EFOMP survey results on national radiotherapy dosimetry audits

PurposeThe Council Directive 2013/58/EURATOM entered into force in 2014, and its transposition into national legislations became applicable in 2018. The Council Directive 2013/58/EURATOM strengthened the importance of clinical audits, and stated that Member States should ensure dosimetry audit compliance in accordance with national procedures. Therefore, the purpose of this work was to picture the status of the implementation of dosimetry audits in European countries. Methods: A questionnaire was designed to describe dosimetry audit standards in radiotherapy across European countries. The questionnaire was sent to 33 EFOMP National Member Organizations (NMO). Results: Nineteen NMOs responded to the survey (14 EU members). For 58% of the participating countries national regulations required dosimetry audits in radiotherapy departments. In 37% of the participating countries there were implemented regulations for independent/secondary dose verification, and in 21% of the participating countries similar procedures for dose verification were already implemented although not regulated by law. In 42% of the participating countries there were implemented mechanisms to review updates and advances in the field of radiotherapy.ConclusionsThe transposition and further implementation of the Council Directive 2013/59/EURATOM was scarce, leading to heterogeneities in national policies about dosimetry audits.     

Congenital hydrocephalus caused by exposure to low level X-radiation at early gestational stage in mice.

Hydrocephalus is a severe and often lethal birth defect in humans resulting from excess accumulation off cerebrospinal fluid (CSF) in the cranial vault, accompanied by enlargement of the head, prominence of the forehead and atrophy of the brain. A wide variety of teratogenic procedures have been used to obtain congenital hydrocephalus in laboratory animals. Radiation, infections, trypan blue, hypervitaminosis A, salisylates and nutritional deficiencies were considered as the teratogens. Several investigators induced congenital hydrocephalus following irradiation of pregnant animals. The purpose off this study is to elucidate the pathogenesis off congenital hydrocephalus induced by X-irradiation in mice. Since the sensitive period for malformations produced by X-radiation in mice ranges from gestational day 7 (G7) to Gl3.     

Cerebellar malformations in prenatally X-irradiated rats: quantitative analysis and detailed description

Pregnant WKA/Hok rats were exposed to 100 R or 200 R X-irradiation on one of gestation days 16 through 21. Offspring were killed at 60 days of age and the cerebellum was examined. The cerebellum of animals exposed to 200 R was slightly reduced in weight but not in width. The observed reduction in the dorsoventral length of the cerebellum was more evident when the X-irradiation was early in gestation. The anteroposterior length of the hemispheres increased following exposure to X-ray on days 16 through 19, and that of the vermis and paravermis decreased following treatment on days 17 through 21. Therefore, the anterior portions of hemispheres were situated anterior to the culmen in every 200 R group. Somewhat anteroposteriorly and horizontally directed lobules, as opposed to the normal transverse arrangement, were seen in the cerebellum of rats treated on day 16 or 17. Lobule contortion and fragmentation and an increased number of sublobules were striking in cases treated later. Histologically, ectopic Purkinje cells in the granule cell layer and white matter appeared following X-irradiation on day 20 or 21, but they were not found following earlier treatment. In the cerebellum of animals exposed to 100 R the reduction in size was mild and the folial abnormalities were rare, but the number of sublobules decreased.     

Application of MOSFET detectors for dosimetry in small animal radiography using short exposure times

Digital subtraction angiography (DSA) X-ray imaging for small animals can be used for functional phenotyping given its ability to capture rapid physiological changes at high spatial and temporal resolution. The higher temporal and spatial requirements for small-animal imaging drive the need for short, high-flux X-ray pulses. However, high doses of ionizing radiation can affect the physiology. The purpose of this study was to verify and apply metal oxide semiconductor field effect transistor (MOSFET) technology to dosimetry for small-animal diagnostic imaging. A tungsten anode X-ray source was used to expose a tissue-equivalent mouse phantom. Dose measurements were made on the phantom surface and interior. The MOSFETs were verified with thermoluminescence dosimeters (TLDs). Bland-Altman analysis showed that the MOSFET results agreed with the TLD results (bias, 0.0625). Using typical small animal DSA scan parameters, the dose ranged from 0.7 to 2.2 cGy. Application of the MOSFETs in the small animal environment provided two main benefits: (1) the availability of results in near real-time instead of the hours needed for TLD processes and (2) the ability to support multiple exposures with different X-ray techniques (various of kVp, mA and ms) using the same MOSFET. This MOSFET technology has proven to be a fast, reliable small animal dosimetry method for DSA imaging and is a good system for dose monitoring for serial and gene expression studies.     

Three-dimensional quality assurance of IMRT prostate plans using gel dosimetry

Intensity modulated radiotherapy (IMRT) is one of the most modern radiation therapy treatment techniques. Although IMRT can deliver high and complex conformational doses to the tumor volume, its implementation requires rigorous quality assurance (QA) procedures that include a dosimetric pre-treatment verification of individual patient planning. This verification usually involves measuring a small volume of absolute dose with an ionization chamber and checking bi-dimensional fluency with an array of detectors. The planning technique has tri-dimensional characteristics, but no tridimensional dosimetry has been established in the clinical routine. One strategy to perform three-dimensional dosimetry is to use polymeric gels associated with magnetic resonance imaging to evaluate dose distribution. Here, we have compared the results of conventional QA procedures involving one- and two-dimensional dosimetry to the results of three-dimensional dosimetry conducted with MAGIC-f gel in 10 cases of prostate cancer IMRT planning. More specifically, we used the gamma index (3%/3 mm) to compare the results of three-dimensional dosimetry to the expected dose distributions obtained with the treatment planning system. Except for one IMRT treatment plan, the gel dosimetry results agreed with the conventional quality control and provided an overview of dose distribution in the target volume.     

Effects of fractionated X-irradiation on subsequent response to acute X-irradiation in two human tumour cell lines in vitro

The exposure of two human tumour cell lines, one derived from a squamous cell carcinoma of the tongue (HN-1) and the other from an adenocarcinoma of the breast (MCF-7), to fractionated X-irradiation in vitro, resulted in altered sensitivity to subsequent acute X-irradiation exposure in the former but not the latter tumour cell type. The X-ray-pretreated HN-1 cells, designated HN-1/DXR11 cells, showed a significantly increased sensitivity to X-irradiation with a D0 of 0.97 Gy, compared with a figure of 1.39 Gy for the parental cells. No significant changes were noted in a number of basic cell kinetic or biological parameters in the X-ray-pretreated cells. However, this enhanced X-ray sensitivity in the HN-1/DXR11 cells was associated with decreased cellular levels of total intracellular glutathione. These findings are consistent with the theory that intracellular thiols are involved in protection from radiation damage. This is one of the first observations that prior exposure to X-irradiation can modify subsequent responses to acute X-irradiation treatment in human tumour cells.     

Protease-mediated enhancement of lymphocyte-induced angiogenesis in X-ray irradiated mice

Angiogenesis was induced in mice by intradermal injection of semi-syngeneic splenocytes, and after three days the number of newly formed blood vessels at the injection site was counted. When recipients were total-body irradiated with 700 R 2 hours before the lymphocyte injection, the angiogenesis was significantly higher than in non-irradiated mice. The angiogenesis enhancement was of a systemic (not local) character as revealed in experiments with shielding of irradiated animals. This enhancement was not due to X-ray dependent immunosuppression, as shown in experiments with non-irradiated, pharmacologically immunosuppressed mice. Decreased angiogenesis was observed in irradiated mice after treatment with cortisone acetate, aprotinin, and EACA. The results suggest that proteases might be involved in mediating the angiogenesis enhancement after X-irradiation.     

Evidence of Zinc in Affording Protection Against X-Ray-Induced Brain Injury in Rats

In the present world, X-rays have been regarded as one of the most efficient tools in medicine, industry and research. On the contrary, extensive human exposure to these rays is responsible for causing detrimental effects on physiological system. The aim of the present study was to investigate the role of zinc (Zn), if any, in mitigating the adverse effects induced by fractionated X-irradiation on rat brain. Female Sprague-Dawley rats weighing 170–200 g were divided into four different groups viz.: (a) normal control, (b) X-irradiated (21Gy), (c) zinc treated (227 mg/L in drinking water) and (d) X-irradiated + zinc treated. The skulls of animals belonging to groups (b) and (d) were exposed to X-rays in 30 fractions. Each fraction delivered a radiation dose of 70 rads, and rats were exposed to two fractions every day for 15 days, consecutively. X-ray treatment resulted in significant alterations in the neurobehavior, neurotransmitter levels and neuro-histoarchitecture of rats, whereas zinc co-treatment with X-rays resulted in significant improvement in these parameters. X-ray exposure also caused a significant increase in the levels of lipid peroxidation as well as activities of catalase and superoxide dismutase, which however were decreased upon simultaneous Zn treatment. On the contrary, X-ray treatment down-regulated the glutathione system, which were found to be up-regulated by zinc co-treatment. Further, protein expressions of p53 and NF-?B were found to be significantly elevated after X-irradiation, which were reversed following Zn supplementation. Hence, Zn seems to be an effective agent in mitigating the detrimental effects caused by exposure to X-rays.     

Cost-effectiveness of the modifications in the quality assurance system in radiotherapy in the example of in-vivo dosimetry

PurposeTo present the methodology for the evaluation of cost-effectiveness of the quality assurance protocol modifications associated with increasing demands on accuracy and reliability in radiotherapy and to present results on cost-effectiveness of in-vivo dosimetry as the chosen example of a technical procedure.Material and methodsIn-vivo dosimetry was used as an example of a quality assurance procedure, whose modifications have an impact on several procedures in the QA system and thus on the cost of radiotherapy. An analysis of 6864 patients, treated between 2001 and 2005 for tumours in the head and neck, breast, pelvis, or lung, was performed. The quality of radiotherapy was expressed as the accuracy of dose delivery and the cost was estimated from labour, equipment and materials.ResultsModifications implemented in the quality assurance protocol have gradually improved the quality of irradiation. Mean deviations between measured and calculated doses, recorded for several groups of treatment sites, were reduced from ?1.5% to 0.5%, 3.4% to 1.4%, 3.9% to 0.1% and ?2.1% to 1.8% for head and neck, breast, pelvis and lung respectively. The standard deviations of the measured values decreased also consistently. Total monthly cost in radiotherapy (related to in-vivo dosimetry) increased from € 4376 to € 10,696 while the unitary cost of radiotherapy procedures remained at the same level. The predominant cost component of in-vivo dosimetry was labour, limited at first to physics staff and later extended to quality assurance personnel and technicians.ConclusionThe application of the presented methodology revealed cost-effectiveness relationships in tested technical procedures.     

DNA-membrane complex restoration in Micrococcus radiodurans after X-irradiation: relation to repair, DNA synthesis and DNA degradation

The DNA-membrane complex in Micrococcus radiodurans was shown to be essentially constituted of proteins, lipids and DNA. The complex was dissociated immediately after X-irradiation of cells and restored during post-incubation in complete medium. In X-irradiated protoplasts some DNA remained associated with the complex. Restoration of the complex during post-incubation was only seen in a medium favouring DNA polymerase and ligase activities. Under this condition no DNA synthesis occurred, suggesting that complex restoration may involve ligase activity. The complex restoration in the wild type and the X-ray sensitive mutant UV17 of M. radiodurans was strictly dependent on the X-ray dose. It was correlated with survival and DNA degradation but always preceded the onset of DNA synthesis after X-irradiation. At the same dose the complex restoration was about 2 fold lower in mutant than in wild type cells indicating that the restoration of the complex is related to repair capacity. The results are consistent with the idea that the complex protects X-irradiated DNA of M. radiodurans from further breakdown and, subsequently, permits DNA synthesis and repair to occur.     

Cell kinetic studies of the effect of a combined therapy with 1-beta D-arabinofuranosylcytosine (Ara-C) and X-irradiation on the L1210 ascites tumour

We studied the effect of combined therapy with X-ray and 1-beta-D-arabinofuranosylcytosine (Ara-C); firstly the effect of whole-body X-irradiation alone on the proliferation of the L1210 ascites tumour of the mouse was studied by autoradiographic and cytofluorometric (FCM) methods. The effect X-irradiation with 4 Gy was mainly a cytostatic one leading to an altered distribution of the cells throughout the cycle due to radiation induced mitotic delay. The cytocidal effect is negligible. As is known from previous studies (Fietkau, Friede & Maurer-Schultze, 1984) the effect of 200 mg/kg Ara-C consists of an inhibition of DNA synthesis and of killing a considerable portion of the L 1210 cells, predominantly of S phase cells. With respect to the importance for potential therapeutic regimens, the influence of the sequence and the time interval between the two therapeutic steps on the survival of tumour-bearing mice was studied. Most combination therapies significantly increase the survival of tumour-bearing mice compared to the single therapeutic steps; however, no significant differences between the various combined therapies were found. Whole-body X-irradiation with 4 Gy followed by the application of 200 mg/kg Ara-C 10 hr later resulted in the greatest increase of the mean survival time of tumour-bearing animals, from 13.2 to 17.4 days. It was shown that apart from the cytocidal effect on S-phase cells, Ara-C also kills cells sublethally damaged by a preceding X-irradiation.     

Delayed enhanced effects of Adriamycin on the X-irradiation-induced gastrointestinal toxicity in mice

The delayed responses of C3H mice which had been pretreated with various single-dose and two-dose fractionated Adriamycin/X-irradiation protocols were evaluated by stressing the 120-day survivors with either whole-abdomen X-irradiation (LD50/7 assay) or whole-body X-irradiation (crypt colony survival). Pretreatment with Adriamycin alone was as toxic as Adriamycin plus X-irradiation for the animals stressed at 120 days (LD50/7 assay). There was no induced cellular radioresistance (D0) and no apparent increase in crypt size as indicated indirectly by the 10-clone dose at 120 days after completion of treatment. The increased lethality of the X-irradiation-stressed 120-day survivors was most likely a primary gastrointestinal response with little or no contribution from either bone marrow or kidney toxicity. The effect was apparently due to a persistent Adriamycin-induced antiproliferative response at the cellular level but the molecular mechanisms are unknown. Such data suggest caution to our clinical colleagues. Cancer patients treated with high doses of Adriamycin, independent of concomitant X-irradiation, will most likely be moderately to severely compromised in their ability to respond to a stress which requires cellular proliferation, and, based on the murine data, this effect is persistent if, indeed, not permanent.     

Cell Kinetic Studies of the Effect of A Combined Therapy With 1-βd-Arabinofuranosylcytosine (Ara-C) and X-Irradiation On the L1210 Ascites Tumour

Abstract. We studied the effect of combined therapy with X-ray and 1-β-D-arabinofuranosylcytosine (Ara-C); firstly the effect of whole-body X-irradiation alone on the proliferation of the L1210 ascites tumour of the mouse was studied by autoradiographic and cytofluorometric (FCM) methods. the effect of X-irradiation with 4 Gy was mainly a cytostatic one leading to an altered distribution of the cells throughout the cycle due to radiation induced mitotic delay. the cytocidal effect is negligible.
As is known from previous studies (Fietkau, Friede & Maurer-Schultze, 1984) the effect of 200 mg/kg Ara-C consists of an inhibition of DNA synthesis and of killing a considerable portion of the L 1210 cells, predominantly of S phase cells.
With respect to the importance for potential therapeutic regimens, the influence of the sequence and the time interval between the two therapeutic steps on the survival of tumour-bearing mice was studied. Most combination therapies significantly increase the survival of tumour-bearing mice compared to the single therapeutic steps; however, no significant differences between the various combined therapies were found. Whole-body X-irradiation with 4 Gy followed by the application of 200 mg/kg Ara-C 10 hr later resulted in the greatest increase of the mean survival time of tumour-bearing animals, from 13.2 to 17.4 days. It was shown that apart from the cytocidal effect on S-phase cells, Ara-C also kills cells sublethally damaged by a preceding X-irradiation.     

Ensuring crustacean product quality in the post-harvest phase

Recent studies of the fisheries for the Norway lobster, Nephrops norvegicus (L.), have illustrated the negative effects of pathogens and of the physiological stresses of capture processes on the exploitation of live animals and their products, and have identified mitigating measures. Firstly, having established that trawl capture of N. norvegicus is highly stressful, but that these animals have powerful physiological mechanisms of recovery, procedures for on-board recovery of animals destined for vivier transport to distant European markets have been implemented commercially, with significant improvements in survival rates. Such procedures also mitigate against the initiation of a stress-induced muscle necrosis. Secondly, measurements of post-mortem autolytic and spoilage processes have identified the existence of a post-capture 'handling window' of several hours which allows the whole or tailed products to be preserved, by icing or freezing, without detriment to quality. Commercial consortia of Scottish fishermen are exploiting this opportunity to extend product shelf-life by freezing at sea within this handling window. Thirdly, the well-documented infections of Scottish N. norvegicus populations by the dinoflagellate Hematodinium sp. not only provide examples of pathogen-induced mortality, but also have effects on post-harvest products including vivier transport losses and changes in post-mortem degradation leading to earlier organoleptic rejection. Under commercial conditions these effects can be mitigated by post-capture visual screening, but only during the periods of peak patent infection when parasitised animals are visually identifiable. Wider implementation of such mitigating procedures during the harvesting of wild-caught crustaceans will contribute to a more sustainable exploitation of these valuable marine resources.     

Regulation of anti-hapten antibody response by chemically modified carrier antigen preferentially provoking delayed-type hypersensitivity (DTH). II. DTH-reactivity and carrier-specific suppression of anti-DNP antibody response induced by priming with dodecanoyl-BSA are mediated by functionally distinct T cell subpopulations.

Experiments were carried out to determine whether or not the cell populations involved in DTH and in the suppression of antibody response are identical. The effects of four treatments, i.e., adult thymectomy (ATx), X-irradiation, anti-mouse thymocyte serum (ATS) and hydrocortisone (HC) on the induction of DTH and on the carrier-specific suppression of antibody response were observed in mice immunized with chemically modified antigen, dodecanoyl-BSA (d-BSA), emulsified with complete Freund's adjuvant (CFA), with the following results: 1) DTH induced by immunization with D -BSA remained constant in adult thymectomized mice, whereas the suppression of antibody response was not inducible in these animals. 2) Injection of low doses of ATS caused the depression of DTH in mice primed with D -BSA, but did not affect the suppressive activities of their spleen cells. 3) Sublethal X-irradiation 1 week prior to D -BSA priming inhibited the generation of suppressor cells but did not affect the generation of cells mediating DTH. The suppressive effect was also abrogated by sublethal X-irradiation given 2 days after immunization with DNP-BSA (14 days after priming with D -BSA). 4) The treatment of animals with HC 2 days before the footpad challenge or immunization with DNP-BSA depressed the ability of animals to induce both DTH and the suppression of antibody response. However, the latter was more sensitive to HC than the former. In addition to these results, it was also found that D -BSA-primed spleen cells were capable of suppressing anti-DNP response, but not of inducing DTH-reactivity upon transfer to recipient mice. These results suggest that DTH-reactivity and the carrier-specific suppression of anti-hapten antibody response induced by injection of D -BSA are mediated by different cell populations.     

Measurement of absorbed doses from X-ray baggage examinations to tooth enamel by means of ESR and glass dosimetry

The contribution of radiation from X-ray baggage scans at airports on dose formation in tooth samples was investigated by electron spin resonance (ESR) dosimetry and by glass dosimetry. This was considered important, because tooth samples from population around the Semipalatinsk Nuclear Test Site (SNTS), Kazakhstan, had been transported in the past to Hiroshima University for retrospective dose assessment of these residents. Enamel samples and glass dosimeters were therefore examined at check-in time at Kansai airport (Osaka, Japan), Dubai airport (Dubai, United Arab Emirates) and Domodedovo airport (Moscow, Russia). These airports are on the route from Kazakhstan to Japan. Three different potential locations of the samples were investigated: in pocket (without X-ray scans), in a small bag (with four X-ray scans) and in large luggage (with two X-ray scans). The doses obtained by glass and ESR dosimetry methods were cross-compared. As expected, doses from X-ray examinations measured by glass dosimetry were in the μGy range, well below the ESR detection limit and also below the doses measured in enamel samples from residents of the SNTS.     

Radiation dose verification of an X-ray based blood irradiator using EBT3 radiochromic films calibrated using Gamma Knife machine

AimBlood irradiators (BI) initial acceptance testing and routine annual dosimetry checks require radiation dose measurements in order to comply with regulatory requirements.BackgroundTraditionally thermo-luminescence dosimeters (TLD) have been used to measure the dose. The EBT3 film is reported to be a better dosimeter for low energy X-rays than its predecessors EBT2 and EBT. To the best of our knowledge, the use of EBT3 films to perform dosimetry on X-ray based BI has not been reported yet.Materials and methodsWe performed routine radiation dosimetry checks using EBT3 films on a new X-ray based BI and compared the results with TLD dosimetry. Calibration films were irradiated with radiation beam from a Co-60 Gamma Knife (GK) radiosurgery machine and, alternatively, using an Ir-192 high dose rate (HDR) brachytherapy device. The films were calibrated to cover a wide dose range from 1 to 40 Gy. Such a wide dose range has not been reported yet in BI film dosimetry.ResultsWe obtained a relative difference of about 6.6% between doses measured using TLD and those measured using EBT3 films. Both irradiation methods using GK or HDR were found to be adequate for the calibration of the EBT3 Gafchromic films.ConclusionsWe recommend the use of EBT3 films in routine X-ray based BI dosimetry checks. The presented method takes advantage of available radiotherapy equipment that can be efficiently used for EBT3 films calibration. The method is fast, reproducible and saves valuable medical physicist's time.     

Effects of sodium butyrate on X-ray and bleomycin-induced chromosome aberrations in human peripheral blood lymphocytes.

Peripheral blood lymphocytes from normal human volunteers or from Down syndrome patients were pre-treated with sodium butyrate (a compound which is known to induce structural modifications in the chromatin through hyperacetylation of nucleosomal core histones) and exposed to X-irradiation or treated with bleomycin in vitro in the G0 and/or G1 stage(s) of the cell cycle. The frequencies of chromosomal aberrations in the first mitosis after treatment were scored. The results show an enhancement in the yield of aberrations in the butyrate pre-treated groups. However, the absolute frequencies of chromosomal aberrations as well as the relative increases with butyrate pre-treatment varied between blood samples from different donors suggesting the existence of inter-individual variations. There is a parallelism between the effects of X-irradiation or of combined treatments in G0 and G1 stages and between effects observed in the X-ray and bleomycin series. The increase in the yields of chromosomal aberrations in butyrate-treated and X-irradiated lymphocytes (relative to those which received X-irradiation alone) is interpreted as a consequence of the inhibition of repair of DNA damage by butyrate.     

An oxygen dependent X-ray lesion in Escherichia coli strain B/r detected by penicillin.

Enhancement of lethal damage to E. coli B/r by penicillin was observed after X-irradiation under aerobic conditions but not after exposure to X-rays under anoxia or after U.V. (260 nm). No enhancement of damage occurred when incubation with penicillin was delayed for 2 hours after aerobic X-irradiation. This enhancing effect was only detected in this strain and not in the filamentous strain E. coli B. It is concluded that an X-ray induced lesion, sensitive to the presence of oxygen at the time of irradiation and probably located in the cell envelope, initiates filamentation in E. coli B/r, which results in lethal damage in this strain.     

A comparative dosimetry study of an alanine dosimeter with a PTW PinPoint chamber at ultra-high dose rates of synchrotron radiation

The use of synchrotron X-ray sources provides innovative approaches in radiation therapy. The unique possibility to generate quasi-parallel beams promoted the development of microbeam radiation therapy (MRT), an innovative approach able to reduce damages to normal tissues while delivering considerable doses in the lesion. Accurate dosimetry in broad-beam configuration (prior to the spatial fractionation of the incident X-ray fan) is very challenging at ultra-high dose rate synchrotron sources.The available reference dosimetry protocol based on the use of a PTW PinPoint ionization chamber was compared with alanine dosimetry at the European Synchrotron Radiation Facility (ESRF) ID17 Biomedical beamline, an orthovoltage X-ray source with an average dose rate of 11.6 kGy/s. Reference dose measurements of the alanine pellets were performed at the National Centre for Radiation Research and Technology (NCRRT) ⁶⁰Co facility in Egypt. All alanine dosimeters were analysed by an electron paramagnetic resonance spectrometer.We determined a relative response r_ESRF = 0.932 ± 0.027 (1σ) of the alanine pellets irradiated at the ESRF compared to the ⁶⁰Co facility. Considering the appropriate corrections for the ESRF polychromatic spectrum and the different field size used, our result is in agreement with the previous work of Waldeland et al. for which the utilised alanine contained the same amount of binder, and it is consistent with the works of Anton et al. and Butler et al. for which the utilised alanine contained a higher amount of binder.We confirm that alanine is an appropriate dosimeter for ultra-high dose rate calibration of orthovoltage X-ray sources.