Table of contents

There is increasing use of three-dimensional rotational angiography (3DRA) during cardiac ablation procedures. As compared with 2D angiography, a large series of images are acquired, creating the potential for high radiation doses. The aim of the present study was to quantify patient-specific effective doses. In this study, we developed a computer model to accurately calculate organ doses and the effective dose incurred during 3DRA image acquisition. The computer model simulates the exposure geometry and uses the actual exposure parameters, including the variation in tube voltage and current that is realized through the automatic exposure control (AEC). We performed 3DRA dose calculations in 42 patients referred for ablation on the Siemens Axiom Artis DynaCT system (Erlangen, Germany). Organ doses and effective dose were calculated separately for all projections in the course of the C-arm rotation. The influence of patient body mass index (BMI), dose–area product (DAP), collimation and dose per frame (DPF) rate setting on the calculated doses was also analysed. The effective dose was found to be 5.5 ± 1.4 mSv according to ICRP 60 and 6.6 ± 1.8 mSv according to ICRP 103. Effective dose showed an inversely proportional relationship to BMI, while DAP was nearly BMI independent. No simple conversion coefficient between DAP and effective dose could be derived. DPF reduction did not result in a proportional effective dose decrease. These paradoxical findings were explained by the settings of the AEC and the limitations of the x-ray tube. Collimation reduced the effective dose by more than 20%. Three-dimensional rotational angiography is associated with a definite but acceptable radiation dose that can be calculated for all patients separately. Their BMI is a predictor of the effective dose. The dose reduction achieved with collimation suggests that its use is imperative during the 3DRA procedure.

A new grid-based Boltzmann equation solver, Acuros™, was developed specifically for performing accurate and rapid radiotherapy dose calculations. In this study we benchmarked its performance against Monte Carlo for 6 and 18 MV photon beams in heterogeneous media. Acuros solves the coupled Boltzmann transport equations for neutral and charged particles on a locally adaptive Cartesian grid. The Acuros solver is an optimized rewrite of the general purpose Attila^© software, and for comparable accuracy levels, it is roughly an order of magnitude faster than Attila. Comparisons were made between Monte Carlo (EGSnrc) and Acuros for 6 and 18 MV photon beams impinging on a slab phantom comprising tissue, bone and lung materials. To provide an accurate reference solution, Monte Carlo simulations were run to a tight statistical uncertainty (σ ≈ 0.1%) and fine resolution (1–2 mm). Acuros results were output on a 2 mm cubic voxel grid encompassing the entire phantom. Comparisons were also made for a breast treatment plan on an anthropomorphic phantom. For the slab phantom in regions where the dose exceeded 10% of the maximum dose, agreement between Acuros and Monte Carlo was within 2% of the local dose or 1 mm distance to agreement. For the breast case, agreement was within 2% of local dose or 2 mm distance to agreement in 99.9% of voxels where the dose exceeded 10% of the prescription dose. Elsewhere, in low dose regions, agreement for all cases was within 1% of the maximum dose. Since all Acuros calculations required less than 5 min on a dual-core two-processor workstation, it is efficient enough for routine clinical use. Additionally, since Acuros calculation times are only weakly dependent on the number of beams, Acuros may ideally be suited to arc therapies, where current clinical algorithms may incur long calculation times.

We proposed a speed-enhanced tomographic reconstruction algorithm, ACOSEM (accelerated complete-data ordered-subset expectation-maximization), to accelerate a convergent OS-type algorithm (COSEM). The ACOSEM algorithm was based on modification of the COSEM update by applying an accelerating power factor or a bigger step size. Unlike the limited enhancement of the other speed-enhanced algorithm (E-COSEM), the proposed ACOSEM with an appropriate power factor can lead to a much faster reconstruction speed than COSEM and ECOSEM. Similar to COSEM, there is no free user-entered relaxation parameter needed for ACOSEM to ensure the convergent performance as required in the other type of fast convergent algorithms such as RAMLA. We derived the ACOSEM algorithm, and compared its performance to those of other fast convergent algorithms including COSEM, ECOSEM and RAMLA with optimized relaxation parameters. Though not convergent, OSEM is the current state-of-the-art reconstruction method used in the clinics, and thus included in the noise performance comparison. The results showed that ACOSEM reached the same image quality as in COSEM but two times faster when a power factor of 2.0 was used. An upper limit of 5 for the power factor with monotonically increasing log-likelihood in ACOSEM was observed under various conditions. Although the convergence proof is not available now, the results of log-likelihood values and noise studies showed that ACOSEM performed consistently with COSEM but with an accelerating reconstruction speed.

A multichannel optical coherence tomography (multi-beam OCT) system and an in vivo endoscopic imaging probe were developed using a swept-source OCT system. The distal optics were micro-machined to produce a high numerical aperture, multi-focus fibre optic array. This combination resulted in a transverse design resolution of <10 µm full width half maximum (FWHM) throughout the entire imaging range, while also increasing the signal intensity within the focus of the individual channels. The system was used in a pre-clinical rabbit study to acquire in vivo structural images of the colon and ex vivo images of the oesophagus and trachea. A good correlation between the structural multi-beam OCT images and H&E histology was achieved, demonstrating the feasibility of this high-resolution system and its potential for in vivo human endoscopic imaging.

In magnetic heating treatments, intratumorally injected superparamagnetic iron oxide nanoparticles (MNP) exposed to an externally applied alternating magnetic field generate heat, specifically at the tumor region. This inactivates cancer cells with minimal side effects to the normal tissue. Therefore, the quantity of MNP needs to be thoroughly controlled to govern adequate heat production. Here, we demonstrate the capability of magnetorelaxometry (MRX) for the non-invasive quantification and localization of MNP accumulation in small animal models. The results of our MRX measurements using a multichannel vector magnetometer system with 304 SQUIDs (superconductive quantum interference device) on three mice hosting different carcinoma models (9L/lacZ and MD-AMB-435) are presented. The position and magnitude of the magnetic moment are reconstructed from measured spatial magnetic field distributions by a magnetic dipole model fit applying a Levenberg–Marquadt algorithm. Therewith, the center of gravity and the total amount of MNP accumulation in the mice are determined. Additionally, for a fourth mouse the distribution of MNP over individual organs and the tumor is analyzed by single-channel SQUID measurements, obtaining a sensitive spatial quantification. This study shows that magnetorelaxometry is well suited to monitor MNP accumulation before cancer therapy, with magnetic heating being an important precondition for treatment success.

Positron emitters such as ¹¹C, ¹³N and ¹⁸F and their labelled compounds are widely used in clinical diagnosis and animal studies, but can also be used to study metabolic and physiological functions in plants dynamically and in vivo. A very particular tracer molecule is ¹¹CO₂ since it can be applied to a leaf as a gas. We have developed a Plant Tomographic Imaging System (PlanTIS), a high-resolution PET scanner for plant studies. Detectors, front-end electronics and data acquisition architecture of the scanner are based on the ClearPET™ system. The detectors consist of LSO and LuYAP crystals in phoswich configuration which are coupled to position-sensitive photomultiplier tubes. Signals are continuously sampled by free running ADCs, and data are stored in a list mode format. The detectors are arranged in a horizontal plane to allow the plants to be measured in the natural upright position. Two groups of four detector modules stand face-to-face and rotate around the field-of-view. This special system geometry requires dedicated image reconstruction and normalization procedures. We present the initial performance of the detector system and first phantom and plant measurements.

A conventional x-ray fluorescence computed tomography (XFCT) technique requires monochromatic synchrotron x-rays to simultaneously determine the spatial distribution and concentration of various elements such as metals in a sample. However, the synchrotron-based XFCT technique appears to be unsuitable for in vivo imaging under a typical laboratory setting. In this study we demonstrated, for the first time to our knowledge, the possibility of performing XFCT imaging of a small animal-sized object containing gold nanoparticles (GNPs) at relatively low concentrations using polychromatic diagnostic energy range x-rays. Specifically, we created a phantom made of polymethyl methacrylate plastic containing two cylindrical columns filled with saline solution at 1 and 2 wt% GNPs, respectively, mimicking tumors/organs within a small animal. XFCT scanning of the phantom was then performed using microfocus 110 kVp x-ray beam and cadmium telluride (CdTe) x-ray detector under a pencil beam geometry after proper filtering of the x-ray beam and collimation of the detector. The reconstructed images clearly identified the locations of the two GNP-filled columns with different contrast levels directly proportional to gold concentration levels. On the other hand, the current pencil-beam implementation of XFCT is not yet practical for routine in vivo imaging tasks with GNPs, especially in terms of scanning time. Nevertheless, with the use of multiple detectors and a limited number of projections, it may still be used to image some objects smaller than the current phantom size. The current investigation suggests several modification strategies of the current XFCT setup, such as the adoption of the quasi-monochromatic cone/fan x-ray beam and XFCT-specific spatial filters or pinhole detector collimators, in order to establish the ultimate feasibility of a bench-top XFCT system for GNP-based preclinical molecular imaging applications.

Myoelectrical recording could provide an alternative technique for assessing intestinal motility, which is a topic of great interest in gastroenterology since many gastrointestinal disorders are associated with intestinal dysmotility. The pacemaker activity (slow wave, SW) of the electroenterogram (EEnG) has been detected in abdominal surface recordings, although the activity related to bowel contractions (spike bursts, SB) has to date only been detected in experimental models with artificially favored electrical conductivity. The aim of the present work was to assess the possibility of detecting SB activity in abdominal surface recordings under physiological conditions. For this purpose, 11 recording sessions of simultaneous internal and external myolectrical signals were conducted on conscious dogs. Signal analysis was carried out in the spectral domain. The results show that in periods of intestinal contractile activity, high-frequency components of EEnG signals can be detected on the abdominal surface in addition to SW activity. The energy between 2 and 20 Hz of the surface myoelectrical recording presented good correlation with the internal intestinal motility index (0.64 ± 0.10 for channel 1 and 0.57 ± 0.11 for channel 2). This suggests that SB activity can also be detected in canine surface EEnG recording.

There is much interest in positron emission tomography (PET) for measurements of regional tracer concentration in hypoxic tumour-bearing tissue, focusing on the need for accurate radiotherapy treatment planning. Generally, relevant data are taken over multiple time frames in the form of tissue activity curves (TACs), thus providing an indication of vasculature structure and geometry. This is a potential key in providing information on cellular perfusion and limited diffusion. A number of theoretical studies have attempted to describe tracer uptake in tissue cells in an effort to understand such complicated behaviour of cellular uptake and the mechanism of washout. More recently, a novel computerized reaction diffusion equation method was developed by Kelly and Brady (2006 A model to simulate tumour oxygenation and dynamic [18F]-FMISO PET data Phys. Med. Biol.51 5859–73), where they managed to simulate the realistic dynamic TACs of ¹⁸F-FMISO. The model was developed over a multi-step process. Here we present a refinement to the work of Kelly and Brady, such that the model allows simulation of a realistic tissue activity curve (TAC) of any hypoxia selective PET tracer, in a single step process. In this work we show particular interest in simulating the TAC of perhaps the most promising hypoxia selective tracer, ⁶⁴Cu-ATSM. In addition, we demonstrate its potential role in tumour sub-volume delineation for radiotherapy treatment planning. Simulation results have demonstrated the significant high contrast of imaging using ATSM, with a tumour to blood ratio ranging from 2.24 to 4.1.

[¹⁸F]Fluorothymidine (FLT) is a cell proliferation marker that undergoes predominantly hepatic metabolism and therefore shows a high level of accumulation in the liver, as well as in rapidly proliferating tumours. Furthermore, the tracer's uptake is substantial in other organs including the heart. We present a nonlinear kinetic filtering technique which enhances the visualization of tumours imaged with FLT positron emission tomography (FLT-PET). A classification algorithm to isolate cancerous tissue from healthy organs was developed and validated using 29 scan data from patients with locally advanced or metastatic breast cancer. A large reduction in signal from the liver and heart of 80% was observed following application of the kinetic filter, whilst the majority of signal from both primary tumours and metastases was retained. A scan acquisition time of 60 min has been shown to be sufficient to obtain the necessary kinetic data. The algorithm extends utility of FLT-PET imaging in oncology research.

Scanned proton pencil beams carry a low-dose envelope that extends several centimeters from the individual beam's central axis. Thus, the total delivered dose depends on the size of the target volume and the corresponding number and intensity of beams necessary to cover the target volume uniformly. This dependence must be considered in dose calculation algorithms used by treatment planning systems. In this work, we investigated the sources of particles contributing to the low-dose envelope using the Monte Carlo technique. We used a validated model of our institution's scanning beam line to determine the contributions to the low-dose envelope from secondary particles created in a water phantom and particles scattered in beam line components. Our results suggested that, for high-energy beams, secondary particles produced by nuclear interactions in the water phantom are the major contributors to the low-dose envelope. For low-energy beams, the low-dose envelope is dominated by particles undergoing multiple Coulomb scattering in the beam line components and water phantom. Clearly, in the latter situation, the low-dose envelope depends directly on beam line design features. Finally, we investigated the dosimetric consequences of the low-dose envelope. Our results showed that if not modeled properly the low-dose envelope may cause clinically relevant dose disturbance in the target volume. This work suggested that this low-dose envelope is beam line specific for low-energy beams, should be thoroughly experimentally characterized and validated during commissioning of the treatment planning system, and therefore is of great concern for accurate delivery of proton scanning beam doses.

The dosimetric consequences of plans optimized using a commercial treatment planning system (TPS) for hypofractionated radiation therapy are evaluated by re-calculating with Monte Carlo (MC). Planning guidelines were in strict accordance with the Canadian BR25 protocol which is similar to the RTOG 0236 and 0618 protocols in patient eligibility and total dose, but has a different hypofractionation schedule (60 Gy in 15 fractions versus 60 Gy in 3 fractions). A common requirement of the BR25 and RTOG protocols is that the dose must be calculated by the TPS without tissue heterogeneity (TH) corrections. Our results show that optimizing plans using the pencil beam algorithm with no TH corrections does not ensure that the BR25 planning constraint of 99% of the PTV receiving at least 95% of the prescription dose would be achieved as revealed by MC simulations. This is due to poor modelling of backscatter and lateral electronic equilibrium by the TPS. MC simulations showed that as little as 75% of the PTV was actually covered by the 95% isodose line. The under-dosage of the PTV was even more pronounced if plans were optimized with the TH correction applied. In the most extreme case, only 23% of the PTV was covered by the 95% isodose.

The integration of medical linear accelerators (linac) with magnetic resonance imaging (MRI) systems is advancing the current state of image-guided radiotherapy. The MRI in these integrated units will provide real-time, accurate tumor locations for radiotherapy treatment, thus decreasing geometric margins around tumors and reducing normal tissue damage. In the real-time operation of these integrated systems, the radiofrequency (RF) coils of MRI will be irradiated with radiation pulses from the linac. The effect of pulsed radiation on MRI radio frequency (RF) coils is not known and must be studied. The instantaneous radiation induced current (RIC) in two different MRI RF coils were measured and presented. The frequency spectra of the induced currents were calculated. Some basic characterization of the RIC was also done: isolation of the RF coil component responsible for RIC, dependence of RIC on dose rate, and effect of wax buildup placed on coil on RIC. Both the time and frequency characteristics of the RIC were seen to vary with the MRI RF coil used. The copper windings of the RF coils were isolated as the main source of RIC. A linear dependence on dose rate was seen. The RIC was decreased with wax buildup, suggesting an electronic disequilibrium as the cause of RIC. This study shows a measurable RIC present in MRI RF coils. This unwanted current could be possibly detrimental to the signal to noise ratio in MRI and produce image artifacts.

Dose-rate-regulated tracking (DRRT) is a novel tumor-tracking technique based on a preprogrammed multileaf-collimator (MLC) sequence and dose-rate modulation. We have performed a parametric study on how limitations of the DRRT system and breathing irregularities affect the tracking error and the duty cycle of DRRT. The time delay and the allowed dose-rate increment (continuous-, discrete-increment or beam switching) were used as two parameters for the DRRT system limitation. The breathing irregularity was quantified in terms of three variables, namely, breathing period variation, variation of peak-to-peak amplitude and baseline drift. DRRT treatments were simulated using 2126 breathing cycles obtained from 24 lung-cancer patients. Tracking errors and duty cycles from all 24 patients were combined to evaluate their dependence on each parameter or variable. The tracking error and the duty cycle show a modest difference among the three dose-rate-increment cases. Time delay, breathing peak-to-peak variation and baseline drift are the main factors affecting tracking error. The duty cycle is affected mostly by the allowed dose-rate increment, peak-to-peak variation and baseline drift.

We present a nanodosimetric model for predicting the yield of double strand breaks (DSBs) and non-DSB clustered damages induced in irradiated DNA. The model uses experimental ionization cluster size distributions measured in a gas model by an ion counting nanodosimeter or, alternatively, distributions simulated by a Monte Carlo track structure code developed to simulate the nanodosimeter. The model is based on a straightforward combinatorial approach translating ionizations, as measured or simulated in a sensitive gas volume, to lesions in a DNA segment of one–two helical turns considered equivalent to the sensitive volume of the nanodosimeter. The two model parameters, corresponding to the probability that a single ion detected by the nanodosimeter corresponds to a single strand break or a single lesion (strand break or base damage) in the equivalent DNA segment, were tuned by fitting the model-predicted yields to previously measured double-strand break and double-strand lesion yields in plasmid DNA irradiated with protons and helium nuclei. Model predictions were also compared to both yield data simulated by the PARTRAC code for protons of a wide range of different energies and experimental DSB and non-DSB clustered DNA damage yield data from the literature. The applicability and limitations of this model in predicting the LET dependence of clustered DNA damage yields are discussed.

Backscatter factors are important parameters in the determination of dose for kilovoltage x-ray beams. However, backscatter factors are difficult to measure experimentally, and tabulated values are based largely on Monte Carlo calculations. In this study we have determined new backscatter factors by both experimental and Monte Carlo methods, and compared them with existing backscatter factors published in the AAPM TG-61 protocol. The purpose of this study is twofold: (1) to evaluate the overall effectiveness of using Gafchromic EBT film for backscatter factor measurements and (2) to determine whether existing Monte Carlo-calculated backscatter factors need to be updated. We measured backscatter factors using Gafchromic EBT film for three field sizes (2, 4 and 6 cm diameter cones) and three kilovoltage beam qualities, including 280 kVp for which similar measurements have not previously been reported. We also present new Monte Carlo-calculated backscatter factors obtained using the EGSnrc/BEAMnrc code system to simulate the Pantak kilovoltage x-ray unit used in our measurements. The results were compared with backscatter factors tabulated in the AAPM TG-61 protocol for kilovoltage x-ray dosimetry. The largest difference between our measured and calculated backscatter factors and the AAPM TG-61 values was found to be 2.5%. This agreement is remarkably good, considering that the AAPM TG-61 values consist of a combination of experimental and Monte Carlo calculations obtained over 20 years ago using different measurement techniques, as well as older Monte Carlo code and cross-section data. Furthermore, our Monte Carlo-calculated backscatter factors agree within 1% with the AAPM TG-61 values for all beam qualities and field sizes. Our Gafchromic film measurements had slightly larger differences with the AAPM TG-61 backscatter factors, up to approximately 2% for the 6 cm diameter cone at a beam quality of 50 kVp. The largest difference in backscatter factors, of 2.5%, was found between Monte Carlo-calculated and Gafchromic film-measured data for the 100 kVp x-ray beam with the 4 cm diameter cone. The differences in backscatter factors between the three data sets (measurements, calculations and published values) are all within the uncertainties from our Gafchromic film measurements and Monte Carlo calculations. Our results demonstrate the suitability of using Gafchromic EBT film to measure equipment-specific backscatter factors for kilovoltage x-ray beams over the entire energy range and also confirm that backscatter factors published in kilovoltage dosimetry protocols still remain valid.

It has recently been demonstrated experimentally that cardiac pulsations seem significantly to affect the arterial spin labelling (ASL) signal. In this paper, we introduce a new theoretical model to examine this effect. Existing models of ASL do not take such effects into account since they model the transit of the ASL signal assuming uniform plug flow with a single transit delay. In this study, we model cardiac pulsations through the coupling of the Navier–Stokes equations with the three-dimensional mass transport equation. Our results complement the experimental findings and suggest that the ASL signal does depend on the timing of the onset of the cardiac cycle relative to the tagging and imaging locations. However, cardiac pulsatility only appears to have a small effect on the quantification of perfusion estimates.

Whole-body (WB) planar imaging has long been one of the staple methods of dosimetry, and its quantification has been formalized by the MIRD Committee in pamphlet no 16. One of the issues not specifically addressed in the formalism occurs when the count rates reaching the detector are sufficiently high to result in camera count saturation. Camera dead-time effects have been extensively studied, but all of the developed correction methods assume static acquisitions. However, during WB planar (sweep) imaging, a variable amount of imaged activity exists in the detector's field of view as a function of time and therefore the camera saturation is time dependent. A new time-dependent algorithm was developed to correct for dead-time effects during WB planar acquisitions that accounts for relative motion between detector heads and imaged object. Static camera dead-time parameters were acquired by imaging decaying activity in a phantom and obtaining a saturation curve. Using these parameters, an iterative algorithm akin to Newton's method was developed, which takes into account the variable count rate seen by the detector as a function of time. The algorithm was tested on simulated data as well as on a whole-body scan of high activity Samarium-153 in an ellipsoid phantom. A complete set of parameters from unsaturated phantom data necessary for count rate to activity conversion was also obtained, including build-up and attenuation coefficients, in order to convert corrected count rate values to activity. The algorithm proved successful in accounting for motion- and time-dependent saturation effects in both the simulated and measured data and converged to any desired degree of precision. The clearance half-life calculated from the ellipsoid phantom data was calculated to be 45.1 h after dead-time correction and 51.4 h with no correction; the physical decay half-life of Samarium-153 is 46.3 h. Accurate WB planar dosimetry of high activities relies on successfully compensating for camera saturation which takes into account the variable activity in the field of view, i.e. time-dependent dead-time effects. The algorithm presented here accomplishes this task.

Proton beam radiotherapy is an effective and non-invasive treatment for uveal melanoma. Recent research efforts have focused on improving the dosimetric accuracy of treatment planning and overcoming the present limitation of relative analytical dose calculations. Monte Carlo algorithms have been shown to accurately predict dose per monitor unit (D/MU) values, but this has yet to be shown for analytical algorithms dedicated to ocular proton therapy, which are typically less computationally expensive than Monte Carlo algorithms. The objective of this study was to determine if an analytical method could predict absolute dose distributions and D/MU values for a variety of treatment fields like those used in ocular proton therapy. To accomplish this objective, we used a previously validated Monte Carlo model of an ocular nozzle to develop an analytical algorithm to predict three-dimensional distributions of D/MU values from pristine Bragg peaks and therapeutically useful spread-out Bragg peaks (SOBPs). Results demonstrated generally good agreement between the analytical and Monte Carlo absolute dose calculations. While agreement in the proximal region decreased for beams with less penetrating Bragg peaks compared with the open-beam condition, the difference was shown to be largely attributable to edge-scattered protons. A method for including this effect in any future analytical algorithm was proposed. Comparisons of D/MU values showed typical agreement to within 0.5%. We conclude that analytical algorithms can be employed to accurately predict absolute proton dose distributions delivered by an ocular nozzle.

The material-dependent x-ray scattering properties of amorphous substances such as tissues and phantom materials used in imaging are determined by their scattering form factors, measured as a function of the momentum transfer argument, x. Incoherent scattering form factors, F_inc, are calculable for all values of x while coherent scattering form factors, F_coh, cannot be calculated except at large x because of their dependence on long-range order. As a result, measuring F_coh is very important to the developing field of x-ray scatter imaging. Previous measurements of F_coh, based on crystallographic techniques, have shown significant variability, as these techniques are not optimal for amorphous materials. We have developed an energy-dispersive technique that uses a polychromatic x-ray beam and an energy-sensitive detector. We show that F_coh can be measured directly, with no scaling parameters, by computing the ratio of two spectra: the first, measured at a given scattering angle and the second, the direct transmission spectrum with no scattering. Experiments have been constructed on this principle and used to measure F_coh for water and polyethylene to explore the reliability of the technique. A 121 kVp x-ray spectrum and seven different scattering angles between 1.67 and 15.09° were used, resulting in a measurable range of x between 0.5 and 9.5 nm⁻¹. These are the first measurements of F_coh made without the need for a scaling factor. Resolution in x varies between 10% for small scattering angles and 2% for large scattering angles. Accuracy in F_coh is shown to be strongly dependent on the precision of the experimental geometry and varies between 5% and 15%. Comparison with previous published measurements for water shows values of the average absolute relative difference between 8% and 14%.

Despite the highly localized doses that may be delivered via stereotactic radiotherapy, a small dose is nonetheless delivered to out-of-field regions, which may cause detriment to the patient. In this work, a systematic set of dose measurements have been undertaken up to a distance of 45 cm from the isocentre, for stereotactic fields shaped by a BrainLAB mini-multileaf collimator (MMLC) mounted on a Varian 600C linear accelerator. A range of treatment parameters were varied so as to determine the factors of greatest influence and establish relationships with dose. The commercial treatment planning software (TPS) miscalculates the dose to out-of-field regions. Measured dose decreases consistently out to 45 cm, whereas the TPS decreases out to 10–15 cm, at which point the predicted dose is constant. At the 5–10 cm off-axis distance (OAD), measurements indicate doses of about 5–10% of the dose at the isocentre, 1% at 15 cm OAD and 0.1% at 45 cm OAD. There are several observed trends. Greater MMLC field sizes (with static jaw) result in higher out-of-field dose, as do shallower depths. The source-to-surface distance does not greatly influence peripheral dose. However, the results given in this work do indicate that simple treatment arrangements, such as preferable collimator rotation, would in certain cases reduce out-of-field dose by an order of magnitude. Peripheral dose raises questions of treatment optimization, particularly in cases where patients have a long life expectancy in which secondary effects may become manifest, such as in the treatment of paediatric patients or those with a non-malignant primary. For instance, for a 20 Gy hypo-fractionated treatment, dose to out-of-field regions is of the order of cGy—a substantial dose in radiation protection terms.

The conventional IMRT planning process involves two stages in which the first stage consists of fast but approximate idealized pencil beam dose calculations and dose optimization and the second stage consists of discretization of the intensity maps followed by intensity map segmentation and a more accurate final dose calculation corresponding to physical beam apertures. Consequently, there can be differences between the presumed dose distribution corresponding to pencil beam calculations and optimization and a more accurately computed dose distribution corresponding to beam segments that takes into account collimator-specific effects. IMRT optimization is computationally expensive and has therefore led to the use of heuristic (e.g., simulated annealing and genetic algorithms) approaches that do not encompass a global view of the solution space. We modify the traditional two-stage IMRT optimization process by augmenting the second stage via an accurate Monte Carlo-based kernel-superposition dose calculations corresponding to beam apertures combined with an exact mathematical programming-based sequential optimization approach that uses linear programming (SLP). Our approach was tested on three challenging clinical test cases with multileaf collimator constraints corresponding to two vendors. We compared our approach to the conventional IMRT planning approach, a direct-aperture approach and a segment weight optimization approach. Our results in all three cases indicate that the SLP approach outperformed the other approaches, achieving superior critical structure sparing. Convergence of our approach is also demonstrated. Finally, our approach has also been integrated with a commercial treatment planning system and may be utilized clinically.

Over the past few years there has been much interest in the development of three-dimensional dosimeters to determine the complex absorbed dose distribution in modern radiotherapy techniques such as IMRT and IGRT. In routine methods used for three-dimensional dosimetry, polymer gels are commonly used. Recently, a novel transparent polymer dosimeter, known as PRESAGE, has been introduced in which a radiochromic color change is observed upon radiation. PRESAGE has some advantages over usual polymer gel dosimeters. It has been noted that the sensitivity of PRESAGE can be changed when different amounts of the components are used for its fabrication. This study has focused on the assessment of dosimetric characteristics of PRESAGE for various amounts of components in its formulation. To achieve this, PRESAGE dosimeters were fabricated using various amounts of their constituting components. Then the dosimeters were irradiated to ⁶⁰Co gamma photons for a range of radiation doses from 0 to 50 Gy. Consequently, the light absorption changes of the dosimeters were measured by a spectrophotometer at different post-irradiation time periods. It was generally observed that as the concentration of the radical initiator is increased, the PRESAGE dosimeter sensitivity is increased while its stability is decreased. Furthermore, it was noted that with the high concentration of the radical initiator and leuco dye, the sensitivity of PRESAGE is decreased.

In intensity-modulated radiation therapy (IMRT), fluence matrices obtained from a treatment planning system are usually delivered by a linear accelerator equipped with a multileaf collimator (MLC). A segmentation method is needed for decomposing these fluence matrices into segments suitable for the MLC, and the number of segments used is an important factor for treatment time. In this work, an algorithm for reduction of the number of segments (NS) is presented for unidirectional segmentations, where there is no backtracking of the MLC leaves. It uses a geometrical representation of the segmentation output for searching the key values in a fluence matrix that complicate its decomposition. The NS reduction is achieved by performing minor modifications in these values, under the conditions of avoiding substantial modifications of the dose–volume histogram, and does not increase in average the total number of monitor units delivered. The proposed method was tested using two clinical cases planned with the PCRT 3D® treatment planning system.

An accurate, simple and time-saving sector integration method for calculating the proton output (dose/monitor unit, MU) is presented based on the following treatment field parameters: aperture shape, aperture size, measuring position, beam range and beam modulation. The model is validated with dose/MU values for 431 fields previously measured at our center. The measurements were obtained in a uniform scanning proton beam with a parallel plate ionization chamber in a water phantom. For beam penetration depths of clinical interest (6–27 cm water), dose/MU values were measured as a function of spread-out Bragg peak (SOBP) extent and aperture diameter. First, 90 randomly selected fields were used to derive the model parameters, which were used to compute the dose/MU values for the remaining 341 fields. The min, max, average and the standard deviation of the difference between the calculated and the measured dose/MU values of the 341 fields were used to evaluate the accuracy and stability, for different energy ranges, aperture sizes, measurement positions and SOBP values. The experimental results of the five different functional sets showed that the calculation model is accurate with calculation errors ranging from −2.4% to 3.3%, and 99% of the errors are less than ±2%. The accuracy increases with higher energy, larger SOBP and bigger aperture size. The average error in the dose/MU calculation for small fields (field size <25 cm²) is 0.31 ± 0.96 (%).

In their recent paper (Venkataraman et al2009 Phys. Med. Biol.54 3173–83) the authors reported on photon beam attenuation and secondary electron production in the novel transmission detector COMPASS, to be placed in the accessory holder of the linac treatment head. In the interest of IMRT patient safety, space-resolved measurements by transmission detectors analysing the MLC-shaped photon fluence pattern in real time are in fact an urgent item for equipment designers. However, there are some constraints for the construction of such devices. The COMPASS system, at its present stage of development, has difficulties in complying with the constraints that the spatial sampling rate should fit the desired task and that the enhanced secondary electron contamination of the photon beam due to the presence of the device should be minimized. The authors also missed to mention a forerunner in this field, the DAVID transmission detector (Poppe et al2006 Phys. Med. Biol.51 1237–48), serving for the real-time supervision of the MLC aperture during patient treatment and ever since proven in clinical practice. The DAVID system, a transparent multiwire ionization chamber placed in the accessory holder, will be shortly described.

The purpose of this work was to investigate the influence of a new transmission detector on 6 MV x-ray beam properties. The device, COMPASS (IBA Dosimetry, Germany), contains 1600 plane parallel ionization chambers with a detector spacing of 6.5 mm and an active volume of 0.02 cm³. Butson et al (1996 Australas. Phys. Eng. Sci. Med19 74–82) studied the causes for the surface dose and dose in the build-up region and concluded that the surface dose at 6 MV is mostly due to electron contamination. We used PTW Markus parallel plane chamber for measurements at the surface and in the build-up region and corrected the over-response using the Mellenberg method (Mellenberg 1990 Med. Phys.17 1041–4) and we found that for moderately narrow beam geometric conditions, the increase in surface dose was small. For the largest field size investigated (20 × 20 cm²) at 90 cm SSD, the surface dose with the detector was 34.9% versus 26.8% in the open field. It was found that beyond d_max, the difference in relative dose (profiles and PDDs) between open and COMPASS fields was insignificant. In summary, the transmission detector was found to increase the relative dose in the buildup region, but had a negligible effect on the beam parameters beyond d_max.