MR-linac MLC positioning QA by digitally stitching dual double-exposed films.

PURPOSE: The picket fence (PF) test is highly recommended for multi-leaf collimator (MLC) quality assurance. However, since the electronic portal imaging device (EPID) on the Elekta Unity only covers a small area, it is not feasible to perform the PF test for the entire MLC. Here, we propose a technique for the PF test by stitching two double-exposed films. METHODS: Two EBT3 films were used to encompass the entire MLC, with each one covering one half of the area. Two fields were employed to apply double exposure: a PF pattern consisting of 11 2 mm wide pickets and a 2.84 cm x 22 cm open field. The edges of the open field defined by the diaphragms were used to correct film rotation as well as align them horizontally. The PF pattern was also measured with the EPID where the pickets were used to align the films vertically. Individual leaf positions were detected on the merged film for quantitative analysis. Various MLC positioning errors were introduced to evaluate the technique's sensitivity. RESULTS: The merged films covered 72 leaf pairs properly (four leaf pairs on both sides were outside the treatment couch). With the EPID, the leaf positioning accuracy was -0.02 ± 0.07 mm (maximum: 0.29 mm) and the picket width variation was 0.00 ± 0.03 mm (maximum: 0.11 mm); with the films, the position accuracy and width variation were -0.03 ± 0.13 mm (maximum: 0.80 mm) and 0.00 ± 0.13 mm (maximum: 0.74 mm), respectively. The EPID was able to detect errors of 0.5 mm or above with submillimeter accuracy; the films were only able to detect errors > 1.0 mm. CONCLUSION: We developed a quantitative technique for the PF test on the Elekta Unity. The merged films covered nearly the entire MLC leaf banks. The technique exhibited clinically acceptable accuracy and sensitivity to MLC positioning errors.

Assessment of image reconstruction algorithm coupled with fine-resolution array of Cherenkov detectors.

The ability to reconstruct fine-resolution images in a high-count-rate environment is an ongoing challenge to the fields of nuclear security, medicine, and high energy physics. This study presents the characterization and performance of an image reconstruction algorithm and detector array in such an environment. The detector array is composed of quartz Cherenkov radiators and lutetium-yttrium oxyorthosilicate inorganic scintillators detector elements with light collection via silicon photomultipliers (SiPM). The reconstruction algorithm was evaluated using ANSI testing standard N42.46-2008 for imaging performance of active interrogation systems for national security applications; this included spatial resolution, wire detection, and penetration studies. The array was tested using a 6-MVp pulsed photon beam where test objects were translated through the detector field of view demonstrating a capability to resolve a 2.05-mm wire at a source standoff of 2.2 m, a horizontal spatial resolution of 3 mm, and a contrast sensitivity of 1.5%.

Reconstruction of volume averaging effect-free continuous photon beam profiles from discrete ionization chamber array measurements using a machine learning technique.

PURPOSE: The use of the ionization chamber array ICProfiler (ICP) is limited by its relatively poor detector spatial resolution and the inherent volume averaging effect (VAE). The purpose of this work is to study the feasibility of reconstructing VAE-free continuous photon beam profiles from ICP measurements with a machine learning technique. METHODS: In- and cross-plane photon beam profiles of a 6 MV beam from an Elekta linear accelerator, ranging from 2 × 2 to 10 × 10 cm2 at 1.5 cm, 5 cm, and 10 cm depth, were measured with an ICP. The discrete measurements were interpolated with a Makima method to obtain continuous beam profiles. Artificial neural networks (ANNs) were trained to restore the penumbra of the beam profiles. Plane-specific (in- and cr-plane) ANNs and a combined ANN were separately trained. The performance of the ANNs was evaluated using the penumbra width difference (PWD, the difference between the penumbra widths of the reconstructed and the reference profile). The plane-specific and the combined ANNs were compared to study the feasibility of using a single ANN for both in- and cross-plane. RESULTS: The profiles reconstructed with all the ANNs had excellent agreement with the reference. For in-plane, the ANNs reduced the PWD from 1.6 ± 0.7 mm at 1.5 cm depth to 0.1 ± 0.1 mm, from 1.8 ± 0.6 mm at 5.0 cm depth to 0.1 ± 0.1 mm, and from 2.4 ± 0.1 mm at 10.0 cm depth to 0.0 ± 0.0 mm; for cross-plane, the ANNs reduced the PWD from 1.2 ± 0.4 mm at 1.5 cm depth, 1.2 ± 0.3 mm at 5.0 cm depth, and 1.6 ± 0.1 mm at 10.0 cm depth, to 0.1 ± 0.1 mm. CONCLUSIONS: This study demonstrated the feasibility of using simple ANNs to reconstruct VAE-free continuous photon beam profiles from discrete ICP measurements. A combined ANN can restore the penumbra of in- and cross-plane beam profiles of various fields at different depths.

Flat-panel imager energy-dependent proton radiography for a proton pencil-beam scanning system.

In proton-based radiotherapy, proton radiography could allow for direct measurement of the water-equivalent path length (WEPL) in tissue, which can then be used to determine relative stopping power (RSP). Additionally, proton radiographs allow for imaging in the beam's-eye-view. In this work, a proton radiography technique using a flat-panel imager and a pencil-beam scanning (PBS) system is demonstrated in phantom. Proton PBS plans were delivered on a Varian ProBeam system to a flat-panel imager. Each proton plan consisted of energy layers separated by 4.8 MeV, and a field size of 25 cm × 25 cm. All measured data is binned into a layer-by-layer delivery in post processing. To build a calibration curve correlating detector response to WEPL, the plans were delivered to slabs of solid water of increasing thickness. Pixel-by-pixel detector response in the time/energy domain is then fit as a function of WEPL. Tissue equivalent phantoms are imaged for evaluation of WEPL accuracy. A spatial resolution phantom and a head phantom are also imaged. For all experiments, the detector was run with an effective pixel size of 0.4 mm × 0.4 mm. The proposed method reconstructed RSP with mean errors of 2.65%, -0.14%, and 0.61% for lung, soft tissue, and bone, respectively. In a 40 mm thick spatial resolution phantom, a 2 mm deep pinhole with 1 mm diameter can be seen. The accuracy and spatial resolution of the method show that it could be implemented for patient position verification. Further development could lead to patient-specific verification of RSP to be used for treatment guidance.

Low-dose material-specific radiography using monoenergetic photons.

Cargo containers constitute the most critical component of global trade: 108 million containers represent the movement of about 95% of the world's manufactured goods. The steady increase in cargo container shipments has had a profound effect on world security: the threat associated with smuggling of shielded special nuclear material is elevated every year. Containers reaching the borders of the U.S. are currently not radiographically inspected due to time and dose considerations stemming from the use of bremsstrahlung beams for imaging. Bremsstrahlung spectra are low-energy peaked, resulting in low penetration values, especially through dense cargoes. The use of monoenergetic radiography beams could alleviate many of these problems due to higher energy and low background continuum. Using Monte Carlo simulations of a realistic imaging scenario with support from previous experimental measurements, we demonstrate how the use of monoenergetic photon beams in radiography can simultaneously reduce the radiation dose imparted to the cargo and any potential stowaways while increasing image quality. Dual-energy methods are leveraged to calculate material atomic number. Image quality is evaluated by measuring the noise standard deviation, contrast-to-noise ratio, and the pixel error as the dose is decreased.

Therapeutic effects of aerobic and resistance exercises for cancer survivors: a systematic review of meta-analyses of clinical trials.

OBJECTIVE: To systematically appraise and summarise meta-analyses investigating the effect of exercise compared with a control condition on health outcomes in cancer survivors. DESIGN: Umbrella review of intervention systematic reviews. DATA SOURCES: Web of Science, Scopus, Cochrane Library, CINAHL and MEDLINE databases were searched using a predefined search strategy. ELIGIBILITY CRITERIA: Eligible meta-analyses compared health outcomes between cancer survivors participating in an exercise intervention and a control condition. Health outcomes were cardiovascular fitness, muscle strength, health-related quality of life, cancer-related fatigue and depression. Pooled effect estimates from each meta-analysis were quantified using standardised mean differences and considered trivial (<0.20), small (0.20-0.49), moderate (0.50-0.79) and large (≥0.80). Findings were summarised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: There were 65 eligible articles that reported a total of 140 independent meta-analyses. 139/140 meta-analyses suggested a beneficial effect of exercise. The beneficial effect was statistically significant in 104 (75%) meta-analyses. Most effect sizes were moderate for cardiovascular fitness and muscle strength and small for cancer-related fatigue, health-related quality of life and depression. The quality of evidence was variable according to the GRADE scale, with most studies rated low or moderate quality. Median incidence of exercise-related adverse events was 3.5%. CONCLUSION: Exercise likely has an important role in helping to manage physical function, mental health, general well-being and quality of life in people undergoing and recovering from cancer and side effects of treatment. PROSPERO REGISTRATION NUMBER: CRD42015020194.