Despite significant improvements in medical sciences over the last decade, cancer still continues to be a major cause of death in humans throughout the world. Parallel to the efforts of understanding the intricacies of cancer biology, researchers are continuously striving to develop effective cancer detection and treatment strategies. Use of nanotechnology in the modern era opens up a wide range of possibilities for diagnostics, therapies and preventive measures for cancer management. Although, existing strategies of cancer detection and treatment, using nanoparticles, have been proven successful in case of cancer imaging and targeted drug deliveries, they are often limited by poor sensitivity, lack of specificity, complex sample preparation efforts and inherent toxicities associated with the nanoparticles, especially in case of in-vivo applications. Moreover, the detection of cancer is not necessarily integrated with treatment. X-rays have long been used in radiation therapy to kill cancer cells and also for imaging tumors inside the body using nanoparticles as contrast agents. However, X-rays, in combination with nanoparticles, can also be used for cancer diagnosis by detecting cancer biomarkers and circulating tumor cells. Moreover, the use of nanoparticles can also enhance the efficacy of X-ray radiation therapy for cancer treatment. This dissertation describes a novel in vitro technique for cancer detection and treatment using X-ray radiation and nanoparticles. Surfaces of synthesized metallic nanoparticles have been modified with appropriate ligands to specifically target cancer cells and biomarkers in vitro. Characteristic X-ray fluorescence signals from the X-ray irradiated nanoparticles are then used for detecting the presence of cancer. The method enables simultaneous detection of multiple iv cancer biomarkers allowing accurate diagnosis and early detection of cancer. Circulating tumor cells, which are the primary indicators of cancer metastasis, have also been detected where the use of magnetic nanoparticles allows enrichment of rare cancer cells prior to detection. The approach is unique in that it integrates cancer detection and treatment under one platform, since, X-rays have been shown to effectively kill cancer cells through radiation induced DNA damage. Due to high penetrating power of X-rays, the method has potential applications for in vivo detection and treatment of deeply buried cancers in humans. The effect of nanoparticle toxicity on multiple cell types has been investigated using conventional cytotoxicity assays for both unmodified nanoparticles as well as nanoparticles modified with a variety of surface coatings. Appropriate surface modifications have significantly reduced inherent toxicity of nanoparticles, providing possibilities for future clinical applications. To investigate cellular damages caused by X-ray radiation, an on-chip biodosimeter has been fabricated based on three dimensional microtissues which allows direct monitoring of responses to X-ray exposure for multiple mammalian cell types. Damage to tumor cells caused by X-rays is known to be significantly higher in presence of nanoparticles which act as radiosensitizers and enhance localized radiation doses. An analytical approach is used to investigate the various parameters that affect the radiosensitizing properties of the nanoparticles. The results can be used to increase the efficacy of nanoparticle aided X-ray radiation therapy for cancer treatment by appropriate choice of X-ray beam energy, nanoparticle size, material composition and location of nanoparticle with respect to the tumor cell nucleus.

Treating cancer with radiotherapy requires precise planning. Several planning pipelines rely on reference dose mimicking, where one tries to find machine parameters best mimicking a given reference dose. Dose mimicking relies on having a function that quantifies dose similarity well, necessitating methods for feature extraction of dose images. In this thesis we investigate ways of extracting features from clinical doseimages, and propose a few proof-of-concept dose mimicking functions using the extracted features. We extend current techniques and lay the foundation for new techniques for feature extraction, using mathematical frameworks developed in entirely different areas. In particular we give an introduction to wavelet theory, which provides signal decomposition techniques suitable for analysing local structure, and propose two different dose mimicking functions using wavelets. Furthermore, we extend ROI-based mimicking functions to use artificial ROIs, and we investigate variational autoencoders and their application to the clinical dose feature extraction problem. We conclude that the proposed functions have the potential to address certain shortcomings of current dose mimicking functions. The four methods all seem to approximately capture some notion of dose similarity. Used in combination with the current framework they have the potential of improving dose mimickingresults. However, the numerical tests supporting this are brief, and more thorough numerical investigations are necessary to properly evaluate the usefulness of the new dose mimicking functions. / Behandling av cancer med strålterapi kräver precis planering. Flera olika planeringsramverk bygger på doshärmning, som innebär att hitta de maskinparametrar som bäst härmar en given referensdos. För doshärmning behövs en funktion som kvantifierar likheten mellan två doser, vilket kräver ett sätt att extrahera utmärkande egenskaper – så kallade features – från dosbilder. I det här examensarbetet undersöker vi olika matematiska metoder för att extrahera features från kliniska dosbilder, och presenterar några olika förslag på prototyper till doshärmningsfunktioner, konstruerade utifrån extraherade features. Vi utvidgar nuvarande tekniker och lägger grunden för nya tekniker genom att använda matematiska ramverk utvecklade för helt andra syften. Speciellt så ger vi en introduktion till wavelet-teori, som ger matematiska verktyg för att analysera lokala beteenden hos signaler, exempelvis bilder. Vi föreslår två olika doshärmningsfunktioner som utnyttjar wavelets, och utvidgar ROI-baseraddoshärmning genom att introducera artificiella ROIar. Vidare så undersökervi så kallade variational autoencoders  och möjligheten att använda dessa för extrahering av features från dosbilder. Vi kommer fram till att de föreslagna funktionerna har potential att åtgärda vissa begränsningar som finns hos de doshärmningsfunktioner som används idag. De fyra metoderna verkar alla approximativt kvantifiera begreppet doslikhet. Användning av dessa nya metoder i kombination med nuvarande ramverk för doshärmning har potential att förbättra resultaten från doshärmning. De numeriska undersökningar som underbygger dessa slutsatser är dock inte särskilt ingående, så mer noggranna numeriska tester krävs för att kunna ge några definitiva svar angående de presenterade doshärmningsfunktionernas användbarhet ipraktiken.

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京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23826号 / 人健博第97号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 精山 明敏, 教授 椎名 毅, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Cancer is one of the leading causes of death in the world, but advances in research and development of treatment methods is constantly ongoing to reduce the number of deaths and the amount of suffering. One of many approaches is radiation therapy, which uses high doses of radiation to kill tumors. Radiation therapy requires advanced software in image analysis to create careful treatment plans, evaluate treatment responses and to perform dose accumulation, among other things. One important tool for this is deformable image registration (DIR) which is used to find a correspondence between the images. The aim with this master thesis is to improve the DIR method ANACONDA by automatically provide additional information to the algorithm before the registration is performed.This work focuses on the registration of internal tubular structures in lung and liver images (bronchial and vascular tree, respectively). Two challenges in registering lung images are the sliding motion of lung surfaces and large motion of small internal structures. Several DIR methods have been proposed for solving the challenging internal structures, however most of them do not take into account the alignment of surrounding tissues. DIR methods applied to the liver are published less frequently, but accurate registration of the liver is of high interest since, for example, knowledge of the anatomy of the vascular tree is essential when removing tumors through liver surgeries. In this work, corresponding (anatomical) points are automatically found in two images and added to the DIR algorithm. The points are found by extracting and comparing the tubular structures between the images, and with use of different distance requirements, nearby points are paired.The new method manages to achieve good registration of both internal structures and surrounding tissue. Mean target registration errors for the internal structures of lungs was 1.11 ± 0.75 and for liver 1.67 ± 1.15 mm.

Tesis por compendio / [ES] La tesi presentada a aquest document, s'emmarca dins de l'àmbit de la física mèdica. Dins d'aquesta branca de la física, es desenvolupen eines computacionals per oferir millores en la planificació de tractaments que involucren radiació ionitzant. En aquestes planificacions, es calculen factors dosimètrics com la dosi total absorbida tant, a la regió d'interès del tractaments, objectiu del mateix, com a la resta de teixits o òrgans de risc propers a la zona objectiu. Per poder efectuar aquests càlculs, existeixen diferents tècniques, sent les simulacions basades en Monte Carlo les considerades com l'eina més precisa. Aquest tipus de simulacions, permeten modelitzar els dispositius mèdics que emeten el feix de tractament als pacients, de forma detallada. A més, les simulacions Monte Carlo, permeten descriure les fonts de radiació minuciosament i considerar el transport de les partícules involucrades en el problema a través de la geometria considerada. En els treballs que conformen aquesta tesi, s'han emprat diferents codis Monte Carlo, depenent del problema a dur a terme. S'ha emprat MCNP6 a diferents treballs per la capacitat, i facilitat, de modelar geometries complexes emprant mallats volumètriques, penEasy com a codi per validar algunes de les eines dissenyades i penRed, per les característiques especialitzades en física mèdica, com la lectura i processament automàtic de DICOM i les fonts de braquiteràpia, el que faciliten molt les simulacions en l'entorn mèdic. Degut a estos fets, i a que penRed, és de codi obert i no requereix llicència, com al cas del MCNP, s'ha decidit estendre les capacitats que manquen en este, per poder equiparar el seu ús a la resta de codis en els problemes abordats durant la realització de la tesi doctoral. Tots aquests treballs contribueixen al desenvolupament d'eines que, mitjançant la simulació Monte Carlo, permeten optimitzar els càlculs en radioteràpia. Més encara, les eines desenvolupades, tenen una aplicabilitat més general i poden emprar-se en altres camps o problemes, com, per exemple, diagnòstic basat en imatge mèdica. El primer dels treballs, cobreix la necessita del codi MCNP6 de ser capaç de llegir i escriure fitxers d'espai de fase en format estàndard de la IAEA, eina que ja tenen implementadas molts dels codis de simulació Monte Carlo. Per suplir la manca de MCNP6 d'aquesta capacitat, es desenvolupa en aquesta tesi un codi capaç de realitzar aquestes conversions entre format d'espai de fase intern de MCNP6 i formats IAEA i a l'inrevés. Al segon treball, s'empren simulacions Monte Carlo per tal de dissenyar un filtre que homogeinitze el feix d'electrons de 12 MeV a l'eixida d'un accelerador de radioteràpia intraoperàtoria. El treball proporciona una configuració de filtre, dissenyada amb simulació Monte Carlo i validada amb altre grup d'investigació independent. El tercer treball, es basa en oferir una millora als elevats temps de computació a l'hora de realitzar planificacions de radioteràpia amb simulacions Monte Carlo per a tractaments amb diferents irradiacions angulars. Amb aquesta eina es pretén agilitzar significativament el procés de càlcul de distribució de dosi en el maniquí o pacient, sense haver de realitzar la simulació a través de tots els components de l'accelerador. Finalment, arrel d'haver emprat geometries basades en malles en les simulacions realitzades amb MCNP6, s'ha vist la importància d'aquesta capacitat, especialment en simulacions en l'àmbit de la física mèdica. La definició de geometries per descriure el sistema, és una part fonamental de qualsevol simulació, independentment del codi que s'utilitza per a dur-la a terme. És per això que, el quart treball, es centra en el desenvolupament d'un mòdul per a simular sobre geometries mallades en penRed. / [CA] La tesis presentada en este documento se enmarca dentro del ámbito de la física médica. Dentro de esta rama de la física, se desarrollan herramientas computacionales para ofrecer mejoras en la planificación de tratamientos que involucran radiación ionizante. En estas planificaciones, se calculan factores dosimétricos como la dosis total absorbida tanto en la región de interés del tratamiento, objetivo del mismo, como en el resto de tejidos u órganos de riesgo cercanos a la zona objetivo. Para poder llevar a cabo estos cálculos, existen diferentes técnicas, siendo las simulaciones basadas en Monte Carlo consideradas como la herramienta más precisa. Este tipo de simulaciones permiten modelar los dispositivos médicos que emiten el haz de tratamiento a los pacientes de forma detallada. Además, las simulaciones Monte Carlo permiten describir las fuentes de radiación minuciosamente y considerar el transporte de las partículas involucradas en el problema a través de la geometría considerada. En los trabajos que conforman esta tesis, se han empleado diferentes códigos Monte Carlo, dependiendo del problema a abordar. Se ha utilizado MCNP6 en diferentes trabajos por su capacidad y facilidad para modelar geometrías complejas utilizando mallas volumétricas, penEasy como código para validar algunas de las herramientas diseñadas y penRed, por sus características especializadas en física médica, como la lectura y procesamiento automático de DICOM y las fuentes de braquiterapia, lo que facilita mucho las simulaciones en el entorno médico. Debido a estos hechos, y a que penRed es de código abierto y no requiere licencia, como es el caso de MCNP, se ha decidido ampliar las capacidades que faltan en este, para poder equiparar su uso al resto de códigos en los problemas abordados durante la realización de la tesis doctoral. Todos estos trabajos contribuyen al desarrollo de herramientas que, mediante la simulación Monte Carlo, permiten optimizar los cálculos en radioterapia. Además, las herramientas desarrolladas tienen una aplicabilidad más general y pueden emplearse en otros campos o problemas, como por ejemplo, el diagnóstico basado en imagen médica. El primero de los trabajos cubre la necesidad del código MCNP6 de ser capaz de leer y escribir archivos de espacio de fase en formato estándar de la IAEA, herramienta que ya tienen implementadas muchos de los códigos de simulación Monte Carlo. Para suplir la falta de MCNP6 de esta capacidad, se desarrolla en esta tesis un código capaz de realizar estas conversiones entre formato de espacio de fase interno de MCNP6 y formatos IAEA y viceversa. En el segundo trabajo, se emplean simulaciones Monte Carlo para diseñar un filtro que homogenice el haz de electrones de 12 MeV en la salida de un acelerador de radioterapia intraoperatoria. El trabajo proporciona una configuración de filtro, diseñada con simulación Monte Carlo y validada con otro grupo de investigación independiente. El tercer trabajo se basa en ofrecer una mejora a los elevados tiempos de computación al realizar planificaciones de radioterapia con simulaciones Monte Carlo para tratamientos con diferentes irradiaciones angulares. Con esta herramienta se pretende agilizar significativamente el proceso de cálculo de distribución de dosis en el maniquí o paciente, sin tener que realizar la simulación a través de todos los componentes del acelerador. Finalmente, a raíz de haber empleado geometrías basadas en mallas en las simulaciones realizadas con MCNP6, se ha visto la importancia de esta capacidad, especialmente en simulaciones en el ámbito de la física médica. La definición de geometrías para describir el sistema es una parte fundamental de cualquier simulación, independientemente del código que se utilice para llevarla a cabo. Es por ello que el cuarto trabajo se centra en el desarrollo de un módulo para simular sobre geometrías malladas en penRed. / [EN] The thesis presented in this document falls within the scope of medical physics. Within this branch of physics, computational tools are developed to offer improvements in the planning of treatments involving ionizing radiation. In these plans, dosimetric factors are calculated, such as the total absorbed dose both in the region of interest of the treatment, which is the treatment's objective, and in the surrounding tissues or organs at risk near the target area. To perform these calculations, different techniques exist, with Monte Carlo simulations considered the most accurate tool. These simulations allow modeling of medical devices emitting the treatment beam to patients in detail. Furthermore, Monte Carlo simulations enable a detailed description of radiation sources and consider the transport of particles involved in the problem through the considered geometry. Different Monte Carlo codes have been used in the works comprising this thesis, depending on the problem addressed. MCNP6 has been used in various works for its capacity and ease in modeling complex geometries using volumetric meshes, penEasy as a code to validate some of the designed tools, and penRed for its specialized features in medical physics, such as reading and automatic processing of DICOM and brachytherapy sources, greatly facilitating simulations in the medical environment. Due to these facts, and because penRed is open-source and does not require a license, unlike MCNP, it has been decided to expand its capabilities to match its use with other codes in the problems addressed during the completion of the doctoral thesis. All of these works contribute to the development of tools that, through Monte Carlo simulation, optimize calculations in radiotherapy. Additionally, the developed tools have broader applicability and can be used in other fields or problems, such as diagnosis based on medical imaging. The first of the works covers the need for the MCNP6 code to be able to read and write phase space files in the standard IAEA format, a tool that many Monte Carlo simulation codes already have implemented. To address the lack of this capability in MCNP6, a code capable of performing these conversions between the internal phase space format of MCNP6 and IAEA formats, and vice versa, is developed in this thesis. In the second work, Monte Carlo simulations are used to design a filter that homogenizes the 12 MeV electron beam at the output of an intraoperative radiotherapy accelerator. The work provides a filter configuration, designed with Monte Carlo simulation and validated with another independent research group. The third work aims to improve the high computation times when performing radiotherapy planning with Monte Carlo simulations for treatments with different angular irradiations. This tool aims to significantly speed up the process of dose distribution calculation in the phantom or patient, without having to simulate through all components of the accelerator. Finally, due to having employed mesh-based geometries in simulations conducted with MCNP6, the importance of this capability has been recognized, especially in simulations in the field of medical physics. The definition of geometries to describe the system is a fundamental part of any simulation, regardless of the code used to perform it. Therefore, the fourth work focuses on the development of a module to simulate on meshed geometries in penRed. / This study was supported by the program “Ayudas para la promoción de empleo joven e implantación de la Garantía Juvenil en I+D+i, Plan Estatal de Investigación Científica y Técnica e Innovación 2017-2020” from the “Iniciativa de Empleo Juvenil” (IEJ) and the “Fondo Social Europeo” (FSE) We would like to acknowledge the Spanish “Ministerio de Ciencia e Innovación” (MCIN) grant PID2021-125096NB-I00 funded by MCIN/AEI/10.13039 and the “Generalitat Valenciana” (GVA) grant PROMETEO/2021/064. / Oliver Gil, S. (2024). Eines computacionals avançades per a planificació radioterapèutica mitjançat simulacions Monte Carlo [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/203890 / Compendio

During prosthetic rehabilitation after tumor therapy in the head and neck region, the dentist must assess whether the prognosis of the remaining teeth is sufficiently good or whether implants should be used to anchor dentures. Thus, the aim of the present study was to compare the survival rate of teeth and implants after and to evaluate factors potentially influencing implant survival. One hundred fifteen patients (male: 70.3%; mean age: 63.2 12.4 years) having received dental treatment before and after at the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination including assessment of dental status and stimulated salivary flow rate was performed. Information about disease progression and therapy was retrieved from medical records. After from a total of 1262 teeth, 27.2% had to be extracted. Of 308 implants inserted after 7.0% were lost. Teeth exhibited lower 5-year survival probability (76.8%) than implants (89.9%; p = 0.001). The risk of loss (RL) of implants increased with age, nicotine use, intraoral defects, and RCT. Radiotherapy did not independently increase the RL. Thus, implants seem to be a reliable treatment option in case of progressive tooth decay after, particularly after RT.

Abstract : Glioblastoma is the most common and aggressive brain cancer in adults. The current standard-of-care treatment includes surgical resection, radiation therapy with concomitant and adjuvant temozolomide (TMZ) chemotherapy. However, the addition of TMZ to radiation therapy only increased the median survival time (MeST) by 2.5 months. This limited improvement is partially attributable to the low accumulation of chemotherapeutic drugs in the brain tumor due to the blood-brain barrier (BBB). Thus, new delivery methods such as intra-arterial, BBB disruption and convection-enhanced delivery (CED) have been proposed to overcome this limitation. Besides, timing tumor irradiation to coincide with the maximal concentration of platinum-DNA adducts could result in improved tumor control. In this study, CED of cisplatin and oxaliplatin, their respective liposomal formulations Lipoplatin™, Lipoxal™, and carboplatin with or without 15 Gy of radiation therapy has been carried out in F98 glioma bearing Fischer rats to assess their toxicity and MeST. The amount of platinum-DNA adducts in the tumor at 4 h and 24 h after CED was measured and irradiation was administered at these two different time periods to test the concomitant effect. In addition, four liposomal carboplatin formulations with different chemo-physical properties were prepared and their toxicity and MeST were also evaluated in this animal model. Among the tested platinum drugs, carboplatin and Lipoxal™ demonstrated a highest maximum-tolerated dose of 25 µg and 30 µg respectively. CED of carboplatin showed the longest MeST of 38.5 days, and increased to 54.0 days with the addition of 15 Gy radiation therapy. However, radiation at 4 h after CED of either oxaliplatin or carboplatin did not show any survival improvement when compared to radiation at 24 h, although the quantity of platinum-DNA adducts at 4 h was higher than at 24 h after CED. In the four liposomal carboplatin formulations, anionic pegylated liposomal carboplatin showed the longest MeST of 49.5 days, due to its longer tumoral retention time and probably larger distribution volume in the brain. / Résumé : Le glioblastome est le cancer primaire du cerveau le plus courant et agressif chez l’adulte. Le traitement standard comprend la résection chirurgicale, la radiothérapie et la chimiothérapie concomitante et adjuvante avec le témozolomide(TMZ). L'addition de TMZ combinée la radiothérapie a augmenté la survie médiane (MeST) de 2,5 mois. Cette faible amélioration est partiellement due à l'accumulation limitée de médicaments chimiothérapeutiques dans la tumeur cérébrale à cause de la barrière hémato-encéphalique (BBB). Ainsi, de nouvelles méthodes comme l’injection intraartérielle, la rupture osmotique de la barrière hémato-encéphalique, la livraison augmentée par convection (CED) ont été suggérées pour surmonter ce problème. En plus, l’optimisation de l’irradiation de la tumeur lorsque le maximum d’adduits platine-ADN est atteint pourrait aboutir à un meilleur contrôle de la tumeur. Dans cette étude, nous avons injecté par CED le cisplatine, l’oxaliplatine, avec leur formulation liposomale Lipoplatin™, Lipoxal™ ainsi que le carboplatine avec ou sans radiation de 15 Gy. La toxicité et le temps de MeST ont été mesurés chez des rats Fischer porteurs du gliome. La quantité d'adduits platine-ADN dans la tumeur a été mesurée 4 h et 24 h après CED. L’irradiation de la tumeur a été effectuée à ces deux temps pour tester l'effet concomitant. En plus, quatre formulations liposomales de carboplatine avec différentes propriétés chimiophysiques ont été préparées et leur toxicité et MeST combiné à la radiation ont également été évalués. Parmi les drogues de platine testées, le carboplatine et Lipoxal™ ont démontré respectivement la dose maximale tolérée la plus élevée, soit 25 µg et 30 µg. La MeST du carboplatine était la plus longue avec 38,5 jours qui a augmenté à 54,0 jours avec l’addition de 15 Gy de radiothérapie. Toutefois, l’irradiation à 4 h après CED effectuée avec l'oxaliplatine et le carboplatine n'a pas amélioré la MeST comparé à l’irradiation à 24 h, bien que la quantité d'adduits platine-ADN à 4 h était supérieure à celle mesurée à 24 h après CED. Pour les quatre formulations liposomales de carboplatine, celle pégylée négatif a démontré la plus longue MeST, soit 49,5 jours.

Ionization chambers (ICs) are the most commonly used detectors for radiation therapy dose measurements. Typical IC measurements use cylindrical ICs in a water phantom and therefore require initial IC alignment to the water surface. This alignment has long been ignored and only recently has a qualitative governing recommendation been made. This thesis describes a reproducible methodology for quantitative ionization chamber water surface alignment. Depth-ionization measurements are taken with twenty-eight IC designs under varying conditions including, but not limited to, changes in scan direction, speed, and resolution, radiation beam type, field size, energy, and electron contamination. Measurements are acquired using standard radiotherapy accelerators in the Virginia Commonwealth University Department of Radiation Oncology and at the National Research Council of Canada, where a customized scanning system capable of better than 0.15 mm IC positioning precision is used. Measurements are also performed with standard commercial scanning equipment on the Accuray CyberKnife, a specialized radiosurgery-class accelerator. An analytical model is developed from basic principles to test the theoretical foundations of IC response near a water surface. The theoretical foundation is further validated via Monte Carlo simulation models that fully account for all details of the ICs used to take measurements. It is determined that the dose gradient as a function of depth is maximized when a given IC reaches the water surface when moving from depth in water. This effect is unchanged under all of the measurement scenarios tested. Measurements taken at 0.1 mm resolution for several seconds per point over several millimeters near the surface will yield a gradient peak that can be used for quantitative alignment. Using developed software, multiple scans at variant resolutions can be stitched into typical clinical scans so as not to significantly affect clinical measurement workflow. The recommended measurement method is developed in a format suitable for inclusion into a clinical protocol for depth-ionization measurement acquisition.