Journal of applied clinical medical physics / American College of Medical Physics, 2010
Recent improvements to the functionality and stability of implantable pacemakers and cardioverter... more Recent improvements to the functionality and stability of implantable pacemakers and cardioverter-defibrillators involve changes that include efficient battery power consumption and radiation hardened electrical circuits. Manufacturers have also pursued MRI-compatibility for these devices. While such newer models of pacemakers and cardioverter-defibrillators are similar in construction to previously marketed devices - even for the recent MRI-compatible designs currently in clinical trials - there is increased interest now with regard to radiation therapy dose effects when a device is near or directly in the field of radiation. Specifically, the limitation on dose to the device from therapeutic radiation beams is being investigated for a possible elevation in limiting dose above 200 cGy. We present here the first-ever study that evaluates dosimetric effects from implantable pacemakers and implantable cardioverter-defibrillators in high energy X-ray beams from a medical accelerator. T...
Medical dosimetry : official journal of the American Association of Medical Dosimetrists, 2010
Titanium clips are commonly used to delineate the location of the tumor bed during breast cancer ... more Titanium clips are commonly used to delineate the location of the tumor bed during breast cancer surgery. Electron beams are frequently used to boost radiation dose to the breast cavity. This research investigated the effect on such boost treatments as a result of metallic clip perturbation potentially exhibited through attenuation and scatter processes using measurements with Gafchromic film and treatment planning simulation with both generalized Gaussian pencil beam and electron Monte Carlo algorithms. Results showed that the potential effect of clip interference is unidentifiable from both algorithms. Dosimetry with Gafchromic external beam therapy film did detect dose perturbations caused by the titanium clips in proximal plane, 0.23 mm away, resulting in 3.0% backscatter and 2.4% attenuation at 6 MeV and 2.0% backscatter and 6.7% attenuation at 9 MeV. The noise contribution of the film scanner is estimated to be about 0.4% and nearly 2% uncertainty in film calibration. As a res...
Vascular access ports are used widely in the administering of drugs for radiation oncology patien... more Vascular access ports are used widely in the administering of drugs for radiation oncology patients. Their dosimetric effect on radiation therapy delivery in photon beams has not been rigorously established. In this work the effects on external beam fields when any of a variety of vascular access ports is included in the path of a high energy beam are studied. This medical physics study specifically identifies side-scatter and back-scatter consequences as well as attenuation effects. The study was divided into two parts: Firstly, a total of 18 ports underwent extended HU range CT scanning followed by 3-D computer treatment planning, where independent homogeneity and heterogeneity plans were created for photon beams of energy 6 MV and 18 MV using a Pencil Beam Convolution (PBC) algorithm. Dose points were analyzed at locations all around each device. A total of 1,440 points were reviewed in this section of the study. Secondly, a mock-up of the largest vascular access port was created in the treatment planning workspace for further investigation with alternative treatment planning algorithms. Plans were generated identically to the above and compared to the results of dose computation between the Pencil Beam Convolution algorithm, the Analytical Anisotropic Algorithm (AAA), and the EGSnrc Monte Carlo algorithm with user code DOSRZnrc (MC). A total of 300 points were reviewed in this part of the study. It was conclusive that ports with more bulky construction and those with partial metal composition create the largest changes. Similar effects are seen for similar port configurations. Considerable differences between the PBC and AAA in comparison to MC are noted and discussed. By thorough examination of planning system results, the presented vascular access ports may now be ranked according to the greatest amount of change exhibited within a treatment planning system. Effects of backscatter, lateral scatter and attenuation are up to 5.0%, 3.4% and 16.8% for 6 MV and 7.0%, 7.7% and 7.2% for 18 MV respectively.
Combining radiation therapy and direct intratumoral (IT) injection of adenoviral vectors has been... more Combining radiation therapy and direct intratumoral (IT) injection of adenoviral vectors has been explored as a means to enhance the therapeutic potential of gene transfer. A major challenge for gene transfer is systemic delivery of nucleic acids directly into an affected tissue. Ultrasound (US) contrast agents (microbubbles) are viable candidates to enhance targeted delivery of systemically administered genes. Here we show that p53, pRB, and p130 gene transfer mediated by US cavitation of microbubbles at the tumor site resulted in targeted gene transduction and increased reduction in tumor growth compared to DU-145 prostate cancer cell xenografts treated intratumorally with adenovirus (Ad) or radiation alone. Microbubble-assisted/US-mediated Ad.p53 and Ad.RB treated tumors showed significant reduction in tumor volume compared to Ad.p130 treated tumors (p<0.05). Additionally, US mediated microbubble delivery of p53 and RB combined with external beam radiation resulted in the most profound tumor reduction in DU-145 xenografted nude mice (p<0.05) compared to radiation alone. These findings highlight the potential therapeutic applications of this novel image-guided gene transfer technology in combination with external beam radiation for prostate cancer patients with therapy resistant disease.
Where no society-based or manufacturer guidance on radiation limits to neuromodulation devices is... more Where no society-based or manufacturer guidance on radiation limits to neuromodulation devices is available, this research provides the groundwork for neurosurgeons and radiation oncologists who rely on the computerized treatment plan clinically for cancer patients. The focus of the article is to characterize radiation parameters of attenuation and scatter when an incident therapeutic x-ray beam is directed upon them. At the time of this writing, manufacturers of Neuromodulation products do not recommend direct exposure of the device in the beam nor provide guidance for the maximum dose for these devices. Ten neuromodulation models were chosen to represent the finite class of devices marketed by Medtronic before 2011. CT simulations permitted computer treatment modeling for dose distribution analysis as used routinely in radiation oncology for patients. Phantom case results were directly compared to actual clinical patient cases. Radiation detection measurements were then correlated to computational results. Where the x-ray beam passes through the device and is attenuated, dose reduction was identified with Varian Eclipse computer modeling for these posterior locations. Although the computer algorithm did not identify physical processes of side-scatter and back-scatter, these phenomena were proven by radiation measurement to occur. In general, the computer results underestimated the level of change seen by measurement. For these implantable neurostimulators, the spread in dose changes were found to be -6.2% to -12.5% by attenuation, +1.7% to +3.8% by side-scatter, and +1.1% to +3.1% by back-scatter at 6 MV. At 18 MV, these findings were observed to be -1.4% to -7.0% by attenuation, +1.8% to 5.7% by side-scatter, and 0.8% to 2.7% by back-scatter. No pattern for the behavior of these phenomena was deduced to be a direct consequence of device size.
Journal of applied clinical medical physics / American College of Medical Physics, 2010
Recent improvements to the functionality and stability of implantable pacemakers and cardioverter... more Recent improvements to the functionality and stability of implantable pacemakers and cardioverter-defibrillators involve changes that include efficient battery power consumption and radiation hardened electrical circuits. Manufacturers have also pursued MRI-compatibility for these devices. While such newer models of pacemakers and cardioverter-defibrillators are similar in construction to previously marketed devices - even for the recent MRI-compatible designs currently in clinical trials - there is increased interest now with regard to radiation therapy dose effects when a device is near or directly in the field of radiation. Specifically, the limitation on dose to the device from therapeutic radiation beams is being investigated for a possible elevation in limiting dose above 200 cGy. We present here the first-ever study that evaluates dosimetric effects from implantable pacemakers and implantable cardioverter-defibrillators in high energy X-ray beams from a medical accelerator. T...
Medical dosimetry : official journal of the American Association of Medical Dosimetrists, 2010
Titanium clips are commonly used to delineate the location of the tumor bed during breast cancer ... more Titanium clips are commonly used to delineate the location of the tumor bed during breast cancer surgery. Electron beams are frequently used to boost radiation dose to the breast cavity. This research investigated the effect on such boost treatments as a result of metallic clip perturbation potentially exhibited through attenuation and scatter processes using measurements with Gafchromic film and treatment planning simulation with both generalized Gaussian pencil beam and electron Monte Carlo algorithms. Results showed that the potential effect of clip interference is unidentifiable from both algorithms. Dosimetry with Gafchromic external beam therapy film did detect dose perturbations caused by the titanium clips in proximal plane, 0.23 mm away, resulting in 3.0% backscatter and 2.4% attenuation at 6 MeV and 2.0% backscatter and 6.7% attenuation at 9 MeV. The noise contribution of the film scanner is estimated to be about 0.4% and nearly 2% uncertainty in film calibration. As a res...
Vascular access ports are used widely in the administering of drugs for radiation oncology patien... more Vascular access ports are used widely in the administering of drugs for radiation oncology patients. Their dosimetric effect on radiation therapy delivery in photon beams has not been rigorously established. In this work the effects on external beam fields when any of a variety of vascular access ports is included in the path of a high energy beam are studied. This medical physics study specifically identifies side-scatter and back-scatter consequences as well as attenuation effects. The study was divided into two parts: Firstly, a total of 18 ports underwent extended HU range CT scanning followed by 3-D computer treatment planning, where independent homogeneity and heterogeneity plans were created for photon beams of energy 6 MV and 18 MV using a Pencil Beam Convolution (PBC) algorithm. Dose points were analyzed at locations all around each device. A total of 1,440 points were reviewed in this section of the study. Secondly, a mock-up of the largest vascular access port was created in the treatment planning workspace for further investigation with alternative treatment planning algorithms. Plans were generated identically to the above and compared to the results of dose computation between the Pencil Beam Convolution algorithm, the Analytical Anisotropic Algorithm (AAA), and the EGSnrc Monte Carlo algorithm with user code DOSRZnrc (MC). A total of 300 points were reviewed in this part of the study. It was conclusive that ports with more bulky construction and those with partial metal composition create the largest changes. Similar effects are seen for similar port configurations. Considerable differences between the PBC and AAA in comparison to MC are noted and discussed. By thorough examination of planning system results, the presented vascular access ports may now be ranked according to the greatest amount of change exhibited within a treatment planning system. Effects of backscatter, lateral scatter and attenuation are up to 5.0%, 3.4% and 16.8% for 6 MV and 7.0%, 7.7% and 7.2% for 18 MV respectively.
Combining radiation therapy and direct intratumoral (IT) injection of adenoviral vectors has been... more Combining radiation therapy and direct intratumoral (IT) injection of adenoviral vectors has been explored as a means to enhance the therapeutic potential of gene transfer. A major challenge for gene transfer is systemic delivery of nucleic acids directly into an affected tissue. Ultrasound (US) contrast agents (microbubbles) are viable candidates to enhance targeted delivery of systemically administered genes. Here we show that p53, pRB, and p130 gene transfer mediated by US cavitation of microbubbles at the tumor site resulted in targeted gene transduction and increased reduction in tumor growth compared to DU-145 prostate cancer cell xenografts treated intratumorally with adenovirus (Ad) or radiation alone. Microbubble-assisted/US-mediated Ad.p53 and Ad.RB treated tumors showed significant reduction in tumor volume compared to Ad.p130 treated tumors (p<0.05). Additionally, US mediated microbubble delivery of p53 and RB combined with external beam radiation resulted in the most profound tumor reduction in DU-145 xenografted nude mice (p<0.05) compared to radiation alone. These findings highlight the potential therapeutic applications of this novel image-guided gene transfer technology in combination with external beam radiation for prostate cancer patients with therapy resistant disease.
Where no society-based or manufacturer guidance on radiation limits to neuromodulation devices is... more Where no society-based or manufacturer guidance on radiation limits to neuromodulation devices is available, this research provides the groundwork for neurosurgeons and radiation oncologists who rely on the computerized treatment plan clinically for cancer patients. The focus of the article is to characterize radiation parameters of attenuation and scatter when an incident therapeutic x-ray beam is directed upon them. At the time of this writing, manufacturers of Neuromodulation products do not recommend direct exposure of the device in the beam nor provide guidance for the maximum dose for these devices. Ten neuromodulation models were chosen to represent the finite class of devices marketed by Medtronic before 2011. CT simulations permitted computer treatment modeling for dose distribution analysis as used routinely in radiation oncology for patients. Phantom case results were directly compared to actual clinical patient cases. Radiation detection measurements were then correlated to computational results. Where the x-ray beam passes through the device and is attenuated, dose reduction was identified with Varian Eclipse computer modeling for these posterior locations. Although the computer algorithm did not identify physical processes of side-scatter and back-scatter, these phenomena were proven by radiation measurement to occur. In general, the computer results underestimated the level of change seen by measurement. For these implantable neurostimulators, the spread in dose changes were found to be -6.2% to -12.5% by attenuation, +1.7% to +3.8% by side-scatter, and +1.1% to +3.1% by back-scatter at 6 MV. At 18 MV, these findings were observed to be -1.4% to -7.0% by attenuation, +1.8% to 5.7% by side-scatter, and 0.8% to 2.7% by back-scatter. No pattern for the behavior of these phenomena was deduced to be a direct consequence of device size.
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Papers by Michael Gossman