Earticle

Background: To monitor proton beam in proton therapy, prompt gamma imaging systems are being developed by several research groups, and these systems are expected to improve the quality of the treatment and the patient safety. To apply the prompt gamma imaging systems into spot scanning proton therapy, the systems should be able to monitor the proton beam range of a spot with a small number of protons ( <108 protons), which is quite often not the case due to insufficient prompt gamma statistics. Materials and Methods: In the present study, we propose to improve prompt gamma statistics by merging the prompt gamma distributions of several individual spots into a new distribution. This proposal was tested by Geant4 Monte Carlo simulations for a multi-slit prompt gamma camera which has been developed to measure the proton beam range in the patient. Results and Discussion: The results show that the proposed method clearly enhance the statistical precision of beam range measurement. The accuracy of beam range verification is improved, within ~1.4 mm error, which is not achievable before applying the developed method. Conclusion: In this study, we tried to improve the statistics of the prompt gamma statistics by merging the prompt gamma distributions of multiple spots, and it was found that the merged distribution provided sufficient prompt gamma statistics and the proton beam range was determined accurately.

Background: Management of an agricultural food product system following a nuclear accident is indispensable for reducing radiation exposure due to ingestion of contaminated food. The present study analyzes the effect of agricultural countermeasures on ingestion dose following a nuclear accident. Materials and Methods: Agricultural countermeasures suitable for domestic farming environments were selected by referring to the countermeasures applied after the Fukushima accident in Japan. The avertable ingestion doses that could be obtained by implementing the selected countermeasures were calculated using the Korean Agricultural Countermeasure Analysis Program (K-ACAP) to investigate the efficiency of each countermeasure. Results and Discussion: Of the selected countermeasures, the management of crops was effective when radionuclide deposition occurred during the growing season of plants. Treatment by soil additive and topsoil removal was effective when deposition occurred during the nongrowing season of plants. The disposal of milk was not effective owing to the small contribution of milk to the overall ingestion dose. Clean feeding of livestock was effective when deposition occurred during the growing season of fodder plants such as pasture and rice-straw. Finally, the effect of food restriction increased with the soil deposition density of radionuclide. The practical effect of countermeasures was very small when the avertable ingestion dose was absolutely low. Conclusion: The agricultural countermeasures selected to reduce the radionuclide ingestion dose after a nuclear accident must be made appropriate by considering the accident situation, such as the soil deposition density of the radionuclide and the deposition date in relation to farming cycles.

Background: Psammaplin A (PsA) is a radiosensitizer whereas its clinical application is hampered by poor bioavailability. This study aimed to synthesize novel radiosensitizers using PsA as the lead compound. Materials and Methods: Eight homodimeric disulfides were synthesized from corresponding acid and cystamine dihydrochloride in N-hydroxysuccinimide and dicyclohexylcarbodiimide coupling conditions. One monomeric thiol analog was obtained by reduction of homodimeric disulfide with dithiothreitol. Clonogenic assay was used to measure cell survival after irradiation and drug treatment in human lung cancer (A549) and glioblastoma (U373MG) cells. Results and Discussion: Using the PsA backbone, nine compounds were synthesized. Eight compounds showed variable cytotoxicity with 50% inhibitory concentrations ranging 16.14 μM to 150.10 μM (A549), and 13.25 μM to 50.15 μM (U373MG). Four and six compounds radiosensitized A549 and U373MG cells, respectively. Two compounds that radiosensitized both cell lines were tested for its inhibitory effects on DNMT1. One of them was shown to significantly inhibit DNMT1 activity. Conclusion: Novel compounds with radiosensitizing activity were synthesized. These compounds have a great potential to serve as a basis for the development of future radiosensitizers. Further investigation is warranted for their clinical application.

Background: Stereotactic ablative radiotherapy (SABR) plans in prostate cancer are compared and analyzed to investigate the low magnetic effect (0.35 T) on the dose distribution, with various dosimetric parameters according to low magnetic field. Materials and Methods: Twenty patients who received a 36.25 Gy in five fractions using the MR-IGRT system (ViewRay) were studied. For planning target volume (PTV), the point mean dose (Dmean), maximum dose (Dmax), minimum dose (Dmin) and volumes receiving 100% (V100%), 95% (V95%), and 90% (V90%) of the total dose. For organs-at-risk (OARs), the differences compared using Dmax, V50%, V80%, V90%, and V100% of the rectum; Dmax, V50%, V30Gy, V100% of the bladder; and V30Gy of both left and right femoral heads. For both the outer and inner shells near the skin, Dmean, Dmin, and Dmax were compared. Results and Discussion: In PTV analysis, the maximum difference in volumes (V100%, V95%, and V90%) according to low magnetic field was 0.54 ± 0.63% in V100%. For OAR, there was no significant difference of dose distribution on account of the low magnetic field. In results of the shells, although there were no noticeable differences in dose distribution, the average difference of dose distribution for the outer shell was 1.28 ± 1.08 Gy for Dmax. Conclusion: In the PTV and OARs for prostate cancer, there are no statistically-significant differences between the plan calculated with and without a magnetic field. However, we confirm that the dose distribution significantly increases near the body shell when a magnetic field is applied.

Background: There have been much efforts to develop the proper and realistic machine Quality Assurance (QA) reflecting on real Volumetric Modulated Arc Therapy (VMAT) plan. In this work we propose and test a special VMAT plan of plan-class specific (pcsr) QA, as a machine QA so that it might be a good solution to supplement weak point of present machine QA to make it more realistic for VMAT treatment. Materials and Methods: We divided human body into 5 treatment sites: brain, head and neck, chest, abdomen, and pelvis. One plan for each treatment site was selected from real VMAT cases and contours were mapped into the computational human phantom where the same plan as real VMAT plan was created and called plan-class specific reference (pcsr) QA plan. We delivered this pcsr QA plan on a daily basis over the full research period and tracked how much MLC movement and dosimetric error occurred in regular delivery. Several real patients under treatments were also tracked to test the usefulness of pcsr QA through comparisons between them. We used dynalog file viewer (DFV) and Dynalog file to analyze position and speed of individual MLC leaf. The gamma pass rate from portal dosimetry for different gamma criteria was analyzed to evaluate analyze dosimetric accuracy. Results and Discussion: The maxRMS of MLC position error for all plans were all within the tolerance limit of < 0.35 cm and the positional variation of maxPEs for both pcsr and real plans were observed very stable over the research session. Daily variations of maxRMS of MLC speed error and gamma pass rate for real VMAT plans were observed very comparable to those in their pcsr plans in good acceptable fluctuation. Conclusion: We believe that the newly proposed pcsr QA would be useful and helpful to predict the mid-term quality of real VMAT treatment delivery.

Background: The mid-term performance of clinical linear accelerator (LINAC) during volumetric modulated arc therapy (VMAT) treatment period is not performed in clinical practice and usually replaced with one-time plan quality assurance (QA). In this research we aim to monitor daily reproducibility of VMAT delivery from tracking individual leaf movement error and dosimetric error to evaluate the mid-term quality of the machine used. Materials and Methods: First, multileaf collimator (MLC) information was imported into MATLAB program to determine which of the MLC leaves in the leaf bank had the maximum RMS position error (maxRMS). We estimated where the maximum positional errors (maxPE) of the chosen leaf occur along its path length and tracked its daily variations over the entire treatment period. Secondly, picture information of dosimetric error from portal dosimetry was imported into MATLAB where representative high gamma index region (HGR) was determined as HGR with length of > 1 cm and their centers were daily tracked. Results and Discussion: The maxPEs in the brain and tongue cases were distributed broader than in other cases, but all data were found located within ± 0.5 mm. From first day to last day all of five cases show the similar visual pattern of HGRs and Centers of the longest HGRs remained within ± 1 mm of that in first day. These findings prove excellent mid-term performance of the LINAC used in VMAT treatments over a full course of treatment. Conclusion: Tracking the daily location changes of leaf movement and dosimetric error can be a good indicator of predicting the daily quality like stability and reproducibility of beam delivering in VMAT treatment.