| 1. |
- Ceberg, S., et al.
(författare)
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FLASH radiotherapy and the associated dosimetric challenges
- 2023
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Ingår i: Journal of Physics: Conference Series. ; 2630
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Konferensbidrag (refereegranskat)abstract
- At Lund University and Skåne University Hospital in Lund, Sweden, we have, as the first clinic, modified a clinical Elekta Precise linear accelerator for convertible delivery of ultrahigh dose rate (FLASH) irradiation. Whereas recently published reviews highlighted the need for standardised protocols for ultra-high dose rate beam dosimetry to be able to determine the true potential of FLASH irradiation, several dosimetry studies as well as in-vitro and in-vivo experiments have been carried out at our unit. Dosimetric procedures for verification of accurate dose delivery of FLASH irradiation to cell cultures, zebrafish embryos and small animals have been established using radiochromic films and thermo-luminescent dosimeters. Also, recently the first experience of electron FLASH radiotherapy (FLASH-RT) in canine patients in our clinical setting was published. Our research facilities also include a laboratory for 3D polymer gel manufacturing. Recently, we started investigating the feasibility of a NIPAM polymer gel dosimeter for ultra-high dose rate dosimetry. Furthermore, in the bunker of the modified Elekta linear accelerator, a Surface Guided Radiotherapy (SGRT) system is accessible. The CatalystTM system (C-Rad Positioning, Uppsala, Sweden) provides optical surface imaging for patient setup, real-time motion monitoring and breathing adapted treatment. Aiming at treating patients using ultra-high dose rates, a real-time validation of the alignment between the beam and the target is crucial as the dose is delivered in a fraction of a second. Our research group has during the last decade investigated and developed SGRT workflows which improved patient setup and breathing adapted treatment for several cancer patient groups. Recently, we also started investigating the feasibility of a real-time motion monitoring system for surface guided FLASH-RT. Both FLASH related studies; 3D polymer gel dosimetry and surface guided FLASH-RT are to our knowledge the first of their kind. Following an introduction to the field of FLASH and the associated dosimetric challenges, we here aim to present the two ongoing studies including some preliminary results.
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| 2. |
- Edvardsson, A., et al.
(författare)
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Breathing-motion induced interplay effects for stereotactic body radiotherapy of liver tumours using flattening-filter free volumetric modulated arc therapy
- 2019
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Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 0031-9155 .- 1361-6560. ; 64:2
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate breathing-motion induced interplay effects for stereotactic body radiotherapy (SBRT) of liver tumours treated with flattening-filter free (FFF) volumetric modulated arc therapy (VMAT). Ten patients previously treated with liver SBRT were included in this study. All patients had four-dimensional computed tomography (4DCT) scans acquired prior to treatment. The 4DCT was sorted into 8-10 phases covering an equal time interval. A FFF VMAT plan was created for one fraction in the mid-ventilation phase for each patient. To generate dose distributions including both interplay effects and dose blurring, a sub-plan was calculated for each phase. The total dose distributions were accumulated to the mid-ventilation phase using the deformed vector fields (DVF) from deformable image registration between the corresponding CT and the mid-ventilation phase CT. A blurred dose distribution, not including interplay effects, was also obtained by distributing the delivery of the whole plan uniformly on all phases, and was similarly accumulated to the mid-ventilation phase. To isolate interplay effects, this blurred dose distribution was subtracted from the total dose distribution with interplay effects. The near minimum dose (D-98%), mean dose (D-mean), heterogeneity index (HI), and the near minimum dose difference (Delta D-98%) between the accumulated dose distributions with and without interplay effects were calculated within the gross tumour volume (GTV) for each patient. Comparing the accumulated dose distributions with and without interplay effects, the D-98(%) decreased for nine of the ten patients and the HI increased for all patients. The median and minimum differences in D-98(%) were -2.1% and -5.0% (p = 0.006), respectively, and the median HI significantly increased from 6.2% to 12.2% (p = 0.002). The median Delta D-98% was -4.0% (range - 7% to - 1.5%). In conclusion, statistically significant breathing-induced interplay effects were observed for a single fraction of FFF VMAT liver SBRT, resulting in heterogeneous dose distributions within the GTV.
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| 3. |
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| 4. |
- Konradsson, E., et al.
(författare)
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Development of dosimetric procedures for experimental ultra-high dose rate irradiation at a clinical linear accelerator
- 2022. - 1
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Ingår i: Journal of Physics: Conference Series. - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 2167
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Konferensbidrag (refereegranskat)abstract
- As radiotherapy using ultra-high dose rates has gained new interest, the dosimetric challenges arising at these conditions needs to be addressed. Ionization chambers suffer from a large decrease in ion collection efficiency due to ion recombination, making on-line dosimetry difficult. In this work we present experimental setups and dosimetric procedures for FLASH irradiation of cells, zebrafish embryos and small animals using a 10 MeV electron beam at a modified clinical linear accelerator, and describe the dosimetric steps required to initiate clinical trials. The dosimetric equipment used for our pre-clinical experiments consisted of radiochromic film, thermoluminescent dosimeters, a Farmer-type ionization chamber and phantom material mimicking the experimental setup for irradiation. In preparation for small animal irradiation, dose profiles and depth dose curves were measured for all collimator sizes. The average dose rates were ≥620 Gy/s, ≥640 Gy/s and ≥400 Gy/s for cells, zebrafish embryos and small animals, respectively.
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| 5. |
- Konradsson, E., et al.
(författare)
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Polymer gel dosimetry for experimental verification of conformal small animal irradiation at a preclinical research platform
- 2023
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Ingår i: Journal of Physics: Conference Series. - 1742-6596. ; 2630:1
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Tidskriftsartikel (refereegranskat)abstract
- In translational research, there is a need for preclinical studies of high quality that corresponds to the conformal dose distributions conventionally delivered to humans in the modern radiotherapy clinic. To facilitate this need, novel preclinical systems consist of preclinical radiation platforms and small animal treatment planning systems. However, small-field dosimetry is challenging and requires dosimeters with high spatial resolution. In this study we demonstrate the feasibility of experimentally validating the dose distribution in small fields at a preclinical X-ray research platform using a polymer gel dosimeter and MRI-readout.
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| 6. |
- Ringborg, U, et al.
(författare)
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The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001 - Summary and conclusions
- 2003
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 42:5-6, s. 357-365
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Tidskriftsartikel (refereegranskat)abstract
- A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) and published in 1996. The assessment reviewed the scientific literature up to 1993 on the use of radiotherapy in the treatment of solid tumours. and estimated the costs associated with radiotherapy It also described the current practise of radiotherapy in Sweden 1992 and compared practise with scientific knowledge. The SBU has now conducted a follow-up study on radiotherapy for cancer, including a review of the scientific literature from 1994 and a prospective survey of radiotherapy practise in Sweden 2001. The following conclusions were drawn: The role of radiotherapy as an important form of treatment for cancer with both curative and palliative intent has been further confirmed. The use of radiotherapy in Sweden has increased and is now at the internationally recommended level. Radiotherapy in Sweden is mostly given in accordance with the scientific evidence but may still be underutilized in certain situations. The resources for radiotherapy are being utilized more efficiently The costs of radiotherapy are still 5% of the total cost of cancer care, while the cost of an individual treatment (fraction) has decreased. The need for radiotherapy capacity will increase. In addition, half of the treatment equipment will have to be replaced in the next few years.
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| 7. |
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| 8. |
- Adrian, Gabriel, et al.
(författare)
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Cancer Cells Can Exhibit a Sparing FLASH Effect at Low Doses Under Normoxic In Vitro-Conditions
- 2021
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Ingår i: Frontiers in Oncology. - : Frontiers Media SA. - 2234-943X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Irradiation with ultra-high dose rate (FLASH) has been shown to spare normal tissue without hampering tumor control in several in vivo studies. Few cell lines have been investigated in vitro, and previous results are inconsistent. Assuming that oxygen depletion accounts for the FLASH sparing effect, no sparing should appear for cells irradiated with low doses in normoxia. Methods: Seven cancer cell lines (MDA-MB-231, MCF7, WiDr, LU-HNSCC4, HeLa [early passage and subclone]) and normal lung fibroblasts (MRC-5) were irradiated with doses ranging from 0 to 12 Gy using FLASH (≥800 Gy/s) or conventional dose rates (CONV, 14 Gy/min), with a 10 MeV electron beam from a clinical linear accelerator. Surviving fraction (SF) was determined with clonogenic assays. Three cell lines were further studied for radiation-induced DNA-damage foci using a 53BP1-marker and for cell cycle synchronization after irradiation. Results: A tendency of increased survival following FLASH compared with CONV was suggested for all cell lines, with significant differences for 4/7 cell lines. The magnitude of the FLASH-sparing expressed as a dose-modifying factor at SF=0.1 was around 1.1 for 6/7 cell lines and around 1.3 for the HeLasubclone. Similar cell cycle distributions and 53BP1-foci numbers were found comparing FLASH to CONV. Conclusion: We have found a FLASH effect appearing at low doses under normoxic conditions for several cell lines in vitro. The magnitude of the FLASH effect differed between the cell lines, suggesting inherited biological susceptibilities for FLASH irradiation.
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| 9. |
- Bäck, S. Å.J., et al.
(författare)
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4D dosimetry and motion management in clinical radiotherapy
- 2019. - 1
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Ingår i: Journal of Physics: Conference Series. - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 1305
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Konferensbidrag (refereegranskat)abstract
- Many novel modulated radiation treatment techniques are sensitive to patient motion which may degrade the dose distribution considerably. As there may be a simultaneous movement of the tumour and treatment machine, undesired heterogeneities in the dose distribution can be resulted. Methods to estimate the dosimetric effect of motion and treatment deliveries for both photons and protons are needed. We have recently studied Hodgkin's lymphoma, liver and left sided breast cancer cases and developed tools to be able to simulate simultaneous organ movement and treatment delivery. Furthermore, it is of great importance to validate potential simulations in a realistic quality control set-up, ideally including a complete dosimetry volume and movement/deformation (4D). Radiation sensitive deformable gels have the potential to meet this dosimetry challenge owing to the unique 3D characteristic to form both phantom and detector in one volume. Multi-array detectors together with a moving platform and a realistic object trajectory is an alternative to evaluate the clinical setting. The evaluation could then in principle be done on-line. Gel/plastic 3D dosimeters have the potential to also be irradiated during motion in a similar matter but have to be read-out post irradiation.
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| 10. |
- Capala, J, et al.
(författare)
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Boron neutron capture therapy for glioblastoma multiforme : Clinical studies in Sweden
- 2003
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Ingår i: Journal of Neuro-Oncology. - 1573-7373. ; 62:1, s. 135-144
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Tidskriftsartikel (refereegranskat)abstract
- A boron neutron capture therapy (BNCT) facility has been constructed at Studsvik, Sweden. It includes two filter/moderator configurations. One of the resulting neutron beams has been optimized for clinical irradiations with a filter/moderator system that allows easy variation of the neutron spectrum from the thermal to the epithermal energy range. The other beam has been designed to produce a large uniform field of thermal neutrons for radio-biological research. Scientific operations of the Studsvik BNCT project are overseen by the Scientific Advisory Board comprised of representatives of major universities in Sweden. Furthermore, special task groups for clinical and preclinical studies have been formed to facilitate collaboration with academia. The clinical Phase II trials for glioblastoma are sponsored by the Swedish National Neuro-Oncology Group and, presently, involve a protocol for BNCT treatment of glioblastoma patients who have not received any therapy other than surgery. In this protocol, p-boronophenylalanine (BPA), administered as a 6-h intravenous infusion, is used as the boron delivery agent. As of January 2002, 17 patients were treated. The 6-h infusion of 900 mg BPA/kg body weight was shown to be safe and resulted in the average blood-boron concentration of 24 μg/g (range: 15-32 μg/g) at the time of irradiation (approximately 2-3 h post-infusion). Peak and average weighted radiation doses to the brain were in the ranges of 8.0-15.5 Gy(W) and 3.3-6.1 Gy(W), respectively. So far, no severe BNCT-related acute toxicities have been observed. Due to the short follow-up time, it is too early to evaluate the efficacy of these studies.
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