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Draeger E, Roberts K, Decker RD, Bahar N, Wilson LD, Contessa J, Husain Z, Williams BB, Flood AB, Swartz HM, Carlson DJ. In Vivo Verification of Electron Paramagnetic Resonance Biodosimetry Using Patients Undergoing Radiation Therapy Treatment. Int J Radiat Oncol Biol Phys 2024; 119:292-301. [PMID: 38072322 DOI: 10.1016/j.ijrobp.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Electron paramagnetic resonance (EPR) biodosimetry, used to triage large numbers of individuals incidentally exposed to unknown doses of ionizing radiation, is based on detecting a stable physical response in the body that is subject to quantifiable variation after exposure. In vivo measurement is essential to fully characterize the radiation response relevant to a living tooth measured in situ. The purpose of this study was to verify EPR spectroscopy in vivo by estimating the radiation dose received in participants' teeth. METHODS AND MATERIALS A continuous wave L-band spectrometer was used for EPR measurements. Participants included healthy volunteers and patients undergoing head and neck and total body irradiation treatments. Healthy volunteers completed 1 measurement each, and patients underwent measurement before starting treatment and between subsequent fractions. Optically stimulated luminescent dosimeters and diodes were used to determine the dose delivered to the teeth to validate EPR measurements. RESULTS Seventy measurements were acquired from 4 total body irradiation and 6 head and neck patients over 15 months. Patient data showed a linear increase of EPR signal with delivered dose across the dose range tested. A linear least-squares weighted fit of the data gave a statistically significant correlation between EPR signal and absorbed dose (P < .0001). The standard error of inverse prediction (SEIP), used to assess the usefulness of fits, was 1.92 Gy for the dose range most relevant for immediate triage (≤7 Gy). Correcting for natural background radiation based on patient age reduced the SEIP to 1.51 Gy. CONCLUSIONS This study demonstrated the feasibility of using spectroscopic measurements from radiation therapy patients to validate in vivo EPR biodosimetry. The data illustrated a statistically significant correlation between the magnitude of EPR signals and absorbed dose. The SEIP of 1.51 Gy, obtained under clinical conditions, indicates the potential value of this technique in response to large radiation events.
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Affiliation(s)
- Emily Draeger
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Kenneth Roberts
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Roy D Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Nina Bahar
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph Contessa
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Zain Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin B Williams
- Department of Radiology & EPR Center, Geisel Medical School at Dartmouth, Hanover, New Hampshire
| | - Ann Barry Flood
- Department of Radiology & EPR Center, Geisel Medical School at Dartmouth, Hanover, New Hampshire
| | - Harold M Swartz
- Department of Radiology & EPR Center, Geisel Medical School at Dartmouth, Hanover, New Hampshire
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
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Prabhu RS, Dhakal R, Piantino M, Bahar N, Meaders KS, Fasola CE, Ward MC, Heinzerling JH, Sumrall AL, Burri SH. Volumetric Modulated Arc Therapy (VMAT) Craniospinal Irradiation (CSI) for Children and Adults: A Practical Guide for Implementation. Pract Radiat Oncol 2021; 12:e101-e109. [PMID: 34848379 DOI: 10.1016/j.prro.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/28/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Volumetric modulated arc therapy (VMAT) craniospinal irradiation (CSI) has been shown to have significant dosimetric advantages compared to 3D-conformal therapy, but is a technically complex process. We sought to develop a guide for all aspects of the VMAT CSI process and report patient dosimetry results. METHODS AND MATERIALS We initiated VMAT CSI in 2017 and have regularly revised our standard operating procedure (SOP) for this process since then. Herein, we report a detailed template for the entire VMAT CSI process from initial patient setup and immobilization at time of CT simulation to contouring and treatment planning, quality assurance, and therapy delivery. The records of 12 patients who were treated with VMAT CSI were also retrospectively reviewed. RESULTS Patient age ranged from 2 to 59 years with 5 pediatric patients (age<18 years), 5 young adults (age 18-35 years) and 2 older adults (age>35 years). The majority of patients (67%) had medulloblastoma. CSI dose ranged from 21.6 Gy to 36 Gy, with a median of 36 Gy. The median CSI planning target volume (PTV) was 2383cc with a median V95% of 99.8% and median 0.03 cc hotspot of 112.5%. The average V107% was 7.4% and the average conformality index was 1.01. CONCLUSIONS VMAT CSI has potentially significant dosimetric and acute toxicity advantages compared to 3D-conformal. However, proper procedures need to be in place throughout the process in order to be able to realize these potential advantages. We herein describe our detailed SOP for VMAT CSI. Recognizing the scarcity of proton beam centers in many areas, VMAT CSI represents a feasible treatment with more widespread availability.
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Affiliation(s)
- Roshan S Prabhu
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | - Reshika Dhakal
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Melanie Piantino
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Nina Bahar
- St. Peter's Health Partners, Albany, New York
| | | | - Carolina E Fasola
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina
| | - Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina
| | - John H Heinzerling
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina
| | - Ashley L Sumrall
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Stuart H Burri
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina
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Skourou C, Sherouse GW, Bahar N, Bauer LA, Fairobent L, Freedman DJ, Genovese LM, Halvorsen PH, Kirby NA, Mahmood U, Ozturk N, Osterman KS, Serago CF, Svatos MM, Wilson ML. Code of ethics for the American Association of Physicists in Medicine (Revised): Report of Task Group 109. Med Phys 2019; 46:e79-e93. [PMID: 30570754 DOI: 10.1002/mp.13351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/08/2022] Open
Abstract
The American Association of Physicists in Medicine (AAPM) has established a comprehensive Code of Ethics for its members. The Code is a formal part of AAPM governance, maintained as Professional Policy 24, and includes both principles of ethical practice and the rules by which a complaint will be adjudicated. The structure and content of the Code have been crafted to also serve the much broader purpose of giving practical ethical guidance to AAPM members for making sound decisions in their professional lives. The Code is structured in four major parts: a Preamble, a set of ten guiding Principles, Guidelines that elucidate the application of the Principles in various practice settings, and the formal Complaint process. Guidelines have been included to address evolving social and cultural norms, such as the use of social media and the broadening scope of considerations important in an evolving workplace. The document presented here is the first major revision of the AAPM Code of Ethics since 2008. This revision was approved by the Board of Directors to become effective 1 January 2019.
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Affiliation(s)
- Christina Skourou
- St. Luke's Radiation Oncology Centre, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | | | - Nina Bahar
- Landauer Medical Physics, Charlotte, NC, 28204, USA
| | - Linda A Bauer
- Greenville Hospital Systems, Greenville, SC, 29605, USA
| | | | | | - Lisa M Genovese
- Krueger-Gilbert Health Physics, Inc., Towson, MD, 21286, USA
| | | | - Neil A Kirby
- University of Texas Health Science Center San Antonio, San Antonio, TX, 78229, USA
| | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Naim Ozturk
- The University of Chicago, Chicago, IL, 60637, USA
| | | | | | | | - Melissa L Wilson
- MHP Radiation Oncology Institute, Farmington Hills, MI, 48334, USA
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Lai CM, Mak KK, Watanabe H, Jeong J, Kim D, Bahar N, Ramos M, Chen SH, Cheng C. The mediating role of Internet addiction in depression, social anxiety, and psychosocial well-being among adolescents in six Asian countries: a structural equation modelling approach. Public Health 2015; 129:1224-36. [PMID: 26343546 DOI: 10.1016/j.puhe.2015.07.031] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examines the associations of Internet addiction with social anxiety, depression, and psychosocial well-being among Asian adolescents. A self-medication model conceptualizing Internet addiction as a mediating role in relating depression and social anxiety to negative psychosocial well-being was tested. STUDY DESIGN A cross-sectional survey. METHODS In the Asian Adolescent Risk Behavior Survey (AARBS), 5366 adolescents aged 12-18 years from six Asian countries (China, Hong Kong, Japan, South Korea, Malaysia, and Philippines) completed a questionnaire with items of the Internet Addiction Test (IAT), Social Anxiety Scale for Adolescents (SAS-A), Center for Epidemiological Studies Depression Scale (CESD), Self-Rated Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA-SR) in the 2012-2013 school year. Structural equation modelling was used to examine the mediating role of Internet addiction in depression, social anxiety, and subjective psychosocial well-being. RESULTS Significant differences on the scores of IAT, SAS-A, CESD, and HoNOSCA-SR across the six countries were found. The proposed self-medication model of Internet addiction received satisfactory goodness-of-fit with data of all countries. After the path from social anxiety to Internet addiction had been discarded in the revised model, there was a significant improvement of the goodness-of-fit in the models for Japan, South Korea, and the Philippines. CONCLUSIONS Depression and social anxiety reciprocally influenced, whereas depression associated with poorer psychosocial well-being directly and indirectly through Internet addiction in all six countries. Internet addiction mediated the association between social anxiety and poor psychosocial well-being in China, Hong Kong, and Malaysia.
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Affiliation(s)
- C M Lai
- Department of Psychology, Chinese University of Hong Kong, Hong Kong
| | - K K Mak
- Department of Psychology, University of Hong Kong, Hong Kong.
| | - H Watanabe
- Department of Children and Women's Health, Osaka University Graduate School of Medicine, Japan
| | - J Jeong
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - D Kim
- Department of Education, Seoul National University, Republic of Korea
| | - N Bahar
- Department of Psychiatry, Selayang Hospital, Malaysia
| | - M Ramos
- Department of Psychiatry, National University Hospital at Manila, Philippines
| | - S H Chen
- Department of Psychology, National Taiwan University, Taiwan
| | - C Cheng
- Department of Psychology, University of Hong Kong, Hong Kong
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Bahar N, Roberts K, Stabile F, Mongillo N, Decker RD, Wilson LD, Husain Z, Contessa J, Williams BB, Flood AB, Swartz HM, Carlson DJ. SU-C-BRD-05: Non-Invasive in Vivo Biodosimetry in Radiotherapy Patients Using Electron Paramagnetic Resonance (EPR) Spectroscopy. Med Phys 2015. [DOI: 10.1118/1.4923800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Guttman O, Baranovski BM, Schuster R, Kaner Z, Freixo-Lima GS, Bahar N, Kalay N, Mizrahi MI, Brami I, Ochayon DE, Lewis EC. Acute-phase protein α1-anti-trypsin: diverting injurious innate and adaptive immune responses from non-authentic threats. Clin Exp Immunol 2015; 179:161-72. [PMID: 25351931 DOI: 10.1111/cei.12476] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 12/29/2022] Open
Abstract
One would assume that the anti-inflammatory activity of α1-anti-trypsin (AAT) is the result of inhibiting neutrophil enzymes. However, AAT exhibits tolerogenic activities that are difficult to explain by serine-protease inhibition or by reduced inflammatory parameters. Targets outside the serine-protease family have been identified, supporting the notion that elastase inhibition, the only functional factory release criteria for clinical-grade AAT, is over-emphasized. Non-obvious developments in the understanding of AAT biology disqualify it from being a straightforward anti-inflammatory agent: AAT does not block dendritic cell activities, nor does it promote viral and tumour susceptibilities, stunt B lymphocyte responses or render treated patients susceptible to infections; accordingly, outcomes of elevated AAT do not overlap those attained by immunosuppression. Aside from the acute-phase response, AAT rises during the third trimester of pregnancy and also in advanced age. At the molecular level, AAT docks onto cholesterol-rich lipid-rafts and circulating lipid particles, directly binds interleukin (IL)-8, ADAM metallopeptidase domain 17 (ADAM17) and danger-associated molecular pattern (DAMP) molecules, and its activity is lost to smoke, high glucose levels and bacterial proteases, introducing a novel entity - 'relative AAT deficiency'. Unlike immunosuppression, AAT appears to help the immune system to distinguish between desired responses against authentic threats, and unwanted responses fuelled by a positive feedback loop perpetuated by, and at the expense of, inflamed injured innocent bystander cells. With a remarkable clinical safety record, AAT treatment is currently tested in clinical trials for its potential benefit in a variety of categorically distinct pathologies that share at least one common driving force: cell injury.
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Affiliation(s)
- O Guttman
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Department of Clinical Biochemistry and Pharmacology, Beer-Sheva, Israel
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Kianmehr N, Bidari A, Mofidi M, Bahar N. SAT0380 Silent Osteonecrosis of the Femoral Head Following High-Dose Corticosteroids in Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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