Hatice Bilge

Surface dose measurements with GafChromic EBT film for 6 and 18 MV photon beams

The aim of this study was to determine the surface doses using GafChromic EBT films and compare them with plane-parallel ionization chamber measurements for 6 and 18 MV high energy photon beams. The measurements were made in a water equivalent solid phantom in the build-up region of the 6 and 18MV photon beams at 100 cm SSD for various field sizes. Markus type plane-parallel ion chamber with fixed-separation between collecting electrodes was used to measure the percent depth doses. GafChromic EBT film measurements were performed both on the phantom surface and maximum dose depth at the same geometry with ion chamber measurements. The surface doses found using GafChromic EBT film were 15%, 20%, 29%and 39%+/-2% (1SD) for 6 MV photons, 6%, 11%, 23% and 32%+/-2% (1SD) for 18 MV photons at 5, 10, 20 and 30 cm(2) field sizes, respectively. GafChromic EBT film provides precise measurements for surface dose in the high energy photons. Agreement between film and plane-parallel chamber measurements was found to be within +/-3% for 18 MV photon beams. There was 5% overestimate on the surface doses when compared with the plane-parallel chamber measurements for all field sizes in the 6 MV photon beams.

Gamma Knife 3-D dose distribution near the area of tissue inhomogeneities by normoxic gel dosimetry

The accuracy of the Leksell GammaPlan, the dose planning system of the Gamma Knife Model-B, was evaluated near tissue inhomogeneities, using the gel dosimetry method. The lack of electronic equilibrium around the small-diameter gamma beams can cause dose calculation errors in the neighborhood of an air-tissue interface. An experiment was designed to investigate the effects of inhomogeneity near the paranosal sinuses cavities. The homogeneous phantom was a spherical glass balloon of 16 cm diameter, filled with MAGIC gel; i.e., the normoxic polymer gel. Two hollow PVC balls of 2 cm radius, filled with N2 gas, represented the air cavities inside the inhomogeneous phantom. For dose calibration purposes, 100 ml gel-containing vials were irradiated at predefined doses, and then scanned in a MR unit. Linearity was observed between the delivered dose and the reciprocal of the T2 relaxation time constant of the gel. Dose distributions are the results of a single shot of irradiation, obtained by collimating all 201 cobalt sources to a known target in the phantom. Both phantoms were irradiated at the same dose level at the same coordinates. Stereotactic frames and fiducial markers were attached to the phantoms prior to MR scanning. The dose distribution predicted by the Gamma Knife planning system was compared with that of the gel dosimetry. As expected, for the homogeneous phantom the isodose diameters measured by the gel dosimetry and the GammaPlan differed by 5% at most. However, with the inhomogeneous phantom, the dose maps in the axial, coronal and sagittal planes were spatially different. The diameters of the 50% isodose curves differed 43% in the X axis and 32% in the Y axis for the Z =90 mm axial plane; by 44% in the X axis and 24% in the Z axis for the Y=90 mm coronal plane; and by 32% in the Z axis and 42% in the Y axis for the X=92 mm sagittal plane. The lack of ability of the GammaPlan to predict the rapid dose fall off, due to the air cavities behind or near the lesion led to an overestimation of the dose that was actually delivered. Clinically, this can result in underdosing of lesions near tissue inhomogeneities in patients under treatment.

Bone healing regulated by nitric oxide: an experimental study in rats.

Nitric oxide has many functions in wound healing and metabolism of bone. In the current study the role of nitric oxide on bone healing was investigated. Thirty-six young adult male Sprague-Dawley rats were divided into three groups: control, nitroso-bovine serum albumin, and aminoguanidine. Five millimeter segmental defects were created in the middle of the right femora. A polyethylene plate and screw posts were used for rigid fixation. Demineralized bone matrix served as the graft material in all groups. Nitroso-bovine serum albumin (an active nitric oxide congener) carried by demineralized bone matrix was applied locally at the defect in the nitroso-bovine serum albumin group. Aminoguanidine (an inducible nitric oxide synthase inhibitor) group received oral aminoguanidine treatment. Formation and healing of bone were determined by radiographic and histologic analyses. In comparison to the control group the healing rate was faster in both experimental groups as indicated by radiographic and histologic data. If accompanied by bone graft with a suitable delivery system, nitric oxide may be useful as a therapeutic adjuvant in clinical situations when local formation of bone is needed. Moreover, when combined appropriately, treatment with orthotopic nitric oxide supplementation and systemic inducible nitric oxide synthase inhibition may enhance bone healing.

The Efficacy of Octreotide in Pancreatic and Intestinal Changes: Radiation-Induced Enteritis in Animals

Radiation enteritis occurs during the radiotherapy of many intraabdominal malignancies. Radiation induces cellular injury directly and through the generation of free radicals. In the present study we aimed to investigate the effect of octreotide (OCT) pretreatment in irradiation-induced enteritis. For this aim, rats were injected with 50 μg/kg OCT 4 days before irradiation and continued for 3 more days, until sacrifice. Then intestinal and pancreatic myeloperoxidase (MPO) activities and intestinal malondialdehyde (MDA) levels of the rats were measured. Irradiation significantly increased intestinal and pancreatic MPO activities and MDA levels of intestinal tissues in comparison to those of the sham group. OCT treatment improved this elevation. The histopathologic evaluation of the mucosal structure was also preserved in the OCT-treated group. Inflammation of pancreatic tissue was also confirmed with histopathological examinations. In the irradiation group, NFκ-B overexpression was detected. OCT treatment decreased the end organ damage and inflammation of the small intestine. In conclusion, OCT appears to have beneficial effects on intestinal and pancreatic damage in abdominal irradiation through the inflammatory process.

Surface dose and build-up region measurements with wedge filters for 6 and 18 MV photon beams

PurposeHigh-energy photons are most commonly used in radiotherapy to treat cancer. Wedge filters are required to obtain homogeneous dose distribution in the patient. Different wedge filter types create different surface doses. In this study, the effect of the virtual and physical wedge filters on the surface and build-up region doses was examined for 6- and 18-MV high-energy photon beams.Materials and methodsThe measurements were made in a water equivalent phantom in the build-up region at a 100-cm source-to-surface distance for various field sizes using virtual and physical wedge filters having different angles. A parallel-plate ion chamber was used to measure the percent depth doses.ResultsThe percentage dose at the surface increased as the field size increased for open, virtual, and physical wedged beams. For open, physical, and virtual wedged beams, the surface doses were found to be 15.4%, 9.9%, and 15.9% with 6-MV photons and 10.6%, 8.8%, 11.9% with 18-MV photons, respectively, at 10 × 10 cm2 field size.ConclusionBuild-up doses of virtual wedged beams were similar to those of open beams. Surface and buildup doses of physical wedged beams were lower than those of open and virtual wedged beams.

Heme Oxygenase Induction Protects Liver Against Oxidative Stress in X-Irradiated Aged Rats

We studied the effect of total body X-ray irradiation on the heme oxygenase-1 (HO-1) induction in the livers of young and aged rats. For this purpose, male rats were irradiated with a dose of 17 Gy. The animals were killed 5 h after irradiation. HO-1 protein expression was found to be increased two fold in aged rat liver, but lipid peroxide levels had decreased significantly where no change was observed either in inducible nitric oxide synthase protein expression or in glutathione levels. Contradictory results with respect to HO-1 and lipid peroxidation levels were obtained in the livers of young animals. These results suggest that the additional oxidative stress produced in irradiated rats may be compensated by HO-1 induction as decreased lipid peroxide levels were shown in the livers of aged animals.

The Effect of Oblique Electron Beams to the Surface Dose Under the Bolus

The aim of this study is to determine the effect of bolus to the surface dose in oblique electron incidences. Irradiations with 4.5, 6, 7.5, 9, and 12-MeV electron beams were made for the incidence angles of 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees, 75 degrees and using 3 different bolus setups: (1) unbolused (no bolus), (2) 5-mm bolus, and (3) 10-mm bolus. A set of EBT gafchromic film pieces placed on the phantom surface was irradiated with a 400-cGy dose at D(max) for each setup. Whereas surface dose increased with increasing incidence degrees in the absence of a bolus, it was seen that there was a large surface dose decreasing in the presence of a bolus with increasing incidence angles. For 60 degrees incidence angle, the relative surface doses with unbolused setup were: 88.10%, 90.06%, 89.35%, 90.25%, and 97.10%; with 5-mm bolus: 66.45%, 81.20%, 99.78%, 124.43%, and 116.07%; and with 10-mm bolus: 22.65%, 45.20%, 55.20%, 65.82%, and 90.27% for 4.5, 6, 7.5, 9, and 12 MeV, respectively. The use of bolus in the treatment of highly oblique surfaces with low-energy electron beams significantly decreases the surface dose.

Investigation of conformal and intensity-modulated radiation therapy techniques to determine the absorbed fetal dose in pregnant patients with breast cancer.

The aim of this research was to investigate the fetal doses of pregnant patients undergoing conformal radiotherapy or intensity-modulated radiation therapy (IMRT) for breast cancers. An Alderson Rando phantom was chosen to simulate a pregnant patient with breast cancer who is receiving radiation therapy. This phantom was irradiated using the Varian Clinac DBX 600 system (Varian Medical System, Palo Alto, CA) linear accelerator, according to the standard treatment plans of both three-dimensional conformal radiation therapy (3-D CRT) and IMRT techniques. Thermoluminescent dosimeters were used to measure the irradiated phantom׳s virtually designated uterus area. Thermoluminescent dosimeter measurements (in the phantom) revealed that the mean cumulative fetal dose for 3-D CRT is 1.39cGy and for IMRT it is 8.48cGy, for a pregnant breast cancer woman who received radiation treatment of 50Gy. The fetal dose was confirmed to increase by 70% for 3-D CRT and 40% for IMRT, if it is closer to the irradiated field by 5cm. The mean fetal dose from 3-D CRT is 1.39cGy and IMRT is 8.48cGy, consistent with theoretic calculations. The IMRT technique causes the fetal dose to be 5 times more than that of 3-D CRT. Theoretic knowledge concerning the increase in the peripheral doses as the measurements approached the beam was also practically proven.

An investigation of the dose distribution effect related with collimator angle in volumetric arc therapy of prostate cancer

To investigate the dose-volume variations of planning target volume (PTV) and organ at risks (OARs) in eleven prostate cancer patients planned with single and double arc volumetric modulated arc therapy (VMAT) when varying collimator angle. Single and double arc VMAT treatment plans were created using Monaco5.0® with collimator angle set to 0°. All plans were normalized 7600 cGy dose to the 95% of clinical target volume (CTV) volume. The single arc VMAT plans were reoptimized with different collimator angles (0°, 15°, 30°, 45°, 60°, 75°, and 90°), and for double arc VMAT plans (0–0°, 15°–345, 30–330°, 45–315°, 60–300°, 75–285°, 90–270°) using the same optimization parameters. For the comparison the parameters of heterogeneity index (HI), dose-volume histogram and minimum dose to the 95% of PTV volume (D95 PTV) calculated and analyzed. The best plans were verified using 2 dimensional ion chamber array IBA Matrixx® and three-dimensional IBA Compass® program. The comparison between calculation and measurement were made by the γ-index (3%/3 mm) analysis. A higher D95 (PTV) were found for single arc VMAT with 15° collimator angle. For double arc, VMAT with 60–300° and 75–285° collimator angles. However, lower rectum doses obtained for 75–285° collimator angles. There was no significant dose difference, based on other OARs which are bladder and femur head. When we compared single and double arc VMATs D95 (PTV), we determined 2.44% high coverage and lower HI with double arc VMAT. All plans passed the γ-index (3%/3 mm) analysis with more than 97% of the points and we had an average γ-index for CTV 0.36, for PTV 0.32 with double arc VMAT. These results were significant by Wilcoxon signed rank test statistically. The results show that dose coverage of target and OARs doses also depend significantly on the collimator angles due to the geometry of target and OARs. Based on the results we have decided to plan prostate cancer patients in our clinic with double arc VMAT and 75°–285° collimator angles.

The peripheral dose outside the applicator in electron beams of Oncor linear accelerator

In this study, the peripheral dose outside the applicator was measured using electron beams produced by an Oncor linear accelerator and compared with the data of the treatment planning system (TPS). The dose profiles have been measured, by using a water-equivalent slab phantom and a parallel plate ionisation chamber, at 6, 9 and 15 MeV energy levels in 5×5, 10×10, 15×15, 20×20 and 25×25 cm(2) applicators and at 0, 10 and 20° gantry angles; and at the surface, 0.2, 0.5, 1 cm and d(max) depth for each electron energy level. The peripheral dose has been determined with these profiles by normalisation at the field central beam axis (CAX). It has been noticed that, using a 10×10 cm(2) applicator, there is a 1.4 % dose peak on the surface 6 cm away from the field edge where the field CAX is at 100 %, at a gantry angle of 0° with 6 and 9 MeV electron beams; also for the 15 MeV electron beam there is a 2.3 % dose peak. It has been discovered that the peak dose approaches a minimum depending on the increase in depth and reaches 2.5-4 % depending on the growth of the field dimension. At gantry angles of 10 and 20°, 6 and 9 MeV electron beams created small peaks and a maximum dose could be reached at 0.2 and 1 cm depth. Electron beam of 15 MeV did not peak at depths of 0.2 and 1 cm at gantry angles of 10 and 20°. The measured peripheral dose outside the applicators has been compared with the data from a TPSs computer using the Pencil Beam algorithm; it has been stated that dose calculations can be made as far as 3 cm outside the field. In conclusion, the TPS is not sufficient to measure the peripheral dose outside the applicators, and this dose can only be determined by direct measurement.