Evaluating dose coverage and conformity in stereotactic ablative body radiotherapy (SABR) plans.

PURPOSE: Accepted conformity metrics in stereotactic ablative body radiotherapy (SABR) have significant limitations. This work aimed to develop a spatial assessment methodology that improves and automates checks of dose prescription and dose gradient from planning target volume (PTV) edge. METHODS: A Python-based script was developed to determine linear distances from the PTV edge to specified isodose, every 15 degrees on all axial slices and along the central axis in the coronal plane. A new "Internal PTV contour" distance metric is introduced as a size and shape indicator. 134 previously treated SABR patients stratified by anatomical site and PTV volume were analysed to establish baselines and tolerances for automation acceptability. RESULTS: In the axial plane, median distance (MD) from PTV edge to the 100 % isodose was 0.13 mm (range: -0.67 to 0.53 mm), and for the 90 % isodose was 2.37 mm (1.36 to 3.40 mm). Lung and non-Lung dose gradient criteria was established by fitting a second order polynomial to the MD as a function of "Internal PTV contour". This resulted in acceptability criteria of MD + 1 mm for 80 % isodose and MD + 2 mm for the 50 % isodose. For the coronal plane, MD to the 100 % isodose was 0.49 mm (-1.24 to 2.14 mm) and for the 90 % was 1.73 mm (-0.49 to 4.13 mm). CONCLUSIONS: Our in-house script enables a high-quality spatial assessment of PTV dose coverage and gradient, with the new 'Internal PTV contour' distance metric correlating well with dose gradient.

A strategy to reduce fraction number in peripheral lung stereotactic ablative body radiotherapy.

Background and purpose: Hypo-fractionated lung Stereotactic Ablative Body Radiotherapy (SABR) has often been avoided when tumours are close to the chest wall. Our strategic objective was the reduction of fraction number, while maintaining target biological effective dose coverage without increasing chest wall toxicity (CWT) predictors. Materials and methods: Twenty previously treated lung SABR patients were stratified into four cohorts according to distance from PTV to the chest wall, <1 cm, <0.5 cm, overlapping up to 0.5 cm and 1.0 cm. For each patient, four plans were created; a chest wall optimised plan for 54 Gy in 3 fractions, the clinical plan re-prescribed for 55 Gy in 5, 48 Gy in 3 and 45 Gy in 3 fractions. Results: For a PTV distance of 0.5-0.0 cm, a reduction of the median (range) Dmax from 55.7 (57.5-54.1) Gy to 40.0 (37.1-42.0 Gy) Gy was observed for the chest wall optimised plans. The median V30Gy decreased from 18.9 (9.7-25.6) cm3 to 3.1 (1.8-4.5) cm3. For a PTV overlap of up to 0.5 cm, the Dmax reduced from 66.5 (64.1-70) Gy to 53.2 (50.6-55.1) Gy. The V30Gy decreased from 21.5 (16.5-29.5) cm3 to 14.9 (11.3-20.2) cm3. For the cohort with up to 1.0 cm overlap, there was a reduction in Dmax values of 9.9 Gy. The V30Gy for clinical plans, at 66.8 (18.7-188.8) cm3, decreased to 55.3 (15.5-149) cm3. Conclusion: When PTVs are within 0.5 cm of chest wall, lung SABR dose heterogeneity can be used to reduce fraction number without increasing CWT predictors.

Clinical treatment planning for kilovoltage radiotherapy using EGSnrc and Python.

Kilovoltage radiotherapy dose calculations are generally performed with manual point dose calculations based on water dosimetry. Tissue heterogeneities, irregular surfaces, and introduction of lead cutouts for treatment are either not taken into account or crudely approximated in manual calculations. Full Monte Carlo (MC) simulations can account for these limitations but require a validated treatment unit model, accurately segmented patient tissues and a treatment planning interface (TPI) to facilitate the simulation setup and result analysis. EGSnrc was used in this work to create a model of Xstrahl kilovoltage unit extending the range of energies, applicators, and validation parameters previously published. The novel functionality of the Python-based framework developed in this work allowed beam modification using custom lead cutouts and shields, commonly present in kilovoltage treatments, as well as absolute dose normalization using the output of the unit. 3D user-friendly planning interface of the developed framework facilitated non-co-planar beam setups for CT phantom MC simulations in DOSXYZnrc. The MC models of 49 clinical beams showed good agreement with measured and reference data, to within 2% for percentage depth dose curves, 4% for beam profiles at various depths, 2% for backscatter factors, 0.5 mm of absorber material for half-value layers, and 3% for output factors. End-to-end testing of the framework using custom lead cutouts resulted in good agreement to within 3% of absolute dose distribution between simulations and EBT3 GafChromic film measurements. Gamma analysis demonstrated poor agreement at the field edges which was attributed to the limitations of simulating smooth cutout shapes. Dose simulated in a heterogeneous phantom agreed to within 7% with measured values converted using the ratio of mass energy absorption coefficients of appropriate tissues and air.

Energy-dependence investigation for a range of clinically used detectors from 70 kV to 6 MV.

PURPOSE: Accurate measurement of out-of-field dose in radiotherapy directly impacts beam data modeling in treatment planning systems, verification of implanted electronic devices/lens/fetus dose, secondary cancer risk estimation, and organ-at-risk dose reporting. When performing out-of-field dosimetry, it is therefore imperative that the response of the detector has been well characterized. Due to the softening of the radiation beam out-of-field, many detectors will exhibit energy dependence. This study investigated the energy dependence of a range of clinical available detectors over typical energies experienced out-of-field. METHODS: The response of detectors to photon beams from 70 kV to 6 MV was measured. The relative change in response from 6 MV down to 70 kV highlighted the expected deviation in the response of detectors that would typically be calibrated in-field for use out-of-field. RESULTS: The Pinpoint detector displayed the most energy-independent response over the energy range investigated. The Micro-Lion detector was the only detector to show an under-response to all low-energy beams relative to 6 MV. The diode-type detectors showed the largest energy dependence. CONCLUSIONS: When considering detectors for use in out-of-field dose measurements, it is important that the energy dependence is investigated over a low-energy range as out-of-field the energy spectra comprise a larger component of photons in the 50-100-keV range. This study highlights the variation in response of a range of clinically available detectors to low-energy radiation beams relative to 6 MV for out-of-field dosimetry. The Pinpoint detector was the most energy-independent detector with a response close to unity over the entire energy range investigated.

Americium incorporation into studtite: a theoretical and experimental study.

Studtite, [UO2(η2-O2)(H2O)2]·2H2O, and metastudtite, [UO2(η2-O2)(H2O)2], are important phase alterations of UO2 in a spent nuclear fuel repository and have previously been shown to react with Np(v). In this work we extend the study to Am(v) on a tracer scale and show spectroscopic evidence that the Am is incorporated into the structure of studtite as Am(iii). A computational study on the possible mechanisms for the incorporation of Np and Am shows that protonation of the -yl oxygen is the favoured route and the calculated incorporation energies are large and positive. The results suggest that Am is less favoured compared to Np but energetically more favoured to incorporate both actinide ions into metastudtite rather than studtite. Finally, we have shown that once incorporated, Am readily leaches into water but spectroscopic measurements suggest subtle changes in the structure of studtite.

The potential for increased tumor control probability in non-small cell lung cancer with a hypofractionated integrated boost to the gross tumor volume.

Treatment outcomes in locally advanced non-small cell lung cancer (NSCLC) to date have been poor, with normal tissue toxicity often limiting the dose that can be delivered to the tumor. Treatment intensification in NSCLC via targeted dose escalation with modern delivery techniques may offer the potential for a significant increase in tumor control probability (TCP) without a clinically significant increase in organ-at-risk (OAR) toxicity. In this planning study, 20 patients were re-planned with a volumetric modulated arc therapy (VMAT) and an inhomogeneous dose distribution with iteratively escalated doses to the gross tumor volume (iGTV) (composite GTV across multiple 4-dimensional computed tomography [4DCT] phases) in a series of 20 fraction regimes. For each plan OAR doses, target coverage and predicted TCPs were collected and compared with homogenous 3-dimensional (3D) and VMAT plans, as well as with each other. In 70% of patients, it was possible to escalate to 75 Gy in 20 fractions within OAR tolerances, opening the possibility of treating these patients to a biological effective dose (BED) of 103.1 Gy10. This planning study forms the basis of a clinical trial INTENSE (Inhomogeneous Targeted Dose Escalation in Non-Small CEll Lung Cancer), CTRIAL 15-47.

Using soil seed banks to assess temporal patterns of genetic variation in invasive plant populations.

Most research on the genetics of invasive plant species has focused on analyzing spatial differences among existing populations. Using a long-established Gunnera tinctoria population from Ireland, we evaluated the potential of using plants derived from seeds associated with different soil layers to track genetic variation through time. This species and site were chosen because (1) G. tinctoria produces a large and persistent seed bank; (2) it has been present in this locality, Sraheens, for ∼90 years; (3) the soil is largely undisturbed; and (4) the soil's age can be reliably determined radiometrically at different depths. Amplified fragment length polymorphic markers (AFLPs) were used to assess differences in the genetic structure of 75 individuals sampled from both the standing population and from four soil layers, which spanned 18 cm (estimated at ∼90 years based on (210)Pb and (137)Cs dating). While there are difficulties in interpreting such data, including accounting for the effects of selection, seed loss, and seed migration, a clear pattern of lower total allele counts, percentage polymorphic loci, and genetic diversity was observed in deeper soils. The greatest percentage increase in the measured genetic variables occurred prior to the shift from the lag to the exponential range expansion phases and may be of adaptive significance. These findings highlight that seed banks in areas with long-established invasive populations can contain valuable genetic information relating to invasion processes and as such, should not be overlooked.

Radionuclide impurities in proton-irradiated [18O]H2O for the production of 18F-: activities and distribution in the [18F]FDG synthesis process.

Proton- and neutron-induced activation products in the components of a high-pressure [(18)O]H(2)O target vessel used for the production of (18)F(-) in a medical cyclotron have been identified using high resolution gamma spectrometry. The activities leached from the target vessel into the [(18)O]H(2)O during irradiation, and the distribution of the identified radionuclide impurities in the various cartridges and solutions used in the [(18)F]FDG synthesis process have been measured and are discussed from the perspective of waste disposal. The results indicate that, at the energies and beam currents employed, only a few, relatively short-lived radionuclides are present in the irradiated [(18)O]H(2)O, and that the activities involved (<10 kBq in each case) are well below typical exemption limits. Activities of beta-emitting (3)H in irradiated [(18)O]H(2)O, produced via the (18)O(p,(3)H)(16)O reaction, have also been determined using liquid scintillation spectrometry. Measured activity concentrations, in the range 150-180 kBq g(-1), are consistent with those reported by other workers. Analyses of the synthesised [(18)F]FDG confirm the radiochemical purity of the product, both for (3)H and for gamma-emitting radionuclides in the energy range 25-1650 keV.

A novel approach to the sequential extraction of plutonium from oxic and anoxic sediment using sodium citrate to inhibit post-extraction resorption.

Sequential extraction has been used extensively to study the solid partitioning of radionuclides in soils and sediments. A difficulty with sequential extraction is that radionuclides released by a particular extractant can be resorbed and artificially redistributed amongst the remaining solid phases. Here, we describe experiments (on selected model phase and natural materials), which were designed to determine whether the inclusion of a chelating agent (sodium citrate) in an established sequential extraction protocol (a) inhibits post-extraction resorption of plutonium, (b) increases non-targeted dissolution of sediment phases, and (c) gives rise to unwanted ligand competition for plutonium. The results clearly demonstrate the capacity of citrate to inhibit the resorption of plutonium from the various extractants, and confirm that there is no discernible increase in non-targeted phase dissolution, but indicate significant ligand competition with the carbonate phase. The merits of using citrate are discussed and an optimised sequential extraction protocol that includes citrate is proposed. Finally, the protocol is applied to oxic and anoxic sediments sampled in the NE Irish Sea and the Roads of Cherbourg, and it is shown that the bulk of the plutonium on these sediments is associated with the more labile geochemical fractions.

Tritium in well waters, streams and atomic lakes in the East Kazakhstan Oblast of the Semipalatinsk Nuclear Test Site.

The concentration of tritium has been determined in well waters, streams and atomic lakes in the Sarzhal, Tel'kem, Balapan and Degelen Mountains areas of the Semipalatinsk Test Site. The data show that levels of tritium in domestic well waters within the settlement of Sarzhal are extremely low at the present time with a median value of 4.4 Bq dm(-3) (95% confidence interval:4.1-4.7 Bq dm(-3)). These levels are only marginally above the background tritium content in surface waters globally. Levels in the atomic craters at Tel'kem 1 and Tel'kem 2 are between one and two orders of magnitude higher, while the level in Lake Balapan is approximately 12,600 Bq dm(-3). Significantly, levels in streams and test-tunnel waters sourced in the Degelen Mountains, the site of approximately 215 underground nuclear tests, are a further order of magnitude higher, being in the range 133,000--235,500 Bq dm(-3). No evidence was adduced which indicates that domestic wells in Sarzhal are contaminated by tritium-rich waters sourced in the Degelen massif, suggesting that the latter are not connected hydrologically to the near-surface groundwater recharging the Sarzhal wells. Annual doses to humans arising from the ingestion of tritium in these well waters are very low at the present time and are of no radiological significance.