[Irradiation of internal mammary nodes: State of the art]. / État de l'art de l'irradiation des ganglions de la chaîne mammaire interne.

In the adjuvant breast cancer treatment, postoperative radiotherapy plays a principal part with an action against the microscopic residual disease in the lymph nodes after mastectomy as well as after breast conserving surgery. This positive effect is observed also in the case of small inner lesions in patients without lymph node involvement. At the same time, there is a recognized risk of cardiac toxicity directly related to the irradiation of internal mammary nodes. This paper is a report on the current available techniques to irradiate the internal mammary nodes, including promising new technology that may help limiting the risk of cardiac toxicity.

Compatibility characteristics of five radiographic films utilised in Brazilian diagnostic radiology.

To evaluate the quality of the radiographic films in Brazil, according to the recommendations of ISO 9236-1, a radiographic images simulator was used. A study of the control of the quality in radiographic films was implemented. With regard to this study, the results of five films of different manufacturers are presented. The characteristic curves for the ISO qualities of 55, 70, 90 and 120 kV are presented. The PTW REX simulator was used to determine the image quality parameters. Film 2 presents problems due to high sensitivity. Film 1 has a higher energy dependence than the other films. Film 5 yields the best results for almost all the sensitometric parameters. In conclusion, existing films in the Brazilian market vary considerably with relation to image quality.

Visualisation of the left anterior descending coronary artery on CT images used for breast radiotherapy planning.

OBJECTIVE: To assess the visualisation of the left anterior descending (LAD) coronary artery on CT images used for breast radiation treatment planning. METHODS: Delineation of the LAD artery was achieved for 25 breast patients by 1 radiologist and 1 radiation oncologist independently on two sets of images for each patient: one pre-operative CT scan using intravenous (IV) contrast media to determine the primary gross tumour volume (GTV) and one post-operative CT scan used for treatment planning. A Student's paired t-test was used to compare the number of CT slices in which the LAD was visible for each patient in the two series. Interpolations and extrapolations of the LAD volume were performed for the left-sided cases using a published heart atlas in order to report doses to the LAD structure. RESULTS: There was a non-significant difference between the results with and without IV contrast media (p=0.34 for the radiologist; p=0.90 for the radiation oncologist). The visible LAD artery corresponded to a 30% portion (range 12-47%) of the interpolated structure. The maximum dose to the left artery varied widely, from 2.7 to 41.7 Gy, in the group of patients with left breast tumours. The largest values (>25 Gy) corresponded to those patients in whom the LAD artery distal extremity lay inside the breast fields. CONCLUSIONS: With the current planning CT protocol, only one-third of the LAD artery could be objectively visualised. Contrast-enhanced imaging used for GTV delineation before the breast surgery did not improve the visualisation of the artery. ADVANCES IN KNOWLEDGE: This study has revealed the lack of consistency that may be encountered when contouring heart vessels, thereby questioning the reliability of dose reporting.

Potential benefits of using cardiac gated images to reduce the dose to the left anterior descending coronary during radiotherapy of left breast and internal mammary nodes.

PURPOSE: To assess the benefits of using cardiac gated images for treatment planning of breast and internal mammary nodes. PATIENTS AND METHODS: Inspiration breath hold computed tomography (CT) series acquired at prospectively gated diastolic phase were used for planning. Three different techniques were compared. Technique A used tangents and an internal mammary nodes field covering the three first inter-rib spaces; technique B used an extended internal mammary nodes including part of the medial breast in junction with tangential fields; the 3(rd) technique used helical tomotherapy. For each technique, two treatment plans were performed: one plan (plan-01) where mean dose and V(25) to the heart were considered for plan evaluation and a second plan (plan-02) where the irradiation of the left anterior descending artery was minimized. RESULTS: V(25) to the heart was found to be less than 5% for all six plans. Mean doses to the heart were within 4.8 to 7.2 Gy. By attempting to lower the dose to the left anterior descending artery, heart D(mean) was decreased by 20-30% for the two techniques A and B while being unchanged for tomotherapy. Regarding target coverage, there was no marked difference between plans where only heart dose was considered (plans-01) and plans where the left anterior descending artery dose was minimized (plans-02). When the left anterior descending artery dose was part of plan evaluation, D(mean) to the left anterior descending artery could be decreased by 24, 19 and 9% for techniques A, B and tomotherapy respectively. The three techniques exposed segments of the left coronary to different levels of dose. CONCLUSION: This study showed that evaluation of the dose to the left anterior descending artery coronary may change the treatment strategy. Cardiac gated images without IV contrast permitted a good visualization of the coronaries in order to optimize the dose on these structures. In addition to heart V(25,) the dose to the coronaries should be included in prospective studies on radiotherapy related heart toxicity in association with all additional risk factors.

The influence of urbanization on natural radiation levels in anomalous areas.

This paper verifies the effects of urbanization on the original levels of environmental gamma radiation in an anomalous area. The fieldwork was done in the city of Guarapari, on the seacoast of the state of Espírito Santo, Brazil. This place was chosen because the whole region is naturally rich in monazite sand, which contains thorium and uranium. A similar study was also carried out in the 1960s. The measurements were done using an inorganic NaI scintillometer detector with Cu+Pb filters coupled to a scaler. The methodology of measurements used was similar to the one applied in the fieldwork carried out in the 1960s. In addition, a simulation was performed in the laboratory, to determine the attenuation of the materials used in the urbanization of the region. The results of this work clearly show that there was a reduction in the levels of external radiation in the streets and squares of Guarapari. It was concluded that the reduction was due to attenuation by the materials used in the urbanization.

Experimental derivation of wall correction factors for ionization chambers used in high dose rate 192Ir source calibration.

At present there are no specific primary standards for 192Ir high dose rate sources used in brachytherapy. Traceability to primary standards is guaranteed through the method recommended by the AAPM that derives the air kerma calibration factor for the 192Ir gamma rays as the average of the air kerma calibration factors for x-rays and 137Cs gamma-rays or the Maréchal et al. method that uses the energy-weighted air kerma calibration factors for 250 kV x rays and 60Co gamma rays as the air kerma calibration factor for the 192Ir gamma rays. In order to use these methods, it is necessary to use the same buildup cap for all energies and the appropriate wall correction factor for each chamber. This work describes experimental work used to derive the A(W) for four different ionization chambers and different buildup cap materials for the three energies involved in the Maréchal et al. method. The A(W) for the two most common ionization chambers used in hospitals, the Farmer NE 2571 and PTW N30001 is 0.995 and 0.997, respectively, for 250 kV x rays, 0.982 and 0.985 for 192Ir gamma rays, and 0.979 and 0.991 for 60Co gamma rays, all for a PMMA build-up cap of 0.550 gm cm(-2). A comparison between the experimental values and Monte Carlo calculations shows an agreement better than 0.9%. Availability of the A(W) correction factors for all commercial chambers allows users of the in-air calibration jig, provided by the manufacturer, to alternatively use the Maréchal et al. method. Calibration laboratories may also used this method for calibration of a well-type ionization chamber with a comparable accuracy to the AAPM method.

Monte Carlo calculations of the ionization chamber wall correction factors for 192Ir and 60Co gamma rays and 250 kV x-rays for use in calibration of 192Ir HDR brachytherapy sources.

As in the method for the calibration of 192Ir high-dose-rate (HDR) brachytherapy sources, the ionization chamber wall correction factor A(w), is needed for 192Ir and 60Co gamma rays and 250 kV x-rays. This factor takes into account the variation in chamber response due to the attenuation of the photon beam in the chamber wall and build-up cap and the contribution of scattered photons. Monte Carlo calculations were performed using the EGS4 code system with the PRESTA algorithm, to calculate the A(w) factor for 51 commercial ionization chambers and build-up caps exposed to the typical energy spectrum of 192Ir and 60Co gamma rays and 250 kV x-rays. The calculated A(w) correction factors for 192Ir and 60Co sources and 250 kV x-rays agree very well to within 0.1% with published experimental data (the statistical uncertainty is less than 0.1% of the calculated correction factor value). For the 192Ir sources, A(w) varies from 0.973 to 0.993 and for the 250 kV x-rays the minimum value of A(w) for all chambers studied is 0.983. The calculated A(w) correction factors can be used to calculate the air kerma calibration factor of HDR brachytherapy sources, when interpolative methods are considered, contributing to the reduction in the overall uncertainties in the calibration procedure.

Intercomparison of calibration procedures for 192Ir HDR sources in Brazil.

The lack of well established dosimetry protocols for HDR sources is a point of great concern regarding the uniformity of procedures within a particular country and worldwide. The main objective of this paper is to report the results from ten institutions of an intercomparison of calibration procedures for 192Ir HDR sources currently in use in Brazil. The treatment irradiator of one institution was calibrated by a reference system and used by all participants with their own measuring electrometers and ionization chambers under the same experimental conditions. Two methods were used: the calibration jig and the well-type ionization chamber. Each participant was allowed to use their own method and formalism. The results of this exercise were very positive since this was the first time in Brazil that a group of users gathered to share their experience and openly discuss the physical concepts behind the calibration procedures. The results were all within +/-3.0%, except one case where -4.6% was observed and later identified as a problem with the Nk value for x-rays. Though the magnitude of the deviations found was generally acceptable considering the diversity of formalisms currently in use, a proposal is now being prepared to be adopted as a national protocol. The identification of the institutions was left out for the sake of confidentiality.

Perturbation corrections for flat and thimble-type cylindrical standard ionization chambers for 60Co gamma rays: Monte Carlo calculations.

The use of an ionization chamber for absorbed dose determinations in a medium requires one to take into account perturbation corrections due to the presence of the chamber cavity in the medium. Evaluation of these corrections for perturbation and their variation with depth in the medium has been performed for a flat cylindrical and a cylindrical (thimble-type) ionization chamber placed in a graphite phantom irradiated by a 60Co gamma beam using Monte Carlo calculations (EGS4 system with correlated sampling variance reduction technique). The results of these calculations agree with published experimental and theoretical data to better than 0.18%, with a statistical uncertainty of less than 0.17%.

Role of SOS and OxyR systems in the repair of Escherichia coli submitted to hydrogen peroxide under low iron conditions.

There are at least two mechanisms by which H2O2 induces DNA lesions in Escherichia coli: one in the presence of physiological iron levels and the other in low iron conditions. The survival as well as the induction of SOS response in different DNA repair mutant strains of E coli was evaluated after H2O2 treatment under low iron conditions (pretreatment with an iron chelator). Our results indicate that, in normal iron conditions RecA protein has a relevant role in recombination repair events, while in low iron conditions RecA protein is important as a positive regulator of the SOS response. On the other hand, the oxy delta R mutant is sensitive to the lethal effects of H2O2 only in low iron conditions and this sensitivity cannot be correlated with DNA strand breaks.

Fpg and UvrA proteins participate in the repair of DNA lesions induced by hydrogen peroxide in low iron level in Escherichia coli.

The survival of different DNA repair mutant strains of Escherichia coli treated with H2O2 was evaluated in the presence or absence of an iron chelator (dipyridyl). Our results suggest that Fpg and UvrA proteins participate in vivo in the repair of DNA lesions produced by higher H2O2 concentrations in the presence of an iron chelator while UvrB and UvrC proteins seem to be ineffective in the repair of these lesions.

The radiological accident in Goiânia: the initial remedial actions.

The removal of a 50.9-TBq 137Cs source from a radiation therapy facility in Goiânia gave rise to a radiological accident in September 1987 whose proportions were aggravated by the 16-d interval from the beginning of a series of acts that resulted in the contamination of people and areas, to the moment of identification and seeking of aid. Data gathered from the declarations of persons involved in the accident, matched with the medical assessment and radiation monitoring of areas affected, made it possible to determine procedures for care of victims and for decontaminating operations of these areas. The priorities of these procedures were to provide care to victims and eliminate critical paths by which other persons might be affected by exposure to radiation or contamination. This paper presents (1) remedial actions taken during the first weeks, (2) management problems associated with the accident, and (3) lessons learned from this episode that are of benefit to us and, hopefully, to others.

A graphite transmission ionization chamber.

A pancake-type transmission chamber made of high-purity graphite and open to the atmosphere has been designed and constructed at the Secondary Standard Dosimetry Laboratory (SSDL-Rio de Janeiro). Tests performed on the chamber following the International Electrotechnical Commission recommendations indicate that its performance characteristics are comparable to those expected from a secondary standard ionization chamber.

Quality assurance in radiation therapy: clinical and physical aspects. Teletherapy equipment and simulators.

A comprehensive Quality Assurance program in a radiation therapy center is desirable regardless of its size, and should cover among others the following areas: physical parameters of the therapy machines, dosimetric standards, preventive maintenance of radiation emitting sources and measuring instruments. In a radiation therapy center, regardless of its size and patient load, it is advisable to have a quality assurance program covering all the treatment planning steps. The following areas should be taken into consideration: physical parameters of the machines; dosimetric standards; radiation safety procedures and preventive maintenance of irradiators and radiation measuring instruments. The minimum instrumentation required and the critical parameters to be observed to establish a quality assurance program are discussed; the suggestions are applicable to the various sizes of radiation therapy centers. It is essential that all the procedures and results obtained are well documented and a critical evaluation of the program be performed periodically. The procedures and frequency suggested are applicable to low, medium and high energy treatment machines and simulators. The fluctuation on physical parameters currently observed in clinical physics practice strongly supports the efforts and costs of a quality assurance program.

A simple device for testing the equilibrium of ion chambers in ambient conditions.

A simple device for testing the response of ion chambers when ambient pressure is varied was built from an inexpensive device normally used to maintain tennis balls under pressure. The results show that one may use this system in routine as well as for teaching purposes.

Build-up curves of scanned high energy electron beams from the Sagittaire linear accelerator.

A study of the build-up curves using an extrapolation chamber for 7, 10, 13, 16, and 19 MeV electron beams, from a Sagittaire linear accelerator, is presented. The effect of the ionization chamber bias polarity, field size, collimation and surface obliquity on the shape of the relative ionization curve was investigated. No clinically significant change is observed except the displacement of the maximum ionization point was observed for the oblique incidence of the beam.

[Isodose curves for the tangential application to the breast]. / "Curvas de isodose para aplicadores tangenciais de mama".

The auxiliary collimating device furnished by Atomic Energy of Canada Ltd is constituted of a metalic base with a acrilic plate at the end and is fixed at the trimmer. This device is generally used in the irradiation of the breast in order to minimize the dose to the lung. Since only one isodose curve was furnished, the construction of others field sizes became necessary. Two systems of measurements were used. Isodose curves were obtained by decrement lines and scanning semi-conductor detector techniques. The problem associated to the measurements are also discussed.