Reconstruction Of Segmental Mandibular Loss With Vascularized Free Fibula Flapsn.

Background: Various methods for mandibular reconstruction have been demonstrated in literature from autogenous bone graft to free flaps and more recently tissue engineered materials. We share our experience of mandibular reconstruction with free fibular flap and evaluate its efficiency as a viable option for mandibular reconstruction.

Methods: It was a cross-sectional study, conducted at Plastic surgery department combined military hospital, Rawalpindi.

A two-stage sequential linear programming approach to IMRT dose optimization.

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.

Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article.

Object: Few long-term studies of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) exist. The authors report their long-term experience with the use of GKS in a previously reported cohort of patients with TN that has now been followed since 1996.

Methods: One hundred twelve patients with TN were treated with GKS at the University of Maryland between June 1996 and July 2001.

Repeat computed tomography simulation to assess lumpectomy cavity volume during whole-breast irradiation.

Purpose: To determine whether the lumpectomy cavity (LPC) decreases in volume during whole-breast radiotherapy (RT) and what factors influence the decrease.

Patients And Methods: Forty-three women with 44 breast lesions were prospectively enrolled. Eligible patients underwent lumpectomy followed by a CT simulation (CT1) within 60 days of surgery.

Effects of tumor motion in GRID therapy.

Clinical and biological evidence suggest that the success of GRID therapy in debulking large tumors depends on the high peak-to-valley contrast in the dose distribution. In this study, we show that the peaks and valleys can be significantly blurred out by respiration-induced tumor motion, possibly affecting the clinical outcome. Using a kernel-based Monte Carlo dose engine that incorporates phantom motion, we calculate the dose distributions for a GRID with hexagonally arranged holes.

Stochastic versus deterministic kernel-based superposition approaches for dose calculation of intensity-modulated arcs.

Dose calculations for radiation arc therapy are traditionally performed by approximating continuous delivery arcs with multiple static beams. For 3D conformal arc treatments, the shape and weight variation per degree is usually small enough to allow arcs to be approximated by static beams separated by 5 degrees -10 degrees . But with intensity-modulated arc therapy (IMAT), the variation in shape and dose per degree can be large enough to require a finer angular spacing.

Doppler broadening effect on low-energy photon dose calculations using MCNP5 and PENELOPE.

Recent releases of the MCNP5 and PENELOPE Monte Carlo codes include the transport algorithm and momentum profiles that are necessary for accounting for Doppler broadening in Compton scattering processes. Such improvements might be particularly important in low-energy photon dose calculations. MCPLIB04 and PENDBASE (PENELOPE photon dataset) are based on the EPDL97 library with Compton momentum profiles, while MCPLIB03 and MCPLIB02 are based on the 1970's old library, with MCPLIB03 including the Compton momentum profiles.

An improved MLC segmentation algorithm and software for step-and-shoot IMRT delivery without tongue-and-groove error.

We present an improved multileaf collimator (MLC) segmentation algorithm, denoted by SLS(NOTG) (static leaf sequencing with no tongue-and-groove error), for step-and-shoot intensity-modulated radiation therapy (IMRT) delivery. SLS(NOTG) is an improvement over the MLC segmentation algorithm called SLS that was developed by Luan et al. [Med.

A difference-matrix metaheuristic for intensity map segmentation in step-and-shoot IMRT delivery.

At an intermediate stage of radiation treatment planning for IMRT, most commercial treatment planning systems for IMRT generate intensity maps that describe the grid of beamlet intensities for each beam angle. Intensity map segmentation of the matrix of individual beamlet intensities into a set of MLC apertures and corresponding intensities is then required in order to produce an actual radiation delivery plan for clinical use. Mathematically, this is a very difficult combinatorial optimization problem, especially when mechanical limitations of the MLC lead to many constraints on aperture shape, and setup times for apertures make the number of apertures an important factor in overall treatment time.

Feasibility of delivering grid therapy using a multileaf collimator.

The feasibility of using a multileaf collimator (MLC) for grid therapy is demonstrated in this study. Grids with the projected field openings of 10 mm x 10 mm and 5 mm x 5 mm were created using multiple MLC-shaped fields. The deposited doses were measured with films at different depths in a solid water phantom and compared to those of Cerrobend grid collimators of similar hole sizes and hole separations.

Using a photon phase-space source for convolution/superposition dose calculations in radiation therapy.

For a given linac design, the dosimetric characteristics of a photon beam are determined uniquely by the energy and radial distributions of the electron beam striking the x-ray target. However, in the usual commissioning of a beam from measured data, a large number of variables can be independently tuned, making it difficult to derive a unique and self-consistent beam model. For example, the measured dosimetric penumbra in water may be attributed in various proportions to the lateral secondary electron range, the focal spot size and the transmission through the tips of a non-divergent collimator; the head-scatter component in the tails of the transverse profiles may not be easy to resolve from phantom scatter and head leakage; and the head-scatter tails corresponding to a certain extra-focal source model may not agree self-consistently with in-air output factors measured on the central axis.

Real-time intra-fraction-motion tracking using the treatment couch: a feasibility study.

Significant differences between planned and delivered treatments may occur due to respiration-induced tumour motion, leading to underdosing of parts of the tumour and overdosing of parts of the surrounding critical structures. Existing methods proposed to counter tumour motion include breath-holds, gating and MLC-based tracking. Breath-holds and gating techniques increase treatment time considerably, whereas MLC-based tracking is limited to two dimensions.

A stochastic convolution/superposition method with isocenter sampling to evaluate intrafraction motion effects in IMRT.

Current methods to calculate dose distributions with organ motion can be broadly classified as "dose convolution" and "fluence convolution" methods. In the former, a static dose distribution is convolved with the probability distribution function (PDF) that characterizes the motion. However, artifacts are produced near the surface and around inhomogeneities because the method assumes shift invariance.

Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas.

Purpose: To determine the long-term outcomes and prognostic factors in benign intracranial meningiomas treated with gamma knife stereotactic radiosurgery (GK-SRS).

Methods And Materials: Between 1992 and 2000, 162 patients with benign meningiomas were treated with GK-SRS at the University of Maryland Medical Center. Complete follow-up was available in 137 patients.

A new MLC segmentation algorithm/software for step-and-shoot IMRT delivery.

We present a new MLC segmentation algorithm/software for step-and-shoot IMRT delivery. Our aim in this work is to shorten the treatment time by minimizing the number of segments. Our new segmentation algorithm, called SLS (an abbreviation for static leaf sequencing), is based on graph algorithmic techniques in computer science.

Benchmark of PENELOPE code for low-energy photon transport: dose comparisons with MCNP4 and EGS4.

The expanding clinical use of low-energy photon emitting 125I and 103Pd seeds in recent years has led to renewed interest in their dosimetric properties. Numerous papers pointed out that higher accuracy could be obtained in Monte Carlo simulations by utilizing newer libraries for the low-energy photon cross-sections, such as XCOM and EPDL97. The recently developed PENELOPE 2001 Monte Carlo code is user friendly and incorporates photon cross-section data from the EPDL97.

Convolution/superposition using the Monte Carlo method.

The convolution/superposition calculations for radiotherapy dose distributions are traditionally performed by convolving polyenergetic energy deposition kernels with TERMA (total energy released per unit mass) precomputed in each voxel of the irradiated phantom. We propose an alternative method in which the TERMA calculation is replaced by random sampling of photon energy, direction and interaction point. Then, a direction is randomly sampled from the angular distribution of the monoenergetic kernel corresponding to the photon energy.

Clinical implementation of an automated planning system for gamma knife radiosurgery.

Purpose: To evaluate an automated treatment planning system for gamma knife radiosurgery. This planning system was developed in our clinic and is now in routine clinical use. The system simultaneously optimizes the shot sizes, locations, and weights.

Clinical implementation of intensity-modulated arc therapy.

Purpose: Intensity-modulated arc therapy (IMAT) is a method for delivering intensity-modulated radiation therapy (IMRT) using rotational beams. During delivery, the field shape, formed by a multileaf collimator (MLC), changes constantly. The objectives of this study were to (1) clinically implement the IMAT technique, and (2) evaluate the dosimetry in comparison with conventional three-dimensional (3D) conformal techniques.