This study aims to evaluate the optical response dependence of the PAKAG polymer gel dosimeter on photon energy and dose rate. The produced gel dosimeters were irradiated using a Varian CL 21EX medical linear accelerator with delivered doses of 0, 2, 4, 6, 8, and 10 Gy. To examine the response dependence on the delivered dose rate, dose rates of 50, 100, 200, and 350 cGy min-1were investigated. Additionally, two incident beam qualities of 6 and 18 MV were examined to study the response dependence on the incident beam energy. The irradiated polymer gel dosimeters were readout using a UV-vis spectrophotometer in the 300 to 800 nm scan range. The results reveal that a wide variation in dose rate (50-350 cGy.min-1) influences the absorbance-dose response and the sensitivity of PAKAG gel. However, smaller variations did not show a significant effect on the response. Furthermore, the response changed insignificantly with beam quality for investigated energies. It was concluded that the optical reading response of the PAKAG polymer gel dosimeter is satisfactorily independent of external parameters, including dose rate and incident beam quality.

This research focused on the determination of scatter radiation levels in x-ray rooms during chest radiography. 108 patients were examined. Four x-ray machines (A, B, C, and D) were used during the research from three centers. Three positions were considered in this study; position Q just beside the (Bucky stand), position R, which is 150 cm from the left of the Bucky stand towards the door and position T, 200 cm from the Bucky stand to the radiographer\'s protective screen respectively. Two machines (A and B) from center 1 and one machine from center 2 (C) and one machine from center 3 (D). The body mass index (BMI) of the participants ranged from 20 to 25 kgm-2 with mean value of 23.97 kgm-2. The background radiation level was read using Radalert 100 m before any exposure, and the mean background level was 0.298 mR/h. The mean of the scatter radiation doses obtained from positions Q with respect to the four machines A, B, C, and D, were 0.109, 0.201, 0.204, 0.200 mR/h (9.166, 16.903, 17.156, 16.819 mSv/yr) and their standard deviations were ±0.052, ±0.053, ±0.064, and ±0.081 respectively. The results were comparable with previous studies. The study recommends staff education and training in determination of radiation levels for enhanced work safety.

OBJECTIVE: The time structures of proton spot delivery in proton pencil beam scanning (PBS) radiation therapy are essential in many clinical applications. This study aims to characterize the time structures of proton PBS delivered by both synchrotron and synchrocyclotron accelerators using a non-invasive technique based on scattered particle tracking.
METHODS: A pixelated semiconductor detector, AdvaPIX-Timepix3, with a temporal resolution of 1.56 ns, was employed to measure time of arrival of secondary particles generated by a proton beam. The detector was placed laterally to the high-flux area of the beam in order to allow for single particle detection and not interfere with the treatment. The detector recorded counts of radiation events, their deposited energy and the timestamp associated with the single events. Individual recorded events and their temporal characteristics were used to analyze beam time structures, including energy layer switch time, magnet switch time, spot switch time, and the scanning speeds in the x and y directions. All the measurements were repeated 30 times on three dates, reducing statistical uncertainty.
RESULTS: The uncertainty of the measured energy layer switch times, magnet switch time, and the spot switch time were all within 1% of average values. The scanning speeds uncertainties were within 1.5% and are more precise than previously reported results. The measurements also revealed continuous sub-milliseconds proton spills at a low dose rate for the synchrotron accelerator and radiofrequency pulses at 7 µs and 1 ms repetition time for the synchrocyclotron accelerator.
CONCLUSIONS: The AdvaPIX-Timepix3 detector can be used to directly measure and monitor time structures on microseconds scale of the PBS proton beam delivery. This method yielded results with high precision and is completely independent of the machine log files.

OBJECTIVE: Rare but severe toxicities of the optic apparatus have been observed after treatment of intracranial tumours with proton therapy. Some adverse events have occurred at unusually low dose levels and are thus difficult to understand considering dose metrics only. When transitioning from double scattering to pencil beam scanning, little consideration was given to increased dose rates observed with the latter delivery paradigm. We explored if dose rate related metrics could provide additional predicting factors for the development of late visual toxicities.
METHODS: Radiation-induced intracranial visual pathway lesions were delineated on MRI for all index cases. Voxel-wise maximum dose rate (MDR) was calculated for 2 patients with observed optic nerve toxicities (CTCAE grade 3 and 4), and 6 similar control cases. Additionally, linear energy transfer (LET) related dose enhancing metrics were investigated.
RESULTS: For the index cases, which developed toxicities at low dose levels (mean, 50 GyRBE), some dose was delivered at higher instantaneous dose rates. While optic structures of non-toxicity cases were exposed to dose rates of up to 1 to 3.2 GyRBE/s, the pre-chiasmatic optic nerves of the 2 toxicity cases were exposed to dose rates above 3.7 GyRBE/s. LET-related metrics were not substantially different between the index and non-toxicity cases.
CONCLUSIONS: Our observations reveal large variations in instantaneous dose rates experienced by different volumes within our patient cohort, even when considering the same indications and beam arrangement. High dose rate regions are spatially overlapping with the radiation induced toxicity areas in the follow up images. At this point, it is not feasible to establish causality between exposure to high dose rates and the development of late optic apparatus toxicities due to the low incidence of injury.

The impact of cobalt-60 dose rate (Co-60 DR) on outcomes of stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs) remains fully elucidated. This study explored the association between Co-60 DR and SRS outcomes in AVM treatment.
772 AVM patients from 1990 to 2020 were included. High DR was defined as ≥ 2.4 Gy/min. AVM patients were categorized into 3 cohorts based on the nidus volume: small (<5 mL), medium (≥5 mL and < 10 mL), and large (≥10 mL). The primary endpoint was AVM obliteration; secondary endpoints included post-SRS hemorrhage.
Cumulative obliteration rates of the large AVM were significantly increased in the high DR group than those in the low DR group (84 % vs. 45 % at 5 years, log-rank test; p = 0.011). Multivariable analysis showed that the obliteration rate was significantly elevated for the high DR group in the large AVM cohort with an adjusted hazard ratio (HR) of 1.78 (95 % confidence interval [CI]: 1.00-3.17, p = 0.049). Post-SRS hemorrhage rates of the entire cohort were significantly decreased in the high DR group than in the low DR group (2.5 % vs. 5.3 % at 5 years, log-rank test; p = 0.035). Multivariable analysis revealed post-SRS hemorrhage was reduced in the high DR group with an adjusted HR of 0.47 (95 % CI: 0.24-0.92, p = 0.026).
High DR may lead to increased efficiency for large AVMs and decreased post-SRS hemorrhage in all AVM cases. Sustaining a higher Co-60 DR could potentially yield favorable outcomes for SRS for AVMs.

The Sentinel Lymph Node (SLN) or Sentinel Lymph Node Biopsy (SLNB) technique involves various professionals from different departments in clinical settings to manage breast cancer patients properly. Tracing the nodular involvement of breast cancer patients requires radiation source Tc99m labeled with colloidal albumin to be injected at the tumor site. The patient becomes a radiation source for a sufficient time, which concerns the Nuclear Medicine (NM) and surgical staff. The study aims to provide the radiation doses of staff in the NM department during the SLN scintigraphy procedure and obtain an empirical model for calculating the radiation doses to staff in the surgical department from that particular patient. Radiation doses in SLN technique for breast cancer patients are minimal, and a sufficient number of SLN biopsy procedures can be performed by hospital staff within the category of non-radiation workers.

OBJECTIVE: This study aimed to develop a user-friendly prediction formula for dose rate adjustment after initial 177Lu-Dotatate therapy from a prospective observational study of patients.
METHODS: This study included consenting patients in a prospective observational study who underwent their first treatment in four cycles of 177Lu-Dotatate treatment at our hospital between January 2022 and February 2024. All patients received 7.4 GBq of 177Lu-Dotatate. The prediction formula was derived from the regression analysis of tumor-related factors and renal function. Creatinine clearance was estimated using the Cockcroft-Gault equation in this study for renal function.
RESULTS: Among the 13 patients (seven males, six females, median age: 59 years), logarithmically transformed total tumor volume (cc) and maximum tumor diameter (mm) of primary tumors or metastases showed strong correlations (p < 0.001, R2 = 0.897). As such, the maximum tumor diameter was used as the tumor parameter in the prediction formula. Additionally, maximum tumor diameter and creatinine clearance showed strong (p < 0.001, R2 = 0.768) and moderate (p = 0.013, R2 = 445) correlations, respectively, with the ratio of the dose rate 5.5-h post-administration to the dose rate immediately post-administration (%) at 1 m from the body surface. The resulting formula, 51.4 + 0.360 × maximum tumor diameter (mm) - 0.212 × creatinine clearance (ml/min), demonstrated an extremely strong correlation (p < 0.001, R2 = 0.937).
CONCLUSIONS: The present study showed that the maximum tumor diameter and renal function affected the declining the dose rate of patients surface after 177Lu-Dotatate, which can inform post-administration dose rate management and potentially facilitate outpatient treatment in Japan.

OBJECTIVE: To propose a straightforward and time-efficient quality assurance (QA) approach of beam time delay for respiratory-gated radiotherapy and validate the proposed method on typical respiratory gating systems, Catalyst™ and AlignRT™.
METHODS: The QA apparatus was composed of a motion platform and a Winston-Lutz cube phantom (WL3) embedded with metal balls. The apparatus was first scanned in CT-Sim and two types of QA plans specific for beam on and beam off time delay, respectively, were designed. Static reference images and motion testing images of the WL3 cube were acquired with EPID. By comparing the position differences of the embedded metal balls in the motion and reference images, beam time delays were determined. The proposed approach was validated on three linacs with either Catalyst™ or AlignRT™ respiratory gating systems. To investigate the impact of energy and dose rate on beam time delay, a range of QA plans with Eclipse (V15.7) were devised with varying energy and dose rates.
RESULTS: For all energies, the beam on time delays in AlignRT™ V6.3.226, AlignRT™ V7.1.1, and Catalyst™ were 92.13 ± $ \\pm $ 5.79 ms, 123.11 ± $ \\pm $ 6.44 ms, and 303.44 ± $ \\pm $ 4.28 ms, respectively. The beam off time delays in AlignRT™ V6.3.226, AlignRT™ V7.1.1, and Catalyst™ were 121.87 ± $ \\pm $ 1.34 ms, 119.33 ± $ \\pm $ 0.75 ms, and 97.69 ± $ \\pm $ 2.02 ms, respectively. Furthermore, the beam on delays decreased slightly as dose rates increased for all gating systems, whereas the beam off delays remained unaffected.
CONCLUSIONS: The validation results demonstrate the proposed QA approach of beam time delay for respiratory-gated radiotherapy was both reproducible and time-efficient to practice for institutions to customize accordingly.

OBJECTIVE: Recently, dose delivery technology has rapidly evolved with flattening filter-free beams (FFF), and the biological effects of high dose rates are a matter of interest. We hypothesized that FFF beams at different dose rates obtained with modern linear accelerators have different effects on the TME.
METHODS: The B16-F10 melanoma syngeneic tumor model was established, and mice were randomized to 2 different doses (2 Gy and 10 Gy) and 3 different dose rates (1 Gy/min, 6 Gy/min, and 14 Gy/min) along with the control group. Euthanasia was performed on the seventh day after RT, and intracardiac blood was collected for a comet assay. Tumors were harvested and examined histomorphologically and immunohistochemically. Statistical analyses were performed using SPSS software version 23 (SPSS Inc., Chicago, IL, USA).
RESULTS: The daily growth rate was uniform, and no difference was observed between tumor volumes across all three dose rates for each dose. Deoxyribonucleic acid (DNA) damage in blood mononuclear cells was not affected by dose or dose rate. In the TME histomorphological examination, the number of mitosis is less in the 10 Gy arm, whereas the pleomorphism score was greater. Nevertheless, varying dose rates had no effect on the number of mitosis or the pleomorphism score. The severity of the inflammation, cell densities in the TME, and expression of immunohistochemical markers were comparable across all doses and dose rates.
CONCLUSIONS: In our study involving the B16-F10 syngeneic tumor model, varying dose rates obtained with FFF beams had no effect on tumor volume, blood mononuclear cell DNA damage, or TME parameters. However, in order to fully understand the biological impacts of novel techniques, our study should be validated with alternative preclinical setups.

The aim of this study was to assess the exposures received by firefighters engaged in extinguishing the large-scale wildfires in the most contaminated areas of the Ukrainian part of the Chornobyl Exclusion Zone in 2016 and 2020. The assessments are based on measurements of radionuclide airborne concentrations in the breathing zones of workers and at the aerosol sampling stations of the automated radiation monitoring system operated by SSE Ecocenter. During the wildfires, the radionuclide airborne concentrations increased by orders of magnitude compared to the background levels, reaching maximum values in the firefighting area of 1.20 ± 0.01 Bq m-3 for 90Sr, 0.18 ± 0.01 Bq m-3 for 137Cs, (1.8 ± 0.3) ∙10-4 Bq m-3 for 238Pu, (4.5 ± 0.7) ∙10-4 Bq m-3 for 239-240Pu, and (8.0 ± 1.3) ∙10-3 Bq m-3 for 241Pu. The internal effective doses to firefighters due to inhaled radionuclides did not exceed 2 μSv h-1 and were 3-5 times lower compared to the external dose of gamma radiation. Thus, the time of firefighting in the ChEZ will be limited by the external dose.