Search

Background: The biological effects and clinical consequences of out-of-field radiation in peripheral organs can be difficult to determine, especially for low doses (0.1 Gy-1 Gy). In recent years, Monte Carlo (MC) methods have been proposed to more accurately predict nontarget doses. The aim of the present study was to assess the feasibility of using Monte Carlo methods to predict the biological response of tissues and critical organs to low dose radiation (0.1 to 1 Gy) based on results published in the literature. Materials and methods: Literature review, including studies published by our group. Results and Conclusions: It has long been assumed that radiation doses to peripheral organs located far from the target volume are too low to have any clinical impact. In recent years, however, concerns about the risk of treatment-induced secondary cancers, even in peripheral organs, have continued to grow in line with increasing life expectancy. At present, it is difficult in routine calculations to accurately determine radiation doses to the whole body and peripheral organs. Moreover, the potential clinical impact of these doses remains uncertain and the biological response to low dose radiation depends on the organ. In this context, MC methods can predict biological response in those organs. Monte Carlo methods have become a powerful tool to better predict the consequences of interactions between ionising radiation and biological matter. MC modelling can also help to characterise microscopic system dynamics and to provide a better understanding of processes occurring at the cellular, molecular, and nanoscales. [ABSTRACT FROM AUTHOR]

Background: Proton therapy has garnered attention as an advanced radiation treatment modality for breast cancer due to its ability to deliver highly precise doses to the target area while minimizing exposure to surrounding healthy tissues. The aim was to detect potential variations in radiobiological response along different parts of the proton depth-dose curve. Materials and methods: MDA-MB-231 cells were specifically irradiated before, within, and beyond the Bragg peak with a 5 Gy dose, with photons used as a reference. The radiobiological response was evaluated using clonogenic assays, relative γH2AX levels, and quantitative polymerase chain reaction (qPCR) analysis of DNA damage response genes. Results: A trend of increasing magnitude in radiobiological response was observed with increasing depth of cell irradiation, accompanied by a decrease in survival fraction. Furthermore, differences were noted, particularly in γH2AX levels along the Bragg peak, with higher values of DNA double-strand breaks (DNA DSB) observed at the end of the depth-dose curve. Conclusions: These findings suggest that despite administering a consistent proton dose to the target area, there can be a range of different biological reactions, which might have significant indications for clinical procedures. [ABSTRACT FROM AUTHOR]

Background: Clinical audits are an important tool to objectively assess clinical protocols, procedures, and processes and to detect deviations from good clinical practice. The main aim of this project is to determine adherence to a core set of consensus-based quality indicators and then to compare the institutions in order to identify best practices. Materials and methods: We conduct a multicentre, international clinical audit of six comprehensive cancer centres in Poland, Spain, Italy, Portugal, France, and Romania as a part of the project, known as IROCATES (Improving Quality in Radiation Oncology through Clinical Audits -- Training and Education for Standardization). Results: Radiotherapy practice varies from country to country, in part due to historical, economic, linguistic, and cultural differences. The institutions developed their own processes to suit their existing clinical practice. Conclusions: We believe that this study will contribute to establishing the value of routinely performing multi-institutional clinical audits and will lead to improvement of radiotherapy practice at the participating centres. [ABSTRACT FROM AUTHOR]

Background: Cancer-associated fibroblasts (CAFs) are a diverse subset of cells, that is recently gaining in popularity and have the potential to become a new target for breast cancer (BC) therapy; however, broader research is required to understand their mechanisms and interactions with breast cancer cells. The goal of the study was to isolate CAFs from breast cancer tumour and characterise isolated cell lines. We concentrated on numerous CAF biomarkers that would enable their differentiation. Materials and methods: Flow cytometry, immunofluorescence, and reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) were used to phenotype the primary CAFs. Results/Conclusions: According to our findings, there was no significant pattern in the classification of cancer-associated fibroblasts. The results of biomarkers expression were heterogeneous, thus no specific subtypes were identified. Furthermore, a comparison of cancer-associated fibroblasts derived from different BC subtypes (luminal A and B, triple-negative, HER2 positive) did not reveal any clear trend of expression. [ABSTRACT FROM AUTHOR]

Since the introduction of computed tomography for planning purposes in the 1970s, we have been observing a continuous development of different imaging methods in radiotherapy. The current achievements of imaging technologies in radiotherapy enable more than just improvement of accuracy on the planning stage. Through integrating imaging with treatment machines, they allow advanced control methods of dose delivery during the treatment. This article reviews how the integration of existing and novel forms of imaging changes radiotherapy and how these advances can allow a more individualised approach to cancer therapy. We believe that the significant challenge for the next decade is the continued integration of a range of different imaging devices into linear accelerators. These imaging modalities should show intra-fraction changes in body morphology and inter-fraction metabolic changes. As the use of these more advanced, integrated machines grows, radiotherapy delivery will become more accurate, thus resulting in better clinical outcomes: higher cure rates with fewer side effects. [ABSTRACT FROM AUTHOR]

FLASH radiotherapy (RT) is a technique involving the delivery of ultra-high dose rate radiation to the target. FLASH-RT has been shown to reduce radiation-induced toxicity in healthy tissues without compromising the anti-cancer effects of treatment compared to conventional radiation therapy. In the present article, we review the published data on FLASH-RT and discuss the current state of knowledge of this novel approach. We also highlight the technological constraints and complexity of FLASH-RT and describe the physics underlying this modality, particularly how technology supports energy transfer by ionising radiation (e.g., beam on/off sequence, pulse-energy load, intervals). We emphasise that current preclinical experience is mostly based on FLASH electrons and that clinical application of FLASH-RT is very limited. The incorporation of FLASH-RT into routine clinical radiotherapy will require the development of devices capable of producing FLASH photon beams. [ABSTRACT FROM AUTHOR]

Background: The availability of linear accelerators (linac) for research purposes is often limited and therefore alternative radiation sources are needed to conduct radiobiological research. The National Centre for Radiation Research in Poland recently developed an intraoperative mobile linac that enables electron irradiation at energies ranging from 4 to 12 MeV and dose rates of 5 or 10 Gy/min. The present study was conducted to evaluate the electron beam parameters of this intraoperative linac and to verify the set-up to evaluate out-of-field doses in a water phantom, which were determined through dosimetric and biological response measurements. Materials and methods: The distribution of radiation doses along and across the radiation beam were measured in a water phantom using a semiconductor detector and absolute doses using an ionisation chamber. Two luminal breast cancer cell lines (T-47D and HER2 positive SK-BR-3) were placed in the phantom to study radiation response at doses ranging from 2 to 10 Gy. Cell response was measured by clonogenic assays. Results and Conclusion: The electron beam properties, including depth doses and profiles, were within expected range for the stated energies. These results confirm the viability of this device and set-up as a source of megavoltage electrons to evaluate the radiobiological response of tumour cells. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to compare the TNM classification with 2-[18F]FDG PE T biological parameters of primary tumor in patients with NSCLC. Materials and methods: Retrospective analysis was performed on a group of 79 newly diagnosed NSCLC patients. PET scans were acquired on Gemini TF PET/CT scanner 60-70 min after injection of 2-[18F]FDG with the mean activity of 364 ± 75 MBq, with the area being examined from the vertex to mid-thigh. The reconstructed PET images were evaluated using MIM 7.0 Software for SUVmax, MTV and TLG values. Results: The analysis of the cancer stage according to TNM 8th edition showed stage IA2 in 8 patients, stage IA3 -- 6 patients, stage IB -- 4 patients, IIA -- 3 patients, 15 patients with stage IIB, stage IIIA -- 17 patients, IIIB -- 5, IIIC -- 5, IVA in 7 patients and stage IVB in 9 patients. The lowest TLG values of primary tumor were observed in stage IA2 (11.31 ± 15.27) and the highest in stage IIIC (1003.20 ± 953.59). The lowest value of primary tumor in SUVmax and MTV were found in stage IA2 (6.8 ± 3.8 and 1.37 ± 0.42, respectively), while the highest SUVmax of primary tumor was found in stage IIA (13.4 ± 11.4) and MTV in stage IIIC (108.15 ± 127.24). Conclusion: TNM stages are characterized by different primary tumor 2-[18F]FDG PET parameters, which might complement patient outcome. [ABSTRACT FROM AUTHOR]

Greater Poland is a region with a high risk of cancer. In terms of age-standardised incidence rate, it is ranked 2nd for men and 3rd for women out of Poland's 16 provinces. Incidence structure in the region of Greater Poland is similar to that in other West European countries. The most common cancers in men are lung, prostate and colorectal, in women: breast, colorectal and lung. In 2016, nearly every third cancer-related death in the region was caused by lung cancer. In women, it was cause no. one. The incidence of chronic diseases, including cancer, is expected to further grow in view of the global ageing of the population. This means that malignancies will remain to be a major challenge for public health care.in the Greater Poland region. [ABSTRACT FROM AUTHOR]

• Relation of dose distribution and plan complexity is a good tool for plans scoring. • MU reduction tool used during VMAT-TMI creation reduce complexity of the plan. • Simultaneously optimised 8-arcs with MU reduction is recommended for VMAT-TMI. Evaluation of different planning methods of treatment plan preparation for volumetric modulated arc therapy during total marrow irradiation (VMAT-TMI). Three different planning methods were evaluated to establish the most appropriate VMAT-TMI technique, based on organ at risk (OAR) dose reduction, conformity and plan simplicity. The methods were: (M 1) the sub-plan method, (M 2) use of eight arcs optimised simultaneously and (M 3) M 2 with monitor unit reduction. Friedman ANOVA comparison, with Nemenyi's procedures, was used in the statistical analysis of the results. The dosimetric results obtained for the planning target volume and for most OARs do not differ statistically between methods. The M 3 method was characterized by the lowest numbers of monitor units (3259 MU vs. 4450 MU for M 1 and 4216 MU for M 2) and, in general, the lowest complexity. The variability of the monitor units from control points was almost half for M 3 than M 1 and M 2 (i.e. 0.33 MU vs. 0.61 MU for M 1 and 0.58 for M 2). Analysing the relationship between the dose distributions obtained for the plans and their complexity, the best result was observed for the M 3 method. The use of eight simultaneously optimised arcs with MU reduction allows to obtain VMAT-TMI plans that are characterized by the lowest complexity, with dose distributions comparable to the plans generated by other methods. [ABSTRACT FROM AUTHOR]

To analyse the impact of different optimization strategies on the compatibility between planned and delivered doses during radiotherapy of cervical cancer. Four treatment plans differing in optimisation strategies were prepared for ten cervical cancer cases. These were: volumetric modulated arc therapy with (_OPT) and without optimization of the doses in the bone marrow and for two sets of margins applied to the clinical target volume that arose from image guidance based on the bones (IG(B)) and soft tissues (IG(ST)). The plans were subjected to dosimetric verification by using the ArcCHECK system and 3DVH software. The planned dose distributions were compared with the corresponding measured dose distributions in the light of complexity of the plans and its deliverability. The clinically significant impact of the plans complexity on their deliverability is visible only for the gamma passing rates analysis performed in a local mode and directly in the organs. While more general analyses show statistically significant differences, the clinical relevance of them has not been confirmed. The analysis showed that IG(ST)_OPT and IG(B)_OPT significantly differ from IG(ST) and IG(B). The clinical acceptance of IG(ST)_OPT obtained for hard combinations of gamma acceptance criteria (2%/2 mm) confirm its satisfactory deliverability. In turn, for IG(B)_OPT in the case of the rectum, the combination of 2%/2 mm did not meet the criteria of acceptance. Despite the complexity of the IG(ST)_OPT, the results of analysis confirm the acceptance of its deliverability when 2%/2 mm gamma acceptance criteria are used during the analysis. [ABSTRACT FROM AUTHOR]

Abstract Background The calculation and measurement on the surface of the skin presents a significant dosimetric problem because of numerous factors which have an influence on the dose distribution in this region. Aim The overall aim of this study was to check the agreement between doses measured with thermoluminescent detectors (TLD) during tomotherapy photon beam irradiation of the skin area of a solid water cylindrical phantom with doses calculated with Hi-Art treatment planning system (TPS). Material and Method The measurements of the dose were made with the use of a solid water cylindrical phantom - Cheese Phantom. Two bolus phantoms were used: 5 mm and 10 mm Six different planning treatments were generated. The doses were measured using TL detectors. Results In the case of a tumor located near the surface of the skin, the mean dose for 0.5 cm bolus was - 1.94 Gy, and for 1 cm bolus - 2.03 Gy. For the tumor located inside the phantom and organ at risk on the same side that TL detectors, for a 0.5 cm bolus, mean dose was 0.658 Gy, and for a 1 cm bolus, 0.62 Gy. Conclusion The analysis of results showed that the relative percentage difference between measured and planned dose in the field of irradiation was less than 10%, while the largest differences were on the board of the field of radiation and outside of the field of irradiation, where the dose was 0.08 Gy to 1 Gy. [ABSTRACT FROM AUTHOR]

Highlights • Different IG protocols implicates different margins for specified parts of CTV. • For IG based on bones, margins for lymph nodes are smallest. • For IG based on soft tissues, margins for vagina/paravaginal tissues are smallest. • Size of margins for lymph nodes do not affect on dose in bone marrow. • VMAT supported by IG based on soft tissue are recommended for RT of cervical cancer. Abstract Purpose In this study, relations between dose cumulated in organs at risk and treatment based on different image guidance strategies (IG) of cervical cancer were analyzed. Material/methods Thirty patients with cervical cancer were subjected to analysis. The first phase of the study involved analysis of shifts resulting from the registration process and calculations of margins based on shifts data. The margin was calculated for two imaging scenarios – based on the analysis of bones and soft tissues. The margins thus obtained were used in the second phase of the study where the VMAT and IMRT treatment plans were prepared and, in consequence, analyzed in the light of the dose distribution. Results Using different IG implicates different margins for specified parts of the CTV. IG based on bones allows to establish margins for lymph nodes (CTV2) that are smaller than margins for the vagina/paravaginal tissues (CTV1). The opposite applies to the IG based on soft tissues, for which margins for CTV1 are smaller than for CTV2. While decreasing the margins for CTV1 reduces the doses in the bladder and rectum, doses cumulated in the bone marrow are independent of the size of the margin resulting from the type of IG used. Nevertheless, the average doses and the values of normal tissue complication probability in the bone marrow were smaller for VMAT than for IMRT. Conclusion The VMAT plan and image guidance based on soft tissue registration for the vagina/paravaginal tissues are recommended for radiotherapy of cervical cancer patients. [ABSTRACT FROM AUTHOR]

Purpose To compare normal tissue complication probability (NTCP) and average doses in the bone marrow (BM), obtained for five different radiotherapy delivery and planning strategies of cervical and endometrial cancer. Material/methods 50 patients were taken to analysis. For each case, 3 different dose delivery techniques were used: 4-field, X15MV, 3DCRT; 7-field, X6MV, IMRT; and 2-arc, X6MV, VMAT. Two optimization scenarios were used for the IMRT and VMAT plans generation: with (+) and without (−) the inclusion of the BM as an optimized structure. Average doses and dose-volume histogram parameters for the PTV, BM, bladder, rectum, bowels and femoral heads were compared. In addition, the BM doses were analyzed with respect to the PTV and/or volume of the BM, and NTCP for the BM were computed. Results The dose in PTV for evaluated plans was similar. The worst doses in organs at risk were obtained for 3DCRT. Using the BM during the optimization of IMRT and VMAT reduces an average dose in BM without increasing the doses in the bladder, rectum and bowels. Differences between doses in BM for IMRT(+) and VMAT(+) plans were similar while NTCP was lower for VMAT(+). A correlation between average dose in BM and the volume ratio of BM and PTV was found for each technique. Conclusion Using the BM during the optimization of the IMRT and VMAT plans effectively reduces the dose in BM without increasing the dose in the bladder, rectum and bowels. The VMAT(+) plans were characterized by the lowest NTCP. [ABSTRACT FROM AUTHOR]

Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine. [ABSTRACT FROM AUTHOR]

Background and aim The Greater Poland Region is one of the most industrialised areas of Poland, with a high rate of cancer incidence and mortality. The present report estimated incidence and mortality data for Greater Poland in the year 2010. Methods Statistical reports in this study include absolute number of cases and crude incidence rates. The derived age-, sex-, and site specific rates were age-standardised (ASRs per 100,000 person-years) using the European (ASRE) standard population. Results In 2010, a total 13,581 new cancer cases were reported to the Greater Poland Cancer Registry. The number of new cases increased by 24% compared to 2001. Greater Poland has the second-highest ASR for both females and males among the 16 regions in Poland. The most common cancers are similar to those in other Western European countries. Among men, the most common cancers are lung (C34), colorectal (C18-C21), and prostate (C61) cancer. In women, breast cancer is the most common (C50), followed by colon (C18-C21) and lung (C34) cancer. Lung cancer in males accounts for more than one-third of all cancer-related deaths in Greater Poland. As in 2009, lung cancer is the leading cause of death in women. Conclusions Given the ageing of the population, the incidence of chronic diseases, including cancer, is expected to grow. These data indicate that cancer will continue to represent an important challenge both to local health authorities and the National Health Fund, which will need to meet the growing demand for cancer care. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: To evaluate the impact interfraction prostate (CTV1) motion corrections on doses delivered to seminal vesicles (CTV2) and lymph nodes (CTV3), and to determine ideal planning target volume (PTV) margins for these targets with prostate-based position verification. Material and methods: Retrospective analysis based on 253 cone beam computed tomography (CBCT) studies of 28 patients. The isocenter-shift method was used to estimate the interfraction prostate and bony shift effects on the original plan coverage. Friedman's test was used to assess statistical significance between dose-volume histogram (DVH) parameters which were calculated for prostate-based sum plans, bony-based sum plans and original treatment plans. The van Herk formula was used to determine the set-up margin size for prostate-based verification. Results: The tracked shifts influenced the minimum, maximum and mean CTV2 and CTV3 doses, with a range differential of 0.17%–2.63% (prostate shifts) and 0.13%–1.92% (bony shifts) compared to the corresponding original parameters. Friedman's test revealed significant differences in the minimum doses to the CTV3 and maximum doses to both the CTV2 and CTV3. The calculated set-up margins of 1.22 cm (vertical), 0.19 cm (longitudinal) and 0.39 cm (lateral) should be added to CTV3 while performing prostate-based positioning. Conclusion: To avoid geographical miss during simultaneous irradiation of independently moving targets (CTV1-3) appropriate margins should be used in accordance with the position verification method used. Based on our findings the following margin sizes should be used: 0.7 cm for the CTV1, 0.8–0.9 cm for the CTV2 , and asymmetric 1.0 cm (vertically) and 0.5 cm (other axes) for the CTV3. [Copyright &y& Elsevier]

Abstract: Aim: To present the results obtained using radiochromic films EBT and RTQA 1010P for the reconstruction the dose distributions for targets irradiated by proton beam and modified by wax boluses. Background: In Medico-Technical Complex at the Joint Institute for Nuclear Research in Dubna implemented technology of wax boluses. Materials and methods: Wax boluses are easier to make and they give better dose distributions than boluses made from modeling clay previously used at our center. We irradiated two imaginary targets, one shaped as a cylinder and the other one as two cuboids. The evaluated calibration curve was used for calculation of the dose distributions measured by the EBT and RTQA radiochromic film. In both cases, the measured dose distributions were compared to the dose distributions calculated by the treatment planning system (TPS). We also compared dose distributions using three different conformity indices at a 95% isodose. Results: Better target coverage and better compliance of measurements (semiconductor detectors and radiochromic films) with calculated doses was obtained for cylindrical target than for cuboidal target. The 95% isodose covered well the tumor for both target shapes, while for cuboidal target larger volume around the target received therapeutic dose, due to the complicated target shape. The use wax boluses provided to be effective tool in modifying proton beam to achieve appropriate shape of isodose distribution. Conclusion: EBT film yielded the best visual matching. Both EBT and RTQA films confirmed good conformity between calculated and measured doses, thus confirming that wax boluses used to modify the proton beam resulted in good dose distributions. [Copyright &y& Elsevier]

Abstract: Background and purpose: To evaluate the current status of radiotherapy facilities, staffing, and equipment, treatment and patients in Poland for the years 2005–2011 following implementation of the National Cancer Programme. Methods: A survey was sent to the radiotherapy centres in Poland to collect data on available equipment, staffing, and treatments in the years 2005–2011. Results: In 2011, 76,000 patients were treated with radiotherapy at 32 centres vs. 63,000 patients at 23 centres in 2005. Number of patients increased by 21%. In 2011, there were 453 radiation oncologists – specialists (1 in 168 patients), 325 medical physicists (1 in 215 patients), and 883 radiotherapy technicians (1 in 86 patients) vs. 320, 188, and 652, respectively, in 2005. The number of linear accelerators increased by 60%, from 70 units in 2005 to 112 in 2011. The current linac/patient ratio in Poland is 1 linac per 678 patients. Waiting times from diagnosis to the start of treatment has decreased. Conclusion: Compared to 2005, there are more treatment facilities, more and better equipment (linacs), and more cancer care specialists. There are still large differences between the 16 Polish provinces in terms of equipment availability and ease of access to treatment. However, radiotherapy services in Poland have improved dramatically since the year 2005. [Copyright &y& Elsevier]

Abstract: Background and purpose: High dose rate (HDR) brachytherapy is a clinically used procedure in prostate cancer treatment. The purpose of this study was to present the influence of using different optimization algorithms in 3D-CBRT planning on the treatment plan quality. Materials and methods: Treatment plans were calculated for 15 patients – three plans for each patient using: geometrical optimization (GO), inverse optimization (IO) and blind inverse optimization (BIO). For each patient, PTV and OAR volumes, number of needles and geometry of the implant were set equal. Differences between dose distributions were tracked using: D90, V100, V200, Dmax (for prostate); D10, Dmax (for urethra); D10, V100, Dmax (for rectum). Results: The analysis of mean values of D90 and V100 in the prostate showed that inverse algorithms gave the best results (mean D90 was 12.1% for BIO and 9.3% for IO better than for GO, mean V100 was 8.2% for BIO and 6.3% for IO better than for GO). From a clinical point of view, GO diminished the doses in the PTV and urethra in all analyzed parameters. The lowest mean doses in the rectum were achieved for plans optimized with IO and BIO (mean D10: 61.2% for GO, 58.1% for IO, 58.0% for BIO; mean Dmax: 92.8% for GO, 85.1% for IO, 83.6% for BIO). Conclusions: Application of the blind inverse optimization (BIO) algorithm led to clinically best dose parameters for PTV and the rectum. Use of geometrical optimization (GO) led to smaller doses in the urethra, which was however associated with a certain dose decrease also in PTV. [Copyright &y& Elsevier]

Abstract: Purpose: To 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 methods: In-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. Results: Modifications 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. Conclusion: The application of the presented methodology revealed cost-effectiveness relationships in tested technical procedures. [Copyright &y& Elsevier]

Abstract: We wanted to verify the response of radiochromic films in a 175MeV clinical proton beam used at the Joint Institute for Nuclear Research in Dubna against doses measured using semiconductor detectors and compare the results with published data from other centres. Radiochromic films (RCFs) MD-55 and a Vidar VXR-16 scanner were used. The films were irradiated in an unmodulated proton beam and with a beam modulated with a bolus and a ridge filter. Obtained dose distributions were compared with dose distributions measured with a Si-semiconductor detector. For the unmodulated beam the difference between the RCF and the semiconductor detector was 12% in the Bragg peak top. For the modulated beam the difference inside the spread-out Bragg peak region was 4%. Observed deviations between doses measured with RCF and Si-detector outside the Bragg peak were caused by the inhomogeneity of radiochromic emulsion. In the Bragg peak region the RCF doses were lower than those measured by semiconductors. The results were in agreement with published data from other proton therapy centres. [Copyright &y& Elsevier]

Abstract: Background/Aim: To examine the new dose-volume verification tool, called the two-component conformity index formula (TCCI), for tumours of the pituitary gland and tonsil cancer IMRT plans using helical Tomotherapy and a linear accelerator. Material and Methods: 10 medically inoperable patients – 5 with tumour of the pituitary gland and 5 tonsil cancers – were considered. Tomotherapy and Eclipse plans were compared by DVH analysis and new TCCI analysis including: 1/ the physician''s intents for dose distribution in PRVs, 2/ more than one dose-volume constraint for dose distribution in PTV and healthy tissues, and 3/ separation between coverage and excess components. Results: DVH analysis shows differences for the PTV received doses close to the prescription dose (PD): 1/in pituitary gland, Eclipse – 61% of PTV volume enclosed by PD and Tomotherapy – 50%, and 2/in tonsil cancer, Eclipse plans – 44% and Tomotherapy – 55%. These differences were clinically confirmed for tonsil cancer through TCCI analysis. Moreover, TCCI analysis shows better coverage of PTV volume through 90% and 95% isodose levels for Tomotherapy plans. Better high dose region reduction for brain stem and optic chiasm in pituitary gland and middle dose region reduction for parotids and spinal cord in tonsil and dose reduction in healthy tissues reported by TCCI analysis were observed for Tomotherapy plans. Conclusions: The usefulness of the information provided means that TCCI could be used as a primary or alternative method of quick dose-volume verification finally supported by advanced DVH analysis. [Copyright &y& Elsevier]

Abstract: Aim: Dosimetric verification of the dose optimisation model used in endovascular brachytherapy, evaluation of the optimised dose distributions using elaborated indices. Background: The equipment used for standard radiotherapy is used in vascular brachytherapy for prevention of restenosis after angioplasty. Material and Method: A paraffin-wax phantom, thermoluminescent detectors and MD-55 Gafchromic® films were used for dose measurements. The edge dose index (EDI), central dose index (CDI) and treatment length index (TLI) were introduced to compare dose distributions calculated and measured. Results: Obtained values (p>0.05) show no statistically significant differences between calculated doses and measured doses. EDI values showed improvement in dose homogeneity on the edges of the application after optimisation. After optimisation CDI values from 0.9% to 1.6% for calculated and from −1.8% to 3.1% for measured showed improvement in dose homogeneity in the central part of the application. Observed values of TLI from 3% to 21% for calculated doses and from 7% to 24% for doses measured by Gafchromic® films showed increase of RIL for optimised treatment plans. Conclusions: 1/ The designed phantom allowed repeatable dosimetric verification of dose distributions in endovascular brachytherapy. 2/ Measurements with thermoluminescent detectors and Gafchromic films proved the accuracy of the calculation algorithm in endovascular brachytherapy conditions. 3/ Elaborated indices were found to be a useful tool in describing dose homogeneity. They allowed the process of optimisation to be controlled and thus an increase in dose homogeneity by 30% at the edges and by 7% in the middle of the treated volume to be achieved. [Copyright &y& Elsevier]

Summary: Background: On 24 December 2002, in compliance with Euratom Directive 97/43, the Minister of Health issued an ordinance on rules and regulations of safe application of ionising radiation for medical purposes and methods of internal control over observance of the rules and regulations. The ordinance obliges managers of institutions which apply ionising radiation for medical purposes (radiotherapy, X-ray diagnostics, nuclear medicine) to implement, maintain and develop the Quality Management System (QMS). On 25 August 2005, the Minister of Health issued an ordinance on rules and regulations of safe application of ionising radiation with reference to all types of medical exposure which overruled the ordinance of 24.12.2002. Aim: The purpose of this paper was (i) the comparative analysis of the aforementioned ordinances in the context of three selected aspects: internal audits, external audits and the system of quality management, and (ii) the analysis of the rise in labour costs, services, depreciation and materials in 2002–2005, as a result of the implementation of the aforementioned legal rules and regulations. Materials and Methods: A comparative analysis of the two a fore mentioned ordinances of the Minister of Health was performed: concerning (i) external clinical audits, (ii) internal clinical audits and (iii) requirements of the quality management system. The total cost of implementation of such rules and regulations (in particular the cost of the Quality Management System) has been calculated based on an analysis of labour costs, depreciation, materials and services in 2002–2005. Results: Legislative changes in the scope of safe application of ionising radiation for medical purposes enhance not only the organisation of health care institutions applying radiotherapy, but also the rise in costs of the organisations as a result of implementation of the changes, e.g. through (i) the costs of salaries for work groups or consulting companies implementing QMS, (ii) costs of external services, dosimetric audits by independent calibration laboratories, (iii) costs of QMS certification, (iv) awards and bonuses for internal auditors, (v) costs of service contracts, etc. Conclusions: The implementation of the quality management system, modernisation of technical infrastructure, systematic controls and measurements of apparatuses and procedures, more effective work organisation, repeatability, regularity and homogeneity not only enhance the quality of medical service, but also the costs in radiotherapy. [Copyright &y& Elsevier]

Summary: Background: Cancer incidence and its mortality depend on a number of factors, including age, socio-economic status and geographic situation, and its incidence is growing around the world [1]. Cancer incidence in Europe is now about 4000 patients per million per year and due to the ageing population a yearly increase of 1–1.5% in cancer cases is estimated in the next two decades [2–4]. Most of the cancer treatments will include external beam radiotherapy or brachytherapy. Brachytherapy has increased its use as a radical or palliative treatment and become more sophisticated with the spread of pulsed dose rate and high dose rate afterloading machines, and the use of new planning systems has additionally improved quality of treatment [5–14] Aim: The aim of the present study was to compare two countries (Poland and Spain) and to report the differences in the use of brachytherapy in these countries. For this reason, several characteristics related to brachytherapy were compared. Materials/Methods: The data used were collected using a website questionnaire for the year 2002 where every centre that participated in the survey could introduce, change or update the information requested. Hospitals included in the study were those that provided data on brachytherapy, because our objective was to compare the brachytherapy facilities between Poland and Spain. Results: Data were available for 22 centres in Poland and 39 centres in Spain that provided brachytherapy in 2002. Spain having more centres that applied brachytherapy (1.0 centre per 1,000,000 inhabitants in Spain vs. 0.6 centre per 1,000,000 inhabitants in Poland), the average number of brachytherapy patients per centre is lower in Spain than in Poland, 137 and 382 respectively. The 5 main tumour sites treated with brachytherapy in Poland were: gynaecological (73.7%), bronchus (13.0%), breast (2.8%), prostate (2.4%) and head and neck (1.6%). In Spain they were: gynaecological (59.7%), breast (15.4%), prostate (12.8%), head and neck (4.2%) and bronchus (1.5%). Statistically significant differences were found in the number of gynaecological, bronchial and breast brachytherapy patients between the countries. Conclusions: Although both countries belong to the European Union, there were observed several differences in the use of brachytherapy. We also found some differences in the brachytherapy techniques used in prostate and head and neck cancers. [Copyright &y& Elsevier]

Purpose Intraoperative electron radiotherapy (IOERT) is a technique enabling to deliver a high dose of ionizing radiation in a single session directly to the surgically exposed organ or tumor bed with the use of a mobile accelerator. Due to the specific features of an intraoperative accelerator in compare to a conventional linear accelerator, it is necessary to develop dedicated Quality Assurance programme. The aim of this study was to develop recommendations for quality control tests and risk management for IOERT to be applicable to three types of accelerators. Methods Two types of accelerators for IOERT are currently used clinically in Poland (Mobetron, IntraOp and Novac11, Sordina), while the third (IntralineIOERT, HITEC ZdAJ) built by the National Centre for Nuclear Research in Poland, is being prepared for clinical use. The authors analysed available recommendations and publications for IOERT accelerators published by the American Association of Physicists in Medicine, Italian – Instituto Superiore di Sanità, by International Atomic Energy Agency and Polish regulations. The study was focused on the description of technological solutions for intraoperative mobile accelerators and development of a consensus on QA tests, proposing in particular: frequency, methodology for QA tests, ranges of tested parameters; the method of dose specification and reporting as well as procedures for risk management of the IOERT. Results The authors divided tests on: daily (door interlock, warning light, accessories, docking system and beam parameters like output and energy constancy); every 4 months (emergency dose counter and beam parameters: energy, symmetry, flatness and output in comparison to the reference values); every 6 months (dose linearity and dose output stability for various gantry angles); annual (stability of the water-to-solid phantom coefficient, output stability during day of work). The most important aspects in IOERT that required additional tests are: non-standard dosimetric measurement conditions (high dose rate and dose per pulse, circle-shaped field size, beveled applicators), docking and positioning system during RT (no lasers and field light simulation). Conclusions It was possible to develop recommendations with parameters to be verified and define values and its ranges values for IOERT, which can be performed effectively for all three studied accelerators. [ABSTRACT FROM AUTHOR]