Abstract Some previous observations suggest that a low platelet count is associated with an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). However, most of the ...data come from post-hoc analyses of randomized controlled trials and from studies including thrombocytopenia developed during hospital stay. Our aim was to assess the impact of low platelet count at admission on cardiovascular outcomes and treatment approach in patients hospitalized for ACS in a current real-life setting in Italy. Patients admitted to Italian coronary care units for ACS were enrolled in the START-ANTIPLATELET registry. Baseline clinical characteristics and treatment at discharge were recorded. Patients were followed-up at 6 months, 1 year and yearly thereafter. Low platelet count was defined as a count at admission < 150 > 100 k/µl or < 100 k/µL. Among 1894 enrolled patients, 157 (8.3%) had a platelet count < 150 > 100 k/µl and 30 (1.6%) < 100 k/µl. The median follow-up was 12.3 months (0.4–50.1). patients with low platelets were older (72 ± 10.4 vs 66 ± 12.4 years, p = 0.006), more frequently males (82.9 vs 72.1%, p = 0.001), hypertensive (90.0% vs 70.4%, p = 0.03), with non-valvular atrial fibrillation (NVAF) (17.1 vs 8.6%, p = 0.02), and peripheral arterial disease (11.5 vs 6.2% p = 0.01) and/or had a previous myocardial infarction (40 vs 18.7%, p = 0.008) and/or a PCI (14.6 vs 7.8%, p = 0.001) than patients with normal platelets. A slightly, but significantly, lower percentage of thrombocytopenic patients were treated with primary PCI (78.1 vs 84.4%, p = 0.04) and they were more frequently discharged on aspirin plus clopidogrel rather than aspirin plus newer P2Y 12 antagonists (51.9 vs 65.4%, p = 0.01). MACE-free survival was significantly shorter in thrombocytopenic patients compared to patients with normal platelets (< 150 > 100 k/µl: 37.6 vs 41.8 months, p = 0.002; HR = 2.7, 95% CIs 1.4–5.2; < 100 k/µl: 31.7 vs 41.8 months, p = 0.01; HR = 6.5, 95% CIs 1.5–29.1). At multivariate analysis, low platelet count, age at enrollment, low glomerular filtration rate, low ejection fraction, a previous ischemic stroke and NVAF were independent predictors of MACE. A low platelet count at admission identifies a subgroup of ACS patients with a significantly increased risk of MACE and these patients should be managed with special care to prevent excess adverse outcomes.
The purpose of this study is to characterize dosimetric properties of thin film photovoltaic sensors as a platform for development of prototype dose verification equipment in radiotherapy. Towards ...this goal, flexible thin‐film sensors of dose with embedded data acquisition electronics and wireless data transmission are prototyped and tested in kV and MV photon beams. Fundamental dosimetric properties are determined in view of a specific application to dose verification in multiple planes or curved surfaces inside a phantom. Uniqueness of the new thin‐film sensors consists in their mechanical properties, low‐power operation, and low‐cost. They are thinner and more flexible than dosimetric films. In principle, each thin‐film sensor can be fabricated in any size (mm2 – cm2 areas) and shape. Individual sensors can be put together in an array of sensors spreading over large areas and yet being light. Photovoltaic mode of charge collection (of electrons and holes) does not require external electric field applied to the sensor, and this implies simplicity of data acquisition electronics and low power operation. The prototype device use for testing consists of several thin film dose sensors, each of about 1.5 cm×5 cm area, connected to simple readout electronics. Sensitivity of the sensors is determined per unit area and compared to EPID sensitivity, as well as other standard photodiodes. Each sensor independently measures dose and is based on commercially available flexible thin‐film aSi photodiodes. Readout electronics consists of an ultra low‐power microcontroller, radio frequency transmitter, and a low‐noise amplification circuit implemented on a flexible printed circuit board. Detector output is digitized and transmitted wirelessly to an external host computer where it is integrated and processed. A megavoltage medical linear accelerator (Varian Tx) equipped with kilovoltage online imaging system and a Cobalt source are use to irradiate different thin‐film detector sensors in a Solid Water phantom under various irradiation conditions. Different factors are considered in characterization of the device attributes: energies (80 kVp, 130 kVp, 6 MV, 15 MV), dose rates (different ms × mA, 100–600 MU/min), total doses (0.1 cGy‐500 cGy), depths (0.5 cm–20 cm), irradiation angles with respect to the detector surface (0°‐180°), and IMRT tests (closed MLC, sweeping gap). The detector response to MV radiation is both linear with total dose (~1‐400 cGy) and independent of dose rate (100‐600 Mu/min). The sensitivity per unit area of thin‐film sensors is lower than for aSi flat‐panel detectors, but sufficient to acquire stable and accurate signals during irradiations. The proposed thin‐film photodiode system has properties which make it promising for clinical dosimetry. Due to the mechanical flexibility of each sensor and readout electronics, low‐cost, and wireless data acquisition, it could be considered for quality assurance (e.g., IMRT, mechanical linac QA), as well as real‐time dose monitoring in challenging setup configurations, including large area and 3D detection (multiple planes or curved surfaces).
PACS number: 87.56.Fc
Purpose:
To characterize a new air vented ionization chamber technology, suitable to build detector arrays with small pixel pitch and independence of sensitivity on dose per pulse.
Methods:
The ...prototype under test is a linear array of air vented ionization chambers, consisting of 80 pixels with 3.5 mm pixel pitch distance and a sensitive volume of about 4 mm3. The detector has been characterized with 60Co radiation and MV x rays from different linear accelerators (with flattened and unflattened beam qualities). Sensitivity dependence on dose per pulse has been evaluated under MV x rays by changing both the source to detector distance and the beam quality. Bias voltage has been varied in order to evaluate the charge collection efficiency in the most critical conditions. Relative dose profiles have been measured for both flattened and unflattened distributions with different field sizes. The reference detectors were a commercial array of ionization chambers and an amorphous silicon flat panel in direct conversion configuration. Profiles of dose distribution have been measured also with intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and volumetric modulated arc therapy (VMAT) patient plans. Comparison has been done with a commercial diode array and with Gafchromic EBT3 films.
Results:
Repeatability and stability under continuous gamma irradiation are within 0.3%, in spite of low active volume and sensitivity (∼200 pC/Gy). Deviation from linearity is in the range 0.3%, −0.9% for a dose of at least 20 cGy, while a worsening of linearity is observed below 10 cGy. Charge collection efficiency with 2.67 mGy/pulse is higher than 99%, leading to a ±0.9% sensitivity change in the range 0.09–2.67 mGy/pulse (covering all flattened and unflattened beam qualities). Tissue to phantom ratios show an agreement within 0.6% with the reference detector up to 34 cm depth. For field sizes in the range 2 × 2 to 15 × 15 cm2, the output factors are in agreement with a thimble chamber within 2%, while with 25 × 25 cm2 field size, an underestimation of 4.0% was found. Agreement of field and penumbra width measurements with the flat panel is of the order of 1 mm down to 1 × 1 cm2 field size. Flatness and symmetry values measured with the 1D array and the reference detectors are comparable, and differences are always smaller than 1%. Angular dependence of the detector, when compared to measurements taken with a cylindrical chamber in the same phantom, is as large as 16%. This includes inhomogeneity and asymmetry of the design, which during plan verification are accounted for by the treatment planning system (TPS). The detector is capable to reproduce the dose distributions of IMRT and VMAT plans with a maximum deviation from TPS of 3.0% in the target region. In the case of VMAT and SRS plans, an average (maximum) deviation of the order of 1% (4%) from films has been measured.
Conclusions:
The investigated technology appears to be useful both for Linac QA and patient plan verification, especially in treatments with steep dose gradients and nonuniform dose rates such as VMAT and SRS. Major limitations of the present prototype are the linearity at low dose, which can be solved by optimizing the readout electronics, and the underestimation of output factors with large field sizes. The latter problem is presently not completely understood and will require further investigations.
An efficient all-fiber optic source is presented; it adopts absorbing films, deposed directly over the fiber tip, as targets. It is demonstrated that the use of absorbing films made of pure graphite, ...or graphite powder mixed with epoxy resin, has produced a conversion efficiency increase of two orders of magnitude with respect to metallic materials. It is observed that the conversion efficiency increases monotonically as thickness is reduced down to the material optical penetration depth. Moreover, the conversion efficiency rises with the concentration of graphite powder. Principal advantages of this kind of source are the ease of production and miniaturization, the excellent electromagnetic compatibility, wide ultrasonic bandwidth and, consequently, high spatial resolution. The ultrasonic bandwidth can be controlled by varying the laser pulse duration. The possibility of generating ultrasonic signals with high frequency and flat spectral distribution makes the proposed device suitable for biological tissue spectral characterization.
Proton radiography for clinical applications Talamonti, C.; Reggioli, V.; Bruzzi, M. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
01/2010, Letnik:
612, Številka:
3
Journal Article
Recenzirano
Proton imaging is not yet applied as a clinical routine, although its advantages have been demonstrated. In the context of quality assurance in proton therapy, proton images can be used to verify the ...correct positioning of the patient and to control the range of protons. Proton computed tomography (pCT) is a 3D imaging method appropriate for planning and verification of proton radiation treatments, because it allows evaluating the distributions of proton stopping power within the tissues and can be directly utilized when the patient is in the actual treatment position. The aim of the PRoton IMAging experiment, supported by INFN, and the PRIN 2006 project, supported by MIUR, is to realize a proton computed radiography (pCR) prototype for reconstruction of proton images from a single projection in order to validate the technique with pre-clinical studies and, eventually, to conceive the configuration of a complete pCT system. A preliminary experiment performed at the 250
MeV proton synchrotron of Loma Linda University Medical Center (LLUMC) allowed acquisition of experimental data before the completion of PRIMA project's prototype. In this paper, the results of the LLUMC experiment are reported and the reconstruction of proton images of two phantoms is discussed.
Bidimensional silicon dosimeter: Development and characterization Talamonti, C.; Bruzzi, M.; Marrazzo, L. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
12/2011, Letnik:
658, Številka:
1
Journal Article
Recenzirano
Clinical dosimetry in radiotherapy is a well known matter but high conformal radiotherapy modalities (Intensity Modulated Radiation Therapy (IMRT), stereotactic treatments with photons and protons, ...Intensity Modulated Proton Therapy (IMPT)) possess problems due to small radiation fields with high dose gradients, variation in space and time of the dose rate and variation in space and time of the beam energy spectrum.
A modular dosimetric detector, adequate for 2D pre-treatment dose verifications, has been developed in the framework of the European Integrated project MAESTRO. The detector is a monolithic segmented sensor obtained by n-type implantation on a 50
μthick epitaxial silicon p-type layer; this is later used to guarantee improved radiation hardness of the device against the accumulated dose. The detector is composed of a matrix of 21×21 pixels with a size of 2×2
mm
2 each and a 3
mm center-to-center distance.
A full dosimetric characterization of the detector was performed with photon and proton beams and with gammas from a
60Co unit. Results have been compared with those obtained with a Farmer and a CC13 Scanditronix/Welhoffer ion chamber as well as with the silicon matrix MapCHECK™. The first application of the MAESTRO prototype in the dosimetric verification of a clinical IMRT field is also reported. Results show that our modular detector represents a valuable tool for quality assurance in IMRT dose delivery and for high precision radiotherapy techniques.
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