In the water equivalent part of the phantom every algorithm correctly predicted the dose (within 2%) everywhere except very close to the interfaces where differences up to 24% were found for 2 x 2 cm2 18 MV photon beams. Consistent values were found between the reference detector (ionization chamber in water and TLD in lung) and Monte Carlo simulations, yielding minimal differences (0.4%+/-1.2%). The penumbra broadening effect in low density media was not predicted by any of the correction-based algorithms, and the only one that matched the experimental values and the Monte Carlo simulations within the estimated uncertainties was the Collapsed Cone Algorithm.

Planning quality and delivery efficiency of sMLC delivered IMRT treatment of oropharyngeal cancers evaluated by RTOG H-0022 dosimetric criteria

The time required to deliver intensity‐modulated radiation therapy (IMRT) treatments can be significantly longer than conventional treatments, especially for the segmented multileaf collimator (sMLC) delivery system with a large record and verification (R&V) overhead. In this work, we evaluate the impact of the number of intensity‐modulated beams (IMBs) and the number of intensity levels (ILs) on the quality and delivery efficiency of IMRT plans, generated by the Corvus planning system for sMLC delivery on a Siemens LINAC with the Lantis R&V system. Detailed studies were performed for three image data sets of previously treated oropharyngeal patients. Treatment plans for patient 1 were developed using 5, 7, 9, or 15 evenly spaced axial IMBs as well as one with 7 axial IMBs whose directions were user‐selected, each using ILs of 3, 5, 10, or 20. For patients 2 and 3, plans with 15 IMBs and 20 ILs were not attempted. A total of 42 plans were developed using three oropharyngeal cancer CT image data sets. Plan quality was evaluated by assessing compliance with the Radiation Therapy Oncology Group (RTOG) H‐0022 protocol criteria and the physician's clinical judgment. Plan efficiency was accessed by the number of segments of each plan. We found that for our treatment‐planning and delivery system, an IMRT plan that uses a moderate number of IMBs and ILs, such as 7 or 9 IMBs with 3 or 5 ILs, would appear to be the optimal approach when both quality of the plan and delivery efficiency are considered. Based on this study, we have routinely used 9 IMBs with 3 ILs or 7 IMBs with 5 ILs for head and neck patients. A retrospective comparison indicates that delivery efficiency is improved on the order of 30% compared to plans generated with 9 IMBs with 5 ILs.

PACS number: 87.53.Tf

Neutron capture autoradiographic study of the biodistribution of 10B in tumor-bearing mice

For the study on boron neutron capture therapy, the whole-body sections of tumor-bearing mice infused with 10B attached to CR-39 plastic track detectors were exposed to thermal and cold neutron beams. Neutron capture autoradiographic images obtained by the cold neutron irradiation were extremely superior in quality to those of the thermal neutron beams. From the autoradiographic images, the 10B reaction dose of the neutron-induced particles was estimated using the differential LET distribution.

Environmental quality criteria for organic chemicals predicted from internal effect concentrations and a food web model

Environmental quality criteria (EQC) for hydrophobic organic chemicals were calculated with a model for bioaccumulation in food webs. The model was calibrated and verified using polychlorinated biphenyl concentrations in food webs of shallow lakes. The EQCs in water and sediment were derived based on internal effect concentrations (IECs) for several modes of toxic action. By reverse calculation with the food web model for each organism in the web, a different water or sediment concentration is calculated corresponding to the IEC in each organism. A statistical procedure with an acute-to-chronic value is used to derive chronic EQCs based on bioaccumulation. The model-based chronic EQCs were compared with previously established EQCs. The EQCs calculated with the food web model generally are within an order of magnitude of the previously derived EQCs based on toxicity data on individual chemicals. Some previously derived EQCs are much lower than model predictions and usually based on small samples of toxicity data such as no-observed-effect concentrations (NOECs) with large assessment factors. When faced with data gaps, it is proposed to use model-based chronic EQCs for (polar) narcotic chemicals. Other modes of action require a different model concept to account for receptor-based toxicity.

Extending the linear–quadratic model for large fraction doses pertinent to stereotactic radiotherapy

Ongoing clinical trials designed to explore the use of extracranial stereotactic radiosurgery (ESR) for different tumour sites use large doses per fraction (15, 20, 30 Gy or even larger). The question of whether the linear-quadratic (LQ) model is appropriate to describe radiation response for such large fraction doses has been raised and has not been answered definitively. It has been proposed that mechanism-based models, such as the lethal-potentially lethal (LPL) model, could be more appropriate for such large fraction/acute doses. However, such models are not well characterized with clinical data and they are generally not easy to use. The purpose of this work is to modify the LQ model to more accurately describe radiation response for high fraction/acute doses. A new parameter is introduced in the modified LQ (MLQ) model. The new parameter introduced is characterized based both on in vitro cell survival data of several human tumour cell lines and in vivo animal iso-effect curves. The MLQ model produces a better fit to the iso-effect data than the LQ model. For a high single dose irradiation, the prediction of the MLQ is consistent with that from the LPL model. Unlike the LPL model, the MLQ model retains the simplicity of the LQ model and uses the well-characterized alpha and beta parameters. This work indicates that the standard LQ model can lead to erroneous results when used to calculate iso-effects with large fraction doses, such as those used for ESR. We present a solution to this problem.

CT-based analysis of dose homogeneity in total body irradiation using lateral beam

A computed tomography (CT) based treatment planning system for total body irradiation (TBI) is presented and compared with the commonly practiced lateral treatment delivery. The TBI regimen has been proved to be an essential conditional regimen for patients undergoing bone marrow transplantation. The advantage of the TBI regimen with bone marrow transplantation (BMT) in hematological malignancies can be offset by toxicities arising from TBI in posttransplant complications. With the increasing survival rates, the evaluation of long‐term side effects and quality of life has become an important area of research interest. There have been several treatment techniques developed over the decades designed to achieve accurate dose delivery and dose homogeneity. This paper reports on the verification of the dose delivery for a basic lateral technique using thermoluminescent dosimeters (TLDs) placed in an anthropomorphic phantom and its correlation with CT‐based treatment planning. CT‐based treatment plans on several patients were used to evaluate the doses delivered to the whole body and critical organs. A large variation in doses delivered to the whole body was demonstrated, with some parts of the bone marrow failing to receive the prescribed dose and some critical organs, such as the lungs, receiving excessive doses. Placing the arms at the sides only partially compensates for the increased transmission of the lungs because the arms only shadow part of the lung. This study shows that CT‐based treatment planning for TBI provides precise and accurate dose calculations and allows for the correlation of clinical outcomes with the doses actually delivered to various organs.

PACS numbers: 87.53.Dq, 87.66.Xa, 87.66.Sq

Screening for depleted uranium in the United Kingdom armed forces: who wants it and why?

BACKGROUND

Depleted uranium (DU) use has been implicated in the poor health of many service personnel who have served in the Gulf and the Balkans. Although the health related risks are thought to be small the UK government has offered to set up a voluntary screening programme for service personnel. This study aimed to find out the characteristics and possible exposures to DU for those personnel who desire DU screening.

METHODS

This study looks at 2369 UK service personnel who were asked if they wanted to be screened for DU. Subjects were asked about their perceived exposure to deployment associated risks including DU and a number of psychological health measures.

RESULTS

The study found that 24% of the cohort wanted screening, a figure that if extrapolated to all those who have been offered screening would represent 36720 requests for screening. Those who wanted DU screening were younger, of lower rank, and more likely to be from the Royal Navy or Army rather than the Royal Air Force. Those requesting DU screening reported poorer health both subjectively and as measured by the GHQ-12 and a symptom checklist. They also reported more exposure to DU and to other deployment associated risks while in military service. Using combat exposure as a proxy for a significant risk of having been exposed to DU, there was a significant correlation.

CONCLUSIONS

This study found that the desire for DU screening is more closely linked to current health status rather than plausible exposure to DU.

A practical method to calculate head scatter factors in wedged rectangular and irregular MLC shaped beams for external and internal wedges

Factor based methods for absorbed dose or monitor unit calculations are often based on separate data sets for open and wedged beams. The determination of basic beam parameters can be rather time consuming, unless equivalent square methods are applied. When considering irregular wedged beams shaped with a multileaf collimator, parametrization methods for dosimetric quantities, e.g. output ratios or wedge factors as a function of field size and shape, become even more important. A practical method is presented to derive wedged output ratios in air (S(c,w)) for any rectangular field and for any irregular MLC shaped beam. This method was based on open field output ratios in air (S(c)) for a field with the same collimator setting, and a relation f(w) between S(c,w) and S(c). The relation f(w) can be determined from measured output ratios in air for a few open and wedged fields including the maximum wedged field size. The function f(w) and its parametrization were dependent on wedge angle and treatment head design, i.e. they were different for internal and external wedges. The proposed method was tested for rectangular wedged fields on three accelerators with internal wedges (GE, Elekta, BBC) and two accelerators with external wedges (Varian). For symmetric regular beams the average deviation between calculated and measured S(c,w) / S(c) ratios was 0.3% for external wedges and about 0.6% for internal wedges. Maximum deviations of 1.8% were obtained for elongated rectangular fields on the GE and ELEKTA linacs with an internal wedge. The same accuracy was achieved for irregular MLC shaped wedged beams on the accelerators with MLC and internal wedges (GE and Elekta), with an average deviation < 1% for the fields tested. The proposed method to determine output ratios in air for wedged beams from output ratios of open beams, combined with equivalent square approaches, can be easily integrated in empirical or semi-empirical methods for monitor unit calculations.

Major histocompatibility complex controls the trajectory but not host-specific adaptation during virulence evolution of the pathogenic fungus Cryptococcus neoformans

Genes of the major histocompatibility complex (MHC) play a critical role in immune recognition and are the most genetically diverse loci known. One hypothesis to explain this diversity postulates that pathogens adapt to common MHC haplotypes and thus favour selection of new or rare alleles. To determine whether the pathogenic yeast Cryptococcus neoformans adapts to MHC-dependent immune responses, it was serially passaged in two independent replicate lines of five B10 MHC-congenic strains and Balb/c mice. All passaged lines increased in virulence as measured by reduced host survival. MHC influenced the rate (trajectory) of virulence increase during passages as measured by significant differences in mortality rate (p < 0.001). However, when the post-passage strains were tested, no MHC differences in mortality rate remained and only minor differences in titres were observed. Also contrary to expectations, increased virulence in three lines passaged in B10 mice had a larger effect in Balb/c mice, and the evolution of virulence in lines passaged in alternating hosts was not retarded. To our knowledge, these data represent the first experimental test of MHC-specific adaptation in a non-viral pathogen. The failure to observe MHC effects despite dramatically increased virulence and host-genotype-specific adaptation to non-MHC genes suggests that escape of MHC-dependent immune recognition may be difficult for pathogens with unlimited epitopes or that other virulence factors can swamp MHC effects.

The separation of the head and phantom scatter components from a phase space description

The formalism based on phantom and collimator scatter factors for high energy photon beams is deduced using a phase space description. The phantom scatter factors (Sp) depend on the field size and shape at the level of the phantom and are generally considered independent of the collimation details used to form the desired field provided the effect of contaminant electrons can be neglected. As demonstrated in this work, this behaviour leads to the applicability of the Clarkson method in irregular fields. However, for a given field formed with a tertiary collimator it is not a priori clear that the variations of extrafocal radiation due to secondary collimator setting do not affect the phantom scatter correction factors. In fact, the extrafocal radiation has a lower mean energy than that of unscattered photons, and this radiation can reach points well outside the radiation field increasing the irradiated phantom volume. Besides, transmission through the blocks contributes to phantom scatter. Therefore, for a given block-defined field, the associated phantom scatter dose, per unit of fluence in air on the central axis, should in principle increase when enlarging the secondary collimator field. To confirm this, isocentric Sp data for 6 MV photons were measured at 10 cm depth in water, reducing with cerrobend blocks several fields formed with the secondary collimators. In particular, when a 30 x 30 cm2 collimator field is reduced with blocks to a 7 x 7 cm2 field, the dose per unit of fluence in air is 1.4% higher than that of the square collimator field equating the given block field. Our calculations indicate that in this case the block transmission accounts for only 0.2% of this increment, showing that the remaining effect is due to extrafocal radiation. As a concluding remark, this work contributes to a better understanding of the classical Clarkson method for irregular fields giving, additionally, a formal interpretation of the commonly used quantities.

A parameter study to determine the optimal source neutron energy in boron neutron capture therapy of brain tumours

The values of the parameters used in boron neutron capture therapy (BNCT) to calculate a given dose to human tissue vary with patients due to different physical, biological and/or medical circumstances. Parameters include the tissue dimensions, the 10B concentration and the relative biological effectiveness (RBE) factors for the different dose components associated with BNCT. Because there is still no worldwide agreement on RBE values, more often than not, average values for these parameters are used. It turns out that the RBE-problem can be circumvented by taking into account all imaginable parameter values. Approaching this quest from another angle: the outcome will also provide the parameters (and values) which influence the optimal source neutron energy. For brain tumours it turns out that the 10B concentration, the RBE factors for 10B as well as fast neutrons, together with the dose limit set for healthy tissue, affect the optimal BNCT source neutron energy. By using source neutrons of a few keV together with neutrons of a few eV, it ensures that, under all imaginable circumstances, a maximum of alpha (and lithium) particles can be delivered in the tumour.

The Human Health Effect Programme in Greenland, a review

The burden of persistent organic pollutants (POPs) in Arctic peoples has been monitored for some years. In 1997, the Alta Declaration extended the mandate of the Arctic Assessment and Monitoring Programme (AMAP) to cover assessment of the combined effects of environmental stressors. The AMAP Phase I assessment report (Assessment report: Arctic pollution issues. Arctic monitoring and assessment programme (AMAP), Oslo Norway, xii+859 pp. Vol xii + 859 pp. Oslo, Norway, 1998) gave an overview of the classical toxicology of contaminants. Only recently a programme for measuring the potential biological effects of these contaminants has been established: The AMAP Human Health Effect Monitoring Programme. Body burden data alone are not enough to assess the health risks associated with exposure to environmental contaminants in Arctic peoples. Furthermore, laboratory studies of the effects of single chemicals or chemical mixtures in laboratory animals and cell cultures cannot fully elucidate the human health risks. Integration of epidemiological health research and effect-biomarker studies on humans from exposed populations in the Arctic is needed in order to obtain information about the real health risks resulting from exposure to the accumulated mixtures of contaminants in the Arctic. The present text aims to give a short account of background literature on known and suspected effects of environmental chemicals on endocrine regulated processes with special emphasis on Arctic conditions. Following the evaluation of existing knowledge, a survey of the recently started Human Health Effect Biomarker Programme in Greenland is given.

Uptake and metabolism of technical nonylphenol and its brominated analogues in the roach (Rutilus rutilus)

Alkylphenols have been implicated as one of the causative agents of oestrogenic contamination in fish. This study reports the fate of a technical mixture of secondary and tertiary isomers of the environmental contaminant 4-nonylphenol (NP) in mature female roach. Fish were exposed to a concentration of 4.9microg/l radio-labelled technical NP over a 4-day period in a flow-through aquarium. NP residues were extracted from all tissues and analysed by reverse phase radio HPLC. The concentration of NP residues was highest in bile and liver, with apparent bioconcentration factors (apparent BCFs) of 34,121 and 605, respectively. In other tissues, apparent BCF values were recorded between 13 and 250. NP was the only residue detected in brain, muscle and blood cells whereas an additional NP derivative was detected in other soft tissues, including gonads and liver, which was identified as the brominated derivative of technical NP, dibromo-4-nonylphenol. Traces of the dibrominated NP were also detected in aquarium water but only in the presence of NP, which suggested that bromination of the NP parent compound occurred in situ in the water due to the presence of trace amounts of oxidised bromine species in municipal water following disinfection. There was no evidence of further metabolism of the brominated derivative in roach, but a single major metabolite of NP was present in liver and bile, which was identified as the glucuronide conjugate of 4-(hydroxy-nonyl)-phenol. This detection of only one NP metabolite suggests that, in contrast to other fish species, the variety of metabolic pathways available for the deactivation of 4-alkylphenols in roach is limited. This study indicates that brominated alkylphenols bioconcentrate in a range of tissues and, as they have been detected in the aquatic environment, they could contribute to the body burden of alkylphenolics in fish. The formation of these brominated derivatives in aquarium water suggest that they could confound toxicity tests to assess the effects of alkyphenols to aquatic organisms.

Gefährdungsabschätzung von Bodenverunreinigungen in einem belasteten Wohngebiet: Bedeutung und Funktion des Human-Biomonitoring - ein Fallbeispiel

BACKGROUND AND PURPOSE

High levels of arsenic, cadmium, mercury and polychlorinated dibenzodioxins and dibenzofuranes (PCDD/PCDF) were detected in the soil of a residential area located at the river Elbe near Hamburg (Germany). Soil contamination resulted from sediments from the Hamburg harbour and from the Elbe that were deposited in this area up to the late 1950ies. The objective of this study was to evaluate whether the soil contamination in this area is associated with increased levels of arsenic, heavy metals and PCCD/PCDF in the blood and urine of selected residents living on highly contaminated grounds.

RESULTS

The blood levels of lead and PCDD/PCDF and the urine levels of arsenic, cadmium and mercury that were measured in 29 residents living on highly contaminated grounds were not elevated in relation to a control group. All individual values were in the range of the background exposure levels of the general population. There were no signs of an increased additional exposure related to soil contamination.

CONCLUSIONS

Based on the results of this study it was agreed to refrain from an expensive redevelopment of this area. As a preventive measure some recommendations were given to the residents to minimize possible exposure to soil contaminants. Human biological monitoring studies should be an essential part of exposure and risk assessment of soil contaminations in residential areas in future studies and as a basis for adequate risk management.

Dose enhancement close to platinum implants for the 4, 6, and 10MV stereotactic radiosurgery

Three photon interaction processes, namely, the photoelectric effect, Compton effect, and pair production, can occur when materials with high atomic numbers are irradiated by the high- and low-energy bremsstrahlung photons from a linear accelerator. A dose enhancement, due to the photoelectric effect and pair production, near targets with platinum implants (with a high atomic number) in radiosurgery cannot be predicted by the XKnife radiosurgery treatment planning system. In the present work, Monte Carlo simulations using PRESTA EGS4 were employed to investigate the resulting dose enhancements from 4, 6, and 10 MV energies commonly used in the stereotactic radiosurgery system. Dose enhancements from 32% to 68% were observed close to the platinum implant for the above energies when using a 12.5 mm collimator. Comparatively higher dose enhancements were observed when using smaller collimators. It was found that this dose enhancement increased with beam energy but decreased as beam size increased.

Internal metal sequestration and its ecotoxicological relevance: a review

Organisms are able to control metal concentrations in certain tissues of their body to minimize damage of reactive forms of essential and nonessential metals and to control selective utilization of essential metals. These physiological aspects of organisms are not accounted for when assessing the risk of metals in the environment. The Critical Body Residue (CBR) approach relates toxicity to bioaccumulation and biomagnification and might at first sight provide a more accurate estimation of effects than the external concentration. When expressing CBRs on total internal concentrations, the capacity of organisms to sequester metals in forms that are not biologically reactive is neglected. The predictability of toxic effects will increase when knowledge on metal compartmentalization within the organisms' body is taken into account. Insight in metal compartmentalization sheds light on the different accumulation strategies organisms can follow upon metal exposure. Using a fractionation procedure to isolate metal-rich granules and tissue fragments from intracellular and cytosolic fractions, the internal compartmentalization of metals can be approximated. In this paper, current knowledge regarding metal compartmentalization in organisms is summarized, and metal fractions are identified that are indicators of toxicity. Guidance is provided on future improvement of models, such as the Biotic Ligand Model (BLM), for risk assessment of metal stress to biota.

Radiation dosimetry estimates for the PET serotonin transporter probe 11C-DASB determined from whole-body imaging in non-human primates

The radiotracer 3-amino-4-(2-dimethylaminomethyl-phenylsulfanyl)-benzonitrile labelled in the N-methyl position (11C-DASB) is a selective radioligand for the in vivo quantification of serotonin transporters (SERTs) using positron emission tomography (PET). The current study quantified the distribution of activity in two rhesus monkeys after the injection of approximately 333 MBq (9 mCi) 11C-DASB. Whole-body images were acquired at 22 time points for a total of 120 min following injection of the radioligand. Source organs were identified at each time point from both tomographic images (using multiple regions of interest on each tomograph for each organ) and a single planar image (using a single region of interest for each organ). The peak activities in planar images in the five identified source organs (expressed as per cent injected dose (ID)) were lungs (24% ID at 1.5 min), kidneys (6.5% ID at 4 min), liver (8% ID at 3 min), brain (4% ID at 5 min) and spleen (0.42% ID at 3 min). Mono-exponential fitting of activity overlying the bladder suggested that approximately 14% of activity was excreted via the urine. The radiation burden to the body was calculated from residence times of these source organs and then scaled to corresponding human values. The calculated effective dose from tomographic and planar images was 6.0 and 6.4 microGy x MBq(-1) (22.3 and 23.7 mrad x mCi(-1)), respectively. The planar analysis was much easier to perform, and generally yielded slightly higher (i.e., more conservative) estimates of radiation burden than the tomographic analysis. The estimated radiation burden of 11C-DASB is relatively modest and would allow multiple scans per research subject per year.

The gender differences in health effects of environmental cadmium exposure and potential mechanisms

On a viewpoint of gender differences in Cd body burden and its health effects, we reviewed the population-based research including our own which conducted in Japan, Thailand, Australia, Poland, Belgium and Sweden to assess health effects of human exposure to environmental cadmium and their potential mechanisms. As a result, six risk factors in Cd health effects in women have been identified; (1) more serious type of renal tubular dysfunction, (2) difference in calcium metabolism and its regulatory hormones, (3) kidney sensitivity; difference in P450 phenotype, (4) pregnancy, (5) body iron store status, and (6) genetic factors. Further studies of Cd toxicity targeted to women would now appear necessary.

Dosimetric evaluation of the clinical implementation of the first commercial IMRT Monte Carlo treatment planning system at 6 MV

In this work we dosimetrically evaluated the clinical implementation of a commercial Monte Carlo treatment planning software (PEREGRINE, North American Scientific, Cranberry Township, PA) intended for quality assurance (QA) of intensity modulated radiation therapy treatment plans. Dose profiles calculated in homogeneous and heterogeneous phantoms using this system were compared to both measurements and simulations using the EGSnrc Monte Carlo code for the 6 MV beam of a Varian CL21EX linear accelerator. For simple jaw-defined fields, calculations agree within 2% of the dose at d(max) with measurements in homogeneous phantoms with the exception of the buildup region where the calculations overestimate the dose by up to 8%. In heterogeneous lung and bone phantoms the agreement is within 3%, on average, up to 5% for a 1 x 1 cm2 field. We tested two consecutive implementations of the MLC model. After matching the calculated and measured MLC leakage, simulations of static and dynamic MLC-defined fields using the most recent MLC model agreed to within 2% with measurements.

Numerical evaluation of heating of the human head due to magnetic resonance imaging

In this paper, we present a numerical model for evaluating tissue heating during magnetic resonance imaging (MRI). Our method, which included a detailed anatomical model of a human head, calculated both the electromagnetic power deposition and the associated temperature elevations during an MRI head examination. Numerical studies were conducted using a realistic birdcage coil excited at frequencies ranging from 63 to 500 MHz. The model was validated both experimentally and analytically. The experimental validation was performed at the MR test facility located at the Food and Drug Administration's Center for Devices and Radiological Health.

Radiation from "extra" images acquired with abdominal and/or pelvic CT: effect of automatic tube current modulation

PURPOSE

To retrospectively determine the number and usefulness of images acquired beyond the intended anatomic area of interest with abdominal and/or pelvic computed tomography (CT) and to assess the effect of automatic tube current modulation (ATCM) on associated radiation.

MATERIALS AND METHODS

Superior and inferior levels at routine abdominal and/or pelvic CT were defined as the dome of the diaphragm and the inferior margin of the pubic symphysis, respectively. Records of 106 consecutive examinations (male-to-female ratio, 45:61; age range, 21-86 years) performed from June 1 to June 30, 2003, were reviewed to determine the number of "extra" images. Sixty-two abdominal and/or pelvic CT examinations performed concurrently with chest or thigh CT or for trauma were not included in the 106. Abdominal and/or pelvic CT was performed with either ATCM (n = 44) or manual selection of tube current (n = 62). CT parameters recorded for each extra image included tube current, peak kilovoltage, and gantry rotation time. Mean and median tube current-time products were calculated for extra images. Extra images were analyzed for pathologic findings. Statistical analysis was performed with the Student t test.

RESULTS

Extra images were acquired above the dome of the diaphragm in 103 (97%) of 106 examinations and below the pubic symphysis in 100 (94%) of 106. A total of 1,280 extra images were acquired in 106 examinations (mean, 12 images per examination). Nineteen additional findings were observed on extra images. With ATCM, mean tube current-time product was 74.5 and 120.6 mAs for extra images acquired above the diaphragm and below the pubic symphysis, respectively; with manual selection, mean tube current-time products were 167.5 and 168.3 mAs (P <.05).

CONCLUSION

Most extra images acquired at abdominal and/or pelvic CT contributed no additional information. With ATCM, the radiation dose was reduced by a mean of 56% (median, 72%) for extra images above the diaphragm and 29% (median, 36%) for images below the pubic symphysis, compared with dose levels with manual selection.