Modeling of a tissue expander with a radiofrequency identification port in postmastectomy radiation therapy planning.

The purpose of this study was to evaluate the dose attenuation of Motiva Flora® (Flora, Establishment Labs, Alajuela, Costa Rica) tissue expander with a radiofrequency identification port locator and to develop a model for accurate postmastectomy radiation therapy planning. Dose attenuation was measured using an EBT3 film (Ashland, Bridgewater, NJ), and the optimal material and density assignment for the radiofrequency identification coil for dose calculation were investigated using the AcurosXB algorithm on the Eclipse (Varian Medical Systems, Palo Alto, CA) treatment planning system. Additionally, we performed in vivo dosimetry analysis using irradiation tangential to the Flora tissue expander to validate the modeling accuracy. Dose attenuations downstream of the Flora radiofrequency identification coil was 1.29% for a 6 MV X-ray and 0.99% for a 10 MV X-ray when the coil was placed perpendicular to the beam. The most suitable assignments for the material and density of the radiofrequency identification coil were aluminum and 2.27 g/cm3, respectively, even though the coil was actually made of copper. Gamma analysis of in vivo dosimetry with criteria of 3% and 2 mm did not fail in the coil region. Therefore, we conclude that the model is reasonable for clinical use.

[Evaluation on the Availability of the Electrometer Inspection by Users Using a Newly Developed Current Source].

BACKGROUND: If we try to perform the inspection for an electrometer, two types of electronic signals energized to the electrometer can be used. One is the signal that occurs in the ionization chamber irradiated by radiation. The other is the signal that is derived from a current source. The former signal is changed by radiation output, so we need to use two or more sets of the chambers and the electrometers in the inspection. In addition, the high-performance current source is relatively expensive. Therefore, it is difficult for users to inspect the electrometer simply. To deal with these, we have developed a new current source that allows users to perform highly accurate electrometer inspections at their own facilities. AIM: The purpose of this study was to verify that users can perform electrometer inspections with high accuracy in their own facilities by using a new current source. MATERIALS AND METHODS: A newly current source equips a dry cell battery as a charge generator. Current, polarity, and energized time can be changed by the source setting. We conducted an inspection by energizing the electrometer using the developed current source. RESULTS: The coefficient of variation of the charge amount in the measurement using the new current source was within 0.05%. The electrometer calibration coefficients measured by sensitivity comparison using this current source could be obtained based on electrometers calibrated at a certified facility of the Japan Calibration Service System. CONCLUSION: We have shown that the new current source can be used as a relative current value by using a calibrated electrometer as a reference, indicating that the user can check the electrometer.

NEW IDEA FOR DETERMINING THE OPTIMAL NUMBER OF MEASUREMENTS IN ABSORBED DOSE-TO-WATER MEASUREMENT OF HIGH-ENERGY PHOTON BEAM.

This study presents a new idea for estimating the number of measurements required for determining the uncertainty in obtaining the desired water absorbed dose using the variation obtained from multicenter absorbed dose measurement data. The number of dose measurements depends on the performance of each linear accelerator (LINAC) tested and the dosimetry equipment and procedure used. However, optimising the number of data collected for the absorbed dose to water has been inadequately reported. Using the absorbed dose measurement data collected 10 times as a reference value, we will compare the changes in the variation of the measurement results caused by the difference in the number of repeated measurements of the absorbed dose. The number of measurements is determined statistically such that this variation would be smaller than the change in absorbed dose. Thus, we can determine the optimum number of measurements suitable for the variability of each LINAC.

Dosimetric comparison between three-dimensional conformal radiotherapy followed by electron beam boost and volumetric modulated arc therapy using concomitant boost for the heart and cardiac segments in patients with left-sided breast cancer at risk for radiation-induced cardiac toxicity.

PURPOSE: We aimed to compare dosimetric parameters between three-dimensional conformal radiation therapy followed by electron beam boost (3D-CRT + EB) and volumetric modulated arc therapy using simultaneous integrated boost (SIB-VMAT) in left-sided breast cancer patients. METHODS: This study included 57 patients with left-sided breast cancer who underwent SIB-VMAT. All patients had a computed tomography-based maximum heart distance of ≥ 1 cm and were prescribed a dose of 42.56 Gy/16 fractions to the planning target volume and a concomitant-boosted target dose of 53.2 Gy or 51.2 Gy. The 3D-CRT + EB plan was retrospectively created for the purpose of comparison using tangential fields with field-in-field technique followed by electron beam irradiation. RESULTS: The doses to the clinical target volume significantly improved in the SIB-VMAT plans. All dosimetric parameters for the left anterior descending coronary artery (LAD) and LAD middle position (LAD mid) in the SIB-VMAT plans were significantly lower than those for 3D-CRT + EB plans (P < 0.01), while the doses to the heart, lung, contralateral breast and non-target tissue were decreased in the 3D-CRT + EB plans compared with those in the SIB-VMAT plans (e.g., 1.9 Gy vs. 2.9 Gy; P < 0.001 for the mean dose of heart). CONCLUSIONS: SIB-VMAT significantly improved the dose to the target while reducing the doses to the LAD and LAD mid, whereas 3D-CRT + EB significantly decreased the doses to the heart and other organs at risk in patients with left-sided breast cancer at risk for radiation-induced coronary artery disease.

[Invention and Evaluation of a Novel Air Leak Check System for Vacuum-type Patient Immobilization Device].

PURPOSE: We developed a novel system to measure air leakage in vacuum cushions, which are used in high-precision radiation therapy. The purpose of this study was to verify the usefulness of this system by evaluating the accuracy and the capability for detecting air leakage. METHODS AND RESULTS: The novel system was used to measure pressure in the cushion using a manometer. The advantage of this system was that we can measure the pressure without deformation of the cushion and check the pressure immediately. We confirmed that the pressure measured using this system is proportional to the reading in the reference manometer by the coefficient of 1.0. This system had a higher capability in the leak detection than the capability by checking softness in our sense of touch. We checked the leakage using this system against 18 cushions without air leakage (NL group) and 7 cushions that had problems regarding usage in patients due to the leakage (CW group). Average pressure variations in the NL group and the CW group were 22 kPa and 46 kPa, respectively. This was a significant difference in both groups. We could decide the criteria of pressure in the cushions that may cause troubles in the future use. CONCLUSION: We concluded that this system can detect air leakage in the cushions with a higher detectivity than our tactile sense.

[Influence of Respiratory Phase during Image Acquisition on Prescribed Dose in Image Guided Radiation Therapy Using Implant Marker for Prostate Cancer].

In image guided radiation therapy (IGRT) using implanted fiducial marker by two-dimensional radiography for prostate cancer, temporal positional relationship during treatment between the isocenter and the prostate is changed by respiratory phase at the time of image acquisition. We examined influence of the respiratory phase in the IGRT on dose variation by interplay effect. Intra-fractional prostate motions of patients who were implanted fiducial marker were measured using fluoroscopy, then we reconstructed plans considering for the respiratory phase in IGRT and the respiratory motion during volumetric modulated arc therapy. Averages of the intra-fractional prostate motion in left-right, anterior-posterior and superior-inferior direction were 0.039, 0.49 and 1.6 mm respectively. There was a patient whose intra-fractional prostate motion was larger than 4 mm that was planning target volume margin. By changing the respiratory phase like inspiration, exhalation and dispersing respiratory phase in each fraction, dose variation from original plan became smaller in order of the inspiration, exhalation and dispersion. The largest variations of dose indices in clinical target volume, bladder and rectum were 8.0%, 4.5% and 9.1% respectively when IGRT was done in inspiration. When the IGRT is performed by the same respiratory phase in each fraction, systematic dose variations may occur even if the respiratory phase at the timing of irradiation is changed. By dispersing the respiratory phase in each fraction, the variations in all dose indices were<1% from original plan. We realized that dispersing the respiratory phase in IGRT by each fraction is effective to reduce the dose variation caused by the respiratory phase in IGRT.

Evaluation of organ-at-risk dose reduction with jaw tracking technique in flattening filter-free beams in lung stereotactic body radiation therapy.

PURPOSE: (i) to investigate the capability of organ-at-risk (OAR) dose reduction with the jaw tracking (JT) technique in flattening filter-free (FFF) beams in lung stereotactic body radiation therapy (SBRT), (ii) to propose a novel metric to quantify the jaw movements during JT, and (iii) to examine the relationships between the quantified jaw movements and reduction rate of OAR doses. METHODS: The individual SBRT plans with volumetric modulated arc therapy using the JT technique (JT-VMAT) and VMAT plans with a fixed jaw (FJ-VMAT) were created for 15 patients, and dosimetric parameters were compared. A jaw tracking complexity score (JTCS) was defined and compared with the multi-leaf collimator (MLC) modulation complexity score (MCS). The correlations between the JTCS and reduction rate of OAR doses were examined. RESULTS: The decrease of OARs doses was statistically significant in the JT-VMAT plans (1.2% in V20 of the lung and <1% in all other OARs). The correlations between the JTCS and MCS were not significant. There were significant correlations between the JTCS and the reduction rates in V20, V2.5, and Dmean of the lung, D1% of the spinal cord, and D90% of the body. CONCLUSIONS: A significant decrease of dosimetric parameters of OARs was found with JT-VMAT in FFF beams. This reduction is very small and probably not clinically relevant. JTCS, a novel metric to quantify the jaw movements during JT, was proposed, and the complexity of jaw movements did not correlate with that of the movements of MLC leaves. There were significant correlations between the JTCS and some dosimetric parameters of OARs.

[Impact of Respiratory Motion on Dose Variation in Radiation Therapy for Glottic Cancer].

In radiation therapy for glottic cancer, respiratory motion of larynx may change the dose variation in the target. The purpose of this study is to measure the respiratory motion of the larynx, and quantify the impact of the motion on the dose variation. This study included 10 patients treated by opposing portal irradiation for glottic cancer. We acquired fluoroscopy and respiratory waveform of the patients simultaneously and formulated the relationship between the displacement of larynx and the respiratory phase. We divided one field into 39 sub-fields on the basis of control points. Dose distributions accounting for the displacement were calculated by shifting isocenter calculated using the formula in every sub-fields. Dose variations of clinical target volume (CTV) were evaluated by subtracting dose distributions with displacement consideration and dose distributions without it. Average amplitude and the maximum amplitude of respiratory motion were 2.5 and 8.7 mm, respectively. Average of mean dose variation in CTV was 0.1% of the prescribed dose, and maximum of local dose variation was 2.0% of the prescribed dose. Hence, it is realized that dose variation in CTV by respiratory motion was slight.

Impact of Jaw Position Accuracy on Dose Variation in Volumetric Modulated Arc Therapy Using Jaw Tracking.

The technique of jaw tracking can be used in volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT). In this technique, jaw tracks apertures of the multi leaf collimator (MLC) during irradiation. It is reported that dose variation is occurred by the changing accuracy of MLC position in VMAT and IMRT. Though jaw moves dynamically in the irradiation by using this technique, the influence of the jaw position accuracy on dose variation is not examined. The purpose of this study is to verify the influence of jaw position accuracy on dose variation in VMAT using jaw tracking. We appended intentional errors on jaw position in digital image communication in medicine-radiation therapy (DICOM-RT) plans created using jaw tracking technique. These plans were irradiated on the phantom that was inserted ion chamber, and we measured dose variation by changing the intentional error. The dose variation in planning target volume (PTV) was enlarged by increasing the error, and agreed with the variation of a collimator scatter factor within 0.03%. In clinical case of oropharyngeal cancer, the maximum dose variations in parotid gland were 0.179% and 1.23% when the errors were 1 mm and 10 mm, respectively. Dose variation in parotid gland was larger than the variation in PTV and spinal cord because of increasing MLC transmission. The dose variation caused by jaw position error was smaller than it caused by MLC position error. So, we can keep the dose error slightly that is related to jaw position error in VMAT by maintaining jaw position accuracy correctly.

[Optimal parameter decision method in VMAT for lung tumors with respiratory motions].

When performing lung cancer treatments using volumetric modulated arc therapy (VMAT) technique, dose error related to respiratory motion of tumors and multi leaf collimator (MLC) movement may occur. The dose error causes daily dose variation in multiple fractionations irradiation. The purpose of this study is to verify the influence of the respiratory motion and the MLC movement on the daily dose variation, and to confirm the feasibility of deciding robust planning parameter against the dose variation. We prepared 5 VMAT plans for imitating lung tumor in thorax dynamic phantom. Dose calculations of these plans were done taking into account the respiratory motions. We examined the relation between dose variation and two parameters that were number of respiration in an arc and MLC gap width. We presented the relationship between the dose variation and each parameters using regression analysis, and we could derive the approximation formula for estimating the dose variation using these parameters. We could estimate dose variation in another VMAT plans using the approximation formula and another plans parameters. By confirming dose variation in planning procedure using this estimation method, we may decide planning parameter taking the dose variation into account. So, we could establish the estimation method to decide adequate planning parameters in VMAT.

[Impact of dynamic parameters on dose delivery accuracy in volumetric modulated arc therapy].

Volumetric modulated arc therapy (VMAT) is an irradiation method in which the multi-leaf collimator (MLC) shape, gantry speed and dose-rate is continuously varied. Gantry speed and dose-rate are treated as specific dynamic parameters (DPs) in VMAT, so there is a need to confirm the influence of DPs on dose distribution. The purpose of this study was to verify the impact of DPs on the accuracy of dose delivery in VMAT. We adopted an irradiation scenario in which DPs were modified from the original plan without making any changes in the dose distribution. We carried out irradiation and measured the dose distributions using a Delta4 diode array phantom, during which we acquired log files that enabled us to calculate DPs. The results showed that dose errors exceeding 1% or geometric errors greater than 1 mm were not produced by modifying the DPs. We were therefore able to verify the impact of DPs on dose delivery accuracy in VMAT.

Optimal radiation shielding for beta and bremsstrahlung radiation emitted by (89)Sr and (90)Y: validation by empirical approach and Monte Carlo simulations.

OBJECTIVE: High-energy beta emitters such as Strontium-89 ((89)Sr) and Yttrium-90 ((90)Y) are becoming increasingly popular nuclear therapy sources in Japan for treating cancer. Various characteristics of materials must be considered when designing radiation protection device for high-energy beta emitters. We empirically measured and simulated dose equivalents of beta and bremsstrahlung radiation arising from (89)Sr and (90)Y radiation shielded with various materials and determined optimal shielding materials against these sources. METHODS: The dose equivalents of (89)Sr and (90)Y determined experimentally using an ionization chamber survey meter were compared with those of Monte Carlo simulations. The relative dose equivalents of beta and bremsstrahlung radiation separately transmitted by changing the thickness of acrylic, aluminum, iron, lead and tungsten shielding materials were simulated. RESULTS: Dose equivalents were consistent between the empirical measurements and the simulation to within ±5%. Shielding ability was more effective in the order of tungsten, lead, iron, aluminum and acrylic against both (89)Sr and (90)Y. The amount of beta and bremsstrahlung radiation transmitted through tungsten and lead was relatively small. Although such high-density material generates much bremsstrahlung radiation, it absorbs the bremsstrahlung radiations. CONCLUSIONS: Tungsten was the optimal material for efficient shielding against (89)Sr and (90)Y radiation and preferable among operators. The present findings provide useful information about how to define an appropriate shielding strategy for high-energy beta emitters.

[A practical procedure to improve the accuracy of radiochromic film dosimetry: a integration with a correction method of uniformity correction and a red/blue correction method].

It has been reported that the light scattering could worsen the accuracy of dose distribution measurement using a radiochromic film. The purpose of this study was to investigate the accuracy of two different films, EDR2 and EBT2, as film dosimetry tools. The effectiveness of a correction method for the non-uniformity caused from EBT2 film and the light scattering was also evaluated. In addition the efficacy of this correction method integrated with the red/blue correction method was assessed. EDR2 and EBT2 films were read using a flatbed charge-coupled device scanner (EPSON 10000G). Dose differences on the axis perpendicular to the scanner lamp movement axis were within 1% with EDR2, but exceeded 3% (Maximum: +8%) with EBT2. The non-uniformity correction method, after a single film exposure, was applied to the readout of the films. A corrected dose distribution data was subsequently created. The correction method showed more than 10%-better pass ratios in dose difference evaluation than when the correction method was not applied. The red/blue correction method resulted in 5%-improvement compared with the standard procedure that employed red color only. The correction method with EBT2 proved to be able to rapidly correct non-uniformity, and has potential for routine clinical IMRT dose verification if the accuracy of EBT2 is required to be similar to that of EDR2. The use of red/blue correction method may improve the accuracy, but we recommend we should use the red/blue correction method carefully and understand the characteristics of EBT2 for red color only and the red/blue correction method.

Measurement of absorbed doses in organs of medical staff at (18)F-FDG pet examination.

In this study, the organ doses were measured using a human- body phantom simulating a medical staff member, and we considered an effective method for decreasing exposure to staff in positron emission tomography examinations. A fluorescence glass dosimeter was arranged for measurements in various organs. Regarding exposure, the average ratio of the dose at 100 cm from the source to the dose at 30 cm was 0.35. The ratio of the dose at 100 cm with a 3 cm lead shield to the dose at 100 cm with no shielding device was 0.01. To reduce the radiation exposure effectively, medical staff members should inform the patient of the details of the examination in advance, reduce the contact time with the patient during the examination, and maximize their distance from the patient when contact is necessary.

Estimation of Background Radiation from e-LINAC for Direct Confirmation of Irradiated Area by Utilizing the Annihilation Photons.

In radiation therapy, there is no suitable method to confirm either the three-dimensional irradiated area or the absorbed dose during irradiation. If there were such a method it would allow verification of the absorbed dose as well as help to avoid extraneous irradiation. We previously proposed a method utilizing annihilation photons generated by therapeutic photon beams to measure the irradiated area directly during irradiation. In the present study, we designed and fabricated a fast YAP:Ce scintillation counter which uses a compact photosensor to measure annihilation photons. The energy resolution and detection efficiency were obtained experimentally using a (22)Na planar source. We measured count rates of background radiation by using the detector and estimated those of background radiation from an e-LINAC by correcting for detection efficiency. The obtained energy resolution of the YAP:Ce scintillation detector was 12.16+/-3.5% and its detection efficiency was 28.36+/-5.3%. The counting rates of background radiation from e-LINAC were approximately from 10(8) to 10(9) cps, and were proportional to the e-LINAC dose rate. Our developed detector had a high sensitivity, good time resolution and compact size which allows for easy radiation shielding. Therefore, we concluded that it was both practical and effective for the measurement of the position-distribution of annihilation photons.

Examination of beam profile measurement using an imaging plate by the light exposure fading method for quality assurance of external radiation therapy.

High-resolution film dosimetry has been used for several decades to check and to measure two-dimensional dose distributions. However, in recent years, the automatic processor has been replaced by the spread of computed radiography, or has been little used hospitals. In this study, we measured the off-center ratio (OCR) of the open field, after an irradiating radiation beam was delivered to the imaging plate (IP) under conditions in which the IP was exposed to a fixed amount of light with fading, and compared these data with the OCR measured by an ionization-chamber dosimeter, which is the standard method used for measuring radiation dose. Profile measurement using IP could be achieved by performing light fading, even at a range of more than 100 MU. Further, by using a metallic filter, we succeeded in demonstrating that the profile measurement of IP in an open irradiation field could approximate the values of those obtained by an ionization chamber dosimeter. This method can serve as a simple, easy-to-use method for evaluating the QA of dose distribution in radiation therapy.

[A Generator of Mono-energetic Electrons for Response Test of Charged Particle Detectors.].

We designed and fabricated a generator of mono-energetic electrons for the response test of charged particle detectors, which is used to measure fragmented particles of the carbon beam for cancer therapy. Mono-energetic electrons are extracted from (90)Sr by analyzing the energy of beta rays in the generator with a magnetic field. We evaluated performance parameters of the generator such as the absolute energy, the energy resolution and the counting rates of extracted electrons. The generator supplies mono-energetic electrons from 0.5MeV to 1.7MeV with the energy resolution of 20% in FWHM at higher energies than 1.0MeV. The counting rate of electrons is 400cpm at the maximum when the activity of (90)Sr is 298kBq. The generator was used to measure responses of fragmented-particle detectors and to determine the threshold energy of the detectors. We evaluated the dependence of pulse height variation on the detector position and the threshold energy by using the generator. We concluded this generator is useful for the response test of general charged particle detectors.