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Tainan, Taiwan

Chang L.,I - Shou University | Ho S.-Y.,Chang Jung Christian University | Ho S.-Y.,Chi Mei Medical Center | Lee T.-F.,National Kaohsiung University of Applied Sciences | And 3 more authors.
Medical Physics

Purpose: Ashland Inc. EBT2 and EBT3 films are widely used in quality assurance for radiation therapy; however, there remains a relatively high degree of uncertainty [B. Hartmann, M. Martisikova, and O. Jakel, Homogeneity of Gafchromic EBT2 film Med. Phys. 37, 1753.1756 (2010)]. Micke et al. (2011) recently improved the spatial homogeneity using all color channels of a flatbed scanner; however, van Hoof et al. (2012) pointed out that the corrected nonuniformity still requires further investigation for larger fields. To reduce the calibration errors and the uncertainty, the authors propose a new red-channel percentage-depth-dose method in combination with a modified three-channel technique. Methods: For the ease of comparison, the EBT2 film image used in the authors' previous study (2012) was reanalyzed using different approaches. Photon beams of 6-MV were delivered to two different films at two different beam on times, resulting in the absorption doses of ranging from approximately 30 to 300 cGy at the vertical midline of the film, which was set to be coincident with the central axis of the beam. The film was tightly sandwiched in a 303-cm3 polystyrene phantom, and the pixel values for red, green, and blue channels were extracted from 234 points on the central axis of the beam and compared with the corresponding depth doses. The film was first calibrated using the multichannel method proposed by Micke et al. (2010), accounting for nonuniformities in the scanner. After eliminating the scanner and dose-independent nonuniformities, the film was recalibrated via the dose-dependent optical density of the red channel and fitted to a power function. This calibration was verified via comparisons of the dose profiles extracted from the films, where three were exposed to a 60. physical wedge field and three were exposed to composite fields, and all of which were measured in a water phantom. A correction for optical attenuation was implemented, and treatment plans of intensity modulated radiation therapy and volumetric modulated arc therapy were evaluated. Results: The method described here demonstrated improved accuracy with reduced uncertainty. The relative error compared with the measurements of a water phantom was less than 1%, and the overall calibration uncertainty was less than 2%. Verification tests revealed that the results were close to those of the authors' previous study, and all differences were within 3%, except those with a high-dose gradient. The gamma pass rates (2%/2 mm) of the treatment plan evaluated using the method described here were greater than 99%, and no obvious stripe patterns were observed in the dose-difference maps. Conclusions: Spatial homogeneity was significantly improved via the calibration method described here. This technique is both convenient and time-efficient because it does not require cutting the film, and only two exposures are necessary. © 2015 American Association of Physicists in Medicine. Source

Chang L.,I - Shou University | Ho S.-Y.,Chi Mei Medical Center | Lee T.-F.,National Kaohsiung University of Applied Sciences | Yeh S.-A.,I - Shou University | And 2 more authors.
Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment

EBT2 film is a convenient dosimetry quality-assurance (QA) tool with high 2D dosimetry resolution and a self-development property for use in verifications of radiation therapy treatment planning and special projects; however, the user will suffer from a relatively higher degree of uncertainty (more than ±6% by Hartmann et al. [29]), and the trouble of cutting one piece of film into small pieces and then reintegrating them each time. To prevent this tedious cutting work, and save calibration time and budget, a dose range analysis is presented in this study for EBT2 film calibration using the Percentage-Depth-Dose (PDD) method. Different combinations of the three dose ranges, 9-26 cGy, 33-97 cGy and 109-320 cGy, with two types of curve fitting algorithms, film pixel values and net optical densities converting into doses, were tested and compared. With the lowest error and acceptable inaccuracy of less than 3 cGy for the clinical dose range (9-320 cGy), a single film calibrated by the net optical density algorithm with the dose range 109-320 cGy was suggested for routine calibration. © 2014 Elsevier B.V. All rights reserved. Source

Chang L.,I - Shou University | Ho S.-Y.,Chi Mei Medical Center | Ding H.-J.,I - Shou University | Lee T.-F.,National Kaohsiung University of Applied Sciences | Chen P.-Y.,Sinlau Christian Hospital
Medical Physics

Purpose: The Ashland Inc. product EBT2 film model is a widely used quality assurance tool, especially for verification of 2-dimensional dose distributions. In general, the calibration film and the dose measurement film are irradiated, scanned, and calibrated at the same postirradiation time (PIT), 1-2 days after the films are irradiated. However, for a busy clinic or in some special situations, the PIT for the dose measurement film may be different from that of the calibration film. In this case, the measured dose will be incorrect. This paper proposed a film calibration method that includes the effect of PIT. Methods: The dose versus film optical density was fitted to a power function with three parameters. One of these parameters was PIT dependent, while the other two were found to be almost constant with a standard deviation of the mean less than 4%. The PIT-dependent parameter was fitted to another power function of PIT. The EBT2 film model was calibrated using the PDD method with 14 different PITs ranging from 1 h to 2 months. Ten of the fourteen PITs were used for finding the fitting parameters, and the other four were used for testing the model. Results: The verification test shows that the differences between the delivered doses and the film doses calculated with this modeling were mainly within 2% for delivered doses above 60 cGy, and the total uncertainties were generally under 5%. The errors and total uncertainties of film dose calculation were independent of the PIT using the proposed calibration procedure. However, the fitting uncertainty increased with decreasing dose or PIT, but stayed below 1.3% for this study. Conclusions: The EBT2 film dose can be modeled as a function of PIT. For the ease of routine calibration, five PITs were suggested to be used. It is recommended that two PITs be located in the fast developing period (1∼6 h), one in 1 ∼ 2 days, one around a week, and one around a month. © 2014 American Association of Physicists in Medicine. Source

Chiu H.-W.,National Cheng Kung University | Lin J.-H.,National Cheng Kung University | Chen Y.-A.,National Cheng Kung University | Ho S.-Y.,Sinlau Christian Hospital | Wang Y.-J.,National Cheng Kung University

The traditional treatments for fibrosarcoma have limited efficacy. Therefore, new therapeutic strategies and/or new adjuvant drugs still need to be explored. Accumulating evidence indicates that programmed cell death (PCD) is closely related to anticancer therapy. Many studies have shown that tumor cells treated with anticancer drugs experience the induction of type I PCD, apoptosis, and type II PCD, autophagy. In the present study, we investigated the anticancer effects of ionizing radiation (IR) combined with arsenic trioxide (ATO) in human fibrosarcoma cells in vitro and in xenograft tumors in SCID mice in vivo. We found that IR increased the population of HT1080 cells in the G 2/M phase in a time-dependent manner within 9 h. IR treatment combined with ATO at this time point induced a significantly prolonged G 2/M arrest and consequently enhanced cell death. Furthermore, damage of mitochondria membrane potential could be involved in the underlying mechanisms. The enhanced cytotoxic effect of combined treatment occurred due to the increased induction of more autophagy and apoptosis through the inhibition of Akt and the activation of ERK1/2 signaling pathways in HT1080 cells. The combined treatment of HT1080 cells pretreated with Z-VAD or 3-MA resulted in a significant reduction in AO-positive cells, apoptotic cells and cytotoxicity. In in vivo studies, the combination of IR and ATO significantly reduced the tumor volume in SCID mice that had received a subcutaneous injection of HT1080 cells. The data suggest that a combination of IR and ATO could be a new potential therapeutic strategy for the treatment of fibrosarcoma. © 2010 Landes Bioscience. Source

Chang L.,I - Shou University | Ding H.-J.,I - Shou University | Ho S.-Y.,Sinlau Christian Hospital
Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment

A simple, practical and economical technique was proposed to calibrate an 192Ir HDR brachytherapy source in terms of air kerma strength. This technique makes use of the 0.6 cm3 Farmer type ion chamber, radiographic film and polystyrene phantom. These tools are commonly used for dosimetry quality assurance of the clinical linear accelerator. In this study, the Exradin A19, PTW N30004 and TM30001 Farmer type ion chambers were used for the calibration of the 192Ir HDR source. To perform the calibration, a 25.4×30.5 cm2 radiographic film was taped on a piece of polystyrene plate, and a straight applicator probe of a HDR brachytherapy unit and the Farmer type ion chamber were affixed to the film envelope. The film was irradiated by the 192Ir source, followed by an exposure in the simulator X-ray beam. The film set with the film removed was then placed on a 5 cm thick polystyrene phantom for calibration measurement. Based on the electrometer reading from the Farmer type ion chamber irradiated by 192Ir and the measured source-to-chamber distance by means of the images on the developed film, we can calculate the air kerma strength of the 192Ir using the new technique. Our calibration results were compared to the data provided by the manufacturer and that of five different well type ion chambers, namely, Sun Nuclear cooperation (SNC) 1008, Nucletron SDS 077.091, SDS 077.094, PTW TN33004 and Standard Imaging (SI) HDR-1000 Plus. The differences were all within 1.6%. Relative to the 7-distance measurement technique by Stump et al., 2002, our method is more efficient if our empirical formula was used. In summary, our method is simpler and cost-effective to calibrate an 192Ir HDR brachytherapy source for those hospitals without a calibration jig or a well type ion chamber. © 2011 Elsevier B.V. All rights reserved. Source

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