Investigation of the neutron spectrum measurement method for dose evaluation in boron neutron capture therapy.

In boron neutron capture therapy, it is important to evaluate the dose administered to a patient's body outside the tumour area. The exposure dose is evaluated by calculation; however, the calculated value must be validated using a measured value. The dose evaluations based on the measured neutron spectrum are investigated. Multi-foil activation, combined with a LiCaAlF6 scintillation detector and an imaging plate, is proposed as a measurement method. The proposed method can measure the neutron spectrum at various points quickly.

Potential for acceleration of bone formation after implant surgery by using a dietary supplement: an animal study.

Dental implant treatment is an effective modality to restore lost aesthetic and masticatory functions. However, healing after implant surgery takes at least 3-6 months. This prolonged healing period poses several difficulties for individuals with a large edentulous area and decreases their quality of life. Consequently, shortening the healing period and accelerating final prosthesis placement after surgery is very clinically important. Peri-implant bone formation may be enhanced by systemic approaches, such as the use of osteoporosis supplements, to promote bone metabolism. To confirm whether intake of a supplement developed for osteoporosis, synthetic bone mineral (SBM), was effective in accelerating peri-implant bone formation as part of the healing process after implantation. Twenty-four 5-week-old female Wistar rats were randomly assigned to receive a standardised diet without (control group, n = 12) or with SBM (n = 12). The rats had implant surgery at 8 weeks of age under general anaesthesia. The main outcome measures were bone mineral density (BMD) and pull-out strength in the implant and femur, which were compared between the groups at 2 and 4 weeks after implantation using the Mann-Whitney U test. BMD was significantly greater in the SBM group at 2 and 4 weeks after implantation compared to the control group. Pull-out strength was significantly greater in the SBM groups at 2 and 4 weeks after implantation compared to the control group. This study demonstrated that SBM could be effective in accelerating peri-implant bone formation during the healing period after implantation.

Total skin electron beam therapy using an inclinable couch on motorized table and a compensating filter.

Total skin electron beam is a specialized technique that involves irradiating the entire skin from the skin surface to only a few millimetres in depth. In the Stanford technique, the patient is in a standing position and six different directional positions are used during treatment. Our technique uses large electron beams in six directions with an inclinable couch on motorized table and a compensating filter was also used to spread the electron beam and move its intensity peak. Dose uniformity measurements were performed using Gafchromic films which indicated that the surface dose was 2.04 ± 0.05 Gy. This technique can ensure the dose reproducibility because the patient is fixed in place using an inclinable couch on a motorized table.

Project for the development of the linac based NCT facility in University of Tsukuba.

A project team headed by University of Tsukuba launched the development of a new accelerator based BNCT facility. In the project, we have adopted Radio-Frequency Quadrupole (RFQ)+Drift Tube Linac (DTL) type linac as proton accelerators. Proton energy generated from the linac was set to 8MeV and average current was 10mA. The linac tube has been constructed by Mitsubishi Heavy Industry Co. For neutron generator device, beryllium is selected as neutron target material; high intensity neutrons are generated by the reaction with beryllium and the 80kW proton beam. Our team chose beryllium as the neutron target material. At present beryllium target system is being designed with Monte-Carlo estimations and heat analysis with ANSYS. The neutron generator consists of moderator, collimator and shielding. It is being designed together with the beryllium target system. We also acquired a building in Tokai village; the building has been renovated for use as BNCT treatment facility. It is noteworthy that the linac tube had been installed in the facility in September 2012. In BNCT procedure, several medical devices are required for BNCT treatment such as treatment planning system, patient positioning device and radiation monitors. Thus these are being developed together with the linac based neutron source. For treatment planning system, we are now developing a new multi-modal Monte-Carlo treatment planning system based on JCDS. The system allows us to perform dose estimation for BNCT as well as particle radiotherapy and X-ray therapy. And the patient positioning device can navigate a patient to irradiation position quickly and properly. Furthermore the device is able to monitor movement of the patient׳s position during irradiation.

Evaluation of three-dimensional polymer gel dosimetry using X-ray CT and R2 MRI.

It is difficult to obtain images of thin slices from measurement of spin-spin relaxation (R2) with magnetic resonance imaging (MRI) using the traditional dose reading method of polymer gel dosimetry. In this study, the dose reading method was performed using X-ray computed tomography (CT) for proton beam measurements in order to enable collection of thin slices. In addition, three-dimensional (3D) images of polymer gels were constructed using volume rendering. As a result of acquisition of thin slices, more detailed 3D data consisting of smaller voxel sizes compared to R2 were acquired. However, it was found that with thin slice thicknesses and small voxels, the signal-to-noise ratio around the voxels deteriorated. In addition, the coefficient of variation of non-irradiated gels with CT was smaller than that with R2 MRI.

An isocenter detection and verification device for use in proton therapy.

We developed a new device for isocenter detection and verification for use in proton therapy. This device can be used to confirm the isocenters of a room laser, a digital radiography system, and a rotational gantry. Agreement between the isocenters of a room laser and a digital radiography system was examined visually. We used the star-shots method for detecting and verifying the rotational gantry isocenter. The gafchromic film could be irradiated with this method using a 2 mm slitted 200 MeV proton beam. The isocenters of a room laser and digital radiography system were in good agreement. The size distribution of the isocenter by the star-shots method was <2 mm, which is the value recommended by the American Association of Physicists in Medicine Task Group 142. This new device can be used to evaluate comprehensive isocenter detection and verification for related equipment. Subsequent checking using this new device will decrease the uncertainty in measuring an isocenter. When using this device, the working time was significantly reduced to about 30 min, including preparation. These measurements should be useful for high accuracy daily treatments.

SU-E-T-395: Achievability and Optimization of Synchrotron-Based Respiratory Gated Spot Scanning Proton Beam Delivery.

PURPOSE: The purpose was to investigate the interplay of residual motion in realistically delivered respiratory gated spot scanning proton beam by a synchrotron. METHODS: A MatriXX 2D ion-chamber array detector was placed on a moving platform. The platform with the 2D ion-chamber array detector was moved based on sin4 motion with 3s and 5s cycle and 20 mm amplitude. Its motion was monitored by a laser displacement sensor (ZS-LDS2VT, omron, Japan). The respiration gate threshold level was set at 30% duty cycle and the residual motion within the gate window was approximately 6 mm. A 10×10 cm2 uniform field was delivered by a matrix of 13×13 spots with ∼ 8 mm spot size (s) and 8 mm spot spacing. Measurements were done for the field delivered with a single painting and multiple re-painting, from 2 to 12 times, for both orthogonal and parallel scan directions. The same field was also measured without moving the detector, defined as the static reference dose. Dose homogeneity was compared between with gated and the static dose distributions. RESULTS: The worst single painting result of the dose homogeneity ratio was 0.90 in 3s motion cycle and 0.93 in 5s motion cycle with the orthogonal scan pattern, and 0.97 in 3s and 0.98 in 5s motion with the parallel scan pattern, respectively . The homogeneity ratio improved to over 0.98 by 4∼6 times repainting in orthogonal and only 2 times re-painting with the parallel scan. CONCLUSIONS: The respiratory gated spot scanning proton beam delivery is sensitive to spot movement direction relative to the residual motion of the target. A proper selection of the number of repainting and the scan direction can improve beam delivery quality. The study offers a basic understanding when implementing respiratory gated spot scanning proton beam treatment.

Multistep Lattice-Voxel method utilizing lattice function for Monte-Carlo treatment planning with pixel based voxel model.

Treatment planning for boron neutron capture therapy generally utilizes Monte-Carlo methods for calculation of the dose distribution. The new treatment planning system JCDS-FX employs the multi-purpose Monte-Carlo code PHITS to calculate the dose distribution. JCDS-FX allows to build a precise voxel model consisting of pixel based voxel cells in the scale of 0.4×0.4×2.0 mm(3) voxel in order to perform high-accuracy dose estimation, e.g. for the purpose of calculating the dose distribution in a human body. However, the miniaturization of the voxel size increases calculation time considerably. The aim of this study is to investigate sophisticated modeling methods which can perform Monte-Carlo calculations for human geometry efficiently. Thus, we devised a new voxel modeling method "Multistep Lattice-Voxel method," which can configure a voxel model that combines different voxel sizes by utilizing the lattice function over and over. To verify the performance of the calculation with the modeling method, several calculations for human geometry were carried out. The results demonstrated that the Multistep Lattice-Voxel method enabled the precise voxel model to reduce calculation time substantially while keeping the high-accuracy of dose estimation.

Correlation between pathological distal esophageal acid exposure and ineffective esophageal motility.

AIM: To assess the correlation between esophageal dysmotility, characterized as inefficient esophageal motility (IEM), and the presence of pathological acid reflux due to a structurally defective lower esophageal sphincter (LES), hiatus hernia. (HH), or esophagitis in patients with suspected gastroesophageal reflux disease (GERD). METHODS: 311 patients referred for GERD diagnostic procedures in a gastroesopahgeal motility laboratory were included in the study. Patients underwent an interview regarding their clinical symptoms, upper endoscopy (UE), stationary esophageal manometry, and 24-h esophageal pH-metry. The following risk factors of patients in the negative pH-metry group were compared to those in the positive pH-metry group: IEM, defective LES, HH, and esophagitis. The association between IEM and positive pH-metry results was first assessed by means of univariate analysis and later determined with multivariate logistic regression analysis. RESULTS: Out of the total of 311 studied patients, 208 met the inclusion criteria; 88 had normal and 120 had positive pH-metry results. Univariate analysis revealed that the occurrence of IEM, defective LES, and HH was significantly greater in the positive pH-metry group. Following logistic regression analysis, the occurrence of IEM remained significantly greater in the positive pH-metry group. CONCLUSIONS: IEM is associated with the presence of abnormal acid reflux, as assessed by 24-h esophageal pH-metry, regardless of the presence of defective LES, HH, or esophagitis.

Effect of fluoride ions on apatite crystal formation in rat hard tissues.

Fluoride is widely believed to be a useful chemical substance for preventing dental caries. However, the mechanism underlying crystal perforation in the tooth enamel and the effect of fluoride on hard tissues are unclear. To clarify the mechanism of the biological action of fluoride in the mineralization process, we examined the hard tissues of rats having received water containing a relatively low fluoride level. Electron microscopy revealed that fluoride ions could interrupt the crystal nucleation process, resulting in crystal perforation in the developing tooth enamel and the presence of amorphous minerals in bone crystals. Furthermore, the results of enzymatic analyses indicated that fluoride directly interfered with the synthesis of carbonic anhydrase by the enamel-forming cells, rather than being directly involved in the crystal formation. From the results, we would like to provide a possible mechanism of crystal perforation in the enamel induced by fluoride intake. Also, we would like to suggest that regardless of its amount, fluoride intake has harmful effects on both tooth and bone formation.

Calcium phosphate formation on the phosphorylated dental bonding agent in electrolyte solution.

The aim of the present study was to study the mineral formation on a phosphorylated dental bonding agent using a mineralization inductive solution. Clearfil Photobond, which contained phosphate monomer, was cured by photo-irradiation and heat treated, and was then immersed in Hanks' balanced salt solution (HBSS) with pH = 7.4 for 1, 3, 5, 7, 14, and 28 days at 37 degrees C. The white substances were deposited on the phosphorylated polymer, i.e. cured Photobond disk, after the immersion in HBSS. The white substances become visible after 3 days immersion. After 7 days immersion, surface of the phosphorylated polymer disk was almost covered with white substance layers. The measurement of white substances by means of X-ray diffraction, Fourier-transform infrared and electron probe microanalysis revealed that their main component was carbonate-containing hydroxyapatite. Scanning electron microscopy pictures showed that a large number of globules of hydroxyapatite were fused together, and that each globule was composed of a group of numerous thin-film form flakes uniting and/or clustering together. The results obtained in this study concluded that the presence of phosphonic acid and phosphate group of phosphorylated dental bonding agent enhanced the nucleation and growth of hydroxyapatite crystals on its surface.

[Good response in case of hepatocellular carcinoma with portal tumor thrombs--a case report of interdisciplinary local therapy].

A 56-year-old male patient with chronic C type hepatitis had HCC which invaded right portal vein trunk (Vp3). In August 2000, we performed intrahepatic artery infusion chemotherapy with CDDP and 5-FU under subcutaneous interferon alpha treatment. In addition, we used chemoradiation therapy for portal tumor thrombus in HCC. As the result of such therapy, the size of HCC and portal tumor thrombus reduced and the level of PIVKA-II decreased. There were no side effects except fever due to interferon alpha treatment. In February 2001, we performed devascularization and RFA therapy for HCC in S7 of liver under laparoscope. The level of PIVKA-II was within the normal range. It is important to perform interdisciplinary therapy appropriate for the HCC status.

Dosimetry of pulsed clinical proton beams by a small ionization chamber.

Response of a micro volume (0.01 ml) ionization chamber has been studied with pulsed proton beams which are used for clinical purposes and has been compared with those of some JARP ionization chambers (0.6 ml). All chambers used had been calibrated by standard 60Co beams at the Electrotechnical Laboratory (ETL) and exposure calibration factors, Nx, were obtained on advance. Two methods are used to compensate the general recombination which occurs during pulsed beam irradiations: theoretical correction by a Boag's formulation and a modified two-voltage technique. An evaluation of absolute absorbed dose-to-water is performed on the basis of the protocol provided by ICRU report 59. The results imply that, to a first approximation, both chambers indicate the almost same result within 2% when unknown chamber-dependent parameters of the micro chamber are tentatively assumed to be identical to those of the JARP chamber for the calibration with 60Co beams. The about 1.5% discrepancy observed in the response of both chambers is not discussible due to presumably 1-2% uncertainty of the protocol of ICRU report 59 which does not include any chamber-dependent corrections for the perturbation effects in proton beams.

[Intra-arterial infusion chemotherapy with docetaxel for locally advanced breast cancer and inflammatory breast cancer].

From 1998 to 2000, we performed neoadjuvant intra-arterial infusion chemotherapy using docetaxel (60 mg/m2) a few times with 5 patients with local advanced breast cancer and inflammatory breast cancer. Therapeutic effects included 3 cases of PR among the breast tumor patients and downstaging was obtained 2 cases. No critical side effects were found due to this chemotherapy. We could perform mastectomy in all the cases. We consider intra-arterial infusion using docetaxel to be highly effective with few side effects in cases of advanced breast cancer.

Multi-layer energy filter for realizing conformal irradiation in charged particle therapy.

A new type of filter for charged particle radiotherapy is developed to reduce unwanted dose transfer to the normal tissues around a tumor. The new filter can make a static irradiation field where the width of the spread-out Bragg peak (SOBP) is two-dimensionally adjusted. That makes the field conformal to the tumor three-dimensionally. The filter is made of many layers produced by using stereolithography. The layer has a miniaturized structure that has geometrical similarity to the conventional ridge filter. Shapes of cone and pyramid are also usable for the unit-cell constructing the layer. The spread of the field in the depth direction is decided by the thickness of the filter, or by the number of layers. The experimental result of the irradiation using the ridge-type construction shows a good agreement with an estimate by the Monte Carlo calculation. By combining this technique with intensity modulation that has lateral position dependence, the conformal irradiation can be achieved by a simple procedure.

Application of high resolution microfocus X-ray CT for the observation of human tooth.

The calcification degree of extracted human teeth was observed by using high resolution microfocus X-ray CT. As samples, upper and lower first premolars extracted from a 21-year-old female were used. The computed tomograms were produced by high resolution microfocus X-ray CT with a open vacuum X-ray source, rotating sample stage, and image sensor. The distinction between enamel and dentin was very clear, and the shape of the pulp cavity was also clearly identified. The secondary dentin was visible in the circumpulpal dentin. The color map displays showed the heterogeneity of the calcification degree not only in the dentin but also in the enamel. The enamel was divided into three layers according to the calcification degree. High resolution microfocus X-ray CT was very useful for the observation of the internal structure of human teeth without destroying the samples.

Ossification of posterior longitudinal ligaments: evaluation with MRI.

Ossification of the posterior longitudinal ligament is a special subcategory of degenerative disease responsible for compression of the spinal cord. On MR images, T2-weighted sequences are the most effective to evaluate both spinal cord compression due to the ossification and abnormal signal intensity of the cord. Although ossification of the ligaments is well demonstrated on CT and plain radiographs, MRI noninvasively provides useful information about the degree and extent of spinal cord compression, as well as the character of the ossification.

Helix structure of ribbon-like crystals in bovine enamel.

In the early mineralized enamel crystals, ribbon-like crystals appear near the ameloblasts. Some ribbon-like crystals showed helical or spiral structure within restricted environment during the preparation of embryonic bovine specimens for electron microscope. These specimens did not suffer from the cutting damages nor staining effects. The main cause of the helix structure is considered a result of the dehydration during preparation. The periodic structure must reflect the regularity of initial enamel crystals. If dehydration caused the ribbon-like crystal to induce the periodic helix, it is one possibility that the earliest enamel crystal is OCP which has been proposed as a precursor of HA. Because it is considered that OCP is more sensitive to dehydration and more symmetric structure than biological HA. The periodicity of the helical ribbon-like structure was about 25 to 55 nm long and could be compared to the periodicity of organic helices which had observed in an immature rat enamel.

Magnesium and carbonate in enamel and synthetic apatites.

This study aimed to: determine the Mg and CO3 distribution in the outer (surface), middle, and inner (closest to the enamel-dentin junction, EDJ) layers of human enamel; and determine the factors affecting the incorporation of Mg into synthetic apatites and the consequence of such incorporation on the properties of the apatites. Results demonstrated that the concentrations of Mg, CO3, and organic components increased from the surface to the inner layers close to the EDJ and a difference in crystallinity from the outer to the inner layers. Initial results indicated that the extent of dissolution of the inner layer enamel is greater than that in the outer or surface enamel. Results on synthetic apatites showed the following: (1) Limited Mg incorporation into apatite was dependent on solution [Mg/Ca] molar ratio, temperature, pH, and the presence of CO3 or fluoride (F); (2) incorporation of Mg causes reduction in crystallinity and an increase in the extent of dissolution of the apatite; (3) the negative effect of Mg on the properties of apatites is synergistic to that of CO3 and antagonistic to that of F; and (4) exposure to acid of Mg-containing apatites causes the dissolution of Mg-rich apatite and precipitation of Mg-poor apatite. The observed decrease in the [Mg/Ca] of enamel and synthetic apatites after acid exposure may explain the observed 'preferential loss' of Mg and CO3 in the initial stages of caries.