Beam quality and the mystery behind the lower percentage depth dose in grid radiation therapy.

Grid therapy recently has been picking momentum due to favorable outcomes in bulky tumors. This is being termed as Spatially Fractionated Radiation Therapy (SFRT) and lattice therapy. SFRT can be performed with specially designed blocks made with brass or cerrobend with repeated holes or using multi-leaf collimators where dosimetry is uncertain. The dosimetric challenge in grid therapy is the mystery behind the lower percentage depth dose (PDD) in grid fields. The knowledge about the beam quality, indexed by TPR20/10 (Tissue Phantom Ratio), is also necessary for absolute dosimetry of grid fields. Since the grid may change the quality of the primary photons, a new [Formula: see text] should be evaluated for absolute dosimetry of grid fields. A Monte Carlo (MC) approach is provided to resolving the dosimetric issues. Using 6 MV beam from a linear accelerator, MC simulation was performed using MCNPX code. Additionally, a commercial grid therapy device was used to simulate the grid fields. Beam parameters were validated with MC model for output factor, depth of maximum dose, PDDs, dose profiles, and TPR20/10. The electron and photon spectra were also compared between open and grid fields. The dmax is the same for open and grid fields. The PDD with grid is lower (~ 10%) than the open field. The difference in TPR20/10 of open and grid fields is observable (~ 5%). Accordingly, TPR20/10 is still a good index for the beam quality in grid fields and consequently choose the correct [Formula: see text] in measurements. The output factors for grid fields are 0.2 lower compared to open fields. The lower depth dose with grid therapy is due to lower depth fluence with scatter radiation but it does not impact the dosimetry as the calibration parameters are insensitive to the effective beam energies. Thus, standard dosimetry in open beam based on international protocol could be used.

How much should you worry about contaminant neutrons in spatially fractionated grid radiation therapy?

Neutron contamination in radiation therapy is of concern in treatment with high-energy photons (> 10 MV). With the development of new radiotherapy modalities such as spatially fractionated grid radiation therapy (SFGRT) or briefly grid radiotherapy, more studies are required to evaluate the risks associated with neutron contamination. In 15 MV SFGRT, high-Z materials such as lead and cerrobend are used as the block on the tray of linear accelerator (linac) which can probably increase the photoneutron production. On the other hand, the high-dose fractions (10-20 Gy) used in SFGRT can induce high neutron contamination. The current study was devoted to addressing these concerns via compression of neutron fluence (Φn) and ambient dose equivalent ([Formula: see text]) at the patient table and inside the maze between SFGRT and conventional fractionated radiation therapy (CFRT). The main components of the 15 MV Siemens Primus equipped with different grids and located inside a typical radiotherapy bunker were simulated by the MCNPX® Monte Carlo code. Evidence showed that the material used for grid construction does not significantly increase neutron contamination inside the maze. However, at the end of the maze, neutron contamination in SFGRT is significantly higher than in CFRT. In this regard, a delay time of 15 minutes after SFGRT is recommended for all radiotherapy staff before entering the maze. It can be also concluded that [Formula: see text] at the patient table is at least 10 times more pronounced than inside the maze. Therefore, the patient is more at risk of neutrons compared to the staff. The [Formula: see text] at the isocenter in SFGRT with grids made of lead and cerrobend was nearly equal to CFRT. Nevertheless, it was dramatically lower than in CFRT by 30% if the brass grid is used. Accordingly, SFGRT with the brass grid is recommended, from radiation protection aspects.

The effect of water resources on spatial and temporal change of soil salinity in Izdkhast playa, Fars Province, Iran.

In the south of Fars Province in Iran, there are several closed basins where the salinity of water and soil resources is one of the main problems. Therefore, to manage the water and soil resources of these basins, identifying the source of salinity and its expansion in playa is necessary. Thus, the Izad-Khast pit in the south of Fars Province of Iran was selected as one of these basins for research. To achieve the goal, 16 soil samples were randomly taken from the basin, and their EC was determined. Landsat 8 image was selected according to sampling day, and ten salinity indices were extracted from it. Then, the best index was determined by the relationship between salinity indices and ground EC using linear regression. Using the determined index and linear equation derived from linear regression and Landsat 7 and 8 images, salinity maps were obtained in three periods 2010, 2015, and 2020. Then, using maps of the three mentioned intervals and the CA-Markov method, soil salinity prediction maps were extracted for 2025 and 2030. Based on the research results, salinity index S2 = (Blue - R)/(Blue + R) provided the best results. Salinity maps derived from this index show that the highest level is related to the area with no salinity or low salinity, and high degrees of salinity are concentrated in some parts of the hills and in some areas of the plain, respectively, which determines the origin of salts. The results also showed that the kappa coefficient of CA-Markov is 0.7282, which shows the high ability of the model to predict soil salinity, in which the distance factor from gypsum and salt minerals is the most critical predictor factor. According to the forecasts, from 2020 to 2025, about 1 km2 and then from 2025 to 2030, about 1.6 km2 will be added to the saline lands.

Monte Carlo evaluation of out-of-field dose in 18 MV pelvic radiotherapy using a simplified female MIRD phantom.

This study was devoted to determining the unwanted dose due to scattered photons to the out-of-field organs and subsequently estimate the risk of secondary cancers in the patients undergoing pelvic radiotherapy. A typical 18 MV Medical Linear Accelerator (Varian Clinac 2100 C/D) was modeled using MCNPX®code to simulate pelvic radiotherapy with four treatment fields: anterior-posterior, posterior-anterior, right lateral, left lateral. Dose evaluation was performed inside Medical Internal Radiation Dose (MIRD) revised female phantom. The average photon equivalent dose in out-of-field organs is 8.53 mSv Gy-1, ranging from 0.17 to 72.11 mSv Gy-1, respectively, for the organs far from the Planning Treatment Volume (Brain) and those close to the treatment field (Colon). Evidence showed that colon with 4.3049% and thyroid with 0.0020% have the highest and lowest risk of secondary cancer, respectively. Accordingly, this study introduced the colon as an organ with a high risk of secondary cancer which should be paid more attention in the follow-up of patients undergoing pelvic radiotherapy. The authors believe that this simple Monte Carlo (MC) model can be also used in other radiotherapy plans and mathematical phantoms with different ages (from childhood to adults) to estimate the out-of-field dose. The extractable information by this simple MC model can be also employed for providing libraries for user-friendly applications (e.g. '.apk') which in turn increase the public knowledge about fatal cancer risk after radiotherapy and subsequently decrease the concerns in this regard among the public.

Evaluation of dosimetric functions for a new 169 Yb HDR Brachytherapy Source.

169 Yb has been recently used as an HDR brachytherapy source for cancer treatment. In this paper, dosimetric parameters of a new design of 169 Yb HDR brachytherapy source were determined by Monte Carlo (MC) method and film dosimetry. In this new source, the radioactive core has been encapsulated twice for safety purposes. The calculations of dosimetric parameters carried out using MC simulation in water and air phantom. In order to exclude photon contamination's cutoff energy, δ was set at 10 keV. TG-43U1 data dosimetric, including Sk , Λ, g(r), F(r, θ) was computed using outputs from the simulation and their statistical uncertainties were calculated. Dose distribution around the new prototype source in PMMA phantom in the framework of AAPM TG-43 and TG-55 recommendations was measured by Radiochromic film (RCF) Gafchromic EBT3. Obtained air kerma strength, Sk , and the dose rate constant, Λ, from simulation has a value of 1.03U ± 0.03 and 1.21 cGyh-1 U-1  ± 0.03, respectively. The radial dose function was calculated at radial distances between 0.5 and 10 cm with a maximum value of 1.15 ± 0.03 at 5-6 cm distances. The anisotropy functions for radial distances of 0.5-7 cm and angle distances 0° to180° were calculated. The dosimetric data of the new HDR 169 Yb source were compared with another reference source of 169 Yb-HDR and were found that has acceptable compatibility. In addition, the anisotropy function of the MC simulation and film dosimetry method at a distance of 1 cm from this source was obtained and a good agreement was found between the anisotropy results.

Characterization of hardware-related spatial distortions for IR-PETRA pulse sequence using a brain specific phantom.

OBJECTIVE: Inversion recovery-pointwise encoding time reduction with radial acquisition (IR-PETRA) is an effective magnetic resonance (MR) pulse sequence in generating pseudo-CTs. The hardware-related spatial-distortion (HRSD) in MR images potentially deteriorates the accuracy of pseudo-CTs. Thus, we aimed at characterizing HRSD for IR-PETRA. MATERIALS AND METHODS: gross-HRSDoverall (Euclidean-sum of gross-HRSDi (i = x, y, z)) for IR-PETRA was assessed using a brain-specific phantom for two MR scanners (1.5 T-Aera and 3.0 T-Prisma). Moreover, hardware imperfections were analyzed by determining gradient-nonlinearity spatial-distortion (GNSD) and B0-inhomogeneity spatial-distortion (B0ISD) for magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) which has well-known distortion characteristics. RESULTS: In 3.0 T, maximum of gross-GNSDoverall (Euclidean-sum of gross-GNSDi) and gross-B0ISD for MP-RAGE was 2.77 mm and 0.57 mm, respectively. For this scanner, the mean and maximum of gross-HRSDoverall for IR-PETRA were 0.63 ± 0.38 mm and 1.91 mm, respectively. In 1.5 T, maximum of gross-GNSDoverall and gross-B0ISD for MP-RAGE was 3.41 mm and 0.78 mm, respectively. The mean and maximum of gross-HRSDoverall for IR-PETRA were 1.02 ± 0.50 mm and 3.12 mm, respectively. DISCUSSION: The spatial accuracy of MR images, besides being impacted by hardware performance, scanner capabilities, and imaging parameters, is mainly affected by its imaging strategy and data acquisition scheme. In 3.0 T, even without applying vendor correction algorithms, spatial accuracy of IR-PETRA image is sufficient for generating pseudo-CTs. In 1.5 T, distortion-correction is required to provide this accuracy.

Functionalization of Magnetic Nanoparticles by Folate as Potential MRI Contrast Agent for Breast Cancer Diagnostics.

In recent years, the intrinsic magnetic properties of magnetic nanoparticles (MNPs) have made them one of the most promising candidates for magnetic resonance imaging (MRI). This study aims to evaluate the effect of different coating agents (with and without targeting agents) on the magnetic property of MNPs. In detail, iron oxide nanoparticles (IONPs) were prepared by the polyol method. The nanoparticles were then divided into two groups, one of which was coated with silica (SiO2) and hyperbranched polyglycerol (HPG) (SPION@SiO2@HPG); the other was covered by HPG alone (SPION@HPG). In the following section, folic acid (FA), as a targeting agent, was attached on the surface of nanoparticles. Physicochemical properties of nanostructures were characterized using Fourier transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM), and a vibrating sample magnetometer (VSM). TEM results showed that SPION@HPG was monodispersed with the average size of about 20 nm, while SPION@SiO2@HPG had a size of about 25 nm. Moreover, HPG coated nanoparticles had much lower magnetic saturation than the silica coated ones. The MR signal intensity of the nanostructures showed a relation between increasing the nanoparticle concentrations inside the MCF-7 cells and decreasing the signal related to the T2 relaxation time. The comparison of coating showed that SPION@SiO2@HPG (with/without a targeting agent) had significantly higher r2 value in comparison to Fe3O4@HPG. Based on the results of this study, the Fe3O4@SiO2@HPG-FA nanoparticles have shown the best magnetic properties, and can be considered promising contrast agents for magnetic resonance imaging applications.

An Exact and Fast CBCT Reconstruction via Pseudo-Polar Fourier Transform based Discrete Grangeat's Formula.

The recent application of Fourier Based Iterative Reconstruction Method (FIRM) has made it possible to achieve high-quality 2D images from a fan beam Computed Tomography (CT) scan with a limited number of projections in a fast manner. The proposed methodology in this article is designed to provide 3D Radon space in linogram fashion to facilitate the use of FIRM with cone beam projections (CBP) for the reconstruction of 3D images in a sparse view angles Cone Beam CT (CBCT). For this reason, in the first phase, the 3D Radon space is generated using CBP data after discretization and optimization of the famous Grangeat's formula. The method used in this process involves fast Pseudo Polar Fourier transform (PPFT) based on 2D and 3D Discrete Radon Transformation (DRT) algorithms with no wraparound effects. In the second phase, we describe reconstruction of the objects with available Radon values, using direct inverse of 3D PPFT. The method presented in this section eliminates noises caused by interpolation from polar to Cartesian space and exhibits no thorn, V-shaped and wrinkle artifacts. This method reduces the complexity to for images of size n × n × n The Cone to Radon conversion (Cone2Radon) Toolbox in the first phase and MATLAB/ Python toolbox in the second phase were tested on three digital phantoms and experiments demonstrate fast and accurate cone beam image reconstruction due to proposed.

Effect of beam configuration with inaccurate or incomplete small field output factors on the accuracy of treatment planning dose calculation.

PURPOSE: To evaluate the effect of beam configuration with inaccurate or incomplete small field output factors on the accuracy of dose calculations in treatment planning systems. METHODS: Output factors were measured using various detectors and for a range of field sizes. Three types of treatment machines were configured in two treatment planning systems. In the first (corrected) machine, the Exradin W1 scintillator was used to determine output factors. In the second (uncorrected) machine, the measured output factors by the A1SL ion chamber without considering output correction factors for small field sizes were utilized. In the third (clinical) machine, measured output factors by the Exradin W1 were used but not for field sizes smaller than 2 × 2 cm2 . The dose computed by the anisotropic analytical algorithm (AAA), Acuros XB (AXB) and collapsed cone convolution/superposition (CCC) algorithms in the three machines were delivered using static (jaw-, MLC-, and jaw/MLC-defined), and composite [intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT)] fields. The differences between measured and calculated dose values were analyzed. RESULTS: For static fields, the percentage differences between measured and calculated doses by the three algorithms in three configured machines were <2% for field sizes larger than 2 × 2 cm2 . In jaw- and jaw/MLC-defined fields smaller than 2 × 2 cm2 , the corrected machine presented better agreement with measurement. Considering output correction factors in MLC-defined fields, among the three configured machines, the accuracy of calculation improved to within ±0.5%. For MLC-defined field size of 1 × 1 cm2 , AXB showed the smallest percentage difference (1%). In IMRT and VMAT plans, the percentage differences between measured and calculated doses at the isocenter, as well as the gamma analysis of different plans, which include field sizes larger than 3 × 3 cm2 , did not vary noticeably. For smaller field sizes, using the corrected machine influences dose calculation accuracy. CONCLUSION: Configuration with corrected output factors improves accuracy of dose calculation for static field sizes smaller than 2 × 2 cm2 . For very small fields, the robustness of the dose calculation algorithm affects the accuracy of dose as well. In IMRT and VMAT plans, which include small subfields, the size of the jaw-defined field is an important factor and using corrected output factors increases dose calculation accuracy.

Essential considerations for accurate evaluation of photoneutron contamination in Radiotherapy.

Nowadays, high-energy X-rays produced by medical linear accelerators (LINACs) are widely used in many Radiation Therapy (RT) centers. High-energy photons (> 8 MeV) produce undesired neutrons in the LINAC head which raise concerns about unwanted neutron dose to the patients and RT personnel. Regarding the significance of radiation protection in RT, it is important to evaluate photoneutron contamination inside the RT room. Unfortunately, neutron dosimeters used for this purpose have limitations that can under the best conditions cause to > 10% uncertainty. In addition to this uncertainty, the present Monte Carlo (MC) study introduces another uncertainty in measurements (nearly up to 20%) when neutron ambient dose equivalent (Hn*(10)) is measured at the patient table or inside the maze and the change in neutron energy is ignored. This type of uncertainty can even reach 35% if Hn*(10) is measured by dosimeters covered by a layer of 10B as converter. So, in these cases, neglecting the change in neutron energy can threaten the credibility of measured data and one should attend to this energy change in order to reduce measurement uncertainty to the possible minimum. This study also discusses the change in neutron spectra and Hn*(10) at the patient table caused by removing a typical RT room from MC simulations. Under such conditions, neutron mean energy (En) overestimated by 0.2-0.4 MeV at the patient table. Neutron fluence (φn) at the isocenter (IC) was underestimated by 23-54% for different field sizes that caused Hn*(10) to be miscalculated up to 24%. This finding informs researchers that for accurate evaluation of Hn*(10) at the patient table, simulating the RT room is an effective parameter in MC studies.

Photoneutron Dose Estimation in GRID Therapy Using an Anthropomorphic Phantom: A Monte Carlo Study.

BACKGROUND: In the past, GRID therapy was used as a treatment modality for the treatment of bulky and deeply seated tumors with orthovoltage beams. Now and with the introduction of megavoltage beams to radiotherapy, some of the radiotherapy institutes use GRID therapy with megavoltage photons for the palliative treatment of bulky tumors. Since GRID can be a barrier for weakening the photoneutrons produced in the head of medical linear accelerators (LINAC), as well as a secondary source for producing photoneutrons, therefore, in terms of radiation protection, it is important to evaluate the GRID effect on photoneutron dose to the patients. METHODS: In this study, using the Monte Carlo code MCNPX, a full model of a LINAC was simulated and verified. The neutron source strength of the LINAC (Q), the distributions of flux (φ), and ambient dose equivalent (H*[10]) of neutrons were calculated on the treatment table in both cases of with/without the GRID. Finally, absorbed dose and dose equivalent of neutrons in some of the tissues/organs of MIRD phantom were computed with/without the GRID. RESULTS: Our results indicate that the GRID increases the production of the photoneutrons in the LINAC head only by 0.3%. The calculations in the MIRD phantom show that neutron dose in the organs/tissues covered by the GRID is on average by 48% lower than conventional radiotherapy. In addition, in the uncovered organs (by the GRID), this amount is reduced to 25%. CONCLUSION: Based on the findings of this study, in GRID therapy technique compared to conventional radiotherapy, the neutron dose in the tissues/organs of the body is dramatically reduced. Therefore, there will be no concern about the GRID effect on the increase of unwanted neutron dose, and consequently the risk of secondary cancer.

Clinical Implications of TiGRT Algorithm for External Audit in Radiation Oncology.

BACKGROUND: Performing audits play an important role in quality assurance program in radiation oncology. Among different algorithms, TiGRT is one of the common application software for dose calculation. This study aimed to clinical implications of TiGRT algorithm to measure dose and compared to calculated dose delivered to the patients for a variety of cases, with and without the presence of inhomogeneities and beam modifiers. MATERIALS AND METHODS: Nonhomogeneous phantom as quality dose verification phantom, Farmer ionization chambers, and PC-electrometer (Sun Nuclear, USA) as a reference class electrometer was employed throughout the audit in linear accelerators 6 and 18 MV energies (Siemens ONCOR Impression Plus, Germany). Seven test cases were performed using semi CIRS phantom. RESULTS: In homogeneous regions and simple plans for both energies, there was a good agreement between measured and treatment planning system calculated dose. Their relative error was found to be between 0.8% and 3% which is acceptable for audit, but in nonhomogeneous organs, such as lung, a few errors were observed. In complex treatment plans, when wedge or shield in the way of energy is used, the error was in the accepted criteria. In complex beam plans, the difference between measured and calculated dose was found to be 2%-3%. All differences were obtained between 0.4% and 1%. CONCLUSIONS: A good consistency was observed for the same type of energy in the homogeneous and nonhomogeneous phantom for the three-dimensional conformal field with a wedge, shield, asymmetric using the TiGRT treatment planning software in studied center. The results revealed that the national status of TPS calculations and dose delivery for 3D conformal radiotherapy was globally within acceptable standards with no major causes for concern.

Monte Carlo dosimetry of the IRAsource high dose rate (192)Ir brachytherapy source.

High-dose-rate (HDR) brachytherapy is a common method for cancer treatment in clinical brachytherapy. Because of the different source designs, there is a need for specific dosimetry data set for each HDR model. The purpose of this study is to obtain detailed dose rate distributions in water phantom for a first prototype HDR (192)Ir brachytherapy source model, IRAsource, and compare with the other published works. In this study, Monte Carlo N-particle (MCNP version 4C) code was used to simulate the dose rate distributions around the HDR source. A full set of dosimetry parameters reported by the American Association of Physicists in Medicine Task Group No. 43U1 was evaluated. Also, the absorbed dose rate distributions in water, were obtained in an along-away look-up table. The dose rate constant, Λ, of the IRAsource was evaluated to be equal to 1.112 ± 0.005 cGy h(-1) U(-1). The results of dosimetry parameters are presented in tabulated and graphical formats and compared with those reported from other commercially available HDR (192)Ir sources, which are in good agreement. This justifies the use of specific data sets for this new source. The results obtained in this study can be used as input data in the conventional treatment planning systems.

Development and validation of MCNPX-based Monte Carlo treatment plan verification system.

A Monte Carlo treatment plan verification (MCTPV) system was developed for clinical treatment plan verification (TPV), especially for the conformal and intensity-modulated radiotherapy (IMRT) plans. In the MCTPV, the MCNPX code was used for particle transport through the accelerator head and the patient body. MCTPV has an interface with TiGRT planning system and reads the information which is needed for Monte Carlo calculation transferred in digital image communications in medicine-radiation therapy (DICOM-RT) format. In MCTPV several methods were applied in order to reduce the simulation time. The relative dose distribution of a clinical prostate conformal plan calculated by the MCTPV was compared with that of TiGRT planning system. The results showed well implementation of the beams configuration and patient information in this system. For quantitative evaluation of MCTPV a two-dimensional (2D) diode array (MapCHECK2) and gamma index analysis were used. The gamma passing rate (3%/3 mm) of an IMRT plan was found to be 98.5% for total beams. Also, comparison of the measured and Monte Carlo calculated doses at several points inside an inhomogeneous phantom for 6- and 18-MV photon beams showed a good agreement (within 1.5%). The accuracy and timing results of MCTPV showed that MCTPV could be used very efficiently for additional assessment of complicated plans such as IMRT plan.