| 1. |
- Johansson, Bengt, 1958-, et al.
(författare)
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Phantom study of radiation doses outside the target volume brachytherapy versus external radiotherapy of early breast cancer
- 2003
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Ingår i: Radiotherapy and Oncology. - Amsterdam : Elsevier. - 1879-0887 .- 0167-8140. ; 69:1, s. 107-112
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Brachytherapy is sometimes suggested as an adjuvant treatment after surgery of some tumours. When introducing this, it would be useful to have an estimate of the dose distribution to different body sites, both near and distant to target, comparing conventional external irradiation to brachytherapy. The aim of the present study was to determine radiation doses with both methods at different body sites, near and distant to target, in an experimental situation on an operated left sided breast cancer on a female Alderson phantom. Methods: Five external beam treatments with isocentric tangential fields were given by a linear accelerator. A specified dose of 1.0 Gy was given to the whole left sided breast volume. Five interstitial brachytherapy treatments were given to the upper, lateral quadrant of the left breast by a two plane, 10 needles implant. A dose of 1.0 Gy specified according to the Paris system was administered by a pulsed dose rate afterloading machine. Absorbed dose in different fixed dose points were measured by thermoluminescence dosimeters. Results: Both methods yielded an absorbed dose of the same size to the bone marrow and internal organs distant to target, 1.0-1.4% of the prescribed dose. There was a trend of lower doses to the lower half of the trunk and higher doses to the upper half of the trunk, respectively, by brachytherapy. A 90% reduction of absorbed dose with brachytherapy compared to external irradiation was found in the near-target region within 5 cm from target boundary where parts of the left lung and the heart are situated. If an adjuvant dose of 50 Gy is given with the external radiotherapy and brachytherapy, the absorbed dose in a part of the myocardium could be reduced from 31.8 to 2.1 Gy. Conclusions: Near target, brachytherapy yielded a considerably lower absorbed dose which is of special importance when considering radiation effects on the myocard and lungs. We could not demonstrate any difference of importance, in absorbed dose to dose points distant to target. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
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| 2. |
- Kjellén, Elisabeth, et al.
(författare)
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Comparison of low dose nicotinamide versus benzamide, administered per os, as radiosensitizers in a C3H mammary carcinoma
- 1988
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 12:4, s. 327-331
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Tidskriftsartikel (refereegranskat)abstract
- We have evaluated if any differences in tumor radiosensitization exist between the two adenosine diphosphate ribosyl transferase (ADPRT) inhibitors nicotinamide and benzamide at fractionated low doses. A significant radiosensitizing effect with nicotinamide at a 10 mg/kg per day dose was found in the tumor model used. We found, however, no radiosensitizing effect with benzamide given according to this schedule.
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| 3. |
- Weber, Lars, et al.
(författare)
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Verification of a dynamic wedge implementation in a pencil beam based dose planning system
- 1995
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 37:Suppl. 1, s. 26-26
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Tidskriftsartikel (refereegranskat)abstract
- The use of dynamic movements on linear accelerators during irradiation have found a revised interest lately due to the integration of computers to control the linear accelerator. An example of this is the generation of fields that resemble ordinary wedge fields. These fields are produced by moving one of the collimator blocks during irradiation, i. e. dynamic wedges.A pencil beam based system with the possibility of modelling dynamically modulated dose distributions from collimator movement specifications has extensively been investigated. Special interest has been focused on depth doses, profiles and output factors which have been generated by dynamic wedge fields. The data from the treatment planning system has been verified with measurements in water on a Varian 4 MV linear accelerator.The results indicate that calculations accurately predicts the outcome from dynamic wedges without any additional measurements than those used for characterisation of static open beams.
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| 4. |
- Adell, Gunnar, 1953-, et al.
(författare)
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p53 status : an indicator for the effect of preoperative radiotherapy of rectal cancer.
- 1999
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 51:2, s. 169-174
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Rectal carcinoma is a common malignancy, with a history of high local recurrence rates following surgery. In recent years. preoperative radiotherapy and refined surgical technique have improved local control rates.AIM: To investigate the relationship between expression of nuclear p53 protein and the outcome in rectal carcinoma, with and without short-term preoperative radiotherapy.MATERIAL: Specimens from 163 patients from the Southeast Swedish Health Care region included in the Swedish rectal cancer trial between 1987-1990.METHOD: New sections from the paraffin blocks of the preoperative biopsy and the surgical specimen were examined immunohistochemically using a p53 antibody (PAb 1801).RESULT: Expression of nuclear p53 protein was seen in 41% of the tumours. The p53 negative patients treated with preoperative radiotherapy had a significant reduction of local failure compared with the non-irradiated p53 negative patients (P = 0.0008). In contrast, p53 positive patients showed no benefit from preoperative radiotherapy. The interaction between p53 status and the benefit of radiotherapy was statistically significant (P = 0.018).CONCLUSION: Expression of nuclear p53 protein in rectal carcinoma seems to be a significant predictive factor for local treatment failure after preoperative radiotherapy. Further investigations are necessary to select patients for preoperative treatment based on analysis of the preoperative biopsies.
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| 5. |
- Blomquist, M, et al.
(författare)
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Test procedures for verification of an electron pencil beam algorithm implemented for treatment planning
- 1996
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 39:3, s. 271-286
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Tidskriftsartikel (refereegranskat)abstract
- The calculation of an electron dose distribution in a patient is a difficult problem because of the presence of tissue and surface inhomogeneities. Verification of the dose planning system is therefore essential. In this investigation, a novel method is used to evaluate a commercially available system (Helax-TMS), at electron energies between 10 and 50 MeV, both for a conventional treatment unit and an MLC-collimated scanned beam unit with a helium-filled treatment head. First, the experiments were designed to verify the local beam database and some fundamental characteristics of the electron beam calculations. Secondly, a number of generalised situations that would be encountered in the clinical treatment planning were evaluated: oblique incidence, field shaping with multi-leaf collimator, bolus edges, and air cavities. Dose distributions in two generalised anatomical phantoms simulating a neck and a nose were also analysed. The results have, when so possible, been presented as the dose ratio within the 'flattened area' for dose profiles and down to the 'treatment depth' (80% dose level) for depth doses. In the penumbra region and in the dose fall-off region, the comparison has been represented by the distance deviation between calculated and measured dose profiles or depth doses. A new tool, 'volume integration', was used to evaluate the deviations from a more clinical point of view. Most results were within +/-2% in dose for volumes larger than a sphere with a diameter of 15 mm, or +/-2 mm in position. Dose deviations were generally found for oblique incidences and below heterogeneities such as small air cavities and bolus edges in limited volumes.
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| 6. |
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| 7. |
- Brynolfsson, Patrik, et al.
(författare)
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Gray-level invariant Haralick texture features
- 2018
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Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 127, s. S279-S280
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 8. |
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| 9. |
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| 10. |
- Daşu, Alexandru, et al.
(författare)
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New insights into factors influencing the clinically relevant oxygen enhancement ratio
- 1998
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 46:3, s. 269-277
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: This paper deals with the variations in the oxygen enhancement ratios that could be observed (OER') when comparing oxic and hypoxic cells in different types of fractionated experiments as a consequence of the non-linearity of the underlying cell survival curves. Calculations have been made of the OER' that would be obtained for fractionated irradiations with a series of small doses to allow the comparison of isoeffective doses in oxic and hypoxic conditions. Two styles of fractionated experiment were modelled. In one, the dose per fraction was kept constant in the oxic and hypoxic arms of the experiment, necessitating more fractions in hypoxia to achieve the same level of cell kill. In the other the number of fractions was kept constant and the fraction size was varied to obtain equal levels of damage. The first is the relevant design for the clinic, whereas the second is the design most commonly used in animal studies. MATERIALS AND METHODS: Three models of the survival curve were used to simulate the response of cells to radiation injury, all based on the linear quadratic model, but with various added assumptions. A simple classical LQ model is compared with two models in which the concept of inducible repair is added. In one of these the induction dose for 'switching on' the more resistant response is assumed to be increased in hypoxia and in the other it is assumed to be independent of the oxygen tension. RESULTS: These calculations show a clear and previously unsuspected dependence of the measured OER' on the design of the fractionated experiment. The values obtained in the clinical and animal types of study differ considerably with all three models. The direction and magnitude of that difference depends critically on the assumptions about the fine structure of the survival curve shape. The authors suggest that the inducible repair version with an oxygen-dependent induction dose is probably the most relevant model. Using this, the measured OER' is reduced at doses around 2 Gy for the clinically relevant design of constant sized fractions to the oxic and hypoxic cells. It may even, in certain model assumptions, fall below unity resulting in an increased sensitivity, not resistance, from the hypoxia. CONCLUSIONS: These calculations indicate the urgent need for more knowledge about the fine structure of the low dose region of the survival curves for human tumour cells and especially for comparisons in the presence and absence of oxygen. The extent of the hypersensitivity at very low doses, the trigger dose needed to induce the repair and its oxygen modification may be dominant factors in determining the response of tumour cells to clinically relevant fractionation schedules.
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| 11. |
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| 12. |
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| 13. |
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| 14. |
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| 15. |
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| 16. |
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| 17. |
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| 18. |
- Johansson, Bengt, 1958-
(författare)
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Brachytherapy a useful tool for nasal and peri-nasal tumours
- 2021
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Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 158:Suppl. 1, s. S62-S62
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- There is an increasing incidence of Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) on the external nose. Surgery is the main treatment but often face problems with respect to cosmetic defects and non-radical resection. Brachytherapy (BT) can be used in the primary treatment to preserve cosmetic appearance and to treat with appropriate margins. Brachytherapy are also indicated in tumor recurrence after surgery and in case of non-radical resection. Long-term local control rate (LCR) in literature is 90-95 %. Treatment time is short 1-2 weeks.There are different BT techniques available such as -Surface BT (Valencia applicator or Mould BT), -interstitial BT (trans-nasal or along nasal) or a combination of both.The choice of BT technique is depending on; -thickness of the tumor, -location on the nose (cartilage part vs bony part), -tumor growth (flat part, curvature part, exophytic part), -extension to peri-nasal areas (upper lip, cheek, medial eye corner).Usually a full dose of BT is prescribed ike 60 Gy PDR (0.83 Gy/ 2nd hour) or 45, 5 Gy HDR (3.5 Gy 2fx/d) (GEC-ESTRO recommendations for head/neck BT RTO 20016:10 and skin RTO 2018:126). Own experience 1998-2019 in 121 patients confirms published results of 93.4 % long-term LCR.Side effects are uncommon and include: septum perforation, telangiectasia, atrophy and sclerosis. Multidisciplinary conferences and teaching of plastic surgeons about potential benefits of BT are fundamental to avoid unnecessary mutilation.
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| 19. |
- Jonsson, Joakim, 1984-
(författare)
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Different methods of creating pseudo-CT images
- 2018
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Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 127, s. S349-S349
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 20. |
- Karlsson, Mikael, et al.
(författare)
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Exploration of new treatment modalities offered by high energy (up to 50 MeV) electrons and photons
- 1997
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 43:3, s. 303-309
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: A number of deep seated tumours are difficult to treat conformally with photon beams mainly dub to the almost exponential dose decrease with depth. Materials and methods: In order to improve the conformity of these treatments a number of useful characteristics of high energy (above 20 MeV) electron beams of the MM50 Racetrack Microtron have been systematically investigated and clinically applied. Results: A typical characteristic of electron beams with energies up to 20 MeV is the sharp dose fall-off with depth. At higher energies this effect is less pronounced but may be improved by adding a small fraction of photons with a matching dose gradient (wedge). With this technique, high energy electrons can be used close to sensitive organs down to 17 cm depth. Another physical characteristic of high energy electrons is the sharp penumbra at depths down to 4-5 cm and the possibility to use opposed electron beams in order to enhance the dose centrally or near the centre of a body. Skin sparing by delivering a part of the absorbed dose with photons through the same beam portal as the electrons has also been systematically studied. These characteristics of the high-energy electron beams have been utilised in the optimisation of some clinical treatments. Conclusions: Electron beams in this high energy region give increased possibilities to achieve dose conformity. Enhanced conformity can be obtained especially if electrons and photons are combined to augment some specific characteristics of the electron beams.
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| 21. |
- Karlsson, Magnus G, et al.
(författare)
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Semi-conductor detectors in output factor measurements
- 1997
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 42:3, s. 293-296
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Output factors are generally measured with cylindrical ionization chambers. It was investigated if Si-diodes of p-type instead could be used. The advantage would be the small detector size and the robust construction of the detector. Materials and methods: Two types of diodes were studied, one with a shielding layer of tungsten specially made to reduce the excess response for scattered photons and one standard diode without any extra shielding. The measurements were performed at accelerating potentials between 4 and 50 MV and beam sizes between 4 cm x 4 cm and 40 cm x 40 cm. Results: The results showed that both types of diodes are suitable for measurements of head scatter factors in mini-phantoms. However, the diodes were found inappropriate for measurement of output factors for large fields in extended water phantoms. For small fields (<10 cm x 10 cm) a small detector is advantageous and no errors due to the scatter contribution were seen. Conclusions: An cylindrical ionization chamber is the best choice for output factor measurements in extended water phantoms for large field sizes while diodes are an alternative in small fields. There were negligible differences between the detectors in head scatter measurements in mini phantoms.
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| 22. |
- Karlsson, Mikael, et al.
(författare)
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Matching of electron and photon beams with a multi-leaf collimator
- 1993
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 29:3, s. 317-326
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Tidskriftsartikel (refereegranskat)abstract
- Multi-leaf collimators (MLCs) are offered as an accessory to many accelerators for radiation therapy. However, beam edges generated with these collimators are not as smooth as can be achieved with individually made blocks. The clinical drawbacks and benefits of this ripple were evaluated both for single field treatments and for combined adjacent fields of different beam qualities. In this investigation the MLC-collimated beams of the MM50 racetrack microtron were studied. The distance between the field edge and the 90% isodose was measured at the reference depth for four beam qualities (20 MV photons and 10, 20 and 50 MeV electrons). This distance was found to vary from approximately 6 mm for straight beam edges (i.e., all collimator leaves aligned) to approximately 2 mm from the tip of the leaves for a saw-tooth shaped beam edge. The over- and under-dosage in the joint between combined adjacent fields was found to be typically +/- 10% in small volumes. Improved clinical techniques using adjacent photon and electron fields with the same isocentre and source position (without moving the gantry) have been developed. For treatments of the breast, including the mammary chain, a uniform dose distribution was created with special attention given to the irradiation of the heart and lung outside the target volume. A method for head and neck treatments was optimised to give uniform dose distribution in the joint between the photon and electron fields and a method of treating the mediastinum, including the chest wall in front of the left lung, was analysed with respect to dose uniformity in the tumour and shielding of the lung.
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| 23. |
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| 24. |
- Mu, Xiangkui, et al.
(författare)
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The effect of fraction time in intensity modulated radiotherapy : theoretical and experimental evaluation of an optimisation problem.
- 2003
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 68:2, s. 181-187
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: In intensity modulated radiotherapy (IMRT), the complexity and the number of treatment fields have expanded. This may imply that the delivery time for each fraction becomes prolonged. In a number of IMRT techniques used in the clinic, the delivery time per fraction is usually 10-15 min, sometimes more than 15 min. In studies on human skin, prolonged delivery time is shown to cause significant reduction of radiation effects compared with acute irradiation. In this paper the effect of changes in fraction delivery time was studied by in vitro irradiation of mammalian cells. MATERIAL AND METHODS: Chinese hamster fibroblasts (V79-379-A) were used for simulating clinical situations. Most experiments were performed with 2Gy/fraction with 4-h intervals in 40-60 replicates. Each fraction was divided into different subfractions, simulating the delivery of a complicated treatment. The effect of changing the delivery time for each fraction was studied. Parameters for the cell survival curve and repair kinetics were determined experimentally. The same methods were also used for large fraction sizes (8Gy). The validity of the most widely used models in the literature, all derived from linear-quadratic formalism, were tested against the experimental results. RESULTS: The effect of prolonging the fraction time for 2-Gy fractions was underestimated by the biological models. The experiments showed that 10-min prolonged delivery time gave a ratio between surviving fractions at 2Gy (S-ratio) of 1.054 with a 95% confidence interval (CI) 1.030-1.080, while the models predicted 1.007 and 1.009. Extending the fraction time to 20 min gave an S-ratio of 1.063 with CI of 1.045-1.080, while the models predicted 1.012 and 1.014. For 8-Gy fractions, there was a good agreement between predications and experimental results. The ratio between surviving fractions at 8Gy is 1.370 with CI of 1.300-1.440, while the models predicated 1.37 and 1.35. CONCLUSIONS: The effect of prolonging fraction time at conventional dose/fraction is underestimated by biological models. Prolonging the fraction time will spare tissues with a fast DNA repair. There is a risk for sparing tumours. This should be considered when IMRT technique is implemented in the clinic.
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| 25. |
- Olofsson, Jörgen, et al.
(författare)
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A widely tested model for head scatter influence on photon beam output
- 2003
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 67:2, s. 225-238
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To construct and test a semi-analytical model describing the effects on Monitor Unit (MU) verification caused by scattering in the treatment head. The implementation of the model should be accomplished using a small set of experimental data. Furthermore, the model should include a geometry dependent estimation of the resulting uncertainty. Material and methods: The input required by the created model consists of basic treatment head geometry and 10 measured output factors in air (OFair) for square fields. It considers primary energy fluence, scattered radiation from an extra-focal source and from secondary collimators, as well as backscatter to the monitor chamber. Measurements and calculations were performed in open symmetric and asymmetric fields at points located both on and off the collimator axis, as well as at arbitrary treatment distances. The model has been verified for 19 photon beams in the range from 4 up to 50 MV, provided by nine different treatment units from six manufacturers. Results: The presented model provided results with errors smaller than 1% (2 S.D.) in typical clinical situations for all beams tested. In more exceptional situations, i.e. combinations of unconventional treatment head designs, very elongated fields, and dosimetry points far away from the isocenter, the total uncertainty increased to approximately 2%. The spread in the results was further analysed in order to create a method for predicting the uncertainties under different treatment conditions. Conclusions: A general head scatter model that is easy to implement has been developed and can be used as the basis for computerised MU verification. The model handles all commercially available treatment units adequately and also includes an estimation of the resulting uncertainty.
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| 26. |
- Rojas, Ana Maria, et al.
(författare)
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Radiosensitisation in normal tissues with oxygen, carbogen and nicotinamide: therapeutic gain comparisons for fractionated X-ray schedules
- 1996
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 39:1, s. 53-64
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Tidskriftsartikel (refereegranskat)abstract
- METHODS: Radiosensitisation with oxygen, carbogen or nicotinamide alone and oxygen or carbogen combined with nicotinamide was compared in early and late responding normal tissues in rodents. X-ray treatments were delivered as single doses or fractionated schedules of 2 fractions in 1 day, 2, 12 and 36 fractions in an overall time of 12 days and 10 fractions in 5 or 12 days. Acute skin reactions, survival of intestinal crypts, breathing rate, reduction in the packed red-cell volume and clearance of 51Cr-EDTA were used as assays of epidermal, gut, lung and renal damage. RESULTS: Relative to air-breathing mice, carbogen or oxygen produced a small, and not always significant, increase in sensitivity (enhancement ratios < or = 1.15) in gut, lung and kidneys; however, in skin a dose enhancement of 1.2-1.3 was observed. The effect of nicotinamide in air, carbogen or oxygen was studied only in lung and gut. The drug produced variable but generally significant increases in radiosensitisation ( < or = 1.26) in all three gases. Relative to treatments in air, enhancement ratios for nicotinamide alone were usually slightly higher than those observed when either carbogen or oxygen were administered without the drug. With all three modifiers (i.e. oxygen, carbogen, nicotinamide alone or for the drug-gas combinations) there was no significant change in the enhancement ratios observed as the number of radiation dose fractions was varied. CONCLUSIONS: Comparisons with fractionated X-ray studies done previously in rodent tumours indicate that a therapeutic benefit, relative to lung, gut and renal damage, would be observed with oxygen or carbogen alone but not with nicotinamide alone. The greatest gain would be achieved with the combination of carbogen and nicotinamide, with which a benefit was observed even relative to epidermal damage. These results indicate that some decrease in normal tissue tolerance could be observed when using these modifiers in clinical radiotherapy and, although small, the appropriate dose reductions should be considered; caution should be exercised especially when carbogen and nicotinamide are used in conjunction with the more radical accelerated schedules.
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| 27. |
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| 28. |
- Sjögren, Rickard, et al.
(författare)
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Depth for dose calibration in high energy photon beams
- 1997
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 43:3, s. 311-313
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: The normalisation depth for determination of output factors in photon fields has frequently been the depth of dose maximum. At high energies the contribution from contaminating electrons is significant at dose maximum and is critically dependent on the beam geometry parameters, which is why a larger depth should be preferred. Materials and methods: The effect of electron contamination was studied using a purging magnet to remove charged particles from the treatment head and a helium bag to minimise production between the head and the phantom. Results: A depth of 10 cm was found to be beyond the range of the contaminating electrons for photon energies up to 20 MV (TPR1020 = 0.772). However, at 50 MV (TPR1020 = 0.810) contaminating electrons contribute 2-3% to the absorbed dose at 10 cm depth. Conclusions: 10 cm is recommended as both reference and normalisation depth for all megavoltage photon beam qualities, i.e. Co-60 and X-rays from accelerators up to 50 MV. (C) 1997 Elsevier Science Ireland Ltd.
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| 29. |
- Tilly, Nina, et al.
(författare)
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In vitro determination of toxicity, binding, retention, subcellular distribution and biological efficacy of the boron neutron capture agentDAC-1
- 1996
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 38:1, s. 41-50
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Tidskriftsartikel (refereegranskat)abstract
- In boron neutron capture therapy (BNCT), 10B is delivered selectively to the tumour cells and the nuclide then forms high-LET radiation (4He2+ and 7Li3+) upon neutron capture. Today much research is focused on development of a variety of boron compounds aimed for BNCT. The compounds must be thoroughly analysed in preclinical tests regarding basic characteristics such as binding and subcellular distribution to enable accurate estimations of dose-modifying factors. DAC-1,2-[2-(3-amino-propyl)-1,2-dicarba-closo-dodecaboran (12)-1-yl-methoxy]- 1,3-propanediol was synthesized at our laboratories and the human colon carcinoma cells LS-174T were used as an in vitro model. The boron compound showed a remarkable intracellular accumulation, 20-100 times higher than the boron content in the culture medium, in cultured cells and was not removed by extensive washes. Approximately half of the boron taken up also remained within the cells for at least 4 days. The DAC-1 compound alone was not toxic at boron concentrations below 2.5 micrograms B/g. The intracellular distribution of the boron compound was investigated by subcellular fractionation experiments and low pH treatments. It is possible that DAC-1 binds to some intracellular molecules or to membranes connected with organelles in the cytoplasm or even to the inside of the outer cell membrane. Another possibility is that the compound, due to the somewhat lipophilic properties, is embedded in the membranes. Thermal neutron irradiations were carried out at the Brookhaven Medical Research Reactor (BMRR). At a survival level of 0.1, DAC-1 + thermal neutrons were about 10.5 times more effective in cell inactivation than the thermal neutrons alone. Monte Carlo calculations gave a mean value of the 10B-dependent specific energy, the dose, of 0.22 Gy. The total physical dose during irradiation of DAC-1-containing cells with a neutron fluence of 0.18 x 10(12) n/cm2 was 0.39 Gy. The dose-modifying factor, at survival level 0.1, when comparing irradiation with thermal neutrons with and without DAC-1 was 3.4, while the dose-modifying factor when comparing neutron irradiations of cells with DAC-1 and irradiation of the cells with 60Co-gamma was 7.3. The results are encouraging and in vivo tests of tissue distributions and tumour uptake should now be carried out.
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| 30. |
- Toma-Dasu, Iuliana, et al.
(författare)
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Theoretical simulation of oxygen tension measurement in the tissue using a microelectrode: II. Simulated measurements in tissues
- 2002
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 64:1, s. 109-118
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The objectives of this study were to make a computer simulation of tissues with different vascular structures and to simulate measurements of oxygen tension using an Eppendorf-like electrode in these tissues and to compare the response to radiation of the tissues with the real oxygen distributions (called input distribution) with the response to radiation of the tissues in which the oxygen distribution is given by the results of the simulated measurements (called output distribution).MATERIALS AND METHODS: The structure of various tissues and the measurements of oxygen tension using a microelectrode were simulated using a computer program. The mathematical model used combines the description of a gradient of tissue oxygenation and the electrode absorption process.RESULTS: We have compared the oxygen distributions resulting from diffusion (input) with those obtained from a simulation of measurements (output) for various tissues in the same points. Because the electrode measurement is an averaging process, the calculated oxygen distributions are different from the expected ones and the extreme high and low values are not detected. We have then calculated the survival curves describing the response to radiation if there is a small fraction of truly hypoxic cells (expected values) or a large fraction of cells at intermediate values (observed results) in order to determine the differences between them.CONCLUSIONS: The results of our study show that oxygen electrode measurements do not give the true distribution of pO(2) values in the tissue. However, our results do not contradict the numerous empirical correlations between the Eppendorf measurements of tumour oxygenation and the outcome of treatments. Measurement results will be misleading for modelling purposes since they do not reflect the actual distributions of oxygen tensions in the measured tissue. Decisions based on such modelling could be very dangerous, especially with respect to the clinical response of tumours to new treatments.
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| 31. |
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| 32. |
- Vatnitsky, S, et al.
(författare)
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Proton dosimetry intercomparison
- 1996
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 41:2, s. 169-77
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Methods for determining absorbed dose in clinical proton beams are based on dosimetry protocols provided by the AAPM and the ECHED. Both groups recommend the use of air-filled ionization chambers calibrated in terms of exposure or air kerma in a 60Co beam when a calorimeter or Faraday cup dosimeter is not available. The set of input data used in the AAPM and the ECHED protocols, especially proton stopping powers and w-value is different. In order to verify inter-institutional uniformity of proton beam calibration, the AAPM and the ECHED recommend periodic dosimetry intercomparisons. In this paper we report the results of an international proton dosimetry intercomparison which was held at Loma Linda University Medical Center. The goal of the intercomparison was two-fold: first, to estimate the consistency of absorbed dose delivered to patients among the participating facilities, and second, to evaluate the differences in absorbed dose determination due to differences in 60Co-based ionization chamber calibration protocols.MATERIALS AND METHODS: Thirteen institutions participated in an international proton dosimetry intercomparison. The measurements were performed in a 15-cm square field at a depth of 10 cm in both an unmodulated beam (nominal accelerator energy of 250 MeV) and a 6-cm modulated beam (nominal accelerator energy of 155 MeV), and also in a circular field of diameter 2.6 cm at a depth of 1.14 cm in a beam with 2.4 cm modulation (nominal accelerator energy of 100 MeV).RESULTS: The results of the intercomparison have shown that using ionization chambers with 60Co calibration factors traceable to standard laboratories, and institution-specific conversion factors and dose protocols, the absorbed dose specified to the patient would fall within 3% of the mean value. A single measurement using an ionization chamber with a proton chamber factor determined with a Faraday cup calibration differed from the mean by 8%.CONCLUSION: The adoption of a single ionization chamber dosimetry protocol and uniform conversion factors will establish agreement on proton absorbed dose to approximately 1.5%, consistent with that which has been observed in high-energy photon and electron dosimetry.
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| 33. |
- Vatnitsky, S, et al.
(författare)
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Proton dosimetry intercomparison based on the ICRU report 59 protocol
- 1999
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 51:3, s. 273-279
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE:A new protocol for calibration of proton beams was established by the ICRU in report 59 on proton dosimetry. In this paper we report the results of an international proton dosimetry intercomparison, which was held at Loma Linda University Medical Center. The goals of the intercomparison were, first, to estimate the level of consistency in absorbed dose delivered to patients if proton beams at various clinics were calibrated with the new ICRU protocol, and second, to evaluate the differences in absorbed dose determination due to differences in 60Co-based ionization chamber calibration factors.MATERIALS AND METHODS:Eleven institutions participated in the intercomparison. Measurements were performed in a polystyrene phantom at a depth of 10.27 cm water equivalent thickness in a 6-cm modulated proton beam with an accelerator energy of 155 MeV and an incident energy of approximately 135 MeV. Most participants used ionization chambers calibrated in terms of exposure or air kerma. Four ionization chambers had 60Co-based calibration in terms of absorbed dose-to-water. Two chambers were calibrated in a 60Co beam at the NIST both in terms of air kerma and absorbed dose-to-water to provide a comparison of ionization chambers with different calibrations.RESULTS:The intercomparison showed that use of the ICRU report 59 protocol would result in absorbed doses being delivered to patients at their participating institutions to within +/-0.9% (one standard deviation). The maximum difference between doses determined by the participants was found to be 2.9%. Differences between proton doses derived from the measurements with ionization chambers with N(K)-, or N(W) - calibration type depended on chamber type.CONCLUSIONS:Using ionization chambers with 60Co calibration factors traceable to standard laboratories and the ICRU report 59 protocol, a distribution of stated proton absorbed dose is achieved with a difference less than 3%. The ICRU protocol should be adopted for clinical proton beam calibration. A comparison of proton doses derived from measurements with different chambers indicates that the difference in results cannot be explained only by differences in 60Co calibration factors.
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| 34. |
- Waligórski, Michael P R, et al.
(författare)
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Cellular parameters and RBE-LET dependences for modelling heavy-ion radiotherapy.
- 2004
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Ingår i: Radiother Oncol. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 73:Supplement 2, s. S173-175
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Tidskriftsartikel (refereegranskat)abstract
- Sets of four parameters (m, Eo, ~o and •) of the cellular track structure model of Katz have been fitted to recently published dataconcerning human melanoma (AA) and mammalian (V79) cells exposed to a variety of lighter ions and to mixed ion-Co60 and ionionirradiation. We discuss the predictive capability of this model and propose standards in reporting cellular radiobiology data forapplication in modelling heavy ion beam radiotherapy.
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| 35. |
- Wengström, Yvonne, 1959-, et al.
(författare)
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Quantitative assessment of skin erythema following breast cancer RT
- 2003
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 68, s. S20-S20
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Tidskriftsartikel (refereegranskat)abstract
- Visual assessment is the most common clinical investigation of skin reactions in radiotherapy. Due to the unquantitative and subjective nature of this method additional non-invasive methods are needed for more accurate evaluation of the visible acute adverse skin reactions due to radiotherapy• The purpose of this study was to evaluate a new objective measure with regard to reliability and validity and compare it with an established objective measure and a visual assessment.Material and Methods: A sample of fifty-three consecutive patients commencing curative tangential radiation therapy to the breast parenchyma was included in the study• The skin area of the treated breast was divided into five sections and assessed individually at 0 Gy, 24 Gy and 50 Gy. The RTOG scoring system was used for the visual assessment of the skin reactions. The first objective measure included reflectance spectrometry (DermaSpectrometer) measures at fixed points within the treatment area. For the second objective measure digital images were taken with a system using a digital camera and software. The images were analyzed using the Adobe Photoshop 5•0 software program•Results: The results provided significant evidence of the test-retest reliability of the camera• The correlation between the objective measures proved to be significant as the treatment progressed• The results suggest that the Camera may be used in a reliable and valid way to measure skin erythema due to radiotherapy•
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| 36. |
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| 37. |
- Zackrisson, Björn, et al.
(författare)
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Matching of electron beams for conformal therapy of target volumes at moderate depths
- 1996
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 39:3, s. 261-270
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Tidskriftsartikel (refereegranskat)abstract
- The basic requirements for conformal electron therapy are an accelerator with a wide range of energies and field shapes. The beams should be well characterised in a full 3-D dose planning system which has been verified for the geometries of the current application. Differences in the basic design of treatment units have been shown to have a large influence on beam quality and dosimetry. Modern equipment can deliver electron beams of good quality with a high degree of accuracy. A race-track microtron with minimised electron scattering and a multi-leaf collimator (MLC) for electron collimating will facilitate the isocentric technique as a general treatment technique for electrons. This will improve the possibility of performing combined electron field techniques in order to conform the dose distribution with no or minimal use of a bolus. Furthermore, the isocentric technique will facilitate multiple field arrangements that decrease the problems with distortion of the dose distribution due to inhomogeneities, etc. These situations are demonstrated by clinical examples where isocentric, matched electron fields for treatment of the nose, thyroid and thoracic wall have been used.
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| 38. |
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| 39. |
- Aarup, Lasse Rye, et al.
(författare)
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The effect of different lung densities on the accuracy of various radiotherapy dose calculation methods: Implications for tumour coverage
- 2009
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 91:3, s. 405-414
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate against Monte-Carlo the performance of various dose calculations algorithms regarding lung turnout coverage in stereotactic body radiotherapy (SBRT) conditions. Materials and methods: Dose distributions in virtual lung phantoms have been calculated using four commercial Treatment Planning System (TPS) algorithms and one Monte Carlo (MC) system (EGSnrc). We compared the performance of the algorithms in calculating the target dose for different degrees of lung inflation. The phantoms had a cubic 'body' and 'lung' and a central 2-cm diameter spherical 'tumour' (the body and turnout have unit density). The lung tissue was assigned five densities (rho(lung)): 0.01, 0.1, 0.2, 0.4 and 1 g/cm(3). Four-field treatment plans were calculated with 6- and 18 MV narrow beams for each value of rho(lung). We considered the Pencil Beam Convolution (PBCEl) and the Analytical Anisotropic Algorithm (AAA(ECl)) from Varian Eclipse and the Pencil Beam Convolution (PBCOMP) and the Collapsed Cone Convolution (CCCOMP) algorithms from Oncentra MasterPlan. Results: When changing rho(lung) from 0.4 to 0.1 g/cm(3), the MC median target dose decreased from 89.2% to 74.9% for 6 MV and from 83.3% to 61.6% for 18 MV (of dose maximum in the homogenous case at both energies), while for both PB algorithms the median target dose was virtually independent of lung density. Conclusions: Both PB algorithms overestimated the target dose, the overestimation increasing as rho(lung) decreased. Concerning target dose, the AAA(ECl) and CCCOMP algorithms appear to be adequate alternatives to MC. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and oncology 91 (2009) 405-414
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| 40. |
- Adolfsson, Emelie, et al.
(författare)
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A system for remote dosimetry audit of 3D-CRT, IMRT and VMAT based on lithium formate dosimetry
- 2014
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Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 113:2, s. 279-282
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this work was to develop and test a remote end-to-end audit system using lithium formate EPR dosimeters. Four clinics were included in a pilot study, absorbed doses determined in the PTV agreed with TPS calculated doses within ±5% for 3D-CRT and ±7% (k=1) for IMRT/VMAT dose plans.
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| 41. |
- Ajithkumar, Thankamma, et al.
(författare)
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SIOPE - Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy
- 2018
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Ingår i: Radiotherapy and Oncology. - : ELSEVIER IRELAND LTD. - 0167-8140 .- 1879-0887. ; 128:2, s. 192-197
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To develop a consensus guideline for craniospinal target volume (TV) delineation in children and young adults participating in SIOPE studies in the era of high-precision radiotherapy. Methods and materials: During four consensus meetings (Cambridge, Essen, Liverpool, and Marseille), conventional field-based TV has been translated into image-guided high-precision craniospinal TV by a group of expert paediatric radiation oncologists and enhanced by MRI images of liquor distribution. Results: The CTVcranial should include the whole brain, cribriform plate, most inferior part of the temporal lobes, and the pituitary fossa. If the full length of both optic nerves is not included, the dose received by different volumes of optic nerve should be recorded to correlate with future patterns of relapse (no consensus). The CTVcranial should be modified to include the dural cuffs of cranial nerves as they pass through the skull base foramina. Attempts to spare the cochlea by excluding CSF within the internal auditory canal should be avoided. The CTVspinal should include the entire subarachnoid space, including nerve roots laterally. The lower limit of the spinal CTV is at the lower limit of the thecal sac, best visible on MRI scan. There is no need to include sacral root canals in the spinal CTV. Conclusion: This consensus guideline has the potential to improve consistency of craniospinal TV delineation in an era of high-precision radiotherapy. This proposal will be incorporated in the RTQA guidelines of future SIOPE-BTG trials using CSI.
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| 42. |
- Al-Hallaq, Hania, et al.
(författare)
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The role of surface-guided radiation therapy for improving patient safety
- 2021
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 163, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- Emerging data indicates SGRT could improve safety and quality by preventing errors in its capacity as an independent system in the treatment room. The aim of this work is to investigate the utility of SGRT in the context of safety and quality. Three incident learning systems (ILS) were reviewed to categorize and quantify errors that could have been prevented with SGRT: SAFRON (International Atomic Energy Agency), UW-ILS (University of Washington) and AvIC (Skåne University Hospital). A total of 849/9737 events occurred during the pre-treatment review/verification and treatment stages. Of these, 179 (21%) events were predicted to have been preventable with SGRT. The most common preventable events were wrong isocentre (43%) and incorrect accessories (34%), which appeared at comparable rates among SAFRON and UW-ILS. The proportion of events due to wrong accessories was much smaller in the AvIC ILS, which may be attributable to the mandatory use of SGRT in Sweden. Several case scenarios are presented to demonstrate that SGRT operates as a valuable complement to other quality-improvement tools routinely used in radiotherapy. Cases are noted in which SGRT itself caused incidents. These were mostly related to workflow issues and were of low severity. Severity data indicated that events with the potential to be mitigated by SGRT were of higher severity for all categories except wrong accessories. Improved vendor integration of SGRT systems within the overall workflow could further enhance its clinical utility. SGRT is a valuable tool with the potential to increase patient safety and treatment quality in radiotherapy.
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| 43. |
- Alevronta, Eleftheria, et al.
(författare)
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Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy
- 2010
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 97:1, s. 54-59
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Determination of the dose-response relations for oesophageal stricture after radiotherapy of the head and neck. Material and methods: In this study 33 patients who developed oesophageal stricture and 39 patients as controls are included. The patients received radiation therapy for head and neck cancer at Karolinska University Hospital, Stockholm, Sweden. For each patient the 3D dose distribution delivered to the upper 5 cm of the oesophagus was analysed. The analysis was conducted for two periods, 1992-2000 and 2001-2005, due to the different irradiation techniques used. The fitting has been done using the relative seriality model. Results: For the treatment period 1992-2005, the mean doses were 49.8 and 33.4 Gy, respectively, for the cases and the controls. For the period 1992-2000, the mean doses for the cases and the controls were 49.9 and 45.9 Gy and for the period 2001-2005 were 49.8 and 21.4 Gy. For the period 2001-2005 the best estimates of the dose-response parameters are D-50 = 61.5 Gy (52.9-84.9 Gy), gamma = 1.4 (0.8-2.6) and s = 0.1 (0.01-0.3). Conclusions: Radiation-induced strictures were found to have a dose response relation and volume dependence (low relative seriality) for the treatment period 2001-2005. However, no dose response relation was found for the complete material.
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| 44. |
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| 45. |
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| 46. |
- Alkner, Sara, et al.
(författare)
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Quality assessment of radiotherapy in the prospective randomized SENOMAC trial
- 2024
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 197
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial.Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1–2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015–2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail.Results: CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98–100 %) of the volume. However, even when not an intended target, full dose was delivered to > 80 % of level I (IQR 75–90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head.Conclusion: Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.
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| 47. |
- Almhagen, Erik, et al.
(författare)
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Modelling tissue specific RBE for different radiation qualities based on a multiscale characterization of energy deposition
- 2023
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Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 182
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Tidskriftsartikel (refereegranskat)abstract
- PurposeWe present the nanoCluE model, which uses nano- and microdosimetric quantities to model RBE for protons and carbon ions. Under the hypothesis that nano- and microdosimetric quantities correlates with the generation of complex DNA double strand breakes, we wish to investigate whether an improved accuracy in predicting LQ parameters may be achieved, compared to some of the published RBE models.MethodsThe model is based on experimental LQ data for protons and carbon ions. We generated a database of track structure data for a number of proton and carbon ion kinetic energies with the Geant4-DNA Monte Carlo code. These data were used to obtain both a nanodosimetric quantity and a set of microdosimetric quantities. The latter were tested with different parameterizations versus experimental LQ-data to select the variable and parametrization that yielded the best fit.ResultsFor protons, the nanoCluE model yielded, for the ratio of the linear LQ term versus the test data, a root mean square error (RMSE) of 1.57 compared to 1.31 and 1.30 for two earlier other published proton models. For carbon ions the RMSE was 2.26 compared to 3.24 and 5.24 for earlier published carbon ion models.ConclusionThese results demonstrate the feasibility of the nanoCluE RBE model for carbon ions and protons. The increased accuracy for carbon ions as compared to two other considered models warrants further investigation.
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| 48. |
- Alsadius, David, 1975, et al.
(författare)
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Patient-reported gastrointestinal symptoms among long-term survivors after radiation therapy for prostate cancer.
- 2014
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Ingår i: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - : Elsevier BV. - 1879-0887. ; 112:2, s. 237-243
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Tidskriftsartikel (refereegranskat)abstract
- With modern radiotherapy technology we have the means to substantially reduce late gastrointestinal toxicities after radiation therapy for prostate cancer. However, there is still a lack of knowledge regarding the spectrum of patient-reported gastrointestinal symptoms after such treatment.
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| 49. |
- Alsadius, David, 1975, et al.
(författare)
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Tobacco smoking and long-lasting symptoms from the bowel and the anal-sphincter region after radiotherapy for prostate cancer.
- 2011
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Ingår i: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - : Elsevier BV. - 1879-0887.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Tobacco smoking can cause vascular injury, tissue hypoxia and fibrosis as can ionizing radiation. However, we do not know if tobacco smoking increases the risk of long-term side effects after radiotherapy for prostate cancer. METHODS: We identified 985 men treated with radiotherapy for prostate cancer between 1993 and 2006. In 2008, long-lasting symptoms appearing after radiotherapy for prostate cancer were assessed through a study-specific questionnaire as were smoking habits and demographic factors of all these men. In the questionnaire the prostate-cancer survivors were asked to report symptom occurrence the previous six months. RESULTS: We obtained information on tobacco smoking from 836 of the 985 prostate-cancer survivors with a median time to follow-up of six years (range 2-14years). The prevalence ratio of defecation urgency among current smokers compared to never smokers was 1.6 (95% CI 1.2-2.2). Corresponding prevalence ratio for diarrhea was 2.8 (95% CI 1.2-6.5), the sensation of bowel not completely emptied after defecation 2.1 (95% CI 1.3-3.3) and for sudden emptying of all stools into clothing without forewarning 4.7 (95% CI 2.3-9.7). CONCLUSION: Tobacco smoking among prostate-cancer survivors treated with radiotherapy increases the risk of certain long-lasting symptoms from the bowel and anal-sphincter region.
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| 50. |
- Anastasi, Gail, et al.
(författare)
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Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I : Intra-fraction breathing motion management
- 2020
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Ingår i: Radiotherapy and Oncology. - : ELSEVIER IRELAND LTD. - 0167-8140 .- 1879-0887. ; 153, s. 79-87
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The POP-ART RT study aims to determine to what extent and how intra-fractional real-time respiratory motion management (RRMM) and plan adaptation for inter-fractional anatomical changes (ART), are used in clinical practice and to understand barriers to implementation. Here we report on part I: RRMM. Material and methods: A questionnaire was distributed worldwide to assess current clinical practice, wishes for expansion or new implementation and barriers to implementation. RRMM was defined as inspiration/expiration gating in free-breathing or breath-hold, or tracking where the target and the beam are continuously realigned. Results: The questionnaire was completed by 200 centres from 41 countries. RRMM was used by 68% of respondents ('users') for a median (range) of 2 (1-6) tumour sites. Eighty-one percent of users applied inspiration breath-hold in at least one tumour site (breast: 96%). External marker was used to guide RRMM by 61% of users. KV/MV imaging was frequently used for liver and pancreas (with fiducials) and for lung (with or without fiducials). Tracking was mainly performed on robotic linacs with hybrid internal-external monitoring. For breast and lung, approximately 75% of respondents used or wished to implement RRMM, which was lower for liver (44%) and pancreas (27%). Seventy-one percent of respondents wished to implement RRMM for a new tumour site. Main barriers were human/financial resources and capacity on the machine. Conclusion: Sixty-eight percent of respondents used RRMM and 71% wished to implement RRMM for a new tumour site. The main barriers to implementation were human/financial resources and capacity on treatment machines. (C) 2020 The Authors. Published by Elsevier B.V.
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