Professor Dr Ngie Min Ung (Lead - WP1)
Assoc Professor Dr Goh Boon Tong (Lead - WP2)
Assoc Professor Dr Jeannie Hsiu Ding Wong (Lead - WP3)
Members:
Assoc Professor Dr Siti Fairus Abdul Sani
Postgraduate students:
Mr Wong Jia Ding
Mr Abdurrahman bin Mohd Hanafi
Mr Wan Dimishqi bin Wan Abdul Manan
Radical radiotherapy is the primary management option of nasopharyngeal carcinoma (NPC). Patients usually will undergo seven weeks of fractionated radiation treatment. Throughout the span of treatment, significant anatomical or structural changes to the tumour and surrounding normal organs may occur. These changes make it impossible to deliver dose as originally planned therefore, the efficacy of the treatment may be compromised. Adaptive radiotherapy (ART) has been introduced to overcome this problem, which includes rescan and replanning of treatment to account for the structural changes. In its basic form, ART enables the treatment to be changed, or adapted, to respond to a ‘signal’ that additional information is known about the patient or that the patient has changed from the original state at the time of planning. The main problem with ART of NPC is with regard to the determination of the ‘signal’ or ‘point of change’ that is deemed appropriate or significant for triggering an action, which may be as simple as creating a new treatment plan deemed needed by the clinical team. Currently, mostly clinics rely on visual observation of patient changes by the treatment staffs which are highly subjective. In this programme, the impact of anatomical changes of NPC patients undergoing radiotherapy will be assessed to show the importance of having an objective ‘trigger point’ that warrant a corrective action during the treatment. In addition, more objective ‘trigger point’ for ART of NPC based on skin dose measured using a novel dosimeter and machine learning-based prediction will be developed. The outcome of this programme can potentially increase the accuracy of radiotherapy delivery, and hence, improving the treatment efficacy as well as quality of life of NPC patients. Furthermore, the more objective tools developed have potential commercial values, which may of interest to the vendors providing adaptive radiotherapy solutions.
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We will approach this research programme in three disciplines with the aim of developing an objective ‘trigger point’ for adaptive radiotherapy for NPC. Work package 1 (WP1) is designed under the radiation oncology discipline to investigate the extent of anatomical and dosimetric changes of the structures involved during the radiotherapy of NPC. Weekly treatment CT images will be registered and deformed with the initial planning CT dataset, with manual modification performed if needed. Significant dosimetric changes should be considered as a ‘trigger point’ at which radiotherapy replanning is indicated. Work package 2 (WP2) and work package 3 (WP3) will develop two objective solutions for determining accurate ‘trigger point’ for adaptive radiotherapy of NPC. WP2 is crafted under the radiation physics discipline to develop novel, low-cost 2D carbon-based materials with high accuracy for in vivo skin dosimetry during radiotherapy for NPC. A significant change in the skin dose during radiotherapy is hypothesized to be correlated with significant changes in the skin dose during radiotherapy. The WP3 is a work under the artificial intelligence discipline with the aim to develop machine-learning based radio-dosiomic-dosimetry model to predict ‘trigger point’ for treatment plan adaptation. WP1 and WP3 will be sharing the same existing imaging and dosimetric data, and the analytical results from WP1 will be used to test and validate the accuracy the radio-dosiomic model developed in WP3. A prospective study on a cohort of NPC patients will be conducted as part of WP1 and WP2, and the dosimetric data from WP1 will be used to verify the skin dose measured in WP2. The combined utility of ‘triggers points’ developed in WP2 and WP3 for adaptive radiotherapy will be evaluated. All three work packages will be conducted concurrently, to ensure the research program delivers pledged outcomes.
S.F. Abdul Sani1*, B.T. Goh1, D.A. Bradley3,4, N.M. Ung4, Jeannie HD Wong5
1Department of Physics, Faculty of Science, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
2Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, 47500 Bandar Sunway, Selangor, Malaysia
3Department of Physics, University of Surrey, Guildford GU2 7XH, UK
4Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
5Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
*Corresponding author: s.fairus@um.edu.my
Imagine a material that is incredibly thin, yet incredibly strong. A material that is as good a conductor as copper, yet lightweight and flexible. This wonder material is called graphene. Graphene is a single layer of carbon atoms arranged in a honeycomb lattice. Think of it as a one-atom-thick sheet of graphite found in your pencil. Despite its simplicity, graphene’s unique structure gives it extraordinary properties. Graphene is renowned for its exceptional strength, being 200 times stronger than steel, flexibility, lightweight nature, and superior electrical and thermal conductivity. These unique properties make it suitable for a wide range of applications in everyday uses, including faster electronics, efficient batteries to advanced medical devices, and stronger composites.
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Now, let’s talk about an exciting new use of graphene: measuring radiation doses in clinical radiotherapy, known as dosimetry. Ionizing radiation is crucial in medical diagnostics and treatments. X-rays and gamma rays are the most common types used in radiology and nuclear medicine. When doctors treat cancer with radiation, they need to know exactly how much radiation the patient is receiving. Too little, and the treatment might not work; too much, and it could damage healthy tissues. This balance is crucial for successful treatment. This is where dosimeters come in, they measure the dose of radiation a patient receives. Due to its high sensitivity, precision, biocompatibility, and durability, graphene can accurately measure radiation doses, crucial for effective cancer therapy.
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A review of existing literature indicates that members of present group (in collaboration with Department of Physics, UM, Sunway University and Clinical Oncology Unit, UMMC) have conducted dosimetric investigations using media rich in graphite, exposing them to various types of ionizing radiation, such as gamma and X-rays (Abdul Sani et al., 2020; Almugren et al., 2022; Bradley et al., 2019, 2020, 2021, 2022a, 2022b, 2024a, 2024b; Lam et al., 2023; Mat Nawi et al., 2020, 2021a; Khandaker et al., 2021, 2024), electron radiation (Mat Nawi et al., 2021b, 2022), and neutron radiation (Mat Nawi et al., 2021c; Khandaker et al., 2022, 2023). While extensive research has explored the impact of high-energy radiation on graphene, studies on the effects of low-dose radiation are still significantly lacking. Therefore, building on the positive dosimetric properties observed in previous graphite-based studies, the current researchers investigate the dosimetric potential of graphene. In treating cancers like nasopharyngeal carcinoma (NPC), measuring the radiation dose to a patient’s skin is vital. NPC treatments often use immobilization masks that can increase the risk of skin damage. Monitoring the skin dose is essential to prevent damage. In present work, our team are developing graphene-based materials to measure radiation doses directly on the skin during head and neck radiotherapy. In this upcoming research, graphene samples will be grown directly onto crystal silicon (c-Si) (111) orientation and quartz substrates, using a custom-built Hot Wire Chemical Vapor Deposition (HWCVD) chamber system (Anuar et al., 2021) available at the Department of Physics, UM. This graphene-media helps predict skin reactions by measuring the radiation dose at different skin depths. Graphene is particularly promising because it closely mimics human tissue, making it an effective and affordable option for monitoring skin doses. Cutting-edge techniques such as Raman spectroscopy, photoluminescence spectroscopy, and X-ray photoelectron spectroscopy (XPS) help detect changes in graphene when exposed to radiation, paving the way for innovative dosimetric tools that ensure safer and more effective treatments. Thus, graphene stands as a promising candidate for revolutionizing radiation measurement in radiotherapy, among other groundbreaking applications.
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The project on using graphene for precise radiation measurement in NPC treatment received a Silver award at the Pertandingan Inovasi Penyelidikan Konvensyen Inovasi & Teknikal Nuklear Malaysia (NITC) 2023, organized by Nuclear Malaysia.
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Moreover, as part of efforts to promote STEM within the community, 12 dedicated students engaged in a collaborative project between the Department of Physics, UM and the Clinical Oncology Unit, UMMC through the “Physics@Work as Service-Learning (SULAM) Community Engagement” course. This initiative, called "Beam Buddies: Improving Healthcare Experiences through Empathy and Education", aims to bridge current research with community impact. The students developed fun and interactive programs to educate patients about medical procedures, ensuring their comfort and well-being during hospital stays. The team successfully interviewed 10 cancer patients, achieving their project goals, and distributed comforting goodies such as homemade cookies, teddy bears, and scented candles.
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References:
Abdul Sani, S. F., Ismail, S. S., Almugren, K. S., Khandaker, M. U., & Bradley, D. A. (2020). Dosimetric utility of structural changes in gamma irradiated graphite-rich pencils. Radiation Physics and Chemistry, 171, 108703.
Anuar, N.A., Nor, N.H.M., binti Awang, R., Nakajima, H., Tunmee, S., Tripathi, M., Dalton, A. and Goh, B.T., (2021). Low-temperature growth of graphene nanoplatelets by hot-wire chemical vapour deposition. Surface and Coatings Technology, 411, 126995.
Almugren, K. S., Abdul Sani, S. F., Sulong, I. A., Nawi, S. M., Shafiqah, A. S., & Bradley, D. A. (2022). Structural and defect changes in black carbon charcoal irradiated with gamma ray. Radiation Physics and Chemistry, 200, 110331.
Bradley, D. A., Rozaila, Z. S., Khandaker, M. U., Almugren, K. S., Meevasana, W., & Abdul Sani, S. F. (2019). Raman spectroscopy and X-ray photo-spectroscopy analysis of graphite media irradiated at low doses. Applied radiation and isotopes, 147, 105-112.
Bradley, D. A., Nawi, S. N. M., Khandaker, M. U., Almugren, K. S., & Abdul Sani, S. F. (2020). Sub kGy photon irradiation alterations in graphite. Applied radiation and isotopes, 161, 109168.
Bradley, D. A., Ee, L. S., Nawi, S. N. M., Abdul Sani, S. F., Khandaker, M., Alzimami, K., & Jambi, L. (2021). Graphite sheets in study of radiation dosimetry and associated investigations of damage. Applied radiation and isotopes, 174, 109769.
Bradley, D. A., Nawi, S. N. M., Abdul Sani, S. F., Khandaker, M. U., & Almugren, K. S. (2022a). Characterisation of graphite-based material for dosimetry in the mammographic energy range. Radiation Physics and Chemistry, 201, 110405.
Bradley, D. A., Ee, L. S., Nawi, S. N. M., Abdul Sani, S. F., Khandaker, M., Alzimami, K., Jambi, and & Alqhatani, A. (2022b). Radiation induced defects in graphite. Applied radiation and isotopes, 182, 110141.
Bradley, D. A., Lam, S. E., Nawi, S. M., Abdul Sani, S. F., Ung, N. M., Alzimami, K., Khandaker, M.U., Moradi, F., & Taheri, A. (2024a). Graphite as a Skin and Epithelium Dosimeter at mammographic energies. Radiation Physics and Chemistry, 111543.
Bradley, D. A., Lam, S. E., Nawi, S. M., Taheri, A., Abdul Sani, S.F., Ung, N. M., Alzimami, K., Khandaker, M.U. & Moradi, F. (2024b). Graphite foils as potential skin and epithelium dosimeters at therapeutic photon energies. Applied Radiation and Isotopes, 111371.
Khandaker, M. U., Nawi, S. N. M., Bradley, D. A., Lam, S. E., Abdul Sani, S. F., & Sulieman, A. (2021). Studies of thermoluminescence kinetic parameters of polymer pencil lead graphite under photon exposures. Applied radiation and isotopes, 174, 109757.
Khandaker, M. U., Nawi, S. M., Abdul Sani, S. F., Karim, J. A., Almugren, K. S., & Bradley, D. A. (2022). Defects and structural changes of graphite-rich media subjected to low-level neutron doses for radiation dosimetry. Radiation Physics and Chemistry, 201, 110498.
Khandaker, M. U., Nawi, S. M., Lam, S. E., Abdul Sani, S. F., Islam, M. A., Islam, M. A., Naseer, K.A., Osman, H., & Bradley, D. A. (2023). Thermoluminescent characterization and defect studies of graphite-rich media under high dose neutron exposure. Applied radiation and isotopes, 196, 110771.
Khandaker, M. U., Lam, S. E., Daud, A. N. A. B. M., Abdul Sani, S. F., Bradley, D. A., Alzimami, K. S., Almohammed, H.I., Hamd, Z.Y.., & Osman, H. (2024). Thermoluminescence dosimetry and microstructural characteristics of gamma-irradiated natural flake graphite. Radiation Physics and Chemistry, 221, 111794.
Lam, S. E., Mat Nawi, S. N., Abdul Sani, S. F., Khandaker, M. U., & Bradley, D. A. (2021). Raman and photoluminescence spectroscopy analysis of gamma irradiated human hair. Scientific reports, 11(1), 7939.
Lam, S. E., Bradley, D. A., Nawi, S. M., Khandaker, M. U., & Abdul Sani, S. F. (2023). Carbon rich media for luminescence-based surface dosimetry and study of associated surface defects. Applied radiation and isotopes, 199, 110920.
Mat Nawi, S. N., Khandaker, M. U., Bradley, D. A., Abdul Sani, S. F., Almugren, K. S., & Sulieman, A. (2020). Polymer pencil lead graphite for in vivo radiation dosimetry. Diamond and related materials, 106, 107860.
Mat Nawi, S. N., Khandaker, M. U., Bradley, D. A., Abdul Sani, S. F., & Al-mugren, K. S. (2021a). Characterization of a promising luminescence-based graphite radiation dosimeter. Radiation Physics and Chemistry, 188, 109663.
Mat Nawi, S. N., Khandaker, M. U., Abdul Sani, S. F., Ung, N. M., Lam, S. E., Al-mugren, K. S., & Bradley, D. A. (2021b). The potential of polymer pencil-lead graphite for clinical electron beam dosimetry. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 1010, 165478.
Mat Nawi, S. N., Khandaker, M. U., Abdul Sani, S. F., Ismail, S. S., Al-Mugren, K. S., Islam, M. A., ... & Bradley, D. A. (2021c). Structural and dosimetric study of sub-kGy neutron-irradiated graphitic media. Radiation Physics and Chemistry, 189, 109709.
Mat Nawi, S. N., Khandaker, M. U., Abdul Sani, S. F., Lam, S. E., Ung, N. M., Almugren, K. S., & Bradley, D. A. (2022). Low-cost commercial graphite-rich pencils subjected to electron irradiation for passive radiation dosimetry. Applied radiation and isotopes, 188, 110419.
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UNIVERSITI MALAYA IMPACT-ORIENTED INTERDISCIPLINARY RESEARCH GRANT PROGRAMME (IIRG) Project No. IIRG003A-2022HWB, IIRG003B-2022HWB and IIRG003C-2022HWB.
