A simplified protocol for the treatment of acute radiation overexposures from sources external to the body

When compared to other types of occupational injuries, radiation overexposure events are somewhat rare, so health care providers may not be familiar with the actual clinical care to be provided when such an event occurs. Radiation overexposure treatment decisions are predicated on the amount of radiation dose received, which is a value many health care providers may not have the knowledge or expertise to either calculate or even estimate. Even the different units of measure for radiation exposure and dose received can be a source of confusion. The prompt treatment of radiation overexposure victims could be enhanced and facilitated through the creation of a single, simple protocol that consists of the various means of dose measurement and estimation, correlated to the corresponding appropriate clinical care measures. This culminating experience will assemble essential information currently maintained in disparate references to create a single, simplified protocol to facilitate the treatment of victims of acute external radiation overexposure. ^

Comparison of Tumor Shrinkage and Cumulative Dose Distribution for Lung Cancers

Background: The physical characteristic of protons is that they deliver most of their radiation dose to the target volume and deliver no dose to the normal tissue distal to the tumor. Previously, numerous studies have shown unique advantages of proton therapy over intensity-modulated radiation therapy (IMRT) in conforming dose to the tumor and sparing dose to the surrounding normal tissues and the critical structures in many clinical sites. However, proton therapy is known to be more sensitive to treatment uncertainties such as inter- and intra-fractional variations in patient anatomy. To date, no study has clearly demonstrated the effectiveness of proton therapy compared with the conventional IMRT under the consideration of both respiratory motion and tumor shrinkage in non-small cell lung cancer (NSCLC) patients. Purpose: This thesis investigated two questions for establishing a clinically relevant comparison of the two different modalities (IMRT and proton therapy). The first question was whether or not there are any differences in tumor shrinkage between patients randomized to IMRT versus passively scattered proton therapy (PSPT). Tumor shrinkage is considered a standard measure of radiation therapy response that has been widely used to gauge a short-term progression of radiation therapy. The second question was whether or not there are any differences between the planned dose and 5D dose under the influence of inter- and intra-fractional variations in the patient anatomy for both modalities. Methods: A total of 45 patients (25 IMRT patients and 20 PSPT patients) were used to quantify the tumor shrinkage in terms of the change of the primary gross tumor volume (GTVp). All patients were randomized to receive either IMRT or PSPT for NSCLC. Treatment planning goals were identical for both groups. All patients received 5 to 8 weekly repeated 4-dimensional computed tomography (4DCT) scans during the course of radiation treatments. The original GTVp contours were propagated to T50 of weekly 4DCT images using deformable image registration and their absolute volumes were measured. Statistical analysis was performed to compare the distribution of tumor shrinkage between the two population groups. In order to investigate the difference between the planned dose and the 5D dose with consideration of both breathing motion and anatomical change, we re-calculated new dose distributions at every phase of the breathing cycle for all available weekly 4DCT data sets which resulted 50 to 80 individual dose calculations for each of the 7 patients presented in this thesis. The newly calculated dose distributions were then deformed and accumulated to T50 of the planning 4DCT for comparison with the planned dose distribution. Results: At the end of the treatment, both IMRT and PSPT groups showed mean tumor volume reductions of 23.6% ( 19.2%) and 20.9% ( 17.0 %) respectively. Moreover, the mean difference in tumor shrinkage between two groups is 3% along with the corresponding 95% confidence interval, [-8%, 14%]. The rate of tumor shrinkage was highly correlated with the initial tumor volume size. For the planning dose and 5D dose comparison study, all 7 patients showed a mean difference of 1 % in terms of target coverage for both IMRT and PSPT treatment plans. Conclusions: The results of the tumor shrinkage investigation showed no statistically significant difference in tumor shrinkage between the IMRT and PSPT patients, and the tumor shrinkage between the two modalities is similar based on the 95% confidence interval. From the pilot study of comparing the planned dose with the 5D dose, we found the difference to be only 1%. Overall impression of the two modalities in terms of treatment response as measured by the tumor shrinkage and 5D dose under the influence of anatomical change that were designed under the same protocol (i.e. randomized trial) showed similar result.

Transcription and activity of antioxidant enzymes after ionizing irradiation in radiation-resistant and radiation-sensitive mice

The involvement of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase in radiobiological processes has been described at the enzyme activity level. We irradiated radiation-resistant (RR) and radiation-sensitive (RS) mice and studied antioxidant enzymes at the transcriptional and activity level. In addition, aromatic hydroxylation and lipid peroxidation parameters were determined to study radiation resistance at the oxidation level. RS BALB/c/J Him mice and RR C3H He/Him mice were whole-body-irradiated with x-rays at 2, 4, and 6 Gy and killed 5, 15, and 30 min after irradiation. mRNA was isolated from liver and hybridized with probes for antioxidant enzymes and β-actin as a housekeeping gene control. Antioxidant enzyme activities were determined by standard assays. Parameters for aromatic hydroxylation (o-tyrosine) and lipid peroxidation (malondialdehyde) were determined by HPLC methods. Antioxidant transcription was unchanged in contrast to antioxidant activities; SOD and CAT activities were elevated within 15 min in RR animals but not in RS mice, at all doses studied. Glutathione peroxidase activity was not different between RR and RS mice and was only moderately elevated after irradiation. No significant differences were found between RR and RS animals at the oxidation level, although a radiation dose-dependent increase of oxidation products was detected in both groups. We found that ionizing irradiation led to increased antioxidant activity only minutes after irradiation in the absence of increased transcription of these antioxidant enzymes. RR animals show higher antioxidant enzyme activities than do RS mice, but oxidation products are comparable in RS and RR mice. As unchanged transcription of antioxidant enzymes could not have been responsible for the increased antioxidant enzyme activities, preformed antioxidant enzymes should have been released by the irradiation process. This would be in agreement with previous studies of preformed, stored SOD. The finding of higher SOD and CAT activities in RR than in RS animals could point to a role for these antioxidant enzymes for the process of radiation sensitivity.

Estimativa de dose nos pulmões para procedimentos de tomografia computadorizada

Desde o seu desenvolvimento na década de 1970 a tomografia computadorizada (TC) passou por grandes mudanças tecnológicas, tornando-se uma importante ferramenta diagnóstica para a medicina. Consequentemente o papel da TC em diagnóstico por imagem expandiu-se rapidamente, principalmente devido a melhorias na qualidade da imagem e tempo de aquisição. A dose de radiação recebida por pacientes devido a tais procedimentos vem ganhando atenção, levando a comunidade científica e os fabricantes a trabalharem juntos em direção a determinação e otimização de doses. Nas últimas décadas muitas metodologias para dosimetria em pacientes têm sido propostas, baseadas especialmente em cálculos utilizando a técnica Monte Carlo ou medições experimentais com objetos simuladores e dosímetros. A possibilidade de medições in vivo também está sendo investigada. Atualmente as principais técnicas para a otimização da dose incluem redução e/ou modulação da corrente anódica. O presente trabalho propõe uma metodologia experimental para estimativa de doses absorvidas pelos pulmões devido a protocolos clínicos de TC, usando um objeto simulador antropomórfico adulto e dosímetros termoluminescentes de Fluoreto de Lítio (LiF). Sete protocolos clínicos diferentes foram selecionados, com base em sua relevância com respeito à otimização de dose e frequência na rotina clínica de dois hospitais de grande porte: Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad) e Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira (ICESP). Quatro protocolos de otimização de dose foram analisados: Auto mA, Auto + Smart mA, Baixa Dose (BD) e Ultra Baixa Dose (UBD). Os dois primeiros protocolos supracitados buscam redução de dose por meio de modulação da corrente anódica, enquanto os protocolos BD e UBD propõem a redução do valor da corrente anódica, mantendo-a constante. Os protocolos BD e UBD proporcionaram redução de dose de 72,7(8) % e 91(1) %, respectivamente; 16,8(1,3) % e 35,0(1,2) % de redução de dose foram obtidas com os protocolos Auto mA e Auto + Smart mA, respectivamente. As estimativas de dose para os protocolos analisados neste estudo são compatíveis com estudos similares publicados na literatura, demonstrando a eficiência da metodologia para o cálculo de doses absorvidas no pulmão. Sua aplicabilidade pode ser estendida a diferentes órgãos, diferentes protocolos de CT e diferentes tipos de objetos simuladores antropomórficos (pediátricos, por exemplo). Por fim, a comparação entre os valores de doses estimadas para os pulmões e valores de estimativas de doses dependentes do tamanho (Size Specific Dose Estimates SSDE) demonstrou dependência linear entre as duas grandezas. Resultados de estudos similares exibiram comportamentos similares para doses no reto, sugerindo que doses absorvidas pelos uma órgãos podem ser linearmente dependente dos valores de SSDE, com coeficientes lineares específicos para cada órgão. Uma investigação mais aprofundada sobre doses em órgãos é necessária para avaliar essa hipótese.

Estimation of Radioactive Dose from Oysters consumed at Hiroshima following a Bomb Detonation, report to Department of Veterans Affairs

We have estimated of the maximum radiation dose received from consuming an oyster at Hiroshima following the A-bomb detonation in 1945

Highly radiation sensitive type IA FBGs for future dosimetry applications

We have studied Co60 gamma-irradiation effect on the characteristics of Type IA fiber Bragg gratings. A record Bragg peak shift of 190 pm was observed for a grating written in Fibercore PS-1250/1500 photosensitive fiber at a radiation dose of 116 kGy. Type IA and Type I gratings show different kinetics under radiation and during post-radiation annealing, which can be used for the design of a grating based dosimetry system.

Highly radiation sensitive type IA FBGs for dosimetry applications

We have studied Co60 ionizing radiation effect on the characteristics of Type IA fiber Bragg gratings. A record Bragg peak shift of 190 pm was observed for a grating written in Fibercore PS-1250/1500 photosensitive fiber at a radiation dose of 116 kGy. Type IA and Type I gratings show different kinetics under radiation and during post-radiation annealing, which can be used for the design of a grating based dosimetry system.

Highly radiation sensitive type IA FBGs for future dosimetry applications

We have studied Co60 gamma-irradiation effect on the characteristics of Type IA fiber Bragg gratings. A record Bragg peak shift of 190 pm was observed for a grating written in Fibercore PS-1250/1500 photosensitive fiber at a radiation dose of 116 kGy. Type IA and Type I gratings show different kinetics under radiation and during post-radiation annealing, which can be used for the design of a grating based dosimetry system.

Highly radiation sensitive type IA FBGs for dosimetry applications

We have studied Co60 ionizing radiation effect on the characteristics of Type IA fiber Bragg gratings. A record Bragg peak shift of 190 pm was observed for a grating written in Fibercore PS-1250/1500 photosensitive fiber at a radiation dose of 116 kGy. Type IA and Type I gratings show different kinetics under radiation and during post-radiation annealing, which can be used for the design of a grating based dosimetry system.

Highly sensitive type IA fiber Bragg gratings as sensors in radiation environments

Type IA fiber gratings have unusual physical properties compared with other grating types. We compare with performance characteristics of Type IA and Type I Bragg gratings exposed to the effects of Co60 gamma-irradiation. A Bragg peak shift of 190 pm was observed for Type IA gratings written in Fibercore PS-1250/1500 photosensitive fiber at a radiation dose of 116 kGy. This is the largest wavelength shift recorded to date under radiation exposure. The Type IA and Type I gratings show different kinetics under radiation and during post-radiation annealing; this can be exploited for the design of a grating based dosimetry system. © 2012 SPIE.

Prospective Estimation of Organ Dose Prior to Examination: Matching Patient to Digital Phantoms

Prospective estimation of patient CT organ dose prior to examination can help technologist adjust CT scan settings to reduce radiation dose to patient while maintaining certain image quality. One possible way to achieve this is matching patient to digital models precisely. In previous work, patient matching was performed manually by matching the trunk height which was defined as the distance from top of clavicle to bottom of pelvis. However, this matching method is time consuming and impractical in scout images where entire trunk is not included. Purpose of this work was to develop an automatic patient matching strategy and verify its accuracy.

Automated Assessment of Image Quality and Dose Attributes in Clinical CT Images

Computed tomography (CT) is a valuable technology to the healthcare enterprise as evidenced by the more than 70 million CT exams performed every year. As a result, CT has become the largest contributor to population doses amongst all medical imaging modalities that utilize man-made ionizing radiation. Acknowledging the fact that ionizing radiation poses a health risk, there exists the need to strike a balance between diagnostic benefit and radiation dose. Thus, to ensure that CT scanners are optimally used in the clinic, an understanding and characterization of image quality and radiation dose are essential.

The state-of-the-art in both image quality characterization and radiation dose estimation in CT are dependent on phantom based measurements reflective of systems and protocols. For image quality characterization, measurements are performed on inserts imbedded in static phantoms and the results are ascribed to clinical CT images. However, the key objective for image quality assessment should be its quantification in clinical images; that is the only characterization of image quality that clinically matters as it is most directly related to the actual quality of clinical images. Moreover, for dose estimation, phantom based dose metrics, such as CT dose index (CTDI) and size specific dose estimates (SSDE), are measured by the scanner and referenced as an indicator for radiation exposure. However, CTDI and SSDE are surrogates for dose, rather than dose per-se.

Currently there are several software packages that track the CTDI and SSDE associated with individual CT examinations. This is primarily the result of two causes. The first is due to bureaucracies and governments pressuring clinics and hospitals to monitor the radiation exposure to individuals in our society. The second is due to the personal concerns of patients who are curious about the health risks associated with the ionizing radiation exposure they receive as a result of their diagnostic procedures.

An idea that resonates with clinical imaging physicists is that patients come to the clinic to acquire quality images so they can receive a proper diagnosis, not to be exposed to ionizing radiation. Thus, while it is important to monitor the dose to patients undergoing CT examinations, it is equally, if not more important to monitor the image quality of the clinical images generated by the CT scanners throughout the hospital.

The purposes of the work presented in this thesis are threefold: (1) to develop and validate a fully automated technique to measure spatial resolution in clinical CT images, (2) to develop and validate a fully automated technique to measure image contrast in clinical CT images, and (3) to develop a fully automated technique to estimate radiation dose (not surrogates for dose) from a variety of clinical CT protocols.

(Table 1) Maximal daily erythemally effective UVB radiation and total ozone content at Vernadsky Station, Antarctica

One of the research programs carried out within the Czech-Ukrainian scientific co-operation is the monitoring of global solar and ultraviolet radiation at the Vernadsky Station (formerly the British Faraday Station), Antarctica. Radiation measurements have been made since 2002. Recently, a special attention is devoted to the measurements of the erythemally effective UVB radiation using a broadband Robertson Berger 501 UV-Biometer (Solar Light Co. Inc., USA). This paper brings some results from modelling the daily sums of erythemally effective UVB radiation intensity in relation to the total ozone content (TOC) in atmosphere and surface intensity of the global solar radiation. Differences between the satellite- and ground-based measurements of the TOC at the Vernadsky Station are taken into consideration. The modelled erythemally effective UVB radiation differed slightly depending on the seasons and sources of the TOC. The model relative prediction error for ground- and satellite-based measurements varied between 9.5% and 9.6% in the period of 2002-2003, while it ranged from 7.4% to 8.8% in the period of 2003-2004.

Growth and photosynthesis of a diatom Cylindrotheca closterium grown under elevated CO2 in the presence of solar UV radiation

The combination of elevated CO2 and the increased acidity in surface oceans is likely to have an impact on photosynthesis via its effects on inorganic carbon speciation and on the overall energetics of phytoplankton. Exposure to UV radiation (UVR) may also have a role in the response to elevated CO2 and acidification, due to the fact that UVR may variously impact on photosynthesis and because of the energy demand of UVR defense. The cell may gain energy by down-regulating the CO2 concentrating mechanism, which may lead to a greater ability to cope with UVR and/or higher growth rates. In order to clarify the interplay of cell responses to increasing CO2 and UVR, we investigated the photosynthetic response of the marine and estuarine diatom Cylindrotheca closterium f. minutissima cultured at either 390 (ambient) or 800 (elevated) ppmv CO2, while exposed to solar radiation with or without UVR (UVR, 280-400 nm). After a 6 day acclimation period, the growth rate of cells was little affected by elevated CO2 and no obvious correlation with the radiation dose (for both PAR and PAR + UV treatments) could be detected. However, the relative electron transport rate was reduced and was more sensitive to UVR in cells main - tained at elevated CO2 as compared to cells cultured at ambient CO2. The CO2 concentrating mechanism was down regulated at 800 ppmv CO2, but was apparently not completely switched off. These data are discussed with respect to their significance in the context of global climate change.

A cloud-based system for measuring radiation treatment plan similarity

PURPOSE: Radiation therapy is used to treat cancer using carefully designed plans that maximize the radiation dose delivered to the target and minimize damage to healthy tissue, with the dose administered over multiple occasions. Creating treatment plans is a laborious process and presents an obstacle to more frequent replanning, which remains an unsolved problem. However, in between new plans being created, the patient's anatomy can change due to multiple factors including reduction in tumor size and loss of weight, which results in poorer patient outcomes. Cloud computing is a newer technology that is slowly being used for medical applications with promising results. The objective of this work was to design and build a system that could analyze a database of previously created treatment plans, which are stored with their associated anatomical information in studies, to find the one with the most similar anatomy to a new patient. The analyses would be performed in parallel on the cloud to decrease the computation time of finding this plan. METHODS: The system used SlicerRT, a radiation therapy toolkit for the open-source platform 3D Slicer, for its tools to perform the similarity analysis algorithm. Amazon Web Services was used for the cloud instances on which the analyses were performed, as well as for storage of the radiation therapy studies and messaging between the instances and a master local computer. A module was built in SlicerRT to provide the user with an interface to direct the system on the cloud, as well as to perform other related tasks. RESULTS: The cloud-based system out-performed previous methods of conducting the similarity analyses in terms of time, as it analyzed 100 studies in approximately 13 minutes, and produced the same similarity values as those methods. It also scaled up to larger numbers of studies to analyze in the database with a small increase in computation time of just over 2 minutes. CONCLUSION: This system successfully analyzes a large database of radiation therapy studies and finds the one that is most similar to a new patient, which represents a potential step forward in achieving feasible adaptive radiation therapy replanning.