Cone beam CT-based dose accumulation and analysis of delivered dose to the dominant intraprostatic lesion in primary radiotherapy of prostate cancer.

BACKGROUND: Evaluation of delivered dose to the dominant intraprostatic lesion (DIL) for moderately hypofractionated radiotherapy of prostate cancer by cone beam computed tomography (CBCT)-based dose accumulation and target coverage analysis. METHODS: Twenty-three patients with localized prostate cancer treated with moderately hypofractionated prostate radiotherapy with simultaneous integrated boost (SIB) between December 2016 and February 2020 were retrospectively analyzed. Included patients were required to have an identifiable DIL on bi-parametric planning magnetic resonance imaging (MRI). After import into the RayStation treatment planning system and application of a step-wise density override, the fractional doses were computed on each CBCT and were consecutively mapped onto the planning CT via a deformation vector field derived from deformable image registration. Fractional doses were accumulated for all CBCTs and interpolated for missing CBCTs, resulting in the delivered dose for PTVDIL, PTVBoost, PTV, and the organs at risk. The location of the index lesions was recorded according to the sector map of the Prostate Imaging Reporting and Data System (PIRADS) Version 2.1. Target coverage of the index lesions was evaluated and stratified for location. RESULTS: In total, 338 CBCTs were available for analysis. Dose accumulation target coverage of PTVDIL, PTVBoost, and PTV was excellent and no cases of underdosage in DMean, D95%, D02%, and D98% could be detected. Delivered rectum DMean did not significantly differ from the planned dose. Bladder mean DMean was higher than planned with 19.4 ± 7.4 Gy versus 18.8 ± 7.5 Gy, p < 0.001. The penile bulb showed a decreased delivered mean DMean with 29.1 ± 14.0 Gy versus 29.8 ± 14.4 Gy, p < 0.001. Dorsal DILs, defined as DILs in the posterior medial peripheral zone of the prostate, showed a significantly lower delivered dose with a mean DMean difference of 2.2 Gy (95% CI 1.3-3.1 Gy, p < 0.001) compared to ventral lesions. CONCLUSIONS: CBCT-based dose accumulation showed an adequate delivered dose to the dominant intraprostatic lesion and organs at risk within planning limits. Cautious evaluation of the target coverage for index lesions adjacent to the rectum is warranted to avoid underdosage.

Comparison of treatment plans for hypofractionated high-dose prostate cancer radiotherapy using the Varian Halcyon and the Elekta Synergy platforms.

PURPOSE: To compare radiotherapy plans between an O-ring and a conventional C-arm linac for hypofractionated high-dose prostate radiotherapy in terms of plan quality, dose distribution, and quality assurance in a multi-vendor environment. METHODS: Twenty prostate cancer treatment plans were irradiated on the O-ring Varian Halcyon linac and were re-optimized for the C-arm Elekta Synergy Agility linac. Dose-volume histogram metrics for target coverage and organ at risk dose, quality assurance, and monitor units were retrospectively compared. Patient-specific quality assurance with ion chamber measurements, gamma index analysis, and portal dosimetry was performed using the Varian Portal Dosimetry system and the ArcCHECK® phantom (Sun Nuclear Corporation). Prostate-only radiotherapy was delivered with simultaneous integrated boost (SIB) volumetric modulated arc therapy (VMAT) in 20 fractions of 2.5/3.0 Gy each. RESULTS: For both linacs, target coverage was excellent and plan quality comparable. Homogeneity in PTVBoost was high for Synergy as well as Halcyon with a mean homogeneity index of 0.07 ± 0.01 and 0.05 ± 0.01, respectively. Mean dose for the organs at risk rectum and bladder differed not significantly between the linacs but were higher for the femoral heads and penile bulb for Halcyon. Quality assurance showed no significant differences in terms of ArcCHECK gamma pass rates. Median pass rate for 3%/2 mm was 99.3% (96.7 to 99.8%) for Synergy and 99.8% (95.6 to 100%) for Halcyon. Agreement between calculated and measured dose was high with a median deviation of -0.6% (-1.7 to 0.8%) for Synergy and 0.2% (-0.6 to 2.3%) for Halcyon. Monitor units were higher for the Halcyon by approximately 20% (p < 0.001). CONCLUSION: Hypofractionated high-dose prostate cancer SIB VMAT on the Halcyon system is feasible with comparable plan quality in reference to a standard C-arm Elekta Synergy linac.

ESTABLISHMENT OF A LOW DOSE RATE GAMMA RAY CALIBRATION FIELD FOR ENVIRONMENTAL RADIATION MONITORING DEVICES.

For routine calibration of dosemeters used for environmental radiation monitoring, a low dose rate 137Cs gamma ray calibration field that fully satisfies the requirement of the ISO 4037 series was established in the Facility of Radiation Standards in Japan Atomic Energy Agency. Two different methods were employed to determine the reference air kerma rate, namely a conventional ionisation chamber and a G(E) function method used a newly developed scintillation spectrometer. To fulfil the requirement of the ISO 4037 and suppress scattering of Cs gamma ray within the room as far as possible, a suitable lead collimator was introduced to limit the irradiation area at test points and placed at the middle height in an irradiation room with a grating floor. From measured results of de-convoluted photon fluence spectrum and the variation of evaluated reference air kerma rates between 1.0 m and 3.0 m from the centre of the source, gamma ray scattering from the room structures was found to be negligible. The reference air kerma rate at distances between1.0 m and 3.0 m could be then interpolated by simply considering the inverse square law of the distance and air attenuation. The resulting Cs gamma ray calibration field could provide ambient dose equivalent rates of 0.7-7.2 µSv h-1 for use with environmental radiation monitoring devices. Finally, we attempted to calibrate a widely used NaI(Tl) scintillation survey metre, obtaining a quite satisfactory calibration factor. These results also imply that such survey metres can be employed to monitor affected areas and assess the progress of decontamination, as they can provide appropriate measurements of the ambient dose equivalent rate.

Metrology for Radiological Early Warning Networks in Europe ("METROERM")-A Joint European Metrology Research Project.

As a consequence of the Chernobyl nuclear power plant accident in 1986, all European countries have installed automatic dosimetry network stations as well as air sampling systems for the monitoring of airborne radioactivity. In Europe, at present, almost 5,000 stations measure dose rate values in nearly real time. In addition, a few hundred air samplers are operated. Most of them need extended accumulation times with no real-time capability. National dose rate data are provided to the European Commission (EC) via the EUropean Radiological Data Exchange Platform (EURDEP). In case of a nuclear emergency with transboundary implications, the EC may issue momentous recommendations to EU member states based on the radiological data collected by EURDEP. These recommendations may affect millions of people and could have severe economic and sociological consequences. Therefore, the reliability of the EURDEP data is of key importance. Unfortunately, the dose rate and activity concentration data are not harmonized between the different networks. Therefore, within the framework of the European Metrology Research Programme (EMRP), 16 European institutions formed the consortium MetroERM with the aim to improve the metrological foundation of measurements and to introduce a pan-European harmonization for the collation and evaluation of radiological data in early warning network systems. In addition, a new generation of detector systems based on spectrometers capable of providing both reliable dose rate values as well as nuclide specific information in real time are in development. The MetroERM project and its first results will be presented and discussed in this article.

Curve encirclement and protein structure.

A method of measuring the extent to which space curves encircle one another is introduced. The method provides a family of sets which characterize encircling curves, allowing curve pairs that engage (and also single curves that self-engage) to be distinguished. The method is applied to the backbone chains of protein molecules.