Brachytherapy treatment verification using gamma radiation from the internal treatment source combined with an imaging panel-a phantom study.

Brachytherapy has an excellent clinical outcome for different treatment sites. However,in vivotreatment verification is not performed in the majority of hospitals due to the lack of proper monitoring systems. This study investigates the use of an imaging panel (IP) and the photons emitted by a high dose rate (HDR)192Ir source to track source motion and obtain some information related to the patient anatomy. The feasibility of this approach was studied by monitoring the treatment delivery to a 3D printed phantom that mimicks a prostate patient. A 3D printed phantom was designed with a template for needle insertion, a cavity ('rectum') to insert an ultrasound probe, and lateral cavities used to place tissue-equivalent materials. CT images were acquired to create HDR192Ir treatment plans with a range of dwell times, interdwell distances and needle arrangements. Treatment delivery was verified with an IP placed at several positions around the phantom using radiopaque markers on the outer surface to register acquired IP images with the planning CT. All dwell positions were identified using acquisition times ≤0.11 s (frame rates ≥ 9 fps). Interdwell distances and dwell positions (in relation to the IP) were verified with accuracy better than 0.1 cm. Radiopaque markers were visible in the acquired images and could be used for registration with CT images. Uncertainties for image registration (IP and planning CT) between 0.1 and 0.4 cm. The IP is sensitive to tissue-mimicking insert composition and showed phantom boundaries that could be used to improve treatment verification. The IP provided sufficient time and spatial resolution for real-time source tracking and allows for the registration of the planning CT and IP images. The results obtained in this study indicate that several treatment errors could be detected including swapped catheters, incorrect dwell times and dwell positions.

A comparison study between single- and dual-energy CT density extraction methods for neurological proton monte carlo treatment planning.

Monte Carlo proton dose calculations requires mass densities calculated from the patient CT image. This work investigates the impact of different single-energy CT (SECT) and dual-energy CT (DECT) to density conversion methods in proton dose distributions for brain tumours.Material and methods: Head CT scans for four patients were acquired in SECT and DECT acquisition modes. Commercial software was used to reconstruct DirectDensity™ images in Relative Electron Densities (RED, [Formula: see text]) and to obtain DECT-based pseudo-monoenergetic images (PMI). PMI and SECT images were converted to RED using piecewise linear interpolations calibrated on a head-sized phantom, these fits were referred to as "PMI2RED" and "CT2RED". Two DECT-based calibration methods ("Hünemohr-15it" and "Saito-15it") were also investigated. [Formula: see text] images were converted to mass-densities ([Formula: see text]) to investigate [Formula: see text]differences and one representative patient case was used to make a proton treatment plan. Using CT2RED as reference method, dose distribution differences in the target and in five organs-at-risk (OARs) were quantified.Results: In the phantom study, Saito-15it and Hünemohr-15it produced the lowest [Formula: see text]root-mean-square error (0.7%) and DirectDensity™ the highest error (2.7%). The proton plan evaluated in the Saito-15it and Hünemohr-15it datasets showed the largest relative differences compared to initial CT2RED plan down to -6% of the prescribed dose. Compared to CT2RED, average range differences were calculated: -0.1 ± 0.3 mm for PMI2RED; -0.8 ± 0.4 mm for Hünemohr-15it, and -1.2 ± 0.4 mm for Saito-15it.Conclusion: Given the wide choice of available conversion methods, studies investigating the density accuracy for proton dose calculations are necessary. However, there is still a gap between performing accuracy studies in reference [Formula: see text]phantoms and applying these methods in human CT images. For this treatment case, the PMI2RED method was equivalent to the conventional CT2RED method in terms of dose distribution, CTV coverage and OAR sparing, whereas Hünemohr-15it and Saito-15it presented the largest differences.

Automatic Quality Assessment of Transperineal Ultrasound Images of the Male Pelvic Region, Using Deep Learning.

Ultrasound guidance is not in widespread use in prostate cancer radiotherapy workflows. This can be partially attributed to the need for image interpretation by a trained operator during ultrasound image acquisition. In this work, a one-class regressor, based on DenseNet and Gaussian processes, was implemented to automatically assess the quality of transperineal ultrasound images of the male pelvic region. The implemented deep learning approach was tested on 300 transperineal ultrasound images and it achieved a scoring accuracy of 94%, a specificity of 95% and a sensitivity of 92% with respect to the majority vote of 3 experts, which was comparable with the results of these experts. This is the first step toward a fully automatic workflow, which could potentially remove the need for ultrasound image interpretation and make real-time volumetric organ tracking in the radiotherapy environment using ultrasound more appealing.

The Accessory muscles of the Axilla.

The axilla is a region of clinical and surgical importance with plenty of anatomical variations. One of these is the presence of accessory muscles. The literature was reviewed in order to identify the different supernumerary muscles that are described in the axilla. Variant muscle slips arising from the pectoral muscle or latissimus dorsi muscle have been described. There still remains controversy regarding the phylogenetic origin of these different muscles. We described the most frequently reported muscles, their origin, and course. Further research is required regarding the innervation and influence on glenohumeral and scapulothoracic kinematics.

Dose distribution for gynecological brachytherapy with dose accumulation between insertions: Feasibility study.

PURPOSE: For gynecological treatments, it is standard to acquire CT images and preferably also MR images before each treatment to calculate the dose of the day. The dose of the complete treatment is calculated by adding the dose metrics of each fraction. It makes the conservative assumption that the same part of the organs at risk always receives the highest dose. The dose calculated this way often limits the prescription dose or the target coverage. We investigated the use of deformable image registration (DIR) as an alternative method to assess the cumulative dose for a treatment course. METHODS AND MATERIALS: Rigid registration is preformed on CT images, followed by DIR. DIR can be based either solely on the three-dimensional images or combined with organ contours. To improve DIR in the pelvic region with low CT contrast, we propose (1) using contours drawn on CT or (2) modifying artificially the contrast in certain volumes. The dose matrix from fraction_n (n > 1) is deformed using a calculated deformation field. RESULTS: The use of the contrast-enhanced images or of contour information helps to guide the DIR. However, because of the very high dose gradients involved in brachytherapy, the uncertainty on the accumulated dose remains of the order of 5-10%. Even for good contour matching, a small local error in the deformation can have significant consequences for the dose distribution. CONCLUSIONS: Using DIR, based on image features and contours, allows to accumulate the dose from different brachytherapy fractions. A robust validation procedure should be developed.

Time-Resolved Versus Integrated Transit Planar Dosimetry for Volumetric Modulated Arc Therapy: Patient-Specific Dose Differences During Treatment, a Proof of Principle.

PURPOSE: It is desirable that dosimetric deviations during radiation treatments are detected. Integrated transit planar dosimetry is commonly used to evaluate external beam treatments such as volumetric-modulated arc therapy. This work focuses on patient geometry changes which result in differences between the planned and the delivered radiation dose. Integrated transit planar dosimetry will average out some deviations. Novel time-resolved transit planar dosimetry compares the delivered dose of volumetric-modulated arc therapy to the planned dose at various time points. Four patient cases are shown where time-resolved transit planar dosimetry detects patient geometry changes during treatment. METHODS: A control point to control point comparison between the planned dose and the treatment dose of volumetric-modulated arc therapy beams is calculated using the planning computed tomography and the kV cone-beam computed tomography of the day and evaluated with a time-resolved γ function. Results were computed for 4 patients treated with volumetric-modulated arc therapy, each showing an anatomical change: pleural effusion, rectal gas pockets, and tumor regression. RESULTS: In all cases, the geometrical change was detected by time-resolved transit planar dosimetry, whereas integrated transit planar dosimetry showed minor or no indication of the dose discrepancy. Both tumor regression cases were detected earlier in the treatment with time-resolved planar dosimetry in comparison to integrated transit planar dosimetry. The pleural effusion and the gas pocket were detected exclusively with time-resolved transit planar dosimetry. CONCLUSIONS: Clinical cases were presented in this proof-of-principle study in which integrated transit planar dosimetry did not detect dosimetrically relevant deviations to the same extent time-resolved transit planar dosimetry was able to. Time-resolved transit planar dosimetry also provides results that can be presented as a function of arc delivery angle allowing easier interpretation compared to integrated transit planar dosimetry.

Monte Carlo study on the sensitivity of prompt gamma imaging to proton range variations due to interfractional changes in prostate cancer patients.

Proton range verification based on prompt gamma imaging is increasingly considered in proton therapy. Tissue heterogeneity normal to the beam direction or near the end of range may considerably degrade the ability of prompt gamma imaging to detect proton range shifts. The goal of this study was to systematically investigate the accuracy and precision of range detection from prompt gamma emission profiles for various fractions for intensity modulated proton therapy of prostate cancer, using a comprehensive clinical dataset of 15 different CT scans for 5 patients. Monte Carlo simulations using Geant4 were performed to generate spot-by-spot dose distributions and prompt gamma emission profiles for prostate treatment plans. The prompt gammas were scored at their point of emission. Three CT scans of the same patient were used to evaluate the impact of inter-fractional changes on proton range. The range shifts deduced from the comparison of prompt gamma emission profiles in the planning CT and subsequent CTs were then correlated to the corresponding range shifts deduced from the dose distributions for individual pencil beams. The distributions of range shift differences between prompt gamma and dose were evaluated in terms of precision (defined as half the 95% inter-percentile range IPR) and accuracy (median). In total about 1700 individual proton pencil beams were investigated. The IPR of the relative range shift differences between the dose profiles and the prompt gamma profiles varied between ±1.4 mm and ±2.9 mm when using the more robust profile shifting analysis. The median was found smaller than 1 mm. Methods to identify and reject unreliable spots for range verification due to range mixing were derived and resulted in an average 10% spot rejection, clearly improving the prompt gamma-dose correlation. This work supports that prompt gamma imaging can offer a reliable indicator of range changes due to anatomical variations and tissue heterogeneity in scanning proton treatment of prostate cancer patients when considering prompt gamma emission profiles.

Efficient scatter distribution estimation and correction in CBCT using concurrent Monte Carlo fitting.

PURPOSE: X-ray scatter is a significant impediment to image quality improvements in cone-beam CT (CBCT). The authors present and demonstrate a novel scatter correction algorithm using a scatter estimation method that simultaneously combines multiple Monte Carlo (MC) CBCT simulations through the use of a concurrently evaluated fitting function, referred to as concurrent MC fitting (CMCF). METHODS: The CMCF method uses concurrently run MC CBCT scatter projection simulations that are a subset of the projection angles used in the projection set, P, to be corrected. The scattered photons reaching the detector in each MC simulation are simultaneously aggregated by an algorithm which computes the scatter detector response, SMC. SMC is fit to a function, SF, and if the fit of SF is within a specified goodness of fit (GOF), the simulations are terminated. The fit, SF, is then used to interpolate the scatter distribution over all pixel locations for every projection angle in the set P. The CMCF algorithm was tested using a frequency limited sum of sines and cosines as the fitting function on both simulated and measured data. The simulated data consisted of an anthropomorphic head and a pelvis phantom created from CT data, simulated with and without the use of a compensator. The measured data were a pelvis scan of a phantom and patient taken on an Elekta Synergy platform. The simulated data were used to evaluate various GOF metrics as well as determine a suitable fitness value. The simulated data were also used to quantitatively evaluate the image quality improvements provided by the CMCF method. A qualitative analysis was performed on the measured data by comparing the CMCF scatter corrected reconstruction to the original uncorrected and corrected by a constant scatter correction reconstruction, as well as a reconstruction created using a set of projections taken with a small cone angle. RESULTS: Pearson's correlation, r, proved to be a suitable GOF metric with strong correlation with the actual error of the scatter fit, SF. Fitting the scatter distribution to a limited sum of sine and cosine functions using a low-pass filtered fast Fourier transform provided a computationally efficient and accurate fit. The CMCF algorithm reduces the number of photon histories required by over four orders of magnitude. The simulated experiments showed that using a compensator reduced the computational time by a factor between 1.5 and 1.75. The scatter estimates for the simulated and measured data were computed between 35-93 s and 114-122 s, respectively, using 16 Intel Xeon cores (3.0 GHz). The CMCF scatter correction improved the contrast-to-noise ratio by 10%-50% and reduced the reconstruction error to under 3% for the simulated phantoms. CONCLUSIONS: The novel CMCF algorithm significantly reduces the computation time required to estimate the scatter distribution by reducing the statistical noise in the MC scatter estimate and limiting the number of projection angles that must be simulated. Using the scatter estimate provided by the CMCF algorithm to correct both simulated and real projection data showed improved reconstruction image quality.

Small animal image-guided radiotherapy: status, considerations and potential for translational impact.

Radiation biology is being transformed by the implementation of small animal image-guided precision radiotherapy into pre-clinical research programmes worldwide. We report on the current status and developments of the small animal radiotherapy field, suggest criteria for the design and execution of effective studies and contend that this powerful emerging technology, used in combination with relevant small animal models, holds much promise for translational impact in radiation oncology.

Factors influencing the accuracy of beam range estimation in proton therapy using prompt gamma emission.

In-vivo imaging is a strategy to monitor the range of protons inside the patient during radiation treatment. A possible method of in-vivo imaging is detection of secondary 'prompt' gamma (PG) photons outside the body, which are produced by inelastic proton-nuclear interactions inside the patient. In this paper, important parameters influencing the relationship between the PG profile and percentage depth dose (PDD) in a uniform cylindrical phantom are explored. Monte Carlo simulations are performed with the new Geant4 based code TOPAS for mono-energetic proton pencil beams (range: 100-250 MeV) and an idealized PG detector. PG depth profiles are evaluated using the inflection point on a sigmoid fit in the fall-off region of the profile. A strong correlation between the inflection point and the proton range determined from the PDD is found for all conditions. Variations between 1.5 mm and 2.7 mm in the distance between the proton range and the inflection point are found when either the mass density, phantom diameter, or detector acceptance angle is changed. A change in cut-off energy of the detector could induce a range difference of maximum 4 mm. Applying time-of-flight discrimination during detection, changing the primary energy of the beam or changing the elemental composition of the tissue affects the accuracy of the range prediction by less than 1 mm. The results indicate that the PG signal is rather robust to many parameter variations, but millimetre accurate range monitoring requires all medium and detector properties to be carefully taken into account.

Multi-institutional dosimetric and geometric commissioning of image-guided small animal irradiators.

PURPOSE: To compare the dosimetric and geometric properties of a commercial x-ray based image-guided small animal irradiation system, installed at three institutions and to establish a complete and broadly accessible commissioning procedure. METHODS: The system consists of a 225 kVp x-ray tube with fixed field size collimators ranging from 1 to 44 mm equivalent diameter. The x-ray tube is mounted opposite a flat-panel imaging detector, on a C-arm gantry with 360° coplanar rotation. Each institution performed a full commissioning of their system, including half-value layer, absolute dosimetry, relative dosimetry (profiles, percent depth dose, and relative output factors), and characterization of the system geometry and mechanical flex of the x-ray tube and detector. Dosimetric measurements were made using Farmer-type ionization chambers, small volume air and liquid ionization chambers, and radiochromic film. The results between the three institutions were compared. RESULTS: At 225 kVp, with 0.3 mm Cu added filtration, the first half value layer ranged from 0.9 to 1.0 mm Cu. The dose-rate in-air for a 40 × 40 mm(2) field size, at a source-to-axis distance of 30 cm, ranged from 3.5 to 3.9 Gy/min between the three institutions. For field sizes between 2.5 mm diameter and 40 × 40 mm(2), the differences between percent depth dose curves up to depths of 3.5 cm were between 1% and 4% on average, with the maximum difference being 7%. The profiles agreed very well for fields >5 mm diameter. The relative output factors differed by up to 6% for fields larger than 10 mm diameter, but differed by up to 49% for fields ≤5 mm diameter. The mechanical characteristics of the system (source-to-axis and source-to-detector distances) were consistent between all three institutions. There were substantial differences in the flex of each system. CONCLUSIONS: With the exception of the half-value layer, and mechanical properties, there were significant differences between the dosimetric and geometric properties of the three systems. This underscores the need for careful commissioning of each individual system for use in radiobiological experiments.

The contribution from transit dose for (192)Ir HDR brachytherapy treatments.

Brachytherapy treatment planning systems that use model-based dose calculation algorithms employ a more accurate approach that replaces the TG43-U1 water dose formalism and adopt the TG-186 recommendations regarding composition and geometry of patients and other relevant effects. However, no recommendations were provided on the transit dose due to the source traveling inside the patient. This study describes a methodology to calculate the transit dose using information from the treatment planning system (TPS) and considering the source's instantaneous and average speed for two prostate and two gynecological cases. The trajectory of the (192)Ir HDR source was defined by importing applicator contour points and dwell positions from the TPS. The transit dose distribution was calculated using the maximum speed, the average speed and uniform accelerations obtained from the literature to obtain an approximate continuous source distribution simulated with a Monte Carlo code. The transit component can be negligible or significant depending on the speed profile adopted, which is not clearly reported in the literature. The significance of the transit dose can also be due to the treatment modality; in our study interstitial treatments exhibited the largest effects. Considering the worst case scenario the transit dose can reach 3% of the prescribed dose in a gynecological case with four catheters and up to 11.1% when comparing the average prostate dose for a case with 16 catheters. The transit dose component increases by increasing the number of catheters used for HDR brachytherapy, reducing the total dwell time per catheter or increasing the number of dwell positions with low dwell times. This contribution may become significant (>5%) if it is not corrected appropriately. The transit dose cannot be completely compensated using simple dwell time corrections since it may have a non-uniform distribution. An accurate measurement of the source acceleration and maximum speed should be incorporated in clinical practice or provided by the manufacturer to determine the transit dose component with high accuracy.

Spatial frequency spectrum of the x-ray scatter distribution in CBCT projections.

PURPOSE: X-ray scatter is a source of significant image quality loss in cone-beam computed tomography (CBCT). The use of Monte Carlo (MC) simulations separating primary and scattered photons has allowed the structure and nature of the scatter distribution in CBCT to become better elucidated. This work seeks to quantify the structure and determine a suitable basis function for the scatter distribution by examining its spectral components using Fourier analysis. METHODS: The scatter distribution projection data were simulated using a CBCT MC model based on the EGSnrc code. CBCT projection data, with separated primary and scatter signal, were generated for a 30.6 cm diameter water cylinder [single angle projection with varying axis-to-detector distance (ADD) and bowtie filters] and two anthropomorphic phantoms (head and pelvis, 360 projections sampled every 1°, with and without a compensator). The Fourier transform of the resulting scatter distributions was computed and analyzed both qualitatively and quantitatively. A novel metric called the scatter frequency width (SFW) is introduced to determine the scatter distribution's frequency content. The frequency content results are used to determine a set basis functions, consisting of low-frequency sine and cosine functions, to fit and denoise the scatter distribution generated from MC simulations using a reduced number of photons and projections. The signal recovery is implemented using Fourier filtering (low-pass Butterworth filter) and interpolation. Estimates of the scatter distribution are used to correct and reconstruct simulated projections. RESULTS: The spatial and angular frequencies are contained within a maximum frequency of 0.1 cm(-1) and 7/(2π) rad(-1) for the imaging scenarios examined, with these values varying depending on the object and imaging setup (e.g., ADD and compensator). These data indicate spatial and angular sampling every 5 cm and π/7 rad (~25°) can be used to properly capture the scatter distribution, with reduced sampling possible depending on the imaging scenario. Using a low-pass Butterworth filter, tuned with the SFW values, to denoise the scatter projection data generated from MC simulations using 10(6) photons resulted in an error reduction of greater than 85% for the estimating scatter in single and multiple projections. Analysis showed that the use of a compensator helped reduce the error in estimating the scatter distribution from limited photon simulations by more than 37% when compared to the case without a compensator for the head and pelvis phantoms. Reconstructions of simulated head phantom projections corrected by the filtered and interpolated scatter estimates showed improvements in overall image quality. CONCLUSIONS: The spatial frequency content of the scatter distribution in CBCT is found to be contained within the low frequency domain. The frequency content is modulated both by object and imaging parameters (ADD and compensator). The low-frequency nature of the scatter distribution allows for a limited set of sine and cosine basis functions to be used to accurately represent the scatter signal in the presence of noise and reduced data sampling decreasing MC based scatter estimation time. Compensator induced modulation of the scatter distribution reduces the frequency content and improves the fitting results.

Interfractional trend analysis of dose differences based on 2D transit portal dosimetry.

Dose delivery of a radiotherapy treatment can be influenced by a number of factors. It has been demonstrated that the electronic portal imaging device (EPID) is valuable for transit portal dosimetry verification. Patient related dose differences can emerge at any time during treatment and can be categorized in two types: (1) systematic-appearing repeatedly, (2) random-appearing sporadically during treatment. The aim of this study is to investigate how systematic and random information appears in 2D transit dose distributions measured in the EPID plane over the entire course of a treatment and how this information can be used to examine interfractional trends, building toward a methodology to support adaptive radiotherapy. To create a trend overview of the interfractional changes in transit dose, the predicted portal dose for the different beams is compared to a measured portal dose using a γ evaluation. For each beam of the delivered fraction, information is extracted from the γ images to differentiate systematic from random dose delivery errors. From the systematic differences of a fraction for a projected anatomical structures, several metrics are extracted like percentage pixels with |γ| > 1. We demonstrate for four example cases the trends and dose difference causes which can be detected with this method. Two sample prostate cases show the occurrence of a random and systematic difference and identify the organ that causes the difference. In a lung cancer case a trend is shown of a rapidly diminishing atelectasis (lung fluid) during the course of treatment, which was detected with this trend analysis method. The final example is a breast cancer case where we show the influence of set-up differences on the 2D transit dose. A method is presented based on 2D portal transit dosimetry to record dose changes throughout the course of treatment, and to allow trend analysis of dose discrepancies. We show in example cases that this method can identify the causes of dose delivery differences and that treatment adaptation can be triggered as a result. It provides an important element toward informed decision-making for adaptive radiotherapy.

ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy.

Task group 43 (TG43)-based dosimetry algorithms are efficient for brachytherapy dose calculation in water. However, human tissues have chemical compositions and densities different than water. Moreover, the mutual shielding effect of seeds on each other (interseed attenuation) is neglected in the TG43-based dosimetry platforms. The scientific community has expressed the need for an accurate dosimetry platform in brachytherapy. The purpose of this paper is to present ALGEBRA, a Monte Carlo platform for dosimetry in brachytherapy which is sufficiently fast and accurate for clinical and research purposes. ALGEBRA is based on the GEANT4 Monte Carlo code and is capable of handling the DICOM RT standard to recreate a virtual model of the treated site. Here, the performance of ALGEBRA is presented for the special case of LDR brachytherapy in permanent prostate and breast seed implants. However, the algorithm is also capable of handling other treatments such as HDR brachytherapy.

In vivo dosimetry for gynaecological brachytherapy using a novel position sensitive radiation detector: feasibility study.

PURPOSE: In gynecological radiotherapy with high dose rate (HDR)(192)Ir brachytherapy, the treatment complexity has increased due to improved optimization techniques and dose constraints. As a consequence, it has become more important to verify the dose delivery to the target and also to the organs at risk (e.g., the bladder). In vivo dosimetry, where dosimeters are placed in or on the patient, is one way of verifying the dose but until recently this was hampered by motion of the radiation detectors with respect to the source. The authors present a novel dosimetry method using a position sensitive radiation detector. METHODS: The prototype RADPOS system (Best Medical Canada) consists of a metal oxide field effect transistor (MOSFET) dosimeter coupled to a position-sensor, which deduces its 3D position in a magnetic field. To assess the feasibility of in vivo dosimetry based on the RADPOS system, different characteristics of the detector need to be investigated. Using a PMMA phantom, the positioning accuracy of the RADPOS system was quantified by comparing position readouts with the known position of the detector along the x and y-axes. RADPOS dose measurements were performed at various distances from a Nucletron(192)Ir source in a PMMA phantom to evaluate the energy dependence of the MOSFET. A sensitivity analysis was performed by calculating the dose after varying (1) the position of the RADPOS detector to simulate organ motion and (2) the position of the first dwell position to simulate errors in delivery. The authors also performed an uncertainty analysis to determine the action level (AL) that should be used during in vivo dosimetry. RESULTS: Positioning accuracy is found to be within 1 mm in the 1-10 cm range from the origin along the x-axis (away from the transmitter), meeting the requirements for in vivo dosimetry. Similar results are obtained for the other axes. The ALs are chosen to take into account the total uncertainty on the measurements. As a consequence for in vivo dosimetry, it is determined that the RADPOS sensor, if placed, for example, in the bladder Foley balloon, would detect a 2 mm motion of the bladder, at a 5% chance of a false positive, with an AL limit of 9% of the dose delivered. The authors found that source position errors, caused by, e.g., a wrong first dwell position, are more difficult to detect; indeed, with our single RADPOS detector, positioned in the bladder, dwell position errors below 5 mm and resulting in a dose error within 10%, could be detected in the tandem but not in the colpostats. A possible solution to improve error detection is to use multiple MOSFETs to obtain multiple dose values. CONCLUSIONS: In this study, the authors proposed a dosimetry procedure, based on the novel RADPOS system, to accurately determine the position of the radiation dosimeter with respect to the applicator. The authors found that it is possible to monitor the delivered dose in a point and compare it to the predetermined dose. This allows in principle the detection of problems such as bladder motion/filling or source mispositioning. Further clinical investigation is warranted.

Monte Carlo calculations of positron emitter yields in proton radiotherapy.

Positron emission tomography (PET) is a promising tool for monitoring the three-dimensional dose distribution in charged particle radiotherapy. PET imaging during or shortly after proton treatment is based on the detection of annihilation photons following the ß(+)-decay of radionuclides resulting from nuclear reactions in the irradiated tissue. Therapy monitoring is achieved by comparing the measured spatial distribution of irradiation-induced ß(+)-activity with the predicted distribution based on the treatment plan. The accuracy of the calculated distribution depends on the correctness of the computational models, implemented in the employed Monte Carlo (MC) codes that describe the interactions of the charged particle beam with matter and the production of radionuclides and secondary particles. However, no well-established theoretical models exist for predicting the nuclear interactions and so phenomenological models are typically used based on parameters derived from experimental data. Unfortunately, the experimental data presently available are insufficient to validate such phenomenological hadronic interaction models. Hence, a comparison among the models used by the different MC packages is desirable. In this work, starting from a common geometry, we compare the performances of MCNPX, GATE and PHITS MC codes in predicting the amount and spatial distribution of proton-induced activity, at therapeutic energies, to the already experimentally validated PET modelling based on the FLUKA MC code. In particular, we show how the amount of ß(+)-emitters produced in tissue-like media depends on the physics model and cross-sectional data used to describe the proton nuclear interactions, thus calling for future experimental campaigns aiming at supporting improvements of MC modelling for clinical application of PET monitoring.

SU-E-J-195: Dosimetric Consequences of Metal Prosthesis in Prostate 3D CRT by Using Monte Carlo Dose Calculation Method.

PURPOSE: To investigate dosimetric consequences of patient metal prosthesis in prostate radiotherapy, considering the body heterogeneity, metal artifacts, prostate daily displacements and target delineation. METHODS: Three prostate patients with metal prosthesis were simulated with CT images and 3D ultrasound images. Conformal RT treatment plans were generated based on target volumes delineated on CT images without artifact correction (PTVa). The patients' treatments were aided with an ultrasound (US) localization system for daily PTV setup correction. We retrospectively reevaluated the delineation of PTVs by 1) using simulation CT images artifact-corrected by using an algorithm developed by M. Bazalova et al (2007) (PTVc) and 2) using the 3D ultrasound simulation images as guide (PTVus). Daily setup corrections to the PTVs were incorporated to calculate composite delivered dose by using XVMC simulation on the patient phantom derived from the artifact-corrected CT images. DVHs and dose distributions for different PTVs were then compared with the reference treatment plans (XVMC-calculated on the artifact-degraded CT images). RESULTS: The PTVa volume was the largest, about 1.3% larger than artifact-corrected PTVc and 5.2% larger than PTVus. Adapting artifact-corrected CT images can improve the DVH curves of PTVc and increase the D95% and V95% for PTVc by more than 5% while D50% and V50% for rectum and bladder are raised by up to 41.6%. DVH analysis on PTVa and PTVus shows a small difference in the changes of their DVH indices, less than 4% for the studied cases. CONCLUSIONS: The strike artifacts from metal prosthesis will increase the volume of PTVa, and affect the patient dose calculation. Original patient plan did not accurately predict the dose degradation. Artifact correction may be necessary for some cases having severe metal artifacts. Using US images to help delineating PTV makes a negligible clinical significance.

SU-F-BRCD-04: Efficient Scatter Distribution Estimation and Correction in CBCT Using Concurrent Monte Carlo Fitting.

PURPOSE: X-ray scatter is a known source of image artifacts, contrast reduction, and CT number inaccuracy in cone-beam CT (CBCT). We present and demonstrate the performance of a novel scatter correction method based on an algorithm that simultaneously combines multiple Monte Carlo (MC) CBCT scatter simulations through the use of a fitting function. METHODS AND MATERIALS: The scatter estimation system consists of concurrently run MC CBCT scatter projection simulations that are a sub-sample of the projection angles used in the reconstruction projection set, P, to be corrected. The photons generated by each MC simulation are simultaneously aggregated in an algorithm which computes the scatter detector response, S(i,j,k), for each down-sampled projection location (i,j) and angle (k). S(i,j,k) is fit to a function, FS, and if FS is determined to have a specified goodness of fit value the simulations are terminated. FS is subtracted from P which is subsequently used to create a scatter corrected reconstruction. The scatter correction method was applied to simulated phantoms using a frequency limited sum of sines and cosines as the fitting function. Image quality in the corrected reconstruction was evaluated using metrics looking at contrast, noise, and artifact reduction. RESULTS: Fitting the scatter distribution to a limited sum of sine and cosine functions, using a low-pass filtered Fast Fourier transform, provides a computationally efficient and accurate fit. Scatter distribution estimates for a 360 image projection set were computed in under one minute. The scatter correction algorithm increased the contrast-to-noise ratio by 46%, reduced the shading artifact by 87%, and decreased the skin line artifact by 79% in reconstructions of a simulated pelvis phantom. CONCLUSION: The algorithm provides an efficient method for estimating and removing the scatter distribution in from CBCT projection images. The results on simulated data show a significant increase in image quality.

SU-E-J-51: Interfractional Trend Analysis of Dose Discrepancies Based on 2D Portal Dosimetry.

PURPOSE: During a radiotherapy treatment course the dose delivery can be influenced by a number of factors, e.g. anatomical changes over time. Thiscan Result in discrepancies between planned and delivered dose. The electronic portal imaging device has been demonstrated to be valuable fortransit dosimetry verification. The aim of this study is to investigate theinformation that can be derived from 2D transit portal dosimetry by examining interfractional dose changes over a treatment course. METHODS AND MATERIALS: To create a trend overview of the interfractional changes intransit dose, the predicted portal dose for the different beams is compared to a measured portal dose using a ? EVALUATION: For each beam of the delivered fraction information is extracted from the ? images to differentiatesystematic from random dose delivery errors. From the systematic dose errors of a fraction for different projected contours, derived from the treatment planning contours several metrics are extracted like percentage pixels with ? exceeding unity. Finally the extracted metrics from each contour and beam are weighted with beam weight and the average andstandard deviation are calculated, resulting in a fraction Result. For this study, we analyzed 6 lung cancer patients and 20 prostate cancer patients. RESULTS: In some prostate cases the rectal filling was causing the dose delivery problems. For the lung cancer patients, anatomy changes from the diminishing atelectasis caused a transit dose difference and adaptations to the plan were applied. CONCLUSION: We have shown that from interfractional trend overview valuable information can be derived. However, to use this for adaptive radiotherapy, 2D transit dose differences with this methodshould be correlated with the 3D delivered dose, to define decision criteria.By optimizing these decision criteria it should be possible to prevent eitherover or under dosage of the tumor or OARs.