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Cicone F, Sjögreen Gleisner K, Sarnelli A, Indovina L, Gear J, Gnesin S, Kraeber-Bodéré F, Bischof Delaloye A, Valentini V, Cremonesi M. The contest between internal and external-beam dosimetry: The Zeno's paradox of Achilles and the tortoise. Phys Med 2024; 117:103188. [PMID: 38042710 DOI: 10.1016/j.ejmp.2023.103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
Radionuclide therapy, also called molecular radiotherapy (MRT), has come of age, with several novel radiopharmaceuticals being approved for clinical use or under development in the last decade. External beam radiotherapy (EBRT) is a well-established treatment modality, with about half of all oncologic patients expected to receive at least one external radiation treatment over their disease course. The efficacy and the toxicity of both types of treatment rely on the interaction of radiation with biological tissues. Dosimetry played a fundamental role in the scientific and technological evolution of EBRT, and absorbed doses to the target and to the organs at risk are calculated on a routine basis. In contrast, in MRT the usefulness of internal dosimetry has long been questioned, and a structured path to include absorbed dose calculation is missing. However, following a similar route of development as EBRT, MRT treatments could probably be optimized in a significant proportion of patients, likely based on dosimetry and radiobiology. In the present paper we describe the differences and the similarities between internal and external-beam dosimetry in the context of radiation treatments, and we retrace the main stages of their development over the last decades.
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Affiliation(s)
- Francesco Cicone
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Nuclear Medicine Unit, "Mater Domini" University Hospital, Catanzaro, Italy.
| | | | - Anna Sarnelli
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Luca Indovina
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
| | - Françoise Kraeber-Bodéré
- Nantes Université, Université Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000 Nantes, France
| | | | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Kim N, Lee S, Lee S, Kang J, Choi Y, Park J, Park C, Khang D, Kim S. Portable Cold Atmospheric Plasma Patch-Mediated Skin Anti-Inflammatory Therapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2202800. [PMID: 36180414 PMCID: PMC9731685 DOI: 10.1002/advs.202202800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/27/2022] [Indexed: 05/29/2023]
Abstract
Although plasma is a promising technology in various fields, its clinical application is restricted by several limitations. A cold atmospheric plasma (CAP) patch is fabricated to help overcome hurdles, especially when treating skin diseases. This patch has surface dielectric barrier discharge, which generates reactive oxygen species (ROS) and reactive nitrogen species (RNS) on a flexible polymer film surface on which the embedded electrode induces a locally strong electric field. The effect of the CAP patch on psoriasis is also evaluated. The distinct characteristics of psoriasis between the lesion and non-lesion area allow the CAP patch to be suitable for only lesion area for its treatment. The CAP patch induces the opening of calcium channels in keratinocytes, thereby restoring abnormal keratinocyte differentiation and the collapse of the tight junction; thus, alleviating psoriatic symptoms. In addition, the favorable effect is due to the induction of ROS/RNS by the CAP patch, not the electric field generated during plasma generation. The findings indicate that the proposed portable CAP patch can help treat inflammatory skin disorders, especially psoriasis. As this can be used easily as a combination therapy with existing drugs, it may help reduce side effects caused by existing drugs.
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Affiliation(s)
- Namkyung Kim
- Cell & Matrix Research InstituteDepartment of PharmacologySchool of MedicineKyungpook National UniversityDaegu41944South Korea
| | - Seunghun Lee
- Department of Nano‐Bio ConvergenceNano Surface Materials DivisionKorea Institute of Materials ScienceChangwon51508South Korea
| | - Soyoung Lee
- Immunoregulatory Materials Research CenterKorea Research Institute of Bioscience and BiotechnologyJeongeup56212South Korea
| | - Jinjoo Kang
- Cell & Matrix Research InstituteDepartment of PharmacologySchool of MedicineKyungpook National UniversityDaegu41944South Korea
| | - Young‐Ae Choi
- Cell & Matrix Research InstituteDepartment of PharmacologySchool of MedicineKyungpook National UniversityDaegu41944South Korea
| | - Jeongsu Park
- Department of PhysiologySchool of MedicineGachon UniversityIncheon21999South Korea
| | - Chul‐Kyu Park
- Department of PhysiologySchool of MedicineGachon UniversityIncheon21999South Korea
| | - Dongwoo Khang
- Department of PhysiologySchool of MedicineGachon UniversityIncheon21999South Korea
| | - Sang‐Hyun Kim
- Cell & Matrix Research InstituteDepartment of PharmacologySchool of MedicineKyungpook National UniversityDaegu41944South Korea
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Thwaites D. Beginnings, endings, histories and horizons. Radiother Oncol 2020; 153:1-4. [PMID: 33189761 DOI: 10.1016/j.radonc.2020.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Affiliation(s)
- David Thwaites
- Institute of Medical Physics, School of Physics, The University of Sydney, NSW 2006, Australia; Medical Physics, Leeds Institute of Cancer and Pathology, School of Medicine, The University of Leeds, UK; West Sydney Radiation Oncology Network and Cancer Research Network, Crown Princess Mary Cancer Centre, Westmead, NSW, Australia
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Casar B, Lopes MDC, Drljević A, Gershkevitsh E, Pesznyak C. Medical physics in Europe following recommendations of the International Atomic Energy Agency. Radiol Oncol 2016; 50:64-72. [PMID: 27069451 PMCID: PMC4825339 DOI: 10.1515/raon-2016-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/17/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Medical physics is a health profession where principles of applied physics are mostly directed towards the application of ionizing radiation in medicine. The key role of the medical physics expert in safe and effective use of ionizing radiation in medicine was widely recognized in recent European reference documents like the European Union Council Directive 2013/59/EURATOM (2014), and European Commission Radiation Protection No. 174, European Guidelines on Medical Physics Expert (2014). Also the International Atomic Energy Agency (IAEA) has been outspoken in supporting and fostering the status of medical physics in radiation medicine through multiple initiatives as technical and cooperation projects and important documents like IAEA Human Health Series No. 25, Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (2013) and the International Basic Safety Standards, General Safety Requirements Part 3 (2014). The significance of these documents and the recognition of the present insufficient fulfilment of the requirements and recommendations in many European countries have led the IAEA to organize in 2015 the Regional Meeting on Medical Physics in Europe, where major issues in medical physics in Europe were discussed. Most important outcomes of the meeting were the recommendations addressed to European member states and the survey on medical physics status in Europe conducted by the IAEA and European Federation of Organizations for Medical Physics. CONCLUSIONS Published recommendations of IAEA Regional Meeting on Medical Physics in Europe shall be followed and enforced in all European states. Appropriate qualification framework including education, clinical specialization, certification and registration of medical physicists shall be established and international recommendation regarding staffing levels in the field of medical physics shall be fulfilled in particular. European states have clear legal and moral responsibility to effectively transpose Basic Safety Standards into national legislation in order to ensure high quality and safety in patient healthcare.
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Affiliation(s)
| | | | - Advan Drljević
- University Clinical Centre Sarajevo, Bosnia and Herzegovina
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Malicki J. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control. Rep Pract Oncol Radiother 2015; 20:161-9. [PMID: 25949219 DOI: 10.1016/j.rpor.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 11/12/2014] [Accepted: 01/08/2015] [Indexed: 11/17/2022] Open
Abstract
Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine.
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Affiliation(s)
- Julian Malicki
- University of Medical Sciences, Electroradiology Department, Garbary 15, 61-866 Poznan, Poland ; Greater Poland Cancer Centre, Medical Physics Department, Garbary 15, 61-866 Poznan, Poland ; Adam Mickiewicz University, Medical Physics Department, Umultowska 85, 61-614 Poznan, Poland
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Thor M, Petersen JBB, Bentzen L, Høyer M, Muren LP. Deformable image registration for contour propagation from CT to cone-beam CT scans in radiotherapy of prostate cancer. Acta Oncol 2011; 50:918-25. [PMID: 21767192 DOI: 10.3109/0284186x.2011.577806] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Daily organ motion occurring during the course of radiotherapy in the pelvic region leads to uncertainties in the doses delivered to the tumour and the organs at risk. Motion patterns include both volume and shape changes, calling for deformable image registration (DIR), in approaches involving dose accumulation and adaptation. In this study, we tested the performance of a DIR application for contour propagation from the treatment planning computed tomography (pCT) to repeat cone-beam CTs (CBCTs) for a set of prostate cancer patients. MATERIAL AND METHODS The prostate, rectum and bladder were delineated in the pCT and in six to eight repeat CBCTs for each of five patients. The pCT contours were propagated onto the corresponding CBCT using the Multi-modality Image Registration and Segmentation application, resulting in 36 registrations. Prior to the DIR, a rigid registration was performed. The algorithm used for the DIR was based on a 'demons' algorithm and the performance of it was examined quantitatively using the Dice similarity coefficient (DSC) and qualitatively as visual slice-by-slice scoring by a radiation oncologist grading the deviations in shape and/or distance relative to the anatomy. RESULTS The average DSC (range) for the DIR over all scans and patients was 0.80 (0.65-0.87) for prostate, 0.77 (0.63-0.87) for rectum and 0.73 (0.34-0.91) for bladder, while the corresponding DSCs for the rigid registrations were 0.77 (0.65-0.86), 0.71 (0.55-0.82) and 0.64 (0.33-0.87). The percentage of propagated contours of good/acceptable quality was 45% for prostate; 20% for rectum and 33% for bladder. For the bladder, there was an association between the average DSC and the different scores of the qualitative evaluation. CONCLUSIONS DIR improved the performance of pelvic organ contour propagation from the pCT to CBCTs as compared to rigid registration only. Still, a large fraction of the propagated rectum and bladder contours were unacceptable. The image quality of the CBCTs was sub-optimal and the usability of CBCTs for dose accumulation and adaptation purposes is therefore likely to benefit from improved image quality and improvements of the DIR algorithm.
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Affiliation(s)
- Maria Thor
- Clinical Institute, Aarhus University, Aarhus, Denmark.
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Grau C, Olsen DR, Overgaard J, Høyer M, Lindegaard JC, Muren LP. Biology-guided adaptive radiation therapy - presence or future? Acta Oncol 2010; 49:884-7. [PMID: 20831476 DOI: 10.3109/0284186x.2010.516010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
MESH Headings
- Adaptation, Biological/physiology
- Adaptation, Biological/radiation effects
- Biology/methods
- Biology/trends
- Dose Fractionation, Radiation
- Fluorodeoxyglucose F18
- Humans
- Radiation Oncology/methods
- Radiation Oncology/trends
- Radiosurgery/methods
- Radiosurgery/trends
- Radiotherapy Dosage
- Radiotherapy, Computer-Assisted/methods
- Radiotherapy, Computer-Assisted/trends
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Radiotherapy, Conformal/trends
- Surgery, Computer-Assisted/methods
- Surgery, Computer-Assisted/trends
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Thor M, Væth M, Karlsdottir A, Muren LP. Rectum motion and morbidity prediction: Improving correlation between late morbidity and DVH parameters through use of rectum planning organ at risk volumes. Acta Oncol 2010; 49:1061-8. [PMID: 20831497 DOI: 10.3109/0284186x.2010.505200] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE The rectum is a major dose-limiting organ at risk (OR) in radiotherapy (RT) of prostate cancer. Methods to predict adverse effects in the rectum are therefore important but their precision often limited, not the least by the internal motion of this organ. In this study late rectal morbidity is investigated in relation to the internal motion of the rectum by applying the 'Planning organ at Risk Volume' (PRV) concept. MATERIALS AND METHODS Late rectal morbidity was analysed in 242 prostate cancer patients treated to 70 Gy with conformal RT to either the prostate, the prostate and seminal vesicles or the whole pelvis (initial 50 Gy only). Late rectal morbidity was classified by the late gastro-intestinal (GI) RTOG toxicity scoring system. Cumulative dose-volume histograms (DVHs) were derived for the rectum OR and six rectum PRVs i.e. the OR expanded with six different margins (narrow/intermediate/wide in anterior direction or in both anterior and posterior direction). The difference in rectum dose-volume parameters between patients with Grade 0-1 vs. Grade 2 or higher morbidity was investigated by logistic regression and permutation tests. RESULTS Late Grade 2 or higher morbidity was observed in 25 of 242 (10%) patients. The logistic regression analysis and the permutation tests reached significance (p ≤ 0.05) for only one dose level of the rectum OR (40 Gy). For the PRVs, several dose levels were found to be significant (p-value range: 0.01-0.046), most pronounced for the PRV with narrow margins of 6 mm anterior and 5 mm posterior with five intermediate (38-42 Gy) and ten high (62-71 Gy) dose levels. CONCLUSIONS The statistical methods applied displayed consistently a small though significant difference in DVH parameters between patients with vs. without Grade 2 or higher late rectal morbidity for intermediate and high dose levels. The difference became most evident when using a PRV with narrow margins.
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Affiliation(s)
- Maria Thor
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark.
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