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1.
Phys Med Biol ; 57(13): 4387-401, 2012 Jul 07.
Article in English | MEDLINE | ID: mdl-22705967

ABSTRACT

Vertebral metastases are a common manifestation of many cancers, potentially leading to vertebral collapse and neurological complications. Conventional treatment often involves percutaneous vertebroplasty/kyphoplasty followed by external beam radiation therapy. As a more convenient alternative, we have introduced radioactive bone cement, i.e. bone cement incorporating a radionuclide. In this study, we used a previously developed Monte Carlo radiation transport modeling method to evaluate dose distributions from phosphorus-32 radioactive cement in simulated clinical scenarios. Isodose curves were generally concentric about the surface of bone cement injected into cadaveric vertebrae, indicating that dose distributions are relatively predictable, thus facilitating treatment planning (cement formulation and dosimetry method are patent pending). Model results indicated that a therapeutic dose could be delivered to tumor/bone within ∼4 mm of the cement surface while maintaining a safe dose to radiosensitive tissue beyond this distance. This therapeutic range should be sufficient to treat target volumes within the vertebral body when tumor ablation or other techniques are used to create a cavity into which the radioactive cement can be injected. With further development, treating spinal metastases with radioactive bone cement may become a clinically useful and convenient alternative to the conventional two-step approach of percutaneous strength restoration followed by radiotherapy.


Subject(s)
Bone Cements/therapeutic use , Bone Neoplasms/radiotherapy , Bone Neoplasms/secondary , Female , Humans , Radiometry , Radiotherapy Dosage , Spine/radiation effects
2.
Med Phys ; 39(6Part7): 3676, 2012 Jun.
Article in English | MEDLINE | ID: mdl-28519803

ABSTRACT

PURPOSE: To determine the impact of atlas size on the performance of atlas-based automatic segmentation (ABAS) in delineation of organs at risk for adaptive radiation therapy. METHODS: A total of 25 patients who had undergone intensity modulated radiation therapy for various head and neck cancers were retrospectively selected for inclusion in a library to be used for ABAS with the MIM VISTA software package (MIM Software, Cleveland OH). Treatment planning computed tomography (CT) scans and subsequent organ at risk (OAR) contours generated as part of the treatment planning process for these patients were added to the library. This library of 25 patients was then successively pruned to generate 5 atlases with 25, 20, 15, 10, and 5 patient subjects respectively. Atlas based segmentation was performed on 10 retrospectively selected treatment planning CT scans to automatically generate right and left parotid glands and brainstem contours. These planning CT scans belonged to a unique set of 10 patient subjects different from the ones used for generating the atlases. One physician (JW), who was blinded to the ABAS results, manually delineated gold-standard contours for the right and left parotid glands and brainstem. Dice similarity coefficients were calculated and analyzed as a function of atlas subject size. RESULTS: For the sites selected in this study, the performance of ABAS was relatively insensitive to atlas size. Furthermore, some patient subjects were repeatedly selected implying that the adoption of a single standard patient for ABAS may be of benefit. CONCLUSIONS: Our preliminary results indicate that the performance of the atlas based segmentation module in MIM VISTA Version 5.2 for the organs studied here may be relatively insensitive to the atlas size.

3.
Med Phys ; 39(6Part7): 3677, 2012 Jun.
Article in English | MEDLINE | ID: mdl-28519814

ABSTRACT

PURPOSE: In this study, we developed a quantitative analysis tool based on patient's longitudinal MR images to 1) measure the radiation dose received by each subcortical structure, 2) follow the change of volume and shape of each structure longitudinally. This tool provides a systematic approach to study the radiation therapy (and subsequent chemotherapy) associated with cognitive impairments. METHODS: MRI scans of one patient taken before and after radiation therapy are demonstrated in this study. 3D Conformal radiation therapy was performed on RapidArc™. An open source MRI analysis tool, FMRIB's Integrated Registration and Segmentation Tool (FIRST), was used for segmentation. The images are registered to a standard template with expert-defined labeling for all sub-cortical structures, and the labeling of each structure is mapped back to the individual MRI space for segmentation. After the segmentation, the radiation dose map was coregistered to the MRI space to calculate the dose received by each structure. RESULTS: For the structure that is contained within the radiation zone, we can calculate the total dose based on the volumetric distribution of radiation dose. For the structure that is outside the radiation field, we can calculate the distance from the radiation zone. We have demonstrated in this work that the analysis can be done for all segmented sub-cortical structures. The change of volume before and after radiation treatment can be analyzed, and the results can be correlated with the change of cognitive performance over time. CONCLUSIONS: We presented an automated tool for efficient, quantitative and user-independent measurements of radiation dose in subcortical structures. The obtained results can be correlated with the cognitive test score and the clinical outcome to evaluate radiation and the subsequent chemotherapy induced changes in brain structures and functions.

4.
Phys Med Biol ; 55(9): 2451-63, 2010 May 07.
Article in English | MEDLINE | ID: mdl-20371905

ABSTRACT

Spinal metastases are a common and serious manifestation of cancer, and are often treated with vertebroplasty/kyphoplasty followed by external beam radiation therapy (EBRT). As an alternative, we have introduced radioactive bone cement, i.e. bone cement incorporated with a radionuclide. In this study, we present a Monte Carlo radiation transport modeling method to calculate dose distributions within vertebrae containing radioactive cement. Model accuracy was evaluated by comparing model-predicted depth-dose curves to those measured experimentally in eight cadaveric vertebrae using radiochromic film. The high-gradient regions of the depth-dose curves differed by radial distances of 0.3-0.9 mm, an improvement over EBRT dosimetry accuracy. The low-gradient regions differed by 0.033-0.055 Gy/h/mCi, which may be important in situations involving prior spinal cord irradiation. Using a more rigorous evaluation of model accuracy, four models predicted the measured dose distribution within the experimental uncertainty, as represented by the 95% confidence interval of the measured log-linear depth-dose curve. The remaining four models required modification to account for marrow lost from the vertebrae during specimen preparation. However, the accuracy of the modified model results indicated that, when this source of uncertainty is accounted for, this modeling method can be used to predict dose distributions in vertebrae containing radioactive cement.


Subject(s)
Bone Cements , Models, Biological , Radiation , Bone Marrow/diagnostic imaging , Bone Marrow/radiation effects , Bone and Bones/diagnostic imaging , Bone and Bones/radiation effects , Female , Humans , Injections , Monte Carlo Method , Precision Medicine , Radiotherapy Dosage , Tomography, X-Ray Computed
5.
Med Dosim ; 26(1): 17-27, 2001.
Article in English | MEDLINE | ID: mdl-11417503

ABSTRACT

Our institutional experience using the Peacock system for intensity-modulated radiation therapy (IMRT) is summarized. Over 100 patients were treated using this system, which is fitted to a Clinac 600C linac. Both cranial and extracranial lesions have been treated using this modality. Immobilization is achieved either with the Talon system for cranial sites or an Aquaplast cast. Target volumes up to 500 cm3 have been treated. Multiple lesions (up to 3) were treated in one setup. The range of dose/fractionation schemes used was 15 Gy/1 fx (radiosurgical treatment) - 80 Gy/40 fx. Dose validation studies were carried out using film and ion chamber dosimetry in a specially designed phantom. Optimal dose distributions were attainable using inverse treatment planning for IMRT delivery. These were found to encompass the target volumes accurately using dose validation phantom studies. Immobilization methods used were accurate to within 1 mm, as evidenced by daily portal films. IMRT using the Peacock system offers the advantage of delivery of conformal therapy to high doses safely and accurately. This provides the opportunity for dose escalation studies, retreatment of previously treated tumors, as well as treating multiple targets in one setup. The system may be fitted to a conventional linac without major modifications.


Subject(s)
Radiotherapy/instrumentation , Adenocarcinoma/radiotherapy , Aged , Astrocytoma/radiotherapy , Brain Neoplasms/radiotherapy , Child , Craniopharyngioma/radiotherapy , Female , Humans , Immobilization , Lung Neoplasms/radiotherapy , Male , Middle Aged , Particle Accelerators , Prostatic Neoplasms/radiotherapy , Radiometry , Radiotherapy/methods , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Conformal/instrumentation , Radiotherapy, Conformal/methods , Spinal Neoplasms/radiotherapy , Tomography, X-Ray Computed
6.
Skull Base ; 11(2): 109-19, 2001 May.
Article in English | MEDLINE | ID: mdl-17167610

ABSTRACT

The objective of this article is to evaluate single-fraction or fractionated stereotactic radiotherapy of central nervous system (CNS) and head and neck lesions using intensity-modulated radiotherapy (IMRT) with a commercially available system (Peacocktrade mark, Nomos Corporation, Sewickley, PA). This system allows tomotherapeutic delivery of intensity-modulated radiation, that is, the slice-by-slice treatment of the volume of interest with an intensity-modulated beam, making the delivery of highly conformal radiation to the target possible in both single or multiple fractions mode. During an 18-month period, 43 (21 males and 22 females) patients were treated, using a removable cranial screw-fixation device. Ages ranged from 10 to 77 years (mean, 52.2; median, 53.5). Intra- and extra-axial lesions, including head and neck malignancies and spine metastases, were treated. Clinical target volume ranged from 0.77 to 195 cm(3) (mean, 47.8; median, 29.90). The dose distribution was normalized to the maximum and was prescribed, in most cases, at the 80% or 90% isodose line (range, 65 to 96%; median, 85%; mean, 83.4%) and ranged from 14 to 80 Gy (mean, 48; median, 50). The number of fractions ranged from 1 to 40 (mean, 23; median, 25). In all but one patient, 90% of the prescription isodose line covered 100% of the clinical target volume. The heterogeneity index (the ratio between the maximum radiation dose and the prescribed dose) ranged between 1.0 and 1.50, whereas the conformity index (the ratio between the volume encompassed by the prescription isodose line and the clinical target volume) ranged between 1.0 and 4.5. There were no complications related to the radiation treatment. With a median follow-up of 6 months, more than 70% of our patients showed decreased lesion size. Stereotactic IMRT of CNS and head and neck lesions can be delivered safely and accurately. The Peacock system delivers stereotactic radiation in single or multiple fractions and has no volume limitations. It has been used to treat intracranial, head and neck, and spinal lesions. The option of fractionation, the lack of volume constraint, and the capability of treating intracranial, head and neck, and spinal pathology make stereotactic IMRT a valuable adjunct to established stereotactic radiotherapy systems delivering convergent-beam irradiation using the Linac or Gamma Knife. In a clinical setting that offers Linac, Gamma Knife radiosurgery, and conformal stereotactic radiotherapy, the latter may have advantages for treating large (> 25-cm(3)) and irregular lesions, especially when fractionation is considered useful.

7.
Med Phys ; 26(11): 2385-9, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10587221

ABSTRACT

Output factors of multileaf-collimator (MLC) shaped radiation fields were measured for a commercial linear accelerator whose MLC leaves form parts of the upper collimator system. The approach of taking into account the reduced phantom scatter due to the MLC shaping on the output factor has previously been shown to be inadequate for this type of machine because of the effect of the MLC leaves on the collimator factor [Palta et al., Med. Phys. 23, 1219-1224(1996)]. In this article, we present two forms of the collimator factor that give satisfactory agreement with measured values of the output factors of MLC-shaped fields. The present method should be directly applicable to other linacs of similar MLC configuration. For clinical treatment planning, we believe the method is practical and accurate enough to be satisfactory. The equation for calculating the output factor requires only peak scatter and output factors of the machine. These are normally measured during machine commissioning.


Subject(s)
Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Algorithms , Computer Simulation , Equipment Design , Models, Theoretical , Phantoms, Imaging , Radiotherapy/instrumentation , Radiotherapy/methods , Scattering, Radiation
8.
Med Phys ; 18(4): 821-8, 1991.
Article in English | MEDLINE | ID: mdl-1921891

ABSTRACT

Dosimetry measurements have been carried out for the electron beams produced by a linear accelerator at energies 6, 8, 10, 14, 18, and 21 MeV. Characteristic parameters of the central axis dose distributions were derived and compared to corresponding values of electron beams from other accelerators in clinical use where such a comparison is appropriate. A comprehensive set of dosimetric parameters is provided for electron beam treatment planning. The data include central axis depth dose, range-energy parameters, beam penumbra and uniformity.


Subject(s)
Particle Accelerators , Radiotherapy/methods , Electrons , Humans , Models, Theoretical , Radiotherapy/instrumentation , Radiotherapy Dosage
9.
Med Phys ; 15(2): 250-7, 1988.
Article in English | MEDLINE | ID: mdl-3386599

ABSTRACT

Parameters of the photon beams (6 and 20 MV) from a dual-energy linear accelerator (Mevatron-KD, Siemens Medical Laboratories, CA) are presented. The depth dose characteristics of the photon beams are dmax of 1.8 and 3.8 cm and percentage depth dose of 68% and 80% at 10-cm depth and 100-cm source-surface distance for a field size of 10 X 10 cm2 for 6 and 20 MV, respectively. The 6 and 20 MV beams were found to correspond to nominal accelerating potentials of 4.7 and 17 MV, respectively. The stability of output is within +/- 1% and flatness and symmetry are within +/- 3%. These figures compare favorably with the manufacturer's specifications.


Subject(s)
Particle Accelerators , Radiotherapy/methods , Humans , Mathematics , Models, Theoretical , Radiotherapy Dosage
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