Jaegi Lee

Pleuropulmonary and abdominal paragonimiasis: CT and ultrasound findings.

OBJECTIVES The purpose of this study was to review radiological images of patients with Paragonimus westermani (PW) that simultaneously involved the chest and abdomen. METHODS Our study included four patients with serologically and histopathologically confirmed paragonimiasis. Abdomen CT (n=3) and chest CT (n=3) scans were available, and abdominal wall ultrasonography was performed in all patients. We retrospectively reviewed the clinical, radiological and histopathological findings of these patients. RESULTS The most common abdominal CT findings were ascites and intraperitoneal or abdominal wall nodules. Low-attenuated serpentine lesions of the liver were another common and relatively specific feature. CONCLUSION Radiologists should consider the possibility of PW when these abdominal CT findings are noted, especially with pleural effusion or subpleural nodules in patients with initial abdominal symptoms.

Volumetric modulated arc therapy for carotid sparing in the management of early glottic cancer

Purpose Radiotherapy of the neck is known to cause carotid artery stenosis. We compared the carotid artery dose received between volumetric modulated arc therapy (VMAT) and conventional fixed-field intensity-modulated radiotherapy (IMRT) plans in patients with early glottic cancer. Materials and Methods Twenty-one early glottic cancer patients who previously underwent definitive radiotherapy were selected for this study. For each patient, double arc VMAT, 8-field IMRT, 3-dimensional conformal radiotherapy (3DCRT), and lateral parallel-opposed photon field radiotherapy (LPRT) plans were created. The 3DCRT plan was generated using lateral parallel-opposed photon fields plus an anterior photon field. VMAT and IMRT treatment plan optimization was performed under standardized conditions to obtain adequate target volume coverage and spare the carotid artery. Dose-volume specifications for the VMAT, IMRT, 3DCRT, and LPRT plans were calculated with radiotherapy planning system. Monitor units (MUs) and delivery time were measured to evaluate treatment efficiency. Results Target volume coverage and homogeneity results were comparable between VMAT and IMRT; however, VMAT was superior to IMRT for carotid artery dose sparing. The mean dose to the carotid arteries in double arc VMAT was reduced by 6.8% compared to fixed-field IMRT (p < 0.001). The MUs for VMAT and IMRT were not significantly different (p = 0.089). VMAT allowed an approximately two-fold reduction in treatment delivery time in comparison to IMRT (3 to 5 minutes vs. 5 to 10 minutes). Conclusion VMAT resulted in a lower carotid artery dose compared to conventional fixed-field IMRT, and maintained good target coverage in patients with early glottic cancer.

Dosimetric effects of roll rotational setup errors on lung stereotactic ablative radiotherapy using volumetric modulated arc therapy

OBJECTIVE To evaluate the dosimetric effects of roll-rotational setup errors of stereotactic ablative radiotherapy (SABR) for lung cancer using volumetric modulated arc therapy (VMAT). METHODS A total of 23 lung SABR cases were evaluated retrospectively. Each of the planning CT images was intentionally rotated by ±1°, ±2° and ±3°. After that, to simulate the translational couch correction, rotated CT images were moved along the x, y and z axis to match the centroid of the target volume in the rotated CT images with that in the original CT images. The differences in D95% and V100% of the target volume, D0.35cc of spinal cord, D0.35cc and D5cc of oesophagus and V20Gy of lung between the original and the rotated CT images were calculated. RESULTS The average differences in D95% and V100% of target volume, D0.35cc of spinal cord, D0.35cc and D5cc of oesophagus and V20Gy of lung were -0.3% ± 0.4% and -0.7% ± 2.4%, 1.6 ± 27.9 cGy, -1.6 ± 37.6 cGy, 15.9 ± 25.3 cGy and 0.0% ± 0.1%, respectively. The dosimetric changes in organs at risk (OARs) near the target volume were sometimes considerable due to roll-rotational setup errors, despite the translational correction, and those were patient specific. CONCLUSION In the case of coplanar VMAT for lung SABR, dosimetric changes to the target volume due to roll-rotational setup errors could be compensated by translational correction, whereas those to the OARs could not in some cases. ADVANCES IN KNOWLEDGE Roll-rotational setup errors would increase the dose to OARs despite the translational correction.

Development of real-time motion verification system using in-room optical images for respiratory-gated radiotherapy.

Phase‐based respiratory‐gated radiotherapy relies on the reproducibility of patient breathing during the treatment. To monitor the positional reproducibility of patient breathing against a 4D CT simulation, we developed a real‐time motion verification system (RMVS) using an optical tracking technology. The system in the treatment room was integrated with a real‐time position management system. To test the system, an anthropomorphic phantom that was mounted on a motion platform moved on a programmed breathing pattern and then underwent a 4D CT simulation with RPM. The phase‐resolved anterior surface lines were extracted from the 4D CT data to constitute 4D reference lines. In the treatment room, three infrared reflective markers were attached on the superior, middle, and inferior parts of the phantom along with the body midline and then RMVS could track those markers using an optical camera system. The real‐time phase information extracted from RPM was delivered to RMVS via in‐house network software. Thus, the real‐time anterior‐posterior positions of the markers were simultaneously compared with the 4D reference lines. The technical feasibility of RMVS was evaluated by repeating the above procedure under several scenarios such as ideal case (with identical motion parameters between simulation and treatment), cycle change, baseline shift, displacement change, and breathing type changes (abdominal or chest breathing). The system capability for operating under irregular breathing was also investigated using real patient data. The evaluation results showed that RMVS has a competence to detect phase‐matching errors between patients motion during the treatment and 4D CT simulation. Thus, we concluded that RMVS could be used as an online quality assurance tool for phase‐based gating treatments. PACS number: 87.55.Qr

Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite(®) treatment.

PURPOSE To investigate dose perturbations for pacemaker-implanted patients in partial breast irradiation using high dose rate (HDR) balloon brachytherapy. METHODS Monte Carlo (MC) simulations were performed to calculate dose distributions involving a pacemaker in Ir-192 HDR balloon brachytherapy. Dose perturbations by varying balloon-to-pacemaker distances (BPD = 50 or 100 mm) and concentrations of iodine contrast medium (2.5%, 5.0%, 7.5%, and 10.0% by volume) in the balloon were investigated for separate parts of the pacemaker (i.e., battery and substrate). Relative measurements using an ion-chamber were also performed to confirm MC results. RESULTS The MC and measured results in homogeneous media without a pacemaker agreed with published data within 2% from the balloon surface to 100 mm BPD. Further their dose distributions with a pacemaker were in a comparable agreement. The MC results showed that doses over the battery were increased by a factor of 3, compared to doses without a pacemaker. However, there was no significant dose perturbation in the middle of substrate but up to 70% dose increase in the substrate interface with the titanium capsule. The attenuation by iodine contrast medium lessened doses delivered to the pacemaker by up to 9%. CONCLUSIONS Due to inhomogeneity of pacemaker and contrast medium as well as low-energy photons in Ir-192 HDR balloon brachytherapy, the actual dose received in a pacemaker is different from the homogeneous medium-based dose and the external beam-based dose. Therefore, the dose perturbations should be considered for pacemaker-implanted patients when evaluating a safe clinical distance between the balloon and pacemaker.

Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite{sup Registered-Sign} treatment

PURPOSE To investigate dose perturbations for pacemaker-implanted patients in partial breast irradiation using high dose rate (HDR) balloon brachytherapy. METHODS Monte Carlo (MC) simulations were performed to calculate dose distributions involving a pacemaker in Ir-192 HDR balloon brachytherapy. Dose perturbations by varying balloon-to-pacemaker distances (BPD = 50 or 100 mm) and concentrations of iodine contrast medium (2.5%, 5.0%, 7.5%, and 10.0% by volume) in the balloon were investigated for separate parts of the pacemaker (i.e., battery and substrate). Relative measurements using an ion-chamber were also performed to confirm MC results. RESULTS The MC and measured results in homogeneous media without a pacemaker agreed with published data within 2% from the balloon surface to 100 mm BPD. Further their dose distributions with a pacemaker were in a comparable agreement. The MC results showed that doses over the battery were increased by a factor of 3, compared to doses without a pacemaker. However, there was no significant dose perturbation in the middle of substrate but up to 70% dose increase in the substrate interface with the titanium capsule. The attenuation by iodine contrast medium lessened doses delivered to the pacemaker by up to 9%. CONCLUSIONS Due to inhomogeneity of pacemaker and contrast medium as well as low-energy photons in Ir-192 HDR balloon brachytherapy, the actual dose received in a pacemaker is different from the homogeneous medium-based dose and the external beam-based dose. Therefore, the dose perturbations should be considered for pacemaker-implanted patients when evaluating a safe clinical distance between the balloon and pacemaker.

Fano cavity test for electron Monte Carlo transport algorithms in magnetic fields: comparison between EGSnrc, PENELOPE, MCNP6 and Geant4

A Fano cavity test was performed for four general-purpose Monte Carlo codes, EGSnrc, PENELOPE, MCNP6 and Geant4 to evaluate the accuracy of their electron transport algorithms in magnetic fields. In the simulations, a plane-parallel ionization chamber was modelled as a circular gas disk sandwiched between two circular solid wall disks. It was assumed that an isotropic and uniform line source per unit mass along the central axis of the gas and solid emits mono-energetic electrons with energies 0.01, 0.1, 1.0 and 3.0 MeV at different magnetic field strengths 0, 0.35, 1.0, 1.5 and 3.0 T in the electron transport mode (no Bremsstrahlung). The relative difference between the calculated dose to the gas region and the initial total energy of emitted electrons per unit mass was defined as the accuracy of Monte Carlo codes. In all results, EGSnrc with the enhanced electric and magnetic field (EEMF) macros was not considerably sensitive to the step size parameters and showed accuracy less than 0.18%  ±  0.06% with a coverage factor k  =  2. The other codes could not achieve competent accuracy with their default settings of step size parameters, compared to EGSnrc with the EEMF macros. With the step size parameters carefully selected, the accuracy of PENELOPE and MCNP6 was within 1.0% and 0.4%, respectively. However, Geant4 showed accuracy within 1.7% except in 3.0 T. EGSnrc with the EEMF macros achieved the best accuracy for the Fano test at the electron energies and the magnetic field strengths investigated in this study and thus, would be recommended to simulate dose responses of ionization chambers in the presence of magnetic fields.

Abstract ID: 13 Monte Carlo simulations for the beam quality factors of a parallel-plate ion-chamber in the presence of magnetic field

Magnetic resonance imaging-guided radiotherapy provides real-time imaging with a superior soft-tissue contrast without radiation exposure. Recently, several groups have been developing such a new technology. Strong magnetic fields can influence trajectories of the secondary electrons by the Lorentz force. The reference dosimetry using an ion-chamber in magnetic fields needs additional correction factors [1]. In this study, we calculated magnetic field correction factors by the Monte Carlo method for the reference dosimetry using a parallel-plate ion-chamber. The EGSnrc user code, egs_chamber was used to simulate an ion-chamber. The full head and spectral source models of Varian therapeutic linear accelerator of 6 MV, 10 MV, and 15 MV photon beam have been simulated by BEAMnrc and beamdp. A parallel-plate ion-chamber (NACP-02 model) was positioned in the water phantom (30 × 30 × 30 cm3) at a depth of 10 cm (5 cm for Co-60 beam). The beam quality factors (KQ) and magnetic field correction factors (KQ,B) were calculated. The absorbed dose of a parallel-plate ion-chamber was scored with and without a 1.5 T of magnetic field. The KQ of 6 MV, 10 MV, and 15 MV were 0.994, 0.980, and 0.976, respectively. These values were compatible to the previous published data (<0.3%) [2]. In a 1.5 T of magnetic field, the KQ,B of 6, 10, and 15 MV were 0.935, 0.985, and 0.994, respectively, compared to 0.975, 0.983, and 0.983 in a 0.35 T of magnetic field. All of simulation uncertainties were within 0.2%. When photon energy increases, KQ,B is also increased, but KQ,B in high strength of a magnetic field are not always smaller than those in low strength of a magnetic field. The magnetic field correction factors of a parallel-plate ion-chamber were successfully calculated by the Monte Carlo method. The parallel-plate ion-chambers need several percent of correction factors when measuring doses in the presence of a magnetic field.

The effect of body contouring on the dose distribution delivered with volumetric-modulated arc therapy technique.

The purpose of the study was to investigate the dosimetric effect defining the body structure with various Hounsfield unit (HU) threshold values on the dose distributions of volumetric‐modulated arc therapy (VMAT) plans. Twenty patients with prostate cancer and twenty patients with head and neck (H&N) cancer were retrospectively selected. For each patient, the body structure was redefined with HU threshold values of −180(Body180), −350(Body350), −700(Body700), and −980(Body980). For each patient, dose‐volumetric parameters with those body structures were calculated using identical VMAT plans. The differences in dose‐volumetric parameters due to the varied HU threshold values were calculated. For the prostate boost target volume, the maximum dose, mean dose, D95%, and D5% with Body180 were higher than those with Body980 by approximately 0.7% (p<0.001). For H&N target volumes, the changes in D95% of the targets receiving 67.5 Gy, 54 Gy, and 48 Gy between Body180 and Body980 were −1.2%, −0.9%, and −1.2%, respectively (p<0.001). The differences were larger for H&N VMAT plans than for prostate VMAT plans due to the inclusion of an immobilization device in the irradiated region in H&N cases. To apply all attenuating materials to dose calculation, the body structure would be defined with −980 HU. Otherwise, systematic error of about 1%, resulting in underdosage of the target volume, can occur. PACS number: 87.55.neThe purpose of the study was to investigate the dosimetric effect defining the body structure with various Hounsfield unit (HU) threshold values on the dose distributions of volumetric-modulated arc therapy (VMAT) plans. Twenty patients with prostate cancer and twenty patients with head and neck (H&N) cancer were retrospectively selected. For each patient, the body structure was redefined with HU threshold values of -180(Body180), -350(Body350), -700(Body700), and -980(Body980). For each patient, dose-volumetric parameters with those body structures were calculated using identical VMAT plans. The differences in dose-volumetric parameters due to the varied HU threshold values were calculated. For the prostate boost target volume, the maximum dose, mean dose, D95%, and D5% with Body180 were higher than those with Body980 by approximately 0.7% (p<0.001). For H&N target volumes, the changes in D95% of the targets receiving 67.5 Gy, 54 Gy, and 48 Gy between Body180 and Body980 were -1.2%, -0.9%, and -1.2%, respectively (p<0.001). The differences were larger for H&N VMAT plans than for prostate VMAT plans due to the inclusion of an immobilization device in the irradiated region in H&N cases. To apply all attenuating materials to dose calculation, the body structure would be defined with -980 HU. Otherwise, systematic error of about 1%, resulting in underdosage of the target volume, can occur. PACS number: 87.55.ne.