SCIENTIFIC AND INFORMATION-ANALYTICAL MAGAZINE

ISSN 1024-6177 (Print), ISSN 2618-9615 (Online)

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The Medical Radiology and Radiation Safety journal ISSN 1024-6177 was founded in January 1956 (before December 30, 1993 it was entitled Medical Radiology, ISSN 0025-8334). In 2018, the journal received Online ISSN: 2618-9615 and was registered as an electronic online publication in Roskomnadzor on March 29, 2018. It publishes original research articles which cover questions of radiobiology, radiation medicine, radiation safety, radiation therapy, nuclear medicine and scientific reviews. In general the journal has more than 30 headings and it is of interest for specialists working in thefields of medicine¸ radiation biology, epidemiology, medical physics and technology. Since July 01, 2008 the journal has been published by State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. The founder from 1956 to the present time is the Ministry of Health of the Russian Federation, and from 2008 to the present time is the Federal Medical Biological Agency.

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Issues journals

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 2. P. 52–60

DOI: 10.12737/article_5ca5fc2765c9f5.02525917

V.S. Khoroshkov

History and Prospects of Proton Therapy

Institute for Theoretical and Experimental Physics, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .

V.S. Khoroshkov – Head of Dep., Dr. Sci. Tech.

Abstract

Purpose: Presentation of the history, status and prospects for the development of proton therapy.

Material and methods: The history of proton therapy (PT) is divided into two periods. The first one – the experimental period lasted since 1954 to 1990, when proton therapy was carried out at the ten facilities in physical institutes. The research accelerators and the horizontal proton beams with a fixed direction are used. The second period is from 1990, when the first clinical proton center was commissioned in a multi-field hospital in the city of Loma Linda, USA. In the first period, the necessary technical tools were developed and the advantages of using accelerated protons in remote radiation therapy formulated by R. Wilson in 1946 were confirmed on a limited (about 9,000) patient population: halving the radiation load on the healthy tissues surrounding the tumor and on the organism as a whole compared to γ- and electron irradiation and high dose gradients at the borders of the dose distributions and the tumors. This allows to increase the dose in the tumor (target), increase the probability of the tumor resorption and at last to irradiate tumors, including small sizes, located near critical organs and structures. By 1990, in three experimental centers in Russia (JINR, ITEP, PNPI) accumulated about 30 % of world clinical experience.

Today, more than 70 multi-cabin and several single-cabin clinical based proton therapy centers operate in the world. Almost all centers are equipped with gantry installations for PT for 95 % of patients. Today proton therapy is indicated and is used for the treatment of 10–15 % of all malignancies of cancer incidence structure.

Results: Healthcare in Russia needs 10–15 multi-cabin proton (and ion) centers. Currently, there are one experimental PT center in the JINR, where up to 100 patients are exposed pea year. The modern proton center was commissioned at the Medical Institute Sergei Berezin in St. Petersburg with two gantry of company Varian. The IBA proton center in Dimitrovgrad is expected. The single-cabin proton complex of domestic production has been operating in Obninsk since 2017. 20th-century technologies and the horizontal beam (without the possibility of its rotation) are used in this complex for treatment of patients with small head and neck tumors.

Conclusion: Equipping the Russian health care facilities with proton therapy facilities is inevitable. Russia will buy them worldwide for decades, like almost all types of high-tech medical equipment, are bought today, or can produce them locally. All the prerequisites needed for production (rich physical – technical experience, scientific and industrial potential) are available.

Key words: proton therapy, cyclotron, synchrotron, gantry, Bragg curve, malignant neoplasm, local tumor control

REFERENCES

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For citation: Khoroshkov VS. History and Prospects of Proton Therapy. Medical Radiology and Radiation Safety. 2019;64(2):52-60. (Russian).

DOI: 10.12737/article_5ca5fc2765c9f5.02525917

PDF (RUS) Full-text article (in Russian)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 2. P. 41–51

DOI: 10.12737/article_5ca5faca81d911.03586886

A.S. Samoylov1, Zh.Zh. Smirnova1, V.A. Klimanov1,2, V.V. Yakovlev3, L.I. Shulepova4, Yu.D. Udalov1

The Main Directions of Clinical Application of Modern Proton Therapy

1. A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. National Research Nuclear University MEPhI, Moscow, Russia;
3. S.M. Kirov Military Medical Academy, Saint-Petersburg, Russia;
4. Federal High-Tech Center for Medical Radiology of Federal Medical Biological Agency, Dimitrovgrad, Russia

A.S. Samoylov – Director General, Dr. Sci. Med., Prof. RAS;
Zh.Zh. Smirnova – Head of Medical Physics Laboratory;
V.A. Klimanov – Leading Researcher, Dr. Sci. (Phys-Math), Professor at NRNU MEPhI;
V.V. Yakovlev – Dr. Sci. Med., Prof.;
L.I. Shulepova – Director General;
Yu.D. Udalov – Deputy Director General, PhD Med.

Abstract

This paper analyzes the current state of clinical application of proton radiation therapy (PRT) for the treatment of cancer. In particular, the indications for the use of PRT for the treatment of specific pathologies, the results and condition of randomized clinical studies of PRT compared to photon radiation therapy (PhRT) are considered, the cost of PRT is compared with the cost of PhRT. The focus is on discussing the results of PRT using in advanced countriesand Russia for the treatment of several common tumor sites. In the conclusion of the work, the ways of further improvement of radiobiology, dose delivering technology and dosimetric support of PRT are considered.

Key words: proton therapy, oncology, medical indications, clinical results, randomized clinical trials

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For citation: Samoylov AS, Smirnova ZhZh, Klimanov VA, Yakovlev VV, Shulepova LI, Udalov YuD. The Main Directions of Clinical Application of Modern Proton Therapy. Medical Radiology and Radiation Safety. 2019;64(2):41-51. (Russian).

DOI: 10.12737/article_5ca5faca81d911.03586886

PDF (RUS) Full-text article (in Russian)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 2. P. 23–32

DOI: 10.12737/article_5ca5e2677a1a06.60363700

V.A. Klimanov1,2, A.S. Samoylov2, A.E. Gadzhinov3, Ya.A. Peshkin3

Physics of Proton Therapy Treatment Planning

1. National Research Nuclear University MEPhI, Moscow, Russia, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia;
3. Federal High-Tech Center for Medical Radiology of Federal Medical Biological Agency, Dimitrovgrad, Russia

V.A. Klimanov – Leading Researcher, Dr. Sci. Phys.-Math., Prof.;
A.S. Samoylov – Director General, Dr. Sci. Med., Prof. RAS;
A.E. Gadzhinov – radiotherapist;
Ya.A. Peshkin – radiologist

Abstract

The most important stage of radiation therapy of oncological diseases is the planning of radiation treatment. In this work, this complex process in relation to proton therapy is proposed to be divided into medical and physical planning. In conventional therapy with photons and electrons, the latter is usually called dosimetric planning, however, when applied to proton radiation therapy, this stage involves a significantly wider range of tasks related to the modification and scanning of the proton beam, spreading and compensation of ranges, taking into account when planning for uncertainties and finiteness of proton ranges, a decrease in the contribution to the dose of secondary neutrons, the creation of error-tolerant optimization algorithms for dosimetric plans, and, finally, a precision calculation of dose distributions. The paper discusses the main stages and problems of physical planning of proton radiation therapy. Particular attention is paid to the formation of an extended high-dose region (extended Bragg peak) using the beam scattering method and scanning method, and to the algorithms for calculating the dose distributions created by protons in the scattering and beam scanning systems. The most detailed consideration is given to different versions of the proton pencil beam method, which allows to increase the dose calculation accuracy and take into account the transverse scattering and fluctuations in proton energy losses, especially at the end of the path (halo effect), analytical and numerical methods. Scanning are divided into three main technologies: homogeneous scanning, single field uniform dose (SFUD), multi-field uniform dose (MFUD), often called intensity modulated proton therapy (IMPT). Actual accounting problems are considered when planning the irradiation of the movement of organs, and uncertainties in determining path lengths and optimization of irradiation plans. In particular features, problems and modern approaches to the optimization of dosimetry plans of proton radiation therapy are discussed. It is noted that one of the most promising practical solutions for the uncertainty management in determining the path lengths of protons in optimization is to include possible errors in the objective function of the optimization algorithm. This technique ensures that an optimized irradiation plan will more reliably protect normal tissues and critical organs adjacent to the irradiation target from overexposure.

Key words: radiotherapy, protons, proton scattering, range modulation, pencil beam, dose, organ movement, range uncertainty, planning optimization

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For citation: Chernyaev AP, Klenov GI, Bushmanov AYu, Pryanichnikov AA, Belikhin MA, Lykova EN. Proton Accelerators for Radiation Therapy. Medical Radiology and Radiation Safety. 2019;64(2):11-22. (Russian).

DOI: 10.12737/article_5ca5e2677a1a06.60363700

PDF (RUS) Full-text article (in Russian)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 2. P. 33–40

DOI: 10.12737/article_5ca5e40c3f79b9.76178616

A.G. Tsovyanov1, P.P. Gantsovskii1, N.K. Shandala1, S.M. Shinkarev1, V.V. Romanov2

Problems of Ensuring Radiation Safety of Personnel when Operating Proton Therapeutic Accelerators Using an Example of the Proton Therapy Center in Dimitrograd

1. A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. Federal Medical Biological Agency, Moscow, Russia

A.G. Tsovyanov – Head of Lab., Member of the Russian branch of the International Association for Radiation Protection;
P.P. Gantsovskii – Engeneer, Member of the Russian branch of the International Association for Radiation Protection;
N.K. Shandala – Deputy Director General, Dr. Sci. Med., Member of the Russian branch of the International Association for Radiation Protection;
S.M. Shinkarev – Head of Dep., Dr. Sc. Tech., Member of the Russian branch of the International Association for Radiation Protection;
V.V. Romanov – Deputy Head, PhD Biol., Chief State Sanitary Doctor of the FMBA of Russia

Abstract

Currently, charged particle accelerators are used not only as a tool for basic research, but they are also becoming increasingly common in industry and medicine. In Russia in the coming years it is planned to create 3 centers of proton and ion therapy. At the same time, the instrumental, methodological, metrological and regulatory support of radiation monitoring does not currently correspond to the energy range of the generated radiation. The paper analyzes the compliance of existing regulatory and advisory documents with the goals of ensuring radiation safety during proton therapy.

Key words: therapeutic proton accelerators, high-energy ionizing radiation, secondary radiation, radiation safety

REFERENCES

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For citation: Tsovyanov AG, Gantsovskii PP, Shandala NK, Shinkarev SM, Romanov VV. Problems of Ensuring Radiation Safety of Personnel when Operating Proton Therapeutic Accelerators Using an Example of the Proton Therapy Center in Dimitrograd. Medical Radiology and Radiation Safety. 2019;64(2):33-40. (Russian).

DOI: 10.12737/article_5ca5e40c3f79b9.76178616

PDF (RUS) Full-text article (in Russian)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 2. P. 11–22

DOI: 10.12737/article_5ca5a0173e4963.18268254

A.P. Chernyaev1, G.I. Klenov2, A.Yu. Bushmanov3, A.A. Pryanichnikov1 ,4, M.A. Belikhin1 ,4 , E.N. Lykova1

Proton Accelerators for Radiation Therapy

1. M.V. Lomonosov Moscow State University, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. Institute for Theoretical and Experimental Physics, Moscow, Russia;
3. A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia;
4. The Lebedev Physical Institute of the Russian Academy of Sciences, Protvino, Russia

A.P. Chernyaev – Head of Dep., Dr. Sci. Phys.-Math., Prof.;
G.I. Klenov – Head of Dep., Dr. Sci. Tech.;
A.Yu. Bushmanov – First Deputy Director General, Dr. Sci. Med., Prof.;
A.A. Pryanichnikov – PhD Student, Research Engineer;
M.A. Belikhin – PhD Student, Research Engineer;
E.N. Lykova – Lecturer of Dep.

Abstract

Purpose: To make an analysis (including statistical data) of accelerator equipment for proton therapy (PT) in Russia and the world; to identify the main trends and directions of development in this area.

Material and methods: Currently, proton therapy is developing rapidly in the world. Every year new proton centers are built. The number of commercial companies and research institutes, that are included in this high-tech sector, grows every year. Physicists and doctors together actively develop and introduce new ideas and technologies that are able to increase the efficiency and quality of proton therapy and also make it less costly. This review is an analysis of both publications in refereed publications, and reports made at relevant conferences and seminars. In addition, the data presented in the review are based on the information from the companies-manufacturers of equipment for proton therapy, which is open or provided for non-commercial use, with an indication of the sources.

Results: In recent years, the main trends in the development of accelerators for proton therapy are: reducing the size and weight of machines, using of active pencil scanning as a standard method of dose delivering, reducing the time spent by patients in treatment rooms, using modulated radiation intensity in proton therapy. There is a transition from the construction of multi-cabin PT centers with an annual number of patients about 1000 people (due to their high cost and need to have an infrastructure for such big number of patients), to the creation of small-sized single-cabin complexes with an annual flow of several hundred people.

Conclusion: Despite proton therapy has a good promotion and popularization activities, it is still an inaccessible method for most cancer patients with the exception of the United States, Japan and Europe. The lack of PT centers, the price per course of treatment, the lack of specialists in this area, and the attitude of most clinicians to PT as an experimental method of treatment is acute. In Russia, proton therapy does not receive enough support, despite the enormous potential and extensive experience that has been used for half a century of using PT. The last open proton center is private, and the only local manufacturer of equipment for PT exists only thanks to foreign contracts. Nevertheless, research and development continues. Moreover, the development is equal to the level of leading countries.

Key words: proton therapy, particle accelerators, cyclotron, synchrotron, Bragg curve

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For citation: Chernyaev AP, Klenov GI, Bushmanov AYu, Pryanichnikov AA, Belikhin MA, Lykova EN. Proton Accelerators for Radiation Therapy. Medical Radiology and Radiation Safety. 2019;64(2):11-22. (Russian).

DOI: 10.12737/article_5ca5a0173e4963.18268254

PDF (RUS) Full-text article (in Russian)

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