A generic computer program for checking photon beam dose calculations

A computer program for checking photon external beam dose calculations is described. It provides a check of the treatment planning calculation by the use of machine data that are independent of that used in the initial calculation. Data required to specify any radiation beam are easily and rapidly set up and the program works for all the major manufacturers' machines. The user interface uses an interactive screen for machine data input and also for dose checking, where dose calculation is performed in real time as data are entered. The dose resulting from the planned field parameters is calculated and compared with the prescribed dose with a warning provided if the agreement is outside a set range (+/-5%). Its purpose is to act as a final quality assurance check to ensure that no significant errors occur in the monitor unit calculation.     

A way to spatial irradiation planning. III. Further information on the procedure for obtaining dose homogeneity in noncoplanar ray beams and its experimental verification]

The method is based on the following principle: Single, initally unsettled parameters of irradiation are determined by explicit calculation in such a way that the dose gradient resulting from the dose gradients of the single ray beams in the point of intersection of their axes becomes zero. The separation or addition of components of the gradients is performed by use of co-ordinates for the ray beam as well as for the body. The following parameters can be determined explicitly: First, the weights of the partial doses which are to form the total dose in the point of intersection and/or second, the angles of the wedges and/or third, the rotational angles of the wedge filters, i. e. the angles of rotation of the wedge filters about an axis corresponding to the central ray. In the course of the following experimental verification of the method, maximally possible dose homogeneity results within the area of the crossing ray beams. Moreover, the advantages of field arrangements with different planes of incidence are coming into view.     

Optimization of combined brachy-teletherapy by the modification technic

A method is presented for combined brachy-teletherapy by which the dose distribution of percutaneous irradiation is adapted to the distribution of short-distance irradiation with 192iridium by means of the so-called "field integrated dose modification". Insufficient or excessive doses within the area of superposition of both therapy modalities can so be avoided. Moreover, the therapist can define zones of deviation from the reference dose, if such a dose heterogeneity seems desirable in the individual case. The combined irradiation of prostata and cervix is given as an example to describe in detail the technical, clinical, and radiobiological aspects of this method.     

Dose estimation in postoperative keloid irradiation with special consideration of ovarian dose

For a long time now, surgery followed by irradiation has been the preferred therapy in the treatment of keloids. Radiation can be administered by means of X-rays (energy level less than or equal to 100 KV), electrons (energy level less than or equal to 5 MeV) or 192Ir wires. The choice of one of these methods depends on the availability of suitable facilities within a short period of time (less than 24 hours postoperatively), and the possibility of adapting the irradiation field quickly and easily to the scar. A further criterion is the dose received by underlying organs possibly, especially the ovaries of women of child-bearing age. It consists of primary and secondary (scattered) parts of radiation and was measured in two standard field sizes for the various types of radiation so as to allow a rapid evaluation. Apart from the types of radiation mentioned above, such measurements were also carried out for 125I seeds. With a field size of 20 x 1.5 cm2 and a surface dose of 10 Gy, ovaries at a depth of 10 cm in the central beam will receive a dose of between less than 1 m Gy in electron therapy to around 1 Gy in X-ray therapy (100 KV).     

Systematic research on the dose distribution in mantle field irradiation with Co60 gamma radiation in the Alderson phantom

A mantle field is localized according to the patient's data in an inhomogenous Alderson phantom. After having established the irradiation scheme, the dose distributions measured in the Alderson phantom are compared with those measured and calculated in an homogenous water phantom. The possible side effects of this irradiation technique can be assessed on the basis of the radiation exposure of heart, lung and spinal marrow. The dose differences found on the central ray are within the margin of error amounting to 5 to 10% which is indicated in the calculation program. In case of a total reference dose of 40 Gy, the radiation exposures of heart and lung do not reach the tolerance limit. A spinal marrow dose of 50 Gy is found in the upper neck marrow. In case of an exact therapy planning, a sufficient dose can be directed to the Waldeyer's tonsillar ring.     

Proton radiation therapy for pediatric malignancies: Status report

Proton radiation therapy allows high degrees of conformity of radiation dose around irregular target volumes of variable sizes. Long-term follow-up in adults, and preliminary data for pediatric patients suggest that local control and survival can be improved in histologies requiring high radiation dose, without increased incidence of late toxicities. In the pediatric patient, avoidance of even moderate amounts of irradiation to normal tissues is of paramount importance. Conformal 3-D planned proton irradiation can contribute to this goal. For late effects, one can expect that reduced dose and volume irradiated will reduce radiation effects. However, full expression of late effects may occur in children five to ten years after treatment, or even later. Proton irradiation is therefore also indicated and used at Loma Linda University Medical Center for pediatric solid neoplasms in which conventional dose levels yield satisfactory local control and survival.

     

Usefulness of intensity-modulated radiation therapy for breast conserving radiation therapy: a three-dimensional treatment planning system comparison of irradiation methods

Until recently, conservative radiation therapy of breast cancer using a wedge-filter combined with rectangular tangential irradiation was widely carried out. This method of irradiation creates uniform dose distribution in the target, minimizing the radiation dose to the lung. However, this method of irradiation results in many cases in which the amount of dose in the irradiated area differs as a result of the shape and size of the breast. It is necessary to prevent excessive doses from reaching the lung. IMRT ensures a uniform dose to the target. Therefore, IMRT was examined because of the possibility that the normal tissue dose can be effectively utilized in cases of conservative radiation therapy of breast cancer by providing a minimum dose. To compare the irradiation of each method of rectangular tangential irradiation, an electronic compensator (ELC), and IMRT, which uses Dynamic MLC, we evaluated target dose uniformity, standard deviation, and target differential DVH in 13 examples. We evaluated the lung dose of the irradiated side (V(30), 30 Gy volume) of the lung to the volume of the lung on the irradiated side based on the report of Hernando.(6)) With this method of irradiation, irrespective of the difference in the shape and size of the target, dose uniformity with ELC was very good. IMRT can reduce the lung dose in comparison with the other irradiation methods. However, it is apt to cause a high-dose area in the irradiation field. In addition, it affects the target and the skin-extracting contour, and the dose to the skin surface declines. Although ELC cannot offer lung doses that are as low as those of IMRT, most of the 13 examples planned for cure with ELC showed rates of 22% of V(30) and below. In conservative radiation therapy of breast cancer, ELC is more effective than the rectangular tangential irradiation method and IMRT.     

用能量沉积核函数方法计算~(60)Co照射野的吸收剂量

目的　介绍了用能量沉积核函数方法计算60 Co照射野吸收剂量的方法。方法　能量沉积核函数方法将吸收剂量的贡献分为 3部分 :原射线、单次散射和多次散射。它使用基本的剂量学数据 ,如射野中心轴百分深度剂量、离轴比和准直系统散射输出因子等 ,这些数据在Fyc 5 0H治疗机上用方形照射野测量得到。再用能量沉积核函数计算吸收剂量。并讨论了散射线对吸收剂量的影响。结果　从测量数据得到了原射线和散射线的能量沉积核函数 ,并利用能量沉积核函数计算60 Co照射野的主要剂量学参数 ,计算值和测量值是一致的 ;不规则照射野的吸收剂量及其分布的计算结果也和测量结果符合得很好。结论　能量沉积核函数方法适用于较精确地计算60 Co不规则照射野的吸收剂量。     

Commissioning and quality assurance for MLC-based IMRT.

The commissioning and quality assurance (QA) associated with the implementation of linear accelerator multileaf collimator (MLC)-based intensity-modulated radiation therapy (IMRT) at the University of Nebraska Medical Center are described. Our MLC-based IMRT is implemented using the PRIMUS linear accelerator interface through the IMPAC record and verification system to the CORVUS treatment planning system. The "step-and-shoot" technique is used for this MLC-based IMRT. Commissioning process requires the verification of predefined parameters available on the CORVUS and the collection of some machine data. The machine data required are output factor in air and output factor in phantom, and percent depth dose for a number of field sizes. In addition, inplane and crossplane dose profiles of 4 x 4 cm and 20 x 20 cm field sizes and diagonal dose profiles of a large field size have to be measured. Validation of connectivity and dose model includes the use of uniform intensity bar strips, triangular-shaped nonuniform intensity bar strip, and N-shaped target. QA procedure follows the recommendation of the AAPM Task Group No. 40 report. In addition, the leaf position accuracy and reproducibility of the MLC should be checked at regular intervals. The dose validation is implemented through the hybrid plan where the patient beam parameters are applied to a flat phantom. Independent dose calculation method is used to confirm the dose delivery plan and data input to the CORVUS.     

Improvement of dose distribution of esophageal irradiation using the field-within-a-field technique

The wide radiation field for mediastinal dose distribution should be inhomogeneous with the usual simple opposed beam irradiation. The purpose of this study was to improve the dose distribution of the mediastinum using a conventional planning system with a dose-volume histogram (DVH) and the field-in-field technique. Three-dimensional (3D) dose distribution is obtained in bilateral opposed-field irradiation. An overdose area obtained from the 3D dose distribution is defined and reprojected into the irradiation field. A new reduced field is created by removing the reprojected overdose area. A 3D dose distribution is again obtained and compared with the results from first one. Procedures were repeated until each of the target volumes was within +/-5% of the prescribed dose and the irradiation volume within 107% or less of the prescribed dose. From the DVH analysis, our field-within-a-field technique resulted in a more uniform dose distribution within the conventional planning. The field-within-a-field technique involves many parameters, and an inverse planning algorithm is suitable for computation. However, with our method, the forward planning system is adequate for planning, at least in a relatively straightforward planning system such as bilateral opposed fields therapy.     

Dose reduction technique in diagnostic X-ray computed tomography by use of 6-channel multileaf collimators

Recently, region-setting computed tomography (CT) has been studied as a region of interest imaging method. This technique can strongly reduce the radiation dose by limiting the irradiation field. Although mathematical studies have been performed for reduction of the truncation artifact, no experimental studies have been performed so far. In this study, we developed a three-dimensional region-setting CT system and evaluated its imaging properties. As an experimental system, we developed an X-ray CT system with multileaf collimators. In this system, truncated projection data can be captured by limiting of the radiation field. In addition, a truncated projection data correction was performed. Finally, image reconstruction was performed by use of the Feldkamp–Davis–Kress algorithm. In the experiments, the line profiles and the image quality of the reconstructed images were evaluated. The results suggested that the image quality of the proposed method is comparable to that of the original method. Furthermore, we confirmed that the radiation dose was reduced when this system was used. These results indicate that a 3D region-setting CT system using 6-channel multileaf collimators can reduce the radiation dose without in causing a degradation of image quality.     

A method to obtain the same levels of CT image noise for patients of various sizes, to minimize radiation dose

The aim of this study was to develop a method of obtaining the same levels of CT image noise for patients of various sizes to minimize radiation dose. Two CT systems were evaluated regarding noise characteristics using phantoms and dosimetric measurements. Both CT systems performed well at dose levels used in normal clinical imaging, but only one was found to be suitable for low radiation dose applications. The CT system with the lowest noise level was used for further detailed studies. A simple strategy for manual selection of patient-specific scan parameters, considering patient size and required image quality, was implemented and verified on 11 volunteers. Images were obtained with at least the prescribed image quality at significantly reduced radiation dose levels compared with standard scan parameters. Depending on the diameter of the tomographic section, i.e. size of the subject, the dose levels could be reduced to 1-45% of the radiation dose with standard scan parameters (120 kV, 250 mAs, 10 mm). The results indicate a general potential for dose reduction in CT for slim patients. For tissue volume determination, large dose reductions can be achieved by adjusting the scan parameters for each individual. The concept of patient-specific scan parameters could be fully automated in the CT system design, but would require the scan to be specified in terms of image quality rather than X-ray tube load.     

用能量沉积核函数方法计算60Co照射野的吸收剂量

目的 介绍了用能量沉积核函数方法计算＾６０Ｃｏ照射野吸收剂理的方法。方法 能量沉积核函数方法将吸收剂量的贡献分为３部分：原射线、单次散射和多次散射。它使用基本的剂量学数据,如射野中心轴百分深度剂量、离轴比和淮直系统散射输出因子等,这些数据在Ｆｙｃ５０Ｈ治疗机上用方形照射野测量得到,再用能量沉积核函数计算吸收剂量,并讨论了散射线对吸收剂量的影响。结果 从测量数据得到了原射线和散射线的能量沉积核函数,并利用能量沉积核函数计算＾６０Ｃｏ照射野的主要剂量学参数。计算值和测量值是一致的;不规则照射野的吸收剂量及其分布的计算结果也和测量结果符合得很好。结论 能量沉积核函数方法适用于较精确地计算＾６０Ｃｏ不规则照射野的吸收剂量。     

Dose Calculation Accuracy of the Monte Carlo Algorithm for CyberKnife Compared with Other Commercially Available Dose Calculation Algorithms

Monte Carlo dose calculation algorithms have the potential for greater accuracy than traditional model-based algorithms. This enhanced accuracy is particularly evident in regions of lateral scatter disequilibrium, which can develop during treatments incorporating small field sizes and low-density tissue. A heterogeneous slab phantom was used to evaluate the accuracy of several commercially available dose calculation algorithms, including Monte Carlo dose calculation for CyberKnife, Analytical Anisotropic Algorithm and Pencil Beam convolution for the Eclipse planning system, and convolution-superposition for the Xio planning system. The phantom accommodated slabs of varying density; comparisons between planned and measured dose distributions were accomplished with radiochromic film. The Monte Carlo algorithm provided the most accurate comparison between planned and measured dose distributions. In each phantom irradiation, the Monte Carlo predictions resulted in gamma analysis comparisons >97%, using acceptance criteria of 3% dose and 3-mm distance to agreement. In general, the gamma analysis comparisons for the other algorithms were <95%. The Monte Carlo dose calculation algorithm for CyberKnife provides more accurate dose distribution calculations in regions of lateral electron disequilibrium than commercially available model-based algorithms. This is primarily because of the ability of Monte Carlo algorithms to implicitly account for tissue heterogeneities, density scaling functions; and/or effective depth correction factors are not required.     

Radiogene Hodenbelastung durch Streustrahlung bei adjuvanter 3-D-Beckenbestrahlung nach anteriorer Resektion beim Rektumkarzinom

BACKGROUND: Rectal cancer is a common malignant disease and occurs not infrequently in younger men. We verified the dose to the testes from scattered radiation in adjuvant pelvic irradiation following anterior resection of rectal cancer. PATIENTS AND METHOD: We measured the scattered gonadal dose of 18 patients in vivo with thermoluminescence detectors, which were fixed on four defined points on the scrotum during radiation on three consecutive days. All patients were treated three-dimensionally planned using a three-field box lying in prone position in a bellyboard. A total dose of 50.4 Gy was given in 28 fractions of 1.8 Gy. From 45 up to 50.4 Gy the radiation fields were modified to lateral-opposing fields which were shortened from the top to protect the small bowel. RESULTS: The mean gonadal dose per fraction of all patients was 0.057 Gy (median 0.05 Gy) with a range between 0.035 and 0.114 Gy. The standard deviation was 0.02 Gy. The calculated cumulative mean gonadal dose after 28 fractions was 1.60 Gy (0.98-3.19 Gy). CONCLUSIONS: Germinal epithelium is very sensitive to low-dose irradiation, according to a negative fractionation effect. It is known that gonadal total doses of 1 Gy with single doses of 0.03-0.05 Gy can result in a temporary azoospermia with following recovery in most cases. If gonadal total doses exceed 1.5 Gy a substantial increase in irreversible azoospermia must be expected. With respect to the data reported in the literature our measured mean gonadal total dose of 1.60 Gy will lead with high probability to an irreversible infertility. Because of the small number of patients in our study, the data must be interpreted with caution, however, it is very important in patient's informed consent to draw attention to the high risk of infertility. The possibility of sperm cryoconservation should be discussed with the patient.     

Appropriate treatment planning method for field joint dose in total body irradiation using helical tomotherapy

Total body irradiation (TBI) using helical tomotherapy (HT) has advantages over the standard linear accelerator-based approach to the conditioning regimen for hematopoietic cell transplantation. However, the radiation field has to be divided into two independent irradiation plans to deliver a homogeneous dose to the whole body. A clinical target volume near the skin increases the skin surface dose; therefore, high- or low-dose regions arise depending on the set-up position accuracy because the two radiation fields are somewhat overlapped or separated. We aimed to determine an adequate treatment planning method robust to the set-up accuracy for the field joint dose distribution using HT-TBI. We calculated treatment plans reducing target volumes at the interface between the upper and lower body irradiations and evaluated these joint dose distributions via simulation and experimental studies. Target volumes used for the optimization calculation were reduced by 0, 0.5, 1.0, 2.0, 2.5, and 3.0 cm from the boundary surface on the upper and lower sides. Combined dose distributions with set-up error simulated by modifying coordinate positions were investigated to find the optimal planning method. In the ideal set-up position, the target volume without a gap area caused field junctional doses of up to approximately 200%; therefore, target volumes reduced by 2.0–3.0 cm could suppress the maximum dose to within 150%. However, with set-up error, high-dose areas exceeding 150% and low-dose areas below 100% were found with 2.0 and 3.0 cm target volume reduction. Using the dynamic jaw (DJ) system, dose deviations caused by set-up error reached approximately 20%, which is not suitable for HT-TBI. Moreover, these dose distributions can be easily adjusted when combined with the intensity modulation technique for field boundary regions. The results of a simulation and experimental study using a film dosimetry were almost identical, which indicated that reducing the target volume at the field boundary surface by 2.5 cm produces the most appropriate target definition.     

Usefulness of the adaptive dose shield for the infant CT

The spiral scan with a wide detector row such as the 64-detector row computed tomography (CT) system may increase radiation exposure for infants because the irradiation range is wider than the planned range. The adaptive dose shield (ADS) prevents radiation exposure greater than the planned range. We examined the usefulness of the protection effect of the ADS for the infant inner ear CT. To confirm the protection effect of the ADS, we scanned X-ray films by using the 64-detector row CT system and measured the difference of the planned range and the irradiation range. The result of that is that when the planned range was small, the protection effect for the scan ending side was inferior to the scan starting side. And also, when the gantry rotation speed and pitch factor (PF) were high values, the protection effect was inferior to a low gantry rotation speed and low PF. There was a combination of gantry rotation speed and PF at which the protection effect decreases. Due to changes of the scanning direction and PF for the infant inner ear, the crystalline lens radiation exposure dose decreased from 11.89 mGy to 4.37 mGy. In conclusion, the ADS can reduce the radiation exposure dose of an adjacent organ. Therefore, it was thought that the ADS was a useful radiation exposure reduction function for infants in the 64-detector row CT system.     

Examination of beam profile measurement using an imaging plate by the light exposure fading method for quality assurance of external radiation therapy

High-resolution film dosimetry has been used for several decades to check and to measure two-dimensional dose distributions. However, in recent years, the automatic processor has been replaced by the spread of computed radiography, or has been little used hospitals. In this study, we measured the off-center ratio (OCR) of the open field, after an irradiating radiation beam was delivered to the imaging plate (IP) under conditions in which the IP was exposed to a fixed amount of light with fading, and compared these data with the OCR measured by an ionization-chamber dosimeter, which is the standard method used for measuring radiation dose. Profile measurement using IP could be achieved by performing light fading, even at a range of more than 100 MU. Further, by using a metallic filter, we succeeded in demonstrating that the profile measurement of IP in an open irradiation field could approximate the values of those obtained by an ionization chamber dosimeter. This method can serve as a simple, easy-to-use method for evaluating the QA of dose distribution in radiation therapy.     

Three dimensional image correlation of CT, MR, and PET studies in radiotherapy treatment planning of brain tumors

A treatment planning system for stereotactic convergent beam irradiation of deeply localized brain tumors is reported. The treatment technique consists of several moving field irradiations in noncoplanar planes at a linear accelerator facility. Using collimated narrow beams, a high concentration of dose within small volumes with a dose gradient of 10-15%/mm was obtained. The dose calculation was based on geometrical information of multiplanar CT or magnetic resonance (MR) imaging data. The patient's head was fixed in a stereotactic localization system, which is usable at CT, MR, and positron emission tomography (PET) installations. Special computer programs for correction of the geometrical MR distortions allowed a precise correlation of the different imaging modalities. The therapist can use combinations of CT, MR, and PET data for defining target volume. For instance, the superior soft tissue contrast of MR coupled with the metabolic features of PET may be a useful addition in the radiation treatment planning process. Furthermore, other features such as calculated dose distribution to critical structures can also be transferred from one set of imaging data to another and can be displayed as three-dimensional shaded structures.