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Clinical outcome of stereotactic body radiotherapy for localized prostate cancer: long-term results 2 2 Background: Stereotactic body radiotherapy (SBRT) is an emerging treatment option which allows for extreme hypofractionation using modern technologies, because the low α/β-ratio favors the use of high dose per fraction in prostate cancer. There is a need for more data about SBRT. We provide a long-term update of SBRT clinical outcome using CyberKnife for the treatment of localized prostate cancer. Materials and Methods: This study was based on a retrospective analysis of 43 patients treated with SBRT using CyberKnife for localized prostate cancer (23.3% in low risk, 67.4% in intermediate risk and 9.3% in high risk). The target volume included the prostate with or without the seminal vesicles depending on the risk stratification and uncertainty margins that are kept at 3-5 mm. Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. Results: 43 patients with a median 73.6 months (range, 14 to 119 months) follow-up were analyzed. There was three biochemical failure (BCF). Eight-year BCF free survival and overall survival were 92.0% and 73.1%, respectively. Median PSA decline rates were -0.301, -0.191 and -0.115 ng/mL/month, respectively, for durations of 1, 2 and 3 years after radiotherapy and has remained plateau. Median PSA nadir was 0.27 ng/mL at median 38 months and PSA bounce (median 0.33 ng/mL) occurred in 32.6% (n = 14) of patients at median 19 months after SBRT. There was no grade 3 acute and late toxicity. Conclusion: Our long-term experience with SBRT using CyberKnife for localized prostate cancer demonstrates favorable efficacy and toxicity. 383 388 2020/04/19 1399/1/31 2020/04/19 1399/1/31 H.J. Kim H.J. Kim Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Korea cancerovercome@gmail.com J.S. Lee J.S. Lee Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Korea W.C. Kim W.C. Kim Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Korea CyberKnife prostate cancer stereotactic body radiotherapy prostate-specific antigen radiotherapy hypofractionation. 1. Miller KD, Siegel RL, Lin CC, et al. (2016) Cancer treatment and survivorship statistics. CA Cancer J Clin, 66(4): 271-289.##2. Parker C, Gillessen S, Heidenreich A, et al. (2015) Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 26: v69–v77.##3. Katz AJ, Santoro M, Diblasio F, Ashley R (2013) Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years. Radiat Oncol, 8: 118.##4. Chen LN, Suy S, Uhm S, et al. (2013) Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol, 8: 58.##5. King CR, Brooks JD, Gill H, Presti JC Jr. (2012) Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys, 82: 877-82.##6. Kothari G, Loblaw A, Tree AC, van As NJ, Moghanaki D, Lo SS, Ost P, Siva S (2018) Stereotactic Body Radiotherapy for Primary Prostate Cancer. Technol Cancer Res Treat, 17: 1-13. ##7. Fowler JF, Ritter MA, Chappell RJ, Brenner DJ (2003) What hypofractionated protocols should be tested for prostate cancer? Int J Radiat Oncol Biol Phys, 56: 1093-104.##8. Brenner DJ and Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys, 43: 1095-101.##9. Arcangeli G, Fowler J, Gomellini S, et al. (2011) Acute and late toxicity in a randomized trial of conventional versus hypofractionated three-dimensional conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys, 79: 1013-21.##10. Freeman DE and King CR (2011) Stereotactic body radiotherapy for low risk prostate cancer: five-year outcomes. Radiat Oncol, 6: 3.##11. Kim HJ, Phak JH, Kim WC (2016) Prostate-specific antigen kinetics after hypofractionated stereotactic body radiotherapy for localized prostate cancer. Int J Radiat Res, 14: 297-303.##12. Pollack A, Zagars GK, Antolak JA, Kuban DA, Rosen II (2002) Prostate biopsy status and PSA nadir level as early surrogates for treatment failure: analysis of a prostate cancer randomized radiation dose escalation trial. Int J Radiat Oncol Biol Phys, 54: 677–85.##13. Shi Z, Pinnock CB, Kinsey-Trotman S, Borg M, Moretti KL, Walsh S, Kopsaftis T (2013) Prostate-specific antigen (PSA) rate of decline post external beam radiotherapy predicts prostate cancer death. Radiother Oncol, 107: 129–33.##14. Network NCC (2014) NCCN clinical practice guidelines in oncology (NCCN Guideline®): prostate cancer (Version 1).##15. Roach M III, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, Sandler H (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO phoenix consensus conference. Int J Radiat Oncol Biol Phys, 65: 965–974.##16. Patel C, Elshaikh MA, Angermeier K, Ulchaker J, Klein EA, Chehade N, Wilkinson DA, Reddy CA, Ciezki JP (2004) PSA bounce predicts early success in patients with permanent iodine-125 prostate implant. Urology, 63: 110-113.##17. Abramowitz MC, Li T, Buyyounouski MK, et al. (2008) The Phoenix definition of biochemical failure predicts for overall survival in patients with prostate cancer. Cancer, 112: 55-60.##18. Lieng H, Pintilie M, Bayley A, Berlin A, Bristow R, Chung P, Gospodarowicz M, Huang R, Ménard C, Warde P, Catton C (2017) Long-term outcomes of a phase II trial of moderate hypofractionated image-guided intensity modulated radiotherapy (IG-IMRT) for localized prostate cancer. Radiother Oncol, 122: 93-98.##19. Teh BS, Lewis GD, Mai W, Pino R, Ishiyama H, Butler EB (2018) Long-term outcome of a moderately hypofractionated, intensity-modulated radiotherapy approach using an endorectal balloon for patients with localized prostate cancer. Cancer Commun (Lond), 38: 11.##20. Wilson C, Waterhouse D, Lane SE, Haworth A, Stanley J, Shannon T, Joseph D (2016) Ten-year outcomes using low dose rate brachytherapy for localised prostate cancer: An update to the first Australian experience. J Med Imaging Radiat Oncol, 60: 531-8.##21. Katz A, Formenti SC, Kang J (2016) Predicting biochemical disease-free survival after prostate stereotactic body radiotherapy: Risk-stratification and patterns of failure. Front Oncol, 6: 168.##22. Katz AJ (2017) Stereotactic body radiotherapy for low-risk prostate cancer: A ten-year analysis. Cures, 9: e1668. ##23. Zelefsky MJ, Chan H, Hunt M, Yamada Y, Shippy AM, Amols H (2006) Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol, 176: 1415-9.##24. Katz AJ and Kang J (2014) Stereotactic body radiotherapy as treatment for organ confined low- and intermediate-risk prostate carcinoma, a 7-year study. Front Oncol, 4: 240. ##25. Katz AJ and Kang J (2014) Quality of life and toxicity after SBRT for organ-confined prostate cancer, a 7-year study. Front Oncol, 4: 301.## ##

Complication analysis of breast cancer patients after mastectomy with immediate autologous breast reconstruction and adjuvant radiotherapy 2 2 Background: After the mastectomy, the complication is different depending on the sequence and method of breast reconstruction and Radiotherapy (RT). The aim of the current study was to investigate complication rates, related factors, and time to complications in breast cancer patients who underwent mastectomy with immediate autologous breast reconstruction (IABR) and adjuvant RT. Materials and Methods: Between April 2009 and January 2017, 52 patients underwent mastectomy with IABR followed by RT. Medical records of patients were retrospectively reviewed. Complications occurring after RT initiation were evaluated in four aspects: fat necrosis, wound infection, revision surgery, and re-reconstruction and classified into: 1) minor complication requiring only conservative treatment, and 2) major complication requiring surgical correction. All patients received RT on the chest wall including total flap. Ipsilateral axillary, supraclavicular and internal mammary regions were included at physician’s discretion. Median RT dose was 50.4 Gy (range, 50.4 – 59.4 Gy). Results: Median follow up duration was 22.3 months (range, 5.3-98.6 months). Complication after RT initiation occurred in 9 (17.3%) patients. Six (11.5%) patients showed minor complications. Three (5.8%) patients developed major complications. Median time to occurrence of complication after RT was 8.6 months (range, 1.8–25.1 months). Two-thirds of complications occurred within one year, while 88.9% occurred within two years after RT. No factor showed correlation with complication. Conclusions: IABR followed by adjuvant RT may be a reasonable option for patients who underwent mastectomy, in terms of postoperative complication. Complications occur most frequently within 1 year after initiation of RT, and most occur within 2 years. 389 396 2020/04/192020/04/19 1399/1/31 2020/04/192020/04/19 1399/1/31 S.J. Lee S.J. Lee Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea Y.K. Kwak Y.K. Kwak Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea E.Y. Park E.Y. Park Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea S.W. Lee S.W. Lee Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea S.Y. Sung S.Y. Sung Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea B.O. Choi B.O. Choi Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea choibo67@catholic.ac.kr Radiotherapy breast reconstruction mastectomy complication. 1. Teo I, Reece GP, Christie IC, Guindani M, Markey MK, Heinberg LJ, et al. (2016) Body image and quality of life of breast cancer patients: influence of timing and stage of breast reconstruction. Psycho-oncology, 25(9): 1106-1112.##2. Harcourt D and Rumsey N (2003) Psychological aspects of breast reconstruction: a review of the literature. J Adv Nurs, 35(4): 477-487.##3. Elder EE, Brandberg Y, Bjorklund T, Rylander R, Lagergren J, Jurell G, et al. (2005) Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast (Edinburgh, Scotland), 14(3): 201-208.##4. Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG (2008) Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg, 247(6): 1019-1028.##5. Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL (2001) Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg, 108(1): 78-82.##6. Chawla AK, Kachnic LA, Taghian AG, Niemierko A, Zapton DT, Powell SN (2002) Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant. INT J RADIAT ONCOL., 54(2): 520-526.##7. Kronowitz SJ and Robb GL (2009) Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg, 124(2): 395-408.##8. Barry M and Kell MR (2011) Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat, 127(1): 15-22.##9. Schaverien MV, Macmillan RD, McCulley SJ (2013) Is immediate autologous breast reconstruction with postoperative radiotherapy good practice? A systematic review of the literature. Journal of plastic, reconstructive & aesthetic surgery. JPRAS, 66(12): 1637-1651.##10. Berbers J, van Baardwijk A, Houben R, Heuts E, Smidt M, Keymeulen K, et al. (2014) Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature. EUR J CANCER, 50(16): 2752-2762.##11. Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F, et al. (2007) Oncoplastic breast surgery--a guide to good practice. Eur J Surg Oncol, 33(1): S1-23.##12. Kronowitz SJ (2007) Immediate versus delayed reconstruction. CLIN PLAST SURG, 34(1): 39-50; abstract vi.##13. Billig J, Jagsi R, Qi J, Hamill JB, Kim HM, Pusic AL, et al. (2017) Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes. Plast Reconstr Surg, 139(6): 1279-1288.##14. Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB, et al. (2017) Patient-reported outcomes 1 year after immediate breast reconstruction: Results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol, 35(22): 2499-2506.##15. Adesiyun TA, Lee BT, Yueh JH, Chen C, Colakoglu S, Anderson KE, et al. (2011) Impact of sequencing of postmastectomy radiotherapy and breast reconstruction on timing and rate of complications and patient satisfaction. Int J RadiaT Oncol, 80(2): 392-397.##16. McKeown DJ, Hogg FJ, Brown IM, Walker MJ, Scott JR, Weiler-Mithoff EM (2009) The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome. Journal of plastic, reconstructive & aesthetic surgery. JPRAS, 62(4): 488-493.##17. Wong JS, Ho AY, Kaelin CM, Bishop KL, Silver B, Gelman R, et al. (2008) Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy. Breast J, 14(1): 49-54.##18. Halyard MY, McCombs KE, Wong WW, Buchel EW, Pockaj BA, Vora SA, et al. (2004) Acute and chronic results of adjuvant radiotherapy after mastectomy and Transverse Rectus Abdominis Myocutaneous (TRAM) flap reconstruction for breast cancer. Am J Clin Oncol, 27(4): 389-394.##19. Anderson PR, Hanlon AL, Fowble BL, McNeeley SW, Freedman GM (2004) Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy. Int J Radiat Oncol, 59(4): 1080-1087.##20. Benson JR and Jatoi I (2017) Highlights of the San Antonio Breast Cancer Symposium 2016. Future Oncol, 13(15): 1291-1295.##21. Cowen D, Gross E, Rouannet P, Teissier E, Ellis S, Resbeut M, et al. (2010) Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications. Breast Cancer Res Treat, 121(3): 627-634.##22. Chang DW, Wang B, Robb GL, Reece GP, Miller MJ, Evans GR, et al. (2000) Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg, 105(5): 1640-8.##23. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions. http://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx##24. Xu F, Sun H, Zhang C, Jiang H, Guan S, Wang X, et al. (2018) Comparison of surgical complication between immediate implant and autologous breast reconstruction after mastectomy: A multicenter study of 426 cases. J Surg Oncol, 118(6): 953-958.##25. Sullivan SR, Fletcher DR, Isom CD, Isik FF (2018) True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg, 122(1): 19-28.##26. Berry T, Brooks S, Sydow N, Djohan R, Nutter B, Lyons J, et al. (2017) Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Oncol, 17 Suppl 3: 202-210. ##27. Sacotte R, Fine N, Kim JY, Alghoul M, Bethke K, Hansen N, et al. (2017) Assessing long-term complications in patients undergoing immediate postmastectomy breast reconstruction and adjuvant radiation. Pract Radiat Oncol, 7(2): e91-e7.##28. Garvey PB, Clemens MW, Hoy AE, Smith B, Zhang H, Kronowitz SJ, et al. (2014) Muscle-sparing TRAM flap does not protect breast reconstruction from postmastectomy radiation damage compared with the DIEP flap. Plast Reconstr Surg, 133(2): 223-233.##29. Chang EI, Liu TS, Festekjian JH, Da Lio AL, Crisera CA (2013) Effects of radiation therapy for breast cancer based on type of free flap reconstruction. Plast Reconstr Surg, 131(1): 1e-8e.##30. Hunt KK, Baldwin BJ, Strom EA, Ames FC, McNeese MD, Kroll SS, et al. (1997) Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction. Ann. Surg. Oncol, 4(5): 377-384.## ##

Natural gamma radiation level detection in agriculture soil after Aila disaster and comparison with deep soil gamma activity in a specific area of Sundarban region, Satkhira, Banglsdesh 2 2 Background: The present work was conducted on some soil samples collected from Shamnagar upazila of Satkhira district of south-west part of world largest mangrove forest Sundarban Rezion, Bangladesh which were affected by natural disaster cyclone Aila. Materials and Methods: The soil samples were analyzed to determine terrestrial γ-ray activity using HPGe γ-ray spectrometry. The measurements conducted in the current study showed that primordial radionuclides namely the 238U and 232Th and 40K are contained in all the soil samples. Results and Discussion: The obtained results of the average activity concentrations of 238U, 232Th and 40K were found to be within the range of the world average of 17-60, 11-64, 140-850 Bq.kg-1 reported by UNSCEAR. The radiation dose is below the permissible limit of 1mSvy-1 recommended by IAEA (2007). No peak of 137Cs from the decay activity was found in the spectrum in the present work. Conclusion: The present work will be useful in providing environmental monitoring data base of those particular areas. 397 404 2020/04/192020/04/192020/04/22 1399/2/3 2020/04/192020/04/192020/04/22 1399/2/3 Sk.A.K. Arafin Sk.A.K. Arafin Department of Natural Sciences, Faculty of Science and Information Technology, Daffodil International University, Sukrabad, Dhaka-1207, Bangladesh skak_arafin@daffodilvarsity.edu.bd A. El-Taher A. El-Taher Department of Physics, Al-Azhar University, Faculty of Science, Assuit 71452, Egypt A.K.M. Fazlul Hoque A.K.M. Fazlul Hoque Office of the Registrar, Daffodil International University, Sukrabad, Dhaka-1207, Bangladesh M. Ashraful Hoque M. Ashraful Hoque Health Physics Division, Atomic Energy Centre, Dhaka, Bangladesh J. Ferdous J. 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J Rad Protect Dosi, 145 (4): 405-410.##Al-Zahrani JH and El-Taher A (2014) Radioactivity Measurements and Radiation Dose Assessments in Soil of Al-Qassim region, Saudi Arabia, Indian. J pure Appl Phys, (52): 147-154.##Hendry JH, Simon SL, Wojcik V, Sohrabi M, Burkart W, Cardis E, Laurier C, Tirmarche M, Hayata I (2009) Human exposure to high natural background radiation: What can it teach us about radiation risks? Jr Radiol Prot, 29(2A): A29-42.##Moubissi AB, Abiama PE, Ekogo TB, Ben- Bolies GH, Mouandza YL (2018) Study of natural radioactivity to Assess of radiation  hazards from soil samples collected  from Mounana in south-east of Gabon. Int J Radiat Res, 16(4): 443-453. ##Taqi AH, Shaker AM, Battawy AA (2018) Natural radioactivity assessment in soil samples from Kirkuk city of Iraq using HPGe detector. 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Ameliorative effects of vitamin C against hepatic pathology related to Wi-Fi (2.45 GHz electromagnetic radiation) in rats 2 2 Background: The aim of this study was to investigate hepatic lesions induced by the 2.45 GHz electromagnetic radiation (EMR) of Wi-Fi and the protective effects of Vitamin C (Vit C) in rats. Materials and Methods: Eighteen Sprague-Dawley female rats were randomly distributed into three groups, each containing six rats. The groups were Control, EMR (EMR, 1 h/day for 30 days) and EMR + Vit C (EMR, 1 h/day for 30 days and Vit C, 250 mg/kg/daily). At the end of the study, blood and liver tissue samples were collected for laboratory examinations. Results: Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were increased in the EMR group compared with the control group. Liver histology of rats in the EMR group revealed severe hyperemia, slight degeneration, and lipidosis. Caspase-3, hypoxia-inducible factor-1 (HIF-1), and HIF-2 immunoexpression was increased, and Sirtuin-1 (SIRT-1) expression was markedly decreased in hepatocytes in the EMR group. Vit C treatment ameliorated both biochemical and pathological findings. Conclusion: The results of this study showed that 2.45 GHz (Wi-Fi) EMR can cause liver damage in rats, but Vit C has an ameliorative effect. 405 412 2020/04/192020/04/192020/04/222020/04/22 1399/2/3 2020/04/192020/04/192020/04/222020/04/22 1399/2/3 O. Ozmen O. Ozmen Burdur Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Pathology, Burdur, Turkey ozlemozmen@mehmetakif.edu.tr O. Kavrik O. Kavrik Suleyman Demirel University, Faculty of Medicine, Department of Physiology, Isparta, Turkey Wi-Fi vitamin C liver pathology caspase-3 HIF-1a HIF-2a SIRT-1 immunohistochemistry. Marjanović AM and Pavičić I, Trošić I (2012) Biological indicators in response to radiofrequency/ microwave exposure. 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Investigation of the radioprotective effect of arbutin on radiation-induced lung injury in rats: a histopathological study 2 2 Background: Radiation-induced lung injury is a common complication after esophageal, breast, etc. cancer radiotherapy. We aimed to evaluate the radioprotective effect of arbutin on acute radiation-induced lung damage in male rats. Materials and Methods: Fifty-two male Wistar rats were divided into 4 groups: (i) control group (n = 10), (ii) vehicle group (n = 10, received distilled water intraperitoneally (ip)), (iii) X-irradiation only (n=16, chest was irradiated to a single dose of 20 Gy x-rays) and (iv) arbutin + X-irradiation (n=16, 75 mg/kg of arbutin 2 hours before irradiation (ip), and then their chest was exposed to 20 Gy x-rays). For histopathological investigation, 8 animals of each group were sacrificed 8 weeks after treatment and the rest of them were sacrificed 3 months after treatment. Results: The histopathological analysis in 8 weeks after X-irradiation showed that there was a significant increase in inflammatory in X-irradiation only group compared to control group. The administration of arbutin 2 hours prior to X-irradiation significantly reduced inflammation and inflammatory factors such as macrophages, mast cell and neutrophil in arbutin + X-irradiation group compared to X-irradiation only group (P<0.05). The histopathologic investigation performed 3 months after lung irradiation indicated a significant reduction in fibrosis formation in arbutin + X-irradiation group compared to irradiation only group (P<0.05). Localized chest X-irradiation with 20 Gy caused histopathologic damage to the lungs for short -term. Conclusion: Arbutin has a great potential in reducing the histopathologic damage to lung tissue after thoracic irradiation. 413 420 2020/04/192020/04/192020/04/222020/04/222020/04/22 1399/2/3 2020/04/192020/04/192020/04/222020/04/222020/04/22 1399/2/3 S.S.A. Jahanbani S.S.A. Jahanbani Department of Anatomical Sciences, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran A.H. Rezaeyan A.H. Rezaeyan Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran ahrezaeyan@gmail.com H. Ghaffari H. Ghaffari Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran A.R. Babae A.R. Babae Department of Anatomical Sciences, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran G.H. Haddadi G.H. Haddadi Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran M.M. Moeni M.M. Moeni Pathology and Stem Cell Research Center, Department of Pathology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Ira A. Jomehzadeh A. Jomehzadeh Department of Medical Physics, Kerman University of Medical Sciences, Kerman, Iran S. Moatamedi S. Moatamedi Department of physiology and pharmacology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran S.H. Eftekhar-Vaghefi S.H. Eftekhar-Vaghefi Department of Anatomical Sciences, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran sheftekharv@yahoo.com Arbutin lung irradiation radioprotector pneumonia fibrosis. 1. Ringborg U, Bergqvist D, Brorsson B, et al. (2003) The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001--summary and conclusion. Acta oncologica, 42: 357-365.##2. Greenberger JS (2009) Radioprotection. In vivo, 23: 323-336.##3. Ghaffari H, Beik J, Talebi A, et al. (2018) New physical approaches to treat cancer stem cells: a review. Clin Transl Oncol, 20: 1502-1521.##4. Hanania AN, Mainwaring W, Ghebre YT, et al. (2019) Radiation-induced lung injury: assessment and management. Chest, 156: 150-62.##5. Giridhar P, Mallick S, Rath GK, et al. (2015) Radiation induced lung injury: prediction, assessment and management. Asian Pac J Cancer Prev, 16: 2613-7.##6. Khanal T, Kim HG, Hwang YP, et al. (2011) Role of metabolism by the human intestinal microflora in arbutin-induced cytotoxicity in HepG2 cell cultures. Biochemical and Biophysical Research Communications, 413: 318-324.##7. Wu L-H, Li P, Zhao Q-L, et al. (2014) Arbutin, an intracellular hydroxyl radical scavenger, protects radiation-induced apoptosis in human lymphoma U937 cells. Apoptosis, 19: 1654-1663.##8. Takebayashi J, Ishii R, Chen J, et al. (2010) Reassessment of antioxidant activity of arbutin: multifaceted evaluation using five antioxidant assay systems. Free Radic Res, 44: 473-8.##9. Chakraborty AK, Funasaka Y, Komoto M, et al. (1998) Effect of arbutin on melanogenic proteins in human melanocytes. Pigment Cell Res, 11: 206-12.##10. Li H, Jeong YM, Kim SY, et al. (2011) Arbutin inhibits TCCSUP human bladder cancer cell proliferation via up-regulation of p21. Pharmazie, 66: 306-9.##11. Mirshahvalad S, Feizi F, Barkhordar A, et al. (2016) Hepatoprotective Effects of Arbutin against Liver Damage Induced by Carbon Tetrachloride in Rats. Jundishapur J Nat Pharm Prod, 11: e33392.##12. Buttner C, Skupin A, Reimann T, et al. (1997) Local production of interleukin-4 during radiation-induced pneumonitis and pulmonary fibrosis in rats: macrophages as a prominent source of interleukin-4. American Journal of Respiratory Cell and Molecular Biology, 17: 315-25.##13. 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(2011) Pretreatment ##nutritional status and locoregional failure of patients with head and neck cancer undergoing definitive concurrent ##chemoradiation therapy. Head Neck, 33: 1561-8.##19. Najafi M, Shirazi A, Motevaseli E, et al. (2017) Melatonin as an anti-inflammatory agent in radiotherapy. Inflammopharmacology, 25: 403-413.##20. Kolivand S, Amini P, Saffar H, et al. (2019) Evaluating the radioprotective effect of curcumin on rat's heart tissues. Curr Radiopharm,12: 23-28.##21. Farhood B, Mortezaee K, Goradel NH, et al. (2019) Curcumin as an anti-inflammatory agent: Implications to radiotherapy and chemotherapy. J Cell Physiol, 234: 5728-5740.##22. Najafi M, Shirazi A, Motevaseli E, et al. (2019) The melatonin immunomodulatory actions in radiotherapy. Biophysical Reviews, 9: 139.##23. Veerappan A, O'Connor NJ, Brazin J, et al. (2013) Mast cells: a pivotal role in pulmonary fibrosis. DNA and cell biology, 32: 206-218.##24. Haston CK, Begin M, Dorion G, et al. (2007) Distinct loci influence radiation-induced alveolitis from fibrosing alveolitis in the mouse. Cancer Res, 67: 10796-803.##25. Groves AM, Johnston CJ, Williams JP, et al. (2018) Role of infiltrating monocytes in the development of radiation-induced pulmonary fibrosis. Radiat Res, 189: 300-311.##26. Nadi S, Monfared AS, Mozdarani H, et al. (2016) Effects of arbutin on radiation-induced micronuclei in mice bone marrow cells and its definite dose reduction factor. Iran J Med Sci, 41:1 80-5.##27. Nadi S, Banaei A, Mozdarani H, et al. (2020) Evaluating the radioprotective effect of arbutin on mice exposed to megavoltage X-rays based on hematological parameters and lymphocytes micronucleus assay. Int J Radiat Res, 18:2 275-282.## ##

Why can COVID-19 fatality in space be significantly higher than on Earth? 2 2 Astronauts are exposed to a wide variety of stressors ranging from radiation and microgravity to persistent fluids shifts, circadian shifts and the psychological stress of prolonged isolation and confinement. On deep space missions, beyond the range of the Earth's magnetosphere, ionizing radiation may increase oxidative stress and DNA damage, immune system dysregulation and alter the effectiveness of the cellular defense mechanisms. By reviewing the health problems reported by astronauts participated in previous space missions, it is evident that viral infections are not rare in space. Recent reports suggest that COVID-19 can last for a long time in communities. Although NASA implements countermeasures designed to limit crew illness during space missions such as a pre-flight quarantine, it is not clear whether an outbreak can be prevented. Currently, it is not likely that astronauts could get a viral infection, but the consequences of potential life-threatening viral diseases such as COVID-19 should be better characterized. In this paper we discuss why COVID-19 fatality in space might be significantly higher than on the Earth. The reasons for such an increased risk include 1) uselessness of social distancing due to microgravity 2) immune system dysregulation 3) possibly higher mutation rates of RNA viruses such as the novel coronavirus (SARS-CoV-2) 4) existence of strong selective pressure and 5) decreased maximum oxygen uptake. Given these considerations, the combined effects of microgravity, space radiation (and possibly other major space stressors) on the immune system of astronauts exposed to SARS-CoV-2 and possible interactions of the virus, space stressors and host should be carefully investigated. 421 426 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/28 1399/2/9 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/28 1399/2/9 J.S. Welsh J.S. Welsh Loyola University Chicago, Edward Hines Jr., VA Hospital, Stritch School of Medicine, Department of Radiation Oncology, Maywood, IL 60153 USA. J.J. Bevelacqua J.J. Bevelacqua Bevelacqua Resources, Richland, Washington 99352, United States. H. Mozdarani H. Mozdarani Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran S.A.R. Mortazavi S.A.R. Mortazavi School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. S.M.J. Mortazavi S.M.J. Mortazavi Medical Physics and Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran mortazavismj@gmail.com Coronavirus COVID-19 Immune system Space Astronauts Microgravity Space radiation SARS-CoV-2. 1. Moreno-Villanueva M, Wong M, Lu T, Zhang Y, Wu H (2017) Interplay of space radiation and microgravity in DNA damage and DNA damage response. Npj Microgravity, 3: 1-8.##2. Crucian BE, Choukèr A, Simpson RJ, Mehta S, Marshall G, Smith SM, et al. (2018) Immune System Dysregulation During Spaceflight: Potential Countermeasures for Deep Space Exploration Missions. Front Immunol, 9: 1437-1437. ##3. Demontis GC, Germani MM, Caiani EG, Barravecchia I, Passino C, Angeloni D (2017) Human Pathophysiological Adaptations to the Space Environment. Front Physiol , 8: 547-547. ##4. Moreno-Villanueva M, Wong M, Lu T, Zhang Y, Wu H (2017) Interplay of space radiation and microgravity in DNA damage and DNA damage response. Npj Microgravity, 3: 14 ##5. 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Monitoring the levels of radon and toxic elements pollutants in bottled drinking water 2 2 Background: The existence of radioactive isotopes and toxic elements in water poses a potential threat to public health. Due to the high consumption of bottled water, the focus of this study is on measuring the concentration of radioactive isotopes (222Rn and 226Ra) and toxic elements (Cr, Mn, Co, Ni, Cu, Zn, Cd, Pb) in different brands of bottled drinking water. Materials and Methods: Therefore, twenty-four samples of bottled water have been carefully selected from local markets in Saudi Arabia. Nuclear track detector of type CR-39 and Inductive Coupled Plasma-Mass Spectrometer were used to measure radioactivity concentrations and toxic elements, respectively. Results: It is observed that the activity concentration of 222Rn and 226Ra in all samples was lower than the recommended values set by different agencies such as WHO, and EPA. The annual effective dose for three age groups (infants, children, and adults) was calculated from the concentration of 222Rn. These measurements provide basic information for consumers who could be at risk of exposure through bottled water consumption. Conclusion: then all types of bottled drinking water are suitable and safe for daily population ingestion. 427 435 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/4 1399/2/15 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/4 1399/2/15 B.A. El-Badry B.A. El-Badry Department of Physics, College of Women, for Arts, Science, and Education, Ain-Shams University, Cairo, Egypt T.I. Al-Naggar T.I. Al-Naggar Department of Physics, College of Women, for Arts, Science, and Education, Ain-Shams University, Cairo, Egypt ty_sab_sy@yahoo.com G.A. Khouqeer G.A. Khouqeer Department of Physics, College of Science, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), P.O. Box 5701, Riyadh 11432, Saudi Arabia Bottled drinking water radon toxic elements CR-39 inductive coupled plasma-mass spectrometer. 1. Hadiani MR, Dezfooli-Manesh S, Shoeibi S, Ziarati P, Mousavi KA (2015) Trace elements and heavy metals in mineral and bottled drinking waters on the Iranian market. Food Additives & Contaminants, Part B, 8: 18-24.##2. Naskar AK, Gazi M, Barman C, Chowdhury S, Mondal M, Ghosh D, Sinha B, Deb A (2018) Estimation of underground water radon danger in Bakreswar and Tantloi Geothermal Region, India. Journal of Radioanalytical and Nuclear Chemistry, 15: 273-283.##3. BEIR VI (1999) Report of the committee on the biological effects of ionizing radiation. Health effects of expose to radon. National research council, The National Academies Press, Washington.##4. Kendal GM and Smith TJ (2002) Dose to organs and tissues from radon and its decay products. J Radiol Prot, 22: 389-406.##5. 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Tareen AK, Sultan IN, Parakulsuksalid SM, Khan A, Khan MW, Hussain S (2014) Detection of heavy metals from drinking waters of district Peshin, Balochistan, Pakistan. Int J Current Microbiol Appl Sci, 3: 299–308.##12. Dark, G, Faanu A, Akoto O, Acheampong A, Goode EJ, Gyamfi O (2015) Distribution of natural and artificial radioactivity in soils, water and tuber crops. Environmental Monitoring and Assessment, 187(6): 1–11.##13. Althoyaib SS and El-Taher A (2016) Natural radioactivity levels of radon, radium and the associated health effects in drinking water consumed in Qassim area, Saudi Arabia. J Environ Sci Technol, 9(2): 208-213.##14. Abdullah S, Ndikilar CE, Suleiman AB, Hafeez HY (2016) Assessment of heavy metals and radioactivity concentration in drinking water collected from local wells and Boreholes of Dotes Town, North West, Nigeria. Journal of Environment Pollution and Human Health, 4(1): 1–8.##15. Sharma S, Duggal V, Srivastava AK, Mehra R (2017) Assessment of radiation dose from exposure to radon in drinking water from western Haryana, India. Int J Environ Res, 11: 141–147.##16. Hatif KH, Muttaleb MK, Abass AH (2017) Health impact of Radon in water to Schools for City of Hilla – Iraq. Int J Chem Tech Res, 10(1): 415-421.##17. Duggal V, Sharma S, Mehra R (2017) Radon levels in drinking water of Fatehabad district of Haryana, India. Appl Radiat Isot, 123: 36-40.##18. Wiedner H, Lotter K, Karner P, Friedmann H, Maringer FJ (2018) Radon in drinking water: Comparison and evaluation of two ionization chamber activity measurement methods. Appl Radiat Isot, 134: 477- 481.##19. El-Tamera A (2011) Terrestrial gamma radioactivity level and their corresponding extent exposure of environmental samples from wade El Acuity protective area, as suit Upper Egypt. Radiate Protect Dosm, 145(4): 405–410.##20. WHO (2008) Guidelines for drinking-water quality. World health Organisation Publication, 1: 197- 209.##21. USEPA (2000) Radionuclides notice of data availability. Technical support document. United States environmental Protection Agency.##22. Jankovic MM, Todorovic DJ, Todorovic NA, Nikolov J (2012) Natural radionuclides in drinking waters in Serbia. Appl Radiat Isot, 70: 2703–2710.##23. Mayeen UK, Noor LMN, Nur SZ, Hasan AK, Khandoker A, Bradley DA, Zulkiflid MY, Adeeb H ( 2017) Radiation dose to the Malaysi an populace via the consumption of bottled mineral water. Radiation. Physics and Chemistry, 140: 173–179.##24. Kralik C, Friedrich M, Vojir F (2003) Natural radionuclides in bottled water in Austria. Journal of Environmental Radioactivity, 65: 233–241.##25. Martina R, Matea R, Ljudmila B, Delko B, Petra P (2014) Radiological characterization of tap waters in Croatia and the age dependent dose assessment. Chemosphere, 111: 272–277.##26. Kralik C, Friedrich M, Vojir F (2003) Natural radionuclides in bottled water in Austria. 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Fakhri Y, Mahvi AH, Langarizadeh G, Zandsalimi Y, Amirhajeloo LR, Kargosha M, Moradi M, Moradi B, Mirzaei M (2015) Effective Dose of Radon- 222 Bottled Water in Different Age Groups Humans: Bandar Abbas City, Iran. Global Journal of Health Science, 8(2): 64-71. ##31. Ali AA, Suha HK, Hussien AAM, Rua RM (2016) Radon levels in different types of bottled drinking water and carbonated drinks in Iraqi markets. Water Supply, 17 (1): 206-211.##32. Mohamed SS (2017) Measurement of radon-222 concentration in bottled natural mineral drinking water in Kuwait using the nuclear track detector (CR-39). Int J Physics, 5(6): 201-207. ##33. Hesham AY (2018) Assessment of the annual effective dose of bottled mineral waters using closed can technique. Journal of Advances in Physics, 14 (3): 5696- 570.##34. Zvi D and Ofir T (2011) Variables with too-frequent values using a Kolmogorov–Smirnov test: A practical approach. Computers & Industrial Engineering, 61: 1240–1244.##35. Jesse F (2016) An exact Kolmogorov–Smirnov test for whether two finite populations are the same. Statistics and Probability Letters, 116: 65–71.##36. Naoya O and Takashi S (2010) On the distributions of multivariate sample skewness. Journal of Statistical Planning and Inference, 140: 2809–2816.##37. Ahmet C and Ugur T (2018) Skewness and kurtosis analysis for non-Gaussian Distributions. Physica A, 499: 325–334.## 38. Alexandra S and Winfried S (2017) Assessing skewness, kurtosis and normality in linear mixed models. J Multivariate Analysis, 161: 123–140.## 39. European Commission (1998) Council Directive 98/83/EC of 3 November 1998 on the quality of water intended for human consumption. Official Journal L 330; 1998. p. 0032–54. 05.12.## 40. Nisar A, Mohamad SJ, Mohammed SA ( 2015) Study of radon concentration and toxic elements in drinking and irrigated water and its implications in Sungai Petani, Kedah, Malaysia. Journal of Radiation Research and Applied Science, 8: 294-299.##41. 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Analysis of various dosimetric parameters using multiple detectors in the cyberknife® robotic radiosurgery system 2 2 Background: Accurate dosimetry in CyberKnife® is challenging because of the unavailability of suitable detectors to satisfy all the criteria of small-field dosimetry. In this work, eight different small-field detectors from PTW and IBA Dosimetry were used to determine the dosimetric parameters for twelve fixed collimators in the CyberKnife® radiosurgery system. The scope of this work was to assist medical physicists in detector selection in small-field dosimetry. Materials and Methods: Dosimetric parameters such as the surface dose (Ds), dose buildup (DB), percentage dose at 100 mm (D100), percentage dose at 200 mm (D200), depth of dose maximum (Dmax), and total scatter factor (Scp) were compared and analyzed from the acquired Percentage Depth Dose(PDD). Results: Large variations in Ds were observed with different detectors for smaller collimator sizes. On analyzing the dose buildup, considerable differences were observed with all detectors from the surface to  6 mm depth for the smallest cone of 5 mm diameter. The D100 and D200 values obtained using ion chambers were higher than those using diodes, likely due to the volume averaging effect. The depth of dose maximum was found to increase with increase in the field size for most of the detectors. Considerable variation in Scp was noticed with all detectors in smaller field ranges. Conclusion: For small fields, the selection of detector is crucial, and awareness of the advantages, disadvantages and limitations of the detectors used is crucial. As in absolute dosimetry, the relative dosimetry in small fields is challenging and requires further studies and recommendations. 437 447 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/4 1399/2/15 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/4 1399/2/15 M. Manavalan M. Manavalan Research and Development Centre, Bharathiar University, Coimbatore, India emailmuthukumaran@gmail.com M. Duraisamy M. Duraisamy Medanta The Medicity Hospital, Gurgaon, India V. Subramani V. Subramani Brunei National Cancer Centre, Brunei H.F. Godson H.F. Godson Department of Radiotherapy, Christian Medical College, Vellore, India G. Krishnan G. Krishnan Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, India M. Venkataraman M. Venkataraman Department of Radiation Oncology, Apollo Speciality Hospitals, Chennai, India T. Ganesh T. Ganesh Manipal Hospitals Dwarka, India CyberKnife® detectors PinPoint chamber diodes PDD small field dosimetry. Guthrie BL and Adler JR Jr. (1992) Computer-assisted preoperative planning, interactive surgery, and frameless stereotaxy. Clin Neurosurg, 38: 112-131.##Echner GG, Kilby W, Lee M, Earnst E, Sayeh S, Schlaefer A, et al. (2009) The design, physical properties and clinical utility of an iris collimator for robotic radiosurgery. Phys Med Biol, 54: 5359-5380.##Das IJ, Ding GX, Ahnesjö A (2008) Small fields: Nonequilibrium radiation Dosimetry. Med Phys, 35(1): 206-215.##Seuntjens J and Verhaegen F (2003) Ionization chamber dosimetry of small photon fields: A Monte Carlo Study on stopping-power ratios for radiosurgery and IMRT beams. Physics in Medicine and Biology, 48(21).##Yarahmadi M, Nedaie HA, Allahverdi M, Asnaashar Kh, Sauer OA (2013) Small photon field dosimetry using EBT2 Gafchromic film and Monte Carlo simulation. Int J Radiat Res, 11(4): 215-224.##Report of AAPM TG 135. (2011) Quality assurance for robotic radiosurgery. Med Phys, 38(6): 2914-36.##Morales JE, Crowe SB, Hill R, Freeman N, Trapp JV (2016) Dosimetry of cone-defined stereotactic radiosurgery fields with a commercial synthetic diamond detector. Medical Physics, 41: 111702-1.##Masi L, Russo S, Francescon P, Doro R, Frassanito MC, Fumagalli ML, et al. (2016) CyberKnife beam output factor measurements: A multi-site and multi-detector study. Physica Medica, 32(12): 1637-1643. ##Sharma S (2014) Challenges of small photon field dosimetry are still challenging. Journal of Medical Physics, 39(3): 131.##Keivan H, Shahbazi-Gahrouei D, Shanei A (2018) Evaluation of dosimetric characteristics of diodes and ionization chambers in small megavoltage photon field dosimetry. Int J Radiat Res, 16(3): 311-321.##Pappas E, Maris TG, Zacharopoulou F, Papadakis A, Manolopoulos S, Green, et al. (2008) Small SRS photon field profile dosimetry performed using a PinPoint air ion chamber, a diamond detector, a novel silicon-diode array (DOSI), and polymer gel dosimetry. Analysis and inter-comparison. Med Phys, 35(10): 4640-8.##Ling CC and Biggs PJ (1979) Improving the buildup and depth-dose characteristics of high energy photon beams by using electron filters. Med Phys, 6: 296–301. ##Mc Parland BJ (1991) The effects of a universal wedge and beam obliquity upon the central axis dose buildup for 6-MV X-rays. Med Phys, 18: 740–743.##Nilsson B and Sorcini B (1989) Surface dose measurements in clinical photon beams. Acta Oncol, 28: 537–442.##Lamb A and Blake S (1998) Investigation and modelling of the surface dose from linear accelerator produced 6 and 10 MV photon beams. Phys Med Biol, 43: 1133–1146.##Devic S, Seuntjens J, Abdel-Rahman W, Evans M, Olivares M, Podgorsak EB, et al. (2006) Accurate skin dose measurements using radiochromic film in clinical applications. Med Phys, 33: 1116.##Scott AJD, Kumar S, Nahum AE, Fenwick JD (2012) Characterizing the influence of detector density on dosimeter response in non-equilibrium small photon fields. Phys Med Biol, 57(14): 4461-4476.##McCullough EC (1994) A measurement and analysis of buildup region dose for open field photon beams (cobalt-60 through 24 MV). Med Dosim, 19: 5 –14.##Ding GX and Ding F (2012) Beam characteristics and stopping‑power ratios of small radiosurgery photon beams. Phys Med Biol, 57: 5509-5521.##Heydarian M, Hoban PW, Beddoe AH (1996) A comparison of dosimetry techniques in stereotactic radiosurgery. Phys Med Biol, 41: 93-110.##Wilcox EE and Daskalov GM (2007) Evaluation of GAFCHROMIC EBT film for Cyberknife dosimetry. Med Phys, 34: 1967-1974.##Bucciolini M, Buonamici FB, Mazzocchi S, De Angelis C, Onori S, Cirrone GA (2003) Diamond detector versus silicon diode and ion chamber in photon beams. Med Phys, 30(8): 2149-2154.##Marsolat F, Tromson D, Tranchant N, Pomorski M, Le Roy M, Donois M, et al. (2013) A new single crystal diamond dosimeter for small beam: Comparison with different commercial active detectors. 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(2017) A 2D silicon detector array for quality assurance in small field dosimetry. Medical Physics, 44: 628-636.##Das IJ, Ding GX, Ahnesjö A (2008) Small fields: Nonequilibrium radiation Dosimetry. Med Phys, 35(1): 206-215.##McCullough EC (1994) A measurement and analysis of buildup region dose for open field photon beams (cobalt-60 through 24 MV). Med Dosim, 19(1): 5-14.##Podgorsak EB (2005) Radiation Oncology Physics: A Handbook for Teachers and Students. International Atomic Energy Agency, Vienna.##Godson HF, Ravikumar M, Sathiyan S, Ganesh KM, Ponmalar YR, Varatharaj C (2016) Analysis of small field percent depth dose and profiles: Comparison of measurements with various detectors and effects of detector orientation with different jaw settings. J Med Phys, 41(1): 12–20.## ##

Assessment of patient dose in routine digital radiography in Iran 2 2 Background: The present study aimed to investigate patient dose in common X-ray examinations to estimate effective dose in the digital radiography in Iran. Materials and Methods: Entrance surface dose (ESD) was measured based on applied exposure parameters for the common actual examination; and then effective dose (ED) was calculated by use of PCXMC software. The study was conducted on 15358 patients in 85 X-ray rooms; and the necessary data was collected for five age groups, 0-1 year, 1-5 years, 5-10 years, 10-15 years old and adults in each projection. Results: The ranges of ESD and ED in different examinations for all the age groups are 0.02-10.20 mGy and 2.42-378.96 µSv respectively. Conclusion: The effective dose as criteria can be used to reduce patients' doses. The special considerations such as: adequate training of imaging staff; updating clinical audits; patient dose considerations; implementation of systematic and regular quality assurance and quality control programs in medical imaging departments should be taken into account to optimize radiological practices. 449 460 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/11 1399/2/22 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/11 1399/2/22 B. Mohsenzadeh B. Mohsenzadeh Biomedical Engineering and Medical Physics Department, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran M.R. Deevband M.R. Deevband Biomedical Engineering and Medical Physics Department, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran mdeevband@sbmu.ac.ir R. Paydar R. Paydar Department of Radiology, Iran University of Medical Sciences and Health Services, Tehran, Iran M. Ghorbani M. Ghorbani Biomedical Engineering and Medical Physics Department, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Patient dose dose reference level dosimetry in diagnostic radiology entrance surface dose effective dose. Karami V and Zabihzadeh M (2017) Beam collimation during lumbar spine radiography: A retrospective study. J Biomed Phys Eng, 7(2): 101-106.##Sabic I, Kljucevsek D, Thaler M, Zontar D (2016) The effect of anti-scatter grid on radiation dose in chest radiography in children. Centr Eur J Paediatr, 12(1): 75-80.##Mozdarani H (2018) Report of fifteen years contributions to radiological sciences: Future directions and prospects. Int J Radiat Res, 16(1): 1-5. ##Giczi F, Pellet S, McLean ID, Meghzifene A (2008) INIS-AR-C-1245 testing the implementation of the code of practice on dosimetry in X-ray diagnostic radiology: Hungarian contribution. IAEA, Argentina. ##Garcia CP, España LML, Fernandez BV, Bermudez LR, Rodriguez MG (2011) A dose index as a tool to estimate paediatric patient doses in digital projection radiography. Radiat Prot dosimetry, 149 (4): 417-423.##Aroua A, Bize R, Buchillier-Decka I, Vader JP, Valley JF, Schnyder P (2003) X-ray imaging of the chest in Switzerland in 1998: a nationwide survey. Eur Radiol, 13(6): 1250-9.##Paydar R, Takavar A, Kardan MR, Babakhani A, Deevband MR, Saber S (2012) Patient effective dose evaluation for chest X-ray examination in three digital radiography centers. Iran J Radiat Res, 10(3-4): 139-143.##Alexander S (2016) Image acquisition and quality in digital radiography. Radiol Technol, 88(1): 53-66.##Castañon PG, España LML., Bedoya VF, Luna RB, Martin GR (2011) A dose index as a tool to estimate paediatric patient doses in digital projection radiography. Radiat Prot Dosimetry, 149 (4): 417-423. ##İnal T and Ataç G (2014) Dose audit for patients undergoing two common radiography examinations with digital radiology systems. Diagn Interv Radiol, 20(1): 100-104. ##Wachabauer D, Röthlin F, Moshammer HM, Homolka P (2019) Diagnostic reference levels for conventional radiography and fluoroscopy in Austria: Results and updated national diagnostic reference levels derived from a nationwide survey. Eur J Radiol, 113: 135-139.##Roch P and Aubert B (2013) French diagnostic reference levels in diagnostic radiology, computed tomography and nuclear medicine: 2004-2008 review. Radiat Prot Dosimetry, 154(1): 52-75.##Mohsenzadeh B, Deevband MR, Pouriran R (2018) The National Diagnostic Reference Level in Routine Digital Radiography Examinations in Iran. 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The effective radium content and radon concentrations in coffee samples 2 2 Background: Many people in Iraq and indeed the world choose to drink coffee on a daily basis; accordingly, we planned to find the radium and uranium concentrations in addition to the Radon emission rate to determine if coffee shows the levels of radioactivity that may affect people’s lives. Material and Methods: A nuclear track detector (CR-39) was used to study the natural radioactivity of ten samples of coffee collected from local Iraqi markets. Results: The effective radium content varied from 0.13 to 0.66 Bq/kg with a mean 0.32 Bq/kg. The mass exhalation rates of radon vary from 0.024 – 0.121/kg .h, with a mean 0.059 Bq/kg .h, while the surface exhalation rates of radon vary from 0.47 – 2.39/?2.h, with a mean 1.16 Bq/m2. h. Uranium content varied from 0.10 to 0.54 ppm with a mean value of 0.26 ppm. Conclusion: Insofar as health effects are concerned, the results have shown that all the samples were entirely safe. 461 466 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/11 1399/2/22 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/11 1399/2/22 A.S. Hameed A.S. Hameed Department of Physics, College of Science, University of Kerbala, 56001 Karbala, Iraq ammar.s@uokerbala.edu.iq A.K. Hashim A.K. Hashim Department of Physics, College of Science, University of Kerbala, 56001 Karbala, Iraq E. Jasim Mohammed E. Jasim Mohammed Department of Physics, College of Science, University of Kerbala, 56001 Karbala, Iraq Coffee CR-39 radon exhalation rates radium. 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Nuclgeophys, 9(6): 653-657. ##Somogi G, Hafez A, Hunyadi I, Toth- Szilagyi M (1986) Measurement of exhalation and diffusion parametersof radon in solids by plastic track detectors. Nucl Track Radiat Meas, 12(6): 701-704. ##Alsaedi AK, Almayahi B, Alasadi AH (2013) Cement Rn And Ra concentration measurements in selected samples from different companies. Asian Journal of Natural and Applied Sciences, 2 (4): 95-100. ##Abbas, J. Al- Saadi., Abdal-Sattar, K. Hashim., Fadhil, M. Hussein (2013), "Measurement Of Radon And Uranium Concentrations In The Dates And Their Seeds Of Different Regions In Karbala Governorate. Journal of Babylon University/Pure and Applied Sciences, 21(6): 2134-2147. ##Rasheed MY and Kamal OA (2013) Measurement of uranium and radon concentrations in resources of water from Sulaimany governorate -Kurdistan region-Iraq. Arpn Journal of Science and Technology, 3(6): 632-638. ##Ibrahim HS, Abdelfatah FH, Elanany NH, Hussein AM, Mohammed AN (2007) Radiological study on soils, foodstuff and fertilizers in the Alexandria region, Egypt. Turkish J Eng Env Sci, 31: 9 – 17.##United Nations, Source and Effects of Ionizing Radiation (1993) United Nations Scientific Committee on the Effects of atomic Radiations, Report to the General Assembly, with Scientific Annexes. United Nations Sales Publication, New York, E.94.IX.2.##Hashim AK and Laith AN (2015) Radium and uranium concentrations measurements in vegetables samples of Iraq. Detection, 3: 21-28.## ##

Tumor shrinkage evaluation based interfractional cone beam computed tomography for limited disease small-cell lung cancer and relevant impact on dosimetry 2 2 Background: The pattern of interfractional tumor changes during limited disease small-cell lung cancer (LD-SCLC) radiotherapy is not clear, The study was to evaluate tumor changes based on interfractional CBCT images and it’s impact on dosimetry. Material and Method: We analyzed tumor changes and it’s dosimetry impact for 30 LD-SCLC patients who were treated with concurrent chemoradiotherapy(cCRT). CBCT images were acquired for each patient every five fractions before each treatment. The grass tumor volume(GTV) and total lung were adapted to create the GTVn and total lungn based on CBCTn. Dose was recalculated for every CBCT fraction. The impact on target dose coverage and lung sparing was also evaluated while relevant tissue's CT density correction was done on plan CT combined with tumor changes adapted by fraction’s CBCT images. Results: Mean GTV volume of each CBCT fraction reduced，and mean GTV volume of 7th CBCT fraction shrank nearly 10% compared to 1st fraction. The centroid positions of left/right tumors moved towards the right/left direction gradually. Most left/right tumor borders had a trend of rightward/leftward shrinkage. Target dose coverage and lung tissue dose volume increased through fractions. CT image density correction slightly increased the target dose coverage and lung tissue dose volume. Conclusion: Tumor shrinkage was seen for LD-SCLC patients, it’s related to the tumor's initial volume and location. It is appropriate that most LD-SCLC patients should be intervened at 21st radiotherapy fraction. 467 475 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/20 1399/2/31 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/20 1399/2/31 H. Wang H. Wang Key Laboratory of Nuclear Physics and Ion-beam Application(MOE), Fudan University, Shanghai, China H. Chen H. Chen Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China Y. Shao Y. Shao Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China J.M. Wang J.M. Wang Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China J.D. Guo J.D. Guo Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China X.W. Cai X.W. Cai Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China X.I. Fu X.I. Fu Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China Z.Y. Xu Z.Y. Xu Radiation Oncology Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China xzyong12vip@sina.com Tumor shrinkage interfractional cone beam CT dosimetry limited disease (LD) small-cell lung cancer. 1. P Goldstraw, J Crowley, K Chansky, LeslieSobin (2007) The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumors. Journal of Thoracic Oncology, 2(8):706-14.##2. Lally BE1, Urbanic JJ, Blackstock AW, Miller AA, Perry MC (2007) Small Cell Lung Cancer: Have We Made Any Progress Over the Last 25 Years? The Oncologist, 12: 1096-1104.##3. Aupérin, Anne Arriagada, Rodrigo Pignon, Jean-Pierre Le Péchoux, Cécile Gregor, and Joseph (1999) Prophylactic Cranial Irradiation for Patients with Small-Cell Lung Cancer in Complete Remission. The New England Journal of Medicine, 341(7): 476-84.##4. Takada M (2002) Phase III Study of Concurrent Versus Sequential Thoracic Radiotherapy in Combination With Cisplatin and Etoposide for Limited-Stage Small-Cell Lung Cancer: Results of the Japan Clinical Oncology Group Study 9104. Journal of Clinical Oncology, 20(14): 3354-60.##5. Han D, Qin Q, Hao SY, Huang W, Wei Y, Li BH (2014) Feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy in patients with limited-disease small cell lung cancer. Radiation Oncology, 9: 280.##6. Liu ZY , Liu WH , Ji K, Wang P, Wang X, Zhao LJ (2015) Simultaneous integrated dose reduction intensity-modulated radiotherapy applied to an elective nodal area of limited-stage small-cell lung cancer. Experimental and Therapeutic Medicine, 10: 2083-87. ##7. Ellegaard MB, Knap MM, Hoffmann L (2013) Inter-tester reproducibility of tumor change in small cell lung cancer patients undergoing chemoradiotherapy. Acta Oncologica, 52: 1520-25. ##8. Knap MM, Hoffmann L, Nordsmark M (2010) Daily cone-beam computed tomography used to determine tumour shrinkage and localisation in lung cancer patients. Acta Oncologica, 49: 1077-84.##9. Brade AM and Ian F (2006) Scheduling of Radiation and Chemotherapy for Limited-Stage Small-Cell Lung Cancer: Repopulation As a Cause of Treatment Failure? Journal of clinical oncology, 24(7): 1020-21.##10. Kazawa N, Kitaichi M, Hiraoka M, Togashi K, Mio N, Mishima M, Wada H (2006) Small cell lung carcinoma: Eight types of extension and spread on computed tomography. Journal of Computer Assisted Tomography, 30(4): 653-661.##11. Berkovic P, Paelinck L, Lievens Y, Gulyban A, Goddeeris B, Derie C, Surmont V, De Neve W, Vandecasteele K (2015) Adaptive radiotherapy for locally advanced non-small cell lung cancer, can we predict when and for whom? Acta Oncologica, 54: 1438-44. ##12. van Elmpt W, Ollers M, van Herwijnen H, den Holder L, Vercoulen L, Wouters M, Lambin P, De Ruysscher (2011) Volume or Position Changes of Primary Lung Tumor During (Chemo-) Radiotherapy Cannot Be Used as a Surrogate for Mediastinal Lymph Node Changes: The Case for Optimal Mediastinal Lymph Node Imaging During Radiotherapy. Int J Radiat Oncol Biol phys, 79(1): 89-95.##13. Mizuki N, Dahlberg SE, Fulton LE, Digumarthy SR, Hiroto H (2015) Volumetric tumor response and progression in EGFR-mutant NSCLC patients treated with erlotinib or gefitinib. Acad Radiol, 23(3): 329–336.##14. Jabbour SK, Kim S, Haider SA, Xu XT, Wu A (2015) Reduction in Tumor Volume by Cone Beam Computed Tomography Predicts Overall Survival in Non-Small Cell Lung Cancer Treated With Chemoradiation Therapy. Int J Radiat Oncol Biol Phys, 92(3): 627–633.##15. Hayes SA, Pietanza MC, O’Driscoll D, Zheng J, Moskowitz CS, Kris MG (2016) Comparison of CT volumetric measurement with RECIST response in patients with lung cancer. Eur J Radiol, 85(3): 524–533.##16. Zhang PP, Yorke E, Hu YC, Mageras G (2012) Predictive Treatment Management: Incorporating a Predictive Tumor Response Model Into Robust Prospective Treatment Planning for Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys, 88(2): 446–452.##17. Meng X, Frey K, Matuszak M, Paul S, Haken RT, Yu JM (2014) Changes in Functional Lung Regions During the Course of Radiation Therapy and Their Potential Impact on Lung Dosimetry for Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys, 89(1): 145–151.##18. Alexander SK, Tidwell VK, Engelbach JA, Alli VV, Nehorai A, Ming Y, Haris GV (2011) Quantitative Monitoring of Murine Lung Tumors by Magnetic Resonance Imaging. Nat Protoc, 7(1): 10.##19. Li Y, Ma Jl, Chen X, Tang FW, Zhang XZ(2016) 4DCT and CBCT based PTV margin in Stereotactic Body Radiotherapy (SBRT) of non-small cell lung tumor adhered to chest wall or diaphragm. Radiation Oncology, 11: 152.##20. Sun Y, Lu Y, Cheng S, Guo W, Ye K, Zhao H, Zheng X, Ge H (2014) Interfractional Variations of Tumor Centroid Position and Tumor Regression during Stereotactic Body Radiotherapy for Lung Tumor. Biomed Res Int, 2014: 372738.## ##

Comparison of different calculation indexes with dose volume histogram parameters for evaluation of radiation treatment plans in gynecologic malignancies 2 2 Background: We aimed to investigate the accordance of Critical Organ Scoring Index (COSI), Conformity Index (CI) and Normal Tissue Complication Probability (NTCP) parameters with Dose Volume Histograms (DVH) used for evaluation of 3 different pelvic radiotherapy plans. Materials and Methods: Ten gynecologic carcinoma patients who underwent adjuvant radiotherapy were enrolled in this study. Treatment plans were created with conformal treatment planning (3DCRT) and intensity modulated radiation therapy (IMRT) to a total dose of 50.4 Gy in 28 fractions. Initially, volume related dose evaluation was done via DVH. Subsequently, HI, CI, COSI and NTCP for selected normal tissues were calculated for each plan and compared with DVH parameters. Finally, a graphical demonstration was evaluated to see if the results were in accordance with DVH. Results: CI results were statistically significant in favor of IMRT (p<0.001). Rectum V40Gy decreased with 9IMRT compared to 3DCRT and 7IMRT (p=0.013 and p=0.013). V40Gy for bladder was also lower with 9IMRT compared with 3DCRT and 7IMRT (p=0.005 and p=0.012). COSI calculations revealed better small intestine protection in IMRT plans similar with DVH (p=0.005 and p=0.022). Femoral heads were better protected with IMRT plans were better compared to 3DCRT in NTCP calculations (p=0.002). Normal tissue protection was worst with 3DCRT via both DVH and COSI evaluations (p=0.001 and p<0.001 respectively). Conclusion: Using the indexes in this study to decide the most appropriate plan among multiple treatment plans in gynecologic cancer patients will be timesaving and easier in comparison with evaluating the DVH of every alternative plan. 477 486 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/20 1399/2/31 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/20 1399/2/31 A. Inal A. Inal Department of Radiation Oncology, University of Health Sciences Antalya Training and Research Hospital 07100, Antalya, Turkey aysuntoy@yahoo.com E. Duman E. Duman Department of Radiation Oncology, University of Health Sciences Antalya Training and Research Hospital 07100, Antalya, Turkey E.E. Ozkan E.E. Ozkan Department of Radiation Oncology, School of Medicine, Suleyman Demirel University, Turkey Gynecological radiotherapy treatment planning dosimetric evaluation. Henley SJ, Miller JW, Dowling NF, Benard VB, Richardson LC (2018) Uterine cancer incidence and mortality United States, 1999-2016. MMWR Morb Mortal Wkly Rep, 67(48): 1333–1338. ##Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: A Gynecologic Oncology Group study. Gynecol Oncol, 92: 744–51.##Creutzberg CL, Nout RA, Lybeert ML, Wárlám‑Rodenhuis CC, Jobsen JJ, Mens JW, et al. (2011) Fifteen‑year radiotherapy outcomes of the randomized PORTEC‑1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys, 81: e631–8.##Alektiar KM (2013) Endometrium In: Perez and Brady’s Principles and Practice of Radiation Oncology, (Halperin EC, Wazer DE, Perez CA, Brady LW, eds) Lippincott, Williams & Wilkins., Philadelphia.##Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ (1999) A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol, 73: 177–83.##Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, et al. (2006) A phase III randomized trial of postoperative pelvic irradiation in stage IB cervical carcinoma with poor prognostic features: Follow‑up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys, 65: 169–76.##Duman E, Inal A, Sengul A, Koca T, Cecen Y, Yavuz MN (2016) Dosimetric comparison of different treatment planning techniques with International Commission on Radiation Units and Measurements Report-83 recommendations in adjuvant pelvic radiotherapy of gynecological malignancies. J Cancer Res Ther, 12(2): 975–80.##Wagner A, Jhingran A, Gaffney D (2013) Intensity modulated radiotherapy in gynecologic cancers: Hope, hype or hyperbole? Gynecol Oncol, 130:229–36.##Ni J, Yin ZM, Yuan SH, Liu NF, Li L, Xu XX, Lou HM (2017) A randomized study of intensity-modulated radiation therapy versus three-dimensional conformal radiation therapy for pelvic radiation in patients of post-operative treatment with gynecologic malignant tumor. Zhonghua Fu Chan Ke Za Zhi, 52(3): 168–174. ##Gomez D, Cahlon O, Mechalakos J, Lee N (2010) An investigation of intensity-modulated radiation therapy versus conventional two-dimensional and 3D-conformal radiation therapy for early stage larynx cancer. Radiat Oncol, 5: 74.##International Commission of Radiation Units and Measurements (2010) ICRU report 83: Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT). J ICRU, 10(1): 1–106.##Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R, et al. (1993) Radiation therapy oncology group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys, 27(5): 1231–9.##Alfonso JC, Herrero MA, Núñez L (2015) A dose-volume histogram-based decision-support system for dosimetric comparison of radiotherapy treatment plans. Radiat Oncol, 10: 263. ##Moore KL, Brame RS, Low DA, Mutic S (2012) Quantitative metrics for assessing plan quality. In: Seminars in radiation oncology. Elsevier, 22: 62–9.##Feuvret L, Noël G, Mazeron JJ, Bey P (2006) Conformity index: a review. Int J Radiat Oncol Biol Phys, 64(2): 333–42.##Menhel J, Levin D, Alezra D, Symon Z, Pfeffer R (2006) Assessing the quality of conformal treatment planning: a new tool for quantitative comparison. Phys Med Biol, 51(20): 5363.##Paddick I (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. J Neurosurg, 3(93): 219–222.##Lyman JT (1985) Complication probability as assessed from dose-volume histograms. Radiat Res, 104(2s): 13–19.##Burman C, Kutcher G, Emami B, Goitein M (1991) Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys, 21(1): 123–35.##Heron DE, Gerszten K, Selvaraj RN, King GC, Sonnik D, Gallion H, et al. (2003) Conventional 3D conformal versus intensity‑modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: A comparative dosimetric study of dose‑volume histograms. Gynecol Oncol, 91: 39‑45.##Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt AJ (2000) Intensity‑modulated whole pelvic radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys, 48: 1613‑21.## ##

Dosimetric comparison of conventional and field-in-field techniques in early-stage breast cancer radiotherapy 2 2 Background: Breast conserving surgery followed by adjuvant whole breast radiotherapy is the accepted treatment in early-stage breast cancer. Due to breast irregularities, it is difficult to achieve homogenous dose distribution with conventional techniques. Currently, it is possible to use varied breast irradiation techniques such as field-in-field (FIF) that is claimed to produce more homogenous distribution of doses within the target volumes while sparing the organs at risk, leading to a better treatment outcome. The present study aimed to compare the conventional and the FIF techniques dosimetrically. Materials and Methods: Twenty patients with early-stage breast cancer underwent computed tomography. Two different treatment plans were created for each patient: the wedge-based (conventional) plan and the FIF plan. Dosimetric parameters and monitor units were compared with paired sample t-test. Results: FIF technique obtained significantly lower dose homogeneity index, lower maximum doses and higher median doses in PTV (P<0.05). Similarly, the conformity index, and mean doses were higher in the FIF technique but the differences were not significant (P>0.05). In ipsilateral lungs, FIF significantly reduced the maximum and mean doses (P<0.05), and showed a tendency to reduce V20 (P>0.05). In patients with left-sided breast cancer, minimum and maximum doses and V40 of heart were significantly decreased in FIF plans (P<0.05). Doses to the contralateral lungs did not differ significantly. Conclusion: These results along with significantly less monitor units required for therapy in FIF suggest that this technique may be more advantageous during breast irradiation.   487 494 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/2 1399/3/13 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/2 1399/3/13 S.M. Hosseini S.M. Hosseini Department of Medical Physics, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran M. Momennezhad M. Momennezhad Department of Medical Physics, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran momennezhadmahdi@gmail.com SH. Naseri SH. Naseri Department of Medical Physics, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran field-in-field 3D conformal radiotherapy wedge breast irradiation OAR dose. Torre LA, Siegel RL, Ward EM, Jemal A (2016) Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiology and Prevention Biomarkers, 25(1): 16-27.##Rafiemanesh H, Rajaei-Behbahani N, Khani Y, Hosseini S (2016) Incidence trend and epidemiology of common cancers in the center of Iran. Global journal of health science, 8(3): 146-55.##Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine, 347(16): 1233-41.##Wallace III HJ (2003) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomyplus irradiation for the treament of invasive breast cancer. Women's Oncology Review, 3(1): 81-2.##Group EBCTC (1995) Effects of radiotherapy and surgery in early breast cancer—an overview of the randomized trials. N Engl j med, 1995(333): 1444-56.##Rapiti E, Fioretta G, Vlastos G, Kurtz J, Schäfer P, Sappino AP, et al. (2003) Breast-conserving surgery has equivalent effect as mastectomy on stage I breast cancer prognosis only when followed by radiotherapy. Radiother Oncol, 69(3): 277-84.##Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Redmond C, et al. (1994) Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. Journal of Clinical Oncology, 12(3): 447-53.##Buchholz TA, Gurgoze E, Bice WS, Prestige BR (1997) Dosimetric analysis of intact breast irradiation in off-axis planes. Int J Radiat Oncol Biol Phys, 39(1): 261-7.##Neal A, TorrM, Helyer S, Yarnold J (1995) Correlation of breast dose heterogeneity with breast size using 3D CT planning and dose-volume histograms. Radiother Oncol, 34(3): 210-18.##Stillie AL, Kron T, Herschtal A, Hornby C, Cramb J, Sullivan K, et al. (2001) Does inverse-planned intensity-modulated radiation therapy have a role in the treatmentof patients with left-sided breast cancer? Journal of medical imaging and radiation oncology, 55(3): 311-9.##Mayo CS, Urie MM, Fitzgerald TJ (2005) Hybrid IMRT plans—concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time. Int J Radiat Oncol Biol Phys, 61(3): 922-32.##Mihai A, Rakovitch E, Sixel K, Woo T, Cardoso M, Bell C, et al. (2005) Inverse vs. forward breast IMRT planning. Medical Dosimetry, 30(3): 149-54.##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. I: dosimetric results. Int J Radiat Oncol Biol Phys, 56(2): 573-85.##Tu CP, Chuang, HD, Chang, NC et al. (2009) Clinical outcomes of the field-in-field technique for breast cancer patients with breast conservative therapy. Ther Radiol Oncol, 16: 63-7.##Dhabaan A, Elder E, Schreibmann E, Crocker I, Curran WJ, Oyesiku NM, et al. (2010) Dosimetric performance of the new high-definition multileaf collimator for intracranial stereotactic radiosurgery. J Appl Clinic Med Phys, 11(3): 17-211.##Mackie TR and Gregoire V (2012) ICRU recommendations [May 13, 2013]. Available from: http://www.aapm.org/meetings/2011SS/documents/MackieUncertainty.pdf.##Romestaing P, Lehingue Y, Carrie C, Coquard R, Montbarbon X, Ardiet J-M, et al. (1997) Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. Journal of clinical oncology, 15(3): 963-8.##Bartelink H, Horiot J-C, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. Journal of Clinical Oncology, 25(22): 3259-65.##Group EBCTC (2000) Favourable and unfavourableeffects on long-term survival of radiotherapy for early breast cancer: an overview of therandomised trials. The Lancet, 355(9217): 1757-70.##Fisher B, Jeong J-H, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. New England Journal of Medicine, 347(8): 567-75.##Senkus-Konefka E and Jassem J (2006) Complications of breast-cancer radiotherapy. Clinical Oncology, 18(3): 229-35.##Vatanen T, Traneus E, Lahtinen T (2009) Comparison of conventional inserts and an add-on electron MLC for chest wall irradiation of left-sided breast cancer. ActaOncologica, 48(3): 446-51.##Ahunbay EE, Chen GP, Thatcher S, Jursinic PA, White J, Albano K, et al. (2007) Direct aperture optimization–based intensity-modulated radiotherapy for whole breast irradiation. Int J Radiat Oncol Biol Phys, 67(4): 1248-58.##Fogliata A, Clivio A, Nicolini G, VanettiE, Cozzi L (2007) A treatment planning study using non-coplanar static fields and coplanar arcs for whole breast radiotherapy of patients with concave geometry. RadiotherOncol, 85(3): 346-54.##Stasi M, Moro G, Ramella S, Bertone A, Maruca S, Ciambellotti E (1997) Factors affecting the contralateral dose for the non-treated breast in irradiation following quadrantectomy. La Radiologiamedica, 93(5): 596-9.##Prabhakar R, Julka P, Malik M, Ganesh T, Joshi R, Sridhar P, et al. (2007) Comparison of contralateralbreast dose for various tangential field techniques in clinical radiotherapy. Technology in cancer research & treatment, 6(2): 135-8.##Prabhakar R, Julka P, Rath G (2008) Can field-in-field technique replace wedge filter in radiotherapy treatment planning: a comparative analysis in various treatment sites. Australasian Physical & Engineering Science in Medicine, 31(4): 317-24.##Ercan T, İğdem Ş, Alço G, Zengin F, Atilla S, Dinçer M, et al. (2010) Dosimetric comparison of field in field intensity-modulated radiotherapy technique with conformal radiotherapy techniques in breast cancer. Japanese journal of radiology, 28(4): 283-9.##Donovan EM, Johnson U, Shentall G, Evans PM, Neal AJ, Yarnold JR (2000) Evaluation of compensation in breast radiotherapy: a planning study using multiple static fields. Int J Radiat Oncol Biol Phys, 46(3): 671-9.##Zackrisson B, Arevärn M, Karlsson M (2000) Optimized MLC-beam arrangements for tangential breast irradiation. RadiotherOncol, 54(3): 209-12. ##Richmond ND, Turner RN, Dawes PJ, Lambert GD, Lawrence GP (2003) Evaluation of the dosimetric consequences of adding a single asymmetric or MLC shaped field to a tangential breast radiotherapy technique. RadiotherOncol, 67(2): 165-70.##Lee JW, Hong S, Choi KS, Kim YL, Park BM, Chung JB, et al. (2008) Performance evaluation of field-in-field technique for tangential breast irradiation. Japanese journal of clinical oncology, 38(2): 158-63.##Sasaoka M and Futami T (2011) Dosimetric evaluation of whole breast radiotherapy using field-in-field technique in early-stage breast cancer. Int J Clin Oncol, 16(3): 250-6.##Yavas G, Yavas C, Acar H (2012)Dosimetric comparison of whole breast radiotherapy using field in fieldand conformal radiotherapy techniques in early stage breast cancer. Int J Radiat Res, 10(3): 131-8.##Onal C, Sonmez A, Arslan G, Oymak E, Kotek A, Efe E, et al. (2012) Dosimetric comparison of the field-in-field technique and tangential wedged beams for breast irradiation. Japanese Journal of Radiology, 30(3): 218-26.##Sun LM, Meng FY, Yang TH, Tsao MJ (2014) Field-in-field plan does not improve the dosimetric outcome compared with the wedged beams plan for breast cancer radiotherapy. Medical Dosimetry, 39(1): 79-82## ##

Demonstration of bystander response in high dose technique of grid using theoretical calculation by linear quadratic model along with experimental investigations 2 2 Background: The Linear Quadratic (LQ) equation as the most common formula in radiotherapy has a debatable accuracy in modeling high-dose effects. The purpose of this study was to demonstrate bystander response of the Grid treatment in SCC cell line, based on both theoretical calculations and experimental investigations. Materials and methods: The linear quadratic model was used to calculate the equivalent uniform dose (EUD) of a Grid-field with the 10 Gy maximum doses. According to the EUD definition, the identical tumor survival fraction (SF) was expected to obtain from both Grid and open-field single fraction. After observing the difference, the clonogenic and apoptosis assays were exerted to investigate bystander response via medium transfer strategy which was performed from 10Gy-irradiated donors to 1.5Gy-irradiated recipients. Results: The EUD was equal to 4 Gy and the SF of 4 Gy EUD and 10 Gy Grid-field were 0.1 ± 0.02 and 0.051 ± 0.008, respectively. These findings contradicted the theoretical expectations of their survivals equality. Moreover, the bystander clonogenic cells death enhanced approximately by 2.91 times (statistically significant); highlighting the bystander response role. The apoptotic findings illustrated that the bystander cells experienced an approximately 10% increase and the apoptotic rate confirmed the clonogenic survival result which was less in the EUD than the Grid-field. Conclusion: Since the SF of the Grid-field was less than the EUD, it revealed the Grid therapeutic advantages plus bystander response manifestation; that was ignored in the LQ equation and may not be demonstrated by sheer theoretical calculations of the modulated-field. 495 504 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/2 1399/3/13 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/2 1399/3/13 F. Pakniyat F. Pakniyat Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran S. Gholami S. Gholami Radiation Oncology Research Center, Cancer institute, Tehran University of Medical Sciences, Tehran, Iran H.A. Nedaie H.A. Nedaie Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran nedaieha@sina.tums.ac.ir H. Mozdarani H. Mozdarani Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran mozdarah@modares.ac.ir A. Mahmoudzadeh A. Mahmoudzadeh Department of Bioscience and Biotechnology, Malek-Ashtar University of Technology, Tehran, Iran M. Salimi M. Salimi National Institute of Genetic Engineering and Biotechnology, Tehran, Iran Linear quadratic grid bystander clonogenic survival apoptosis. 1. Fowler JF (1989) The linear-quadratic formula and progress in fractionated radiotherapy. The British journal of radiology, 62(740): 679-94.##2. Brenner DJ (2008) The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Seminars in radiation oncology, 18(4): 234-239.##3. Kirkpatrick JP, Meyer JJ, Marks LB (2008) The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Seminars in radiation oncology, 18(4): 240-243.##4. Lea D, Lea D, Catcheside D, Catcheside D (1942) The mechanism of the induction by radiation of chromosome aberrations in Tradescantia. Journal of genetics, 44(02-03).##5. Asur R, Butterworth KT, Penagaricano JA, Prise KM, Griffin RJ (2015) High dose bystander effects in spatially fractionated radiation therapy. Cancer letters, 356(1): 52-7.##6. Peñagarícano JA, Moros EG, Ratanatharathorn V, Yan Y, Corry P (2010) Evaluation of spatially fractionated radiotherapy (GRID) and definitive chemoradiotherapy with curative intent for locally advanced squamous cell carcinoma of the head and neck: initial response rates and toxicity. International Journal of Radiation Oncology Biology Physics, 76(5): 1369-75.##7. Ha JK, Zhang G, Naqvi SA, Regine WF, Yu CX (2006) Feasibility of delivering grid therapy using a multileaf collimator. Medical physics, 33(1): 76-82.##8. Neuner G, Mohiuddin MM, Vander Walde N, Goloubeva O, Ha J, Cedric XY, et al. (2012) High-dose spatially fractionated GRID radiation therapy (SFGRT): a comparison of treatment outcomes with Cerrobend vs. MLC SFGRT. International Journal of Radiation Oncology Biology Physics, 82(5): 1642-9.##9. Billena, C., & Khan, A. J. (2019) A current review of spatial fractionation: Back to the future?. International Journal of Radiation Oncology Biology Physics, 104(1): 177-187.##10. Kanagavelu S, Gupta S, Wu X, Philip S, Wattenberg MM, Hodge JW, et al. (2014) In-vivo effects of lattice radiation therapy on local and distant lung cancer: potential role of immunomodulation. Radiation research, 182(2): 149-62.##11. Prasanna A, Ahmed MM, Mohiuddin M, Coleman CN (2014) Exploiting sensitization windows of opportunity in hyper and hypo-fractionated radiation therapy. Journal of thoracic disease, 6(4): 287-302. ##12. Nagasawa H and Little JB (1992) Induction of sister chromatid exchanges by extremely low doses of α-particles. Cancer research, 52(22): 6394-6.##13. Bromley R, Oliver L, Davey R, Harvie R, Baldock C (2008) Predicting the clonogenic survival of A549 cells after modulated X-ray irradiation using the linear quadratic model. Physics in Medicine & Biology, 54(2): 187.##14. Mackonis EC, Suchowerska N, Zhang M, Ebert M, McKenzie D, Jackson M (2007) Cellular response to modulated radiation fields. Physics in Medicine & Biology, 52(18): 5469.##15. Suchowerska N, Ebert MA, Zhang M, Jackson M (2005) In-vitro response of tumour cells to non-uniform irradiation. Physics in Medicine & Biology, 50(13): 3041.##16. Butterworth KT, McGarry CK, Trainor C, O’Sullivan JM, Hounsell AR, Prise KM (2011) Out-of-field cell survival following exposure to intensity-modulated radiation fields. International Journal of Radiation Oncology Biology Physics, 79(5): 1516-22.##17. Peng V, Suchowerska N, Rogers L, Claridge Mackonis E, Oakes S, McKenzie DR (2017) Grid therapy using high definition multileaf collimators: realizing benefits of the bystander effect. Acta oncologica, 56(8): 1048-59.##18. Gholami S, Nedaie HA, Longo F, Ay MR, Wright S, Meigooni AS (2016) Is grid therapy useful for all tumors and every grid block design? Journal of applied clinical medical physics, 17(2): 206-19.##19. Poh SS, Chua ML, Wee JT (2018) Why we should give spatially fractionated radiation therapy (GRID) a second look—especially in nasopharyngeal carcinoma. Annals of Nasopharynx Cancer, 2(4).##20. Gholami S, Nedaie HA, Longo F, Ay MR, Dini SA, Meigooni AS (2017) Grid block design based on monte carlo simulated dosimetry, the linear quadratic and Hug–Kellerer radiobiological models. Journal of medical physics, 42(4): 213.##21. Zhang D, Zhou T, He F, Rong Y, Lee SH, Wu S, et al (2016) Reactive oxygen species formation and bystander effects in gradient irradiation on human breast cancer cells. Oncotarget, 7(27): 41622.##22. Meigooni A, Parker S, Zheng J, Kalbaugh K, Regine W, Mohiuddin M (2002) Dosimetric characteristics with spatial fractionation using electron grid therapy. Medical Dosimetry, 27(1): 37-42.##23. Reiff JE, Huq MS, Mohiuddin M, Suntharalingam N (1995) Dosimetric properties of megavoltage grid therapy. International Journal of Radiation Oncology Biology Physics, 33(4): 937-42.##24. Buckey C, Stathakis S, Cashon K, Gutierrez A, Esquivel C, Shi C, et al. (2010) Evaluation of a commercially‐available block for spatially fractionated radiation therapy. Journal of applied clinical medical physics, 11(3): 2-11.##25. Zhang X, Penagaricano J, Yan Y, Sharma S, Griffin R, Hardee M, et al. (2016) Application of spatially fractionated radiation (GRID) to helical tomotherapy using a novel TOMOGRID template. Technology in cancer research & treatment, 15(1): 91-100.##26. Huhn JL, Regine WF, Valentino JP, Meigooni AS, Kudrimoti M, Mohiuddin M (2006) Spatially fractionated GRID radiation treatment of advanced neck disease associated with head and neck cancer. Technology in cancer research & treatment, 5(6): 607-12.##27. Mohiuddin M, Fujita M, Regine WF, Megooni AS, Ibbott GS, Ahmed MM (1999) High-dose spatially-fractionated radiation (GRID): a new paradigm in the management of advanced cancers. Int J Radiat Oncol Biol Phys, 45(3): 721-7.##28. Asur RS, Sharma S, Chang C-W, Penagaricano J, Kommuru IM, Moros EG, et al. (2012) Spatially fractionated radiation induces cytotoxicity and changes in gene expression in bystander and radiation adjacent murine carcinoma cells. Radiation research,177(6): 751-65.##29. Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, et al. 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Comparison of level-I, -II and -III dosimetry quality audits for MV-photon beams emitted from medical linear accelerators 2 2 Background: Dosimetry audits have an important role to safely deliver the prescribed radiation dose to the cancerous area.  It not only maintains and improve the treatment standards but also identify issues that are potentially harmful to the patients. This article presents the results of a comparative study of beam output measurements of a high-energy photon beam emitted from a medical linear accelerator. Materials and Methods: The measurements were performed by an International Atomic Energy Commission (IAEA) Quality Assurance/Quality Control survey mission (level-I dosimetry), a national Secondary Standard Dosimetry Laboratory (SSDL) experts (level-II dosimetry) and hospital physicists (level-III dosimetry). Glass dosimeters and cylindrical ionization chambers for level I and cylindrical ionization chambers for level-II and -III dosimetry were used in water by following IAEA TRS-398 protocol. Results: The level-I dosimetry results of glass dosimeters and ionization chambers were compared and percent deviations of -0.4 % and 0.3 % were found for 6 and 15 MV-photon beams, respectively. Similarly, level-II and -III dosimetry results with respect to level-I are in good agreement and within the optimum uncertainty level of ±5%. The annual level-II dosimetry quality audits (i.e., from 2010 to 2015) showed that only one dosimetry audit is out of the optimum level set for this study. However, it is within the tolerance level set for level-II quality audit programs (i.e., < ±5%). Conclusion: In conclusion, this article has demonstrated consistent radiotherapy radiation dosimetry results for MV-photons beams. It also showed quantitative information in-line with the currently achieved accuracy and precision of external megavoltage photon beam dosimetry. Furthermore, this study also established a baseline for current routine audits of radiotherapy dosimetry. Studies of this type are essential to appropriately follow the recommendations and procedures of the pertinent dosimetry protocols. 505 510 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/2 1399/3/13 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/2 1399/3/13 Kh. Masood Kh. Masood Institute of Nuclear Medicine and Oncology Lahore (INMOL), Lahore 54600, Pakistan A. Ullah A. Ullah Health Physics Division, Pinstech, Islamabad, Pakistan A. Hussain A. Hussain Radiation Oncology, Western Manitoba Cancer Centre, Brandon R7A 2B3, MB, Canada Kh. Mahmood Kh. Mahmood Health Physics Division, Pinstech, Islamabad, Pakistan G.R. Hart G.R. Hart Department of Therapeutic Radiology, Yale School of Medicine, Yale University New Haven, CT 06520-8040, USA W. Muhammad W. Muhammad Health Physics Division, Pinstech, Islamabad, Pakistan wazir.muhammad@yale.edu Radiotherapy level-I -II and -III radiation dosimetry on-site dosimetry tours quality audits. 1. Iżewska J, Georg D, Bera P, Thwaites D, Arib M, Saravi M, et al. (2007) A methodology for TLD postal dosimetry audit of high-energy radiotherapy photon beams in non-reference conditions. Radiotherapy and oncology, 84(1): 67-74.##2. Kron T, Hamilton C, Roff M, Denham J (2002) Dosimetric intercomparison for two Australasian clinical trials using an anthropomorphic phantom. Int J Radiat Oncol Bio Phys, 52(2):566-79.##3. Andreo P, Cunningham JR, Hohlfeld K, Svensson H (1987) Absorbed dose determination in photon and electron beams. An international Code of Practice.##4. Ebert M, Harrison K, Cornes D, Howlett S, Joseph D, Kron T, et al. (2009)Comprehensive Australasian multicentre dosimetric intercomparison: issues, logistics and recommendations. J Med Imaging and RadiatOncol, 53(1): 119-31.##5. Ebert M, Harrison K, Denham J, Howlett S, Cornes D, Hamilton C (2006) QA of conformal radiotherapy for multi-centre radiotherapy trials in Australasia.##6. Muhammad W, Hussain A, Ullah A (2016) EP-1502: Effects on dosimetric measurements due to difference in calibration and dosimetry protocols followed. Radiotherapy & Oncology, 119(1): S694.##7. Muhammad W, Ullah A, Khan G, Khan TZ, Jamaal T, Ullah F, et al. (2018)Variation in patient dose due to differences in calibration and dosimetry protocols. Nuclear Science and Techniques, 29(5): 296603-66.##8. Muhammad W, Ullah A, Mahmood K, Matiullah (2016) Assessment of national dosimetry quality audits results for teletherapy machines from 1989 to 2015. J Appl Clinic Med Phys, 17(2): 145-52.##9. Amies C, Rose A, Metcalfe P, Barton M (1996) Multicentre dosimetry study of mantle treatment in Australia and New Zealand. Radiotherapy and oncology, 40(2): 171-80.##10. Delaney G, Beckham W, Veness M, Ahern V, Back M, Boyages J, et al. (2000) Three-dimensional dose distribution of tangential breast irradiation: results of a multicentre phantom dosimetry study. Radiotherapy and oncology, 57(1): 61-8.##11. Kron T, Barnes K, O'Brien P (2003) Multicentre dosimetric comparison of photon‐junctioning techniques in head and neck radiotherapy. Australasian radiology, 47(3): 289-94.##12. Bentzen S, Bernier J, Davis J, Horiot J, Garavaglia G, Chavaudra J, et al. (2000) Clinical impact of dosimetry quality assurance programmes assessed by radiobiological modelling of data from the thermoluminescent dosimetry study of the European Organization for Research and Treatment of Cancer. Euro J Cancer, 36(5): 615-20.##13. Gajewski R, Gwiazdowska B, Kania M, Rostkowska J (1995) TLD postal dose intercomparison for megavoltage units in Poland. Radiotherapy and oncology, 36(2): 143-52.##14. Izewska J, Andreo P, Vatnitsky S, Shortt KR (2003) The IAEA/WHO TLD postal dose quality audits for radiotherapy: a perspective of dosimetry practices at hospitals in developing countries. Radiotherapy and oncology, 69(1): 91-7.##15. Izewska Je, Bera P, Vatnitsky S (2002) IAEA/WHO TLD postal dose audit service and high precision measurements for radiotherapy level dosimetry. Radiat prot dosi, 101(1-4): 387-92.##16. Svensson H, Hanson G, Zsdénszky K (1990) The IAEA/WHO TL dosimetry service for radiotherapy centres 1969–1987. Acta Oncologica, 29(4): 461-7.##17. Ferreira IH, Dutreix A, Bridier A, Chavaudra J, Svensson H (2000) The ESTRO-QUALity assurance network (EQUAL). Radiotherapy and oncology, 55(3): 273-84.##18. Hansson U, Johansson K, Horiot J, Bernier J (1993) Mailed TL dosimetry programme for machine output check and clinical application in the EORTC radiotherapy group. Radiotherapy and oncology, 29(2): 85-90.##19. Roue A, Van Dam J, Dutreix A, Svensson H (2004) [The EQUAL-ESTRO external quality control laboratory in France]. Cancer radiotherapie: Journal de la Societe francaise de radiotherapie oncologique, 8: S44-9.##20. Ebert MA, Howlett S, Harrison K, Cornes D, Hamilton C, Denham J (2008) Linear-accelerator X-ray output: a multicentre chamber-based intercomparison study in Australia and New Zealand. Australasian Physics & Engineering Sciences in Medicine, 31(4): 268-79.##21. Nisbet A and Thwaites DA (1997) Dosimetric intercomparison of electron beams in UK radiotherapy centres. Physics in medicine and biology, 42(12): 2393.##22. Nisbet A, Thwaites DI, Sheridan ME (1998) A dosimetric intercomparison of kilovoltage X-rays, megavoltage photons and electrons in the Republic of Ireland. Radiotherapy and oncology, 48(1): 95-102.##23. Thwaites D, Williams J, Aird E, Klevenhagen S, Williams PC (1992) A dosimetric intercomparison of megavoltage photon beams in UK radiotherapy centres. Physics in Medicine and Biology, 37(2): 445.##24. Venables K (2006) The national trials QA centre. Who are we, what we do, and how we can help you. Scope, 15: 10-5.##25. Musolino SV (2001) Absorbed dose determination in external beam radiotherapy: An international code of practice for dosimetry based on standards of absorbed dose to water; technical reports series No. 398. LWW.##26. Followill DS, Tailor RC, Tello VM, Hanson WF (1998) An empirical relationship for determining photon beam quality in TG-21 from a ratio of percent depth doses. Medical Physics, 25(7): 1202-5.##27. Aguirre J, Tailor R, Ibbott G, Stovall M, Hanson W, et al. (2002) Thermoluminescence dosimetry as a tool for the remote verification of output for radiotherapy beams: 25 years of experience. Proceedings of the International Symposium on Standards and Codes of Practice in Medical Radiation Dosimetry IAEA-CN-96/82, Vienna: IAEA.##28. Al-Mokhlef JM and Noori N (2003) Quality assurance study for dosimetry of radiation therapy equipment in Saudi Arabia. Annals of Saudi Medicine, 23(3/4): 148-51.##29. Butler D, Palmans H, Webb D (2005) Shift in absorbed dose for megavoltage photons when changing to TRS-398 in Australia. Australasian Physics & Engineering Sciences in Medicine, 28(3): 159-64.##30. Davis B and Faessler P (1993) Quality audit of megavoltage radiotherapy units: intercomparison of dose at a reference point using a mailed TL-dosimetry system. Radiotherapy and oncology, 28(1): 79-81.##31. Dutreix A, Derreumaux S, Chavaudra J, van der Schueren E (1995) Quality control of radiotherapy centres in Europe: Beam calibration. Medical Dosimetry, 20(1): 68.##32. Huntley R and Nette H (1992) International Atomic Energy Agency/World Health Organization TLD radiotherapy dosimetry intercomparison.##33. Kroutilı́ková D, Novotný J, Judas L (2003) Thermoluminescent dosimeters (TLD) quality assurance network in the Czech Republic. Radiotherapy and oncology, 66(2): 235-44.##34. Millar M, Cramb J, Das R, Ackerly T, Brown G, Webb D (1997) Recommendations for the safe use of external beams and sealed brachytherapy sources in radiation oncology.##35. Schiefer H, Seelentag W, Stucki G, et al. (2001) Ein nationaler Dosimetrievergleich durch Postversand von TLDs. Proceedings of the SGSMP Scientific meeting in Sion.##36. Wittkämper F, Mijnheer B, Van Kleffens H (1987) Dose intercomparison at the radiotherapy centres in The Netherlands. 1. Photon beams under reference conditions and for prostatic cancer treatment. Radiotherapy and oncology, 9(1): 33-44.##37. Castro P, García-Vicente F, Mínguez C, Floriano A, Sevillano D, Pérez L, et al. (2008) Study of the uncertainty in the determination of the absorbed dose to water during external beam radiotherapy calibration. J Appl Clinic Medical Phys, 9(1): 70-86.##38. Clark CH, Aird EG, Bolton S, Miles EA, Nisbet A, Snaith JA, et al. (2015) Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials. The British journal of radiology, 88(1055): 20150251.##39. Kron T, Haworth A, Williams I, et al. (2013) Dosimetry for audit and clinical trials: challenges and requirements. Journal of Physics: Conference Series; IOP Publishing.##40. IAEA (2007) On-site Visits to Radiotherapy Centres: Medical Physics Procedures. International Atomic Energy Agency 2007 Contract No.: IAEA-TECDOC-1543.##41. Thwaites DI (2010) The significance and impact of dosimetry audits in radiotherapy.## ##

Patient radiation dosimetry during interventional cardiac procedures 2 2 Background: Cardiac catheterization plays an essential role in the evaluation of suspected heart failure patients. This work aimed to determine the mean effective dose of patients undergoing catheterization tests and to estimate the associated radiation risk of malignancy. Material and Methods: Measurements were performed during 65 coronary angiographies (CA), 70 coronary angioplasties (PTCA) 27, radio fluoroscopy (RF) ablations and 25 electro physiologies procedures in a dedicated laboratory. The procedures were undertaken with the Siemens and General Electric X-ray equipment. A dose area product (DAP) meter was also used. The DAP values and fluoroscopy times were recorded for each patient. Results: The mean DAP values and patient effective doses were 19.53 Gy.cm2 and 1.71 mSv for CA, 49.74 Gy.cm2 and 4.57 mSv for PTCA, 153.34 Gy.cm2 and 16.38 mSv for ablations and 14.88 Gy.cm2 and 1.65 mSv for electrophysiology, respectively. The patient radiation risk was estimated at 13, 1.3, 1.3, 3.6 fatal cancer per 10000 procedures of ablations, electrophysiology, CA and PTCA cases, respectively. Conclusion: Results showed that the radiation risk due to RF cardiac ablation is higher than the other complication procedures so, efforts should be made to minimize patient radiation risk from RF ablation procedures. Also we found no clear correlation between cardiologist level of experience and reduced level of patient’s dose. 511 519 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/2 1399/3/13 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/2 1399/3/13 F. Omidvar F. Omidvar Department of Medical Physics, Shahid Sadoughi University of Medical Science, Yazd, Iran F. Bouzarjomehri F. Bouzarjomehri Department of Medical Physics, Shahid Sadoughi University of Medical Science, Yazd, Iran f.bouzarj@gmail.com F. Falahati F. Falahati Department of Medical Physics, Shahid Sadoughi University of Medical Science, Yazd, Iran M.H. Zare M.H. 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Radiography, 26(2): e25-e30.##21. Radiation UNscoteoa (1996) UNSCEAR. Report to the General Assembly, with Scientific Annexes. United Nations.##22. Vassileva J, Vano E, Ubeda C, Rehani M, Zotova R (2013) Impact of the X-ray system setting on patient dose and image quality; a case study with two interventional cardiology systems. Radiat Prot Dosim, 155(3): 329-334.##23. Vano E, Sanchez R, Fernandez J, Gallego J, Verdu J, de Garay MG, et al. (2009) Patient dose reference levels for interventional radiology: a national approach. Cardiovasc Intervent Radiol, 32(1): 19-24.##24. Picano E, Santoro G, Vano E (2007) Sustainability in the cardiac cath lab. Int J Cardiovasc Imaging, 23(2): 143-147.##25. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation, 116(11): 1290-1305.##26. Picano E (2004) Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. Bmj, 329(7470): 849-851.##27. Stratis AI, Anthopoulos PL, Gavaliatsis IP, Ifantis GP, Salahas AI, Antonellis IP, et al. (2009) Patient dose in cardiac radiology. Hellenic J Cardiol, 50(1): 17-25.##28. Livingstone RS, Chase D, Varghese A, George PV, George OK (2015) Transition from image intensifier to flat panel detector in interventional cardiology: impact of radiation dose. J Med Phys, 40(1): 24.##29. McGain F, Cox NR, Cecchin SS, McAlister S, Barach PR (2012) Sustainable cardiac services—From the catheterization laboratory to the operating room and beyond. Pediatr Cardiol, 33(1): 81-84.##30. Curry TS, Dowdey JE, Murry RC (1990) Christensen's physics of diagnostic radiology. Lippincott Williams & Wilkins.##31. Bouzarjomehri F and Tsapaki V (2009) Patient dose values during interventional cardiology examinations in Yazd hospital, Iran. Int J Radiat Res, 6(4): 167.##32. Miller DL, Vañó E, Bartal G, Balter S, Dixon R, Padovani R, et al. (2010) Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. CardioVasc Interv Radiol, 2010. 33(2): 230-239.##33. Padovani R, Vano E, Trianni A, Bokou C, Bosmans H, Bor D, et al. (2008) Reference levels at European level for cardiac interventional procedures. Radiat Prot Dosim, 129(1-3): 104-107.##34. Bahreyni Toossi M, Zare H, Bayani S, Esmaili S (2007) Organ and effective doses of patients arising from coronary angiography and percutaneous transluminal coronary angioplasty at two hospitals in Mashhad-Iran. Radiat Prot Dosim, 128(3): 363-366.##35. Lobotessi H, Karoussou A, Neofotistou V, Louisu A, Tsapaki V (2001) Effective dose to a patient undergoing coronary angiography. Radiat Prot Dosim, 94(1-2): 173-176.##36. Tsapaki V, Kottou S, Vano E, Faulkner K, Giannouleas J, Padovani R, et al. (2003) Patient dose values in a dedicated Greek cardiac centre. Br J Radiol, 76(910): 726-730.##37. Mercuri M, Mehta S, Xie C, Valettas N, Velianou JL, Natarajan MK (2011) Radial artery access as a predictor of increased radiation exposure during a diagnostic cardiac catheterization procedure. JACC Cardiovasc Interv, 4(3): 347-352.##38. Scott-Moncrieff A, Yang J, Levine D, Taylor C, Tso D, Johnson M, et al. (2011) Real-world estimated effective radiation doses from commonly used cardiac testing and procedural modalities. Can J Cardiol, 27(5): 613-618.##39. Reay J, Chapple C, Kotre C (2003) Is patient size important in dose determination and optimization in cardiology? Radiat Prot Dosim, 48(23): 3843.##40. Hirshfeld JW, Balter S, Brinker JA, Kern MJ, Klein LW, Lindsay BD, et al. (2004) ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol, 44(11): 2259-2282.##41. Børretzen I, Lysdahl KB, Olerud HM (2007) Diagnostic radiology in Norway—trends in examination frequency and collective effective dose. Radiat Prot Dosim, 124(4): 339-347.##42. Bouzarjomehri F and Tsapaki V (2010) Evaluation of cancer risk of the patients undergoing coronary angiography in Yazd, Iran. Int J Radiat Res, 8(3): 161.##43. Bouzarjomehri F, Zare MH, Shahbazi-Gahrouei D (2006) Patient dose resulting from CT examinations in Yazd, Iran. Int J Radiat Res, 4(3): 121-127.##44. Abdelaal E, Plourde G, MacHaalany J, Arsenault J, Rimac G, Déry JP, et al. (2014) Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions. JACC Cardiovasc Interv, 7(5): 567-574.##45. Tsapaki V, Patsilinakos S, Voudris V, Magginas A, Pavlidis S, Maounis T, et al. (2008) Level of patient and operator dose in the largest cardiac centre in Greece. Radiat Prot Dosim, 129(1-3): 71-73.##46. Efstathopoulos EP, Katritsis DG, Kottou S, Kalivas N, Tzanalaridou E, Giazitzoglou E, et al. (2006) Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis. Europace, 8(6): 443-448.##47. McFadden S, Mooney R, Shepherd P (2002) X-ray dose and associated risks from radiofrequency catheter ablation procedures. Br J Radiol, 75(891): 253-265.## ##

Effect of dose grid resolution on the results of patient-specific quality assurance for intensity-modulated radiation therapy and volumetric modulated arc therapy 2 2 Background: This study aims to investigate the effect of reference dose calculation grid size (RDCGS) on gamma passing rate (GPR) for patient-specific quality assurance of intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). Materials and Methods: A total of 20 patients were retrospectively selected. Both IMRT and VMAT plans were generated for each patient. Reference dose distributions for gamma analysis were calculated with RDCGS of 1–5 mm at intervals of 1 mm. Dose distributions were measured using MapCHECK2 and ArcCHECK dosimeters. Both global and local gamma analyses with gamma criteria of 3%/3 mm, 2%/3 mm, 2%/2 mm, and 2%/1 mm were performed with various RDCGS. Results: As the RDCGS increased from 1 mm to 5 mm, the average global GPRs with 2%/2 mm for VMAT with MapCHECK2 and ArcCHECK decreased by 9.3% and 5.9%, respectively. The average local GPRs decreased by 14% and 11.7%, respectively. For IMRT, the global GPRs decreased by 4.8% and 6%, respectively, whereas the local GPRs decreased by 10.5% and 8.6%, respectively. The effect of the RDCGS on the GPRs became larger when performing local gamma analysis as well as when applying small distance-to-agreement (DTA). As the RDCGS increased, the average changes in the GPR per mm of DTA change increased regardless of the type of radiotherapy, detector, or gamma analysis. Conclusion: For an accurate verification of the IMRT and VMAT plans, it is recommended that the reference dose distribution must be calculated with the smallest possible RDCGS. 521 530 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/2 1399/3/13 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/2 1399/3/13 M. Chun M. Chun Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea J.I. Kim J.I. Kim Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea D.H. Oh D.H. Oh Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea; H.G. Wu H.G. Wu Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea J.M. Park J.M. Park Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea leodavinci@naver.com Dose calculation grid gamma analysis intensity-modulated radiation therapy patient-specific QA volumetric modulated arc therapy. 1. Bhardwaj AK, Kehwar TS, Chakarvarti SK, Oinam AS, Sharma SC (2007) 3-Dimensional conformal radiotherapy versus intensity modulated radiotherapy for localized prostate cancer: Dosimetric and radiobiologic analysis. Int J Radiat Res, 5(1): 1-8.##2. Brahme A (1988) Optimization of stationary and moving beam radiation therapy techniques. Radiother Oncol, 12(2): 129-140.##3. Otto K (2008) Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys, 35(1):310–317.##4. Koksal C, Kesen ND, Akbas U, Kalafat U, Ozkaya K, Okutan M, et al. (2017) Dosimetric comparison of 3-dimensional conformal and intensity-modulated radiotherapy techniques for whole breast irradiation in the prone and supine positions. Int J Radiat Res, 15(4): 353-362.##5. Goldman SP, Chen JZ, Battista JJ (2005) Feasibility of a fast inverse dose optimization algorithm for IMRT via matrix inversion without negative beamlet intensities. Med Phys, 32(9): 3007-3016.##6. Lougovski P, LeNoach J, Zhu L, Ma Y, Censor Y, Xing L (2010) Toward truly optimal IMRT dose distribution: inverse planning with voxel-specific penalty. Technol Cancer Res Treat, 9(6): 629-636.##7. Ezzell GA, Burmeister JW, Dogan N, LoSasso TJ, Mechalakos JG, Mihailidis D, et al. (2009) IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Med Phys, 36(11): 5359-5373.##8. Park JM, Park SY, Kim H (2015) Modulation index for VMAT considering both mechanical and dose calculation uncertainties. Phys Med Biol, 60(18): 7101-7125.##9. Esmaili G, Mahdavi S, Nikoofar A, Fadavi P, Ameri A, Nazari V (2018) Dosimetric verification of pre-treatment intensity modulated radiation therapy in the commissioning process. Int J Radiat Res, 16(4): 493-497.##10. Won H, Chung J, Eom KY, Hwang D, Kang S, Suh T (2018) Feasibility study of multi-purpose quality assurance phantom for pretreatment verification of volumetric modulated arc therapy. Int J Radiat Res, 16(3): 279-287.##11. Firouzjah RA, Nickfarjam A, Bakhshandeh M, Farhood B (2019) The use of EBT3 film and Delta4 for the dosimetric verification of EclipseTM treatment planning system in a heterogeneous chest phantom: an IMRT technique. Int J Radiat Res, 17(2): 355-361.##12. Low DA, Harms WB, Mutic S, Purdy JA (1998) A technique for the quantitative evaluation of dose distributions. Med Phys, 25(5): 656–661.##13. Fredh A, Scherman JB, Fog LS, Munck af Rosenschold P (2013) Patient QA systems for rotational radiation therapy: a comparative experimental study with intentional errors. Med Phys, 40(3): 031716.##14. Heilemann G, Poppe B, Laub W (2013) On the sensitivity of common gamma-index evaluation methods to MLC misalignments in Rapidarc quality assurance. Med Phys, 40(3): 031702.##15. Kim JI, Park SY, Kim HJ, Kim JH, Ye SJ, Park JM (2014) The sensitivity of gamma-index method to the positioning errors of high-definition MLC in patient-specific VMAT QA for SBRT. Radiat Oncol, 9: 167.##16. Kim JI, Choi CH, Wu HG, Kim JH, Kim K, Park JM (2017) Correlation analysis between 2D and quasi-3D gamma evaluations for both intensity-modulated radiation therapy and volumetric modulated arc therapy. Oncotarget, 8(3): 5449-5459.##17. Park JM, Wu HG, Kim JH, Carlson JN, Kim K (2015) The effect of MLC speed and acceleration on the plan delivery accuracy of VMAT. Br J Radiol: 20140698.##18. Park SY, Park JM, Kim JI, Kim H, Kim IH, Ye SJ (2015) Textural feature calculated from segmental fluences as a modulation index for VMAT. Phys Med, 31(8): 981-990.##19. Huang JY, Pulliam KB, McKenzie EM, Followill DS, Kry SF (2014) Effects of spatial resolution and noise on gamma analysis for IMRT QA. J Appl Clin Med Phys, 15(4): 93-104.##20. Tanooka M, Doi H, Miura H, Inoue H, Niwa Y, Takada Y, et al. (2013) Three-dimensional radiochromic film dosimetry for volumetric modulated arc therapy using a spiral water phantom. J Radiat Res, 54(6): 1153-1159.##21. Shang Q, Godley A, Huang L, Qi P, Xia P (2017) Sensitivity of array detector measurements in determining shifts of MLC leaf positions. J Appl Clin Med Phys, 18(5): 80-88.##22. Almond PR, Biggs PJ, Coursey BM, Hanson WF, Huq MS, Nath R, et al. (1999) AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. Med Phys, 26(9): 1847-1870.##23. Low DA and Dempsey JF (2003) Evaluation of the gamma dose distribution comparison method. Med Phys, 30(9): 2455-2464.##24. Pan Y, Yang R, Zhang S, Li J, Dai J, Wang J, et al. (2019) National survey of patient specific IMRT quality assurance in China. Radiat Oncol, 14(1): 69.## ##

Oral cavity cancers treated with superselective intra-arterial chemoradiotherapy with radiation doses less than 60 Gy: implications for dose reduction from a propensity score-matched analysis 2 2 Background: The optimal radiation dose for oral cavity cancers treated with retrograde superselective intra-arterial chemoradiotherapy (SIACRT) is unclear. The aim of the present study was to evaluate the treatment outcome and toxicity in patients treated with <60 Gy compared with those treated with ≥60 Gy to provide evidence for determining the optimal dose. Materials and Methods: Between January 2009 and December 2013, 159 oral cavity cancer patients were treated with SIACRT with curative intent at a single institution. One hundred and twenty-nine patients received ≥60 Gy and 30 received <60 Gy. Local control (LC), disease-free survival (DFS), overall survival (OS), and toxicity were compared. Propensity score matching was performed to reduce bias. Results: The median follow-up period was 48 months (range, 2–88 months). LC (<60 Gy vs. ≥60 Gy, 81.5% vs. 86.1% at 3 years, p = 0.534), DFS (68.8% vs. 72.4% at 3 years, p = 0.816), and OS (85.9% vs. 72.3% at 3 years, p = 0.132) were comparable between the two groups. There was also no difference in toxicity. However, the median overall treatment period was significantly shorter in the <60 Gy cohort (39 days vs. 49 days, p < 0.0001). Conclusion: The radiation dose may be reduced to <60 Gy when treating oral cavity cancers with SIACRT. 531 538 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/10 1399/3/21 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/10 1399/3/21 H. Kaizu H. Kaizu Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan hkaizu1980@ybb.ne.jp M. Hata M. Hata Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan K. Mitsudo K. Mitsudo Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan Y. Hayashi Y. Hayashi Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan E. Ito E. Ito Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan M. Sugiura M. Sugiura Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan S. Takano S. Takano Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan Y. Mukai Y. Mukai Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan I. Koike I. Koike Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan T. Koizumi T. Koizumi Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan Catheterization chemoradiotherapy oral cancer survival rate toxicity. 1. Montero PH and Patel SG (2015) Cancer of the oral cavity. Surg Oncol Clin N Am, 24: 491-508.##2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin, 61: 69-90. ##3. NCCN Clinical Practice Guidelines in Oncology, National Comprehensive Cancer Network.accessed Sep 19 2017. Available from: http://www.nccn.org/professionals/.##4. Doweck I, Robbins KT, Samant S, Vieira F (2008) Intra-arterial chemoradiation for T3-4 oral cavity cancer: treatment outcomes in comparison to oropharyngeal and hypopharyngeal carcinoma. World J Surg Oncol, 6: 2. ##5. Mitsudo K, Koizumi T, Iida M, Iwai T, Nakashima H, Oguri S, Kioi M, Hirota M, Koike I, Hata M, Tohnai I (2014) Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: analysis of therapeutic results in 112 cases. Radiother Oncol, 111: 306-310.##6. Sobin LH, Gospodarowicz MK, Wittekind CH (2009) International Union Against Cancer (UICC) TNM Classification of Malignant Tumours, 7th edition. Wiley–Blackwell, Oxford. ##7. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 45: 228-247.##8. NCI Common Terminology Criteria for Adverse Events v4.0 (CTCAE), National Cancer Institute. Accessed Jul 17 2017. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.##9. Shah JP and Gil Z (2009) Current concepts in management of oral cancer – surgery. Oral Oncol, 45: 394-401.##10. Chan AK, Huang SH, Le LW, Yu E, Dawson LA, Kim JJ, Cho BC, Bayley AJ, Ringash J, Goldstein D, Chan K, Waldron J, O'Sullivan B, Cummings B, Hope AJ (2013) Postoperative intensity-modulated radiotherapy following surgery for oral cavity squamous cell carcinoma: patterns of failure. Oral Oncol, 49: 255-260.##11. Vermorken JB, Herbst RS, Leon X, Amellal N, Baselga J (2008) Overview of the efficacy of cetuximab in recurrent and/or metastatic squamous cell carcinoma of the head and neck in patients who previously failed platinum-based therapies. Cancer, 112: 2710-2719.##12. Hellman S and Weichselbaum RR (1995) Oligometastases. J Clin Oncol, 13: 8-10.##13. Otter S, Schick U, Gulliford S, Lal P, Franceschini D, Newbold K, Nutting C, Harrington K, Bhide S (2015) Evaluation of the risk of grade 3 oral and pharyngeal dysphagia using atlas-based method and multivariate analyses of individual patient dose distributions. Int J Radiat Oncol Biol Phys, 93: 507-515.##14. Shankar A, Roy S, Bhandari M, Rath GK, Biswas AS, Kanodia R, Adhikari N, Sachan R (2017) Current trends in management of oral mucositis in cancer treatment. Asian Pac J Cancer Prev, 18: 2019-2026. ##15. Yahya S, Benghiat H, Nightingale P, Tiffany M, Sanghera P, Hartley A (2016) Does dose to an oral mucosa organ at risk predict the duration of grade 3 mucositis after intensity-modulated radiotherapy for oropharyngeal cancer? Clin Oncol (R Coll Radiol), 28: e216-219.##16. Mendenhall WM (2004) Mandibular osteoradionecrosis. J Clin Oncol, 22: 4867-4868.##17. Tsai CJ, Hofstede TM, Sturgis EM, Garden AS, Lindberg ME, Wei Q,  Tucker SL, Dong L (2013) Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys, 85: 415-420.##18. Ahmed M, Hansen VN, Harrington KJ, Nutting CM (2009) Reducing the risk of xerostomia and mandibular osteoradionecrosis: the potential benefits of intensity modulated radiotherapy in advanced oral cavity carcinoma. Med Dosim, 34: 217-224.##19. Clarke A (1996) Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change. Qual Health Care, 5: 172-179.##20. Lagoe RJ, Westert GP, Kendrick K, Morreale G, Mnich S (2005) Managing hospital length of stay reduction: a multihospital approach. Health Care Manage Rev, 30: 82-92.## ##

Development of radiolabeled dextran coated iron oxide nanoparticles with 111-In and its biodistribution studies 2 2 Background: The main aim of this study is to radiolabel dextran coated iron oxide nanoparticles (NPs) (with 80 nm hydrodynamic size) with the Indium-111 and evaluation their biodistribution after intravenous injection normal mice. Materials and Method: The chelator Diethylenetriamine Pentaacetic Acid (DTPA) dianhydride was conjugated to SPION using a small modification of the well-known cyclic anhydride method at a ratio of 1:5 (NPs:DTPA) molar ratio. The reaction was purified with magnetic assorting columns (MACs) using high gradient magnetic field following incubation. Then the radiochemical purity of the radiolabeled NPs were determined using RTLC method. The magnetic properties of nanoparticles were measured by a 1.5 tesla clinical human MRI. Results: The NPs showed high super paramagnetic properties whereas their r2/r1 was 17.6. The RTLC showed that the purity of compound was above 99% after purification and the compound has shown a good in-vitro stability until 6 hours in the presence of human serum. The biodistribution of 111In-DTPA-NPs in mice demonstrated high uptake in the reticuloendothelial system (RES) and the blood clearance was so fast. Conclusion: Due to magnificent uptakes of this radiotracer in the liver and spleen, its stability and their fast clearance from other tissues, especially in blood, it is suggested that this radiotracer would be suitable for RES theranostics purposes. 539 547 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/14 1399/3/25 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/14 1399/3/25 S.H. Mousavie Anijdan S.H. Mousavie Anijdan Department of Medical Physics, Babol University of Medical Sciences, Babol, Iran A. Gholami A. Gholami Department of Nuclear Medicine, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran A. Lahooti A. Lahooti Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical sciences, Tehran, Iran lahootia@razi.tums.ac.ir Dextran-coated superparamagnetic iron oxide 111In radioisotope biodistribution theranostics reticuloendothelial system radiopharmaceuticals. 1. Najafian N, Shanehsazzadeh S, Hajesmaeelzadeh F, Lahooti A, Gruettner C, Oghabian MA (2015) Effect of Functional Group and Surface Charge of PEG and Dextran-Coated USPIO as a Contrast Agent in MRI on Relaxivity Constant. Appl Magn Reson, 46: 685-92. ##2. Shanehsazzadeh S, Lahooti A, Hajipour MJ, Ghavami M, Azhdarzadeh M (2015) External magnetic fields affect the biological impacts of superparamagnetic iron nanoparticles. Colloids Surf B Biointerfaces, 136: 1107-12. ##3. Oghabian MA, Gharehaghaji N, Masoudi A, Shanehsazzadeh S, Ahmadi R, Majidi RF, et al. (2013) Effect of coating materials on lymph nodes detection using magnetite nanoparticles. Adv Sci Eng Med, 5: 37-45. ##4. Laurent S, Saei AA, Behzadi S, Panahifar A, Mahmoudi M (2014) Superparamagnetic iron oxide nanoparticles for delivery of therapeutic agents: opportunities and challenges. Expert Opin Drug Deliv, 11: 1449-70. ##5. Mousavie Anijdan SH, Shirazi A, Mahdavi SR, Ezzati A, Mofid B, Khoei S, et al. (2012) Megavoltage dose enhancement of gold nanoparticles for different geometric set-ups: Measurements and Monte Carlo simulation. Int J Radiat Res, 10(3): 183-6. ##6. Shanehsazzadeh S, Oghabian MA, Allen BJ, Amanlou M, Masoudi A, Johari Daha F (2013) Evaluating the effect of ultrasmall superparamagnetic iron oxide nanoparticles for a long-term magnetic cell labeling. J Med Phys, 38: 34-40. ##7. Hajesmaeelzadeh F, Shanehsazzadeh S, Grüttner C, Johari Daha F, Oghabian MA (2016) Effect of coating thickness of iron oxide nanoparticles on their relaxivity in the MRI. Iran J Basic Med Sci, 19: 166-71. ##8. Lahooti A, Sarkar S, Laurent S, Shanehsazzadeh S (2016) Dual nano-sized contrast agents in PET/MRI: a systematic review. Contrast Media Mol Imaging, 11: 428-47. ##9. Lederer CM, Hollander JM, Perlman I (1967) Table of isotopes. John Wiley & Sons Inc. ##10. Fazaeli Y, Shanehsazzadeh S, Lahooti A, Feizi S, Jalilian AR (2016) Preclinical dosimetric estimation of [111In] 5, 10, 15, 20-tetra phenyl porphyrin complex as a possible imaging/PDT agent. Radiochim Acta 104: 327–36. ##11. Lahooti A, Shanehsazzadeh S, Jalilian AR, Tavakoli MB (2013) Assessment of effective absorbed dose of 111In-DTPA-Buserelin in human on the basis of biodistribution rat data. Radiat Prot Dosim, 154: 1-8. ##12. Jalilian AR, Sardari D, Kia L, Rowshanfarzad P, Garousi J, Akhlaghi M, et al. (2008) Preparation, quality control and biodistribution studies of two [111In]-rituximab immunoconjugates. Scientia Pharmaceutica, 76(2): 151-70. ##13. National Institutes of Health (1985) Guide for the care and use of laboratory animals. NIH Publication, 85-123. ##14. Omid H, Oghabian MA, Ahmadi R, Shahbazi N, Hosseini HR, Shanehsazzadeh S, et al. (2014) Synthesizing and staining manganese oxide nanoparticles for cytotoxicity and cellular uptake investigation. Biochim Biophys Acta, 1840(1): 428-33. ##15. Hatamie S, Ahadian MM, Ghiass MA, Iraji Zad A, Saber R, Parseh B, et al. (2016) Graphene/cobalt nanocarrier for hyperthermia therapy and MRI diagnosis. Colloids Surf B Biointerfaces, 146: 271-9. ##16. Jahanbakhsh R, Atyabi F, Shanehsazzadeh S, Sobhani Z, Adeli M, Dinarvand R (2013) Modified Gadonanotubes as a promising novel MRI contrasting agent. Daru, 21: 53-62. ##17. Sahnehszzadeh S and Jalilian A (2009) Development of [67ga]-Dtpa-Gonadorelin in Normal Rats. J Label Compd Rad, 52: S326. ##18. Jalilian AR, Shanehsazzadeh S, Akhlaghi M, Garousi J, Rajabifar S, Tavakoli M (2008) Preparation and biodistribution of [67Ga]-DTPA-gonadorelin in normal rats. J Radioanal Nucl Ch, 278: 123-9. ##19. Shanehsazzadeh S, Oghabian MA, Lahooti A, Abdollahi M, Haeri SA, Amanlou M et al. (2013) Estimated background doses of [67Ga]-DTPA-USPIO in normal Balb/c mice as a potential therapeutic agent for liver and spleen cancers. Nucl Med Commun, 34: 915-25. ##20. Jalilian AR, Shanehsazzadeh S, Akhlaghi M, Kamali-dehghan M, Moradkhani S (2010) Development of [111In]- DTPA-buserelin for GnRH receptor studies. Radiochim Acta, 98: 113-9. ##21. Nosrati S, Shanehsazzadeh S, Yousefnia H, Gholami A, Grüttner C, Jalilian AR, et al. (2016) Biodistribution evaluation of 166Ho–DTPA–SPION in normal rats. J Radioanal Nucl Ch, 307: 1559-66. ##22. 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Radiosensitization of [Ru(bpy)2(phen)]Cl2 on nasopharyngeal carcinoma cells 2 2 Background: To investigate effect of radiosensitization of [Ru(bpy)2(phen)]Cl2 complex on nasopharyngeal carcinoma cell line CNE1 and its mechanism. Materials and Methods: Nasopharyngeal carcinoma cell line CNE1 in vitro culture was divided into control group, light irradiation group (4 Gy, 6 MV photonic line), simple metal ruthenium complex treatment group (Ru group, 100 μmol/L [Ru(bpy)2(phen)]Cl2) and metal ruthenium complex combined with radiotherapy group (Combined radiotherapy group, cells were irradiated with 4 Gy and 6 MV photons at 2 days after 100 μmol/L [Ru(bpy)2(phen)]Cl2). Results: Transcriptional level of P53 gene in combined radiotherapy group was higher than that in the other groups (P<0.001). Inhibition rate of combined radiotherapy group was higher than that of Ru group and irradiation group (P<0.001). Apoptotic rate was the highest (P<0.05) in the combined radiotherapy group, and irradiation group was higher than Ru group and control group (P<0.05). Survival rate of Ru group was lower than that of control group under the same radiation dose (P<0.05), and the radiotherapy sensitization ratio was 1.227 (Dq ratio). Conclusion: [Ru(bpy)2(phen)]Cl2 increases the sensitivity of nasopharyngeal carcinoma cell line CNE1 to X-ray, which may be related to increase of P53 gene expression. 549 555 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/14 1399/3/25 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/14 1399/3/25 J. Chen J. Chen Department of Radiotherapy, Fujian Medical University Union Hospital, Fuzhou 350001, and the Third Affiliated Hospital, Fujian Medical University, Fuzhou 350108, People's Republic of China jw_chen18@outlook.com Y. Xiao Y. Xiao State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Science, Fuzhou 350002, People's Republic of China L. Wu L. Wu The Second Clinical Medical College, Fujian Medical University, Quanzhou 362000, People's Republic of China F. Xiao F. Xiao State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Science, Fuzhou 350002, People's Republic of China Q. Wang Q. Wang Department of Oncology, The First people’s Hospital of Jingde Municipal, Jingdezhen 333000, People's Republic of China J. Hong J. Hong Department of Radiotherapy, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, People's Republic of China P. Zhu P. Zhu Department of Pathogenic Biology, Basic Medicine College, Fujian Medical University, Fuzhou 350122, People's Republic of China [Ru(bpy)2(phen)]Cl2 nasopharyngeal carcinoma cells P53 gene radiosensitization. Chua ML, Wee JT, Hui EP, Chan AT (2016) NPC. Lancet, 387: 1012.##Hambley TW (2007) Developing new metal-based therapeutics: challenges and opportunities. Dalton transactions (Cambridge, England : 2003), 21: 4929-4937.##Hesling C, D'Incan M, D'Incan C, et al. (2004) Downregulation of BRCA1 in A375 melanoma cell line increases radio-sensitivity and modifies metastatic and angiogenic gene expression. J Invest Dermatol, 122: 369-380.##Rosenberg B, Vancamp L, Trosko JE, Mansour VH (1969) Platinum Compounds: a New Class of Potent Antitumour Agents. Nature, 222: 385.##Kelland L (2007) The resurgence of platinum-based cancer chemotherapy. Nat Rev Cancer, 7: 573-584.##Dilruba Sand Kalayda GV (2016) Platinum-based drugs: past, present and future. 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Bio Metals, 1-11.##Chow MJ, Babak MV, Wong DYQ, Pastorin G, Gaiddon C, Ang WH (2016) Structural Determinants of p53-Independence in Anticancer Ruthenium-Arene Schiff-Base Complexes. Mol Pharm, 13: 2543-2554.## ##

Volume and dosimetric analysis of rectum and bladder for prostate carcinoma patients by using kilo voltage cone beam computed tomography (CBCT) 2 2 Background: To study and analyze the variations in delivered doses to rectum and bladder of carcinoma prostate patients by using kilo Voltage (kV) ‘Cone Beam Computed Tomography’ (CBCT) images. Materials and Methods: 2-Dimensional kilo Voltage (2D kV) Imaging and CBCT were done for seven prostate cancer patients. The deviations among their shifts were correlated and the volumetric changes of the rectum and bladder were analyzed. Rectum and bladder contours were redrawn on every boost fractions and dose calculation were performed on CBCT images to study the effect on dose volume histograms. Results: A correlation coefficient for set-up variations was within 0.78 for all directions between CBCT soft tissue matching and kV bone match. The mean deviation of bladder and rectum volume over the boost fractions was -12% to +9% (SD 31cc to 70cc) and -10.2% to+12% (SD 3.1cc to14.9cc), respectively. Bladder mean dose variation was <1.5Gy for all three positions whereas it was <3.65Gy for rectum. D1% dose deviation from reference plan for bladder was 1.1Gy (CBCT matched position), 1.4Gy (kV matched position), and 1.7Gy (no correction), and for rectum, the deviations were 1.2Gy, 2.2Gy, 3.6Gy, respectively. No significant deviation was found statistically significant at the low dose region. Conclusion: It is possible to achieve good dose delivery and conformity in target (prostate) with CBCT image guidance rather than kV bone match, but dose contribution to the rectum is dependent on the patient’s anatomy, bladder filling, and rectum filling, pertaining to the day of examination. 557 569 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/14 1399/3/25 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/14 1399/3/25 K. Venkatesan K. Venkatesan Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India. C.J. Raphael C.J. Raphael Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India. K.M. Varghese K.M. Varghese Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India. P. Gopu P. Gopu Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India. S. Sivakumar S. Sivakumar Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India. M. Boban M. Boban Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680555, Kerala, India. N.A.N. Raj N.A.N. Raj Centre for Biomaterials,Cellular and Molecular Theranostics (CBCMT) VIT University, Vellore-632014, India K. Senthilnathan K. Senthilnathan Department of Physics, School of Advanced Sciences VIT University, Vellore 632 014, Tamil Nadu, India P. Ramesh Babu P. Ramesh Babu Department of Physics, School of Advanced Sciences VIT University, Vellore 632 014, Tamil Nadu, India prameshbabu@vit.ac.in Image-guided radiotherapy prostate bladder rectum. Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH, Cheung MR, et al. (2008) Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys, 70(1): 67-74.##Kalbasi A, Li J, Berman AT, Swisher-McClure S, Smaldone M, Uzzo RG et al. (2015) Dose-escalated irradiation and overall survival in men with non metastatic prostate cancer. JAMA Oncol, 1(7): 897-906.##Zaorsky NG, Keith SW, Shaikh T, Nguyen PL, Horwitz EM, Dicker AP, et al. (2018) Impact of radiation therapy dose escalation on prostate cancer outcomes and toxicities. American Journal of Clinical Oncology, 41(4): 409-415.##Wortel RC, Incrocci L, Pos FJ, Lebesque JV, Witte MG, van der Heide UA, et al.(2015) Acute toxicity after image-guided intensity modulated radiation therapy compared to 3D conformal radiation therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys, 91(4): 737-44.##Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A, et al. (2008) Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys, 70(4): 1124-9.##Dearnaley DP, Jovic G, Syndikus I, et al. (2014) Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol, 15(4): 464-473.##Dolezel M, Odrazka K, Zouhar M, Vaculikova M, Sefrova J, Jansa J et al. (2015) Comparing morbidity and cancer control after 3D-conformal (70/74Gy) and intensity modulated radiotherapy (78/82Gy) for prostate cancer. Strahlenther Onkol, 191(4): 338-46.##Bhardwaj AK, Kehwar TS, Chakarvarti SK, Oinam AS, Sharma SC (2007) 3-Dimensional conformal radiotherapy versus intensity modulated radiotherapy for localized prostate cancer: Dosimetric and radiobiologic analysis. Int J Radiat Res, 5(1): 1-8.##Mayyas E, Chetty IJ, Chetvertkov M, Wen N, Neicu T, Nurushev T, Ren L, et al. (2013) Evaluation of multiple image-based modalities for image-guided radiation therapy (IGRT) of prostate carcinoma: a prospective study. Med Phys, 40(4): 041707(1-9).##Zelefsky MJ, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X, et al.(2012) Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J RadiatOncolBiol Phys, 84(1): 125-9.##Dang A, Kupelian PA, Cao M, Agazaryan N, Kishan AU (2018) Image-guided radiotherapy for prostate cancer. TranslAndrol Urol, 7(3): 308–320.##Yartsev S and Bauman G (2016) Target margins in radiotherapy of prostate cancer. Br J Radiol, 89(1067): 20160312.##Mahdavi SR, Jazayeri Gharehbagh E, Mofid B, Jafari AH, Nikoofar AR (2017) Accuracy of the dose delivery in prostate cancer patients-using an electronic portal imaging device (EPID) Int J Radiat Res, 15(1): 39-47.##Jason CY, Qureshi MM, Clancy P, Dise LN, Willins J, Hirsch AE (2015) Daily patient setup error in prostate image guided radiation therapy with fiducial-based kilovoltage onboard imaging and conebeam computed tomography. Quant Imaging Med Surg, 5(5): 665–672.##Ghilezan M, Yan D, Martinez A (2010) Adaptive radiation therapy for prostate cancer. Semin Radiat Oncol, 20: 130–137. ##McVicar N, Popescu IA, Heath E (2016) Techniques for adaptive prostate radiotherapy. Phys Med, 32(3): 492-8.##McPartlin AJ, Li XA, Kershaw LE, Heide U, Kerkmeijer L, Lawton C et al.(2016) MRI-guided prostate adaptive radiotherapy - A systematic review. 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(2017) Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy. Strahlenther Onkol, 193(9): 722-732.##Chen Z, Yang Z, Wang J, Hu W (2016) Dosimetric impact of different bladder and rectum filling during prostate cancer radiotherapy. Radiat Oncol, 11: 103.##Gill SK, Reddy K, Campbell N, Chen C, Pearson D (2015) Determination of optimal PTV margin for patients receiving CBCT-guided prostate IMRT: comparative analysis based on CBCT dose calculation with four different margins. J ApplClin Med Phys, 16(6): 252–262. ##Brenner DJ, Martinez AA, Edmundson GK, Mitchell C, Thames HD, Armour EP (2002) Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. 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Effects of adrenomeduline and ramp2 on the lung of mice exposed to total body radiation 2 2 Background: Adrenomedullin (AM) and its receptor, receptor activity-modifying protein (RAMP) 2 have pleiotropic regulatory functions in normal tissue and cancer tissue. AM is produced and secreted both numerous stromal cells and tumor cells. This study aims to investigate a possible role of AM and RAMP2 in the radiation exposure in the normal lung tissue. Materials and Methods: Four groups with 6 male adult Swiss Albino mice per group were investigated. The mice were subjected to a 500 cGy single-dose radiation exposure in the total body radiation device and lung tissues were collected. 1, 2, and 7 days after radiation exposure, with 1 reference group which was not exposed to radiation. Results: The general histology and the immunohistochemistry of the tissue samples prepared with anti- AM, anti–RAMP2, and monoclonal antibodies were investigated, yielding a statistically significant increase for AM on day 3 and for RAMP2 on day 1 after radiation exposure. Conclusion: The observed increase of AM and RAMP2 concentrations in the normal tissue matrix after radiation exposure may play a role in the side effects of radiotherapy.  571 578 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/14 1399/3/25 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/14 1399/3/25 M.K. Ozbilgin M.K. Ozbilgin Department of Histology and Embryology, Celal Bayar University School of Medicine, Manisa, Turkey kemalozbilgin@yahoo.com G.Z. Karaman G.Z. Karaman Department of Histology and Embryology, Celal Bayar University School of Medicine, Manisa, Turkey S. Gencur S. Gencur Department of Histology and Embryology, Celal Bayar University School of Medicine, Manisa, Turkey E. Gumustepe E. Gumustepe Department of Radiation Oncology, Ankara University School of Medicine, Ankara, Turkey C. Kurtman C. Kurtman Department of Radiation Oncology, Ankara University School of Medicine, Ankara, Turkey AM RAMP2 radiation lung carcinogens. 1. Hei TK, Zhou H, Ivanov VN, Hong M, Lieberman HB, Brenner DJ, Amundson SA, Geard CR (2008) Mechanism of radiation-induced bystander effects: a unifying model. J Pharm Pharmacol, 60: 943–950.##2. Kitamura K, Kangawa K, Kawamoto M, Ichiki Y, Nakamura S, Matsuo H, Eto T (1993) Adrenomedullin: A Novel Hypotensive Peptide Isolated from Human Pheochromocytoma. Biochem Biophys Res Commun, 192: 553–560.##3. Jougasaki M, Wei CM, Aarhus LL, Heublein DM, Sandberg SM, Burnett JC (1995) Renal localization and actions of adrenomedullin: a natriuretic peptide. Am J Physiol Physiol, 268: F657–F663.##4. Ebara T, Miura K, Okumura M, Matsuura T, Kim S, Yukimura T, Iwao H (1994) Effect of adrnomedullin on renal hemodynamics and functions in dogs. Eur J Pharmacol, 263: 69–73.##5. Kanazawa H, Kurihara N, Hirata K, Kudoh S, Kawaguchi T, Takeda T (1994) Adrenomedullin, a Newly Discovered Hypotensive Peptide, Is a Potent Bronchodilator. Biochem Biophys Res Commun, 205: 251–254.##6. Takahashi H, Watanabe TX, Nishimura M, Nakanishi T, Sakamoto M, Yoshimura M, Komiyama Y, Masuda M, Murakami T (1994) Centrally Induced Vasopressor and Sympathetic Responses to a Novel Endogenous Peptide, Adrenomedullin, in Anesthetized Rats. Am J Hypertens, 7: 478–482.##7. Brain SD and Grant AD (2004) Vascular actions of calcitonin gene-related peptide and adrenomedullin. Physiol Rev, 84: 903–934.##8. Pavel M and Georg HE (2006) Adrenomedullin is a novel marker of tumor progression in neuroendocrine carcinomas. Horm Metab Res, 38: 112–118.##9. Kadmiel M, Matson BC, Espenschied ST, Lenhart PM, Caron KM (2017) Loss of receptor activity-modifying protein 2 in mice causes placental dysfunction and alters PTH1R regulation. PLoS One, 12: e0181597.##10. Tanaka M, Koyama T, Sakurai T, Kamiyoshi A, Ichikawa-Shindo Y, Kawate H, Liu T, Xian X, Imai A, Zhai L, et al. (2016) The endothelial adrenomedullin-RAMP2 system regulates vascular integrity and suppresses tumour metastasis. Cardiovasc Res, 111: 398–409.##11. Koyama T, Ochoa-Callejero L, Sakurai ; Takayuki, Kamiyoshi A, Yuka Ichikawa-Shindo, Iinuma N, Arai T, Yoshizawa T, Iesato Y, Lei Y, et al. (2013) Vascular Endothelial Adrenomedullin-RAMP2 System is Essential for Vascular Integrity and Organ Homeostasis. Circulation, 127: 842–853.##12. Ichikawa-Shindo Y, Sakurai T, Kamiyoshi A, Kawate H, Iinuma N, Yoshizawa T, Koyama T, Fukuchi J, Iimuro S, Moriyama N, et al. (2008) The GPCR modulator protein RAMP2 is essential for angiogenesis and vascular integrity. J Clin Invest, 118: 29–39.##13. Fritz-Six KL, Dunworth WP, Li M, Caron KM (2008) Adrenomedullin signaling is necessary for murine lymphatic vascular development. J Clin Invest, 118: 40–50.##14. Soni S, Basu M, Agrawal P, Kumar N, Bhatnagar A, Chhillar N (2016) Multiple parametric approaches to assess acute radiation lung injury of rats. Ukr Biochem J, 88: 22–30.##15. Ozbilgin MK, Onal T, Ozcan C, Temel M, Aktas C, Gareveran MS, Uluer ET, Inan S, Kurtman C (2016) Effects of Cyclooxygenase on the Urothelium of the Urinary Bladder of Mice Exposed to Pelvic Radiation. Anal Quant Cytopathol Histopathol, 38: 103–110.##16. Aktaş C, Kurtman C, Ozbilgin MK, Tek I, Toprak SK (2013) An experimental study of radiation effect on normal tissue: analysis of HIF-1α, VEGF, eIF2, TIA-1, and TSP-1 expression. Turkish J Haematol Off J Turkish Soc Haematol, 30: 371–378.##17. Ozbilgin MK, Aktas C, Uluer ET, Buyukuysal MC, Gareveran MS, Kurtman C (2016) Influence of radiation exposure during radiotherapy. Evidence for the Increase of Versican and Heparin-Binding EGF-like Growth Factor Concentrations. Anal Quant Cytopathol Histopathol, 38: 126–132.##18. Martinez A, Miller MJ, Unsworth EJ, Siegfried JM, Cuttitta F (1995) Expression of adrenomedullin in normal human lung and in pulmonary tumors. Endocrinology, 136: 4099–4105.##19. Satoh F, Takahashi K, Murakami O, Totsune K, Sone M, Ohneda M, Abe K, Miura Y, Hayashi Y, Sasano H (1995) Adrenomedullin in human brain, adrenal glands and tumor tissues of pheochromocytoma, ganglioneuroblastoma and neuroblastoma. J Clin Endocrinol Metab, 80: 1750–1752.##20. Larráyoz IM, Martínez-Herrero S, García-Sanmartín J, Ochoa-Callejero L, Martínez A (2014) Adrenomedullin and tumour microenvironment. J Transl Med, 12: 339.##21. Iimuro S, Shindo T, Moriyama N, Amaki T, Niu P, Takeda N, Iwata H, Zhang Y, Ebihara A, Nagai R (2004) Angiogenic effects of adrenomedullin in ıschemia and tumor growth. Circ Res, 95: 415–423.##22. Miyashita K, Itoh H, Sawada N, Fukunaga Y, Sone M, Yamahara K, Yurugi T, Nakao K (2003) Adrenomedullin promotes proliferation and migration of cultured endothelial cells. Hypertens Res, 26: S93–S98.##23. Ishikawa T, Chen J, Wang J, Okada F, Sugiyama T, Kobayashi T, Shindo M, Higashino F, Katoh H, Asaka M, et al. (2003) Adrenomedullin antagonist suppresses in-vivo growth of human pancreatic cancer cells in SCID mice by suppressing angiogenesis. Oncogene, 22: 1238–1242.##24. Hinson JP, Kapas S, Smith DM (2000) Adrenomedullin, a Multifunctional Regulatory Peptide. Endocr Rev, 21: 138–167.##25. Golding SE, Rosenberg E, Neill S, Dent P, Povirk LF, Valerie K (2007) Extracellular signal-related kinase positively regulates ataxia telangiectasia mutated, homologous recombination Repair, and the DNA damage response. Cancer Res, 67: 1046–1053.##26. Smith RS, Gao L, Bledsoe G, Chao L, Chao J (2009) Intermedin is a new angiogenic growth factor. Am J Physiol Circ Physiol, 297: H1040–H1047.##27. Gandhi S and Chandna S (2017) Radiation-induced inflammatory cascade and its reverberating crosstalks as potential cause of post-radiotherapy second malignancies. Cancer Metastasis Rev, 36: 375–393.##28. Zhou P-H, Hu W, Zhang X-B, Wang W, Zhang LJ (2016) Protective effect of adrenomedullin on rat leydig cells from lipopolysaccharide-ınduced ınflammation and apoptosis via the PI3K/Akt Signaling Pathway ADM on Rat Leydig Cells from Inflammation and Apoptosis. Mediators Inflamm, 2016: 1–16.##29. Ahmed KM, Nantajit D, Fan M, Murley JS, Grdina DJ, Li JJ (2009) Coactivation of ATM/ERK/NF-κB in the low-dose radiation-induced radioadaptive response in human skin keratinocytes. Free Radic Biol Med, 46: 1543–1550.##30. Kimura K and Gelmann EP (2002) Propapoptotic effects of NF-κB in LNCaP prostate cancer cells lead to serine protease activation. Cell Death Differ, 9: 972–980.##31. Heissig B, Rafii S, Akiyama H, Ohki Y, Sato Y, Rafael T, Zhu Z, Hicklin DJ, Okumura K, Ogawa H, et al. (2005) Low-dose irradiation promotes tissue revascularization through VEGF release from mast cells and MMP-9-mediated progenitor cell mobilization. J Exp Med, 202: 739–750.##32. Martínez A (2002) Biology of adrenomedullin. Microsc Res Tech, 57: 1–2.##33. Ouafik L, Sauze S, Boudouresque F, Chinot O, Delfino C, Fina F, Vuaroqueaux V, Dussert C, Palmari J, Dufour H, et al. (2002) Neutralization of adrenomedullin ınhibits the growth of human glioblastoma cell lines in- vitro and suppresses tumor xenograft growth in-vivo. Am J Pathol, 160: 1279–1292.##34. Yamauchi A, Sakurai T, Kamiyoshi A, Ichikawa-Shindo Y, Kawate H, Igarashi K, Toriyama Y, Tanaka M, Liu T, Xian X, et al. (2014) Functional differentiation of RAMP2 and RAMP3 in their regulation of the vascular system. J Mol Cell Cardiol 77: 73–85.##35. Vadivel A, Abozaid S, van Haaften T, Sawicka M, Eaton F, Chen M, Thébaud B (2010) Adrenomedullin promotes lung angiogenesis, alveolar development, and repair. Am J Respir Cell Mol Biol, 43: 152–160.##36. Ono Y, Okano I, Kojima M, Okada K, Kangawa K (2000) Decreased gene expression of adrenomedullin receptor in mouse lungs during sepsis. Biochem Biophys Res Commun, 271: 197–202.## ##

Effect of lung inhomogeneity on dose distribution during radiotherapy of patient with lung cancer 2 2 Background: Presence of inhomogeneities such as lung tissue with low density can perturbs the dose distribution in the path of therapeutic photon beam and causes undesired cold or hot spots. The aim of this study was to investigate the effect of lung tissue inhomogeneities on dose distribution in thorax irradiation. Materials and Methods: The Monte Carlo simulation (MC) code of EGSnrc-based BEAMnrc was used to calculate dose distribution for 6 MV- Siemens Primus linear accelerator (Linac) in a homogenous phantom. Dose perturbation and inhomogeneity corrected factors (ICFs) were calculated due to implementation of lung tissue depended to the lung density and field size. Results: The maximum increased dose in lung tissue with lung density of 0.5 and 0.25gr/cm3 was 15.9%, 16.2%, 15.6%, 23.8 %, 24.8% and 25.0% for 6 × 6, 10 × 10 and 20 × 20 cm2 field sizes, respectively. The maximum ICF for these field sizes was 1.16 and 1.25 for lung density of 0.5 and 0.25gr/cm3, respectively. The maximum dose reduction in lung tissue with density of 0.25 and 0.5gr/cm3 was 19.5% and 4.2 %, and the related ICF was estimated 0.84 and 0.95, respectively. Conclusion: Involvement of lung tissue in the path of irradiation perturbs the dose distribution which is dependent to the lung density and field size. The ICFs resulted from our MC model could be useful to accurately calculate the dose distribution in radiotherapy of lung abnormalities. 579 586 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/22 1399/4/2 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/22 1399/4/2 M. Zabihzadeh M. Zabihzadeh Cancer Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. manzabih@gmail.com Z. Ghahremani Z. Ghahremani Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran S.M. Hoseini S.M. Hoseini H. Shahbazian H. Shahbazian Department of Clinical Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran M. Hoseini Ghahfarokhi M. Hoseini Ghahfarokhi Radiology and Nuclear Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran Electronic disequilibrium lung cancer radiotherapy Monte Carlo simulation inhomogeneity correction factor. 1. American Cancer Society. Cancer Facts & Figures 2008. Atlanta: American Cancer Society.##2. Allisy-Roberts P, Ambrosi P, Bartlett DT, Coursey BM, DeWerd LA, Fantuzzi E, et al. (2006) Report 76: Measurment quality assurance for ionizing radiation dosimetry. Journal of the International Commission on Radiation Units and Measurements, 6(2): NP-NP.##3. Glide-Hurst CK and Chetty IJ (2014) Improving radiotherapy planning, delivery accuracy, and normal tissue sparing using cutting edge technologies. J Thorac Dis, 6(4): 303-318.##4. Tissue inhomogeneity corrections for MV photon beams Report of Task Group No. 65 of the Radiation Therapy Committee of the American Association of Physicists in Medicine. Madison: Medical Physics Publishing; 2004. American Association of Physicists in Medicine (AAPM) Report 85.##5. Keall PJ, Kini VR, Vedam SS, Mohan R (2002) Potential radiotherapy improvements with respiratory gating. Australas Phys Eng Sci Med, 25(1): 1-6.##6. Mesbahi A, Dadgar H, Ghareh-Aghaji N, Mohammadzadeh M (2014) A Monte Carlo approach to lung dose calculation in small fields used in intensity modulated radiation therapy and stereotactic body radiation therapy. J Cancer Res Ther, 10(4): 896-902.##7. Giraud P, Garcia R (2010) Respiratory gating for radiotherapy: main technical aspects and clinical benefits. Bull Cancer, 97(7): 847-856.##8. Chang-li R, Yu-xin C, Lu-zhou W, WU-bing, Qi-bin S (2015) The influence of respiratory motion on dose distribution of 3D-CRT and IMRT- A simulation study. Int J Radiat Res, 13(1): 39-43.##9. Altunbas C, Kavanagh B, Dzingle W, Stuhr K, Gaspar L, Miften M (2013) Dosimetric errors during treatment of centrally located lung tumors with stereotactic body radiation therapy: Monte Carlo evaluation of tissue inhomogeneity corrections. Med Dosim, 38(4): 436-41.##10. Senthilkumar S, Ramakrishnan V (2011) Fabrication of low cost in-house slab homogeneous and heterogeneous phantoms for lung radiation treatment. Int J Radiat Res, 9(2): 109-19.##11. Sterpin E, Salvat F, Olivera G, Vynckier S (2009) Monte Carlo evaluation of the convolution/superposition algorithm of Hi-Art tomotherapy in heterogeneous phantoms and clinical cases. Med Phys, 36(5): 1566-1575.##12. Andreo P, Burns DT, Huq MS, Kanai T, laitano F, Symth VG, et al. (2000) IAEA; TRS-398: Absorbed dose determination in external beam radiotherapy: An International code of practice for dosimetry based on standards of absorbed dose to water. Vienna: IAEA: International atomic energy agency, 10: 46-80.##13. Rogers DW, Faddegon BA, Ding GX, Ma CM, We J, Mackie TR (1995) BEAM: a Monte Carlo code to simulate radiotherapy treatment units. Med phys, 22(5): 503-524.##14. White DR, Booz J, Griffith RV, Spokas JJ, Wilson IJ (1989) Report 44. Journal of the International Commission on Radiation Units and Measurements, 23(1): NP-NP.##15. Fraser D, Parker W, Seuntjens J (2009) Characterization of cylindrical ionization chambers for patient specific IMRT QA. J Appl Clin Med Phys, 10(4): 2923.##16. Chung H, Jin H, Dempsey JF, Liu C, Palta J, Suh TS, et al. (2005) Evaluation of surface and build-up region dose for intensity-modulated radiation therapy in head and neck cancer. Med phys, 32(8): 2682-2689.##17. Venselaar J, Welleweerd H, Mijnheer B (2001) Tolerances for the accuracy of photon beam dose calculations of treatment planning systems. Radiother Oncol, 60(2): 191-201.##18. Mesbahi A, Thwaites DI, Reilly JA (2006) Experimental and Monte Carlo evaluation of Eclipse treatment planning system for lung dose calculations. Rep Pract Oncol Radiother, 11(3): 123-133.##19. Ding W, Johnston PN, Wong TP, Bubb IF (2004) Investigation of photon beam models in heterogeneous media of modern radiotherapy. Australas Phys Eng Sci Med, 27(2): 39-48.##20. Stathakis S, Esquivel C, Quino LS, Myers P, Calvo O, P M (2012) Accuracy of the small field dosimetry using the acuros XB dose calculation algorithm within and beyond heterogeneous media for 6 MV photon beams. Int J Med Phys Clin Eng Radiat Oncol, 1: 78-87.##21. Asnaashari K, Nodehi MR, Mahdavi SR, Gholami S, Khosravi HR (2013) Dosimetric comparison of different inhomogeneity correction algorithms for external photon beam dose calculations. J Med Phys, 38(2): 74-81.##22. da Rosa LA, Cardoso SC, Campos LT, Alves VG, Batista DV, Facure A (2010) Percentage depth dose evaluation in heterogeneous media using thermoluminescent dosimetry. J Appl Clin Med Phys, 11(1): 117-127.##23. Kim YL, Suh TS, Choe BY, Choi BO, Chung JB, Lee JW, et al. (2016) Dose distribution evaluation of various dose calculation algorithms in inhomogeneous media. Int J Radiat Res, 14(4): 269-78.## ##

The relationship between collective effective doses of radiation and urinary concentration of 8-Dihydroxy-2'-Deoxyguanosine among radiography staff 2 2 Background: The effect of ionizing radiation of 8-HYDROXY- 2’- DEOXYGUANOSINE (8-OHdG) level in radiographers’ urine as the oxidative damage biomarker was investigated in this study and this biomarker was compared with the collective effective doses. Materials and Methods: The samples were selected into two categories in this cross-sectional study, 35 of whom were from different radiography groups (including nuclear medicine, radiology, radiotherapy, CT scan), and 35 subjects were from the staff who had no exposure to radiation. The results of the film badge were gathered from the hospitals, and the collective effective dose was obtained according to the respective formula. Then, at the end of the work shift, the urine samples were taken to determine the 8-OHdG concentration. The samples were obtained via the SPE (solid-phase extraction) method. After that, the 8-OHdG concentration was read by the GC/MS analyzer. Finally, the data resulted from the 8-OHdG concentration and the collective effective dose of the radiation were analyzed by the SPSS software. Result: The results showed that the 8-hydroxy-2-deoxy-guanosine concentration in the urine of the radiation workers had significant correlation with the collective effective dose of the radiation the past 6 periods (P=0.009) and also with the collective effective dose of the radiation of the 30 last periods (P=0.009). Conclusion: Observing the radiation protection principles by radiation workers results in decreased radiation and, in turn, reduces the level of oxidative stress, thus, reducing the potential effects of radiation. 587 592 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/22 1399/4/2 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/22 1399/4/2 A. Salehi A. Salehi Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran K. Ebrahimpour K. Ebrahimpour Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran F. Forouharmajd F. Forouharmajd Department of Occupational Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran forouhar@hlth.mui.ac.ir M. Zarean M. Zarean Environment Research center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran Radiography staff collective effective dose 8-Dihydroxy-2’- Deoxyguanosine. 1. Gao Y, Wang P, Wang Z, Han L, Li J, Tian C, Zhao1 F, Wang J, Zhao F, Zhang Q, Lyu Y (2019) Serum 8-Hydroxy-2′-Deoxyguanosine Level as a Potential Biomarker of Oxidative DNA Damage Induced by Ionizing Radiation in Human Peripheral Blood. Dose-Response, 17(1): 1559325818820649.##2. Kato S, Yoshimura K, Kimata T, Mine K, Uchiyama T, Kaneko K (2015) Urinary 8-hydroxy-2′-deoxyguanosine: a biomarker for radiation-induced oxidative DNA damage in pediatric cardiac catheterization. J Pediatr, 167(6): 1369-74.##3. Hallberg LM, Ward JB, Hernandez C, Ameredes BT, Wickliffe JK (2015) Committee HHR. Part 3. Assessment of genotoxicity and oxidative damage in rats after chronic exposure to new-technology diesel exhaust in the ACES bioassay. Res Rep Health Eff Inst, 184: 87-105.##4. Płachetka A, Adamek B, Strzelczyk JK, Krakowczyk Ł, Migula P, Nowak P, Wiczkowski A (2013) 8-hydroxy-2′-deoxyguanosine in colorectal adenocarcinoma–is it a result of oxidative stress? Med Sci Monit, 19: 690.##5. Jacob KD, Hooten NN, Trzeciak AR, Evans MK (2013) Markers of oxidant stress that are clinically relevant in aging and age-related disease. Mech Ageing Dev, 134(3-4): 139-57.##6. Collins AR, Oscoz AA, Brunborg G, Gaivao I, Giovannelli L, Kruszewski M, Smith C, Štětina R (2008) The comet assay: topical issues. Mutagenesis, 23(3): 143-51.##7. Sanaa A, Sadek NA, Behery AK, Issa NM, Ali OK (2015) Chromosomal aberrations and oxidative DNA adduct 8-hydroxy-2-deoxyguanosine as biomarkers of radiotoxicity in radiation workers.##8. International Atomic Energy Agancy (1994) Convention on Nuclear Safety, INFC1RC/449.##9. Institute of Standards and Industrial Research of Iran (2005) Protection against ionizing radiation and the safety of radiation sources – Basic standards.##10. Slot C (1965) Plasma creatinine determination a new and specific Jaffe reaction method. Scand J Clin Lab Invest, 17(4):381-7.##11. Hai-Shu L, Jenner AM, Ong CN, Huang SH, Whiteman M, Halliwell B (2004) A high-throughput and sensitive methodology for the quantification of urinary 8-hydroxy-2′-deoxyguanosine: measurement with gas chromatography-mass spectrometry after single solid-phase extraction. Biochem J, 380(2): 541-8.##12. Lim KS, Jenner A, Halliwell B (2006) Quantitative gas chromatography mass spectrometric analysis of 2′-deoxyinosine in tissue DNA. Nat Protoc, 1(4): 1995.##13. Silva R, Folgosa F, Soares P, Pereira AS, Garcia R, Gestal-Otero JJ, Tavares P, Gomes da Silva MDR  (2013) Occupational cosmic radiation exposure in Portuguese airline pilots: study of a possible correlation with oxidative biological markers. Radiat Environ Biophys, 52(2): 211-20.##14. Xuan Z, Gao S, Ye A, Cai D, Yu S, Zhao Y (2013) Detection and analysis of 8-hydroxy-2′-deoxyguanosine in urine in radiation workers. Chin J Health Lab Technol, 75(13): 127-32.##15. Rahimipour S and Javadi I (2017) DNA damage in radiology staff. 14 th Congress of Toxicology.##16. El-Benhawy SA, Sadek NA, Behery AK, Issa NM, Ali OK (2016) Chromosomal aberrations and oxidative DNA adduct 8-hydroxy-2-deoxyguanosine as biomarkers of radiotoxicity in radiation workers. Journal of Radiation Research and Applied Sciences, 9(3): 249-58.##17. Li X, Li K, Chen Y, Chen Q, Liu J (2014) 8-Hydroxydeoxyguanine level in urine among uranium mining workers. Chin Prev Med, 15(3): 208-11.##18. Su S, Jin Y, Guo Q, LI X-l, WEN W (2012) Level of 8-OHdG and hOGG1 among the residents in Yangjiang high background radiation area. China Occupat Med, 39(6): 467-70.##19. Sackett G (2017) Radiation safety issues for radiologic techologies. Integrated Science Support, Radiology safety.## ##

Changes in the radiochemical purity of [18-F]FDG radiopharmaceutical according to the amount of ethanol added 2 2 Background: we aimed to find the optimal level of ethanol that can be added such that the radiochemical purity of [18F]FDG is increased and the MFDS and USP stipulated guidelines are met. Materials and Methods: Changes in the radiochemical purity of [18F]FDG were analyzed according to changes in the concentrations of ethanol added. The study used 1 L of 99.9% pure ethanol. The ethanol concentrations used were 0.0% (0 µL) for the control group and 0.1% (1 µL), 0.2% (2 µL), and 0.3% (3 µL) for the experimental groups. Since the radiochemical purity of [18F]FDG may differ according to the radioactive concentrations used, four different radioactive concentrations were prepared: 1580 mCi/16 mL, 3320 mCi/16 mL, 4840 mCi/16 mL, and 6470 mCi/16 mL. Results: The radiochemical purity of [18F]FDG increased significantly when ethanol was added to it at different radioactive concentrations in comparison to when ethanol was not added. When ethanol concentrations of 0.1%, 0.2%, and 0.3% were added, the radiochemical purity increased at all radioactive concentrations (100 mCi/mL, 200 mCi/mL, 300 mCi/mL, and 400 mCi/mL) while meeting the KP and USP standards even after 10 hours following the EOS. Conclusion: It was determined in our study that adding ethanol at the concentration of 0.1% to [18F]FDG is most suitable as it generates the least residual ethanol while maintaining the radiochemical purity of [18F]FDG at stable levels that meet the KP and USP standards. 593 598 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/222020/06/22 1399/4/2 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/222020/06/22 1399/4/2 S. Kim S. Kim Department of Cyclotron Center of Nuclear Medicine, CareCamp Inc, Daegu 42415, Korea stkim@carecamp.com E. Han E. Han Department of Education & Research, Korea Academy of Nuclear Safety, Seoul 13630, Korea haneunok@gmail.com [18-F]FDG ethanol radiochemical purity radiopharmaceutical US pharmacopeia Korean pharmacopeia 1. Lee JT (2003) Nuclear medicine-Molecular imaging. Komoonsa. 1-413. ISBN 8973862383, 9788973862382.http://www.riss.kr/search/detail/DetailView.do?p_mat_type=d7345961987b50bf&control_no=df8d34e539939e8e.##2. Saha GB (2004) Basics of PET Imaging, second edition. New York: Springer-Verlag, ISBN 978-1-4419-0805-6. ##3. Walters LR, Martin KJ, Jacobson MS, Hung JC, Mosman EA (2012) Stability Evaluation of 18F- FDG at high radioactive concentrations. J Nucl Med Technol, 40(1): 52-56. ##4. Zhang J, Li Y, Liu J, Zhang X, Tian J (2010) The analysis of radiolysis impurities in 18F-FDG and methods of repurification. J Radioanal Nucl Chem, 283(3): 565-569. ##5. United States Pharmacopeia 39 - National Formulary 34 (USP39-NF34) (2015). Rockville: United States Pharmacopeial Convention, Inc. https://www.uspnf.com/official-text/proposal-statuscommentary/usp-39-nf-34.##6. Lee SK (2011) Variations in radiochemical purity according to the desired final concentration in 18F-FDG. Master’s thesis, Graduate School of Life Sciences, Catholic University of Pusan, 1-39. ##7. Park JN (2009) Stability of 2-[18F] Fluoro-2-deoxy-D-glucose under various experimental conditions. Master’s thesis, Department of Pharmacology, Kosin University College of Medicine, 1-26. ##8. Chung JK, Lee MC, Koh CS (2008) Nuclear medicine, 3rd edition. Korea Medical Book Publishing, 1-828. ISBN 9788970436593 93510. ##9. Kim ST, Yong CS, Han EO (2010) A study on the quality control of 18F-FDG radiopharmaceutical. J Radiat Prot, 35(4): 151-156. ##10. http://www.earticle.net/article.aspx?sn=132533.##11. Lake R (2008) Revised USP 467 Residual Solvent Method (2008). Satisfy new method requirements with restek columns and standards. http://www.restek.com/Technical-Resources/Technical-Library/Pharmaceutical/pharm_A017.##12. National Institute of Food and Drug Safety Evaluation, Drug Evaluation Department, Pharmaceutical Standardization Division (2015). Pharmaceutical residual solvent guideline, 1-21. ##13. Jacobson MS, Dankwart HR, Mahoney DW (2009). Radiolysis of 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) and the role of ethanol, radioactive concentration. Appl Radiat Isot, 67(6): 990-995. ##14. Dantas NM, Nascimento JE, Santos-Magalhães NS, Oliveira ML (2013) Radiolysis of 2-[¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) and the role of ethanol, radioactive concentration and temperature of storage. Appl Radiat Isot, 72: 158-162. ##15. Fawdry RM (2007) Radiolysis of 2-[18F]fluoro-2-deoxy-D-glucose ([FDG) and the role of reductant stabilizers. Appl Radiat Isot, 65(11): 1193-1201.## ##

Volumetric-modulated arc stereotactic radiotherapy for intramedullary cervical spinal cord metastases: Report of two cases 2 2 The treatment results of intensity-modulated stereotactic radiotherapy (IM-SRT) by volumetric-modulated arc therapy (VMAT) for intramedullary cervical spinal cord metastases (IMCSCM) in two cases were presented. Case 1: A 76-year-old woman showed left-sided motor weakness and left arm pain and dysesthesia due to IMCSCM at C [cervical] 6-7 (located a little to the left laterally) with multiple small brain metastases from thyroid carcinoma.  Multiple brain metastases were successfully treated by stereotactic radiosurgery (SRS). In addition, IMCSCM was treated by IM-SRT. Case 2: A 48-year-old man presented with asymptomatic IMCSCM at C2 (located a little to the right laterally) after conventional whole brain radiotherapy (WBRT) and multiple sessions of SRS/SRT for multiple brain metastases from lung adenocarcinoma. IMCSCM was treated by IM-SRT. In both cases 39 Gy in 13 fractions (without PTV [planning target volume] margin, D95%=95% dose) was delivered to the IMCSCM (0.3 ml and 0.5 ml in volume respectively) by coplanar 2-full circular arc VMAT. The maximum dose to the tumor was 46.3 Gy in case 1 and 47.1 Gy in case 2. IMCSCM in both cases shrank markedly without adverse effects during the follow-up period of 32 months and 8 months respectively. The symptoms of the extremities in case 1 were subsided completely until the patient’s death at 34 months after SRT from lung metastasis. In case 1 IMCSCM had been thought to be a relatively radioresistant thyroid carcinoma metastasis. In case 2 IMCSCM was near the field of the prior WBRT. However, both tumors were successfully treated without adverse effects by VMAT IM-SRT. 599 604 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/222020/06/222020/06/22 1399/4/2 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/222020/06/222020/06/22 1399/4/2 Y. Mori Y. Mori Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan yoshim@aichi-med-u.ac.jp T. Mori T. Mori Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan K. Adachi K. Adachi Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan S. Abe S. Abe Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan Y. Oshima Y. Oshima Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan A. Takeuchi A. Takeuchi Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan M. Ito M. Ito Department of Radiology and Radiation Oncology, Aichi Medical University, Nagakute, Aichi, Japan Metastasis spinal cord intramedullary cervical volumetric-modulated arc therapy.  1. Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, Nagano O, Kenai H, Moriki A, Suzuki S, Kida Y, Iwai Y, Hayashi M, Onishi H, Gondo M, Sato M, Akimitsu T, Kubo K, Kikuchi Y, Shibasaki T, Goto T, Takanashi M, Mori Y, Takakura K, Saeki N, Kunieda E, Aoyama H, Momoshima S, Tsuchiya K (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol, 15: 387-395. ##2. Shin DA, Huh R, Chung SS, Rock J, Ryu S (2009) Stereotactic spine radiosurgery for intradural and intramedullary metastasis. Neurosurg Focus, 27: E10.##3. Parikh S, Heron DE (2009) Fractionated radiosurgical management of intramedullary spinal cord metastasis: a case report and review of the literature. Clin Neurol Neurosurg, 111: 858-861. ##4. Veeravagu A, Lieberson RE, Mener A, ChenY-R, Soltys SG, Gibbs IC, Adler JR, Tian AG, Chang SD (2012) CyberKnife stereotactic radiosurgery for the treatment of intramedullary spinal cord metastases. J Clin Sci, 19: 1273-1277. ##5. Mori Y, Hashizume C, Shibamoto Y, Kobayashi T, Nakazawa H, Hagiwara M, Tsugawa T (2013) Stereotactic radiotherapy for spinal intradural metastases developing within or adjacent to the previous irradiation field. Report of three cases. Nagoya J Med Sci, 75: 263-271.##6. Mori Y, Kawamura T, Ohshima Y, Takeuchi A, Mori T, Ishiguchi T (2016) Stereotactic radiotherapy for cervical spinal intramedullary metastasis and multiple brain metastases: A case report. Cureus, 8: e590.##7. Sagal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang U-K, Werner-Wasik M, Angelov L, Chang EL, Sohn M-J, Soltys SG, Letourneau D, Ryu S, Gerszten PC, Fowler J, Wong CS, Larson DA (2012) Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys, 82: 107-116.##8. Majmundar N, Shao B, Assina R (2018) Lung adenocarcinoma presenting as a intramedullary spinal cord metastasis: Case report and review of literature. J Clin Neurosci, 52: 124-131. ##9. Chason JL and Landers JW (1963) Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study. Cancer, 16:781-787.##10. Ghia AJ, Guha-Thakurta N, Hess K, Yang JN, Settle SH, Sharpe HJ, Li J, MaAleer MF, Chang EL, Tatsui CE, Brown PD, Rhines LD (2018) Phase 1 study of spinal cord constraint relaxation with single session spine stereotactic radiosurgery in the primary management of patients with inoperable, previously unirradiated metastatic epidural spinal cord compression. Int J Radiat Oncol Biol Phys, 102: 1481-1488.##11. Bishop AJ, Guadagnolo BA, Allen PK, Rebueno NC, Wang XA, Amini B, Tatsui CE, Rhines LD, Li J, Chang EL, Brown PD, Ghia AJ (2017) Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations. J Neurosurg Spine, 27: 303-311. ##12. Ho JC, Tang C, Deegan BJ, Allen PK, Jonasch E, Amini B, Wang XA, Li J, Tatsui CE, Rhines LD, Brown PD, Ghia AJ (2016) The use of spine stereotactic radiosurgery for oligometastatic disease. J Neurosurg Spine, 25: 239-247.##13. Ryu S, Jin RY, Chen Q, Rock J, Anderson J, Movsas B (2008) Pain control by image-guided radiosurgery for solitary spinal metastasis. J Pain Symptom Manag, 35: 292-298.##14. Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK, Weinberg JS, Brown BW, Wang XS, Woo SY, Cleeland C, Maor MH, Rhines LD (2007) Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine, 7: 151-160.##15. Garg AK, Shiu AS, Yang J, Wang XS, Allen P, Brown BW, Grossman P, Frija EK, McAleer MF, Azeem S, Brown PD, Rhines LD, Chang EL (2012) Phase 1/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer, 118: 5069-5077.##16. Yamada Y, Katsoulakis E, Laufer I, Lovelock M, Barzilai O, McLaughlin LA, Zhang Z, Schmitt AM, Higginson DS, Lis E, Zelefsky MJ, Mechalakos J, Bilsky MH (2017) The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery. Neurosurg Focus, 42: E6.##17. Endo S, Hida K, Yano S, Ito M, Yamaguchi S, Kashiwazaki D, Kinoshita R, Shirato H, Iwasaki Y (2008) Intramedullary spinal cord metastasis treated with radiation therapy: report of 3 cases. No Shinkei Geka, 36: 345-349.##18. Ryu S, Gorty S, Kazee AM, Bogart J, Hahn SS, Dalal PS, Chung CT, Sagermann RH (2000) ‘Full dose’ reirradiation of human cervical spinal cord. Am J Clin Oncol, 23: 29-31.##19. Schultheiss TE (1990) Spinal cord radiation “tolerance”: doctrine versus data. In t J Radiat Oncol Biol Phys, 19: 219-221.##20. Park HK and Chang JC (2013) Review of stereotactic radiosurgery for intramedullary spinal lesions. Korean J Spine, 10: 1-6.## ##

Brainstem schwannoma: A case report and review of clinical and imaging features 2 2 Background: Intracerebral schwannoma is an extremely rare disease, accounting for fewer than 1% of intracranial schwannomas. The most common site for this type of schwannoma is the cerebral hemisphere, especially the frontal and temporal lobes; brainstem schwannoma is infrequent. Case Description: Here, we report a 51-year-old man with a monthlong history of blurred vision and weakness in his left lower limb. Magnetic resonance imaging showed a heterogeneous cystic tumor with a solid nodule arising from the brainstem. The patient underwent a craniotomy with complete resection of the tumor, which was confirmed to be a brainstem schwannoma by histopathological examination. We also performed a literature review of the 19 reported cases of brainstem schwannoma. Conclusions: Brainstem schwannomas predominated in children and young adults (60% of cases occurred in patients ≤ 30 years of age), and were more common in females (65%). Most of these schwannomas exhibited heterogeneous intensity, containing cystic (78%) and solid-enhanced components. The vast majority of reported cases (94.9%) followed a benign course, with an improved prognosis following tumor resection. 605 610 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/222020/06/222020/06/222020/06/27 1399/4/7 2020/04/192020/04/192020/04/222020/04/222020/04/222020/04/282020/05/42020/05/42020/05/112020/05/112020/05/202020/05/202020/06/22020/06/22020/06/22020/06/22020/06/22020/06/102020/06/142020/06/142020/06/142020/06/142020/06/222020/06/222020/06/222020/06/222020/06/27 1399/4/7 X. Liang X. Liang Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China W. Shi W. Shi Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China X. Wang X. Wang Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China J. Qin J. Qin Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China L. Wang L. Wang Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China X. Wu X. Wu Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China X. Liang X. Liang Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China H. Zhang H. Zhang Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China zhanghui_mr@163.com Y. Tan Y. Tan Department of Medical Imaging, Shanxi Medical University, Shanxi Province, China tanyan123456@sina.com Brainstem schwannoma clinical and imaging features. Ahmed KJ, Ahmed M, Jafri HS, Raashid Y, Ahmed S. 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