Comparison of visual and semi-automated kilovoltage cone beam CT image QA analysis.

Established kilovoltage cone-beam computed tomography (kV-CBCT) image quality assurance (QA) guidelines often rely on recommendations provided by the American Association of Physicists in Medicine (AAPM) task group (TG) reports with metrics that use visual analysis. This can result in measurement variations by different users, especially in visually subjective analyzes such as low contrast resolution. Consequently, there is a growing interest in more automated means of image QA analysis that can offer increased consistency, accuracy, and convenience. This work compares visual QA to semi-automated software QA analysis to establish the performance and viability of a semi-automated method. In this study, a commercial product (RIT Radia. Radiological Imaging Technology, Colorado Springs, CO) was used to evaluate 68 months of kV-CBCT images of a Catphan® 504 phantom obtained from a Varian TrueBeam® linear accelerator. Six key metrics were examined: high contrast resolution, low contrast resolution, Hounsfield unit constancy, uniformity and noise, and spatial linearity. The results of this method were then compared to those recorded visually using Bland-Altman, and/or paired sample t-test. Comparison of all modules showed a non-random, statistically significant difference between visual and semi-automated methods except for LDPE and Teflon in the Hounsfield unit constancy analysis, which falls outside the paired sample t-test's 5% significance level. A small high contrast resolution bias indicates the two analysis methods are largely equivalent, while a large low contrast resolution bias indicates greater semi-automated target detection. Wide limits of agreement in the uniformity module suggests variability due to multiple visual observers. Spatial linearity results measured differences of less than 0.17%. Semi-automated QA analysis offered greater stability over visual analysis. Additionally, semi-automated QA results satisfied or exceeded visual QA passing criteria and allowed for fast and consistent image quality analysis.

A Patient-Specific correspondence model to track tumor location in thorax during radiation therapy.

PURPOSE: We present a patient-specific model to estimate tumor location in the thorax during radiation therapy using chest surface displacement as the surrogate signal. METHODS: Two types of data are used for model construction: Four-dimensional computed tomography (4D-CT) images of the patient and the displacement of two points on the patient's skin on the thoracic area. Principal component analysis is used to fit the correspondence model. This model incorporates the recorded surrogate signals during radiation delivery as input and delivers the 3D trajectory of the tumor as output. We evaluated the accuracy of the proposed model on a respiratory phantom and five lung cancer patients. RESULTS: For the respiratory phantom, the location of the center of the sphere during treatment was calculated in three directions: Left-Right (LR), Anterior-Posterior (AP) and, Superior-Inferior (SI). The error of localization was less than 1 mm in the LR and AP directions and less than 2 mm in the SI direction. The location of the tumor center for two of the patients, and the location of the apex of the diaphragm for the other three, was calculated in three directions. For all patients, the localization error in the LR and AP directions was less than 1.1 mm for two fractions and the maximum localization error in the SI direction was 6.4 mm. CONCLUSIONS: This work presents a feasibility study of utilizing surface displacement data to locate the tumor in the thorax during radiation treatment. Future work will validate the model on a larger patient population.

A novel analytical method for computing dose from kilovoltage beams used in Image-Guided radiation therapy.

PURPOSE: A modified convolution/superposition algorithm is proposed to compute dose from the kilovoltage beams used in IGRT. The algorithm uses material-specific energy deposition kernels instead of water-energy deposition kernels. METHODS: Monte Carlo simulation was used to model the Elekta XVI unit and determine dose deposition characteristics of its kilovoltage beams. The dosimetric results were compared with ion chamber measurements. The dose from the kilovoltage beams was then computed using convolution/superposition along with material-specific energy deposition kernels and compared with Monte Carlo and measurements. The material-specific energy deposition kernels were previously generated using Monte Carlo. RESULTS: The obtained gamma indices (using 2%/2mm criteria for 95% of points) were lower than 1 in almost all instances which indicates good agreement between simulated and measured depth doses and profiles. The comparisons of the algorithm with measurements in a homogeneous solid water slab phantom, and that with Monte Carlo in a head and neck CT dataset produced acceptable results. The calculated point doses were within 4.2% of measurements in the homogeneous phantom. Gamma analysis of the calculated vs. Monte Carlo simulations in the head and neck phantom resulted in 94% of points passing with a 2%/2mm criteria. CONCLUSIONS: The proposed method offers sufficient accuracy in kilovoltage beams dose calculations and has the potential to supplement the conventional megavoltage convolution/superposition algorithms for dose calculations in low energy range.

First Multimodal, Three-Dimensional, Image-Guided Total Marrow Irradiation Model for Preclinical Bone Marrow Transplantation Studies.

PURPOSE: Total marrow irradiation (TMI) has significantly advanced radiation conditioning for hematopoietic cell transplantation in hematologic malignancies by reducing conditioning-induced toxicities and improving survival outcomes in relapsed/refractory patients. However, the relapse rate remains high, and the lack of a preclinical TMI model has hindered scientific advancements. To accelerate TMI translation to the clinic, we developed a TMI delivery system in preclinical models. METHODS AND MATERIALS: A Precision X-RAD SmART irradiator was used for TMI model development. Images acquired with whole-body contrast-enhanced computed tomography (CT) were used to reconstruct and delineate targets and vital organs for each mouse. Multiple beam and CT-guided Monte Carlo-based plans were performed to optimize doses to the targets and to vary doses to the vital organs. Long-term engraftment and reconstitution potential were evaluated by a congenic bone marrow transplantation (BMT) model and serial secondary BMT, respectively. Donor cell engraftment was measured using noninvasive bioluminescence imaging and flow cytometry. RESULTS: Multimodal imaging enabled identification of targets (skeleton and spleen) and vital organs (eg, lungs, gut, liver). In contrast to total body irradiation (TBI), TMI treatment allowed variation of radiation dose exposure to organs relative to the target dose. Dose reduction mirrored that in clinical TMI studies. Similar to TBI, mice treated with different TMI regimens showed full long-term donor engraftment in primary BMT and second serial BMT. The TBI-treated mice showed acute gut damage, which was minimized in mice treated with TMI. CONCLUSIONS: A novel multimodal image guided preclinical TMI model is reported here. TMI conditioning maintained long-term engraftment with reconstitution potential and reduced organ damage. Therefore, this TMI model provides a unique opportunity to study the therapeutic benefit of reduced organ damage and BM dose escalation to optimize treatment regimens in BMT and hematologic malignancies.

Generation of material-specific energy deposition kernels for kilovoltage x-ray dose calculations.

PURPOSE: Dose calculation of kilovoltage x rays used in Image-Guided Radiotherapy has been investigated in recent years using various methods. Among these methods are model-based ones that suffer from inaccuracies in high-density materials and at interfaces when used in the kilovoltage energy range. The main reason for this is the use of water energy deposition kernels and simplifications employed such as density scaling in heterogeneous media. The purpose of this study was to produce and characterize material-specific energy deposition kernels, which could be used for dose calculations in this energy range. These kernels will also have utility in dose calculations in superficial radiation therapy and orthovoltage beams utilized in small animal irradiators. METHODS: Water energy deposition kernels with various resolutions; and high-resolution, material-specific energy deposition kernels were generated in the energy range of 10-150 kVp, using the EGSnrc Monte Carlo toolkit. The generated energy deposition kernels were further characterized by calculating the effective depth of penetration, the effective radial distance, and the effective lateral distance. A simple benchmarking of the kernels against Monte Caro calculations has also been performed. RESULTS: There was good agreement with previously reported water kernels, as well as between kernels with different resolution. The evaluation of effective depth of penetration, and radial and laterals distances, defines the relationship between energy, material density, and the shape of the material-specific kernels. The shape of these kernels becomes more forwardly scattered as the energy and material density are increased. The comparison of the dose calculated using the kernels with Monte Carlo provides acceptable results. CONCLUSIONS: Water and material-specific energy deposition kernels in the kilovoltage energy range have been generated, characterized, and compared to previous work. These kernels will have utility in dose calculations in this energy range once algorithms capable of employing them are fully developed.

How low can you go? A CBCT dose reduction study.

PURPOSE: Cone beam computed tomography (CBCT) is often used for patient setup based solely on bony anatomy. The goal of this work was to evaluate whether CBCT dose can be lowered to the level of kV image pair doses when used for bony anatomy-based IGRT without compromising positioning accuracy. METHODS: An anthropomorphic phantom was CT scanned in the head, head and neck, chest, and pelvis regions and setup on the linear accelerator couch with the isocenter near the planned location. Cone beam computed tomographies were performed with the standard "full dose" protocol supplied by the linac vendor. With sequentially lowering the dose, three-dimensional (3D) matching was performed for each without shifting the couch. The standard kV image pair protocol for each site was also used to image the phantoms. For all studies, six degrees of freedom was included in the 2D or 3D matching to the extent they could be employed. Imaging doses were determined in air at isocenter following the TG-61 formalism. RESULTS: Cone beam computed tomography dose was reduced by 81-98% of the standard CBCT protocol to nearly that of the standard kV image pair dose for each site. Relative to the standard CBCT shift values, translational shifts were within 0.3 and 1.6 mm for all sites, for the reduced dose CBCT and kV image pair, respectively. Rotational shifts were within 0.2 degree and 0.7 degrees for all sites, for the reduced dose CBCTs and kV image pair, respectively. CONCLUSION: For bony anatomy-based image guidance, CBCT dose can be reduced to a value similar to that of a kV image pair with similar or better patient positioning accuracy than kV image pair alignment. Where rotations are important to correct, CBCT will be superior to orthogonal kV imaging without significantly increased imaging dose. This is especially important for image guidance for pediatric patient treatments.

First clinical implementation of GammaTile permanent brain implants after FDA clearance.

PURPOSE: GammaTile cesium-131 (131Cs) permanent brain implant has received Food and Drug Administration (FDA) clearance as a promising treatment for certain brain tumors. Our center was the first institution in the United States after FDA clearance to offer the clinical use of GammaTile brachytherapy outside of a clinical trial. The purpose of this work is to aid the medical physicist and radiation oncologist in implementing this collagen carrier tile brachytherapy (CTBT) program in their practice. METHODS: A total of 23 patients have been treated with GammaTile to date at our center. Treatment planning system (TPS) commissioning was performed by configuring the parameters for the 131Cs (IsoRay Model CS-1, Rev2) source, and doses were validated with the consensus data from the American Association of Physicists in Medicine TG-43U1S2. Implant procedures, dosimetry, postimplant planning, and target delineations were established based on our clinical experience. Radiation safety aspects were evaluated based on exposure rate measurements of implanted patients, as well as body and ring badge measurements. RESULTS: An estimated timeframe of the GammaTile clinical responsibilities for the medical physicist, radiation oncologist, and neurosurgeon is presented. TPS doses were validated with published dose to water for 131Cs. Clinical aspects, including estimation of the number of tiles, treatment planning, dosimetry, and radiation safety considerations, are presented. CONCLUSION: The implementation of the GammaTile program requires collaboration from multiple specialties, including medical physics, radiation oncology, and neurosurgery. This manuscript provides a roadmap for the implementation of this therapy.

Practice patterns and recommendations for pediatric image-guided radiotherapy: A Children's Oncology Group report.

This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes the practice patterns of pediatric image-guided radiotherapy (IGRT) based on a member survey and provides practice recommendations accordingly. The survey comprised of 11 vignettes asking clinicians about their recommended treatment modalities, IGRT preferences, and frequency of in-room verification. Technical questions asked physicists about imaging protocols, dose reduction, setup correction, and adaptive therapy. In this report, the COG Radiation Oncology Discipline provides an IGRT modality/frequency decision tree and the expert guidelines for the practice of ionizing image guidance in pediatric radiotherapy patients.

Two-dimensional dose reconstruction using scatter correction of portal images.

CONTEXT: Electronic portal imaging devices (EPIDs) could potentially be useful for patient setup verification and are also increasingly used for dosimetric verification. The accuracy of EPID for dose verification is dependent on the dose-response characteristics, and without a comprehensive evaluation of dose-response characteristics, EPIDs should not be used clinically. AIMS: A scatter correction method is presented which is based on experimental data of a two-dimensional (2D) ion chamber array. An accurate algorithm for 2D dose reconstruction at midplane using portal images for in vivo dose verification has been developed. SUBJECTS AND METHODS: The procedure of scatter correction and dose reconstruction was based on the application of several corrections for beam attenuation, and off-axis factors, measured using a 2D ion chamber array. 2D dose was reconstructed in slab phantom, OCTAVIUS 4D system, and patient, by back projection of transit dose map at EPID-sensitive layer using percentage depth dose data and inverse square. Verification of the developed algorithm was performed by comparing dose values reconstructed in OCTAVIUS 4D system and with that provided by a treatment planning system. RESULTS: The gamma analysis for dose planes within the OCTAVIUS 4D system showed 98% ±1% passing rate, using a 3%/3 mm pass criteria. Applying the algorithm for dose reconstruction in patient pelvic plans showed gamma passing rate of 96% ±2% using the same pass criteria. CONCLUSIONS: An accurate empirical algorithm for 2D patient dose reconstruction has been developed. The algorithm was applied to phantom and patient data sets and is able to calculate dose in the midplane. Results indicate that the EPID dose reconstruction algorithm presented in this work is suitable for clinical implementation.

Effect of beam configuration with inaccurate or incomplete small field output factors on the accuracy of treatment planning dose calculation.

PURPOSE: To evaluate the effect of beam configuration with inaccurate or incomplete small field output factors on the accuracy of dose calculations in treatment planning systems. METHODS: Output factors were measured using various detectors and for a range of field sizes. Three types of treatment machines were configured in two treatment planning systems. In the first (corrected) machine, the Exradin W1 scintillator was used to determine output factors. In the second (uncorrected) machine, the measured output factors by the A1SL ion chamber without considering output correction factors for small field sizes were utilized. In the third (clinical) machine, measured output factors by the Exradin W1 were used but not for field sizes smaller than 2 × 2 cm2 . The dose computed by the anisotropic analytical algorithm (AAA), Acuros XB (AXB) and collapsed cone convolution/superposition (CCC) algorithms in the three machines were delivered using static (jaw-, MLC-, and jaw/MLC-defined), and composite [intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT)] fields. The differences between measured and calculated dose values were analyzed. RESULTS: For static fields, the percentage differences between measured and calculated doses by the three algorithms in three configured machines were <2% for field sizes larger than 2 × 2 cm2 . In jaw- and jaw/MLC-defined fields smaller than 2 × 2 cm2 , the corrected machine presented better agreement with measurement. Considering output correction factors in MLC-defined fields, among the three configured machines, the accuracy of calculation improved to within ±0.5%. For MLC-defined field size of 1 × 1 cm2 , AXB showed the smallest percentage difference (1%). In IMRT and VMAT plans, the percentage differences between measured and calculated doses at the isocenter, as well as the gamma analysis of different plans, which include field sizes larger than 3 × 3 cm2 , did not vary noticeably. For smaller field sizes, using the corrected machine influences dose calculation accuracy. CONCLUSION: Configuration with corrected output factors improves accuracy of dose calculation for static field sizes smaller than 2 × 2 cm2 . For very small fields, the robustness of the dose calculation algorithm affects the accuracy of dose as well. In IMRT and VMAT plans, which include small subfields, the size of the jaw-defined field is an important factor and using corrected output factors increases dose calculation accuracy.

Multi-institutional evaluation of MVCT guided patient registration and dosimetric precision in total marrow irradiation: A global health initiative by the international consortium of total marrow irradiation.

PURPOSE: Total marrow irradiation (TMI) is a highly conformal treatment of the human skeleton structure requiring a high degree of precision and accuracy for treatment delivery. Although many centers worldwide initiated clinical studies using TMI, currently there is no standard for pretreatment patient setup. To this end, the accuracy of different patient setups was measured using pretreatment imaging. Their impact on dose delivery was assessed for multiple institutions. METHODS AND MATERIALS: Whole body imaging (WBI) or partial body imaging (PBI) was performed using pretreatment megavoltage computed tomography (MVCT) in a helical Tomotherapy machine. Rigid registration of MVCT and planning kilovoltage computed tomography images were performed to measure setup error and its effect on dose distribution. The entire skeleton was considered the planning target volume (PTV) with five sub regions: head/neck (HN), spine, shoulder and clavicle (SC), and one avoidance structure, the lungs. Sixty-eight total patients (>300 images) across six institutions were analyzed. RESULTS: Patient setup techniques differed between centers, creating variations in dose delivery. Registration accuracy varied by anatomical region and by imaging technique, with the lowest to the highest degree of pretreatment rigid shifts in the following order: spine, pelvis, HN, SC, and lungs. Mean fractional dose was affected in regions of high registration mismatch, in particular the lungs. CONCLUSIONS: MVCT imaging and whole body patient immobilization was essential for assessing treatment setup, allowing for the complete analysis of 3D dose distribution in the PTV and lungs (or avoidance structures).

Technical Note: Impact of region of interest size and location in Gafchromic film dosimetry.

PURPOSE: To evaluate dependence of measured dose on size and location of region of interest (ROI) in Gafchromic EBT3 film dosimetry. METHODS: Gafchromic EBT3 films were irradiated perpendicularly using the 6MV beam from a linear accelerator at 10 cm depth (100 cm SSD) of a 30 × 30 × 20 cm3 solid water phantom for a range of field sizes of 6 × 6 to 100 × 100 mm2 . ImageJ software was used for reading pieces of film. The appropriate location of ROIs in scanned films was found by two methods. First, the ROI was visually placed at the center of image. Second, the profile of pixel value versus distance was plotted and the center of profile was used for drawing ROI. Each scanned film was read using both methods and for three ROI sizes (1, 2, and 4 mm). A plastic scintillator, Exradin W1, was used as the reference dosimeter. RESULTS: Comparing the three ROI sizes using both methods showed that there was less than 2% difference from reference in output factor measurements for field sizes larger or equal to 10 × 10 mm2 . The percentage differences were increased in field sizes smaller than 10 × 10 mm2 and for ROI size of 4 × 4 mm2 for both centered-ROI and profiled-ROI methods. The mean percentage differences from reference measurements, for field sizes of 100 × 100 to 20 × 20 mm2 , were smaller than 1% in both methods of ROI positioning. For field sizes of 15 × 15 and 10 × 10 mm2 , the smaller mean percentage differences were observed in profiled-ROI (4 × 4 mm2 ) and centered-ROI (4 × 4 mm2 ). For the field sizes of 8 × 8 and 6 × 6 mm2 , the profiled-ROI (2 × 2 mm2 ) had smallest mean percentage difference, which was 0.88%. CONCLUSION: The ROI size of 4 × 4 mm2 is appropriate for dose measurements in field sizes of 100 × 100 mm2 to 10 × 10 mm2 , regardless of the method of finding location of ROI. In field sizes smaller than 10 × 10 mm2 , finding location of the ROI by profile of pixel values increases the accuracy of measurement, and ROI size of 2 × 2 mm2 has the smallest difference from the reference dose measurements.

Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180.

BACKGROUND: With radiotherapy having entered the era of image guidance, or image-guided radiation therapy (IGRT), imaging procedures are routinely performed for patient positioning and target localization. The imaging dose delivered may result in excessive dose to sensitive organs and potentially increase the chance of secondary cancers and, therefore, needs to be managed. AIMS: This task group was charged with: a) providing an overview on imaging dose, including megavoltage electronic portal imaging (MV EPI), kilovoltage digital radiography (kV DR), Tomotherapy MV-CT, megavoltage cone-beam CT (MV-CBCT) and kilovoltage cone-beam CT (kV-CBCT), and b) providing general guidelines for commissioning dose calculation methods and managing imaging dose to patients. MATERIALS & METHODS: We briefly review the dose to radiotherapy (RT) patients resulting from different image guidance procedures and list typical organ doses resulting from MV and kV image acquisition procedures. RESULTS: We provide recommendations for managing the imaging dose, including different methods for its calculation, and techniques for reducing it. The recommended threshold beyond which imaging dose should be considered in the treatment planning process is 5% of the therapeutic target dose. DISCUSSION: Although the imaging dose resulting from current kV acquisition procedures is generally below this threshold, the ALARA principle should always be applied in practice. Medical physicists should make radiation oncologists aware of the imaging doses delivered to patients under their care. CONCLUSION: Balancing ALARA with the requirement for effective target localization requires that imaging dose be managed based on the consideration of weighing risks and benefits to the patient.

Early assessment of dosimetric and biological differences of total marrow irradiation versus total body irradiation in rodents.

PURPOSE: To develop a murine total marrow irradiation (TMI) model in comparison with the total body irradiation (TBI) model. MATERIALS AND METHODS: Myeloablative TMI and TBI were administered in mice using a custom jig, and the dosimetric differences between TBI and TMI were evaluated. The early effects of TBI/TMI on bone marrow (BM) and organs were evaluated using histology, FDG-PET, and cytokine production. TMI and TBI with and without cyclophosphamide (Cy) were evaluated for donor cell engraftment and tissue damage early after allogeneic hematopoietic cell transplantation (HCT). Stromal derived factor-1 (SDF-1) expression was evaluated. RESULTS: TMI resulted in similar dose exposure to bone and 50% reduction in dose to bystander organs. BM histology was similar between the groups. In the non-HCT model, TMI mice had significantly less acute intestinal and lung injury compared to TBI. In the HCT model, recipients of TMI had significantly less acute intestinal injury and spleen GVHD, but increased early donor cell engraftment and BM:organ SDF-1 ratio compared to TBI recipients. CONCLUSIONS: The expected BM damage was similar in both models, but the damage to other normal tissues was reduced by TMI. However, BM engraftment was improved in the TMI group compared to TBI, which may be due to enhanced production of SDF-1 in BM relative to other organs after TMI.

Evaluation of dose calculation accuracy of treatment planning systems at hip prosthesis interfaces.

There are an increasing number of radiation therapy patients with hip prosthesis. The common method of minimizing treatment planning inaccuracies is to avoid radiation beams to transit through the prosthesis. However, the beams often exit through them, especially when the patient has a double-prosthesis. Modern treatment planning systems employ algorithms with improved dose calculation accuracies but even these algorithms may not predict the dose accurately at high atomic number interfaces. The current study evaluates the dose calculation accuracy of three common dose calculation algorithms employed in two commercial treatment planning systems. A hip prosthesis was molded inside a cylindrical phantom and the dose at several points within the phantom at the interface with prosthesis was measured using thermoluminescent dosimeters. The measured doses were then compared to the predicted ones by the planning systems. The results of the study indicate all three algorithms underestimate the dose at the prosthesis interface, albeit to varying degrees, and for both low- and high-energy x rays. The measured doses are higher than calculated ones by 5-22% for Pinnacle Collapsed Cone Convolution algorithm, 2-23% for Eclipse Acuros XB, and 6-25% for Eclipse Analytical Anisotropic Algorithm. There are generally better agreements for AXB algorithm and the worst results are for the AAA.

Implementation of full/half bowtie filter models in a commercial treatment planning system for kilovoltage cone-beam CT dose estimations.

The purpose of this study was to implement full/half bowtie filter models in a com-mercial treatment planning system (TPS) to calculate kilovoltage (kV) cone-beam CT (CBCT) doses of Varian On-Board Imager (OBI) kV X-ray imaging system. The full/half bowtie filter models were created as compensators in Pinnacle TPS using MATLAB software. The physical profiles of both bowtie filters were imported and hard-coded in the MATLAB system. Pinnacle scripts were written to import bowtie filter models into Pinnacle treatment plans. Bowtie filter-free kV X-ray beam models were commissioned and the bowtie filter models were validated by analyzing the lateral and percent-depth-dose (PDD) profiles of anterior/posterior X-ray beams in water phantoms. A CT dose index (CTDI) phantom was employed to calculate CTDI and weighted CTDI values for pelvis and pelvis-spotlight CBCT protocols. A five-year-old pediatric anthropomorphic phantom was utilized to evaluate absorbed and effective doses (ED) for standard and low-dose head CBCT protocols. The CBCT dose calculation results were compared to ion chamber (IC) and Monte Carlo (MC) data for the CTDI phantom and MOSFET and MC results for the pediatric phantom, respectively. The differences of lateral and PDD profiles between TPS calculations and IC measurements were within 6%. The CTDI and weighted CTDI values of the TPS were respectively within 0.25 cGy and 0.08 cGy compared to IC measurements. The absorbed doses ranged from 0 to 7.22 cGy for the standard dose CBCT and 0 to 1.56 cGy for the low-dose CBCT. The ED values were found to be 36-38 mSv and 7-8 mSv for the standard and low-dose CBCT protocols, respectively. This study demonstrated that the established full/half bowtie filter beam models can produce reasonable dose calculation results. Further study is to be performed to evaluate the models in clinical situations.

Imaging dose from cone beam computed tomography in radiation therapy.

Imaging dose in radiation therapy has traditionally been ignored due to its low magnitude and frequency in comparison to therapeutic dose used to treat patients. The advent of modern, volumetric, imaging modalities, often as an integral part of linear accelerators, has facilitated the implementation of image-guided radiation therapy (IGRT), which is often accomplished by daily imaging of patients. Daily imaging results in additional dose delivered to patient that warrants new attention be given to imaging dose. This review summarizes the imaging dose delivered to patients as the result of cone beam computed tomography (CBCT) imaging performed in radiation therapy using current methods and equipment. This review also summarizes methods to calculate the imaging dose, including the use of Monte Carlo (MC) and treatment planning systems (TPS). Peripheral dose from CBCT imaging, dose reduction methods, the use of effective dose in describing imaging dose, and the measurement of CT dose index (CTDI) in CBCT systems are also reviewed.

Characterization of an orthovoltage biological irradiator used for radiobiological research.

Orthovoltage irradiators are routinely used to irradiate specimens and small animals in biological research. There are several reports on the characteristics of these units for small field irradiations. However, there is limited knowledge about use of these units for large fields, which are essential for emerging large-field irregular shape irradiations, namely total marrow irradiation used as a conditioning regimen for hematological malignancies. This work describes characterization of a self-contained Orthovoltage biological irradiator for large fields using measurements and Monte Carlo simulations that could be used to compute the dose for in vivo or in vitro studies for large-field irradiation using this or a similar unit. Percentage depth dose, profiles, scatter factors, and half-value layers were measured and analyzed. A Monte Carlo model of the unit was created and used to generate depth dose and profiles, as well as scatter factors. An ion chamber array was also used for profile measurements of flatness and symmetry. The output was determined according to AAPM Task Group 61 guidelines. The depth dose measurements compare well with published data for similar beams. The Monte Carlo-generated depth dose and profiles match our measured doses to within 2%. Scatter factor measurements indicate gradual variation of these factors with field size. Dose rate measured by placing the ion chamber atop the unit's steel plate or solid water indicate enhanced readings of 5 to 28% compared with those measured in air. The stability of output over a 5-year period is within 2% of the 5-year average.