R Mini

Inselspital, Universitätsspital Bern, Bern, BE, Switzerland

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Publications (27)50.4 Total impact

  • Radiotherapy and Oncology - RADIOTHER ONCOL. 01/2011; 99.
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    ABSTRACT: to report acute and late toxicity in prostate cancer patients treated by high-dose intensity-modulated radiation therapy (IMRT) with daily image-guidance. from 06/2004-03/2008, 102 men were treated with 80 Gy IMRT with daily image-guidance. The risk groups were as follows: low, intermediate, and high risk in 21%, 27%, and 52% of patients, respectively. Hormone therapy was given to 65% of patients. Toxicity was scored according to the CTC scale version 3.0. median age was 69 years and median follow-up was 39 months (range, 16-61 months). Acute and late grade 2 gastrointestinal (GI) toxicity occurred in 2% and 5% of patients, respectively, while acute and late grade 3 GI toxicity was absent. Grade 2 and 3 pretreatment genitourinary (GU) morbidity (PGUM) were 15% and 2%, respectively. Acute grade 2 and 3 GU toxicity were 43% and 5% and late grade 2 and 3 GU toxicity were 21% and 1%, respectively. After multiple Cox regression analysis, PGUM was an independent predictor of decreased late ≥ grade 2 GU toxicity-free survival (hazard ratio = 9.4 (95% confidence interval: 4.1, 22.0), p < 0.001). At the end of follow-up, the incidence of late grade 2 and 3 GU toxicity decreased to 7% and 1%, respectively. GI toxicity rates after IMRT with daily image-guidance were excellent. GU toxicity rates were acceptable and strongly related to PGUM.
    Strahlentherapie und Onkologie 12/2010; 186(12):687-92. · 4.16 Impact Factor
  • Barbara Ott, Anja Stüssi, Roberto Mini
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    ABSTRACT: Protective patient equipment for CT examinations is not routinely provided. The aim of this study was to determine whether, and if so what, specific protective equipment is beneficial during CT scans. The absorbed organ doses and the effective doses for thorax, abdomen/pelvis and brain CT investigation with and without the use of protective patient equipment have been determined and compared. All measurements were carried out on modern multislice CT scanner using an anthropomorphic phantom and thermoluminescence dosemeters. The measurements show that protective equipment reduces the dose within the scattered beam area. The highest organ dose reduction was found in organs that protrude from the trunk like the testes or the female breasts that can largely be covered by the protective equipment. The most reduction of the effective dose was found in the male abdomen/pelvis examination (0.32 mSv), followed by the brain (0.11 mSv) and the thorax (0.06 mSv). It is concluded that the use of protective equipment can reduce the applied dose to the patient.
    Radiation Protection Dosimetry 12/2010; 142(2-4):213-21. · 0.91 Impact Factor
  • Medical Physics 01/2010; 37(6). · 2.91 Impact Factor
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    ABSTRACT: In order to use a single implant with one treatment plan in fractionated high-dose-rate brachytherapy (HDR-B), applicator position shifts must be corrected prior to each fraction. The authors investigated the use of gold markers for X-ray-based setup and position control between the single fractions. Caudad-cephalad movement of the applicators prior to each HDR-B fraction was determined on radiographs using two to three gold markers, which had been inserted into the prostate as intraprostatic reference, and one to two radiopaque-labeled reference applicators. 35 prostate cancer patients, treated by HDR-B as a monotherapy between 10/2003 and 06/2006 with four fractions of 9.5 Gy each, were analyzed. Toxicity was scored according to the CTCAE Score, version 3.0. Median follow-up was 3 years. The mean change of applicators positions compared to baseline varied substantially between HDR-B fractions, being 1.4 mm before fraction 1 (range, -4 to 2 mm), -13.1 mm before fraction 2 (range, -36 to 0 mm), -4.1 mm before fraction 3 (range, -21 to 9 mm), and -2.6 mm at fraction 4 (range, -16 to 9 mm). The original position of the applicators could be readjusted easily prior to each fraction in every patient. In 18 patients (51%), the applicators were at least once readjusted > 10 mm, however, acute or late grade > or = 2 genitourinary toxicity was not increased (p = 1.0) in these patients. Caudad position shifts up to 36 mm were observed. Gold markers represent a valuable tool to ensure setup accuracy and precise dose delivery in fractionated HDR-B monotherapy of prostate cancer.
    Strahlentherapie und Onkologie 11/2009; 185(11):731-5. · 4.16 Impact Factor
  • Strahlentherapie Und Onkologie - STRAHLENTHER ONKOL. 01/2009; 185(11):731-735.
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    ABSTRACT: The problem of re-sampling spatially distributed data organized into regular or irregular grids to finer or coarser resolution is a common task in data processing. This procedure is known as 'gridding' or 're-binning'. Depending on the quantity the data represents, the gridding-algorithm has to meet different requirements. For example, histogrammed physical quantities such as mass or energy have to be re-binned in order to conserve the overall integral. Moreover, if the quantity is positive definite, negative sampling values should be avoided. The gridding process requires a re-distribution of the original data set to a user-requested grid according to a distribution function. The distribution function can be determined on the basis of the given data by interpolation methods. In general, accurate interpolation with respect to multiple boundary conditions of heavily fluctuating data requires polynomial interpolation functions of second or even higher order. However, this may result in unrealistic deviations (overshoots or undershoots) of the interpolation function from the data. Accordingly, the re-sampled data may overestimate or underestimate the given data by a significant amount. The gridding-algorithm presented in this work was developed in order to overcome these problems. Instead of a straightforward interpolation of the given data using high-order polynomials, a parametrized Hermitian interpolation curve was used to approximate the integrated data set. A single parameter is determined by which the user can control the behavior of the interpolation function, i.e. the amount of overshoot and undershoot. Furthermore, it is shown how the algorithm can be extended to multidimensional grids. The algorithm was compared to commonly used gridding-algorithms using linear and cubic interpolation functions. It is shown that such interpolation functions may overestimate or underestimate the source data by about 10-20%, while the new algorithm can be tuned to significantly reduce these interpolation errors. The accuracy of the new algorithm was tested on a series of x-ray CT-images (head and neck, lung, pelvis). The new algorithm significantly improves the accuracy of the sampled images in terms of the mean square error and a quality index introduced by Wang and Bovik (2002 IEEE Signal Process. Lett. 9 81-4).
    Physics in Medicine and Biology 12/2008; 53(21):6245-63. · 2.70 Impact Factor
  • Source
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    ABSTRACT: To report acute and late toxicity in prostate cancer patients treated by dose escalated intensity-modulated radiation therapy (IMRT) and organ tracking. From 06/2004 to 12/2005 39 men were treated by 80 Gy IMRT along with organ tracking. Median age was 69 years, risk of recurrence was low 18%, intermediate 21% and high in 61% patients. Hormone therapy (HT) was received by 74% of patients. Toxicity was scored according to the CTC scale version 3.0. Median follow-up (FU) was 29 months. Acute and maximal late grade 2 gastrointestinal (GI) toxicity was 3% and 8%, late grade 2 GI toxicity dropped to 0% at the end of FU. No acute or late grade 3 GI toxicity was observed. Grade 2 and 3 pre-treatment genitourinary (GU) morbidity (PGUM) was 20% and 5%. Acute and maximal late grade 2 GU toxicity was 56% and 28% and late grade 2 GU toxicity decreased to 15% of patients at the end of FU. Acute and maximal late grade 3 GU toxicity was 8% and 3%, respectively. Decreased late > or = grade 2 GU toxicity free survival was associated with higher age (P = .025), absence of HT (P = .016) and higher PGUM (P < .001). GI toxicity rates after IMRT and organ tracking are excellent, GU toxicity rates are strongly related to PGUM.
    Radiation Oncology 10/2008; 3:35. · 2.11 Impact Factor
  • Source
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    ABSTRACT: BEAMnrc, a code for simulating medical linear accelerators based on EGSnrc, has been bench-marked and used extensively in the scientific literature and is therefore often considered to be the gold standard for Monte Carlo simulations for radiotherapy applications. However, its long computation times make it too slow for the clinical routine and often even for research purposes without a large investment in computing resources. VMC++ is a much faster code thanks to the intensive use of variance reduction techniques and a much faster implementation of the condensed history technique for charged particle transport. A research version of this code is also capable of simulating the full head of linear accelerators operated in photon mode (excluding multileaf collimators, hard and dynamic wedges). In this work, a validation of the full head simulation at 6 and 18 MV is performed, simulating with VMC++ and BEAMnrc the addition of one head component at a time and comparing the resulting phase space files. For the comparison, photon and electron fluence, photon energy fluence, mean energy, and photon spectra are considered. The largest absolute differences are found in the energy fluences. For all the simulations of the different head components, a very good agreement (differences in energy fluences between VMC++ and BEAMnrc <1%) is obtained. Only a particular case at 6 MV shows a somewhat larger energy fluence difference of 1.4%. Dosimetrically, these phase space differences imply an agreement between both codes at the <1% level, making VMC++ head module suitable for full head simulations with considerable gain in efficiency and without loss of accuracy.
    Medical Physics 04/2008; 35(4):1521-31. · 2.91 Impact Factor
  • Medical Physics 01/2008; 35(6). · 2.91 Impact Factor
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    ABSTRACT: Currently photon Monte Carlo treatment planning (MCTP) for a patient stored in the patient database of a treatment planning system (TPS) can usually only be performed using a cumbersome multi-step procedure where many user interactions are needed. This means automation is needed for usage in clinical routine. In addition, because of the long computing time in MCTP, optimization of the MC calculations is essential. For these purposes a new graphical user interface (GUI)-based photon MC environment has been developed resulting in a very flexible framework. By this means appropriate MC transport methods are assigned to different geometric regions by still benefiting from the features included in the TPS. In order to provide a flexible MC environment, the MC particle transport has been divided into different parts: the source, beam modifiers and the patient. The source part includes the phase-space source, source models and full MC transport through the treatment head. The beam modifier part consists of one module for each beam modifier. To simulate the radiation transport through each individual beam modifier, one out of three full MC transport codes can be selected independently. Additionally, for each beam modifier a simple or an exact geometry can be chosen. Thereby, different complexity levels of radiation transport are applied during the simulation. For the patient dose calculation, two different MC codes are available. A special plug-in in Eclipse providing all necessary information by means of Dicom streams was used to start the developed MC GUI. The implementation of this framework separates the MC transport from the geometry and the modules pass the particles in memory; hence, no files are used as the interface. The implementation is realized for 6 and 15 MV beams of a Varian Clinac 2300 C/D. Several applications demonstrate the usefulness of the framework. Apart from applications dealing with the beam modifiers, two patient cases are shown. Thereby, comparisons are performed between MC calculated dose distributions and those calculated by a pencil beam or the AAA algorithm. Interfacing this flexible and efficient MC environment with Eclipse allows a widespread use for all kinds of investigations from timing and benchmarking studies to clinical patient studies. Additionally, it is possible to add modules keeping the system highly flexible and efficient.
    Physics in Medicine and Biology 11/2007; 52(19):N425-37. · 2.70 Impact Factor
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    ABSTRACT: The aim of this work is to investigate to what extent it is possible to use the secondary collimator jaws to reduce the transmitted radiation through the multileaf collimator (MLC) during an intensity modulated radiation therapy (IMRT). A method is developed and introduced where the jaws follow the open window of the MLC dynamically (dJAW method). With the aid of three academic cases (Closed MLC, Sliding-gap, and Chair) and two clinical cases (prostate and head and neck) the feasibility of the dJAW method and the influence of this method on the applied dose distributions are investigated. For this purpose the treatment planning system Eclipse and the Research-Toolbox were used as well as measurements within a solid water phantom were performed. The transmitted radiation through the closed MLC leads to an inhomogeneous dose distribution. In this case, the measured dose within a plane perpendicular to the central axis differs up to 40% (referring to the maximum dose within this plane) for 6 and 15 MV. The calculated dose with Eclipse is clearly more homogeneous. For the Sliding-gap case this difference is still up to 9%. Among other things, these differences depend on the depth of the measurement within the solid water phantom and on the application method. In the Chair case, the dose in regions where no dose is desired is locally reduced by up to 50% using the dJAW method instead of the conventional method. The dose inside the chair-shaped region decreased up to 4% if the same number of monitor units (MU) as for the conventional method was applied. The undesired dose in the volume body minus the planning target volume in the clinical cases prostate and head and neck decreased up to 1.8% and 1.5%, while the number of the applied MU increased up to 3.1% and 2.8%, respectively. The new dJAW method has the potential to enhance the optimization of the conventional IMRT to a further step.
    Medical Physics 10/2007; 34(9):3674-87. · 2.91 Impact Factor
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    ABSTRACT: The purpose of this work was to study and quantify the differences in dose distributions computed with some of the newest dose calculation algorithms available in commercial planning systems. The study was done for clinical cases originally calculated with pencil beam convolution (PBC) where large density inhomogeneities were present. Three other dose algorithms were used: a pencil beam like algorithm, the anisotropic analytic algorithm (AAA), a convolution superposition algorithm, collapsed cone convolution (CCC), and a Monte Carlo program, voxel Monte Carlo (VMC++). The dose calculation algorithms were compared under static field irradiations at 6 MV and 15 MV using multileaf collimators and hard wedges where necessary. Five clinical cases were studied: three lung and two breast cases. We found that, in terms of accuracy, the CCC algorithm performed better overall than AAA compared to VMC++, but AAA remains an attractive option for routine use in the clinic due to its short computation times. Dose differences between the different algorithms and VMC++ for the median value of the planning target volume (PTV) were typically 0.4% (range: 0.0 to 1.4%) in the lung and -1.3% (range: -2.1 to -0.6%) in the breast for the few cases we analysed. As expected, PTV coverage and dose homogeneity turned out to be more critical in the lung than in the breast cases with respect to the accuracy of the dose calculation. This was observed in the dose volume histograms obtained from the Monte Carlo simulations.
    Physics in Medicine and Biology 08/2007; 52(13):3679-91. · 2.70 Impact Factor
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    ABSTRACT: Purpose: Modern treatment planning systems (TPS) are able to calculate doses within the patient for numerous delivery techniques as e. g. intensity modulated radiation therapy (IMRT). Even dose predictions to an electronic portal image device (EPID) are available in some TPS, but with limitations in accuracy. With the steadily increasing number of facilities using EPIDs for pre-treatment and treatment verification, the desire of calculating accurate EPID dose distributions is growing. A solution for this problem is the use of Monte Carlo (MC) methods. Aims of this study were firstly to implement geometries of an amorphous silicon based EPID with varying levels of geometry complexity. Secondly to analyze the differences between simulation results and measurements for each geometry. Thirdly, to compare different transport algorithms within all EPID geometries in a flexible C++ MC environment. Materials and Methods: In this work three geometry sets, representing the EPID, are implemented and investigated. To gain flexibility in the MC environment geometry and particle transport code are independent. That allows the user to select between the transport algorithms EGSnrc, VMC++ and PIN (an in-house developed transport code) while using one of the implemented geometries of the EPID. For all implemented EPID geometries dose distributions were calculated for 6 MV and 15 MV beams using different transport algorithms and are then compared with measurements. Results: A very simple geometry, consisting of a water slab, is not capable to reproduce measurements, whereas 8 material layers perform well. The more layers with different materials are used, the longer last the calculations. EGSnrc and VMC++ lead to dosimetrically equal results. Gamma analysis between calculated and measured EPID dose distributions, using a dose difference criterion of ± 3% and a distance to agreement criterion of ± 3 mm, revealed a gamma value < 1 within more than 95% of all pixels, that have a higher dose than 3% of the measured maximum dose. Conclusions: The same geometry can be used to compare transport codes within the flexible C++ MC environment. A simplified 8 layer geometry results in similar EPID dose distributions compared with the accurate 24 layer geometry by gaining about a factor of 6 in CPU-time. The implementation of the amorphous silicon detector in our MC system has the potential to perform independent pre-treatment as well as treatment verification.
    Journal of Physics Conference Series 07/2007; 74(1):021005.
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    ABSTRACT: Today's brachytherapy planning systems perform computation of energy deposition in patients by assuming homogeneous water medium and multiplicative transmission factors for shielding. Patient heterogeneities, shape and size are not fully taken into account. Aim of this study is the implementation of the microSelectron 192Ir high dose rate brachytherapy source in the Swiss Monte Carlo Plan, an in-house developed MC environment, where a defined geometry can be simulated by using one out of three different transport algorithms: EGSnrc, VMC++ or PIN. Additionally, the impact of different phantom shapes and clinical relevant inhomogeneities on dose distributions are studied. Radial dose functions, dose rate constants and anisotropy functions according to the AAPM TG-43 formalism have been determined. The implemented source has been validated by comparing dose distributions in a 30 × 30 × 30 cm3water phantom derived from MC simulations using the three transport algorithms with literature data. Dose rate constants, radial dose functions and anisotropy functions agree within 3% with literature data. Placing the source toward the surface of a water phantom can result in local underdosage of up to 17% when compared with the dose distribution around the source at the centre of a 30 × 30 × 30 cm3water phantom. Taking into account the presence of an air and cortical bone inclusion positioned at 1 cm from the source can lead to dose deviations in the region behind these inhomogeneities of up to +7% and -4%, respectively, if compared with the dose in a 30 × 30 × 30 cm3water phantom. The same geometry can be used to compare different transport codes within one Monte Carlo system. Apart from the inverse square law, the impact of the size and the geometry of the phantom as well as heterogeneities on dose distributions have to be considered.
    Journal of Physics Conference Series 07/2007; 74(1):021022.
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    ABSTRACT: Currently photon Monte Carlo treatment planning (MCTP) for a patient stored in the patient database of a treatment planning system (TPS) usually can only be performed using a cumbersome multi-step procedure where many user interactions are needed. Automation is needed for usage in clinical routine. In addition, because of the long computing time in MCTP, optimization of the MC calculations is essential. For these purposes a new GUI-based photon MC environment has been developed resulting in a very flexible framework, namely the Swiss Monte Carlo Plan (SMCP). Appropriate MC transport methods are assigned to different geometric regions by still benefiting from the features included in the TPS. In order to provide a flexible MC environment the MC particle transport has been divided into different parts: source, beam modifiers, and patient. The source part includes: Phase space-source, source models, and full MC transport through the treatment head. The beam modifier part consists of one module for each beam modifier. To simulate the radiation transport through each individual beam modifier, one out of three full MC transport codes can be selected independently. Additionally, for each beam modifier a simple or an exact geometry can be chosen. Thereby, different complexity levels of radiation transport are applied during the simulation. For the patient dose calculation two different MC codes are available. A special plug-in in Eclipse providing all necessary information by means of Dicom streams was used to start the developed MC GUI. The implementation of this framework separates the MC transport from the geometry and the modules pass the particles in memory, hence no files are used as interface. The implementation is realized for 6 and 15 MV beams of a Varian Clinac 2300 C/D. Several applications demonstrate the usefulness of the framework. Apart from applications dealing with the beam modifiers, three patient cases are shown. Thereby, comparisons between MC calculated dose distributions and those calculated by a pencil beam or the AAA algorithm. Interfacing this flexible and efficient MC environment with Eclipse allows a widespread use for all kinds of investigations from timing and benchmarking studies to clinical patient studies. Additionally, it is possible to add modules keeping the system highly flexible and efficient.
    Journal of Physics Conference Series 07/2007; 74(1):021004.
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    ABSTRACT: Individual monitoring regulations in Switzerland are based on the ICRP60 recommendations. The annual limit of 20 mSv for the effective dose applies to the sum of external and internal radiation. External radiation is monitored monthly or quarterly with TLD, DIS or CR-39 dosemeters by 10 approved external dosimetry services and reported as Hp(10) and Hp(0.07). Internal monitoring is done in two steps. At the workplace, simple screening measurements are done frequently in order to recognise a possible incorporation. If a nuclide dependent activity threshold is exceeded then one of the seven approved dosimetry services for internal radiation does an incorporation measurement to assess the committed effective dose E50. The dosimetry services report all the measured or assessed dose values to the employer and to the National Dose Registry. The employer records the annually accumulated dose values into the individual dose certificate of the occupationally exposed person, both the external dose Hp(10) and the internal dose E50 as well as the total effective dose E=Hp(10)+E50. Based on the national dose registry an annual report on the dosimetry in Switzerland is published which contains the statistics for the total effective dose, as well as separate statistics for external and internal exposure.
    Radiation Protection Dosimetry 02/2007; 125(1-4):47-51. · 0.91 Impact Factor
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    ABSTRACT: Daily use of conventional electronic portal imaging devices (EPID) for organ tracking is limited due to the relatively high dose required for high quality image acquisition. We studied the use of a novel dose saving acquisition mode (RadMode) allowing to take images with one monitor unit per image in prostate cancer patients undergoing intensity-modulated radiotherapy (IMRT) and tracking of implanted fiducial gold markers. Twenty five patients underwent implantation of three fiducial gold markers prior to the planning CT. Before each treatment of a course of 37 fractions, orthogonal localization images from the antero-posterior and from the lateral direction were acquired. Portal images of both the setup procedure and the five IMRT treatment beams were analyzed. On average, four localization images were needed for a correct patient setup, resulting in four monitor units extra dose per fraction. The mean extra dose delivered to the patient was thereby increased by 1.2%. The procedure was precise enough to reduce the mean displacements prior to treatment to < o =0.3 mm. The use of a new dose saving acquisition mode enables to perform daily EPID-based prostate tracking with a cumulative extra dose of below 1 Gy. This concept is efficiently used in IMRT-treated patients, where separation of setup beams from treatment beams is mandatory.
    Radiotherapy and Oncology 05/2006; 79(1):101-8. · 4.52 Impact Factor
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    ABSTRACT: Analyses of permanent brachytherapy seed implants of the prostate have demonstrated that the use of a preplan may lead to a considerable decrease of dosimetric implant quality. The authors aimed to determine whether the same drawbacks of preplanning also apply to high-dose-rate (HDR) brachytherapy. 15 patients who underwent two separate HDR brachytherapy implants in addition to external-beam radiation therapy for advanced prostate cancer were analyzed. A pretherapeutic transrectal ultrasound was performed in all patients to generate a preplan for the first brachytherapy implant. For the second brachytherapy, a subset of patients were treated by preplans based on the ultrasound from the first brachytherapy implant. Preplans were compared with the respective postplans assessing the following parameters: coverage index, minimum target dose, homogeneity index, and dose exposure of organs at risk. The prostate geometries (volume, width, height, length) were compared as well. At the first brachytherapy, the matching between the preplan and actual implant geometry was sufficient in 47% of the patients, and the preplan could be applied. The dosimetric implant quality decreased considerably: the mean coverage differed by -0.11, the mean minimum target dose by -0.15, the mean homogeneity index by -0.09. The exposure of organs at risk was not substantially altered. At the second brachytherapy, all patients could be treated by the preplan; the differences between the implant quality parameters were less pronounced. The changes of prostate geometry between preplans and postplans were considerable, the differences in volume ranging from -8.0 to 13.8 cm(3) and in dimensions (width, height, length) from -1.1 to 1.0 cm. Preplanning in HDR brachytherapy of the prostate is associated with a substantial decrease of dosimetric implant quality, when the preplan is based on a pretherapeutic ultrasound. The implant quality is less impaired in subsequent implants of fractionated brachytherapy.
    Strahlentherapie und Onkologie 07/2004; 180(6):351-7. · 4.16 Impact Factor
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    ABSTRACT: In external beam radiotherapy, electronic portal imaging becomes more and more an indispensable tool for the verification of the patient setup. For the safe clinical introduction of high dose conformal radiotherapy like intensity modulated radiation therapy, on-line patient setup verification is a prerequisite to ensure that the planned dosimetric coverage of the tumor volume is actually realized in the patient. Since the direction of setup fields often deviates from the direction of the treatment beams, extra dose is delivered to the patient during the acquisition of these portal images which may reach clinical relevance. The aim of this work was to develop a new acquisition mode for the PortalVision aS500 electronic portal imaging device from Varian Medical Systems that allows one to take portal images with reduced dose while keeping good image quality. The new acquisition mode, called RadMode, selectively enables and disables beam pulses during image acquisition allowing one to stop wasting valuable dose during the initial acquisition of "reset frames." Images of excellent quality can be taken with 1 MU only. This low dose per image facilitates daily setup verification with considerably reduced extra dose.
    Medical Physics 05/2004; 31(4):828-31. · 2.91 Impact Factor