MEDICAL PHYSICS INTERNATIONAL Journal, vol.7, No.

1, 2019

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Let's imagine the future together!

24th INTERNATIONAL CONFERENCE ON MEDICAL PHYSICS

8th LATIN AMERICAN CONGRESS OF MEDICAL PHYSICS

2nd CHILEAN CONGRESS OF MEDICAL PHYSICS

September 8-11, 2019, Santiago, Chile

BOOK OF ABSTRACTS

Editors:
Jose-Luis Rodriguez, Rodolfo Alfonso, Maria-Ester Brandan, Geoffrey Ibbott

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ICMP 2019 Organizing Committee (COC)

Madan Rehani
IOMP President

José Luis Rodríguez

SOFIMECH President

Rodolfo Alfonso
ALFIM President

Eva Bezak
IOMP Secretary General
(from Aug 1st 2019)

Virginia Tsapaki
IOMP Secretary General
(until July 31 2019)

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ICMP 2019 Scientific/Programme Committee

Maria-Ester Brandan
Co-Chair

Geoffrey Ibbott
Co-Chair

Program Planning Scientific

Committee Committee
Arun Chougule (IOMP) Cecilia Hadadd (Brazil)
Caridad Borras (AAPM) Facundo Ballester (Spain)
Carlos E. de Almeida (Brazil) Guerda Massillon (Mexico)
Debbie Van-der-Merwe (IAEA) Horacio Patrocinio (COMP)
Giorgia Loreti, (IAEA) Hugo Palmans (UK)
John Damilakis (IOMP) Ioannis Sechopoulos (Netherlands)
Jose Luis Rodriguez (Chile) Laurence Dauer (USA)
Ibrahim Duhaini (IOMP) Luc Beaulieu (Canada)
Madan Rehani (IOMP) Malcolm McEwen (Canada)
Mahadevappa Mahesh (AAPM) Maria-Esperanza Castellanos (Colombia)
Ola Holmberg (IAEA) Mark Rivard (USA)
Pablo Jiménez (PAHO) Miguel-Angel Avila (Mexico)
Rodolfo Alonso (ALFIM) Patricia Mora (Costa Rica)
Saiful Huq (AAPM) Paulo Costa (Brazil)
Virginia Tsapaki (IOMP) Sergio Mosconi (Argentina)
Yakov Pipman (IOMP) Sha Chang (USA)
Wilbroad Muhogora (Tanzania)

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ICMP 2019 Local Organizing Committee

José Luis Rodríguez Claudia Morales

President Secretary

Paola Caprile Manuel Castrillón

Vice-President Treasure

Rubén Yañez Gabriela Verdugo

Director Redes Sociales

Web, Media and

Exhibition Committee
Chandra P Joshi, Canada
Claudia Morales,
SOFIMECH
Magdalena Stoeva, IOMP

International Advisory Committee

Ana Maria Marques, Brazil,
Erno Sajo, USA
Godfrey Azangwe, Zimbabwe.
Kwan Hoong Ng, Malaysia
Paolo Russo, IOMP
Simone Kudlulovic Renha, IOMP
Slavik Tabakov, IOMP
Wilfred Ngwa, USA

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ICMP2019 Presidential Message

Dear Readers,

We are delighted to bring to you the Book of Abstracts of the International Conference
on Medical Physics (ICMP) held on 8-11 September 2019 at the Hotel InterContinental,
Santiago, Chile. The conference was jointly organized by the International Organization
for Medical Physics (IOMP), the Latin American Medical Physics Association (ALFIM)
and the Chilean Medical Physics Society (SOFIMECH).

ICMP2019 is the 24th ICMP. The Latin American region had the pleasure of hosting 18th
ICMP in 2011 in Porto Alegre, Brazil as also the World Congress on Medical Physics
and Biomedical Engineering (WC1994) in 1994.

The conferences provide impetus to the development of medical physics and radiation
safety in the region. Medical physics in Latin America has been developing steadily and
there is a need to keep up with changing scenario that are happening all over the world in
terms of newer technology being adopted some of them may help to strengthen the
profession whereas others may pose threat. The abstract book shall give a window to the
world as to where countries in the region stand in terms of academic pursuits and
professional and scientific activities.

Santiago is not a typical Convention city and holding this event in Chile meant a huge
challenge and a great responsibility for SOFIMECH. We are delighted that SOFIMECH
took this challenge in the interest of professional development of colleagues in Latin
American region to bring the latest knowledge in medical physics to a large number of
professionals who otherwise would not have access to listening to so many experts
directly and having the chance to interact informally.

The Scientific and Program Planning Committees headed by Geoffrey Ibbott and Maria-
Ester Brandan have worked hard to create an excellent Scientific Program for ICMP
2019.

Happy reading and collectively we can make our profession strong and useful to the
humankind.

Madan Rehani Rodolfo Alfonso Jose Luis Rodriguez

IOMP President ALFIM President SOFIMECH President

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ICMP2019 Scientific Committee /

Program Planning Committee Message
On behalf of the ICMP2019 Scientific Committee and Program Planning Committee, we
are pleased to offer this program of invited and proffered talks and electronic posters. We
are confident that you will agree that the program includes a wide variety of contemporary
topics, presents numerous scientific accomplishments, and represents a range of regional
and cultural perspectives.

We thank the members of the Scientific and Program Planning Committees who worked
diligently to evaluate the nearly 400 abstracts that were submitted for the conference, and
to sort the accepted abstracts into a coherent and meaningful program. We believe their
efforts have resulted in a highly-organized program of exceptional quality, with easily-
navigable tracks and sessions that will appeal to all attendees.

We were fortunate to be able to work closely with the members of the Conference
Organizing Committee, who created a program structure that fit with past ICMPs and
who undertook to contact many of the invited speakers. This program, like those in the
past, is designed to entice international attendees, and at the same time, offer sessions
designed specifically for local participants.

In particular, you will notice that every morning, there is at least one session in Spanish,
with a mix of international and local speakers, and topics of special interest to Latin
American physicists. In most afternoons, there will be four parallel tracks of proffered
oral presentations, grouped without overlap so that most attendees should find talks of
interest and relevance to their specialties. E-poster sessions are organized to minimize
conflicts with the oral sessions, to allow participants to visit posters without having to
miss oral presentations on related topics.

We are sure that you will enjoy this program and look forward to meeting many of you
during the week.

María-Ester Brandan
Geoffrey S. Ibbott

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ICMP 2019 / ALFIM 2019

PLENARY TALKS AND INVITED

PAPERS

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IOMP School, joint session with IAEA-PAHO-ISR: The role of medical physicists
in justification in medical imaging

O. Holmberg (IAEA), A. Bouëtté (Luxembourg), D. Remedios (UK), P. Jiménez (PAHO), P. Soffia (ISR).

Over the past 20 years much successful work has been devoted to developing and consolidating approaches
to optimization of radiation protection in diagnostic imaging. Less effort has been committed to justification
of medical exposure, although authoritative sources suggest that a significant fraction (20-40 % in some
areas) of radiological examinations may be inappropriate. While the main responsibilities rest with the
radiological medical practitioner and the referring medical practitioner, other professional groups such as
the medical physicists may have radiation protection competence and a key professional role that makes
them vital for strengthening the implementation of the principle of justification of medical exposure in
diagnostic imaging in their country. The workshop will aim to discuss the main facts and concepts regarding
justification in imaging; practical measures that can be taken to strengthen the implementation of
justification; and examples of implementation where medical physicists have played a key role.

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The role of medical physicists in justification in medical imaging

Pablo Jimenez

Regional Advisor in Radiological Health. Department of Health Systems and Services. Pan American
Health Organization (PAHO). Washington, DC 20037. USA; e-mail: [email protected]

Applying the justification principle in medical imaging requires a special approach. It is generally accepted
that the use of radiation in medicine produces more benefits than harm. However, it is necessary a generic
justification of a given radiological procedure by the health authorities in conjunction with appropriate
professional bodies. This generic justification must be appropriate to the local epidemiological situation,
be based on the best available evidence, and consider aspects of cost effectiveness. It should be reviewed
from time to time taking into account new knowledge and new technical developments as they evolve.
Finally, the justification of a radiological procedure to a given individual should be carried out by the
radiological medical practitioner, in consultation with the referring medical practitioner. This individual
justification should consider objectives of the exposure, the clinical circumstances and the characteristics
of the individual involved. Medical physicists have an advisory role in the justification mainly for the new
procedures, and on the risk assessment of the procedures.

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The role and relevance of virtual imaging trials in imaging research and practice

Ehsan Samei, Ph.D.

Professor, Departments of Radiology, Physics, Medical Physics, Biomedical Engineering, Electrical and
Computer Engineering
Duke University, Durham, NC 27710, USAm e-mail: [email protected]

The complexity of medical imaging technologies has continued to accelerate, outpacing our ability to
optimize their design and clinical use. Given this rapid technological evolution with their multitudes of
features and abilities, determining the optimal design and use of imaging technologies has proven to be a
significant challenge across many and diverse objectives of scientific inquiry and clinical application. The
evaluation of new imaging technologies and applications would ideally be achieved through clinical
imaging trials. However, such trials are often not feasible or even definitive due to ethical limitations,
expense, time-requirements, difficulty in accruing enough subjects, or the fundamental lack of ground truth.
Meanwhile, assessment of imaging technologies currently relies on simplistic models and subjective
perception of image aesthetics, the results from which cannot readily predict clinical utility, leaving the
effectiveness of many imaging techniques tenuous at best.
Virtual imaging trials (VITs) offer a powerful solution to the above challenge, allowing scientists to conduct
realistic and accurate “human” trials of emerging imaging concepts and technologies via simulation. With
virtual trials, experiments are conducted quickly and cost effectively on a computer, giving researchers the
ability to answer fundamental questions that can only be practically answered using the precise controls
and known ground truth afforded in the virtual domain. In this presentation, we discuss the components
and needs of VITs in terms of realistic modeling of a) the patient, b) the imaging system, and c) the image
interpreter. We further discuss the needed realism of the simulations and offer demonstrations of select
applications in CT imaging.

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Precision Imaging Through Medical Physics

Ehsan Samei, Ph.D.

Professor, Departments of Radiology, Physics, Medical Physics, Biomedical Engineering, Electrical and
Computer Engineering
Duke University, Durham, NC 27710, USA, e-mail: [email protected]

Precision imaging involves targeting, delivery, and confidence that each imaging examination is precisely
performed to provide maximum value to each patient. This requires proper quantification of quality, safely,
and consistency of each exam, tracking them across the imaging practice, and taking proactive adjustments
to the imaging processes to achieve a priori operational goals for each. These tasks are most in line with
the expertise of medical physicists. Based on the foundations of medical physics, in this presentation, we
offer a description of quantification approaches in image quality (eg, task-based performance, detectability,
estimability), in safety (eg, effective dose, organ dose), and consistency. This follows with the methods to
integrate quantifications into an informatics infrastructure to enable monitoring of the attributes, as well as
strategies for establishing operational goals and conformance for each of the three goals. Demonstrations
are offered for select applications in CT imaging and beyond.

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Quantitative CT: The role and limitations of radiomics

Ehsan Samei, Ph.D.

Professor, Departments of Radiology, Physics, Medical Physics, Biomedical Engineering, Electrical and
Computer Engineering
Duke University, Durham, NC 27710, USAm e-mail: [email protected]

CT-based quantification is the extraction of quantitative measures from patient images. The measures, often
terms radiomics, are in turn are related to patient outcomes. A strong relation enables predictive models.
Ideally, the measures are rooted in the biology of the disease and thus their predictive power. However, a
lack of direct correlation between the biology and the imagery has led to much ambiguity in the field of
quantitative imaging. This presentation aims to clarify some of these ambiguities. For CT-based
quantification to be most effective, radiomics quantification should meet four requirements: relevance,
objectivity, robustness, and implementability. Relevance refers to measures of biological or clinical
phenomena. Relevance can be assessed by studying how the quantification metrics correlate with clinical
patient outcomes. Objectivity refers to the accuracy of quantifications in terms of ground truth. Robustness
refers to the precision of the quantification. Objectivity and robustness can be assessed using phantoms and
biological models to test how different feature extraction workflows lead to different biases and variabilities
in the feature measurements. Finally, implementability speaks to the practicality of the use of the measures
in a clinical environment and workflow. That includes provisions for automation and interfaces that are
intuitive and efficient. CT-based quantification has the potential to improve consistency and quality of
patient care if it is implemented using the principles of relevance, objectivity, robustness, and ability to be
implemented.

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Quantitative Ultrasound Imaging: How to do it

Ivan Miguel Rosado-Mendez

Assistant Professor, Grupo de Dosimetría y Física Médica, Instituto de Física, Universidad Nacional
Autónoma de México,
e-mail: [email protected]

This talk will review the physical principles and technical aspects of three Quantitative Ultrasound
techniques aimed at reducing the well-known operator and system dependence of ultrasound imaging:
Backscatter Ultrasound Spectroscopy (BUS), Speckle Statistics Analysis (SSA), and Shear Wave
Viscoelasticity Analysis (SWVA). These techniques allow the extraction of quantitative imaging
biomarkers (QIBs) that are surrogates of physical and structural properties of tissue from echo signals
produced by clinical scanners. BUS allows quantification of the ultrasonic attenuation and backscatter
coefficients. In particular, the backscatter coefficient can be used to extract information on structural
properties of tissue below the resolution limit of the ultrasound system. SSA informs on the level of
microstructural organization by fitting models to the histogram of ultrasonic echo-signal
amplitudes. Lastly, SWVA provides elastic and viscous properties of tissue by analyzing the propagation
of shear waves created with conventional ultrasound transducers. Special emphasis will be paid to the
importance of assumptions about the structural and physical properties of tissue behind these techniques in
the context of clinical applications.

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Quantitative Ultrasound Imaging: Strengths, limitations and current applications

Ivan M. Rosado-Mendez[1,2], Hassan Rivaz[3], James A. Zagzebski[2], Chrysanthy Ikonomidou[4], Helen

Feltovich[5], and Timothy Hall[2]

[1]Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, MEX

[2]Department of Medical Physics, University of Wisconsin, Madison, WI, USA
[3]Electrical and Computer Engineering, Concordia University, Montreal, CA
[4]Department of Neurology, University of Wisconsin, Madison, WI, USA
[5]Intermountain Healthcare, Provo, UT, USA

Radiomics (the mining of large amounts of quantitative data from medical images to be used in clinical
decision support) plays an important role in the development of personalized medicine. At the heart of
Radiomics are Quantitative Imaging Biomarkers (QIBs), image features that can be obtained from medical
images and that are surrogates of the morphological and physiological state of tissue. The wide-spread
availability, safety and low cost of ultrasound imaging provide a great opportunity to expand the use of
Radiomics, particularly in healthcare systems with limited resources. For this idea to succeed, the well-
known system- and operator-dependence of ultrasound need to be reduced. This talk will cover applications
in gynecology, obstetrics and perinatal care of Quantitative Ultrasound (QUS) imaging techniques that are
being developed to provide QIBs with reduced system- and operator-dependence. Special emphasis will be
put on the strengths and limitations of various QUS techniques, as well as on current challenges that need
to be addressed to extend their translation to the clinic.

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Improving patient radiation protection or evaluating risks in medical imaging:

what matters most?

Cari Borrás, D.Sc.

Consultant, Radiological Physics and Health Services; Adjunct Assistant Professor (Radiology), The
George Washington University, School of Medicine and Health Sciences, Washington, DC 20007, USA; e-
mail: [email protected]

This presentation will define and discuss quantities and units used for radiation protection in the medical
field and those acceptable for patient dosimetry, including risk assessment. Although effective dose is often
used as a patient dose metric, the term was never meant to express risk, since it applies to a reference person
-the wR and wT factors used in its computation were derived averaging age and gender from large
populations. Risk can only be inferred by assessing organ doses. Current methods and uncertainties of organ
dose determinations, such as exposing film, TLD or OSL dosimeters on the patient’s skin; making ion-
chamber measurements in/on patient-simulating phantoms; performing Monte Carlo computations
modeling patient and radiation transport; and accessing electronic data calculated by the imaging system
during a patient procedure, such as the Radiation Dose Structured Report (RDSR) and the Patient-RSDR
DICOM standards, will be reviewed. On the other hand, if the goal is not to assess risk, but to reduce it,
dose-related machine parameters such as incident or entrance air-kerma and kerma-area product for
radiography/fluoroscopy and CTDIvol and DLP for CT, can be measured easily and compared against
previously-established diagnostic reference levels (DRLs). Typical DRLs for adults and children will be
presented.

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Real-time dosimetry in Interventionism

John Willians

Fluke Health Solutions – Business Development Manager;

e-mail: [email protected]

While interventional therapies using fluoroscopy offer significant and well-documented benefits to
patients, the exposure to radiation in the work environment can create major health risks. These risks exist
for the whole care team: physicians and staff, which can include radiation-related illnesses and orthopedic
issues. It is extremely important to understand and now “see” when radiation is emitted and know how to
minimize or avoid exposure during a procedure.

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Image Quality Improvement in Breast Tomosynthesis and Breast CT

Ioannis Sechopoulos, Ph.D.

Associate Professor, Department of Radiology and Nuclear Medicine, Radboud University Medical Center,
Nijmegen, The Netherlands
Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
e-mail: [email protected]

The main limitation of mammography, screen-film and digital, is its two-dimensional nature, resulting in
tissue superimposition. This effect limits the sensitivity and specificity of mammography, especially in
dense breasts. To overcome this issue, over the last two decades, and thanks to the introduction of flat panel
digital detectors, two new imaging modalities have been introduced: digital breast tomosynthesis and
dedicated breast CT. The former has already achieved widespread implementation, and has already taken
over the diagnostic workload from mammography, and the screening workload in some countries. Breast
CT, a more recent development, although now clinical commercial technology, is in a more exploratory
phase, with its clinical impact still being evaluated. This session will review the physical and technological
principles of both of these modalities, and the impact on image quality of the several parameters that affect
them: acquisition technique and dose, hardware characteristics, reconstruction algorithms, and image post-
processing. The current and future clinical impact of these modalities will also be discussed.

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Personal dosimetry results on interventional radiology.

Sapra Landauer Historical data from 2013 to 2017

Yvone M Mascarenhas, Ph.D.

Sapra Landauer – Serviço de Assessoria e Proteção Radiologica – Dosimetry Supervisor and Director;
e-mail: [email protected]

The use of X-rays in the operating rooms, hemodynamic and interventional procedures is of great benefit
for patient recovery time lap, minimizing infection risks and allowing for better use of health service
installations. There has been a significant increase in these procedures in the last ten years. This increase in
the number of intervention procedures has led to an increase in the number of facilities for these procedures
as well as the number of exposed persons. In this study we performed an analysis of the doses received by
professionals in this area monitored by Sapra Landauer in the last 5 years. This study indicates the growth
in the last five years in the radiation dose accumulated annually and a clear manifestation of inappropriate
use of radiation monitors by these health professionals. Urgent actions in this area of X-ray application in
interventional medicine in order to implant a radiological protection culture at this moment is crucial.

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CT technology – and dose – in the 21st century

Cynthia H. McCollough, PhD, DABR, FAIMBE, FACR, FAAPM

Professor of Medical Physics and Biomedical Engineering,

Mayo Clinic, Rochester, MN, USA
President, American Association of Physicists in Medicine;
e-mail: [email protected]

Since its introduction in 1971, x-ray computed tomography (CT) has experienced many major advances in
technology. The 20th century saw the introduction of spiral CT and multi-detector-row CT, making possible
numerous new clinical applications, including imaging of the thorax in a single breath-hold and CT
angiography. Since the dawn of the 21st century, cardiac CT has become a routine exam, and images of the
entire heart can be acquired in just one heartbeat, lowering the effective dose from cardiac CT from
~15 mSv to less than 1 mSv. Dose optimization efforts, including tube current modulation, automated tube
potential selection, and iterative reconstruction have reduced dose levels by almost a factor of 4 since the
1980s. Dual-energy CT is now in widespread clinical use, enabling the assessment of material composition
and concentration, as well as a range of new clinical applications, and isotropic spatial resolution of 150
microns has also been demonstrated. All of these advances have increased the medical benefit and
decreased the potential radiation risk associated with CT. However, care must be taken to ensure that doses
are not lowered too much, to the point where the clinical value is compromised.

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Imagenología Mamaria con Rayos X

Ioannis Sechopoulos, Ph.D.

Associate Professor, Department of Radiology and Nuclear Medicine, Radboud University Medical Center,
Nijmegen, The Netherlands
Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
e-mail: [email protected]

El cáncer de mama es el cáncer mas común en la mujer en el mundo. La introducción de cribado

mamográfico ha tenido un importante impacto en la reducción de la mortalidad por cáncer de mama, pero
este sigue resultando mundialmente en medio millón de muertes al año. En las ultimas dos décadas, sin
embargo, el mundo clínico de la imagenologia mamaria con rayos x ha cambiado radicalmente. Hemos
pasado de las mamografías con placas con tubos de molibdeno a la mamografía y tomosíntesis digital con
tubos de tungsteno y nuevos filtros, y con la tomografía computada de mama asomando por el horizonte.
En esta presentación haremos un raconto de la nueva tecnología, hoy y a futuro, presente en la imagenologia
del cáncer de mama con rayos x, y su posible impacto en la física medica y en la radiología. Discutiremos
sobre las bases físicas, los avances tecnológicos, los algoritmos de reconstrucción, procesamiento y análisis
de imágenes, la percepción de imágenes por los radiólogos, y las consideraciones dosimétricas de las
distintas modalidades.

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Theoretical and practical workshop on Dosimetry of Small Static Fields in

External Beam Radiotherapy - IAEA TRS 483

M. Saiful Huq

AAPM President-Elect and Chair of TG-100

Jan Seuntjens,

Unit Director Medical Physics Unit, McGill University;

Technological advances in the different radiotherapy modalities currently used have generated a
considerable increase in the use of small photon fields. Different radiotherapy techniques, including
Stereotactic Radiosurgery (SRS), Fractionated Stereotactic Radiotherapy (SRT), Stereotactic Body
Radiotherapy (SBRT) and Intensity Modulated Radiotherapy (IMRT), are based on the conformations and
calculations that integrate small field dosimetry. .
In addition to dedicated equipment for these types of treatment, like Tomotherapy, Ciberknife and
Gammaknife, the use of non-dedicated conventional linear accelerators has highlighted the need to use a
code of practice for dosimetry of small fields, thereby enabling increased accuracy in dose delivery to the
patient.
Historically, in conventional radiotherapy dosimetry, agreements have been reached in the use of Codes of
Practice such as IAEA TRS 398 (IAEA, Vienna, 2000), where reference dosimetry is based on a field size
of 10cm x 10cm, but the difficulty in defining this geometry in some of the most specialized equipment has
required to include different proposals in the development of this dosimetry.
The aim of this course is delivering theoretical and practical classes, to disseminate the clinical application
of the new IAEA / AAPM CoP 438 Code of Practice for the calibration of small photon beams and train
medical physicists in their implementation.

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Emerging Techniques and New Protocols in Brachytherapy

Sergio Lozares Cordero, PhD.

Miguel Servet Hospital, Zaragoza, Spain

Santiago Pellejero, PhD.

Complejo Hospitalario de Navarra, Spain

Victor González Pérez, PhD.

Instituto Valenciano De Oncologia

In the workshop on Emerging Techniques and New Protocols in Brachytherapy, an overview will be given
of the advances and new protocols in brachytherapy in which professionals from the Spanish Society of
Medical Physics (SEFM) are involved. The different sessions will deal with following aspects of
brachytherapy:
- New calculation algorithms in BT.
- Trends in prostate BT: focal therapies and alternative treatment techniques from the perspective of the
medical physicist.
- Skin brachytherapy and dosimetry controversies.
- Electronic brachytherapy. Indications and results in gynecological and breast cancer.
- Accelerated partial breast irradiation in breast BT and very accelerated fractionations.
- Advances in gynecological BT.
- Presentation of the cervical gynaecological brachytherapy protocol of the SEFM and current state of
EMBRACE project.
- Transfer of European and American treatment guidelines and protocols to the reality in Latin America.

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Treatment planning of SRS and SBRT treatments

Daniel Venencia, Ph.D.

Chief of Medical Physics Department of the Instituto Zunino – Fundacion Marie Curie, Cordoba,
Argentina; e-mail: [email protected]

A practical course on treatment planning techniques os SRS and SBRT treatments. Introduction to Physical
aspects of SRS and SBRT treatments. SRS of multiple metastasis, Acoustic Neurinoma, Pituitary tumors.
Patient specific QA on SBRT treatment. Practical sessions implemented on 10 treatment planning
workstations with ELEMENTS Spine, Multiple Mts and Cranial SRS from BRAINLAB. Exercises on
Image fusion, distortion correction, automatic organ segmentation, treatment volume delineation, PTV
generation, treatment planning, and treatment plan evaluation.

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Recent advances in image guidance for radiation therapy

Geoffrey S. Ibbott, Ph.D.

Professor Emeritus, Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX

77030, USA; e-mail: [email protected]

The introduction of image guidance in radiation therapy has revolutionized the delivery of cancer treatment.
Modern imaging systems can supplement and often replace the historical practice of relying on external
landmarks and laser alignment systems. Rather than assuming a constant relationship between skin
markings and internal anatomy, image-guided radiation therapy (IGRT) uses x-ray-based techniques such
as computed tomography (CT), cone-beam CT, MV on-board imaging (OBI), kV OBI, as well as optical
surface imaging, MRI, and PET. IGRT and its variants allow the patient to be positioned based on the
internal anatomy. These advances in technology have enabled more accurate delivery of radiation doses to
anatomically complex tumor volumes, while simultaneously sparing surrounding healthy tissues. While x-
ray imaging modalities provide excellent bony anatomy image quality, magnetic resonance imaging (MRI)
surpasses them in soft tissue image contrast for better visualization and tracking of soft tissue tumors with
no additional radiation dose to the patient. However, the introduction of MRI into a radiotherapy facility
carries with it a number of complications including the influence of the magnetic field on the dose
deposition, as well as the affects it can have on dosimetry systems. Similarly, a novel PET-guided treatment
system allows treatment guidance based on biology and physiology, but requires a small additional
radiation dose. The development and introduction of these new IGRT techniques will be reviewed and the
benefits and disadvantages of each will be described.

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Advanced Imaging in Radiotherapy

J. Daniel Bourland, PhD

AAPM

Medical imaging contributes greatly and is invaluable for the radiotherapy processes of treatment planning
and simulation, validation of treatment delivery, and assessment of treatment response. Such images
contribute anatomical, biological and temporal information on the spatial extent and biological functionality
of tumor and normal tissues, providing “a picture of the patient.” In particular, molecular and biological
imaging have great potential and progress for showing the distribution of disease, it’s severity or grade, and
local environmental conditions that may affect the outcome of treatment. Modalities with molecular or
biological imaging capabilities include optical, ultrasound, radiologic, radionuclide and magnetic resonance
techniques. These techniques typically require or may provide anatomical or structural information, as well.
This presentation will review molecular imaging terminology, advanced and biological imaging modalities
and techniques, including their physical and biological bases and relevance across spatial scale, and the
applications of these images in radiotherapy planning and assessment of treatment response. Additionally,
roles and challenges for the medical physicist in the use of advanced oncology images will be discussed.

Learning Objectives:
1. Understand the physical and biological bases of biological and molecular imaging.
2. Review imaging modalities used for biological and molecular imaging.
3. Review the spatial domains of anatomical and biological imaging.
4. Understand the current status and future directions of biological and molecular imaging in radiotherapy
planning and assessment of treatment response.

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Artificial/Augmented Intelligence Applications in Radiotherapy

Jatinder R Palta, PhD

AAPM

Despite many studies over the last three decades that have attempted to explicitly quantify the decision-
making process for radiotherapy treatment planning and delivery, judgments of an individual radiation
treatment’s degree of quality are still largely subjective and can show inter- and intra-practitioner variability
even if the clinical treatment goals are the same. Several factors conspire to confound the full quantification
of radiation treatment quality, including uncertainties in dose response of cancerous and normal tissue, the
rapid pace of new technology adoption, and the human component of treatment planning. However, the
advent of artificial/augmented intelligence (AI) technologies in many fields such as computer vision,
natural language processing, audio processing, and automobile auto piloting have opened the doors for its
applications in radiotherapy. In radiotherapy, AI is likely to improve the treat outcome and reduce toxicity
by providing more precise cancer detection, diagnosis, more personalized and precision treatment strategy,
more accurate target delineation and organ segmentation, better, faster, and more precise treatment planning
and delivery, and more convenient, frequent, and accurate patient follow up. AI may greatly improve patient
safety by automatically detecting and preventing medical errors. This review discusses the potential impact
of AI on four important aspects of radiation oncology; organ segmentation and target delineation, treatment
planning, adaptive therapy, and response assessment.

Learning Objectives:
Understand the challenges associated with advanced radiotherapy planning and delivery techniques;
Understand the current status and future direction of AI research for radiotherapy planning, delivery and
outcome assessment.

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End-to-End Testing for Stereotactic Radiosurgery

F. Bregains

Foundation CEMENER, Entre Rios, Argentina; e-mail: [email protected]

The End-to-End test for Stereotactic Radiosurgery (SRS) consists of simulating a treatment technique from
its beginning to the end. This simulation checks the process of the treatment while analyzing the accuracy
of the delivery. In this presentation the StereoPHAN ™ Phantom will be discussed as a tool designed to
perform End-to-End quality control of radiosurgery systems. Using a series of inserts, the StereoPHAN
allows quality assurance of image fusion algorithms of CT and MRI modalities, as well as the possibility
to use different tools for dose measurement, such as diode array, ionization chamber or radiochromic film.
The experience of CEMENER Foundation using this tool on a TrueBeam® linac, with both cones and high
definition multi-leaf collimators will be presented. All aspects of treatment are considered, including
immobilization, simulation, planning and treatment delivery. In addition, a new detector array, SRS
MapCHECK, will be introduced showing high resolution, accuracy and allowing real-time results to be
shown quickly.

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Patient-specific QA in stereotactic treatments

Tomas Spretz

Fundacion CEMENER, Entre Rios, Argentina;

Eduardo Sabino

Sun Nuclear; e-mail: [email protected]

SRS and SBRT is a technique that uses high doses of treatment in small volumes, demanding extreme
accuracy and high dose gradients. For this reason, a Quality Assurance procedures are highly recommended
for this type of technique. During this session we will discuss aspects of ICRU 91, TG 101 and TG-218
protocols presenting an analysis of uncertainty during each stage of treatment, guidelines according to the
implemented techniques and the current tools to perform quality assurance. We will present experiences
with multiple solutions for Patient Specific QA in SRS, such as Gafchromic EBT3 film, Portal Dosimetry,
SRS MapCHECK and point measurements with detectors, comparing the performance of each in different
clinical cases. Additionally, an integrated and automated platform, SunCHECK ™, will be presented to
improve the routine quality assurance of patient and machine quality management. Also, we will discuss
the workflow for Patient Specific Quality Assurance from Secondary Dose Calculation algorithms, using
ArcCHECK or EPID (phantom-less), to in-vivo transit dosimetry of each fraction of treatment.

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Pilot testing of the CoP TRS-483: Results of an IAEA CRP

Rodolfo Alfonso, Ph.D.

Full Professor, Master program in Medical Physics, University of Havana, Cuba; e-mail:
[email protected]

The IAEA has organized a Coordinated Research Project (CRP E2.40.21) in order to test the practical
implementation of the small field Code of Practice TRS-483, by clinical medical physicists from Member
States (MS) and identify potential challenges. Through this CRP, the participating MSs developed and
implemented a state of the art research in the field of small field dosimetry. The preliminary results on
application of the TRS-483 recommendations with different treatment machines, detectors and phantom
media from the participating MSs are presented and discussed.

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Automated planning and Artificial Intelligence

Laurence E. Court, PhD

Associate Professor, Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX

77030, USA; [email protected]

Carlos E. Cardenas, PhD

Assistant Professor, Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX

77030, USA; [email protected]

The field of artificial intelligence has been a driving force in automation across a breadth of disciplines
including health care. In radiation oncology, we have seen very rapid and promising work focused on
automated segmentation, treatment planning, quality assurance, and numerous other areas. To continue
fostering these advances, it is critical to understand the basic principles behind these artificial intelligence
techniques. This will lead to successful implementation and clinical deployment of these novel tools. In
this session, we will introduce basic artificial intelligence concepts, demonstrate current topics of artificial
intelligence research for radiotherapy treatment planning, and introduce the Radiation Planning Assistant
which is being developed to bring high quality radiotherapy planning to clinics with limited resources.

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Updates on nonstandard beam dosimetry

Jan Seuntjens, Ph.D.

Professor & Director, Medical Physics Unit, Gerald Bronfman Department of Oncology, McGill University

Modern external photon beam radiation therapy for several sites is often delivered by using high radiation
doses in few fractions using robotic machines that deliver these treatments using small fields or composites
of small fields. The calibration of these machines often cannot be done using conventional dosimetry
protocols, since standard reference conditions typically cannot be realized. Recently, IAEA-AAPM Report
TRS-483 was published and provides guidelines to calibrate these nonstandard reference fields and also
provides guidance on the measurement of output factors in small fields. The goal of this presentation is to
provide a review of the TRS-483 protocol with emphasis on new elements that have come up since its
publication in terms of data, detectors and application limitations. In the presentation we will discuss (1)
limitations of machine-specific clinical reference dosimetry; (2) update on detectors for output factors in
small and composite fields and (3) updates on standards for nonstandard beams.

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Independent Patient QA verification of Advanced Treatment Techniques

Jan Würfel, PhD.

PTW-Freiburg, Germany; e-mail: [email protected]

In this presentation, we will introduce the concepts of calculation-based and measurement-based patient
QA and then go deeper into patient QA employing array dosemeters within a phantom. This will cover the
algorithms of the PTW OCTAVIUS 4D and DVH 4D system, gamma pass rates and their parameters, the
differences between global and local percent values and how much all this depends on the specific array in
use. At the end of the session, the presented features will be demonstrated in a software demo using PTW
DIAMOND and PTW VeriSoft.

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Detector Physics for Modern Linac Modalities

Jan Würfel, PhD.

PTW-Freiburg, Germany; e-mail: [email protected]

The lecture will begin with a quick introduction of the most important small field dosimetry aspects and
then move on to the basic physical properties of dosimetry detectors. The different types of detectors on
the market will be thoroughly discussed and some examples will be given where the detector properties
enter into every-day and small field measurements. The small field part finishes with some information on
TRS483 correction factors. Then, the focus will move on to an introduction to FFF linac physics and dose
rate dependence with a focus on the practical application of the presented information. The electrometer is
an important part of the dosimetry signal chain. The lecture will finish with a roundup of electrometers and
their properties.

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SHORT COURSE ON “MONTE CARLO BASED VERIFICATION OF

COMPLEX TREATMENT PLANS: THE PRIMO PLATFORM”.

Miguel Rodriguez, PhD

Centro Medico Paitilla, Grupo Hospiten, Panama; e-mail: [email protected]

A two hours course on the PRIMO system will be lectured. The course will focus on the use of the PRIMO
system for radiotherapy treatment verification. PRIMO is a software solution for the Monte Carlo
simulation of beams of linear accelerators and the estimation of the absorbed dose. PRIMO simulates the
radiation transport through the whole linac head and multi-layered phantoms or patient CT using the
general-purpose Monte Carlo code PENELOPE 2011 or a parallel version of the fast-Monte Carlo code
DPM. The system supports a wide range of Varian linacs. The linac geometries are part of the package;
therefore, the user is not required to enter any geometrical information. PRIMO can produce PSFs at the
downstream end of the upper parts of the linac and can import external PSFs, provided they are compliant
with the IAEA specification. To reduce simulation time, the code incorporates a number of specifically
developed variance-reduction techniques. Additionally, the simulation can be distributed among the cores
in a computer. The system can import CT volumes, structures and treatment plans in DICOM format and
is able to estimate the dose distribution for dynamic treatment plans. PRIMO operates in interactive mode
as well as in macro-mode; the later uses a command interpreter to automatically execute configuration,
simulation and data processing operations and enables the incorporation of PRIMO as calculation tool in a
treatment verification platform. The system is freely distributed in the site http://www.primoproject.net.
The topics addressed in the lecture will be the following:
- The Monte Carlo method for radiation transport. Generalities.
- Introduction to the Monte Carlo codes PENELOPE and DPM.
- PRIMO architecture
- PRIMO operations
- Radiotherapy plan and treatment verification with PRIMO.

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What Physics says about Co-60 source for HDR brachytherapy

Daniel Rodríguez Latorre, Ph.D.

Medical Physicist, Hospital Universitario Central de Asturias, Oviedo, Spain

The lecture is on past and present of Co-60 brachytherapy sources; Ir-192 vs Co-60: half time, energy,
absorption coefficients, TG-43 parameters, integral dose, shielding.

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Co-60 HDR brachytherapy source in the clinic

Daniel Rodríguez Latorre, Ph.D.

Medical Physicist, Hospital Universitario Central de Asturias, Oviedo, Spain

The lecture is on quality assurance issues with Co-60 HDR brachytherapy sources, source changes,
traceability; applicators: is there differences in applicators between Co-60 and Ir-192?; TG-43 accuracy for
Co-60 dose calculation in different body sites.

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Out-of-field doses and secondary cancer risks estimations in modern Radiotherapy

Beatriz Sánchez-Nieto, PhD.

Associate Professor, Institute of Physic, Pontificia Universidad Católica de Chile, Santiago, Chile;
e-mail: [email protected]

In recent years, radiotherapy (RT) has undergone considerable development that has had a positive impact
on the survival rate after a cancer diagnosis. This has increased interest in the possible risk of induction of
second primary cancers with a late onset of at least five years. The induction of a second cancer is associated
with the inevitable exposure to radiation of organs or tissues outside the treatment field.
The difficulties in the calculation of peripheral doses have hindered reasonable estimations of second cancer
risks (LNT models and parameters –e.g. in BEIR VII- were available more than a decade ago). Regardless
of the type of radiotherapy being used, out-of-field doses delivered by photons (commertial treatment
planning systems can only provide accurate photon dosimetrical information within the 5% isodose),
electrons, protons, or neutrons pose unique challenges to medical physicists (AAPM TG 158). This talk
focuses on the challenges associated to nontarget radiation dosimetry by photon and neutron and provides
solutions on on how to best determine the out-of-field doses associated with individual photon RT plans.
Then, a methodology to estimate the risk of second cancers based on the the best source of dosimetrical
information available for individual plans will be presented and discussed in the light of the findings of
epidemiological studies.

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The potential impact of convergent X-rays beams: High performance radiotherapy

by CONVERAY & integral theranostics by OSIRIS

Rodolfo Figueroa Saavedra, PhD

Universidad de La Frontera (UFRO), Temuco, Chile

The state of progress, characteristics and impact of two technologies under development at UFRO
are shown. These innovations will be known as CONVERAY (Convergent Ray) and OSIRIS
(Integral System of Orthovoltage Source Induced Radiation).
CONVERAY is an experimental convergent beam device adaptable to a LINAC, with dual output of
electrons or photons and will allow the future CBRT (convergent beam radiotherapy) technique.
CBRT therapy is characterized by presenting a peak of relative high intensity dose, similar to that
shown by a hadrontherapy device. However in this case, it is with photons or electrons that can
focus on the area of the tumor. This technique will improve effectiveness in the irradiated area,
reduce side effects and treat hard-to-reach tumors. To achieve its current state, the development of
CONVERAY has carried out several projects. The global project takes about nine years and a
device is expected to be started in the clinical phase within two years.
On the other hand, OSIRIS is a device in the development stage of prototype for the detection of
tumors, functional images and simultaneous radiation therapy in a single device at orthovoltage
energy level. This device will operate on the basis of a large confocal array (103 cc) and secondary
radiation induced in metal nanoparticles (Au, Gd) used as biomarkers. Secondary radiation is
composed of: photoelectrons, Auger electrons and high energy characteristics X-ray, XRF from K
edge in heavy metal. These nanoparticles will be previously injected into the patient and are stick
to the tumor as a bio-targeting agent, allowing its detection and guided radiation therapy in real time
and also improves contrast and dose. The studies we have done show that confocal geometry
allows the application of convergent beams in the orthovoltage energy range (CONVERAY Low).
The focuses the radiation on the bio marked point and appropriate arrangement of solid state CdTe
detectors or scintillators or both, make it possible to detect deep neoplastic tissue and simultanealy
generated electrons in the focal spot zone impart dose. Making a 3D scan of the focal spot of the
radiation in on the tumor zone it is possible to obtain a functional image of the bio marked volume.
An increase in the intensity of the tube current can make a second accurate sweep through the
effectively marked area. It will also be possible to include a second converging beam of higher
power and slightly offset (ms) of the first and guided by it. A highly accurate treatment scan will not
require immobilization of the patient.
In summary, these technologies based on a convergent beam will allow to make CBRT in
conventional tele-therapy equipment with CONVERAY technology and also more the future, more
precise and economical effective theranostics processes (OSIRIS) could be carried.

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Advances in Nuclear Medicine Physics

Sergio L. Mosconi

Head of the Department of Nuclear Medicine of the Fundación Escuela de Medicina Nuclear (FUESMEN),
Mendoza, Argentina; e-mail: [email protected]

Mauro Namías

Head of medical physics at Fundación Centro Diagnóstico Nuclear, Buenos Aires, Argentina; e-mail:
[email protected]

Quantitative harmonization in PET: current status and new developments: Measurements derived from PET
scans are usually non comparable accross different scanner models and/or reconstruction settings. In this
talk, the major aspects affecting quantification of PET images will be discussed as well as current
harmonization approaches.
Protocol optimization in PET: Acquisition factors affecting image quality will be discussed . Current and
state-of-the-art strategies for injected dose and acquisition time adaptation will be introduced.
Quantification in SPECT/CT: The main requirements for converting a conventional SPECT/CT system into
a quantitative device will be discussed, with emphasis on attenuation and scatter correction and absolute
system calibration.

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Methodological Aspects for in vivo activity quantification and dose assessments

during the RT.

Leonel Torres, PhD.

Center for Clinical Research, Havana, Cuba; e-mail: [email protected]

Formalisms for absorbed dose estimations at cellular, organ and voxel levels will be presented and
discussed. It will include the procedures for in vivo activity quantification and patient specific methods for
dose calculations. Dosimetry formalisms such as the MIRD methodologies, Monte Carlo techniques, local
deposition approaches, etc. will be presented enhancing their main features and their requirements for
practical use; their strengths and limitations will be also highlighted. The available methods for in vivo
activity quantification will be discussed considering correction of the main physical factors affecting the
quantification accuracy such as attenuation, scatter, partial volume effect, background, etc. Finally, well-
known and new tools for activity quantification will be analyzed.

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Clinical Dosimetry in the therapy of malignant and benign diseases.

Marco A. Coca, MSc.

Medscan Concepción, Chile; e-mail: [email protected].

Specific procedures for Internal dose estimations will be shown emphasizing on the dosimetry calculations
of current clinical procedures for cancer treatment using radionuclide therapies. It will include dose
estimations methods during the therapy of HCC with labeled spheres SIRTEX, NET with 177lu-peptides,
thyroid diseases treatments, etc.

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Image-based radiobiological dosimetry.

Carlos Calderon, MSc.

Nuclear Medicine Department, National Oncology Institute, Havana, Cuba; e-mail:

[email protected]

The radiobiology aspects and mechanisms of actions involved on the cancer therapy-using beta and alpha
emitters will be presented. The contribution of radiobiological parameters to the response and radiotoxicity
prediction after the radionuclide therapy of malignant diseases will be evaluated using a comprehensive
approach. Basis for personalized biological treatment planning in radiopharmaceutical therapy, as well as,
the combination with external beam radiotherapy or different radionuclides based on iso-effective
relationships will be discussed.

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The Challenges Professional in the Radiation Protection of the Patients

Carlos E. de Almeida Ph.D. FAAPM. FIOMP

Rio de Janeiro University, Rio de Janeiro, Brazil, E-mail: [email protected]

The continuous increase of the use of ionizing radiation sources for diagnosis and treatment has been
substantial in last decades. There is no doubt that and effective benefit to the patient is a reality, but in some
cases the family doctor may request a disproportionate number of exams or the exam is repeated due to
lack of appropriate QA. As result, the radiation dose that some patients are submitted may turn out not
having a positive net benefit. The whole process we all know is very complex, as it enroll several factors
such as, the clinical indication, human errors, management, education, QA programs, regulations and the
technology available.
In addition, even more important is to promote the user understand of the source of the data (UNSCEAR)
that allow the periodical update of the recommendations made the international bodies i.e. ICRP and IAEA.
Unfortunately, the documents in most cases are just translated without a thorough discussion among the
local scientific community, the regulatory agencies and the final users.
Those challenges must be faced, discussed and be part of the educational curriculum of each professional
working in the area and the professional societies as well as the regulatory agencies must play a considerable
role to promote that. This paper expects to address those issues mainly for our reflection.

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Workshop on optimization of safety in modern radiotherapy

Antonio Torres, PhD.

Department of Nuclear Engineering, InSTEC, University of Havana, Cuba; e-mail: [email protected]

Radiotherapy practices move towards the application of increasingly sophisticated techniques, from the
hardware and software point of view, such as IMRT itself, which would mean the reduction of human errors
and the doses applied to patients during treatments. However, when it seems that in some stages human
participation decreases, just to mention two examples: the quality controls are increased, as well as the
maintenance actions of the equipment. Thus, the necessary monitoring of possible human errors becomes
more important, which is associated with the development and application of the study of risks in these
practices. The workshop provides for the active involvement of participants through discussion of their own
cases with a focus on risk modeling. The workshop includes three work sessions during which training and
exchange will be achieved through a focus on problems for teaching-learning.

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Radiation Protection of Patients in the Latin American and the Caribbean Region

Pablo Jimenez

Regional Advisor in Radiological Health. Department of Health Systems and Services. Pan American
Health Organization (PAHO). Washington, DC 20037. USA; e-mail: [email protected]

The continuous introduction of technologies that use ionizing radiation in the health sector is producing
substantial benefits for public health. Latin American and the Caribbean Region is benefiting to some extent
from these advances. Demand for radiological services is increasing in the Region due to the surge in
illness, new clinical applications, and broader societal trends. This is stimulated by the increase in
population and specifically aging population, lifestyle changes, and increase in healthcare programs and
reforms towards Universal Health. However, these procedures may be dangerous to patients. At the
facilities level, quality assurance programs designed to obtain accurate diagnoses or efficient therapies, and
to ensue radiation protection of patients are more necessary than ever. The existence of well-trained
professionals is essential for achieving the main clinical objective. At the governmental level, there are still
challenges to establish appropriate and sustainable national regulatory infrastructures. In many countries
their technical capacity and resources are still too limited to satisfactorily carry out the functions established
in the BSS, while in others there are non-existent. PAHO has been advising governments and providing
technical cooperation for many years in this field.

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Radiation Protection Symposium: Analysis and Evaluation of Radiology Facilities

in preparation for IAEA Audits

Arias C. Omar, MsCs.

Professor, Department of Technology, Faculty of Medicine, Venezuela Central University, Venezuela / SEO
SEROFCA, Curazao
e-mail: [email protected]

Radiology environments must meet a series of requirements that guarantee the safety of occupational
workers and the public. For this, knowledge of the type of radiation, the equipment to be installed, as well
as its characteristics (maximum value of kV and mA), the estimation of the number of studies and the
description of the continuous areas to the environment in question is essential ; with which the physicists
in charge of fulfilling the function of radiological safety officer of a health center, must handle not only the
technical documents related to the calculation of the protection and the radiometric survey, but also must
analyze the workflow of the workers, patients and the public, in order to ensure that estimates, shielding
and verification measures go hand in hand, optimizing the resources of the institution and ensuring the
safety of all.

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Radiation effects in the uterus, the embryo/fetus and children

Cari Borrás, D.Sc.

Consultant, Radiological Physics and Health Services; Adjunct Assistant Professor (Radiology), The
George Washington University, School of Medicine and Health Sciences, Washington, DC 20007, USA; e-
mail: [email protected]

The course will review stochastic and deterministic radiation effects on the uterus prior and after
conception. The effects of in utero radiation should not be confused with the heritable effects that can be
manifested by irradiating germ cells (ovules or sperm cells) before conception, which are always stochastic.
Irradiation of somatic cells of the embryo/fetus can cause: embryonic death, which can happen in the period
of pre-implantation at doses above 100 mGy; malformations, which can occur during organogenesis with
a threshold dose of 300 mGy, and severe mental retardation (decrease of 30 IQ), which can appear 8-15
weeks after conception with a threshold of 500 mGy. It is important to note that the spontaneous incidence
of these effects is, respectively, 1 in 17, 1 in 200 and 1 in 1,000 unirradiated embryos or fetuses.
Epidemiological data from large in utero exposed cohorts in Hiroshima and Nagasaki, Chernobyl and the
Southern Urals (Mayak Plant and Techa River) will be presented. Epidemiological studies on radiation
effects on children, highlighting their different tissue radiosensitivities, will also be examined. The impact
of these findings on therapeutic and diagnostic radiology procedures will be explored.

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Education & Training in Medical Physics. From academic training to recognition

Pablo Jimenez

Regional Advisor in Radiological Health. Department of Health Systems and Services. Pan American
Health Organization (PAHO). Washington, DC 20037. USA; e-mail: [email protected]

Medical physicists have been working in the health sector for many decades, however both proper training
and recognition are still major challenges worldwide. The International Basic Safety Standards (BSS)
require that medical physicists have education and training in the concepts and techniques of applying
physics in medicine, and that are competent to practice independently in one or more of the subfields
(specialties) of medical physics. Additionally, medical physicists should be recognized as health
professionals. Only national health authorities are able to include medical physicists in the cadre of health
professionals. Therefore, additional efforts from the professional societies and from intergovernmental
organizations such as PAHO and WHO should continue in order to achieve the deserved recognition.

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IAEA guidelines for postgraduate medical physics academic education

Giorgia Loreti

Training Officer (Medical Physics), International Atomic Energy Agency (IAEA), Vienna

The IAEA guidelines, published in 2013 and endorsed by the International Organization for Medical
Physics (IOMP), provide recommendations for the establishment of a postgraduate academic education
programme in medical physics. Concurrently, they highlight the importance of a postgraduate-level degree
in medical physics to underpin the subsequent clinical training providing the competencies needed to work
in a clinical setting. The postgraduate-level academic education and related knowledge also play a key role
in contributing to the recognition of medical physicists, placing them at the same level as other medical
professionals with whom they collaborate in their daily clinical work. Despite its inclusion among the
healthcare professions by the International Labour Organization, the medical physics profession has yet to
be recognized worldwide. The IAEA is committed to addressing this lack of recognition, as it often
undermines the impact of the contribution of clinical medical physics professionals to safe, quality and
effective patient care.

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Practical Experience with Training in Low-to-Middle Income Countries

Ivan M. Rosado-Mendez

Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, MX

Diane Alvarez

Baptist Health South Florida, Miami Cancer Institute, Miami, FL, USA.

Laura Padilla

School of Medicine, Virginia Commonwealth University, Richmond, VA, USA

Mariela Porras-Chaverri

Escuela de Física, Universidad de Costa Rica, San Jose, CR

New generations of medical physicists, particularly in low- and middle-income countries, face the challenge
of decreasing access to resources for research and training. However, the increasing availability of virtual
communication and learning tools offers new opportunities to bring students, scientists and clinical medical
physicists closer to new advances in the application of physics to diagnostics and therapy. This talk will
present some ongoing efforts aimed at using free virtual communication resources to improve access to
Medical Physics training in Latin America, with special focus on the International Academic Virtual
Exchange (IAVE) Network. IAVE is a collective of students, academic and clinical medical physicists with
the mission of promoting a culture of collaborative research and mentorship among students from different
international institutions using virtual platforms. A summary of the achievements and challenges of the
first two years of activities will be presented.

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A hands-on introduction to deep learning for medical physics.

Gilmer Valdes, PhD.

Assistant Professor in the Department of Radiation Oncology at University of California, San Francisco,
USA;
e-mail: [email protected]

Yanet Interian, PhD.

Assistant Professor at the University of San Francisco, in the Masters in Data Science program; e-mail:
[email protected]

Background: The application of machine learning to medical physics has created tremendous excitements
with research that encompass: quality assurance1-3, outcome prediction4, 5, segmentation and image
registration 6 or dosimetric prediction 7. Within machine learning algorithms, deep learning techniques in
particular seem to motivate big part of the hype due to successes in other industries. The popularity of deep
learning algorithms started in 2012 when Krizhevsky et al won the 2012 ImageNet Large-Scale Visual
Recognition Challenge (ILSVRC) by more than 11 percent compare to the next competitor using a
Convolutional Neural Network (CNN)8. Convolutional Neural Networks were not new but access to a big
annotated dataset (1.2 million images), new regularization techniques called dropout, techniques to generate
more training examples by transforming the existing ones (data augmentation) and computational power
made this achievement possible. Soon, other applications followed with similar results (e.g. machine
translation). Medical Physics has not been oblivious to this excitement and many applications of deep
learning algorithms can be found in the literature.
Session description: Deep learning is the state-of-the-art machine learning technique in object recognition,
image segmentation, speech recognition, and machine translation. Deep learning is also the best tool for
medical image analysis. PyTorch is an open source deep learning library developed by Facebook AI. This
course is a hands-on introduction to deep learning and its application to medical physics. You will learn
model building for image analysis using PyTorch. Additionally, you will learn direct application of these
models to medical physics which goes from predicting patient specific quality assurance metrics to
predicting 3D dose distributions. The future of Deep Learning in Medical Physics will be discussed at
length.
Outline:
1) Introduction to deep learning with PyTorch. (1 hr)
2) Applications of deep learning to medical physics. (45 mins)
3) Hands-on image analysis pipeline with PyTorch. (1hr 15 mins)
Prerequisites: The examples will run in Python, so knowing the basics of Python syntax is recommended.
Bring a computer with Anaconda (Python 3) and PyTorch installed.

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X-Ray Based Breast Imaging

Ioannis Sechopoulos, Ph.D.

Associate Professor, Department of Radiology and Nuclear Medicine, Radboud University Medical
Center, Nijmegen, The Netherlands
Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
e-mail: [email protected]

Breast cancer is the most common type of cancer in women worldwide. The introduction of mammographic
screening has had a substantial impact on breast cancer mortality, but breast cancer continues to cause half
a million deaths a year. In the last two decades, there have been important changes in the realm of x-ray
based breast imaging. We have moved from screen-film mammography with molybdenum-anode x-ray
tubes to digital mammography and breast tomosynthesis with tungsten targets and new filters, and with
dedicated breast computed tomography being recently introduced and its impact in the clinic approaching.
The current and future technology involved in x-ray based breast cancer imaging, and their possible impact
on medical physics and radiology will be reviewed. The physical and technological basis for these
advances, and their dosimetric aspects will be discussed.

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Results of IAEA survey on clinical training in the LAC Region - part of the
regional workshop on new approaches for clinical medical physics.

Giorgia Loreti

Training Officer (Medical Physics), International Atomic Energy Agency (IAEA), Vienna

According to IAEA guidelines Roles and Responsibilities, and Education and Training Requirements for
Clinically Qualified Medical Physicists, published in 2013 and endorsed by International Organization for
Medical Physics (IOMP) and the American Association of Physicists in Medicine (AAPM), structured
clinical training is essential to achieving the competencies required to work independently in a clinical
setting as a medical physicist. In early 2019, a survey was circulated by the IAEA in the Latin America and
Caribbean region with the aim of collecting information on the ongoing clinical training in the three medical
physics sub-specialties. The good response rate to the survey, together with the information received,
helped provide an overview of clinical training in the region. Audience interaction and discussion will be
encouraged, with the aim of sharing information on this important topic.

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The Professional Master Degree on Medical Physics in Brazil, a Novel Experience

Carlos E. De Almeida

Rio de Janeiro University and Fundação do Câncer - Rio De Janeiro, Rio de Janeiro, Brazil,
[email protected]

A Medical Physics Master's degree program in progress is a joint effort of the Cancer Foundation and the
State University of Rio de Janeiro as part of the National Education Program in Radiotherapy. The purpose
of this program is to train, qualify and update professionals, linked to public, philanthropic or private health
therapy centers that treat patients from the Brazilian Health Care System (SUS). This program aims to train
20 medical physicists to work in Radiotherapy during the period 24 months ending in June 2018. It is
intended to help to minimize the present gap of qualified medical physicists in Brazil enhanced by
installation of 80 new Linac’s within the next 2 years. The total workload of the Master of 5410 hours
divided in 610 hours of theory and lab work plus 4800 hours of clinical experience plus clinical research
project. Each student was awarded a fellowship, and received a laptop with a treatment planning system
installed, internet access to the bibliography, lectures and the clinical cases. This innovative paperless
Project allows an effective interaction among the students, professors and the coordination team. All
lectures, exams, lab reports and home works are loaded into the managing platform developed in-house,
called Tandle (Teach and Learning) to be made available to other training programs in the Latin America
region. For the clinical training the students are distributed in 15 different carefully selected institutions
under the supervision o of Board Certified Medical Physicist.
This project was financed by the Ministry of Health –PRONON

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Clinical Training in Medical Physics as per IAEA Guidelines and Relevant

Activities

Giorgia Loreti

Training Officer (Medical Physics), International Atomic Energy Agency (IAEA), Vienna

In pursuit of supporting safe, quality and effective diagnosis and treatment of patients, the IAEA is
committed to help Member States enhance their healthcare services through the contribution of competent
and well-trained health professionals. Consequently, the IAEA developed specific documents to provide
guidance on structured and supervised clinical training to medical physicists, with the aim of equipping
them with the competencies needed to work in a clinical setting. The best practices contained in IAEA
guidelines will be presented, exploring pathways toward their sustainable implementation in the region, for
example considering harmonization through regional or sub-regional approaches. The IAEA encourages
regional ownership and strategic planning to enhance sustainable approaches to clinical medical physics
competency building, as done for example in the Asia and Pacific and Africa regions. The workshop aims
at encouraging the exchange of opinions among participants, with a view toward addressing the specific
regional challenges of the medical physics profession.

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Current Issues regarding Artificial Intelligence in Cancer Care. Implications for

Medical Physicists and Biomedical Engineers.

Eva Bezak1,2, Loredana Marcu1,3 and Chris Boyd1,4

1
Cancer Research Institute and School of Health Sciences, University of South Australia,
2
School of Physical Sciences, University of Adelaide, North Terrace, Adelaide, South Australia 5005,
Australia
3
Faculty of Science, University of Oradea, Oradea 410087, Romania
Adelaide SA 5001, Australia
4
SA Medical Imaging Medical Physics Group, Adelaide SA 5000, Australia

The development of Artificial Intelligence (AI) in health has been a long road with many significant
obstacles that at the same time present opportunities for Biomedical Engineers and Medical Physicists to
assume leadership roles in development and implementation of AI and data mining in health. IOMP,
IFMBE and IUPESM must take initiative in addressing the current challenges in AI and big data science,
including:
A) Big data collection. Large data set acquisition is needed across all areas (clinical, treatment,
imaging, biological/genetic, etc.), requiring multi-institutional and multinational collaboration.
B) Registries. Development of national and international registries is a must for big data collection.
C) Data Privacy while performing Data Sharing (potential obstructions to data sharing owing to
patient privacy protection).
D) Data Input and Standardization of Reporting. There is need to standardize data reporting.
E) Image variability. Differences in quality and interpretation of images.
F) What knowledge/data should be recorded and used. The volume and variability of data mean that
it is hard to translate them into knowledge and leverage that knowledge to guide clinical decisions.
G) Algorithms. A diagnosis can only be expected to have as much accuracy as the information on
which it is based.
H) How can we use these models in a strategically optimal manner to adapt a patient’s treatment
protocol?
I) Implementation, validation, and quality assurance.
J) Rapidly growing volumes of data to be stored and processed (IT infrastructure and data storage).
K) Ethical consideration – e.g. the bearing of responsibility in case of misdiagnosis done by an AI
system.
L) Many others.

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The IMPCB certification process

María-Ester Brandan, Ph.D.

Institute of Physics, National Autonomous University of Mexico, Mexico City, Mexico; e-mail:
[email protected]

This lecture will be given in Spanish (slides in English). The International Medical Physics Certification
Board, IMPCB, was formed on year 2010 with the purpose to support the practice of medical physics
through an individual certification program in accordance with IOMP (International Organization for
Medical Physics) guidelines. Among IMPCB objectives are to establish requirements and procedures for
the accreditation of medical physics certification programs, to establish the examination procedures for the
certification of medical physicists, and to provide guidance to medical physics organizations for the
establishment of national medical physics certification boards and to conduct board examinations for
physicists in countries which have not yet established certification boards. This lecture will present an
overview of IMPCB and the model for its Medical Physics Certification Process.

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IOMP School, joint session with IAEA-PAHO-ISR: The role of medical physicists
in justification in medical imaging.

Ola Holmberg

IAEA

Over the last decades, there has been much progress in the area of optimization, but progress in the area
of justification has been progressing more slowly. Authoritative sources suggest that a substantial fraction
of radiological examinations may be inappropriate, from 20% to 50% in some areas. Key practical issues
to the effective implementation of justification are first, the means of ensuring that those referred for
radiological examinations really need them, second, auditing of the effectiveness of referrals and related
processes and third, effectively communicating radiation risks to the relevant persons involved.
The International Atomic Energy Agency, in cooperation with the World Health Organization, has over a
number of years been systematically addressing the strengthening of justification of medical exposure in
diagnostic imaging. Outcomes of this work has been e.g. the AAA Campaign which advocates actions to
take in relation to Awareness, Appropriateness and Audit; the highlighting of the justification issue within
the Bonn Call for Action; and the series of technical meetings and scientific articles on clinical imaging
guidelines, guiding health professionals, mainly radiologists and referring physicians, as well as
regulators. These approaches will be discussed, together with what the role of a medical physicist can be
in this context.

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From academic training to recognition

Renato Padovani,

ICTP, Italy

Recognition of clinical medical physicist profession is a constant issue in all countries and, in particular, in
countries where medical physics programmes are not present or where medical physics is not a developed
profession. International and national MP societies have and are working to develop strategies to give to
the clinical medical physicists the necessary knowledge and competences, the certification of the individual
competences and the formal recognition.
Which are the keys for a successful strategy? Primarily a solid and high-level academic education. Due to
the increasing complexity of medical practices, a Master in medical physics is a prerequisite. Organisations,
like IOMP, IAEA, EFOMP, AAPM, are requesting this level of education and are providing
recommendations and syllabi. Then a supervised structured clinical training of at least 2-4 years is also
requested.
Medical physics organisation should work to establish this type of education and training programmes. This
level of education and training, similar to that of medical specialist, will give a different reputation to the
MP inside the health service. Another not trivial aspect, with this level of E&T the contract and the salary
can be expected to be similar to the medical specialist.
Regional or international accreditation of the E&T programme (e.g. by IOMP and IMPCB) can help
national societies to harmonise programmes and this is another step to reach recognition.
Due to the rapid changes of clinical practices and technologies, a continuous professional development
programme (CPD) is another mandatory step. If CPD is not required by national rules, MP societies should
develop and maintain a CPD programme.
All these steps, assuring the delivery of a high quality health service, will facilitate the recognition of the
profession and, finally, the recognition of our MP colleagues as high level and necessary professionals in
the health services.

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New approaches for Clinical Training of Medical Physicists in Latin America and
the Caribbean

Renato Padovani

ICTP, Italy

At the Master after master of medical physics, jointly organised by ICTP and the Trieste University and
supported by IAEA, we had up-to-now 21 students from Latin America and Caribbean. For the
development of medical physics In the region, our graduates can be seen as new resources for their
international experience and the year spent in an advanced medical physics department in Italy. Many of
them have reached a good level of competences, mainly in radiation therapy, to act as teachers and trainers
of medical physicists.
Concerning the small countries in the region, a critical mass for the development of MP can be reached, in
my opinion, only through collaborations and integration of programmes for nearby countries. ALFIM
should support these actions with a strategic plan that provides expertise, harmonisation and accreditation
of programmes, CPD resources, and government contacts. IAEA supporting programmes should integrate
and support such a strategic plan.
In an education and training programme, the clinical training part is probably the most difficult task to
achieve. Accredited training centres with a number of senior medical physicists and up-to-date technologies
should be identified over the network of countries. However, the network of training centres should be
supervised, audited and coordinated at the regional level, e.g. throughout ALFIM or an ad-hoc institution.
Do not forget that the training can take advantage of distance learning platforms and mentors, but only a
extended period of supervised clinical training in a training centre can provide the necessary skills and
competences that can be acquired solving the daily problems and with the inter-professional interactions.

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First Tomotherapy System in Argentina: experience of its clinical commissioning

and the impact of placing it far from large cities.

Graciela R. Velez, M.P.

Head, Medical Physics, Sunchales Oncology Center – Santa Fe, Argentine. e-mail: [email protected]

The arrival of Tomotherapy System at Argentina occurred in a small town in the interior of the country.
How is it done to take advantage of the potential of this technology in a small city far from big urban
centers? The challenge was not easy; however, the hiring of experienced personnel and acquisition of high-
quality QA devices allowed the institution to perform the 2-3 first months operation successful and safe.
Commissioning new kind of advanced technology equipment is a complex issue, not only for the users
(MP, MD, RTTs, including administrative staff), but also for the authorities because it requires to
incorporate new concepts as well as updating traditional knowledge.

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ICMP 2019 / ALFIM 2019

ORAL PRESENTATIONS

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O-1

MEASUREMENT OF DOSE TO THE LENS OF THE EYE DURING FLUOROSCOPIC

IMAGE GUIDANCE OF INTRA-ARTERIAL CHEMOTHERAPY

Leonardo Vieira Travassos1, Rafael Figueiredo Pohlmann Simões1, Cláudia Lúcia De Pinho
Maurício2, Alfredo Viamonte Marin1, Kelma Macedo Pohlmann Simões3
1
Instituto Nacional do Câncer, Brazil
2
Instituto de Radioproteção e Dosimetria
3
Instituto Brasileiro de Oftalmologia

Diagnostic and Interventional Radiology – General

Objective: This work aims to estimate, under simulation conditions, the absorbed doses of radiation
received by the patient lens during treatments of retinoblastoma by intra-arterial chemotherapy (TRIC)
using optically stimulated luminescent (OSL) detectors placed on the ocular region surface (ORS) of an
anthropomorphic phantom of head and neck.

Methods: The absorbed doses were measured with a set of four OSL detectors placed on both left and right
ORS of the phantom. All irradiations were done using the same Philips Allura Xper FD20 angiograph,
following the same protocols used in the TRIC. Three consecutive irradiations were performed for five
different fluoroscopy times (5, 10, 15, 20 and 25 min) and two source positions, right (+90°) and left (-90°),
totaling six irradiations for each interval of time. The detectors were calibrated in an ISO W 80 x-ray beam
from the Brazilian National Metrology Laboratory in order to ensure the traceability.

Results: The absorbed doses in the ORS increase linearly to the irradiation time. According to literature
data, the threshold recommended to ensure that there are no late effects on the lens, such as cataracts, is
ideally up to 100 mGy and, certainly, less than 500 mGy. The ORS adjacent to the source accumulates a
dose around five times greater than in the opposite ORS. The irradiation time threshold on the eye adjacent
to the source that would guarantee doses absorbed in the ORS up to 100 mGy would be 35 min and 162
min for opposite eye for the set and beam characteristics considered at this work.

Conclusion: The adoption of time control and the possibility of calculating the time alternation of the
position of the source present themselves as determinants for the optimization of the irradiation doses and,
consequently, increasing the chance of preserving the patient visual acuity.

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O-2

NEW SUGGESTION OF WINDOW AND ENERGY LEVEL FOR PROTOCOLS USED

FOR ACQUIRING IMAGES OF PATIENTS ADMINISTERED BY RA-223

Rafael Figueiredo Pohlmann Simões1, Lídia Vasconcellos De Sá2, Carlos José Da Silva2, Ronaldo Lins
Da Silva2
1
Instituto Nacional do Câncer, Brazil
2
Instituto de Radioproteção e Dosimetria

Nuclear Medicine

The Radium-223 has being used for a nuclear medicine therapeutic technique in patients affected by
prostate cancer metastasis. The dosage are currently only defined by the patient’s weight as the directions
of the drug laboratory. This study has the aim of collaborate to the trend of individualizing the therapeutic
protocol for each patient according to the lesions extensions and clinic conditions. Gamma Camera’s
images of patients administrated by Radium-223 can be determinant for theses intentions. This radionuclide
has a very small gamma emission probability, less than 2%, and this is a theranostics ability’s obstacle. The
literature recommends to acquire images with an 20% window centralized in 82 keV at the x-ray region in
spectrum, however this region has an emission of characteristic x-ray from the lead collimator together and
its results in a relevant level of noise that turn the internal dosimetry very hard. Therefore, the goal of this
study is to propose a new window and energy center avoiding the lead collimator’s characteristic x-ray
emission using the results of an spectroscopic GeHP (High-Purity Germanium), ORTEC® GWL well-type
model 120-15 that means 120 cc active volume GWL detector with 15.5 mm diameter well tube and 70
mm diameter endcap. This detector has a greater energy resolution that can split and identify the
components of the only one peak visualized at the NaI crystal of the major of gamma cameras equipments.
The results of this analysis suggest a window of 24% centralized at 89 keV in order to be open from 78
keV to 100 keV. It shown that the traditionally used window eliminates an important region of x-rays
emmited by the Radium-223 and collect almost 50% of noise from lead collimator's characteristic x-ray, so
this results can collaborate to the redefinition of the acquire image protocol for this radionuclide.

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O-3

CAD SYSTEM FOR MICROCALCIFICATIONS AND MASSES IN DIGITAL

MAMMOGRAPHY

Marlen Perez-Diaz1, Ruben Orozco-Morales1, Eduardo Daniel Suarez-Aday1, Rosana Pirchio2

1
Universidad Central "Marta Abreu" de las Villas, Cuba
2
Comision Nacional de Energia Atomica de Argentina

Diagnostic and Interventional Radiology – General

Breast cancer is the most common malignant injury among women and the second cause of death after lung
cancer. It represents 16% of all female cancers. The X-ray mammography is the diagnostic test of choice
for early detection. It manifests basically by some characteristic lesions such as masses, microcalcifications
and abnormal ducts. However, the breast is composed of soft tissues and the anomalies do not differ much
from healthy areas in attenuation of X-rays, which is why it is essential to have high contrast and resolution
images, low noise and no artifacts; otherwise, radiologists have trouble diagnosing accurately for lack of
visibility and false positives or negatives can be obtained. In this context, computer-aided detection (CAD)
systems are a diagnostic aid tool for physicians.

In this work a CAD system is proposed, which improves the quality of the digital mammographic image;
segments the gland and remark the presence of micro-calcifications and / or masses on the improved
images. The system is based on the implementation of segmentation methods using Laplacian, opening of
binary areas, determination of binary related components, global thresholding based on the image entropy,
morphological filtering, iterative methods for the improvement of image contrast and segmentation by
active contours. The system was tested with the database (DB) annotated MIAS, in oblique lateral views,
of glandular, glandular-dense and predominantly adipose breasts, which included lesions or were normal.
The system was evaluated with respect to the DB annotation, for a sample of 115 images. A sensitivity of
93.2% was obtained, a specificity of 85.3%, an accuracy of 90.4% and an precision of 92%.

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O-12

DOSIMETRIC CONSIDERATIONS IN TRANSLATIONAL RESEARCH WITH

PRECLINICAL IRRADIATION DEVICES (SMALL ANIMALS AND CELLS
IRRADIATORS)

Ileana Silvestre Patallo1, Sam Flynn2, Amanda Tulk3, Chris Cawthorne4, Ricky Sharma5, Giuseppe
Schettino1, Anna Subiel1
1
National Physical Laboratory, United Kingdom
2
University of Birmingham, Particle Physics, Birmingham, United Kingdom.
3
Xstrahl
4
University of Hull
5
Cancer Institute, University College London, London, United Kingdom

Dosimetry – Reference quality

Introduction
Although there is clear evidence that drug-radiotherapy combinations improve overall survival, one of the
problems related to new drugs development has been irreproducibility of preclinical data. Among the
variables involved are the dosimetric aspects of the irradiations. Uncertainty for absolute and relative dose
measurements in medium energy X-rays small animals and cell irradiators is still at relatively high level.
Very small fields collimators and purposely build microbeams like patterns, add to the level of complexity.
Dosimetric complications can undermine translation of data and information between in vitro and in vivo
models into clinical practice.

Methods and Materials

The current state of dosimetry in radiobiological studies is presented. Studies referring to the consequences
of the lack of dosimetric harmonization among centres performing preclinical studies are summarized. The
challenges of dosimetry in medium energy X-Rays beams and in conditions different from the ones referred
by the known dosimetry protocols are explained.
A project leaded by the National Physical Laboratory in collaboration with Xstrahl, the University of Hull
and supported by Innovate UK Research and Innovation Group had investigated different detectors that
could be used for absolute and relative measurements of dose (EBT3 films, inorganic scintillators, pixelated
detectors). The effect of different back and lateral scatter conditions were also investigated. A SARRP
device at UCL Cancer Institute had been commissioned and a mouse phantom and alanine measurements
of targeted deliveries were compared with treatment planning calculated doses.

Results and conclusions

Dosimetry in preclinical irradiations is currently non standardized. Procedures and methodologies that are
identified with the true geometry of the irradiations are required. Zoomorphic like phantoms are more
suitable for dose verification of treatment planning systems. Pixelated detectors could be a way forward for
characterization of very small fields and microbeams. Biological research will benefit from more accurate
and traceably dosimetry.

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O-14

EVALUATION OF AAPM REPORTS 204 AND 220: ESTIMATION OF EFFECTIVE

DIAMETER, WATER-EQUIVALENT DIAMETER, AND ELLIPTICITY RATIOS FOR
ADULT AND PEDIATRIC CHEST AND ABDOMEN CT LOCALIZER

Christiane Sarah Burton

Harvard Medical School, USA

Diagnostic Radiology –Dosimetry

PURPOSE
AAPM Reports 220 reported that water-equivalent diameter (WED) is a sound descriptor of patient size
because it depends on the patient’s attention to calculate the size-specific dose estimate (SSDE) from a CT
examination. It also mentions that calculating WED from CT localizer radiographs will make it possible to
calculate SSDE prior to CT scanning. However, a calibration method that relates pixel values to represent
water-equivalent attenuation has been proposed but not tested on phantom data.

METHOD
To perform the calibration we acquired CT axial and CT localizer scans of CTDIvol phantoms of 1.0, 10,
16, 32 cm diameters. We extracted localized pixel values (LPV) from all lines in the CT localizer within
the CT axial scan range. We plotted the water-equivalent area per lateral diameter as a function of LPV to
get a linear calibration line-of-best fit, to calculate the WED. We scanned CT axial and CT localizer CIRS
abdomen and chest phantoms for adult and pediatric scans obtained from a clinical CT system. We extracted
LPV from the lines in the CT localizer and used the calibration curve to calculate WED. We plot the WED
extracted from the “gold standard” CT axial scan as a function of the WED calculated from the CT localizer.
We use the AAPM 204 formula to calculate NDC.

RESULTS
The localizer-based WED calculated had an excellent correlation (R^2=0.98) with the gold standard
approach. The minimum and maximum of difference between localizer-based and gold standard was 6.6
and 14%, respectively. The correlations were excellent for abdomen only (R^2=0.99) and chest (R^2=0.98)
scans with a minimum/maximum difference of 6.8/8.8% and 6.6/14% difference, respectively. The
localizer based NDC had an excellent correlation (R^2=0.98) with a maximum of 10% difference.

CONCLUSION
The calibration and model-based magnification method gives an accurate estimate of NDC to achieve
accurate SSDE.

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O-15

SYSTEMIC RESPONSE TO RADIO- AND CHEMORADIOTHERAPY BY MEANS OF

1H-NMR BASED METABOLOMICS AND BATCH MODELLING

Lukasz Boguszewicz, Agata Bieleń, Jolanta Mrochem-Kwarciak, Krzysztof Składowski, Maria Sokół

Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland

Radiation Oncology – Dosimetry

Introduction
Anticancer treatment results in temporary/permanent toxicity considered as changes in normal tissues
and/or involved regions. The net effect is mirrored in morphological, functional and molecular disturbances,
thus in a systemic response. We aimed to investigate the real-time (during-treatment) changes in serum
metabolome in order to identify metabolic signatures of acute radiation sequelae (ARS) in head and neck
cancer (HNC) patients, as well as to find the biomarkers that could help prevent of ARS escalation.

Methods and Materials

170 HNC patients were enrolled into the study. Patients were treated radically with radiotherapy and
chemo-radiotherapy. Chemotherapy was realized as induction and/or concurrent treatment. Blood samples
were collected weekly, starting from the day before the treatment and stopping within the week after the
treatment completion. Patients were clinically monitored until the resolution of all ARS symptoms. Serum
samples were analyzed using 1H-NMR spectroscopy followed by multivariate projection techniques and
batch analysis.

Results and Conclusions

Biomarkers related to the outlying cases (e.g. due to ARS escalation) as well as those related to the general
response to treatment were successfully identified. Intensified ARS resulting in dysphagia, weight loss and
cachexia was accompanied by significant increase of ketone bodies (KB) concentration in serum. In 45%
of patients the during-treatment percentage weight loss was above 10%. The measurement of KB
concentration predicted significant weight loss earlier than standard clinical nutrition markers (albumin,
prealbumin, BMI). The general response to treatment was mostly reflected in altered concentrations of
inflammatory and energy involved metabolites.
Metabolic monitoring of anticancer therapy may give insight into individual treatment toleration as well as
contributes to a better understanding of metabolic and cellular background of ARS. Presented results show
possibility of clinical application of 1H-NMR based metabolomics in detection of high risk patients.

The work has been funded by National Science Centre grant 2015/17/B/NZ5/01387.

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O-20

IAEA-ATIA SOFTWARE FOR IMAGE QUALITY EVALUATION IN PLANAR

RADIOGRAPHY

Patricia Mora Rodríguez1, Douglas Pfeiiffer2, Guozhi Zhang3, Hilde Bosmans3, Harry Delis4
1
University of Costa Rica, Costa Rica, Costa Rica
2
Boulder Community Health, USA
3
University Hospitals Leuven, Belgium
4
International Atomic Energy Agency, Austria

Diagnostic and Interventional Radiology – General

Objective: To generate a software tool that will allow performing quality control of radiographic and
mammographic imaging systems using a remote and automated method.

Methodology: A working group was established by the IAEA to provide Member States with a framework
that can facilitate frequent constancy testing without the need of on-site supervision by the medical
physicist. Two simple and cost-effective radiographic and mammographic phantoms are proposed. An
Automated Tool for Image Analysis (ATIA) was developed in order to facilitate the analysis of images
from both phantoms. ATIA tracks the AEC performance by following the kilovoltage, current, mean pixel
value (MPV), dose level, and dose to the detector. It automatically calculates the following IQ metrics:
signal to noise ratio (SNR), signal difference to noise ratio (SDNR), modulation transfer function (MTF),
normalized noise power spectrum (NNPS) and detectability index (d´). It can also extract and report
relevant tags from the DICOM header. Additionally, ATIA can generate a variance map of the image
phantom and check for uniformity and image artefacts.

Results: Prototypes of both phantoms have been constructed and tested satisfactorily in different clinical
scenarios. Images generated for both CR and DR in radiology and mammography have been analyzed with
ATIA software both locally and remotely. Information about IQ metrics on weekly images over a period
of more than a year in some facilities have generated good data to assess the image quality over time of
those devices.

Conclusions: ATIA is a free software tool from the IAEA that works with images of two easily constructed
and inexpensive phantoms. This framework will facilitate the evaluation of image quality in planar images
on a frequent basis that will complement regular QC by a medical physicist and can do the analysis in a
remote fashion.

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O-21

DEVELOPMENT AND CONSTRUCTION OF AN IMAGE QUALITY PHANTOM FOR

DENTAL CT SCANNERS CBCT.

Silvio Rizo Balladares, Patricia Mora

University of Costa Rica, Costa Rica

Diagnostic and Interventional Radiology – General

Objetive:
The aim of this paper is to present the development and construction of a phantom that allows the evaluation
of image quality metrics in dental Cone Beam Computed Tomography (CBCT). This equipment is
increasing in use and no formal image evaluation is always possible due to lack of phantoms in our
countries.
Method:
The Mora-Rizo phantom consists of two bases of 16 cm in diameter and 5 cm in thickness (to provide
support and rigidity, adequate dispersion to simulate the head of a patient, alignment and positioning) and
5 interchangeable PMMA modules to evaluate: MTF, CNR, uniformity, noise/artifacts and CT numbers of
dental inserts. MTF evaluation was done through a copper wire of 0.22 mm in diameter and CNR through
a PVC test object. The innovative part is the introduction of dental materials (such as gutta percha, lithium
disilicate, porcelain, fiberglass, resin) in different discs sizes . These materials used for prostheses and shims
in dental clinics will be used to assign gray and CT values for specific clinical protocols.
Results:
A first prototype was constructed and evaluated in 3 different CBCT equipment using a clinical protocol of
80 kVp and 5 mA. For each equipment MTF, CNR, uniformity and noise/artifacts were evaluated and
validated with the QUART phantom of the SEDENTEXCT project (exposed under the same clinical
conditions). Dental inserts allowed the assignment of CT numbers for each of the dental materials.
Conclusions:
The Mora-Rizo phantom is a low cost, versatile and easy to use device that has allowed the evaluation of
different image quality metrics, obtaining similar results as when the QUART phantom is used. The added
advantage of characterizing dental inserts with their CT numbers is important for clinicians when evaluating
the patient image and identification of foreign objects in the anatomy of the patient.

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O-26

SAFETY EVALUATION FOR AN ORTHOVOLTAGE RADIATION THERAPY

SYSTEM, WOMED T-200

Luis Rafael Sánchez Zamora1, Antonio Torres Del Valle2, Alejandro De Jesus Gonzáles Linares1,
1
"Hermanos Ameijeiras" Surgical Clinical Hospital, Cuba
2
Institute of Applied Sciences and Technologies InSTEC

Radiation Protection

Orthovoltage equipment uses low-energy photons to treat tumors that are located on or near the skin. These
treatments are very effective in treating this type of injuries, their quality is linked to multidisciplinary
factors that need to be taken into account whenever a safety assessment is made. Objectives: To carry out
the evaluation of the safety of the treatment process in a superficial radiotherapy team and to identify the
causes and consequences that can cause accidental exposures, for patients, worker or public, from the
installation of the equipment, to the completion of the treatment. Methodology: The Risk Matrices method
was used, using the SECURE-MR-FMEA 3.0 code that allows a combined analysis of the frequency of
occurrence of the initiating event, the probability of human errors or failure of barriers and the severity of
the consequences , facilitating the identification of the risk associated with the procedures. The method
establishes priorities for risk management and identifies the main causes that could cause accidental
exposures, allows to prevent the occurrence of accidents using risk criteria that take into account the
probability and magnitude of potential exposures. Results: We evaluated 79 initiating events of them 6 with
RA for 8%, 41 RM for 52% and 32 RB for 40%. Conclusion: We identified the main causes that can cause
accidental exposures, the vulnerable points, related to the treatment that is provided, we worked on them,
and it was possible to decrease all the initiators with high risk. The work showed that human errors are the
main cause that can trigger an accidental risk sequence.

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O-36

RADIATION EXPOSURE TO ANAESTHETISTS ASSISTING EMBOLIZATION

INTERVENTIONAL PROCEDURES

William Jaramillo1, Jailton Cordeiro2, Gustavo Andrade2, Helen Khoury3

1
Laboratorio de Radiaciones Nucleares, Universidad Pedagógica y Tecnológica de Colombia, Colombia
2
Angiorad, Recife, Brazil
3
Departamento de Energia Nuclear, Universidade Federal de Pernambuco

Radiology – Radiation Protection

Introduction
Anaesthetists are frequently involved in exams requiring X-rays during interventional radiology
procedures. As well as the main operator, anaesthetists may also be subject to significant radiation exposure.
Some studies have found that anaesthetists assisting interventional procedures may receive high radiation
doses in a single procedure that may be three times greater than doses received by the main operator. The
aim of this study was to assess the exposure received by anaesthetists assisting embolization procedures in
a reference hospital in Recife, Brazil.

Methods and Materials

This study was conducted in the largest public hospital in the city of Recife, Brazil. Occupational dosimetry
was performed to one anaesthetist who participated in ten prostatic artery embolization (PAE) and seven
hepatic chemoembolization (HC) interventional procedures. The exposure received by the anaesthetist, was
quantify with thermoluminiscent dosemeters at the following physician’s positions: on the eyes, at the neck
level (over the collar), at the chest level (under the apron), at the wrists and on the feet. The effective dose
was estimated using a conservative double dosimetry algorithm.

Results
The results show that the mean doses per procedure to the eyes, the wrists and the feet of the monitored
anaesthetist in PAE and HC procedures were: 143.0 μSv, 112.8 μSv, 389.6 μSv, 127,5 μSv, 58.3 μSv, 283.4
μSv, respectively. The highest doses in PAE procedures result by the use of oblique projections that require
the anaesthetist then to stand closer to the patient in complex procedures.

Conclusions
This study found that anaesthetists assisting embolization procedures can be subject to high radiation doses
when they assist in complex procedures that require then to stand closer to the patient. In these instances
the effective dose and the eye´s doses of anaesthetists may be five to eight times greater than doses received
by the interventionalist.

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O-47

ENERGY DEPENDENCE OF AN INDIVIDUAL DOSIMETER: EXPERIMENTAL

AND PENELOPE-MONTE CARLO ASSESSMENT

Cassiana Viccari Viccari, Patrícia Nicolucci

University of São Paulo, Brazil

Radiation Protection

Introduction
Thermoluminescent dosimetry is widely used for individual monitoring. In Brazil, CaSO4:Dy is the most
used phosphor for that purpose. The energy dependence coefficients obtained for these dosimeters are used
to determine the operational quantities in individual monitoring. The goal of this work was to assess the
energy dependence curves of the multi-filter thermoluminescent dosimeter used at Brazillian laboratory
CIDRA.

Methods
Experimental data was obtained in selected energies and Monte Carlo simulation with PENELOPE was
used to interpolate experimental data. CIDRA’s dosimeter employs three CaSO4:Dy detectors in an acrylic
badge. The three CaSO4:Dy pellets are filtered by plastic, copper and copper+lead, respectively. The
dosimeters were irradiated with beams ranging from 15 to 250 keV, as described in ISO 4037-1. Monte
Carlo simulations with PENELOPE were performed in the same geometry and irradiation conditions. The
energy dependence curves were used to determine Hp(10) in a blind test for 63 dosimeters irradiated in
beams ranging from 15 keV up to Cs-137. Trumpet curves were used to evaluate the Hp(10) assessments.

Results
Experimental and simulated curves show similar behavior, presenting high energy dependence of the
CaSO4:Dy for energies lower than 250 keV, as shown in the literature. The largest energy dependence was
found for the pellet positioned between the copper+lead filters (0.01 relative response to 15 keV relative to
Cs-137). The maximum differences between experimental and simulated data was observed also for the
copper+lead filter in the energy range of 30 to 70 keV (up to 4.5%). All the Hp(10) values determined for
the 63 dosimeters were inside the trumpet acceptance limits.

Conclusions
The comparisons of obtained experimental and simulated results show that simulation has become an
essential tool, making it possible to interpolate and extrapolate energy dependence coefficients used in
individual monitoring dose determinations.

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O-50

EVALUATION OF THE IRRADIATION OF AN ANTHROPOMORPHIC LIVER

PHANTOM WITH PHOTON BEAMS

Paola Alvarez, Paige Taylor, Hunter Mehrens, David Followill

IROC Houston - UT MD Anderson Cancer Center, USA

Radiation Oncology – Quality Assurance

Purpose:
Evaluate the pass rate for irradiations of an anthropomorphic liver phantom with multiple targets and
motion using photon beams.

Methods:
The phantom has one insert that represents the liver and includes two non-coplanar targets PTV1 and PTV2.
The insert is made of polystyrene and the targets are made of solid water. PTV1 is an ovoid 2 cm in diameter
and 2.5 cm long. PTV2 is a 3 cm diameter sphere. There is one TLD and 2 planes of radiochromic film in
each PTV. The phantom includes a motion table to simulate 1 cm respiratory motion mostly in the superior-
inferior direction. Institutions were instructed to design and deliver a plan that delivers 6 Gy to ≥95% of
each PTV. Algorithm for dose calculations include Superposition Convolution type of calculations as well
as Monte Carlo based dose calculations. Motion management include gating, breath hold, tracking and ITV.

Results:
More than 200 irradiations were evaluated. The mean TLD/TPS value was 0.99 (±0.03). While the TLD
values were statistically different by TPS algorithm (ANOVA, p<0.05), the pass rates were not different by
algorithm. The mean percent of pixels passing the 7%/4mm gamma analysis were 91% (±9%). The pass
rate was 72.8%. The pass rate was statistically worse for phantom irradiations using an ITV technique
compared to other motion-management techniques (Chi-square, p=0.05).

Conclusions:
The pass rate for the liver phantom, while low, continues to improve. The ITV technique of motion
management performs worse than other motion-mitigation techniques. All centers could potentially
improve their pass rate with implementation of tracking, gating, or breath-hold techniques.

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O-56

COMPARISON OF ELECTRONIC BRACHYTHERAPY WITH MAMMOSITE

SYSTEM IN BREAST TREATMENTS FOR SKIN, LUNG AND HEART DOSE

Sergio Lozares, Jose Antonio Font Gómez, Almudena Gandía Martínez, David Villa Gazulla, Reyes
Ibáñez Carreras

Miguel Servet University Hospital (Zaragoza-Spain), Spain

Radiation Oncology – Brachytherapy

Purpose
We have treated 350 patients at our center from May 2015 to December 2018 for breast cancer with Axxent
(Xoft Inc.) intraoperative radiotherapy (IORT), in this work we compare the doses in the skin, lung and
heart of the 350 patients treated with the 50 kVp source with the doses they would have received using the
Mammosite system using an Ir192 source.

Material and Methods

To the 350 patients treated in our center after removing the tumor, the appropriate balloon size is chosen to
cover the tumor area with a dose of 20 Gy on the balloon surface.

Results
The differences in maximum skin dose for both types of treatment are 8.1 ± 1.2 Gy for the case of
Mammosite and 5.7 ± 1.5 Gy for patients treated with electronic brachytherapy source. This explains the
very few cases of acute dermatitis at 6 months (8 cases of grade 2 and 2 cases of grade 3) with no recurrence
to date.We also show the mean and maximum doses (expressed as percentage of prescribed dose) for the
left lung (Axxent 1% and 20.4% vs Mammosite 3.9% and 29.9%) and heart (Axxent 0.8% and 4.1% vs
Mammosite 3.3% and 10.4%) in cases of left breast tumor for the volumes of 30 and 35 cm3, which are the
most common in our hospital (70% of cases):

Conclusion
It is concluded that the IORT treatments performed with the Axxent equipment with electronic source are
a good alternative to those performed with Ir192 and our 350 patients treated to date to the good results
presented by other centers are joined.In addition to the low skin toxicity, there is no recurrence in patients
treated so far, which makes us very optimistic about the results.

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O-57

SINGLE CELL DOSIMETRY FOR IODINE RADIOISOTOPES USING GEANT4-DNA

Baljeet Seniwal Seniwal, Telma C. F. Fonseca

Departamento de Engenharia Nuclear – UFMG BH/MG, Brazil

Radiation Oncology – Dosimetry

In this study low energy extension of Geant4-toolkit, Geant4-DNA,was used to compute the cellular
S-value, mean energy deposited and radial energy profile in different sub-cellular regions when radiation
sources are distributed within different cellular compartments. The electron emission spectra for 123I, 125I
and 131I was also simulated using radioactivedecay module of Geant4. To study the effect of using
different emission spectra on S-value, the comparison was made between the S-values obtained using the
emission spectra from ICRP 2008 Nuclear decay data for 125I and decay of 125I simulated using Geant4.
The radial energy profiles displayed that the energy deposited by 125I along the radius was twice of that
deposited by 123I and approximately four times of 131I. Mean energy deposited per decay was found
in good agreement with the literature, with approximate variation of 10%. The S-values obtained using
ICRP decay spectra was found deviating by∼30% on an average with respect to the one obtained using
Geant4 radioactive decay module. On comparison of S-values against the literature for S(C←C), S(N←N),
S(C←CS) on average variation of 10% was observed, moderate variations were obtained in case of
S(N←Cy) upto -28% and the highest deviations up to 69% were noted for S(N←CS). It was also found
that the electron emission spectra plays very important role in computation of the mathematical quantities

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O-60

COMPARISON OF EXCRETORY FUNCTION BY INTRAVENOUS PYELOGRAM

(IVP/IVU) & DIETHYLENETRIAMINEPENTACETATE (DTPA RENOGRAM) OF
OBSTRUCTIVE UROPATHY

Shamima Afroz1, Nupur Karmaker1, Md. Selim Reza2, Zakaria Golam Abu1
1
Dept of Medical Physics and Biomedical Engineering (MPBME) Gono Bishwabidyalay, savar, Dhaka,
Bangladesh
2
Institute of Nuclear Medicine and Allied Sciences, Bangladesh Atomic Energy Commission

Nuclear Medicine

The aim of the study is to about excretory function and different kidney status, to study about effective dose
of IVU and DTPA Renogram, to study about time measurement of diagnostic modalities and find out the
comparison between IVU and DTPA renogram for evaluation renal function of Obstructive Uropathy.
According to IAEA guideline, study has performed prospectively conducted at radioisotope center in
INMAS, Dhaka and Gonoshasthaya Kendra, Savar, Dhaka. X-ray contrast medium or dye (Lopidam-370)
has injected to a patient via a needle or cannula into the patient arm vein. Tc-99m DTPA has injected to the
patient according to patient conditions, age and weight. The demonstration of kidney function by IVU are-
Normal functioning kidney LK is 33% and RK is 50%. Nonfunctioning kidney LK is 23% and RK is
12%.Mild HDN kidney LK is 8% and RK is 10%. Moderate HDN kidney is 16% and RK is 15%.Marked
HDN LK 3% and RK is 4%,Gross HDN kidney LK is 9% and 7%.Horseshoe kidney is LK is 2% and RK
is 2%PUJO LK is 6%. The demonstration of kidney function by DTPA are-Normal functioning kidney LK
is 43% and 71%. Nonfunctioning kidney LK is 12% and 5%.Mild HDN kidney LK is 16% and
5%.Moderate HDN kidney LK is 6% and RK is 3%.Marked HDN LK is 8% and RK is 8%.Gross HDN
kidney LK is 14% and RK is 7%. Horseshoe kidney LK is 1% and RK is 1%.The IVU is valuable
examination of urinary tract anatomical images. DTPA Tc-99m scan superior to IVU because it can be
easily performed, less preparation needed, and less radiation hazard to the patient and others, more accurate
divided relative function and even determines blood flow of obstructive kidney.

Key Words: Intravenous Urogram, DTPA renogram, Obstructive Uropathy, Excretory functions, gamma
camera, X-ray.

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O-61

AUTOMATED WINSTON-LUTZ TEST USING XML SCRIPT AND DEVELOPER

MODE IN TRUEBEAM STX

Alberto Alarcon, Daniel Venencia

Instituto Privado de Radioterapia, Argentina

Radiation Oncology – Quality Assurance

Purpose: The use of Winston-Lutz (WL) test for isocenter verification, prior to a radiosurgery procedure,
is recommended in TG101. The objective of this work was to develop an automatic WL test procedure
using XML script with the developer mode of a TrueBeam STx.

Methods: The WL test consist in the setup of a WL phantom (Brainlab) with the mechanical isocenter of
the TrueBeam STx (Varian). After verification, 12 EPID images (aS1200), with different combinations of
gantry (0, 90,180, 270 deg), collimator (90, 270 deg) and couch (0, 45, 90, 270, 315 deg) angles are
obtained. EPID images are analyzed by RIT software v6.7 (Radiological Imaging Technology) to obtain
the deviation between radiation and mechanical isocenter. An XML script was created in the development
environment Microsoft Visual Studio Community (2017). The script contains automatization sequences
with specific control points including acquisition of all images. The XML file is executed in the Developer
Mode version 2.0. Comparison between manual and automatic WL were done for 5 procedures based on
execution time, WL displacement and 3D maximum displacement are compared.

Results: The XML routine run satisfactorily without any bug. The average execution time for manual and
automatic WL test was 12.7±0.2 min and 4.28±0.02 min respectively. The WL displacement for manual
and automatic was 0.58±0.04 mm and 0.50±0.10 mm respectively and the WL 3D maximum displacement
for manual and automatic was 0.61±0.06 mm and 0.75±0.05 mm respectively.

Conclusion: The automatization of WL test using XML script is feasible and reduces the execution time
and the displacement obtained are the same to the obtained manually. XML script and Developer Mode
improves test WL time efficiency. Adaptations of the current XML are being extended to automate others
quality controls in our institution.

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O-62

AUTOMATIC GENERATION OF PLANNING PROSTATE SBRT STRUCTURES

WITH SCRIPTING

Alberto Alarcon, Daniel Venencia

Instituto Privado de Radioterapia, Argentina

Radiation Oncology –Treatment Planning

Purpose: Prostate SBRT planning require the generation of multiple planning structures based on the
treatment volumes defined by the physician. This procedure is done by the dosimetrist, is time consuming
and could have user's errors. The objective of this work was to create an automatization process to generate
planning structures using Eclipse's scripts.

Methods: Varian's Eclipse scripting application programming interface (API) v15.1 together with
integrated development environment Microsoft Visual Studio Community (2017) (write and compile a
plugin-script in C # executable) in Eclipse was used. A graphic interface was done using windows
presentation foundation (WPF) and forms (WF). Manipulation and operations of structures was done using
the "Structure Class" contained in the Eclipse’s “Model.API.dll” library. All structures were transformed
to high resolution and named following TG263 recommendation. The script can be executed in External
Beam Planning workspace of Eclipse and automatically detect CTVs and OARs. Comparison between
manual and automatic structures were done measuring the volumes for 15 patients.

Results: The Script run well for all test patients. The average script execution time was 39±2 seconds.
Planning time was reduced by 20±3 min. The maximum difference between volumes generated
automatically and manually was 1.9cc (0.5% of volume) for large structures (bladder) and 0.02cc (0.3%)
for smaller structures (urethra).

Conclusion: Through the implementation of the Script it was possible to standardize criteria among users
when creating the planning structures, it was possible to reduce the human random errors and the planning
time was reduced. No significant difference was found between structures generated with the script and
manually. Implementation and adaptations of the current script are being extended to different treatment
sites in our institution.

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O-63

DENOISING FRAMEWORK USING THE BLOCK MATCHING AND 3-D

COLLABORATIVE FILTER FOR DOSE REDUCTION IN MOLECULAR BREAST
IMAGING

Michael O'Connor1, Ashley Tao1, Lucas Borges2, Carrie Hruska1

1
Mayo Clinic, USA
2
Univ Sao Paulo

Nuclear Medicine

Purpose: The objective of this study was to determine if application of a block matching and 3-D
collaborative filtering (BM3D) denoising algorithm to molecular breast imaging (MBI) studies would allow
for a reduction in the total number of counts that needed to be acquired in an image to retain lesion
conspicuity.

Methods: The initial input dataset contained 20 MBI patient studies with positive findings, acquired in
dynamic mode that allowed summation to simulate full-dose or half-dose images. The BM3D filter setting
for the half-dose images was optimized by two methods. In the 1st method, the filter setting was adjusted
so that the relative noise in the filtered image (matched half-dose image) matched that of the original full-
dose image. In the 2nd method, the filter setting was adjusted to provide user-preferred image quality. After
validating both filter settings, a second dataset of 50 MBI patient studies with positive findings, was used
in 2-alternative forced-choice (2AFC) studies where 2 readers were presented with the full-dose image and
either the half-dose image, or one of the 2 filtered images (matched half-dose, or preferred half-dose image).
In each 2AFC study, readers selected the image that best showed the documented lesion and assign a lesion
conspicuity score.

Results: As expected, the full-dose image was selected 96% of the time over the half-dose. The full-dose
and matched half-dose images were each selected 50% of the time. The preferred half-dose images were
selected over the full-dose images 76% of the time. Inter-observer agreement ranged from 85%-90%. There
were no reports of any induced artifacts from the BM3D algorithm.

Conclusion: The BM3D algorithm can be used to post-process MBI images that were acquired at half-dose
to provide equivalent or better lesion conspicuity to images that were acquired at full dose.

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O-65

PREDICTION OF RESPONSE AFTER CHEMORADIATION FOR ESOPHAGEAL

CANCER USING A COMBINATION OF DOSIMETRY AND CT RADIOMICS

Xiance Jin, Xiaomin Zheng, Congying Xie

the First Affiliated Hospital of Wenzhou Medical University, China

Radiation Oncology – Dosimetry

Purpose: To investigate the treatment response prediction feasibility and accuracy of an integrated model
combining computed tomography (CT) radiomic features and dosimetric parameters for patients with
esophageal cancer (EC) who underwent concurrent chemoradiation (CRT) using machine learning.
Methods: The radiomics features and dosimetric parameters of 94 EC patients were extracted and modeled
using Support Vector Classification (SVM) and Extreme Gradient Boosting algorithm (XGBoost). The 94-
sample dataset was randomly divided into a 70-sample training subset and a 24-sample independent test set
while keeping the class proportions intact via stratification. A receiver operating characteristic (ROC) curve
was used to assess the performance of models using radiomics features alone and using combined radiomics
features and dosimetric parameters. Results: A total of 42 radiomics features and 18 dosimetric parameters
plus the patients’ characteristic parameters were extracted for these 94 cases (58 responders and 36 non-
responders). XGBoost plus principal component analysis (PCA) achieved an accuracy and area under the
curve of 0.708 and 0.541, respectively, for models with radiomics features combined with dosimetric
parameters, and 0.689 and 0.479, respectively, for radiomics features alone. Image features of GlobalMean
X.333.1, Coarseness, Skewness, and GlobalStd contributed most to the model. The dosimetric parameters
of gross tumor volume (GTV) homogeneity index (HI), Cord Dmax, Prescription dose, Heart-Dmean and
Heart-V50 also had a strong contribution to the model. Conclusions: The model with radiomics features
combined with dosimetric parameters is promising and outperforms that with radiomics features alone in
predicting the treatment response of patients with EC who underwent CRT.

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O-66

QUANTITATIVE EVALUATION OF MATERIAL DECOMPOSITION METHODS IN

CHEST DIGITAL TOMOSYNTHESIS

Haenghwa Lee1, Dong-Hoon Lee2, Dohyeon Kim2, Seungyeon Choi2, Hee-Joung Kim2
1
Department of Radiological Science, Research Institute of Health Science, Yonsei University,1
Yonseidae-gil, Wonju, Gangwon, 220-710, Korea
2
Department of Radiation Convergence Engineering, Research Institute of Health Science, Yonsei
University, 1 Yonseidae-gil, Wonju, Gangwon, 220-710, Korea

Diagnostic and Interventional Radiology – General

Dual-energy chest digital tomosynthesis (DECDT) is a promising new medical technique that could
improve capability of differentiating among materials compared to CDT. However, the development of
DECDT is challenging due to noise amplification during material decomposition. In this study, we
investigated the feasibility of four material decomposition methods for CDT system and quantitatively
evaluated how different material decomposition methods affect the image quality. We used a prototype
CDT system consists of a CsI(Tl) scintillator flat panel digital detector (Pixium RF 4343, Thales, France)
and X-ray tube (TE-E7869X, Toshiba, Japan). To acquire the dual energy images, the image intensifier of
CDT system was used with tube voltages of 80 and 120 kVp in LUNGMAN (Kyoto Kagaku, Japan)
phantom. Reconstructed images were acquired by using simultaneous algebraic reconstruction technique
(SART). To evaluate the image quality of decomposed images for CDT system, we applied four methods
such as standard log subtraction (SLS), simple smoothing of the high-energy image (SSH), anti-correlated
noise reduction (ACNR), and general linear noise reduction algorithm (GLNR). Quantitative evaluations
of reconstructed images were performed by both contrast-to-noise ratio (CNR) and artifacts spread function
(ASF). We found proper values of decomposition parameters improving reconstructed images. The
resulting images showed that CNRs were highest in GLNR method for decomposed bone and soft-tissue
images. Particularly, the CNR with GLNR method for bone image was 2.1 times higher than that for the
single energy technique. We calculated the ASF curves to compare the quality of vertical resolution with
four material decompositions. This results show that GLRN provides better ASF. This study demonstrated
that DECDT could improve the diagnostic accuracy by providing images of specific tissues. We highlight
the potential of GLNR method with proper decomposition parameters to improve the image quality.

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O-73

3D GYNY HYBRIDE HDR BRACHYTHERAPY FOR CERVIX

Boutayeb Salwa, Bakkali Hanae

Morocco

Radiation Oncology – Brachytherapy

INTRODUCTION
Brachytherapy (BT) plays a major role in the therapeutic management of patients with cervix cancer from
stage I to IV. The rapid dose fall-off allows a very high dose to the central pelvis, while relatively sparing
bladder, rectum, sigmoid and small bowel
Hybrid adaptive and MRI guided brachytherapy is used when intracavitary alone could not cover the
volume. (large Stage IIB/IIIB with minor parametrial response)
We will present the results of 8 cases where we use this technique
METHODS AND MATERIALS
A dedicated applicator is used for this technique, it s Utrecht from Elekta the application is done at the
theatre then CT scan and MRI with applicator in place after contouring of targets and OAR by physicians,
and reconstruction of applicators by physicist, then optimisation and evaluation according to GEC ESTRO
Recommendations, our patients are treated
RESULTS AND CONCLUSIONS
Hybrid adaptive and MRI guided brachytherapy significantly improves the coverage of large target
volumes, while retaining sufficient organs at risk, in addition it allows a synchronous parametrial
complement which results in a considerable gain on the spreading total of radiotherapy. It constitutes the
best all-in-one technical solution available to date for the implementation of interstitial brachytherapy in
centers that do not have sufficient expertise to apply a free-hand gynecological brachytherapy

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O-76

ESTIMATION OF WATER EQUIVALENT DIAMETER FROM DOSIMETRIC

MEASUREMENTS IN COMPUTED TOMOGRAPHY

Rafael Miller-Clemente

Radiation Medical Physics Group. Center of Medical Biophysics. Universidad de Oriente. Cuba

Diagnostic Radiology –Dosimetry

The average dose delivered in a study of Computed Tomography (CT) can be found by using Size Specific
Dose Estimators (SSDE). The effective diameter has been replaced by the water equivalent diameter dw to
take into account the attenuation properties of patients for the estimation of the SSDE. The use of the dw
facilitates to obtain an exact value of absorbed dose. In order to guarantee the equivalence of dw with those
on phantoms and its high precision, the x ray spectra were estimated at the entrance of dosimetric phantoms
of Polymethyl Methacrylate (PMMA). These spectra were attenuated for each dw and fitted to guarantee
relative differences lower than 2% between the air kerma measured at the center of the phantom and those
simulated from spectra. The function spektrEquiv_mmAl_CompoundsNIST from the software SPEKTR
3.0 was modified to calculate the dw. The dw corresponding to each combination of diameters of PMMA
phantoms (dpmma) with scanning factors was calculated. For the dpmma of 16 and 32 cm, the values of
dw were equal to 16.9 ± 0.6 cm and 35.8 ± 1.6 cm respectively. The estimation of spectra fitted from
dosimetric measurements in phantoms, allows to estimate the water-equivalent diameter and include it in
predictive models of kerma indexes for CT and image quality. Once known the association between the dw
and the effective diameter for each anatomical region, the drawbacks of the estimation of the dw based on
previous irradiations of the patient can be overcome. With respect to the attributes of the patient, it is
recommended to develop investigations that contribute to make reference records of magnitudes of water-
equivalent dimensions of pediatric and adult patients for the different anatomical regions of interest in
imaging.

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O-80

DEVELOPMENT OF KV X-RAY IMAGING DOSE CALCULATION SYSTEM FOR

IMAGE GUIDED RADIATION THERAPY

Yoshitomo Ishihara1, Mitsuhiro Nakamura2, Yukinori Matsuo2, Yusuke Iizuka2, Masahiro Hiraoka1
1
Japanese Red Cross Wakayama Medical Center, Japan
2
Kyoto University

Diagnostic Radiology –Dosimetry

Purpose: Knowledge of the imaging doses delivered to patients and accurate dosimetry of the radiation to
organs from various imaging procedures is becoming increasingly important for clinicians. The purposes
of this study were to develop kV X-ray imaging dose calculation system for image guided radiation therapy
and to evaluate the impact of kV X-ray imaging doses on treatment doses.

Methods: The Vero4DRT was equipped with gantry-mounted orthogonal kV X-ray imaging subsystems,
consisting of two sets of X-ray tubes and flat-panel detectors. The EGSnrc/BEAMnrc and
EGSnrc/DOSXYZnrc packages were used to simulate kV X-ray imaging dose distributions of Vero4DRT.
Then, the kV X-ray imaging dose distributions such as 4D-CBCT, 3D-CBCT, correlation modeling and
monitoring doses were calculated for 9 lung cancer patients based on the planning CT images with dose
calculation grid size of 2.5×2.5×2.5 mm3. Finally, the imaging dose distributions derived via 4D-CBCT,
3D-CBCT, correlation modeling and monitoring, of planning target volume (PTV), the skin and the bone,
were evaluated by examining dose-volume histograms (DVHs).

Results: Based on 4D-CBCT and 3D-CBCT, the doses covering 2-cc volumes (D2cc) were maximally 6.0,
10.5 and 58.1 cGy for the PTV, the skin and the bone. Then, the maximum D2cc of correlation modeling
and monitoring imaging were 6.0, 9.3 and 48.4 cGy for the PTV, the skin and the bone.

Conclusions: We have developed kV X-ray imaging dose calculation system for image guided radiation
therapy using Vero4DRT and evaluated the impact of kV X-ray imaging dose on treatment dose.

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O-83

COMPARISON OF THE STANDARDS OF AIR KERMA AND ABSORBED DOSE TO

WATER IN CO-60 RADIATION FOR THE NATIONAL RESEARCH COUNCIL
CANADA AND THE DEPARTAMENTO DE METROLOGÍA DE RADIACIONES
IONIZANTES, COMISIÓN CHILENA DE ENERGÍA NUCLEAR.

Malcolm Mcewen1, Hernan Rodriguez2, Fernando Ortega2, Carlos Oyarzun2, Humberto Peñaloza2
1
NRC-CNRC, Canada
2
CCHEN

Dosimetry – Reference quality

Purpose: An indirect comparison has been carried out of the standards for air kerma and absorbed dose to
water for 60Co radiation of the National Research Council (NRC), Canada and of the Laboratorio de
Metrologia de Radiaciones Ionizantes (LMRI), Chile. The DMRI is currently traceable to the National
Physical Laboratory, UK.
Methods: A single reference-class Farmer-type ionization chamber (IBA FC-65 G) was used as the transfer
instrument and additional measurements were carried out at both laboratories to confirm the correct
operation of the transfer chamber throughout the comparison exercise and to evaluate influence quantities
such as atmospheric pressure, equilibration, polarity effect, beam uniformity and experimental set-up.
Results: There was no observed difference in the performance and operation of the transfer chamber at the
two laboratories (NRC altitude = 70 m, DMRI altitude = 600 m). The polarity correction was determined
to be 0.9996, consistent with published values and showing no significant difference at the 0.01% level
between measurements at the two laboratories. For the absorbed dose determination at DMRI, both a
vertical and horizontal beam geometry was tested with two different water phantoms and agreement was at
the ± 0.2% level. Measurements also confirmed that using a solid PMMA phantom introduced no
significant additional error.
The comparison results, based on the calibration coefficients, evaluated as a ratio of the DMRI and the
NRC standards, were 0.9972 for absorbed dose to water, with a combined standard uncertainty of 8.9 × 10-
3, and 0.9945 for air kerma, with a combined standard uncertainty of 8.6 × 10-3.
Conclusion: The comparison results are consistent with the NRC/NPL ratios for these quantities published
in the BIPM key comparison database at the 0.3% level, indicating no significant error in the dissemination
of air kerma and absorbed dose to water calibrations by the DMRI.

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O-85

PRESAGE® DOSIMETER AS ANTHROPOMORPHIC PHANTOM.

Khalid Iqbal1, Saeed Ahmad Buzdar2, Ryan Grant Lafratta3, Kent A Gifford3, Jeoffrey S Ibbott3
1
Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Pakistan, Pakistan
2
The Islamia University Bahawalpur, Pakistan
3
M D Anderson Cancer Center University of Texas Houston USA

Radiation Oncology – Dosimetry

Abstract:
Introduction: Radiation oncology has been rapidly improved by the application of new equipment and
techniques. With the advent of new complex and precise radiotherapy techniques such as intensity
modulated radiotherapy, stereotactic radiosurgery, and volumetric modulated arc therapy, the demand for
an accurate and feasible three-dimensional (3-D) dosimetry system has increased. Methods and Materials:
In this study anthropomorphic PRESAGE® was used for evaluation of radiation dose delivery. The most
important features of 3-D PRESAGE® dosimeter, apart from being precise, accurate and reproducible,
include also its low cost, feasibility, and availability. Many studies have been performed on the
PRESAGE® dosimeters that show acceptable agreement between measured and reference doses. It also
demonstrated that the PRESAGE®/optical CT system has excellent precision, accuracy, reproducibility,
and robustness for 3D dosimetry. Results: Previous work has focused on the basic dosimetric characteristics
of PRESAGE® and investigation of the feasibility of the PRESAGE®/optical CT system for 3D dosimetry.
The latter investigations involved delivering simple dose distributions or IMRT distributions to dosimeters
fabricated in regular cylindrical shapes. The present study evaluates the feasibility of a breast shaped
anthropomorphic PRESAGE® dosimeter, and builds on this earlier work by applying the
PRESAGE®/optical CT system for the verification of IMRT, 3D and HDR brachytherapy dose delivery.
Conclusion: This work demonstrates the feasibility of fashioning PRESAGE® into an anthropomorphic
shape for verification of radiation doses, and it provides groundwork for future investigations into more
complex anthropomorphic phantoms.

Keywords: PRESAGE®, 3D dosimetry, Optical CT, Anthropomorphic, radiation dose

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O-89

DETERMINATION OF THE MEAN ENERGY REQUIRED TO FORM AN ION-PAIR

(W-VALUE) IN GASES OF RELEVANCE IN REFERENCE DOSIMETRY FOR
PROTONTHERAPY

Verónica Tessaro1,3, Gervais Benoit2, Poignant Floriane3, Beuve Michael3, Galassi Mariel1
1
Instituto de Física de Rosario (CONICET-UNR) and Facultad de Ciencias Exactas, Ingeniería y
Agrimensura, Universidad Nacional de Rosario (UNR), Argentina
2
Centre de Recherche sur les Ions, les Matériaux et la Photonique, Caen (France)
3Université de Lyon, Institut de Physique Nucléaire de Lyon - Villeurbanne (France)

Dosimetry – Reference quality

International protocols for reference dosimetry in radiotherapy, as TRS-398, provide a methodology to

determine the absorbed dose in water using ionization chambers filled with air. The percentage of gas
ionization can be determined using an electrometer that collects the electrons generated. The dosimeter
lecture is proportional to the absorbed dose in liquid water, but conversion factors like W-values (mean
energy required to form an ion-electron pair after the complete dissipation of the projectile initial energy)
are required. For swift protons used in protontherapy, W-values are not accessible precisely by experiments;
therefore, they must be obtained using theoretical models able to simulate all the physical processes
involved in the ion-matter interaction. As experimental data are scarce and theoretical calculations are very
complex, international dosimetry protocols for protons and heavy ions take constant values corresponding
to the trend observed by electron impact. Uncertainties in W-values for hadrontherapy dominates the global
uncertainties of the absorbed dose.

In a recent work (Tessaro et.al, NIMB 2018), we calculated W-values by electron and proton impact on
vapour and liquid water. We used two different methods considering all the processes involved in the
energy deposition by the primary and secondary particles. These are: the Monte Carlo code MDM, which
allow us to represent the stochastic nature of the ion-matter interactions, and the Fowler Equation, based in
the Continuous Slowing Down Approximation. The results obtained for vapour water are in very good
agreement with experimental data and with simulations results reported in the literature from other authors.
Here, we present an extension of these models in air gases by proton impact. We present results in the
middle and high-energy range, reaching energies higher than 100 MeV where no experimental values exit.
Results are in good agreement with experimental data and with recommended values at intermediate impact
energies.

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O-101

3D PRINTED TUMOR-SHAPE SCINTILLATOR MEASUREMENT SYSTEM

Hyun-Tai Chung1, Tae Hoon Kim2, Dong Geon Kim2, Thomas Schaarschmidt2, Yong Kyun Kim2
1
Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
2
Department of Nuclear Engineering, Hanyang University

Radiation Oncology – Dosimetry

We developed a tumor-shaped scintillator detector system using a customized 3-D printable scintillating
plastic resin to measure the whole absorbed energy in the tumor and assess the accuracy of modern
radiotherapy treatment plans. A scintillating plastic material was developed to be used in a commercial 3-
D printer and three patient specific scintillator models were printed along the shape of the tumor. The
scintillator was fixed by a probe head adapter which is connectable to optical fiber probe, and they were
inserted into a spherical solid water phantom. A photomultiplier tube was used to measure scintillation
lights. The effect of Čerenkov light was excluded by subtracting the light output of a dummy adapter. The
conversion factors from net current to absorbed dose rates were obtained by comparing results of Monte
Carlo simulations using Geant4 10.03 to measured values in GK PFX. A treatment plan for the tumor
shaped scintillator in the phantom was created using CT images of the system. The total absorbed energy
to the tumor-shaped scintillator was obtained by integrating over the irradiated time and compared with the
treatment plan values. The conversion factor was 4.18±0.05, 2.88±0.04, and 4.09±0.05 (Gy/min∙uA) for
each of the three models, and the adjusted R-square was 0.9990, 0.9989 and 0.9991, respectively. The total
dose measured on the tumor-shaped scintillator according to the treatment plan was 7.493 ± 0.034 Gy,
which is 1.3% different from treatment planning system. The accuracy of the light output conversion factor
showed good linearity so that the feasibility of the system was proved, but more sophisticated
manufacturing and verification are necessary to be used in actual patient specific quality assurance.

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O-102

KNOWLEDGE-BASED PROSTATE RADIOTHERAPY PLANNING: AN

INNOVATIVE MODEL FOR HYPOFRACTIONATION WITH SIMULTANEOUS
INTEGRATED BOOST

Avishek Chatterjee, Monica Serban, Sergio Faria, Luis Souhami, Jan Seuntjens

McGill University Health Centre, Montreal, QC, Canada.

Radiation Oncology –Treatment Planning

Purpose: To create a knowledge-based model for prostate cancer radiotherapy with unique ability to handle
two distinct target doses in a hypofractionated regimen.

Material and Methods: An initial RapidPlan model was trained using 48 patients treated with 60 Gy to
prostate (PTV60) and 44 Gy to pelvic nodes (PTV44) in 20 fractions. All clinical plans used volumetric
modulated arc therapy (VMAT) and met institutional dose constraints. To improve the model's goodness-
of-fit, an intermediate model was generated using the dose-volume histograms of best-spared organs at risk
(OARs) of the initial model. Using the intermediate model and manual tweaking, all 48 cases were re-
planned. The final model was trained using these re-plans and validated on 50 additional patients. The
validated final model was used to determine any planning advantage obtained by using three arcs instead
of two on 16 VMAT cases. It was also tested on 25 additional cases to determine its efficacy for single PTV
(60 Gy to prostate) treatment planning.

Results: For the model validation study, PTV V95% of 99.9% was obtained by both clinical and knowledge-
based planning. D1% was lower for model plans: by 1.2±0.1 Gy (PTV60), and by 2.4±0.4 Gy (PTV44).
OAR sparing was superior for knowledge-based planning: ΔDmean = 3.7±0.4 Gy (bladder), and 3.2±0.4
Gy (rectum); ΔD2% = 1.2±0.3 Gy (bowel bag), and 4.8±0.4 Gy (femoral heads). All stated improvements
have p<0.001. Total knowledge-based planning time (typically under 30 minutes) was shorter than manual
planning (typically 2.5 hours). The benefits of using three arcs instead of two on OAR sparing and PTV
coverage were statistically significant, but of magnitudes less than 1 Gy. The model failed to produce
reliable DVH predictions for single PTV plans.

Conclusions: Our knowledge-based planning model delivers efficient, consistent plans with excellent PTV
coverage and improved OAR sparing compared to clinical plans.

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O-108

ANALYSIS OF RAMAN SPECTROSCOPY IN NAILS FOR DIABETES

IDENTIFICATION: PRELIMINARY RESULTS

Angelica Hernandez Rayas1, Teodoro Córdova Fraga1, Christian Gómez Solís1, Andrea Ceja Fernández1,
Martha A. Hernández González2
1
Division of Sciences and Engineering of the University of Guanajuato, Mexico
2
UMAE Clínica T1 Bajío National Medical Center

Biomedical Engineering

The relationship of the nails with the general state of health and nutritional deficiencies is reflected in the
changes in the intercellular links and epithelial cells of the keratinization, which is affected due to the
alterations of biochemical processes that cause diseases, like Diabetes. In Mexico, according to the World
Health Organization WHO one of the main diseases that is increasing is Diabetes Mellitus 2 (DM2) of 422
million by 2030. Diabetes is a metabolic disease due to the alteration of carbohydrates and the variation in
blood sugar levels, this change is related to a protein glycation process that generates hardening of collagen
causing different neurological disorders, hyperglycemia and is considered a risk factor for the development
of osteoporosis. Some authors, such as Gupta D. et al, correlate depression in diabetes, presenting lower
levels of free tryptophan in relation to other neutral amino acids and the inhibition of the enzyme 5-
hydroxylase 2 of tryptophan (5HT) that decreases serotonin. Therefore, tryptophan circulates in plasma
through proteins along with other essential amino acids, present in patients with diabetes. In this pilot test,
24 nail samples from people with the Raman DRX spectroscopy technique were analyzed, of which 12 are
from healthy patients and 12 from patients diagnosed with DM2. To obtain samples, a cut was made in the
distal area or free edge of the nail. The results provided information where a significant tryptophan increase
of (α = 0.15%) in the mineral ratio of each patient's fingernail was detected, as well as the identification of
the main amino acids. The relation as such of tryptophan with diabetic patients so a larger sample will be
made, and statistically analyze the difference in intensities between peaks of each mineral identified.

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O-111

PHYSICAL DOSIMETRY OF THE TREATMENT OF HYPERTHYROIDISM WITH I-

131 COMPARED TO THE COMET'S ASSAY.

Fredy Julián Gómez Grance, Yamila Rodriguez

Universidad Nacional de Asunción, Paraguay

Nuclear Medicine

In hyperthyroidism, the MN doctor prescribes the activity of I131 using the Marinelli ‘404’ equation, in
this sense, patient-specific dosimetry has not been implemented in the region. This work shows the
possibility of performing post-treatment dosimetry in 50 patients, accompanied by cytogenetic evaluation
with the comet assay (EC), the results are consistent with the compartmental model of internal dosimetry.
An image dosimetry conjugated with a SPECT and a Pinhole collimator was implemented, using the MIRD
methodology. Fifty patients were sampled, obtaining the conjugated images of the thyroid in five samples
spaced during 6, 12, 24, 48, 96 hours and different peripheral blood samples were obtained from the fifty
patients in 3 days. Once the images were obtained, the relative count number of the images was determined
by the free program ImagenJ 1.51K, these values were represented as a fraction of incorporation as a
function of time, to which a least-squares approximation was applied, the area under the curve was
determined, which represents the activity of I131 accumulated during the residence time, with which the
absorbed dose was determined. The cytogenetic damage values were determined with the EC. Some
patients do not follow the retention curve considered ideal, it could be observed that in several of them the
thyroid did not normally capture I131, so the images were distorted with respect to the normal thyroid. In
general, the doses are greater than the doses estimated as euthyroid doses, which for women of childbearing
age means complications to procreate. The physical dosimetry shows a great coherence with the values of
residence time in blood determined with the EC and, according to the experience acquired, the feasibility
of applying a specific dosimetry for the patient has been demonstrated.

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O-112

IRRADIATION PROTOCOL FOR THE CENTRAL NERVOUS SYSTEM WITH THE

CRANIAL-NEURAXIS TECHNIQUE IN TOMOTHERAPY

Uvaldo Reyes, Higmar Herrera, Marco Rosales

Servicios de Salud de Durango, Mexico

Radiation Oncology – Dosimetry

TomoTherapy equipment, unlike conventional linear accelerators, allow the treatment of volumes with
lengths greater than 100 cm in the same treatment plan to be carried out. An example of these types of
volumes occurs when radiation needs to be applied to the Central Nervous System due to the presence of
some type of cancer. This work shows the protocol that was developed and applied to 3 patients at the State
Cancerology Center in Durango, Mexico using TomoTherapy HDA equipment and the cranial-neuraxis
irradiation technique. The development of the Simulation Process, Treatment Plan, Specific Patient Quality
Control, and Delivered Dose Verification is presented. Gamma results greater than 97% are obtained for
the Specific Patient Quality Controls taking into consideration a 3% dose and a 3 mm distance to agreement
with more than 4,000 points measured (using ArcCHECK). The results for the Delivered Dose Verification
have less than 1% difference between what was planned and what was delivered to the patient on a daily
basis. Based on the procedures shown for carrying out the Quality Control, Specific Patient and Delivered
Dose Verification, the ease and good performance of the TomoTherapy equipment to perform treatments
at volumes with lengths longer than 40 cm in one treatment plan is demonstrated; this avoids the
complications implicit in conventional accelerators for this type of treatment.

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O-114

DOSE HOMOGENEITY ON INTRABEAM®-SYSTEM SURFACE APPLICATOR

BEAM OVERLAPPING AND NON-OVERLAPPING REGION USING 3D PRINTED
BOLUS

Rajan Prajapati Prajapati1, Golam Abu Zakaria1, Hasin Anupama Azhari1, Volker Steil2, Sven
Clausen2
1
Gono Bishwabidyalay(university), Bangladesh, Bangladesh
2
University Medical Center Mannheim, Heidelberg university, Germany

Radiation Oncology –Treatment Planning

Purpose:The Carl Zeiss INTRABEAM® system is a mobile miniature x-rays device which delivers
treatment by a number of methods; including intraoperative, interstitial, intra-cavity, and surface
treatments. The main purpose of the study is to develop Dose homogeneity on INTRABEAM®-System
surface applicator beam overlapping and non-overlapping region using 3D printed bolus.
Material and Methods:The different thickness and filament densities ABS (Acrylonitrile Butadiene
Styrene) concave, convex and main body parts of bolus was made for Carl Zeiss INTRABEAM® system
surface applicator of diameter 4cm with the help of German RepRap 3D printer. GafChromic eBT films
were irradiated with 50 kv x-ray of carl Zeiss INTRABEAM® system with surface applicator in presence
of bolus. Then films were scanned with an EPSON® Expression 10000 XL/Pro flat bed scanner and dose
profile were plotted with ImageJ Software.
Result:The dose profiles were plotted for the different combination of concave and convex boluses (printed
from 3D printer) with thickness 5mm, 6mm, 7mm, 8mm, 9mm and 10mm. From the plotted profiles, the
maximum flat profile was seen in the boluses with each thickness 10mm and combination of concave
filament density 45% and convex filament density 100%.
Conclusion: The dose homogeneity can be achieved for the INTRABEAM® system Surface applicator
beam overlapping and non-overlapping region by using homemade bolus with different combination and
filament density of concave and convex parts of bolus.

Keywords: INTRABEAM® system (Electronic Brachytherapy), surface applicator, 3D printer.

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O-116

DIRECT MR IMAGE TO SYNTHETIC CT CONVERSION METHOD – OVERVIEW

OF THE SIX-YEAR EXPERIENCE ON THE CLINICALLY USED PROSTATE
PROTOCOL WITH RESEARCH ON ABDOMEN, THORAX AND H&N

Lauri Koivula1, Tiina Seppälä1, Mikko Tenhunen1, Leonard Wee2, Juha Korhonen3
1
Department of Radiation Oncology, Cancer Center, Helsinki University Hospital, Finland
2
School of Oncology and Developmental Biology, Maastricht University Medical Centre, The
Netherlands
3
Medical Imaging and Radiation Therapy, Kymenlaakso Central Hospital, Kymenlaakso Social and
Health Services (Carea), Kotka, Finland

Radiation Oncology – Treatment Delivery

Introduction: Establishing the whole RT workflow based on MR images can reduce coregistration
uncertainties, eliminate unnecessary dose to healthy tissue, increase patient comfort, and optimize clinical
resources. Purpose of this work is to overview the in-house sCT method for prostate cancer patients with
reflecting possible usage in abdomen, thorax and head.
Materials/Methods: The dual model technique for sCT creation is based on a single MRI sequence and
consists of two consecutive steps: automatic contouring of bone volumes, following direct MR intensity to
HU value conversion.
Results: Mean absolute HU uncertainties in sCTs were 34 HU in head and 42 HU in pelvis. Mean CTV
dose differences against CT images with VMAT and IMPT in brain and prostate were below 0.3 %.
Technique was tested also for prostate patients with metallic hip implants, providing absolute dose
calculation accuracy of 0.2±0.1% for mean PTV dose. The sCT method was tested on four different MRI
platforms - with large intensity variation between scanners – with PTV mean dose difference of -0.6 ±
0.4%. Pediatric patients imaged with T2w images were investigated for targets in abdomen, vertebrae and
lungs. Mean dose difference on abdomen target ITV V95% for VMAT and PBS scanning were 0.5 % and
0.0 % against CT images, respectively. Lung and vertebrae PTV mean dose comparison resulted 0.1 ± 1.4
% and 0.2±0.1 %, respectively. The MR-only protocol has been used for nearly 500 prostate patients in our
clinic. Approximately in 8% of cases, CT image has been applied due to either poor gold seed visualization,
artifacts caused by metallic implants, or motion artifact.
Conclusion: Dual model method can provide flexible and practical sCT creation based on widely available
MRI sequences, and has performed properly during our six-year utilization. Workflow can be performed
on an open source software platform if necessary.

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O-124

MONTE CARLO MODELING AND VALIDATION OF AN ORTHOVOLTAGE

RADIATION THERAPY UNIT FOR TREATMENT PLANNING OF SUPERFICIAL
LESIONS

Chandra P. Joshi1, Ingrid H. Lai1, Xiangyang Mei1, Gabor Fichtinger2, L. John Schreiner1
1
Kingston Health Sciences Centre, Kingston, Ontario, Canada, Canada
2
Queen’s University, Kingston, Ontario, Canada

Radiation Oncology –Treatment Planning

Introduction
Monte Carlo (MC) modeling of an orthovoltage radiation therapy unit was performed, and simulated
orthovoltage X-ray beam data was validated with measurements. This MC model of the unit will be used
with a CT image based orthovoltage radiation treatment planning system (ORTPS) for volumetric dose
calculations.

Methods and Materials

The EGSnrc MC code system (NRCC, Ottawa) was used to simulate the Xstrahl 200 orthovoltage unit
(Xstrahl, Surrey, UK) with various beam energies and applicators (20 cm and 50 cm FSD). The MC-
calculated dose distributions were validated against dose profiles and PDDs measured with a CC13 ion
chamber (IBA Dosimetry) in water. The phase space files generated at the bottom of the applicators will
be used in the ORTPS for the MC dose calculation within the patient.
The ORTPS, currently under development, is being built on the existing open-source software for 3D image
analysis and visualisation, 3D Slicer, and will be based on the treatment planning module in the SlicerRT
extension. In order to do MC dose calculations, the software will be integrated with EGSnrc.

Results
The MC-calculated and measured dose profiles and PDDs agree better than 2% for both types of
applicators, except for 4% in the heel effect regions for the 50 cm FSD applicators. The MC-calculated
dose in a water phantom with voxels of size 0.20×0.20×0.25 cm3 has an estimated uncertainty of less than
1% of the dose in the high dose regions.

Conclusions
A MC model of the Xstrahl 200 orthovoltage unit has been validated. This model will be used for dose
calculations in the ORTPS. Additional investigations are being done to improve agreements between MC-
calculated and measured dose profiles in the heel effect regions for 50 cm FSD applicators.

Key words
Monte Carlo, Orthovoltage, Treatment Planning System, EGSnrc, 3D Slicer, SlicerRT

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O-125

VALIDATION OF ADAPTIVE IRRADIATION PROCEDURES FOR MR-GUIDED

RADIOTHERAPY USING A NOVEL DEFORMABLE PHANTOM

Alina Elter1,2,3, Stefan Dorsch1,2,3, Philipp Mann1,3, Sebastian Klüter3,4, Christian P. Karger1,3
1
German Cancer Research Center DKFZ, Heidelberg, Germany;
2
University of Heidelberg, Faculty of Physics and Astronomy, Heidelberg, Germany;
3
Heidelberg Institute for Radiation Oncology HIRO, National Center for Radiation Research in Oncology
NCRO, Heidelberg, Germany
4
University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany

Radiation Oncology – Treatment Delivery

Introduction:
In MRgRT, interfractional anatomical changes can be corrected by treatment plan adaption. Due to the
complex correction process, specific end-to-end tests must be performed that require new phantoms, which
should include:
i. Flexible, reproducible positioning of organ-like inserts
ii. Anthropomorphic imaging contrasts (MRI, CT)
iii. 3D dose measurements
While (i) and (ii) are necessary to test deformable image registration algorithms (DIR), (iii) enables the
verification of dose application and may be implemented using 3D polymer gels (PG).

Methods & Materials:

For this purpose, a phantom was designed with different anthropomorphic structures meeting the
requirements (i)-(iii), which can be reproducibly rotated, linearly shifted and exchanged. It was applied on
a clinical MR linear accelerator (MRidian, ViewRay, USA) to test parts of the online adaptive planning
procedure for interfractional target deformation. A PG container was homogeneously irradiated within the
phantom. The PG container was then replaced, rotated by a defined angle and a bony structure was replaced
by an air cavity. The treatment plan was adapted accordingly, and the irradiation repeated. The pseudo-CT
required for plan adaptation was generated by DIR of a previously acquired CT to current MR datasets.

Results:
First measurements showed a good performance of DIR algorithms for linear insert displacements but were
not able to fully detect rotations. The PG evaluation showed a homogeneous dose response (<2%) in all
irradiations performed. Due to the replacement of the bone structure by an air cavity, the dose was higher
in the latter case as this was not correctly identified by the plan adaption procedure.

Conclusion:
The phantom could be used to test a DIR algorithm and simulate an adaptive treatment. Future experiments
will focus on the 3D-dosimetric verification of adapted irradiation plans and the development of suitable
end-to-end tests for the validation of complete interfractional adaptive treatments in MRgRT.

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O-128

A MODEL TO SIMULATE OXYGEN TENSION IN AND AROUND A TUMOR

CAPILLARY

Ignacio Espinoza1, Ignacio López-Martínez1, Edgardo Doerner1, Araceli Gago-Arias2

1
Institute of Physics, Pontificia Universidad Católica de Chile, Chile
2
Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria (IDIS), Santiago de
Compostela, Spain

Radiation Oncology – Treatment Delivery

Introduction. As hypoxic cells are more resistant to photon radiation, it is desirable to obtain information
about the oxygen tension (PO2) distribution in tumors prior to the radiation treatment. Mathematical models
are typically used to assess these microscopic PO2 distributions since non-invasive imaging method are
currently not able to provide quantitative high-resolution information. Many current models are very
simplistic and do not consider intracapillary oxygen flow. In this work, the effect of considering this process
, together with the corresponding oxygen flux through the capillary wall and diffusion-consumption in
tumor tissue, is studied.

Methods and Materials. Three equations were solved with a Finite Differences Method implemented in
Matlab in three subregions of a volume of interest containing one cylindrical capillary: i) Inside the
capillary: advection equation, ii) through the capillary wall: flux/conservation equation and iii) in the tumor
tissue surrounding the capillary: diffusion-consumption equation. The effect on tumor oxygenation of
changing capillary radius and blood velocity is studied.

Results. Simulated PO2 distributions indicate PO2 drops of 0.01 to 0.07 mmHg/µm along a capillary, for
the following values of capillary radius and blood velocity (r,v), respectively: (7.5 µm,0.8 mm/s) and
(5µm,0.4mm/s). In general, the change in PO2 is larger for smaller capillaries and slower blood flow. For
the first case, the number of tumor cells oxygenated by one single capillary is 29% larger than for the second
case.

Conclusions.
Considering oxygen advection along tumor capillaries, the variation of radius and blood velocity has a non-
negligible effect in the assessment of tumor oxygenation. Simpler 2D models already used for this purpose
may be calibrated with our results, in order to make them able to assess a more realistic (effective)
oxygenation status.

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O-130

REAL TIME MOTION TRACKING WITH EPID BASED OPTICAL FLOW

TECHNIQUES

Stephen Pistorius, Gabrielle Fonteine, Teo Troy

University of Manitoba, Canada

Radiation Oncology – Dosimetry

[Introduction] Intra-fraction tumour and organ motion during radiation therapy must be monitored to ensure
optimal patient treatment and safety. The tumour motion can be accounted for in many ways: (1) by
increasing the ITV, (2) the use of gating or breathing restrictions and (3) beam and tumour alignment.
Increasing the ITV increases the dose to healthy surrounding tissue while gating and breath hold techniques
decrease treatment efficiency. Direct tracking systems using implanted fiducial markers are invasive, and
lung cancer patients are at risk of a pneumothorax. Indirect systems do not pose a health risk, but weak
correlation between the secondary signals and the tumour have been reported.

[Methods & Materials] We have demonstrated the feasibility of tracking an uncontoured-target using the
motion detected by an Electronic Portal Imaging Device (EPID) at 2.5 frames/sec, within both a moving
treatment aperture and with a rotating gantry. Tracking was achieved using a weighted optical flow
algorithm. Portal images sequences were acquired on a 6MV linear accelerator and an optical flow
algorithm was used to calculate the tumour velocity and position. Lung tumour motion was simulated using
a 3D printed tumour moved by an actuator controlled by LabView. Tumour motion taken from the breathing
patterns of seven lung cancer patients was simulated.

[Results & Conclusions] The optical flow algorithm tracked motion with an average accuracy of better than
0.5 mm for both a static treatment gantry with a moving aperture and with a rotating gantry. Motion at the
edges of the irradiated field were detected with a tracking error of -0.4 ± 0.3 mm and a precision of 1.1 mm.
These results demonstrate that real-time EPID tracking with an optical flow algorithm is a viable approach
to improved dosimetric efficiency and patient safety.

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O-133

SMALL FIELDS DOSIMETRY: DIFFERENT DETECTORS COMPARISON

Tomas Spretz1, Nicolas Larragueta1, Federico Bregains1, María Laura Haye2

1
Fundación Centro de Medicina Nuclear y Molecular Entre Ríos CEMENER, Argentina
2
Unidad de Terapia Oncológica UTO

Dosimetry – Reference quality

A photon beam becomes a Small Field when lateral charged particle equilibrium is not reached regardless
of the collimating system or the detector type being used. Thus, the conditions required by the cavity theory
to relate ionization to dose, are not satisfied. Additionally, both partial focal spot occlusion and volume
averaging are important effects to be considered when measuring narrow fields. The present work is aimed
to analyze and compare measurements performed by using different small field detectors, according to the
new IAEA-AAPM TRS483 protocol recommendations.

Two different diodes (SunNuclear EDGE and PTW T60017 Diode E), a diamond detector (PTW
microDiamond 60019), and a micro-ionization chamber (PTW PinPoint 31016) were used. Measurements
of dose profiles, percent-depth dose (PDD) curves, and output factors were obtained using a SunNuclear
3D Scanner. A Varian TrueBeam™ linac, at Fundación Centro de Medicina Nuclear y Molecular Entre
Ríos (CEMENER), was used to generate 0,5 to 3 cm square jaw collimated beams of 6 and 10 MV, both
with and without flattening filter. For output factors, the ratios of detector readings were multiplied by
correction factors. For dose profiles, size of penumbra and full widths at half maximum were analyzed and
compared. In the case of PDD, consistency of curves for each detector according to energy and field size
was observed.

For output factors, it was verified that solid-state detectors need smaller corrections than the ionization
chamber. In the case of dose profiles, the curves obtained with diodes showed the steepest penumbra values,
minimizing the volume averaging effect. For extremely small field sizes, PDD curves were affected not
only by sensitive volume averaging effect, but also by detector housing size. In that regard, the best results
were obtained by using detectors with the smallest housing, such as EDGE and PinPoint.

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O-135

DOSE INDEX ESTIMATES FOR A GE OPTIMACT580 SIMULATOR

Edwin Ges Suarez1, Rafael A. Miller-Clemente2

1
MINSAP, Cuba
2
Center of Medical Biophysics. Cuba

Radiation Oncology – Dosimetry

The goals of this work were to estimate and study the dose values received by cancer patients in a Simulator
by x-ray computed tomography (CT-Simulator). The study shows the results of dosimetric measurements
using the methodology recommended by the AAPM and those recommended by the manufacturer. The
electrometer readings were taken in dose mode and corrected for temperature and pressure. The CTDI100,
CTDIw and CTDIvol values were estimatedaccording to AAPM protocols respectively. The estimated
values were compared with the doses reported by the manufacturer, shown on the console (CTDIvol) for
the two tests.

It shows how dose measures for both abdomen and head are very close to those published for this kind of
equipment as well as those recommended by the manufacturer and published in the reviewed literature. The
average weighted CTDI values were 34.06 mGy and 18.07 mGy for head and abdomen respectively.
CTDIvol values of 38.15mGy and 20.24mGyare also obtained for head and abdomen respectively. These
dose values are acceptable for this kind of equipment and for the acquisition protocols used in clinical
practice. In the comparison of these results, it is essential to take into account the protocols and the
parameters of image acquisition since these are directly related to the final dose, fundamentally associated
with the voltage of the x-ray tube and the product of the tube current x time product, two important factors
to consider for a later adjustment and optimization of the protocols.

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O-138

ESTIMATION OF THE ABSORBED DOSE IN EYE LENS IN PATIENTS TREATED

FOR THYROID PATHOLOGIES WITH I-131 IN NUCLEAR MEDICINE

Modesto Sosa Aquino, Pedro Luis Márquez, Basilia Quispe, Pablo Cerón, Miguel A. Vallejo

Universidad de Guanajuato, Mexico

Nuclear Medicine

Introduction. One of the main treatments against thyroid cancer involves the incorporation of a radioactive
material such as I-131 in the patient. The radiation emitted by this material has therapeutic effects, however,
due to the penetrating power of the ionizing radiation, an undesired secondary component (scattered
radiation) is generated that can affect radio-sensitive organs. The eye lens is a component of the eyeball,
highly sensitive to ionizing radiation, so it is important to study the scattered radiation that can reach this
organ in a thyroid treatment with I-131. Methods and Materials. For this study, a batch of TLD-100
thermoluminescent dosimeters was used to estimate the radiation dose in this organ. The dosimeters were
characterized under ISO 12794 and NPL Report standards. Also, batch repetitiveness, homogeneity and
linearity studies were carried out to construct a calibration curve by irradiating the materials with a 60Co
source. In this study, we analyzed 20 patients with metastatic tissue remaining after surgery, to which the
radioactive material was added orally. The activities of the supplied radionuclide were 50, 100 and 150
mCi. Results and Conclusions. An average eye lens absorbed dose of 21 mSv was obtained in this study.
The experimental data reveal that the dose absorbed in eye lens is below the threshold dose for the
production of cataracts due to ionizing radiation, however, the doses received in this organ can be
considered high, so unwanted biological effects could appear at the long of the time.

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O-157

THE U NAPOLI – UC DAVIS – U VARNA VIRTUAL CLINICAL TRIAL FOR 3D X-

RAY BREAST IMAGING

Giovanni Mettivier1, Antonio Sarno2, John M. Boone3, Kristina Bliznakova4, Paolo Russo1
1
Universita' di Napoli Federico II - Dipartimento di Fisica "Ettore Pancini", and INFN Napoli, Napoli,
Italy
2
INFN Sezione di Napoli, Napoli, Italy
3
University of California Davius Medical Center, CA, USA
4
Technical University of Varna, Varna, Bulgaria

Diagnostic Radiology –Dosimetry

Introduction The groups at Universities of: Naples (Italy), Davis (USA) and Varna (Bulgaria), are
collaborating in a Virtual Clinical Trial (VCT) for dosimetry and image quality assessment in computed
tomography dedicated to the breast (BCT), which is based on about 100 digital phantoms of the
uncompressed breast from clinical BCT scans acquired at UC Davis.

Methods and Materials The voxels (0.20-0.40 mm by side) of reconstructed BCT slices were segmented
into air/gland/adipose tissue/skin and input to a GEANT4 code which produces computer simulated
projections of the uncompressed breast with defined X-ray source spectra, at equivalent doses comparable
to that of clinical scans. Using a mechanical compression module produced by U Varna we produce an
analogous set of compressed digital breast phantoms for simulating image acquisition in digital
mammography and in digital breast tomosynthesis. Synthetic reconstructed CT slices are then compared
with Davis’ clinical CT scans at 80 kV.

Results We produced 3D maps of the glandular dose distribution in the digital phantoms, then calculating
the mean glandular dose per unit air kerma and the dose volume histogram in the breast. We also calculated
synthetic BCT datasets (reconstructed via FDK or iterative algorithms) at 49 kV and 80 kV, as the sum of
the primary and scatter contributions. The comparison of the computer simulated and clinical CT scans at
comparable dose levels allows the assessment of differences between scans at different tube potentials and
potential changes in the glandular dose distribution.

Conclusions A VCT is ongoing, based on digital phantoms derived from clinical scans using dedicated
breast CT. The dataset of about 100 anatomically-realistic, uncompressed breast data sets are processed to
produce additional phantoms of the compressed breast, allowing exceptional flexibility for breast imaging
research and evaluation of breast CT, digital breast tomosynthesis and mammography in the context of a
VCT.

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O-164

RESIDENCE IN PHYSICAL PHYSICS WITH UNIVERSITY ACCREDITATION -

CHALLENGES AND EXPERIENCE

Ricardo Miguel Ruggeri1, Graciela Velez2, Daniel Ramirez1, Alejandro Schroeder1

1
Fundacion Medica de Rio Negro y Neuquen, Argentina
2
Hospital Oncologico de Córdoba

Education and Professional Issues

Introduction

In Latin America, there are several educational institutions that offer theoretical training in Medical Physics,
but none of them contemplate their subsequent structured clinical training.
For this reason the Residency in Medical Physics of Fundación Médica de Rio Negro y Neuquén and the
Universidad Nacional del Comahue has been implemented, being the first in Argentina accredited by a
University.

Methods and Materials

The residence was created following the recommendations of the IAEA through its technical documents
HHR N ° 1 and HHS N ° 25, using TCS documents 56, 37, 47 and 50 as theoretical bases.
The structure and contents were complemented according to the theoretical training requirements
established by the Nuclear Regulatory Authority (ARN) of Argentina for recognition as a training career
for the obtaining of individual permits as specialists in Radiotherapy Physics and / or Nuclear medicine.
The Universidad Nacional del Comahue through the regulatory disposition of the Faculty of Medicine
determined the final format and structure of the residence.
It was essential the collaboration of companies in the areas of Diagnostic and Nuclear Medicine through
Siemens, the participation of Elekta in Radiotherapy and PTW in quality control in all areas.

Results
We currently have two first and second year residents, with a total duration of 3 calendar years, rotating
through the areas of Diagnostic Imaging, Nuclear Medicine and Radiotherapy according to the
recommendations of the IAEA.

Conclusions
The incorporation of external professors with professional experience and expert advice from the IAEA
were key points to achieve its implementation.
It is important to bear in mind that the creation and consolidation of a Residency in Medical Physics in the
region is a dynamic process of continuous growth, especially due to the limitations in infrastructures and
technologies existing in the region.

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O-173

FEASIBILITY OF AN INDEPENDENT DOSIMETRIC VALIDATION FOR THE

SMALL ANIMAL RADIATION RESEARCH PLATFORM (SARRP) WITH A
CHEMICAL DOSIMETER FRICKE

Erika Tatiana Muñoz Arango, Andrea Mantuano, Carlos Eduardo De Almeida, Erika Tatiana Muñoz
Arango

University of the State of Rio de Janeiro, Brazil

Radiation Oncology – Dosimetry

Small animal irradiators through translational research are radiobiological support for the most modern
radiotherapy techniques. For SARRP-Small Animal Radiation Research Platform, with x-ray photon beams
(220 kVp), current reference dosimetry performed by the vendor follows the recommendations of the
AAPM TG-61 (farmer ionization chamber-IC and solid water phantom). Currently, there is not
independent dosimetry standardized for SARRP. The objective of this work is to evaluate the feasibility of
performer an independent dosimetry with the chemical dosimeter Fricke. The Fricke solution with many
desirable dosimetric characteristics has been shown for many authors to be a feasible option for the
absorbed dose standard for different beam qualities.
In this study, half value layer-HVL for 220kVp/13 mAs was measured to be 0.66 mm Cu. Effective energy
was calculated to be 63.61 keV, and G-value (Fe3+) for absorbed dose to water was 1.441x10-6 ± 0.012
mol/J. Time of irradiation was calculated using the Point-Dose-Calculator (PDC-vendor software), to give
20Gy with two parallel oppose beams at the isocenter with a 3x3 cm2 field size, PDC uses the data from
manufacturer commissioning. Fricke solution was distributed inside the PMMA holder (n=5), similar in
geometry to the farmer IC and positioned inside a small water phantom. Absorbed dose to water was
measured with a farmer IC (PTW-NE2571) in the same setup (n=5).
Very good agreement between Fricke and IC was obtained. The mean dose measured with Fricke dosimeter
was 21.793 ± 1.636 Gy and 21.460 ± 0.003 Gy with IC, the deviation between dosimeters was 1.6%.
Deviation from calculated dose was 8.9% and 7.3% respectively, in agreement with our previous results
obtained with a PTW-PinPoint 3D Chamber in water. The presented dosimeter has been shown to be a good
potential independent dosimeter for SARRP, with the option to extend to x-ray small photon fields in further
studies.

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O-174

MONITORING OF ANATOMY CHANGES DURING MULTI-FRACTIONAL

RADIATION THERAPY

Slav Yartsev

London Regional Cancer Program, London healthSciences Centre, London, ON, Canada

Radiation Oncology – Treatment Delivery

Introduction: Patient’s anatomy may change significantly during radiation treatment. Our routine practice
for evaluating the necessity for plan adaptation is presented.

Methods and Materials: Megavoltage CT (MVCT) scan is performed prior to every fraction of radiation
treatment on helical tomotherapy unit in our center. Planned Adaptive software is used for QA purpose and
calculation of the dose distribution in the MVCT study imbedded into original planning CT. In the case of
significant changes observed by radiation therapists, Planned Adaptive procedure is repeated and both dose-
volume histograms and point dose values are compared with the ones obtained for the first fraction.

Results: For the Head and Neck cases treated with VMAT on Varian linacs in 2018, 16.5% of patients were
re-scanned and new plans were created. For the patients treated in the same period on tomotherapy with
implementation of the proposed Planned Adaptive evaluation, only 2.9% of head and neck cancer patients
were required to be re-scanned and new plans developed. Off-line consultation with the treating radiation
oncologist was crucial in determining the need for plan adaptation. Both patient’s clinical status and the
number of remaining fractions were taken into account for the final decision on whether to adapt the initial
plan. Re-contouring of the organs with changed anatomy was done only in the projects of evaluating volume
change as a function of time, but was not necessary for decision of adaptation.

Conclusions: Planned Adaptive software was shown to be an effective tool for evaluation of the dosimetric
significance of observed anatomy changes during radiation treatment on helical tomotherapy. A
comparative analysis of dose distributions calculated for the first fraction and for the fraction of suspected
large variation in anatomy can save resources in a busy clinic.

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O-177

POSTOPERATIVE ENDOMETRIAL CANCER TREATMENTS WITH ELECTRONIC

BRACHYTHERAPY SOURCE. COMPARISON TO IR192 AND CO60 HIGH-DOSE-
RATE BRACHYTHERAPY SOURCES

Sergio Lozares, Jose Antonio Font, David Villa, Verónica Alba, Sara Jiménez

Miguel Servet University Hospital (Zaragoza-Spain), Spain

Radiation Oncology – Brachytherapy

Introduction: To compare the first 200 endometrial cancer patients treated in our center with cylindrical
applicators and Axxent (Xoft Inc.) electronic brachytherapy and equivalent planning made for Ir-192 source
and Co-60
Methods and Material:
200 patients previously treated with Axxent (50 kV source) have been replanned with Ir-192 and Co-60
source. The calculation for three types of source were performed on BrachyVision (Varian Inc.) treatment
planning system.
The prescription was 5 Gy per fraction. 3 fractions or 5 fractions depending on previous radiotherapy
treatment.
Planning parameters of a planning target volume (PTV) countoured from the cylinder surface to 5 mm
along the active length were evaluated. V150 and V200 data for PTV and D2cm3, V50% and V35% for
organs at risk (OAR) were evaluated, the percentage volume receiving 35% and 50% of the prescription
dose, respectively, and D2cm3, highest dose to a 2 cubic centimetre volume of an OAR. Results for bladder,
rectum and sigmoid are showed.

Results:
We may observe a reduction in dose at V35% and V50% in all OAR and also a reduction in D2cm3 occurs.
PTV parameters increase in the case of Axxent ,as reported previously, but only one case of vaginal
mucositis with grade≥2 has been reported in our center. All patients were treated between 2015 and 2018,
enough time to develop early problems.
Conclusions:
Preliminary results are very optimistic about the adequacy of Xoft equipment for treatment of endometrial
cancer with a clear reduction of the physical dose in organs at risk and no development of acute mucositis
except one patient despite the considerable increase V150 in the treatment volume.
Further studies will be necessary to take into account the RBE in treatments such sources.

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O-184

METHODOLOGY FOR THE INTEGRATION OF SPECT WITH EEG INVERSE

SOLUTION IN THE LOCATION OF THE EPILEPTOGENIC ZONE IN DRUG-
RESISTANT EPILEPSY

Karla Batista1, Carlos Sanchez2, Lilia Morales1, Angel Aguila1, Abel Sanchez1
1
International Center for Neurological Restoration, Cuba
2
University Medical Center Groningen, International Center for Neurological Restoration

Nuclear Medicine

Introduction: The goal of this work is to propose a methodology that combines the non-invasive functional
neuroimages of electroencephalography (EEG) and SPECT for the identification of the epileptogenic zone
(EZ) in the surgical evaluation of patients with drug-resistant non-lesional epilepsy.
Methods: This methodology consists of: i) estimation of the sources from the inverse solution (IS) of the
ictal EEG; ii) application of the SISCOM (Subtraction Ictal SPECT Co-registered to MRI) methodology;
and iii) estimation of the IS of the ictal EEG but using the output of the SISCOM as a priori information
for the estimation of the sources. The methodology was implemented retrospectively in five patients to
evaluate its capacity to identify EZ. A gold standard and a coincidence analysis based on measures of
sensitivity and specificity were used to assess the accuracy of the EZ estimated by the methodology.
Results: In the patients with good postoperative evolution, the estimated EZ presented a spatial coincidence
with the resection site represented by high values of sensitivity and specificity. For the patient with poor
postoperative evolution, the methodology showed a partial incoherence between the estimated EZ and the
resection site. In cases of multifocal epilepsy, the method proposed spatially extensive epileptogenic zones.
Conclusions: The results demonstrate the ability of the methodology to identify EZ in cases that had good
post-surgery evolution, as well as partial incoherence between the estimated EZ and the resection site in a
case of poor post-surgical evolution. The novelty of the work is based on the estimation of the sources of
ictal EEG from an inverse solution method using the SISCOM result as a prior. This methodology
contributes to identify EZ, the correct identification of EZ and eloquent regions has an impact on the
decrease in invasive records during surgery and at surgical outcome.

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O-185

DEVELOPMENT OF AN AUTOMATED TOOL FOR PHANTOM AND

COLLIMATOR SCATTER FACTORS TABLE GENERATION

Nicolás Larragueta1, Federico Bregains1, Jose Biurrun2

1
CEMENER, Argentina
2
FIUNER

Radiation Oncology – Dosimetry

Introduction: the commissioning process is a demanding and time consuming task. As part of this process,
output factors have to be measured in order to create the models in treatment planning systems (TPS).
Varian Eclipse™ TPS require a bi-dimensional output factor table containing both X and Y field sizes. In
particular, the commissioning of Varian TrueBeam™ linear accelerator (linac) presents an additional
challenge since it has up to 5 photon energies with flattening filter and 2 energies without flattening filter.
Methods and Materials: in this work, we developed an application that can read a text file generated by Sun
Nuclear PC Electrometer in Data Logging mode, and a RT Plan exported from Varian Eclipse™ and
automatically create the bi-dimensional table in the format required to be imported in Eclipse™ Beam
Configuration. The irradiation was done in a Varian TrueBeam™ linac in automation mode. Two methods
were implemented, one by the evaluating accumulated charge and another by inspection of the current. We
measured the 27 output factor tables and compared them with the Varian representative data
Results: The acquisition time for an entire table was approximately 10 to 15 minutes., finding very good
agreement (<1%).
Conclusions: this method is a fast alternative to generate the output factors tables, making it possible to
reduce the commissioning process time from several days to a few hours.

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O-188

QUALITY ASSURANCE FOR CO-60 HIGH DOSE RATE BRACHYTHERAPY

Gustavo Píriz, Henry Ortega-Spina, Gabriel González-Sprinberg

Faculty of Medicine, UDELAR, Uruguay

Radiation Oncology – Brachytherapy

Introduction: In high dose rate remote afterloading brachytherapy, quality assurance strongly depends on
the accurate determination of the source strength, dwell time, and also on the position and transit time of
the source. In order to check these parameters in a remote afterloader with Co-60 sources, two devices for
well-type chambers were designed, constructed and characterized.

Methods and Materials: QA Cerrobend and tungsten inserts were built for HDR brachytherapy equipped
with Co-60 sources. They consisted in a cylinder with a transverse spacer of acrylic at a precisely known
distance from the source. The distance of the source to this acrylic window characterizes the response of
the detector to the signal. We used a Co-60 HDR afterloading system (E&Z BEBIG 60 Co HDR Co0-A86,
Berlin, Germany) and a well-type chamber (PTW 33004, Freiburg, Germany). Acrylic windows of different
thickness were tested in order to optimize the signal. The dwell position step was 1 mm and a Vernier
caliper fixed to the holder allowed to select different steps. Background current with no window was
subtracted in order to determine the source position accuracy. An optimum window and several
characteristic points of the response curve were obtained for each holder. From the readings at these points,
it was possible to determine the accuracy of dwell positions and transit time.

Results: With Cerrobend and tungsten, respectively, we obtained a sensitivity of the source position better
than 2% per mm and a precision of 0.14 mm, a sensitivity and precision of 1% per mm and 0.13 mm and
the transit time with a relative precision of 8.3% and 51%.

Conclusion: This methodology may provide an easy and precise way to periodically check source position
for HDR Co-60 sources in brachytherapy up to an accuracy of ±0.14 mm.

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O-192

DEVELOPMENT OF A 3D-PRINTED HETEROGENEOUS UPTAKE PHANTOM FOR

THE ASSESSMENT OF TUMOR VOLUME DELINEATION METHODS USING FDG
PET/CT IMAGES

Ana Lucía Poma1, Virginia Venier2, Humberto Leonardo Romano2, Pablo Daniel Goldaraz2, Camilo
García3
1
Instituto Balseiro, Comisión Nacional de Energía Atómica, Fundación INTECNUS - San Carlos de
Bariloche, Argentina
2
Comisión Nacional de Energía Atómica, Fundación INTECNUS - San Carlos de Bariloche
3Service de Médecine Nucléaire - CHU Saint Pierre - Université Libre de Bruxelles - Brussels - Belgium

Nuclear Medicine

Introduction: Tumor volume delineation based on PET image segmentation has gained increasing attention
in radiotherapy. This interest is triggered by the clinical implementation of dose-painting techniques, which
aim to deliver non-uniform dose-distributions inside the tumor, based on the metabolic activity of the PET
images. Here, we describe the challenges faced when designing a Lego-like anthropomorphic,
heterogeneous uptake phantom. We also describe the subsequent construction of three inserts for the
NEMA image quality phantom.

Methods and materials: We designed a Lego-like female pelvis phantom to evaluate PET segmentation
methods in heterogeneous cervical tumor-like activity distribution patterns, near areas of high bladder
uptake. Several challenges were faced when attempting to divide it into parts that could be obtained using
3D-printing, as well as when gluing these parts together. These challenges led to the design of three inserts,
which could be placed inside the NEMA phantom. The first insert is a smaller version of the female pelvis
phantom, described above. The second, shaped like a bicycle chain, contains concentric and non-concentric
chambers, allowing us to obtain controlled heterogeneous uptake volumes. The third one is empty, and can
be filled with materials of different water absorption indices, resulting in tumor-like uptake patterns.

Results: The PET/CT images obtained from the three inserts ranged from uniform activity distributions to
uncontrollable, heterogeneous uptake patterns, similar to those found in patients. We were also able to
analyze different tumor to background ratios. In addition, the “bicycle chain” insert allowed us to model
several controlled heterogeneous uptake patterns.

Conclusions: The designed inserts may be used to simulate different FDG uptake pattern distribution. This
would allow us to assess PET segmentation methods for heterogeneous volume delineation, which may
then be used in dose-painting radiotherapy applications. Further work will seek to assess alternative
construction methods for the Lego-like phantom.

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O-193

DEVELOPMENT OF A SEMI-AUTOMATIC SEGMENTATION TOOL FOR THE

EVALUATION OF PET IMAGE BASED TUMOR VOLUME SEGMENTATION:
PRELIMINARY RESULTS

Ana Lucía Poma1, Virginia Venier2, Humberto Leonardo Romano2, Tania Telford2, Camilo García3
1
Instituto Balseiro, Comisión Nacional de Energía Atómica, Fundación INTECNUS - San Carlos de
Bariloche, Argentina
2
Comisión Nacional de Energía Atómica, Fundación INTECNUS - San Carlos de Bariloche
3
Service de Médecine Nucléaire - CHU Saint Pierre - Université Libre de Bruxelles - Brussels - Belgium

Nuclear Medicine

Introduction: Dose-painting has led to a growing interest in tumor volume delineation based on PET GTV
image segmentation, including any heterogeneities found within the tumor. Despite the use of this novel
method in several countries, radiotherapy treatment planning in Argentina is generally based on CT-only
images and assume uniform dose delivery inside the GTV. Here, we describe the preliminary results in the
development of a semi-automatic tool for tumor volume delineation and the assessment of this tool using
PET/CT images of patients and of specially designed phantoms.

Methods and materials: We designed a tool to segment PET/CT images using methods described in the
literature. The chosen algorithms included: fixed- and adaptive-thresholding, gradient- and texture-based
segmentation, supervised clustering, and manual delineation. The performance of the tool was assessed by
comparing the manually drawn GTV in CT-only and PET/CT images, with those obtained by PET
segmentation methods, paying special attention to any heterogeneous areas. The volumes were drawn by a
dual accredited radiotherapy and nuclear medicine physician, who also evaluated the results. This analysis
was carried out on uptake patterns obtained in FDG-PET/CT images of NEMA spheres, in phantoms
developed in-house, and a range of different tumors.

Results: The GTVs based on the PET/CT images, which were drawn both manually and with the aid of the
program, were smaller than those drawn manually by the physician and based solely on the CT images.
This is in agreement with previous findings. The segmented GTV, and the heterogeneities within it, were
consistently well-delineated by gradient- and texture-based segmentation.

Conclusions: Our results show that it may be feasible to carry out the delineation of both GTV and
heterogeneus areas within it using our program. Although preliminary, these results show that the best
segmentation method to use depends on patient’s pathology, and tumor to background ratio.

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O-196

THE ROAD TO FIRST PATIENT TREATMENT ON ELEKTA'S UNITY MR-LINAC

Jihong Wang, Sastry Vedam, Dave Fuller, Jinzhong Yang, Caroline Chung

MD Anderson Cancer Center, USA

Radiation Oncology – Treatment Delivery

Introduction: Our institution installed the first Unity MR-Linac systems in North America and was the first
to treat patient with it. In this presentation, we will review and share our experience about the process for
clinical operation of this system.

Methods: The steps leading to patient treatment on the Unity MR-Linac were reviewed and analyzed,
including site planning and preparation, system installation and initial assessment, staff education and
training, development of policies and procedures, system commissioning, design and evaluation of QA
procedures, and development of a workflow. Each step was reviewed and successfully completed with
improvements and potential pitfalls identified and discussed.

Results: Clinical implementation of an MR-Linac system was a complex task that requires expertise in
multiple domains. A multidisciplinary team approach was absolutely critical in order to ensure successful
clinical implementation and operation. MRI-guided RT is an evolving technology in many aspects which
requires continuous development and innovation by the medical physics community in order to realize the
full potential of such paradigm changing technology.

Conclusion: Clinical implementation of the Unity MR-Linac system required a collaborative,

multidisciplinary approach and involved several groups of staff with cross-domain expertise. It was critical
to prepare and educate staff; assemble the right people together into an implementation team; and establish
the right processes, tools and safety policies early to ensure the success of clinical operation.

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O-199

EPIDEMIOLOGIC STUDY OF OCCUPATIONAL LOW DOSE EXPOSURES AND

THE DESIGN OF FUTURE CANADIAN COHORT STUDIES

Gavin Cranmer-Sargison1, Hazel Williams-Roberts2, Watara Ibrahim2, Bonnie Janzen2

1
Saskatchewan Cancer Agency, Canada
2
University of Saskatchewan

Radiation Protection

The goal of this work was to perform an epidemiologically driven literature review regarding the health
effects of occupational low dose exposure. A scoping review was conducted with pre-defined inclusion and
exclusion criteria for previously published systematic reviews on the topic as well as primary studies. The
body of research was found to be a dense network of overlapping studies across specific types of
occupational cohorts. Five occupation specific cohorts were used throughout this study: medical personnel,
nuclear industry workers, uranium miners, Mayak cohort and other. Methods of dose reconstruction varied
across studies and even when personal dosimeters were used, they often only represented a subset of the
study cohort. Information from questionnaires on work history practices, including facility type, number of
years worked, and types of procedures performed were used to generate artificial personal dosimeter data
when individual badge measurements were not available. Several health outcomes have been reported
across the various occupational cohorts. Earlier studies focused on mortality (all causes and specific causes
including cancer). Mortality comparisons between cohorts and the general populations have found lower
standard mortality ratios - described as the healthy worker effect. More recent studies have focused on
disease incidence including exploration of association between radiation dose and circulatory diseases.
However, studies continue to experience challenges that result from the lack of information about potential
lifestyle con-founders that influence the reported associations. The results of the review will be presented
as well as a data quality proposal for the utilization of the Canadian National Dose Registry (NDR) database
for the study of occupational exposure in Canada.

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O-200

WORLDWIDE IMPLEMENTATION OF DIGITAL IMAGING IN MAMMOGRAPHY:

REPORT FROM AN IAEA WORKGROUP

Maria-Ester Brandan1, Hilde Bosmans2, Martin J. Yaffe3, Harry Delis4

1
Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
2
Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
3
Sunnybrook Research Institute, University of Toronto, ON, Canada
4
International Atomic energy Agency, Vienna, Austria

Diagnostic and Interventional Radiology – General

Introduction:
In 2016, the IAEA published document HHS28 “Worldwide Implementation of Digital Imaging in
Radiology” supporting the introduction of digital imaging in general radiology. In response to the need to
advise Member States, and recognizing that there was no practical guidance on how to make potential
transitions toward digital mammography, a workgroup was formed in 2017 with the objective to investigate
the topic and develop relevant guidelines.

Methods:
The workgroup consisted of medical physicists and a radiologist with experience in the technical and
organizational requirements of high-quality breast cancer imaging. Recommendations were in the form of
a transition “roadmap” to guide a facility from its current operational state to one with the potential to
provide better results.

Results and conclusions:

Recommendations describe transitions that are desirable and possible, given the limitations of available
resources at a site. Guidelines on the Worldwide Implementation of Digital Imaging in Mammography,
expected to be published in 2019, are intended to assist policy decision makers, planners, program
administrators and professionals working in health care in establishing or upgrading capabilities for
diagnostic or screening mammography. Specific attention is given to the transition between technologies,
including retrofitted solutions (either for computed(CR) or digital(DR) mammography). Although this can
be a financially realistic and reliable solution, the ease of transition is sometimes misleading and if the
process is not carefully planned and implemented, it can easily lead to suboptimal performance.
Guidelines include examples of decision trees, for medical imaging facilities of different size and levels of
technical development, suggesting how to move forward toward providing higher-quality mammography.
These can guide informed decision making on the initiation or upgrade of services. The publication analyses
implementation scenarios, describing viable and realistic solutions for different facilities with different
needs, capacities and resources, and provides information on resources and requirements for different
technologies.

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O-201

IMPROVEMENT OF DOSE DISTRIBUTIONS IN VOLUMETRIC MODULATED ARC

THERAPY (RAPIDARC) WITH JAW TRACKING TECHNIQUE FOR
LATERALIZED TARGETS

Rogelio Manuel Diaz Moreno, Daniel Venencia, Albin García Andino

Instituto Privado de Radioterapia, Argentina

Radiation Oncology –Treatment Planning

Introduction: Jaw tracking technique (JTT) in RapidArc treatments allows blocking unwanted leakage
radiation. For patient's lateralized targets, keeping the isocenter centered can be helpful to avoid collisions,
spare couch motions and treatment times. Nevertheless, in these cases the standard, static jaw technique
(SJT) could result in more healthy tissue dose. This work compared dosimetric differences between JTT
and SJT in RapidArc treatments for lateralized targets with isocenter in patient’s midline.
Methods and Materials: Four pancreatic SBRT standard plans were replanned with JTT. Plans were created
using a 6X beam of a TrueBeam STx and Eclipse v15.1 (Varian). PTV's D95%, D2% and Paddick's
conformity index (CI) were compared. V5Gy, V10Gy, V20Gy and normal tissue's Dmean were compared.
Portal images were taken for verification.
Results: The variations of PTV’s D95% and D2% between JTT and SJT plans averaged 2% with a standard
deviation of the same order. The first two cases, with the most lateralized targets, presented almost no
change in CI while the other two improved 38% and 18%. Increased dose ring shaped areas were observed
in the first two SJT plans. Dose in those areas decreased from 7.13 Gy to 5.44 Gy and from 10.4 Gy to 6.53
Gy with JTT. Portal images of those SJT plans showed radiation leakage between closed opposed leaves
with a peak about 30% of the maximum fluence. Dmean reduction with JTT compared to SJT in all plans
averaged 11% with standard deviation of 7%. Almost all V5Gy, V10Gy and V20Gy values decreased an
average of 11,7% with JTT in comparison with standard plans, with a standard deviation of 11.1%. An
isolated V10Gy value actually increased 5%.
Conclusions: JTT plans were capable of delivering better dose distributions for all cases, either due to
improved healthy tissue protection or better PTV coverage.

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O-209

END-TO-END TESTS WITH SRS MAPCHECK FOR FRAMELESS RADIOSURGERY

IN THE RADIOTHERAPY DEPARTMENT OF CLINICA ALEMANA DE SANTIAGO.

Gabriel Zelada, Jugleys Seijas, Hernan Barriga, Teresa Resquin

Clinica Alemana de Santiago, Chile

Radiation Oncology – Dosimetry

Introduction
Radiosurgery is a complex treatment technique, where high doses of radiation are delivered to small
volumes in one or a few sessions, which requires high precision in the delivery of doses, whose process
involves several steps, such as image, planning and treatment. At each stage, rigorous quality controls must
be carried out to ensure its efficiency and fidelity.
Materials and methods
The SRS MAPCHECK is a phantom specially designed to perform end-to-end tests on radiosurgery
techniques quickly and safely, checking the overall fidelity of the treatment. In the Clinica Alemana, the
radiosurgery technique without stereotactic frame (Frameless) was implemented with multileaf (MLC
Agility), with a Linac Elekta Synergy Performing these tests to ensure all steps of the treatment
administration process. First, the phantom was characterized by checking its response (according to) to
field size (small fields), dose rate, and angular dependency. Then, the designed tests were performed,
starting with checking the matching accuracy between CT/MR images (fusion), following the
reproducibility of positioning using XVI imaging system. The algorithm for the calculation of the
Treatment Planning System (TPS) Monaco was then verified through dose distribution analysis with
Gamma factor and criteria 1 mm and 1%, also absolute dose measurements.
Results and Conclusions
Given the results obtained, the implementation of the Frameless radiosurgery technique in the Radiotherapy
service of the Clinica Alemana of Santiago is in accordance with international standards. All parameters
evaluated in the treatment process indicate that the planned dose distributions match spatially and
dosimetrically with those delivered. Whereas, the minimum size of the lesion should be 5mm and the
stretcher angles used for the plan must be within ± 45 °, multiple lesions can be verified as long as they are
not too far from the isocenter and are within the area of 7x7cm2.

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O-211

RADIOSURGERY CONICAL COLLIMATORS COMMISSIONING BASED ON TRS

483
Joaquin Galvan, Tomas Spretz, Federico Bregains, Nicolas Larragueta

CEMENER, Argentina

Radiation Oncology – Quality Assurance

Radiosurgery is a complex radiotherapy technique requiring high levels of precision due to the high dose
delivered in few fractions over a small target volume surrounded by critical structures. In order to protect
such structures and achieve a high dose gradient, the technique can be administered using conical
collimators generating small fields. This modality implies dosimetric difficulties and challenges, for which
the new Code of Practice IAEA-AAPM TRS 483 has been recently developed.
The aim of this project was to commissioning the Varian ICVI radiosurgery system, including seven conical
collimators ranging 4 mm to 17.5 mm, to be used in a TrueBeam STx® accelerator with 6 MV and 10 MV
beams, with and without flattening filter, and with Eclipse™ Cone Planning software. Dose profiles, tissue
maximum ratios and output factors were measured following the new recommendations and using Edge™,
microDiamond™ and Diode E™ detectors, as well as the 3D Scanner™ phantom, and the results were
compared with the manufacturer’s reference data. After calculation model was created, calculated profiles
and dose depth curves were validated against measured data using different gamma criteria. An End-to-
End test was also carried out using PinPoint® 3D ionization chamber and the recently released SRS
MapCheck™, as well as the StereoPhan™ phantom, for which special considerations of material had to be
made.
Relative dosimetry curves passed gamma criteria of 2%1mm in lowest energies. A disagreement of up to
10% compared with reference data could be observed in the output factors, which were calculated
employing the output correction factors introduced in the new protocol. After End-to-End test using
ionization chamber, the cones equal or greater than 7.5 mm showed differences within 2% between the
measured and the calculated dose. The smaller cones were later validated using SRS MapCheck™ for 6
MV beam and showed differences within 3%.

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O-213

APPLYING TG-218 METHODOLOGY TO LARGE FIELD VMAT QA USING A

GANTRY-RESOLVED EPID-BASED TECHNIQUE

Pedro Cardoso1, Qiuwen Wu2, Bin Liang3, Ran Wei3

1
Duke Kunshan University, China
2
Duke University
3
Beihang University

Radiation Oncology – Quality Assurance

Introduction: The purpose of the study was to evaluate the performance of a gantry-resolved EPID-based
QA method for patient-specific QA of large VMAT fields using process-based limits per TG-218.

Methods and Materials: A gantry-resolved EPID-based QA method was used for patient-specific QA of 35
large VMAT fields (field size range from 17x30cm2 to 30x40cm2) used for GYN cancer treatments. All
fields were measured with two EPID models and two photon energies, accounting for a total of 140
measurements divided into 4 different groups (processes). The method created pseudo-3D dose
distributions from stacked portal images acquired on TrueBeam Linac using dosimetry (integrated)
acquisition. Predicted portal dose distributions were calculated based on MU information contained in the
image headers. Gamma pass rates for pseudo-3D and composite 2D dose distributions were used to
calculate process-based tolerance and action limits following the TG-218 methodology
(3%/2mm/10%threshold criteria). For the pseudo-3D distribution, the gantry angle accuracy requirement
was given by an angle-to-agreement (ATA) criteria of 3⁰.

Results: All gamma pass rates for gantry-resolved pseudo-3D distributions were within the recommended
universal action limit of 90%, and average pass rates were higher than 95% for all processes. Gamma
analysis of 2D distributions produced average gamma pass rates close to 99% and an overall performance
superior to Varian’s Portal Dosimetry. All calculated tolerance limits were stricter than the action limits
and no process displayed an out-of-control behavior. The differences in performance among the processes
(EPID models and energies) illustrated they are affected by different sources of variation. The calculated
process-based tolerance and action limits complied with TG-218 recommendations.

Conclusion: The method has shown its suitability for use in patient-specific QA of large VMAT fields. The
results met the recommendations of TG-218. The variability among different processes indicates that
improvements are possible to obtain stricter process-specific tolerance and action limits.

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O-221

TO INVESTIGATE AND VALIDATE OPTIMAL PLANNING STRATEGY, RAPID

DOSE DELIVERY METHODOLOGY IN GAMMA KNIFE RADIOSURGERY
(GKSRS) FOR ACOUSTIC NEUROMA TUMORS.

Gopishankar Natanasabapathi1, Priyanka Agarwal2, Rajkishor Bisht1, Ss Kale1, Subash Chander1

1
ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, INDIA
2
HBCH, VARANASI, INDIA

Radiation Oncology – Treatment Delivery

Introduction:
To investigate and validate optimal planning strategy, rapid dose delivery methodology among forward,
inverse and inverse modified planning in Gamma Knife Radiosurgery (GKSRS) for acoustic neuroma
tumors.
Methods and Materials:
Seventeen patients with acoustic neuroma tumor were planned for GKSRS using (1)forward planning(FP),
(2)inverse planning(IP) and (3)inverse modified planning(IMP) methods in Leksell Gamma Plan
(LGPVersion10.1) with TMR10 algorithm. All patients were scanned in MRI (GE, USA) with following
scanning parameters: T1W images-MPRAGE sequence, FOV-256mmx256mm, matrix size-
512mmx512mm, slice thickness-1mm. The prescription dose was 12Gy at 50% for all cases. Validation of
all three planning strategies was performed by simulating treatment in an inhouse made phantom with EBT3
film insert. As a first step, X-ray CT was done with phantom using following scanning parameters: FOV-
256mmx256mm, Tube Voltage-120kVp, slice thickness-1mm. The acquired CT images were imported into
TPS and co-registered with MRI of patients for target/critical organ delineation. The phantom with EBT3
film was mounted in GK couch for film measurement.
Results and Discussion:
Mean tumor volume for seventeen patients was 7.2cc. The mean coverage Index (CI) for FP, IP, IMP were
96.47±2.35, 96.06±0.90, 95.76±1.44 and mean beam ON time (in minutes) were 51.6±14.6, 76.9±17.0,
60.5±16.0. The TPS calculation versus film measurement showed that for gamma pass criteria of 3%/3
mm, 2%/2 mm and 1%/1 mm, pixel pass rate was 98%, 97%, 92% for FP, 81%, 74%, 60% for IP, 99%,
99%, 97% for IMP respectively. Line profile comparison between TPS and film measurement dose for FP,
IP, IMP showed a dose difference of 5%, 12%, 5% respectively. Brainstem (BS) dose was minimal in FP
and IMP whereas IP delivered dose twice to BS than FP.
Conclusion:
Overall results show that IMP based planning is an efficient, time saving strategy which has the potential
for implementation in a busy radiosurgery clinic.

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O-224

SMALL FIELD DOSIMETRY OF ROTATIONAL PHOTON BEAMS: A FEASIBILITY

STUDY

Rodolfo Alfonso1, Adrian Acosta2, Jesus Perez2, Ernesto Olivares2, Andy Abreu2
1
Faculty of Nuclear Sciences and Technologies, University of Havana, Cuba
2
Department of Radiotherapy, National Oncology and Radiobioloy Institute, Havana

Radiation Oncology – Dosimetry

Introduction
The new code of practice for small field dosimetry TRS-483 addresses static photon beams only.
Nevertheless, current practices with such beams are more frequently applied to rotational beams. Plan
verification of radiosurgery treatments, using very small cone shaped beams, could require the application
of field output correction factors, that have been reported in the TRS-483 for static beams; the feasibility
of using such factors in rotational beams is assessed.
Methods and Materials
The Monaco treatment planning system (TPS) has been recently commissioned for stereotactic treatments
in an Elekta Synergy linac, using add-on cones, defining field sizes from 5 to 35 mm diameter. The field
output factors generated by the TPS were verified for static, orthogonal incident beams, using the
recommendations of the TRS-483, comparing against the results of several PTW detectors, including
unshielded diodes (60017 and 60018) and microdiamond (60019). For verification of rotational beams, a
single co-planar arc was planned and delivered for each cone size, using a cylindrical phantom, model PTW
IMRT Matrix T40026. The detectors were placed at the isocenter, in the phantom’s central hole.
Results and conclusions
Main issues related to using TRS-483 field output correction factors in rotational beams, incident on
cylindrical phantoms, were associated to the centring of the detector and the orientation of the beam
regarding the solid-state detectors. CBCT and EPID improved the accuracy of centring, but still, it can be
the main cause of measurement uncertainty. Results showed that TRS-483 correction factors are applicable
to rotational beams, if accurate centring is achieved. The effect of perpendicular incidence on the detector
showed negligible impact when using the microdiamond detector, while systematic discrepancies appears
with silicon diodes, showing a reduced output factors. TRS-483 for relative dosimetry can improve
accuracy in absolute dose verifications for radiosurgery treatment with very small fields.

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O-226

RECONSTRUCTION OF TOTAL BODY COMPUTED TOMOGRAPHY- ROBOCOT:

A PATIENT-SPECIFIC VIRTUAL WHOLE-BODY CT SCAN GENERATOR FOR
ASSESSING PERIPHERAL ORGAN PHOTON DOSE.

José Luis Rodríguez Mongua, Ignacio Espinoza, Karem Nathalie Medina Ascanio, Edgardo Dörner,
Beatriz Sánchez Nieto

Instituto de Física de la Pontificia Universidad Católica de Chile, Chile

Radiation Protection

Purpose: In order to being able to assess peripheral photon dose in patients undergoing radiotherapy,
information about organs’ position and geometry is necessary. However, planning CTs are usually
restricted to the region surrounding the PTV and do not include the majority of the patient’s organs. In this
work, a Reconstruction Of total BOdy COmputed Tomography –ROBOCOT- tool for generating patient-
specific virtual whole-body CT scans has been developed. For that purpose, ROBOCOT uses the patients’
planning CTs and the ICRP-110 reference computational phantoms.
Method: Some of the capabilities of MATLAB and its Image Processing Toolbox are used to convert a CT
image and one of the computational phantoms (male or female) to the same format and finally to make a
rigid image registration. A user-friendly graphical interface has been developed to aid those steps.
Result: Through the graphical interface, the user can load the patient’s CT image and the corresponding
reference computational phantom and then visually select the region of the phantom corresponding to the
patient CT image. After that, an automatic rigid registration takes place, producing a virtual whole-body
CT representative of this patient’s geometry and including the segmentation and identification of the organs
specified in the ICRP Publication 110. The interface has been integrated with PERIPHOCAL, an analytical
model for assessing peripheral photon dose, also implemented in MATLAB. The image registration and
the dose calculation were validated with the anthropomorphic phantom ATOM for a prostate cancer
treatment.
Conclusion: A tool for calculating patient-specific photon dose to out-of-field organs during radiotherapy,
based on the generation of a virtual CT image, was developed.
BSN is in debt to Conicyt (Fondecyt N1181133). I.E. acknowledges the support of Conicyt (Fondecyt
N111505601).

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O-227

ASSESSMENT OF ORGAN-SPECIFIC OUT-OF-FIELD DOSES AFTER A THREE-

FIELD IRRADIATION BASED ON MONACO ALGORITHMS AND MONTE CARLO

José Luis Rodríguez Mongua, Karem Nathalie Medina Ascanio, Ignacio Espinoza, Edgardo Dörner,
Beatriz Sánchez Nieto

Instituto de Física de la Pontificia Universidad Católica de Chile, Chile

Radiation Protection

Purpose: Treatment Planning Systems (TPS) are not designed for out-of-field dose calculations. Large
errors (up to 70%) have been reported even for modern Collapsed Cone (CC) and anisotropic analytic
algorithm (AAA) algorithms. To our knowledge no reports exist on the accuracy of the Monte Carlo (MC)
and the CC algorithms as implemented in the MONACO® TPS with regard to out-of-field dose estimation.
This study compares the EGSnrc MC simulation with a conventional plan by MONACO® TPS.

Method: BEAMnrc was used to create a model of an Elekta Axesse™ accelerator head operating at 6 MV.
The model was validated with measurements with a semiflex chamber in water. A simple 6MV three-field
plan centered at the right lung was considered. DICOM and EGSPHANT files of the reference
computational phantom ICRP-110 were generated for dose computation with Monaco® and the dose
scoring utility DOSXYZnrc, respectively. Distances (in craneo-caudal direction) from the center of mass
of 13 organs to the 50% isodose were calculated. Dose volumetric information for these organs were
generated with MONACO® and the EGS4nrc MC simulation.

Results: Compared to the MC simulation, both algorithms underestimated the mean and minimum doses to
organs beyond 4 cm outside the 50% isodose. Differences in average dose were up to 90%. Generally, CC
performed better than MC in the TPS. For some organs, local maximum doses reported by CC were
overestimated due to an artifact of the CC algorithm which could be visualized as isodosis beyond 1%
bearing a strong resemblance to the incident ray. We did not find that the underestimation worsened for
increasing distances to the treatment fields.

Conclusions: The found differences motivate out-of-field dose estimation by experimental measurements
and/or specific analytical models.
BSN is in debt to Conicyt (Fondecyt N1181133) and PUC (P1702/2017). I.E. acknowledges the support of
Conicyt (Fondecyt N111505601).

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O-228

FILMAT: AN OPEN SOURCE USER-FRIENDLY TOOLKIT FOR RADIOCHROMIC

FILM DOSIMETRY

José Luis Rodríguez Mongua, Karem Nathalie Medina Ascanio, Ignacio Espinoza, Edgardo Dörner,
Beatriz Sánchez Nieto

Instituto de Física de la Pontificia Universidad Católica de Chile, Chile

Radiation Oncology – Dosimetry

Introduction: Radiochromic film dosimetry is frequently carried out using costly pieces of software which,
for clinical safety and commercial reasons, hide the functionality under closed-software architecture. These
features may compromise the flexible usage required by academic/research purposes. This work presents
the implementation and validation of FilMat, an open source and user-friendly toolkit for an efficient and
costless implementation of radiochromic film dosimetry.
Material and methods: FilMat is written in Matlab under a Graphical-Unit-Interface which assures an
efficient workflow and smart visualization of plots. The code includes the generation of a calibration curve
and the conversion from film images to dose maps. Furthermore, it creates dose profiles along any axis as
well as a 2D γ-index (with global/local reference points) analysis for comparison of absolute/relative dose
distributions under a chosen criteria. For the latter, FilMat features a DICOM import module allowing the
automatic registration with dose files from the TPS. The γ-index analysis results (for 3% -3mm criteria),
for planned and measured dose files, by FilMat and the commercial Verisoft®-PTW- were compared.
Results: A set of fitting functions were implemented. An interesting feature is the option of generating a
calibration curve combining two different methods (Samuel Peet, 2016) depending on dose level. Thus, for
measurements under dose gradients, uncertainties in the low-dose region are diminished. It also comprises
advanced tools such as a multichannel method (fundamentally superior to the traditional single channel
method) to convert film images to dose maps. Performance test of FilMat with Verisoft® revealed small
differences between the numbers of points passing the criteria (1.6%) with both systems.
Conclusion: An open-source and user-friendly software has been created for efficient analysis of
radiochromic films. Advanced tools such as an optimized calibration and multichannel conversion methods
should ease academic and research work.
BSN is in debt to Conicyt (Fondecyt N1181133).

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O-234

CHARACTERIZATION OF THYROID DOSE IN STANDARD MAMMOGRAPHY

STUDIES IN THE HOSPITAL CLÍNICO UNIVERSIDAD DE CHILE

Alejandra Lopez, Daniel Castro, Leslie Muñoz, Javier Ortiz, Cristian Garrido

Hospital Clínico Universidad de Chile, Chile

Radiology – Radiation Protection

There is currently controversy over the use of leaded thyroid protector in mammography studies. Their
use is being justified by the increase in thyroid cancer in women and the use of X-rays in these
examinations, generating confusion in patients who attend centers that do not have this device. In the
mammography unit of the del Hospital Clínico Universidad de Chile, the skin dose at the level of the
thyroid gland of 309 patients was measured (mean age: 53,6 ± 8,6 years and mean BMI: 30,1 ± 4,6) that
were performed in 2018 standard mammography studies (4 projections) in a Siemens Mamomat 3000
associated with AGFA CR system, under informed consent and established inclusion criteria. Two TLD
glasses type UD 807 Panasonic located over skin at the level of each thyroid lobe were used and read on a
UD7900-M device of the same brand. The dose in the gland was calculated as one tenth of the dose
measured in skin of each lobe, and finally averaged. Descriptive analysis was carried out with the help of
STATA 12. A skin dose of 0.19 ± 0.15 mGy and 0.20 ± 0.18 mGy was observed in right and left lobe,
respectively. No statistically significant difference was observed between the means of these doses (t=-
0.9669, d.f= 616 con p<0.05). The average dose in gland was 0.198 ± 0.015 mGy, which implies a
extremely low risk of thyroid cancer according with BEIR VII (1.6%/Gy as excess risk in the lifetime),
which would not justify the use of thyroid protector, according with the statement of several international
organizations.

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O-241

DEVELOPMENT OF A DYNAMIC ANTHROPOMORPHIC THORAX PHANTOM

FOR RADIOTHERAPY QUALITY ASSURANCE

Chuan-Dong Wen1,3, Trevor Ackerly2,3, Moshi Geso3

1
INWENTECH, Australia
2
Alfred Radiation Oncology Alfred Health Melbourn, Australia
3
School of Biomed. & Health Sciences RMIT University Melbourne, Australia

Radiation Oncology – Quality Assurance

Introduction
We invented a dynamic anthropomorphic phantom, with expandable chest and deform-able organs in 2014.
It has been developed by Australian institutions after winning the Australasian College of Physical
Scientists and Engineers in Medicine David Robinson Innovation Award 2016 and its intellectual properties
protected globally. This paper describes the development process of the inventive device.

Method
A dynamic phantom capable of simulating patient’s thorax motions inside and on surface is in great need.
Through collaborations between professional designer, artists and clinical institutions with government
financial supports, a dynamic phantom was architecturally designed then prototyped as an
electromechanical, computer-driven and remote-controlled device. Deformable organs included in the
thorax, e.g. heart, lung and diaphragms were digitally modelled and artistically fabricated. Advanced 3D
printing technologies were employed to produce the human-like ribs and heart with great similarity. Series
validations of functions and features of the phantom were conducted on CT and 4DCT in clinical
environment. Of importance, the device has been used to assist new technologies development by a World-
leading manufacturer in Europe.

Results
It is evident that this breathing phantom can simulate patient’s chest motions in details, the skin and breast
are deform-able, the heart and lung behave like human’s movement when simulating both free-breathing
and deep-inhalation breath-hold (DIBH) modes. Built-in fiducial marks and tumors can represent thus
simulate the clinical targets in stereotactic body radiotherapy (SBRT) and DIBH treatment processes, hence
the phantom, can be used as equipment commission and end-to-end (E2E) pre-treatment verification for
SBRT of lung cancer and DIBH of left breast cancer.

Conclusions
A clinical orientated purposely-built dynamic breathing phantom has been invented and is available for
clinical research and training purposes. With continued improvement, this Australian invention will be
commercialized and can benefit many patients in undertaking advanced radiotherapy treatments with higher
standard and complication-less outcomes.

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O-244

SKIN-DOSE MAPPING FOR PATIENTS UNDERGOING INTERVENTIONAL

RADIOLOGY PROCEDURES: CLINICAL EXPERIMENTATIONS VERSUS A DOSE
ARCHIVING AND COMMUNICATION SYSTEM

Aya Al Masri1, Stefaan Carpentier2, Fabrice Leroy2, Thibault Julien1, Fouad Maaloul1
1
BIOMEDIQA Groupe / Department of Medical Physics Villeneuve d'Ascq, France
2
Private Hospital of Louvière / Department of Interventional Radiology / Lille - France

Diagnostic Radiology –Dosimetry

INTRODUCTION: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may
become very high for a burn, necrosis and ulceration to appear. To prevent these deterministic effects,
accurate calculation of the patient skin-dose mapping is essential. We developed a model that reconstructs
the magnitude, shape, and localization of irradation fields on patient's skin. In case of critical dose
exceeding, the system generates alerts. The reconstruction is based on the geometric and dosimetric
information provided by the DICOM files for each acqusition incidence. We present the results of its
comparison with clinical studies.
MATERIALS AND METHODS: Two series of comparison of the skin-dose mapping of our model with
clinical studies were performed. At a first time, clinical tests were performed on patient's phantoms.
Gafchromic films were placed on the table of the IR machine under PMMA plates that simulate the patient.
After irradiation, the film darkening is proportional to the radiation dose received by the patient's back.
After film scanning and analysis, the exact dose value can be obtained at each point of the mapping. Four
experimentation were performed, constituting a total of 34 acquisition incidences including all available
exposure configurations. At a second time, clinical trials were launched on real patients during real 'Chronic
Total Occlusion (CTO)' procedures for a total of 50 cases. Gafchromic films were placed on the back of
the patients. Comparison on the dose values, distribution, and shape of the irradiation fields were
performed.
RESULTS: The comparison between the dose value shows a difference less than 15%. Moreover, the
geometrical accuracy of our software is excellent: all fields have the same shape, size and location
(uncertainty < 5%).
CONCLUSION: This study shows that our software is a reliable tool to warn physicians when a high
radiation dose is reached and then deterministic effects can be avoided.

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O-245

FEASIBILITY OF DEFORMED MR IMAGES IN THE ACCURATE DELINEATION

OF GROSS TUMOUR VOLUME IN LIVER STEREOTACTIC BODY
RADIOTHERAPY.

Subramani Vellaiyan1, Anantharaman A2,3, Shanmugha Subramanian S2, Arun G2

1
All India Institute of Medical Sciences, New Delhi, India
2
Yashodha Hospital Hyderabad and
3
Bharathiar Univerysity, Coimbatore, Tamilnadu

Radiation Oncology –Treatment Planning

Introduction:
Accurate delineation of tumour in SBRT of hepatocellular carcinoma (HCC) is highly necessary because
of high dose per fraction. MR images complement CT in the delineation of gross tumour volume (GTV).
An acceptable matching of MR by rigid registration is difficult due to difference in patient positioning and
breathing levels. In this study, we have attempted to validate and incorporate deformed MR images for
accurate tumour delineation in liver SBRT.
Methods and materials:
Ten patients who had underwent SBRT for HCC and had MRI as part of imaging process were selected
retrospectively. Deep inspiratory breath hold (DIBH) CT was acquired for treatment planning and liver
acquisition volume acquisition (LAVA) MR sequence to aid tumour delineation. MR images were aligned
with CT rigidly (RR) over the region of interest. GTVs were delineated separately on both CT & MRI and
GTVRR was generated by combining CT and rigid MR volumes. In such cases the inherent registration
errors lead to a increased tumour volume. To improve the delineation accuracy, we have tried MR to CT
deformation (DIR). Prior to clinical use, the SmartAdapt system was validated by ImSimQA. MR images
were then deformed to DIBH-CT to obtain GTVDIR. GTVRR was compared against GTVDIR while liver
volumes generated by RR and DIR were compared with CT by conformity index (CI), mean distance to
conformity (MDC) and dice similarity index (DSI) metrics.
Results:
CI of 0.63±0.22, MDC of 2.29±1.21 and DSI of 0.81±0.16 were obtained for GTVRR against GTVDIR.
CI of 0.78±0.06 & 0.69±0.11, MDC of 6.03±2.73 & 8.48±3.49 and DSC of 0.92±0.04 & 0.88±0.06 were
obtained for liver by DIR & RR respectively against CT.
Conclusion:
The SmartAdapt system was validated for MR to CT deformation and accurate & concise contours could
be obtained using deformed MR images thereby reducing normal tissue toxicity.

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O-247

XPEKTRIN, AN EASY TO USE AND HIGHLY DISTRIBUTABLE X-RAY SPECTRA

SIMULATOR IN GENERAL RADIOGRAPHY

Camilo De La Barra Olate1, Marianela Hervias Jara2

1
Centro de Imagenología Hospital Clínico Universidad de Chile, Chile
2
Departamento de Tecnología Médica Facultad de Medicina Universidad de Chile

Dosimetry – Reference quality

A user-friendly application based on Microsoft Excel, Xpektrin, was developed to simulate X-ray spectra
in general radiography using the TASMICS model of Hernandez and Boone.

Using as inputs air kerma (Kair) and Half-value layer (HVL) measurements, Xpektrin allows the calculation
of several radiometric and dosimetric quantities, such as the entrance surface air kerma (Ke) and the skin
dose (Dskin), depending on the exposure factors, filter material type, filter thickness, focus-skin distance
and field size.

Xpektrin was validated against the Matlab toolkit SPEKTR 3.0, using dose and HVL measurements of X-
ray tubes from three different hospitals. It was found good correlation in both applications between the
experimental measurements and the calculated HVL and Kair values with Pearson coefficients R² > 0.99
in all cases. However, experimental and calculated HVL have better agreement with Xpektrin (median
percent difference -0.4%, -0.04% and 0.01%) than SPEKTR 3.0 (median percent difference -1.8%, 2.2%
and -7.09%), particularly for the tube with greater filtration thickness.

Using Xpektrin, Ke was determined for adults in PA chest and AP lumbar standard projections according
to the typical exposure conditions from each hospital. It was found that the calculated Ke values for both
projections (PA chest: 0.19, 0.30, 0.15 mGy and AP lumbar: 5.23, 6.69, 7.63 mGy) are within the dose
reference level range described in the literature (0.14 - 0.3 and 3.8 - 10 mGy, respectively).

Xpektrin may be used in radiology departments to establish local dose reference levels or as part of a
dosimetric record system. In addition, due to its simulator characteristics, it can be useful as a pedagogical
tool. The use of Excel allows Xpektrin to be highly distributable and easy to use, without the need for
programming skills.

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O-248

DEVELOPMENT OF A GANTRY-RESOLVED EPID-BASED FRAME-BY-FRAME

PATIENT-SPECIFIC VMAT QA METHOD

Pedro Cardos1, Qiuwen Wu2, Bin Liang3, Ran Wei3

1
Duke Kunshan University, China
2
Duke University
3
Beihang University

Radiation Oncology – Quality Assurance

Purpose: Develop a gantry-resolved EPID-based method for patient-specific QA using integrated

acquisition in TrueBeam clinical mode, and test it on large VMAT fields.

Methods: We developed a QA method using MATLAB that creates gantry-resolved pseudo-3D dose
distributions from stacked portal images acquired on TrueBeam Linacs using dosimetry (integrated)
acquisition mode. Predicted portal dose distributions were calculated based on MU information contained
in XIM image headers. An independent calibration procedure was established, including a 2D profile
correction map. Gamma index calculations were performed with a two-step calculation procedure that
resamples steep dose gradient regions for improved calculation accuracy. Post-processing was used to
address two acquisition artifacts: header ΔMU variations that do not reflect signal intensity variations, and
banding patterns on acquired frames. Gantry angle accuracy requirement is given by angle-to-agreement
(ATA) criteria. The method’s performance was assessed with gamma analysis (3%/2mm/3˚/10%threshold
criteria) of 35 large VMAT fields using two EPID models and two photon energies.

Results: The improved gamma index calculation increased pass rates by an average of 2.8%, with many
cases displaying increases of 6% to 8%. MU variations were reduced to less than 1% for irradiations with
a constant dose rate, and smoothing effects on variations caused by dose rate changes were small (up to
1.5%). Banding patterns on central portions of the fields were almost eliminated without smoothing field
borders. The resulting average pass rates were 95.4%, 97.8%, 98.6% and 96.2%, and no result was inferior
to 90%. Analysis took around 6 to 8 minutes per field.

Conclusion: Our method presented excellent results for gantry-resolved gamma index analysis of VMAT
fields. The two-step improved gamma calculation greatly improved pass rates and reduced variation in the
results. Processing of acquisition artifacts enabled our method to be used in clinical dosimetry acquisition
mode without the need of external acquisition hardware.

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A STUDY ON VMAT PLAN COMPLEXITY AND PATIENT-SPECIFIC

MEASUREMENT RESULTS

Michael Nguyen1, Gordon Chan2

1
Juravinski Cancer Centre, McMaster University, Canada
2
Juravinski Cancer Centre

Radiation Oncology – Quality Assurance

Introduction
Patient-specific dosimetric measurements are often performed prior to VMAT treatments due to the nature
of the complex delivery. While considerable resources are dedicated to this practice, relatively few
clinically significant errors are captured. In this study, the relationship between plan complexity and
measurements based on Gamma analysis was investigated to determine if there is a significant correlation
between certain plan complexity parameters and Gamma passing rates (GPRs).
Methods and Materials
43 clinical VMAT plans that have been planned in Pinnacle [V9.10] and treated on two Varian TrueBeam
STx linacs were randomly selected retrospectively for this study. Plan complexity metrics such as Monitor
Unit Factor, Plan Aperture Irregularity, Average Field Width (AFW), Modulation Complexity Score and
Small Aperture Score (SAS) were extracted for each plan. Measurements were performed using the IBA
MatriXX array detector in a polystyrene phantom. Comparisons between measured and planned dose
distributions in phantom geometry were evaluated by Gamma analysis. Both measurements and analyses
followed the AAPM Task Group 218 recommendations. Spearman’s Rank correlation coefficient (rho)
was used to assess plan complexity parameters and GPRs.
Results
Of the plan complexity metrics investigated, the two parameters with the most significant correlation with
the Gamma passing rates using the evaluation criteria of 3%/2mm, 10% dose threshold are AFW and SAS
(20mm). AFW has a monotonic increasing relationship with GPR (rho = 0.76, P < 0.001), where SAS
(20mm) has a monotonic decreasing relation with GPR (rho = -0.69, P < 0.001). Threshold values of
approximately 1.5 and 0.74, respectively, were determined to ensure a GPR > 90%.
Conclusions
Plan complexity metrics, AFW and SAS (20mm), were found to correlate significantly with measured
GPRs using 3%/2mm with rho’s = 0.76 and -0.69, respectively. They can be used to reduce the amount of
patient-specific VMAT measurements by determining suitable threshold values.

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O-259

PERFORMANCE STUDIES OF LGAD SILICON DETECTORS FOR APPLICATIONS

IN CHARGED PARTICLE THERAPY

Vincenzo Monaco, Omar Hammad Ali, Roberto Sacchi, Zahra Shakarami, Anna Vignati

Istituto Nazionale di Fisica Nucleare (INFN Torino), Universita' degli Studi di Torino, Italy

Radiation Oncology – Dosimetry

Introduction
Silicon sensors based on the Low Gain Avalanche Diode (LGAD) technology, characterized by enhanced
signals and excellent time resolution, are investigated as a possible alternative to overcome speed and
sensitivity limitations of the gas detectors currently used for beam monitoring in charged particle therapy.

Methods and Materials.

Two prototypes of beam monitoring devices with dedicated LGAD strip structures produced by FBK
(Trento, Italy) are under development. One device will be used to identify single beam particles and count
their number up to high rates. A custom electronic VLSI chip was produced for its readout, employing the
enhanced signals of LGAD detectors for fast operation (>100 MHz/channel) and high efficiency. A second
device takes advantage of the LGAD high time resolution (~35 ps in 50 μm) to measure the beam energy
from the time of flight of protons in a telescope of two thin strip sensors.

Results
The detectors developed for the two applications were tested with proton beams at CNAO (Pavia, Italy)
and at the Trento proton therapy facility (Italy). Their counting capability was assessed and their
performance characterized in terms of radiation resistance, response linearity and reproducibility. With the
current strip structure, the counting inefficiency is < 1 % up to 108 p/cm^2. Dedicated pile-up mitigation
algorithms were studied and implemented to increase the maximum counting rate. Timing measurements
from a telescope of two strip sensors provide an energy resolutions of 1 MeV at 227 MeV.

Conclusions
The encouraging results suggest to continue the investigation of LGAD technology for future clinical
applications, where the high sensitivity and fast response time of silicon sensors will be useful for beam
monitoring in high speed or low dose delivery schemes. Future prospective of developments of LGAD
detectors for imaging applications in charged particle therapy applications will also be discussed.

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O-261

THE FUTURE OF MEDICAL PHYSICS: A CASE STUDY OF ZAMBIA

Kangwa Alex Nkonde1, Mwansa Kawesha2, Kabuswa Davy Manyika3, Barbara Chanda M’Ule4, Mwape
Mofya4,5
1
Mulungushi University, Zambia
2
Cancer Diseases Hospital
3
Mulungushi University
4
Cancer Diseases Hospital
5
University of Trieste

Education and Professional Issues

The last few decades have seen tremendous growth in the health sector in Zambia. At the beginning of the
21st century, policies were developed and resources allocated, leading to the establishment of the first
radiation Centre in the country; Cancer Diseases Hospital (CDH). Among the key personnel needed to run
this kind of specialized hospital are medical physicists (MPs). As of January 2019, the country had less
than five medical physicists on the Health Professions Council of Zambia (HPCZ) register.
In 2018, CDH had recorded about 2500 new cancer cases corresponding to a 25% increase from the past
years. In order to accommodate this rise in patient load, two radiotherapy centres and smaller satellite
radiotherapy departments, attached to the Central hospitals, are envisioned. Furthermore, a planned Centre
for Nuclear Science and Technology (CNST), hosting Radiotherapy and Nuclear Medicine facilities. These
increase therefore, necessitates the procurement of more diagnostic and therapeutic equipment.
Subsequently, requiring a substantial number of MPs commensurate with the International Atomic Energy
Agency (IAEA) staffing recommendation.
Growth of Medical physics in Latin America, North America, Europe, Asia, Australia and Africa was
looked at and a comparison to Zambia undertaken. The IAEA tool was used to estimate the recommended
staffing requirements of MPs and a comparison with the prevailing situation done from 2006 to 2019.
Future projections and trends were also analysed to offer a much clearer perspective.
Results showed that the current growth in MPs is below the recommended threshold, the future trends are
also indicative of a deficit which will likely not be met in the next 10 years. The following conclusions
were made; the need to develop local curricula, improve enumerations and career prospects.

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O-265

AN INNOVATIVE SYSTEM FOR PREVENTING RADIOLOGICAL RISK FOR STAFF

IN THE OPERATING THEATER

Kamel Guerchouche1, Aya Al Masri1,2, Stéphanie Battini1, Fouad Maaloul1

1
BIOMEDIQA Groupe / Villeneuve d'Ascq - France
2
Polytechnic School / Villeneuve d'Ascq - France

Radiation Protection

Introduction: Interventional procedures are performed in the operating theater under X-ray guidance. The
international radiation protection organizations, recommands that access to a room containing X-ray
facilities must include signage to prevent unnecessary exposure.
Materials and methods: We developed an innovative solution, named “DOSALERT”, that responds to all
related challenges.
DOSALERT consists of two boxes that interact with each other by radiofrequency. The first box
“Detectbox” is placed in the intervention room and plugged in the amplifier, it can detect the energy levels
of the image intensifier. The second box or “AlertBox” is placed outside the room, above the block room
for example. It informs about the danger of exposure thanks to a luminous signage. DOSALERT answers
to 3-exposure scenarios: (1)if the image intensifier is powered-on and emits X-rays, the Detectbox detects
the X-ray emission and informs the staff outside the room about the existing danger tharough a flashing red
light emitted by the Alertbox. (2)The intensifier is powered on but it does not emit X-rays, so the signaling
is flashing orange and the nurse outside the room can enter, knowing that the amp is powered. (3)the
amplifier is not powered-on, so the signaling is flashing yellow: the operation is complete and the cleaning
team can perform its role.
Results: The detection rate is 100%: DOSALERT detects the slightest shot. The probability of false alarm
is less than 10exp-5: the risk of a false alarm is very low. It detects low energy emissions (low voltages :
70 - 150 Kvp). Tests show that it detects low photon rates (amperages between 2 and 10 mA). Finally, shots
made in pulsed and continuous transmission modes are also detected, as well as image and visualisation
mode. Tested on all amp brands such as siemens GE philips ....
Conculsion: Our system is a reliable tool.

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O-266

QUANTIFICATION OF RADIODERMATITIS THROUGH IMAGE PROCESSING: A

FEASIBILITY STUDY

Ignacio Verdugo Naranjo, Juliana Fernandes Pavoni, George Cunha Cardoso

University of São Paulo, Brazil

Radiation Oncology – Treatment Delivery

Radiodermatitis rating is currently done qualitatively using the "RTOG Scoring Schema." At present, there
is no quantitative method to assess the degree of injury that is affecting the skin throughout Breast Cancer
radiotherapy used in the clinical setting. This study proposes a novel method using digital, polarized light
images to evaluate erythema. Breast cancer patients were randomly chosen with different skin colour, tumor
types, treatment type, and were followed up throughout their treatments. Circularly polarized light digital
images of the patients were taken along the treatment. For each day, pictures were taken in different
positions in different setups. Image registration between images of different days, for the same patients,
was done using anatomical regions, skins marks, and tattoos in the border of the treatment field. The ROIs
chosen for RGB color-space analysis were the ones that reached at least grade 1 during treatment. Each
erythema was independently evaluated by physicians using the RTOG schema so that it could test and
validate the image method under development. Different groups were analysed: white , brown skin, and
dark skin. All three groups included hypofractionated vs. conventional treatment. It was verified that the
RGB normalized intensities decrease as the radiodermatitis grade increases and that brown skin presents a
more pronounced decrease. The most sensitive channel to radiodermatitis grade was the green one. The
most statistically significant sensitivity in the image method was found in the differentiation between
radiodermatitis grade 0 and 1 for the white and brown skin patients. The present study demonstrated a novel
approach to evaluate radiodermatitis quantitatively. Despite similar past attempts in the literature, they all
lack in the number of patients and the diversity of patients. This work presented a simple methodology that
has to be further developed as an objective radiodermatitis quantification methodology to help the physician
practice.

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O-269

VALIDATION OF THE ELECTRON MONTE CARLO ALGORITHM

Andrea Paola Rodriguez, Federico Bregains, Nicolas Larragueta, Georgina Lopez

CEMENER, Colombia

Radiation Oncology – Dosimetry

The present work evaluated the electron Monte Carlo algorithm (eMC) available in Varian EclipseTM
planning system for the use of electron beams. This study was done in order to define the best calculation
options with which clinical test should be performed in the planning system.

The evaluation was carried out in two stages, first evaluating the algorithm in homogeneous medium and
second in heterogeneous medium. The tests were performed for 4 electron energies 6, 9, 12 y 15MeV. The
influence of varying parameters such as calculation grid, uncertainty, type and level of smoothing was
analyzed.

The test in homogeneous medium were made with extended SSD, oblique incidence, shaped fields,
irregular surfaces with a water phantom; In heterogeneous medium, solid water sheets and various materials
such as cork, air, PMMA were used, simulating different regions of the body.

In each of the scenarios, PDDs, dose profiles and planes were measured. To perform these measurements,
3D-SCANNER automatic scan phantom, microDiamond detector and 2D-array of MapCHECK2 diodes
were used.

Applying the gamma evaluation criteria, it was observed that in homogeneous medium the algorithm
satisfies the criterion 3%3mm in more than 95% of the points analyzed and for heterogeneous medium the
same agreement was obtained, but being more flexible in the comparison criterion.

Once these tests were realized was possible to conclude that when using a calculation grid of 2mm,
uncertainty of 2% and Gaussian-smoothing medium-level, results obtained are clinically acceptable both
in calculation time and in dose precision.

With the tests carried out, it was concluded that the eMC is suitable for use in the clinical setting, simulating
in an appropriate way the dose distribution in basic and complex configurations. However, it is
recommended to be cautious in its implementation with low energies, because still presents differences
between the measured and the calculated.

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O-277

PEDIATRIC PROTOCOL OPTIMIZATION FOR CHEST CT SCANS IN THREE

RADIOLOGICAL SERVICES

Marcel Frederico1,2, Pablo Gigirey2, Yolma Banguero1, Hugo Cerecetto1, Arnaldo Prata Mourao3
1
Centro de Investigaciones Nucleares Universidad de la República, Uruguay
2
Hospital Pereira Rossell
3
Centro de Engenharia Biomédica CEFET MG Belo Horizonte Brasil

Diagnostic Radiology –Dosimetry

Introduction
Radiological exams are increasingly used in the clinic for diagnostic analysis of different types of
pathologies. In particular, the number of Computed Tomography (CT) studies has grown exponentially in
the last decades, especially pediatric ones. In addition, the risks of exposure to ionizing radiation are higher
in children. The above implies the necessity to optimize the protocols used in this technique, especially for
pediatric patients.

Methods and Materials

From the variation of the tension, tube current and beam thickness, regarding on the pitch factor, optimized
protocols have been suggested to reduce the dose and improve image quality for two years old patients in
three radiological services. All the tests were performed using a PMMA phantom designed to represent the
thorax of a patient with these characteristics. For optimization, the percentage noise index has been kept
below 1%.

Results
Three optimized protocols have been obtained for tomograph 1, three for tomograph 2 and two for
tomograph 3. Except for two of them, protocols suggested have been reduced the doses with respect to the
pediatric protocols used in the services. CTDIvol values have been found between 2.42 mGy and 9.84
mGy. Also, all of them produced an acceptable diagnostic image quality.

Conclusions
The protocols presented will optimize the acquisitions of images for each of these technologies. They
cannot be applied directly to another technology and guarantee the same optimization result. If this were
done, the dosimetric response - image quality would be different.
Parameters proposed for each protocol should be modified depending on the patient in question; protocols
using modulated current can be an option to achieve these objectives.
For pediatric acquisitions of children of 2 years old, voltages below 120 kV are the most recommended. In
case of existing voltages 100 kV and 80 kV, these are the most recommendable.

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O-281

IMPLEMENTATION OF QUALITY ASSURANCE PROGRAM IN RADIODIAGNOSIS

María Sol Gallo, Joaquín Santiago De Brida, Eliana Quinteros, Ezequiel Larger, Ricardo Ruggeri

Fundación Médica de Rio Negro y Neuquén, Argentina

Diagnostic Radiology –Dosimetry

INTRODUCTION
The aim of a quality assurance program is to ensure that the images have an optimal diagnostic quality with
minimal exposure of the patient to the radiation source. It is the basis for the development of an independent
quality system, without the need of selftests provided by the manufacturers, and allows not only to
guarantee the safety of patients but also to reduce maintenance costs by administrating corrective tasks in
advance.

METHODS AND MATERIALS

For the implementation of the program, specific equipment from PTW are available and it is divided into
stages: Survey of the department; Constancy tests; Elaboration of the manual of standards; paper less
quality assurance and implementation of dose chart.
It involves the departments of Computed Tomography, Mammography, Continuous RX, Densitometry,
Orthopantomography, and Conventional Radiology. In each of them, the corresponding protocol or
international quality guideline is applied, such as the Spanish Protocol for Quality Control in
Radiodiagnosis.

CONCLUSIONS
The main challenge of the implementation of the program was the change in the quality culture at all levels
at the institution.
Up to now, the implementation has been completed in the department of Computed Tomography, in which
it was observed that the acquisition protocols had not been optimized since the commissioning. In this
instance, the goal of optimizing clinical protocols for an average patient was fulfilled, which implies in all
cases that the voltage used does not exceed 110 kV since above this value the doses received by the patients
is up to 10 times greater than for smaller voltages without a decisive improvement in the image quality.
After this stage, we are in a position to begin the study of our population for the determination of dose
reference levels.

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RADIATION DOSE FOR PEDIATRIC CT: 4 YEARS OF IMPROVEMENT

Jose Agustín Daza, Gustavo Triana, Javier Romero, Sergio Valencia

Fundación Santa Fe de Bogotá, Colombia

Diagnostic Radiology –Dosimetry

Introduction:
Since the radiation dose indexes became available, quality programs begin to reduce the radiation dose
given to the patients. In pediatric imaging registry, follow-up, and reduction of radiation dose index is one
of the main concerns in all radiology departments, due to the possibles long-term consequences. The
purpose of this study is to show the improvement in the reduction of radiation dose index for pediatric CT
in a 4 year period at a third level academical institution.

Methods and Materials

A cross-sectional study was made between 2015 and 2018 in the Fundación Santa Fe de Bogotá hospital in
Bogotá, Colombia. Random data by year from radiation dose indexes ( CTDIvol and DLP) from a brain
and abdominal CTs in patients under 17 years old were collected. For data analysis, effective diameter
groups were made. A univariate and bivariate analysis was made using SPSS version 25.

Results
A total of 910 pediatrics CT were collected, 544 (59.8%) brain CT and 366 (40.2) abdominal CT.
Distribution of the effective diameter groups from brain CT was 0-14cm 33 (6.1%), >14-15.5 cm 132
(24.4%), >15.5-17 cm 109 (20.1%), >17-18 cm 268 (49.4%); for abdominal CT was 0-14.5 cm 12 (3.3%),
>14.5-18 cm 60 (16.4%), >18-22cm 188 (51.4%), >22-25cm 106 (29%). A t student t showed a reduction
of mean CTDIvol and DLP in 2016, with a p-value < 0.001, this reduction was consever in 2017 and 2018.
ANOVA test showed a reduction of the radiation dose index between groups.

Conclusion
There was an evident reduction in the radiation dose index in 2016; this reduction was due to the inclusion
of a quality program for radiation doses in pediatric imaging on our institution. This program is based on
protocols for control and improvement in each procedure. A medical physicist leads the quality program.

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O-298

PSQA IN RADIOSURGERY: EVALUATION OF DETECTORS AND

IMPLEMENTATION

Karen González-Pérez, Tomás Emanuel Spretz, A. Federico Bregains, Joaquín Galvañ, Nicolás Omar
Larragueta

CEMENER, Instituto Balseiro, Argentina

Radiation Oncology – Quality Assurance

Radiosurgery is a radiotherapeutic technique based on the delivery of a single high-dose application to a

small specific volume. Therefore, pre-treatment patient-specific quality assurance (PSQA) is highly
recommended. PSQA verifies the concordance between the treatment generated in the treatment planning
system (TPS) and the one delivered by the linear accelerator, by means of dose comparison. In this work,
four detectors were contrasted: Gafchromic EBT3, ArcCHECK, EPID and SRS MapCHECKTM.
Verification was performed upon three pathologies (meningioma, multiple metastasis and schwannoma),
using three different techniques (VMAT, IMRT and Dyn Arc), employing EclipseTM TPS. Analysis of the
separation of the micro-MLC in each control point was carried out. Evaluation of the different techniques
using each of the detectors was performed with three independents gamma criteria: 1mm/3%, 1mm/5% and
2mm/3%. Results showed that the greater the number of MLC’s leaves with separation less than 0.5 cm,
smaller the number of points that fulfilled the gamma evaluation criterion, especially for complex
techniques such as VMAT, where the deviation showed a maximum. As a conclusion, it was determined
that 1mm/3% with 95% of approval and 2mm/3% with 97% of approval were the best options for PSQA
in radiosurgery in CEMENER. The optimal detector to be used is SRS MapCheckTM, since measurements
were made in dose units and ready-to-use, it evaluated gantry and collimator movements and couch shifts
of up to ±45. In addition, measurements could be directly compared with the ones taken with Gafchromic
EBT3 films finding a very good agreement. Also, it was suggested VMAT treatments should be executed
using field sizes greater than 0.5 cm.

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O-302

APPLYING THE NEWS ANALYSING CRITERIA FOR IMRT TREATMENT PLAN

VERIFICATION

Camilo Beltran1, Fabian Erazo2, Boris Martínez1

1
PTW Latin America, Brazil
2
Sociedad de Lucha Contra el Cancer, Núcleo Cuenca

Radiation Oncology – Quality Assurance

Treatment verification for IMRT techniques play an important role to evaluate differences between planned
and delivered doses, in clinical practice, those differences are predominantly assessed implementing the
gamma-index method. Tolerances and acceptance criteria are neither well defined nor consistently applied
across centers.
Several reports discuss the patient specific IMRT QA due to poor sensitivity and specificity of the gamma
method. In recent years, in combination with the development of devices for measuring dose distributions,
novel metrics for the gamma-index calculation are being implemented in clinical routine. For the gamma-
index evaluation, the pass/fail criteria must be defined based on the follow calculations parameters: Dose
Difference DD (%), Distance to Agreement DTA (mm), dose normalization value (local or global),
increased tolerances and suppressing doses. In this work gamma-index 3D (3mm/3% criteria) and volume
analysis, are studied to evaluate 15 Head & Neck (H&N) and 15 prostate plans, calculated with an Eclipse
TPS, and delivered with a TrueBeam LINAC (Varian M.S). Quality control plans were measured with the
Octavius4D 1500 system (PTW, Freiburg-Germany).
As analysis parameters affect the gamma results in all the associated anatomical regions, we have evaluated
the practical relevance and clinical impact of rejected points.
The mean of points passing the initial acceptance criteria is better than 98.2% for H&N and 98% for
prostate, 96.9% for H&N volume analyses and 91.7% for prostate cases.
Thereafter we have investigated variations on dose normalization criteria in combination with low dose
region tolerances and the resolution of calculation grid and their impact on the gamma histogram. From our
study, we can suggest that it is important to establish acceptance criteria depending on the anatomical region
in the pursuit of making decisions to improve the IMRT QA acceptance analyses.

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O-303

CLINICAL IMPLEMENTATION OF IGRT: PROTOCOLS AND ASSOCIATED

DOSES

Eddie Palacios, Georgina López, Joaquín Galvañ, Nicolás Larragueta, Federico Bregains

Instituto Balseiro, Cemener, Argentina

Radiation Oncology – Dosimetry

IGRT provides an efficient way of delimitation, planning and positioning the patient. However, we must
consider the cost-benefit relationship and the ALARA philosophy in case ionizing radiation in medical
imaging is required. Although the doses delivered are smaller than those for therapy, radiosensitive organs
and large portions of the body are irradiated. The IGRT protocols provide a safe way to achieve high
accuracy in the treatment, reducing geometric variations, and provides an evaluation of appropriated CTV-
PTV margins extension. Therefore, we sought to obtain specific IGRT protocols and establishing reference
levels for IGRT exposures.
A retrospective analysis was performed on a 37 prostate cancer (PCa) patients and 31 head and neck (H&N)
patients. We proposed IGRT positioning protocols for PCa and H&N patients. Such strategy consisted of
averaging the positions of the treatment couch in the first sessions and taking images scheduled in
subsequent sessions. Additionally, we measured and compared the associated doses with the acquisition of
planar and CBCT (CBDIw method) images; PTW solutions for low energy x-ray were required for such
purpose: the Nomex system and the CTDI phantoms. We calculated the effective doses using the wT factors
suggested by the ICRP and by Hyer et al.
We have implemented two protocols for H&N, when the tumor had had variation and when it was required
to irradiate a surgical bed; the effective doses imparted by were 0.90 mSv and 0.43 mSv, respectively. The
effective dose for PCa patients was 48.90 mSv. Couch displacements were restricted to 3mm and 5mm and
used as action levels. Finally, we suggested new CTV-PTV margins, which represented a reduction of 1 –
2mm, according to Van Herk Formula.
Early results have suggested a reduction of CTV-PTV margins. However, these margins are still being
evaluated as more data are collected.

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O-310

ACTUAL DOSE DELIVERED AND PATIENT-REPORTED OUTCOMES

John Kildea, Haley Patrick, Luis Souhami, Kelly Agnew, Tarek Hijal

McGill University, Canada

Radiation Oncology – Quality Assurance

Background:
It is well established that the radiotherapy dose-volume (DV) parameter and treatment outcomes are related,
both for tumor control and for normal tissue complications. However, the expected DV-outcome
relationship for any given tumor or normal tissue is seldom borne out in clinical practice. We hypothesized
that there are two likely reasons for this: (1) the dose that is planned is not necessarily the dose that is
delivered, and (2) the outcomes that are recorded by physicians are often not fully representative of true
patient experience.

Methods:
With our hypothesis in mind, we built a research program to study (a) actual dose delivered to radiotherapy
patients and (b) capture patient-reported outcomes (PROs).

(a) To measure actual dose delivered, we built a DVH registry and a dose re-calculation pipeline with which
we can calculate daily-delivered dose using daily cone-beam CT (CBCT) scans.

(b) To capture PROs, we built a novel patient portal smartphone app (opalmedapps.com) and integrated it
into our clinic’s waiting room management system. Patients are sent a symptom questionnaire to their
smartphones at the time of check-in asking them validated questions regarding possible treatment-related
symptoms.

Results:
Using a retrospective data set of 20 prostate cancer patients treated with 60 Gy in 20 fractions, we have
demonstrated that daily CBCT dose re-calculation is feasible and we have shown that for some patients the
delivered dose to the rectum is significantly different to the planned dose.

Using a prospective cohort of head and neck cancer patients, we have demonstrated that PRO capture using
a smartphone app at the time of check-in is feasible and acceptable to patients.

Conclusion:
We have demonstrated that it is possible to measure actual dose delivered and to collect PROs, both of
which we believe more accurately reflect the true dose and outcomes of radiotherapy.

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O-312

CRANIOSPINAL IRRADIATION WITH VOLUMETRIC MODULATED ARC

THERAPY: PLANNING METHOD OF THREE-ISOCENTER AND FIELD OVERLAP-
JUNCTION AREA DOSE VERIFICATION

Alan Martínez1,2, Teresa Resquín1, María Palmer3, Gabriel Zelada1, Hernán Barriga1
1
Clínica Alemana de Santiago, Chile
2
Universidad del Desarrollo
3
Universitat de Valencia

Radiation Oncology – Treatment Delivery

Introduction: Craniospinal Irradiation delivered with 3D CRT methods result in the high-dose gradients
between the matched fields have the potential to create unintentional high and/or low doses in the spinal
cord when even a small setup error is introduced. We have developed a VMAT technique with three
isocenters and two overlap-junctions.
Methods and Materials: Three patients were set up in a supine position with thermoplastic facial mask and
body VacLoc bag. Planning CT was performed with 3mm slices. The planning target volume (PTV) was
countered to include the whole contents of the brain and spinal canal with a uniform margin of 5 mm.
VMAT plans generated whit 7 fields. A Elekta Synergy linear accelerator equipped with collimator, 160-
leaf MLC was used to implement the treatment plan using 6MV beams.
The area of overlap-junction was 3 cm. The QA was conducted with a Map Check and Arc Check, the
plans were generated in Monaco TPS . The analysis was performed using SNC Patient software. QA
evaluations were performed using Gamma index (3% in difference dose and 3 mm in distance to
agreement). The gamma index to approve plan must be equal or superior at 95%. In addition were verified
the absolute dose, measured using a pin point ionization camera in a phantom RW3 PMMA, the difference
between points must be less than 3%. In CSI also is very important made the same analysis in an overlap-
junction area.
Results:p= 0.12 (p>0.05) for variation of absolute dose, taking net differences between values without
correction and+/- 5 mm.
p=0.24 (p>0.05) for values of gamma index.
Conclusions: The Craniospinal irradiation with VMAT generate a treatment plan homogeneous and
conformal to PTV, showing that it is less sensitive to possible longitudinal shift in the range of +/- 5mm
that a 3D CRT plan.

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O-313

NEUTRON-INDUCED CARCINOGENIC EFFECTS

John Kildea, Logan Montgomery, Chris Lund, Felix Mathew, Michael Evans

McGill University, Canada

Radiobiology

Background:
Human exposure to neutron irradiation is generally tightly controlled such that the carcinogenic risk to
individuals and populations is very low. Patients undergoing high-energy (>10 MeV) radiation therapy,
however, represent a population group for whom whole-body neutron exposure cannot be controlled. Such
patients are thus at risk for second radiation-induced malignancies. The risk is difficult to calculate for two
reasons. First, the radiobiological effectiveness (RBE) of neutrons is poorly understood and varies as a
function of energy. Second, the measurement of neutron spectra, particularly in the vicinity of high-dose-
rate radiotherapy linear accelerators, is very difficult. With the above in mind, we have built a research
program to (a) better measure neutron spectra and (b) better understand neutron RBE.
Methods:
(a) Using the Nested Neutron Spectrometer (NNS, Detec Inc, Gatineau, Canada) incorporating a He-3
detector in current mode, we have demonstrated that it is possible to quickly (one hour or less) measure a
neutron spectrum in a radiotherapy bunker. (b) Using a combination of Monte Carlo and track structure
modelling (similar to the ANDANTE group), we are attempting to better understand the biophysical basis
of the energy-dependent RBE of neutrons.
Results:
To date, we have conducted neutron spectral measurements around photon, electron and proton beams and
we have put in place a modified Maximum Likelihood Estimation Maximization algorithm to improve the
neutron spectrum unfolding process.
We have developed a Geant4 and Geant4-DNA simulation pipeline to model DNA damage at the
nanodosimetric level and are currently using it to examine DNA damage as a function of neutron energy.
Conclusion:
We have put in place a program to accurately and quickly measure neutron spectra in radiotherapy and to
better understand neutron RBE using Monte Carlo and track structure modelling.

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O-318

PROTECTION OF THE EXPOSED WORKER: EFFICIENCY OF THE LEAD APRON

IN RADIODIAGNOSIS

Alfonso Quintero-Quintero1, Agustín Daza1,2, Sergio Valencia2

1
Universidad Nacional de Colombia, Colombia
2
Hospital Universitario de la Fundación Santa Fe de Bogotá

Radiation Protection

Introduction

The use of radiological protection elements such as lead aprons will always be important for any institution
that uses ionizing radiation. In this work the effectiveness of the use of leaded aprons in a conventional
radiology service, nuclear medicine and PET-CT was studied.

Methods and Materials

Using the NIST database, for three spectrum of radiation sources used in a diagnostic imaging service (RX,
Tc-99m and F-18), the attenuation percentage of a leaded apron was determined. These calculations were
contrasted with Monte Carlo (MC) simulations using the PENELOPE code, for which simplified exposure
conditions were simulated in the three scenarios. The MC calculations allowed to establish the spectrum of
photons that arrive to the user without and with shielding, as well as the percentage of attenuation. Finally,
the calculations were validated with experimental measurements in the simulated configurations.

Results
For Tc-99m and F-18 the experimental, simulated and theoretical data represent high correlation with a
relative error of less than 3.8% respectively, while for experimental versus simulated RX scattering data
the error is 13.8%. From the simulated results we find scattered beam attenuation in: RX 83.2%, Tc-99m
72.26% and PET-CT 7.4% respectively. These results are in agreement with the experimental measures,
with a maximum difference of 5%. The discrepancies are presented in the experimental data with the
theoretical efficiency in RX with a difference of 30.4%.

Conclusions
We must work on the evaluation and validation of the experimental data for the RX spectrum in order to
strengthen the correlation of the data.
The use of the apron in conventional radiology considerably reduces the dose received by users, in nuclear
medicine although the efficiency is so significant is debatable its use in specific tasks, while in PET-CT is
not justified by the low efficiency of the shielding.

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O-319

CONNECTIVITY CONFIGURATION USING GRAPHITE FOR A THREE-

DIMENSIONAL ELECTRONIC DETECTOR ARRAY

José Vidal Valladolid Salazar1, Dante Roa2, Roger Challco Challco1, Andres Gonzales1, Sandra
Guzman1
1
Universidad Nacional de Ingeniería (UNI), Peru
2
Universidad de Irvine - California

Radiation Oncology – Quality Assurance

A high spatial resolution three-dimensional (3D) electronic detector array for intracranial and extracranial
dose verification in radiation therapy is under development. It consists of 31,560 submillimeter size diode
detectors arranged in an isotropic configuration within a semi-spherical volume of 20 cm diameter. Detector
readout is based on an active matrix configuration and a 200 micron thick wire lines will be used to connect
the detectors. Monte Carlo (MC) simulations using Penelope and Peneasy were performed to determine the
dosimetric effects that copper and graphite wires could have on detector readout. The MC simulations
consisted of calculations of percent depth-doses (PDDs) in a 20 x 20 x 20 cm3 water phantom with five
200 micron thick layers at 6, 8, 10, 12, and 14 cm depths and in water only. The MCs used 100 micron bin
size and ran for 1 week per calculation, on average. The PDDcopper showed a 23.5% dose increment due
to backscattering at 0.3 cm before the layer, and 7.2% dose reduction at the layer’s central point, both
compared to PDDwater. The PDDgraphite showed a comparable dose distribution to PDDwater
immediately before a layer and an 8.3% dose reduction at the layer’s central point compared to PDDwater.
Experimental validation of these results are underway, meanwhile, the MC data provides an initial
justification for using graphite as a connectivity material in the 3D detector array. In conclusion, graphite
should reduce perturbations effects during dose measurements, which would limit the use of dose correction
factors in the raw data and increase accuracy. Finally, the high-spatial resolution 3D detector array will an
innovative system for dose verification in radiotherapy. It will have an active matrix detector readout
design, graphite connections and provide measured 3D data, which are features not currently available in
the market.

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O-321

ESTABLISHMENT OF COMPUTED TOMOGRAPHY DIAGNOSTIC REFERENCE

LEVELS IN THE NATIONAL INSTITUTE OF CANCEROLOGY.

Lady Garcia, Victor Ramos

Universidad Nacional de Colombia, Colombia

Radiology – Radiation Protection

The present work aims to implement the reference levels for the practice of Computed Tomography at the
National Cancer Institute (INC). Being the INC a reference entity that works for the control and care of
cancer through research and development of public health actions (REF), it must be the manager of
radiological protection to the patient, in line with international recommendations of organizations working
for radiological protection such as the ICRP and the IAEA. It is intended to perform in the modality of CT,
with respect to its dosimetric magnitudes in pediatric population of 10 years and adult reference person
based on CTDI_vol and DLP dose reports of the patient's images of a specific year approximately 1490
images of the population and specific examinations, with current protocols and evaluate the dose adsorbed
on physical simulators with thermoluminescent dosimetry TLD to evaluate the relevance of the acquisition
techniques currently used in the development of TC practice in the INC. In addition, perform the dose
evaluation and perform dose optimization with an image analysis and physical parameters together with
the clinical evaluation of anthropomorphic physical simulators and evaluation of the quality of the image.

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O-324

DETERMINATION OF REFERENCE LEVELS DOSE INDEX IN COMPUTED

TOMOGRAPHY (CTDIVOL) AND PRODUCT DOSE LENGTH (DLP) IN
EXAMINATIONS OF THORAX, ABDOMEN AND ABDOMEN AND PELVIS AT THE
NATIONAL CANCER INSTITUTE

Lady Garcia, Victor Ramos, Maria Cristina P Plazas

Universidad Nacional de Colombia, Colombia

Radiology – Radiation Protection

Obtaining the reference levels. A sample of the TC conducted in 2016 is reviewed in order to determine the
range of reference levels in adult men, adult women, children aged 8 to 12 years served in the institution in
that period. This consultation will be carried out in the institutional platform, where CTDI and DLP are
reported for chest, abdomen and pelvis images. Approximately the number of TC is 20,000 in the year, so
the review of 1470 reports is expected. Subsequently, the del CTDI measurement was performed on
phantom of TC dosimetry and pencil ionization chamber and the traceability was verified with the
equipment dose report. Radiation dose measurement is carried out with current protocols in the computed
tomography image acquisition in the INC, using Thermoluminescence dosimeters (TDL), distributed
uniformly in specific points of the thorax, abdomen, abdomen and pelvis region. Adult woman, adult man
and thorax region, 10-year-old abdomen on anthropomorphic physical simulator. Finally, the optimization
of acquisition parameters is performed by modifying the tomograph parameters of mAs, Kv and Pitch.
Once the minimum value of mAs is obtained with which diagnostic quality is reached. This quality
assessment is done in conjunction with the radiologist on anthropomorphic physical simulators and the
medical physicist on physical imaging simulators to ensure an adequate diagnostic quality and an
optimization of the institutional dose.
It is important to establish new institutional reference levels after optimization and monitor these values.

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O-326

DESIGN AND FABRICATION OF HUMAN BONE (PELVIS) USING 3D PRINTER

Rana Mitra, Joye Kundu, Rashed Al Amin, Golam Abu Zakaria

Department Of Medical Physics and Biomedical Engineering, Gono Bishwabidyalay (University),Dhaka,

Bangladesh, Bangladesh

Biomedical Engineering

Three-dimensional (3D) printing is an additive manufacturing technique, which allows the fabrication of
patient-specific scaffolds with high structural complexity and design flexibility, and gains growing
attention. Human bone is very essential for medical study and research. However, human bone preservation
is a complex and costly process and the preserved bone erosive with time. This research aims to design and
fabricate human bone (Pelvis) by Poly lactic acid (PLA) material with same geometry and anatomical
structure by 3D printer. The anatomical structure and geometry of Pelvis has been collected from CT data.
The bone was designed by AutoCAD 3D by using CT data. After comparing designed bones with original
bones, designed bones is converted to Stereo-lithographic file by a slicing software (breaks the model
surface in slices) and then fabricated by a 3D printer. However, the fabricated bones is exactly similar to
the real bones with same anatomical structure and geometry. 3D printed human bones is cheap, long lasting
and environmentally safe. This 3D printed bones enhance the medical study and research by its degrading
behavior.

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O-330

TOLERANCE DOSE OF NORMAL TISSUE TO NONCONVENTIONAL SCHEDULED

RADIOTHERAPY

Hussain Albarakaty, Ashwaq AldogmahHussain Albarakaty

King Abdulaziz University, Saudi Arabia

Radiation Oncology – Treatment Delivery

The use of hypofractionation and dose escalation has been increased recently, because they show high local
control rate. Despite that, the tolerance dose (TD) of normal tissue has not been sufficiently investigated
beyond the conventional schedules. We aim to set TD independent of prescription dose and for any number
of fractions (N). We used radiobiological modelling to extend Quantec TD, which is widely accepted for
conventional treatment, for nonconventional schedules. We apply the model for lung but can be applied to
any organ.
Quantec model is limited for a prescription dose of ≤60 Gy and 30 fractions. To extend it for prescription
doses ≥60 Gy, we translate the perception dose condition to an additional volume dose restriction, which is
that the tolerated volume at 60 Gy is close to zero (V60 ≤0.5). So, the TD can be considered to be
independent of the prescription dose. Then, we scale up the normal lung DVH for a random sample of 24
NSCLC until the NTCP reaches 20%. We release the restriction on V60 but to compensate that we increase
the restriction on the V20. The average V20, V60, mean dose (Dmean) are taken to be the TD for normal
lung. To extend Quantec TD for any N, Wither formula (WIF) was used to find the equivalent dose for 15,
20, 60 Gy and the volume restrictions are kept the same.
The new dose volume restrictions were found to be V20≤ 16%, V60≤ 7%, V250 ≤ 0.5% and the Dmean
≤15.6 Gy. We verify that NTCP ≤ 20 %, when these conditions are imposed. From these conditions, the
tolerance dose at any N were derived to be VEQ20≤ 16%, VEQ60≤ 7% , VEQ250 ≤ 0.5% and the Dmean
≤ EQ15.6 Gy, where the equivalent dose was calculated using WIF at N.

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O-331

PRELIMINARY ASSESSMENT OF INTER- AND INTRA-OPERATOR VARIABILITY

OF QUANTITATIVE ULTRASOUND PARAMETERS USED IN BREAST CANCER
DIAGNOSIS

Laura Castañeda-Martinez1, Jorge Patricio Castillo-López2, Héctor Galván-Espinosa2, Yolanda

Villaseñor-Navarro2, Ivan Miguel Rosado-Mendez1
1
Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico, Mexico
2
Instituto Nacional de Cancerología, Mexico City, Mexico

Non-ionizing applications

Introduction: Ultrasound Radiomics is being investigated for breast cancer diagnosis and prognosis. It is
based on the extraction of highly reproducible quantitative biomarkers from ultrasound images to build
large data bases to be used in clinical decision tools. Previous studies have focused on describing the lesion
margin due to its high positive predictive value for malignancy. Here we present a preliminary comparison
of the inter-operator (InterOP) and intra-operator (IntraOp) variability of parameters describing the lesion
margin and Quantitative Ultrasound (QUS) parameter describing echo amplitude statistics.
Methods: 10 patients with suspicious breast lesions were enrolled in our protocol. Acquisition of
radiofrequency (RF) echo signals from each patient was performed by three radiologists using a linear array
transducer on a research-enabled Siemens ultrasound system. Each radiologist performed three
acquisitions, allowing patient repositioning between acquisitions. B-mode and QUS images based on the
Nakagami M parameter (related to echogenicity) were reconstructed from RF data. InterOP and IntraOp
were compared between the lesion margin (manually drawn) and the mean value of M within the lesion.
Discrepancy of lesion boundary and M were quantified as the fractional discrepancy between lesion areas
(FMargin) and mean M values (FQUS) from a pair of images over their mean. Statistical significance
between IntraOp (among acquisitions) and InterOp (among radiologists) discrepancies was assessed with
a Wilcoxon rank sum test.
Results: All lesions were biopsy-confirmed to be invasive ductal carcinoma. Median [95% Confidence
Interval] of FMargin was 27.1 [26.3-27.8]% for IntraOp and 30.6 [30.0-31.1]% for InterOp, with p<0.0001.
In the case of FM, IntraOp and InterOp were 15.5 [14.7-16.4]% and 16.5 [15.9-17.1]%, respectively, with
p<0.01.
Conclusion: Our results indicate that the InterOp and IntraOp variability of the Nakagami M parameter
was less than half the variability of the B-mode contour, suggesting QUS analysis might be more
reproducible than B-mode margin parameters.

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O-332

EVALUATION OF INTER-/INTRA-FRACTIONAL POSITIONAL ERROR USING 3D

PATIENT SURFACE GUIDANCE IN DEEP BREATH-HOLD LEFT BREAST
IRRADIATION.

Naoki Hayashi1, Tatsunori Saito2, Hiroshi Amma2, Masashi Nozue2

1
Fujita Health University, Japan
2
Seirei Hamamatsu General Hospital

Radiation Oncology – Treatment Delivery

【Purpose】
In recent years, radiotherapy with deep breath-hold technique is widely used to reduce radiation dose to the
heart. We use a 3D patient surface guidance to ensure the state of deep breath-hold and the reproducibility
of posture. In this study, we evaluated Inter- and Intra-fractional variation of deep breath-hold left breast
irradiation.
【Method】
Fourteen patients with left breast cancer who had breast irradiation using surface guidance system
(VOXELAN HEV-600 M / RMS Ver. 1.0.5 (manufactured by ERD) were analyzed (age: 39-49 y.o.,
median 45 y.o.). From the electrical portal imaging device (EPID) image obtained during treatment, the
distance between the irradiation field edge and the breast skin surface was measured at three points in the
upper, middle and lower regions. The inter-fractional variation for 14 fractions was calculated by finding
the error of the distance of three ROIs in the first irradiation and 2nd ~ 15th fractions respectively.
Correlation between EPID and VOXELAN was compared in phantom exams and patient data.
【Result】
Inter-fractional variation was 3.1% for differences of 4 mm or more, 9.2% for differences of 3 mm or more,
25.9% for differences of 2 mm or more. Intra-fractional variation was 0.7% for differences of 3 mm or
more, 5.2% for differences of 2 mm or more. The difference was smaller than 99% or more than 3 mm. In
Phantom, the correlation coefficient was 0.99, and a significant positive correlation was confirmed. The
correlation coefficient for each patient was between 0.62 and 0.99, the average value was 0.79, the P value
was 0.031 or less in all cases, and a significant positive correlation was confirmed.
【Conclusion】
The obtained values by VOXELAN and EPID were satisfactory matched. Observing patient body surface
with VOXELAN is useful to maintain the reproducibility of breath-hold without radiation exposure.

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O-337

DOSIMETRIC ANALISIS IN PEDIATRIC CATHETERISM

Victor Bourel1, Patricia Maggiorano1, Jose Luis Alfonso2, Alberto Sciegata2, Gabriel Monticeli2
1
Favaloro University, Argentina
2
Prof. Dr. Juan P. Garrahan Hospital

Diagnostic Radiology –Dosimetry

Background:
The amount of fluoroscopic procedures and studies has been significantly increased during the last decades
and its more frequent application to pediatric patients make dosimetry a concern. The objective is to
measure the skin dose in hemodynamic procedures in pediatry and observe the relation between these
readings and the calculated values in the console dose report.

Evaluation:
The C-Arm is a Philips Allura Clarity FD10. The dosimeters are nanoDots (Landauer) with OSL technology
and Al2O3 as its active material. To analyze the measured dose we use a MicroStar reader.
The nanoDot is applied with adhesive tape to the patients in the highest assumed dose spot.
Once the procedure is completed the skin dose in the nanoDot is read within 24 hours.
These dose values are then related to the air kerma (KA) and product dose-area product (DAP) estimation
made by the equipment software.
For the evaluation the weight ranges recommended by the ICRP are taken into account.

Discussion:
100 children were studied, aged 3 days to 18 years and weighing between 3,1 kg and 75 kg. The readings
resulted between 1,02 mGy and 89,29 mGy. The total kerma and PDA reported by the software ranged
from 9,19 mGy to 547 mGy and 760 mGycm2 to 35411 mGycm2 respectively. A linear tendency was
observed between the nanoDot readings and the air kerma (R2=0,804, R=0,897).

Conclusions:
The measured dose was inferior to the KA calculated by the C-Arm’s Software and to the adult size
reference levels for fluoroscopy.
NanoDot dosimeters are a useful tool for the direct measurement of skin dose in pediatric fluoroscopy.

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O-344

OBSTACLES IN IMPLEMENTING ADVANCED RADIOTHERAPY AS REVEALED

THROUGH IROC'S END-TO-END PHANTOM PROGRAM

Stephen Kry, Mallory Glenn, Sharbacha Edward, Hunter Mehrens, David Followill

MD Anderson Cancer Center, USA

Radiation Oncology – Quality Assurance

Introduction: The Imaging and Radiation Oncology Core (IROC) provides end-to-end phantoms to
institutions world-wide for clinical trial credentialing. These phantoms are treated like a patient by the
institution, and the planned versus delivered dose distributions are compared in different phantoms for
advanced radiotherapy including IMRT, moving target, SBRT, and SRS.
Methods: Phantom results from 2012-present were evaluated to understand the performance of institutions
in delivering advanced radiotherapy. The rate at which acceptable deliveries were achieved was quantified
for the established criteria of 5-7% point dose disagreement and 5%/3mm to 7%/4mm gamma analysis
(varies by phantom). For those cases that failed to meet criteria, the patterns of failure were qualitatively
examined and categorized, including missing the target, systematic dose errors, etc. Finally, for cases with
dose errors, we developed and performed independent recalculations to understand the nature of these
errors.
Results: More than 2000 phantom irradiation results were evaluated. Pass rates were only: 90% for IMRT,
87% for moving lung, 82% for SBRT, and 84% for SRS. For highly modulated treatments (IMRT and
SBRT), failures were primarily because of systematic dose errors: the correct dose distribution was given
to the correct location, but the dose was incorrect (69% of IMRT failures and 56% of SBRT failures). For
the low-modulation moving lung treatments, only 22% showed systematic dose errors, whereas 50% of
failing irradiations missed the target in the direction of motion. The SRS phantom showed a mixture of
dosimetric errors and localization errors. Dosimetric errors in modulated treatments were found to have
suboptimal treatment planning system calculations, implicating weaknesses in beam modeling.
Conclusions: Different advanced radiotherapy techniques are associated with different primary failure
modes. This work highlights several of those failure modes, and provides a cautionary tale in particular
about the challenges of beam modelling for modulated radiotherapy.

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O-345

DOSIMETRIC EVALUATION OF CARDIAC SUBSTRUCTURES ON LEFT BREAST

CANCER RADIOTHERAPY: IMPACT OF DOSE CALCULATION ALGORITHM
AND TREATMENT TECHNIQUE

Carolin Rippke1, Paola Caprile2, Tomás Merino3,4, Elias Torres3, Araceli Gago2,5
1
Physics Faculty, Heidelberg University, Heidelberg, Germany
2
Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
3
Red de Salud Christus-UC; Santiago, Chile
4
Facultad de Medicina, Pontificia Universidad Católica de Chile
5
Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain

Radiation Oncology – Dosimetry

Introduction: This study evaluates the dosimetric impact of respiratory movement, treatment techniques
and dose calculation algorithms, to the dose to the heart and cardiac substructures during radiotherapy.
Methods and Materials: Dose metrics were evaluated for a cohort of 10 patients treated with a field in field
technique. Plans were calculated on a random respiratory phase CT (RPCT) using a pencil beam (PB)
algorithm, and then recalculated on a 4DCT of the patient. For these patients 4DCT optimized and deep
inspiration breath hold (DIBH) plans were evaluated. The impact of dose calculation algorithms was also
analyzed for PB, collapsed cone (CC) and Monte Carlo (MC). Additionally, an in house developed
respiratory phantom with TLDs was used to complement the dosimetric study. The impact of the calculated
dose variations was assessed using a linear estimation of relative ischemic disease risk. Results: The left
ventricle (LV) was the substructure receiving the highest mean dose, on average 61±21% larger than the
mean heart dose (MHD), calculated on the RPCT. Due to the respiratory motion, MHD was underestimated
by a 26.7±8.1%. Regarding the treatment technique, by implementing DIBH, MHD and LV dose reductions
of about 40% and 50% were achieved, respectively. For the 4DCT optimized plans, MHD and LV doses
were also reduced, but to a lesser extent. For the phantom, it was shown that all algorithms underestimated
the out of field cardiac dose. For the PB implementation the discrepancy between TLDs and calculated
point doses reached a 60%. In terms of ischemic disease risk, considering movement increased the relative
risk in about 20% with respect to conventional planning, while DIBH plans reduced this risk in about 30%.
Conclusion: Our findings motivate the implementation of heart protecting measures and promote a more
accurate determination of the dose to the heart and its substructures.

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O-346

SIMULATION OF TUMOR RESPONSE TO RADIATION CONSIDERING HYPOXIA

INDUCED DEATH DUE TO VASCULAR DAMAGE ON 3D VASCULAR
ARCHITECTURES

María Araceli Gago-Arias1,2, Juan Antonio Paredes1, Ignacio Espinoza1, Juan Pardo-Montero2,3, Pedro
Rodríguez-Barbeito2,4, Pablo Díaz-Botana2,5
1
Instituto de Fisica, Pontificia Universidad Católica de Chile, Santiago, Chile
2
Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
3
Departmento de Radioterapia, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.
4
Departamento de Matemática Aplicada, Universidade de Santiago de Compostela, Spain
5
Centro de supercomputación de Galicia (CESGA), Santiago de Compostela, Spain.

Radiobiology

Introduction:
High radiation doses (> 8–10 Gy) induce a vascular damage that has been suggested to be one of the possible
causes for the increased response of tumors to hypofractionated radiotherapy. The hypothesis is that
vascular damage would produce reduced blood perfusion and indirect tumor cell death due to severe
hypoxia. The purpose of this work is to develop a model of vascular damage considering realistic 3D
vascular architectures (VA) to assess the possible role of vascular damage after high dose radiotherapy.
Material and Methods:
Tree-like tumor VAs of 1 mm^3 with 4% vascular fraction are generated and the diffusion-consumption
equation is solved to calculate oxygen distributions. Vascular segments are deactivated using a serial-
parallel model considering published endothelial radiosensitivity parameters. Vascular damage produces
tumor oxygenation decrease and cells entering a severe hypoxia status die according to a hypoxia-death
model based on experimental results. The OER modified LQ model is used to calculate RT surviving
fractions (SF). The impact of these mechanisms on tumor response is studied at different dose levels,
analyzing the effect of hierarchy in the tumor vasculature.
Results and Conclusions:
Radiosensitivity and hypoxia-death parameter values were adjusted in a model without hierarchical death
to reproduce SFs observed on FSaII fibrosarcomas in mice irradiated from 10 to 30 Gy (Song et al. Int J
Radiat Oncol Biol Phys 2015;93:166-72). At 20 Gy, the VA functionality decays to a ~5% 2 days after
radiotherapy, recovering to a ~40% after 5 days. At this dose level, the SF due to vascular damage amounts
to ~35%. When hierarchical inactivation of the VA is simulated, hypoxia induced SF is drastically
decreased, reaching ~5%. This study is a stepping stone towards the consideration of vascular damage
during hypofractionated treatment planning.
A.G-A. acknowledges the support of Conicyt (Fondecyt N11170575).

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O-347

ORGAN DOSE IN CT: A COMPARISON BETWEEN THE RADIMETRICS

ENTERPRISE PLATFORM ESTIMATION AND TLD MEASUREMENTS USING AN
ANTHROPOMORPHIC PHANTOM

Beatriz Sánchez-Nieto1, Jessica Hernández-Sánchez1, Daniella Fabri2

1
Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
2
Departamento de Imágenes, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo,
Santiago

Diagnostic Radiology –Dosimetry

Purpose: Dose-length product is not an accurate representation of the organ dose to individual patients,
particularly if tube current modulation is used. RadimetricsTM Enterprise Platform (REP) calculates organ
dose from pre-run MonteCarlo simulations on a set of the Christy-Eckerman phantoms). The goal was to
compare organ doses estimated by REP with organ dose measured using thermoluminescent dosimeters
(TLD) on an anthropomorphic phantom during CT examination.
Method: A male 701-D ATOM phantom with 268 holes for TLD-chips dosimetry distributed in 22 internal
organs was used. The phantom weights 73 kg and consists of the head and torso only. A whole-body scan
was carried out in a Siemens Biograph64 mCT (acquisition parameters: 120Kv, 99.7mAs in average). TLDs
had been previously cross-calibrated to a FC65-G in a 120kV beam of a Philips X-ray tube SRO33100
(6.141 mm Al at the calibration depth). Estimated organ doses from REP were compared to measured
values for 17 organs in common by the two methods.
Results: In average, REP overestimated organ dose in 40% approximately (except for intestine for which
REP underestimated by around 3%). Greatest difference was observed for the eyes, for which estimation
to measurements ratio were more than threefold. As REP estimation is based on pre-run simulations for
various scan protocols with different parameters (such as kVp) for a set of phantoms, differences between
the body mass of the ATOM phantom and the Christy´s adult phantom might explain some of the
differences observed.
Conclusion: Reasonable estimation of organ dose for a whole-body CT using REP was obtained (ratio of
REP estimations to measurements of 1.5). Further analysis should be performed for other protocols where
the accuracy of organ dose estimation for organs outside the scan range can be tested.
BSN acknowledges the support of Conicyt (Fondecyt N1181133).

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O-350

A COMPOUND REFRACTIVE LENS FOR MEGAVOLTAGE RADIATION

ONCOLOGY LINEAR ACCELERATORS

Ricardo Rademacher

San Diego State University, Genesis Healthcare Partners, USA

Radiation Oncology – Treatment Delivery

Purpose: Conventional wisdom in medical physics holds that the megavoltage X-rays used in radiation
oncology cannot be manipulated. However, advancements in the field of x-ray optics over the last two
decades may prove this is no longer the case. By creating a compound refractive lens to collimate and focus
mega-voltage x-rays, radiation oncology linear accelerator beams can be more effectively controlled.

Methods: The test will consist of recording an open field, a blocked field, and the lens field If successful,
we expect to see a “barbell” pattern insofar as the central lens field has been collimated while the outside
blocked and open fields remain divergent. A success would also show larger dose gains and smaller
penumbra in the lens field compared to the open and closed fields. The original CRL design consisted of
cylindrical holes drilled into aluminum with the interstices between the holes functioning as the lens. We
will use the same design for our prototype and characterize it with three parameters: focal length,
transmission, and gain. This lens will be created by an KNMF in Germany and tested on a LINAC at a
Genesis Healthcare Partners.

Results: As this experiment is ongoing, any and all preliminary results will be presented at the meeting.

Conclusion: If successful, this lens will result in higher dosage gains, smaller penumbras, reduced normal
tissue irradiation, and better field conformality, all of which lead to better patient outcomes.

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O-352

TOWARDS ESTABLISHING NATIONAL DRLS FOR CT IN CHILE: THE FIRST

STEP, COMPUTED YOUR OWN INSTITUTION DRL OR TYPICAL VALUE.

Daniella Fabri, Javiera Sanguesa, Ricardo Castillo, Pablo Soffia

Departamento de Imágenes, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo,

Santiago, Chile

Diagnostic Radiology –Dosimetry

DRLs are a useful tool in the process of optimization, and although in Europe and the US National DRLs
are wildly available, it is difficult to find records of radiation dose delivered in Latin America and there for
is no formal establishment of NDRLs or RDRLs.

The first step for establishing National DRLs is to be able to access Local DRLs or “typical value”. Local
data should be obtained from a representative sample of typical patients. With larger numbers of patient
doses available from electronic data collection methods no big constrains on patient type should be done.
If this is not an option and the number of patients for whom data are collected is limited it is important to
have some standardization of patient size. A group of at least 30 patients within the agreed weight range is
preferable for CT procedures.

Methods and Materials,

DRLs for 1 of the most frequent CT exams at our hospital was computed by three different methods, the
first approximation (M1) is taking into account all patients of 2018 were information of patient diameter is
available (used as reference), the second methods (M2) only using “average size patients (patient diameter
between p25 and p75), and the third method using 30 average patients taken on a define observation time.
For all three method DRL were computed as the median of the data distribution.

Results
DRL M1 661 mGycm, M2 654 mGycm (less than 2% difference with M1), M# 642 mGycm (less than 3%
difference with M1).

Conclusions.
The three methods used show no big differences for CT ABDPELVIS WO&W IVCON protocol. The study
will be performed for the 5 more frequent protocols done at our institution. Using only 30 average patients
by protocol, by institution is an accessible first step towards establishing NDRLs in Chile.

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O-362

DOSIMETRY STUDY OF A LOW COST MATERIAL FOR USE AS A BOLUS IN

RADIOTHERAPY.

José Antonio Díaz Merchán1,2, Deisy Nataly Castellanos Castellanos1, Segundo Agustín Martinez
Ovalle1,2, Claudia Patricia Amaya Sanchez2
1
Universidad Pedagógica y Tecnológica de Colombia, Colombia
2
Centro de Cancerología de Boyacá

Radiation Oncology – Dosimetry

Introduction
In the practice, to optimize skin radiotherapy, materials such as bolus are used, but in some cases air gaps
that change the dosimetry are generated. In the literature, different materials have been proposed for use in
radiotherapy of difficult anatomical regions such as medial canthus or auricular pavilion. Monte Carlo (MC)
simulation is an alternative study in detail the irradiation of different materials and their dosimetric
response.
In this work, a material was contructed and characterized through simulation, experimental measurements
and CT for use and implementation as a bolus in radiotherapy. Dosimetric characteristics are compared
with two paraffins used in radiotherapy some centers, also evaluating the formation of Air Gaps and
Fractures in this materials.

Material and Methods

Different plates of a flexible and transparent material with density 1.08 g/cm3 called BolusCM was
constructed. Also plates of different paraffyn was constructed. This materials was irradiated with electrons
of therapeutic energies and PDDs were measures.
In order to analyze abnormalities formed in the process, CT was made to the plates and HU were measures.
Using Geant4 the materials and interaction of electron beams were simulated. For diferent energies PDD’s
were calculated in detail.
The Montecarlo results were comparated with experimental measurements and other characteristics taken
from CT

Results
BolusCM material is flexible, at environmental conditions or high dose radiation no changes.
The PDD’s for three materials were measures and from CT the HU were obtained. In the paraffyn 1 and 2,
and BolusCM were measures 70 HU ± 5 HU, 83 HU ± 7 HU and 100 HU± 3 HU respectively. With MC
Method the PDDs in water, Paraffyin and Bolus CT were obtained.

Conclusions
The Bolus CM Material shows homogeneity, allowing uniformity in the deposited dose. This Material can
be used and implemented as a bolus in radiotherapy.

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O-364

QUANTITATIVE ANALYSIS OF THE DOSE DELIVERED ACCURACY IN

RADIOTHERAPY TREATMENT USING IMRT TECHNIQUE IN HEAD AND NECK
TUMORS USING ANTHROPOMORFIC SIMULATOR

Beatriz Martins De Medeiros1, Luiz Flavio Kalil Telles2, José Guilherme Pereira Peixoto3, Fernando
Parois Japiassu2, Ricardo Reis2
1
Fundação do Câncer, Rio de Janeiro State University, Brazil
2
Liga Norte Riograndense Contra o Câncer
3
Comissão Nacional de Energia Nuclear

Radiation Oncology – Dosimetry

The dose administered to the patient in treatments of radiotherapy verification has a great importance for
the patient safety. Head and neck tumors represents more than a quarter of the diseases treated in the
hospital, losing only to breast and prostate tumors. Due to the number of organ at rick that are present in
the region, the concern becomes even greater. Thus, in order to verify the IMRT technique validation
efficiency using an anthropomorphic phantom with different materials simulating the head and neck
heterogeneities developed in-house , the endto-end tests quality control from head and neck radiotherapy
treatments, the Nasopharingeal Carcinoma were chosen, were quantitative evaluated using an A16 Exradin
micro ion chamber and the dose were delivered by a Varain Clinac IX . Verifying the dose delivery in the
volume of interest and adjacent volumes, and evaluating the uncertainties associated with the absolute dose
calculation in different areas. The radiotherapy treatments planning using the IMRT technique showed a
relative deviation between the absolute dose calculated by TPS Eclipse and the absolute dose measured
with the ionization microchamber lower than 3% at all studied regions points. In the Lung, Cervical,
Marrow and PTV70 regions the relative dose deviation were 2.24%; 0.21%; 2.47% and 1.73%, respectively.
Therefore, It can be concluded that, from the use of a composed by different materials anthropomorphic
simulator characterizing different heterogeneities, the quality assurance verification from the absolute dose
process in head and neck tumors treatments using the IMRT technique can be assessed by assuring an
expanded relative uncertainty of approximately 6.6% in the absolute dose calculation with a confidence
interval of 95.45% and ensuring the reliability of correct dose delivered to the patient.

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O-368

DETERMINATION OF AMORPHOUS SILICON PANEL PRECISION TO DETECT

CYBERKNIFE M6 BEAM QUALITY SHIFTS

Alvaro Ruiz, Alexis Troncoso, Karla Torzsok, Oscar Moreno, Marcelo Ribeiro

FALP, Chile

Radiation Oncology – Quality Assurance

Cyberknife uses small radiations fields, quality assurance devices resolution should be very high in order
to obtain reliable measurements. QASC, Standard Imaging®, uses Amorphous silicon (aSi) panels which
are of the highest resolution detectors in the market combined with a new software that has been so far
scarcely used in clinical mode in order to measure small field beam parameters.

Quantifying the reliability of the above mentioned device is the objective of this work, precision and
accuracy determination will be discussed.

The methodology involves usage of the aSi-panel in a daily basis, during approximately 7 months, with a
reproducible image processing set up, to measure inline and crossline beam parameters, with a record of
the baseline image then analyse further results in comparison to this starting point.

Preliminary results for flatness, symmetry, penumbra and field size, have shown a very high device
performance for very well studied beam parameters; e.g. for Inline profile: baseline 6.69 %, average 6.61%,
standard deviation 0.09%, maximum difference 0.3 %, difference between maximum and minimum 0.38
% and variation coefficient 1.36 %.

Compliance to the objective, from measured aSi-panel to processed statistical data, the statistical process
used proved the aSi-panel to be of very high precision and able to detect small changes in the radiation
beam. These results lead us to continue evaluating the accuracy and sensitivity of the device by making
more measurements in the water tank. In a few months it will be possible to establish a relationship between
the behaviour of the aSi-panel and measurements obtained in the water tank. We would then be able to
restrict usage of the water tank to occasions when the aSi-panel analysis fails.

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O-371

TIME-DRIVEN ACTIVITY-BASED COSTING FOR COMPETING TREATMENTS

USING DIFFERENT TECHNOLOGY SOLUTIONS

Karla Torzsok, Marcelo Ribeiro, Herve Broque, Jhonalberth Aponte, Alvaro Ruiz

FALP, Chile

Radiation Oncology – Treatment Delivery

Purpose: Equitable access to radiotherapy (RT) must be a reasonable health care goal worldwide. Low to
middle income countries face challenges: lack of professionals, reimbursement schemes and public
policies. Given costs of delivering advanced RT care remain poorly described, we report results of time-
driven activity-based costing (TDABC) for competing treatments and opens way for discussions on how to
account for and utilize resources.
Methods: TDABC is a cost calculation technique that iteratively allocates resource costs to products based
on activity consumption weighed by treatment complexity. Process maps were developed for each phase
of care from the initial visit to end of treatment through 2 years of clinical practice using Cyberknife
Stereotactic body radiation therapy treatments (SBRT), Radiosurgery (SRS), Elekta Volumetric Arc
therapy (VMAT), Tomotherapy (TOMO) and conformal RT (3D).
Results: Substantial cost variation was observed, with costs ranging from TOMO, to SBRT. TOMO was
notably cheaper than VMAT, SRS was cheaper than VMAT. Cost savings attributable to shorter procedure
times and fewer fractions despite of higher initial capital costs. Both equipment costs and quality assurance
contributed to the high cost of SBRT, where machine quality assurance (QA) and patient specific delivery
quality assurance (DQA) costs range up to 54% when single fraction. 3D was only 20% cheaper than
TOMO, largely because of workflow. RT costs are predominantly determined by personnel 38% and
equipment cost 39%. Machine usage activities consume most: treatment delivery 65%, QA 12% and DQA
8%.
Conclusion: TDABC analyses cancer services and provides insights into cost-reduction and value. It
impulsed evaluating practice changes in the 3 major cost drivers: fractionation, QA and DQA. Our aim is
to develop a model that establishes direct relationship between equipment, human resources, fractionation
and quality assurance. Unlike benchmarks estimating number of Linacs/ million people, we vouch for
considering the whole patient workflow.

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O-376

EVALUATION OF CALCULATION OPTIONS OF EMC ALGORITHM

Gabriela Miranda Holley, Alejandro Floriano Pardal

Instituto Nacional del Cancer, Chile

Radiation Oncology – Dosimetry

INTRODUCTION: The electron Monte Carlo dose calculation algorithm (eMC) available in Eclipse
Treatment Planning System is a fast implementation or macro Monte Carlo algorithm. The eMC algorithm
has been commissioned at Instituto Nacional del Cancer. Prior to clinical use, the different adjustable
calculation options have been studied, in order to fully understand the changes implied in each one of them.
The calculation options evaluated are statistical uncertainty, grid size, smoothing method and smoothing
levels.
METHODS AND MATERIALS: The evaluation was done in Varian Eclipse v13.6 for a Varian iX linear
accelerator, for one beam energy and one applicator size. Each one of the calculation options was changed
at a time and some plan parameters were compared. These parameters were calculation time, monitor units
and dose distribution.
RESULTS It was found that calculation time is greatly affected by changes in statistical uncertainty. Also,
dose distribution looks different for the various calculation options. Therefore, care must be taken in
selecting calculation options and dosimetrists should be consistent in their selection for different plans.
Also, radiation oncologists should be aware of altered appearance of dose distribution when they evaluate
isodoses curves and target coverage for eMC, in comparison with other electron beam calculation
algorithms.
CONCLUSION: A complete understanding of new algorithms is needed when selecting dose calculation
options. Dosimetrists and physicians need to be aware of differences within the algorithm for proper plan
evaluations.

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O-378

REFERENCE TEST SET TO VALIDATE MAIN DOSIMETRIC PARAMETERS OF A

TPS COMMISSIONING

Franklyn Reggio, Jose Luis Rodriguez

Venezuela

Radiation Oncology – Dosimetry

INTRODUCTION
In order to detect systematic deviations in dose calculation, we have developed a couple of sets of tests to
use as a reference to validate the proper acquisition of dosimetric data and the corrected feed of the
Treatment Planning System (TPS). The main parameters to compare by other users are the Monitor Units
of these test sets calculated by a Matlab code, which reads the planning data from an RT Dicom file. This
code follows the formalism and get the dosimetric data from the AAPM Task Group 71 report, for a 6 MV
linear accelerator.
METHODS AND MATERIALS
The first test set was composed of 20 treatment fields that were planned with basic setups, which were
calculated by the Matlab code and compared to the AAA Algorithm within the Eclipse TPS fed for this
research, with the preconfigured data provided by the manufacturer. These fields are intended to facilitate
the audit of the data measured and entered into the TPS, as well as the calculation it performs in main
parameters such as: i) the absolute dose value; ii) beam quality within the TPS; (iii) adequate measurement
and use of physical wedge factors entered; and (iv) the dynamic wedge factors calculated by the TPS.
The second test set is based on the phantom propose by the TG119, which is composed of different structure
mocks of Head and Neck and prostate. The user has to make a couple of 3D standard plans following
specific instructions.
RESULTS AND CONCLUSIONS.
We verify 3 different linacs and we get differences smaller than 2.5% respect to the expected MUs for all
evaluated fields. The use of this methodology can substantially detect systematic errors of a TPS
commissioning, because we are using a completely independent reference set of dosimetric data to the MU
comparison.

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O-379

CHARACTERIZING 3D PRINTER IN A HIGH DOSE RATE (HDR)

BRACHYTHERAPY CENTER.

Alejandro Ferreira1, Ignacio Véliz1, Evelyn San Martín2, Apolo Salgado1, Alejandro Floriano1
1
Instituto Nacional del Cáncer, Chile
2
Universidad de Chile

Radiation Oncology – Brachytherapy

Introduction.
3D printing has generated great interest in the brachytherapy community due to its versatility in the
manufacture of different customized applicators and the increasing availability of this technology.
This study aims to present a characterizing process for a 3D printer in a HDR Brachytherapy Center.
Methods and Materials.
A 3D printer Creality Ender 3 and dark gray polylactic acid (PLA) were used to make the applicator, using
a defined configuration for printing in all cases.
Different applicators devices were printed, using a 20% infill, and were contrasted with their commercial
devices. The evaluation was made measuring with EBT3 radiochromic films located in a fixed position on
one side of the applicators, for both 3D impressions and commercial applicators, evaluating depth dose
profiles based on source distance.
Results.
Differences in dimensions between the designed applicator and the resulting impression were less than 1.0
mm.
Using computed tomography, it was found that 3D impressions show a reasonable uniformity in their
internal structure.
In radiochromic films, differences of less than 5.0% in dose in the first 10.0 mm near the source were found.
However, differences decreased gradually as a function of distance until becoming lower than 1.5%.
Conclusions
3D printing provides a viable and economical method in the manufacture of applicators, presenting
dosimetric differences of less than 5% in the first millimeters compared to commercial applicators. These
applicators can be used in Brachytherapy treatments, (aiming) for personalized treatments for each patient.

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O-380

QA WITH A PORTAL IMAGING DEVICE FOR CO-60 HDR BRACHYTHERAPY

Gustavo Piriz, Henry Ortega-Spina, Gabriel Gonzalez-Sprinberg

Faculty of Science, UDELAR, Uruguay

Radiation Oncology – Quality Assurance

Introduction: In high dose rate remote (HDR) afterloading brachytherapy, quality assurance (QA) strongly
depends on the accurate determination of position, transit time and velocity of the source. In order to check
these parameters in a remote afterloader with Co-60 sources, a portal imaging device was constructed and
characterized.

Methods: QA portal imaging device was built for HDR brachytherapy equipped with Co-60 sources. It
consisted in an aluminum chassis with three different web cameras to detect the emitted radiation. We used
a Co-60 HDR afterloading system (E&Z BEBIG 60 Co HDR Co0-A86, Berlin, Germany). Original photons
from the source were attenuated in a thin copper surface to generate electrons. Attached to this surface there
was an emulsion where electrons produced photons in the visible range which were reflected by a 45-
degrees mirror and detected by the cameras. The images were analysed with Matlab R2013b. Noise was
subtracted from the images and geometric positions of the source were determined. Then transit time and
velocity of the source were obtained.

Results: We obtained some preliminary results. Sensitivity of the source position was better than 0.6 mm
per pixel for all cameras. All transit times were also consistent and around 0.6 seconds. Source velocities
were 87 mm/s for two cameras and around 100 mm/s for the other.

Conclusion: Preliminary results indicate that this methodology may provide an easy and precise way to
periodically check source position, transit time and velocity for HDR Co-60 sources in brachytherapy with
good accuracies.

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O-386

REDUNDANT DOSE CALCULATION BASED ON A RADIOLOGICAL RAY

TRACING PATH AND EXPERIMENTAL DATA

Diego Carrasco, Sebastian Bianchini

CNEA - INTECNUS, Argentina

Radiation Oncology – Quality Assurance

Radiotherapy dose calculation engines like Monte Carlo and alike have increased the trust on the planning
outcome of IMRT and VMAT techniques. It is not unreasonable for redundant dose calculation algorithms
to improve their complexity and correctly calculate highly modulated IMRT or ARC plans. Given the
undeniable trust in semi empirical redundant calculations an algorithm based on Venselaar methodology
and radiological ray tracing path was developed. Using a transformation based on radiological path that
accounts for the distance of a dose point to all the tomography voxels, we traced the plan information to
typical measurements done in water while maintaining a high precision. The developed software listens to
the DICOM communication between the TPS and the record and verify system to automatically output a
calculation. We used the treatment planning of more than 50 patients accounting for different oncology
pathologies and treatment modalities. Using the Monte Carlo engine present in Elekta’s Monaco TPS, the
dose of several interest points was compared. The difference between both algorithms was lower than 3%
for off axis interest points located in risk organs and lower than 2% on the isocenter. We believe the
automatization and precision of this algorithm makes it an excellent redundant tool for the new highly
complex treatment modalities of radiotherapy.

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O-397

QUALITY CONTROL WITH FLATPANEL 1500 IN SURFACE TREATMENTS WITH

HIGH DOSE RATE (HDR) BRACHYTHERAPY

Anthony Paredes Vargas, Bertha Garcia Gutierrez

Red AUNA, Peru

Radiation Oncology – Quality Assurance

The objective of this study is to provide a viable method for the quality control of surface treatment plans.
Dosimetrically 15 treatments of superficial Brachyrapia of high dose rate with the applicator H.A.M of
Ecker & Ziegler were reviewed. The applicator was reconstructed three-dimensionally and planned with
the planning system HDR plus 2.6.5 without the need for tomographic images.
The treatment was delivered by a HDR Multisource charging equipment from Ecker & Ziegler with a Co-
60 source. The passage of the fountain is arranged in 5mm stops and separated by 1cm. The plans were
analyzed using the Flat Panel 1500 and analyzed through VeriSoft software, the observation of the
maximum surface dose of the applicator (in contact with the skin) and the prescribed dose at the depth
requested by OSL.
The uncertainty of performing surface treatments with HDR was the distribution of doses, hot spots, so an
OSL dosimeter placed in the center and at the ends of the treated area was used.
A coverage between 90% and 100% of the surface to be treated was observed with maximum points of
150% of the prescribed dose evenly distributed over the surface of the applicator (0.5cm from the
trajectories of the source).
The reading of the OSL dosimeters had a difference of 3% in the maximum points and in the center smaller
1%.
After all this analysis we can say that an easy and objective dosimetric analysis can be carried out with the
Flat Panel 1500 that covers the treatment needs.

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O-399

DOSIMETRIC ANALYSIS OF INDIGENOUSLY MADE INTRACAVITARY AND

INTERSTITIAL (IC+IS) GYNECOLOGICAL APPLICATOR IN IMAGE-BASED
BRACHYTHERAPY

Kaliyaperumal Venkatesan, Dr Susovan Banarjee, Dr Tejinder Kataria, Merin C Raju, Dr Durai

Manigandan

The Medicity Hospital Gurgaon, India

Radiation Oncology – Brachytherapy

Aim: To evaluate the dosimetric parameters of indigenously developed applicator for the Carcinoma Cervix
Methods and Materials: Teflon cylindrical applicator was made with holes for needle insertion based on
the virtually created applicator in TPS. For commissioning of the needle and applicator, the autoradiograph
was performed on Gafchromic film. The applicator has the provision for inserting 19 needles (straight and
angulated) and a central tandem. For validation of the applicator, various HRCTV (High risk clinical target
volume) (n=21) were made with clinically correlated dimensions and it has the maximum extension of
4.2cm (Right), 4.9cm (left), 3cm (anterior) and 2.8cm (posterior). Brachytherapy dose plans were generated
based on the Point A prescription and the source positions were activated on the reconstructed needles for
the HR-CTV. Manual dwell time optimization was performed and 8% to 20% loading time was kept for
the needles. Dosimetric parameters of V90%, V98%, V100%, V200% and TRAK (total reference air kerma
at 1m) values were analyzed for different HR-CTVs.
Results: In autoradiograph, the active source position is 6mm from the needle edge. The volume of the
HRCTV ranged from 13.9cc to 98.8cc (mean 57.9cc, SD 21.7cc).The mean of V90% and V98% was 97.3%
(SD 2.6%) and 95.85(SD 3.5%) respectively. The mean value of V100% and V200% is 95.25 (SD 3.6%)
and 53.1% (SD 9.4%) respectively. The mean TRAK value is 0.5302cGy (SD 0.039 cGy) for 6Gy and
varies from0.459cGy to 0.603cGy depending on volume of HRCTV.
Conclusion: Our indigenously made intra-cavitary and interstitial brachytherapy applicator can able to
create the volume dose distribution for different HRCTVs. At the same time this applicator can create the
Point A based dose distribution along with lateral and anterior-posterior dose extension. It can fulfill the
clinical requirements for extended target volumes in the case of Carcinoma Cervix.

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O-402

INITIAL EXPERIENCE: QUALITY CONTROL IN INTRACRANIAL

STEREOTACTIC RADIOSURGERY

Jonathan Pacheco Colqui, Walter Vilca Vega, Mercedes Del Pilar Marcos Castillo

INEN, Peru

Radiation Oncology – Quality Assurance

Introduction
Radiosurgery is a technique used to radiate small intracranial lesions at very high doses. These injuries are
usually located in regions very close to risk organs that require a high degree of precision. Due to this, the
determination of the isocenter of radiation (IR) and its dimensions has a considerable relevance in the
quality of the administered treatment. The so-called Winston-Lutz test (WL) is a method of quality control
that allows us to verify both the position and the dimensions of the IR with respect to the mechanical
isocenter (IM) in a linear electron accelerator. In parallel, the start of the technique in our National Institute
of Neoplastic Diseases (INEN) in 2018, led to a thorough study of the geometric variables involved.

Materials and methods

In the National Institute of Neoplastic Diseases (INEN) there is a linear accelerator of 6 MV, Elekta, Sinergy
model, with Agility multileaf systems, with portal dosimetry system and a pointer (ball baring), acquisitions
were made of images using the portal for the WL test, these images were then analyzed in a dosimetry
software (RIT v6.6.64).
The WL test was used a cone, which served to reduce the gloom of the radiation field, several acquisitions
were made with variable angles of stretcher and gantry, the radiation field size was 5x5 cm2, the images
were obtained in the Iview.

Results and conclusions

The results show a variation of the isocenter of less than 1 mm, which is accepted according to the American
protocol TG-142, the WL test allows to guarantee the high degree of precision of delivery of the dose and
a good quality in the treatments.

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O-403

OPTIMIZATION OF MEDICAL EXPOSURE IN PEDIATRIC NUCLEAR MEDICINE

PROCEDURES

Leonel Torres1, Alejandro Perera1, Caridad Casaco1, Yamile Peña1, Yolaine Sanchez1, Alanis Prats1,
Gian Luca Poli2
1
Division of Nuclear Researches, CENTIS, Havana, Cuba
2
International Atomic Energy Agency

Nuclear Medicine

Introduction: Pediatric studies in nuclear medicine provide valuable information for the diagnosis and
monitoring of different pathologies. Many efforts are currently performed to reduce the irradiation levels
of pediatric patients without affecting the image quality. The most relevant clinical protocols were
evaluated and optimized in two NM services, emphasizing on the morpho-functional kidney studies with
99mTc-DMSA.

Methods: The activity administered to 67 pediatric patients (scintigraphy) was randomly evaluated
from 99mTc-DMSA, 99mTc-MDP and 99mTc-MAG3 studies, divided by age groups of 0-5, 5-10 and 10-
18 years; the absorbed doses were also estimated and evaluated. These values were compared with
recommendations from international organizations (SNMMI and EANM). The
exams that showed the highest levels of irradiation were the 99Tc-DMSA scans. The optimization process
of DMSA-99mTc studies was based on using acquisition techniques that simulate fractions of the
administered dose (1/5, 2/5, 3/5 4/5 and 5/5). These images were evaluated by two independent observers
experts on renal studies. The optimal levels of activity to be administered were defined.
Results: It was identified a significant increase in the levels of activity administered with respect to
those recommended. Renal studies with 99mTc-DMSA showed the highest levels of
administered activity in the three age groups studied (149%, 103% and 57%, respectively). These
values were lower in the case of bone scintigraphy with 99mTc-MDP (93%, 68% and
43%, respectively) and renal studies with 99mTc-MAG3 (31%, 12% and 22%,
respectively). Optimization studies performed for 99mTc-DMSA
allowed to decrease the activity administered to infants without affecting the quality of
studies, with the consequent decrease in radiation doses absorbed in more than 34%.
Conclusions
It was possible to optimize the pediatric doses in static renal studies with 99mTc-DMSA in
the two participating institutions. Currently, a similar analysis is in course in order to optimize the 99mTc-
MDP and 99mTc-MAG3 scintigraphic studies.

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O-404

INTER-COMPARISON OF TOOLS FOR QA OF 4D POSITIONING IN ADAPTIVE

RADIOTHERAPY

Eilen Llanes1, Rodolfo Alfonso2

1
Department of Radiotherapy, National Oncology and Radiobioloy Institute, Havana, Cuba
2
Faculty of Nuclear Sciences and Technologies, University of Havana, Cuba

Radiation Oncology – Quality Assurance

Introduction: In external beam radiotherapy, advances in technology have enabled the possibility of
transitioning from basic 2-dimensional treatment planning and delivery (2-D radiotherapy) to a more
sophisticated approach with 3-dimensional conformal radiotherapy (3-D CRT) and 4-dimensional
respiratory motion (4D). Similarly, technology advances have meant that verification of the positioning of
the patient with radiographic film analyzed after treatment (“off-line”) has progressed to advanced imaging
of the patient volume at the time of treatment with immediate “on-line” corrective strategies. Intrafraction
motion is an issue that is becoming increasingly important in the era of image-guided radiotherapy.
Intrafraction motion can be caused by the respiratory, skeletal muscular, cardiac, and gastrointestinal
systems. For the determination of these movements, different systems for capturing images have been
developed, which can be generated by megavoltage or kilovoltage beams. Materials and Methods: In order
to optimize the positioning process and determination of these internal movements, an intercomparison was
made between different quality control tools of the 4D positioning. A dynamic phantom (CIRS Dynamic
Thorax Phantom) was used to acquire images with the iView in Movie mode and with XVI in Motion View
mode and Symmetry mode. From the images taken, the calculation of the overlays was made, which were
compared with those reported by the CIRS manual. Results and Conclusions: The discrepancies obtained
for the different tools are within the tolerance reported by the consulted bibliography. As a conclusion, for
the realization of the QA of the 4D positioning, it was possible to establish a protocol in which the XVI
was used on the first day of treatment and in the remaining days the iView.

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O-408

PATIENT DOSE MANAGEMENT IN X-RAY CT: EXPERIENCE FROM YALE

HEALTH SYSTEM IN THE UNITED STATES

Adel Mustafa

Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA, USA

Diagnostic Radiology –Dosimetry

CT diagnostic procedures are associated with relatively high radiation doses required to obtain acceptable
diagnostic quality images. Introduction of recent CT technologies helped adjust CT acquisition protocols
to a more acceptable dose levels with reduced risk to patients. CT dose adjustment and modulation can be
achieved using several techniques including auto mAs and kVp, dual energy CT, a wide range of statistical
iterative reconstruction algorithms, better patient positioning and the use of gated cardiac studies. We use
radiation dose management system, Radimetrics™, to query/retrieve the CT exam’s “Radiation Dose
Structured Report” (RDSR) for comparison and further analysis. Using data from more than 300,000 CT
examinations at our institution we could identify CT doses higher than established benchmarks for multiple
master and sub master CT protocols and correct for protocol appropriateness, scanners inadequacies and
operator deviations from standard operations including patient variations. We will present samples of our
approach to investigate, correct practices and update acquisition protocols to help reduce CT doses.

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O-409

PROGRESS IN MEDICAL PHYSICS CAPACITY BUILDING IN AFRICA – THE

FAMPO PERSPECTIVE

Christoph Trauernicht1, Taofeeq Ige2, Francis Hasford3, Graeme Lazarus4, Nadia Khelassi-Toutaoui5
1
FAMPO Vice President, South Africa, South Africa
2
FAMPO President, Nigeria
3
FAMPO Secretary General, Ghana
4
Chair: Professional Development Committee, South Africa
5
Chair: Education and Training Committee, Algeria

Education and Professional Issues

Background:
FAMPO is the Federation of African Medical Physics Organizations. It is the African chapter of the
International Organization of Medical Physics, IOMP. FAMPO has membership from 30 countries in the
region and for countries without a medical physics society individual membership is possible.
There are currently about 500 – 600 Medical Physicists in Africa, but many African countries do not
recognize medical physics as a profession. Only Ghana and South Africa register medical physicists with
a national authority or a Health Professions Council.
Objective:
Current projections estimate that by 2035 22.000 medical physicists are required to cover the need in
radiotherapy alone in low-and-middle-income countries (LMIC). It is therefore an urgent need to progress
the concept of clinically qualified medical physicists and to increase clinical training and the number of
trainers.
Methods:
The Education and Training Committee (ETC) of FAMPO could provide ‘certification’ of various courses
(academic and/or clinical training). The ETC can work on accreditation mechanisms for regional training
programmes and look into partial training capabilities. The International Atomic Energy Agency has
offered use of an online platform to capture achieved competencies.
The Professional Development Committee (PDC) of FAMPO is envisaged to start registering clinically
trained medical physicists one they have undergone training at an accredited training site.
It is imperative that the ETC and PDC work independently.
Results:
The ETC and PDC are currently both collecting relevant data and working on a grandfather clause for
registration.
Conclusion:
In this way FAMPO hopes to help address the dire shortage of medical physicists in Africa.

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ICMP 2019 / ALFIM 2019

POSTER PRESENTATIONS

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P-004

ANALYSIS OF ANGULAR AND SPACE DISPLACEMENTS IN THE REGISTER OF

IMAGES IN TOMOTHERAPY

Uvaldo Reyes, Omar Vela, Daniel Calderón, Higmar Herrera

Servicios de Salud de Durango, Mexico

Radiation Oncology – Quality Assurance

At Centro Estatal de Cancerología of Durango, Mexico, a TomoTherapy HDA was installed in June 2016.
From that date until now, more than one thousand patients have been treated and more than 24 thousand
treatment sessions have been delivered. As part of the training in the management of this image-guided
radiotherapy technology, a phantom was designed, it was named EVA.
This phantom includes different densities and Hounsfield Units similar to the human body.
The aim of using this mannequin is to find correlations between translations and rotations manually applied
to it and the translations and rotations corrections detected by the TomoTherapy Image system. In this work
we present the measurements made with the phantom EVA and a brief analysis of them.
These measurements have allowed us to determine the enormous importance of the correct choice of the
image technique depending on the treatment site to obtain a correct image registration and to make sense
of the suggested corrections.

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P-005

RADIOBIOLOGIC COMPARISON OF TEARDROP TECHNIQUE FOR BREAST

CANCER RADIOTHERAPY TREATMENT PLANNING ON A TOMOTHERAPY
SYSTEM

Higmar Herrera, Uvaldo Reyes

Centro Estatal de Cancerología de Durango, Mexico

Radiation Oncology –Treatment Planning

Breast cancer in Mexico is the first cause of death in women. Radiotherapy has proven to be a great tool to
control such ailment and TomoTherapy a relatively new technology to accomplish it. To obtain good
clinical outcomes, tight dosimetric constraints are placed on organs at risk to maximize TCP and minimize
NTCP. The teardrop technique helps meeting this constraints by placing a virtual block over the ipsilateral
lung and part of the heart but it contributes to lengthen the treatment time. We present our experience in
using this technique and compare its radiobiological estimations with similar plans without it.
Seven patients diagnosed with breast cancer were planned twice, with and without the teardrop technique.
Dose-Volume histograms were obtained on Tomotherapy Planning System and analyzed on Albireo Target
Cygnus X1 to get UTCP and fEUD parameters. Matlab Statistics Toolbox was used to examine the results
significance through bootstrapping of Student’s and Wilkinson’s tests. The heart, both lungs and
contralateral breast were considered. The same statistical tests were applied to the treatment delivery time.
UTCP for unblocked plans ranged 0.910 - 0.952 with a mean of 0.925, while the same parameter for
teardrop plans ranged 0.920-0.964 with a mean of 0.939. fEUD ranged 0.423-0.562 and 0.492-0.612; mean
delivery time was 344.7±84.8s and 496.8±70.5s for unblocked and blocked plans respectively.
This observed differences were significant with 95% confidence (p<0.05).
Although a 2% difference was observed for UTCP all constraints were met, but it was easier to accomplish
it with the teardrop that also permitted a 10% gain in fEUD. This came with a 40% increase in delivery
time which is still below our 10 minute allocation established internally.
The teardrop technique was observed to have a net radiobiological benefit with little impact on patient
scheduling.

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P-006

COMMISSIONING OF MONACO TPS FOR 3D RADIOTHERAPY USING THE

THORAX CIRS PHANTOM, BASED ON THE AIEA TECDOC 1583

Christian Betancourt1, Deivis Errada2

1
Student -Venezuela
2
ALFIM - SOVEPRA

Radiation Oncology –Treatment Planning

In the application of radiotherapy for planning and calculating doses, so-called planning treatment systems
are used, which help specialized personnel to prescribe dose, number of sessions of a treatment and the
configuration of radiation beams to maximize the dose to the tumor and decrease it to healthy organs.
In this work the commissioning of the Monaco treatment planning system was carried out based on the
technical document of the IAEA 1583, which dictates step by step how to carry out the commissioning
using CIRS thorax phantom.
A curve of Hounsfield units vs electronic density was obtained for the AcQsim simulator tomograph, which
is linked to the planning system, a series of verification cases was planned with all the calculation
algorithms that the Monaco has to do a dose verification using a FARMER type ionization chamber
comparing the measure obtained with what was calculated by the system, finally a comparison was made
between the two calculation algorithms available in the Monaco, Collapsed Cone and Monte Carlo XVMC,
based on the measurements made in the verification cases and only in the cases without wedge, since the
Monte Carlo algorithm does not have this function available.
It was concluded that the planning system is apt to apply treatments without the use of wedge in both
calculation algorithms. With wedges it shows failures that require a more exhaustive investigation.
The Monte Carlo XVMC algorithm is recommended because it is within a tolerance of 3% in almost all
cases of dose verification performed, unlike the Collapsed Cone.

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P-007

DIAGNOSTIC REFERENCE LEVELS FOR COMMON X - RAYS PROCEDURES IN

PERU

Andrés Portocarrero Bonifaz, Caterina Camarena Rodriguez, Ricardo Palma Esparza, Nicolas Romero
Carlos, Pedro Manuel Lazo Ramirez

QC Dose S.A.C., Peru

Radiation Protection

Reference levels for common X-ray procedures have been established in various countries.
In Peru, during quality control tests, these international reference levels establish the tolerance of surface
dose, which is the basis for different protocols.
However, more studies can be carried out to evaluate the national reality and the different parameters for
exposure techniques such as kV, mAs, type of equipment (conventional or digital), etc.
In this work two radiographic procedures were taken into account, general X-rays (fixed and mobile) and
intraoral X-rays (fixed, mobile and portable).
An Unfors RaySafe Xi detector was used; the kerma (Kair) was measured at a distance - focus of the
detector that varied depending on the procedure, and was subsequently corrected to calculate the surface
dose as mentioned in the Arcal XLIX protocol. The data used in this document was collected over a period
of 3 years (2015-2017).
In addition, for each X-ray machine, only the last evaluation made during this period was taken into
consideration.
The results hope to achieve a new standard that reflects local practice and addresses the problems of the
"Bonn Call for Action" in Peru.

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P-009

ESTABLISHING LOCAL DIAGNOSTIC REFERENCE LEVELS (LDRL) FOR A

TYPICAL FLUOROSCOPIC EXAMINATION IN SOME RADIOLOGICAL IMAGING
INSTITUTIONS IN GHANA

Joana Otoo1, Mary Boadu2, Edem Sosu1

1
Ghana Atomic Energy Commission, Ghana
2
School of Nuclear and Allied Sciences, University of Ghana

Radiation Protection

The primary aim of this work was to propose local diagnostic reference levels for fluoroscopic examinations
in some selected radiological imaging facilities in Ghana. The work also aimed at investigating the
distribution levels of patient radiation dose received during fluoroscopic examinations for subsequent
improvement of optimization. The materials used for the research were, Piranha kit, KAP meter and
Fluoroscopy machine. The research was done at two public hospitals (coded Facility A and B), located in
the Greater Accra Region, between December 2017 and June 2018. Prior to the starting of this research a
series of quality control tests were performed using the Piranha kit to assess the machine output. The patient
data and dose descriptors collected during the work included, gender, age and Kerma-Area Product. The
Diagnostic Reference Levels (DRLs) was estimated for each facility using the 75% percentile. A total of
one hundred and sixty-nine (169) patient dose data were collected for this study. DRLs was established for
the frequently performed procedures which includes, hysterosalpingogram (HSG) and barium swallow
(BaS) examinations. The DRLs for KAP and screening time values estimated for hysterosalpingography
was 6.0 Gy.cm2 and 0.60 minutes and Barium swallow was 12.1 Gy.cm2 and 1.4 minutes for Facility A
respectively. The DRLs for KAP and screening time values estimated for hysterosalpingography was 4.1
Gy.cm2 and 0.50 minutes and Barium swallow was 11.2 Gy.cm2 and 1.2 minutes for Facility B
respectively. There was variation of values observed across facilities and were attributed mainly to
difference in protocols and techniques used in the two facilities. Due to the variations in DRL values,
standardization of protocols across facilities as a means to increase optimization is recommended.

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P-011

ASSESSMENT OF DOSE – AREA PRODUCT OF COMMON RADIOGRAPHIC

EXAMINATIONS IN SELECTED SOUTHERN NIGERIAN HOSPITALS

Lateef Bamidele1, David. O. Osahon2

1
Osun State College of Technology, Esa-Oke, Nigeria
2
Department of Physics, University of Benin, Benin - City, Nigeria

Diagnostic Radiology –Dosimetry

Over the years, radio graphic examinations is the most used diagnostic tools in Nigerian health care system
but most diagnostic examinations carried out do not have records of patient doses.
Lack of adequate information on patient doses has been a major hindrance in quantifying the radiological
risk associated with radio graphic examinations.
This study aimed at estimating dose – area product (DAP) of patient examined in X – ray units in selected
hospitals in Southern Nigeria.
The standard projections selected are Chest Posterior-Anterior (PA), Abdomen Anterior-Posterior (AP),
Pelvis AP, Pelvis Lateral (LAT), Skull AP/PA, Skull LAT, Lumbar Spine AP, Lumbar Spine, LAT.
Measurement of entrance surface dose (ESD) was carried out using thermoluminescent dosimeter (TLD).
Measured ESDs were converted into DAP using the beam area of patients.
The results show that the mean DAP ranged from 0.17 to 1.71 for chest PA and abdomen AP respectively
Gycm2. TheresultsobtainedinthisstudywhencomparedwiththoseofNRPB-HPEwerefoundtobehigher.
Theseareanindication of non-optimization of operational conditions.
Keywords: Dose – Area product, Radiographic examinations, Patient doses, optimization.

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P-016

METROLOGICAL CARE IN RADIOMETRIC SURVEY IN MAMMOGRAPHY:

LABORATORY ANALYSIS OF BEHAVIOR OF FIELD EQUIPMENTS

Eric Macedo1,2, Marcus Navarro1, Daniele Andrade1, Igor Garcia1, Jose Guilherme Peixoto2
1
LABPROSAUD/IFBA, Brazil
2
IRD

Dosimetry – Reference quality

A review about Radiometric Survey in Mammography (RSM) in terms of national and international
regulations and recommendations, specifications of radiation meters, besides field and calibration
laboratories practices shows that there is not many specific information about how RSM tests really works.
Laboratorial tests performed in a wide range of field meters, submitted to calibration tests under ISO N 25
and 30 conditions (most of them have no matched energetic range), and compared also with ISO N 60, 80
and 100 calibration results, which them have matched specifications. The result of this work suggests that
some RSM performed in Brazil, with nonspecific chambers and calibration, can have underestimation of
around 30% in those measurements. Then, specific calibration tests should be indicated to those equipments
used in RSM tests aiming to improve metrological reliability in these tests.

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P-018

VULVAR CANCER: DOSIMETRIC COMPARISON OF ADVANCED 3D

CONFORMAL RADIATION THERAPY TECHNIQUE WITH ANTEROPOSTERIOR
AND POSTEROANTERIOR IRRADIATION TECHNIQUES

Nourreddine Abdelati, Marnouche El Amine

National Institute of Oncology Rabat , Morocco

Radiation Oncology – Treatment Delivery

Introduction:
The commonly used technique of radiation therapy for vulvar cancer consists of anteroposterior (AP) and
posteroanterior (PA) fields. This is the first study that reports the dosimetric comparison between the AP-
PA techniques and the new 3D advanced conformal technique (3D-ACT) based on the multiplicity of
treatment fields in patients with squamous cell cancer of the vulva in the postoperative setting.
Materials and Methods:
This comparative planning study was conducted on 15 patients with vulvar carcinoma treated with adjuvant
radiation therapy at the National Institute of Oncology in Rabat, Morocco. Three treatment plans were
performed, corresponding to three techniques, namely photons with source-skin distance inguinal
supplement, modified segmental boost technique, and 3D advanced conformal technique. For each plan,
the dose-volume histogram was used to generate planning target volumes (total and inguinal PTV) and
organs at risk (bladder, rectum, bowel and femoral heads) parameters.
Results:
The 95% isodose volume was significantly reduced with the advanced conformal technique (P<0.0001)
without compromising the total PTV coverage (P= 0.94). This technique resulted in the best conformity
and homogeneity index. The 3D-ACT decreased significantly the PTVs D max and D mean (P<0.0001),
and offered better homogeneity for inguinal PTV (i.e., 1.07±0.01, P<0.0001). The 3D-ACT decreased the
rectum absorbed dose, V40 (volume receiving ≥40Gy), V45, and D max to 50.21±27.21, 22.81±10.22, and
46.56±1.11, respectively. With regard to femoral heads, the 3D-ACT decreased the D max and V45 in
comparison to the other two techniques.
Conclusion:
The 3D-ACT seems to be an alternative to the AP-PA irradiation techniques in postoperative setting when
IMRT is unavailable.

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P-022

DETERMINATION OF THE HIGH CONTRAST SPATIAL RESOLUTION BY MEANS

OF THE MODULATION TRANSFER FUNCTION IN CBCT DENTALS

Silvio Rizo Balladares, Patricia Mora, David Solano Solano

Fisica, Costa Rica

Diagnostic and Interventional Radiology – General

Objetive: Evaluate the performance of the high contrast spatial resolution module of the Mora-Rizo
phantom in dental cone beam CT (CBCT) scanners.
Method: For the evaluation of image quality metrics in dental CBCT, the Mora-Rizo phantom was
developed at the University of Costa Rica. It has an MTF evaluation module, which consists of a copper
wire of 0.22 mm in diameter inserted in a 16 cm diameter circumference of PMMA and 2.55 cm of
thickness; the copper wire is angled to five degrees with respect to the central axis of the disc. Images with
3 different scanners using 80 kVp and 5mA technique factors, were analyzed using ImageJ software. Using
a 60mm2 regions of interest (ROI) on the bright point of the wire, a matrix in shades of gray was generated,
which is then subjected to a Fourier transform to obtain the Gaussian curve. The MTF at 10% is finally
extrapolated from the curve. The Mora-Rizo phantom was validated using the PVC border and associated
software of the QUART phantom (a commercial CBCT phantom).
Results: MTF obtained with Mora-Rizo phantom for the 3 equipments evaluated were: 2.8, 2.65 and 2.70
lp/mm and with the QUART phantom 2.70, 2.60 and 2.58 lp/mm. Both phantoms reported values greater
than 2.5 lp/mm as expected by the manufacturers of the CBCT equipment.
Conclusions: The Mora-Rizo phantom is a low-cost device that allows QC checks in dental CBCT
equipment. Data obtained are in agreement with those obtained with the QUART phantom. Available
commercial phantoms are very expensive for low income countries and this new phantom allows, in one of
its modules, the evaluation of spatial resolution, an IQ metrics that is not usually evaluated in CBCT QC
programs due to lack of test object and associated software.

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P-023

PATIENT DOSES IN INTERVENTIONAL CARDIOLOGY PROCEDURES

Adalberto Machado Tejeda1, Oxana Elvira Collado Caballero1, Luis Rafael Sánchez Zamora2, Alien Díaz
Díaz2, Alejandro de Jesús González Linares2
1
Center for State Control of drugs and Medical Devices, Cuba
2
Hermanos Ameijeiras Surgical Clinical Hospital

Diagnostic Radiology –Dosimetry

Introduction: The aim of this study is to evaluate the dose received by patients undergoing Interventional
Cardiology procedures in Hemodynamic services and to establish a follow-up of these patients from the
check of a record of doses that exceed the references values for these interventional procedures.
Material and Methods: The research used the management of dosimetric data corresponding to diagnostic
coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures,
obtained of DICOM information provided by the equipment. The dosimetric quantities used were Kerma-
Area Product and Entrance Surface Air Kerma, fluoroscopy time and number of images adquired.
Results: The value of the PKA in the PTCA was 104.92 Gy.cm2 compared to 45.4 Gy.cm2 in the CA, being
lower than those determined in a study carried out in 2009 by the International Atomic Energy Agency,
which reached 125 Gy.cm2 and 50 Gy.cm2 respectively. The results for the other quantities evaluated were:
in the CA the fluoroscopy time was 6.5 minutes, the number of images 662 and the kerma of 812.6 mGy,
whereas for the PTCA the fluoroscopy time was 17, 8 minutes, number of images 1364 and air kerma of
1773.7 mGy.
Conclusions: It was identified that 10.8% of cases exceed the value of 200Gy.cm2 for PKA during
therapeutic procedures. In addition, it was verified that some of these patients were re-intervened, reaching
values in the second moment superior to 100 Gy.cm2. The specialists of the service are aware of the need
to optimize the practice and guarantee the radiological safety of the patient as well as to implement a
monitoring protocol that provides the required surveillance in these cases.
Key words: Interventional radiology, diagnostic coronary angiography and percutaneous transluminal
coronary angioplasty.

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P-024

CHARACTERIZATION OF A SYSTEM OF COMPUTED RADIOGRAPHY

DEDICATED TO THE OBTAINING OF MAMMOGRAPHIC IMAGES

Oxana Elvira Collado Caballero1, Luis Rafael Sánchez Zamora2, Alejandro de Jesús González Linares2,
Adalberto Machado Tejeda1
1
Center for State Control of drugs and Medical Devices, Cuba
2
Hermanos Ameijeiras Surgical Clinical Hospital

Diagnostic and Interventional Radiology – General

Introduction: The installation of new digital technologies on mammography services in Cuba began quite
recently. The aim of this study is the characterization of a digital mammography unit based on a
Radiography Computed System starting from the evaluation of its main technical parameters.
Methods and Materials: Recommendations of the manufacturer and the International Atomic Energy
Agency (IAEA) were taken into account and applied on a Viola equipment, manufactured by General
Medical Merate (GMM), which was provided with FCR Capsula XLII system produced by Fujifilm. The
measurements performed were grouped into five categories: beam quality, automatic exposure control
evaluation, the detector's performance, image quality and dosimetry.
Results: We were able to verify that the system complies with both national and international requirements
implemented in our country, with the exception of the automatic exposure control evaluation tests, where
the Signal Difference Noise Ratio (SDNR) value obtained for 70 mm of breast thickness is below the
established tolerances.
Conclusions: It also demonstrates the feasibility in the application of this methodology to similar
technologies to be installed in other services of the country.
Keywords: digital mammography; computed radiography.

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P-025

CALCULATION SHIELD FOR AN INSTALLATION OF ORTHOVOLTAGE

MACHINE, T-200 (WOMED)

Luis Rafael Sánchez Zamora, Arnaldo Rubio Rivero

Hermanos Ameijeiras Surgical Clinical Hospital, Cuba

Radiation Protection

Introduction. For the installation of a surface radiotherapy equipment, in a relatively small room, it was
necessary to calculate the shielding and remodel the room for the new use that was going to be used, the
calculation was optimized, to guarantee the dose restrictions at each point and at the same time that it would
not affect the area for its location. The methodology described in the IAEA Safety Reports No. 47 was the
used one. Radiation Protection in the Design of Radiotherapy Facilities. Frequently they are used for
shielding, concrete, lead, steel / iron for their well-known characteristics, here we propose the use of
refractory brick, due to its properties (density 3.5 g / cm3) and the strict quality control that is carried out.
Objectives: perform the calculation to determine the thickness of barriers using the before mentioned
material and validate its use as a low-cost material, available in the country, mainly in those buildings that
must be remodeled, for its easy handling and its characteristics. The equipment located, a T-200 of Wolf -
Medizintechnik (WOmed), with voltages between 20 - 200 kV, (superficial radiotherapy). The calculations
were made taking into account the characteristics of the existing walls, the location and orientation of the
equipment, as well as the distance to the calculation point, according to the information provided by the
manufacturer. The results show the required thicknesses for each of the barriers, (effective concrete
thickness 2.35 g / cm3) and its equivalent in refractory bricks. It is concluded that all walls should be
reinforced. The roof, being an area that has restricted access and taking into account the principle of
optimization, without compromising the safety, we evaluate that it is sufficient to maintain strict control
measures in the area.

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P-027

FAILURES IN SAFETY DETECTED IN THE DEVELOPMENT

OF BONE STUDIES IN GAMMA CAMERA IN NUCLEAR MEDICINE FRANK PAÍS
HOSPITAL

Yudmila Reyes González, Luis Oscar Marrero Ricerón

CCOI Frank Pais, Cuba

Radiation Protection

Due to the use of ionizing radiation in the specialty of Nuclear Medicine Diagnostics, it is necessary to take
into account norms and measures to prevent the occurrence of any type of incident that is harmful to both
TOEs, the public and patients. In this work, an evaluation of the safety failures detected during the
development of bone studies in the nuclear medicine service is carried out Detailing the process, evaluating
events and initiating events and failures that may cause radiological events or accidents. An estimation of
their impact is made, and solutions are proposed to the problems encountered. From this work it was
obtained that taking into account the 20 years of experience accumulated by the Department of Nuclear
Medicine, the radiological events of higher risk are linked to the exceeding of the guidelines for diagnostic
studies, followed by those associated with spillage of radioactive substances.

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P-028

EVALUATION OF SAFETY IN INTERVENTIONAL RADIOLOGY USING THE

CODE SECURE-MR-FMEA 3.0

Alejandro de Jesús González Linares1, Luis Rafael Sánchez Zamora1, Antonio Torres del Valle2,
Adalberto Machado Tejeda3, Alién Díaz Díaz1
1
Hermanos Ameijeiras Hospital, Cuba
2
InSTEC
3
CECMED

Radiology – Radiation Protection.

Introduction: Interventional Radiology is a sub-specialty of radiology where imaging techniques are used
to perform minimally invasive procedures. The use of this technique has multiplied vertiginously in recent
times, becoming also one of the medical applications that produces the highest doses of radiation to both
the patient and the personnel involved in the procedure, as well as the possible occurrence of serious
injuries. For this reason, an assessment of the risks associated with this practice was made. Objectives:
Carry out the risk pattern of the practice of interventional radiology and identify the causes and
consequences that can cause these unwanted events, whether for patients, workers or the public, from the
installation of the equipment, to the post-treatment monitoring of the patient. Methods and Materials: We
used the semi-quantitative risk matrix method, using the Cuban code SECURE-MR-FMEA 3.0, which is a
tool that gives us the possibility to establish priorities in the risk management of a practice from the
combined analysis of the frequency of an unwanted event, the probability of failure of existing barriers and
their consequences. Results: The process map was prepared, identifying 6 stages with 80 initiating events,
of which 90 % had an impact on the human factor. The results showed that the first risk assessment for the
developed model, reports 30% of high risks, 35% of medium risks and 35% of low risks, and once the
number of controllers increases the high risks decrease up to 0 % and there is an increase in medium and
low risks of 47.5 % and 52.5% respectively. Conclusion: A risk analysis was performed on the practice of
interventional radiology, where the main reasons that may trigger adverse situations and the vulnerable
points related to this practice were identified.

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P-029

THEORETICAL ARGUMENT FOR THE CONVERSION OF FMEA TO A RISK

MATRIX

Antonio Torres1, Rodolfo Alfonso1, Ramón López2

1
University of Havana, Cuba
2
CNSNS, Mexico

Radiation Protection

Introduction: Currently two approaches are used for risk assessment in radiation medicine, namely, the risk
matrix (RM) and the Failure Mode and Effect Analysis (FMEA) methods. Methods and Materials: A
general description of RM and FMEA is shown, revealing each method's pros & cons, and the advantages
of a coupled approach. The methodology for the conversion from one method to the other is described.
Results: A theoretical analysis of their similarities and differences between them is presented. The
rationality for coupling both methods is discussed, arguing on their positive and negative features for
complementarily. Conclusions: The article demonstrates the feasibility of theoretically deducing a RM from
a previous FMEA study.
Keywords: risk matrix, FMEA, defense measures, quality assurance.

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P-030

ILLUSTRATION OF THE SYNERGY FMEA RISK MATRIX USING THE RISK

STUDY OF THE IMRT PRACTICE

Antonio Torres1, Rodolfo Alfonso2

University of Havana, Cuba

Radiation Protection

Introduction: Studies of theoretical argumentation justify the complementarily between FMEA methods
and risk matrix (MR).
Materials: Risk study of intensity modulated radiotherapy (IMRT) based on the FMEA methodology.
Methods: FMEA, MR and FMEA-MR conversion method.
Results and discussion: The article include several transcendent failures modes of the IMRT study as well
as the corresponding accidental sequences resulting from its conversion. The structures of these sequences
are discussed, in terms of defense measures, and their levels of risk.
Conclusions: The conversion of failure modes (FMEA) to accidental sequences (MR) shows some typical
situations of risk control that constitute patterns of behavior of said application.
Keywords: risk matrix, FMEA, defense measures, failures modes, accidental sequences.

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P-032

MECHANICAL, CHEMICAL, STRUCTURAL, AND RADIOLOGICAL CHANGES

ASSOCIATED WITH DIETARY INTAKE OF NICKEL RECOVERY SLAG IN
PIGEON BONE

Eduardo Galiano Galiano, Michel Lapointe

Laurentian University, Canada

Biomedical Engineering

Slag from nickel smelting operations in the Sudbury basin has become ubiquitous. This material rich in
heavy metals such as iron, upon ingestion has the potential to effect physical, radiological, chemical,
mechanical, and structural changes in biological systems. In this work, we analyze the effects of slag
ingestion through diet, on several quantitative and qualitative parameters of the tibio-tarsal bones in pigeons
(Columba livia domestica). The specimens were divided into a control group provided a (normal) diet of
clean limestone, and an experimental group fed slag-based grit, both for a period of one year. Their tibio-
tarsal bones were then harvested for further analysis. Quantitative analytical methods included conventional
density measurements, caliper-based cortical thickness measurements, bone mineral density measurements
using Dual Energy X-ray Absorptiometry (DEXA), calcium and iron concentration measurements using
mass spectrometry, and the determination of Young's Modulus and ultimate breaking strength (both in
compression) using a universal testing machine (UTM). Qualitative microscopy studies, both optical and
electron, including energy dispersive spectroscopy (EDS) was also carried out for both sample groups. A
student t test (single tail) was used to compare means of the six quantitative parameters between control
and experimental samples, and in all cases a statistically significant difference was found (p ≤ .05).
Microscopy and EDS analysis revealed structural differences in bone between the two groups. Engineering
hardness testing of dietary components revealed that the experimental group diet contained components
approximately twice as hard (Brinell and Rockwell hardness) as those in the control group diet. We
conclude that slag ingestion through diet in the species examined, is associated with measurable changes
in physical, radiological, mechanical, chemical, and structural properties of the tibio-tarsal bones.

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P-035

THE USE OF DYNAMIC MEMBERSHIP FUNCTIONS ON IMRT PLANS

Eduardo Cisternas, Fang-Fang Yin

Duke University, USA

Radiation Oncology –Treatment Planning

Purpose: The tuning for the weighting factors in the objective function for an IMRT plan is driven by
humans to achieve an ideal dose distribution. This is done manually in a tedious and time-consuming
process based on trial and error and user experience. In the past fuzzy inference system (FIS) relying on
static membership functions were used to tuning the weighting factors. The aim of this work is to propose
a method for self-generating membership functions using an unsupervised learning method.
Methods: A dynamic membership function generator was implemented to translate linguistic humans tag
(i.e. High or low dose) for different types of organs (target volume, the organ at risk and normal tissue) into
a degree of truth. The membership function was generated using an iterative algorithm implemented in
MATLAB using three mains points: central, left and right vertex for different types of membership
functions, such as triangular, Gaussian, sigmoid and s-shaped. Then, they were evaluated in a Fuzzy logic
guided inverse planning system to optimize the optimal combination of weighting factors in the objective
function for an IMRT plan.
Results: The performance of the algorithm was examined using the C-Shape TG119 IMRT phantom using
the variations of weighting factors and mean dose versus the iteration number as well as dose volume
histograms. Fuzzy logic guided inverse planning system is capable of finding the optimal combination of
mean dose and weighting factors for different anatomical structures involved in treatment planning within
20 iterations.
Conclusion: It is possible to use a feasible way to automatically tune the weighting factors for an IMRT
plan under the guidance of FIS using an unsupervised membership functions generator without human
intervention other than providing the treatment plan parameters and set of constraints.

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P-037

LOCAL DIAGNOSTIC REFERENCE LEVELS FOR RADIOGRAPHIC

PROCEDURES AT HAMAD MEDICAL CORPORATION HOSPITALS IN QATAR

Huda Al Naemi, Mohammad Kharita, Antar Aly

Hamad Medical Corporation, Qatar

Radiology – Radiation Protection.

Introduction: Surveys of dose estimates from different imaging modalities highlight the substantial
variations in dose between some healthcare facilities for the same examinations or procedure. LDRLs were
determined for different hospitals. The dose quantity used is air kerma-area product (KAP). The results
indicated will be used for standardization of dose and reduction in variation in dose without compromising
the image quality. The aim of this work is to establish local diagnostic reference levels (LDRL) for typical
radiographic examinations in Hamad Medical Corporation (HMC) Hospitals.
Methods: The initial survey included 7 radiologic projections for patients undergoing standard radiographic
examinations using digital radiography (DR) in 4 general hospitals within Hamad Medical Corporation
(HMC) in Qatar: Hamad General Hospital (HGH), Al Wakra Hospital (AWH), Al Khor Hospital (AKH)
and The Cuban Hospital (CH). These hospitals were selected for this project as it is the biggest healthcare
provider in country. Data were recorded from different X-ray rooms in HMC hospitals. Air kerma-area
product (KAP) were determined for the most common X-ray examinations namely: Skull, Chest, Abdomen,
Lumbar Spine and Pelvis. The 75-percentile value for each examination was taken as the LDRL for each
room. The average value for all the room was taken as the LDRL for each of the hospitals and compared
with the national Diagnostic Reference Level.
Results and conclusion: the initial results showed that for the studied sample the average age was 46 years,
the average weight of 85 kg and mean height of 160 cm. The most procedure performed during the time of
this study was chest PA (28%), and the least procedure performed was skull AP/LAT (15%). The LDRL in
all hospitals were found to be lower than the National DRL values. More detailed analysis will be provided
upon completion of the work in the next three months.

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P-038

USEFULNESS OF LOCALLY CONSTRUCTED PHANTOMS FOR THE

VALIDATION OF PLANNED RADIATION FOR BREAST CANCER
RADIOTHERAPY TREATMENT

Theresa Bebaaku Dery1, Adolf Kofi Awua1, Samuel Nii Tagoe2, Joseph Kwabena Amoako3, Paul
Kingsley Bauh-Bassuah4
1
Radiological and Medical Sciences Research Institute (RAMSRI), Ghana Atomic Energy Commission,
Ghana
2
National Centre for Radiotherapy and Nuclear Medicine Department, Korle-Bu
3
Radiation Protection Institute (RPI), Ghana Atomic Energy Commission
4
Department of Physics, University of Cape Coast

Radiation Oncology – Quality Assurance

GLOBOCAN estimates, indicate that 4645 new cases were diagnosed, and 1871 death occurred due to
breast cancer in Ghana in 2018; making it a major public health problem. To ensure the facilities in Ghana
implement quality control measures, this study was designed to determine and compare planned with actual
doses delivered to the breast during treatment. This is to achieve this, the major limitation of the non-
availability of phantoms was addressed by the construction of phantoms, using perspex and locally
available materials that mimic organs of the female thoracic cavity.
Based on scanned images, two phantoms were constructed. Balloons, mango seed, cassava stick and candle
were radiologically assessed and used as surrogates for the lung, heart, spinal cord and glandular tissue of
the breast respectively. Higher photon energies from a 60Co and LINAC machine were targeted at the left
breast of a standard and the two constructed phantoms. EBT3 film dosimeter was used to measure absorbed
doses to the breast and non-target organs.
The deviations of delivered doses from planned doses when the standard anthropomorphic phantom,
constructed phantoms A and B were used, ranged as follows, -0.05 – 0.03 Gy; -0.08 – 0.01 Gy; -0.14 – 0.01
Gy respectively, when the radiation was delivered by a Cobolt-60 machine. When the radiation was
delivered by a linear accelerator systems, the deviations were -0.05 – 0.03 Gy; -006 – 0.07 Gy; -0.06 – 0.04
Gy respectively. The left lung and spinal cord received the highest and lowest unintended dose, 0.74±0.04
Gy (Co-60) and 0.78±0.01 Gy (LINAC), and 0.03±0.02 Gy and 0.05±0.01 Gy respectively.
The study has demonstrated that local materials are potentially useful for the construction of phantoms,
which can be good substitutes for standard commercial phantoms in ensuring the safety of patients under-
going radiotherapy treatment for breast cancer.

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P-039

131I INTAKE SURVEILLANCE OF NUCLEAR MEDICINE WORKERS USING A

THYROID PROBE “IN SITU”

Adlin López Díaz, Juan Miguel Martín Escuela, Viviana Fernández Rodríguez, Venus Amelia García
Mena, Luis Sánchez Zamora

Nuclear Medicine Department, Hospital “Hermanos Ameijeiras”, Cuba

Nuclear Medicine

This research, propose and verify a monitoring procedure of 131I intake of nuclear medicine workers using
the thyroid probe of the Nuclear Medicine Department. The counter used is a gamma probe with
NaI(Tl)scintillationdetectorof30x30cm. The efficiency calibration was performed with a thyroid phantom,
simulating the adult thyroid anatomical shape and volume, filled with radioactive solution of known activity
of 131I (uncertain activities < 2.24%). The intake and the effective dose estimation were made following
the steps suggested in the IDEAS - General Guidelines for the Estimation of the Committed Effective Dose
from Incorporation Monitoring Data. The efficiency (E) was 3.76x 10-3± 1.15x 10-4 CPS/Bq, Minimum
Detectable Amount (MDA)was46Bq. The probe system is capable to detect dose as low as 0,004mSv at
24h and 0,02mSv at 2h. A worker monitoring 131I intakes procedure was proposed and established, based
on routine screening 2 and 24hours after to finish daily activities in the “hot lab”, “administration routine”
of 131I dose to patient, contaminated wastes manipulations, or in case of detected or suspected radionuclide
intake. If the contamination is positive, confirmatory monitoring should be developed using the “probe”
and the gamma camera if preliminary intake is greater than 75KBq for spatial uptake distribution. The
committed equivalent thyroid dose will be evaluated taking into account the real thyroid mass, using the
up-taking mass correlated with ultrasound and the real worker bio-kinetic behaviour. The use of probe, for
this purpose, produces a significant reduction of dose estimation deviation caused by the thyroid mass,
effective half-time and the time of intake. The measurement uncertainof100Bqthyroiduptakewas±15%.
During14 months, the monitoring program has detected 2 intakes of 0.03 y 0.026 mSv, which using 15 days
monitoring frequency could be undetected, proving its efficacy and appropriateness.

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P-040

ESTIMATION OF VOLUMETRIC DOSE DISTRIBUTION IN I131

HYPERTHYROIDISM TREATMENT: PRELIMINARY RESULTS

Adlin López Díaz1, Viviana Fernández Rodríguez1, Rosa María Real Cancio2, Juan Miguel Martín
Escuela1
1
Nuclear Medicine Department, Hospital “Hermanos Ameijeiras”, Cuba
2
Endocrinology Service, Hospital “Hermanos Ameijeiras”

Nuclear Medicine

To estimate the 3D dose delivery deviations produced by prescribed activity during I131 Hyperthyroidism
treatment, a computer Matlab application was developed and verified. It was design to execute:
radiopharmaceutical curve fitting, cumulated activity calculations, functional thyroid mass estimation, to
obtain the therapeutic planning activity to warranty the prescribed dose or to obtain the dose caused by
prescribed activity, using a theoretical or “S” factors method. It also produces the 3D planning dose map
and related dosimetry parameters. The developed system was verify successfully using a test image
phantom and 6 known pharmacokinetics data. To test the clinical application were used 10 patient ́s
information (activity prescribed, I131 SPECT and biokinetics). The tridimensional thyroid volume
cumulated activity and dose distributions were heterogeneous. 3D dose distribution showed standard
deviations between 21,8-83,9Gy of mean dose calculated by “S” factors. The differences between mean
dose calculated by theoretical and “S” factors were no significant and less than 10% (p>0.05), showing the
system capability to proper dosimetry calculation. The biological effective dose (BED) showed significant
difference between the same patient (p≤0.05). The 3D dose distribution dissimilarities between “S” factors
and theoretical methods took the maximum value of 23%, near to the thyroids boundaries tissue. Despite
this difference is inside the typical uncertain range of dose determination method, the issue should be study
deeply using Monte Carlo (MC) approach in order to clarify the voxel dose accuracy of the two methods.
Conclusions: the 3D treatment planning dose distribution were completely no-homogenous, the significant
difference observed should be study in the future more deeply in order to optimized the hyperthyroidism
iodine treatment. This study found significant dose differences in the target volume to be treated, suggesting
that average tissue dose could not be the best approach to develop a nuclear medicine thyroid treatment
planning.

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P-041

ESTIMATION OF THYROID'S DOSE UNCERTAIN DURING I131

HYPERTHYROIDISM TREATMENT PLANNING

Adlin López Díaz1, Rodolfo Alfonso Laguardia2, Joaquín González González3

1
Nuclear Medicine Department, Hospital “Hermanos Ameijeiras”, Cuba
2
INsTEC, Havava University
3
Nuclear Medicine Department, Oncology and Radiobiology National Institute

Nuclear Medicine

To estimate the thyroid's dose and its uncertain during I131 hyperthyroidism treatment planning, the
information of ultrasound (US), gammagraphy (2D), SPECT(3D) images and I131 pharmaco-kinetic
diagnostic measurement of 10 patients with their activity prescription were used. The thyroid average dose
was estimated using hybrid methods based in US, 2D and 3D information (mass and biodistribution)
combined with I131 kinetic evaluation using a thyroid probe. The thyroid dose distribution was calculated
using a theoretical and “S” factors methods using 3D images and the probe data. The uncertain sources
taking into account were grouped like: (1) measurement of the administered activity, (2) quantitative
imaging activity and thyroid mass estimation (QI), (3) quantitative of I131 kinetic with the probe, (4)
integration of activity measurements over the time of diagnose/treatment, (5) calculation of the dose from
different methods. The overall uncertainty of the estimated thyroid dose was expressed with 95%
confidence interval. The dependence of dose's combined uncertainty varied between methods for the same
patient, but they had determinant parameters like uncertainty related to mass's determination method used,
statistical of thyroid activity measurement, variation of body-thyroid dimensions and overlaying structures-
tissue and the kinetic modelling parameters used. The dose uncertain of 3D SPECT and US mass
determination combined with double exponential pharmacokinetic showed the values around 10%,
meanwhile 2D gammagraphy/double exponential and US mass determination combined with one
exponential fit or only one patient specific pharmacokinetic parameters were 16.2±6.4%, 11.1±2.8% and
29.4±14.6% respectively. The 3D dose distribution showed uncertain of 10.1±0.2% for theoretical methods
and 9.8±0.2% by “S” factor method. The uncertain dose estimation can be implemented during
hyperthyroidism I131 treatment planning, under patient specific bases. Those estimations can help the
physician to select the most accuracy treatment and encourage the implementation of better prediction of
treatment results.

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P-042

INTRODUCTION OF RADIOGUIDED SURGICAL PROCEDURES: MEDICAL

PHYSICS ASPECTS

Adlin López Díaz1, Consuelo Varela Corona2, Adela Peña Tornes3

1
Nuclear Medicine Department, Hospital “Hermanos Ameijeiras” , Cuba
2
CECMED
3
CENTIS

Radiation Protection

Introduction: With the purpose to warranty the safety introduction of radioguided surgery (RGS) procedures
in Cuba, all the related medical physics (MP) technical details were reviewed and stablished with a quality
management process philosophy. All the project was support by the IAEA National Project CUB6027.
Materials and Methods: the selected multidisciplinary team analyzed the national situation using a NM
survey and all the related information available. The process map to setup the multi-disciplinary process,
showing the primary and support management processes were generated, including all the medical physics
details involved, as part of the multidisciplinary approach.
Results: The strategic planning included the MP human resource and the sustainability of the education
RGS aspects, the develop of national quality control guidelines for the related equipment were stablished,
the traceability process and legal issues were defined. The gradual introduction was planning: starting for
3 reference centers and it will continue with 6 hospitals more. The human resource education and training
was planned using the principles of “train the trainers”. A national specialized training course was
accredited for the multidisciplinary team. The risk analysis was taking into account during the planning.
The evaluation of different steps was systematic, patient orientated and outcome based. Aspects of radiation
safety and patient protection were also integrated to the process.
Conclusion: the RGS were planed and stablished including all the MP related aspects. This approach
ensures consistency in providing safe, high quality and high-level services to patients and staff. Increasingly
the standardized clinical protocols and evidence-based medicine.

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P-043

SAFETY ASSESSMENTS THROUGH THE USE OF THE RISK MATRIX METHOD

IN NUCLEAR MEDICINE

Alén Díaz Díaz1, Luis Rafael Sánchez Zamor1, Adalberto Machado Tejeda2, Juan Miguel Martín Escuela1
1
Hermanos Ameijeiras Hospital, Cuba
2
CECMED

Nuclear Medicine

Introduction: The quality of the diagnosis and treatment in Nuclear Medicine are bound to different factors
that needs to be kept in mind. The accidents happened in this area can affect to patients, workers and public,
should be controlled the causes and consequences that could lead to them. It was our objective to carry out
a security evaluation to a Department of Nuclear Medicine in a Cuban hospital, using the method Risk
Matrix, to demonstrate their utility for it, keeping in mind the probability and magnitude of the potential
exhibitions. Material and method: We use the software SEVRRA (realized by the National Commission of
Nuclear Safety and Safeguards of Mexico), the module of nuclear medicine was developed by Cuban
specialists. The method allows to identify the causes that can cause an accidental exhibition, keeping in
mind the frequency of occurrence of the event initiator(EI), If the probability of flaws of existent barriers
and the consequences graveness, facilitating the identification of the associate risk from the acceptance and
setting in service of the equipment, the diagnosis and treatment, included the maintenance. We could
identify which accidental sequences have bigger risk and to propose the measures that allow to reduce the
same one. Results: The obtained profile showed that during the treatments, just 2(EI) classify with high risk
(HR), these constitute 4% of the total of the analyzed initiators, 88% with medium risk (MR) and 4% low
risk (LR). The diagnosis, 9% of (EI) classify as HR, and 75% MR and 15% LR, Conclusions: We should
take an attitude of continuous surveillance on these initiators and to be attentative to the implied barriers in
this analysis are always active to guarantee the safety, of the patients, workers and public: don't pass to be
part of the high risk initiators.

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P-044

INVESTIGATION OF A BRAZILIAN MINERAL TO ACT AS OSL NATURAL

DOSIMETER

Neilo M. Trindade1, Matheus C. S. Nunes1, Luan S. Lima2, Anna L. M. C. Malthez3, Elisabeth M.

Yoshimura2
1
Federal Institute of Education, Science and Technology of São Paulo, Department of Physics, São Paulo,
SP, Brazil
2
University of São Paulo, Institute of Physics, São Paulo, SP, Brazil
3
Federal University of Technology – Parana, Department of Physics, Curitiba, PR, Brazil

Radiation Oncology – Dosimetry

Introduction: Natural and synthetic dosimetric materials are used for the determination of the irradiation
dose received in the environment as well as in medical and technological activities. Natural dosimeters find
application, e.g., in retrospective dosimetry and may be a lower-cost alternative to synthetic ones. Brazil is
one of the largest producers of minerals in the world, including alexandrite (BeAl2O4: Cr3+). The chemical
nature of the mineral alexandrite combines two binary oxides, BeO and Al2O3, both oxides being
commercially used as dosimeters. So this suggests alexandrite an interesting candidate for investigation as
a natural dosimetric material.
Methods and Materials: Alexandrite-polymer pellets, disc-shaped, homogenous and ductile were evaluated
using OSL technique. OSL is the process by which a previously irradiated material emits light when
illuminated. The OSL measurements were performed using a Riso equipment (beta source). OSL emission
was stimulated using blue light emitting diodes (470 nm, FWHM = 20 nm) delivering 80 mW/cm2 at the
sample position in CW mode. The characteristics studied were dose - response (0.1 up to 5 Gy),
reproducibility and fading.
Results: The results showed that the OSL intensity signal varies linearly with the dose, a fast fading of 40%
in the first half hour of storage, but with the signal remaining constant for at least five hours more. The
reproducibility results showed a variation smaller than 5%, within the 95% confidence interval. Results
obtained with these pellets showed sensitivity in a large range of doses. In addition, it was also noted that
the shape of the OSL decay curve was independent of the radiation dose, an important feature for an OSL
dosimetric material.
Conclusion: Composites based on alexandrite powder were successfully fabricated. Our results showed
alexandrite mineral is a promising natural material for OSL dosimetry.

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P-045

DOSIMETRY VERIFICATION OF HIGH DOSE RATE BRACHYTHERAPY FOR

CERVICAL CANCER USING COBALT-60 SOURCE

Bright Kwadwo Bour1, Stephen Inkoom2, Samuel Nii-Adu Tagoe3, John Humphrey Amuasi1, Francis
Hasford1
1
Department of Medical Physics, Graduate School of Nuclear and Allied Sciences, University of Ghana,
Ghana
2
Radiation Protection Institute, Ghana Atomic Energy Commission, Accra, Ghana
3
National Center for Radiotherapy and Nuclear Medicine, Korle-bu Teaching Hospital, Accra, Ghana

Radiation Oncology – Brachytherapy

Introduction: Transition from the low dose rate brachytherapy to high dose rate brachytherapy at our
department necessitated the performance of dose verification test, which served as an end-to-end quality
assurance procedure to verify and validate dose delivery in intracavitary brachytherapy of the cervix and
the vaginal walls based on the Manchester system.
Materials: One dimensional manual water phantom, Gafchromic EBT3 film (Lot number: 04201601), in-
house cervix phantom.
Methodology: An in-house water phantom was designed and constructed from perspex sheets to represent
the cervix region of a standard adult patient. The phantom was used to verify whole dose delivery chain
such as calibration of the cobalt-60 source in use, applicator and source localization method, output of
treatment planning with dedicated treatment planning system and actual dose delivery process. Doses were
measured with calibrated gafchromic EBT3 films at various points within in-house phantom for a number
of clinical implants that were likely to be used to treat patient based on departmental protocol.
Results and Conclusion: The measured doses were compared to those of the treatment planning system.
The discrepancies between measured doses and their corresponding calculated doses obtained with the
treatment planning system ranged from - 28.75% to 42.19% (mean of plus or minus 12.50%). The results
of this study provide a good evidence for agreement in dose distribution in a definite clinical condition
regarding doses to the specific points in the phantom with a non-significant difference in accuracy. The
study can therefore be used as a quality assurance tool to evaluate the entire procedures involved with
brachytherapy treatment.

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P-046

PRODUCTION AND STUDY OF THERMOLUMINESCENT MATERIALS FOR LOW

DOSE DOSIMETRY

Laís Aparecida Forner, Patrícia Nicolucci

University of São Paulo, Brazil

Radiation Protection

Introduction
Thermoluminescent dosimeters (TLDs) are widely used for the quantification of radiation doses in different
applications. Calcium sulfate doped with dysprosium (CaSO4:Dy) is the only TLD commercially produced
in Brazil and is largely used on individual dosimetry.
The goal of this work was to produce TLD pellets with CaSO4 dopped with different rare earths and study
its response parameters, such as the emission curve, sensitivity, energetic and dose dependence and fading.
Methods and Materials
TLDs were produce using the Yamashita method, in that crystals are formed in a CaCO3 solution of
H2SO4. Pellets of CaSO4 doped with Dy;Tm, Tm, Dy;Tb, Tb, Eu and Dy;Eu were produced. Pellets of
CaSO4:Dy, produced and marketed by MRA Indústria Ltda, Brazil, were used for comparison.
Beams ranging from 30 to 120 kVp from an X-ray unit (model ISOVOL TITAN 160-EG) were used for
the energy dependence study. All the other tests were performed using Cs137. The calibration dose was
2.02 mGy. The pre-irradiation thermal treatment was at 300°C for 20 min, and the pre-reading thermal
treatment was at 100°C for 30 min. The readings were performed with a Thermo Scientific TL reader
(model Harshaw TLD 3500).
Results
The produced tablets of CaSO4:Tm presented the largest response (153 ± 14 nC/mGy), 17% higher than
the commercial pellets in average. The pellets of CaSO4:Tb and CaSO4:Eu presented the smallest
responses (88% and 42% of the commercial pellets). After 21 days, there was 5% fading for the CaSO4:Tm
pellets, 9% for CaSO 4:Dy,Tm and 13% for CaSO4:Dy. Moreover, the pellets of CaSO4:Tm presented the
higher homogeneity coefficient (36%). All the pellets presented energy dependence in agreement with the
literature, being maximum for beam N40 (ISO 4037-1).
Conclusions
The TL materials produced, especially CaSO4:Tm, presented suitable dosimetric characteristics for diverse
applications, and sensitivity for applications in individual dosimetry.

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P-048

VARIOUS APPROACHES FOR BREAST 3DCRT PLANNING

Matrika Prasad Adhikari Adhikari

B. P. Koirala Memorial Cancer Hospital, Nepal

Radiation Oncology –Treatment Planning

Introduction:
Two parallel oppose and single direct supraclav field is standard conventional planning technique in breast
planning. However, while doing 3DCRT the new technique needs to be used to address the hot spots, cold
spots and under coverage. Each case is different, and the same method of planning does not work in breast
planning.
Material and methods:
We have been using varian Clinac IX machine with 120 leaves Millennium MLC, Eclipse TPS version 15.5
and ARIA R& V system, version 15.5.
The following techniques are practiced for breast planning. All plan uses the hit and trail for mixed energy
6 and 15 Mv x-rays, MLC, wedge and Bolus.
1. Parallel oppose field to cover both chest wall and supraclave
2. Two parallel oppose field for chest wall and single direct field for supraclav
3. Multiple field technique.
4. SSD plan
Result:
Our experience shows that the cosmesis of breast surgery greatly affects the dose distribution and
optimization of the plan. Generally hot spot is found near the entrance of lateral tangential field. This can
be removed using 15 Mv x-rays. Sometime bolus is found to be useful to address the underdose on chest
wall. Multiple field increases dose to the organ at risk but can be used carefully to get better coverage
Conclusion:
The mixed energy method is very useful to reduce hot spot. Generally hot spot is found near the entrance
of lateral tangential field. This can be removed using 15 Mv x-rays while the medio tangential field has 6
Mv x-rays. Bolus is found to be useful to address the underdose on chest wall. SSD technique is not very
useful as it needs to set patient every day. If distribution is not good a multiple field approach can be used.

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P-049

STUDY OF DOSE DISTRIBUTION IN RADIOPHARMACEUTICALS AND THEIR

INTERCOMPARING WITH 3D HAND ARTICULATED SIMULATOR IN A
NUCLEAR MEDICINE SERVICE USING TLD-100H

Bruno Alves Brenga Vieira1, Cláudia Lúcia de Pinho Mauricio1, Marcus Alexandre Vallim de Alencar1,
Jorge Wagner Esteves da Silva2
1
Instituto de Radioproteção e Dosimetria (IRD-CNEN), Brazil
2
Instituto Nacional de Câncer (INCA-RJ)

Nuclear Medicine

In occupational nuclear medicine procedures, care should be taken to protect workers in order to keep doses
as low as reasonably practicable, thereby minimizing the risks associated with the occurrence of stochastic
effects.
In Brazil, the evaluation of the doses received by the IOE must be part of an occupational dosimetry
program. In a nuclear medicine service, the occupational dosimetry program must comply with CNEN-
NN-3.01 and CNEN-NN-3.05 of the National Nuclear Energy Commission.
Thus, this study aims to determine the equivalent dose in the lens and the distribution of doses at the ends
of the IOE of a Nuclear Medicine Service, in addition to the use of physical simulation through 3D printing
technology to aid in this search and obtain the relation between the most exposed point and the most
operationally adequate region for its monitoring. We evaluated four radiopharmaceuticals directly involved
in the routine manipulation of 99mTc-labeled radiopharmaceuticals. For each measurement point,
dosimetric assemblies containing four TLD-100H (LiF: Mg, Cu, P) were used. Termoluminescent
Dosimetry Laboratory (LDT) of the Division of Dosimetry of the Institute of Radioprotection and
Dosimetry of the National Commission of Nuclear Energy. The dose result obtained in each region was
calculated as the mean of the doses obtained in four TLDs present in the dosimetric set. The characterization
and calibration of the TLDs was done in the LDT according to ISO 4037-3.
From the results, it can be concluded that the occupational monitoring for the endpoint can be
underestimated 2 to 12 times in relation to the dose received by the radiopharmaceuticals, this
underestimation is directly related to the differences attributed to the monitoring model adopted by the
service. The estimation of the equivalent dose of crystalline from the value obtained by the effective dose
shows a good method for the estimation of the same.

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P-051

FINITE ELEMENT MODEL OF THE HUMAN EYE

Osiris Núñez, Claudia Muñoz, Alfo Jose Batista, Adrian Garmendía

The Higher Institute of Technologies and Applied Sciences (InSTEC), Cuba

Biomedical Engineering

The deformation of the eyeball is a topic of interest for the study of ocular traumas caused by blunt objects.
Hence in this work, two computational models of the ocular globe of the human eye were implemented in
a finite element modeling system in order to analyze such traumas.
The first geometric model of the eyes included the cornea, sclera, limbus, the optical nerve head and the
adipose tissue. Lineal elastic and hyperplastic material models were selected to represent the behavior of
the tissues. Using this globe model, the influence of the variation of intraocular pressure was considered in
the zone of the optical nerve; when the values of the maximum shear stress obtained were comparable with
those reported in the modern literature. This model was also employed to study traumas caused by the
impact of blunt objects, evaluating stresses and strains in the lamina cribrosa and the retina.
The rectus extraocular muscles were incorporated into in a second model, which included the cornea,
limbus and sclera. The action of a blunt object at different impact velocities was simulated to study the
influence of muscles on the deformation of ocular structures. An optimal meshing was obtained for which
the numerical simulation results are independent of the number of volumes in the computational domain.
The apical displacements of the cornea were compared in the model with and without taking into account
the presence of the rectus muscles. From this comparison, the minor apical displacement was obtained in
the model with muscles; this result may be due to a greater distribution of the loads in the system. However,
the behavior of the apical displacement when varying the impact velocity of the projectile is very similar
in both cases, which shows a stability in the response of the system.

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P-052

DOSE OPTIMIZATION IN PEDIATRICS CARDIAC X-RAY IMAGING

Hadijah Ndagire1, Emmy Okello2, John Omagino3, Wilson Nyakoojo2

1
Medical Physicist Uganda Heart Institute Mulago Hospital, Uganda
2
Consultant Adult Cardiology
3
Executive Director Uganda Heart Institute

Diagnostic Radiology –Dosimetry

Objective: To quantify the patient radiation dose reduction after the introduction of an X-ray imaging
technology using advanced real time image noise reduction and optimized acquisition chain for fluoroscopy
in pediatric and adult population with congenital heart disease
Background: Pediatric catheterization exposes patients to varying radiation doses. Dose optimization was
assessed by obtained radiation data collection. Biplane X-ray angiography Siemens Artis zee equipment
was used for clinical procedures. It is equipped with two flat detectors - a frontal detector measuring
30x38cm (48 cm diagonal) and lateral detector measuring 20x20cm (25cm diagonal). The flat detectors are
mounted on C-arm of the angiography system and move through a 360 degrees range around the patients.
Methodology: Patients and radiation doses were retrospectively collected August 2014 - August 2015 for
100 consecutive patients treated with a system using state of the art image processing and reference
acquisition chain. Radiation dose was quantified using dose area product (DAP), while procedure
complexity using fluoroscopy time, procedure duration and volume of contrast medium. Patients were
divided into three weight groups: A) below 10kg B) 10-40 kg and c) over 40kg. Results: For below 10kg,
10-40kg, over 40kg mean DAP values were 63.7cGycm2, 200 cGycm2, and 1900cGycm2 with
quantification at 50%, 70% and 60% respectively.
Conclusion: The new system provides significant patient dose reduction compared to the reference system.
Despite no other changes in the procedural approach, X-ray imaging technology provides a substantial
radiation dose reduction.

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P-053

DETERMINATION OF DOSIMETRIC LEAF GAP FACTOR WITH ROUNDED UNIT

MONITOR METHOD AND STUDY OF THE DOSIMETRIC EFFECT OF VARIATION
OF THIS FACTOR FOR PATIENTS TREATED IN IMRT WITH LINAC 80 LEAVES

Saidi Ridha1, Bouaouina Noureddine2

1
Medical Physicist, Tunisia
2
Departement Chief

Radiation Oncology – Dosimetry

Materials and Methods:

6MV beam energies and the Eclipse V.13.7 TPS are used in this study.
1- First Objective:
For the Rounded Monitor Unit method ( RMUM ), we use sweeping dynamic MLC leaf gap fields created
by Varian MLC shaper software with gaps: 4 mm, 10 mm and 20 mm.
The RMUM is based on this formula:
Vmax=VMmax/(D/60)
Vmax = Maximum value of speed of leaves deplacement = X jaw dimension / Monitor Unit = X / UM
V M max = Maximum value of mechanical speed of laves = 2.5 cm / s for our linac D = Dose rate used for
treatment : 300 UM/min
DLG values are measured with both 0.13 cc semi-flex ionization chamber and 0.6 cc Farmer Chamber, for
2 fields 10 cm x10 cm and 10 cm x 40 cm, for Water phantom and slides phantom, for different SSD (Skin
Source distance) and 2 rotation collimator angles 0 and 90 degrees and for different rotation bras angles.
For each method, the final DLG Value is the mean of the all values.
2- Second Objective:
On TPS, for ten Patients, we change the value of DLG. With the verification plans created on TPS, we
measure the absolute dose with 0.13 cc semiflex chamber and the 2D dose distribution with 2D
Array Matrix and Portal Imaging.
Results:
The difference between the DLG Values measured by Constructor Method and Rounded Unit Monitor
Method is around 0.5 mm. For ten patients, The DLG value determined by Rounded Unit Monitor Method
gives us results more than 95% for all fields. Those results are not found for the constructor method for
some fields.

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P-054

DOSIMETRIC COMPARISON OF CERVICAL CANCER TREATMENTS BETWEEN

ELECTRONIC BRACHYTHERAPY AND IR 192

Sergio Lozares1, Jose Antonio Font Gómez1, Almudena Gandía Martínez1, David Villa Gazulla1, Agustina
Méndez Villamón2
1
Medical Physicist, Spain
2
Radiation Oncologist

Radiation Oncology – Brachytherapy

Purpose:
We report the first cervical cancer cases treated with interstitial electronic brachytherapy (eBT) at our
hospital and compare them with plans made with high dose rate interstitial brachytherapy based on Ir192
(HDR-BT).
Materials and methods:
Eight patients with cervical cancer were treated with the Axxent eBT device (Xoft, Inc.). Planning was with
magnetic resonance imaging and computed tomography following the recommendations of the EMBRACE
protocol.
The dosimetry parameters of organs at risk (OAR) were evaluated for the bladder, rectum, and sigmoid
colon (D2cc, D1cc, D0.1cc). In addition, the V150 and V200 of irradiated tissue were compared for both
eBT and HDR-BT.
All patients received intensity-modulated external beam radiation therapy with a regimen of 23 sessions of
2 Gy followed by 4 sessions of 7 Gy of eBT performed over 2 weeks (2 sessions followed by another 2
sessions a week later) following the EMBRACE recommendations. Each of the 8 patients was followed to
assess acute toxicity associated with treatment.
Results:
The doses reaching OAR for eBT plans were lower than for HDR-BT plans. As for acute toxicity associated
with eBT, very few cases of mucositis were detected. No cases of rectal toxicity and 1 case with grade 1
urinary toxicity were detected. The results at 1 month are equally good, and no relapses have occurred to
date.
Conclusions:
The first results of treatment with the Axxent eBT device are promising, as no recurrences have been
observed and toxicity is very low. eBT is a good alternative for treating cervical cancer in centers without
access to conventional HDR.

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P-055

GENERALIZATION OF AN ANALYTICAL MODEL FOR PHOTON PERIPHERAL

DOSE CALCULATION

Beatriz Sánchez-Nieto1, Maite Romero-Expósito2

1
Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
2
Departament de Física, Universitat Autònoma de Barcelona, Bellaterra, Spain

Radiation Oncology – Dosimetry

Introduction: A simple analytical model that allows estimation of photon peripheral dose to organs in adult
patients, valid for any isocentric technique, has been proposed by Sánchez-Nieto et al.
(Biomed.Phys.Eng.Express 1,2015). This model fails in predicting a) dose to peripheral organ in paediatric
patients and b) peripheral dose to skin (for both, adults and children). The aim is to provide model
parameters for these two specific cases.
Method: The original peripheral photon dose-to-points model was fitted to the midline dose profile
measured with an EBT3 film sandwiched along a polyethylene block of 15×14×60 cm3, simulating the
volume of a child. An isocentric 6MV irradiation with 8 coplanar 6x6cm2 open beam was carried out.
Afterwards, validation was done using data from a clinical head treatment by EURADOS-WG9
(Rad.Prot.Dosim. 176:331-340,2017).
To generate the model for calculation of peripheral skin dose, the same humanoid phantom and irradiation
setting (but 6MV) as in (Sánchez-Nieto, 2015) was used to measure peripheral surface dose with EBT3-
films. A modified version of the model (avoiding the term related to depth in tissue) was then fitted to these
surface doses. Model validation was done with TLD-100 and EBT3-films placed on the surface of the adult
and child geometries, respectively.
Result: Parameters for the paediatric and skin dose models were A=0.0020 ±0.0001mSv/UM and
B=10.769±0.021mSv.cm2/UM and A=0.008±0.001mSv/UM and B=18.045±0.097mSv.cm2/UM,
respectively. Agreement between predictions and measurements were within 17%, except for the peripheral
skin dose model in the paediatric case. The resulting dose-at-points models were integrated between cranial-
caudal organ limits for peripheral dose-to-organ calculations.
Conclusion: Generalization of a peripheral dose model has been carried out to consider superficial dose and
paediatric cases. Validation of the model with the ATOM adult phantom and improvement of the surface
dose model for the paediatric case are in progress.
Acknowledgements: BSN acknowledges (Fondecyt N1181133) and PUC (P1702/2017).

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P-058

EFFECTS OF NON-CONFORMAL RADIOTHERAPY TECHNIQUES IN BREAST

CANCER PATIENTS

Iyobosa B. Uwadiae1, Anthony B. Ashun2, Samuel N. Tagoe2, Fatai A. Balaogun3, Akintunde A. Okunade4
1
University College Hospital, Ibadan, Nigeria
2
National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
3
Centre for Energy Research and Development, Obafemi Awolowo University, Ile-Ife, Nigeria
4
Department of Physics and Engineering Physics, Obafemi Awolowo University, Ile-Ife, Nigeria

Radiation Oncology –Treatment Planning

Introduction: Breast cancer is the most prevalent cancer type in women and global best practice in radiation
treatment of cancer requires the use of conformal techniques. Unavailability of required equipment in some
developing countries result in a deviation from standard practice. This study set out to estimate the ensuing
risk.
Methods and Materials: Twenty (20) breast cancer patients (stages I – III) were planned on a Prowess
Panther TPS using a 1.25 MeV cobalt beam of 80 cm SSD. The patients were simulated using both the
standard 3D two laterally opposed tangential fields with appropriate wedge angles and a 2D technique in
which the field borders were determined using bony landmarks on the Digitally Reconstructed Radiographs
(DRR) images mimicking the scenario in a typical low resource radiotherapy center. The beam was
conformed to the target using Cerrobend blocks for the standard 3D technique only. The two techniques
were compared in terms of the doses to the Planning Target Volume (PTV) and the Organs at Risk (OAR);
the lungs and the heart. The Lyman Kutcher Burman (LKB) Normal Tissue Complication Probability
(NTCP) model was used to assess the possibility of developing radiation pneumonitis and pericarditis in
the OARs respectively.
Results: The mean and maximum doses to the PTVs and OARs were significantly higher in the 3D
technique for all patients. The NTCP values showed that there was no risk of pericarditis while the risk for
pneumonitis was higher in the 3D technique. Conclusion: The doses to the OARs were lower in the 2D
technique than the 3D technique however at the expense of the coverage to the PTV.

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P-059

THE NEW IAEA PUBLICATION AND E-LEARNING MATERIAL ON IMAGE

GUIDED RADIOTHERAPY (IGRT)

Giorgia Loreti, Karen Christaki, Debbie van der Merwe , Brendan Healy

International Atomic Energy Agency, Austria

Education and Professional Issues

Introduction
In February 2019, the IAEA published new guidelines highlighting the milestones to be achieved by
radiotherapy departments in the safe and effective introduction of image guided radiotherapy (IGRT). The
publication, titled “Introduction of Image Guided Radiotherapy into Clinical Practice”, is available for free
download on the IAEA website and is accompanied by an e- learning module available on the open IAEA
e-learning platform CLP4NET. Part of the material of the e-learning was produced during a joint
International Centre for Theoretical Physics (ICTP) - International Atomic Energy Agency (IAEA)
workshop held in Miramare, Trieste in 2017. During this course, the lectures were video recorded with the
aim of creating virtual classes that would be included in an e-learning module.
Methods and Materials
The interest in the published educational material is analyzed from the number of downloads of the
publication and accesses to the online e-learning module. Correlations of regional distribution and other
users' data collected through the e-learning module are explored.
Results and Conclusions
The users accessed the material from all regions and the e-learning module, which included a self-
assessment in between each sub-module, showed a systematic progression of the users through the sub-
modules. This confirms the importance of self- assessment in pacing e-learning activities and ensuring that
key concepts are absorbed before e-students are allowed to access a module at a higher level of difficulty.

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P-064

PARTICULARITIES OF THE CONVERSION OF FMEA TO RISK MATRIX

Antonio Torres1, Rodolfo Alfonso1, Ramón López2

1
University of Havana, Cuba
2
CNSNS, Mexico

Education and Professional Issues

Introduction: Currently two approaches are used for risk assessment in radiation medicine, namely, the risk
matrix (RM) and the Failure Mode and Effect Analysis (FMEA) methods. Methods and Materials: A
general description of RM and FMEA is shown, revealing each method's pros & cons, and the advantages
of a coupled approach. The methodology for the conversion from one method to the other is described.
Results: The analysis of their similarities and differences between them is presented. The rationality for
coupling both methods is discussed, arguing on their positive and negative features. Conclusions: The
article demonstrates the feasibility of deducing a RM from a previous FMEA study.
Keywords: risk matrix, FMEA, defense measures, quality assurance.

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P-068

CLINICAL INDICATION BASED DIAGNOSTIC REFERENCE LEVELS (DRLs) FOR

CONTRAST RADIOGRAPHY EXAMINATIONS: A GUIDE FOR MEDICAL
PHYSICIST WITH EXCERPTS FROM ICRP PUBLICATION 135

Dlama Zira Joseph1, Nkubli Flaviuos2, Moi Silas1, Christian Nzotta3

1
Lecturer/ Medical Physicist, Nigeria
2
Lecturer/ Radiographer
3
Prof. Medical Physics

Diagnostic Radiology –Dosimetry

Background: The study is an excerpt of a comprehensive project to establish clinically based DRLs for
contrast radiography procedures in Nigeria and to guide medical physicist in achieving the international
recommendations and current trends in dose optimization steps using ICRP Publication 135 as a guide.
Methods and Materials: Prospective cross - sectional study conducted in two major University Teaching
Hospitals. Three hundred and Sixty (360) patients were recruited for the study. Doses were recorded using
thermo-luminescent dosimeter (TLD) chips and dose area product (DAP) meter. Student T-test was used
to determine the relationship between the mean entrance skin dose (ESD) obtained in the two centers while
Pearson's correlation was used to determine the relationship between the dose and anthropo-technical
parameters. Statistical significance was set at p < 0.05.
Results: Clinical DRLs for this study were 6.68 mGy and 10.66 mGy.cm2 (IVU), 2.31 mGy and 3.67
mGy.cm2 (HSG), 2.66 mGy and 8.98 mGy.cm2 (barium meal), 12.78 mGy and 20.64 mGy.cm2 (barium
enema), 2.73 mGy and 6.56 mGy.cm2 (barium swallow), and 2.05 mGy and 7.77 mGy.cm2 (RUG),
respectively. The ESD and DAP showed statistically significant relationship with technical parameters for
barium enema. The remaining studies showed no statistical significance (p > 0.05). Conclusion: Clinical
DRLs in this work recorded lower values. However, regular dose optimization technique and etiquettes are
required to ensure good practice.
Key words: Barium Meal, Barium Enema, Barium Swallow, Hysterosalpingography (HSG), Intravenous
Urography (IVU).

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P-069

RADIOLOGICAL IMPORTANCE OF THE COMPUTER RADIOGRAPHY SYSTEM

FOR TOTAL BODY IRRADIATION TREATMENTS

Arnaldo Rubio Rivero, Luis Rafael Sanchez Zamora, Juan Pablo Gallardo Fiandor, Roberto Caballero
Pinelo

Hermanos Ameijeiras Hospital, Cuba

Radiation Oncology – Treatment Delivery

Introduction: The Computer Radiography system, installed in the Ameijeiras Hospital, is only used as an
image basis for the design of the pulmonary blocks in Total Body Irradiation treatments. Taking into
account that the positioning should be supported by images, it would be important to assess the advantages
of this system over films such as EDR2 type for the correct position of blockages lungs and how this affects
the absorption doses in this organ. Materials and Methods: The doses absorbed in the lung were calculated
for the treatments that were not corrected with images. For this, we made measurements with the block in
different positions and plot how the dose varies with the movement of the blocks. The image quality tests
were carried out and verified, reporting the dose and the minimum time to obtain a good image quality for
each system. Results: In the comparison of the two systems, it was demonstrated that the CR presents better
resolution of high and low contrast. In addition, this quality is obtained with much less exposure time,
which represents a dose reduction of 97% of dose that is necessary to obtain an adequate image with the
other system. Also, it was demonstrated that without images for the positioning of the lung blockages, this
organ can receive doses more than 9.2 Gy. Conclusions: The use of CR was validated as an image portal
system for the individual positioning of each patient by direct influence on the quality of treatment by
absorbing doses in lungs at different displacements, verifying that in the correct positions of the block, the
lung dose is maximum 7 Gy. The optimal image quality parameters for each system and their dosimetry
contribution were determined and compared, demonstrating the advantages of CR over the films in each of
the selected aspects.

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P-071

CHALLENGES ON PROCESS VALIDATION IN BRACHYTHERAPY SOURCES

PRODUCTION

Tatyana Baptista, Maria Rostelato, Carlos Zeituni, Anselmo Feher, João Moura

Tecnhology Radiation Departament – IPEN, Brazil

Radiation Oncology – Brachytherapy

Cancer is a devastating disease not only Brazil but in whole world. New brachytherapy sources production
laboratories are being implemented in several countries, including in our facility. A great challenge when
implementing a production laboratory is to follow the Good Manufacturing Practices (GMPs), which
involves process validation and all supporting activities such as cleaning and sanitization. Much more than
compliance with regulatory guidelines, required for certification and inspections, a validation builds large
process knowledge, provides possibilities for optimization and improvement, increasing the degree of
maturity of all people involved and also the quality system as a whole. The process validation results in a
document that certifies that any procedure, process, equipment, material, operation or system actually leads
to the expected results. In theory, it is a simple and objective definition. In practice, it brings a series of
issues and challenges.
The purpose of this work was to execute a process validation in the Brachytherapy sources production
laboratory on Radiation Technology Center located at IPEN- Brazil.
Materials and Methods: The fabrication process was performed three times for evaluation. The parameters
evaluated in this study were: the source welding efficiency and the leakage tests results (immersion test).
The welding efficiency doesn't have an established parameter, since is visually evaluated by the operator,
and the leakage detection has to be under 5 nCi / 185 Bq, accordingly ISO 9978.
Results: The observed values were: 70% welding efficiency and 32% leakage detection. Although
established values for the global efficiency aren't available in the literature, the results showed high
consistency and acceptable percentages, especially when other similar manufacturing processes are used in
comparison (average 85-70% found in the literature for other similar metallic structures).
Conclusions: Those values will be important data when drafting the validation document and to follow the
Good Manufacturing Practices (GMPs).

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P-072

KNOWLEDGE-BASED RAPIDPLAN MODEL FOR PROSTATE SBRT WITH AND

WITHOUT LYMPH NODES

Oscar Apaza, Carlos Daniel Venencia, Pablo Castro Peña, Fabian Muñoz, Maria Almada

Instituto de Radioterapia - Fundación Marie Curie, Córdoba, Argentina

Radiation Oncology –Treatment Planning

Purpose: The use of Knowledge-Based Planning (KBP) in radiotherapy it is becoming increasingly

common. The objective of this work was to create and validate a KBP RapidPlan model for prostate SBRT
with and without lymph nodes.
Methods: Forty SBRT prostate patients' clinical plans (CP) with a total dose of 36.25Gy/5 fractions and a
second group of 40 SBRT prostate/lymph node CP with a total dose of 40Gy/25Gy/ 5 fractions were
selected. OARs and PTVs structures and constraints were added to the Model Structure and Objectives.
Dosimetric and geometric data were extracted from the selected patient plans and added to the DVH
estimation model. Two KBP models were generated (Model1: SBRT prostate and Model2: prostate/lymph
node) and verified using RapidPlan of Eclipse v15.1 (Varian). The quality of the models was evaluated
using R2 and x2 value. The models were validated for 10 patients in each SBRT protocol, comparing the
RapidPlan with the CP for PTVs, rectum and bladder.
Results: During the verification process some structures were excluded if it did not well represent the model
estimation using in field DVH plots. For Model1 the R2>0.46 and x2 <1.61 and for Model2 R2>0.41 and
x2<1.3. For Model1 the differences between RapidPlan and CP was: PTV_High_3625, 0.19±0.10 [Gy] for
D98% and 0.77±0.92 [Gy] for D2%; bladder, maximum difference (MD) 0.82±0.63 [%] for V18Gy;
rectum, MD 2.33±1.5[%] for V18Gy. For Model2 the results were: PTV_High_4000, 0.55±0.36 [Gy] for
D98% and 1.83±1.14 [Gy] for D2%; PTV_Low_2500, 0.40±0.25 [Gy] for D98%; bladder, MD 12.55±9.42
[cc] for V25Gy; rectum MD 3.09±2.63 [%] for V20Gy.
Conclusion: We successfully implemented two models with RapidPlan for prostate SBRT with and without
lymph nodes. Small adjustments are required in the optimization process to achieve clinical protocol
restrictions and obtain high quality plans. More plans are required to improve statistics.

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P-074

FEASIBILITY STUDY OF BORON NEUTRON CAPTURE THERAPY

CONCOMITANT WITH INTERSTITIAL BRACHYTHERAPY

Esteban Fabián Boggio1, Mariel Elisa Galassi3, Sara González4, Lucas Provenzano2
1
Centro de Terapia Radiante Junín, Argentina
2
CNEA
3
CONICET-UNR
4
CONICET-CNEA

Radiation Oncology – Treatment Delivery

Cancer recurrence represents a great challenge when evaluating possible treatments. Thus, clinical trials
based on advanced radiotherapies such as Boron Neutron Capture Therapy (BNCT) are being performed.
BNCT is an extremely hypofractionated technique that involves an intravenous injection of a selective
borated compound to tumor cells, follow by an external irradiation of the target using a suitable neutron
beam. Boron-10 atoms cumulated into tumor have a high thermal neutron capture probability, giving rise
to a nuclear reaction and high-LET products able to produce lethal cellular damage with great advantages
in the treatment of radio-resistant and hypoxic tumors. BNCT has been applied mainly in glioblastomas,
melanomas and head-and-neck tumors (HN), with varying results. A precisely control of the borated
compound biodistribution is currently the most important challenge.
In this work, we study the feasibility of using “Beta Enhancers” in BNCT. We propose to complement the
biochemical dependence of the dose distribution with a physical dependence of an interstitial
brachytherapy, by implanting a non- radioactive material matrix that activates during irradiation with
neutrons and become short life Beta emitters. This technique does not sensibly perturb the original
procedure.
Feasibility studies were performed using the Monte Carlo code MCNP. Several implant distributions and
materials within a water cube using the clinical BNCT beam available in Argentina were analyzed.
Different figures-of-merit to assess the performance of the proposed technique were evaluated: suitable
geometry and distance between implants, thicknesses and masses, flux perturbation, among others.
Using the most appropriate implant arrangement for a HN cancer patient treated with BNCT, a retrospective
treatment planning was carried out concomitantly with Interstitial Brachytherapy. The advantages obtained
in terms of dose-volume histograms and dose distributions were analyzed.
We concluded that it is possible to obtain relevant additional doses due to the implants. Further research
for clinical development is in progress.

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P-075

CLINICAL INDICATION BASED DIAGNOSTIC REFERENCE LEVELS (DRLs) FOR

CONTRAST RADIOGRAPHY EXAMINATIONS: A GUIDE FOR MEDICAL
PHYSICIST WITH EXCERPTS FROM ICRP PUBLICATION 135

Dlama Zira Joseph1, Moi Silas2, Christian Nzotta3, Flavious Nkubli2

1
Department of Medical Radiography,College of Health Sciences, Bayero University Kano, Nigeria
2
Department of Medical Radiography, University of Maiduguri, Borno State, Nigeria
3
Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Nigeria

Radiology – Radiation Protection.

Background: The study is an excerpt of a comprehensive project to establish clinically based DRLs for
contrast radiography procedures in Nigeria and to guide medical physicist in achieving the international
recommendations and current trends in dose optimization steps using ICRP Publication 135 as a guide.
Methods and Materials: Prospective cross - sectional study conducted in two major University Teaching
Hospitals. Three hundred and Sixty (360) patients were recruited for the study. Doses were recorded using
thermo-luminescent dosimeter (TLD) chips and dose area product (DAP) meter. Student T-test was used
to determine the relationship between the mean entrance skin dose (ESD) obtained in the two centers while
Pearson's correlation was used to determine the relationship between the dose and anthropo-technical
parameters. Statistical significance was set at p < 0.05.
Results: Clinical DRLs for this study were 6.68 mGy and 10.66 mGy.cm2 (IVU), 2.31 mGy and 3.67
mGy.cm2 (HSG), 2.66 mGy and 8.98 mGy.cm2 (barium meal), 12.78 mGy and 20.64 mGy.cm2 (barium
enema), 2.73 mGy and 6.56 mGy.cm2 (barium swallow), and 2.05 mGy and 7.77 mGy.cm2 (RUG),
respectively. The ESD and DAP showed statistically significant relationship with technical parameters for
barium enema. The remaining studies showed no statistical significance (p > 0.05). Conclusion: Clinical
DRLs in this work recorded lower values. However, regular dose optimization technique and etiquettes are
required to ensure good practice.
Key words: Barium Meal, Barium Enema, Barium Swallow, Hysterosalpingography (HSG), Intravenous
Urography (IVU).

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P-077

ASSOCIATION BETWEEN STOCHASTIC NOISE IN CT IMAGES AND THE AREA

UNDER THE ROC CURVE

Rafael Miller-Clemente

Radiation Medical Physics Group. Center of Medical Biophysics. Universidad de Oriente. Santiago de
Cuba, Cuba

Diagnostic and Interventional Radiology – General

One hundred Images of head studies in adults were obtained with a Siemens Sensation 64 CT unit in a
previously performed ROC study. The images corresponded to five levels of the dose index Cvol (22.9,
32.9, 42.7, 52.8 and 59.3 mGy), with five levels of the tube current per exposure time (145, 209, 272, 336
and 380 mAs). The images obtained for Cvol < 59.3 mGy were simulated by adding stochastic noise
proportional to the mAs levels. Regions of Interest (ROIs) were placed in homogeneous areas of the
resulting image from the difference between two adjacent images. The stochastic noise was estimated as
the average of the standard deviations of the ROIs in each image. The standard deviation was divided by
the square root of two to consider the added noise due to the subtraction. The association between the Area
Under the ROC Curve (ABCROC) and the stochastic noise was analyzed. The minimum stochastic noise
level for which the ABCROC = 80% was set as a reference to identify feasible protocols with Cvol lower
than for default protocol but preserving an acceptable diagnostic quality. A fit was made between the
ABCROC and stochastic noise for a hyperbolic secant function whose argument is a potential function of
stochastic noise, where the 80% point of the AUCROC corresponded to 6 HU. This minimum value of
stochastic noise corresponds to a minimum value of Cvol = 33.53 mGy, below which the diagnostic
accuracy would be reduced to less than 80% for the sample of cases studied. The association of noise, with
measures of image quality based on observer models, compensates the limitations of using stochastic noise
as a unique measure of image quality and allows to define reasonable restrictions for the optimization of
clinical head protocols.

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P-078

RESPONSE OF A MINIATURE SPHERICAL DIODE AS A DOSIMETER FOR

THERAPEUTIC CARBON-ION BEAM

Naruhiro Matsufuji

NIRS QST, Japan

Radiation Oncology – Dosimetry

Introduction:
As the best use of the Bragg curve nature, hypofractionated ion-beam therapy has been promoted on various
tumor site. In carbon-ion therapy for prostate cancer treatment at the Heavy Ion Medical Accelerator in
Chiba (HIMAC), radical hypofractionation has been performed by selectively reducing the urethral dose
located at the center of the prostate tumor. It is needed there to establish an in-vivo dosimeter to confirm if
the dose to urethra is surely reduced as planned during the therapeutic irradiation. This study investigated
a response of a miniature sphere diode as a candidate for the in-vivo dosimeter for therapeutic carbon-ion
beam.
Material and Methods:
Sphere diode of 1.2 and 1.8mm in diameter made by Sphelar Power Co., Ltd. (Kyoto, Japan) was tested.
The measurement was carried out at the therapeutic port of HIMAC with pristine 290 MeV/n of carbon
beam as well as therapeutic 350 MeV/n spread-out Bragg peak (SOBP) beams. Output current from the
diode during the irradiation was measured with an electrometer as integral charge. A pinpoint ionization
chamber was also used for the sake of comparison.
Result and Discussion:
The spherical geometry of silicon caused slight broadening or pristine Bragg peak of the carbon-ion beam,
however, for SOBP beam it showed superior dosimetric response free from LET dependency as almost
comparable as those measured with an ionization chamber. The measurement with the smaller diode
successfully reproduced the decrease in dose at the middle of the SOBP intentionally designed to simulate
the therapeutic irradiation reducing urethral dose. The diode showed decrease in sensitivity of about 1% /
Gy as a function of integral dose, however, the output linearity on dose and subtle incident angular
dependence together with the smallness and safeness make the silicon diode as a good candidate for the in-
vivo dosimeter in ion-beam therapy.

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P-079

EFFECT OF LONGITUDINAL AND PERPENDICULAR MAGNETIC FIELDS ON

RADIOCHROMIC EBT3 FILM RESPONSE TO CARBON-ION BEAMS

Taku Inaniwa, Masayuki Muramatsu, Akira Noda, Yoshiyuki Iwata,

National Institute of Radiological Sciences, QST, Japan

Radiation Oncology – Dosimetry

Introduction: Merging MR imaging and charged-particle therapy (MRiPT) has gained interest to increase
the targeting accuracy of radiations. The radiochromic films are suited to measure the 2D dose distribution
of charged particle beams with high special resolution. However, the dose response of the films under
magnetic fields to the charged-particle beams has never been studied intensively. The purpose of this study
is to investigate the effect of longitudinal and perpendicular magnetic fields, BL and BP, on radiochromic
EBT3 file response to therapeutic carbon-ion beams.
Methods and Materials: A water-cooled solenoid (dipole) magnet was used to produce a magnetic field
longitudinal (perpendicular) to the carbon-ion beams. The radiochromic EBT3 films placed within the bore
(gap) of the magnet were exposed to low (12 keV/μm) and high (50 keV/μm) linear energy transfer (LET)
carbon-ion beams of 5 Gy dose under BL (BP) of 0, 0.3, and 0.6 T. The dose-monitor output was calibrated
with the ionization chamber for each LET beams without the magnetic field. The optical density (OD) of
the films was measured in red color channels of a scanner. The change in ODs by the orientation and the
strength of magnetic fields were investigated for each LET beams based on t-test.
Results: Under BL of 0.3 and 0.6 T, the ODs decreased significantly by 1.0% and 0.6% for low LET beams
and by 1.4% and 1.3% for high LET beams from the ODs without BL. Similarly, under BP of 0.3 and 0.6
T, the ODs decreased significantly by 1.0% and 0.8% for low LET beams and by 1.3% and 1.1% for high
LET beams from the ODs without BP.
Conclusion: We observed small (~ 1%) but significant reductions in ODs of radiochromic EBT3 films
exposed to low and high LET carbon-ion beams by the longitudinal and perpendicular magnetic fields.

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P-081

SAFETY ASSESSMENT FOR THERAPEUTIC NUCLEAR MEDICINE IN CUBA

Zayda Haydeé Amador Balbona1, Antonio Torres Valle2, Teresa Fundora Sarraf3, Adlín López Díaz4,
Fernando Machado Acuña5
1
CENTIS, Cuba
2
INSTEC
3
IHI
4
HHA
5
HOCBG

Nuclear Medicine

Introduction: The most useful prospective methods to risk analysis in medical practices with ionizing
radiation are the risk matrix (RM) and the failure mode and effect analysis (FMEA). In another hand, at the
world level developed various systems for reactive risk analysis, for example ROSIS and SAFRON. In the
state of the art the tools for these two approaches (prospective and reactive) are not matching. This study is
aimed to identify the most contributors to the radiological risk for radionuclide therapy in Cuba.
Methods and Materials: Generic models for nuclide therapy were adapted to five nuclear medicine services.
This includes the radiosynoviorthesis and the myelosupressor treatment with Phosphorous 32 of
polycythemia Vera. For safety assessment are used RM, FMEA and the reactive method of the incident
learning system. The use of Cuban code SECURE-MR-FMEA version 3.0 allows increasing the efficacy
and efficiency in this study.
Results: The application of generic models shows a 63% of the total accidental sequences, 76% of barriers,
58% of frequency reducers and 50% of consequence reducers, as minimum. For patient specific treatment
these were higher than 91%. For the first, the clinical prescription of the treatment is most important. The
stages of pre and post treatment image acquisition and the preparation of radiopharmaceuticals are the most
risk contributors in the last case. The main elements for decision makers are obtained. Most important
identified steps, control elements and root causes for the risk are showed as integrators of the improvement
quality and safety plan.
Conclusions: This study focused on analyzing of all possible radiological events in representative nuclear
services in Cuba with a holistic approach. The human errors are the most contributors and the fatigue of
staff as the main cause. This research allowed identifying priority measures to keep exposure optimization
for patients, workers, and public.

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P-084

EVALUACIÓN DEL RENDIMIENTO DEL CICLOTRÓN PETTRACE 800

Gladys Aquino Aquino, Modesto Montoya

Hancco, Peru

Nuclear Medicine

El estudio con Pet ct y el usos de radiofármacos en la actualidad ya es casi común a nivel mundial para
detectar el cáncer en estadio temprano y en problemas cardiológicos y neurolépticos y mi principal motivo
para realizar este estudio fue siempre conocer la producción de 18F-FDG y la aplicación de la detección de
cáncer en pacientes en el Hospital Nacional Alberto Sabogal Sologuren y en el Hospital Edgardo Rebagliatti
Martins y escoge como tema la capacidad de producción de 18FFDG y espero que se sigan abriendo más
ciclotrones en Perú y se produzca más radiofármacos para uso clínico en la evaluación de diferentes
enfermedades. Este radiofármaco 18 F-Fluorodesoxiglucosa es el que más aplicaciones tiene en
oncológicos, neurológicos y cardiológicos. 18F-fluorurotimidina, 18F-fluorodopa
Se conoce que el incremento del índice de mortalidad debido al cáncer ha crecido en el Perú, de acuerdo a
lo que se conoce el Instituto Nacional de Enfermedades Neoplásicas (INEN). El organismo especializado
atiende nada más que a 12 mil 500 nuevos pacientes por año. Es decir, al 18 por ciento. Al resto, a los otros
54 mil enfermos de cáncer (el 82 por ciento), son recibidos por otro hospital ESSALUD o simplemente no
se atienden.
Detrás de las cifras hay personas. Seres humanos atrapados por una espantosa enfermedad.

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P-087

EFFECTIVE POINT OF CYLINDRICAL IONIZATION CHAMBER IN ABSORBED

DOSE MEASUREMENT OF CARBON BEAMS

Shigekazu Fukuda1, Menamu Sano2

1
QST / NIRS, Japan
2
Chiba Graduate School of Science

Radiation Oncology – Dosimetry

Introduction:
Using a cylindrical ionization chamber is recommended by the protocols (TRS-398) for measurement of
water absorbed dose with carbon beams because of its small uncertainty compared to that of parallel plate
ionizing chambers. It is very important, therefore, to evaluate the effective point of the cylindrical ionization
chamber. The value of the effective point is defined in the protocol. In the case of carbon beams, the point
is displaced by 0.75 times the cavity radius from the geometric center to the incident side. Because this is
a value obtained from the material and geometric shape of the cylindrical ionization chamber, we examined
whether it depends on the energy of the incident beam and the SOBP width.
Methods and Materials:
We decided the value of the effective point by measuring the displacement of depth dose distribution in
combination with the parallel plate ionization chambers (PTW23343 and PTW34045) and the cylindrical
ionization chambers (PTW30001. PTW30013) And we used the optical theodolite to measure the position
of the reference point of each ionization chamber in the water phantom with high accuracy.
Results and Conclusions:
The measured values of the effective point were slightly larger than the value of 0.75 defined in the protocol.
They did not depend on the energy and SOBP width of carbon beams and also did not depend on the
ionization chamber combinations. We will examine the reason for the slightly large effective point of the
cylindrical ionization chamber.

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P-088

3D CONFORMAL RADIOTHERAPY END-TO-END TEST WITH CUSTOMIZED

ANTHROPOMORPHIC PHANTOM CHEST CONSIDERING HIGH
HETEROGENEITY CORRECTION

Pedro Iwai

UOPECCAN Hospital, Brazil

Radiation Oncology – Quality Assurance

Introduction: 3D conformal radiation therapy is the standard method of treatment in many places in Brazil.
AAPM TG40 states that it is recommended that dose measurents deviations lies under 5%, as well as
geometric deviations don't go further than 5 mm. A method to test the overall treatment delivery precision
consists in performing the so-called ""end-to-end test"", which can make use of an anthropomorphic
phantom and considering heterogeneity corrections for different relative electronic densities just like tissues
in a real human body.
Methods and Materials: An anthropomorphic phantom torso was made using a hollow plastic dummy chest
filled with paraffin. Inside this phantom, there is a tissue like lung, made of cork slabs piled up one above
the other, so this phantom could test the overall precision of the treatment planning system when high
heterogeneities are present. A hole was drilled for an ionization chamber to be placed inside this lung. A
simple 3DCRT plan was planned in Varian Eclipse Version 13.6 treatment planning system and dose
distribution was calculated with AAA considering heterogeneity corrections. Measured mean dose
delivered to the ionization chamber sensitive volume was used as reference to assess the percentage
deviation from treatment planning system calculated mean dose.
Results: The construction method applied in the phantom chest produced a consistent external anatomy
shape. Heterogeneities inside the phantom helped exploring the treatment planning system dose calculation
capabilities while also not compromising dosimetric accuracy due to lack of ion chamber electronic
equilibrium. The percentage dose deviation obtained was 4,60±(0,14)% and it's geometric deviation was
3,16±(0,10) mm.
Conclusion: Since our dosimetric and geometric measurements showed a deviation bellow the AAPM
TG40 recommended threshold, we could assume our institution overall treatment delivery precision to be
in accordance to the highest international protocols, such as AAPM TG40 and the IAEA ICRU No. 24.

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P-090

IMPLEMENTATION OF DIBH TECHNIQUE USING RAPIDARC IN TRUEBEAM

STX

Luis Fernando Paredes Ocampo, Alberto Alarcon, Fabian Munoz, Daniel Venencia

Instituto Zunino (Fundación Marie Curie), Argentina

Radiation Oncology – Treatment Delivery

Purpose: Implementation of DIBH technique using RapidArc in Truebeam STx for its clinical use in left
sided breast cancer. Methods: A Truebeam STx equipped with real time position management system
(RPM, Varian) was used. The breathing signal was obtained by the optical camera, tracking the movement
of the reflector block. A respiratory phantom (Brainlab) with three movement modalities: static position,
free breathing (amplitude 1.6cm, sinusoidal wave and breathing period of 5 seconds) and DIBH (gated
limits 20% of maximum amplitude, breath hold 10 seconds) was used. A Rapidarc plan with a recognizable
form with angles and borders (letter S) was planned on Eclipse TPS. Phantom positioning was achieved
using gated MV-KV orthogonal images, using markers fusion and 2D-3D comparison. Static versus gated
DIBH CBCT was compared using distances between phantom internal markers. The accuracy of the dose
delivery was verified comparing static, free breathing (FB) and gated treatments using EBT3 film dosimetry
on a coronal plane (γ<1, 3%-2mm-Th30%) and absolute dose variation using ion chamber measurement.
Results: Plan delivery time without interruption was 2:51min and its increased 50% (30%) with 10s (20s)
breath hold. The differences between static and DIBH CBCT was less than 0.1cm. The difference between
phantom positioning using gated orthogonal MV-KV and DIBH CBCT was less than 0.1cm. Dose
distribution comparison between static and FB plans showed less than 60% of the pixels with γ<1 and
absolute dose variation higher than 40%. Dose distribution comparison between static and gated DIBH
plans showed 99.8% of the pixels with γ<1 and absolute dose variation less than 1%
Conclusion: Truebeam STx equipped with RPM system is capable to delivery gated DIBH Rapidarc plans
for left sided breast cancer. Gated DIBH CBCT and MV-kV images can be used for patient positioning.

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P-092

PERFORMANCE OF MONACO TREATMENT PLANNING SYSTEM

Isiaka Akala1, Benard Omuvwie2, BabaTunde Isiaka3

1
Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
2
Eko Hospital, Ikeja, Lagos, Nigeria
3
University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria

Radiation Oncology –Treatment Planning

Background: Monaco commercial treatment planning system (Version 2.03.00) was recently introduced in
our clinic for making IMRT and VMAT treatment planning. As we all know when a TPS is newly
introduced like this, it's important to verify its performance as part of commissioning procedure.
The Aim and Objectives: To investigate the performance of Monaco TPS by manipulating some optional
and required parameters to see how We can achieve better dose distribution to target volume and sparing
of organs at risk in a short calculation time and good plan efficiency.
Materials and Method: Materials used are Monaco software version 2.03.00(Elekta CMS software),
Microsoft windows XP professional x64 Edition, Version 2003; Mat Lab (imaging processing software),
computer system, Hewlett-Packard (CPU Intel®Xeon®,[email protected]; Ram of 2.67GHz,15.9GB ).Six
patients CT slices set of following entities: stomach, head& neck, prostate, brain, breast and lungs were
transferred to Monaco treatment planning software version 2.00.03. The necessary clinical structures were
outlined (Target volume and the OARS). And IMRT and VMAT reference plan were generated with Centre
of the target structure as the isocenter for all plans. (6mv) energy was used for the plans with 0.0cm couch
angles and collimator angles. All plans were also generated with factor (1) for maximum number shape
changes.
Result: Comparing reference plan of fixed parameters: Maximum number shape changes, Multicriterial and
Grid size spacing with the manipulated plan of different values of the same parameters.
Conclusion: It was obvious that reference plan forboth in IMRT and VMAT, there is little or no significant
differences in the result of dose distribution to the target volume and sparing of OARs when compared with
the manipulated plans despite the difference in calculation time. In choosing value in maximum number of
shape changes parameter, it is advisable to save time with factor (1).

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P-094

MONTE CARLO STUDY ON OPTIMAL BREAST VOXEL RESOLUTION FOR

DOSIMETRY ESTIMATES IN DIGITAL BREAST TOMOSYNTHESIS

Carolina Rabin1, Christian Fedon2

1
Instituto de Física, Facultad de Ciencias, Uruguay, Uruguay
2
Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmgen, The
Netherlands

Diagnostic Radiology – Dosimetry

Introduction: Digital Breast Tomosynthesis (DBT) is currently used as an adjunct technique to

Mammography for breast cancer imaging. Being a quasi-3D image, DBT is capable of providing depth
information on the internal breast glandular tissue distribution, which may be enough to obtain an accurate
patient-specific radiation dose estimate. However, for this, information regarding the location of the
glandular tissue, especially in the vertical direction, is needed. Therefore, a dedicated reconstruction
algorithm designed to localize the amount of glandular tissue, rather than for optimal diagnostic value,
could be desirable. Such a reconstruction algorithm could benefit from the use of larger voxels, rather than
the small sizes typically used for the diagnostic task. In addition, the Monte Carlo (MC) based dose
estimates would be accelerated by the representation of the breast tissue with fewer and larger voxels.
Methods: In this study we investigate the optimal DBT reconstructed voxel size that allows accurate dose
evaluations using a validated Geant4-based MC code. Two re-binning approaches were applied, leading to
isotropic and anisotropic voxels of different volumes.
Results: Isotropic cubic voxels of 2.73 mm size provide a dose estimate accurate to within 5%, while a
comparable accuracy is obtained with anisotropic voxels of dimension 5.46 x 5.46 x 2.73 mm3. In addition,
the MC simulation time is reduced by more than half, in respect with the original voxel dimension, when
either of the proposed re-binning approaches is used. Conclusions: we have determined the optimal voxel
size for dose estimate in DBT by MC simulation, reducing the computation time by half.

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P-095

CURRENT STATUS OF ABSORBED DOSE RATE IN AIR IN KANTO DISTRICT

AFTER THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT ACCIDENT

Kazumasa Inoue1, Hiroshi Tsuruoka2, Masahiro Fukushi1

1
Tokyo Metropolitan University, Japan
2
Tsukuba International University

Radiation Protection

The distribution of environmental radiation in eastern Japan was dramatically changed after the Fukushima
Daiichi Nuclear Power Plant accident of March 2011. While the relevant ministries and local government
authorities have been measuring absorbed dose rates in air with car-borne surveys or fixed-point
observations, simple comparisons of these results are not possible because the dosimeters used, and the
measurement conditions differ among the groups doing the measurements. In this study, the absorbed dose
rates in air in the Kanto district (Tokyo and six surrounding prefectures; 32,423 km2) were extensively
measured with the car-borne survey technique and fixed-point observations using the same NaI(Tl)
scintillation spectrometers and same measurement conditions. The measurements were done in 2015, 2016
and 2017 (n = 31,147). The average and range of absorbed dose rates in air from all radionuclides (i.e.,
natural and artificial radionuclides) were: 59 nGy h- 1 (28 – 106 nGy h-1) for Tokyo; 45 nGy h-1 (14 – 243
nGy h-1) for Saitama Prefecture; 55 nGy h-1 (18 - 197 nGy h-1) for Chiba Prefecture; 66 nGy h-1 (29 -
289 nGy h-1) for Tochigi Prefecture; 44 nGy h-1 (18 – 99 nGy h-1) for Gunma Prefecture; 67 nGy h-1 (31
- 223 nGy h-1) for Ibaraki Prefecture; and 45 nGy h-1 (13 – 80 nGy h-1) for Kanagawa Prefecture. The
maximum combined standard uncertainty in these surveys ranged from 3.5 to 6.7%. The maximum
contribution ratio of long half-live artificial radionuclides (134Cs + 137Cs) measured for all absorbed dose
rates in air (22%) was observed for Chiba and Tochigi Prefectures. These findings will be useful to estimate
impact of nuclear disaster.

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P-096

EFFECTS OF IMMOBILIZATION DEVICES ON SKIN DOSES AND DOSES IN THE

BUILD-UP REGIONS FOR HIGH ENERGY PHOTON BEAMS

Bismark Djan

Self, Ghana

Radiation Oncology – Dosimetry

This study presents the significant increase in skin dose caused by the presence of thermoplastic masks
used for positioning and immobilization of cancer patients during treatments in the head-and-neck region.
The use of the mask in treatment plays a key role in achieving the therapeutic aim in head-and-neck
treatments but can as well lead to a rise in patient surface dose. Measurements in the PMMA coupled with
an electrometer and an ionization chamber at the surface, dmax and a specified depth of 10cm for the 6MV
photon beam were made and recorded employing the isocentric technique for varying field sizes with
100MU. Measurements were also made on the phantom with and without the mask. GafChromic films were
also used to assess the skin dose and dmax and compared to the measured values.
Surface dose increased significantly due to the presence of the thermoplastic masks. It was observed that
the estimated surface doses with the mask were consistently higher than those without the mask. The mask
increased the dose to the build-up region, subsequently shifting the dmax to shallower depths to the skin
surface. The skin-sparing effect which is an advantage for megavoltage beams was not achieved due to the
presence of the masks.
The skin and build-up region doses increased significantly with increasing; field size and thermoplastic
mask thickness. For high energy photon beams, the surface dose depends on the energy and field size,
hence, the higher the energy, the lower the surface dose and the deeper the penetration. For the given beam
energy, the surface and build-up region dose increased with the presence of the thermoplastic mask and
increasing field size.

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P-097

QUALITY ASSURANCE OF DYNAMIC WEDGES IN A LINEAR ELECTRON

ACCELERATOR WITH A DAILY VERIFICATION EQUIPMENT

Fernando Tato de las Cuevas, Fernando Fernández Belmonte

Hospital Universitario de Canarias, Tenerife, Spain

Radiation Oncology – Quality Assurance

Introduction:
The QuickCheck device (PTW) has a software tool to verify the wedge angle. The objective of this work
is to verify the capacity of detectability of errors in dynamic wedges beams using the QuickCheck in a
LINAC.
Methods and Materials:
The LINAC used is a CLINAC 2100 with Millenium MLC. The energy and field size used are 6 MV and
20x20 cm2.
The QuickCheck device is used for daily dosimetric checks of a LINAC, consisting of 9 ionization
chambers (IC) on the main axes (one central and eight peripheral), in addition to 4 more IC used to measure
the quality of the beam.
In order to evaluate de capacity of the device to check dynamic wedges, irradiations are made for several
wedge angles and both wedge directions. Two methods are used for checking the wedge angle:
1) Using the QuickCheck software tool, which provides a wedge angle parameter.
2) Calculating the ratio of the reading of two IC (accessible from the software), placed 5 cm from the beam
center in the wedge direction.
Results and Discussion:
1) Applying a 5o change in nominal wedge angle, the QuickChec software provides a change in the
""wedge"" parameter of 4- 5o. With a change in wedge direction, the software provides the same wedge
angle.
2) Using the data from the two IC: a nominal change of 5o in wedge angle, provides a change > 3 % in the
ratio between the two peripheral IC. Changing wedge direction, the differences in the ratio are bigger than
30%.
Conclusions:
The ""wedge"" parameter of the QuickCheck software doesn't allow to discriminate wedge direction.
However, the QuickCheck is a device capable to discriminate small angle changes and wedge direction
using the measurements from peripheral cameras.

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P-098

QUALITY ASSURANCE OF MULTILEAF COLLIMATOR IN A LINEAR ELECTRON

ACCELERATOR USING A 2D ARRAY

Fernando Tato de las Cuevas, Fernando Fernández Belmonte

Hospital Universitario de Canarias, Tenerife, Spain

Radiation Oncology – Quality Assurance

Introduction:
The Starcheck device (PTW) includes a MLC positioning verification module. The objective of this work
is to check the capacity for detecting leaf position errors though Starcheck.
Methods and materials:
The LINAC is an Elekta Synergy with Agility MLC. The energy and field used are 6 MV and 26x26 cm2.
The Starcheck measuring device consist of detectors on the main and diagonal axes. In addition, at 13 cm
from the field center it has detectors on the left and right sides of the field, separated 5 mm one from the
other. This allows the software to detect the position of the leaves in a 26x26 cm2 radiation field.
First, a measurement of a rectangular field (reference) is made. Secondly, a field with some mispositioned
leaves is created and irradiated. The displacement errors are 0.5 and 1 mm, both opening and closing leaves.
Errors are made for individual and pairs of adjacent leaves.
Finally, leaves position from the field with errors are compared with those of reference field. The
displacements between leaves (with and without errors) are measured.
Results:
The Starcheck software detects the displacement errors of 0.5 and 1.0 mm in both directions.
The displacement accuracy is 0,2 mm greater when two adjacent leaves are displaced instead of one.
Conclusions:
The accuracy of the measured displacement is greater when two adjacent leaves are displaced instead of
one (because leaves width is the same than distance between consecutive detectors). Despite this difference,
it can be concluded that StarCheck is a valid device to verify leaves positioning errors as low as 0.5 mm
for a field 26 cm wide.

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P-099

ACCURACY AND REPEATABILITY OF AGILITY MLC IN STATIC FIELDS USING

THE PORTAL IMAGING DEVICE

Fernando Tato de las Cuevas, Fernando Fernández Belmonte

Hospital Universitario de Canarias, Tenerife, Spain

Radiation Oncology – Quality Assurance

Introduction:
The purpose of this work is to investigate the accuracy and repeatability of the positioning of the Agility
multileaf collimator (MLC) in static fields, using the Electronic Portal Imaging Device (EPID). An in-house
software is used for this purpose. Methods and materials:
The Electron Linear Accelerator (LINAC) is an Elekta Synergy with Agility MLC.
To perform this study is used a strip-test, consisting of 10 step-and-shoot segments with 4 mm gap between
them. The images are acquired with the EPID. For image analysis is used our own software made in Matlab.
Analysis algorithm:
A horizontal profile is acquired in the middle of each leaf. The profile of every gap is adjusted to a Gaussian
curve. The maximum PV (pixel value) of every curve is obtained. A calibration of the strip-test with gap
width from 1 to 10 mm is performed, relating the nominal gap width to the maximum PV.
The software developed is validated using film.
Measurements:
6 strip-test are made without displacing the EPID. The leaf positions in every gap are exported to a Excel
workbook. Average positions and standard deviations are calculated for each leaf.
Results:
The average position error for the whole set of leaves is -0,01 mm and its standard deviation is 0.27 mm,
then position accuracy for MLC system is 0,54 mm (when K=2 is considered). The average standard
deviation for leaves positions is 0,14 mm, the mean repeatability for all the leaves is 0,28 mm.
Conclusions:
The developed software is able to check the MLC in static fields. Position accuracy and repeatability of the
MLC agility is within tolerance for all the leaves (< 1mm).

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P-100

QUANTITATIVE BREAST ELASTOGRAPHY FROM B-MODE IMAGES

Carolina Rabin, Nicolás Benech

Instituto de Física, Facultad de Ciencias, Uruguay

Non-ionizing applications

Purpose: In this work we investigate, from a physics point of view, the feasibility of quantifying the Young's
modulus of breast tissue from the auto-correlation of a diffuse field computed from a sequence of B-mode
images acquired through conventional ultrasound scanners.
Methods: Inspired in the seismological approach of retrieving the Green's function by cross-correlation, we
obtained a quantitative expression that relates the shear modulus of soft tissue to the auto-correlation of the
displacement field. We designed a mechanical prototype device adaptable to the breast anatomy, in order
to create the necessary conditions in terms of diffuse field generation. The device is easy to handle, and its
positioning does not interfere with the ultrasonic probe, being friendly to use within the clinical
environment. The displacement field was measured from a sequence of B-mode images acquired with
conventional ultrasound equipment. This method was tested in a breast tissue mimicking phantom using
standard ultrasound scanners. We also performed an in-vivo measurement as a preliminary validation.
Results: In the reconstructed elasticity maps the inclusions were identified and the obtained quantitative
results of the phantom are in good agreement with the values reported by the phantom's manufacturer. In
the case of the in-vivo measurement, the obtained images are in accordance with the patient known
pathology (BI-RADS 5, Infiltrating Ductal Carcinoma, Score 6). The pathological breast showed a
heterogeneous elasticity map with a mean Young's modulus of 98 KPa, while the normal breast displayed
a homogeneous map with a mean Young's modulus of 25 KPa.
Conclusions: We successfully reconstructed the Young's modulus map of the breast tissue mimicking
phantom and of a real breast tumor using B-mode images acquired with conventional ultrasound scanners.
The results support that our technique can be developed as a medical tool to obtain quantitative breast tissue
elasticity maps.

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P-103

ANALYSIS OF NTCP BASED RADIOBIOLOGICAL MODELS: A SYSTEMATIC

REVIEW OF LITERATURES

Mahafuzur Rahman1, Mafuz Abu Kausar2, Hasin Anupoma3, Golam Abu4

1
Rahman M, Bangladesh
2
Kausar A
3
Azhari HA
4
Zakaria GA

Radiobiology

Background and purpose: To achieve the optimal treatment goal, radiobiological parameters have to
evaluate and predict the outcome of this treatment plan in terms of both TCP and NTCP. Different types of
radiobiological model were used to achieve prescribed treatment dose of radiation during the tumor control.
Where TCP models play a important role in order to achieve desired dose to the tumor. A suitable NTCP
model was theoretically found among different models that can be used in treatment plan evaluation.
Materials and Methods: Theoretically, six different radiobiological dose response models were analyzed in
this project. Lyman–Kutcher–Burman, Critical element, critical volume, Relative Seriality, Parallel
architecture, Weibull distribution models were analyzed from the derivation. All models were discussed
elaborately with its various parameters and were used in the calculation of normal tissue complication
probability during the treatment in radiotherapy. Further, all models were compared with each other.
Results: The models denote the dose for 50% complication probability (D50) parameters is the most
commonly used radiobiological models for the normal tissues. The functional subunit response models
(critical element & Relative seriality, Critical Volume, parallel architecture) are used in the derivation of
the formulae for the normal tissue.
Since all complicated NTCP model predict same as the simple NTCP model that is Lyman–Kutcher–
Burman model as well as it is computationally efficient. Also, Lyman–Kutcher–Burman model can be used
in different treatment planning system incorporating with another model. For this reason, our suggested
model is Lyman–Kutcher–Burman NTCP model which can be used in treatment plan evaluation.
Conclusion: After analyzing six different model of NTCP, finding of the study is the treatment plan
evaluation in where Lyman–Kutcher–Burman model is the best model for biological plan evaluation.
Keywords: TCP, NTCP.

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P-104

STUDY OF BIOLOGICAL-BASED OPTIMIZATION FOR INTENSITY MODULATED

RADIATION THERAPY (IMRT) PROSTATE AND HEAD AND NECK CASES

Juliana Sandoval Navia1, Esperanza Castellanos López1, Alejandro González Motta3, Flavia Molina
Durán2
1
Pontificia Universidad Javeriana, Colombia
2
Strahlentherapie Rhein-Main-Nahe
3
Hospital Universitario San Ignacio

Radiation Oncology –Treatment Planning

Introduction:
Although present treatment planning systems apply biological-based optimization, its cost functions are not
always entirely understood by users, thus limiting the adequate implementation of that method. In this work,
we aimed to gain a deeper comprehension on how biological optimization is carried out in Monaco 5.1,
apply it in order to find the best possible plan, and compare these results with those obtained with physical
optimization for VMAT prostate and head and neck cases.
Materials and Methods:
Biological and physical optimization for various prostate and head and neck cases was implemented using
Monaco 5.1 for VMAT. An in-depth exploration of Monaco's biological cost functions was performed,
particularly of the influence of the various function parameters on target coverage and OAR sparing. We
also assessed the need to include further physical cost functions. Treatment plans were evaluated by DVH
analysis and calculating TCP and NTCP using DVH reduction methods. Results:
Both in prostate and head and neck cases, high-quality treatment plans were achieved by using biological
optimization in combination with some physical cost functions, which we found to be necessary to shape
the DVH and limit high dose points in targets and OARs. We found that the use of biological cost functions
facilitates the tailoring of the DVH, avoiding the use of multiple physical cost functions to obtain the same
result. As opposed to physical optimization, biological optimization provided better OAR sparing, without
sacrifice of conformality and homogeneity.
Conclusions:
Biological optimization provides an efficient optimization method for treatment planning, with the
advantage of being associated to radiobiological concepts necessary for the evaluation of IMRT plans. By
applying these functions in combination with physical cost functions, high-quality plans were achieved for
prostate and head and neck cases.

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P-105

DEVELOPMENT OF SECOND-CHECK 3D DOSE CALCULATION SOFTWARE FOR

HIGH-DOSE-RATE BRACHYTHERAPY

Tae Suk Suh, Sang-Won Kang

The Catholic University of Korea, Republic of Korea

Radiation Oncology –Treatment Planning

Purpose: To implement fast and comprehensive dose evaluation beyond a point-based plan decision in high-
dose-rate brachytherapy (BTHDR), volumetric independent dose calculation (vIDC) software was
developed. The feasibility and clinical practicality of the calculation module were evaluated for patient
cases.
Methods: As a fractional dose of 550 cGy was prescribed to 90% of the high-risk critical target volume
(HR-CTV), five patients with cervix carcinoma were selected to evaluate dose distributions in BTHDR
using a tandem and ring applicator. The vIDC adopts an updated version of the TG-43 formalism and the
same air-kerma rate for iridium-192 with a clinical treatment planning system (TPS). Volumetric dose
evaluation using the vIDC was preceded by an accuracy test at the ICRU reference points, namely point A
and B, and rectal points. Dose differences were presented with dose-volume histograms (DVHs) and
primary dose-volume parameters such as D2cc for organs-at-risk (OAR). A grid size of 1.0 x 1.0 mm2 (G-
1.0) was chosen for elaborate dose calculation. However, a sparse and a fine grid resolution of 2.5 x 2.5
mm2 (G-2.5) and 0.5 x 0.5 mm2 (G-0.5) were used to evaluate effect of grid size, especially at the high-
dose gradient.
Results: The averaged difference throughout an entire volume of dose points was less than -1.79%. When
the 1-mm grid resolution was used, the DVHs for the CTV and OAR showed the insignificant difference
between the vIDC and the TPS. While D2cc of OAR showed averaged dose deviation less than 10 cGy,
D90 of CTV showed the averaged difference of - 12.90%, -8.26%, and -6.18% in G-2.5, G-1.0, and G-0.5,
respectively.
Conclusion: The vIDC was usefully used for efficient second-check 3D dose evaluation for BTHDR using
iridium-192. Volumetric dose calculation using the sparse grid size can affect delivered dose distributions
using volume-based dose prescription.

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P-106

MONITORING RADIOACTIVE AIRBORNE CONTAMINATION DURING F18-FDG

PRODUCTION

Carlos Vergara1, German Arenas2, Guillermo Calderon2

1
Instituto Balseiro, UNCuyo, Argentina
2
FUESMEN

Radiation Protection

Airborne contamination monitoring is part of the Radiation Surveillance Program at PET

radiopharmaceuticals production centers in Argentina. This work presents the design and validation of a
quantitative airborne radioactivity monitoring methodology, associated to the production of FDG in the
Cyclotron-Radiopharmacy division at FUESMEN. As a significant improvement, the system was optimized
through the design and installation of an activated carbon filter. At present, our division has two FDG
synthesizers: a cGMP IBA Synthera, and non-cGMP Nuclear Interface, each installed inside a TAEN
Hotcell. First, the F-18 net activity from ventilation stack is evaluated. Second, the activity concentration
of F-18 in air, in DAC, is evaluated in workplaces. In both cases, an air sampling system based on a portable
pump with an air flow meter was used, with a two-filter set: fiberglass paper and carbon impregnated with
TEDA. In addition, an appropriate isokinetic probe was created and installed for in-line air sampling from
ventilation stack. In order to estimate activity levels in air, a method based on the use of a PET-CT scanner
was developed to measure the activity of F18 retained in sampling filters. For the detection system, a
Minimum Detectable Activity (MDA) of 3.18 KBq and a sensitivity of 0.0624 Kc/KBq have been
determined. When measured in workplaces, F-18 DAC values fell within regulatory limits. Regarding the
discharge ventilation stack measurements, activity values showed room for improvement, particularly for
FDG production using the non-cGMP synthetizer Nuclear Interface. In response, a modernization on the
two FDG TAEN hotcells was performed, adding a mixed bed activated carbon filter in hotcells exhaust air
duct, downstream the existing HEPA exhaust filter. As a result, F-18 emissions in the venting stack
remained below the MDA of the developed measurement method.

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P-107

GAMMA-CAMERA CALIBRATION TO DETERMINE UPTAKE ACTIVITY ON

THYROID SCINTIGRAPHY WITH Tc-99m

Danny Giancarlo Apaza Veliz1, Vinícius Fernando Dos Santos2, Fabio Matheus Waldomiro2, Wilson
Eduardo Furlan Matos Alves2, Eder Rezende Moraes1
1
Universidade de São Paulo, Brazil
2
Hospital de Câncer de Barretos

Nuclear Medicine

Introduction:
Thyroid scintigraphy with technetium 99 metastable (Tc-99m) allows the physiological and functional
evaluation of the thyroid gland and thus to determine some disease, the advantage of using Tc-99m is its
short half-life and rapid uptake in the patient. This image is common in the clinical routine of diagnosis in
the thyroid, but the activity collected and cumulated as well as the dose in the thyroid and organs around
are not known, so it is necessary to have the calibration factor that allows to determine the activity captured
due to the number of thyroid counts in the obtained image.
Materials and methods:
The scintigraphy images of two groups of three Petri dishes were acquired and studied, in two Gamma-
Chamber General Electric Models Discovery NM 630 and NM/CT 670. For each acquisition, Petri dishes
filled with 93, 64 and 19 MBq of Tc- 99m in a volume of 20 ml each and placed on 8 PMMA plates each
one 1 cm thick, then two more PMMA plates were placed on the Petri dish. The acquisition of each image
was performed 5 cm from the detector, image size 15x15 cm2, matrix 256x256 pixels and 360 seconds time
in all cases. The study of the images was done by determining the number of counts within an ROI
delimiting the main region, and four smaller ROIs to determine the background counts in the thyroid image.
Results and Conclusions:
The calibration factors of the two Gamma-Chambers were calculated, obtaining values of 1.71x10-2 and
1.95x10-2 MBq.s/cts for the models Discovery NM 630 and NM/CT 670, respectively. These factors will
allow to determine the activity uptake in the thyroid using imaging thus being able to perform dosimetry
both in the thyroid and in the adjacent organs as well.

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P-109

CORNEA INFLATION TESTS TO COMPLEMENT A BIOMECHANICAL MODEL

OF THE HUMAN CORNEA

Claudia Muñoz Villaescusa, Osiris de la Caridad Núñez Chongo, Alfo José Batista Leyva

InSTEC, Cuba

Biomedical Engineering

Numerical modeling of human cornea has paramount importance to test in silica surgical procedures and
to understand the effect on human eyes of injuries and other external aggressions. To prepare a numerical
model that could reproduce correctly the corneal behavior, it is necessary firstly to select a type of elastic
material and its mechanical model of response. Then a numerical procedure must be implemented; normally
FEM is used for calculations. It is then necessary to select geometry, create a mesh and calculate the elastic
constants of the model. It was created a mesh consisting in three layers and eleven elements per meridian
from the apex to limbus. Two geometries were tested: cornea fixed by limbus and a second one formed by
cornea, corneal limbus and part of sclera. It was prepared and tested the numerical procedure for
establishing the stress-free configuration. In the present contribution, it is shown an experimental
installation that is being employed in inflation tests. Due to their similarity to human corneas, porcine
corneas were used to help in developing a methodology in order to get stress- strain relations from inflation
tests. From these relations the numerical parameters of a Mooney Rivlin hyperelastic material model are
obtained.

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P-110

DOSIMETRIC COMMISSIONING OF AN UPGRADED EQUINOX-100 COBALT-60

UNIT IN THE VARIAN ECLIPSE TREATMENT PLANNING SYSTEM

Thomas N. Bulenga1, Chandra P. Joshi1, C. Jechel2, G. Salomons1, L. J. Schreiner1

1
Department of Physics, Department of Oncology, Queen's University, Kingston, ON, Canada
2
Best Theratronics, Kanata, ON, Canada

Radiation Oncology – Quality Assurance

Introduction: An existing clinical Theratron 780C (T780C) (Best Theratronics, Kanata, CA) Cobalt 60 unit
with 80 cm source to axis (SAD) was upgraded to an Equinox-100 Cobalt-60 unit with 100 cm SAD. The
upgraded Equinox-100 has increased clearance to accommodate a removable multi-leaf collimator enabling
conformal radiation therapy, and potential intensity modulation capabilities. The upgrade also included
installation of a computer-controlled collimator system with a motorized 60° wedge, and a new Avanza
patient support system to enable patient positioning with improved motion accuracy and stability. This was
the first upgrade of a T780C unit worldwide and represents an exciting opportunity to advance conventional
Cobalt 60 technology.
Methods: In this work we present mechanical commissioning of the upgraded unit following Task Group
45 report (AAPM) recommendations, and commissioning of the Cobalt-60 source in the Eclipse treatment
planning system (TPS) (Varian Medical Systems, Palo Alto, CA) for dose calculations. Dosimetric
measurements required for configuration of the Eclipse AAA algorithm were acquired, and various source
modeling parameters were adapted and optimized in the Eclipse TPS to model the Cobalt 60 source. The
Eclipse TPS was validated by comparing the treatment plan calculations with ion chamber, and
radiochromic film dosimetry measurements in water phantom.
Results: The mechanical test results were mostly comparable to typical tolerances acceptable for clinical
linear accelerator as recommended in TG 45 report. This suggests that upgrading a conventional Cobalt 60
unit improves treatments without compromising the mechanical accuracy. Treatment plan calculations in
the Eclipse TPS showed excellent agreement with measurements for 5×5 cm2 or larger radiation fields.
Our results show that the Eclipse TPS can be appropriately commissioned for forward treatment planning
with Cobalt-60 beams for 3D conformal radiation therapy for large fields. We continue investigating the
accuracy of the Eclipse calculations for Cobalt 60 small fields.

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P-113

A WAY TO PRESENT THE INSTITUTIONAL DOSIMETRY

Diego Mauricio Orejuela Mosquera

Hospital Universitario del Valle "Evaristo García" E.S.E, Colombia

Radiation Protection

Introduction:
Currently, dosimetry focuses on the worker through records between annual, quarterly or monthly periods,
but at the institutional level is not analyzed. To guarantee a radiological protection program that is sustained
over time, it is necessary to know in which area of the institution a greater resource of the estimated ones
is required due to the risk that the practice merits. Methods:
The last 5 years of registration were taken. The data were analyzed by means of a normal distribution and
plotted by means of box and whisker diagrams. You can compare the classic method of representing the
data plotted month by month to a global graph of box and whiskers where all the data of a worker in a same
year is synthesized.
Results:
The maximum and minimum values are differentiated, while the median and with them comparing them
with the reference levels, can determine the dosimetric range as the difference between 75% percentile and
25%. With this, the dosimetric range of the practice is estimated
Conclusions:
The box and mustache diagram allow to visualize in a practical way the personal occupational dosimetry
better than the classical form. This type of graphs also allows us to observe where most of the data are
concentrated and to estimate in what level of dose the worker is with respect to its last 5 years of records,
with respect to the group or department that belongs and at the same time compare the different Services
to estimate where the highest dosimetric risk is obtained. Finally, the values of the institutional dosimetric
range, the confidence interval, the standard deviation can be obtained since the dosimetric data of the
institution behave in a normal way and allow to synthesize the institutional dose in statistical values
traceable in time.

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P-115

DEVELOPMENT OF CALCULATION APPROACH FOR THE DETERMINATION OF

CENTRAL AXIS DEPTH DOSES IN WATER FOR COBALT 60 BEAM

Dorcas Oforiwaah Addo1, Francis Hasford1, Samuel Tagoe2, Cyril Schandorf 1

1
Department of Medical Physics. School of Nuclear and Allied Sciences, University of Ghana, Legon,
Ghana
2
Korle-Bu Teaching Hospital, Department of Medical Physics. School of Nuclear and Allied Sciences,
University of Ghana, Legon

Radiation Oncology – Dosimetry

One of the dosimetric functions, which is of great importance, is central axis percentage depth dose, which
are usually measured with automated systems. The aim of the study was to develop and propose a semi-
empirical formula that can be used to determined central axis percentage depth doses through manual
calculations and also be used as a quality assurance tool to check uncertainties associated with measured
central axis depth doses. Linear attenuation coefficients of water were measured for water with beams from
a Theratron Equinox 100 cobalt 60 teletherapy unit using field sizes ranging from 4 cm x 4 cm to 30 cm x
30 cm. The linear attenuation coefficient measurements were done in air with a 0.125cc Semiflex ionization
chamber with its build-up cap on. With the expression for the primary component of the PDD and the
measured PDD data obtained during commissioning of the telecobalt machine, a semi-empirical formula
was developed and proposed for the determination of PDD, which considered both the primary and the
scatter components of the PDD. The PDDs calculated with the proposed semi-empirical formula compared
well with their measured counterpart with percentage differences between measured and calculated PDDs
ranging from 0.10% to 2.01% (mean of 1.24±0.88%), which is within the 2% acceptable limit for central
axis parameter constancy (PDD, TAR) as recommended in the report of the TG-40. The use of the proposed
formula for calculating PDD is recommended for clinical application, but one needs to be circumspective
in the use of the formula as some few PDDs (2%) calculated with the formula compared to their measured
counterparts were found to have discrepancies beyond the tolerance of 2% recommended for the
determination of central axis depth doses.

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P-117

OCCUPATIONAL RADIATION DOSE TO OPERATOR BY HANDHELD DENTAL

INTRAORAL EQUIPMENT VERSUS A FIXED INTRAORAL X-RAY SYSTEM

Ana Maria Rodriguez1, Fernando Leyton2, Simona Molina3, Camila Rengifo3, Oscar Edding4
1
Hospital del Salvador, Chile
2
Instituto do Câncer do Estado de São Paulo, Cancer Institute of São Paulo State, Brazil and Universidad
Diego Portales, Chile
3
Universidad Mayor
4
Instituto de Salud Pública de Chile, Chile

Radiology – Radiation Protection.

Medical and dental exposures are the main contribution of radiation dose to the population due to artificial
sources. Then, operator and staff must be aware of safe use of ionizing radiation. The intraoral X-ray
equipment is designed to be fixed or arranged on a mobile support. A new X-ray equipment has been
introduced, which can be held by operator`s hands during exposure. The aim of this study was to estimate
radiation dose to operator when using a handheld dental intraoral X-ray system without a backscatter shield
during intraoral radiography and to compare the measurements with fixed dental equipment with and
without protection barrier. Measurements were taken at a maxillofacial radiological clinic. A Planmeca
Intra fixed intraoral equipment and DX 3000 Dexcowin handheld intraoral equipment were used. A dental
simulator to calibrate the radiographic technique was used, together with the Kodak film and Sirona digital
system. The diagnostic images were obtained with 0.3 and 0.15 s for film and digital system, respectively.
Then, an exposure time scale for each tooth piece was made. Scattered radiation was measured using a
Thermo Scientific Mini-ION ionization chamber. The chamber was positioned at 30 cm to skull simulator,
simulating working conditions. The method to calculate occupational radiation dose is based on the protocol
of Public Health Institute of Chile. This study shows the first results for Chile estimating radiation dose to
operator when using a handheld intraoral X-ray system. The operator radiation dose using handheld
intraoral equipment with digital system and fixed dental equipment with film was 12 and 14 μSv,
respectively. When handheld intraoral equipment is used with film system, the dose was 28 μSv,
significantly higher than fixed intraoral equipment. Consequently, the limit of 20 mSv / year can be easily
exceeded. Therefore, precautions must be taken to avoid unnecessary exposures to operator.

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P-118

METHOD FOR NOISE REDUCTION IN COMPUTED TOMOGRAPHY IMAGES

WITH AN APPROXIMATED BILATERAL FILTER

David Adame, Rafael Miller Clemente

Medical Biophysics Center, Cuba

Diagnostic and Interventional Radiology – General

Despite the clear evidence that computed tomography provides very valuable information for diagnosis,
there is a potential risk for the use of ionizing radiation. In CT, decreasing the dose of radiation increases
the amount of noise in the images; therefore, the noise can hide anatomical details and decrease the
detection of injuries. The Bilateral filter, proposed by Tomasi and Manduchi, is able to preserve the edges
of the image and to reduce noise in uniform regions. The ability of the BF to reduce noise depends on the
function of two sub-factors including spatial distance and intensity weights. In the BF the functions of these
weights are exponential. This function has the advantage of reducing the greater amount of noise and better
preserving the structural details. The disadvantage is that this noise reduction and detail preservation
capability decreases after a certain noise value by reducing filter performance. The advantages of this
feature have a very narrow margin and can easily be lost in practical applications where noise variability
increases. This affects the performance of the BF causing blurring in the details of the image and a decrease
in the ability to reduce noise in the image. In order to be more effective, the filtering process in our work,
we made a reformulation of the sub-factors of spatial distance and intensity. The function exponential of
these sub-factors was approximated to fractional through the MacLaurin serial development. The
reformulation guarantees a better stability in the noise reduction capacity, a better preservation of details in
the image when there is an increase in noise variability as well as a reduction in the execution time.

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P-119

DETERMINATION OF ABSORBED DOSE TO WATER FOR MEDIUM AND HIGH

ENERGY X-RAY BEAMS USING FRICKE DOSIMETRY

Paulo Henrique Rosado1, Camila Salata1, Mariano Gazineu David2, Andrea Mantuano2, Carlos Eduardo
de Almeida2
1
Brazilian Nuclear Energy Authority, Brazil
2
Rio de Janeiro State University

Dosimetry – Reference quality

Introduction: Currently, the determination of absorbed dose to water for medium and high energy X-ray
beams is done using water calorimetry or ionization chamber. However, these measurements need to be
validated and the technique used is very restricted to a few standard primary metrology laboratories. This
work presents the Fricke dosimetry as a solution for the measurement of the absolute absorbed dose to
water for medium and high energy beams. Material and Methods: First, the chemical yield curve of the
Fricke solution was determined as a function of photon energy. From the chemical yield curve, it was
possible to determine the absorbed dose to water equivalent depth of 2 cm in X-ray beams, defined by the
CCRI/BIPM, as well as the expanded uncertainties of the dose value. For the CCRI/BIPM qualities, the
spectra were also simulated and the R2.5 parameter was evaluated experimentally to be used as a quality
index for medium energy photon beams. In addition, the quality factor of three ionization chambers were
determined experimentally for high energy beams. The expanded uncertainties of the quantities obtained
were calculated. Results: The uncertainties obtained for the medium X-ray measurements were 2.3% (k=2),
which is lower than the uncertainties obtained with the ionization chamber. For the high energy beams, the
absolute dosimetry was done with ionization chamber and Fricke dosimetry. The results of absorbed dose
to water shows a difference of 0.9% among them. Conclusion: Fricke dosimetry has shown good potential
to be used as a primary standard for the absorbed dose to water measurement. Some important aspects
should be observed, as this is a chemical dosimeter, any contamination at the Fricke solution can change
the results. The prepare of the solution must be done carefully to avoid contamination.

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P-120

AN UNCERTAINTY ANALYSIS FOR OPTIMIZATION OF COMPUTED

TOMOGRAPHY PROTOCOLS

Rafael Miller-Clemente

Radiation Medical Physics Group. Center of Medical Biophysics. Universidad de Oriente. Santiago de
Cuba, Cuba

Diagnostic Radiology –Dosimetry

The objective of this work was to identify the uncertainties with the greatest contribution into the
optimization of Computed Tomography (CT) protocols and their possible reduction for measurements
under clinical conditions. A continuous uniform distribution was assumed to estimate the relative
uncertainty of kQ, equal to u(kQ) = 0.3% for k = 1. The ionization chamber used (CT chamber 30009,
PTW-Freiburg) has a response variability in the energy range (80-140 keV) used =<4%. The expanded
uncertainties of air kerma free-air (Ca,100) and Polymethyl Methacrylate phantom (Cpmma,c) indices were
11.1% and 12.7% for k = 2, respectively. The uncertainties >1% contributed 92% to the combined
uncertainty. According to the results obtained and the recommendations of the Report TRS-457 of the
International Atomic Energy Agency, when replacing the dosimeter used by a reference class dosimeter,
such as a Farmer 30010 type camera (PTW, Freiburg), the uncertainty =<0.5% per year corresponds to a
scenario 3. In addition, the Farmer 30010 type camera has a response in the energy range =<2%, and its
directional response =<0.5% for an inclination range of the camera axis of ±5°, which belongs to a scenario
3 as well. Therefore, the uncertainty budget is reduced by 49.5% and 66.1% for Ca,100 and Cpmma,c
respectively. We estimated the spectra that satisfy the calculation of Ca,100 and Cpmma,c with relative
differences less than 2%, in addition to the primary and scattered spectra. The reduction of the expanded
uncertainty for measurements in clinical conditions improves the accuracy of the dosimetry for the
optimization of CT protocols. The determination of fitted spectra contributes to the knowledge of the
influence quantities of uncertainty due to scattered radiation and beam hardening.

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P-122

QUALITY CONTROL OF OPEN FIELDS WITH EPID IN AN ELEKTA SYNERGY

Fernando Tato de las Cuevas, Fernando Fernández Belmonte

Hospital Universitario de Canarias,Tenerife, Spain

Radiation Oncology – Dosimetry

Introduction:
The Electronic Portal Imaging Device (EPID) is sometimes used as quality control device for linear electron
accelerators (LINACs). Due to the corrections applied to the image by the EPID software, the homogeneity
of a square field obtained by the EPID is different from the one obtained by a conventional detector. In this
work, the use of EPID as a tool for dosimetric quality control of open fields is analyzed.
Methods and Materials:
The LINAC is an Elekta Synergy with iViewGT EPID and 6 MV energy. The focus-detector distance is
fixed, 160 cm.
Air profiles are acquired with the 2D Linear Array (PTW), for a 23x23 cm field (the largest field which
allow to adquire the whole penumbra and part of the profile tail with EPID), dose rate 200 UM/min.
1) For the analysis of the images obtained with the EPID, a Matlab software developed by ourselves is
used.
Using a 200 UM/min dose rate, the dose profiles along GT and LR axes are analyzed. The differences in
homogeneity are evaluated for fluences of 10, 20, 50 and 100 MU.
2) The differences in symmetry between Linear Array and EPID are evaluated in both axes for 5 months.
Results and Discussion:
1) The maximum value of the homogeneity is reached at 50 MU, so this value is taken.
2) The differences in symmetry between Linear Array and the EPID along GT and LR axes are: -0.4 and
+0.7, respectively. These differences can be attributed to the lack of homogeneity in the EPID dispersion.
Conclusions:
Despite the differences in symmetry between both devices, the EPID can detect changes in symmetry of
open fields after establishing an initial reference.

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P-123

PET/CT AND HYPO-FRACTIONATED RADIOTHERAPY OF PATIENTS WITH

HEAD AND NECK CANCER

Misleidy Napoles Morales, Carlos Fabian Calderon Marin, Juaquin Gonzalez Gonzalez

MINSAP- CUBA, Cuba

Radiation Oncology –Treatment Planning

Positron emission tomography/Computer tomography (PET/CT) is a multimodality imaging diagnostic

technique that analyzes the uptake and retention of different radiopharmaceuticals by cells providing
metabolic information on biochemical processes. PET/CT has been used for radiotherapy planning,
providing useful information to the Radio-oncologist about the localization, size and metabolic activity of
tumor lesions. In this paper, we show advantages of the 18F-FDG PET/CT respect to simple CT imaging
for target volume delineation in patients with diagnosis of Squamous Head and Neck Carcinoma that has
been scheduled to undergo a hypofractionated radiotherapy treatment. On ten studied patients, the target
volume defined from PET/CT images was less extensive than those defined from simple CT images. In six
patients the target volume was significantly less extensive and in two of them a new lymph node disease
was reported, re-staging and corresponding target volume was also delineated with less extensive margins
from PET/CT images. A greater accuracy in delineating the volumes and improving the distribution of
doses in the planning of the radiant treatment in these patients was possible, allowing a high precision in
the delivery of the prescribed dose to the target volume diminishing the maximum dose to the adjacent
healthy tissues. In conclusion we show that the use of 18F-FDG PET/CT was superior than the simple CT
as the primary modality of imaging for hypofractioned radiotherapy treatment planning in patients with
Squamous Head and Neck Carcinoma.

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P-126

DETERMINATION OF THE DYNAMIC VISCOSITY IN SAMPLES OF BLOOD

PLASMA AND HEMOGLOBIN SOLUTION BY NUCLEAR MAGNETIC
RELAXATION

Yulianela Mengana Torres1, Manuel Arsenio Lores Guevara1, Juan Carlos García Naranjo1, Lidia Clara S
Uárez Beyries2, Inocente Clemente Rodríguez Reyes2
1
Centro De Biofisica Médica, Cuba
2
Hospital Juan Bruno Zayas

Biomedical Engineering

A procedure based on proton magnetic resonance is presented for the evaluation of the dynamic viscosity
in blood plasma and in hemoglobin solution from the determination of the transverse relaxation time (T2).
To experimentally determine the T2 value, the impulse series Carr-Purcell-Meiboon-Gill was used in a
MARAN DRX console (OXFORD INSTRUMENTS) and a homogeneous magnetic system (B0 = 0.095T).
Values were obtained for blood plasma viscosity and hemoglobin of 1.68 ± 0.12 mPas and 12.78 ± 3.55
mPas respectively, which coincided with the determined, in the same samples, using an Ostwald viscometer
(1.45 ± 0.06 mPas for the plasma and 12.82 ± 3.35 mPas for the dissolution of hemoglobin). The dynamic
viscosity of the blood plasma was determined in 236 patients with multiple myeloma (2.19 ± 0.58 mPas),
142 with sickle cell anemia (2.20 ± 0.79 mPas) who showed statistically significant increases with respect
to the characteristic values of the controls (1.68 ± 0.12mPas ).

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P-127

INTRAOPERATIVE RADIATION BEAM MODELING AND BREAST TREATMENT

SIMULATION

Camila Baltazar, Patrícia Nicolucci

University of São Paulo, Brazil

Radiation Oncology –Treatment Planning

Introduction: Intraoperative radiation therapy (IORT) delivers the treatment dose in a single fraction during
the surgical procedure. IORT beams present different characteristics from conventional external therapy
beams, and there is little information about the techniques's dose distribution. The goal of the present study
is to assess IORT dedicated beams and simulate a breast treatment using the Monte Carlo method.
Methods: Monte Carlo simulation package PENELOPE was used to model IORT applicators and obtain
the radiation beam spectra. The modeling geometry consisted in the applicator for NOVAC7 and the probe
for Intrabeam, both inserted in a water filled phantom. The radiation spectra were validated through
comparisons with literature. A breast treatment was simulated for both beams. A female thorax geometry
was built into PENELOPE, using soft tissue and skin materials. Dose distributions were qualitatively
evaluated.
Results: The beam modeling validation showed a maximum divergence between simulated and literature
data of 7.8pp for NOVAC7 and 8.6pp for Intrabeam. For millimeter distances, the divergences in NOVAC7
are acceptable, while for Intrabeam both curves present the same behavior, and the biggest divergence
occurs in close proximity to the probe tip, representing a small influence at the prescription depth. The
Intrabeam dose distributions presented doses higher than 100% in the target volume, since the treatment is
prescribed at 1 cm from the applicator. For NOVAC7, the dose distribution showed, for all the energies, a
region of high doses in the intersection between air and soft tissue.
Conclusion: The high dose region observed for both IORT beams may compromise a large fraction of the
target volume and must be carefully considered for treatment planning. The knowledge of the dose
distribution can improve the treatment planning, allowing the study of target volume definition and
improving treatment results.

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P-129

STRUCTURING OF THE NATIONAL QUALITY CONTROL PROTOCOL FOR

MAMMOGRAPHS CR

Napoleon Ortiz

Aspiring to Masters in Medical Physics, Colombia

Diagnostic and Interventional Radiology – General

This work makes available to the country, a protocol for computerized mammography; among other
reasons, because this is the most abundant family of equipment in the national inventory. An important
number of CR mammographs in the country were and will continue to be the product of a
""transformation"" of analogue equipment already in service, which have been converted into CR, by
adding the module that allows the formation of the digital image, with all the implications that this brings;
which is why it deserves to structure its specific protocol for quality control. The initial proposal is based
on the existing protocols for both analogous and digital mammography, as relevant in each case; which is
applied through a pilot, to 16 teams (14% of the country's total) of 14 hospitals (5.4% of the country),
located 6 of them in a department of the Colombian Andes and the remaining 8 in a department of the
Caribbean area. The relevant material used was: CR cassettes of each institution, Ray Safe System,
mechanical weight, Free Software ""ImageJ"", blocks of PMMA and ACR mannequin. Once the pilot
product information has been processed and analyzed, the final version of the protocol is structured,
including the estimation of average glandular dose, as well as tools for the acquisition, processing and
analysis of the information acquired in the application of the protocol, in such a way that it is ensured and
facilitated, obtaining the results and conclusions of it. The most representative brands of mammographs
and CR readers in the country were established, as well as the results of the application of the protocol tests,
by type of test and by equipment. The protocol obtained will be harmonized with the participation of a
group of medical physicists who work in hospitals that have mammography.

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P-131

BIOSPECKLE LASER TO STUDY THE RED BLOOD CELL AGGREGATION IN

ALTERED CONDITIONS

Martin Toderi1, Bibiana Riquelme1,2, Gustavo Galizzi1

1
Instituto de Física Rosario (CONICET-UNR), Rosario, Argentina
2
FCByF (UNR), Rosario, Argentina

Biomedical Engineering

Dynamics of human red blood cell aggregation was studied by means of biospeckle laser analysis. Red
blood cells from healthy donors were suspended at 40% in autologous plasma with different concentrations
of dextran 500 (0.2 g/mL, 0.4 g/mL y 0.8 g/mL) in order to modify the aggregation process. He-Ne laser
light was used to obtain the biospeckle pattern from forward scattered light by the samples. Biospeckle
parameters such as Correlation Coefficient and Inertia Moment, were calculated in order to assess their
sensitivity and versatility. Results show variations of the calculated indexes related with the dextran
concentration used. Consequently, the proposed biospeckle parameters could be used as a tool for assessing
red blood cell aggregation and eventually diagnosis pathological conditions related the aggregation
dynamics to prevent possible microvascular alterations.

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P-132

PROTECTION OF CRYSTALLINE LENSES BY THE SEAT CONTAINING SHIELD

MATERIAL

Hiroki Ohtani, Naoki Sekiya, Mayumi Santa, Toru Ishibashi

Teikyo University, Japan

Radiation Protection

Introduction: The absorbed dose of crystalline lenses in a computed tomography (CT) is decreased using
the seat containing shield material. Influence on image quality by the shield material is estimated.
Methods and Materials: The bismuth containing seat and the barium containing seat were used for the shield
material. An image evaluation of the CT in which the shielding seat was installed on the water phantom
was done. A standard deviation of an obtained picture was measured using the Image J, and influence of
image quality was estimated. The Image J is image analysis software. The absorbed dose of crystalline
lenses was measured using the optically stimulated luminescence (OSL) dosimeter installed in head
Phantom. The location of the OSL dosimeter was made the root of the nose, the eye socket center and an
outer corner of the eye. The eye socket covered by the shielding seat did CT photography.
Results: A standard deviation was increased so that it increased in the thickness of the bismuth containing
seat. However, the barium containing seat could get the same standard deviation irrespective of the
thickness. Decrease of the absorbed dose of crystalline lenses showed by the shielding seat. The absorbed
dose decreased so that it increased in the thickness of the shielding seat. The protective effect of the
shielding seat of barium 15 mm and bismuth 3 mm was same.
Conclusions: The barium containing seat didn't influence diagnostic imaging, and it was possible to
decrease radiation exposure of crystalline lenses. Influence on image quality of CT by the shielding seat
was estimated using the Image J.

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P-134

CHARACTERIZATION AND CALIBRATION OF RADIOCHROMIC FILMS EBT2

FOR USE IN PERIPHERAL DOSE MEASUREMENT

Cecilia Querebalu Garcia1, Carlos Javier Solano Salinas2, Sandra Guzman Calcina3, Rolando Paucar
Jauregui1, Eduardo Carrasco Solis4
1
Inrape, Peru
2
Universidad Nacional de Ingenieria
3
Universidad Nacional Federico Villarreal
4
Inen

Dosimetry – Reference quality

In radiotherapy treatments, there is an absorbed dose that is deposit outside the treatment field, this dose is
known as ""Peripheral Dose"". The objective of this work was to characterize and calibrate the EBT2
radiochromic films in a range of lower doses with a beam of photons of 6 MV generated in a linear
accelerator Clinac 2100C / D, in order that they can be used as dosimeters in the measurement of peripheral
dose. The characterization of the radiochromic films, shows a reproducibility with uncertainty of ± 1.3 %
(2μ), linearity for a range of low dose of up to 93 cGy with linearity coefficient of r2 = 0.9998, dependence
of the dose rate of ± 4.7 % ( 2μ), energy dependence with linearity coefficient of r2 = 0.9412 and in the
calibration a maximum uncertainty of 1.8 % (2μ). It is concluded that EBT2 radiochromic films can be used
to measure peripheral dose, due to the characteristics they have, such as the low energy dependence
(between 1% and 2% for the same dose) and in addition to being suitable for placing them on the surface
of a patient

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P-136

SCATTER RADIATION DOSE AT HEIGHT OF THE CARDIOLOGIST`S EYE: A

MULTICENTRE STUDY

Fernando Leyton1, Maria do Socoro Nogueira2

1
Instituto do Câncer do Estado de São Paulo, Brazil
2
Centro de Desenvolvimento da Tecnologia Nuclear, Brazil

Radiology – Radiation Protection.

Cases of radiation induced cataract among cardiologists have been reported in studies, estimates for the
dose to eye lens ranged from 450 to 900 mSv per year (without ceiling suspended screen). Recent surveys
regarding high prevalence of lens changes likely induced by radiation exposure suggest an urgent need for
improved radiation safety and training, use of eye protection during catheterization procedures, and
improved occupational dosimetry. The ICRP recommends limiting radiation dose to the lens of the eyes to
20 mSv per year for occupational exposure. The aim of this paper was to report scattered radiation doses at
the height of the operator's eye at interventional cardiology facilities and correlate these values with
different angiographic projections. Measurements were taken in three cardiac laboratories. Clinical working
conditions were reproduced during the experiments for seven angiographic projections and three
fluoroscopy modes and a cine mode were used. PMMA plates were used to simulate a standard patient and
a cardiac protocol for patients between 70 to 90 kg was used. Measurements of ambient dose equivalent
(H*(10)) were performed with Unfors Xi detector. The detector measuring scatter radiation was positioned
at the usual distance of the cardiologist's eyes. A first entrance surface air kerma (Ka,e) rate reference
proposal for the characterization of angiography for fluoroscopy low, normal, high and cine modes were
16; 35; 40 and 220 (mGy/min), respectively. An experimental correlation factor range 3.9 to 5.3
μSv/Gy*cm2 were calculated. Considering the typical PKA values to patient in interventional cardiology
procedures, we have obtained that the dose at the height of the operator's eye lens ranged from 0.078 to
1.490 mSv per procedure when the radiological protection devices have not been used. Therefore, an
operator could easily exceed the annual dose limit if the radiological protection devices are not used.

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P-137

ALTERNATIVE FOR THE DESIGN OF THE CURRICULUM IN THE FORMATION

OF MEDICAL PHYSICISTS

Irene Cruz-Martínez1, Rafael A. Miller-Clemente2

1
University of Medical Sciences. Santiago de Cuba. 90400, Santiago de Cuba, Cuba
2
Group of Radiation Medical Physics. Center of Medical Biophysics. University of Orient, 90400, Santiago
de Cuba, Cuba

Education and Professional Issues

The subject is inserted in the complex process of improvement of Cuban Higher Education and the
formation of Bachelor in Physics (BP), with emphasis on Medical Physics (MP). The main destinations for
the location of these professionals are in scientific research and health centers or other associated with
medical applications. However, a significant number of graduates from BP enter the labor market of the
MP without prior training in the subject, a limitation that has its genesis in the curricular design of the
career. A research was developed in which theoretical methods such as analysis-synthesis,
ion, socialization workshops and theoretical exchange with professors were applied in order to analyze the
curriculum in relation to the formation of BP, with emphasis on MP. The process of
ion carried out favored the proposal of an alternative for the design of the curriculum in which a proposal
of the optional curriculum and the identification of the professional competences in FM have been taken
into account. The first includes the subjects Biophysical Fundamentals of Morphophysiology, Radiological
Protection, Radiobiology and Radiation Medical Physics, with which a greater level of essentiality is sought
in the contents for performance as medical physicists. The second is aimed at the identification and
contextualization of the specific competences that will allow the profession to be exercised according to
the standards of the medical physicist in Cuba and internationally. The proposal of the alternative for the
design of the BP curriculum allows an integral approach to the object of the profession from the initial
stages of the career, from the implementation in the praxis of alternatives that respond to the totality of the
social context related with the training of this professional.

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P-139

GATED VMAT IMPLEMENTATION USING HOMEMADE 4D PHANTOM

Isabela Araujo1, Joao Paulo Leite2, Vanessa Nobrega1, Leandro Cardoso1

1
Universidade de Brasília, Brazil
2
Hospital Sírio-Libanês

Radiation Oncology – Dosimetry

Introduction:
Radiotherapy treatment in lung cancer is a challenge due to intrafraction tumor motion. Additional margins
added to the target volume trajectory can ensure treatment but also increase complications due to toxicity
in adjacent tissues. Radiotherapy with respiratory gating reduces irradiated area to a specific window of the
respiratory cycle. Gated technique implementation requires quality assurance tests that guarantee treatment
accuracy for targets tracked by external references. For this purpose, we developed a phantom capable of
mimicking the respiratory movement.
Methods and Materials:
An oval styrofoam cylinder reproduces a pulmonary lobe enclosed in a thick shell of casting plaster, as it
is easily modeled and has soft tissue equivalent Hounsfield (200HU). The tumor has spherical format and
approximately 2 cm diameter also of plaster positioned in the center of styrofoam lung that was parted in
half to insert radiochromic film.
For reproduction of respiratory cycle, we attached the produced phantom to the respiratory phantom of the
Siemens Anzai® only to take advantage of its longitudinal movement.
We acquired a 4D tomography for planning using Varian RPM® (Real-Time Position Management), which
was also used for treatment. Using Eclipse® we planned 18Gy in 2 half volumetric arcs (RapidArc®) for
a TrueBeam® with 10MV flattening filter free (FFF) beam and 2400MU/min dose rate calculated with
Acuros.
We performed measurements with EBT3 radiochromic film positioned at the center of the moving lesion
and Portal Dosimetry® (PD) with RPM.
Results:
The result of gamma analysis for both measurements, film and PD compared to the calculated dose
distribution had agreement of 98.86% with criterion 3%/3mm with film and 99.2% with 3%/1mm with
Portal Dosimetry.
Conclusions:
The phantom made possible the implementation of VMAT technique with Gating in a reliable and efficient
way, besides being a cheap option compared to the commercial models.

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P-140

RELEVANT CLINICAL ADVANCES WITH THE IMPLEMENTATION OF NEW

RADIOTHERAPY TECHNOLOGIES IN JAMAICA

Venedicta Vasquez Perez1, Misleidy Napoles Morales2, Damion Andre George Gilpin1
1
MOH-Jamaica- JMDA, Jamaica
2
MINSAP-CUBA

Radiation Oncology –Treatment Planning

Cancer is one of the leading causes of death globally and radiotherapy is currently an essential component
in the management of cancer patients, either alone or in combination with surgery or chemotherapy, both
for cure or palliation. Advances in computer technology have enabled the possibility of transitioning from
basic 2-dimensional treatment planning and delivery (2-D radiotherapy) to a more sophisticated approach
with 3-dimensional conformal radiotherapy (3-D CRT).
Material and Methods: The planning of patients with malignant pathologies in the head and neck, prostate,
central nervous system, Cervix and breast in 2 dimensions, treated in the Cobalt machine, simulated with a
conventional simulator and the new plans in 3 dimensions done after the acquisition of the CT simulator
and the CLINAC iX of Varian and the complications reported during the treatment were compared.
Results: The patients treated in 2D presented greater toxicity during the treatment than those who received
the treatment in 3D dimensions, tolerating it better despite the increase the tumor dose.
Conclusions: the new technologies introduced in the country since March 2018 have allowed to improve
the quality of radiant treatments and to personalize the treatments by increasing the dose to the tumor,
decreasing to the maximum the dose in healthy tissues.

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P-141

NEW QUALITY CONTROL PARAMETERS OF ALUMINA COLUMNS USED IN

99Mo/99m Tc GENERATORS

Mohammed Rabie Bricha, Kaddour Benhamou, Naoual Bentaleb

Department of Radiopharmaceuticals Production, National Centre for Nuclear Energy, Sciences and
Technologies (CNESTEN) Rabat, Morocco

Nuclear Medicine

Currently, in Morocco, the demand for radioisotopes and radiolabeled compounds is steadily increasing
with the emergence of new nuclear medicine centers. To support this evolution, the National Center for
Nuclear Energy, Sciences and Technologies (CNESTEN-Morocco). was placed an ambitious program for
the development and manufacture of radioisotopes for medical purposes. The most important one is
technetium-99m generators production. In order to improve the efficiency of technetium generators
manufacturing in CNESTEN-Morocco), we evaluated the influence of different parameters of molybdenum
adsorption by alumina. Firstly, samples in different conditions have been investigated in order to determine
the intrinsic surface properties of α-Al2O3, which is a point zero charge, isoelectric point and the number
of active sites. These studies show that α-Al2O3 with 63-200 μm of particles seizes oxide, have the best
intrinsic surface properties. In the other hand, several parameters have been studied to optimize the fixation
of molybdenum on alumina involved for adsorption evaluation, such as: pH, contact time, partial seize of
the oxide, chlorination, electrolyte concentration. In addition, ATR-FTIR spectra were investigated to
inspect the molybdenum adsorption on the oxide. Finally, we have been able to define the behavior of the
molybdenum-alumina complex according the variations of pH and contact time. The influence of the
mixture of partial sizes was carried out. The mechanism of adsorption of molybdenum is greatly influenced
by pH modification. This investigation needs a very large number of experiences. For many reasons of
radio protection; radioactive waste management and economics investment, the study was divided into two
parts. In the first one ""cold investigation"" we used stable molybdenum. In the second one ""hot
investigation"" we reproduced the most relevant experiments in hot cells using radioactive molybdenum
99mMo solutions.

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P-142

STABLE ISOTOPES IN ARCHAEOLOGY: A REVIEW USING MIXING MODELS IN

R

Maria Eliza Antunes1, Vladimir Eliodoro Costa2, Joel Mesa Hormaza1

1
Departamento de Física e Biofísica - Instituto de Biociências/Universidade Estadual Paulista, SP, Brazil
2
Centro de Isótopos Estáveis - Instituto de Biociências/Universidade Estadual Paulista, SP, Brazil

Radiobiology

Introduction:
Isotopes are forms of the same element that differ by the number of neutrons in their nucleus. Information
collected through isotopic analysis is important for the reconstruction of past human diets, providing the
main sources of protein in the diet. With the advancement of technology and the need to use this
information, the usage of tools to aid in processing stable isotope data is necessary. A computational
package was developed to solve mixing models' equations for stable isotopic data within a Bayesian
structure, called simmr. This work aimed to show the efficiency of stable isotope mixing models in
archeology, revisiting a study on Byzantine paleontology in Crete.
Methods and Materials:
The basis for this work was a study published in 2007 on paleontological information of humans and fauna
of Crete. The carbon and nitrogen stable isotopic analysis results for bone collagen of adult and subadult
skeletons of the middle Byzantine (11th century AD) were processed through the ""simmr"" package,
available in R. Thus, it was possible to generate graphs and trophic level and food preference information.
Results:
As a result, all human adult data have high values of δ (_^15)N, indicating that the dietary protein was
mainly of animal origin, including meat, milk and dairy, with the most likely candidates being dairy and
fish. The δ(_^13)C value of most humans is consistent with a terrestrial diet (based on C_3). In the analysis
of the fauna, the results found for pig, deer and sheep were already expected and, for goats, there was a
range of changes in δ (_^13)C values, which may indicate consumption of some C_4 protein.
Conclusion:
This work was able to prove the efficiency of the mixing models in stable isotopes applied to the
archaeological area, revisiting an already realized study and reaching the same results.

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P-143

EVALUATION OF DOSES AT RENAL SCAN OF INTERNAL DOSIMETRY (IMAGE

BASED) AND CORRELATION OF THE TRACER BIO-DISTRIBUTIONS OF DTPA,
DMSA AND MAG3

Alvina Tanvin Bidhu1, Suranjan Kumar Das Suranjan2, Ahmed Biman Biman3
1
Department of Physics, Jagannath University, Dhaka-1100, Bangladesh
2
Professor, Department of Physics, Jagannath University, Dhaka-1100, Bangladesh
3
National Institute of Nuclear Medicine and Allied Science (NINMAS), Bangladesh Atomic Energy
Commission, Bangabandhu Sheikh Mujib Medical University Campus, Dhaka-1000, Bangladesh

Nuclear Medicine

Introduction:
Renal scintigraphy is a diagnostic procedure that uses nuclear medicine to examine the anatomy and
functioning of kidneys. This work has been carried out to evaluate bio-distribution of different agents
(MAG3, DMSA, DTPA) for scintillation scan for renal function and measure internal dosimetry of patients
by image-based dosimetry. The correlation of the results using different types of pharmaceuticals (MAG3
, DMSA , DTPA) in renal scintigraphy procedures in nuclear medicine has also been studied.
Methods and Materials:
A total of 200 patients (124 male and 74 female) have been selected and studied for renography using
99mTc-DTPA, 99mTc- MAG3 and 99mTc-DMSA scan methods in the present work. The sample patients
referred to the National Institute of Nuclear Medicine and Allied Science (NINMAS), BSMMU, Dhaka-
1000. This study will evaluate the comparison between these two scans and also will evaluate the bio-
distribution of these three agents and measure internal dosimetry using image.
Results and Conclusions:
It has been observed that age group below 20 years got moderated average uptake 67.00%, age group (20-
50 years) got highest average uptake 69.51% and age group above 50 years got lowest average uptake
56.49%; which indicates that renal dysfunction arises with the age. To correlate the uptake through image-
based dosimetry using two dynamic scintillation scans in same age group, in the study MAG3 and DTPA
agents were used. Using MAG3 and DTPA the average uptake in kidney was found 72.36% and 66.91%
respectively; which caused by the variation of the clearance flow of these agents. However, DMSA agent
was implemented in static scan; which was not effective to measure directly the obstruction of renal flow
as we got from dynamic studies using MAG3 and DTPA. The anatomical structures found in DMSA scan
may portend the existence of obstructions in kidney caused by renal dysfunctions.

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P-144

IRRADIATION OF BLOOD SAMPLES USING A RADIOTHERAPY WATER

PHANTOM

Rónald Carrillo1, Patricia Mora1, Luisa Valle2, Melissa Vásquez2, David Solano1
1
Physics School, Universidad de Costa Rica, Costa Rica
2
Health Research Institute, Universidad de Costa Rica

Radiation Oncology – Dosimetry

Introduction:
The Institute of Health Research of the University of Costa Rica, acquired in 2018 a water phantom to place
blood samples, which will be irradiated with known doses, to subsequently make biological effect curves
at various absorbed dose points. Because the water phantom was developed to perform quality controls in
Radiotherapy and not for blood irradiations, an acrylic support was created to place the test tubes.
Subsequently, all the dosimetric aspects recommended by the International Atomic Energy Agency for
blood irradiation were verified.
Objective:
Verify that the water phantom purchased by the Health Research Institute complies with the dosimetric
requirements established by the International Atomic Energy Agency regarding blood sample irradiation.
Materials and methods:
All irradiations were performed at the Radiotherapy Department of the San Juan de Dios Hospital with a
Co-60 source. Using the linear attenuation coefficients of water and PMMA, the phantom's irradiation
center was theoretically calculated. Subsequently, the location of the irradiation center for opposite beams
was verified for 10x10 cm fields with a SSD of 80cm, using 10 radiation beams at 0° and 10 beams at 180°;
all for 7 different dose points. Finally, the charge released in each irradiation was measured, as well as the
absorbed dose, obtaining the discrepancy for opposite beams in each of the dose points.
Results:
The irradiation center of the phantom was located theoretically and experimentally, obtaining a difference
of 1,7 mm between both positions (14,72 cm and 14,55 cm). The greatest discrepancy between opposite
beams for the same dose point was 0,7%. Conclusions:
The irradiation center of the phantom is located 14,55 cm from the main irradiation face. As the discrepancy
between doses of opposite beams was less than 2%, it is concluded that the phantom is suitable for the
irradiation of blood samples.

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P-145

COMPUTED TOMOGRAPHY DOSE CALIBRATION: AN EGYPTIAN SURVEY

CONTAINING CTDI DOSE MEASUREMENT FOR FIFTEEN CT SCANNERS OF SIX
DIFFERENT VENDORS

H. S. Abou-Elenein1, Fatma Mostafa2

1
Medical physics department at Almenia Oncology center, Egypt
2
Executive Office for Radiation Protection

Diagnostic Radiology –Dosimetry

Purpose: Because the high risk of cancer incidence due to radiation exposure we tried in this work to
estimate our actual level of CT dose index (CTDI).
Material and methods: Radiation dose was measured using a longitudinal ionization chamber dedicated for
CT dose measurement. CT head and body phantoms were used. Dose measurement were performed at
different tube voltage ranged from 100 to 120 kVp, and time - current tube range of 50 to 250 mAs.
Results: Although this survey is carried out on a random sample whoever, the results showed good
agreement between the measured CTDIs and the published one for the most common used imaging
protocols (Head, Chest, Abdomen and pelvis protocols. The average CTDIvol for head scan was found to
vary from 4.3 mGy (±3.2SD) to 16.4mGy (±7.32SD) for 100 kVp and 50mAs and 120 kVp and 100 mAs
respectively. For body scan the average CTDIvol was found to vary from 2.1 mGy to 14.1 mGy for 100
kVp and 50 mAs and 120 kVp and 100 mAs respectively. The DLP for head scan varies from 43.5mGy.cm
to 150.26mGy.cm. The average DLP at 120 Kvp and 250 mAs were ranged from 250mGy.cm to 540
mGy.cm. According to our results there was very good agreement between measured DLP using ionization
chamber for all imaging protocols and that recorded on the CT monitor.
Conclusion: Quality control program is mandatory for dose optimization and performance evaluation of
CT imaging procedures. Qualified Medical physicists must be included into The health care team in
diagnostic radiology departments. The calculated DLP which showed on the CT monitor can be recorded
and collected to use as the patient exposure record.
KEY WORDS: Computed Tomography, CTDI, Risk of Cancer Incidence, and Qualified Medical Physicists
(QMP).

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P-146

DEVELOPMENT OF PORTABLE ALPHA-RAY SPECTRUM SURVEY METER

Masahiro Fukushi1, Hiroshi Tsuruoka2, Narita Masato1, Kazumasa Inoue1

1
Tokyo Metropolitan University, Japan
2
Tsukuba International University / Tokyo Metropolitan University

Nuclear Medicine

Since 2016, RI internal use therapy of radioactive radium chloride (Ra-223 Cl2 half-life 11.13 days), which
is a short-lived alpha nuclide, has been started in Japan as an effective treatment for castration-resistant
prostate cancer with bone metastasis. In the clinical field, contamination of alpha nuclides occurs. Direct
measurement of alpha rays requires a dedicated measuring instrument. Also, energy discrimination is
necessary to identify alpha nuclides. Therefore, it is necessary to acquire the energy spectrum of alpha rays.
We tried to develop a new portable alpha ray spectrum survey meter with an ion-implanted silicon detector.
As a detector, a large area ion implanted silicon semiconductor detector of 2,000 square mm was adopted.
A resolution of around 100 keV was confirmed for the alpha nucleus of Am-241. We would like to report
the performance of the collected energy spectrum and so on.

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P-147

PROPOSAL OF A LEAD-FREE AND NON-METALLIC MATERIAL FOR USE IN

RADIATION PROTECTION

Andrea Vargas-Castillo1, Angel Miguel Ardila Vargas2

1
Medical Physics Group and Applied Physics Group / Universidad Nacional de Colombia, Colombia
2
Universidad Nacional de Colombia

Radiation Protection

Lead is a material that has been used for many purposes for thousands of years. Due to its properties as
density, ductility, stability and because it is relatively easy to extract and recycle, it is the most commonly
used element as an effective shield against electromagnetic radiation (X and gamma rays) in radiological
protection. Despite its excellent properties for the construction of radiation shielding thanks to its great
absorption of incident radiation, its easy adaptation to the shielding and its low cost, it has been associated
to effects harmful to health. Therefore, the main of this research is to propose a lead-free and non-toxic
material that allows reduce the dose received by patients due to dispersion. For this purpose, the
characterization of sintered hydroxyapatite (HAp) and potassium iodide (KI) was carried out using different
techniques such as X-ray Diffraction (XRD), X-ray Dispersive Energy (EDX), Fourier-transform infrared
spectroscopy (FTIR) and Raman spectroscopy, to obtain information on the physical, chemical and
structural properties of materials. On the other hand, the attenuation capacity of the X radiation was
determined with an X-ray equipment (30-60 kV) and an RTMS (Real-Time Multiple Strip) detector, taking
into account the intensity of the radiation as a function of the thickness and density of the sample compared
to lead. In conclusion, it was identified that the non-metallic material that best attenuates the X-rays in this
study for the possible application in radiological protection is potassium iodide.

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P-148

DEVELOPMENT OF PORTABLE RADIATION DEPTH DISTRIBUTION

SPECTROMETER

Hiroshi Tsuruoka1, Kazumasa Inoue2, Masahiro Fukushi2

1
Tsukuba International University, Tokyo Metropolitan University, Japan
2
Tokyo Metropolitan University

Radiation Protection

Eight years have passed since the Fukushima Daiichi Nuclear Power Plant accident caused by the Great
East Japan Earthquake, and the radioactive fallout from the accident shifts from the soil surface to the
deeper layer. The difference from the Chernobyl accident is that Japan is an island country with many
mountainous areas, and it has a wet and humid climate, so the influence of sediments is large unlike the flat
continent. The developed measuring instrument is a rod-like radiation depth distribution spectrometer
length of 40 cm and a diameter of 3 cm, and 20 CsI scintillators are arranged at intervals of 2 cm. It is
possible to measure the concentration of radioactive cesium at intervals of 2 cm in each layer at depths of
up to 40 cm from the surface layer in approximately 10 minutes. We report the depth distribution survey of
radioactive cesium in contaminated areas including Fukushima prefecture using the developed portable
depth distribution spectrometer.

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P-149

MEASURED AND CALCULATED DOSES IN A UNIQUE EYE APPLICATOR - THE

“CLAWS”

Christoph Trauernicht1, Egbert Hering2, Freek du Plessis3, Gert Maree4, Dete van Eeden3
1
Tygerberg Hospital, Stellenbosch University, South Africa
2
University of Cape Town
3
University of the Free State
4
Groote Schuur Hospital

Radiation Oncology – Dosimetry

Introduction:
Brachytherapy is the preferred radiation treatment modality for various intraocular tumours. The “Claws”
is a gold applicator that is loaded with I-125 seeds for localized whole-eye radiotherapy, particularly for
stage 0 retinoblastoma. Under general anaesthesia, a pericorneal ring is attached to the four extra-ocular
muscles, and four appendages, each loaded with I-125 seeds, are inserted beneath the conjunctiva in-
between each pair of muscles and attached anteriorly to the ring. The applicator has an inside diameter of
22 mm. A typical treatment prescription is 40 Gy given over four days to the centre of the eye. General
anaesthesia is also required for the removal of the applicator.
Method:
A solid water eye phantom was manufactured and doses in the “Claws” were measured with
thermoluminescent dosimeters and gafchromic film. These doses were compared to planned doses.
Results:
Normalized doses measured with TLDs and film agree to within one standard deviation. Calculated doses
overestimated the dose by more than 20 % in some areas of the eye, because the treatment planning system
does not take into account the gold shielding, which becomes evident near the periphery of the eye.
Conclusion:
It is important to know the limitations of the treatment planning system when doing eye intra-ocular
brachytherapy. In this case, measurements in a simple eye phantom have shown such a shortcoming. The
clinical impact may require an investigation.

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P-152

AN INSTITUTIONAL EVALUATION OF RADIATION DOSES TO PATIENTS AND

PERSONNEL DURING ERCP; DOSE OPTIMIZATION AND RISK ESTIMATION

Arun Chougule, Mukesh Jain, Rameshchandra Sharma, Mary Joan

SMS Medical College & Hospitals, Jaipur, India

Diagnostic and Interventional Radiology – General

Introduction:
Endoscopic retrograde cholangiopancreatography (ERCP) relies on the use of ionizing radiation but risks
to operator and patient associated with radiation exposure are unclear. The aim of this prospective study
was to estimate the radiation dose received by patients and personnel during fluoroscopic endoscopic
procedures, mainly ERCP. We intended to optimize the radiation dose during therapeutic ERCP, and to
estimate the risk for personnel and patients, to compare the doses based on available data and reference
levels recommended by international organizations.
Materials and Methods:
Dose Area Product (DAP) measurements can be used to estimate the effective dose (ED) to patients
undergoing ERCP. A DAP meter was fitted to the x-ray tube before each of the ERCP procedure. The use
of OSLDs to measure radiation exposure to the anterior and posterior body surface of the patient and
abdomen, thyroid gland, forehead and hands of the personnel performing the procedure permitted an
estimation of radiation doses received. 25 ERCP procedures of therapeutic intent were evaluated in this
study. All the procedures were performed on Allengers HF fluoroscope.
Results and Discussion:
Therapeutic ERCP was associated with higher radiation exposure than diagnostic ERCP as the fluoroscopic
time was higher for therapeutic procedures. The patient dose can be optimized by the presence of an
experienced interventionist in the team by reducing the fluoroscopic time and reduction of radiographic
images. The radiation dose to the personnel was well within established safety limits. The radiation
absorbed doses to the different organs are relatively low. Proper use of lead curtains and lead aprons also
is important in reducing the personnel dose.

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P-153

RADIATION OXIDATIVE STRESS DURING RADIOTHERAPY CAN INDUCE

SECONDARY CANCERS

Rajani Verma, Arun Chougule

SMS Medical College & Hospitals, JAIPUR, India

Radiobiology

Radiation therapy involves significant exposure of cells to ionizing radiation, which is responsible for
production of intracellular reactive oxygen species (ROS). ROS can act as a primary messenger, modulating
several intracellular signaling cascades leading to cancer progression. The balance between ROS generated
during metabolic activities and level of endogenous antioxidant is a must for normal function of cells in
human body. ROS are responsible for regulation of various functions such as cell division, signal
transduction and apoptosis. Patients undergoing radiotherapy experiences cellular oxidative stress which
affect cellular function due to ionizing radiation interaction with cell in form of DNA strand break,
chromosomal aberrations, gene mutations, alteration in intracellular signaling mechanism and inhibition of
apoptosis leading to higher risk of secondary cancer occurrence and other diseases as radiation induced
ROS are involved in initiation and promotion of carcinogenesis. Investigation has found significant
oxidative stress in cancer patients during radiation therapy. Our study included 127 cancer patients (82 male
and 45 female) with age group of (28-50) years, underwent radiation therapy. 40 control samples for the
comparison are involved in the study. Investigation on blood serum samples of the patients showed
significant higher levels of lipid peroxides (ROS) species and significant reduction in levels of Glutathione
(antioxidative response of the body to balance oxidative stress) in comparison to control. This higher
oxidative stress levels can affect cellular system of body in significant manner and further may increase the
risk factor of secondary cancer generation.

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P-154

COMPARISON OF DIRECT AND INDIRECT METHODS FOR ASSESSING

RADIATION DOSE FROM DIAGNOSTIC RADIOLOGICAL EXAMINATIONS

Gourav Jain, Arun Chougule, Rajni Verma

SMS Medical College & Hospital, JAIPUR, India

Diagnostic Radiology –Dosimetry

Purpose:
The present study aimed to assess the radiation doses to adults from common diagnostic radiological
examinations for optimization purposes. This study also examines direct and indirect methods of entrance
skin dose (ESD) measurement. Materials & methods:
This study was carried out on conventional X-ray unit (Meditronics Manufacturing Company Pvt Ltd,
India). The quality assurance (QA) of the X-ray machine was performed. The standardized exposure
parameters were used for chest (66 kV, 16 mAs), pelvis (66 kV, 30 mAs) and skull (66 kV, 20 mAs)
diagnostic radiological examinations to perform the present study. The ESD was measured using
MagicMax (IBA Dosimetry GmbH, Germany). The output of the X-ray machine was measured at 80 kV
at a distance of 1m normalized to 10 mAs for radiation field of 20x20 cm2. The ESD was calculated using
the Davies model. This model used output of machine, applied tube voltage (kV), mAs, focus to skin (FSD)
and back scatter factor (BSF) for ESD calculation for the exposure. In this study, the BSF value was used
1.35 for adult patients as suggested in European guidelines.
Results:
The QA parameters of the machine were found within tolerance in compliance with AERB QA protocol.
The output of the X- ray machine was measured 0.0273±0.023 mGy/mAs. The calculated ESD for chest,
pelvis and skull diagnostic radiological examinations were estimated 0.401 mGy, 0.753 mGy and 0.502
mGy respectively. The calculated average ESD for chest, pelvis and skull diagnostic radiological
examinations were observed 0.358±0.027, 0.641±0.033 and 0.428±0.018 respectively. The percentage
deviation between calculated and measured ESD for chest, pelvis and skull diagnostic radiological
examinations was found 10.70%, 14.89% and 14.79% respectively.
Conclusion:
The present study provided methodologies for direct and indirect assessment of radiation dose optimization
purposes. This study examined direct and indirect methods of ESD measurement from diagnostic
radiological examinations.

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P-155

FURTHER EDUCATION IN MEDICAL PHYSICS: BLENDED-LEARNING

SETTINGS FOR STUDENTS AND PROFESSIONALS

Schäfer Marcel, Moshanina Anna, Jäkel Oliver, Barthold-Bess Simone

German Cancer Research Center (DKFZ) Heidelberg, Heidelberg Institute for Radiooncology (HIRO),
Germany

Education and Professional Issues

Introduction:
During the last years we have developed different courses in Medical Physics that adopt the so called
“blended learning approach”. In 2009 we established online-based Master's programs for national and
international students at Heidelberg University, Germany (UHD), and we have extended our teaching
activities to a set of long- and short-term courses for students as well as professionals working in the field
of Medical Physics for several years (see www.dkfz.de/medphys_edu). Our short- term courses combine
an online phase of 4-8 weeks with a 1,5 day attendance phase either in Heidelberg, Germany or in Santiago
de Chile. During our long-term programs (1,5 years) our participants attend several online phases (4-6
weeks each) that terminate with an attendance phase of 4 days.
Materials and Methods:
We would like to discuss and explain our teaching and learning settings that are part of our long- and short-
term courses and that have been developed as part of our Master's courses. Some teaching activities will be
presented in detail, which have been evaluated very positively, but also some less successful examples will
be presented to highlight potential pitfalls of our approach.
Results:
In our setting, recorded video lectures including pdf-slides seem to be the most attractive teaching activity
for both participants and lecturers. With longer course duration, however, our participants ask for more
learner-centered and interactive methods. Our selected examples will show how to avoid student's
frustration in online learning.
Conclusion:
The combination of recorded video lectures and learner-centered methods seem to be the key to success in
online teaching. We are very glad to continue with our teaching activities together with our Chilean
colleagues as part of the “Center of Excellence in Investigation and Teaching” at UHD which is funded by
the German Academic Exchange Service (DAAD) and supported by the German Federal Foreign Office.

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P-158

EXPERIMENTAL AND NUMERICAL ANALYSIS ON FOCUSED SOUND FOR

MEDICAL APPLICATIONS

Marysol García, José Alfredo Soto, Teodoro Córdova,

Universidad de Guanajuato, Mexico

Non-ionizing applications

Introduction: Bone mineral density (BMD) has been the gold standard to assess the fracture risk of bones
and is measured using X-ray absorptiometric techniques. Focused sound technique could help in the
diagnosis, it does not ionize the tissue and its implementation is relatively inexpensive. The most general
definition of sound is a longitudinal wave in a medium. The propagation of the acoustic wave is influenced
by the bone mass, structure and properties of the material. So that, it can be used to characterize the elastic
properties of cortical and cancellous bone for some time. The aim of this work is to analyze the behavior
of sound through different materials in experimental and simulation way. Methods and Materials: For the
experimental part, an electroacoustic device was used (Bone Radar) this one was built in the Medical
Physics Laboratory at the University of Guanajuato. Measurements were made with cylinders of different
materials and lengths, placing the transducer and receiver on the cylinder faces. In parallel, it was carried
out the simulation for the wave equation by using the finite difference method. Results and Conclusions: It
was observed a change in the sound intensities reported respect the density of each material measured, in
the same way there were analyzed the variations of the intensities respect to the position in which the
transducer was placed. In the part of simulation, it was established a sinusoidal function as Dirichlet initial
condition, adding the damping factors corresponding to the medium through which the wave was affected.
The method was solved for the wave equation in a simplified geometry in one dimension, allowing the
comparison of the experimental measurements with the numerical results.

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P-159

NORMAL BRAIN TISSUE IRRADIATION IN INTRACRANIAL METASTASIS

TREATMENTS: MULTIPLE ISOCENTERS VS SINGLE ISOCENTER TECHNIQUES
FOR VMAT TREATMENTS

Caroline Descamps, Diego Franco, Egle Aon, Lucas Caussa, Edgardo Garrigo

Centro Médico Deán Funes, Argentina

Radiation Oncology –Treatment Planning

Introduction:
The single-fraction stereotactic radiosurgery (SRS) with volumetric modulated arc therapy (VMAT) is
commonly used for multiple brain lesions treatments and is typically performed using a multiple isocenter
approach (one isocenter per tumor) to reduce the normal brain tissue irradiation. However, these treatments
are time-consuming (new setup for each isocenter). Patient plans with two metastases were optimized using
one or two isocenters and compared in terms of normal brain irradiation depending on the distance D
between lesions.
Methods and Materials:
30 patients plan with two lesions were calculated using EclipseTM TPS (one single-fraction of 21 Gy) with
one isocenter (4 coplanar arcs), and with one isocenter per lesion (4 coplanar arcs for each isocenter). The
distance between the lesions was registered. For both approaches, a dose normalization of 100%Dp at
95%PTV and Timermann's constraints for the organs at risk (brainstem, optical nerves, eyes, chiasm) were
adopted. The volumes of normal brain-minus-PTV that received 4, 12 and 18Gy in both cases were recorded
depending on the distance between the lesions: D<6cm (10plans), 6cm<D<9cm (10plans), D>9cm (10
plans).
Results:
For each patient, both plans satisfied PTV and OARs acceptance criteria. For all distances between the
lesions, V12Gy and V18Gy differences between 2isocenters vs 1isocenter are insignificant
(average±standard deviation: D<6cm: ∆V12Gy=0.13±0.13%, ∆V18Gy=0.00±0.04%; 6cm<D<9cm:
∆V12Gy=0.12±0.13%, ∆V18Gy=0.00±0.06%; D>9cm: ∆V12Gy=0.01±0.05%, ∆V18Gy=-0.01±0.03%).
Concerning the low dose irradiation, for 6cm<D<9cm, the use of 2 isocenters reduced the normal brain
tissue (∆V4Gy=8.35±3.53%) but for smaller o larger distances, the influence is lower (D<6cm:
∆V4Gy=2.65±1.37%; D>9cm: ∆V4Gy=2.49±1.12%).
Conclusion:
For all calculated plans, V12Gy and V18Gy of normal brain-minus-PTV were similar using one or two
isocenters and V4Gy were slightly lower using 2 isocenters. Given that the use of a single-isocenter
treatment leads to shorter treatment times, it appears to be a very interesting approach.

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P-161

ANALYSIS OF TRUEBEAM® VARIATION OF DOSEMED EXPERIENCE

DATABASE

Glauco Rogério Veneziani1, Pedro Argôlo Piedade1, Wagner Gonçalves Maia1, Paulo Tarso Vianna
Nogueira Filho1, Luciana Cardoso Matsushima2
1
Dosemed Solutions in Radiation Therapy, Brazil
2
Institute of Physics - Federal University of Goiás

Radiation Oncology – Dosimetry

Introduction:
Since commissioning beam data are treated as a reference and ultimately used by treatment planning
systems, it is vitally important that the collected data are of the highest quality to avoid dosimetric and
patient treatment errors that may subsequently lead to a poor radiation outcome. This study aimed the
comparison between data of commissioning tests of four linear accelerators TrueBeam® of Varian Medical
Systems for photon beam of 10 MV. The Dosemed database has analised parameters like PDD curves and
beam profile.
Methods and Materials:
In this study were used a blue phantom 2 and two ionization chambers cc13 (both of IBA Dosimetry), a
CRS phantom and two ionization chambers semiflex 0.125cc (both of PTW).The arrangement of phantoms
and ionization chambers was prepared for the commissioning tests, the data were collected and analised by
software Omnipro 7.4®.
Results:
The analysis of PDD curves for a field size 10x10 cm2 measured in a water phantom at a depth of 10 cm
and SSD of 100 cm were 73.6, 73.3, 73.5 and 73.4, for linacs TrueBeam® 1, 2, 3 and 4, respectively. The
analysis of beam profiles for a field size 30x30 cm2 measured in a water phantom at a depth of 10 cm and
SSD of 100 cm were 33.03, 33.17, 33.00 and 33.24 cm2, respectively, for linacs 1, 2, 3 and 4. The measures
for linac 1 were made with CRS phantom and for the other linacs with Blue phantom2.
Conclusions:
Beam data commissioning should be independent of individuals collecting the data and scanning systems
if it is performed with appropriate knowledge and proper tools. Data variation among beam collectors
should be as minimal as possible (<1%). The analysis of both dosimetric arrangement showed that the
evaluated data do not presented variation, thus the data showed a good reproducibility

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P-162

IMPLEMENTATION OF THE AAPM-TG100 FOR THE RISK ASSESSMENT OF

STEREOTACTIC RADIOSURGERY (SRS) DEVELOPED IN CUBA

Ernesto Olivares Romero1, Antonio Torres Valle2, Adrián Acosta Andrés1

1
Instituto Nacional de Oncología y Radiobiología (INOR), Cuba
2
Instituto Superior de Tecnologías y Ciencias Aplicadas (InSTEC)

Radiation Oncology – Quality Assurance

Introduction: In order to improve the safety and quality of the practice of Stereotactic Radiosurgery (SRS),
the quality assurance program established for this technique was evaluated at a radiotherapy (RT) service
in Havana, Cuba.
Methods and materials: The Process Map (PM), the risk assessment technique Failure Mode and Effect
Analysis (FMEA) and the Fault Tree analysis were used; implementing the methodology established in
AAPM TG-100 into a computational tool dedicated for this purpose: SECURE-MR-FMEA
Results: Seven subprocesses were identified, starting from ""Placement of the stereotactic frame"" until
""Application of the treatment"". Treatment divided into 43 steps, with 116 potential failure modes, due to
50 possible causes. In total, 603 Failure Modes -Cause (FM-C) were quantified, 10% of which had risk
priority numbers (RPN)> = 100 and 63% with severity (S)>= 7. The ""lack of attention"", the ""lack of
patience"" and the ""lack of training"" are the main causes that contribute to the occurrence of high-risk
NPR and S.
Conclusions: The methodology proposed by the AAPM-TG 100 together with the SECURE-MR form an
effective strategy for the knowledge of the risk profile of the radiotherapy service. The results show that
human error is the biggest source of potential accidents and incidents in this type of treatment in the
evaluated service. Hence, actions to reduce risk, that contribute to the improvement of the quality assurance
program of the institution, were proposed. In addition, the FMEA risk pattern for the practice of SRS at the
RT service, was deployed and incorporated into the SECURE-MR-FMEA database as a guide for future
studies.

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P-163

ACCEPTANCE TESTS OF THE NOMEX® SL SURVEY DETECTOR FOR SCATTER

AND LEAKAGE MEASUREMENTS

Camilo Beltrán, Andrea Pérez, Lucio Andrade, Boris Martinez

PTW Latin America, Brazil

Radiology – Radiation Protection.

Quality assurance protocols on medical ionizing radiations modalities recommend radiation protection
measurements to account for scatter, leakage, and shielding on the installations to evaluate radiation
exposure limits to professionals and public, in order to accomplish acceptable levels. For this purpose, the
novel PTW NOMEX® SL Survey Detector based on semiconductor technology is designed in combination
with the NOMEX® Dosemeter for air-kerma, exposure and ambient- equivalent-dose H*(10)
measurements within the diagnostic energy range (33 keV to 1.33 MeV). The response to scattered radiation
for different nominal voltages was evaluated on two X-ray devices placing the detector at one meter from
the beam. At medical tube, measurements were compared to 1800 cm3 ionization chamber (Radcal
Inc.10X5-1800), yielding a mean percentage difference 3.4%, and 4.8% maximum deviation.
Measurements at Small Animal Radiation Research Platform (SARRP) were compared to a 350 cm3
ionization chamber (Fluke-Biomedical 451B) achieve 2.9% mean percentage difference with 3.9%
maximum deviation. The dose linearity was evaluated through variations on the mAs at fixed tube voltage,
on the medical tube the mean deviation compared to the ionization chamber was 2.5% (linear regression
coefficient, R2 = 0.999). On the SARRP, the mean deviation was 0.4% (R2=1). The PTW NOMEX® SL
Survey Detector response to extended energy ranges was evaluated at radiotherapy installations by
measuring the leakage through the primary barrier for different nominal energies as well to variations to
dose rate. The response to inverse square distance in front a Cs-137 source was evaluated, as well. Thus,
the novel PTW NOMEX® SL Survey Detector provides a solution for radiation protection measurement
on X-ray facilities and its measurement results allow further characterization in extended applications.

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P-165

MONTE CARLO SIMULATION OF THE ACCURACY OF HD TOMOTHERAPY

Basilia Quispe Huillcara1, Pablo Victor Cerón Ramírez1, Miguel Angel Vallejo Hernández1, Modesto
Antonio Sosa Aquino1, Héctor René Vega Carrillo2
1
División de Ciencias e Ingenierías de la Universidad de Guanajuato, León, México
2
Unidad Académica de Estudios Nucleares de la Universidad Autónoma de Zacatecas, Zacatecas, México

Radiation Oncology – Treatment Delivery

In recent years, the use of helical TomoTherapy equipment has increased worldwide, so that to ensure the
quality of the beam, the corresponding dosimetric tasks must be performed. Currently there are protocols
to carry out this work. However, due to the large differences in equipment and radiotherapy facilities, it is
necessary to conduct studies in a particular way. Monte Carlo calculations allow performing dosimetric
tasks indirectly, which can be compared with measurements obtained with other techniques or estimating
the dose at points where there is no access. In this paper we present the calculations of radiation transport
and dosimetry in 6 MV Accuracy HD TomoTherapy equipment using the code MCNP5. To model the
accelerator, we useda1.5 mm thick conical tungsten target, and we included primary collimators and jaws.
As a source term, an electron beam of 6 MeV of energy was modeled on the tungsten target. The collimators
were modeled to produce an irradiation area of 5x40 cm2 in the isocenter, located 85 cm from the target.
The X-ray spectrum at the isocenter, the dose-to-depth percentage (PDD) and the profile curves for the
maximum dose depth (d = 1.5 cm within the spectrum) were estimated in a 50x30x50 cm3 water phantom.
The estimated values are comparable with the experimental data obtained with an ionization chamber A1SL
of the TomoTherapy equipment installed in the State Center of Cancerology of Durango, Mexico.
Keywords: Monte Carlo Simulation, Accuracy HD TomoTherapy, PDD, Profile Curves, X-ray spectrum

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P-166

EVALUATION OF OPTIMIZED DYNAMIC CONFORMAL ARC FOR DYNAMIC

TARGETS

Alisson Dal Col1,2, Anselmo Mancini1, Wellington Furtado Pimenta Neves Junior1
1
Hospital Sírio Libanês
2
Centro de Oncologia e Radioterapia Sant'Ana, Brazil

Radiation Oncology –Treatment Planning

In our institution, it is common perform the Optimized Dynamic Conformal Arc (DCAopt) technique for
lung SBRT, which it is the regular forward DCA technique tuned with bit of modulation. A systematic
comparison was performed among DCAopt, VMAT and VMAT with Monitor Units optimized
(VMATMU). A retrospective study over 31 patients was done and it was accessed the Conformity Index
(CI), Dose Gradient (DG), organ at risk (OAR) sparing and MUs used. A GTV of 2 cm diameter was
irradiated in a dynamic thorax phantom using these three techniques in amplitudes of 1 and 2 cm, dictated
by a sinusoidal wave of 4 seconds of period, and the dose distribution degradation was evaluated by EBT3
film dosimetry. There were significant differences (p < 0.05) in favor of VMAT plans in terms of CI, DG
and OAR's sparing (i.e., V20 Gy in lungs), when compared to DCAopt and VMATMU, as follows in terms
of 95% of confidence interval, respectively: CI = [(-0.011, - 0.026);(-0.015, -0.027)], DG = [(-0.88, -1.71);(-
1.06, -1.79)] Gy and V20 Gy = [(-0.26,-0.06);(-0.22,-0.07)] %. However, it has consumed too much MU.
In the opposite, DCAopt and VMATMU were proved that perhaps they assumed equivalent statistically
significant results in dose conformity, gradient and OAR's sparing, VMATMU was better than DCAopt for
delivering plans with a smaller MU's. The dose degradation was evident for all techniques (i.e. blurring and
interplay effect) but less for VMATMU. For this technique, as well as the others, the interplay effect
produced higher dose than the predicted and it occurred inside the ITV, which is good once it is guaranteed
the safety margins and the properly IGRT protocol. In conclusion, if the total number of MU is a point of
concern, one must be use VMATMU technique. If not, VMAT is the appropriate choice.

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P-167

HDR - BRACHYTHERAPY IN THE SKIN TREATMENT USING CUSTOMIZED

SURFACE APPLICATORS MADE BY 3D PRINTING

Ignacio Véliz R.1, Alejandro Ferreira T.1, Evelyn San Martín M.2, Apolo Salgado F.1,3. Javier Faúndez S.2,
1
Instituto Nacional del Cáncer, Chile
2
Universidad de Chile
3
Universidad San Sebastián

Radiation Oncology – Brachytherapy

Introduction: In the last few years, the High Dose Rate Brachytherapy (HDR-BT) has been gained
interesting for its good results in the management of cancer with skin involvement. The objective of this
study is to report the manufacturing process of a customized surface applicator using a 3D printer and its
use in the treatment of a Fungoid Mycosis.
Methods and Materials: Has been created a custom mold of the patient head surface's and catheters have
been placed into it, permitting a uniform distribution over all the treatment zone because the right
positioning of the sources. The final surface applicator is composed by 4 pieces printed in a 3D printer and
filled by 20% of PLA.
When it has been verified that all the pieces are correctly joined and placed on the patient, a new TC of
simulation is done, and the dosimetry is ran. All the material printed and the set up used were previously
approved for the clinical use.
Results: It was prescribed a total dose of 12 Gy in 6 fractions. The sessions were executed without incidents
in a total time of 25 minutes each one and finally the patient didn't have any complications and evolved
with a good clinical response of this treatment.
Conclusions: We demonstrated the feasibility of making HDR-BT on tumors that compromise the skin,
using custom surface applicators made by 3D printers. So, this modality could be used in the future for
many pathologies and body locations safely.

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P-168

DOSE EVALUATION ABSORBED IN ADJACENT ORGANS FOR LUNG CANCER

TREATMENT IN RADIOTHERAPY

Paulo Roberto Domingues de Souza1,2, Bruna Teiga Rodrigues1, Carlos Alberto Zeitune1, Andreza
Aparecida Del Carmen Castro Gonzalez1, Maria Elisa Chuery Martins Rostelato1
1
Instituto de Pesquisas Energéticas e Nucleares, Brazil
2
Hospital das Clinicas FMUSP, Brazil

Radiation Oncology – Dosimetry

Introduction: Radiation therapy acts as a form of treatment which has two basic modalities for the treatment
of cancer: teletherapy and brachytherapy. In teletherapy is used a linear accelerator with photon energy to
make the application and before starting the treatment a planning that makes the acquisition of all
anatomical information of the patient is carried out and then the classification of areas of interest in the
patient.
Objective: This work has the objective of comparing the dosimetric plan of lung cancer in adjacent organs
- in this case the organ of risk to the heart - with dose values calculated in the planning system (TPS) using
an anthropomorphic phantom. Materials/Methods: All dosimetry was performed with thermoluminescents
dosimeters (Lif: Mg, Ti-TLD-100). Were selected 33 TLDs that underwent a calibration process with the
following steps: thermal treatment, followed by irradiation and reading. In the heat treatment a furnace
manufactured by Grion Industrial Furnaces was used. The dosimeters were irradiated using a Varian model
2100 photon energy / 6 MeV linear accelerator and the reading was done with the Thermo-Harshaw model
3500 reader. With the dosimeters already selected, the treatment plan was elaborated in the system using
the Varian Eclipse software and then compared with the dosimetry performed with the TLDs allocated to
the anthropomorphic phantom, for this same case. A linear accelerator with photon energy / 6 MeV, model
2100 from Varian was used to apply the dose of 200 cGy using the intensity-modulated radiotherapy
(IMRT) technique.
Results: The dose verified in the lungs showed that the planning is within the allowed values according to
protocols - less than 5% (206 cGy).
Conclusion: No dose was measured in the heart, which allows concluding that there was a good planning
of the treatment that spared the heart and adjacent healthy tissues.

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P-169

DETERMINISTIC AND STOCHASTIC COMPARTMENT MODELS FOR TOTAL

BODY IRRADIATION

Ernesto P. Esteban, Gabriel Meléndez

University of Puerto Rico-Humacao, Puerto Rico

Radiobiology

We have modified the Jones model of radiation-induced myelopoiesis by adding new compartments for the
mutated and cancerous cells populations. This carcinogenesis model is mathematical described by five non-
linear coupled differential equations. The objective of this research is to develop algorithms and
computational codes (deterministic and stochastic) to mimic a clinical radiotherapy procedure TBI (Total
Body Irradiation). Our approach is useful to make a comparison among different TBI regimens used
worldwide. For a given TBI regimen we can also study the evolution on time of non-aggressive and
aggressive cancers. The developed algorithms allow us to quickly update a planned TBI regime after the
patient's treatment was interrupted for a length of time (due to a hurricane, earthquake, or blackout). As
other application, we show that U.S. and Canadian TBI regimens kill about the same percentage of
malignant cells. However, between irradiations the U.S. TBI regimen is less efficient than the Canadian
TBI regimen. Finally, the transition rates that mediate movement of cells among all compartments are
replaced for random numbers. This stochasticity procedure after 100 runs shows in average a mortality of
83% of the malignant cells, in agreement with the US and Canadian TBI regimens.

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P-171

QUALITY MANAGEMENT OF MEDICAL EXPOSURES IN RADIOTHERAPY AT

ONCOLOGY HOSPITAL "CONRADO BENITEZ"

Niela González-Muñoz, Acelis Suárez-Batista, Yaile Quiala-Castellanos, Ernesto Martínez-Sánchez,

Rafael A. Miller-Clemente

Centro de Biofísica Médica. Universidad de Oriente. Cuba

Radiation Oncology – Quality Assurance

Radiotherapy is a method of treating malignant lesions in which mainly ionizing radiation is used. The
International Atomic Energy Agency (IAEA) has issued several documents which focus on Quality
Management Systems (QMS) for radiotherapy and clearly define the importance of these for the needs of
patients, the institution and in the context from the country. The objective of this work is to design a quality
management system, according to the standards adopted by Cuba ISO 9001: 2015, ISO 13485: 2018, in the
radiotherapy unit at the Oncology Hospital "Conrado Benitez" in Santiago de Cuba. We made a broad
review of the Cuban regulations, which establishes the requirements to establish a QMS, as well as the
regulations issued by the National Center for Nuclear Safety (CNSN) and the Territorial Delegations of
CITMA, designated in the different territories of the country to fulfill the functions of regulation and control
of the safely use of nuclear energy. As a result, we complemented the quality assurance program that will
guarantee not only the efficacy of the antitumor treatment, but also the adequate radiological protection of
patients, workers and the public. The managers were provided with a tool that will allow it to manage with
a process-based approach, guaranteeing radiological safety, to increase excellence in the radiotherapy
service.

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P-172

A CRITICAL REVIEW OF TRANSLATIONAL PROCESSES IN PRE-CLINICAL

RADIOTHERAPY ASSOCIATED WITH THE LIMITATIONS IN THE DOSIMETRY
OF BIOLOGICAL CONFORMATIONAL IRRADIATORS

Erika Tatiana Muñoz Arango1, José Guilherme Peixoto2, Carlos Eduardo de Almeida3
1
Ph.D Student at the University of the State of Rio de Janeiro, Brazil, Brazil
2
Institute of Radiation Protection and Dosimetry IRD/CNEN, Brazil
3
University of the State of Rio de Janeiro, Brazil

Radiobiology

Translation of results of pre-clinical radiotherapy research to clinical trials represents an optimization of

the resources destined to fight cancer. The development of the most modern micro-irradiators systems, with
x-ray photon beams of medium energy (225 kVp) and small fields, has allowed a considerable
approximation between the current techniques of radiotherapy and radiobiological research. While in
clinical radiotherapy it is recommended that differences between prescribed and absorbed dose to the target
should vary maximum 5%, in pre-clinical radiotherapy these deviations can reach very different values, as
reported by many authors. In this work through a literature review, were analyzed the differences between
the planned and the delivery dose in researches involving micro-irradiator systems. This information was
correlated with the impact on the applicability of the results within the concepts of clinical radiotherapy.
We present the evolution of dosimetric proposals for these modern micro-irradiators systems, mainly for
the Small animal radiation research platform SARRP. The proposals for reference and relative dosimetry
for small fields, close to 5mm, are nowadays insufficient for this energy range and are mainly based in a
radiochromic film dosimeter. This work aims to highlight the main challenges in the small photon field
dosimetry for kV energies and the need for new dosimetric proposals with the same metrological rigor as
in the clinical radiotherapy. As a conclusion we suggest the integration of dosimetric methods, considering
the uncertainties in the use of different detectors according to the field size, the energy response and
response in the medium, as well as the evaluation of the dose distributions based on the gamma index
criterion. This would allow an integrated assessment of new dosimetric proposals for commissioning and
validation of small animal irradiator systems.

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P-175

COMMISSIONING FOUR 50–100 kV “SENSUS SRT-100” X-RAY UNITS FOR SKIN

CANCER TREATMENT

Yoval Aguiar Ferro, Julio Nazco Torres, Alberto Blanco Rodriguez

Cuban Society of Medical Physics, Cuba

Radiation Oncology – Dosimetry

Surface therapy systems are an alternative or complement to the surgical variant for many patients with
basal and squamous cell carcinoma that cannot be treated by surgery. This type of treatment offers excellent
cosmetic results and is considerably less invasive than conventional surgical methods. Four treatment units
manufactured by Sensus Healthcare (Boca Raton, FL) were studied. All of the same model, SRT-100, with
nominal energies of x-rays of 50, 70 and 100 kV. the AAPM Task Group 61 protocol was used for beam
dosimetry. The dose to water at the surface of a water phantom was obtained based on an in-air
measurement using an ion chamber calibrated in air. The results were compared with measurements in
PMMA using a chamber calibrated in terms of absorbed dose in water. A Farmer-type chamber and a thin-
window parallel plate ion chamber with IBA Dose1, PTW UNIDOS electrometers and soft x-ray slab
phantom were used. Data collected during commissioning were: linearity and end effect, stability of the
machines, HVL, absolute outputs, dose profile and applicator cone factors. The data measured were
compared between them as well as those reported by the vendor. All treatment units showed excellent
linearity in the range of 0.1 to 0.8 minutes. The end effect values were less than 0.0001 min. The HVLs
showed a variability between 2%. The absolute outputs showed low variability between machines (CV
<3%). There was also a coincidence between the calculations from measurements in air and directly in
PMMA phantom. Within a 2 cm diameter circle, the dose profile is uniform, however, the dose decreases
as distance from center increases. The cross-line profile is more symmetric than the in-line dose profile,
This is expected due to the X-ray target heel effect. All units show good stability and are ready for the use
in patients.

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P-176

BREAST TREATMENTS WITH AXXENT IORT. COMPARISON WITH

MAMMOSITE SYSTEM

Sergio Lozares, Jose Antonio Font, David Villa, Verónica Alba, Sara Jiménez

Miguel Servet University Hospital, Zaragoza , Spain

Radiation Oncology – Dosimetry

Introduction:
We have treated 400 patients at our center from May 2015 to April 2019 for breast cancer with Axxent
(Xoft Inc.) intraoperative radiotherapy (IORT), in this work we compare the doses in the skin, lung and
heart of the first 250 patients treated with the 50 kVp source with the doses they would have received using
the Mammosite system using an Ir192 source. Methods and Material:
To the 400 patients treated in our center after removing the tumor, the appropriate balloon size is chosen to
cover the tumor area with a dose of 20 Gy on the balloon surface.
Results:
The differences in maximum skin dose for both types of treatment are 8.1 ± 1.2 Gy for the case of
Mammosite and 5.7 ± 1.5 Gy for patients treated with electronic brachytherapy source. This explains the
very few cases of acute dermatitis at 6 months.We also show the mean and maximum doses (expressed as
percentage of prescribed dose) for the left lung (Axxent 1% and 20.4% vs Mammosite 3.9% and 29.9%)
and heart (Axxent 0.8% and 4.1% vs Mammosite 3.3% and 10.4%) in cases of left breast tumor for the
volumes of 30 and 35 cm3, which are the most common in our hospital (70% of cases).
Conclusions:
It is concluded that the IORT treatments performed with the Axxent equipment with electronic source are
a good alternative to those performed with Ir192 and our 400 patients treated to date to the good results
presented by other centers are joined.In addition to the low skin toxicity, there is no recurrence in patients
treated so far, which makes us very optimistic about the results.

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P-178

DESIGN OF A DIGITIZER CARD FOR THE PHOTOMULTIPLIER TUBES OF A

GAMMA CAMERA

Jorge Luis Dominguez Martinez1 Jorge Luis Dominguez Martinez Doris del Carmen Rivero Ramirez2 Juan
Francisco Osorio Deliz3
1
Surgical Clinical Hospital ''Hermanos Ameijeiras'' (HHA), Cuba
2
Instituto Superior de Tecnologías y Ciencias Aplicadas (InSTEC)
3
Instituto Nacional de Oncología y Radiobiología (INOR)

Nuclear Medicine

The service provided by the GC (Gamma Cameras) in the Nuclear Medicine departments fails because of
their breakdown, generally due to the associated electronics and not to the physical detection components.
For this reason, it was decided to develop an electronic system that allows the recovery and optimization
of disused GC. Previously, it was designed a preamplifier card for the Photomultiplier Tubes (PMT) signals,
so, this work is following with the design of the digitizer card for the PMT signals. The circuit was designed
and simulated and the list of components necessary for the construction of the digitizer was generated, as
well as the printed circuit board was designed for its assembly. The simulation of the digitizer worked in
linear mode; this determines that the digital value of the output signal is proportional to the amount of
charge delivered by the detector. The digitizer card associated with the preamplifier card allows an
automatic adjustment of the signals of the PMT as do the modern GC. We recommend to mount the
proposed circuits for the digitizer of 1 PMT, check its operation, and make the necessary adjustments for
the subsequent assembly of the 37 and 75 PMTs cards; develop a processing program for these signals to
minimize analog and digital processing electronics in the GC; and develop a Multi- Channel Analyzer
(MCA) for the record of the amount of pulse converted by the ADC.

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P-179

RADIOLOGICAL SURVEILLANCE DURING THE USE OF DIAGNOSTIC X-RAYS

Cecilia Miranda Pantoja, Héctor Cartas Aguila

Nuclear Engineer, Cuba

Radiology – Radiation Protection.

The radiological surveillance of areas and workplaces and the evaluation of results is part of the of the
radiological protection program of any entity that performs radiological practices. The objective of this
work was to measure and evaluate the environmental equivalent dose rate of X-radiation in the workplaces
and public places adjacent to the departments that use diagnostic X-rays in the Provincial Hospital Dr.
Gustavo Aldereguía Lima of Cienfuegos and to reach to conclusions that allow to act to conserve the good
practices in the work and to optimize the radiological protection. The environmental equivalent dose rate
of X-radiation was measured at important points in the departments where diagnostic X-rays are used, with
the portable radiometer RADIAGEM 2000, verified by the Secondary Laboratory of Dosimetric Calibration
of the Center of Protection and Hygiene of Radiation. The processing of the data was carried out with
Microsoft Office Excel 2007. The interpretation and evaluation were carried out according to the Combined
Resolution CITMA-MINSAP Basic Norms of Radiological Safety. Anomalous values of the environmental
equivalent dose rate of the X-radiation were detected as a consequence of deficiencies in doors, frames,
leaded glass location and deviations of the good practices at work, which demonstrated insufficiencies in
compliance with the principle of Optimization in Radiological Protection.

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P-180

DEVELOPMENT OF A MONTECARLO MODEL FOR A MEDICAL ONCOR LINAC

Andrea Russomando1, Sergey Kuleshov1, Jose Luis Rodriguez2, Manuel Castrillon2

1
Centro Científico Tecnológico de Valparaíso -CCTVal, Universidad Técnica Federico Santa María,
Valparaíso, Chile
2
Departamento de Radioterapia, Clínica Las Condes, Estoril 450, Las Condes, Santiago, Chile

Radiation Oncology – Dosimetry

Introduction: Radiation therapy is an established method in cancer treatment. To obtain a more accurate
estimation of the dose delivered in the radiotherapy treatment plan a growing use of Monte Carlo methods
is envisaged. Because photon beams of equivalent nominal energies can change substantially between
different accelerator manufacturers, a model for Siemens ONCOR linear accelerator was developed and
tested, to be later used as an aid in radiotherapy treatment plan. Methods and Materials: The machine
geometry is accurately reproduced in the Monte Carlo code using measures and accelerator manufacturer's
specifications. The capability of the software to reproduce the dose distributions has been verified by
comparisons with standard measurements acquired with ionization chambers in a water phantom. The tests
were made for photon and electron beams, considering PDD and lateral profiles at several nominal beam
energy. Lastly the configuration was used to reproduce the data of standard dosimetries. Results and
Conclusions: Experimental and calculated dose values are in good agreement both in PDD and in transverse
sections. The proposed model could accurately reproduce the experimental data and could be used as an
aid in the clinical practice.

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P-181

EVALUATION OF CARDIAC SPECT IMAGES USING TEW METHOD

CORRECTION FOR TL-201

Youssef Bouzekraoui1, Bentayeb Farida1, Bonutti Faustino2

1
Laboratory of high energy physics M-S, Faculty of Sciences, University Mohammed V, Rabat, Morocco
2
Academic Hospital of Udine, Medical Physics Department, Italy

Nuclear Medicine

Thalium-Chloride (Tl) is a myocardial perfusion SPECT agent with excellent biochemical properties
commonly used to evaluate tissue viability. However, the images are severely degraded by scattered
photons in the thorax. The precise correction of this dispersion is complicated by the non-uniform density
and different thorax sizes, the additional attenuation and dispersion caused by the patients' breasts, and the
Tl-201 energy spectrum. The aim of this work was to determine the sub- energy windows for the triple
energy window (TEW) scatter correction method using Monte Carlo simulation SIMIND code for (Tl-201)
imaging.
Methods:
We used the SIMIND Monte Carlo code to simulate General electric gamma camera with low-energy high
resolution (LEHR) parallel whole collimators. The detector is characterized by intrinsic spatial resolution
of 0.34 cm. Energy window was set for main energy window width 20% and sub energy window width (3
and 6 keV).We simulated a source routine representing a heart consisting of a combination of a half sphere
shell and a cylindrical shell - both with the same thickness. The source distribution can be very accurately
being matched to the physical cardiac insert manufactured by Data SPECTRUM Inc, filled with Tl-201
(3,7MBq).We used the main-energy window widths 20% centered on 70 keV and sub-energy window
widths (3 and 6 keV).We compared the true primary to total ratio with the primary to total ratio estimated
using TEW method.
Results:
Sub-energy 6 keV was found to be optimal for implementation of the TEW method in Tl-201. The primary
to total photons ratio (P / T) percentage is higher with the correction method than with the standard one.
The difference is around to 2% for activities from 3.7 to 200 MBq.

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P-182

COMPARISON OF OCCUPATIONAL DOSE PROFILES OF RADIATION WORKERS

WITH LIF:Mg,Ti AND LIF:Mg,Cu,P TL CHIPS IN HOSPITALS

Arun Kumar LS Nair1, Mohammed Al-Ajmi2, Jamal Al-Shanfar2

1
Head, Dept. of Medical Physics, Ministry of Health, Oman
2
Ministry of Health

Radiation Protection

In Ministry of Health (MOH), Oman; recently we have established a new Thermo Luminescent (TL) based
Personal Monitoring Service with LiF:Mg,Cu,P TLD chips as the monitoring cards by replacing the existing
LiF:Mg,Ti TLD cards. In the ensuing process, we compared the dose profiles of radiation workers in MOH
hospitals with simultaneous double badging of radiation workers with the above two types of TLD cards.
We have used two Harshaw 6600 Plus TL readers for the measurement. Though we are employing a variety
of Harshaw dosimeters such as 8850MCP, DXT-707H MCP, XD-107H MCP and 8806MT; the current
study was done only for whole body badges. Of the 160 MOH health establishments of MOH, we have
conducted the present study in three hospitals alone. 37 workers were monitored by issuing the above two
TL personal dosimeters every month for three months. End of every month, both the TLD's were collected
back and processed for Hp(10) and Hp(0.07).
The measured dose results shown that 62% of the LiF:MCP TLD cards recorded occupational doses, though
majority of them were near or just above the threshold detection levels of doses, where as 38% cards yielded
dose values below the threshold. On the other hand, only 12 % of the LiF:MT cards recorded doses above
threshold and 88% cards recorded values below the threshold limit. Doses above 0.5 mSv, both the cards
started picking almost identical way. This indicates that LiF:MCP cards have 50% more detection ability
over MT.
Hence, it may be concluded that in a radiation department where lower levels of occupational doses are
encountered, LiF:MCP chip is the TL material of choice in a TL based PM service. Of course, the cost vs
benefit must be kept in mind, before considering the changeover in an establishment with a large number
of workers.

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P-183

WIDE CONE BEAM COMPUTED TOMOGRAPHY DOSIMETRY

Fillipe Machado de Jesus1, Luciana Tourinho Campos2, Leonardo de Castro Pacífico3, Delson Braz4, Luís
Alexandre Gonçalves Magalhães5
1
Programa de Engenharia Nuclear (PEN)/ COPPE/ Universidade Federal do Rio de Janeiro (UFRJ),
Laboratório de Ciências Radiológicas (LCR)/ DBB/ Universidade do Estado do Rio de Janeiro (UERJ),
Brazil
2
Departamento de Física Aplicada e Termodinâmica (DFAT), Universidade do Estado do Rio de Janeiro
(UERJ), Laboratório de Ciências Radiológicas (LCR)/ DBB/ Universidade do Estado do Rio de Janeiro
(UERJ)
3
Laboratório de Ciências Radiológicas (LCR)/ DBB/ Universidade do Estado do Rio de Janeiro (UERJ)
4
Programa de Engenharia Nuclear (PEN)/ COPPE/ Universidade Federal do Rio de Janeiro (UFRJ)
5
Laboratório de Ciências Radiológicas (LCR)/ DBB/ Universidade do Estado do Rio de Janeiro (UERJ)

Diagnostic Radiology –Dosimetry

The International Electrotechnical Commission developed an efficient methodology based on the

equipment traditionally available in the health institutions - thus solving the complications observed by the
scientific community - which was described and recommended in the IAEA Human Health Report No. 5
of the International Atomic Energy Agency. The present study was developed in a CT scanner equipped
with the technology entitled Dynamic Volume Computed Tomography. The Aquilion ONE ViSION
Edition launched by Canon Medical Systems in 2012. As the research developed by our research group has
been focused on cardiac and cardiovascular angiographic CT exams performed in pediatrics, the study was
based on the recommended protocol for these types of examination – 160 mm maximum collimation
provided by the CT scanner and 80 kV X-ray tube potential - in publications of the Image Gently
organization. The values of normalized CT dose index measured free-in-air for the dosimetry in 3 steps
were not feasible because they were associated with uncertainties 6 times higher. Taking into account, then,
the dosimetry in 2 steps, the corrected normalized weighted CT dose index values were as follows: 0.064
mGy / mAs, 0.058 mGy / mAs, 0.051 mGy / mAs and 0.023 mGy / mAs, for bowtie filters extra small,
small, medium and large, respectively. In conclusion, the study demonstrated the possibility of health
institutions that have wide cone beam CT scanners implemented in their radiological routines are able to
use the same equipment classically applied in the field of CT dosimetry, if they follow the methodology
recommended by the International Agency of Atomic Energy.

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P-186

SOCIAL AND SCIENTIFIC IMPACT OF THE UAEM-ININ M.SC. AND D.SC.

GRADUATE PROGRAM IN MEDICAL PHYSICS IN MEXICO: 23 YEAR
EXPERIENCE

Eleni Mitsoura, Keila Isaac-Olive, Eugenio Torres-Garcia, Miguel Angel Camacho-Lopez, Alberto
Ernesto Hardy-Perez, Liliana Aranda-Lara

Universidad Autónoma del Estado de Mexico, Mexico

Education and Professional Issues

Introduction: In Mexico, cancer is the third cause of mortality. In the last decades, the worldwide tendency
has been that of prevention and early detection, as well as, accurate and personalised treatment. The role of
ionising radiation in both diagnosis and treatment is particularly important. In Mexico, the presence of
advanced diagnostic and treartment techniques in hospitals all over the country, has multiplied in the last
three decades. For their successful and optimal application, a multidisciplinary team is required, that
includes physicians, medical physicists, biomedical engineers, computer specialists, among others. The
number of qualified medical physicists is insufficient.
Methods and Materials: In order to address the later, in 1994 the Instituto Nacional de Investigaciones
Nucleares (ININ), sponsored by the International Atomic Energy Agency (IAEA), started in Mexico a
teaching and training program (Diplomado) in Radiotherapy Medical Physics. Based on this experience,
the Universidad Autónoma del Estado de México (UAEM) and the Instituto Nacional de Investigaciones
Nucleares (ININ) launched two years later, the first Graduate Program in Science (M.Sc. and D.Sc.),
specialised in Medical Physics in Mexico.
Results: Twenty three years after its creation, an analysis of the social and scientific impact of the UAEM-
ININ program is presented in this work, based on the achievements attained, regarding the number of
graduated Medical Physicists, their geographic and academic origin, their current professional activities
and the number of scientific publications produced as a result of their thesis.
Conclusions: The indicators presented in this work will demonstrate that the UAEM-ININ M.Sc. and D.Sc.
Medical Physics Graduate Program, has been achieving its goals in forming clinical medical physicists and
researchers and it is continuously aiding in the improvement of health care in México, as well as the
advancement of science and technology in the medical physics field.

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P-189

MAMMOGRAPHY IN BRAZIL: A DISTRIBUTION OF RESOURCES RELATED TO

FEMALE POPULATION AND INCIDENCE
OF BREAST CANCER

Maria Eliza Antunes1, Rodrigo Sanchez Giarola1, Samuel Perri Gimenes2, Ney Lemke1, Joel Mesa
Hormaza1
1
Departamento de Física e Biofísica - Instituto de Biociências/Universidade Estadual Paulista, Botucatu,
SP, Brazil
2
Centro de Isótopos Estáveis - Instituto de Biociências/Universidade Estadual Paulista, Botucatu, SP, Brazil

Diagnostic and Interventional Radiology – General

Introduction:
Mammography is the main path for breast cancer diagnosis and prevention in early stages, a disease that is
known for fast and disordered growth rate of breast tissue. The exam, if done in women of age between 40
and 49 years old, can decrease the breast cancer death ratio by a good margin. That reduction is due to
cancer controlling programs, specifically in actions of precocious detection and treatment. In Brazil, the
National Mammography Quality Program (Programa Nacional de Qualidade em Mamografia-PNQM) was
created by Health Ministry (Ministério da Saúde) to ensure mammography exam quality all over the
country. This study focuses on evaluating the overall situation of mammography in Brazil, be it related to
equipment distribution, female population, and the breast cancer incidence.
Methods and Materials:
Data were overall analyzed from 2002 to 2018. Information about the equipment distribution were gathered
through DATASUS, a digital platform that contains all sorts of data regarding from Health Unique System
(Sistema único de Saúde- SUS). For female population data, Brazilian Institute of Geography and Statistics
(IBGE) was used instead.
Results:
With all those data, we calculated the number relating from mammography equipment number per million
women, the number of women per radiology doctor in Brazil, and the amount of breast cancer per
population per region.
The mammography accessibility per region is clearly not uniform, being it biased towards South and South-
east regions, with a lower amount of equipment for the North and North-eastern part of the country.
Conclusion:
To ensure quality and regularity in performing mammograms throughout the entire territory, it is necessary
a bigger amount of equipment and professionals working the area and ensuring that the PNQM program is
established in the correct manner.

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P-190

EFFECT OF APPLICATOR DIAMETER ON DELIVERED DOSES TO NORMAL

TISSUES IN INTRA OPERATIVE RADIOTHERAPY (IORT)

Gilnaz Omyan1, Somayeh Gholami 2

1
Department of Physics, Faculty of Science, University of Guilan, Rasht, Iran /
Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran,
Iran
2
Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences,
Tehran, Iran

Radiation Oncology – Dosimetry

Introduction: Intraoperative radiotherapy (IORT) is a treatment method for cancer, involving the direct
application of ionizing radiation to surgically opened tumor bed without irradiating surrounding healthy
tissues. Using Monte Carlo (MC) simulation, we aimed to evaluate the dose delivered to normal brain
tissues beyond the tumor bed. Brain tissues are extremely delicate, hence the need for simulation studies
towards effective management of delivered doses.
Methods and Materials: The Zeiss IORT machine (Carl Zeiss, Oberkochen, Germany) was simulated using
Geant4 toolkit (version 4-10.p03). We also simulated the diameter of its spherical applicators ranging from
1.5 to 5 cm in 0.5 cm increments. The accuracy of the MC simulation technique was examined by
reproducing several different simulated dosimetry parameters of the primary beams with the experimental
data. Experimental measurements were carried out using a water phantom as well as a soft X-ray ionization
chamber (PTW Freiburg, Germany, type 23342). With a prescribed dose of 10 Gy to 4 mm depth of head
water phantom, the dose delivered to normal brain tissue was evaluated according to calculated relative
dose obtained from MC simulation for different applicator sizes.
Results: Our results showed that the relative dose delivered to the normal brain tissue increased with
applicator size. With a prescribed dose of 10 Gy, the respective doses delivered to normal brain tissue
located at depth of 10 mm had an average of 4.77 ± 1.03 Gy. Our simulated results were in good agreement
with experimental measurements, with a statistical uncertainty of 1%.
Conclusions: MC simulation results of this study has shown that the delivered dose to normal brain tissues
beyond the tumor bed increases with applicator size. Hence, we recommend the use of smaller sized
applicators for brain IORT to ensure that the least dose is delivered to the normal brain tissues.

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P-191

EVALUATION OF RADIATION DOSE IN CT CARDIAC IMAGING PROCEDURES:

INITIAL EXPERIENCE BASED ON CLINICAL INDICATION

Mohammad Hassan Kharita1, Huda AlNaemi1, Virginia Tsapaki2, Maryam AlKuwari1, Antar Aly1
1
Hamad Medical Corporation - Doha, Qatar
2
Konstantopoulio General Hospital - Athens, Greece

Diagnostic Radiology –Dosimetry

Introduction:
Computed Tomography (CT) is the most important technological development of the 20th century as far
as medical technology is concerned. Its technological evolution led to many new clinical applications such
as cardiac CT (for evaluation of coronary angiography disease (CAD), stent placement evaluation, pre
Transcatheter aortic valve implantation (TAVI) evaluation, etc.). CT provides excellent quality images at
the expense of high radiation exposure. Typical CT effective doses (E) range between 1-10 mSv, easily
increased due to protocol used to answer the clinical problem. Literature on complex cardiac CT is limited
compared to conventional CT regarding radiation dose. The aim of study was to evaluate radiation dose in
CT based on clinical indication.
Methods and Materials:
The study was performed in Heart Hospital in Qatar. The CT scanner Model Somatom Definition Flash
Dual-source was used to perform this study. The hospital has a dose management software (Radiation Dose
Monitor Software, PACS Health, LLC) facilitating data collection. Apart from clinical data (patient weight,
height, etc.) and technical data (kV, CTDI, DLP, etc), the software calculates also E.
Results:
Data from 431 patients with various cardiac clinical indications are presented. Clinical indications were:
suspected CAD (93.3%), stent evaluation (2.8%), pre-TAVI evaluation (2.3%) and coronary anomaly
(1.6%). Large radiation dose values were observed exhibiting non normal distribution and thus median
dosimetric values are presented. Median values of CTDI, DLP and E were 24.5 mGy, 377 Gycm, 5.3 mSv,
22.5 mGy, 343 Gycm, 4.8 mSv, 6.7 mGy, 640 Gycm, 9.0 mSv and 23.7 mGy, 566 Gycm, 7.9 mSv,
respectively. Large variations (max/min) were observed for all dose quantities. For E specifically these
were 14.2, 5.9, 4 and 11.8 respectively.
Conclusions:
This is the first study on cardiac CT based on clinical indication. The study is continued to establish clinical
DRL in cardiac CT.

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P-194

MONITORING OF PERSONAL DOSE ON TWO FACILITIES OF NUCLEAR

MEDICINE. A RETROSPECTIVE STUDY

Elmer Gastelo ,Hector Loro, Alexis Lecuna

Universidad Nacional de Ingenieria, Peru

Nuclear Medicine

Nuclear medicine has been developed around last years in Peru, the staff: physicians, technologist, medical
physicist have been increased. Actually, there are around 16 facilities on nuclear medicine in Lima. In order
to new requirements, dose monitoring of technologist is required by regulatory. The effective dose Hp (10);
lens dose and skin dose Hp(0,7) respectively have been parameters to monitoring of personal.
First, the technologist risks on nuclear medicine were estimated accord the system of evaluation of risk on
radiotherapy (SEVRRA), then the personal dose was registered using dosimetry reports on two facilities.
The Hp (10), lens dose and Hp (0,7) were registered on ORIGIN SRO v8.0724. The effective dose was
estimated using a simplified calculation accord the risk evaluation; finally, the results were compared within
two facilities. 4 technologists were monitoring around 6 years. The risk evaluation to technologist was high
risk to administration and preparation of radioactive source and medium risk to reception of radioactive
sources. Accord the personal dose it was verified that at 2010-2016 the effective dose was 2,2 mSv/year –
9,9 mSv/year, lens dose was 2,0 mSv/year -10,5 mSv/year and skin dose was 2,0 mSv/year-10,8 mSv/year
respectively. Finally, the dose effective estimated by calculations was 2,43 mSv/year. Accord the results
lens dose is less that limit to regulatory Peruvians. The risks evaluation was realized in two facilities on
nuclear medicine. The high risk was to administration a preparation of radioactive source and medium risks
was the reception of radioactive source. Accord to monitoring results, lens dose limit was not exceeded
around 2010-2016 periods. However, in order to the high values to lens doses were necessary investigations.
the dose effective estimated by calculations was around 2,43 mSv/year underestimated the dose monitored.
Posterior calculations with Montecarlo method can be corrected these results.

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P-195

IRRADIATION OF THE CRANIOSPINAL WITH HIPPOCAMPUS SPARING WITH

VMAT TECHNIQUE

Nicolas Fuentes, Ricardo Ruggeri

Fundacion Medica de Rio Negro y Neuquen, Argentina

Radiation Oncology –Treatment Planning

Introduction:
Historically, craniospinal irradiation represents a challenge when planning conventional treatment with 3D
technique since it is necessary to take into account, generally, large field sizes, turn of table and gantry, as
well as the position and size of the patient. but currently the VMAT technique offers us other possibilities
to face this type of treatment, optimizing the resources when planning and applying the treatment.
Method and materials:
The Monaco TPS was used, with the Infinity Linac, with Agility from Elekta. For the specific patient QA,
Octavius 4D and Mephisto mc 2 software from PTW were used. It was prescribed to the PTV 30Gy in 10
fractions. Three isocenters were generated along the patient with two field junctions. In these unions,
gradient rings were created with a prescription of 25Gy, 20Gy, 15Gy, 10Gy, 5Gy achieving a total of 5
rings of 1 cm each. In turn, the PTV that includes the whole brain was cut 5mm from the hippocampus for
further optimization.
Results:
A treatment plan was obtained with homogeneous doses, with a coverage greater than 95% in all the PTV,
complying with the objectives of the RTOG 0933 for the protection of the hippocampus, in addition to the
restrictions in all the OARs. The specific patient QA, with a criterion of 3mm 3%, gave a result greater than
95% The application of the treatment in the room was optimized, only having a displacement in the
longitudinal direction of the stretcher
Conclusions:
Regarding the 3D technique, this work shows a high practicality in the planning with VMAT for this type
of treatment, ensuring homogeneity in the PTV, and low doses in the OAR, including hippocampus, in
addition to the simplicity in the daily application.

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P-198

BACKSCATTER CORRECTION FACTOR FOR A PERSONAL DOSIMETER WORN

OVER LEAD APRONS IN FLUOROSCOPY SCATTERED FIELDS

Alfonso Quintero-Quintero1, Cristian Candela-Juan2, Facundo Ballester3, Javier Vijande3, Juan Diego
Palma2
1
Universidad Nacional de Colombia, Colombia
2
Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
3
Department of Atomic, Molecular and Nuclear Physics, Universitat de València, Burjassot, Spain

Radiation Protection

Introduction:
Medical staff working near the scattered radiation field in fluoroscopy guided interventional procedures
may be exposed to high cumulative equivalent doses, thus requiring shielding devices such as lead aprons
and thyroid collars. It remains an acceptable practice to derive the equivalent dose to unprotected soft
tissues such as the eye lenses with a thermoluminescent dosimeter (TLD) placed above the leaded elements.
Nevertheless, it is not being considered that the backscattered radiation for a dosimeter worn above a lead
shield differs from that generated during dosimeter calibration. The aim of this research was to study the
effect of backscattered radiation in the response of a TLD when is worn over a lead shield and derive a
correction factor to be applied to the personal equivalent dose Hp(0.07) calculation algorithm.
Methods and Materials:
A on a card with four LiF:Mg,Ti chips sandwiched in between different filter plates was model led by
means of the Monte Carlo (MC) code Penelope. The results obtained were validated against measurements
performed in reference conditions in a secondary standard calibration laboratory. Next, the MC model was
used to evaluate the backscatter correction factor needed to estimate Hp(0.07) to unprotected soft tissues.
For this purpose, the TLD was irradiated over a water slab phantom with a photon beam representative of
a fluoroscopy beam scattered by a patient. Several setups were evaluated that consider different incident
beam angles and lead thicknesses between the TLD and phantom.
Results and Conclusions:
The TLD readings should be corrected by a backscatter correction factor equal to 1.23 when worn over lead
shielding. For leaded shield thicknesses greater than 0.25 mm the response is independent of this thickness.
The inclusion of the backscatter correction factor in the calculation algorithm improves the dose estimation
to unprotected soft tissues such as the eye lenses.

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P-202

RADIATION PROTECTION IN PEDIATRIC COMPUTED TOMOGRAPHY (CT):

ASSESSMENT OF COMPLIANCE LEVEL

Dheyauldeen Shabeeb1, Ahmed Eleojo Musa2

1
Department of Physiology, College of Medicine, University of Misan, Amarah, Iraq
2
Department of Medical Physics, Tehran University of Medical Sciences, Tehran, Iran

Radiology – Radiation Protection.

Introduction:
Despite the benefits of computed tomography (CT) imaging in medicine, there is a need to ensure that
possible side effects to patients are minimized, especially in pediatrics, who are more radiosensitive. Hence,
adherence to radiation safety standards is important. We aimed to assess the level of compliance to
international dose reference levels (DRLs) in terms of effective doses in pediatric CT scans conducted in
three Iraqi hospitals.
Methods and Materials:
CT brain and abdomen/pelvis examinations were conducted for pediatric patients (<15 years) in Wasiti,
Neuroscience and Omara hospitals using a Somatom Sensation CT scanner. Volumetric CT dose index
(CTDIvol) and dose length product (DLP) were collected for 180 patients (60 in each hospital). Afterwards,
their effective doses were estimated from DLP values and compared with international DRLs.
Results:
Brain CT: DLP values obtained for Wasiti, Neuroscience and Omara hospitals were in the range; 789-
918.8, 833-874.6 and 627.6-810 mGy.cm, respectively, while their corresponding effective doses were;
1.8-2.09, 1.9-2.06 and 1.43-1.83 mSv. Abdomen/Pelvis: DLP values obtained for Wasiti, Neuroscience and
Omara hospitals were; 392.9-425.8, 355-395 and 314.8- 383.6 mGy.cm, respectively, while their
corresponding effective doses were; 6.65-7.22, 6-6.7 and 5.34-6.51 mSv.
Using the International Commission on Radiological Protection (ICRP) publication 103 as basis for
assessing compliance level, for brain CT we observed slightly higher values in Wasiti and Neuroscience
hospitals while Omara was similar to the international DRLs. However, for abdomen/pelvis CT
examinations, the effective doses in all three hospitals were within the acceptable limits of international
DRLs.
Conclusion:
We observed encouraging levels of compliance towards adequate radiation protection management in
pediatric CT examinations among the three hospitals. Although, the best compliance level was observed in
Omara hospital. Regular monitoring should be enforced to ensure that CT doses delivered to pediatric
patients are as low as reasonably achievable without compromising diagnostic quality.

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P-204

3D SIMULATION OF OXYGEN AND HYPOXIA-TRACER DISTRIBUTIONS IN

TUMOURS: A PARAMETRIC SENSITIVITY STUDY

Isabela Paredes Cisneros1, Ignacio Espinoza2, Christian Karger1, Paola Caprile2, Araceli Gago-Arias3
1
German Cancer Research Center DKFZ - Medical Physics in Radiation Oncology - Heidelberg - Germany
Heidelberg Institute for Radiation Oncology HIRO - National Center for Radiation Research in Oncology
NCRO - Heidelberg Heidelberg University - Faculty of Physics and Astronomy Heidelberg
2
Pontificia Universidad Católica de Chile - Institute of Physics - Santiago - Chile
3
Group of Medical Physics and Biomathematics - Instituto de Investigación Sanitaria de Santiago (IDIS) -
Santiago de Compostela

Radiobiology

Introduction: Hypoxic tumour cells are known to be more resistant to ionizing radiation. Treatment outcome
improvements may be achieved by irradiating hypoxic regions with higher doses. 18F-fluoromisonidazole
positron emission tomography (FMISO-PET) can be used to identify hypoxic regions. However, the
interpretation of hypoxia-PET images still remains challenging since radiotracer binding and oxygen
distribution are not uniquely related. Mathematical modelling is a useful tool to increase the understanding
on this topic. The purpose of this study was to implement a model for simulating oxygen and radiotracer
distributions in tumours, and to analyse the impact of the different input parameters of the model on the
resulting distributions.
Materials and Methods: Spatiotemporal distributions of oxygen and FMISO were described by partial
differential equations (PDEs). The simulation domain consisted of a cubic tumour volume with vascular
architectures. Vascular fractions (VFs) of 1% and 3% were studied. FMISO binding model parameters were
varied within published value intervals. IFs were taken from previous experimental studies.
Results: Similar oxygen distributions were obtained for architectures with parallel and perpendicular
vessels. This was reflected in time-activity-curves TACs and tissue-to-blood ratios (TBRs). For most
FMISO binding model parameters variations were observed in bound-concentration Cb as a function of
pO2 and TACs. TBR varied 9% and 3% for VF 1% and 3% respectively. IF had the most impact on TACs,
with TBR variations of up to 21.3% for VF 1%.
Conclusion: Simulations performed in this study showed how FMISO binding is not uniquely related to
pO2 and how this relationship is sensitive to the input parameters of the model. TBR as a measurement of
hypoxia might not account for TAC variations due to biological or interpatient uncertainties. Sensitivity to
the IF arises the question if this function truly represents the arrival of the radiotracer to the tumour.

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P-205

THE USE OF A MULTILAYER PERCEPTRON IN IOL CALCULATION

Alfo José Batista-Leyva

Instituto Superior de Tecnologías y Ciencias Aplicadas, Universidad de la Habana, La Habana, Cuba

Biomedical Engineering

Introduction: Determining the power of IOL to be implanted is a key issue in cataract surgery. Though
many formulae have been developed, only 80% of cases reach emetropia, there are still a 20% of possible
improvement. We aim to determine the capabilities of a machine learning algorithm (Multilayer Perceptron
MLP) for calculating the power of an IOL to be implanted, achieving a given postoperative refraction. The
research is a collaboration between the Cuban Institute of Ophthalmology and the InSTEC, University of
Havana.
Methods and Material: A retrospective review of patients (15728 eyes) who had uneventful
phacoemulsification cataract surgery for six years was used as a train data base. Exclusion criteria: previous
intraocular or refractive corneal surgery, any corneal disease, pathological or complicated cataracts,
intraoperative complications, preoperative astigmatism beyond 3 diopters, postoperative CDVA worse than
20/40, missing postoperative refractive information, eyes with axial length AL<19.36 mm, AL>27 mm,
corneal average power K <3 6 D or K>50.9 D, and refractive surprises larger than ± 3 D. Data was used to
train a MLP in order to predict the value of the IOL power needed for a given postoperative refraction.
Using AL, K, predicted and real postoperative refraction, the MLP predicts lens power. Models were trained
using the library of Python Keras with Tensorflow backend in a PC with an Intel core i5 – [email protected] GHz
with 4 Gb DDR3 RAM.
Results: MLP predicted the value of the implanted IOL with an error smaller than 0.5 D in more than 95 %
of patients, even for a surgeon not included in the training process.
Conclusions: The accuracy attained by the trained MLP is high, indicating the feasibility of a prospective
study leading to a new method of predicting the IOL power in refractive surgery with an error smaller than
current prediction methods.

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P-206

ASPECTS OF PET TECHNOLOGY IN BRAZIL

Vítor Uriche, Cassio Miri

Department of Imaging Diagnosis of the Federal University of São Paulo (UNIFESP), Campus São Paulo,
Brazil

Nuclear Medicine

Positron Emission Tomography (PET) scan is a highly sensitive imaging technique used in oncology,
cardiology, neurology and in infectious and inflammatory diseases. Due to its applications in different areas
it is possible to observe the expansion of this image technique around the world. Objective of this work is
to evaluate the PET technology scenario in Brazil. The number of PET equipment's, analysis of density of
equipment per capita according to international recommendations, number of 18F-FDG producer's centers
and cost of the procedure was analyzed. The data were acquired from government's official sites DATASUS
and CNEN. Results showed that there was a significant evolution of the number of PET equipment's in
Brazil. However, the number of PET equipment's per capita 67/3.1 million still is below when compared
of the international recommendations. Currently, Brazil has 13 18F-FDG producers' centers. This grown of
18F-FDG producers is due the end of monopoly by the government allowing private companies enter on
the segment. PET scan it is considered a procedure of high complexity, having high cost per examination.
It was observed a high variation in costs, from US$ 726.67 to US$ 1598.12. Even with the evolution of the
number of PET equipment installed in Brazil, some regions of the country still lack equipment installed. In
addition, the cost of the exam and access to the exams through public funding is still an obstacle to further
expansion of the PET exams.

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P-207

MODELING A PTW SEMICONDUCTOR PROBE USED FOR PERIPHERAL DOSES

DETERMINATION, WITH THE MONTE CARLO CODE GATE

Gabriel de la Fuente Rosales, Cesar Eduardo Garcia Trapaga, Rodolfo Alfonso Laguardia, Jose Alejandro
Fragoso Negrin

InSTEC, Cuba

Radiation Oncology – Dosimetry

The Monte Carlo method has been widely used in medical applications for many years. In Cuba, the
introduction of advanced technologies in radiotherapy has greatly improved our ability to administer the
desired dose to the tumor site with a high level of complexity, while minimizing doses to organs at risks.
There is still a great concern about this unwanted dose in healthy tissues being detrimental to the therapeutic
benefits, especially in children, who have high expectations of survival. In this work, a model of a silicon
semiconductor probe commonly used for in vivo verification in IMRT treatments at the National Institute
of Oncology and Radiobiology (INOR) was developed using the Monte Carlo code GATE. Several
calibration tests were carried out in order to obtain the optimal parameters of the simulation and the
Venseelar criterion was used as the criterion of acceptability. The 6 MV photon beam energy of the linear
accelerator was set up, the best energy / FWHM combination obtained was 5.8 MV / 3 mm for which the
percentage point-to-point differences between simulated and experimental values were always below 2%.
The diode model was validated for in-field calculations, obtaining a 2.4% as maximum deviation during
the comparisons made. Dose profiles outside the treatment field were determined for a field size 10x10
cm2, on the surface of water and at the depth of the maximum, being able to confirm that the peripheral
doses decrease as we move away from the central axis. The percentage point-to-point differences between
the simulated values and the experimental values were always below 6%, and because we do not find in the
bibliography an acceptability criterion for measurements outside the treatment field, based on the
comparison with similar works concluded that the results obtained were satisfactory.

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P-208

VALIDATION OF A HEAD & TORSO CIRS PHANTOM FOR QUALITY CONTROL

IN RADIATION THERAPY TREATMENTS

Manuel Castrillon1, Jose Luis Rodriguez1, Niurka Perez2, Gabriela Chorbadjian2

1
Clinica Las Condes, Chile
2
Instituto de Salud Publica, Chile

Radiation Oncology – Quality Assurance

Introduction:
The growth of radiation therapy in Chile has made it necessary to implement quality assurance protocols
for the medical equipment involved. The tendency is to perform an end-to-end quality control process,
based on procedures and instruments that allow measuring the administered dose.
Methods and Materials:
A 6MV beam of a linear accelerator (Oncor, Siemens) was used to irradiate created plans in the treatment
planning system (TPS) (Eclipse, Varian) on a phantom (Head & Torso, CIRS) with bone, air and ionization
chamber (IC) inserts, scanned in a CT (Definition AS, Siemens). The irradiated plans were 10x10, BOX
and IMRT. The absorbed dose for each plan was measured using an IC (Farmer, PTW) and compared with
the calculated dose by the TPS. A phantom of the same dimensions and Hounsfield Units as the used CIRS
phantom was created in Eclipse and another TPS (Prowess), and the measured and calculated doses by both
TPS were compared. Two configurations were used for the inserts: air-up/bone-down (AU/BD) and bone-
up/air-down (BU/AD).
Results and Conclusions:
The measured dose presented greater difference (±4%) in the plans with IC insert in both configurations
and below 2% without IC insert, and less than 1% in plans on the phantom created in Eclipse. When
comparing the UM between the 10x10 and BOX calculated plans using the CT images without and with
insert for IC a maximum difference of 2% was obtained. The difference when comparing the two TPS is
within 2% for AU/BD and 1% for BU/AD. Using the phantom created for IMRT control quality, a
difference of 1% was obtained between the measured and calculated doses for both configurations. As the
differences of the tests performed are less than 2%, it is possible to use the CIRS phantom for quality control
of 3D and IMRT treatments.

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IROC MD ANDERSON POSTAL AUDIT PROGRAM EXPERIENCE AND RESULTS

CLINICA ALEMANA RADIOTHERAPY DEPARTMENT SANTIAGO CHILE

Hernan Barriga, Gabriel Zelada, Teresa Resquin, Jugleys Seijas

Medical Physicist, Chile

Radiation Oncology – Quality Assurance

Introduction: Reports from various institutions dealing with quality assurance in radiotherapy equipment
have established good practice, performing periodic external auditing procedures using dosimetry systems
based on radiation detector crystals. The oldest is the one administered by the International Atomic Energy
Agency (IAEA) using thermolumiscent dosimetry (TLD) based on lithium fluoride crystals (Lif:Mg). Since
the 1980s, the Centre for Radiation Imaging and Oncology, Houston Quality Assurance Center (IROC) has
been conducting these types of audits as part of its services.
Method and Materials: Since 2017 the Clinica Alemana Radiotherapy Department is attached to annual
audits offered by the IROC (Imaging and Radiation Oncology Core) MD Anderson Houston Texas USA,
to check the absolute dose for electrons and photons beams. This center uses as detector element Al2O3:C
crystals using optically stimulated luminescence (OSLD). Together with these crystals, Phantoms designed
for photons and electrons are attached and irradiated at predetermined points with a required dose, usually
100 cGy. Results: The results obtained for Linac Synergy were: 6MV 1.02±0.02, 15MV 1.02±0.01
respectively and for the 5 electron energies (6, 9, 12, 15, and 18 MeV), was 0.9±8 0.02. In this sense, for
Linac Platform the results were: 6MV 1.01±0.02, 15MV 1.00±0.02 respectively and for the 5 electron
energies (6, 9, 12, 15 y 18 MeV), was 0.99±0.02.
Conclusions: This program demonstrates, in the period studied, the dosimetric stability of both accelerators
and the similarity of one accelerator with the other and Clinica Alemana is within established international
standards and tolerances.

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DETERMINATION OF THE EFFECTIVE DOSE IN A RADIATION THERAPY

BUNKER USING BeOSL DOSIMETRY

Manuel Castrillon, Ernesto Hermosilla, Jose Luis Rodriguez

Clinica Las Condes, Chile

Radiation Protection

Introduction:
The main uses of effective dose are the prospective dose assessment for the optimization of radiological
protection and the demonstration of compliance with dose limits for regulatory purposes. To know the value
of effective dose within a radiotherapy bunker can be important in the event of an accidental situation.
Methods and Results:
This study measure effective dose in a radiotherapy bunker using a 6MV photon beam of a linear accelerator
(Oncor, Siemens). Different groups of BeOSL dosimeters (OSL Control Chile) were irradiated. These were
positioned on the treatment table at different distances from the isocenter (50, 100 and 150cm). A solid
phantom centered on the beam axis was used as scatter material. The following dependencies were
evaluated gantry and couch angulation, beam energy, monitor units, dosimeters orientation (front-back and
front-side), and attenuation effect by interposition between dosimeters. The measurements were repeated
using Farmer ionization chamber (IC) located at the same distances from the isocenter, and using buildup
cap. Results and Conclusions:
For MU dependence, the average deviation between the measurements obtained with the dosimeters and
with the IC was below 1%. For energy dependence, the difference between the average values measured
with dosimeters and with IC for both energies at the distances used was below 3%. The maximum
differences obtained when comparing the frontal vs. lateral and frontal vs. posterior position were 5% and
2% respectively, for all distances. Likewise, attenuation effect by interposition between dosimeters presents
differences less than 5%, being greater for the largest distance. In the case of the gantry angulation
dependence, the dosimeters show a deviation below 5% for 0° and 90° angles. This study establishes the
parameters to be taken into account in order to use the BeOSL dosimeters in the determination of effective
dose in a radiotherapy bunker and its comparison with IC.

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P-214

EFFECT OF JAWS COLLIMATOR POSITION ON THE PENUMBRA OF

RADIATION FIELD SHAPED BY VARIAN 80-LEAF MILLENNIUM MULTILEAF
COLLIMATOR SYSTEM

João Paulo Lima, Samuel Avelino, Luis Felipe Oliveira e Silva, Pedro Cintra

University Hospital of Brasília, Brazil

Radiation Oncology – Dosimetry

Introduction: Radiation field penumbra has an impact on the sparing of healthy tissue and on field junction.
The purpose of this study was to evaluate the influence of jaws position on the field penumbra shaped by
Varian 80-leaf Millennium MLC system. Method and materials: We measured MLC-shaped field profiles
in the in-plane and cross-plane direction for 6 MV and 10 MV photon energy using Radiochromic EBT3
films. The films were irradiated at 5 cm depth in a water-equivalent phantom with SAD setup and 10x10
cm2 field size. We measured the 80% to 20% penumbra width varying the jaws collimator position. The
jaws were placed: (1) with no gap between jaws and MLC; (2) 5 mm distant from MLC in the cross-plane
and in-plane direction; (3) in the recommended positions by the software Eclipse version 13.6 (8 mm in the
cross-plane and 2 mm in the in- plane direction); (4) at 10 and 15 mm distant from MLC in the in-plane
and cross-plane direction, respectively.
Results and Conclusions: The penumbra widths were, in the cross-plane direction, for 6 MV: 3.3, 3.5, 3.8,
4.2 ± 0.3 mm and for 10 MV: 3.9, 4.7, 5.2, 5.9 ± 0.3 mm with the jaws at: zero, 5, 8 and 15 mm distant
from the MLC position, respectively. In the in- plane direction, the penumbra widths were: for 6 MV: 3.1,
3.2, 3.2, 3.6 ± 0.3 mm and for 10 MV: 4.1, 4.2, 4.5, 4.8 ± 0.3 mm with the jaws positioned at zero, 2, 5 and
10 mm distant from MLC position, respectively. For healthy tissue sparing, the fields shaped with no gap
between jaws and MLC provided the narrowest penumbras. For field junction, the most distant jaws
collimator positions from MLC provided the largest penumbras.

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P-216

CONTRIBUTION OF HIGH ENERGY ELECTRONS OUTSIDE OF THE FIELD

EDGE DUE TO THE LEAK FROM A LINEAR ACCELERATOR HEAD USED IN THE
CLINIC

Nahum Xicohténcatl-Hernández, Guerda Massillon-JL

Instituto de Física, Universidad Nacional Autónoma de México, Mexico

Radiation Protection

Introduction:
Different research groups have performed Monte Carlo simulation of electron spectra outside of the
radiation field edge generated by linear accelerators (linac) used in the clinic. They commonly reported
average energies of electrons greater than those for photons, suggesting a contribution of high energy
electrons which are not due to the photon interaction. This work investigated the origin of these high energy
electrons.
Methods and Materials:
A Varian iX linac has been designed using the Monte Carlo BEAMnrc code to generate the phase space of
a 6 MV x-ray beam. The FLURZnrc module of the EGSnrc code was used to calculate the electron spectra
produced by the phase space, a 6 MV x- ray point source (without the head of the linac) and a 60Co gamma
beam for several field sizes and depths in liquid water. The calculation was made at 10 mm and 20 mm
from the edge of each field.
Results and Conclusions:
We observed that for the phase space of the 6 MV x-ray beam, the average energies of the electron spectra
outside of the fields can be up to 3 times the photon energy, depending on the distance from the field edge,
which decrease with increasing water depth. However, for the 6 MV x-ray point source and the 60Co
gamma beam, the average energies of the electron spectra outside of the fields are always smaller than those
of the photons, independent of the field size, as expected considering the energy conservation. These results
suggest that the high energy electrons are generated from head of the linac and did not contribute to the x-
ray production.
This work was partially supported by PAPIIT-UNAM grant IN115117 and Royal Society-Newton Advance
Fellowship grant NA150212.

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P-217

PRELIMINARY CONCEPTUAL DESIGN OF A NEUTRON MODERATOR USED IN

NEUTRON CAPTURE THERAPY

Lida Y. Velásquez Sierra1, J. Alfonso Leyva1, Edwin Munevar2, José Antonio Sarta Fuentes1
1
Pontificia Universidad Javeriana, Colombia
2
Universidad Distrital Francisco José de Caldas

Radiation Oncology – Treatment Delivery

Introduction:
Since 2015, the research group Biophysics & Structural Biochemistry at the Pontificia Universidad
Javeriana (PUJ), in cooperation with the International Atomic Energy Agency (IAEA), has been working
on Neutron Capture Therapy (NCT), together with graduate students of the Master Program in Medical
Physics at PUJ. Within our research program, one of the goals is to study how neutrons coming from a D-
D reaction can be moderated in order to be used in NCT.
Methods and Materials:
In order to establish the most common materials and geometries for a beam shaping assembly (BSA) used
in NTC, a review of the specialized literature has been carried out. The selected material for the moderator
was FLUENTALTM and the selected geometry was a semi-infinite plane. The neutron flux, for the fast
and epithermal neutrons as a function of the FLUENTALTM thickness, has been calculated using the
removal-diffusion theory. While the neutron flux spectrum equation for epithermal neutrons has been
evaluated with the Placzek's solution of the transport Boltzmann and for the thermal neutrons with the
inverse energy law. For all calculations the elastic and inelastic macroscopic cross sections for
FLUENTALTM has been considered.
Results:
The maximum flux of epithermal neutrons with energies between 0.5 eV to 10 keV has been obtained for
a deepness of 38 cm in FLUENTALTM. For the evaluation of the epithermal neutron spectrum, the cross
sections were taken from the Evaluated Nuclear Data File ENDF, with a FLUENTALTM composition of
(40% Al60% AlF3). The maximum energy of the epithermal neutron was 25 keV.
Conclusions:
This work has shown that using FLUENTALTM as moderator, the neutron flux is constant, the fast
neutrons are effectively moderated. The obtained values for the normalized neutron flux and spectrum agree
with the recommended values by the IAEA.

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P-218

END-TO-END DOSIMETRY AUDIT USING ANTHROPOMORPHIC HEAD AND

NECK PHANTOM TOWARDS CREDENTIALING FOR CLINICAL TRIALS: A
SINGLE INSTITUTION STUDY

Subramani Vellaiyan, Daya Nand Sharma, Megha Singh Sairem, Seema Sharma, Subhash Chander

All India Institute of Medical Sciences, New Delhi, India

Radiation Oncology – Dosimetry

Introduction:
The purpose of this study was to report our institution' result of end-to-end dosimetry audit using
anthropomorphic head and neck phantom towards credentialing for clinical trials of intensity modulated
radiation therapy.
Materials and Methods:
This study was performed using IROC Houston anthropomorphic head and neck phantom incorporating
dosimetry insert. The dosimetry inserts consisted of one primary PTV containing four TLD capsules, a
secondary PTV and an organ at risk (OAR), each containing two TLD capsules and also radiochromic
films. The phantom was imaged. The PTVs, OAR and TLD capsules were contoured and planned in
Monaco treatment planning system (TPS) with 6 MV X-rays beam IMRT using Elekta VersaHD linear
accelerator. After phantom irradiation, the analysis was done at IROC Houston and comparison was made
between IROC TLDs and radiochromic film measurements and our institution TPS calculations data. The
passing criterion was set as that minimum 85% of pixel points should meet gamma index criteria of +7%
and 4mm.
Results:
The phantom irradiation results showed that the ratio between institution's reported mean doses and IROC
measured doses were 0.99, 0.97, 0.99, 0.98, 1.00, 0.97, 0.95 and 0.98 at four different locations in the
primary PTV, two locations at both secondary PTV and OAR respectively. For the relative dose
comparison, the pixel passing rates for the axial and sagittal films were 98% and 96% respectively.
Conclusion:
This study demonstrated the ability of our institution's equipment commissioning and QA procedure and
met the criteria established by IROC Houston in credentialing for clinical trials.

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P-219

TWO STAGED STEREOTACTIC RADIO-SURGERY TO HIGH NUMBER OF BRAIN

METASTASES WITH GAMMA KNIFE PERFEXION

Raj Kishor Bisht, Gopishankar Natanasabapathy, Vallian Subramani, Manmohan Jit Singh, Shashank
Sharad Kale

All India Institute of Medical Sciences New Delhi, India

Radiation Oncology –Treatment Planning

Introduction: The treatment options for brain metastasis includes surgical resection, whole-brain
radiotherapy (WBRT), corticosteroids, stereotactic radio-surgery (SRS) or some combination thereof.
Among radiotherapy techniques, WBRT is traditionally preferred treatment for the patients with high
number of brain metastasis. In recent years, SRS alone has become an equal and potentially preferred
treatment option for the patients with larger number of brain lesions. The study demonstrates an efficacy
of SRS Gamma Knife (GKSRS) in high number of brain metastases over WBRT. Methods: An operated
case of ca-breast, presented with multiple brain metastasis after one year of adjuvant chemotherapy and
radiotherapy. The patient responded to WBRT (30Gy/10#), however the follow up imaging revealed
increased metastases in number & size after nine months. Staged GKSRS was performed to treat multiple
brain lesions in view of patient comfort, prolonged treatment time and targeted frame fixation limitations.
Results: Nine lesions of volume range 38.9mm3-10.44cc were treated in the first stage whereas 12 lesions
of volume range 17.2mm3-1.47cc were treated in the second stage GKSRS. Marginal dose of 12Gy at 50%
isodose line was delivered to all lesions. Mean tumor coverage was 98.20%. The mean selectivity,
conformity and gradient index were 0.63, 0.56 and 3.5 respectively. An integral dose of 6.2J was observed
to the patient skull. Mean V8 (volume covered by 8Gy) and V10 were 60.64cc and 37.63cc in first stage
and 9.81cc and 5.66cc in the second stage of treatment. 17.46cc of the normal brain received >10Gy of the
radiation dose. The second stage planning MRI showed reduced volume of the tumors treated in first stage.
Conclusions: A high number of brain lesions favoured WBRT, however GKSRS may spare normal brain
tissue from redundant radiation dose. Localized GKSRS may be an alternative, where the patient received
palliative WBRT and have limited treatment options.

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P-220

EVALUATION OF INDIAN-MADE SIMULATOR-BASED CONE-BEAM COMPUTED

TOMOGRAPHY SYSTEM

Subramani Vellaiyan, Megha Singh Sairem, Ashish Binjola, Subhash Chander, Goura kishore Rath

All India Institute of Medical Sciences, New Delhi, India

Radiation Oncology – Quality Assurance

Introduction:
To evaluate the characteristics of first Indian make commercial system of Cone Beam Computed
Tomography (CBCT) system integrated with Radiotherapy Simulator.
Materials and Methods:
Measurements were performed on indigenously developed Panacea Imagin simulator (Panacea Medical
Technologies Pvt.Ltd, Bangalore, India) based cone beam computed tomography (CBCT) system which
was recently installed at our institution. The performance evaluation involved comparison of volumetric
image data acquired from a Siemens Somatom sensation CT scanner, Philips wide bore-CT scanner and
Elekta VersaHD linear accelerator CBCT system. The image quality of CBCT was quantitatively evaluated
using Catphantom and CIRS image quality phantom for geometrical accuracy, HU accuracy, uniformity
and noise, high contrast resolution and low contrast resolution and CT dose index.
Results:
The Imagin Simulator CBCT performance tests results showed that geometric distortion accuracy of 1mm,
the mean pixels of 5 different ROIs based uniformity index of 112.20, signal-to-noise ratio of 2%,
maximum HU accuracy of 11.7% deviation for derlin out of seven different materials, smallest resolvable
pattern/bar seen as a spatial resolution of 6line/cm and 2mm and Low contrast resolution observed was
7mm at 1% and the image quality results of Philips fan beam CT and Elekta CBCT was little superior than
Imagin Simulator CBCT results. The maximum difference in CT dose index was about 2%.
Conclusion:
This evaluation of the CBCT demonstrated that the system currently meets all image quality parameters
and suitable for all clinical applications. However, it was suggested that there is room to improve the image
quality.

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P-222

THE CHALLENGES IN LATIN AMERICA TO IMPROVE RADIATION

PROTECTION IN MEDICINE

Eduardo Medina Gironzini

Red Latinoamericana de Protección Radiológica en Medicina, Peru

Radiation Protection

Attention to medical exposures increased considerably in the 1980s and 1990s. In order to address this
issue, in March 2001, the First International Conference on the Radiological Protection of Patients was held
in Malaga, Spain, where an Action Plan was drawn up based on the contribution of national and
international organizations and whose purpose was ensure that radiation protection is an integral part of
medical practice, recognizing the benefits of medical uses of radiation and radiation protection without
limiting such benefits. Within the framework of this Plan of Action, various activities have been carried
out. Ten years after the adoption of this Plan of Action, the International Conference on Radiation
Protection in Medicine: Setting the scene for the next decade, was held, which took place in Bonn,
Germany, in December 2012. It was organized by the IAEA and WHO. The main outcome of this
Conference was the so-called ""Bonn Call to Action"" that identifies ten priority measures to improve
radiation protection in medicine.
With the main objective of verifying the progress in the implementation of the proposed actions, identifying
problems and possible solutions as well as defining indicators of progress in these actions, the Ibero-
American Conference on Radiation Protection in Medicine - CIPRAM was held in Madrid, Spain (October
2016) with the support of national and international organizations.
In order to identify problems and solutions for the Latin American region, the International Symposium on
Radiation Protection in Medicine is held in Arequipa, Peru (August 2017). And at the XI Regional Congress
on Radiological and Nuclear Safety held in Havana, Cuba (April 2018), important conclusions were
obtained that, like those obtained in the other technical meetings, will be presented in this work. In addition,
the actions carried out in the region to comply with the Bonn Call to Action are presented.

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P-223

OSL TECHNIQUE OF AGATE STONES SAMPLES

Maria Ines Teixeira, Linda V.E. Caldas

Rubens Teixeira and Beatriz Teixeira, Brazil

Dosimetry – Reference quality

Introduction:
Brazilian stones have great interest in studies for use in gamma high-dose dosimetry. At the Radiation
Metrology Laboratory of IPEN, Brazil, different stones have been studied for application in high-dose
dosimetry as: amethyst, onyx, and jasper and have shown their usefulness for gamma dosimetry, using TL,
OSL and TSEE. Agate is a variety of chalcedony, a form of quartz, in which the color appears in bands or
concentric zones. The samples for this study were prepared from four different types of agate stones:
yellow, moss green, gray and purple. The objective of the work was to characterize agate samples as
detectors for gamma high dose radiation.
Materials methods:
To facilitate the process, agate pellets were prepared at the IPEN, using Teflon as binder, and the parts were
mixed in the ratio 2 (Teflon):1 (powdered sample). The irradiations of the samples were performed using a
Gamma Cell-220 System of 60Co, for doses from 50 Gy up to 10 kGy. The OSL measurements were taken
using a RISÖ TL/OSL Reader and Controller, model DA- 20, and the data acquisition was realized using a
personal computer.
Results:
In order to verify the possibility of utilization of agate pellets in high-dose dosimetry, their properties were
studied using the OSL technique as lower detection limits, reproducibility and dose-response curve. The
OSL dose-response curves of the agate pellets were obtained for 60Co, after thermal treatment at 300°C/1h
and irradiation in the range of 500 Gy to 300 kGy. Conclusions:
In the studies of agate samples (four kinds) the results on the main dosimetric propertis show that they may
be useful for high- dose dosimetry in industrial processes and in the sterilization of materials in hospitals.
The main advantage of using agate samples is their very low cost and their usefulness for high-dose
dosimetry using the OSL technique.

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P-225

DEVELOPMENT OF PET/MR MULTIPARIMETRIC ACQUISITION PROTOCOL IN

MARKED BRAIN TUMORS WITH [11C]-METHIONINE

Franco Profili1, Emiliano Marino2, Gustavo Peña1, Roberto Isoardi1, Manuel A Guirao3
1
FUESMEN, Argentina
2
CNEA
3
UN Cuyo

Nuclear Medicine

Brain tumors are one of the most aggressive and difficult to control among all these that afflict the human
body. Its treatment continues to be agree at challenge in clinical neurology due to its invasive
characteristics. One of the most difficult tasks is to define its true extent. Currently, magnetic resonance
images represent the most commonly used method to determine tumor volume, however, neuro-oncology
has shown that glioma cells are found beyond the enhancement area with gadolinium contrast. Given the
complexity of the anatomo-physiological phenomena related to these brain lesions, PET is considered a
promising imaging technique that complements MR techniques in the diagnosis and treatment of patients
with gliomas, by providing metabolic data. Most clinical studies of PET use FDG, but the uptake of this
radiopharmaceutical depends on several factors and has demonstrated its lack of specificity in the study of
gliomas. On the other hand, the use of L−metil−11{C} methionine as a radio-tracer in neuro-oncological
PET images is under investigation, given its specificity in the detection of brain injuries. During this
research, an acquisition protocol was developed for multiparameter brain PET/MR study, with [11C]-met,
for its implementation with the system SIGNATM PET/MR 3T, manufactured by GE. The protocol
includes a list of technical procedures (involving from the preparation of the patient to the administration
of the radio-tracer and subsequently the MC), the PET-MET acquisition and finally a list of MR sequences.
The creation of the protocol involved the adjustment of a set of specific parameters of both acquisition and
processing of series of images. An analysis of the PET-MET studies carried out in FUESMEN was
accomplished, allowing to study the tumor delimitation from segmentation techniques in PET-MET images
and to relate this information to the results of the main biomarkers provided by the perfusion sequences,
diffusion and spectroscopy.

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P-230

EVIDENCE OF OVERUSE, UNDERUSE AND MISUSE OF MEDICAL IMAGING:

IMPLICATIONS FOR RADIATION PROTECTION IN CHILDREN

Flavious Nkubli1, Dlama Joseph2, Christian Nzotta3

1
Department of Medical Radiography University of Maiduguri, Radiology Department University of
Maiduguri Teaching Hospital, Nigeria
2
Department of Medical Radiography Bayero University Kano
3
Department of Radiography & Radiological Sciences Nnamdi Azikiwe University Awka Nigeria

Radiology – Radiation Protection.

Introduction: Overuse of medical imaging implies giving patients care that they do not need, underuse
means failing to give patients the care that they need while, misuse of medical imaging implies making
errors that can harm people's health. The idea of giving the right radiation dose to patients goes beyond the
boundaries of radiation protection to the realm of good medical practice. This is because children by nature
and certain pathologies unique to them are more vulnerable to certain forms of cancers than adults.
Objective: this study explores current literature on the subject of overuse, underuse and misuse of medical
imaging services in children.
Materials and methods: an in-depth review of current scientific literature on the subject of overuse, underuse
and misuse of medical imaging was undertaken. Reputable scientific websites, databases and journals such
as the International Commission on Radiological Protection, World Health Organization, the Lancet, and
Springer were consulted. Only articles related to the subject were included.
Results; findings from the study show overwhelming evidence of overuse of medical imaging services
especially CT in high- income countries while in a number of low and middle-income countries findings
are consistent with underuse and misuse of medical imaging. However, there still exists an argument in
some quarters as to what defines 'overuse' of medical imaging. Conclusion: overuse, misuse and underuse
of medical imaging services most of which involves the use of ionizing radiation is a global trend which is
likely to go undetected, undocumented and unreported in developing countries among children with serious
radiation protection implication. Hence, a need for a closer collaboration among relevant stake holders to
minimize or possibly eliminate this ugly trend.
Keywords; misuse, underuse, overuse, medical imaging.

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P-231

VERIFICATION OF SKIN DOSE USING THERMOLUMINESCENT DOSIMETERS

FOR EXTERNAL RADIOTHERAPY

Beatriz Elena Quiroz Revelo1, María Cristina Plazas1,2

1
Grupo de Física Médica Facultad de Ciencias Universidad Nacional de Colombia, Colombia
2
Fundación Santa Fe de Bogotá

Radiation Oncology – Dosimetry

The skin is the only organ that is always located between the source and the target organ in treatments with
external radiotherapy. Treatment Planning Systems (TPS) have algorithms that perform calculations and
report absorbed dose in a certain organ, however, the exact calculation of dose in build-up regions as well
as the skin, they remain indispensable knowledge for the radiation oncologist in the clinical management
of the treatments. Since skin toxicity can occur, in the most severe cases, such as ulcerations, hemorrhage
and necrosis, this is a reason to interrupt the treatment. Therefore, the goal of this study is to determine the
dose received by the skin using a detector that can be used in “in-vivo” dosimetry. For these, CaF2:Mn
thermoluminescent dosimeters (TLD) were used as they are small, easy to localize during irradiation and
show linear response and repeatability in the range of doses and energy used. The treatment plans were
made for 6 MeV photons beams on RW3 plates and on a physical chest simulator with the AAA (Analytical
Anisotropic Algorithm). Additionally, TLD were placed on these surfaces to determine the dose. A better
correspondence was found between the values calculated by the TPS and the values measured with the
dosimeters in the field of 10x10 cm on the RW3 than on the physical chest simulator. Moreover, the
thermoluminescent dosimeters were used to measure the dose on the skin of the jaw and the cheek of a
patient, whose symptoms showed a very important affectation in the skin and oral cavity, being able to
correlate her symptoms with the dose received. Consequently, it is considered that an adequate estimate of
the dose received by the skin in patients can be determined by using thermoluminescent detectors, provided
that the correct location of the TLD in the planning is guaranteed.

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P-232

IMPLEMENTATION OF A TASK REGISTRATION SYSTEM IN A RADIOTHERAPY

CLINIC BASED ON MOSAIQ

Ezequiel Larger1, Eliana Quinteros1, Ricardo Ruggeri2

1
Resident of Medical Physics, Argentina
2
Chief of the Department of Medical Physics

Radiation Oncology – Treatment Delivery

Introduction:
Every health service must have an organizational system that allows the human group to distribute its
responsibilities and functions, by defining a specific work methodology. If duties and responsibilities are
not clearly delineated and written down, it can cause considerable confusion throughout the organization.
Then, the organizational structure must be able to be expressed in a flowchart that determines the
dependence of each sector and individual with respect to the rest.
Methods and Materials:
This work shows our experience in the implementation of an organization system based on task registration,
using the Record & Verify software MOSAIQ of ELEKTA, in a radiotherapy service. The goal should
always be to increase the efficiency and effectiveness of our service in order to improve the quality of the
patient's treatment.
To achieve this, the operation of the radiotherapy service must be analyzed; the scope and implications of
each sector must be defined; the service must be modeled through a flow chart using free online software;
the workflow must be optimized defining the implications of each task through accessible procedures to all
users (printed and online); the flowchart must be assembled in MOSAIQ; the feedback of the coworkers
must be analyzed to take corrective measures until the model becomes representative of the reality; perform
an analysis of the organization system achieved; discuss new modifications for the optimization of it.
Results and conclusions:
As a result, the new system allows the user to constantly monitor the work flow of their clinic. This
facilitates decision-making through a quick analysis of the performance of the critical points of the service
allowing a study of the time used in each task and user productivity. This allowed to improve the quality of
treatment by reducing the time between the patient's first consultation and the start of treatment.

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INDEPENDENT DOSE CALCULATION IN 3D CONFORMED RADIOTHERAPY

WITH MLC THROUGH MATLAB SOFTWARE

Ezequiel Larger1, Eliana Quinteros1, Ricardo Ruggeri2

1
Resident of Medical Physics, Argentina
2
Chief of the Department of Medical Physics

Radiation Oncology – Quality Assurance

Introduction:
The institutions that offer radiotherapy treatments must acquire independent dose calculation software,
external to the treatment planner (TPS) in order to evaluate them. Commercially there are different
programs to perform independent control but the development and implementation of an algorithm by
professionals of the institution provides confidence and extensive knowledge of the tools to be used.
The objective of this work is to present an independent dose calculation system developed in the Centro
Oncológico Integral for 3D shaped fields with multileaf collimation systems (MLC), through the
knowledge of dosimetric parameters of the treatment machine and particular characteristics of each field,
which allows to validate the calculations of the treatments of the service and to implement it in the daily
clinic.
Methods and Materials:
A calculation software was made under the MATLAB programming platform. The system uses files in
DICOM RT format, exported from the MONACO TPS. This file contains detailed information on the dose,
UM, position of each MLC lamina and collimators for each treatment field. The equivalent field size is
obtained from the positions of each lamina. The depth of the calculation point is based on the 3D coordinates
of the isocenter and the normalization point for the treatment plan obtained from the file. From this
information the system searches for the dosimetric parameters and calculates the UM.
Results and Conclusions:
The program is used in the daily clinic, analyzing 177 patients for a total of 480 plans so far. It helps to
reduce the probability of occurrence of errors in the planning, allowing a detailed analysis of the dose to be
delivered and revision of the normalization point (PN). This shows the importance of having an independent
software to the TPS since it allows to detect user-dependent errors.

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P-236

VERIFICATION OF THE EFFECTIVE DOSE REGISTRY METHOD OF COMPUTED

TOMOGRAPHY BRAIN SCANS AT THE HOSPITAL CLÍNICO UNIVERSIDAD DE
CHILE

Daniel Castro1, Gaston Cortes2, Cristian Garrido1, Madeleine Facusse2

1
Hospital Clínico Universidad de Chile, Departamento Tecnología Médica Universidad de Chile, Chile
2
Escuela de Tecnología Médica, Universidad de Chile

Radiation Oncology – Dosimetry

The dosimetric indicators registry for radiologic examinations is the first step for the setting of local
reference levels and dose management in diagnostic imaging. Although new automated tools have been
developed in recent years to obtain and manage these indicators, many of them are expensive or difficult
to implement. With the help of a data field enabled in the RIS system (Qdocv6.1.0,AGFA) of the Center of
Imaging of the Hospital Clínico Universidad de Chile, manual recording of effective dose for computed
tomography was extracted from all patients older than 15 years who underwent CT scan of the brain in the
years 2013 – 2014, to perform a first pilot of this modality of registration. To corroborate the validity of the
data, DLP values converted from the effective doses recorded using the factors and equations set forth in
ICRP publication 102, and then compared with the reports of doses sent as image by the computed
tomograph (Siemens, Somatom Sensation 64) to the PACS system of the institution. Finally, a descriptive
statistical analysis of the dose indicators was performed with the help of STATA 12 for 3236 studies
without contrast and 534 with contrast. The effective dose and DLP values observed were 1.94 ± 0.10 mSv
and 924.3 ± 45.8 mGy*cm for unenhanced Brain CT scans, and 3.85 ± 0.21 mSv and 1853.4 ± 98.2
mGy*cm for studies with contrast, being close to those indicated as a reference in international reports. The
registration of dosimetric indicators through this method allowed for a reliable analysis of these, being a
guide for the management of protocols with the purpose of optimizing radiation doses in radiological
studies when necessary.

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P-237

QUALITY CONTROL END-TO-END TO IMPLEMENT STEREOTACTIC

RADIOCISURGY (SRS)

Ezequiel Larger1, Eliana Quinteros1, Ricardo Ruggeri2

1
Resident of Medical Physics, Argentina
2
Chief of the Department of Medical Physics

Radiation Oncology – Quality Assurance

Introduction:
Stereotactic radiosurgery is a modern and complex radiotherapy technique that is used to treat functional
abnormalities and small tumors in the brain. It requires millimeter precision levels because high doses (>
10Gy) of ionizing radiation are delivered to small targets (<2.4cm) located stereotactically in few fractions.
There is a high gradient of dose outside the volume of interest, which implies a high conformation of the
dose to minimize the damage to healthy tissues. The objective of this work is to present the end-to-end tests
to identify the components of the system, to guarantee the connectivity between them, to verify that the
clinical personnel understand their tasks; as well as evaluate the accuracy and precision of the treatment
process.
Methods and Materials:
To achieve this, all the steps in this type of treatment are executed, which include: immobilization,
simulation, planning and administration. The first stage consists of tomo-simulation, in which a tomography
of the PMMA SRS phantom with micro- camera and another with Gafchromic films is performed using the
necessary positioners. Then the treatment of a non- cylindrical deformed target is planned, which contain
the micro-camera and Gafchromic area in the MONACO planning station. Subsequently, the calibration
curve for the dose versus optical density was obtained and then the cross-calibration of the micro-camera
is performed with the Semiflex used by the service in quality controls. The planned treatment is
administered to the fantastic SRS, irradiating both the films and the camera. Finally, the GafchromicTM
are scanned and processed with the VeriSoft Software from PTW.
Results and Conclusions:
It is concluded that the process allows familiarization with the different activities of the service, since it
must be carried out by the personnel that will be in charge once it is implemented clinically. Also, anticipate
possible errors that may occur in this process.

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P-238

INTERNATIONAL COOPERATION FOR THE EXPORTATION OF DISUSED

HEADS OF TELETHERAPY UNITS

Mario Mallaupoma Gutiérrez ,Victor Ramos, Ludwig Guiop

Peruvian Institute of Nuclear Energy / Engineering National University / Peruvian Nuclear Academy, Peru

Radiation Protection

Each Member State must consider all feasible options for the most appropriate management of disused
sources which were used in teletherapy. In that sense, the Peruvian Government signed an agreement with
the International Atomic Energy Agency in order to promote the repatriation of all the disused heads of
teletherapy units with Cobalt - 60. This paper describes administrative and technical details about the
agreement, technical requirements about the inventory which considered both, radioactive material and
nuclear material and the preparation of the packages Type B, containing eight sources with 65 TBq and
305,2 kg of depleted uranium considered as nuclear material by the Peruvian regulatory body.

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P-239

SECURITY MEASURES FOR THE TRANSPORTATION OF A DISUSED

TELETHERAPY UNIT

Mario Mallaupoma Gutiérrez ,Victor Ramos, Ludwig Guiop

Peruvian Institute of Nuclear Energy / Engineering National University / Peruvian Nuclear Academy, Peru

Radiation Protection

Peru Government has approved a specific regulation to cover the need of security measures in the transport
of nuclear and radioactive material. According to the recommendations given by the International Atomic
Agency, has defined five categories considering their risks and vulnerabilities, with a graduated approach.
The requirements are rigorous in the case of the transportation of a disused teletherapy units taking in
account some bad experiences and accidents occurred in other Member States. This paper describes all the
technical considerations that were taken for the transportation of a disused teletherapy unit during 600 km
of travel by earth and considering different jurisdictions. The teletherapy unit had a cobalt-60 source with
an activity of 5200 GBq. The operation had the financial support of the United States of North America,
through the Global Threat Reduction Program.

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P-240

OVERVIEW OF THE HEALTH PHYSICS MASTERY IN PERU AND ITS

COMMITMENT WITH THE BONN CALL FOR ACTION

Mario Mallaupoma Gutiérrez1, Modesto Montoya Zavaleta2

1
Peruvian Institute of Nuclear Energy, Engineering National University, Peruvian Nuclear Academy, Peru
2
Engineering National University, Peruvian Nuclear Academy

Education and Professional Issues

The Bonn call for action considers both, strengthen radiation education and training of health professionals
and enhance the implementation of the principle of optimization of protection and safety. Peru recognized
the importance of both issues so in 1996 decided the creation of the Master in Health Physics considering
an agreement amongst Engineering National University, Peruvian Institute of Nuclear Energy and the
International Atomic energy Agency. The education and training of technical professionals with a high
level of knowledge has permitted the enhance of the quality of service and the reduction of risks. This paper
describes all aspects, updated to the present, related to the evolution of the education training, the number
of formed professionals and their real effective contribution for the medical applications, considering
radiodiagnostic with X ray, nuclear medicine and radiotherapy. As learned lesson, this paper corroborates
the positive considerations of the Bonn call.

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P-242

CLINICAL VALIDATIONS OF A DYNAMIC ANTHROPOMORPHIC PHANTOM

FOR RADIOTHERAPY QA

Chuan-Dong Wen1, Trevor Ackerly2, Moshi Geso3

1
INWENTECH Melbourne VIC 3150 / School of Biomed. & Health Sciences RMIT University Melbourne
VIC 3083, Australia
2
Alfred Radiation Oncology Alfred Health Melbourne VIC 3004 Australia / School of Biomed. & Health
Sciences RMIT University Melbourne VIC 3083 Australia
3
School of Biomed. & Health Sciences RMIT University Melbourne VIC 3083 Australia

Radiation Oncology – Quality Assurance

Introduction:
A novel dynamic anthropomorphic phantom, ChestPhan-4D has been invented and built in Australia to
assist the clinical implementations of advanced radiotherapy techniques since 2015. It is available for
clinical research and training purposes, has wide applications due to its broad capabilities of expandable
chest and deformable and movable organs included. This paper describes the phantom's clinical validations,
readily available and potential clinical applications in 4D treatment and imaging of tumors in the thorax
region.
Method:
The published studies on tumor movements due to respiratory and cardiac motions were reviewed. The
validations of this phantom's clinical uses are conducted on GE 4DCT and Varian True-Beam-TM
platforms. The direct applications on tracking and targeting tumor in thorax using surface surrogate
technologies were analyzed from both temporal and spatial aspects. Potential applications in deformable
imaging registration (DIR) and proton therapy QA are also analyzed primarily. The application of this
device as “dosimetry discrepancy identifier” is explored with 4DCT data sets.
Results:
It has demonstrated that this dynamic phantom has the required capabilities in simulating organ motions
and deformities of the chest surface, lung and heart during any breathing cycle. It has direct applications in
SBRT, DIBH, DIR planning verification processes. With some improvements, it can be applied in proton
therapy QA and to be used for verification of DIR software programs.
Conclusion:
A list of clinical applications with this dedicated, diseases-focused dynamic phantom has been preliminary
explored and its clinical values have been confirmed in advanced radiotherapy quality assurance processes
in both conventional and emerging MRI-guided as well as proton therapy technologies.

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CALCULATION OF ORGAN DOSE FOR PEDIATRIC PATIENTS UNDERGOING

COMPUTED TOMOGRAPHY EXAMINATIONS: A SOFTWARE COMPARISON

Aya Al Masri1, Naima Oubenali2, Stéphanie Battini3, Thibault Julien4, Fouad Maaloul5
1
BIOMEDIQA Groupe / Department of Medical Physics / 99C Rue Parmentier, Villeneuve d'Ascq - France,
France
2
Faculty of Engineering / Villeneuve d'Ascq - France
3
BIOMEDIQA Groupe / Department of Medical Physics / 99C Rue Parmentier, Villeneuve d'Ascq - France
4
BIOMEDIQA Groupe /
Department of Engineering Innovation Informatics / 99C Rue Parmentier, Villeneuve d'Ascq - France
5
BIOMEIDQA Groupe / Villeneuve d'Ascq - France

Diagnostic Radiology –Dosimetry

Introduction: The increased number of performed 'Computed Tomography (CT)' examinations raise public
concerns regarding associated stochastic risk to patients. Pediatric patients are more susceptible to
radiation-induced risks than are adults owing to their rapidly growing tissues and greater post exposure life
expectancy. We developed a Dose Archiving and Communication System that gives multiple dose indexes
(organ dose, effective dose, and skin-dose mapping) for patients undergoing radiological imaging exams.
The aim of this study was to compare the organ dose values given by our software for pediatric patients
undergoing CT exams with those of another software named VirtualDose.
Materials and Methods: Our software uses Monte Carlo method to calculate organ doses for patients
undergoing computed tomography exams. The general calculation principle consists to simulate: (1) the
scanner machine with all its technical specifications and associated irradiation cases (Kvp, field collimation,
mAs, pitch ...) (2) detailed geometric and compositional information of dozens of well identified organs of
computational phantoms that contains the necessary anatomical data. The comparison sample includes the
exams of thirty patients for each of the following age groups: newborn, 1-2 years, 3-7 years, 8-12 years,
and 13-16 years (a total of 150 patients). The comparison protocol is the «Head» protocol. Results: The
percentage of dose difference between the two software does not exceed 20%. This difference may be due
to the use of two different generations of hybrid phantoms by the two software.
Conclusion: This study shows that our software provides a reliable dosimetric information for pediatric
patients undergoing CT exams.

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P-246

MANAGEMENT OF MAGNETO-PROTECTION OF WORKERS IN MAGNETIC

RESONANCE IMAGING

Safoin Aktaou1, Kamel Guerchouche2, Fouad Maaloul3,

Aya Al Masri1
1
BIOMEDIQA Groupe / Department of Medical Physics / Villeneuve d'Ascq, France
2
BIOMEDIQA Groupe / Department of Electronics / Villeneuve d'Ascq - France
3
BIOMEDIQA Groupe / Villeneuve d'Ascq - France

Non-ionizing applications

Introduction: In the Magnetic Resonance Imaging (MRI) department, all workers involved in preparing the
patient, setting it up, tunnel cleaning actions, ... are likely to be exposed to electromagnetic fields (EMF)
emitted by the device. Exposure to EMF can cause undesirable radio-biological effects to workers. Several
international health organizations (such as the World Health Organization, Medicines and Healthcare
Regulatory Agency, American Radiology Society), determine the specific terms of protection against EMF
exposure in MRI services. The purpose of this communication is to propose an organizational process to
make it easier to integrate these magneto-protection methods into risk management and control. Materials
& Methods: The study was conducted in seven MRI departments using 1.5 and 3 Tesla magnets. We
performed an exposure assessment for each power by measuring the two electromagnetic fields (static and
dynamic) at different points on the MRI machine both inside and around the examination room. We
compared our results with British and American references (those of the UK's Medicines and Healthcare
Regulatory Agency (MHRA) and the American Radiology Society (ACR)). Results: Following the results
of EMF measurements and their comparison with the recommendations of learned societies consulted, a
zoning system that adapts to the needs of different MRI services across the country has been proposed. In
effect, three risk areas have been identified within the MRI services. This has led to the development of a
good practice guide related to the magneto-protection of MRI workers. Conclusion: The guide established
by our study is a standard that allows MRI responders to protect themselves against the risk of
electromagnetic fields.

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P-250

CALCULATION OF ORGAN DOSES FOR ADULT PATIENTS UNDERGOING

COMPUTED TOMOGRAPHY EXAMINATION: A SOFTWARE COMPARISON

Aya Al Masri1, Thibault Julien2, Fouad Maaloul3, Stéphanie Battini4

1
Polytechnique School / Lille - France, BIOMEDIQA Groupe / Department of Medical Physics /, France
2
BIOMEDIQA Groupe / Department of Informatics / Villeneuve d'Ascq - France
3
BIOMEDIQA Groupe / Villeneuve d'Ascq - France
4
BIOMEDIQA Groupe / Department of Medical Physics / Villeneuve d'Ascq - France

Diagnostic Radiology –Dosimetry

Introduction: 'Computed tomography (CT)' use increases rapidly worldwide. CT examinations deliver a
relatively high radiation dose to patients. It is essential to have an organ-specific dose estimation tool that
reflects the average damage to the organ per unit of its mass and consequently the appearance of
deterministic effects. We developed a software solution to optimize patient's dose received from medical
imaging techniques that use ionizing radiations. We present the comparison of the dose values given by our
software for adult patients with those of another software named “VitrualDose”.
Materials & Methods: Organ doses from computed tomography are calculated based on Monte Carlo
simulations. The general calculation principle consists to simulate: (1) the scanner machine with all its
technical specifications and associated irradiation cases (Kvp, field collimation, mAs, pitch ...) (2) detailed
geometric and compositional information of dozens of well identified organs of computational phantoms
that contains the necessary anatomical data. Organ doses can be calculated for any desired scanner machine
using scanner specific correction factors and the considered exam parameters. A total of 270 patients were
used for the comparison whose data corresponds to exams carried out in France hospital centers ; the
comparison dataset includes adult males and females for three different scanner machines and three
different protocols : « Head », « Chest », and « Chest/Abdomen/Pelvis ».
Results: The percentage of dose difference between the two software does not exceed 20%. This difference
may be due to the use of two different generations of hybrid phantoms by the two software. This dose
difference may due to a difference of the anatomical definition of the organs between the phantoms utilized
by each software within the same hybrid family. Conclusion: This study shows that our software provides
a reliable dosimetric information for pediatric patients undergoing CT exams.

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P-251

RADIATION SAFETY TRAINING IN MEDICINE

Ibrahim Duhaini

Rafik Hariri University Hospital, Lebanon

Education and Professional Issues

The use of radiation in Medicine has been on the rise in many countries. A lot of diagnostic and therapeutic
procedures may expose patients and staff to high radiation dose which can be reduced to low levels to
ensure the safety and protection against the harmful effects of radiation exposures. The objective of this
presentation is to ensure the following:
1. Implementing an effective radiation safety strategy
2. Examining the role of the hospitals in creating a radiation safety program
3. Enforcing radiation safety practice for patients, staff, physicians and visitors.
4. Providing regular radiation safety education to concerned staff
5. Identifying opportunities to improve radiation safety performance
6. Using appropriate shielding devices and related materials
By adhering to the principles and doctrines of radiation safety set forth by international organizations, the
safety culture among radiation workers will be enhanced and the productivity as well as performance of the
protocols will be optimized.

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P-252

MEDICAL PHYSICS EDUCATION AND TRAINING IN MEFOMP COUNTRIES

Ibrahim Duhaini

Rafik Hariri University Hospital, Lebanon

Education and Professional Issues

The Education and Training of medical Physics in MEFOMP countries have been evolved since the last
decade to better suit the demand and fulfill the market need of physicists in our region. The programs of
Medical Physics will be reviled for some countries in our region. The mission of MEFOMP Educational
and Training Committee (ETC) is to promote activities related to education and training of medical
physicists for the purpose of improving the quality of medical services for patients in the region through
advancement in the practice of physics in medicine. ETC helps and provides support for all medical physics
trainee in all member countries to understanding of different levels of learning, and the types of knowledge
required for higher level functions such as problem solving, creative innovations, and applied clinical
applications. Medical physics education can be much more effective and efficient when all regional
chapters of IOMP share their knowledge and experience to enhance the outcome with coordination of
highly qualified experts of medical physics professionals.

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P-253

MEDICAL PHYSICISTS CERTIFICATION PROCESS AND EXAMINATION IN THE

MIDDLE EAST

Ibrahim Duhaini

Rafik Hariri University Hospital, Lebanon

Education and Professional Issues

Certifying medical physics is becoming an essential part in recruiting medical physicists in hospitals across
the Middle East region. Due to the lack of a comprehensive post graduate programs in MP in most of ME
countries; hospitals find it very difficult to hire MP without the proper credentials and clinical experiences.
Also, MP in the region find it very difficult to apply and travel for certification in Europe or North America
due to visa and other related issues. So, if these certifying bodies are willing to cooperate with MEFOMP
and/or similar organizations in the ME region so that certifications will be offered in the region for the
region in a way to ease the process and save efforts and resources from the burdens of MP. Certifying
Medical Physicist requires an individual to obtain a university degree at the level of Master degree in
Medical Physics, this is followed with at least a one year of clinical residency program in the Medical
Physics fields applied in a Hospital. The existing local/national certifying organization exam models are
utilized as reference to design the final exam structure which can be customized for the medical physicists
that will be working in the Middle East. Three Exam Model proposals will be discussed here, all of which
aim to evaluate the competencies of the individual medical physicist knowledge and skills by following
various examination approaches.

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P-254

STATUS OF RADIOTHERAPY TREATMENT IN LEBANON

Ibrahim Duhaini

Rafik Hariri University Hospital, Lebanon

Radiation Oncology – Treatment Delivery

Lebanon is located in the heart of the Middle East Region with a population of 4.5 million and is considered
one of the best places of Medical Hot Spot destination that attracts many of the neighboring Arab countries
to seek medical treatment. This is due to the fact of the highly skilled medical professionals and advanced
health infrastructure in the country. Radiotherapy started in the early 70's with Cobalt Machines and has
developed tremendously thought the years to include the highly technological and advanced Linac Systems.
Now, there are 13 Hospitals that offer Radiotherapy Treatment with 20 Linacs equipped with the state-of-
the-art technology using 3-D Conformal, IMRT, Stereotactic Radiosurgery, IGRT and other modalities. In
this presentation, an overview of the current cancer treatment in these 13 hospitals will be revealed. Detailed
information will be unwrapped for the newly opened Radiotherapy Center at Ain Wazein Medical Village
(AWMV) in Mount Lebanon, which covers one third of the Lebanese population in that region. Also,
detailed information will be exposed for the newly Upgraded Radiotherapy Department at Rafik Hariri
University Hospital in Beirut.

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P-256

BREAST CANCER: FROM DIAGNOSIS TO THERAPY

Ibrahim Duhaini

Rafik Hariri University Hospital, Lebanon

Radiation Oncology – Dosimetry

Breast cancer screening techniques and treatment methods especially external beam radiation therapy and
mastectomy increased the survival rate for patient with breast cancer. The early detection of breast cancer
helps in the management progression and lessens the complications involved in the treatment modalities
used like surgery, chemotherapy, radiation therapy, and other non-traditional therapies. Many countries in
the world are performing breast screening campaigns that encourage women above the age of 45 to do
mammography at least once every year. Clinicians depend on the progress of tumor in case found to give
the best treatment options which could be a mixture of many modalities mentioned above. The most
prominent method is using Radiation Therapy approach. Many techniques have been developed from 2D
planning, 3D planning, IMRT, Brachytherapy using Mammosite techniques and others will be revealed.

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P-257

SENSUS SRT 100: VERIFICATION OF THE CONSTANCY OF DOSE RATE AND

QUALITY INDEX

Reytel S. Pérez Velázquez1, Gabriela Manfugás Mojena2, Wilfredo Sol Zamora3, Celia Sánchez Luis4,
Manuel Perasmo Cordovés4, Yoval Aguilar Ferro5
1
Especialista Física Médica, Centro Oncológico Territorial. Holguín, Cuba
2
Dra., Especialista Oncología Clínica, Centro Oncológico Territorial. Holguín
3
Especialista Física Médica, Centro Oncológico Territorial. Holguín
4
Lic. Imagenología y Radiofísica, Centro Oncológico Territorial. Holguín
5
Especialista Física Médica , Unidad Oncológica. Pinar del Río

Radiation Oncology – Quality Assurance

Introduction: SENSUS SRT 100 is alow clinical energies (50KV, 70KV and 100KV) radiotherapy machine
for the treatment of skin lesions. Given the high doses that can be delivered to the patient's skin in a very
short time, strict quality controls are carried out with different frequencies.
Methods and Materials: Daily, between March 2018 and February 2019, before the start of the delivery of
the treatments, the RAD CHECK constancy of the dose rates of each clinical energy was verified and
recorded. The constancy of the dose rates for each clinical energy and in addition, the quality indexes, were
also verified with a PTW dosimetric system, monthly, as it is recommended by the IAEA TEC DOC 1151.
Results and Conclusions: The daily results of the RAD CHECK measurements between 98% and 100%,
indicated the stability of the reference dose rate delivered by the machine (recommended tolerance by
manufacturer 97%-103%); likewise, we observed stability for the monthly controls, in which the constancy
of the dose rates and the quality indexes showed a deviation less than 2,1% of the reference values, within
the internationally recommended tolerance, 3%. It is concluded that the treatments delivered with the
SENSUS SRT 100 machine were accurate and precise in terms of doses delivered to patients, which is
verifiable with the clinical results in the period analyzed.

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P-258

LATTICE BOLTZMANN MODEL FOR TIME DEPENDENT 1-D NEUTRON

TRANSPORT IN A HOMOGENEOUS SEMI-INFINITE MEDIUM WITH ISOTROPIC
SCATTERING

K. Alexis Luna1, J. Antonio Sarta1,Edwin Munevar2, J. Alfonso Leyva1

1
Pontificia Universidad Javeriana, Colombia
2
Universidad Francisco Jose de Caldas

Radiation Oncology – Dosimetry

Introduction:
Since 2015, the research group Biophysics & Structural Biochemistry at the Pontificia Universidad
Javeriana (PUJ), in cooperation with the International Atomic Energy Agency (IAEA), has been working
on Neutron Capture Therapy (NCT), together with graduate students of the Master Program in Medical
Physics at PUJ. Within our research program, one of the main goals is to learn and implement new
numerical methods to study the neutron transport problem using the Boltzmann transport equation. In this
paper we use the lattice Boltzmann method (LBM) to solve the time-dependent one-dimensional transport
equation for monoenergetic neutral particles in a homogenous semi-infinite medium with isotropic
scattering. Methods and Materials:
The LBM for transient neutron transport problem is adapted from the phase space discretization of the
standard neutron transport equation where the collision and streaming processes at each time step are
specified through the calculation of the relaxation time and equilibrium particle distribution function
suggested by the Bhatnagar-Gross-Krook (BGK) approximation. In order to apply the one-dimensional
neutron transport lattice Boltzmann-BGK model for a homogeneous half-space with isotropic scattering
problem, a computational algorithm in Matlab has been made. The time-dependent neutron flux and
deposited dose for different macroscopic cross section values have been obtained.
Results:
Simulation results show that the LBM can be effectively applied to study the 1-D neutron transport process
with a reduced computational cost leading to a consistent description of neutral particles interaction with
matter.
Conclusions:
We have shown that the proposed approach provides a powerful alternative for solving the Boltzmann
transport equation required to characterize neutron distributions and other ionizing radiations for a given
geometry. This methodology can be also considered as an alternative numerical technique for the treatment
of particle transport problem.

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P-260

MONTE CARLO SIMULATION OF LOCAL DOSE ENHANCEMENT IN RADIATION

THERAPY WITH GOLD NANOPARTICLES

Vinicius Fernando Dos Santos, Patrícia Nicolucci

University of São Paulo, Brazil

Radiation Oncology – Dosimetry

Introduction:
The use of nanoparticles in radiotherapy has been studied given the dose enhancement that can be obtained
in the target volume of the treatment. Studies indicate that gold nanoparticles (AuNP) are among the most
biologically viable and can promote radiosensitization. This work aimed to study the dose enhancement
factor (DEF) and the local distribution of doses in radiotherapy with AuNPs.
Methods and materials:
Using PENELOPE Monte Carlo simulation package, clinical beams of orthovoltage (50 to 150 kVp),
brachytherapy with 192- Ir and teletherapy (6 MV) were simulated, along with a cell model with
incorporated AuNPs. Two models of incorporation of the AuNPs were used: homogeneous (HM) and
heterogeneous (μM). In the HM, a homogeneous mixture of water and different concentrations of gold fills
the nucleus of the cell. In the μM, individual AuNPs (50 to 220 nm) are simulated in the cell nucleus. DEFs
were obtained as the dose ratio in the cell nucleus with and without incorporated AuNPs. The dose
distributions around AuNPs were used to calculate the extent of dose reinforcement.
Results:
In the HM, beams of 50 and 80 kVp presented DEF of 2.80 ± 0.02 and 2.99 ± 0.04, respectively. In the μM
of a cell with six clusters of AuNPs, the DEF found was 1.79, ± 0.01. The dose distributions showed that
the dose enhancement is local to the AuNPs. For the 50 kVp, 150 kVp and 192-Ir beams, respectively, the
50% isodose occurs at 1.93 μm, 1.49 μm and 1.38 μm from the AuNP's surface.
Conclusions:
The results show that orthovoltage beams provide the highest DEFs in radiotherapy with AuNPs. Dose
enhancement is local, on a micrometric scale around the AuNPs, and may provide cellular radiosensitization
if the AuNPs are incorporated into the nucleus of the cells.

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P-262

CONSTRUCTION AND CHARACTERIZATION OF MATERIALS EQUIVALENT TO

SOLID WATER, ADIPOSE AND LUNG TISSUES USING CODE PENELOPE

Danny Giancarlo Apaza Veliz1, Ruben Dario Chahuara Cruz1, Pedro Peter Sellerico Mamani1, Jose Luis
Javier Vega Ramirez2
1
University of São Paulo, Brazil
2
National University of San Agustin

Radiation Oncology – Dosimetry

Introduction:
Equivalent materials or phantoms are used in radiotherapy, radiodiagnostic and nuclear medicine to observe
the behavior of ionizing radiation when interacting with matter. The use of these phantoms allows to
approximate the interaction of ionizing radiation in the human body, which allows to determine the range
of dose in different organs and tissues according to their sensitivity.
Methods and Materials:
The objective of this work was to construct equivalent materials or phantoms to solid water, adipose and
lung tissues, in accordance with standard characteristics recommended by international organisms.
Materials were constructed with densities of 1.032g/cm3, 0.922g/cm3, 0.320g/cm3 respectively. To verify
the equivalence of the constructed phantoms with its respective tissue, was designed the material using the
percentage composition, by weight, of the chemical elements of each of the materials equivalented in the
code PENELOPE v.2008.
Results and Conclusions:
was obtaining parameter comparisons of interaction of beams from photons and electrons with each
phantom constructed, using for this purpose the coefficient of total mass attenuation as a function of energy
and stopping power coefficients, which were compared and validated with the results of the International
Commission on Radio Protection (ICRP) And International Commission on Radiation Units &
Measurements (ICRU). This comparations present relative difference of the 1 to 3% between of equivalent
materials constructed and those presented in the reports of the ICRU and ICRP.

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P-263

EXPLORING A NEW MICRODOSIMETRIC QUANTITY FOR ESTIMATING RBE

FOR ION BEAMS

Adriana Marcela Forero Torres1, Mario Antonio Bernal Rodriguez2, Maria Cristina Plazas de Pinzón1
1
National University of Colombia, Colombia
2
Campinas State University

Radiation Oncology – Dosimetry

Ionizing radiations induce damages in DNA when interacting with living beings. These damages may lead
to biological effects such as chromosome aberrations and cell death. The radiation potential for inducing
DNA damages is related to the capacity of radiation for producing densely ionization pattern in the
irradiated tissues. This capacity is often related to the linear energy transfer (LET), however, this quantity
is not enough for determining the relative biological effectiveness (RBE) of a given radiation quality. For
instance, two heavy charged particles (ions) with the same LET show different RBE. So far, researchers
have used the dose-mean lineal energy as a quantity for estimating the RBE of ionizing radiations. In this
work, we explore a new microdosimetric quantity called dose mean energy transfer. We also implemented
a computational tool for the calculation of such variable using Geant4-DNA toolkit. In addition, a
comparison with another classical microdosimetric variable known as dose-mean linear energy was made
and RBE variable was determine for each of them. The results show consistent values between dose-mean
linear energy and the proposed new microdosimetric variable dose-mean transfer energy. Finally, based on
the results obtained for the RBE of each of the variables, the impact of the new variable on the RBE
estimation was studied.

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P-264

INFLUENCE OF THE MEASURING SYSTEM IN MEAN GLANDULAR DOSE

ESTIMATION

Noelia Solís Preciado, José Ángel Merino Gestoso, María Luisa Chapel Gómez, Diego Jiménez Vegas,
Breogán Sobral Aspérez

Hospital Universitario Nuestra Señora de Candelaria, Spain

Diagnostic and Interventional Radiology – General

Introduction:
Current European protocols use the Robson's method to the setting of tube output and half value layer
(HVL) to estimate mean glandular dose (AGD) in digital mammography (DM) and digital breast
tomosynthesis (DBT). The dose at the upper surface of the breast is calculated from these data, and by
applying conversion factors of Dance calculations based on Monte Carlo, AGD is obtained. The aim of this
study is to analyze the influence by measurement with different dosimeters in the AGD results obtained.
Methods and Materials:
Experiments have been carried out in three digital mammography units: Selenia Dimensions (Hologic),
Senographe Essential (General Electric) and Mammomat Inspiration (Siemens). Six dosimeters have been
used: two ionization chambers with a sensitive volume of 6 cm3 (PTW and RADCAL); and four solid-state
dosimeters: multipurpose detector of Barracuda (RTI), NOMEX Multimeter (PTW), NOMEX MAM
detector (PTW) and Black Piranha (RTI). All of them are calibrated for the evaluated beam quality. It has
been used a second-degree polynomial to set both tube output and HVL.
Results:
AGD was evaluated for 2D and 3D available target/filter combinations. Results from tube output show
differences from 0.01% to almost 8%. With reference to HVL, variations are among 0.2% and 15%,
reaching 20% in some cases in DBT. For the beam qualities used in 2D, AGD varies to 12% depending on
the dosimeter. In DBT with pulsed radiation, differences increase to 20% in some cases.
Conclusions:
This study demonstrates that the results from the measurement of HVL and output, and the subsequent
calculation of AGD are highly influenced by the measuring system employed. Consequently, it is very
important to know properly the different dosimeters responses since slight variances in measurements affect
considerably AGD estimations.

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P-267

CT CURVE CALIBRATION FOR LUNG SBRT TREATMENTS WITH AAA

Maíra R. Santos, Lucas B. Cavalcanti

Instituto Nacional do Cancer - INCA, Brazil

Radiation Oncology – Dosimetry

Introduction: During the beam commissioning process for radiosurgery and SBRT treatments, the first
obstacle encountered was the lack of a survey of the electronic density curve for the CT Hounsfield,
necessary for a reliable heterogeneity correction. Given the number of lung SBRT patients treated at the
National Cancer Institute (INCA – Brazil), the question was urgent. Therefore, the objective of this present
work was to calibrate the tomograph curve with the experimental method and to validate the TPS
calculation for all the beams.
Methods and materials: The imaging protocols were defined to have the same kV and the images were
acquired in the established protocols in two different FOVs. The phantom 062M (Cirs) was used for this
stage. The values of HU found were measured with analysis of the histogram of the image within the Eclipse
(Varian) using 1 cm side square and the final table with its mean values, relative electronic density and
mass density were fed in the CT calibration configurations. For the validation process, two phantoms were
irradiated, a simpler one with heterogeneous slices manufactured to be irradiated with direct field and the
second phantom was the IMRT Dose Verification Phantom produced by Standard Imaging.
Results and Conclusion: The values found in the CT scans were in accordance with the stoichiometric
analysis and with current literature. The highest density was not high enough to match a metal prosthesis,
so the value was obtained by extrapolating the line in the graph. In the irradiation of treatment plans in the
two phantoms, different setups and different planes were tested to identify the largest possible variation.
The maximum difference in doses was 2.2% in the setup of greater uncertainty in a single energy. It was
clear that the calibration was efficient and satisfactory to move to the next step.

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P-268

METHODOLOGY FOR IMRT PLANNING BASED ON PET-CT IMAGING

Katheryn de la Caridad Serrano Calabuche1, Rodolfo Alfonso Laguardia1, Carlos Calderón3, Adrian
Acosta Andres2
1
Faculty of Nuclear Sciences and Technologies, University of Havana, Cuba, Cuba
2
Department of Radiotherapy, National Oncology and Radiobioloy Institute, Havana, Cuba
3Department of Nuclear Medicine, National Oncology and Radiobioloy Institute, Havana, Cuba

Radiation Oncology – Quality Assurance

Introduction: IMRT allows delivering of high dose to GTV while effectively sparing the OARs. In order to
ensure a higher accuracy in target definition, the use of hybrid imaging based on PET-CT is continuously
growing. In order to ensure an adequate use of these images for target delineation purposes in head and
neck IMRT treatment planning, a protocol for quality assurance and clinical implementation is proposed.
Materials and Methods: Based on the recommendations of the IAEA TECDOC 1151 (update) and recently
published national guidelines (CECMED protocol, 2017), a specific protocol for routine QA of a Phillips
Gemini TF 64 PET-CT-Simulator system was designed and implemented, ensuring the adequacy of the
hybrid images for radiotherapy treatment planning purposes. As part of a designed clinical protocol, a
procedure for optimal values of SUV for GTV delineation was established. For clinical implementation, a
single patient was planned, initially only based on CT and then on PEC-CT images. The results of each
plan were compared, based on DVH analysis.
Results and conclusions: The designed QA protocol was implemented, demonstrating its feasibility for
routine testing of the system and improving the quality and compatibility of images for planning purposes.
The clinical protocol has provided the physicians a more consistent procedure for PET-based GTV
delineation. Relevant discrepancies were found when PET images were considered for target delineation
in head and neck tumors. Further work is ongoing for expanding the QA protocol to 4D imaging and the
clinical protocol to other relevant anatomical sites.
This works has been performed as part of the bachelor research thesis of the main author.

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P-270

EXPANDING SCOPE OF IAEA TECDOC-1583 FOR COMMISSIONING

STEREOTACTIC RADIOSURGERY TREATMENTS

Javier Pérez Curbelo1, Rogelio Diaz Moreno2, Roberto Caballero Pinelo3, Adrián Acosta Andrés1, Ernesto
Olivares Romero1
1
National Institute of Oncology and Radiobiology, Cuba
2
Instituto de Radioterapia-Fundación Marie Curie
3
Hermanos Ameijeiras Hospital

Radiation Oncology – Quality Assurance

Introduction: Specialized techniques such as stereotactic radiosurgery is not addressed in IAEA TECDOC-
1583. Here two comprehensive test cases are presented for dosimetric commissioning of a radiosurgery
system.
Materials and Methods: The system to be commissioned consisted of an Elekta Precise linear accelerator,
an Apex micro multi-leaf collimator (mMLC), and a Monaco treatment planning system (TPS). The dose
calculated by the TPS was compared with the absolute dose measured with ionization chambers. Two
radiosurgery test plans were created. Test I use a PTW's IMRT Head/Neck Phantom and two coplanar arcs
with IMRT cost functions planned; the purpose was to assess the dose calculation accuracy with small
coplanar arc beams. Test II is an end-to-end type test, where a stereotactic frame is fixed to a watermelon
and Ergo++ TPS is used for stereotactic coordinates definition; a plan was created using six non-coplanar
arcs and IMRT cost functions. The purpose of Test II was to assess the dose accuracy with no-coplanar arc
beams and the influence of geometrical accuracy of the whole process. Semi-flex and pinpoint chambers
were used for dose measurement inside the phantoms.
Results and conclusions: After successfully passing the conventional tests included in TECDOC-1583, the
designed test cases showed being adequate for further assessment of TPS accuracy in more complex
treatment configurations, like those used in stereotactic radiosurgery. Results of Test I showed that
discrepancies below 1% are achievable, while results of Test II allowed detection of geometric shifts < 1
mm with dose discrepancies lower than 1%.

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P-271

PRELIMINARY DOSE CALCULATION FOR NEUTRON CAPTURE THERAPY

USING REMOVAL-DIFFUSION THEORY

Yuly Marcela Cruz Guerra1, J. Alfonso Leyva1, Edwin Munevar Espitia2, Jose Antonio Sarta Fuentes1
1
Pontificia Universidad Javeriana, Colombia
2
Universidad Distrital Francisco Jose de Caldas

Radiation Oncology – Dosimetry

Introduction:
Since 2015, the research group Biophysics & Structural Biochemistry at the Pontificia Universidad
Javeriana (PUJ), in cooperation with the International Atomic Energy Agency (IAEA), has been working
on Neutron Capture Therapy (NCT), together with graduate students of the Master Program in Medical
Physics at PUJ. Within our research program, one of the goals is to study the dose distribution in a phantom
due to epithermal neutrons.
Methods and Materials:
In order to determine the dose distribution due to epithermal neutrons coming from a D-D reaction we use
a phantom to carry out all calculations. For this work a phantom is as a semi-infinite aqueous medium with
a flat geometry and a 10 ppm 10B concentration. The distribution dose calculation due to epithermal
neutrons is evaluated using the removal-diffusion theory. The dose rates for thermal and epithermal
neutrons, boron and gamma radiation have been calculated using 4 different energy groups and kerma
factors taken from ICRU 44.
Results:
We have carried out all calculation with an incident normalized neutron flux. In the case of thermal
neutrons, we have obtained a maximum boron dose rate of 7,0 x 10 – 7 cGy/s for a deepness of 2,4 cm and
a minimum of 1,9 x 10 – 13 cGy/s for a deepness of 2,8 cm. In the case of epithermal neutrons, the obtained
dose rate was of 1,9x10–10cGy/s for a deepness of 1,0 cm. Finally, for the gamma radiation the obtained
dose rate was of de 2,8 x 10 – 10 cGy/s for a deepness of 1,2 cm.
Conclusions:
We have successfully implemented an established methodology to calculate a dose distribution in a
phantom for epithermal neutrons in NCT.

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P-272

IN VIVO DOSIMETRY IN TOTAL BODY IRRADIATION (TBI)

Jorge Emilio Munoz Bravo1, Martha Liliana Fajardo Velasco2

1
Medical Physics in Hospital Universitario San Ignacio, Colombia
2
Student Medical Physics

Radiation Oncology – Quality Assurance

Introduction:
TBI is a technique used as a conditioning regimen before the transplantation of hematopoietic cells,
providing a dose difference to the whole body no greater than 10% of the prescribed dose. To guarantee
accuracy in the administration of the dose in TBI, an In Vivo Dosimetry (IVD) system based on diodes and
EBT-3 films is implemented with the objective of carrying out a direct verification.
Methods and materials:
All the dosimetric parameters for the implementation of the technique are characterized to SSD=3.8m, with
6MV and 15MV for treatment with AP-PA field from the radiological distances obtained in different
thicknesses of the patient. The IVD systems implemented are calibrated independently using ionization
chambers as a reference, guaranteeing traceability. Recommended tests were carried out by international
quality control protocols, such as: drift, repeatability, reproducibility, linear response, subsequent response,
shadow effect and independence of dose rate and energy.
Results:
There is a 160cm dosimetric profile for treatment of TBI with energies of 6MV and 15MV less than 2% in
homogeneity and the main sources of uncertainty associated with the TBI and the IVD were analyzed. The
IVD system was used in several phantom where correction factors were found by backscattering at the
pulmonary and pelvic level, correction considerations were made in the measurements by influence of the
patient's thickness and the distance source-surface.
Conclusions:
The IVD system based on diodes and EBT-3 films implemented is redundant in measured but is an effective
tool for the detection of inaccuracies greater than 10% for TBI dose calculations and carries out an integral
verification of the process. Action and tolerance levels are established for the use of IVD with diodes during
treatment.

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P-273

IMPLEMENTATION OF TRS 483 GUIDELINES FOR FIELD OUTPUT FACTOR

DETERMINATION WITH AN ADD-ON MICRO MULTI-LEAF COLLIMATOR

Javier Pérez Curbelo1, Rodolfo Alfonso Laguardia2, Rogelio Diaz Moreno1, Adrián Acosta Andrés1,
Ernesto Olivares Romero3
1
National Institute of Oncology and Radiobiology (INOR), Cuba
2
Higher Institute of Technologies and Applied Sciences (InSTEC)
3
Oncology and Radiobiology (INOR)

Radiation Oncology – Dosimetry

Introduction: Stereotactic radiosurgery is a treatment technique that involved the use of very small fields.
Recently, an add-on micro multi-leaf collimator (mMLC) Apex has been commissioned at the National
Institute of Oncology and Radiobiology, Havana, Cuba, as part of a stereotactic radiosurgery system. The
purpose of this work was to evaluate, as part of an IAEA Coordinated Research Project (E2.40.21), the use
of the procedures and recommendations established in the TRS 483 for obtaining the field output factors
when using add-on mMLC collimation.
Materials and Methods: The measurements were performed in an Elekta Precise linear accelerator. Ten
field sizes, ranging from 0.49 cm x 0.49 cm to 11.27 cm x 11.27 cm, were evaluated. A fix field size of 12
cm x 14 cm was set above the mMLC. As machine specific reference field in the mMLC, a field size of 9.8
cm x 9.8 cm was used. The following detectors were employed: ionization chamber pinpoint 3D 31016,
unshielded diode E 60017 and microdiamond 60019, all from PTW. The beam energy used was 6 MV
WFF. The corrected output factors obtained were compared among all detectors.
Results and Conclusions: The equivalent field size obtained experimentally from the FWHM agreed within
± 0.1 mm among the three detectors. The comparison of the corrected field output factors, for all field sizes,
showed relative discrepancies less than 1.3 %. The results have shown excellent agreement between
multiple detectors, demonstrating the feasibility of the new code of practice for using with this type of
collimation.

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P-274

FEASIBILITY EVALUATION OF TANGENTIAL VOLUMETRIC MODULATED ARC

THERAPY TECHNIQUE FOR WHOLE BREAST IRRADIATION PLUS
CONCURRENT BOOST

Joaquín Santiago De Brida, María Sol Gallo, Ricardo Ruggeri

Fundación Médica de Rio Negro y Neuquén, Argentina

Radiation Oncology –Treatment Planning

Introduction:
Intensity modulated techniques (IMRT), particularly the ones denominated arc therapy techniques, have
grown in popularity and have demonstrated to be more effective in restricting the prescribed dose to the
target in numerous pathologies.
The aim of the present study is to evaluate the feasibility of the application of this new technique in the
treatment of breast cancer, one of the most common malignance's worldwide, where today's standard is the
tangential field-in-field technique. Methods and Materials:
The comparative retrospective study was performed in 20 patients with breast cancer without nodal
involvement. The prescription dose was 50 Gy in whole breast and 60 Gy in concurrent boost, daily, in 25
fractions. For each patient, 2 plans were generated: 1) standard 3D field-in-field and 2) tangential
volumetric arc therapy (tVMAT) with two 60° dual arcs. Plans where generated using Monaco® Treatment
planning system (TPS), delivered for quality assurance (QA) purposes in Elekta Infinity® accelerator with
5 mm Agility® MLC, and measured in PTW OCTAVIUS®4D with OCTAVIUS® 1500 detector. Results
and Conclusions:
Conformality indexes demonstrate the advantages of tVMAT technique versus the standard one, the
average volume of breast irradiated with a boost dose (60Gy) in tVMAT technique is roughly 2,21%
(±1,71), in contrast with a 9,33% (±7,07) in standard technique. Results indicate that dose to ipsilateral lung
and heart can be reduced without compromising dose to target and contralateral structures. However, further
assessments of clinical outcomes of treatments with tVMAT technique are needed to justify the need of
additional QA and increased Monitor Units. Each particular institution should decide if the dosimetrical
benefits of tVMAT technique can overcome the extra demands in time and resources.

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P-275

ANALYSIS FOR INTEGRAL FIGURE OF MERIT (FOM) TO THE EFFICIENCY IN

COMPARISON OF IMRT AND VMAT COMPLEX DECISION PLANS

Sergio Bustos, Matias Vasquez, Harold Novoa

Centro Oncológico del Norte, Chile

Radiation Oncology – Quality Assurance

Introduction: The techniques of intensity-modulated external radiotherapy (IMRT) and volumetric

modulated arc therapy (VMAT) achieve clinical objectives satisfactorily, but due to their complexity, more
robust quality assurance programs are needed. The choice of rival plans is complex, and it is necessary to
take the best one, since it must be considered from the clinical objectives to the efficiency in the delivery
of the treatment. Therefore, analysis tools are needed with parameters that evaluate not only the fulfillment
of clinical objectives, but also the quality and efficiency with which they are reached. Methods and
Materials: For the evaluation we used a Figure of Merit (FOM) expression constructed from various
recommendations and that reveals which is the best plan by an index close to 1. We compared the treatment
plans of IMRT and VMAT for 100 patients with the same clinical objectives. for a given region (breast,
thorax, head, neck, pelvis), optimized by reverse planning and calculated with a treatment planning system
(TPS),
Results: The results with the FOM reveal the strengths of both techniques in some specific situations, both
techniques show excellent indexes (1 ± 0.1) of conformality (CI) homogeneity (HI) and gradient (GI), but
the FOM reveals that the VMAT is more efficient than the IMRT. In spite of this, it is also shown that the
IMRT is superior to the dose of dose / volume dependent organs at low doses such as in breast and thorax.
Conclusions: The choice of the best plan can become a problem when the clinical objectives seem very
similar when comparing techniques. A robust figure of merit beyond the clinical, can be of great help for
this decision.

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P-276

AN ADAPTATIVE RADIATION THERAPY WORFLOW WITH ELEKTA SYSTEMS

María Sol Gallo, Joaquín Santiago De Brida, Ricardo Ruggeri

Fundación Médica de Rio Negro y Neuquén, Argentina

Radiation Oncology – Dosimetry

Introduction:
During the radiation treatment, variations in the patient's anatomy or target volume may occur, which
translates into a discrepancy between the planned dose distribution and that delivered to the patient. In
response to these variations, it is possible to adjust the treatment plan during the course by means of
complementary systems that allow, through the use of images, to adapt the treatment to reach a higher
therapeutic quality. This type of treatment is called ""adaptive radiation therapy"".
Methods and Materials:
To execute the clinical procedures of adaptive radiotherapy, a specific set of ELEKTA systems is used.
Before the treatment application, the location of the isocenter is verified by volumetric images (CBCT)
obtained with the X-ray Volume Imaging System (XVI) that has a kiloVoltage x-ray tube. The
radiotherapist, in conjunction with the Physicist, evaluates positioning corrections that are applied through
the HexaPODTM RT system that includes the HexaPOD six-degree robotic couch and the iGUIDE®
system to controls these adjustments. The CBCT images are exported to the MONACO® Treatment
Planning System (TPS) to perform the dose calculation received by the patient in that application. In this
instance, the anatomical and dosimetric variations and the need to perform a new planning tomography are
evaluated. The dose of each session and the planned Histogram-Volume is compared with that delivered to
the patient at the end of the treatment.
Results and Conclusions:
The methodology proposed with the available technology has allowed us to examine accurately the
evolution of the patient's treatment, adjust the treatment in a short time to define new therapeutic strategies,
deliver the dose with greater precision and maintain the volume treated with a greater conformation on the
target volume.

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DETERMINATION OF THE IMPACT THAT IMPLIES THE USE OF REFERENCE

DETECTORS IN THE MEASUREMENT OF SMALL FIELDS FOR THE OBTENTION
OF OUTPUT FACTORS

María Sol Gallo, Joaquín Santiago De Brida, Ricardo Ruggeri

Fundación Médica de Rio Negro y Neuquén, Argentina

Radiation Oncology – Dosimetry

Introduction:
The behaviour of the physical phenomenon involved in the so called “small fields” represent restrictions in
terms of measurements conditions and detector technology because they drift away from the reference
conditions stablished in classical dosimetry protocols. The aim of the present study is to analyse the impact
that implies the use of different type of detectors to measure the reference signal during the acquisition of
transversal profiles of the beam, fundamental for the small field dosimetry procedure.
Methods and Materials:
The International Code of Practice, Technical Report Series N° 483 (TRS483), was applied to obtain Output
Factors (OF) in Elekta Infinity® accelerator with 5 mm Agility® MLC. Measurements where made with
PTW equipment: unshielded Diode E, parallel plane ionization chamber T-REF, ionization chamber
semiflex 3D 0,07 cm3, ionization chamber Farmer 0,6 cm3 and automatic phantom BEAMSCANTM.
Different measurements setups where defined, three of them used a reference detector (either Farmer,
semiflex or T-REF) and a fourth with no reference detector. For each case profiles were surveyed and used
both for the centering of the dosimeter and for the determination of the radiant field, necessary to obtain
the correction factor k_(Qclin,Q_msr)^(f_clin,f_msr ). Since the T-REF camera was designed specifically
for small field dosimetry, these measurements were taken as reference for intercomparison, made with PTW
Software Analyze.
Results and Conclusions:
It is observed that the reference signal obtained with T-REF has a greater stability compared to the signals
obtained with semiflex 3D and farmer. However, the impact on the determination of field factors, in any
case, even without using a reference chamber, is less than 0,25% for 6x6 mm2 fields, this difference
becomes even smaller when the field size is increased.

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P-279

START-UP OF MANUFACTURED ACCESSORIES WITH 3D PRINTER FOR USE IN

RADIOTHERAPY AND BRACHYTHERAPY

Matias Vasquez, Sergio Bustos, Harold Novoa

Centro Oncologico del Norte, Chile

Radiation Oncology – Dosimetry

The bolus used in radiotherapy correspond to uniform gel plates which do not always adapt to the anatomy
of the patient, leaving air spaces which produce differences up to 10% in the dose for highly complex
treatments. To improve this limitation, bolus with wax are generated, limited by their manufacture and
mechanical resistance, until designing specific boluses printed in 3D. This technology is also applicable to
brachytherapy creating superficial applicators and intracavitary devices. PLA and ABS are studied, offering
a good equivalence tissue with approximate densities of 1.25 and 1.04 g/cm3 respectively. 10x10cm2 and
1cm thick plates are manufactured with 100% and 50% infill percentages with resolution of 0.2mm. These
are scanned together with an assembly of RW3, ionization chambers and EBT3 slab. The dose calculation
is performed for photons of 6, 18MV and Ir192 and 6 and 9MeV for electrons with the Acuros and eMC
calculation algorithms respectively. For its clinical implementation, resistance tests of steam sterilization
are carried out. Differences between the calculated and the measured are of 1.8% and 0.7% for photons of
6 and 18MV, obtaining for electrons 5% and 0.5% for beams of 6 and 9MeV. The planar results of the
plates evaluating gamma tests are 90% for photons and 96% for electrons. The sterilization tests guarantee
that the use of PLA at 100% infill the structure is not altered. This methodology will allow evaluating the
materials to take a step towards clinical implementation. It is proposed to evaluate the optimization of
printing time by modifying parameters such as resolution, filling percentage and the equivalence of the
fabric to the plastic by varying the thickness according to the material used.

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IMPLEMENTATION OF A PAPERLESS QUALITY ASSURANCE PROGRAM

María Sol Gallo, Joaquín Santiago De Brida, Eliana Quinteros, Ezequiel Larger, Ricardo Ruggeri

Fundación Médica de Rio Negro y Neuquén, Argentina

Radiation Oncology – Quality Assurance

Introduction:
A quality assurance program establishes systematic actions to guarantee the quality and safety of medical
exposures to ionizing radiation, both for the patient and for the personnel involved. The advantages of using
a digital platform to manage quality controls are mainly the agility in the recording and the access to the
information to improve the result ś monitoring and evaluation
Methods and Materials:
The paperless quality program is designed completely in PTW Track-it platform. The implementation is
programmed in stages which correspond to different departments (Radiotherapy, Brachytherapy,
Radiodiagnosis and Nuclear Medicine), according to international protocols and recommendations specific
for each department. Worklists were designed so that radiologists, physicists and engineers can access the
platform and record their assigned tasks. Tests are organized in mentioned worklists by frequency and
category so that they can be easily recognized. The platform can be accessed by mobile devices to make
the task more fluid and the measuring devices used can be linked to the platform to achieve automatic
registration of the results obtained in the tests. In order to filter the data and evaluate a specific parameter
and analyze its behavior over time, customized templates where applied. This allows to manage the
preventive and / or corrective tasks in the equipment in advance. Conclusions:
So far, the first stage of implementation has been completed, which corresponds to the Radiotherapy
department.
The Track-It platform has proved to behave as a closed system, with an automatic non-rewritable and non-
erasable link between the uploaded data, the device and the user who registered the result. Because of this,
the platform has received the approval of The Nuclear Regulatory Authority of Argentina (ARN). In our
experience, this system has allowed us to manage the pending tasks and the administration of resources to
successfully complete the quality assurance program.

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P-283

ADAPTIVE PTV MODELING IN SET-UP MARGIN FOR VMAT HEAD AND NECK
TREATMENTS

Sergio Bustos, Matias Vasquez, Harold Novoa

Centro Oncológico del Norte, Chile

Radiation Oncology – Treatment Delivery

Introduction: Radiation therapy of the head and neck is complex due to its target volumes and the proximity
of several risk organs. The need for fixation and margins for the planning target volume (PTV) due to the
uncertainty of the process, are necessary to guarantee the quality of the treatment. These baseline set-up
margins (PTV = 5 mm) can be reduced by means of a quantitative image analysis allowing to create a
model that achieves it safely and even adaptively. Achieving this, a greater decrease in morbidity.
Method and Materials: A semianalytical statistical modeling is created, generated by the offline and online
measurements of the daily images acquired before each fraction of treatment. We analyze the cartesian
displacements of the position of the planned isocenter (digital radiography image) and acquired (electronic
portal image), through the bone marks and the relation of the accessory as a validating element. Isocenter
displacement measurements are made for 100 head and neck patients with volumetric modulated
radiotherapy arc therapy (VMAT). The treatments and their verification are with Linear Accelerator of 6
MV with electronic portal image system. The verification images used are anteroposterior (AP),
posteroanterior (PA) and oblique.
Results: Post-modeling verifications show that the reduction of the PTV baseline margins (<5mm in X, Y,
and Z) are safe, keeping the white volume covered.
Conclusions: For some anatomical regions where radiotherapy is performed, the movement of organs or
internal margin volumen (ITV) is practically null, the set-up margin becomes relevant, and if the fixation
elements are safe, these can be reduced by modeling reduction that can guarantee coverage to the PTV.

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MONITORING OF CRYSTALLINE DOSE IN INTERVENTIONAL RADIOLOGISTS.

OPPORTUNITY FOR IMPROVEMENT AND OPTIMIZATION

Jorge Alberto Caro Vargas1, José Agustín Daza Moreno2, Oscar Rivero2, Anibal Morillo2, Sergio
Valencia2
1
Universidad Nacional de Colombia, Colombia
2
Fundación Santa Fe de Bogotá

Diagnostic Radiology –Dosimetry

Introduction: The Santa Fe Foundation within its radiological surveillance program has follow-up on the
crystalline readings of interventional physicians since 2016. With the proposed new limit of 20 mSv / year,
the readings of the last year were evaluated and compared with references of the European Union project
ORAMED (Optimization of Rdication protection for MEDICAL).
Materials and methods: monthly TLD crystalline dosimetry monitoring data were analyzed for the group
of 3 interventional radiologists dedicated to performing procedures based on the characterization of
fluoroscopy times and accumulated dose (AD) of the most frequent procedures and of higher DA for the
procedures performed in the institution, finally the doses in crystalline-month versus DA-month were
normalized by interventionist for the last quarter of 2018.
Results: crystalline dose for 2018 of 25.3mSv 55.63mSv and 123.42mSv for each specialist exceed the
proposed new limit of 20mSv. In the institution the most frequent studies are the placement and revision of
endovascular devices with 21.9% and 10.6% respectively and the ones that contribute the most are
Pharmacoangiography with 6224mGy and Arterio Pulmonar with 5860.6mGy. The values of Drystalline-
month / DA-month for each collaborator in the last quarter of 2018 were compared with data from
ORAMED, obtaining an average of 2.8 e-4 compared to 2 of the reference.
Conclusions:
Both the DA / Dc ratio and the readings of the three interventional doctors surpass the values of the
reference and in all cases the proposed limit of 20mSv / year respectively, values that agree with the
ORAMED data. What leaves open the discussion of the implementation of this limit in different countries,
as well as the adoption of radiological protection strategies to optimize the doses found.

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P-285

IMPLEMENTATION OF THE TRS-483 CODE OF PRACTICE: DOSIMETRY OF

SMALL STATIC FIELDS USED IN EXTERNAL BEAM RADIOTHERAPY

Jorge Emilio Munoz Bravo1, Ivan Dario Ardila Martinez2

1
Medical Physics in Hospital Universitario San Ignacio, Colombia
2
Student Medical Physics

Radiation Oncology – Dosimetry

Introduction:
In 2017, between the IAEA and the AAPM, the CoP TRS-483 was published for the dosimetry of small
static fields, where the formalism, the physics of small fields and the recommendations dosimetry reference
and relative are established. CoP TRS- 483 is implemented seeking to improve dosimetric accuracy when
using small static beams of photons.
Methods and Materials:
Quality Control (QC) is performed in the ionization chambers (3 semiflex 31010, 1 PinPoint 31023, 1
microDiamond 60019) using CT images to verify their status and rLCPE value, the QC tests are also
performed in the tandem electrometer, cables and water scanning systems MP3-M. The measurements of
CoP TRS-483 in beam of 6 MV are made for each Linac that allows the supply of dose of intensity
modulated: precise with MLC 10 mm, synergy with MLC Agility 5 mm and Axesse with mini-MLC Beam
Modulator 4 mm.
Results:
The calibration factor NDW of each of the ionization chambers is determined, the beam quality is
determined for the Axesse from a fmsr=4x4cm2 and compared with the one made in its commissioning at
10.4x10.4cm2, the depth profiles (PDD, online, cross line) of small fields with different detectors and
output factor values are compared between the TPS and each Linac. A program of dosimetric
intercomparison of the calibration factors with their associated uncertainties is created and it is expected to
create an inter-institutional intercomparison program in the Bogota city.
Conclusions:
The measurement of the NDW is established as an annual frequency test within the QA of the measuring
instruments and the output factor in the QA to the planning system. The field size limit of each segment is
established for the inverse planning process in Monaco IMRT or VMAT in: 1.5 cm (Precise), 1.0 cm
(Synergy) and 0.8 cm (Axesse).

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P-286

TYPICAL VALUES OF CONCOMITANT DOSE IN EXTERNAL RADIOTHERAPY

TREATMENTS

Jorge Emilio Munoz Bravo1, Fausto Alejandro Papamija Montenegro2

1
Medical Physics in Hospital Universitario San Ignacio, Colombia
2
Student Medical Physics

Radiation Oncology – Treatment Delivery

Introduction:
Image Guided Radiotherapy (IGRT) uses 2D and 3D images during treatment administration in order to
test reproducibility and reduce uncertainties. In this technique concomitant dose can be excessive and
typical dose values specification defines a good strategy to evaluate dose to patient and optimize the image
quality required for therapeutic purposes. Considering that in this aspect the ICRP publication 135 does not
provide numerical values or implementation details, we propose a method to determine typical dose values
through the calculation of DLP for CT, D for iView system and CTDIvol for XVI.
Methods and Materials:
We compare quality assurance recomendations for image radiotherapy systems suggested by AAPM TG.
No. 142, IAEA HH No. 16, ESTRO and SEFM. We implement, security, mechanic, imaging and dosimetric
tests, where the optimization process is performed between the quality of the image and dose to the
acquisition protocols. We study the statistic concomitant dose values obtained from simulation to treatment
reproducibility for 30 patients clasified for clinical pathology, where the typical dose values are specified
using the median of the data set.
Results:
With the proposed statistical analisys we designed a quality assurance program which leads to a
improvement on the imaging process and treatment accuracy. for example: registration correction,
calibration curve DER vs UH at different kV, optimization of gain and frame parameters in iView, and
collimation, filter, angle of gantry and kV in XVI.
Conclusions:
The magnitude of typical dose values in radiotherapy treatments is determined, being no greater than 0.5%
of the dose prescription. The quality assurance program for the institutional image system is established
and the optimal protocols for image acquisition are defined.

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P-287

CORRELATION FACTORS BETWEEN DOSE TO WATER AND TISSUE OBTAINED

FROM MCNP CODE FOR LOW ENERGY BRACHYTHERAPY PHOTON SOURCES

Paula Cristina Guimarães Antunes, Hélio Yoriyaz, Isabela Soares Branco

Instituto de Pesquisas Energéticas e Nucleares (IPEN), Brazil

Radiation Oncology – Brachytherapy

Introduction - Nowadays, it is well known in the literature the need to consider the composition of the
medium in brachytherapy planning systems, especially in procedures that use low-energy photon emitting
seeds. Despite this knowledge, the best way to report the absorbed dose is still a matter of debate, with
favourable points for both water and tissue absorbed dose estimates. In order to perform a dosimetric
calculation closer to reality, but still report the dose in water, was introduced the notation Dw,m (radiation
transported in medium, dose scored in water). The goal of this work is to explore different estimates of
Dm,m and Dw,m obtained from Monte Carlo (MC) simulations for a subset of human tissues of interest in
brachytherapy, seeking to estimate conversion factors between them and to compare with the values
obtained in the literature. Methods and Materials - State-of-the art MC calculations are used to score
absorbed doses in spherical geometries centered on three types of low energy brachytherapy sources: 125I,
103Pd and 131Cs. In addition, the photon fluence differential in energy is estimated, since the correlation
between the doses in water and the doses in tissue is performed through the cavity theory, which generally
assumes that the fluence of the photons in water and in tissue are identical.
Results and Conclusions - The calculated conversion factors showed that the absorbed dose to water
underestimates the absorbed dose to bone by up to 80 % but overestimates the dose in adipose tissue by
approximately 75 %, emphasizing the need to consider the composition and the density of tissue in the dose
estimates. All the results obtained showed that the estimation of the dose absorbed in low energy
brachytherapy procedures differ significantly when performed in water and in biological tissues,
emphasized the need to accurately consider tissue composition.

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P-288

COMMISSIONING OF GENERALISED GAUSSIAN PENCIL BEAM ALGORITHM

FOR IRREGULAR FIELDS

Carlos Gonzalez, Franklyn Reggio

Medical Physicist, Venezuela

Radiation Oncology – Dosimetry

Introduction:
Many centers usually measure the electron output for each field with insert. We want to use the
methodology proposed by the AAPM Task Group 71, to calculate the output factors and PDDs for different
clinical inserts, from different square inserts measurements.
Methods and Materials:
Output factors (OF) values and extended SSD were measured for all the electron beams available using the
Trilogy linac at the Hospital de Clinicas Caracas's (HCC) Radiotherapy Department, for all the applicators
available and square field sizes from 2x2 cm2 to 25x25 cm2 (according to the applicator), using a PTW
diode model 60017. In order to validate our methodology for other energies, measures of the 9 MeV electron
beam were compared to the dosimetric data published by TG71. We feed our Eclipse Treatment Planning
System (Generalised Gaussian Pencil Beam) with this data because initially it only considered the data of
the OF for open fields and didn't consider the effect of inserts into the applicators for the monitor units
(MU) calculation. Then, test treatment plans were created using rectangular and squared fields, different
energies and different values of source- surface distance to the regularly used (100 cm). Test treatment
plans were calculated by the TPS, calculated manually and dosimetrically measured in order to be able to
compare the calculated with the measured data.
Results and Conclusions:
Results of the comparison between the MU's calculated by the TPS, manually and measured were within
the tolerance value for most cases. This methodology simplifies the constant routine of measure the electron
output for each patient.

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P-289

MULTIPLE BILATERAL LUNG LESIONS SABR TREATMENT: SINGLE-

ISOCENTER Vs MULTIPLE-ISOCENTER VMAT APPROACH

Caroline Descamps, Egle Aon, Diego Franco, Diego Fernandez, Edgardo Garrigo

Centro Médico Dean Funes Córdoba, Argentina

Radiation Oncology –Treatment Planning

Introduction:
Stereotactic ablative radiotherapy (SABR) with volumetric-modulated arc therapy (VMAT) is used since
2008 to treat limited lung disease. In this study, we proposed to compare single-isocenter vs multiple-
isocenter approach in case of synchronous multiple bilateral lung lesions SABR.
Methods and Materials:
Six patients with bilateral lung disease were calculated in EclipseTM TPS (five fractions of 10Gy). For the
first approach with one isocenter (located between the two lesions), two coplanar arcs were used. For the
multiple-isocenter approach (isocenters placed centrally in each target), four coplanar semi-arcs were used
for each isocenter. All plans were normalized to at least 95% of the PTV receiving 100% of the prescribed
dose and Timmermann's constraints for the organs at risk were adopted. Conformity indices (CIs), normal
lung V5Gy, V10Gy and V20Gy, spinal cord Dmax, D0.35cc and D1.2cc, heart Dmax and D15cc,
esophagus Dmax and D5cc, trachea Dmax and D4cc were recorded in order to compare the two planning
methods. Results:
PTV and OARs acceptance criteria were reached for all plans. No significant differences were observed in
CI mean values (1.01±0.02 for single-isocenter vs 1.03±0.02 for multiple-isocenter). Mean normal lung
V5Gy, V10Gy and V20Gy differences between single vs multiple-isocenter were 0.08±0.06%, 0.04±0.03%
and 0.01±0.01% respectively. In the same way, the other OARs absolute dose differences between both
methods were insignificant (spinal cord: ΔDmax=3.67±2.75Gy, ΔD0.35cc=3.56±2.14Gy and
ΔD1.2cc=1.88±3.26Gy; heart ΔDmax=1.39±1.57Gy and ΔD15cc=2.77±1.84Gy; esophagus ΔDmax=-
0.66±4.48Gy and ΔD5cc=0.03±1.90Gy; trachea ΔDmax=-0.28±4.1Gy and ΔD4cc=0.18±2.79Gy).
Conclusion:
The results obtained in this study show that single-isocenter approach is dosimetrically equivalent to
multiple-isocenter plans and can be recommended to obtain excellent plan quality with faster treatment
time (single set-up) in bilateral lung lesions SABR.

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P-290

AN ALGORITHM FOR MEDICAL MAGNETIC RESONANCE IMAGE NON LOCAL

MEANS DENOISING

Xiomara Plasencia Hernández, Onelio Ciscal Chiclana, Reinaldo Roque Dias, Leodanis Herrera Aguila

Cuban Society of Medical Physics, Cuba

Non-ionizing applications

Magnetic resonance imaging uses a magnetic field and pulses of radio wave energy in order to make
pictures of organs and structures inside the human body. Reading MRI can give different information about
organs. For medical image processing noise is one of the major problems which undesirably corrupts
medical images. Removing the noise from an image can be done through a non-local means filter which
has its own parameters. For this method it is necessary to find the optimal parameters for different levels
of noise so that the filter be adaptable to the characteristics of the noise in the magnetic resonance images.
In this paper, we propose a novel medical image denoising approach which is based on traditional NL-
means algorithm. Non-local algorithm calculates pixel similarity weight of the entire neighborhood. The
accuracy similarity weights depend on the level of the noise intensity. Non-local means algorithm is based
on a process of averaging to incorporate all pixels in the image. In the filter processing, the process of
averaging may be restricted to M ×M window matrix that includes only some pixels, so that the window
matrix M × M is smaller than the dimensions of the entire image. Value of centered pixel of window matrix
is calculated as weighted average of pixels that belong to that window.

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P-292

ESTIMATION OF MAMMOGRAPHIC DENSITY IN WOMEN OF THE MAIN CITIES

OF COLOMBIA – PRELIMINARY STUDY

John Sandoval1, Alexandra Peña1, Emeterio Cruz2, Devi Puerto1

1
Instituto Nacional de Cancerología E.S.E., Colombia
2
Universidad ECCI

Diagnostic and Interventional Radiology – General

Introduction:
In Colombia, screening mammography was implemented as a strategy for the early detection of breast
cancer, which seeks to facilitate the diagnosis of disease in early stages and generate a positive impact in
reducing the mortality rate. The sensitivity of the mammography depends on the mammographic density,
decreasing for the case of dense breasts. In addition, a high breast density increases the likelihood of
developing breast cancer. This study aims to estimate the mammographic density of women who undergo
screening mammography, allowing to improve the effectiveness of early detection programs for breast
cancer. Methods and Materials:
In institutions that provide health services in the main cities of Colombia, a sample of 768 women who had
digital mammography of screening was taken. The craniocaudal view and mediolateral oblique view for
each breast were used to estimate the mammographic density. Only asymptomatic women were included,
with ages between 50 and 69 years old. Mammography of breast that have prostheses, operations,
microcalcifications or masses were not included. With each image, an estimate of the mammographic
density was made using the open software Dmscan 4.0.
Conclusions:
· This study seeks to increase the positive impact on the screening of breast cancer, providing more
information that may lead to changes in public health strategies.
· This study does not quantify the risk of developing breast cancer associated with breast density, but the
information obtained from this analysis could be very useful for future studies on this topic.
· This is the first phase of a study in which the results found will be corroborated using a commercial
software and the reports made by two radiologists.
· The national average corresponds to low density values (BI-RADS-2), so screening mammography in
Colombia is in most cases an effective early detection method.

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THE EXPERIENCE OF 6 YEARS WITH VOLUMETRIC MODULATED RADIATION

ARC THERAPY (VMAT) FROM AN ACCREDITED RADIOTHERAPY CENTER TO
PERFORM IT IN HEAD & NECK PATIENTS: FROM COMMISSIONING TO
TREATMENT

Sergio Bustos1, Matias Vasquez2, Harold Novoa2

1
Centro Oncológico del Norte, Chile
2
Centro Oncológico Antofagasta

Radiation Oncology – Quality Assurance

Introduction: Volumetric Modulated Radiation Arc Therapy (VMAT) is one of the most used techniques
in head & neck treatments. The VMAT technique must be commissioned following several
recommendations. This process can last a long time (fine tuning) to reach a high standard of quality. This
work describes the processes that must be carried out according to the experience of 6 years, which led not
only to an important accreditation, but to the successful treatment of hundreds of head and neck patients.
Method and Materials: The commissioning was carried out by acquiring mandatory curves for each
calculation algorithm according to the manufacturer for depth profiles and doses for fields from 1 cm x 1
cm to 40 cm x 40 cm. In addition, the transmissions and dosimetric leaf gap (DLG) of the multileaf
collimation system (MLC) were measured. All data was processed and formatted for the treatment planning
system (TPS). Several cases recommended internationally were calculated and the respective adjustments
were made to achieve accreditation with an anthropomorphic phantom of the PRC. Planning integrates
Virtual Simulation with fixation with 3 and 5 point masks and clinical dosimetry must be verified with
control by specific patient by dosimetry by ionization chamber, portal and radiochromic. The machine is a
Linear Accelerator of 6 MV x- ray with electronic portal system (EPID).
Results: The results of the process obtain in the verifications by specific patient a gamma index standard of
2% / 2mmL for 2D dosimetry and <3% for 1D.
Conclusions: A robust Quality Assurance Program gives good results as planned. The development is done
by sharing experiences and making improvements in time.

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P-294

CONSTRUCTION OF GYNECOLOGICAL PHANTOM FOR VERIFICATIONS OF

THREE-DIMENSIONAL HIGH DOSE RATE BRACHYTHERAPY

Sofia S. Dropsi1, Mariana R. Casal2, Pablo R. Menéndez2

1
Centro Oncológico de Asociación de Lucha Contra el Cáncer (ALCEC), Argentina
2
Departamento de Terapia Radiante- Instituto de Oncología "Angel H. Roffo" / Universidad de Buenos
Aires

Radiation Oncology – Brachytherapy

High-dose rate brachytherapy is the main treatment for uterine cervix cancer. Brachytherapy based on three-
dimensional images requires a quality control prior to its implementation to ensure that the prescribed
treatment is delivered properly. The objetive of this work is to design and construct a phantom that allows
reproducing 3D-brachytherapy treatments based on Computed Tomography images. The phantom
consisted in polystyrene blocks and a block made of agarose gel with a mass concentration of 3%, where
gynecological applicators and dosimeters were inserted. Dosimetric measurements were made at different
points on the phantom using a PTW Farmer chamber type 30013, and compared with the results calculated
by the brachytherapy planning software BrachyVision. TLD 700LiF:Mg,Ti and Gafchromics EBT2 films
were also used to verify the feasibility of their utilization in the built phantom. For measurements with the
cylindrical chamber, an absorbed dose in water calibration factor for Iridium-192, previously obtained
according to the formalism proposed by the German Society of Medical Physics, was used. The measured
dose with the Farmer chamber and the planned dose differs in ±1.0%. It was possible to insert the TLDs
and films in the desired positions, obtaining point dose values and a planar distribution respectively.
However, the analysis of these results is not quantitative, since these dosimeters were not calibrated in the
energy of the Iridium-192. The evaluations carried out on the phantom propose the agarose as a tissue-
equivalent material adaptable to the desired shape and size. The phantom turned out to be useful and very
ductile, allowing measurements with the different types of dosimeters. In particular, it was demonstrated
that the values calculated by the TPS are reproduced when measurements are made with appropriately
calibrated ionization chamber, and in case of having a good calibration, TLD and films can be inserted with
ease in the desired positions.

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P-295

COMMISSIONING OF BRAQUITERAPIA WITH 3D ACQUISITION AT THE

ONCOLOGICAL HOSPITAL OF CÓRDOBA

Stefanía Ayelén Maturana, Ariel Hernan Martinez, Graciela Remedios Velez, Ariel Miguel Moreno

Hospital Oncológico de Córdoba, Argentina

Radiation Oncology – Brachytherapy

The path taken towards the commissioning of 3D Brachytherapy with Co-60 at the Oncology Hospital of
Córdoba is presented in full, in conjunction with the Quality Control Program implemented. Until 2017,
the hospital had a Nucletron Microselectron Ir192 unit, using a reconstruction procedure based on semi-
orthogonal radiographic plates for treatment planning. In the year 2018, a Co-60 ""Flexitron HDR"" team
was acquired with gynecological applicators suitable for Computed Tomography and Magnetic Resonance,
which in conjunction with the Treatment Planning System ""Oncentra Brachy""; The Siemens Somatom
Emotion 16 tomograph and the Phillips MAC D digital portable device, make up the equipment of the
brachytherapy service. It also has a dosimetric set suitable for the development of controls consisting of a
well chamber and a PTW electrometer. Acceptance and Commissioning of the brachytherapy equipment
and planner were carried out, developing the necessary safety tests; mechanical and dosimetric. The steps
related to the procedure involving a treatment session were then adjusted: image acquisition, planning and
administration. The change from 2D to 3D brachytherapy meant a decrease in spatial uncertainties in the
reconstruction of applicators. The precision in the volumetric delivery of doses and the protection of organs
at risk was clearly superior. While the times of the new procedure were similar to those previously recorded.
In conclusion, the transfer achieves a great leap of quality in the hospital's Brachytherapy treatments.
Currently there are more than 50 patients treated with 3D brachytherapy. It is expected to expand the use
of MRI and incorporate complementary systems such as ultrasound to optimize the application of the
treatment. Also develop a 3D printing phantom for accurate dosimetric measurements.

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P-296

SHIELDING CALCULATION USING MONTECARLO METHOD, FOR A

CYCLOTRON OF HOSPITAL. DESIGN OF LOCAL SHIELDING ELEMENTS

Franco Profili, Germán M. Arenas

FUESMEN, Argentina

Radiation Protection

In the last decade, cyclotrons have been widely disseminated in industrial facilities, hospitals and research
sites. In the field of medicine, they are used in the implementation of diagnostic techniques, from the
production of radioisotopes used as tracers and in radiotherapy in the treatment of cancer. The
radioprotection in the use of accelerators, is a concept that presents many aspects, the knowledge of the
radiation fields is necessary for the design of shielding. There are numerous guides related to planning and
installation as well as radio-protection protocols, however, these documents offer analytical methods for
the calculation of shielding only in idealized geometries. Given the complexity of the physical phenomena
related to the transport of particles, Monte Carlo simulations have become an increasingly popular tool.
There are numerous Monte Carlo simulation packages, these codes equipped with libraries for the transport
of radiation and neutron and charged particle interactions, together with the increase in the power of the
computer, allow to perform evaluations of the radiation fields, the shielding equipment and magnitudes for
radio protection. During this research was developed a Montecarlo model of the RDS-112 ""Radioisotope
Delivery System"" installed in FUESMEN, through the use of the FLUKA code. The model includes the
main geometric details of all the constituent systems of the accelerator and the complete architecture of the
bunker. It was used to study the behavior of the current shield during the production of 18F. Multiple
measurements allowed us to document the current levels of H * (10) doses of neutrons and gamma, during
the irradiation of the new target with Niobium insert in the production of 18F. Two alternative proposals
for shield optimization, called Model A and B, were modeled, based on the reuse of the present shielding
pieces, for their subsequent evaluation based on the Montecarlo simulations.

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P-297

APPLICATION OF THE SEVRRA RISK MATRIX IN A BRACHYTHERAPY

SERVICE

Alejandro Ferreira1, Ignacio Véliz1, Apolo Salgado1,2, Evelyn San Martín3

1
Instituto Nacional del Cáncer, Chile
2
Universidad San Sebastián
3
Universidad de Chile

Radiation Protection

Introduction: Radiotherapy is a treatment characterized for being a complex process with multiple steps, in
which the safety of its execution must be granted to avoid accidents. There are matrix of risk, like the
System of Evaluation of Risk in Radiotherapy (SEVRRA) which allows the evaluation of radiotherapy
facilities through a combined analysis of the frequency of occurrence of events that can initiate accidents,
the probability of human mistakes or failures of safety barriers and the severity of the consequences of the
events. This allows to define criteria of acceptability of the treatments and to identify the events that
generate high levels of risk with its adequate proposal of barriers to avoid or mitigate such events. The
objective of this work is to present the implementation of this tool in the Brachytherapy service at the
Instituto Nacional del Cáncer (INC) its results.
Materials and Methods: The SEVRRA methodology was applied during March 2019 in the Brachytherapy
service at the INC. Results: An 8% high risk was identified, corresponding mostly to the acceptance and
start-up phase of the treatment, 57% moderate risk and 22% low risk, while the other practices used as
references did not apply to activities carried out in the service.
Conclusions: This study allowed us to quantify and identify the defenses and weaknesses of the
Brachytherapy service at INC that contribute to its safe use. In the present, work continues on the
appropriate recommendations and considering the low percentage of high risk in its application, it's
appreciated that there's no imminent risk of an actual accident. Finally, the applicability of the SEVRRA
method in Brachytherapy and its great utility in the prevention of accidents is confirmed.

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P-299

PREDICTION OF ISCHEMIC RISK BASED ON CARDIAC PRESSURE WAVES: AN

APPROXIMATION FROM ARTIFICIAL INTELLIGENCE

Constanza Hormazabal1, Araceli Gago-Arias1, Gonzalo Martinez2, Paola Caprile1

1
Instituto de Física Pontificia Universidad Católica de Chile, Chile
2
Red de Salud Christus-UC, Facultad de Medicina Pontificia Universidad Católica de Chile

Biomedical Engineering

Introduction: Fractional flow reserve (FFR) is considered nowadays as the gold standard to indicate whether
a stenosis can be held responsible for ischemia. FFR is measured in cardiac pressure wave during the state
of maximum hyperemia induced by the drug Adenosine, where a value of FFR≤0.8 indicates risk of
ischemia. This is an expensive and invasive procedure with possible side effects. In the last years, machine
learning algorithms have demonstrated their potential in medical decision making, by predicting results
based on a large amount of clinical data.
Methods and Materials: We worked with 141 patient's data. 54,6% of them have FFR≤0.8. For each patient,
43 features of the pressure wave in resting state were extracted, including physical and clinical interest
features. The database was divided in a stratified way: 80% for training set and 20% for testing set. Seven
different machine learning algorithms were trained using 10- fold cross-validation method. After that the
performance of each model was evaluated.
Results and Conclusions: The algorithm that achieved the best prediction was Linear Discriminant Analysis
(LDA). LDA has shown an accuracy of 0.85 ± 0.05 and area under the curve (AUC) of a Receiver Operating
Characteristic curve (ROC) of 0.93 ± 0.04, compared to the prediction of another method: the ratio of distal
pressure to aortic pressure in diastole region (accuracy of 0.79 ± 0.03 and AUC of 0.89 ± 0.5). When these
two methods were compared a p-value of 0.05 was obtained. Therefore, the development of an algorithm
based on pressure waves can be a useful tool in the prediction of ischemic risk without the need for
Adenosine administration. We expect to validate this algorithm by achieving good predictions in a new
group of patients and obtain the final classification model.

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P-300

SRS MAPCHECKTM CHARACTERIZATION

Karen González-Pérez1,2, Tomás Emanuel Spretz1, A. Federico Bregains1, Nicolás Omar Larragueta1
1
CEMENER, Argentina
2
Instituto Balseiro, Argentina

Radiation Oncology – Quality Assurance

The use of different detectors in CEMENER for patient-specific quality assurance (PSQA) in radiosurgery
has been essential for pre-treatment verification. The SRS MapCheckTM is a specialized small-fields
detector, since it contains 1013 diodes in an area of 77x77 mm2. The SRS MapCheckTM was characterized
for energies of 6 and 10 MV. The calibration was carried out under manufacturers conditions, using the
corresponding accessories. In addition, we used a StereoPHAN phantom for the response of the SRS
MapCheckTM, as a function of monitor units and angle of incidence. Dependencies were determined
relatives to source-surface distance, field size and dose rate. The results showed that the signal was linear
in relation to the monitor units with a adjustment equal a R=1, it remained constant regarding the angle of
incidence and the dose rate; also showed an increase respect to the field size but decreased with the source-
surface distance. Therefore, the SRS MapCheckTM detector was ideal for pre-treatment verification in
radiosurgery, since it varied less than 1% relative to linearity, angle of incidence and dose rate and less than
2% field size and source-surface distance. In this last version it was possible to calculate couch shifts in 6
degree of freedom, it had immediate response, it was necessary to use the StereoPHAN phantom and that
measurements were in dose units.

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P-301

DETERMINATION OF TRANSMISSION FACTORS FOR PHOTONS IN

MULTILAYERED SHIELDINGS USING 4 MATERIALS: COMPARISON BETWEEN
ANALYTICAL FORMULAE AND COMPUTATIONAL MODELING

João Vitor Mendes da Silva, Sergio Gavazza, Domingos Cardoso, Marcos Paulo Cavaliere, Gabriela
Martins

Mestrando, Brazil

Radiation Protection

The aim of this paper is to determine the Transmission Factors (TF) for photons in multilayered shieldings
using 4 different materials, through analytical calculation methods and computational modeling. The
thicknesses and materials considered are as follows: 1.00 cm of ordinary concrete, 0.15 cm of aluminum,
0.10 cm of iron and 0.11 cm of lead. The layers were permuted in 24 different sequential arrangements. It
was considered an isotropic point source emitting monoenergetic photons of energy 0.661657 MeV for
interactions with matter. Analytically, the exponential attenuation and Taylor's buildup factors (TB) were
calculated for infinite medium, it was also used the Broder's Equation (BE) and then, Microsoft Excel to
calculate the TFs for different arrangements. In the computational modeling, the Monte Carlo N-Particle
code (MCNP), based on the Monte Carlo Method (MCM), was used. MCNP simulations were performed
to obtain dose values with and without the use of shielding arrangements, respectively, I and I0. The ratio
I/I0 is termed as TF. The TFs of the 24 possible permutations has shown good agreement between the
analytical methodology and MCNP simulations. Simulated TFs presents a slightly higher value in each
combination. Regarding dose attenuation, the most appropriate order of materials in the source-detector
direction is as follows: ordinary concrete, aluminum, iron and lead.

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P-304

CORNEAL TOPOGRAPHY ACCURACY AFFECTED BY THE IMPROPER

LOCATIONS OF THE CORNEA

Amilcar Estrada-Molina1, Yobani Mejía-Barbosa2, Rufino Díaz-Uribe3

1
Pontificia Universidad Javeriana, Colombia
2
Universidad Nacional de Colombia, Bogotá
3
ICAT-UNAM

Radiology – Radiation Protection.

In this paper, we quantified the error of the corneal elevation due to the improper location of the cornea
(defocus and decentration). We have been studying the effect in the evaluation of the corneal topography
when is assesses by a reflection- based topographer. We have found important deviations from the actual
values of the corneal reconstruction.
A prolate cornea (good approximation for a normal cornea) with radius r = 7.80 mm and conic constant k
= -0.25, was simulated with its vertex in ten different locations (range: – 1 mm to 1 mm with step of 0.2
mm) respect to the optical axis. During these simulations both the radius and conic constant of the prolate
cornea do not change to guarantee that the errors in the corneal reconstructions are only due to the improper
locations of the cornea.
The RMS error increase as the defocus and decentration is larger. When the cornea has defocus of ±1 mm,
the RMS error is not greater than 0.2 mm. While that, when the cornea has decentration of ±1 mm, the RMS
error is not greater than 0.02 mm. Therefore, the defocus has a greater impact than the decentration in the
accuracy of the corneal reconstruction. The reconstructed corneal surface at different defocus and
decentration positions do not match with the actual cornea simulated in this study. The greater the defocus
and decentration, the reconstructed values, move away respect to the actual value.
Results obtained in this study are of interest, because the effects described above could be associated to the
corneal surface imperfections and not to an improper location of the corneal vertex as really happens, since
the reflection-based topography system measures the deviations of the pattern imaged in the CCD to relate
these with changes in radii of curvature, astigmatism, keratoconus, among others.

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P-305

COMPUTATIONAL SIMULATION OF THE FLOW OF MAGNETIC

NANOPARTICLES IN A NEWTONIAN VASCULAR FLUID

Juan Sebastián Quimbayo Gómez1, Sergio Iván Carrillo Guerrero2, María Cristina Plazas3
1
Universidad Nacional de Colombia, Fundación Universitaria San Mateo, Colombia
2
Combustión Ingenieros SAS, Fundación Universitaria San Mateo
3
Universidad Nacional de Colombia

Radiology – Radiation Protection.

The drugs transport through the bloodstream is a problem which has generated a large number of research
and applications in bioengineering and has gained great relevance to combat tumors and vascular diseases.
Among the available techniques, special attention is drawn to magnetic targeting drug-delivery by
nanoparticles through the bloodstream to provide medicines to specific places within the human body where
tumors and malignant tissues may be detected.
The principal dynamic variables to be considered in the study of the nanoparticle movement are usually the
thrust forces, Stokes forces, magnetization force, and diffusion and reflection coefficients. The present work
evaluates the scope of the implementation of a theoretical model which links these dynamic variables
through the Newton dynamics formulation and the principles of hydrodynamics and hemodynamics.
The physical situation takes into account a cylindrical contour, adapting some geometrical characteristics
to the large blood vessels. A set of magnetic nanoparticles is directed, through a vascular fluid with constant
viscosity, by the incidence of external magnetic fields. This physical situation is simulated by the finite-
element method to solve the differential equations obtained from the theoretical model, and the comparison
of the results with other existing models let us find aspects to validate and to improve in the development
of the implemented physical model.

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P-306

RADIATION DOSE OPTIMIZATION IN CHEST X RAY: PHANTOM STUDY

Felipe Allende, Maria Paz Escobar, Fernanda Saez

Universidad Mayor, Chile

Radiology – Radiation Protection.

Introduction: Radiation dose optimization is a subject of constant concern in the field of radiology research.
In order to reduce radiation doses, image quality parameters must be evaluated in order not to negatively
impact the diagnosis of a patient due to a non-evaluable image.
Objective: This study sought to evaluate and optimize the radiation dose for the posteroanterior (PA)
projection in the chest radiographic study, decreasing the exposure factors obtained from the literature.
Methods: For this, an acrylic model with attenuation characteristics similar to those of an adult standard
thorax was manufactured, which is associated with a realistic analysis to simulate x-ray absorption and
dispersion. Image quality was evaluated quantitatively using the NORMI 13 test phantom. Dose
measurements included kerma in air at the entrance surface with ionization chamber, as well as an analysis
of the variation of radiographic Exposure Index and Deviation Index were conducted.
Results: The exposure factors were reduced to 100 kVp and 2.5 mA in compliance with the appropriate
image quality parameters. A dose value of 0.118 mGy was obtained with the use of such parameters.
Conclusion: This research provides a useful guide for medical technicians to optimize the radiation dose
for this projection, in addition to clarifying concepts such as the Radiographic Exposure index and
Deviation index.

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P-307

CHARACTERIZATION OF OSL DETECTOR FOR IN VIVO DOSIMETRY

Yolma Banguero1, Joaquin Irigoyen2, Aldo Quarneti3, Gustavo Piriz3

1
CIN-Facultad de Ciencias-UdelaR, Radioterapia-Hospital de Clinicas-UdelaR, Uruguay
2
CIN-Facultad de Ciencias-UdelaR
3
Radioterapia-Hospital de Clinicas-UdelaR

Radiation Oncology – Quality Assurance

Introduction:
The accurate in radiotherapy is very important because compromise the treatment result. As part of the
quality assurance in radiotherapy the in vivo dosimetry is an effective tool to detect errors or
misadministrations. The most common detectors used for in vivo dosimetry are diodes, mosfets and TLD.
This work characterized optically stimulated (OSL) dosimeters for in vivo dosimetry; that are designed
primarily for external dose in radioprotection.
Methods and Materials:
Based on Report 87 of the AAPM, OSL dosimeters were characterized. With a 6MV beam (Compact
Elekta). Factors were obtained: linearity with dose, reproducibility, field size, distance and angles.
Optical stimulated luminescence system that use dosimeters with aluminium oxide Al2O3:C, which are
readout by a device connected to a software and use a calibration to determine the dose.
Results:
The corrected factors obtained for the detectors, it was found similar behaviour that we expect with diodes.
Conclusion:
The optical stimulated luminescence system with the detectors used in this work have the potential to use
in clinic for dosimetry in vivo taking in account with the action levels.

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P-309

EVALUATION OF PATIENT ́S DOSE FOR CORONARY ANGIOGRAPHY AND

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTIC PROCEDURES

Sheila Petro B.1, María Esperanza Castellanos L.1, Diego Ardila2

1
Pontificia Universidad Javeriana, Colombia
2
Hospital Universitario San Ignacio

Diagnostic Radiology –Dosimetry

Over the past years, the application of fluoroscopically-guided interventional radiology (FGIR) procedures
has spread to diagnostic and treatment centers, evolving into more complex procedures. These procedures
are characterized by prolonged exposure times due to diagnostic and therapeutic needs, which implies an
increased risk of deterministic effects, as well as an increased of the probability of stochastic effects in
patients. In view of the above and following the recommendations of the ICRP Report No.135, typical
values (TV) applicable to groups of patients undergoing coronary angiography (CA) and percutaneous
transluminal coronary angioplastic (PTCA) procedures were determined in a hemodynamics service that
counts with two angiographers from the Allura Clarity family. The evaluation and characterization tests of
the radiation beam were carried out with the Radcal Accu-gold system, adopting the recommendations of
the IAEA Safety Reports Series No. 59. The monitoring and analysis of 27 and 15 patients of CA and PTCA
procedures, respectively, was performed. The entrance surface air kerma rates was evaluated using a solid
water phantom. Our results show a VT for PKA of 4,5 y 12,3 Gy·cm2 for AC and PTCA procedures. The
phantom entrance surface air kerma rates for the same techniques were 23% and 17% of the tolerance for
the high and normal fluoroscopy modes, without magnification. Using a magnification of 22 cm, the values
were 56% and 33% of the tolerance. The VTs found in this study are inferior to the published NRDs
obtained in international studies. This study represented an advance in Colombia in terms of
interdisciplinary work between interventional physicians and medical physicists, which is essential for the
determination of reference levels and the optimization of patient ́s doses for the interventional radiology
procedures in the country.

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P-311

COMPUTED RADIOGRAPHY EXPOSURE INDEX AS A DOSIMETRIC

OPTIMIZATION TOOL

Felipe Allende, Cristian Barraza, Daniela Navarrete

Universidad Mayor, Chile

Diagnostic and Interventional Radiology – General

Introduction: The screen-film radiography system limits the operator to use a limited range of technical
factors to obtain adequate exposure. The implementation of the digital system had the advantage of a wide
dynamic range of the detector that allows operators to use various exposure parameters, this led to an
increase in patient doses, since technicians tended to use higher exposure parameters given the response of
the detectors. the exposure index was developed In order to know the exposure received by the detector.
So, this indicator allows the operator to objectively know if the exposure was adequate, sub or overexposed.
Objective: The aim of this study was to obtain the lowest possible value for the IgM (AgfaTM Expo Index)
by modifying the exposure factors without affecting image quality. Methods: Radiographic exposures were
made to simulated diameters of a standard patient ́s thorax, lumbar spine and pelvis in a computed radiology
system. Simulated patients were designed using acrylic blocks. Based on the technical parameters indicated
in a previous research, these were reduced by at least half, with the values of Kerma in Air in the Entry
Area and Exposure Index recorded. Image quality evaluation was performed quantitatively using the
NORMI 13 test object.
Results: It was possible to demonstrate that the IgM decreased by at least 0.3 with respect to the reference
IgM. Kerma in Air at the Entrance Surface decreased to half with respect to the initial exposure factors and
image quality was not impaired, therefore, the exposure index is a tool that allows to better guide the doses
given to patients in each radiographic examination. Conclusion: The value of the Exposure Index should
be considered as an essential data in the evaluation of the quality of a radiological projection with
dosimetric.

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P-314

EVALUATION OF A FREE TOOL DEVELOPED TO PERFORM MECHANICAL

QUALITY CONTROLS ON LINACS USING THEIR OWN PORTAL IMAGING
DEVICE

Nicolas Catriel Chavez Milquevich, Maria Florenca Zalazar, Graciela Velez, Ariel Hernan Martinez,
Ariel Miguel Moreno

Hospital Oncologico de Cordoba, Argentina

Radiation Oncology – Quality Assurance

The present work was motivated by need to perform quality controls on linacs in a low-income institution
such as a public hospital, optimizing use of resources. The objective is to obtain a tool easy to use and
quickly to implement clinically, that facilitates control documentation. The work was implemented in a
Siemens Artiste linear accelerator with Optiviue portal image system, which was proposed as a replacement
for radiochromic films for routine controls. For the analysis of these images, the pylinac library written in
python was available as well as several language libraries such as Scikit-image, Numpy, SciPy and
Matplotlib. Through the use of these libraries and the acquisition of the portal images, Picket-Fence
Starshot, Winston-Lutz, flatness and symmetry tests, orthogonality of MLC, coincidence of asymmetric
fields and superposition of the symmetrical and parallel opposites fields were performed. The results
obtained were compared with films, typically used to validate them. Finally, a graphic interface was
developed in order to facilitate the analysis and documentation of these controls. In conclusion, a simple
tool was obtained that allows the fast analysis and documentation of controls and thus increasing the
frequency as well. This allows that the taking of images is done by the therapyst staff and that the controls
will be then evaluated by the physics personnel.

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P-317

DOSIMETRIC COMPARISON IN SMALL FIELDS SHAPED BY JAWS AND

MULTILEAF COLLIMATOR

Jaime Hipólito Cabrera Salcedo, Maria Cristina Plazas, Edwin Eduardo Rozo Albarracin

Universidad Nacional de Colombia, Colombia

Radiation Oncology – Dosimetry

Small fields of radiation are used often in the current external beam radiation treatments, since the advent
of techniques such as intensity modulated radiation therapy and both intracranial and extracranial
radiosurgery. Small fields present loss of lateral electronic equilibrium and most commercial detectors are
too bulky to be used for this characterization, and when these are used it is necessary to take into account
various correction factors. For this reason, it is important to perform a dosimetric characterization of small
fields with appropriate detectors as used for this work (PTW microDiamond), this characterization ensures
the use of small fields in a service of external radiotherapy with treatment techniques as above is showed.
Dosimetry was made for small square and rectangular fields shaped by jaws and MLC Millenium from 0.5
cm x 1 cm with an increase of 1 cm in each axis, up to 4 cm x 4 cm for a photon beam with energy 6 MeV.
Dosimetric characterization includes measurements of OARs at different depths: 15 mm, 50 mm, 100 mm,
200 mm, 300 mm; and PDDs. These dosimetric parameters were measured in a linear accelerator Clinac
iX with a PTW Scanlift, and a diode PTW micro Diamond. From these measurements it was found: first,
the penumbra of transverse axis of fields shaped by MLC is greater than with jaws because of the interleaf
transmission of the multileaf collimator. Second in rectangular fields shaped by the jaws collimator when
the field size in radial axis increases, the penumbra is modified in the transverse axis. A shift was also
observed in the percentage depth dose to resize the field using both jaws collimator and MLC. It is
noteworthy the importance of type of detector in performing dosimetric characterization small fields, which
is not affected by the lack of lateral electronic equilibrium.

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P-322

IMPLEMENTATION AND TRAINING OF ADVANCED RADIOTHERAPY

TREATMENT TECHNIQUES TO RADIATION ONCOLOGY PERSONNEL –
SERVICES PROVIDED BY HRS ONCOLOGY INTERNATIONAL

Elena Fernandez, Heidi Zeleznik, Helber Cortez, Franklin Reggio, Javier Cifuentes

HRS Oncology International, USA

Education and Professional Issues

Introduction:
The purpose of this work is to describe the methodology employed by HRS Oncology on the IMRT, VMAT
and SBRT clinical implementation for prostate and Head and Neck in the Hospital Naval and Instituto
Nacional del Cancer in Mexico City, Mexico.
Methods and Materials:
The following methodology was used: i.- Internal audit of dosimetric parameters required for linear
accelerator commissioning, ii.- Optimization of required dosimetric parameters: Dosimetric Leaf Gap
(DLG) and transmission factor (TF) to achieve correct delivery of advanced treatment techniques of IMRT,
VMAT and SBRT, iii.- Internal audit and personnel training on treatment planning for advanced techniques
using AAPM task group report TG119, iv.- Training on anatomical structures contouring and volume
delineation in radiotherapy using ICRU 62 and 63 guidelines. Training on strategies for simulation, patient
immobilization and positioning, and treatment planning for prostate and head and neck previously planned
in 3DRCT. v.- Last but not least, obtain certification for this methodology by implementing an external
audit from IROC, MD Anderson.
Results:
Results from internal audit of both relative and absolute dosimetry parameters show differences less than
0.8% compared to published references. Optimization of dosimetric leaf gap (DLG) and transmission (T)
improved results of gamma index analysis from 95.7% to 96.7%. Implementation of TG119 demonstrates
that current TPS installed in these sites calculates treatment plans according to this guideline and verifies
that delivered doses by the linear accelerator corresponds to those calculated by the TPS
Conclusions:
The methodology implemented allowed radiation oncology department staff to perform in a safe and
independent way all aspects related to simulation, planning, verification and treatment delivery of prostate
and head and neck clinical cases for IMRT, VMAT and SBRT treatment techniques. These processes are
within international quality standards and all obtained certification by IROC.

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P-323

EVALUATION OF LONGITUDINAL TELEHEALTH COURSES FOR SRS/SBRT

TRAINING IN LATIN AMERICA

David Martinez Perez 1, Michael Hermansen 2, Bertha Garcia 3, Dante Roa 4, Benjamin Li 5
1
Oncosalud - AUNA, Rayos Contra Cancer Inc., Peru
2
University of Florida, Rayos Contra Cancer Inc.
3
Oncosalud - AUNA, Rayos Contra Cancer Inc.
4
University of California Irvine, Rayos Contra Cancer Inc.
5
University of California San Francisco, Rayos Contra Cancer Inc.

Education and Professional Issues

Introduction:
Stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) are effective treatments
that can reduce treatment times and increase tumor control. While a growing number of Latin American
clinics have acquired advanced technologies capable of administering SBRT and SRS, there are few
accessible training opportunities and experienced clinicians that feel comfortable treating patients with
SBRT/SRS. Rayos Contra Cancer (RCC) seeks to measure the effectiveness of telehealth support
(providers assisting other providers) for practical skills in SBRT/SRS, which would greatly expand training
opportunities for low-middle income country clinics worldwide.
Methods and Materials:
RCC performed telehealth training using the Project ECHOTM model for two high-volume cancer centers
in Lima, Peru. During January to March 2019, twelve telehealth virtual classroom sessions were conducted
through a SBRT/SRS curriculum developed by RCC. Sessions featured U.S.-based radiation oncology
educators using the Zoom Web Conference platform. Surveys were given pre- and post-curriculum to
measure participants' confidence in practical aspects of SBRT/SRS, based on Likert-scales of 1 to 5.
Confidence in Identifying Structural Anatomy, Contouring Ability, Evaluating DVH, Plan Evaluation,
Delineation of Tissues, Port Film Evaluation, and Cone Beam CT Evaluation was recorded through a
RedCap Database. Results:
Pre- and post- surveys were completed by 31 telehealth participants: 8 radiation oncologists, 7 medical
physicists, and 16 medical technologists. Participants' mean change in confidence was +0.2 (4.6 to 4.8) in
Identifying Structural Anatomy, +0.1 (4.3 to 4.4) in Contouring Ability, +0.3 (4.3 to 4.6) in Evaluating
DVH, +0.4 (4.3 to 4.7) in Plan Evaluation, +0.3 (4.2 to 4.5) in Delineation of Tissues, +0.2 (4.1 to 4.3) in
Port Film Evaluation, and +0.0 (4.5 to 4.5) in CBCT Evaluation.
Conclusion:
Training for SBRT and SRS can be augmented via telehealth virtual classroom sessions for radiation
oncologists, medical physicists, and medical technologists.

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P-327

FABRICATION OF A BIO-CERAMIC BONE SUBSTITUTE BY USING SPONGE

REPLICA METHOD

Joye Kundu1, Swapan kumar Sarker1, Golam Abu Zakaria1,2, Rana Mitra1
1
Department Of Medical Physics and Biomedical Engineering, Gono Bishwabidyalay (University),Dhaka,,
Bangladesh
2
South Asia Center for Medical Physics and Cancer Research (SCMPCR),Dhaka, Bangladesh

Biomedical Engineering

Hydroxylapatite has its good biocompatibility and similar chemical composition to the mineral part of the
bone. It has an important role and various application in bone tissue engineering. Porous hydroxyapatite
scaffold has a high surface area, which leads to excellent osteoinductivity as well as reabsorbability and
also providing fast bone in growth at the site of injury. In this study highly porous body of a nano structure
hydroxyapatite scaffold was successfully replicated by sponge replica method.
Characterization: The compressive strength and the morphological structure of the scaffold were
characterized by UTM machine and SEM image respectively. XRD technique was used to investigate the
proof of formation of BCP powder.
The result of SEM analysis that, the prepared scaffold has highly interconnected spherical pores with a size
in the range of 100- 500 micrometer and the compressive strength of the scaffold with the value of 1.425 ±
0.15 mega Pascal, Strut Diameter is 91 ± 53.27 μm; Porosity 80.57 ± 1.58 % and Standard reference value
of porosity is 71 %.
The mentioned properties could make the Bi Phasic calcium phosphate (BCP) ceramic scaffold as a good
candidate for bone regeneration application.

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P-329

IMRT COMMISSIONING: IMPLEMENTATION OF AAPM'S TG 119 TO ONCENTRA

EXTERNAL BEAM PLANNING SYSTEM

Graciela Remedios Velez, Maria Florencia Zalazar2

SAFIM, Argentina

Radiation Oncology – Dosimetry

Due to the recent clinical commissioning of the intensity modulated radiotherapy technique at the Hospital
Oncológico of Córdoba, and to perform an independent check of the intensity modulated's algorithm
available in the planning system that complements the TECDOC 1583's tests already performed on the
system, the tests of American Association of Physicists in Medicine's TG 119 report are applied to the
Oncentra External Beam planner.
Plans indicated by the report were made with targets and pre-defined structures drawn on the tomographic
images of a solid wáter phantom 15 cm high to fulfill the objectives established in the document.
The obtained plans were irradiated with a Siemens Artiste linear accelerator, 160 leaf collimator.
Absolute point doses were measured with a PTW 31003 cylindrical ionization chamber and relative dose
distributions by using a MapCheck 2 diode array from Sun Nuclear.
The maximum deviation of the measurements with ionization chamber was lower than the 3% limit
recommended by the document. While the percentage of points passed the gamma criterion of 3%, 3mm
was greater than the 95% recommended.

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P-333

EVALUATION OF THE UNCERTAINTY IN THE POSITIONING IN

RADIOSURGERY WITH THE ANGLED TREATMENT COUCH USING IGRT
SYSTEM

Richard Morimoto1, Roberto Kenji Sakuraba2, Carlos Eduardo De Almeida3, Jose Guilherme Pereira
Peixoto4
1
Oncoclinica Clinica Medica, Brazil
2
Hospital Israelita Albert Einstein
3
LCR-UERJ
4
IRD, CNEN

Radiation Oncology – Dosimetry

Stereotactic radiosurgery delivers a high dose (≥ 18 Gy) in small brain lesions in a single session. Therefore,
it is extremely important to obtain high accuracy in the positioning and this can be achieved by using IGRT
systems. The objective of the study was to evaluate the positioning uncertainty in radiosurgery technique
with couch angulation, as well as to validate MV images for position verification. Using skull phantom
printed in 3D, MV images were taken on the same incidents as HyperArc software. The linear accelerator
used was the TrueBeam STx of the Hospital Israelita Albert Einstein and the immobilization of the phantom
was performed with thermoplastic mask. The MV image was first validated with the CBCT, determining
the residual uncertainty. In order to evaluate the identification of these errors using MV image, errors of
0.1 to 5 mm were inserted. Such errors were inserted through the displacement of the robotic couch.
The validation results of the robotic couch were within the expected range with an uncertainty near to the
value obtained in the MPC test. A standard deviation of the order of 0.05 mm was obtained for the
translation coordinates and 0.05 ° for rotation. The inserted errors of 0.1 to 0.3 mm showed reasonable
compatibility in the longitudinal and lateral coordinates, but the rotational correction was not efficient for
errors smaller than 1 ° since the correction was compensated in the other coordinates.
From the statistical analysis of measurements and other factors of influence, we can conclude that the MV
image of verification during a frameless radiosurgery procedure in positions based on the HyperArc®
technique can be used with confidence. It was possible to identify positioning errors greater than 0.2 mm
with a 95% confidence level, due to the variation of the automatic correction software.

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P-334

THE FIELD OF MEDICAL PHYSICS IN BRAZIL: (DIS)CONSTRUCTION IN

PROGRESS

Janaína Dutra Silvestre Mendes1, Lidia Vasconcellos de Sá2

1
Instituto Nacional de Câncer, Brazil
2
Instituto de Radioproteção e Dosimetris

Education and Professional Issues

This paper addresses the paradoxical construction condition of the Medical Physics field in the Brazilian
scenario through an analysis of the representativeness of area, subarea and specialization in governmental
agencies of science promotion and scientific-academic production. Therefore, the objective is to critically
understand the state of Brazilian medical physics in its academic dimensions. The methodology was based
on webscrapping and quantitative and qualitative analysis tools (such as ScriptLattes, Gephi, etc.) to collect
and analyze data collected in public and open databases (Lattes curriculum, Sucupira platform, Lattes etc.)
that have as a refrence the dissemination and the Brazilian technoscientific communication. The preliminary
results point to the fact that the greater areas of medicine and physics produced in their overlap a field, or
community of practices, whose knowledge of this egress does not necessarily contribute to the
consolidation of a supposed field or area independent of physics. So, it is necessary to create a new scientific
culture for the creation, maintenance, and reproducibility of the independent field of medical physics.

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P-335

ANALYSIS AND INTERCOMPARING THE SMALL PHOTON FIELD PROFILE

ACQUIRED WITH DIFFERENT COMMERCIAL ACTIVE DETECTORS, EBT3
FILMS AND SOLID STATE DETECTO, BeO CYLINDERS

Yelina González Pérez1, Karen Pieri2, Thiago Schmeling3, Lucas Delven4, Helen Khoury5
1
Nuclear Energy Department - UFPE, Brazil
2
Royal Portuguese Hospital of Pernambuco (RHP)
3
Royal Portuguese Hospital of Pernambuco (RHP), Nuclear Energy Department - UFPE
4
Royal Portuguese Hospital of Pernambuco (RHP)
5
Nuclear Energy Department - UFPE

Radiation Oncology – Dosimetry

Introduction: Advanced techniques introduced in radiotherapy, such as IMRT and stereotactic radiotherapy
(SRS / SRT) use small photon beams, where the measurements of the profiles can lead to uncertainties that
affect the treatments. These measurements are challenging due mainly to the absence of equilibrium
conditions of charged particles, the size of the detector and the effects of composition and positioning
problems [Pappas et al., 2008].
Methods and Materials: This study has been performed at the Royal Portuguese Hospital of Pernambuco,
using a 6 MV, 10 MV, 15 MV, 6 MV FFF y 10 MV FFF beams of an STX linear accelerator model
TrueBeam; measurements were carried out with a Blue Phantom2 (IBA) type beam scanning system and
the OminiPro Accept v.s7 (IBA) software was used for data processing. The profiles were measured at 10
cm in depth with field sizes of 1x1cm2, 2x2cm2, 3x3cm2, 5x5 cm2, 8x8 cm2 and 10x10 cm2 (reference),
and source-surface distance (SSD) of 100cm. The measurements were performed with the silicon diode
(IBA-RAZOR), the ionization chambers ( PTW-31022, PTW-31010, IBA-Razor Nanochamber), the solid
state detector, BeO discs (Thermalox 995, Materion Ceramics Inc) with 3mm diameter and 1.5mm in
thickness and were compared with radiochromic system, composed by EBT3 films and a scanner Epson
11000 XL.
Results: The silicon diode RAZOR and nanochamber penumbra widths are in good agreement with those
obtained with the EBT3 films. Profiles measured with the PTW-31022 and PTW-31010 ionization
chambers overestimated the penumbra of the fields, mainly due to their larger detection volume.
Conclusions: The silicon diode RAZOR and nanochamber presents an excellent spatial resolution for dose
profile measurements, due to its small detection volume. The field sizes generally used in radiosurgery can
be measured correctly, without producing significant uncertainties in the acquired data.

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P-336

A RETROSPECTIVE ANALYSIS OF CYBERKNIFE TRACKING ACCURACY

THROUGH E2E RESULTS

Marcelo Picioli, Alvaro Ruiz Plata, Karla Torzsok, JohnAlbert Aponte, Filippo Marangoni

FALP, Chile

Radiation Oncology – Quality Assurance

Background: One of the most important parameters that must be accomplished during SRS/SBRT
treatments is geometrical accuracy, which could be achieved by means of rigid immobilization devices.
However, in frameless systems such as Cyberknife a set of trackings specified in accords to anatomical
areas are applied in real time during treatment using online image guidance. Any residual displacements
are made by the robotic arm. Total targeting error could be addressed by E2E tests. Comparing results
against machine specifications is part of present scope of this work.
Materials and Methods: E2E results for a Cyberknife M6 were evaluated for 6D Skull, Xsight Spine and
Fiducial tracking modalities using both cones and MLC collimators. An anthropomorphic head and neck
phantom were used during the measurements. The mean value, standard deviation and coefficient of
variation have been calculated. The latest parameter normalizes the standard deviation by its mean values
and allows a better understanding between sample dispersions.
Results: Total mean accuracy of 0.35 ± 0,17 mm was found as a composite of all trackings. Individual
results of 0,38 ± 0,16 mm, 0,35 ± 0,16 mm, 0,45 ± 0,16 mm were calculated for 6D Skull, Fiducial and
Spine respectively. A maximum deviation of 0.84 mm for spine tracking was observed. The coefficient of
variation applied for cones and MLC samples, regarding the same tracking, revealed a smaller dispersion
for MLC.
Conclusions:
E2EtestshavebeenshowntobeaverypowerfulmechanismtoaddressmachinespecificationsforCyberknife.
Moreover, provide a description of the entire process, providing a meaningful evaluation of the human
handling process and not merely mechanical behavior of the machine.

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P-338

PLAN COMPLEXITY ANALYSIS AND ITS CORRELATION WITH ARC

INCREMENTS DIMENSIONS IN MONACO TPS

Marcelo Picioli, Felipe Lucic, Gabriel Angulo, Justo Perez, Paulina Cantillana

FALP, Chile

Radiation Oncology – Dosimetry

Purpose/Objective: The correct understanding of the treatment planning system parameters is paramount
to avoid creating plans that could not be representative or that might cause extra machine stress during
delivery. From the numerous parameters available in Monaco TPS for VMAT planning we have tested how
arc increment dimensions would affect other treatment parameters such as MU, treatment time and number
of segments.
Materials and Methods: Ten prostate plans were evaluated using the increment sizes of 10, 20 and 30 in
Monaco TPS. In order to avoid asymmetries in MLC distribution related to leaf over travels, isocenter was
placed in the geometric center of the PTV. Despite of the increment values, all parameters such as number
of arcs, minimum segment size and prescription remained the same. Values for modulation factor, number
of segments, treatment time and total MU provided by Monaco console were evaluated and compared.
Results: Using smaller increment allows the system to create extra number of sectors in the arc, meaning
that leafs will sweep back and forward more frequently. In terms of complexity metric, calculated by the
modulation factor in Monaco it had a small impact. Modulation factors were spread from 2,3 to 4,5
regardless the increment size being used. However, by reducing the increment size from 30 to 10 have
showed to duplicate the MU for the majority of the cases. Treatment time has been also affected.
Conclusions: Although changing arcs sector dimensions will not dramatically impact on modulation factors
for prostate, it can be seen that increasing this value could reduce treatment time and MU. Nevertheless,
it's important mention that it could potentially also increase the number of segments with less MU that
could lead to dosimetric error during delivery.

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P-339

GOING CLINICAL WITH THE FIRST VARIAN HALCYON® MACHINE IN

ARGENTINA

Maria Del Pilar Duran, Flavio Salinas, Diego Dodat, Rosana Sansogne, Silvio Arbiser

Vidt Centro Médico, Argentina

Radiation Oncology – Dosimetry

Introduction: The first Varian Halcyon LINAC in Argentina had been installed replacing an older machine
in a very busy office. Therefore, it was required that it went clinical in the vendor's specified time for that.
This work describes the basic and clinically relevant tasks conducted by the Physics Department to achieve
that goal.
Methods and Materials: A set of safety checks and a radiation area survey were conducted to assure a safe
environment for public and staff before initiating the Installation Product Acceptance procedure as per the
vendor's IPA-AL-ICP-A document. Percentage depth doses and off axis ratio dose distributions for
Halcyon's 6X FFF beam were obtained using 2D automatic scanner and 0.125 cm3 ionization chambers,
for different field sizes from 2 to 28 cm @ 90 cm SSD. Beam profiles were obtained at five different depth
from Dmax to 30 cm. Detector positioning and water surface detection were achieved using a detector cap
with radio opaque BBs. SSD verification was performed as per the vendor's image-based method too. 1D
gamma fit analysis between measured data and both pre-configured and TPS calculated data was evaluated.
Absorbed dose at reference depth was adjusted following IAEA TRS 398 protocol. MLC alignment, speed,
positioning accuracy, repeatability and RapidArc Gantry speed/dose-rate/MLC speed tests were performed
and analyzed with Portal Dosimetry. Several E2E IMRT and VMAT plans were produced using Varian
Eclipse TPS on the CIRS thorax phantom and on a H&N phantom. Dose was determined in different points
and compared to TPS calculation. Plans were also evaluated using Portal Dosimetry. Results and
Conclusions: Mechanical and dosimetrical specifications were in tolerance as per the vendor's IPA-AL-
ICP-A document. PDDs and OARs dose distributions passed 1D gamma fit analysis for 2% 2mm. E2E
point doses were under 3% of TPS planned dose in all points.

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P-340

PORTAL DOSIMETRY IMAGE PREDICTION (PDIP) VALIDATION:

COMPARATIVE BETWEEN COLLIMATOR SCATTER FACTORS (Sc) MEASURED
AND CALCULATED

Claudio Mancilla, Alejandro Floriano

Instituto Nacional del Cáncer, Chile

Radiation Oncology – Dosimetry

Introduction: Our center implemented VMAT in a high-energy linear accelerator Trilogy® (Varian Medical
Systems) installed in September 2017. Trilogy has an EPID detector with a software that allows to measure
fluences from planning treatments and their comparison with calculated fluences. Portal Image Prediction
Dosimetry Portal model (PDIP®) requires commissioning data and standard data provided by Varian. The
outcome of this process is a kernel curve that is used to generate theoretical fluence planes. Validation of
the whole system is a prerequisite prior to clinical use. Our goal was developing a complementary PDIP
validation method by a comparative of measured collimator scatter factors (Sc) and calculated Sc by output
factors (Scp) provided by Varian.
Materials and method: Sc from rectangular fields was measured with semiflex ion chamber with build-up
cap. To obtain phantom scatter factors (Sp) from PDIP calculations, standard Scp data for PortalVision®
IDU20, the final kernel curve and a script programmed in Python with related libraries were used.
Results: Our results show differences between measured data (Sc_IC) and calculated data from PDIP model
(Sc_PDIP) for rectangular fields from 3x3cm to 30x30cm, with 6MV and 10 MV energies respectively.
Until to 15x15cm, the results show differences less than 2.0%. Larger fields show concordant discrepancies
with limitations reported by Varian.
Conclusion: The methodology shown, with other validation forms, allows us to implement the EPID / PDIP
set and begin its clinical use for treatment arcs with fields smaller than 15x15cm. The advantage of this
complementary validation is done through Sc, which is an independent parameter not used in the PDIP
model generation.

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P-341

USE THE DRR IMAGES FOR 3D PLANNING IN BRACHYTHERAPY

Bertha Garcia, Anthony Paredes, Gustavo Sarria

ONCOSALUD - RED AUNA, Peru

Radiation Oncology –Treatment Planning

Purpose:
Use the DRR images for 3D planning in brachytherapy.
Materials / Methods
Cone beam Elekta. Serie 335587 with program DRR XVI Version: 5.0.2. b72. 2014 Acelerator lineal Elekta
Infinity with Agility Head. Serie153350
Planificador HDR Plus for Braquiterapy Version 3.0.6
Equipment for Brachyterapy Multisource HDR-Plus
Tomografo Optima
Methods:
Treatment was planned in 3d brachytherapy for cases of cervix and prostate in 30 patients, using the DRR
images of the Cone Beam Linear Accelerator.
Results:
The reconstruction of needles and the dosimetry were compared with images of conventional Tomografo
vs DRR images of Cone Beam. And a smaller difference of 3mm of positioning was obtained in the needle
reconstruction for the case of prostate and intrauterine devices for the case of cervix. Regarding dose, no
appreciable difference was observed.
Conclusion:
1. It is recommended to use the volumetric DRR to plan cases of 3D Brachytherapy.
2. A considerable saving of time was observed in the acquisition of the images during the treatment.
3. There was a noticeable benefit in the monetary cost for the center.
4. In case the brachytherapy service is inside the radiotherapy service, a great time gain is observed.
5. In centers that do not count, or their access is limited to tomographic images, they may choose to use the
volumetric DRR images.

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P-342

SURVIVAL AND MIGRATION ASSESSMENT IN BREAST CELLS EXPOSED TO

RADIATION MAMMOGRAPHIC

Leslie Silva Pereira1, Samara Cristina Ferreira Machado2

1
Instituto de Radioproteção e Dosimetria, Universidade Federal do Rio de Janeiro, Brazil
2
Universidade do Estado do Rio de Janeiro, Universidade Federal Fluminense

Diagnostic and Interventional Radiology – General

Introduction: Mammography is a diagnostic imaging practice that uses ionizing radiation, which when
interacted with DNA can cause mutations and may contribute to the carcinogenic process. The objective of
this study was to evaluate whether the exposure to mammographic doses (8mGy and 16mGy) and the high
dose of ionizing radiation (2000mGy) are capable of altering cell survival and migration capacity in human
breast cancer cell lines (MDA- MB-231) and non-tumor (MCF-10A). Methodology: The cell survival assay
is standard and determines reproductive cell death after exposure to ionizing radiation. This parameter,
survival, was mathematically determined. To evaluate cell migration at low doses of ionizing radiation of
8 and 16mGy the Wound Healing test was performed.
Results: For cell survival, low doses of 8 and 16mGy X-rays were not able to induce cell death in the studied
strains. On the other hand, the dose of 2000mGy produced the death of 50% of the population of irradiated
cells, reducing the formation of colonies by 50%. In the evaluation of cell migration, the data suggest that
low doses of ionizing radiation do not induce changes in the cellular microenvironment that lead to an
increase in the migratory capacity of the analyzed cell lines. Conclusion: These data together suggest that
low doses of ionizing radiation (8 and 16mGy) similar to those used in breast screening were not able to
induce molecular changes leading to decreased cell survival and increased ability to migrate and eventually
metastasize to secondary sites, in normal cell line and triple negative mammary tumor line, characteristics
considered important in the process of carcinogenesis.

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P-343

CALCULATION OF THE STOPPING POWER RATIO WATER-TO-AIR FOR

REFERENCE DOSIMETRY IN HADRONTHERAPY

Mariel Elisa Galassi1, Benoit Gervais3, Michael Beuve4, Verónica Belén Tessaro2
1
Grupo de Física Biomédica, Instituto de Física de Rosario (CONICET-UNR) and Facultad de Ciencias
Exactas, Ingeniería y Agrimensura, Universidad Nacional de Rosario (UNR), Av. Pellegrini 250 – C.P.2000
Rosario, Argentina
2
Grupo de Física Biomédica, Instituto de Física de Rosario (CONICET-UNR) and Facultad de Ciencias
Exactas, Ingeniería y Agrimensura, Universidad Nacional de Rosario (UNR), Av. Pellegrini 250 – C.P.2000
Rosario (Argentina)
3
Centre de Recherche sur les Ions, les Matériaux et la Photonique (UMR6252), CEA/CNRS/ENSICAEN/
Université de Caen-Basse Normandie UCBN, CIMAP-CIRIL-Ganil, BP 5133, 14070, Cedex 05 -Caen
(France)
4
Université de Lyon, F-69622; Université de Lyon 1, CNRS/IN2P3, Institut de Physique Nucléaire de Lyon
- Villeurbanne (France)

Dosimetry – Reference quality

Accuracy in the Stopping power of liquid water and air is of fundamental interest in reference dosimetry
for Hadrontherapy. In particle therapy, ionization chamber dosimetry requires the knowledge of the water-
to-air stopping power ratio (SPRT). According to the International Atomic Energy Agency Technical
Report TRS-398, the SPRT for swift proton beams can be calculated using a semi-empirical law as a particle
range function. However, due to the complexity of the particle-energy spectrum for heavier ions, the
protocol recommends taking a constant value of 1.13 with an estimated uncertainty of 2%. In more recent
publications, a parametrization of the water-to-air stopping power ratio is proposed, but it depends strongly
on the ionization potentials of water and air used. Other authors propose an approach based on indirect
experimental measurements. In the present work, Stopping power of proton, helium, carbon and oxygen
ions in liquid water and air are calculated using a distorted-wave model to approximate the ionization cross
sections required. Taking into account only the primary particle spectrum (at the entrance channel), the
SPRT can be approximated as the ratio of the stopping powers of water and air. The ratios of theoretical
Stopping powers as a function of the incident energy and charge are compared with the obtained using the
values recommended by ICRU Reports 49 (for proton and helium) and 73 (for carbon and oxygen ions).
The dependence of the SPRT with the charge and energy of the incident ions is analyzed. Results are
compared with the proposed by TRS-398 and the calculated by the semi-empirical approaches.

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P-348

COMPARISON OF HALF VALUE LAYER MEASUREMENT METHODS IN

RADIOLOGY: DIRECTLY BY A SOLID-STATE RADIATION DETECTOR AND BY
X RAY PRIMARY BEAM ATTENUATION USING 99% PURITY ALUMINUM WITH
KNOWN THICKNESS SLABS

Denyel Jefferson Prado de Faria, Rafael Figueiredo Pohlmann Simões, Fernando Mecca Augusto,
Vinícius Daniel Caldas Santos Costa, Júlio Cesar de Souza Ribeiro

Instituto Nacional do Câncer, Brazil

Diagnostic and Interventional Radiology – General

The Half Value Layer (HVL) is a parameter used in the quality control to evaluate the x ray beam quality.
The HVL can be obtained directly by a multifunction dosimeter with a solid-state radiation detector
(method 1) or through the dosimetry of the x ray primary beam attenuation using aluminum with known
thickness slab with 99% purity (method 2). The main problem of the method 1 is the under-checking x ray
source equipment should be equal and operated under the same conditions as the tube reference quality
diagram (graphic that presents the relationship among total filtration and HVL for certain tension).
Knowing that the equipment is not alike or operated by the same manner, there are an uncertainty associated
to these HVL measurement obtained automatically. Therefore, using a NOMEX® (PTW) and Cobia
Smart®(RTI) dosimeter, and as source, x ray conventional (RX) equipment and mammographic (MM), the
measurement of HVL were performed by both methods, using the tension of 28 kVp, for MM, and 80 kVp
for RX, and the current-time product of 50 mAs. Using a NOMEX dosemeter the greatest percentage
differences found were 30,8% for MM, presenting with as result (0,529 ± 0,001) mmAl and (0,7646 ±
0,0007) mmAl by the method 1 and 2 respectively. For RX the greater difference was 14,3% for fixed RX
fine focus. For mobile RX (unique focus), 2,2%. For Cobia Smart detector the results were 3,1% for fixed
RX fine focus, and for mobile RX, 2,8%. The discrepancy in the results, varying from 2,2% for mobile RX
to 30,8% in MM, show the need of a calibration factor for the measurements of HVL performed when using
method 1.

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P-349

DEVELOPMENT OF RISK ANALYSIS MODEL FOR RADIOTHERAPY

Paulo Alfonso Varela Meléndez1, Carlos Eduardo de Almeida2

1
Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro., Brazil
2
Laboratório de Ciências Radiológicas, Universidade do Estado do Rio de Janeiro

Radiation Protection

In the radiotherapy process, it is essential to guarantee the quality of all the activities that ensure consistency
between clinical prescription and administration to the patient, the prescribed dose in the target volume,
minimum dose in the healthy tissue, treatment verification that determine the patient outcome and minimize
the risks associated with the use of ionizing radiation. Worldwide, during the past 25 years, the growth in
radiological incidents or accidents in the radiotherapy area have been documented, most of which are
caused by events associated with human failures and not by failures associated with equipment, occurred
more frequently in centers classified as high technology institutions. The aim of this study was to develop
one model for risk assessment of the linear accelerator teletherapy process in Radiotherapy Services, using
the risk matrix method proposed by the International Atomic Energy Agency (IAEA) and using a Risk
Index (IR), which considers the frequency of initializing events, their consequences and the probability of
failure of the security barriers involved. This model allows a regressive risk analysis, facilitating the
identification of the safety barriers not implemented in the Radiotherapy Service and which ones have a
considerable impact on the total risk. The model was tested using the information obtained through data
collection in ten Radiotherapy Services located in Brazil, through interviews and filling out a form
developed based on the auditing system of the International Atomic Energy Agency (IAEA) and the
mapping of the linear accelerator teletherapy process. From the value of the Risk Index, it was possible to
classify the level risk for each Radiotherapy Service. The results of this study indicate that the proposed
model for assessing risk was sensitive enough to identify the areas that need improvement and the safety
barriers that should be implemented to decrease the risk.

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P-351

PRELIMINARY STUDY OF THE EFFECT OF PROPOFOL, REMIFENTANIL AND

VECURONIUM ON DYNAMIC VISCOELASTICITY OF HUMAN RED BLOOD
CELLS

Nicolás A. Alet1, Marcus Vinicius Batista da Silva2, Horacio V. Castellini3, Martín Toderi4, Bibiana D.
Riquelme5, Analía I. Alet6
1
HECA, Argentina
2
FCByF (UNR)
3
FCEIA (UNR)
4
HECA FCByF(UNR)
5
Grupo de Física Biomédica, IFIR (CONICET-UNR), FCByF (UNR)
6
FCByF (UNR)

Biomedical Engineering

Several studies have shown that Propofol, a drug commonly used in anesthesia, can alter the rheological
properties of human red blood cells (RBCs) but there are poor reports about hemorheologic effect of
Vecuronium and Remifentanil. In the present work, we have studied the effect of Propofol, Remifentanil,
Vecuronium on dynamic viscoelastic parameters of erythrocytes from healthy donors using a newly
developed instrument called Reómetro Eritrocitario Computarizado (Erythrocyte Computerized
Rheometer), which is based on laser diffractometry technique. For this, healthy donor blood samples (n =
2) obtained by venous puncture and anticoagulated with EDTA were used. Samples were incubated at 37oC
diluting equal volumes of blood with saline solution added with the corresponding anesthetic drug (Propofol
4 mg/mL whole blood; Vecuronium 0.15 mg/mL plasma; Remifentanil 5 and 10 ng/mL plasma). The
following dynamic viscoelastic parameters were determined by quintuplicate for each RBC sample: elastic
modulus (μ), membrane surface viscosity (η), deformability index (DI), shift phase and complex
viscoelastic parameters (G', G'', n ,́ n”) at oscillation frequencies of 0.5, 1 and 1.5Hz. Results show that all
anesthetics used for treatment produced changes in the rheological behavior of the erythrocyte membrane,
but in different ways. Finally, this type of study would be important to prevent possible postoperative
microvascular complications.

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P-353

INFLUENCE OF CALCULATED DOSE MATRIX RESOLUTION IN PATIENT-

SPECIFIC VMAT QA RESULTS: SINGLE-POINT AND 2D MEASUREMENTS

Alejandro Floriano Pardal, Claudio Mancilla

Instituto Nacional del Cáncer, Chile

Radiation Oncology – Quality Assurance

Introduction: TG-218 recommendations have been implemented in our institution for the patient-specific
VMAT QA measurements. Absolute dose verification is carried out with a single-point ion chamber,
comparing dose measurement with volume average dose calculated by TPS. 2D measurements are carried
out with a diode matrix detector attached to the gantry (perpendicular field-by-field method), with a plane
dose comparison for each arc. In this study, we analyze the influence of the calculated dose matrix
resolution from TPS calculation (Eclipse 13.6) in the QA results
Materials and method: Patient-specific QA calculations in phantoms were carried out with three different
dose matrix resolution: 1.25mm, 2.5mm and 5mm for twenty patients. Difference found in average dose
for single-point and dose plane distribution were recorded for each resolution.
Results: For single-point measurements, differences up to 1.3% can be found depending on the resolution
used for TPS phantom calculation. In all cases, decrease the matrix resolution implies a higher average dose
in the ion chamber. For 2D measurements, the low gradient regions were not affected by the changes in the
dose matrix resolution, but areas with high gradient changed significantly. The 95% passing rate with 3%-
2mm gamma analysis was achieved with the three-resolution matrix, but only the 1.25mm resolution was
able to achieve it with the 3%-1mm gamma analysis.
Conclusion: Dose matrix resolution is a parameter that has an effect in the patient-specific VMAT QA
results, so it has to be taken into account when comparisons are carried out between measurement and TPS
calculations, especially if the TG-218 new recommendations are followed.
Keywords: TG-218, dose matrix resolution, patient-specific VMAT QA

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P-354

ANALYSIS OF THE VMAT-ARC PLANNING CONFIGURATION FOR SBRT

PATIENTS: OPTIMUM TECHNICAL DELIVERY AND TOTAL TREATMENT TIME

Alejandro Floriano Pardal, Claudio Mancilla

Instituto Nacional del Cáncer, Chile

Radiation Oncology – Treatment Delivery

Introduction: In SBRT lung patient, number of VMAT arcs used is a parameter that has to be selected
during TPS planning. In a standard 2Gy/daily fraction using two arcs, Eclipse/Trilogy® system (Varian
Medical System) is configured to obtain the best plan keeping constant the maximum gantry speed (4.8º/s)
whenever possible, in order to avoid gantry accelerations and decelerations. For 18Gy/fraction scheme, this
is no longer possible with two arcs. A decision must to be made about numbers of arcs used. This study
analyses the gantry speed variation and total delivery time in a SBRT scheme (3fraction x 18Gy) when a
two VMAT arcs technique is used, compared with the minimum number of arcs necessary to remain 4.8º/s
constant gantry speed recommendation.
Materials and method: Five dummy patients were planned with the SBRT scheme (18Gy x 3 fractions) with
two different techniques: a) two coplanar VMAT arcs and b) the minimum number of VMAT arcs
necessaries to remain gantry speed constant during the delivery. The speed gantry distribution and the total
treatment time was analyzed in both cases.
Results: For the a) option, speed gantry varies between 1.4º/s and 2.5º/s, with a mean delivery time of 7.5
minutes. The minimum number of beams necessaries for keeping constant the speed was eight arcs, with a
total treatment time of 10 minutes. In both techniques, the treatment plans achieved the RTOG-0915
constrains.
Conclusion: We have evaluated the minimum necessary number of VMAT-arcs for delivery 18Gy in a
fraction remaining constant the maximum gantry speed (something desirable to avoid gantry accelerations
and decelerations). A secondary advantage of using more VMAT-arcs would be that more control points
are included during the inverse dosimetry. The disadvantage is that delivery time is increase in around 2.5
minutes.
Keywords: Treatment planning, delivery, SBRT, VMAT.

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P-355

DETERMINATION OF REFERENCE LEVELS FOR SOME CONVENTIONAL

RADIOLOGY STUDIES AT THE NATIONAL UNIVERSITY HOSPITAL
OF COLOMBIA

Luz Dary Torres Angarita1, Maria Cristina Plazas1, Mara Edith Perez2
1
Grupo Física Médica Facultad de Ciencias Universidad Nacional de Colombia, Colombia
2
Hospital Universitario Nacional de Colombia

Diagnostic Radiology –Dosimetry

Reference levels in radiology work as a guide to apply actions which ensure doses of patients exposed to
ionizing radiation and begin through them processes of optimization, with the aim to obtain an acceptable
diagnosis image quality. A fundamental issue for determining the so-called indicative levels was the
development of the quality control of the X-ray conventional equipment in order to ensure the reliability of
the measurements. Two methods were used to measure the surface entrance dose, the former through the
use of the tube efficiency with specific parameters for each exam including a backscatter factor, the latter
by using thermoluminescent dosimeters. The reference levels were established at the Hospital Universitario
Nacional for thorax exam as it is the most frequent, lumbar spine since it involves greater radiation doses
and abdomen. The clinical evaluation of the image was made for every exam at least on one of its
projections. Results produced reference levels below the international levels, which can be explained by
the advances in digital radiology. However, it is suggested that the process of optimization of the installation
is started by introducing the scrap factor and training in the operation of the automatic exposure control as
an essential tool to diminish radiation doses with the purpose of reaching the standardization of the
acquisition protocols of the majority of conventional radiography exams.

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P-356

QUANTITATIVE AND QUALITATIVE EVALUATION OF THE EFFECT OF

ATTENUATION AND SCATTERING CORRECTIONS IN DEEP AND PERIPHERAL
REGIONS ON SPECT IMAGES

João Pedro Fiorelli, Eder Rezende Moraes

University of Sao Paulo, Brazil

Nuclear Medicine

Two phenomena that influence the formation of images within nuclear medicine are the scattering and the
attenuation of photons. The first one deflects the path of the photons in order to make it difficult to locate
the emitting source within the patient and thus to form images. The second reduces the number of photons,
causing the count to change and again we have an interference in the produced images. Due to the above-
mentioned facts, it is important to use corrective methods for these effects, since both generate a decrease
in the quality of nuclear medicine images. In this work we will be using some methods for correction of
attenuation and scattering in order to compare them and to verify which one presents a more significant
improvement in the quality of SPECT images. In addition, we will observe the influence of distance in
these processes, when evaluating the emission of radiopharmaceuticals housed in deep and peripheral
regions of the objects of study, due to the fact that the greater the path traveled by the radiation, the more
interactions will occur. The main methods for correction are Dual Energy Window (DEW) and Factor
Analysis for scattering, and correction considering a single attenuation coefficient (Chang) or considering
an attenuation map by means of CT for attenuation. In this study, these methods were developed in the form
of software in Matlab, and were applied to images obtained by simulations using the GATE software. After
GATE imaging, corrective methods were performed and corrected images were compared by quantitative
methods (such as gamma function) and qualitative methods (improvement in the visualization of structures)
in order to observe the positives and negatives of each method.

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P-357

BREAST CANCER: IMMOBILIZATION SYSTEM FOR HYPOFRACTIONATED

SCHEME IN PATIENTS WITH INCREASED BREAST VOLUME

Erika P. Rodríguez1, Bejarano B. Daniela2

1
Centro de Diagnostico y Tratamiento, CEDITRA S.A., Argentina
2
Vidt Centro Médico

Radiation Oncology – Treatment Delivery

Currently, in our institution 30% of the patients are treated for breast cancer and in some cases, we use
hypofractionation scheme, mostly in early stages, with equal oncological and long-term cosmetic results.
Patients with increased breast volume are frequently excluded from the hypofractionation scheme due to
the toxicities associated with the organs at risk (lung, heart, maximum point of global dose and in the areas
of folds). The purpose of this work is to earn experience with a thermoplastic thorax/breast immobilizer,
thus improving key factors such as: dose homogeneity, reproducibility of treatment fields, percentage
reduction of dose in organs at risk and minimization of toxicities in areas of folds, to be able to incorporate
this group of patients to the hypofractionated scheme.
Methods and Materials:
From the breast immobilizers that we have available in our service (WingBoard/Breast Ramp) an adaptation
was made to incorporate a thermoplastic mesh with dimensions of 290x530mm and 2.4mm thickness. A
group of patients were selected according to clinical characteristics and then two tomographies were
performed (with or without immobilizer) to make a dosimetric comparison with the Eclipse treatment
planning system. A clinical evaluation according to RTOG criteria was made to follow up these patients.
Results and conclusions:
The study showed:
A dosimetric reduction in 30% and 40% of the maximum dose and V20 in ipsilateral lung, respectively.
Decreased diaphragmatic movements improving the uncertainties associated with positioning. Skin toxicity
RTOG grade 1 and 2 in all cases. We observe good versatility of the device to reduce/eliminate skin folds
and to improve positioning reproducibility in these groups of patients with large breast volumes.

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P-358

BEHAVIOR OF THE CT NUMBERS USING SEVERAL RELATIVE ELECTRONIC

DENSITIES PHANTOMS IN A CONE BEAM CT

Claudio Mancilla, Rodrigo Cherubini Cisternas, Alejandro Floriano Pardal

Instituto Nacional del Cáncer, Chile

Radiation Oncology –Treatment Planning

Introduction: Our center VMAT with IGRT was implemented in a high-energy linear accelerator Trilogy®
(Varian Medical Systems) installed in September 2017. This accelerator has a conical-beam (CBCT) X-ray
source/detector (OBI) that allows to correct the planned target volume (PTV) location prior to patient
irradiation. In order to use 3D-OBI images in clinical dosimetry planning, with inhomogeneities
corrections, is mandatory to perform a CT number (#CT) to respect a relative electronic densities (RED)
calibration curve. Our goal was to determine the #CT behavior in CBCT with respect to its reference
behavior in a fan-beam CT.
Materials and methods: CIRS062® and CATPHAN604® cylindrical phantoms were used to determine the
#CT behavior with a length of 5 cm and 20 cm (Z-axis), respectively. These have calibrated RED inserts
with soft tissue, bone, water, air and dense polymers. The #CT were obtained from images acquired from
CBCT in half-fan mode at 125kVp.
Results: Our result shows the #CT behavior in a CBCT with respect its reference behavior in a CT. In
CBCT, #CT from CATPHAN604 showed a similar behavior to the reference behavior, both with positive
slopes in DER > 1.000 zone. In another hand, CIRS062 showed an anomalous behavior with #CT
significantly lower in DER > 1.000 zone. This alteration is a consequence of the increase in scattered
radiation that reaches the OBI detector panel.
Conclusion: The behavior of #CT in a CBCT for DER phantoms of different lengths was determined. For
#CT calibration in a CBCT, the use of phantoms designed for fan-beams is not recommended, since their
#CT are computed in an altered manner.

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P-359

EXPERIENCE OF 14 YEARS OF QUALITY AUDITS IN RADIOTHERAPY IN CHILE

Niurka Pérez1, José Luis Rodriguez2 , Gabriel Zelada3, Gabriela Chorbadjian1

1
Instituto de Salud Pública de Chile, Chile
2
Clínica Las Condes
3
Clínica Alemana

Radiation Oncology – Quality Assurance

Introduction:
With the modernization of the radiotherapy public services, the evaluations carried out by the Institute of
Public Health of Chile (ISP) in these services were modified and from 2006 they acquire the character of
quality audits. At present, these audits have expanded to all services and have also incorporated different
evaluation methodologies depending on the new technologies installed in the country.
Methodologies:
Through technical visits, the reference dosimetric systems of the radiotherapy services are compared with
the dosimetric system of the ISP. The calibration of photon beams is verified, according to the TRS-398
protocol. The calculation and administration of the dose is verified using type fields. Postal dosimetry
system is also used, developed by the Radiotherapy Quality Program of the National Cancer Institute in
Rio de Janeiro, Brazil, which allows the verification of the dose under reference and non-reference
conditions.
Results:
The number of equipment included in the evaluation of the audit, from 2006 to 2019, increased by more
than 300%. The comparison of the reference dosimetric systems has shown satisfactory results within ±
2%. The deviations detected in the calibration of the photon beams during the technical visits have been
within the research level.
Conclusions:
The work developed through quality audits has demonstrated the importance of redundant checks on
radiological protection of the patient. The incorporation of the postal audit allowed increasing the number
of equipment evaluated per year. The need of the incorporation of new evaluation methodologies for
advanced and more complex techniques that are implemented in radiotherapy services is confirmed.

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P-360

IMPLEMENTATION AND MONITORING OF SERVICE THE HIGH-DOSE

THERAPY WITH IODINE 131

Jose Ignacio Delgado Martinez

MEDINUCLEAR, Colombia

Radiation Protection

Iodine 131 in high doses is used for treatment of thyroid cancer, all the therapeutic procedures that are
carried out in nuclear medicine, iodine 131 is the most exposure generate for staff and public. During
therapy with Iodine 131, external exposure is considered the patient which is itself a radiation source, there
is risk of internal and external exposure through secretions in urine, saliva, sweat, patient waste between
others.
MEDINUCLEAR, implemented the therapy service with Iodine 131, taking account the optimization
practice and dose limitation, dedicated area was designed with rooms, solid waste management, washing
and external area to visit by video call , shielding calculation was established; the risk of internal exposure
due to contamination in the rooms is handled by cleaning protocol, protection of contact areas and
separation of excreta, the handling urine is carried out with a system of EDEC decay tanks from TEMA
SINERGYE. The service was implemented in 2015. During the first year dosimetric follow-up was
performed to the nursing assistant where the average monthly dose was within the allowed dose of the
public, the dose for medical physicist and specialist in nuclear medicine are within the levels for personnel
occupationally Exposure, the risk to external radiation for clinic staff was optimized with the use of an
internal barrier with 6mm lead shielding, the patient is educated in the food they eat and making use of
disposable implements, annual discharges of 3000 liters have been released to the environment fulfilling
the levels of dispensation.

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P-361

REDUCTION OF THE ACQUISITION TIME TO HALF IN THE MYOCADIAC

PERFUSION IMAGING BY IMPLEMENTING THE OSEM-3D RECONSTRUCTION
METHOD OF THE OASIS SOFTWARE PACKAGE

Marco Antonio Coca Pérez, Claudia Paola Velasquez Bazaes, Jacob Garay Urrutia

Medscan Nuclear Medicine and PET-CT Center, Chile

Nuclear Medicine

Results of Myocadiac Perfusion Imaging (MPI) using OSEM3D reconstruction and half-time acquisition
were compared with the results of FBP reconstruction and MPI full time by mean of CardiacREquant-
Cardiogam (Oasis 1.9.4.2 sp2.10735 on Windows 7 x64) for the same patient. The images were evaluated
by a clinical expert. Fifteen patients suffering or suspected coronary artery disease were included in this
study. Gated-SPECT of MPI were performed to all patients. Full time (25s and 20s per angle, for 8-10mCi
and 30-35mCi, respectively) and half time (12s and 10s per angle, for 8-10mCi and 30-35mCi, respectively)
acquisitions were carried out to each patient. We evaluate that the MPI half-time applying OSEM3D
reconstruction is clinically acceptable for use. Correlation between FBP- MPI full time and OSEM3D-MPI
half time result is within reasonable clinical parameters in patients included in this study.
Myocardial perfusion per segment, ejection fraction and wall motion and thickness were evaluated in each
patient by an expert nuclear medicine doctor. As results, a good correlation between FBP-MPI full time
and OSEM3D-MPI half time result within reasonable clinical parameters was obtained in patients included
in this study.

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P-363

MEASUREMENT OF PERFORMANCE CHARACTERISTICS OF PHILIPS GEMINI

TF64 PET/CT

Joaquín González González1, Carlos Calderón Marín1, Consuelo Varela Corona2

1
Instituto de Oncología y Radiobiología de Cuba, Cuba
2
Centro para el Control Estatal de la Calidad de los Medicamentos

Nuclear Medicine

The Philips Gemini TF64 PET/CT is integrated by a third generation fully tridimensional whole body PET
scanner with time- of-flight technology (TOF) and a 64-slice Brilliance CT scanner. The main purpose of
this study was to measure the performance characteristics of PET component of the PET/CT scanner.
Spatial resolution, sensitivity, scatter fraction, counting rate performance, image quality and accuracy were
measured according to the NEMA NU-2 2007 procedures. Additionally, to characterize the effect of TOF
reconstruction on lesion contrast and noise, the standard NEMA image quality phantom was reconstructed
with and without TOF capability. The measured values of transversal and axial resolutions, absolute
sensitivity of the PET scanner at the center and at 10 cm off-center, scatter fraction, counting rate
performance, accuracy of correction for count losses and random coincidences as well as image quality
measurements of lesions contrast and background variability were within manufacturer specifications. A
modest improvement of lesion detectability was observed when standard NEMA image quality phantom
was reconstructed using TOF capability. The measurements of performance characteristics of the PET
component of Philips Gemini TF64 PET/CT scanner installed at the Institute of Oncology & Radiobiology
satisfies the manufacturer specifications.

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P-365

DOSIMETRIC EVALUATION OH THE LINEAR ACCELERATOR MODEL

SYNERGY AIMING THE IMPLEMENTATIONS OF THE TECHNIQUE VMAT

Marcos Aurélio Gomes de Albuquerque1, Edimario Costa1, Carlos Eduardo Veloso de Almeida2
1
Hospital Portugues da Bahia, Brazil
2
Rio de Janeiro State University

Radiation Oncology – Dosimetry

In recent decades radiotherapy lived with a great technological evolution, not only in equipment but also in
treatment techniques. The rotational intensity modulated technique also known as VMAT is even more
complex when compared to IMRT due to their higher number of degrees of freedom, such as gantry rotation
and dose rate. Despite few centers have VMAT as a treatment option, this technique is already a reality in
Brazil and its clinical implementation requires a rigorous quality control program. Aiming to ensure that
the linear accelerator, using this technique, delivered the correct dose to the patient, in this work a
dosimetric study was performed to implement this technique. The work was adapted by TG119 and divided
into three parts. It was assumed that all mechanical tests had already been performed, so the End to End
tests were performed for dosimetric verification. In the first step a solid water plates phantom with two
ionization chambers was used to measure dose in the low and high gradient region. In the second step the
main TG119 tests were adapted for the VMAT technique and performed following the TG119
recommendations. In the third step a phantom with heterogeneity was used in order to force a more complex
fluencemap. In all tests satisfactory results were found, since the objectives planes until the planning quality
controls and the point dose comparison with the ionization chamber. The plannings were evaluated by the
Gamma evaluation method and approved following the criteria proposed by TG119 and TG128, were all
points has an approval beyond 95% as the previous documents named recommend. The dose comparisons
between the TPS and the ionization chamber had smaller differences than 3% suggested by TG119.So it
can be concluded that the dose delivered to the patient will be performed in a correct way under the
established limits.

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P-366

DOSIMETRIC ANALYSIS BY MONTE CARLO SIMULATION OF PHOTON

RADIATION THERAPY IN THE PRESENCE OF ORTHOPEDIC FEMUR
PROSTHESIS

Diego Fernando Andrade Melo1, Luz Stella Veloza Salcedo2, Pamela Ochoa Parra1
1
Departamento de Física, Facultad de Ciencias, Universidad Nacional de Colombia, Colombia
2
Associate Professor, Department of Physics, Universidad Nacional de Colombia /
Humboldt Ambassador Scientist of the Alexander von Humboldt Foundation

Radiation Oncology – Dosimetry

A factor that affects the quantification of dose in an external radiotherapy treatment is the presence of
artifacts, such as those generated by femoral prostheses, which have high density and high atomic number
Z. Since in these cases it is a challenge to accurately calculate the dose distribution, one of the most common
method to solve the problem is contouring in the treatment planning, as if they were water, the high density
and high-Z materials and the artifacts around. Recalling the higher incidence of prostate cancer in elder
men, the goal of this work was to determine by Monte Carlo simulation how dose distributions in 3DRT
and IMRT prostate cancer treatments are affected due to the proximity between the prostate and the femur.
A titanium (Ti) prosthesis submerged in an elliptical water phantom (representing the pelvic region of the
human body) was simulated and irradiated by photons of 6 and 18 MV using the Geant4/TOPAS Monte
Carlo code. The dose distribution was analyzed and compare with the simulation without Ti prosthesis. It
was found that in the presence of Ti implants the dose increases between 20% - 35% due to scattered
radiation. Additionally, different prostate tumor sizes were simulated with the presence of prosthesis,
finding that around of the PTV the relative dose increases by approximately 2%.

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P-367

FEASIBILITY STUDY: USE OF CINE-MRI FOR MR-GUIDED PT

César Sepúlveda1,2, Kai Dolde2, Lucas Burigo2, Nami Saito3, Asja Pfaffenberger2
1
Pontificia Universidad Católica, Chile
2
German Cancer Research Center, Heidelberg Institute for Radiation Oncology, Heidelberg University
3
German Cancer Research Center, Heidelberg Institute for Radiation Oncology, Heidelberg University
Hospital

Radiation Oncology – Treatment Delivery

Introduction:
Cinematic Magnetic Resonance Imaging (cine-MRI) are fast time-resolved 2D MRI sequences that allow
online visualization of organ motion without exposing patients to ionizing radiation. In this study, the
potential of cine-MRI for the definition of an image-based gating criterion in particle therapy of pancreatic
cancer is investigated. Transversal cine-MRI are employed to segment the pancreas, since they can provide
information on tissue changes in the beam-path during delivery.
Methods and Materials:
Volunteer data were acquired on 10 different acquisition days. An image-based gating window was defined
based on the breathing-curve (BC) of the first day (end-exhale breathing phase). The superposition of the
pancreas segmentations in this window was calculated. For other days of data acquisition, the agreement
with this initial superposition contour was evaluated by using different segmentation image similarity
metrics.
Additionally, a motion analysis of the pancreas was performed.
Results and Conclusions:
From the metrics comparisons, a gating criterion was defined to establish when irradiation can be allowed.
An evaluation of the dosimetric differences due to differences in the segmentations achieving the criterion
and the spatial location of the organs was carried out for a proton treatment. This study shows the potential
of an image-based gating window definition by using similarity metrics and cine-MRI. Although the
method applied was subjected to several limitations, it was proved to be feasible.

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P-369

AMORPHOUS SILICON PANEL USAGE TO DEVELOP A NEW CYBERKNIFE M6

LASER SYSTEM-RADIATION COINCIDENCE VERIFICATION METHOD

Alvaro Ruiz, Andrés Alarcon, Betsabe Diaz, Jhonalberth Aponte, Filippo Marangoni

FALP, Chile

Radiation Oncology – Quality Assurance

The Cyberknife-M6 laser system is used to visually represent the radiation field centre within 1 mm
tolerance. It is used for important tasks like positioning detectors in water tanks, paths verifications and
calibrations for each collimator type (Fixed and MLC) and user recorded points shifts over time. Thus, a
high constancy of laser position is required. Manufacturer recommended test requires use of films, result
time consuming, user dependent and a low precision method. To develop and establish a filmless, less time
consuming, less user dependent and higher precision test is the objective of this work. Methodology makes
use of an amorphous silicon (aSi) panel, the Ciberknife conventional film method and an IBA® water tank
to measure laser-radiation deviation. ASi-panel measurements were done right after water tank and film
measurements taking into account aSi-panel effective point position. These 3 sets and methods were used
to determine precision and accuracy among the three. Knowing the panel resolution, pixel position was
transformed into distance. Controlled displacements, from 0.2 until 3.3 mm, were introduced in Crossline
and Inline directions in order to test device response.
Results: water tank method: 0.24 mm average deviation, 0.03 mm standard deviation and 11.47 % variation
coefficient. aSi- panel method: 0.8 mm initial deviation and deviation measurements for introduced
displacements are between 1.02 mm and 3.44 mm. film conventional method: 0.68+/-0.34 mm average
deviation. As for objective compliance, a simple experiment and calculation have been necessary to
determine acceptable precision and low accuracy for aSi-panel. Therefore, it is recommended to use aSi-
panel for constancy only tests. Correlation with water tank deviation values should be determined by a new
software development. Film method has shown no overall process advantage. Time saving is notable aSi-
panel 15 minutes, films (1 hour), water tank (4 hours).

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P-370

CONVERAY: CONVERGENT BEAM RADIOTHERAPY

Mauro Valente, Rodolfo Figueroa, Jorge Leiva, Roberto Moncada, Mauricio Santibañez

Centro de Física e Ingeniería en Medicina - CFIM, Universidad de La Frontera, Chile

Biomedical Engineering

Introduction:
Converay® is a novel technology suitably designed to be adapted to LINAC head producing convergent
photon beam, which is produced by the perpendicular impact of LINAC electrons on thin cap target.
Methods and Materials:
Initially, device concept was studied and optimized by Monte Carlo simulations. Then, the first prototype
was constructed demonstrating the feasibility for the electron beam control by high intensity magnets as
well as the production of convergent photon beam by bremsstrahlung.
Results:
Remarkable improvements in dosimetry performance are achievable by CONVERAY®, obtaining high
peak dose at convergence focus, this strongly minimizing surface and surrounding tissues.
Conclusions:
The CONVERAY® device demonstrated to be feasible and reliable with noticeable advantage when
compared with traditional (divergent) beams. CONVERAY® output can be adapted for photon as well as
electron convergent beams.

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P-372

INFLUENCE OF THE KILOVOLTAGE VARIATION IN THE PET-CT

QUANTIFICATION

Marco Antonio Coca Pérez1, Claudia Paola Velasquez Bazaes1, Miguel Rivera Carrillo2, Jacob Garay
Urrutia1
1
Medscan Nuclear Medicine and PET-CT Center, Chile
2
Universidad Nacional Andrés Bello, sede Concepción, Chile

Nuclear Medicine

PET-CT studies have great relevance in the diagnosis of pathologies associated with neoplasms and tumor,
due to the fused images with anatomical (CT) and metabolic (PET) information. Despite the benefits
provided by this type of study, there are some disadvantages, such as the high radiation doses received by
the patient, from the radiopharmaceutical administered and the dose provided by the CT. Therefore, the
radiation dose optimization in these studies is very important. In this work, we proposed to evaluate the
effects of the kV level on the CT part, in the quantification of PET images. To do that, a cylindrical phantom
filled with water and four FDG sources fixed in its interior was used, and PET-CT images of this phantom
were acquired using different values of kV. The images were processed with the OSIRIX/HOROS software,
obtaining SUV values from each source of FDG. Subsequently, a statistical analysis was carried out in
order to evaluate the significant differences between the SUV values of each sources for the different kV.
As conclusions, it was corroborated that the variations of the kV in the CT did not affect the quantification
of lesions in the PET images. Due to, we proposed that the dose provided by the CT can be decreased,
without affecting the detectability of PET lesions.

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P-373

KIDNEY MOTION DURING RESPIRATION - IMPLICATIONS FOR SABR

TREATMENTS

Horacio Patrocinio1, João Fonseca3, Fábio Cury1, Izabela Matos2

1
McGill University Health Centre, Montreal, Canada
2
HCor, São Paulo, Brasil
3
IPOLFG, Lisboa, Portugal

Radiation Oncology – Treatment Delivery

Introduction: Stereotactic ablative radiation therapy (SABR) is a promising option for treating kidney
tumors. This study aims to investigate the normal kidney motion and its implications for margin definition
in such treatments.
Materials and Methods: 50 patients were imaged using 4D computed tomography for SABR to the
abdominal region other than the kidney. Images at inhale and exhale phases of the natural breathing were
obtained with the aid of a commercial bellows system and transferred to a registration system (MIM v. 6.5,
MIM Software Inc.). We assessed volume changes, displacements of the center of mass and organ rotations
between the two phases.
Results: No population trend for renal volume change due to breathing was observed despite individual
variations of up to 25%. Mean displacements were 0.3mm±0.8mm (range -1.7mm to 3.4mm), -
0.5mm±0.9mm (range -4.7 to 1.4) and 3.6mm±3.3mm (range -0.4mm to 16.4mm) in the left/right,
anterior/PA and superior/inferior directions for left kidneys, and 0.2mm±0.9mm (range -3.0mm to 1.3mm),
-0.9mm±1.5mm (range -4.5 to 1.0) and 3.9mm±4.1mm (range -1.3mm to 18.3mm) in the corresponding
directions for right kidneys. Mean rotations about the left-right and anterior-posterior axes were zero for
both kidneys (standard deviations of 0.3° to 0.6°) but with individual kidneys showing rotations of up to 3
degrees. Rotations about the superior-inferior axis were -0.6°±0.7° (range -3.0° to 0.2°) for the left kidney
and -0.6°±0.7° (range -3.0° to 0.2°) for the right kidney. The impact of these deviations on SABR plans
was examined through test cases involving the largest motions observed.
Conclusions: Although mean displacements about the center of mass and rotations of the kidneys were
small, large individual deviations were observed. Our results suggest that care should be exercised on an
individual basis when choosing SABR margins around renal tumors and that an assessment for each patient
may be warranted.

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P-374

PRELIMINARY CONCEPTUAL DESIGN OF AN ION ACCELERATION COLUMN

FOR A COMPACT NEUTRON GENERATOR EMPLOYED IN NEUTRON CAPTURE
THERAPY

Jorge Alberto Cifuentes Parada1, José Antonio Sarta Fuentes1, José Alfonso Leyva Rojas1, Edwin
Munevar Espitia2, Victor Alfonso Díaz Gomez2,
1
Pontificia Universidad Javeriana, Colombia
2
Universidad Distrital Francisco José de Caldas

Biomedical Engineering

Introduction:
We have been working on the development of a neutron source suitable for the application in NCT. In this
paper we focused on the construction of ion accelerators that enable the implementation of a compact
neutron source.
Methods and Materials:
With the purpose to establish the basis design for a Compact Neutron Generator CNG for NTC applications,
the ion column acceleration is of great importance. We have reviewed the specialized literature and focused
mainly on the different types of ion sources, extraction and acceleration systems and also on the used targets
for the CNG. After choosing the geometry for the acceleration column we have solved the Laplace equation
for this specific geometry using numerical methods and obtained the equipotential surfaces and the ion
trajectories. We have also experimentally validated these particular set of electrodes. Finally, we have
estimated the neutron flux as a function of the column accelerating voltage and its ion current for a given
target.
Results:
Considering the necessary absorbed doses for a tumor, the design parameters chosen in the present study
for a CNG corresponded to an ion source chosen corresponds to an RF source that generates a monoatomic
deuterium D+ beam. The linear acceleration system of 100 kV consists of three regions: one of extraction,
one of acceleration and one of suppression. With extraction voltage changeable of 0 -10 kV, acceleration
voltage of 100kV and suppression 10 kV, for a deuteron current 1500 mA, generating neutrons with a of
fluence 1x1010 n/s, a flux of 1x109 n/s cm2 with a current density between 10 mA/cm2 and 100 mA/cm2.
Conclusions:
In this work we present the preliminary basis design of the ion column acceleration of a CNG used in NCT.
We also present an estimated of the neutron production in this CNG.

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P-375

A NOVEL METHOD AND ASSOCIATED DEVICE FOR TUMOR THERANOSTICS

Rodolfo G. Figueroa, Mauro Valente, Jorge Leiva, Francisco Malano, Jaime Gaurda

Centro de Física e Ingeniería en Medicina - CFIM, Universidad de La Frontera, Chile

Diagnostic and Interventional Radiology – General

Introduction:
A novel method and device for simultaneous tumor diagnosis and treatment is presented. The main strategy
is based on detection of deep X-ray fluorescence (produced at deep positions due to a suitable convergent
beam) by tumor targeting with high atomic number nanoparticles, which can be adhered to the tumor
through the antibodies. Moreover, the proposed confocal irradiation-detection configuration may
significantly improve the overall process for step-by-step sample scanning. Materials and Methods:
During first stage, PENELOPE Monte Carlo simulation code served as study tool for several setups and
GNPs concentrations that served to design the prototype, currently in construction (Pat Pending).
Results:
According to the obtained results, position of the X-ray fluorescent emission point (inside target area) was
defined according to focal point of the convergent beam. Infusing with suitable non-toxic GNPs
concentrations, it would be possible to detect deep tumors (more than 5 cm deep, at least).
Expected spatial resolution was assessed to be around 1mm, thus improving functional techniques typical
of nuclear medicine. The first experimental results were already obtained capable of mapping Au
distribution within a bioequivalent phantom. Conclusions:
Preliminary results are promising and supporting the development of a novel theranostic technique capable
of imaging and/or simultaneous treatment.

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P-377

EXPERIMENTAL AND MONTE CARLO ANALYSIS OF ABSORBED DEPTH- DOSE

CURVE INDUCED BY 20 KV-160 KV X-RAYS IN LIQUID WATER

Adriana Moreno-Ramírez, Guerda Massillon-JL, Abel Hernández-Guzmán

Instituto de Física, Universidad Nacional Autónoma de México, Mexico

Diagnostic Radiology –Dosimetry

The use of low energy photons in medical applications varies from mammography beams (~ 20 kV) up to
computed tomography and conventional radiography (~120 kV). It is well known that at these energies, the
photon fluence decreases drastically with increasing distance from the source due to the photoelectric effect.
Consequently, a high dose gradient exists. Therefore, very few accurate and precise data are actually
available for low photon energy beams. This work aims at investigating, experimentally and through Monte
Carlo (MC) simulations, the absorbed depth-dose curve induced by 20 kV- 160 kV x-rays in liquid water.
For the experimental part, the measurements are performed in a home-made water phantom using 3
ionizations chambers; whereas for the MC simulation, the calculations are done using the NIST M-series
x-ray spectra measured in our lab with a high purity germanium detector and the N-series x-ray beams
measured and reported by PTB Germany. The analysis will be done to determine the influence of the beam
qualities in the depth-dose curve.

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P-381

STUDY OF THE PARAMETERS OF CALCULATION OF DOSE IN THE PLANNING

SYSTEM FOR RADIOCIRURGICAL TREATMENTS

Carmen Sandra Guzman Calcina1, Yuliana Marilyn Ayala Piñella2, Oscar Barriga Tantalean2
1
Centro de Radioterpia de Lima / Universidad Nacional Federico Villarreal, Peru
2
Centro de Radioterapia de Lima

Radiation Oncology –Treatment Planning

One of the important aspects in the application of treatment with radiosurgery is the conformity of the white
volume, for such, it is used: Index of homogeneity (IH) which evaluates the distribution of doses that are
homogeneous and the index of conformity (IC) measures the conformity of dose distribution and it was
developed as a section-by-section extension of the dose-volume. Histograms can be defined as an absolute
value result from the relationship between the volume of the lesion or a fraction of this volume and the
volume delimited by an isodose or a fraction of this volume. This work aims to carry out this dosimetric
evaluation by means of the IC proposed by Lomax, for this evaluation were considered a group of 98 plans
performed with Radiosurgery stereotactic (76 arteriovenous malformations, 8 neurinomas of the acoustic,
7 tumors, 5 meningiomas and 2 cerebral cavernomas), the planning system was used Computerized MNPS
(MEVIS), with the technique with cones with diameter sizes between 9 and 33mm (BlueFrame NS/SRS),
for the immobilization a stereotactic frame and the lesion to be used, as well as position the skull in relation
to the irradiation device. The results obtained were: IH average 1.89, IH ≤ 2 (66%, the treatment is
considered to comply with the Protocol), 2 < IH < 2.5 (34%, the treatment violation is considered minor),
IH > 2.5 (0% The protocol is completely violated) and the average IC was 0.98, IC = 1 (73%, treatment is
considered ideal), 0.8 < IC < 1 (28%, treatment is considered to violate the protocol but in a small
proportion) and IC < 0.8 (0% treatment is considered to violate the protocol completely), which can be
concluded that the treatments given were appropriate.

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P-382

CALIRAD: A TOOL TO EVALUATE QUALITY RADIOLOGY SERVICES

Luis Yoel Hernández López1, María del Carmen Tellería Prieto2

1
Sociedad Cubana de Imagenología / Sociedad Cubana de Bioingeniería, Cuba
2
Sociedad Cubana de Bioingeniería

Diagnostic and Interventional Radiology – General

The main objective in radiology is to obtain images of good quality for certain diagnosis, without
unnecessarily irradiating the patient. Each element in the chain of obtaining radiographic image must be
verified in order to achieve such goal. This paper shows an informatic tool that help to evaluate quality in
the radiology service of the Hospital “Abel Santamaría Cuadrado”, Pinar del Río, Cuba. The basic
indicators of quality: rate reject films, clinical image quality and patient dose were the basis for this tool.
Methods and materials: National and international protocols were useful like guides for evaluation of the
quality's indicators. The unified modeling language UML, Enterprise Architect, Axure RP, Symfony,
MySQL and PHP, were utilized in order to develop the application.
Results: A multiplatform web server-client online 24 hours a day was developed with an authentication
access for the registered users. The patients' data, their studies, medical reports and image quality
evaluations must be registered in this tool by X-ray technicians, radiologists. The quality control, the
radiographic and mammographic equipment's data, maintenances status must be showed by the web after
that medical physicist, electromedical introduce important data. This informatic tool calculates rates
rejections films, scores of clinical image quality evaluations, estimates patients' dose and records the online
time of medical equipment. This tool evaluates, generates graphics and reports of the department quality.
Conclusions: An informatic tool was developed to controls and evaluates the performance of the radiology
department. It's a useful tool for comparisons between health institutions and to carry out external and
internal audits.

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P-383

DOSIMETRIC LEAF GAP AND TRANSMISSION FACTOR MEASUREMENT:

INFLUENCE IN PATIENT-SPECIFIC QA

Rodrigo Cherubini Cisternas, Alejandro Floriano Paradal

Instituto Nacional del Cancer, Chile

Radiation Oncology –Treatment Planning

Introduction:
Among parameters that must be determined for Multileaf Collimator (MLC) characterization and
commissioning, and of importance for intensity modulated techniques (IMRT, VMAT), are Dosimetric
Leaf Gap (DLG) and Transmission Factor (TF). This study aims to determine the influence of both factors
in patient-specific quality assurance.
Methods:
DLG and TF were measured with Farmer ionization chamber (IC), Mapcheck2 (MC2) and Portal
Dosimetry (PD), according to the procedure described by Varian, with 6MV photons in a Varian Trilogy
LINAC, in order to compare the values obtained with each detector.
The Chair Test was measured with MC2 and PD, and then compared with the calculated plans in the
treatment planning system with different values of DLG and TF, by global gamma analysis of 1%-1mm
and 3%-2mm, with a 5% dose threshold.
Then, DLG and TF values that showed the best results in gamma evaluation in the chair test were used for
IMRT and VMAT plan comparisons.
Results:
We found differences between the resulting DLG and TF values when measured with IC, MC2 and PD.
In Chair Test with MC2, an improvement up to 8% was obtained over the results with the commissioned
values in 1%-1mm gamma evaluation, and near about 1% in 3%-2mm evaluation. In PD, an improvement
up to 1% was obtained over the results with the commissioned values. In patient-specific measurements
(IMRT and VMAT plans), an improvement of less than 1% was obtained in 3%-2mm gamma evaluation
with both detectors.
Conclusions:
Minor variations of commissioned DLG and TF values do not show significant differences in patient-
specific quality assurance. Only large variations in DLG and TF can significantly affect gamma analysis in
the comparison of patient-specific measurements.

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P-385

EVALUATION OF CALCULATION ALGORITHMS ACUROS XB (AXB) AND AAA

(ANISOTROPIC ANALYTICAL ALGORITHM) FOR PHOTON BEAM IN
HYPOFRACTIONATED BREAST PLANS

Tatiane E. Mirapalheta1, Antonio Augusto Freitas Peregrino2, Carlos Eduardo Veloso de Almeida1, Érika
Munõz2, Rafael Simões
1
Fundaçâo do Câncer, Universidade do Estado do Rio de Janeiro, Brazil
2
Universidade do Estado do Rio de Janeiro

Radiation Oncology –Treatment Planning

The objective of this study was comparing the Acuros XB algorithms to AAA algorithm, in dosimetric
impact, in treatment volumes and Organ on risk (OAR), especially involving pulmonary heterogeneities.
Strategies used as assessment, CI (Conformity Index) and IH (Homogeneity Index), dose distribution with
V95% and V107% for PTV. In OARs, the evaluations were performed observing reference values for
hypofractionated treatments, proposed by QUANTEC and RTOG 1005. Two methodologies used (constant
UM and re-optimization), treatment plans were elaborated based on twenty tomographic studies of female
patients with left breast cancer, opposing tangential fields in the field in field technique, 6MV and 10 MV
photon energy, integrated reinforcement fields with a 45o or 60o dynamic filter. For a constant, V107% the
PTV breast where AAA underestimates at -7.52% and AAA SCH at -18.71%. In OAR evaluations for the
left lung, between AAA and Acuros XB algorithm the difference was 1.62% for V5Gy, AAA being
overestimating the dose. While for AAA SCH the percentage difference underestimates at -18.67. For
average dose in cardiac region, AAA presented 2.14% and AAA SCH 3.30% in relation to Acuros XB,
overestimating the dose. For region-delimited skin, the mean dose for AAA presents -5.54% and AAA-
SCH-11.70%, underestimating the dose relative to Acuros XB. For re-optimization the largest difference
observed for V107% in PTV breast, in comparison of AAA SCH with Acuros XB of 34.32%, and AAA
found 13.34%, overestimating the dose relative to reference. For average dose in cardiac region, AAA
presents 2.20% and AAA SCH 5.70% in relation to Acuros XB, overestimating the dose. In delimited skin
region, the mean dose for AAA presented -4.54% and AAA-SCH - 8.50%, underestimating dose relative
to Acuros XB. In clinical transitions from one algorithm to another, these should be accompanied by studies
and simulations in planning systems, before considering clinical implementation.

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P-387

DOSIMETRIC COMPARISON WITH DIFFERENT HYPOFRACTIONATED IMRT

TECHNIQUES FOR PROSTATE CANCER RADIOTHERAPY

Alexis Troncoso1,2, Valeria Zurita2, Jorge Berrios2, Tatiana Umaña2, Herve Broque2
1
Medical Technologist Department Universidad de Chile, Chile
2
FALP

Radiation Oncology –Treatment Planning

Dosimetric comparison with different hypofractionated imrt techniques for prostate cancer radiotherapy.
Prostate cancer is a diagnosis that can be treated with radiotherapy in multiple ways. Considering that
control patient position and treat and control the position of the tumor and organs at risk at the same time
are relevant dosimetric goals to achieve in any hypofractionated treatment. In a hospital with different kind
of technologies could be useful to well understand the capabilities of each one of them in such an important
dose delivery. Calculating plans for different machines in order to compare dosimetric aspects has been the
objective of this investigation.
Methodology: 10 cyberknife plans of patients with located prostate cancer have been selected, prescription
dose was 36,25 gy delivered in 5 fractions of 7,25gy each one. Alternative treatment plans for every patient
were carried out with Vmat and helicoidal tomotherapy technique, using the same dosimetry protocol in
order to evaluate the PTVS and organs at risk. In addition, conformality and homogeneity index were
calculated as well. As a result of the dosimetric comparisons no differences between the techniques to
achieve the dose in the PTV and low dose in organs at risk was found, being cyberknife which delivered
less doses in rectum and tomotherapy calculated less doses in bladder, urethra and femoral heads.
Conclusion: the three techniques are useful for the treatment of the located prostate cancer from the
dosimetric point of view, but the great superiority of cyberknife is the ability to follow the movement of
the organs with registration of images, online or intrafraction, which guarantees a greater quality during the
fraction.

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P-388

Geant4 SOFTWARE FOR IN SILICO COMPARISON OF THE BRACHYTHERAPY

DOSIMETRY DUE TO Co-60 AND Ir-192 HIGH RATE DOSE SOURCES

José Antonio Díaz Merchán1, Diana Jazmín Ortegón Pineda3, Segundo Agustín Martinez Ovalle4, Armando
Cristian Camilo Castellanos Jerez2
1
Universidad Pedagógica y Tecnológica de Colombia, Centro de Cancerología de Boyacá., Colombia
2
Instituto de Cancerología Las Américas
3
Universidad Nacional de Colombia
4
Universidad Pedagógica y Tecnológica de Colombia, Centro de Cancerología de Boyacá

Radiation Oncology – Dosimetry

Introduction:
In this work we developed a program for the study of dose distributions due to different sources of
brachytherapy with Ir-192 and Co-60 Isotopes. Experimental validation is done in water using literature
data and experimental measurements using radiochromic film.
Materials and methods:
Using Geant4, we simulate the geometries of different brachytherapy sources of high rate dose with Ir-192
and Co-60 in detail. Based on ICRU 44 and using the Monte Carlo method, a Geant4 program was building
and the dose distributions deposited in water and soft tissue were studied, making a comparison of the
spatial distribution for the two cases and different source geometries. Subsequently, a radiochromic film
was irradiated with a MicroSelectron-HDR-192Ir-V2 brachytherapy source in order to measure the
deposited dose distribution and compare to Monte Carlo calculations using the gamma index.
Results:
The PDDs for Co-60 and Ir-192 brachytherapy sources and dose distributions in different axes were
obtained through Monte Carlo method. A comparison of the dose distribution in the points near the source
was made it observing the variations due to the shape of the nucleus. The Monte Carlo's does maps were
compared with measurements through the gamma index getting results higher than 95% with 2% / 2 mm
criteria.
Conclusions:
The software was building under Geant4 and were validated with experimental measurements, it can be
used for studding dose distribution in detail for cases were measurements are very difficult to perform. The
shape of the source influences in the dose distribution and for this reason it can not be taken like an isotropic
point source. The Co-60 and Ir192 doses are similar in first millimeter depth.

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P-389

EXPERIMENTAL DETERMINATION OF THE GADOLINIUM DOSE

ENHANCEMENT IN PHANTOM IRRADIATED WITH LOW ENERGY X-RAY
SOURCES BY A SPECTROPHOTOMETER -GAFCHROMIC-EBT3 DOSIMETRY
SYSTEM

Mauricio Santibañez, Fabian Torres, Asticio Vargas, Melani Fuentealba

Departamento de Ciencias Físicas - Universidad de La Frontera - Temuco - Chile

Radiation Oncology – Dosimetry

This work reports the experimental determination of dose enhancement produced in phantoms containing
target volumes doped with Gadolinium and irradiated with low-energy X-ray beams. EBT3 Gafchromic
films were immersed into 5 ml target volumes to mimic tumor filling with 100% ultra-pure water (blank
sample) and ultra-pure water infused with Gd solution (Omniscan®) in different concentration (9-24
mg/ml). The dose enhancement due to excitation of Gd K-edge (50.2 keV) was evaluated in terms of the
increment in the optical density, obtained by a Spectrophotometer-Gafchromic-EBT3 dosimetry system
calibrated in terms of the dose-response for the range of 1-8 Gy. The dose enhancement was evaluated in
two condition: a beam quality with spectrum above the absorption edge in a medium with and without Gd;
and two beam qualities (above and below the absorption edge) in a medium with a fixed concentration of
Gd (18 mg/ml). The obtained results confirmed increments in relative dose enhancement according to Gd
concentrations up to 18 mg/ml, with a dose enhancement of 1.1 Gy and an average percentage enhancement
of 28.4%. For higher values of concentration, the attenuation interaction of the primary beam is more
relevant instead of dose enhancement process. On the other hand, the dose enhancement obtained to
comparison the spectra above and below the absorption edge, shown results up to 3.6 Gy of enhancement
and average percentage enhancement of 86%. These results constitute a promising future alternative for
replacing radioactive sources by implementing electronic brachytherapy together High Z agents, achieving
local high dose levels.

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P-390

CHARACTERIZATION, DOSIMETRY OF SMALL FIELDS AND QUALITY

CONTROL OF THE PLANNING SYSTEM OF RADIOSURGERY

Yuliana Ayala, Sandra Guzman

Universidad Ricardo Palma, Centro de Radioterapia de Lima, Peru

Radiation Oncology – Dosimetry

The present work develops a method, capable of implementing a radiosurgery dosimetry system by means
of Monte Carlo Simulation (CM), in such a way that the dosimetric data can be obtained in a truthful and
reliable way, and with the optimization of the acquisition time. It is developed counting on the Radiosurgery
System installed in a Linear Photon Accelerator (LINAC) with energy of 6 MV, experimental dosimetric
measurements were made to the system, by means of the use of a Wellhofer 700 automatic Fantoma, a
micro ionization chamber ""Pin Point"" Chamber PTW "", an electrometer Model KEITHELEY
35617EBS, a collimator and collimators used for radiosurgery (cones) of different diameters. The
PENELOPE code was used to perform the MC simulation under the same experimental geometrical
conditions, for which the data of the LINAC Configuration were granted by the Siemens Medical Systems
and Oncology Care Systems. The Winston- Lutz test was used to perform the quality control of the planning
software together with a phantom adapted to perform in vivo dosimetry. We can be obtained by means of
MC simulation: Percentage of Dose in Depth (PDD), Off axes doses; both for the 24 mm diameter cone;
the Output Factors were obtained by MC, for in cones of diameter different. These measurements obtained
by MC when compared with the data obtained experimentally show a maximum percentage difference of
2%.It should be mentioned that for the comparison of experimentally obtained data for field factors, these
were corrected using the new protocol, TRS 483 of the AIEA. Noting the importance of using this protocol
to obtain the dosimetry of small beams. In relation to the quality control of the planning system (TPS)and
to the dosimetry performed on the system, the results obtained show a percentage deviation of 1.8% in
relation to the planned dose and the dose delivered.

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P-392

ASSESSMENT OF LINEAR ACCELERATOR COMMISSIONING BY EVALUATING

THE ACCURACY OF THE AAA ALGORITHM

Armando Cristian Camilo Castellanos Jerez1, Maria Cristina Plazas1, Edwing Rozo2
1
Universidad Nacional de Colombia, Colombia
2
Fundación Santa Fe

Radiation Oncology –Treatment Planning

The evaluation of the dosimetric accuracy was performed over a treatment planning system (TPS) called
Eclipse in its version 11.0.31 for AAA photon dose distribution algorithm using a comparison between
some measurements and its counterpart of dose calculations. That quantitative comparison was developed
for absolute and relative dosimetries under controlled conditions to ensure its feasibility, and following
international recommendations like Task Group report 53. Additionally, we did absolute dosimetric
measures in an anthropomorphic thorax phantom to evaluate the accuracy of this algorithm under high
heterogeneity mediums. The overall results were not like we expected and other author found, but gave us
some clues that in somehow the measurements obtained for the commissioning stage were not getting in
the best way. Some consequences could imply a possible sub estimation of dose in the umbra region and at
considerable depths, so this work could be apply as a quality control over a TPS after the commissioning
stage is done, those implications may yield us a possible complications for side effects mainly in sensitive
organs for radiation.

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P-393

MONTE CARLO EVALUATION OF THE RADIATION SHIELDING OF HEALTHY

TISSUE SURROUNDING TUMOR TISSUE DOPED WITH GD, BY AN
ENDOCAVITARY BRACHYTHERAPY SYSTEM BASED ON A 241AM SOURCE

Mauricio Santibañez1, Yaniro Guillen2, Mauro Valente3

1
Departamento de Cs. Fisicas - Universidad de La Frontera - Temuco, Chile
2
Unidad de Radioterapia - Hospital Base de Valdivia - Valdivia - Chile
3
Universidad Nacional de Cordoba

Radiation Oncology – Dosimetry

In this work we evaluate the increase of protection to healthy tissue surrounding irradiated tumor tissue, for
an endocavitary brachytherapy system based on a source of 241Am and doping the tumor zone with Gd
agents for a simultaneous production of dose enhancement. This source offers advantages over the
traditional 192Ir, such as a much longer half-life, and the possibility of greater dose enhancement by having
an energy closer to the absorption edge of the Gd. As also the lower energy spectrum allows secondary use
of the agent as a radiopaque element decreasing the dose in regions outside the tumor. For this, a geometry
of concentric cylinders with different diameters was simulated. The first was fixed at 0.6 mm in diameter
and the 241Am source was located on it. The second was fixed at 2 cm in diameter represents the tumor
area to be treated which was studied with or without Gd doping. The last one was fixed at 10 cm in diameter
and its composition was exclusively water representing the healthy tissue. The evaluation of the protection
was determined as a function of the reduction of the dose achieved in the external region of the phantom
due to the attenuation of the Gd over the primary beam and given the total absorbed dose is increased in
the area doped with Gd, causing shorter irradiation time to reach the prescribed dose in the region of interest.
The results obtained for a Gd concentration of 20mg / ml show percentages of protection of 64.2 ± 0.5%
with an uncertainty lower than 0.6% and a reduction of 55% in the irradiation time, product of the dose
enhancement achieved. This result showing the advantages of a future system based on this type of long
life and low energy sources together new high Z agents.

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P-394

DOSIMETRIC COMPARISON OF MULTIPLE BRAIN METASTASIS

RADIOSURGERY PLANNING USING CONVENTIONAL VMAT (RapidArcTM)
VERSUS HyperArcTM AUTOMATED PLANNING

Milton Ixquiac1, William Trinca2

1
FIXCA, Guatemala
2
Hospital Mãe de Deus

Radiation Oncology –Treatment Planning

Varian Medical Systems recently developed a new feature for Radiosurgery planning.
automated settings for the isocenter location, automated beam arrangement and collimator angles,
HyperArcTM generates non-coplanar planes for multiple metastasis. We compared 5 plans generated with
conventional VMAT (C-VMAT) approach by an experient planner using the same number of arcs and
couch rotations with HyperArcTM plans, but choosing manually the collimator angles and jaw settings, as
well as the optimization parameters. We also analyzed the differences using two calculation algorithms,
Acuros and AAA. All plans were normalized for the same target coverage, with de prescribed dose of 20Gy
covering 99% of the PTV. The CT scans were performed with a 1,25mm slice thickness and the calculation
grid was also set to 1,25mm; the TPS was a Varian EclipseTM V15.5. The plans with AAA and Acuros,
for C-VMAT, respectively, have reached a mean V10%=643cc (Equivalent Sphere of 10,7), V30%=68cc
(5,1) and V50%=29cc (3,8); V10%=578cc (10,3), V30%=64cc (5,0) and V50%=27cc (3,7). The plans
generated by HyperArcTM obtained, for AAA and Acuros, V10%=551cc (10,2), V30%=64cc (5,0) and
V50%=28cc (3,8); V10%=525cc (10,0), V30%=64cc (5,0) and V50%=28cc (3,8). We note the plans are
comparable in terms of volume for the 50% dose level, but HyperArc had some significant advantages
specially in the low dose levels. We conclude HyperArcTM is a very easy and time-saver tool for Multiple
Metastasis planning. Even in a scenarium where we had an experient planner performing C-VMAT plans,
the software achieved comparable and even slightly better results with a minimum workload, creating
extremaly good clinical plans in times around 10minutes. We also intend to measure these cases to evaluate
the adequacy of the algorithms, since they present different results especially at the 50% dose level.
With a minimal workload including

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P-395

DEVELOPMENT OF A NEW ALGORITHM FOR GAMMA EVALUATION IN 2D

MEASUREMENTS

Jhonalbert Aponte, Alvaro Ruiz, Karla Torzsok, Marcelo Riveiro, Herve Broque

Fundacion Arturo Lopez Perez, Chile

Radiation Oncology –Treatment Planning

Introduction: With the use of intensity modulation radiotherapy treatments, it is necessary to implement
patient specific quality controls in order to find differences between measured and calculated dose
distributions. When measuring with a 2D planar array, commercial gamma algorithms does not use a
volumetric searching range, resulting in a misconsider of the volume average effects, laser thickness and
couch precision among others. All these factors might result in a less accurate gamma analysis. Regarding
these facts, a new 2D gamma analysis algorithm has been developed, addressing real clinical situations.
Materials and Method: 10 VMAT patients were calculated with Monaco TPS and measured using a
MatriXX Evolution detector, which is a planar array by IBA. Seven coronal sections with a thickness of 1
mm were exported from the TPS. An algorithm based on the gamma index was created using Matlab as a
programming language, which allows to compare a measured dose plane against a calculated dose volume.
results of these calculations were compared with commercial algorithms. Preliminary Results: After
comparing three different gamma index calculation algorithms, the algorithm devised in this work shows
higher gamma results. The difference between algorithms exceeds 5%, obtaining for several cases 100% of
the points achieving the gamma criteria. And for cases that did not accomplish the gamma criteria with
commercial algorithms, they now do.
Conclusions: Adding an additional dimension to the gamma analysis increases the possibilities of obtaining
points that reach the agreement, in addition, it allows to have uncertainties in all spatial planes, a feature
that with other algorithms is not allowed.

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P-396

EXPERIMENTAL MEASUREMENT OF ENHANCEMENT AND RADIATION

SHIELDING EFFECT OF DOSES BY GD USING PAGAT DOSIMETERS IN
PHANTOMS IRRADIATED WITH 192IR FOR HIGH DOSE RATE
BRACHYTHERAPY TREATMENT

Melani Fuentealba1 Jose Vedelago3,4, Melani Fuentealba Mauro Valente1,2,3,4, Mauricio Santibanez1,2
1
Departamento de Ciencias Físicas Universidad de La Frontera, Chile
2
Centro de Física e Ingeniería en Medicina - CFIM Universidad de La Frontera
3
Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes por Rayos X
(LIIFAMIRx) Universidad Nacional de Córdoba,
4
Instituto de Física E. Gaviola – CONICET Argentina

Radiation Oncology – Dosimetry

The aim of radiotherapy is to give high doses of radiation to the tumor tissue without exceeding surrounding
healthy organs, however, there are anatomical areas whose access is difficult for external radiotherapy both
by its homogeneous dose delivery and by risk for surrounding volume. For this reason, treatments such as
brachytherapy allow a more viable treatment method due to its abrupt dose drop at a distance. Currently
several investigations have shown that the injection of a high Z material in tumor volumes subsequently
irradiated, generates a dose enhancement due to the increase in photoelectric absorption and the subsequent
emission of photoelectrons and Auger electrons that locally deposit their energy in the vicinity of the doping
agent. The dosimetric measurement was performed using a set of PAGAT gel dosimeters in the form of 12
cm3 substrates doped with Gd at concentrations of 68 mM and 138 mM, which were inserted into a solid
water phantom at a distance of 0.5 cm from a radioactive source of Ir-192, obtaining a thickness of 1.5cm
of Gd-PAGAT to measure dose enhancement and 0.5 cm of PAGAT to measure radiation shielding effect,
this geometry simulates the irradiation of a tumor doped by high dose rate brachytherapy. Subsequently,
they were irradiated with a total dose of 4Gy, obtaining results by optical transmission/absorbance,
considering the enhancement at 2 cm from the source, according to the evaluation criteria of the
brachytherapy treatments and the radiation shielding produced by this material in the vicinity of the
undoped volume. Experimentally, it was possible to check the dose enhancement in agreement with Monte
Carlo simulations performed parallel to the experiment with comparing purpose, reporting a dose increase
of 10-12% depending on the dopant material concentration and a radiation shielding of the dose
proportional to the studied concentration.

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P-398

OPTIMIZATION OF NEUTRON CAPTURE THERAPY BY VARYING THE BORON

CONCENTRATION WITH THE HELP OF GEANT4

William Alexander Guevara Zambrano

Universidad Nacional de Colombia, Colombia

Radiation Oncology – Dosimetry

There are certain types of cancer that are radioresistant, such as cutaneous malignant melanoma capable of
surviving conventional radiotherapy. There are also brain tumors that are impossible to operate due to the
high risk of surgery and in which external beam radiation therapy is not a good option since it generates
side effects due to the delivery of doses to healthy tissue by radiation. For this reason, neutron capture
therapy is used, which allows tumor cell destruction in a selective manner, decreasing the condition to
adjacent healthy tissue, since it consists of supplying Boro-10 to the tumor tissue through which a thermal
neutron beam passes. is captured by Boron-10 and becomes Boron-11, which in turn fissiones into an alpha
particle and a Lithium-7 nucleus, with high LET (linear energy transfer). These particles have a spatial
range in the order of the diameter of a cell. The objective of this work is to perform a simulation in GEANT4
by varying the concentration of Boron-10 in a phantom, to verify which is the adequate density for the
coverage of the dose at 100% of the PTV. A phantom is taken that possesses the tumor characteristics with
Boron uptake with different concentration, immersed in another phantom of water simulating the human
body. Which is irradiated with a beam of epithermic neutrons with energy of 0.3 ev (varies with the depth
of the tumor). It was found that the optimal concentration for the treatment is between (10-30) mg of boron
per gram of tissue. As a conclusion, it is possible to determine the adequate range of boron concentration
in the tissue and it is also appreciated that the delivery of doses to adjacent tissue is low.

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P-400

INITIAL EXPERIENCE IN GUATEMALA PERFORMING QUALITY CONTROL IN

X-RAYS, MAMMOGRAPHY AND TOMOGRAPHY

Milton Ixquiac1, Marcelo Ixquiac1,2, Freddy Pérez1, Mildred Jiménez1

1
FIXCA, Guatemala
2
Universidad de San Carlos de Guatemala

Diagnostic and Interventional Radiology – General

In Guatemala there was no obligation to perform tests of dose controls on equipment that emit ionizing
radiation, but just over two years ago the regulatory body started with this requirement. FIXCA is an
accredited company in Guatemala to perform these tests through the regulatory body. The tests in X-ray
equipment in general was performed without receive the corresponding maintenance service. The tests for
the X-rays have been with an average of 7% (absolute dose), accuracy of kV ± 5% (absolute dose), tests of
collimation ± 1.4 cm (averaged all directions and field sizes), yield for 80kV (depending on the case three-
phase or single-phase) 10% of equipment the result has not been within the acceptable range, filter ± 8%.
In the case of fluoroscopy, accuracy of kV ± 4%, automatic exposure control (CAE) ± 3%, filter ± 3%, in
the case of performance more than 85% the result has been within the acceptable range. In the case of
Mammography, the accuracy of kV ± 9% (absolute dose), glandular dose ± 8% (absolute dose), filter ± 3%,
performance for 28kV 12% of equipment has not been within the acceptable range. For the case of
Tomography, the accuracy of kV has been an average of ± 3%, the values of dose in air per kV, CTDI for
head and body have been evaluated comparing them with the publications of IMPACTSCAN.ORG, which
have coincided more 80% of equipment evaluated. In general, only the approved equipment will receive a
quality certificate and/or inform. Because all the tests can ́t be approved if exist one parameter out of range
and this could affect the results of the other parameters.

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P-401

SAFETY EVALUATION OF ONE BRACHYTHERAPY INSTALLATION OF HIGH

DOSE RATE

Leina Patricia Gutierrez Diaz

Centro de Radiologia Elisa Clara RF S.A.S, Colombia

Radiation Protection

The safety evaluation of the Brachytherapy installation of the Elisa Clara Radiology Center RF S.A.S was
carried out, in order to determine the level of risk existing in the area. The evaluation was carried out in
accordance with the requirements of Resolution 90874-2014 of the Ministry of Mines and Energy of
Colombia, in which the criteria for the application of the general principles of control (based on the
international recommendations and the International Atomic Energy Agency), with a graded risk approach
for the authorizations applicable to the radioactive sources used in any activity, in our case, only the
operational and special procedures performed in the facility during the practice of High Dose Rate
Brachytherapy (developed with an Ir-192 radioactive source and only for Intracavitary Brachytherapy
procedures). The results of the risk profile of the practice were obtained using the software tool SEVRRA
2.0 (online mode); 97 events were analyzed in total, of which 20 were not applicable to the practice. From
the evaluation, 74 (76.3%) events evaluated with consequences on the patient were obtained; 16 (16.5%)
events with consequences on the occupationally exposed worker and 7 (7.1%) events with consequences
on members of the public. A first and second screening was performed; in this last, there was a reduction
to the maximum (0%) in the probability of occurrence of incidents with very high and high consequences
that could develop during the practice of Brachytherapy; this led to a significant increase in consequences
with medium risk 60 (78%) and low risk 17 (22%). The conclusion of the safety assessment shows us, that
certain technological barriers, as well as the application of the processes and protocols of protection
Radiologic in the area during the practice, help significantly in the control the occurrence of possible
potential exposures in the installation.

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P-405

OCCUPATIONAL RADIATION DOSE IN MEDICAL WORKERS IN A HIGH

COMPLEXITY HOSPITAL

Jose Luis Rodriguez

Clinica Las Condes, Chile

Radiation Protection

Introduction: Monitoring the results of the personal dosimetry of all Occupationally Exposed Workers
(OEW) is the main indicator of the effectiveness of radiological protection in a given institution. The
objective of this work was to evaluate the behavior of the effective dose values in medical staff of “Clinica
Las Condes” Hospital received for 7 years. Methods: The occupationally exposed workers of the services
that use ionizing radiations were taken into account in an important way, the quarterly record was kept for
seven years of the doses reported. To optimize the statistical management of the values to be analyzed, a
database was created where the demographic, labor and quarterly dose values of each of the workers
participating in this study were recorded. The variables that were followed in this study were: The number
of workers occupationally exposed by service, the annual average of equivalent dose or Hp(10) per service,
the number of workers whose annual dose it did not exceed 0.1 mSv in each service and the totals of the
institution for each of the years analyzed. Results: Around 513 workers per year were in the radiological
surveillance program with personal dosimetry between 2012 and 2018 with an average dose of 0.13 mSv
per year and more than 75 % of doses were registered as lower than the dosimeter recording level (0.1
mSv). Conclusions: Through the results it can be seen that the workers in this hospital work in a safe
environment, since in general the average dose was 0.1 mSv, that is 10 times less than the allowable dose
for the general public (1 mSv) according to ICRP 103. The implementation of the Radiological Protection
Program at Clinica Las Condes Hospital has fulfilled its objective, in the sense of keeping the doses of
workers as low as possible.

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P-407

A MORE ACCURATE PEAK SKIN DOSE (PSD) ESTIMATE FOR FLUOROSCOPY-

GUIDED INTERVENTIONAL PROCEDURES

Adel Mustafa, Matthew Hoerner, Daniel Vergara

Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA

Diagnostic Radiology –Dosimetry

A more accurate peak skin dose (PSD) estimate for fluoroscopy-guided interventional procedures (FGI)
can be obtained by accounting for X-ray tube angulation, table positions and patient dimensions. An
algorithm for calculating and reporting PSD, which includes these factors, is described. Radiation dose
management system, RadimetricsTM, is used to query/retrieve the fluoroscopy exam's radiation dose
structured report (RDSR) and exports acquisition parameters in a Microsoft Excel format. PSD calculation
utilizes parameters within the RDSR including IRP air-kerma, primary and secondary x-ray tube angles,
and table coordinates to determine the acquisition-specific source to skin distances (SSD) and skin entrance
air-kerma. Field overlap as a function of angulation and patient size is then used to determine the cumulative
skin dose from the FGI. Patients are modelled as ellipsoids referring to each patients' dimensions obtained
from recent CT scans to the FGI region of interest. Validation testing of the PSD calculation method is
done by performing FGI on a phantom, with varying levels of complexity. PSD measurements are obtained
using radiation detectors positioned on the phantom's surface. Then, PSD calculations are performed using
the new method described above and the traditional “dose-conservative” method. Comparisons between
the measured and calculated PSD values determine the level of accuracy the new method provides.
Preliminary results suggest that the new method yields a more accurate PSD estimate than the dose-
conservative method, with a dose difference of 42%- 53%.

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P-410

RESULTS WITH MACACO II: A COMPTON TELESCOPE FOR HADRON

THERAPY MONITORING

Luis Barrientos, John Barrio, Marina Borja-Lloret, Carlos Lacasta, Enrique Muñoz, José Francisco Oliver,
Ana Ros, Jorge Roser, Carles Solaz, Rita Viegas, Gabriela Llosá

Instituto de Física Corpuscular (CSIC-UV), Valencia, Spain

Radiation Oncology – Dosimetry

Hadron therapy is a technique used in cancer treatment that consists in the irradiation of tumours using light
ions or protons instead of photons. The use of this technique is increasing in the world given its precise
energy deposition to the tumors and the dose reduction to healthy tissue as compared to conventional photon
radiotherapy. Real-time treatment monitoring is one of the main challenges addressed nowadays.
The IRIS group at IFIC-Valencia is developing a Compton telescope with this purpose. The system is made
of three LaBr3 detector planes coupled to silicon photomultipliers (SiPMs). The first MACACO (Medical
Applications CompAct COmpton camera) prototype demonstrated the viability of the proposed technology
and served to identify its limitations. The second prototype features new detectors and image reconstruction
codes, improving significantly the performance in laboratory and accelerator facilities [1,2].
The dimensions of the LaBr3 detectors of a new prototype (MACACO II) are 25.8 x 25.8 x 5 mm3 for the
first and second plane and 32 x 36 x 10 mm3 for the third one. The characterization in the laboratory has
been performed using Na-22 and Eu-152 radioactive sources while keeping constant temperatures. An
energy resolution of the detectors of 5.6 % at 511 keV, an angular resolution of 4.6° and an efficiency of
coincidence detection of 1 x 10-3 at 1275 keV were obtained.
To validate the functionality of a second version of MACACO, Monte Carlo simulations were made with
GATE V 7.0 (toolkit based on GEANT4) getting a good correlation with the experimental measurements.
Through the simulations, the intrinsic spatial resolution of the Compton telescope has been determined (≈
3mm) using a derenzo phantom.
MACACO II has been characterized in the laboratory and in beam tests. It has been tested at CNA (Sevilla)
with 18 MeV proton beams on a graphite target to produce 4.4 MeV gamma rays. Data have been taken
with the system in different positions and beam intensities, and the target image has been reconstructed.
Further tests have been carried out at KVI-CART (Groningen) with a 150 MeV proton beam impinging a
PMMA target and the Bragg peak has been reconstructed in different positions.
In spite of the significant progress, the system does not yet reach the necessary performance for the
application and thus, possible improvements are being assessed. Tests include the evaluation of SiPMs of
different types and manufacturers to enhance energy resolution and the improvement of the readout
electronics. The MADDAQ board currently employed is being replaced by AliVATA, that will allow to
operate the three system detectors with just one board and improve the readout speed. In addition, tests are
being carried out with the PETsys system, improving significantly the detector timing resolution.

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