Development of an adjoint sensitivity field-based treatment-planning technique for the use of newly designed directional LDR sources in brachytherapy.

The development and application of an automated 3D greedy heuristic (GH) optimization algorithm utilizing the adjoint sensitivity fields for treatment planning to assess the advantage of directional interstitial prostate brachytherapy is presented. Directional and isotropic dose kernels generated using Monte Carlo simulations based on Best Industries model 2301 I-125 source are utilized for treatment planning. The newly developed GH algorithm is employed for optimization of the treatment plans for seven interstitial prostate brachytherapy cases using mixed sources (directional brachytherapy) and using only isotropic sources (conventional brachytherapy). All treatment plans resulted in V100 > 98% and D90 > 45 Gy for the target prostate region. For the urethra region, the D10(Ur), D90(Ur) and V150(Ur) and for the rectum region the V100cc, D2cc, D90(Re) and V90(Re) all are reduced significantly when mixed sources brachytherapy is used employing directional sources. The simulations demonstrated that the use of directional sources in the low dose-rate (LDR) brachytherapy of the prostate clearly benefits in sparing the urethra and the rectum sensitive structures from overdose. The time taken for a conventional treatment plan is less than three seconds, while the time taken for a mixed source treatment plan is less than nine seconds, as tested on an Intel Core2 Duo 2.2 GHz processor with 1GB RAM. The new 3D GH algorithm is successful in generating a feasible LDR brachytherapy treatment planning solution with an extra degree of freedom, i.e. directionality in very little time.

Multi-species prostate implant treatment plans incorporating 192Ir and 125I using a Greedy Heuristic based 3D optimization algorithm.

The goals of interstitial implant brachytherapy include delivery of the target dose in a uniform manner while sparing sensitive structures, and minimizing the number of needles and sources. We investigated the use of a multi-species source arrangement (192Ir with 125I) for treatment in interstitial prostate brachytherapy. The algorithm utilizes an "adjoint ratio," which provides a means of ranking source positions and is the criterion for the Greedy Heuristic optimization. Three cases were compared, each using 0.4 mCi 125I seeds: case I is the base case using 125I alone, case II uses 0.12 mCi 192Ir seeds mixed with 125I, and case III uses 0.25 mCi 192Ir mixed with 125I. Both multi-species cases result in lower exposure of the urethra and central prostate region. Compared with the base case, the exposure to the rectum and normal tissue increases by a significant amount for case III as compared with the increase in case II, signifying the effect of slower dose falloff rate of higher energy gammas of 192Ir in the tissue. The number of seeds and needles decreases in both multi-species cases, with case III requiring fewer seeds and needles than case II. Further, the effect of 192Ir on uniformity was investigated using the 0.12 mCi 192Ir seeds in multi-species implants. An increase in uniformity was observed with an increase in the number of 0.12 mCi 1921r seeds implanted. The effects of prostate size on the evaluation parameters for multi-species implants were investigated using 0.12 mCi 192Ir and 0.4 mCi 125I, and an acceptable treatment plan with increased uniformity was obtained.

Laser treatment of discoid lupus (case report).

This is a case report of vaporization of the characteristic disfiguring plaques of discoid lupus erythematosus (DLE) with the carbon dioxide laser. This patient had a dramatic clinical and cosmetic improvement. It is suggested that the altered but not vaporized cells that remained were responsible for the retardation of the disease process.

Factitious decompression sickness.

The diagnosis of decompression sickness is made largely by history; there are few physical findings and no radiographic or laboratory tests to support the diagnosis. We present three cases of factitious decompression sickness in which patients fabricated an appropriate history and underwent compression therapy. Due to the potential severity of decompression sickness and the relative safety of compression therapy, the initiation of therapy must not be delayed in a case of decompression sickness. Once therapy is begun, investigation into the particulars of a suspicious case can be made.

Argon and carbon dioxide laser treatment of hypertrophic and keloid scars.

Laser physiology has shown that while wound healing is generally excellent after laser impaction, it nevertheless is delayed. It is thought that this factor may be important in the treatment of hypertrophic and keloid scars. These scars have been treated in a variety of ways with the laser, and the results, which have been good, are reported. A possible explanation of the complex mode of action has been given. It is thought that more work should be undertaken in this field.