Radiation

Background: Stereotactic Radiotherapy (SRT) in pancreatic and biliary tract cancer (PBC) suffers from proximity to any organ(s) at risk (OARs). Some strategies to manage this issue have previously been proposed, such as Simultaneous Integrated Protection (SIP), with the aim of maintaining a biological effective dose prescription while reducing toxicities. We performed a systematic review of the literature about SRT techniques applied in patients with tumor in proximity to OARs, with the aim of testing safety and efficacy. Methods: using PRISMA guidelines, we selected studies from a pool of more than 25,000 articles published from 2010 to 30 January 2023 that explored the use of SRT to deliver targeted treatment for PBC. We then selected the ones referring to decreases in prescription doses (for SRT only) in the area of overlap between planning target volume (PTV) and OARs. Local control (LC) and toxicities being detailed were exclusion criteria for articles. Results: 9 studies were included in our review, considering 368 patients. One-year LC probability ranges between 67% and 98.3% were reported. Late G3 toxicities ranged between 0% and 5.3%, while G4-G5 late toxicities were both reported as 0.3%. Conclusion: prioritizing critical OAR constraints limits severe toxicities while preserving LC in PBC SRT. Improving in-study reporting is essential to confirm these promising results. Full article

Background: Erectile dysfunction (ED) is common after prostate cancer treatment. It has been studied for conventional radiotherapy, but associations in the hypofractionated radiotherapy context are less clear. This study aimed to determine which factors are predicted for worsening ED after highly conformal, modestly hypofractionated radiotherapy to the prostate. Methods: Two hundred and twelve patients treated with 6000 cGy in twenty fractions across four centers were included in this study. Demographic, clinical, and dosimetry factors were then evaluated for post-treatment declines in erectile function using logistic regression and an explainable machine learning-based neural network. Results: 212 patients with a median follow-up of 3.6 years were evaluated. A total of 104 (49%) patients received androgen deprivation therapy. Prior to treatment, 52 (25%) patients were on ED medication. Mean doses to the penile bulb, penile crus, and penile shaft were 2490 (IQR: 1529–3656) cGy, 2095 (1306–3036) cGy, and 444 (313–650) cGy, respectively. Fifty-nine (28%) patients had a worsening of ED after treatment. On multivariable analysis, only the mean dose to the penile shaft [OR >345 vs. ≤345: 4.47 (1.43–13.99); p = 0.010] and pretreatment use of ED medication [OR yes vs. no: 12.5 (5.7–27.5; p < 0.001)] predicted for worsening ED. The neural network confirmed that the penile shaft mean dose and pre-treatment ED medication use are the most important factors in predicting ED. Conclusions: Pre-treatment ED and penile shaft dosimetry are important predictors for ED after hypofractionated radiotherapy for prostate cancer. Full article

This study aimed to evaluate the safety of gadobutrol, a gadolinium-based contrast agent used in medical imaging, by investigating its effect on the nervous system under physiological and inflammatory conditions. Male Sprague Dawley rats were divided randomly into four groups, including gadobutrol, saline, LPS + gadobutrol, and LPS + saline, and were given intraperitoneal injections of gadobutrol (2.5 mmol/kg) or saline for 20 days. Weekly sensorimotor and cognitive behavioral tests were performed over 4 weeks, and Gd concentration in nervous tissues was analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Lactate dehydrogenase (LDH) activity was measured to evaluate cytotoxicity, and electromyography (EMG) recordings from the gastrocnemius muscle were also obtained to examine signal transmission in sciatic nerves. The results indicated that gadobutrol did not induce significant behavioral changes under normal conditions. However, when administered along with LPS, the combination led to behavioral dysfunction. ICP-MS analysis revealed a higher concentration of Gd in the cerebrum and spinal cord of gadobutrol + LPS-treated rats, while peripheral nerves showed lower concentrations. In addition, there was a significant increase in LDH activity in the hippocampus of the gadobutrol group. EMG responses to electrical stimulation of the sciatic nerve demonstrated a decreased threshold of nociceptive reflexes in the gadobutrol group. Overall, while gadobutrol may be considered safe under normal physiological conditions, the findings suggest that its safety may be compromised under inflammatory conditions. Full article

We investigated the influence of modifying the voltage of an X-ray tube with a tungsten anode between 30 kV and 225 kV, and therefore its photon energy spectrum (up to 225 keV), on the Total Ionizing Dose deposited in a single-mode, phosphorus-doped optical fiber, already identified as a promising dosimeter. Simulation data, obtained using a toolchain combining SpekPy and Geant4 software, are compared to experimental results obtained on this radiosensitive optical fiber and demonstrate an increase of the deposited dose with operating voltage, at a factor of 4.5 between 30 kV and 225 kV, while keeping the same operating current of 20 mA. Analysis of simulation results shows that dose deposition in such optical fibers is mainly caused by the low-energy part of the spectrum, with 90% of the deposited energy originating from photons with an energy below 30 keV. Comparison between simulation and various experimental measurements indicates that phosphosilicate fibers are adapted for performing X-ray dosimetry at different voltages. Full article

The space radiation environment outside the protection of the Earth’s magnetosphere is severe and difficult to shield against. The cumulative effective dose to astronauts on a typical Mars mission would likely introduce risk exceeding permissible limits for carcinogenesis without innovative strategies for radiation shielding. Damaging cardiovascular and central nervous system effects are also expected in these space environments. There are many potential options for advanced shielding and risk mitigation, but magnetic shielding using superconductors offers several distinct advantages including using the conditions in space to help maintain the superconductor’s critical temperature and lower mass compared to equivalent passive shielding materials. Despite these advantages, the development of magnetic shielding technology has remained primarily in conceptual stages since the introduction of the idea in 1961. Over the last several decades, magnetic shielding has experienced periods of high and low attention by the human spaceflight community, leading to computational tools with single-use or other limitations and a non-uniform distribution of publications on the topic over time. Within the context of technology development and the surrounding space policy environment, this paper reviews and summarizes the available literature on the application of active magnetic shielding for space radiation protection, identifies challenges, and highlights areas for future research. Full article

Secondary lymphedema is caused by damage to the lymphatic system, often following an oncological tumor removal intervention, or even by an accident. The diagnosis of lymphedema is not easy, because the disease can also be confused with other clinical manifestations (for example, venous insufficiency edema), though an experienced Lymphologist is usually able to diagnose it with good accuracy. To confirm the diagnosis, it is often necessary to resort to specialist imaging tests for an anatomo-functional definition of the pathology. Among these, lymphoscintigraphy is confirmed as the “gold standard” procedure for the diagnosis of lymphedema. Lymphoscintigraphy has been included in the Italian Guidelines by the Ministry of Health. Full article

The Rothmund–Thomson syndrome (RTS) is a rare autosomal recessive disease associated with poikiloderma, telangiectasias, sun-sensitive rash, hair growth problems, juvenile cataracts and, for a subset of some RTS patients, a high risk of cancer, especially osteosarcoma. Most of the RTS cases are caused by biallelic mutations of the RECQL4 gene, coding for the RECQL4 DNA helicase that belongs to the RecQ family. Cellular and post-radiotherapy radiosensitivity was reported in RTS cells and patients since the 1980s. However, the molecular basis of this particular phenotype has not been documented to reliably link the biological and clinical responses to the ionizing radiation (IR) of cells from RTS patients. The aim of this study was therefore to document the specificities of the radiosensitivity associated with RTS by examining the radiation-induced nucleo-shuttling of ATM (RIANS) and the recognition and repair of the DNA double-strand breaks (DSB) in three skin fibroblasts cell lines derived from RTS patients and two derived from RTS patients’ parents. The results showed that the RTS fibroblasts tested were associated with moderate but significant radiosensitivity, a high yield of micronuclei, and impaired DSB recognition but normal DSB repair at 24 h likely caused by a delayed RIANS, supported by the sequestration of ATM by some RTS proteins overexpressed in the cytoplasm. To our knowledge, this report is the first radiobiological characterization of cells from RTS patients at both molecular and cellular scales. Full article

This article highlights advancements in polymeric composite/nanocomposites processes and applications for improved radiation shielding and high-rate attenuation for the spacecraft. Energetic particles, mostly electrons and protons, can annihilate or cause space craft hardware failures. The standard practice in space electronics is the utilization of aluminum as radiation safeguard and structural enclosure. In space, the materials must be lightweight and capable of withstanding extreme temperature/mechanical loads under harsh environments, so the research has focused on advanced multi-functional materials. In this regard, low-Z materials have been found effective in shielding particle radiation, but their structural properties were not sufficient for the desired space applications. As a solution, polymeric composites or nanocomposites have been produced having enhanced material properties and enough radiation shielding (gamma, cosmic, X-rays, protons, neutrons, etc.) properties along with reduced weight. Advantageously, the polymeric composites or nanocomposites can be layered to form multi-layered shields. Hence, polymer composites/nanocomposites offer promising alternatives to developing materials for efficiently attenuating photon or particle radiation. The latest technology developments for micro/nano reinforced polymer composites/nanocomposites have also been surveyed here for the radiation shielding of space crafts and aerospace structures. Moreover, the motive behind this state-of-the-art overview is to put forward recommendations for high performance design/applications of reinforced nanocomposites towards future radiation shielding technology in the spacecraft. Full article

The aim of the current work was to study natural radioactivity in soil and the correlation between ²²²Rn and ²²⁶Ra in the ground and to assess the onsite and indoor long-term excess cancer risk at the bauxite bearing area of Fongo-Tongo in Western Cameroon. ²²²Rn was measured in the ground at a depth of one meter, using Markus 10 detector. ²²⁶Ra, ²³²Th, and ⁴⁰K activity concentrations were measured in soil by two techniques, in situ and laboratory gamma spectrometry. The mean values of ²²²Rn concentrations in the ground were 69 ± 18 kBqm⁻³ for Fongo-Tongo and 82 ± 34 kBq m⁻³ for the locality of Dschang, respectively. The mean values of ²²⁶Ra, ²³²Th, and ⁴⁰K activity concentrations obtained with in situ gamma spectrometry were 129 ± 22, 205 ± 61, and 224 ± 39 Bq kg⁻¹ for ²²⁶Ra, ²³²Th, and ⁴⁰K, respectively, and those obtained by laboratory gamma spectrometry were 129 ± 23, 184 ± 54, and 237 ± 44 Bq kg⁻¹, respectively. A strong correlation between ²²²Rn and ²²⁶Ra activity concentrations determined by in situ and laboratory measurements (R² = 0.86 and 0.88, respectively) was found. In addition, it is shown that the total excess cancer risk has a maximum value of 8.6 × 10⁻³ at T = 0 year and decreases progressively in the long term. It is also shown that ²²⁶Ra makes a major contribution, i.e., above 70%, to the total excess cancer risk. Full article

Cardiovascular diseases represent one of the most frequent diseases worldwide; among these, lower limb ischemia is a threatening condition, which can lead to permanent disability if not promptly and correctly diagnosed and treated. A patient’s clinical evaluation and diagnostic imaging (e.g., color-Doppler ultrasound, computed tomography angiography (CTA), and magnetic resonance imaging (MRI)) are mandatory to carefully assess arterial lesion extension and severity. Digital subtraction angiography (DSA) is a minimally invasive technique that represents the gold standard for percutaneous revascularization treatment of symptomatic patients who are refractory to medical management. However, when dealing with patients with lower limb terminal ischemia, the correct interpretation of diagnostic DSA findings is mandatory for treatment re-planning and to effectively evaluate post-treatment results and complications. The purpose of this review is to provide interventional radiologists and endovascular practitioners with an up-to-date practical guide to diagnostic angiography of the lower limbs, which is mandatory to address correct treatment decisions and post-treatment evaluation. Full article

In order to test the theory of Brizhik et al. about the dynamic allocation of acupuncture meridians on human body and their role as hydric paths for solitons, we tested the effect of both acupuncture and exposure to extremely low frequencies (ELF) tuned with suitable ion cyclotron frequencies. The similarity of the effects, inducing variations of body impedance measured in well-known acupuncture points, up to the interchangeability and the synergy of the two treatments, the mechanic and the electromagnetic ones, turns to be evidence of the validity of the theory. Resistance and reactance variations have been detected in a group of 31 healthy volunteers before and after stimulation with a standard sequence of cyclotron frequencies, emitted from an innovative electromagnetic therapy (EMT) device. These variations were then compared with the variations produced by the well-known percutaneous stimuli of mechanical and piezoelectric nature, and, in particular in this work, acupuncture. Our results show that the observed variations can be considered as significant in both groups: cyclotron and acupuncture. The greater variations brought about by the cyclotron treatment stand out clearly. Full article

The purpose of the study was to calibrate and commission optically-stimulated luminescence dosimeters (OSLDs) for in vivo measurements in contact-based ¹⁹²Ir treatments for superficial high dose rate (HDR) brachytherapy in place of metal-oxide-semiconductor field-effect transistors (MOSFETs). Dose linearity and dose rate dependence were tested by varying source-to-OSLD distance and dwell time. Angular dependence was measured using a solid water phantom setup for OSLD rotation. A group of OSLDs were readout 34 consecutive times to test readout depletion while OSLDs were optically annealed using a mercury lamp for 34.7 h. End-to-end tests were performed using a Freiburg flap and Valencia applicator. OSLD measurements were compared to MOSFETs and treatment planning system (TPS) doses. OSLD response was supralinear for doses above 275 cGy. They were found to be independent of dose rate and dependent on the incident angle in edge-on scenarios. OSLDs exhibited minimal readout depletion and were successfully annealed after 24 h of illumination. Freiburg flap measurements agreed well with the TPS. For the Valencia, OSLDs showed to be the more accurate system over MOSFETs, with a maximum disagreement with the TPS being 0.09%. As such, OSLDs can successfully be used in place of MOSFETs for in vivo dosimetry for superficial HDR brachytherapy. Full article

While radical cystectomy remains the primary treatment of choice for bladder cancer, increased evidence supports the use of bladder-preservation strategies based on adjuvant radiotherapy. This highlights the need for a better understanding of bladder cancer radiosensitivity to different types of treatment deliveries. The purpose of this study is to analyze the effect of treatment time, dose and fractionation on the number and sizes of grown three-dimensional (3D) bladder cancer spheres, and to assess the capacity of the linear-quadratic model in describing the response of cells cultured in 3D. 3D Matrigel^TM-based cultures were employed to enrich for cancer stem cells (CSCs) from three human bladder cancer cell lines, RT4, T24 and UM-UC-3. Three single dose radiation treatments were performed at different time points after plating, and sphere number and sizes were assessed. Anti-CD44 immunofluorescence, clonogenic assay and anti-γH2AX staining were also performed to analyze the cell lines’ radiosensitivity. The radiosensitivity of spheres was dependent on the treatment timing after plating. Current linear quadratic dose fractionation models were shown to over-estimate radiosensitivity in 3D models. Our results showed the importance of treatment timing on the radio-response of bladder cancer spheres. We also demonstrated that bladder cancer spheres are more resistant to dose-fractionation than the estimation from the theoretical linear-quadratic model. Full article

There is significant interest in the response of the mammalian brain to low-dose ionizing radiation (LDIR), mainly examined by gene or protein expression, with applications in radiation safety on Earth, the atmosphere and outer space. Potential associations of molecular-level responses with sensory or cognitive defects and neurodegenerative diseases are currently under investigation. Previously, we have described a light-weight approach for the storage, analysis and distribution of relevant datasets, with the platform BRIDE. We have re-implemented the platform as BRIDE v2 on the cloud, using the bioinformatics infrastructure ELIXIR. We connected the annotated list of 3174 unique gene records with modern omics resources for downstream computational analysis. BRIDE v2 is a cloud-based platform with capabilities that enable researchers to extract, analyze, visualize as well as export the gene collection. The resource is freely available online at <http://bride-db.eu>. Full article

Waterhouse-Friderichsen syndrome is a rare disease characterized by bleeding into the adrenal glands, and its symptoms may vary from non-specific abdominal pain to multi-organ failure. Commonly related to a variety of infectious diseases among which sepsis from Neisseria meningitidis is the most frequent, many other etiologies have been described, and in some rare cases, even no apparent cause can be identified. We report a rare case of an idiopathic bilateral adrenal hemorrhage in a 70-year-old male who presented to our emergency department with non-specific abdominal pain. Ultrasonography Scan (US) and Computed Tomography (CT) findings were crucial for making an early diagnosis, which resulted in a short hospitalization time and, eventually, a complete recovery of the adrenal function. After discharge, Magnetic Resonance Imaging (MRI) was also performed, providing a more complete ensemble of multimodality imaging findings that can be associated with this rare syndrome. Full article

The critical arguments for radiofrequency radiation exposure limits are currently based on the principle that radio frequencies (RF) and electromagnetic fields (EMFs) are non-ionising, and their exposure limits are even 100-fold lower than those emitted from the Sun in the whole RF-EMF spectrum. Nonetheless, this argument has been challenged by numerous experimental and theoretical studies on the diverse biological effects of RF-EMF at much lower power density (W/m²) levels than today’s exposing limits. On the other hand, less attention has been given to counterarguments based on the differences in the physics concepts underlying man-made versus natural electromagnetic radiation (EMR) and on the fact that man’s biology has been adapted to the natural EMR levels reaching Earth’s surface at single EMF wavelengths, which are the natural limits of man’s exposure to EMFs. The article highlights the main points of interaction of natural and man-made radiation with biomatter and reveals the physical theoretical background that explains the effects of man-made microwave radiation on biological matter. Moreover, the article extends its analysis on experimental quantum effects, establishing the “ionising-like” effects of man-made microwave radiation on biological matter. Full article

The optimal sequence and combination of radium-223 therapy (Ra-223) for castration-resistant prostate cancer with bone metastasis (mCRPC) remain unclear. This study aimed to explore the prognostic factors after Ra-223 administration and to determine the optimal treatment strategy. We enrolled 64 patients with mCRPC who underwent Ra-223 therapy from June 2016 to July 2022 at a single institution in Japan. Overall survival (OS) and pain progression-free survival (p-PFS), which was proposed as a measure of quality of life (QOL), were analyzed using Cox proportional hazards models and log-rank tests, and between-factor analysis was performed with the Mann–Whitney U (MWU) test. Univariable and multivariable analyses revealed prognostic factors; specifically, early treatment (≤third line), completion of six treatment cycles, low bone scan index (BSI) (<0.61), alkaline phosphatase (ALP) (<140 U/L), prostate-specific antigen (PSA; <22.9 ng/mL), lactate dehydrogenase (LDH; <240 U/L), high hemoglobin (Hb) (≥11.4 g/dL), and prior denosumab use significantly prolonged OS. Low BSI, low ALP, and early Ra-223 treatment also prolonged p-PFS in the log-rank tests. The MWU test showed that high BSI (≥0.61) was associated with high PSA and high ALP and a tendency for Hb to decrease. Late Ra-223 treatment (≥fourth line) was significantly associated with low Hb and high PSA. Early Ra-223 treatment was significantly associated with improved OS, and administering Ra-223 before novel hormonal or anticancer agents may be meaningful. Full article

At the beginning of the COVID-19 emergence, many scientists believed that, thanks to the proofreading enzyme of SARS-CoV-2, the virus would not have many mutations. Our team introduced the concept of radiation at extremely low doses in an attempt to establish selected pressure-free treatment approaches for COVID-19. The capacity of low-dose radiation to modulate excessive inflammatory responses, optimize the immune system, prevent the occurrence of dangerous cytokine storm, regulate lymphocyte counts, and control bacterial co-infections as well as different modalities were proposed as a treatment program for patients with severe COVID-19-associated pneumonia. There is now substantial evidence which indicates that it would be unwise not to further investigate low-dose radiation therapy (LDRT) as an effective remedy against COVID-19-associated pneumonia. Full article