Use of CT and MR imaging in radiation therapy planning of imaging-diagnosed canine intracranial meningioma achieves better tumor coverage than CT alone.

The aim of this retrospective, secondary analysis study was to quantify the dosimetric impact of the lack of interobserver agreement on gross tumor volume (GTV) delineation for canine meningioma. This study used a previously reported population of 13 dogs with GTVs contoured on CT alone and on registered CT-MR by 18 radiation oncologists. The "true" GTV was generated for each dog using a simultaneous truth and performance-level estimation algorithm, and "true" brain was defined as the whole brain minus true GTV. Treatment plans were generated for each dog and observer combination, using criteria applied to the observer's GTV and brain contours. Plans were then categorized as a pass (met all planning criteria for true GTV and true brain) or fail. A mixed-effects linear regression was performed to examine differences in metrics between CT and CT-MR plans and mixed-effects logistic regression was performed to examine differences in percentages of pass/fail between CT and CT-MRI plans. The mean percent coverage of true GTV by prescribed dose was higher for CT-MR plans than for CT plans (mean difference 5.9%; 95% CI, 3.7-8.0; P < 0.001). There was no difference in the mean volume of true brain receiving ≥24 Gy and in maximum true brain dose between CT plans and CT-MR plans (P ≥ 0.198). CT-MR plans were significantly more likely to pass the criteria for true GTV and true brain than CT plans (OR 1.75; 95% CI, 1.02-3.01; P = 0.044). This study demonstrated significant dosimetric impact when GTV contouring was performed on CT alone compared with CT-MR.

X-ray tube operators can be exposed to equal or higher scattered radiation doses to the hand as cassette holders during diagnostic radiographic procedures of the equine vertebral column and limbs.

OBJECTIVE: The objectives of this study were to investigate scattered radiation doses to the hands of equine workers holding the cassette and the x-ray tube by hand, for both limb and vertebral column studies, and to compare the scattered radiation attenuation of lead with radiation protection lead-free gloves. Radiation doses to the hands of the cassette holder in the primary beam were also investigated. SAMPLE: A whole-body horse cadaver. PROCEDURES: A portable x-ray unit was used to simulate 6 radiographic study types in the horse cadaver. Doses were measured with no shielding and, for cassette holders, with the ion chamber enclosed in a lead glove and a lead-free glove. Thirty exposures were performed for each study view and condition (n = 1,920). RESULTS: Mean scattered doses to x-ray unit operators were higher than doses to cassette holders for ungula (hoof), thoracic vertebrae, and lumbar vertebrae studies, whereas doses to cassette holders were higher than doses to x-ray tube operators for studies of the metacarpophalangeal joint (fetlock) and tarsus (hock). Doses did not differ for the stifle joint. Mean percentage decrease in scattered radiation dose was 99.58% with lead gloves and 98.9% with lead-free gloves. CLINICAL RELEVANCE: X-ray tube operators can be exposed to equal or higher scattered radiation doses to the hand as cassette holders. Lead-free hand shielding should only be considered as an alternative to lead gloves if their lighter weight increases frequency of use by workers.

Radiation safety practices among Canadian equine veterinary workers during diagnostic procedures with portable X-ray equipment.

The objective of this study was to report observed radiation safety practices among equine workers using portable X-ray units at 3 veterinary practices in Canada. Practice 1 was comprised of equine field service workers from an academic institution, whereas Practices 2 and 3 were comprised of workers from private equine referral practices. Out of 2969 exposure-worker observations, protective aprons were worn for > 99% (2968/2969), thyroid shields for 87% (2584/2969), and eyeglasses for 10% (310/2969). The cassette was held by hand for 97% (1078/1114) of observations, and the X-ray unit was held by hand for 100% (1293/1293) of observations. Gloves were used for 54% (606/1114) and < 1% (5/1293) of observations involving cassette holders and X-ray tube operators, respectively. Use of gloves was more frequent among technologists than DVMs (P = 0.004), and among workers in Practices 1 and 3 than in Practice 2 (P < 0.001). In conclusion, given that workers commonly hold cassettes and X-ray tubes by hand, improvement in shielding use is needed. Consideration should be given to specific behavior recommendations in radiation regulations.

Pratiques de radioprotection chez les travailleurs vétérinaires équins canadiens pendant les procédures de diagnostic avec un équipement de radiographie portable. L'objectif de la présente étude était de rapporter les pratiques de radioprotection observées chez les travailleurs équins utilisant des appareils de radiographie portatifs dans trois pratiques vétérinaires au Canada. La pratique 1 était composée de travailleurs équins sur le terrain d'une institution universitaire, tandis que les pratiques 2 et 3 étaient composées de travailleurs sur le terrain issus de pratiques de référence équines privées. Sur 2969 observations de travailleurs exposés, des tabliers de protection ont été portés pour > 99 % (2968/2969), des écrans thyroïdiens pour 87 % (2584/2969) et des lunettes pour 10 % (310/2969). La cassette a été tenue à la main pour 97 % (1078/1114) des observations et l'unité de radiographie a été tenue à la main pour 100 % (1293/1293) des observations. Des gants ont été utilisés pour 54 % (606/1114) et < 1 % (5/1293) des observations impliquant des porteurs de cassette et des opérateurs de tubes à rayons X, respectivement. L'utilisation de gants était plus fréquente chez les technologues que chez les vétérinaires (P = 0,004) et chez les travailleurs des Pratiques 1 et 3 que ceux de la Pratique 2 (P < 0,001). En conclusion, étant donné que les travailleurs tiennent généralement des cassettes et des tubes à rayons X à la main, une amélioration de l'utilisation du blindage est nécessaire. Il faudrait tenir compte des recommandations de comportement spécifiques dans les réglementations relatives aux rayonnements.(Traduit par Dr Serge Messier).

Use of MRI increases interobserver agreement on gross tumor volume for imaging-diagnosed canine intracranial meningioma.

There is a lack of information regarding interobserver agreement on canine meningioma gross tumor volume (GTV) delineation, and on the impact of MRI on this agreement. The objectives of this retrospective, secondary analysis, observer agreement study were to describe agreement between veterinary radiation oncologists on GTV for canine intracranial meningioma, and to compare interobserver agreement between delineation based on CT alone and delineation based on fused CT-MRI. Eighteen radiation oncologists delineated GTV for 13 dogs with an imaging diagnosis of meningioma on pre- and postcontrast CT, pre- and postcontrast T1-weighted magnetic resonance, and T2-weighted magnetic resonance images. Dice similarity coefficient (DSC), concordance index (CI), and center of volume (COV) were used to quantify interobserver agreement. Multilevel mixed models were used to examine the difference in volume, DSC, CI and COV 3D distance between CT and CT-MR imaging. The mean volume for GTV contours delineated using fused CT-MRI was larger than when CT alone was used for delineation (mean difference CT-MR - CT = 0.89 cm3, 95% CI 0.66 to 1.12, P < .001). Interobserver agreement on GTV was improved when MRI was used; the mean DSC and CI were higher, and the mean COV 3D distance was lower, when fused CT-MRI was used than when CT alone was used (P < .001 for all differences). Based on our results, fused CT-MRI is recommended for radiation therapy planning of canine intracranial meningioma.

Setup error with and without image guidance using two canine intracranial positioning systems for radiation therapy.

Daily image guidance reduces inter-fractional variation in patient position for intracranial radiation therapy. However, the ability to detect and correct positioning errors is limited below a certain level. Because of these limitations, the accuracy achieved with a positioning system prior to image guidance may affect the error remaining after image guidance (the residual setup error). The objective of this study was to compare the setup accuracy achieved before and after megavoltage (MV) and cone-beam computed tomography (CBCT) guidance between two intracranial positioning systems. Equipment included a four degrees-of-freedom couch capable of 1 mm translational moves. Six dog cadavers were positioned 24 times as for clinical treatment in a head re-positioner (HPS), and the coordinates of five fiducial markers were measured before and after image-guided correction. The values obtained for the HPS were compared with those previously reported for the standard positioning system (SPS) used at this facility. The mean three-dimensional distance vector (3DDV) was lower for the HPS than for the SPS when no image guidance was used (P = .019). The mean 3DDV after MV guidance was lower for the HPS than for the SPS (P = .027), but not different after CBCT guidance (P = .231). The 95th percentiles of the 3DDV after MV and CBCT guidance were 2.1 and 2.9 mm, respectively, for the HPS, and 2.8 and 3.6 mm for the SPS. The setup error after MV guidance was lower for the positioning system that achieved a more accurate patient position before image guidance.

Residual setup error in the canine intracranial region after megavoltage, kilovoltage, or cone-beam computed tomographic image guidance for radiation therapy.

Sources of residual setup error after image guidance include image localization accuracy, errors associated with image registration, and inability of some treatment couches to correct submillimeter translational errors and/or pitch and roll errors. The purpose of this experimental study was to measure setup error after image-guided correction of the canine intracranial region, using a four degrees-of-freedom couch capable of 1 mm translational moves. Six cadaver dogs were positioned 45 times as for clinical treatment using a vacuum deformable body cushion, a customizable head cushion, a thermoplastic mask and an indexed maxillary plate with a dental mould. The location of five fiducial markers in the skull bones was compared between the reference position and after megavoltage (MV), kilovoltage (kV) and cone-beam computed tomography (CBCT)-guided correction using orthogonal kV images. The mean three-dimensional distance vectors (3DDV) after MV, kV and CBCT-guided correction were 1.7, 1.5 and 2.2 mm, respectively. All values were significantly different (P < .01). The 95th percentiles of the 3DDV after online MV, kV and CBCT-guided correction were 2.8, 2.6 and 3.6 mm, respectively. Residual setup error in the clinical scenario examined was on the order of millimetres and should be considered when choosing PTV margins for image-guided radiation therapy of the canine intracranial region.

Effect of full versus open-palm hand shielding on worker radiation dose during manual restraint for small animal radiography.

Open-palm hand shields are used by veterinary workers during manual restraint for small animal radiography. The objective of this study was to measure the reduction in scatter and primary beam radiation dose to the hand provided by a full glove and an open-palm shield, using a cadaver dog to simulate restraint by 2 workers of an awake, cooperative patient undergoing thoracic and abdominal radiography. Dose was measured for 30 exposures for each condition, for a total of 795 exposures. The mean percentage decrease in scatter radiation dose was 99.9% for a full glove and 40% for an open-palm shield. The mean percentage decrease in primary beam radiation dose was 98.4% for a full glove. To optimize worker protection, fully enclosing gloves should be used during manual restraint for radiography, and body parts should never be placed in the primary beam, even when shielded.

Des protecteurs à paume ouverte sont utilisés par le personnel vétérinaire pour la contention manuelle des animaux de compagnie lors de radiographie. L'objectif de la présente étude était de mesurer la réduction de radiation du faisceau primaire et de rayonnement de dispersion du faisceau fournie par un gant complet et un protecteur à paume ouverte, en utilisant un cadavre de chien pour simuler la contention par deux employés d'un patient coopératif soumis à des radiographies thoracique et abdominale. La dose fut mesurée pour 30 expositions de chaque condition, pour un total de 795 expositions. Le pourcentage moyen de diminution de radiation du rayonnement de dispersion du faisceau était de 99,9 % pour le gant complet et de 40 % pour le protecteur à paume ouverte. Le pourcentage moyen de diminution de radiation du faisceau primaire était de 98,4 % pour le gant complet. Afin d'optimiser la protection des employés, des gants complets devraient être utilisés durant la contention manuelle pour les radiographies, et des parties du corps ne devraient jamais être dans le faisceau primaire, même si elles sont protégées.(Traduit par Docteur Serge Messier).

Use of protective hand shielding by veterinary workers during small animal radiography.

Federal government guidelines recommend wearing hand shielding that provides full protection for the entire hand during manual restraint of animals for radiography. The primary objective of this cross-sectional survey of 143 Saskatchewan veterinary workers was to describe behaviors of workers who do not follow guidelines for effective hand shielding, and to examine the factors associated with these behaviors. An electronic invitation to complete an online questionnaire was sent to 1261 members of the provincial veterinary medical and veterinary technologist associations. More than half of the workers reported that their hand protection was visible on a radiograph at least once a month, and 1/5 reported visible unshielded body parts at least once a month. More than 1/3 of workers never used shielding that fully enclosed their hands. Use of fully enclosing gloves or mittens was more likely for workers in academic workplaces (P < 0.001).

Usage d'une protection pour les mains par les préposés vétérinaires durant la radiographie des petits animaux. Les lignes directrices du gouvernement fédéral recommandent le port d'une protection pour les mains qui offre une protection complète pour l'ensemble de la main durant la retenue manuelle des animaux lors de la radiographie. L'objectif primaire de cette enquête ponctuelle auprès de 143 préposés vétérinaires de la Saskatchewan consistait à décrire les comportements des préposés qui ne respectent pas les lignes directrices en matière de protection efficace des mains et à examiner les facteurs associés avec ces comportements. Une invitation électronique à répondre au questionnaire en ligne a été envoyée aux 1261 membres des associations provinciales de médecins vétérinaires et de technologues vétérinaires. Plus de la moitié des préposés ont signalé que leur protection était visible sur une radiographie au moins une fois par mois et 1/5 a signalé des parties du corps visibles non protégées au moins une fois par mois. Plus de 1/3 des préposés n'utilisait jamais une protection complète des mains. L'usage de gants ou de mitaines entièrement fermées était plus probable pour les préposés travaillant en milieu universitaire (P < 0,001).(Traduit par Isabelle Vallières).

Outcomes and adverse effects associated with stereotactic body radiation therapy in dogs with nasal tumors: 28 cases (2011-2016).

OBJECTIVE To assess outcomes, factors associated with survival time, and radiation-induced toxicoses in dogs treated for nasal tumors with curative-intent stereotactic body radiation therapy (SBRT). DESIGN Retrospective case series. ANIMALS 28 client-owned dogs. PROCEDURES By use of a 6-MV linear accelerator, dogs were treated with SBRT (3 consecutive-day fractions of 9 or 10 Gy or once with 1 fraction of 20 Gy). Data regarding adverse effects, outcomes, and survival times were obtained from the medical records. RESULTS The median survival time to death due to any cause was 388 days. Of the 24 dogs known to be dead, 14 (58%) died or were euthanized because of local disease progression. Acute radiation-induced adverse effects developed in the skin (excluding alopecia) in 26% (6/23) of dogs and in the oral cavity in 30% (7/23) of dogs. Acute ocular adverse effects included discharge in 26% (6/23) of dogs and keratoconjunctivitis sicca in 4% (1/23) of dogs. Among the 22 dogs alive at > 6 months after SBRT, 4 (18%) developed a unilateral cataract; 4 (18%) developed other complications that may have been late-onset radiation toxicoses (excluding leukotrichia and skin hyperpigmentation). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dogs treated with SBRT had outcomes comparable to those reported for dogs with nasal carcinomas and sarcomas that undergo conventionally fractionated radiation therapy. Administration of SBRT was associated with a comparatively lower frequency of acute radiation-induced adverse effects. For SBRT and conventionally fractionated radiation therapy, the frequencies of serious late-onset adverse effects appear similar.

Use of a real-time three-dimensional motion tracking system for measurement of intrafractional motion of the thoracic wall in dogs.

OBJECTIVE: To measure respiratory motion of the thoracic wall region in dogs using a real-time motion tracking system and compare the amount of respiratory motion between dogs positioned with and without a vacuum-formable cushion. ANIMALS: 8 healthy adult mixed-breed dogs (median weight, 23 kg). PROCEDURES: Dogs were anesthetized and positioned in sternal and dorsal recumbency with and without a vacuum-formable cushion. Three-dimensional movement of anatomic landmarks was measured with a real-time motion capture system that tracked the locations of infrared light-emitting diodes attached externally to the dorsal or ventral and lateral aspects of the thoracic wall. RESULTS: Dogs positioned in sternal recumbency had significantly less cranial-to-caudal and left-to-right respiratory motion at the lateral aspect of the thoracic wall, compared with dogs positioned in dorsal recumbency, whether or not a cushion was used. For dogs treated in sternal recumbency, use of a cushion significantly increased the peak displacement vector (overall movement in 3-D space) for 3 of 4 marker locations on the dorsal thoracic wall. As respiratory rate increased, respiratory motion at the lateral and ventral aspects of the thoracic wall decreased when data for all dogs in dorsal recumbency were evaluated together. CONCLUSIONS AND CLINICAL RELEVANCE: Associations between respiratory rate and respiratory motion suggested that the use of rapid, shallow ventilation may be beneficial for dogs undergoing highly conformal radiation treatment. These results provide a basis for further research on respiratory motion in anesthetized dogs.

Planning target volume margin evaluation and critical structure sparing for rectal cancer patients treated prone on a bellyboard.

AIMS: To calculate a planning target volume (PTV) margin that would account for inter-fractional systematic and random clinical target volume positional errors for patients treated prone on a recently available couch top bellyboard and to evaluate potential critical structure dose reduction using intensity-modulated radiotherapy (IMRT) techniques. MATERIALS AND METHODS: Twenty-four patients (12 men and 12 women) were included in this study, all treated on a commercial bellyboard. Cone beam computed tomography (CBCT) data were acquired once every five fractions for a total of five images per patient. A three-dimensional-three-dimensional bony anatomy auto-match was carried out off-line and the residual difference in position used as a surrogate for clinical target volume inter-fractional positional errors. Systematic (Σ) and random (σ) variations were evaluated and used in PTV(margin)=1.96Σ+0.7σ. The influence of intra-fractional positional errors was evaluated in the margin analysis by introducing published values. Critical structure sparing, as a function of PTV(margin) size, was investigated through the evaluation of three-dimensional conformal radiation therapy (3DCRT) and IMRT treatment plans developed using the margin derived from this work, the American Society for Radiation Oncology Contouring Atlas and the Radiation Therapy Oncology Group 0822 trial specifications. RESULTS: The PTV(margin) that accounts for only the inter-fractional positional errors was calculated to be (anterior-posterior (AP), superior-inferior (SI), left-right (LR))=(5.2mm, 3.1mm, 2.8mm). If we assumed a combined intra-fractional motion up to 3.0mm then the required PTV(margin) increased to (AP, SI, LR)=(7.0mm, 5.0mm, 5.0mm). Treatment plan evaluation showed that the bellyboard provides excellent small bowel sparing regardless of planning technique. In most cases, IMRT reduced the average femoral head, bladder and small bowel dose by 20, 15 and 40% with respect to 3DCRT planning. CONCLUSION: A PTV(margin) expansion of (AP, SI, LR)=(7.0mm, 5.0mm, 5.0mm) is required to account for all positional uncertainties. The use of a bellyboard with IMRT provides better critical structure sparing when compared with a bellyboard with 3DCRT.

Using kV-kV and CBCT imaging to evaluate rectal cancer patient position when treated prone on a newly available belly board.

The goal of this work was to use daily kV-kV imaging and weekly cone-beam CT (CBCT) to evaluate rectal cancer patient position when treated on a new couch top belly board (BB). Quality assurance (QA) of the imaging system was conducted weekly to ensure proper performance. The positional uncertainty of the combined kV-kV image match and subsequent couch move was found to be no more than ± 1.0 mm. The average (1 SD) CBCT QA phantom match was anterior-posterior (AP) = -0.8 ± 0.2 mm, superior-inferior (SI) = 0.9 ± 0.2 mm, and left-right (LR) = -0.1 ± 0.1 mm. For treatment, a set of orthogonal kV-kV images were taken and a bony anatomy match performed online. Moves were made along each axis (AP, SI, and LR) and recorded for analysis. CBCT data were acquired once every 5 fractions for a total of 5 images per patient. The images were all taken after the couch move but before treatment. A 3-dimensional (3D-3D) bony anatomy auto-match was performed offline and the residual difference in position recorded for analysis. The average (± 1 SD) move required from skin marks, calculated over all 375 fractions (15 patients × 25 fractions/patient), were AP = -2.6 ± 3.7 mm, SI = -0.3 ± 4.9 mm, and LR = 1.8 ± 4.5 mm. The average residual difference in patient position calculated from the weekly CBCT data (75 total) were AP = -1.7 ± 0.4 mm, SI = 1.1 ± 0.6 mm, and LR = -0.5 ± 0.2 mm. These results show that the BB does provide simple patient positioning that is accurate to within ± 2.0 mm when using online orthogonal kV-kV image matching of the pelvic bony anatomy.

Experimental small field 6 MV output ratio analysis for various diode detector and accelerator combinations.

BACKGROUND AND PURPOSE: The goal of this work was to measure 6MV small field, detector specific, output ratios (OR(det)) using the IBA stereotactic field diode (SFD) and the PTW T60008, T60012, T60016 and T60017 field diodes on both Varian iX and Elekta Synergy accelerators, to establish estimates for the experimental uncertainty and characterize the measurement precision under various conditions. MATERIALS AND METHODS: Data were acquired at depths of 1.5, 5.0 and 10.0 cm for square field sizes of 3.0, 1.0, 0.9, 0.8, 0.7, 0.6 and 0.5 cm. Three isocentric measurements comprised of five readings were made to calculate an experimental output ratio OR(det) with respect to a field size of 5.0 cm. The coefficient of variation (CV) was calculated to characterize the precision associated with each detector-linac combination. Another measurement set was made to investigate the influence of jaw position accuracy. RESULTS: As expected for field sizes smaller than 3.0 cm, the measured OR(det) were not consistent across all detectors. The standard percent uncertainty in measured OR(det) was found to be nearly consistent across all detector-linac combinations: less than ±0.25% for the 3.0 cm field size, increasing to approximately ±1.25% for the smallest field sizes. As the field size was reduced to 0.5 cm the CV increased to 0.10% and 0.15% on the Varian and Elekta linacs, respectively. CONCLUSION: Experimental small field OR(det) measured with the diode detectors used in this study are reproducible to within ±1.25% (standard uncertainty), with the precision of any one set of measurements can be characterized with a CV between 0.10% and 0.15%.

Collimator design for experimental minibeam radiation therapy.

PURPOSE: To design and optimize a minibeam collimator for minibeam radiation therapy studies using a 250 kVp x-ray machine as a simulated synchrotron source. METHODS: A Philips RT250 orthovoltage x-ray machine was modeled using the EGSnrc/BEAMnrc Monte Carlo software. The resulting machine model was coupled to a model of a minibeam collimator with a beam aperture of 1 mm. Interaperture spacing and collimator thickness were varied to produce a minibeam with the desired peak-to-valley ratio. RESULTS: Proper design of a minibeam collimator with Monte Carlo methods requires detailed knowledge of the x-ray source setup. For a cathode-ray tube source, the beam spot size, target angle, and source shielding all determine the final valley-to-peak dose ratio. CONCLUSIONS: A minibeam collimator setup was created, which can deliver a 30 Gy peak dose minibeam radiation therapy treatment at depths less than 1 cm with a valley-to-peak dose ratio on the order of 23%.

Comparison of interfractional variation in canine head position using palpation and a head-repositioning device.

Radiation treatment planning is performed on images that do not take variation in patient position into account. To compensate for expected variations in position of the patient, a three-dimensional expansion of the clinical target volume, or set-up margin, is added. Variations in patient position can be decreased through use of an immobilization device, allowing selection of a smaller set-up margin. The objective of this prospective study was comparison of interfractional variation in patient position between set-ups of the canine head region using palpation of bony landmarks and set-ups using a head-repositioning device. Fiducial markers were attached to the skull bones of three research dogs, and the dogs were positioned as for a typical radiation treatment of the head region using both set-up methods. A kilovoltage on-board imager was used to acquire orthogonal images and the difference between the x-, y-, and z-axis coordinates of each fiducial marker relative to the initial reference isocenter was measured. The difference in patient position for each axis coordinate was significantly lower for set-ups using the head-repositioning device than for set-ups using bony landmarks (P < 0.05). Ninety-five percent of the absolute values of the displacement vector differences were < 4.62 mm for set-up using bony landmarks, and < 1.93 mm for set-up using the head-repositioning device. A minimum set-up margin of 5-6 mm is recommended when patient set-up is based on bony landmarks and of 2-3 mm when the head-repositioning device is used.

The effects of dose calculation resolution on dose accuracy for radiation therapy treatments of the lung. Part I. A Monte Carlo model of the lung.

PURPOSE: The purpose of this work was to create an anatomically detailed EGSnrc Monte Carlo based model of the right lung. The resulting model, called BRANCH, includes an accurate representation of the right bronchial, arterial, and venous branching networks down to a scale of 0.1 mm. The model may be varied to represent lung shape and density at any phase of the respiration cycle. METHODS: Polynomial surfaces were used to approximate the anatomic boundaries that define the right lung surface at several phases of the respiration cycle. A branching network algorithm was used to generate the bronchial, arterial, and venous trees within the anatomic boundaries. The branching networks were modeled as a series of bifurcating cylinders connected by spherical junctions. The validity of the BRANCH dose calculation was verified using an all-water version of the model. RESULTS: The geometric dimensions of the BRANCH model corresponded well with published data. The bronchial tree model contained 27 798 branches ranging from 0.02 to 0.54 cm in diameter. The arterial tree model had 27,957 branches ranging from 0.02 to 1.2 cm in diameter. The venous model tree had 26 347 branches ranging from 0.02 to 0.34 cm in diameter. A gamma analysis indicated that the all-water BRANCH Monte Carlo code produced dose distributions that agreed within 0.1 cm and 0.5% to conventional DOSXYZnrc results. CONCLUSIONS: The BRANCH model is a useful tool for performing detailed dosimetric studies within a realistic representation of the lung.

The effects of dose calculation resolution on dose accuracy for radiation therapy treatments of the lung. Part II. A comparison of dose distributions from an explicit lung model to dose distributions derived from a CT representation.

PURPOSE: Due to limitations in computer memory and computation time, typical radiation therapy treatments are calculated with a voxel dimension on the order of several millimeters. The anatomy below this practical resolution is approximated as a homogeneous region uniform in atomic composition and density. The purpose of this article is to examine whether the exclusion of anatomic structure below the practical dose calculation resolution produces deviations in the resulting dose distributions. METHODS: EGSnrc calculated dose distributions from the BRANCH lung model of Part I are compared and contrasted to dose distributions from a CT representation of the same BRANCH model for three different phases of the respiration cycle. RESULTS: The exclusion of branching structures below a CT resolution of 1 x 1 x 2 mm3 resulted in a deviation in dose. The deviation in dose was as high as 14% but was localized around the branching structures. There was no significant variation in the dose deviation as a function of either field size or lung density. CONCLUSIONS: The exclusion of explicit branching structures of the lung in a CT representation creates localized deviations in dose. To ensure accurate dose calculations, CT resolution must be increased

Impact of tissue inhomogeneity on dose distribution in the canine carpal and tarsal regions for cobalt and 6 MV photons.

We quantified the effect of tissue inhomogeneity on dose distribution in a canine distal extremity resulting from treatment with cobalt photons and photons from a 6MV accelerator. Monitor units for a typical distal extremity treatment were calculated by two methods, using equally weighted, parallel-opposed fields. The first method was a computed tomography (CT)-based, computerized treatment plan, calculated without inhomogeneity correction. The second method was a manual point dose calculation to the isocenter. A computerized planning system was then used to assess the dose distribution achieved by these two methods when tissue inhomogeneity was taken into account. For cobalt photons, the median percentage of the planning target volume (PTV) that received < 95% of the prescribed dose was 4.5% for the CT-based treatment plan, and 26.2% for the manually calculated plan. For 6 MV photons, the median percentage of the PTV that received < 95% of the prescribed dose was < 1% for both planning methods. The PTV dose achieved without using inhomogeneity correction for cobalt photons results in potentially significant under dosing of portions of the PTV.

Use of a petroleum-based bolus for photon radiation therapy of distal extremities in dogs.

While skin sparing is an advantage of megavoltage beams, in certain clinical situations the planning target volume includes the skin surface and a skin sparing effect is not desirable. A tissue equivalent material, termed build up bolus, is used in these situations to provide adequate absorbed dose at the surface of the skin. However, an irregular patient contour can lead to air gaps between the build up bolus and the skin surface, which may result in variability in radiation dose across the target volume. The shape of the canine distal hind extremity is irregular, and commercially available bolus materials do not conform well to this region. The purpose of this study was to assess the dose homogeneity achieved using a petroleum-based bolus material, in combination with a commercially available sheet bolus, for radiation treatment of the canine tarsus. Repeated setups were performed to mimic daily treatment setups in the clinic setting, and computed tomographic scans were performed after each setup. Dose distribution achieved with a cobalt therapy machine and a 6 MV linear accelerator was assessed using three-dimensional treatment planning software. The dose to the clinicaltarget volume fell within 95% and 107% of the prescribed dose for both treatment machines, which is considered clinically acceptable by the authors. This petroleum-based bolus is equivalent to water in its photon attenuation, conforms well to an irregular patient contour, and retains its shape after positioning. Applications to other anatomical sites could be considered.

An enhanced HOWFARLESS option for DOSXYZnrc simulations of slab geometries.

The Monte Carlo code DOSXYZnrc is a valuable instrument for calculating absorbed dose within a three-dimensional Cartesian geometry. DOSXYZnrc includes several variance reduction techniques used to increase the efficiency of the Monte Carlo calculation. One such technique is HOWFARLESS which is used to increase the efficiency of beam commissioning calculations in homogeneous phantoms. The authors present an enhanced version of HOWFARLESS which extends the application to include phantoms inhomogeneous in one dimension. When the enhanced HOWFARLESS was used, efficiency increases as high as 14 times were observed without any loss in dose accuracy. The efficiency gains of an enhanced HOWFARLESS simulation was found to be dependent on both slab geometry and slab density. As the number of two-dimensional voxel layers per slab increases, so does the efficiency gain. Also, as the mass density of a slab is decreased, the efficiency gains increase.