Nanoliposomal Topical Formulation for Increasing Safety and Combating Microbial Drug Resistance in Leprosy

Nanoliposomes were prepared using solvent injection method and topical spray using simple dispersion method. The particle size and % Entrapment Efficiency were found 18.01 ± 0.21 nm and 87.71 ± 0.12% respectively. TEM studies showed that the particles were in spherical shape. Drying time, volume per spray, area of film and dose uniformity were found to be 280 ± 0.002 sec, 0.16± 0.021 ml, 155.57 ± 0.012 cm2 and 0.15± 0.0012 ml respectively which showed good spraying conditions on the affected area. Stability study shows that dapsone and chaulmoogra oil loaded nanoliposomal topical spray was stable at accelerated condition up to 1 month. The present investigation provides a safe approach by improving the outer membrane permeability to combat microbial drug resistance and increasing safety in leprosy treatment.

Types of deviation and review criteria in pretreatment central quality control of tumor bed boost in medulloblastoma—an analysis of the German Radiotherapy Quality Control Panel in the SIOP PNET5 MB trial

Purpose In Germany, Austria, and Switzerland, pretreatment radiotherapy quality control (RT-QC) for tumor bed boost (TB) in non-metastatic medulloblastoma (MB) was not mandatory but was recommended for patients enrolled in the SIOP PNET5 MB trial between 2014 and 2018. This individual case review (ICR) analysis aimed to evaluate types of deviations in the initial plan proposals and develop uniform review criteria for TB boost. Patients and methods A total of 78 patients were registered in this trial, of whom a subgroup of 65 patients were available for evaluation of the TB treatment plans. Dose uniformity was evaluated according to the definitions of the protocol. Additional RT-QC criteria for standardized review of target contours were elaborated and data evaluated accordingly. Results Of 65 initial TB plan proposals, 27 (41.5%) revealed deviations of target volume delineation. Deviations according to the dose uniformity criteria were present in 14 (21.5%) TB plans. In 25 (38.5%) cases a modification of the RT plan was recommended. Rejection of the TB plans was rather related to unacceptable target volume delineation than to insufficient dose uniformity. Conclusion In this analysis of pretreatment RT-QC, protocol deviations were present in a high proportion of initial TB plan proposals. These findings emphasize the importance of pretreatment RT-QC in clinical trials for MB. Based on these data, a proposal for RT-QC criteria for tumor bed boost in non-metastatic MB was developed.

The influence of beam delivery uncertainty on dose uniformity and penumbra for pencil beam scanning in carbon-ion radiotherapy

The dose uniformity and penumbra in the treatment field are important factors in radiotherapy, which affects the outcomes of radiotherapy. In this study, the integrated depth-dose-distributions (IDDDs) of 190 MeV/u and 260 MeV/u carbon beams in the active spot-scanning delivery system were measured and calculated by FLUKA Monte Carlo simulation based on the Heavy Ion Medical Machine (HIMM). Considering the dose distributions caused by secondary particles and scattering, we also used different types of pencil beam (PB) models to fit and compare the spatial distributions of PB. We superposed a bunch of PB to form a 20×20 cm2 treatment field with the double Gaussian and double Gaussian logistic beam models and calculated the influence of beam delivery error on the field flatness and penumbra, respectively. The simulated IDDDs showed good agreement with the measured values. The triple Gaussian and double Gaussian logistic beam models have good fitness to the simulated dose distributions. There are different influences on dose uniformity and penumbra resulting from beam uncertainties. These results would be helpful for understanding carbon ion therapy, and physical therapists are more familiar with beam characteristics for active scanning therapy, which provides a reference for commissioning and optimization of treatment plans in radiotherapy.

Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma

Purpose Several studies have demonstrated the negative impact of radiotherapy protocol deviations on tumor control in medulloblastoma. In the SIOP PNET5 MB trial, a pretreatment radiotherapy quality control (RT-QC) program was introduced. A first analysis for patients enrolled in Germany, Switzerland and Austria with focus on types of deviations in the initial plan proposals and review criteria for modern radiation technologies was performed. Methods and patients Sixty-nine craniospinal irradiation (CSI) plans were available for detailed analyses. RT-QC was performed according to protocol definitions on dose uniformity. Because of the lack of definitions for high-precision 3D conformal radiotherapy within the protocol, additional criteria for RT-QC on delineation and coverage of clinical target volume (CTV) and planning target volume (PTV) were defined and evaluated. Results Target volume (CTV/PTV) deviations occurred in 49.3% of initial CSI plan proposals (33.3% minor, 15.9% major). Dose uniformity deviations were less frequent (43.5%). Modification of the RT plan was recommended in 43.5% of CSI plans. Unacceptable RT plans were predominantly related to incorrect target delineation rather than dose uniformity. Unacceptable plans were negatively correlated to the number of enrolled patients per institution with a cutoff of 5 patients (p = 0.001). Conclusion This prospective pretreatment individual case review study revealed a high rate of deviations and emphasizes the strong need of pretreatment RT-QC in clinical trials for medulloblastoma. Furthermore, the experiences point out the necessity of new RT-QC criteria for high-precision CSI techniques.

X-ray: An Effective Photon

Following years of discussion and debate regarding the economics of X-ray radiation for sterilization of healthcare products, the benefits of the technology are now being realized. X-ray, like gamma radiation, is a process whereby energic photons penetrate to sterilize medical devices. Compared to gamma, photons in the bremsstrahlung spectrum from X-ray radiation allow for improved dose uniformity ratio, higher dose rates, and shorter process time, which provide additional opportunities for sterilization process enhancement. Such improvements may be realized in a number of ways: 1) economic, where more products may be processed on a carrier; 2) improved dose range fit; and/or 3) wider material compatibility. Despite noted benefits, X-ray sterilization has not yet been widely accepted and currently accounts for less than 5% of the contract sterilization market. This article brings X-ray sterilization into focus by sharing knowledge and experience gained over the past 10 years at the STERIS Däniken site, with an aim to identify opportunities for future medical device sterilization.

Optimizing the Gamma Process

This article will discuss opportunities to improve the efficiency of cobalt-60 (Co-60) utilization within a gamma irradiator. It will show how redistributing the Co-60 within the source rack may lead to improved throughput or dose uniformity within a product. It presents examples of modifications to the equipment within the source pass; these include reduction in the carrier wall thickness and changes to the product stack size. It will discuss the process of scheduling and present ideas of how to optimize both the order of the products and transitions between the products to maximize process efficiencies.