Yunping Zhu

Preliminary results from a Phase II trail of conforml radiation therapy for pediatric patients with localised low-grade astrocytoma and ependymoma

PURPOSEnTo estimate the local control and patterns of failure for pediatric patients with low-grade astroglial tumors (LGA) and ependymoma (EP) treated with three-dimensional conformal radiation therapy (CRT) using an anatomically defined clinical target volume (CTV).nnnMETHODS AND MATERIALSnFrom an ongoing, prospective Phase II trial initiated in July 1997, 102 pediatric patients with LGA (n = 38) and EP (n = 64) have been treated with CRT using an anatomically defined CTV extending 1.0 cm beyond the gross tumor volume and a 0.5-cm margin (planning target volume) extending outside of the CTV. The prescribed dose was 54 Gy (LGA) and 59.4 Gy (EP).nnnRESULTSnPatients with EP have been followed for a median of 17 months (range 3--43 months), and six failures have occurred. Patients with LGA have been followed for a median of 17 months (3--44 months), and four failures have occurred. Three-dimensional magnetic resonance (MR) studies performed to document treatment failure were registered with the MR and computed tomography (CT) data used in the treatment planning process. Failure occurred within the CTV for 5 patients with EP, including 3 with concurrent subarachnoid dissemination. One patient with EP developed metastatic disease with no evidence of local failure. Three patients with LGA failed within the CTV and one failed immediately outside of the CTV.nnnCONCLUSIONSnTreatment of an anatomically defined CTV, encompassing 1.0 cm of non-involved brain beyond the margin of resection or neuroimaging-defined tumor, appears to be safe for pediatric patients with LGA and EP based on these preliminary data. Normal tissue sparing through the use of advanced radiation therapy treatment planning and delivery techniques should be beneficial to pediatric patients if the rate and patterns of failure are similar to conventional techniques and toxicity reduction can be objectively documented.

Minimizing the number of segments in a delivery sequence for intensity-modulated radiation therapy with a multileaf collimator.

This paper proposes a sequencing algorithm for intensity-modulated radiation therapy with a multileaf collimator in the static mode. The algorithm aims to minimize the number of segments in a delivery sequence. For a machine with a long verification and recording overhead time (e.g., 15 s per segment), minimizing the number of segments is equivalent to minimizing the delivery time. The proposed new algorithm is based on checking numerous candidates for a segment and selecting the candidate that results in a residual intensity matrix with the least complexity. When there is more than one candidate resulting in the same complexity, the candidate with the largest size is selected. The complexity of an intensity matrix is measured in the new algorithm in terms of the number of segments in the delivery sequence obtained by using a published algorithm. The beam delivery efficiency of the proposed algorithm and the influence of different published algorithms used to calculate the complexity of an intensity matrix were tested with clinical intensity-modulated beams. The results show that no matter which published algorithm is used to calculate the complexity of an intensity matrix, the sequence generated by the algorithm proposed here is always more efficient than that generated by the published algorithm itself. The results also show that the algorithm used to calculate the complexity of an intensity matrix affects the efficiency of beam delivery. The delivery sequences are frequently most efficient when the algorithm of Bortfeld et al. is used to calculate the complexity of an intensity matrix. Because no single variation is most efficient for all beams tested, we suggest implementing multiple variations of our algorithm.

Verification of multileaf collimator leaf positions using an electronic portal imaging device

An automated method is presented for determining individual leaf positions of the Siemens dual focus multileaf collimator (MLC) using the Siemens BEAMVIEW(PLUS) electronic portal imaging device (EPID). Leaf positions are computed with an error of 0.6 mm at one standard deviation (sigma) using separate computations of pixel dimensions, image distortion, and radiation center. The pixel dimensions are calculated by superimposing the film image of a graticule with the corresponding EPID image. A spatial correction is used to compensate for the optical distortions of the EPID, reducing the mean distortion from 3.5 pixels (uncorrected) per localized x-ray marker to 2 pixels (1 mm) for a rigid rotation and 1 pixel for a third degree polynomial warp. A correction for a nonuniform dosimetric response across the field of view of the EPID images is not necessary due to the sharp intensity gradients across leaf edges. The radiation center, calculated from the average of the geometric centers of a square field at 0 degrees and 180 degrees collimator angles, is independent of graticule placement error. Its measured location on the EPID image was stable to within 1 pixel based on 3 weeks of repeated extensions/retractions of the EPID. The MLC leaf positions determined from the EPID images agreed to within a pixel of the corresponding values measured using film and ionization chamber. Several edge detection algorithms were tested: contour, Sobel, Roberts, Prewitt, Laplace, morphological, and Canny. These agreed with each other to within < or = 1.2 pixels for the in-air EPID images. Using a test pattern, individual MLC leaves were found to be typically within 1 mm of the corresponding record-and-verify values, with a maximum difference of 1.8 mm, and standard deviations of <0.3 mm in the daily reproducibility. This method presents a fast, automatic, and accurate alternative to using film or a light field for the verification and calibration of the MLC.

A mixed‐encoding genetic algorithm with beam constraint for conformal radiotherapy treatment planning

In this paper we propose a new hierarchical evolutionary algorithm that combines binary encoding and floating-point encoding to automatically select the beam directions and determine the weights of the selected beams. With traditional optimization methods the beam directions are fixed a priori by the operator in recognition of the fact that computer selection of beam directions is a difficult problem. In this investigation, we used a hybrid-encoding scheme. The binary encoding part of each chromosome was used to select the beam directions, and its corresponding floating-point encoding part of the same chromosome was used to determine the weights of those selected beams. Before beginning the optimization process, we set a constraint on the number of the beam directions we wanted in the final solution. We present three examples to verify this method. These examples differ with each other in tumor sites, problem sizes, and optimization parameters. Three-dimensional optimization results and statistical data showed that this method is feasible. We think this method can be easily extended to solve more complex target problems (such as nonconvex target problems).

COMPARISON OF TWO IMMOBILIZATION TECHNIQUES USING PORTAL FILM AND DIGITALLY RECONSTRUCTED RADIOGRAPHS FOR PEDIATRIC PATIENTS WITH BRAIN TUMORS

PURPOSEnTo compare the accuracy of two immobilization techniques for pediatric brain tumor patients.nnnMETHODS AND MATERIALSnWe analyzed data from 128 treatments involving 22 patients. Patients were immobilized with either a relocatable head frame (12 patients) or a vacuum bag (10 patients). Orthogonal portal films were used as verification images. Errors in patient positioning were measured by comparing verification images with digitally reconstructed radiographs generated by a three-dimensional treatment-planning system.nnnRESULTSnWith the head frame, systematic errors ranged from 1.4 mm to 2.1 mm; random errors, from 1.7 mm to 2.1 mm. With the vacuum bag, systematic errors ranged from 2.1 mm to 2.5 mm; random errors, from 2.0 mm to 2.6 mm. For the head frame, the mean length of the radial displacement was 4.4 mm; 90% of the total three-dimensional deviation was less than 6.8 mm. The corresponding values for the vacuum bag were 5.0 and 6.6 mm, respectively.nnnCONCLUSIONSnThe head frame and vacuum bag techniques limit the random and systematic errors in each of the three directions to within +/- 5 mm. We have used these results to determine the margin used to create the planning target volume for conformal radiation therapy.

Adaptive portal CT reconstruction: A simulation study

In radiotherapy, radiation treatment beams contain valuable information for patient setup verification. These beams may be used for portal CT reconstruction. However, direct use of the beam data for reconstruction may yield inadequate CT images simply because these beams cover only a part of the patient body. In this study, we use the treatment beams in addition to a set of regular CT projection beams to reconstruct a locally enhanced portal CT image. This approach is called adaptive portal CT reconstruction. A computer simulation demonstrated the advantages of the approach. The image reconstruction was carried out by the multilevel scheme algebraic reconstruction technique. Results indicated that the image quality of adaptive portal CT reconstruction is equivalent to that obtained from a full set of projections. This proposed technique should be not only valuable for three-dimensional radiotherapy verification, but also applicable to diagnostic CT imaging.

Conversion of dose?volume constraints to dose limits

The purpose of this study is to introduce two techniques for converting dose-volume constraints to dose limits for treatment planning optimization, and to evaluate their performance. The first technique, called dose-sorting, is based on the assumption that higher dose limits should be assigned to the constraint points receiving higher doses, and vice versa. The second technique, the hybrid technique, is a hybrid of the dose-sorting technique and the mixed integer linear programming (MILP) technique. Among all constraint points in an organ at risk, the dose limits for the points far from a dose-volume constraint are determined by dose-sorting, while the dose limits for the points close to a dose-volume constraint are determined by MILP. We evaluated the performance of the two new techniques for one treatment geometry by comparing them with the MILP technique. The dose-sorting technique had a high probability of finding the global optimum when no more than three organs at risk have dose-volume constraints. It was much faster than the MILP technique. The hybrid technique always found the global optimum when the MILP percentage (the percentage of constraint points for which the dose limits are determined by the MILP technique) was large enough, but its computation time increased dramatically with the MILP percentage. In conclusion, the dose-sorting technique and the hybrid technique with a low MILP percentage are clinically feasible.

Optimizing beam weights and wedge filters with the concept of the super-omni wedge

This study introduces a new concept, the super-omni wedge, and proposes an algorithm for optimizing beam weights, wedge angles, and wedge orientations on the basis of this new concept. The super-omni wedge is a generalization of the omni wedge. Instead of combining one open beam and two orthogonal wedged beams, it uses two orthogonal pairs of nominal wedged beams to generate a wedged dose distribution with an arbitrary wedge angle and an arbitrary wedge orientation. The orientations of a pair of nominal wedges are opposite each other. In this way, the effective wedge orientation can vary from 0 degrees to 360 degrees rather than being restricted to one quadrant. When the concept of the super-omni wedge is used, the optimization of beam weights, wedge angles, and wedge orientations for J beams is transformed into the optimization of beam weights for 4J beams. A quadratic dose-based objective function is defined, and the method of sequential quadratic programming is used to find the 4J beam weights that minimize it. After the weights of the nominal wedged beams have been determined, the beams can be delivered in one of four methods: Directly, by using the omni wedge technique, by using the universal wedge technique, and by using the virtual wedge technique. When tested with two clinical cases, the algorithm achieved homogeneous dose distributions in target volumes while meeting the constraints to the organs at risk. A prominent feature of the algorithm is that there is no need to manually preselect the orientations of nominal wedges.

Theoretical developments on fast Fourier transform convolution dose calculations in inhomogeneous media.

A theory is presented on dose calculations in inhomogeneous media that takes advantage of fast Fourier transform (FFT) convolution for practical three-dimensional treatment planning using photon beams. While the initial work of Boyer and Mok [Med. Phys. 13, 503-509 (1986)] provided a theory which is based on first principles, it failed to give satisfactory predictions inside inhomogeneities. Subsequently, Zhu and Boyer [Phys. Med. Biol. 35, 351-368 (1990)] showed that their formulas agreed well with measured data, but these formulas were empirically altered from Boyer and Moks. In this work, Boyer and Moks first-order theory is extended to include second-order inhomogeneity effects. A new correction dose formula is derived which corrects the first scattered dose due to the presence of inhomogeneities. This correction dose formula works better than Zhu and Boyers empirical correction dose formula. Furthermore, the primary dose formula used by Zhu and Boyer, which was empirically modified from Boyer and Moks, is justified theoretically. Clear statements are made about the assumptions and the approximations that enter into the derivation which in turn uncover the limitations of this FFT convolution dose calculation.

Selecting beam weight and wedge filter on the basis of dose gradient analysis

This study proposes an algorithm for selecting beam weight, wedge angle, and wedge orientation for three-dimensional radiation therapy treatment planning. According to dose gradient analysis, the necessary and sufficient condition for achieving a homogeneous dose over the target volume is that the total vector sum of the dose gradients of all beams be zero everywhere in the target volume. This study presents equations for calculating the beam weight, wedge angle, and collimator angle (because the collimator angle determines wedge orientation when beam direction is known) for treatment plans using two angled beams or three coplanar or noncoplanar beams. It also provides suggestions for calculations of treatment plans using more than three beams, for which many feasible solutions will be available. When tested using two clinical cases, this algorithm achieved homogeneous dose distributions over target volumes. With this algorithm, repeated manual adjustments are reduced, and the quality and efficiency of treatment planning are improved.