Using a 2D detector array for meaningful and efficient linear accelerator beam property validations.

Following linear accelerator commissioning, the qualified medical physicist is responsible for monitoring the machine's ongoing performance, detecting and investigating any changes in beam properties, and assessing the impact of unscheduled repairs. In support of these responsibilities, the authors developed a method of using a 2D ionization chamber array to efficiently test and validate important linear accelerator photon beam properties. A team of three physicists identified critical properties of the accelerator and developed constancy tests that were sensitive to each of the properties. The result was a 14-field test plan. The test plan includes large and small fields at varying depths, a reduced SSD field at shallow depth for sensitivity to extra focal photon and electron components, and analysis of flatness, symmetry, dose, dose profiles, and dose ratios. Constancy tests were repeated five times over a period of six weeks and used to set upper and lower investigation levels at ± 3 SDs. Deliberate variations in output, penumbra, and energy were tested to determine the suitability of the proposed method. Measurements were also performed on a similar, but distinct, machine to assess test sensitivity. The results demonstrated upper and lower investigation levels significantly smaller than the comparable TG-142 annual recommendations, with the exception of the surrogate used for output calibration, which still fell within the TG-142 monthly recommendation. Subtle changes in output, beam energy, and penumbra were swiftly identified for further investigation. The test set identified the distinct nature of the second accelerator. The beam properties of two photon energies can be validated in approximately 1.5 hrs using this method. The test suite can be used to evaluate the impact of minor repairs, detect changes in machine performance over time, and supplement other machine quality assurance testing.

Validation of a radiographic model for the assessment of mesh migration.

BACKGROUND: The natural history of laparoscopically placed mesh remains uncharacterized. Mesh migration is not infrequently discovered at reoperation and implicated as a cause of hernia recurrence, and it has also been associated with more serious complications, such as enteric and bladder erosion and fistula formation. To date, there is no noninvasive method by which to reliably assess the in-vivo behavior of laparoscopically placed mesh. In this study, we devised and validated a safe and noninvasive model, utilizing computed radiography (CR), for measuring postoperative mesh migration that may be applied to the clinical setting. METHODS: The anatomical structures of the inguinal region were recreated using a skeletal male pelvic model. A sheet of commercially available surgical mesh, marked with three 5mm surgical clips at its medial and superior corners, was moved along the inguinal ligament wire for various random distances. The mesh displacement was measured from the model, and a CR film was obtained. The corresponding mesh displacement was then measured on the CR using two different calibration methods (calibration disk and clip measurement). RESULTS: A total of 60 measurements were made and recorded. There were no statistically significant differences between the true (as measured from the model) and CR-measured distances of mesh migration. In comparing the two methods, only method 1 (calibration disk) showed a tendency towards a significant difference when lateral or superior displacement was measured, but correlation remained excellent (r(2) = 0.99). All other measurements showed no significant difference and excellent correlation (r(2) > 0.96). Pearson's correlation coefficients showed no significant inter-rater variability using either of these methods. CONCLUSION: Our CR model reliably provides a noninvasive means to characterize mesh movement in the postoperative clinical setting. This should provide an instrument to facilitate future clinical evaluation of mesh migration in human trials.

Development of a 35-MHz piezo-composite ultrasound array for medical imaging.

This paper discusses the development of a 64-element 35-MHz composite ultrasonic array. This array was designed primarily for ocular imaging applications, and features 2-2 composite elements mechanically diced out of a fine-grain high-density Navy Type VI ceramic. Array elements were spaced at a 50-micron pitch, interconnected via a custom flexible circuit and matched to the 50-ohm system electronics via a 75-ohm transmission line coaxial cable. Elevation focusing was achieved using a cylindrically shaped epoxy lens. One functional 64-element array was fabricated and tested. Bandwidths averaging 55%, 23-dB insertion loss, and crosstalk less than -24 dB were measured. An image of a tungsten wire target phantom was acquired using a synthetic aperture reconstruction algorithm. The results from this imaging test demonstrate resolution exceeding 50 microm axially and 100 microm laterally.

Treatment planning for SBRT using automated field delivery: A case study.

Stereotactic body radiation therapy (SBRT) treatment planning and delivery can be accomplished using a variety of techniques that achieve highly conformal dose distributions. Herein, we describe a template-based automated treatment field approach that enables rapid delivery of more than 20 coplanar fields. A case study is presented to demonstrate how modest adaptations to traditional SBRT planning can be implemented to take clinical advantage of this technology. Treatment was planned for a left-sided lung lesion adjacent to the chest wall using 25 coplanar treatment fields spaced at 11° intervals. The plan spares the contralateral lung and is in compliance with the conformality standards set forth in Radiation Therapy and Oncology Group protocol 0915, and the dose tolerances found in the report of the American Association of Physicists in Medicine Task Group 101. Using a standard template, treatment planning was accomplished in less than 20 minutes, and each 10Gy fraction was delivered in approximately 5.4 minutes. For those centers equipped with linear accelerators capable of automated treatment field delivery, the use of more than 20 coplanar fields is a viable SBRT planning approach and yields excellent conformality and quality combined with rapid planning and treatment delivery. Although the case study discusses a laterally located lung lesion, this technique can be applied to centrally located tumors with similar results.

A 30-MHz piezo-composite ultrasound array for medical imaging applications.

Ultrasound imaging at frequencies above 20 MHz is capable of achieving improved resolution in clinical applications requiring limited penetration depth. High frequency arrays that allow real-time imaging are desired for these applications but are not yet currently available. In this work, a method for fabricating fine-scale 2-2 composites suitable for 30-MHz linear array transducers was successfully demonstrated. High thickness coupling, low mechanical loss, and moderate electrical loss were achieved. This piezo-composite was incorporated into a 30-MHz array that included acoustic matching, an elevation focusing lens, electrical matching, and an air-filled kerf between elements. Bandwidths near 60%, 15-dB insertion loss, and crosstalk less than -30 dB were measured. Images of both a phantom and an ex vivo human eye were acquired using a synthetic aperture reconstruction method, resulting in measured lateral and axial resolutions of approximately 100 microm.

Design of efficient, broadband single-element (20-80 MHz) ultrasonic transducers for medical imaging applications.

This paper discusses the design, fabrication, and testing of sensitive broadband lithium niobate (LiNbO3) single-element ultrasonic transducers in the 20-80 MHz frequency range. Transducers of varying dimensions were built for an f# range of 2.0-3.1. The desired focal depths were achieved by either casting an acoustic lens on the transducer face or press-focusing the piezoelectric into a spherical curvature. For designs that required electrical impedance matching, a low impedance transmission line coaxial cable was used. All transducers were tested in a pulse-echo arrangement, whereby the center frequency, bandwidth, insertion loss, and focal depth were measured. Several transducers were fabricated with center frequencies in the 20-80 MHz range with the measured -6 dB bandwidths and two-way insertion loss values ranging from 57 to 74% and 9.6 to 21.3 dB, respectively. Both transducer focusing techniques proved successful in producing highly sensitive, high-frequency, single-element, ultrasonic-imaging transducers. In vivo and in vitro ultrasonic backscatter microscope (UBM) images of human eyes were obtained with the 50 MHz transducers. The high sensitivity of these devices could possibly allow for an increase in depth of penetration, higher image signal-to-noise ratio (SNR), and improved image contrast at high frequencies when compared to previously reported results.

Design, fabrication, and evaluation of high frequency, single-element transducers incorporating different materials.

The performance of high frequency, single-element transducers depends greatly on the mechanical and electrical properties of the piezoelectric materials used. This study compares the design and performance of transducers incorporating different materials. The materials investigated include 1-3 lead zirconate titanate (PZT) fiber composite, lead titanate (PbTiO3) ceramic, poly(vinylidene fluoride) (PVDF) film, and lithium niobate (LiNbO3) single crystal. All transducers were constructed with a 3-mm aperture size and an f-number between 2 and 3. Backing and matching materials were selected based on design goals and fabrication limitations. A simplified coaxial cable tuning method was employed to match the transducer impedance to 50 ohms for the PZT fiber composite and PbTiO3 ceramic transducers. Transducers were tested for two-way loss and -6 dB bandwidth using the pulse/echo response from a flat quartz target. Two-way loss varied from 21 to 46 dB, and bandwidths measured were in the range from 47 to 118%. In vitro ultrasonic backscatter microscope (UBM) images of an excised human eye were obtained for each device and used to compare imaging performance. Both press-focusing and application of a lens proved to be useful beam focusing methods for high frequency. Under equal gain schemes, the LiNbO3 and PbTiO3 transducers provided better image contrast than the other materials.