Characterization of the onboard imaging unit for the first clinical magnetic resonance image guided radiation therapy system.

Purpose: To characterize the performance of the onboard imaging unit for the first clinical magnetic resonance image guided radiation therapy (MR-IGRT) system.

Methods: The imaging performance characterization included four components: ACR (the American College of Radiology) phantom test, spatial integrity, coil signal to noise ratio (SNR) and uniformity, and magnetic field homogeneity. The ACR phantom test was performed in accordance with the ACR phantom test guidance.

The ViewRay system: magnetic resonance-guided and controlled radiotherapy.

A description of the first commercially available magnetic resonance imaging (MRI)-guided radiation therapy (RT) system is provided. The system consists of a split 0.35-T MR scanner straddling 3 (60)Co heads mounted on a ring gantry, each head equipped with independent doubly focused multileaf collimators.

Lung tumor motion change during stereotactic body radiotherapy (SBRT): an evaluation using MRI.

The purpose of this study is to investigate changes in lung tumor internal target volume during stereotactic body radiotherapy treatment (SBRT) using magnetic resonance imaging (MRI). Ten lung cancer patients (13 tumors) undergoing SBRT (48 Gy over four consecutive days) were evaluated. Each patient underwent three lung MRI evaluations: before SBRT (MRI-1), after fraction 3 of SBRT (MRI-3), and three months after completion of SBRT (MRI-3m).

Dosimetry tools and techniques for IMRT.

Intensity modulated radiation therapy (IMRT) poses a number of challenges for properly measuring commissioning data and quality assurance (QA) radiation dose distributions. This report provides a comprehensive overview of how dosimeters, phantoms, and dose distribution analysis techniques should be used to support the commissioning and quality assurance requirements of an IMRT program. The proper applications of each dosimeter are described along with the limitations of each system.

Intravenous contrast agent influence on thoracic computed tomography simulation investigated through a heterogeneous dose calculation method using 5-bulk densities.

Objective: Using 5-bulk-density heterogeneous dose calculation, we investigated whether contrast-enhanced (CE+) computed tomography (CT) will affect dose-calculation accuracy in the thoracic area.

Methods: We analyzed 17 radiation-oncology patients who underwent thoracic CE+ CTs. Full-resolution CT and 5-bulk-density plans were generated using an adaptive convolution algorithm.

Interior point algorithms: guaranteed optimality for fluence map optimization in IMRT.

One of the most widely studied problems of the intensity-modulated radiation therapy (IMRT) treatment planning problem is the fluence map optimization (FMO) problem, the problem of determining the amount of radiation intensity, or fluence, of each beamlet in each beam. For a given set of beams, the fluences of the beamlets can drastically affect the quality of the treatment plan, and thus it is critical to obtain good fluence maps for radiation delivery. Although several approaches have been shown to yield good solutions to the FMO problem, these solutions are not guaranteed to be optimal.

Assessment of the setup dependence of detector response functions for mega-voltage linear accelerators.

Purpose: Accurate modeling of beam profiles is important for precise treatment planning dosimetry. Calculated beam profiles need to precisely replicate profiles measured during machine commissioning. Finite detector size introduces perturbations into the measured profiles, which, in turn, impact the resulting modeled profiles.

Accurate heterogeneous dose calculation for lung cancer patients without high-resolution CT densities.

The aim of this study was to investigate the relative accuracy of megavoltage photon-beam dose calculations employing either 5 bulk densities or independent voxel densities determined by calibration of the CT Houndsfield number. Full-resolution CT and bulk density treatment plans were generated for 70 lung or esophageal cancer tumors (66 cases) using a commercial treatment planning system with an adaptive convolution dose calculation algorithm (Pinnacle3, Philips Medicals Systems). Bulk densities were applied to segmented regions.

Comparative analysis of 60Co intensity-modulated radiation therapy.

In this study, we perform a scientific comparative analysis of using (60)Co beams in intensity-modulated radiation therapy (IMRT). In particular, we evaluate the treatment plan quality obtained with (i) 6 MV, 18 MV and (60)Co IMRT; (ii) different numbers of static multileaf collimator (MLC) delivered (60)Co beams and (iii) a helical tomotherapy (60)Co beam geometry. We employ a convex fluence map optimization (FMO) model, which allows for the comparison of plan quality between different beam energies and configurations for a given case.

Evaluating target cold spots by the use of tail EUDs.

Purpose: To propose a new measure of target underdose that can be used in the evaluation and optimization of radiotherapy dose distributions.

Methods And Materials: We compare various formulations of the equivalent uniform dose (EUD) and introduce a modification of existing EUD definitions, which we call tail EUD. Tail EUD is a measure of "cold spots" below the prescription dose in the target dose distribution, using units of gray (Gy).

A computational implementation and comparison of several intensity modulated proton therapy treatment planning algorithms.

The authors present a comparative study of intensity modulated proton therapy (IMPT) treatment planning employing algorithms of three-dimensional (3D) modulation, and 2.5-dimensional (2.5D) modulation, and intensity modulated distal edge tracking (DET) [A.

A prototype quantitative film scanner for radiochromic film dosimetry.

We have developed a high resolution, quantitative, two-dimensional optical film scanner for use with a commercial high sensitivity radiochromic film (RCF) for measuring single fraction external-beam radiotherapy dose distributions. The film scanner was designed to eliminate artifacts commonly observed in RCF dosimetry. The scanner employed a stationary light source and detector with a moving antireflective glass film platen attached to a high precision computerized X-Y translation stage.

An exact approach to direct aperture optimization in IMRT treatment planning.

We consider the problem of intensity-modulated radiation therapy (IMRT) treatment planning using direct aperture optimization. While this problem has been relatively well studied in recent years, most approaches employ a heuristic approach to the generation of apertures. In contrast, we use an exact approach that explicitly formulates the fluence map optimization (FMO) problem as a convex optimization problem in terms of all multileaf collimator (MLC) deliverable apertures and their associated intensities.

Optimization of equivalent uniform dose using the L-curve criterion.

Optimization of equivalent uniform dose (EUD) in inverse planning for intensity-modulated radiation therapy (IMRT) prevents variation in radiobiological effect between different radiotherapy treatment plans, which is due to variation in the pattern of dose nonuniformity. For instance, the survival fraction of clonogens would be consistent with the prescription when the optimized EUD is equal to the prescribed EUD. One of the problems in the practical implementation of this approach is that the spatial dose distribution in EUD-based inverse planning would be underdetermined because an unlimited number of nonuniform dose distributions can be computed for a prescribed value of EUD.

TG-69: radiographic film for megavoltage beam dosimetry.

TG-69 is a task group report of the AAPM on the use of radiographic film for dosimetry. Radiographic films have been used for radiation dosimetry since the discovery of x-rays and have become an integral part of dose verification for both routine quality assurance and for complex treatments such as soft wedges (dynamic and virtual), intensity modulated radiation therapy (IMRT), image guided radiation therapy (IGRT), and small field dosimetry like stereotactic radiosurgery. Film is convenient to use, spatially accurate, and provides a permanent record of the integrated two dimensional dose distributions.

Predicting changes in dose distribution to tumor and normal tissue when correcting for heterogeneity in radiotherapy for lung cancer.

Purposes: The purposes of this study were to examine dose alterations to gross tumor volume (GTV) and lung using heterogeneity corrections and to predict the magnitude of these changes.

Methods: Three separate conformal plans were generated for 37 patients with lung cancer: plan 1 corrected for heterogeneity, plan 2 did not correct for heterogeneity, and plan 3 used identical beams and monitor units from plan 2 but with heterogeneous calculations. Plans 1 and 2 were normalized to the 95% isodose line.

Prospects for quantitative two-dimensional radiochromic film dosimetry for low dose-rate brachytherapy sources.

Radiochromic film (RCF) has been shown to be a precise and accurate two-dimensional dosimeter for acute exposure radiation fields. However, "temporal history" mismatch between calibration and brachytherapy films due to RCF dose-rate effects could introduce potentially large uncertainties in low dose-rate (LDR) brachytherapy absolute dose measurement. This article presents a quantitative evaluation of the precision and accuracy of a laser scanner-based RCF-dosimetry system and the effect of the temporal history mismatch in LDR absolute dose measurement.

Important considerations for radiochromic film dosimetry with flatbed CCD scanners and EBT GAFCHROMIC film.

In this study, we present three significant artifacts that have the potential to negatively impact the accuracy and precision of film dosimetry measurements made using GAFCHROMIC EBT radiochromic film when read out with CCD flatbed scanners. Films were scanned using three commonly employed instruments: a Macbeth TD932 spot densitometer, an Epson Expression 1680 CCD array scanner, and a Microtek ScanMaker i900 CCD array scanner. For the two scanners we assessed the variation in optical density (OD) of GAFCHROMIC EBT film with scanning bed position, angular rotation of the film with respect to the scan line direction, and temperature inside the scanner due to repeated scanning.

A fourier analysis on the maximum acceptable grid size for discrete proton beam dose calculation.

We developed an analytical method for determining the maximum acceptable grid size for discrete dose calculation in proton therapy treatment plan optimization, so that the accuracy of the optimized dose distribution is guaranteed in the phase of dose sampling and the superfluous computational work is avoided. The accuracy of dose sampling was judged by the criterion that the continuous dose distribution could be reconstructed from the discrete dose within a 2% error limit. To keep the error caused by the discrete dose sampling under a 2% limit, the dose grid size cannot exceed a maximum acceptable value.

Fast voxel and polygon ray-tracing algorithms in intensity modulated radiation therapy treatment planning.

We present work on combining three algorithms to improve ray-tracing efficiency in radiation therapy dose computation. The three algorithms include: An improved point-in-polygon algorithm, incremental voxel ray tracing algorithm, and stereographic projection of beamlets for voxel truncation. The point-in-polygon and incremental voxel ray-tracing algorithms have been used in computer graphics and nuclear medicine applications while the stereographic projection algorithm was developed by our group.

A high-speed scintillation-based electronic portal imaging device to quantitatively characterize IMRT delivery.

We have developed an electronic portal imaging device (EPID) employing a fast scintillator and a high-speed camera. The device is designed to accurately and independently characterize the fluence delivered by a linear accelerator during intensity modulated radiation therapy (IMRT) with either step-and-shoot or dynamic multileaf collimator (MLC) delivery. Our aim is to accurately obtain the beam shape and fluence of all segments delivered during IMRT, in order to study the nature of discrepancies between the plan and the delivered doses.

The impact of heterogeneity correction on dosimetric parameters that predict for radiation pneumonitis.

Purpose: To determine if heterogeneity correction significantly affects commonly measured dosimetric parameters predicting pulmonary toxicity in patients receiving radiation for lung cancer.

Methods And Materials: Sixty-eight patients treated for lung cancer were evaluated. The conformal treatment technique mostly employed anteroposterior/posterior-anterior fields and off-cord obliques.

Evaluation of surface and build-up region dose for intensity-modulated radiation therapy in head and neck cancer.

Despite much development, there remains dosimetric uncertainty in the surface and build-up regions in intensity-modulated radiation therapy treatment plans for head and neck cancers. Experiments were performed to determine the dosimetric discrepancies in the surface and build-up region between the treatment planning system (TPS) prediction and experimental measurement using radiochromic film. A head and neck compression film phantom was constructed from two semicylindrical solid water slabs.

Novel breathing motion model for radiotherapy.

Purpose: An accurate model of breathing motion under quiet respiration is desirable to obtain the most accurate and conformal dose distributions for mobile lung cancer lesions. On the basis of recent lung motion measurements and the physiologic functioning of the lungs, we have determined that the motion of lung and lung tumor tissues can be modeled as a function of five degrees of freedom, the position of the tissues at a user-specified reference breathing phase, tidal volume and its temporal derivative airflow (tidal volume phase space). Time is an implicit variable in this model.

Late xerostomia after intensity-modulated radiation therapy versus conventional radiotherapy.

Purpose: To evaluate xerostomia following intensity-modulated radiation therapy (IMRT).

Materials And Methods: An institutional review board-approved study of xerostomia was conducted in 210 head and neck cancer patients who were beyond the acute recovery phase (> 1 year) after radiation therapy. Xerostomia was evaluated with the 8-question XQ developed and validated at the University of Michigan.