Table of contents

The dielectric properties of tissues have been extracted from the literature of the past five decades and presented in a graphical format. The purpose is to assess the current state of knowledge, expose the gaps there are and provide a basis for the evaluation and analysis of corresponding data from an on-going measurement programme.

Three experimental techniques based on automatic swept-frequency network and impedance analysers were used to measure the dielectric properties of tissue in the frequency range 10 Hz to 20 GHz. The technique used in conjunction with the impedance analyser is described. Results are given for a number of human and animal tissues, at body temperature, across the frequency range, demonstrating that good agreement was achieved between measurements using the three pieces of equipment. Moreover, the measured values fall well within the body of corresponding literature data.

A parametric model was developed to describe the variation of dielectric properties of tissues as a function of frequency. The experimental spectrum from 10 Hz to 100 GHz was modelled with four dispersion regions. The development of the model was based on recently acquired data, complemented by data surveyed from the literature. The purpose is to enable the prediction of dielectric data that are in line with those contained in the vast body of literature on the subject. The analysis was carried out on a Microsoft Excel spreadsheet. Parameters are given for 17 tissue types.

We have measured the microdosimetric spectra of a Senographe 600T mammography machine employing an Mo target with 0.8 mm Be inherent filtration and 0.03 mm Mo added filtration, giving a half-value layer of 0.35 mm Al at 28 kVp. In all of our measurements a large collimator producing a field at 65 cm was used. Two different phantom compositions differing in the ratio of adipose to fibroglandular tissue were compared, using simulated breast material from Nuclear Associates. Spectra were taken at various depths and locations in simulated breasts of 3, 4 and 5 cm thickness. The detector used was a miniature proportional counter having outer dimensions of diameter, with a sensitive volume The small dimensions of the counter and the cavity allowed total embedding in the breast material with minimal disturbance of the photon and secondary electron spectrum. Our results show that there can be changes in the radiation quality amounting to as much as 17% (as measured by the dose mean lineal energy, ) between breasts of different thickness, at the same relative position within the breast. There is little difference due to breast composition.

This paper, which is divided into parts I and II, describes the physical aspects of work on total-body irradiation (TBI) at the Middlesex Hospital, London, from 1988 to 1993. Irradiation is fractionated and bi-lateral with horizontal accelerator photon beams of 8 MV (1988 - 1992) at a source - surface distance (SSD) of 3.36 m and 10 MV (1992 - 1993) at an SSD of 4.62 m. The main aims were maximum patient comfort, a simple, accurate set-up with overall times per fraction of 30 min or less, dose homogeneity throughout the body within to , pre-irradiation treatment planning on nine CT slices using our commercial IGE RTplan (1988 - 1992) and Target 2 (1992 - 1993) treatment planning systems and, most important, verification of the plans by in vivo dosimetry to within . Verification of the planned lung doses, which are distributed over five CT slices, was given special attention.

In part I of this paper we describe the preliminary work, most of which was done prior to patient treatment. This consisted of standard dosimetric measurements (central axis depth doses, beam profiles at several depths, build-up and build-down curves, beam output calibrations, effect of body compensators, etc), in evaluating silicon diode dosimeters for in vivo dosimetry and of adapting and verifying the methods of treatment planning for TBI conditions. The results obtained with phantoms, including a Rando body phantom, showed that, in principle, our aims could be achieved. The final proof depended, however, on an analysis of the results of the in vivo work and this forms the subject of part II of this paper.

Part II of this paper gives the results of applying the TBI methods described in part I, to in vivo patient planning and dosimetry. Patients are planned on nine CT based body slices, five of which pass through the lungs. Planned doses are verified with ten silicon diodes applied bi-laterally to five body sites, at each treatment. LiF TLDs are applied to seven other body sites at the first treatment only. For 84 patients and at least 1016 measurements per body site with the diodes, the mean measured total doses agreed with planned doses within at most 2% except at lung levels, where the mean measured dose was 3% too low. Standard deviations of the measurements about the mean were between 2.4 and 3.1%. For the LiF TLDs, the mean measured doses for all seven body sites were within of planned doses. A separate assessment of measured entrance and transmitted doses showed that the former agreed well with planned doses, but that the latter tended to be low, especially over the lungs, and that they had a wider dispersion. Possible reasons for this are discussed. These results show measurement uncertainties similar to those for non-TBI treatments of Nilsson et al, Leunens et al and Essers et al. An analysis of the treatment plans showed a mean dose inhomogeneity in the body (75 patients, nine slices) of (1 s.d.) and in the lungs (40 patients, five slices) of (1 s.d.). The conclusions are that, overall, the methods are reasonably satisfactory but that, with an extra effort, even closer agreement between measured and planned doses and a further limited reduction in the body dose inhomogeneity could be obtained. However, if it were thought desirable to make a substantial reduction in the dose inhomogeneity in the body and lungs, this could only be achieved with the available equipment by changing from lateral to anterior - posterior irradiation and any potential advantages of this change would have to be balanced against a likely deterioration in patient comfort and an increase in treatment set-up times.

Fixed-pattern noise in electronic portal images (EPIs) is normally eliminated by dividing raw image data by an open-field calibration image (OFCI). However, for successful elimination, there must be exact registration between the two image sets. Any movement within the imaging system, such as that which occurs with gantry angle, will result in misregistration and a subsequent increase in noise. This paper describes, both qualitatively, by way of example, and quantitatively, by way of variance analysis, the consequences of misregistration and its effects on image quality. Our results show that image quality is found to degrade significantly with change in gantry angle, when a single OFCI is used, with a loss of low-contrast, fine detail. Variance is observed to increase over 2.5-fold. A simple solution of using multiple OFCIs is described, along with a technique for optimizing the number of images required, and the gantry angles at which they are acquired. When five OFCIs are used, the variance changes with gantry angle are limited to less than 20%. These changes are observed in both long and very short exposures (5 MU or 1 s).

A method of reading exposed radiochromic film is described which has significant advantages over conventional densitometry. The method employs a document scanner and associated software for imaging the film. The resulting images are easily analysed using standard software to yield high-resolution dose maps. A calibration was performed which relates scanner signal to dose, allowing for the determination of dose at any point on an exposed film. Results obtained using a broad-band densitometer are compared to those where the scanner has been used. The technique was used to measure the dose distribution around a COMS-type ophthalmic applicator.

In interstitial hyperthermia using ferromagnetic seeds, multi-filament seeds have gained interest because of a more effective power absorption than solid seeds. Palladium - nickel (PdNi) seeds composed of filaments with diameters in the range from 0.1 to 1.0 mm (maximally 90 filaments) have been investigated to find the conditions for optimal power absorption and temperature control. Magnetic and calorimetric experiments have shown that a decreasing filament radius results in a more effective power absorption. The power absorption approaches a common asymptote for high field intensities at all filament diameters. This asymptotic behaviour can be understood as a consequence of the approach of saturation magnetization of PdNi. The sharpness of the transition at the Curie temperature, which is a measure for the quality of temperature control, improves as the magnetic field strength increases, but it is limited by the asymptote of the power absorption. When the asymptote has been reached the quality of temperature regulation of a seed can only be improved by increasing the amount of PdNi, e.g. by increasing the number of filaments. Calculations of the power absorption, using the generally applied theory based on a linear relation between the magnetization of PdNi and the magnetic field strength, do not correspond quantitatively with experimental results for seeds having an induction number smaller than the `optimal value' of 2.5. For these seeds the measured heat production is larger than the calculated one.

Kerma - area product meters (KAP meters) are frequently used in diagnostic radiology to measure the integral of air-collision kerma over an area perpendicular to the x-ray beam. In this work, a precise method for calibrating a KAP meter to measure is described and calibration factors determined for a broad range of tube potentials (40 - 200 kV). The integral is determined using a large number of TL dosimeters spread over and outside the nominal field area defined as the area within 50% of maximum . The method is compared to a simplified calibration method which approximates the integral by multiplying the kerma in the centre of the field by the nominal field area . While the calibration factor using the precise method is independent of field area and distance from the source, that using the simplified method depends on both. This can be accounted for by field inhomogeneities caused by the heel effect, extrafocal radiation and scattered radiation from the KAP meter. The deviations between the calibration factors were as large as for collimator apertures of and distances from the source of 50 - 160 cm. The uncertainty in the calibration factor using the precise method was carefully evaluated and the expanded relative uncertainty estimated to be with a confidence level of 95%.

A system for monitoring multiple scatter during a clinical Compton scatter densitometry measurement of bone density is described. Multiple scatter from the measurement site was measured using a supplementary collimated detector positioned so that only multiply scattered photons could enter the detector. The data from the detector were used to form a multiple-scatter correction factor ( mcf) to correct for the bias attributed to multiple scatter. The results of experimental and computer simulations are presented which demonstrate the relationship between the multiple-scatter reading and calculated mcf values. The influence of bone size on the values of mcf in large measurement sites, such as the femoral neck, was shown to be negligible. A simulation was used to produce a visualization of the multiple scatter in order to ascertain the optimum position of the supplementary detector. This technique was shown to be a rapid and accurate method of measuring the multiple-scatter bias and suitable for use during clinical CSD measurements.

There is growing interest in assessing the clinical value of ultrasound in the prediction and management of osteoporosis. However, the mechanism of ultrasound propagation in cancellous bone is not well understood. The Biot theory is one approach to modelling the interaction of sound waves with cancellous structure, and porosity is one of its input parameters. In this paper we report the relationship between broadband ultrasonic attenuation (BUA) corrected for specimen thickness (nBUA) and porosity in a porous Perspex cancellous bone mimic, a stereolithography cancellous bone mimic and in natural human and bovine tissue. nBUA and porosity have a non-linear parabolic relationship. The maximum nBUA value occurs at approximately 30% porosity in the Perspex mimic, approximately 70% in the stereolithography mimic and approximately 75% in natural cancellous bone. We discuss the effect of structure on the form of the nBUA - porosity relationship.

Different methods for ultrasonic velocity determination using broad-band pulse transmission have been investigated in 70 human calcanae in vitro. The work took place within the context of the EC BIOMED1 concerted action Assessment of Quality of Bone in Osteoporosis. Ultrasonic velocities were determined using three different transit time definitions: first arrival (TTV1), thresholding (TTV2), and first zero crossing (TTV3). Phase velocity (PV) was determined over a range of frequencies from 200 to 800 kHz using a new phase spectral analysis technique. The different velocity measurements were compared in terms of their magnitudes and their inter-correlations.

There were significant differences of up to between different transit time velocities (p < 0.0001), indicating the sensitivity of the measurement to the arrival criteria used. Phase velocities were lower than all of the transit time velocities (p < 0.0001) and decreased with increasing frequency (p < 0.005). A strong correlation was observed between PV at 400 kHz (PV400) and TTV3, with much weaker correlations between PV and the other transit time velocities. Reproducibility for transit time velocity measurement was optimal for TTV3 (coefficient of variation, cv = 0.41%), and for PV it was optimal at 600 kHz (cv = 0.34%).

These data indicate that transit time measurements may be subject to errors due to the modification of the pulse shape during propagation through bone by attenuation and dispersion. Velocity measurement by phase spectral analysis appears to offer advantages over the transit time approach, and should be the method of choice for velocity measurement in trabecular bone. Where transit time velocity measurements are made, the first-zero-crossing criterion appears to be have some advantages over other arrival criteria. We also note that PV measurements provide new information on dispersion which could prove to be relevant to the structural and mechanical characterization of trabecular bone.

Accurate tumour volume measurement from MR images requires some form of objective image segmentation, and therefore a certain degree of automation. Manual methods of separating data according to the various tissue types which they are thought to represent are inherently prone to operator subjectivity and can be very time consuming. A segmentation procedure based on morphological edge detection and region growing has been implemented and tested on a phantom of known adjustable volume. Comparisons have been made with a traditional data thresholding procedure for the determination of tumour volumes on a set of patients with intracerebral glioma. The two methods are shown to give similar results, with the morphological segmentation procedure having the advantages of being automated and faster.

An anthropomorphic phantom was used to calibrate a supine geometry sodium iodide total body potassium monitor. Correction factors accommodating variability in subject size were empirically determined. Measurements on 12 males of weight 45 - 96 kg, height 161 - 184 cm and 18 females of weight 48 - 89 kg, height 153 - 175 cm, showed that the calibration factor was significantly correlated (r = 0.88, p < 0.0001) to subject , indicating comparable accuracy to -based calibration procedures. Fat-free mass determined from the potassium measurements of 16 subjects correlated significantly with fat-free mass estimated from skinfold thickness (r = 0.98, p < 0.0001), dual-energy x-ray absorptiometry (r = 0.99, p < 0.0001) and bioimpedance analysis (r = 0.98, p < 0.0001). These data, together with the precision (coefficient of variation, CV = 1.5%) and accuracy (CV = 4.5%) of the system, indicate that this calibration procedure represents a relatively low-cost, non-invasive alternative to -based methods of calibrating total body potassium monitors.

Therapy with intraarterial microspheres is a technique which involves incorporation of radioisotope-labelled microspheres into a capillary bed of tumour and normal tissue. Beta-emitters such as and are used for this purpose. This technique provides tumour to normal tissue (TNT) dose ratios in the range of 2 - 10 and demonstrates significant clinical benefit, which could potentially be increased with more accurate dose predictions and delivery. However, dose calculations in this modality face the difficulties associated with nonuniform and inhomogeneous activity distribution. Most of the dose calculations used clinically do not account for the nonuniformity and assume uniform activity distribution. This paper is devoted to the development of a model which would allow more accurate prediction of dose distributions from microspheres. The model calculates dose assuming that microspheres are aggregated into randomly distributed clusters, and using precomputed dose kernels for the clusters. The dose kernel due to a microsphere cluster was found by numerical integration of a point source dose kernel over the volume of the cluster. It is shown that a random distribution of clusters produces an intercluster distance distribution which agrees well with the one measured by Pillai et al in liver. Dose volume histograms (DVHs) predicted by the model agree closely with the results of Roberson et al for normal tissue and tumour. Dose distributions for different concentrations and types of radioisotope, as well as for tumours of different radii, have been calculated to demonstrate the model's possible applications.

Scatter correction is a prerequisite for quantitative SPECT, but potentially increases noise. Monte Carlo simulations (EGS4) and physical phantom measurements were used to compare accuracy and noise properties of two scatter correction techniques: the triple-energy window (TEW), and the transmission dependent convolution subtraction (TDCS) techniques. Two scatter functions were investigated for TDCS: (i) the originally proposed mono-exponential function and (ii) an exponential plus Gaussian scatter function demonstrated to be superior from our Monte Carlo simulations. Signal to noise ratio (S/N) and accuracy were investigated in cylindrical phantoms and a chest phantom. Results from each method were compared to the true primary counts (simulations), or known activity concentrations (phantom studies). was used in all cases.

The optimized method overall performed best, with an accuracy of better than 4% for all simulations and physical phantom studies. Maximum errors for TEW and of -30 and -22%, respectively, were observed in the heart chamber of the simulated chest phantom. TEW had the worst S/N ratio of the three techniques. The S/N ratios of the two TDCS methods were similar and only slightly lower than those of simulated true primary data. Thus, accurate quantitation can be obtained with , with a relatively small reduction in S/N ratio.

An algorithm is presented for the reconstruction of PET images using prior anatomical information derived from MR images of the same subject. The cross-entropy or Kullback - Leiber distance is a measure of dissimilarity between two images. We propose to reconstruct PET images by minimizing a weighted sum of two cross-entropy terms. The first is the cross-entropy between the measured emission data and the forward projection of the current estimate of the PET image. Minimizing this term alone is equivalent to the ML - EM reconstruction. The second term is the cross-entropy between the current estimate of the PET image and a prior image model which incorporates anatomical information derived from registered MR images. A weighting parameter determines the relative emphasis given to the emission data and the prior model in the reconstruction. Details of this algorithm are presented as well as test reconstructions for real and simulated data. The performance of the algorithm was evaluated with respect to errors in prior anatomical information. The algorithm provided significant improvement in the quality of reconstructed images as compared with the ML - EM reconstruction technique. The reconstructed images had higher resolution as compared with the images obtained from MAP-like reconstructions which do not utilize anatomical information. The algorithm displayed robustness with respect to errors in prior anatomical information.

The similarity studied in this paper links the diffusion exponent to the reduced albedo. If F is the ratio of the diffusion exponent assumed by standard diffusion theory to the actual value of the diffusion exponent, it is shown that for forward-scattering functions, as often found in biological tissues, the values of F approach limiting curves. These curves depend on a constant in the homologous scattering patterns, which can describe Henyey - Greenstein scattering patterns, but which can also approximate Rayleigh - Gans phase functions. Finally, a practical approach for estimating the solution for mixtures of these forward-scattering phase functions with isotropic scatterers has been given.

We developed a SQUID based susceptometer with a large available magnetized volume for the investigation of large objects. The magnetizing field is generated by a pair of Helmoltz coils. To achieve a high signal-to-noise ratio, the susceptometer is operated in a lock-in mode with an AC magnetizing field. A negative feedback control allows the rejection of the applied field with a relative residual of . The apparatus was tested with substances of known magnetic susceptibility. The overall sensitivity, stated in terms of the magnetic moment, is better than for small samples.

The safe and accurate delivery of the prescribed absorbed dose is the central function of the dose monitoring and beam stabilization system in a medical linear accelerator. The absorbed dose delivered to the patient during radiotherapy is often monitored by a transmission ionization chamber. Therefore it is of utmost importance that the chamber behaves correctly. We have noticed that the sensitivity of an unsealed chamber in a Philips SL linear accelerator changes significantly, especially during and after the summer season. The reason for this is probably a corrosion effect of the conductive plates in the chamber due to the increased relative humidity during hot periods. We have found that the responses of the different ion chamber plates change with variations in air humidity and that they do not return to their original values when the air humidity is returned to ambient conditions.

Patients with Crigler - Najjar syndrome Type I are being treated with long-term blue-light phototherapy into childhood, adolescence and beyond. Phototherapy systems adapted from sunbed-type bases fitted with blue-emitting fluorescent tubes have been described. These systems provide higher irradiances and improved patient compliance compared with overhead therapy systems used in neonatal phototherapy. The acrylic bases of such units are, however, not designed to provide adequate levels of comfort for prolonged treatment in the long term.

Previous work has shown that layer(s) of transparent `bubble-wrap' can be used to address this problem, although the material absorbs light and provides lower levels of comfort for older or larger patients. We have used designs of transparent plastic lilos that provide better cushioning, although tend to puncture, and share with bubble-wrap a low porosity leading to patient discomfort. We have investigated the use of standard mesh and high-transmission fabrics stretched over an adjustable-tension frame. This method in particular combines a high degree of comfort with a clinically effective blue-light irradiance level, and hence appears to provide a satisfactory method of phototherapy delivery. The development of higher transmission materials offers further potential for improvement.