Biomedical subjects

J F Williamson

Publications and source records attributed to J F Williamson.

At least 73 records · Page 4Linked to original sources

PubMed1995

Clinical quality management in Air Force optometry.

BACKGROUND: Promoting professional competence, providing quality care, and improving health care processes are issues of major importance in Air Force Optometry as well as the entire Air Force Medical Service. METHODS: Clinical Quality Management is the mechanism through which these issues are addressed. Without a Quality Management Program, accreditation by the Joint Commission on Accreditation of Healthcare Organizations is impossible. RESULTS: The two main components of Clinical Quality Management; the credentials/privileging process and quality assessment and improvement, are presented to discuss how they are used in Air Force Optometry. CONCLUSION: Clinical Quality Management is not a perfect management method, but it does force professionals and organizations to constantly assess themselves in order to effect improvements.

Aerospace Medicine↗

PubMed1994

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↗

PubMed1994

Dosimetric characteristics, air-kerma strength calibration and verification of Monte Carlo simulation for a new Ytterbium-169 brachytherapy source.

PURPOSE: Ytterbium-169 (169Yb) is a promising new isotope for brachytherapy with a half life of 32 days and an average photon energy of 93 KeV. It has an Ir-192-equivalent dose distribution in water but a much smaller half-value layer in lead (0.2 mm), affording improved radiation protection and customized shielding of dose-limiting anatomic structures. The goals of this study are to: (a) experimentally validate Monte Carlo photon transport dose-rate calculations for this energy range, (b) to develop a secondary air-kerma strength standard for 169Yb, and (c) to present essential treatment planning data including the transverse-axis dose-rate distribution and dose correction factors for a number of local shielding materials. METHODS AND MATERIALS: Several interstitial 169Yb sources (type 6) and an experimental high dose-rate source were made available for this study. Monte-Carlo photon-transport (MCPT) simulations, based upon validated geometric models of source structure, were used to calculate dose rates in water. To verify MCPT predictions, the transverse-axis dose distribution in homogeneous water medium was measured using a silicon-diode detector. For use in designing shielded applicators, heterogeneity correction factors (HCF) arising from small cylindrical heterogeneities of lead, aluminum, titanium, steel and air were measured in a water medium. Finally, to provide a sound experimental basis for comparing experimental and theoretical dose-rate distributions, the air-kerma strength of the sources was measured using a calibrated ion chamber. To eliminate the influence of measurement artifacts on the comparison of theory and measurement, simulated detector readings were compared directly to measured diode readings. The final data are presented in the format endorsed by the Interstitial Collaborative Working Group. RESULTS: The in-air calibration revealed that the air-kerma strength per unit activity (mCi), as quoted by the vendor, varied from 1.30 to 1.57 cGy.cm2/mCi.h depending on seed design. The maximum difference between measured and MCPT-simulated absolute diode readings on the transverse axis was less than 2%, indicating that MCPT accurately predicts dose rate in medium for brachytherapy sources in this energy range. Comparison of measured and simulated HCFs for each of the 16 different cylindrical heterogeneities demonstrated 1-3% agreement. The HCFs vary by as much as 200% with respect to distance and by as much as 48% as a function of disk diameter, showing that HCF is strongly dependent on heterogeneity location and lateral dimensions as well as thickness. The dose-rate constant for water medium was found to be 1.225 cGy/h per kerma unit air-strength and 1.962 cGy/h per unit mCi as measured by the vendor. CONCLUSION: Monte Carlo simulation is an accurate and powerful tool for dosimetric characterization of brachytherapy sources in this energy range. Thin lead foils produce shielding factors comparable to standard shielded applicators for 137Cs. Meaningful theoretical absolute dose calculations in brachytherapy require accurately implemented air-kerma strength standards.

Brachytherapy↗

PubMed1994

A comparative study of dosimetric properties of Plastic Water and Solid Water in brachytherapy applications.

In this study the dosimetric properties of Plastic Water and Solid Water phantom materials are evaluated using Monte Carlo photon transport simulations. In particular, their water-equivalence with respect to absorption and attenuation of photons in the brachytherapy energy range are examined. For the given chemical compositions of the materials, the linear attenuation coefficients were calculated for photons of 1 keV-2 MeV. Moreover, absorbed doses to water in each phantom material were calculated at distances of 0.5-12.0 cm from point sources of 20 keV to 60Co gamma rays. These results show that at low photon energies (below 100 keV), there are substantial differences (up to a factor of 5) between the absorbed dose in Plastic Water and that in liquid water. The differences decrease as photon energy increases, and they become insignificant at 60Co gamma rays, as claimed by the manufacturer. In contrast, calculations show that the difference in absorbed dose in Solid Water from that in liquid water, over the entire range of photon energies employed in this study, is less than 25%. The results of this study demonstrate the necessity of careful dosimetric evaluation of a new phantom material, before its clinical application, particularly in energy ranges outside those referred to by the manufacturer.

Biophysical Phenomena↗

PubMed1993

Pre-installation empirical testing of room shielding for high dose rate remote afterloaders.

PURPOSE: Many facilities are acquiring high dose rate remote afterloading units. It is economical that these units be placed in existing shielded teletherapy rooms. Scatter-radiation barriers marginally protect uncontrolled areas from a high dose rate source especially in a room that houses a non-dynamic Cobalt-60 unit. In addition the exact thickness and material composition of the barriers are unknown and therefore, a calculation technique may give misleading results. Also, it would be impossible to evaluate an entire wall barrier by taking isolated core samples in order to assist in the calculations. A quick and inexpensive measurement of dose equivalent using a rented high activity 192Ir source evaluates the barriers and locates shielding deficiencies. METHODS AND MATERIALS: We performed transmission calculations for primary and scattered radiation based on National Council on Radiation Protection and Measurements Reports 49 and 51, respectively. We then rented a high activity 21.7 Ci (8.03 x 10(11) Bq) Ir-192 source to assess our existing teletherapy room shielding for adequacy and voids. This source was placed at the proposed location for clinical high dose rate treatment and measurements were performed. RESULTS: No deficiencies were found in controlled areas surrounding the room, but large differences were found between the calculated and measured values. Our survey located a region in the uncontrolled area above the room requiring augmented shielding which was not predicted by the calculations. A canopy shield was designed to potentially augment the shielding in the ceiling direction. CONCLUSION: Pre-installation testing by measurement is an invaluable method for locating shielding deficiencies and avoiding unnecessary enhancement of shielding particularly when there is lack of information of the inherent shielding.

Brachytherapy↗

PubMed1993

Anatomic variation of gynecologic brachytherapy prescription points.

PURPOSE: The purpose of this report is to evaluate the geometric movement (relative to the bony pelvis) of fixed brachytherapy reference points during the time interval of the first and second gynecologic intracavitary implant. METHODS AND MATERIALS: The radiation therapy records of 40 consecutive patients with all stages of carcinoma of the cervix treated at the Radiation Oncology Center, Mallinckrodt Institute of Radiology, from January 1991 through December 1991 were reviewed. All patients received external beam irradiation and two intracavitary implants with Fletcher-Suit tandem and ovoids. Prescription points, per ICRU #38, were used: point A, B, and P, bladder, and rectum. Comparison of the location of points for the first and second implants (2 weeks time interval) was performed using the bony pelvis as reference anatomy and calculating the 3-dimensional spherical coordinates from a common origin for both implants. RESULTS: Analysis of the movement of the second implant relative to the first revealed that the x, y, and z coordinates for the various points shifted from 0 to 6 mm in a single plain. Vector analysis showed that the magnitude and direction of the average shift was on the order of 1.0 to 1.5 cm with displacement posteriorly and inferiorly. The effect of this movement on dose rates to the various points can result in dose rate differences up to 35%. A regression analysis was performed to identify factors affecting this movement. The time interval from the first to the second implant was the factor which correlated best with the movement. CONCLUSION: There is movement of the absolute position of ICRU #38 reference points between the first and second intracavitary implants. This movement results in significant differences in absolute dose rates to these reference points in the two implants. The clinical significance of this movement relative to dose to the tumor is unknown.

Adult↗

PubMed1993

Estimation of tissue volume irradiated by intracavitary implants.

PURPOSE: The volume of space enclosed by a specified isodose surface arising from an intracavitary implant may correlate with clinical outcome. Several investigators have proposed using the product of the three maximum orthogonal dimensions of the isodose surface as a measure of this volume. We have examined the accuracy of this proposal and compared it to a simpler model for estimating volume which requires only knowledge of the mgRaEq-hrs (total reference air kerma) and the dose level. METHODS AND MATERIALS: Orthogonal films from 204 intracavitary implants of 128 patients with carcinoma of the cervix were used to reconstruct the 137Cs-source coordinates. The source location, strength and duration data were used to calculate dose-volume histograms, yielding the volume enclosed by each dose level as well as its orthogonal dimensions: thickness, width, and height. Using bony landmarks to align films for different insertions in the same patient, similar calculations were repeated for composite implant source coordinates. RESULTS: Curve-fitting techniques revealed that the volume encompassed by each isodose level could be predicted by a modified power-law function of the mgRaEq-hr/dose ratio: predicted volume = [104.8 - 8.103.(M/D) + 0.437.(M/D)2].(M/D)1.635 where M/D = mgRaEq-hr/cGy. The volume predicted by this simple model is accurate within +/- 10% in 95% of the implants when mgRaEq-hr/cGy = 0.8. Accuracy increases with increasing mgRaEq-hr/cGy. In contrast, the ratio, product of orthogonal dimensions/actual volume, varies widely from implant-to-implant, as well as differing systematically from one implant type to another. Investigation of the individual orthogonal dimensions demonstrated that width and height, but not thickness, were moderately well correlated with corresponding maximum implant dimensions. However, in all cases the dimensions were more sensitive to changes in mgRaEq-hr/cGy than to changes in implant geometry. CONCLUSIONS: The product of the orthogonal dimensions is an unsatisfactory estimator of the actual irradiated volume encompassed by an isodose surface. Isodose surface volumes can be accurately estimated knowing only mgRaEq-hr. Prescribing intracavitary brachytherapy by mgRaEq-hr, or its derivative, total reference air kerma, is equivalent to requiring that an isodose surface encompass a specified volume which does not depend on the implant geometry. Constraining the mgRaEq-hr delivered therefore serves to limit the volume of tissue irradiated to high doses.

Brachytherapy↗

PubMed1993

Monte Carlo calculation of kerma to a point in the vicinity of media interfaces.

Recent work has demonstrated that Monte Carlo photon transport (MCPT) simulation is a practical and accurate dosimetry tool for characterizing brachytherapy dose distributions in the presence of complex three-dimensional (3D) geometries. Because of the steep dose gradients encountered in this application, the choice of estimation algorithm, i.e., the algorithm for extracting dose estimates from individual photon histories, is critical to ensure adequate spatial resolution and computational efficiency. While conventional MCPT dose estimation techniques are sufficiently accurate in many cases, they inevitably fail when the point of interest is located near media interfaces, since they require the point of interest to be contained by a region of homogeneous medium of several millimetres in diameter. This severely limits the domain of application of MCPT in brachytherapy dosimetry and prevents dose estimation at points such as those immediately behind lead shields contained in gynaecological applicators, or simulation of small intricately structured detector response. We have successfully adapted to an MCPT code a neutron-flux estimator, the once-more-collided flux estimator (OMCFE), which overcomes this problem. OMCFE is derived from the familiar next-flight estimation algorithm, and, through the use of a photon trajectory resampling scheme, does not require homogeneous media at the point of interest. It is therefore a true point-dose estimator. OMCFE was tested against a variety of one- and three-dimensional benchmark problems. These benchmarks included mono-energetic point sources of 30 and 600 keV, as well as a 3M model 6702 125I seed, a 137Cs tube, and an 192Ir seed in geometries approximating common brachytherapy dosimetric problems. OMCFE agrees closely with conventional MCPT dose estimation algorithms in solving these benchmark problems, while in many cases being much more efficient. It therefore makes possible brachytherapy dose estimation with high spatial resolution, in contrast to the larger than 1 mm spatial resolution achievable using conventional MCPT estimation algorithms. It should be noted that the method presented in this paper is only valid when charged-particle equilibrium is assumed.

Electrons↗

PubMed1993

Genomic MHC haplotyping of mutant cell lines using a novel marker.

The aim of this study was to characterize MHC mutant cell lines by studying haplospecific markers within the MHC and specifically in the 250 kilobase (kb) region between the HLA B and TNF loci. This region has been difficult to define because of the lack of appropriate markers. Spontaneous MHC mutants were isolated after immunoselection with an anti-HLA A2 monoclonal antibody and complement. Ten mutants were characterized using serological or allelic and genomic DNA markers within the HLA A to HLA DQ region of the MHC. Most mutants lost at least the 3 megabases of DNA from HLA A to HLA DQ viz the whole haplotype carrying HLA A2. Variants which have lost either HlA A alone or HLA A and HLA B were also found. The results show that it is possible to map the extent of the deletion between HLA B and TNF. Haplospecific scanning patterns for the CL region appear particularly useful.

Cell Line↗

PubMed1992

Source configuration and dose rates for the Selectron afterloading equipment for gynecologic applicators.

This paper describes source train configurations of the Selectron LDR-6 that can be used to duplicate commonly used manually afterloadable source configurations for gynecological intracavitary brachytherapy. We demonstrate that the recommended source configuration using 2.5 mm 137Cs spheres is dosimetrically equivalent to its manually afterloaded counterparts using 3M 137Cs sources (20 mm overall length, 14 mm active length). Isodose distributions are in agreement to within 5% for the Fletcher-Suit-Delclos family of tandems, colpostats, and vaginal cylinders. Our data also demonstrate that the isotropic point source model used by most computerized treatment planning systems is a good approximation to source trains of filtered, spherical sources interspersed with solid steel spacers. We conclude that the use of 2.5 mm 137Cs sources in the Selectron remote afterloading system can accurately reproduce the isodose distribution achieved with linear 137Cs manually afterloaded sources.

Brachytherapy↗

PubMed1992

Dosimetry and dose specification for a new gynecological brachytherapy applicator.

A new afterloadable gynecological intracavitary applicator has been designed and is now in use for the treatment of a wide range of vaginal, cervical, and endometrial cancers in a single application, with a dose distribution that more closely matches the prescribed treatment than previous methods. The plexiglass applicator consists of a bulbous section that is inserted up to the vaginal apex and loaded with right and left ovoid sources. The distal portion is cylindrical with a central channel for tandem sources. A straight tandem is used when the target volume extends to the vaginal apex, but an intrauterine tandem can also be used. Extensive dosimetric and radiographic evaluations were performed to guide design refinements and to validate the surface dose predictions of the brachytherapy treatment planning system. The final applicator design delivers 110-120 cGy/hr to the vaginal apex surface and 95-100 cGy/hr to the distal vaginal surfaces when loaded with a 144.6 U (20 mgRaEq) cesium tube in each ovoid channel and 72.3, 72.3, and 144.6 U (10, 10, and 20 mgRaEq) cesium tubes in the vaginal cylinder channel. A system for treatment dose specification has been established that includes dose tables for manually calculating surface doses to reference points. A dose distribution comparison with a sequential colpostat-vaginal cylinder treatment demonstrates that dose delivery is more precise and uniform with this new applicator.

Brachytherapy↗

PubMed1992

Rapid two-dimensional dose measurement in brachytherapy using plastic scintillator sheet: linearity, signal-to-noise ratio, and energy response characteristics.

Because of the large dose gradients encountered near brachytherapy sources, an efficient, accurate, low-atomic number areal detector, which can record dose at many points simultaneously, is highly desirable. We have developed a prototype of such a system using thin plates of plastic scintillator as detectors. A micro-channel plate (MCP) image intensifier was used to amplify the optical scintillation images produced by radioactive 125I and 137Cs sources in water placed 0.5-5.7 cm distance from the detector. A charge-coupled device (CCD) digital camera was used to acquire 2-D light-intensity distributions from the image intensifier output window. For both isotopes, a small area (2 x 3 mm2) PVT detector yields a CCD net count rate that is linear with respect to absorbed dose rate within +/- 3% out to 5.7 cm distance. Acquisition times range from 1.5-400 sec with a reproducibility of 0.5-5.5%. If a large-area (6 x 20 cm2) PVT detector is used, a four-fold increase in count rate and large deviations from linearity are observed, indicating that neighboring pixels contribute light to the signal through diffusion and scattering in PVT and water. A detailed noise analysis demonstrates that the image intensifier reduces acquisition time 10000-fold, reduces noise relative to signal 200-fold, and reduces amplifier gain noise as well.

Brachytherapy↗

PubMed1990

Dose calculations about shielded gynecological colpostats.

Although shielded gynecological colpostats have been shown experimentally to reduce doses to bladder and rectal tissue by as much as 50%, nearly all previously described dose computation algorithms ignore applicator heterogeneities. We describe the use of realistic Monte Carlo calculations to study the dosimetric effects of applicator structure. Use of sophisticated solid modeling techniques allows the complex internal structure of two commercially-available Fletcher-Suit colpostats, as well as that of 226Ra or 137Cs tubes, to be accurately simulated. Our results show significant differences among these source-applicator combinations. In addition, a novel dose computation algorithm for efficiently estimating absorbed dose near shielded applicators is described. Our approach is based upon empirical separation of primary- and scatter-dose components. The algorithm requires a small base of Monte Carlo-generated data, reproduces the Monte Carlo dose estimates within 3%, and is faster than Monte Carlo by a factor of 15,000. The scatter-separation method has the potential to make accurate dose estimates to bladder, rectum, tumor, and vagina available for clinical treatment planning and for extraction of more meaningful dose-response curves from clinical data.

Brachytherapy↗

PubMed1988

Monte Carlo and analytic calculation of absorbed dose near 137Cs intracavitary sources.

This paper presents dose-rate tables and treatment planning data needed to accurately implement the Sievert line-source integral, found on most commercial computer-aided treatment planning systems, for two recently introduced 137Cs intracavitary sources. One source uses a high-density active core designed to reproduce the non-elliptical isodose curves characteristic of the traditional radium tube. The other source consists of two or three discrete 137Cs seeds encapsulated in stainless steel. Using Monte Carlo dose-rate calculations as the standard of accuracy, we show that the Sievert model, using conventionally defined filtration corrections, overestimates kerma-rate in free space by as much as 20%. In addition, tissue attenuation and scatter build-up factors, derived from an isotropic point source, do not accurately characterize the distribution of scatter dose about heavily filtered sources. By varying the input parameters of the Sievert line-source integral so as to optimize its agreement with the more rigorous Monte Carlo data, accuracy of 3% can be achieved.

Brachytherapy↗

PubMed1987

Random selection of points distributed on curved surfaces.

Monte Carlo simulation is widely used in medical physics to obtain realistic solutions to radiation transport problems involving complex geometries. An important step is the random selection of the initial point in space from which the primary photon or charged particle originates. In many practical cases, the primary-particle sites are distributed over curved surfaces. We describe general sampling techniques that can be used to randomly choose the trajectory origin for sources distributed over any smooth surface that can be parametrically represented as a function of two variables. The source distribution need not be uniform. Implementation of these methods is particularly straight-forward for surfaces enclosing simple convex volumes such as spheres and ellipsoids.

Humans↗

PubMed1987

Ionizing radiation enhances malignant progression of mouse skin tumors.

Chemical carcinogenesis in mouse skin has been divided into the process of initiation, promotion and progression. Recently we have shown that ionizing radiation acts as an initiator in this model system. In this paper we describe a three-stage experiment using ionizing radiation in the third stage of mouse skin carcinogenesis. CD-1 mice were initiated with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) followed by biweekly promotion with 12-O-tetradecanoylphorbol-13-acetate (TPA). After 20 weeks of promotion, the animals were treated with either acetone, TPA (twice a week for 2 weeks) or eight fractions of 1 MeV electrons (1 Gy/fraction over a period of 10 days). The conversion of papillomas to squamous cell carcinomas was 80% for animals treated with ionizing radiation compared with 25% for tumor-bearing animals treated with TPA. Ionizing radiation increased the number of cumulative carcinomas per group. The lack of an increase in the number of cumulative papillomas per group due to ionizing radiation suggests that the dose and fractionation protocol used in this study enhanced the progression of pre-existing papillomas.

Acetone↗

PubMed1987

Template-guided interstitial implants: Cs-137 reusable sources as a substitute for Ir-192.

Template-guided implantation of rigid steel or plastic guide needles for afterloading of radioactive sources is widely used in the treatment of gynecologic, rectal, and urologic malignant neoplasms. Iridium-192 is used almost universally, despite the high cost per implant, due to its short half-life and limited need for a flexible, trimmable source. A reusable afterloading system containing cesium-137 was developed. Each source has an effective active length of 6.8 cm and is encapsulated at the distal end of a 21-cm-long stainless steel tube. The sources can be afterloaded into the same plastic guide needles normally used for Ir-192 ribbons. Physical and dosimetric aspects of these sources are compared with those of Ir-192, and radiation protection and cost effectiveness are also discussed.

Brachytherapy↗

PubMed1986

The accuracy of the line and point source approximations in Ir-192 dosimetry.

The dosimetric approximations used in computer-aided treatment planning of Ir-192 seed implants generally ignore individual seed dimensions and internal structure. Most commonly, each seed is approximated by an isotropic point source. Alternately, each ribbon assembly consisting of uniformly spaced seeds is replaced by an unfiltered line source. Using filtration corrections applicable to platinum- and steel-encapsulated seeds calculated by the Monte Carlo method, the dosimetric errors introduced by these models into two-and-three-dimensional dose distributions arising from multiple plane implants are analyzed. Our results demonstrate that when anisotropy correction factors of 0.96 and 0.99 are used for platinum- and steel-filtered seeds, respectively, the point source model is accurate within 2%. The accuracy of the line source approximation depends significantly upon the details of its implementation. If the linear density of the line is set equal to individual seed strength for an inter-seed spacing of 1 cm, and filtration correction factors of 0.94 and 0.97 are used for platinum- and steel-clad seeds, respectively, the accuracy of the line source model is 1.5% near the implant center. The method of dose-volume histograms is used to compare the predictions of the different models.

Brachytherapy↗