Proton Treatment Suppresses Exosome Production in Head and Neck Squamous Cell Carcinoma

Proton therapy (PT) is emerging as an effective and less toxic alternative to conventional X-ray-based photon therapy (XRT) for patients with advanced head and neck squamous cell carcinomas (HNSCCs) owing to its clustered dose deposition dosimetric characteristics. For optimal efficacy, cancer therapies, including PT, must elicit a robust anti-tumor response by effector and cytotoxic immune cells in the tumor microenvironment (TME). While tumor-derived exosomes contribute to immune cell suppression in the TME, information on the effects of PT on exosomes and anti-tumor immune responses in HNSCC is not known. In this study, we generated primary HNSCC cells from tumors resected from HNSCC patients, irradiated them with 5 Gy PT or XRT, and isolated exosomes from cell culture supernatants. HNSCC cells exposed to PT produced 75% fewer exosomes than XRT- and non-irradiated HNSCC cells. This effect persisted in proton-irradiated cells for up to five days. Furthermore, we observed that exosomes from proton-irradiated cells were identical in morphology and immunosuppressive effects (suppression of IFN-γ release by peripheral blood mononuclear cells) to those of photon-irradiated cells. Our results suggest that PT limits the suppressive effect of exosomes on cancer immune surveillance by reducing the production of exosomes that can inhibit immune cell function.

Reconstruction of thermoacoustic emission sources induced by proton irradiation using numerical time reversal

Objective.Mapping of dose delivery in proton beam therapy can potentially be performed by analyzing thermoacoustic emissions measured by ultrasound arrays. Here, a method is derived and demonstrated for spatial mapping of thermoacoustic sources using numerical time reversal, simulating re-transmission of measured emissions into the medium.Approach.Spatial distributions of thermoacoustic emission sources are shown to be approximated by the analytic-signal form of the time-reversed acoustic field, evaluated at the time of the initial proton pulse. Given calibration of the array sensitivity and knowledge of tissue properties, this approach approximately reconstructs the acoustic source amplitude, equal to the product of the time derivative of the radiation dose rate, mass density, and Grüneisen parameter. This approach was implemented using two models for acoustic fields of the array elements, one modeling elements as line sources and the other as rectangular radiators. Thermoacoustic source reconstructions employed previously reported measurements of emissions from proton energy deposition in tissue-mimicking phantoms. For a phantom incorporating a bone layer, reconstructions accounted for the higher sound speed in bone. Dependence of reconstruction quality on array aperture size and signal-to-noise ratio was consistent with previous acoustic simulation studies.Main results.Thermoacoustic source distributions were successfully reconstructed from acoustic emissions measured by a linear ultrasound array. Spatial resolution of reconstructions was significantly improved in the azimuthal (array) direction by incorporation of array element diffraction. Source localization agreed well with Monte Carlo simulations of energy deposition, and was improved by incorporating effects of inhomogeneous sound speed.Significance.The presented numerical time reversal approach reconstructs thermoacoustic sources from proton beam radiation, based on straightforward processing of acoustic emissions measured by ultrasound arrays. This approach may be useful for ranging and dosimetry of clinical proton beams, if acoustic emissions of sufficient amplitude and bandwidth can be generated by therapeutic proton sources.

AAPM Report 373: The content, structure, and value of the Professional Doctorate in Medical Physics (DMP)

The Professional Doctorate in Medical Physics (DMP) was originally conceived as a solution to the shortage of medical physics residency training positions. While this shortage has now been largely satisfied through conventional residency training positions, the DMP has expanded to multiple institutions and grown into an educational pathway that provides specialized clinical training and extends well beyond the creation of additional training spots. As such, it is important to reevaluate the purpose and the value of the DMP. Additionally, it is important to outline the defining characteristics of the DMP to assure that all existing and future programs provide this anticipated value. Since the formation and subsequent accreditation of the first DMP program in 2009–2010, four additional programs have been created and accredited. However, no guidelines have yet been recommended by the American Association of Physicists in Medicine. CAMPEP accreditation of these programs has thus far been based only on the respective graduate and residency program standards. This allows the development and operation of DMP programs which contain only the requisite Master of Science (MS) coursework and a 2‐year clinical training program. Since the MS plus 2‐year residency pathway already exists, this form of DMP does not provide added value, and one may question why this existing pathway should be considered a doctorate. Not only do we, as a profession, need to outline the defining characteristics of the DMP, we need to carefully evaluate the potential advantages and disadvantages of this pathway within our education and training infrastructure. The aims of this report from the Working Group on the Professional Doctorate Degree for Medical Physicists (WGPDMP) are to (1) describe the current state of the DMP within the profession, (2) make recommendations on the structure and content of the DMP for existing and new DMP programs, and (3) evaluate the value of the DMP to the profession of medical physics.

Modification of a linear accelerator table top for non-coplanar conformal brain radiotherapy

The use of non-coplanar conformal therapy necessitates the use of unusual beam projections that may not be accomplished with a conventional linear accelerator table top. Modification of the table top can increase the available combinations of gantry and couch rotation. A standard Philips table top, supplied with an SL 75-5 linear accelerator, was modified to increase available combinations of gantry and couch rotation. This was accomplished by shortening the length and decreasing the width of the table top. The modified table top increases the combinations of gantry and couch angles significantly, simplifying the delivery of non-coplanar conformal therapy without significant compromise to routine treatment. The modification of a standard linear accelerator table top has increased the available combinations of gantry and couch rotation to accommodate non-coplanar conforrmal radiotherapy.

Comparison of effectiveness of thermoluminescent crystals LiF:Mg,Ti, and LiF:Mg,Cu,P for clinical dosimetry

This study compared the relative effectiveness of TLD crystals LiF:Mg,Ti (TLD-100) and LiF:Mg,Cu,P (TLD-700H) for clinical dosimetry, focusing on reproducibility, linearity, and energy response. Experimental results indicated that TLD-700H was superior to TLD-100 with regard to reproducibility, lack of supralinearity, and the absence of variation in TL signal with radiation quality. TLD-700H also had the additional advantages of higher sensitivity and immediate readability. The investigators conclude that this relatively new TLD crystal shows promising potential for clinical dosimetry.

A self-collimating convolution backprojection algorithm for optimizing dose distributions of I-125 prostate implants

The algorithm presented here for optimizing brachytherapy dose distributions is based on the idea that the seed distribution can be modeled as an activity distribution determined analogously to gamma camera imaging. The peripheral dose to the tumor is converted to a set of uncollimated projection data that are then filtered and backprojected to produce an initial seed distribution. The actual doses resulting from the seed placement are used to correct the initial projection data for attenuation, scatter, and lack of collimation. The corrected projection data are backprojected a second time to yield the optimized but unconstrained seed distribution. Clinical constraints such as the number of different seed activities, the maximum seed activity, the minimum peripheral tumor dose, and the minimum percentage of the volume which receives less than a specified dose are then applied to the unconstrained solution. Through the entire process, the dose calculations are functions of source anisotropy, scatter, and attenuation. When applied to a set of elliptical contours, the algorithm produces elliptical peripheral dose isodose contours and reasonable dose volume histograms for a constrained solution. The results for actual patient prostate contours were not as good, primarily because of the difficulties encountered in dealing with the irregular geometry of the prostate. However, the algorithm shows promise for further research.

A method to reduce systematic spatial shift associated with magnetic resonance imaging

To reduce the chemical shifts during magnetic resonance (MR) imaging, the authors replaced the petroleum gel in the Brown-Roberts-Well (BRW) MR localizer with chromium chloride. Computed tomography and MR scans were obtained of a phantom skull containing objects with known spatial coordinates. A 2-to 3-mm systematic spatial shift in the frequency-encoded direction was observed with petroleum gel, but not with CrCl3. Results were verified by reconstructing the three-dimensional spatial location of each object using X-Knife computer software. The authors conclude that spatial localization is more accurate with a CrCl3-filled than a petroleum-filled BRW-MR localizer.