Systematic quantitative evaluation of Plan-IQ for intensity-modulated radiation therapy after modified radical mastectomy.

Radiotherapy (RT) is one of the main treatment strategies of breast cancer. It is challenging to design RT plans that can completely cover the target area while protecting organs at risk (OAR). The Plan-IQ feasibility tool can estimate the best sparing dose of OAR before optimizing the Plan. A systematic quantitative evaluation of the quality change of intensity-modulated radiation therapy (IMRT) using the Plan-IQ feasibility tool was performed for modified radical mastectomy in this study. We selected 50 patients with breast cancer treated with IMRT. All patients received the same dose in the planning target volume (PTV). The plans are categorized into two groups, with each patient having one plan in each group: the clinically accepted normal plan group (NP group) and the repeat plan group (RP group). An automated planning strategy was generated using a Plan-IQ feasibility dose volume histogram (FDVH) in RP group. These plans were assessed according to the dosimetry parameters. A detailed scoring strategy was based on the RTOG9804 report and 2018 National Comprehensive Cancer Network guidelines, combined with clinical experience. PTV coverage in both groups was achieved at 100% of the prescribed dose. Except for the thyroid coverage, the dose limit of organs at risk (OAR) in RP group was significantly better than that in NP group. In the scoring analysis, the total scores of RP group decreased compared to that of NP group (P < 0.05), and the individual scores of PTV and OAR significantly changed. PTV scores in RP group decreased (P < 0.01); however, OAR scores improved (P < 0.01). The Plan-IQ FDVH was useful for evaluating a class solution for IMRT planning. Plan-IQ can automatically help physicians design the best OAR protection plan, which sacrifices part of PTV, but still meets clinical requirements.

Monte Carlo simulation-based design for an electron-linear-accelerator-driven subcritical neutron multiplier for boron neutron capture therapy.

Fuel configurations for a subcritical neutron multiplier, which was embedded in a beam-shaping assembly and irradiated by electrons from a linear accelerator, were examined to maximize the production of the epithermal neutron flux for boron neutron capture therapy. The epithermal neutron flux at the treatment position increased as the area per uranium fuel plate increased and was estimated to be 2 × 109 cm-2 s-1 when the subcritical neutron multiplier was irradiated by a 4.4 kW (0.22 mA) beam of 20 MeV electrons.

Radiation hardness of the storage phosphor europium doped potassium chloride for radiation therapy dosimetry.

PURPOSE: An important property of a reusable dosimeter is its radiation hardness, that is, its ability to retain its dosimetric merits after irradiation. The radiation hardness of europium doped potassium chloride (KC1:Eu2+), a storage phosphor material recently proposed for radiation therapy dosimetry, is examined in this study. METHODS: Pellet-style KCl:Eu2+ dosimeters, 6 mm in diameter, and 1 mm thick, were fabricated in-house for this study. The pellets were exposed by a 6 MV photon beam or in a high dose rate 137Cs irradiator. Macroscopic properties, such as radiation sensitivity, dose response linearity, and signal stability, were studied with a laboratory photostimulated luminescence (PSL) readout system. Since phosphor performance is related to the state of the storage centers and the activator, Eu2+, in the host lattice, spectroscopic and temporal measurements were carried out in order to explore radiation-induced changes at the microscopic level. RESULTS: KCl:Eu2+ dosimeters retained approximately 90% of their initial signal strength after a 5000 Gy dose history. Dose response was initially supralinear over the dose range of 100-700 cGy but became linear after 60 Gy. Linearity did not change significantly in the 0-5000 Gy dose history spanned in this study. Annealing high dose history chips resulted in a return of supralinearity and a recovery of sensitivity. There were no significant changes in the PSL stimulation spectra, PSL emission spectra, photoluminescence spectra, or luminescence lifetime, indicating that the PSL signal process remains intact after irradiation but at a reduced efficiency due to reparable radiation-induced perturbations in the crystal lattice. CONCLUSIONS: Systematic studies of KCl:Eu2+ material are important for understanding how the material can be optimized for radiation therapy dosimetry purposes. The data presented here indicate that KCl:Eu2+ exhibits strong radiation hardness and lends support for further investigations of this novel material.

Megavoltage photon beam attenuation by carbon fiber couch tops and its prediction using correction factors.

The purpose of this study was to evaluate the effect of megavoltage photon beam attenuation (PBA) by couch tops and to propose a method for correction of PBA. Four series of phantom measurements were carried out. First, PBA by the exact couch top (ECT, Varian) and Imaging Couch Top (ICT, BrainLAB) was evaluated using a water-equivalent phantom. Second, PBA by Type-S system (Med-Tec), ECT and ICT was compared with a spherical phantom. Third, percentage depth dose (PDD) after passing through ICT was measured to compare with control data of PDD. Forth, the gantry angle dependency of PBA by ICT was evaluated. Then, an equation for PBA correction was elaborated and correction factors for PBA at isocenter were obtained. Finally, this method was applied to a patient with hepatoma. PBA of perpendicular beams by ICT was 4.7% on average. With the increase in field size, the measured values became higher. PBA by ICT was greater than that by Type-S system and ECT. PBA increased significantly as the angle of incidence increased, ranging from 4.3% at 180 degrees to 11.2% at 120 degrees . Calculated doses obtained by the equation and correction factors agreed quite well with the measured doses between 120 degrees and 180 degrees of angles of incidence. Also in the patient, PBA by ICT was corrected quite well by the equation and correction factors. In conclusion, PBA and its gantry angle dependency by ICT were observed. This simple method using the equation and correction factors appeared useful to correct the isocenter dose when the PBA effect cannot be corrected by a treatment planning system.

Evaluation of all dose components in the LVR-15 reactor epithermal neutron beam using Fricke gel dosimeter layers.

Fricke gel dosimeters in the form of layers are suitable to reconstruct bidimensional distributions of the absorbed dose; in accordance with their chemical composition and applying suitably developed algorithms, they can provide dose images of the different radiation components in a BNCT field. After the description of the applied method, this work presents the results obtained at the epithermal column of the BNCT facility at the NRI in Rez (CZ). The measured dose distributions are shown in comparison with data taken by means of other dosimeters thermoluminescence dosimeters (TLDs) and with calculations carried out with the Monte Carlo code MCNP5. The agreement with the results obtained by means of the different techniques is satisfying.

Characterization of a fiber-coupled Al2O3:C luminescence dosimetry system for online in vivo dose verification during 192Ir brachytherapy.

A prototype of a new dose-verification system has been developed to facilitate prevention and identification of dose delivery errors in remotely afterloaded brachytherapy. The system allows for automatic online in vivo dosimetry directly in the tumor region using small passive detector probes that fit into applicators such as standard needles or catheters. The system measures the absorbed dose rate (0.1 s time resolution) and total absorbed dose on the basis of radioluminescence (RL) and optically stimulated luminescence (OSL) from aluminum oxide crystals attached to optical fiber cables (1 mm outer diameter). The system was tested in the range from 0 to 4 Gy using a solid-water phantom, a Varian GammaMed Plus 192Ir PDR afterloader, and dosimetry probes inserted into stainless-steel brachytherapy needles. The calibrated system was found to be linear in the tested dose range. The reproducibility (one standard deviation) for RL and OSL measurements was 1.3%. The measured depth-dose profiles agreed well with the theoretical expectations computed with the EGSNRC Monte Carlo code, suggesting that the energy dependence for the dosimeter probes (relative to water) is less than 6% for source-to-probe distances in the range of 2-50 mm. Under certain conditions, the RL signal could be greatly disturbed by the so-called stem signal (i.e., unwanted light generated in the fiber cable upon irradiation). The OSL signal is not subject to this source of error. The tested system appears to be adequate for in vivo brachytherapy dosimetry.

Clinic based transfer of the N(D,W)(60Co) calibration coefficient using a linear accelerator.

Ionization chambers used for reference dosimetry require a local secondary standard ionization chamber with a 60Co absorbed dose to water calibration coefficient N(D,W)(60Co) traceable to a national primary standards dosimetry laboratory or an accredited secondary dosimetry calibration laboratory. Clinic based (in-house) transfer of this coefficient to tertiary reference ionization chambers has traditionally been accomplished with chamber cross calibration in water using a 60Co beam; however, access to 60Co teletherapy machines has become increasingly limited for clinic based physicists. In this work, the accuracy of alternative methods of transferring the N(D,W)(60Co) calibration coefficient using 6 and 18 MV photon beams from a linear accelerator in lieu of 60Co has been investigated for five different setups and four commonly used chamber types.

LVR-15 reactor epithermal neutron beam parameters--results of measurements.

The epithermal neutron beam of the LVR-15 reactor provides the appropriate conditions for varied BNCT activity. The principal parameters have been frequently determined. The following detectors have been used for the measurement: set of activation monitors of different nuclides irradiated in free beam and in the water phantom, Si semiconductor detector with (6)LiF converter, twin ionization chambers, thermoluminescence dosimeters, gel dosimeters used for imaging of separate part of dose, neutron spectrometer of Bonner type. Obtained results of measured parameters are presented in the paper.

Magnetic field effects on the energy deposition spectra of MV photon radiation.

Several groups worldwide have proposed various concepts for improving megavoltage (MV) radiotherapy that involve irradiating patients in the presence of a magnetic field-either for image guidance in the case of hybrid radiotherapy-MRI machines or for purposes of introducing tighter control over dose distributions. The presence of a magnetic field alters the trajectory of charged particles between interactions with the medium and thus has the potential to alter energy deposition patterns within a sub-cellular target volume. In this work, we use the MC radiation transport code PENELOPE with appropriate algorithms invoked to incorporate magnetic field deflections to investigate electron energy fluence in the presence of a uniform magnetic field and the energy deposition spectra within a 10 microm water sphere as a function of magnetic field strength. The simulations suggest only very minor changes to the electron fluence even for extremely strong magnetic fields. Further, calculations of the dose-averaged lineal energy indicate that a magnetic field strength of at least 70 T is required before beam quality will change by more than 2%.

Patient-specific radiation dosimetry for radionuclide therapy of liver tumors with intrahepatic artery rhenium-188 lipiodol.

A clinically practical algorithm has been developed for the treatment of liver cancer by the administration of rhenium-188 ((188)Re)-labeled lipiodol via the hepatic artery. This algorithm is based on the "maximum tolerated-activity" paradigm for radionuclide therapy. A small "scout" activity of (188)Re-labeled lipiodol is administered to the patient before the actual therapeutic administration. At approximately 3 hours after administration, the activities in the normal liver, liver tumors, lungs, and total body are measured by gamma camera imaging using the conjugate-view method, with first-order corrections for attenuation (using a (188)Re transmission scan) and scatter (using the "dual-window" method). At the same time, peripheral blood samples are counted, and the activity concentrations in whole blood are calculated. The blood activity concentrations are then converted to red marrow activity concentrations and then total red marrow activity using anatomic data from Standard Man anthropomorphic models. Next, the cumulated activities in the normal liver, liver tumors, lungs, red marrow, and total body are calculated using the measured activities in the respective source regions and conservatively assuming elimination of activity only by physical decay in situ. The absorbed doses to the therapy-limiting normal tissues, liver, lung, and red marrow, are then calculated using the Medical Internal Radiation Dose Committee schema, adjusting the pertinent S factors for differences in total body and organ masses between the patient and the anthropomorphic model and including the dose contribution from the liver tumors. Finally, based on maximum tolerated absorbed doses of 3,000, 1,200, and 150 rad (cGy) to liver, lung, and red marrow, the respective absorbed doses per unit administered activity are used to calculate the therapy activity. Although not required for treatment planning, tumor absorbed dose may also be estimated. This algorithm has been automated using an Excel (Microsoft, Redmond, WA) spreadsheet.

Calculations of electron fluence correction factors using the Monte Carlo code PENELOPE.

In electron-beam dosimetry, plastic phantom materials may be used instead of water for the determination of absorbed dose to water. A correction factor phi(water)plastic is then needed for converting the electron fluence in the plastic phantom to the fluence at an equivalent depth in water. The recommended values for this factor given by AAPM TG-25 (1991 Med. Phys. 18 73-109) and the IAEA protocols TRS-381 (1997) and TRS-398 (2000) disagree, in particular at large depths. Calculations of the electron fluence have been done, using the Monte Carlo code PENELOPE, in semi-infinite phantoms of water and common plastic materials (PMMA, clear polystyrene, A-150, polyethylene, Plastic water and Solid water (WT1)). The simulations have been carried out for monoenergetic electron beams of 6, 10 and 20 MeV, as well as for a realistic clinical beam. The simulated fluence correction factors differ from the values in the AAPM and IAEA recommendations by up to 2%, and are in better agreement with factors obtained by Ding et al (1997 Med. Phys. 24 161-76) using EGS4. Our Monte Carlo calculations are also in good accordance with phi(water)plastic values measured by using an almost perturbation-free ion chamber. The important interdependence between depth- and fluence-scaling corrections for plastic phantoms is discussed. Discrepancies between the measured and the recommended values of phi(water)plastic may then be explained considering the different depth-scaling rules used.

Smoothing Monte Carlo calculated dose distributions by iterative reduction of noise.

A smoothing algorithm based on an optimization procedure is presented and evaluated for single electron and photon beams and a full intensity modulated radiation therapy (IMRT) delivery. The algorithm iteratively reduces the statistical noise of Monte Carlo (MC) calculated dose distributions. It is called IRON (iterative reduction of noise). By varying the dose in each voxel, the algorithm minimizes the second partial derivatives of dose with respect to X, Y and Z. An additional restoration term ensures that too large dose changes are prevented. IRON requires a MC calculated one-dimensional or three-dimensional dose distribution with or without known statistical uncertainties as input. The algorithm is tested using three different treatment plan examples, a photon beam dose distribution in water, an IMRT plan of a real patient and an electron beam dose distribution in a water phantom with inhomogeneities. It is shown that smoothing can lead to an additional reduction of MC calculation time by factors of 2 to 10. This is especially useful if MC dose calculation is part of an inverse treatment planning system. In addition to this, it is shown that smoothing a noisy dose distribution may introduce some bias into the final dose values by converting the statistical uncertainty of the dose distribution into a systematic deviation of the dose value.

An energy-based beam hardening model in tomography.

As a consequence of the polychromatic x-ray source, used in micro-computer tomography (microCT) and in medical CT, the attenuation is no longer a linear function of absorber thickness. If this nonlinear beam hardening effect is not compensated, the reconstructed images will be corrupted by cupping artefacts. In this paper, a bimodal energy model for the detected energy spectrum is presented, which can be used for reduction of artefacts caused by beam hardening in well-specified conditions. Based on the combination of the spectrum of the source and the detector efficiency, the assumption is made that there are two dominant energies which can describe the system. The validity of the proposed model is examined by fitting the model to the experimental datapoints obtained on a microtomograph for different materials and source voltages.

Comparison of high-energy photon and electron dosimetry for various dosimetry protocols.

The American Association of Physicists in Medicine Task Group 51 (TG-51) and the International Atomic Energy Agency (IAEA) published a new high-energy photon and electron dosimetry protocol, in 1999 and 2000, respectively. These protocols are based on the use of an ion chamber having an absorbed-dose to water calibration factor with a 60Co beam. These are different from the predecessors, the TG-21 and IAEA TRS-277 protocols, which require a 60Co exposure or air-kerma calibration factor. The purpose of this work is to present the dose comparison between various dosimetry protocols and the AAPM TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. The absorbed-dose to water calculated according to the Japanese Association of Radiological Physics (JARP), International Atomic Energy Agency Technical Report Series No. 277 (IAEA TRS-277) and No. 398 (IAEA TRS-398) protocols is compared to that calculated using the TG-51 protocol. For various Farmer-type chambers in photon beams, TG-51 is found to predict 0.6-2.1% higher dose than JARP. Similarly, TG-51 is found to be higher by 0.7-1.7% than TRS-277. For electron beams TG-51 is higher than JARP by 1.5-3.8% and TRS-277 by 0.2-1.9%. The reasons for these differences are presented in terms of the cavity-gas calibration factor, Ngas, and a dose conversion factor, Fw, which converts the absorbed-dose to air in the chamber to the absorbed-dose to water. The ratio of cavity-gas calibration factors based on absorbed-dose to water calibration factors, N60Co(D,w), in TG-51 and cavity-gas calibration factors which are equivalent to absorbed-dose to air chamber factors, N(D,air), based on the IAEA TRS-381 protocol is 1.008 on average. However, the estimated uncertainty of the ratio between the two cavity-gas calibration factors is 0.9% (1 s.d.) and consequently, the observed difference of 0.8% is not significant. The absorbed-dose to water and exposure or air-kerma calibration factors are based on standards traceable to the National Institute of Standards and Technology (NIST). In contrast, the absorbed-dose to water determined with TRS-398 is in good agreement with TG-51 within about 0.5% for photon and electron beams.

Dosimetric investigation and portal dose image prediction using an amorphous silicon electronic portal imaging device.

A two step algorithm to predict portal dose images in arbitrary detector systems has been developed recently. The current work provides a validation of this algorithm on a clinically available, amorphous silicon flat panel imager. The high-atomic number, indirect amorphous silicon detector incorporates a gadolinium oxysulfide phosphor scintillating screen to convert deposited radiation energy to optical photons which form the portal image. A water equivalent solid slab phantom and an anthropomorphic phantom were examined at beam energies of 6 and 18 MV and over a range of air gaps (approximately 20-50 cm). In the many examples presented here, portal dose images in the phosphor were predicted to within 5% in low-dose gradient regions, and to within 5 mm (isodose line shift) in high-dose gradient regions. Other basic dosimetric characteristics of the amorphous silicon detector were investigated, such as linearity with dose rate (+/- 0.5%), repeatability (+/- 2%), and response with variations in gantry rotation and source to detector distance. The latter investigation revealed a significant contribution to the image from optical photon spread in the phosphor layer of the detector. This phenomenon is generally known as "glare," and has been characterized and modeled here as a radially symmetric blurring kernel. This kernel is applied to the calculated dose images as a convolution, and is successfully demonstrated to account for the optical photon spread. This work demonstrates the flexibility and accuracy of the two step algorithm for a high-atomic number detector. The algorithm may be applied to improve performance of dosimetric treatment verification applications, such as direct image comparison, backprojected patient dose calculation, and scatter correction in megavoltage computed tomography. The algorithm allows for dosimetric applications of the new, flat panel portal imager technology in the indirect configuration, taking advantage of a greater than tenfold increase in detector sensitivity over a direct configuration.

A measured data set for evaluating electron-beam dose algorithms.

The purpose of this work was to develop an electron-beam dose algorithm verification data set of high precision and accuracy. Phantom geometries and treatment-beam configurations used in this study were similar to those in a subset of the verification data set produced by the Electron Collaborative Working Group (ECWG). Measurement techniques and quality-control measures were utilized in developing the data set to minimize systematic errors inherent in the ECWG data set. All measurements were made in water with p-type diode detectors and using a Wellhöfer dosimetry system. The 9 and 20 MeV, 15 x 15 cm2 beams from a single linear accelerator composed the treatment beams. Measurements were made in water at 100 and 110 cm source-to-surface distances. Irregular surface measurements included a "stepped surface" and a "nose-shaped surface." Internal heterogeneity measurements were made for bone and air cavities in differing orientations. Confidence in the accuracy of the measured data set was reinforced by a comparison with Monte Carlo (MC)-calculated dose distributions. The MC-calculated dose distributions were generated using the OMEGA/BEAM code to explicitly model the accelerator and phantom geometries of the measured data set. The precision of the measured data, estimated from multiple measurements, was better than 0.5% in regions of low-dose gradients. In general, the agreement between the measured data and the MC-calculated data was within 2%. The quality of the data set was superior to that of the ECWG data set, and should allow for a more accurate evaluation of an electron beam dose algorithm. The data set will be made publicly available from the Department of Radiation Physics at The University of Texas M. D. Anderson Cancer Center.

Conformal photon-beam therapy with transverse magnetic fields: a Monte Carlo study.

This work studies the idea of using strong transverse magnetic (B) fields with high-energy photon beams to enhance dose distributions for conformal radiotherapy. EGS4 Monte Carlo code is modified to incorporate charged particle transport in B fields and is used to calculate effects of B fields on dose distributions for a variety of high-energy photon beams. Two types of hypothetical B fields, curl-free linear fields and dipole fields, are used to demonstrate the idea. The major results from the calculation for the linear B fields are: (1) strong transverse B fields (> 1 T) with high longitudinal gradients (G) (> 0.5 T/cm) can produce dramatic dose enhancement as well as dose reduction in localized regions for high-energy photon beams; (2) the magnitude of the enhancement (reduction) and the geometric extension and the location of this enhancement (reduction) depend on the strength and gradient of the B field, and photon-beam energy; (3) for a given B field, the dose enhancement generally increases with photon-beam energy; (4) for a 5 T B field with infinite longitudinal gradient (solenoidal field), up to 200% of dose enhancement and 40% of dose reduction were obtained along the central axis of a 15 MV photon beam; and (5) a 60% of dose enhancement was observed over a 2 cm depth region for the 15 MV beam when B = 5 T and G = 2.5 T/cm. These results are also observed, qualitatively, in the calculation with the dipole B fields. Calculations for a variety of B fields and beam configurations show that, by employing a well-designed B field in photon-beam radiotherapy, it is possible to achieve a significant dose enhancement within the target, while obtaining a substantial dose reduction over critical structures.

Measurement of the dose components of fast and thermal neutrons and photons from a 0.1 mg 252Cf source in water for brachytherapy treatment planning.

The use of 252Cf in brachytherapy is expected to be more effective with the therapy of bulky tumors than the conventional therapy with photons. For treatment planning a code developed for calculation of gamma dose was used to generate the dose distributions of fast and 10B enhanced thermal neutrons and photons. Dose distributions of these components measured with ionization chambers and a GM counter were fitted to analytical functions as required by the modified treatment planning program. A comparison of these experimental results and the treatment planning output indicate good agreement. Therefore, the program may be used to optimize the brachytherapy procedure considering all three dose components. A realistic case of a patient being treated with conventional brachytherapy has been used to calculate the dose distribution that would be obtained by use of the 252Cf source.

Experimental measurements of dosimetric parameters on the transverse axis of a new 125I source.

Permanent prostate implant using 125I or 103Pd sources is a common treatment choice in the management of early prostate cancer. As sources of new designs are developed and marketed for application in permanent prostate implants, it is of paramount importance that their dosimetric characteristics are carefully determined, in order to maintain a high accuracy of patient treatment. This report presents the results of experimental measurements of the dosimetric parameters performed for a newly available 125I seed source, the model MED3631-A/M source (IoGold), manufactured by North American Scientific, Inc. The measurements were performed in a large scanning water phantom, using a diode detector. The positioning of the source and the diode detector was achieved by a computer-controlled positioning mechanism in the scanning water phantom. The dose rate constant in water for the new 125I source was measured in comparison with an existing 125I source of similar design and verified using thermoluminescent dosimetry (TLD) measurement. The radial dose function values for the source were measured using the diode detector. The measurement technique and the results are compared with the dose distribution parameters for the 125I sources discussed in the AAPM TG43 report and elsewhere [Med. Phys. 26, 570-573 (1999)]. For the dose rate constant in water of the new source, it is recommended that a value of 0.950 cGy/U-hr be used based on the NIST 1985 air-kerma strength calibration standard, or 1.060 cGy/U-hr based on the 1999 NIST air-kerma strength standard. The measured radial dose function values for the MED3631-A/M source agree closely with those of the model 6702 source. It is therefore recommended that the radial dose function values for the model 6702 125I source, as recommended by the AAPM TG43 report, be adopted for the new source as well.

Monte Carlo calculations and experimental measurements of dosimetry parameters of a new 103Pd source.

Permanent prostate implantation using 125I (iodine) or 103Pd (palladium) sources is a popular treatment option in the management of early prostate cancer. As sources of new designs are developed and marketed for application in permanent prostate implantations, their dosimetric characteristics must be carefully determined in order to maintain the accuracy of patient treatment. This report presents the results of experimental measurements and Monte Carlo calculations of the dosimetric parameters performed for a newly available 103Pd seed source. The measurements were performed in a large scanning water phantom using a diode detector. The positioning of the source and detector was achieved by a computer-controlled positioning mechanism in the scanning water phantom. The dose rate constant in water for the new 103Pd source was determined from measurements with the diode detector calibrated with 125I sources of known air-kerma strength. The radial dose function values for the source were measured using the diode detector. Monte Carlo photon transport calculations were then used to calculate the dosimetric parameters of dose rate constant, radial dose function, and anisotropy function using an accurate geometric model of the source. The measured dose rate constant of 0.693 cGy/U-hr compares well with the Monte Carlo calculated value of 0.677 cGy/U-hr. These results are further compared with data on existing 103Pd sources.