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PubMed2003

PM10 and asthma medication in schoolchildren.

The authors found that the use of asthma medication among elementary schoolchildren was associated with particulate pollution (particulate matter < 10 microm in aerodynamic diameter [PM10]) in a locale where PM10 consisted primarily of coarse fraction material derived from road sanding and reentrained volcanic ash. School nurses' records in 12 neighborhood schools located close to an ambient air monitoring station were abstracted, and the numbers of oral and inhaled doses of asthma medication given daily over a period of 2.5 yr were calculated. Time-series regression models, adjusted for autocorrelation, were developed, with temperature, time trend, day of the week, and month as additional variables. Regression models were estimated, and a lagged moving average of PM10 for 7, 14, 21, and 28 days was used. All models showed positive and significant coefficients for PM10 during periods when asthma medication was administered to the schoolchildren. However, the 21-day moving average was the best fit to the model.

Air Pollutants↗

PubMed1987

Radiotherapeutic computed tomography with scanned photon beams.

Radiotherapeutic computed tomography is a powerful technique to generate anatomical transversal tomograms of the patient in treatment position by using the therapy beam from the treatment unit. For this purpose the treatment unit has to be equipped with a detector array that can detect the beam transmitted through the patient and a computer that analyzes the data and performs the back projection. When the treatment unit uses scanned elementary photon beams, the only practical technique available for generating high quality high energy photon beams, the operation principle and, to some extent, the image quality is similar to that of a 3rd generation CT-scanner. The optimum choice of detection geometry and type of radiation detectors for radiotherapeutic computed tomography particularly at high photon energies are discussed indicating the merits of BGO (bismuthgermanate) or CWO (cadmiumtungstate) photodiod arrays. The first tomographic images of a thorax phantom at an acceleration potential of 50 MV using such detectors are presented. The image contrast is similar to that for 300 kV X rays mainly because the considerable influence of pair production at 50 MV. Line spread and modulation transfer functions are presented indicating a resolution of the order of two millimeters using a crystal thickness of 5 mm. The advantages with radiotherapeutic computed tomography, beside forming a new general communication channel between different diagnostic techniques, dose planning, and radiation delivery, are the elimination of position errors and the provision of exact attenuation data for dose planning.

Humans↗

PubMedDate not supplied

[Comparative dosimetry study of two methods of intensity modulation performed on the same accelerator].

Intensity modulated radiation therapy (IMRT) is an advanced method of conformal radiotherapy. It permits optimal dose distribution to the target volume while preserving surrounding normal tissues. IMRT, with a multileaf collimator, can be realised in two different ways: either the segmented mode, which consists of combining small elementary static field, or the dynamic mode, which consists of moving the leaves while irradiating. The purpose of this work was to study these two methods of modulation on a Varian linear accelerator equipped with a collimator consisting of 40 pairs of one-centimetre-wide leaves. The measurements, obtained by using a diode array, showed that the quality of the irradiation in the dynamic mode does not depend on either the dose rate or the duration of the irradiation. In the segmented mode, weak magnitude segments are preferable, but increase the errors in the delivered dose. Comparisons of various profiles showed that the measured profiles are consistent with those programmed. Both modes seem to be equivalent for step-shaped profiles. In the case of profiles with constant slope, the segmentation generated by the segmented method deteriorates the profile. Even though the choice of technique is strongly dependent on the material available, the dynamic mode presents greater flexibility of use and has been chosen in our institution for IMRT.

Calibration↗

PubMed1998

Electron wedges for radiation therapy.

PURPOSE: Brain tumors can be advantageously treated with electron over photon radiation, by exploiting the rapid fall-off in dose with depth. This advantage could be further enhanced by utilizing multiple electron beams. However, in some beam configurations, wedged dose profiles would be necessary for the dose uniformity. Unlike photons, shaped pieces of material placed in electron beam severely degrade the energy, give additional scattering and, therefore, are suboptimal. The purpose of this study was to create wedged electron fields, using intensity modulation. The combination of electron wedges enables a more uniform coverage of brain tumors with a reduced dose to normal tissue. METHODS AND MATERIALS: Intensity modulation was performed for 10 to 50 MeV electrons using a narrow scanning elementary beam of a racetrack Microtron accelerator, delivering radiation pulses with coordinates and intensities prescribed by a custom scan matrix. Dispensing more pulses (or longer pulses) within the field to increase the local dose, one can sharpen the penumbra at depth and generate wedged dose distributions of arbitrary angle as well as many other desired profiles. We modulated the electron beams, measured dose distributions using film in an anthropomorphic phantom, and compared the results with conventional techniques. RESULTS: Intensity modulation of electron beams decreases the 50-90% penumbra at depth by 40% and increases the flatness by 80%. Wedged profiles at depth can be created for any angle up to about 70 degrees, depending on the beam energy. Multiple modulated electron beams give smaller 20-70% but larger 70-100% isodose regions than photon beams. CONCLUSIONS: Electron beams can improve dose distributions in brain compared to the same number of photon beams, reducing the 20-70% isodoses region in normal tissue by 30%. Intensity modulation significantly improves the dose distribution from combined electron beams providing a sharper penumbra, better conformity, and reduced margin.

Brain Neoplasms↗

PubMedDate not supplied

Application of Fermi scattering theory to a magnetically scanned electron linear accelerator.

This paper uses a solution to the Fermi electron transport equation for an isotropic point source to characterize the magnetically scanned broad electron beams from the Sagittaire Therac 40 accelerator in the air space above patients. Thick lead collimation is shown to be adequately modeled by an infinitely thin absorbing plate when used to predict penumbra shape. A relationship between broad beam penumbra width and the value of the root-mean-square spatial Gaussian spread sigma (z) of an elementary pencil beam is derived. This relationship is applicable for any rectangular field size. Measurement of the variation in broad beam penumbra width with source-surface distance (SSD) for a 7-MeV beam locates the isotropic source to be coincident with the exit window of the accelerator and indicates that the scattering effect of the monitor chamber may be considered negligibly small. Using this source location accurate predictions of beam profile shape for any clinically used beam energy, SSD, or field size are made in the presence of lead trimmer collimation. Field penumbra beyond the photon collimation system is formed in each lateral direction by two lead blocks whose faces are aligned along a diverging ray emanating from the source. The photon collimator closest to the source restricts the field size causing a variation of both fluence and the mean square angle spread of the electrons across the plane at the level of the lower collimator. This variation is accounted for by introducing an empirical perturbation factor into the mathematical formalism. An interesting feature of this perturbation factor is that it is field size dependent and its effect on penumbra width may be scaled for both beam energy and SSD to accurately predict beam profile shape.

Humans↗

PubMed1994

An analytical solution for the dynamic control of multileaf collimators.

All current optimization techniques in radiation therapy benefit from the use of strongly non-uniform radiation beams. The most flexible way of generating these fields under real time control is by elementary beam scanning and/or dynamic multileaf collimation. In this work general analytical expressions are derived for the required motion of the collimator leaves to achieve a desired energy fluence distribution or collimator opening density in the patient in the shortest possible time. By simplification of the general expressions the equations of motion have been derived for both the shrinking field and the curtain shutter techniques with the associated approximations clearly quantified. The mechanical limitations on leaf motion, caused by the finite velocity and acceleration, are taken into account. It is shown that almost any desired energy fluence distribution can be created even when the limitations on velocity and acceleration are considered. The basic rule with the curtain shutter technique is that when the energy fluence gradient along the direction of motion of the leaves is positive, the leading leaf should move at maximum speed and the lagging leaf should modulate the field. In regions where the gradient is negative the lagging leaf should instead move at full speed and the leading leaf should modulate the field. The overall treatment time is then proportional to the total increment in energy fluence or opening density between consecutive minima and maxima. For energy fluence profiles with numerous high peaks the treatment time may therefore increase considerably over that for conventional uniform dose delivery. However, in general the treatment time is prolonged by a factor of about two compared to a traditional uniform treatment. Obviously the method developed here for multileaf collimators is also suitable for simple block collimators since it can be used to deliver arbitrary regular or irregular 'dynamic wedge' profiles along the direction of motion of the collimator blocks.

Humans↗

PubMed1997

Intensity-modulated radiotherapy by means of static tomotherapy: a planning and verification study.

There is currently much research interest in developing, evaluating, and verifying intensity-modulation techniques. Of particular interest is how well the delivery of intensity-modulated profiles can be simulated by planning algorithms, and how accurately these profiles can be delivered given the specification constraints of linear accelerators. In this paper we present a planning and verification study based on delivering radiation in "static-tomotherapy" mode via the NOMOS MIMiC (Multileaf intensity-modulation collimator), which sheds some light on these issues. An inverse-planning algorithm was used to compute intensity-modulated profiles for a 9-coplanar-field plan for a body phantom. The algorithm makes several approximations about the form of the elementary fluence profile through bixels during delivery. Specifically, it is independent of the state of adjacent bixels (i.e., open or closed) and obeys the superposition principle. From the standpoint of comparing the predicted versus the delivered dose, these assumptions were made irrelevant by a final one-step forward dose calculation performed using the optimized intensity profiles. This forward dose calculation took into account the penumbral characteristics of the delivery system by decomposing the intensity profiles into the set of delivery components. Each component was assigned the appropriate penumbral functions thereby ensuring that the calculated dose distribution closely predicted the delivered dose distribution. The nine intensity modulated fields were delivered to a perspex phantom with the same geometry, containing a verification film. In general good agreement was found between the predicted and the measured delivered dose distributions. All the main features of the predicted dose distribution are seen in the delivered. The 90% isodoses were consistently in spatial agreement to within 3 mm. At the 50% isodose level consistent spatial agreement was again found to within 3 mm, the largest deviation being about 5 mm. The close correspondence between the predicted and measured dose distribution demonstrates the potential of the MIMiC delivery system. Our results indicate the level of dose conformation that is achievable in practice and the accuracy of the dose computation algorithm. However, this study only concerned delivery of radiation to a 2 cm thick slice, and the dose distribution was only verified in the central plane of the phantom where the film was placed. We therefore cannot comment as yet on what happens to the dose distribution away from the central film-plane.

Algorithms↗

PubMed2002

Assessment of personal and community-level exposures to particulate matter among children with asthma in Detroit, Michigan, as part of Community Action Against Asthma (CAAA).

We report on the research conducted by the Community Action Against Asthma (CAAA) in Detroit, Michigan, to evaluate personal and community-level exposures to particulate matter (PM) among children with asthma living in an urban environment. CAAA is a community-based participatory research collaboration among academia, health agencies, and community-based organizations. CAAA investigates the effects of environmental exposures on the residents of Detroit through a participatory process that engages participants from the affected communities in all aspects of the design and conduct of the research; disseminates the results to all parties involved; and uses the research results to design, in collaboration with all partners, interventions to reduce the identified environmental exposures. The CAAA PM exposure assessment includes four seasonal measurement campaigns each year that are conducted for a 2-week duration each season. In each seasonal measurement period, daily ambient measurements of PM2.5 and PM10 (particulate matter with a mass median aerodynamic diameter less than 2.5 microm and 10 microm, respectively) are collected at two elementary schools in the eastside and southwest communities of Detroit. Concurrently, indoor measurements of PM2.5 and PM10 are made at the schools as well as inside the homes of a subset of 20 children with asthma. Daily personal exposure measurements of PM10 are also collected for these 20 children with asthma. Results from the first five seasonal assessment periods reveal that mean personal PM10 (68.4 39.2 microg/m(3)) and indoor home PM10 (52.2 30.6 microg/m(3)) exposures are significantly greater (p < 0.05) than the outdoor PM10 concentrations (25.8 11.8 microg/m(3)). The same was also found for PM2.5 (indoor PM2.5 = 34.4 21.7 microg/m(3); outdoor PM2.5 = 15.6 8.2 microg/m(3)). In addition, significant differences (p < 0.05) in community-level exposure to both PM10 and PM2.5 are observed between the two Detroit communities (southwest PM10 = 28.9 14.4 microg/m(3)), PM2.5 = 17.0 9.3 microg/m(3); eastside PM10 = 23.8 12.1 microg/m(3), PM2.5 = 15.5 9.0 microg/m(3). The increased levels in the southwest Detroit community are likely due to the proximity to heavy industrial pollutant point sources and interstate motorways. Trace element characterization of filter samples collected over the 2-year period will allow a more complete assessment of the PM components. When combined with other project measures, including concurrent seasonal twice-daily peak expiratory flow and forced expiratory volume at 1 sec and daily asthma symptom and medication dairies for 300 children with asthma living in the two Detroit communities, these data will allow not only investigations into the sources of PM in the Detroit airshed with regard to PM exposure assessment but also the role of air pollutants in exacerbation of childhood asthma.

Adolescent↗