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At least 127 records · Page 7
All sourcesNASA NTRSDOE OSTI
DOE OSTI2016

Accuracy of a dose-area product compared to an absorbed dose to water at a point in a 2 cm diameter field

Purpose: Graphite calorimeters with a core diameter larger than the beam can be used to establish dosimetric references in small fields. The dose-area product (DAP) measured can theoretically be linked to an absorbed dose at a point by the determination of a profile correction. This study aims at comparing the DAP-based protocol to the usual absorbed dose at a point protocol in a 2 cm diameter field for which both references exist. Methods: Two calorimeters were used, respectively, with a sensitive volume of 0.6 cm (for the absorbed dose at a point measurement) and 3 cm diameter (for the DAP measurement). Profile correction was calculated from a 2D dose mapping using three detectors: a PinPoint chamber, a synthetic diamond, and EBT3 films. A specific protocol to read EBT3 films was implemented and the dose-rate and energy dependences were studied to assure a precise measurement, especially in the penumbra and out-of-field regions. Results: EBT3 films were found independent on dose rates over the range studied but showed a strong under-response (18%) at low energies. Depending on the dosimeter used for calculating the profile correction, a deviation of 0.8% (PinPoint chamber), 0.9% (diamond), or 1.9% (EBT3 films) was observed between the calibration coefficient derived from DAP measurements and the one directly established in terms of absorbed dose to water at a point. Conclusions: The DAP method can currently be linked to the classical dosimetric reference system based in an absorbed dose at a point only with a confidence interval of 95% (k = 2). None of the detectors studied can be used to determine an absorbed dose to water at a point from a DAP measurement with an uncertainty smaller than 1.2%.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-474: Evaluation of Dose Perturbation, Temperature and Sensitivity Variation With Accumulated Dose of MOSFET Detector

Purpose: The use of mega voltage gamma and x-ray sources with their skin sparring qualities in radiation therapy has been a boon in relieving patient discomfort and allowing high tumor doses to be given with fewer restrictions due to radiation effects in the skin. However, high doses given to deep tumors may require careful consideration of dose distribution in the buildup region in order to avoid irreparable damage to the skin. Methods: To measure the perturbation of MOSFET detector in Co60,6MV and 15MV the detector was placed on the surface of the phantom covered with the brass build up cap. To measure the effect of temperature the MOSFET detector was kept on the surface of hot water polythene container and the radiation was delivere. In order to measure the sensitivity variation with accumulated dose Measurements were taken by delivering the dose of 200 cGy to MOSFET until the MOSFET absorbed dose comes to 20,000 cGy Results: the Measurement was performed by positioning the bare MOSFET and MOSFET with brass build up cap on the top surface of the solid water phantom for various field sizes in order to find whether there is any attenuation caused in the dose distribution. The response of MOSFET was monitored for temperature ranging from 42 degree C to 22 degree C. The integrated dose dependence of MOSFET dosimeter sensitivity over different energy is not well characterized. This work investigates the dual-bias MOSFET dosimeter sensitivity response to 6 MV and 15 MV beams. Conclusion: From this study it is observed that unlike diode, bare MOSFET does not perturb the radiation field.. It is observed that the build-up influences the temperature dependency of MOSFET and causes some uncertainty in the readings. In the case of sensitivity variation with accumulated dose MOSFET showed higher sensitivity with dose accumulation for both the energies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-340: Direct Editing of Dose Volume Histograms: Algorithms and a Unified Convex Formulation for Treatment Planning with Dose Constraints

Purpose: To develop a procedure for including dose constraints in convex programming-based approaches to treatment planning, and to support dynamic modification of such constraints during planning. Methods: We present a mathematical approach that allows mean dose, maximum dose, minimum dose and dose volume (i.e., percentile) constraints to be appended to any convex formulation of an inverse planning problem. The first three constraint types are convex and readily incorporated. Dose volume constraints are not convex, however, so we introduce a convex restriction that is related to CVaR-based approaches previously proposed in the literature. To compensate for the conservatism of this restriction, we propose a new two-pass algorithm that solves the restricted problem on a first pass and uses this solution to form exact constraints on a second pass. In another variant, we introduce slack variables for each dose constraint to prevent the problem from becoming infeasible when the user specifies an incompatible set of constraints. We implement the proposed methods in Python using the convex programming package cvxpy in conjunction with the open source convex solvers SCS and ECOS. Results: We show, for several cases taken from the clinic, that our proposed method meets specified constraints (often with margin) when they are feasible. Constraints are met exactly when we use the two-pass method, and infeasible constraints are replaced with the nearest feasible constraint when slacks are used. Finally, we introduce ConRad, a Python-embedded free software package for convex radiation therapy planning. ConRad implements the methods described above and offers a simple interface for specifying prescriptions and dose constraints. Conclusion: This work demonstrates the feasibility of using modifiable dose constraints in a convex formulation, making it practical to guide the treatment planning process with interactively specified dose constraints. This work was supported by the Stanford BioX Graduate Fellowship and NIH Grant 5R01CA176553.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Dose Rate Effects on Degradation of Nuclear Power Plant Electrical Cable Insulation at a Common Dose

The intent of this report is to address an identified knowledge gap in relating accelerated aging of nuclear electrical cables to service aging: dose rate effects (DRE). Here, DRE refer to gamma radiation-induced polymer degradation being a function of dose rate in addition to total absorbed dose. The concern raised is that historical qualification conducted at higher dose rates to simulate service lifetime may underestimate insulation degradation that occurs at lower dose rates in service. In the work described herein, common nuclear cable insulation materials—cross-linked polyethylene (XLPE) and ethylene propylene diene elastomer (EPDM)—were subjected to accelerated aging at ambient temperature (26°C) at different gamma dose rates of 100, 200 and 1800 Gy/h for select exposure durations to achieve constant total doses of 170, 210 and 300 kGy to evaluate DRE. First, the cable insulation material types investigated are described. Then, the accelerated aging experimental process involving gamma irradiation applied to the insulation specimens at room temperature and different dose rates is discussed. Then, the experimental characterization techniques used to perform this work are elucidated. These include elongation at break (EAB), mass change, yellowness index (YI), carbonyl index (CI), density, indenter modulus (IM), and relaxation constant (t). Theory of polymer degradation is discussed, and characterization results and discussion are provided. Finally, concluding remarks are made. The findings from this work and cited prior work reveal that DRE are material dependent, even between similar material categories (e.g., XLPE). In the case of the EPDM studied, degradation of ductility was observed to be greater at higher dose rate for the same total dose, indicating accelerated gamma aging to be more conservative than extended aging. Thus, conclusions regarding the conservatism of historical qualification likely require additional consideration for specific materials and conditions in question. The results of this study support the contention that, due to inherent limitations and uncertainties associated with prediction of cable remaining useful life from accelerated aging experiments, trending of installed cable insulation health status will be more practical and useful for safe and efficient cable aging management repair and replace decisions than lifetime prediction from historical qualification. The combination of material robustness demonstrated by the qualification process and ongoing monitoring of cable health status combine to provide confidence in continued safe use of existing nuclear cables. Additional research into effective and efficient condition monitoring methods for non-destructive evaluation of installed cables is needed to support aging cable management, including material studies to inform interpretation of measured results.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗
NASA NTRS1992

Commentary 2 to Cox and Little: radiation-induced oncogenic transformation: the interplay between dose, dose protraction, and radiation quality

There is now a substantial body of evidence for end points such as oncogenic transformation in vitro, and carcinogenesis and life shortening in vivo, suggesting that dose protraction leads to an increase in effectiveness relative to a single, acute exposure--at least for radiations of medium linear energy transfer (LET) such as neutrons. Table I contains a summary of the pertinent data from studies in which the effect is seen. [table: see text] This phenomenon has come to be known as the "inverse dose rate effect," because it is in marked contrast to the situation at low LET, where protraction in delivery of a dose of radiation, either by fractionation or low dose rate, results in a decreased biological effect; additionally, at medium and high LET, for radiobiological end points such as clonogenic survival, the biological effectiveness is independent of protraction. The quantity and quality of the published reports on the "inverse dose rate effect" leaves little doubt that the effect is real, but the available evidence indicates that the magnitude of the effect is due to a complex interplay between dose, dose rate, and radiation quality. Here, we first summarize the available data on the inverse dose rate effect and suggest that it follows a consistent pattern in regard to dose, dose rate, and radiation quality; second, we describe a model that predicts these features; and, finally, we describe the significance of the effect for radiation protection.

Review, Tutorial↗
NASA NTRSDate not supplied

Dose Error Impacts on A Collection of Realistic Dose-Response Curves Based on A NASA Sonic Boom Community Noise Survey

The National Aeronautics and Space Administration (NASA) plans to conduct surveys of community response to quiet supersonic flight to collect dose-response data for international regulators. Previous models of noise dose versus annoyance response ignored uncertainty in the noise dose experienced by survey respondents. This dose error causes attenuation bias and results in inaccurate dose-response relationships. The impacts of dose errors can be explored by introducing error into the dose estimates of a simulated community noise survey. The simulated population annoyance response is determined by specific noise response characteristics, including the onset of annoyance intercept, rate of increasing annoyance, participant intercept variability, and response rates. This paper explores the effects of dose errors on notional populations created by perturbing the noise response characteristics observed in participants in a recent NASA flight test, QSF18. The QSF18-based population parameters were shifted up to ±20% to create the study populations. For the anticipated dose range of the X-59, changes to the onset of annoyance intercept have the greatest impact on erroneous model results. Quantifying point estimate errors illustrates the impact of dose error, with errors up to 14 dB observed for a fixed high annoyance percentage.

dose-response modeling↗
NASA NTRSDate not supplied

Dose Error Impacts on A Collection of Realistic Dose-Response Curves Based on A NASA Sonic Boom Community Noise Survey

The National Aeronautics and Space Administration (NASA) plans to conduct surveys of community response to quiet supersonic flight to collect dose-response data for international regulators. Previous models of noise dose versus annoyance response ignored uncertainty in the noise dose experienced by survey respondents. This dose error causes attenuation bias and results in inaccurate dose-response relationships. The impacts of dose errors can be explored by introducing error into the dose estimates of a simulated community noise survey. The simulated population annoyance response is determined by specific noise response characteristics, including the onset of annoyance intercept, rate of increasing annoyance, participant intercept variability, and response rates. This paper explores the effects of dose errors on notional populations created by perturbing the noise response characteristics observed in participants in a recent NASA flight test, QSF18. The QSF18-based population parameters were shifted up to ±20% to create the study populations. For the anticipated dose range of the X-59, changes to the onset of annoyance intercept have the greatest impact on erroneous model results. Quantifying point estimate errors illustrates the impact of dose error, with errors up to 14 dB observed for a fixed high annoyance percentage.

dose-response modeling↗
DOE OSTI2014

HDRMC, an accelerated Monte Carlo dose calculator for high dose rate brachytherapy with CT-compatible applicators

Purpose: To present a new accelerated Monte Carlo code for CT-based dose calculations in high dose rate (HDR) brachytherapy. The new code (HDRMC) accounts for both tissue and nontissue heterogeneities (applicator and contrast medium). Methods: HDRMC uses a fast ray-tracing technique and detailed physics algorithms to transport photons through a 3D mesh of voxels representing the patient anatomy with applicator and contrast medium included. A precalculated phase space file for the{sup 192}Ir source is used as source term. HDRM is calibrated to calculated absolute dose for real plans. A postprocessing technique is used to include the exact density and composition of nontissue heterogeneities in the 3D phantom. Dwell positions and angular orientations of the source are reconstructed using data from the treatment planning system (TPS). Structure contours are also imported from the TPS to recalculate dose-volume histograms. Results: HDRMC was first benchmarked against the MCNP5 code for a single source in homogenous water and for a loaded gynecologic applicator in water. The accuracy of the voxel-based applicator model used in HDRMC was also verified by comparing 3D dose distributions and dose-volume parameters obtained using 1-mm{sup 3} versus 2-mm{sup 3} phantom resolutions. HDRMC can calculate the 3D dose distribution for a typical HDR cervix case with 2-mm resolution in 5 min on a single CPU. Examples of heterogeneity effects for two clinical cases (cervix and esophagus) were demonstrated using HDRMC. The neglect of tissue heterogeneity for the esophageal case leads to the overestimate of CTV D90, CTV D100, and spinal cord maximum dose by 3.2%, 3.9%, and 3.6%, respectively. Conclusions: A fast Monte Carlo code for CT-based dose calculations which does not require a prebuilt applicator model is developed for those HDR brachytherapy treatments that use CT-compatible applicators. Tissue and nontissue heterogeneities should be taken into account in modern HDR brachytherapy planning.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-165: Characterization of Dose Distributions in High-Dose-Rate Surface Brachytherapy

Purpose: To characterize dose distributions in high-dose-rate(HDR) surface brachytherapy using an Ir-125 source for different geometries, field sizes and topology of the clinical targets(CT). To investigate the depth doses at the central axis(CAX), edges of the treatment fields(E), and lateral dose distributions(L) present when using flap applicators in skin cancer treatments. Methods: When malignancies diagnosed on the skin are treated, various geometries of the CT require proper adaptation of the flap or custom-made applicators to the treatment site. Consequently, the dose at the depth on CAX and field edges changes with variation of the curvatures and size of the applicators. To assess the dose distributions, we created a total of 10 treatment plans(TP) for 10×10 and 20×20 field sizes(FS) with a step size of 1cm. The geometry of the applicators was: planar(PA), curved to 30(CA30) and 60(CA60) degrees with respect to the CAX, half-cylinder(HC), and cylindrical shape(CS). One additional TP was created in which the applicators were positioned to form a dome shape(DS) with a diameter of 16cm. This TP was used to emulate treatment of the average sized scalp. All TPs were optimized to deliver a prescription dose at 8mm equidistantly from the planes containing the dwell positions. This optimization is equivalent to the clinical arrangement since the SSD for the flap applicators is 5mm and the prescription depth is 3mm in the majority of clinical cases. Results: The depths (in mm) of the isodose lines were: FS(10×10):PA[90%(9.1CAX,8.0E,7.6L),50%(28.3CAX,20E,17.3L), 25%(51.1CAX,40E,27L)],CA30[90%(10.3CAX,8.2E,7.9L),50%(32.1CAX, 16.2E,15.8L),25%(61.3CAX,36.7E,31.8L)],CA60[90%(12.2CAX,6.1E,6.3L ),50%(47CAX,14E,16.6L),25%(70.8CAX,31.9E,35.4L)],HC[90%(11.1CA X,6.3E,7.3L),50%(38.3CAX,14.6E,16.1L),25%(66.2CAX,33.8E,34.2L)];FS (20×20):PA[90%(11.1CAX,9.0E,7.0L),50%(34.4CAX,21.9E,15.3L),25%(7 0.4CAX,50.9E,34.8L)],CA30[90%(10.9CAX,7.5E,7.1L),50%(38.8CAX,16. 7E,15.4L),25%(80.7CAX,39.9E,35.7L)],HC[90%(11.1CAX,10.9E,10.6L),5 0%(34.4CAX,38.8E,47.2L),25%(70.4CAX,80.7E,96.6L);DS[90%(12.1CA X,8.5E,6.8L),50%(60.6CAX,17.7E,15.8L),25%(109.6CAX,40.3E,34.3L)]. Conclusion: These results can be used for the approximate calculation and quick assessment of the radiation dose to the organs-at-risk at depth (heart,brain,thyroid, optical nerve) or at the surface distance from the CT (breast,eyes, gonads), and only the geometry of the CT needs to be measured. Understanding of the dose distributions in HDR surface brachytherapy may improve clinical decision making process.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-347: Effect of MLC Leaf Position Inaccuracy On Dose Distribution for Spinal SBRT with Different Energies and Dose Rates

Purpose: To evaluate dosimetric impact of spinal SBRT when MLC leaf positions deviate from planning positions for different energies and doserates. Methods and Materials: 18 localized spinal metastases patients were selected for SBRT using IMRT planning with 9 posterior beams delivered at gantry angles ranging between 100°–260°. A modern linear accelerator(Varian Turebeam STX with HDMLC 2.5 mm thick leaf at isocenter) IMRT plans were generated using both 6X and 6X-FFF(Flattening filter free) beams with a nominal prescription dose of 6 Gy/fraction to PTV. Doserates ranging from 200–600 MU/min for 6X and 400–1400 MU/min for 6X-FFF, with 200 increments were examined. A fixed amount(0.3, 0.5, 1, and 2 mm) of MLC-leaf position deviation was simulated to each plan under following conditions: 1)only along X1 collimator; 2)with increments at both X1 and X2 collimator directions;3)with reductions at both X1 and X2 collimator directions. Dose was recalculated for each modified plans. Both original and modified plans were delivered using Turebeam STX machine and measured using both portal dosimetry and a 3D dosimeter(Delta4 of ScandiDos). Each field’s Result were compared using following three parameters: the 95% iso-dose level Conformal Index(95%CI), the spinal cord maximum dose(SCDmax), and the planned target volume(PTV) mean dose. Results: Dosimetric impacts on the 95%CI, SCDmax and the PTV mean dose are: 1)negligible if MLC-leaf position deviation only along a single collimator direction ≥1.0 mm,2)substantial if MLC-leaf position increment along both collimator directions ≥0.3 mm(95% CI decreases while SCDmax and PTV mean-dose increase), 3)substantial if MLC-leaf position reduction along both collimator directions ≥0.3 mm(95% CI first increases and then decreases while SCDmax and PTV mean-dose decrease). Different energies and doserates demonstrated comparable dosimetric impacts. Conclusion: Substantial dose deviations could happen for spinal SBRT using IMRT plan with HD-MLC if leaf position deviation ≥0.3 mm. The effects of different energy and doserate are negligible.

60 APPLIED LIFE SCIENCES↗
NASA NTRS1992

Dose rate, dose-equivalent rate, and quality factor in SLS-1

A tissue-equivalent proportional counter (TEPC) sensitive to the lineal energy range of 0.26-300 keV micrometer-1 was flown on STS-40 (39 degrees x 278 km x 296 km) inside the Spacelab. This instrument was previously flown on STS-31 but was modified to provide a finer resolution at lower lineal energies to better map the South Atlantic Anomaly (SAA) protons. The instrument was turned on 6 June 1991, and operated for 7470 min (124.5 h). The flight duration was characterized by a very large number of X-ray solar flares and enhanced magnetic field fluctuations; however, no significant dose from the solar particles was measured at the location of this instrument. The flight data can be separated into trapped and galactic cosmic radiation parts. The dose rate, dose-equivalent rate and quality factor for trapped radiation were 4.21 +/- 0.03 mrad day-1, 7.72 +/- 0.05 mrem day-1, and 1.83 +/- 0.1, respectively. The dose rate, dose-equivalent rate, and quality factor for galactic cosmic radiation were 5.34 +/- 0.03 mrad day-1, 14.63 +/- 0.06 mrem day-1, and 2.74 +/- 0.1, respectively. The overall quality factor for the flight was 2.38. The dose from the GCR is higher than from SAA protons because of the high inclination and low altitude of this flight. The AP8MAX model of the trapped radiation gives a dose rate of 2.43 mrad day-1 and a quality factor of 1.77. The CREME solar maximum model of galactic cosmic radiation gives a dose rate of 2.54 mrad day-1 and a quality factor of 2.91. Thus the AP8MAX model underestimates the dose by a factor of 1.8 whereas the CREME model leads to an underestimation of the dose by a factor of 2. A comparison of the LET spectra using the AP8MAX model and galactic cosmic radiation transport codes shows only a qualitative agreement.

NASA Discipline Number 00-00↗
DOE OSTI2023

A Comparison of As-loaded Dose Calculations to Measured Dose Rates

Demonstrating that the radiation dose fields surrounding spent nuclear fuel (SNF) storage and transportation systems meet the applicable limits set forth in 10 CFR 72 for storage and 10 CFR 71 for transportation is essential for the safe handling of radioactive material. The Used Nuclear Fuel-Storage, Transportation, and Disposal Analysis Resource and Data System (UNF-ST&DARDS) [2] is used to provide realistic estimates of SNF-related safety margins. The UNF-ST&DARDS dose rate analysis approach differs from that used in typical licensing approaches, which use design-basis assemblies with bounding source term characteristics to demonstrate the packaging design complies with the regulations. These bounding licensing approaches can increase the time needed to qualify fuel for loading into dry storage and the time a loaded system must wait prior to transportation. UNF-ST&DARDS dose rate assessments allow quantification of realistic, uncredited safety margins associated with actual fuel loading compared with the regulatory limits. While realistic estimation of the dose field surrounding SNF systems may allow for additional flexibility in operations, it is essential to understand how these predictions compare to measured doses. The U.S. Department of Energy Office of Integrated Waste Management and the Prairie Island Indian Community conducted a transportation dose assessment to estimate the site-specific incident-free radiation doses from shipping SNF by rail from the Prairie Island Nuclear Generating Plant (PINGP) through the Prairie Island Indian Community Reservation and Trust Land [5,6]. For that effort, the dose rates were obtained for 50 TN-40 and TN-40HT systems in storage configurations. This work compares the predicted dose rates from UNF-ST&DARDS as-loaded calculations with dose rates measured from 50 SNF storage systems at PINGP. The remainder of this paper discusses the data obtained for the evaluation, the modeling methods, and the results of the calculations.

spent nuclear fuel (SNF), UNF-ST&DARDS, Validation↗
DOE OSTI2014

SU-F-19A-03: Dosimetric Advantages in Critical Structure Dose Sparing by Using a Multichannel Cylinder in High Dose Rate Brachytherapy to Treat Vaginal Cuff Cancer

Purpose: The multichannel cylindrical vaginal applicator is a variation of traditional single channel cylindrical vaginal applicator. The multichannel applicator has additional peripheral channels that provide more flexibility in the planning process. The dosimetric advantage is to reduce dose to adjacent organ at risk (OAR) such as bladder and rectum while maintaining target coverage with the dose optimization from additional channels. Methods: Vaginal HDR brachytherapy plans are all CT based. CT images were acquired in 2 mm thickness to keep integrity of cylinder contouring. The CTV of 5mm Rind with prescribed treatment length was reconstructed from 5mm expansion of inserted cylinder. The goal was 95% of CTV covered by 95% of prescribed dose in both single channel planning (SCP)and multichannel planning (MCP) before proceeding any further optimization for dose reduction to critical structures with emphasis on D2cc and V2Gy . Results: This study demonstrated noticeable dose reduction to OAR was apparent in multichannel plans. The D2cc of the rectum and bladder were showing the reduced dose for multichannel versus single channel. The V2Gy of the rectum was 93.72% and 83.79% (p=0.007) for single channel and multichannel respectively (Figure 1 and Table 1). To assure adequate coverage to target while reducing the dose to the OAR without any compromise is the main goal in using multichannel vaginal applicator in HDR brachytherapy. Conclusion: Multichannel plans were optimized using anatomical based inverse optimization algorithm of inverse planning simulation annealing. The optimization solution of the algorithm was to improve the clinical target volume dose coverage while reducing the dose to critical organs such as bladder, rectum and bowels. The comparison between SCP and MCP demonstrated MCP is superior to SCP where the dwell positions were based on geometric array only. It concluded that MCP is preferable and is able to provide certain features superior to SCP.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Impact of Dose to the Bladder Trigone on Long-Term Urinary Function After High-Dose Intensity Modulated Radiation Therapy for Localized Prostate Cancer

Purpose: To determine the potential association between genitourinary (GU) toxicity and planning dose–volume parameters for GU pelvic structures after high-dose intensity modulated radiation therapy in localized prostate cancer patients. Methods and Materials: A total of 268 patients who underwent intensity modulated radiation therapy to a prescribed dose of 86.4 Gy in 48 fractions during June 2004-December 2008 were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Dose–volume histograms of the whole bladder, bladder wall, urethra, and bladder trigone were analyzed. The primary endpoint for GU toxicity was an IPSS sum increase ≥10 points over baseline. Univariate and multivariate analyses were done by the Kaplan-Meier method and Cox proportional hazard models, respectively. Results: Median follow-up was 5 years (range, 3-7.7 years). Thirty-nine patients experienced an IPSS sum increase ≥10 during follow-up; 84% remained event free at 5 years. After univariate analysis, lower baseline IPSS sum (P=.006), the V90 of the trigone (P=.006), and the maximal dose to the trigone (P=.003) were significantly associated with an IPSS sum increase ≥10. After multivariate analysis, lower baseline IPSS sum (P=.009) and increased maximal dose to the trigone (P=.005) remained significantly associated. Seventy-two patients had both a lower baseline IPSS sum and a higher maximal dose to the trigone and were defined as high risk, and 68 patients had both a higher baseline IPSS sum and a lower maximal dose to the trigone and were defined as low risk for development of an IPSS sum increase ≥10. Twenty-one of 72 high-risk patients (29%) and 5 of 68 low-risk patients (7%) experienced an IPSS sum increase ≥10 (P=.001; odds ratio 5.19). Conclusions: The application of hot spots to the bladder trigone was significantly associated with relevant changes in IPSS during follow-up. Reduction of radiation dose to the lower bladder and specifically the bladder trigone seems to be associated with a reduction in late GU toxicity.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Chemoradiation of Hepatic Malignancies: Prospective, Phase 1 Study of Full-Dose Capecitabine With Escalating Doses of Yttrium-90 Radioembolization

Purpose: Radiosensitizing chemotherapy improves the outcomes in comparison with radiation alone for gastrointestinal cancers. The delivery of radiation therapy with yttrium90 ({sup 90}Y) radioembolization, in combination with the radiosensitizing chemotherapeutic agent capecitabine, provides the opportunity to enhance the effects of radiation on hepatic malignancies. This phase 1 study sought to determine the maximum tolerated dose (MTD) of {sup 90}Y plus capecitabine in patients with cholangiocarcinoma or liver metastases confined to the liver. Methods and Materials: Patients were given initial treatment at full-dose capecitabine during days 1 to 14 of a 21-day cycle. At days 1 to 7 of the second cycle, whole-liver {sup 90}Y was given at the test dose, after which time capecitabine was continued. Dose-limiting toxicity (DLT) was determined 6 weeks after {sup 90}Y infusion. If a DLT was not observed, the {sup 90}Y dose was escalated. The planned dose cohorts were 110, 130, 150, and 170 Gy. The primary endpoint was to determine the MTD of {sup 90}Y with full-dose capecitabine. Results: Sixteen patients were treated according to the study protocol. Two patients experienced DLTs. Nine patients required capecitabine dose reduction as a result of toxicities attributable to capecitabine alone. The criteria for establishing {sup 90}Y MTD were not met, indicating an MTD of >170 Gy. Conclusion: The MTD of {sup 90}Y delivered in conjunction with capecitabine in the setting of intrahepatic cholangiocarcinoma or metastatic disease confined to the liver exceeds 170 Gy. This is the highest {sup 90}Y dose reported to date and has important implications on combined therapy with the radiosensitizing oral chemotherapeutic capecitabine. Further studies are under way.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Spine stereotactic body radiation therapy plans: Achieving dose coverage, conformity, and dose falloff

We report our experience of establishing planning objectives to achieve dose coverage, conformity, and dose falloff for spine stereotactic body radiation therapy (SBRT) plans. Patients with spine lesions were treated using SBRT in our institution since September 2009. Since September 2011, we established the following planning objectives for our SBRT spine plans in addition to the cord dose constraints: (1) dose coverage—prescription dose (PD) to cover at least 95% planning target volume (PTV) and 90% PD to cover at least 99% PTV; (2) conformity index (CI)—ratio of prescription isodose volume (PIV) to the PTV < 1.2; (3) dose falloff—ratio of 50% PIV to the PTV (R{sub 50%}); (4) and maximum dose in percentage of PD at 2 cm from PTV in any direction (D{sub 2cm}) to follow Radiation Therapy Oncology Group (RTOG) 0915. We have retrospectively reviewed 66 separate spine lesions treated between September 2009 and December 2012 (31 treated before September 2011 [group 1] and 35 treated after [group 2]). The χ{sup 2} test was used to examine the difference in parameters between groups. The PTV V{sub 100%} {sub PD} ≥ 95% objective was met in 29.0% of group 1 vs 91.4% of group 2 (p < 0.01) plans. The PTV V{sub 90%} {sub PD} ≥ 99% objective was met in 38.7% of group 1 vs 88.6% of group 2 (p < 0.01) plans. Overall, 4 plans in group 1 had CI > 1.2 vs none in group 2 (p = 0.04). For D{sub 2cm}, 48.3% plans yielded a minor violation of the objectives and 16.1% a major violation for group 1, whereas 17.1% exhibited a minor violation and 2.9% a major violation for group 2 (p < 0.01). Spine SBRT plans can be improved on dose coverage, conformity, and dose falloff employing a combination of RTOG spine and lung SBRT protocol planning objectives.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

Dose painting to treat single-lobe prostate cancer with hypofractionated high-dose radiation using targeted external beam radiation: Is it feasible?

Targeted focal therapy strategies for treating single-lobe prostate cancer are under investigation. In this planning study, we investigate the feasibility of treating a portion of the prostate to full-dose external beam radiation with reduced dose to the opposite lobe, compared with full-dose radiation delivered to the entire gland using hypofractionated radiation. For 10 consecutive patients with low- to intermediate-risk prostate cancer, 2 hypofractionated, single-arc volumetric-modulated arc therapy (VMAT) plans were designed. The first plan (standard hypofractionation regimen [STD]) included the entire prostate gland, treated to 70 Gy delivered in 28 fractions. The second dose painting plan (DP) encompassed the involved lobe treated to 70 Gy delivered in 28 fractions, whereas the opposing, uninvolved lobe received 50.4 Gy in 28 fractions. Mean dose to the opposing neurovascular bundle (NVB) was considerably lower for DP vs STD, with a mean dose of 53.9 vs 72.3 Gy (p < 0.001). Mean penile bulb dose was 18.6 Gy for DP vs 19.2 Gy for STD (p = 0.880). Mean rectal dose was 21.0 Gy for DP vs 22.8 Gy for STD (p = 0.356). Rectum V{sub 70} (the volume receiving ≥70 Gy) was 2.01% for DP vs 2.74% for STD (p = 0.328). Bladder V{sub 70} was 1.69% for DP vs 2.78% for STD (p = 0.232). Planning target volume (PTV) maximum dose points were 76.5 and 76.3 Gy for DP and STD, respectively (p = 0.760). This study demonstrates the feasibility of using VMAT for partial-lobe prostate radiation in patients with prostate cancer involving 1 lobe. Partial-lobe prostate plans appeared to spare adjacent critical structures including the opposite NVB.

61 RADIATION PROTECTION AND DOSIMETRY↗