Ann E. Wright

High dose rate intracoronary radiation for inhibition of neointimal formation in the stented and balloon-injured porcine models of restenosis : Angiographic, morphometric, and histopathologic analyses

PURPOSE We examined the effects of intracoronary irradiation delivered at a high dose rate on neointimal hyperplasia after injury induced by two methods: balloon overstretch injury, and stent implantation in a porcine model of coronary restenosis. METHODS AND MATERIALS In 34 Hanford miniature swine, a segment of each coronary artery was targeted for injury and treatment. The artery segments were treated with 192Ir at doses of 10 Gy over 4 min (eight animals), 15 Gy over 6 min (nine animals), 25 Gy over 10 min (nine animals) or control (simulation wire only; eight animals). The treated segments were subjected to stent implantation (left anterior descending and right coronary artery) or balloon overstretch (circumflex) injury. Twenty-eight days later, repeat coronary angiography and sacrifice were done. Quantitative coronary angiography, morphometry, and extensive histopathologic analyses were carried out in a blinded fashion. RESULTS The change in minimal lumen diameter from postinjury to presacrifice in the stent-injured left anterior descending was -0.79 +/- 0.34 (mean: +/- SD) mm in the control group, compared to -0.43 +/- 0.35 mm in the 15 Gy (p = 0.04) and -0.21 +/- 0.50 mm in the 25 Gy (p = 0.01) groups; and in the balloon-injured circumflex was -0.31 +/- 0.22 mm in the control group compared to -0.03 +/- 0.18 mm in the 10 Gy (p = 0.05) and 0.00 +/- 0.33 in the 15 Gy (p = 0.01) groups. Percent area stenosis in the left anterior descending was 36 +/- 9% in the control group compared to 18 +/- 12% in the 15 Gy (p = 0.003) and 11 +/- 11% in the 25 Gy (p < 0.001) groups; and in the circumflex was 16 +/- 10% in the control groups, compared to 5 +/- 5% in the 15 Gy (p = 0.02) and 2 +/- 2% in the 25 Gy (p = 0.009) groups. Histopathology showed a striking reduction in the amount of neointima in the irradiated arteries compared with control vessels. Other radiation effects were stromal fibrin exudate, thinning of the media, and adventitial fibrosis and leukocyte infiltration in the radiated arterial segments. CONCLUSIONS High dose rate intracoronary irradiation with 192Ir effectively inhibits intimal proliferation after stent-induced as well as balloon-overstretch injury. This shorter treatment time (4 to 10 min) may provide a clinically practical approach to the prevention of restenosis after angioplasty.

Experience with fast neutron therapy for unresectable carcinoma of the pancreas.

The records of 70 patients with adenocarcinoma of the pancreas treated with radiotherapy were reviewed. Fifteen were treated with 50-MeVd→Be neutrons or a combination of 50-MeVd→Be neutrons and 25–32 MeV photons (neutron group), 30 with external beam photons alone (photon group) and 25 with radioactive gold-grain implantation (198Au-implant group). The 12-month survival rate was 40 % (615) for the neutron group; three patients in this group were living at the time of analysis, 16, 19, and 42 months from the date of diagnosis. By comparison, the 12-month survival rate was 2396 (7/30) for the photon group mad 32% (825) for the 198Au-implant group. The actuarial survival curve for the neutron group was significantly better than the survival curve for the pboton group (Wilcoxon test7: p = .03). Altbough the difference between the survival curves for the neutron and 198Au-implant groups is not statistically significant, the neutron patients presented more advanced disease than those treated with radioactive gold-grain implants. No radiotherapy complications were observed in the neutron group, whereas 396 (130) of patients in the photon group and 2496 (625) of patients in the 198Au-implant group developed major complications.

Silicon diode detectors used in radiological physics measurements. Part I: Development of an energy compensating shield.

Silicon diode detectors have the advantages of high resolution, large signal, and fast response, but lack the flat energy response of the Farmer ion chamber. A study was undertaken to develop a compensating shield for a diode which would make it suitable for use in the spectrum of energies produced by a high-energy radiation beam at depth in a phantom. The energy response of the unshielded diode was quantitated over a range of energies from 18.5 keV to 8 MeV. Shields of different thickness, density, and design were tested experimentally. A partial shield of high-Z material over a diode with miniaturized contacts produced a probe which duplicated the relative dose measurements of the Farmer chamber with less than 1% variation. Typical central axis depth-dose curves and a beam profile, measured with the chamber and the shielded and unshielded probe, are illustrated.

Silicon diode detectors used in radiological physics measurements. Part II. Measurement of dosimetry data for high-energy photons

Initial calibration of a linear accelerator requires physics instruments to measure accurately central axis depth-dose and off-axis data, both in and out of the beam. These data for an 8- MeV unit were first measured using film, a Farmer 0.6-cm3 ion chamber, a 0.3-cm3 ion chamber, and a 0.1-cm3 silicon diode. Both small probes and film gave a high response compared to the Farmer probe, which has a uniform energy response. Measurements with the diode interfaced to an X-Y recorder required only a fraction of the time required with the chambers, minimizing error due to change in machine output, and permitted resolution of isodose lines in the penumbra. However, corrections required at points in depth due to nonuniform energy response of the unshielded diode were laborious. Construction of a partially shielded diode which duplicates the response of the Farmer probe eliminated the necessity for corrections, permitting rapid accumulation of a wide range of depth-dose and off-axis data.

Comparison of moving‐strip therapy using a Cobalt‐60 teletherapy unit, a Varian 4‐MV linear accelerator, and a Varian 10‐MV linear accelerator

Cobalt-60 gamma rays and 4- and 10-MV x rays are compared for moving-strip therapy in terms of the dose uniformity and the given dose needed to deliver a prescribed tumor dose. Dose distributions in phantoms of 14--32-cm thickness were calculated for each therapy unit. Individual given doses which would deliver the most uniform dose along the midline of the treatment volume were determined by computer and were verified experimentally by thermoluminescent dosimetry. Using computer optimization techniques, the midplane dose uniformity is improved significantly for the three therapy units considered.