Semi-quantitative analysis with 99mTc-Besilesomab in musculoskeletal system infections.

Objectives: To evaluate the usefulness of 99mTc-Besilesomab to diagnose infectious processes by using monoclonal antibodies BW 250/183 in a semi-quantitative analysis, and to determine the effect on diagnostic capacity of different thresholds for the difference between counts in early versus delayed images. Methods: The study included 77 patients with suspected osteomyelitis who underwent scintigraphy with 99mTc-Besilesomab. After confirming the absence of human anti-mouse antibodies in all patients, early and delayed static images were acquired at 4 and 24 h post-injection, respectively. Visual and semi-quantitative analyses were conducted of regions of interest (ROIs) in areas suspected of infection on early and delayed images. Findings were considered positive when the ratio between counts in delayed and early images exceeded a given threshold after correction for decay. The definitive diagnosis was obtained by clinical follow-up, microbiological culture, or response to medical and/or surgical treatment. Results: The optimal threshold was 1.02 (i.e., positive result = count increase of >2 % in delayed image), obtaining a sensitivity of 0.864, specificity of 0.858, positive predictive value of 0.708, negative predictive value of 0.940, and accuracy of 0.860. Application of the usual threshold of 1.10 (10 %) reduced the sensitivity to 0.734. Conclusion: Semi-quantitative analysis of studies with 99mTc-Besilesomab is a useful technique for the diagnosis of musculoskeletal system infections and contributes to the definitive diagnosis when visual assessments are doubtful or non-conclusive.

Commercial photodiodes and phototransistors as dosimeters of photon beams for radiotherapy.

PURPOSE: The response to radiation typically used in radiotherapy treatments has been experimentally evaluated for three samples of two phototransistors (BPW85B and OP505A) and two PIN photodiodes types (VTB8440BH and BPW34S). METHODS: To that end, a staggered irradiation cycle has been applied which included dose rate values from 0.81 to 4.87 cGy/s, achieving a total absorbed dose of 21.4 Gy. The samples have been irradiated with a linear accelerator and the relations between the induced photocurrent and the average and instantaneous dose rates, and between the accumulated charge and the absorbed dose, have been determined. The radiation-induced output currents were measured by means of an external interface of the devices to a previously designed readout unit. RESULTS: Experimental results of Si PIN photodiode BPW34S have shown a sensitivity of (13.9 ± 0.5) nC/cGy, slight sensitivity dependence on dose rate, and a high linearity of the current with the average and instantaneous dose rate, requiring only 10 V of reverse bias voltage. This device thermal drift has characterized and modeled for temperature effect compensation. CONCLUSIONS: Silicon PIN photodiode BPW34S, previously tested for X-rays and Co-60 gamma ray source, can also be a reliable candidate for dose rate and absorbed skin dose determination in typical radiotherapy treatments irradiations. A low sensitivity loss below 2% up to 21.4 Gy has been measured, allowing its use as an affordable reusable skin dosimeter. Moreover, no significant difference has been observed between its response to dose-per-pulse and changing pulse repetition frequency in terms of sensitivity and dependence with dose-rate value.

Response of the ArcCHECK® device at 6 MV and 15 MV for VMAT and IMRT quality control.

PURPOSE: To study the response of the ArcCHECK® device as VMAT and IMRT verification system. METHODS: Various tests analyzing the linearity, the repeatability and the angular dependence of the device response, its dependence with the pulse repetition rate and the leakage losses were performed. The long-term response in dose measurements and the uniformity of the detectors conforming the system were controlled using a statistical process control program. The Elekta Infinity™ 6 and 15MV photon beams were used. RESULTS: The device showed excellent repeatability and linearity. The differences between the responses obtained for any pair of angular incidences were less than 2%. The absorbed dose increased by 3% when the pulse repetition rate varied from 50 to 600MU/min. Results are in overall agreement with those found in previous works for the ArcCHECK®, in which a reduced number of the device diodes were analyzed, and for the MapCheck®, an older 2D device that used the same diodes. Charge losses were found to be negligible except for some of the diodes of the device. The statistical process control program is a very useful tool to control the correct functioning of the device in the long term. CONCLUSIONS: The results of the analysis carried out indicate that the working and stability conditions of the ArcCHECK® device are adequate for its purpose. The dependence with the pulse repetition rate should be considered when VMAT or similar treatments are evaluated. A control program for the statistical monitoring of the device would be desirable and useful.

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer.

PURPOSE: Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT. MATERIAL AND METHODS: Published HDR-BT clinical results for low- and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods. RESULTS: We obtained a value of α/ß = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively. CONCLUSIONS: The α/ß obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of α/ß explains reasonably well the data available in the region of high doses per fraction considered.

Light-Dependent Resistors as Dosimetric Sensors in Radiotherapy.

Safe quality control of radiotherapy treatments lies in reliable dosimetric sensors. Currently, ionization chambers and solid-state diodes along with electrometers as readout systems are accomplishing this task. In this work, we present a well-known and low-cost semiconductor sensor, the light-dependent resistor (LDR), as an alternative to the existing sensing devices for dosimetry. To demonstrate this, a complete characterization of the response to radiation of commercial LDRs has been conducted in terms of sensitivity, reproducibility and thermal correction under different bias voltages. Irradiation sessions have been applied under the common conditions in radiotherapy treatments using a hospital linear accelerator. Moreover, the same electrometer used for the ionization chamber has also been successfully used for LDRs. In comparison with the sensitivity achieved for the ionization chamber (0.2 nC/cGy at 400 V bias voltage), higher sensitivities have been measured for the proposed LDRs, ranging from 0.24 to 1.04 nC/cGy at bias voltages from 30 to 150 V, with a reproducibility uncertainty among samples of around 10%. In addition, LDR temperature dependence has been properly modeled using the simple thermistor model so that an easy thermal drift correction of dose measurements can be applied. Therefore, experimental results show that LDRs can be a reliable alternative to dosimetric sensors with the advantages of low size, affordable cost and the fact that it could be adopted with minimal changes in routine dosimetry quality control since the same readout system is fully compatible.

Characterization of microMOSFET detectors for in vivo dosimetry in high-dose-rate brachytherapy with 192 Ir.

PURPOSE: The objective of this study was to characterize the Best Medical Canada microMOSFET detectors for their application in in vivo dosimetry for high-dose-rate brachytherapy (HDRBT) with 192 Ir. We also developed a mathematical model to correct dependencies under the measurement conditions of these detectors. METHODS: We analyzed the linearity, reproducibility, and interdetector variability and studied the microMOSFET response dependence on temperature, source-detector distance, and angular orientation of the receptor with respect to the source. The correction model was applied to 19 measurements corresponding to five simulated treatments in a custom phantom specifically designed for this purpose. RESULTS: The detectors (high bias applied in all measurements) showed excellent linearity up to 160 Gy. The response dependence on source-detector distance varied by (8.65 ± 0.06)% (k = 1) for distances between 1 and 7 cm, and the variation with temperature was (2.24 ± 0.05)% (k = 1) between 294 and 310 K. The response difference due to angular dependence can reach (10.3 ± 1.3)% (k = 1). For the set of measurements analyzed, regarding angular dependences, the mean difference between administered and measured doses was -4.17% (standard deviation of 3.4%); after application of the proposed correction model, the mean difference was -0.1% (standard deviation of 2.2%). For the treatments analyzed, the average difference between calculations and measures was 4.7% when only the calibration coefficient was used, but it is reduced to 0.9% when the correction model is applied. CONCLUSION: Important response dependencies of microMOSFET detectors used for in vivo dosimetry in HDRBT treatments, especially the angular dependence, can be adequately characterized by a correction model that increases the accuracy of this system in clinical applications.

Evaluation of the overdiagnosis in breast screening programmes using a Monte Carlo simulation tool: a study of the influence of the parameters defining the programme configuration.

OBJECTIVES: To build up and test a Monte Carlo simulation procedure for the investigation of overdiagnosis in breast screening programmes (BSPs). DESIGN: A Monte Carlo tool previously developed has been adapted for obtaining the quantities of interest in order to determine the overdiagnosis: the annual and cumulative number of cancers detected by screening, plus interval cancers, for a population following the BSP, and detected clinically for the same population in the absence of screening. Overdiagnosis is obtained by comparing these results in a direct way. RESULTS: Overdiagnosis between 7% and 20%, depending on the specific configuration of the programme, have been found. These range of values is in agreement with some of the results available for actual BSPs. In the cases analysed, a reduction of 11% at most has been found in the number of invasive tumours detected by screening in comparison to those clinically detected in the control population. It has been possible to establish that overdiagnosis is almost entirely linked to ductal carcinoma in situ tumours. CONCLUSIONS: The use of Monte Carlo tools may facilitate the analysis of overdiagnosis in actual BSPs, permitting to address the role played by various quantities of relevance for them.

Radiobiological considerations in combining doses from external beam radiotherapy and brachytherapy for cervical cancer.

The recommended radio-therapeutic treatment for cervix cancer consists of a first phase of external beam radiotherapy (EBRT) plus a second phase of brachytherapy (BT), the combined treatment being delivered within 8 weeks. In order to assess a comprehensive dosimetry of the whole treatment, it is necessary to take into account that these two phases are characterized by different spatial and temporal dosimetric distributions, which complicates the task of the summation of the two contributions, EBRT and BT. Radiobiology allows to tackle this issue pragmatically by means of the LQ model and, in fact, this is the usual tool currently in use for this matter. In this work, we describe the rationale behind the summation of the dosimetric contributions of the two phases of the treatment, EBRT and BT, for cervix cancer, as carried out with the LQ model. Besides, we address, from a radiobiological point of view, several important considerations regarding the use of the LQ model for this task. One of them is the analysis of the effect of the overall treatment time in the result of the global treatment. Another important question considered is related to the fact that the capacity of LQ to predict the treatment outcomes is deteriorated when the dose per fraction of the radiotherapic scheme exceeds 6-10 Gy, which is a typical brachytherapy fractionation. Finally, we analyze the influence of the uncertainty and the variability of the main parameters utilized in the LQ model formulation in the assessment of the global dosimetry.

Radiobiological parameters for breast cancer: a Monte Carlo analysis of START trial published results.

OBJECTIVE:: Trial results are usually given in terms of end point confidence intervals, the data concerning the participating patients being not available. Sometimes, it would be useful or necessary to obtain derived quantities, such as dose-response relationships, from the known information. In this work, we describe a methodology that allows to do that and illustrate it by analyzing the UK standardization of breast radiotherapy (START) trials. METHODS:: Using Monte Carlo techniques, virtual data sets were generated by sampling trial outcome distributions in terms of the tumor control probability (described by means of a logistic dose response and the equations of isoeffect in the linear-quadratic model). After fitting the available experimental data, the radiobiological parameters of interest and their confidence intervals were obtained from the TCP vs 'EQD2 curve in which the surgery effect is also taken into account. RESULTS:: The value of [Formula: see text] obtained for breast cancer was 3.6 Gy, with a 95% confidence interval of (1.5,15.5) Gy, in agreement with the one estimated by the START group. The time factor, referred to a scheme of 2 Gy per fraction, was 0.74 (0.41,2.67) Gy day-1, of the same order than that estimated for head and neck cancers. CONCLUSION:: A methodology permitting an analysis of trial results was developed and tested with the results of the START trials. The procedure does not require detailed knowledge of the distributions actually found in the trials. The values obtained for the parameters are similar to those of the START estimations and this can be considered an independent confirmation of their validity, thus showing the model usefulness. The methodology presented here relies on basic statistical methods that are general enough to permit it to be applied to any kind of trial. This may be particularly interesting when the original data are no longer available. ADVANCES IN KNOWLEDGE:: The main novelty of this paper is to provide with a Monte Carlo based tool that permits an independent analysis of published trial results in order to obtain radiobiological parameters without a detailed knowledge of the data corresponding to the participating patients.

Air density dependence of the soft X-ray PTW 34013 ionization chamber.

PURPOSE: We studied the dependence on air density of the response of the PTW 34013 ionization chamber, recently upgraded for dosimetry control of low energy X-ray beams. METHODS: Measurements were performed by changing the pressure conditions inside a pressure chamber. The behavior of the measurements against the air density inside this chamber was analyzed. X-ray beams generated with 50, 70, 100, 150 and 200 kVp and the two electrometer polarities were considered. RESULTS: For all beams studied, measurements corrected with the conventional temperature and pressure factor showed a residual dependence on the air density that was described with a linear function of the air density. For the 50 and 70 kVp beams, corrected measurements remained ∼1% smaller than the value found at standard pressure/temperature conditions, for both electrometer polarities and for the air density range typical in clinical conditions. For air densities smaller than the standard one, measurements found for 100, 150 and 200 kVp beams were below or above the value found at standard pressure and temperature when the negative or positive electrometer polarities were used, respectively. The differences with the measurements at standard conditions were less than 1% for the 100 kVp beam and below 4% for the other two beams. CONCLUSIONS: The PTW 34013 ionization chamber showed a dependence on the air density that is not properly described with the usual temperature and pressure correction factor. This residual dependence is negligible for low energy beams, for which this chamber is recommended, but is more substantial for beams with energy above 80 kVp.

A Monte Carlo analysis of breast screening randomized trials.

PURPOSE: To analyze breast screening randomized trials with a Monte Carlo simulation tool. METHODS: A simulation tool previously developed to simulate breast screening programmes was adapted for that purpose. The history of women participating in the trials was simulated, including a model for survival after local treatment of invasive cancers. Distributions of time gained due to screening detection against symptomatic detection and the overall screening sensitivity were used as inputs. Several randomized controlled trials were simulated. Except for the age range of women involved, all simulations used the same population characteristics and this permitted to analyze their external validity. The relative risks obtained were compared to those quoted for the trials, whose internal validity was addressed by further investigating the reasons of the disagreements observed. RESULTS: The Monte Carlo simulations produce results that are in good agreement with most of the randomized trials analyzed, thus indicating their methodological quality and external validity. A reduction of the breast cancer mortality around 20% appears to be a reasonable value according to the results of the trials that are methodologically correct. Discrepancies observed with Canada I and II trials may be attributed to a low mammography quality and some methodological problems. Kopparberg trial appears to show a low methodological quality. CONCLUSION: Monte Carlo simulations are a powerful tool to investigate breast screening controlled randomized trials, helping to establish those whose results are reliable enough to be extrapolated to other populations and to design the trial strategies and, eventually, adapting them during their development.

Characterization of the PTW SourceCheck ionization chamber with the Valencia lodgment for (125)I seed verification.

In brachytherapy using (125)I seed implants, a verification of the air kerma strength of the sources used is required. Typically, between 40 and 100 seeds are implanted. Checking all of them is unaffordable, especially when seeds are disposed in sterile cartridges. Recently, a new procedure allowing the accomplishment of the international recommendations has been proposed for the seedSelectron system of Elekta Brachytherapy. In this procedure, the SourceCheck ionization chamber is used with a special lodgment (Valencia lodgment) that allows to measure up to 10 seeds simultaneously. In this work we analyze this procedure, showing the feasibility of the approximations required for its application, as well as the effect of the additional dependence with the air density that shows the chamber model used. Uncertainty calculations and the verification of the approximation needed to obtain a calibration factor for the Valencia lodgment are carried out. The results of the present work show that the chamber dependence with the air density is the same whether the Valencia lodgment is used or not. On the contrary, the chamber response profile is influenced by the presence of the lodgment. The determination of this profile requires various measurements due to the nonnegligible variability found between different experiments. If it is considered, the uncertainty in the determination of the air-kerma strength increases from 0.5% to 1%. Otherwise, a systematic additional uncertainty of 1% would occur. This could be relevant for the comparison between user and manufacturer measurements that is mandatory in the case studied here.

Patient and staff dosimetry during radiographic procedures in an intensive care unit.

The performance of radiography in the Intensive Care Unit (ICU) may be associated with a certain level of radiation exposure for staff and patients in the unit. Little evidence on exposure levels is available in the literature. However, healthcare professionals in the ICUs at our centre tend to leave the room during radiographic examinations, potentially compromising patient care. The objectives of this study were to quantify dose levels within the ICU and to evaluate the performance of ICU x-ray studies according to patient dose measurements. This study was conducted in the 18-bed ICU of a third-level hospital. The scattering radiation due to mobile x-ray examinations was measured by using four personal thermoluminiscent dosimeters (TLDs). The dose area product (DAP) was measured at each examination using a transmission chamber installed on the diaphragm of the x-ray equipment. Based on the TLD readings and taking account of the error margin, the annual dose to patients and staff was less than 0.6 mSv. The value given by the DAP meter for chest x-rays was 94 ± 17 mGy cm(2); this value is well below the lower limit recommended by different agencies and committees. Exposure levels were found to be extremely low and pose no apparent risk to staff or to those in beds adjacent to the patients undergoing x-ray examinations, which were correctly performed in the unit.

Human mesenchymal stem cells enhance the systemic effects of radiotherapy.

The outcome of radiotherapy treatment might be further improved by a better understanding of individual variations in tumor radiosensitivity and normal tissue reactions, including the bystander effect. For many tumors, however, a definitive cure cannot be achieved, despite the availablity of more and more effective cancer treatments. Therefore, any improvement in the efficacy of radiotherapy will undoubtedly benefit a significant number of patients. Many experimental studies measure a bystander component of tumor cell death after radiotherapy, which highlights the importance of confirming these observations in a preclinical situation. Mesenchymal stem cells (MSCs) have been investigated for use in the treatment of cancers as they are able to both preferentially home onto tumors and become incorporated into their stroma. This process increases after radiation therapy. In our study we show that in vitro MSCs, when activated with a low dose of radiation, are a source of anti-tumor cytokines that decrease the proliferative activity of tumor cells, producing a potent cytotoxic synergistic effect on tumor cells. In vivo administration of unirradiated mesenchymal cells together with radiation leads to an increased efficacy of radiotherapy, thus leading to an enhancement of short and long range bystander effects on primary-irradiated tumors and distant-non-irradiated tumors. Our experiments indicate an increased cell loss rate and the decrease in the tumor cell proliferation activity as the major mechanisms underlying the delayed tumor growth and are a strong indicator of the synergistic effect between RT and MSC when they are applied together for tumor treatment in this model.

Dependence with air density of the response of the PTW SourceCheck ionization chamber for low energy brachytherapy sources.

PURPOSE: Air-communicating well ionization chambers are commonly used to assess air kerma strength of sources used in brachytherapy. The signal produced is supposed to be proportional to the air density within the chamber and, therefore, a density-independent air kerma strength is obtained when the measurement is corrected to standard atmospheric conditions using the usual temperature and pressure correction factor. Nevertheless, when assessing low energy sources, the ionization chambers may not fulfill that condition and a residual density dependence still remains after correction. In this work, the authors examined the behavior of the PTW 34051 SourceCheck ionization chamber when measuring the air kerma strength of (125)I seeds. METHODS: Four different SourceCheck chambers were analyzed. With each one of them, two series of measurements of the air kerma strength for (125)I selectSeed(TM) brachytherapy sources were performed inside a pressure chamber and varying the pressure in a range from 747 to 1040 hPa (560 to 780 mm Hg). The temperature and relative humidity were kept basically constant. An analogous experiment was performed by taking measurements at different altitudes above sea level. RESULTS: Contrary to other well-known ionization chambers, like the HDR1000 PLUS, in which the temperature-pressure correction factor overcorrects the measurements, in the SourceCheck ionization chamber they are undercorrected. At a typical atmospheric situation of 933 hPa (700 mm Hg) and 20 °C, this undercorrection turns out to be 1.5%. Corrected measurements show a residual linear dependence on the density and, as a consequence, an additional density dependent correction must be applied. The slope of this residual linear density dependence is different for each SourceCheck chamber investigated. The results obtained by taking measurements at different altitudes are compatible with those obtained with the pressure chamber. CONCLUSIONS: Variations of the altitude and changes in the weather conditions may produce significant density corrections, and that effect should be taken into account. This effect is chamber-dependent, indicating that a specific calibration is necessary for each particular chamber. To our knowledge, this correction has not been considered so far for SourceCheck ionization chambers, but its magnitude cannot be neglected in clinical practice. The atmospheric pressure and temperature at which the chamber was calibrated need to be taken into account, and they should be reported in the calibration certificate. In addition, each institution should analyze the particular response of its SourceCheck ionization chamber and compute the adequate correction factors. In the absence of a suitable pressure chamber, a possibility for this assessment is to take measurements at different altitudes, spanning a wide enough air density range.

A Monte Carlo tool to study the mortality reduction due to breast screening programs.

PURPOSE: To develop a Monte Carlo tool that permits to study the reduction in breast cancer mortality rate due to breast screening programs. METHODS: Simulations implement woman histories undergoing a screening program, include a model of survival after local treatment of invasive cancers and use distributions of time gained due to screening detection against symptomatic detection and overall sensitivity of the screening obtained previously. Mortalities for the whole woman population and for those women with ages within the range considered in the program have been calculated. RESULTS: For the whole woman population, a reduction in breast cancer mortality up to 29% has been found for a configuration that includes women aged between 50 and 70 years, with a screening interval of two years and 100% acceptance rate. If an acceptance of 70% is considered, this percentage reduces to 20%. If, in the same conditions, the program starts at 40 years, the reduction of the mortality reaches 24% while if the screening interval is one year, this percentage raises to 28%. If mortalities are calculated for those women with ages within the range included in the program these reductions are greater and no significant differences are found between the programs with age ranges [50-70] and [40-70]. In the model, radio-induced cancers have no effect in survival. CONCLUSIONS: The results agree reasonably well with those of different trials. Mortality reductions of 12%-20% (between two and four deaths per year and 10(5) women) are obtained only for acceptances above 50%. This could be considered as a threshold for the acceptance, which appears to be a critical parameter.

Statistical control of the spectral quality index in electron beams.

BACKGROUND AND PURPOSE: In radiotherapy with electron linear accelerators, it is mandatory to guarantee the stability of beam output spectra. In this work we study the quality control of the magnitude that provides the beam spectral quality, by following statistical techniques usual in industry process. METHODS: We establish the differences between the measurement of the reference quality index, R(50,ion), which involves usually a costly procedure, and that of the index used for the statistical control, which can be done in an easier way and with a higher frequency. The methodology developed is applied to a Siemens Mevatron KDS electron linear accelerator, specifically for the 6, 12 and 18 MeV modes. The uncertainties of both procedures are evaluated and are correlated. A retrospective analysis of the data registered during more than 13 years is carried out using CUSUM algorithmic and moving range charts. RESULTS: The larger uncertainties in R(50,ion) come from the measurement device and the observer. The uncertainty in the measurement of the statistical control variable, which is mainly due to the geometry setup, is negligible against its intrinsic variability. The application of CUSUM charts pointed out different out of control situations linked in much cases to assignable causes. In addition, moving range charts showed up situations of anomalous functioning of the LINAC. CONCLUSIONS: Algorithmic CUSUM charts permit a nice monitoring of R(50,ion). If the variability is not controlled, by using charts such as the moving range ones, the number of false alarms could increase without a change in the mean value of R(50,ion).

I-125 seed calibration using the SeedSelectron(®) afterloader: a practical solution to fulfill AAPM-ESTRO recommendations.

PURPOSE: SeedSelectron(®) v1.26b (Nucletron BV, The Netherlands) is an afterloader system used in prostate interstitial permanent brachytherapy with I-125 selectSeed seeds. It contains a diode array to assay all implanted seeds. Only one or two seeds can be extracted during the surgical procedure and assayed using a well chamber to check the manufacturer air-kerma strength (S(K)) and to calibrate the diode array. Therefore, it is not feasible to assay 5-10% seeds as required by the AAPM-ESTRO. In this study, we present a practical solution of the SeedSelectron(®) users to fulfill the AAPM- ESTRO recommendations. MATERIAL AND METHODS: THE METHOD IS BASED ON: a) the SourceCheck(®) well ionization chamber (PTW, Germany) provided with a PTW insert; b) n = 10 selectSeed from the same batch and class as the seeds for the implant; c) the Nucletron insert to accommodate the n = 10 seeds on the SourceCheck(®) and to measure their averaged S(K). Results for 56 implants have been studied comparing the S(K) value from the manufacturer with the one obtained with the n = 10 seeds using the Nucletron insert prior to the implant and with the S(K) of just one seed measured with the PTW insert during the implant. RESULTS: We are faced with S(K) deviation for individual seeds up to 7.8%. However, in the majority of cases S(K) is in agreement with the manufacturer value. With the method proposed using the Nucletron insert, the large deviations of S(K) are reduced and for 56 implants studied no deviation outside the range of the class were found. CONCLUSIONS: The new Nucletron insert and the proposed procedure allow to evaluate the S(K) of the n = 10 seeds prior to the implant, fulfilling the AAPM-ESTRO recommendations. It has been adopted by Nucletron to be extended to seedSelectron(®) users under request.

Obtaining the intrinsic electron spectrum of linear accelerators using the relation between the current of the bending magnet and the absorbed dose in water.

PURPOSE: To present a novel methodology to model the intrinsic electron spectra of a linear accelerator and its situation with respect to the energy window. METHODS: The spectra are obtained by fitting the variation of R(50) and the maximum dose rate measured in a water phantom with the bending magnet current. The obtained spectra are verified with a realistic Monte Carlo simulation of the accelerator. RESULTS: The intrinsic spectra and their relative position with respect to the energy window of the bending magnet have been obtained for a Siemens Mevatron KDS and an ELEKTA SL20 accelerators. CONCLUSIONS: Using this method in the commissioning and scheduled revisions of the accelerator, the tuning of the current of the bending magnet could be done in such a way that both the quality of the beam and the dose rate would reach a better long-term stability.

Effect on tumour control of time interval between surgery and postoperative radiotherapy: an empirical approach using Monte Carlo simulation.

In this work, a procedure, based on Monte Carlo techniques, to analyse the effect on the tumour control probability of the time interval between surgery and postoperative radiotherapy is presented. The approach includes the tumour growth as well as the survival of tumour cells undergoing fractionated radiotherapy. Both processes are described in terms of the binomial distribution. We have considered two different growth models, exponential and Gompertz, the parameters of which have been fixed to reproduce the clinical outcome corresponding to a retrospective study for patients with head and neck squamous cell carcinomas. In the cases analysed, we have not found significant differences between the results obtained for both growth models. The mean doubling times found for residual clonogens after surgery are less than 40 days. The rate of decrease in local control is around 0.09% per day of delay between surgery and radiotherapy and the corresponding time factor is about 0.11 Gy per day.