Wearable glass beads for in vivo dosimetry of total skin electron irradiation treatments

Glass beads have recently been proposed for use as radiation therapy dosimeters. Glass beads have a number of characteristics that make them suitable for in vivo skin dose measurements, including an ability to be worn on a string, and therefore avoid possible patient discomfort that may result from the use of adhesives. In this study, their use for in vivo dose measurements in total skin electron irradiation treatments has been tested. First, the dosimetric properties of cylindrical beads with a 3 mm diameter were characterised using electron fields produced by a linear accelerator. The mean individual bead reproducibility was demonstrated to be within 3%; and a batch variation of 7% was observed. The beads were shown to have a linear dose response, and both dose rate and beam energy independence, within the measurement uncertainty. Phantom measurements were then performed for a total skin electron irradiation beam arrangement, and results compared against optically stimulated luminescent dosimeters at five anatomical sites. For a majority of measurement locations, agreement within 3% was observed between the two dosimetry techniques, demonstrating the feasibility of glass beads as in vivo dosimeters for total skin electron irradiation; though further investigation may be needed to minimise uncertainty in results

Wearable glass beads for in vivo dosimetry of total skin electron irradiation treatments

Glass beads have recently been proposed for use as radiation therapy dosimeters. Glass beads have a number of characteristics that make them suitable for in vivo skin dose measurements, including an ability to be worn on a string, and therefore avoid possible patient discomfort that may result from the use of adhesives. In this study, their use for in vivo dose measurements in total skin electron irradiation treatments has been tested. First, the dosimetric properties of cylindrical beads with a 3 mm diameter were characterised using electron fields produced by a linear accelerator. The mean individual bead reproducibility was demonstrated to be within 3%; and a batch variation of 7% was observed. The beads were shown to have a linear dose response, and both dose rate and beam energy independence, within the measurement uncertainty. Phantom measurements were then performed for a total skin electron irradiation beam arrangement, and results compared against optically stimulated luminescent dosimeters at five anatomical sites. For a majority of measurement locations, agreement within 3% was observed between the two dosimetry techniques, demonstrating the feasibility of glass beads as in vivo dosimeters for total skin electron irradiation; though further investigation may be needed to minimise uncertainty in results

Wearable glass beads for in vivo dosimetry of total skin electron irradiation treatments

Glass beads have recently been proposed for use as radiation therapy dosimeters. Glass beads have a number of characteristics that make them suitable for in vivo skin dose measurements, including an ability to be worn on a string, and therefore avoid possible patient discomfort that may result from the use of adhesives. In this study, their use for in vivo dose measurements in total skin electron irradiation treatments has been tested. First, the dosimetric properties of cylindrical beads with a 3 mm diameter were characterised using electron fields produced by a linear accelerator. The mean individual bead reproducibility was demonstrated to be within 3%; and a batch variation of 7% was observed. The beads were shown to have a linear dose response, and both dose rate and beam energy independence, within the measurement uncertainty. Phantom measurements were then performed for a total skin electron irradiation beam arrangement, and results compared against optically stimulated luminescent dosimeters at five anatomical sites. For a majority of measurement locations, agreement within 3% was observed between the two dosimetry techniques, demonstrating the feasibility of glass beads as in vivo dosimeters for total skin electron irradiation; though further investigation may be needed to minimise uncertainty in results

Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial.

BACKGROUND: HIV antiretroviral therapy (ART) is often managed without routine laboratory monitoring in Africa; however, the effect of this approach is unknown. This trial investigated whether routine toxicity and efficacy monitoring of HIV-infected patients receiving ART had an important long-term effect on clinical outcomes in Africa. METHODS: In this open, non-inferiority trial in three centres in Uganda and one in Zimbabwe, 3321 symptomatic, ART-naive, HIV-infected adults with CD4 counts less than 200 cells per microL starting ART were randomly assigned to laboratory and clinical monitoring (LCM; n=1659) or clinically driven monitoring (CDM; n=1662) by a computer-generated list. Haematology, biochemistry, and CD4-cell counts were done every 12 weeks. In the LCM group, results were available to clinicians; in the CDM group, results (apart from CD4-cell count) could be requested if clinically indicated and grade 4 toxicities were available. Participants switched to second-line ART after new or recurrent WHO stage 4 events in both groups, or CD4 count less than 100 cells per microL (LCM only). Co-primary endpoints were new WHO stage 4 HIV events or death, and serious adverse events. Non-inferiority was defined as the upper 95% confidence limit for the hazard ratio (HR) for new WHO stage 4 events or death being no greater than 1.18. Analyses were by intention to treat. This study is registered, number ISRCTN13968779. FINDINGS: Two participants assigned to CDM and three to LCM were excluded from analyses. 5-year survival was 87% (95% CI 85-88) in the CDM group and 90% (88-91) in the LCM group, and 122 (7%) and 112 (7%) participants, respectively, were lost to follow-up over median 4.9 years' follow-up. 459 (28%) participants receiving CDM versus 356 (21%) LCM had a new WHO stage 4 event or died (6.94 [95% CI 6.33-7.60] vs 5.24 [4.72-5.81] per 100 person-years; absolute difference 1.70 per 100 person-years [0.87-2.54]; HR 1.31 [1.14-1.51]; p=0.0001). Differences in disease progression occurred from the third year on ART, whereas higher rates of switch to second-line treatment occurred in LCM from the second year. 283 (17%) participants receiving CDM versus 260 (16%) LCM had a new serious adverse event (HR 1.12 [0.94-1.32]; p=0.19), with anaemia the most common (76 vs 61 cases). INTERPRETATION: ART can be delivered safely without routine laboratory monitoring for toxic effects, but differences in disease progression suggest a role for monitoring of CD4-cell count from the second year of ART to guide the switch to second-line treatment. FUNDING: UK Medical Research Council, the UK Department for International Development, the Rockefeller Foundation, GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim, and Abbott Laboratories