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Biomedical subjects

E G Moros

Publications and source records attributed to E G Moros.

At least 37 records · Page 2Linked to original sources

Simplified model and measurement of specific absorption rate distribution in a culture flask within a transverse electromagnetic mode exposure system.

In vitro experiments in bioelectromagnetics frequently require the determination of specific absorption rate (SAR) within a layer of cells on the bottom of a culture flask when the SAR has rapid spatial variation both horizontally within the cell layer and vertically in the medium bathing the cells. This problem has only recently been treated in the literature; and it is here approached differently for another irradiation system. It is shown that a simple two-dimensional frequency-domain guided-wave treatment yields results qualitatively comparable to those of more computationally intensive three-dimensional time-domain free-field scattering treatments. The problem of inferring local SARs from temperature-vs.-time curves is shown to be seriously confounded by thermal diffusion; and specific analytic and numerical results are presented to aid in understanding this effect. A novel experimental technique is introduced for measuring millikelvin temperature offsets with subsecond resolution, and illustrative experimental data are presented. Finally, present experimental and theoretical uncertainties are considered; and it is pessimistically asserted that, in a culture flask where spatial SAR variation is rapid, point SAR measurements by thermal methods may be in error by as much as +/- 3 dB. More reliable thermal determinations will require extreme care, challenging technological innovations, or both.

Cells, Cultured↗

Ultrasound power deposition model for the chest wall.

An ultrasound power deposition model for the chest wall was developed based on secondary-source and plane-wave theories. The anatomic model consisted of a muscle-ribs-lung volume, accounted for wave reflection and refraction at muscle-rib and muscle-lung interfaces, and computed power deposition due to the propagation of both reflected and transmitted waves. Lung tissue was assumed to be air-equivalent. The parts of the theory and numerical program dealing with reflection were experimentally evaluated by comparing simulations with acoustic field measurements using several pertinent reflecting materials. Satisfactory agreement was found. A series of simulations were performed to study the influence of angle of incidence of the beam, frequency, and thickness of muscle tissue overlying the ribs on power deposition distributions that may be expected during superficial ultrasound (US) hyperthermia of chest wall recurrences. Both reflection at major interfaces and attenuation in bone were the determining factors affecting power deposition, the dominance of one vs. the other depending on the angle of incidence of the beam. Sufficient energy is reflected by these interfaces to suggest that improvements in thermal doses to overlying tissues are possible with adequate manipulation of the sound field (advances in ultrasonic heating devices) and prospective treatment planning.

Computer Simulation↗

Experimental assessment of power and temperature penetration depth control with a dual frequency ultrasonic system.

A novel ultrasound applicator for superficial simultaneous thermoradiotherapy consisting of two parallel-opposed linear arrays and a double-sided scanning reflector was constructed and tested for penetration depth control. In this design the arrays operate at different frequencies (1 and 5 MHz, in this study) and the input power to each array element (five 2 X 2 cm2 elements per array) is computer adjustable. The ultrasonic beams from the arrays are aimed at the scanning reflector which in turn deflects them simultaneously and in parallel toward the treatment volume. Relative intensity distributions generated by the prototype were measured in a degassed water phantom using a thermal technique for a selected reflector position; these showed that the ultrasonic intensity distribution can be controlled in the lateral dimensions by varying the input power level to individual array elements. A fixed-perfused canine kidney phantom was employed to demonstrate experimentally that real time penetration depth control is possible by varying the excitation magnitude of one array (frequency) relative to that of the other. It is concluded that the dual-frequency scanned-reflected ultrasound applicator offers a degree of dynamic three-dimensional control of the power deposition pattern of clinical significance.

Animals↗

Compact shielded exposure system for the simultaneous long-term UHF irradiation of forty small mammals. II. Dosimetry.

A four-antenna collinear array in an electromagnetically shielded chamber was designed and constructed to preferentially irradiate the brains of a large number of small mammals using cellular telephony microwave signals. Ten animals in special restrainers were positioned symmetrically around a centrally located antenna. These restrainers are resting on a circular structure made of acrylic plastic called a "carousel." Four carousels are stacked vertically, forming the array, inside a microwave anechoic chamber called a "chamberette." (Details of the design of this irradiator and of a 12-chamberette irradiation facility are given in a previous article.) In this article, the dosimetry on rats is reported. Both thermometric and thermographic measurements were performed. The average specific absorption rate (SAR) in brain tissue measured thermometrically was 0.85+/-0.34 W/kg per watt of net input power into the radiating antenna. This range agrees with the SAR levels reported in the literature for cellular telephones. Thermographic evaluation using splittable phantoms showed that most of the energy absorbed by the rats is concentrated in and around the brain. Moreover, it was found that the SAR in brain tissue can vary considerably for rats of similar weights, depending on position of the rats' heads inside the restrainers, and that there exists a significant dependence of SAR on animal weight. These variations may be of importance in the interpretation of results of lifelong studies. The data presented clearly show that the chamberette is, dosimetrically, a suitable irradiation system for electromagnetic bioeffects studies in the cellular communication frequency range, especially when a large number of laboratory animals is required.

Animals↗

Proto-oncogene mRNA levels and activities of multiple transcription factors in C3H 10T 1/2 murine embryonic fibroblasts exposed to 835.62 and 847.74 MHz cellular phone communication frequency radiation.

This study was designed to determine whether two differently modulated radiofrequencies of the type generally used in cellular phone communications could elicit a general stress response in a biological system. The two modulations and frequencies studied were a frequency-modulated continuous wave (FMCW) with a carrier frequency of 835.62 MHz and a code division multiple-access (CDMA) modulation centered on 847.74 MHz. Changes in proto-oncogene expression, determined by measuring Fos, Jun, and Myc mRNA levels as well as by the DNA-binding activity of the AP1, AP2 and NF-kappaB transcription factors, were used as indicators of a general stress response. The effect of radiofrequency exposure on proto-oncogene expression was assessed (1) in exponentially growing C3H 10T 1/2 mouse embryo fibroblasts during their transition to plateau phase and (2) during transition of serum-deprived cells to the proliferation cycle after serum stimulation. Exposure of serum-deprived cells to 835.62 MHz FMCW or 847.74 MHz CDMA microwaves (at an average specific absorption rate, SAR, of 0.6 W/kg) did not significantly change the kinetics of proto-oncogene expression after serum stimulation. Similarly, these exposures did not affect either the Jun and Myc mRNA levels or the DNA-binding activity of AP1, AP2 and NF-kappaB in exponential cells during transit to plateau-phase growth. Therefore, these results suggest that the radiofrequency exposure is unlikely to elicit a general stress response in cells of this cell line under these conditions. However, statistically significant increases (approximately 2-fold, P = 0.001) in Fos mRNA levels were detected in exponential cells in transit to the plateau phase and in plateau-phase cells exposed to 835.62 MHz FMCW microwaves. For 847.74 MHz CDMA exposure, the increase was 1.4-fold (P = 0.04). This increase in Fos expression suggests that expression of specific genes could be affected by radiofrequency exposure.

Animals↗

On the assumption of negligible heat diffusion during the thermal measurement of a nonuniform specific absorption rate.

The problem of measuring a spatially varying specific absorption rate (SAR) by thermal techniques is treated both analytically and numerically. It is shown that, unless the measurement is attempted at an inflection point of the SAR distribution, it will be confounded by thermal diffusion within the medium. Rules of thumb are provided to enable the experimenter to gauge the thermal conduction contributions (i.e. error) to the thermally determined SAR near a spatial extremum. The simplest of these is that the width t(m) [s] of the time window, over which temperature variation associated with SAR is measured, should satisfy the inequality t(m) </approximately alpha(2)/pi(2)D, where alpha [m] is a characteristic length scale of the spatial variation of the SAR and D [m(2)/s] is the thermal diffusivity of the medium. The above considerations are valid, independent of the source of the deposited energy.

Absorption↗

Radiofrequency electromagnetic fields have no effect on the in vivo proliferation of the 9L brain tumor.

The intracranial 9L tumor model was used to determine if exposure to a radiofrequency (RF) electromagnetic field similar to those used in cellular telephone has any effects on the growth of a central nervous system tumor. Fischer 344 rats implanted with different numbers of 9L gliosarcoma cells were exposed to 835.62 MHz frequency-modulated continuous wave (FMCW) or 847.74 MHz code division multiple access (CDMA) RF field with nominal slot-average specific absorption rates in the brain of 0.75 +/- 0.25 W/kg. The animals were exposed to the RF field for 4 h a day, 5 days a week starting 4 weeks prior to and up to 150 days after the implantation of tumor cells. Among sham-exposed animals injected with 2 to 10 viable cells (group 1), the median survival was 70 days, with 27% of the animals surviving at 150 days. The median survival length and final survival fraction for animals injected with 11 to 36 viable cells (group 2) were 52 days and 14%, respectively, while the values for those injected with 37 to 100 cells (group 3) were 45 days and 0%. The animals exposed to CDMA or FMCW had similar survival parameters, and the statistical comparison of the survival curves for each of the groups 1, 2 and 3 showed no significant differences compared to sham-exposed controls.

Animals↗

A compact shielded exposure system for the simultaneous long-term UHF irradiation of forty small mammals: I. Electromagnetic and environmental design.

To carry out in vivo studies of the possible health effects of radiation from cellular telephone handsets, it is necessary to expose large numbers of small mammals at realistic power densities, modulations, and frequencies. Because even microwatt leakage could compromise the local cellular system, extreme care in shielding is required. Experimental logistics dictate, however, that the irradiated animals be easily accessed and that it be possible to irradiate them in small groups, while other groups are being loaded into or unloaded from the irradiators. This problem has been resolved by exposing the animals in aluminum-sheathed rectangular parallelepipeds, lined with microwave absorber and having doors that can be opened readily. Inside each of these microwave anechoic "chamberettes" is a vertical, four-element collinear array of dipole antennas; and around each antenna, 10 animal restrainers can be arranged like spokes on a wheel. The system has worked efficiently in studies of up to 480 rats. There is negligible coupling between antennas, and back reflection at an antenna's feed line is down 7-9 dB. Received CDMA power at the local base station is below the receiver's noise floor. Interior illumination reinforces the rats' diurnal rhythms, and the rats sleep during irradiation. Experimental logistics are excellent. In this paper, the irradiator design is presented.

Absorption↗

An investigation of penetration depth control using parallel opposed ultrasound arrays and a scanning reflector.

A theoretical study of penetration depth control in superficial hyperthermia utilizing parallel opposed linear ultrasound arrays and a double-faced (V-shaped) scanning reflector is presented. This is a dual array system (DAS), where one array operates at a low frequency and the other at a high frequency (1 and 5 MHz, respectively in this study). The arrays are positioned facing each other and both are aimed at a double-faced scanning reflector which distributes the energy over the scanned surface. Each reflecting surface is angled at 45 degrees with respect to the sound propagation direction so that both beams are deflected in the same direction toward the treatment volume. The system was designed to be compatible for combined operation with a medical linear accelerator for the delivery of simultaneous thermoradiotherapy. It is demonstrated that by varying the excitation magnitude of one array relative to the other, it is possible to control the magnitude of absorbed energy as a function of depth, and thus improved control of the heating pattern in all three spatial dimensions is obtained. This improvement is demonstrated with bio-heat transfer simulations which show how penetration depth control translates into control of temperature distributions. The simulations also show that the DAS is able to produce more uniform temperature distributions in highly perfused tissue.

Auditory Perception↗

Acoustic field prediction for a single planar continuous-wave source using an equivalent phased array method.

Phased array theory is combined with the Rayleigh-Sommerfeld diffraction integral to predict measured acoustic fields generated by a single-source ultrasonic transducer. The idea is to treat a single-source as a "phased array," which is composed of many small elements. The goal is to find the excitation source for the phased array, that is, the amplitude and phase for each array element, which produces an acoustic field similar to the experimentally measured field generated by the single-source transducer. A pressure field measured at a given plane parallel and close to the face of the transducer in degased water was used to calculate the excitation source of the equivalent phased array using an inverse technique. The excitation source of the equivalent phased array was then used to calculate the acoustic field from this measurement plane to the far field. It was demonstrated that this phased array approach accurately predicted the location of major grating lobes and the general distributions of the near and far pressure fields for four different transducers. This equivalent phased array method (EPAM) used to model a single-source transducer should be useful in both diagnostic and therapeutic ultrasound applications.

Acoustics↗

Measurement of DNA damage after exposure to 2450 MHz electromagnetic radiation.

Recent reports suggest that exposure to 2450 MHz electromagnetic radiation causes DNA single-strand breaks (SSBs) and double-strand breaks (DSBs) in cells of rat brain irradiated in vivo (Lai and Singh, Bioelectromagnetics 16, 207-210, 1995; Int. J. Radiat. Biol. 69, 513-521, 1996). Therefore, we endeavored to determine if exposure of cultured mammalian cells in vitro to 2450 MHz radiation causes DNA damage. The alkaline comet assay (single-cell gel electrophoresis), which is reportedly the most sensitive method to assay DNA damage in individual cells, was used to measure DNA damage after in vitro 2450 MHz irradiation. Exponentially growing U87MG and C3H 10T1/2 cells were exposed to 2450 MHz continuous-wave (CW) radiation in specially designed radial transmission lines (RTLs) that provided relatively uniform microwave exposure. Specific absorption rates (SARs) were calculated to be 0.7 and 1.9 W/kg. Temperatures in the RTLs were measured in real time and were maintained at 37 +/- 0.3 degrees C. Every experiment included sham exposure(s) in an RTL. Cells were irradiated for 2 h, 2 h followed by a 4-h incubation at 37 degrees C in an incubator, 4 h and 24 h. After these treatments samples were subjected to the alkaline comet assay as described by Olive et al. (Exp. Cell Res. 198, 259-267, 1992). Images of comets were digitized and analyzed using a PC-based image analysis system, and the "normalized comet moment" and "comet length" were determined. No significant differences were observed between the test group and the controls after exposure to 2450 MHz CW irradiation. Thus 2450 MHz irradiation does not appear to cause DNA damage in cultured mammalian cells under these exposure conditions as measured by this assay.

Animals↗

Measurement of DNA damage after exposure to electromagnetic radiation in the cellular phone communication frequency band (835.62 and 847.74 MHz).

Mouse C3H 10T1/2 fibroblasts and human glioblastoma U87MG cells were exposed to cellular phone communication frequency radiations to investigate whether such exposure produces DNA damage in in vitro cultures. Two types of frequency modulations were studied: frequency-modulated continuous-wave (FMCW), with a carrier frequency of 835.62 MHz, and code-division multiple-access (CDMA) centered on 847.74 MHz. Exponentially growing (U87MG and C3H 10T1/2 cells) and plateau-phase (C3H 10T1/2 cells) cultures were exposed to either FMCW or CDMA radiation for varying periods up to 24 h in specially designed radial transmission lines (RTLs) that provided relatively uniform exposure with a specific absorption rate (SAR) of 0.6 W/kg. Temperatures in the RTLs were monitored continuously and maintained at 37 +/- 0.3 degrees C. Sham exposure of cultures in an RTL (negative control) and 137Cs gamma-irradiated samples (positive control) were included with every experiment. The alkaline comet assay as described by Olive et al. (Exp. Cell Res. 198, 259-269, 1992) was used to measure DNA damage. No significant differences were observed between the test group exposed to FMCW or CDMA radiation and the sham-treated negative controls. Our results indicate that exposure of cultured mammalian cells to cellular phone communication frequencies under these conditions at an SAR of 0.6 W/kg does not cause DNA damage as measured by the alkaline comet assay.

Animals↗

An ultrasound system for simultaneous ultrasound hyperthermia and photon beam irradiation.

PURPOSE: An existing ultrasound system has been adapted for simultaneous use with external photon beam irradiation. The system is being used to investigate the potential for increased biological benefit of simultaneously combined hyperthermia and external beam irradiation with currently achievable temperature distributions. METHODS AND MATERIALS: An existing clinical ultrasound system has been modified for simultaneous operation with a 60Co teletherapy machine. The generator, thermometry system, computer, and applicators are located inside the treatment room, while the monitor and system control are located at the control console. Two approaches have been used clinically to combine the two modalities. In the first approach, an en-face setup is used in which the ultrasound beam and the photon beam travel through the same window of entry to the tumor. This is acheived by a reflecting system designed to deflect the ultrasound to the tumor while positioning the ultrasound transducer outside the radiation beam. The reflecting system consists of water and water-equivalent materials except for a 1 mm sheet of polished brass that is used as the reflector. The relative pressure fields were measured in water at the same distance from the ultrasound source using a scanning hydrophone with and without the reflector at the two operating frequencies of the device (1.0 and 3.4 MHz) for two applicators. Radiation dosimetry measurements were performed to determine the relationship between 60Co irradiation through the reflector and absorbed dose. In the second approach the ultrasound and the radiation beam travel into the tumor from different windows of entry such that the radiation beam passes through no portion of the water bolus prior to entering the patient. We have termed this approach the orthogonal approach. For both approaches, the radiation fraction is given in the middle of an uninterrupted 60-min hyperthermia treatment. RESULTS: The system modifications did not impair the ability to effectively deliver ultrasound hyperthermia or 60Co teletherapy. With the en-face approach the ultrasonic patterns generated with and without the reflector demonstrated that the ultrasound system maintained both a uniform and controllable heating pattern. The 60Co beam had no effect on the performance of the thermocouple thermometers. The radiation beam is attenuated nearly uniformly by the reflector system. To date, 10 patients have been treated with the en-face approach and 12 have been treated with the orthogonal approach (90 treatments). CONCLUSIONS: The clinical implementation of ultrasound hyperthermia simultaneous with 60Co irradiation is technically and clinically feasible without any complications or hazards to the patient. The implementation of a reflecting device allows en-face delivery of both the ultrasound and 60Co irradiation. Temperatures obtained during simultaneous treatments are comparable to those historically obtained during sequential treatments with the same commercial ultrasound device.

Calorimetry↗

Simultaneous delivery of electron beam therapy and ultrasound hyperthermia using scanning reflectors: a feasibility study.

PURPOSE: The feasibility of simultaneously delivering external electron beam radiation and superficial hyperthermia using a scanning ultrasound reflector-array system (SURAS) was experimentally investigated and demonstrated. METHODS AND MATERIALS: A new system uses a scanning reflector to distribute the acoustic energy from a planar ultrasound array over the surface of the target volume. External photon/electron beams can be concurrently delivered with hyperthermia by irradiating through the scanning reflectors. That is, this system enables the acoustic waves and the radiation beams to enter the target volume from the same direction. Reflectors were constructed of air-equivalent materials for maximum acoustic reflection and minimum radiation attenuation. Acoustically, the air reflectors were compared to brass reflectors (assumed ideal) for reflectivity and specular quality using several single transducers ranging in frequency from 0.68 to 4.8 MHz. The relative reflectivity was determined from acoustic power measurements using a force-balance technique. The specular quality was assessed by comparing the acoustic pressure fields reflected by air reflectors with those reflected by brass reflectors. Also, acoustic pressure fields generated by a SURAS prototype for two different arrays (2.24 and 4.5 MHz) were measured to investigate field distribution variations as a function of the distance separating the array and the scanning reflector. All pressure fields were measured with a hydrophone in a degassed water tank. Finally, to determine the effect of the air reflectors on electron dose distributions, these were measured using film in a water-equivalent solid phantom after passage of a 20 MeV electron beam through the SURAS. These measurements were performed with the reflector scanning continuously across the electron beam and at rest within the electron beam. RESULTS: The measurements performed using single ultrasound transducers showed that the air reflectors had power reflectivities of 87-96% that of brass, and that for smooth surfaces the reflections from air reflectors were as specular as those from brass reflectors. Acoustic pressure fields measurements of the SURAS for two different arrays showed that the 50% pressure amplitude contours were well-distributed across the projected surface area of the array for different distances separating the array and the reflector. Finally, film dosimetry showed that the electron dose distribution was not affected by the air reflector of the SURAS either for the scanning case or the stationary case. This indicates that the reflectors as made are basically water-equivalent in terms of high energy ionizing radiation. The measured isodoses also indicate that the constructed SURAS prototype would allow the delivery of adequate radiation (90% isodose) to a depth of 2.0 cm. CONCLUSIONS: The results presented show that the SURAS design has the potential to deliver hyperthermia to large superficial tumors, while allowing simultaneous irradiation with 20 MeV electron beams without adverse effects on the radiation dose delivery.

Acoustics↗

High dose-rate induced temperature artifacts: thermometry considerations for simultaneous interstitial thermoradiotherapy.

PURPOSE: The goal of the present study was to investigate the effect of high dose-rate radiation on a flouroptic thermometry system commonly used during microwave hyperthermia. METHODS AND MATERIALS: Measurements were performed by placing the flouroptic thermometry sensors at distances of < or = 1.5, 5, 10, and 15 mm from a remote afterloading high dose-rate 192Ir source in a water bath (at two different temperatures) and in a tissue equivalent radiation bolus medium. A simulated volumetric clinical setup using a radiation bolus medium was performed with thermometry sensors placed at 1.5, 7.5, 8.4, and 10.6 mm from a scanning high dose-rate source. RESULTS: It was found that high dose-rate radiation caused thermometry artifacts greater than 1.5 degrees C within 2 min for flouroptic thermometers placed 1.5 mm from a 5 Ci activity high dose-rate source. Simple calculations showed that artifacts of this magnitude could not be due to any heating caused by the energy deposited by the high dose-rate source. The artifact decayed, but was still evident 24 h after the exposure. The effect strongly depended on distance with a 0.7 degrees C artifactual increase in temperature seen for the probe 5 mm from the high dose-rate source. Moreover, experiments performed under conditions that represented a clinical setup with a 7 Ci high dose-rate source showed that for exposure times of 10 s, at distances of 1.5 mm, significant artifacts (> 0.5 degrees C) are produced. CONCLUSIONS: These findings indicate that high dose-rate-induced temperature artifacts should be taken into account in the quality assurance procedures for the treatment of patients with simultaneous interstitial thermoradiotherapy.

Artifacts↗

A comparison of theoretical and experimental ultrasound field distributions in canine muscle tissue in vivo.

Relative ultrasound field distributions were measured using thermal techniques in canine thighs in vivo and in water. The experimental results were compared with distributions obtained from a numerical model based on the one-dimensional integration of the Rayleigh-Sommerfeld diffraction integral. The comparisons showed that the theoretical model is a good approximation to the distributions measured in water, with the agreement decreasing for regions in front of the acoustic focus. The main lobe profiles obtained in the muscle tissue also agreed well with both theoretical results and results measured in water (focussing was not lost). However, these in vivo distributions showed enlargement of the side lobes indicating scattering of the waves. It was also found that the interfaces between muscle groups produced considerable beam distortions as well as increased side lobe levels. Scattering of energy from the main lobe to the side lobes was verified by measurements of the peak intensity and the total acoustic power attenuation coefficients for passage of the beams through the thighs which showed that the former was about 40% higher than the latter. Also, absolute intensity values at the acoustic focus were measured in water using a hydrophone (0.5 mm active diameter) for 11 transducers ranging in frequency from 0.246 to 3.54 MHz. When these absolute values were compared with the model predictions, it was found that the model consistently overestimated the experimental data by a factor of less than 2. That is, the model can also be used to obtain upper bounds for absolute intensity values. Consequences of these results on ultrasound hyperthermia treatments are discussed.

Animals↗

The impact of ultrasonic parameters on chest wall hyperthermia.

A transient, three-dimensional acousto-thermal numerical model for chest wall anatomies was developed to evaluate the impact of ultrasonic parameters on thermal coverage. The following independent variables were considered: (1) the relative output intensities of the low and high frequency components of an unfocused dual-frequency ultrasonic beam (xi1); (2) the depths of the soft-tissue bone (d(b)) and soft-tissue-lung (d(u)) interfaces; (3) the intensity reflectivities of these interfaces; and (4) the intensity attenuation coefficient of bone. Several important results were obtained. First, acoustic reflections from the underlying bone and lung surfaces may contribute significantly to heating of the overlying soft-tissue. Secondly, a strong dependence of optimal xi1 values on d(b) and d(u) values was found. Chest wall volumes with 2-3 cm of soft-tissue overlying the ribs were optimal targets for unfocused ultrasound hyperthermia. Thirdly, the maximum steady state temperature in bone also strongly depended on xi1. Finally, the largest difference between the maximum temperature in bone and the maximum temperature in soft-tissue during initial transient heating was between -1.4 degrees C and 0.8 degrees C. That is, the maximum temperature in the field, either during the transient period or at steady state, did not always occur in bone. It is concluded that control of power deposition penetrability offers great potential for improving hyperthermia to chest wall targets in real time.

Hyperthermia, Induced↗

Dosimetry and techniques for simultaneous hyperthermia and external beam radiation therapy.

An increased biological effect is realized when hyperthermia and radiation therapy are combined simultaneously. To take advantage of this effect, techniques have been developed that combine existing hyperthermia devices with a linear accelerator. This allows concomitant delivery of either ultrasound or microwave hyperthermia with photon radiation therapy. Two techniques have been used clinically: the orthogonal technique, in which the microwave or ultrasound beam and the radiation beam are orthogonal to one another, and the en face technique, in which the ultrasound or microwave beam and the radiation beam travel into the tumour through the same treatment window. The en face technique has necessitated the development of special attachments so that the hyperthermia device can be mounted to the linear accelerator and so that non-uniform portions of the hyperthermia device can be removed from the radiation beam. For microwave therapy, applicators are mounted onto the linear accelerator using the compensating filter tray holder. For ultrasound, special reflector devices are mounted to a frame that is mounted onto the compensating filter tray holder of the linear accelerator. Because the linear accelerator is an isocentric device, the height of the radiation source is fixed, and this has necessitated specially designed devices so that the ultrasound support system is compatible with the linear accelerator. The treatment setups for both the en face technique and the orthogonal technique require the interaction of both hyperthermia and radiation therapy personnel and equipment. The dosimetry and day-to-day operations for each technique are unique. The simulation for the en face technique is much different from the simulation of a normal radiation treatment and requires the presence of a hyperthermia physicist. Also, for the en face technique, the attenuation of the microwave applicator and the thickness and attenuation of the ultrasound reflector system are taken into account for radiation dosimetry. This paper presents details of the dosimetry and logistics of the techniques for simultaneous thermoradiotherapy based on 7 years of experience treating more than 50 patients.

Cobalt Radioisotopes↗