I. Clairand

Small fields output factors measurements and correction factors determination for several detectors for a CyberKnife® and linear accelerators equipped with microMLC and circular cones.

PURPOSE The use of small photon fields is now an established practice in stereotactic radiosurgery and radiotherapy. However, due to a lack of lateral electron equilibrium and high dose gradients, it is difficult to accurately measure the dosimetric quantities required for the commissioning of such systems. Moreover, there is still no metrological dosimetric reference for this kind of beam today. In this context, the first objective of this work was to determine and to compare small fields output factors (OF) measured with different types of active detectors and passive dosimeters for three types of facilities: a CyberKnife(®) system, a dedicated medical linear accelerator (Novalis) equipped with m3 microMLC and circular cones, and an adaptive medical linear accelerator (Clinac 2100) equipped with an additional m3 microMLC. The second one was to determine the kQclin,Qmsr (fclin,fmsr) correction factors introduced in a recently proposed small field dosimetry formalism for different active detectors. METHODS Small field sizes were defined either by microMLC down to 6 × 6 mm(2) or by circular cones down to 4 mm in diameter. OF measurements were performed with several commercially available active detectors dedicated to measurements in small fields (high resolution diodes: IBA SFD, Sun Nuclear EDGE, PTW 60016, PTW 60017; ionizing chambers: PTW 31014 PinPoint chamber, PTW 31018 microLion liquid chamber, and PTW 60003 natural diamond). Two types of passive dosimeters were used: LiF microcubes and EBT2 radiochromic films. RESULTS Significant differences between the results obtained by several dosimetric systems were observed, particularly for the smallest field size for which the difference in the measured OF reaches more than 20%. For passive dosimeters, an excellent agreement was observed (better than 2%) between EBT2 and LiF microcubes for all OF measurements. Moreover, it has been shown that these passive dosimeters do not require correction factors and can then be used as reference dosimeters. Correction factors for the active detectors have then been determined from the mean experimental OF measured by the passive dosimeters. CONCLUSIONS Four sets of correction factors needed to apply the new small field dosimetry formalism are provided for several active detectors. A protocol for small photon beams OF determination based on passive dosimeters measurements has been recently proposed to French radiotherapy treatment centers.

Lessons from recent accidents in radiation therapy in France

Many accidents in radiotherapy have been reported in France over the last years. This is due to the recent legal obligation to declare to the national safety authorities any significant incident relative to the use of ionising radiation including medical applications. The causes and consequences of the most serious events in radiotherapy are presented in this paper. Lessons can be learned from possible technical dysfunctions, from human errors or organisational weaknesses as to how such events can be prevented. The technical aspects are addressed here: in particular, dosimetric issues.

New emerging concepts in the medical management of local radiation injury.

Treatment of severe radiation burns remains a difficult medical challenge. The response of the skin to ionizing radiation results in a range of clinical manifestations. The most severe manifestations are highly invalidating. Although several therapeutic strategies (excision, skin grafting, skin or muscle flaps) have been used with some success, none have proven entirely satisfying. The concept that stem cell injections could be used for reducing normal tissue injury has been discussed for a number of years. Mesenchymal stem cells therapy may be a promising therapeutic approach for improving radiation-induced skin and muscle damages. Pre-clinical and clinical benefit of mesenchymal stem cell injection for ulcerated skin and muscle restoration after high dose radiation exposure has been successfully demonstrated. Three first patients suffering from severe radiological syndrome were successfully treated in France based on autologous human grade mesenchymal stem cell injection combined to plastic surgery or skin graft. Stem cell therapy has to be improved to the point that hospitals can put safe, efficient, and reliable clinical protocols into practice.

Radiation Accident Dosimetry On Glass By Tl And Epr Spectrometry

Retrospective dosimetry using glass has been investigated. Radiation-induced signals have been surveyed for a large number of watch glasses and display windows of mobile phones with TL and EPR techniques in order to study the variability of dosimetric properties among the different types of samples. Dose response, signal stability, and effects of storage conditions are presented.

A correlation study of eye lens dose and personal dose equivalent for interventional cardiologists.

This paper presents the dosimetry part of the European ELDO project, funded by the DoReMi Network of Excellence, in which a method was developed to estimate cumulative eye lens doses for past practices based on personal dose equivalent values, H(p)(10), measured above the lead apron at several positions at the collar, chest and waist levels. Measurement campaigns on anthropomorphic phantoms were carried out in typical interventional settings considering different tube projections and configurations, beam energies and filtration, operator positions and access routes and using both mono-tube and biplane X-ray systems. Measurements showed that eye lens dose correlates best with H(p)(10) measured on the left side of the phantom at the level of the collar, although this correlation implicates high spreads (41 %). Nonetheless, for retrospective dose assessment, H(p)(10) records are often the only option for eye dose estimates and the typically used chest left whole-body dose measurement remains useful.

Radiation accident dosimetry on electronic components by OSL.

In the event of large-scale radiation accidents and considering a growing terrorism concern, non-invasive and sufficiently accurate retrospective dosimetry methods are necessary to carry out a fast population triage in order to determine which radiation-exposed individuals need medical treatment. Retrospective dosimetry using different electronic components such as resistors, capacitors, and integrated circuits present on mobile phone circuit boards have been considered. Their response has been investigated with luminescence techniques (OSL, IRSL, and TL). The majority of these electronic components exhibit radiation-induced luminescence signals, and the OSL technique seems the most promising for these materials. Results concerning three types of components that present the most interesting OSL characteristics (in terms of signal annealing and sensitivity) and that are the most often present on mobile phone circuit boards are presented. Preheating effects on OSL signal, sensitization, and dose-response curves from 0.7 to 27 Gy for resistors and from 0.7 to 160 Gy for capacitors and integrated circuits, dose recovery tests, and signal stability 10 h after irradiation have been studied and interests and limits of their use evaluated.

Overview of physical and biophysical techniques for accident dosimetry

From feedback experience from recent radiation accident cases, in addition to biological dosimetry and physical dosimetry based on Monte Carlo calculations or experimental means, there is a need for complementary methods of dosimetry for radiation accident. Electron paramagnetic resonance (EPR) spectrometry on bones or teeth is considered as efficient but is limited by the invasive character of the sampling. Since 2005, Institute for Radiological Protection and Nuclear Safety (IRSN) develops some new approaches and methodologies based on the EPR and luminescence techniques. This article presents the overview of the different studies currently in progress in IRSN.

Intercomparison of active personal dosemeters in interventional radiology

The use of active personal dosemeters (APD) in interventional radiology was evaluated by Working Group 9 (Radiation protection dosimetry of medical staff) of the CONRAD project, which is a Coordination Action supported by the European Commission within its sixth Framework Programme. Interventional radiology procedures can be very complex and they can lead to relatively high doses to personnel who stand close to the primary radiation field and are mostly exposed to radiation scattered by the patient. For the adequate dosimetry of the scattered photons, APDs must be able to respond to low-energy [10-100 keV] and pulsed radiation with relatively high instantaneous dose rates. An intercomparison of five APD models deemed suitable for application in interventional radiology was organised in March 2007. The intercomparison used pulsed and continuous radiation beams, at CEA-LIST (Saclay, France) and IRSN (Fontenay-aux-Roses, France), respectively. A specific configuration, close to the clinical practice, was considered. The reference dose, in terms of Hp(10), was derived from air kerma measurements and from the measured and calculated energy distributions of the scattered radiation field. Additional Monte Carlo calculations were performed to investigate the energy spectra for different experimental conditions of the intercomparison. The results of this intercomparison are presented in this work and indicate which APDs are able to provide a correct response when used in the specific low-energy spectra and dose rates of pulsed X-rays encountered in interventional radiology.

Application of Autologous Hematopoietic Cell Therapy to a Nonhuman Primate Model of Heterogeneous High-Dose Irradiation

Abstract Bertho, J-M., Prat, M., Frick, J., Demarquay, C., Gaugler, M-H., Dudoignon, N., Clairand, I., Chapel, A., Gorin, N-C., Thierry, D. and Gourmelon, P. Application of Autologous Hematopoietic Cell Therapy to a Nonhuman Primate Model of Heterogeneous High-Dose Irradiation. Radiat. Res. 163, 557– 570 (2005). We developed a model of heterogeneous irradiation in a nonhuman primate to test the feasibility of autologous hematopoietic cell therapy for the treatment of radiation accident victims. Animals were irradiated either with 8 Gy to the body with the right arm shielded to obtain 3.4 Gy irradiation or with 10 Gy total body and 4.4 Gy to the arm. Bone marrow mononuclear cells were harvested either before irradiation or after irradiation from an underexposed area of the arm and were expanded in previously defined culture conditions. We showed that hematopoietic cells harvested after irradiation were able to expand and to engraft when reinjected 7 days after irradiation. Recovery was observed in all 8-Gy-irradiated animals, and evidence for a partial recovery was observed in 10-Gy-irradiated animals. However, in 10-Gy-irradiated animals, digestive disease was observed from day 16 and resulted in the death of two animals. Immunohistological examinations showed damage to the intestine, lungs, liver and kidneys and suggested radiation damage to endothelial cells. Overall, our results provide evidence that such an in vivo model of heterogeneous irradiation may be representative of accidental radiation exposures and may help to define the efficacy of therapeutic interventions such as autologous cell therapy in radiation accident victims.

Monte Carlo modeling of proton therapy installations: a global experimental method to validate secondary neutron dose calculations

Monte Carlo calculations are increasingly used to assess stray radiation dose to healthy organs of proton therapy patients and estimate the risk of secondary cancer. Among the secondary particles, neutrons are of primary concern due to their high relative biological effectiveness. The validation of Monte Carlo simulations for out-of-field neutron doses remains however a major challenge to the community. Therefore this work focused on developing a global experimental approach to test the reliability of the MCNPX models of two proton therapy installations operating at 75 and 178 MeV for ocular and intracranial tumor treatments, respectively. The method consists of comparing Monte Carlo calculations against experimental measurements of: (a) neutron spectrometry inside the treatment room, (b) neutron ambient dose equivalent at several points within the treatment room, (c) secondary organ-specific neutron doses inside the Rando-Alderson anthropomorphic phantom. Results have proven that Monte Carlo models correctly reproduce secondary neutrons within the two proton therapy treatment rooms. Sensitive differences between experimental measurements and simulations were nonetheless observed especially with the highest beam energy. The study demonstrated the need for improved measurement tools, especially at the high neutron energy range, and more accurate physical models and cross sections within the Monte Carlo code to correctly assess secondary neutron doses in proton therapy applications.