The accuracy of dose calculations by anisotropic analytical algorithms for stereotactic radiotherapy in nasopharyngeal carcinoma.

Nasopharyngeal tumors are commonly treated with intensity-modulated radiotherapy techniques. For photon dose calculations, problems related to loss of lateral electronic equilibrium exist when small fields are used. The anisotropic analytical algorithm (AAA) implemented in Varian Eclipse was developed to replace the pencil beam convolution (PBC) algorithm for more accurate dose prediction in an inhomogeneous medium. The purpose of this study was to investigate the accuracy of the AAA for predicting interface doses for intensity-modulated stereotactic radiotherapy boost of nasopharyngeal tumors. The central axis depth dose data and dose profiles of phantoms with rectangular air cavities for small fields were measured using a 6 MV beam. In addition, the air-tissue interface doses from six different intensity-modulated stereotactic radiotherapy plans were measured in an anthropomorphic phantom. The nasopharyngeal region of the phantom was especially modified to simulate the air cavities of a typical patient. The measured data were compared to the data calculated by both the AAA and the PBC algorithm. When using single small fields in rectangular air cavity phantoms, both AAA and PBC overestimated the central axis dose at and beyond the first few millimeters of the air-water interface. Although the AAA performs better than the PBC algorithm, its calculated interface dose could still be more than three times that of the measured dose when a 2 × 2 cm(2) field was used. Testing of the algorithms using the anthropomorphic phantom showed that the maximum overestimation by the PBC algorithm was 20.7%, while that by the AAA was 8.3%. When multiple fields were used in a patient geometry, the dose prediction errors of the AAA would be substantially reduced compared with those from a single field. However, overestimation of more than 3% could still be found at some points at the air-tissue interface.

Alpha-particle radiobiological experiments using thin CR-39 detectors.

The present paper studied the feasibility of applying comet assay to evaluate the DNA damage in individual HeLa cervix cancer cells after alpha-particle irradiation. We prepared thin CR-39 detectors (<20 microm) as cell-culture substrates, with UV irradiation to shorten the track formation time. After irradiation of the HeLa cells by alpha particles, the tracks on the underside of the CR-39 detector were developed by chemical etching in (while floating on) a 14 N KOH solution at 37 degrees C. Comet assay was then applied. Diffusion of DNA out of the cells could be generally observed from the images of stained DNA. The alpha-particle tracks corresponding to the comets developed on the underside of the CR-39 detectors could also be observed by just changing the focal plane of the confocal microscope.

Absorbed dose in target cell nuclei and dose conversion coefficient of radon progeny in the human lung.

To calculate the absorbed dose in the human lung due to inhaled radon progeny, ICRP focussed on the layers containing the target cells, i.e., the basal and secretory cells. Such an approach did not consider details of the sensitive cells in the layers. The present work uses the microdosimetric approach and determines the absorbed alpha-particle energy in non-spherical nuclei of target cells (basal and secretory cells). The absorbed energy for alpha particles emitted by radon progeny in the human respiratory tract was calculated in basal- and secretory-cell nuclei, assuming conical and ellipsoidal forms for these cells. Distributions of specific energy for different combinations of alpha-particle sources, energies and targets are calculated and shown. The dose conversion coefficient for radon progeny is reduced for about 2mSv/WLM when conical and ellipsoidal cell nuclei are considered instead of the layers. While changes in the geometry of secretory-cell nuclei do not have significant effects on their absorbed dose, changes from spherical to conical basal-cell nuclei have significantly reduced their absorbed dose from approximately 4 to approximately 3mGy/WLM. This is expected because basal cells are situated close to the end of the range of 6MeV alpha particles. This also underlines the significance of better and more precise information on targets in the T-B tree. A further change in the dose conversion coefficient can be achieved if a different weighting scheme is adopted for the doses for the cells. The results demonstrate the necessity for better information on the target cells for more accurate dosimetry for radon progeny.

Comparison of dose conversion factors for radon progeny from the ICRP 66 regional model and an airway tube model of tracheo-bronchial tree.

Current epidemiological approaches to radon dosimetry yield a dose conversion factor (DCF) of 4 mSv WLM(-1) while the dosimetric approaches give a value closer to 13 mSv WLM(-1). The present study investigated whether the application of compartment models for the bronchial (BB) and bronchiolar (bb) regions, rather than more anatomically realistic airway tube models, has brought the dosimetric DCF to the higher values. The airway tube model of the tracheo-bronchial tree was used to calculate the effective dose per unit radon exposure. All other elements of the human respiratory tract from the reports of the ICRP or NRC were adopted. A dosimetric derivation of the radon DCF using the airway tube model yielded a value of 14.2 mSv WLM(-1). This value is slightly larger than, but not significantly different from, the result obtained through the ICRP 66 approach. It is concluded that utilization of the airway tube model instead of the regional ICRP 66 compartmental model cannot reconcile the gap between dose conversion factors derived from epidemiological and dosimetric approaches.

Assessment of environmental radon hazard using human respiratory tract models.

Radon is a natural radioactive gas derived from geological materials. It has been estimated that about half of the total effective dose received by human beings from all sources of ionizing radiation is attributed to 222Rn and its short-lived progeny. In this paper, the use of human respiratory tract models to assess the health hazard from environmental radon is reviewed. A short history of dosimetric models for the human respiratory tract from the International Commission on Radiological Protection (ICRP) is first presented. The most important features of the newest model published by ICRP in 1994 (as ICRP Publication 66) are then described, including the morphometric model, physiological parameters, radiation biology, deposition of aerosols, clearance model and dose weighting. Comparison between different morphometric models and comparison between different deposition models are then given. Finally, the significance of various parameters in the lung model is discussed, including aerosol parameters, subject related parameters, target and cell related parameters, and parameters that define the absorption of radon from the lungs to blood. Dosimetric calculations gave a dose conversion coefficient of 15 mSv/WLM, which is higher than the value 5 mSv/WLM derived from epidemiological studies. ICRP stated that dosimetric models should only be used for comparison of doses in the human lungs resulted from different exposure conditions.

Killing of target cells due to radon progeny in the human lung.

The dose conversion coefficient (DCC) is used to assess the risk due to inhaled radon progeny in the human lung. The present work uses the microdosimetric approach and determines the linear energy transfer in the target cell nuclei. Killing of target cells was also taken into account through an effect-specific track length model. To focus on the relevant part of the absorbed dose in the cell nuclei, the absorbed dose, which causes cell-killing is discarded in the final calculations of the DCC. Following this approach, the calculated DCC has become 3.4 mSv WLM(-1) which is very close to the epidemiologically derived value of approximately 4 mSv WLM(-1).

Metakaolin as a radon retardant from concrete.

Granite aggregates are known to be the radon source in concrete. Recently, metakaolin has been introduced as a partial substitution of Portland cement to produce high strength concrete. It can effectively reduce the porosity of both the matrix and the aggregate/paste transition zone, which suggests its ability to retard radon emission from concrete aggregates. In the present work, radon exhalation rates from concrete cubes substituted with metakaolin were measured using charcoal canisters and gamma spectroscopy, and were considerably lower than those from normal concrete, by about 30%. The indoor radon concentration reduction is estimated as approximately 9 Bq m(-3) calculated using a room model, causing a 30% reduction in the indoor radon concentration and the corresponding radon dose. Therefore, metakaolin is a simple material to reduce the indoor radon concentration and the radon dose.

Radon progeny dose conversion coefficients for Chinese males and females.

The airway dimensions for Caucasian males have been scaled by multiplying by factors 0.95 and 0.88 to give those for Chinese males and females, respectively. Employing the most recent data on physical and biological parameters, the radiation doses to the basal and secretory cells due to alpha particles from 218Po and 214Po, homogeneously distributed in the mucous layer, have been calculated. The emission of alpha particles has been simulated by a Monte Carlo method. For both basal and secretory cells, the dose conversion coefficients (DCCs) for physical conditions of sleep, rest, light and heavy exercise, have been obtained for Chinese males and females for unattached progeny, and for attached progeny of diameters 0.02, 0.15, 0.25, 0.30 and 0.50 micron. For basal cells, the coefficients lie in the range 0.69-6.82 mGy/(Js/m3) or 8.7-86 mGy/WLM for unattached progeny and in the range 0.045-1.98 mGy/(Js/m3) or 0.57-25 mGy/WLM for attached progeny. The corresponding ranges for Caucasian males are 1.27-8.81 mGy/(Js/m3) or 16-111 mGy/WLM-1 and 0.05-2.30 mGy/(Js/m3) or 0.64-29 mGy/WLM. For secretory cells, the coefficients lie in the range 0.095-16.82 mGy/(Js/m3) (1.2-212 mGy/WLM) for unattached progeny and in the range 0.095-6.67 mGy/(Js/m3) (1.2-84 mGy/WLM) for attached progeny. The corresponding ranges for Caucasian males are 0.34-21.51 mGy/(Js/m3) (4.3-271 mGy/WLM) and 0.1-7.78 mGy/(Js/m3) (1.3-98 mGy/WLM). The overall DCCs calculated for a typical home environment are 0.59 and 0.52 mSv/(Js/m3) (7.4 and 6.5 mSv/WLM) for Chinese males and females, respectively, which are 80 and 70% of the value, 0.73 mSv/(Js/m3) (9.2 mSv/WLM), for Caucasian males.

Indoor dose conversion coefficients for radon progeny for different ambient environments.

Inhaled progeny of 222Rn (radon progeny) are the most important source of irradiation of the human respiratory tract. Their attachment to atmospheric aerosols follows a well-established relationship between the activity size distribution (ASD) and the number size distribution. Recent studies have shown that indoor aerosols are derived primarily from outdoor sources, so it is pertinent to study the effects of different ambient environments on the indoor radon dose (in terms of the dose conversion coefficient or DCC, in units of mSv WLM-1). Commonly encountered ambient aerosols were studied here, which included the traffic-, urban-, and marine-influenced aerosols. The ASDs of attached radon progeny for all three studied ambient environments were well-represented by normal distributions. From these ASDs, the DCCs were calculated using the ICRP66 model and the scaled Yeh-Schum model. All other employed parameters were adopted from original references or authoritative reports. The DCCs for a nominal home calculated using the James model and the Yeh-Schum model were 12 and 8 mSv WLM-1, respectively. The DCCs were largest for urban-influenced ambient environments and smallest for marine-influenced ambient environments, and those for traffic-influenced ambient environments were close to that for a nominal home. If we adopt the stochastic model, the probability of contracting radon-induced lung cancer by a person living with a marine-influenced ambient environment will be half that of a person living with an urban-influenced ambient environment.

Bronchial Rn dose survey for residences.

The bronchial dosimeter for Rn progeny proposed by Yu and Guan in 1998 was employed to survey the bronchial dose from Rn progeny in 30 residences in Hong Kong. An average bronchial deposition fraction of Rn progeny was obtained as 0.0334, which gave an average dose conversion factor (DCF) of 8.5 mSv WLM-1. The mean values of potential alpha energy concentration (PAEC) deposited in the tracheobronchial region (PAECT-B), total PAEC in air (PAECT), annual effective dose (E), concentration of Rn gas (RC) and annual dose conversion factor (ADCF) for all the residential sites combined were 0.11 +/- 0.05, 3.1 +/- 1.4 mWL, 1.2 +/- 0.5 mSv yr-1, 23 +/- 10 Bq m-3 and 0.055 +/- 0.020 (mSv yr-1 per Bqm-3), respectively, with air-conditioned sites (AC sites) and non-AC sites having significantly different mean ADCF values. The indoor relative humidity affected PAECT and RC with high confidence levels (> 95%).

[Non-Hodgkin's lymphoma in children: improved prognosis through aggressive multiple drug combination and irradiation (author's transl)]. / Non-Hodgkin-Lymphon im Kindersalter: Verbesserte Prognose durch aggressive Kombinationschemotherapie und Radiotherapie.

From 1964-1975 43 children with non-Hodgkin's lymphoma (NHL) were treated. 60% of the patients had far advanced disease at diagnosis. Therapy before 1970 consisted of low dose irradiation to the primary and single agent chemotherapy; no C.N.S. irradiation to prevent meningeal recurrence was given. Median survival in this group was 5 months; all patients died. Since 1970 all children with NHL were entered into a modified leukaemia protocol regardless of stage or primary site. Therapy comprised an aggressive multiple drug combination, high dose local irradiation and prophylactic C.N.S. irradiation with intrathecal methotrexate. 41% of the patients treated since 1970 survive in continuous complete remission with a median observation time of 31+ (1-93+) months. All relapses occurred within 30 months after diagnosis. Stage of disease was the most important prognostic factor in our patients. Risk of a primary C.N.S. relapse in the total group was 30% for patients without prophylactic C.N.S. therapy compared to only 6% for patients with treatment.

Lymphoblast cell size and prognosis in acute lymphoblastic leukemia in childhood.

The significance of cell size as a prognostic indicator in acute lymphoblastic leukemia (ALL) is controversial. Accuracy in measurement of cell size can be improved by determination of cell areas instead of single cell diameters. In the present study cell areas of 200 cells were determined in pretreatment bone marrows of 35 children with ALL. For better comparison with other studies which had used cell diameters only, the measured area was expressed as circle area from which the circle diameter was calculated. Cells with a diameter of greater than 12 micron were defined as macrolymphoblasts (MLB). Several clinical characteristics considered to be risk factors in ALL were ascertained for each patient. The duration of first complete remission was used to assess the prognostic significance of cell size and of number of risk factors. In contrast to previous reports patients with more than 25% MLB had longer remissions. However, nearly all patients of this group had no or one risk factor only. When patients with more than one risk factor were excluded from statistical analysis, the group with more than 25% MLB had no longer a better prognosis compared to the group with 25% MLB or less. Thus, in this study the percentage of MLB was not an independent prognostic indicator for risk of relapse in ALL.

Combination chemotherapy and radiotherapy for Hodgkin's disease in children.

31 children with Hodgkin's disease were treated at the Children's Hospital, University of Munich, between 1963-1976. Before 1971 the diagnosis of abdominal involvement was based solely on physical findings and radiological studies. Treatment consisted of involved-field radiation; chemotherapy was added in selected cases. Of 15 children treated between 1963-1971, 5 are still in their first remission and 2 in their second remission. Since 1971 exploratory laparotomy and splenectomy have been performed. Radiation therapy was changed from involved- to extended-field therapy and combination chemotherapy was added in all the children. No patient from this group of 16 children relapsed during a median observation time of 24 months (range 12-55 months). The toxicity of the combined treatment does not seem to be prohibitive.