Metformin Protects against Radiation-Induced Pneumonitis and Fibrosis and Attenuates Upregulation of Dual Oxidase Genes Expression

Purpose: Lung tissue is one of the most sensitive organs to ionizing radiation (IR). Early and late side effects of exposure to IR can limit the radiation doses delivered to tumors that are within or adjacent to this organ. Pneumonitis and fibrosis are the main side effects of radiotherapy for this organ. IL-4 and IL-13 have a key role in the development of pneumonitis and fibrosis. Metformin is a potent anti-fibrosis and redox modulatory agent that has shown radioprotective effects. In this study, we aimed to evaluate possible upregulation of these cytokines and subsequent cascades such as IL4-R1, IL-13R1, Dual oxidase 1 (DUOX1) and DUOX2. In addition, we examined the potential protective effect of metformin in these cytokines and genes, as well as histopathological changes in rat’s lung tissues. Methods: 20 rats were divided into 4 groups: control; metformin treated; radiation + metformin; and radiation. Irradiation was performed with a 60Co source delivering 15 Gray (Gy) to the chest area. After 10 weeks, rats were sacrificed and their lung tissues were removed for histopathological, real-time PCR and ELISA assays. Results: Irradiation of lung was associated with an increase in IL-4 cytokine level, as well as the expression of IL-4 receptor-a1 (IL4ra1) and DUOX2 genes. However, there was no change in the level of IL-13 and its downstream gene including IL-13 receptor-a2 (IL13ra2). Moreover, histopathological evaluations showed significant infiltration of lymphocytes and macrophages, fibrosis, as well as vascular and alveolar damages. Treatment with metformin caused suppression of upregulated genes and IL-4 cytokine level, associated with amelioration of pathological changes. Conclusion: Results of this study showed remarkable pathological damages, an increase in the levels of IL-4, IL4Ra1 and Duox2, while that of IL-13 decreased. Treatment with metformin showed ability to attenuate upregulation of IL-4–DUOX2 pathway and other pathological damages to the lung after exposure to a high dose of IR

Assessment of Dose Calculation Accuracy of TiGRT Treatment Planning System for Physical Wedged fields in Radiotherapy

Introduction Wedge modifiers are commonly applied in external beam radiotherapy to change the dose distribution corresponding to the body contour and to obtain a uniform dose distribution within the target volume. Since the radiation dose delivered to the target must be within ±5% of the prescribed dose, accurate dose calculation by a treatment planning system (TPS) is important. The objective of the present study was to quantify the dose calculation accuracy of TiGRT TPS for physical wedged fields in radiotherapy. Materials and Methods A Semiflex™ ionization chamber was used for dose measurements in a water phantom; TiGRT TPS was also applied for dose calculations. The central axis (i.e., high dose-small dose gradient), build-up (i.e., high dose-large dose gradient), off-axis (i.e., high dose-small dose gradient), and out-of-field (i.e., low dose-small dose gradient) regions were evaluated in this study. Finally, the confidence limit values were obtained to quantify the dose calculation accuracy of TPS in these regions. Results The confidence limit values for the central axis, build-up, off-axis, and out-of-field regions were 1.01, 8.62, 1.79, and 55.24, respectively. Furthermore, the results showed that TiGRT TPS underestimated the dose of build-up and out-of-field regions for most points. Conclusion According to the results of the present study, it can be concluded that the dose calculation accuracy of TiGRT TPS for physical wedged fields in the central axis, build-up, and off-axis regions is adequate, while it is insufficient for out-of-field regions

Evaluation of the photon dose calculation accuracy in radiation therapy of malignant pleural mesothelioma

Background: Photon dose distribution of malignant pleural mesothelioma (MPM) in matched photon-electron technique is influenced by media inhomogeneity, lateral electronic disequilibrium at interfaces and narrow field. These may influence the dose calculation accuracy, calculated by treatment planning systems (TPS). This study aimed to evaluate the dose calculation accuracy of TiGRT TPS in radiation therapy of MPM. Materials and Methods: 18 MV photon beams of ONCOR Siemens linear accelerator was simulated using EGSnrc Monte Carlo (MC) code. Data of four patients were used to compare TPS and MC results in different regions included: Open and in-field, under shied and out of field regions. Results: Compared to MC results, the TPS overestimated the pleura dose coverage (90% of prescribed dose) about 3-12 mm, and also it overestimated the dose in under the shielded regions of lung (4-74%). While the TPS underestimated the dose profile width about 1-16 mm in low dose region (<50% prescribed dose) as well as the out of field region dose (4-100%). Conclusions: Results showed that TPS underestimated the dose in out of field and overestimated the dose in under the shielded regions. Unlike MC measurements, TPS calculation showed adequate pleural dose coverage. Based on the results, MC calculation can be used in matched photon-electron beam radiation therapy of MPM to modify the TPS photon dose calculations in the presence of heterogeneity, interfaces, and shield in MPM radiotherapy

Evaluation of dose calculations accuracy of a commercial treatment planning system for the head and neck region in radiotherapy

AimThe objective was to quantify dose calculation accuracy of TiGRT TPS for head and neck region in radiotherapy.BackgroundIn radiotherapy of head and neck cancers, treatment planning is difficult, due to the complex shape of target volumes and also to spare critical and normal structures. These organs are often very near to the target volumes and have low tolerance to radiation. In this regard, dose calculation accuracy of treatment planning system (TPS) must be high enough.Materials and methodsThermoluminescent dosimeter-100 (TLD-100) chips were used within RANDO phantom for dose measurement. TiGRT TPS was also applied for dose calculation. Finally, difference between measured doses (Dmeas) and calculated doses (Dcalc) was obtained to quantify the dose calculation accuracy of the TPS at head and neck region.ResultsFor in-field regions, in some points, the TiGRT TPS overestimated the dose compared to the measurements and for other points underestimated the dose. For outside field regions, the TiGRT TPS underestimated the dose compared to the measurements. For most points, the difference values between Dcalc and Dmeas for the in-field and outside field regions were less than 5% and 40%, respectively.ConclusionsDue to the sensitive structures to radiation in the head and neck region, the dose calculation accuracy of TPSs should be sufficient. According to the results of this study, it is concluded that the accuracy of dose calculation of TiGRT TPS is enough for in-field and out of field regions

Assessment of the accuracy of dose calculation in the build-up region of the tangential field of the breast for a radiotherapy treatment planning system

Aim of the study : Our objective was to quantify the accuracy of dose calculation in the build-up region of the tangential field of the breast for a TiGRT treatment planning system (TPS). Material and methods : Thermoluminescent dosimeter (TLD) chips were arranged in a RANDO phantom for the dose measurement. TiGRT TPS was also used for the dose calculation. Finally, confidence limit values were obtained to quantify the accuracy of the dose calculation of the TPS at the build-up region. Results : In the open field, for gantry angles of 15°, 30°, and 60°, the confidence limit values were 17.68, 19.97, and 34.62 at a depth of 5 mm, and 24.01, 19.07, and 15.74 at a depth of 15 mm, respectively. In the wedge field, for gantry angles of 15°, 30°, and 60°, the confidence limit values were 21.64, 26.80, and 34.87 at a depth of 5 mm, and 27.92, 22.04, and 20.03 at a depth of 15 mm, respectively. Additionally, the findings showed that at a depth of 5 mm, the confidence limit values increased with increasing gantry angle while at a depth of 15 mm, the confidence limit values decreased with increasing gantry angle. Conclusions : Overall, TiGRT TPS overestimated doses compared to TLD measurements, and the confidence limit values were greater for the wedge field than for the open fields. Our findings suggest that the assessment of dose distributions in large-dose gradient regions (i.e. build-up region) should not entirely rely on TPS calculations

Evaluation of the accuracy of various dose calculation algorithms of a commercial treatment planning system in the presence of hip prosthesis and comparison with Monte Carlo

Purpose: High atomic number elements are commonly used in a hip prosthesis which can cause uncertainty in accurate dose calculations in radiation therapy. The aim of this study is to assess the accuracy of the three various algorithms of ISOgray treatment planning system in the presence of hip prosthesis by Monte Carlo (MC). Materials and Methods: A MC model of Siemens PRIMUS linear accelerator has been built and verified by the measured data of the different algorithms of ISOgray treatment planning systems (TPS) in 6 and 15 MV photon beam energies. Two types of hip prosthesis have been used: stainless steel and titanium. The accuracy of mentioned dose calculation algorithms in the presence of hip prosthesis was evaluated. Results: There were 24.78%, 27.68%, and 27.72% errors in fast Fourier transform (FFT) Convolution, collapsed cone (CC), and superposition in 6 MV photon beam and 26.45%, 30.45%, and 28.63% in 15 MV photon beam for titanium type, respectively. However, there were 32.84%, 35.89%, and 35.57% in 6 MV photon beam and 38.81%, 47.31%, and 39.91% errors in 15 MV photon beam in steel type, respectively. In addition, the ISOgray TPS algorithms are not able to predict the dose enhancement and reduction at the proximal and distal prosthesis interfaces, respectively. Conclusions: Hip prosthesis creates a considerable disturbance in dose distribution which cannot be predicted accurately by the FFT convolution, CC, and superposition algorithms. It is recommended to use of MC-based TPS for the treatment fields including the hip prosthesis

Physical, dosimetric and clinical aspects and delivery systems in neutron capture therapy

Neutron capture therapy (NCT) is a targeted radiotherapy for cancer treatment. In this method, neutrons with a spectra/specific energy (depending on the type of agent used for NCT) are captured with an agent that has a high cross-section with these neutrons. There are some agents that have been proposed in NCT including 10B, 157Gd and 33S. Among these agents, only 10B is used in clinical trials. Application of 157Gd is limited to in-vivo and in-vitro research. In addition, 33S has been applied in the field of Monte Carlo simulation. In BNCT, the only two delivery agents which are presently applied in clinical trials are BPA and BSH, but other delivery systems are being developed for more effective treatment in NCT. Neutron sources used in NCT are fission reactors, accelerators, and 252Cf. Among these, fission reactors have the most application in NCT. So far, BNCT has been applied to treat various cancers including glioblastoma multiforme, malignant glioma, malignant meningioma, liver, head and neck, lung, colon, melanoma, thyroid, hepatic, gastrointestinal cancer, and extra-mammary Paget's disease. This paper aims to review physical, dosimetric and clinical aspects as well as delivery systems in NCT for various agents

Assessment of Radiographers’ Awareness about Radiation Protection Principles in Hospitals of Bandar Abbas, Iran

Introduction This study was conducted to evaluate the radiographers’ awareness of radiation protection principles in the radiology centers of the hospitals of Bandar Abbas, Iran. Materials and Methods This analytical cross-sectional study was conducted on 50 radiographers of three hospitals affiliated with Hormozgan University of Medical Sciences in 2015. The data were collected using a two-part questionnaire. The first part was related to the demographic information of the radiographers(i.e. age, gender, work experience, workplace, and passing related training courses). The second part consisted of questions related to the radiographers’ awareness in three fields of radiology physics, radiation protection, and hazards of radiation. Results According to the results of the present study, the mean total scores of the radiographers’ awareness about the radiology physics, radiation protection, and hazards of radiation was 18.41±1.14 out of 22. However, the radiographers’ awareness of the three investigated fields had no statistically significant relationships with the work experience (P=0.244) and gender (P=0.386). However, there was a significant relationship between the radiographers’ awareness about the radiation protection and their education level (P=0.034). Moreover, a significant association was found between the radiographers’ awareness and their workplace (P=0.009). Additionally, the participation in the radiation training courses was significantly correlated with the radiographers’ awareness regarding the radiation hazards (P=0.022). Conclusion According to the findings of the present study, the awareness level of the radiographers about the radiation protection principles was relatively good. However, it seems that the education level of the staff should be enhanced through holding regular short-term radiation training courses