Multi-center planning study of radiosurgery for intracranial metastases through Automation (MC-PRIMA) by crowdsourcing prior web-based plan challenge study.

BACKGROUND: Planning radiosurgery to multiple intracranial metastases is complex and shows large variability in dosimetric quality among planners and treatment planning systems (TPS). This project aimed to determine whether autoplanning using the Muliple Brain Mets (AutoMBM) software can improve plan quality and reduce inter-planner variability by crowdsourcing results from prior international planning study. METHODS: Twenty-four institutions autoplanned with AutoMBM on a five metastases case from a prior international planning competition from which population statistics (means and variances) of 23 dosimetric metrics and resulting composite plan score (maximum score = 150) of other TPS (Eclipse, Monaco, RayStation, iPlan, GammaPlan, MultiPlan) were crowdsourced. Plan results of AutoMBM and each of the other TPS were compared using two sample t-tests for means and Levene's tests for variances. Plan quality of AutoMBM was correlated with the planner' experience and compared between academic and non-academic centers. RESULTS: AutoMBM produced plans with comparable composite plan score to GammaPlan, MultiPlan, Eclipse and iPlan (127.6 vs. 131.7 vs. 127.3 vs. 127.3 and 126.7; all p > 0.05) and superior to Monaco and RayStation (118.3 and 108.6; both p < 0.05). Inter-planner variability of overall plan quality was lowest for AutoMBM among all TPS (all p < 0.05). AutoMBM's plan quality did not differ between academic and non-academic centers and uncorrelated with planning experience (all p > 0.05). CONCLUSIONS: By plan crowdsourcing prior international plan challenge, AutoMBM produces high and consistent plan quality independent of the planning experience and the institution that is crucial to addressing the technical bottleneck of SRS to intracranial metastases.

Assessment of radiation protection of patients and staff in interventional procedures in four Algerian hospitals.

This study was aimed to assess patient dosimetry in interventional cardiology (IC) and radiology (IR) and radiation safety of the medical operating staff. For this purpose, four major Algerian hospitals were investigated. The data collected cover radiation protection tools assigned to the operating staff and measured radiation doses to some selected patient populations. The analysis revealed that lead aprons are systematically worn by the staff but not lead eye glasses, and only a single personal monitoring badge is assigned to the operating staff. Measured doses to patients exhibited large variations in the maximum skin dose (MSD) and in the dose area product (DAP). The mean MSD registered values are as follows: 0.20, 0.14 and 1.28 Gy in endoscopic retrograde cholangiopancreatography (ERCP), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures, respectively. In PTCA, doses to 3 out of 22 patients (13.6 %) had even reached the threshold value of 2 Gy. The mean DAP recorded values are as follows: 21.6, 60.1 and 126 Gy cm(2) in ERCP, CA and PTCA procedures, respectively. Mean fluoroscopic times are 2.5, 5 and 15 min in ERCP, CA and PTCA procedures, respectively. The correlation between DAP and MSD is fair in CA (r = 0.62) and poor in PTCA (r = 0.28). Fluoroscopic time was moderately correlated with DAP in CA (r = 0.55) and PTCA (r = 0.61) procedures. Local diagnostic reference levels (DRLs) in CA and PTCA procedures have been proposed. In conclusion, this study stresses the need for a continuous patient dose monitoring in interventional procedures with a special emphasis in IC procedures. Common strategies must be undertaken to substantially reduce radiation doses to both patients and medical staff.

Monte Carlo photon beam modeling and commissioning for radiotherapy dose calculation algorithm.

The aim of the present work was a Monte Carlo verification of the Multi-grid superposition (MGS) dose calculation algorithm implemented in the CMS XiO (Elekta) treatment planning system and used to calculate the dose distribution produced by photon beams generated by the linear accelerator (linac) Siemens Primus. The BEAMnrc/DOSXYZnrc (EGSnrc package) Monte Carlo model of the linac head was used as a benchmark. In the first part of the work, the BEAMnrc was used for the commissioning of a 6 MV photon beam and to optimize the linac description to fit the experimental data. In the second part, the MGS dose distributions were compared with DOSXYZnrc using relative dose error comparison and γ-index analysis (2%/2 mm, 3%/3 mm), in different dosimetric test cases. Results show good agreement between simulated and calculated dose in homogeneous media for square and rectangular symmetric fields. The γ-index analysis confirmed that for most cases the MGS model and EGSnrc doses are within 3% or 3 mm.

Experimental evaluation of PCXMC and prepare codes used in conventional radiology.

The objective of this study is to evaluate the precision of dose-calculation computer codes used in our laboratory (PCXMC and PREPARE) for organ dose evaluation. Measurements of entrance and organ dose were performed using ionisation chamber and thermoluminescence dosimetry. To obtain a mean dose of organ, we have used the Rando-Alderson phantom. The results showed that computed and measured doses correlate well (within 28%) in 60% of the samples. The percentage shows that the computed doses correlate with the experimental doses rather well for PCXMC software than PREPARE. Although the two programs are based on the Monte-Carlo method, their calculations differ. PCXMC carries out a simulation of the trajectory of the photon, whereas PREPARE provides interpolated values. Our experimental results are close to the values given by the PCXMC, a program which takes into account the weight, the height of the patient and field dimensions.