Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 2. P. 47-54

RADIATION THERAPY

DOI: 10.12737/article_5ac620f416a449.50054749

On Some Methodological Issues of Studying Cytogenetic Effects in Cancer Patients Treated with Neutron Therapy Using U-120 Cyclotron

V.A. Lisin

Tomsk Cancer Research Institute, Tomsk, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

V.A. Lisin - Dr. Sc. Tech., Prof.

Abstract

Purpose: To study dosimetric characteristics of neutron radiation field, to determine their role in the formation of the total cytogenetic effect in the patient’s body and to assess the cytogenetic dosimetry capabilities in improving the quality of NT.

Material and methods: A therapeutic beam with the average neutron energy of ~6.3 MeV was obtained from the V-120 cyclotron. The radiation field of the beam was investigated with the help of two ionization chambers with different sensitivity to neutrons. Chamber with high and low sensitivities were made of polyethylene and graphite, respectively. To exclude the uncertainty associated with the change in beam intensity in time, a dosimeter monitor operating in the integral mode was used.

Results: The dependence of the monitor factor on the irradiated area was measured. The distributions of the absorbed dose of neutrons and γ-radiation over the depth of the tissue-equivalent medium were found. The contribution of γ-radiation to the neutron dose was increased from ~10 % at the entry to the medium to ~30 % at a depth of 16 cm. Dose distributions of scattered neutron and γ-radiation in the plane of the end face of the forming device were obtained. The contribution of these radiations to the dose received by the patient’s body was estimated. This contribution was shown to be comparable with that from the therapeutic beam. The analysis of the influence of NT on the estimation of the frequency of chromosome aberrations in the blood of patients was carried out.

Conclusion: The frequency of chromosome aberrations in the blood of patients was determined by the whole-body dose, including dose due to scattered radiation. When using equal focal doses, the cytogenetic effect was found to be dependent on the area of the irradiated field and the depth of the tumor in the patient’s body. The differences in the RBE of neutrons and γ-radiation as well as the instability of the therapeutic neutron beam intensity create uncertainties that do not allow for the necessary control over the doses using the cytogenetic dosimetry. Therefore, cytogenetic dosimetry should be combined with an effective instrument dosimetry method.

The use of biodosimetry based on the assessment of the frequency of chromosome aberrations is promising for controlling the average whole-body dose, on which the overall radiation response of the body depends.

Key words: neutron therapy, cytogenetic effect, cyclotron U-120

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For citation: Lisin VА. On Some Methodological Issues of Studying Cytogenetic Effects in Cancer Patients Treated with Neutron Therapy Using U-120 Cyclotron. Medical Radiology and Radiation Safety. 2018;63(2):47-54. Russian. DOI: 10.12737/article_5ac620f416a449.50054749.

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

Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 2. P. 33-40

RADIATION EPIDEMIOLOGY

DOI: 10.12737/article_5ac61ede369432.74296396

Risk Assessment and Dose Thresholds at the Plutonium Pnevmosclerosis

S.V. Osovets, T.V. Azizova, E.S. Grigoryeva

Southern Urals Biophysics Institute, Ozyorsk, Chelyabinsk region, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

S.V. Osovets - Senior Researcher, PhD Tech., T.V. Azizova - Deputy Director, Head of Dep., PhD Med., ICRP Committee Member; E.S. Grigoryeva - Researcher

Abstract

Purpose: To assess risks curves, dose thresholds, and their uncertainties for plutonium-induced pneumosclerosis (PPS) among Mayak PA workers based on developed methods of mathematical modeling.

Material and methods: PPS risk modeling with further calculation of dose thresholds and their uncertainties was performed using a comparative analysis of estimates of individual absorbed lung doses from incorporated plutonium-239 provided by two Mayak Worker Dosimetry Systems: MWDS-2008 and MWDS-2013. To carry out the calculations, four groups of workers were formed: workers with PPS induced only by plutonium (pure PPS; n = 107); workers with PPS induced by both plutonium and other factors (mixed PPS; n = 46); workers with undefined PPS (n = 153); control workers (comparison group; n = 188). Weibull’s dose distribution model was applied to assess risk curves. Dose distribution parameters were calculated using the least square technique. Dose thresholds were estimated using two basic methods: quantile threshold method and estimation based on dose distribution functions for each group with PPs and the comparison group. Common uncertainties were calculated using two methods: Monte-Carlo method and error propagation.

Results: Risk curves were plotted based on Weibull’s models for three groups of workers diagnosed with PPS. Modeling results were statistically significant (R² = 0.96 - 0.99) with both dosimetry systems used (MWDS-2008 and MWDS-2013). Median absorbed lung alpha-dose (D₅₀) estimated using Weibull’s model varied significantly with the dosimetry system. E.g., in the group with pure PPS D₅₀= 0.79 Gy when MWDS-2008 was used while the corresponding estimate was D₅₀= 2.05 Gy when MWDS-2013 was used, demonstrating more than a two-fold difference between the estimates. Dose thresholds for PPS occurrence and their standard uncertainties were estimated. With MWDS-2013 used, the dose thresholds were D₀= 0,63 Gy for the lung and D₀= 1.0 Gy for alveolar-interstitial lung tissues, respectively. The mean relative uncertainty of these thresholds was U = 23 %. Quantile dose thresholds were an order of magnitude lower than those above and their standard uncertainty, on the contrary, was 23 % higher: the mean uncertainty of 5 % quantile was U = 60 % while the corresponding value for 1 % quantile was U = 95 %.

Conclusions: For the first time dose thresholds and their uncertainties for the formation of PPS with internal alpha irradiation were estimated. The reported results are of considerable interest both for scientific and practical application in radiation safety and medicine.

Key words: plutonium pneumosclerosis, risk, dose thresholds, Weibull distribution, standard uncertainty, Mayak PA

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For citation: Osovets SV, Azizova TV, Grigoryeva ES. Risk Assessment and Dose Thresholds at the Plutonium Pnevmosclerosis. Medical Radiology and Radiation Safety. 2018;63(2):33-40. Russian. DOI: 10.12737/article_5ac61ede369432.74296396

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Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 2. P. 41-46

NUCLEAR MEDICINE

DOI: 10.12737/article_5ac61fd62feba6.78437892

Osteoscintigraphy and SPECT/CT in the Diagnosis of Various Variants of Bone Metastases

A.D. Ryzhkov, A.S. Krylov, A.B. Bludov, S.V. Shiryaev

N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

A.D. Ryzhkov - Senior Researcher, Dr. Sc. Med.; A.S. Krylov - Radiologist, PhD Med, Member of the European Association of Nuclear Medicine and Molecular Imaging (EANMMI); A.B. Bludov - Research Worker, PhD Med.; S.V. Shiryaev - Head of Lab., Dr. Sc. Med., President of the OSMI, Member of EANMMI, Member of ACNMMI, Member of SNMMI

Abstract

Purpose: To determine the diagnostic capabilities of body scan (BS) and SPECT/CT in the diagnosis of various variants of bone metastases (BM).

Material and methods: The data of 37 patients with BM of breast cancer (20 patients), prostate cancer (7 patients) and other tumors various localization (10 patients) were analyzed. The study was carried out in two stages: first, BS was performed, 3 hours after intravenous introduction of an osteotropic radiopharmaceutical labeled with ^99mTc (technephor or phosphotech), followed by SPECT/CT of the selected zone of interest. All studies were performed on a combined system Symbia T2 (Siemens) with a 2-slice low dose CT.

Results: With BS the foci of the tumor lesion were identified in 33 cases, and in SPECT/CT in 37 cases. There were detected 159 BM (21 sites: 0.4-0.9, 59 sites: 1.0-1.9, 79 sited: 2.0-4.5 сm). The total detectable incidence of metastases with BS was 66.0 % (105 BM) of all metastases detected in comparison with SPECT/CT (159 BM). Detectability with BS increased with increasing size of detectable foci. Foci less than 1 cm are detected in isolated case (1 from 21 cases). Metastases measuring from 1 cm to 1.9 cm are detected only in 52.5 % of cases (31 from 59 cases). The detectability of large metastases (2 cm or more) with BS (92.4 %) approaches the SPECT/CT (100 %) - 73 from 79 cases.

There were detected with BS 27 osteoblastic BM in comparison 56 BM with SPECT/CT (48.2 %). The detectability with BS of mixed BM (76.3 %) and octeolitic BM (75.4 %) showed no differences. Firstly it can be explained by a predominance of smaller osteoblastic foci, and secondly reparative processes in metastases, accompanied by reduction of the radiopharmaceutical. The correction of the conclusion of the BS was required just in 24 cases: in 8 cases, when the BS was marked overdiagnosis, 16 - underdiagnosis. However, BS does not lose its value as a screening. In one case, even if BS has been revealed metastasis, it is not yet accompanied by destruction of bone tissue.

Despite such significant differences in diagnostic accuracy of BS and SPECT/CT, BS proved to be uninformative only in 2 cases: when undetected metastases without primary tumor identified, and in the case of the screening of metastasis the accumulation of the radiopharmaceutical in the bladder. In 2 other cases, the lack of accumulation of the radiopharmaceutical was determined by the reparation that can only be considered conditionally uninformative.

However, SPECT/CT shows clear advantages in the visualization of bone metastases due to computed tomography, allowing to estimate the structure of bone tissue. In 9 cases even to SPECT-slices metastases were not accompanied by pathological accumulation of the radiopharmaceutical.

Conclusion: SPECT/CT is a highly informative method for detecting bone metastases, the use of which allows reducing the time of examination and dose irradiation of patients due to the rejection of additional radiological procedures. In addition, SPECT/CT at the same time allows differential diagnosis of structural and metabolic bone changes, which increases both the accuracy of primary diagnosis and control of treatment.

Key words SP: ECT/CT, bone scintigraphy, bone metastases

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For citation: Ryzhkov AD, Krylov AS, Bludov AB, Shiryaev SV. Osteoscintigraphy and SPECT/CT in the Diagnosis of Various Variants of Bone Metastases. Medical Radiology and Radiation Safety. 2018;63(2):41-6. Russian. DOI: 10.12737/article_5ac61fd62feba6.78437892.

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Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 2. P. 25-32

RADIATION MEDICINE

DOI: 10.12737/article_5ac61d88969a97.33709654

Mathematical Model and Software for Prognosis the of Probability of the Lethal Outcome of Oncosurgical Patients Exposed to Radiation Exposure in the Conditions of Production

Yu.D. Udalov¹, I.V. Vasilyeva¹, A.V. Gordienko², S.A. Bakharev¹

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. S.M. Kirov Military Medical Academy, Saint-Petersburg, Russia

Yu.D. Udalov - PhD Med., Deputy Director General; I.V. Vasilyeva - PhD Med., Medical Statistician; A.V. Gordienko - Dr. Sc. Med., Prof., Head of Dep.; S.A. Bakharev - Physician, Anesthesiologist

Abstract

Purpose: Identification of risk factors that influence the outcome of the patient, their ranking on the contribution to the outcome of treatment, as well as determining the possibility of their additional diagnostic evaluation and correction in the deviation at the preoperative preparation stage with the subsequent construction of a prognostic model.

Material and methods: The study included patients who received treatment in the surgical department in A.I. Burnasyan Federal Medical Biophysical Center from January 2009 to July 2017, including workers of nuclear facilities that are exposed to ionizing radiation in professional conditions. The study was conducted in 112 patients, 42 of whom (37.5 %) were men and 70 (62.5 %) women aged 25 to 85 years (59.6 ± 13.2). Among the persons included in the study, 25 men and 26 women were exposed to long-term exposure to ionizing radiation from external sources under production conditions during labor activity within the limits of annual maximum permissible doses, averaged 124.6 ± 10.7 mSv. The work experience under conditions of exposure to ionizing radiation ranged from 5 to 35 years, an average of 24 years. The mean age was 59.1 ± 13.4 years. At the end of hospitalization after surgical treatment, 51 patients were discharged (45.5 %), and 61 (54.5 %) died. In all patients, the parameters of the functioning of various organs and systems were collected, including taking into account the anamnestic data of oncological patients, with differentiation in the final outcome of surgical treatment. To determine the leading risk factors for the lethal outcome of the oncosurgical patient, the Fisher criterion χ² was used. Based on the leading risk factors for constructing mathematical models, the logistic regression equation was used. The mathematical models were analyzed by researching the area under the ROC curves.

Results: Using the Fisher criterion χ², factors were determined by which the groups of survivors and died patients differ: patient age, body mass index, history of heart rhythm disorders, fraction of cardiac output, Hb level in the blood, presence of protein in urine, INR indicator in coagulograms. Based on the identified factors, twelve mathematical models were constructed using the binary logistic regression method, allowing patients to be divided into groups with the outcomes of hospitalization died / survived after surgery. A mathematical model with the best discriminating ability was chosen. Based on the prognostic model, a decision rule was designed that allows to rank patients into three groups: green (patients with a minimal risk of death), yellow (patients who need preoperative correction), red (patients with the maximum risk of death, decision about surgery is necessary to be solved on a consultation).

Key words: prognostic score, prognosis of lethal outcome of oncosurgical patients, radioactive exposure

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For citation: Udalov YuD, Vasilyeva IV, Gordienko AV, Bakharev SA. Mathematical Model and Software for Prognosis the of Probability of the Lethal Outcome of Oncosurgical Patients Exposed to Radiation Exposure in the Conditions of Production. Medical Radiology and Radiation Safety. 2018;63(2):25-32. Russian. DOI: 10.12737/article_5ac61d88969a97.33709654

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