J Jung

Dosimetric characterization of 142Pr glass seeds for brachytherapy

A glass bead consisted of the beta(-)-emitting (142)Pr is proposed for brachytherapy treatment of prostate cancer. Appropriate radionuclide and seed dimensions were selected and sample seeds were manufactured. For the quantitative dosimetric parameters, two-dimensional dose distributions were calculated using the MCNP5 Monte Carlo code and measured using radiochromic film. The computational results compared well with measurements. Dose at 0.6 cm from the seed center can exceed 130 Gy. The reference dose rate, radial dose function and the anisotropy function were derived.

Dose reconstruction for intensity-modulated radiation therapy using a non-iterative method and portal dose image

A straightforward and accurate method was developed to verify the delivery of intensity-modulated radiation therapy (IMRT) and to reconstruct the dose in a patient. The method is based on a computational algorithm that linearly describes the physical relationship between beamlets and dose-scoring voxels in a patient and the dose image from an electronic portal imaging device (EPID). The relationship is expressed in the form of dose response functions (responses) that are quantified using Monte Carlo (MC) particle transport techniques. From the dose information measured by the EPID the received patient dose is reconstructed by inversely solving the algorithm. The unique and novel non-iterative feature of this algorithm sets it apart from many existing dose reconstruction methods in the literature. This study presents the algorithm in detail and validates it experimentally for open and IMRT fields. Responses were first calculated for each beamlet of the selected fields by MC simulation. In-phantom and exit film dosimetry were performed on a flat phantom. Using the calculated responses and the algorithm, the exit film dose was used to inversely reconstruct the in-phantom dose, which was then compared with the measured in-phantom dose. The dose comparison in the phantom for all irradiated fields showed a pass rate of higher than 90% dose points given the criteria of dose difference of 3% and distance to agreement of 3 mm.

Fast transit portal dosimetry using density‐scaled layer modeling of aSi‐based electronic portal imaging device and Monte Carlo method

PURPOSE Fast and accurate transit portal dosimetry was investigated by developing a density-scaled layer model of electronic portal imaging device (EPID) and applying it to a clinical environment. METHODS The model was developed for fast Monte Carlo dose calculation. The model was validated through comparison with measurements of dose on EPID using first open beams of varying field sizes under a 20-cm-thick flat phantom. After this basic validation, the model was further tested by applying it to transit dosimetry and dose reconstruction that employed our predetermined dose-response-based algorithm developed earlier. The application employed clinical intensity-modulated beams irradiated on a Rando phantom. The clinical beams were obtained through planning on pelvic regions of the Rando phantom simulating prostate and large pelvis intensity modulated radiation therapy. To enhance agreement between calculations and measurements of dose near penumbral regions, convolution conversion of acquired EPID images was alternatively used. In addition, thickness-dependent image-to-dose calibration factors were generated through measurements of image and calculations of dose in EPID through flat phantoms of various thicknesses. The factors were used to convert acquired images in EPID into dose. RESULTS For open beam measurements, the model showed agreement with measurements in dose difference better than 2% across open fields. For tests with a Rando phantom, the transit dosimetry measurements were compared with forwardly calculated doses in EPID showing gamma pass rates between 90.8% and 98.8% given 4.5 mm distance-to-agreement (DTA) and 3% dose difference (DD) for all individual beams tried in this study. The reconstructed dose in the phantom was compared with forwardly calculated doses showing pass rates between 93.3% and 100% in isocentric perpendicular planes to the beam direction given 3 mm DTA and 3% DD for all beams. On isocentric axial planes, the pass rates varied between 95.8% and 99.9% for all individual beams and they were 98.2% and 99.9% for the composite beams of the small and large pelvis cases, respectively. Three-dimensional gamma pass rates were 99.0% and 96.4% for the small and large pelvis cases, respectively. CONCLUSIONS The layer model of EPID built for Monte Carlo calculations offered fast (less than 1 min) and accurate calculation for transit dosimety and dose reconstruction.

Estimation of external radiation dose to caregivers of patients treated with radioiodine after thyroidectomy.

AbstractDue to the remarkable increase in thyroid cancer cases, the number of patients treated with radioiodine (131I) shows a sharply increasing trend in recent years. Accordingly, radiation exposure of other people, particularly caregivers or comforters, after release of patients from hospitals is getting more attention than ever. In the present study, empirical equations are proposed for estimation of doses to caregivers. Only patients administered with therapeutic amounts of 131I after thyroidectomy were considered. External radiation doses to 70 caregivers or family members were measured using thermoluminescence dosimeters (TLDs). The mean, external, effective dose to caregivers, during a nursing period of 5–9 d after patient quarantine for 3–4 d in the hospital, was 0.12 ± 0.10 mSv. This is only 2.5% of the dose limit recommended by the International Commission on Radiological Protection for caregivers. By analyzing those individual doses to the caregivers, values of a factor affecting caregiver doses, K, are obtained for use in estimation of caregivers’ doses. The factor reflects the degree of engagement of the caregiver to the patient, and hence it is named the “engagement factor.” The mean value of the engagement factor in this study was 1.3 ± 0.88. With the help of the engagement factor, the total external dose to a caregiver can be estimated as 1.1 × Q0 × e−0.05Tr mSv, where Q0 is the administered activity of 131I (GBq) and Tr is the patient’s release time (h) after admistration of radioiodine. Based on the dose estimation model developed in this study, by comparing the cost of extended quarantine against that incurred by release of the patient, including the burden of radiation exposure of caregivers or family members, the reasonableness of current quarantine periods was revisited. It was found that the dichotomous policy (i.e., hospitalizing patients administered 131I over 1.1 GBq for a period of 3–4 d compared with treating other patients administered below 1.1 GBq as outpatients) is unjustifiable; this is particularly true for those treated with a few GBq. Based upon the dose estimation model presented herein, tables suggesting an appropriate quarantine period depending upon the activity of the administered 131I are provided for use as reference in deciding when to release patients treated with therapy levels of 131I after thyroidectomy.

Reconstruction of organ dose for external radiotherapy patients in retrospective epidemiologic studies

Organ dose estimation for retrospective epidemiological studies of late effects in radiotherapy patients involves two challenges: radiological images to represent patient anatomy are not usually available for patient cohorts who were treated years ago, and efficient dose reconstruction methods for large-scale patient cohorts are not well established. In the current study, we developed methods to reconstruct organ doses for radiotherapy patients by using a series of computational human phantoms coupled with a commercial treatment planning system (TPS) and a radiotherapy-dedicated Monte Carlo transport code, and performed illustrative dose calculations. First, we developed methods to convert the anatomy and organ contours of the pediatric and adult hybrid computational phantom series to Digital Imaging and Communications in Medicine (DICOM)-image and DICOM-structure files, respectively. The resulting DICOM files were imported to a commercial TPS for simulating radiotherapy and dose calculation for in-field organs. The conversion process was validated by comparing electron densities relative to water and organ volumes between the hybrid phantoms and the DICOM files imported in TPS, which showed agreements within 0.1 and 2%, respectively. Second, we developed a procedure to transfer DICOM-RT files generated from the TPS directly to a Monte Carlo transport code, x-ray Voxel Monte Carlo (XVMC) for more accurate dose calculations. Third, to illustrate the performance of the established methods, we simulated a whole brain treatment for the 10 year-old male phantom and a prostate treatment for the adult male phantom. Radiation doses to selected organs were calculated using the TPS and XVMC, and compared to each other. Organ average doses from the two methods matched within 7%, whereas maximum and minimum point doses differed up to 45%. The dosimetry methods and procedures established in this study will be useful for the reconstruction of organ dose to support retrospective epidemiological studies of late effects in radiotherapy patients.

Conditions for reliable time-resolved dosimetry of electronic portal imaging devices for fixed-gantry IMRT and VMAT.

PURPOSE The continuous scanning mode of electronic portal imaging devices (EPID) that offers time-resolved information has been newly explored for verifying dynamic radiation deliveries. This study seeks to determine operating conditions (dose rate stability and time resolution) under which that mode can be used accurately for the time-resolved dosimetry of intensity-modulated radiation therapy (IMRT) beams. METHODS The authors have designed the following test beams with variable beam holdoffs and dose rate regulations: a 10 × 10 cm open beam to serve as a reference beam; a sliding window (SW) beam utilizing the motion of a pair of multileaf collimator (MLC) leaves outside the 10 × 10 cm jaw; a step and shoot (SS) beam to move the pair in step; a volumetric modulated arc therapy (VMAT) beam. The beams were designed in such a way that they all produce the same open beam output of 10 × 10 cm. Time-resolved ion chamber measurements at isocenter and time-resolved and integrating EPID measurements were performed for all beams. The time-resolved EPID measurements were evaluated through comparison with the ion chamber and integrating EPID measurements, as the latter are accepted procedures. For two-dimensional, time-resolved evaluation, a VMAT beam with an infield MLC travel was designed. Time-resolved EPID measurements and Monte Carlo calculations of such EPID dose images for this beam were performed and intercompared. RESULTS For IMRT beams (SW and SS), the authors found disagreement greater than 2%, caused by frame missing of the time-resolved mode. However, frame missing disappeared, yielding agreement better than 2%, when the dose rate of irradiation (and thus the frame acquisition rates) reached a stable and planned rate as the dose of irradiation was raised past certain thresholds (a minimum 12 s of irradiation per shoot used for SS IMRT). For VMAT, the authors found that dose rate does not affect the frame acquisition rate, thereby causing no frame missing. However, serious inplanar nonuniformities were found. This could be overcome by sacrificing temporal resolution (10 frames or 0.95 s/image): the continuous images agreed with ion chamber responses at the center of EPID and the calculation two-dimensionally in a time-resolved manner. CONCLUSIONS The authors have determined conditions under which the continuous mode can be used for time-resolved dosimetry of fixed-gantry IMRT and VMAT and demonstrated it for VMAT.

A Monte Carlo calculation model of electronic portal imaging device for transit dosimetry through heterogeneous media.

PURPOSE To develop and evaluate a fast Monte Carlo (MC) dose calculation model of electronic portal imaging device (EPID) based on its effective atomic number modeling in the XVMC code. METHODS A previously developed EPID model, based on the XVMC code by density scaling of EPID structures, was modified by additionally considering effective atomic number (Zeff) of each structure and adopting a phase space file from the EGSnrc code. The model was tested under various homogeneous and heterogeneous phantoms and field sizes by comparing the calculations in the model with measurements in EPID. In order to better evaluate the model, the performance of the XVMC code was separately tested by comparing calculated dose to water with ion chamber (IC) array measurement in the plane of EPID. RESULTS In the EPID plane, calculated dose to water by the code showed agreement with IC measurements within 1.8%. The difference was averaged across the in-field regions of the acquired profiles for all field sizes and phantoms. The maximum point difference was 2.8%, affected by proximity of the maximum points to penumbra and MC noise. The EPID model showed agreement with measured EPID images within 1.3%. The maximum point difference was 1.9%. The difference dropped from the higher value of the code by employing the calibration that is dependent on field sizes and thicknesses for the conversion of calculated images to measured images. Thanks to the Zeff correction, the EPID model showed a linear trend of the calibration factors unlike those of the density-only-scaled model. The phase space file from the EGSnrc code sharpened penumbra profiles significantly, improving agreement of calculated profiles with measured profiles. CONCLUSIONS Demonstrating high accuracy, the EPID model with the associated calibration system may be used for in vivo dosimetry of radiation therapy. Through this study, a MC model of EPID has been developed, and their performance has been rigorously investigated for transit dosimetry.

A Novel Method to Extend a Partial-Body CT for the Reconstruction of Dose to Organs beyond the Scan Range

Epidemiological investigation is an important approach to assessing the risk of late effects after radiotherapy, and organ dosimetry is a crucial part of such analysis. Computed tomography (CT) images, if available, can be a valuable resource for individualizing the dosimetry, because they describe the specific anatomy of the patient. However, CT images acquired for radiation treatment planning purposes cover only a portion of the body near the target volume, whereas for epidemiology, the interest lies in the more distant normal tissues, which may be located outside the scan range. To address this challenge, we developed a novel method, called the Anatomically Predictive Extension (APE), to extend a partial-body CT image stack using images of a computational human phantom matched to the patient based on their height and weight. To test our method, we created five APE phantoms from chest and abdominal images extracted from the chest-abdomen-pelvis (CAP) CT scans of five patients. Organ doses were calculated for simple chest and prostate irradiations that were planned on the reference computational phantom (assumed patient geometry if no CT images are available), APE phantoms (patient-phantom hybrid given a partial-body patient CT) and full patient CAP CT scans (ground truth). The APE phantoms and patient CAP CT scans resulted in nearly identical dosimetry for those organs that were fully included in the partial-body CT used to construct the APE. The calculated doses to these same organs in the reference phantoms differed by up to 20% and 52% for the chest and prostate cases, respectively. For organs outside the scan coverage, the reference phantom showed, on average, dose differences of 31% (chest case) and 41% (prostate case). For the APE phantoms, these values were 26% (chest) and 17% (prostate). The APE method combines patient and phantom images to improve organ dosimetry both inside and outside the scan range. We intend to use the APE method for estimating dose for organs peripheral to the treatment fields; however, this method is quite generalizable with many potential applications.

Comparison of normal tissue dose calculation methods for epidemiological studies of radiotherapy patients

Radiation dosimetry is an essential input for epidemiological studies of radiotherapy patients aimed at quantifying the dose-response relationship of late-term morbidity and mortality. Individualised organ dose must be estimated for all tissues of interest located in-field, near-field, or out-of-field. Whereas conventional measurement approaches are limited to points in water or anthropomorphic phantoms, computational approaches using patient images or human phantoms offer greater flexibility and can provide more detailed three-dimensional dose information. In the current study, we systematically compared four different dose calculation algorithms so that dosimetrists and epidemiologists can better understand the advantages and limitations of the various approaches at their disposal. The four dose calculations algorithms considered were as follows: the (1) Analytical Anisotropic Algorithm (AAA) and (2) Acuros XB algorithm (Acuros XB), as implemented in the Eclipse treatment planning system (TPS); (3) a Monte Carlo radiation transport code, EGSnrc; and (4) an accelerated Monte Carlo code, the x-ray Voxel Monte Carlo (XVMC). The four algorithms were compared in terms of their accuracy and appropriateness in the context of dose reconstruction for epidemiological investigations. Accuracy in peripheral dose was evaluated first by benchmarking the calculated dose profiles against measurements in a homogeneous water phantom. Additional simulations in a heterogeneous cylinder phantom evaluated the performance of the algorithms in the presence of tissue heterogeneity. In general, we found that the algorithms contained within the commercial TPS (AAA and Acuros XB) were fast and accurate in-field or near-field, but not acceptable out-of-field. Therefore, the TPS is best suited for epidemiological studies involving large cohorts and where the organs of interest are located in-field or partially in-field. The EGSnrc and XVMC codes showed excellent agreement with measurements both in-field and out-of-field. The EGSnrc code was the most accurate dosimetry approach, but was too slow to be used for large-scale epidemiological cohorts. The XVMC code showed similar accuracy to EGSnrc, but was significantly faster, and thus epidemiological applications seem feasible, especially when the organs of interest reside far away from the field edge.

SU-F-J-114: On-Treatment Imagereconstruction Using Transit Images of Treatment Beams Through Patient and Thosethrough Planning CT Images

PURPOSE To reconstruct patient images at the time of radiation delivery using measured transit images of treatment beams through patient and calculated transit images through planning CT images. METHODS We hypothesize that the ratio of the measured transit images to the calculated images may provide changed amounts of the patient image between times of planning CT and treatment. To test, we have devised lung phantoms with a tumor object (3-cm diameter) placed at iso-center (simulating planning CT) and off-center by 1 cm (simulating treatment). CT images of the two phantoms were acquired; the image of the off-centered phantom, unavailable clinically, represents the reference on-treatment image in the image quality of planning CT. Cine-transit images through the two phantoms were also acquired in EPID from a non-modulated 6 MV beam when the gantry was rotated 360 degrees; the image through the centered phantom simulates calculated image. While the current study is a feasibility study, in reality our computational EPID model can be applicable in providing accurate transit image from MC simulation. Changed MV HU values were reconstructed from the ratio between two EPID projection data, converted to KV HU values, and added to the planning CT, thereby reconstructing the on-treatment image of the patient limited to the irradiated region of the phantom. RESULTS The reconstructed image was compared with the reference image. Except for local HU differences>200 as a maximum, excellent agreement was found. The average difference across the entire image was 16.2 HU. CONCLUSION We have demonstrated the feasibility of a method of reconstructing on-treatment images of a patient using EPID image and planning CT images. Further studies will include resolving the local HU differences and investigation on the dosimetry impact of the reconstructed image.