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Index of content:
Volume 38, Issue 10, October 2011
The 2014 initiative is not only unnecessary but it constitutes a threat to the future of medical physics38(2011); http://dx.doi.org/10.1118/1.3601021View Description Hide Description
- MEDICAL PHYSICS LETTERS
38(2011); http://dx.doi.org/10.1118/1.3633905View Description Hide DescriptionPurpose:
Burgesset al. have shown that the power-spectral density of mammographic breast tissue P(f) follows a power-law, P(f) = c/f β.1 Due to the complexity of the breast anatomy, breast phantoms often make use of power-law backgrounds to approximate the irregular texture of breast images. However, the current methodology of estimating power-law coefficients assumes that the breast structure is isotropic. The purpose of this letter is to demonstrate that breast anatomic structure is not isotropic, but in fact has a preferred orientation. Further, we present a formalism to estimate power-law coefficients β and c while accounting for tissue orientation in mammographic regions-of-interests (ROIs). We then show the effect of structure orientation on β and c, as well as on the appearance of simulated power-law backgrounds.Methods:
When breast tissue exhibits a preferred orientation, the radial symmetry in the associated power spectrum is broken. The new symmetry was fit by an ellipsoidal model. Ellipse tilt angle and axis ratio were accounted for in the power-law fit.Results:
On average, breast structure was found to point toward the nipple: the average orientation in MLO views was 22.5 °, while it was 5 ° for CC views, and the mean orientation for left breasts was negative while it was positive for right breasts. For both power-law magnitude and exponent, the mean difference was statistically significant (<Δβ > = −0.096, <Δlog(c) > =−0.192).Conclusions:
A formalism for quantification of breast structure and structure orientation is provided. The difference in power-law coefficient estimates when accounting for orientation was found to be statistically significant. Examples of statistically defined backgrounds indicate that breast structure is mimicked more closely when structure orientation is accounted for.
- VISION 20/20
38(2011); http://dx.doi.org/10.1118/1.3633909View Description Hide Description
Early diagnosis and therapy increasingly operate at the cellular, molecular, or even at the genetic level. As diagnostic techniques transition from the systems to the molecular level, the role of multimodality molecular imaging becomes increasingly important. Positron emission tomography(PET) and magnetic resonance imaging(MRI) are powerful techniques for in vivo molecular imaging. The inability of PET to provide anatomical information is a major limitation of standalone PETsystems. Combining PET and CT proved to be clinically relevant and successfully reduced this limitation by providing the anatomical information required for localization of metabolic abnormalities. However, this technology still lacks the excellent soft-tissue contrast provided by MRI. Standalone MRIsystems reveal structure and function but cannot provide insight into the physiology and/or the pathology at the molecular level. The combination of PET and MRI, enabling truly simultaneous acquisition, bridges the gap between molecular and systems diagnosis. MRI and PET offer richly complementary functionality and sensitivity; fusion into a combined system offering simultaneous acquisition will capitalize the strengths of each, providing a hybrid technology that is greatly superior to the sum of its parts. A combined PET/MRI system provides both the anatomical and structural description of MRI simultaneously with the quantitative capabilities of PET. In addition, such a system would allow exploiting the power of MR spectroscopy (MRS) to measure the regional biochemical content and to assess the metabolic status or the presence of neoplasia and other diseases in specific tissue areas. This paper briefly summarizes state-of-the-art developments and latest advances in dedicated hybrid PET/MRI instrumentation. Future prospects and potential clinical applications of this technology will also be discussed.
- RADIATION THERAPY PHYSICS
38(2011); http://dx.doi.org/10.1118/1.3633890View Description Hide DescriptionPurpose:
The aim of the work was to investigate the influence of intrafractional tumormotion to the accumulated (absorbed) dose. The accumulated dose was determined by means of calculations and measurements with a robot driven motion phantom.Methods:
Different motion scenarios and compensation techniques were realized in a phantom study to investigate the influence of motion on image acquisition,dose calculation, and dose measurement. The influence of motion on the accumulated dose was calculated by employing two methods (a model based and a voxel based method).Results:
Tumormotion resulted in a blurring of steep dose gradients and a reduction of dose at the periphery of the target. A systematic variation of motion parameters allowed the determination of the main influence parameters on the accumulated dose. The key parameters with the greatest influence on dose were the mean amplitude and the pattern of motion. Investigations on necessary safety margins to compensate for dose reduction have shown that smaller safety margins are sufficient, if the developed concept with optimized margins (OPT concept) was used instead of the standard internal target volume (ITV) concept. Both calculation methods were a reasonable approximation of the measured dose with the voxel based method being in better agreement with the measurements.Conclusions:
Further evaluation of available systems and algorithms for dose accumulation are needed to create guidelines for the verification of the accumulated dose.
38(2011); http://dx.doi.org/10.1118/1.3633897View Description Hide DescriptionPurpose:
Accurate localization of prostate implants from several C-arm images is necessary for ultrasound-fluoroscopy fusion and intraoperative dosimetry. The authors propose a computational motion compensation method for tomosynthesis-based reconstruction that enables 3D localization of prostate implants from C-arm images despite C-arm oscillation and sagging.Methods:
Five C-arm images are captured by rotating the C-arm around its primary axis, while measuring its rotation angle using a protractor or the C-arm joint encoder. The C-arm images are processed to obtain binary seed-only images from which a volume of interest is reconstructed. The motion compensation algorithm, iteratively, compensates for 2D translational motion of the C-arm by maximizing the number of voxels that project on a seed projection in all of the images. This obviates the need for C-arm full pose tracking traditionally implemented using radio-opaque fiducials or external trackers. The proposed reconstruction method is tested in simulations, in a phantom study and on ten patient data sets.Results:
In a phantom implanted with 136 dummy seeds, the seed detection rate was 100% with a localization error of 0.86 ± 0.44 mm (Mean ± STD) compared to CT. For patient data sets, a detection rate of 99.5% was achieved in approximately 1 min per patient. The reconstruction results for patient data sets were compared against an available matching-based reconstruction method and showed relative localization difference of 0.5 ± 0.4 mm.Conclusions:
The motion compensation method can successfully compensate for large C-arm motion without using radio-opaque fiducial or external trackers. Considering the efficacy of the algorithm, its successful reconstruction rate and low computational burden, the algorithm is feasible for clinical use.
38(2011); http://dx.doi.org/10.1118/1.3626482View Description Hide DescriptionPurpose:
To perform absorbed dose calculations based on Monte Carlo simulations for a hypothetical170Tm source and to investigate the influence of encapsulating material on the energy spectrum of the emitted electrons and photons.Methods:
GEANT4 Monte Carlo code version 9.2 patch 2 was used to simulate the decay process of170Tm and to calculate the absorbed dose distribution using the GEANT4 Penelope physics models. A hypothetical 170Tm source based on the Flexisource brachytherapy design with the active core set as a pure thulium cylinder (length 3.5 mm and diameter 0.6 mm) and different cylindrical source encapsulations (length 5 mm and thickness 0.125 mm) constructed of titanium, stainless-steel, gold, or platinum were simulated. The radial dose function for the line source approximation was calculated following the TG-43U1 formalism for the stainless-steel encapsulation.Results:
For the titanium and stainless-steel encapsulation, 94% of the total bremsstrahlung is produced inside the core, 4.8 and 5.5% in titanium and stainless-steel capsules, respectively, and less than 1% in water. For the gold capsule, 85% is produced inside the core, 14.2% inside the gold capsule, and a negligible amount (<1%) in water. Platinum encapsulation resulted in bremsstrahlung effects similar to those with the gold encapsulation. The range of the beta particles decreases by 1.1 mm with the stainless-steel encapsulation compared to the bare source but the tissue will still receive dose from the beta particles several millimeters from the source capsule. The gold and platinum capsules not only absorb most of the electrons but also attenuate low energy photons. The mean energy of the photons escaping the core and the stainless-steel capsule is 113 keV while for the gold and platinum the mean energy is 160 keV and 165 keV, respectively.Conclusions:
A170Tm source is primarily a bremsstrahlung source, with the majority of bremsstrahlung photons being generated in the source core and experiencing little attenuation in the source encapsulation. Electrons are efficiently absorbed by the gold and platinum encapsulations. However, for the stainless-steel capsule (or other lower Z encapsulations) electrons will escape. The dose from these electrons is dominant over the photondose in the first few millimeter but is not taken into account by current standard treatment planning systems. The total energy spectrum of photons emerging from the source depends on the encapsulation composition and results in mean photon energies well above 100 keV. This is higher than the main gamma-ray energy peak at 84 keV. Based on our results, the use of 170Tm as a brachytherapy source presents notable challenges.
38(2011); http://dx.doi.org/10.1118/1.3626485View Description Hide DescriptionPurpose:
Recently, the new high definition multileaf collimator (HD120 MLC) was commercialized by Varian Medical Systems providing high resolution in the center section of the treatment field. The aim of this work is to investigate the characteristics of the HD120 MLC using Monte Carlo(MC) methods.Methods:
Based on the information of the manufacturer, the HD120 MLC was implemented into the already existing Swiss MC Plan (SMCP). The implementation has been configured by adjusting the physical density and the air gap between adjacent leaves in order to match transmission profile measurements for 6 and 15 MV beams of a Novalis TX. These measurements have been performed in water using gafchromic films and an ionization chamber at an SSD of 95 cm and a depth of 5 cm. The implementation was validated by comparing diamond measured and calculated penumbra values (80%–20%) for different field sizes and water depths. Additionally, measured and calculated dose distributions for a head and neck IMRT case using theDELTA4 phantom have been compared. The validated HD120 MLC implementation has been used for its physical characterization. For this purpose, phase space (PS) files have been generated below the fully closed multileaf collimator(MLC) of a 40 × 22 cm2field size for 6 and 15 MV. The PS files have been analyzed in terms of energy spectra, mean energy, fluence, and energy fluence in the direction perpendicular to the MLC leaves and have been compared with the corresponding data using the well established Varian 80 leaf (MLC80) and Millennium M120 (M120 MLC)MLCs. Additionally, the impact of the tongue and groove design of the MLCs on dose has been characterized.Results:
Calculated transmission values for the HD120 MLC are 1.25% and 1.34% in the central part of the field for the 6 and 15 MV beam, respectively. The corresponding ionization chambermeasurements result in a transmission of 1.20% and 1.35%. Good agreement has been found for the comparison between transmission profiles resulting from MC simulations and film measurements. The simulated and measured values for the penumbra agreed within <0.5 mm for all field sizes, depths, and beam energies, and a good agreement has been found between the measured and the calculated dose distributions for the IMRT case. The total energy spectra are almost identical for the three MLCs. However, the mean energy, fluence and energy fluence are significantly different. Due to the different leaf widths of the MLCs, the shape of these distributions is different, each representing its leave structure. Due to the increase in width from the inner to the outer HD120 MLC leaves, the fluence and energy fluence clearly decrease below the outer leaves. The MLC80 and the M120 MLC resulted in an increase of the fluence and energy fluence compared with those resulted for the HD120 MLC. The dose reduction can exceed 20% compared with the dose of the open field due to the tongue and groove design of the HD120 MLC.Conclusions:
The HD120 MLC has been successfully implemented into the SMCP. Comparisons between MC calculations and measurements show very good agreement. The SMCP is now able to calculate accurate dose distributions for treatment plans using the HD120 MLC.
Design, manufacture, and evaluation of an anthropomorphic pelvic phantom purpose-built for radiotherapy dosimetric intercomparison38(2011); http://dx.doi.org/10.1118/1.3626573View Description Hide Description
Purpose: An anthropomorphic pelvic phantom was designed and constructed to meet specific criteria for multicenter radiotherapydosimetric intercomparison.Methods: Three dimensional external and organ outlines were generated from a computed tomographyimage set of a male pelvis, forming the basis of design for an anatomically realistic phantom. Clinically relevant points of interest were selected throughout the dataset where point-dose values could be measured with thermoluminescence dosimeters and a small-volume ionization chamber. Following testing, three materials were selected and the phantom was manufactured using modern prototyping techniques into five separate coronal slices. Time lines and resource requirements for the phantom design and manufacture were recorded. The ability of the phantom to mimic the entire treatment chain was tested.Results: The phantom CTimages indicated that organ densities and geometries were comparable to those of the original patient. The phantom proved simple to load for dosimetry and rapid to assemble. Due to heat release during manufacture, small air gaps and density heterogeneities were present throughout the phantom. The overall cost for production of the prototype phantom was comparable to other commercial anthropomorphic phantoms. The phantom was shown to be suitable for use as a “patient” to mimic the entire treatment chain for typical external beam radiotherapy for prostate and rectal cancer.Conclusions: The phantom constructed for the present study incorporates all characteristics necessary for accurate Level III intercomparison studies. Following use in an extensive Level III dosimetric comparison over a large time scale and geographic area, the phantom retained mechanical stability and did not show signs of radiation-induced degradation.
38(2011); http://dx.doi.org/10.1118/1.3633946View Description Hide Description
Purpose: Currently, there are no successful long-term treatments or preventive strategies for radiation-induced cognitive impairments, and only a few possibilities have been suggested. One such approach involves reducing the dose to neural stem cell compartments (within and outside of the hippocampus) during whole-brain radiation treatments for brain metastases. This study investigates the fundamental physics issues associated with the sparing of neural stem cells during photonradiotherapy for brain metastases.Methods: Several factors influence the stem cell dose: intracranial scattering, collimator leakage, beam energy, and total number of beams. The relative importance of these factors is investigated through a set of radiation therapy plans, which are all variations of an initial 6 MV intensity-modulated radiation therapy(IMRT) plan designed to simultaneously deliver a whole-brain dose of 30 Gy and maximally reduce stem cell compartment dose. Additionally, an in-house leaf segmentation algorithm was developed that utilizes jaw motion to minimize the collimator leakage.Results: The plans are all normalized such that 50% of the PTV receives 30 Gy. For the initial 6 MV IMRT plan, 50% of the stem cells receive a dose greater than 6.3 Gy. Calculations indicate that 3.6 Gy of this dose originates from intracranial scattering. The jaw-tracking segmentation algorithm, used in conjunction with direct machine parameter optimization, reduces the 50% stem cell dose to 4.3 and 3.7 Gy for 6 and 10 MV treatment beams, respectively.Conclusions: Intracranial scattering alone is responsible for a large dose contribution to the stem cell compartment. It is, therefore, important to minimize other contributing factors, particularly the collimator leakage, to maximally reduce dose to these critical structures. The use of collimator jaw tracking in conjunction with modern collimators can minimize this leakage.
38(2011); http://dx.doi.org/10.1118/1.3633902View Description Hide DescriptionPurpose:
A feature based deformable registration model with sliding transformation was developed in the upper abdominal region for livercancer.Methods:
A two-step thin-plate spline (bi-TPS) algorithm was implemented to deformably register the liverorgan. The first TPS registration was performed to exclusively quantify the sliding displacement component. A manual segmentation of the thoracic and abdominal cavity was performed asa priori knowledge. Tissue feature points were automatically identified inside the segmented contour on the images. The scale invariant feature transform method was utilized to match feature points that served as landmarks for the subsequent TPS registration to derive the sliding displacement vector field. To a good approximation, only motion along superior/inferior (SI) direction of voxels on each slice was averaged to obtain the sliding displacement for each slice. A second TPS transformation, as the last step, was carried out to obtain the local deformation field. Manual identification of bifurcation on liver, together with the manual segmentation of liverorgan, was employed as a “ground truth” for assessing the algorithm’s performance.Results:
The proposed two-step TPS was assessed with six liver patients. The average error of liverbifurcation between manual identification and calculation for these patients was less than 1.8 mm. The residual errors between manual contour and propagated contour of liverorgan using the algorithm fell in the range between 2.1 and 2.8 mm. An index of Dice similarity coefficient (DSC) between manual contour and calculated contour for livertumor was 93.6% compared with 71.2% from the conventional TPS calculation.Conclusions:
A high accuracy (∼2 mm) of the two-step feature based TPS registration algorithm was achievable for registering the liverorgan. The discontinuous motion in the upper abdominal region was properly taken into consideration. Clinical implementation of the algorithm will find broad application in radiation therapy of livercancer.
38(2011); http://dx.doi.org/10.1118/1.3633912View Description Hide DescriptionPurpose:
To investigate the potential of three fractal dimension (FD) analysis methods (i.e., the variation, power spectrum, and variogram methods) as metrics for quantifying the degree of modulation in planned intensity modulated radiation therapy(IMRT)treatment fields, and compare the most suitable FD method to the number of monitor units (MUs), the average leaf gap, and the 2D modulation index (2D MI) for assessing modulation.Methods:
The authors implemented, validated, and compared the variation, power spectrum, and variogram methods for computing the FD. Validation of the methods was done using mathematical fractional Brownian surfaces of known FD that ranged in size from 128 × 128 to 512 × 512. The authors used a test set consisting of seven head and neck carcinoma plans (50 prescribed treatment fields) to choose an FD cut-point that ensures no false positives (100% specificity) in distinguishing between moderate and high degrees of field modulation. The degree of field modulation was controlled by adjusting the fluence smoothing parameters in the Eclipse™ treatment planning system (Varian Medical Systems, Palo Alto, CA). The moderate modulation fields were representative of the degree of modulation used clinically at the authors’ institution. The authors performed IMRTquality assurance (QA) on the 50 test fields using the MapCHECK™ device. The FD cut-point was applied to a validation set consisting of four head and neck plans (28 fields). The area under the curve (AUC) from receiver operating characteristic (ROC) analysis was used to compare the ability of FD, number of MUs, average leaf gap, and the 2D MI for distinguishing between the moderate and high modulation fields.Results:
The authors found the variogram FD method to be the most suitable for assessing the modulation complexity of IMRT fields for head and neck carcinomas. Pass rates as measured by the gamma criterion for the MapCHECK™ IMRT field measurements were higher for the moderately modulated fields, and a gamma criterion with 1 mm distance-to-agreement and 1% dose difference showed a clear separation between the 94% pass rates of the moderate and high modulation groups. From the ROC analysis of the test set, the authors found the AUC of the variogram FD, number of MUs, average leaf gap, and 2D MI methods to be 0.99 (almost perfect), 0.91 (excellent), 0.91 (excellent), and 0.92 (excellent), respectively. A cut-point of FD > 2.25 correctly identified 92.8% of the high modulation fields and 100% of the moderately modulated fields in the validation set, satisfying the condition of no false positives.Conclusions:
Of the three FD methods investigated, the variogram method is the most accurate and precise metric for identifying high modulation treatment fields. It is also more accurate and precise than the number of MUs, the average leaf gap, and the 2D MI. Although MapCHECK™ IMRT QA does a reasonable job at identifying high modulation fields, the variogram FD method provides one with the opportunity to quantitatively and accurately assess modulation and adjust overly modulated fields at the treatment planning stage before they are sent to the treatment machine for QA or patient treatment.
Iodine kinetics and dosimetry in the salivary glands during repeated courses of radioiodine therapy for thyroid cancer38(2011); http://dx.doi.org/10.1118/1.3602459View Description Hide DescriptionPurpose:
The present study was conducted to investigate salivary iodine kinetics and dosimetry during repeated courses of radioiodine (131I) therapy for differentiated thyroid cancer (DTC). Such data could provide a better understanding of the mechanisms of 131I induced salivary toxicity and help to develop appropriate methods to reduce this injury.Methods:
Seventy-eight consecutive DTC patients (mean age 45 ± 17 years, 60%, female) undergoing131I therapy for remnant ablation or metastatic tumors were prospectively recruited. Planar quantitative scintigraphy of head–neck images was serially acquired after administration of 2.9–7.4 GBq of 131I to assess kinetics in the salivary glands of patients. Salivary absorbed doses were calculated based on the schema of Medical Internal RadiationDosimetry.Results:
The maximum uptakes in percentage of administered131I activity per kilogram of gland tissue (%/kg) were 12.9% ± 6.5%/kg (range, 0.4%–37.3%/kg) and 12.3% ± 6.2%/kg (range, 0.4%–35.1%/kg) for the parotid and submandibular glands, respectively. Statistically significant correlations of maximum uptake versus cumulative activity (r = −0.74, P < 0.01, for the parotid glands; r = −0.71, P < 0.01, for the submandibular glands) and treatment cycle (P < 0.001, for both gland types) were found. The effective half-lives of 131I in the parotid and submandibular glands were 9.3 ± 3.5 h (range, 1.5–19.8 h) and 8.6 ± 3.2 h (range, 0.8–18.0 h), respectively. A statistically significant correlation was observed between effective half-life with cumulative activity (r = 0.37, P < 0.01) and treatment cycle (P = 0.03) only for the parotid glands. The calculated absorbed doses were 0.20 ± 0.10 mGy/MBq (range, 0.01–0.92 mGy/MBq) and 0.25 ± 0.09 mGy/MBq (range, 0.01–1.52 mGy/MBq) for the parotid and submandibular glands, respectively. The photon contribution to the salivary absorbed dose was minimal in relation to the beta dose contribution. Photon-absorbed dose fractions of total absorbed dose were 4.9% ± 1.3% (range, 1.1%–8.7%) and 3.7% ± 2.5% (range, 0.8%–7.9%) for the parotid and submandibular glands, respectively.Conclusions:
The iodine uptake of salivary glands is continuously reduced during the courses of therapy. The phenomenon of hyper-radiosensitivity may to some extent account for the occurrence of salivary gland hypofunction at very low radiationdoses with low dose rates in131I therapy. On the other hand, failure to incorporate a nonuniform and preferential uptake by salivary gland ductal cells may result in underestimating the actual dose for the critical tissue. Other methods, including 124I voxel-based dosimetry, are warranted to further investigate the 131I-induced salivary gland toxicity.
In vivo dosimetry with optically stimulated luminescent dosimeters, OSLDs, compared to diodes; the effects of buildup cap thickness and fabrication material38(2011); http://dx.doi.org/10.1118/1.3633939View Description Hide DescriptionPurpose
: For external beamin vivo measurements, the dosimeter is normally placed on the patient’s skin, and the dose to a point of interest inside the patient is derived from surface measurements. In order to obtain accurate and reliable measurements, which correlate with the dose values predicted by a treatment planning system, a dosimeter needs to be at a point of electronic equilibrium. This equilibrium is accomplished by adding material (buildup) above the detector. This paper examines the use of buildup caps in a clinical setting for two common detector types: OSLDs and diodes. Clinically built buildup-caps and commercially available hemispherical caps are investigated. The effects of buildup cap thickness and fabricationmaterial on field-size correction factors, C FS, are reported, and differences between the effects of thickness and fabricationmaterial are explained based on physical parameters.Methods:
Measurements are made on solid water phantoms for 6 and 15 MV x-ray beams. Two types of dosimeters are used: OSLDs, InLight/OSL Nanodotdosimeters (Landauer, Inc., Glenwood, IL) and a P-type surface diode (Standard Imaging, Madison, WI). Buildup caps for these detectors were fabricated out of M3, a water-equivalent material, and sheet-metal stock of Al, Cu, and Pb. Also, commercially available hemispherical buildup caps made of plastic water and brass (Landauer, Inc., Glenwood, IL) were used with Nanodots. OSLDs were read with an InLight microStar reader (Landauer, Inc., Glenwood, IL). Dose calculations were carried out with the XiO treatment planning system (CMS/Elekta, Stockholm) with tissue heterogeneity corrections.Results:
For OSLDs and diodes, when measurements are made with no buildup cap a change inC FS of 200% occurs for a field-size change from 3 cm × 3 cm to 30 cm × 30 cm. The change in C FS is reduced to about 4% when a buildup cap with wall thickness equal to the depth of maximum dose is used. Buildup caps with larger wall thickness do not cause further reduction in C FS. The buildup cap fabricationmaterial has little or no effect on C FS. The perturbation to the delivered dose caused by placing a detector with a buildup cap on the surface of a patient is measured to be 4%–7%. A comparison between calculated dose and dose measured with a Nanodot and a diode for 6 and 15 MV x-rays is made. When C FS factors are carefully determined and applied to measurements made on a phantom, the differences between measured and calculated doses were found to be between ±1.3%.Conclusions:
OSLDs and diodes with appropriate buildup caps can be used to measure dose on the surface of a patient and predict the delivered dose to depth dmax in a range of ±1.3% for 100 cGy. The buildup cap: can be fabricated from any material examined in this work, is best with wall thickness dmax, and causes a perturbation to the delivered dose of 4%–7% when the wall thickness is dmax. OSLDs and diodes with buildup caps can both give accurate measurements of delivered dose.
Experimental verification of a real-time compensation functionality for dose changes due to target motion in scanned particle therapy38(2011); http://dx.doi.org/10.1118/1.3633891View Description Hide DescriptionPurpose:
Implementation and experimental assessment of a real-time dose compensation system for beam tracking in scanned carbon beam therapy of intrafractionally moving targets.Methods:
A real-time dose compensation functionality has been developed and implemented at the experimental branch of the beam tracking system at GSI Helmholtzzentrum für Schwerionenforschung (GSI). Treatment plans for different target geometries have been optimized. They have been delivered using scanned carbon ions withbeam tracking (BT) and real-time dose compensation combined with beam tracking (RDBT), respectively. Target motion was introduced by a rotating table. Dose distributions were assessed by ionization chamber measurements and dose reconstructions. These distributions have been compared to stationary delivery for BT as well as RDBT. Additionally simulations have been performed to investigate the dependence of delivereddose distributions on varying motion starting phases for BT and RDBT, respectively.Results:
Average measured dose differences between static delivery and motion influenced delivery could be reduced from 27–68 mGy when BT was used to 12–37 mGy when RDBT was used. Nominal dose was 1000 mGy. Simulated dosedeliveries showed improvements in dosedelivery and robustness against varying starting motion phases when RDBT was used.Conclusions:
Areal-time dose compensation functionality extending the existing beam tracking functionality has been implemented and verified by measurements. Measurements and simulated dosedeliveries show that real-time dose compensation can substantially improve delivereddose distributions for large rotational target motion compared to beam tracking alone.
38(2011); http://dx.doi.org/10.1118/1.3633904View Description Hide DescriptionPurpose:
The purpose of this work is to explore the usefulness of the gamma passing rate metric for per-patient, pretreatment dose QA and to validate a novel patient-dose/DVH-based method and its accuracy and correlation. Specifically, correlations between: (1) gamma passing rates for three 3D dosimeter detector geometries vs clinically relevant patient DVH-based metrics; (2) Gamma passing rates of whole patient dose grids vs DVH-based metrics, (3) gamma passing rates filtered by region of interest (ROI) vs DVH-based metrics, and (4) the capability of a novel software algorithm that estimates corrected patient Dose-DVH based on conventional phan-tom QA data are analyzed.Methods:
Ninety six unique “imperfect” step-and-shoot IMRT plans were generated by applying four different types of errors on 24 clinical Head/Neck patients. The 3D patient doses as well as the dose to a cylindrical QA phantom were then recalculated using an error-free beam model to serve as a simulated measurement for comparison. Resulting deviations to the planned vs simulated measured DVH-based metrics were generated, as were gamma passing rates for a variety of difference/distance criteria covering: dose-in-phantom comparisons and dose-in-patient comparisons, with the in-patient results calculated both over the whole grid and per-ROI volume. Finally, patient dose and DVH were predicted using the conventional per-beam planar data as input into a commercial “planned dose perturbation” (PDP) algorithm, and the results of these predicted DVH-based metrics were compared to the known values.Results:
A range of weak to moderate correlations were found between clinically relevant patient DVH metrics (CTV-D95, parotid D mean, spinal cord D1cc, and larynx D mean) and both 3D detector and 3D patient gamma passing rate (3%/3 mm, 2%/2 mm) for dose-in-phantom along with dose-in-patient for both whole patient volume and filtered per-ROI. There was considerable scatter in the gamma passing rate vs DVH-based metric curves. However, for the same input data, the PDP estimates were in agreement with actual patient DVH results.Conclusions:
Gamma passing rate, even if calculated based on patient dose grids, has generally weak correlation to critical patient DVH errors. However, the PDP algorithm was shown to accurately predict the DVH impact using conventional planar QA results. Using patient-DVH-based metrics IMRT QA allows per-patient dose QA to be based on metrics that are both sensitive and specific. Further studies are now required to analyze new processes and action levels associated with DVH-based metrics to ensure effectiveness and practicality in the clinical setting.
Response of LiF:Mg,Ti thermoluminescent dosimeters at photon energies relevant to the dosimetry of brachytherapy (<1 MeV)38(2011); http://dx.doi.org/10.1118/1.3633892View Description Hide DescriptionPurpose:
High energy photon beams are used in calibratingdosimeters for use in brachytherapy since absorbed dose to water can be determined accurately and with traceability to primary standards in such beams, using calibrated ion chambers and standard dosimetry protocols. For use in brachytherapy, beam quality correction factors are needed, which include corrections for differences in mass energy absorption properties between water and detector as well as variations in detector response (intrinsic efficiency) with radiation quality, caused by variations in the density of ionization (linear energy transfer (LET) -distributions) along the secondary electron tracks. The aim of this work was to investigate experimentally the detector response of LiF:Mg,Ti thermoluminescent dosimeters(TLD) for photon energies below 1 MeV relative to60Co and to address discrepancies between the results found in recent publications of detector response.Methods:
LiF:Mg,Ti dosimeters of formulation MTS-N Poland were irradiated to known values of air kerma free-in-air in x-ray beams at tube voltages 25–250 kV, in137Cs- and 60Co-beams at the Swedish Secondary Standards Dosimetry Laboratory. Conversions from air kerma free-in-air into values of mean absorbed dose in the dosimeters in the actual irradiation geometries were made using EGSnrc Monte Carlo simulations.X-ray energy spectra were measured or calculated for the actual beams. Detector response relative to that for 60Co was determined at each beam quality.Results:
An increase in relative response was seen for all beam qualities ranging from 8% at tube voltage 25 kV (effective energy 13 keV) to 3%–4% at 250 kV (122 keV effective energy) and137Cs with a minimum at 80 keV effective energy (tube voltage 180 kV). The variation with effective energy was similar to that reported by Davis et al. [Radiat. Prot. Dosim.106, 33–43 (2003)] with our values being systematically lower by 2%–4%. Compared to the results by Nunn et al. [Med. Phys. 35, 1861–1869 (2008)], the relative detector response as a function of effective energy differed in both shape and magnitude. This could be explained by the higher maximum read-out temperature (350 °C) used by Nunn et al. [Med. Phys. 35, 1861–1869 (2008)], allowing light emitted from high-temperature peaks with a strong LET dependence to be registered. Use of TLD-100 by Davis et al. [Radiat. Prot. Dosim.106, 33–43 (2003)] with a stronger super-linear dose response compared to MTS-N was identified as causing the lower relative detector response in this work.Conclusions:
Both careful dosimetry and strict protocols for handling the TLDs are required to reach solid experimental data on relative detector response. This work confirms older findings that an over-response relative to60Co exists for photon energies below 200–300 keV. Comparison with the results from the literature indicates that using similar protocols for annealing and read-out, dosimeters of different makes (TLD-100, MTS-N) differ in relative detector response. Though universality of the results has not been proven and further investigation is needed, it is anticipated that with the use of strict protocols for annealing and read-out, it will be possible to determine correction factors that can be used to reduce uncertainties in dosemeasurements around brachytherapy sources at photon energies where primary standards for absorbed dose to water are not available.
38(2011); http://dx.doi.org/10.1118/1.3633903View Description Hide DescriptionPurpose:
For routine clinical dosimetry of photon beams, it is often necessary to know the minimum thickness of backscatter phantom material to ensure that full backscatter condition exists.Methods:
In case of insufficient backscatter thickness, one can determine the backscatter correction factor,BCF(s,d,t), defined as the ratio of absorbed dose measured on the central-axis of a phantom with backscatter thickness of t to that with full backscatter for square field sizes and forward depth d. Measurements were performed in SAD geometry for 6 and 15 MV photon beams using a 0.125 cc thimble chamber for field sizes between 10 × 10 and 30 × 30 cm at depths between d max (1.5 cm for 6 MV and 3 cm for 15 MV) and 20 cm.Results:
A convolution method was used to calculateBCF using Monte-Carlo simulated point-spread kernels generated for clinical photon beams for energies between Co-60 and 24 MV. The convolution calculation agrees with the experimental measurements to within 0.8% with the same physical trend. The value of BCF deviates more from 1 for lower energies and larger field sizes. According to our convolution calculation, the minimum BCF occurs at forward depth d max and 40 × 40 cm field size, 0.970 for 6 MV and 0.983 for 15 MV.Conclusions:
The authors concluded that backscatter thickness is 6.0 cm for 6 MV and 4.0 cm for 15 MV for field size up to 10 × 10 cm whenBCF = 0.998. If 4 cm backscatter thickness is used, BCF is 0.997 and 0.983 for field size of 10 × 10 and 40 × 40 cm for 6 MV, and is 0.998 and 0.990 for 10 × 10 and 40 × 40 cm for 15 MV, respectively.
38(2011); http://dx.doi.org/10.1118/1.3633907View Description Hide DescriptionPurpose:
Prediction of respiratory motion traces has become an important research topic. Especially for motion compensated radiotherapy, compensation of the latencies arising from mechanical constraints and signal processing is necessary. In recent years, many algorithms have been developed and evaluated. It is, however, still unclear how well a specific patient will be suited to motion prediction before the treatment actually starts.Methods:
In this work, we have analyzed 304 respiratory motion traces with an average duration of 71 min. A total of 21 features characterizing these signals (12 from the frequency domain and 9 from the time domain) have been determined for each motion trace. The correlation between these features and the overall prediction quality for three different algorithms (based on wavelet-based multiscale autoregression, support vector regression, and linear expansion of the prediction error) has been analyzed and six dominant features have been identified (three each from the time and frequency domains). Additionally, the optimized results of the multistep-linear method (MULIN) prediction algorithm on the first 300 s of motion data have been used as a seventh, independent feature. Assessing the prediction algorithms’ quality was done by calculating the relative root mean squared (RMSrel) error, i.e., the ratio between the RMS error of the prediction output and the RMS error of the delayed signal (the RMS error obtained when doing no prediction). Then, for each algorithm, the signals themselves were grouped into four classes according to the quality of prediction: relative RMS less than 0.8 (C1), between 0.8 and 0.9 (C2), between 0.9 and 1.0 (C3), and over 1.0 (C4). The goal of this work is to identify, prior to treatment, those patients whose respiratory behavior indicates probable (RMSrel ≥ 0.9) or certain (RMSrel ≥ 1.0) failure of respiratory motion prediction. Consequently, all signals from C4 must be identified and rejected and no signals from C1 may be falsely rejected. The restriction on C2 and C3 is slightly weaker: C2 are those signals that should be kept and C3 are those signals that should be rejected.Results:
Rejecting all signals from C4 and C3, keeping as many signals from C1 and as few from C2 as possible, has been achieved for the wLMS algorithm when using six feature pairs and the result of prediction on the short signal. Here, the false rejectance rate for C1 was less than 13% and the false acceptance rate for C2 was 15%. For the SVRpred and MULIN algorithms, the results are somewhat worse: in both cases, signals from C3 were falsely accepted (25.0% and 14.3%, respectively) but all signals from C4 were rejected. The false rejectance rate for C1 was 11.4% (MULIN) and 26.3% (SVRpred).Conclusions:
In general, it has been shown that pretreatment classification of the quality of respiratory motion prediction is possible and that signals with high relative RMS error can be identified with great reliability. This is especially true for the wLMS algorithm, which has also been identified as the most precise and robust of the presented methods.
38(2011); http://dx.doi.org/10.1118/1.3633896View Description Hide Description
Purpose:Positron emission tomography(PET) of lungtumors suffers from breathing-motion induced blurring. Respiratory-correlated PET ameliorates motion blurring and enables visualization of lungtumor functional uptake throughout the breathing cycle but has achieved limited clinical use in radiotherapy planning. In this work, the authors propose a process for generating a gated PET maximum intensity projection (MIP), a breathing-phase projection of the 4D image set comprising gated PETimages, as a technique to quantitatively and efficiently incorporate respiratory-correlated PET information into radiotherapytreatment planning.Methods: 4D-CT and respiratory-gated PET using [18F]fluorodeoxyglucose (FDG) were acquired of three patients with a total of four small (4–18 cc), clearly defined lower-lobe lungtumors. Internal target volumes (ITVs) for the lungtumors were generated by threshold-based segmentation of PET-MIP images and ungated PETimages (ITVPET-MIP and ITV3D-PET, respectively), and by manual contouring of CT-MIP and end-exhale and end-inhale phases of 4D-CT (ITVCT-MIP) by a radiation oncologist. Because of the sensitivity of tumor segmentation to threshold value, several different thresholds were tested for ITV generation, including 40%, 30%, and 20% of maximum standardized uptake value (SUVmax) for FDG as well as absolute SUV thresholds of 2.5 and 3.0. The normalized overlap and relative volumes of ITVPET-MIP and ITV3D-PET with respect to ITVCT-MIP were compared. The images were also visually compared. ITVCT-MIP was considered a gold standard for these tumors with CT-visible morphology.Results: The mean and standard deviation normalized overlap and relative volumes between ITVPET-MIP and ITVCT-MIP were 0.68 ± 0.07 and 1.07 ± 0.42, respectively, averaged over all four tumors and all five threshold values. The mean and standard deviation normalized overlap and relative volumes of ITV3D-PET and ITVCT-MIP were 0.47 ± 0.12 and 0.69 ± 0.56, respectively.Conclusions: PET-MIP images better match CT-MIP images for this sample of four small CT-visible tumors as compared to ungated PETimages, based on the metrics of volumetric overlap and relative volumes as well as visual interpretation. The PET-MIP is a way to incorporate 4D-PET imaging into the process of lungtumor contouring that is time-efficient for the radiation oncologist and involves minimal effort to implement in treatment planningsoftware, because it requires only a single PETimage beyond contouring on CT alone.
38(2011); http://dx.doi.org/10.1118/1.3641644View Description Hide DescriptionPurpose
: Gamma Knife (GK) radiosurgery is a minimally invasive surgical technique for the treatment of intracranial lesions. To minimize neurological deficits, submillimeter accuracy is required during treatment delivery. In this paper, the delivery accuracy of GK radiosurgery was assessed with the gamma evaluation method using planning dose distribution and film measurement data.Methods
: Single 4, 8, and 16 mm and composite shot plans were developed for evaluation using the GK Perfexion (PFX) treatment planning system (TPS). The planning dose distributions were exported as digital image communications in medicine – radiation therapy (DICOM RT) files using a new function of GK TPS. A maximum dose of 8 Gy was prescribed for four test plans. Irradiation was performed onto a spherical solid water phantom using Gafchromic EBT2 films in the axial and coronal planes. The exposed films were converted to absolute dose based on a 4th-order polynomialcalibration curve determined using ten calibration films. The film measurement results and planning dose distributions were registered for further analysis in the same Leksell coordinate using in-house software. The gamma evaluation method was applied to two dose distributions with varying spatial tolerance (0.3–2.0 mm) and dosimetric tolerance (0.3–2.0%), to verify the accuracy of GK radiosurgery. The result of gamma evaluation was assessed using pass rate, dose gamma index histogram (DGH), and dose pass rate histogram (DPH).Results
: The 20, 50, and 80% isodose lines found in film measurements were in close agreement with the planning isodose lines, for all dose levels. The comparison of diagonal line profiles across the axial plane yielded similar results. The gamma evaluation method resulted in high pass rates of >95% within the 50% isodose line for 0.5 mm/0.5% tolerance criteria, in both the axial and coronal planes. They satisfied 1.0 mm/1.0% criteria within the 20% isodose line. Our DGH and DPH also showed that low isodose lines exhibited inferior gamma indexes and pass rates compared with higher isodose lines.Conclusions
: The gamma evaluation method was applicable to GK radiosurgery. For all test plans, planning dose distribution and film measurement met the tolerance criteria of 0.5 mm/0.5% within the 50% isodose line which are used for marginal dose prescription