Salahuddin Ahmad

Dosimetric and radiobiologic comparison of 3D conformal, IMRT, VMAT and proton therapy for the treatment of early‐stage glottic cancer

This study aims to compare dosimetrically and radiobiologically 3D conformal, intensity modulated radiation therapy (IMRT), RapidArc (RA) volumetric modulated arc therapy and proton therapy techniques for early‐stage glottic cancer.

A motion algorithm to extract physical and motion parameters of mobile targets from cone-beam computed tomographic images

PURPOSE A motion algorithm has been developed to extract length, CT number level and motion amplitude of a mobile target from cone-beam CT (CBCT) images. MATERIALS AND METHODS The algorithm uses three measurable parameters: Apparent length and blurred CT number distribution of a mobile target obtained from CBCT images to determine length, CT-number value of the stationary target, and motion amplitude. The predictions of this algorithm are tested with mobile targets having different well-known sizes that are made from tissue-equivalent gel which is inserted into a thorax phantom. The phantom moves sinusoidally in one-direction to simulate respiratory motion using eight amplitudes ranging 0-20 mm. RESULTS Using this motion algorithm, three unknown parameters are extracted that include: Length of the target, CT number level, speed or motion amplitude for the mobile targets from CBCT images. The motion algorithm solves for the three unknown parameters using measured length, CT number level and gradient for a well-defined mobile target obtained from CBCT images. The motion model agrees with the measured lengths which are dependent on the target length and motion amplitude. The gradient of the CT number distribution of the mobile target is dependent on the stationary CT number level, the target length and motion amplitude. Motion frequency and phase do not affect the elongation and CT number distribution of the mobile target and could not be determined. CONCLUSION A motion algorithm has been developed to extract three parameters that include length, CT number level and motion amplitude or speed of mobile targets directly from reconstructed CBCT images without prior knowledge of the stationary target parameters. This algorithm provides alternative to 4D-CBCT without requirement of motion tracking and sorting of the images into different breathing phases. The motion model developed here works well for tumors that have simple shapes, high contrast relative to surrounding tissues and move nearly in regular motion pattern that can be approximated with a simple sinusoidal function. This algorithm has potential applications in diagnostic CT imaging and radiotherapy in terms of motion management.

Yields of positron and positron emitting nuclei for proton and carbon ion radiation therapy: A simulation study with GEANT4

A Monte Carlo application is developed to investigate the yields of positron-emitting nuclei (PEN) used for proton and carbon ion range verification techniques using the GEANT4 Toolkit. A base physics list was constructed and used to simulate incident proton and carbon ions onto a PMMA or water phantom using pencil like beams. In each simulation the total yields of PEN are counted and both the PEN and their associated positron depth-distributions were recorded and compared to the incident radiations Bragg Peak. Alterations to the physics lists are then performed to investigate the PEN yields dependence on the choice of physics list. In our study, we conclude that the yields of PEN can be estimated using the physics list presented here for range verification of incident proton and carbon ions.

Tumor control probability (TCP) in prostate cancer: Role of radiobiological parameters and radiation dose escalation

The objective of this work was to assess the relative impact of radiobiological parameters and radiation dose escalation on Tumor Control Probability for prostate cancer patients treated with radiation. Radiobiological parameters included alpha/beta ratios, cell surviving fraction at 2 Gy (SF(2) and clonogenic cell density (CCD). Using the Niemierko method, TCP was calculated in ten prostate cancer patients as a function of increasing radiation doses (70-140 Gy), alpha/beta ratios (1.5-20), SF(2) (0.3-0.7) and CCD (10-20 million cells/cm(3). At 70 Gy and CCD of 10 million/cm(3), TCP was above 99% for SF(2) of 0.3 or 0.4, 97.4%-98.6% for SF(2) of 0.5 and less than 2% for SF(2) of 0.6 or 0.7. With dose escalation, TCP values above 99% were demonstrated at 80 Gy for SF(2) of 0.5 and 100 Gy for SF(2) of 0.6. For SF(2) of 0.7, TCP above 99% was demonstrated with 100 Gy and CCD of 10(4)cells/cm(3) or 140 Gy and CCD of 10(7) cells/cm(3). TCP decreased with lower alpha/beta of 1.5, but at a much smaller scale compared to SF(2) changes. TCP modeling predicts that SF(2) and CCD are dominant predictors of radioresistance in prostate cancer. Radiation doses of 100 Gy or greater may be required for tumors with SF(2) of 0.6 or above. Relating clinical tumor prognostic indicators such as Gleason score and PSA to radiobiological parameters will allow us to identify subsets of patients in need of higher radiation doses and adjuvant therapy to maximize treatment outcomes.

Quantitative investigation of the effects of the scanning parameters in the digitization of EBT and EBT2 Gafchromic film dosimetry with flatbed scanners

With increasing popularity and complexity of intensity-modulated radiation therapy (IMRT) delivery modalities including regular and arc therapies, there is a growing challenge for validating the accuracy of dose distributions. Gafchromic films have superior characteristics for dose verification over other conventional dosimeters. In order to optimize the use of Gafchromic films in clinical IMRT quality assurance procedures, the scanning parameters of EBT and EBT2 films with a flatbed scanner were investigated. The effects of several parameters including scanning position, orientation, uniformity, film sensitivity and optical density (OD) growth after irradiation were quantified. The profiles of the EBT and EBT2 films had a noise level of 0.6% and 0.7%, respectively. Considerable orientation dependence was observed and the scanner value difference between landscape and portrait modes were about 12% and 10% for EBT and EBT2 films, respectively. The highest response sensitivity was observed using digitized red color images of the EBT2 film scanned with landscape mode. The total system non-uniformity composed of contributions from the film and the scanner was less than 1.7%. OD variations showed that EBT gray scale grew slower, however, reached higher growth values of 15% when compared with EBT2 gray scale which grew 12% after a long time (480 hours) post-irradiation. The EBT film using the red color channel showed the minimal growth where OD increased up to 3% within 3 days after irradiation, and took one week to stabilize.

An antiproton simulation study using MCNPX for radiation therapy.

Radiation therapy using antiprotons is a potential interesting future modality. Energetic antiprotons penetrate matter with almost near identical stopping powers and radio biological effectiveness (RBE) as protons in the region well before the Bragg peak region. When the antiprotons come to rest at or near the Bragg peak, they annihilate releasing almost 2 GeV per annihilation. Most of the energy is carried away on the average by 4 to 5 energetic pi mesons. The annihilations lead to roughly a doubling of physical dose with additional increase due to RBE in the Bragg peak region. This study was undertaken in order to assess the effect of the products of antiproton annihilations on depth dose profiles through MCNPX simulations. Beams of protons and antiprotons with varying energies and field sizes were used in the simulations. In our study, for 126 MeV beam, the peak to entrance (P/E) dose ratios of 4.9 for protons and 8.9 for antiprotons were found which gave the antiproton/proton P/E dose ratio equals to 1.8. This is in excellent agreement with the previous result obtained with FLUKA simulations.

Correction of image artifacts from treatment couch in cone-beam CT from kV on-board imaging

PURPOSE To investigate image artifacts caused by a standard treatment couch on cone-beam CT (CBCT) images from a kV on-board imager and to develop an algorithm based on spatial domain filtering to remove image artifacts in CBCT induced by the treatment couch. METHODS Image artifacts in CBCT induced by the treatment couch were quantified by scanning a phantom used to quantify CT image performance. This was performed by scanning the phantom setup on a regular treatment couch and in air with the kV on-board imager. An algorithm was developed to filter image artifacts from the treatment couch by processing of cone-beam radiographic projections using two scans: one scan of the phantom and treatment couch and a second scan of the treatment couch only. This algorithm is based on a pixel-by-pixel removal of beam attenuation due to the treatment couch from each projection of the phantom and couch scan. The net couch-filtered projections were then used to reconstruct CBCT. RESULTS We found that the treatment couch causes considerable image artifacts: CT number uniformity is degraded and varies as much as 15%, and noise in CBCT scans with phantom plus couch (3.5%) is higher than for the phantom in air (1.5%). The spatial domain filtering technique reduces noise by more than 1.5%, improves uniformity by a factor of 2, and removes ringing and streaking artifacts related to the standard treatment couch in CBCT reconstructed from couch-filtered projections. This filtering technique was tested successfully to filter other hardware objects such as a patient immobilization body-fix frame. CONCLUSIONS The standard treatment couch causes image artifact in CBCT from kV on-board imaging systems. The spatial domain filtering technique developed in this work improves image quality of CBCT by preprocessing the projections prior to CBCT reconstruction. This technique might be useful to filter other hardware objects from CBCT which may contribute to the degradation of image quality.

Clinical implementation of an empirical method for electron output factor determination.

The objective of this work has been to develop and implement an empirical calculation method for the determination of clinical electron output factors. Electron beams with various energies, field sizes, and source to surface distances using cutouts of varying radii were used to measure dose output at the depth of maximum dose in water. A 30 cm x 30 cm x 17.8 cm water equivalent phantom with a 0.125 cc cylindrical ion-chamber (PTW Model 31010) was used. The calculation model predicted the output factor as a product of the cone factor, radius dependent cutout factor, the effective source to surface distance factor and the area dependent aspect ratio factor. A comparative analysis of clinical cutout output factors, determined through both empirical calculation and direct measurement was performed to evaluate the clinical viability of the calculation method before its implementation in our clinic. A total of 643 output factors for 294 different cutout shapes were determined through both traditional measurement and predictive calculation. Predictive calculation differed from definitive measurement by at most 3.5% for all cases, a majority of cases falling within 1%. The method developed successfully predicts electron output factors on the basis of cutout geometry with accuracy better than 96% for all cases and better then 98% for most cases. This ability holds true for all practical SSD, electron energy, cone, and irregular shape combinations. The method has been clinically implemented and in use at our center since 2007.

Optimal densitometry wavelengths that maximize radiochromic film sensitivity while minimizing OD growth and temperature sensitivity artifacts.

It is well known that optical density (OD) of the radiochromic film (RCF) continues to grow after exposure at rates that have a complex dependence on dose, temperature, and densitometry wavelength. Dose rate and fractionation artifacts associated with variations in OD growth may limit the accuracy achievable by RCF dosimetry in brachytherapy and external beam applications, particularly at low doses (<5 Gy) and low dose rates (<10 cGy/h) where OD growth and sensitivity effects are large. To identify densitometry wavelengths that minimize OD growth artifacts and enhance RCF sensitivity at low doses, we have investigated Model MD-55-2 RCF response as a function of densitometry wavelength, irradiation-to-densitometry time interval, dose and temperature. Using a Perkin Elmer spectrophotometer, the absorption spectrum in the 500-700 nm range was measured for doses ranging from 1-100 Gy, over post-irradiation times from 1 h to 60 days. An empirical model with time-independent, fast and slow growth components was used to fit single exposure data and the dependence of the resulting best-fit parameters on dose and densitometry wavelength was investigated. RCF OD variation with temperature in the range 22-40 degrees was measured. Wavelengths in the 660-690 nm range were found to minimize the dose-dependence of OD post-exposure growth. Densitometry wavelengths in the range of 670-680 nm enhance RCF sensitivity and show small variations in OD with temperature in the range from 22-40 degrees. Compared to 633 nm light, 675 nm densitometry reduces OD growth at 1 Gy from 70% to 10% over a period of nearly 1174.0 h relative to the initial OD measured at 1.7 h post-irradiation. In addition, RCF sensitivity is nearly doubled at this wavelength for all dose levels.

Theoretical modeling of mobile target broadening in helical and axial computed tomographic imaging.

PURPOSE To investigate variations in mobile target length induced by sinusoidal motion in helical (HCT) and axial CT (ACT) imaging. A mathematical model was derived that predicts the measured broadening of the apparent lengths of mobile targets and its dependence on motion parameters, target size, and imaging couch speed in CT images. MATERIALS AND METHODS Three mobile targets of differing lengths and sizes were constructed of tissue-equivalent gel material and embedded into artificial lung phantom. Respiratory motion was mimicked with a mobile phantom that moves in one-dimension along the superior-inferior direction with sinusoidal motion patterns. A mathematical model was derived to predict quantitatively the variations of apparent lengths for mobile targets and its dependence on phantom and imaging couch motion parameters in HCT and ACT. The model predictions were verified by length measurements of the mobile phantom targets that were imaged with the different motion patterns using CT imaging. RESULTS The measured lengths of mobile targets enlarged or shrunk depending on the phantom motion parameters that include phantom speed, amplitude, frequency, phase and speed of the imaging couch. The target length variations were significant where some targets doubled lengths or shrunk to less than half of their actual length. The apparent lengths of mobile targets decreased if the target was moving in the same direction as the imaging couch motion and increased if the mobile target was moving opposed to imaging couch in both HCT and ACT. The model predicts well the variations in the mobile target apparent lengths and their dependence on the motion parameters. CONCLUSION The measured and model variations of apparent lengths of mobile targets are considerable and may affect the accuracy of tumor volumes obtained from HCT and ACT. This mathematical model provides a method to quantitatively assess the length variations of mobile targets and their dependence on motion parameters of the phantom and imaging system which may have potential applications in the fields of diagnostic imaging and radiotherapy.