Systematic analysis and modeling of the FLASH sparing effect as a function of dose and dose rate

Ultrahigh-dose-rate radiotherapy(FLASH-RT)is a revolutionary radiotherapy technology that can spare normal tissues without compromising tumor control.Although qualitative experimental results have been reported,quantitative and systematic analysis of data is necessary.Particularly,the FLASH effect response model to the dose or dose rate is still unclear.This study investigated the relationships between the FLASH effect and experimental parameters,such as dose,dose rate,and other factors by analyzing published in vivo experimental data from animal models.The data were modeled based on logistic regression analysis using the sigmoid function.The model was evaluated using prediction accuracy,receiver operating characteristic(ROC)curve,and area under the ROC curve.Results showed that the FLASH effect was closely related to the dose,mean dose rate,tissue type,and corresponding biological endpoints.The dose rate corresponding to a 50% probability of triggering cognitive protection in the brain was 45 Gy s^(-1).The dose rate corresponding to a 50% probability of triggering intestinal crypt survival and regeneration was 140 Gy s^(-1).For the skin toxicity effect,the dose corresponding to a 50% probability of triggering the FLASH effect was 24 Gy.This study helps to characterize the conditions underlying the FLASH effect and provides important information for optimizing experiments.

Effect of ionizing radiation on dual 8-bit analog-to-digital converters (AD9058) with various dose rates and bias conditions

The radiation effects on several properties （reference voltage, digital output logic voltage, and supply current） of dual 8-bit analog-to-digital （A/D） converters （AD9058） under various biased conditions are investigated in this paper. Gamma ray and 10-MeV proton irradiation are selected for a detailed evaluation and comparison. Based on the measurement results induced by the gamma ray with various dose rates, the devices exhibit enhanced low dose rate sensitivity （ELDRS） under zero and working bias conditions. Meanwhile, it is obvious that the ELDRS is more severe under the working bias condition than under the zero bias condition. The degradation of AD9058 does not display obvious ELDRS during 10-MeV proton irradiation with the selected flux.

Relationship between Patient-Dependent Parameters and Radiation Dose Rates Measured around Patients Undergoing PET/CT Imaging Using ¹⁸F-FDG

Objectives: Patients undergoing 18F-FDG PET/CT imaging are considered external radiation sources. Accurate dose rate estimates are important for conducting realistic risk assessments and performing dose reconstruction in cases of accidental exposures. The patient radiation self-attenuation factor is assumed to be a function of the patient’s body size metrics, but we can use these metrics to predict the dose rate around the patients with accuracy. The objective of this work was first to measure the patient attenuation factor by performing direct dose rate measurements from patients undergoing PET/CT imaging studies using 18F-FDG. The second objective was to study the possible correlation between the measured dose rate constant per unit activity from the patients and their body size metrics;five metrics were tested in this work. The last objective was to measure the patients’ voiding factor. Methods: We have measured dose rates at one meter from 57 patients and noted the patient’s height (H), weight (W) and calculated patient size metrics namely: Equivalent Cylindrical Diameter (ECD), Equivalent Spherical Diameter (ESD) and the Body Mass Index (BMI). Results: The measured average dose rate was 92.2 ± 14 μSv·h-1·GBq-1 measured at one meter. Therefore, the dose rate constant of 92 μSv·h-1·GBq-1 proposed by the AAPM, TG-108 report is adequate for radiation protection purposes. There was no statistically significant correlation between the dose rate constant per unit activity and the patient body size metrics. We have measured a patient voiding factor of 0.89 ± 0.06 in comparison with 0.85 recommended by the AAPM. Conclusions: The presented data can be used by medical physicist working in nuclear medicine in formulating more accurate risk estimations resulting from radiation exposure from patients undergoing 18F-FDG PET/CT imaging.

An Accelerated Simulation Method for ELDRS of Bipolar Operational Amplifiers Using a Dose-Rate Switching Experiment

Through different dose-rate switching evaluation methods,the radiation-response rules of operational amplifiers are studied when the irradiation dose rate is switched from high to low under different radiation temperatures and total doses. The experimental results indicate that the response characteristics could be affected by the switching total doses, irradiation temperatures,and dose rates individually or together. Accelerated evaluation on the ELDRS can be realized by adopting a proper dose-rate switching method. Meanwhile, the irradiation time can also be reduced. Finally, the mechanisms of the difference between various radiation responses are analyzed.

High-dose-rate intraluminal brachytherapy during preoperative chemoradiation for locally advanced rectal cancers

AIM:To determine the feasibility and safety of high dose rate intraluminal brachytherapy(HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.METHODS:Between 2008 and 2009,thirty-six patients with locally advanced rectal cancer(≥ T3 or N+),were treated initially with concurrent capecitabine(825 mg/m2 oral twice daily) and pelvic external beam radiotherapy(EBRT)(45 Gy in 25 fractions),then were randomized to group A;HDR-ILBT group(n = 17) to receive 5.5-7 Gy×2 to gross tumor volume(GTV) and group B;EBRT group(n = 19) to receive 5.4 Gy×3 fractions to GTV with EBRT.All patients underwent total mesorectal excision.RESULTS:Grade 3 acute toxicities were registered in 12 patients(70.6%) in group A and in 8(42.1%) in group B.Complete pathologic response of T stage(ypT0) in group A was registered in 10 patients(58.8%) and in group B,3 patients(15.8%) had ypT0(P < 0.0001).Sphincter preservation was reported in 6/9 patients(66.7%) in group A and in 5/10 patients(50%) in group B(P < 0.01).Overall radiological response was 68.15% and 66.04% in Group A and B,respectively.During a median follow up of 18 mo,late grade 1 and 2 sequelae were registered in 3 patients(17.6%) and 4 patients(21.1%) in the groups A and B,respectively.CONCLUSION:HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers,with higher response rates,downstaging and with manageable acute toxicities.

Dose-volume parameters and clinical outcome of CT-guided free-hand high-dose-rate interstitial brachytherapy for cervical cancer

Currently, image-based 3-dimentional (3D) planning brachytherapy allows for a better assessment of gross tumor volume (GTV) and the definition and delineation of target volume in cervix cancer. In this study, we investigated the feasibility of our novel computed tomography (CT)-guided free-hand high-dose- rate interstitial brachytherapy (HDRISBT) technique for cervical cancer by evaluating the dosimetry and preliminary clinical outcome of this approach. Dose-volume histogram (DVH) parameters were analyzed according to the Gynecological GEC-ESTRO Working Group recommendations for image-based 3D treatment in cervical cancer. Twenty cervical cancer patients who underwent CT-guided free-hand HDRISBT between March 2009 and June 2010 were studied. With a median of 5 (range, 4-7) implanted needles for each patient, the median dose of brachytherapy alone delivered to 90% of the target volume (D90 ) was 45 (range, 33-54) Gyα/β10 for high-risk clinical target volume (HR-CTV) and 30 (range, 20-36) Gyα/β10 for intermediate-risk clinical target volume (IR-CTV). The percentage of the CTV covered by the prescribed dose (V100 ) of HR-CTV with brachytherapy alone was 81.9%-99.2% (median, 96.7%). With an additional dose of external beam radiotherapy (EBRT), the median D90 was 94 (range, 83-104) Gyα/β10 for HR-CTV and 77 (range, 70 -87) Gyα/β10 for IR-CTV; the median dose delivered to 100% of the target volume (D100 ) was 75 (range, 66-84) Gyα/β10 for HR-CTV and 65 (range, 57-73) Gyα/β10 for IR-CTV. The minimum dose to the most irradiated 2 cc volume (D2cc ) was 73-96 (median, 83) Gyα/β3 for the bladder, 64-98 (median, 73) Gyα/β3 for the rectum, and 52-69 (median, 61) Gyα/β3 for the sigmoid colon. After a median follow-up of 15 months (range, 3 -24 months), two patients experienced local failure, and 1 showed internal iliac nodal metastasis. Despite the relatively small number of needles used, CT-guided HDRISBT for cervical cancer showed favorable DVH parameters and clinical outcome.

Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.

Study of the External Dose Rate and Retained Body Activity of Patients with Hyperthyroidism Who Are Receiving Ⅰ-131 Therapy

Hyperthyroidism refers to a clinical state that results from inappropriately hight hyroid hormone levels in the tissues;.Ⅰ-131 therapy plays a critical role and provides a remarkable curative effect in targeting thyroid diseases. Thyroid cells can take up isotope I-131, which emits not only beta rays but also

Calibration of a neutron dose rate meter in various neutron standard fields

This paper presents the calibration of a neutron dose rate meter and the evaluation of its calibration factors(CFs)in several neutron standard fields(i.e.,two standard fields with bare sources of252Cf and241Am-Be,and five simulated workplace fields with241Am-Be moderated sources).The calibration in standard fields with bare sources was conducted by following the recommendations of the ISO 8529 standard.The measured total neutron ambient dose equivalent rates,denoted as H*(10)tot,were analyzed to obtain direct components,denoted as H*(10)dir,using a reduced fitting method.The CF was then calculated as the ratio between the conventional true value of the neutron ambient dose equivalent rate in a free field,denoted as H*(10)FF,and the value of H*(10)dir.In contrast,in the simulated workplace neutron fields,the calibration of the neutron dose rate meter was conducted by following the ISO 12789 standard.The CF was calculated as the ratio between the values of H*(10)totmeasured by a standard instrument(i.e.,Bonner sphere spectrometer)and the neutron dose rate meter.The CF values were obtained in the range of 0.88–1.0.The standard uncertainties(k=1)of the CFs were determined to be in the range of approximately 6.6–13.1%.

Estimation of enhanced low dose rate sensitivity mechanisms using temperature switching irradiation on gate-controlled lateral PNP transistor

The mechanisms occurring when the switched temperature technique is applied,as an accelerated enhanced low dose rate sensitivity(ELDRS)test technique,are investigated in terms of a specially designed gate-controlled lateral PNP transistor(GLPNP)that used to extract the interface traps(Nit)and oxide trapped charges(Not).Electrical characteristics in GLPNP transistors induced by ^(60)Co gamma irradiation are measured in situ as a function of total dose,showing that generation of Nit in the oxide is the primary cause of base current variations for the GLPNP.Based on the analysis of the variations of Nit and Not,with switching the temperature,the properties of accelerated protons release and suppressed protons loss play critical roles in determining the increased Nit formation leading to the base current degradation with dose accumulation.Simultaneously the hydrogen cracking mechanisms responsible for additional protons release are related to the neutralization of Not extending enhanced Nit buildup.In this study the switched temperature irradiation has been employed to conservatively estimate the ELDRS of GLPNP,which provides us with a new insight into the test technique for ELDRS.

Activation and shutdown dose-rate analyses for the EAST NBI test facility

An analysis of the neutron activation and shutdown dose rates was performed for the EAST high-power deuterium neutral beam injector test facility(EAST NBITF) by using the multiparticle transport code FLUKA2011.2. Also, the neutron and neutron-induced gamma spectra of the facility's vacuum vessel were evaluated. The results identified the major radionuclides^(99) Mo,^(65)Ni,^(58) Co,^(56)Mn, and^(51) Cr for the vacuum vessel and the primary nuclide^(64) Cu for both the ion dump and the calorimeter.The simulated results indicated that, when the EAST NBITF operates within the design parameters of deuterium energy 80 ke V, current 50 A, and pulse 100 s, the neutron intensity will achieve 10^(11)n/s with no radiation safety problems after the EAST NBITF shuts down.

Energy spectrum measurement and dose rate estimation of natural neutrons in Tibet region

In this work, natural neutron spectra at nine sites in Tibet region were measured using a multi-sphere neutron spectrometer. The altitude-dependence of the spectra total fluence rate and ambient dose equivalent rate were analyzed. From the normalized natural neutron spectra at different altitudes, the spectrum fractions for neutrons of greater than 0.1 MeV do not differ obviously, while those of the thermal neutrons differ greatly from each other. The total fluence rate, effective dose rate and the ambient dose equivalent rate varied with the altitude according to an exponential law.

Measurement of air kerma rate and ambient dose equivalent rate using the G(E) function with hemispherical CdZnTe detector

Since the room-temperature detector CdZnTe(CZT) has advantages in terms of detection efficiency,energy resolution, and size, it has been extensively used to detect X-rays and gamma-rays. So far, nuclear radiation detectors such as cerium chloride doped with lanthanum bromide(LaBr_3(Ce)), thallium doped with cesium iodide(sI(Tl)), thallium doped with sodium iodide(NaI(Tl)),and high-purity germanium(HPGe) primarily use the spectroscopy-dose rate function(G(E)) to achieve the accurate measurement of air kerma rate(K_a) and ambient dose equivalent rate(H*(10)). However, the spectroscopy-dose rate function has been rarely measured for a CZT detector. In this study, we performed spectrum measurement using a hemispherical CZT detector in a radiation protection standards laboratory. The spectroscopy-dose rate function G(E) of the CZT detector was calculated using the least-squares method combined with the standard dose rate at the measurement position. The results showed that the hemispherical CZT detector could complete the measurement of air kerma rate(K_a) and ambient dose equivalent rate(H*(10)) by using the G(E) function at energies between 48 keV and 1.25 MeV, and the relative intrinsic errors were, respectively, controlled within ± 2. 3 and ± 2. 1%.

Study on the dose rate upset effect of partially depleted silicon-on-insulator static random access memory

This paper implements the study on the Dose Rate Upset effect of PDSOI SRAM （Partially Depleted Silicon- On-Insulator Static Random Access Memory） with the Qiangguang-I accelerator in Northwest Institute of Nuclear Technology. The SRAM （Static Random Access Memory） chips are developed by the Institute of Microelectronics of Chinese Academy of Sciences. It uses the full address test mode to determine the upset mechanisms. A specified address test is taken in the same time. The test results indicate that the upset threshold of the PDSOI SRAM is about l×10s Gy（Si）/s. However, there are a few bits upset when the dose rate reaches up to 1.58 x 109 Gy（Si）/s. The SRAM circuit can still work after the high level 3~ ray pulse. Finally, the upset mechanism is determined to be the rail span collapse by comparing the critical charge with the collected charge after γ ray pulse. The physical locations of upset cells are plotted in the layout of the SRAM to investigate the layout defect. Then, some layout optimizations are made to improve the dose rate hardened performance of the PDSOI SRAM.

Implementation and application of PyNE sub-voxel R2S for shutdown dose rate analysis

PyNE R2S is a mesh-based R2S implementation with the capability of performing shutdown dose rate(SDR)analysis directly on CAD geometry with Cartesian or tetrahedral meshes.It supports advanced variance reduction for fusion energy systems.However,the assumption of homogenized materials of PyNE R2S with a Cartesian mesh throughout a mesh voxel introduces an approximation in the case where a voxel covers multiple non-void cells.This work implements a sub-voxel method to add fldelity to PyNE R2S with a Cartesian mesh during the process of activation and photon source sampling by performing independent inventory calculations for each cell within a mesh voxel and using the results of those independent calculations to sample the photon source more precisely.PyNE sub-voxel R2S has been verifled with the Frascati Neutron Generator(FNG)-ITER and ITER computational shutdown dose rate benchmark problems.The results for sub-voxel R2S show satisfactory agreement with the experimental values or reference results.PyNE sub-voxel R2S has been applied to the shutdown dose rate calculation of the Chinese Fusion Engineering Testing Reactor(CFETR).In conclusion,sub-voxel R2S is a reliable tool for SDR calculation and obtains more accurate results with the same voxel size than voxel R2S.

TrueBeam Low Dose Rate Investigation for Pulsed Reduced Dose Rate IMRT

The capability of the TrueBeam treatment system to deliver step and shoot IMRT plans at low dose rates was evaluated. Beam characteristics during low dose rates (5 to 100 MU/min) were evaluated for consistency using a planar ion chamber array. MU constancy, linearity, and beam profile symmetry were all found to be equivalent within 0.5%. The response of the Scandi Dos Delta 4 system was also evaluated at low dose rates of using static open beams compared to ion chamber measurements, and step and shoot IMRT plans comparing 5 - 20 MU/min and 100 MU/min dose rates, with a maximum observed absolute dose difference of 0.8% and equivalence margin of 0.2%. The Gamma Index and measurement reproducibility were also found to be equivalent.

Will High Dose Rate Interstitial Brachytherapy Be a Surrogate to Surgery in Early Mobile Squamous Cell Carcinoma of Tongue—An Indian Experience

The study was intended to highlight functional outcome and survival advantage when High Dose Rate (HDR) interstitial implant was used for anterior 2/3rd tongue, either as a primary or as boost depending upon stage of disease. Materials and Methods: Fifty-one patients with squamous cell carcinoma of anterior 2/3rd tongue received interstitial brachytherapy either as primary or as boost with Iridium 192 remote after loading high dose rate (Microselectron or Gamma MediX) machines from November 2008 to September 2013. Age group ranged from 32 to 73 years, mean 52.1. Of these 51, 37 were males and 14 were females. 8 patients belonged to Stage I, 18 from Stage II and 28 patients were Stage III. Stage I patients received primary brachytherapy alone of dose 38.50 Gy to 40 Gy and fraction dose ranged from 250 cGy to 350 cGy. Stage II and Stage III patients received external beam radiation of dose 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. Stage III patients received concurrent chemotherapy with Injection Cisplatin along with external beam radiotherapy 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. 55% of patients were habituated to tobacco and alcohol in one form or the other or both. Surprisingly 45% of patients were nonsmokers and non-alcoholic. Results: Follow-up period ranged from eight months to sixty months. 42 patients had complete response. 9 patients had residual disease. 2 patients died due to non-cancerous cause though they had excellent local control, one with pulmonary tuberculosis and the other with massive Myocardial Infarction. 2 patients died due to disease progression. Overall complete response rate was 82.35%. Those patients who had good coverage index and conformal index had good response compared to those patients with lesser these values. Conclusion: It is surprising to observe from the study that oral cavity cancers are not uncommon in non-smokers and non-alcoholics. Overall complete response of 82% is comparable to any other study quoted in literature. Surgery offers same cure rate but at the rate of organ loss and functional impairment. Organ preservation with good functional outcome is possible in radiotherapy unlike surgery. This study proves brachytherapy can be considered as a surrogate to surgery in early stage tongue cancers with good functional outcome and with lesser morbidity.

Organ at Risk Doses during High Dose Rate Intracavitary Brachytherapy for Cervical Cancer: A Dosimetric Study

Background: Treatment of Cervical cancer includes a combination of external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT). ICBT helps to boost radiation dose to primary disease. Organs like rectum, bladder, sigmoid and small bowel lie close to the cervix region and these organs receive dose from EBRT as well as ICBT and we want to know the dose to these organ at risk (OAR). Materials & Methods: Dosimetric details of 174 ICBT applications done in 58 patients were retrospectively analysed. All patients received EBRT dose of 50.4 Gy in 28 fractions. All patients had ICBT, three sessions with 7 Gy prescribed to point A. Dosimetric data including dose to right and left point A and dose to OARs were recorded from Oncentra Planning System. Results: Mean dose to point A on right side was 6.89 Gy and left side was 6.91 Gy. Mean D2cc dose to rectum, bladder, sigmoid and small bowel was 3.5 Gy, 5.25 Gy, 4.75 Gy and 4.2 Gy respectively. Mean EQD2 dose combining EBRT and ICBT in point A was 78.7 Gy on right side and 79 Gy on left side. Mean EQD2 doses to D2cc of rectum, bladder, sigmoid and small bowel was 62 Gy, 74.4 Gy, 70.5 Gy and 66.5 Gy respectively. Conclusion: From the results of this dosimetric study it is evident that OARs like rectum, sigmoid, bladder & bowel are receiving only acceptable doses of radiation using point A prescribed CT based ICBT planning. Hence with regards to OAR doses, CT based ICBT planning with dose prescribed to point A is a feasible option.

Commissioning and Optimization of a Total Skin Electron Therapy Technique Using a High Dose Rate Electron Facility

Total skin electron therapy (TSET) is used for the treatment of Mycosis Fungoides. Several tech-niques have been developed, in order to achieve homogeneous dose distribution over the complete body surface. To implement a TSET technique, one has to optimize a variety of parameters. Monte Carlo simulation of TSET can facilitate this optimization. The aim of this study was to commission and optimize a TSET technique using the 4 and 6 MeV electron and the high dose rate facility on the Elekta Precise accelerator. The EGS4nrc/BEAMnrc Monte Carlo code was used. The beam data were calculated and measured at two different scoring planes for a single beam. The Model was validated by comparing the simulation with measurements. Two different vertical angles were used to obtain a uniform dose. The angle was optimized for best dose uniformity. The Rando phantom is placed on a rotating platform and rotates 60 degrees apart to facilitate the six patient position orientations. The doses delivered in a phantom by complete treatment were measured with Kodak EDR2 films and TLDs. The dose distribution varied among various scanning directions by 2 - 3 mm and 3 - 4 mm for 4 and 6 MeV respectively. The composite percentage depth dose of all six dual fields for the 4 and 6 MeV yielded an R80 of ~4 mm and ~6 mm, respectively. Dose uniformity was ±6% for 4 MeV and ±5% for 6 MeV. The bremsstrahlung contamination was 0.9% - 1.3%. Good agreements were found with published literature and inline with international protocols.

Assessment of Natural Radioactivity Levels and Radiation Dose Rate in Some Soil Samples from Historical Area, AL-RAKKAH, Saudi Arabia

This study aims to determine the activity concentrations of naturally occurring, technically-enhanced levels of radiation and the gamma absorbed dose rates in soil samples collected across the land scape of historical area which discovered in east of Saudi Arabia at 2009 G, Called AL- RAKKAH. By using an HPGe detector gamma-ray spectrometer, the activity concentrations of 226Ra 232Th and 40K were found in surface soil samples ranged from 17. 4 ± 1.2 Bq/kg to 28.3 ± 2.3 Bq/kg with an average value of 23 ± 1.6 Bq/kg, ranging from 1.1 ± 1.8 Bq/kg to 81.0 ± 1.7 Bq/kg with the average value 20 ± 1.4 Bq/kg and from 218 ± 11 Bq/kg to 255 ± 18 Bq/kg, with the mean value of 233 ± 12 Bq/kg respectively. The mean radium equivalent (Raeq) and outdoor radiation hazard index (Hex) for the area under study were determined as 69.52 Bq/kg and 0.16 respectively. The total absorbed dose rate due to three primordial radionuclides lies in the range of 17.74 - 72.24 nGy·h-1 with a mean of 32.69 nGy·h-1, which yields total annual effective dose of 0.37 mSv·y-1. The measured values are comparable with other global radioactivity measurements and are found to be safe for public and environment. The baseline data of this type will almost certainly be of importance in making estimations of population exposure.