The step-and-shoot IMRT overshooting phenomenon: a novel method to mitigate patient overdosage.

The goal of this work is to evaluate the dosimetric impact of an overshooting phenomenon in step-and-shoot IMRT delivery, and to demonstrate a novel method to mitigate the issue. Five pelvis IMRT patients treated on Varian 2100C EX linacs with larger than +4.5% phantom ion chamber point-dose difference relative to planned dose were investigated. For each patient plan, 5 fractions were delivered. DynaLog files were recorded and centi-MU pulses from dose integrator board for every control point (CP) were counted using a commercial pulse counter. The counter recorded CP MU agrees with DynaLog records, both showing an ~ 0.6MU overshoot of the first segment of every beam. The 3D patient dose was recalculated from the counter records and compared to the planned dose, showing that the overshoot resulted in on average 2.05% of PTV D95 error, and 2.49%, 2.61% and 2.45% of D1cc error for rectum, bladder, and bowel, respectively. The initial plans were then modified by inserting a specially designed MLC segment to the start of every beam. The modified plans were also delivered five times. The dose from the modified delivery was calculated using counter recorded CP MU. The corresponding Dx parameters were all within 0.31% from the original plan. IMRT QA results also show a 2.2% improvement in ion chamber point-dose agreement. The results demonstrate that the proposed plan modification method effectively eliminates the overdosage from the overshooting phenomenon.

Breaking bad IMRT QA practice.

Agreement between planned and delivered dose distributions for patient-specific quality assurance in routine clinical practice is predominantly assessed utilizing the gamma index method. Several reports, however, fundamentally question current IMRT QA practice due to poor sensitivity and specificity of the standard gamma index implementation. An alternative is to employ dose volume histogram (DVH)-based metrics. An analysis based on the AAPM TG 53 and ESTRO booklet No.7 recommendations for QA of treatment planning systems reveals deficiencies in the current "state of the art" IMRT QA, no matter which metric is selected. The set of IMRT benchmark plans were planned, delivered, and analyzed by following guidance of the AAPM TG 119 report. The recommended point dose and planar dose measurements were obtained using a PinPoint ionization chamber, EDR2 radiographic film, and a 2D ionization chamber array. Gamma index criteria {3% (global), 3 mm} and {3% (local), 3 mm} were used to assess the agreement between calculated and delivered planar dose distributions. Next, the AAPM TG 53 and ESTRO booklet No.7 recommendations were followed by dividing dose distributions into four distinct regions: the high-dose (HD) or umbra region, the high-gradient (HG) or penumbra region, the medium-dose (MD) region, and the low-dose (LD) region. A different gamma passing criteria was defined for each region, i.e., a "divide and conquer" (D&C) gamma method was utilized. The D&C gamma analysis was subsequently tested on 50 datasets of previously treated patients. Measured point dose and planar dose distributions compared favorably with TG 119 benchmark data. For all complex tests, the percentage of points passing the conventional {3% (global), 3 mm} gamma criteria was 97.2% ± 3.2% and 95.7% ± 1.2% for film and 2D ionization chamber array, respectively. By dividing 2D ionization chamber array dose measurements into regions and applying 3mm isodose point distance and variable local point dose difference criteria of 7%, 15%, 25%, and 40% for HD, HG, MD, and LD regions, respectively, a 93.4% ± 2.3% gamma passing rate was obtained. Identical criteria applied using the D&C gamma technique on 50 clinical treatment plans resulted in a 97.9% ± 2.3% gamma passing score. Based on the TG 119 standard, meeting or exceeding the benchmark results would indicate an exemplary IMRT QA program. In contrast to TG 119 analysis, a different scrutiny on the same set of data, which follows the AAPM TG 53 and ESTRO booklet No.7 guidelines, reveals a much poorer agreement between calculated and measured dose distributions with large local point dose differences within different dose regions. This observation may challenge the conventional wisdom that an IMRT QA program is producing acceptable results.

Estimation of the minimum detectable activity of preclinical PET imaging systems with an analytical method.

PURPOSE: The traditional figures of merit used in the evaluation of positron emission tomography (PET) systems, including system sensitivity and spatial resolution, do not directly reflect the minimum detectable activity (MDA) performance, despite the fact that it is one of the most important tasks for a PET system. MDA, as a combination of the more traditional PET system parameters, is directly related to lesion detection. However, MDA evaluation is task specific and cannot be done by a single measurement. Therefore, a simple method to evaluate system detectability needs to be developed. METHODS: In this work, an analytical method of MDA estimation was developed, taking into account system sensitivity, spatial resolution, source properties, and noise propagation in image reconstruction by using the Rose criterion and/or the Curie equation as the detection standard. In the implementation, the source background, as well as the intrinsic activity background from the scintillation material of the system, was also taken into consideration. The accuracy of this method was evaluated in two commercially available preclinical PET systems, with phantom experiments that were designed to closely mimic in vivo tumor uptake without introducing finite boundaries between the source and the background. RESULTS: The lesion contrast-to-noise ratio calculated by the analytical evaluation showed good agreement with that obtained from the experiments. Visual assessment of the reconstructed images at the detection limit (based on analytical evaluation) also was in agreement with the Rose criterion. The MDA performance was quantitatively compared between the two preclinical PET systems and showed different detection limits under different imaging conditions, suggesting that the detection limit of a PET system strongly depends on the lesion properties and acquisition settings. CONCLUSIONS: An analytical method of evaluating the PET system detectability was developed and validated by experiments. Overall, the analytical MDA calculation provides a simple way to evaluate the signal detectability of a PET system and can be used for comparing different systems. It also provides guidelines for designing new PET tomographs as well as optimizing data acquisition protocols.

Performance evaluation of the inveon dedicated PET preclinical tomograph based on the NEMA NU-4 standards.

UNLABELLED: The Inveon dedicated PET (DPET) scanner is the latest generation of preclinical PET systems devoted to high-resolution and high-sensitivity murine model imaging. In this study, we report on its performance based on the National Electrical Manufacturers Association (NEMA) NU-4 standards. METHODS: The Inveon DPET consists of 64 lutetium oxyorthosilicate block detectors arranged in 4 contiguous rings, with a 16.1-cm ring diameter and a 12.7-cm axial length. Each detector block consists of a 20 x 20 lutetium oxyorthosilicate crystal array of 1.51 x 1.51 x 10.0 mm elements. The scintillation light is transmitted to position-sensitive photomultiplier tubes via optical light guides. Energy resolution, spatial resolution, sensitivity, scatter fraction, and counting-rate performance were evaluated. The NEMA NU-4 image-quality phantom and a healthy mouse injected with (18)F-FDG and (18)F(-) were scanned to evaluate the imaging capability of the Inveon DPET. RESULTS: The energy resolution at 511 keV was 14.6% on average for the entire system. In-plane radial and tangential resolutions reconstructed with Fourier rebinning and filtered backprojection algorithms were below 1.8-mm full width at half maximum (FWHM) at the center of the field of view. The radial and tangential resolution remained under 2.0 mm, and the axial resolution remained under 2.5-mm FWHM within the central 4-cm diameter of the field of view. The absolute sensitivity of the system was 9.3% for an energy window of 250-625 keV and a timing window of 3.432 ns. At a 350- to 625-keV energy window and a 3.432-ns timing window, the peak noise equivalent counting rate was 1,670 kcps at 130 MBq for the mouse-sized phantom and 590 kcps at 110 MBq for the rat-sized phantom. The scatter fractions at the same acquisition settings were 7.8% and 17.2% for the mouse- and rat-sized phantoms, respectively. The mouse image-quality phantom results demonstrate that for typical mouse acquisitions, the image quality correlates well with the measured performance parameters in terms of image uniformity, recovery coefficients, attenuation, and scatter corrections. CONCLUSION: The Inveon system, compared with previous generations of preclinical PET systems from the same manufacturer, shows significantly improved energy resolution, sensitivity, axial coverage, and counting-rate capabilities. The performance of the Inveon is suitable for successful murine model imaging experiments.

A technique for pediatric total skin electron irradiation.

BACKGROUND: Total skin electron irradiation (TSEI) is a special radiotherapy technique which has generally been used for treating adult patients with mycosis fungoides. Recently, two infants presented with leukemia cutis isolated to the skin requiring TSEI. This work discusses the commissioning and quality assurance (QA) methods for implementing a modified Stanford technique using a rotating harness system to position sedated pediatric patients treated with electrons to the total skin. METHODS AND RESULTS: Commissioning of pediatric TSEI consisted of absolute calibration, measurement of dosimetric parameters, and subsequent verification in a pediatric patient sized cylindrical phantom using radiographic film and optically stimulated luminance (OSL) dosimeters. The depth of dose penetration under TSEI treatment condition was evaluated using radiographic film sandwiched in the phantom and demonstrated a 2 cm penetration depth with the maximum dose located at the phantom surface. Dosimetry measurements on the cylindrical phantom and in-vivo measurements from the patients suggested that, the factor relating the skin and calibration point doses (i.e., the B-factor) was larger for the pediatric TSEI treatments as compared to adult TSEI treatments. Custom made equipment, including a rotating plate and harness, was fabricated and added to a standard total body irradiation stand and tested to facilitate patient setup under sedated condition. A pediatric TSEI QA program, consisting of daily output, energy, flatness, and symmetry measurements as well as in-vivo dosimetry verification for the first cycle was developed. With a long interval between pediatric TSEI cases, absolute dosimetry was also repeated as part of the QA program. In-vivo dosimetry for the first two infants showed that a dose of ± 10% of the prescription dose can be achieved over the entire patient body. CONCLUSION: Though pediatric leukemia cutis and the subsequent need for TSEI are rare, the ability to commission the technique on a modified TBI stand is appealing for clinical implementation and has been successfully used for the treatment of two pediatric patients at our institution.

NEMA NU 4-2008 comparison of preclinical PET imaging systems.

UNLABELLED: The National Electrical Manufacturers Association (NEMA) standard NU 4-2008 for performance measurements of small-animal tomographs was recently published. Before this standard, there were no standard testing procedures for preclinical PET systems, and manufacturers could not provide clear specifications similar to those available for clinical systems under NEMA NU 2-1994 and 2-2001. Consequently, performance evaluation papers used methods that were modified ad hoc from the clinical PET NEMA standard, thus making comparisons between systems difficult. METHODS: We acquired NEMA NU 4-2008 performance data for a collection of commercial animal PET systems manufactured since 2000: microPET P4, microPET R4, microPET Focus 120, microPET Focus 220, Inveon, ClearPET, Mosaic HP, Argus (formerly eXplore Vista), VrPET, LabPET 8, and LabPET 12. The data included spatial resolution, counting-rate performance, scatter fraction, sensitivity, and image quality and were acquired using settings for routine PET. RESULTS: The data showed a steady improvement in system performance for newer systems as compared with first-generation systems, with notable improvements in spatial resolution and sensitivity. CONCLUSION: Variation in system design makes direct comparisons between systems from different vendors difficult. When considering the results from NEMA testing, one must also consider the suitability of the PET system for the specific imaging task at hand.

In vivo mouse bioluminescence tomography with radionuclide-based imaging validation.

INTRODUCTION: Bioluminescence imaging, especially planar bioluminescence imaging, has been extensively applied in in vivo preclinical biological research. Bioluminescence tomography (BLT) has the potential to provide more accurate imaging information due to its 3D reconstruction compared with its planar counterpart. METHODS: In this work, we introduce a positron emission tomography (PET) radionuclide imaging-based strategy to validate the BLT results. X-ray computed tomography, PET, spectrally resolved bioluminescence imaging, and surgical excision were performed on a tumor xenograft mouse model expressing a bioluminescent reporter gene. RESULTS: With different spectrally resolved measured data, the BLT reconstructions were acquired based on the third-order simplified spherical harmonics (SP3) approximation and the diffusion approximation (DA). The corresponding tomographic images were obtained for validation of bioluminescence source reconstruction. CONCLUSION: Our results show the strength of PET imaging compared with other validation methods for BLT and improved source localization accuracy based on the SP(3) approximation compared with the diffusion approximation.

Performance evaluation of PETbox: a low cost bench top preclinical PET scanner.

PURPOSE: PETbox is a low cost bench top preclinical PET scanner dedicated to pharmacokinetic and pharmacodynamic mouse studies. A prototype system was developed at our institute, and this manuscript characterizes the performance of the prototype system. PROCEDURES: The PETbox detector consists of a 20 × 44 bismuth germanate crystal array with a thickness of 5 mm and cross-section size of 2.05 × 2.05 mm. Two such detectors are placed facing each other at a spacing of 5 cm, forming a dual-head geometry optimized for imaging mice. The detectors are kept stationary during the scan, making PETbox a limited angle tomography system. 3D images are reconstructed using a maximum likelihood and expectation maximization (ML-EM) method. The performance of the prototype system was characterized based on a modified set of the NEMA NU 4-2008 standards. RESULTS: In-plane image spatial resolution was measured to be an average of 1.53 mm full width at half maximum for coronal images and 2.65 mm for the anterior-posterior direction. The volumetric reconstructed resolution was below 8 mm(3) at most locations in the field of view (FOV). The sensitivity, scatter fraction, and noise equivalent count rate (NECR) were measured for different energy windows. With an energy window of 150 - 650 keV and a timing window of 20 ns optimized for mouse imaging, the peak absolute sensitivity was 3.99% at the center of FOV and a peak NECR of 20 kcps was achieved for a total activity of 3.2 MBq (86.8 µCi). Phantom and in vivo imaging studies were performed and demonstrated the utility of the system at low activity levels. The quantitation capabilities of the system were also characterized showing that despite the limited angle tomography, reasonably good quantification accuracy was achieved over a large dynamic range of activity levels. CONCLUSIONS: The presented results demonstrate the potential of this new tomograph for small animal imaging.