A clinical 3D/4D CBCT-based treatment dose monitoring system.

To monitor delivered dose and trigger plan adaptation when deviation becomes unacceptable, a clinical treatment dose (Tx-Dose) reconstruction system based on three-dimensional (3D)/four-dimensional (4D)-cone beam computed tomograpy (CBCT) images was developed and evaluated on various treatment sites, particularly for lung cancer patient treated by stereotactic body radiation therapy (SBRT). This system integrates with our treatment planning system (TPS), Linacs recording and verification system (R&V), and CBCT imaging system, consisting of three modules: Treatment Schedule Monitoring module (TSM), pseudo-CT Generating module (PCG), and Treatment Dose Reconstruction/evaluation module (TDR). TSM watches the treatment progress in the R&V system and triggers the PCG module when new CBCT is available. PCG retrieves the CBCTs and performs planning CT to CBCT deformable registration (DIR) to generate pseudo-CT. The 4D-CBCT images are taken for target localization and correction in lung cancer patient before treatment. To take full advantage of the valuable information carried by 4D-CBCT, a novel phase-matching DIR scheme was developed to generate 4D pseudo-CT images for 4D dose reconstruction. Finally, TDR module creates TPS scripts to automate Tx-Dose calculation on the pseudo-CT images. Both initial quantitative commissioning and patient-specific qualitative quality assurance of the DIR tool were utilized to ensure the DIR quality. The treatment doses of ten patients (six SBRT-lung, two head and neck (HN), one breast and one prostate cancer patients) were retrospectively constructed and evaluated. The target registration error (mean ± STD: 1.05 ± 1.13 mm) of the DIR tool is comparable to the interobserver uncertainty (0.88 ± 1.31 mm) evaluated by a publically available lung-landmarks dataset. For lung SBRT patients, the D99 of the final cumulative Tx-Dose of GTV is 93.8 ± 5.5% (83.7-100.1%) of the originally planned D99 . CTV D99 decreases by 3% and mean ipsilateral parotid dose increases by 11.5% for one of the two HN patients. In conclusion, we have demonstrated the feasibility and effectiveness of a treatment dose verification system in our clinical setting.

A real time dose monitoring and dose reconstruction tool for patient specific VMAT QA and delivery.

PURPOSE: To develop a real time dose monitoring and dose reconstruction tool to identify and quantify sources of errors during patient specific volumetric modulated arc therapy (VMAT) delivery and quality assurance. METHODS: The authors develop a VMAT delivery monitor tool called linac data monitor that connects to the linac in clinical mode and records, displays, and compares real time machine parameters with the planned parameters. A new measure, called integral error, keeps a running total of leaf overshoot and undershoot errors in each leaf pair, multiplied by leaf width, and the amount of time during which the error exists in monitor unit delivery. Another tool reconstructs Pinnacle(3)™ format delivered plan based on the saved machine logfile and recalculates actual delivered dose in patient anatomy. Delivery characteristics of various standard fractionation and stereotactic body radiation therapy (SBRT) VMAT plans delivered on Elekta Axesse and Synergy linacs were quantified. RESULTS: The MLC and gantry errors for all the treatment sites were 0.00 ± 0.59 mm and 0.05 ± 0.31°, indicating a good MLC gain calibration. Standard fractionation plans had a larger gantry error than SBRT plans due to frequent dose rate changes. On average, the MLC errors were negligible but larger errors of up to 6 mm and 2.5° were seen when dose rate varied frequently. Large gantry errors occurred during the acceleration and deceleration process, and correlated well with MLC errors (r = 0.858, p = 0.0004). PTV mean, minimum, and maximum dose discrepancies were 0.87 ± 0.21%, 0.99 ± 0.59%, and 1.18 ± 0.52%, respectively. The organs at risk (OAR) doses were within 2.5%, except some OARs that showed up to 5.6% discrepancy in maximum dose. Real time displayed normalized total positive integral error (normalized to the total monitor units) correlated linearly with MLC (r = 0.9279, p < 0.001) and gantry errors (r = 0.742, p = 0.005). There is a strong correlation between total integral error and PTV mean (r = 0.683, p = 0.015), minimum (r = 0.6147, p = 0.033), and maximum dose (r = 0.6038, p = 0.0376). CONCLUSIONS: Errors may exist during complex VMAT planning and delivery. Linac data monitor is capable of detecting and quantifying mechanical and dosimetric errors at various stages of planning and delivery.

Programming in the small.

Academic medical centers, in general, and radiation oncology research, in particular, rely heavily on custom software tools and applications. The code development is typically the responsibility of a single individual or at most a small team. Often these individuals are not professional programmers but physicists, students, and physicians. While they possess domain expertise and algorithm knowledge, they often are not fully aware of general "safe coding" practices--nor do they need the full complexity familiar in large commercial software projects to succeed. Rather, some simple guidelines we refer to as "programming in the small" can be used.

Evaluation of algebraic iterative image reconstruction methods for tetrahedron beam computed tomography systems.

Tetrahedron beam computed tomography (TBCT) performs volumetric imaging using a stack of fan beams generated by a multiple pixel X-ray source. While the TBCT system was designed to overcome the scatter and detector issues faced by cone beam computed tomography (CBCT), it still suffers the same large cone angle artifacts as CBCT due to the use of approximate reconstruction algorithms. It has been shown that iterative reconstruction algorithms are better able to model irregular system geometries and that algebraic iterative algorithms in particular have been able to reduce cone artifacts appearing at large cone angles. In this paper, the SART algorithm is modified for the use with the different TBCT geometries and is tested using both simulated projection data and data acquired using the TBCT benchtop system. The modified SART reconstruction algorithms were able to mitigate the effects of using data generated at large cone angles and were also able to reconstruct CT images without the introduction of artifacts due to either the longitudinal or transverse truncation in the data sets. Algebraic iterative reconstruction can be especially useful for dual-source dual-detector TBCT, wherein the cone angle is the largest in the center of the field of view.

The quest for market exclusivity in biotechnology: navigating the patent minefield.

A patent is a legal device that grants an inventor market exclusivity over a new invention or medication. Market exclusivity can mean tremendous economic rewards for the patent holder because it provides the inventor with a monopoly over the invention for the 20-year patent term. Obtaining a patent and retaining market exclusivity can be a treacherous process, especially in the arena of biotechnology patents. Scientific, legal, and practical considerations must be carefully weighed to best protect an inventor's rights. This article explores some common patenting pitfalls as well as emerging issues that are specific to the area of biotechnology patenting.