The geometric and dosimetric accuracy of kilovoltage cone beam computed tomography images for adaptive treatment: a systematic review.

Objectives: To provide an overview and meta-analysis of different techniques adopted to accomplish kVCBCT for dose calculation and automated segmentation. Methods: A systematic review and meta-analysis were performed on eligible studies demonstrating kVCBCT-based dose calculation and automated contouring of different tumor features. Meta-analysis of the performance was accomplished on the reported γ analysis and dice similarity coefficient (DSC) score of both collected results as three subgroups (head and neck, chest, and abdomen). Results: After the literature scrutinization (n = 1008), 52 papers were recognized for the systematic review. Nine studies of dosimtric studies and eleven studies of geometric analysis were suitable for inclusion in meta-analysis. Using kVCBCT for treatment replanning depends on a method used. Deformable Image Registration (DIR) methods yielded small dosimetric error (≤2%), γ pass rate (≥90%) and DSC (≥0.8). Hounsfield Unit (HU) override and calibration curve-based methods also achieved satisfactory yielded small dosimetric error (≤2%) and γ pass rate ((≥90%), but they are prone to error due to their sensitivity to a vendor-specific variation in kVCBCT image quality. Conclusions: Large cohorts of patients ought to be undertaken to validate methods achieving low levels of dosimetric and geometric errors. Quality guidelines should be established when reporting on kVCBCT, which include agreed metrics for reporting on the quality of corrected kVCBCT and defines protocols of new site-specific standardized imaging used when obtaining kVCBCT images for adaptive radiotherapy. Advances in knowledge: This review gives useful knowledge about methods making kVCBCT feasible for kVCBCT-based adaptive radiotherapy, simplifying patient pathway and reducing concomitant imaging dose to the patient.

Evaluation of Anticancer and Cytotoxic Effects of Genistein on PC3 Prostate Cell Line under Three-Dimensional Culture Medium

Background: Prostate cancer is a major cause of disease and mortality among men. Genistein (GNT) is an isoflavone found naturally in legumes. Isoflavones, a subset of phytoestrogens, are structurally similar to mammalian estrogens. This study aimed to evaluate the anticancer and cytotoxic effects of GNT on PC3 cell line under three dimensional (3D) culture medium. Methods: The 3D culture was created by encapsulating the PC3 cells in alginate hydrogel. MTT assay, neutral red uptake, comet assay, and cytochrome C assay were used to study the anticancer and cytotoxic effects of GNT at 120, 240, and 480 µM concentrations. Also, nitric oxide (NO), catalase, and glutathione assay levels were determined to evaluate the effect of GNT on the cellular stress. The culture medium was used as the negative control. Results: GNT reduced the production of cellular NO and increased the production of catalase and glutathione, confirming the results of the NO test. Evaluation of the toxicity effect of GNT at the concentrations of 120, 240, and 480 µM using comet assay showed that this chemical agent induces apoptosis in PC3 cells in a dose-dependent manner. As the level of cytochrome C in PC3 cells treated with different concentrations of GNT was not significantly different from that of the control, GNT could induce apoptosis in PC3 cells through the non-mitochondrial pathway. Conclusion: The findings of this study disclose that the anticancer effect of GNT on PC3 cells under 3D culture conditions could increase the effectiveness of treatment. Also, the cell survival rate is dependent on GNT concentration.

Neutron contamination in radiotherapy processes: a review study.

Using high-energy photon beams is one of the most practical methods in radiotherapy treatment of cases in deep site located tumors. In such treatments, neutron contamination induced through photoneutron interaction of high energy photons (>8 MeV) with high Z materials of LINAC structures is the most crucial issue which should be considered. Generated neutrons will affect shielding calculations and cause extra doses to the patient and the probability of increase induced secondary cancer risks. In this study, different parameters of neutron production in radiotherapy processes will be reviewed.

Synthesis and evaluation of thermoluminescence properties of ZrO2:Mg for radiotherapy dosimetry.

This study aimed to investigate the thermoluminescent properties of ZrO2:Mg irradiated with a 6 MV X-ray beam and its potential application in radiotherapy dosimetry. ZrO2 powder was synthesized using the sol-gel method and Mg was used as a dopant. Irradiations were performed with ZrO2:Mg chips located at the center of a 10 × 10 cm2 radiation field at a source surface distance of 100 cm, below a stack of solid water slabs, at the depth of maximum absorbed dose. The investigated characteristics of the material included linearity with radiation dose, reproducibility, accuracy, sensitivity and fading. Regarding the intrinsic difference of the samples, the glow curves of the investigated ZrO2:Mg chips exposed to 1 Gy of 6 MV X-rays exhibited three or four peaks. The ZrO2:Mg samples showed a 47% fading at 24 h after irradiation, and the reproducibility of the thermoluminescence reading of ZrO2:Mg for equal irradiation conditions was ± 21%. The thermoluminescence response of the investigated ZrO2:Mg samples to various absorbed doses from 0.5 to 2.5 Gy showed a gentle increase of the thermoluminescence intensity with increasing absorbed dose. The obtained results show that ZrO2:Mg is not an appropriate candidate for X-ray photons in radiotherapy, due to low thermoluminescence peak temperature, low reproducibility, low sensitivity to various absorbed doses and significant fading.

Evaluating the effects of metal artifacts on dose distribution of the pelvic region.

AIM OF THE STUDY: Some cancerous patients have hip prosthesis of metal elements when they undergo radiation therapy. Metal implants are a cause of metal artifacts in computed tomography (CT) images due to their higher density compared to normal tissues. The aim of this study is to evaluate the quantitative effects of metal artifacts on dose distribution of the pelvic region. MATERIALS AND METHODS: Seven patients with metal implants in the pelvic region were scanned and CT images were exported to the Monaco treatment planning system. Based on the diagnosis of each patient, three-dimensional plans were implemented on CT images and dose distributions were extracted. At the next step, metal artifacts were contoured and electron densities of these new structures were modified to the extent of soft tissue. Finally, dose distributions and the differences were investigated by VeriSoft software. RESULTS: The results of this study showed that if the electron density to metal artifacts is not assigned properly, it will increase the calculated monitor units (MUs) by almost 3.78 MUs/fraction which will significantly affect total dose distribution of treatment. CONCLUSION: For the precise implementation of the treatment and in order to minimize the systematic errors related to the calculated MUs, necessary corrections on the electron density of metal artifacts should be considered before the treatment planning. The issue will be more critical in advanced treatment modalities where dose escalation is needed.

Enhanced dose measurement of zinc oxide nanoparticles by radiochromic polymer dosimeter and Monte Carlo simulation.

AIM: The aim of this study is to evaluate the effects of Zinc Oxide nanoparticles on dose enhancement factor using PRESAGE dosimeter and Monte Carlo simulation. BACKGROUND: High Z materials absorb X-ray remarkably. Among Nano-science, Zinc Oxide nanoparticles are interesting semiconductors, producing reactive oxygen species when irradiated by photons. Therefore, it seems that dose enhancement originating by incorporating ZnO NPs in irradiated volume would increase the therapeutic ratio. MATERIALS AND METHODS: Initially, the PRESAGE dosimeter was fabricated and calibrated. Then Zinc Oxide nanoparticles with an average particle size of about 40 nm were synthesized. At next step, various concentrations of the nanoparticles were incorporated into the PRESAGE composition and irradiated in radiation fields. Then, the mentioned processes were simulated. RESULTS: Practical measurements revealed that by incorporating 500, 1000 and 3000 µg ml-1 ZnO NPs into PRESAGE the dose enhancement factor of 1.36, 1.39, 1.44 for 1 × 1 cm 2 field size, 1.39, 1.41, 1.46 for 2 × 2 cm 2 and 1.40, 1.45 and 1.50 for 3 × 3 cm 2 could be found, respectively. Simulation results showed that in the mentioned condition, the dose enhancement factor of 1.05, 1.08, 1.10 for 1 × 1 cm 2 field size, 1.06, 1.09, 1.10 for 2 × 2 cm 2 and 1.08, 1.11 and 1.13 for 3 × 3 cm 2 could be derived, respectively. CONCLUSION: The results of this study showed that dose enhancement increases by increasing concentration of Zinc Oxide nanoparticles. Many reasons such as photoelectric, pair production effects and even Compton scattering can cause dose enhancement for megavoltage beams.

The effect of magnetic field on Linac based Stereotactic Radiosurgery dosimetric parameters.

Objective: MR-linac machines are being developed for image-guided radiation therapy but the magnetic field of such machines could affect dose distributions. The purpose of this work was to evaluate the effect of a magnetic field on linac beam dosimetric parameters including penumbra for circular cones used in radiosurgery.Methods: Monte Carlo simulation was conducted for a linac machine with circular cones at 6 MV beam. A homogenous magnetic field of 1.5 T was applied transversely and parallel to the radiation beam. Percentage depth dose (PDD) and beam profiles in a water phantom with and without the magnetic field were calculated.Results: The results have shown that when the magnetic field is applied transversely, the PDDs in the water phantom differ in the buildup region and distant part of PDD curves. The beam profiles at three different depths are all significantly different from those without the magnetic field. The penumbra is greater when a magnetic field has been applied.Conclusion: Linear accelerator-based SRT and SRS use small circular cones. The beam penumbra for these cones can change in the presence of a magnetic field. The perturbation of dose distribution has been also observed in a patient plan due to the presence of a magnetic field. The results of this study show that dose distributions in the presence of a magnetic field must be considered for MR-guided radiotherapy treatments.

Dosimetric evaluation of electron total skin irradiation using gafchromic film and thermoluminescent dosimetry.

AIM OF STUDY: The aim of this study is to evaluate some dosimetry parameters such as uniformity, surface dose, and max depth dose with thermoluminescent dosimetry (TLD) and EBT3 film in total skin electron beam therapy (TSEBT). METHODS: Stationary and rotary methods were set on Varian linear accelerator, Clinac 2100C. To create a radiation field large enough (168 cm × 60 cm) and uniform, the source skin distance was set 400 cm. Electron beam energy was 6 MeV. The skin dose values were obtained in 21 different points on the phantom surface. RESULTS: The results of dose uniformity in stationary technique were obtained as 10% and 2.6% by TLDs and 6% and 2.3% by films in longitudinal axis and transverse axis, respectively. The measurements at rotational technique by TLDs at the referred conditions showed a homogeneous total field with intensity variation of 10% in the longitudinal axis and 4% at horizontal axis. CONCLUSION: Based on the results of this study, stationary techniques are preferred for TSEBT. The main advantage of rotational techniques is reducing the time of treatment. The results also demonstrate that TLD should be routinely used in TSEBT treatment. Due to the high sensitivity of radiochromic films, this type of film was suitable for a wide therapeutic field. Comprehensive treatment to Rando phantom showed that the uniformity is better at the trunk than in the mobile parts of the body; the soles of the feet, perineum region, and scalp vertex should be treated in boost.

Determination of geometric accuracy of radiotherapy fields by port film and DRR using Matlab graphical user interface.

The purpose of this study is to determine and verify the exact location of radiation therapy fields by using port-film and digital reconstruction radiograph (DRR) as a low-cost tool. Initially, an appropriate algorithm was written for the application of port film in the megavoltage beam irradiation. Detectable contrast was created for the image and then by using appropriate markers and developed written program by MATLAB as DRrPortRegistartion. Semi-automatic and automatic registration between port-film and DRR images were performed for pelvic and chest phantoms. Then, results were compared with electronic portal imaging device (EPID) images in similar conditions. By using this software, DRR and port film as treatment verification tools, the precision of treatment verification and the accuracy of radiation therapy fields were achieved in the extent of the millimeter. Validation results with EPID demonstrated that the mean absolute average error in angle is equal to 0.59 degrees, 1.70 mm in the X-direction, and 2.42 mm in the Y-direction. The results of this study illustrated that using this software and suitable low-cost hardware in the machines without EPID can increase the precision of treatment verification to the millimeter and it can be introduced as a suitable alternative for EPID in centers for increasing treatment accuracy. Graphical abstract ᅟ.

Determination of the dose enhancement exclusively in tumor tissue due to the presence of GNPs.

PURPOSE: The purpose of this study is to investigate the differences between obtained percentage dose enhancements in areas around nanoparticles in GNPs (gold nanoparticles) enriched medium and percentage dose enhancements in the entire GNPs enriched medium including nanoparticles region. METHODS AND MATERIALS: To verify the accuracy of Ir-192 source simulation, the obtained values of air kerma strength, dose rate constants, and radial dose functions were compared against previously published results. Then a 1 cm × 1 cm× 1 cm tumor volume loaded with different diameters of GNPs were considered at a source to the tumor center of 1 cm. Finally, dose enhancements were obtained for 50, 100 and 200 nm GNPs as a function of various concentrations of the radiosensitizer and depth in phantom. RESULTS: Calculations showed that dose enhancement could be customized by varying the size of nanoparticles, concentrations and radial distance from the source. The highest PDEGNP (The ratio of the increased deposited dose in the tumor region to the dose deposition in the no nano gold-containing structure) was acquired by 50 nm nanoparticles, 30 mg/g concentrations and in the highest distance from the source. (PDEGNP) and (PDEaround-GNP) due to the presence of 7-30 mg/g concentration of GNPs ranged from 3-18.19% and 3.45-21.13%, respectively. The results of this study revealed that the correlation is significant at the 0.01 level and there is a non-negligible difference (up to 3%) between (Daround-GNP)and (DGNP). CONCLUSION: By considering exclusively determination of dose enhancement in the just tumor tissue, calculating (Daround-GNP) Instead of DGNP may be a strategy for clinical use of nanoparticles in the radiation therapy. The results showed that with the increasing trend of dose enhancement in the GNPs loaded-tumor, dose enhancement decreases with an increase in the size of GNPs.

Comparison of penumbra regions produced by ancient Gamma knife model C and Gamma ART 6000 using Monte Carlo MCNP6 simulation.

The accuracy of penumbral measurements in radiotherapy is pivotal because dose planning computers require accurate data to adequately modeling the beams, which in turn are used to calculate patient dose distributions. Gamma knife is a non-invasive intracranial technique based on principles of the Leksell stereotactic system for open deep brain surgeries, invented and developed by Professor Lars Leksell. The aim of this study is to compare the penumbra widths of Leksell Gamma Knife model C and Gamma ART 6000. Initially, the structure of both systems were simulated by using Monte Carlo MCNP6 code and after validating the accuracy of simulation, beam profiles of different collimators were plotted. MCNP6 beam profile calculations showed that the penumbra values of Leksell Gamma knife model C and Gamma ART 6000 for 18, 14, 8 and 4 mm collimators are 9.7, 7.9, 4.3, 2.6 and 8.2, 6.9, 3.6, 2.4, respectively. The results of this study showed that since Gamma ART 6000 has larger solid angle in comparison with Gamma Knife model C, it produces better beam profile penumbras than Gamma Knife model C in the direct plane.

Comparison of full width at half maximum and penumbra of different Gamma Knife models.

As a radiosurgical tool, Gamma Knife has the best and widespread name recognition. Gamma Knife is a noninvasive intracranial technique invented and developed by Swedish neurosurgeon Lars Leksell. The first commercial Leksell Gamma Knife entered the therapeutic armamentarium at the University of Pittsburgh in the United States on August 1987. Since that time, different generation of Gamma Knife developed. In this study, the technical points and dosimetric parameters including full width at half maximum and penumbra on different generation of Gamma Knife will be reviewed and compared. The results of this review study show that the rotating gamma system provides a better dose conformity.

Dosimetric properties of new formulation of PRESAGE® with tin organometal catalyst: Development of sensitivity and stability to megavoltage energy.

AIM: Tin-base catalyst is one of the widely used organometallic catalysts in polyurethane technology. The purpose of this study was to evaluate the effect of tin organometallic catalyst in the radiation response and radiological properties of a new formula of PRESAGE®. MATERIALS AND METHODS: In the study, two types of PRESAGE were fabricated. A very little amount of dibutyltindillaurate (DBTDL) (0.07% weight) was used as a catalyst in the fabrication of new PRESAGE (i.e., PRESAGE with catalyst), which components were: 93.93% weight polyurethane, 5% weight tetrachloride, and 1% weight leucomalachite green (LMG). For PRESAGE without catalyst, 94% weight polyurethane, 4% weight tetrachloride, and 2% weight LMG were used. Radiochromic response and postirradiation stability of PRESAGEs were determined. Also, radiological characteristics of PRESAGEs, such as mass density, electron density, mass attenuation coefficient, and mass stopping power in different photon energies were assessed and compared with water. RESULTS: The absorption peak of new PRESAGE compared to PRESAGE without catalyst was observed without change. Sensitivity of new PRESAGE was higher than PRESAGE without catalyst and its stability after the first 1 h was relatively constant. Also, Mass attenuation coefficient of new PRESAGE in energy ranges <0.1 MeV was 10% more than water, whereas the maximum difference of mass stopping power was only 3%. CONCLUSIONS: Tin organometallic catalyst in very low concentration can be used in fabrication of radiochromic polymer gel to achieve high sensitivity and stability as well as good radiological properties in the megavoltage photon beam.

Monte Carlo calculation of photo-neutron dose produced by circular cones at 18 MV photon beams.

AIM: The aim of this study is to calculate neutron contamination at the presence of circular cones irradiating by 18 MV photons using Monte Carlo code. BACKGROUND: Small photon fields are one of the most useful methods in radiotherapy. One of the techniques for shaping small photon beams is applying circular cones made of lead. Using this method in high energy photon due to neutron contamination is a crucial issue. MATERIALS AND METHODS: Initially, Varian linac producing 18 MV photons was simulated and after validating the code, various circular cones were also simulated. Then, the number of neutrons, neutron equivalent dose and absorbed dose per Gy of photon dose were calculated along the central axis. RESULTS: Number of neutrons per Gy of photon dose had their maximum value at depth of 2 cm and these values for 5, 10, 15, 20 and 30 mm circular cones were 9.02, 7.76, 7.61, 6.02 and 5.08 (n cm-2 Gy-1), respectively. Neutron equivalent doses per Gy of photon dose had their maximum at the surface of the phantom and these values for mentioned collimators were 1.48, 1.33, 1.31, 1.12 and 1.08 (mSv Gy-1), respectively. Neutron absorbed doses had their maximum at the surface of the phantom and these values for mentioned collimators sizes were 103.74, 99.71, 95.77, 81.46 and 78.20 (µGy/Gy), respectively. CONCLUSIONS: As the field size gets smaller, number of neutrons, equivalent and absorbed dose per Gy of photon increase. Also, neutron equivalent dose and absorbed dose are maximum at the surface of phantom and then these values will be decreased.

Optical computed tomography in PRESAGE® three-dimensional dosimetry: Challenges and prospective.

With the advent of new complex but precise radiotherapy techniques, the demands for an accurate, feasible three-dimensional (3D) dosimetry system have been increased. A 3D dosimeter system generally should not only have accurate and precise results but should also feasible, inexpensive, and time consuming. Recently, one of the new candidates for 3D dosimetry is optical computed tomography (CT) with a radiochromic dosimeter such as PRESAGE®. Several generations of optical CT have been developed since the 90s. At the same time, a large attempt has been also done to introduce the robust dosimeters that compatible with optical CT scanners. In 2004, PRESAGE® dosimeter as a new radiochromic solid plastic dosimeters was introduced. In this decade, a large number of efforts have been carried out to enhance optical scanning methods. This article attempts to review and reflect on the results of these investigations.

Measurement of neutron dose in the compensator IMRT treatment.

A radiation treatment delivery technique, intensity modulated radiation therapy (IMRT), has found widespread use in the treatment of cancers. One of IMRT implementing methods is IMRT compensator based, which the modulation are done by high Z materials. When photons with energies higher than 8MV interact with high Z material in path, Photoneutrons are produced. In this study, the effect of compensator on photoneutron production was investigated. The Monte Carlo code MCNPX was used to calculate the neutron dose equivalent as a function of the depth in phantom with and without compensator. Measurements were made using CR-39 track-etched detectors. CR-39 detectors, were cut in dimensions of 2.5×2.5 cm2 by laser, placed in different depths of slab phantom and then irradiated by 18MV photons. Same procedure was performed with the compensator present and absent. The measured data were compared with MCNP calculations. In both experimental and simulation results, neutron dose equivalent when compensator used, was less than non-compensator field. The calculated neutron dose equivalent was maximum at surface and decreased exponentially by increasing depth, but in experimental data, the neutron dose equivalent reached a maximum at approximately 3cm depth in the phantom and beyond which decreased with depth.CR-39 calibration was carried out in air, by considering that neutron energy spectrum changes toward thermal neutrons by depth in phantom increasing, it is suggested that for measuring equivalent neutron dose at phantom depth, should have proper neutron calibration in terms of energy spectrum.

Neutron dose measurements of Varian and Elekta linacs by TLD600 and TLD700 dosimeters and comparison with MCNP calculations.

High-energy linacs produce secondary particles such as neutrons (photoneutron production). The neutrons have the important role during treatment with high energy photons in terms of protection and dose escalation. In this work, neutron dose equivalents of 18 MV Varian and Elekta accelerators are measured by thermoluminescent dosimeter (TLD) 600 and TLD700 detectors and compared with the Monte Carlo calculations. For neutron and photon dose discrimination, first TLDs were calibrated separately by gamma and neutron doses. Gamma calibration was carried out in two procedures; by standard 60Co source and by 18 MV linac photon beam. For neutron calibration by (241)Am-Be source, irradiations were performed in several different time intervals. The Varian and Elekta linac heads and the phantom were simulated by the MCNPX code (v. 2.5). Neutron dose equivalent was calculated in the central axis, on the phantom surface and depths of 1, 2, 3.3, 4, 5, and 6 cm. The maximum photoneutron dose equivalents which calculated by the MCNPX code were 7.06 and 2.37 mSv.Gy(-1) for Varian and Elekta accelerators, respectively, in comparison with 50 and 44 mSv.Gy(-1) achieved by TLDs. All the results showed more photoneutron production in Varian accelerator compared to Elekta. According to the results, it seems that TLD600 and TLD700 pairs are not suitable dosimeters for neutron dosimetry inside the linac field due to high photon flux, while MCNPX code is an appropriate alternative for studying photoneutron production.