1
|
Liang Y, Xu H, Tang W, Du X. The impact of metal implants on the dose and clinical outcome of radiotherapy (Review). Mol Clin Oncol 2024; 21:66. [PMID: 39091418 PMCID: PMC11289751 DOI: 10.3892/mco.2024.2764] [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: 02/19/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
Radiotherapy (RT) is one of the most widely used and effective cancer treatments. With the increasing need for organ reconstruction and advancements in material technology, an increasing number of patients with cancer have metallic implants. These implants can affect RT dosage and clinical outcomes, warranting careful consideration by oncologists. The present review discussed the mechanisms by which different types of metallic implants impact various stages of the RT process, examined methods to mitigate these effects during treatment, and discussed the clinical implications of metallic implants on RT outcomes. In summary, when metallic implants are present within the RT field, oncologists should carefully assess their impact on the treatment.
Collapse
Affiliation(s)
- Yuwen Liang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Haonan Xu
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Wenqiang Tang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| |
Collapse
|
2
|
Bălan C, Granja C, Mytsin G, Shvidky S, Molokanov A, Marek L, Chiș V, Oancea C. Particle tracking, recognition and LET evaluation of out-of-field proton therapy delivered to a phantom with implants. Phys Med Biol 2024; 69:165006. [PMID: 38986478 DOI: 10.1088/1361-6560/ad61b8] [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: 12/22/2023] [Accepted: 07/10/2024] [Indexed: 07/12/2024]
Abstract
Objective.This study aims to assess the composition of scattered particles generated in proton therapy for tumors situated proximal to some titanium (Ti) dental implants. The investigation involves decomposing the mixed field and recording Linear Energy Transfer (LET) spectra to quantify the influence of metallic dental inserts located behind the tumor.Approach.A therapeutic conformal proton beam was used to deliver the treatment plan to an anthropomorphic head phantom with two types of implants inserted in the target volume (made of Ti and plastic, respectively). The scattered radiation resulted during the irradiation was detected by a hybrid semiconductor pixel detector MiniPIX Timepix3 that was placed distal to the Spread-out Bragg peak. Visualization and field decomposition of stray radiation were generated using algorithms trained in particle recognition based on artificial intelligence neural networks (AI NN). Spectral sensitive aspects of the scattered radiation were collected using two angular positions of the detector relative to the beam direction: 0° and 60°.Results.Using AI NN, 3 classes of particles were identified: protons, electrons & photons, and ions & fast neutrons. Placing a Ti implant in the beam's path resulted in predominantly electrons and photons, contributing 52.2% of the total number of detected particles, whereas for plastic implants, the contribution was 65.4%. Scattered protons comprised 45.5% and 31.9% with and without metal inserts, respectively. The LET spectra were derived for each group of particles identified, with values ranging from 0.01 to 7.5 keVμm-1for Ti implants/plastic implants. The low-LET component was primarily composed of electrons and photons, while the high-LET component corresponded to protons and ions.Significance.This method, complemented by directional maps, holds the potential for evaluating and validating treatment plans involving stray radiation near organs at risk, offering precise discrimination of the mixed field, and enhancing in this way the LET calculation.
Collapse
Affiliation(s)
- Cristina Bălan
- Faculty of Physics, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Radiotherapy, The Oncology Institute 'Prof. Dr Ion Chiricuta', Cluj-Napoca, Romania
| | | | - Gennady Mytsin
- International Intergovernmental Organization Joint Institute for Nuclear Research (JINR), Dubna, Russia
| | - Sergey Shvidky
- International Intergovernmental Organization Joint Institute for Nuclear Research (JINR), Dubna, Russia
| | - Alexander Molokanov
- International Intergovernmental Organization Joint Institute for Nuclear Research (JINR), Dubna, Russia
| | | | - Vasile Chiș
- Faculty of Physics, Babeș-Bolyai University, Cluj-Napoca, Romania
| | | |
Collapse
|
3
|
Rijs Z, Kawsar KA, Saha P, van de Sande M, Lui D. Evaluation of computed tomography artefacts of carbon-fiber and titanium implants in patients with spinal oligometastatic disease undergoing stereotactic ablative radiotherapy. Sci Rep 2024; 14:6700. [PMID: 38509154 PMCID: PMC10954645 DOI: 10.1038/s41598-024-52498-2] [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: 04/11/2023] [Accepted: 01/19/2024] [Indexed: 03/22/2024] Open
Abstract
This study evaluated artefacts on computed tomography (CT) images using Hounsfield units (HU) in patients with spinal oligometastatic disease who received carbon-fiber (CF; n = 11) or titanium (n = 11) spine implants and underwent stereotactic ablative radiotherapy (SABR). Pre- and postoperative HU were measured at the vertebral body, pedicle, and spinal cord at three different levels: the lower instrumented vertebra, the level of metastatic spinal cord compression, and an uninvolved level. Areas measured at each level were delicately matched pre- and postoperatively. Significant differences in HU were observed at the vertebral body, the pedicle, and the spinal cord at the lowest instrumented vertebra level for both CF and titanium (average increase 1.54-fold and 5.11-fold respectively). At the metastatic spinal cord compression level, a trend towards a higher HU-increase was observed in titanium compared with CF treated patients (average increase 2.51-fold and 1.43-fold respectively). The relatively high postoperative HU-increase after insertion of titanium implants indicated CT artefacts, while the relatively low HU-increase of CF implants was not associated with artefacts. Less CT artefacts could facilitate an easier contouring phase in radiotherapy planning. In addition, we propose a CT artefact grading system based on postoperative HU-increase. This system could serve as a valuable tool in future research to assess if less CT artefacts lead to time savings during radiotherapy treatment planning and, potentially, to better tumoricidal effects and less adverse effects if particle therapy would be administered.
Collapse
Affiliation(s)
- Zeger Rijs
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Priyanshu Saha
- Department of Orthopedic and Spinal Surgery, St. George's Hospital, London, UK
| | - Michiel van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Darren Lui
- Department of Orthopedic and Spinal Surgery, St. George's Hospital, London, UK
| |
Collapse
|
4
|
Ekinci F, Asuroglu T, Acici K. Monte Carlo Simulation of TRIM Algorithm in Ceramic Biomaterial in Proton Therapy. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4833. [PMID: 37445147 DOI: 10.3390/ma16134833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Biomaterials play a crucial role in enhancing human health and quality of life. They are employed in applications such as tissue substitution, diagnostic tools, medical supplies, therapeutic treatments, regenerative medicine, and radiation dosimetric studies. However, their predisposition to proton therapy, which is a trending treatment in the world, has not been adequately studied. Ceramic biomaterials, known for their hardness and durability, offer versatile uses, especially in bone tissue replacements. The wide range of physical, mechanical, and chemical properties exhibited by ceramics has spurred extensive research, development, and application in this field. This study focuses on investigating and analyzing the ionization, recoils, phonon release, collision events, and lateral scattering properties of ceramic biomaterials that closely resemble bone tissue in proton therapy applications. Monte Carlo (MC) Transport of Ions in Matter (TRIM) simulation tools were utilized for this analysis. The results showed that Silicon dioxide exhibited the Bragg peak position closest to bone tissue, with a deviation of 10.6%. The average recoils differed by 1.7%, and the lateral scattering differed by 3.6%. The main innovation of this study lies in considering interactions such as recoil, collision events, phonon production, and lateral scattering when selecting biomaterials, despite their limited digitization and understanding. By evaluating all these interactions, the study aimed to identify the most suitable ceramic biomaterial to replace bone tissue in proton therapy.
Collapse
Affiliation(s)
- Fatih Ekinci
- Institute of Nuclear Sciences, Ankara University, 06830 Ankara, Turkey
| | - Tunc Asuroglu
- Faculty of Medicine and Health Technology, Tampere University, 33720 Tampere, Finland
| | - Koray Acici
- Artifical Intelligence and Data Engineerig, Ankara University, 06830 Ankara, Turkey
| |
Collapse
|
5
|
Andrew Katsifis G, McKenzie DR, Hill R, Connor MO, Milross C, Suchowerska N. Radiation dose perturbation at the tissue interface with PEEK and Titanium bone implants: Monte Carlo simulation, treatment planning and film dosimetry. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Barlaz Us S, Ataol AS, Ergun G. Impact of different fixed dental prostheses on radiation dose in helical tomotherapy as measured with metal oxide semiconductor field-effect transistor dosimetry. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:716-724. [PMID: 35248513 DOI: 10.1016/j.oooo.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This ex vivo study evaluated the effects of different fixed dental prostheses and protective materials on scattered radiation during radiation therapy (RT). STUDY DESIGN Natural teeth (group NT) and 4 types of prostheses (group BL: bilayer lithium disilicate glass-ceramic; group MZ: monolithic zirconia ceramic; group BZ: bilayer zirconia-based all ceramic; and group BM: bilayer metal-ceramic restorations) were examined in maxillary and mandibular arch phantoms. All groups were divided into 3 subgroups: (1) without protective material over the prostheses; (2) protected with a soft acrylic night guard; and (3) protected with polyvinylsiloxane putty. All groups were irradiated with helical RT at 2 Gy and 6 MV photon energy. Doses were measured internally and externally 3 times on each phantom. Results were significant at P < .05. RESULTS No statistically significant differences in doses were found between groups NT and BL in either phantom, but these groups were different from the others. The differences between groups BZ and MZ were insignificant. Doses in group BM were significantly larger than all other groups. No significant differences existed between doses with and without protective material. CONCLUSIONS Doses increased significantly due to scattered radiation from the prostheses with increasing material density. Protective materials had no significant effect on dose.
Collapse
Affiliation(s)
- Songul Barlaz Us
- Faculty of Medicine, Department of Radiation Oncology, Mersin University, Mersin, Turkey.
| | | | - Gulfem Ergun
- Faculty of Dentistry, Department of Prosthodontics, Gazi University, Ankara, Turkey.
| |
Collapse
|
7
|
Li J, Zhang X, Pan Y, Zhuang H, Yang R. Comparison of Ray Tracing and Monte Carlo Calculation Algorithms for Spine Lesions Treated With CyberKnife. Front Oncol 2022; 12:898175. [PMID: 35600341 PMCID: PMC9116717 DOI: 10.3389/fonc.2022.898175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This study attempts to evaluate Ray Tracing (RT) and Monte Carlo (MC) algorithms for CyberKnife treatments of spine lesions and determine whether the MC algorithm is necessary for all spine treatment and compare the RT algorithm and MC algorithm at various spine lesion sites. Methods The CyberKnife is used for stereotactic body radiotherapy for lesions in the cervical spine (30), thoracic spine (50), lumbar spine (30), and sacral spine (15). Dose was calculated using RT and MC algorithms for patients planned with the same beam angles and monitor units. Dose-volume histograms of the target and selected critical structures are evaluated. Results The average target coverage of prescribed dose with MC algorithms was 94.80%, 88.47%, 92.52%, and 93.41%, respectively, in cervical, thoracic, lumbar, and sacral spine. For the thoracic spine, the RT algorithm significantly overestimates the percentage volume of the target covered by the prescribed dose, as well as overestimates doses to organs at risk in most cases, including lung, spinal cord, and esophagus. For cervical, lumbar, and sacral spine, the differences of the target coverage of prescription dose were generally less than 3% between the RT and MC algorithms. The differences of doses to organs at risk varied with lesion sites and surrounding organs. Conclusions In the thoracic spine lesions with beams through air cavities, RT algorithm should be limited and verified with MC algorithm, but the RT algorithm is adequate for treatment of cervical, lumbar, and sacral spine lesions without or with a small amount of beams passing through the lungs.
Collapse
Affiliation(s)
- Jun Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xile Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuxi Pan
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| |
Collapse
|
8
|
Dur MP, Celik N, Seven N. Evaluation of the changes in physical properties and mineral content of enamel exposed to radiation after treating with remineralization agent. Clin Oral Investig 2022; 26:5673-5685. [PMID: 35552532 DOI: 10.1007/s00784-022-04524-8] [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: 12/09/2021] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of different remineralization agents on the physical properties and elemental content of enamel exposed to radiation. MATERIAL AND METHOD The enamel surfaces of impacted third molar teeth were prepared, and six study groups were created (n = 6). Next, 60 Gy radiation was applied to each group. Between applications, each group except for the control group was treated with a different remineralization agent (sodium fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium phosphate with fluorite (CPP-ACFP), bioactive glass, or chitosan). The results were evaluated in terms of pre- and post-radiation values and the difference between the two. The paired-samples t test and analysis of variance test were used in the analysis of normally distributed hardness and roughness values, while Wilcoxon's signed ranks test, and the Kruskal Wallis and Mann-Whitney U tests were used in the analysis of elemental content without normal distribution. RESULTS A statistically significant decrease was observed in microhardness measurements in all groups. Intragroup evaluation revealed a statistically significant difference between the NaF and bioactive glass groups (p < 0.05). No significant difference was observed between the groups' roughness measurements (p < 0.05). Intergroup evaluation of surface roughness revealed a significant difference in the CPP-ACFP and chitosan groups (p < 0.05). Pre- and post-radiation oxygen, magnesium, and potassium levels and Ca/P ratios also differed significantly (p < 0.05). CONCLUSION Radiation caused a statistically significant difference in the microhardness and elemental content of enamel. However, no significant difference was observed in enamel roughness. The applied remineralizing agents have a partial ameliorating effect on the adverse impacts of radiation. CLINICAL RELEVANCE Radiation causes changes in the mechanical properties and elemental content of tooth enamel. Remineralizing agent application is a promising option in reducing the adverse effects of irradiation.
Collapse
Affiliation(s)
- Merve Pelin Dur
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey.
| | - Neslihan Celik
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
| | - Nilgun Seven
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
| |
Collapse
|
9
|
Katsifis GA, McKenzie DR, Suchowerska N. Monte Carlo calculations of radiotherapy dose distributions within and around orthopaedic implants. Phys Imaging Radiat Oncol 2022; 22:123-130. [PMID: 35619642 PMCID: PMC9127420 DOI: 10.1016/j.phro.2022.04.011] [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: 09/29/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background and purpose Cancer patients often require a titanium orthopaedic implant to support or replace lost bone. In radiation treatment, the dose distribution is perturbed causing regions of high and low dose at material interfaces. Since the survival of integrating bone tissue is critical to implant success, the aim of this study was to determine the dose distribution in and around the scaffold, when constructed from titanium or Poly-ether-ether-ketone (PEEK). Materials and methods The dose distributions in the pores and along boundaries for three implant scaffold designs were calculated using Monte-Carlo methods in Geant4/GATE, with the material taken as titanium or PEEK. The 3D dose distributions were analysed in MATLAB and segmented using image masks, yielding the dose distributions in key regions of interest. To evaluate the effect of the predicted dose perturbations, the cell survival was calculated using the linear-quadratic model for SAOS-2 cells (bone) using experimentally determined radiation response data. Results High dose gradients were found along the boundaries of the titanium implants, but not for the corresponding PEEK implants. The dose to the internal cavities of the titanium implants was enhanced by 10–15% near the proximal interface whereas for PEEK, there was no significant dose perturbation. The predicted perturbation caused by the titanium implant was shown to decrease the survival for SAOS-2 cells by 7% which was not found for the PEEK implants. Conclusion PEEK was shown to be a more favourable orthopaedic implant material over titanium for cancer patients considering radiation therapy.
Collapse
|
10
|
Akyol O, Olgar T, Toklu T, Eren H, Dirican B. Dose distrubution evaluation of different dental implants on a real human dry-skull model for head and neck cancer radiotherapy. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
11
|
Bi S, Zhao M, Ma J, Chen Z, Liang J. Effects of peripherally inserted central catheter on dosimetry of the blood vessel region in volumetric modulated arc therapy planning for lung cancer. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Suyan Bi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical Col lege Shenzhen 518116 China
| | - Mang Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical Col lege Shenzhen 518116 China
| | - Jun Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical Col lege Shenzhen 518116 China
| | - Zhijian Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical Col lege Shenzhen 518116 China
| | - Jun Liang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical Col lege Shenzhen 518116 China
| |
Collapse
|