Table of contents

Glioblastoma multiforme (GBM) is the most malignant form of primary brain tumors known as gliomas. They proliferate and invade extensively and yield short life expectancies despite aggressive treatment. Response to treatment is usually measured in terms of the survival of groups of patients treated similarly, but this statistical approach misses the subgroups that may have responded to or may have been injured by treatment. Such statistics offer scant reassurance to individual patients who have suffered through these treatments. Furthermore, current imaging-based treatment response metrics in individual patients ignore patient-specific differences in tumor growth kinetics, which have been shown to vary widely across patients even within the same histological diagnosis and, unfortunately, these metrics have shown only minimal success in predicting patient outcome. We consider nine newly diagnosed GBM patients receiving diagnostic biopsy followed by standard-of-care external beam radiation therapy (XRT). We present and apply a patient-specific, biologically based mathematical model for glioma growth that quantifies response to XRT in individual patients in vivo. The mathematical model uses net rates of proliferation and migration of malignant tumor cells to characterize the tumor's growth and invasion along with the linear-quadratic model for the response to radiation therapy. Using only routinely available pre-treatment MRIs to inform the patient-specific bio-mathematical model simulations, we find that radiation response in these patients, quantified by both clinical and model-generated measures, could have been predicted prior to treatment with high accuracy. Specifically, we find that the net proliferation rate is correlated with the radiation response parameter (r = 0.89, p = 0.0007), resulting in a predictive relationship that is tested with a leave-one-out cross-validation technique. This relationship predicts the tumor size post-therapy to within inter-observer tumor volume uncertainty. The results of this study suggest that a mathematical model can create a virtual in silico tumor with the same growth kinetics as a particular patient and can not only predict treatment response in individual patients in vivo but also provide a basis for evaluation of response in each patient to any given therapy.

Water calorimetric measurements have been performed in a 180 MeV scanned pulsed proton beam and the absorbed dose determined has been compared with the results obtained using two NE2571 Farmer chambers and the IAEA TRS-398 code of practice. The depth of measurement in water corresponded to a residual range of R_res = 16.5 cm, corresponding to a mean energy of about 150 MeV. Ionization chambers were calibrated in terms of the absorbed dose to water in ⁶⁰Co at the Swedish Secondary Standard Dosimetry Laboratory, directly traceable to Bureau International des Poids et Mesures. The present experimental investigation has shown that water calorimetry is feasible in a high-energy scanned pulsed proton beam. When comparing the results obtained with water calorimetry and ionometry, the beam quality correction factor, k_Q, could be determined for the two NE2571 ionization chambers used. The k_Q-factor was found to be 1.032 ± 0.013, which is in good agreement with the factor tabulated in IAEA TRS-398 for this chamber type (1.039 ± 0.018). The present result has also been compared with a previously obtained result in a passively scattered proton beam having similar energy. This comparison yielded a 1.1% deviation, which is not significant considering the combined uncertainties of the two experimental determinations of k_Q. The dominating contribution to the combined uncertainty stems from the correction factor for ion recombination in the scanned proton beam (1%), and further studies are required in order to reduce this uncertainty and reveal any possible differences in the k_Q-factor between these two proton beam delivery techniques.

Clinical image guided radiotherapy (IGRT) systems have kV imagers and respiratory monitors, the combination of which provides an 'internal–external' correlation for respiratory-induced tumor motion tracking. We developed a general framework of correlation-based position estimation that is applicable to various imaging configurations, particularly alternate stereoscopic (ExacTrac) or rotational monoscopic (linacs) imaging, where instant 3D target positions cannot be measured. By reformulating the least-squares estimation equation for the correlation model, the necessity to measure 3D target positions from synchronous stereoscopic images can be avoided. The performance of this sequential image-based estimation was evaluated in comparison with a synchronous image-based estimation. Both methods were tested in simulation studies using 160 abdominal/thoracic tumor trajectories and an external respiratory signal dataset. The sequential image-based estimation method (1) had mean 3D errors less than 1 mm at all the imaging intervals studied (0.2, 1, 2, 5 and 10 s), (2) showed minimal dependencies of the accuracy on the geometry and (3) was equal in accuracy to the synchronous image-based estimation method when using the same image input. In conclusion, the sequential image-based estimation method can achieve sub-mm accuracy for commonly used IGRT systems, and is equally accurate and more broadly applicable than the synchronous image-based estimation method.

We introduce a novel x-ray imaging approach that yields information about the local texture of structures smaller than the image pixel resolution inside an object. The approach is based on a recently developed x-ray dark-field imaging technique, using scattering from sub-micron structures in the sample. We show that the method can be used to determine the local angle and degree of orientation of bone, and fibers in a leaf. As the method is based on the use of a conventional x-ray tube we believe that it can have a great impact on medical diagnostics and non-destructive testing applications.

The treatment of lung cancer with radiation therapy is hindered by respiratory motion. Real-time adjustments to compensate for this motion are hampered by mechanical system latencies and imaging-rate restrictions. To better understand tumour motion behaviour for adaptive image-guided radiation therapy of lung cancer, the volume of a tumour's motion space was investigated. Motion data were collected by tracking an implanted fiducial using fluoroscopy at 30 Hz during treatment sessions. A total of 637 treatment fractions from 31 tumours were used in this study. For each fraction, data points collected from three consecutive breathing cycles were used to identify instantaneous tumour location. A convex hull was created over these data points, defining the tumour motion envelope. The study sought a correlation between the tumour location in the lung and the convex hull's volume and shape. It was found that tumours located in the upper apex had smaller motion envelopes (<50 mm³), whereas tumours located near the chest wall or diaphragm had larger envelopes (>70 mm³). Tumours attached to fixed anatomical structures had small motion spaces. Three general shapes described the tumour motion envelopes: 50% of motion envelopes enclosed largely 1D oscillation, 38% enclosed an ellipsoid path, 6% enclosed an arced path and 6% were of hybrid shape. This location–space correlation suggests it may be useful in developing a predictive model, but more work needs to be done to verify it.

Accurate modeling of system response and scatter distribution is crucial for image reconstruction in emission tomography. Monte Carlo simulations are very well suited to calculate these quantities. However, Monte Carlo simulations are also slow and many simulated counts are needed to provide a sufficiently exact estimate of the detection probabilities. In order to overcome these problems, we propose to split the simulation into two parts, the detection system and the object to be imaged (the patient). A so-called 'virtual boundary' that separates these two parts is introduced. Within the patient, particles are simulated conventionally. Whenever a photon reaches the virtual boundary, its detection probability is calculated analytically by evaluating a multi-dimensional B-spline that depends on the photon position, direction and energy. The unknown B-spline knot values that define this B-spline are fixed by a prior 'pre-' simulation that needs to be run once for each scanner type. After this pre-simulation, the B-spline model can be used in any subsequent simulation with different patients. We show that this approach yields accurate results when simulating the Biograph 16 HiREZ PET scanner with Geant4 Application for Emission Tomography (GATE). The execution time is reduced by a factor of about 22 × (scanner with voxelized phantom) to 30 × (empty scanner) with respect to conventional GATE simulations of same statistical uncertainty. The pre-simulation and calculation of the B-spline knots values could be performed within half a day on a medium-sized cluster.

We have evaluated a 4D ultrasound-based motion tracking system developed for tracking of abdominal organs during therapy. Tracking accuracy and precision were determined using a tissue-mimicking phantom, by comparing tracked motion with known 3D sinusoidal motion. The feasibility of tracking 3D liver motion in vivo was evaluated by acquiring 4D ultrasound data from four healthy volunteers. For two of these volunteers, data were also acquired whilst simultaneously measuring breath flow using a spirometer. Hepatic blood vessels, tracked off-line using manual tracking, were used as a reference to assess, in vivo, two types of automated tracking algorithm: incremental (from one volume to the next) and non-incremental (from the first volume to each subsequent volume). For phantom-based experiments, accuracy and precision (RMS error and SD) were found to be 0.78 mm and 0.54 mm, respectively. For in vivo measurements, mean absolute distance and standard deviation of the difference between automatically and manually tracked displacements were less than 1.7 mm and 1 mm respectively in all directions (left–right, anterior–posterior and superior–inferior). In vivo non-incremental tracking gave the best agreement. In both phantom and in vivo experiments, tracking performance was poorest for the elevational component of 3D motion. Good agreement between automatically and manually tracked displacements indicates that 4D ultrasound-based motion tracking has potential for image guidance applications in therapy.

The use of the spectral derivative method in visible and near-infrared optical spectroscopy is presented, whereby instead of using discrete measurements around several wavelengths, the difference between nearest neighbouring spectral measurements is utilized. The proposed technique is shown to be insensitive to the unknown tissue and fibre contact coupling coefficients providing substantially increased accuracy as compared to more conventional techniques. The self-calibrating nature of the spectral derivative techniques increases its robustness for both clinical and industrial applications, as is demonstrated based on simulated results as well as experimental data.

The performance of a scintillation dosimeter that uses a silvered air core light guide is examined by Monte Carlo (MC) simulations and by experiment to determine its suitability for array dosimetry in external beam radiotherapy. The air core light guide avoids the generation of the Cerenkov background that is produced in a conventional optical fibre. MC simulations using a 6 MV photon beam showed that silver thicknesses of less than 1 µm compensated for the effects of the other material components, to give the dosimeter water equivalence within 0.5%. A second dosimeter located adjacent to the primary dosimeter in any direction affected the dose measurement by less than 1.5%, when the centre-to-centre spacing was 1.3 mm or greater. When the dosimeter array is located perpendicular to the beam central axis, with a spacing of 2.5 mm, the calculated deviation from the dose deposited in water was less than 2%. When the dosimeter array is located parallel to the beam central axis with a spacing of 10 mm, the calculated dose readings deviated from water by less than 2.5%. The simulation results were confirmed with experiment for two neighbouring dosimeters and a small densely packed array. No proximity effects were measured within the experimental error of ±1.5%. These results confirm the dosimetric accuracy of the air core dosimeter design without the need for correction factors. The dosimeter has excellent potential for use in arrays.

This paper presents a fast and accurate marker-based automatic registration technique for aligning uncalibrated projections taken from a transmission electron microscope (TEM) with different tilt angles and orientations. Most of the existing TEM image alignment methods estimate the similarity between images using the projection model with least-squares metric and guess alignment parameters by computationally expensive nonlinear optimization schemes. Approaches based on the least-squares metric which is sensitive to outliers may cause misalignment since automatic tracking methods, though reliable, can produce a few incorrect trajectories due to a large number of marker points. To decrease the influence of outliers, we propose a robust similarity measure using the projection model with a Gaussian weighting function. This function is very effective in suppressing outliers that are far from correct trajectories and thus provides a more robust metric. In addition, we suggest a fast search strategy based on the non-gradient Powell's multidimensional optimization scheme to speed up optimization as only meaningful parameters are considered during iterative projection model estimation. Experimental results show that our method brings more accurate alignment with less computational cost compared to conventional automatic alignment methods.

In order to characterize the complex radiation field produced by heavy-ion beams in water, in particular the lateral dose fall-off and the radiation quality, microdosimetry measurements were performed at GSI Darmstadt using pencil-like beams of 300 MeV/u ¹²C and 185 MeV/u ⁷Li ions delivered by the heavy-ion synchrotron SIS-18. The ion beams (range in water about 17 cm) were stopped in the center of a 30 × 30 × 30 cm³ water phantom and their radiation field was investigated by in-phantom measurements using a tissue-equivalent proportional chamber (TEPC). The chamber was placed at 35 different positions in the central plane at various depths along the beam axis and at radial distances of 0, 1, 2, 5 and 10 cm. The off-axis measurements for both ¹²C and ⁷Li ions show very similar distributions of the lineal energy, all peaking between 1 and 10 which is a typical range covered by secondary hydrogen fragments and neutrons. The radiation quality given by the dose-mean lineal energy was found to be at a constant level of 1–2 at radial distances larger than 2 cm. The relative absorbed dose at each position was obtained by integration of the measured spectra normalized to the number of incident primary beam particles. The results confirm that the lateral dose profile of heavy ions shows an extremely steep fall-off, with relative values of about 10⁻³, 10⁻⁴ and 10⁻⁵ at the 2, 5 and 10 cm distance from the beam axis, respectively. The depth–dose curves at a fixed distance from the beam axis slowly rise until they reach the depth of the Bragg peak, reflecting the build-up of secondary fragments with increasing penetration depth. The measured ¹²C dose profiles were found to be in good agreement with a similar experimental study at HIMAC (Japan).

A common approach to quantify gadolinium (Gd) contrast agents involves measuring the post-contrast change in T1 rate and then using the constant T1 relaxivity R to determine the contrast agent concentration. Because this method is fast and non-invasive, it could be potentially valuable in many areas of brain research. However, to accurately measure contrast agent concentrations in the brain, the T1 relaxivity R of the specific agent must be accurately known. Furthermore, the macromolecular content and compartmentalization of the brain extracellular space (ECS) are expected to significantly alter R from values measured in aqueous solutions. In this study, the T1 relaxivity R of gadolinium-diethylene-triamine penta-acetic acid (Gd-DTPA) was measured following direct interstitial infusions of three different contrast agent concentrations to the parenchyma of rat brains. Changes in magnetic resonance (MR) T1 values were compared to brain slice concentrations determined with inductively coupled plasma atomic emission spectroscopy (ICP-AES) to determine R in 15 rats. Additionally, samples of cerebrospinal fluid, blood and urine were analyzed to evaluate possible Gd-DTPA clearance from the brain. The T1 relaxivity R of Gd-DTPA in the brain ECS was measured to be 5.35 (mM s)⁻¹ in a 2.4 T field. This value is considerably higher than estimations used in studies by other groups. Measurements of brain Gd-DTPA tissue concentrations using MRI and ICP-AES demonstrated a high degree of coincidence. Clearance of Gd-DTPA was minimal at the time point immediately after infusion. These results suggest that the environment of the brain does in fact significantly affect Gd T1 relaxivity, and that MRI can accurately measure contrast agent concentrations when this relaxivity is well characterized.

In scanned proton beam radiotherapy, multiple pencil beams are used to deliver the total dose to the target volume. Because the number of such beams can be very large, an accurate dosimetric characterization of every single pencil beam is important to provide adequate input data for the configuration of the treatment planning system. In this work, we present a method to measure the low-dose envelope of single pencil beams, known to play a meaningful role in the dose computation for scanned proton beams. We measured the low-dose proton beam envelope, which extends several centimeters outwards from the center of each single pencil beam, by acquiring lateral dose profile data, down to relative dose levels that were a factor of 10⁴ lower than the central axis dose. The overall effect of the low-dose envelope on the total dose delivered by multiple pencil beams was determined by measuring the dose output as a function of field size. We determined that the low-dose envelope can be influential even for fields as large as 20 cm × 20 cm.

This study introduces a method incorporating 4DCT data to determine the impact of respiratory motion in single-arc intensity-modulated arc therapy (IMAT). Simulation was done by re-warping the static dose distribution of all phases of a 4DCT image set with a 3D deformation map to reference CT images at end-inspiration and end-expiration. To calculate the dose received during respiration under IMAT, the control points were interpolated and re-distributed into separate IMAT plans corresponding to each respiratory phase. This study also investigated the role that plan complexity may play in the dosimetric impact of the respiratory motion in the delivery of IMAT. The dosimetric impact of organ motion was evaluated by analyzing the degradation of D_95,D₅₀ and D₀₅ of the CTV and PTV. From the results shown for the patients in this study who had maximum organ motion displacement ∼15 mm, the dosimetric impact is rather small. Therefore, our preliminary results suggest that respiratory motion of less than 1.5 cm may be ignored for both moderately and highly modulated IMAT, irrespective of the number of fractions. Specifically, highly modulated plans only increased the degradation of D₉₅ of the DVH curves for a single fraction by 2% in the CTV and 9% in the PTV compared to the expected value of the multi-fraction plan.

Fast radiological range adaptation of the ion beam is essential when target motion is mitigated by beam tracking using scanned ion beams for dose delivery. Electromagnetically controlled deflection of a well-focused ion beam on a small static wedge degrader positioned between two dipole magnets, inside the beam delivery system, has been considered as a fast range adaptation method. The principle of the range adaptation method was tested in experiments and Monte Carlo simulations for the therapy beam line at the GSI Helmholtz Centre for Heavy Ions Research. Based on the simulations, ion optical settings of beam deflection and realignment of the adapted beam were experimentally applied to the beam line, and additional tuning was manually performed. Different degrader shapes were employed for the energy adaptation. Measured and simulated beam profiles, i.e. lateral distribution and range in water at isocentre, were analysed and compared with the therapy beam values for beam scanning. Deflected beam positions of up to ±28 mm on degrader were performed which resulted in a range adaptation of up to ±15 mm water equivalence (WE). The maximum deviation between the measured adapted range from the nominal range adaptation was below 0.4 mm WE. In experiments, the width of the adapted beam at the isocentre was adjustable between 5 and 11 mm full width at half maximum. The results demonstrate the feasibility/proof of the proposed range adaptation method for beam tracking from the beam quality point of view.

In this paper, the accuracy of dose planning calculations for boron neutron capture therapy (BNCT) of brain and head and neck cancer was studied at the FiR 1 epithermal neutron beam. A cylindrical water phantom and an anthropomorphic head phantom were applied with two beam aperture-to-surface distances (ASD). The calculations using the simulation environment for radiation application (SERA) treatment planning system were compared to neutron activation measurements with Au and Mn foils, photon dose measurements with an ionization chamber and the reference simulations with the MCNP5 code. Photon dose calculations using SERA differ from the ionization chamber measurements by 2–13% (disagreement increased along the depth in the phantom), but are in agreement with the MCNP5 calculations within 2%. The ⁵⁵Mn(n,γ) and ¹⁹⁷Au(n,γ) reaction rates calculated using SERA agree within 10% and 8%, respectively, with the measurements and within 5% with the MCNP5 calculations at depths >0.5 cm from the phantom surface. The ⁵⁵Mn(n,γ) reaction rate represents the nitrogen and boron depth dose within 1%. Discrepancy in the SERA fast neutron dose calculation (of up to 37%) is corrected if the biased fast neutron dose calculation option is not applied. Reduced voxel cell size (⩽0.5 cm) improves the SERA calculation accuracy on the phantom surface. Despite the slight overestimation of the epithermal neutrons and underestimation of the thermal neutrons in the beam model, neutron calculation accuracy with the SERA system is sufficient for reliable BNCT treatment planning with the two studied treatment distances. The discrepancy between measured and calculated photon dose remains unsatisfactorily high for depths >6 cm from the phantom surface. Increasing discrepancy along the phantom depth is expected to be caused by the inaccurately determined effective point of the ionization chamber.

Accurate and precise estimation of organ activities is essential for treatment planning in targeted radionuclide therapy. We have previously evaluated the impact of processing methodology, statistical noise and variability in activity distribution and anatomy on the accuracy and precision of organ activity estimates obtained with quantitative SPECT (QSPECT) and planar (QPlanar) processing. Another important factor impacting the accuracy and precision of organ activity estimates is accuracy of and variability in the definition of organ regions of interest (ROI) or volumes of interest (VOI). The goal of this work was thus to systematically study the effects of VOI definition on the reliability of activity estimates. To this end, we performed Monte Carlo simulation studies using randomly perturbed and shifted VOIs to assess the impact on organ activity estimates. The 3D NCAT phantom was used with activities that modeled clinically observed ¹¹¹In ibritumomab tiuxetan distributions. In order to study the errors resulting from misdefinitions due to manual segmentation errors, VOIs of the liver and left kidney were first manually defined. Each control point was then randomly perturbed to one of the nearest or next-nearest voxels in three ways: with no, inward or outward directional bias, resulting in random perturbation, erosion or dilation, respectively, of the VOIs. In order to study the errors resulting from the misregistration of VOIs, as would happen, e.g. in the case where the VOIs were defined using a misregistered anatomical image, the reconstructed SPECT images or projections were shifted by amounts ranging from −1 to 1 voxels in increments of with 0.1 voxels in both the transaxial and axial directions. The activity estimates from the shifted reconstructions or projections were compared to those from the originals, and average errors were computed for the QSPECT and QPlanar methods, respectively. For misregistration, errors in organ activity estimations were linear in the shift for both the QSPECT and QPlanar methods. QPlanar was less sensitive to object definition perturbations than QSPECT, especially for dilation and erosion cases. Up to 1 voxel misregistration or misdefinition resulted in up to 8% error in organ activity estimates, with the largest errors for small or low uptake organs. Both types of VOI definition errors produced larger errors in activity estimates for a small and low uptake organs (i.e. −7.5% to 5.3% for the left kidney) than for a large and high uptake organ (i.e. −2.9% to 2.1% for the liver). We observed that misregistration generally had larger effects than misdefinition, with errors ranging from −7.2% to 8.4%. The different imaging methods evaluated responded differently to the errors from misregistration and misdefinition. We found that QSPECT was more sensitive to misdefinition errors, but less sensitive to misregistration errors, as compared to the QPlanar method. Thus, sensitivity to VOI definition errors should be an important criterion in evaluating quantitative imaging methods.

Treatment planning for proton tumor therapy requires a fast and accurate dose-calculation method. We have implemented a simplified Monte Carlo (SMC) method in the treatment planning system of the National Cancer Center Hospital East for the double-scattering beam delivery scheme. The SMC method takes into account the scattering effect in materials more accurately than the pencil beam algorithm by tracking individual proton paths. We confirmed that the SMC method reproduced measured dose distributions in a heterogeneous slab phantom better than the pencil beam method. When applied to a complex anthropomorphic phantom, the SMC method reproduced the measured dose distribution well, satisfying an accuracy tolerance of 3 mm and 3% in the gamma index analysis. The SMC method required approximately 30 min to complete the calculation over a target volume of 500 cc, much less than the time required for the full Monte Carlo calculation. The SMC method is a candidate for a practical calculation technique with sufficient accuracy for clinical application.

Human arteries affected by atherosclerosis are characterized by altered wall viscoelastic properties. The possibility of noninvasively assessing arterial viscoelasticity in vivo would significantly contribute to the early diagnosis and prevention of this disease. This paper presents a noniterative technique to estimate the viscoelastic parameters of a vascular wall Zener model. The approach requires the simultaneous measurement of flow variations and wall displacements, which can be provided by suitable ultrasound Doppler instruments. Viscoelastic parameters are estimated by fitting the theoretical constitutive equations to the experimental measurements using an ARMA parameter approach. The accuracy and sensitivity of the proposed method are tested using reference data generated by numerical simulations of arterial pulsation in which the physiological conditions and the viscoelastic parameters of the model can be suitably varied. The estimated values quantitatively agree with the reference values, showing that the only parameter affected by changing the physiological conditions is viscosity, whose relative error was about 27% even when a poor signal-to-noise ratio is simulated. Finally, the feasibility of the method is illustrated through three measurements made at different flow regimes on a cylindrical vessel phantom, yielding a parameter mean estimation error of 25%.

A study was carried out to evaluate the possibility of delivering volumetric modulated arc therapy with the RapidArc technology under respiratory-gated conditions. The experiments were performed in the framework of a non-clinically released environment. Plans of six patients, all realized for a single arc, were used for the experiments. The Real-time Position Management™ (RPM) respiratory gating system from Varian was used to generate gate-open signals of different durations. Arcs were delivered applying the different gates creating sequences of beam-hold/beam-on during the dose delivery: the average number of interruptions for a single arc ranged from 0 to 45. Dose prescription was set to 2 Gy and different gate-open periods of 30, 15 and 5 s to keep gantry speed constant at maximum. 5 Gy and 15 Gy doses were then applied to gate-open signals of 5 and 8 s, respectively, to mimic the most challenging conditions of slow gantry rotation and high-frequency interruptions. The 5 and 15 Gy experiments represent dose conditions of clinical interest for stereotactic treatments. For each patient and gating condition, pre-treatment 2D verification measurements were performed using the PTW-729 array in conjunction with the Octavius phantom (PTW, Freiburg); measurements were performed on different days (one per patient, with the complete setup of phantom and detectors every time), while each gating experiment was repeated seven consecutive times for reproducibility (without a new setup of the measurement equipment). Measurements were compared with dose calculations in the treatment planning system (performed without any gating) to appraise the dosimetric impact of the presence of gating and the eventual dependence from the number of interruptions during a single arc. Analysis of machine-registered log files in terms of average deviations between actual and expected positions (from automatic measurements every 50 ms) resulted in mean ΔMU (monitor units) <0.02% for all gating conditions. Δ(Gantry angle) = 0.38 ± 0.01° for 2 Gy (all gate periods), 0.24 ± 0.01° for 5 Gy, and 0.10 ± 0.01° for 15 Gy deliveries. Average deviations for multileaf collimator (MLC) positions (root mean square over all 120 leaves) were 0.45 ± 0.01 mm for 2 Gy (all gate periods), 0.32 ± 0.01 mm for 5 Gy and 0.14 ± 0.01 mm for 15 Gy. Results in terms of dose measurements confirmed that the application of gating to RapidArc delivery does not affect the quality of the dose delivery. With criteria of ΔD = 3%, DTA = 3 mm, the gamma test was passing in a range of 99 to 100% of the measured points for most of the cases (with maximum number of interruptions of about 20 per arc) and from 97 to 98% for the extreme case of 15 Gy and 8 s gate-open signal (corresponding to almost 50 interruptions per arc). In conclusion, RapidArc delivery proved, in a pre-clinical phase and non-clinically released framework, to be reliable and dosimetrically accurate also when applied in conjunction with gating procedures.

The INTRABEAM 50 kV x-ray device can be used for intra-operative partial breast irradiation. Spherical applicators are added to the source probe to deliver a radially symmetric radiation dose. Dosimetric data for calculation of absorbed dose were measured for this unit and a superficial unit with a similar beam quality, as defined by half value layer (HVL). Chamber calibration factors, N_K, and chamber correction factors, k_ch, were determined based on HVL, according to the IPEMB code of practice and addendum. Depth doses were also measured using an ionization chamber and GafChromic EBT film. HVL was measured as 0.85–1.30 mm Al across the range of applicator sizes. Values for N_K and k_ch were found to be similar for the two units and all INTRABEAM applicator sizes. Therefore, calibration of ionization chambers, radiochromic film and other relative dosimeters could be performed on the superficial unit. This has the advantage of higher dose rates and lower dependence on small variations in detector positioning. Depth dose measurements performed using film also agreed with chamber values, published and manufacturer data, giving a simple and robust method for commissioning and regular quality assurance.