Browsing by Author "Lalit Mohan Aggarwal"

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A comparison between revised Manchester Point A and ICRU-89–recommended Point A definition absorbed-dose reporting using CT images in intracavitary brachytherapy for patients with cervical carcinoma
(Elsevier Inc., 2021) Ankur Mourya; Sunil Choudhary; Uday Pratap Shahi; Neeraj Sharma; Himani Gautam; Ganeshkumar Patel; Satyajit Pradhan; Lalit Mohan Aggarwal
Purpose: This study is a comparison between revised Manchester Point A and International Commission on Radiation Units and measurements (ICRU) 89 report–recommended Point A absorbed-dose reporting in intracavitary brachytherapy for patients with cervical carcinoma. Methods and Materials: The retrospective dosimetric study is based on the data of 32 patients with cervical carcinoma treated with high-dose-rate brachytherapy. Patients received 21 Gy in three fractions (7.0 Gy X three fractions) to Point A (Aflange, revised Manchester definition). All the patients were replanned with a new Point A (Aicru89) defined on CT images as per the American Brachytherapy Society/ICRU-89. The data collected were compared with the data obtained from Point A (Aflange). Results: When using the Aflange plan normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 820.79 ± 207.47 cGy, 654.66 ± 152.69 cGy, and 588.91 ± 136.35 cGy, respectively. Likewise, when using the ICRU-89 Point Aicru89 normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 869.30 ± 224.67 cGy, 693.24 ± 166.20 cGy, and 616.61 ± 150.32 cGy, respectively. For the rectum, Point Aflange normalization plans, the mean dose of 0.1 cc, 1 cc, and 2 cc volumes was 589.37 ± 163.26 cGy, 487.51 ± 126.03 cGy, and 442.70 ± 111.43 cGy, respectively. Likewise, using the Aicru89 plan, the mean 0.1 cc, 1 cc, and 2 cc rectum volume was 625.07 ± 171.31 cGy, 517.50 ± 131.05 cGy, 464.94 ± 121.81 cGy, respectively. The statistical mean difference of Total Reference Air Kerma rate, V100 (cc), bladder, rectum and sigmoid, was found significant. Conclusions: It has been found that the position of revised Manchester (Aflange) and ICRU-89 Point A does not match on CT images/radiograph, which resulted in variation in doses to the tumor, V100 (cc), organ at risk, and Total Reference Air Kerma. © 2021 American Brachytherapy Society
A comparison of TG-43 and TG-186 dose calculation algorithms for treatment planning of intra-cavitary brachytherapy using tandem and ovoid applicator
(Termedia Publishing House Ltd., 2024) Syed Mohamed Shajid; Lalit Mohan Aggarwal; Ankur Mourya; Sunil Choudhary; V. Gogul Priean; Ankita Singh; Saji Oommen
Purpose: The present study evaluated the dosimetric impact and compared the dose variations between the advanced collapsed cone engine (Task Group 186) and Task Group 43 plans for cervical cancer using tandem and ovoid applicators. Material and methods: Thirty cervical cancer patients underwent iridium-192 (192Ir) high-dose-rate (HDR) intra-cavitary brachytherapy using tandem and ovoid applicator. Original treatment plans for all patients were created using TG-43 dose calculation formalism. Subsequently, these plans were re-calculated using ACE (TG-186) algorithm and were not re-optimized, so that dwell time and dwell positions were identical in both plans. High-risk clinical target volume and organs at risk were contoured in each dataset. Significant air gaps within region of interest and use of high density applicator materials were also considered. The assessment encompassed a point-based evaluation, extraction of dosimetric parameters from dose-volume histogram (DVH), and plan evaluation indices for each algorithm. Results: Compared with ACE (TG-186) plans, TG-43 plans predicted higher doses for point A, point B, D90, D100, V100, V150, V200, and V300for HR-CTV (p < 0.05). Similarly, TG-43 plans indicated higher doses for bladder point, rectum point, D0.1cm3, D10cm3, and D2cm3 for bladder, rectum, and sigmoid (p < 0.05). Additionally, overall plan quality score (PQS) was significantly greater in plans calculated with ACE (TG-186) formalism than in TG-43 plans (p < 0.05). In TG-186 (ACE) plans, gradient index (GI) was found to be lower than that in TG-43 plans (p < 0.05). Conclusions: TG-43 tends to overestimate doses compared with ACE (TG-186); nonetheless, both methods meet clinical standards. Material differences in the applicator are notable, and dose overestimations by TG-43 are within 5%. © 2024 Termedia Publishing House Ltd.. All rights reserved.
A mathematical model to predict the different isodose volumes using TRAK value in HDR intracavitary brachytherapy for revised Manchester and ICRU-89 based Point A plans using computer tomography images
(Wolters Kluwer Medknow Publications, 2022) Ankur Mourya; Sunil Choudhary; Neeraj Sharma; Uday Pratap Shahi; Gaganpreet Singh; Satyajit Pradhan; Lalit Mohan Aggarwal
Purpose: To find out the simple relationship between Total Reference Air Kerma (TRAK) and various isodose volumes. Calculated isodose volumes were compared with experimental data for revised Manchester and International Commission on Radiation Units and measurements (ICRU)-89 Point A-based treatment plans. The accuracy of the formula was compared with the results of other relationships available in the literature. Materials and Methods: Dosimetric data from 62 intracavitary brachytherapy (ICBT) treatment plans of 31 patients with cervical cancer were studied. Each patient had treatment plans normalized to revised Manchester and ICRU-89 Points A (A flange and A icru89). For each treatment plan, TRAK values, V 350, V 700, V 1050, and V 1400 were obtained. The modeling curve was plotted between Isodose volume (V d) and the ratio of d/TRAK obtained from A flange plans to get a mathematical relation. The results of this formula were compared with the experimental data and outcomes of other formulas available in the literature. A paired-sample t-Test was performed to assess the statistical significance. Results: In the case of revised Manchester-based A flange normalization plans, the mean isodose volume of V 350, V 700, V 1050, and V 1400 were 285.98 ± 32.3 cm 3, 101.96 ± 10.63 cm 3, 52.71 ± 4.72 cm 3, and 31.44 ± 2.33 cm 3 respectively. Likewise, for ICRU-89 based A icru89 normalization plans, the mean isodose volumes of V 350, V 700, V 1050, and V 1400 were 304.11 ± 26.17 cm 3, 108.88 ± 8.29 cm 3, 56.62 ± 3.69 cm 3 and 34 ± 2.23 cm 3 respectively. The mean difference was significant. The Mathematical relationship developed was [INLINE:1]. No correlation was found between TRAK and D 0.1cm 3,D 2cm 3 for organs at risk. Conclusions: The developed formula calculated isodose volumes within the accuracy of ± 3% in ICBT plans. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
A new method to correct the attenuation map in simultaneous transmission/emission tomography using 153Gd/ 67Ga radioisotopes
(2012) Subhash Chand Kheruka; Brian F. Hutton; Umesh Chand Naithani; Lalit Mohan Aggarwal; Nirmal Kumar Painuly; Anil Kumar Maurya; Sanjay Gambhir
Reconstruction of the tomographic images without attenuation correction can cause erroneously high count densities and reduced image contrast in low attenuation regions. In order to solve the problem of photon attenuation, one needs to know the attenuation coefficient for the individual patient being studied. Therefore, we made an attempt to correct the attenuation map in simultaneous transmission/emission tomography with 153Gd/ 67Ga using maximum likelihood method using the expectation maximization (ML-EM) algorithm to correct the transmission window for both the spillover and downscatter. Spillover fraction, scatter fraction and parameters for the scatter function (A, b and c) were determined experimentally and optimized using the optimization program written in IDL based on simplex theory. All measurements were performed on a Vertex gamma camera using the anthropomorphic thorax phantom for validation of data obtained by the proposed method. It was observed that without spillover and downscatter correction, the mean counts were 19.29 in liver and 26.90 in lung, whereas after after applying the corrections, the mean counts were reduced to 3.80 and 15.10 in liver and lung, respectively, which were close to true mean counts (liver 2.15 and lung 14.89). In this proposed method, we introduced the set of F t (spillover) and K t (downscatter) to account for the variations in projection pixels (f t and k t) with the density and thickness. The F t and K t were determined using the transmission data by an iterative process. The quantitative error was reduced by 98.0% for lung and 90.0% for liver when the corrected transmission images were obtained after the subtraction of spillover and downscatter fraction.
A Prospective Study to Evaluate the Feasibility and Outcome of Completing Concurrent Chemo-radiation and Brachytherapy Within 4 Weeks Using Two Different Chemotherapy Regimens in Carcinoma Cervix
(Springer, 2018) Sovan Sarang Dhar; Uday Pratap Shahi; Tejbali Singh; Anupam Kumar Asthana; Satyajit Pradhan; Lalit Mohan Aggarwal; Sunil Choudhary; Abhijit Mandal; Deepak Kumar
Purpose: A prospective study was performed to assess the feasibility and outcome of completing concurrent chemo-radiotherapy (CCRT) in ≤ 4 weeks in cervical cancer patients using combination of paclitaxel and cisplatin as weekly regimen versus weekly cisplatin as concurrent chemotherapy. Methods: Forty patients of mostly locally advanced stage were prospectively allocated to receive either weekly cisplatin (40 mg/m2) [arm A] or weekly paclitaxel (50 mg/m2) and cisplatin (30 mg/m2) [arm B]. External Beam Radiotherapy [EBRT] in both arms given was 45 Gy/20 fractions/5 fractions per week (using conventional technique, Co60 teletherapy), intracavitary radiotherapy 30 Gy to point A (using LDR in a single setting) in between EBRT fractions, starting after completion of 10 fractions of EBRT. Results: Treatment of 65% of arm B and 70% of arm A patients could be completed by 4 weeks. At a median follow-up of 24 months, 85% patients in each arm had complete loco-regional control, on intention to treat analysis. Thirty-month survival in the respective arms were 69 and 72.2%. Grade 3 acute toxicity varied between 10 and 15% in both arms. Grade-5 acute haematological toxicity was found in one patient (5%) of each arm. Difference between the two arms was statistically not significant for response, survival or toxicity. Conclusion: Completing CCRT by 4 weeks is feasible with acceptable acute toxicity and encouraging outcome for carcinoma cervix. Concurrent weekly cisplatin + paclitaxel do not improve loco-regional control or survival as compared to weekly cisplatin alone at the cost of similar toxicity. Large sample study and long follow-up are needed to establish the same and identify late toxicities. © 2018, Association of Gynecologic Oncologists of India.
Addition of Etoricoxib During Concurrent Chemo-radiation of Cervical Cancer Patients Could Result in Faster Resolution of Gross Disease: A Prospective Single-Institution Study
(Springer, 2020) Sovan Sarang Dhar; Uday Pratap Shahi; Deepak Kumar; Ritusha Mishra; Prashant Kaser; Satish Dewangan; Abhijit Mandal; Sunil Choudhary; Lalit Mohan Aggarwal; Anupam Kumar Asthana; Satyajit Pradhan
Objective: A prospective study was conducted to assess the effect of adding COX-2 inhibitor Etoricoxib during concurrent chemo-radiotherapy schedule of cervical cancer patients on tumour response and acute toxicities. Materials and Methods: Forty patients of carcinoma cervix [mostly locally advanced] were treated using external beam radiotherapy (EBRT) [telecobalt, 45 Gy/20F/5F per week] concurrent with weekly cisplatin- or cisplatin + paclitaxel-based chemotherapy. Low-dose-rate (LDR) intracavitary brachytherapy (ICBT) 30 Gy to point A was delivered in between EBRT fractions in a single setting. Patients were prospectively allocated either to receive Etoricoxib 90 mg OD during the entire course of chemo-radiation [arm A] or not [arm B]. Weekly assessment with clinical evaluation and routine blood tests were done during the course of treatment, with pre-ICBT clinical evaluation taken into consideration for disease response comparison between arms. Results: When evaluated clinically before intracavitary brachytherapy procedure, the gross disease was found to have regressed more in the arm receiving Etoricoxib [p = 0.042]. Acute grade-3 toxicities ranged between 5 and 15% for patients who received Etoricoxib and 10–15% for those who did not. Difference in toxicities was not statistically significant. Conclusion: Addition of COX-2 inhibitor [Etoricoxib] during concurrent chemo-radiation results in a faster response of the primary disease in locally advanced cervical cancer patients, without a significant difference in acute toxicities. © 2019, Association of Gynecologic Oncologists of India.
An assessment of serum oxidative stress and antioxidant parameters in patients undergoing treatment for cervical cancer
(Elsevier Inc., 2021) Anju Shrivastava; Surendra Pratap Mishra; Satyajit Pradhan; Sunil Choudhary; Saurav Singla; Kulsoom Zahra; Lalit Mohan Aggarwal
Objectives: Oxidative stress and antioxidants are involved in all aspects of cervical cancer. The present study evaluated serum levels of oxidative stress and antioxidant biomarkers in cervical cancer patients and healthy controls. Moreover, the effect of Concurrent chemoradiotherapy (CCRT) on these biomarkers and their association with treatment outcome was investigated. Design: This study included ninety-seven cervical cancer patients and thirty controls. Three oxidative stress parameters (8-hydroxy-2-deoxyguanosine, Protein Carbonyl, and Malondialdehyde) and four antioxidant parameters (Superoxide Dismutase, Catalase, Glutathione Peroxidase, and Total Antioxidant Status) were measured. The analysis was conducted using repeated measures ANOVA for comparing among the phases (before, during, and follow-up) of treatment. The control group was compared using the Dunnet test. Logistic regression analysis was also conducted between oxidative stress and antioxidant parameters to study their association. Results: Significant rises in oxidative damage markers were observed in cervical cancer patients of all stages, compared to controls. There was a further increase in oxidative stress markers during CCRT among complete responders. However, among non-responders, the oxidative stress biomarkers like Protein Carbonyl and Malondialdehyde were unaltered during CCRT. Simultaneously, there was a significant decrease in antioxidant parameters in cervical cancer patients of all stages compared to controls. During CCRT, antioxidant levels continuously depleted among complete responders. Nevertheless, in non-responders, antioxidant parameters like Superoxide Dismutase and Total Antioxidant Status were consistent. The oxidative stress markers and antioxidant parameters normalized among complete responders at six months follow up. While in non-responders, the normalization of these parameters was not observed. Conclusion: Our results indicate that increased oxidative stress and diminished antioxidants among patients were associated with carcinoma cervix. Induced oxidative stress and decreased antioxidant parameters during CCRT among the complete responders show the treatment's efficacy. Oxidant-antioxidant profile merits investigation as markers of diagnosis, treatment response, survival, and recurrence in extensive prospective studies. © 2021 Elsevier Inc.
An inexpensive method of small photon field dosimetry with EBT3 radiochromic film
(Springer Verlag, 2018) Ankur Mourya; Lalit Mohan Aggarwal; Abhijit Mandal; Uday Pratap Shahi; Chhape Ram; Anupam Kumar Asthana; Satyajit Pradhan
The relative output factor for small field photon beams with EBT3 (External beam therapy, Gafchromic ™) Radiochromic film were obtained using indigenously developed a program in MATLAB. MLC and JAWS created square small field sizes for dosimetry. To calibrate Radiochromic film, we have cut the film into several small segments of 6 × 6 cm2. These small pieces of film were irradiated to known doses ranging from 25 to 300 cGy by SAD technique using 6 MV photon beam from Linear accelerator. A Program in MATLAB was written to analyze the scanned film data and all the images of the films were imported into this Program. To validate the accuracy of calibration curve, radiochromic films were irradiated with different field sizes of 10 × 10 cm2, 15 × 1 5 cm2, 20 × 20 cm2 to known dose of 200 cGy each by SAD technique. Field sizes were defined using two methods, in the first method fields were defined using X-Y collimator Jaws with the MLC retracted to their maximum position. In the Second method, MLCs were used to define square field sizes of 1 × 1 cm2 to 5 × 5 cm2, 10 × 10 cm2 and 15 × 15 cm2. Calibration curve created using gafchromic film show percentage variation between measured and delivered dose within 3% of standard field size. Output factors measured by Gafchromic EBT3 film showed close agreement with those measured using the other detector for field sizes of 2.0 × 2.0 cm2 and above. EBT3 film has properties such as linear response, energy, and dose-rate independence. It makes it suitable detector for small field dosimetry. Our Indigenous developed MATLAB Program for film dosimetry gave the desired results. From this study, we can conclude that EBT3 film can be used for relative output factors ranging from small field to large fields. © 2018, IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature.
An investigation of a sinogram discontinuity artifact on myocardial perfusion imaging
(2012) Subhash Chand Kheruka; Umesh Chand Naithani; Lalit Mohan Aggarwal; Nirmal Kumar Painuly; Anil Kumar Maurya; Sanjay Gambhir
Our purpose was to find out the cause of an unusual distinct break seen on a patient's sinogram despite within-tolerance results on all quality assurance tests during myocardial perfusion imaging (MPI) and corrective measures. Methods: SPECT quality control is a prerequisite to obtaining high-quality diagnostic images. Daily uniformity and energy-peaking tests and weekly center-of-rotation (COR) tests are run to check the performance of the SPECT system. A distinct break in the sinogram of an MPI study was noticed for 1 patient, despite routine quality control tests that showed the system to be well within tolerance limits. Critical inspection of the g-camera revealed that the 2 detector heads did not make complete contact with each other at a 90° position and that a gap of as much as 10.0 mm was left between the 2 edges of the detectors even though COR testing showed the system to be within tolerance limits. After this gap had been minimized (210-mm position), the MPI study of this patient was repeated. Results: Reduction of the gap between detectors corrected the sinogram discontinuity. On the MPI study, the break in the sinogram existed because the 2 detectors were not acquiring the data at the same position in their useful fields of view. When one of the detectors was tilted to exactly 45°, the gap was reduced and the data were acquired at the same useful field of view for both detectors. Conclusion: The sinogram artifact may arise even after perfect COR calibration, and in the reported case, the discontinuity in the sinogram was rectified by correcting the angle of the detectors. Meticulous investigation for artifacts must be performed to minimize the probability of false results. © 2012 by the Society of Nuclear Medicine, Inc.
Body Composition Analysis Techniques and Its Application in Oncology: A Review
(Taylor and Francis Ltd., 2024) Anil Kumar Maurya; Lalit Mohan Aggarwal; Sunil Choudhary
The oncology community has shown growing interest to understand how body composition measures can be utilized to improve cancer treatment and survivorship care for about 20 million individuals diagnosed with cancer annually. Recent observational studies demonstrate that muscle and adipose tissue distribution are risk factors for clinical outcomes such as postoperative complications, and worse overall survival. There is an emergent recognition that body mass index (BMI) is neither adequate to identify patients with adverse health outcomes due to poor muscle health or excess adiposity, nor does BMI accurately classify the distribution of adiposity. Abdominal CT is a most frequently imaging examination for a wide variety of clinical indications, but it is only used to diagnose the immediate problem. Additionally, each CT examination contains very robust data on body composition which generally goes unused in routine clinical practice. The field is eager to identify therapeutic interventions that modify body composition and reduce the incidence of poor clinical outcomes in this population. Large scale population based screening is feasible now by making all of these relevant biometric measures fully automated through the use of artificial intelligence algorithms, which provide rapid and objective assessment. © 2024 Taylor & Francis Group, LLC.
Carbon-based brilliance: a novel approach to renewable energy in radiotherapy centers
(Oxford University Press, 2024) Pitchaikannu Venkatraman; Lalit Mohan Aggarwal; Sunil Choudhary
The energy produced from other sources which does neither come from fossil fuels nor contribute in the production of any greenhouse effects that causes climate changes is called as ‘Alternative Energy’. Since our world’s primary energy sources such as coal, oil and natural gases are exploited to a greater extent, we are in an urge to switch to an alternative energy. Scattered radiation, a common byproduct in radiation therapy and diagnostic radiology, presents a unique opportunity in the realm of alternative energy. As a potential source of interference, scattered radiation can be repurposed to contribute to sustainable energy solutions. Addressing the issue of scattered radiation wastage and utilizing it for alternative energy, an activated carbon-based solar cell emerges as a solution. This solar cell, a conventional one in which cadmium Telluride is replaced by coconut shell based carbon material, has the potential in producing a significant amount of electrical energy by utilizing scattered radiation from radiotherapy and radiology machines. Furthermore, this activated carbon based-material undergoes thorough characterization into various teletherapy and radiology machines, and it can be seamlessly integrated into clinical practices. © The Author(s) 2024. Published by Oxford University Press. All rights reserved.
Clinical significance of cumulative biological effective dose and overall treatment time in the treatment of carcinoma cervix
(Medknow Publications and Media Pvt. Ltd, 2007) Abhijit Mandal; Anupam Kumar Asthana; Lalit Mohan Aggarwal
The purpose of this retrospective study is to report the radiotherapy treatment response of, and complications in, patients with cervical cancer on the basis of cumulative biologic effective dose (BED) and overall treatment time (OTT). Sixty-four (stage II - 35/64; stage III - 29/64) patients of cervical cancer were treated with combination of external beam radiotherapy (EBRT) and low dose rate intracavitary brachytherapy (ICBT). The cumulative BED was calculated at Point A (BED10); and bladder, rectal reference points (BED2.5) using the linear-quadratic BED equations. The local control (LC) rate and 5-year disease-free survival (DFS) rate in patients of stage II were comparable for BED10 > 84.5 and BED10 > 84.5 but were much higher for BED10 > 84.5 than BED10 < 84.5 ( P < 0.01) in stage III patients. In the stage II patients, The LC rate and 5-year DFS rate were comparable for OTT > 50 days and for OTT> 50 days but were much higher in stage III patients with OTT < 50 than OTT> 50 days ( P < 0.001). It was also observed that patients who received BED 2.5 < 105 had lesser rectal ( P < 0.001) and bladder complications than BED2.5 > 105. Higher rectal complication-free survival (CFSR ) rate, bladder complication-free survival (CFS B ) rate and all-type late complication-free survival rate were observed in patients who received BED2.5 < 105 than BED 2.5 > 105. A balanced, optimal and justified radiotherapy treatment schedule to deliver higher BED10 (> 84.5) and lower BED2.5 (< 105) in lesser OTT (< 50 days) is essential in carcinoma cervix to expect a better treatment outcome in all respects.
Comparison of two hypofractionated radiotherapy schedules in locally advanced postmastectomy breast cancer patients
(Wolters Kluwer Medknow Publications, 2020) Sunil Choudhary; Neha Gupta; Shagun Misra; Narvada Narain Munnee; Amit Kumar; Rakesh Ranjan; Sovan Sarang Dhar; Deepak Kumar; Ankur Mourya; Lalit Mohan Aggarwal
Introduction: The role of hypofractionated radiotherapy (HFRT) in postmastectomy breast cancer patients is not well established. This study was done to establish the role of two different HFRT schedules in the treatment of chest wall and regional lymph nodes after mastectomy. Materials and Methods: Between 2012 and 2016, consecutively registered patients of locally advanced breast cancer patients having undergone mastectomy and adjuvant radiotherapy (RT) at a tertiary cancer center were analyzed. Locoregional recurrence (LRR) was the primary endpoint, whereas overall survival (OS), disease-free survival (DFS), and both acute and late adverse events were secondary endpoints. Results: A total of 34 patients who were treated with 39 Gy in 13 fractions over 2½ weeks and 35 patients who were treated with 40 Gy in 15 fractions over 3 weeks were identified. The median follow-up period was 47 months and 63.5 months in the 39 Gy and 40 Gy arms, respectively. LRR was seen in 11.8% and 8.6% of patients in the 39 Gy and 40 Gy arms, respectively. OS at 4 years was 66% and 71.5% in the 39 Gy and 40 Gy arms, respectively. The mean DFS for 39 Gy and 40 Gy arms was 43.6 months and 66.4 months, respectively (P = 0.822). Acute skin toxicity was similar in the two groups. Arm edema was significantly more in the 40 Gy arm. Conclusion: The two HFRT schedules are equivalent to each other in terms of survival outcomes. Arm edema is higher with 40 Gy arm as compared to 39 Gy arm. © 2020 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow.
Diagnostic and prognostic application of Raman spectroscopy in carcinoma cervix: A biomolecular approach
(Elsevier B.V., 2021) Anju Shrivastava; Lalit Mohan Aggarwal; Chilakapati Murali Krishna; Satyajit Pradhan; Surendra Pratap Mishra; Sunil Choudhary; Chandan Bhai Patel; Saurav Singla; Ashish; Ranjan Kumar Singh
Blood serum samples from 63 cervical cancer patients and 30 controls were collected at three different phases of the treatment (i.e. before, during, and at follow up). The spectra of serum samples from control as well as patients were classified into different groups using principal component analysis (PCA) and linear discriminant analysis (LDA) based on different phases of treatment using R software. The spectra of blood serum samples have shown the distinct changes and differences compared with each other in the profile of various biochemical parameters. The sensitivity (92.5%) and specificity (85%) were observed maximum between control and cervical cancer patients (before treatment). Between different phases of treatment, the sensitivity and specificity were less but, all accuracies of detection and classification reached above 50%. This method can be considered as a screening method for detection and treatment monitoring. © 2020
Dose optimization comparison study of inverse planning simulated annealing [IPSA] and hybrid inverse planning optimization [HIPO] in interstitial brachytherapy of head and neck cancer
(Elsevier Inc., 2021) Bijay Kumar Barik; Sovan Sarang Dhar; Rumita Singh; Abhijit Mandal; Lalit Mohan Aggarwal; Uday Pratap Shahi; Sunil Choudhary
Purpose: This study was a retrospective dose optimization comparison of two commercially available inverse planning algorithms, the inverse planning simulated annealing (IPSA) and hybrid inverse planning optimization (HIPO) for head and neck cancer interstitial brachytherapy. Materials and Methods: Seven patients with head and neck cancer were selected (4 with tongue cancer, 2 with buccal mucosa cancer and 1 with carcinoma lip) who were previously treated with interstitial brachytherapy using a flexible nylon tube catheter and graphical optimization/geometric optimization technique. All seven patients were retrospectively re-planned using both IPSA as well as HIPO algorithms available in the Oncentra Brachytherapy Treatment Planning System (TPS) version V4.5.3.30. The dosimetric parameters [PTV-V100, V150, V200, D90; mandible-D2cc, parotid-D2cc, conformity index (CI), dose homogeneity index (HI), overdose volume index (ODI)] were chosen for evaluation in compliance with the objective function and organ at risk dose constraints. Results: Using the paired sample T test in chosen parameters (PTV-V100, V150, V200, D90; mandible-D2cc, CI, HI, ODI both the inverse planning algorithms), it was found that IPSA and HIPO were comparable. Conclusions: Even though both IPSA and HIPO are largely comparable in most of the dosimetric parameters for inverse planning in brachytherapy of head and neck cancers, differences in the algorithms can be exploited to improve certain parameters in specific situations such as D2cc parotid. © 2021
Evaluation of single-photon emission computed tomography images obtained with and without copper filter by segmentation
(Medknow Publications, 2016) Subhash Chand Kheruka; Lalit Mohan Aggarwal; Neeraj Sharma; Umesh Chand Naithani; Anil Kumar Maurya; Sanjay Gambhir
Background: Measurement of accurate attenuation of photon flux in tissue is important to obtain reconstructed images using single-photon emission computed tomography (SPECT). Computed tomography (CT) scanner provides attenuation correction data for SPECT as well as anatomic information for diagnostic purposes. Segmentation is a process of dividing an image into regions having similar properties such as gray level, color, texture, brightness, and contrast. Image segmentation is an important tool for evaluation of medical images. X-ray beam used in CT scan is poly-energetic; therefore, we have used a copper filter to remove the low energy X-rays for obtaining correct attenuation factor. Images obtained with and without filters were quantitatively evaluated by segmentation method to avoid human error. Materials and Methods: Axial images of AAPM CT phantom were acquired with 3 mm copper filter (low intensity) and without copper filter (high intensity) using low-dose CT (140 kvp and 2.5 mA) of SPECT/CT system (Hawkeye, GE Healthcare). For segmentation Simulated Annealing Based Fuzzy c-means, algorithm is applied. Quantitative measurement of quality is done based on universal image quality index. Further, for the validation of attenuation correction map of filtered CT images, Jaszczak SPECT phantom was filled with 500 MBq of 99m Tc and SPECT study was acquired. Low dose CT images were acquired for attenuation correction to be used for reconstruction of SPECT images. Another set of CT images were acquired after applying additional 3 mm copper filter. Two sets of axial SPECT images were reconstructed using attenuation map from both the CT images obtained without and with a filter. Results and Conclusions: When we applied Simulated Annealing Based Fuzzy c-means segmentation on both the CT images, the CT images with filter shows remarkable improvement and all the six section of the spheres in the Jaszczak SPECT phantom were clearly visualized.
Evolution of Bioelectric Membrane Potentials: Implications in Cancer Pathogenesis and Therapeutic Strategies
(Springer, 2024) Anju Shrivastava; Amit Kumar; Lalit Mohan Aggarwal; Satyajit Pradhan; Sunil Choudhary; Ashish Ashish; Keshav Kashyap; Shivani Mishra
Electrophysiology typically deals with the electrical properties of excitable cells like neurons and muscles. However, all other cells (non-excitable) also possess bioelectric membrane potentials for intracellular and extracellular communications. These membrane potentials are generated by different ions present in fluids available in and outside the cell, playing a vital role in communication and coordination between the cell and its organelles. Bioelectric membrane potential variations disturb cellular ionic homeostasis and are characteristic of many diseases, including cancers. A rapidly increasing interest has emerged in sorting out the electrophysiology of cancer cells. Compared to healthy cells, the distinct electrical properties exhibited by cancer cells offer a unique way of understanding cancer development, migration, and progression. Decoding the altered bioelectric signals influenced by fluctuating electric fields benefits understanding cancer more closely. While cancer research has predominantly focussed on genetic and molecular traits, the delicate area of electrophysiological characteristics has increasingly gained prominence. This review explores the historical exploration of electrophysiology in the context of cancer cells, shedding light on how alterations in bioelectric membrane potentials, mediated by ion channels and gap junctions, contribute to the pathophysiology of cancer. Graphical Abstract: (Figure presented.) © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
Experience of wireless local area network in a radiation oncology department
(Medknow Publications and Media Pvt. Ltd, 2010) Abhijit Mandal; Anupam Kumar Asthana; Lalit Mohan Aggarwal
The aim of this work is to develop a wireless local area network (LAN) between different types of users (Radiation Oncologists, Radiological Physicists, Radiation Technologists, etc) for efficient patient data management and to made easy the availability of information (chair side) to improve the quality of patient care in Radiation Oncology department. We have used mobile workstations (Laptops) and stationary workstations, all equipped with wireless-fidelity (Wi-Fi) access. Wireless standard 802.11g (as recommended by Institute of Electrical and Electronic Engineers (IEEE, Piscataway, NJ) has been used. The wireless networking was configured with the Service Set Identifier (SSID), Media Access Control (MAC) address filtering, and Wired Equivalent Privacy (WEP) network securities. We are successfully using this wireless network in sharing the indigenously developed patient information management software. The proper selection of the hardware and the software combined with a secure wireless LAN setup will lead to a more efficient and productive radiation oncology department.
Fabrication and Characterization of Beam Quality Phantom for External Beam Radiotherapy
(Mashhad University of Medical Sciences, 2024) M. Boopathi; D. Khanna; P. Venkatraman; Joshua Sahay; C.S. Sureka; Varshini Raju; Lalit Mohan Aggarwal; Sunil Choudhary
Introduction: Radiation dose measurement plays a major role in Radiation Dosimetry. Effective dose delivery to the patient is ensured with the recommendation of some protocol called Quality assurance (QA). It is necessary to confirm that the beam that is used for treatment is a good quality beam and it is given by beam quality factor TPR 20/10 which is one of the QA protocols. Material and Methods: In the present TPR20, 10 phantom both depth (20 and 10 cm) doses can be measured at the same procedure without changing any setup. As the reference condition is maintained, the Gelatin-based phantom is kept for irradiation in the Siemens Linear Accelerator (LINAC) machine. Initially Source Axis Distance (SAD) of 100 cm from the surface and 10×10 cm2 of field size. The measurement is taken by ion chamber at 10 and 20 cm depth in gantry angles 90° and 270° And the ratio of these values is taken and compared with the measurements of the water-based TPR phantom. Results: The values for the TPR20, 10 ratio for the Gelatin and water phantom are measured using the above method and the values are tabulated and compared. Likewise, the output measurements are done and tabulated for comparison. These measurements are carried out for several days to check the repeatability, and reproducibility of the phantom. Also, the measured set of values was analyzed using mean, median, standard deviation, etc. Conclusion: The fabricated phantom had good outcomes in its response. And the result projects that the phantom can be a better alternative for the other phantom materials and gelatin has more advantages over water, we conclude that gel can be used for better dosimetric procedures. © (2024), (Mashhad University of Medical Sciences). All rights reserved.
Feasibility of using polytetrafluoroethylene flexible implant tube for interstitial brachytherapy patients
(Elsevier Inc., 2022) Ankur Mourya; Lalit Mohan Aggarwal; Sunil Choudhary; Uday Pratap Shahi; Neeraj Sharma; Rajiv Prakash; Ritusha Mishra
PURPOSE: To design the different Polytetrafluoroethylene (PTFE) based flexible implant tubes using an in-house developed device and to evaluate them for High dose rate (HDR) interstitial brachytherapy using computer tomography images. METHODS AND MATERIALS: PTFE hollow tube having a 2 mm (6 French) outer diameter (OD) and 1.4 mm inner diameter (ID) was used to design in-house single and/or double leader flexible catheters for interstitial brachytherapy implant. An in-house Plastic Wire Drawing Plate (PWDP) machine was developed. Customization of PTFE hollow flexible implant tube (FIT) was done through PWDP. Different percentages of BaSO4 (5%, 10%, & 15%) were added to Nylon 6 to make radiopaque button. Various quality assurance tests were performed with the PTFE tubes implanted in the brinjal (phantom) before using them on the patients. That is, coupling of brachytherapy machine transfer tube with flexible PTFE Tubes, CT scan artifacts, tube kinks, breast template, and free-hand compatibility. RESULTS: With the help of the PWDP machine, plastic wires of different lengths were made for single leader and double leader tubes. The different plastic leader ends of 1 cm to 50 cm lengths having 1 mm diameter were created. The radiopaque button of Nylon 6 in circular shape having 1 cm diameter and 0.5 cm thick was created. Developed radiopaque buttons were visible on CT scan images as well as on radiograph images. CONCLUSIONS: PTFE tubes of the desired length can be made depending upon the size of the brachytherapy implant and are inexpensive than commercially available flexible implant tubes. © 2022 American Brachytherapy Society