Evaluation of Eye Lens Dose Reduction Technics in Head CT

The purpose of this study is to find the best protocol to reduce the X-ray dose to the eye lens during head diagnostic computed tomography (CT) without decreasing image quality in the organs of interest according to the type of scanner. The lens of the eye is one of radiosensitive tissues in the body. Radiation induced cataract has been demonstrated among staff involved in interventional procedures using X-rays. This study compares the absorbed dose and image quality of several dose reduction technics to the eye lens during head CT exam namely bismuth shielding, organ-based dose modulation, tube current modulation, tube voltage modulation and the combination of a number of these techniques. Compared to the reference scan (Fixed tube current without bismuth shielding), the dose to the eye lens was reduced by 29.91% with bismuth shield, 14.55% with tube current modulation, 37.76% with tube current modulation and bismuth shield. The combination of organ-based dose modulation with tube voltage modulation reduced the dose by 44.93% that of tube current modulation with tube voltage modulation reduced by 19.03% and that of tube current modulation with tube voltage modulation and shield by 46.73%. The combination of organ-based dose with tube voltage modulation provided superior image quality than that of tube current modulation with tube voltage modulation and shield while similarly reducing dose to the eye lens.

Spatial Resolution and Frequency Characteristics for Dose Modulation on the TrueBeam Medical Accelerator

Purpose: To study the spatial resolution achievable by dose modulation in a water phantom using a multi-leaf collimator, jaws and their combination. To estimate the power spectrum density of the useful signal (dose distribution) and statistical noise, evaluate the frequency interval containing the useful signal. Material and methods: Using the Gafchromic EBT2 radiochromic film, nested squares dose patterns formed in a water-equivalent phantom by 6 and 15 MV photon beams of the TrueBeam medical accelerator, jaws, a multi-leaf collimator, and a combination of these devices were measured. Dose response to step function (ESF) data was extracted from the penumbra and the linear photon source dose response function (LSF) was calculated. To move to frequency domain, fast Fourier transform was performed over the obtained datasets, as well as over individual LSF peaks, and then power spectra densities were calculated. The Nyquist frequency associated with data sampling was 1.42 mm-1, the Hann window was used to minimize leakage effect. Results: The shape of the obtained LSF peaks was approximated by a sum of two Gaussian distributions with the same center positions but different widths. The LSF peak width at half maximum (FWHM) was 1.7-3.9 mm depending on the modulation device. No significant difference was observed in the peak widths at energies of 6 and 15 MV. In most cases, the width of the peak along the X-axis was wider than along the Y-axis. The power spectrum of the useful signal had a maximum near zero frequency, a 50 % level was near 0.09 mm-1 and its high frequency limit was about 0.4 mm-1. Above this value, only the spectrum of statistical noise was recorded, uniformly distributed over frequency. Conclusion: The obtained values of the LSF peak width in the range 1.7-3.9 mm characterize the ability of dose modulation by the considered devices or their combination, which can be significant for treatment of small targets (less than 3-4 cm), where these limits of spatial resolution can be reached. The obtained relationships in frequency domain can be used for optimal removal of statistical noise using Wiener filters from profiles or two-dimensional dose distributions.

Coronary flow quantification estimated by dynamic 320-detector CT angiography: validation by 13N ammonia PET myocardial flow reserve

Objectives: Resting coronary flow index (rCFI) estimated by 320-detector low-dose dynamic coronary CT angiography (CCTA) is a direct flow quantification using intracoronary attenuation. We propose modified-rCFI from new protocol combining dynamic scan and standard CCTA using dose-modulation, and validate its consistency with quantitative values and ischemia depicted by 13N-ammonia PET (NH3-PET). Methods: 46 patients who underwent dynamic CCTA and NH3-PET for coronary artery disease were evaluated using original rCFI in 21 patients and modified-rCFI in 25 patients. Two types of rCFI were calculated for three major coronary arteries. Myocardial blood flow (MBF) at rest and stress, myocardial flow reserve (MFR), and the presence or absence of ischemia for three major territories were depicted by NH3-PET. Coronary territories were categorized as territories with MFR <2.0, ≥2.0, or with and without ischemia. Receiver operating characteristic analysis was performed to determine the optimal cut-off of rCFI to distinguish territories with MFR <2.0 or the presence of ischemia. Results: rCFI and modified-rCFI had significant positive correlations with stress MBF and MFR. The optical cut-offs of rCFI and modified-rCFI of 0.39 and 0.61 could detect territories with MFR <2.0, with AUCs of 0.75 and 0.73, sensitivities of 48 and 34%, and specificities of 97 and 98%. Optimal cut-offs of rCFI and modified-rCFI distinguished ischemic segments from non-ischemic segments, with AUCs of 0.75 and 0.91, sensitivities of 53 and 50%, and specificities of 93 and 95%. Conclusion: Two types of rCFI correlated with quantitative values from NH3-PET, and were consistent with a high specificity in detecting functional ischemia. Advances in knowledge: rCFI can contribute as additional functional test over standard CCTA in clinical work-up.

Antitumor activity of the combination of artemisinin and epirubicin in human leukemia cells

Aim: We evaluated the tumor-inhibiting effect of artemisinin applied separately and in combination with epirubicin on leukemia HL-60 and HL-60/Dox cell lines, its dose modulation effect and its potency to&nbsp; influence iron-induced oxidative damage of biologically relevant molecules. Materials and methods: MTT assay and the method of Chou-Talalay were used to show the inhibition of tumor cell proliferation and to evaluate the synergistic effect and modulation effect of artemisinin and epirubicin at varying concentrations. We also used spectrophotometric assays to determine the potency of artemisinin to influence iron-induced molecular degradation of lecithin and deoxyribose. Results: Artemisinin exhibits tumor-inhibiting effect on both the anthracycline-sensitive and anthracycline-resistant promyelocytic cell lines, reaching 88% and 61% (T/C), respectively, when applied at higher concentrations in a dose-dependent manner. The combination of artemisinin and epirubicin shows synergistic effects in all tested concentrations on doxorubicin-resistant cells (CI<0.7). Artemisinin sensitizes the resistant cells towards epirubicin as shown by the CI (combination index) values and has a dose-modulation effect as shown by DRI (dose reduction index). Artemisinin induces deoxyribose oxidative degradation when applied alone and exerts synergistic deoxyribose degradation effect when applied with iron. However, artemisinin does not influence the studied processes in the lecithin-containing model system and has no potential to induce lipid peroxidation. Conclusions: This study presents a new opportunity to enhance the effectiveness of epirubicin-based treatment regimens with addition of artemisinins for resistant tumors.

Analisis Reduksi Dosis Efektif Mata Pada Fantom Menggunakan TLD Mata dengan Implementasi Software Organ Dose Modulation (ODM) dan Eyeshield pada Protokol CT Kepala dengan Alat GE Revolution Evo 128 Slice

The eye is one of the sensitive organs that need attention in the head CT-Scan. This study aims to reduce the effective eye dose on a head CT-Scan using ODM (Organ Dose Modulation) software and use eyeshield on the phantom. The study was conducted using a CT-Scan tool GE Revolution Evo 128 Slice. The research method was carried out by placing three pairs of eye TLDs (Hp3 Dosimeters) on the phantom for the three examination configurations, CT-Scan standard (routine) examinations, examinations using ODM software, and examinations using ODM software and eyeshield. The estimated effective dose calculation based on TLD reading for the eye lens on a standard CT-Scan (routine) is 1.29 mSv. Examination with ODM software is 1.03 mSv. Examination with ODM software and eyeshield of 0.9 mSv. Based on the results obtained, a head CT-Scan with ODM software can reduce the dose by 20% from a routine head CT-Scan, and if added with an eyeshield, it can reduce the dose by 30%. The quality of the image produced by implementing ODM software, SNR value decreased from 39 to 35 in the anterior phantom, central and posterior parts remained. However, the change in SNR value is not significant, so it does not change the image quality. Furthermore, the addition of eyeshield does not alter the SNR value, which means that the addition eyeshield does not cause artifacts that affect image quality. Using ODM and eyeshield software is indeed a little more complicated than a routine head CT-Scan. Still, the benefits obtained are pretty significant, reducing the effective dose received by the eye without reducing image quality.

Levothyroxine Therapy Adequacy, Dose Estimation and Vitamin D Effect Assessment in a Sample of Iraqi Female Patients with Different Causes of Hypothyroidism

Exogenous levothyroxine dose modulation and euthyroidism achievement is a persistent challenge in clinical settings. This study strives to assess the adequacy of treatment and identify the patients’ factors that can be used to estimate the euthyroid levothyroxine dose. A secondary objective was to assess vitamin D supplementation impact on thyroid status. A review of a prospectively collected information from 142 female patients from Baghdad Center of Nuclear Medicine from June 2019 until March 2020 who were receiving levothyroxine for different causes was done. After a follow-up period, the patients’ thyroid tests were assessed and the euthyroid doses for each cause category were statistically analyzed. Thyroid function was assessed before and after three months of vitamin D supplementation for 29 out of 50 patients who measured its level. Sixty-six patients (47%) of the sample were inadequately replaced

MBRS-33. TEMPORARY RESTORATION OF p53 ACTIVITY DURING FRACTIONATED RADIOTHERAPY IN A GROUP3 MEDULLOBLASTOMA GEMM REPRESENTS A POWERFUL TOOL FOR RADIOBIOLOGY STUDIES

TP53 pathway alterations are well-described events in medulloblastoma (MB) and are predictive of poor clinical outcome. Alterations are rare at diagnosis in Group3 (Gr3) and Group4, but enriched in Sonic Hedgehog and WNT subgroups. However, TP53 mutations are observed in all subgroups at relapse. Radiation therapy, along with surgery and chemotherapy, represents the standard of care treatment for MB. Loss of p53 function correlates with increased resistance to radiation in several cancers conferring poor survival for patients. In this study, we exposed the MYCN-driven/Trp53kiki (with tamoxifen-inducible p53 activation) Gr3 MB GEMM to a clinically relevant fractionated radiation therapy (RT) regime, to assess the role of p53 in Gr3 radio-resistance and relapse. Mice exhibiting tumour progression (bioluminescence (BLI) signal &gt;109 photons/second) were randomized to treatment groups. A small animal radiation research platform was used to deliver CT-guided cranio-spinal irradiation (CSI) and a cranial boost (CB). Mice were followed for survival and tumour burden tracked using BLI. Bodyweight was monitored to evaluate treatment tolerability. Full dose radiation therapy (54Gy CB, 36Gy CSI, α/β=10) or dose modulation (12Gy CB, 8Gy CSI) was performed. The results showed comparable primary tumour regression in response to RT in p53 inactive and active backgrounds, followed by imminent relapse or prolonged remission respectively. No significant acute toxicity was observed. Temporary activation of p53 during RT improved tumour-free survival and decreased the incidence of relapse. In conclusion, we developed a new model which will help improve understanding of the radiobiology of high-risk MB and future preclinical trials.