Index of content:
Volume 40, Issue 4, April 2013
The aim of this study was to develop a prototype magnetic resonance (MR)-compatible positron emission tomography (PET) that can be inserted into a MR imager and that allows simultaneous PET and MR imaging of the human brain. This paper reports the initial results of the authors’ prototype brain PET system operating within a 3-T magnetic resonance imaging (MRI) system using newly developed Geiger-mode avalanche photodiode (GAPD)-based PET detectors, long flexible flat cables, position decoder circuit with high multiplexing ratio, and digital signal processing with field programmable gate array-based analog to digital converter boards.Methods:
A brain PET with 72 detector modules arranged in a ring was constructed and mounted in a 3-T MRI. Each PET module was composed of cerium-doped lutetium yttrium orthosilicate (LYSO) crystals coupled to a tileable GAPD. The GAPD output charge signals were transferred to preamplifiers using 3 m long flat cables. The LYSO and GAPD were located inside the MR bore and all electronics were positioned outside the MR bore. The PET detector performance was investigated both outside and inside the MRI, and MR image quality was evaluated with and without the PET system.Results:
The performance of the PET detector when operated inside the MRI during MR image acquisition showed no significant change in energy resolution and count rates, except for a slight degradation in timing resolution with an increase from 4.2 to 4.6 ns. Simultaneous PET/MR images of a hot-rod and Hoffman brain phantom were acquired in a 3-T MRI. Rods down to a diameter of 3.5 mm were resolved in the hot-rod PET image. The activity distribution patterns between the white and gray matter in the Hoffman brain phantom were well imaged. The hot-rod and Hoffman brain phantoms on the simultaneously acquired MR images obtained with standard sequences were observed without any noticeable artifacts, although MR image quality requires some improvement.Conclusions:
These results demonstrate that the simultaneous acquisition of PET and MR images is feasible using the MR insertable PET developed in this study.
The need for performance standards in clinical translation and adoption of fluorescence molecular imaging40(2013); http://dx.doi.org/10.1118/1.4789499View Description Hide Description
40(2013); http://dx.doi.org/10.1118/1.4789492View Description Hide Description
- MEDICAL PHYSICS LETTER
40(2013); http://dx.doi.org/10.1118/1.4794925View Description Hide DescriptionPurpose:
To obtain on-treatment volumetric patient anatomy during respiratory gated volumetric modulated arc therapy (VMAT).Methods:
On-board imaging device integrated with Linacs offers a viable tool for obtaining patient anatomy during radiation treatment delivery. In this study, the authors acquired beam-level kV images during gated VMAT treatments using a Varian TrueBeam™STx Linac. These kV projection images are triggered by a respiratory gating signal and can be acquired immediately before treatment MV beam on at every breathing cycle during delivery. Because the kV images are acquired with an on-board imaging device during a rotational arc therapy, they provide the patient anatomical information from many different angles or projection views (typically 20–40). To reconstruct the volumetric image representing patient anatomy during the VMAT treatment, the authors used a compressed sensing method with a fast first-order optimization algorithm. The conventional FDK reconstruction was also used for comparison purposes. The method was tested on a dynamic anthropomorphic physical phantom as well as a lung patient.Results:
The reconstructed volumetric images for a dynamic anthropomorphic physical phantom and a lung patient showed clearly visible soft-tissue target as well as other anatomical structures, with the proposed compressed sensing-based image reconstruction method. Compared with FDK, the compressed sensing method leads to a ∼two and threefold increase in contrast-to-noise ratio around the target area in the phantom and patient case, respectively.Conclusions:
The proposed technique provides on-treatment volumetric patient anatomy, with only a fraction (<10%) of the imaging dose used in conventional CBCT procedures. This anatomical information may be valuable for geometric verification and treatment guidance, and useful for verification of treatment dose delivery, accumulation, and adaptation in the future.
- RADIATION THERAPY PHYSICS
40(2013); http://dx.doi.org/10.1118/1.4793408View Description Hide DescriptionPurpose
: Monte Carlo simulations of radiation therapy require conversion from Hounsfield units (HU) in CT images to an exact tissue composition and density. The number of discrete densities (or density bins) used in this mapping affects the simulation accuracy, execution time, and memory usage in GEANT4 and other Monte Carlo code. The relationship between the number of density bins and CT noise was examined in general for all simulations that use HU conversion to density. Additionally, the effect of this on simulation accuracy was examined for proton radiation.Methods
: Relative uncertainty from CT noise was compared with uncertainty from density binning to determine an upper limit on the number of density bins required in the presence of CT noise. Error propagation analysis was also performed on continuously slowing down approximation range calculations to determine the proton range uncertainty caused by density binning. These results were verified with Monte Carlo simulations.Results
: In the presence of even modest CT noise (5 HU or 0.5%) 450 density bins were found to only cause a 5% increase in the density uncertainty (i.e., 95% of density uncertainty from CT noise, 5% from binning). Larger numbers of density bins are not required as CT noise will prevent increased density accuracy; this applies across all types of Monte Carlo simulations. Examining uncertainty in proton range, only 127 density bins are required for a proton range error of <0.1 mm in most tissue and <0.5 mm in low density tissue (e.g., lung).Conclusions
: By considering CT noise and actual range uncertainty, the number of required density bins can be restricted to a very modest 127 depending on the application. Reducing the number of density bins provides large memory and execution time savings in GEANT4 and other Monte Carlo packages.
40(2013); http://dx.doi.org/10.1118/1.4793262View Description Hide DescriptionPurpose:
To develop and test a method for optimizing and constructing a dual scattering system in passively scattered proton therapy.Methods:
A beam optics optimization algorithm was developed to optimize the thickness of the first scatterer (S1) and the profile (of both the high-Z material and Lexan) of the second scatterer (S2) to deliver a proton beam matching a given set of parameters, including field diameter, fluence, flatness, and symmetry. A new manufacturing process was also tested that allows the contoured second scattering foil to be created much more economically and quickly using Cerrobend casting. Two application-specific scattering systems were developed and tested using both experimental and Monte Carlo techniques to validate the optimization process described.Results:
A scattering system was optimized and constructed to deliver large uniform irradiations of radiobiology samples at low dose rates. This system was successfully built and tested using film and ionization chambers. The system delivered a uniform radiation field of 50 cm diameter (to a dose of ±7% of the central axis) while the depth dose profile could be tuned to match the specifications of the particular investigator using modulator wheels and range shifters. A second scattering system for intermediate field size (4 cm < diameter < 10 cm) stereotactic radiosurgery and radiation therapy (SRS and SRT) treatments was also developed and tested using GEANT4. This system improved beam efficiency by over 70% compared with existing scattering systems while maintaining field flatness and depth dose profile. In both cases the proton range uniformity across the radiation field was maintained, further indicating the accuracy of the energy loss formalism in the optimization algorithm.Conclusions:
The methods described allow for rapid prototyping of scattering foils to meet the demands of both research and clinical beam delivery applications in proton therapy.
40(2013); http://dx.doi.org/10.1118/1.4794180View Description Hide DescriptionPurpose:
The authors evaluated the absorbed dose received by the gonads during roboticstereotactic radiosurgery(SRS) for the treatment of different tumor localizations.Methods:
The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters(TLDs).SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA).Results:
The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035–2.71 Gy) and 0.34 Gy (range, 0.066–3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03–0.159 Gy) and 0.05 Gy (range, 0.015–0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056–1.97 Gy) and 0.306 Gy (range, 0.065–2.25 Gy).Conclusions:
Gonad doses are below sterility threshold in roboticSRS for different tumor localizations. However, particular attention should be given to gonads during roboticSRS for pelvic tumors.
40(2013); http://dx.doi.org/10.1118/1.4793766View Description Hide DescriptionPurpose:
The purpose of this work was to study the feasibility of a new inverse planning technique based on the generalized equivalent uniform dose for image-guided high dose rate (HDR) prostate cancer brachytherapy in comparison to conventional dose-volume based optimization.Methods:
The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO (Hybrid Inverse Planning Optimization) is compared with alternative plans, which were produced through inverse planning using the generalized equivalent uniform dose (gEUD). All the common dose-volume indices for the prostate and the organs at risk were considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by comparing dose volume histogram and gEUD evaluators.Results:
Our results demonstrate the feasibility of gEUD-based inverse planning in HDR brachytherapy implants for prostate. A statistically significant decrease in D10 or/and final gEUD values for the organs at risk (urethra, bladder, and rectum) was found while improving dose homogeneity or dose conformity of the target volume.Conclusions:
Following the promising results of gEUD-based optimization in intensity modulated radiation therapy treatment optimization, as reported in the literature, the implementation of a similar model in HDR brachytherapy treatment plan optimization is suggested by this study. The potential of improved sparing of organs at risk was shown for various gEUD-based optimization parameter protocols, which indicates the ability of this method to adapt to the user's preferences.
40(2013); http://dx.doi.org/10.1118/1.4794497View Description Hide DescriptionPurpose:
The accuracy of motion prediction, utilized to overcome the system latency of motion management radiotherapy systems, is hampered by irregularities present in the patients’ respiratory pattern. Audiovisual (AV) biofeedback has been shown to reduce respiratory irregularities. The aim of this study was to test the hypothesis that AV biofeedback improves the accuracy of motion prediction.Methods:
An AV biofeedback system combined with real-time respiratory data acquisition and MR images were implemented in this project. One-dimensional respiratory data from (1) the abdominal wall (30 Hz) and (2) the thoracic diaphragm (5 Hz) were obtained from 15 healthy human subjects across 30 studies. The subjects were required to breathe with and without the guidance of AV biofeedback during each study. The obtained respiratory signals were then implemented in a kernel density estimation prediction algorithm. For each of the 30 studies, five different prediction times ranging from 50 to 1400 ms were tested (150 predictions performed). Prediction error was quantified as the root mean square error (RMSE); the RMSE was calculated from the difference between the real and predicted respiratory data. The statistical significance of the prediction results was determined by the Student'st-test.Results:
Prediction accuracy was considerably improved by the implementation of AV biofeedback. Of the 150 respiratory predictions performed, prediction accuracy was improved 69% (103/150) of the time for abdominal wall data, and 78% (117/150) of the time for diaphragm data. The average reduction in RMSE due to AV biofeedback over unguided respiration was 26% (p < 0.001) and 29% (p < 0.001) for abdominal wall and diaphragm respiratory motion, respectively.Conclusions:
This study was the first to demonstrate that the reduction of respiratory irregularities due to the implementation of AV biofeedback improves prediction accuracy. This would result in increased efficiency of motion management techniques affected by system latencies used in radiotherapy.
Accuracy verification of infrared marker-based dynamic tumor-tracking irradiation using the gimbaled x-ray head of the Vero4DRT (MHI-TM2000)a)40(2013); http://dx.doi.org/10.1118/1.4794506View Description Hide DescriptionPurpose:
To verify the accuracy of an infrared (IR) marker-based dynamic tumor-tracking irradiation system (IR tracking) using the gimbaled x-ray head of the Vero4DRT (MHI-TM2000).Methods:
The gimbaled 6-MV C-band x-ray head of the Vero4DRT can swing along the pan-and-tilt direction to track a moving target. During beam delivery, the Vero4DRT predicts the future three-dimensional (3D) target position in real time using a correlation model [four-dimensional (4D) model] between the target and IR marker motion, and then continuously transfers the corresponding tracking orientation to the gimbaled x-ray head. The 4D-modeling error (E4DM) and the positional tracking error (EP) were defined as the difference between the predicted and measured positions of the target in 4D modeling and as the difference between the tracked and measured positions of the target during irradiation, respectively. For the clinical application of IR tracking, we assessed the relationship between E4DM and EP for three 1D sinusoidal (peak-to-peak amplitude [A]: 20–40 mm, breathing period [T]: 2–4 s), five 1D phase-shifted sinusoidal (A: 20 mm, T: 4 s, phase shift [τ]: 0.2–2 s), and six 3D patient respiratory patterns.Results:
The difference between the 95th percentile of the absoluteEP () and the mean (μ) + two standard deviations (SD) of absolute E4DM () was within ±1 mm for all motion patterns. As the absolute correlation between the target and IR marker motions decreased from 1.0 to 0.1 for the 1D phase-shifted sinusoidal patterns, the and increased linearly, from 0.4 to 3.0 mm (R = −0.98) and from 0.5 to 2.2 mm (R = −0.95), respectively. There was a strong positive correlation between and in each direction [(lateral, craniocaudal, anteroposterior) = (0.99, 0.98, 1.00)], even for the 3D respiratory patterns; thus, was readily estimated from .Conclusions:
Positional tracking errors correlated strongly with 4D-modeling errors in IR tracking. Thus, the accuracy of the 4D model must be verified before treatment, and margins are required to compensate for the 4D-modeling error.
Evaluation of multiple image-based modalities for image-guided radiation therapy (IGRT) of prostate carcinoma: A prospective study40(2013); http://dx.doi.org/10.1118/1.4794502View Description Hide DescriptionPurpose
: Setup errors and prostate intrafraction motion are main sources of localization uncertainty in prostate cancer radiation therapy. This study evaluates four different imaging modalities 3D ultrasound (US), kV planar images, cone-beam computed tomography (CBCT), and implanted electromagnetic transponders (Calypso/Varian) to assess inter- and intrafraction localization errors during intensity-modulated radiation therapy based treatment of prostate cancer.Methods:
Twenty-seven prostate cancer patients were enrolled in a prospective IRB-approved study and treated to a total dose of 75.6 Gy (1.8 Gy/fraction). Overall, 1100 fractions were evaluated. For each fraction, treatment targets were localized using US, kV planar images, and CBCT in a sequence defined to determine setup offsets relative to the patient skin tattoos, intermodality differences, and residual errors for each patient and patient cohort. Planning margins, following van Herk's formalism, were estimated based on error distributions. Calypso-based localization was not available for the first eight patients, therefore centroid positions of implanted gold-seed markers imaged prior to and immediately following treatment were used as a motion surrogate during treatment. For the remaining 19 patients, Calypso transponders were used to assess prostate intrafraction motion.Results:
The means (μ), and standard deviations (SD) of the systematic (Σ) and random errors (σ) of interfraction prostate shifts (relative to initial skin tattoo positioning), as evaluated using CBCT, kV, and US, averaged over all patients and fractions, were: [μ CBCT = (−1.2, 0.2, 1.1) mm, Σ CBCT = (3.0, 1.4, 2.4) mm, σ CBCT = (3.2, 2.2, 2.5) mm], [μ kV = (−2.9, −0.4, 0.5) mm, Σ kV = (3.4, 3.1, 2.6) mm, σ kV = (2.9, 2.0, 2.4) mm], and [μ US = (−3.6, −1.4, 0.0) mm, Σ US = (3.3, 3.5, 2.8) mm, σ US = (4.1, 3.8, 3.6) mm], in the anterior–posterior (A/P), superior–inferior (S/I), and the left–right (L/R) directions, respectively. In the treatment protocol, adjustment of couch was guided by US images. Residual setup errors as assessed by kV images were found to be: μ residual = (−0.4, 0.2, 0.2) mm, Σ residual = (1.0, 1.0,0.7) mm, and σ residual = (2.5, 2.3, 1.8) mm. Intrafraction prostate motion, evaluated using electromagnetic transponders, was: μ intrafxn = (0.0, 0.0, 0.0) mm, Σ intrafxn = (1.3, 1.5, 0.6) mm, and σ intrafxn = (2.6, 2.4, 1.4) mm. Shifts between pre- and post-treatment kV images were: μ kV(post–pre) = (−0.3, 0.8, −0.2), Σ kV(post–pre) = (2.4, 2.7, 2.1) mm, and σ kV(post–pre) = (2.7, 3.2, 3.1) mm. Relative to skin tattoos, planning margins for setup error were within 10–11 mm for all image-based modalities. The use of image guidance was shown to reduce these margins to less than 5 mm. Margins to compensate for both residual setup (interfraction) errors as well as intrafraction motion were 6.6, 6.8, and 3.9 mm in the A/P, S/I, and L/R directions, respectively.Conclusions:
Analysis of interfraction setup errors, performed with US, CBCT, planar kV images, and electromagnetic transponders, from a large dataset revealed intermodality shifts were comparable (within 3–4 mm). Interfraction planning margins, relative to setup based on skin marks, were generally within the 10 mm prostate-to-planning target volume margin used in our clinic. With image guidance, interfraction residual planning margins were reduced to approximately less than 4 mm. These findings are potentially important for dose escalation studies using smaller margins to better protect normal tissues.
40(2013); http://dx.doi.org/10.1118/1.4794479View Description Hide DescriptionPurpose:
Current amorphous silicon electronic portal imaging devices (a-Si EPIDs) that are frequently used in radiotherapy applications employ a metal plate/phosphor screen configuration to optimize x-ray detection efficiency. The phosphor acts to convert x rays into an optical signal that is detected by an underlying photodiode array. The dosimetric response of EPIDs has been well characterized, in part through the development of computational models. Such models, however, have generally made simplifying assumptions with regards to the transport of optical photons within these detectors. The goal of this work was to develop and experimentally validate a new Monte Carlo (MC) model of an a-Si EPID that simulates both x-ray and optical photon transport in a self-contained manner. Using this model the authors establish a definitive characterization of the effects of optical transport on the dosimetric response of a-Si EPIDs employing gadolinium oxysulfide phosphor screens.Methods:
The Geant4 MC toolkit was used to develop a model of ana-Si EPID that employs standard electromagnetic and optical physics classes. The sensitivity of EPID response to uncertainties in optical transport parameters was evaluated by investigating their effects on the EPID point spread function (PSF). An optical blur kernel was also calculated to isolate the component of the PSF resulting purely from optical transport. A 6 MV photon source model was developed and integrated into the MC model to investigate EPID dosimetric response. Field size output factors and relative dose profiles were calculated for a set of open fields by separately scoring energy deposited in the phosphor and optical absorption events in the photodiode. These were then compared to quantify effects resulting from optical photon transport. The EPID model was validated against experimental measurements taken using a research EPID.Results:
Optical photon scatter within the phosphor screen noticeably broadened the PSF. Variations in optical transport parameters reported in the literature caused fluctuations in the PSF full width at half maximum (FWHM) and full width at tenth maximum (FWTM) of less than 3% and 5%, respectively, confirming model robustness. Greater deviations (up to 9.5% and 36% for FWHM and FWTM, respectively) were observed when optical parameters were largely different from reference values. When scoring energy deposition in the phosphor, measured and calculated output factors agreed within statistical uncertainties and at least 94% of the MC simulated profile data points passed 3%/3 mm γ-index criterion for all field sizes considered. Despite statistical uncertainties in optical simulations arising from computational limitations, no differences were observed between optical and energy deposition profiles.Conclusions:
Simulations demonstrated noticeable blurring of the EPID PSF when scoring optical absorption events in the photodiode relative to energy deposition in the phosphor. However, modeling the standard electromagnetic transport alone should suffice when using MC methods to predict EPID dose–response to static, open 6 MV fields with a standarda-Si photodiode array. Therefore, using energy deposition in the phosphor as a surrogate for EPID dose–response is a valid approach that should not require additional corrections for optical transport effects in current a-Si EPIDs employing phosphor screens.
BrachyView: Proof-of-principle of a novel in-body gamma camera for low dose-rate prostate brachytherapy40(2013); http://dx.doi.org/10.1118/1.4794487View Description Hide DescriptionPurpose:
The conformity of the achieved dose distribution to the treatment plan strongly correlates with the accuracy of seed implantation in a prostate brachytherapy treatment procedure. Incorrect seed placement leads to both short and long term complications, including urethral and rectal toxicity. The authors present BrachyView, a novel concept of a fast intraoperative treatment planning system, to provide real-time seed placement information based on in-body gamma camera data. BrachyView combines the high spatial resolution of a pixellated silicon detector (Medipix2) with the volumetric information acquired by a transrectal ultrasound (TRUS). The two systems will be embedded in the same probe so as to provide anatomically correct seed positions for intraoperative planning and postimplant dosimetry. Dosimetric calculations are based on the TG-43 method using the real position of the seeds. The purpose of this paper is to demonstrate the feasibility of BrachyView using the Medipix2 pixel detector and a pinhole collimator to reconstruct the real-time 3D position of low dose-rate brachytherapy seeds in a phantom.Methods:
BrachyView incorporates three Medipix2 detectors coupled to a multipinhole collimator. Three-dimensionally triangulated seed positions from multiple planar images are used to determine the seed placement in a PMMA prostate phantom in real time. MATLAB codes were used to test the reconstruction method and to optimize the device geometry.Results:
The results presented in this paper show a 3D position reconstruction accuracy of the seed in the range of 0.5–3 mm for a 10–60 mm seed-to-detector distance interval (Z direction), respectively. The BrachyView system also demonstrates a spatial resolution of 0.25 mm in the XY plane for sources at 10 mm distance from Medipix2 detector plane, comparable to the theoretical value calculated for an equivalent gamma camera arrangement. The authors successfully demonstrated the capability of BrachyView for real-time imaging (using a 3 s data acquisition time) of different brachytherapy seed configurations (with an activity of 0.05 U) throughout a 60 × 60 × 60 mm3 Perspex prostate phantom.Conclusions:
The newly developed miniature gamma camera component of BrachyView, with its high spatial resolution and real time capability, allows accurate 3D localization of seeds in a prostate phantom. Combination of the gamma camera with TRUS in a single probe will complete the BrachyView system.
Objected constrained registration and manifold learning: A new patient setup approach in image guided radiation therapy of thoracic cancer40(2013); http://dx.doi.org/10.1118/1.4794489View Description Hide DescriptionPurpose:
The management of thoracic malignancies with radiation therapy is complicated by continuous target motion. In this study, a real time motion analysis approach is proposed to improve the accuracy of patient setup.Methods:
For 11 lung cancer patients a long training fluoroscopy was acquired before the first treatment, and multiple short testing fluoroscopies were acquired weekly at the pretreatment patient setup of image guided radiotherapy (IGRT). The data analysis consisted of three steps: first a 4D target motion model was constructed from 4DCT and projected to the training fluoroscopy through deformable registration. Then the manifold learning method was used to construct a 2D subspace based on the target motion (kinetic) and location (static) information in the training fluoroscopy. Thereafter the respiratory phase in the testing fluoroscopy was determined by finding its location in the subspace. Finally, the phase determined testing fluoroscopy was registered to the corresponding 4DCT to derive the pretreatment patient position adjustment for the IGRT. The method was tested on clinical image sets and numerical phantoms.Results:
The registration successfully reconstructed the 4D motion model with over 98% volume similarity in 4DCT, and over 95% area similarity in the training fluoroscopy. The machine learning method derived the phase values in over 98% and 93% test images of the phantom and patient images, respectively, with less than 3% phase error. The setup approach achieved an average accumulated setup error less than 1.7 mm in the cranial-caudal direction and less than 1 mm in the transverse plane. All results were validated against the ground truth of manual delineations by an experienced radiation oncologist. The expected total time for the pretreatment setup analysis was less than 10 s.Conclusions:
By combining the registration and machine learning, the proposed approach has the potential to improve the accuracy of pretreatment setup for patients with thoracic malignancy.
Microionization chamber air-kerma calibration coefficients as a function of photon energy for x-ray spectra in the range of 20–250 kVp relative to 60Co40(2013); http://dx.doi.org/10.1118/1.4794491View Description Hide DescriptionPurpose:
To investigate the applicability of a wide range of microionization chambers for reference dosimetry measurements in low- and medium-energy x-ray beams.Methods:
Measurements were performed with six cylindrical microchamber models, as well as one scanning chamber and two Farmer-type chambers for comparison purposes. Air-kerma calibration coefficients were determined at the University of Wisconsin Accredited Dosimetry Calibration Laboratory for each chamber for a range of low- and medium-energy x-ray beams (20–250 kVp), with effective energies ranging from 11.5 keV to 145 keV, and a60Co beam. A low-Z proof-of-concept microchamber was developed and calibrated with and without a high-Z silver epoxy on the collecting electrode.Results:
All chambers composed of low-Z materials (Z ≤ 13), including the Farmer-type chambers, the scanning chamber, and the PTW TN31014 and the proof-of-concept microchambers, exhibited air-kerma calibration coefficients with little dependence on the quality of the beam. These chambers typically exhibited variations in calibration coefficients of less than 3% with the beam quality, for medium energy beams. However, variations in air-kerma calibration coefficients of greater than 50% were measured over the range of medium-energy x-ray beams for each of the microchambers containing high-Z collecting electrodes (Z > 13). For these high-Z chambers, which include the Exradin A14SL and A16 chambers, the PTW TN31006 chamber, the IBA CC01 chamber, and the proof-of-concept chamber containing silver, the average variation in air-kerma calibration coefficients between any two calibration beams was nearly 25% over the entire range of beam qualities investigated.Conclusions:
Due to the strong energy dependence observed with microchambers containing high-Z components, these chambers may not be suitable dosimeters for kilovoltage x-ray applications, as they do not meet the TG-61 requirements. It is recommended that only microchambers containing low-Z materials (Z ≤ 13) be considered for air-kerma calibrations for reference dosimetry in low- and medium-energy x-ray beams.
Experimental evaluations of the accuracy of 3D and 4D planning in robotic tracking stereotactic body radiotherapy for lung cancers40(2013); http://dx.doi.org/10.1118/1.4794505View Description Hide DescriptionPurpose:
Due to the complexity of 4D target tracking radiotherapy, the accuracy of this treatment strategy should be experimentally validated against established standard 3D technique. This work compared the accuracy of 3D and 4D dose calculations in respiration tracking stereotactic body radiotherapy (SBRT).Methods:
Using the 4D planning module of the CyberKnife treatment planning system, treatment plans for a moving target and a static off-target cord structure were created on different four-dimensional computed tomography (4D-CT) datasets of a thorax phantom moving in different ranges. The 4D planning system used B-splines deformable image registrations (DIR) to accumulate dose distributions calculated on different breathing geometries, each corresponding to a static 3D-CT image of the 4D-CT dataset, onto a reference image to compose a 4D dose distribution. For each motion, 4D optimization was performed to generate a 4D treatment plan of the moving target. For comparison with standard 3D planning, each 4D plan was copied to the reference end-exhale images and a standard 3D dose calculation was followed. Treatment plans of the off-target structure were first obtained by standard 3D optimization on the end-exhale images. Subsequently, they were applied to recalculate the 4D dose distributions using DIRs. All dose distributions that were initially obtained using the ray-tracing algorithm with equivalent path-length heterogeneity correction (3DEPL and 4DEPL) were recalculated by a Monte Carlo algorithm (3D MC and 4D MC ) to further investigate the effects of dose calculation algorithms. The calculated 3DEPL, 3D MC , 4DEPL, and 4D MC dose distributions were compared to measurements by Gafchromic EBT2 films in the axial and coronal planes of the moving target object, and the coronal plane for the static off-target object based on the γ metric at 5%/3mm criteria (γ 5%/3mm). Treatment plans were considered acceptable if the percentage of pixels passing γ 5%/3mm (Pγ<1) ≥ 90%.Results:
The averaged Pγ<1 values of the 3DEPL, 3D MC , 4DEPL, and 4D MC dose calculation methods for the moving target plans are 95%, 95%, 94%, and 95% for reproducible motion, and 95%, 96%, 94%, and 93% for nonreproducible motion during actual treatment delivery. The overall measured target dose distributions are in better agreement with the 3D MC dose distributions than the 4D MC dose distributions. Conversely, measured dose distributions agree much better with the 4DEPL/MC than the 3DEPL/MC dose distributions in the static off-target structure, resulting in higher Pγ<1 values with 4DEPL/MC (91%) vs 3DEPL (24%) and 3D MC (25%). Systematic changes of target motion reduced the averaged Pγ<1 to 47% and 53% for 4DEPL and 4D MC dose calculations, and 22% for 3DEPL/MC dose calculations in the off-target films.Conclusions:
In robotic tracking SBRT, 4D treatment planning was found to yield better prediction of the dose distributions in the off-target structure, but not necessarily in the moving target, compared to standard 3D treatment planning, for reproducible and nonreproducible target motion. It is important to ensure on a patient-by-patient basis that the cumulative uncertainty associated with the 4D-CT artifacts, deformable image registration, and motion variability is significantly smaller than the cumulative uncertainty occurred in standard 3D planning in order to make 4D planning a justified option.
Feasibility of producing a short, high energy s-band linear accelerator using a klystron power source40(2013); http://dx.doi.org/10.1118/1.4794928View Description Hide DescriptionPurpose:
To use a finite-element method (FEM) model to study the feasibility of producing a short s-band (2.9985 GHz) waveguide capable of producing x-rays energies up to 10 MV, for applications in a linac-MR, as well as conventional radiotherapy.Methods:
An existing waveguide FEM model developed by the authors' group is used to simulate replacing the magnetron power source with a klystron. Peak fields within the waveguide are compared with a published experimental threshold for electric breakdown. The RF fields in the first accelerating cavity are scaled, approximating the effect of modifications to the first coupling cavity. Electron trajectories are calculated within the RF fields, and the energy spectrum, beam current, and focal spot of the electron beam are analyzed. One electron spectrum is selected for Monte Carlo simulations and the resulting PDD compared to measurement.Results:
When the first cavity fields are scaled by a factor of 0.475, the peak magnitude of the electric fields within the waveguide are calculated to be 223.1 MV/m, 29% lower than the published threshold for breakdown at this operating frequency. Maximum electron energy increased from 6.2 to 10.4 MeV, and beam current increased from 134 to 170 mA. The focal spot FWHM is decreased slightly from 0.07 to 0.05 mm, and the width of the energy spectrum increased slightly from 0.44 to 0.70 MeV. Monte Carlo results show dmax is at 2.15 cm for a 10 × 10 cm2 field, compared with 2.3 cm for a Varian 10 MV linac, while the penumbral widths are 4.8 and 5.6 mm, respectively.Conclusions:
The authors' simulation results show that a short, high-energy, s-band accelerator is feasible and electric breakdown is not expected to interfere with operation at these field strengths. With minor modifications to the first coupling cavity, all electron beam parameters are improved.
40(2013); http://dx.doi.org/10.1118/1.4795129View Description Hide DescriptionPurpose:
Recent developments in radiation therapy such as intensity modulated radiotherapy (IMRT) or dose painting promise to provide better dose distribution on the tumor. For effective application of these methods the exact positioning of the patient and the localization of the irradiated organ and surrounding structures is crucial. Especially with respect to the treatment of the prostate, ultrasound (US) allows for differentiation between soft tissue and was therefore applied by various repositioning systems, such as BAT or Clarity. The authors built a new system which uses 3D US at both sites, the CT room and the intervention room and applied a 3D/3D US/US registration for automatic repositioning.Methods:
In a first step the authors applied image preprocessing methods to prepare the US images for an optimal registration process. For the 3D/3D registration procedure five different metrics were evaluated. To find the image metric which fits best for a particular patient three 3D US images were taken at the CT site and registered to each other. From these results an US registration error was calculated. The most successful image metric was then applied for the US/US registration process. The success of the whole repositioning method was assessed by taking the results of an ExacTrac system as golden standard.Results:
The US/US registration error was found to be 2.99 ± 1.54 mm with respect to the mutual information metric by Mattes (eleven patients) which revealed to be the most suitable of the assessed metrics. For complete repositioning chain the error amounted to 4.15 ± 1.20 mm (ten patients).Conclusions:
The authors developed a system for patient repositioning which works automatically without the necessity of user interaction with an accuracy which seems to be suitable for clinical application.
Loss of local control due to tumor displacement as a function of margin size, dose–response slope, and number of fractions40(2013); http://dx.doi.org/10.1118/1.4795131View Description Hide DescriptionPurpose:
Geometric uncertainties are inevitable in radiotherapy. To account for these uncertainties, a margin is added to the clinical target volume (CTV) to create the planning target volume (PTV), and its size is critical for obtaining an optimal treatment plan. Dose-based (i.e., physical) margin recipes have been published and widely used, but it is important to consider fractionation and the radiobiological characteristics of the tumor when deriving margins. Hence a tumor control probability (TCP)-based margin is arguably more appropriate.Methods:
Margins required for ≤1% loss in mean population TCP (relative to a static tumor) for varying numbers of fractions, varying slope of the dose–response curve (γ50) and varying degrees of dose distribution conformity are investigated for spherical and four-field (4F)-brick dose distributions. To simulate geometric uncertainties, systematic (Σ) and random (σ) tumor displacements were sampled from Gaussian distributions and applied to each fraction for a spherical CTV. Interfraction tumor motion was simulated and the dose accumulated from fraction to fraction on a voxel-by-voxel basis to calculate TCP. PTV margins derived from this work for various fraction numbers and dose–response slopes (γ50) for different degrees of geometric uncertainties are compared with margins calculated using published physical-dose- and TCP-based recipes.Results:
Larger margins are required for a decrease in the number of fractions and for an increase in γ50 for both spherical and 4F-brick dose distributions. However, the margins can be close to zero for the 4F-brick distribution for small geometric uncertainties (Σ = 1, σ = 1 mm) irrespective of the number of fractions and the magnitude of γ50 due to the higher “incidental” dose outside the tumor. For Σ = 1 mm and σ = 3 mm, physical-dose-based recipes underestimate the margin only for the combination of hypofractionated treatments and tumors with a high γ50. For all other situations TCP-based margins are smaller than physical-dose-based recipes.Conclusions:
Margins depend on the number of fractions and γ50 in addition to Σ and σ. Dose conformity should also be considered since the required margin increases with increasing dose conformity. Ideally margins should be anisotropic and individualized, taking into account γ50, number of fractions, and the dose distribution, as well as estimates of Σ and σ. No single “recipe” can adequately account for all these variables.