Systematic and random errors of PET-based 90 Y 3D dose quantification.

PURPOSE: The objective was to characterize both systematic and random errors in Positron Emission Tomography (PET)-based 90 Y three-dimensional (3D) dose quantification. METHODS: A modified NEMA-IEC phantom was used to emulate 90 Y-microsphere PET imaging conditions: sphere activity concentrations of 1.6 and 4.8 MBq/cc, sphere-to-background ratios of 4 and 13, and sphere diameters of 13, 17, and 37 mm. PET data were acquired using a GE D690 PET/CT scanner for 300 min on days 0-11. The data were downsampled to 60-5 min for multiple realizations to evaluate the count starvation effect. The image reconstruction algorithm was 3D-OSEM with PSF + TOF modeling; the parameters were optimized for dose-volume histogram (DVH), as a 90 Y 3D dose quantification. 90 Y-PET images were converted to dose maps using the local deposition method, then the sphere DVHs were calculated. The ground truth for the DVH was calculated using convolution method. Dose linearity was evaluated in decaying 90 Y activity (reduced count rate and total count) and decreasing acquisition durations (reduced total count only). Finally, the impacts of the low 32-ppm positron yield on PET-based 3D 90 Y-dose quantification were evaluated; the bias and variability of resulting DVHs were characterized. RESULTS: We observed nonlinear errors that depended on the 90 Y activity (count rate) and not on the total true prompt counts. These nonlinear errors in mean dose underestimated the measured mean dose by> 20% for a measured dose range of 40-230 Gy; although the shapes of the DVH were not altered. Compensation based on empirical models reduced the nonlinearity errors to be within 5% for measured dose range of 40-230 Gy. In contrast, the errors due to nonuniformity introduced by image noise dominated the systematic errors in the DVH and stretched the DVH on both tails. For the 37-mm sphere, the magnitude of errors in D80 increased from -25% to -36% when acquisition duration was decreased from 300 to 10 min. The effect of image noise on DVH was more extensive in smaller spheres; for the 17-mm sphere, the magnitude of errors in D80 increased from -29% to -45% acquisition duration was decreased from 300 to 10 min. For the 37-mm sphere, the errors in D20 increased from +3.5% to only +10.5% when the acquisition duration was decreased from 300 to 10 min; in the 17-mm sphere, the errors in D20 were 6.5% for both 300- and 10-min sphere images. CONCLUSIONS: Count-starved 90 Y-PET data introduce both systematic and random errors. The systematic error increases the apparent nonuniformity of the DVH, while the random error increases the uncertainty in the DVH. The systematic errors were larger than the random errors. Lower count rate of 90 Y-PET also introduces systematic bias, which is scanner specific. The errors of bias-compensated mean tumor dose were <10% when 90 Y-PET scan time was >15 min/bed for tumors >37 mm. Dmedian and Dmean were the most stable dose metrics. An acquisition duration of 30 min is recommended to keep the random errors < 10% for a typical tumor with sphere equivalent diameter >17 mm and average tumor dose >40 Gy.

Use of magnetic resonance imaging in low-dose-rate and high-dose-rate prostate brachytherapy from diagnosis to treatment assessment: Defining the knowledge gaps, technical challenges, and barriers to implementation.

MRI is rapidly evolving as an imaging tool in both low-dose-rate and high-dose-rate brachytherapy for prostate cancer. The ability of MRI to identify intraprostatic tumors and reduce uncertainties in the workflow process should enable a more accurate and precise radiation delivery approach while simultaneously improving the quality assurance process. The ability to identify functional anatomic structures adjacent to the prostate cancer could reduce or eliminate some of the more common side effects of the treatment. However, MRI is complex, and collaborative efforts and future research are required to address the current knowledge gaps, technical challenges, and barriers to widespread the implementation of MRI-assisted and MRI-guided prostate brachytherapy.

Intraoperative high-dose-rate brachytherapy: An American Brachytherapy Society consensus report.

PURPOSE: This report presents recommendations from the American Brachytherapy Society for the use of intraoperative high-dose-rate (IOHDR) brachytherapy. METHODS AND MATERIALS: Members of the American Brachytherapy Society with expertise in IOHDR formulated this document based on their clinical experience and a review of the literature. This report covers the use of IOHDR in colorectal cancer, soft tissue sarcoma, gynecologic cancers, head and neck cancers, and pediatric cancers. This report does not cover intraoperative brachytherapy for breast cancer. Details about treatment planning and delivery are emphasized so this document can serve as a guide to practices implementing this technique. RESULTS: IOHDR brachytherapy is generally most beneficial for patients with either close or positive margins and/or recurrent disease in a previous resection bed or previously irradiated area. IOHDR brachytherapy requires a well-coordinated multidisciplinary team. IOHDR brachytherapy is recommended in the treatment of both recurrent and primary locally advanced disease for colorectal and gynecologic malignancies, soft tissue sarcoma, and selected head and neck and pediatric malignancies. Other techniques such as perioperative fractionated brachytherapy are also acceptable in many cases with some advantages and disadvantages compared to IOHDR. CONCLUSIONS: IOHDR brachytherapy is a specialized technique in radiation therapy with unique properties and advantages in cancer control. Special considerations for treatment planning and delivery are outlined herein.

Biochemical control and toxicity for favorable- and intermediate-risk patients using real-time intraoperative inverse optimization prostate seed implant: Less is more!

PURPOSE: To report the biochemical control rate and clinical outcomes with real-time inverse planning (inverse optimization prostate seed implant [IO-PSI]) for favorable-risk (FR) and intermediate-risk (IR) prostate adenocarcinoma in a community practice setting. This analysis is an extended followup of our initial report, with favorable early biochemical control rate (biochemical nonevidence of disease) of 97% at 4 years. METHODS AND MATERIALS: Three hundred fifty-seven evaluable patients with FR and IR prostate cancer underwent real-time IO-PSI (iodine-125/145 Gy or palladium-103/120 Gy) between 2001 and 2013. RESULTS: With a median followup of 54 months (range, 24-110 months), the absolute biochemical failure free survival of disease was 96%. The 8-year actuarial probability of prostate-specific antigen failure-free survival for FR and IR cohorts was 92.4% and 87%, respectively. Late genitourinary and gastrointestinal toxicity remained low. Late Grade 2 and Grade 3 genitourinary toxicity was 19% and 1%, respectively. Late Grade 2 and 3 rectal bleeding rates were 1% and 0%, respectively. No difference in biochemical control was observed with preimplant short course androgen deprivation or between Gleason score 3 + 4 vs. 4 + 3 patients. No dosimetric parameter was predictive of biochemical failure. Patients with FR had a significantly decreased risk of failure (hazard ratio = 0.26; 95% confidence interval = 0.09-0.78; p = 0.02) compared with those with IR. Patients with a prostate-specific antigen nadir >0.4 ng/mL had an increased risk of failure (hazard ratio = 1.37; 95% confidence interval = 1.27-1.47; p < 0.0001). CONCLUSIONS: Our initial biochemical and clinical outcomes using real-time IO-PSI persisted with extended followup and support our original hypothesis for use of a reduced number of sources, needles, and total activity, suggesting that with IO, less is more.

Effects of image noise, respiratory motion, and motion compensation on 3D activity quantification in count-limited PET images.

The aims of this study were to evaluate the effects of noise, motion blur, and motion compensation using quiescent-period gating (QPG) on the activity concentration (AC) distribution-quantified using the cumulative AC volume histogram (ACVH)-in count-limited studies such as 90Y-PET/CT. An International Electrotechnical Commission phantom filled with low 18F activity was used to simulate clinical 90Y-PET images. PET data were acquired using a GE-D690 when the phantom was static and subject to 1-4 cm periodic 1D motion. The static data were down-sampled into shorter durations to determine the effect of noise on ACVH. Motion-degraded PET data were sorted into multiple gates to assess the effect of motion and QPG on ACVH. Errors in ACVH at AC90 (minimum AC that covers 90% of the volume of interest (VOI)), AC80, and ACmean (average AC in the VOI) were characterized as a function of noise and amplitude before and after QPG. Scan-time reduction increased the apparent non-uniformity of sphere doses and the dispersion of ACVH. These effects were more pronounced in smaller spheres. Noise-related errors in ACVH at AC20 to AC70 were smaller (<15%) compared to the errors between AC80 to AC90 (>15%). The accuracy of ACmean was largely independent of the total count. Motion decreased the observed AC and skewed the ACVH toward lower values; the severity of this effect depended on motion amplitude and tumor diameter. The errors in AC20 to AC80 for the 17 mm sphere were -25% and -55% for motion amplitudes of 2 cm and 4 cm, respectively. With QPG, the errors in AC20 to AC80 of the 17 mm sphere were reduced to -15% for motion amplitudes <4 cm. For spheres with motion amplitude to diameter ratio >0.5, QPG was effective at reducing errors in ACVH despite increases in image non-uniformity due to increased noise. ACVH is believed to be more relevant than mean or maximum AC to calculate tumor control and normal tissue complication probability. However, caution needs to be exercised when using ACVH in post-therapy 90Y imaging because of its susceptibility to image degradation from both image noise and respiratory motion.

Technical Note: Dosimetry of Leipzig and Valencia applicators without the plastic cap.

PURPOSE: High dose rate (HDR) brachytherapy for treatment of small skin lesions using the Leipzig and Valencia applicators is a widely used technique. These applicators are equipped with an attachable plastic cap to be placed during fraction delivery to ensure electronic equilibrium and to prevent secondary electrons from reaching the skin surface. The purpose of this study is to report on the dosimetric impact of the cap being absent during HDR fraction delivery, which has not been explored previously in the literature. METHODS: geant4 Monte Carlo simulations (version 10.0) have been performed for the Leipzig and Valencia applicators with and without the plastic cap. In order to validate the Monte Carlo simulations, experimental measurements using radiochromic films have been done. RESULTS: Dose absorbed within 1 mm of the skin surface increases by a factor of 1500% for the Leipzig applicators and of 180% for the Valencia applicators. Deeper than 1 mm, the overdosage flattens up to a 10% increase. CONCLUSIONS: Differences of treating with or without the plastic cap are significant. Users must check always that the plastic cap is in place before any treatment in order to avoid overdosage of the skin. Prior to skin HDR fraction delivery, the timeout checklist should include verification of the cap placement.

SU-E-T-519: Experimental Evaluation of Deterministic Acuros XB Radiation Transport Algorithm for Heterogeneity Dose Calculation Using the Radiological Physics Center's Lung Phantom.

PURPOSE: To evaluate the heterogeneity corrected dose calculations from the Acuros XB (AXB), a novel deterministic dose calculation algorithm based on grid-based Boltzmann transport equation solver (GBBS), for IMRT and VMAT plans. METHODS: The Radiological Physics Center's lung phantom was used to create clinically equivalent IMRT and VMAT plans (RapidArc) with the Eclipse planning system 10.0 that were delivered using a Varian 23 iX. Absolute doses and relative dose distributions were measured with thermoluminescent dosimeters (TLDs) and radiochromic film. The measured dose distributions were compared with calculated doses from both AXB (11.0.3) and AAA (10.0.24) dose calculation algorithms. The AXB calculated dose-to-water and dose-to-medium were both compared to measurements. Gamma analysis (±7%/4mm, ±5%/3mm, and ±3%/3mm) was used to quantify correspondence between AXB dose distributions and the film measurements. The computation time between AAA and AXB were also evaluated. RESULTS: For TLD point doses, both AAA and AXB heterogeneity corrected dose calculations are within 5% inside the PTV for both IMRT and VMAT plans. The agreements observed between the measured and calculated doses for both AXB dose reporting methods are better than those observed with the AAA algorithm. The gamma analysis showed that the differences between AAA, AXB and film measurement met the RPC ±7%/4 mm criteria. The percent of pixels passing rate for both the AXB dose to medium and AXB dose to water are higher than AAA. The computation time between AAA and AXB are comparable for IMRT plans but AXB is significantly faster (4 times) than AAA for VMAT plans. CONCLUSIONS: The AXB implemented in the Eclipse planning system calculates a more accurate heterogeneity corrected dose than the AAA algorithm as compared to measurement in lung and improve the calculation speed for VMAT radiotherapy. Work supported by grants CA10953, CA81647, 2R44CA105806-02, CA016672 (NCI, DHHS).

SU-E-T-425: Impact of Model Based Dose Calculation Algorithm for Ir-192 Intracavitary Brachytherapy with Shielded Applicator.

PURPOSE: To determine the impact of a grid based Boltzmann solver (GBBS) on a cohort of cervical cancer patients treated with Ir-192 intracavitary brachytherapy with shielded applicators. METHODS: Retrospective plans were generated using BrachyVision v8.8 (TPS) with GBBS Acuros v1.3.1. The study includes 24 patients that had CT planning images acquired with CT/MR compatible applicators. Using the TPS applicator library, shielded colpostats and tandem (#AL13122005) were virtually positioned to replace the applicators seen on CT. Dwell weights were based on TG43 delivering 6 Gy to point A. Four GBBS calculations were performed to assess differences from the standard of practice TG43. The different GBBS calculations were: 1) no applicator modeled, body= 1 g/cc muscle, 2) applicator modeled, body=1g/cc muscle, 3) applicator modeled, CT-to-material mapping with contrast (vaginal packing, rectal, Foley balloon) = 1g/cc muscle, and 4) applicator model, CT-to-material mapping without material overrides. The multiple GBBS calculations allow differences from TG43 to be attributed to factors representing the modeling of source and patient boundaries (scatter conditions), tissue heterogeneities, and applicators. RESULTS: Differences between GBBS4 and TG43 at clinical dosimetric points were as follows: [mean ± standard (min, max)], Point A: - 2.5% ± 0.5% (-3.8%, -1.2%), Point B: -1.5% ± 1.0% (-3.2%, 1.1%), ICRU rectum: -8.4% ± 2.5% (-14.0%, -4.1%), D2cc rectum: -6.2% ± 2.6% (- 11.9%, -0.8%), ICRU bladder: -7.2% ± 3.6% (-15.7%, -2.1%); D2cc bladder: -3.4% ± 1.8% (-7.2%, -1.1%). Bar plots comparing the modeling factors previously listed show that applicator modeling is the largest contributor to differences from TG43. CONCLUSIONS: Clinically significant dose differences (>5%) relative to TG43 exist when using a model-based dose calculation algorithm such as the GBBS with shielded applicators. Differences were largely due to applicator modeling, not tissue heterogeneities, source modeling, or patient boundary modeling.

SU-E-T-313: Probe-Type Experimental Dosimetry in Terms of Absorbed Dose to Water in Photon-Brachytherapy a Proposal for a Radiation-Quality Index.

PURPOSE: In photon-brachytherapy (BT), all data for clinical dosimetry (e.g., the dose-rate constant) are not measured in water, but calculated, based on MC-simulation. To enable the measurement of absorbed dose to water, DW, in the vicinity of a source, the complex energy-dependence and other influence quantities must be considered. METHODS: The detectors response, R=M/D, is understood as product of a detector-material dependent 'absorbed dose response', Ren, and Rin, the 'intrinsic response'. Ren is described by the Burlin-theory and because of dissimilarities between the detector-material and water, will have energy dependent correction factors which convert Ren into the clinically relevant DW,Qo=MQo × ND,W,Qo. To characterize BT- source-types, we propose a new 'radiation-quality index' QBT=Dprim(2cm)/Dprim(1cm), the ratio of the primary-dose to water at r=2cm to that at the reference distance r=1cm, similar to external beam dosimetry. Although QBT cannot be measured directly, it can be derived from primary and scatter separated dose-data, published as consensus data e.g., in the Carlton AAPM-TG-43-database. RESULTS: Mean QBT-values are: for nine HDR and four PDR 192Ir-sources: 0.2258±0.5%; one 169Yb- source: 0.2142; and one 125I-source: 0.1544. CONCLUSIONS: The main benefit of this new QBT-concept is that a type of BT-dosimetry-detector needs to be calibrated only for one reference radiation-quality, e.g., for Q0=192Ir. To measure the dose for different source-types, DW can be determined using calculated radiation-quality conversion factors kQ,QoBT, to be included in the AAPM-database and to be provided by the manufacturer for each detector-type. Typical BT-dosimetry-detectors are plastic scintillation detectors, radiochromic film, thermoluminescence detectors, optically stimulated detectors, and small volume ionization chambers. Recently, different DW(1cm)-primary standards have been developed in several European NMIs, enabling to calibrate BT-radiation- sources and BT-dosimetry-detectors and allowing to verify MC-calculated dose-rate constant values. The proposed definition of QBT has to be discussed internationally to find broad consensus.

SU-E-T-528: Appraisal of Acorus XB and Convolution Dose Algorithms in Field Junction of Breast Tangential/superclavicular Fields.

PURPOSE: Dose accuracy injunction regions of breast-tangential therapy is a challenge, and inaccurate dose predictions may lead to unreal hot/cold spots. Availability of the novel deterministic radiation transport method Acuros XB (AXB) provides a potential for more accurate dose predictions. This study assesses relative dose accuracies of this and the widely used other algorithms: collapsed cone convolution (CCC) and anisotropic analytical algorithm (AAA) against film measurements. METHODS: A typical tangential and superclav fileld combination was planned for an anthropomorphic body phantom using Pinnacle-9.0 treatment-planning system (TPS). The created plan employing 6MV beam was delivered to the phantom on a Varian linac. In region of the field junction of tangentials & superclav, films (EBT2) were placed in coronal planes at two depths (∼ 2 and 4 cm). Optical density was measured along and ± 5mm away from the field-match line, and converted to dose using film-calibration curve specific to the batch of film. The same plan was also imported to Eclipse TPS using an import filter written in MATLAB. Algorithms Pinnacle CCC 9.0, Eclipse AAA 10.0.24 and AXB 11.0.3 were used for calculations. Comparison of the measured doses (assumed as gold standard) against doses calculated from planning-systems were preformed in a MATLAB platform. RESULTS: In general, dose distributions from all three TPS algorithms are found to agree closely with film data. Agreements between AXB and CCC dose calculations were found to be reasonable. AXB appears to be better in modeling the backscatter effects in the heterogeneous regions. AAA calculations gives acceptable results, but with less accuracy compared to CCC and AXB. CONCLUSIONS: The novel deterministic algorithm AXB in Eclipse is found to provide better agreement with measured data in breast-tangential therapy. Benefits of using Acuors XB algorithm in tangential fields planning requires further investigation. This work was funded by National Institutes of Health through grant 2R44CA105806-02 and MD Anderson’s Cancer Center Support Grant CA0 16672.

106Ru/106Rh plaque and proton radiotherapy for ocular melanoma: a comparative dosimetric study.

The objective of this study was to perform comparative dosimetric studies of both 106Ru/106Rh plaque brachytherapy and external beam proton therapy proposed for ocular treatments at the University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. These modalities were also compared with traditional 125I plaque brachytherapy. Using a standardised eye model with a representative ocular melanoma tumour, the relative dose distributions within the tumour and surrounding tissue were calculated using the Monte Carlo code MCNPX. Published absorbed dose distributions benchmarked the Monte Carlo models. Results indicate that the proton beam provided superior dose uniformity within the tumour volume, whereas the dose distribution from 106Ru/106Rh was more heterogeneous. Relative to 125I COMS plaque, both 106Ru/106Rh and protons have shown more confined dose distributions to the tumour volume in this situation, thus sparing other critical ocular structures. For protons, it has been shown that only doses lower than the maximum dose are delivered outside the tumour volume. Depending on the clinical situation, this may aid in the sparing of critical structures located in the sclera and optic disc boundary. The Monte Carlo model's statistical uncertainties of the mean dose estimates for the 106Ru/106Rh plaque and proton beam were 3 and 2.5%, respectively.

Dose rate table for a 32P intravascular brachytherapy source from Monte Carlo calculations.

Studies of intravascular brachytherapy to prevent restenosis following angioplasty have shown many promising results. Accurate dose rate tables based on detailed models of the brachytherapy sources are necessary for treatment planning. This work will present an away and along dose rate table for a 27 mm long catheter based 32P beta source. MD-55-2 radiochromic film has been exposed at five different depths (0.5 mm-4 mm) in a polystyrene phantom using a 27 mm long Guidant 32P beta source. The total dose to the active region of the film was determined using the absolute detector response of the MD-55-2 radiochromic film. The Monte Carlo code MCNP4B2 was also used to calculate the dose to the active region of the film using a detailed model of the source, encapsulation, and radiochromic film. The dose to film calculations showed good agreement with the measurements presented in this work with an average difference of 7%. The Monte Carlo calculations were also verified against previously published depth dose in water measurements determined using radiochromic film and plastic scintillator. The depth dose calculations in water showed good agreement with the previously published measurements with the calculations being about 2.5% lower than the film measurements and about 2.5% higher than the scintillator measurements. This work then uses the verified Monte Carlo code to present a dose rate table for the 32P intravascular beta source.

Dosimetry of beta-ray ophthalmic applicators: comparison of different measurement methods.

An international intercomparison of the dosimetry of three beta particle emitting ophthalmic applicators was performed, which involved measurements with radiochromic film, thermoluminescence dosimeters (TLDs), alanine pellets, plastic scintillators, extrapolation ionization chambers, a small fixed-volume ionization chambers, a diode detector and a diamond detector. The sources studied were planar applicators of 90Sr-90Y and 106Ru-106Rh, and a concave applicator of 106Ru-106Rh. Comparisons were made of absolute dosimetry determined at 1 mm from the source surface in water or water-equivalent plastic, and relative dosimetry along and perpendicular to the source axes. The results of the intercomparison indicate that the various methods yield consistent absolute dosimetry results at the level of 10%-14% (one standard deviation) depending on the source. For relative dosimetry along the source axis at depths of 5 mm or less, the agreement was 3%-9% (one standard deviation) depending on the source and the depth. Crucial to the proper interpretation of the measurement results is an accurate knowledge of the detector geometry, i.e., sensitive volume and amount of insensitive covering material. From the results of these measurements, functions which describe the relative dose rate along and perpendicular to the source axes are suggested.

Calculation of beta-ray dose distributions from ophthalmic applicators and comparison with measurements in a model eye.

Dose distributions throughout the eye, from three types of beta-ray ophthalmic applicators, were calculated using the EGS4, ACCEPT 3.0, and other Monte Carlo codes. The applicators were those for which doses were measured in a recent international intercomparison [Med. Phys. 28, 1373 (2001)], planar applicators of 106Ru-106Rh and 90Sr-90Y and a concave 106Ru-106Rh applicator. The main purpose was to compare the results of the various codes with average experimental values. For the planar applicators, calculated and measured doses on the source axis agreed within the experimental errors (<10%) to a depth of 7 mm for 106Ru-106Rh and 5 mm for 90Sr-90Y. At greater distances the measured values are larger than those calculated. For the concave 106Ru-106Rh applicator, there was poor agreement among available calculations and only those calculated by ACCEPT 3.0 agreed with measured values. In the past, attempts have been made to derive such dose distributions simply, by integrating the appropriate point-source dose function over the source. Here, we investigated the accuracy of this procedure for encapsulated sources, by comparing such results with values calculated by Monte Carlo. An attempt was made to allow for the effects of the silver source window but no corrections were made for scattering from the source backing. In these circumstances, at 6 mm depth, the difference in the results of the two calculations was 14%-18% for a planar 106Ru-l06Rh applicator and up to 30% for the concave applicator. It becomes worse at greater depths. These errors are probably caused mainly by differences between the spectrum of beta particles transmitted by the silver window and those transmitted by a thickness of water having the same attenuation properties.

Dosimetry characterization of 32P catheter-based vascular brachytherapy source wire.

Dosimetry measurements and Monte Carlo simulations for a catheter-based 32P endovascular brachytherapy source wire are described. The measured dose rates were obtained using both radiochromic dye film and an automated plastic scintillator. The investigated source has dimensions of 27 mm in length and 0.24 mm in diameter, and is encapsulated in NiTi. For the radiochromic film measurements, calibrated radiochromic dye film was irradiated at distances between 1 and 5 mm from the source axis in A-150 plastic, and read out with a high-resolution scanning densitometer. The depth-dose curve measured in A-150 is then converted to that in water using correction factors obtained from Monte Carlo calculations. For the scintillator system, direct measurements in water were acquired at distances between 1 and 6 mm from the center of the source, along the perpendicular bisector of the source axis. The scintillator was calibrated in terms of absorbed-dose rate in a reference beta-particle field at multiple depths. The measured dose rates obtained from the film and scintillator measurements were then normalized to the measured source activity, i.e., to convert the measured data to units of cGy/s/mCi. Theoretical dosimetry calculations of the catheter-based 32P wire geometry were also obtained from Monte Carlo simulations using the Electron Gamma Shower code (EGS4), the Monte Carlo N-particle transport code (MCNP4B), and CYLTRAN from the Integrated Tiger Series codes (ITS v.3) and found to be in good agreement. The results of both measurements and calculations are expressed as absorbed-dose rate in water per unit of contained activity (cGy/s/mCi). Comparisons indicate that the measured and calculated dosimetry are in good agreement (<10%) within the relevant treatment distances (1-5 mm). This work fully characterizes the radiation field around a novel 32P beta brachytherapy source in water. The depth-dose curve can be used to calculate the dose to the vessel wall from a 27 mm 32P source wire centered within the vessel lumen.

Brachytherapy optimal planning with application to intravascular radiation therapy.

We have been studying brachytherapy planning with the objective of minimizing the maximum deviation of the delivered dose from prescribed dose bounds for treatment volumes. A general framework for optimal treatment planning is presented and the minmax optimization is formulated as a linear program. Dose rate calculations are based on the dosimetry formulation of the American Association of Physicists in Medicine, Task Group 43. We apply the technique to optimal planning for intravascular brachytherapy of intimal hyperplasia using ultrasound data and 192Ir seeds. The planning includes determination of an optimal dwell-time sequence for a train of seeds that deliver radiation while stepping through the vessel lesion. The results illustrate the advantage of this strategy over the common approach of delivering radiation by positioning a single train of seeds along the whole lesion.

Experimental testing of a DEXA-derived curved beam model of the proximal femur.

This study was designed to test whether, using curved beam theory, a structural model of the proximal femur derived from two-dimensional dual energy x-ray absorptiometry could be used to predict femoral strength in an experimental simulation of a fall on the greater trochanter. A set of 22 fresh cadaveric femoral specimens were scanned with use of two-dimensional dual energy x-ray absorptiometry and then were tested to failure in a materials testing system, under three-point loading, with the ground impact vector aligned within the plane and along the bisector of the femoral neck-shaft angle. Failure locations generally corresponded to stress peak locations predicted by the curved beam model. Predicted failure loads correlated well with measured failure loads for femoral neck fractures (r=0.89; percent SE of estimate=23%) and some-what less well for intertrochanteric fractures (r=0.83; percent SE of estimate=29%). Overall predictions for failure load calculated from the maximum stress peak value over both locations corresponded to measured failure loads with an r value of 0.91 (percent SE of estimate=21%). This kind of structural approach to the analysis of data for hip bone mass has the potential to provide mechanistic interpretations of the statistical associations frequently shown between conventional bone mineral measures and either hip fracture risk in vivo or bone strength in vitro.

Theoretical analysis of error propagation in triple-energy absorptiometry: application to measurement of lead in bone in vivo.

We propose a three component tissue decomposition for quantifying lead in bone from a mixture of bone and muscle in vivo using a triple-energy absorptiometric method. The theoretical optimization of this method, by relating signal uncertainty to radiation dose, requires an expression of the signal variance. The error propagation was therefore theoretically modeled for a counting detector, assuming noise dominance by quantum statistics and neglecting covariance between energy levels. A final expression for the lead signal variance at each energy level was obtained via a Jacobian matrix. The Jacobian was maximized by choosing the first energy as low as permissible by dose constraints below the lead K edge. A second optimum was achieved when the upper energy was just above and the middle energy was just below the lead K edge. While the signal-to-noise ratio (SNR) had similar behavior to that of the Jacobian as a function of middle and upper energies, the SNR was almost constant as a function of lower energy in the 40-60 keV range. Hence, dose could be reduced without SNR loss. A simulated clinical measurement on an adult tibia using a 50 mCi 155Eu source and a 10 min acquisition time resulted in a standard deviation of 4 micrograms Pb/g bone mass. This approach can be applied to other systems containing three components, provided there is a K edge within the counting energy range.

Histopathologic appearance of arterial occlusions with hydrogel and polyvinyl alcohol embolic material in domestic swine.

PURPOSE: This study observes the histologic changes resulting from a hydrogel embolic agent (polyacrylonitrile [PAN]) compared with polyvinyl alcohol particles (PVA) of similar size. MATERIALS AND METHODS: Hepatic and renal embolizations were performed in 13 domestic swine by selecting small (1-mm) branches utilizing a coaxial 3-F microcatheter. The hydrogel embolic agent (tantalum-loaded and plain) and PVA were delivered through microcatheters. The longest follow-up period was 8 weeks. Postmortem examination of the embolized tissues included gross examination and histologic analysis. RESULTS: Tantalum-loaded PAN particles were radiopaque and seen in groups fluoroscopically and individually with specimen radiography. Histologic studies showed similar luminal and cellular response to PVA and the hydrogel embolic agents. The arterial lesion induced by the hydrogel embolic agents led to an absence of the arterial wall locally in the area of deployment. Hydrogel embolic particles became surrounded in fibrous connective tissue with no arterial wall. PVA and porous hydrogel capsules produced an inflammatory response, resulting in less wall reorganization, and surrounding fibrous connective tissue at 8 weeks than the solid PAN particles. CONCLUSION: These hydrogel embolic create a permanent arterial occlusion by transmural arterial damage. Mechanical effects and, to a lesser degree, inflammatory changes are responsible.

Curved beam model of the proximal femur for estimating stress using dual-energy X-ray absorptiometry derived structural geometry.

The investigation of individual differences in hip strength requires a method to measure structural geometry in vivo and a valid analytical approach to calculate mechanical stress. We developed a method for deriving structural geometry of the femur from the proximal shaft through the femoral neck, using data from dual energy X-ray absorptiometry. The geometric properties are employed in a two-dimensional curved beam model of the proximal femur to estimate stresses on the lateral and medial bone surfaces. Stresses calculated by this method are compared with those from the conventional flexure formula and with results produced from a cadaver femur with use of three-dimensional finite element analysis of computed tomography data. Loading conditions simulating a one-legged stance and a fall on the greater trochanter are employed. Stresses calculated by curved beam theory are in much better agreement with three-dimensional finite element analysis than are those for which the conventional straight beam formula was used. In simulation of a fall on the greater trochanter, all three methods show peaks of stress at the femoral neck but only the curved beam and finite element analysis methods show an additional peak at the medial intertrochanteric margin. Both neck and trochanter regions correspond to common failure sites for hip fractures in the elderly. The curved beam treatment of hip structure derived from dual-energy X-ray absorptiometry provides an approach for the in vivo engineering analysis of hip structure that is not practical by other methods.