Index of content:
Volume 42, Issue 11, November 2015
42(2015); http://dx.doi.org/10.1118/1.4929980View Description Hide Description
- RADIATION THERAPY PHYSICS
Technical Note: Motion-perturbation method applied to dosimetry of dynamic MLC target tracking—A proof-of-concept42(2015); http://dx.doi.org/10.1118/1.4931605View Description Hide DescriptionPurpose:
Previous studies show that dose to a moving target can be estimated using 4D measurement-guided dose reconstruction based on a process called virtual motion simulation, or VMS. A potential extension of VMS is to estimate dose during dynamic multileaf collimator (MLC)-tracking treatments. The authors introduce a modified VMS method and quantify its performance as proof-of-concept for tracking applications.Methods:
Direct measurements with a moving biplanar diode array were used to verify accuracy of the VMS dose estimates. A tracking environment for variably sized circular MLC apertures was simulated by sending preprogrammed control points to the MLC while simultaneously moving the accelerator treatment table. Sensitivity of the method to simulated tracking latency (0–700 ms) was also studied. Potential applicability of VMS to fast changing beam apertures was evaluated by modeling, based on the demonstrated dependence of the cumulative dose on the temporal dose gradient.Results:
When physical and virtual latencies were matched, the agreement rates (2% global/2 mm gamma) between the VMS and the biplanar dosimeter were above 96%. When compared to their own reference dose (0 induced latency), the agreement rates for VMS and biplanar array track closely up to 200 ms of induced latency with 10% low-dose cutoff threshold and 300 ms with 50% cutoff. Time-resolved measurements suggest that even in the modulated beams, the error in the cumulative dose introduced by the 200 ms VMS time resolution is not likely to exceed 0.5%.Conclusions:
Based on current results and prior benchmarks of VMS accuracy, the authors postulate that this approach should be applicable to any MLC-tracking treatments where leaf speeds do not exceed those of the current Varian accelerators.
Optimization of the fractionated irradiation scheme considering physical doses to tumor and organ at risk based on dose–volume histograms42(2015); http://dx.doi.org/10.1118/1.4931969View Description Hide DescriptionPurpose:
Radiotherapy of solid tumors has been performed with various fractionation regimens such as multi- and hypofractionations. However, the ability to optimize the fractionation regimen considering the physical dose distribution remains insufficient. This study aims to optimize the fractionation regimen, in which the authors propose a graphical method for selecting the optimal number of fractions (n) and dose per fraction (d) based on dose–volume histograms for tumor and normal tissues of organs around the tumor.Methods:
Modified linear-quadratic models were employed to estimate the radiation effects on the tumor and an organ at risk (OAR), where the repopulation of the tumor cells and the linearity of the dose-response curve in the high dose range of the surviving fraction were considered. The minimization problem for the damage effect on the OAR was solved under the constraint that the radiation effect on the tumor is fixed by a graphical method. Here, the damage effect on the OAR was estimated based on the dose–volume histogram.Results:
It was found that the optimization of fractionation scheme incorporating the dose–volume histogram is possible by employing appropriate cell surviving models. The graphical method considering the repopulation of tumor cells and a rectilinear response in the high dose range enables them to derive the optimal number of fractions and dose per fraction. For example, in the treatment of prostate cancer, the optimal fractionation was suggested to lie in the range of 8–32 fractions with a daily dose of 2.2–6.3 Gy.Conclusions:
It is possible to optimize the number of fractions and dose per fraction based on the physical dose distribution (i.e., dose–volume histogram) by the graphical method considering the effects on tumor and OARs around the tumor. This method may stipulate a new guideline to optimize the fractionation regimen for physics-guided fractionation.
Analysis of the track- and dose-averaged LET and LET spectra in proton therapy using the geant4 Monte Carlo code42(2015); http://dx.doi.org/10.1118/1.4932217View Description Hide DescriptionPurpose:
The motivation of this study was to find and eliminate the cause of errors in dose-averaged linear energy transfer (LET) calculations from therapeutic protons in small targets, such as biological cell layers, calculated using the geant 4 Monte Carlo code. Furthermore, the purpose was also to provide a recommendation to select an appropriate LET quantity from geant 4 simulations to correlate with biological effectiveness of therapeutic protons.Methods:
The authors developed a particle tracking step based strategy to calculate the average LET quantities (track-averaged LET, LET t and dose-averaged LET, LET d ) using geant 4 for different tracking step size limits. A step size limit refers to the maximally allowable tracking step length. The authors investigated how the tracking step size limit influenced the calculated LET t and LET d of protons with six different step limits ranging from 1 to 500 μm in a water phantom irradiated by a 79.7-MeV clinical proton beam. In addition, the authors analyzed the detailed stochastic energy deposition information including fluence spectra and dose spectra of the energy-deposition-per-step of protons. As a reference, the authors also calculated the averaged LET and analyzed the LET spectra combining the Monte Carlo method and the deterministic method. Relative biological effectiveness (RBE) calculations were performed to illustrate the impact of different LET calculation methods on the RBE-weighted dose.Results:
Simulation results showed that the step limit effect was small for LET t but significant for LET d . This resulted from differences in the energy-deposition-per-step between the fluence spectra and dose spectra at different depths in the phantom. Using the Monte Carlo particle tracking method in geant 4 can result in incorrect LET d calculation results in the dose plateau region for small step limits. The erroneous LET d results can be attributed to the algorithm to determine fluctuations in energy deposition along the tracking step in geant 4. The incorrect LET d values lead to substantial differences in the calculated RBE.Conclusions:
When the geant 4 particle tracking method is used to calculate the average LET values within targets with a small step limit, such as smaller than 500 μm, the authors recommend the use of LET t in the dose plateau region and LET d around the Bragg peak. For a large step limit, i.e., 500 μm, LET d is recommended along the whole Bragg curve. The transition point depends on beam parameters and can be found by determining the location where the gradient of the ratio of LET d and LET t becomes positive.
42(2015); http://dx.doi.org/10.1118/1.4932219View Description Hide DescriptionPurpose:
Treatment planning for carbon ion therapy requires an accurate modeling of the biological response of each tissue to estimate the clinical outcome of a treatment. The relative biological effectiveness (RBE) accounts for this biological response on a cellular level but does not refer to the actual impact on the organ as a whole. For photon therapy, the concept of equivalent uniform dose (EUD) represents a simple model to take the organ response into account, yet so far no formulation of EUD has been reported that is suitable to carbon ion therapy. The authors introduce the concept of an equivalent uniform effect (EUE) that is directly applicable to both ion and photon therapies and exemplarily implemented it as a basis for biological treatment plan optimization for carbon ion therapy.Methods:
In addition to a classical EUD concept, which calculates a generalized mean over the RBE-weighted dose distribution, the authors propose the EUE to simplify the optimization process of carbon ion therapy plans. The EUE is defined as the biologically equivalent uniform effect that yields the same probability of injury as the inhomogeneous effect distribution in an organ. Its mathematical formulation is based on the generalized mean effect using an effect-volume parameter to account for different organ architectures and is thus independent of a reference radiation. For both EUD concepts, quadratic and logistic objective functions are implemented into a research treatment planning system. A flexible implementation allows choosing for each structure between biological effect constraints per voxel and EUD constraints per structure. Exemplary treatment plans are calculated for a head-and-neck patient for multiple combinations of objective functions and optimization parameters.Results:
Treatment plans optimized using an EUE-based objective function were comparable to those optimized with an RBE-weighted EUD-based approach. In agreement with previous results from photon therapy, the optimization by biological objective functions resulted in slightly superior treatment plans in terms of final EUD for the organs at risk (OARs) compared to voxel-based optimization approaches. This observation was made independent of the underlying objective function metric. An absolute gain in OAR sparing was observed for quadratic objective functions, whereas intersecting DVHs were found for logistic approaches. Even for considerable under- or overestimations of the used effect- or dose–volume parameters during the optimization, treatment plans were obtained that were of similar quality as the results of a voxel-based optimization.Conclusions:
EUD-based optimization with either of the presented concepts can successfully be applied to treatment plan optimization. This makes EUE-based optimization for carbon ion therapy a useful tool to optimize more specifically in the sense of biological outcome while voxel-to-voxel variations of the biological effectiveness are still properly accounted for. This may be advantageous in terms of computational cost during treatment plan optimization but also enables a straight forward comparison of different fractionation schemes or treatment modalities.
Technical Note: Fabricating Cerrobend grids with 3D printing for spatially modulated radiation therapy: A feasibility study42(2015); http://dx.doi.org/10.1118/1.4932223View Description Hide DescriptionPurpose:
Grid therapy has promising applications in the radiation treatment of large tumors. However, research and applications of grid therapy are limited by the accessibility of the specialized blocks that produce the grid of pencil-like radiation beams. In this study, a Cerrobend grid block was fabricated using the 3D printing technique.Methods:
A grid block mold was designed with flared tubes which follow the divergence of the beam. The mold was 3D printed using a resin with the working temperature below 230 °C. The melted Cerrobend liquid at 120 °C was cast into the resin mold to yield a block with a thickness of 7.4 cm. At the isocenter plane, the grid had a hexagonal pattern, with each pencil beam diameter of 1.4 cm; the distance between the beam centers was 2.1 cm.Results:
The dosimetric properties of the grid block were studied using small field dosimeters: a pinpoint ionization chamber and a stereotactic diode. For a 6 MV photon beam, its valley-to-peak ratio was 20% at d max and 30% at 10 cm depth; the output factor was 84.9% at d max and 65.1% at 10 cm depth.Conclusions:
This study demonstrates that it is feasible to implement 3D printing technique in applying grid therapy in clinic.
- RADIATION IMAGING PHYSICS
42(2015); http://dx.doi.org/10.1118/1.4931964View Description Hide DescriptionPurpose:
Currently applied calibration approaches lead to satisfying 3D roadmapping overlay and 3D reconstruction accuracies; however, the required calibration times are extensive. The aim of this paper is the introduction of a novel model-based approach for geometric system calibrations, leading to a significant reduction of calibration times.Methods:
By using physical insight into the system, a physical model is derived which can be exploited to predict geometric calibrations parameters. Model-parameters are estimated using a limited set of phantom-based measurement data. Effectively, the calibration procedure is recast to a parameter identification experiment.Results:
The potential of the proposed approach is illustrated by virtue of a benchmark object, successful reconstruction of a clinical phantom, and comparison to phantom-based accuracies.Conclusions:
Accurate models are required to achieve the desired accuracies. Based on the results in this work, the approach seems to be feasible for practical applications; however, to achieve all the desired specifications, future research should focus on enhanced modeling techniques.
42(2015); http://dx.doi.org/10.1118/1.4931958View Description Hide DescriptionPurpose:
To develop and test an automated algorithm to classify different types of tissue in dedicated breast CT images.Methods:
Images of a single breast of five different patients were acquired with a dedicated breast CT clinical prototype. The breast CT images were processed by a multiscale bilateral filter to reduce noise while keeping edge information and were corrected to overcome cupping artifacts. As skin and glandular tissue have similar CT values on breast CT images, morphologic processing is used to identify the skin based on its position information. A support vector machine (SVM) is trained and the resulting model used to create a pixelwise classification map of fat and glandular tissue. By combining the results of the skin mask with the SVM results, the breast tissue is classified as skin, fat, and glandular tissue. This map is then used to identify markers for a minimum spanning forest that is grown to segment the image using spatial and intensity information. To evaluate the authors’ classification method, they use DICE overlap ratios to compare the results of the automated classification to those obtained by manual segmentation on five patient images.Results:
Comparison between the automatic and the manual segmentation shows that the minimum spanning forest based classification method was able to successfully classify dedicated breast CT image with average DICE ratios of 96.9%, 89.8%, and 89.5% for fat, glandular, and skin tissue, respectively.Conclusions:
A 2D minimum spanning forest based classification method was proposed and evaluated for classifying the fat, skin, and glandular tissue in dedicated breast CT images. The classification method can be used for dense breast tissue quantification, radiation dose assessment, and other applications in breast imaging.
Adult abdomen–pelvis CT: Does equilibrium dose-pitch product better account for the kVp dependence of organ dose than conventional CTDI?42(2015); http://dx.doi.org/10.1118/1.4932222View Description Hide DescriptionPurpose:
In CT imaging, a desirable quality assurance dose quantity should account for the dose variability across scan parameters and scanner models. Recently, AAPM Task Group 111 proposed to use equilibrium dose-pitch product , in place of CT dose index (CTDI 100), for scan modes involving table translation. The purpose of this work is to investigate whether this new concept better accounts for the tube voltage (kVp) dependence of organ dose than the conventional CTDI 100.Methods:
Three extended cardiac-torso patient models were included in this study. They represented normal-weight, overweight, and obese patients with abdomen–pelvis diameters ranging between 23 and 36 cm and body mass indices ranging between 20 and 42. A Monte Carlo program developed and validated for a 128-slice CT system was used to simulate organ dose for abdomen–pelvis scans at five tube voltages (70, 80, 100, 120, 140 kVp) with a pitch of 0.8 and a collimation of 38.4 mm. The same Monte Carlo program was also used to obtain CTDI 100 and as well as their volume-averaged values, CTDI vol and .Results:
With other scan parameters kept constant, organ dose itself depended strongly on kVp. For the normal-weight patient model, the coefficient of variation (COV) across the five kVp values ranged between 72% and 75% for nine organs (liver, spleen, stomach, pancreas, kidneys, colon, small intestine, bladder, and ovaries) fully encompassed by the primary radiation beam. The COV generally increased with increasing patient size, ranging between 72%–77% and 76%–81% for the overweight and obese patient models, respectively. One-way analysis of variance for the effect of kVp was highly significant for all patient models (p < 2 × 10−26). When organ dose was normalized by CTDI vol, the COV across kVps reduced to 5%–11%, 6%–15%, 12%–22% for the normal-weight, overweight, and obese patients, respectively. The effect of kVp was still highly significant (p = 0.0001–0.004). When organ dose was normalized by , the COV further reduced to 1%–8%, 3%–11%, 9%–19%, respectively. The effect of kVp was still significant for the obese patient model (p = 0.004), but no longer significant for the normal-weight and overweight patient models (p = 0.4 and 0.09, respectively). Finally, if organ dose conversion factors obtained at 120 kVp were used to approximate the values at 70 and 80 kVp, the resulting errors in the estimated organ dose were significantly reduced when the conversion factors were based on instead of CTDI vol.Conclusions:
In adult abdomen–pelvis CT, equilibrium dose-pitch product better accounts for the kVp dependence of organ dose than CTDI 100.
A new technique to characterize CT scanner bow-tie filter attenuation and applications in human cadaver dosimetry simulations42(2015); http://dx.doi.org/10.1118/1.4932364View Description Hide DescriptionPurpose:
To present a noninvasive technique for directly measuring the CT bow-tie filter attenuation with a linear array x-ray detector.Methods:
A scintillator based x-ray detector of 384 pixels, 307 mm active length, and fast data acquisition (model X-Scan 0.8c4-307, Detection Technology, FI-91100 Ii, Finland) was used to simultaneously detect radiation levels across a scan field-of-view. The sampling time was as short as 0.24 ms. To measure the body bow-tie attenuation on a GE Lightspeed Pro 16 CT scanner, the x-ray tube was parked at the 12 o’clock position, and the detector was centered in the scan field at the isocenter height. Two radiation exposures were made with and without the bow-tie in the beam path. Each readout signal was corrected for the detector background offset and signal-level related nonlinear gain, and the ratio of the two exposures gave the bow-tie attenuation. The results were used in the geant4 based simulations of the point doses measured using six thimble chambers placed in a human cadaver with abdomen/pelvis CT scans at 100 or 120 kV, helical pitch at 1.375, constant or variable tube current, and distinct x-ray tube starting angles.Results:
Absolute attenuation was measured with the body bow-tie scanned at 80–140 kV. For 24 doses measured in six organs of the cadaver, the median or maximum difference between the simulation results and the measurements on the CT scanner was 8.9% or 25.9%, respectively.Conclusions:
The described method allows fast and accurate bow-tie filter characterization.
42(2015); http://dx.doi.org/10.1118/1.4932365View Description Hide DescriptionPurpose:
Accurate segmentation and quantification of liver metastases on CT images are critical to surgery/radiation treatment planning and therapy response assessment. To date, there are no reliable methods to perform such segmentation automatically. In this work, the authors present a method for semiautomatic delineation of liver metastases on contrast-enhanced volumetric CT images.Methods:
The first step is to manually place a seed region-of-interest (ROI) in the lesion on an image. This ROI will (1) serve as an internal marker and (2) assist in automatically identifying an external marker. With these two markers, lesion contour on the image can be accurately delineated using traditional watershed transformation. Density information will then be extracted from the segmented 2D lesion and help determine the 3D connected object that is a candidate of the lesion volume. The authors have developed a robust strategy to automatically determine internal and external markers for marker-controlled watershed segmentation. By manually placing a seed region-of-interest in the lesion to be delineated on a reference image, the method can automatically determine dual threshold values to approximately separate the lesion from its surrounding structures and refine the thresholds from the segmented lesion for the accurate segmentation of the lesion volume. This method was applied to 69 liver metastases (1.1–10.3 cm in diameter) from a total of 15 patients. An independent radiologist manually delineated all lesions and the resultant lesion volumes served as the “gold standard” for validation of the method’s accuracy.Results:
The algorithm received a median overlap, overestimation ratio, and underestimation ratio of 82.3%, 6.0%, and 11.5%, respectively, and a median average boundary distance of 1.2 mm.Conclusions:
Preliminary results have shown that volumes of liver metastases on contrast-enhanced CT images can be accurately estimated by a semiautomatic segmentation method.
Large area CMOS active pixel sensor x-ray imager for digital breast tomosynthesis: Analysis, modeling, and characterization42(2015); http://dx.doi.org/10.1118/1.4932368View Description Hide DescriptionPurpose:
Large area x-ray imagers based on complementary metal-oxide-semiconductor (CMOS) active pixel sensor (APS) technology have been proposed for various medical imaging applications including digital breast tomosynthesis (DBT). The low electronic noise (50–300 e−) of CMOS APS x-ray imagers provides a possible route to shrink the pixel pitch to smaller than 75 μm for microcalcification detection and possible reduction of the DBT mean glandular dose (MGD).Methods:
In this study, imaging performance of a large area (29 × 23 cm2) CMOS APS x-ray imager [Dexela 2923 MAM (PerkinElmer, London)] with a pixel pitch of 75 μm was characterized and modeled. The authors developed a cascaded system model for CMOS APS x-ray imagers using both a broadband x-ray radiation and monochromatic synchrotron radiation. The experimental data including modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE) were theoretically described using the proposed cascaded system model with satisfactory consistency to experimental results. Both high full well and low full well (LFW) modes of the Dexela 2923 MAM CMOS APS x-ray imager were characterized and modeled. The cascaded system analysis results were further used to extract the contrast-to-noise ratio (CNR) for microcalcifications with sizes of 165–400 μm at various MGDs. The impact of electronic noise on CNR was also evaluated.Results:
The LFW mode shows better DQE at low air kerma (Ka < 10 μGy) and should be used for DBT. At current DBT applications, air kerma (Ka ∼ 10 μGy, broadband radiation of 28 kVp), DQE of more than 0.7 and ∼0.3 was achieved using the LFW mode at spatial frequency of 0.5 line pairs per millimeter (lp/mm) and Nyquist frequency ∼6.7 lp/mm, respectively. It is shown that microcalcifications of 165–400 μm in size can be resolved using a MGD range of 0.3–1 mGy, respectively. In comparison to a General Electric GEN2 prototype DBT system (at MGD of 2.5 mGy), an increased CNR (by ∼10) for microcalcifications was observed using the Dexela 2923 MAM CMOS APS x-ray imager at a lower MGD (2.0 mGy).Conclusions:
The Dexela 2923 MAM CMOS APS x-ray imager is capable to achieve a high imaging performance at spatial frequencies up to 6.7 lp/mm. Microcalcifications of 165 μm are distinguishable based on reported data and their modeling results due to the small pixel pitch of 75 μm. At the same time, potential dose reduction is expected using the studied CMOS APS x-ray imager.
42(2015); http://dx.doi.org/10.1118/1.4931407View Description Hide DescriptionPurpose:
X-ray computed tomography (CT) is widely used, both clinically and preclinically, for fast, high-resolution anatomic imaging; however, compelling opportunities exist to expand its use in functional imaging applications. For instance, spectral information combined with nanoparticle contrast agents enables quantification of tissue perfusion levels, while temporal information details cardiac and respiratory dynamics. The authors propose and demonstrate a projection acquisition and reconstruction strategy for 5D CT (3D + dual energy + time) which recovers spectral and temporal information without substantially increasing radiation dose or sampling time relative to anatomic imaging protocols.Methods:
The authors approach the 5D reconstruction problem within the framework of low-rank and sparse matrix decomposition. Unlike previous work on rank-sparsity constrained CT reconstruction, the authors establish an explicit rank-sparse signal model to describe the spectral and temporal dimensions. The spectral dimension is represented as a well-sampled time and energy averaged image plus regularly undersampled principal components describing the spectral contrast. The temporal dimension is represented as the same time and energy averaged reconstruction plus contiguous, spatially sparse, and irregularly sampled temporal contrast images. Using a nonlinear, image domain filtration approach, the authors refer to as rank-sparse kernel regression, the authors transfer image structure from the well-sampled time and energy averaged reconstruction to the spectral and temporal contrast images. This regularization strategy strictly constrains the reconstruction problem while approximately separating the temporal and spectral dimensions. Separability results in a highly compressed representation for the 5D data in which projections are shared between the temporal and spectral reconstruction subproblems, enabling substantial undersampling. The authors solved the 5D reconstruction problem using the split Bregman method and GPU-based implementations of backprojection, reprojection, and kernel regression. Using a preclinical mouse model, the authors apply the proposed algorithm to study myocardial injury following radiation treatment of breast cancer.Results:
Quantitative 5D simulations are performed using the MOBY mouse phantom. Twenty data sets (ten cardiac phases, two energies) are reconstructed with 88 μm, isotropic voxels from 450 total projections acquired over a single 360° rotation. In vivo 5D myocardial injury data sets acquired in two mice injected with gold and iodine nanoparticles are also reconstructed with 20 data sets per mouse using the same acquisition parameters (dose: ∼60 mGy). For both the simulations and the in vivo data, the reconstruction quality is sufficient to perform material decomposition into gold and iodine maps to localize the extent of myocardial injury (gold accumulation) and to measure cardiac functional metrics (vascular iodine). Their 5D CT imaging protocol represents a 95% reduction in radiation dose per cardiac phase and energy and a 40-fold decrease in projection sampling time relative to their standard imaging protocol.Conclusions:
Their 5D CT data acquisition and reconstruction protocol efficiently exploits the rank-sparse nature of spectral and temporal CT data to provide high-fidelity reconstruction results without increased radiation dose or sampling time.
Breast dose in mammography is about 30% lower when realistic heterogeneous glandular distributions are considered42(2015); http://dx.doi.org/10.1118/1.4931966View Description Hide DescriptionPurpose:
Current dosimetry methods in mammography assume that the breast is comprised of a homogeneous mixture of glandular and adipose tissues. Three-dimensional (3D) dedicated breast CT (bCT) data sets were used previously to assess the complex anatomical structure within the breast, characterizing the statistical distribution of glandular tissue in the breast. The purpose of this work was to investigate the effect of bCT-derived heterogeneous glandular distributions on dosimetry in mammography.Methods:
bCT-derived breast diameters, volumes, and 3D fibroglandular distributions were used to design realistic compressed breast models comprised of heterogeneous distributions of glandular tissue. The bCT-derived glandular distributions were fit to biGaussian functions and used as probability density maps to assign the density distributions within compressed breast models. The MCNPX 2.6.0 Monte Carlo code was used to estimate monoenergetic normalized mean glandular dose “DgN(E)” values in mammography geometry. The DgN(E) values were then weighted by typical mammography x-ray spectra to determine polyenergetic DgN (pDgN) coefficients for heterogeneous (pDgNhetero) and homogeneous (pDgNhomo) cases. The dependence of estimated pDgN values on phantom size, volumetric glandular fraction (VGF), x-ray technique factors, and location of the heterogeneous glandular distributions was investigated.Results:
The pDgNhetero coefficients were on average 35.3% (SD, 4.1) and 24.2% (SD, 3.0) lower than the pDgNhomo coefficients for the Mo–Mo and W–Rh x-ray spectra, respectively, across all phantom sizes and VGFs when the glandular distributions were centered within the breast phantom in the coronal plane. At constant breast size, increasing VGF from 7.3% to 19.1% lead to a reduction in pDgNhetero relative to pDgNhomo of 23.6%–27.4% for a W–Rh spectrum. Displacement of the glandular distribution, at a distance equal to 10% of the compressed breast width in the superior and inferior directions, resulted in a 37.3% and a −26.6% change in the pDgNhetero coefficient, respectively, relative to the centered distribution for the Mo–Mo spectrum. Lateral displacement of the glandular distribution, at a distance equal to 10% of the compressed breast width, resulted in a 1.5% change in the pDgNhetero coefficient relative to the centered distribution for the W–Rh spectrum.Conclusions:
Introducing bCT-derived heterogeneous glandular distributions into mammography phantom design resulted in decreased glandular dose relative to the widely used homogeneous assumption. A homogeneous distribution overestimates the amount of glandular tissue near the entrant surface of the breast, where dose deposition is exponentially higher. While these findings are based on clinically measured distributions of glandular tissue using a large cohort of women, future work is required to improve the classification of glandular distributions based on breast size and overall glandular fraction.
- RADIATION MEASUREMENT PHYSICS
42(2015); http://dx.doi.org/10.1118/1.4931963View Description Hide DescriptionPurpose:
Out-of-field neutron doses resulting from photonuclear interactions in the head of a linear accelerator pose an iatrogenic risk to patients and an occupational risk to personnel during radiotherapy. To quantify neutron production, in-room measurements have traditionally been carried out using Bonner sphere systems (BSS) with activation foils and TLDs. In this work, a recently developed active detector, the nested neutron spectrometer (NNS), was tested in radiotherapy bunkers.Methods:
The NNS is designed for easy handling and is more practical than the traditional BSS. Operated in current-mode, the problem of pulse pileup due to high dose-rates is overcome by measuring current, similar to an ionization chamber. In a bunker housing a Varian Clinac 21EX, the performance of the NNS was evaluated in terms of reproducibility, linearity, and dose-rate effects. Using a custom maximum-likelihood expectation–maximization algorithm, measured neutron spectra at various locations inside the bunker were then compared to Monte Carlo simulations of an identical setup. In terms of dose, neutron ambient dose equivalents were calculated from the measured spectra and compared to bubble detector neutron dose equivalent measurements.Results:
The NNS-measured spectra for neutrons at various locations in a treatment room were found to be consistent with expectations for both relative shape and absolute magnitude. Neutron fluence-rate decreased with distance from the source and the shape of the spectrum changed from a dominant fast neutron peak near the Linac head to a dominant thermal neutron peak in the moderating conditions of the maze. Monte Carlo data and NNS-measured spectra agreed within 30% at all locations except in the maze where the deviation was a maximum of 40%. Neutron ambient dose equivalents calculated from the authors’ measured spectra were consistent (one standard deviation) with bubble detector measurements in the treatment room.Conclusions:
The NNS may be used to reliably measure the neutron spectrum of a radiotherapy beam in less than 1 h, including setup and data unfolding. This work thus represents a new, fast, and practical method for neutron spectral measurements in radiotherapy.
42(2015); http://dx.doi.org/10.1118/1.4931979View Description Hide DescriptionPurpose:
The authors’ objective was to systematically assess the performance of seven photodetectors used in plastic scintillation dosimetry. The authors also propose some guidelines for selecting an appropriate detector for a specific application.Methods:
The plastic scintillation detector (PSD) consisted of a 1-mm diameter, 10-mm long plastic scintillation fiber (BCF-60), which was optically coupled to a clear 10-m long optical fiber of the same diameter. A light-tight plastic sheath covered both fibers and the scintillator end was sealed. The clear fiber end was connected to one of the following photodetectors: two polychromatic cameras (one with an optical lens and one with a fiber optic taper replacing the lens), a monochromatic camera with an optical lens, a PIN photodiode, an avalanche photodiode (APD), or a photomultiplier tube (PMT). A commercially available W1 PSD was also included in the study, but it relied on its own fiber and scintillator. Each PSD was exposed to both low-energy beams (120, 180, and 220 kVp) from an orthovoltage unit and high-energy beams (6 and 23 MV) from a linear accelerator. Various dose rates were tested to identify the operating range and accuracy of each photodetector.Results:
For all photodetectors, the relative uncertainty was less than 5% for dose rates higher than 3 mGy/s. The cameras allowed multiple probes to be used simultaneously, but they are less sensitive to low-light signals. The PIN, APD, and PMT had higher sensitivity, making them more suitable for low dose rate and out-of-field dose monitoring. The relative uncertainty of the PMT was less than 1% at the lowest dose rate achieved (0.10 mGy/s), suggesting that it was optimal for use in live dosimetry.Conclusions:
For dose rates higher than 3 mGy/s, the PIN diode is the most effective photodetector in terms of performance/cost ratio. For lower dose rates, such as those seen in interventional radiology or high-gradient radiotherapy, PMTs are the optimal choice.
Evaluation of a real-time BeO ceramic fiber-coupled luminescence dosimetry system for dose verification of high dose rate brachytherapy42(2015); http://dx.doi.org/10.1118/1.4931968View Description Hide DescriptionPurpose:
The authors evaluate the capability of a beryllium oxide (BeO) ceramic fiber-coupled luminescence dosimeter, named radioluminescence/optically stimulated luminescence (RL/OSL) BeO FOD, for dosimetric verification of high dose rate (HDR) treatments. The RL/OSL BeO FOD is capable of RL and OSL measurements.Methods:
The RL/OSL BeO FOD is able to be inserted in 6F proguide needles, used in interstitial HDR treatments. Using a custom built Perspex phantom, 6F proguide needles could be submerged in a water tank at 1 cm separations from each other. A second background fiber was required to correct for the stem effect. The stem effect, dose linearity, reproducibility, depth-dose curves, and angular and temperature dependency of the RL/OSL BeO FOD were characterised using an Ir-192 source. The RL/OSL BeO FOD was also applied to the commissioning of a 10 mm horizontal Leipzig applicator.Results:
Both the RL and OSL were found to be reproducible and their percentage depth-dose curves to be in good agreement with those predicted via TG-43. A combined uncertainty of 7.9% and 10.1% (k = 1) was estimated for the RL and OSL, respectively. For the 10 mm horizontal Leipzig applicator, measured percentage depth doses were within 5% agreement of the published reference calculations. The output at the 3 mm prescription depth for a 1 Gy delivery was verified to be 0.99 ± 0.08 Gy and 1.01 ± 0.10 Gy by the RL and OSL, respectively.Conclusions:
The use of the second background fiber under the current setup means that the two fibers cannot fit into a single 6F needle. Hence, use of the RL is currently not adequate for the purpose of in vivo brachytherapy dosimetry. While not real-time, the OSL is shown to be adequate for in vivo brachytherapy dosimetry.
42(2015); http://dx.doi.org/10.1118/1.4931970View Description Hide DescriptionPurpose:
In this work, the authors describe an electron sealed water calorimeter (ESWcal) designed to directly measure absorbed dose to water in clinical electron beams and its use to derive electron beam quality conversion factors for two ionization chamber types.Methods:
A functioning calorimeter prototype was constructed in-house and used to obtain reproducible measurements in clinical accelerator-based 6, 9, 12, 16, and 20 MeV electron beams. Corrections for the radiation field perturbation due to the presence of the glass calorimeter vessel were calculated using Monte Carlo (MC) simulations. The conductive heat transfer due to dose gradients and nonwater materials was also accounted for using a commercial finite element method software package.Results:
The relative combined standard uncertainty on the ESWcal dose was estimated to be 0.50% for the 9–20 MeV beams and 1.00% for the 6 MeV beam, demonstrating that the development of a water calorimeter-based standard for electron beams over such a wide range of clinically relevant energies is feasible. The largest contributor to the uncertainty was the positioning (Type A, 0.10%–0.40%) and its influence on the perturbation correction (Type B, 0.10%–0.60%). As a preliminary validation, measurements performed with the ESWcal in a 6 MV photon beam were directly compared to results derived from the National Research Council of Canada (NRC) photon beam standard water calorimeter. These two independent devices were shown to agree well within the 0.43% combined relative uncertainty of the ESWcal for this beam type and quality. Absorbed dose electron beam quality conversion factors were measured using the ESWcal for the Exradin A12 and PTW Roos ionization chambers. The photon-electron conversion factor, k ecal, for the A12 was also experimentally determined. Nonstatistically significant differences of up to 0.7% were found when compared to the calculation-based factors listed in the AAPM’s TG-51 protocol. General agreement between the relative electron energy dependence of the PTW Roos data measured in this work and a recent MC-based study are also shown.Conclusions:
This is the first time that water calorimetry has been successfully used to measure electron beam quality conversion factors for energies as low as 6 MeV (R 50 = 2.25 cm).
- MAGNETIC RESONANCE PHYSICS
Technical Note: Clinical translation of the Rapid-Steady-State-T 1 MRI method for direct cerebral blood volume quantification42(2015); http://dx.doi.org/10.1118/1.4932218View Description Hide DescriptionPurpose:
In preclinical studies, the Rapid-Steady-State-T 1 (RSST 1) MRI method has advantages over conventional MRI methods for blood volume fraction (BVf) mapping, since after contrast agent administration, the BVf is directly quantifiable from the signal amplitude corresponding to the vascular equilibrium magnetization. This study focuses on its clinical implementation and feasibility.Methods:
Following sequence implementation on clinical Philips Achieva scanners, the RSST 1-method is assessed at 1.5 and 3 T in the follow-up examination of neurooncological patients receiving 0.1–0.2 mmol/kg Gd-DOTA to determine the threshold dose needed for cerebral BVf quantification. Confounding effects on BVf quantification such as transendothelial water exchange, transverse relaxation, and contrast agent extravasation are evaluated.Results:
For a dose ≥0.13 mmol/kg at 1.5 T and ≥0.16 mmol/kg at 3 T, the RSST 1-signal time course in macrovessels and brain tissue with Gd-DOTA impermeable vasculature reaches a steady state at maximum amplitude for about 8 s. In macrovessels, a BVf of 100% was obtained validating cerebral microvascular BVf quantification (3.5%–4.5% in gray matter and 1.5%–2.0% in white matter). In tumor tissue, a continuously increasing signal is detected, necessitating signal modeling for tumor BVf calculation.Conclusions:
Using approved doses of Gd-DOTA, the steady state RSST 1-signal in brain tissue is reached during the first pass and corresponds to the BVf. The first-pass duration is sufficient to allow accurate BVf quantification. The RSST 1-method is appropriate for serial clinical studies since it allows fast and straightforward BVf quantification without arterial input function determination. This quantitative MRI method is particularly useful to assess the efficacy of antiangiogenic agents.
- OPTICAL PHYSICS
Early detection of chemotherapy-refractory patients by monitoring textural alterations in diffuse optical spectroscopic images42(2015); http://dx.doi.org/10.1118/1.4931603View Description Hide DescriptionPurpose:
Changes in textural characteristics of diffuse optical spectroscopic (DOS) functional images, accompanied by alterations in their mean values, are demonstrated here for the first time as early surrogates of ultimate treatment response in locally advanced breast cancer (LABC) patients receiving neoadjuvant chemotherapy (NAC). NAC, as a standard component of treatment for LABC patient, induces measurable heterogeneous changes in tumor metabolism which were evaluated using DOS-based metabolic maps. This study characterizes such inhomogeneous nature of response development, by determining alterations in textural properties of DOS images apparent at early stages of therapy, followed later by gross changes in mean values of these functional metabolic maps.Methods:
Twelve LABC patients undergoing NAC were scanned before and at four times after treatment initiation, and tomographic DOS images were reconstructed at each time. Ultimate responses of patients were determined clinically and pathologically, based on a reduction in tumor size and assessment of residual tumor cellularity. The mean-value parameters and textural features were extracted from volumetric DOS images for several functional and metabolic parameters prior to the treatment initiation. Changes in these DOS-based biomarkers were also monitored over the course of treatment. The measured biomarkers were applied to differentiate patient responses noninvasively and compared to clinical and pathologic responses.Results:
Responding and nonresponding patients demonstrated different changes in DOS-based textural and mean-value parameters during chemotherapy. Whereas none of the biomarkers measured prior the start of therapy demonstrated a significant difference between the two patient populations, statistically significant differences were observed at week one after treatment initiation using the relative change in contrast/homogeneity of seven functional maps (0.001 < p < 0.049), and mean value of water content in tissue (p = 0.010). The cross-validated sensitivity and specificity of these parameters at week one of therapy ranged between 80%–100% and 67%–100%, respectively. Higher levels of statistically significant differences were exhibited at week four after start of treatment, with cross-validated sensitivities and specificities ranging between 80% and 100% for three textural and three mean-value parameters. The combination of the textural and mean-value parameters in a “hybrid” profile could better separate the two patient populations early on during a course of treatment, with cross-validated sensitivities and specificities of up to 100% (p = 0.001).Conclusions:
The results of this study suggest that alterations in textural characteristics of DOS images, in conjunction with changes in their mean values, can classify noninvasively the ultimate clinical and pathologic response of LABC patients to chemotherapy, as early as one week after start of their treatment. This provides a basis for using DOS imaging as a tool for therapy personalization.