Volume 41, Issue 5, May 2014
Index of content:
Practicing and aspiring medical physicists can safely disregard university rankings at no peril to them41(2014); http://dx.doi.org/10.1118/1.4866835View Description Hide Description
- VISION 20/20
Vision 20/20: The role of Raman spectroscopy in early stage cancer detection and feasibility for application in radiation therapy response assessment41(2014); http://dx.doi.org/10.1118/1.4870981View Description Hide Description
Raman spectroscopy is an optical technique capable of identifying chemical constituents of a sample by their unique set of molecular vibrations. Research on the applicability of Raman spectroscopy in the differentiation of cancerous versus normal tissues has been ongoing for many years, and has yielded successful results in the context of prostate, breast, brain, skin, and head and neck cancers as well as pediatric tumors. Recently, much effort has been invested on developing noninvasive “Raman” probes to provide real-time diagnosis of potentially cancerous tumors. In this regard, it is feasible that the Raman technique might one day be used to provide rapid, minimally invasive real-time diagnosis of tumors in patients. Raman spectroscopy is relatively new to the field of radiation therapy. Recent work involving cell lines has shown that the Raman technique is able to identify proteins and other markers affected by radiation therapy. Although this work is preliminary, one could ask whether or not the Raman technique might be used to identify molecular markers that predict radiation response. This paper provides a brief review of Raman spectroscopic investigations in cancer detection, benefits and limitations of this method, advances in instrument development, and also preliminary studies related to the application of this technology in radiation therapy response assessment.
- RADIATION THERAPY PHYSICS
Fast dose kernel interpolation using Fourier transform with application to permanent prostate brachytherapy dosimetry41(2014); http://dx.doi.org/10.1118/1.4870440View Description Hide DescriptionPurpose:
Boyer and Mok proposed a fast calculation method employing the Fourier transform (FT), for which calculation time is independent of the number of seeds but seed placement is restricted to calculation grid points. Here an interpolation method is described enabling unrestricted seed placement while preserving the computational efficiency of the original method.Methods:
The Iodine-125 seed dose kernel was sampled and selected values were modified to optimize interpolation accuracy for clinically relevant doses. For each seed, the kernel was shifted to the nearest grid point via convolution with a unit impulse, implemented in the Fourier domain. The remaining fractional shift was performed using a piecewise third-order Lagrange filter.Results:
Implementation of the interpolation method greatly improved FT-based dose calculation accuracy. The dose distribution was accurate to within 2% beyond 3 mm from each seed. Isodose contours were indistinguishable from explicit TG-43 calculation. Dose-volume metric errors were negligible. Computation time for the FT interpolation method was essentially the same as Boyer's method.Conclusions:
A FT interpolation method for permanent prostate brachytherapy TG-43 dose calculation was developed which expands upon Boyer's original method and enables unrestricted seed placement. The proposed method substantially improves the clinically relevant dose accuracy with negligible additional computation cost, preserving the efficiency of the original method.
Out-of-field organ doses and associated radiogenic risks from para-aortic radiotherapy for testicular seminoma41(2014); http://dx.doi.org/10.1118/1.4870376View Description Hide DescriptionPurpose:
The aims of this study were to (a) calculate the radiation dose to out-of-field organs from radiotherapy for stage I testicular seminoma and (b) estimate the associated radiogenic risks.Methods:
Monte Carlo methodology was employed to model radiation therapy with typical anteroposterior and posteroanterior para-aortic fields on an anthropomorphic phantom simulating an average adult. The radiation dose received by all main and remaining organs that defined by the ICRP publication 103 and excluded from the treatment volume was calculated. The effect of field dimensions on each organ dose was determined. Additional therapy simulations were generated by introducing shielding blocks to protect the kidneys from primary radiation. The gonadal dose was employed to assess the risk of heritable effects for irradiated male patients of reproductive potential. The lifetime attributable risks (LAR) of radiotherapy-induced cancer were estimated using gender- and organ-specific risk coefficients for patient ages of 20, 30, 40, and 50 years old. The risk values were compared with the respective nominal risks.Results:
Para-aortic irradiation to 20 Gy resulted in out-of-field organ doses of 5.0–538.6 mGy. Blocked field treatment led to a dose change up to 28%. The mean organ dose variation by increasing or decreasing the applied field dimensions was 18.7% ± 3.9% and 20.8% ± 4.5%, respectively. The out-of-field photon doses increased the lifetime intrinsic risk of developing thyroid, lung, bladder, prostate, and esophageal cancer by (0.1–1.4)%, (0.4–1.1)%, (2.5–5.4)%, (0.2–0.4)%, and (6.4–9.2)%, respectively, depending upon the patient age at exposure and the field size employed. A low risk for heritable effects of less than 0.029% was found compared with the natural incidence of these defects.Conclusions:
Testicular cancer survivors are subjected to an increased risk for the induction of bladder and esophageal cancer following para-aortic radiotherapy. The probability for the appearance of any other malignant disease to out-of-field organs was slightly elevated in respect to the nominal cancer incidence rates.
41(2014); http://dx.doi.org/10.1118/1.4870441View Description Hide DescriptionPurpose:
To present a novel needle, catheter, and radiation source system for interstitial rotating shield brachytherapy (I-RSBT) of the prostate. I-RSBT is a promising technique for reducing urethra, rectum, and bladder dose relative to conventional interstitial high-dose-rate brachytherapy (HDR-BT).Methods:
A wire-mounted 62 GBq153Gd source is proposed with an encapsulated diameter of 0.59 mm, active diameter of 0.44 mm, and active length of 10 mm. A concept model I-RSBT needle/catheter pair was constructed using concentric 50 and 75 μm thick nickel-titanium alloy (nitinol) tubes. The needle is 16-gauge (1.651 mm) in outer diameter and the catheter contains a 535 μm thick platinum shield. I-RSBT and conventional HDR-BT treatment plans for a prostate cancer patient were generated based on Monte Carlo dose calculations. In order to minimize urethral dose, urethral dose gradient volumes within 0–5 mm of the urethra surface were allowed to receive doses less than the prescribed dose of 100%.Results:
The platinum shield reduced the dose rate on the shielded side of the source at 1 cm off-axis to 6.4% of the dose rate on the unshielded side. For the case considered, for the same minimum dose to the hottest 98% of the clinical target volume (D 98%), I-RSBT reduced urethral D 0.1cc below that of conventional HDR-BT by 29%, 33%, 38%, and 44% for urethral dose gradient volumes within 0, 1, 3, and 5 mm of the urethra surface, respectively. Percentages are expressed relative to the prescription dose of 100%. For the case considered, for the same urethral dose gradient volumes, rectum D 1cc was reduced by 7%, 6%, 6%, and 6%, respectively, and bladder D 1cc was reduced by 4%, 5%, 5%, and 6%, respectively. Treatment time to deliver 20 Gy with I-RSBT was 154 min with ten 62 GBq 153Gd sources.Conclusions:
For the case considered, the proposed153Gd-based I-RSBT system has the potential to lower the urethral dose relative to HDR-BT by 29%–44% if the clinician allows a urethral dose gradient volume of 0–5 mm around the urethra to receive a dose below the prescription. A multisource approach is necessary in order to deliver the proposed 153Gd-based I-RSBT technique in reasonable treatment times.
Characterization of a two-dimensional liquid-filled ion chamber detector array used for verification of the treatments in radiotherapy41(2014); http://dx.doi.org/10.1118/1.4870439View Description Hide DescriptionPurpose:
The purpose of the study is to investigate the characteristics of a two-dimensional (2D) liquid-filled ion chamber detector array, which is used for the verification of radiotherapy treatment plans that use small field sizes of up to 10 × 10 cm.Methods:
The device used in this study was Octavius 1000 SRS model (PTW, Freiburg, Germany). Its 2D array of detectors consists of 977 liquid-filled ion chambers arranged over an area of 11 × 11 cm. The size of the detectors is 2.3 × 2.3 × 0.5 mm (volume of 0.003 cm3) and their spacing in the inner area of 5.5 × 5.5 cm is 2.5 mm center-to-center, whereas in the outer area it is 5 mm center-to-center. The detector reproducibility, dose linearity, and sensitivity to positional changes of the collimator were tested. Also, the output factors of field sizes ranging from 0.5 × 0.5 to 10 × 10 cm2 both for open and wedged fields have been measured and compared against those measured by a pin-point ionization chamber, liquid filled microchamber, SRS diode, and EDR2 film.Results:
Its short-term reproducibility was within 0.2% and its medium and long-term reproducibility was within 0.5% (verified with air ionization chamber absolute dose measurements), which is an excellent result taking into account the daily fluctuation of the linear accelerator and the errors in the device setup reproducibility. The dose linearity and dose rate dependence were measured in the range of 0.5–85 Gy and 0.5–10 Gy min−1, respectively, and were verified with air ionization chamber absolute dose measurements was within 3%. The measurements of the sensitivity showed that the 2D Array could detect millimetric collimator positional changes. The measured output factors showed an agreement of better than 0.3% with the pinpoint chamber and microliquid filled chamber for the field sizes between 3 × 3 and 10 × 10 cm2. For field sizes down to 1 × 1 cm2, the agreement with SRS diode and microliquid filled chamber is better than 2%. The measurements of open and wedge-modulated field profiles were compared to the film and ionization chamber in water measurements.Conclusions:
The Octavius Detector 1000 SRS is an accurate, precise, and reliable detector, very useful for the daily performance of the patient specific quality assurance of radiotherapy treatment plans.
Predicting oropharyngeal tumor volume throughout the course of radiation therapy from pretreatment computed tomography data using general linear models41(2014); http://dx.doi.org/10.1118/1.4870437View Description Hide DescriptionPurpose:
The purpose of this work was to develop and evaluate the accuracy of several predictive models of variation in tumor volume throughout the course of radiation therapy.Methods:
Nineteen patients with oropharyngeal cancers were imaged daily with CT-on-rails for image-guided alignment per an institutional protocol. The daily volumes of 35 tumors in these 19 patients were determined and used to generate (1) a linear model in which tumor volume changed at a constant rate, (2) a general linear model that utilized the power fit relationship between the daily and initial tumor volumes, and (3) a functional general linear model that identified and exploited the primary modes of variation between time series describing the changing tumor volumes. Primary and nodal tumor volumes were examined separately. The accuracy of these models in predicting daily tumor volumes were compared with those of static and linear reference models using leave-one-out cross-validation.Results:
In predicting the daily volume of primary tumors, the general linear model and the functional general linear model were more accurate than the static reference model by 9.9% (range: −11.6%–23.8%) and 14.6% (range: −7.3%–27.5%), respectively, and were more accurate than the linear reference model by 14.2% (range: −6.8%–40.3%) and 13.1% (range: −1.5%–52.5%), respectively. In predicting the daily volume of nodal tumors, only the 14.4% (range: −11.1%–20.5%) improvement in accuracy of the functional general linear model compared to the static reference model was statistically significant.Conclusions:
A general linear model and a functional general linear model trained on data from a small population of patients can predict the primary tumor volume throughout the course of radiation therapy with greater accuracy than standard reference models. These more accurate models may increase the prognostic value of information about the tumor garnered from pretreatment computed tomography images and facilitate improved treatment management.
Increasing dose gradient and uniformity in small fields using modulation: Theory and prototypes for cone-based stereotactic radiosurgery41(2014); http://dx.doi.org/10.1118/1.4870380View Description Hide DescriptionPurpose:
To investigate the theoretical limits to the tradeoff between dose gradient and uniformity when modulation is used in the context of cone based SRS, and to design a prototype collimation device that allows for steeper dose gradients and/or higher target uniformity as compared to a standard circular collimator.Methods:
An inverse planning optimization is performed in the context of idealized phantom geometry to determine the ideal fluence pattern that best approximates a “rect function” dose distribution. Ideal fluence patterns were approximated in a prototype device and radiochromic film dosimetry was utilized to compare the prototype device to a standard circular collimator.Results:
For choices of prescription isodose lines above approximately 50%, utilizing modulation allows for an improved tradeoff between dose gradient index and dose heterogeneity index. Compensators placed within the circular collimator can achieve the necessary modulation.Conclusions:
Using modulation with features on a submillimeter distance scale, it is possible to increase the dose gradient and/or uniformity in small fields.
Monte Carlo simulation of TrueBeam flattening-filter-free beams using Varian phase-space files: Comparison with experimental data41(2014); http://dx.doi.org/10.1118/1.4871041View Description Hide DescriptionPurpose:
Phase-space files for Monte Carlo simulation of the Varian TrueBeam beams have been made available by Varian. The aim of this study is to evaluate the accuracy of the distributed phase-space files for flattening filter free (FFF) beams, against experimental measurements from ten TrueBeam Linacs.Methods:
The phase-space files have been used as input in PRIMO, a recently released Monte Carlo program based on thePENELOPE code. Simulations of 6 and 10 MV FFF were computed in a virtual water phantom for field sizes 3 × 3, 6 × 6, and 10 × 10 cm2 using 1 × 1 × 1 mm3 voxels and for 20 × 20 and 40 × 40 cm2 with 2 × 2 × 2 mm3 voxels. The particles contained in the initial phase-space files were transported downstream to a plane just above the phantom surface, where a subsequent phase-space file was tallied. Particles were transported downstream this second phase-space file to the water phantom. Experimental data consisted of depth doses and profiles at five different depths acquired at SSD = 100 cm (seven datasets) and SSD = 90 cm (three datasets). Simulations and experimental data were compared in terms of dose difference. Gamma analysis was also performed using 1%, 1 mm and 2%, 2 mm criteria of dose-difference and distance-to-agreement, respectively. Additionally, the parameters characterizing the dose profiles of unflattened beams were evaluated for both measurements and simulations.Results:
Analysis of depth dose curves showed that dose differences increased with increasing field size and depth; this effect might be partly motivated due to an underestimation of the primary beam energy used to compute the phase-space files. Average dose differences reached 1% for the largest field size. Lateral profiles presented dose differences well within 1% for fields up to 20 × 20 cm2, while the discrepancy increased toward 2% in the 40 × 40 cm2 cases. Gamma analysis resulted in an agreement of 100% when a 2%, 2 mm criterion was used, with the only exception of the 40 × 40 cm2 field (∼95% agreement). With the more stringent criteria of 1%, 1 mm, the agreement reduced to almost 95% for field sizes up to 10 × 10 cm2, worse for larger fields. Unflatness and slope FFF-specific parameters are in line with the possible energy underestimation of the simulated results relative to experimental data.Conclusions:
The agreement between Monte Carlo simulations and experimental data proved that the evaluated Varian phase-space files for FFF beams from TrueBeam can be used as radiation sources for accurate Monte Carlo dose estimation, especially for field sizes up to 10 × 10 cm2, that is the range of field sizes mostly used in combination to the FFF, high dose rate beams.
- RADIATION IMAGING PHYSICS
Evaluation of dual energy quantitative CT for determining the spatial distributions of red marrow and bone for dosimetry in internal emitter radiation therapy41(2014); http://dx.doi.org/10.1118/1.4870378View Description Hide DescriptionPurpose:
To evaluate a three-equation three-unknown dual-energy quantitative CT (DEQCT) technique for determining region specific variations in bone spongiosa composition for improved red marrow dose estimation in radionuclide therapy.Methods:
The DEQCT method was applied to 80/140 kVp images of patient-simulating lumbar sectional body phantoms of three sizes (small, medium, and large). External calibration rods of bone, red marrow, and fat-simulating materials were placed beneath the body phantoms. Similar internal calibration inserts were placed at vertebral locations within the body phantoms. Six test inserts of known volume fractions of bone, fat, and red marrow were also scanned. External-to-internal calibration correction factors were derived. The effects of body phantom size, radiation dose, spongiosa region segmentation granularity [single (∼17 × 17 mm) region of interest (ROI), 2 × 2, and 3 × 3 segmentation of that single ROI], and calibration method on the accuracy of the calculated volume fractions of red marrow (cellularity) and trabecular bone were evaluated.Results:
For standard low dose DEQCT x-ray technique factors and the internal calibration method, the RMS errors of the estimated volume fractions of red marrow of the test inserts were 1.2–1.3 times greater in the medium body than in the small body phantom and 1.3–1.5 times greater in the large body than in the small body phantom. RMS errors of the calculated volume fractions of red marrow within 2 × 2 segmented subregions of the ROIs were 1.6–1.9 times greater than for no segmentation, and RMS errors for 3 × 3 segmented subregions were 2.3–2.7 times greater than those for no segmentation. Increasing the dose by a factor of 2 reduced the RMS errors of all constituent volume fractions by an average factor of 1.40 ± 0.29 for all segmentation schemes and body phantom sizes; increasing the dose by a factor of 4 reduced those RMS errors by an average factor of 1.71 ± 0.25. Results for external calibrations exhibited much larger RMS errors than size matched internal calibration. Use of an average body size external-to-internal calibration correction factor reduced the errors to closer to those for internal calibration. RMS errors of less than 30% or about 0.01 for the bone and 0.1 for the red marrow volume fractions would likely be satisfactory for human studies. Such accuracies were achieved for 3 × 3 segmentation of 5 mm slice images for: (a) internal calibration with 4 times dose for all size body phantoms, (b) internal calibration with 2 times dose for the small and medium size body phantoms, and (c) corrected external calibration with 4 times dose and all size body phantoms.Conclusions:
Phantom studies are promising and demonstrate the potential to use dual energy quantitative CT to estimate the spatial distributions of red marrow and bone within the vertebral spongiosa.
41(2014); http://dx.doi.org/10.1118/1.4870379View Description Hide DescriptionPurpose:
The Digital Database for Screening Mammography (DDSM) is the largest publicly available resource for mammographic image analysis research and has been used extensively in the past for computer assisted diagnosis (CADx) studies. However, the database has not been searchable for a specific kind of lesion, which rendered the case selection process in past studies oftentimes arbitrary. Therefore, the authors want to provide the complete metadata of the DDSM in an accessible format.Methods:
The authors semiautomatically transformed the data available athttp://marathon.csee.usf.edu/Mammography/Database.html into table format. The 1769 cases (914 from cancer volumes, 855 from benign volumes) comprise 1220 mass lesions (578 benign, 642 malignant) and 859 calcifications (433 benign, 426 malignant). Additionally, 694 normal cases were processed to allow for matching according to age and breast density.Results:
The authors provide the entire DDSM metadata (for benign, malignant, and normal cases) as tab-delimited text files[see supplementary material at http://dx.doi.org/10.1118/1.4870379 E-MPHYA6-41-006405 for DDSM metadata].Conclusions:
The data provided make the case selection for future studies using the DDSM reproducible. Furthermore, it may serve as a validation dataset for CADx approaches using the BI-RADS lexicon.
41(2014); http://dx.doi.org/10.1118/1.4870955View Description Hide DescriptionPurpose:
In this paper, the authors present a free software for assisting users in achieving the physical characterization of x-ray digital systems and image quality checks.Methods:
The program was developed as a plugin of a well-known public-domain suite ImageJ. The software can assist users in calculating various physical parameters such as the response curve (also termed signal transfer property), modulation transfer function (MTF), noise power spectra (NPS), and detective quantum efficiency (DQE). It also includes the computation of some image quality checks: defective pixel analysis, uniformity, dark analysis, and lag.Results:
The software was made available in 2009 and has been used during the last couple of years by many users who gave us valuable feedback for improving its usability. It was tested for achieving the physical characterization of several clinical systems for digital radiography and mammography. Various published papers made use of the outcomes of the plugin.Conclusions:
This software is potentially beneficial to a variety of users: physicists working in hospitals, staff working in radiological departments, such as medical physicists, physicians, engineers. The plugin, together with a brief user manual, are freely available and can be found online (www.medphys.it/downloads.htm). With our plugin users can estimate all three most important parameters used for physical characterization (MTF, NPS, and also DQE). The plugin can run on any operating system equipped with ImageJ suite. The authors validated the software by comparing MTF and NPS curves on a common set of images with those obtained with other dedicated programs, achieving a very good agreement.
41(2014); http://dx.doi.org/10.1118/1.4870959View Description Hide DescriptionPurpose:
Content-based image retrieval aims to assist radiologists by presenting example images with known pathology that are visually similar to the case being evaluated. In this work, the authors investigate several fundamental issues underlying the similarity ratings between pairs of microcalcification (MC) lesions on mammograms as judged by radiologists: the degree of variability in the similarity ratings, the impact of this variability on agreement between readers in retrieval of similar lesions, and the factors contributing to the readers’ similarity ratings.Methods:
The authors conduct a reader study on a set of 1000 image pairs of MC lesions, in which a group of experienced breast radiologists rated the degree of similarity between each image pair. The image pairs are selected, from among possible pairings of 222 cases (110 malignant, 112 benign), based on quantitative image attributes (features) and the results of a preliminary reader study. Next, the authors apply analysis of variance (ANOVA) to quantify the level of variability in the readers’ similarity ratings, and study how the variability in individual reader ratings affects consistency between readers. The authors also measure the extent to which readers agree on images which are most similar to a given query, for which the Dice coefficient is used. To investigate how the similarity ratings potentially relate to the attributes underlying the cases, the authors study the fraction of perceptually similar images that also share the same benign or malignant pathology as the query image; moreover, the authors apply multidimensional scaling (MDS) to embed the cases according to their mutual perceptual similarity in a two-dimensional plot, which allows the authors to examine the manner in which similar lesions relate to one another in terms of benign or malignant pathology and clustered MCs.Results:
The ANOVA results show that the coefficient of determination in the reader similarity ratings is 0.59. The variability level in the similarity ratings is proved to be a limiting factor, leading to only moderate correlation between the readers in their readings. The Dice coefficient, measuring agreement between readers in retrieval of similar images, can vary from 0.45 to 0.64 with different levels of similarity for individual readers, but is higher for average ratings from a group of readers (from 0.59 to 0.78). More importantly, the fraction of retrieved cases that match the benign or malignant pathology of the query image was found to increase with the degree of similarity among the retrieved images, reaching average value as high as 0.69 for the radiologists (p-value <10−4 compared to random guessing). Moreover, MDS embedding of all the cases shows that cases having the same pathology tend to cluster together, and that neighboring cases in the plot tend to be similar in their clustered MCs.Conclusions:
While individual readers exhibit substantial variability in their similarity ratings, similarity ratings averaged from a group of readers can achieve a high level of intergroup consistency and agreement in retrieval of similar images. More importantly, perceptually similar cases are also likely to be similar in their underlying benign or malignant pathology and image features of clustered MCs, which could be of diagnostic value in computer-aided diagnosis for lesions with clustered MCs.
Assessment of contrast enhanced respiration managed cone-beam CT for image guided radiotherapy of intrahepatic tumors41(2014); http://dx.doi.org/10.1118/1.4870385View Description Hide DescriptionPurpose:
Contrast enhancement and respiration management are widely used during image acquisition for radiotherapy treatment planning of liver tumors along with respiration management at the treatment unit. However, neither respiration management nor intravenous contrast is commonly used during cone-beam CT (CBCT) image acquisition for alignment prior to radiotherapy. In this study, the authors investigate the potential gains of injecting an iodinated contrast agent in combination with respiration management during CBCT acquisition for liver tumor radiotherapy.Methods:
Five rabbits with implanted liver tumors were subjected to CBCT with and without motion management and contrast injection. The acquired CBCT images were registered to the planning CT to determine alignment accuracy and dosimetric impact. The authors developed a simulation tool for simulating contrast-enhanced CBCT images from dynamic contrast enhanced CT imaging (DCE-CT) to determine optimal contrast injection protocols. The tool was validated against contrast-enhanced CBCT of the rabbit subjects and was used for five human patients diagnosed with hepatocellular carcinoma.Results:
In the rabbit experiment, when neither motion management nor contrast was used, tumor centroid misalignment between planning image and CBCT was 9.2 mm. This was reduced to 2.8 mm when both techniques were employed. Tumors were not visualized in clinical CBCT images of human subjects. Simulated contrast-enhanced CBCT was found to improve tumor contrast in all subjects. Different patients were found to require different contrast injections to maximize tumor contrast.Conclusions:
Based on the authors’ animal study, respiration managed contrast enhanced CBCT improves IGRT significantly. Contrast enhanced CBCT benefits from patient specific tracer kinetics determined from DCE-CT.
- RADIATION MEASUREMENT PHYSICS
41(2014); http://dx.doi.org/10.1118/1.4870387View Description Hide DescriptionPurpose:
The absolute dose rate of the Imaging and Medical Beamline (IMBL) on the Australian Synchrotron was measured with a graphite calorimeter. The calorimetry results were compared to measurements from the existing free-air chamber, to provide a robust determination of the absolute dose in the synchrotron beam and provide confidence in the first implementation of a graphite calorimeter on a synchrotron medical beam line.Methods:
The graphite calorimeter has a core which rises in temperature when irradiated by the beam. A collimated x-ray beam from the synchrotron with well-defined edges was used to partially irradiate the core. Two filtration sets were used, one corresponding to an average beam energy of about 80 keV, with dose rate about 50 Gy/s, and the second filtration set corresponding to average beam energy of 90 keV, with dose rate about 20 Gy/s. The temperature rise from this beam was measured by a calibrated thermistor embedded in the core which was then converted to absorbed dose to graphite by multiplying the rise in temperature by the specific heat capacity for graphite and the ratio of cross-sectional areas of the core and beam. Conversion of the measured absorbed dose to graphite to absorbed dose to water was achieved using Monte Carlo calculations with the EGSnrc code. The air kerma measurements from the free-air chamber were converted to absorbed dose to water using the AAPM TG-61 protocol.Results:
Absolute measurements of the IMBL dose rate were made using the graphite calorimeter and compared to measurements with the free-air chamber. The measurements were at three different depths in graphite and two different filtrations. The calorimetry measurements at depths in graphite show agreement within 1% with free-air chamber measurements, when converted to absorbed dose to water. The calorimetry at the surface and free-air chamber results show agreement of order 3% when converted to absorbed dose to water. The combined standard uncertainty is 3.9%.Conclusions:
The good agreement of the graphite calorimeter and free-air chamber results indicates that both devices are performing as expected. Further investigations at higher dose rates than 50 Gy/s are planned. At higher dose rates, recombination effects for the free-air chamber are much higher and expected to lead to much larger uncertainties. Since the graphite calorimeter does not have problems associated with dose rate, it is an appropriate primary standard detector for the synchrotron IMBL x rays and is the more accurate dosimeter for the higher dose rates expected in radiotherapy applications.
Adaptive error detection for HDR/PDR brachytherapy: Guidance for decision making during real-time in vivo point dosimetry41(2014); http://dx.doi.org/10.1118/1.4870438View Description Hide DescriptionPurpose:
This study presents an adaptive error detection algorithm (AEDA) for real-timein vivo point dosimetry during high dose rate (HDR) or pulsed dose rate (PDR) brachytherapy (BT) where the error identification, in contrast to existing approaches, does not depend on an a priori reconstruction of the dosimeter position. Instead, the treatment is judged based on dose rate comparisons between measurements and calculations of the most viable dosimeter position provided by the AEDA in a data driven approach. As a result, the AEDA compensates for false error cases related to systematic effects of the dosimeter position reconstruction. Given its nearly exclusive dependence on stable dosimeter positioning, the AEDA allows for a substantially simplified and time efficient real-time in vivo BT dosimetry implementation.Methods:
In the event of a measured potential treatment error, the AEDA proposes the most viable dosimeter position out of alternatives to the original reconstruction by means of a data driven matching procedure between dose rate distributions. If measured dose rates do not differ significantly from the most viable alternative, the initial error indication may be attributed to a mispositioned or misreconstructed dosimeter (false error). However, if the error declaration persists, no viable dosimeter position can be found to explain the error, hence the discrepancy is more likely to originate from a misplaced or misreconstructed source applicator or from erroneously connected source guide tubes (true error).Results:
The AEDA applied on twoin vivo dosimetry implementations for pulsed dose rate BT demonstrated that the AEDA correctly described effects responsible for initial error indications. The AEDA was able to correctly identify the major part of all permutations of simulated guide tube swap errors and simulated shifts of individual needles from the original reconstruction. Unidentified errors corresponded to scenarios where the dosimeter position was sufficiently symmetric with respect to error and no-error source position constellations. The AEDA was able to correctly identify all false errors represented by mispositioned dosimeters contrary to an error detection algorithm relying on the original reconstruction.Conclusions:
The study demonstrates that the AEDA error identification during HDR/PDR BT relies on a stable dosimeter position rather than on an accurate dosimeter reconstruction, and the AEDA’s capacity to distinguish between true and false error scenarios. The study further shows that the AEDA can offer guidance in decision making in the event of potential errors detected with real-timein vivo point dosimetry.
- MAGNETIC RESONANCE PHYSICS
The effects of magnetic field distortion on the accuracy of passive device localization frames in MR imaging41(2014); http://dx.doi.org/10.1118/1.4870961View Description Hide DescriptionPurpose:
The interventional magnetic resonance (MR) imaging environment presents many challenges for the accurate localization of interventional devices. In particular, geometric distortion of the static magnetic field may be both appreciable and unpredictable. This paper aims to quantify the sensitivity of localization error of various passive device localization frames to static magnetic field distortion in MR.Methods:
Three localization frames were considered based on having distinctly different methods of encoding position and orientation in MR images. For each frame, the effects of static field distortion were modeled, allowing rotational and translational errors to be computed as functions of the level of distortion, which was modeled using a first order approximation. Validation of the model was performed by imaging the localization frames in a 3T clinical MR scanner, and simulating the effects of static field distortion by varying the scanner's center frequency and gradient shim values.Results:
Plots of the rotational and translational components of error in localization frame position and orientation estimates are provided for ranges of uniform static field distortions of 1–100μT and static field distortion gradients of 0.01–1 mT/m in all three directions. The theoretical estimates are in good agreement with the results obtained by imaging.Conclusions:
The error in position and orientation estimation of passive localization frames in MR can be sensitive to static magnetic field distortions. The level of sensitivity, the type of error (i.e., rotational or translational), and the direction of error are dependent on the frame's design and the method used to image it. If 2D gradient echo imaging is employed, frames with position and orientation estimate sensitivity to slice-select error (such as the z-frame) should be avoided, since this source of error is not easily correctable. Accurate frame position and orientation estimates that are insensitive to static field distortion can be achieved using 2D gradient echo imaging if: (a) the method of determining position and orientation only uses in-plane measurements of marker positions, (b) the in-plane marker positions in images are not sensitive to slice-select error, and (c) methods of correcting in-plane error in the frequency-encoded direction are employed.
- NUCLEAR MEDICINE PHYSICS
41(2014); http://dx.doi.org/10.1118/1.4870382View Description Hide DescriptionPurpose:
Lipoma arborescens (LA) is a benign intra-articular lipomatous proliferation of the synovial membrane. This extremely rare condition has previously been treated by intra-articular90Y radiosynoviorthesis but dosimetry literature on this form of radionuclide therapy is nonexistent. The authors detail methodology for successful treatment of LA and provide for the first time estimates of radiation dosimetry. The authors also analyze the biodistribution of the radiopharmaceutical over the course of the patient's treatment through sequential imaging.Methods:
A patient with bilateral LA underwent intracavity injection of90Y citrate colloid to the right and left knee joint spaces (181 and 198 MBq, respectively). SPECT/CT datasets were acquired over 9 days to quantify the biodistribution and kinetics of the radiopharmaceutical. Radiation dosimetry was performed using the MIRD schema (through OLINDA software), a custom voxel-based method, and a direct Monte Carlo calculation (OEDIPE).Results:
Follow-up MRI showed marked reduction in LA size in both knees. Mean absorbed doses to the LA were 21.2 ± 0.8 and 42.9 ± 2.3 Gy using OLINDA, 8.1 ± 0.3 and 16.7 ± 0.5 Gy using voxel based methodology, and 8.2 ± 0.3 and 15.7 ± 0.5 Gy for OEDIPE in the right and left LA, respectively. Distribution of the radiopharmaceutical within the joint space alters over the imaging period, with less than 1% of the remaining activity having moved posteriorly in the knee cavity. No uptake was detected outside of the joint space after assessment with whole-body scintigraphy.Conclusions:
An activity of approximately 185 MBq successfully relieved clinical symptoms of LA. There was good correlation between direct Monte Carlo and voxel based techniques, but OLINDA was shown to overestimate the absorbed dose to the tumor. Accurate dosimetry may help select an activity more tailored to the specific size and location of the LA.
Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies41(2014); http://dx.doi.org/10.1118/1.4870979View Description Hide DescriptionPurpose:
Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine.Methods:
One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method.Results:
Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect.Conclusions:
The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.
41(2014); http://dx.doi.org/10.1118/1.4870985View Description Hide DescriptionPurpose:
Measuring and incorporating a scanner-specific point spread function (PSF) within image reconstruction has been shown to improve spatial resolution in PET. However, due to the short half-life of clinically used isotopes, other long-lived isotopes not used in clinical practice are used to perform the PSF measurements. As such, non-optimal PSF models that do not correspond to those needed for the data to be reconstructed are used within resolution modeling (RM) image reconstruction, usually underestimating the true PSF owing to the difference in positron range. In high resolution brain and preclinical imaging, this effect is of particular importance since the PSFs become more positron range limited and isotope-specific PSFs can help maximize the performance benefit from using resolution recovery image reconstruction algorithms.Methods:
In this work, the authors used a printing technique to simultaneously measure multiple point sources on the High Resolution Research Tomograph (HRRT), and the authors demonstrated the feasibility of deriving isotope-dependent system matrices from fluorine-18 and carbon-11 point sources. Furthermore, the authors evaluated the impact of incorporating them within RM image reconstruction, using carbon-11 phantom and clinical datasets on the HRRT.Results:
The results obtained using these two isotopes illustrate that even small differences in positron range can result in different PSF maps, leading to further improvements in contrast recovery when used in image reconstruction. The difference is more pronounced in the centre of the field-of-view where the full width at half maximum (FWHM) from the positron range has a larger contribution to the overall FWHM compared to the edge where the parallax error dominates the overall FWHM.Conclusions:
Based on the proposed methodology, measured isotope-specific and spatially variant PSFs can be reliably derived and used for improved spatial resolution and variance performance in resolution recovery image reconstruction. The benefits are expected to be more substantial for more energetic positron emitting isotopes such as Oxygen-15 and Rubidium-82.