Journal of Medical Physics (J Med Phys)

Publications in this journal

• Article: Discrepancies in determining electron energy for lumpectomy boost treatment.

  Aime M Gloi, Robert Buchanan
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  ABSTRACT: The aim of this study was to compare lumpectomy cavity depth measurements obtained through ultrasound (U/S) and retrospective computed tomography (CT). Twenty-five patients with stage T1-2 invasive breast cancer formed the cohort of this study. Their U/S and CT measurements were converted into electron energy and compared. The mean U/S depth was 3.6 ± 1.3 cm, while the mean CT depth was 4.9 ± 1.9 cm; the listed error ranges are one standard deviation. Electron energies for treatment ranged from 6 MeV to 12 MeV based on the U/S determination. There was no significant correlation between cavity depths measured by U/S and CT (R(2)= 0.459, P < 0.002). Furthermore, only 20% of CT-based electron energy determinations matched the corresponding U/S determinations. This ratio increased to 40% when taking into account an upper limit based on the depth of organs at risk below the cavity. The study shows that there is a significant discrepancy between cavity depths determined by U/S and CT. It also supports the concept that post-lumpectomy radiotherapy boosts should be tailored according to the needs and comfort of individual practices and institutions.
  Journal of Medical Physics 07/2012; 37(3):138-44.
• Article: Use of ubiquitous materials for the estimation of accidental exposures.

  A S Pradhan, J L Kim, J I Lee
  Journal of Medical Physics 07/2012; 37(3):121-3.
• Article: An analytic approach to the dosimetry of a new BEBIG (60)Co high-dose-rate brachytherapy source.

  Subhalaxmi Bhola, T Palani Selvam, Sahoo Sridhar, Ramkrishna S Vishwakarma
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  ABSTRACT: We present a simple analytic tool for calculating the dose rate distribution in water for a new BEBIG high-dose-rate (HDR) (60)Co brachytherapy source. In the analytic tool, we consider the active source as a point located at the geometric center of the (60)Co material. The influence of the activity distribution in the active volume of the source is taken into account separately by use of the line source-based geometric function. The exponential attenuation of primary (60)Co photons by the source materials ((60)Co and stainless-steel) is included in the model. The model utilizes the point-source-based function, f(r) that represents the combined effect of the exponential attenuation and scattered photons in water. We derived this function by using the published radial dose function for a point (60)Co source in an unbounded water medium of radius 50 cm. The attenuation coefficients for (60)Co and the stainless-steel encapsulation materials are deduced as best-fit parameters that minimize the different.
  Journal of Medical Physics 07/2012; 37(3):129-37.
• Article: The influence of the patient size and geometry on cone beam-computed tomography hounsfield unit.

  Heng Siew Ping, Sivamany Kandaiya
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  ABSTRACT: The objective of this work is to study the influence of the patient size and geometry on CBCT Hounsfield Unit and the accuracy of calibration Hounsfield Unit to electron density (HU-ED) using patient specific HU-ED mapping method for dose calculation. Two clinical cases, namely nasopharyngeal carcinoma (NPC) case and prostate case for 4 patients with different size and geometry were enrolled to assess the impact of size and geometry on CBCT Hounsfield Unit. The accuracy of the patient specific HU-ED mapping method was validated by comparing dose distributions based on planning CT and CBCT, dose-volume based indices and the digitally reconstructed radiograph (DRR) by analyzing their line profile plots. Significant differences in Hounsfield unit and line profile plots were found for NPC and prostate cases. The doses computed based on planning CT data sets and CBCT datasets for both clinical cases agree to within 1% for planning target volumes and 3% for organs at risk. The data shows that there are high dependence of HU on patient size and geometry; thus, the use of one CBCT HU-ED calibration curve made of one size and geometry will not be accurate for use with a patient of different size and geometry.
  Journal of Medical Physics 07/2012; 37(3):155-8.
• Article: Pocket-size solid-state iPOD and flash drives for gigabyte storage, display and transfer of digital medical images: Technology Update.

  Sankaran Ananthanarayanan
  Journal of Medical Physics 07/2012; 37(3):159-62.
• Article: Dosimetric analysis of trigeminal nerve, brain stem doses in CyberKnife radiosurgery of trigeminal neuralgia.

  H Sudahar, P G G Kurup, V Murali, J Velmurugan
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  ABSTRACT: CyberKnife radiosurgery treatment of Trigeminal neuralgia (TN) is performed as a non-invasive image guided procedure. The prescription dose for TN is very high. The brainstem is the adjacent critical organ at risk (OAR) which is prone to receive the very high target dose of TN. The present study is to analyze the dose distribution inside the tiny trigeminal nerve target and also to analyze the dose fall off in the brain stem. Seven TN cases treated between November 2010 and January 2012 were taken for this study retrospectively. The treatment plans were analyzed for target dose conformity, homogeneity and dose coverage. In the brainstem the volume doses D(1%), D(2%) were taken for analyzing the higher doses in the brain stem. The dose fall off was analyzed in terms of D(5%) and D(10%). The mean value of maximum dose within the trigeminal nerve target was 73.5±2.1Gy (P=0.0007) and the minimum dose was 50.0±4.1Gy (P=0.1315). The mean conformity index was 2.19 and the probable reason could be the smallest CyberKnife collimator of 5mm used in the treatment plan. The mean D(1%), of the brainstem was 10.5± 2.1Gy (P=0.5316) and the mean value of the maximum point dose within the brainstem was 35.6±3.8Gy. This shows the degree of dose fall off within the brainstem. Though the results of the present study are showing superior sparing of brain stem and reasonable of target coverage, it is necessary to execute the treatment plan with greater accuracy in CyberKnife as the immobilization is noninvasive and frameless.
  Journal of Medical Physics 07/2012; 37(3):124-8.
• Article: Commissioning and initial acceptance tests for a commercial convolution dose calculation algorithm for radiotherapy treatment planning in comparison with Monte Carlo simulation and measurement.

  Farhad Moradi, Seyed Rabi Mahdavi, Ahmad Mostaar, Mohsen Motamedi
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  ABSTRACT: In this study the commissioning of a dose calculation algorithm in a currently used treatment planning system was performed and the calculation accuracy of two available methods in the treatment planning system i.e., collapsed cone convolution (CCC) and equivalent tissue air ratio (ETAR) was verified in tissue heterogeneities. For this purpose an inhomogeneous phantom (IMRT thorax phantom) was used and dose curves obtained by the TPS (treatment planning system) were compared with experimental measurements and Monte Carlo (MCNP code) simulation. Dose measurements were performed by using EDR2 radiographic films within the phantom. Dose difference (DD) between experimental results and two calculation methods was obtained. Results indicate maximum difference of 12% in the lung and 3% in the bone tissue of the phantom between two methods and the CCC algorithm shows more accurate depth dose curves in tissue heterogeneities. Simulation results show the accurate dose estimation by MCNP4C in soft tissue region of the phantom and also better results than ETAR method in bone and lung tissues.
  Journal of Medical Physics 07/2012; 37(3):145-50.
• Article: Computed organ doses to an Indian reference adult during brachytherapy treatment of esophagus, breast, and neck cancers.

  Biju Keshavkumar
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  ABSTRACT: This study aims to generate the normalized mean organ dose factors (mGy min(-1) GBq(-1)) to healthy organs during brachytherapy treatment of esophagus, breast, and neck cancers specific to the patient population in India. This study is in continuation to the earlier published studies on the estimation of organ doses during uterus brachytherapy treatments. The results are obtained by Monte Carlo simulation of radiation transport through MIRD type anthropomorphic mathematical phantom representing reference Indian adult with (192)Ir and (60)Co high dose rate sources in the esophagus, breast, and neck of the phantom. The result of this study is compared with a published computational study using voxel-based phantom model. The variation in the organ dose of this study to the published values is within 50%.
  Journal of Medical Physics 07/2012; 37(3):151-4.
• Article: Evaluation of PTW Seven29 for tomotherapy patient-specific quality assurance and comparison with ScandiDos Delta(4).

  Pamela Myers, Sotirios Stathakis, Alonso N Gutiérrez, Carlos Esquivel, Panayiotis Mavroidis, Niko Papanikolaou
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  ABSTRACT: For routine quality assurance of helical tomotherapy plans, an alternative method, as opposed to the TomoTherapy suggested cylindrical solid water phantom with film and ionization chamber, is proposed using the PTW Seven29 2D-ARRAY inserted in a dedicated octagonal phantom, called Octavius. First, the sensitivity of the array to pitch was studied by varying the pitch during planning to 0.287, 0.433, 1.0, and 2.0. For each pitch selected, the dependence on field size was investigated by generating plans with field widths (FWs) of 1.06 cm, 2.49 cm, and 5.02 cm, for a total of 12 plans. Secondly, a total of 15 patient QA plans were delivered using helical tomotherapy with the Delta(4) and Seven29/Octavius for comparison. Using the clinical gamma criteria, 3% and 3 mm, all FW and pitch plans had a passing percentage of >90%. For patient QA plans, the average gamma pass percentage was 97.0% (94.4-99.8%) for the Delta(4) and 97.6% (92.5-100.0%) for the Seven29/Octavius. Both the Seven29/Octavius and Delta(4) performed to a high standard of measurement accuracy and had a 90% or greater gamma percent for all plans and were considered clinically acceptable.
  Journal of Medical Physics 04/2012; 37(2):72-80.
• Article: Impact of edema and seed movement on the dosimetry of prostate seed implants.

  Ron S Sloboda, N Usmani, T T Monajemi, D M-C Liu
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  ABSTRACT: This article summarizes current knowledge concerning the characterization of prostatic edema and intra-prostatic seed movement as these relate to dosimetry of permanent prostate implants, and reports the initial application to clinical data of a new edema model used in calculating pre- and post-implant dose distributions. Published edema magnitude and half-life parameters span a broad range depending on implant technique and measurement uncertainty, hence clinically applicable values should be determined locally. Observed intra-prostatic seed movements appear to be associated with particular aspects of implant technique and could be minimized by technique modification. Using an extended AAPM TG-43 formalism incorporating the new edema model, relative dose error RE associated with neglecting edema was calculated for three I-125 seed implants (18.9 cc, 37.6 cc, 60.2 cc) performed at our center. Pre- and post-plan RE average values and ranges in a 50 × 50 × 50 mm(3) calculation volume were similar at ~2% and ~0-3.5%, respectively, for all three implants; however, the spatial distribution of RE varied for different seed configurations. Post-plan values of D90 and V100 for prostate were reduced by ~2% and ~1%, respectively. In cases where RE is not clinically negligible as a consequence of large edema magnitude and / or use of Pd-103 seeds, the dose calculation method demonstrated here can be applied to account for edema explicitly and there by improve the accuracy of clinical dose estimates.
  Journal of Medical Physics 04/2012; 37(2):81-9.
• Article: Comparing the level of bystander effect in a couple of tumor and normal cell lines.

  Shokouhozaman Soleymanifard, Mohammad T Toossi Bahreyni
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  ABSTRACT: Radiation-induced bystander effect refers to radiation responses which occur in non-irradiated cells. The purpose of this study was to compare the level of bystander effect in a couple of tumor and normal cell lines (QU-DB and MRC5). To induce bystander effect, cells were irradiated with 0.5, 2, and 4 Gy of (60)Co gamma rays and their media were transferred to non-irradiated (bystander) cells of the same type. Cells containing micronuclei were counted in bystander subgroups, non-irradiated, and 0.5 Gy irradiated cells. Frequencies of cells containing micronuclei in QU-DB bystander subgroups were higher than in bystander subgroups of MRC5 cells (P < 0.001). The number of micronucleated cells counted in non-irradiated and 0.5 Gy irradiated QU-DB cells was also higher than the corresponding values for MRC5 cells (P < 0.001). Another difference between the two cell lines was that in QU-DB bystander cells, a dose-dependent increase in the number of micronucleated cells was observed as the dose increased, but at all doses the number of micronucleated cells in MRC5 bystander cells was constant. It is concluded that QU-DB cells are more susceptible than MRC5 cells to be affected by bystander effect, and in the two cell lines there is a positive correlation between DNA damages induced directly and those induced due to bystander effect.
  Journal of Medical Physics 04/2012; 37(2):102-6.
• Article: Cancer incidence risks to patients due to hysterosalpingography.

  Prince K Gyekye, Geoffrey Emi-Reynolds, Mary Boadu, Emmanuel O Darko, Johnson Yeboah, Stephen Inkoom, Cynthia K Mensah
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  ABSTRACT: Cancer incidence estimates and dosimetry of 120 patients undergoing hysterosalpingography (HSG) without screening at five rural hospitals and with screening using image intensifier-TV at an urban hospital have been studied. Free in air kerma measurements were taken for patient dosimetry. Using PCXMC version 1.5, organ and effective doses to patients were estimated. Incidence of cancer of the ovary, colon, bladder and uterus due to radiation exposure were estimated using biological effects of ionising radiation committee VII excess relative risk models. The effective dose to patients was estimated to be 0.20 ± 0.03 mSv and 0.06 ± 0.01 mSv for procedures with and without screening, respectively. The average number of exposures for both procedures, 2.5, and screening time of 48.1 s were recorded. Screening time contributed majority of the patient doses due to HSG; therefore, it should be optimised as much as possible. Of all the cancers considered, the incidence of cancer of the bladder for patients undergoing HSG procedures is more probable.
  Journal of Medical Physics 04/2012; 37(2):112-6.
• Article: A case study for online plan adaptation using helical tomotherapy.

  Christopher E Neilson, Slav Yartsev
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  ABSTRACT: Helical tomotherapy's ability to provide daily megavoltage (MV) computed tomography (CT) images for patient set-up verification allows for the creation of adapted plans. As plans become more complex by introducing sharper dose gradients in an effort to spare healthy tissue, inter-fraction changes of organ position with respect to plan become a limiting factor in the correct dose delivery to the target. Tomotherapy's planned adaptive option provides the possibility to evaluate the dose distribution for each fraction and subsequently adapt the original plan to the current anatomy. In this study, 30 adapted plans were created using new contours based on the daily MVCT studies of a bladder cancer patient with considerable anatomical variations. Dose to the rectum and two planning target volumes (PTVs) were compared between the original plan, the dose that was actually delivered to the patient, and the theoretical dose from the 30 adapted plans. The adaptation simulation displayed a lower dose to 35% and 50% of the rectum compared to no adaptation at all, while maintaining an equivalent dose to the PTVs. Although online adaptation is currently too time-consuming, it has the potential to improve the effectiveness of radiotherapy.
  Journal of Medical Physics 04/2012; 37(2):97-101.
• Article: On the use of "effective dose" (E) in medical exposures.

  A S Pradhan, J L Kim, J I Lee
  Journal of Medical Physics 04/2012; 37(2):63-5.
• Article: Equivalent normalized total dose estimates in cyberknife radiotherapy dose delivery in prostate cancer hypofractionation regimens.

  H Sudahar, P G G Kurup, V Murali, P Mahadev, J Velmurugan
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  ABSTRACT: As the α/β value of prostate is very small and lower than the surrounding critical organs, hypofractionated radiotherapy became a vital mode of treatment of prostate cancer. Cyberknife (Accuray Inc., Sunnyvale, CA, USA) treatment for localized prostate cancer is performed in hypofractionated dose regimen alone. Effective dose escalation in the hypofractionated regimen can be estimated if the corresponding conventional 2 Gy per fraction equivalent normalized total dose (NTD) distribution is known. The present study aims to analyze the hypofractionated dose distribution of localized prostate cancer in terms of equivalent NTD. Randomly selected 12 localized prostate cases treated in cyberknife with a dose regimen of 36.25 Gy in 5 fractions were considered. The 2 Gy per fraction equivalent NTDs were calculated using the formula derived from the linear quadratic (LQ) model. Dose distributions were analyzed with the corresponding NTDs. The conformity index for the prescribed target dose of 36.25 Gy equivalent to the NTD dose of 90.63 Gy (α/β = 1.5) or 74.31 Gy (α/β = 3) was ranging between 1.15 and 1.73 with a mean value of 1.32 ± 0.15. The D5% of the target was 111.41 ± 8.66 Gy for α/β = 1.5 and 90.15 ± 6.57 Gy for α/β = 3. Similarly, the D95% was 91.98 ± 3.77 Gy for α/β = 1.5 and 75.35 ± 2.88 Gy for α/β = 3. The mean values of bladder and rectal volume receiving the prescribed dose of 36.25 Gy were 0.83 cm3 and 0.086 cm3, respectively. NTD dose analysis shows an escalated dose distribution within the target for low α/β (1.5 Gy) with reasonable sparing of organs at risk. However, the higher α/β of prostate (3 Gy) is not encouraging the fact of dose escalation in cyberknife hypofractionated dose regimen of localized prostate cancer.
  Journal of Medical Physics 04/2012; 37(2):90-6.
• Article: Technetium-99m production issues in the United Kingdom.

  Christopher H Green
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  ABSTRACT: Nuclear Medicine developed when it was realised that a radioisotopic substitution of Iodine-131 for the stable Iodine-127 would follow the same metabolic pathway in the body enabling the thyroid to be imaged and the thyroid uptake measured. The Iodine could be complexed with pharmaceutical substrates to enable other organs to be imaged, but its use was limited and high gamma energy and beta emission restricted the activity of each radiopharmaceutical used, leading to long acquisition times and degraded images. As a pure gamma emitter of 140 keV and with a 6-h half-life, Technetium-99m is a better radionuclide and images a wider range of bodily organs. However, its short half-life also requires it to be eluted from its mother radionuclide, Mo-99, in a generator, delivered weekly from radiopharmaceutical companies who obtain the Mo-99 in liquid form from high-flux research reactors. All went well till around 2007, when the NRU Reactor in Canada was closed and all other reactors went down for various periods for unrelated problems, leading to widespread Mo-99 shortages. Although the reactors have since recovered, they are 48 to 57 years old, and it seems that few governments have made any future provision such as building replacement reactors.
  Journal of Medical Physics 04/2012; 37(2):66-71.
• Article: A simple calculation method for determination of equivalent square field.

  Seyed Ali Shafiei, Hadi Hasanzadeh, Seyed Ahmad Shafiei
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  ABSTRACT: Determination of the equivalent square fields for rectangular and shielded fields is of great importance in radiotherapy centers and treatment planning software. This is accomplished using standard tables and empirical formulas. The goal of this paper is to present a formula based on analysis of scatter reduction due to inverse square law to obtain equivalent field. Tables are published by different agencies such as ICRU (International Commission on Radiation Units and measurements), which are based on experimental data; but there exist mathematical formulas that yield the equivalent square field of an irregular rectangular field which are used extensively in computation techniques for dose determination. These processes lead to some complicated and time-consuming formulas for which the current study was designed. In this work, considering the portion of scattered radiation in absorbed dose at a point of measurement, a numerical formula was obtained based on which a simple formula was developed to calculate equivalent square field. Using polar coordinate and inverse square law will lead to a simple formula for calculation of equivalent field. The presented method is an analytical approach based on which one can estimate the equivalent square field of a rectangular field and may be used for a shielded field or an off-axis point. Besides, one can calculate equivalent field of rectangular field with the concept of decreased scatter radiation with inverse square law with a good approximation. This method may be useful in computing Percentage Depth Dose and Tissue-Phantom Ratio which are extensively used in treatment planning.
  Journal of Medical Physics 04/2012; 37(2):107-11.
• Article: Evaluation of the Effects of Inhomogeneities on Dose Profiles Using Polymer GelDosimeter and Monte Carlo Simulation in Gamma Knife

  Tayeb Allahverdi Pourfallah, Mahmoud Allahverdi, Mohammad Hasan Zahmatkesh
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  ABSTRACT: Introduction Polymer gel dosimeters offer a practical solution to 3D dose verification for conventional radiotherapy as well as intensity-modulated and stereotactic radiotherapy. In this study, EGSnrc calculated and PAGAT polymer gel dosimeter measured dose profiles from single shot irradiation with 18 mm collimator of Gamma Knife in homogeneous and inhomogeneous phantoms were compared with each other. Materials and Methods The head phantom was a custom-built 16 cm diameter plexiglas sphere. Inside the phantom, there were two cubic cutouts for inserting the gel vials and inhomogeneities. Following irradiation with the Gamma Knife unit, the polymer gel dosimeters were scanned with a 1.5 T MRI scanner. For the purpose of simulation the simplified channel of 60Co source of Gamma Knife BEAMnrc and for extracting the 3D dose distribution in the phantom, DOSXYZnrc codes were used. Results Within high isodose levels (>80%), there are dose differences higher than 7%, especially between air inserted and PTFE inserted phantoms, which were obtained using both simulation and experiment. This means that these values exceed the acceptance criterion of conformal radiotherapy and stereotactic radiosurgery (i.e., within some isodose levels, less than 93% of prescription dose are delivered to the target). Conclusion The discrepancies observed between the results obtained from heterogeneous and homogeneous phantoms suggest that Leksell Gamma Knife planning system (LGP) predictions which assume the target as a homogeneous material must be corrected in order to take care of the air- and bone-tissue inhomogeneities.
  Journal of Medical Physics 01/2012; 8(1):1-18.