Correction to: Planning comparison of five automated treatment planning solutions for locally advanced head and neck cancer.

Following publication of the original article [1], the authors reported that one of the authors' names was processed incorrectly.

Planning comparison of five automated treatment planning solutions for locally advanced head and neck cancer.

BACKGROUND: Automated treatment planning and/or optimization systems (ATPS) are in the process of broad clinical implementation aiming at reducing inter-planner variability, reducing the planning time allocated for the optimization process and improving plan quality. Five different ATPS used clinically were evaluated for advanced head and neck cancer (HNC). METHODS: Three radiation oncology departments compared 5 different ATPS: 1) Automatic Interactive Optimizer (AIO) in combination with RapidArc (in-house developed and Varian Medical Systems); 2) Auto-Planning (AP) (Philips Radiation Oncology Systems); 3) RapidPlan version 13.6 (RP1) with HNC model from University Hospital A (Varian Medical Systems, Palo Alto, USA); 4) RapidPlan version 13.7 (RP2) combined with scripting for automated setup of fields with HNC model from University Hospital B; 5) Raystation multicriteria optimization algorithm version 5 (RS) (Laboratories AB, Stockholm, Sweden). Eight randomly selected HNC cases from institution A and 8 from institution B were used. PTV coverage, mean and maximum dose to the organs at risk and effective planning time were compared. Ranking was done based on 3 Gy increments for the parallel organs. RESULTS: All planning systems achieved the hard dose constraints for the PTVs and serial organs for all patients. Overall, AP achieved the best ranking for the parallel organs followed by RS, AIO, RP2 and RP1. The oral cavity mean dose was the lowest for RS (31.3 ± 17.6 Gy), followed by AP (33.8 ± 17.8 Gy), RP1 (34.1 ± 16.7 Gy), AIO (36.1 ± 16.8 Gy) and RP2 (36.3 ± 16.2 Gy). The submandibular glands mean dose was 33.6 ± 10.8 Gy (AP), 35.2 ± 8.4 Gy (AIO), 35.5 ± 9.3 Gy (RP2), 36.9 ± 7.6 Gy (RS) and 38.2 ± 7.0 Gy (RP1). The average effective planning working time was substantially different between the five ATPS (in minutes): < 2 ± 1 for AIO and RP2, 5 ± 1 for AP, 15 ± 2 for RP1 and 340 ± 48 for RS, respectively. CONCLUSIONS: All ATPS were able to achieve all planning DVH constraints and the effective working time was kept bellow 20 min for each ATPS except for RS. For the parallel organs, AP performed the best, although the differences were small.

Calculation of correction factors for ionization chamber measurements with small fields in low-density media.

The quantity of interest for high-energy photon beam therapy recommended by most dosimetric protocols is the absorbed dose to water. Thus, ionization chambers are calibrated in absorbed dose to water, which is the same quantity as what is calculated by most treatment planning systems (TPS). However, when measurements are performed in a low-density medium, the presence of the ionization chamber generates a perturbation at the level of the secondary particle range. Therefore, the measured quantity is close to the absorbed dose to a volume of water equivalent to the chamber volume. This quantity is not equivalent to the dose calculated by a TPS, which is the absorbed dose to an infinitesimally small volume of water. This phenomenon can lead to an overestimation of the absorbed dose measured with an ionization chamber of up to 40% in extreme cases. In this paper, we propose a method to calculate correction factors based on the Monte Carlo simulations. These correction factors are obtained by the ratio of the absorbed dose to water in a low-density medium □D(w,Q,V1)(low) averaged over a scoring volume V1 for a geometry where V1 is filled with the low-density medium and the absorbed dose to water □D(w,QV2)(low) averaged over a volume V2 for a geometry where V2 is filled with water. In the Monte Carlo simulations, □D(w,QV2)(low) is obtained by replacing the volume of the ionization chamber by an equivalent volume of water, according to the definition of the absorbed dose to water. The method is validated in two different configurations which allowed us to study the behavior of this correction factor as a function of depth in phantom, photon beam energy, phantom density and field size.

The Swiss IMRT dosimetry intercomparison using a thorax phantom.

PURPOSE: In 2008, a national intensity modulated radiation therapy (IMRT) dosimetry intercomparison was carried out for all 23 radiation oncology institutions in Switzerland. It was the aim to check the treatment chain focused on the planning, dose calculation, and irradiation process. METHODS: A thorax phantom with inhomogeneities was used, in which thermoluminescence dosimeter (TLD) and ionization chamber measurements were performed. Additionally, absolute dosimetry of the applied beams has been checked. Altogether, 30 plan-measurement combinations have been used in the comparison study. The results have been grouped according to dose calculation algorithms, classified as "type a" or "type b," as proposed by Kntis et al. ["Comparison of dose calculation algorithms for treatment planning in external photon beam therapy for clinical situations," Phys. Med. Biol. 51, 5785-5807 (2006)]. RESULTS: Absolute dosimetry check under standard conditions: The mean ratio between the dose derived from the single field measurement and the stated dose, calculated with the treatment planning system, was 1.007 +/- 0.010 for the ionization chamber and 1.002 +/- 0.014 (mean+/- standard deviation) for the TLD measurements. IMRT Plan Check: In the lung tissue of the planning target volume, a significantly better agreement between measurements (TLD, ionization chamber) and calculations is shown for type b algorithms than for type a (p <0.001). In regions outside the lungs, the absolute differences between TLD measured and stated dose values, relative to the prescribed dose, [(Dm-Ds)/Dprescribed], are 1.9 +/- 0.4% and 1.4 +/- 0.3%, respectively. These data show the same degree of accuracy between the two algorithm types if low-density medium is not present. CONCLUSIONS: The results demonstrate that the performed intercomparison is feasible and confirm the calculation accuracies of type a and type b algorithms in a water equivalent and low-density environment. It is now planned to offer the intercomparison on a regular basis to all Swiss institutions using IMRT techniques.

Assessment of radiographic screen-film systems: a comparison between the use of a microdensitometer and a drum film digitiser.

A high-end drum film digitiser (Tango, Germany) and a calibrated linear microdensitometer developed by PTB were used to assess the modulation transfer function (MTF) and the noise power spectra (NPS) of 3 mammographic screen film systems at optical density levels of 0.8, 1.5 and 2.5. The use of a drum scanner to assess MTF and NPS data appears to be adequate but requires an appropriate characterisation of the scanner to verify its internal noise level and its MTF. It is further necessary to calibrate the scanner output in terms of visual diffuse optical densities. Processing of two-dimensional digital data of grating images need to be more strictly defined for accurate MTF measurements of screen-film systems. Nevertheless, even now it seems to be feasible to use commercially available high-end and well calibrated scanners to assess screen film systems. This is especially important for quality assurance purposes because important parameters of screen film systems such like MTF and NPS can now be determined without using sophisticated microdensitometers which are not commercially available.

Monte Carlo simulation of a mammographic test phantom.

A test phantom, including a wide range of mammographic tissue equivalent materials and test details, was imaged on a digital mammographic system. In order to quantify the effect of scatter on the contrast obtained for the test details, calculations of the scatter-to-primary ratio (S/P) have been made using a Monte Carlo simulation of the digital mammographic imaging chain, grid and test phantom. The results show that the S/P values corresponding to the imaging conditions used were in the range 0.084-0.126. Calculated and measured pixel values in different regions of the image were compared as a validation of the model and showed excellent agreement. The results indicate the potential of Monte Carlo methods in the image quality-patient dose process optimisation, especially in the assessment of imaging conditions not available on standard mammographic units.

Influence of detector collimation on SNR in four different MDCT scanners using a reconstructed slice thickness of 5 mm.

The purpose of this paper is to compare the influence of detector collimation on the signal-to-noise ratio (SNR) for a 5.0 mm reconstructed slice thickness for four multi-detector row CT (MDCT) units. SNRs were measured on Catphan test phantom images from four MDCT units: a GE LightSpeed QX/I, a Marconi MX 8000, a Toshiba Aquilion and a Siemens Volume Zoom. Five-millimetre-thick reconstructed slices were obtained from acquisitions performed using detector collimations of 2.0-2.5 mm and 5.0 mm, 120 kV, a 360 degrees tube rotation time of 0.5 s, a wide range of mA and pitch values in the range of 0.75-0.85 and 1.25-1.5. For each set of acquisition parameters, a Wiener spectrum was also calculated. Statistical differences in SNR for the different acquisition parameters were evaluated using a Student's t-test (P<0.05). The influence of detector collimation on the SNR for a 5.0-mm reconstructed slice thickness is different for different MDCT scanners. At pitch values lower than unity, the use of a small detector collimation to produce 5.0-mm thick slices is beneficial for one unit and detrimental for another. At pitch values higher than unity, using a small detector collimation is beneficial for two units. One manufacturer uses different reconstruction filters when switching from a 2.5- to a 5.0-mm detector collimation. For a comparable reconstructed slice thickness, using a smaller detector collimation does not always reduce image noise. Thus, the impact of the detector collimation on image noise should be determined by standard deviation calculations, and also by assessing the power spectra of the noise.

Objective comparison of image quality and dose between conventional and synchrotron radiation mammography.

The shape of the energy spectrum produced by an x-ray tube has a great importance in mammography. Many anode-filtration combinations have been proposed to obtain the most effective spectrum shape for the image quality-dose relationship. On the other hand, third generation synchrotrons such as the European Synchrotron Radiation Facility in Grenoble are able to produce a high flux of monoenergetic radiation. It is thus a powerful tool to study the effect of beam energy on image quality and dose in mammography. An objective method was used to evaluate image quality and dose in mammography with synchrotron radiation and to compare them to standard conventional units. It was performed systematically in the energy range of interest for mammography through the evaluation of a global image quality index and through the measurement of the mean glandular dose. Compared to conventional mammography units, synchrotron radiation shows a great improvement of the image quality-dose relationship, which is due to the beam monochromaticity and to the high intrinsic collimation of the beam, which allows the use of a slit instead of an anti-scatter grid for scatter rejection.

A real-time flat-panel X-ray pixel imaging system for low-dose medical diagnostics and craniofacial applications.

The aim of this study was to evaluate on-line performance of a real-time digital imaging system based on amorphous silicon technology and to compare it with conventional film-screen equipment. The digital detecting imager consists of (1) a converter, which transforms the energy of the incident X rays into light; (2) a real-time digital detecting system, capable of producing as many as 10 pictures per second using a large-area pixel matrix (20 x 20 cm2) based on solid-state amorphous silicon sensor technology with a pitch of 400 microns; and (3) appropriate computer tools for control, real-time image treatment, data representation, and off-line analysis. Different phantoms were used for qualitative comparison with the conventional film-screen technique, with images obtained with both systems at the normal dose (used as a reference), as well as with dose reduction by a factor of 10 to 100. Basic image quality parameters evaluated showed that the response of the detector is linear in a wide range of entrance air kerma; the dynamic range is higher compared with the conventional film-screen combination; the spatial resolution is 1.25 lp per millimeter, as expected from the pixel size; and good image quality is ensured at doses substantially lower than for the film-screen technique. The flat-panel X-ray imager based on amorphous silicon technology implemented in standard radiographic equipment permits acquisition of real-time images in radiology (as many as 10 images per second) of diagnostic quality with a marked reduction of dose (as much as 100 times) and better contrast compared with the standard film technique. Preliminary results obtained with a 100-micron pitch imager based on the same technology show better quality but a less substantial dose reduction. Applications in craniofacial surgery look promising.

[Universal treatment of ophthalmic migraine]. / Traitement universel de la migraine ophtalmique.

It's about a therapeutic method, particular to the author, which gets its universality from an optic prescription with a prismatic aspect. The ophthalmic headache's crisis is caused, in fact, by a spasm of convergence on an unknown exophory of which the amplitude of fusion is satisfying, and the presence of which can only be seen with test under screen.