Abdominal imaging dose in radiology and radiotherapy – Phantom point dose measurements,effective dose and secondary cancer risk

PurposeTo compare abdominal imaging dose from 3D imaging in radiology (standard/low-dose/dual-energy CT) and radiotherapy (planning CT, kV cone-beam CT (CBCT)).MethodsDose was measured by thermoluminescent dosimeters (TLD’s) placed at 86 positions in an anthropomorphic phantom. Point, organ and effective dose were assessed, and secondary cancer risk from imaging was estimated.ResultsOverall dose and mean organ dose comparisons yield significantly lower dose for the optimized radiology protocols (dual-source and care kV), with an average dose of 0.34±0.01 mGy and 0.54±0.01 mGy (average ± standard deviation), respectively. Standard abdominal CT and planning CT involve considerably higher dose (13.58 ± 0.18 mGy and 18.78±0.27 mGy, respectively). The CBCT dose show a dose fall-off near the field edges. On average, dose is reduced as compared with the planning or standard CT (3.79 ± 0.21 mGy for 220° rotation and 7.76 ± 0.37 mGy for 360°), unless the high-quality setting is chosen (20.30 ± 0.96 mGy). The mean organ doses show a similar behavior, which translates to the estimated secondary cancer risk. The modelled risk is in the range between 0.4 cases per million patient years (PY) for the radiological scans dual-energy and care kV, and 300 cases per million PY for the high-quality CBCT setting.ConclusionsModern radiotherapy imaging techniques (while much lower in dose than radiotherapy), involve considerably more dose to the patient than modern radiology techniques. Given the frequency of radiotherapy imaging, a further reduction in radiotherapy imaging dose appears to be both desirable and technically feasible.     

Cytogenetic effect of low dose γ-radiation in Hordeum vulgare seedlings: non-linear dose–effect relationship

The induction of chromosome aberrations in Hordeum vulgare germinated seeds was studied after ionizing irradiation with doses in the range of 10–1,000 mGy. The relationship between the frequency of aberrant cells and the absorbed dose was found to be nonlinear. A dose-independent plateau in the dose range from about 50 to 500 mGy was observed, where the level of cytogenetic damage was significantly different from the spontaneous level. The comparison of the goodness of the experimental data fitting with mathematical models of different complexity, using the most common quantitative criteria, demonstrated the advantage of a piecewise linear model over linear and polynomial models in approximating the frequency of cytogenetical disturbances. The results of the study support the hypothesis of indirect mechanisms of mutagenesis induced by low doses. Fundamental and applied implications of these findings are discussed. An erratum to this article can be found at     

A “quality-control-based correction method” for displayed dose indices on CT scanner consoles in patient dose surveys

PurposeA new quality-control-based (QC-based) method is introduced to obtain correction factors to be applied to displayed patient dose indices (CTDI_Vol and DLP) on CT scanner consoles to verify improvement of dose surveys for diagnostic reference levels (DRLs) determination.MethodAn available data-base of QC documents and reports of 57 CT scanners in Tehran, Iran was used to estimate CTDI_Vol, DLP and relevant correction factors for three CT examination types including head, chest and abdomen/pelvis. The correction factor is the ratio of QC-based estimated dose to displayed dose. A dose survey was performed by applying on-site “data collection method” and correction factors obtained in order to select CT scanners in three modes for determination of CT DRLs by inclusion of: (a) all CT scanners before displayed dose indices were corrected (57), (b) only CT scanners calibrated by QC experts (41) and (c) all CT scanners after displayed dose indices were corrected (57).ResultsFor the 41 CT scanners, correction factors of three examination types obtained in this study are within the acceptance tolerance of IAEA HHS-19. The correction factors range from 0.45 to 1.7 (average of 3 examinations) which is due to the change in the calibrated value of CTDI_Vol over extended time. The DRL differences in three modes are within ±1.0% for CTDI_Vol and ±12.4% for DLP.ConclusionsThe “QC-based correction method” applied to mode (c) has improved the DRLs obtained by other two modes. This method is a strong alternative to “direct dose measurement” with simplicity and cost effectiveness.     

Bladder dose–surface maps and urinary toxicity: Robustness with respect to motion in assessing local dose effects

The purpose of this study was to quantify the impact of inter-fraction modifications of bladder during RT of prostate cancer on bladder dose surface maps (DSM).Eighteen patients treated with daily image-guided Tomotherapy and moderate hypofractionation (70–72.8 Gy at 2.5–2.6 Gy/fr in 28 fractions and full bladder) were considered. Bladder contours were delineated on co-registered daily Megavoltage CT (MVCT) by a single observer and copied on the planning CT to generate dose–volume/surface histograms (DVH/DSH) and bladder DSMs. Discrepancies between planned and daily absorbed doses were analyzed through the average of individual systematic errors, the population systematic errors and the population random errors for the DVH/DSHs and DSMs.In total, 477 DVH/DSH and 472 DSM were available. DSH and DVH showed small population systematic errors of absolute surfaces (<3.4 cm²) and volumes (<8.4 cm³) at the highest doses.The dose to the posterior bladder base assessed on DSMs showed a mean systematic error below 1 Gy, with population systematic and random errors within 4 and 3 Gy, respectively. The region surrounding this area shows higher mean systematic errors (1–3 Gy), population systematic (8–11 Gy) and random (5–7 Gy) errors.In conclusion, DVH/DSH and DSMs are quite stable with respect to inter-fraction variations in the high-dose region, within about 2 cm from bladder base. Larger systematic variations occur in the anterior portion and cranially 2.5–3.5 cm from the base.Results suggest that dose predictors related to the high dose area (including the trigone dose) are likely to be sufficiently reliable with respect to the expected variations due to variable bladder filling.     

The ΔT thermal dose concept 1: in vivo teratogenesis

This project was an initial test of the hypothesis that there would be a ΔT thermal dose relationship for birth defects in rats (Rattus norvegicus) during neural tube closure (NTC). Additionally, the same thermal dose as applied during NTC in utero in vivo, was also applied to exteriorized (i.e., ex vivo) in utero pregnant uterine horns at a comparable stage of organogenesis. Since the yields of the two regimens were comparable, the hyperthermia-induced teratogenic effects appear to result from the thermal dosing of the in utero embryos and not the elevated temperature of the mother. The hypothesis was supported.     

Alleviation of salt stress by low dose γ-irradiation in rice

The effects of salt stress on the growth, photosynthesis, and antioxidative ability of the rice (Oryza sativa L.) plants raising from -irradiated seeds were investigated using two cultivars, Ilpumbyeo and Sanghaehyanghyella. The 50 and 100 mM NaCl solutions caused a remarkable decrease of the early germination rate and seedling growth. However, the salt stress-induced inhibition of the growth was significantly alleviated in the -irradiated plants. The chlorophyll contents and the effective quantum yield of photosystem 2 ( _{PS 2}) were lower in the NaCl-treated plants than in the control ones, while the non-photochemical quenching was higher in the former ones. Activities of the antioxidant enzymes such as superoxide dismutase (SOD) and ascorbate peroxidase (APX) increased with increasing NaCl concentrations, and the irradiated groups had even higher SOD and APX activities than the non-irradiated ones. These alleviation effects were observed similarly in both the cultivars tested.     

How does radiation damage in protein crystals depend on X-ray dose?

Is radiation damage to cryopreserved protein crystals strictly proportional to accumulated dose at the high-flux density of beams from undulators at third-generation synchrotron sources? The answer is "yes," for overall damage to several different kinds of protein crystals at flux densities up to 10(15) ph/sec/mm(2) (APS beamline 19-ID). We find that, at 12 keV (1 A wavelength), about ten absorbed photons are sufficient to "kill" a unit cell. As this corresponds to about one elastically scattered photon, each unit cell can contribute only about one photon to total Bragg diffraction. The smallest crystal that can yield a full data set to 3.5 A resolution has a diameter of about 20 microm (100 A unit cell).     

The ΔT thermal dose concept 2: in vitro cellular effects

The results of this project provide proof of concept for an analysis of hyperthermia-induced in vitro cellular effects in relation to a thermal dose determination with a temperature-differential basis from each cell line's historical physiological temperature (HPT). Human (Homo sapiens) fetal cells, whose HPT was assumed to be 37°C, and guinea pig (Cavia porcellus) fetal cells, whose HPT was assumed to be 39.5°C, were used. It was hypothesized that in vitro cellular functionality (e.g., fastest cell doubling time) would be maximal at each line's respective HPT and decrease with temperatures above and below each line's HPT. The hypothesis was supported.     

The dose response of chromosome aberrations in human lymphocytes induced in vitro by very low-dose γ rays

This paper considers the dose-effect relationship for unstable chromosome aberration yields in human lymphocytes in very low-dose range. Data are presented for (60)Co γ-ray doses of 0, 10, 20, 40 and 1000 mGy. More than 5,000 metaphases were scored for each data point at the very low doses, and each cell was double-checked using a semi-automated metaphase finding/relocation system. Aberration yields of dicentrics plus centric rings followed an excellent linear dose response down to zero dose; the yields were significantly above the control frequency from 20 mGy.     

Sunitinib versus imatinib dose escalation after failure of imatinib standard dose in patients with advanced Gastrointestinal stromal tumors – a real-world multi-center study

BackgroundWhether to escalate imatinib dosage or directly switch to sunitinib in gastrointestinal stromal tumors (GISTs) failing on standard dose 400 mg/d of imatinib is still controversial.MethodsWe evaluated progression-free survival (PFS), overall survival (OS), and time to sunitinib failure (TTSF) of patients selecting imatinib dose escalation or directly switching to sunitinib after the failure of imatinib 400 mg/d therapy from 3 tertery referring centers between January 2008 to December 2016.ResultsA total of 240 patients receiving sunitinib (37.5 mg continuous daily dose or 50 mg 4 weeks on with 2 weeks off) for at least 8 weeks were examined. After failure on imatinib 400 mg/d, 100 (49.3%) patients had dose escalation to 600 mg or 800 mg per day (IM group, imatinib group), and 103 (50.7%) directly switched to sunitinib (SU group, sunitinib group). The PFS in the SU and IM groups was 12 months and 5.0 months (P < 0.001), respectively. TTSF or OS in both groups was not statistically significantly different.ConclusionsAfter the progression of imatinib standard-dose treatment in recurrent/metastatic GISTs, the PFS of patients directly switching to sunitinib was significantly longer compared with the PFS of patients with imatinib dose escalation. However, when the patients continued with sunitinib therapy after the failure of IM dose escalation, TTSF and OS in the IM group were similar to those in the SU group. Further exploration of the characteristics of the population benefiting from imatinib dose escalation are warranted.     

Clinical trials of endothelin antagonists in heart failure: a question of dose?

Circulating plasma endothelin (ET)-1 concentrations are substantially elevated, and correlate with the hemodynamic severity and New York Heart Association (NYHA) class, in patients with chronic heart failure (CHF). In early preclinical studies involving different models of experimental heart failure, ET antagonists reduced cardiac pressures, increased cardiac output, and prolonged survival. ET receptor antagonists also impressively improved systemic and pulmonary hemodynamics in patients with CHF, without causing neurohormonal activation. However, recent clinical trials, including the ENABLE (Endothelin Antagonist Bosentan for Lowering Cardiac Events in Heart Failure) and EARTH (Endothelin A Receptor Antagonist Trial in Heart Failure) studies, have shown neutral effects in terms of mortality and symptoms. This paper describes the possible reasons why benefit was not seen in these clinical studies, and suggests what lessons can be learnt from the way the studies were undertaken to apply to future studies.     

Is a larger refuge always better? Dispersal and dose in pesticide resistance evolution

The evolution of resistance against pesticides is an important problem of modern agriculture. The high‐dose/refuge strategy, which divides the landscape into treated and nontreated (refuge) patches, has proven effective at delaying resistance evolution. However, theoretical understanding is still incomplete, especially for combinations of limited dispersal and partially recessive resistance. We reformulate a two‐patch model based on the Comins model and derive a simple quadratic approximation to analyze the effects of limited dispersal, refuge size, and dominance for high efficacy treatments on the rate of evolution. When a small but substantial number of heterozygotes can survive in the treated patch, a larger refuge always reduces the rate of resistance evolution. However, when dominance is small enough, the evolutionary dynamics in the refuge population, which is indirectly driven by migrants from the treated patch, mainly describes the resistance evolution in the landscape. In this case, for small refuges, increasing the refuge size will increase the rate of resistance evolution. Our analysis distils major driving forces from the model, and can provide a framework for understanding directional selection in source‐sink environments.     

γ-Tocopherol abolishes postprandial increases in plasma methylglyoxal following an oral dose of glucose in healthy, college-aged men

Postprandial hyperglycemia contributes to the risk of cardiovascular disease in part by increasing concentrations of the reactive dicarbonyl methylglyoxal (MGO), a byproduct of glucose metabolism. Oxidative stress increases MGO formation from glucose in vitro and decreases its glutathione-dependent detoxification to lactate. We hypothesized that the antioxidant γ-tocopherol, a form of vitamin E, would decrease hyperglycemia-mediated postprandial increases in plasma MGO in healthy, normoglycemic, college-aged men. Participants (n=12 men; 22.3±1.0 years; 29.3±2.4 kg/m(2)) received an oral dose of glucose (75 g) in the fasted state prior to and following 5-day ingestion of a vitamin E supplement enriched in γ-tocopherol (500 mg/day). γ-Tocopherol supplementation increased (P<.0001) plasma γ-tocopherol from 2.22±0.32 to 7.06±0.71 μmol/l. Baseline MGO concentrations and postprandial hyperglycemic responses were unaffected by γ-tocopherol supplementation (P>.05). Postprandial MGO concentrations increased in the absence of supplemental γ-tocopherol (P<.05), but not following γ-tocopherol supplementation (P>.05). Area under the curve for plasma MGO was significantly (P<.05) smaller with the supplementation of γ-tocopherol than without (area under the curve (0-180 min), -778±1010 vs. 2277±705). Plasma concentrations of γ-carboxyethyl-hydroxychroman, reduced glutathione and markers of total antioxidant capacity increased after supplementation, and these markers and plasma γ-tocopherol were inversely correlated with plasma MGO (r=-0.48 to -0.67, P<.05). These data suggest that short-term supplementation of γ-tocopherol abolishes the oral glucose-mediated increases in postprandial MGO through its direct and indirect antioxidant properties and may reduce hyperglycemia-mediated cardiovascular disease risk.     

A single dose of the DENV-1 candidate vaccine rDEN1Δ30 is strongly immunogenic and induces resistance to a second dose in a randomized trial

Dengue is an emerging infectious disease that has become the most important arboviral infection worldwide. There are four serotypes of dengue virus, DENV-1, DENV-2, DENV-3, and DENV-4, each capable of causing the full spectrum of disease. rDEN1Δ30 is a live attenuated investigational vaccine for the prevention of DENV-1 illness and is also a component of an investigational tetravalent DENV vaccine currently in Phase I evaluation. A single subcutaneous dose of rDEN1Δ30 was previously shown to be safe and immunogenic in healthy adults. In the current randomized placebo-controlled trial, 60 healthy flavivirus-naive adults were randomized to receive 2 doses of rDEN1Δ30 (N = 50) or placebo (N = 10), either on study days 0 and 120 (cohort 1) or 0 and 180 (cohort 2). We sought to evaluate the safety and immunogenicity of this candidate vaccine in 50 additional vaccinees and to test whether the humoral immune response could be boosted by a second dose administered 4 or 6 months after the first dose. The first dose of vaccine was well tolerated, infected 47/50 vaccinees and induced seroconversion in 46/50 vaccinees. Irrespective of dosing interval, the second dose of vaccine was also well tolerated but did not induce any detectable viremia or ≥4-fold rise in serum neutralizing antibody titer.Only five subjects had an anamnestic antibody response detectable by ELISA following a second dose of vaccine, demonstrating that the vaccine induced sterilizing humoral immunity in most vaccinees for at least six months following primary vaccination.The promising safety and immunogenicity profile of this vaccine confirms its suitability for inclusion in a tetravalent dengue vaccine.     

An effective calibration technique for radiochromic films using a single-shot dose distribution in Gamma Knife®

PurposeA method of calibrating radiochromic films for Gamma Knife^® (GK) dosimetry was developed. The applicability and accuracy of the new method were examined.MethodsThe dose distribution for a sixteen millimeter single-shot from a GK was built using a reference film that was calibrated using the conventional multi-film calibration (MFC) method. Another film, the test film, from a different set of films was irradiated under the same conditions as the reference film. The calibration curve for the second set of films was obtained by assigning the dose distribution of the reference film to the optical density of the test film, point by point. To assess the accuracy of this single-film calibration (SFC) method, differences between gamma index pass rates (GIPRs) were calculated.ResultsThe SFC curves were successfully obtained with estimated errors of 1.46%. GIPRs obtained with the SFC method for films irradiated using a single-shot showed differences less than one percentage point when dose difference criterion (ΔD) was 2% and the distance to agreement criterion (Δd) was 1 mm. The GIPRs of the SFC method when the films were irradiated following a virtual target treatment plan were consistent with the GIPRs of the MFC method, with differences of less than 0.2 percentage points for ΔD = 1% and Δd = 1 mm.ConclusionThe accuracy of the SFC method is comparable to that of conventional multi-film calibration method for GK film dosimetry.     

Low dose β blockade in acute stroke (“BEST” trial): an evaluation

The β blocker stroke (“BEST”) trial was designed to see if the apparent protective effect of propranolol on cerebral function in patients with subarachnoid haemorrhage applied also to patients suffering from acute stroke. Three hundred and two conscious patients with clinically diagnosed hemispheric strokes sustained within the past 48 hours were randomly assigned to receive atenolol, propranolol, or matching placebo capsules for three weeks. More early deaths occurred among the patients allocated to receive β blockers, but this was largely explained by differences in the initial characteristics of the patients among the different treatment groups. By contrast, the outcome in a further 60 patients, who had been taking β blockers at the time of their stroke but were otherwise similar to the patients in the trial, was considerably better, suggesting that prior treatment with β blockers might be protective.The search for an effective medical treatment for acute stroke must continue. The approach used here, in which neurological outcome was assessed in a modest number of patients with a view to proceeding subsequently to a full scale trial of functional outcome, allows practical benefits of a treatment to be evaluated under realistic conditions and an ineffective treatment to be eliminated without undue cost.     

How might spatial nonuniformity of dose in a homogeneous biological system affect its total response?

The total response of a homogeneous biological system to a fixed total dose of a biological agent is modeled by dividing the system into N cubical voxels, each of which can be associated with an individual dose D(n) and an individual response R(n) =F(D(n)). Among the results shown are the following: A. (Voxel Theorem). Let the average dose D(avg) be held fixed as the dose distribution is shifted from uniform u to arbitrary a. Then, if F' > or = 0 over [D(min), D(max)] and R = summation operator (n = 1)(N) R(n), a sufficient condition that NF(D(avg)) = R(u) < or = R(a) is that F be a concave-upwards function of dose; that is, F" > or = 0 over [D(min), D(max)]. B.If F' is constant over [D(min), D(max)], then R(a) = R(u). That is, the total response is a function of D(avg) only. The applications of these (and other) results are illustrated by examples from bioelectromagnetics.     

Importance of dose‐response model form in probabilistic risk assessment: A case study of health effects from methylmercury in fish

We compared the effect of uncertainty in dose‐response model form on health risk estimates to the effect of uncertainty and variability in exposure. We used three different dose‐response models to characterize neurological effects in children exposed in utero to methylmercury, and applied these models to calculate risks to a native population exposed to potentially contaminated fish from a reservoir in British Columbia. Uncertainty in model form was explicitly incorporated into the risk estimates. The selection of dose‐response model strongly influenced both mean risk estimates and distributions of risk, and had a much greater impact than altering exposure distributions. We conclude that incorporating uncertainty in dose‐response model form is at least as important as accounting for variability and uncertainty in exposure parameters in probabilistic risk assessment.