Gnathic changes after head and neck radiotherapy have not been thoroughly characterized radiographically. The objectives of this study are to characterize changes to the teeth and jaws on panoramic images following intensity modulated radiotherapy (IMRT), and to determine whether subject comorbidities and radiation dose affect these changes. This retrospective analysis reviews the charts and panoramic images of 126 head and neck cancer patients who received IMRT at Princess Margaret Hospital between January 1, 2005 and December 31, 2008. Of the 126 subjects, 75 (60%) showed changes on panoramic radiographs; 66 (88%) of which consisted of widened periodontal ligament spaces (WPLS). The median time to WPLS was 29 months after IMRT. Female sex and dose correlated with decreased time to WPLS. These results suggest that WPLS is a common radiographic sign following IMRT that may not require endodontic intervention as post-IMRT WPLS is unrelated to the pulpal status of the tooth.

Despite that most vestibular schwannomas are successfully treated with radiotherapy, current follow-up protocols entail years of serial magnetic resonance imaging (MRI) scans to ensure cessation of growth. This pilot study sought to identify early predictors of radiation treatment response using a non-invasive multi-modality imaging approach. We hypothesized that by combining information acquired from dynamic contrast-enhanced MRI (DCE-MRI), diffusion tensor imaging (DTI), and L-¹¹C-methionine positron emission tomography (MET-PET) treatment response could be identified sooner than the current several year waiting period. This thesis presents the baseline MRI and MET-PET results of the pilot study acquired to-date with follow-up data to be acquired in the next six months. Baseline results suggest that DTI and DCE-MRI yield information that may be useful in identifying the response of vestibular schwannomas to radiotherapy. In particular, vestibular schwannomas display elevated mean diffusion coefficients relative to the contra-lateral cerebellum. Also, the novel use of arterial input functions derived from the anterior inferior cerebellar arteries has led to the successful implementation of DCE-MRI pharmaco-kinetic models which may be used to quantitatively monitor tumor response to radiotherapy. Furthermore, MET-PET has shown promise as a tool for evaluating response as all tumors exhibited enhancement under this modality as compared to the contra-lateral side of the brain. Single-voxel spectroscopy with 3T MRI has proven to be a poor technique with which to examine vestibular schwannomas since only two of eight spectra were acquired successfully. All of the techniques that have shown promise as investigatory tools of tumor response can potentially be implemented clinically in the near future.

The purpose of this study was to evaluate the support program, given to cancer patients in order to promote their own efforts to quit smoking and to study if they kept their changed cigarette consumption 6-18 months after their cancer treatment was done.Method: We have used a descriptive qualitative method with semistructured interviews which were made in the spring of 2010 at Uppsala University. The informants in this study were smoking cancer patients which had been given radiotherapy at the oncology department at Ryhov hospital in Jönköping, Sweden.The results showed that three out of eleven informants were still not smoking after their treatment ended. All informants agreed that information about the effects of smoking on their radiotherapy were important.This study also showed that there are areas in which the support program could benefit from being changed. Of those informants who did not succeed in their efforts to quit smoking, many felt that the support should have been more direct in the sense that the staff should have followed up on their progress more frequently. These unsuccessful informants also stressed that the location for where the information was given could have been more private. Also some of the informants felt that the hospital staff giving the information seemed to be stressed and/or did not seem to have time to support them in their efforts to quit smoking.

published_or_final_version / Surgery / Master / Master of Philosophy

Despite that most vestibular schwannomas are successfully treated with radiotherapy, current follow-up protocols entail years of serial magnetic resonance imaging (MRI) scans to ensure cessation of growth. This pilot study sought to identify early predictors of radiation treatment response using a non-invasive multi-modality imaging approach. We hypothesized that by combining information acquired from dynamic contrast-enhanced MRI (DCE-MRI), diffusion tensor imaging (DTI), and L-¹¹C-methionine positron emission tomography (MET-PET) treatment response could be identified sooner than the current several year waiting period. This thesis presents the baseline MRI and MET-PET results of the pilot study acquired to-date with follow-up data to be acquired in the next six months. Baseline results suggest that DTI and DCE-MRI yield information that may be useful in identifying the response of vestibular schwannomas to radiotherapy. In particular, vestibular schwannomas display elevated mean diffusion coefficients relative to the contra-lateral cerebellum. Also, the novel use of arterial input functions derived from the anterior inferior cerebellar arteries has led to the successful implementation of DCE-MRI pharmaco-kinetic models which may be used to quantitatively monitor tumor response to radiotherapy. Furthermore, MET-PET has shown promise as a tool for evaluating response as all tumors exhibited enhancement under this modality as compared to the contra-lateral side of the brain. Single-voxel spectroscopy with 3T MRI has proven to be a poor technique with which to examine vestibular schwannomas since only two of eight spectra were acquired successfully. All of the techniques that have shown promise as investigatory tools of tumor response can potentially be implemented clinically in the near future.

Monte Carlo (MC) methods for radiotherapy dose calculation are widely accepted as capable of achieving high accuracy. In particular, MC calculations have been demonstrated to successfully reproduce measured dose distributions in complex situations where alternative dose calculation algorithms failed (for example, regions of charged particle disequilibrium). For this reason, MC methods are likely to play a central role in radiotherapy dose calculations and dose verification in the future. However, clinical implementations of MC calculations have typically been limited due to the high computational demands. In order to improve the feasibility of using MC simulations clinically, the simulation techniques must be made more efficient. This dissertation presents a number of approaches to improve the efficiency of MC dose calculations. One of the most time consuming parts of source modeling is the simulation of the secondary collimators, which absorb particles to define the rectangular boundaries of radiation fields. The approximation of assuming negligible transmission through and scatter from the secondary collimators was evaluated for accuracy and efficiency using both graphics processing unit (GPU)-based and central processing unit (CPU)-based MC approaches. The new dose calculation engine, gDPM, that utilizes GPUs to perform MC simulations was developed to a state where accuracy comparable to conventional MC algorithms was attained. However, in GPU- based dose calculation, source modeling was found to be an efficiency bottleneck. To address this, a sorted phase-space source model was implemented (the phase-space- let, or PSL model), as well as a hybrid source model where a phase-space source was used only for extra-focal radiation and a point source modeled focal source photons. All of these methods produced results comparable with standard CPU-based MC simulations in minutes, rather than hours, of calculation time. While maintaining reasonable accuracy, the hybrid source model increased source generation time by a factor of ~2-5 when compared with the PSL source model. A variance reduction technique known as photon splitting was also implemented into gDPM, to evaluate its effectiveness at reducing simulation times in GPU calculations. Finally, an alternative CPU-based MC dose calculation technique was presented for specific applications in pre-treatment dose verification. The method avoids the requirement of plan-specific MC simulations. Using measurements from an electronic portal imaging device (EPID), pre-calculated MC beamlets in a spherical water phantom were modulated to obtain a dose reconstruction. / Graduate

No description available.

Bibliography: p. 185-195. / xxii, 195 p. : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Two rigorous dose calculation methods have been devised to address the deficiencies of currently available dose calculation algorithms. The 1st method incorporates Fermi-Eyges mutiple scattering theory, the 2nd method developed is the Super-Monte Carlo method. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physics and Mathematical Physics, 1996?

Current radiotherapy techniques are focused on delivering effective treatments while sparing surrounding healthy tissues. As a result, radiotherapy treatments are using narrower and more tightly conforming therapy techniques. For these treatments to be effective an accurate measure of the dose delivered by these very narrow radiotherapy beams, both in and around the target volume, is required. It is a challenging task for the conventional type dosimeters to determine dose distribution in such small fields. The best example of such fields is microbeam beam radiotherapy (MRT), a developing treatment technique that takes this requirement even further. MRT delivers an array of micrometre size radiotherapy beams to the target. MRT has been shown to be highly effective, but reliable dosimetry of MRT is challenging due to the micrometre scales involved. Attempts to determine the MRT dose distribution have been documented for using special type dosimeters such as radioch romic film and MOSFET detectors, as well as Monte Carlo simulations. This thesis investigates polymer gels as a dosimeter for dose distribution measurements of small radiotherapy fields and microbeams. Polymer gel dosimetry is a technique which uses a tissue-equivalent gel to act as both a three-dimensional dosimeter and a phantom at the same time. These gels polymerise when exposed to ionising radiation and the response is locally dose dependent linearly. This thesis investigates the use of polymer gels for the dosimetry of small sub-centimetre (down to 3 × 3 mm2) and micrometre radiotherapy fields. A high resolution imaging technique is also required for such small beam dosimetry. This work used special high strength MRI scanners to analyse polymer gels at high resolution. This work explores the feasibility of polymer gels irradiated by microbeams and analysed using Raman spectroscopy as a dosimeter for synchrotron generated microbeams. MRT is characterised by very high doses, and special high-dose resistive types of gel were developed as part of this work. It is shown that polymer gels imagined using Raman spectroscopy techniques are capable of measuring the dose distribution of microbeam radiation techniques. This thesis also investigates the use of polymer gels to measure dose perturbations caused by metallic artefacts. Metallic artefacts, such as a surgical aneurysm clip, can be left in a patient and cause dose perturbations during radiotherapy procedures. Polymer gels were used to determine the degree of dose enhancement induced by an aneurysm clip placed inside when irradiated with a typical stereotactic radiotherapy procedure. In addition, this thesis used gels in several other innovative applications. Photonuclear interactions generated in gel by high energy x-ray beams were measured via secondary neutrons. Special clear-type gels that do not change colour with irradiation were developed. Polymer gels were investigated for dosimetry of an extremely high dose rate capacitor type linear accelerator. And polymer gels were for measurement of a high energy proton beam.

Thesis (Ph.D.)--University of Western Australia, 2007.