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Prostate IMRT: Two-dimensional model of rectal NTCP employing the variability of rectal motion and rectum wall thickness 2 2 Background: In order to improve the evaluation of possible rectal toxicity based on the rectal normal tissue complication probability (NTCP), we consider the fractional dependence of the NTCP on the wall thickness (tW) and rectal displacement (RM). Materials and Methods: The two-dimensional NTCP model (NTCP2D) was developed using radiotherapy plans of ten randomly selected patients with prostate cancer. The clinical rectal structures were substituted with rectal walls of cylindrical shape. To simulate full, partially-full and empty state of the rectum, three tW were generated under the conditions of same length of the rectum and same volume of the rectal wall. A threshold iso-line, NTCPTR, was used to split the NTCP2D field into areas: a lower risk area and a higher risk area for rectal toxicity. Two factors are introduced to help with the estimation of NTCP: a volume factor k1 which is the ratio between the volumes of the rectal wall and the intersection of the rectal wall with the planning target volume and a probability factor k2, which is the ratio between the area of low risk to the entire area of the NTCP2D. Results: A correlation > 0.9 between factors k1 and k2 was found. Conclusion: The NTCP2D field and the ratios k1 and k2 can be used as a patient-specific parameters to evaluate the probability of rectal toxicity. 283 293 2014/12/31 1393/10/10 2014/12/31 1393/10/10 Gr.N. Grigorov Gr.N. Grigorov Medical Physics Department, GRRCC, 835 King Street West, Kitchener, ON, Canada Canada grigor.grigorov@grhosp.on.ca K. Foster K. Foster Medical Physics Department, GRRCC, 835 King Street West, Kitchener, ON, Canada Canada J.C.L. Chow J.C.L. Chow Radiation Medicine Program, Princes Margaret Cancer Center, Toronto, ON, Canada Canada E.K. Osei E.K. Osei Medical Physics Department, GRRCC, 835 King Street West, Kitchener, ON, Canada Canada Prostate IMRT rectal motion variability of the rectal wall thickness 2D field of possible rectal NTCPs Huang E, Pollack A, Levy L, Starkschall G, Dong L, Rosen I and Kuban D (2002) Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer. Int J Radiation Oncology Biol Phys, 54: 1314–21. ##Tucker S, Cheung R, Dong L, et. al. (2004) Dose–Volume Response Analyses of Late Rectal Bleeding After Radiotherapy for Prostate Cancer. Int J Radiation Oncology Biol Phys, 59: 353–65.##Livi L, Detti B, Meattini M, Sánchez L, Biti G (2007) Organ-Confined Prostate Cancer: Treatment With High Doses Of Radiotherapy (Intensity Modulated Radiation Therapy). Actas Urol Esp, 31: 611–6.##Lyman L, 1985 Complication probability as assessed from dose volume histograms, Radiat Res Suppl, 104: 13–19.##Craig T, Wong E, Bauman G, Battista J, and Van Dyk J (2005) Impact of geometric uncertainties on evaluation of treatment techniques for prostate cancer. Int J Radiation Oncology Biol Phys, 62: No. 2, 426–36.##Lattanzi J, McNeely S, Hanlon A, Das I, Schultheiss T and Hanks E (1998) CT localization for correcting portal errors in the treatment of prostate cancer. Int J Radiation Oncology Biol Phys, 41: 1079–86.##Pouliot J, Aubin M, Langen K, Liu Y, Pickett B, Shinnohara K and Roach M (2003) (Non)- migration of radiopaque markers used for on-line localization of the prostate with an electronic portal imaging device. Int J Radiation Oncology Biol Phys, 56: 862–6.##Van Herk, Bruce A, Kroes A, et al. (1995) Quantification of organ motion during conformal radiotherapy of the prostate by three dimensional image registration. Int J Radiation Oncology Biol Phys, 33: 1311–20.##Britton K, Takai Y, Mittsuya M, Nemoto K, Ogawa Y and Yamada S (2005) Evaluation of inter- and intrafraction organ motion during IMRT for localized prostate cancer measured by a newly developed on-board image-guided system. Radiation Medicine, 23: 14–24.##Moseley D, White E, Wiltshire K, et. al. (2007) Comparison of localization performance with implanted fiducial markers and cone-beam computed tomography for on-line image-guided radiotherapy of the prostate. Int J Radiation Oncology Biol Phys, 67: 942–53. ##Sawyer L, Whittle S, Matthews, Starritt H and Jupp T (2009) Estimation of organ and effective doses resulting from cone beam CT imaging for radiotherapy treatment planning. British Journal of Radiology, 82: 577–84.##Pauwelsa R, Beinsbergera J, Collaertb B, Theodorakouc C, Rogerse J, Walkerc A, Cockmartinf L, Jacobsa R, Bogaertsg R, Hornerd K (2012) Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol, 81: 267–71.##Grigorov G, Chow J and Barnett R (2007) A novel algorithm for calculation of dynamic rectal NTCP. Radiother Oncol, 84/2: S30, The annual CARO-COMP meeting, Toronto.##Grigorov G, Chow J and Foster K (2012) Prostate IMRT QA: Prediction of the range of rectal NTCP using a 2D field approach based on variations of the rectal wall motion and thickness. Med Phys, 39: 3837.##Michalski J, Purdy J, Bruner D and Amin M (1993) ICRU Report 50 Prescribing, Recording, and Reporting Photon Beam Therapy (Bethesda, MD: International Commission on Radiation Units and Measurements).##Fontenla E, Pelizzari C, Roeske J and Chen G (2001) Numerical analysis of a model of organ motion using serial imaging measurements from prostate radiotherapy. Phys Med Biol, 46: 2337–58. ##Kutcher G, Burman C (1989) Calculation of complication probability factors for non-uniform normal tissue irradiation: The effective volume method. Int. J. Radiat. Oncol Biol Phys, 16: 1623–130.##Emanmi B, Lyman J and Brown A (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiation Oncology Biol Phys, 21: 109–22.##Booth J and Zavgorodni S (2001) Modeling the dosimetric consequences of organ motion at CT imaging on radiotherapy treatment planning. Phys Med Biol, 46: 1369–77.##Meijer M. Brink M. Hoogeman, Meiders J and Lebesque J (1999) Dose-wall histograms and normalized dose-surface histograms for the rectum: a new method to analyze the dose distribution over the rectum in conformal radiotherapy. Int J Radiation Oncology Biol Phys, 45: No. 4, 1073–80.##J. Leong 1987 Implementation of random positioning error in computerised radiation treatment planning systems as a result of fractionation. Phys Med Biol. 32, 327–34.##Rancati T, Fiorino C, Gagliardi G et al (2004) Fitting late rectal bleeding data using different NTCP models: results from an Italian multi-centric study (AIROPROS0101). Radiother Oncol, 73: 21–32##Michalski JM, Gay H, Jackson A, et al. (2010) Radiation dose volume effects in radiation-induced rectal injury. Int J Radiation Oncology Biol Phys, 76: 123-9.##Hamstra D, Stenmark M, Ritter T, Litzenberg D, Jackson W, Johnson S, et al (2013) Age and comorbid illness are associated with late rectal toxicity following dose-escalated radiation therapy for prostate cancer. Int J Radiation Oncology Biol Phys, 85: 1246–53.## ##

Optimum reckoning of contra lateral breast dose using physical wedge and enhanced dynamic wedge in radiotherapy treatment planning system 2 2 Background: It was intended to investigate the effect of physical wedge (PW) and enhanced dynamic wedges (EDW) on contralateral breast dose during primary breast irradiation in radiotherapy treatment, using high energy photon beams. Materials and Methods: The Varian’s Clinac dual mode linear accelerator model 2100 C/D and Siemen’s Primus accelerators were used for radiation doses with 6 MV and 15 MV. Doses were delivered using Tangential field techniques and asymmetric collimator jaws. Eclipse three-dimensional Treatment Planning System (3DTPS) was used to measure contralateral breast dose for all fiend settings. Sixty five patients (with cancerous breast as well as chest wall) were taken and their contralateral breast doses were measured at a point 5 cm across, at 2 cm depth from the end of the medial field. Results: The contralateral breast dose mean difference was 0.25 cGy and 0.24 cGy during the comparison of PW and EDW on Varian’s Clinac and 0.19 cGy and 0.18 cGy were found for medial EDW and without medial EDW for the same machine in breast cases and chest wall cases respectively as per total prescribed dose. The mean difference for PW (Clinac) and PW (Primus) was found 0.08 cGy and 0.31 cGy and during the comparison of medial PW and without medial PW on primus machine this mean difference was 0.25 cGy and 0.51 cGy in breast cases and chest wall cases respectively as per total prescribed dose. Conclusion: The investigation demonstrates the significance that the EDW produces less scattered dose, which can cause second breast malignancy, compared to PW. Furthermore, the medial wedge, too, can cause second breast malignancy and should be avoided in planning. 295 302 2014/12/312014/12/31 1393/10/10 2014/12/312014/12/31 1393/10/10 M. Akram M. Akram Department of physics, The Islamia University of Bahawalpur Pakistan Pakistan K. Iqbal K. Iqbal Department of physics, The Islamia University of Bahawalpur Pakistan Pakistan M. Isa M. Isa Department of physics, The Islamia University of Bahawalpur Pakistan Pakistan M. Afzal M. Afzal Department of physics, The Islamia University of Bahawalpur Pakistan Pakistan S.A. Buzdar S.A. Buzdar Department of physics, The Islamia University of Bahawalpur Pakistan Pakistan saeed.buzdar@iub.edu.pk Radiotherapy contralateral breast treatment planning system scatter dose Varatharaj C, Ravikumar M, Sathiy S , Sanjay S Supe (2011) Variation of beam characteristics between three different wedges from a dual-energy accelerator. J Med Phys, 36(3): 133–137.## 2. Ahmad M, Hussain A, Muhammad W, Rizvi SA, Matiullah (2010) Studying wedge factors and beam profiles for physical and enhanced dynamic wedges. J Med Phys, 35:33–4.## 3. Kijewski PK, Chin LM, Bjärngard BE (1978) a wedge- shaped dose distribution by computer controlled  collimator  motion. Med Phys, 5:426-29.##4. Ravichandran R , Binukumar J, Davis C (2007) evaluation methods for detecting changes in beam output and energy in radiation beam from high energy Linac. J Med Phys, 32: 92-96.##5. Hande BA, Metin G, Cemile C, Nadir K, Kayihan E (2011) Comparsion of dose distribution and organ at risk (OAR) doses in conventional tangential technique (CTT) and IMRT plans with different number of bean in left sides breast cancer. Rep Pract Oncol Radiotherapy, 16:102–97.##6. Lippman Jharris M and morlow M (2004) diseases of the breast. Philadephia, Lippincott     Williams and Wilkins.## 7. American cancer society (2002) Cancer facts and figures Atlanta.##8. Parker W and Patrocinio H (2005) Clinical treatment planning in external photon beam radiotherapy. In: radiation oncology physics: A hand book for teacher and students (E.B.Podgorsak.Ed,219) International atomic energy agency, Vienna. ##9. Elshaikh M, Ljungman M, tenHaken R, Lichter A (2006) Advances in radiation oncology.  Annu Rev Med, 57: 19-31.##10. Meyer Jl, Ed…..IMRT, IGRT and SBRT (2007) Advances in treatment planning and delivery of radiotherapy Basel,Switzerland, S. Karcher AG.##11. Anjum M, Qadir A, Afzal M (2008) Dosimetric evaluation of a treatment planning system using pencil beam convolution algorithm for EDW with symmetric and asymmetric fields. International Journal of Radiation Research, 5(4):169-174.##12. IAEA (2000) Absorbed dose determination in external beam radiotherapy. Code of Practice for high energy photon beam.TRS-398.Vienna, Austria,IAEA.##13. Beavis ?? and ??? A.W (1996) The implementation of the Varian EDW into a commercial RTP system. Phys Med Biol, 41:1691-1704.##14. Early L (1997) An advantage of the dynamic wedges. Med. Dosim, 22(3):193-195.##15. Gibboms JP (1998) Calculation of enhanced dynamic wedge factors for symmetric and asymmetric photon fields. Med Phys, 25:1411-18.##16. Huntzinger CJ (1993) Dynamic wedge: a physicist’s perspective Proceedings of the Varian Dynamic Wedge Users’ Meeting, Calgary, 1992 (Varian, Palo Alto, CA)##17. Sehti A, Leybovich LB, Dogan N, Glasgow GP (2000) Elimination of field size  dependence of enhanced dynamic wedge factors. Phy Med Biol, 45:3359–65.##18. Leavitt DD, Lee WL, Gaffney DK, Moeller JH, O'Rear JH (1997) Dosimetric  parameters of Enhanced dynamic wedge for treatment planning and verification. Med Dosim, 22:177–83.##19. Zhu J (2005) Generation of wedge-shaped dose distributions through dynamic  multileaf collimator dose delivery. J Appl Clin Med Phys, 6:37-45. ## 20. Miften M, Wiesmeyer M, Beavis A, Takahashi K, Broad S (2000) Implementation  of enhanced dynamic wedge in the Focus RTP system. Med Dosim, 25:81-86. ##21. Leavitt DD (1993) Reduction of peripheral dose by dynamic wedge techniques. Med Phys, 20-877.## 22. Kelly C, Wang X, Chu J, Hartselle W (1996) Dose to contralateral breast: Comparison    of  four primary breast irradiation techniques. Int J Radiat Oncol Biol Phys, 34:727-32.  ##23. Bhatnagar AK, Brandner E, Sonnik D, Wu A, Kalnicki S, Deutch M (2004)   Intensity  modulated radiation therapy (IMRT) reduces the dose to the  contralateral breast when compared to conventional tangential fields for  primary breast   irradiation: Initial report. Cancer Jr, 10::381-5.## 24. Tarcilla O, Krasin F and Lawn-Tsao L (1989) Comparison of contralateral breast doses  from  1/2 ] beam block and isocentric treatment techniques for patients treated with   primary breast irradiation with 60CO. Int J Radiat Oncol Biol Phys, 17:205-10.  ## 25. Chougule A (2007) Radiation dose to contra lateral breast during treatment of breast malignancy by radiotherapy. J cancer Resther, 3:8-11.## 26. Muller-Runkel R and Kalokhe UP (1994) Method for reducing scatter radiation dose to the contralateral breast during tangential breast irradiation therapy. Radiology, 191:853-5.  ##27. Almond PR, Biggs PJ, Coursey BM et al. (1999) AAPM’s TG-51 protocol for clinical   reference dosimetry of high-energy photon and electron beams. Med Phys, 26:1847–70.##28. Iqbal k, Isa M, Buzdar SA, Kent Aallen Gifford, Afzal M (2013) Treatment planning evaluation of sliding window and multiple static segments technique in intensity modulated radiotherapy. Reports of practical oncology and radiotherapy, 18:101–106. ##29. Gadhi MA, Buzdar SA, Afzal M, Fatmi Sh, Akhtar MS, Nizamani AH (2013)   Calibration of iridium-192 source by ionization chamber for high dose rate  brachytherapy. Int J Radiat Res, 11(3):189-193.##30. Ismail M, Afzal M, Nadeem M, Rana AM, Amjad S, Buzdar SA (2011) Evaluation  of depth dose characteristics of superficial X-rays machine using different kVp and applicators diameter. Int J Radiat Res, 9(3):159-166.## ##

Optimization of clinical target volume delineation using magnetic resonance spectroscopic imaging (MRSI) in 3D conformal radiotherapy of prostate cancer 2 2 Background: For the purpose of individual clinical target volume assessment in radiotherapy of prostate cancer, MRSI was used as a molecular imaging modality with MRI and CT images. Materials and Methods: The images of 20 prostate cancer patients were used in this study. The MR and MRSI images were registered with CT ones using non-rigid registration technique. The CT based planning (BP), CT/MRI BP and CT/MRSI BP was performed for each patient. For plan evaluation, Dose Volume Histograms (DVHs) data were used. A paired sample T-test was used for the analysis of the obtained data. Results: The percentage of variation of CTVMRI to CTVCT and PTVMRI to PTVCT were 12.83% and 8.97%, respectively. CTVMRSI and PTVMRSI were 21% and 27.41% more than their corresponding values of CT volumes. The mean percentage of variation in rectum volume that received 60% of the prescribe dose (V60R) in MRSI/CT BP relative to CT BP was 14.66%. Conclusion: The use of MRSI in detecting of prostate adenocarcinoma could provide some decisive information to determine optimum volume and safe margin for target definition to improve adaptive radiotherapy in prostate cancer. 303 309 2014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/31 1393/10/10 M. Robatjazi M. Robatjazi Department of Medical Physics, Tehran University of Medical sciences, Tehran, Iran Iran S.R. Mahdavi S.R. Mahdavi Department of Medical Physics, Iran University of Medical sciences, Tehran, Iran Iran srmahdavi@hotmail.com A.R. Nikofar A.R. Nikofar Department of Radiation Oncology, Iran University of Medical sciences, Tehran, Iran Iran B. Bolouri B. Bolouri Department of Medical Physics, Iran University of Medical sciences, Tehran, Iran Iran H.R. Baghani H.R. Baghani Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran Iran MRSI MRI prostate cancer 3D-CRT radiotherapy target definition Parkin DM Bray, Ferlay F, Pisani JP(2005) Global cancer statistics, 2002. CA: a cancer journal for clinicians, 55(2):74.##2. Coakley F, Kurhanewicz J Lu, Jones Y, Swanson K, Chang M, Carroll S, Hricak PH (2002) Prostate Cancer Tumor Volume: Measurement with Endorectal MR and MR Spectroscopic Imaging 1. Radiology, 223(1):91.##3. Yu K, Scheidler J, Hricak H, Vigneron D, Zaloudek C, Males R, Nelson S, Carroll P, Kurhanewicz J (1999) Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology, 213(2):481.##4. Payne G and Leach M (2006) Applications of magnetic resonance spectroscopy in radiotherapy treatment planning. British Journal of Radiology, 79(Special Issue 1):S16.##5. Yuen J, CH T, Khin PH, Phee LW, Xiao SJL, Lau D, Ng WKO, Cheng WS (2004) Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy. The Journal of urology, 171(4):1482-6.##6. Nelson S Graves, Pirzkall E, Li A, Antiniw Chan X, Vigneron A, McKnight DT (2002) In-vivo molecular imaging for planning radiation therapy of gliomas: an application of 1H MRSI. Journal of Magnetic Resonance Imaging, 16(4):464-76.##7. Pouliot JH, Kurhanewicz I, Noworelski JS (2005) Targeting MRS-Defined Dominant Intraprostatic Lesions with Inverse-Planned High Dose Rate Brachytherapy: DTIC Document 2005.##8. Pouliot J Kim, Lessard Y, Hsu E, Vigneron I, Kurhanewicz DJ (2004) Inverse planning for HDR prostate brachytherapy used to boost dominant intraprostatic lesions defined by magnetic resonance spectroscopy imaging. International Journal of Radiation Oncology Biology Physics, 59(4):1196-207.##9. van Lin, Futterer EN, Heijmink JJ, van der Vight SW, Hoffmann LP, van Kollenburg AL, Huisman P, Scheenen HJ, Witjes TW, Leer JA, Barentsz JW, Visser JO, AG. (2006) IMRT boost dose planning on dominant intraprostatic lesions: gold marker-based three-dimensional fusion of CT with dynamic contrast-enhanced and 1H-spectroscopic MRI. International Journal of Radiation Oncology Biology Physics, 65(1):291-303.##10. ZaiderM, Zelefsky M, Lee EK, Zakian K, Amols H, Dyke J, Cohen G, Hu Y, Endi AK, Chui C (2000) Treatment planning for prostate implants using magnetic-resonance spectroscopy imaging1. International Journal of Radiation Oncology Biology Physics, 47(4):1085-96.##11. Kim Y, Noworolski S, Pouliot J, Hsu IC, Kurhanewicz J (2004) Analysis of prostate deformation due to different MRI/MRS endorectal coils for image fusion and brachytherapy treatment planning. Medical Physics, 31: 1728.##12. John SS, Zietman AL, Shipley WU, Harisinghani MG (2008) Newer imaging modalities to assist with target localization in the radiation treatment of prostate cancer and possible lymph node metastases. International Journal of Radiation Oncology Biology Physics, 71(1 Suppl):S43-7.##13. Khoo VS, Padhani AR, Tanner SF, Finnigan DJ, Leach MO, Dearnaley DP(1999) Comparison of MRI with CT for the radiotherapy planning of prostate cancer: a feasibility study. British Journal of Radiology, 72(858):590-7.##14. Mack R, Pamela F, Christine M, John H, Hedvi H (1996) Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for three-dimensional conformal radiotherapy. International Journal of Radiation Oncology Biology Physics, 35(5):1011-8.##15. Prando A (2010) Clinical stage T1c prostate cancer: evaluation with endorectal MR imaging and MR spectroscopic imaging. International Brazilian jouranl of urology, 36: 100-1.##16. Scheidler J, Hricak H, Vigneron D, Yu K, Sokolov D, Huang L, Zaloudek C, Nelson S, Carroll P, Kurhanewicz J (1999) Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging-clinicopathologic study. Radiology, 213(2):473.##Crehange G, Parfait S, Liegard M, Maingon P, Ben Salem, Cochet D, Al Funes de la Vega, Cormier M, Bonnetain L, Mirjolet F, Brunotte C, Walker FP (2010) Tumor Volume and Metabolism of Prostate Cancer Determined by Proton Magnetic Resonance Spectroscopic Imaging at 3T Without Endorectal Coil Reveal Potential Clinical Implications in the Context of Radiation Oncology. International Journal of Radiation Oncology Biology Physics, [doi: DOI: 10.1016/j.ijrobp.2010.03.007].In Press##18. Teh B, Bastasch M, Mai W, Butler E, Brian W, Thomas M (2003) Predictors of Extracapsular Extension and Its Radial Distance in Prostate Cancer: Implications for Prostate IMRT, Brachytherapy, and Surgery. The Cancer Journal, 9(6): p. 454-460.##19. Steenbakkers R, Deurloo K, Nowak P, Lebesque J, Marcel R, Coen R (2003) Reduction of dose delivered to the rectum and bulb of the penis using MRI delineation for radiotherapy of the prostate. International Journal of Radiation Oncology Biology Physics, 57(5):1269-79. ##20. Jackson A, Reinsberg S, Sohaib S, Charles-Edwards, Mangar E, South S, C.Leach M, Dearnaley D (2007) Distortion-corrected T2 weighted MRI: a novel approach to prostate radiotherapy planning. British Journal of Radiology, 80(959): 926.## ##

Dosimetric comparison of two different whole brain radiotherapy techniques in patients with brain metastases: How to decrease lens dose? 2 2 Background: Palliative whole brain radiotherapy (WBRT) has been the standard treatment for brain metastases. Ionizing radiation is known to be one of the most potent cataractogenic agents. We aimed to evaluate two different radiotherapy techniques with respect to the doses received by the organs at risk (OAR) in patients with brain metastasis who undergone WBRT. Materials and Methods: Ten consecutive patients with brain metastasis were included. For each patient, two different treatment plans were created for whole brain. Helmet-field (HF) (anterior border was 2 cm posterior to lens, inferior border was the bottom of C2 vertebra) and classical technique with collimation (CT) (anterior border was defined as skin fall off, inferior border was the bottom of cranial base) were generated for all patients. Two techniques were compared with respect to the doses received by the OAR including bilateral lenses, optic nerves and eye-balls, the dose homogeneity index (DHI), and the monitor unit counts (MU) required for the treatment. Student-t test was used for statistical analysis. Results: There was no difference between two techniques in terms of both DHI (p: 0.182) and MU counts (p: 0.167). The maximum and mean doses received by the right lens, left lens and right eye-ball were significantly reduced with CT (p values for maximum doses 0.007, 0.012 and 0.010 for median doses 0.027, 0.046 and 0.002 respectively). Conclusion: CT was found to be more advantageous, with respect to the lens doses in addition the dose received by the right eye-ball during WBRT. 311 317 2014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/31 1393/10/10 G. Yavas G. Yavas Selcuk University, Department of Radiation Oncology, Konya, Turkey Turkey guler.aydinyavas@gmail.com C. Yavas C. Yavas Konya Training and Research Hospital, Department of Radiation Oncology, Konya, Turkey Turkey O.V. Gul O.V. Gul Medipol University, Department of Radiation Oncology, Istanbul, Turkey Turkey H. Acar H. Acar Medipol University, Department of Radiation Oncology, Istanbul, Turkey Turkey O. Ata O. Ata Selcuk University, Department of Medical Oncology, Konya, Turkey Turkey Brain metastasis whole brain radiotherapy lens dose cataract Posner JB (1992) Management of brain metastases. Rev Neurol, (Paris) 148(6–7): 477–87.##Graus F, Walker RW, Allen JC (1983) Brain metastases in children. J Pediatr, 103(4):558–61.##Murray KJ, Scott C, Greenberg HM, Emami B, Seider M, Vora NL, Olson C, Whitton A, Movsas B, Curran W(1997) A randomized phase III study of accelerated hyperfractionation versus standard in patients with unresected brain metastases: A report of the Radiation Therapy Oncology Group (RTOG) 9104. Int J Radiat Oncol Biol Phys, 39:571–574.##Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R(1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys, 37(4): 745–751.##Khan AJ and Dicker AP (2013) On the merits and limitations of whole-brain radiation therapy. J Clin Oncol, 1;31(1):11-3.##Harding JJ and Crabbe JC (1984) The lens. In: Davson H. (Ed.), The Eye, 3rd ed. Vol. 1b. Academic Press, New York, NY, pp. 207–492.##Horwitz J and Jaffe NS (1992) Lens and cataract. In: Podos, S.M., Yanoff, M. (Eds.), Textbook of Ophthalmology, Vol. 3. Gower Medical Publishing, New York, NY.##Bantseev V, Bhardwaj R, Rathbun W, Nagasawa H, Trevithick JR (1997) Antioxidants and cataract: (cataract induction in space environment and application to terrestrial aging cataract). Biochem Mol Biol Int, 42: 1189–1197.##Bardak Y, Cekic O, Totan Y, Cengiz M (1998) Effect of verapamil on lenticular calcium, magnesium and iron in radiation exposed rats. Int Ophthalmol, 22:285–288.##Von Sallmann L (1951) Experimental studies on early lens changes after roentgen irradiation. III. Effect of X-radiation on mitotic activity and nuclear fragmentation of lens epithelium in normal and cysteine treated rabbits. Arch. Ophthalmol, 47: 305-320.##Von Sallman L (1957) The lens epithelium in the pathogenesis of cataract. Am J Ophthalmol, 44: 159– 170.##Harding CV, Thayer MN, Eliashof PA, Rugh R (1965) Effects of X-irradiation on the injury reaction in lens epithelium. Radiat Res, 25: 305-311.##Cogan DG, Donaldson DD, Reese AB (1952) Clinical and pathological characteristics of radiation cataract. Arch Ophthalmol, 47: 55–70.##Worgul BV, Merriam GR, Szechter A, Srinivasan BD (1976) Lens epithelium and radiation cataract. Arch Ophthalmol, 94: 996–999.##Cogan DG, Donaldson DD (1951) Experimental radiation cataracts. I. Cataracts in the rabbit following single X-ray exposure. Arch Ophthalmol, 45: 508–522.##Beyzadeoglu M, Ozyigit G, Ebruli C (2010) Clinical Radiation Oncology. Springer-Verlag Berlin Heidelberg pp:196.##Wu Q, Mohan R, Morris M, Lauve A, Schmidt-Ullrich R (2003) Simultaneous integrated boost intensity modulated radiotherapy for locally advanced head and neck squamous cell carcinomas. Dosimetric results. Int J Radiat Oncol Biol Phys, 56:573-585.##Brown PD, Asher AL, Farace A (2008) Adjuvant whole brain radiotherapy: strong emotions decide but rational studies are needed. Int J Radiat Oncol Biol Phys, 70: 1305-1309.##Regine WF, Scott C, Murray K, Curran W (2009) Neurocognitive outcome in brain metastases patients treated with accelerated-fraction vs. accelerated-hyperfrationated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-04. Int J Radiat Oncol Biol Phys, 51(3):711-717.##Narita Y and Shibui S (2009) Strategy of surgery and radiation therapy for brain metastases. Int J Clin Oncol, 14: 275-280.##Suh JH (2010) Stereotactic radiosurgery for the management of brain metastases. N Engl J Med, 362: 1119-1127.##Andic F, Ors Y, Niang U, Kuzhan A, Dirier A (2009) Dosimetric comparison of conventional helmet-field whole brain irradiation with three-dimesional conformal radiotherapy: dose homogeneity and retro-orbital coverage. The British J of Radiol 82:118-122.##Gripp S, Doeker R, Glag M, Vogelsang P, Bannach B, Doll T, Muskalla K, Schmitt G(1999) The role of CT simulation in whole-brain irradiation. Int J Radiat Oncol Biol Phys, 45(4):1081-1088.##Weiss E, Krebeck M, Kohler B, Pradier O, Hess CF (2001) Does the standardized helmet technique lead to adequate coverage of the cribriform plate? An analysis of current practice with respect to the ICRU 50 report. Int J Radiat Oncol Biol Phys 49:1475–80.##Ugurluer G, İzmirli M, Palabiyik ZA, Cakir T (2009) The comparison of brain and lens doses in whole brain radiotherapy with different treatment plannnings. UHOD, 19(3):140-146.##Bouffler S, Ainsbury E, Gilvin P, Harrison J (2012) Radiation-induced cataracts: the Health Protection Agency’s response to the ICRP statement on tissue reactions and recommendation on the dose limit for the eye lens. J Radiol Prot, 32: 479–488.##Berthoud VM and Beyer EC (2009) Oxidative stress, lens gap junctions and cataracts Antioxid. Redox Signal, 11: 339–53.##Beebe DC, Holekamp NM, Siegfried C, Shui YB (2011) Vitreoretinal influences on lens function and cataract Phil. Trans R Soc Lond B, 366: 1293–300.##Bardak Y, Ozerturk Y, Ozguner F, Durmus M , Delibas N (2000) Effect of melatonin against oxidative stress in ultraviolet-B exposed rat lens. Curr Eye Res, 20:225–230.##Barros PS, Angelotti AC, Nobre F, Morales A, Fantoni DT, Barros SB (1999) Antioxidant profile of cataractous English Cocker Spaniels. Vet Ophthalmol, 2: 83-86.## ##

Evaluation the early effects of single high dose radioiodine therapy on lacrimal gland function 2 2 Background: The therapeutic administration of 131I for thyroid remnant ablation and for metastases comes up with some adverse effects. This study was conducted to investigate whether single high dose radioiodine therapy affects lacrimal gland functions or not. Materials and Methods: Seventy-eight eyes of 39 patients, who were diagnosed as differentiated thyroid carcinoma, were objectively tested with Schiermer’s test and tear film break-up time test before and 1 and 6 months after high dose (&ge 3700 MBq) 131I therapy. Results: The median values of pre-treatment Schiermer’s test were 10.00 mm and 9.60 mm for right and left eyes, respectively. At the post-treatment first and sixth months, no significant change was observed in the median values of Schiermer’s test in both eyes (p= 0.189 and p=0.085, respectively, Friedman test). The median values of pre-treatment tear film break-up time test were 9.15 sn and 9.20 sn for right and left eyes, respectively. The median values of post-treatment tear film break-up times reduced at first and sixth months and the difference between the pre-treatment and post-treatment values were significant in both eyes (p=0.020 and p=0.022 for right and left eyes, respectively, Friedman test). Conclusion: Impairment of goblet cell function occurs early after administration of single high dose 131I application. However, reduction in tear secretion from lacrimal gland is not observed. 319 324 2014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 G.K. Gedik G.K. Gedik Selcuk University Medical Faculty, Department of Nuclear Medicine, Konya, Turkey Turkey goncakara@yahoo.com S. Gedik S. Gedik Selcuk University Medical Faculty, Department of Ophthalmology, Konya, Turkey Turkey B.E. Koktekir B.E. Koktekir Selcuk University Medical Faculty, Department of Ophthalmology, Konya, Turkey Turkey L. Kebapcilar L. Kebapcilar Selcuk University Medical Faculty, Department of Endocrinology, Konya, Turkey Turkey P.O. Kara P.O. Kara Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey Turkey 131I lacrimal gland dysfunction therapy thyroid cancer ##Bohuslavizki KH, Brenner W, Lassmann S, Tinnemeyer S, Tönshoff G, Sippel C, et al. (1996) Quantitative salivary gland scintigraphy in the diagnosis of parenchymal damage after treatment with radioiodine . Nucl Med Commun, 17: 681-86.##Bakheet SM and Hammami MM (1994) False-positive radioiodine whole-body scan in thyroid cancer patients due to unrelated pathology. Clin Nucl Med, 19: 325-29. ##Zettinig G, Karanikas G, Hanselmayer G, Havlik E, Dudczak R (2000) Radioactive contamination of contact lenses during radioiodine therapy. Nucl Med Commun, 21: 955-57.##Zettinig G, Hanselmayer G, Fueger BJ, Hofmann A, Pirich C, Nepp J et al. (2002) Long-term impairment of the lacrimal glands after radioiodine therapy: a cross-sectional therapy. Eur J Nucl Med Mol Imaging, 29: 1428-32.##Fard-Esfahani A, Mirshekarpour H, Fallahi B, Eftekhari M, Saghari M, Beiki D, et al. (2007) The effect of high-dose radioiodine treatment on lacrimal gland function in patients with differentiated thyroid carcinoma. Clin Nucl Med, 32: 696-99.##Solans R, Bosch JA, Galofre P, Porta F, Rosello J, Selva-O’Callagan A et al. (2001) Salivary and lacrimal gland dysfunction (Sicca Syndrome) after radioiodine therapy. J Nucl Med, 42: 738-43.##Wang HF, Fukuda M, Shimomura Y (2005) Diagnosis of dry eye. Semin Ophthalmol, 20: 53-62. ##Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ et al. (2008) Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med, 35: 1941-59.##Caglar M, Tuncel M, Alpar R (2002) Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment. Clin Nucl Med, 27: 767-71.##Rocha EM, Mantelli F, Nominato LF, Bonini S (2013) Hormones and dry eye syndrome: an update on what we do and don’t know. Curr Opin Ophthalmol, 24: 348-355.##Koca G, Acar U, Atılgan HI, Ergintürk Acar D, Altıparmak UE, Demirel K, et al. (2013) Changes in conjunctival cytology and tear function tests with radioiodine treatment for hyperthyroidism. Ann Nucl Med. 27:694-9. ##Dias AC, Modulo CM, Jorge AG, Braz AM, Jordao AA Jr, Filho RB, et al. (2007) Influence of thyroid hormone on thyroid hormone receptor β-1 expression on lacrimal gland and ocular surface morphology. Invest Ophthalmol Vis Sci, 48: 3038-3042.##13. Markitziu A, Lustmann J, Uzieli B, Krausz Y, Chisin R (1993)Salivary and lacrimal gland involvement in a patient who had undergone a thyroidectomy and was treated with radioiodine for thyroid cancer. Oral Surg Oral Med Pathol, 75: 318-22.## ##

HVL evaluation of orthovoltage X-ray machine using EGSnrc code of simulation 2 2 Background: Making use of the orthovoltage machines in Radiotherapy, is one of the routine methods for the treatment of the superficial lesions. In this study, an important determinant of X-ray quality, the HVL (Half Value Layer), has been evaluated. Materials and Methods: The HVLs of a orthovoltage X-ray machine in 120 and 180 kVp are measured, using an empirical method, in which the HVLs are derived from the absorption curves. The measured HVLs are compared with calculated (Monte Carlo simulation) HVLs. Using the BEAMDP code of simulation, the output spectra are obtained and employed for the measurement of the HVLs. Results: Comparing the calculated and measured HVL values, the results show that the highest and lowest differences between the two are 4.96% and 2.27%, respectively, which are, in fairly good agreement with those obtained in the former studies. Conclusion: This study shows that the EGSnrc simulation code is capable of being used for the extraction of the quality indices for the superficial X-ray radiotherapy machines. It seems that, the mentioned code, with the mentioned experimental method, can be employed as a routine clinical test tool for every superficial radiotherapy department. 325 330 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 A. Shabestani Monfared A. Shabestani Monfared Biochemistry and Biophysics Deptartment, Babol University of Medical Sciences, Shahid Rajaee Oncology Hospital, Babolsar, Iran Iran T. Allahverdi Pourfallah T. Allahverdi Pourfallah Biochemistry and Biophysics Department, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Iran tpourfallah@mazums.ac.ir H. Babapour H. Babapour Nuclear Engineering Department, Azad Islamic University- Sciences and Researches Branch, Tehran, Iran Iran A.R. Shirazi A.R. Shirazi Medical Physics Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Iran HVL EGSnrc MC simulation orthovoltage machine Johns HE, Cunningham JR (1983) The Physics of Radiology. 4th edn. Springfield & Illinois: Charles C. Thomas Publisher. ##2. Khan FM (2003) Physics of Radiation Therapy. 3rd edn. Philadelphia: Lippincott Williams & Wilkins. ##3. Chica U, Anguiano M, Lallena AM (2009) Benchmark of penelope for low and medium energy X-rays. Phys Med, 25: 51-57. ##4. Mainegra-Hing E, Kawrakow I (2006) Efficient X-ray tube simulations. Med Phys, 33: 2683-2690. ##5. Allahverdi Pourfallah T, Allahverdi M, Riahi Alam N, Ay M, Zahmatkesh M (2009) Verifying the accuracy of dose distribution in gamma knife unit in presence of inhomogeneities using PAGAT polymer gel dosimeter and MC simulation. Iran J Radiat Res, 7: 49-56. ##6. Pourfallah T, Allahverdi M, Alam N, Ay M, Zahmatkesh M, Ibbott G (2009) Performance evaluation of MRI-based PAGAT polymer gel dosimeter in an inhomogeneous phantom using EGSnrc code on a Co-60 machine. Appl Radiat Isot, 67: 186-191. ##7. Pourfallah T, Allahverdi M, Riahi Alam N, Ay M, Zahmatkesh M (2009) Differential dose volume histograms of Gamma Knife in the presence of inhomogeneities using MRI–polymer gel dosimetry and MC simulation. Med Phys, 36: 3002-3012. ##8. Rogers DWO, Faddegon BA, Ding GX, Ma CM, Wei J, Mackie TR (1995) BEAM: A Monte Carlo code to simulate radiotherapy treatment units. Med Phys, 22: 503 – 524. ##9. Rogers D, Walters B, Kawrakow I (2007) BEAMnrc Users Manual. Ottawa : National Research Council of Canada; 2007 May. 268 p. Report PIRS-0509(A) revL. ##10. Ma CM and Rogers DWO (2009) BEAMDP Users Manual : National Research Council of Canada; 2009 July. 35 p. Report PIRS-0509(C) revA. ##11. Nelson W, Hirayama H, Rogers D (1985) The EGS4 Code System. Stanford Linear Accelerator Center, Stanford, California; 1985. Report SLAC–265. ##12. Kawrakow I and Rogers DWO (2003) The EGSnrc code system: Monte Carlo simulation of electron and photon transport. Technical Report PIRS-701, 4th printing: Ottawa, Canada: National Research Council of Canada. ##13. Kawrakow I, Mainegra-Hing E, Rogers D, Tessier F, Walters B (2011) The EGSnrc Code System: Monte Carlo Simulation of Electron and Photon Transport. Ottawa: National Research Council of Canada; 2011. Report PIRS-701. ##14. Knöös T, Rosenschöld PM, Wieslander E (2007) Modelling of an Orthovoltage X-ray Therapy Unit with the EGSnrc Monte Carlo Package Radiation Physics. J Phys, Conf. Ser.: 021009. ##15. Hubbell JH and Seltzer SM (2004) Tables of X-ray mass attenuation coefficients and mass energy-absorption coefficients from 1 keV to 20 MeV for elements Z=1 to 92 and 48 additional substances of dosimetric interest. National Institute of Standards and Technology, Gaithersburg: NISTIR 5632. Version 5631.5634 [Online]. ##16. Kawrakow I (2002) Electron impact ionization cross sections for EGSnrc. Med Phys, 29: 1230. ##17. Berger MJ and Hubbell JH (1987) XCOM: Photon Cross Sections on a Personal Computer. NBSIR 87-3597, National Bureau of Standards (former name of NIST), Gaithersburg, MD. ##18. Mainegra-Hing E and Kawrakow I (2006) Efficient X-ray tube simulations. Med Phys, 33: 2683-2690. ##19. Rogers DWO, Faddegon BA, Ding GX, Ma CM, Wei J, Mackie TR (1995) BEAM: A Monte Carlo code to simulate radiotherapy treatment units. Med Phys, 22: 503 – 524. ##20. Nelson WR, Hirayama H, Rogers DWO (1985) The EGS4 Code System. Stanford Linear Accelerator Center, Stanford, California; 1985. Report SLAC–265. ##21. Treurniet J, Walters B, Kawrakow I, Rogers D (2005) BEAMnrc, DOSXYZnrc and BEAMDP GUI User’s Manual. Ottawa: National Research Council of Canada; 2005 Jul. 17 p. Report PIRS-0623(rev C). ##22. Verhaegen F, NA E, Van de Putte S, Namito Y (1999) Monte Carlo modelling of radiotherapy kV X-ray units. Phys Med Biol, 44: 1767-1789. ##23. Omrane LB, Verhaegen F, Chahed N, Mtimet S (2003) An investigation of entrance surface dose calculations for diagnostic radiology using Monte Carlo simulations and radiotherapy dosimetry formalisms. Phys Med Biol, 48: 1809-1824. ## ##

Effect of acute tritiated water (HTO) exposure on Maze learning in adult Swiss albino mice 2 2 Background: Brain is the most important organ as it controls and co- ordinates all the activities of our body. Reports on neuroethological investigations in mice particularly associated with learning and memory after radiation exposure are very scanty. Hence, present investigation is an attempt to examine the effects of low dose tritiated water (HTO) acute exposure on adult Swiss albino mice in the light of behavioral parameters. Materials and Methods: Swiss albino adult male mice were trained in a Hebb William’s Maze, model D. When the mice had learned the Maze, they were injected with tritiated water and then the same batch (pre learned mice) again tested for memory retention. Results: Our results clearly show that the adult mice learned the Maze in ten trials. On day ten of the experiment mice were injected with dose 111.0 kBq/gm. bd. wt. tritiated water. Immediately after the exposure, the mice started taking relatively more time to reach the goal which continued till trials 11, 12 and 13 of the experiment. However, after this, a reversal in the learned performance was observed in most of the experimental mice whereby the learned activity returned to a near normal on trials 14 and 15. From 16th trial onwards, the performance of the irradiated mouse was found to be even superior over the prelearned mice though, their pattern did not show the steady state as was evident just prior to HTO injection. Conclusion: The findings from our experiments signify that the possible alterations in behaviour in adult Swiss albino mice after low doses of acute tritiated water exposure cannot be safely ruled out. 331 334 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 N. Jain N. Jain Department of Zoology, BBD Government P. G. College, Chimanpura (Shahpura) – 303103 Jaipur, Rajasthan, India India drnjain1@gmail.com Brain Maze tritium tritiated water learning NCRP (1979) Tritium and other radionuclide labeled organic compounds incorporated in genetic material. National Council on Radiation Protection and Measurements, Report 63, Washington D.C##2. Jacobs DJ (1968) sources of tritium and its behavior upon release to the environment, Report No. TID- 24635, US Atomic Energy Commission, Washington##3. Watson JS (1972) A summary of tritium handling problems in fusion reactors. Report ORNL-TM-4022.##4. Häfele W, Holdren JP, Kessler G, Kulcinsky GL (1977)Fusion and fast breeder reactors. Report International Institute for Applied System Analysis, Luxemburg/Austria.##5. Thompson RC and Ballou JE (1956) Studies on metabolic turnover with H3 as tracer. J Biol Chem, 23: 795- 805.##6. Takeda H and Kasida Y (1979) Biological behavior of tritium after administration of tritiated water in rat. J Radiat Res, 20: 174- 185.##7. Bruwaene RV, Gerber JB, Kirchmann R ,Van den Hoek J, Vankerkom J (1982) Tritium metabolism in young pigs after exposure of mothers to tritium oxide during pregnancy. Radiat Res, 91: 124- 134.##8. Blair WC and Arnold WJ (1956) The effects of cranial X- irradiation of retention of Maze learning in rats. J Comp & Physiol Psychol, 49: 525- 528.##9. Blair WC (1958) The effects of cranial X- irradiation on Maze acquisition in rats. J Comp & Physiol Psychol, 51: 175- 177.##10.Jensh RP, Brent RL, Vogel WH (1986) Studies concerning the effects of low level prenatal X- irradiation on postnatal growth and adult behavior in the Wistar rat. Int J Radiat Biol, 6: 1069- 1081.##11. Jain N (2012) Neuroethological investigations in pregnant Swiss albino mice continuously exposed to low dose tritiated water. Paper presented in 11th Int LOWRAD Conf 17- 18 Dec 2012 Lyon France P 37.##12.Jones DC, Kimeldorf DJ, Rubadeau DD, Osborne GK and Castaner TJ (1954) Effect of X- irradiation on performance of volitional activity by the adult male rat. Am J Physiol, 177: 243- 250.##13.Landauer MR, Davis HD, Dominitz JD, Weiss JF (1987) Dose and time relationship of the radio protector, WR 2721 on locomotor activity in mice. J Pharmacol Biochem Beh, 27: 573- 576. ##14.Walker RI and Porvaznik M (1983) Association of bacteria and endotoxin with post- trauma events. In: Traumatic Injury: Infection and other immunologic sequels (Ed. JJ Ninnemann) Baltimore. Univ. Park Press. 1- 15.##15.Chiu EK and Richardson JS (1985) Behavioral and neurochemical aspects of prostaglandin in brain function. Gen Pharmacol, 16: 163- 175.##16. Jain N and Bhatia AL (2011) Tritium in the environment and its impact assessment against the existing radiation protection framework revisited. Radioprotection, 46: No. 6: S385- S391. ## ##

Tissue inhomogeneity in proton therapy and investigation of its effects on BRAGG peak by using MCNPX code 2 2 Background: Hadron therapy for malignant tumor is becoming increasingly popular. There are many factors which effect on implementation of a proper treatment planning. The purpose of this work is to investigate the inhomogeneity effects as affecting factor on proton range, Full width at half maximum (FWHM) and 20% position of penumbra (P20) by MCNPX code. Materials and Methods: An inhomogeneous tissue (Bone or Adipose) with a variable thickness (0.1 cm, 0.5cm and 1.0 cm) was inserted into a phantom. Then this phantom was irradiated by 108.8 MeV proton beam located at 10 cm away from it. Particle energy deposition (PEDEP) in mesh tally card was used for simulation of Bragg curve and obtaining the proton range, FWHM and 20% position of penumbra (P20). Finally, the MCNPX results were compared with GEANT4. Results: The results of MCNPX for water phantom including 1cm adipose for range and P20 were 8.87 and 9.10 cm respectively, and for 1cm bone, range and P20 were 8.52 and 8.58 cm. By increasing the adipose thickness, range and P20 were reduced but it was vice versa for increasing the bone thickness. Also FWHM does not show a regular variation in both bone and adipose tissues. Conclusion: The results show that the location of the inhomogeneous tissues does not affect the variation of the whole shape of the Bragg curve, while it radically affects the dose in the Bragg curve. The comparison between MCNPX and GEANT4 results showed that the MCNPX results have the closer values than GEANT4 to references. 335 341 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 S.P. Shirmardi S.P. Shirmardi Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran Iran p_shirmardi@aut.ac.ir E. Saniei E. Saniei Faculty of Energy Engineering and Physics, Amir Kabir University of Technology, Tehran, Iran Iran M. Erfani M. Erfani Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran Iran M. Shafiei M. Shafiei Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran Iran B. Sepehri B. Sepehri Faculty of Physics, Islamic Azad University, Central Tehran Branch, Tehran, Iran Iran Proton therapy MCNPX GEANT4 brag peak plateau Wilson RR (1946) Radiological use of fast protons. Radiology, 47: 487-491.##2. Lee M, Wynne C, Webb S, Nahum AE, Dearnaley D (1994) A comparison of proton and megavoltage X-ray treatment planning for prostate cancer. Radiother Oncol, 33: 239-253.##4. Lomax A (1999) Intensity modulation methods for proton radiotherapy. Phys Med Biol, 44:185-205.##5. Zheng J, Fontenot J, Taddei P, Mirkovic D, Newhauser WD (2008) Monte Carlo simulations of neutron spectral fluence, radiation weighting factor and ambient dose equivalent for a passively scattered proton therapy unit. Phys Med Biol, 53: 187–201.##6. Sawakuchi GO, Titt U, Mirkovic D, Ciangaru G, Zhu XR, Sahoo N, Gillin MT and MohanR (2010) Monte Carlo investigation of the low-dose envelope from scanned proton pencil beams. Phys Med Biol, 55: 711–721.##7.Waters LS, Hendricks J, McKinney G (2002) Monte Carlo N-Particle Transport Code system for Multiparticle and High Energy Applications. Los Alamos, NM: Los Alamos National Laboratory.##8. Paganetti H (1998) Monte Carlo method to study the proton fluence for treatment planning. Med Phys, 25: 2370–2375.##9.Newhauser WD, Fontenot JD, Zheng Y, Polf J, Titt U, Koch N, Zhang X and Mohan R (2007) Monte Carlo simulations for configuring and testing an analytical proton dose-calculation algorithm. Phys Med Biol, 52: 4569–4584.##10. Titt U, Sahoo N, Ding X, Zheng Y, Newhauser WD, Zhu XR, Polf JC, Gillin MT and Mohan R (2008) Assessment of the accuracy of an MCNPX-based Monte Carlo simulation model for predicting threedimensional absorbed dose distributions. Phys Med Biol, 53: 4455–4470.##11. Shultis J K, Faw R E (2010) AN MCNP PRIMER Department of Mechanical and Nuclear Engineering, Kansas State University.##12. Sharifi Sh, Bagheri R, Shirmardi SP (2013) Comparison of shielding properties for ordinary, barite, serpentine and steel-magnetite concretes using MCNP-4C code and available experimental results. Ann Nucl Energy, 53: 529–534.##13. Allison J (2006) GEANT4 developments and applications. IEEE Trans. Nucl Sci, 53: 270-278.##14. GEANT4 Physics Reference Manual (2009).##15.Park SH, Jung WG, SUH TS, Jang HS, Choi BO, Rah JE, Park S, Lee SB (2011) Variation of bragg Curve Characteristic Induced by Changing the Position of Inhomogeneous Material:GEANT4 Simulation Study. Journal of the Korean Physical Society, 58(2): 187-197.##16. Pflugfelder D (2007) Quantifying lateral tissue heterogeneities in hadron therapy. Med Phys 34: 1506.##17. Schneider U, Pedroni E, Lomax A (1996) The calibration of CT Hounsfield units for radiotherapy treatment planning. Phys Med Biol, 41:111-124.##18. Szymanowski H, Pflugfelder D, Nill S, Oelfke U (2005) Practical implementation of an improved proton dose algorithm for heterogeneous media. Radiother Oncol, 76: p. S56.##19. Urie M, Goitein M, Holley W R and Chen GTY (1986) Degradation of the bragg peak due to inhomogeneities. Phys Med Biol, 31: 1, 1-15.##20. Paganetti H (1998) Monte Carlo method to study the proton fluence for treatment planning. Med. Phys, 25(12): 2370-5.##21. Ciangaru G1, Polf JC, Bues M, Smith AR (2005) Benchmarking analytical calculations of proton doses in heterogeneous matter. Med Phys, 32(12): 3511-23.## ##

Assessment of molybdenum breakthrough levels in molybdenum-99/technetium-99m generators: One year experience at NIMRA Jamshoro Pakistan 2 2 Background: Technetium-99m radioisotope is the backbone of any nuclear medicine institute. This radioisotope is acquired by the elution of Molybdenum-99/Technetium-99m generator which emits 141 keV gamma ray and having 6.04 hour half-life. Occasionally the contents of Molybdenum-99 may mix up with elute, which may affect image quality and patients may receive higher doses than recommended. This study was initiated to check and evaluate the contamination of Molybdenum-99 in Molybdenum-99/Technetium-99m generators used at Nuclear Institute of Medicine and Radiotherapy (NIMRA) Jamshoro Pakistan before its administration to patients for diagnostic procedures. Materials and Methods: The Molybdenum-99 impurity in Technetium-99m elute for 50 generators was studied during the year 2012. The measurements were made using dose calibrator and a standard canister at the time of first elution of the generators. The dose calibrator displays result after executing various steps in a sequence. Due to some production process error or any mechanical fault high activity of Molybdenum-99 was recorded and removed with decrease in Technetium-99m yield. Results: The most of eluted generators (90%) contained 10% of molybdenum breakthrough of the permissible limit (P < 0.05). The high activity of Molybdenum-99 was recorded in only 6% of the generator and removed by using standard methods with some reduced Technetium-99m activity. Conclusion: The molybdenum breakthrough was according to recommended standards in most of the generators. The removal of high contents of Molybdenum-99 enabled the institute to continue routine imaging services by improved image quality and reduction in radiation dose to the patients. 343 346 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 S.A. Memon S.A. Memon Nuclear Institute of Medicine and Radiotherapy (NIMRA) Jamshoro, Pakistan Pakistan physicistsajjad@hotmail.com N.A. Laghari N.A. Laghari Nuclear Institute of Medicine and Radiotherapy (NIMRA) Jamshoro, Pakistan Pakistan S.T. Qureshi S.T. Qureshi University of Sindh, Jamshoro, Pakistan Pakistan F. Mehdi F. Mehdi Nuclear Institute of Medicine and Radiotherapy (NIMRA) Jamshoro, Pakistan Pakistan Dose calibrator 99Mo-99mTc generator 99Mo molybdenum breakthrough 99mTc 1. Fatima N, Zaman M, Niayz K, Raza H, Iqbal J , Hameed A , Hashmi H, Habib S (2008) Effective method to minimize molybdenum content of 99molybdenum-99mTechnetium generator eluate. Pakistan J Radiol, 18: 20-21.##2. Williams CC, Kereiakes JG, Grossman LW (1981) The accuracy of 99Molybdenum assays in 99mTechnetium solutions. Radiology, 138: 445-448.##3. Fabiola MG, Archundia LVD, Sabino HC (2008) 99Mo/99mTc Generators Performances Prepared from Zirconium Molybate Gels. J Brazil Chem Soc, 19: 380-388.## 4. Arano Y(2002) Recent advances in 99mTc radiopharmaceuticals. Ann Nucl Med, 16: 79-93.##5. Hou X, Jensen M, Nielsen SP (2007) Use of 99mTc from a commercial 99Mo/99mTc generator as yield tracer for the determination of 99Tc at low levels. Appl Radiat Isotopes, 65: 610-618.##6. Shah AS, Hameedullah, Khan A, Khan SU, Shahid S (2009) Comparisons of 99Mo breakthrough levels in 99Mo/99mTc generator eluates from two manufacturers and its purification for nuclear medicine imaging. Pakistan J Radiol, 19: 46-49.##7. Vučina J (2001) Elution efficiency of Mo-99/Tc-99m generator. Facta Universitatis Series: Physics, Chemistry and Technology, 2: 125-130.##8. Dantas BM, Dantas AA, Marques FN, Bertelli L, and Stabin MG (2005) Determination of 99Mo contamination in a nuclear medicine patient submitted to a diagnostic procedure with 99mTc. Braz Arch Biol Techn, 48: 215-220.##9. Momennezhad M, Zakavi SR, Sadeghi R (2010) Determination of 99Mo contamination in 99mTc elute obtained from 99Mo /99mTc- generator. Iran J Radiat Res, 8: 31-35.##10. Firestone RB and Ekström LP (2004) Lawrence Berqueley National Laboratory. LBNL Isotopes Project-LUNDS Universitet. WWW Table of Radioactive Isotopes, Available from: http://ie.lbl.gov/toi/index.asp (cited on 28 March 2013).## 11. Pakistan Nuclear Regulatory Authority (2008) Regulatory Guide on Quality Assurance in Nuclear Medicine, Pak-9043, Rev. 0; pp21.##12. National Regulatory Commission (2005) 35:204. Permissible molybdenum-99, strontium-82, and strontium-85 concentrations, Available from: http://www.nrc.gov/reading-rm/doc-collections/cfr/part035/part035-0204.html (Updated on March 01, 2013).##13. International Atomic Energy Agency (1999) Manual de protocolos de calidad de radiofármacos. Projeto ARCAL XV - Producción y control de radiofármacos. IAEA##14. Essig T (2004) Health Physics Society website. Available from: http://hps.org/publicinformation/ate/q3745.html (cited on 21 December 2012).##15. Chianta M (2008) Covidien imaging solutions-potential for molybdenum-99 breakthrough Available from: http://www.aapm.org/government_affairs/Covidien.asp (cited on 04 April 2013).##16. Reese IC and Mishkin FS (1968) A simple method of reducing the molybdenum content of the elute from a 99Mo-Tc99m generator. Am J Roentgenol, 103: 896.##17. Khoury HJ, Dornellas F, Lopes F (2003) Evaluation of the quality control of the radiopharmaceuticals used at the nuclear medicine clinics of Recife, Brazil. Radioproteccão, 2: 79-86.## ##

The basic radiation properties of the N-isopropylacrylamide based polymer gel dosimeter 2 2 Background: In this study the basic radiation properties of N-isopropylacrylamaide polymer gel dosimeter were determined together with verification of its soft tissue equivalency. Materials and Methods: The NIPAM gel was prepared and irradiated approximately 2 h after manufacturing. The magnetic resonance (MR) images were made 24 h after irradiation. The nuclear magnetic resonance (NMR) response (R2) of the dosimeters was analyzed for conditions of varying dose, batch, dose rate, time post-irradiation and energy. In order to verify tissue equivalence of NIPAM dosimeter, several parameters such as physical density, effective atomic number, relative electron density, CT (Computed Tomography) number and also elemental composition were determined and compared with those for soft tissue. Results: The response of the gel was found to be stable 24 hours after irradiation. The results showed that the dose response of the NIPAM polymer gel is reproducible in same and different batches of chemical and the gel response was linear up to 26 Gy with r2=0.995. In the measured range, the dose response of the NIPAM gel is independent of beam energy within less than ±0.02 and the dose rate had no effect on the gel response. This polymer gel has been found to be tissue equivalent. Conclusion: NIPAM gel dosimeter appears to be a promising dosimeter in all aspects of dosimetric properties which were assessed in this study, in addition to the advantage of reduced toxicity which it has over other polymer gels. 347 354 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 A.R. Farajollahi A.R. Farajollahi Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Iran F. Pak F. Pak Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Iran f-pak@razi.tums.ac.ir M. Horsfield M. Horsfield Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK U.K Z. Myabi Z. Myabi Department of Radiology, Emam Reza teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Iran NIPAM magnetic resonance imaging MRI R2 Baldock C, De Deene Y, Doran S, Ibbott G, Jirasek A, Lepage M, Mc Auley KB, Oldham M, Schreiner LJ (2010) . Polymer gel dosimetry. Phys Med Biol, 55:R1-63.## 2. Hurley CA (2006) The development of normoxic polymer gel dosimetry using high resolution MRI. Ph.D. thesis, Queensland University of Technology, Brisbane## 3. Gore JC, Kang YS, Schulz RJ (1984) Measurement of radiation dose distributions by nuclear magnetic resonance (NMR) imaging. Phys Med Biol, 29:1189-97.## 4. Chan MF and Ayyangar KM(1995) Confirmation of target localization and dosimetry for 3D conformal radiotherapy treatment planning by MR imaging of a ferrous sulfate gel head phantom. Med Phys, 22:1171-5.## 5. Schulz RJ, deGuzman AF, Nguyen DB, Gore JC (1990) Dose-response curves for Fricke-infused agarose gels as obtained by nuclear magnetic resonance. Phys Med Biol, 35:1611-22.##6. Baldock C, Harris PJ, Piercy AR, Healy B (2001) Experimental determination of the diffusion coefficient in two-dimensions in ferrous sulphate gels using the finite element method. Australas Phys Eng Sci Med, 24:19-30.## 7. Maryanski MJ, Schulz RJ, Ibbott GS, Gatenby JC, Xie J, Horton D, Gore JC (1994) Magnetic resonance imaging of radiation dose distributions using a polymer-gel dosimeter. Phys Med Biol, 39:1437-55.## 8. Baldock C, Burford RP, Billingham N, Wagner GS, Patval S, Badawi Rd, Keevil SF (1998) Experimental procedure for the manufacture and calibration of polyacrylamide gel (PAG) for magnetic resonance imaging (MRI) radiation dosimetry. Phys Med Biol, 43:695-702.## 9. De Deene Y, De WC, Van DB, Derycke S, De NW, Achten E (1998) Three-dimensional dosimetry using polymer gel and magnetic resonance imaging applied to the verification of conformal radiation therapy in head-and-neck cancer. Radiother Oncol, 48:283-91.## 10. Farajollahi AR, Bonnett DE, Ratcliffe AJ, Aukett RJ, Mills JA (1999) An investigation into the use of polymer gel dosimetry in low dose rate brachytherapy. Br J Radiol, 72:1085-92.## 11. Hepworth SJ, Leach MO, Doran SJ (1999) Dynamics of polymerization in polyacrylamide gel (PAG) dosimeters: (II) modeling oxygen diffusion. Phys Med Biol, 44: 1875-84.## 12. Papagiannis P, Pantelis E, Georgiou E, Karaiscos P, Angelopoulos A, Sakelliou L, Stiliaris S, Baltas D, Seimenis I (2006) Polymer gel dosimetry for the TG-43 dosimetric characterization of a new 125I interstitial brachytherapy seed. Phys Med Biol, 51: 2101-11.## 13. Fong PM, Keil DC, Does MD, Gore JC (2001) Polymer gels for magnetic resonance imaging of radiation dose distributions at normal room atmosphere. Phys Med Biol, 46: 3105-13.## 14. De Deene Y, Hurley C, Venning A, Veergote K, Mather M, Healy BJ, Baldock C (2002) A basic study of some normoxic polymer gel dosimeters. Phys Med Biol, 47: 3441-63.## 15. Clive B (2006)Historical overview of the development of gel dosimetry: a personal perspective. Journal of Physics: Conference Series, 56:14.## 16. Bayreder C, Georg D, Moser E, Berg A (2006) Basic investigations on the performance of a normoxic polymer gel with tetrakis-hydroxy-methyl-phosphonium chloride as an oxygen scavenger: reproducibility, accuracy, stability, and dose rate dependence. Med Phys, 33: 2506-18.## 17. De Deene Y, Vergote K, Claeys C, De WC (2006) The fundamental radiation properties of normoxic polymer gel dosimeters: a comparison between a methacrylic acid based gel and acrylamide based gels. Phys Med Biol, 51:653-73.## 18. Karlsson A, Gustavsson H, Mansson S, McAuley KB, Back SA (2007) Dose integration characteristics in normoxic polymer gel dosimetry investigated using sequential beam irradiation. Phys Med Biol, 52:4697-706.##19. Koeva VI, Csaszar ES, Senden RJ, McAuley KB, Schreiner LJ (2008) Polymer Gel Dosimeters with Increased Solubility: A Preliminary Investigation of the NMR and Optical Dose-Response Using Different Crosslinkers and Co-Solvents. Macromol Symp, 261:157-66.## 20. Geoffrey S Ibbott (2004) Applications of gel dosimetry. Journal of Physics: Conference Series, 3:58.## 21. MSDS (2006) Material safety sheet acrylamaide. Sigma Aldrich, USA.## 22. Senden RJ, De JP, McAuley KB, Schreiner LJ (2006) Polymer gel dosimeters with reduced toxicity: a preliminary investigation of the NMR and optical dose-response using different monomers. Phys Med Biol, 51:3301-14.## 23. Pak F, Farajollahi AR, Movafaghi A, Naseri AR (2013) Influncing factors on reproducibility and stability of MRI NIPAM polymer gel dosimetry. BioImpacts, BI, 3: 163.## 24. Kim BM (2006) Fundamentals of Polymer Gel Dosimeters. Journal of Physics: Conference Series, 56:35.## 25. McCullough EC and Holmes TW (1985) Acceptance testing computerized radiation therapy treatment planning systems: direct utilization of CT scan data. Med Phys, 12:237-42.## 26. Parker RP, Hobday PA, Cassell KJ (1979) The direct use of CT numbers in radiotherapy dosage calculations for inhomogeneous media. Phys Med Biol, 24:802-9.## 27. Kron T, Metcalfe P, Pope JM (1993) Investigation of the tissue equivalence of gels used for NMR dosimetry. Phys Med Biol, 38:139-50.## 28. Farajollahi AR (1999) An investigation into the application of polymer gel dosimetry in radiotherapy. Medical Physics, 26: 493-493.## 29. Hsieh B, Chang Y, Han R, Wu J, Hsieh L, Chang C (2011) A study on dose response of NIPAM-based dosimeter used in radiotherapy. Journal of Radioanalytical and Nuclear Chemistry 290:141-8.## 30. Chang YJ, Hsieh BT, Liang JA (2011) A systematic approach to determine optimal composition of gel used in radiation therapy. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 652:783-5.## 31. Sellakumar P, James Jebaseelan Samuel E (2010) Study on energy dependence of PAGAT polymer gel dosimeter evaluated using X-Ray CT. Radiation Measurements, 45:92-7.## 32. Low DA and Mutic S (1997)Abutment region dosimetry for sequential arc IMRT delivery. Phys Med Biol 42:1465-70.## 33. Novotny J, Jr., Spevacek V, Dvorak P, Novotny J, Cechak T (2001) Energy and dose rate dependence of BANG-2 polymer-gel dosimeter. Med Phys, 28:2379-86.## 34. Chain JN, Jirasek A, Schreiner LJ, McAuley KB (2011) Cosolvent-free polymer gel dosimeters with improved dose sensitivity and resolution for X-ray CT dose response. Phys Med Biol, 56:2091-102.## 35. Jirasek A, Hilts M, McAuley KB (2010) Polymer gel dosimeters with enhanced sensitivity for use in X-ray CT polymer gel dosimetry. Phys Med Biol, 55:5269-81.## ##

Dose measurement outside of radiotherapy treatment field (Peripheral dose) using thermoluminesent dosimeters 2 2 Background: In radiation therapy, peripheral dose or the dose outside the radiotherapy field, is important when anatomical structures with very low dose tolerances are involved. One of these critical organs in pelvic irradiation is testis. The amount of radiation delivered to the testes in radiotherapy must be kept as small as possible, consistent with the limit dose of this organ. The threshold doses for temporary and permanent sterility are 0.15 Gy and 6-8 Gy, respectively. Therefore, in pelvic irradiation, protecting testis from these doses and also scattered radiation which could escalate testis dose should be considered. Materials and Methods: In order to determine the possibility of using testicular shield for high and low energies, TLD dosimetry was done on phantom and 27 patients involved with bladder, rectum and prostate cancers. Results: Dosimetric results showed that the ability of testicular shield in reducing testes absorbed dose is approximately the same (about 7 cGy) for low and high energy photon beams. Conclusion: a testicular shield with a fixed thickness of 1.27cm can be used as testis protection for either high and low energies. 355 359 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 N. Banaee N. Banaee Department of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran Iran H.A. Nedaie H.A. Nedaie Radiotherapy Oncology Department, Cancer research Centre, Tehran University of Medical Sciences, Tehran, Iran Iran Nedaieha@sina.tums.ac.ir E. Esmati E. Esmati Radiotherapy Oncology Department, Cancer research Centre, Tehran University of Medical Sciences, Tehran, Iran Iran H. Nosrati H. Nosrati Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran M. Jamali M. Jamali Radiotherapy Oncology Department, Cancer research Centre, Tehran University of Medical Sciences, Tehran, Iran Iran Testicular shield pelvic irradiation peripheral dose Nazmy MS, El-Taher MM, Attalla EM, El-Hosiny HA, Lotayef MM (2007) Shielding for Scattered Radiation to the Testis During Pelvic Radiotherapy: Is it worth?. Journal of the Egyptian Nat. Cancer Inst, 19 :127-132.## 2. Sharma DS, Animesh, Deshpande SS, Phurailatpam RD, Deshpande DD, Shrivastava SK, Dinshaw KA (2006) Peripheral dose from uniform dynamic multileaf collimation fields: implications for sliding window intensity-modulated radiotherapy. British Journal of Radiology, 79: 331–335##3. hall JE and Amato J (2006) Radiobiology for the radiobiologist. LIPPINCOTT WILLIAMS & WILKINS Co, USA.##4. Budgell GJ, Cowan RA, Hounsell AR (2001) Prediction of scattered dose to the testes in abdominopelvic radiotherapy. Clinical Oncology, 13:120 125.##5. Shirazi A, Mahdavi SR, Khodadadee A, Gaffory M, Mesbahi A (2008) Monte Carlo simulation of TLD response function: Scattered radiation field application. Rep Pract Oncol Radiother, 13(1): 23-28 ## 6. Kase RK and Svensson GK (1986) Head scatter data for several linear accelerators (4–18 MV). Medical physics, 13:530-532.##7. Jacobsen KD, Olsen DR, Fosa K, Fossa SD (1997) External beam abdominal radiotherapy in patients with seminoma stage I: field type, testicular dose and spermatogenesis. Int J Radiat Oncol Biol Phys, 38: 83-94.##8. Boehmer D, Badakhshi H, Kuschke W, Bohsung J, Budach V (2005) Testicular dose in prostate cancer radio-therapy: Impact on impairment of fertility and hormonal function. Strahlenther Onkol, 181: 179-84.##9. Daniell HW and Tam EW (1998) Testicular atrophy in therapeutic orchiectomy specimens from men with prostate carcinoma. Cancer, 83: 1174-9.##10. Herrmann T, Thiede G, Trott KR, Voigtmann L (2004) Off-springs of preconceptionally irradiated parents. Strahlenther Onkol, 180: 21-30.## ##

Lessons learnt from errors in radiotherapy centers 2 2 Background: The purpose of this work is to discover and analyze errors and incidents in some radiotherapy centers, and to introduce methods that could reduce their occurrences, especially those which had happened due to the use of improper and inadequate equipment. This work is a first step toward clarifying the role of education in a risk-conscious culture, and changing the attitude of radiotherapy staff when they are working under encouraging conditions that remove barriers for reporting errors. Materials and Methods: For the present study clinical investigation, the data of 6000 patients were checked. They were treated at a few radiotherapy centers during one year. Patients were treated by linear accelerator or cobalt machine, photon or electron beams. A purposely designed check list was used for error data collection. Incidents were discovered by manual check at different steps of treatment. By highlighting frequency of occurrence, further investigation for preventing error repetition can be possible. Eighty five incidents were reported by Technologists, fifty four were reported by Physicists, and twenty six events were pointed out by Radiation Oncologists. Results: About fifty percent of total 165 detected events were classified as treatment field errors. Geometrical misses in treatment field have the highest probability for both photon and electron beams. Conclusion: Incident prevention considering likelihood of individual event can be possible when using facilities like record-and-verification (R&V) system and electronic-portal-image-device (EPID), taking seriously QA, defining and implementing layers of defense in depth, and making an organized system for reporting and analyzing errors. 361 367 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 K. Asnaashari K. Asnaashari School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Iran S. Gholami S. Gholami Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran Iran s-gholami@razi.tums.ac.ir H.R. Khosravi H.R. Khosravi Nuclear and Radiation Support department, Iran Nuclear Regulatory Authority, Tehran, Iran Iran Quality control radiotherapy errors clinical audit lack of technology ##1.Delaney G, Jacob S, Featherstone C, Barton M (2005) The role of radiotherapy in cancer treatment, estimating optimal utilization from a review of evidence-based clinical guidelines, American Cancer Society. Cancer, 104: 1129-37.##2.World Health Organization (2008) Radiotherapy Risk Profile-Technical Manual.##3.Moller TR, Ceberg J, Einhorn N, Lindholm C, Nyhle´n U, Svensson S, for the SBU Survey Group (2003) Radiotherapy techniques in current use in Sweden. Acta Oncol, 42: 376-86.##4.Fraass B, Doppke K, Hunt M, Kutcher G,  Starkschall G, Stern R, Van Dyke J. (1998) American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: Quality assurance for clinical radiotherapy treatment planning .Med Phys, 25: 1773-1829.##5.Thwaites D, Scalliet P, Leer JW, Overgaard J (1995) Quality assurance in radiotherapy. European Society for Therapeutic Radiology and Oncology Advisory Report to the Commission of the European :union: for the 'Europe Against Cancer Program. Radiother Oncol, 35(1):61-73.##6.Karp SJ (1999) The Clinical Oncology Information Network (COIN) Project: background, purpose and products. J Eval Clin Pract, 5(2):179-87. ##7.Ortiz P, Cosset J M, Dunscombe P, Holmberg O ,Rosenwald JC, Ashton L, Vilaragut Llanes J, Vatnitsky S. (2009) Preventing Accidental Exposures from New External Beam Radiation Therapy Technologies. ICRP Publication 112, Annals of the ICRP, 39 (4):63-74.##8.Pennsylvania Patient Safety Advisory (2009) Errors in Radiation Therapy, 6(3):87-92. ‎##9.Williams MV (2007) Improving patient safety in radiotherapy by learning from near misses incidents and errors. BJR, 80: 297–301.##10.Ishikura S (2008) Quality Assurance of Radiotherapy in Cancer Treatment: Toward Improvement of Patient Safety and Quality of Care. Jpn J Clin Oncol, 38: 723–729.##11.Gerard K, Grandhaye J, Marchesi V, Aletti P, Husson F, Noel A, Kafrouni H (2009) Feasibility study of using statistical process control to optimize quality assurance in Radiotherapy Quality assurance in radiotherapy. Journal of Quality in Maintenance Engineering, 15: 331-43. ##12.Gluhchev G and Shalev S (1996) The systematic error detection as a classification problem. Pattern Recognition Letters archive, 17: 1233-1238. ##13.Baiotto B, Bracco C, Bresciani S, Mastantuoni A, Gabriele P, and Stasi M (2009) Quality assurance of a record-and-verify system. Tumori, 95: 467- 472.##14.Klein E, Drzymala R, Purdy J, Michalski J (2005) Errors in radiation oncology: A study in pathways and dosimetric impact. Journal of Applied clinical medical physics, 6: 81-94.##15.International commission on radiation units and measurements (1976) Determination of Absorbed Dose in a Patient Irradiated by Beams of X or Gamma Rays in Radiotherapy Procedures. ICRU Report 24.##16.International Atomic Energy Agency (2000) Lessons learned from accidents in radiotherapy. Vienna: IAEA Safety Reports Series No.##17.IAEA training course. Prevention of accidental exposure in radiotherapy. Available from: http://rpop.iaea.org/RPOP/RPoP/Content/Documents/TrainingAccidentPrevention/Lectures/AccPr_5.01_Preventive_measures_WEB.ppt. ##18.Lefresne S, Olivotto IA, Joe H, Blood PA, Olson RA (2013) Impact of quality assurance rounds in a Canadian radiation therapy department. Int J Radiat Oncol Biol Phys, 85: e117-21.## ##

Rectal wall dose estimation in intracavitary brachytherapy: A preliminary comparison of an in-house rectal wire versus ICRU 38 recommendations 2 2 Background: In intracavitary brachytherapy for gynecological cancers, various techniques are used to locate the anterior rectal wall nearest to the sources but there is no consensus on the best method to do so. This study aimed to compare a technique used routinely in some centers that employs a wire marker to locate the position of the maximum rectal dose point, versus the method recommended by the ICRU Report 38. Materials and Methods: In a preliminary prospective study on 34 intracavitary insertions for patients with cervical or endometrial cancer, treated at our center based on the Manchester system, the dose distributions were obtained from a treatment planning system following the input of scanned orthogonal anteroposterior and lateral radiographs. For each case, an in-house marked wire was inserted in the rectal lumen and the doses were calculated on several points along the wire seen on the radiographs, to obtain the maximum dose. For the same insertions, the ICRU method was also applied by considering the rectal wall hot spot as a point 0.5 cm posterior to the posterior vaginal wall (visualized on the radiographs by vaginal packing material containing contrast medium). Results: Averaged over all insertions, mean rectal wall hot spot dose calculated using the positional information obtained by the wire technique was lower by 28.6% than that given by the ICRU method (P < 0.001). Conclusion: Our initial results add evidence to the suggestion that the wire technique underestimates the rectal wall hot spot dose significantly compared to the ICRU method. 369 372 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/31 1393/10/10 M.A. Mosleh-Shirazi M.A. Mosleh-Shirazi Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Iran S. Norouzi S. Norouzi Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Iran saeedeh_now@yahoo.com M. Ansari M. Ansari Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Iran N. Ahmadloo N. Ahmadloo Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Iran S.M.J. Mortazavi S.M.J. Mortazavi The Center for Research on Protection against Ionizing and Non-ionizing Radiation, Shiraz University of Medical Sciences, Shiraz, Iran Iran S. Karbasi S. Karbasi Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Iran A. Mosalaei A. Mosalaei Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Iran Rectal wall dose gynecological brachytherapy cervical and endometrial cancer rectal wire ICRU 38 ##1. Crook JM, Esche BA, Chaplain G, Isturiz J, Sentenac I, Horiot JC (1987) Dose-volume analysis and the prevention of radiation sequelae in cervical cancer. Radiotherapy and Oncology, 8(4): 321-332.##2. Baucal M, Babić J, Kuzmanović Z (2002) Rectal dosimetry in intracavitary applications of cervix carcinoma: Comparison of two methods. Archive of oncology, 10(4): p. 253-259.##3. Serkies K, Badzio A, Jereczek-Fossa B, Tarnawska Z, Nowak R, Szewczyk P, Jassem J (2001) Rectal doses in intracavitary brachytherapy of gynecological malignancies: comparison of two dosimetric methods. Radiotherapy and Oncology, 58(1): 37-41.##4. International Commission on Radiation Units and Measurments (1985) Dose and volume specification for reporting intracavitary therapy in gynecology, ICRU Report Number 38.##5. Pötter R, Van Limbergen E, Gerstner N, Wambersie A (2001) Survey of the use of the ICRU 38 in recording and reporting cervical cancer brachytherapy. Radiotherapy and Oncology, 58(1): 11-18.##6. Khan FM and Gibbons JP (2014) Khan’s The Physics of Radiation Therapy. 5th Ed., Lippincott, Williams & Wilkins.##7. Sina S, Faghihi R, Meigooni AS, Mehdizadeh S, Zehtabian M, Mosleh Shirazi MA (2009) Simulation of the shielding effects of an applicator on the AAPM TG-43 parameters of CS-137 Selectron LDR brachytherapy sources. Iran J Radiat Res, 7(3): 135-40.##8. Sina S, Faghihi R, Meigooni AS, Mehdizadeh S, Mosleh Shirazi MA, Zehtabian M (2011) Impact of the vaginal applicator and dummy pellets on the dosimetry parameters of Cs-137 brachytherapy source. Journal of Applied Clinical Medical Physics, 12(3).##9. Mosleh-Shirazi MA, Faghihi R, Siavashpour Z, Nedaie HA, Mehdizadeh S (2012) Independent evaluation of an in-house brachytherapy treatment planning system using simulation, measurement and calculation methods. J Applied Clin Med Physics, 13(2):103-112.##10. Nag S, Erickson B, Parikh S, Gupta N, Varia M, Glasgow G (2000) The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiation Oncol Biol Physics, 48(1): 201-211.##11. Shrivastava R, Umbarkar RB, Sarje MB, Singh KK (2009) Rectal dosimetry in intracavitary brachytherapy by HDR at rural center of Maharashtra: Comparison of two methods. J Med Physics, 34(2): 93.##Moslemi V, Esmaili-Torshabi A, Mosleh-Shirazi MA, Faghihi R, Mosallae A, Mehdizadeh S, Hadad K (2011) CT-based brachytherapy treatment planning using Monte Carlo simulation aided by an interface software. Iran J of Med Physics, 8(1):41-53.##Sina S, Faghihi R, Meigooni AS, Siavashpour Z, Mosleh-Shirazi MA (2013) Developing a treatment planning software based on TG-43U1 formalism for Cs-137 LDR brachytherapy. Iranian Red Crescent Medical Journal, 15: 712-17.## ##

The future balance between training and demand for radiologists in Iran 2 2 Background: The present study aimed to evaluate the balance between training and demand for radiologists in the Iranian health care system between 2008 and 2027. Materials and Methods: A total number of 250 clusters were randomly selected from urban and rural areas of Iran, of which 168 were selected from urban areas and 82 were selected from rural areas. In order to collect basic medical data and to determine the number of radiology visits in the last two weeks, questionnaires were prepared and sent out to the subjects' houses. Information on the number of radiologists as well as statistics on the Iran's population were provided by the Medical Council of the Islamic Republic of Iran (IRI) and the Statistics Center of IRI, respectively. Results: Radiologists were visited 245 times during a two-week time period, which resulted in an average referral to radiologists of 0.125 for each individual. Our results indicated a slight shortage of radiologists in 2008, which is expected to disappear till 2023. Afterwards, the training of radiologists is expected to slightly surpass the demands. Conclusion: Results from the present study suggested that an overall balance between training and demand for radiologists in Iran is likely to happen in near future. 373 376 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/1 1393/10/11 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/1 1393/10/11 H. Esmailzadeh H. Esmailzadeh Medical Informatics, Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran Iran m_h_sowlat@yahoo.com A.R. Delavari A.R. Delavari Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital Tehran, Iran Iran S.M.R. Kazemi-Bajestani S.M.R. Kazemi-Bajestani Health Researchers, Research and Development Institute, Tehran, Iran Iran S. Alikhani S. Alikhani Ministry of Health and Medical Education, No 58, Iranshahr St., Tehran, Iran Iran R. Tabibzadeh Dezfouli R. Tabibzadeh Dezfouli Health Researchers, Research and Development Institute, Tehran, Iran Iran F. Alaeddini F. Alaeddini Health Researchers, Research and Development Institute, Tehran, Iran Iran Radiologist demand training Iran Facilities. ACoRTFoMa (1975) Report of the American College of Radiology task force on manpower and facilities. Reston, VA: American College of Radiology.##2. Hawkins J (2001) Addressing the shortage of radiologists. Radiol Manage, 23:26-28.##3. Rosenquist C (1995) How many radiologists will be needed in the years 2000 and 2010? Projections based on estimates of future supply and demand. AJR Am J Roentgenol, 165:1303-1305.##4. Jones D, O'Donnell C, Stuckey J (1998) Australian radiology workforce report. Australas Radiol 2000, 44:41-52.##5. Jones D ( 2002) Australian radiology workforce report. Australas Radiol 2002, 46:231-248.##6. Nakajima Y, Yamada K, Imamura K, et al. (2008) Radiologist supply and workload: international comparison--Working Group of Japanese College of Radiology. Radiat Med, 26:455-465.##7. Applegate K (2005) The future workforce in academic radiology: gender, generational, and cultural influences. J Am Coll Radiol, 2:133-138.##8. Dodd G, Fletcher T, Thorwarth W, Jr. (2006) The crisis in academic radiology: will we help ourselves? J Am Coll Radiol, 3:229-230.##9. Levin D and Rao V (2007) Turf wars in radiology: the future of radiology depends on research--and on your support of it! J Am Coll Radiol, 4:184-186.##10. GMENA Committee (1980) GMENAC summary report, 1:81 -651.##11. Feil E, Welch H, Fisher E (1993) Why estimates of physician supply and requirements disagree. JAMA, 269:2659-2663.##12. Sunshine J, Evens R, Chan W (1992) How accurate was GMENAC? A retrospective review of supply projections for diagnostic radiologists. Radiology, 182:365-368.## ##

Comparison between Amperometric and Chemiluminescence methods in detection and dosimetry of cobalt-60 gamma ray emission 2 2 Background: Hydrogen peroxide (H2O2), produced by gamma ray irradiation to watery solution, was used as an analytical parameter for dosimetry of cobalt-60 (60Co) radiation. Materials and Methods: Detection of the produced H2O2 was carried out using two methods: an amperometric biosensor fabricated by immobilization of anthraquinone 2-carboxylic acid modified horseradish peroxidase on glassy carbon electrode, and chemiluminescence technique using luminol as a fluorophore and diperiodatocuprate as a catalyst. Results: In the first method, at the applied potential of -550 mV (vs. Ag/AgCl) the biosensor showed the sensitivity of 74.46 nA/Gray and detection limit of 0.061 Gray (R.S.D=3.67% for N=3) towards H2O2 produced by 60Co. In the second method, the sensitivity and detection limit for 60Co gamma ray was determined to be 2.34 (luminescence intensity/Gray) and 0.069 Gray (R.S.D=4.16% for N=3), respectively. Conclusion: The obtained results revealed that both proposed techniques, with leaner range from 0.25 to 5 Grays are applicable for detection and dosimetry of gamma ray from 60Co. 377 382 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/12015/01/1 1393/10/11 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/12015/01/1 1393/10/11 M. Shourian M. Shourian Institute of Biochemistry and Biophysics, University of Tehran, P.O. Box 13145-1384, Tehran, Iran Iran H. Ghourchian H. Ghourchian Institute of Biochemistry and Biophysics, University of Tehran, P.O. Box 13145-1384, Tehran, Iran Iran hadi@ibb.ut.ac.ir Cobalt-60 gamma ray hydrogen peroxide electrochemistry chemiluminescence 1. Rybka AV , Davydov LN, Shlyakhov IN, Kutny VE, Prokhoretz IM , Kutny DV , Orobinsky AN (2004) Gamma-radiation dosimetry with semiconductor CdTe and CdZnTe detectors. Nucl Instrum Methods Phys Res, 531: 147-156. ##2. Mognato M, Girardi C, Fabris S, Celotti L (2009) DNA repair in modeled microgravity: double strand break rejoining activity in human lymphocytes irradiated with γ-rays. Mutat Res, 663: 32-39. ##3. Shackelford RE, Kaufmann WK, Paules RS (2000) Oxidative stress and cell cycle checkpoint function. Free Radic Biol Med, 28: 1387-1404. ##4. Janik D, Janik I, Bartels DM (2007) Neutron and beta/gamma radiolysis of water up to supercritical conditions. 1. beta/gamma yields for H (2), H(.) atom, and hydrated electron. J Phys Chem A, 111: 7777-7786. ##5. Breen AP and Murphy JA (1995) Reactions of oxyl radicals with DNA. Free Radic Biol Med, 18: 1033-1077.##6. Fattahi M, Houée-Levin C, Ferradini C, Jacquier P (1992) Hydrogen peroxide formation and decay in γ-irradiated clay water. Int J Radiat Appl Instrum, 40: 167-173.##7. Lyons MJ, Gibson JF, Ingram DJE (1958) Free-Radicals produced in Cigarette Smoke. Nature. 181: 1003-1004. ##8. Tang B, Wang Y, Sun Y, Shen HX (2002) Spectrofluorimetric determination of hydrogen peroxide with 2-hydroxy-1-naphthaldehyde salicyloylhydrazone (HNSH) as the substrate for horseradish peroxidase (HRP). Spectrochim Acta A, 58: 141-148.##9. Taniai T, Sakuragawa A, Okutani T (1999) Fluorometric determination of hydrogen peroxide in natural water samples by flow injection analysis with a reaction column of peroxidase immobilized onto chitosan beads. Anal Sci, 15: 1077-1082. ##10. Schachl K, Alemu H, Kalcher K, Moderegger H, Svancera I, Vytras K (1998) Amperometric determination of hydrogen peroxide with a manganese dioxide film- modified screen printed carbon electrode. Fresenius J Anal Chem, 368: 194-200. ##11. Mogharrab N and Ghourchian H (2005) Anthraquinone 2-carboxylic acid as an electron shuttling mediator and attached electron relay for horseradish peroxidase. Electrochem Commun, 7: 466-471.##12. Hu Y, Zhang Z, Yang CA (2008) Sensitive chemiluminescence method for the determination of H2O2 in exhaled breath condensate. Anal Sci, 24: 201-205.##13. Kumar Jena and B Retna Raj C (2011) Enzyme integrated silicate-Pt nanoparticle architecture: A versatile biosensing platform. Biosens and Bioelectron, 26: 2960-2966.##14. Shourian M and Ghourchian H (2010) Biosensing improvement of horseradish peroxidase towards hydrogen peroxide upon modifying the accessible lysines. Sens Actuators B, 145: 607-612.##15. Shourian M, Rafiee-Pour HA, Tavakoli H, Ghourchian H (2010) Dose rate determination of gamma rays emitted by Thallium-201 and Technetium-99m using a modified horseradish peroxidase based biosensing system. J Iran Chem Soc, 7(4): 900-907.##16. Shourian M, Tavakoli H, Ghourchian H, Rafiee-Pour HA (2010) Detection and dosimetry of gamma ray emitted from thallium-201and technetium-99m based on chemiluminescence technique. Radiat Meas, 45: 906-910. ##17. University of Wisconsin (2005) Madison Safety Department's Chemical and Radiation Protection Office Radiation Safety for Radiation Workers, in: chapter 7, Radiation Detection and Measurement. University of Wisconsin, Madison Safety Department 30 North Murray St. Madison, WI 53715-2609; pp. 89-126. ## ##

Early onset radiation induced sarcoma of scalp: A case report 2 2 Radiation induced sarcoma is a rare but recognized complication of radiotherapy and is associated with poor prognosis, frequently occurs 5 years after completion of treatment. We report radiation-induced sarcoma in a 42 years old male, involving the left parietooccipital scalp region following treatment of brain tumor with craniotomy and post-operative radiation with 60Co machine. Diagnosis of radiation induced sarcoma was confirmed by history, latency period and biopsy. This Radiation induced malignancy was diagnosed only 2 years after completion of Radiotherapy for primary lesion. 383 385 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/12015/01/12015/01/1 1393/10/11 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/12015/01/12015/01/1 1393/10/11 F. Amouzegar Hashemi F. Amouzegar Hashemi Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran Iran A. Maddah Safaei A. Maddah Safaei Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran Iran afsan1980@ymail.com E. Esmati E. Esmati Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran Iran Radiation induced sarcoma brain tumor glioblastoma multiform Khan M, Chandramala R, Sharma R (2009) Radiation Induced Spindle cell sarcoma: A rare case report. Ind J Dent, 20: 380-84.##2. Pfeiffer J,Boedeker CC, Rider GJ (2006) Radiation Induced Leio myosarcoma of the oropharynx. Diagn Pathol, 1: 22. ##3. Sedghizade PP, Angiero f, Allen CM, et al. (2004) Post-irradiation Leiomyosarcoma of maxilla: Report of a case in a patient with prior radiation treatment for retinoblastoma. Oral Surg Oral Med, 97: 726-31.##4. Brady SG, Gaynor J, Brennan MF (1992) Radiation associated sarcoma of bone ans soft tissue. Arch Surg, 127: 1379-85.##5. Patel SG,See AC,Williamson PA et al. (1999) Radiation induced sarcoma of the head and neck. Head Neck, 21: 346-354.##6. Sedney CL, Morris JM, Giannini C, Link MJ, Swetz KM (2012) Radiation-associated sarcoma of the skull base after irradiation for pituitary adenoma. Rare Tumors, 4(1): e7.##7. Johns MS, Concus AP, Beals TF (2002) Early onset post irradiation sarcoma of the head and neck :report of three cases. Ear Nose Throat J, 81(6):402-6. ## ##

Successful treatment of inflammatory myofibroblastic tumor by surgical resection and radiotherapy: A case report 2 2 Background: Inflammatory myofibroblastic tumor (IMT) is a tumor composed of myofibroblasts and a mixed inflammatory infiltrate that rarely undergoes malignant transformation. The most common sites of involvement include the lung, liver and orbit, but it has been reported to occur in nearly every site of the body, including oral cavity and soft tissue. Although common in other sites, such a tumor in rarer location including inguinal region is likely to be missed/misdiagnosed and hence need to be reported. Case Report: We present an unusual case of a 50 year old male with bilateral inguinal swelling attended our institute few days back with history of local excision twice, but still showing recurrence. He was treated by wide local excision with bilateral orchiectomy this time. Histopathological report revealed inflammatory myofibroblastic tumor with malignant transformation. Adjuvant radiotherapy was also given and patient taken in followup. At one year of serial follow-ups, the patient is disease-free both clinically and on investigations, indicating successful combined surgery and radiotherapy in the treatment of malignant IMT. Conclusion: IMT of the inguinal region is very rare. Its clinical presentation may resemble malignant tumor, so IMT should be kept as differential diagnosis. The recommended treatment is complete surgical resection with adjuvant corticosteroid. Adjuvant radiotherapy may be considered depending upon the location of the tumor. 387 390 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/12015/01/12015/01/12015/01/1 1393/10/11 2014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312014/12/312015/01/12015/01/12015/01/12015/01/1 1393/10/11 P.K. Bagri P.K. Bagri Department of Radiation Oncology Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner (Rajasthan) - 334001, India India drpuneetkb@yahoo.com D. Singh D. Singh Department of Radiation Oncology Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner (Rajasthan) - 334001, India India P. Kumari P. Kumari Department of Radiation Oncology Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner (Rajasthan) - 334001, India India S. Kumari S. Kumari Department of Radiation Oncology Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner (Rajasthan) - 334001, India India S. Beniwal S. Beniwal Medical Oncology Section, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner (Rajasthan) - 334001, India India H.S. Kumar H.S. Kumar Department of Radiation Oncology Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner (Rajasthan) - 334001, India India Inflammatory myofibroblastic tumor (IMT) surgery adjuvant radiotherapy Narla LD, Newman B, Spottswood SS, Narla S, Koll IR (2003) Inflammatory pseudotumor. Radiographics, 23: 719–729.##2. Shek AW, Wu PC, Samman N (1996) Inflammatory pseudotumour of the mouth and maxilla. J Clin Pathol, 49: 164–7.##3. Van Weert S, Manni JJ, Driessen A (2005) Inflammatory myofibroblastic tumor of the parotid gland: case report and review of the literature. Acta Otolaryngol, 125: 433–7.##4. Ide F, Shimoyama T, Horie N (1998) Intravenous myofibroblastic pseudotumour of the buccal mucosa. Oral Oncol.  34: 232–235.##5. Gleason BC and Hornick JL (2008) Inflammatory myofibroblastic tumours: where are we now? J Clin Pathol, 61: 428–437.##6. Morotti RA, Legman MD, Kerkar N, Pawel BR, Sanger WG, Coffin CM (2005) Pediatric inflammatory myofibroblastic tumor with late metastasis to the lung: case report and review of the literature. Pediatric and Developmental Pathology, 8(2): 224–229. ##7. De Oliveira Ribeiro AC, Joshi VM, Funkhouser WK, Mukherji SK (2001) Inflammatory myofibroblastic tumor involving the pterygopalatine fossa. American Journal of Neuroradiology, 22: 518–520. ##8. Maier HC and Sommers SC (1987) Recurrent and metastatic pulmonary fibrous histiocytoma/plasma cell granuloma in a child. Cancer, 60(5): 1073–1076.##9. Srigley JR (2004) Tumor-Like Lesions of the Testis and Paratestis. Augusta, GA: United States and Canadian Academy of Pathology. ##10. Kovach SJ, Fischer AC, Katzman PJ, et al. (2006) Inflammatory myofibroblastic tumors. J Surg Oncol, 94: 385–391.##11. Kapur P, Treat K, Chuang AT, Hoang MP (2004)  Pathologic quiz case. Paratesticular mass in a young man: inflammatory myofibroblastic tumor of the paratestis. Arch Pathol Lab Med, 128:589–5901.##12. Lee DK, Cho YS, Hong SH, Chung WH, Ahn YC (2006) Inflammatory pseudotumor involving the skull base: response to steroid and radiation therapy. Otolaryngology, 135(1): 144–148.##13. Maire JP, Eimer S, San Galli F, et al. (2013) Inflammatory myofibroblastic tumor of the skull base. Case Rep Otolaryngol. Article ID 103646.## ##