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O'Connell J, Weil MD, Bazalova-Carter M. Non-coplanar lung SABR treatments delivered with a gantry-mounted x-ray tube. Phys Med Biol 2024; 69:025002. [PMID: 38035372 DOI: 10.1088/1361-6560/ad111a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/30/2023] [Indexed: 12/02/2023]
Abstract
Objective.To create two non-coplanar, stereotactic ablative radiotherapy (SABR) lung patient treatment plans compliant with the radiation therapy oncology group (RTOG) 0813 dosimetric criteria using a simple, isocentric, therapy with kilovoltage arcs (SITKA) system designed to provide low cost external radiotherapy treatments for low- and middle-income countries (LMICs).Approach.A treatment machine design has been proposed featuring a 320 kVp x-ray tube mounted on a gantry. A deep learning cone-beam CT (CBCT) to synthetic CT (sCT) method was employed to remove the additional cost of planning CTs. A novel inverse treatment planning approach using GPU backprojection was used to create a highly non-coplanar treatment plan with circular beam shapes generated by an iris collimator. Treatments were planned and simulated using the TOPAS Monte Carlo (MC) code for two lung patients. Dose distributions were compared to 6 MV volumetric modulated arc therapy (VMAT) planned in Eclipse on the same cases for a Truebeam linac as well as obeying the RTOG 0813 protocols for lung SABR treatments with a prescribed dose of 50 Gy.Main results.The low-cost SITKA treatments were compliant with all RTOG 0813 dosimetric criteria. SITKA treatments showed, on average, a 6.7 and 4.9 Gy reduction of the maximum dose in soft tissue organs at risk (OARs) as compared to VMAT, for the two patients respectively. This was accompanied by a small increase in the mean dose of 0.17 and 0.30 Gy in soft tissue OARs.Significance.The proposed SITKA system offers a maximally low-cost, effective alternative to conventional radiotherapy systems for lung cancer patients, particularly in low-income countries. The system's non-coplanar, isocentric approach, coupled with the deep learning CBCT to sCT and GPU backprojection-based inverse treatment planning, offers lower maximum doses in OARs and comparable conformity to VMAT plans at a fraction of the cost of conventional radiotherapy.
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Affiliation(s)
| | - Michael D Weil
- Sirius Medicine LLC, Half Moon Bay, CA, United States of America
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Mettivier G, Sarno A, Varallo A, Russo P. Attenuation coefficient in the energy range 14–36 keV of 3D printing materials for physical breast phantoms. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. To measure the monoenergetic x-ray linear attenuation coefficient, μ, of fused deposition modeling (FDM) colored 3D printing materials (ABS, PLAwhite, PLAorange, PET and NYLON), used as adipose, glandular or skin tissue substitutes for manufacturing physical breast phantoms. Approach. Attenuation data (at 14, 18, 20, 24, 28, 30 and 36 keV) were acquired at Elettra synchrotron radiation facility, with step-wedge objects, using the Lambert–Beer law and a CCD imaging detector. Test objects were 3D printed using the Ultimaker 3 FDM printer. PMMA, Nylon-6 and high-density polyethylene step objects were also investigated for the validation of the proposed methodology. Printing uniformity was assessed via monoenergetic and polyenergetic imaging (32 kV, W/Rh). Main results. Maximum absolute deviation of μ for PMMA, Nylon-6 and HD-PE was 5.0%, with reference to literature data. For ABS and NYLON, μ differed by less than 6.1% and 7.1% from that of adipose tissue, respectively; for PET and PLAorange the difference was less than 11.3% and 6.3% from glandular tissue, respectively. PLAorange is a good substitute of skin (differences from −9.4% to +1.2%). Hence, ABS and NYLON filaments are suitable adipose tissue substitutes, while PET and PLAorange mimick the glandular tissue. PLAwhite could be printed at less than 100% infill density for matching the attenuation of glandular tissue, using the measured density calibration curve. The printing mesh was observed for sample thicknesses less than 60 mm, imaged in the direction normal to the printing layers. Printing dimensional repeatability and reproducibility was less 1%. Significance. For the first time an experimental determination was provided of the linear attenuation coefficient of common 3D printing filament materials with estimates of μ at all energies in the range 14–36 keV, for their use in mammography, breast tomosynthesis and breast computed tomography investigations.
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Quantitative comparison of different dosimetry methods in orthovoltage X-ray therapy. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tudda A, Donzelli E, Nicolini G, Semperboni S, Bossi M, Cavaletti G, Castriconi R, Mangili P, Vecchio AD, Sarno A, Mettivier G, Russo P. Breast radiotherapy with kilovoltage photons and gold nanoparticles as radiosensitizer: An in vitro study. Med Phys 2021; 49:568-578. [PMID: 34778990 PMCID: PMC9299863 DOI: 10.1002/mp.15348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose We investigated the dose enhancement and internalization of gold nanoparticles (AuNPs) used as a radiosensitizer agent for rotational radiotherapy of breast cancer using a kilovoltage (kV) X‐ray beam. Methods Human breast cancer cells MDA‐MB‐231 were incubated with or without 100 μg/mL (4.87 nM) or 200 μg/mL (9.74 nM) 15 nm AuNPs and irradiated with 100 kV, 190 kV, or 6 MV X‐rays. To assess the toxicity of the AuNPs, we performed a Sulforhodamine B assay. Using atomic absorption spectroscopy, scanning electron microscopy, transmission electron microscopy, and time‐lapse optical microscopy (rate of 2 frames per minute), we carried out a quantitative assessment of the amount of gold internalized by MDA‐MB‐231 cells and a characterization of the static and dynamical aspects of this internalization process. Results No effect of AuNPs alone was shown on cell viability. Time‐lapse optical microscopy showed for the first time AuNPs cellular uptake and the dynamics of AuNPs internalization. Electron microscopy demonstrated AuNPs localization in endosomal vesicles, preferentially in the perinuclear region. After irradiation at doses up to 2 Gy, cell survival fraction curves showed increased mortality with AuNPs, with respect to irradiation without AuNPs. The highest effect of radioenhancement by AuNPs (at 9.74 nM AuNPs concentration) was observed at 190 kV showing a dose enhancement factor of 1.33 ± 0.06 (1.34 ± 0.02 at 100 kV), while at 6 MV it was 1.14 ± 0.06. Conclusions The observed radio‐sensitization effect is promising for future radio‐enhanced kV radiotherapy of breast cancer and quantitatively in the order of previous observations for 15 nm AuNPs. These results of a significant dose enhancement were obtained at 15 nm AuNPs concentration as low as several nanomolar units, at dose levels typical of a single dose fraction in a radiotherapy session. Dynamical behavior of the 3D spatial distribution of 15 nm AuNPs outside the nucleus of single breast cancer cell was observed, with possible implications for future models of AuNPs sensitization.
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Affiliation(s)
- Alessia Tudda
- Department of Physics "Ettore Pancini", University of Naples Federico II, Naples, Italy.,INFN Division of Naples, Naples, Italy.,Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Physics, Specialty School of Medical Physics, University of Milan, Milan, Italy
| | - Elisabetta Donzelli
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,INFN Division of Milano-Bicocca, Milan, Italy
| | - Gabriella Nicolini
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,INFN Division of Milano-Bicocca, Milan, Italy
| | - Sara Semperboni
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,INFN Division of Milano-Bicocca, Milan, Italy
| | - Mario Bossi
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Roberta Castriconi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,INFN Division of Milan, Milan, Italy
| | - Paola Mangili
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,INFN Division of Milan, Milan, Italy
| | - Antonella Del Vecchio
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,INFN Division of Milan, Milan, Italy
| | - Antonio Sarno
- Department of Physics "Ettore Pancini", University of Naples Federico II, Naples, Italy.,INFN Division of Naples, Naples, Italy
| | - Giovanni Mettivier
- Department of Physics "Ettore Pancini", University of Naples Federico II, Naples, Italy.,INFN Division of Naples, Naples, Italy
| | - Paolo Russo
- Department of Physics "Ettore Pancini", University of Naples Federico II, Naples, Italy.,INFN Division of Naples, Naples, Italy
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External beam radiation therapy with kilovoltage x-rays. Phys Med 2020; 79:103-112. [PMID: 33221545 DOI: 10.1016/j.ejmp.2020.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022] Open
Abstract
Kilovoltage (kV) x-rays are most commonly used for diagnostic imaging due to their sensitivity to tissue composition. In radiation therapy (RT), due to their fast attenuation, kV x-rays are typically only used for superficial irradiation of skin cancer and for intra-operative RT (IORT). Recently, however, a number of kV RT techniques have emerged. In this review article, we provide a brief overview of the use of kV x-rays for RT. Various kV x-ray source technologies suitable for RT, such as conventional x-ray tubes as well as novel x-ray sources, are first described. This x-ray source section is then followed by a section on their implementation in terms of clinical, veterinary and preclinical applications. Specifically, IORT, superficial RT and dose enhancement with iodine and gold nanoparticles, as well as microbeam RT and FLASH RT are discussed in this context. Then, a number of kV x-ray RT applications in modeling and proof-of-principle stages, such as breast external beam RT with rotational sources, kilovoltage arc therapy and the BriXS Compton pulsed x-ray sources, are reviewed. Finally, some clinical and economic considerations for the development of kV RT techniques are discussed.
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di Franco F, Sarno A, Mettivier G, Hernandez A, Bliznakova K, Boone J, Russo P. GEANT4 Monte Carlo simulations for virtual clinical trials in breast X-ray imaging: Proof of concept. Phys Med 2020; 74:133-142. [DOI: 10.1016/j.ejmp.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
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Mettivier G, Masi M, Arfelli F, Brombal L, Delogu P, Di Lillo F, Donato S, Fedon C, Golosio B, Oliva P, Rigon L, Sarno A, Taibi A, Russo P. Radiochromic film dosimetry in synchrotron radiation breast computed tomography: a phantom study. JOURNAL OF SYNCHROTRON RADIATION 2020; 27:762-771. [PMID: 32381779 PMCID: PMC7285685 DOI: 10.1107/s1600577520001745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
This study relates to the INFN project SYRMA-3D for in vivo phase-contrast breast computed tomography using the SYRMEP synchrotron radiation beamline at the ELETTRA facility in Trieste, Italy. This peculiar imaging technique uses a novel dosimetric approach with respect to the standard clinical procedure. In this study, optimization of the acquisition procedure was evaluated in terms of dose delivered to the breast. An offline dose monitoring method was also investigated using radiochromic film dosimetry. Various irradiation geometries have been investigated for scanning the prone patient's pendant breast, simulated by a 14 cm-diameter polymethylmethacrylate cylindrical phantom containing pieces of calibrated radiochromic film type XR-QA2. Films were inserted mid-plane in the phantom, as well as wrapped around its external surface, and irradiated at 38 keV, with an air kerma value that would produce an estimated mean glandular dose of 5 mGy for a 14 cm-diameter 50% glandular breast. Axial scans were performed over a full rotation or over 180°. The results point out that a scheme adopting a stepped rotation irradiation represents the best geometry to optimize the dose distribution to the breast. The feasibility of using a piece of calibrated radiochromic film wrapped around a suitable holder around the breast to monitor the scan dose offline is demonstrated.
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Affiliation(s)
- Giovanni Mettivier
- Dipartimento di Fisica ‘Ettore Pancini’, Università di Napoli ‘Federico II’, I-80126 Napoli, Italy
- INFN, Sezione di Napoli, I-80126 Napoli, Italy
| | - Marica Masi
- Dipartimento di Fisica ‘Ettore Pancini’, Università di Napoli ‘Federico II’, I-80126 Napoli, Italy
- INFN, Sezione di Napoli, I-80126 Napoli, Italy
| | - Fulvia Arfelli
- Department of Physics, Università di Trieste, I-34127 Trieste, Italy
- Sezione di Trieste, INFN, I-34127 Trieste, Italy
| | - Luca Brombal
- Department of Physics, Università di Trieste, I-34127 Trieste, Italy
- Sezione di Trieste, INFN, I-34127 Trieste, Italy
| | - Pasquale Delogu
- Department of Physical Science, Earth and Environment, Università di Siena, I-53100 Siena, Italy
- Sezione di Pisa, INFN, I-34127 Pisa, Italy
| | - Francesca Di Lillo
- Dipartimento di Fisica ‘Ettore Pancini’, Università di Napoli ‘Federico II’, I-80126 Napoli, Italy
- INFN, Sezione di Napoli, I-80126 Napoli, Italy
- ELETTRA-Sincrotrone Trieste SCpA, Bassovizza, I-34149 Trieste, Italy
| | - Sandro Donato
- Department of Physics, Università di Trieste, I-34127 Trieste, Italy
- Sezione di Trieste, INFN, I-34127 Trieste, Italy
| | - Christian Fedon
- Sezione di Trieste, INFN, I-34127 Trieste, Italy
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Bruno Golosio
- Department of Physics, Università di Cagliari, I-09042 Cagliari, Italy
- Sezione di Cagliari, INFN, I-09042 Cagliari, Italy
| | - Piernicola Oliva
- Sezione di Cagliari, INFN, I-09042 Cagliari, Italy
- Department of Chemistry and Pharmacy, Università di Sassari, Sassari, Italy
| | - Luigi Rigon
- Department of Physics, Università di Trieste, I-34127 Trieste, Italy
- Sezione di Trieste, INFN, I-34127 Trieste, Italy
| | | | - Angelo Taibi
- Department of Physics and Earth Science, Università di Ferrara, I-44122 Ferrara, Italy
- Sezione di Ferrara, INFN, I-44122 Ferrara, Italy
| | - Paolo Russo
- Dipartimento di Fisica ‘Ettore Pancini’, Università di Napoli ‘Federico II’, I-80126 Napoli, Italy
- INFN, Sezione di Napoli, I-80126 Napoli, Italy
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Incerti S, Brown JM, Guatelli S. Advances in Geant4 applications in medicine. Phys Med 2020; 70:224-227. [DOI: 10.1016/j.ejmp.2020.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/27/2022] Open
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