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Saki M, Grewal H, Artz M, Willoughby TR, Park J, Brooks E, Getman N, Senterfitt A, Johnson P. Navigating Complexities: Leadless Pacemaker Management in Proton Therapy for a Pacemaker-Dependent Bilateral Breast Cancer Patient. Int J Part Ther 2024; 13:100112. [PMID: 39105198 PMCID: PMC11298889 DOI: 10.1016/j.ijpt.2024.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/10/2024] [Accepted: 06/26/2024] [Indexed: 08/07/2024] Open
Abstract
This case study explores the strategic decision-making and safety considerations in managing a unique scenario where a pacemaker dependent patient, requiring adjuvant radiotherapy for bilateral breast cancer. The conventional pacemaker was located entirely within the treatment target, without the option for transposition because of the bilateral chest treatment, resulting in significant risk of malfunction caused by exposing it to the full prescribed dose. Consequently, the decision was made to replace the conventional pacemaker with a leadless device Micra implanted directly into the heart to mitigate direct device radiation and potential adverse effects of proton therapy on the cardiac device. Following Micra implantation, the patient underwent the proton treatment without complications or serious device malfunctions. This study explores solutions to address the challenges posed by within-the-field cardiac devices and highlights the use of pencil beam proton therapy for individuals with leadless cardiac devices while acknowledging the potential for neutron production and the associated risk of single-event upsets (SEU) in cardiac implantable electronic devices (CIEDs). The findings underscore the significance of strategic decision-making, risk assessment, and continuous monitoring for successful outcomes, particularly in the context of proton therapy for patients with advanced cardiac considerations.
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Affiliation(s)
- Mohammad Saki
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Hardev Grewal
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Mark Artz
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Twyla R. Willoughby
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Jiyeon Park
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Eric Brooks
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Nataly Getman
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Abby Senterfitt
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
| | - Perry Johnson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA
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Jelínek Michaelidesová A, Kundrát P, Zahradníček O, Danilová I, Pachnerová Brabcová K, Vachelová J, Vilimovský J, David M, Vondráček V, Davídková M. First independent validation of the proton-boron capture therapy concept. Sci Rep 2024; 14:19264. [PMID: 39164312 PMCID: PMC11335746 DOI: 10.1038/s41598-024-69370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024] Open
Abstract
Boron has been suggested to enhance the biological effectiveness of proton beams in the Bragg peak region via the p + 11B → 3α nuclear capture reaction. However, a number of groups have observed no such enhancement in vitro or questioned its proposed mechanism recently. To help elucidate this phenomenon, we irradiated DU145 prostate cancer or U-87 MG glioblastoma cells by clinical 190 MeV proton beams in plateau or Bragg peak regions with or without 10B or 11B isotopes added as sodium mercaptododecaborate (BSH). The results demonstrate that 11B but not 10B or other components of the BSH molecule enhance cell killing by proton beams. The enhancement occurs selectively in the Bragg peak region, is present for boron concentrations as low as 40 ppm, and is not due to secondary neutrons. The enhancement is likely initiated by proton-boron capture reactions producing three alpha particles, which are rare events occurring in a few cells only, and their effects are amplified by intercellular communication to a population-level response. The observed up to 2-3-fold reductions in survival levels upon the presence of boron for the studied prostate cancer or glioblastoma cells suggest promising clinical applications for these tumour types.
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Affiliation(s)
- Anna Jelínek Michaelidesová
- Nuclear Physics Institute of the Czech Academy of Sciences, Husinec - Řež 130, 250 68, Řež, Czech Republic
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 78/7, 115 19, Prague, Czech Republic
| | - Pavel Kundrát
- Nuclear Physics Institute of the Czech Academy of Sciences, Husinec - Řež 130, 250 68, Řež, Czech Republic
| | - Oldřich Zahradníček
- Nuclear Physics Institute of the Czech Academy of Sciences, Husinec - Řež 130, 250 68, Řež, Czech Republic
| | - Irina Danilová
- Nuclear Physics Institute of the Czech Academy of Sciences, Husinec - Řež 130, 250 68, Řež, Czech Republic
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 78/7, 115 19, Prague, Czech Republic
| | | | - Jana Vachelová
- Nuclear Physics Institute of the Czech Academy of Sciences, Husinec - Řež 130, 250 68, Řež, Czech Republic
| | - Jan Vilimovský
- Proton Therapy Center Czech, Prague, Budínova 2437/1a, 180 00, Prague, Czech Republic
| | - Miroslav David
- Thomayer University Hospital, Vídeňská 800, 140 59, Prague, Czech Republic
| | - Vladimír Vondráček
- Proton Therapy Center Czech, Prague, Budínova 2437/1a, 180 00, Prague, Czech Republic
- Thomayer University Hospital, Vídeňská 800, 140 59, Prague, Czech Republic
| | - Marie Davídková
- Nuclear Physics Institute of the Czech Academy of Sciences, Husinec - Řež 130, 250 68, Řež, Czech Republic.
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3
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Geser FA, Stabilini A, Christensen JB, Muñoz ID, Yukihara EG, Jäkel O, Vedelago J. A Monte Carlo study on the secondary neutron generation by oxygen ion beams for radiotherapy and its comparison to lighter ions. Phys Med Biol 2024; 69:015027. [PMID: 37995363 DOI: 10.1088/1361-6560/ad0f45] [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: 08/16/2023] [Accepted: 11/23/2023] [Indexed: 11/25/2023]
Abstract
Objective.To study the secondary neutrons generated by primary oxygen beams for cancer treatment and compare the results to those from primary protons, helium, and carbon ions. This information can provide useful insight into the positioning of neutron detectors in phantom for future experimental dose assessments.Approach.Mono-energetic oxygen beams and spread-out Bragg peaks were simulated using the Monte Carlo particle transport codesFLUktuierende KAskade, tool for particle simulation, and Monte Carlo N-Particle, with energies within the therapeutic range. The energy and angular distribution of the secondary neutrons were quantified.Main results.The secondary neutron spectra generated by primary oxygen beams present the same qualitative trend as for other primary ions. The energy distributions resemble continuous spectra with one peak in the thermal/epithermal region, and one other peak in the fast/relativistic region, with the most probable energy ranging from 94 up to 277 MeV and maximum energies exceeding 500 MeV. The angular distribution of the secondary neutrons is mainly downstream-directed for the fast/relativistic energies, whereas the thermal/epithermal neutrons present a more isotropic propagation. When comparing the four different primary ions, there is a significant increase in the most probable energy as well as the number of secondary neutrons per primary particle when increasing the mass of the primaries.Significance.Most previous studies have only presented results of secondary neutrons generated by primary proton beams. In this work, secondary neutrons generated by primary oxygen beams are presented, and the obtained energy and angular spectra are added as supplementary material. Furthermore, a comparison of the secondary neutron generation by the different primary ions is given, which can be used as the starting point for future studies on treatment plan comparison and secondary neutron dose optimisation. The distal penumbra after the maximum dose deposition appears to be a suitable location for in-phantom dose assessments.
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Affiliation(s)
- Federico A Geser
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Forschungsstrasse 111, Villigen PSI 5232, Switzerland
| | - Alberto Stabilini
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Forschungsstrasse 111, Villigen PSI 5232, Switzerland
| | - Jeppe B Christensen
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Forschungsstrasse 111, Villigen PSI 5232, Switzerland
| | - Iván D Muñoz
- Department of Physics and Astronomy, Heidelberg University, Im Neuenheimer Feld 226, Heidelberg D-69120, Germany
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Eduardo G Yukihara
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Forschungsstrasse 111, Villigen PSI 5232, Switzerland
| | - Oliver Jäkel
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Im Neuenheimer Feld 450, Heidelberg D-69120, Germany
| | - José Vedelago
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 400, Heidelberg D-69120, Germany
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4
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Oancea C, Granja C, Marek L, Jakubek J, Šolc J, Bodenstein E, Gantz S, Pawelke J, Pivec J. Out-of-field measurements and simulations of a proton pencil beam in a wide range of dose rates using a Timepix3 detector: Dose rate, flux and LET. Phys Med 2023; 106:102529. [PMID: 36657235 DOI: 10.1016/j.ejmp.2023.102529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
Stray radiation produced by ultra-high dose-rates (UHDR) proton pencil beams is characterized using ASIC-chip semiconductor pixel detectors. A proton pencil beam with an energy of 220 MeV was utilized to deliver dose rates (DR) ranging from conventional radiotherapy DRs up to 270 Gy/s. A MiniPIX Timepix3 detector equipped with a silicon sensor and integrated readout electronics was used. The chip-sensor assembly and chipboard on water-equivalent backing were detached and immersed in the water-phantom. The deposited energy, particle flux, DR, and the linear energy transfer (LET(Si)) spectra were measured in the silicon sensor at different positions both laterally, at different depths, and behind the Bragg peak. At low-intensity beams, the detector is operated in the event-by-event data-driven mode for high-resolution spectral tracking of individual particles. This technique provides precise energy loss response and LET(Si) spectra with radiation field composition resolving power. At higher beam intensities a rescaling of LET(Si) can be performed as the distribution of the LET(Si) spectra exhibits the same characteristics regardless of the delivered DR. The integrated deposited energy and the absorbed dose can be thus measured in a wide range. A linear response of measured absorbed dose was obtained by gradually increasing the delivered DR to reach UHDR beams. Particle tracking of scattered radiation in data-driven mode could be performed at DRs up to 0.27 Gy/s. In integrated mode, the saturation limits were not reached at the measured out-of-field locations up to the delivered DR of over 270 Gy/s. A good agreement was found between measured and simulated absorbed doses.
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Affiliation(s)
- Cristina Oancea
- ADVACAM, U Pergamenky 12, 170 00 Prague 7, Czech Republic; University of Bucharest, Bucharest, Romania.
| | - Carlos Granja
- ADVACAM, U Pergamenky 12, 170 00 Prague 7, Czech Republic
| | - Lukas Marek
- ADVACAM, U Pergamenky 12, 170 00 Prague 7, Czech Republic; Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Jan Jakubek
- ADVACAM, U Pergamenky 12, 170 00 Prague 7, Czech Republic
| | - Jaroslav Šolc
- Czech Metrology Institute, Okruzni 31, 638 00 Brno, Czech Republic
| | - Elisabeth Bodenstein
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Sebastian Gantz
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Jörg Pawelke
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Jiri Pivec
- ADVACAM, U Pergamenky 12, 170 00 Prague 7, Czech Republic
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Evaluation and modelling of the lithium fluoride based thermoluminescent detector response at the CERN-EU high-energy reference field (CERF). RADIAT MEAS 2023. [DOI: 10.1016/j.radmeas.2023.106923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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6
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Gómez-Ros J, Bedogni R, Domingo C. Personal neutron dosimetry: State-of-the-art and new technologies. RADIAT MEAS 2023. [DOI: 10.1016/j.radmeas.2023.106908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Griffin KT, Yeom YS, Mille MM, Lee C, Jung JW, Hertel NE, Lee C. Comparison of out-of-field normal tissue dose estimates for pencil beam scanning proton therapy: MCNP6, PHITS, and TOPAS. Biomed Phys Eng Express 2022; 9:10.1088/2057-1976/acaab1. [PMID: 36562506 PMCID: PMC10772933 DOI: 10.1088/2057-1976/acaab1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022]
Abstract
Monte Carlo (MC) methods are considered the gold-standard approach to dose estimation for normal tissues outside the treatment field (out-of-field) in proton therapy. However, the physics of secondary particle production from high-energy protons are uncertain, particularly for secondary neutrons, due to challenges in performing accurate measurements. Instead, various physics models have been developed over the years to reenact these high-energy interactions based on theory. It should thus be acknowledged that MC users must currently accept some unknown uncertainties in out-of-field dose estimates. In the present study, we compared three MC codes (MCNP6, PHITS, and TOPAS) and their available physics models to investigate the variation in out-of-field normal tissue dosimetry for pencil beam scanning proton therapy patients. Total yield and double-differential (energy and angle) production of two major secondary particles, neutrons and gammas, were determined through irradiation of a water phantom at six proton energies (80, 90, 100, 110, 150, and 200 MeV). Out-of-field normal tissue doses were estimated for intracranial irradiations of 1-, 5-, and 15-year-old patients using whole-body computational phantoms. Notably, the total dose estimates for each out-of-field organ varied by approximately 25% across the three codes, independent of its distance from the treatment volume. Dose discrepancies amongst the codes were linked to the utilized physics model, which impacts the characteristics of the secondary radiation field. Using developer-recommended physics, TOPAS produced both the highest neutron and gamma doses to all out-of-field organs from all examined conditions; this was linked to its highest yields of secondary particles and second hardest energy spectra. Subsequent results when using other physics models found reduced yields and energies, resulting in lower dose estimates. Neutron dose estimates were the most impacted by physics model choice, and thus the variation in out-of-field dose estimates may be even larger than 25% when considering biological effectiveness.
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Affiliation(s)
- Keith T. Griffin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yeon Soo Yeom
- Department of Radiation Convergence Engineering, Yonsei University, Wonju, South Korea
| | - Matthew M. Mille
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jae Won Jung
- Department of Physics, East Carolina University, Greenville, NC, USA
| | - Nolan E. Hertel
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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8
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Pazzaglia S, Eidemüller M, Lumniczky K, Mancuso M, Ramadan R, Stolarczyk L, Moertl S. Out-of-field effects: lessons learned from partial body exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:485-504. [PMID: 36001144 PMCID: PMC9722818 DOI: 10.1007/s00411-022-00988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/03/2022] [Indexed: 05/27/2023]
Abstract
Partial body exposure and inhomogeneous dose delivery are features of the majority of medical and occupational exposure situations. However, mounting evidence indicates that the effects of partial body exposure are not limited to the irradiated area but also have systemic effects that are propagated outside the irradiated field. It was the aim of the "Partial body exposure" session within the MELODI workshop 2020 to discuss recent developments and insights into this field by covering clinical, epidemiological, dosimetric as well as mechanistic aspects. Especially the impact of out-of-field effects on dysfunctions of immune cells, cardiovascular diseases and effects on the brain were debated. The presentations at the workshop acknowledged the relevance of out-of-field effects as components of the cellular and organismal radiation response. Furthermore, their importance for the understanding of radiation-induced pathologies, for the discovery of early disease biomarkers and for the identification of high-risk organs after inhomogeneous exposure was emphasized. With the rapid advancement of clinical treatment modalities, including new dose rates and distributions a better understanding of individual health risk is urgently needed. To achieve this, a deeper mechanistic understanding of out-of-field effects in close connection to improved modelling was suggested as priorities for future research. This will support the amelioration of risk models and the personalization of risk assessments for cancer and non-cancer effects after partial body irradiation.
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Affiliation(s)
- S. Pazzaglia
- Laboratory of Biomedical Technologies, ENEA CR-Casaccia, Via Anguillarese 301, 00123 Rome, Italy
| | - M. Eidemüller
- Institute of Radiation Medicine, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - K. Lumniczky
- Department of Radiobiology and Radiohygiene, Unit of Radiation Medicine, National Public Health Centre, Albert Florian u. 2-6, 1097 Budapest, Hungary
| | - M. Mancuso
- Laboratory of Biomedical Technologies, ENEA CR-Casaccia, Via Anguillarese 301, 00123 Rome, Italy
| | - R. Ramadan
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - L. Stolarczyk
- Danish Centre for Particle Therapy, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - S. Moertl
- Federal Office for Radiation Protection, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
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9
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Knežević Ž, Stolarczyk L, Ambrožová I, Caballero-Pacheco MÁ, Davídková M, De Saint-Hubert M, Domingo C, Jeleń K, Kopeć R, Krzempek D, Majer M, Miljanić S, Mojżeszek N, Romero-Expósito M, Martínez-Rovira I, Harrison RM, Olko P. Out-of-Field Doses Produced by a Proton Scanning Beam Inside Pediatric Anthropomorphic Phantoms and Their Comparison With Different Photon Modalities. Front Oncol 2022; 12:904563. [PMID: 35957900 PMCID: PMC9361051 DOI: 10.3389/fonc.2022.904563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Since 2010, EURADOS Working Group 9 (Radiation Dosimetry in Radiotherapy) has been involved in the investigation of secondary and scattered radiation doses in X-ray and proton therapy, especially in the case of pediatric patients. The main goal of this paper is to analyze and compare out-of-field neutron and non-neutron organ doses inside 5- and 10-year-old pediatric anthropomorphic phantoms for the treatment of a 5-cm-diameter brain tumor. Proton irradiations were carried out at the Cyclotron Centre Bronowice in IFJ PAN Krakow Poland using a pencil beam scanning technique (PBS) at a gantry with a dedicated scanning nozzle (IBA Proton Therapy System, Proteus 235). Thermoluminescent and radiophotoluminescent dosimeters were used for non-neutron dose measurements while secondary neutrons were measured with track-etched detectors. Out-of-field doses measured using intensity-modulated proton therapy (IMPT) were compared with previous measurements performed within a WG9 for three different photon radiotherapy techniques: 1) intensity-modulated radiation therapy (IMRT), 2) three-dimensional conformal radiation therapy (3D CDRT) performed on a Varian Clinac 2300 linear accelerator (LINAC) in the Centre of Oncology, Krakow, Poland, and 3) Gamma Knife surgery performed on the Leksell Gamma Knife (GK) at the University Hospital Centre Zagreb, Croatia. Phantoms and detectors used in experiments as well as the target location were the same for both photon and proton modalities. The total organ dose equivalent expressed as the sum of neutron and non-neutron components in IMPT was found to be significantly lower (two to three orders of magnitude) in comparison with the different photon radiotherapy techniques for the same delivered tumor dose. For IMPT, neutron doses are lower than non-neutron doses close to the target but become larger than non-neutron doses further away from the target. Results of WG9 studies have provided out-of-field dose levels required for an extensive set of radiotherapy techniques, including proton therapy, and involving a complete description of organ doses of pediatric patients. Such studies are needed for validating mathematical models and Monte Carlo simulation tools for out-of-field dosimetry which is essential for dedicated epidemiological studies which evaluate the risk of second cancers and other late effects for pediatric patients treated with radiotherapy.
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Affiliation(s)
- Željka Knežević
- Ruđer Bošković Institute, Zagreb, Croatia
- *Correspondence: Željka Knežević,
| | - Liliana Stolarczyk
- Danish Centre for Particle Therapy, Aarhus, Denmark
- Institute of Nuclear Physics, PAN, Krakow, Poland
| | - Iva Ambrožová
- Nuclear Physics Institute of the Czech Academy of Sciences, CAS, Řež, Czechia
| | | | - Marie Davídková
- Nuclear Physics Institute of the Czech Academy of Sciences, CAS, Řež, Czechia
| | | | | | - Kinga Jeleń
- Institute of Nuclear Physics, PAN, Krakow, Poland
- Tadeusz Kosciuszko Cracow University of Technology, Cracow, Poland
| | - Renata Kopeć
- Institute of Nuclear Physics, PAN, Krakow, Poland
| | | | | | | | | | - Maite Romero-Expósito
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Skandion Clinic, Uppsala, Sweden
| | | | - Roger M. Harrison
- University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
| | - Paweł Olko
- Institute of Nuclear Physics, PAN, Krakow, Poland
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10
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Mares V, Farah J, De Saint-Hubert M, Domański S, Domingo C, Dommert M, Kłodowska M, Krzempek K, Kuć M, Martínez-Rovira I, Michaś E, Mojżeszek N, Murawski Ł, Ploc O, Romero-Expósito M, Tisi M, Trompier F, Van Hoey O, Van Ryckeghem L, Wielunski M, Harrison RM, Stolarczyk L, Olko P. Neutron Radiation Dose Measurements in a Scanning Proton Therapy Room: Can Parents Remain Near Their Children During Treatment? Front Oncol 2022; 12:903706. [PMID: 35912238 PMCID: PMC9330633 DOI: 10.3389/fonc.2022.903706] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose This study aims to characterize the neutron radiation field inside a scanning proton therapy treatment room including the impact of different pediatric patient sizes. Materials and Methods Working Group 9 of the European Radiation Dosimetry Group (EURADOS) has performed a comprehensive measurement campaign to measure neutron ambient dose equivalent, H*(10), at eight different positions around 1-, 5-, and 10-year-old pediatric anthropomorphic phantoms irradiated with a simulated brain tumor treatment. Several active detector systems were used. Results The neutron dose mapping within the gantry room showed that H*(10) values significantly decreased with distance and angular deviation with respect to the beam axis. A maximum value of about 19.5 µSv/Gy was measured along the beam axis at 1 m from the isocenter for a 10-year-old pediatric phantom at 270° gantry angle. A minimum value of 0.1 µSv/Gy was measured at a distance of 2.25 m perpendicular to the beam axis for a 1-year-old pediatric phantom at 140° gantry angle. The H*(10) dependence on the size of the pediatric patient was observed. At 270° gantry position, the measured neutron H*(10) values for the 10-year-old pediatric phantom were up to 20% higher than those measured for the 5-year-old and up to 410% higher than for the 1-year-old phantom, respectively. Conclusions Using active neutron detectors, secondary neutron mapping was performed to characterize the neutron field generated during proton therapy of pediatric patients. It is shown that the neutron ambient dose equivalent H*(10) significantly decreases with distance and angle with respect to the beam axis. It is reported that the total neutron exposure of a person staying at a position perpendicular to the beam axis at a distance greater than 2 m from the isocenter remains well below the dose limit of 1 mSv per year for the general public (recommended by the International Commission on Radiological Protection) during the entire treatment course with a target dose of up to 60 Gy. This comprehensive analysis is key for general neutron shielding issues, for example, the safe operation of anesthetic equipment. However, it also enables the evaluation of whether it is safe for parents to remain near their children during treatment to bring them comfort. Currently, radiation protection protocols prohibit the occupancy of the treatment room during beam delivery.
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Affiliation(s)
- Vladimir Mares
- Helmholtz Zentrum München, Institute of Radiation Medicine, Neuherberg, Germany
- *Correspondence: Vladimir Mares,
| | - Jad Farah
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-Santé, Fontenay-aux-Roses, France
| | - Marijke De Saint-Hubert
- Belgian Nuclear Research Center, (SCK CEN), Institute for Environment, Health and Safety (EHS), Mol, Belgium
| | - Szymon Domański
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division, Otwock-Świerk, Poland
| | - Carles Domingo
- Departament de Física, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Martin Dommert
- Helmholtz Zentrum München, Institute of Radiation Medicine, Neuherberg, Germany
| | - Magdalena Kłodowska
- Cambridge University Hospital National Health Service (NHS) Trust, Medical Physics, Cambridge, United Kingdom
| | - Katarzyna Krzempek
- Institute of Nuclear Physics, Polish Academy of Sciences, (IFJ PAN), Krakow, Poland
| | - Michał Kuć
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division, Otwock-Świerk, Poland
| | | | - Edyta Michaś
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division, Otwock-Świerk, Poland
| | - Natalia Mojżeszek
- Institute of Nuclear Physics, Polish Academy of Sciences, (IFJ PAN), Krakow, Poland
| | - Łukasz Murawski
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division, Otwock-Świerk, Poland
| | - Ondrej Ploc
- Department of Radiation Dosimetry, Nuclear Physics Institute of the Czech Academy of Sciences (CAS), Prague, Czechia
| | | | - Marco Tisi
- Helmholtz Zentrum München, Institute of Radiation Medicine, Neuherberg, Germany
| | - François Trompier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-Santé, Fontenay-aux-Roses, France
| | - Olivier Van Hoey
- Belgian Nuclear Research Center, (SCK CEN), Institute for Environment, Health and Safety (EHS), Mol, Belgium
| | - Laurent Van Ryckeghem
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-Santé, Fontenay-aux-Roses, France
| | - Marek Wielunski
- Helmholtz Zentrum München, Institute of Radiation Medicine, Neuherberg, Germany
| | - Roger M. Harrison
- Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
| | - Liliana Stolarczyk
- Institute of Nuclear Physics, Polish Academy of Sciences, (IFJ PAN), Krakow, Poland
- Danish Centre for Particle Therapy, Aarhus University Hospital (AUH), Aarhus, Denmark
| | - Pawel Olko
- Institute of Nuclear Physics, Polish Academy of Sciences, (IFJ PAN), Krakow, Poland
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11
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De Saint-Hubert M, Verbeek N, Bäumer C, Esser J, Wulff J, Nabha R, Van Hoey O, Dabin J, Stuckmann F, Vasi F, Radonic S, Boissonnat G, Schneider U, Rodriguez M, Timmermann B, Thierry-Chef I, Brualla L. Validation of a Monte Carlo Framework for Out-of-Field Dose Calculations in Proton Therapy. Front Oncol 2022; 12:882489. [PMID: 35756661 PMCID: PMC9213663 DOI: 10.3389/fonc.2022.882489] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Proton therapy enables to deliver highly conformed dose distributions owing to the characteristic Bragg peak and the finite range of protons. However, during proton therapy, secondary neutrons are created, which can travel long distances and deposit dose in out-of-field volumes. This out-of-field absorbed dose needs to be considered for radiation-induced secondary cancers, which are particularly relevant in the case of pediatric treatments. Unfortunately, no method exists in clinics for the computation of the out-of-field dose distributions in proton therapy. To help overcome this limitation, a computational tool has been developed based on the Monte Carlo code TOPAS. The purpose of this work is to evaluate the accuracy of this tool in comparison to experimental data obtained from an anthropomorphic phantom irradiation. An anthropomorphic phantom of a 5-year-old child (ATOM, CIRS) was irradiated for a brain tumor treatment in an IBA Proteus Plus facility using a pencil beam dedicated nozzle. The treatment consisted of three pencil beam scanning fields employing a lucite range shifter. Proton energies ranged from 100 to 165 MeV. A median dose of 50.4 Gy(RBE) with 1.8 Gy(RBE) per fraction was prescribed to the initial planning target volume (PTV), which was located in the cerebellum. Thermoluminescent detectors (TLDs), namely, Li-7-enriched LiF : Mg, Ti (MTS-7) type, were used to detect gamma radiation, which is produced by nuclear reactions, and secondary as well as recoil protons created out-of-field by secondary neutrons. Li-6-enriched LiF : Mg,Cu,P (MCP-6) was combined with Li-7-enriched MCP-7 to measure thermal neutrons. TLDs were calibrated in Co-60 and reported on absorbed dose in water per target dose (μGy/Gy) as well as thermal neutron dose equivalent per target dose (μSv/Gy). Additionally, bubble detectors for personal neutron dosimetry (BD-PND) were used for measuring neutrons (>50 keV), which were calibrated in a Cf-252 neutron beam to report on neutron dose equivalent dose data. The Monte Carlo code TOPAS (version 3.6) was run using a phase-space file containing 1010 histories reaching an average standard statistical uncertainty of less than 0.2% (coverage factor k = 1) on all voxels scoring more than 50% of the maximum dose. The primary beam was modeled following a Fermi–Eyges description of the spot envelope fitted to measurements. For the Monte Carlo simulation, the chemical composition of the tissues represented in ATOM was employed. The dose was tallied as dose-to-water, and data were normalized to the target dose (physical dose) to report on absorbed doses per target dose (mSv/Gy) or neutron dose equivalent per target dose (μSv/Gy), while also an estimate of the total organ dose was provided for a target dose of 50.4 Gy(RBE). Out-of-field doses showed absorbed doses that were 5 to 6 orders of magnitude lower than the target dose. The discrepancy between TLD data and the corresponding scored values in the Monte Carlo calculations involving proton and gamma contributions was on average 18%. The comparison between the neutron equivalent doses between the Monte Carlo simulation and the measured neutron doses was on average 8%. Organ dose calculations revealed the highest dose for the thyroid, which was 120 mSv, while other organ doses ranged from 18 mSv in the lungs to 0.6 mSv in the testes. The proposed computational method for routine calculation of the out-of-the-field dose in proton therapy produces results that are compatible with the experimental data and allow to calculate out-of-field organ doses during proton therapy.
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Affiliation(s)
- Marijke De Saint-Hubert
- Research in Dosimetric Applications, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Nico Verbeek
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,Radiation Oncology and Imaging, German Cancer Consortium DKTK, Heidelberg, Germany.,Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Johannes Esser
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,Faculty of Mathematics and Science Institute of Physics and Medical Physics. Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Wulff
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany
| | - Racell Nabha
- Research in Dosimetric Applications, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Olivier Van Hoey
- Research in Dosimetric Applications, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Jérémie Dabin
- Research in Dosimetric Applications, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Florian Stuckmann
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,Faculty of Mathematics and Science Institute of Physics and Medical Physics. Heinrich-Heine University, Düsseldorf, Germany.,Klinikum Fulda GAG, Universitätsmedizin Marburg, Fulda, Zurich, Germany
| | - Fabiano Vasi
- Physik Institut, Universität Zürich, Zürich, Switzerland
| | | | | | - Uwe Schneider
- Physik Institut, Universität Zürich, Zürich, Switzerland
| | - Miguel Rodriguez
- Hospital Paitilla, Panama City, Panama.,Instituto de Investigaciones Cientificas y de Alta Tecnología INDICASAT-AIP, Panama City, Panama
| | - Beate Timmermann
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.,Radiation Oncology and Imaging, German Cancer Consortium DKTK, Heidelberg, Germany.,Department of Particle Therapy, University Hospital Essen, Essen, Germany
| | - Isabelle Thierry-Chef
- Radiation Programme, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,University Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Lorenzo Brualla
- West German Proton Therapy Centre Essen WPE, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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12
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Shrestha S, Newhauser WD, Donahue WP, Pérez-Andújar A. Stray neutron radiation exposures from proton therapy: physics-based analytical models of neutron spectral fluence, kerma and absorbed dose. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Patients who receive proton beam therapy are exposed to unwanted stray neutrons. Stray radiations increase the risk of late effects in normal tissues, such as second cancers and cataracts, and may cause implanted devices such as pacemakers to malfunction. Compared to therapeutic beams, little attention has been paid to modeling stray neutron exposures. In the past decade, substantial progress was made to develop semiempirical models of stray neutron dose equivalent, but models to routinely calculate neutron absorbed dose and kerma are still lacking. The objective of this work was to develop a new physics based analytical model to calculate neutron spectral fluence, kerma, and absorbed dose in a water phantom. Approach. We developed the model using dosimetric data from Monte Carlo simulations and neutron kerma coefficients from the literature. The model explicitly considers the production, divergence, scattering, and attenuation of neutrons. Neutron production was modeled for 120–250 MeV proton beams impinging on a variety of materials. Fluence, kerma and dose calculations were performed in a 30 × 180 × 44 cm3 phantom at points up to 43 cm in depth and 80 cm laterally. Main Results. Predictions of the analytical model agreed reasonably with corresponding values from Monte Carlo simulations, with a mean difference in average energy deposited of 20%, average kerma coefficient of 21%, and absorbed dose to water of 49%. Significance. The analytical model is simple to implement and use, requires less configuration data that previously reported models, and is computationally fast. This model appears potentially suitable for integration in treatment planning system, which would enable risk calculations in prospective and retrospective cases, providing a powerful tool for epidemiological studies and clinical trials.
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13
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Majer M, Ambrožová I, Davídková M, De Saint-Hubert M, Kasabašić M, Knežević Ž, Kopeć R, Krzempek D, Krzempek K, Miljanić S, Mojżeszek N, Veršić I, Stolarczyk L, Harrison RM, Olko P. Out-of-field doses in pediatric craniospinal irradiations with 3D-CRT, VMAT and scanning proton radiotherapy - a phantom study. Med Phys 2022; 49:2672-2683. [PMID: 35090187 DOI: 10.1002/mp.15493] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Craniospinal irradiation (CSI) has greatly increased survival rates for patients with a diagnosis of medulloblastoma and other primitive neuroectodermal tumors. However, as it includes exposure of a large volume of healthy tissue to unwanted doses, there is a strong concern about the complications of the treatment, especially for the children. To estimate the risk of second cancers and other unwanted effects, out-of-field dose assessment is necessary. The purpose of this study is to evaluate and compare out-of-field doses in pediatric CSI treatment using conventional and advanced photon radiotherapy (RT) and advanced proton therapy. To our knowledge, it is the first such comparison based on in-phantom measurements. Additionally, for out-of-field doses during photon RT in this and other studies, comparisons were made using analytical modeling. METHODS In order to describe the out-of-field doses absorbed in a pediatric patient during actual clinical treatment, an anthropomorphic phantom which mimics the 10-year-old child was used. Photon 3D-conformal radiotherapy (3D-CRT) and two advanced, highly conformal techniques: photon volumetric modulated arc therapy (VMAT) and active pencil beam scanning (PBS) proton radiotherapy were used for CSI treatment. Radiophotoluminescent (RPL) and poly-allyl-diglycol-carbonate (PADC) nuclear track detectors were used for photon and neutron dosimetry in the phantom, respectively. Out-of-field doses from neutrons were expressed in terms of dose equivalent. A two-Gaussian model was implemented for out-of-field doses during photon RT. RESULTS The mean VMAT photon doses per target dose to all organs in this study were under 50% of the target dose (i.e., <500 mGy/Gy), while the mean 3D-CRT photon dose to oesophagus, gall bladder and thyroid, exceeded that value. However, for 3D-CRT, better sparing was achieved for eyes and lungs. The mean PBS photon doses for all organs were up to 3 orders of magnitude lower compared to VMAT and 3D-CRT and exceeded 10 mGy/Gy only for the oesophagus, intestine and lungs. The mean neutron dose equivalent during PBS for 8 organs of interest (thyroid, breasts, lungs, liver, stomach, gall bladder, bladder, prostate) ranged from 1.2 mSv/Gy for bladder to 23.1 mSv/Gy for breasts. Comparison of out-of-field doses in this and other phantom studies found in the literature showed that a simple and fast two-Gaussian model for out-of-field doses as a function of distance from the field edge can be applied in a CSI using photon RT techniques. CONCLUSIONS PBS is the most promising technique for out-of-field dose reduction in comparison to photon techniques. Among photon techniques, VMAT is a preferred choice for most of out-of-field organs and especially for the thyroid, while doses for eyes, breasts and lungs, are lower for 3D-CRT. For organs outside the field edge, a simple analytical model can be helpful for clinicians involved in treatment planning using photon RT but also for retrospective data analysis for cancer risk estimates and epidemiology in general. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marija Majer
- Ruđer Bošković Institute, Zagreb, 10000, Croatia
| | - Iva Ambrožová
- Nuclear Physics Institute of the CAS, Řež, CZ-250 68, Czech Republic
| | - Marie Davídková
- Nuclear Physics Institute of the CAS, Řež, CZ-250 68, Czech Republic
| | | | - Mladen Kasabašić
- Osijek University Hospital, Osijek, 31000, Croatia.,Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, Osijek, 31000, Croatia
| | | | - Renata Kopeć
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Dawid Krzempek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Katarzyna Krzempek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | | | - Natalia Mojżeszek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Ivan Veršić
- Department of Physics, Faculty of Science, University of Zagreb, Zagreb, 10000, Croatia
| | - Liliana Stolarczyk
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland.,Danish Center for Particle Therapy, Aarhus, Denmark
| | - Roger M Harrison
- University of Newcastle, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Paweł Olko
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
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14
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Tillery H, Moore M, Gallagher KJ, Taddei PJ, Leuro E, Argento DC, Moffitt GB, Kranz M, Carey M, Heymsfield S, Newhauser WD. Personalized 3D-printed anthropomorphic whole-body phantom irradiated by protons, photons, and neutrons. Biomed Phys Eng Express 2022; 8. [PMID: 35045408 DOI: 10.1088/2057-1976/ac4d04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022]
Abstract
The objective of this study was to confirm the feasibility of three-dimensionally-printed (3D-printed), personalized whole-body anthropomorphic phantoms for radiation dose measurements in a variety of charged and uncharged particle radiation fields. We 3D-printed a personalized whole-body phantom of an adult female with a height of 154.8 cm, mass of 90.7 kg, and body mass index of 37.8 kg/m2. The phantom comprised of a hollow plastic shell filled with water and included a watertight access conduit for positioning dosimeters. It is compatible with a wide variety of radiation dosimeters, including ionization chambers that are suitable for uncharged and charged particles. Its mass was 6.8 kg empty and 98 kg when filled with water. Watertightness and mechanical robustness were confirmed after multiple experiments and transportations between institutions. The phantom was irradiated to the cranium with therapeutic beams of 170-MeV protons, 6-MV photons, and fast neutrons. Radiation absorbed dose was measured from the cranium to the pelvis along the longitudinal central axis of the phantom. The dose measurements were made using established dosimetry protocols and well-characterized instruments. For the therapeutic environments considered in this study, stray radiation from intracranial treatment beams was the lowest for proton therapy, intermediate for photon therapy, and highest for neutron therapy. An illustrative example set of measurements at the location of the thyroid for a square field of 5.3 cm per side resulted in 0.09, 0.59, and 1.93 cGy/Gy from proton, photon, and neutron beams, respectively. In this study, we found that 3D-printed personalized phantoms are feasible, inherently reproducible, and well-suited for therapeutic radiation measurements. The measurement methodologies we developed enabled the direct comparison of radiation exposures from neutron, proton, and photon beam irradiations.
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Affiliation(s)
- Hunter Tillery
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Meagan Moore
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Kyle Joseph Gallagher
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Phillip J Taddei
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, UNITED STATES
| | - Eric Leuro
- Seattle Cancer Care Alliance, 1570 N 115th St, Seattle, Washington, 98133, UNITED STATES
| | - David C Argento
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Gregory B Moffitt
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Marissa Kranz
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Margaret Carey
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Steven Heymsfield
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Wayne David Newhauser
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
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15
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The influence of nuclear models and Monte Carlo radiation transport codes on stray neutron dose estimations in proton therapy. RADIAT MEAS 2022. [DOI: 10.1016/j.radmeas.2021.106693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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De Saint-Hubert M, Tymińska K, Stolarczyk L, Brkić H. Fetus dose calculation during proton therapy of pregnant phantoms using MCNPX and MCNP6.2 codes. RADIAT MEAS 2021. [DOI: 10.1016/j.radmeas.2021.106665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Puchalska M. Modelling and measurements of distributions in an adult human phantom undergoing proton scanning beam radiotherapy: lung- and prostate-located tumours. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:243-256. [PMID: 33651168 PMCID: PMC8116245 DOI: 10.1007/s00411-021-00895-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Proton radiotherapy has been shown to offer a significant dosimetric advantage in cancer patients, in comparison to conventional radiotherapy, with a decrease in dose to healthy tissue and organs at risk, because the bulk of the beam energy is deposited in the Bragg peak to be located within a tumour. However, it should be kept in mind that radiotherapy of cancer is still accompanied by adverse side effects, and a better understanding and improvement of radiotherapy can extend the life expectancy of patients following the treatment of malignant tumours. In this study, the dose distributions measured with thermoluminescent detectors (TLDs) inside a tissue-equivalent adult human phantom exposed for lung and prostate cancer using the modern proton beam scanning radiotherapy technique were compared. Since the TLD detection efficiency depends on the ionization density of the radiation to be detected, and since this efficiency is detector specific, four different types of TLDs were used to compare their response in the mixed radiation fields. Additionally, the dose distributions from two different cancer treatment modalities were compared using the selected detectors. The measured dose values were benchmarked against Monte Carlo simulations and available literature data. The results indicate an increase in the lateral dose with an increase of the primary proton energy. However, the radiation quality factor of the mixed radiation increases by 20% in the vicinity to the target for the lower initial proton energy, due to the production of secondary charged particles of low-energy and short range. For the cases presented here the MTS-N TLD detector seems to be the most optimal tool for dose measurements within the target volume, while the MCP-N TLD detector, due to an interplay of its enhanced thermal neutron response and decreased detection efficiency to highly ionising radiation, is a better choice for the out-of-field measurements. The pairs of MTS-6 and MTS-7 TLDs used also in this study allowed for a direct measurement of the neutron dose equivalent. Before it can be concluded that they offer an alternative to the time-consuming nuclear track detectors, however, more research is needed to unambiguously confirm whether this observation was just accidental or whether it only applies to certain cases. Since there is no universal detector, which would allow the determination of the dosimetric quantities relevant for risk estimation, this work expands the knowledge necessary to improve the quality of dosimetry data and might help scientists and clinicians in choosing the right tools to measure radiation doses in mixed radiation fields.
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Affiliation(s)
- Monika Puchalska
- Radiation Physics, Technische Universität Wien, Stadionalle 2, 1020, Vienna, Austria.
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18
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Gallagher KJ, Youssef B, Georges R, Mahajan A, Feghali JA, Nabha R, Ayoub Z, Jalbout W, Taddei PJ. Proton Radiotherapy Could Reduce the Risk of Fatal Second Cancers for Children with Intracranial Tumors in Low- and Middle-Income Countries. Int J Part Ther 2021; 7:1-10. [PMID: 33829068 PMCID: PMC8019578 DOI: 10.14338/ijpt-20-00041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To test our hypothesis that, for young children with intracranial tumors, proton radiotherapy in a high-income country does not reduce the risk of a fatal subsequent malignant neoplasm (SMN) compared with photon radiotherapy in low- and middle-income countries. MATERIALS AND METHODS We retrospectively selected 9 pediatric patients with low-grade brain tumors who were treated with 3-dimensional conformal radiation therapy in low- and middle-income countries. Images and contours were deidentified and transferred to a high-income country proton therapy center. Clinically commissioned treatment planning systems of each academic hospital were used to calculate absorbed dose from the therapeutic fields. After fusing supplemental computational phantoms to the patients' anatomies, models from the literature were applied to calculate stray radiation doses. Equivalent doses were determined in organs and tissues at risk of SMNs, and the lifetime attributable risk of SMN mortality (LAR) was predicted using a dose-effect model. Our hypothesis test was based on the average of the ratios of LARs from proton therapy to that of photon therapy ()(H0: = 1; H A : < 1). RESULTS Proton therapy reduced the equivalent dose in organs at risk for SMNs and LARs compared with photon therapy for which the for the cohort was 0.69 ± 0.10, resulting in the rejection of H0 (P < .001, α = 0.05). We observed that the younger children in the cohort (2-4 years old) were at a factor of approximately 2.5 higher LAR compared with the older children (8-12 years old). CONCLUSION Our findings suggest that proton radiotherapy has the strong potential of reducing the risk of fatal SMNs in pediatric patients with intracranial tumors if it were made available globally.
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Affiliation(s)
- Kyle J. Gallagher
- Oregon Health and Science University, Portland, OR, USA
- Oregon State University, Corvallis, OR, USA
| | - Bassem Youssef
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Georges
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- Radiation Oncology Department, Mayo Clinic, Rochester, MN, USA
| | | | - Racile Nabha
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Ayoub
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Jalbout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Phillip J. Taddei
- American University of Beirut Medical Center, Beirut, Lebanon
- Radiation Oncology Department, Mayo Clinic, Rochester, MN, USA
- University of Washington School of Medicine, Seattle, WA, USA
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19
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Wochnik A, Stolarczyk L, Ambrožová I, Davídková M, De Saint-Hubert M, Domański S, Domingo C, Knežević Ž, Kopeć R, Kuć M, Majer M, Mojżeszek N, Mares V, Martínez-Rovira I, Caballero-Pacheco MÁ, Pyszka E, Swakoń J, Trinkl S, Tisi M, Harrison R, Olko P. Out-of-field doses for scanning proton radiotherapy of shallowly located paediatric tumours-a comparison of range shifter and 3D printed compensator. Phys Med Biol 2021; 66:035012. [PMID: 33202399 DOI: 10.1088/1361-6560/abcb1f] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The lowest possible energy of proton scanning beam in cyclotron proton therapy facilities is typically between 60 and 100 MeV. Treatment of superficial lesions requires a pre-absorber to deliver doses to shallower volumes. In most of the cases a range shifter (RS) is used, but as an alternative solution, a patient-specific 3D printed proton beam compensator (BC) can be applied. A BC enables further reduction of the air gap and consequently reduction of beam scattering. Such pre-absorbers are additional sources of secondary radiation. The aim of this work was the comparison of RS and BC with respect to out-of-field doses for a simulated treatment of superficial paediatric brain tumours. EURADOS WG9 performed comparative measurements of scattered radiation in the Proteus C-235 IBA facility (Cyclotron Centre Bronowice at the Institute of Nuclear Physics, CCB IFJ PAN, Kraków, Poland) using two anthropomorphic phantoms-5 and 10 yr old-for a superficial target in the brain. Both active detectors located inside the therapy room, and passive detectors placed inside the phantoms were used. Measurements were supplemented by Monte Carlo simulation of the radiation transport. For the applied 3D printed pre-absorbers, out-of-field doses from both secondary photons and neutrons were lower than for RS. Measurements with active environmental dosimeters at five positions inside the therapy room indicated that the RS/BC ratio of the out-of-field dose was also higher than one, with a maximum of 1.7. Photon dose inside phantoms leads to higher out-of-field doses for RS than BC to almost all organs with the highest RS/BC ratio 12.5 and 13.2 for breasts for 5 and 10 yr old phantoms, respectively. For organs closest to the isocentre such as the thyroid, neutron doses were lower for BC than RS due to neutrons moderation in the target volume, but for more distant organs like bladder-conversely-lower doses for RS than BC were observed. The use of 3D printed BC as the pre-absorber placed in the near vicinity of patient in the treatment of superficial tumours does not result in the increase of secondary radiation compared to the treatment with RS, placed far from the patient.
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Affiliation(s)
- A Wochnik
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - L Stolarczyk
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland.,Skandionkliniken, von Kraemers Allé 26, Uppsala 752 37, Sweden.,Dansk Center for Partikelterapi, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - I Ambrožová
- Department of Radiation Dosimetry, Nuclear Physics Institute Czech Academy of Sciences, Prague CZ-250 68 Řež, Czech Republic
| | - M Davídková
- Department of Radiation Dosimetry, Nuclear Physics Institute Czech Academy of Sciences, Prague CZ-250 68 Řež, Czech Republic
| | - M De Saint-Hubert
- Belgium Nuclear Research Centre (SCK CEN), Boeretang 200, Mol BE-2400, Belgium
| | - S Domański
- National Centre for Nuclear Research, Otwock-Świerk 05-400, Poland
| | - C Domingo
- Departament de Física, Universitat Autònoma de Barcelona (UAB), Bellaterra E-08193, Spain
| | - Ž Knežević
- Ruđer Bošković Institute, Bijenička c. 54, Zagreb 10000, Croatia
| | - R Kopeć
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - M Kuć
- National Centre for Nuclear Research, Otwock-Świerk 05-400, Poland
| | - M Majer
- Ruđer Bošković Institute, Bijenička c. 54, Zagreb 10000, Croatia
| | - N Mojżeszek
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - V Mares
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
| | - I Martínez-Rovira
- Departament de Física, Universitat Autònoma de Barcelona (UAB), Bellaterra E-08193, Spain
| | - M Á Caballero-Pacheco
- Departament de Física, Universitat Autònoma de Barcelona (UAB), Bellaterra E-08193, Spain
| | - E Pyszka
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - J Swakoń
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - S Trinkl
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstraße 1, Neuherberg 85764, Germany.,Technische Universität München, Physik-Department, Garching 85748, Germany
| | - M Tisi
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
| | - R Harrison
- University of Newcastle upon Tyne, Tyne and Wear, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - P Olko
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
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Rühm W, Harrison RM. High CT doses return to the agenda. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:3-7. [PMID: 31844985 DOI: 10.1007/s00411-019-00827-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 05/03/2023]
Affiliation(s)
- W Rühm
- Helmholtz Zentrum München, Institute of Radiation Therapy, Ingolstädter Landstr. 1, 85764, Oberschleißheim, Germany.
| | - R M Harrison
- Institute of Cellular Medicine, University of Newcastle, Newcastle, UK
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Rühm W, Ainsbury E, Breustedt B, Caresana M, Gilvin P, Knežević Ž, Rabus H, Stolarczyk L, Vargas A, Bottollier-Depois J, Harrison R, Lopez M, Stadtmann H, Tanner R, Vanhavere F, Woda C, Clairand I, Fantuzzi E, Fattibene P, Hupe O, Olko P, Olšovcová V, Schuhmacher H, Alves J, Miljanic S. The European radiation dosimetry group – Review of recent scientific achievements. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hälg RA, Schneider U. Neutron dose and its measurement in proton therapy-current State of Knowledge. Br J Radiol 2020; 93:20190412. [PMID: 31868525 PMCID: PMC7066952 DOI: 10.1259/bjr.20190412] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022] Open
Abstract
Proton therapy has shown dosimetric advantages over conventional radiation therapy using photons. Although the integral dose for patients treated with proton therapy is low, concerns were raised about late effects like secondary cancer caused by dose depositions far away from the treated area. This is especially true for neutrons and therefore the stray dose contribution from neutrons in proton therapy is still being investigated. The higher biological effectiveness of neutrons compared to photons is the main cause of these concerns. The gold-standard in neutron dosimetry is measurements, but performing neutron measurements is challenging. Different approaches have been taken to overcome these difficulties, for instance with newly developed neutron detectors. Monte Carlo simulations is another common technique to assess the dose from secondary neutrons. Measurements and simulations are used to develop analytical models for fast neutron dose estimations. This article tries to summarize the developments in the different aspects of neutron dose in proton therapy since 2017. In general, low neutron doses have been reported, especially in active proton therapy. Although the published biological effectiveness of neutrons relative to photons regarding cancer induction is higher, it is unlikely that the neutron dose has a large impact on the second cancer risk of proton therapy patients.
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Isobe T, Mori Y, Takei H, Sato E, Sakae T. [14. Biological Dose and Effects of Neutrons in Proton Beam Therapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:863-869. [PMID: 32814743 DOI: 10.6009/jjrt.2020_jsrt_76.8.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | - Eisuke Sato
- Faculty of Health Science, Juntendo University
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Gallagher KJ, Taddei PJ. ANALYTICAL MODEL TO ESTIMATE EQUIVALENT DOSE FROM INTERNAL NEUTRONS IN PROTON THERAPY OF CHILDREN WITH INTRACRANIAL TUMORS. RADIATION PROTECTION DOSIMETRY 2019; 183:459-467. [PMID: 30272222 PMCID: PMC6596440 DOI: 10.1093/rpd/ncy166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/15/2018] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
This study developed a computationally efficient and easy-to-implement analytical model to estimate the equivalent dose from secondary neutrons originating in the bodies ('internal neutrons') of children receiving intracranial proton radiotherapy. A two-term double-Gaussian mathematical model was fit to previously published internal neutron equivalent dose per therapeutic absorbed dose versus distance from the field edge calculated using Monte Carlo simulations. The model was trained using three intracranial proton fields of a 9-year-old girl. The resulting model was tested against two intracranial fields of a 10-year-old boy by comparing the mean doses in organs at risk of a radiogenic cancer estimated by the model versus those previously calculated by Monte Carlo. On average, the model reproduced the internal neutron organ doses in the 10-year-old boy within 13.5% of the Monte Carlo at 3-10 cm from the field edge and within a factor of 2 of the Monte Carlo at 10-20 cm from the field edge. Beyond 20 cm, the model poorly estimated H/DRx, however, the values were very small, at <0.03 mSv Gy-1.
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Affiliation(s)
- Kyle J Gallagher
- Oregon Health and Science University, Portland, OR, USA
- Oregon State University, Corvallis, OR, USA
| | - Phillip J Taddei
- American University of Beirut Medical Center, Beirut, Lebanon
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, WA, USA
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Parisi A, Van Hoey O, Mégret P, Vanhavere F. Microdosimetric specific energy probability distribution in nanometric targets and its correlation with the efficiency of thermoluminescent detectors exposed to charged particles. RADIAT MEAS 2019. [DOI: 10.1016/j.radmeas.2018.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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