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The long object problem is practically important and theoretically challenging. To solve the long object problem, spiral cone-beam CT was first proposed in 1991, and has been extensively studied since then. As a main feature of the next generation medical CT, spiral cone-beam CT has been greatly improved over the past several years, especially in terms of exact image reconstruction methods. Now, it is well established that volumetric images can be exactly and efficiently reconstructed from longitudinally truncated data collected along a rather general scanning trajectory. Here we present an overview of some key results in this area.

This paper describes a method for 4D imaging, which is used to study respiratory organ motion, a key problem in various treatments. Whilst the commonly used imaging methods rely on simplified breathing patterns to acquire one breathing cycle, the proposed method was developed to study irregularities in organ motion during free breathing over tens of minutes. The method does not assume a constant breathing depth or even strict periodicity and does not depend on an external respiratory signal. Time-resolved 3D image sequences were reconstructed by retrospective stacking of dynamic 2D images using internal image-based sorting. The generic method is demonstrated for the liver and for the lung. Quantitative evaluations of the volume consistency show the advantages over one-dimensional measurements for image sorting. Dense deformation fields describing the respiratory motion were estimated from the reconstructed volumes using non-rigid 3D registration. All obtained motion fields showed variations in the range of minutes such as drifts and deformations, which changed both the exhalation position of the liver and the breathing pattern. The obtained motion data are used in proton therapy planning to evaluate dose delivery methodologies with respect to their motion sensitivity. Besides this application, the new possibilities of studying respiratory motion are valuable for other applications such as the evaluation of gating techniques with respect to residual motion.

Understanding and quantifying the mechanical properties of breast tissues has been a subject of interest for the past two decades. This has been motivated in part by interest in modelling soft tissue response for surgery planning and virtual-reality-based surgical training. Interpreting elastography images for diagnostic purposes also requires a sound understanding of normal and pathological tissue mechanical properties. Reliable data on tissue elastic properties are very limited and those which are available tend to be inconsistent, in part as a result of measurement methodology. We have developed specialized techniques to measure tissue elasticity of breast normal tissues and tumour specimens and applied them to 169 fresh ex vivo breast tissue samples including fat and fibroglandular tissue as well as a range of benign and malignant breast tumour types. Results show that, under small deformation conditions, the elastic modulus of normal breast fat and fibroglandular tissues are similar while fibroadenomas were approximately twice the stiffness. Fibrocystic disease and malignant tumours exhibited a 3–6-fold increased stiffness with high-grade invasive ductal carcinoma exhibiting up to a 13-fold increase in stiffness compared to fibrogalndular tissue. A statistical analysis showed that differences between the elastic modulus of the majority of those tissues were statistically significant. Implications for the specificity advantages of elastography are reviewed.

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We consider several inverse problems motivated by elastography. Given the (possibly transient) displacement field measured everywhere in an isotropic, compressible, linear elastic solid, and given density ρ, determine the Lamé parameters λ and μ. We consider several special cases of this problem: (a) for μ known a priori, λ is determined by a single deformation field up to a constant. (b) Conversely, for λ known a priori, μ is determined by a single deformation field up to a constant. This includes as a special case that for which the term λ∇ ⋅ u ≡ 0. (c) Finally, if neither λ nor μ is known a priori, but Poisson's ratio ν is known, then μ and λ are determined by a single deformation field up to a constant. This includes as a special case plane stress deformations of an incompressible material. Exact analytical solutions valid for 2D, 3D and transient deformations are given for all cases in terms of quadratures. These are used to show that the inverse problem for μ based on the compressible elasticity equations is unstable in the limit λ → ∞. Finally, we use the exact solutions as a basis to compute non-trivial modulus distributions in a simulated example.

The purpose of this investigation is to characterize the beams produced by a kilovoltage (kV) imager integrated into a linear accelerator (Varian on-board imager integrated into the Trilogy accelerator) for acquiring high resolution volumetric cone-beam computed tomography (CBCT) images of the patient on the treatment table. The x-ray tube is capable of generating photon spectra with kVp values between 40 and 125 kV. The Monte Carlo simulations were used to study the characteristics of kV beams and the properties of imaged target scatters. The Monte Carlo results were benchmarked against measurements, and excellent agreements were obtained. We also studied the effect of including the electron impact ionization (EII), and the simulation showed that the characteristic radiation is increased significantly in the energy spectra when EII is included. Although only slight beam hardening is observed in the spectra of all photons after passing through the phantom target, there is a significant difference in the spectra and angular distributions between scattered and primary photons. The results also show that the photon fluence distributions are significantly altered by adding bow tie filters. The results indicate that a combination of large cone-beam field size and large imaged target significantly increases scatter-to-primary ratios for photons that reach the detector panel. For phantoms 10 cm, 20 cm and 30 cm thick of water placed at the isocentre, the scatter-to-primary ratios are 0.94, 3.0 and 7.6 respectively for an open 125 kVp CBCT beam. The Monte Carlo simulations show that the increase of the scatter is proportional to the increase of the imaged volume, and this also applies to scatter-to-primary ratios. This study shows both the magnitude and the characteristics of scattered x-rays. The knowledge obtained from this investigation may be useful in the future design of the image detector to improve the image quality.

The accurate segmentation of the articular cartilages from magnetic resonance (MR) images of the knee is important for clinical studies and drug trials into conditions like osteoarthritis. Currently, segmentations are obtained using time-consuming manual or semi-automatic algorithms which have high inter- and intra-observer variabilities. This paper presents an important step towards obtaining automatic and accurate segmentations of the cartilages, namely an approach to automatically segment the bones and extract the bone–cartilage interfaces (BCI) in the knee. The segmentation is performed using three-dimensional active shape models, which are initialized using an affine registration to an atlas. The BCI are then extracted using image information and prior knowledge about the likelihood of each point belonging to the interface. The accuracy and robustness of the approach was experimentally validated using an MR database of fat suppressed spoiled gradient recall images. The (femur, tibia, patella) bone segmentation had a median Dice similarity coefficient of (0.96, 0.96, 0.89) and an average point-to-surface error of 0.16 mm on the BCI. The extracted BCI had a median surface overlap of 0.94 with the real interface, demonstrating its usefulness for subsequent cartilage segmentation or quantitative analysis.

The purpose of this work is to evaluate the error associated with temperature and SAR measurements using fluoroptic® temperature probes on pacemaker (PM) leads during magnetic resonance imaging (MRI). We performed temperature measurements on pacemaker leads, excited with a 25, 64, and 128 MHz current. The PM lead tip heating was measured with a fluoroptic® thermometer (Luxtron, Model 3100, USA). Different contact configurations between the pigmented portion of the temperature probe and the PM lead tip were investigated to find the contact position minimizing the temperature and SAR underestimation. A computer model was used to estimate the error made by fluoroptic® probes in temperature and SAR measurement. The transversal contact of the pigmented portion of the temperature probe and the PM lead tip minimizes the underestimation for temperature and SAR. This contact position also has the lowest temperature and SAR error. For other contact positions, the maximum temperature error can be as high as −45%, whereas the maximum SAR error can be as high as −54%. MRI heating evaluations with temperature probes should use a contact position minimizing the maximum error, need to be accompanied by a thorough uncertainty budget and the temperature and SAR errors should be specified.

A new method to measure the effect of the backscatter into the beam monitor chambers in linear accelerators is introduced from first principles. The technique, applicable to high-energy photon beams, is similar to the well-known telescopic method although here the heavy blocks are replaced by a very small, centred block on the shadow tray, thus the name 'ecliptic method'. This effect, caused mainly by backscattering from the secondary collimators, is known to be an output factor constituent and must be accounted for when detailed calculations involving the machine's head are required. Since its magnitude is generally small, experimental errors might obscure the behaviour of the phenomenon. Consequently, the procedure introduced goes along with an uncertainty assessment. Our theory was confirmed via measurements in cobalt-60 beams, where the studied effect does not contribute to the output factor. Measurements were also performed on our Saturne 41 linear accelerator and the results were qualitatively similar to those described elsewhere. The collimation systems were studied separately by varying one jaw setting while keeping the other at its maximum value. In the light of these results, we deduced an algorithm that can correlate the former data with the effect of backscattering to the beam monitor chambers for any rectangular field within 0.5%, which is of the order of the experimental uncertainty (0.6%). As we show, the experimental procedure is safe, simple, not invasive for the linac and requires only basic dosimetry equipment.

In an effort to understand dynamic optical changes during laser interstitial thermal therapy (LITT), we utilize the perturbative solution of the diffusion equation in heterogeneous media to formulate scattering weight functions for cylindrical line sources. The analysis explicitly shows how changes in detected interstitial light intensity are associated with the extent and location of the volume of thermal coagulation during treatment. Explanations for previously reported increases in optical intensity observed early during laser heating are clarified using the model and demonstrated with experimental measurements in ex vivo bovine liver tissue. This work provides an improved understanding of interstitial optical signal changes during LITT and indicates the sensitivity and potential of interstitial optical monitoring of thermal damage.

Determining the 'best' optimization parameters in IMRT planning is typically a time-consuming trial-and-error process with no unambiguous termination point. Recently we and others proposed a goal-programming approach which better captures the desired prioritization of dosimetric goals. Here, individual prescription goals are addressed stepwise in their order of priority. In the first step, only the highest order goals are considered (target coverage and dose-limiting normal structures). In subsequent steps, the achievements of the previous steps are turned into hard constraints and lower priority goals are optimized, in turn, subject to higher priority constraints. So-called 'slip' factors were introduced to allow for slight, clinically acceptable violations of the constraints. Focusing on head and neck cases, we present several examples for this planning technique. The main advantages of the new optimization method are (i) its ability to generate plans that meet the clinical goals, as well as possible, without tuning any weighting factors or dose-volume constraints, and (ii) the ability to conveniently include more terms such as fluence map smoothness. Lower level goals can be optimized to the achievable limit without compromising higher order goals. The prioritized prescription-goal planning method allows for a more intuitive and human-time-efficient way of dealing with conflicting goals compared to the conventional trial-and-error method of varying weighting factors and dose-volume constraints.

A neutron irradiation cavity for in vivo activation analysis has been characterized to estimate its dosimetric specifications. The cavity is defined to confine irradiation to the hand and modifies the neutron spectrum produced by a low energy accelerator neutron source to optimize activation per dose. Neutron and gamma-ray dose rates were measured with the microdosimetric technique using a tissue-equivalent proportional counter at the hand irradiation site and inside the hand access hole. For the outside of the cavity, a spherical neutron dose equivalent meter and a Farmer dosemeter were employed instead due to the low intensity of the radiation field. The maximum dose equivalent rate at the outside of the cavity was 2.94 µSv/100 µA min, which is lower by a factor of 1/2260 than the dose rate at the hand irradiation position. The local dose contributions from a hand, an arm and the rest of a body to the effective dose rate were estimated to be 1.73, 0.782 and 2.94 µSv/100 µA min, respectively. For the standard irradiation protocol of the in vivo hand activation, 300 µA min, an effective dose of 16.3 µSv would be delivered.

Treatment management decisions in three-dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) are usually made based on the dose distributions in the target and surrounding normal tissue. These decisions may include, for example, the choice of one treatment over another and the level of tumour dose escalation. Furthermore, biological predictors such as tumour control probability (TCP) and normal tissue complication probability (NTCP), whose parameters available in the literature are only population-based estimates, are often used to assess and compare plans. However, a number of other clinical, biological and physiological factors also affect the outcome of radiotherapy treatment and are often not considered in the treatment planning and evaluation process. A statistical outcome analysis tool, EUCLID, for direct use by radiation oncologists and medical physicists was developed. The tool builds a mathematical model to predict an outcome probability based on a large number of clinical, biological, physiological and dosimetric factors. EUCLID can first analyse a large set of patients, such as from a clinical trial, to derive regression correlation coefficients between these factors and a given outcome. It can then apply such a model to an individual patient at the time of treatment to derive the probability of that outcome, allowing the physician to individualize the treatment based on medical evidence that encompasses a wide range of factors. The software's flexibility allows the clinicians to explore several avenues to select the best predictors of a given outcome. Its link to record-and-verify systems and data spreadsheets allows for a rapid and practical data collection and manipulation. A wide range of statistical information about the study population, including demographics and correlations between different factors, is available. A large number of one- and two-dimensional plots, histograms and survival curves allow for an easy visual analysis of the population. Several visual and analytical methods are available to quantify the predictive power of the multivariate regression model. The EUCLID tool can be readily integrated with treatment planning and record-and-verify systems.

An amorphous silicon EPID has been investigated to test its suitability as a daily check device for linac output and to provide daily monitoring of beam profile parameters such as flatness, symmetry, field size and wedge factor. Open and wedged 6 and 8 MV photon beams were collected on a daily basis for a period of just over a year and analysed in software to determine daily values of these parameters. Daily output results gave agreement between EPID measured dose and ion chamber measurements with a standard deviation of 0.65%. Step changes in flatness, symmetry and field size were readily detected by the EPID and could be correlated with adjustments made on service days and QC sessions. The results could also be used to assess the long term beam stability. Recalibration of the EPID required new baseline values of the parameters to be set. Wedge factors measured at one collimator angle proved stable but sensitive to changes in beam steering. The EPID proved to be a useful daily check device for linac output which can simultaneously be used for daily monitoring of beam profiles and field sizes.

In this work, we investigate the relation between lateral fluence/dose distributions and photon beam uniformity, possibly identifying ways to improve these characteristics. The calculations included treatment head scatter properties associated with three common types of linear accelerators in order to study their impact on the results. For 6 and 18 MV photon beams the lateral fluence distributions were optimized with respect to the resulting calculated flatness, as defined by the International Electrotechnical Commission (IEC), at 10 cm depth in six different field sizes. The limits proposed by IEC for maximum dose ratios ('horns') at the depth of dose maximum have also been accounted for in the optimization procedure. The conclusion was that typical head scatter variations among different types of linear accelerators have a very limited effect on the optimized results, which implies that the existing differences in measured off-axis dose distributions are related to non-equivalent optimization objectives. Finally, a comparison between the theoretically optimized lateral dose distributions and corresponding dose measurements for the three investigated accelerator types was performed. Although the measured data generally fall within the IEC requirements the optimized distributions show better results overall for the evaluated uniformity parameters, indicating that there is room for improved flatness performance in clinical photon beams.

Rheumatoid arthritis is one of the most common epidemic diseases in the world. For some patients, the treatment with steroids or nonsteroidal anti-inflammatory drugs is not effective, thus necessitating physical removal of the inflamed synovium. Alternative approaches other than surgery will provide appropriate disease control and improve the patient's quality of life. In this research, we evaluated the feasibility of conducting boron neutron capture synovectomy (BNCS) with the Tsing Hua open-pool reactor (THOR) as a neutron source. Monte Carlo simulations were performed with arthritic joint models and uncertainties were within 5%. The collimator, reflector and boron concentration were optimized to reduce the treatment time and normal tissue doses. For the knee joint, polyethylene with 40%-enriched Li₂CO₃ was used as the collimator material, and a rear reflector of 15 cm thick graphite and side reflector of 10 cm thick graphite were chosen. The optimized treatment time was 5.4 min for the parallel-opposed irradiation. For the finger joint, polymethyl methacrylate was used as the reflector material. The treatment time can be reduced to 3.1 min, while skin and bone doses can be effectively reduced by approximately 9% compared with treatment using the graphite reflector. We conclude that using THOR as a treatment modality for BNCS could be a feasible alternative in clinical practice.

The basic design and performance of a novel x-ray scalpel device for interstitial radiosurgery are reported. The x-ray scalpel is comprised of a capillary optics collimator conjugated with a high brilliance microfocus x-ray tube and a thin hollow needle (tip) attached to the collimator. The device is capable of producing a high dose rate (about 140 Gy min⁻¹ in water-like absorber at the exit window), 0.7 mm diameter, quasi-parallel beam that can be delivered to a targeted site by a minimally invasive procedure. Contrary to insertable x-ray tubes or radionuclides used in brachytherapy and complying with the 1/r² radiation attenuation law, the dose rate for a quasi-parallel beam decreases with distance as μ exp(−μr), where μ is the energy-dependent linear attenuation coefficient in the exposed medium. Moreover, the shape, energy and the dose attenuation curve of the x-ray beam can be adjusted. Two versions of the x-ray scalpel device (5.4 keV and 20.2 keV) are described. We present results from our first test of the x-ray scalpel as a controllable source of focal radiation for producing radiation necrosis in rat brain tissue. Irradiation was transdurally delivered to the rat cerebral cortex for 10 min at a dose rate of 20 Gy min⁻¹.

White matter connectivity in the human brain can be mapped by diffusion tensor magnetic resonance imaging (DTI). After reconstruction, the diffusion tensors, the diffusion amplitude and the diffusion direction can be displayed on a morphological background. Consequently, diffusion tensor fibre tracking can be applied as a non-invasive in vivo technique for the delineation and quantification of specific white matter pathways. The aim of this study was to show that normalization to the Montreal Neurological Institute (MNI) stereotaxic standard space preserves specific diffusion features. Therefore, techniques for tensor imaging and fibre tracking were applied to the normalized brains as well as to the group averaged brain data. A normalization step of individual data was included by registration to a scanner- and sequence-specific DTI template data set which was created from a normal database transformed to MNI space. The algorithms were tested and validated for a group of 13 healthy controls.