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Physics in Medicine and Biology 04/2013; 58(8):E01. · 2.83 Impact Factor
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ABSTRACT: The purpose of the present study was to quantify the concomitant dose received by patients undergoing cone beam computed tomography (CBCT) scanning in different clinical scenarios as a part of image-guided radiotherapy (IGRT) procedures.
We calculated the three-dimensional concomitant dose received as a result of CBCT scans in 6 patients representing different clinical scenarios: two pelvis, two head and neck, and two chest. We assessed the effect that a daily on-line IGRT strategy would have on the patient dose distribution, assuming 40 CBCT scans throughout the treatment course. The additional dose to the planning target volume margin region was also estimated.
In the pelvis, a single CBCT scan delivered a mean dose to the femoral heads of 2-6 cGy and the rectum of 1-2 cGy. An additional dose to the planning target volume was within 1-3 cGy. In the chest, the mean dose to the planning target volume varied from 2.5 to 5 cGy. The lung and spinal cord planning organ at risk volume received ≤4 cGy and ≤5 cGy, respectively. In the head and neck, a single CBCT scan delivered a mean dose of 0.3 cGy, with bony structures receiving 0.5-0.8 cGy. The femoral heads received an additional dose of 1.5-2.5 Gy. A reduction of 20-30% in the mean dose to the organs at risk was achieved using bowtie filtration. In the head and neck, the dose to the eyes and brainstem was eliminated by decreasing the craniocaudal field size.
The additional dose from on-line IGRT procedures can be clinically relevant. The organ dose can be significantly reduced with the use of appropriate patient-specific settings. The concomitant dose from CBCT should be accounted for and the acquisition settings optimized for optimal IGRT strategies on a patient basis.
International journal of radiation oncology, biology, physics 10/2011; 83(1):419-26. · 4.59 Impact Factor
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Medical Physics 02/2009; 36(3):1040-1040. · 2.83 Impact Factor
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ABSTRACT: In this work the authors characterized the radiation field produced by a kilovolt cone beam computed tomography (CBCT) unit integrated in the Elekta Synergy linear accelerator. The x-ray volume imaging (XVI) radiation unit was modeled in detail using the BEAMNRC Monte Carlo (MC) code system. The simulations of eight collimator cassettes and the neutral filter F0 were successfully carried out. MC calculations from the EGSNRC code DOSXYZNRC were benchmarked against measurements in water. A large set of depth dose and lateral profiles was acquired with the ionization chamber in water, with the x-ray tube in a stationary position, and with the beam energy set to 120 kV. Measurements for all the available collimator cassettes were compared with calculations, showing very good agreement (< 2% in most cases). Furthermore, half value layer measurements were carried out and used to validate the MC model of the XVI unit. In this case dose calculations were performed with the EGSNRC code cavity and these showed excellent agreement. In this manuscript the authors also report on the optimization work of the relevant parameters that influenced the development of the MC model. The dosimetric part of this work was very useful in characterizing the XVI radiation output for the energy of interest. The detailed simulation part of the work is the first step toward an accurate MC based assessment of the dose delivered to patients during routine CBCT scans for image and dose guided radiotherapy.
Medical Physics 02/2009; 36(1):127-36. · 2.83 Impact Factor
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ABSTRACT: The implementation of Monte Carlo dose calculation algorithms in clinical radiotherapy treatment planning systems has been anticipated for many years. Despite a continuous increase of interest in Monte Carlo Treatment Planning (MCTP), its introduction into clinical practice has been delayed by the extent of calculation time required. The development of newer and faster MC codes is behind the commercialisation of the first MC-based treatment planning systems. The intended scope of this article is to provide the reader with a compact 'primer' on different approaches to MCTP with particular attention to the latest developments in the field.
Radiation Protection Dosimetry 11/2008; 131(1):123-9. · 0.82 Impact Factor
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ABSTRACT: To investigate the impact of a commercial IMRT/IGRT carbon-fibre tabletop in radiotherapy planning optimization and clinical dose distribution.
In this investigation the Siemens IGRT carbon fibre tabletop, routinely used for IMRT treatments in our Centre, has been incorporated into the CT volume of 6 IMRT patients. This was done by CT scanning the tabletop and by adding the obtained volume to the clinical dataset, acquired using the standard couch available in our CT scanner. This procedure was tested and validated for the purpose of this study. The radiotherapy plans have been optimized using both the original CT volume and the modified CT volume.
IMRT optimization with the tabletop included in the clinical volume produced significantly different deliverable plans compared to standard optimized plans which did not include the treatment couch. Differences up to 6%/7% in terms of total number of MU were found in half of the clinical cases. Differences up to 37% in the number of MU per beam were also found. The number of iterations needed to reach an optimal solution also varied between -18% and +25%. Although the DVH analysis produced similar results, due to the fulfilment of the optimization objectives, differences higher than 10% were found in the dose calculated to superficial regions of the body.
The results of this investigation show that the presence of the carbon fibre tabletop significantly affects the outcome of the beam parameters optimization. We suggest including carbon fibre tabletops into patient treatment planning dose calculation and optimization.
Radiotherapy and Oncology 09/2008; 89(1):114-22. · 5.58 Impact Factor
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ABSTRACT: To evaluate the effect of the use of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in radiotherapy target delineation for head-and-neck cancer compared with CT alone.
A total of 38 consecutive patients with head-and-neck cancer were included in this study. The primary tumor sites were as follow: 20 oropharyngeal tumors, 4 laryngeal tumors, 2 hypopharyngeal tumors, 2 paranasal sinuses tumors, 9 nasopharyngeal tumors, and 1 parotid gland tumor. The FDG-PET and CT scans were performed with a dedicated PET/CT scanner in one session and then fused. Subsequently, patients underwent treatment planning CT with intravenous contrast enhancement. The radiation oncologist defined all gross tumor volumes (GTVs) using both the PET/CT and CT scans.
In 35 (92%) of 38 cases, the CT-based GTVs were larger than the PET/CT-based GTVs. The average total GTV from the CT and PET/CT scans was 34.54 cm(3) (range, 3.56-109) and 29.38 cm(3) (range, 2.87-95.02), respectively (p < 0.05). Separate analyses of the difference between the CT- and PET/CT-based GTVs of the primary tumor compared with the GTVs of nodal disease were not statistically significant. The comparison between the PET/CT-based and CT-based boost planning target volumes did not show a statistically significant difference. All patients were alive at the end of the follow-up period (range, 3-38 months).
GTVs, but not planning target volumes, were significantly changed by the implementation of combined PET/CT. Large multicenter studies are needed to ascertain whether combined PET/CT in target delineation can influence the main clinical outcomes.
International journal of radiation oncology, biology, physics 09/2008; 73(3):759-63. · 4.59 Impact Factor
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Barbara Vanderstraeten,
Pik Wai Chin,
Michael Fix,
Antonio Leal,
Grisel Mora,
Nick Reynaert,
Joao Seco,
Martin Soukup, Emiliano Spezi,
Wilfried De Neve,
Hubert Thierens
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ABSTRACT: The conversion of computed tomography (CT) numbers into material composition and mass density data influences the accuracy of patient dose calculations in Monte Carlo treatment planning (MCTP). The aim of our work was to develop a CT conversion scheme by performing a stoichiometric CT calibration. Fourteen dosimetrically equivalent tissue subsets (bins), of which ten bone bins, were created. After validating the proposed CT conversion scheme on phantoms, it was compared to a conventional five bin scheme with only one bone bin. This resulted in dose distributions D(14) and D(5) for nine clinical patient cases in a European multi-centre study. The observed local relative differences in dose to medium were mostly smaller than 5%. The dose-volume histograms of both targets and organs at risk were comparable, although within bony structures D(14) was found to be slightly but systematically higher than D(5). Converting dose to medium to dose to water (D(14) to D(14wat) and D(5) to D(5wat)) resulted in larger local differences as D(5wat) became up to 10% higher than D(14wat). In conclusion, multiple bone bins need to be introduced when Monte Carlo (MC) calculations of patient dose distributions are converted to dose to water.
Physics in Medicine and Biology 03/2007; 52(3):539-62. · 2.83 Impact Factor
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ABSTRACT: In this work, the dosimetric characteristics of a new commercial carbon fiber treatment table are investigated. The photon beam attenuation properties of the Siemens image-guided radiation therapy (IGRT) tabletop were studied in detail. Two sets of dosimetric measurements were performed. In the first experiment a polystyrene slab phantom was used: the central axis attenuation and the skin-sparing detriment were investigated. In the second experiment, the off-axis treatment table transmission was investigated using a polystyrene cylindrical phantom. Measurements were taken at the isocenter for a 360 degrees rotation of the radiation beam. Our results show that the photon beam attenuation of the Siemens IGRT carbon fiber tabletop varies from a minimum of 2.1% (central axis) to a maximum of 4.6% (120 degrees and 240 degrees beam incidence). The beam entrance dose increases from 82% to 97% of the dose at the depth of maximum for a clinical 6-MV radiation field. The depth of maximum also decreases by 0.4 cm. Despite the wedge cross section of the table the beam attenuation properties of the IGRT tabletop remain constant along the longitudinal direction. American Association of Medical Dosimetrists.
Medical Dosimetry 02/2007; 32(4):295-8. · 1.00 Impact Factor
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ABSTRACT: The technique known as the 'gamma evaluation method' incorporates pass-fail criteria for both distance-to-agreement and dose difference analysis of 3D dose distributions and provides a numerical index (gamma) as a measure of the agreement between two datasets. As the gamma evaluation index is being adopted in more centres as part of treatment plan verification procedures for 2D and 3D dose maps, the development of methods capable of encapsulating the information provided by this technique is recommended.
In this work the concept of gamma index was extended to create gamma histograms (GH) in order to provide a measure of the agreement between two datasets in two or three dimensions. Gamma area histogram (GAH) and gamma volume histogram (GVH) graphs were produced using one or more 2D gamma maps generated for each slice of the irradiated volume. GHs were calculated for IMRT plans, evaluating the 3D dose distribution from a commercial treatment planning system (TPS) compared to a Monte Carlo (MC) calculation used as reference dataset.
The extent of local anatomical inhomogenities in the plans under consideration was strongly correlated with the level of difference between reference and evaluated calculations. GHs provided an immediate visual representation of the proportion of the treated volume that fulfilled the gamma criterion and offered a concise method for comparative numerical evaluation of dose distributions.
We have introduced the concept of GHs and investigated its applications to the evaluation and verification of IMRT plans. The gamma histogram concept set out in this paper can provide a valuable technique for quantitative comparison of dose distributions and could be applied as a tool for the quality assurance of treatment planning systems.
Radiotherapy and Oncology 06/2006; 79(2):224-30. · 5.58 Impact Factor
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ABSTRACT: This investigation deals with the implementation of a multiple acquisition (MA) sequence for radiotherapy beam verification with a 2-dimensional (2D) ion chamber array. The acquisition is carried out through multiple beam deliveries with the 2D detector array in different positions. The MA sequence is performed through remote-controlled movements of the treatment couch. In this work, the MA dose map of an intensity-modulated radiotherapy (IMRT) modulated beam is presented and compared to standard acquisition mode data and ion chamber measurements. The implementation of MA sequence increases the number of measurement points and therefore the efficiency of the detection system and the final imaging resolution. Results from this investigation show that the imaging resolution of the system used in standard acquisition mode can be increased up to 4 times. The procedure described in this work can be automated, including couch movements in the radiotherapy plan sent to the treatment workstation. Furthermore, this specific solution could be successfully applied to matrices of detector with a different construction design.
Medical Dosimetry 02/2006; 31(4):269-72. · 1.00 Impact Factor
