The dose response of normoxic polymer gel dosimeters measured using X-ray CT

X-ray CT was used to determine the dose response of normoxic polymer gel dosimeters. Normoxic polymer gel dosimeters were manufactured and irradiated up to 150 Gy. Up to 50 CT images were acquired on a Toshiba Aquilion Multislice CT scanner using protocols for 80 kV and 135 kV to determine dose response. HU-dose sensitivity, the linear regression of data for the HU versus dose for the linear part of the curve up to 60 Gy was 0.38+/-0.07 HU Gy(-1) for 135 kV and 0.37+/-0.01 HU Gy(-1) for 80 kV. Dose resolution was found to be < 1.3 Gy for an absorbed dose range up to 70 Gy for 135 kV, similar to that measured previously for polyacrylamide gel (PAG). Although the HU-dose sensitivity was lower than that previously measured for PAG gel dosimeters it had a greater range of absorbed dose indicating that normoxic polymer gel dosimeters have potential in CT gel dosimetry.     

A comparison of polyacrylamide gels and radiochromic film for source measurements in intravascular brachytherapy

For intravascular brachytherapy with catheter-based systems, AAPM Task Group 60 has recommended measurements that should be made to characterize the sources. Beta emitters, including (90)Sr/(90)Y are ideal for intravascular brachytherapy, but problems arise in measuring dose distributions in the high dose gradient region at short distances from the source. In this paper, measurements of radial and orthogonal dose distributions and dose profiles for a (90)Sr/(90)Y source train using polyacrylamide gel (PAG) dosimetry and a high-field 4.7 Tesla MRI scanner are presented and compared with measurements made with two types of radiochromic film, MD-55 and HD-810. For the PAG system, the dose distributions were determined with in-plane resolutions of 0.4 mm and 0.2 mm. The measurements of absorbed dose distributions both orthogonal and parallel to the source axis show good agreement between the PAG and radiochromic film. The absolute dose at a radial distance of 2 mm in the central 32 mm of a line parallel to the axis was measured. For the PAG the measured absorbed dose was 1.25% lower, for MD-55 4% higher and for the HD-810 1.6% higher when compared with the value given by the source calibration. These results confirm that both absorbed dose and dose distributions for high gradient vascular brachytherapy sources can be measured using PAG but the disadvantages of gel manufacture and the need for access to a high resolution scanner suggests that the use of radiochromic film is the method of choice.     

Accurate dosimetry in 131I radionuclide therapy using patient-specific, 3-dimensional methods for SPECT reconstruction and absorbed dose calculation.

(131)I radionuclide therapy studies have not shown a strong relationship between tumor absorbed dose and response, possibly due to inaccuracies in activity quantification and dose estimation. The goal of this work was to establish the accuracy of (131)I activity quantification and absorbed dose estimation when patient-specific, 3-dimensional (3D) methods are used for SPECT reconstruction and for absorbed dose calculation. METHODS: Clinically realistic voxel-phantom simulations were used in the evaluation of activity quantification and dosimetry. SPECT reconstruction was performed using an ordered-subsets expectation maximization (OSEM) algorithm with compensation for scatter, attenuation, and 3D detector response. Based on the SPECT image and a patient-specific density map derived from CT, 3D dosimetry was performed using a newly implemented Monte Carlo code. Dosimetry was evaluated by comparing mean absorbed dose estimates calculated directly from the defined phantom activity map with those calculated from the SPECT image of the phantom. Finally, the 3D methods were applied to a radioimmunotherapy patient, and the mean tumor absorbed dose from the new calculation was compared with that from conventional dosimetry obtained from conjugate-view imaging. RESULTS: Overall, the accuracy of the SPECT-based absorbed dose estimates in the phantom was >12% for targets down to 16 mL and up to 35% for the smallest 7-mL tumor. To improve accuracy in the smallest tumor, more OSEM iterations may be needed. The relative SD from multiple realizations was <3% for all targets except for the smallest tumor. For the patient, the mean tumor absorbed dose estimate from the new Monte Carlo calculation was 7% higher than that from conventional dosimetry. CONCLUSION: For target sizes down to 16 mL, highly accurate and precise dosimetry can be obtained with 3D methods for SPECT reconstruction and absorbed dose estimation. In the future, these methods can be applied to patients to potentially establish correlations between tumor regression and the absorbed dose statistics from 3D dosimetry.     

A 3-dimensional absorbed dose calculation method based on quantitative SPECT for radionuclide therapy: evaluation for (131)I using monte carlo simulation.

A general method is presented for patient-specific 3-dimensional absorbed dose calculations based on quantitative SPECT activity measurements. METHODS: The computational scheme includes a method for registration of the CT image to the SPECT image and position-dependent compensation for attenuation, scatter, and collimator detector response performed as part of an iterative reconstruction method. A method for conversion of the measured activity distribution to a 3-dimensional absorbed dose distribution, based on the EGS4 (electron-gamma shower, version 4) Monte Carlo code, is also included. The accuracy of the activity quantification and the absorbed dose calculation is evaluated on the basis of realistic Monte Carlo-simulated SPECT data, using the SIMIND (simulation of imaging nuclear detectors) program and a voxel-based computer phantom. CT images are obtained from the computer phantom, and realistic patient movements are added relative to the SPECT image. The SPECT-based activity concentration and absorbed dose distributions are compared with the true ones. RESULTS: Correction could be made for object scatter, photon attenuation, and scatter penetration in the collimator. However, inaccuracies were imposed by the limited spatial resolution of the SPECT system, for which the collimator response correction did not fully compensate. CONCLUSION: The presented method includes compensation for most parameters degrading the quantitative image information. The compensation methods are based on physical models and therefore are generally applicable to other radionuclides. The proposed evaluation methodology may be used as a basis for future intercomparison of different methods.     

Voxel-based mouse and rat models for internal dose calculations.

The ability to estimate absorbed doses in experimental animals to which radiolabeled material has been administered may be important in explaining and controlling potential radiation toxicity observed during preclinical trials. Most previously reported models for establishing doses to small animals have been stylized and mathematically based. This study establishes dose factors for internal sources in realistic models of a typical mouse and a typical rat, based on image data obtained using a dedicated small-animal CT scanner. METHODS: A transgenic mouse (body mass, 27 g) and a Sprague-Dawley rat (body mass, 248 g) were imaged using the dedicated small-animal CT scanner. Identified organs were segmented using computer tools that Vanderbilt University applies to process human images for 3-dimensional dosimetry. Monte Carlo N-particle transport code (MCNP) input files were prepared from the 3-dimensional, voxel-based image data. Using methods established for human studies, radiation transport calculations of absorbed fractions (AFs) were performed using MCNP, version 4C, on the segmented images, and dose conversion factors for several radionuclides were developed. RESULTS: AFs were established at discrete energies for electron and photon sources assumed to be uniformly distributed throughout approximately 10 source and target regions in both models. Electron self-irradiation AFs were significantly less than 1.0 for many organs, at energies above 0.5 MeV, and significant cross irradiation was observed for high-energy electrons, such as those from (90)Y or (188)Re, in many organs. Calculated dose conversion factors reflected these trends and agreed well with the results of other authors who have undertaken similar investigations. CONCLUSION: The AFs calculated in this study will be useful in determining the dose to organs for mice and rats similar in size to those studied here. The segmented, voxel-based models developed here can be used for external dose calculations as well.     

Absolute quantification in SPECT

Single-photon emission computed tomography (SPECT) allows the three-dimensional visualization of radioactivity within the human body and is widely used for clinical purposes. In SPECT, image quality is compromised by several factors including photon attenuation, photon scatter, the partial volume effect, and motion artefacts. These variables also confound the capacity of SPECT to quantify the concentration of radioactivity within given volumes of interest in absolute units, e.g. as kilobecquerels per cubic centimetre. In the last decade, considerable technical progress has been achieved in SPECT image reconstruction, involving, in particular, the development of iterative image reconstruction techniques. Furthermore, hybrid cameras integrating a SPECT camera with an X-ray CT scanner have become commercially available. These systems allow the acquisition of SPECT and CT datasets registered to each other with a high anatomical accuracy. First studies have shown that iterative SPECT image reconstruction techniques incorporating information from SPECT/CT image datasets greatly increase the accuracy of SPECT in quantifying radioactivity concentrations in phantoms and also in humans. This new potential of SPECT may improve not only diagnostic accuracy, but also dosimetry for internal radiotherapy.     

Lung dosimetry for radioiodine treatment planning in the case of diffuse lung metastases.

The lungs are the most frequent sites of distant metastasis in differentiated thyroid carcinoma. Radioiodine treatment planning for these patients is usually performed following the Benua-Leeper method, which constrains the administered activity to 2.96 GBq (80 mCi) whole-body retention at 48 h after administration to prevent lung toxicity in the presence of iodine-avid lung metastases. This limit was derived from clinical experience, and a dosimetric analysis of lung and tumor absorbed dose would be useful to understand the implications of this limit on toxicity and tumor control. Because of highly nonuniform lung density and composition as well as the nonuniform activity distribution when the lungs contain tumor nodules, Monte Carlo dosimetry is required to estimate tumor and normal lung absorbed dose. Reassessment of this toxicity limit is also appropriate in light of the contemporary use of recombinant thyrotropin (thyroid-stimulating hormone) (rTSH) to prepare patients for radioiodine therapy. In this work we demonstrated the use of MCNP, a Monte Carlo electron and photon transport code, in a 3-dimensional (3D) imaging-based absorbed dose calculation for tumor and normal lungs. METHODS: A pediatric thyroid cancer patient with diffuse lung metastases was administered 37 MBq of (131)I after preparation with rTSH. SPECT/CT scans were performed over the chest at 27, 74, and 147 h after tracer administration. The time-activity curve for (131)I in the lungs was derived from the whole-body planar imaging and compared with that obtained from the quantitative SPECT methods. Reconstructed and coregistered SPECT/CT images were converted into 3D density and activity probability maps suitable for MCNP4b input. Absorbed dose maps were calculated using electron and photon transport in MCNP4b. Administered activity was estimated on the basis of the maximum tolerated dose (MTD) of 27.25 Gy to the normal lungs. Computational efficiency of the MCNP4b code was studied with a simple segmentation approach. In addition, the Benua-Leeper method was used to estimate the recommended administered activity. The standard dosing plan was modified to account for the weight of this pediatric patient, where the 2.96-GBq (80 mCi) whole-body retention was scaled to 2.44 GBq (66 mCi) to give the same dose rate of 43.6 rad/h in the lungs at 48 h. RESULTS: Using the MCNP4b code, both the spatial dose distribution and a dose-volume histogram were obtained for the lungs. An administered activity of 1.72 GBq (46.4 mCi) delivered the putative MTD of 27.25 Gy to the lungs with a tumor absorbed dose of 63.7 Gy. Directly applying the Benua-Leeper method, an administered activity of 3.89 GBq (105.0 mCi) was obtained, resulting in tumor and lung absorbed doses of 144.2 and 61.6 Gy, respectively, when the MCNP-based dosimetry was applied. The voxel-by-voxel calculation time of 4,642.3 h for photon transport was reduced to 16.8 h when the activity maps were segmented into 20 regions. CONCLUSION: MCNP4b-based, patient-specific 3D dosimetry is feasible and important in the dosimetry of thyroid cancer patients with avid lung metastases that exhibit prolonged retention in the lungs.     

Dedicated breast CT: radiation dose and image quality evaluation.

PURPOSE: To evaluate the feasibility of breast computed tomography (CT) in terms of radiation dose and image quality. MATERIALS AND METHODS: Validated Monte Carlo simulation techniques were used to estimate the average glandular dose (AGD). The calculated photon fluence at the detector for high-quality abdominal CT (120 kVp, 300 mAs, 5-mm section thickness) was the benchmark for assessing the milliampere seconds and corresponding radiation dose necessary for breast CT. Image noise was measured by using a 10-cm-diameter cylinder imaged with a clinical CT scanner at 10-300 mAs for 80, 100, and 120 kVp. A cadaveric breast was imaged in the coronal plane to approximate the acquisition geometry of a proposed breast CT scanner. RESULTS: The AGD for 80-kVp breast CT was comparable to that for two-view mammography of 5-cm breasts (compressed breast thickness). For thicker breasts, the breast CT dose was about one-third less than that for two-view mammography. The maximum dose at mammography assessed in 1-mm(3) voxels was far higher (20.0 mGy) than that at breast CT (5.4 mGy) for a typical 5-cm 50% glandular breast. CT images of an 8-cm cadaveric breast (AGD, 6.3 mGy) were subjectively superior to digital mammograms (AGD, 10.1 mGy) of the same specimen. CONCLUSION: The potential of high signal-to-noise ratio images with low anatomic noise, which are obtainable at dose levels comparable to those for mammography, suggests that dedicated breast CT should be studied further for its potential in breast cancer screening and diagnosis.     

Development of a cone-beam CT system for radiological technologist education

For radiological technologists, it is very important to understand the principle of computed tomography (CT) and CT artifacts derived from mechanical and electrical failure. In this study, a CT system for educating radiological technologists was developed. The system consisted of a cone-beam CT scanner and educational software. The cone-beam CT scanner has a simple structure, using a micro-focus X-ray tube and an indirect-conversion flat panel detector. For the educational software, we developed various educational functions of image reconstruction and reconstruction parameters as well as CT artifacts. In the experiments, the capabilities of the system were evaluated using an acrylic phantom. We verified that the system produced the expected results.     

Single-slice and multi-slice computerized tomography: dosimetric comparison with diagnostic reference dose levels]

PURPOSE: The absorbed dose during clinical examinations of the head, thorax, abdomen and pelvis performed with a single-slice CT scanner and a new multi-slice CT system was measured and compared. Technical parameters, defined at installation and memorized on the two CT machines relate to a standard-sized patient and were considered the reference standard. Our experimental data were also been compared with the Diagnostic Reference Levels (D.L. 26/5/2000 n.187, Annex V). MATERIAL AND METHODS: We compared the performance of a multi-slice GE LightSpeed QX/i ADVANTAGE to that of a single-slice GE ProSpeed SX. The radiation beam profiles were measured at isocenter using a phosphor plate. Dose measurements were performed, according to the EUR 16262 EN Guidelines, with a 10-cm long CT pencil ionisation chamber and two PMMA phantoms (CEI EN 61223-2-6) for head and body respectively. RESULTS: The obtained (normalised and weighted) computed tomographic dose index (nCTDIW) values were systematically higher for the multi-slice system (up to 36%) and the dose-length product (DLP) values on the multi-slice scanner exceeded the equivalent single-slice DLP values. The values were, however, always lower than DRLs, except in the case of the head multi-slice protocol, the technical parameters of which need to be improved. Our results allowed moreover to calibrate the automatic dose evaluation system of the multi-slice system, which systematically underestimated DLP values. DISCUSSION AND CONCLUSIONS: The comparison showed that the multi-slice scanner delivers a higher dose compared to the single-slice scanner. This is due to the radiation beam profile which is wider than the total active detector width, to the shorter focal spot-to-isocenter distance and to the effective scan length, which is longer than the nominal irradiated volume because the reconstruction algorithm of a multi-slice helical CT image requires the projection data from all detector rows. Nevertheless, the technology of new CT systems equipped with a multiple row detectors array can improve the protection of the patient thanks to very short irradiation time (less than 1 s) and reduced current values. In order to optimize the dose to the patient some acquisition parameters have been adjusted for head examinations.     

In-phantom imaging of all dose components in boron neutron capture therapy by means of gel dosimeters.

The experimental method for in-phantom imaging and profiling the absorbed dose in neutron capture therapy has been improved. The method separates the contributions of the various secondary radiation components and is based on suitably designed gel dosimeters in the form of layers. The discrimination of the dose components is achieved by means of pixel-to-pixel manipulations of images obtained with gel dosimeters having different isotopic composition. Large dose images are obtainable with this method, because the layer geometry of dosimeters avoids sensible variation of neutron transport due to the isotopic composition of gel. Operation modalities aimed at attaining more reliable results have been studied. Some results, together with the results of punctual measurements performed with conventional dosimeters and with MC calculations, are here reported.     

A novel hybrid reconstruction algorithm for first generation incoherent scatter CT (ISCT) of large objects with potential medical imaging applications

This work presents a first generation incoherent scatter CT (ISCT) hybrid (analytic-iterative) reconstruction algorithm for accurate ρ{e}imaging of objects with clinically relevant sizes. The algorithm reconstructs quantitative images of ρ{e} within a few iterations, avoiding the challenges of optimization based reconstruction algorithms while addressing the limitations of current analytical algorithms. A 4π detector is conceptualized in order to address the issue of directional dependency and is then replaced with a ring of detectors which detect a constant fraction of the scattered photons. The ISCT algorithm corrects for the attenuation of photons using a limited number of iterations and filtered back projection (FBP) for image reconstruction. This results in a hybrid reconstruction algorithm that was tested with sinograms generated by Monte Carlo (MC) and analytical (AN) simulations. Results show that the ISCT algorithm is weakly dependent on the ρ{e} initial estimate. Simulation results show that the proposed algorithm reconstruct ρ{e} images with a mean error of -1% ± 3% for the AN model and from -6% to -8% for the MC model. Finally, the algorithm is capable of reconstructing qualitatively good images even in the presence of multiple scatter. The proposed algorithm would be suitable for in-vivo medical imaging as long as practical limitations can be addressed.     

Characteristics of a new polymer gel for high-dose gradient dosimetry using a micro optical CT scanner

The properties of a new polymer gel with two sensitivities, made specifically for high-dose-gradient dosimetry, were investigated. The measurements were performed at NIST using a 1 cm×1 cm calibrated ⁶⁰Co field, and a 1 cm active diameter ⁹⁰Sr/⁹⁰Y beta particle source. A high-resolution laser CT scanner was used to quantify the response. The results show that the high-sensitivity gel responds linearly to the absorbed dose for doses from 0.5 up to 15 Gy, while the low-sensitivity one is linear up to 225 Gy. For both radiation types, the gel response remains stable in time up to a month after the irradiation. The response of the gel was found to have no dose rate dependence for dose rates ranging from 3.7 to 15 mGy/s. Within the measurement uncertainty, the gel response is more sensitive for beta particles than high energy photons.     

Effect of Contrast Media on Megavoltage Photon Beam Dosimetry

The purpose of this study was to quantify changes in photon beam dosimetry caused by using contrast media during computed tomography (CT) simulation and determine if the resulting changes are clinically significant. The effect of contrast on dosimetry was first examined for a single 6-MV photon beam incident on a plane phantom with a structure of varying electron densities (ρ_e) and thickness. Patient studies were then undertaken in which CT data sets were collected with and without contrast for 6 typical patients. Three patients received IV contrast (Optiray-240™) only and 3 received IV plus oral (Gastrograffin™) contrast. Each patient was planned using conformal multifield techniques in accordance with the department standards. Two methods were used to compare the effect of contrast on dosimetry for each patient. The phantom analysis showed that the change in dose at the isocenter for a single 10 × 10 cm² 6-MV photon beam traversing 10 cm of a contrast-enhanced structure with ρ_e 1.22 was 7.0% (1.22 was the highest average ρ_e observed in the patient data). As a result of using contrast, increases in ρ_e were observed in structures for the 6 patients studied. Consequently, when using contrast-enhanced CT data for multifield planning, increases in dose at the isocenter and in critical structures were observed up to 2.1% and 2.5%, respectively. Planning on contrast-enhanced CT images may result in an increase in dose of up to 2.1% at the isocenter, which would generally be regarded as clinically insignificant. If, however, a critical organ is in close proximity to the planning target volume (PTV) and is planned to receive its maximum allowable dose, planning on contrast-enhanced CT images may result in that organ receiving dose beyond the recommended tolerance. In these instances, pre-contrast CT data should be used for dosimetry.     

Validation of MR-based polymer gel dosimetry as a preclinical three-dimensional verification tool in conformal radiotherapy.

The aim of this work was to investigate MR-based polymer gel dosimetry as a three-dimensional (3D) dosimetry technique in conformal radiotherapy. A cylindrical container filled with polymer gel was placed in a water-filled torso phantom to verify a treatment plan for the conformal irradiation of a mediastinal tumor located near the esophagus. Magnetic resonance spin-spin relaxation rate images were acquired and, after calibration, converted to absorbed dose distributions. The dose maps were compared with dose distributions measured using radiographic film. The average root-mean-square structural deviation, for the complete dose distribution, amounted to less than 3% between gel and film dose maps. It may be expected that MR gel dosimetry will become a valuable tool in the verification of 3D dose distributions. The influence of imaging artifacts arising from eddy currents, temperature drift during scanning, and B1 field inhomogeneity on the dose maps was taken into account and minimized.     

Three-dimensional radiobiologic dosimetry: application of radiobiologic modeling to patient-specific 3-dimensional imaging-based internal dosimetry.

Phantom-based and patient-specific imaging-based dosimetry methodologies have traditionally yielded mean organ-absorbed doses or spatial dose distributions over tumors and normal organs. In this work, radiobiologic modeling is introduced to convert the spatial distribution of absorbed dose into biologically effective dose and equivalent uniform dose parameters. The methodology is illustrated using data from a thyroid cancer patient treated with radioiodine. METHODS: Three registered SPECT/CT scans were used to generate 3-dimensional images of radionuclide kinetics (clearance rate) and cumulated activity. The cumulated activity image and corresponding CT scan were provided as input into an EGSnrc-based Monte Carlo calculation: The cumulated activity image was used to define the distribution of decays, and an attenuation image derived from CT was used to define the corresponding spatial tissue density and composition distribution. The rate images were used to convert the spatial absorbed dose distribution to a biologically effective dose distribution, which was then used to estimate a single equivalent uniform dose for segmented volumes of interest. Equivalent uniform dose was also calculated from the absorbed dose distribution directly. RESULTS: We validate the method using simple models; compare the dose-volume histogram with a previously analyzed clinical case; and give the mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for an illustrative case of a pediatric thyroid cancer patient with diffuse lung metastases. The mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for the tumor were 57.7, 58.5, and 25.0 Gy, respectively. Corresponding values for normal lung tissue were 9.5, 9.8, and 8.3 Gy, respectively. CONCLUSION: The analysis demonstrates the impact of radiobiologic modeling on response prediction. The 57% reduction in the equivalent dose value for the tumor reflects a high level of dose nonuniformity in the tumor and a corresponding reduced likelihood of achieving a tumor response. Such analyses are expected to be useful in treatment planning for radionuclide therapy.     

IAEA剂量实用规范与我国“放疗剂量学规定”的比较研究

目的研究用于放射治疗剂量测定的国际原子能机构(IAEA)第277号技术报告《光子束和电子束吸收剂量的确定》国际实用规范和我国1984年国家计量局和卫生部颁布的基于ICRU23号技术报告的《关于肿瘤放射治疗剂量学的若干规定》之间的差异。方法用理论计算和实验测量2种方法比较了不同的电离室在测量^60Co γ射线和3种能量的高能X射线水中吸收剂量所得结果。结果大部分常用的电离室在不同的光子能量下使用两种方法所测的结果差异小于1％，只有1个电离室的结果大于1％，并小于1．5％。结论现在放射治疗对剂量有更高的精度要求，所以我们建议尽量采用IAEA国际实用规范。     

The use of 3-dimensional CT reconstruction in childhood. Technics and dosimetry

A new computer method has been developed that allows the reprocessing of standard CT scans to produce 3D surface images. We employed the 3D reconstruction program developed by Hitachi Medical System using an Ansaldo A-TOM XR 1200 scanner. The process requires only standard CT scanner hardware, and reconstruction time is comparable to that of sagittal and coronal reconstructions. The applications of this technique and methodology to pediatric patients are discussed. In order to assess the relationship between image quality and radiation dose, we performed many CT scans with different protocols. A skull was employed for phantom, and plunged into a physiological solution, which helped us to determine the radiation exposure dose from every single CT scan. The measurements were taken with film and thermoluminescent crystal dosimeters (TLD). The results confirm that low-dose techniques allow a significant reduction in the total exposure. The authors discuss the clinical indications and the eventual applications of these techniques.     

Initial results for Hybrid SPECT--conjugate-view tumor dosimetry in 131I-anti-B1 antibody therapy of previously untreated patients with lymphoma.

A study of the use of 131I-labeled anti-B1 monoclonal antibody, proceeded by an unlabeled predose, for therapy of previously untreated non-Hodgkin's lymphoma patients has recently been completed at the University of Michigan, Ann Arbor. More than half of the patients treated were imaged intratherapy with SPECT to separate apparently large tumors, unresolved by conjugate views, into individual ones specified by CT scan. The dosimetry of these tumors is reported here. METHODS: The activity-quantification procedure used 3-dimensional CT-to-SPECT fusion so that attenuation maps could be computed from CT and that volumes of interest could be drawn on the CT slices and transferred to the SPECT images. Daily conjugate-view images after a tracer dose of labeled anti-B1 antibody followed by an unlabeled predose provided the shape of the time-activity curve for the calculation of therapy dosimetry. Reconstructed SPECT counts that were within a volume of interest were converted to activity by using a background-and-radius-adaptive conversion factor. Activities were increased for tumors less than 200 g using a recovery-coefficient factor derived from activity measurements for a set of spheres with volumes ranging from 1.6 to 200 cm3. The calculated tumor radiation absorbed dose was based, in part, on the CT volume and on the intratherapy-SPECT activity. RESULTS: The mean of the radiation dose values for 131 abdominal or pelvic tumors in 31 patients was 616 cGy with a standard deviation of +/- 50 cGy. The largest dose was 40 Gy and the smallest dose was 73 cGy. The mean volume for the tumors was 59.2 +/- 11.2 cm3. The correlation coefficient between absorbed dose and tumor volume was small (r2 = 0.007), and the slope of the least-squares fit represented a decrease of only 36.4 cGy per 100 cm3 increase in volume. This small slope may reflect a characteristic of anti-B1 antibody therapy that is important for its success. The mean absorbed dose per unit administered activity was 1.83 +/- 0.145 Gy/GBq. The largest value was 12.6 Gy/GBq, and the smallest value was 0.149 Gy/GBq. The mean dose for 9 axillary tumors in 5 patients was significantly lower than the average dose for abdominal and pelvic tumors (P = 0.01). Therefore, axillary tumors should be grouped separately in assessing dose-response relationships. Anecdotal patient results tended to verify the validity of using the shape of the conjugate-view time-activity curve for the average SPECT-intratherapy curve. However, there was also an indication that the shape varies somewhat for individual tumors with respect to time to peak. CONCLUSION: Hybrid SPECT-conjugate-view dosimetry provided radiation absorbed dose estimates for the individual patient tumors that were resolved by CT.     

Dose attenuation effect of hip prostheses in a 9-MV photon beam: commercial treatment planning system versus Monte Carlo calculations

Purpose The purpose of this study was to investigate the dosimetric effect of various hip prostheses on pelvis lateral fields treated by a 9-MV photon beam using Monte Carlo (MC) and effective path-length (EPL) methods. Material and methods The head of the Neptun 10 pc linac was simulated using the MCNP4C MC code. The accuracy of the MC model was evaluated using measured dosimetric features including depth dose values and dose profiles in a water phantom. The Alfard treatment planning system (TPS) was used for EPL calculations. A virtual water phantom with dimensions of 30 × 30 × 30 cm³ and a cube with dimensions of 4 × 4 × 4 cm³ made of various metals centered in 12 cm depth was used for MC and EPL calculations. Various materials including titanium, Co-Cr-Mo, and steel alloys were used as hip prostheses. Results Our results showed significant attenuation in absorbed dose for points after and inside the prostheses. Attenuations of 32%, 54% and 55% were seen for titanium, Co-Cr-Mo, and steel alloys, respectively, at a distance of 5 cm from the prosthesis. Considerable dose increase (up to 18%) was found at the water–prosthesis interface due to back-scattered electrons using the MC method. The results of EPL calculations for the titanium implant were comparable to the MC calculations. This method, however, was not able to predict the interface effect or calculate accurately the absorbed dose in the presence of the Co-Cr-Mo and steel prostheses. Conclusion The dose perturbation effect of hip prostheses is significant and cannot be predicted accurately by the EPL method for Co-Cr-Mo or steel prostheses. The use of MC-based TPS is recommended for treatments requiring fields passing through hip prostheses.