Estimation of neutron-equivalent dose in organs of patients undergoing radiotherapy by the use of a novel online digital detector.

Neutron peripheral contamination in patients undergoing high-energy photon radiotherapy is considered as a risk factor for secondary cancer induction. Organ-specific neutron-equivalent dose estimation is therefore essential for a reasonable assessment of these associated risks. This work aimed to develop a method to estimate neutron-equivalent doses in multiple organs of radiotherapy patients. The method involved the convolution, at 16 reference points in an anthropomorphic phantom, of the normalized Monte Carlo neutron fluence energy spectra with the kerma and energy-dependent radiation weighting factor. This was then scaled with the total neutron fluence measured with passive detectors, at the same reference points, in order to obtain the equivalent doses in organs. The latter were correlated with the readings of a neutron digital detector located inside the treatment room during phantom irradiation. This digital detector, designed and developed by our group, integrates the thermal neutron fluence. The correlation model, applied to the digital detector readings during patient irradiation, enables the online estimation of neutron-equivalent doses in organs. The model takes into account the specific irradiation site, the field parameters (energy, field size, angle incidence, etc) and the installation (linac and bunker geometry). This method, which is suitable for routine clinical use, will help to systematically generate the dosimetric data essential for the improvement of current risk-estimation models.

Poster - Thur Eve - 46: The upcoming international code of practice for small static photon field dosimetry.

The increased use of small photon fields in stereotactic and intensity-modulated radiotherapy has raised the need for standardizing the dosimetry of such fields using procedures consistent with those for conventional radiotherapy. An international working group, established by the IAEA in collaboration with AAPM and IPEM, is finalising a Code of Practice for the dosimetry of small static photon fields. Procedures for reference dosimetry in nonstandard machine specific reference (msr) fields are provided following the formalism of Alfonso et al. (Med. Phys. 35: 5179; 2008). Reference dosimetry using ionization chambers in machines that cannot establish a conventional 10 cm × 10 cm reference field is based on either a direct calibration in the msr field traceable to primary standards, a calibration in a reference field and a generic correction factor or the product of a correction factor for a virtual reference field and a correction factor for the difference between the msr and virtual fields. For the latter method, procedures are provided for determining the beam quality in non-reference conditions. For the measurement of field output factors in small fields, procedures for connecting large field measurements using ionization chambers to small field measurements using high-resolution detectors such as diodes, diamond, liquid ion chambers, organic scintillators and radiochromic film are given. The Code of Practice also presents consensus data on correction factors for use in conjunction with measured, detector-specific output factors. Further research to determine missing data according to the proposed framework will be strongly encouraged by publication of this document.

Neutron cross-sections for next generation reactors: new data from n_TOF.

In 2002, an innovative neutron time-of-flight facility started operation at CERN: n_TOF. The main characteristics that make the new facility unique are the high instantaneous neutron flux, high resolution and wide energy range. Combined with state-of-the-art detectors and data acquisition system, these features have allowed to collect high accuracy neutron cross-section data on a variety of isotopes, many of which radioactive, of interest for Nuclear Astrophysics and for applications to advanced reactor technologies. A review of the most important results on capture and fission reactions obtained so far at n_TOF is presented, together with plans for new measurements related to nuclear industry.

The determination of beam quality correction factors: Monte Carlo simulations and measurements.

Modern dosimetry protocols are based on the use of ionization chambers provided with a calibration factor in terms of absorbed dose to water. The basic formula to determine the absorbed dose at a user's beam contains the well-known beam quality correction factor that is required whenever the quality of radiation used at calibration differs from that of the user's radiation. The dosimetry protocols describe the whole ionization chamber calibration procedure and include tabulated beam quality correction factors which refer to 60Co gamma radiation used as calibration quality. They have been calculated for a series of ionization chambers and radiation qualities based on formulae, which are also described in the protocols. In the case of high-energy photon beams, the relative standard uncertainty of the beam quality correction factor is estimated to amount to 1%. In the present work, two alternative methods to determine beam quality correction factors are prescribed-Monte Carlo simulation using the EGSnrc system and an experimental method based on a comparison with a reference chamber. Both Monte Carlo calculations and ratio measurements were carried out for nine chambers at several radiation beams. Four chamber types are not included in the current dosimetry protocols. Beam quality corrections for the reference chamber at two beam qualities were also measured using a calorimeter at a PTB Primary Standards Dosimetry Laboratory. Good agreement between the Monte Carlo calculated (1% uncertainty) and measured (0.5% uncertainty) beam quality correction factors was obtained. Based on these results we propose that beam quality correction factors can be generated both by measurements and by the Monte Carlo simulations with an uncertainty at least comparable to that given in current dosimetry protocols.

A new formalism for reference dosimetry of small and nonstandard fields.

The use of small fields in radiotherapy techniques has increased substantially, in particular in stereotactic treatments and large uniform or nonuniform fields that are composed of small fields such as for intensity modulated radiation therapy (IMRT). This has been facilitated by the increased availability of standard and add-on multileaf collimators and a variety of new treatment units. For these fields, dosimetric errors have become considerably larger than in conventional beams mostly due to two reasons; (i) the reference conditions recommended by conventional Codes of Practice (CoPs) cannot be established in some machines and (ii) the measurement of absorbed dose to water in composite fields is not standardized. In order to develop standardized recommendations for dosimetry procedures and detectors, an international working group on reference dosimetry of small and nonstandard fields has been established by the International Atomic Energy Agency (IAEA) in cooperation with the American Association of Physicists in Medicine (AAPM) Therapy Physics Committee. This paper outlines a new formalism for the dosimetry of small and composite fields with the intention to extend recommendations given in conventional CoPs for clinical reference dosimetry based on absorbed dose to water. This formalism introduces the concept of two new intermediate calibration fields: (i) a static machine-specific reference field for those modalities that cannot establish conventional reference conditions and (ii) a plan-class specific reference field closer to the patient-specific clinical fields thereby facilitating standardization of composite field dosimetry. Prior to progressing with developing a CoP or other form of recommendation, the members of this IAEA working group welcome comments from the international medical physics community on the formalism presented here.

Monte Carlo correction factors for a Farmer 0.6 cm3 ion chamber dose measurement in the build-up region of the 6 MV clinical beam.

Reference dosimetry of photon fields is a well-established subject and currently available protocols (such as the IAEA TRS-398 and AAPM TG-51) provide methods for converting the ionization chamber (IC) reading into dose to water, provided reference conditions of charged particle equilibrium (CPE) are fulfilled. But these protocols cannot deal with the build-up region, where the lack of CPE limits the applicability of the cavity theorems and so the chamber correction factors become depth dependent. By explicitly including the IC geometry in the Monte Carlo simulations, depth-dependent dose correction factors are calculated for a PTW 30001 0.6 cm(3) ion chamber in the build-up region of the 6 MV photon beam. The corrected percentage depth dose (PDD) agrees within 2% with that measured using the NACP 02 plane-parallel ion chamber in the build-up region at depths greater than 0.4 cm, where the Farmer chamber wall reaches the phantom surface.

Polypodium leucotomos extract inhibits trans-urocanic acid photoisomerization and photodecomposition.

In this report, we demonstrate a possible molecular mechanism by which a hydrophilic extract of the leaves of the fern Polypodium leucotomos (Fernblock, PL) blocks ultraviolet (UV)-induced skin photodamage. The extract inhibits UVA and UVB light induced photoisomerization of trans-urocanic acid (t-UCA), a common photoreceptor located in the stratum corneum, and also blocks its photodecomposition in the presence of oxidizing reagents such as H2O2, and titanium dioxide (TiO2). PL protects in vitro human fibroblasts from UV-induced death as well. These results suggest the potential of employing the PL extract as a component of sunscreen moistures in order to prevent photodecomposition of t-UCA, to inhibit UV-induced deleterious effects of TiO2 and to protect skin cells and endogenous molecules directly involved in skin immunosurveillance.

Neutron capture cross section measurement of 151Sm at the CERN neutron time of flight facility (n_TOF).

The151Sm(n,gamma)152Sm cross section has been measured at the spallation neutron facility n_TOF at CERN in the energy range from 1 eV to 1 MeV. The new facility combines excellent resolution in neutron time-of-flight, low repetition rates, and an unsurpassed instantaneous luminosity, resulting in rather favorable signal/background ratios. The 151Sm cross section is of importance for characterizing neutron capture nucleosynthesis in asymptotic giant branch stars. At a thermal energy of kT=30 keV the Maxwellian averaged cross section of this unstable isotope (t(1/2)=93 yr) was determined to be 3100+/-160 mb, significantly larger than theoretical predictions.

Experimental dosimetry of a 32P catheter-based endovascular brachytherapy source.

The experimental dosimetry in a water phantom of a 32P linear source, 20 mm in length, used for the brachytherapy of coronary vessels is reported. The source content activity, A, was determined by means of a calibrated well ion-chamber and the value was compared with the contained activity reported in the manufacturer's certification. In this field of brachytherapy dosimetry, radiochromic film supplies a high enough spatial resolution. A highly sensitive radiochromic film, that presents only one active layer, was used in this work for the source dosimetry in a water phantom. The radiochromic film was characterized by electron beams produced by a clinical linac. A Monte Carlo calculation of beta spectra in water at different distances along the source transverse bisector axis allowed to take into account the low dependence of film response from the electron beam energy. The adopted experimental set-up, with the source in its catheter positioned on the film plane inside the water phantom, supplies accurate dosimetric information. The measured dose rate to water per unit of source activity at reference distance, D(r0, theta0)/A, in units of cGy s(-1) GBq(-1), was in agreement with the value reported in the manufacturer's certification within the experimental uncertainty. The radial dose function, g(r), is in good agreement with the literature data. The anisotropy function F(r, theta) is also reported. The analysis of the dose profile obtained at 2 mm from the source longitudinal axis shows that the uniformity is within 10% along 75% of the 20 mm treatment length. The adopted experimental set-up seems to be adequate for the quality control procedure of the dose homogeneity distribution in the water medium.

Ionization chamber dosimetry of small photon fields: a Monte Carlo study on stopping-power ratios for radiosurgery and IMRT beams.

Absolute dosimetry with ionization chambers of the narrow photon fields used in stereotactic techniques and IMRT beamlets is constrained by lack of electron equilibrium in the radiation field. It is questionable that stopping-power ratio in dosimetry protocols, obtained for broad photon beams and quasi-electron equilibrium conditions, can be used in the dosimetry of narrow fields while keeping the uncertainty at the same level as for the broad beams used in accelerator calibrations. Monte Carlo simulations have been performed for two 6 MV clinical accelerators (Elekta SL-18 and Siemens Mevatron Primus), equipped with radiosurgery applicators and MLC. Narrow circular and Z-shaped on-axis and off-axis fields, as well as broad IMRT configured beams, have been simulated together with reference 10 x 10 cm2 beams. Phase-space data have been used to generate 3D dose distributions which have been compared satisfactorily with experimental profiles (ion chamber, diodes and film). Photon and electron spectra at various depths in water have been calculated, followed by Spencer-Attix (delta = 10 keV) stopping-power ratio calculations which have been compared to those used in the IAEA TRS-398 code of practice. For water/air and PMMA/air stopping-power ratios, agreements within 0.1% have been obtained for the 10 x 10 cm2 fields. For radiosurgery applicators and narrow MLC beams, the calculated s(w,air) values agree with the reference within +/-0.3%, well within the estimated standard uncertainty of the reference stopping-power ratios (0.5%). Ionization chamber dosimetry of narrow beams at the photon qualities used in this work (6 MV) can therefore be based on stopping-power ratios data in dosimetry protocols. For a modulated 6 MV broad beam used in clinical IMRT, s(w,air) agrees within 0.1% with the value for 10 x 10 cm2, confirming that at low energies IMRT absolute dosimetry can also be based on data for open reference fields. At higher energies (24 MV) the difference in s(w,air) was up to 1.1%, indicating that the use of protocol data for narrow beams in such cases is less accurate than at low energies, and detailed calculations of the dosimetry parameters involved should be performed if similar accuracy to that of 6 MV is sought.

The wall correction factor for a spherical ionization chamber used in brachytherapy source calibration.

The effect of wall chamber attenuation and scattering is one of the most important corrections that must be determined when the linear interpolation method between two calibration factors of an ionization chamber is used. For spherical ionization chambers the corresponding correction factors A(w) have to be determined by a non-linear trend of the response as a function of the wall thickness. The Monte Carlo and experimental data here reported show that the A(w) factors obtained for an Exradin A4 chamber, used in the brachytherapy source calibration, in terms of reference air kerma rate, are up to 1.2% greater than the values obtained by the linear extrapolation method for the studied beam qualities. Using the Aw factors derived from Monte Carlo calculations, the accuracy of the calibration factor N(K,Ir) for the Exradin A4, obtained by the interpolation between two calibration factors, improves about 0.6%. The discrepancy between the new calculated factor and that obtained using the complete calibration curve of the ion-chamber and the 192Ir spectrum is only 0.1%.

A standard dosimetry procedure for 192Ir sources used for endovascular brachytherapy.

The experimental dosimetry of a high dose rate (HDR) 192Ir source used for the brachytherapy of peripheral vessels is reported. The direct determination of the reference air kerma rate Kr agrees, within the experimental uncertainty, with the results obtained by a well ionization chamber calibrated at the NIST and the manufacturer's certification. A highly sensitive (HS) radiochromic film (RCF), that presents only one active layer, was used for the source dosimetry in a water phantom. The adopted experimental set-up, with the source in its catheter positioned on the RCF plane, seems to have given better accuracy of the RCF optical density measurements. The agreement between the measurement of the dose rate constant DKr (10 mm, pi/2) and the literature data confirmed the coherence of the HS RCF calibration obtained by the kerma in air measurements. The RCF measurements supplied dosimetric information about the dose to water per reference air kerma rate D(r, theta)/Kr along the source transverse bisector axis, the radial dose function g(r) and the anisotropy function F(r, theta). The value D(2 mm, pi/2)/Kr = 22.4 +/- 1.2 cGy h(-1)/(microGy h(-1)) is supplied with a dose uncertainty that is essentially due to the indeterminacy of the source position in the catheter. The data of the radial and anisotropy functions have been compared with Monte Carlo determinations reported in the literature.

Anisotropy function for 192Ir low-dose-rate brachytherapy sources: an EGS4 Monte Carlo study.

The anisotropy function of low-dose-rate 192Ir interstitial brachytherapy sources was studied. Absolute dose rates around 192Ir seeds with stainless steel or platinum cladding and a platinum covered wire have been estimated using the EGS4 Monte Carlo simulation system with a very well tested user code. Our results were compared with available experimental data. Excellent agreement between calculated and measured anisotropy function was found for stainless steel clad 192Ir sources, except along the longitudinal axis of the sources. Dosimetry data for the platinum covered seed and 3 mm long wire with platinum cladding as well as for the stainless steel clad 192Ir source are presented in TG43 format. The influence of phantom dimensions on the anisotropy function was found to be non-negligible over 7 cm, enhancing the anisotropy function by 1-2%. Our results have estimated statistical uncertainties below 1% at 1 sigma level up to 10 cm excluding the longitudinal axis where statistical uncertainties below 3% up to 10 cm are observed.

Anisotropy functions for low energy interstitial brachytherapy sources: an EGS4 Monte Carlo study.

Anisotropy functions for low energy interstitial brachytherapy sources are examined. Absolute dose rates around 103Pd seed model 200 and 125I seed models 6702 and 6711 have been estimated by means of the EGS4 Monte Carlo simulation system. The DLC-136/PHOTX cross section library, water molecular form factors, bound Compton scattering and Doppler broadening of the Compton-scattered photon energy were considered in the calculations. Following the formalism developed by the Interstitial Brachytherapy Collaborative Working Group, anisotropy functions, F(r, theta), have been calculated. Our Monte Carlo results were compared against a limited set of measured data selected from the literature and other Monte Carlo results. Binding corrections and phantom material selection have been found to have no influence on the anisotropy function. The accuracy of the geometrical source models used for the Monte Carlo calculations was validated against experimental measurements of in-air relative fluence at 100 cm from the source. More detailed knowledge about the geometrical design of 103Pd seed model 200 is needed in order to improve the agreement with experimentally measured in-air fluence. Values for in-air fluence of 125I model 6702 are sensitive to source position within the inner seed cylinder. Excellent agreement between calculated and measured in-air fluence is found for 125I model 6711. It was observed that using in-air relative fluence at 100 cm from the source to calculate the anisotropy function yields a less anisotropic dose distribution at distances close to the source than full Monte Carlo simulation, in contradiction with experimental data. Our results have estimated statistical uncertainties of 1%-3% at the 1sigma level within clinically relevant regions, but contain systematic uncertainties related to the assumed geometrical details.

Anisotropy functions for 169Yb brachytherapy seed models 5, 8 and X1267. An EGS4 Monte Carlo study.

Anisotropy functions for 169Yb sources used in interstitial brachytherapy are investigated. A comprehensive study of several factors affecting the angular dose distribution around four 169Yb seed models (Amersham International) has been undertaken. Absolute dose rates around 169Yb seed models 5, 8a, 8b and X1267 have been estimated by means of the EGS4 Monte Carlo Simulation System. An updated cross section library (DLC-136/PHOTX), binding corrections for Compton scattering and water molecular form factors were included in the calculations. Following the formalism developed by the Interstitial Brachytherapy Collaborative Working Group, anisotropy functions, F(r, theta), have been calculated and compared with other Monte Carlo results and whenever possible with experimental data. Excellent agreement is found with other Monte Carlo calculations. Considering the large experimental errors reported, a fairly good coincidence has been achieved between experimental and Monte Carlo data for models 8a and 8b. For model X1267 large discrepancies with experiment are obtained. Monte Carlo calculations for all seed models showed model 5 to be the least anisotropic and models 8b and X1267 to be almost identical. Statistical fluctuations can be drastically reduced computationally, offering an efficient alternative to measured data. Our results have estimated uncertainties of 0.5%-1.0% within one standard deviation everywhere excluding the longitudinal source axis, where uncertainties are below 3% up to 5 cm, this accuracy being excellent for clinical calculations.

Radial dose functions for 103Pd, 125I, 169Yb and 192Ir brachytherapy sources: an EGS4 Monte Carlo study.

Radial dose functions g(r) in water around 103Pd, 125I, 169Yb and 192Ir brachytherapy sources were estimated by means of the EGS4 simulation system and extensively compared with experimental as well as with theoretical results. The DLC-136/PHOTX cross section library, water molecular form factors, bound Compton scattering and Doppler broadening of the Compton-scattered photon energy were considered in the calculations. Use of the point source approach produces reasonably accurate values of the radial dose function only at distances beyond 0.5 cm for 103Pd sources. It is shown that binding corrections for Compton scattering have a negligible effect on radial dose function for 169Yb and 192Ir seeds and for 103Pd seeds under 5.0 cm from the source centre and for the 125I seed model 6702 under 8.0 cm. Beyond those limits there is an increasing influence of binding corrections on radial dose function for 103Pd and 125I sources. Results in solid water medium underestimate radial dose function for low-energy sources by as much as 6% for 103Pd and 2.5% for 125I already at 2 cm from source centre resulting in a direct underestimation of absolute dose rate values. It was found necessary to consider medium boundaries when comparing results for the radial dose function of 169Yb and 192Ir sources to avoid discrepancies due to the backscattering contribution in the phantom medium. Values of g(r) for all source types studied are presented. Uncertainties lie under 1% within one standard deviation.

[Report of a case of purulent rhinitis caused by Streptococcus pneumoniae in a patient with HIV/AIDS]. / Reporte de 1 caso de rinitis purulenta por Streptococcus pneumoniae en un paciente VIH/SIDA.

This paper reports a case of acute purulent rhinitis caused by Streptococcus pneumoniae in a HIV/AIDS patient seen at the Hospitalization Center of "Pedro Kourí" Tropical Medicine Institute. The clinical findings were fever, severe purulent rhinorrea and affected general condition. Streptococcus pneumoniae was isolated with standard and advanced diagnosis techniques. Antimicrobial sensitivity test revealed that it was sensitive to cefaloridien, ampicillin, penicillin G and oxacillin. The patient was treated with a dose of 2 g of ampicillin daily for 10 days. The clinical picture of the patient improved and there was a total remission of the symptoms.

[Molluscacidal activity of Paraiso (Melia azedarach L.) (Meliaceae) on Lymnaea cubensis, host snail of fascioliasis]. / Actividad molusquicida del Paraiso (Melia azedarach L.) (Meliaceae) sobre Lymnaea cubensis, molusco vector de Fasciolosis.

INTRODUCTION: Fasciolosis is a source of serious economic loss in various regions of Brazil and when control measures of its host (molluscs) are not taken under favorable ecological conditions, isolated cases of human Fasciolosis may occur. Among the alternative measures for its control is the use of vegetable extracts and the purpose of this project is the assessment of the use of juice extracted from the fruit and seeds of the Paraiso plant (Melia azedarach L.) in the control of Lymnaea cubensis, the main vector of Fasciolosis in Cuba. MATERIAL AND METHOD: Various concentrations of the juice extracted from the Paraiso fruit (Melia azedarach L.) were tested to determine the average and maximum lethal doses (DL50 and DL90' respectively) used in a computerized PROBIT-LOG program. Seven experimental series were undertaken, 72 molluscs being used in each of them. Three groups of ten molluscs were tested to determine the effect on cardiac frequency, two of them being treated with CL50 = 0.88627 and CL90 = 1.7641, respectively, the third being used as control. RESULTS AND CONCLUSIONS: A considerable effect of both doses on the cardiac frequency of the mollusc studied was observed. The results were encouraging, for they demonstrated the potential use of this plant in the control of undesirable molluscs.

Dose rate constants for 125I, 103Pd, 192Ir and 169Yb brachytherapy sources: an EGS4 Monte Carlo study.

An exhaustive revision of dosimetry data for 192Ir, 125I, 103Pd and 169Yb brachytherapy sources has been performed by means of the EGS4 simulation system. The DLC-136/PHOTX cross section library, water molecular form factors, bound Compton scattering and Doppler broadening of the Compton-scattered photon energy were considered in the calculations. The absorbed dose rate per unit contained activity in a medium at 1 cm in water and air-kerma strength per unit contained activity for each seed model were calculated, allowing the dose rate constant (DRC) A to be estimated. The influence of the calibration procedure on source strength for low-energy brachytherapy seeds is discussed. Conversion factors for 125I and 103Pd seeds to obtain the dose rate in liquid water from the dose rate measured in a solid water phantom with a detector calibrated for dose to water were calculated. A theoretical estimate of the DRC for a 103Pd model 200 seed equal to 0.669 +/- 0.002 cGy h(-1) U(-1) is obtained. Comparison of obtained DRCs with measured and calculated published results shows agreement within 1.5% for 192Ir, 169Yb and 125I sources.

[The reactogenicity and immunogenicity of the first Cuban vaccine against human leptospirosis]. / Reactogenicidad e inmunogenicidad de la primera vacuna cubana contra la leptospirosis humana.

A controlled double-blind trial was conducted with the participation of 80 adult volunteers of both sexes, who were randomly divided into groups of 40 individuals each one. The case-base study received the vaccine and the control group was administered placebo to know the safety, the behaviour of reactogenicity, and to star the immunogenicity studies of the first Cuban vaccine against human leptospirosis. The vaccine used in the case-base study was an inactivated and trivalent vaccine containing strains of Leptospira canicola, icterohaemorrhagiae and pomona, since they have the highest circulation in the country. The results obtained showed the inocuity of the vaccine as no adverse severe reactions were detected. The general symptomatology observed was low, where as febricula was the most common general symptom. It appeared during the first 3 days of observation and there were no significant differences between the 2 group. Only a mild pain at the site of the injection was reported as a local symptom, which was more frequent in the vaccinated group than in the control group (7.8 against 1.5%, respectively). The seroconversion obtained was of 29% by microagglutination, and of 34.2% by ELISA. The final results allowed to conclude that this vaccine is safe for human adults at the ages under study, and give the possibility to continue other studies in more advanced stages to complete the requirements for obtaining its license.