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Leite AMM, Bonfrate A, Da Fonseca A, Lansonneur P, Alapetite C, Mammar H, De Marzi L. Double scattering and pencil beam scanning Monte Carlo workflows for proton therapy retrospective studies on radiation-induced toxicities. Cancer Radiother 2023:S1278-3218(23)00070-7. [PMID: 37164897 DOI: 10.1016/j.canrad.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Monte Carlo (MC) simulations can be used to accurately simulate dose and linear energy transfers (LET) distributions, thereby allowing for the calculation of the relative biological effectiveness (RBE) of protons. We present hereby the validation and implementation of a workflow for the Monte Carlo modelling of the double scattered and pencil beam scanning proton beamlines at our institution. METHODS The TOPAS/Geant4 MC model of the clinical nozzle has been comprehensively validated against measurements. The validation also included a comparison between simulated clinical treatment plans for four representative patients and the clinical treatment planning system (TPS). Moreover, an in-house tool implemented in Python was tested to assess the variable RBE-weighted dose in proton plans, which was illustrated for a patient case with a developing radiation-induced toxicity. RESULTS The simulated range and modulation width closely matches the measurements. Gamma-indexes (3%/3mm 3D), which compare the TPS and MC computations, showed a passing rate superior to 98%. The calculated RBE-weighted dose presented a slight increase at the necrosis location, within the PTV margins. This indicates the need for reporting on the physical and biological effects of irradiation in high dose regions, especially at the healthy tissues and increased LET distributions location. CONCLUSION The results demonstrate that the Monte Carlo method can be used to independently validate a TPS calculation, and to estimate LET distributions. The features of the in-house tool can be used to correlate LET and RBE-weighted dose distributions with the incidence of radiation-induced toxicities following proton therapy treatments.
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Affiliation(s)
- A M M Leite
- Inserm U 1021- CNRS UMR 3347, Institut Curie, PSL Research University, University Paris Saclay, 91898, Orsay, France; Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France
| | - A Bonfrate
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France
| | - A Da Fonseca
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France
| | - P Lansonneur
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France
| | - C Alapetite
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France
| | - H Mammar
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, centre universitaire, 91898 Orsay, France; Inserm LITO, Institut Curie, PSL Research University, University Paris Saclay, 91898 Orsay, France.
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Zucchi S, Pavan M, Mastrocola E, Marzi LD, Bassan A, Ragni L. P08-02 A pharma case study on an N-nitrosamine impurity: A comparison of results obtained with two different Ames test methods. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Loap P, Mirandola A, De Marzi L, Barcellini A, Vitolo V, Iannalfi A, Dendale R, Kirova Y, Orlandi E. PD-0172 Multi-parameter patient selection strategy for Hodgkin lymphoma proton therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Loap P, De Marzi L, Kirov K, Servois V, Fourquet A, Khoubeyb A, Kirova Y. PO-1600 Development of simplified auto-segmentable functional cardiac atlas. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03564-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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de Kermenguy F, Alvarez Andres E, De Marzi L, Fidon L, Carré A, Bolle S, Paragios N, Deutsch E, Ammari S, Robert C. PO-1621 An efficient training approach for brain paediatrics synthetic CT generation for protontherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03585-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loap P, Mirandola A, De Marzi L, Barcellini A, Vitolo V, Iannalfi A, Dendale R, Orlandi E, Kirova Y. PD-0175 Cardiac conduction system exposure during modern radiation therapy for mediastinal Hodgkin lymphoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Flacco A, Bayart E, Cavallone M, De Marzi L, Patriarca A, Lamarre-Jouenne I, Schreiber J, Rösch T, Parodi K, Grangeon T. FLASH Modalities Track (Oral Presentations) LASER-DRIVEN PROTON SOURCE FOR IN-VITRO AND IN-VIVO HIGH DOSE, ULTRA-HIGH DOSE-RATE EXPERIMENTS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Blaha P, Manti L, De Marzi L, Megnin-Chanet F, Leite AM, Patriarca A, Ricciardi V, Michalickova K. PROTONTHERAPY THERAPEUTIC WINDOW WIDENING BY PBCT AND FLASH MODALITIES. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Davídková M, Dasu A, De Angelis C, De Marzi L, De Saint-Hubert M, Ekendahl D, Michaelidesová AJ, Knežević Ž, Kukolowicz P, Liszka M, Lorentini S, Leite AM, Majer M, Michalec B, Navrátil M, Reniers B, Van Goethem M, Vestergaard A, Vilches-Freixas G, Vondráček V, Stolarczyk L, Olko P. FLASH Modalities Track (Oral Presentations) PRELIMINARY RESULTS OF DOSIMETRY AUDIT OF ACTIVE SCANNING PROTON BEAMS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Leite AM, Cavallone M, Ronga M, Trompier F, Patriarca A, De Marzi L. FLASH Modalities Track (Oral Presentations) ION RECOMBINATION CORRECTION FACTORS AND BENCHMARK OF DETECTORS IN A VERY-HIGH DOSE RATE PROTON SCANNING BEAM. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Leite AMM, Ronga MG, Giorgi M, Ristic Y, Perrot Y, Trompier F, Prezado Y, Créhange G, De Marzi L. Secondary neutron dose contribution from pencil beam scanning, scattered and spatially fractionated proton therapy. Phys Med Biol 2021; 66. [PMID: 34673555 DOI: 10.1088/1361-6560/ac3209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/21/2021] [Indexed: 11/11/2022]
Abstract
The Orsay Proton therapy Center (ICPO) has a long history of intracranial radiotherapy using both double scattering (DS) and pencil beam scanning (PBS) techniques, and is actively investigating a promising modality of spatially fractionated radiotherapy using proton minibeams (pMBRT). This work provides a comprehensive comparison of the organ-specific secondary neutron dose due to each of these treatment modalities, assessed using Monte Carlo (MC) algorithms and measurements. A MC model of a universal nozzle was benchmarked by comparing the neutron ambient dose equivalent,H*(10), in the gantry room with measurements obtained using a WENDI-II counter. The secondary neutron dose was evaluated for clinically relevant intracranial treatments of patients of different ages, in which secondary neutron doses were scored in anthropomorphic phantoms merged with the patients' images. The MC calculatedH*(10) values showed a reasonable agreement with the measurements and followed the expected tendency, in which PBS yields the lowest dose, followed by pMBRT and DS. Our results for intracranial treatments show that pMBRT yielded a higher secondary neutron dose for organs closer to the target volume, while organs situated furthest from the target volume received a greater quantity of neutrons from the passive scattering beam line. To the best of our knowledge, this is the first study to compare MC secondary neutron dose estimates in clinical treatments between these various proton therapy modalities and to realistically quantify the secondary neutron dose contribution of clinical pMBRT treatments. The method established in this study will enable epidemiological studies of the long-term effects of intracranial treatments at ICPO, notably radiation-induced second malignancies.
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Affiliation(s)
- A M M Leite
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, F-91898 Orsay, France.,Institut Curie, PSL Research University, University Paris Saclay, Inserm U 1021- CNRS UMR 3347, F-91898 Orsay, France
| | - M G Ronga
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, F-91898 Orsay, France
| | - M Giorgi
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, F-91898 Orsay, France
| | - Y Ristic
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie, Laboratoire de Dosimétrie des Rayonnements Ionisants, F-92262 Fontenay-aux-Roses Cedex, France
| | - Y Perrot
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie, Laboratoire de Dosimétrie des Rayonnements Ionisants, F-92262 Fontenay-aux-Roses Cedex, France
| | - F Trompier
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie, Laboratoire de Dosimétrie des Rayonnements Ionisants, F-92262 Fontenay-aux-Roses Cedex, France
| | - Y Prezado
- Institut Curie, PSL Research University, University Paris Saclay, Inserm U 1021- CNRS UMR 3347, F-91898 Orsay, France
| | - G Créhange
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, F-91898 Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, F-91898 Orsay, France.,Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, F-91898 Orsay, France
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Ortiz Catalan R, De Marzi L, Prezado Y. PO-1868 First dosimetric assessment of proton minibeam arc radiation therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Guardiola C, Bachiller-Perea D, Fleta C, Quirion D, De Marzi L, Maia Leite A, Gómez F. OC-0198 First microdosimetry 2D maps with an array of new 3D-cylindrical microdetectors in proton therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vidal M, Moignier C, Patriarca A, Sotiropoulos M, Schneider T, De Marzi L. Future technological developments in proton therapy - A predicted technological breakthrough. Cancer Radiother 2021; 25:554-564. [PMID: 34272182 DOI: 10.1016/j.canrad.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
In the current spectrum of cancer treatments, despite high costs, a lack of robust evidence based on clinical outcomes or technical and radiobiological uncertainties, particle therapy and in particular proton therapy (PT) is rapidly growing. Despite proton therapy being more than fifty years old (first proposed by Wilson in 1946) and more than 220,000 patients having been treated with in 2020, many technological challenges remain and numerous new technical developments that must be integrated into existing systems. This article presents an overview of on-going technical developments and innovations that we felt were most important today, as well as those that have the potential to significantly shape the future of proton therapy. Indeed, efforts have been done continuously to improve the efficiency of a PT system, in terms of cost, technology and delivery technics, and a number of different developments pursued in the accelerator field will first be presented. Significant developments are also underway in terms of transport and spatial resolution achievable with pencil beam scanning, or conformation of the dose to the target: we will therefore discuss beam focusing and collimation issues which are important parameters for the development of these techniques, as well as proton arc therapy. State of the art and alternative approaches to adaptive PT and the future of adaptive PT will finally be reviewed. Through these overviews, we will finally see how advances in these different areas will allow the potential for robust dose shaping in proton therapy to be maximised, probably foreshadowing a future era of maturity for the PT technique.
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Affiliation(s)
- M Vidal
- Centre Antoine-Lacassagne, Fédération Claude Lalanne, 227, avenue de la Lanterne, 06200 Nice, France
| | - C Moignier
- Centre François Baclesse, Department of Medical Physics, Centre de protonthérapie de Normandie, 14000 Caen, France
| | - A Patriarca
- Institut Curie, PSL Research University, Radiation oncology department, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, 91898 Orsay, France
| | - M Sotiropoulos
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
| | - T Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation oncology department, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, 91898 Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Campus universitaire, 91898 Orsay, France.
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Zahradnik I, Pomorski M, Tran L, Kada W, De Marzi L, Tromson D, Barberet P, Pastuovic Z, Vohradsky J, Salvador S, Leterrier L, Prezado Y, Pourcher T, Herault J, Rosenfeld A. PH-0045: Characterization of proton, carbon and silicon ion beams using scCVD diamond-based microdosimeters. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Rousselle A, Amelot A, Thariat J, Jacob J, Mercy G, De Marzi L, Feuvret L. Metallic implants and CT artefacts in the CTV area: Where are we in 2020? Cancer Radiother 2020; 24:658-666. [PMID: 32859465 DOI: 10.1016/j.canrad.2020.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022]
Abstract
Radiation therapy (RT) is one of the main modalities of cancer treatment worldwide with computed tomography (CT), as the most commonly used imaging method for treatment planning system (TPS). Image reconstruction errors may greatly affect all the radiation therapy planning process, such as target delineation, dose calculation and delivery, particularly with particle therapy. Metallic implants, such as hip and spinal implants, and dental filling significantly deteriorate image quality. These hardware structures are often very complex in geometry leading to geometric complex artefacts in the clinical target volume (CTV) area, rendering the delineation of CTV challenging. In our review, we focus on the methods to overcome artefact consequences on CTV delineation: 1- medical approaches anticipating issues associated with imaging artefacts during preoperative multidisciplinary discussions while following standard recommendations; 2- common metal artefact reduction (MAR) methods such as manually override artefact regions, ballistics avoiding beam paths through implanted materials, megavoltage-CT (MVCT); 3- prospects with radiolucent implants, MAR algorithms and various methods of dual energy computed tomography (DECT). Despite substantial and broad evidence for their benefits, there is still no universal solution for cases involving implanted metallic devices. There is still a high need for research efforts to adapt technologies to our issue: "how do I accurately delineate the ideal CTV in a metal artefact area?"
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Affiliation(s)
- A Rousselle
- Department of Radiation Oncology, Sorbonne Université, AP-HP, hôpitaux universitaires La Pitié Salpêtrière-Charles-Foix, 75013 Paris, France
| | - A Amelot
- Department of Neurosurgery, CHRU de Tours, 37000 Tours, France
| | - J Thariat
- Department of Radiation Oncology, centre François-Baclesse/ARCHADE, Laboratoire de physique corpusculaire IN2P3-UMR6534 - Normandie Université, 1400 Caen, France
| | - J Jacob
- Department of Radiation Oncology, Sorbonne Université, AP-HP, hôpitaux universitaires La Pitié Salpêtrière-Charles-Foix, 75013 Paris, France
| | - G Mercy
- Department of Medical Imaging, Sorbonne Université, AP-HP, hôpitaux universitaires La Pitié Salpêtrière-Charles-Foix, 75013 Paris, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre universitaire, 91898 Orsay, France
| | - L Feuvret
- Department of Radiation Oncology, Sorbonne Université, AP-HP, hôpitaux universitaires La Pitié Salpêtrière-Charles-Foix, 75013 Paris, France.
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De Marzi L, Patriarca A, Scher N, Thariat J, Vidal M. Exploiting the full potential of proton therapy: An update on the specifics and innovations towards spatial or temporal optimisation of dose delivery. Cancer Radiother 2020; 24:691-698. [PMID: 32753235 DOI: 10.1016/j.canrad.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
Prescription and delivery of protons are somewhat different compared to photons and may influence outcomes (tumour control and toxicity). These differences should be taken into account to fully exploit the clinical potential of proton therapy. Innovations in proton therapy treatment are also required to widen the therapeutic window and determine appropriate populations of patients that would benefit from new treatments. Therefore, strategies are now being developed to reduce side effects to critical normal tissues using alternative treatment configurations and new spatial or temporal-driven optimisation approaches. Indeed, spatiotemporal optimisation (based on flash, proton minibeam radiation therapy or hypofractionated delivery methods) has been gaining some attention in proton therapy as a mean of improving (biological and physical) dose distribution. In this short review, the main differences in planning and delivery between protons and photons, as well as some of the latest developments and methodological issues (in silico modelling) related to providing scientific evidence for these new techniques will be discussed.
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Affiliation(s)
- L De Marzi
- Institut Curie, centre de protonthérapie d'Orsay, campus universitaire, bâtiment 101, 91898 Orsay, France; Université PSL (Paris Sciences & Lettres), 60, rue Mazarine, 75006 Paris, France; Université Paris-Saclay, route de l'Orme-aux-Merisiers, RD 128, 91190 Saint-Aubin, France; Inserm U1021, centre universitaire, bâtiment 110, rue Henri-Becquerel, 91405 Orsay cedex, France; CNRS, UMR 3347, centre universitaire, bâtiment 110, rue Henri-Becquerel, 91405 Orsay cedex, France.
| | - A Patriarca
- Institut Curie, centre de protonthérapie d'Orsay, campus universitaire, bâtiment 101, 91898 Orsay, France; Université PSL (Paris Sciences & Lettres), 60, rue Mazarine, 75006 Paris, France
| | - N Scher
- Institut Curie, centre de protonthérapie d'Orsay, campus universitaire, bâtiment 101, 91898 Orsay, France; Université PSL (Paris Sciences & Lettres), 60, rue Mazarine, 75006 Paris, France
| | - J Thariat
- Service de radiothérapie oncologique, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Laboratoire de physique corpusculaire de Caen, 6, boulevard du Maréchal-Juin, 14050 Caen cedex, France; Institut national de physique nucléaire et physique des particules (IN2P3), 6, boulevard du Maréchal-Juin, 14050 Caen cedex, France; EnsiCaen, 6, boulevard du Maréchal-Juin, 14050 Caen cedex, France; CNRS, UMR6534, 6, boulevard du Maréchal-Juin, 14050 Caen cedex, France; Unicaen, 6, boulevard du Maréchal-Juin, 14050 Caen cedex, France; Normandie Université, 6, boulevard du Maréchal-Juin, 14050 Caen cedex, France
| | - M Vidal
- Centre Antoine-Lacassagne, 33, avenue Valombrose, 06000 Nice, France
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Zahradnik IA, Barberet P, Tromson D, De Marzi L, Pomorski MT. A diamond guard ring microdosimeter for ion beam therapy. Rev Sci Instrum 2020; 91:054102. [PMID: 32486707 DOI: 10.1063/5.0002403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
A single crystal chemical vapor deposition diamond-based microdosimeter prototype featuring an array of micro-sensitive volumes (μSVs) and surrounded by a so-called guard ring (GR) electrode has been fabricated using various microfabrication techniques available at Diamond Sensors Laboratory of CEA, Saclay. The GR microdosimeter was irradiated by a raster scanning method with 2 MeV proton microbeams. The charge transport properties of the GR sensor were determined with sub-micron spatial resolution by measuring the charge collection efficiency (CCE), the μSV geometry, and the pulse-height spectra. The response of the microdosimeter showed a well-defined and homogeneously active μSV. Appropriate biasing of the μSV structures led toward a full CCE for protons with lineal energies of ∼46 keV/μm. This shows the GR microdosimeter's great potential for applications in microdosimetry in clinical beam conditions.
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Affiliation(s)
- I A Zahradnik
- CEA-LIST, Diamond Sensors Laboratory, 91191 Gif-sur-Yvette, France
| | - P Barberet
- Université de Bordeaux, CENBG, Chemin du Solarium, 33175 Gradignan, France
| | - D Tromson
- CEA-LIST, Sensors and Electronic Architectures Laboratory, 91191, Gif-sur-Yvette, France
| | - L De Marzi
- Institut Curie, Centre de Protonthérapie d'Orsay, 91400 Orsay, France
| | - M T Pomorski
- CEA-LIST, Diamond Sensors Laboratory, 91191 Gif-sur-Yvette, France
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Lansonneur P, Mammar H, Nauraye C, Patriarca A, Hierso E, Dendale R, Prezado Y, De Marzi L. First proton minibeam radiation therapy treatment plan evaluation. Sci Rep 2020; 10:7025. [PMID: 32341427 PMCID: PMC7184593 DOI: 10.1038/s41598-020-63975-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/08/2020] [Indexed: 11/09/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel dose delivery method based on spatial dose fractionation. pMBRT has been shown to be promising in terms of reduced side effects and superior tumour control in high-grade glioma-bearing rats compared to standard irradiation. These findings, together with the recent optimized implementation of pMBRT in a clinical pencil beam scanning system, have triggered reflection on the possible application to patient treatments. In this context, the present study was designed to conduct a first theoretical investigation of the clinical potential of this technique. For this purpose, a dedicated dose engine was developed and used to evaluate two clinically relevant patient treatment plans (high-grade glioma and meningioma). Treatment plans were compared with standard proton therapy plans assessed by means of a commercial treatment planning system (ECLIPSE-Varian Medical systems) and Monte Carlo simulations. A multislit brass collimator consisting of 0.4 mm wide slits separated by a centre-to-centre distance of 4 or 6 mm was placed between the nozzle and the patient to shape the planar minibeams. For each plan, spread-out Bragg peaks and homogeneous dose distributions (±7% dose variations) can be obtained in target volumes. The Peak-to-Valley Dose Ratios (PVDR) were evaluated between 9.2 and 12.8 at a depth of 20 mm for meningioma and glioma, respectively. Dose volume histograms (DVHs) for target volumes and organs at risk were quantitatively compared, resulting in a slightly better target homogeneity with standard PT than with pMBRT plans, but similar DVHs for deep-seated organs-at-risk and lower average dose for shallow organs. The proposed delivery method evaluated in this work opens the way to an effective treatment for radioresistant tumours and will support the design of future clinical research.
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Affiliation(s)
- P Lansonneur
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - H Mammar
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - C Nauraye
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - A Patriarca
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - E Hierso
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - R Dendale
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France
| | - Y Prezado
- Institut Curie, PSL Research University, University Paris Saclay, Inserm U 1021-CNRS UMR 3347, 91898, Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898, Orsay, France. .,Institut Curie, PSL Research University, University Paris Saclay, Inserm U 1021-CNRS UMR 3347, 91898, Orsay, France.
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De Marzi L, Nauraye C, Lansonneur P, Pouzoulet F, Patriarca A, Schneider T, Guardiola C, Mammar H, Dendale R, Prezado Y. Spatial fractionation of the dose in proton therapy: Proton minibeam radiation therapy. Cancer Radiother 2019; 23:677-681. [DOI: 10.1016/j.canrad.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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Peters N, Wohlfahrt P, Bolsi A, Dahlgren C, De Marzi L, Ellerbrock M, Fracchiolla F, Free J, Gomà C, Góra J, Kajdrowicz T, MacKay R, Molinelli S, Nørrevang O, Rinaldi I, Rompokos V, Van der Tol P, Vermeren X, Richter C. OC-0667 Experimental assessment of inter-centre variation and accuracy in SPR prediction within the EPTN. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31087-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schneider T, De Marzi L, Patriarca A, Prezado Y. PO-1017 Towards magnetically focused proton minibeams: investigating the limits of a clinical PBS nozzle. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Krah N, De Marzi L, Patriarca A, Pittá G, Rinaldi I. Proton radiography with a commercial range telescope detector using dedicated post processing methods. Phys Med Biol 2018; 63:205016. [PMID: 30203783 DOI: 10.1088/1361-6560/aae043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Proton transmission imaging uses protons with high enough energy to fully traverse the phantom/patient and to be captured in a suitable detector placed behind it. The measured residual energy or residual range provide a direct estimate of the water equivalent thickness (WET) of the image volume. Requirements for proton imaging to be exploitable in clinical practice include: sufficient WET accuracy and integrability into the treatment room and the clinical workflow, as well as an acceptably low dose to the patient and a sufficient spatial resolution. In this work, we report on experiments performed at the Institut Curie-Proton therapy center in Orsay (IC-CPO), France, using a commercial range telescope commonly employed for quality assurance measurements. The purpose was to keep the experimental set-up as simple as possible and to achieve nonetheless high WET accuracy radiographies by developing and applying dedicated post processing methods. We explain these methods in detail and discuss their performance. We assess the WET accuracy based on two different reference phantoms: a CIRS electron density phantom with tissue equivalent inserts and a homogeneous step phantom. We find an agreement between the measured and the reference WET values of 0.2-0.5 mm. The lowest investigated dose was 10 mGy per acquisition. It could be lowered by modifying the irradiation plan and lowering the beam current, though the latter would impose slight optimisations of the detector hardware. Our work suggests that proton radiographies with good WET accuracy can be obtained with a reasonable experimental effort that would facilitate integration into clinical routine.
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Affiliation(s)
- N Krah
- Lyon University, CNRS, Inserm, CREATIS UMR5220, France. CNRS/IN2P3 and Lyon 1 University, UMR 5822, Villeurbanne, France
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Taasti V, Bäumer C, Dahlgren C, Deisher A, Ellerbrock M, Free J, Góra J, Kozera A, Lomax A, De Marzi L, Molinelli S, Teo B, Wohlfahrt P, Petersen J, Muren L, Hansen D, Richter C. PO-0969: Inter-center variability of CT-to-SPR conversion in particle therapy: Survey-based evaluation. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31279-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marsolat F, De Marzi L, Patriarca A, Nauraye C, Moignier C, Pomorski M, Moignau F, Heinrich S, Tromson D, Mazal A. Dosimetric characteristics of four PTW microDiamond detectors in high-energy proton beams. Phys Med Biol 2016; 61:6413-29. [DOI: 10.1088/0031-9155/61/17/6413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chuard D, Anthonipillai V, Dendale R, Nauraye C, Khan E, Mabit C, De Marzi L, Narici L. Mechanisms of phosphene generation in ocular proton therapy as related to space radiation exposure. Life Sci Space Res (Amst) 2016; 10:23-28. [PMID: 27662784 DOI: 10.1016/j.lssr.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/15/2016] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
Particle therapy provides an opportunity to study the human response to space radiation in ground-based facilities. On this basis, a study of light flashes analogous to astronauts' phosphenes reported by patients undergoing ocular proton therapy has been undertaken. The influence of treatment parameters on phosphene generation was investigated for 430 patients treated for a choroidal melanoma at the proton therapy centre of the Institut Curie (ICPO) in Orsay, France, between 2008 and 2011. 60% of them report light flashes, which are predominantly (74%) blue. An analysis of variables describing the patient's physiology, properties of the tumour and dose distribution shows that two groups of tumour and beam variables are correlated with phosphene occurrence. Physiology is found to have no influence on flash triggering. Detailed correlation study eventually suggests a possible twofold mechanism of phosphene generation based on (i) indirect Cerenkov light in the bulk of the eye due to nuclear interactions and radioactive decay and (ii) direct excitation of the nerve fibres in the back of the eye and/or radical excess near the retina.
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Affiliation(s)
- D Chuard
- Institut de Physique Nucléaire IN2P3/CNRS, Univ. Paris-Sud, Orsay, France.
| | - V Anthonipillai
- Institut de Physique Nucléaire IN2P3/CNRS, Univ. Paris-Sud, Orsay, France
| | - R Dendale
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - C Nauraye
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - E Khan
- Institut de Physique Nucléaire IN2P3/CNRS, Univ. Paris-Sud, Orsay, France
| | - C Mabit
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - L De Marzi
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - L Narici
- Department of Physics, University of Rome 'Tor Vergata', Rome, Italy
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Moignier C, Tromson D, Marsolat F, De Marzi L, Pomorski M, Agelou M, Hernandez JG, Lazaro D, Mazal A. SU-F-T-178: Optimized Design of a Diamond Detector Specifically Dedicated to the Dose Distribution Measurements in Clinical Proton Pencil Beams. Med Phys 2016. [DOI: 10.1118/1.4956315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bonfrate A, Farah J, De Marzi L, Delacroix S, Hérault J, Sayah R, Lee C, Bolch WE, Clairand I. Influence of beam incidence and irradiation parameters on stray neutron doses to healthy organs of pediatric patients treated for an intracranial tumor with passive scattering proton therapy. Phys Med 2016; 32:590-9. [PMID: 27050170 DOI: 10.1016/j.ejmp.2016.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/05/2016] [Accepted: 03/14/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In scattering proton therapy, the beam incidence, i.e. the patient's orientation with respect to the beam axis, can significantly influence stray neutron doses although it is almost not documented in the literature. METHODS MCNPX calculations were carried out to estimate stray neutron doses to 25 healthy organs of a 10-year-old female phantom treated for an intracranial tumor. Two beam incidences were considered in this article, namely a superior (SUP) field and a right lateral (RLAT) field. For both fields, a parametric study was performed varying proton beam energy, modulation width, collimator aperture and thickness, compensator thickness and air gap size. RESULTS Using a standard beam line configuration for a craniopharyngioma treatment, neutron absorbed doses per therapeutic dose of 63μGyGy(-1) and 149μGyGy(-1) were found at the heart for the SUP and the RLAT fields, respectively. This dose discrepancy was explained by the different patient's orientations leading to changes in the distance between organs and the final collimator where external neutrons are mainly produced. Moreover, investigations on neutron spectral fluence at the heart showed that the number of neutrons was 2.5times higher for the RLAT field compared against the SUP field. Finally, the influence of some irradiation parameters on neutron doses was found to be different according to the beam incidence. CONCLUSION Beam incidence was thus found to induce large variations in stray neutron doses, proving that this parameter could be optimized to enhance the radiation protection of the patient.
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Affiliation(s)
- A Bonfrate
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France.
| | - J Farah
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France.
| | - L De Marzi
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO) - Campus universitaire bâtiment 101, 91898 Orsay, France
| | - S Delacroix
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO) - Campus universitaire bâtiment 101, 91898 Orsay, France
| | - J Hérault
- Centre Antoine Lacassagne (CAL) - Cyclotron biomédical, 227 avenue de la Lanterne, 06200 Nice, France
| | - R Sayah
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France
| | - C Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD 20850, USA
| | - W E Bolch
- J Crayton Pruitt Family Departments of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - I Clairand
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France
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Vidal M, De Marzi L, Szymanowski H, Guinement L, Nauraye C, Hierso E, Freud N, Ferrand R, François P, Sarrut D. An empirical model for calculation of the collimator contamination dose in therapeutic proton beams. Phys Med Biol 2016; 61:1532-45. [PMID: 26816191 DOI: 10.1088/0031-9155/61/4/1532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Collimators are used as lateral beam shaping devices in proton therapy with passive scattering beam lines. The dose contamination due to collimator scattering can be as high as 10% of the maximum dose and influences calculation of the output factor or monitor units (MU). To date, commercial treatment planning systems generally use a zero-thickness collimator approximation ignoring edge scattering in the aperture collimator and few analytical models have been proposed to take scattering effects into account, mainly limited to the inner collimator face component. The aim of this study was to characterize and model aperture contamination by means of a fast and accurate analytical model. The entrance face collimator scatter distribution was modeled as a 3D secondary dose source. Predicted dose contaminations were compared to measurements and Monte Carlo simulations. Measurements were performed on two different proton beam lines (a fixed horizontal beam line and a gantry beam line) with divergent apertures and for several field sizes and energies. Discrepancies between analytical algorithm dose prediction and measurements were decreased from 10% to 2% using the proposed model. Gamma-index (2%/1 mm) was respected for more than 90% of pixels. The proposed analytical algorithm increases the accuracy of analytical dose calculations with reasonable computation times.
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Affiliation(s)
- M Vidal
- Institut Curie: Centre de Protonthérapie d'Orsay, 91400 Orsay, France. Dosisoft, 94230 Cachan, France
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Marsolat F, De Marzi L, Pouzoulet F, Mazal A. Analytical linear energy transfer model including secondary particles: calculations along the central axis of the proton pencil beam. Phys Med Biol 2016; 61:740-57. [PMID: 26732530 DOI: 10.1088/0031-9155/61/2/740] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In proton therapy, the relative biological effectiveness (RBE) depends on various types of parameters such as linear energy transfer (LET). An analytical model for LET calculation exists (Wilkens' model), but secondary particles are not included in this model. In the present study, we propose a correction factor, L sec, for Wilkens' model in order to take into account the LET contributions of certain secondary particles. This study includes secondary protons and deuterons, since the effects of these two types of particles can be described by the same RBE-LET relationship. L sec was evaluated by Monte Carlo (MC) simulations using the GATE/GEANT4 platform and was defined by the ratio of the LET d distributions of all protons and deuterons and only primary protons. This method was applied to the innovative Pencil Beam Scanning (PBS) delivery systems and L sec was evaluated along the beam axis. This correction factor indicates the high contribution of secondary particles in the entrance region, with L sec values higher than 1.6 for a 220 MeV clinical pencil beam. MC simulations showed the impact of pencil beam parameters, such as mean initial energy, spot size, and depth in water, on L sec. The variation of L sec with these different parameters was integrated in a polynomial function of the L sec factor in order to obtain a model universally applicable to all PBS delivery systems. The validity of this correction factor applied to Wilkens' model was verified along the beam axis of various pencil beams in comparison with MC simulations. A good agreement was obtained between the corrected analytical model and the MC calculations, with mean-LET deviations along the beam axis less than 0.05 keV μm(-1). These results demonstrate the efficacy of our new correction of the existing LET model in order to take into account secondary protons and deuterons along the pencil beam axis.
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Affiliation(s)
- F Marsolat
- Institut Curie, Centre de Protonthérapie d'Orsay, France. Institut Curie, Centre de Recherche, Plateforme de Radiothérapie Expérimentale, France
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Bonfrate A, Farah J, De Marzi L, Delacroix S, Herault J, Sayah R, Lee C, Bolch W, Clairand I. SU-E-T-598: Parametric Equation for Quick and Reliable Estimate of Stray Neutron Doses in Proton Therapy and Application for Intracranial Tumor Treatments. Med Phys 2015. [DOI: 10.1118/1.4924961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Farah J, Bonfrate A, De Marzi L, De Oliveira A, Delacroix S, Martinetti F, Trompier F, Clairand I. Configuration and validation of an analytical model predicting secondary neutron radiation in proton therapy using Monte Carlo simulations and experimental measurements. Phys Med 2015; 31:248-56. [PMID: 25682475 DOI: 10.1016/j.ejmp.2015.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 01/15/2023] Open
Abstract
PURPOSE This study focuses on the configuration and validation of an analytical model predicting leakage neutron doses in proton therapy. METHODS Using Monte Carlo (MC) calculations, a facility-specific analytical model was built to reproduce out-of-field neutron doses while separately accounting for the contribution of intra-nuclear cascade, evaporation, epithermal and thermal neutrons. This model was first trained to reproduce in-water neutron absorbed doses and in-air neutron ambient dose equivalents, H*(10), calculated using MCNPX. Its capacity in predicting out-of-field doses at any position not involved in the training phase was also checked. The model was next expanded to enable a full 3D mapping of H*(10) inside the treatment room, tested in a clinically relevant configuration and finally consolidated with experimental measurements. RESULTS Following the literature approach, the work first proved that it is possible to build a facility-specific analytical model that efficiently reproduces in-water neutron doses and in-air H*(10) values with a maximum difference less than 25%. In addition, the analytical model succeeded in predicting out-of-field neutron doses in the lateral and vertical direction. Testing the analytical model in clinical configurations proved the need to separate the contribution of internal and external neutrons. The impact of modulation width on stray neutrons was found to be easily adjustable while beam collimation remains a challenging issue. Finally, the model performance agreed with experimental measurements with satisfactory results considering measurement and simulation uncertainties. CONCLUSION Analytical models represent a promising solution that substitutes for time-consuming MC calculations when assessing doses to healthy organs.
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Affiliation(s)
- J Farah
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle Radioprotection de l'Homme, External Dosimetry Department, BP17, 92260 Fontenay-aux-Roses, France.
| | - A Bonfrate
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle Radioprotection de l'Homme, External Dosimetry Department, BP17, 92260 Fontenay-aux-Roses, France
| | - L De Marzi
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO), Campus Universitaire Bâtiment 101, 91898 Orsay, France
| | - A De Oliveira
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO), Campus Universitaire Bâtiment 101, 91898 Orsay, France
| | - S Delacroix
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO), Campus Universitaire Bâtiment 101, 91898 Orsay, France
| | - F Martinetti
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle Radioprotection de l'Homme, External Dosimetry Department, BP17, 92260 Fontenay-aux-Roses, France
| | - F Trompier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle Radioprotection de l'Homme, External Dosimetry Department, BP17, 92260 Fontenay-aux-Roses, France
| | - I Clairand
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Pôle Radioprotection de l'Homme, External Dosimetry Department, BP17, 92260 Fontenay-aux-Roses, France
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De Marzi L, Feuvret L, Boulé T, Habrand JL, Martin F, Calugaru V, Fournier-Bidoz N, Ferrand R, Mazal A. Use of gEUD for predicting ear and pituitary gland damage following proton and photon radiation therapy. Br J Radiol 2015; 88:20140413. [PMID: 25671247 DOI: 10.1259/bjr.20140413] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine the relationship between the dose to the inner ear or pituitary gland and radiation-induced late effects of skull base radiation therapy. METHODS 140 patients treated between 2000 and 2008 were considered for this study. Hearing loss and endocrine dysfunction were retrospectively reviewed on pre- and post-radiation therapy audiometry or endocrine assessments. Two normal tissue complication probability (NTCP) models were considered (Lyman-Kutcher-Burman and log-logistic) whose parameters were fitted to patient data using receiver operating characteristics and maximum likelihood analysis. The method provided an estimation of the parameters of a generalized equivalent uniform dose (gEUD)-based NTCP after conversion of dose-volume histograms to equivalent doses. RESULTS All 140 patients had a minimum follow up of 26 months. 26% and 44% of patients experienced mild hearing loss and endocrine dysfunction, respectively. The fitted values for TD50 and γ50 ranged from 53.6 to 60.7 Gy and from 1.9 to 2.9 for the inner ear and were equal to 60.6 Gy and 4.9 for the pituitary gland, respectively. All models were ranked equal according to Akaike's information criterion. CONCLUSION Mean dose and gEUD may be used as predictive factors for late ear and pituitary gland late complications after skull base proton and photon radiation therapy. ADVANCES IN KNOWLEDGE In this study, we have reported mean dose effects and dose-response relationship of small organs at risk (partial volumes of the inner ear and pituitary gland), which could be useful to define optimal dose constraints resulting in an improved therapeutic ratio.
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Affiliation(s)
- L De Marzi
- 1 Department of Radiotherapy, Institut Curie, Orsay Proton Therapy Centre, Paris, France
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Sayah R, Farah J, Donadille L, Hérault J, Delacroix S, De Marzi L, De Oliveira A, Vabre I, Stichelbaut F, Lee C, Bolch WE, Clairand I. Secondary neutron doses received by paediatric patients during intracranial proton therapy treatments. J Radiol Prot 2014; 34:279-96. [PMID: 24704989 DOI: 10.1088/0952-4746/34/2/279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This paper's goal is to assess secondary neutron doses received by paediatric patients treated for intracranial tumours using a 178 MeV proton beam. The MCNPX Monte Carlo model of the proton therapy facility, previously validated through experimental measurements for both proton and neutron dosimetry, was used. First, absorbed dose was calculated for organs located outside the clinical target volume using a series of hybrid computational phantoms for different ages and considering a realistic treatment plan. In general, secondary neutron dose was found to decrease as the distance to the treatment field increases and as the patient age increases. In addition, secondary neutron doses were studied as a function of the beam incidence. Next, neutron equivalent dose was assessed using organ-specific energy-dependent radiation weighting factors determined from Monte Carlo simulations of neutron spectra at each organ. The equivalent dose was found to reach a maximum value of ∼155 mSv at the level of the breasts for a delivery of 49 proton Gy to an intracranial tumour of a one-year-old female patient. Finally, a thorough comparison of the calculation results with published data demonstrated the dependence of neutron dose on the treatment configuration and proved the need for facility-specific and treatment-dependent neutron dose calculations.
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Affiliation(s)
- R Sayah
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN)-PRP-HOM/SDE-BP17, F-92262 Fontenay-aux-Roses Cedex, France
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Kannan V, Misra BK, Kapadia A, Bajpai R, Deshpande S, Almel S, Sankhe M, Desai K, Shaikh M, Anand V, Kannan A, Teo WY, Ross J, Bollo R, Seow WT, Tan AM, Kang SG, Kim DS, Li XN, Lau CC, Mohila CA, Adesina A, Su J, Ichimura K, Fukushima S, Matsushita Y, Tomiyama A, Niwa T, Suzuki T, Nakazato Y, Mukasa A, Kumabe T, Nagane M, Iuchi T, Mizoguchi M, Tamura K, Sugiyama K, Nakada M, Kanemura Y, Yokogami K, Matsutani M, Shibata T, Nishikawa R, Takami H, Fukushima S, Fukuoka K, Yanagisawa T, Nakamura T, Arita H, Narita Y, Shibui S, Nishikawa R, Ichimura K, Matsutani M, Sands S, Guerry W, Kretschmar C, Donahue B, Allen J, Matsutani M, Nishikawa R, Kumabe T, Sugiyama K, Nakamura H, Sawamura Y, Fujimaki T, Hattori E, Arakawa Y, Kawabata Y, Aoki T, Miyamoto S, Kagawa N, Hirayama R, Fujimoto Y, Chiba Y, Kinoshita M, Takano K, Eino D, Fukuya S, Nakanishi K, Yamamoto F, Hashii Y, Hashimoto N, Hara J, Yoshimine T, Murray M, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson J, Sumerauer D, Zapotocky M, Churackova M, Cyprova S, Zamecnik J, Malinova B, Kyncl M, Tichy M, Stary J, Lassen-Ramshad Y, von Oettingen G, Agerbaek M, Ohnishi T, Kohno S, Inoue A, Ohue S, Kohno S, Iwata S, Inoue A, Ohue S, Kumon Y, Ohnishi T, Acharya S, DeWees T, Shinohara E, Perkins S, Kato H, Fuji H, Nakasu Y, Ishida Y, Okawada S, Yang Q, Guo C, Chen Z, Alapetite C, Faure-Conter C, Verite C, Pagnier A, Laithier V, Entz-Werle N, Gorde-Grosjean S, Palenzuela G, Lemoine P, Frappaz D, Nguyen HA, Bui L, Ngoc, Cerbone M, Ederies A, Losa L, Moreno C, Sun K, Spoudeas HA, Nakano Y, Okada K, Kosaka Y, Nagashima T, Hashii Y, Kagawa N, Soejima T, Osugi Y, Sakamoto H, Hara J, Nicholson J, Alapetite C, Kortmann RD, Garre ML, Ricardi U, Saran F, Frappaz D, Calaminus G, Muda Z, Menon B, Ibrahim H, Rahman EJA, Muhamad M, Othman IS, Thevarajah A, Cheng S, Kilday JP, Laperriere N, Drake J, Bouffet E, Bartels U, Sakamoto H, Matsusaka Y, Watanabe Y, Umaba R, Hara J, Osugi Y, Alapetite C, Ruffier-Loubiere A, De Marzi L, Bolle S, Claude L, Habrand JL, Brisse H, Frappaz D, Doz F, Bourdeaut F, Dendale R, Mazal A, Fournier-Bidoz N, Fujimaki T, Fukuoka K, Shirahata M, Suzuki T, Adachi JI, Mishima K, Wakiya K, Matsutani M, Nishikawa R, Fukushima S, Yamashita S, Kato M, Nakamura H, Takami H, Suzuki T, Yanagisawa T, Mukasa A, Kumabe T, Nagane M, Sugiyama K, Tamura K, Narita Y, Shibui S, Shibata T, Ushijima T, Matsutani M, Nishikawa R, Ichimura K, Consortium IGA, Calaminus G, Kortmann RD, Frappaz D, Alapetite C, Garre ML, Ricardi U, Saran FH, Nicholson J, Calaminus G, Kortmann RD, Frappaz D, Alapetite C, Garre ML, Ricardi U, Saran FH, Nicholson J, Czech T, Nicholson J, Frappaz D, Kortmann RD, Alapetite C, Garre ML, Ricardi U, Saran F, Calaminus G, Hayden J, Bartels U, Calaminus G, Joseph R, Nicholson J, Hale J, Lindsay H, Kogiso M, Qi L, Yee TW, Huang Y, Mao H, Lin F, Baxter P, Su J, Terashima K, Perlaky L, Lau C, Parsons D, Chintagumpala M, Li XAN, Osorio D, Vaughn D, Gardner S, Mrugala M, Ferreira M, Keene C, Gonzalez-Cuyar L, Hebb A, Rockhill J, Wang L, Yamaguchi S, Burstein M, Terashima K, Ng HK, Nakamura H, He Z, Suzuki T, Nishikawa R, Natsume A, Terasaka S, Dauser R, Whitehead W, Adesina A, Sun J, Munzy D, Gibbs R, Leal S, Wheeler D, Lau C, Dhall G, Robison N, Judkins A, Krieger M, Gilles F, Park J, Lee SU, Kim T, Choi Y, Park HJ, Shin SH, Kim JY, Robison N, Dhir N, Khamani J, Margol A, Wong K, Britt B, Evans A, Nelson M, Grimm J, Finlay J, Dhall G. GERM CELL TUMOURS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Farah J, Martinetti F, Sayah R, Lacoste V, Donadille L, Trompier F, Nauraye C, Marzi LD, Vabre I, Delacroix S, Hérault J, Clairand I. Monte Carlo modeling of proton therapy installations: a global experimental method to validate secondary neutron dose calculations. Phys Med Biol 2014; 59:2747-65. [DOI: 10.1088/0031-9155/59/11/2747] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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De Marzi L, Ottaviano L, Perrozzi F, Nardone M, Santucci S, De Lapuente J, Borras M, Treossi E, Palermo V, Poma A. Flake size-dependent cyto and genotoxic evaluation of graphene oxide on in vitro A549, CaCo2 and vero cell lines. J BIOL REG HOMEOS AG 2014; 28:281-289. [PMID: 25001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study was carried out by varying both graphene oxide (GO) concentration (10 μg/mL, 50 μg/mL, 100 μg/mL) and flakes sizes of 1320 nm and 130 nm. Characterization by scanning electron microscopy and Raman spectroscopy demonstrate that the area of GO flakes varies of one order of magnitude but their chemical structure remains unmodified. A 24-h cytotoxicity test showed, for A549, a loss in the viability, while the test exhibits overall a positive increase in the viability for CaCo2 and Vero. A 24-h comet assay shows a marked GO genotoxicity: for micrometer-sized GO flakes the genotoxicity is in positive correlation with the concentration, while for nanometer-sized GO flakes there was a high degree of genotoxicity at the lowest concentration tested.
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Affiliation(s)
- L De Marzi
- Department of Life, Health and Environmental Sciences, University of LAquila, LAquila, Italy
| | - L Ottaviano
- Department of Physical and Chemical Sciences, University of LAquila, LAquila, Italy
| | - F Perrozzi
- Department of Physical and Chemical Sciences, University of LAquila, LAquila, Italy
| | - M Nardone
- Department of Physical and Chemical Sciences, University of LAquila, LAquila, Italy
| | - S Santucci
- Department of Physical and Chemical Sciences, University of LAquila, LAquila, Italy
| | - J De Lapuente
- Unit of Experimental Toxicology and Ecotoxicology CERETOX, Barcelona Science Park Barcelona, Spain
| | - M Borras
- Unit of Experimental Toxicology and Ecotoxicology CERETOX, Barcelona Science Park Barcelona, Spain
| | | | | | - A Poma
- Department of Life, Health and Environmental Sciences, University of LAquila, LAquila, Italy
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Bonfrate A, Farah J, De Marzi L, Delacroix S, Fontaine J, Hérault J, Sayah R, Trompier F, Lee C, Bolch W, Clairand I. Secondary doses to healthy tissues during proton therapy treatments: influence of irradiation parameters. Phys Med 2014. [DOI: 10.1016/j.ejmp.2014.07.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Feuvret L, Calugaru V, Bolle S, De Marzi L, Nauraye C, Alapetite C, Mammar H, Habrand JL, Dendale R. Irradiation par protons de chondrosarcome de la base du crâne : expérience du centre de protonthérapie d’Orsay. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chea M, Llagostera C, Meyer P, Cristina K, Itti R, Culot F, De Marzi L, Cuenca X, Mahé M, Mazeron J, Lisbona A, Jenny C. Feasibility study of total marrow irradiation using helical tomotherapy. Phys Med 2013. [DOI: 10.1016/j.ejmp.2013.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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De Marzi L, Lesven C, Ferrand R, Sage J, Boulé T, Mazal A. Calibration of CT Hounsfield units for proton therapy treatment planning: use of kilovoltage and megavoltage images and comparison of parameterized methods. Phys Med Biol 2013; 58:4255-76. [PMID: 23719506 DOI: 10.1088/0031-9155/58/12/4255] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Proton beam range is of major concern, in particular, when images used for dose computations are artifacted (for example in patients with surgically treated bone tumors). We investigated several conditions and methods for determination of computed tomography Hounsfield unit (CT-HU) calibration curves, using two different conversion schemes. A stoichiometric methodology was used on either kilovoltage (kV) or megavoltage (MV) CT images and the accuracy of the calibration methods was evaluated. We then studied the effects of metal artifacts on proton dose distributions using metallic implants in rigid phantom mimicking clinical conditions. MV-CT images were used to evaluate relative proton stopping power in certain high density implants, and a methodology is proposed for accurate delineation and dose calculation, using a combined set of kV- and MV-CT images. Our results show good agreement between measurements and dose calculations or relative proton stopping power determination (<5%). The results also show that range uncertainty increases when only kV-CT images are used or when no correction is made on artifacted images. However, differences between treatment plans calculated on corrected kV-CT data and MV-CT data remained insignificant in the investigated patient case, even with streak artifacts and volume effects that reduce the accuracy of manual corrections.
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Affiliation(s)
- L De Marzi
- Institut Curie-Centre de protonthérapie d'Orsay, France.
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Vogin G, Biston M, Marchesi V, Amessis M, Zefkili S, De Marzi L, Lacroix F, Leroy A, Gassa F, Helfre S. Sarcome d’Ewing localisé au rachis : une étude d’escalade de dose chez l’enfant. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Vidal M, De Marzi L, Szymanowski H, Nauraye C, Grevillot L, Hierso E, Ferrand R, Freud N, Sarrut D. Proton therapy aperture contamination analytical model: consequences on dose calculation. Phys Med 2011. [DOI: 10.1016/j.ejmp.2011.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Habrand JL, Bolle S, Datchary J, Alapetite C, Petras S, Helfre S, Feuvret L, Calugaru V, De Marzi L, Bouyon-Monteau A, Dendale R, Kalifa C, Grill J, Doz F. La protonthérapie en radiothérapie pédiatrique. Cancer Radiother 2009; 13:550-5. [DOI: 10.1016/j.canrad.2009.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Revised: 06/29/2009] [Accepted: 07/01/2009] [Indexed: 11/29/2022]
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Habrand J, Bolle S, Pétras S, Schneider R, Alapetite C, Helfre S, Feuvret L, De Marzi L, Beaudré A, Bey P. Tolerance to High Dose Proton Therapy of Normal CNS Structures in Children. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stefanelli P, De Marzi L, Robino L, Roman D, Basso F, D'Orazio P, Di Tommaso S, Vasile E, Caciolo E, Spigaglia P, Mastrantonio P. Characterization of Bordetella pertussis strains of recent isolation. New Microbiol 1999; 22:187-94. [PMID: 10423736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
During the clinical trial conducted in Italy to evaluate the efficacy of new acellular pertussis vaccines, the most favorable conditions for the recovery and characterization of Bordetella pertussis strains, isolated from children with cough, were adopted. The nasopharyngeal aspirates were collected and sent to the laboratory in refrigerated conditions within 24 hours. Charcoal agar selective and non selective plates were used, and most of the isolates were recovered after 3-4 days of incubation. Confirmation of all suspected colonies included the use of biochemical tests and specific agglutination reaction with B. pertussis antiserum. Serotyping of fimbriae, susceptibility to erythromycin and DNA fingerprinting by Pulsed Field Gel Electrophoresis (PFGE), were performed to characterize B. pertussis isolates and to determine relatedness among different strains. Serotype 1,3 was the most represented in the bacterial population examined. A predominant pulsetype (PTA) characterized most of the isolates accounting for 71.4% of the strains examined. Eight subclones (23.5%) and three unrelated pulsetypes were also found. No resistant strains to erythromycin were detected.
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Affiliation(s)
- P Stefanelli
- Laboratory of Bacteriology and Medical Mycology, Istituto Superiore di Sanità, Rome, Italy
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Mastrantonio P, Giuliano M, Stefanelli P, Sofia T, De Marzi L, Tarabini G, Quarto M, Moiraghi A. Bordetella parapertussis infections. Dev Biol Stand 1997; 89:255-9. [PMID: 9272358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The rate of isolation of Bordetella parapertussis among children with cough during the follow-up of different clinical efficacy studies has been evaluated. In the Italian trial, a comparison of clinical characteristics between B. pertussis and B. parapertussis infections showed lower frequencies and shorter duration of typical symptoms of whooping cough such as paroxysmal coughing, whooping, and vomiting in the group of children affected with B. parapertussis infections. In about 70% of B. parapertussis infections, there was a two-fold increase of IgA or IgG anti-FHA from acute- and convalescent-phase serum specimens. The analysis of the distribution of B. parapertussis cases in children fully immunized with each pertussis vaccine suggested that vaccination is irrelevant in preventing B. parapertussis infection.
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Affiliation(s)
- P Mastrantonio
- Laboratory of Bacteriology and Medical Mycology, Istituto Superiore di Sanità, Rome, Italy
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Trivello R, Ngatchu T, Marin V, Moretti G, Malatesta R, Maini P, Moschen ME, Baldo V, De Marzi L, Majori S, Puppo A, Renzulli G. Immunity status to polioviruses among non-European union immigrants in Veneto Region (North-East Italy). Ann Clin Lab Sci 1996; 26:154-9. [PMID: 8852425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Widespread use of poliovirus vaccines has lead to a dramatic decline on the incidence of paralytic poliomyelitis in the Western Hemisphere. In Italy, the use of live attenuated vaccine (OPV) has lead to virtual eradication of poliomyelitis. However, wild poliovirus is still endemic in some less developed countries, and there is still a risk of importation of wild-virus poliomyelitis as result of immigration from these areas. Therefore, a serologic study of the immunologic status to poliovirus was carried out in 242 immigrants from less developed countries in the Veneto Region (North-East Italy). The overall prevalence of serum neutralizing antibodies was 98.3 percent for poliovirus type 1, 99.6 percent for type 2, and 95.9 percent for type 3. The modal titres were 1:128 (21.1 percent), 1:512 (26.4 percent), and 1:32 (22.3 percent) for poliovirus type 1, type 2, and type 3, respectively. No subject was simultaneously lacking neutralizing antibodies to all three polioviruses. The mean duration of stay in Italy before testing was 1.53 years (range 1 month to 7 years). These results show a good level of the immunity status, similar to those found in the Veneto general population. Although the risk of paralytic poliomyelitis in our population is very low, seronegative immigrants originating from areas of high endemicity could reintroduce wild poliovirus. It is therefore important to maintain a careful surveillance system on the importation of wild poliovirus and to plan vaccination programs for unprotected immigrants.
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Affiliation(s)
- R Trivello
- Institute of Hygiene, University of Padua, Italy
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