2D EPID dose calibration for pretreatment quality control of conformal and IMRT fields: A simple and fast convolution approach.

PURPOSE: This work presents an original algorithm that converts the signal of an electronic portal imaging device (EPID) into absorbed dose in water at the depth of maximum. METHODS: The model includes a first image pre-processing step that accounts for the non-uniformity of the detector response but also for the perturbation of the signal due to backscatter radiation. Secondly, the image is converted into absorbed dose to water through a linear conversion function associated with a dose redistribution kernel. These two computation parameters were modelled by correlating the on-axis EPID signal with absorbed dose measurements obtained on square fields by using an ionization chamber placed in water at the depth of maximum dose. The accuracy of the algorithm was assessed by comparing the dose determined from the EPID signal with the dose derived by the treatment planning system (TPS) using the ϒ-index. These comparisons were performed on 8 conformal radiotherapy treatment fields (3DCRT) and 18 modulated fields (IMRT). RESULTS: For a dose difference and a distance-to-agreement set to 3% of the maximum dose and 2 mm respectively, the mean percentage of points with a ϒ-value less than or equal to 1 was 99.8% ± 0.1% for 3DCRT fields and 96.8% ± 2.7% for IMRT fields. Moreover, the mean gamma values were always less than 0.5 whatever the treatment technique. CONCLUSION: These results confirm that our algorithm is an accurate and suitable tool for clinical use in a context of IMRT quality assurance programmes.

Intensity modulated arc therapy in bilaterally irradiated head and neck cancer: a comparative and prospective multicenter planning study.

A dosimetric comparison was made of Helical Tomotherapy (HT) and Rapid'Arc(®) (RA) in 115 patients with head and neck carcinoma included in a prospective and multicentric study. HT and RA provided highly conformal plans that easily complied with dose volume constraints for organs at risk. HT reduced high doses to the planning target volumes (PTVs) compared to RA and provided a more homogeneous dose distribution but with an increased Non Tumoral Integral Dose (NTID) than RA. However, the clinical consequences of these dosimetric advantages and disadvantages need further investigation.

Electron beam quality correction factors for plane-parallel ionization chambers: Monte Carlo calculations using the PENELOPE system.

Simulations of three plane-parallel ionization chambers have been used to determine directly the chamber- and quality-dependent factors fc,Q, instead of the product (Sw,air p)Q, and kQ,Q0 (or kQ,Q,int) for a broad range of electron beam qualities (4-20 MeV) using divergent monoenergetic beams and phase-space data from two accelerators. An original calculation method has been used which circumvents the weakness of the so far assumed independence between stopping-power ratios and perturbation factors. Very detailed descriptions of the geometry and materials of the chambers have been obtained from the manufacturers, and prepared as input to the PENELOPE 2003 Monte Carlo system using a computer code that includes correlated sampling and particle splitting. Values of the beam quality factors have been determined for the case of an electron reference beam. The calculated values have been compared with those in the IAEA TRS-398 dosimetry protocol and the differences analysed. The results for a NACP-02 chamber show remarkably good agreement with TRS-398 at high electron beam qualities but differ slightly at low energies. Arguments to explain the differences include questioning the undemonstrated assumption that the NACP is a 'perturbation-free' chamber even at very low electron beam energies. Results for Wellhöfer PPC-40 and PPC-05 chambers cannot be compared with data from others for these chambers because no calculations or reliable experimental data exist. It has been found that the results for the PPC-40 are very close to those of a Roos chamber, but the values for the PPC-05 are considerably different from those of a Markus chamber, and rather approach those of a Roos chamber. Results for monoenergetic electrons and accelerator phase-space data have been compared to assess the need for detailed and costly simulations, finding very small differences. This questions the emphasis given in recent years to the use of 'realistic' source data for accurate electron beam dosimetry.

Morphometric and histological changes in the vascular wall after external radiation for the prevention of intimal hyperplasia.

BACKGROUND: Recent reports describe spontaneous dissections and aneurysms after coronary and peripheral artery irradiation for the prevention of intimal hyperplasia. We investigated histological changes and the vasomotor reaction in the vascular wall after external radiation for the prevention of intimal hyperplasia in rabbits. MATERIALS AND METHODS: The aorta was experimentally injured in 34 rabbits who were then assigned to one of three groups: irradiation with 20 Gy; with 25 Gy; and a control group with no irradiation. Before the arterial injury and 45 days later, vasomotor function was assessed with an intravascular ultrasound catheter. The aorta was resected for morphometric and histological studies. RESULTS: After injury and irradiation, vasomotor responses were significantly lower in the two irradiated groups (P < 0.05). Intimal thickness and the intima/media ratio were significantly lower in irradiated groups. In the irradiated group histological examination showed reduced intimal proliferation with an intact endothelium. In the 20-Gy irradiated group the vascular media contained necrotic areas, and in the 25-Gy irradiated group, severe fibrosis. CONCLUSION: After arterial injury, external irradiation at 20 and 25 Gy effectively reduces aortic intimal and medial thickening. Histological changes include recasting with necrosis and fibrosis causing a decreased vasomotor response. Further investigations are needed to confirm medial necrosis and replacement with fibrosis. Because the irradiation doses in this study match those currently used and also recommended for experimental and clinical use, if confirmed in humans parietal recasting might possibly explain the reported spontaneous dissections and aneurysm formation after irradiation.