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Sample records for radiotherapy fields based

  1. Predictive local receptive fields based respiratory motion tracking for motion-adaptive radiotherapy.

    Science.gov (United States)

    Yubo Wang; Tatinati, Sivanagaraja; Liyu Huang; Kim Jeong Hong; Shafiq, Ghufran; Veluvolu, Kalyana C; Khong, Andy W H

    2017-07-01

    Extracranial robotic radiotherapy employs external markers and a correlation model to trace the tumor motion caused by the respiration. The real-time tracking of tumor motion however requires a prediction model to compensate the latencies induced by the software (image data acquisition and processing) and hardware (mechanical and kinematic) limitations of the treatment system. A new prediction algorithm based on local receptive fields extreme learning machines (pLRF-ELM) is proposed for respiratory motion prediction. All the existing respiratory motion prediction methods model the non-stationary respiratory motion traces directly to predict the future values. Unlike these existing methods, the pLRF-ELM performs prediction by modeling the higher-level features obtained by mapping the raw respiratory motion into the random feature space of ELM instead of directly modeling the raw respiratory motion. The developed method is evaluated using the dataset acquired from 31 patients for two horizons in-line with the latencies of treatment systems like CyberKnife. Results showed that pLRF-ELM is superior to that of existing prediction methods. Results further highlight that the abstracted higher-level features are suitable to approximate the nonlinear and non-stationary characteristics of respiratory motion for accurate prediction.

  2. Large field radiotherapy

    International Nuclear Information System (INIS)

    Vanasek, J.; Chvojka, Z.; Zouhar, M.

    1984-01-01

    Calculations may prove that irradiation procedures, commonly used in radiotherapy and represented by large-capacity irradiation techniques, do not exceed certain limits of integral doses with favourable radiobiological action on the organism. On the other hand integral doses in supralethal whole-body irradiation, used in the therapy of acute leukemia, represent radiobiological values which without extreme and exceptional further interventions and teamwork are not compatible with life, and the radiotherapeutist cannot use such high doses without the backing of a large team. (author)

  3. Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

    International Nuclear Information System (INIS)

    Cho, Oyeon; Chun, Mi Son; Oh, Young Taek; Kim, Mi Hwa; Park, Hae Jin; Nam, Sang Soo; Heo, Jae Sung; Noh, O Kyu; Park, Sung Ho

    2013-01-01

    Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p 98% of prescribed dose were 99.7% for CF and 99.5% for MF. Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

  4. Dose enhancement in radiotherapy of small lung tumors using inline magnetic fields: A Monte Carlo based planning study

    Energy Technology Data Exchange (ETDEWEB)

    Oborn, B. M., E-mail: brad.oborn@gmail.com [Illawarra Cancer Care Centre (ICCC), Wollongong, NSW 2500, Australia and Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW 2500 (Australia); Ge, Y. [Sydney Medical School, University of Sydney, NSW 2006 (Australia); Hardcastle, N. [Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065 (Australia); Metcalfe, P. E. [Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong NSW 2500, Australia and Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 (Australia); Keall, P. J. [Sydney Medical School, University of Sydney, NSW 2006, Australia and Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 (Australia)

    2016-01-15

    Purpose: To report on significant dose enhancement effects caused by magnetic fields aligned parallel to 6 MV photon beam radiotherapy of small lung tumors. Findings are applicable to future inline MRI-guided radiotherapy systems. Methods: A total of eight clinical lung tumor cases were recalculated using Monte Carlo methods, and external magnetic fields of 0.5, 1.0, and 3 T were included to observe the impact on dose to the planning target volume (PTV) and gross tumor volume (GTV). Three plans were 6 MV 3D-CRT plans while 6 were 6 MV IMRT. The GTV’s ranged from 0.8 to 16 cm{sup 3}, while the PTV’s ranged from 1 to 59 cm{sup 3}. In addition, the dose changes in a 30 cm diameter cylindrical water phantom were investigated for small beams. The central 20 cm of this phantom contained either water or lung density insert. Results: For single beams, an inline magnetic field of 1 T has a small impact in lung dose distributions by reducing the lateral scatter of secondary electrons, resulting in a small dose increase along the beam. Superposition of multiple small beams leads to significant dose enhancements. Clinically, this process occurs in the lung tissue typically surrounding the GTV, resulting in increases to the D{sub 98%} (PTV). Two isolated tumors with very small PTVs (3 and 6 cm{sup 3}) showed increases in D{sub 98%} of 23% and 22%. Larger PTVs of 13, 26, and 59 cm{sup 3} had increases of 9%, 6%, and 4%, describing a natural fall-off in enhancement with increasing PTV size. However, three PTVs bounded to the lung wall showed no significant increase, due to lack of dose enhancement in the denser PTV volume. In general, at 0.5 T, the GTV mean dose enhancement is around 60% lower than that at 1 T, while at 3 T, it is 5%–60% higher than 1 T. Conclusions: Monte Carlo methods have described significant and predictable dose enhancement effects in small lung tumor plans for 6 MV radiotherapy when an external inline magnetic field is included. Results of this study

  5. Biophysical analysis of the acute toxicity of radiotherapy in Hodgkin's lymphoma-a comparison between extended field and involved field radiotherapy based on the data of the German Hodgkin Study Group

    International Nuclear Information System (INIS)

    Eich, Hans Theodor; Haverkamp, Uwe; Engert, Andreas; Kocher, Martin; Skripnitchenko, Roman; Brillant, Corinne; Sehlen, Susanne; Duehmke, Eckhart; Diehl, Volker; Mueller, Rolf-Peter

    2005-01-01

    Purpose: To determine biophysical parameters from the complication probability data during and after radiotherapy of Hodgkin's lymphoma (HL), based on the number of gastrointestinal side effects that were found in the multicenter HD8 trial of the German Hodgkin Lymphoma Study Group. Methods and Materials: Between 1993 and 1998, 1204 patients with newly diagnosed, histology-proven HL in clinical Stages I/IIA/IIB with defined risk factors and stage IIIA without risk factors were enrolled into the multicenter HD8 study. Patients were randomized to receive two cycles of COPP (cyclophosphamide, vincristine, procarbazine, prednisone) alternating with two cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) followed by radiotherapy (RT) of 30 Gy extended field plus 10 Gy to bulky disease (Arm A) or 30 Gy involved field plus 10 Gy to bulky disease (Arm B). For 910 patients, the rates of acute gastrointestinal side effects during and after RT could be determined. Comparison showed differences between Arms A and B (Grade 1-2: 16.6 vs. 3.9; Grade 3-4: 0.9 vs. 0.2; p 3 ), we determined the normal tissue complication probability (NTCP) (V, D, m, n, TD 50 ), the biophysical parameter TD 50 , and n (volume dependent) in such a manner that the observed NTCP in Arm A in cases of supradiaphragmatic involvement only and in cases of infradiaphragmatic involvement correlated with the calculated values. Results: Of 1,204 patients randomized, 1,064 patients were informative for the comparison of study arms. The median observation time was 54 months. The overall survival for all eligible patients was 91%, and freedom from treatment failure was 83%. Survival rates at 5 years after start of RT revealed no differences in terms of freedom from treatment failure (85.8% in Arm A, 84.2% in Arm B) and overall survival (90.8% and 92.4%). There were also no differences between the two arms in terms of complete remission, progressive disease, relapse, death, and secondary neoplasias. In

  6. Dosimetry and microdosimetry using LET spectrometer based on the track-etch detector: radiotherapy Bremsstrahlung beam, onboard aircraft radiation field

    International Nuclear Information System (INIS)

    Jadrnickova, I.; Spurny, F.

    2006-01-01

    The spectrometer of linear energy transfer (Let) based on the chemically etched poly-allyl-diglycol-carbonate (P.A.D.C.) track-etch detector was developed several years ago in our institute. This Let spectrometer enables determining Let of particles approximately from 10 to 700 keV/μm. From the Let spectra, dose characteristics can be calculated. The contribution presents the Let spectra and other dosimetric characteristics obtained onboard a commercial aircraft during more than 6 months long exposure and in the 18 MV radiotherapy Bremsstrahlung beam. (authors)

  7. Magneto-radiotherapy: using magnetic fields to guide dose deposition

    International Nuclear Information System (INIS)

    Nettelbeck, H.; Lerch, M.; Takacs, G.; Rosenfeld, A.

    2006-01-01

    Full text: Magneto-radiotherapy is the application of magnetic fields during radiotherapy procedures. It aims to improve the quality of cancer treatment by using magnetic fields to 1 g uide the dose-deposition of electrons in tissue. Monte Carlo (MC) studies have investigated magneto-radiotherapy applied to conventional photon and electron linac beams. In this study, a combination of MC PENELOPE simulations and physical experiments were done to investigate magneto-radiotherapy applied to MRT (Microbeam Radiation Therapy) and conventional linac radiotherapy.

  8. Out-of-field dose measurements in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kaderka, Robert

    2011-07-13

    This thesis describes the results from measurements of the out-of-field dose in radiotherapy. The dose outside the treatment volume has been determined in a water phantom and an anthropomorphic phantom. Measurements were performed with linac photons, passively delivered protons, scanned protons, passively delivered carbon ions as well as scanned carbon ions. It was found that the use of charged particles for radiotherapy reduces the out-of-field dose by up to three orders of magnitude compared to conventional radiotherapy with photons.

  9. Radiotherapy of tumors under respiratory motion. Estimation of the motional velocity field and dose accumulation based on 4D image data

    International Nuclear Information System (INIS)

    Werner, Rene

    2013-01-01

    belong to the most precise methods currently available. In clinical practice, however, there exists the problem that many medical facilities are not equipped with 4D imaging devices. Further, 4D images still offer only a snapshot of the patient-specific motion range and potential motion variability may limit the conclusions that can be drawn from them. To address these aspects, in the next part of the thesis - based on the optimized methods for motion field estimation in 4D CT image data and further including statistical motion information and models, respectively - model-based approaches for motion field estimation and prediction are developed. First, a novel approach for statistical modeling of lung motion in a patient collective is presented, and methods for adapting the model for prediction of patient-specific motion patterns are provided. The latter allow, for instance, the estimation of respiratory lung and lung tumor motion for radiation therapy treatment planning, if no temporally resolved image sequences are available for the patient; this use case is demonstrated. Further, techniques of multivariate statistics are applied to account for variations of motion patterns by integrating additional information provided by motion indicators used in 4D radiation therapy (e.g. abdominal belts or spirometer measurements) for a patient-specific, situation-related adaption of the motion fields computed using 4D images and the methods for motion field estimation described before. In the last part of the thesis, the developed methods are finally applied for assessing and analyzing the dosimetric impact of respiratory motion during radiation therapy of lung tumors. Both 3D conformal radiotherapy and intensity modulated radiotherapy are modeled as treatment modalities. In the case of intensity modulated radiotherapy, short delivery times for single radiation fields lead to the risk that the corresponding dose contributions are not only subject to a motion-induced dose blurring

  10. Determination of Absorbed Dose in Large 60-Co Fields Radiotherapy

    International Nuclear Information System (INIS)

    Hrsak, H.

    2003-01-01

    Radiation in radiotherapy has selective impact on ill and healthy tissue. During the therapy the healthy tissue receives certain amount of dose. Therefore dose calculations in outer radiotherapy must be accurate because too high doses produce damage in healthy tissue and too low doses cannot ensure efficient treatment of cancer cells. A requirement on accuracy in the dose calculations has lead to improvement of detectors, and development of absolute and relative dosimetry. Determination of the dose distribution with use of computer is based on data provided by the relative dosimetry. This paper compares the percentage depth doses in cubic water phantoms of various dimensions with percentage depth doses calculated with use of Mayneord factor from the experimental depth doses measured in water phantom of large dimension. Depth doses in water phantoms were calculated by the model of empirical dosimetrical functions. The calculations were based on the assumption that large 6 0C o photon field exceeds the phantom's limits. The experimental basis for dose calculations by the model of empirical dosimetrical functions were exposure doses measured in air and dose reduction factors because of finite phantom dimensions. Calculations were performed by fortran 90 software. It was found that the deviation of dosimetric model was small in comparison to the experimental data. (author)

  11. Isocentric integration of intensity-modulated radiotherapy with electron fields improves field junction dose uniformity in postmastectomy radiotherapy.

    Science.gov (United States)

    Wright, Pauliina; Suilamo, Sami; Lindholm, Paula; Kulmala, Jarmo

    2014-08-01

    In postmastectomy radiotherapy (PMRT), the dose coverage of the planning target volume (PTV) with additional margins, including the chest wall, supraclavicular, interpectoral, internal mammary and axillar level I-III lymph nodes, is often compromised. Electron fields may improve the medial dose coverage while maintaining organ at risk (OAR) doses at an acceptable level, but at the cost of hot and cold spots at the electron and photon field junction. To improve PMRT dose coverage and uniformity, an isocentric technique combining tangential intensity-modulated (IM)RT fields with one medial electron field was implemented. For 10 postmastectomy patients isocentric IMRT with electron plans were created and compared with a standard electron/photon mix and a standard tangent technique. PTV dose uniformity was evaluated based on the tolerance range (TR), i.e. the ratio of the standard deviation to the mean dose, a dice similarity coefficient (DSC) and the 90% isodose coverage and the hot spot volumes. OAR and contralateral breast doses were also recorded. IMRT with electrons significantly improved the PTV dose homogeneity and conformity based on the TR and DSC values when compared with the standard electron/photon and tangent technique (p < 0.02). The 90% isodose coverage improved to 86% compared with 82% and 80% for the standard techniques (p < 0.02). Compared with the standard electron/photon mix, IMRT smoothed the dose gradient in the electron and photon field junction and the volumes receiving a dose of 110% or more were reduced by a third. For all three strategies, the OAR and contralateral breast doses were within clinically tolerable limits. Based on these results two-field IMRT combined with an electron field is a suitable strategy for PMRT.

  12. Linac based radiosurgery and stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Mackie, T.R.

    2008-01-01

    The following topics were discussed: Definition of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT); Stereo market; Indications for SRS/SRT; History of linac-based SRS/SRT; Variety of systems; QA for SRS; Localization; and Imaging. (P.A.)

  13. Treating all fields in every radiotherapy session? - Questioning the old dogma (or, pelvis radiotherapy: speculations on fractioning)

    International Nuclear Information System (INIS)

    Faria, S.L.; Ferrigno, R.; Osti, N.

    1995-01-01

    Twenty years ago Wilson and Hall published paper on the advisability of treating all fields at each radiotherapy session. That was based on the widely accepted method for calculating the biological effect of fractionated treatment in terms of a single quantity: the concept of a nominal standard dose (NSD). It was the beginning of an old dogma in radiation oncology: treating all fields every day. The basis megavoltage units of treatment in Brazil are cobalt and low energy linacs. The country is poor and it is not rare to have patients waiting lines. Due to that situation since five years ago we have been treating pelvic tumors with four fields (box technique) but irradiating only two fields per day. After treating hundreds of patients this way we have found no increased late complications, particularly subcutaneous tissue fibrosis. Previous data showed that TDE factors equal or lower than 90 were not related to any kind of fibrosis. treating pelvic tumors with the box technique but irradiating only two fields per day gives TDF values little greater than doing all four fields per day, but still lower than 90. That may explain why we have found no fibrosis. The impression is that not to treat all fields at each radiotherapy session may be possible with no increased rate of late complications. (author). 10 refs, 3 tabs, 2 figs

  14. Dosimetric comparison of field in field intensity-modulated radiotherapy technique with conformal radiotherapy techniques in breast cancer

    International Nuclear Information System (INIS)

    Ercan, T.; Alco, G.; Zengin, F.; Atilla, S.; Dincer, M.; Igdem, S.; Okkan, S.

    2010-01-01

    The aim of this study was to be able to implement the field-in-field intensity-modulated radiotherapy (FiF) technique in our daily practice for breast radiotherapy. To do this, we performed a dosimetric comparison. Treatment plans were produced for 20 consecutive patients. FiF plans and conformal radiotherapy (CRT) plans were compared for doses in the planning target volume (PTV), the dose homogeneity index (DHI), doses in irradiated soft tissue outside the target volume (SST), ipsilateral lung and heart doses for left breast irradiation, and the monitor unit counts (MU) required for treatment. Averaged values were compared using Student's t-test. With FiF, the DHI is improved 7.0% and 5.7%, respectively (P<0.0001) over the bilateral and lateral wedge CRT techniques. When the targeted volumes received 105% and 110% of the prescribed dose in the PTV were compared, significant decreases are found with the FiF technique. With the 105% dose, the SST, heart, and ipsilateral lung doses and the MU counts were also significantly lower with the FiF technique. The FiF technique, compared to CRT, for breast radiotherapy enables significantly better dose distribution in the PTV. Significant differences are also found for soft tissue volume, the ipsilateral lung dose, and the heart dose. Considering the decreased MUs needed for treatment, the FiF technique is preferred over tangential CRT. (author)

  15. Dose profile analysis of small fields in intensity modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Medel B, E. [IMSS, Centro Medico Nacional Manuel Avila Camacho, Calle 2 Nte. 2004, Barrio de San Francisco, 72090 Puebla, Pue. (Mexico); Tejeda M, G.; Romero S, K., E-mail: romsakaren@gmail.com [Benemerita Universidad Autonoma de Puebla, Facultad de Ciencias Fisico Matematicas, Av. San Claudio y 18 Sur, Ciudad Universitaria, 72570 Puebla, Pue.(Mexico)

    2015-10-15

    Full text: Small field dosimetry is getting a very important worldwide task nowadays. The use of fields of few centimeters is more common with the introduction of sophisticated techniques of radiation therapy, as Intensity Modulated Radiotherapy (IMRT). In our country the implementation of such techniques is just getting started and whit it the need of baseline data acquisition. The dosimetry under small field conditions represents a challenge for the physicists community. In this work, a dose profile analysis was done, using various types of dosimeters for further comparisons. This analysis includes the study of quality parameters as flatness, symmetry, penumbra, and other in-axis measurements. (Author)

  16. Staffing in Radiotherapy: An Activity Based Approach

    International Nuclear Information System (INIS)

    2015-01-01

    Radiotherapy requires competent professional staff to ensure safe and effective patient treatment and management. There is a need to provide guidelines that recommend appropriate staffing levels to support the initiation of new services as well as the expansion or upgrade of existing services as even simple upgrades or replacement of existing equipment may have a significant impact on staffing needs. Similarly, the introduction of education and training programmes will require staffing adjustments. A calculation algorithm was developed to predict staffing levels based on the inputs that are known or can be easily estimated. This publication complements other IAEA publications used to support the initiation of basic radiation medicine services including Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects, published in 2008

  17. External beam abdominal radiotherapy in patients with seminoma stage I: field type, testicular dose, and spermatogenesis

    International Nuclear Information System (INIS)

    Jacobsen, Kari Dolven; Olsen, Dag Rune; Fossaa, Kristian; Fossaa, Sophie Dorothea

    1997-01-01

    Purpose: To establish a predictive model for the estimation of the gonadal dose during adjuvant para-aortic (PA) or dog leg (DL: PA plus ipsilateral iliac) field radiotherapy in patients with testicular seminoma. Methods and Materials: The surface gonadal dose was measured in patients with seminoma Stage I receiving PA or DL radiotherapy. Sperm cell analysis was performed before and 1 year after irradiation. PA and DL radiotherapy were simulated in the Alderson phantom while we measured the dose to the surface and middle of an artificial testicle, varying its position within realistic anatomical constraints. The symphysis-to-testicle distance (STD), field length, and thickness of the patient were experimental variables. The developed mathematical model was validated in subsequent patients. Results: The mean gonadal dose in patients was 0.09 and 0.32 Gy after PA and DL irradiation, respectively (p < 0.001). DL radiotherapy, but not PA irradiation led to significant reduction of the sperm count 1 year after irradiation. The gonadal dose-reducing effect of PA irradiation was confirmed in the Alderson phantom. A significant correlation was found between the STD and the gonadal dose during DL irradiation. A mathematical model was established for calculation of the gonadal dose and confirmed by measurements in patients. Conclusions: During radiotherapy of seminoma, the gonadal dose decreases with increasing STD. It is possible to predict the individual gonadal dose based on delivered midplane dose and STD

  18. Respiratory gating and multi field technique radiotherapy for esophageal cancer

    International Nuclear Information System (INIS)

    Ohta, Atsushi; Kaidu, Motoki; Tanabe, Satoshi

    2017-01-01

    To investigate the effects of a respiratory gating and multi field technique on the dose-volume histogram (DVH) in radiotherapy for esophageal cancer. Twenty patients who underwent four-dimensional computed tomography for esophageal cancer were included. We retrospectively created the four treatment plans for each patient, with or without the respiratory gating and multi field technique: No gating-2-field, No gating-4-field, Gating-2-field, and Gating-4-field plans. We compared the DVH parameters of the lung and heart in the No gating-2-field plan with the other three plans.Result In the comparison of the parameters in the No gating-2-field plan, there are significant differences in the Lung V 5Gy , V 20Gy , mean dose with all three plans and the Heart V 25Gy -V 40Gy with Gating-2-field plan, V 35Gy , V 40Gy , mean dose with No Gating-4-field plan and V 30Gy -V 40Gy , and mean dose with Gating-4-field plan. The lung parameters were smaller in the Gating-2-field plan and larger in the No gating-4-field and Gating-4-field plans. The heart parameters were all larger in the No gating-2-field plan. The lung parameters were reduced by the respiratory gating technique and increased by the multi field technique. The heart parameters were reduced by both techniques. It is important to select the optimal technique according to the risk of complications. (author)

  19. Radiotherapy

    International Nuclear Information System (INIS)

    Prosnitz, L.R.; Kapp, D.S.; Weissberg, J.B.

    1983-01-01

    This review highlights developments over the past decade in radiotherapy and attempts to summarize the state of the art in the management of the major diseases in which radiotherapy has a meaningful role. The equipment, radiobiology of radiotherapy and carcinoma of the lung, breast and intestines are highlighted

  20. External beam radiotherapy of localized prostatic adenocarcinoma. Evaluation of conformal therapy, field number and target margins

    International Nuclear Information System (INIS)

    Lennernaes, B.; Rikner, G.; Letocha, H.; Nilsson, S.

    1995-01-01

    The purpose of the present study was to identify factors of importance in the planning of external beam radiotherapy of prostatic adenocarcinoma. Seven patients with urogenital cancers were planned for external radiotherapy of the prostate. Four different techniques were used, viz. a 4-field box technique and four-, five- or six-field conformal therapy set-ups combined with three different margins (1-3 cm). The evaluations were based on the doses delivered to the rectum and the urinary bladder. A normal tissue complication probability (NTCP) was calculated for each plan using Lyman's dose volume reduction method. The most important factors that resulted in a decrease of the dose delivered to the rectum and the bladder were the use of conformal therapy and smaller margins. Conformal therapy seemed more important for the dose distribution in the urinary bladder. Five- and six-field set-ups were not significantly better than those with four fields. NTCP calculations were in accordance with the evaluation of the dose volume histograms. To conclude, four-field conformal therapy utilizing reduced margins improves the dose distribution to the rectum and the urinary bladder in the radiotherapy of prostatic adenocarcinoma. (orig.)

  1. An assessment of radiotherapy dosimeters based on CVD grown diamond

    International Nuclear Information System (INIS)

    Ramkumar, S.; Buttar, C.M.; Conway, J.; Whitehead, A.J.; Sussman, R.S.; Hill, G.; Walker, S.

    2001-01-01

    Diamond is potentially a very suitable material for use as a dosimeter for radiotherapy. Its radiation hardness, the near tissue equivalence and chemical inertness are some of the characteristics of diamond, which make it well suited for its application as a dosimeter. Recent advances in the synthesis of diamond by chemical vapour deposition (CVD) technology have resulted in the improvement in the quality of material and increased its suitability for radiotherapy applications. We report in this paper, the response of prototype dosimeters based on two different types (CVD1 and CVD2) of CVD diamond to X-rays. The diamond devices were assessed for sensitivity, dependence of response on dose and dose rate, and compared with a Scanditronix silicon photon diode and a PTW natural diamond dosimeter. The diamond devices of CVD1 type showed an initial increase in response with dose, which saturates after ∼6 Gy. The diamond devices of CVD2 type had a response at low fields ( 1162.8 V/cm), the CVD2-type devices showed polarisation and dose-rate dependence. The sensitivity of the CVD diamond devices varied between 82 and 1300 nC/Gy depending upon the sample type and the applied voltage. The sensitivity of CVD diamond devices was significantly higher than that of natural diamond and silicon dosimeters. The results suggest that CVD diamond devices can be fabricated for successful use in radiotherapy applications

  2. A multileaf collimator field prescription preparation system for conventional radiotherapy

    International Nuclear Information System (INIS)

    Du, M.N.; Yu, C. X.; Symons, M.; Yan, D.; Taylor, R.; Matter, R.C.; Gustafson, G.; Martinez, A.; Wong, J.W.

    1995-01-01

    Purpose: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice. Methods and Material: The multileaf collimator prescription preparation system developed by us acquires prescription images from different sources, including film scanner and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link. Results: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments. Conclusion: Our

  3. Radiotherapy

    Directory of Open Access Journals (Sweden)

    Rema Jyothirmayi

    1999-01-01

    Full Text Available Purpose. Conservative treatment in the form of limited surgery and post-operative radiotherapy is controversial in hand and foot sarcomas, both due to poor radiation tolerance of the palm and sole, and due to technical difficulties in achieving adequate margins.This paper describes the local control and survival of 41 patients with soft tissue sarcoma of the hand or foot treated with conservative surgery and radiotherapy. The acute and late toxicity of megavoltage radiotherapy to the hand and foot are described. The technical issues and details of treatment delivery are discussed. The factors influencing local control after radiotherapy are analysed.

  4. Implementation of small field radiotherapy dosimetry for spinal metastase case

    Science.gov (United States)

    Rofikoh, Wibowo, W. E.; Pawiro, S. A.

    2017-07-01

    The main objective of this study was to know dose profile of small field radiotherapy in the spinal metastase case with source axis distance (SAD) techniques. In addition, we evaluated and compared the dose planning of stereotactic body radiation therapy (SBRT) and conventional techniques to measurements with Exradin A16 and Gafchromic EBT3 film dosimeters. The results showed that film EBT3 had a highest precision and accuracy with the average of the standard deviation of ±1.7 and maximum discrepancy of 2.6 %. In addition, the average value of Full Wave Half Maximum (FWHM) and its largest deviation in small field size of 0.8 x 0.8 cm2 are 0.82 cm and 16.3 % respectively, while it was found around 2.36 cm and 3 % for the field size of 2.4 x 2.4 cm2. The comparison between penumbra width and the collimation was around of 37.1 % for the field size of 0.8 x 0.8 cm2, while it was found of 12.4 % for the field size of 2.4 x 2.4 cm2.

  5. PET/CT Based Dose Planning in Radiotherapy

    DEFF Research Database (Denmark)

    Berthelsen, Anne Kiil; Jakobsen, Annika Loft; Sapru, Wendy

    2011-01-01

    radiotherapy planning with PET/CT prior to the treatment. The PET/CT, including the radiotherapy planning process as well as the radiotherapy process, is outlined in detail. The demanding collaboration between mould technicians, nuclear medicine physicians and technologists, radiologists and radiology......This mini-review describes how to perform PET/CT based radiotherapy dose planning and the advantages and possibilities obtained with the technique for radiation therapy. Our own experience since 2002 is briefly summarized from more than 2,500 patients with various malignant diseases undergoing...... technologists, radiation oncologists, physicists, and dosimetrists is emphasized. We strongly believe that PET/CT based radiotherapy planning will improve the therapeutic output in terms of target definition and non-target avoidance and will play an important role in future therapeutic interventions in many...

  6. Radiotherapy

    International Nuclear Information System (INIS)

    Zedgenidze, G.A.; Kulikov, V.A.; Mardynskij, Yu.S.

    1984-01-01

    The technique for roentgenotopometric and medicamentous preparation of patients for radiotherapy has been reported in detail. The features of planning and performing of remote, intracavitary and combined therapy in urinary bladder cancer are considered. The more effective methods of radiotherapy have been proposed taking into account own experience as well as literature data. The comparative evaluation of treatment results and prognosis are given. Radiation pathomorphism of tumors and tissues of urinary bladder is considered in detail. The problems of diagnosis, prophylaxis and treatment of complications following radiodiagnosis and radiotherapy in patients with urinary bladder cancer are illustrated widely

  7. Can field-in-field technique replace wedge filter in radiotherapy treatment planning: a comparative analysis in various treatment sites

    International Nuclear Information System (INIS)

    Prabhakar, R.; Julka, P.K.; Rath, G.K.

    2008-01-01

    The aim of the study was to show whether field-in-field (FIF) technique can be used to replace wedge filter in radiation treatment planning. The study was performed in cases where wedges are commonly used in radiotherapy treatment planning. Thirty patients with different malignancies who received radiotherapy were studied. This includes patients with malignancies of brain, head and neck, breast, upper and lower abdomen. All the patients underwent computed tomography scanning and the datasets were transferred to the treatment planning system. Initially, wedge based planning was performed to achieve the best possible dose distribution inside the target volume with multileaf collimators (Plan1). Wedges were removed from a copy of the same plan and FIF plan was generated (Plan2). The two plans were then evaluated and compared for mean dose, maximum dose, median dose, doses to 2% (D 2 ) and 98% (D 9 8) of the target volume, volume receiving greater than 107% of the prescribed dose (V>107%), volume receiving less than 95% of the prescribed dose (V 2 , V>107% and CI for more of the sites with statistically significant reduction in monitor units. FIF results in better dose distribution in terms of homogeneity in most of the sites. It is feasible to replace wedge filter with FIF in radiotherapy treatment planning.

  8. Radiobiology: radiotherapy and radiation protection, fundamental bases

    International Nuclear Information System (INIS)

    Tubiana, M.

    2008-01-01

    The radiobiology constitutes one of the most successful tools of the research in biology. It has for twenty years, as all the biology, strangely progressed with the increase of the knowledge in molecular biology and the new techniques of the genome exploration. It allows to dissect the living matter, to analyze the repair mechanisms of the damage in the molecular, cellular and tissular scale, to understand the transformation of a normal cell in cancer cell as well as the system of defence, multiple and powerful, against the carcinogenesis to mammals, notably to man. The radiobiology is the base on which the radiotherapy was built and perfected, now this one contributes largely to the cure of half of the cancers. With the increase of the number of the long-term cures, the indication of the second cancers provoked by the ionizing radiations and the cytotoxic largely increased: to reduce their frequency is an imperative, the radiobiology has to help to make it. (N.C.)

  9. Accurate radiotherapy positioning system investigation based on video

    International Nuclear Information System (INIS)

    Tao Shengxiang; Wu Yican

    2006-01-01

    This paper introduces the newest research production on patient positioning method in accurate radiotherapy brought by Accurate Radiotherapy Treating System (ARTS) research team of Institute of Plasma Physics of Chinese Academy of Sciences, such as the positioning system based on binocular vision, the position-measuring system based on contour matching and the breath gate controlling system for positioning. Their basic principle, the application occasion and the prospects are briefly depicted. (authors)

  10. Treatment planning and delivery of involved field radiotherapy in advanced Hodgkin's disease: results from a questionnaire-based audit for the UK Stanford V regimen vs ABVD clinical trial quality assurance programme (ISRCTN 64141244).

    Science.gov (United States)

    Diez, P; Hoskin, P J; Aird, E G A

    2007-10-01

    This questionnaire forms the basis of the quality assurance (QA) programme for the UK randomized Phase III study of the Stanford V regimen versus ABVD for treatment of advanced Hodgkin's disease to assess differences between participating centres in treatment planning and delivery of involved-field radiotherapy for Hodgkin's lymphoma The questionnaire, which was circulated amongst 42 participating centres, consisted of seven sections: target volume definition and dose prescription; critical structures; patient positioning and irradiation techniques; planning; dose calculation; verification; and future developments The results are based on 25 responses. One-third plan using CT alone, one-third use solely the simulator and the rest individualize, depending on disease site. Eleven centres determine a dose distribution for each patient. Technique depends on disease site and whether CT or simulator planning is employed. Most departments apply isocentric techniques and use immobilization and customized shielding. In vivo dosimetry is performed in 7 centres and treatment verification occurs in 24 hospitals. In conclusion, the planning and delivery of treatment for lymphoma patients varies across the country. Conventional planning is still widespread but most centres are moving to CT-based planning and virtual simulation with extended use of immobilization, customized shielding and compensation.

  11. Radiotherapy of tumors under respiratory motion. Estimation of the motional velocity field and dose accumulation based on 4D image data; Strahlentherapie atmungsbewegter Tumoren. Bewegungsfeldschaetzung und Dosisakkumulation anhand von 4D-Bilddaten

    Energy Technology Data Exchange (ETDEWEB)

    Werner, Rene

    2013-07-01

    developed methods belong to the most precise methods currently available. In clinical practice, however, there exists the problem that many medical facilities are not equipped with 4D imaging devices. Further, 4D images still offer only a snapshot of the patient-specific motion range and potential motion variability may limit the conclusions that can be drawn from them. To address these aspects, in the next part of the thesis - based on the optimized methods for motion field estimation in 4D CT image data and further including statistical motion information and models, respectively - model-based approaches for motion field estimation and prediction are developed. First, a novel approach for statistical modeling of lung motion in a patient collective is presented, and methods for adapting the model for prediction of patient-specific motion patterns are provided. The latter allow, for instance, the estimation of respiratory lung and lung tumor motion for radiation therapy treatment planning, if no temporally resolved image sequences are available for the patient; this use case is demonstrated. Further, techniques of multivariate statistics are applied to account for variations of motion patterns by integrating additional information provided by motion indicators used in 4D radiation therapy (e.g. abdominal belts or spirometer measurements) for a patient-specific, situation-related adaption of the motion fields computed using 4D images and the methods for motion field estimation described before. In the last part of the thesis, the developed methods are finally applied for assessing and analyzing the dosimetric impact of respiratory motion during radiation therapy of lung tumors. Both 3D conformal radiotherapy and intensity modulated radiotherapy are modeled as treatment modalities. In the case of intensity modulated radiotherapy, short delivery times for single radiation fields lead to the risk that the corresponding dose contributions are not only subject to a motion

  12. Radiotherapy

    International Nuclear Information System (INIS)

    Wannenmacher, M.; Debus, J.; Wenz, F.

    2006-01-01

    The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy

  13. Radiotherapy.

    Science.gov (United States)

    Krause, Sonja; Debus, Jürgen; Neuhof, Dirk

    2011-01-01

    Solitary plasmocytoma occurring in bone (solitary plasmocytoma of the bone, SBP) or in soft tissue (extramedullary plasmocytoma, EP) can be treated effectively and with little toxicity by local radiotherapy. Ten-year local control rates of up to 90% can be achieved. Patients with multiple myeloma often suffer from symptoms such as pain or neurological impairments that are amenable to palliative radiotherapy. In a palliative setting, short treatment schedules and lower radiation doses are used to reduce toxicity and duration of hospitalization. In future, low-dose total body irradiation (TBI) may play a role in a potentially curative regimen with nonmyeloablative conditioning followed by allogenic peripheral blood stem cell transplantation.

  14. Analysis of the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Song-Lin Wang

    2017-04-01

    Full Text Available Objective: To explore the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy. Methods: A total of 84 patients who were admitted in our hospital after modified radical mastectomy were included in the study and divided into the conventional radiotherapy group (n=42 and the three-dimensional conformal radiotherapy group (n=42 according to different radiotherapy methods. The patients in the conventional radiotherapy group were given conventional radiotherapy of chest wall and clavicular field, while the patients in the three-dimensional conformal radiotherapy group were given three-dimensional conformal radiotherapy. The serum tumor markers and peripheral blood T lymphocyte subsets 6-8 weeks after treatment in the two groups were detected. The clinical efficacy, and toxic and side effects in the two groups were evaluated. Results: The serum CA15-3, CA125, CEA, and CK19 levels after treatment in the two groups were significantly reduced when compared with before treatment, CD3 +,CD4 +, and CD4 +/CD8 + were significantly elevated, while CD8 + was significantly reduced when compared with before treatment, but the comparison of the above indicators between the two groups was not statistically significant. The occurrence rate of radioactive skin damage and pneumonia after treatment in the conventional radiotherapy group was significantly higher than that in the three-dimensional conformal radiotherapy group. Conclusions: The two kinds of radiotherapy schemes have an equal efficacy, but the toxic and side effects of three-dimensional conformal radiotherapy are significantly lower than those by the conventional radiotherapy, with a certain advantage.

  15. Microdosimetric characterisation of radiation fields for modelling tissue response in radiotherapy

    Directory of Open Access Journals (Sweden)

    He Wang

    2014-02-01

    Full Text Available Purpose: Our overall goal is the development of an approach to model tissue response to radiotherapy in which a tissue is viewed as a statistical ensemble of interacting cells. This involves characterisation of radiation fields on the spatial scale of subcellular structures. On this scale, the spatial distribution of radiation energy imparted to tissue is highly non-uniform and should be characterised in statistical terms. Microdosimetry provides a formalism developed for that purpose. This study addresses limitations of the standard microdosimetric approach to modelling tissue response by introducing two new characteristics that include additional information in a form convenient for this application.Methods: The standard microdosimetric approach is based on the concept of a sensitive volume (SV representing a target volume in the cell. It is considered in isolation from other SVs, implying that energy depositions in different SVs are statistically independent and that individual cells respond to radiation independent of each other. In this study, we examined the latter approximation through analysis of correlation functions. All calculations were performed with Geant4-DNA Monte Carlo code. Results: We found that for some realistic scenarios, spatial correlations of deposited energy can be significant. Two new characteristics of radiation fields are proposed. The first is the specific energy-volume histogram (zVH, which is a microscopic analogue of the dose-volume histogram. The second describes the probability distribution of deposited energies in two SVs without assuming statistical independence between the SVs. Numerical examples for protons and carbon ions of therapeutic energies are presented and discussed.Conclusion: We extended the microdosimetric approach to modelling tissue response by including additional important characteristics and presented them in a more conventional radiotherapy format

  16. Quality audit for dose determination in the field of radiotherapy using TLD

    International Nuclear Information System (INIS)

    Kharita, M. H.; Anjak, O.

    2010-08-01

    Quality audit is one of the important procedures in radiotherapy centers in order to verify the accuracy of the delivered radiation doses. The aim of this work is to establish a procedure for dose audit using TL dosimeters and to apply this procedure in radiotherapy centers. TL Dosimeters were distributed to several radiotherapy centers in Syria and Lebanon (4 with Co-60 and 14 with high energy photon beam radiotherapy units). They were exposed to 2 Gy in order to make an intercomparison study of the absorbed dose in water determined under reference conditions. The results show that only two beams were outside the accepted range, which is ±3.5%. and the were within the accepted range. External Quality audit is one of the important procedures in field of radiotherapy dosimeter in order to verify the accuracy of the radiation doses delivered to patients. (Author)

  17. Radiotherapy

    International Nuclear Information System (INIS)

    Pistenma, D.A.

    1980-01-01

    The need for radiotherapy research is exemplified by the 100,000 cancer patients who will fail treatment locally and/or regionally annually for the next several years but who would benefit from better local treatment modalities. Theoretically, all of the areas of investigation discussed in this projection paper have the potential to significantly improve local-regional treatment of cancer by radiotherapy alone or in combination with other modalities. In many of the areas of investigation discussed in this paper encouraging results have been obtained in cellular and animal tumor studies and in limited studies in humans as well. In the not too distant future the number of patients who would benefit from better local control may increase by tens of thousands if developments in chemotherapy and/or immunotherapy provide a means to eradicate disseminated microscopic foci of cancer. Thus the efforts to improve local-regional control take on even greater significance

  18. Radiobiologically based assessments of the net costs of fractionated radiotherapy

    International Nuclear Information System (INIS)

    Dale, Roger G.; Jones, Bleddyn

    1996-01-01

    Purpose: To examine how the long-term costs of radiation therapy may be influenced by modifications to fractionation schemes, and how any improvements in tumor control might, in principle, be translated into a potential cost saving for the responsible healthcare organization. Methods and Materials: Standard radiobiological modeling based on the linear-quadratic (LQ) model is combined with financial parameters relating to the estimated costs of different aspects of radiotherapy treatment delivery. The cost model includes provision for the long-term costs of treatment failure and enables the extra costs of near optimal radiotherapy to be balanced against suboptimal alternatives, which are more likely to be associated with further radiotherapy, salvage surgery, and continuing care. Results: A number of caveats are essential in presenting a model such as this for the first time, and these are clearly stated. However, a recurring observation is that, in terms of the whole cost of supporting a patient from first radiotherapy treatment onwards, high quality radiotherapy (i.e., based on individual patterns of fractionation that are near optimal for particular subpopulations of tumor) will frequently be associated with the lowest global cost. Conclusions: This work adds weight to the case for identifying fast and accurate predictive assay techniques, and supports the argument that suboptimal radiotherapy is usually more costly in the long term. Although the article looks only at the cost-benefit consequences of altered patterns of fractionation, the method will, in principle, have application to other changes in the way radiotherapy can be performed, e.g., to examining the cost-benefit aspects of tumor dose escalation as a consequence of using advanced conformal treatment planning

  19. Supplemental computational phantoms to estimate out-of-field absorbed dose in photon radiotherapy

    Science.gov (United States)

    Gallagher, Kyle J.; Tannous, Jaad; Nabha, Racile; Feghali, Joelle Ann; Ayoub, Zeina; Jalbout, Wassim; Youssef, Bassem; Taddei, Phillip J.

    2018-01-01

    The purpose of this study was to develop a straightforward method of supplementing patient anatomy and estimating out-of-field absorbed dose for a cohort of pediatric radiotherapy patients with limited recorded anatomy. A cohort of nine children, aged 2-14 years, who received 3D conformal radiotherapy for low-grade localized brain tumors (LBTs), were randomly selected for this study. The extent of these patients’ computed tomography simulation image sets were cranial only. To approximate their missing anatomy, we supplemented the LBT patients’ image sets with computed tomography images of patients in a previous study with larger extents of matched sex, height, and mass and for whom contours of organs at risk for radiogenic cancer had already been delineated. Rigid fusion was performed between the LBT patients’ data and that of the supplemental computational phantoms using commercial software and in-house codes. In-field dose was calculated with a clinically commissioned treatment planning system, and out-of-field dose was estimated with a previously developed analytical model that was re-fit with parameters based on new measurements for intracranial radiotherapy. Mean doses greater than 1 Gy were found in the red bone marrow, remainder, thyroid, and skin of the patients in this study. Mean organ doses between 150 mGy and 1 Gy were observed in the breast tissue of the girls and lungs of all patients. Distant organs, i.e. prostate, bladder, uterus, and colon, received mean organ doses less than 150 mGy. The mean organ doses of the younger, smaller LBT patients (0-4 years old) were a factor of 2.4 greater than those of the older, larger patients (8-12 years old). Our findings demonstrated the feasibility of a straightforward method of applying supplemental computational phantoms and dose-calculation models to estimate absorbed dose for a set of children of various ages who received radiotherapy and for whom anatomies were largely missing in their original

  20. Comparison of curricula in radiation technology in the field of radiotherapy in selected European Union countries

    International Nuclear Information System (INIS)

    Janaszczyk, A.; Bogusz-Czerniewicz, M.

    2011-01-01

    Background: Radiation technology is a discipline of medical science which deals with diagnostics, imaging and radiotherapy, that is treatment by ionizing radiation. Aim: To present and compare the existing curricula of radiation technology in selected EU countries. Materials and methods: The research work done for the purpose of the comparative analysis was based on the methods of diagnostic test and document analysis. Results: The comparison of curricula in selected countries, namely Austria, France, the Netherlands and Poland, showed that admission criteria to radiation technology courses are varied and depend on regulations of respective Ministries of Health. The most restrictive conditions, including written tests in biology, chemistry and physics, and psychometric test, are those in France. Contents of basic and specialist subject groups are very similar in all the countries. The difference is in the number of ECT points assigned to particular subjects and the number of course hours offered. The longest practical training is provided in the Netherlands and the shortest one in Poland. The duration of studies in the Netherlands is 4 years, while in Poland it is 3 years. Austria is the only country to offer extra practical training in quality management. Conclusion: Graduates in the compared EU countries have similar level of qualifications in the fields of operation of radiological equipment, radiotherapy, nuclear medicine, foreign language and specialist terminology in the field of medical and physical sciences, general knowledge of medical and physical sciences, and detailed knowledge of radiation technology. (authors)

  1. A Dosimetric Evaluation of Conventional Helmet Field Irradiation Versus Two-Field Intensity-Modulated Radiotherapy Technique

    International Nuclear Information System (INIS)

    Yu, James B.; Shiao, Stephen L.; Knisely, Jonathan

    2007-01-01

    Purpose: To compare dosimetric differences between conventional two-beam helmet field irradiation (external beam radiotherapy, EBRT) of the brain and a two-field intensity-modulated radiotherapy (IMRT) technique. Methods and Materials: Ten patients who received helmet field irradiation at our institution were selected for study. External beam radiotherapy portals were planned per usual practice. Intensity-modulated radiotherapy fields were created using the identical field angles as the EBRT portals. Each brain was fully contoured along with the spinal cord to the bottom of the C2 vertebral body. This volume was then expanded symmetrically by 0.5 cm to construct the planning target volume. An IMRT plan was constructed using uniform optimization constraints. For both techniques, the nominal prescribed dose was 3,000 cGy in 10 fractions of 300 cGy using 6-MV photons. Comparative dose-volume histograms were generated for each patient and analyzed. Results: Intensity-modulated radiotherapy improved dose uniformity over EBRT for whole brain radiotherapy. The mean percentage of brain receiving >105% of dose was reduced from 29.3% with EBRT to 0.03% with IMRT. The mean maximum dose was reduced from 3,378 cGy (113%) for EBRT to 3,162 cGy (105%) with IMRT. The mean percent volume receiving at least 98% of the prescribed dose was 99.5% for the conventional technique and 100% for IMRT. Conclusions: Intensity-modulated radiotherapy reduces dose inhomogeneity, particularly for the midline frontal lobe structures where hot spots occur with conventional two-field EBRT. More study needs to be done addressing the clinical implications of optimizing dose uniformity and its effect on long-term cognitive function in selected long-lived patients

  2. Determination of the optimal method for the field-in-field technique in breast tangential radiotherapy

    International Nuclear Information System (INIS)

    Tanaka, Hidekazu; Hayashi, Shinya; Hoshi, Hiroaki

    2014-01-01

    Several studies have reported the usefulness of the field-in-field (FIF) technique in breast radiotherapy. However, the methods for the FIF technique used in these studies vary. These methods were classified into three categories. We simulated a radiotherapy plan with each method and analyzed the outcomes. In the first method, a pair of subfields was added to each main field: the single pair of subfields method (SSM). In the second method, three pairs of subfields were added to each main field: the multiple pairs of subfields method (MSM). In the third method, subfields were alternately added: the alternate subfields method (ASM). A total of 51 patients were enrolled in this study. The maximum dose to the planning target volume (PTV) (Dmax) and the volumes of the PTV receiving 100% of the prescription dose (V100%) were calculated. The thickness of the breast between the chest wall and skin surface was measured, and patients were divided into two groups according to the median. In the overall series, the average V100% with ASM (60.3%) was significantly higher than with SSM (52.6%) and MSM (48.7%). In the thin breast group as well, the average V100% with ASM (57.3%) and SSM (54.2%) was significantly higher than that with MSM (43.3%). In the thick breast group, the average V100% with ASM (63.4%) was significantly higher than that with SSM (51.0%) and MSM (54.4%). ASM resulted in better dose distribution, regardless of the breast size. Moreover, planning for ASM required a relatively short time. ASM was considered the most preferred method. (author)

  3. Configuration control based on risk matrix for radiotherapy treatment

    International Nuclear Information System (INIS)

    Montes de Oca Quinnones, Joe; Torres Valle, Antonio

    2015-01-01

    The incorporation of the science and technique breakthroughs in the application of the radiotherapy represents a challenge so that, the appearance of equipment failure or human mistakes that triggers unfavorable consequences for patients, public, or the occupationally exposed workers; it is also diversified forcing to incorporate besides, as part of the efforts, new techniques for the evaluation of risk and the detection of the weak points that can lead to these consequences. In order to evaluate the risks of the radiotherapy practices there is the SEVRRA code, based on the method of Risk Matrix. The system SEVRRA is the most frequently used code in the applications of risk studies in radiotherapy treatment. On the other hand, starting from the development of tools to control the dangerous configurations in nuclear power plants, it has been developed the SECURE code, which in its application variant of Risk Matrix, has gain a comfortable interface man-machine to make risk analyses to the radiotherapy treatment, molding in this way a lot of combinations of scenarios. These capacities outstandingly facilitate the studies and risk optimization applications in these practices. In the system SECURE-Risk Matrix are incorporated graphic and analytical capacities, which make more flexible the analyses and the subsequent documentation of all the results. The paper shows the the application of the proposed system to an integral risk study for the process of radiotherapy treatment with linear accelerator. (Author)

  4. Automated Image-Based Procedures for Adaptive Radiotherapy

    DEFF Research Database (Denmark)

    Bjerre, Troels

    be employed for contour propagation in adaptive radiotherapy. - MRI-radiotherapy devices have the potential to offer near real-time intrafraction imaging without any additional ionising radiation. It is detailed how the use of multiple, orthogonal slices can form the basis for reliable 3D soft tissue tracking.......-based treatment replanning and real-time intrafraction guidance techniques. The selected contributions detail a number of findings and techniques, in particular: - For ten head & neck cancer patients, changes in tumour density were well described by linear functions with patient-specific slope and intercept...

  5. Osteoradionecrosis of the skull base after radiotherapy for nasopharynx cancer

    International Nuclear Information System (INIS)

    Mnejja, W.; Siala, W.; Daoud, J.; Boudawara, T.; Ghorbel, A.; Frikha, M.

    2009-01-01

    The purpose of this work was to study the incidence and the risk factors of osteoradionecrosis occurrence at the skull base after radiotherapy for nasopharynx cancer. It is often asymptomatic. Its incidence is not low. The systematic realisation of radiological examinations during the surveillance allows to detect the asymptomatic forms. No factor of risk was identified in the study. (N.C.)

  6. Dosimetric Evaluation of Intensity Modulated Radiotherapy and 4-Field 3-D Conformal Radiotherapy in Prostate Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Bora Uysal

    2013-03-01

    Full Text Available Objective: The purpose of this dosimetric study is the targeted dose homogeneity and critical organ dose comparison of 7-field Intensity Modulated Radiotherapy (IMRT and 3-D 4-field conformal radiotherapy. Study Design: Cross sectional study. Material and Methods: Twenty patients with low and moderate risk prostate cancer treated at Gülhane Military Medical School Radiation Oncology Department between January 2009 and December 2009 are included in this study. Two seperate dosimetric plans both for 7-field IMRT and 3D-CRT have been generated for each patient to comparatively evaluate the dosimetric status of both techniques and all the patients received 7-field IMRT. Results: Dose-comparative evaluation of two techniques revealed the superiority of IMRT technique with statistically significantly lower femoral head doses along with reduced critical organ dose-volume parameters of bladder V60 (the volume receiving 60 Gy and rectal V40 (the volume receiving 40 Gy and V60. Conclusion: It can be concluded that IMRT is an effective definitive management tool for prostate cancer with improved critical organ sparing and excellent dose homogenization in target organs of prostate and seminal vesicles.

  7. Gene therapy and radiotherapy in malignant tumor

    International Nuclear Information System (INIS)

    Zhang Yaowen; Cao Yongzhen; Li Jin; Wang Qin

    2008-01-01

    Tumor treatment is one of the most important fields in medical research. Nowadays, a novel method which is combined gene therapy with radiotherapy plays an important role in the field of cancer research, and mainly includes immune gene therapy combined with radiotherapy, suicide gene therapy or tumor suppressor gene therapy combined with radiotherapy, antiangiogenesis gene therapy combined with radiotherapy and protective gene therapy combined with radiotherapy based on the technical features. This review summarized the current status of combined therapies of gene therapy and radiotherapy and possible mechanism. (authors)

  8. Clinical dosimetry in photon radiotherapy. A Monte Carlo based investigation

    International Nuclear Information System (INIS)

    Wulff, Joerg

    2010-01-01

    Practical clinical dosimetry is a fundamental step within the radiation therapy process and aims at quantifying the absorbed radiation dose within a 1-2% uncertainty. To achieve this level of accuracy, corrections are needed for calibrated and air-filled ionization chambers, which are used for dose measurement. The procedures of correction are based on cavity theory of Spencer-Attix and are defined in current dosimetry protocols. Energy dependent corrections for deviations from calibration beams account for changed ionization chamber response in the treatment beam. The corrections applied are usually based on semi-analytical models or measurements and are generally hard to determine due to their magnitude of only a few percents or even less. Furthermore the corrections are defined for fixed geometrical reference-conditions and do not apply to non-reference conditions in modern radiotherapy applications. The stochastic Monte Carlo method for the simulation of radiation transport is becoming a valuable tool in the field of Medical Physics. As a suitable tool for calculation of these corrections with high accuracy the simulations enable the investigation of ionization chambers under various conditions. The aim of this work is the consistent investigation of ionization chamber dosimetry in photon radiation therapy with the use of Monte Carlo methods. Nowadays Monte Carlo systems exist, which enable the accurate calculation of ionization chamber response in principle. Still, their bare use for studies of this type is limited due to the long calculation times needed for a meaningful result with a small statistical uncertainty, inherent to every result of a Monte Carlo simulation. Besides heavy use of computer hardware, techniques methods of variance reduction to reduce the needed calculation time can be applied. Methods for increasing the efficiency in the results of simulation were developed and incorporated in a modern and established Monte Carlo simulation environment

  9. Local field radiotherapy without elective nodal irradiation for postoperative loco-regional recurrence of esophageal cancer.

    Science.gov (United States)

    Kimoto, Takuya; Yamazaki, Hideya; Suzuki, Gen; Aibe, Norihiro; Masui, Koji; Tatekawa, Kotoha; Sasaki, Naomi; Fujiwara, Hitoshi; Shiozaki, Atsushi; Konishi, Hirotaka; Nakamura, Satoaki; Yamada, Kei

    2017-09-01

    Radiotherapy is an effective treatment for the postoperative loco-regional recurrence of esophageal cancer; however, the optimal treatment field remains controversial. This study aims to evaluate the outcome of local field radiotherapy without elective nodal irradiation for postoperative loco-regional recurrence of esophageal cancer. We retrospectively investigated 35 patients treated for a postoperative loco-regional recurrence of esophageal cancer with local field radiotherapy between December 2008 and March 2016. The median irradiation dose was 60 Gy (range: 50-67.5 Gy). Thirty-one (88.6%) patients received concurrent chemotherapy. The median follow-up period was 18 months (range: 5-94 months). The 2-year overall survival was 55.7%, with a median survival time of 29.9 months. In the univariate analysis, the maximal diameter ≤20 mm (P = 0.0383), solitary lesion (P = 0.0352), and the complete remission after treatment (P = 0.00411) had a significantly better prognosis. A total of 27 of 35 patients (77.1%) had progressive disease (loco-regional failure [n = 9], distant metastasis [n = 7], and both loco-regional failure and distant metastasis [n = 11]). No patients had Grade 3 or greater mucositis. Local field radiotherapy is a considerable treatment option for postoperative loco-regional recurrence of esophageal cancer. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Characterisation of neutron fields around high-energy x-ray radiotherapy machines

    Czech Academy of Sciences Publication Activity Database

    Králík, M.; Turek, Karel

    2004-01-01

    Roč. 110, 1-4 (2004), s. 503-507 ISSN 0144-8420 Institutional research plan: CEZ:AV0Z1048901 Keywords : radiotherapy machines * neutron fields * high-energy Subject RIV: DN - Health Impact of the Environment Quality Impact factor: 0.617, year: 2003

  11. An adaptive radiotherapy planning strategy for bladder cancer using deformation vector fields

    International Nuclear Information System (INIS)

    Vestergaard, Anne; Kallehauge, Jesper Folsted; Petersen, Jørgen Breede Baltzer; Høyer, Morten; Søndergaard, Jimmi; Muren, Ludvig Paul

    2014-01-01

    Purpose: Adaptive radiotherapy (ART) has considerable potential in treatment of bladder cancer due to large inter-fractional changes in shape and size of the target. The aim of this study was to compare our clinically applied method for plan library creation that involves manual bladder delineations (Clin-ART) with a method using the deformation vector fields (DVFs) resulting from intensity-based deformable image registrations (DVF-based ART). Materials and methods: The study included thirteen patients with urinary bladder cancer who had daily cone beam CTs (CBCTs) acquired for set-up. In both ART strategies investigated, three plan selection volumes were generated using the CBCTs from the first four fractions; in Clin-ART boolean combinations of delineated bladders were used, while the DVF-based strategy applied combinations of the mean and standard deviation of patient-specific DVFs. The volume ratios (VRs) of the course-averaged PTV for the two ART strategies relative the non-adaptive PTV were calculated. Results: Both Clin-ART and DVF-based ART considerably reduced the course-averaged PTV, compared to non-adaptive RT. The VR for DVF-based ART was lower than for Clin-ART (0.65 vs. 0.73; p < 0.01). Conclusions: DVF-based ART for bladder irradiation has a considerable normal tissue sparing potential surpassing our already highly conformal clinically applied ART strategy

  12. An adaptive radiotherapy planning strategy for bladder cancer using deformation vector fields.

    Science.gov (United States)

    Vestergaard, Anne; Kallehauge, Jesper Folsted; Petersen, Jørgen Breede Baltzer; Høyer, Morten; Søndergaard, Jimmi; Muren, Ludvig Paul

    2014-09-01

    Adaptive radiotherapy (ART) has considerable potential in treatment of bladder cancer due to large inter-fractional changes in shape and size of the target. The aim of this study was to compare our clinically applied method for plan library creation that involves manual bladder delineations (Clin-ART) with a method using the deformation vector fields (DVFs) resulting from intensity-based deformable image registrations (DVF-based ART). The study included thirteen patients with urinary bladder cancer who had daily cone beam CTs (CBCTs) acquired for set-up. In both ART strategies investigated, three plan selection volumes were generated using the CBCTs from the first four fractions; in Clin-ART boolean combinations of delineated bladders were used, while the DVF-based strategy applied combinations of the mean and standard deviation of patient-specific DVFs. The volume ratios (VRs) of the course-averaged PTV for the two ART strategies relative the non-adaptive PTV were calculated. Both Clin-ART and DVF-based ART considerably reduced the course-averaged PTV, compared to non-adaptive RT. The VR for DVF-based ART was lower than for Clin-ART (0.65 vs. 0.73; p<0.01). DVF-based ART for bladder irradiation has a considerable normal tissue sparing potential surpassing our already highly conformal clinically applied ART strategy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  14. Biology-based combined-modality radiotherapy: workshop report

    International Nuclear Information System (INIS)

    Mason, Kathryn A.; Komaki, Ritsuko; Cox, James D.; Milas, Luka

    2001-01-01

    Purpose: The purpose of this workshop summary is to provide an overview of preclinical and clinical data on combined-modality radiotherapy. Methods and Materials: The 8th Annual Radiation Workshop at Round Top was held April 13-16, 2000 at the International Festival Institute (Round Top, TX). Results: Presentations by 30 speakers (from Germany, Netherlands, Australia, England, and France along with U.S. participants and M. D. Anderson Cancer Center faculty) formed the framework for discussions on the current status and future perspectives of biology-based combined-modality radiotherapy. Conclusion: Cellular and molecular pathways available for radiation modification by chemical and biologic agents are numerous, providing new opportunities for translational research in radiation oncology and for more effective combined-modality treatment of cancer

  15. Estimating radiotherapy demands in South East Asia countries in 2025 and 2035 using evidence-based optimal radiotherapy fractions.

    Science.gov (United States)

    Yahya, Noorazrul; Roslan, Nurhaziqah

    2018-01-08

    As about 50% of cancer patients may require radiotherapy, the demand of radiotherapy as the main treatment to treat cancer is likely to rise due to rising cancer incidence. This study aims to quantify the radiotherapy demand in countries in Southeast Asia (SEA) in 2025 and 2035 using evidence-based optimal radiotherapy fractions. SEA country-specific cancer incidence by tumor site for 2015, 2025 and 2035 was extracted from the GLOBOCAN database. We utilized the optimal radiotherapy utilization rate model by Wong et al. (2016) to calculate the optimal number of fractions for all tumor sites in each SEA country. The available machines (LINAC & Co-60) were extracted from the IAEA's Directory of Radiotherapy Centres (DIRAC) from which the number of available fractions was calculated. The incidence of cancers in SEA countries are expected to be 1.1 mil cases (2025) and 1.4 mil (2035) compared to 0.9 mil (2015). The number of radiotherapy fractions needed in 2025 and 2035 are 11.1 and 14.1 mil, respectively, compared to 7.6 mil in 2015. In 2015, the radiotherapy fulfillment rate (RFR; required fractions/available fractions) varied between countries with Brunei, Singapore and Malaysia are highest (RFR > 1.0 - available fractions > required fractions), whereas Cambodia, Indonesia, Laos, Myanmar, Philippines, Timor-Leste and Vietnam have RFR fractions, estimation for number of machines required can be obtained which will guide acquisition of machines in SEA countries. RFR is low with access varied based on the economic status. © 2018 John Wiley & Sons Australia, Ltd.

  16. Brainstem tolerance to conformal radiotherapy of skull base tumors

    International Nuclear Information System (INIS)

    Debus, J.; Hug, E.B.; Liebsch, N.J.; O'Farrel, D.; Finkelstein, D.; Efird, J.; Munzenrider, J.E.

    1997-01-01

    Purpose: The aim of this study was to analyze the long-term incidence of brainstem toxicity in patients treated for skull base tumors with high dose conformal radiotherapy. Methods and Materials: Between 1974 and 1995, 367 patients with chordomas (n = 195) and chondrosarcomas (n = 172) of the base of skull have been treated with combined megavoltage photon and 160 MeV proton radiotherapy. Following 3D treatment planning with delineation of target volumes and critical nontarget structures dose distributions and dose-volume histograms were calculated. Radiotherapy was given an 1.8 Gy or CGE (=Cobalt Gray Equivalent) dose per fraction, with prescribed target doses ranging from 63 CGE to 79.2 CGE (mean = 67.8 CGE). Doses to the brainstem surface were limited to ≤64 CGE and to the brainstem center to ≤53 CGE. Results: Follow-up time ranged from 6 months to 21.4 years (mean = 42.5 months). Brainstem toxicity was observed in 17 of 367 patients attributable to treatment, resulting in death of three patients. Actuarial rates of 5 and 10-year high-grade toxicity-free survival were 94 and 88%, respectively. Increased risk of brainstem toxicity was significantly associated with maximum dose to brainstem, volume of brainstem receiving ≥50 CGE, ≥55 CGE, and ≥60 CGE, number of surgical procedures, and prevalence of diabetes or high blood pressure. Multivariate analysis identified three independent factors as important prognosticators: number of surgical procedures (p < 0.001), volume of the brainstem receiving 60 CGE (p < 0.001), and prevalence of diabetes (p < 0.01). Conclusions: Tolerance of brainstem to fractionated radiotherapy appears to be a steep function of tissue volume included in high dose regions rather than the maximum dose of brainstem alone. In addition, presence of predisposing factors as well as extent of surgical manipulation can significantly lower brainstem tolerance in the individual patient

  17. Upfront Chemotherapy and Involved-Field Radiotherapy Results in More Relapses Than Extended Radiotherapy for Intracranial Germinomas: Modification in Radiotherapy Volume Might Be Needed

    International Nuclear Information System (INIS)

    Eom, Keun-Yong; Kim, Il Han; Park, Charn Il; Kim, Hak Jae; Kim, Jin Ho.; Kim, Kyubo; Kim, Seung Ki; Wang, Kyu-Chang; Cho, Byung-Gyu; Jung, Hee-Won; Heo, Dae Seog; Kang, Hyoung Jin; Shin, Hee Young; Ahn, Hyo Seop

    2008-01-01

    Purpose: To retrospectively compare the outcome of upfront chemotherapy plus radiotherapy (CRT) and the outcome of the use of extended radiotherapy (RT) only for intracranial germinoma. Methods and Materials: Of 81 patients with tissue-confirmed intracranial germinoma, 42 underwent CRT and 39 underwent RT only. For CRT, one to five cycles of upfront chemotherapy was followed by involved-field or extended-field RT, for which the dose was dependent on the M stage. For RT only, all 39 patients underwent craniospinal RT alone. The median follow-up was 68 months. Results: The 5- and 10-year overall survival rate was 100% and 92.5% for RT alone and 92.9% and 92.9% for CRT, respectively. The 5-year recurrence-free survival rate was 100.0% for RT and 88.1% for CRT (p = 0.0279). No recurrences developed in patients given RT, but four relapses developed in patients who had received CRT-three in the brain and one in the spine. Only one patient achieved complete remission from salvage treatment. The proportion of patients requiring hormonal replacement was greater for patients who received RT than for those who had received CRT (p = 0.0106). Conclusions: The results of our study have shown that the better quality of life provided by CRT was compensated for by the greater rate of relapse. The possible benefit of including the ventricles in involved-field RT after upfront chemotherapy, specifically for patients with initial negative seeding, should be addressed in a prospective study

  18. Progressive Muscle Atrophy and Weakness After Treatment by Mantle Field Radiotherapy in Hodgkin Lymphoma Survivors

    International Nuclear Information System (INIS)

    Leeuwen-Segarceanu, Elena M. van; Dorresteijn, Lucille D.A.; Pillen, Sigrid; Biesma, Douwe H.; Vogels, Oscar J.M.; Alfen, Nens van

    2012-01-01

    Purpose: To describe the damage to the muscles and propose a pathophysiologic mechanism for muscle atrophy and weakness after mantle field radiotherapy in Hodgkin lymphoma (HL) survivors. Methods and Materials: We examined 12 patients treated by mantle field radiotherapy between 1969 and 1998. Besides evaluation of their symptoms, the following tests were performed: dynamometry; ultrasound of the sternocleidomastoid, biceps, and antebrachial flexor muscles; and needle electromyography of the neck, deltoid, and ultrasonographically affected arm muscles. Results: Ten patients (83%) experienced neck complaints, mostly pain and muscle weakness. On clinical examination, neck flexors were more often affected than neck extensors. On ultrasound, the sternocleidomastoid was severely atrophic in 8 patients, but abnormal echo intensity was seen in only 3 patients. Electromyography of the neck muscles showed mostly myogenic changes, whereas the deltoid, biceps, and antebrachial flexor muscles seemed to have mostly neurogenic damage. Conclusions: Many patients previously treated by mantle field radiotherapy develop severe atrophy and weakness of the neck muscles. Neck muscles within the radiation field show mostly myogenic damage, and muscles outside the mantle field show mostly neurogenic damage. The discrepancy between echo intensity and atrophy suggests that muscle damage is most likely caused by an extrinsic factor such as progressive microvascular fibrosis. This is also presumed to cause damage to nerves within the radiated field, resulting in neurogenic damage of the deltoid and arm muscles.

  19. Decreasing Temporal Lobe Dose With Five-Field Intensity-Modulated Radiotherapy for Treatment of Pituitary Macroadenomas

    International Nuclear Information System (INIS)

    Parhar, Preeti K.; Duckworth, Tamara; Shah, Parinda; DeWyngaert, J. Keith; Narayana, Ashwatha; Formenti, Silvia C.; Shah, Jinesh N.

    2010-01-01

    Purpose: To compare temporal lobe dose delivered by three pituitary macroadenoma irradiation techniques: three-field three-dimensional conformal radiotherapy (3D-CRT), three-field intensity-modulated radiotherapy (3F IMRT), and a proposed novel alternative of five-field IMRT (5F IMRT). Methods and Materials: Computed tomography-based external beam radiotherapy planning was performed for 15 pituitary macroadenoma patients treated at New York University between 2002 and 2007 using: 3D-CRT (two lateral, one midline superior anterior oblique [SAO] beams), 3F IMRT (same beam angles), and 5F IMRT (same beam angles with additional right SAO and left SAO beams). Prescription dose was 45 Gy. Target volumes were: gross tumor volume (GTV) = macroadenoma, clinical target volume (CTV) = GTV, and planning target volume = CTV + 0.5 cm. Structure contouring was performed by two radiation oncologists guided by an expert neuroradiologist. Results: Five-field IMRT yielded significantly decreased temporal lobe dose delivery compared with 3D-CRT and 3F IMRT. Temporal lobe sparing with 5F IMRT was most pronounced at intermediate doses: mean V25Gy (% of total temporal lobe volume receiving ≥25 Gy) of 13% vs. 28% vs. 29% for right temporal lobe and 14% vs. 29% vs. 30% for left temporal lobe for 5F IMRT, 3D-CRT, and 3F IMRT, respectively (p -7 for 5F IMRT vs. 3D-CRT and 5F IMRT vs. 3F IMRT). Five-field IMRT plans did not compromise target coverage, exceed normal tissue dose constraints, or increase estimated brain integral dose. Conclusions: Five-field IMRT irradiation technique results in a statistically significant decrease in the dose to the temporal lobes and may thus help prevent neurocognitive sequelae in irradiated pituitary macroadenoma patients.

  20. Radiobiological analysis of the field in field technique in breast cancer radiotherapy treatments

    Energy Technology Data Exchange (ETDEWEB)

    Medel B, E.; Vasquez R, M. A. [IMSS, Centro Medico Nacional Manuel Avila Camacho, Calle 2 Nte. 2004, Barrio de San Francisco, 72090 Puebla, Pue. (Mexico); Tejeda M, G., E-mail: marcosalivasquez@gmail.com [Benemerita Universidad Autonoma de Puebla, Facultad de Ciencias Fisico Matematicas, Av. San Claudio y 18 Sur, Ciudad Universitaria, 72570 Puebla, Pue. (Mexico)

    2015-10-15

    Full text: In vivo dosimetry was performed in 6 unilateral breast cancer patients treated with external beam radiation therapy in order to evaluate the dose calculated by the radiotherapy treatment planning system (Xi O, ELEKTA). Results show a maximum difference of 0.473 Gy between the dose calculated by the treatment planning system and the dose measured in vivo using solid state detectors. Based on the DVHs statistics, tumor control probability (Tcp) was obtained using the Target-Poisson model, with the following Tcp parameters: α=0.288/Gy, α{sub s}pread= 0.13 and α/β=4.9 Gy. Tcp average obtained for the Clinical Tumor Volume (Ctv) is 35.1% and for Supra Clavicle Volume (Scv) is 35.345%. Finally using Lyman model Normal Tissue Complication Probability (Ntcp) was obtained for the following endpoints: contralateral breast fibrosis, lung radiation pneumonitis and heart pericarditis. Nonetheless the Ntcp values are not high; the improvement of the Tcp based on this plan makes Ntcp for lung radiation pneumonitis reach the 100% of probability in some cases. (Author)

  1. Image based radiotherapy, where we stand?

    International Nuclear Information System (INIS)

    Rangacharyulu, Chary

    2016-01-01

    Since the invention of X-ray tube, image based therapy has evolved in many ways. The latest tool is the MR-Linac, where MRI guided Linac Bremsstrahlung radiation therapy is being promoted to cure cancers. Studies are underway to combine proton radiation therapy with positron emission tomography. Also, there are ideas for Bremsstrahlung beam therapy using a few MeV photons to combine with real-time positron emission tomography. While these technologies offer promises to revolutionize radiation oncology, one should be concerned about the potential excessive doses and their consequences to the patient. Also, one should be wary about the instantaneous real-time responses from oncologist or, even a bit scarier, automated decisions based on algorithm dictated protocols, which may result in life and death or even worse, those which may adversely affect the well being of a patient. In essence, treatment protocols which incorporate a thorough, careful assessments are warranted. Further concerns are economics of these developments weighed against the quality of life to the patients and their beloved's. This talk will present the current status and speculate on the possible developments with a few cautionary remarks. (author)

  2. Evidence-based optimal number of radiotherapy fractions for cancer: A useful tool to estimate radiotherapy demand.

    Science.gov (United States)

    Wong, Karen; Delaney, Geoff P; Barton, Michael B

    2016-04-01

    The recently updated optimal radiotherapy utilisation model estimated that 48.3% of all cancer patients should receive external beam radiotherapy at least once during their disease course. Adapting this model, we constructed an evidence-based model to estimate the optimal number of fractions for notifiable cancers in Australia to determine equipment and workload implications. The optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the evidence-based recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of variables on the model. Of the 27 cancer sites, the optimal number of fractions for the first course of radiotherapy ranged from 0 to 23.3 per cancer patient, and 1.5 to 29.1 per treatment course. Brain, prostate and head and neck cancers had the highest average number of fractions per course. Overall, the optimal number of fractions was 9.4 per cancer patient (range 8.7-10.0) and 19.4 per course (range 18.0-20.7). These results provide valuable data for radiotherapy services planning and comparison with actual practice. The model can be easily adapted by inserting population-specific epidemiological data thus making it applicable to other jurisdictions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Brainstem tolerance to conformal radiotherapy of skull base tumors

    International Nuclear Information System (INIS)

    Debus, J.; Hug, E.B.; Munzenrider, J.E.; Liebsch, N.J.; O'Farrell, D.; Efird, J.; Daly, W.; Suit, H.D.

    1996-01-01

    Purpose/Objective: Brainstem tolerance to inhomogenous radiation doses applied by modern conformal radiotherapy has not yet been examined. The aim of this study was to analyse the incidence of brainstem toxicity in patients treated for skull base tumors with high dose conformal radiotherapy. Materials and Methods: Between 1974 and 1995, 367 patients with chordomas (n=195) and chondrosarcomas (n=172) of the base of skull have been treated with combined megavoltage photon and 160 MeV proton radiotherapy. All patients had previously undergone biopsy, subtotal or total tumor removal. 104 patients had two or more surgical procedures before radiotherapy. Following 3D treatment planning with delineation of target volumes and critical non-target structures, dose distributions and dose volume histograms were calculated [at the time of treatment delivery]. Radiotherapy was given once a day, 1.8 Gy or CGE (Cobalt Gy Equivalent: Proton Gy X 1.1) per fraction, 5 fractions per week, with prescribed target doses ranging from 63 CGE to 79.2 CGE (mean = 67.8 CGE). Doses to the brainstem surface were limited to ≤64 CGE and to the brainstem center to ≤53 CGE. Dose distributions were developed to limit dose to brainstem surface and center; current plans limit dose to surface and center to ≤64 CGE and ≤53 CGE, respectively. Brainstem toxicity was scored according to the RTOG grading system. Results: Follow-up ranged from 6 months to 21.4 years (mean = 42.5 months). Brainstem symptoms, attributable to the treatment, developed in 17 of 282 patients with local tumor control (6.0%), resulting in death of three patients. The mean time to onset of symptoms was 17 months (range: 4.5 to 177 months). These symptoms appeared in 89.5% within 3 years. Grading of the brainstem toxicity is listed in table 1. Actuarial rates of 5 and 10 year toxicity free survival were 87% and 82% respectively. Increased risk of brainstem toxicity was significantly associated with maximum brainstem dose

  4. Improving bladder cancer treatment with radiotherapy using separate intensity modulated radiotherapy plans for boost and elective fields

    Energy Technology Data Exchange (ETDEWEB)

    Van Rooijen, D.; Van de Kamer, J.; Hulshof, M.; Koning, C.; Bel, A. [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands)

    2010-06-01

    The aim of this study is to investigate to what extent IMRT can decrease the dose to the organs at risk in bladder cancer treatment compared with conformal treatment while making separate treatment plans for the elective field and the boost. Special attention is paid to sparing small intestines. Twenty patients who were treated with the field-in-field technique (FiF) were re-planned with intensity modulated radiotherapy (IMRT) using five and seven beams, respectively. Separate treatment plans were made for the elective field (including the pelvic lymph nodes) and the boost, which enables position correction for bone and tumour separately. The prescribed dose was 40 Gy to the elective field and 55 or 60 Gy to the planning target volume (PTV). For bladder and rectum, V{sub 45}Gy and V{sub 55}Gy were compared, and for small intestines, V{sub 25}Gy and V{sub 40}Gy. The dose distribution with IMRT conformed better to the shape of the target. There was no significant difference between the techniques in dose to the healthy bladder. The median V{sub 40}Gy of the small intestines decreased from 114 to 66 cc (P = 0.001) with five beam IMRT, and to 55 cc (P = 0.001) with seven beam IMRT compared with FiF. V{sub 45}Gy for rectum decreased from 34.2% to 17.5% (P = 0.004) for both five and seven beam plans, while V{sub 55}Gy for rectum remained the same. With IMRT, a statistically significant dose decrease to the small intestines can be achieved while covering both tumour and elective PTV adequately.

  5. Improving bladder cancer treatment with radiotherapy using separate intensity modulated radiotherapy plans for boost and elective fields

    International Nuclear Information System (INIS)

    Van Rooijen, D.; Van de Kamer, J.; Hulshof, M.; Koning, C.; Bel, A.

    2010-01-01

    The aim of this study is to investigate to what extent IMRT can decrease the dose to the organs at risk in bladder cancer treatment compared with conformal treatment while making separate treatment plans for the elective field and the boost. Special attention is paid to sparing small intestines. Twenty patients who were treated with the field-in-field technique (FiF) were re-planned with intensity modulated radiotherapy (IMRT) using five and seven beams, respectively. Separate treatment plans were made for the elective field (including the pelvic lymph nodes) and the boost, which enables position correction for bone and tumour separately. The prescribed dose was 40 Gy to the elective field and 55 or 60 Gy to the planning target volume (PTV). For bladder and rectum, V 45 Gy and V 55 Gy were compared, and for small intestines, V 25 Gy and V 40 Gy. The dose distribution with IMRT conformed better to the shape of the target. There was no significant difference between the techniques in dose to the healthy bladder. The median V 40 Gy of the small intestines decreased from 114 to 66 cc (P = 0.001) with five beam IMRT, and to 55 cc (P = 0.001) with seven beam IMRT compared with FiF. V 45 Gy for rectum decreased from 34.2% to 17.5% (P = 0.004) for both five and seven beam plans, while V 55 Gy for rectum remained the same. With IMRT, a statistically significant dose decrease to the small intestines can be achieved while covering both tumour and elective PTV adequately.

  6. CNR considerations for rapid real-time MRI tumor tracking in radiotherapy hybrid devices: Effects of B0 field strength

    International Nuclear Information System (INIS)

    Wachowicz, K.; De Zanche, N.; Yip, E.; Volotovskyy, V.; Fallone, B. G.

    2016-01-01

    Purpose: This work examines the subject of contrast-to-noise ratio (CNR), specifically between tumor and tissue background, and its dependence on the MRI field strength, B 0 . This examination is motivated by the recent interest and developments in MRI/radiotherapy hybrids where real-time imaging can be used to guide treatment beams. The ability to distinguish a tumor from background tissue is of primary importance in this field, and this work seeks to elucidate the complex relationship between the CNR and B 0 that is too often assumed to be purely linear. Methods: Experimentally based models of B 0 -dependant relaxation for various tumor and normal tissues from the literature were used in conjunction with signal equations for MR sequences suitable for rapid real-time imaging to develop field-dependent predictions for CNR. These CNR models were developed for liver, lung, breast, glioma, and kidney tumors for spoiled gradient-echo, balanced steady-state free precession (bSSFP), and single-shot half-Fourier fast spin echo sequences. Results: Due to the pattern in which the relaxation properties of tissues are found to vary over B 0 field (specifically the T 1 time), there was always an improved CNR at lower fields compared to linear dependency. Further, in some tumor sites, the CNR at lower fields was found to be comparable to, or sometimes higher than those at higher fields (i.e., bSSFP CNR for glioma, kidney, and liver tumors). Conclusions: In terms of CNR, lower B 0 fields have been shown to perform as well or better than higher fields for some tumor sites due to superior T 1 contrast. In other sites this effect was less pronounced, reversing the CNR advantage. This complex relationship between CNR and B 0 reveals both low and high magnetic fields as viable options for tumor tracking in MRI/radiotherapy hybrids.

  7. Two Metachronous Neoplasms in the Radiotherapy Fields of a Young Man With Familial Adenomatous Polyposis

    Directory of Open Access Journals (Sweden)

    Patrick A. Williams BS

    2013-04-01

    Full Text Available Background: It is recognized that various radiation-induced malignancies often follow childhood radiotherapy. Radiation-induced neoplasms have been shown to occur with increased frequency in syndromes due to mutated tumor suppressor genes. There exist no recommendations for the management of cancer patients with germline APC gene mutations. Preclinical data suggest that APC gene mutations cause enhanced radiosensitivity, but no clinical observations exist that show that patients with this mutation are at higher risk for radiation-induced malignancies. Results: We report the case of a 32-year-old man with a genetic diagnosis of familial adenomatous polyposis (FAP who initially presented at age 10 with a medulloblastoma treated with radiotherapy and surgery. Radiation-induced papillary thyroid carcinoma followed 13 years later. Finally, radiation-induced soft tissue osteosarcoma occurred with widespread metastasis 20 years thereafter. Conclusions: This is the first report of 2 malignancies in the prior radiotherapy fields of a patient with a genetic diagnosis of FAP. More important, this suggests that APC-defective cells are at an enhanced sensitivity to the carcinogenic effects of radiotherapy compared with APC-proficient cells. This could argue for genetic screening in affected members of these families and for creation of treatment recommendations to more seriously consider the risks of radiation therapy.

  8. Small-field fractionated radiotherapy with or without stereotactic boost for vestibular schwannoma

    International Nuclear Information System (INIS)

    Kagei, K.; Shirato, H.; Suzuki, K.; Isu, T.; Sawamura, Y.; Sakamoto, T.; Fukuda, S.; Nishioka, T.; Hashimoto, S.; Miyasaka, K.

    1999-01-01

    Purpose: To assess the efficacy and toxicity of small-field fractionated radiotherapy with or without stereotactic boost (SB) for vestibular schwannomas.Methods and materials: Thirty-nine patients with vestibular schwannoma were treated with irradiation between March 1991 and February 1996. Extra-meatal tumor diameters were under 30 mm. Thirty-three patients received small-field fractionated radiotherapy followed by SB. Basic dose schedule was 44 Gy in 22 fractions over 5 1/2 weeks plus 4 Gy in one session. Six patients received small-field fractionated radiotherapy only (40-44 Gy in 20-22 fractions over 5-5 1/2 weeks or 36 Gy in 20 fractions over 5 weeks).< Results: Follow-up ranged from 6 to 69 months (median, 24 months). Tumors decreased in size in 13 cases (33%), were unchanged in 25 (64%), and increased in one (3%). The actuarial 2-year tumor control rate was 97%. Fifteen patients had useful hearing (Gardner-Robertson class 1-2) and 25 patients had testable hearing (class 1-4) before irradiation. The 2-year actuarial rates of useful hearing preservation (free of deterioration from class 1-2 to class 3-5) were 78%. The 2-year actuarial rates of any testable hearing preservation (free of deterioration from class 1-4 to class 5) were 96%. No permanent facial and trigeminal neuropathy developed after irradiation. The 2-year actuarial incidences of facial and trigeminal neuropathies were 8% and 16%, respectively.Conclusions: Small-field fractionated radiotherapy with or without SB provides excellent short-term local control and a relatively low incidence of complications for vestibular schwannoma, although further follow-up is necessary to evaluate the long-term results. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  9. Surface dose measurements in and out of field. Implications for breast radiotherapy with megavoltage photon beams

    Energy Technology Data Exchange (ETDEWEB)

    Lonski, Peta; Kron, Tomas [Peter MacCallum Cancer Centre, Melbourne (Australia); RMIT Univ., Melbourne (Australia); Ramachandran, Prabhakar; Franich, Rick [Peter MacCallum Cancer Centre, Melbourne (Australia)

    2017-07-01

    This study examines the difference in surface dose between flat and flattening filter free (FFF) photon beams in the context of breast radiotherapy. The surface dose was measured for 6 MV, 6 MV FFF, 10 MV, 10 MV FFF and 18 MV photon beams using a thin window ionisation chamber for various field sizes. Profiles were acquired to ascertain the change in surface dose off-axis. Out-of-field measurements were included in a clinically representative half beam block tangential breast field. In the field centres of FFF beams the surface dose was found to be increased for small fields and decreased for large fields compared to flat beams. For FFF beams, surface dose was found to decrease off-axis and resulted in lower surface dose out-of-field compared to flat beams.

  10. Optimization of Stereotactic Radiotherapy Treatment Delivery Technique for Base-Of-Skull Meningiomas

    International Nuclear Information System (INIS)

    Clark, Brenda G.; Candish, Charles; Vollans, Emily; Gete, Ermias; Lee, Richard; Martin, Monty; Ma, Roy; McKenzie, Michael

    2008-01-01

    This study compares static conformal field (CF), intensity modulated radiotherapy (IMRT), and dynamic arcs (DA) for the stereotactic radiotherapy of base-of-skull meningiomas. Twenty-one cases of base-of-skull meningioma (median planning target volume [PTV] = 21.3 cm 3 ) previously treated with stereotactic radiotherapy were replanned with each technique. The plans were compared for Radiation Therapy Oncology Group conformity index (CI) and homogeneity index (HI), and doses to normal structures at 6 dose values from 50.4 Gy to 5.6 Gy. The mean CI was 1.75 (CF), 1.75 (DA), and 1.66 (IMRT) (p 3 , the CI (IMRT) was always superior to CI (DA) and CI (CF). At PTV sizes below 25 cm 3 , there was no significant difference in CI between each technique. There was no significant difference in HI between plans. The total volume of normal tissue receiving 50.4, 44.8, and 5.6 Gy was significantly lower when comparing IMRT to CF and DA plans (p 3 , due to improved conformity and normal tissue sparing, in particular for the brain stem and ipsilateral temporal lobe

  11. Left-sided breast cancer irradiation using rotational and fixed-field radiotherapy

    International Nuclear Information System (INIS)

    Qi, X. Sharon; Liu, Tian X.; Liu, Arthur K.; Newman, Francis; Rabinovitch, Rachel; Kavanagh, Brian; Hu, Y. Angie

    2014-01-01

    The 3-dimensional conformal radiotherapy (3DCRT) technique is the standard for breast cancer radiotherapy. During treatment planning, not only the coverage of the planning target volume (PTV) but also the minimization of the dose to critical structures, such as the lung, heart, and contralateral breast tissue, need to be considered. Because of the complexity and variations of patient anatomy, more advanced radiotherapy techniques are sometimes desired to better meet the planning goals. In this study, we evaluated external-beam radiation treatment techniques for left breast cancer using various delivery platforms: fixed-field including TomoDirect (TD), static intensity-modulated radiotherapy (sIMRT), and rotational radiotherapy including Elekta volumetric-modulated arc therapy (VMAT) and tomotherapy helical (TH). A total of 10 patients with left-sided breast cancer who did or did not have positive lymph nodes and were previously treated with 3DCRT/sIMRT to the entire breast were selected, their treatment was planned with Monaco VMAT, TD, and TH. Dosimetric parameters including PTV coverage, organ-at-risk (OAR) sparing, dose-volume histograms, and target minimum/maximum/mean doses were evaluated. It is found that for plans providing comparable PTV coverage, the Elekta VMAT plans were generally more inhomogeneous than the TH and TD plans. For the cases with regional node involvement, the average mean doses administered to the heart were 9.2 (± 5.2) and 8.8 (± 3.0) Gy in the VMAT and TH plans compared with 11.9 (± 6.4) and 11.8 (± 9.2) Gy for the 3DCRT and TD plans, respectively, with slightly higher doses given to the contralateral lung or breast or both. On average, the total monitor units for VMAT plans are 11.6% of those TH plans. Our studies have shown that VMAT and TH plans offer certain dosimetric advantages over fixed-field IMRT plans for advanced breast cancer requiring regional nodal treatment. However, for early-stage breast cancer fixed-field

  12. Dosimetric evaluation of tomography and four-box field conformal radiotherapy in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Yu, Mina; Lee, Hyo Chun; Chung, Mi Joo; Kim, Sung Hwan; Lee, Jong Hoon; Jang, Hong Seok; Jeon, Dong Min; Cheon, Geum Seong

    2013-01-01

    To report the results of dosimetric comparison between intensity-modulated radiotherapy (IMRT) using Tomotherapy and four-box field conformal radiotherapy (CRT) for pelvic irradiation of locally advanced rectal cancer. Twelve patients with locally advanced rectal cancer who received a short course preoperative chemoradiotherapy (25 Gy in 5 fractions) on the pelvis using Tomotherapy, between July 2010 and December 2010, were selected. Using their simulation computed tomography scans, Tomotherapy and four-box field CRT plans with the same dose schedule were evaluated, and dosimetric parameters of the two plans were compared. For the comparison of target coverage, we analyzed the mean dose, Vn Gy, Dmin, Dmax, radical dose homogeneity index (rDHI), and radiation conformity index (RCI). For the comparison of organs at risk (OAR), we analyzed the mean dose. Tomotherapy showed a significantly higher mean target dose than four-box field CRT (p 0.001). But, V26.25 Gy and V27.5 Gywere not significantly different between the two modalities. Tomotherapy showed higher Dmax and lower Dmin. The Tomotherapy plan had a lower rDHI than four-box field CRT (p = 0.000). Tomotherapy showed better RCI than four-box field CRT (p = 0.007). For OAR, the mean irradiated dose was significantly lower in Tomotherapy than four-box field CRT. In locally advanced rectal cancer, Tomotherapy delivers a higher conformal radiation dose to the target and reduces the irradiated dose to OAR than four-box field CRT.

  13. Dosimetric evaluation of tomography and four-box field conformal radiotherapy in locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Mina; Lee, Hyo Chun; Chung, Mi Joo; Kim, Sung Hwan; Lee, Jong Hoon [Dept. of Radiation Oncology, St. Vincent' s Hospital, The Catholic University of Korea College of Medicine, Suwon (Korea, Republic of); Jang, Hong Seok; Jeon, Dong Min; Cheon, Geum Seong [Dept. of Radiation Oncology, Seoul St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    To report the results of dosimetric comparison between intensity-modulated radiotherapy (IMRT) using Tomotherapy and four-box field conformal radiotherapy (CRT) for pelvic irradiation of locally advanced rectal cancer. Twelve patients with locally advanced rectal cancer who received a short course preoperative chemoradiotherapy (25 Gy in 5 fractions) on the pelvis using Tomotherapy, between July 2010 and December 2010, were selected. Using their simulation computed tomography scans, Tomotherapy and four-box field CRT plans with the same dose schedule were evaluated, and dosimetric parameters of the two plans were compared. For the comparison of target coverage, we analyzed the mean dose, Vn Gy, Dmin, Dmax, radical dose homogeneity index (rDHI), and radiation conformity index (RCI). For the comparison of organs at risk (OAR), we analyzed the mean dose. Tomotherapy showed a significantly higher mean target dose than four-box field CRT (p 0.001). But, V26.25 Gy and V27.5 Gywere not significantly different between the two modalities. Tomotherapy showed higher Dmax and lower Dmin. The Tomotherapy plan had a lower rDHI than four-box field CRT (p = 0.000). Tomotherapy showed better RCI than four-box field CRT (p = 0.007). For OAR, the mean irradiated dose was significantly lower in Tomotherapy than four-box field CRT. In locally advanced rectal cancer, Tomotherapy delivers a higher conformal radiation dose to the target and reduces the irradiated dose to OAR than four-box field CRT.

  14. Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Nadeau, Sylvain; Bouchard, Myriam; Germain, Isabelle; Raymond, Paul-Emile; Beaulieu, Frederic; Beaulieu, Luc; Roy, Rene; Gingras, Luc

    2007-01-01

    Purpose: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies. Methods and Materials: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU). Results: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively. Conclusion: With respect to conventional techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements

  15. Adaptive radiotherapy based on contrast enhanced cone beam CT imaging

    International Nuclear Information System (INIS)

    Soevik, Aaste; Skogmo, Hege K.; Roedal, Jan; Lervaag, Christoffer; Eilertsen, Karsten; Malinen, Eirik

    2010-01-01

    Cone beam CT (CBCT) imaging has become an integral part of radiation therapy, with images typically used for offline or online patient setup corrections based on bony anatomy co-registration. Ideally, the co-registration should be based on tumor localization. However, soft tissue contrast in CBCT images may be limited. In the present work, contrast enhanced CBCT (CECBCT) images were used for tumor visualization and treatment adaptation. Material and methods. A spontaneous canine maxillary tumor was subjected to repeated cone beam CT imaging during fractionated radiotherapy (10 fractions in total). At five of the treatment fractions, CECBCT images, employing an iodinated contrast agent, were acquired, as well as pre-contrast CBCT images. The tumor was clearly visible in post-contrast minus pre-contrast subtraction images, and these contrast images were used to delineate gross tumor volumes. IMRT dose plans were subsequently generated. Four different strategies were explored: 1) fully adapted planning based on each CECBCT image series, 2) planning based on images acquired at the first treatment fraction and patient repositioning following bony anatomy co-registration, 3) as for 2), but with patient repositioning based on co-registering contrast images, and 4) a strategy with no patient repositioning or treatment adaptation. The equivalent uniform dose (EUD) and tumor control probability (TCP) calculations to estimate treatment outcome for each strategy. Results. Similar translation vectors were found when bony anatomy and contrast enhancement co-registration were compared. Strategy 1 gave EUDs closest to the prescription dose and the highest TCP. Strategies 2 and 3 gave EUDs and TCPs close to that of strategy 1, with strategy 3 being slightly better than strategy 2. Even greater benefits from strategies 1 and 3 are expected with increasing tumor movement or deformation during treatment. The non-adaptive strategy 4 was clearly inferior to all three adaptive strategies

  16. Quality assurance procedure for assessing mechanical accuracy of a radiation field center in stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Tatsumi, Daisaku; Ienaga, Akinori; Nakada, Ryosei; Yomoda, Akane; Inoue, Makoto; Ichida, Takao; Hosono, Masako

    2012-01-01

    Stereotactic radiotherapy requires a quality assurance (QA) program that ensures the mechanical accuracy of a radiation field center. We have proposed a QA method for achieving the above requirement by conducting the Winston Lutz test using an electronic portal image device (EPID). An action limit was defined as three times the standard deviation. Then, the action limits for mean deviations of the radiation field center during collimator rotation, gantry rotation, and couch rotation in clockwise and counterclockwise resulted in 0.11 mm, 0.52 mm, 0.37 mm, and 0.41 mm respectively. Two years after the QA program was launched, the mean deviation of the radiation field center during gantry rotation exceeded the above action limit. Consequently, a mechanical adjustment for the gantry was performed, thereby restoring the accuracy of the radiation field center. A field center shift of 0.5 mm was also observed after a micro multi-leaf collimator was unmounted. (author)

  17. Impact of field number and beam angle on functional image-guided lung cancer radiotherapy planning

    Science.gov (United States)

    Tahir, Bilal A.; Bragg, Chris M.; Wild, Jim M.; Swinscoe, James A.; Lawless, Sarah E.; Hart, Kerry A.; Hatton, Matthew Q.; Ireland, Rob H.

    2017-09-01

    To investigate the effect of beam angles and field number on functionally-guided intensity modulated radiotherapy (IMRT) normal lung avoidance treatment plans that incorporate hyperpolarised helium-3 magnetic resonance imaging (3He MRI) ventilation data. Eight non-small cell lung cancer patients had pre-treatment 3He MRI that was registered to inspiration breath-hold radiotherapy planning computed tomography. IMRT plans that minimised the volume of total lung receiving  ⩾20 Gy (V20) were compared with plans that minimised 3He MRI defined functional lung receiving  ⩾20 Gy (fV20). Coplanar IMRT plans using 5-field manually optimised beam angles and 9-field equidistant plans were also evaluated. For each pair of plans, the Wilcoxon signed ranks test was used to compare fV20 and the percentage of planning target volume (PTV) receiving 90% of the prescription dose (PTV90). Incorporation of 3He MRI led to median reductions in fV20 of 1.3% (range: 0.2-9.3% p  =  0.04) and 0.2% (range: 0 to 4.1%; p  =  0.012) for 5- and 9-field arrangements, respectively. There was no clinically significant difference in target coverage. Functionally-guided IMRT plans incorporating hyperpolarised 3He MRI information can reduce the dose received by ventilated lung without comprising PTV coverage. The effect was greater for optimised beam angles rather than uniformly spaced fields.

  18. Radiotherapy access in Belgium: How far are we from evidence-based utilisation?

    Science.gov (United States)

    Lievens, Y; De Schutter, H; Stellamans, K; Rosskamp, M; Van Eycken, L

    2017-10-01

    Underutilisation of radiotherapy has been observed worldwide. To evaluate the current situation in Belgium, optimal utilisation proportions (OUPs) adopted from the European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project were compared to actual utilisation proportions (AUPs) and with radiotherapy advised during the multidisciplinary cancer team (MDT) meetings. In addition, the impact of independent variables was analysed. AUPs and advised radiotherapy were calculated overall and by cancer type for 110,810 unique cancer diagnoses in 2009-2010. Radiotherapy utilisation was derived from reimbursement data and distinguished between palliative and curative intent external beam radiotherapy (EBRT) and/or brachytherapy (BT). Sensitivity analyses regarding the influence of the follow-up period, the survival length and patient's age were performed. Advised radiotherapy was calculated based on broad treatment categories as reported at MDT meetings. The overall AUP of 37% (39% including BT) was lower than the OUP of 53%, but in line with advised radiotherapy (35%). Large variations by tumour type were observed: in some tumours (e.g. lung and prostate cancer) AUP was considerably lower than OUP, whereas in others there was reasonable concordance (e.g. breast and rectal cancer). Overall, 84% of treatments started within 9 months following diagnosis. Survival time influenced AUP in a cancer type-dependent way. Elderly patients received less radiotherapy. Although the actually delivered radiotherapy in Belgium aligns well to MDT advices, it is lower than the evidence-based optimum. Further analysis of potential barriers is needed for radiotherapy forecasting and planning, and in order to promote adequate access to radiotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Involved-field radiotherapy for esophageal squamous cell carcinoma: theory and practice.

    Science.gov (United States)

    Li, Minghuan; Zhang, Xiaoli; Zhao, Fen; Luo, Yijun; Kong, Li; Yu, Jinming

    2016-02-05

    Esophageal carcinoma (EC) is characterized by a high rate of lymph node metastasis and its spread pattern is not always predictable. Chemoradiotherapy has an important role in the treatment of EC in both the inoperable and the pre-operative settings. However, regarding the target volume for radiation, different clinical practices exist. Theoretically, in addition to the clinical target volume administered to the gross lesion, it might seem logical to deliver a certain dose to the uninvolved regional lymph node area at risk for microscopic disease. However, in practice, it is difficult because of the intolerance of normal tissue to radiotherapy (RT), particularly if all regions containing the cervical, mediastinal, and upper abdominal nodes are covered. To date, the use of elective nodal irradiation (ENI) is still controversial in the field of radiotherapy. Some investigators use involved-field radiotherapy (IFRT) in order to reduce treatment-related toxicities. It is thought that micrometastases can be controlled, to some extent, by chemotherapy and the abscopal effects of radiation. It is the presence of overtly involved lymph nodes rather than the micrometastatic nodes negatively affects survival in patients with EC. In another hand, lymph nodes stationed near primary tumors also receive considerable incidental irradiation doses that may contribute to the elimination of subclinical lesions. These data indicate that an irradiation volume covering only the gross tumor is appropriate. When using ENI or IFRT, very few patients experience solitary regional node failure and out-of-field lymph node failure is not common. Primary tumor recurrence and distant metastases, rather than regional lymph node failure, affect the overall survival in patients with EC. The available evidence indicates that the use of ENI seems to prevent or delay regional nodal relapse rather than improve survival. In a word, these data suggest that IFRT is feasible in EC patients.

  20. Comparison of RapidArc plans and fixed field intensity modulated radiotherapy planning in cervical cancer radiotherapy

    International Nuclear Information System (INIS)

    Liu Xiangyu; Liu Xianfeng; He Ya'nan; Yin Wenjuan; Wu Yongzhong

    2011-01-01

    Objective: To explore the advantages and disadvantages between the RapidArc plans and fixed-field IMRT plan (IMRT). Methods: Ten cases of cervical cancer,aged 55 (36-70), who were to receive post-operative radiotherapy were selected randomly. Single arc (Arc 1), two arcs (Arc 2), and three arc (Arc 3) RapidArc plans and fixed-field IMRT plan were designed respectively in the Eclipse 8.6 planning system. The designing, treatment time, target area, and dose distribution of organs at risk by these 4 planning techniques were compared. Results: The values of average planned treatment time by the Arc 1, Arc 2, and Arc 3 ten cases was 98, 155, 185, and 46 min, respectively. The values of average treatment time in the Varian IX accelerator were 2.15, 3.32, 4.48, and 6.95 min, respectively. The average mean doses were (48.99±1.08),(49.40±0.51), (49.51±0.62), and (48.65±0.92) Gy, respectively. The values of homogeneity index (HI) of target were 1.11±0.07, 1.07±0.02, 1.06±0.02, and 1.12±0.05, respectively. The values of conformal index (CI) of target were 0.73±0.13, 0.87±0.06, 0.87±0.06, and 0.79±0.06, respectively. The doses at rectum, bladder, and small intestine calculated by IMRT plan were the lowest, and the doses at the femoral neck calculated by these 4 plans were similar. Conclusions: The RapidArc plan is superior in dose distribution at target, HI, CI, and treatment time to IMRT, but IMRT plan is superior to RapidArc in planned dose calculation time and protection of organs at risk. However, in general, the RapidArc plan is better in clinical application than IMRT plan. (authors)

  1. Development and experimental validation of a tool to determine out-of-field dose in radiotherapy

    International Nuclear Information System (INIS)

    Bessieres, I.

    2013-01-01

    Over the last two decades, many technical developments have been achieved on intensity modulated radiotherapy (IMRT) and allow a better conformation of the dose to the tumor and consequently increase the success of cancer treatments. These techniques often reduce the dose to organs at risk close to the target volume; nevertheless they increase peripheral dose levels. In this situation, the rising of the survival rate also increases the probability of secondary effects expression caused by peripheral dose deposition (second cancers for instance). Nowadays, the peripheral dose is not taken into account during the treatment planning and no reliable prediction tool exists. However it becomes crucial to consider the peripheral dose during the planning, especially for pediatric cases. Many steps of the development of an accurate and fast Monte Carlo out-of-field dose prediction tool based on the PENELOPE code have been achieved during this PhD work. To this end, we demonstrated the ability of the PENELOPE code to estimate the peripheral dose by comparing its results with reference measurements performed on two experimental configurations (metrological and pre-clinical). During this experimental work, we defined a protocol for low doses measurement with OSL dosimeters. In parallel, we highlighted the slow convergence of the code for clinical use. Consequently, we accelerated the code by implementing a new variance reduction technique called pseudo-deterministic transport which is specifically with the objective of improving calculations in areas far away from the beam. This step improved the efficiency of the peripheral doses estimation in both validation configurations (by a factor of 20) in order to reach reasonable computing times for clinical application. Optimization works must be realized in order improve the convergence of our tool and consider a final clinical use. (author) [fr

  2. Determination of two- and three-dimensional radiation fields for neutron radiotherapy planning

    International Nuclear Information System (INIS)

    Boehm, J.K.

    1986-01-01

    The thesis deals with the computerized investigations for fast neutron radiotherapy planning, explaining the calculation and modelling of local dose distributions in patients as a result of mixed neutron and gamma radiation fields. For a computed irradiation program (elaborated for instance by the COMRAD program system), dose distribution functions are required for the simulation of multi-field or moving beam irradiations, the functions being derived semi-empirically by non-linear regression. The necessary data on stationary field doses are derived by measurements or by computed simulation with specific transport programs from the nuclear engineering sector. Transport calculations show the effects of inhomogeneities in the patient's body on the dose distribution. The determined, strong inhomogneity effects (lungs, head) have to be taken into account as precisely as possible in order to achieve optimum irradiation planning. (orig./HP) [de

  3. Efficient CT simulation of the four-field technique for conformal radiotherapy of prostate carcinoma

    International Nuclear Information System (INIS)

    Valicenti, Richard K.; Waterman, Frank M.; Croce, Raymond J.; Corn, Benjamin; Suntharalingam, Nagalingam; Curran, Walter J.

    1997-01-01

    Purpose: Conformal radiotherapy of prostate carcinoma relies on contouring of individual CT slices for target and normal tissue localization. This process can be very time consuming. In the present report, we describe a method to more efficiently localize pelvic anatomy directly from digital reconstructed radiographs (DRRs). Materials and Methods: Ten patients with prostate carcinoma underwent CT simulation (the spiral mode at 3 mm separation) for conformal four-field 'box' radiotherapy. The bulbous urethra and bladder were opacified with iodinated contrast media. On lateral and anteroposterior DRRs, the volume of interest (VOI) was restricted to 1.0-1.5 cm tissue thickness to optimize digital radiograph reconstruction of the prostate and seminal vesicles. By removing unessential voxel elements, this method provided direct visualization of those structures. For comparison, the targets of each patient were also obtained by contouring CT axial slices. Results: The method was successfully performed if the target structures were readily visualized and geometrically corresponded to those generated by contouring axial images. The targets in 9 of 10 patients were reliable representations of the CT-contoured volumes. One patient had 18 mm variation due to the lack of bladder opacification. Using VOIs to generate thin tissue DRRs, the time required for target and normal tissue localization was on the average less than 5 min. Conclusion: In CT simulation of the four-field irradiation technique for prostate carcinoma, thin-tissue DRRs allowed for efficient and accurate target localization without requiring individual axial image contouring. This method may facilitate positioning of the beam isocenter and provide reliable conformal radiotherapy

  4. Geometric accuracy of field alignment in fractionated stereotactic conformal radiotherapy of brain tumors

    International Nuclear Information System (INIS)

    Kortmann, Rolf D.; Becker, Gerd; Perelmouter, Jury; Buchgeister, Markus; Meisner, Christoph; Bamberg, Michael

    1999-01-01

    Purpose: To assess the accuracy of field alignment in patients undergoing three-dimensional (3D) conformal radiotherapy of brain tumors, and to evaluate the impact on the definition of planning target volume and control procedures. Methods and Materials: Geometric accuracy was analyzed in 20 patients undergoing fractionated stereotactic conformal radiotherapy for brain tumors. Rigid head fixation was achieved by using cast material. Transfer of stereotactic coordinates was performed by an external positioning device. The accuracy during treatment planning was quantitatively assessed by using repeated computed tomography (CT) examinations in treatment position (reproducibility of isocenter). Linear discrepancies were measured between treatment plan and CT examination. In addition, for each patient, a series of 20 verifications were taken in orthogonal projections. Linear discrepancies were measured between first and all subsequent verifications (accuracy during treatment delivery). Results: For the total group of patients, the distribution of deviations during treatment setup showed mean values between -0.3-1.2 mm, with standard deviations (SD) of 1.3-2.0 mm. During treatment delivery, the distribution of deviations revealed mean values between 0.7-0.8 mm, with SDs of 0.5-0.6 mm, respectively. For all patients, deviations for the transition to the treatment machine were similar to deviations during subsequent treatment delivery, with 95% of all absolute deviations between less than 2.8 and 4.6 mm. Conclusion: Random fluctuations of field displacements during treatment planning and delivery prevail. Therefore, our quantitative data should be considered when prescribing the safety margins of the planning target volume. Repeated CT examination are useful to detect operator errors and large random or systematic deviations before start of treatment. Control procedures during treatment delivery appear to be of limited importance. In addition, our findings should help to

  5. The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Maraldo, M V; Jørgensen, M; Brodin, N P

    2014-01-01

    BACKGROUND: The use of radiotherapy (RT) is debated for pediatric patients with Hodgkin lymphoma (HL) due to the late effects of treatment. Radiation doses to the thyroid, heart, lungs, and breasts are compared with the extensive mantle field (MF), Involved Field RT(IFRT), Modified IFRT (m......IFRT), and Involved Node RT (INRT) and the risk of radiation-induced cardiovascular disease, secondary cancers, and the corresponding Life Years Lost (LYL) is estimated with each technique. PROCEDURE: INRT, mIFRT, IFRT, and MF plans (20 and 30 Gy) were simulated for 10 supradiaphragmatic, clinical stage I......–II classical HL patients lung, breast, and thyroid cancer with each technique were estimated. The estimated excess risks attributable to RT were based on HL series with long-term follow...

  6. Magnetic-field-induced dose effects in MR-guided radiotherapy systems: dependence on the magnetic field strength.

    Science.gov (United States)

    Raaijmakers, A J E; Raaymakers, B W; Lagendijk, J J W

    2008-02-21

    Several institutes are currently working on the development of a radiotherapy treatment system with online MR imaging (MRI) modality. The main difference between their designs is the magnetic field strength of the MRI system. While we have chosen a 1.5 Tesla (T) magnetic field strength, the Cross Cancer Institute in Edmonton will be using a 0.2 T MRI scanner and the company Viewray aims to use 0.3 T. The magnetic field strength will affect the severity of magnetic field dose effects, such as the electron return effect (ERE): considerable dose increase at tissue air boundaries due to returning electrons. This paper has investigated how the ERE dose increase depends on the magnetic field strength. Therefore, four situations where the ERE occurs have been simulated: ERE at the distal side of the beam, the lateral ERE, ERE in cylindrical air cavities and ERE in the lungs. The magnetic field comparison values were 0.2, 0.75, 1.5 and 3 T. Results show that, in general, magnetic field dose effects are reduced at lower magnetic field strengths. At the distal side, the ERE dose increase is largest for B = 0.75 T and depends on the irradiation field size for B = 0.2 T. The lateral ERE is strongest for B = 3 T but shows no effect for B = 0.2 T. Around cylindrical air cavities, dose inhomogeneities disappear if the radius of the cavity becomes small relative to the in-air radius of the secondary electron trajectories. At larger cavities (r > 1 cm), dose inhomogeneities exist for all magnetic field strengths. In water-lung-water phantoms, the ERE dose increase takes place at the water-lung transition and the dose decreases at the lung-water transition, but these effects are minimal for B = 0.2 T. These results will contribute to evaluating the trade-off between magnetic field dose effects and image quality of MR-guided radiotherapy systems.

  7. Magnetic-field-induced dose effects in MR-guided radiotherapy systems: dependence on the magnetic field strength

    International Nuclear Information System (INIS)

    Raaijmakers, A J E; Raaymakers, B W; Lagendijk, J J W

    2008-01-01

    Several institutes are currently working on the development of a radiotherapy treatment system with online MR imaging (MRI) modality. The main difference between their designs is the magnetic field strength of the MRI system. While we have chosen a 1.5 Tesla (T) magnetic field strength, the Cross Cancer Institute in Edmonton will be using a 0.2 T MRI scanner and the company Viewray aims to use 0.3 T. The magnetic field strength will affect the severity of magnetic field dose effects, such as the electron return effect (ERE): considerable dose increase at tissue air boundaries due to returning electrons. This paper has investigated how the ERE dose increase depends on the magnetic field strength. Therefore, four situations where the ERE occurs have been simulated: ERE at the distal side of the beam, the lateral ERE, ERE in cylindrical air cavities and ERE in the lungs. The magnetic field comparison values were 0.2, 0.75, 1.5 and 3 T. Results show that, in general, magnetic field dose effects are reduced at lower magnetic field strengths. At the distal side, the ERE dose increase is largest for B = 0.75 T and depends on the irradiation field size for B = 0.2 T. The lateral ERE is strongest for B = 3 T but shows no effect for B = 0.2 T. Around cylindrical air cavities, dose inhomogeneities disappear if the radius of the cavity becomes small relative to the in-air radius of the secondary electron trajectories. At larger cavities (r > 1 cm), dose inhomogeneities exist for all magnetic field strengths. In water-lung-water phantoms, the ERE dose increase takes place at the water-lung transition and the dose decreases at the lung-water transition, but these effects are minimal for B = 0.2 T. These results will contribute to evaluating the trade-off between magnetic field dose effects and image quality of MR-guided radiotherapy systems

  8. Trial study on design of irradiated fields of radiotherapy in cervical and upper thoracic esophageal cancer

    International Nuclear Information System (INIS)

    Liu Hui; Zeng Zhifan; Cui Nianji; He Zhichun; Huang Shaomin

    2006-01-01

    Objective: To compare three kinds of irradiation treatment plans for cervical and upper thoracic esophageal cancer, in order to arrived at proper decision for the patient. Methods: From February 2001 to June 2004, 43 such patients were studied with three different simulated treatment plans made including conformal plan, conventional four-field plan and conventional two-field plan for every one. All plans were evaluated with iso- dose curve and dose-volume histogram. Results: GTV on 95% isodose curve was 99.5%, 98.2% and 87.4% in conformal plan, conventional four-field plan and conventional two-field plan, respectively; PTV 1 and PTV 2 on 95% isodose with 97.8%, 97.2%, 94.8% and 95.8%, 86.6%, 73.7%. The volume of > 20 Gy dose of left lung accepted was 18.6%, 17.2% and 32.3%, in conformal plan, conventional four-field plan and conventional two-field plan, respectively; the right lung received 20.5% ,19.9% and 35.5%. Conclusions: Conformal plan is the best in radiotherapy, as it can provide ideal dose distribution of irradiated target with adequate protection of the normal tissues. Conventional four-field plan, being easy to carry, out, can replace the conformal plan in most situations. Conventional two-field has the most uneven dose distribution and largest lung volume irradiated. (authors)

  9. Knowledge-based computer systems for radiotherapy planning.

    Science.gov (United States)

    Kalet, I J; Paluszynski, W

    1990-08-01

    Radiation therapy is one of the first areas of clinical medicine to utilize computers in support of routine clinical decision making. The role of the computer has evolved from simple dose calculations to elaborate interactive graphic three-dimensional simulations. These simulations can combine external irradiation from megavoltage photons, electrons, and particle beams with interstitial and intracavitary sources. With the flexibility and power of modern radiotherapy equipment and the ability of computer programs that simulate anything the machinery can do, we now face a challenge to utilize this capability to design more effective radiation treatments. How can we manage the increased complexity of sophisticated treatment planning? A promising approach will be to use artificial intelligence techniques to systematize our present knowledge about design of treatment plans, and to provide a framework for developing new treatment strategies. Far from replacing the physician, physicist, or dosimetrist, artificial intelligence-based software tools can assist the treatment planning team in producing more powerful and effective treatment plans. Research in progress using knowledge-based (AI) programming in treatment planning already has indicated the usefulness of such concepts as rule-based reasoning, hierarchical organization of knowledge, and reasoning from prototypes. Problems to be solved include how to handle continuously varying parameters and how to evaluate plans in order to direct improvements.

  10. Testicular function after radiotherapy to inverted 'Y' field for malignant lymphoma

    International Nuclear Information System (INIS)

    Asbjoernsen, G.; Molne, K.; Klepp, O.; Aakvaag, A.

    1976-01-01

    Testicular function was estimated by sperm counts, hormone assays and recording of reported conceptions in 9 patients irradiated for malignant lymphoma. The treatment had been an inverted 'Y' field including the inguinal regions with, in addition, a mantle field in 8 patients. Azoospermia or severe oligozoospermia was found in all but 1 patient, and the FSH levels were uniformly elevated. Testosterone and LH were within normal limits except in 2 patients with slightly subnormal testosterone levels. 7 of the patients were married to women of fertile age, and in 3 cases the wife became pregnant and gave birth to a healthy child. The time lapses from irradiation to conception were 18, 40 and 57 months. 2 of these patients had severe oligozoospermia on examination 2 and 4 months respectively from conception. Thus fertility may possibly be underestimated by sperm counting and hormone assays after this type of radiotherapy. (author)

  11. Testicular function after radiotherapy to inverted 'Y' field for malignant lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Asbjoernsen, G; Molne, K; Klepp, O; Aakvaag, A [Norske Radiumhospital, Oslo; Rikshospitalet, Oslo (Norway))

    1976-01-01

    Testicular function was estimated by sperm counts, hormone assays and recording of reported conceptions in 9 patients irradiated for malignant lymphoma. The treatment had been an inverted 'Y' field including the inguinal regions with, in addition, a mantle field in 8 patients. Azoospermia or severe oligozoospermia was found in all but 1 patient, and the FSH levels were uniformly elevated. Testosterone and LH were within normal limits except in 2 patients with slightly subnormal testosterone levels. 7 of the patients were married to women of fertile age, and in 3 cases the wife became pregnant and gave birth to a healthy child. The time lapses from irradiation to conception were 18, 40 and 57 months. 2 of these patients had severe oligozoospermia on examination 2 and 4 months respectively from conception. Thus fertility may possibly be underestimated by sperm counting and hormone assays after this type of radiotherapy.

  12. Measurement of Thyroid Dose by TLD arising from Radiotherapy of Breast Cancer Patients from Supraclavicular Field

    Directory of Open Access Journals (Sweden)

    Farhood B.

    2016-06-01

    Full Text Available Background: Breast cancer is the most frequently diagnosed cancer and the leading global cause of cancer death among women worldwide. Radiotherapy plays a significant role in treatment of breast cancer and reduces locoregional recurrence and eventually improves survival. The treatment fields applied for breast cancer treatment include: tangential, axillary, supraclavicular and internal mammary fields. Objective: In the present study, due to the presence of sensitive organ such as thyroid inside the supraclavicular field, thyroid dose and its effective factors were investigated. Materials and Methods: Thyroid dose of 31 female patients of breast cancer with involved supraclavicular lymph nodes which had undergone radiotherapy were measured. For each patient, three TLD-100 chips were placed on their thyroid gland surface, and thyroid doses of patients were measured. The variables of the study include shield shape, the time of patient’s setup, the technologists’ experience and qualification. Finally, the results were analyzed by ANOVA test using SPSS 11.5 software. Results: The average age of the patients was 46±10 years. The average of thyroid dose of the patients was 140±45 mGy (ranged 288.2 and 80.8 in single fraction. There was a significant relationship between the thyroid dose and shield shape. There was also a significant relationship between the thyroid dose and the patient’s setup time. Conclusion: Beside organ at risk such as thyroid which is in the supraclavicular field, thyroid dose possibility should be reduced. For solving this problem, an appropriate shield shape, the appropriate time of the patient’s setup, etc. could be considered.

  13. Poster - 21: Verification of Monitor Unit Calculations for Breast Field-In-Field Three-Dimensional Conformal Radiotherapy Plans

    International Nuclear Information System (INIS)

    Kosztyla, Robert; Pierce, Greg; Ploquin, Nicolas; Roumeliotis, Michael; Schinkel, Colleen

    2016-01-01

    Purpose: To determine the source of systematic monitor unit (MU) calculation discrepancies between RadCalc and Eclipse treatment planning software for three-dimensional conformal radiotherapy field-in-field breast treatments. Methods: Data were reviewed for 28 patients treated with a field-in-field breast technique with MU calculations from RadCalc that were larger than MU calculations from Eclipse for at least one field. The distance of the calculation point from the jaws was measured in each field’s beam’s-eye-view and compared with the percentage difference in MU (%ΔMU) between RadCalc and Eclipse. 10×10, 17×13 and 20×20 cm 2 beam profiles were measured using the Profiler 2 diode array for 6-MV photon beams and compared with profiles calculated with Eclipse and RadCalc using a gamma analysis (3%, 3 mm). Results: The mean %ΔMU was 1.3%±0.3%. There was a statistically-significant correlation between %ΔMU and the distance of the calculation point from the Y jaw (r=−0.43, p<0.001). RadCalc profiles differed from measured profiles, especially near the jaws. The gamma pass rate for 6-MV fields of 17×13 cm 2 field size was 95%±1% for Eclipse-generated profiles and 53%±20% for RadCalc-generated profiles (p=0.01). Conclusions: Calculations using RadCalc for field-in-field breast plans resulted in MUs that were larger than expected from previous clinical experience with wedged plans with calculation points far from the jaws due to the position of the calculation point near the jaws in the beam’s-eye-view of each field.

  14. Poster - 21: Verification of Monitor Unit Calculations for Breast Field-In-Field Three-Dimensional Conformal Radiotherapy Plans

    Energy Technology Data Exchange (ETDEWEB)

    Kosztyla, Robert; Pierce, Greg; Ploquin, Nicolas; Roumeliotis, Michael; Schinkel, Colleen [Tom Baker Cancer Centre, Calgary, AB, Tom Baker Cancer Centre, Tom Baker Cancer Centre, Tom Baker Cancer Centre, Calgary, AB, Tom Baker Cancer Centre, Calgary, AB (Canada)

    2016-08-15

    Purpose: To determine the source of systematic monitor unit (MU) calculation discrepancies between RadCalc and Eclipse treatment planning software for three-dimensional conformal radiotherapy field-in-field breast treatments. Methods: Data were reviewed for 28 patients treated with a field-in-field breast technique with MU calculations from RadCalc that were larger than MU calculations from Eclipse for at least one field. The distance of the calculation point from the jaws was measured in each field’s beam’s-eye-view and compared with the percentage difference in MU (%ΔMU) between RadCalc and Eclipse. 10×10, 17×13 and 20×20 cm{sup 2} beam profiles were measured using the Profiler 2 diode array for 6-MV photon beams and compared with profiles calculated with Eclipse and RadCalc using a gamma analysis (3%, 3 mm). Results: The mean %ΔMU was 1.3%±0.3%. There was a statistically-significant correlation between %ΔMU and the distance of the calculation point from the Y jaw (r=−0.43, p<0.001). RadCalc profiles differed from measured profiles, especially near the jaws. The gamma pass rate for 6-MV fields of 17×13 cm{sup 2} field size was 95%±1% for Eclipse-generated profiles and 53%±20% for RadCalc-generated profiles (p=0.01). Conclusions: Calculations using RadCalc for field-in-field breast plans resulted in MUs that were larger than expected from previous clinical experience with wedged plans with calculation points far from the jaws due to the position of the calculation point near the jaws in the beam’s-eye-view of each field.

  15. Less gastrointestinal toxicity after adjuvant radiotherapy on a small pelvic field compared to a standard pelvic field in patients with endometrial carcinoma

    NARCIS (Netherlands)

    de Jong, Renske A.; Pras, Elisabeth; Boezen, H. Marike; van der Zee, Ate G. J.; Mourits, Marian J. E.; Arts, Henriette J. G.; Aalders, Jan G.; Slot, Annerie; Timmer, Paul R.; Hollema, Harry; Nijman, Hans W.

    Objective: Radiotherapy is associated with short-term and long-term morbidity. This study compared toxicity rates among patients with endometrial carcinoma (EC) treated with adjuvant external beam radiation therapy (EBRT) on a small pelvic field (SmPF) in comparison with a standard pelvic field

  16. Comparison of static conformal field with multiple noncoplanar arc techniques for stereotactic radiosurgery or stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Hamilton, Russell J.; Kuchnir, Franca T.; Sweeney, Patrick; Rubin, Steven J.; Dujovny, Manuel; Pelizzari, Charles A.; Chen, George T. Y.

    1995-01-01

    Purpose: Compare the use of static conformal fields with the use of multiple noncoplanar arcs for stereotactic radiosurgery or stereotactic radiotherapy treatment of intracranial lesions. Evaluate the efficacy of these treatment techniques to deliver dose distributions comparable to those considered acceptable in current radiotherapy practice. Methods and Materials: A previously treated radiosurgery case of a patient presenting with an irregularly shaped intracranial lesion was selected. Using a three-dimensional (3D) treatment-planning system, treatment plans using a single isocenter multiple noncoplanar arc technique and multiple noncoplanar conformal static fields were generated. Isodose distributions and dose volume histograms (DVHs) were computed for each treatment plan. We required that the 80% (of maximum dose) isodose surface enclose the target volume for all treatment plans. The prescription isodose was set equal to the minimum target isodose. The DVHs were analyzed to evaluate and compare the different treatment plans. Results: The dose distribution in the target volume becomes more uniform as the number of conformal fields increases. The volume of normal tissue receiving low doses (> 10% of prescription isodose) increases as the number of static fields increases. The single isocenter multiple arc plan treats the greatest volume of normal tissue to low doses, approximately 1.6 times more volume than that treated by four static fields. The volume of normal tissue receiving high (> 90% of prescription isodose) and intermediate (> 50% of prescription isodose) doses decreases by 29 and 22%, respectively, as the number of static fields is increased from four to eight. Increasing the number of static fields to 12 only further reduces the high and intermediate dose volumes by 10 and 6%, respectively. The volume receiving the prescription dose is more than 3.5 times larger than the target volume for all treatment plans. Conclusions: Use of a multiple noncoplanar

  17. Conformal fields in prostate radiotherapy: A comparison between measurement, calculation and simulation

    Directory of Open Access Journals (Sweden)

    Seied R Mahdavi

    2012-01-01

    Full Text Available Aims: The objective of this study is to evaluate the accuracy of a treatment planning system (TPS for calculating the dose distribution parameters in conformal fields (CF. Dosimetric parameters of CF′s were compared between measurement, Monte Carlo simulation (MCNP4C and TPS calculation. Materials and Methods: Field analyzer water phantom was used for obtaining percentage depth dose (PDD curves and beam profiles (BP of different conformal fields. MCNP4C was used to model conformal fields dose specification factors and head of linear accelerator varian model 2100C/D. Results: Results showed that the distance to agreement (DTA and dose difference (DD of our findings were well within the acceptance criteria of 3 mm and 3%, respectively. Conclusions: According to this study it can be revealed that TPS using equivalent tissue air ratio calculation method is still convenient for dose prediction in non small conformal fields normally used in prostate radiotherapy. It was also showed that, since there is a close correlation with Monte Carlo simulation, measurements and TPS, Monte Carlo can be further confirmed for implementation and calculation dose distribution in non standard and complex conformal irradiation field for treatment planning systems.

  18. Follow-up Thallium-201 scintigraphy after mantle field radiotherapy for Hodgkin's disease

    International Nuclear Information System (INIS)

    Pierga, J.Y.; Girinski, T.; Henry-Amar, M.; Maunoury, C.; Valette, H.; Tchernia, G.; Desgrez, A.; Socie, G.; Cosset, J.M.

    1993-01-01

    Assessment of the long-term cardiac effects of mediastinal radiotherapy for Hodgkin's disease, by Thallium scintigraphy. 32 patients (14 males and 18 females) who underwent mantle field radiotherapy for Hodgkin's disease were included in this study. Twenty patients received 4 fractions of 2.5 Gy per week and 12, five fraction of 2 Gy per week, delivered on alternate days. All the patients, except three, performed exercise testing electrocardiogram and Thallium-201 tomoscintigraphy. The average time interval from completion of treatment to the study was 7 years (range 3--13 years). No patients had clinical symptoms of cardiac disease. Mean age at the time of the study was 35 years (range 23--48 years). Two electrocardiograms revealed left bundle branch block and the patients were excluded from the study. Only one out of 27 exercise electrocardiograms was abnormal in a patient with mitral valve prolapse, who was also excluded from the study. Twenty-six scintigraphies were evaluable. Twenty-two (85%) were clearly abnormal with partial or complete redistribution on delayed images. The anterior region was affected in 19 of these cases (86%). Four explorations were undoubtedly normal. Coronary angiography was not performed for ethical reasons in these asymptomatic patients. Despite possible false positive tests, the high rate of abnormality (85%) in this small series is striking. These preliminary data justify larger studies and a close long-term follow-up of these patients. 24 refs., 1 fig., 2 tabs

  19. Definition of postlumpectomy tumor bed for radiotherapy boost field planning: CT versus surgical clips

    International Nuclear Information System (INIS)

    Goldberg, Hadassah; Prosnitz, Robert G.; Olson, John A.; Marks, Lawrence B.

    2005-01-01

    Purpose: To compare the location and extent of the tumor bed as defined by surgical clips and computed tomography (CT) scans, after lumpectomy, for electron boost planning as part of breast radiotherapy. Methods and Materials: Planning CT images of 31 operated breasts in 30 patients who underwent lumpectomy were reviewed. One or more clips were placed in the lumpectomy cavity. Serial CT images were used to measure the depth and transverse and longitudinal dimensions. The area and geometric center of the tumor bed were defined by the clips and CT. Results: The CT and clip measurements were identical for the maximal tumor depth in 27 of 30 patients. The CT bed extended beyond the clips by 0-7 mm medially in the transverse/longitudinal extent (multiclip patients). The median distance between the geometric centers in the coronal plane for the tumor bed center was larger for patients with single clips than for those with multiple clips (p 2 . The CT bed was more readily visible in patients with a shorter interval between surgery and radiotherapy. Conclusion: The maximal depth of the tumor bed was similar using the two methods. The extent and centers of the clip-and CT-determined beds differed significantly. This may indicate an underestimation of the tumor bed as defined by clips only and justifies integration of CT information in boost field planning

  20. Radiation Field Design and Patterns of Locoregional Recurrence Following Definitive Radiotherapy for Breast Cancer

    International Nuclear Information System (INIS)

    Chen, Susie A.; Schuster, David M.; Mister, Donna; Liu Tian; Godette, Karen; Torres, Mylin A.

    2013-01-01

    Purpose: Locoregional control is associated with breast cancer-specific and overall survival in select women with breast cancer. Although several patient, tumor, and treatment characteristics have been shown to contribute to locoregional recurrence (LRR), studies evaluating factors related to radiotherapy (XRT) technique have been limited. We investigated the relationship between LRR location and XRT fields and dose delivered to the primary breast cancer in women experiencing subsequent locoregional relapse. Methods and Materials: We identified 21 women who were previously treated definitively with surgery and XRT for breast cancer. All patients developed biopsy-result proven LRR and presented to Emory University Hospital between 2004 and 2010 for treatment. Computed tomography (CT) simulation scans with XRT dose files for the initial breast cancer were fused with 18 F-labeled fluorodeoxyglucose positron emission tomography (FDG PET)/CT images in DICOM (Digital Imaging and Communications in Medicine) format identifying the LRR. Each LRR was categorized as in-field, defined as ≥95% of the LRR volume receiving ≥95% of the prescribed whole-breast dose; marginal, defined as LRR at the field edge and/or not receiving ≥95% of the prescribed dose to ≥95% of the volume; or out-of-field, that is, LRR intentionally not treated with the original XRT plan. Results: Of the 24 identified LRRs (3 patients experienced two LRRs), 3 were in-field, 9 were marginal, and 12 were out-of-field. Two of the 3 in-field LRRs were marginal misses of the additional boost XRT dose. Out-of-field LRRs consisted of six supraclavicular and six internal mammary nodal recurrences. Conclusions: Most LRRs in our study occurred in areas not fully covered by the prescribed XRT dose or were purposely excluded from the original XRT fields. Our data suggest that XRT technique, field design, and dose play a critical role in preventing LRR in women with breast cancer.

  1. Metrological legal frame in the field of the photon dosimetry of radiotherapy in Cuba

    International Nuclear Information System (INIS)

    Walwyn S, G.; Gutierrez L, S.; Gonzalez R, N.

    2006-01-01

    The Clinical Dosimetry in the planning of the doses to administer to patients under radiant treatment is of great importance. At the moment the clinical dosemeters its are manufactured with a high technology but errors of production or manipulation cannot be discarded that lead to errors in this planning. It also exists, a group of metrological and of operation parameters that are not checked in a routine calibration, and for those that are checked, legal base that restricts its use in cases of bad operation doesn't exist. This motivated to the Cuban standard elaboration NC 352:2005, for the verification of reference dosemeters of radiotherapy, process that trafficked for an exhaustive search and study of standards and international technical reports, selecting as base document, the standard IEC 60731:1997, for essays of approval of model of clinical dosemeters used in radiotherapy. The present article shows the main technical aspects considered and the requirements and verification methods for the declaration of aptitude of the dosemeters. This document constitutes the scientific base for the implementation from a verification service to national level and an important contribution to the standardization of the metrology of ionizing radiations of Cuba. (Author)

  2. Evaluation of compensation in breast radiotherapy: a planning study using multiple static fields

    International Nuclear Information System (INIS)

    Donovan, Ellen M.; Johnson, Ursula; Shentall, Glyn; Evans, Philip M.; Neal, Anthony J.; Yarnold, John R.

    2000-01-01

    Purpose: A method that uses electronic portal imaging to design intensity-modulated beams for compensation in breast radiotherapy was implemented using multiple static fields in a planning study. We present the results of the study to verify the algorithm, and to assess improvements to the dosimetry. Methods and Materials: Fourteen patients were imaged with computed tomography (CT) and on a treatment unit using an electronic portal imager. The portal imaging data were used to design intensity-modulated beams to give an ideal dose distribution in the breast. These beams were implemented as multiple static fields added to standard wedged tangential fields. Planning of these treatments was performed on a commercial treatment planning system (Target 2, IGE Medical Systems, Slough, U.K.) using the CT data for each patient. Dose-volume histogram (DVH) analysis of the plans with and without multileaf collimator (MLC) compensation was carried out. This work has been used as the basis for a randomized clinical trial investigating whether improvements in dosimetry are correlated with the reduction of long-term side effects from breast radiotherapy. Results: The planning analysis showed a mean increase in target volume receiving 95-105% of prescribed dose of 7.5% (range -0.8% to 15.9%) when additional MLC compensation was applied. There was no change to the minimum dose for all 14 patient data sets. The change in the volume of breast tissue receiving over 105% of prescribed dose, when applying MLC compensation, was between -1.4% and 11.9%, with positive numbers indicating an improvement. These effects showed a correlation with breast size; the larger the breast the greater the amount of improvement. Conclusions: The method for designing compensation for breast treatments using an electronic portal imager has been verified using planning on CT data for 14 patients. An improvement was seen in planning when applying MLC compensation and this effect was greater the larger the

  3. The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Maraldo, M. V.; Jorgensen, M.; Brodin, N. P.

    2014-01-01

    –II classical HL patients 4 x 2 plans for each patient. The lifetime excess risks of cardiac morbidity, cardiac mortality, lung, breast, and thyroid cancer with each technique were estimated. The estimated excess risks attributable to RT were based on HL series with long-term follow......IFRT), and Involved Node RT (INRT) and the risk of radiation-induced cardiovascular disease, secondary cancers, and the corresponding Life Years Lost (LYL) is estimated with each technique. PROCEDURE: INRT, mIFRT, IFRT, and MF plans (20 and 30 Gy) were simulated for 10 supradiaphragmatic, clinical stage I...... to the heart, lungs, breasts, and thyroid compared to past,extended fields, even for patients with mediastinal disease. This translated into a significantly reduced estimated risk of cardiovascular disease, secondary cancers, and LYL. CONCLUSIONS: Involved Node Radiotherapy should be considered for pediatric...

  4. 'Tongue-and-groove' effect in intensity modulated radiotherapy with static multileaf collimator fields

    International Nuclear Information System (INIS)

    Que, W; Kung, J; Dai, J

    2004-01-01

    The 'tongue-and-groove problem' in step-and-shoot delivery of intensity modulated radiotherapy is investigated. A 'tongue-and-groove' index (TGI) is introduced to quantify the 'tongue-and-groove' effect in step-and-shoot delivery. Four different types of leaf sequencing methods are compared. The sliding window method and the reducing level method use the same number of field segments to deliver the same intensity map, but the TGI is much less for the reducing level method. The leaf synchronization method of Van Santvoort and Heijmen fails in step-and-shoot delivery, but a new method inspired by the method of Van Santvoort and Heijmen is shown to eliminate 'tongue-and-groove' underdosage completely

  5. Dosimetric and geometric evaluation of an open low-field magnetic resonance simulator for radiotherapy treatment planning of brain tumours

    DEFF Research Database (Denmark)

    Kristensen, B.H.; Laursen, F.J.; Logager, V.

    2008-01-01

    Background and purpose: Magnetic resonance (MR) imaging is superior to computed tomography (CT) in radiotherapy of brain tumours. In this study an open low-field MR-simulator is evaluated in order to eliminate the cost of and time spent on additional CT scanning. Materials and methods: Eleven...

  6. Cranial radiotherapy guided by computed tomography with or without fields conformation in pediatric

    International Nuclear Information System (INIS)

    Fernandez, Diego; Caussa, Lucas; Murina, Patricia; Zunino, Silvia

    2007-01-01

    Many malignancies in children can be cured by radiotherapy, acute toxicity and the significant effect of delayed treatment are worrying for the patient, family and society. Therefore, the end of the pediatric radiotherapy is to maintain or improve the cure rate of cancer, diminishing the aftermath of treatment. The goal of this study is to measure differences in doses to the healthy tissue of the central nervous system with two radiotherapy techniques, both guided by computed tomography [es

  7. Functional signatures of radio-induction in sarcomas developing in the radiation field after radiotherapy

    International Nuclear Information System (INIS)

    Hadj-Hamou, N.S.

    2010-01-01

    Radiotherapy plays an important role in the treatment of cancers. However, exposure to ionizing radiation is a well-known risk factor for secondary cancer development. Currently, rigorous defined scientific criteria are lacking to establish if an individual tumor has a radiation-induced or a sporadic origin. The main aim of my thesis program was to identify a transcriptome signature of the ionizing radiation effects in radiation-induced cancers. The series of cancers used in this study is composed of sarcomas developing in the irradiation field of patients treated by radiotherapy for a primary cancer. Strict selection criteria (histology different from the primary cancer, latency longer than 5 years) were used to establish with a high probability the sarcomas-radiation induced origin. Their transcriptomes were compared with those from patients without irradiation history. A method of classification adapted to small series was used for the study of all the 60 collected sarcomas (34 radiation-induced and 26 sporadic). A learning set composed of 24 sarcomas from known aetiology allowed us to determine a signature of 135 genes discriminating the sarcomas according to their aetiology. The signature classified 86% of the remaining sarcomas as a function of their aetiology with an accuracy of 97%. The analysis of the genes-function shows that the radiation-induced sarcomas suffered the effects of a chronic oxidative stress mainly generated by mitochondrial dysfunctions. This study shows, for the first time, that it is possible to diagnose, at the case by case level, radiation-induced sarcomas on a rigorous scientific basis. (author)

  8. Evaluation of a liquid ionization chamber for relative dosimetry in small and large fields of radiotherapy photon beams

    International Nuclear Information System (INIS)

    Benítez, E.M.; Casado, F.J.; García-Pareja, S.; Martín-Viera, J.A.; Moreno, C.; Parra, V.

    2013-01-01

    Commissioning and quality assurance of radiotherapy linear accelerators require measurement of the absorbed dose to water, and a wide range of detectors are available for absolute and relative dosimetry in megavoltage beams. In this paper, the PTW microLion isooctane-filled ionization chamber has been tested to perform relative measurements in a 6 MV photon beam from a linear accelerator. Output factors, percent depth dose and dose profiles have been obtained for small and large fields. These quantities have been compared with those from usual detectors in the routine practice. In order to carry out a more realistic comparison, an uncertainty analysis has been developed, taking type A and B uncertainties into account. The results present microLion as a good option when high spatial resolution is needed, thanks to its reduced sensitive volume. The liquid filling also provides a high signal compared to other detectors, like that based on air filling. Furthermore, the relative response of microLion when field size is varied suggests that this detector has energy dependence, since it is appreciated an over-response for small fields and an under-response for the large ones. This effect is more obvious for field sizes wider than 20 × 20 cm 2 , where the differences in percent depth dose at great depths exceed the uncertainties estimated in this study. - Highlights: • When high spatial resolution is required the results confirm the suitability of the liquid chamber. • Some energy dependence of the liquid detector can be appreciated in OFs and PDDs for small and large fields. • For field sizes >20 × 20 cm 2 , the differences in PDDs at great depths exceed the uncertainties estimated. • Some drawbacks should be considered: the time to reach stability, the high voltage supply required and the acquiring cost

  9. SU-E-T-66: A Prototype for Couch Based Real-Time Dosimetry in External Beam Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ramachandran, P [Peter MacCallum Cancer Centre, Bendigo (Australia)

    2015-06-15

    Purpose: The main purpose of this study is to design a prototype for couch-based based real time dosimetry system in external beam radiotherapy Methods: A prototype of 100 ionization chambers was designed on a printed circuit board by etching the copper layer and each ionization chamber was wired to a 50 pin connector. The signals from the two 50 pin connectors collected from the ionization chambers were then transferred to a PXI module from National Instruments. The PXI module houses a current amplifier that amplifies the charge collected from the ionization chamber. The amplified signal is then sent to a digital multimeter module for converting the analog signal to digital signal. A software was designed in labview to read and display the signals obtained from the PXI module. A couch attachment frame was designed to house the 100 ionization chamber module. The frame was fixed underneath the treatment couch for measuring the dose during treatment. Resutls: The ionization chamber based prototype dosimetry was tested for simple radiotherapy treatment fields and found to be a useful device for measuring real time dosimetry at the treatment couch plane. This information could be used to assess the delivered dose to a patient during radiotherapy. It could be used as an invivo dosimeter during radiotherapy. Conclusion: In this study, a prototype for couch based real time dosimetry system was designed and tested. The prototype forms a basis for the development of large scale couch based real time dosimetry system that could be used to perform morning QA prior to treatment, assess real time doses delivered to patient and as a device to monitor the output of the treatment beam. Peter MacCallum Cancer Foundation.

  10. SU-E-T-66: A Prototype for Couch Based Real-Time Dosimetry in External Beam Radiotherapy

    International Nuclear Information System (INIS)

    Ramachandran, P

    2015-01-01

    Purpose: The main purpose of this study is to design a prototype for couch-based based real time dosimetry system in external beam radiotherapy Methods: A prototype of 100 ionization chambers was designed on a printed circuit board by etching the copper layer and each ionization chamber was wired to a 50 pin connector. The signals from the two 50 pin connectors collected from the ionization chambers were then transferred to a PXI module from National Instruments. The PXI module houses a current amplifier that amplifies the charge collected from the ionization chamber. The amplified signal is then sent to a digital multimeter module for converting the analog signal to digital signal. A software was designed in labview to read and display the signals obtained from the PXI module. A couch attachment frame was designed to house the 100 ionization chamber module. The frame was fixed underneath the treatment couch for measuring the dose during treatment. Resutls: The ionization chamber based prototype dosimetry was tested for simple radiotherapy treatment fields and found to be a useful device for measuring real time dosimetry at the treatment couch plane. This information could be used to assess the delivered dose to a patient during radiotherapy. It could be used as an invivo dosimeter during radiotherapy. Conclusion: In this study, a prototype for couch based real time dosimetry system was designed and tested. The prototype forms a basis for the development of large scale couch based real time dosimetry system that could be used to perform morning QA prior to treatment, assess real time doses delivered to patient and as a device to monitor the output of the treatment beam. Peter MacCallum Cancer Foundation

  11. Patterns of failure after involved field radiotherapy for locally advanced esophageal squamous cell carcinoma.

    Science.gov (United States)

    Li, Duo-Jie; Li, Hong-Wei; He, Bin; Wang, Geng-Ming; Cai, Han-Fei; Duan, Shi-Miao; Liu, Jing-Jing; Zhang, Ya-Jun; Cui, Zhen; Jiang, Hao

    2016-01-01

    To retrospectively analyze the patterns of failure and the treatment effects of involved-field irradiation (IFI) on patients treated with locally advanced esophageal squamous cell carcinoma (ESCC) and to determine whether IFI is practicable in these patients. A total of 79 patients with locally advanced ESCC underwent three dimensional conformal (3D)CRT) or intensity modulated radiotherapy (IMRT) using IFI or elective nodal irradiation (ENI) according to the target volume. The patterns of failure were defined as local/regional, in-field, out)of)field regional lymph node (LN) and distant failure. With a median follow)up of 32.0 months, failures were observed in 66 (83.6%) patients. The cumulative incidence of local/regional failure (55.8 vs 52.8%) and in)field regional lymph node failure (25.6 vs 19.4%) showed no statistically significant difference between the IFI and the ENI group (p=0.526 and 0.215, respectively). Out)of)field nodal relapse rate of only 7.0% was seen in the IFI group. Three)year survival rates for the ENI and IFI group were 22.2 and 18.6%, respectively (p=0.240), and 3)year distant metastasis rates were 27.8 and 32.6%, respectively (p=0.180). The lung V10, V20, V30 and mean lung dose of the ENI group were greater than those of the IFI group, while the mean lung dose and V10 had statistically significant difference. The patterns of failure and survival rates in the IFI group were similar as in the ENI group; the regional recurrence and distant metastasis are the main cause of treatment failure. IFI is feasible for locally advanced ESCC. Further investigation is needed to increase local control and decrease distant metastasis in these patients.

  12. Radiation for skull base meningiomas: review of the literature on the approach to radiotherapy.

    Science.gov (United States)

    Moraes, Fabio Y; Chung, Caroline

    2017-07-01

    Skull base meningiomas (SBM) pose unique challenges for radiotherapy as these tumors are often in close proximity to a number of critical structures and may not be surgically addressed in many cases, leaving the question about the tumor grade and expected biological behaviour. External beam radiotherapy and radiosurgery are longstanding treatments for meningioma that are typically used as upfront primary therapy, for recurrent tumors and as adjuvant therapy following surgical resection. There is controversy regarding the optimal timing and approach for radiation therapy in various clinical settings such as the role of adjuvant radiotherapy for completely resected grade 2 tumours. Despite the use of radiotherapy for many decades, the evidence to guide optimal radiation treatment is limited largely to single institution series of EBRT, SRS and particle therapy. In this article, we review the published data to clarify the role of external beam radiotherapy, proton radiotherapy and single and multi-fraction radiosurgery for SBM. We also highlight the areas of potential research and need for clinical improvement, including the growing awareness and effort to improve cognitive function in this patient population, who typically have long life expectancy following their meningioma diagnosis.

  13. The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis : Importance of field size.

    Science.gov (United States)

    Kaltenborn, Alexander; Bulling, Elke; Nitsche, Mirko; Carl, Ulrich Martin; Hermann, Robert Michael

    2016-08-01

    The purpose of this work was to evaluate the efficacy of low-dose radiotherapy (RT) for thumb carpometacarpal osteoarthritis (rhizarthrosis). The responses of 84 patients (n = 101 joints) were analyzed 3 months after therapy (n = 65) and at 12 months (n = 27). Patients were treated with 6 fractions of 1 Gy, two times a week, with a linear accelerator. At the end of therapy, about 70 % of patients reported a response (partial remission or complete remission), 3 months later about 60 %, and 1 year after treatment 70 %. In univariate regression analysis, higher patient age and field size greater than 6 × 4 cm were associated with response to treatment, while initial increase of pain under treatment was predictive for treatment failure. Duration of RT series (more than 18 days), gender, time of symptoms before RT, stress pain or rest pain, or prior ortheses use, injections, or surgery of the joint were not associated with treatment efficacy. In multivariate regression analysis, only field size and initial pain increase were highly correlated with treatment outcome. In conclusion, RT represents a useful treatment option for patients suffering from carpometacarpal osteoarthritis. In contrast to other benign indications, a larger field size (>6 × 4 cm) seems to be more effective than smaller fields and should be evaluated in further prospective studies.

  14. Reproduction of set-up of the fields in x-ray radiotherapy

    International Nuclear Information System (INIS)

    Izawa, Kazuo; Hata, Kiyoshi; Sasaki, Junichi; Matsugi, Shunpei; Takeshita, Masanori; Okamoto, Hideaki; Nakajima, Tadashi

    1985-01-01

    We measured the reproducibility of the field in radiotherapy by lineacgram and carried out the measurement of the following sites such as the larynx, pharynx, whole brain and the whole pelvis. The measurement points are 5 in the head and neck, and 7 in pelvis. The data of this study were obtained from 536 film sheets for 62 patients during May 1983 to September 1983 period. We used the XTL-5 localization film and Kyokko GF intensifying screen. The reproducibility error was decided with the use of the average and standard deviations. The following results were obtained: 1) The site that has the minimal error is larynx with 4.8 mm; the maximal error is whole brain with 11.2 mm; and the whole pelvis with 6 mm. 2) The fixing device is always needed at the head and neck site. 3) Using the fixing device, it was comfirmed that the reproducibility error of the field is due to arrangement of place rather than the patients movement during the treatment time. We further aim, to reduce the scattering shown by the standard deviation than the one by the average value. (author)

  15. Adjuvant radiotherapy versus observation alone for patients at risk of lymph-node field relapse after therapeutic lymphadenectomy for melanoma : a randomised trial

    NARCIS (Netherlands)

    Burmeister, Bryan H.; Henderson, Michael A.; Ainslie, Jill; Fisher, Richard; Di Iulio, Juliana; Smithers, B. Mark; Hong, Angela; Shannon, Kerwin; Scolyer, Richard A.; Carruthers, Scott; Coventry, Brendon J.; Babington, Scott; Duprat, Joao; Hoekstra, Harald J.; Thompson, John F.

    Background The use of radiotherapy after therapeutic lymphadenectomy for patients with melanoma at high risk of further lymph-node field and distant recurrence is controversial. Decisions for radiotherapy in this setting are made on the basis of retrospective, non-randomised studies. We did this

  16. Proposal of procedures to prevent errors in radiotherapy based in learned lessons of accidental expositions

    International Nuclear Information System (INIS)

    Bueno, Giselle Oliveira Vieira

    2007-01-01

    In order to consider some procedures to prevent errors in radiotherapy based in learned lessons of accidental expositions and in accordance with information contained in international reports elaborated by International Atomic Energy Agency (IAEA) and of the data base availability by the European group Radiation Oncology Safety Information System (ROSIS) on the events, a research of the occurred errors was performed. For the evaluation of the incidents a data base based in the ROSIS and added plus a parameter was created 'type of error'. All the stored data make possible the evaluation of the 839 incidents in terms of frequency of the type of error, the process of detention, the number of reached patients and the degree of severity. Of the 50 types of found errors, the type of error more frequently was 'incorrect treatment coordinate', confirmed with the data of literature and representing 28,96 por cent of the total of the incidents. The results showed 44,44 por cent are discovered at the moment of the treatment and that the process of verification of the fiche or clinical revision of the patient is a verification more occurred insurance and in 43,33 por cent of the searched events. The results indicated that more than 50 por cent of the incidents the severity degree are void and approximately 62 por cent a patient are affected during the accomplishment of the radiotherapy. This work showed that to analyze the data base according to methodology proposal for Klein et al.; for Reason, and Dunscombe et al. is interesting to insert more characteristic detailed in the data base such as: the number of fractions for affected patient, number of fields of treatment for fraction that was affected, shunting line of the prescribed dose and shunting line of the volume prescribed in all the registered in cadastral map events. Some causes exist that can lead the errors when patient they are submitted to the radiotherapy. Some measures can be taken so that these errors do not

  17. An independent dose calculation algorithm for MLC-based stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Lorenz, Friedlieb; Killoran, Joseph H.; Wenz, Frederik; Zygmanski, Piotr

    2007-01-01

    We have developed an algorithm to calculate dose in a homogeneous phantom for radiotherapy fields defined by multi-leaf collimator (MLC) for both static and dynamic MLC delivery. The algorithm was developed to supplement the dose algorithms of the commercial treatment planning systems (TPS). The motivation for this work is to provide an independent dose calculation primarily for quality assurance (QA) and secondarily for the development of static MLC field based inverse planning. The dose calculation utilizes a pencil-beam kernel. However, an explicit analytical integration results in a closed form for rectangular-shaped beamlets, defined by single leaf pairs. This approach reduces spatial integration to summation, and leads to a simple method of determination of model parameters. The total dose for any static or dynamic MLC field is obtained by summing over all individual rectangles from each segment which offers faster speed to calculate two-dimensional dose distributions at any depth in the phantom. Standard beam data used in the commissioning of the TPS was used as input data for the algorithm. The calculated results were compared with the TPS and measurements for static and dynamic MLC. The agreement was very good (<2.5%) for all tested cases except for very small static MLC sizes of 0.6 cmx0.6 cm (<6%) and some ion chamber measurements in a high gradient region (<4.4%). This finding enables us to use the algorithm for routine QA as well as for research developments

  18. Radiation dose and cancer risk to out-of-field and partially in-field organs from radiotherapy for symptomatic vertebral hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Mazonakis, Michalis, E-mail: mazonak@med.uoc.gr; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, Crete 71003 (Greece); Tzedakis, Antonis [Department of Medical Physics, University Hospital of Iraklion, Iraklion, Crete 71110 (Greece); Lyraraki, Efrossyni [Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete 71110 (Greece)

    2016-04-15

    Purpose: Vertebral hemangiomas (VHs) are the most common benign tumors of the spine that may cause bone resorption. Megavoltage irradiation is usually the treatment of choice for the management of symptomatic VHs. The current study was conducted to estimate the risk for carcinogenesis from radiotherapy of this benign disease on the basis of the calculated radiation doses to healthy organs. Methods: The Monte Carlo N-particle transport code was employed to simulate the irradiation with 6 MV x-rays of a VH presented in the cervical, upper thoracic, lower thoracic, and lumbar spine. The average radiation dose (D{sub av}) received by each critical organ located outside the primarily irradiated area was calculated. Three-dimensional treatment plans were also generated for the VHs occurring at the four different sites of the spinal cord based on patients’ computed tomography data. The organ equivalent dose (OED) to each radiosensitive structure, which was partly encompassed by the applied treatment fields, was calculated with the aid of differential dose–volume histograms. The D{sub av} and the OED values were combined with a linear-no-threshold model and a nonlinear mechanistic model, respectively, to estimate the organ-, age-, and gender-specific lifetime attributable risks (LARs) for cancer development. The estimated risks were compared with the respective nominal lifetime intrinsic risks (LIRs) for the unexposed population. Results: For a standard target dose of 34 Gy, the OED varied from 0.39–5.15 Gy by the organ of interest and the irradiation site. The D{sub av} range for the out-of-field organs was 4.9 × 10{sup −4} to 0.56 Gy. The LAR for the appearance of malignancies in the partially in-field organs after radiotherapy of male and female patients was (0.08%–1.8%) and (0.09%–1.9%), respectively. These risk values were 1.5–15.5 times lower when compared to the respective LIRs. The lifetime probability for out-of-field cancer induction in irradiated

  19. Radiation dose and cancer risk to out-of-field and partially in-field organs from radiotherapy for symptomatic vertebral hemangiomas

    International Nuclear Information System (INIS)

    Mazonakis, Michalis; Damilakis, John; Tzedakis, Antonis; Lyraraki, Efrossyni

    2016-01-01

    Purpose: Vertebral hemangiomas (VHs) are the most common benign tumors of the spine that may cause bone resorption. Megavoltage irradiation is usually the treatment of choice for the management of symptomatic VHs. The current study was conducted to estimate the risk for carcinogenesis from radiotherapy of this benign disease on the basis of the calculated radiation doses to healthy organs. Methods: The Monte Carlo N-particle transport code was employed to simulate the irradiation with 6 MV x-rays of a VH presented in the cervical, upper thoracic, lower thoracic, and lumbar spine. The average radiation dose (D_a_v) received by each critical organ located outside the primarily irradiated area was calculated. Three-dimensional treatment plans were also generated for the VHs occurring at the four different sites of the spinal cord based on patients’ computed tomography data. The organ equivalent dose (OED) to each radiosensitive structure, which was partly encompassed by the applied treatment fields, was calculated with the aid of differential dose–volume histograms. The D_a_v and the OED values were combined with a linear-no-threshold model and a nonlinear mechanistic model, respectively, to estimate the organ-, age-, and gender-specific lifetime attributable risks (LARs) for cancer development. The estimated risks were compared with the respective nominal lifetime intrinsic risks (LIRs) for the unexposed population. Results: For a standard target dose of 34 Gy, the OED varied from 0.39–5.15 Gy by the organ of interest and the irradiation site. The D_a_v range for the out-of-field organs was 4.9 × 10"−"4 to 0.56 Gy. The LAR for the appearance of malignancies in the partially in-field organs after radiotherapy of male and female patients was (0.08%–1.8%) and (0.09%–1.9%), respectively. These risk values were 1.5–15.5 times lower when compared to the respective LIRs. The lifetime probability for out-of-field cancer induction in irradiated males and

  20. Conventional radiotherapy of localized right side breast cancer after radical mastectomy: development of innovative “field in field” technique

    Directory of Open Access Journals (Sweden)

    Goran Marošević

    2011-12-01

    Full Text Available Introduction: The aim of this paper is to study the distribution of the therapy dosage applied by a modified conventional “field in field” technique and compare it to the distribution of the dosage applied by the standard conventional technique.Methods: The study included ten patients with right side breast cancer, after they were exposed to radical mastectomy and chemotherapy. Radiotherapy dosage of TD 50 Gy in 25 fractions was applied to the anterolateral side of the right thoracic wall, with two opposite conventional tangential fields by the linear accelerator Elekta Synergy and the energy of 6 megavolts (MV. A delineation of the target volume (CTV – Clinical Target Volume was done within conventional fields. At the XiO system for planning we included additional fields within the existing conventional fields, which was the so called “field in field” technique. On the basis of CTV the Dose Volume  Histogram (DVH was calculated for conventional and “field in field” plans. VD90%, VD95%, VD107%, VD115%, CI and HI were calculated for both techniques. Means were pared with the paired Student's t-test. The results were considered significantly different if p<0.05.Results: VD90% and VD 95% were significantly higher for the “field in field” technique. Therefore, CI also favored the “field in field” technique (p=0.02. There was no difference in VD107% and VD115% between the compared groups. Consequently, there was no statistically significant difference in HI (1.13±0.03 vs.1.13±0.03, p=0.06.Conclusion: Conventional postoperative radiotherapy of localized right side breast cancer by “field in field” technique provides excellent coverage of the target volume by radiotherapy isodose.

  1. Proton radiotherapy in management of pediatric base of skull tumors

    International Nuclear Information System (INIS)

    Hug, Eugen B.; Sweeney, Reinhart A.; Nurre, Pamela M.; Holloway, Kitty C.; Slater, Jerry D.; Munzenrider, John E.

    2002-01-01

    Purpose: Primary skull base tumors of the developing child are rare and present a formidable challenge to both surgeons and radiation oncologists. Gross total resection with negative margins is rarely achieved, and the risks of functional, structural, and cosmetic deficits limit the radiation dose using conventional radiation techniques. Twenty-nine children and adolescents treated with conformal proton radiotherapy (proton RT) were analyzed to assess treatment efficacy and safety. Methods and Materials: Between July 1992 and April 1999, 29 patients with mesenchymal tumors underwent fractionated proton (13 patients) or fractionated combined proton and photon (16 patients) irradiation. The age at treatment ranged from 1 to 19 years (median 12); 14 patients were male and 15 female. Tumors were grouped as malignant or benign. Twenty patients had malignant histologic findings, including chordoma (n=10), chondrosarcoma (n=3), rhabdomyosarcoma (n=4), and other sarcomas (n=3). Target doses ranged between 50.4 and 78.6 Gy/cobalt Gray equivalent (CGE), delivered at doses of 1.8-2.0 Gy/CGE per fraction. The benign histologic findings included giant cell tumors (n=6), angiofibromas (n=2), and chondroblastoma (n=1). RT doses for this group ranged from 45.0 to 71.8 Gy/CGE. Despite maximal surgical resection, 28 (97%) of 29 patients had gross disease at the time of proton RT. Follow-up after proton RT ranged from 13 to 92 months (mean 40). Results: Of the 20 patients with malignant tumors, 5 (25%) had local failure; 1 patient had failure in the surgical access route and 3 patients developed distant metastases. Seven patients had died of progressive disease at the time of analysis. Local tumor control was maintained in 6 (60%) of 10 patients with chordoma, 3 (100%) of 3 with chondrosarcoma, 4 (100%) of 4 with rhabdomyosarcoma, and 2 (66%) of 3 with other sarcomas. The actuarial 5-year local control and overall survival rate was 72% and 56%, respectively, and the overall survival

  2. 2nd Tuebingen radiotherapy symposium: Whole body, large field and whole skin irradiation. Introduction

    International Nuclear Information System (INIS)

    Huebener, K.H.; Frommhold, W.

    1987-01-01

    The symposium which took place on the 11th and 12th April 1986 set itself the task of discussing three different groups of radiotherapy topics. The chief issue was whole-body irradiation prior to bone marrow transplants, in which all the therapy centres in West Germany, Austria, East Germany and German-speaking Switzerland made clinical and radiophysical contributions. The second part of the Symposium consisted mainly of talks and discussions on large-field irradiation, more precisely half-body and sequential partial body irradiation. This topic was chosen because this type of therapy is scarcely practised at all, particularly in West Germany, whereas in the United States, East Germany, Switzerland and a number of other countries it has long since become one of the established methods. The last talk at the Symposium explained clinical and radiophysical aspects of whole-skin irradiation. Here too, one was impressed by the wide diversity of the equipment and methods of irradiation used which, nevertheless, all demonstrated satisfactory practical solutions in their common aim of distributing the dose as homogeneously as possible. (orig./MG) [de

  3. Radiotherapy of ovarian epithelial cancer by total orthogonal field irradiation of the abdomen

    International Nuclear Information System (INIS)

    Delouche, G.; Valinta, D.; Bachelot, F.

    1981-01-01

    Isotopic intraperitoneal curietherapy by 32 P is the simplest method for irradiating the peritoneum, but it has only limited indications. This irradiation has usually to be given by the percutaneous route, but because of the size of the region to be irradiated it raises delicate problems poorly resolved by the traditional methods applied. For this reason, a particular method is suggested including, among other characteristics: 4 orthogonal fields; 2 sessions daily, irradiating one part of the abdomen in the morning and the other part in the afternoon; spreading of the doses in confirmity with current specifications; and modulation of the total dose as a function of the maximum size of the tumoral remnants. Abdominal radiotherapy is currently the method of choice in cases where lesions are in their early stages, in so far as chemotherapy, much more restrictive for the patient, has not yet demonstrated its long-term efficacy. A controlled clinical study is necessary in order to determine the most effective method [fr

  4. A chronicle of radiotherapy, 1900-1960. Selected chapters of the German literature in the field of radiooncology. Vol. 1

    International Nuclear Information System (INIS)

    Scherer, E.

    1992-01-01

    This is the first publication to review the history of development of radiotherapy as a method of treatment, starting with the first publications form the fields of dermatology, gynecology, surgery and internal medicine, showing the whole way up to the emergence of radiooncology as an independent field of work. The most important monographies and many other contributions published in the years from 1912 to 1925 in the journal 'Strahlentherapie und Onkologie' have been compiled in this book to illustrate the various phases of development of techniques and methods as well as of research in the field of physics, or radiobiology. (orig.) [de

  5. Postmastectomy radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shikama, Naoto; Koguchi, Masahiko; Sasaki, Shigeru; Kaneko, Tomoki; Shinoda, Atsunori; Nishikawa, Atsushi [Shinshu Univ., Matsumoto, Nagano (Japan). School of Medicine

    2000-10-01

    Since there have been few reports on postmastectomy radiotherapy having a high evidence level in Japan, the significance of postoperative radiotherapy and the irradiation techniques were reviewed based on reports from Western countries. Authors focused on the indications for postoperative irradiation, irradiation methods (irradiation sites, irradiation techniques; prosthetics, methods of irradiating the chest wall and lymph nodes, timing of irradiation), and complications, and discuss them. The factors thought to be adaptable to postmastectomy radiotherapy have been listed. Axillary lymph node metastasis and the size of the primary focus are thought to be important factors in locoregional recurrence. The chest wall and the supraclavicular lymph nodes are the usual sites of irradiation after mastectomy. The irradiation method consists of tangential irradiation of the chest wall and single-field irradiation of the supraclavicular lymph nodes, with 46-50 Gy in fractional doses of 1.8-2 Gy x 5/w is administered for 4.5-5.5 weeks. The timing of irradiation in the West is generally after chemotherapy. Adverse radiation effects include ischemic heart disease, pneumonitis, arm edema, rib fractures, and brachial plexus paralysis. The frequency of these complications is increased by the combined use of chemotherapy or surgery. The breast cancer cure rate in Japan is generally better than in the West. It remains to be determined whether the clinical data from Europe and America are applicable to the treatment of breast cancer in Japan. To address this issue, a clinical investigation should be performed in Japan with close cooperation between surgeons, physicians, pathologists, and radiotherapists. (K.H.)

  6. Radiotherapy for bone metastases - Practice in Norway 1997 - 2007. A national registry-based study

    Energy Technology Data Exchange (ETDEWEB)

    Sande Laugsand, Tonje [European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian Univ. of Technology and Science (NTNU), Trondheim (Norway)], e-mail: tonje.laugsand@ntnu.no; Kaasa, Stein; Lund, Jo-Aasmund [European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian Univ. of Technology and Science (NTNU), Trondheim (Norway); Cancer Clinic, St. Olavs Hospital, Univ. Hospital of Trondheim, Trondheim (Norway); Romundstad, Paal [Dept. of Public Health, Faculty of Medicine, Norwegian Univ. of Technology and Science (NTNU), Trondheim (Norway); Johannesen, Tom Boerge [Cancer Registry of Norway, Oslo (Norway)

    2013-08-15

    Numerous randomised clinical trials have shown that the efficacy of single fraction radiotherapy for metastatic bone pain corresponds to that of multiple fractions of radiotherapy for the majority of patients. It is not clear to which extent single fraction radiotherapy has been implemented into clinical practice. Material and methods: A Norwegian national registry based study was conducted, including all radiotherapy schedules of 8 Gy x 1 and 3 Gy x 10 delivered to bone metastases in 1997 - 2007. Binomial regression analyses were used to study whether treatment centre, primary diagnosis, anatomical region irradiated, age, sex, and travel distance, were associated with the choice of fractionation. Results: A total of 14 380 radiotherapy episodes were identified. During the period 31% of the treatments were delivered as 8 Gy x 1. The proportion of single fraction treatments increased from 16% in 1997 to 41% in 2007. There were substantial differences in the proportion of single fraction treatments between the treatment centres (range 25 - 54%). These differences persisted after adjustment for sex, age, primary diagnosis, anatomical region, and travel distance. Conclusions: The study demonstrates an under utilisation of single fraction treatment for bone metastases in Norway during the study period.

  7. Adjuvant radiotherapy after radical prostatectomy: A failure of marketing-based medicine?

    International Nuclear Information System (INIS)

    Shakespeare, Thomas P.

    2016-01-01

    Adjuvant radiotherapy for high-risk patients after radical prostatectomy has been shown to reduce local and metastatic failure, improve overall survival and improve quality of life (QOL). The evidence, based on three randomised studies and a meta-analysis, is so compelling that the national and internatioanl professional bodies, representing urologists and radiation oncologist alike, recommend that high-risk patients be offered immediate adjuvant radiotherapy. Despite this being the standard of care, few patients fo on to recive it. This paper looks at the possibilities of why this is so, highlighting that it could possibly be related to poor marketing, communication and delivery of health information to patients and professional alike. It concludes that we need a more coordinated way to increase utilisation of the gold standard adjuvant radiotherapy post-radical prostatectomy, perhaps learning some valuable lessons from the business community.

  8. A DICOM-RT-based toolbox for the evaluation and verification of radiotherapy plans

    International Nuclear Information System (INIS)

    Spezi, E; Lewis, D G; Smith, C W

    2002-01-01

    The verification of radiotherapy plans is an essential step in the treatment planning process. This is especially important for highly conformal and IMRT plans which produce non-intuitive fluence maps and complex 3D dose distributions. In this work we present a DICOM (Digital Imaging and Communication in Medicine) based toolbox, developed for the evaluation and the verification of radiotherapy treatment plans. The toolbox offers the possibility of importing treatment plans generated with different calculation algorithms and/or different optimization engines and evaluating dose distributions on an independent platform. Furthermore the radiotherapy set-up can be exported to the BEAM Monte Carlo code system for dose verification. This can be done by simulating the irradiation of the patient CT dataset or the irradiation of a software-generated water phantom. We show the application of some of the functions implemented in this toolbox for the evaluation and verification of an IMRT treatment of the head and neck region

  9. Constitution of a centralised data base for the internal quality control in radiotherapy

    International Nuclear Information System (INIS)

    Fau, P.; Rodrigues, C.; Ruchaud, R.; Bravetti, J.

    2009-01-01

    The objective of this project was to implement a centralised data base of internal quality control in radiotherapy according to the criteria of the decree of A.f.s.s.a.p.s. (French agency of sanitary safety of health products on 27 july 2007, about the internal quality control of external radiotherapy facilities. The software on one year meets the objectives: compliance by comparison with A.f.s.s.a.p.s. criteria but particularly optimization of the centralisation and analysis of the internal quality controls. (N.C.)

  10. First patients treated with a 1.5 T MRI-Linac: clinical proof of concept of a high-precision, high-field MRI guided radiotherapy treatment

    Science.gov (United States)

    Raaymakers, B. W.; Jürgenliemk-Schulz, I. M.; Bol, G. H.; Glitzner, M.; Kotte, A. N. T. J.; van Asselen, B.; de Boer, J. C. J.; Bluemink, J. J.; Hackett, S. L.; Moerland, M. A.; Woodings, S. J.; Wolthaus, J. W. H.; van Zijp, H. M.; Philippens, M. E. P.; Tijssen, R.; Kok, J. G. M.; de Groot-van Breugel, E. N.; Kiekebosch, I.; Meijers, L. T. C.; Nomden, C. N.; Sikkes, G. G.; Doornaert, P. A. H.; Eppinga, W. S. C.; Kasperts, N.; Kerkmeijer, L. G. W.; Tersteeg, J. H. A.; Brown, K. J.; Pais, B.; Woodhead, P.; Lagendijk, J. J. W.

    2017-12-01

    The integration of 1.5 T MRI functionality with a radiotherapy linear accelerator (linac) has been pursued since 1999 by the UMC Utrecht in close collaboration with Elekta and Philips. The idea behind this integrated device is to offer unrivalled, online and real-time, soft-tissue visualization of the tumour and the surroundings for more precise radiation delivery. The proof of concept of this device was given in 2009 by demonstrating simultaneous irradiation and MR imaging on phantoms, since then the device has been further developed and commercialized by Elekta. The aim of this work is to demonstrate the clinical feasibility of online, high-precision, high-field MRI guidance of radiotherapy using the first clinical prototype MRI-Linac. Four patients with lumbar spine bone metastases were treated with a 3 or 5 beam step-and-shoot IMRT plan. The IMRT plan was created while the patient was on the treatment table and based on the online 1.5 T MR images; pre-treatment CT was deformably registered to the online MRI to obtain Hounsfield values. Bone metastases were chosen as the first site as these tumors can be clearly visualized on MRI and the surrounding spine bone can be detected on the integrated portal imager. This way the portal images served as an independent verification of the MRI based guidance to quantify the geometric precision of radiation delivery. Dosimetric accuracy was assessed post-treatment from phantom measurements with an ionization chamber and film. Absolute doses were found to be highly accurate, with deviations ranging from 0.0% to 1.7% in the isocenter. The geometrical, MRI based targeting as confirmed using portal images was better than 0.5 mm, ranging from 0.2 mm to 0.4 mm. In conclusion, high precision, high-field, 1.5 T MRI guided radiotherapy is clinically feasible.

  11. A practical and theoretical definition of very small field size for radiotherapy output factor measurements.

    Science.gov (United States)

    Charles, P H; Cranmer-Sargison, G; Thwaites, D I; Crowe, S B; Kairn, T; Knight, R T; Kenny, J; Langton, C M; Trapp, J V

    2014-04-01

    This work introduces the concept of very small field size. Output factor (OPF) measurements at these field sizes require extremely careful experimental methodology including the measurement of dosimetric field size at the same time as each OPF measurement. Two quantifiable scientific definitions of the threshold of very small field size are presented. A practical definition was established by quantifying the effect that a 1 mm error in field size or detector position had on OPFs and setting acceptable uncertainties on OPF at 1%. Alternatively, for a theoretical definition of very small field size, the OPFs were separated into additional factors to investigate the specific effects of lateral electronic disequilibrium, photon scatter in the phantom, and source occlusion. The dominant effect was established and formed the basis of a theoretical definition of very small fields. Each factor was obtained using Monte Carlo simulations of a Varian iX linear accelerator for various square field sizes of side length from 4 to 100 mm, using a nominal photon energy of 6 MV. According to the practical definition established in this project, field sizes ≤ 15 mm were considered to be very small for 6 MV beams for maximal field size uncertainties of 1 mm. If the acceptable uncertainty in the OPF was increased from 1.0% to 2.0%, or field size uncertainties are 0.5 mm, field sizes ≤ 12 mm were considered to be very small. Lateral electronic disequilibrium in the phantom was the dominant cause of change in OPF at very small field sizes. Thus the theoretical definition of very small field size coincided to the field size at which lateral electronic disequilibrium clearly caused a greater change in OPF than any other effects. This was found to occur at field sizes ≤ 12 mm. Source occlusion also caused a large change in OPF for field sizes ≤ 8 mm. Based on the results of this study, field sizes ≤ 12 mm were considered to be theoretically very small for 6 MV beams. Extremely

  12. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

    Energy Technology Data Exchange (ETDEWEB)

    Droege, L.H.; Hinsche, T.; Hess, C.F.; Wolff, H.A. [University Hospital of Goettingen, Department of Radiotherapy and Radiation Oncology, Goettingen (Germany); Canis, M. [University of Goettingen, Department of Otorhinolaryngology, Head and Neck Surgery, Goettingen (Germany); Alt-Epping, B. [University of Goettingen, Department of Palliative Medicine, Goettingen (Germany)

    2014-02-15

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. (orig.)

  13. Radiotherapy of tonsillar and base of the tongue carcinoma. Prediction of local control

    NARCIS (Netherlands)

    Mak-Kregar, S.; Baris, G.; Lebesque, J. V.; Balm, A. J.; Hart, A. A.; Hilgers, F. J.

    1993-01-01

    119 patients with squamous cell carcinoma of the tonsillar region (68) and the base of the tongue (51), who received external radiotherapy with curative intent between 1966 and 1984, are analysed with respect to overall treatment results, local tumour control and prognostic factors. Radiation doses

  14. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

    International Nuclear Information System (INIS)

    Droege, L.H.; Hinsche, T.; Hess, C.F.; Wolff, H.A.; Canis, M.; Alt-Epping, B.

    2014-01-01

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. (orig.)

  15. Magnetic resonance imaging in the evaluation of standard radiotherapy field borders in patients with uterine cervix cancer

    International Nuclear Information System (INIS)

    Freire, Geison Moreira; Dias, Rodrigo Souza; Giordani, Adelmo Jose; Segreto, Helena Regina Comodo; Segreto, Roberto Araujo; Ribalta, Julisa Chamorro Lascasas

    2010-01-01

    Objective: to evaluate, by means of magnetic resonance imaging, the standardized field borders in radiotherapy for malignant neoplasm of uterine cervix, and to determine the role of this method in the reduction of possible planning errors related to the conventional technique. Materials and methods: magnetic resonance imaging studies for planning of treatment of 51 patients with uterine cervix cancer were retrospectively analyzed. The parameters assessed were the anterior and posterior field borders on sagittal section. Results: The anterior field border was inappropriate in 20 (39.2%) patients and geographic miss was observed in 37.3% of cases in the posterior border. The inappropriateness of both field borders did not correlate with clinical parameters such as patients' age, tumor staging, histological type and degree. Conclusion: the evaluation of standardized field borders with the use of magnetic resonance imaging has demonstrated high indices of inappropriateness of the lateral field borders, as well as the relevant role of magnetic resonance imaging in the radiotherapy planning for patients with uterine cervix cancer with a view to reduce the occurrence of geographic miss of the target volume. (author)

  16. Pseudomembranous colitis within radiotherapy field following concurrent chemoradiation therapy: a case report

    Directory of Open Access Journals (Sweden)

    Shen BJ

    2013-01-01

    Full Text Available Bing-Jie Shen,1 Shih-Chiang Lin,2 Pei-Wei Shueng,1,3 Yueh-Hung Chou,4 Li-Ming Tseng,5 Chen-Hsi Hsieh1,6,71Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Division of Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan; 3Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan; 4Department of Anatomical Pathology, Far Eastern Memorial Hospital, Taipei, Taiwan; 5Division of Colorectal Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan; 6Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, TaiwanAbstract: Development of nonantibiotic-associated pseudomembranous colitis has been reported in patients receiving chemotherapy. Herein, we report a case of a 70-year-old man with diabetes mellitus and hypertension who received concurrent chemoradiation therapy after surgery for stage III pT3N1M0 rectal cancer. After completion of the therapy, the patient presented with a 2-week history of intermittent watery diarrhea (seven to nine times per day. However, the patient was afebrile and laboratory examination revealed no evidence of leukocytosis. Computed tomography disclosed inflammation of the sigmoid colon, infiltrative changes around the anastomotic site, and edematous changes straddling the serosal surface. Colonoscopic examination revealed multiple whitish patches within the radiation field, a finding suggestive of pseudomembranous colitis. No concomitant antibiotics were used during the period of concurrent chemoradiation therapy. Empirical oral metronidazole (500 mg every 8 hours was administrated for 2 weeks. At the end of this treatment, stool culture was negative for Clostridium difficile. Physicians should be aware of the potential for the development of

  17. Methods for improving limited field-of-view radiotherapy reconstructions using imperfect a priori images

    International Nuclear Information System (INIS)

    Ruchala, Kenneth J.; Olivera, Gustavo H.; Kapatoes, Jeffrey M.; Reckwerdt, Paul J.; Mackie, Thomas R.

    2002-01-01

    There are many benefits to having an online CT imaging system for radiotherapy, as it helps identify changes in the patient's position and anatomy between the time of planning and treatment. However, many current online CT systems suffer from a limited field-of-view (LFOV) in that collected data do not encompass the patient's complete cross section. Reconstruction of these data sets can quantitatively distort the image values and introduce artifacts. This work explores the use of planning CT data as a priori information for improving these reconstructions. Methods are presented to incorporate this data by aligning the LFOV with the planning images and then merging the data sets in sinogram space. One alignment option is explicit fusion, producing fusion-aligned reprojection (FAR) images. For cases where explicit fusion is not viable, FAR can be implemented using the implicit fusion of normal setup error, referred to as normal-error-aligned reprojection (NEAR). These methods are evaluated for multiday patient images showing both internal and skin-surface anatomical variation. The iterative use of NEAR and FAR is also investigated, as are applications of NEAR and FAR to dose calculations and the compensation of LFOV online MVCT images with kVCT planning images. Results indicate that NEAR and FAR can utilize planning CT data as imperfect a priori information to reduce artifacts and quantitatively improve images. These benefits can also increase the accuracy of dose calculations and be used for augmenting CT images (e.g., MVCT) acquired at different energies than the planning CT

  18. Measurement and modeling of out-of-field doses from various advanced post-mastectomy radiotherapy techniques

    Science.gov (United States)

    Yoon, Jihyung; Heins, David; Zhao, Xiaodong; Sanders, Mary; Zhang, Rui

    2017-12-01

    More and more advanced radiotherapy techniques have been adopted for post-mastectomy radiotherapies (PMRT). Patient dose reconstruction is challenging for these advanced techniques because they increase the low out-of-field dose area while the accuracy of out-of-field dose calculations by current commercial treatment planning systems (TPSs) is poor. We aim to measure and model the out-of-field radiation doses from various advanced PMRT techniques. PMRT treatment plans for an anthropomorphic phantom were generated, including volumetric modulated arc therapy with standard and flattening-filter-free photon beams, mixed beam therapy, 4-field intensity modulated radiation therapy (IMRT), and tomotherapy. We measured doses in the phantom where the TPS calculated doses were lower than 5% of the prescription dose using thermoluminescent dosimeters (TLD). The TLD measurements were corrected by two additional energy correction factors, namely out-of-beam out-of-field (OBOF) correction factor K OBOF and in-beam out-of-field (IBOF) correction factor K IBOF, which were determined by separate measurements using an ion chamber and TLD. A simple analytical model was developed to predict out-of-field dose as a function of distance from the field edge for each PMRT technique. The root mean square discrepancies between measured and calculated out-of-field doses were within 0.66 cGy Gy-1 for all techniques. The IBOF doses were highly scattered and should be evaluated case by case. One can easily combine the measured out-of-field dose here with the in-field dose calculated by the local TPS to reconstruct organ doses for a specific PMRT patient if the same treatment apparatus and technique were used.

  19. Absorbed doses behind bones with MR image-based dose calculations for radiotherapy treatment planning.

    Science.gov (United States)

    Korhonen, Juha; Kapanen, Mika; Keyrilainen, Jani; Seppala, Tiina; Tuomikoski, Laura; Tenhunen, Mikko

    2013-01-01

    Magnetic resonance (MR) images are used increasingly in external radiotherapy target delineation because of their superior soft tissue contrast compared to computed tomography (CT) images. Nevertheless, radiotherapy treatment planning has traditionally been based on the use of CT images, due to the restrictive features of MR images such as lack of electron density information. This research aimed to measure absorbed radiation doses in material behind different bone parts, and to evaluate dose calculation errors in two pseudo-CT images; first, by assuming a single electron density value for the bones, and second, by converting the electron density values inside bones from T(1)∕T(2)∗-weighted MR image intensity values. A dedicated phantom was constructed using fresh deer bones and gelatine. The effect of different bone parts to the absorbed dose behind them was investigated with a single open field at 6 and 15 MV, and measuring clinically detectable dose deviations by an ionization chamber matrix. Dose calculation deviations in a conversion-based pseudo-CT image and in a bulk density pseudo-CT image, where the relative electron density to water for the bones was set as 1.3, were quantified by comparing the calculation results with those obtained in a standard CT image by superposition and Monte Carlo algorithms. The calculations revealed that the applied bulk density pseudo-CT image causes deviations up to 2.7% (6 MV) and 2.0% (15 MV) to the dose behind the examined bones. The corresponding values in the conversion-based pseudo-CT image were 1.3% (6 MV) and 1.0% (15 MV). The examinations illustrated that the representation of the heterogeneous femoral bone (cortex denser compared to core) by using a bulk density for the whole bone causes dose deviations up to 2% both behind the bone edge and the middle part of the bone (diameter bones). This study indicates that the decrease in absorbed dose is not dependent on the bone diameter with all types of bones. Thus

  20. Quality control of involved field radiotherapy in the HD 13 and HD 14 trials. Report of the radiotherapy panel of the German Hodgkin Study Group (GHSG)

    International Nuclear Information System (INIS)

    Kriz, J.; Haverkamp, U.; Eich, H.T.; Baues, C.; Engenhart-Cabillic, R.; Herfarth, K.; Lukas, P.; Pluetschow, A.; Fuchs, M.; Engert, A.; Schmidberger, H.; Staar, S.

    2017-01-01

    As part of the foundation of the German Hodgkin Study Group (GHSG) in 1978, a central radiotherapy (RT) reference centre was established to evaluate and to improve the quality of treatment. During the study generations, the quality assurance programs (QAP) were continued and adapted to the demands of each study. The purpose of this article is to demonstrate the results of the fifth study generation and to compare them to the previous findings. With the start of the fourth GHSG study generation (HD10-12), a central prospective review of all diagnostic images was established to create an individual treatment plan for each early stage study patient. The quality of involved field RT was retrospectively evaluated by an expert panel of radiation oncologists. In the fifth study generation (HD13-15), the retrospective review of radiotherapy performed was refined and the results were compared with the findings of the fourth generation. The expert panel analyzed the RT planning and application of 1037 (28 %) patients (HD13 n = 465, HD14 n = 572). Simulation films were available in 85 % of cases and verification films in 87 %. RT was assessed as major violation in 46 % (HD13 = 38 %, HD14 = 52 %), minor violation in 9 % (HD13 = 9 %, HD14 = 9 %) and according to the protocol in 45 % (HD13 = 52 %, HD14 = 38 %). The value for QAP of RT within the GHSG trials is well known. Still there were several protocol violations. In the future, the QAP program has to be adapted to the requirements of ''modern RT'' in malignant lymphoma. (orig.) [de

  1. Base-of-tongue carcinoma: treatment results using concomitant boost radiotherapy

    International Nuclear Information System (INIS)

    Mak, Albert C.; Morrison, William H.; Garden, Adam S.; Ang, Kian K.; Goepfert, Helmuth; Peters, Lester J.

    1995-01-01

    Purpose: To evaluate the efficacy of accelerated fractionated radiotherapy using the concomitant boost schedule for patients with squamous cell carcinoma of the base of tongue. Methods and Materials: Between September 1984 and July 1992, 54 patients with squamous carcinoma of the base of tongue were treated at The University of Texas M. D. Anderson Cancer Center using the concomitant boost schedule. The distribution of T and N stages was T1-4, T2-27, T3-22, and T4-1; N0-9, N1-11, N2-24, N3-7, and NX-3. American Joint Committee on Cancer (AJCC) stage groupings were II-6, III-14, and IV-34. Before radiation, nodal excision and neck dissection were done in 5 and 10 patients, respectively; 5 patients had neck dissections after radiotherapy. Standard on and off spinal cord fields were irradiated with 1.8 Gy fractions to 54 Gy given over 6 weeks. The boost was given concomitantly during the large field treatment as a second daily (1.5 Gy) fraction, with an interfraction interval of 4-6 h. The median dose to the primary tumor was 72 Gy (range, 66-74 Gy). The median treatment duration was 42 days (range, 39-48 days). Only three patients had treatment interrupted for more than one scheduled treatment day. Results: The 5-year actuarial overall survival and disease-specific survival rates were 59 and 65%, respectively, with a median follow-up of 41 months. The 5-year actuarial locoregional control rate was 76%. The actuarial local control rates achieved with radiotherapy at 5 years for T1, T2, and T3 primary tumors were 100%, 96%, and 67%, respectively; including surgical salvage, the local control rate of T3 primary tumors was 70%. Six patients had regional failures, which in three patients occurred in conjunction with primary tumor recurrence. Twenty-six patients with regional adenopathy were treated with radiation alone to full dose and had a complete clinical response in the neck; no planned neck dissections were performed in these patients. Only 2 of these 26 patients

  2. Why Radiotherapy Works. Chapter 6

    International Nuclear Information System (INIS)

    Tashiro, S.; Nishibuchi, I.; Wondergem, J.

    2017-01-01

    The history of radiotherapy began in 1895, when Röntgen discovered X rays, and in the following year, radiation was used for medical treatment. In the early days, the development of radiotherapy was based extensively on empiricism. Radiotherapists worked closely with radiation biologists in attempting to describe and understand the phenomena produced by ionizing radiation in the clinic and in biological systems. During the ensuing 120 years, radiotherapy has been improved significantly and, in addition to radiation biology, medical physics has played an important role in the design and development of equipment, quality assurance and dosimetry. Over recent decades, advances have been made in the field of molecular biology. Currently available techniques enable us to elucidate the molecular mechanisms of cellular response to ionizing irradiation, and it is anticipated that the role and contributions of radiation biology in radiotherapy will remain relevant. This chapter describes the clinically important biological points, including knowledge from current molecular biology.

  3. Development of a computational system based in the code GEANT4 for dosimetric evaluation in radiotherapy

    International Nuclear Information System (INIS)

    Oliveira, Alex Cristovao Holanda de

    2016-01-01

    The incidence of cancer has grown in Brazil, as well as around the world, following the change in the age profile of the population. One of the most important techniques and commonly used in cancer treatment is radiotherapy. Around 60% of new cases of cancer use radiation in at least one phase of treatment. The most used equipment for radiotherapy is a linear accelerator (Linac) which produces electron or X-ray beams in energy range from 5 to 30 MeV. The most appropriate way to irradiate a patient is determined during treatment planning. Currently, treatment planning system (TPS) is the main and the most important tool in the process of planning for radiotherapy. The main objective of this work is to develop a computational system based on the MC code Geant4 for dose evaluations in photon beam radiotherapy. In addition to treatment planning, these dose evaluations can be performed for research and quality control of equipment and TPSs. The computer system, called Quimera, consists of a graphical user interface (qGUI) and three MC applications (qLinacs, qMATphantoms and qNCTphantoms). The qGUI has the function of interface for the MC applications, by creating or editing the input files, running simulations and analyzing the results. The qLinacs is used for modeling and generation of Linac beams (phase space). The qMATphantoms and qNCTphantoms are used for dose calculations in virtual models of physical phantoms and computed tomography (CT) images, respectively. From manufacturer's data, models of a Varian Linac photon beam and a Varian multileaf collimator (MLC) were simulated in the qLinacs. The Linac and MLC modelling were validated using experimental data. qMATphamtoms and qNCTphantoms were validated using IAEA phase spaces. In this first version, the Quimera can be used for research, radiotherapy planning of simple treatments and quality control in photon beam radiotherapy. The MC applications work independent of the qGUI and the qGUI can be used for

  4. Linear programming based on neural networks for radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Xingen Wu; Limin Luo

    2000-01-01

    In this paper, we propose a neural network model for linear programming that is designed to optimize radiotherapy treatment planning (RTP). This kind of neural network can be easily implemented by using a kind of 'neural' electronic system in order to obtain an optimization solution in real time. We first give an introduction to the RTP problem and construct a non-constraint objective function for the neural network model. We adopt a gradient algorithm to minimize the objective function and design the structure of the neural network for RTP. Compared to traditional linear programming methods, this neural network model can reduce the time needed for convergence, the size of problems (i.e., the number of variables to be searched) and the number of extra slack and surplus variables needed. We obtained a set of optimized beam weights that result in a better dose distribution as compared to that obtained using the simplex algorithm under the same initial condition. The example presented in this paper shows that this model is feasible in three-dimensional RTP. (author)

  5. Intensity-Modulated Radiotherapy Results in Significant Decrease in Clinical Toxicities Compared With Conventional Wedge-Based Breast Radiotherapy

    International Nuclear Information System (INIS)

    Harsolia, Asif; Kestin, Larry; Grills, Inga; Wallace, Michelle; Jolly, Shruti; Jones, Cortney; Lala, Moinaktar; Martinez, Alvaro; Schell, Scott; Vicini, Frank A.

    2007-01-01

    Purpose: We have previously demonstrated that intensity-modulated radiotherapy (IMRT) with a static multileaf collimator process results in a more homogenous dose distribution compared with conventional wedge-based whole breast irradiation (WBI). In the present analysis, we reviewed the acute and chronic toxicity of this IMRT approach compared with conventional wedge-based treatment. Methods and Materials: A total of 172 patients with Stage 0-IIB breast cancer were treated with lumpectomy followed by WBI. All patients underwent treatment planning computed tomography and received WBI (median dose, 45 Gy) followed by a boost to 61 Gy. Of the 172 patients, 93 (54%) were treated with IMRT, and the 79 patients (46%) treated with wedge-based RT in a consecutive fashion immediately before this cohort served as the control group. The median follow-up was 4.7 years. Results: A significant reduction in acute Grade 2 or worse dermatitis, edema, and hyperpigmentation was seen with IMRT compared with wedges. A trend was found toward reduced acute Grade 3 or greater dermatitis (6% vs. 1%, p = 0.09) in favor of IMRT. Chronic Grade 2 or worse breast edema was significantly reduced with IMRT compared with conventional wedges. No difference was found in cosmesis scores between the two groups. In patients with larger breasts (≥1,600 cm 3 , n = 64), IMRT resulted in reduced acute (Grade 2 or greater) breast edema (0% vs. 36%, p <0.001) and hyperpigmentation (3% vs. 41%, p 0.001) and chronic (Grade 2 or greater) long-term edema (3% vs. 30%, p 0.007). Conclusion: The use of IMRT in the treatment of the whole breast results in a significant decrease in acute dermatitis, edema, and hyperpigmentation and a reduction in the development of chronic breast edema compared with conventional wedge-based RT

  6. Consideration of safety of implant-based breast reconstruction with postreconstruction radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    Aomatsu, Naoki; Tei, Seika; Haraoka, Goichi

    2016-01-01

    There is controversy as to whether immediate autologous breast reconstruction followed by postoperative radiotherapy has acceptable complications and aesthetic outcomes. To evaluate the interval between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy and immediate expander-implant reconstruction, and to evaluate locoregional and distant control and cosmesis in these patients. Between 2011 and 2015, 9 patients with breast cancer were treated at our institution with definitive mastectomy and axillary lymph node dissection followed by immediate tissue expander placement and postreconstruction radiotherapy. We reviewed the complications of implant-based breast reconstruction followed by postreconstruction radiotherapy. The timing of irradiation was after implant insertion for 8 patients and after tissue expander insertion for 1 patient. The mean follow-up was 601 days. There were no unacceptable complications or local recurrences. For the majority of patients, overall symmetry, aesthetic results, and patient satisfaction were high. Breast reconstruction using tissue expansion and implants is an acceptable option for the subset of patients who may undergo postreconstruction radiotherapy. (author)

  7. An ill-conditioning conformal radiotherapy analysis based on singular values decomposition

    International Nuclear Information System (INIS)

    Lefkopoulos, D.; Grandjean, P.; Bendada, S.; Dominique, C.; Platoni, K.; Schlienger, M.

    1995-01-01

    Clinical experience in stereotactic radiotherapy of irregular complex lesions had shown that optimization algorithms were necessary to improve the dose distribution. We have developed a general optimization procedure which can be applied to different conformal irradiation techniques. In this presentation this procedure is tested on the stereotactic radiotherapy modality of complex cerebral lesions treated with multi-isocentric technique based on the 'associated targets methodology'. In this inverse procedure we use the singular value decomposition (SVD) analysis which proposes several optimal solutions for the narrow beams weights of each isocentre. The SVD analysis quantifies the ill-conditioning of the dosimetric calculation of the stereotactic irradiation, using the condition number which is the ratio of the bigger to smaller singular values. Our dose distribution optimization approach consists on the study of the irradiation parameters influence on the stereotactic radiotherapy inverse problem. The adjustment of the different irradiation parameters into the 'SVD optimizer' procedure is realized taking into account the ratio of the quality reconstruction to the time calculation. It will permit a more efficient use of the 'SVD optimizer' in clinical applications for real 3D lesions. The evaluation criteria for the choice of satisfactory solutions are based on the dose-volume histograms and clinical considerations. We will present the efficiency of ''SVD optimizer'' to analyze and predict the ill-conditioning in stereotactic radiotherapy and to recognize the topography of the different beams in order to create optimal reconstructed weighting vector. The planification of stereotactic treatments using the ''SVD optimizer'' is examined for mono-isocentrically and complex dual-isocentrically treated lesions. The application of the SVD optimization technique provides conformal dose distribution for complex intracranial lesions. It is a general optimization procedure

  8. Dosimetric effect of images of double field exposure and positioning in radiotherapy of breast treatment

    International Nuclear Information System (INIS)

    Bermudez Luna, R.; Rodriguez Rodriguez, C.; Martin Martin, G.; Lopez Fernandez, A.; Caballero Perea, B.; Ludena Martinez, B.; Prados Losa, R.

    2013-01-01

    The objectives of this study are to quantify the increased dose in white volume and the organ at risk in breast radiotherapy treatment, derived from portals of double-exposure images scheduled for treatment, evaluate dose reduction by passing images of single exposure and consider whether it would be wise to consider this doses in the planning process. (Author)

  9. Multileaf collimator in radiotherapy

    International Nuclear Information System (INIS)

    Jeraj, M.; Robar, V.

    2004-01-01

    Background. Basic goal of radiotherapy treatment is the irradiation of a target volume while minimizing the amount of radiation absorbed in healthy tissue. Shaping the beam is an important way of minimizing the absorbed dose in healthy tissue and critical structures. Conventional collimator jaws are used for shaping a rectangular treatment field; but, as usually treatment volume is not rectangular, additional shaping is required. On a linear accelerator, lead blocks or individually made Cerroben TM blocks are attached onto the treatment head under standard collimating system. Another option is the use of multileaf collimator (MLC). Conclusions. Multileaf collimator is becoming the main tool for beam shaping on the linear accelerator. It is a simple and useful system in the preparation and performance of radiotherapy treatment. Multileaf collimators are reliable, as their manufacturers developed various mechanisms for their precision, control and reliability, together with reduction of leakage and transmission of radiation between and through the leaves. Multileaf collimator is known today as a very useful clinical system for simple field shaping, but its use is getting even more important in dynamic radiotherapy, with the leaves moving during irradiation. This enables a precise dose delivery on any part of a treated volume. Intensity modulated radiotherapy (IMRT), the therapy of the future, is based on the dynamic use of MLC. (author)

  10. Out-of-field organ doses and associated radiogenic risks from para-aortic radiotherapy for testicular seminoma

    Energy Technology Data Exchange (ETDEWEB)

    Mazonakis, Michalis, E-mail: mazonak@med.uoc.gr; Berris, Theocharis; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P. O. Box 2208, 71003 Iraklion, Crete (Greece); Varveris, Charalambos; Lyraraki, Efrossyni [Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Crete (Greece)

    2014-05-15

    Purpose: The aims of this study were to (a) calculate the radiation dose to out-of-field organs from radiotherapy for stage I testicular seminoma and (b) estimate the associated radiogenic risks. Methods: Monte Carlo methodology was employed to model radiation therapy with typical anteroposterior and posteroanterior para-aortic fields on an anthropomorphic phantom simulating an average adult. The radiation dose received by all main and remaining organs that defined by the ICRP publication 103 and excluded from the treatment volume was calculated. The effect of field dimensions on each organ dose was determined. Additional therapy simulations were generated by introducing shielding blocks to protect the kidneys from primary radiation. The gonadal dose was employed to assess the risk of heritable effects for irradiated male patients of reproductive potential. The lifetime attributable risks (LAR) of radiotherapy-induced cancer were estimated using gender- and organ-specific risk coefficients for patient ages of 20, 30, 40, and 50 years old. The risk values were compared with the respective nominal risks. Results: Para-aortic irradiation to 20 Gy resulted in out-of-field organ doses of 5.0–538.6 mGy. Blocked field treatment led to a dose change up to 28%. The mean organ dose variation by increasing or decreasing the applied field dimensions was 18.7% ± 3.9% and 20.8% ± 4.5%, respectively. The out-of-field photon doses increased the lifetime intrinsic risk of developing thyroid, lung, bladder, prostate, and esophageal cancer by (0.1–1.4)%, (0.4–1.1)%, (2.5–5.4)%, (0.2–0.4)%, and (6.4–9.2)%, respectively, depending upon the patient age at exposure and the field size employed. A low risk for heritable effects of less than 0.029% was found compared with the natural incidence of these defects. Conclusions: Testicular cancer survivors are subjected to an increased risk for the induction of bladder and esophageal cancer following para-aortic radiotherapy. The

  11. Implementation of a risk assessment tool based on a probabilistic safety assessment developed for radiotherapy practices

    International Nuclear Information System (INIS)

    Paz, A.; Godinez, V.; Lopez, R.

    2010-10-01

    The present work describes the implementation process and main results of the risk assessment to the radiotherapy practices with Linear Accelerators (Linac), with cobalt 60, and with brachytherapy. These evaluations were made throughout the risk assessment tool for radiotherapy practices SEVRRA (risk evaluation system for radiotherapy), developed at the Mexican National Commission in Nuclear Safety and Safeguards derived from the outcome obtained with the Probabilistic Safety Analysis developed at the Ibero-American Regulators Forum for these radiotherapy facilities. The methodology used is supported by risk matrices method, a mathematical tool that estimates the risk to the patient, radiation workers and public from mechanical failures, mis calibration of the devices, human mistakes, and so. The initiating events are defined as those undesirable events that, together with other failures, can produce a delivery of an over-dose or an under-dose of the medical prescribed dose, to the planned target volume, or a significant dose to non prescribed human organs. Initiating events frequency and reducer of its frequency (actions intended to avoid the accident) are estimated as well as robustness of barriers to those actions, such as mechanical switches, which detect and prevent the accident from occurring. The spectrum of the consequences is parameterized, and the actions performed to reduce the consequences are identified. Based on this analysis, a software tool was developed in order to simplify the evaluations to radiotherapy installations and it has been applied as a first step forward to some Mexican installations, as part of a national implementation process, the final goal is evaluation of all Mexican facilities in the near future. The main target and benefits of the SEVRRA implementation are presented in this paper. (Author)

  12. Implementation of a risk assessment tool based on a probabilistic safety assessment developed for radiotherapy practices

    Energy Technology Data Exchange (ETDEWEB)

    Paz, A.; Godinez, V.; Lopez, R., E-mail: abpaz@cnsns.gob.m [Comision Nacional de Seguridad Nuclear y Salvaguardias, Dr. Barragan No. 779, Col. Narvarte, 03020 Mexico D. F. (Mexico)

    2010-10-15

    The present work describes the implementation process and main results of the risk assessment to the radiotherapy practices with Linear Accelerators (Linac), with cobalt 60, and with brachytherapy. These evaluations were made throughout the risk assessment tool for radiotherapy practices SEVRRA (risk evaluation system for radiotherapy), developed at the Mexican National Commission in Nuclear Safety and Safeguards derived from the outcome obtained with the Probabilistic Safety Analysis developed at the Ibero-American Regulators Forum for these radiotherapy facilities. The methodology used is supported by risk matrices method, a mathematical tool that estimates the risk to the patient, radiation workers and public from mechanical failures, mis calibration of the devices, human mistakes, and so. The initiating events are defined as those undesirable events that, together with other failures, can produce a delivery of an over-dose or an under-dose of the medical prescribed dose, to the planned target volume, or a significant dose to non prescribed human organs. Initiating events frequency and reducer of its frequency (actions intended to avoid the accident) are estimated as well as robustness of barriers to those actions, such as mechanical switches, which detect and prevent the accident from occurring. The spectrum of the consequences is parameterized, and the actions performed to reduce the consequences are identified. Based on this analysis, a software tool was developed in order to simplify the evaluations to radiotherapy installations and it has been applied as a first step forward to some Mexican installations, as part of a national implementation process, the final goal is evaluation of all Mexican facilities in the near future. The main target and benefits of the SEVRRA implementation are presented in this paper. (Author)

  13. Evaluation of the accuracy of the calculation of irregular photon fields in a radiotherapy planning system

    International Nuclear Information System (INIS)

    Bax, D.P.; Verlinde, P.H.; Storchi, P.; Woudstra, E.; Puurunen, H.

    1995-01-01

    In the Cadplan external beam planning system, irregular fields are calculated using the pencil beam convolution model. This model uses measured PDDs, profiles, and peak scatter factor data to extract pencil beam kernels. The scatter kernel is convolved with a matrix describing the field shape to calculate the PDD of the irregular field. The boundary kernel is used in the calculation of the off-axis ratios. The field matrix used in the convolution has a value of 1 in the open parts of the field a value of zero outside the field and equals the transmission in the blocked part. The evaluation of the model was done using two test cases. Both test cases are based on a 20x20 cm 2 field. In the first case, the central part of the field is blocked by an 8x8 cm 2 block. On one side this block is connected to the field edge by another block with a width of 3 cm. In the second case, two corners of the field are blocked by an 8x8.5 cm 2 block. There is a gap of 3 cm between the two blocks. The two cases were measured in a waterphantom for open and 45 deg. wedged beams of 4 different energies. 4, 6 and 23 MV were measured on conventional accelerators using customized blocks. 25 MV was measured on a scanned beam MM50 using a multileaf collimator. For all fields PDDs, and profiles were measured centrally and at 2 or more off-axis distances. All the measured doses are relative to the normalisation dose of a 20x20 cm 2 open field at d max . The PDDs and profiles measured for the two test cases were compared to results of the calculation of the pencil beam convolution model. The profiles were compared at four depths: d max , 5, 10, and 20 cm. The difference found between measurement and calculation was within acceptable limits, making it possible to use the model in routine clinical planning

  14. Preirradiation evaluation and technical assessment of involved-field radiotherapy using computed tomographic (CT) simulation and neoadjuvant chemotherapy for intracranial germinoma

    International Nuclear Information System (INIS)

    Kitamura, Kei; Shirato, Hiroki; Sawamura, Yutaka; Suzuki, Keishiro; Ikeda, Jun; Miyasaka, Kazuo

    1999-01-01

    Purpose: To investigate the importance of preirradiation mental and endocrinological evaluation, and the effectiveness of involved-field radiotherapy following neoadjuvant chemotherapy. Methods and Materials: Following etoposide and cisplatin with or without ifosfamide, 13 patients with nondisseminated disease received involved-field irradiation of 24 Gy in 12 fractions within 3 weeks and 2 patients with disseminated germinoma received 24 Gy craniospinal irradiation (CSI). CT simulation was used to cover the tumor bed. Results: Full-scale intelligence quotient (IQ) tests given at the time of the initial radiotherapy showed less than 90 in 7 of 11 patients who had tumors involving the neurohypophyseal region, but the 4 patients who had solitary pineal tumors showed higher scores. Panhypopituitarism was observed in 9 patients with tumors involving the neurohypophyseal region. All patients are alive without disease, with a median follow-up period of 40 months. No in-field relapse was noted after the involved-field radiotherapy. One patient experienced a recurrence outside of the planning target volume. Conclusion: Decline of neurocognitive and endocrine functions were often seen in patients with tumors involving the hypophyseal region, but not in patients with solitary pineal germinoma before radiotherapy. Involved-field radiotherapy using 24 Gy is effective with the help of CT simulation and neoadjuvant chemotherapy

  15. Low-Dose Involved-Field Radiotherapy as Alternative Treatment of Nodular Lymphocyte Predominance Hodgkin's Lymphoma

    International Nuclear Information System (INIS)

    Haas, Rick L.M.; Girinsky, Theo; Aleman, Berthe; Henry-Amar, Michel; Boer, Jan-Paul de; Jong, Daphne de

    2009-01-01

    Purpose: Nodular lymphocyte predominance Hodgkin's lymphoma is a very rare disease, characterized by an indolent clinical course, with sometimes very late relapses occurring in a minority of all patients. Considerable discussion is ongoing on the treatment of primary and relapsed disease. Patients and Methods: A group of 9 patients were irradiated to a dose of 4 Gy on involved areas only. Results: After a median follow-up of 37 months (range, 6-66), the overall response rate was 89%. Six patients had complete remission (67%), two had partial remission (22%), and one had stable disease (11%). Of 8 patients, 5 developed local relapse 9-57 months after radiotherapy. No toxicity was noted. Conclusion: In nodular lymphocyte predominance Hodgkin's lymphoma, low-dose radiotherapy provided excellent response rates and lasting remissions without significant toxicity.

  16. Localized field conformation radiotherapy combined with endocrine therapy for the treatment of prostate cancer

    International Nuclear Information System (INIS)

    Karasawa, Katsuyuki; Kaizu, Toshihide; Kurosaki, Hiromasa; Tanaka, Yoshiaki

    1999-01-01

    To improve the quality of life (QOL) of the patients with prostate cancer, we limit the radiotherapy target volume to the prostate and seminal vesicles while using endocrine therapy towards the disease outside the target volume. Radiotherapy technique was rotation conformation technique with computer-controlled multileaf collimators to the total doses of up to 66-70 Gy. Among 145 evaluable cases with the median age of 74, overall and cause-specific 5-year survival rates were 59.3% and 84.1%, respectively, and the relative survival rate of the Stage A-C cases was 100%. The two thirds (33/50) of the deaths were not of prostate cancer. The rate of severe complication was 1.4%. As for QOL, the rate of impotence was 90%, however, the patients' overall satisfaction towards the treatment was 90%. From this analysis, this combined treatment seems beneficial in the treatment of prostate cancer. (author)

  17. Photoneutron intensity variation with field size around radiotherapy linear accelerator 18-MeV X-ray beam

    Energy Technology Data Exchange (ETDEWEB)

    Al-Ghamdi, H.; Fazal-ur-Rehman [Physics Department, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia); Al-Jarallah, M.I. [Physics Department, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia)], E-mail: mibrahim@kfupm.edu.sa; Maalej, N. [Physics Department, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia)

    2008-08-15

    In X-ray radiotherapy accelerators, neutrons are produced mainly by ({gamma},n) reaction when high energy X-rays interact with high Z materials of the linear accelerator head. These materials include the lead (Pb) used as shielding in the collimator, tungsten (W) target used for the production of X-rays and iron (Fe) in the accelerator head. These unwanted neutrons contaminate the therapeutic beam and contribute to the patient dose during the treatment of a cancer patient. Knowing the neutron distribution around the radiotherapy accelerator is therefore desired. CR-39 nuclear track detectors (NTDs) were used to study the variation of fast and thermal neutron relative intensities around an 18 MeV linear accelerator X-ray beam with the field sizes of 0, 10x10, 20x20, 30x30 and 40x40cm{sup 2}. For fast neutron detection, bare NTDs were used. For thermal neutron detection, NTDs were covered with lithium tetra borate (Li{sub 2}B{sub 4}O{sub 7}) converters. The NTDs were placed at different locations in the direction perpendicular to the treatment couch (transversal) and in the direction parallel to the treatment couch (longitudinal) with respect to the isocenter of the accelerator. The fast neutron relative intensity is symmetrical about the beam axis and exhibits an exponential-like drop with distance from the isocenter of the accelerator for all the field sizes. At the primary beam (isocenter), the relative fast neutron intensity is highest for 40x40cm{sup 2} field size and decreases linearly with the decrease in the field size. However, fast neutron intensities do not change significantly with beam size for the measurements outside the primary beam. The fast neutron intensity in the longitudinal direction outside the primary beam decreases linearly with the field size. The thermal neutron intensity, at any location, was found to be almost independent of the field size.

  18. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement.

    Science.gov (United States)

    Dröge, L H; Hinsche, T; Canis, M; Alt-Epping, B; Hess, C F; Wolff, H A

    2014-02-01

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting.

  19. Auxiliary collimating device for obtaining irradiation fields of any shape for high energy radiotherapy apparatus

    International Nuclear Information System (INIS)

    Piret, P.; Fraikin, H.; Hubert, A.

    1976-01-01

    An auxiliary collimator is added to the main collimator of a radiotherapy apparatus and comprises a master-container filled with mercury and a localizing container containing a block of nonabsorbent material having a predetermined shape; means being provided for automatically positioning these containers with respect to the main collimator and for allowing the mercury to enter the localizing container when once it has taken its working position

  20. Quality control of involved field radiotherapy in the HD 13 and HD 14 trials. Report of the radiotherapy panel of the German Hodgkin Study Group (GHSG)

    Energy Technology Data Exchange (ETDEWEB)

    Kriz, J.; Haverkamp, U.; Eich, H.T. [University of Muenster, Department of Radiation Oncology, Muenster (Germany); Baues, C. [University of Cologne, Department of Radiation Oncology, Cologne (Germany); Engenhart-Cabillic, R. [University of Marburg, Department of Radiation Oncology, Marburg (Germany); Herfarth, K. [University of Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Lukas, P. [University of Innsbruck, Department of Radiation Oncology, Innsbruck (Austria); Pluetschow, A.; Fuchs, M.; Engert, A. [University of Cologne, Department of Internal Medicine, Cologne (Germany); Schmidberger, H. [University of Mainz, Department of Radiation Oncology, Mainz (Germany); Staar, S. [Bremen Mitte, Department of Radiation Oncology, Bremen (Germany)

    2017-02-15

    As part of the foundation of the German Hodgkin Study Group (GHSG) in 1978, a central radiotherapy (RT) reference centre was established to evaluate and to improve the quality of treatment. During the study generations, the quality assurance programs (QAP) were continued and adapted to the demands of each study. The purpose of this article is to demonstrate the results of the fifth study generation and to compare them to the previous findings. With the start of the fourth GHSG study generation (HD10-12), a central prospective review of all diagnostic images was established to create an individual treatment plan for each early stage study patient. The quality of involved field RT was retrospectively evaluated by an expert panel of radiation oncologists. In the fifth study generation (HD13-15), the retrospective review of radiotherapy performed was refined and the results were compared with the findings of the fourth generation. The expert panel analyzed the RT planning and application of 1037 (28 %) patients (HD13 n = 465, HD14 n = 572). Simulation films were available in 85 % of cases and verification films in 87 %. RT was assessed as major violation in 46 % (HD13 = 38 %, HD14 = 52 %), minor violation in 9 % (HD13 = 9 %, HD14 = 9 %) and according to the protocol in 45 % (HD13 = 52 %, HD14 = 38 %). The value for QAP of RT within the GHSG trials is well known. Still there were several protocol violations. In the future, the QAP program has to be adapted to the requirements of ''modern RT'' in malignant lymphoma. (orig.) [German] Seit Gruendung der German Hodgkin Study Group (GHSG) im Jahr 1978 wurde ein zentrales Qualitaetssicherungsprogramm (QAP) der Radiotherapie (RT) etabliert, um die Qualitaet der RT sicherzustellen. Waehrend der fortlaufenden Studiengenerationen wurde dieses QAP kontinuierlich weiterentwickelt. In dieser Auswertung werden die Ergebnisse der fuenften Studiengeneration (HD13-15) praesentiert und mit frueheren Ergebnissen

  1. Dose optimization in radiotherapy patients for IMRT based on 4D-CBCT

    International Nuclear Information System (INIS)

    Alfonso, R.; Castillo, D.; Ascensión, Y.; Linares, H.; García, F.; Argota, R.

    2015-01-01

    The use of tomographic systems based on conical photon beams kVp (kV-CBCT) to verify the accuracy of the positioning of patients in external radiotherapy treatments has expanded in recent years, with increasing availability of linear accelerators systems for image guided radiation therapy (IGRT) based kV-CBCT systems, incorporated into the gantry of the equipment. Several studies have evaluated the collateral doses received by patients using these positioning systems for radiotherapy (RT). Recently, the firm Elekta has developed a solution to manage the effects of respiratory movements and reduce internal margins that affect the planning target volume (Symmetry TM ), which is based on the acquisition of dynamic tomographic studies (4D- CBCT), making it possible to estimate the average white temporal position in each treatment, without using methods triggered or ‘tracking’. These 4D studies however require a greater number of images per gantry angle, potentially involves a higher dose administered to patients, besides the actual dose treatment beam. The present study investigated a methodology to assess dose rates 4DCBCT (4D-CBDI) using dosimetric instrumentation and phantoms as those typically available in radiotherapy departments. The doses received by different techniques are compared using as criteria of merit image quality and overall geometric accuracy achieved in positioning and internal margins. The results show that it is possible to reduce the administered to patients in studies of CBCT static and dynamic, without significantly affecting the objectives of the same in terms of geometric accuracy dose. [es

  2. Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials

    Science.gov (United States)

    Bekelman, Justin E.; Deye, James A.; Vikram, Bhadrasain; Bentzen, Soren M.; Bruner, Deborah; Curran, Walter J.; Dignam, James; Efstathiou, Jason A.; FitzGerald, T. J.; Hurkmans, Coen; Ibbott, Geoffrey S.; Lee, J. Jack; Merchant, Timothy E.; Michalski, Jeff; Palta, Jatinder R.; Simon, Richard; Ten Haken, Randal K.; Timmerman, Robert; Tunis, Sean; Coleman, C. Norman; Purdy, James

    2012-01-01

    Background In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute (NCI) sponsored a two day workshop to examine the challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. Lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities like proton beam therapy, and the international harmonization of clinical trial QA. Results Four recommendations were made: 1) Develop a tiered (and more efficient) system for radiotherapy QA and tailor intensity of QA to clinical trial objectives. Tiers include (i) general credentialing, (ii) trial specific credentialing, and (iii) individual case review; 2) Establish a case QA repository; 3) Develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and 4) Explore the feasibility of consolidating clinical trial QA in the United States. Conclusion Radiotherapy QA may impact clinical trial accrual, cost, outcomes and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based. PMID:22425219

  3. Quality of life outcomes after primary radiotherapy for squamous cell carcinoma of the base of tongue

    International Nuclear Information System (INIS)

    Moore, Giselle J.; Parsons, James T.; Mendenhall, William M.

    1996-01-01

    Purpose: To determine quality of life functional outcome after primary radiotherapy for carcinoma of the base of tongue. Methods and Materials: At the University of Florida, essentially all patients with squamous cell carcinoma of the base of tongue are treated with primary continuous-course, external-beam radiotherapy alone or followed by a neck dissection. Fifty-three patients who remained continuously free of disease at 2 to 23 years were eligible to participate in an assessment of the posttreatment quality of their lives. Three patients could not be located for quality of life assessment, and one patient refused to participate, leaving 49 evaluable patients. Radiotherapy doses were 60 to 75 Gy in once daily fractions, or 74 to 79 Gy in twice daily fractions. The subjective Performance Status Scale for Head and Neck Cancer, which assigns a functional score ranging from 0 to 100, was completed by each of the patients during routine follow-up appointments. The scale measures ability to eat in public, understandability of speech, and normalcy of diet. Results: Patients treated with external-beam radiotherapy alone had excellent results with regard to eating in public, though scores showed a decline as T stage increased (average scores were T1: 90.6%; T2: 88.1%; T3: 82.8%; T4: 75.0%). Results for understandability of speech were T1: 93.75%; T2: 100%; T3: 82.8%; and T4: 87.5%. Fixation of the tongue at diagnosis was not a predictor of poor function. Normalcy of diet scores likewise decreased with increasing T stage: T1: 93.8%; T2: 89.5%; T3: 71.3%; T4: 60.0%. The addition of a neck dissection had no impact on the functional outcomes that were evaluated. Functional results did not deteriorate with prolonged follow-up of more than 5 years. Results were compared with those from the literature for patients treated by surgery plus postoperative radiotherapy or external-beam irradiation plus interstitial 192 Ir implant. The functional results of high-dose external

  4. CNR considerations for rapid real-time MRI tumor tracking in radiotherapy hybrid devices: Effects of B{sub 0} field strength

    Energy Technology Data Exchange (ETDEWEB)

    Wachowicz, K., E-mail: keith.wachowicz@albertahealthservices.ca; De Zanche, N.; Yip, E. [Division of Medical Physics, Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Volotovskyy, V. [Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Fallone, B. G. [Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada and Departments of Oncology and Physics, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada)

    2016-08-15

    Purpose: This work examines the subject of contrast-to-noise ratio (CNR), specifically between tumor and tissue background, and its dependence on the MRI field strength, B{sub 0}. This examination is motivated by the recent interest and developments in MRI/radiotherapy hybrids where real-time imaging can be used to guide treatment beams. The ability to distinguish a tumor from background tissue is of primary importance in this field, and this work seeks to elucidate the complex relationship between the CNR and B{sub 0} that is too often assumed to be purely linear. Methods: Experimentally based models of B{sub 0}-dependant relaxation for various tumor and normal tissues from the literature were used in conjunction with signal equations for MR sequences suitable for rapid real-time imaging to develop field-dependent predictions for CNR. These CNR models were developed for liver, lung, breast, glioma, and kidney tumors for spoiled gradient-echo, balanced steady-state free precession (bSSFP), and single-shot half-Fourier fast spin echo sequences. Results: Due to the pattern in which the relaxation properties of tissues are found to vary over B{sub 0} field (specifically the T{sub 1} time), there was always an improved CNR at lower fields compared to linear dependency. Further, in some tumor sites, the CNR at lower fields was found to be comparable to, or sometimes higher than those at higher fields (i.e., bSSFP CNR for glioma, kidney, and liver tumors). Conclusions: In terms of CNR, lower B{sub 0} fields have been shown to perform as well or better than higher fields for some tumor sites due to superior T{sub 1} contrast. In other sites this effect was less pronounced, reversing the CNR advantage. This complex relationship between CNR and B{sub 0} reveals both low and high magnetic fields as viable options for tumor tracking in MRI/radiotherapy hybrids.

  5. National arrangements for radiotherapy

    International Nuclear Information System (INIS)

    2007-01-01

    After a presentation of several letters exchanged between the French health ministry and public agencies in charge of public health or nuclear safety after a radiotherapy accident in Epinal, this report comments the evolution of needs in cancerology care and the place given to radiotherapy. It outlines the technological and organisational evolution of radiotherapy and presents the distribution of radiotherapy equipment, of radio-therapists and other radiotherapy professionals in France. Within the context of radiotherapy accidents which occurred in 2007, it presents the regulatory arrangements which aimed at improving the safety, short term and middle term arrangements which are needed to support and structure radiotherapy practice quality. It stresses the fact that the system will deeply evolve by implementing a radiotherapy vigilance arrangement and a permanent follow-on and adaptation plan based on surveys and the creation of a national committee

  6. Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma. When should they be considered and which questions remain open

    Energy Technology Data Exchange (ETDEWEB)

    Lohr, Frank; Koeck, Julia; Abo-Madyan, Yasser [University of Heidelberg, Department of Radiation Oncology, University Medical Center Mannheim, Mannheim (Germany); Georg, Dietmar; Knaeusl, Barbara; Dieckmann, Karin [Medical University Vienna/AKH Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna (Austria); Medical University Vienna/AKH Vienna, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Comprehensive Cancer Center, Vienna (Austria); Cozzi, Luca [Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Eich, Hans Theodor [University Hospital, Department of Radiotherapy, Muenster (Germany); Weber, Damien C. [Paul Scherrer Institute, University of Bern, Center for Proton Therapy, Bern (Switzerland); Fiandra, Christian; Ricardi, Umberto [University of Torino, Radiation Oncology Unit, Department of Oncology, Turin (Italy); Mueller, Rolf-Peter [University of Cologne, Department of Radiation Oncology, Cologne (Germany); Engert, Andreas [University of Cologne, Department of Medical Oncology, Cologne (Germany)

    2014-10-15

    Hodgkin lymphoma (HL) is a highly curable disease. Reducing late complications and second malignancies has become increasingly important. Radiotherapy target paradigms are currently changing and radiotherapy techniques are evolving rapidly. This overview reports to what extent target volume reduction in involved-node (IN) and advanced radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy-compared with involved-field (IF) and 3D radiotherapy (3D-RT)- can reduce high doses to organs at risk (OAR) and examines the issues that still remain open. Although no comparison of all available techniques on identical patient datasets exists, clear patterns emerge. Advanced dose-calculation algorithms (e.g., convolution-superposition/Monte Carlo) should be used in mediastinal HL. INRT consistently reduces treated volumes when compared with IFRT with the exact amount depending on the INRT definition. The number of patients that might significantly benefit from highly conformal techniques such as IMRT over 3D-RT regarding high-dose exposure to organs at risk (OAR) is smaller with INRT. The impact of larger volumes treated with low doses in advanced techniques is unclear. The type of IMRT used (static/rotational) is of minor importance. All advanced photon techniques result in similar potential benefits and disadvantages, therefore only the degree-of-modulation should be chosen based on individual treatment goals. Treatment in deep inspiration breath hold is being evaluated. Protons theoretically provide both excellent high-dose conformality and reduced integral dose. Further reduction of treated volumes most effectively reduces OAR dose, most likely without disadvantages if the excellent control rates achieved currently are maintained. For both IFRT and INRT, the benefits of advanced radiotherapy techniques depend on the individual patient/target geometry. Their use should therefore be decided case by case with comparative treatment planning

  7. Bone Health and Pelvic Radiotherapy.

    Science.gov (United States)

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. MRI-based treatment plan simulation and adaptation for ion radiotherapy using a classification-based approach

    International Nuclear Information System (INIS)

    Rank, Christopher M; Tremmel, Christoph; Hünemohr, Nora; Nagel, Armin M; Jäkel, Oliver; Greilich, Steffen

    2013-01-01

    In order to benefit from the highly conformal irradiation of tumors in ion radiotherapy, sophisticated treatment planning and simulation are required. The purpose of this study was to investigate the potential of MRI for ion radiotherapy treatment plan simulation and adaptation using a classification-based approach. Firstly, a voxelwise tissue classification was applied to derive pseudo CT numbers from MR images using up to 8 contrasts. Appropriate MR sequences and parameters were evaluated in cross-validation studies of three phantoms. Secondly, ion radiotherapy treatment plans were optimized using both MRI-based pseudo CT and reference CT and recalculated on reference CT. Finally, a target shift was simulated and a treatment plan adapted to the shift was optimized on a pseudo CT and compared to reference CT optimizations without plan adaptation. The derivation of pseudo CT values led to mean absolute errors in the range of 81 - 95 HU. Most significant deviations appeared at borders between air and different tissue classes and originated from partial volume effects. Simulations of ion radiotherapy treatment plans using pseudo CT for optimization revealed only small underdosages in distal regions of a target volume with deviations of the mean dose of PTV between 1.4 - 3.1% compared to reference CT optimizations. A plan adapted to the target volume shift and optimized on the pseudo CT exhibited a comparable target dose coverage as a non-adapted plan optimized on a reference CT. We were able to show that a MRI-based derivation of pseudo CT values using a purely statistical classification approach is feasible although no physical relationship exists. Large errors appeared at compact bone classes and came from an imperfect distinction of bones and other tissue types in MRI. In simulations of treatment plans, it was demonstrated that these deviations are comparable to uncertainties of a target volume shift of 2 mm in two directions indicating that especially

  9. Image registration assessment in radiotherapy image guidance based on control chart monitoring.

    Science.gov (United States)

    Xia, Wenyao; Breen, Stephen L

    2018-04-01

    Image guidance with cone beam computed tomography in radiotherapy can guarantee the precision and accuracy of patient positioning prior to treatment delivery. During the image guidance process, operators need to take great effort to evaluate the image guidance quality before correcting a patient's position. This work proposes an image registration assessment method based on control chart monitoring to reduce the effort taken by the operator. According to the control chart plotted by daily registration scores of each patient, the proposed method can quickly detect both alignment errors and image quality inconsistency. Therefore, the proposed method can provide a clear guideline for the operators to identify unacceptable image quality and unacceptable image registration with minimal effort. Experimental results demonstrate that by using control charts from a clinical database of 10 patients undergoing prostate radiotherapy, the proposed method can quickly identify out-of-control signals and find special cause of out-of-control registration events.

  10. A reference dosimetric system for dose interval of radiotherapy based on alanine/RPE

    International Nuclear Information System (INIS)

    Rodrigues Junior, Orlando; Galante, Ocimar L.; Campos, Leticia L.

    2001-01-01

    This work describes the development of a reference dosimetric system based on alanine/EPR for radiotherapy dose levels. Currently the IPEN is concluding a similar system for the dose range used for irradiation of products, 10-10 5 Gy. The objective of this work is to present the efforts towards to improve the measure accuracy for doses in the range between 1-10 Gy. This system could be used as reference by radiotherapy services, as much in the quality control of the equipment, as for routine accompaniment of more complex handling where the total doses can reach some grays. The system uses alanine as detector and electronic paramagnetic resonance - EPR as measure technique. To reach accuracy better than 5% mathematical studies on the best optimization of the EPR spectrometer parameters and methods for the handling of the EPR sign are discussed. (author)

  11. Comparison of radiotherapy dosimetry for 3D-CRT, IMRT, and SBRT based on electron density calibration

    International Nuclear Information System (INIS)

    Kartutik, K; Pawiro, S A; Wibowo, W E

    2016-01-01

    Accurate calculation of dose distribution affected by inhomogeneity tissue is required in radiotherapy planning. This study was performed to determine the ratio between radiotherapy planning using 3D-CRT, IMRT, and SBRT based on a calibrated curve of CT-number in the lung for different target's shape in 3D-CRT, IMRT, and spinal cord for SBRT. Calibration curves of CT-number were generated under measurement basis and introduced into TPS, then planning was performed for 3D-CRT, IMRT, and SBRT with 7, and 15 radiation fields. Afterwards, planning evaluation was performed by comparing the DVH curve, HI, and CI. 3D-CRT and IMRT produced the lowest HI at calibration curve of CIRS 002LFC with the value 0.24 and 10. Whereas SBRT produced the lowest HI on a linear calibration curve with a value of 0.361. The highest CI in IMRT and SBRT technique achieved using a linear calibration curve was 0.97 and 1.77 respectively. For 3D-CRT, the highest CI was obtained by using calibration curve of CIRS 062M with the value of 0.45. From the results of CI and HI, it is concluded that the calibration curve of CT-number does not significantly differ with Schneider's calibrated curve, and inverse planning gives a better result than forward planning. (paper)

  12. The practical application of scintillation dosimetry in small-field photon-beam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Elisa; Poppinga, Daniela; Schoenfeld, Andreas A.; Poppe, Bjoern; Looe, Hui Khee [Oldenburg Univ. (Germany). Univ. Clinic for Medical Radiation Physics; Harder, Dietrich [Goettingen Univ. (Germany). Medical Physics and Biophysics

    2017-07-01

    Plastic scintillation detectors are a new instrument of stereotactic photon-beam dosimetry. The clinical application of the plastic scintillation detector Exradin W1 at the Siemens Artiste and Elekta Synergy accelerators is a matter of current interest. In order to reduce the measurement uncertainty, precautions have to be taken with regard to the geometrical arrangement of the scintillator, the light-guide fiber and the photodiode in the radiation field. To determine the ''Cerenkov light ratio'' CLR with a type A uncertainty below 1%, the Cerenkov calibration procedure for small-field measurements based on the two-channel spectral method was used. Output factors were correctly measured with the W1 for field sizes down to 0.5 x 0.5 cm{sup 2} with a type A uncertainty of 1.8%. Measurements of small field dose profiles and percentage depth dose curves were carried out with the W1 using automated water phantom profile scans, and a type A uncertainty for dose maxima of 1.4% was achieved. The agreement with a synthetic diamond detector (microDiamond, PTW Freiburg) and a plane parallel ionization chamber (Roos chamber, PTW Freiburg) in relative dose measurements was excellent. In oversight of all results, the suitability of the plastic scintillation detector Exradin W1 for clinical dosimetry under stereotactic conditions, in particular the tried and tested procedures for CLR determination, output factor measurement and automated dose profile scans in water phantoms, have been confirmed.

  13. Comparison of onboard low-field magnetic resonance imaging versus onboard computed tomography for anatomy visualization in radiotherapy.

    Science.gov (United States)

    Noel, Camille E; Parikh, Parag J; Spencer, Christopher R; Green, Olga L; Hu, Yanle; Mutic, Sasa; Olsen, Jeffrey R

    2015-01-01

    Onboard magnetic resonance imaging (OB-MRI) for daily localization and adaptive radiotherapy has been under development by several groups. However, no clinical studies have evaluated whether OB-MRI improves visualization of the target and organs at risk (OARs) compared to standard onboard computed tomography (OB-CT). This study compared visualization of patient anatomy on images acquired on the MRI-(60)Co ViewRay system to those acquired with OB-CT. Fourteen patients enrolled on a protocol approved by the Institutional Review Board (IRB) and undergoing image-guided radiotherapy for cancer in the thorax (n = 2), pelvis (n = 6), abdomen (n = 3) or head and neck (n = 3) were imaged with OB-MRI and OB-CT. For each of the 14 patients, the OB-MRI and OB-CT datasets were displayed side-by-side and independently reviewed by three radiation oncologists. Each physician was asked to evaluate which dataset offered better visualization of the target and OARs. A quantitative contouring study was performed on two abdominal patients to assess if OB-MRI could offer improved inter-observer segmentation agreement for adaptive planning. In total 221 OARs and 10 targets were compared for visualization on OB-MRI and OB-CT by each of the three physicians. The majority of physicians (two or more) evaluated visualization on MRI as better for 71% of structures, worse for 10% of structures, and equivalent for 14% of structures. 5% of structures were not visible on either. Physicians agreed unanimously for 74% and in majority for > 99% of structures. Targets were better visualized on MRI in 4/10 cases, and never on OB-CT. Low-field MR provides better anatomic visualization of many radiotherapy targets and most OARs as compared to OB-CT. Further studies with OB-MRI should be pursued.

  14. Intensity modulation in breast radiotherapy: Development of an innovative field-in-field technique at Institut Gustave-Roussy

    International Nuclear Information System (INIS)

    Heymann, S.; Bourhis, J.; Bourgier, C.; Verstraet, R.; Pichenot, C.; Vergne, E.; Lefkopoulos, D.; Husson, F.; Kafrouni, H.; Mahe, J.; Kandalaft, B.; Marsiglia, H.

    2011-01-01

    Purpose. - To assess the potential dosimetric gain of pre-segmentation modulated radiotherapy (OAPS, DosiSoft TM ) of breast, compared to routine 3D conformal radiotherapy. Patients and methods. - Twenty patients treated with conservative surgery for breast cancer (9 right and 11 left sided) with various breast volume (median 537 cm 3 ; range [100-1049 cm 3 ]) have been selected. For each patient, we have delineated a breast volume and a compensation volume (target volumes), as well as organs at risk (lungs and heart). Two treatment plans have been generated: one using the routine 3D conformal technique and the other with the pre-segmentation algorithm of DosiSoft TM (OAPS). The dose distribution were analyzed using the conformity index for target volumes, mean dose and V 30 Gy for the heart, and mean dose, V 20 Gy and V 30 Gy for lungs. Results. - Over the 20 patients, the conformity index increased from 0.897 with routine technique to 0.978 with OAPS (P TM ) is an original method of segmentation of breast. It is automatic, fast and easy, and is able to increase the conformity index, while sparing organ at risk. (authors)

  15. Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks.

    Science.gov (United States)

    Murray, L; Sethugavalar, B; Robertshaw, H; Bayman, E; Thomas, E; Gilson, D; Prestwich, R J D

    2015-07-01

    Recent radiotherapy guidelines for lymphoma have included involved site radiotherapy (ISRT), involved node radiotherapy (INRT) and irradiation of residual volume after full-course chemotherapy. In the absence of late toxicity data, we aim to compare organ at risk (OAR) dose-metrics and calculated second malignancy risks. Fifteen consecutive patients who had received mediastinal radiotherapy were included. Four radiotherapy plans were generated for each patient using a parallel pair photon technique: (i) involved field radiotherapy (IFRT), (ii) ISRT, (iii) INRT, (iv) residual post-chemotherapy volume. The radiotherapy dose was 30 Gy in 15 fractions. The OARs evaluated were: breasts, lungs, thyroid, heart, oesophagus. Relative and absolute second malignancy rates were estimated using the concept of organ equivalent dose. Significance was defined as P risks of second cancers were significantly higher with IFRT compared with ISRT for lung, breast and thyroid; INRT and residual volume resulted in significantly lower relative risks compared with ISRT for lung, breast and thyroid. The median excess absolute risks of second cancers were consistently lowest for the residual technique and highest for IFRT in terms of thyroid, lung and breast cancers. The risk of oesophageal cancer was similar for all four techniques. Overall, the absolute risk of second cancers was very similar for ISRT and INRT. Decreasing treatment volumes from IFRT to ISRT, INRT or residual volume reduces radiation exposure to OARs. Second malignancy modelling suggests that this reduction in treatment volumes will lead to a reduction in absolute excess second malignancy. Little difference was observed in second malignancy risks between ISRT and INRT, supporting the use of ISRT in the absence of a pre-chemotherapy positron emission tomography scan in the radiotherapy treatment position. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  16. Remote Cherenkov imaging-based quality assurance of a magnetic resonance image-guided radiotherapy system.

    Science.gov (United States)

    Andreozzi, Jacqueline M; Mooney, Karen E; Brůža, Petr; Curcuru, Austen; Gladstone, David J; Pogue, Brian W; Green, Olga

    2018-06-01

    Tools to perform regular quality assurance of magnetic resonance image-guided radiotherapy (MRIgRT) systems should ideally be independent of interference from the magnetic fields. Remotely acquired optical Cherenkov imaging-based dosimetry measurements in water were investigated for this purpose, comparing measures of dose accuracy, temporal dynamics, and overall integrated IMRT delivery. A 40 × 30.5 × 37.5 cm 3 water tank doped with 1 g/L of quinine sulfate was imaged using an intensified charge-coupled device (ICCD) to capture the Cherenkov emission while being irradiated by a commercial MRIgRT system (ViewRay™). The ICCD was placed down-bore at the end of the couch, 4 m from treatment isocenter and behind the 5-Gauss line of the 0.35-T MRI. After establishing optimal camera acquisition settings, square beams of increasing size (4.2 × 4.2 cm 2 , 10.5 × 10.5 cm 2 , and 14.7 × 14.7 cm 2 ) were imaged at 0.93 frames per second, from an individual cobalt-60 treatment head, to develop projection measures related to percent depth dose (PDD) curves and cross beam profiles (CPB). These Cherenkov-derived measurements were compared to ionization chamber (IC) and radiographic film dosimetry data, as well as simulation data from the treatment planning system (TPS). An intensity-modulated radiotherapy (IMRT) commissioning plan from AAPM TG-119 (C4:C-Shape) was also imaged at 2.1 frames per second, and the single linear sum image from 509 s of plan delivery was compared to the dose volume prediction generated by the TPS using gamma index analysis. Analysis of standardized test target images (1024 × 1024 pixels) yielded a pixel resolution of 0.37 mm/pixel. The beam width measured from the Cherenkov image-generated projection CBPs was within 1 mm accuracy when compared to film measurements for all beams. The 502 point measurements (i.e., pixels) of the Cherenkov image-based projection percent depth dose curves (pPDDs) were compared to p

  17. The comparison of 5-field conformal radiotherapy techniques for the treatment of prostate cancer: The best for femoral head sparing

    International Nuclear Information System (INIS)

    Zare, Mahkameh; Lashkari, Marzieh; Ghalehtaki, Reza; Ghasemi, Arash; Dehghan Manshadi, Hamidreza; Mir, Ali; Noorollahi, Somayeh; Alamolhoda, Mahboobeh

    2016-01-01

    External radiotherapy is a standard treatment procedure for localized prostate cancer. Given the relatively high long term survival treatment complications have been brought in center of attention. In this planning study, between 2012 and 2014, CT simulation data of 90 consecutive high-risk prostate cancer patients were collected. In the first phase, all were planned for whole pelvis irradiation up to 46Gy in 23 daily fractions. In the second phase, only the prostate gland was the target of radiation. Next, the subjects were divided randomly into three groups and each received a unique 5field conformal radiation plan including Plan A (Gantry angle: 0, 60, 120, 240, and 300), Plan B (Gantry angles: 0, 90, 120, 240, and 270) and Plan C (Gantry angles: 0, 60, 90, 270, and 300). The total dose was 70Gy. For each patient, the rectum, bladder, and both femoral heads were contoured as the at risk organs (OAR). From dose volume histograms, the proportional dose of PTV V100, the bladder and rectum V80 and V90 and femoral head V50 and V100 were calculated in all subjects and compared across plans. A statistically significant difference in the femoral head V50 and V100 was found between our studied 5field plans so that in Plan A (beam angles: 0, 60, 120, 240 and 300) less dose was received by both heads of femur. This study suggests that 5 field treatment planning including an anterior, two anterior oblique and two posterior oblique portals to be more proper for 3D conformal radiotherapy in order to spare femoral head with acceptable PTV coverage, and bladder and rectal doses.

  18. Theoretical and experimental study about dose distribution in irregular fields used in radiotherapy

    International Nuclear Information System (INIS)

    Feld de Lindenboim, D.B.; Lopez de Gomez, C.M.

    1979-02-01

    Considering the broad use of irregular fields in treatments with teletherapy machines, it is necessary to have simple calculation methods. The purpose of this work is to verify, through measures made with a water phantom, the reliability of a particular calculation method based on measures made in airand the use of the Tables of scatter-air ratio. Based on the values obtained, we may conclude that the method is acceptable for points distant from the lead blocks. Simultaneously, it was proved that secondary radiation in points under lead protections is so important that it becomes of small effectiveness to increase the lead block thickness in order to diminish the total dose in those points. (author) [es

  19. Concurrent chemoradiotherapy for advanced pancreatic cancer. 1,000 mg/m{sup 2} gemcitabine can be administered using limited-field radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Hideya [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Radiation Oncology; National Hospital Organization, Osaka National Hospital, Osaka (Japan). Dept. of Radiology; Nishiyama, Kinji; Koizumi, Masahiko; Tanaka, Eiichi [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Radiation Oncology; Ioka, Tatsuya; Uehara, Hiroyuki; Iishi, Hiroyasu; Nakaizumi, Akihiko [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Internal Medicine; Ohigashi, Hiroaki; Ishikawa, Osamu [Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (Japan). Dept. of Surgery

    2007-06-15

    Purpose: To examine the feasibility of concurrent use of full-dose gemcitabine (GEM) and radiotherapy for advanced pancreatic cancer. Patient and Methods: 22 patients with advanced pancreatic cancer were subjected to concurrent chemoradiotherapy (GEM 1,000 mg/m2 weekly, three times during 4 weeks). They received limited-field irradiation by three-dimensional radiotherapy planning. Results: Of the 22 patients, 16 (72%) completed the treatment (50 Gy irradiation and at least three times concurrent administration of 1 g/m{sup 2} GEM). One patient with unresectable tail cancer showed peritonitis carcinomatosa and both chemotherapy and radiotherapy had to be stopped. Dose reduction or omission of GEM was necessary in another four patients. In addition, radiotherapy was discontinued in one patient for fatigue. Grade 3 hematologic toxicity was detected in eight patients (36%), and grade 3 nonhematologic toxicity (anorexia) in one patient (5%). In total, the response rate amounted to 32% (seven partial responses), and the median survival time (MST) was 16 months. Among the twelve patients who received preoperative chemoradiotherapy, nine underwent surgery and showed a survival rate of 78% at 1 year. Another 13 patients without surgery showed 14 months of MST. No regional lymph node failure has appeared so far. Conclusion: Limited-field radiotherapy enables the safe concurrent administration of 1,000 mg/m{sup 2} GEM.

  20. Status and advances of p53-gene therapy and radiotherapy in malignant tumor

    International Nuclear Information System (INIS)

    Duan Xin; Chinese Academy of Sciences, Beijing; Zhang Hong

    2006-01-01

    Cancer treatment is one of the most important fields in medical research. All strategies such as radio-therapy, chemotherapy, surgery, and gene-based therapy have their own advantages and disadvantages. Nowadays, a novel method which combined p53-gene therapy with radiotherapy plays an important role in the field of cancer research. This review summarized the current state of combined therapies of p53-gene therapy and radiotherapy, possible mechanism and recent progress. (authors)

  1. On the use of EPID-based implanted marker tracking for 4D radiotherapy

    International Nuclear Information System (INIS)

    Keall, P.J.; Todor, A.D.; Vedam, S.S.; Bartee, C.L.; Siebers, J.V.; Kini, V.R.; Mohan, R.

    2004-01-01

    Four-dimensional (4D) radiotherapy delivery to dynamically moving tumors requires a real-time signal of the tumor position as a function of time so that the radiation beam can continuously track the tumor during the respiration cycle. The aim of this study was to develop and evaluate an electronic portal imaging device (EPID)-based marker-tracking system that can be used for real-time tumor targeting, or 4D radiotherapy. Three gold cylinders, 3 mm in length and 1 mm in diameter, were implanted in a dynamic lung phantom. The phantom range of motion was 4 cm with a 3-s 'breathing' period. EPID image acquisition parameters were modified, allowing image acquisition in 0.1 s. Images of the stationary and moving phantom were acquired. Software was developed to segment automatically the marker positions from the EPID images. Images acquired in 0.1 s displayed higher noise and a lower signal-noise ratio than those obtained using regular (>1 s) acquisition settings. However, the markers were still clearly visible on the 0.1-s images. The motion of the phantom blurred the images of the markers and further reduced the signal-noise ratio, though they could still be successfully segmented from the images in 10-30 ms of computation time. The positions of gold markers placed in the lung phantom were detected successfully, even for phantom velocities substantially higher than those observed for typical lung tumors. This study shows that using EPID-based marker tracking for 4D radiotherapy is feasible, however, changes in linear accelerator technology and EPID-based image acquisition as well as patient studies are required before this method can be implemented clinically

  2. 30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes

    International Nuclear Information System (INIS)

    Spencer, Katie; Morris, Eva; Dugdale, Emma; Newsham, Alexander; Sebag-Montefiore, David; Turner, Rob; Hall, Geoff; Crellin, Adrian

    2015-01-01

    Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems

  3. Dosimetric comparison between intensity-modulated with coplanar field and 3D conformal radiotherapy with noncoplanar field for postocular invasion tumor.

    Science.gov (United States)

    Wenyong, Tu; Lu, Liu; Jun, Zeng; Weidong, Yin; Yun, Li

    2010-01-01

    This study presents a dosimetric optimization effort aiming to compare noncoplanar field (NCF) on 3 dimensions conformal radiotherapy (3D-CRT) and coplanar field (CF) on intensity-modulated radiotherapy (IMRT) planning for postocular invasion tumor. We performed a planning study on the computed tomography data of 8 consecutive patients with localized postocular invasion tumor. Four fields NCF 3D-CRT in the transverse plane with gantry angles of 0-10 degrees , 30-45 degrees , 240-270 degrees , and 310-335 degrees degrees were isocentered at the center of gravity of the target volume. The geometry of the beams was determined by beam's eye view. The same constraints were prepared with between CF IMRT optimization and NCF 3D-CRT treatment. The maximum point doses (D max) for the different optic pathway structures (OPS) with NCF 3D-CRT treatment should differ in no more than 3% from those with the NCF IMRT plan. Dose-volume histograms (DVHs) were obtained for all targets and organ at risk (OAR) with both treatment techniques. Plans with NCF 3D-CRT and CF IMRT constraints on target dose in homogeneity were computed, as well as the conformity index (CI) and homogeneity index (HI) in the target volume. The PTV coverage was optimal with both NCF 3D-CRT and CF IMRT plans in the 8 tumor sites. No difference was noted between the two techniques for the average D(max) and D(min) dose. NCF 3D-CRT and CF IMRT will yield similar results on CI. However, HI was a significant difference between NCF 3D-CRT and CF IMRT plan (p 3D-CRT versus CF IMRT set-up is very slight. NCF3D-CRT is one of the treatment options for postocular invasion tumor. However, constraints for OARs are needed. 2010 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  4. Rectal cancer: The radiation basis of radiotherapy, target volume; Cancers du rectum: volumes cible de la radiotherapie, bases rationnelles

    Energy Technology Data Exchange (ETDEWEB)

    Bosset, J.F.; Servagi-Vernat, S. [Service oncologie-radiotherapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besancon (France); Crehange, G. [Service oncologie-radiotherapie, centre Georges-Francois-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex (France); Azria, D. [Service oncologie-radiotherapie, centre Val-d' Aurelle, rue Croix-Verte, 34298 Montpellier cedex 5 (France); Gerard, J.P. [Service oncologie-radiotherapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice (France); Hennequin, C. [Service oncologie-radiotherapie, hopital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris (France)

    2011-10-15

    Since the implementation of preoperative chemo-radiotherapy and meso-rectal excision, the 5-year rates of locoregional failures in T3-T4 N0-N1M0 rectal cancer fell from 25-30% thirty years ago to 5-8% nowadays. A critical analysis of the locoregional failures sites and mechanisms, as well as the identification of nodal extension, helps the radiation oncologist to optimize the radiotherapy target definition. The upper limit of the clinical target volume is usually set at the top of the third sacral vertebra. The lateral pelvic nodes should be included when the tumor is located in the distal part of the rectum. The anal sphincter and the levator muscles should be spared when a conservative surgery is planned. In case of abdomino-perineal excision, the ischio-rectal fossa and the sphincters should be included in the clinical target volume. A confrontation with radiologist and surgeon is mandatory to improve the definition of the target volumes to be treated. (authors)

  5. Stereotactic body radiotherapy for lung cancer: how much does it really cost?

    Science.gov (United States)

    Lievens, Yolande; Obyn, Caroline; Mertens, Anne-Sophie; Van Halewyck, Dries; Hulstaert, Frank

    2015-03-01

    Despite the lack of randomized evidence, stereotactic body radiotherapy (SBRT) is being accepted as superior to conventional radiotherapy for patients with T1-2N0 non-small-cell lung cancer in the periphery of the lung and unfit or unwilling to undergo surgery. To introduce SBRT in a system of coverage with evidence development, a correct financing had to be determined. A time-driven activity-based costing model for radiotherapy was developed. Resource cost calculation of all radiotherapy treatments, standard and innovative, was conducted in 10 Belgian radiotherapy centers in the second half of 2012. The average cost of lung SBRT across the 10 centers (6221&OV0556;) is in the range of the average costs of standard fractionated 3D-conformal radiotherapy (5919&OV0556;) and intensity-modulated radiotherapy (7379&OV0556;) for lung cancer. Hypofractionated 3D-conformal radiotherapy and intensity-modulated radiotherapy schemes are less costly (3993&OV0556; respectively 4730&OV0556;). The SBRT cost increases with the number of fractions and is highly dependent of personnel and equipment use. SBRT cost varies more by centre than conventional radiotherapy cost, reflecting different technologies, stages in the learning curve and a lack of clear guidance in this field. Time-driven activity-based costing of radiotherapy is feasible in a multicentre setup, resulting in real-life resource costs that can form the basis for correct reimbursement schemes, supporting an early yet controlled introduction of innovative radiotherapy techniques in clinical practice.

  6. Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Gondi, Vinai; Tolakanahalli, Ranjini; Mehta, Minesh P.; Tewatia, Dinesh; Rowley, Howard; Kuo, John S.; Khuntia, Deepak; Tome, Wolfgang A.

    2010-01-01

    Purpose: Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. Methods and Materials: Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy (IMRT) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. Results: On average, the hippocampal avoidance volume was 3.3 cm 3 , occupying 2.1% of the whole-brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy 2 using helical tomotherapy and by 81% to 0.73 Gy 2 using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-off with helical tomotherapy. Conclusion: Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.

  7. A FAST MORPHING-BASED INTERPOLATION FOR MEDICAL IMAGES: APPLICATION TO CONFORMAL RADIOTHERAPY

    Directory of Open Access Journals (Sweden)

    Hussein Atoui

    2011-05-01

    Full Text Available A method is presented for fast interpolation between medical images. The method is intended for both slice and projective interpolation. It allows offline interpolation between neighboring slices in tomographic data. Spatial correspondence between adjacent images is established using a block matching algorithm. Interpolation of image intensities is then carried out by morphing between the images. The morphing-based method is compared to standard linear interpolation, block-matching-based interpolation and registrationbased interpolation in 3D tomographic data sets. Results show that the proposed method scored similar performance in comparison to registration-based interpolation, and significantly outperforms both linear and block-matching-based interpolation. This method is applied in the context of conformal radiotherapy for online projective interpolation between Digitally Reconstructed Radiographs (DRRs.

  8. Spiritual Well-Being for Increasing Life Expectancy in Palliative Radiotherapy Patients: A Questionnaire-Based Study.

    Science.gov (United States)

    Hematti, Simin; Baradaran-Ghahfarokhi, Milad; Khajooei-Fard, Rasha; Mohammadi-Bertiani, Zohreh

    2015-10-01

    Spiritual well-being in patients with an advanced cancer has been found to positively correlate with subjective well-being, lower pain levels, hope and positive mood states, high self-esteem, social competence, purpose in life, and overall quality of life. In this regard, Quran recitation is stated to be an efficient way to increase patient spirituality and also to handle life's everyday challenges. The aim of this study was to investigate the effects of listening, reading, and watching the text of the Holy Quran, called (in this study) Quran recitation, for increasing life expectancy (LE) in palliative radiotherapy patients admitted to Radiotherapy Department of Seyed alshohada Hospital, Isfahan, Iran. A questionnaire-based study was carried out on a total of 89 palliative radiotherapy patients between March 2012 and June 2012. Informed consent was obtained. The patients were requested to complete a standardized questionnaire which was designed based on the European Organization for Research and Treatment of Cancer C30 Scale Quality of Life Questionnaire (EORTC C30 Scale QLQ). A computer program (SPSS version 16.0, Chicago, IL, USA) was used, and data were analyzed by the Wilcoxon test and Spearman's rank correlation. All hypotheses were tested using a criterion level of P = 0.05. There was a significant difference for frequency and duration of Quran recitation among patients, before and after the diagnosis of their cancer (P = 0.03). Using the Spearman's rank correlation, it was found that there was a correlation between Quran recitation and subjective well-being (r = 0.352, P Quran recitation and increasing LE (r = 0.311, P Quran are useful for increasing LE in palliative radiotherapy patients admitted to Radiotherapy Department. In other words, a benefit of Quran recitation on outcome of radiotherapy for palliative radiotherapy patients was found.

  9. Pulmonary radio-responses to surface field radiotherapy of Morbus Hodgkin using a 4 MeV linear accelerator

    International Nuclear Information System (INIS)

    Krueger, H.U.

    1982-01-01

    In 119 patients suffering from Morbus Hodgkin who were treated between 1974 and 1979, the pulmonary radioresponse was retroperspectively investigated. Besides incidence and degree of severity also the course over the time of the individual stages of radio-response where investigated. 14 patients showed no paramediastinal irradiation fibrosis as lasting stationary change, 52 showed a light one, 34 a medium-sized and 19 a severe one. Each fibrosis had been preceded by the radiomorphologic sign of pneumonitis of always the same degree of severity. The course over the time of the radiomorphologically subdivided stages determined that on the average the signs of a beginning pneumonitis occurred 11.6 weeks after onset of radiotherapy. An active pneumonitis was detectable after 14.8 weeks (on the average) and 20.4 weeks after radiotherapy had been started, a still florid pneumonitis with beginning shrinkage of the paramediastinal regions was found. The stage of stationary pulmonary fibrosis was reached 34.1 weeks (averaged value) after surface field irradiation had been started. Correlative relations to different individual diseasedependent and radiotherapeutic factors were detected, which are considered to be responsible for the intensity and character of the floride radio-response and the remaining pulmonary fibrosis. Considered from the radiomorphologic course of pulmonary irradiation reaction and its intensity and character, no significant advantage of tumor-reducing chemotherapy compared to irradiation or of split-course-technique compared to continuous fractioning was found. The introduction of individually adjustable shields helped to reduce the degree of severity of radio-response. (orig./MG) [de

  10. Extension of radiotherapy (involved field vs subtotal nodal) after short-term chemotherapy in early-stage Hodgkin's disease (ESHD)

    International Nuclear Information System (INIS)

    Zanini, M.; Bonfante, V.; Soncini, F.; Di Russo, A.; Santoro, A.; Viviani, S.; Devizzi, L.; Gasparini, M.; Tesoro, Tess J.D.; Valagussa, P.; Bonadonna, G.

    1995-01-01

    Aims of this study were to avoid staging laparotomy, to improve the results of radiotherapy (RT) alone by a combined modality approach, to evaluate the optimal extent of RT after short-term chemotherapy (CT) and to reduce the long-term toxicity in patients cured for ESHD. From (2(90)) to (1(95)), 110 consecutive patients with clinical stage I (bulky and/or B), IIA, IIA bulky and IIEA entered a randomized trial comparing subtotal nodal irradiation (STNI) vs involved field radiotherapy (IFRT), both after short-term chemotherapy (ABVD for 4 cycles). The doses of RT were 30 Gy to uninvolved and 36 Gy to involved sites, respectively. With a median follow-up of 38 mos., the main results in 96 evaluable patients (stage I: 13 pts., stage II: 83 pts., median age 28 yrs., range 17-64) are as reported below. Most patients achieved complete remission (CR) after CT (92%), while 8 partial responders attained CR with RT (IFRT 5 pts., STNI 3 pts.). Four stage II patients relapsed (IFRT 2, pts., STNI 2 pts.), mainly in extranodal or not irradiated sites. Up-to-date the most remarkable toxicities include: acute myocardial infarction (1%), aspecific EKG changes (5%), reductions in pulmonary function tests (most mild and/or transient) in 45%, subclinical or clinical hypothyroidism 26% (only in pts. irradiated to the neck), 3 cases of azoospermia in 23 evaluable patients (13%) and transient amenorreha in(1(44)) patients. No second malignancies have been so far observed. The results of this study seem to indicate that 4 courses of ABVD plus RT are an effective treatment in clinical ESHD, with moderate long-term toxicities. In almost 10% of patients RT changed partial into complete remission. Should these results be confirmed on a longer follow-up, IFRT will definitely replace STNI in a combined modality treatment

  11. A new transmission methodology for quality assurance in radiotherapy based on radiochromic film measurements

    Science.gov (United States)

    do Amaral, Leonardo L.; Pavoni, Juliana F.; Sampaio, Francisco; Netto, Thomaz Ghilardi

    2015-01-01

    Despite individual quality assurance (QA) being recommended for complex techniques in radiotherapy (RT) treatment, the possibility of errors in dose delivery during therapeutic application has been verified. Therefore, it is fundamentally important to conduct in vivo QA during treatment. This work presents an in vivo transmission quality control methodology, using radiochromic film (RCF) coupled to the linear accelerator (linac) accessory holder. This QA methodology compares the dose distribution measured by the film in the linac accessory holder with the dose distribution expected by the treatment planning software. The calculated dose distribution is obtained in the coronal and central plane of a phantom with the same dimensions of the acrylic support used for positioning the film but in a source‐to‐detector distance (SDD) of 100 cm, as a result of transferring the IMRT plan in question with all the fields positioned with the gantry vertically, that is, perpendicular to the phantom. To validate this procedure, first of all a Monte Carlo simulation using PENELOPE code was done to evaluate the differences between the dose distributions measured by the film in a SDD of 56.8 cm and 100 cm. After that, several simple dose distribution tests were evaluated using the proposed methodology, and finally a study using IMRT treatments was done. In the Monte Carlo simulation, the mean percentage of points approved in the gamma function comparing the dose distribution acquired in the two SDDs were 99.92%±0.14%. In the simple dose distribution tests, the mean percentage of points approved in the gamma function were 99.85%±0.26% and the mean percentage differences in the normalization point doses were −1.41%. The transmission methodology was approved in 24 of 25 IMRT test irradiations. Based on these results, it can be concluded that the proposed methodology using RCFs can be applied for in vivo QA in RT treatments. PACS number: 87.55.Qr, 87.55.km, 87.55.N‐ PMID

  12. Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

    Science.gov (United States)

    Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

    2015-05-01

    Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system.

  13. Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

    International Nuclear Information System (INIS)

    Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

    2015-01-01

    Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system. (paper)

  14. Radiotherapy for chordomas and low-grade chondrosarcomas of the skull base with carbon ions

    International Nuclear Information System (INIS)

    Schulz-Ertner, Daniela; Haberer, Thomas; Jaekel, Oliver; Thilmann, Christoph; Kraemer, Michael; Enghardt, Wolfgang; Kraft, Gerhard; Wannenmacher, Michael; Debus, Juergen

    2002-01-01

    Purpose: Compared to photon irradiation, carbon ions provide physical and biologic advantages that may be exploited in chordomas and chondrosarcomas. Methods and Materials: Between August 1998 and December 2000, 37 patients with chordomas (n=24) and chondrosarcomas (n=13) were treated with carbon ion radiotherapy within a Phase I/II trial. Tumor conformal application of carbon ion beams was realized by intensity-controlled raster scanning with pulse-to-pulse energy variation. Three-dimensional treatment planning included biologic plan optimization. The median tumor dose was 60 GyE (GyE Gy x relative biologic effectiveness). Results: The mean follow-up was 13 months. The local control rate after 1 and 2 years was 96% and 90%, respectively. We observed 2 recurrences outside the gross tumor volume in patients with chordomas. Progression-free survival was 100% for chondrosarcomas and 83% for chordomas at 2 years. Partial remission after carbon ion radiotherapy was observed in 6 patients. Treatment toxicity was mild. Conclusion: These are the first data demonstrating the clinical feasibility, safety, and effectiveness of scanning beam delivery of ion beams in patients with skull base tumors. The preliminary results in patients with skull base chordomas and low-grade chondrosarcomas are encouraging, although the follow-up was too short to draw definite conclusions concerning outcome. In the absence of major toxicity, dose escalation might be considered

  15. Improved normal tissue sparing in head and neck radiotherapy using biological cost function based-IMRT.

    Science.gov (United States)

    Anderson, N; Lawford, C; Khoo, V; Rolfo, M; Joon, D L; Wada, M

    2011-12-01

    Intensity-modulated radiotherapy (IMRT) has reduced the impact of acute and late toxicities associated with head and neck radiotherapy. Treatment planning system (TPS) advances in biological cost function based optimization (BBO) and improved segmentation techniques have increased organ at risk (OAR) sparing compared to conventional dose-based optimization (DBO). A planning study was undertaken to compare OAR avoidance in DBO and BBO treatment planning. Simultaneous integrated boost treatment plans were produced for 10 head and neck patients using both planning systems. Plans were compared for tar get coverage and OAR avoidance. Comparisons were made using the BBO TPS Monte Carlo dose engine to eliminate differences due to inherent algorithms. Target coverage (V95%) was maintained for both solutions. BBO produced lower OAR doses, with statistically significant improvement to left (12.3%, p = 0.005) and right parotid mean dose (16.9%, p = 0.004), larynx V50_Gy (71.0%, p = 0.005), spinal cord (21.9%, p < 0.001) and brain stem dose maximums (31.5%, p = 0.002). This study observed improved OAR avoidance with BBO planning. Further investigations will be undertaken to review any clinical benefit of this improved planned dosimetry.

  16. ‘Inverted Y’ field radiotherapy planning with multi-leaf collimator: A single isocentric technique using multiple fields

    Directory of Open Access Journals (Sweden)

    Puja Sahai

    2015-01-01

    Full Text Available The purpose of our study is to describe a planning technique using multi-leaf collimator and asymmetric fields for irradiating an ‘inverted Y’ shaped geometry in a patient with testicular seminoma. The entire target area covering the para-aortic, pelvic, and inguinal nodal regions was split into three fields. Single isocenter half-beam block technique was employed. The fields were planned with antero-posterior and postero-anterior portals with a differential weightage. The dose was prescribed at the respective reference points of the fields. A uniform dose distribution for the entire portal was achieved without any under- or over-dosing at the field junctions.  

  17. Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials—Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance

    International Nuclear Information System (INIS)

    Bekelman, Justin E.; Deye, James A.; Vikram, Bhadrasain; Bentzen, Soren M.; Bruner, Deborah; Curran, Walter J.; Dignam, James; Efstathiou, Jason A.; FitzGerald, T.J.; Hurkmans, Coen; Ibbott, Geoffrey S.; Lee, J. Jack; Merchant, Thomas E.; Michalski, Jeff; Palta, Jatinder R.; Simon, Richard; Ten Haken, Randal K.; Timmerman, Robert; Tunis, Sean; Coleman, C. Norman

    2012-01-01

    Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.

  18. Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials-Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance

    Energy Technology Data Exchange (ETDEWEB)

    Bekelman, Justin E., E-mail: bekelman@uphs.upenn.edu [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Deye, James A.; Vikram, Bhadrasain [National Cancer Institute, Bethesda, Maryland (United States); Bentzen, Soren M. [University of Wisconsin, Madison, Wisconsin (United States); Bruner, Deborah [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Curran, Walter J. [Emory University, Atlanta, Georgia (United States); Dignam, James [University of Chicago, Chicago, Illinois (United States); Efstathiou, Jason A. [Massachusetts General Hospital, Boston, Massachusetts (United States); FitzGerald, T.J. [University of Massachusetts, Boston, Massachusetts (United States); Hurkmans, Coen [European Organization for Research and Treatment of Cancer, Brussels (Belgium); Ibbott, Geoffrey S.; Lee, J. Jack [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Merchant, Thomas E. [St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Michalski, Jeff [University of Washington, St. Louis, Missouri (United States); Palta, Jatinder R. [University of Florida, Miami, Florida (United States); Simon, Richard [National Institutes of Health, Bethesda, Maryland (United States); Ten Haken, Randal K. [University of Michigan, Ann Arbor, Michigan (United States); Timmerman, Robert [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Tunis, Sean [Center for Medical Technology Policy, Baltimore, Maryland (United States); Coleman, C. Norman [National Cancer Institute, Bethesda, Maryland (United States); and others

    2012-07-01

    Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.

  19. Elective nodal irradiation (ENI) vs. involved field radiotherapy (IFRT) for locally advanced non-small cell lung cancer (NSCLC): A comparative analysis of toxicities and clinical outcomes

    International Nuclear Information System (INIS)

    Fernandes, Annemarie T.; Shen, Jason; Finlay, Jarod; Mitra, Nandita; Evans, Tracey; Stevenson, James; Langer, Corey; Lin, Lilie; Hahn, Stephen; Glatstein, Eli; Rengan, Ramesh

    2010-01-01

    Background: Elective nodal irradiation (ENI) and involved field radiotherapy (IFRT) are definitive radiotherapeutic approaches used to treat patients with locally advanced non-small cell lung cancer (NSCLC). ENI delivers prophylactic radiation to clinically uninvolved lymph nodes, while IFRT only targets identifiable gross nodal disease. Because clinically uninvolved nodal stations may harbor microscopic disease, IFRT raises concerns for increased nodal failures. This retrospective cohort analysis evaluates failure rates and treatment-related toxicities in patients treated at a single institution with ENI and IFRT. Methods: We assessed all patients with stage III locally advanced or stage IV oligometastatic NSCLC treated with definitive radiotherapy from 2003 to 2008. Each physician consistently treated with either ENI or IFRT, based on their treatment philosophy. Results: Of the 108 consecutive patients assessed (60 ENI vs. 48 IFRT), 10 patients had stage IV disease and 95 patients received chemotherapy. The median follow-up time for survivors was 18.9 months. On multivariable logistic regression analysis, patients treated with IFRT demonstrated a significantly lower risk of high grade esophagitis (Odds ratio: 0.31, p = 0.036). The differences in 2-year local control (39.2% vs. 59.6%), elective nodal control (84.3% vs. 84.3%), distant control (47.7% vs. 52.7%) and overall survival (40.1% vs. 43.7%) rates were not statistically significant between ENI vs. IFRT. Conclusions: Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients.

  20. Elective nodal irradiation (ENI) vs. involved field radiotherapy (IFRT) for locally advanced non-small cell lung cancer (NSCLC): A comparative analysis of toxicities and clinical outcomes.

    Science.gov (United States)

    Fernandes, Annemarie T; Shen, Jason; Finlay, Jarod; Mitra, Nandita; Evans, Tracey; Stevenson, James; Langer, Corey; Lin, Lilie; Hahn, Stephen; Glatstein, Eli; Rengan, Ramesh

    2010-05-01

    Elective nodal irradiation (ENI) and involved field radiotherapy (IFRT) are definitive radiotherapeutic approaches used to treat patients with locally advanced non-small cell lung cancer (NSCLC). ENI delivers prophylactic radiation to clinically uninvolved lymph nodes, while IFRT only targets identifiable gross nodal disease. Because clinically uninvolved nodal stations may harbor microscopic disease, IFRT raises concerns for increased nodal failures. This retrospective cohort analysis evaluates failure rates and treatment-related toxicities in patients treated at a single institution with ENI and IFRT. We assessed all patients with stage III locally advanced or stage IV oligometastatic NSCLC treated with definitive radiotherapy from 2003 to 2008. Each physician consistently treated with either ENI or IFRT, based on their treatment philosophy. Of the 108 consecutive patients assessed (60 ENI vs. 48 IFRT), 10 patients had stage IV disease and 95 patients received chemotherapy. The median follow-up time for survivors was 18.9 months. On multivariable logistic regression analysis, patients treated with IFRT demonstrated a significantly lower risk of high grade esophagitis (Odds ratio: 0.31, p = 0.036). The differences in 2-year local control (39.2% vs. 59.6%), elective nodal control (84.3% vs. 84.3%), distant control (47.7% vs. 52.7%) and overall survival (40.1% vs. 43.7%) rates were not statistically significant between ENI vs. IFRT. Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  1. Using a Monte Carlo model to predict dosimetric properties of small radiotherapy photon fields

    International Nuclear Information System (INIS)

    Scott, Alison J. D.; Nahum, Alan E.; Fenwick, John D.

    2008-01-01

    Accurate characterization of small-field dosimetry requires measurements to be made with precisely aligned specialized detectors and is thus time consuming and error prone. This work explores measurement differences between detectors by using a Monte Carlo model matched to large-field data to predict properties of smaller fields. Measurements made with a variety of detectors have been compared with calculated results to assess their validity and explore reasons for differences. Unshielded diodes are expected to produce some of the most useful data, as their small sensitive cross sections give good resolution whilst their energy dependence is shown to vary little with depth in a 15 MV linac beam. Their response is shown to be constant with field size over the range 1-10 cm, with a correction of 3% needed for a field size of 0.5 cm. BEAMnrc has been used to create a 15 MV beam model, matched to dosimetric data for square fields larger than 3 cm, and producing small-field profiles and percentage depth doses (PDDs) that agree well with unshielded diode data for field sizes down to 0.5 cm. For fields sizes of 1.5 cm and above, little detector-to-detector variation exists in measured output factors, however for a 0.5 cm field a relative spread of 18% is seen between output factors measured with different detectors--values measured with the diamond and pinpoint detectors lying below that of the unshielded diode, with the shielded diode value being higher. Relative to the corrected unshielded diode measurement, the Monte Carlo modeled output factor is 4.5% low, a discrepancy that is probably due to the focal spot fluence profile and source occlusion modeling. The large-field Monte Carlo model can, therefore, currently be used to predict small-field profiles and PDDs measured with an unshielded diode. However, determination of output factors for the smallest fields requires a more detailed model of focal spot fluence and source occlusion.

  2. Constitution of a centralised data base for the internal quality control in radiotherapy; Constitution d'une base de donnees centralisee pour le controle de qualite interne en radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Fau, P.; Rodrigues, C.; Ruchaud, R.; Bravetti, J. [Centre Prive de Radiotherapie de Metz, 57 - Metz (France)

    2009-10-15

    The objective of this project was to implement a centralised data base of internal quality control in radiotherapy according to the criteria of the decree of A.f.s.s.a.p.s. (French agency of sanitary safety of health products on 27 july 2007, about the internal quality control of external radiotherapy facilities. The software on one year meets the objectives: compliance by comparison with A.f.s.s.a.p.s. criteria but particularly optimization of the centralisation and analysis of the internal quality controls. (N.C.)

  3. Optimum radiotherapy schedule for uterine cervical cancer based-on the detailed information of dose fractionation and radiotherapy technique

    International Nuclear Information System (INIS)

    Cho, Jae Ho; Kim, Hyun Chang; Suh, Chang Ok

    2005-01-01

    The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of 23.4 ∼ 59.4 Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-ICBT) was also performed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of 14.4∼ 43.2 Gy (Median 36.0) of EBRT in 495 patients, while in the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder and rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor (α / β = 10) and late-responding tissues (α /β = 3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED Gy 3 and the risk of complication was assessed using serial multiple logistic regressions models. The associations between R-BED Gy 3 and rectal complications

  4. Challenges in Linear Accelerator Radiotherapy for Chordomas and Chondrosarcomas of the Skull Base: Focus on Complications

    Energy Technology Data Exchange (ETDEWEB)

    Hauptman, Jason S., E-mail: jhauptman@mednet.ucla.edu [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Barkhoudarian, Garni; Safaee, Michael; Gorgulho, Alessandra [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Tenn, Steven; Agazaryan, Nzhde; Selch, Michael [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); De Salles, Antonio A.F. [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States)

    2012-06-01

    Purpose: Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that infiltrate the skull base. Currently, consensus therapy includes surgical resection and adjuvant radiotherapy. Radiation delivery is typically limited by the proximity of these tumors to critical skull base structures. Methods: This is a retrospective review of 13 cases of chordomas and 2 cases of chondroid chondrosarcomas of the skull based treated with linear accelerator stereotactic radiotherapy (SRT, n = 10) or stereotactic radiosurgery (SRS, n = 5). The average time to the most recent follow-up visit was 4.5 years. The tumor characteristics, treatment details, and outcomes were recorded. Each radiation plan was reviewed, and the dosage received by the brainstem, optic apparatus, and pituitary was calculated. Results: Of the 10 patients treated with SRT, 6 were found to have unchanged or decreased tumor size as determined from radiographic follow-up. Of the 5 patients treated with SRS, 3 were found to have stable or unchanged tumors at follow-up. The complications included 1 SRT patient who developed endocrinopathy, 2 patients (1 treated with SRS and the other with SRT), who developed cranial neuropathy, and 1 SRS patient who developed visual deficits. Additionally, 1 patient who received both SRS and SRT within 2 years for recurrence experienced transient medial temporal lobe radiation changes that resolved. Conclusions: Where proton beam therapy is unavailable, linear accelerator-based SRT or radiosurgery remains a safe option for adjuvant therapy of chordomas and chondrosarcomas of the skull base. The exposure of the optic apparatus, pituitary stalk, and brainstem must be considered during planning to minimize complications. If the optic apparatus is included in the 80% isodose line, it might be best to fractionate therapy. Exposure of the pituitary stalk should be kept to <30 Gy to minimize endocrine dysfunction. Brainstem exposure should be

  5. Challenges in Linear Accelerator Radiotherapy for Chordomas and Chondrosarcomas of the Skull Base: Focus on Complications

    International Nuclear Information System (INIS)

    Hauptman, Jason S.; Barkhoudarian, Garni; Safaee, Michael; Gorgulho, Alessandra; Tenn, Steven; Agazaryan, Nzhde; Selch, Michael; De Salles, Antonio A.F.

    2012-01-01

    Purpose: Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that infiltrate the skull base. Currently, consensus therapy includes surgical resection and adjuvant radiotherapy. Radiation delivery is typically limited by the proximity of these tumors to critical skull base structures. Methods: This is a retrospective review of 13 cases of chordomas and 2 cases of chondroid chondrosarcomas of the skull based treated with linear accelerator stereotactic radiotherapy (SRT, n = 10) or stereotactic radiosurgery (SRS, n = 5). The average time to the most recent follow-up visit was 4.5 years. The tumor characteristics, treatment details, and outcomes were recorded. Each radiation plan was reviewed, and the dosage received by the brainstem, optic apparatus, and pituitary was calculated. Results: Of the 10 patients treated with SRT, 6 were found to have unchanged or decreased tumor size as determined from radiographic follow-up. Of the 5 patients treated with SRS, 3 were found to have stable or unchanged tumors at follow-up. The complications included 1 SRT patient who developed endocrinopathy, 2 patients (1 treated with SRS and the other with SRT), who developed cranial neuropathy, and 1 SRS patient who developed visual deficits. Additionally, 1 patient who received both SRS and SRT within 2 years for recurrence experienced transient medial temporal lobe radiation changes that resolved. Conclusions: Where proton beam therapy is unavailable, linear accelerator-based SRT or radiosurgery remains a safe option for adjuvant therapy of chordomas and chondrosarcomas of the skull base. The exposure of the optic apparatus, pituitary stalk, and brainstem must be considered during planning to minimize complications. If the optic apparatus is included in the 80% isodose line, it might be best to fractionate therapy. Exposure of the pituitary stalk should be kept to <30 Gy to minimize endocrine dysfunction. Brainstem exposure should be

  6. Fast time-of-flight camera based surface registration for radiotherapy patient positioning

    International Nuclear Information System (INIS)

    Placht, Simon; Stancanello, Joseph; Schaller, Christian; Balda, Michael; Angelopoulou, Elli

    2012-01-01

    Purpose: This work introduces a rigid registration framework for patient positioning in radiotherapy, based on real-time surface acquisition by a time-of-flight (ToF) camera. Dynamic properties of the system are also investigated for future gating/tracking strategies. Methods: A novel preregistration algorithm, based on translation and rotation-invariant features representing surface structures, was developed. Using these features, corresponding three-dimensional points were computed in order to determine initial registration parameters. These parameters became a robust input to an accelerated version of the iterative closest point (ICP) algorithm for the fine-tuning of the registration result. Distance calibration and Kalman filtering were used to compensate for ToF-camera dependent noise. Additionally, the advantage of using the feature based preregistration over an ''ICP only'' strategy was evaluated, as well as the robustness of the rigid-transformation-based method to deformation. Results: The proposed surface registration method was validated using phantom data. A mean target registration error (TRE) for translations and rotations of 1.62 ± 1.08 mm and 0.07 deg. ± 0.05 deg., respectively, was achieved. There was a temporal delay of about 65 ms in the registration output, which can be seen as negligible considering the dynamics of biological systems. Feature based preregistration allowed for accurate and robust registrations even at very large initial displacements. Deformations affected the accuracy of the results, necessitating particular care in cases of deformed surfaces. Conclusions: The proposed solution is able to solve surface registration problems with an accuracy suitable for radiotherapy cases where external surfaces offer primary or complementary information to patient positioning. The system shows promising dynamic properties for its use in gating/tracking applications. The overall system is competitive with commonly-used surface registration

  7. Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer.

    Science.gov (United States)

    Okadome, Masao; Saito, Toshiaki; Kitade, Shoko; Ariyoshi, Kazuya; Shimamoto, Kumi; Kawano, Hiroyuki; Minami, Kazuhito; Nakamura, Motonobu; Shimokawa, Mototsugu; Okushima, Kazuhiro; Kubo, Yuichiro; Kunitake, Naonobu

    2018-02-01

    We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Reirradiation of brain and skull base tumors with fractionated stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Tokuuye, Koichi; Akine, Yasuyuki; Sumi, Minako; Kagami, Yoshikazu; Ikeda, Hiroshi; Oyama, Hiroshi; Inou, Yasushi; Shibui, Soichiro; Nomura, Kazuhiro

    1998-01-01

    Purpose: We evaluated the feasibility of fractionated stereotactic radiotherapy for small intracranial recurrences after conventional radiotherapy. Methods and Materials: Nineteen patients who had initially undergone conventional radiotherapy to intracranial lesions, receiving a median total dose of 50 Gy in 5 weeks, were retreated with stereotactic radiotherapy for their recurrences and received a median total dose of 42 Gy in seven fractions over 2.3 weeks. Results: Of the 19 patients, 15 achieved local control 3-51 months after reirradiation. No patient suffered from acute reaction, but one patient with a history of extensive radiotherapy developed progressive radionecrosis 9 months after reirradiation. Conclusions: Fractionated stereotactic radiotherapy of intracranial recurrences appears to be effective in achieving in local control with negligible morbidity. We believe it merits further investigation in a prospective study

  9. Human reliability in high dose rate afterloading radiotherapy based on FMECA

    International Nuclear Information System (INIS)

    Deng Jun; Fan Yaohua; Yue Baorong; Wei Kedao; Ren Fuli

    2012-01-01

    Objective: To put forward reasonable and feasible recommendations against the procedure with relative high risk during the high dose rate (HDR) afterloading radiotherapy, so as to enhance its clinical application safety, through studying the human reliability in the process of carrying out the HDR afterloading radiotherapy. Methods: Basic data were collected by on-site investigation and process analysis as well as expert evaluation. Failure mode, effect and criticality analysis (FMECA) employed to study the human reliability in the execution of HDR afterloading radiotherapy. Results: The FMECA model of human reliability for HDR afterloading radiotherapy was established, through which 25 procedures with relative high risk index were found,accounting for 14.1% of total 177 procedures. Conclusions: FMECA method in human reliability study for HDR afterloading radiotherapy is feasible. The countermeasures are put forward to reduce the human error, so as to provide important basis for enhancing clinical application safety of HDR afterloading radiotherapy. (authors)

  10. A self-adaptive case-based reasoning system for dose planning in prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mishra, Nishikant; Petrovic, Sanja; Sundar, Santhanam [Automated Scheduling, Optimisation and Planning Research Group, School of Computer Science, University of Nottingham, Nottingham NG8 1BB (United Kingdom); Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB (United Kingdom)

    2011-12-15

    Purpose: Prostate cancer is the most common cancer in the male population. Radiotherapy is often used in the treatment for prostate cancer. In radiotherapy treatment, the oncologist makes a trade-off between the risk and benefit of the radiation, i.e., the task is to deliver a high dose to the prostate cancer cells and minimize side effects of the treatment. The aim of our research is to develop a software system that will assist the oncologist in planning new treatments. Methods: A nonlinear case-based reasoning system is developed to capture the expertise and experience of oncologists in treating previous patients. Importance (weights) of different clinical parameters in the dose planning is determined by the oncologist based on their past experience, and is highly subjective. The weights are usually fixed in the system. In this research, the weights are updated automatically each time after generating a treatment plan for a new patient using a group based simulated annealing approach. Results: The developed approach is analyzed on the real data set collected from the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. Extensive experiments show that the dose plan suggested by the proposed method is coherent with the dose plan prescribed by an experienced oncologist or even better. Conclusions: The developed case-based reasoning system enables the use of knowledge and experience gained by the oncologist in treating new patients. This system may play a vital role to assist the oncologist in making a better decision in less computational time; it utilizes the success rate of the previously treated patients and it can also be used in teaching and training processes.

  11. A self-adaptive case-based reasoning system for dose planning in prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Mishra, Nishikant; Petrovic, Sanja; Sundar, Santhanam

    2011-01-01

    Purpose: Prostate cancer is the most common cancer in the male population. Radiotherapy is often used in the treatment for prostate cancer. In radiotherapy treatment, the oncologist makes a trade-off between the risk and benefit of the radiation, i.e., the task is to deliver a high dose to the prostate cancer cells and minimize side effects of the treatment. The aim of our research is to develop a software system that will assist the oncologist in planning new treatments. Methods: A nonlinear case-based reasoning system is developed to capture the expertise and experience of oncologists in treating previous patients. Importance (weights) of different clinical parameters in the dose planning is determined by the oncologist based on their past experience, and is highly subjective. The weights are usually fixed in the system. In this research, the weights are updated automatically each time after generating a treatment plan for a new patient using a group based simulated annealing approach. Results: The developed approach is analyzed on the real data set collected from the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. Extensive experiments show that the dose plan suggested by the proposed method is coherent with the dose plan prescribed by an experienced oncologist or even better. Conclusions: The developed case-based reasoning system enables the use of knowledge and experience gained by the oncologist in treating new patients. This system may play a vital role to assist the oncologist in making a better decision in less computational time; it utilizes the success rate of the previously treated patients and it can also be used in teaching and training processes.

  12. WE-E-BRB-11: Riview a Web-Based Viewer for Radiotherapy.

    Science.gov (United States)

    Apte, A; Wang, Y; Deasy, J

    2012-06-01

    Collaborations involving radiotherapy data collection, such as the recently proposed international radiogenomics consortium, require robust, web-based tools to facilitate reviewing treatment planning information. We present the architecture and prototype characteristics for a web-based radiotherapy viewer. The web-based environment developed in this work consists of the following components: 1) Import of DICOM/RTOG data: CERR was leveraged to import DICOM/RTOG data and to convert to database friendly RT objects. 2) Extraction and Storage of RT objects: The scan and dose distributions were stored as .png files per slice and view plane. The file locations were written to the MySQL database. Structure contours and DVH curves were written to the database as numeric data. 3) Web interfaces to query, retrieve and visualize the RT objects: The Web application was developed using HTML 5 and Ruby on Rails (RoR) technology following the MVC philosophy. The open source ImageMagick library was utilized to overlay scan, dose and structures. The application allows users to (i) QA the treatment plans associated with a study, (ii) Query and Retrieve patients matching anonymized ID and study, (iii) Review up to 4 plans simultaneously in 4 window panes (iv) Plot DVH curves for the selected structures and dose distributions. A subset of data for lung cancer patients was used to prototype the system. Five user accounts were created to have access to this study. The scans, doses, structures and DVHs for 10 patients were made available via the web application. A web-based system to facilitate QA, and support Query, Retrieve and the Visualization of RT data was prototyped. The RIVIEW system was developed using open source and free technology like MySQL and RoR. We plan to extend the RIVIEW system further to be useful in clinical trial data collection, outcomes research, cohort plan review and evaluation. © 2012 American Association of Physicists in Medicine.

  13. Accuracy of radiotherapy dose calculations based on cone-beam CT: comparison of deformable registration and image correction based methods

    Science.gov (United States)

    Marchant, T. E.; Joshi, K. D.; Moore, C. J.

    2018-03-01

    Radiotherapy dose calculations based on cone-beam CT (CBCT) images can be inaccurate due to unreliable Hounsfield units (HU) in the CBCT. Deformable image registration of planning CT images to CBCT, and direct correction of CBCT image values are two methods proposed to allow heterogeneity corrected dose calculations based on CBCT. In this paper we compare the accuracy and robustness of these two approaches. CBCT images for 44 patients were used including pelvis, lung and head & neck sites. CBCT HU were corrected using a ‘shading correction’ algorithm and via deformable registration of planning CT to CBCT using either Elastix or Niftyreg. Radiotherapy dose distributions were re-calculated with heterogeneity correction based on the corrected CBCT and several relevant dose metrics for target and OAR volumes were calculated. Accuracy of CBCT based dose metrics was determined using an ‘override ratio’ method where the ratio of the dose metric to that calculated on a bulk-density assigned version of the same image is assumed to be constant for each patient, allowing comparison to the patient’s planning CT as a gold standard. Similar performance is achieved by shading corrected CBCT and both deformable registration algorithms, with mean and standard deviation of dose metric error less than 1% for all sites studied. For lung images, use of deformed CT leads to slightly larger standard deviation of dose metric error than shading corrected CBCT with more dose metric errors greater than 2% observed (7% versus 1%).

  14. Knowledge-based prediction of three-dimensional dose distributions for external beam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shiraishi, Satomi; Moore, Kevin L., E-mail: kevinmoore@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California 92093 (United States)

    2016-01-15

    Purpose: To demonstrate knowledge-based 3D dose prediction for external beam radiotherapy. Methods: Using previously treated plans as training data, an artificial neural network (ANN) was trained to predict a dose matrix based on patient-specific geometric and planning parameters, such as the closest distance (r) to planning target volume (PTV) and organ-at-risks (OARs). Twenty-three prostate and 43 stereotactic radiosurgery/radiotherapy (SRS/SRT) cases with at least one nearby OAR were studied. All were planned with volumetric-modulated arc therapy to prescription doses of 81 Gy for prostate and 12–30 Gy for SRS. Using these clinically approved plans, ANNs were trained to predict dose matrix and the predictive accuracy was evaluated using the dose difference between the clinical plan and prediction, δD = D{sub clin} − D{sub pred}. The mean (〈δD{sub r}〉), standard deviation (σ{sub δD{sub r}}), and their interquartile range (IQR) for the training plans were evaluated at a 2–3 mm interval from the PTV boundary (r{sub PTV}) to assess prediction bias and precision. Initially, unfiltered models which were trained using all plans in the cohorts were created for each treatment site. The models predict approximately the average quality of OAR sparing. Emphasizing a subset of plans that exhibited superior to the average OAR sparing during training, refined models were created to predict high-quality rectum sparing for prostate and brainstem sparing for SRS. Using the refined model, potentially suboptimal plans were identified where the model predicted further sparing of the OARs was achievable. Replans were performed to test if the OAR sparing could be improved as predicted by the model. Results: The refined models demonstrated highly accurate dose distribution prediction. For prostate cases, the average prediction bias for all voxels irrespective of organ delineation ranged from −1% to 0% with maximum IQR of 3% over r{sub PTV} ∈ [ − 6, 30] mm. The

  15. Knowledge-based prediction of three-dimensional dose distributions for external beam radiotherapy

    International Nuclear Information System (INIS)

    Shiraishi, Satomi; Moore, Kevin L.

    2016-01-01

    Purpose: To demonstrate knowledge-based 3D dose prediction for external beam radiotherapy. Methods: Using previously treated plans as training data, an artificial neural network (ANN) was trained to predict a dose matrix based on patient-specific geometric and planning parameters, such as the closest distance (r) to planning target volume (PTV) and organ-at-risks (OARs). Twenty-three prostate and 43 stereotactic radiosurgery/radiotherapy (SRS/SRT) cases with at least one nearby OAR were studied. All were planned with volumetric-modulated arc therapy to prescription doses of 81 Gy for prostate and 12–30 Gy for SRS. Using these clinically approved plans, ANNs were trained to predict dose matrix and the predictive accuracy was evaluated using the dose difference between the clinical plan and prediction, δD = D clin − D pred . The mean (〈δD r 〉), standard deviation (σ δD r ), and their interquartile range (IQR) for the training plans were evaluated at a 2–3 mm interval from the PTV boundary (r PTV ) to assess prediction bias and precision. Initially, unfiltered models which were trained using all plans in the cohorts were created for each treatment site. The models predict approximately the average quality of OAR sparing. Emphasizing a subset of plans that exhibited superior to the average OAR sparing during training, refined models were created to predict high-quality rectum sparing for prostate and brainstem sparing for SRS. Using the refined model, potentially suboptimal plans were identified where the model predicted further sparing of the OARs was achievable. Replans were performed to test if the OAR sparing could be improved as predicted by the model. Results: The refined models demonstrated highly accurate dose distribution prediction. For prostate cases, the average prediction bias for all voxels irrespective of organ delineation ranged from −1% to 0% with maximum IQR of 3% over r PTV ∈ [ − 6, 30] mm. The average prediction error was less

  16. Observer variability when evaluating patient movement from electronic portal images of pelvic radiotherapy fields

    International Nuclear Information System (INIS)

    Geraint Lewis, D.; Ryan, Karen R.; Smith, Cyril W.

    2005-01-01

    Background and purpose: A study has been performed to evaluate inter-observer variability when assessing pelvic patient movement using an electronic portal imaging device (EPID). Materials and methods: Four patient image sets were used with 3-6 portal images per set. The observer group consisted of nine radiographers with 3-18 months clinical EPID experience. The observers outlined bony landmarks on a digital simulator image and used matching software to evaluate field placement errors (FPEs) on each portal image relative to the reference simulator image. Data were evaluated statistically, using a two-component analysis of variance technique, to quantify both the inter-observer variability in evaluating FPEs and inter-fraction variability in patient position relative to the residuals of the analysis. Intra-observer variability was also estimated using four of the observers carrying out three sets of repeat readings. Results: Eight sets of variance data were analysed, based on FPEs in two orthogonal directions for each of the four patient image sets studied. Initial analysis showed that both inter-observer variation and inter-fraction-patient position variation were statistically significant (P<0.05) in seven of the eight cases evaluated. The averaged root-mean-square (RMS) deviation of the observers from the group mean was 1.1 mm, with a maximum deviation of 5.0 mm recorded for an individual observer. After additional training and re-testing of two of the observers who recorded the largest deviations from the group mean, a subsequent analysis showed the inter-observer variability for the group to be significant in only three of the eight cases, with averaged RMS deviation reduced to 0.5 mm, with a maximum deviation of 2.7 mm. The intra-observer variability was 0.5 mm, averaged over the four observers tested. Conclusions: We have developed a quantitative approach to evaluate inter-observer variability in terms of its statistical significance compared to inter

  17. Radiotherapy Treatment Planning for Testicular Seminoma

    International Nuclear Information System (INIS)

    Wilder, Richard B.; Buyyounouski, Mark K.; Efstathiou, Jason A.; Beard, Clair J.

    2012-01-01

    Virtually all patients with Stage I testicular seminoma are cured regardless of postorchiectomy management. For patients treated with adjuvant radiotherapy, late toxicity is a major concern. However, toxicity may be limited by radiotherapy techniques that minimize radiation exposure of healthy normal tissues. This article is an evidence-based review that provides radiotherapy treatment planning recommendations for testicular seminoma. The minority of Stage I patients who choose adjuvant treatment over surveillance may be considered for (1) para-aortic irradiation to 20 Gy in 10 fractions, or (2) carboplatin chemotherapy consisting of area under the curve, AUC = 7 × 1−2 cycles. Two-dimensional radiotherapy based on bony anatomy is a simple and effective treatment for Stage IIA or IIB testicular seminoma. Centers with expertise in vascular and nodal anatomy may consider use of anteroposterior–posteroanterior fields based on three-dimensional conformal radiotherapy instead. For modified dog-leg fields delivering 20 Gy in 10 fractions, clinical studies support placement of the inferior border at the top of the acetabulum. Clinical and nodal mapping studies support placement of the superior border of all radiotherapy fields at the top of the T12 vertebral body. For Stage IIA and IIB patients, an anteroposterior–posteroanterior boost is then delivered to the adenopathy with a 2-cm margin to the block edge. The boost dose consists of 10 Gy in 5 fractions for Stage IIA and 16 Gy in 8 fractions for Stage IIB. Alternatively, bleomycin, etoposide, and cisplatin chemotherapy for 3 cycles or etoposide and cisplatin chemotherapy for 4 cycles may be delivered to Stage IIA or IIB patients (e.g., if they have a horseshoe kidney, inflammatory bowel disease, or a history of radiotherapy).

  18. Radiotherapy Treatment Planning for Testicular Seminoma

    Energy Technology Data Exchange (ETDEWEB)

    Wilder, Richard B., E-mail: richardbwilder@yahoo.com [Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States); Buyyounouski, Mark K. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Efstathiou, Jason A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Beard, Clair J. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States)

    2012-07-15

    Virtually all patients with Stage I testicular seminoma are cured regardless of postorchiectomy management. For patients treated with adjuvant radiotherapy, late toxicity is a major concern. However, toxicity may be limited by radiotherapy techniques that minimize radiation exposure of healthy normal tissues. This article is an evidence-based review that provides radiotherapy treatment planning recommendations for testicular seminoma. The minority of Stage I patients who choose adjuvant treatment over surveillance may be considered for (1) para-aortic irradiation to 20 Gy in 10 fractions, or (2) carboplatin chemotherapy consisting of area under the curve, AUC = 7 Multiplication-Sign 1-2 cycles. Two-dimensional radiotherapy based on bony anatomy is a simple and effective treatment for Stage IIA or IIB testicular seminoma. Centers with expertise in vascular and nodal anatomy may consider use of anteroposterior-posteroanterior fields based on three-dimensional conformal radiotherapy instead. For modified dog-leg fields delivering 20 Gy in 10 fractions, clinical studies support placement of the inferior border at the top of the acetabulum. Clinical and nodal mapping studies support placement of the superior border of all radiotherapy fields at the top of the T12 vertebral body. For Stage IIA and IIB patients, an anteroposterior-posteroanterior boost is then delivered to the adenopathy with a 2-cm margin to the block edge. The boost dose consists of 10 Gy in 5 fractions for Stage IIA and 16 Gy in 8 fractions for Stage IIB. Alternatively, bleomycin, etoposide, and cisplatin chemotherapy for 3 cycles or etoposide and cisplatin chemotherapy for 4 cycles may be delivered to Stage IIA or IIB patients (e.g., if they have a horseshoe kidney, inflammatory bowel disease, or a history of radiotherapy).

  19. External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Beetz, Ivo; Schilstra, Cornelis; Luijk, Peter van; Christianen, Miranda E.M.C.; Doornaert, Patricia; Bijl, Henk P.; Chouvalova, Olga; Heuvel, Edwin R. van den; Steenbakkers, Roel J.H.M.; Langendijk, Johannes A.

    2012-01-01

    Purpose: The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER 6M ) and sticky saliva (STIC 6M ) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). Methods and materials: Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER 6M consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC 6M consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R 2 Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer–Lemeshow “goodness-of-fit” test. Results: Overall model performance of the 3D-CRT based predictive models for XER 6M and STIC 6M was significantly worse in terms of the Brier score and R 2 Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer–Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. Conclusion: 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or

  20. Experimental assessment of out-of-field dose components in high energy electron beams used in external beam radiotherapy.

    Science.gov (United States)

    Alabdoaburas, Mohamad M; Mege, Jean-Pierre; Chavaudra, Jean; Bezin, Jérémi Vũ; Veres, Atilla; de Vathaire, Florent; Lefkopoulos, Dimitri; Diallo, Ibrahima

    2015-11-08

    The purpose of this work was to experimentally investigate the out-of-field dose in a water phantom, with several high energy electron beams used in external beam radiotherapy (RT). The study was carried out for 6, 9, 12, and 18 MeV electron beams, on three different linear accelerators, each equipped with a specific applicator. Measurements were performed in a water phantom, at different depths, for different applicator sizes, and off-axis distances up to 70 cm from beam central axis (CAX). Thermoluminescent powder dosimeters (TLD-700) were used. For given cases, TLD measurements were compared to EBT3 films and parallel-plane ionization chamber measurements. Also, out-of-field doses at 10 cm depth, with and without applicator, were evaluated. With the Siemens applicators, a peak dose appears at about 12-15 cm out of the field edge, at 1 cm depth, for all field sizes and energies. For the Siemens Primus, with a 10 × 10 cm(²) applicator, this peak reaches 2.3%, 1%, 0.9% and 1.3% of the maximum central axis dose (Dmax) for 6, 9, 12 and 18 MeV electron beams, respectively. For the Siemens Oncor, with a 10 × 10 cm(²) applicator, this peak dose reaches 0.8%, 1%, 1.4%, and 1.6% of Dmax for 6, 9, 12, and 14 MeV, respectively, and these values increase with applicator size. For the Varian 2300C/D, the doses at 12.5 cm out of the field edge are 0.3%, 0.6%, 0.5%, and 1.1% of Dmax for 6, 9, 12, and 18 MeV, respectively, and increase with applicator size. No peak dose is evidenced for the Varian applicator for these energies. In summary, the out-of-field dose from electron beams increases with the beam energy and the applicator size, and decreases with the distance from the beam central axis and the depth in water. It also considerably depends on the applicator types. Our results can be of interest for the dose estimations delivered in healthy tissues outside the treatment field for the RT patient, as well as in studies exploring RT long-term effects.

  1. Dosimetric Comparison Between Intensity-Modulated with Coplanar Field and 3D Conformal Radiotherapy with Noncoplanar Field for Postocular Invasion Tumor

    International Nuclear Information System (INIS)

    Tu Wenyong; Liu Lu; Zeng Jun; Yin Weidong; Li Yun

    2010-01-01

    This study presents a dosimetric optimization effort aiming to compare noncoplanar field (NCF) on 3 dimensions conformal radiotherapy (3D-CRT) and coplanar field (CF) on intensity-modulated radiotherapy (IMRT) planning for postocular invasion tumor. We performed a planning study on the computed tomography data of 8 consecutive patients with localized postocular invasion tumor. Four fields NCF 3D-CRT in the transverse plane with gantry angles of 0-10 deg., 30-45 deg., 240-270 deg., and 310-335 deg. degrees were isocentered at the center of gravity of the target volume. The geometry of the beams was determined by beam's eye view. The same constraints were prepared with between CF IMRT optimization and NCF 3D-CRT treatment. The maximum point doses (D max) for the different optic pathway structures (OPS) with NCF 3D-CRT treatment should differ in no more than 3% from those with the NCF IMRT plan. Dose-volume histograms (DVHs) were obtained for all targets and organ at risk (OAR) with both treatment techniques. Plans with NCF 3D-CRT and CF IMRT constraints on target dose in homogeneity were computed, as well as the conformity index (CI) and homogeneity index (HI) in the target volume. The PTV coverage was optimal with both NCF 3D-CRT and CF IMRT plans in the 8 tumor sites. No difference was noted between the two techniques for the average D max and D min dose. NCF 3D-CRT and CF IMRT will yield similar results on CI. However, HI was a significant difference between NCF 3D-CRT and CF IMRT plan (p < 0.001). Physical endpoints for target showed the mean target dose to be low in the CF IMRT plan, caused by a large target dose in homogeneity (p < 0.001). The impact of NCF 3D-CRT versus CF IMRT set-up is very slight. NCF3D-CRT is one of the treatment options for postocular invasion tumor. However, constraints for OARs are needed.

  2. Monte Carlo simulations of patient dose perturbations in rotational-type radiotherapy due to a transverse magnetic field: A tomotherapy investigation

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Y. M.; Geurts, M.; Smilowitz, J. B.; Bednarz, B. P., E-mail: bbednarz2@wisc.edu [Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703 (United States); Sterpin, E. [Molecular Imaging, Radiotherapy and Oncology, Université catholique de Louvain, Brussels, Belgium 1348 (Belgium)

    2015-02-15

    Purpose: Several groups are exploring the integration of magnetic resonance (MR) image guidance with radiotherapy to reduce tumor position uncertainty during photon radiotherapy. The therapeutic gain from reducing tumor position uncertainty using intrafraction MR imaging during radiotherapy could be partially offset if the negative effects of magnetic field-induced dose perturbations are not appreciated or accounted for. The authors hypothesize that a more rotationally symmetric modality such as helical tomotherapy will permit a systematic mediation of these dose perturbations. This investigation offers a unique look at the dose perturbations due to homogeneous transverse magnetic field during the delivery of Tomotherapy{sup ®} Treatment System plans under varying degrees of rotational beamlet symmetry. Methods: The authors accurately reproduced treatment plan beamlet and patient configurations using the Monte Carlo code GEANT4. This code has a thoroughly benchmarked electromagnetic particle transport physics package well-suited for the radiotherapy energy regime. The three approved clinical treatment plans for this study were for a prostate, head and neck, and lung treatment. The dose heterogeneity index metric was used to quantify the effect of the dose perturbations to the target volumes. Results: The authors demonstrate the ability to reproduce the clinical dose–volume histograms (DVH) to within 4% dose agreement at each DVH point for the target volumes and most planning structures, and therefore, are able to confidently examine the effects of transverse magnetic fields on the plans. The authors investigated field strengths of 0.35, 0.7, 1, 1.5, and 3 T. Changes to the dose heterogeneity index of 0.1% were seen in the prostate and head and neck case, reflecting negligible dose perturbations to the target volumes, a change from 5.5% to 20.1% was observed with the lung case. Conclusions: This study demonstrated that the effect of external magnetic fields can

  3. SU-D-BRB-05: Quantum Learning for Knowledge-Based Response-Adaptive Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    El Naqa, I; Ten, R [Haken University of Michigan, Ann Arbor, MI (United States)

    2016-06-15

    Purpose: There is tremendous excitement in radiotherapy about applying data-driven methods to develop personalized clinical decisions for real-time response-based adaptation. However, classical statistical learning methods lack in terms of efficiency and ability to predict outcomes under conditions of uncertainty and incomplete information. Therefore, we are investigating physics-inspired machine learning approaches by utilizing quantum principles for developing a robust framework to dynamically adapt treatments to individual patient’s characteristics and optimize outcomes. Methods: We studied 88 liver SBRT patients with 35 on non-adaptive and 53 on adaptive protocols. Adaptation was based on liver function using a split-course of 3+2 fractions with a month break. The radiotherapy environment was modeled as a Markov decision process (MDP) of baseline and one month into treatment states. The patient environment was modeled by a 5-variable state represented by patient’s clinical and dosimetric covariates. For comparison of classical and quantum learning methods, decision-making to adapt at one month was considered. The MDP objective was defined by the complication-free tumor control (P{sup +}=TCPx(1-NTCP)). A simple regression model represented state-action mapping. Single bit in classical MDP and a qubit of 2-superimposed states in quantum MDP represented the decision actions. Classical decision selection was done using reinforcement Q-learning and quantum searching was performed using Grover’s algorithm, which applies uniform superposition over possible states and yields quadratic speed-up. Results: Classical/quantum MDPs suggested adaptation (probability amplitude ≥0.5) 79% of the time for splitcourses and 100% for continuous-courses. However, the classical MDP had an average adaptation probability of 0.5±0.22 while the quantum algorithm reached 0.76±0.28. In cases where adaptation failed, classical MDP yielded 0.31±0.26 average amplitude while the

  4. Regional MLEM reconstruction strategy for PET-based treatment verification in ion beam radiotherapy

    International Nuclear Information System (INIS)

    Gianoli, Chiara; Riboldi, Marco; Fattori, Giovanni; Baselli, Giuseppe; Baroni, Guido; Bauer, Julia; Debus, Jürgen; Parodi, Katia; De Bernardi, Elisabetta

    2014-01-01

    In ion beam radiotherapy, PET-based treatment verification provides a consistency check of the delivered treatment with respect to a simulation based on the treatment planning. In this work the region-based MLEM reconstruction algorithm is proposed as a new evaluation strategy in PET-based treatment verification. The comparative evaluation is based on reconstructed PET images in selected regions, which are automatically identified on the expected PET images according to homogeneity in activity values. The strategy was tested on numerical and physical phantoms, simulating mismatches between the planned and measured β + activity distributions. The region-based MLEM reconstruction was demonstrated to be robust against noise and the sensitivity of the strategy results were comparable to three voxel units, corresponding to 6 mm in numerical phantoms. The robustness of the region-based MLEM evaluation outperformed the voxel-based strategies. The potential of the proposed strategy was also retrospectively assessed on patient data and further clinical validation is envisioned. (paper)

  5. A 1.5 T transverse magnetic field in radiotherapy of rectal cancer: Impact on the dose distribution

    Energy Technology Data Exchange (ETDEWEB)

    Uilkema, Sander, E-mail: s.uilkema@nki.nl; Heide, Uulke van der; Sonke, Jan-Jakob; Triest, Baukelien van; Nijkamp, Jasper [Department of Radiotherapy, NKI-AVL, Amsterdam 1066 CX (Netherlands); Moreau, Michel [RTP Research Group, Elekta, Maryland Heights, Missouri 63043 (United States)

    2015-12-15

    Purpose: MRI guidance during radiotherapy has the potential to enable more accurate dose delivery, optimizing the balance between local control and treatment related toxicity. However, the presence of a permanent magnetic field influences the dose delivery, especially around air cavities. Here, electrons are able to return to the surface through which they entered the air cavity (electron return effect, ERE) locally resulting in dose hot- and cold-spots. Where RT of rectal cancer patients might benefit from MRI guidance for margin reduction, air cavities in and around the target volume are frequently present. The purpose of this research is to evaluate the impact of the presence of a 1.5 T transverse magnetic field on dose delivery in patients with rectal cancer. Methods: Ten patients treated with 5 × 5 Gy RT having large changes in pelvic air content were selected out of a cohort of 33 patients. On the planning CT, a 1.5 T, 6 MV, 7-field intensity modulated radiotherapy (IMRT) plan was created. This plan was subsequently recalculated on daily CT scans. For each daily CT, the CTV V{sub 95%} and V{sub 107%} and bowel area V{sub 5Gy}, V{sub 10Gy}, V{sub 15Gy}, V{sub 20Gy}, and V{sub 25Gy} were calculated to evaluate the changes in dose distribution from fraction to fraction. For comparison, the authors repeated this procedure for the 0 T situation. To study the effect of changing air cavities separate from other anatomical changes, the authors also generated artificial air cavities in the CTV of one patient (2 and 5 cm diameter), in the high dose gradient region (2 cm), and in the low dose area (2 cm). Treatment plans were optimized without and with each simulated air cavity. For appearing and disappearing air cavities, the CTV V{sub 95%} and V{sub 107%} were evaluated. The authors also evaluated the ERE separate from attenuation changes locally around appearing gas pockets. Results: For the ten patients, at 1.5 T, the V{sub 95%} was influenced by both appearing and

  6. Estimation of extremely small field radiation dose for brain stereotactic radiotherapy using the Vero4DRT system.

    Science.gov (United States)

    Nakayama, Shinichi; Monzen, Hajime; Onishi, Yuichi; Kaneshige, Soichiro; Kanno, Ikuo

    2018-06-01

    The purpose of this study was a dosimetric validation of the Vero4DRT for brain stereotactic radiotherapy (SRT) with extremely small fields calculated by the treatment planning system (TPS) iPlan (Ver.4.5.1; algorithm XVMC). Measured and calculated data (e.g. percentage depth dose [PDD], dose profile, and point dose) were compared for small square fields of 30 × 30, 20 × 20, 10 × 10 and 5 × 5 mm 2 using ionization chambers of 0.01 or 0.04 cm 3 and a diamond detector. Dose verifications were performed using an ionization chamber and radiochromic film (EBT3; the equivalent field sizes used were 8.2, 8.7, 8.9, 9.5, and 12.9 mm 2 ) for five brain SRT cases irradiated with dynamic conformal arcs. The PDDs and dose profiles for the measured and calculated data were in good agreement for fields larger than or equal to 10 × 10 mm 2 when an appropriate detector was chosen. The dose differences for point doses in fields of 30 × 30, 20 × 20, 10 × 10 and 5 × 5 mm 2 were +0.48%, +0.56%, -0.52%, and +11.2% respectively. In the dose verifications for the brain SRT plans, the mean dose difference between the calculated and measured doses were -0.35% (range, -0.94% to +0.47%), with the average pass rates for the gamma index under the 3%/2 mm criterion being 96.71%, 93.37%, and 97.58% for coronal, sagittal, and axial planes respectively. The Vero4DRT system provides accurate delivery of radiation dose for small fields larger than or equal to 10 × 10 mm 2 . Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  7. Aptamer-based radiopharmaceuticals for diagnostic imaging and targeted radiotherapy of epithelial tumors

    International Nuclear Information System (INIS)

    Missailidis, Sotiris; Perkins, Alan; Santos-Filho, Sebastiao David; Fonseca, Adenilson de Souza da; Bernardo-Filho, Mario

    2008-01-01

    In the continuous search for earlier diagnosis and improved therapeutic modalities against cancer, based on our constantly increasing knowledge of cancer biology, aptamers hold the promise to expand on current antibody success, but overcoming some of the problems faced with antibodies as therapeutic or delivery agents in cancer. However, as the first aptamer reached the market as an inhibitor against angiogenesis for the treatment of macular degeneration, aptamers have found only limited applications or interest in oncology, and even less as radiopharmaceuticals for diagnostic imaging and targeted radiotherapy of tumours. Yet, the chemistry for the labelling of aptamers and the options to alter their pharmacokinetic properties, to make them suitable for use as radiopharmaceuticals is now available and recent advances in their development can demonstrate that these molecules would make them ideal delivery vehicles for the development of targeted radiopharmaceuticals that could deliver their radiation load with accuracy to the tumour site, offering improved therapeutic properties and reduced side effects. (author)

  8. Proton-Based Stereotactic Ablative Radiotherapy in Early-Stage Non-Small-Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Jonathan D. Grant

    2014-01-01

    Full Text Available Stereotactic ablative radiotherapy (SABR, a recent implementation in the practice of radiation oncology, has been shown to confer high rates of local control in the treatment of early stage non-small-cell lung cancer (NSCLC. This technique, which involves limited invasive procedures and reduced treatment intervals, offers definitive treatment for patients unable or unwilling to undergo an operation. The use of protons in SABR delivery confers the added physical advantage of normal tissue sparing due to the absence of collateral radiation dose delivered to regions distal to the target. This may translate into clinical benefit and a decreased risk of clinical toxicity in patients with nearby critical structures or limited pulmonary reserve. In this review, we present the rationale for proton-based SABR, principles relating to the delivery and planning of this modality, and a summary of published clinical studies.

  9. Aptamer-based radiopharmaceuticals for diagnostic imaging and targeted radiotherapy of epithelial tumors

    Energy Technology Data Exchange (ETDEWEB)

    Missailidis, Sotiris [The Open University, Milton Keynes (United Kingdom). Dept. of Chemistry and Analytical Sciences]. E-mail: s.missailidis@open.ac.uk; Perkins, Alan [University of Nottingham (United Kingdom). Dept. of Medical Physics; Santos-Filho, Sebastiao David; Fonseca, Adenilson de Souza da; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria

    2008-12-15

    In the continuous search for earlier diagnosis and improved therapeutic modalities against cancer, based on our constantly increasing knowledge of cancer biology, aptamers hold the promise to expand on current antibody success, but overcoming some of the problems faced with antibodies as therapeutic or delivery agents in cancer. However, as the first aptamer reached the market as an inhibitor against angiogenesis for the treatment of macular degeneration, aptamers have found only limited applications or interest in oncology, and even less as radiopharmaceuticals for diagnostic imaging and targeted radiotherapy of tumours. Yet, the chemistry for the labelling of aptamers and the options to alter their pharmacokinetic properties, to make them suitable for use as radiopharmaceuticals is now available and recent advances in their development can demonstrate that these molecules would make them ideal delivery vehicles for the development of targeted radiopharmaceuticals that could deliver their radiation load with accuracy to the tumour site, offering improved therapeutic properties and reduced side effects. (author)

  10. Development of dose audits for complex treatment techniques in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Stefanic, A. M.; Molina, L.; Vallejos, M.; Montano, G.; Zaretzky, A.; Saravi, M., E-mail: stefanic@cae.cnea.gov.ar [Centro Regional de Referencia con Patrones Secundarios para Dosimetria - CNEA, Presbitero Juan Gonzalez y Aragon 15, B1802AYA Ezeiza (Argentina)

    2014-08-15

    This work was performed in the frame of a Coordinated Research Project (CRP) with IAEA whose objective was to extend the scope of activities carried out by national TLD-based networks from dosimetry audit for rectangular radiation fields to irregular and small fields relevant to modern radiotherapy. External audit is a crucial element in QA programmes for clinical dosimetry in radiotherapy, therefore a methodology and procedures were developed and were made available for dose measurement of complex radiotherapy parameters used for cancer treatment. There were three audit steps involved in this CRP: TLD based dosimetry for irregular MLC fields for conformal radiotherapy, dosimetry in the presence of heterogeneities and 2D MLC shaped fields relevant to stereotactic radiotherapy and applicable to dosimetry for IMRT. In addition, a new development of film-based 2D dosimetry for testing dose distributions in small field geometry was included. The plan for each audit step involved a pilot study and a trial audit run with a few local hospitals. The pilot study focused on conducting and evaluation of the audit procedures with all participants. The trial audit run was the running of the audit procedures by the participants to test them with a few local radiotherapy hospitals. This work intends to provide audits which are much nearer clinical practice than previous audits as they involve significant testing of Tps methods, as well as verifications to determinate whether hospitals can correctly calculate dose delivery in radiation treatments. (author)

  11. Development of dose audits for complex treatment techniques in radiotherapy

    International Nuclear Information System (INIS)

    Stefanic, A. M.; Molina, L.; Vallejos, M.; Montano, G.; Zaretzky, A.; Saravi, M.

    2014-08-01

    This work was performed in the frame of a Coordinated Research Project (CRP) with IAEA whose objective was to extend the scope of activities carried out by national TLD-based networks from dosimetry audit for rectangular radiation fields to irregular and small fields relevant to modern radiotherapy. External audit is a crucial element in QA programmes for clinical dosimetry in radiotherapy, therefore a methodology and procedures were developed and were made available for dose measurement of complex radiotherapy parameters used for cancer treatment. There were three audit steps involved in this CRP: TLD based dosimetry for irregular MLC fields for conformal radiotherapy, dosimetry in the presence of heterogeneities and 2D MLC shaped fields relevant to stereotactic radiotherapy and applicable to dosimetry for IMRT. In addition, a new development of film-based 2D dosimetry for testing dose distributions in small field geometry was included. The plan for each audit step involved a pilot study and a trial audit run with a few local hospitals. The pilot study focused on conducting and evaluation of the audit procedures with all participants. The trial audit run was the running of the audit procedures by the participants to test them with a few local radiotherapy hospitals. This work intends to provide audits which are much nearer clinical practice than previous audits as they involve significant testing of Tps methods, as well as verifications to determinate whether hospitals can correctly calculate dose delivery in radiation treatments. (author)

  12. Reshaping of computational system for dosimetry in neutron and photons radiotherapy based in stochastic methods - SISCODES

    International Nuclear Information System (INIS)

    Trindade, Bruno Machado

    2011-02-01

    This work shows the remodeling of the Computer System for Dosimetry of Neutrons and Photons in Radiotherapy Based on Stochastic Methods . SISCODES. The initial description and status, the alterations and expansions (proposed and concluded), and the latest system development status are shown. The SISCODES is a system that allows the execution of a 3D computational planning in radiation therapy, based on MCNP5 nuclear particle transport code. The SISCODES provides tools to build a patient's voxels model, to define a treatment planning, to simulate this planning, and to view the results of the simulation. The SISCODES implements a database of tissues, sources and nuclear data and an interface to access then. The graphical SISCODES modules were rewritten or were implemented using C++ language and GTKmm library. Studies about dose deviations were performed simulating a homogeneous water phantom as analogue of the human body in radiotherapy planning and a heterogeneous voxel phantom, pointing out possible dose miscalculations. The Soft-RT and PROPLAN computer codes that do interface with SISCODES are described. A set of voxels models created on the SISCODES are presented with its respective sizes and resolutions. To demonstrate the use of SISCODES, examples of radiation therapy and dosimetry simulations for prostate and heart are shown. Three protocols were simulated on the heart voxel model: Sm-153 filled balloon and P-32 stent, to prevent angioplasty restenosis; and Tl-201 myocardial perfusion, to imaging. Teletherapy with 6MV and 15MV beams were simulated to the prostate, and brachytherapy with I-125 seeds. The results of these simulations are shown on isodose curves and on dose-volume histograms. The SISCODES shows to be a useful tool for research of new radiation therapy treatments and, in future, can also be useful in medical practice. At the end, future improvements are proposed. I hope this work can contribute to develop more effective radiation therapy

  13. Neural stem cell sparing by linac based intensity modulated stereotactic radiotherapy in intracranial tumors

    International Nuclear Information System (INIS)

    Oehler, Julia; Brachwitz, Tim; Wendt, Thomas G; Banz, Nico; Walther, Mario; Wiezorek, Tilo

    2013-01-01

    Neurocognitive decline observed after radiotherapy (RT) for brain tumors in long time survivors is attributed to radiation exposure of the hippocampus and the subventricular zone (SVZ). The potential of sparing capabilities for both structures by optimized intensity modulated stereotactic radiotherapy (IMSRT) is investigated. Brain tumors were irradiated by stereotactic 3D conformal RT or IMSRT using m3 collimator optimized for PTV and for sparing of the conventional OARs (lens, retina, optic nerve, chiasm, cochlea, brain stem and the medulla oblongata). Retrospectively both hippocampi and SVZ were added to the list of OAR and their dose volume histograms were compared to those from two newly generated IMSRT plans using 7 or 14 beamlets (IMSRT-7, IMSRT-14) dedicated for optimized additional sparing of these structures. Conventional OAR constraints were kept constant. Impact of plan complexity and planning target volume (PTV) topography on sparing of both hippocampi and SVZ, conformity index (CI), the homogeneity index (HI) and quality of coverage (QoC) were analyzed. Limits of agreement were used to compare sparing of stem cell niches with either IMSRT-7 or IMSRT-14. The influence of treatment technique related to the topography ratio between PTV and OARs, realized in group A-D, was assessed by a mixed model. In 47 patients CI (p ≤ 0.003) and HI (p < 0.001) improved by IMSRT-7, IMSRT-14, QoC remained stable (p ≥ 0.50) indicating no compromise in radiotherapy. 90% of normal brain was exposed to a significantly higher dose using IMSRT. IMSRT-7 plans resulted in significantly lower biologically effective doses at all four neural stem cell structures, while contralateral neural stem cells are better spared compared to ipsilateral. A further increase of the number of beamlets (IMSRT-14) did not improve sparing significantly, so IMSRT-7 and IMSRT-14 can be used interchangeable. Patients with tumors contacting neither the subventricular zone nor the cortex benefit

  14. Phantom measurements and computed estimates of breast dose with radiotherapy for Hodgkin's lymphoma: dose reduction with the use of the involved field

    International Nuclear Information System (INIS)

    Wirth, A.; Kron, T.; Sorell, G.; Cramb, J.; Wittwer, H.; Sullivan, K.

    2008-01-01

    Full text: The risk of breast cancer following radiotherapy for Hodgkin's lymphoma appears to be dose related. In this study we compared breast dose in an anthropomorphic phantom for conventional 'mantle'; upper mediastinal/bilateral neck (minimantle) and unilateral neck fields, and evaluated the accuracy of computer planned dose estimates for out-of-field doses. For each field, computer-planned breast dose (CPD) estimates were compared with thermolu-minescence dosimetry measurements in five locations within 'breast tissue'. CPD were also compared with ion chamber measurements in a slab phantom. Measured dose and CPD were within 20% of each other up to approximately 10 cm from the field edge. Beyond 10 cm, the CPD underestimated dose by a factor of 2 or more. The minimantle reduced the breast dose by a factor of approximately 10 compared with the mantle treatment. Treating the neck field lowered the breast dose by a further 50% or more. Modern involved-field radiotherapy for lymphoma substantially reduces breast dose compared with mantle fields. Computer dosimetery underestimated dose at larger distances from the field. This needs to be considered if computer dosimetery is used to estimate breast dose and, by extrapolation, breast cancer risk.

  15. Factors influencing time between surgery and radiotherapy : A population based study of breast cancer patients

    NARCIS (Netherlands)

    Katik, S.; Gort, M.; Jobsen, Jan J.; Maduro, John H.; Struikmans, H.; Siesling, S.

    2015-01-01

    This study describes variation in the time interval between surgery and radiotherapy in breast cancer (BC) patients and assesses factors at patient, hospital and radiotherapy centre (RTC) level influencing this variation. To do so, the factors were investigated in BC patients using multilevel

  16. Multiple comparisons permutation test for image based data mining in radiotherapy

    NARCIS (Netherlands)

    Chen, Chun; Witte, Marnix; Heemsbergen, Wilma; van Herk, Marcel

    2013-01-01

    : Comparing incidental dose distributions (i.e. images) of patients with different outcomes is a straightforward way to explore dose-response hypotheses in radiotherapy. In this paper, we introduced a permutation test that compares images, such as dose distributions from radiotherapy, while tackling

  17. Thermal and epithermal neutron fluence rate gradient measurements by PADC detectors in LINAC radiotherapy treatments-field

    Energy Technology Data Exchange (ETDEWEB)

    Barrera, M. T., E-mail: mariate9590@gmail.com; Barros, H.; Pino, F.; Sajo-Bohus, L. [Universidad Simón Bolívar, Nuclear Physics Laboratory, Sartenejas, Caracas (Venezuela, Bolivarian Republic of); Dávila, J. [Física Médica C. A. and Universidad Central de Venezuela, Caracas (Venezuela, Bolivarian Republic of)

    2015-07-23

    LINAC VARIAN 2100 is where energetic electrons produce Bremsstrahlung radiation, with energies above the nucleon binding energy (E≈5.5MeV). This radiation induce (γ,n) and (e,e’n) reactions mainly in the natural tungsten target material (its total photoneutron cross section is about 4000 mb in a energy range from 9-17 MeV). These reactions may occur also in other components of the system (e.g. multi leaf collimator). During radiation treatment the human body may receive an additional dose inside and outside the treated volume produced by the mentioned nuclear reactions. We measured the neutron density at the treatment table using nuclear track detectors (PADC-NTD). These covered by a boron-converter are employed, including a cadmium filter, to determine the ratio between two groups of neutron energy, i.e. thermal and epithermal. The PADC-NTD detectors were exposed to the radiation field at the iso-center during regular operation of the accelerator. Neutron are determined indirectly by the converting reaction {sup 10}B(n,α){sup 7}Li the emerging charged particle leave their kinetic energy in the PADC forming a latent nuclear track, enlarged by chemical etching (6N, NaOH, 70°C). Track density provides information on the neutron density through calibration coefficient (∼1.6 10{sup 4} neutrons /track) obtained by a californium source. We report the estimation of the thermal and epithermal neutron field and its gradient for photoneutrons produced in radiotherapy treatments with 18 MV linear accelerators. It was obsered that photoneutron production have higher rate at the iso-center.

  18. High-dose rate fractionated interstitial radiotherapy for oropharyngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Nose, Takayuki; Inoue, Toshihiko; Inoue, Takehiro; Teshima, Teruki; Murayama, Shigeyuki [Osaka Univ. (Japan). Faculty of Medicine

    1995-03-01

    The limitations of treating oropharyngeal cancer patients with definitive external radiotherapy are the complications of salivary glands, taste buds, mandible and temporomandibular joints. To avoid these complications we started interstitial radiotherapy as boost after 46 Gy of external radiotherapy. Ten cases (retromolar trigone; 1, soft palate; 1, base of tongue; 3, lateral wall; 5) were treated with this method and seven cases were controlled locally. With short follow-up period, xerostomia and dysgeusia are less than definitive external radiotherapy as clinical impression and no in-field recurrences have been experienced. With markedly increased tumor dose, the local control rate can be improved. This treatment method will be an alternative to definitive external radiotherapy to gain better QOL and higher control rate. (author).

  19. Monte Carlo based simulation of LIAC intraoperative radiotherapy accelerator along with beam shaper applicator

    Directory of Open Access Journals (Sweden)

    N Heidarloo

    2017-08-01

    Full Text Available Intraoperative electron radiotherapy is one of the radiotherapy methods that delivers a high single fraction of radiation dose to the patient in one session during the surgery. Beam shaper applicator is one of the applicators that is recently employed with this radiotherapy method. This applicator has a considerable application in treatment of large tumors. In this study, the dosimetric characteristics of the electron beam produced by LIAC intraoperative radiotherapy accelerator in conjunction with this applicator have been evaluated through Monte Carlo simulation by MCNP code. The results showed that the electron beam produced by the beam shaper applicator would have the desirable dosimetric characteristics, so that the mentioned applicator can be considered for clinical purposes. Furthermore, the good agreement between the results of simulation and practical dosimetry, confirms the applicability of Monte Carlo method in determining the dosimetric parameters of electron beam  intraoperative radiotherapy

  20. Dosimetry performed on inverted 'Y' field for radiotherapy of Hodgkin's disease

    International Nuclear Information System (INIS)

    Dorsch, G.

    1984-01-01

    Examinations with integrated spleen volume on the Alderson phantom were performed with photon rays of the telecobalt device and linear accelerators with 6 and 10 MeV limit energy. Concerning radiation quality and field homogeneity, 10 MeV linear accelerators are to be preferred. Exposure of one third of the leftside kidney to damaging radiation doses obtain with spleen irradiation only. Lumbar spinal marrow can be protected against radiation damage by using dorsal absorbers from 20 Gy focal dose onwards. Craniolateral oophoropexy has to be performed prior to irradiation in order to maintain ovary functions. (DG) [de

  1. Competing-Risks Mortality After Radiotherapy vs. Observation for Localized Prostate Cancer: A Population-based Study

    Energy Technology Data Exchange (ETDEWEB)

    Abdollah, Firas, E-mail: firas.abdollah@gmail.com [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Department of Urology, Vita Salute San Raffaele University, Milan (Italy); Sun, Maxine [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Schmitges, Jan [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg (Germany); Thuret, Rodolphe [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Department of Urology, University of Montpellier Health Centre, Montpellier (France); Tian, Zhe [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Shariat, Shahrokh F. [Department of Urology, Weill Medical College of Cornell University, New York, NY (United States); Briganti, Alberto [Department of Urology, Vita Salute San Raffaele University, Milan (Italy); Jeldres, Claudio; Perrotte, Paul [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Department of Urology, University of Montreal Health Centre, Montreal (Canada); Montorsi, Francesco [Department of Urology, Vita Salute San Raffaele University, Milan (Italy); Karakiewicz, Pierre I. [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal (Canada); Department of Urology, University of Montreal Health Centre, Montreal (Canada)

    2012-09-01

    Purpose: Contemporary patients with localized prostate cancer (PCa) are more frequently treated with radiotherapy. However, there are limited data on the effect of this treatment on cancer-specific mortality (CSM). Our objective was to test the relationship between radiotherapy and survival in men with localized PCa and compare it with those treated with observation. Methods: A population-based cohort identified 68,797 men with cT1-T2 PCa treated with radiotherapy or observation between the years 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type (radiotherapy vs. observation) on CSM, after accounting to other-cause mortality. All analyses were carried out within PCa risk, baseline comorbidity status, and age groups. Results: Radiotherapy was associated with more favorable 10-year CSM rates than observation in patients with high-risk PCa (8.8 vs. 14.4%, hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.50-0.68). Conversely, the beneficial effect of radiotherapy on CSM was not evident in patients with low-intermediate risk PCa (3.7 vs. 4.1%, HR: 0.91, 95% CI: 0.80-1.04). Radiotherapy was beneficial in elderly patients (5.6 vs. 7.3%, HR: 0.70, 95% CI: 0.59-0.80). Moreover, it was associated with improved CSM rates among patients with no comorbidities (5.7 vs. 6.5%, HR: 0.81, 95% CI: 0.67-0.98), one comorbidity (4.6 vs. 6.0%, HR: 0.87, 95% CI: 0.75-0.99), and more than two comorbidities (4.2 vs. 5.0%, HR: 0.79, 95% CI: 0.65-0.96). Conclusions: Radiotherapy substantially improves CSM in patients with high-risk PCa, with little or no benefit in patients with low-/intermediate-risk PCa relative to observation. These findings must be interpreted within the context of the limitations of observational data.

  2. Quality assessment for VMAT prostate radiotherapy planning based on data envelopment analysis

    International Nuclear Information System (INIS)

    Lin, Kuan-Min; Simpson, John; Raith, Andrea; Ehrgott, Matthias; Sasso, Giuseppe

    2013-01-01

    The majority of commercial radiotherapy treatment planning systems requires planners to iteratively adjust the plan parameters in order to find a satisfactory plan. This iterative trial-and-error nature of radiotherapy treatment planning results in an inefficient planning process and in order to reduce such inefficiency, plans can be accepted without achieving the best attainable quality. We propose a quality assessment method based on data envelopment analysis (DEA) to address this inefficiency. This method compares a plan of interest to a set of past delivered plans and searches for evidence of potential further improvement. With the assistance of DEA, planners will be able to make informed decisions on whether further planning is required and ensure that a plan is only accepted when the plan quality is close to the best attainable one. We apply the DEA method to 37 prostate plans using two assessment parameters: rectal generalized equivalent uniform dose (gEUD) as the input and D95 (the minimum dose that is received by 95% volume of a structure) of the planning target volume (PTV) as the output. The percentage volume of rectum overlapping PTV is used to account for anatomical variations between patients and is included in the model as a non-discretionary output variable. Five plans that are considered of lesser quality by DEA are re-optimized with the goal to further improve rectal sparing. After re-optimization, all five plans improve in rectal gEUD without clinically considerable deterioration of the PTV D95 value. For the five re-optimized plans, the rectal gEUD is reduced by an average of 1.84 Gray (Gy) with only an average reduction of 0.07 Gy in PTV D95. The results demonstrate that DEA can correctly identify plans with potential improvements in terms of the chosen input and outputs. (paper)

  3. Process-based quality management for clinical implementation of adaptive radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Noel, Camille E.; Santanam, Lakshmi; Parikh, Parag J.; Mutic, Sasa, E-mail: smutic@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110 (United States)

    2014-08-15

    Purpose: Intensity-modulated adaptive radiotherapy (ART) has been the focus of considerable research and developmental work due to its potential therapeutic benefits. However, in light of its unique quality assurance (QA) challenges, no one has described a robust framework for its clinical implementation. In fact, recent position papers by ASTRO and AAPM have firmly endorsed pretreatment patient-specific IMRT QA, which limits the feasibility of online ART. The authors aim to address these obstacles by applying failure mode and effects analysis (FMEA) to identify high-priority errors and appropriate risk-mitigation strategies for clinical implementation of intensity-modulated ART. Methods: An experienced team of two clinical medical physicists, one clinical engineer, and one radiation oncologist was assembled to perform a standard FMEA for intensity-modulated ART. A set of 216 potential radiotherapy failures composed by the forthcoming AAPM task group 100 (TG-100) was used as the basis. Of the 216 failures, 127 were identified as most relevant to an ART scheme. Using the associated TG-100 FMEA values as a baseline, the team considered how the likeliness of occurrence (O), outcome severity (S), and likeliness of failure being undetected (D) would change for ART. New risk priority numbers (RPN) were calculated. Failures characterized by RPN ≥ 200 were identified as potentially critical. Results: FMEA revealed that ART RPN increased for 38% (n = 48/127) of potential failures, with 75% (n = 36/48) attributed to failures in the segmentation and treatment planning processes. Forty-three of 127 failures were identified as potentially critical. Risk-mitigation strategies include implementing a suite of quality control and decision support software, specialty QA software/hardware tools, and an increase in specially trained personnel. Conclusions: Results of the FMEA-based risk assessment demonstrate that intensity-modulated ART introduces different (but not necessarily

  4. Process-based quality management for clinical implementation of adaptive radiotherapy

    International Nuclear Information System (INIS)

    Noel, Camille E.; Santanam, Lakshmi; Parikh, Parag J.; Mutic, Sasa

    2014-01-01

    Purpose: Intensity-modulated adaptive radiotherapy (ART) has been the focus of considerable research and developmental work due to its potential therapeutic benefits. However, in light of its unique quality assurance (QA) challenges, no one has described a robust framework for its clinical implementation. In fact, recent position papers by ASTRO and AAPM have firmly endorsed pretreatment patient-specific IMRT QA, which limits the feasibility of online ART. The authors aim to address these obstacles by applying failure mode and effects analysis (FMEA) to identify high-priority errors and appropriate risk-mitigation strategies for clinical implementation of intensity-modulated ART. Methods: An experienced team of two clinical medical physicists, one clinical engineer, and one radiation oncologist was assembled to perform a standard FMEA for intensity-modulated ART. A set of 216 potential radiotherapy failures composed by the forthcoming AAPM task group 100 (TG-100) was used as the basis. Of the 216 failures, 127 were identified as most relevant to an ART scheme. Using the associated TG-100 FMEA values as a baseline, the team considered how the likeliness of occurrence (O), outcome severity (S), and likeliness of failure being undetected (D) would change for ART. New risk priority numbers (RPN) were calculated. Failures characterized by RPN ≥ 200 were identified as potentially critical. Results: FMEA revealed that ART RPN increased for 38% (n = 48/127) of potential failures, with 75% (n = 36/48) attributed to failures in the segmentation and treatment planning processes. Forty-three of 127 failures were identified as potentially critical. Risk-mitigation strategies include implementing a suite of quality control and decision support software, specialty QA software/hardware tools, and an increase in specially trained personnel. Conclusions: Results of the FMEA-based risk assessment demonstrate that intensity-modulated ART introduces different (but not necessarily

  5. Dose distribution over the radiation field and organs of the body during radiotherapy procedures

    International Nuclear Information System (INIS)

    Roy, S.; Begum, M.; Ambia, A.S.M.; Akhter, S.; Banu, H.

    2001-01-01

    Beam profile of the 60 Co teletherapy unit for 10 cm x 10 cm along central axis was measured to study the symmetry of the gamma beam and found that the average dose was 98.44±1.40 mGy. Output dose versus field size was also measured and values were found reasonable. Dose prescription to delivery was measured by placing TLD onto the treatment field for lung and cervix cancer patient which was found to be 39.16±2.98 Gy and 50.48±3.68 Gy respectively which are within 2 % and 0.17 % of the prescribed dose as 40.00 and 50.40 Gy respectively, reveals good agreement with the treatment planning. Six typical types of patients (both male and female) with cancers in lung, larynx, breast, cervix, oesophagus and brain treated with 60 Co teletherapy were particularly considered for dose assessment at different critical organs of interest. It was observed that the doses to the lens of eye with a maximum value of 460.35+78.87 mGy for a larynx cancer patient to a minimum value of 30.80+4.00 mGy of a cervix cancer patient. Doses to the gonad vary with a maximum value of 3810.80+389.76 mGy for a cervix cancer patient to a minimum value of 8.20+1.00 mGy for a brain cancer patient. (author)

  6. SU-E-J-198: Out-Of-Field Dose and Surface Dose Measurements of MRI-Guided Cobalt-60 Radiotherapy

    International Nuclear Information System (INIS)

    Lamb, J; Agazaryan, N; Cao, M; Low, D; Thomas, D; Yang, Y

    2015-01-01

    Purpose: To measure quantities of dosimetric interest in an MRI-guided cobalt radiotherapy machine that was recently introduced to clinical use. Methods: Out-of-field dose due to photon scatter and leakage was measured using an ion chamber and solid water slabs mimicking a human body. Surface dose was measured by irradiating stacks of radiochromic film and extrapolating to zero thickness. Electron out-of-field dose was characterized using solid water slabs and radiochromic film. Results: For some phantom geometries, up to 50% of Dmax was observed up to 10 cm laterally from the edge of the beam. The maximum penetration was between 1 and 2 mm in solid water, indicating an electron energy not greater than approximately 0.4 MeV. Out-of-field dose from photon scatter measured at 1 cm depth in solid water was found to fall to less than 10% of Dmax at a distance of 1.2 cm from the edge of a 10.5 × 10.5 cm field, and less that 1% of Dmax at a distance of 10 cm from field edge. Surface dose was measured to be 8% of Dmax. Conclusion: Surface dose and out-of-field dose from the MRIguided cobalt radiotherapy machine was measured and found to be within acceptable limits. Electron out-of-field dose, an effect unique to MRI-guided radiotherapy and presumed to arise from low-energy electrons trapped by the Lorentz force, was quantified. Dr. Low is a member of the scientific advisory board of ViewRay, Inc

  7. Coordinated research efforts for establishing an international radiotherapy dose intercomparison service based on the alanine/ESR system

    International Nuclear Information System (INIS)

    Nette, H.P.; Onori, S.; Fattibene, P.; Regulla, D.; Wieser, A.

    1993-01-01

    The IAEA has long been active in the field of high-dose standardization. An International Dose Assurance Service (IDAS) was established based on alanine/ESR dosimetry. This service operates over the range of 100 Gy to 100 kGy and is directed towards industrial radiation processing in IAEA member states. It complements the IAEA/WHO TLD postal dose intercomparison service for dose assurance in hospital radiotherapy departments. Experience with the alanine high dose service suggests that the alanine dosimeter might provide superior performance to TLD in the therapy dose range. Preliminary test measurements with the participation of GSF/Germany, Istituto Superiore di Sanita/Italy (both providing alanine dosimeters and their evaluation) and IAEA (providing reference irradiations) seems to justify research efforts through an IAEA Coordinated Research Programme (CRP). This CRP, entitled ''Therapy Level Dosimetry with the Alanine/ESR System'' is presently under set-up. It will include general work common to all assigned/potential contract holders as well as some specific research topics in accordance to individual proposals of each participant. (author)

  8. Fast time-of-flight camera based surface registration for radiotherapy patient positioning.

    Science.gov (United States)

    Placht, Simon; Stancanello, Joseph; Schaller, Christian; Balda, Michael; Angelopoulou, Elli

    2012-01-01

    This work introduces a rigid registration framework for patient positioning in radiotherapy, based on real-time surface acquisition by a time-of-flight (ToF) camera. Dynamic properties of the system are also investigated for future gating/tracking strategies. A novel preregistration algorithm, based on translation and rotation-invariant features representing surface structures, was developed. Using these features, corresponding three-dimensional points were computed in order to determine initial registration parameters. These parameters became a robust input to an accelerated version of the iterative closest point (ICP) algorithm for the fine-tuning of the registration result. Distance calibration and Kalman filtering were used to compensate for ToF-camera dependent noise. Additionally, the advantage of using the feature based preregistration over an "ICP only" strategy was evaluated, as well as the robustness of the rigid-transformation-based method to deformation. The proposed surface registration method was validated using phantom data. A mean target registration error (TRE) for translations and rotations of 1.62 ± 1.08 mm and 0.07° ± 0.05°, respectively, was achieved. There was a temporal delay of about 65 ms in the registration output, which can be seen as negligible considering the dynamics of biological systems. Feature based preregistration allowed for accurate and robust registrations even at very large initial displacements. Deformations affected the accuracy of the results, necessitating particular care in cases of deformed surfaces. The proposed solution is able to solve surface registration problems with an accuracy suitable for radiotherapy cases where external surfaces offer primary or complementary information to patient positioning. The system shows promising dynamic properties for its use in gating/tracking applications. The overall system is competitive with commonly-used surface registration technologies. Its main benefit is the

  9. Outcome after PSMA PET/CT based radiotherapy in patients with biochemical persistence or recurrence after radical prostatectomy.

    Science.gov (United States)

    Schmidt-Hegemann, Nina-Sophie; Fendler, Wolfgang Peter; Ilhan, Harun; Herlemann, Annika; Buchner, Alexander; Stief, Christian; Eze, Chukwuka; Rogowski, Paul; Li, Minglun; Bartenstein, Peter; Ganswindt, Ute; Belka, Claus

    2018-03-02

    PSMA PET/CT visualises prostate cancer residual disease or recurrence at lower PSA levels compared to conventional imaging and results in a change of treatment in a remarkable high number of patients. Radiotherapy with dose escalation to the former prostate bed has been associated with improved biochemical recurrence-free survival. Thus, it can be hypothesised that PSMA PET/CT-based radiotherapy might improve the prognosis of these patients. One hundred twenty-nine patients underwent PSMA PET/CT due to biochemical persistence (52%) or recurrence (48%) after radical prostatectomy without evidence of distant metastases (February 2014-May 2017) and received PSMA PET/CT-based radiotherapy. Biochemical recurrence free survival (PSA ≤ 0.2 ng/ml) was defined as the study endpoint. Patients with biochemical persistence were significantly more often high-risk patients with significantly shorter time interval before PSMA PET/CT than patients with biochemical recurrence. Patients with biochemical recurrence had significantly more often no evidence of disease or local recurrence only in PSMA PET/CT, whereas patients with biochemical persistence had significantly more often lymph node involvement. Seventy-three patients were started on antiandrogen therapy prior to radiotherapy due to macroscopic disease in PSMA PET/CT. Cumulatively, 70 (66-70.6) Gy was delivered to local macroscopic tumor, 66 (63-66) Gy to the prostate fossa, 61.6 (53.2-66) Gy to PET-positive lymph nodes and 50.4 (45-52.3) Gy to lymphatic pathways. Median PSA after radiotherapy was 0.07 ng/ml with 74% of patients having a PSA ≤ 0.1 ng/ml. After a median follow-up of 20 months, median PSA was 0.07 ng/ml with ongoing antiandrogen therapy in 30 patients. PET-positive patients without antiandrogen therapy at last follow-up (45 patients) had a median PSA of 0.05 ng/ml with 89% of all patients, 94% of patients with biochemical recurrence and 82% of patients with biochemical persistence having a

  10. Palliation of dysphagia with radiotherapy for exophytic base tongue metastases in a case of renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Tabassum Wadasadawala

    2011-01-01

    Full Text Available Base tongue involvement is a rare presentation of lingual metastases from renal cell carcinoma. A 48-year-old gentleman was treated with open radical nephrectomy and adjuvant radiotherapy for Stage II Furhman grade I clear cell carcinoma of the left kidney at an outside hospital. He presented metachronously 5 years later with progressive dysphagia and change of voice. Clinicoradiological evaluation revealed a large exophytic mass in the oropharynx with epicenter in the right base of tongue. Metastatic workup revealed widespread dissemination to multiple organs and bone. In view of predominant symptom of dysphagia, base tongue metastasis was treated with protracted course of palliative radiotherapy to a dose of 50 Gy in conventional fractionation over 5 weeks. This resulted in excellent and durable response at the base tongue lesion (till the time of last follow-up. Radiation therapy is an acceptable palliative strategy for advanced lingual metastasis as it produces prompt relief of pain, bleeding, and dysphagia.

  11. Primary radiotherapy or postoperative radiotherapy in patients with head and neck cancer. Comparative analysis of inflammation-based prognostic scoring systems

    International Nuclear Information System (INIS)

    Selzer, Edgar; Grah, Anja; Heiduschka, Gregor; Thurnher, Dietmar; Kornek, Gabriela

    2015-01-01

    Inflammation-based scoring systems have potential value in evaluating the prognosis of cancer patients; however, detailed comparative analyses in well-characterized head and neck cancer patient collectives are missing. We analyzed overall survival (OS) in locally advanced head and neck cancer patients who were treated with curative intent by primary radiotherapy (RT) alone, by RT in combination with cetuximab (RIT) or with cisplatin (RCHT), and by primary surgery followed by postoperative radiotherapy (PORT). The primary RT collective (N = 170) was analyzed separately from the surgery plus RT group (N = 148). OS was estimated using the Kaplan-Meyer method. Cox proportional-hazard regression models were applied to compare the risk of death among patients stratified according to risk factors and the inflammation-based Glasgow Prognostic Score (GPS), the modified GPS (mGPS), the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the prognostic index (PI). A prognostic relevance of the scoring systems for OS was observed in the primarily irradiated, but not in the PORT collective. OS was 35.5, 18.8, and 15.4 months, respectively, according to GPS 0, 1, and 2. OS according to mGPS 0-2 was identical. The PLR scoring system was not of prognostic relevance, while OS was 27.3 months in the NLR 0 group and 17.3 months in the NLR 1 group. OS was 35.5 months in PI 0, 16.1 months in PI 1, and 22.6 months in PI 2. GPS/mGPS scoring systems are able to discriminate between three risk groups in primarily, but not postoperatively irradiated locally advanced head and neck cancer patients. (orig.) [de

  12. Knowledge-light adaptation approaches in case-based reasoning for radiotherapy treatment planning.

    Science.gov (United States)

    Petrovic, Sanja; Khussainova, Gulmira; Jagannathan, Rupa

    2016-03-01

    Radiotherapy treatment planning aims at delivering a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour-surrounding area. It is a time-consuming trial-and-error process that requires the expertise of a group of medical experts including oncologists and medical physicists and can take from 2 to 3h to a few days. Our objective is to improve the performance of our previously built case-based reasoning (CBR) system for brain tumour radiotherapy treatment planning. In this system, a treatment plan for a new patient is retrieved from a case base containing patient cases treated in the past and their treatment plans. However, this system does not perform any adaptation, which is needed to account for any difference between the new and retrieved cases. Generally, the adaptation phase is considered to be intrinsically knowledge-intensive and domain-dependent. Therefore, an adaptation often requires a large amount of domain-specific knowledge, which can be difficult to acquire and often is not readily available. In this study, we investigate approaches to adaptation that do not require much domain knowledge, referred to as knowledge-light adaptation. We developed two adaptation approaches: adaptation based on machine-learning tools and adaptation-guided retrieval. They were used to adapt the beam number and beam angles suggested in the retrieved case. Two machine-learning tools, neural networks and naive Bayes classifier, were used in the adaptation to learn how the difference in attribute values between the retrieved and new cases affects the output of these two cases. The adaptation-guided retrieval takes into consideration not only the similarity between the new and retrieved cases, but also how to adapt the retrieved case. The research was carried out in collaboration with medical physicists at the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. All experiments were performed using real-world brain cancer

  13. Postoperative radiotherapy for prostate cancer. Morbidity of local-only or local-plus-pelvic radiotherapy

    International Nuclear Information System (INIS)

    Waldstein, Cora; Poetter, Richard; Widder, Joachim; Goldner, Gregor; Doerr, Wolfgang

    2018-01-01

    The aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer. Based on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups. For local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7 Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3 Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5-year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5-year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%. Despite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4-field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects. (orig.) [de

  14. Evidence-based review: Quality of life following head and neck intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Scott-Brown, Martin; Miah, Aisha; Harrington, Kevin; Nutting, Chris

    2010-01-01

    Inverse planned Intensity modulated radiotherapy (IMRT) can minimize the dose to normal structures and therefore can reduce long-term radiotherapy-related morbidity and may improve patients' long-term quality of life. Despite overwhelming evidence that IMRT can reduce late functional deficits in patients with head and neck cancer, treated with radiotherapy, a review of the published literature produced conflicting results with regard to quality of life outcomes. Following a critical appraisal of the literature, reasons for the discrepant outcomes are proposed.

  15. Clinical outcome of extended-field irradiation vs. pelvic irradiation using intensity-modulated radiotherapy for cervical cancer.

    Science.gov (United States)

    Ouyang, Yi; Wang, Yanhong; Chen, Kai; Cao, Xinping; Zeng, Yiming

    2017-12-01

    The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para-aortic node involvement, who were treated with extended-field intensity-modulated radiotherapy (EF-IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF-IMRT and 52 patients treated with pelvic IMRT at the Sun Yat-Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF-IMRT had the highest level of lymph node involvement to the para-aortic or common iliac nodes, while patients treated with pelvic IMRT had no para-aortic or common iliac nodes involved (Pirradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF-IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF-IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para-aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.

  16. Similar-Case-Based Optimization of Beam Arrangements in Stereotactic Body Radiotherapy for Assisting Treatment Planners

    Directory of Open Access Journals (Sweden)

    Taiki Magome

    2013-01-01

    Full Text Available Objective. To develop a similar-case-based optimization method for beam arrangements in lung stereotactic body radiotherapy (SBRT to assist treatment planners. Methods. First, cases that are similar to an objective case were automatically selected based on geometrical features related to a planning target volume (PTV location, PTV shape, lung size, and spinal cord position. Second, initial beam arrangements were determined by registration of similar cases with the objective case using a linear registration technique. Finally, beam directions of the objective case were locally optimized based on the cost function, which takes into account the radiation absorption in normal tissues and organs at risk. The proposed method was evaluated with 10 test cases and a treatment planning database including 81 cases, by using 11 planning evaluation indices such as tumor control probability and normal tissue complication probability (NTCP. Results. The procedure for the local optimization of beam arrangements improved the quality of treatment plans with significant differences (P<0.05 in the homogeneity index and conformity index for the PTV, V10, V20, mean dose, and NTCP for the lung. Conclusion. The proposed method could be usable as a computer-aided treatment planning tool for the determination of beam arrangements in SBRT.

  17. Fast CPU-based Monte Carlo simulation for radiotherapy dose calculation

    Science.gov (United States)

    Ziegenhein, Peter; Pirner, Sven; Kamerling, Cornelis Ph; Oelfke, Uwe

    2015-08-01

    Monte-Carlo (MC) simulations are considered to be the most accurate method for calculating dose distributions in radiotherapy. Its clinical application, however, still is limited by the long runtimes conventional implementations of MC algorithms require to deliver sufficiently accurate results on high resolution imaging data. In order to overcome this obstacle we developed the software-package PhiMC, which is capable of computing precise dose distributions in a sub-minute time-frame by leveraging the potential of modern many- and multi-core CPU-based computers. PhiMC is based on the well verified dose planning method (DPM). We could demonstrate that PhiMC delivers dose distributions which are in excellent agreement to DPM. The multi-core implementation of PhiMC scales well between different computer architectures and achieves a speed-up of up to 37× compared to the original DPM code executed on a modern system. Furthermore, we could show that our CPU-based implementation on a modern workstation is between 1.25× and 1.95× faster than a well-known GPU implementation of the same simulation method on a NVIDIA Tesla C2050. Since CPUs work on several hundreds of GB RAM the typical GPU memory limitation does not apply for our implementation and high resolution clinical plans can be calculated.

  18. Stereotactic radiotherapy using Novalis for skull base metastases developing with cranial nerve symptoms.

    Science.gov (United States)

    Mori, Yoshimasa; Hashizume, Chisa; Kobayashi, Tatsuya; Shibamoto, Yuta; Kosaki, Katsura; Nagai, Aiko

    2010-06-01

    Skull base metastases are challenging situations because they often involve critical structures such as cranial nerves. We evaluated the role of stereotactic radiotherapy (SRT) which can give high doses to the tumors sparing normal structures. We treated 11 cases of skull base metastases from other visceral carcinomas. They had neurological symptoms due to cranial nerve involvement including optic nerve (3 patients), oculomotor (3), trigeminal (6), abducens (1), facial (4), acoustic (1), and lower cranial nerves (1). The interval between the onset of cranial nerve symptoms and Novalis SRT was 1 week to 7 months. Eleven tumors of 8-112 ml in volume were treated by Novalis SRT with 30-50 Gy in 10-14 fractions. The tumors were covered by 90-95% isodose. Imaging and clinical follow-up has been obtained in all 11 patients for 5-36 months after SRT. Seven patients among 11 died from primary carcinoma or other visceral metastases 9-36 months after Novalis SRT. All 11 metastatic tumors were locally controlled until the end of the follow-up time or patient death, though retreatment for re-growth was done in 1 patient. In 10 of 11 patients, cranial nerve deficits were improved completely or partially. In some patients, the cranial nerve symptoms were relieved even during the period of fractionated SRT. Novalis SRT is thought to be safe and effective treatment for skull base metastases with involvement of cranial nerves and it may improve cranial nerve symptoms quickly.

  19. SU-G-BRA-03: PCA Based Imaging Angle Optimization for 2D Cine MRI Based Radiotherapy Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Chen, T; Yue, N; Jabbour, S; Zhang, M [Rutgers University, New Brunswick, NJ (United States)

    2016-06-15

    Purpose: To develop an imaging angle optimization methodology for orthogonal 2D cine MRI based radiotherapy guidance using Principal Component Analysis (PCA) of target motion retrieved from 4DCT. Methods: We retrospectively analyzed 4DCT of 6 patients with lung tumor. A radiation oncologist manually contoured the target volume at the maximal inhalation phase of the respiratory cycle. An object constrained deformable image registration (DIR) method has been developed to track the target motion along the respiration at ten phases. The motion of the center of the target mass has been analyzed using the PCA to find out the principal motion components that were uncorrelated with each other. Two orthogonal image planes for cineMRI have been determined using this method to minimize the through plane motion during MRI based radiotherapy guidance. Results: 3D target respiratory motion for all 6 patients has been efficiently retrieved from 4DCT. In this process, the object constrained DIR demonstrated satisfactory accuracy and efficiency to enable the automatic motion tracking for clinical application. The average motion amplitude in the AP, lateral, and longitudinal directions were 3.6mm (min: 1.6mm, max: 5.6mm), 1.7mm (min: 0.6mm, max: 2.7mm), and 5.6mm (min: 1.8mm, max: 16.1mm), respectively. Based on PCA, the optimal orthogonal imaging planes were determined for cineMRI. The average angular difference between the PCA determined imaging planes and the traditional AP and lateral imaging planes were 47 and 31 degrees, respectively. After optimization, the average amplitude of through plane motion reduced from 3.6mm in AP images to 2.5mm (min:1.3mm, max:3.9mm); and from 1.7mm in lateral images to 0.6mm (min: 0.2mm, max:1.5mm), while the principal in plane motion amplitude increased from 5.6mm to 6.5mm (min: 2.8mm, max: 17mm). Conclusion: DIR and PCA can be used to optimize the orthogonal image planes of cineMRI to minimize the through plane motion during radiotherapy

  20. SU-G-BRA-03: PCA Based Imaging Angle Optimization for 2D Cine MRI Based Radiotherapy Guidance

    International Nuclear Information System (INIS)

    Chen, T; Yue, N; Jabbour, S; Zhang, M

    2016-01-01

    Purpose: To develop an imaging angle optimization methodology for orthogonal 2D cine MRI based radiotherapy guidance using Principal Component Analysis (PCA) of target motion retrieved from 4DCT. Methods: We retrospectively analyzed 4DCT of 6 patients with lung tumor. A radiation oncologist manually contoured the target volume at the maximal inhalation phase of the respiratory cycle. An object constrained deformable image registration (DIR) method has been developed to track the target motion along the respiration at ten phases. The motion of the center of the target mass has been analyzed using the PCA to find out the principal motion components that were uncorrelated with each other. Two orthogonal image planes for cineMRI have been determined using this method to minimize the through plane motion during MRI based radiotherapy guidance. Results: 3D target respiratory motion for all 6 patients has been efficiently retrieved from 4DCT. In this process, the object constrained DIR demonstrated satisfactory accuracy and efficiency to enable the automatic motion tracking for clinical application. The average motion amplitude in the AP, lateral, and longitudinal directions were 3.6mm (min: 1.6mm, max: 5.6mm), 1.7mm (min: 0.6mm, max: 2.7mm), and 5.6mm (min: 1.8mm, max: 16.1mm), respectively. Based on PCA, the optimal orthogonal imaging planes were determined for cineMRI. The average angular difference between the PCA determined imaging planes and the traditional AP and lateral imaging planes were 47 and 31 degrees, respectively. After optimization, the average amplitude of through plane motion reduced from 3.6mm in AP images to 2.5mm (min:1.3mm, max:3.9mm); and from 1.7mm in lateral images to 0.6mm (min: 0.2mm, max:1.5mm), while the principal in plane motion amplitude increased from 5.6mm to 6.5mm (min: 2.8mm, max: 17mm). Conclusion: DIR and PCA can be used to optimize the orthogonal image planes of cineMRI to minimize the through plane motion during radiotherapy

  1. Radiotherapy physics

    International Nuclear Information System (INIS)

    Chen, G.T.Y.; Collier, J.M.; Lyman, J.T.; Pitluck, S.

    1982-01-01

    The Radiotherapy Physics Group works on the physical and biophysical aspects of charged particle radiotherapy. Our activities include the development of isosurvival beams (beams of uniform biological effect), computerized treatment planning development for charged particle radiotherapy, design of compensation to shape dose distributions, and development of dosimetry techniques to verify planned irradiations in both phantoms and patients

  2. A singular value decomposition linear programming (SVDLP) optimization technique for circular cone based robotic radiotherapy

    Science.gov (United States)

    Liang, Bin; Li, Yongbao; Wei, Ran; Guo, Bin; Xu, Xuang; Liu, Bo; Li, Jiafeng; Wu, Qiuwen; Zhou, Fugen

    2018-01-01

    With robot-controlled linac positioning, robotic radiotherapy systems such as CyberKnife significantly increase freedom of radiation beam placement, but also impose more challenges on treatment plan optimization. The resampling mechanism in the vendor-supplied treatment planning system (MultiPlan) cannot fully explore the increased beam direction search space. Besides, a sparse treatment plan (using fewer beams) is desired to improve treatment efficiency. This study proposes a singular value decomposition linear programming (SVDLP) optimization technique for circular collimator based robotic radiotherapy. The SVDLP approach initializes the input beams by simulating the process of covering the entire target volume with equivalent beam tapers. The requirements on dosimetry distribution are modeled as hard and soft constraints, and the sparsity of the treatment plan is achieved by compressive sensing. The proposed linear programming (LP) model optimizes beam weights by minimizing the deviation of soft constraints subject to hard constraints, with a constraint on the l 1 norm of the beam weight. A singular value decomposition (SVD) based acceleration technique was developed for the LP model. Based on the degeneracy of the influence matrix, the model is first compressed into lower dimension for optimization, and then back-projected to reconstruct the beam weight. After beam weight optimization, the number of beams is reduced by removing the beams with low weight, and optimizing the weights of the remaining beams using the same model. This beam reduction technique is further validated by a mixed integer programming (MIP) model. The SVDLP approach was tested on a lung case. The results demonstrate that the SVD acceleration technique speeds up the optimization by a factor of 4.8. Furthermore, the beam reduction achieves a similar plan quality to the globally optimal plan obtained by the MIP model, but is one to two orders of magnitude faster. Furthermore, the SVDLP

  3. A singular value decomposition linear programming (SVDLP) optimization technique for circular cone based robotic radiotherapy.

    Science.gov (United States)

    Liang, Bin; Li, Yongbao; Wei, Ran; Guo, Bin; Xu, Xuang; Liu, Bo; Li, Jiafeng; Wu, Qiuwen; Zhou, Fugen

    2018-01-05

    With robot-controlled linac positioning, robotic radiotherapy systems such as CyberKnife significantly increase freedom of radiation beam placement, but also impose more challenges on treatment plan optimization. The resampling mechanism in the vendor-supplied treatment planning system (MultiPlan) cannot fully explore the increased beam direction search space. Besides, a sparse treatment plan (using fewer beams) is desired to improve treatment efficiency. This study proposes a singular value decomposition linear programming (SVDLP) optimization technique for circular collimator based robotic radiotherapy. The SVDLP approach initializes the input beams by simulating the process of covering the entire target volume with equivalent beam tapers. The requirements on dosimetry distribution are modeled as hard and soft constraints, and the sparsity of the treatment plan is achieved by compressive sensing. The proposed linear programming (LP) model optimizes beam weights by minimizing the deviation of soft constraints subject to hard constraints, with a constraint on the l 1 norm of the beam weight. A singular value decomposition (SVD) based acceleration technique was developed for the LP model. Based on the degeneracy of the influence matrix, the model is first compressed into lower dimension for optimization, and then back-projected to reconstruct the beam weight. After beam weight optimization, the number of beams is reduced by removing the beams with low weight, and optimizing the weights of the remaining beams using the same model. This beam reduction technique is further validated by a mixed integer programming (MIP) model. The SVDLP approach was tested on a lung case. The results demonstrate that the SVD acceleration technique speeds up the optimization by a factor of 4.8. Furthermore, the beam reduction achieves a similar plan quality to the globally optimal plan obtained by the MIP model, but is one to two orders of magnitude faster. Furthermore, the SVDLP

  4. Biomarkers of Tumour Radiosensitivity and Predicting Benefit from Radiotherapy.

    Science.gov (United States)

    Forker, L J; Choudhury, A; Kiltie, A E

    2015-10-01

    Radiotherapy is an essential component of treatment for more than half of newly diagnosed cancer patients. The response to radiotherapy varies widely between individuals and although advances in technology have allowed the adaptation of radiotherapy fields to tumour anatomy, it is still not possible to tailor radiotherapy based on tumour biology. A biomarker of intrinsic radiosensitivity would be extremely valuable for individual dosing, aiding decision making between radical treatment options and avoiding toxicity of neoadjuvant or adjuvant radiotherapy in those unlikely to benefit. This systematic review summarises the current evidence for biomarkers under investigation as predictors of radiotherapy benefit. Only 10 biomarkers were identified as having been evaluated for their radiotherapy-specific predictive value in over 100 patients in a clinical setting, highlighting that despite a rich literature there were few high-quality studies for inclusion. The most extensively studied radiotherapy predictive biomarkers were the radiosensitivity index and MRE11; however, neither has been evaluated in a randomised controlled trial. Although these biomarkers show promise, there is not enough evidence to justify their use in routine practice. Further validation is needed before biomarkers can fulfil their potential and predict treatment outcomes for large numbers of patients. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  5. 331 cases of clinically node-negative supraglottic carcinoma of the larynx: a study of a modest size fixed field radiotherapy approach

    International Nuclear Information System (INIS)

    Sykes, Andrew J.; Slevin, Nicholas J.; Gupta, Nirmal K.; Brewster, Allison E.

    2000-01-01

    Purpose: For node-negative supraglottic carcinoma of the larynx, radiotherapy with surgery in reserve commonly provides very good results in terms of both local control and survival, while preserving function. However uncertainty exists over the treatment of the node-negative neck. Elective whole neck radiotherapy, while effective, may be associated with significant morbidity. The purpose of this study was to examine our practice of treating a modest size, fixed field to a high biologically effective dose and compare it with the patterns of recurrence from other centers that use different dose/volume approaches. Methods and Materials: Over a 10-year period 331 patients with node-negative supraglottic carcinoma of the larynx were treated with radiotherapy at the Christie Hospital Manchester. Patients were treated with doses of 50-55 Gy in 16 fractions over 3 weeks. Data were collected retrospectively for local and regional control, survival, and morbidity. Results: Overall local control, after surgical salvage in 17 cases, was 79% (T1-92%, T2-81%, T3-67%, T4-73%). Overall regional lymph node control, after surgical salvage in 13 cases, was 84% (T1-91%, T2-88%, T3-81%, T4-72%). Five-year crude survival was 50%, but after correcting for intercurrent deaths was 70% (T1-83%, T2-78%, T3-53%, T4-61%). Serious morbidity requiring surgery was seen in 7 cases (2.1%) and was related to prescribed dose (50 Gy-0%, 52.5 Gy-1.3%, 55 Gy-3.4%). Discussion: Our results confirm that treating a modest size, fixed field to a high biologically effective dose is highly effective. It enables preservation of the larynx in most cases, with acceptable regional control and no loss of survival compared to whole neck radiotherapy regimes

  6. Paperless and paper-based processes in the modern radiotherapy department

    Energy Technology Data Exchange (ETDEWEB)

    Middleton, M. [Radiation Oncology Queensland, 280 North Street, Toowoomba 4350 (Australia)], E-mail: mark.middleton@roq.net.au; Bradford, C. [Harley St. Cancer Centre, London (United Kingdom); Frantzis, J. [Radiation Oncology Queensland, 280 North Street, Toowoomba 4350 (Australia); Ambler, A. [Harley St. Cancer Centre, London (United Kingdom); Sisson, T. [Radiation Oncology Queensland, 280 North Street, Toowoomba 4350 (Australia); Montgomerie, D. [Harley St. Cancer Centre, London (United Kingdom); Martin, J. [Radiation Oncology Queensland, 280 North Street, Toowoomba 4350 (Australia)

    2009-11-15

    Purpose: To assess the implications on workflow and efficiency in a paperless environment versus a traditional paper-based environment. This paper summarises the comparison of specific workflow practices conducted in a paperless and paper-based approach, comparing time taken, potential advantages and disadvantages of each approach, and the cost-effectiveness of a paperless approach. Methods and materials: A time study was undertaken on three specific workflow areas for 5 patients with breast and prostate cancer respectively, and comparison made between paperless and paper-based methodology. The workflow areas analysed were electronic treatment record (ETR) versus treatment sheet preparation, digital history check process versus paper-based and digital image and trend analysis versus paper-based. The cost-effectiveness of a paperless approach was then analysed. Additionally a staff questionnaire was undertaken, assessing Information Technology (IT) skills of staff and comfort levels pertaining to a paperless environment. Results: There was on average a 50% reduction in workload when comparing an ETR versus a paper-based treatment sheet, a 50% reduction in workload by utilising a paperless history check process and a 70% reduction in workload with a paperless image and trend analysis process. There was also significant cost savings by introducing a paperless workflow. The survey showed a higher level of comfort with information technology in the paperless environment, and less frustration with aspects of working in the paper-based centre. Conclusion: The digital radiotherapy department offers highly significant improvements in efficiency. These potentially translate into major financial savings and increased job satisfaction.

  7. Paperless and paper-based processes in the modern radiotherapy department

    International Nuclear Information System (INIS)

    Middleton, M.; Bradford, C.; Frantzis, J.; Ambler, A.; Sisson, T.; Montgomerie, D.; Martin, J.

    2009-01-01

    Purpose: To assess the implications on workflow and efficiency in a paperless environment versus a traditional paper-based environment. This paper summarises the comparison of specific workflow practices conducted in a paperless and paper-based approach, comparing time taken, potential advantages and disadvantages of each approach, and the cost-effectiveness of a paperless approach. Methods and materials: A time study was undertaken on three specific workflow areas for 5 patients with breast and prostate cancer respectively, and comparison made between paperless and paper-based methodology. The workflow areas analysed were electronic treatment record (ETR) versus treatment sheet preparation, digital history check process versus paper-based and digital image and trend analysis versus paper-based. The cost-effectiveness of a paperless approach was then analysed. Additionally a staff questionnaire was undertaken, assessing Information Technology (IT) skills of staff and comfort levels pertaining to a paperless environment. Results: There was on average a 50% reduction in workload when comparing an ETR versus a paper-based treatment sheet, a 50% reduction in workload by utilising a paperless history check process and a 70% reduction in workload with a paperless image and trend analysis process. There was also significant cost savings by introducing a paperless workflow. The survey showed a higher level of comfort with information technology in the paperless environment, and less frustration with aspects of working in the paper-based centre. Conclusion: The digital radiotherapy department offers highly significant improvements in efficiency. These potentially translate into major financial savings and increased job satisfaction.

  8. Concurrent radiotherapy with temozolomide vs. concurrent radiotherapy with a cisplatinum-based polychemotherapy regimen. Acute toxicity in pediatric high-grade glioma patients

    International Nuclear Information System (INIS)

    Seidel, Clemens; Kortmann, Rolf D.; Bueren, Andre O. von; Bojko, Sabrina; Hoffmann, Marion; Kramm, Christof M.; Pietsch, Torsten; Gielen, Gerrit H.; Warmuth-Metz, Monika; Bison, Brigitte

    2018-01-01

    As the efficacy of all pediatric high-grade glioma (HGG) treatments is similar and still disappointing, it is essential to also investigate the toxicity of available treatments. Prospectively recorded hematologic and nonhematologic toxicities of children treated with radiochemotherapy in the HIT GBM-C/D and HIT-HGG-2007 trials were compared. Children aged 3-18 years with histologically proven HGG (WHO grade III and IV tumors) or unequivocal radiologic diagnosis of diffuse intrinsic pontine glioma (DIPG) were included in these trials. The HIT-HGG-2007 protocol comprised concomitant radiochemotherapy with temozolomide, while cisplatinum/etoposide (PE) and PE plus ifosfamide (PEI) in combination with weekly vincristine injections were applied during radiochemotherapy in the HIT GBM-C/D protocol. Regular blood counts and information about cellular nadirs were available from 304 patients (leukocytes) and 306 patients (thrombocytes), respectively. Grade 3-4 leukopenia was much more frequent in the HIT GBM-C/D cohort (n = 88, 52%) vs. HIT-HGG-2007 (n = 13, 10%; P <0.001). Grade 3-4 thrombopenia was also more likely in the HIT GBM-C/D cohort (n = 21, 12% vs. n = 3,2%; P <0.001). Grade 3-4 leukopenia appeared more often in children aged 3-7 years (n = 38/85, 45%) than in children aged 8-12 years (n = 39/120, 33%) and 13-18 years (24/100, 24%; P =0.034). In addition, sickness was more frequent in the HIT GBM-C/D cohort (grade 1-2: 44%, grade 3-4: 6% vs. grade 1-2: 28%, grade 3-4: 1%; P <0.001). Radiochemotherapy involving cisplatinum-based polychemotherapy is more toxic than radiotherapy in combination with temozolomide. Without evidence of differences in therapeutic efficacy, the treatment with lower toxicity, i. e., radiotherapy with temozolomide should be used. (orig.) [de

  9. Cardiac Side-effects From Breast Cancer Radiotherapy.

    Science.gov (United States)

    Taylor, C W; Kirby, A M

    2015-11-01

    Breast cancer radiotherapy reduces the risk of cancer recurrence and death. However, it usually involves some radiation exposure of the heart and analyses of randomised trials have shown that it can increase the risk of heart disease. Estimates of the absolute risks of radiation-related heart disease are needed to help oncologists plan each individual woman's treatment. The risk for an individual woman varies according to her estimated cardiac radiation dose and her background risk of ischaemic heart disease in the absence of radiotherapy. When it is known, this risk can then be compared with the absolute benefit of the radiotherapy. At present, many UK cancer centres are already giving radiotherapy with mean heart doses of less than 3 Gy and for most women the benefits of the radiotherapy will probably far outweigh the risks. Technical approaches to minimising heart dose in breast cancer radiotherapy include optimisation of beam angles, use of multileaf collimator shielding, intensity-modulated radiotherapy, treatment in a prone position, treatment in deep inspiration (including the use of breath-hold and gating techniques), proton therapy and partial breast irradiation. The multileaf collimator is suitable for many women with upper pole left breast cancers, but for women with central or lower pole cancers, breath-holding techniques are now recommended in national UK guidelines. Ongoing work aims to identify ways of irradiating pan-regional lymph nodes that are effective, involve minimal exposure of organs at risk and are feasible to plan, deliver and verify. These will probably include wide tangent-based field-in-field intensity-modulated radiotherapy or arc radiotherapy techniques in combination with deep inspiratory breath-hold, and proton beam irradiation for women who have a high predicted heart dose from intensity-modulated radiotherapy. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Establishment of dosimetric references for high energy X-ray beams of very small field sizes (≤ 1 cm2) used in radiotherapy

    International Nuclear Information System (INIS)

    Dufreneix, Stephane

    2014-01-01

    The French primary standard dosimetry laboratory 'Laboratoire National Henri Becquerel' is in charge of the establishment of dosimetric standards for ionizing radiation beams. Absolute dose measurements are thus available for X-Ray beams used in radiotherapy for field sizes between 10 and 2 cm. Since the miniaturization of absolute dosimeters is not possible for smaller field sizes, a dose area product (DAP) has been suggested as a substitute to the absorbed dose at a point.In order to measure a DAP with dosimeters which sensitive surface is larger than the beam, a graphite calorimeter with a sensitive surface of 3 cm diameter was designed, built and tested. An ionization chamber with the same diameter was realized and tested to transfer the dosimetric references to the end users. Its calibration factor in terms of DAP was determined in circular beams of 2, 1 and 0.75 cm diameter with an uncertainty smaller than 0.7 %. The two-Dimension relative dose distribution was measured thanks to a diamond dosimeter, a PinPoint ionization chamber and gafchromic films, using a specific protocol. Both approaches, respectively based on a PDS and an absorbed dose to water at a point, were in good agreement in the 2 cm beam. Correction factors determined from Monte Carlo simulations and measured dose distributions were needed for this comparison. The calibration factor of the large ionization chamber in the 1 and 0.75 cm diameter beams were in good agreement within the uncertainties but a gap of -2.6 % was found with the one established in the 2 cm diameter beam. As a result, the DAP can be used if the sensitive surface is much larger than the beam section. (author) [fr

  11. A modified VMAT adaptive radiotherapy for nasopharyngeal cancer patients based on CT-CT image fusion

    International Nuclear Information System (INIS)

    Jin, Xiance; Han, Ce; Zhou, Yongqiang; Yi, Jinling; Yan, Huawei; Xie, Congying

    2013-01-01

    To investigate the feasibility and benefits of a modified adaptive radiotherapy (ART) by replanning in the initial CT (iCT) with new contours from a repeat CT (rCT) based on CT-CT image fusion for nasopharyngeal cancer (NPC) patients underwent volumetric modulated arc radiotherapy (VMAT). Nine NPC patients underwent VMAT treatment with a rCT at 23rd fraction were enrolled in this study. Dosimetric differences for replanning VMAT plans in the iCT and in the rCT were compared. Volumetric and dosimetric changes of gross tumor volume (GTV) and organs at risk (OARs) of this modified ART were also investigated. No dosimetric differences between replanning in the iCT and in the rCT were observed. The average volume of GTV decreased from 78.83 ± 38.42 cm 3 in the iCT to 71.44 ± 37.46 cm 3 in the rCT, but with no significant difference (p = 0.42).The average volume of the left and right parotid decreased from 19.91 ± 4.89 cm 3 and 21.58 ± 6.16 cm 3 in the iCT to 11.80 ± 2.79 cm 3 and 13.29 ± 4.17 cm 3 in the rCT (both p < 0.01), respectively. The volume of other OARs did not shrink very much. No significant differences on PTV GTV and PTV CTV coverage were observed for replanning with this modified ART. Compared to the initial plans, the average mean dose of the left and right parotid after re-optimization were decreased by 62.5 cGy (p = 0.05) and 67.3 cGy (p = 0.02), respectively, and the V5 (the volume receiving 5 Gy) of the left and right parotids were decreased by 7.8% (p = 0.01) and 11.2% (p = 0.001), respectively. There was no significant difference on the dose delivered to other OARs. Patients with NPC undergoing VMAT have significant anatomic and dosimetric changes to parotids. Repeat CT as an anatomic changes reference and re-optimization in the iCT based on CT-CT image fusion was accurate enough to identify the volume changes and to ensure safe dose to parotids

  12. A technique for generating phase-space-based Monte Carlo beamlets in radiotherapy applications

    International Nuclear Information System (INIS)

    Bush, K; Popescu, I A; Zavgorodni, S

    2008-01-01

    As radiotherapy treatment planning moves toward Monte Carlo (MC) based dose calculation methods, the MC beamlet is becoming an increasingly common optimization entity. At present, methods used to produce MC beamlets have utilized a particle source model (PSM) approach. In this work we outline the implementation of a phase-space-based approach to MC beamlet generation that is expected to provide greater accuracy in beamlet dose distributions. In this approach a standard BEAMnrc phase space is sorted and divided into beamlets with particles labeled using the inheritable particle history variable. This is achieved with the use of an efficient sorting algorithm, capable of sorting a phase space of any size into the required number of beamlets in only two passes. Sorting a phase space of five million particles can be achieved in less than 8 s on a single-core 2.2 GHz CPU. The beamlets can then be transported separately into a patient CT dataset, producing separate dose distributions (doselets). Methods for doselet normalization and conversion of dose to absolute units of Gy for use in intensity modulated radiation therapy (IMRT) plan optimization are also described. (note)

  13. Dosimetric impact of a frame-based strategy in stereotactic radiotherapy of lung tumors

    International Nuclear Information System (INIS)

    Waldeland, Einar; Ramberg, Christina; Arnesen, Marius Roethe; Helland, Aaslaug; Brustugun, Odd Terje; Malinen, Eirik

    2012-01-01

    Introduction. Technological innovations have taken stereotactic body radiotherapy (SBRT) from frame-based strategies to image-guided strategies. In this study, cone beam computed tomography (CBCT) images acquired prior to SBRT of patients with lung tumors was used to study the dosimetric impact of a pure frame-based strategy. Material and methods. Thirty patients with inoperable lung tumors were retrospectively analyzed. All patients had received CBCT-guided SBRT with 3 fractions of 15 Gy to the planning target volume (PTV) margin including immobilization in a stereotactic body frame (SBF). Using the set-up corrections from the co-registration of the CBCT with the planning CT, all individual dose plans were recalculated with an isocenter position equal to the initial set-up position. Dose Volume Histogram (DVH) parameters of the recalculated dose plans were then analyzed. Results. The simulated plans showed that 88% of all fractions resulted in minimum 14.5 Gy to the internal target volume (ITV). For the simulated summed treatment (3 fractions per patient), 83% of the patients would minimum receive the prescription dose (45 Gy) to 100% of the ITV and all except one would receive the prescription dose to more than 90% of the ITV. Conclusions. SBRT including SBF, but without image guidance, results in appropriate dose coverage in most cases, using the current margins. With image guidance, margins for SBRT of lung tumors could possibly be reduced

  14. Quantification of dose uncertainties for the bladder in prostate cancer radiotherapy based on dominant eigenmodes

    Science.gov (United States)

    Rios, Richard; Acosta, Oscar; Lafond, Caroline; Espinosa, Jairo; de Crevoisier, Renaud

    2017-11-01

    In radiotherapy for prostate cancer the dose at the treatment planning for the bladder may be a bad surrogate of the actual delivered dose as the bladder presents the largest inter-fraction shape variations during treatment. This paper presents PCA models as a virtual tool to estimate dosimetric uncertainties for the bladder produced by motion and deformation between fractions. Our goal is to propose a methodology to determine the minimum number of modes required to quantify dose uncertainties of the bladder for motion/deformation models based on PCA. We trained individual PCA models using the bladder contours available from three patients with a planning computed tomography (CT) and on-treatment cone-beam CTs (CBCTs). Based on the above models and via deformable image registration (DIR), we estimated two accumulated doses: firstly, an accumulated dose obtained by integrating the planning dose over the Gaussian probability distribution of the PCA model; and secondly, an accumulated dose obtained by simulating treatment courses via a Monte Carlo approach. We also computed a reference accumulated dose for each patient using his available images via DIR. Finally, we compared the planning dose with the three accumulated doses, and we calculated local dose variability and dose-volume histogram uncertainties.

  15. MRI-based treatment planning for radiotherapy: Dosimetric verification for prostate IMRT

    International Nuclear Information System (INIS)

    Chen, Lili; Price, Robert A.; Wang Lu; Li Jinsheng; Qin Lihong; McNeeley, Shawn; Ma, C.-M. Charlie; Freedman, Gary M.; Pollack, Alan

    2004-01-01

    and dose predicted by the planning system in the physical phantom. Conclusions: Magnetic resonance imaging is a useful tool for radiotherapy simulation. Compared with CT-based treatment planning, MR imaging-based treatment planning meets the accuracy for dose calculation and provides consistent treatment plans for prostate IMRT. Because MR imaging-based digitally reconstructed radiographs do not provide adequate bony structure information, a technique is suggested for producing a wire-frame image that is intended to replace the traditional digitally reconstructed radiographs that are made from CT information

  16. IMRT and 3D conformal radiotherapy with or without elective nodal irradiation in locally advanced NSCLC: A direct comparison of PET-based treatment planning.

    Science.gov (United States)

    Fleckenstein, Jochen; Kremp, Katharina; Kremp, Stephanie; Palm, Jan; Rübe, Christian

    2016-02-01

    The potential of intensity-modulated radiation therapy (IMRT) as opposed to three-dimensional conformal radiotherapy (3D-CRT) is analyzed for two different concepts of fluorodeoxyglucose positron emission tomography (FDG PET)-based target volume delineation in locally advanced non-small cell lung cancer (LA-NSCLC): involved-field radiotherapy (IF-RT) vs. elective nodal irradiation (ENI). Treatment planning was performed for 41 patients with LA-NSCLC, using four different planning approaches (3D-CRT-IF, 3D-CRT-ENI, IMRT-IF, IMRT-ENI). ENI included a boost irradiation after 50 Gy. For each plan, maximum dose escalation was calculated based on prespecified normal tissue constraints. The maximum prescription dose (PD), tumor control probability (TCP), conformal indices (CI), and normal tissue complication probabilities (NTCP) were analyzed. IMRT resulted in statistically significant higher prescription doses for both target volume concepts as compared with 3D-CRT (ENI: 68.4 vs. 60.9 Gy, p ENI, there was a considerable theoretical increase in TCP (IMRT: 27.3 vs. 17.7 %, p ENI: 12.3 vs. 30.9 % p < 0.0001; IF: 15.9 vs. 24.1 %; p < 0.001). The IMRT technique and IF target volume delineation allow a significant dose escalation and an increase in TCP. IMRT results in an improved sparing of OARs as compared with 3D-CRT at equivalent dose levels.

  17. Characterizing spatiotemporal information loss in sparse-sampling-based dynamic MRI for monitoring respiration-induced tumor motion in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Arai, Tatsuya J. [Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Nofiele, Joris; Yuan, Qing [Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Madhuranthakam, Ananth J.; Pedrosa, Ivan; Chopra, Rajiv [Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Sawant, Amit, E-mail: amit.sawant@utsouthwestern.edu [Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, 21201 (United States)

    2016-06-15

    Purpose: Sparse-sampling and reconstruction techniques represent an attractive strategy to achieve faster image acquisition speeds, while maintaining adequate spatial resolution and signal-to-noise ratio in rapid magnetic resonance imaging (MRI). The authors investigate the use of one such sequence, broad-use linear acquisition speed-up technique (k-t BLAST) in monitoring tumor motion for thoracic and abdominal radiotherapy and examine the potential trade-off between increased sparsification (to increase imaging speed) and the potential loss of “true” information due to greater reliance on a priori information. Methods: Lung tumor motion trajectories in the superior–inferior direction, previously recorded from ten lung cancer patients, were replayed using a motion phantom module driven by an MRI-compatible motion platform. Eppendorf test tubes filled with water which serve as fiducial markers were placed in the phantom. The modeled rigid and deformable motions were collected in a coronal image slice using balanced fast field echo in conjunction with k-t BLAST. Root mean square (RMS) error was used as a metric of spatial accuracy as measured trajectories were compared to input data. The loss of spatial information was characterized for progressively increasing acceleration factor from 1 to 16; the resultant sampling frequency was increased approximately from 2.5 to 19 Hz when the principal direction of the motion was set along frequency encoding direction. In addition to the phantom study, respiration-induced tumor motions were captured from two patients (kidney tumor and lung tumor) at 13 Hz over 49 s to demonstrate the impact of high speed motion monitoring over multiple breathing cycles. For each subject, the authors compared the tumor centroid trajectory as well as the deformable motion during free breathing. Results: In the rigid and deformable phantom studies, the RMS error of target tracking at the acquisition speed of 19 Hz was approximately 0.3–0

  18. The development and implementation of MOSAIQ Integration Platform (MIP) based on the radiotherapy workflow

    Science.gov (United States)

    Yang, Xin; He, Zhen-yu; Jiang, Xiao-bo; Lin, Mao-sheng; Zhong, Ning-shan; Hu, Jiang; Qi, Zhen-yu; Bao, Yong; Li, Qiao-qiao; Li, Bao-yue; Hu, Lian-ying; Lin, Cheng-guang; Gao, Yuan-hong; Liu, Hui; Huang, Xiao-yan; Deng, Xiao-wu; Xia, Yun-fei; Liu, Meng-zhong; Sun, Ying

    2017-03-01

    To meet the special demands in China and the particular needs for the radiotherapy department, a MOSAIQ Integration Platform CHN (MIP) based on the workflow of radiation therapy (RT) has been developed, as a supplement system to the Elekta MOSAIQ. The MIP adopts C/S (client-server) structure mode, and its database is based on the Treatment Planning System (TPS) and MOSAIQ SQL Server 2008, running on the hospital local network. Five network servers, as a core hardware, supply data storage and network service based on the cloud services. The core software, using C# programming language, is developed based on Microsoft Visual Studio Platform. The MIP server could offer network service, including entry, query, statistics and print information for about 200 workstations at the same time. The MIP was implemented in the past one and a half years, and some practical patient-oriented functions were developed. And now the MIP is almost covering the whole workflow of radiation therapy. There are 15 function modules, such as: Notice, Appointment, Billing, Document Management (application/execution), System Management, and so on. By June of 2016, recorded data in the MIP are as following: 13546 patients, 13533 plan application, 15475 RT records, 14656 RT summaries, 567048 billing records and 506612 workload records, etc. The MIP based on the RT workflow has been successfully developed and clinically implemented with real-time performance, data security, stable operation. And it is demonstrated to be user-friendly and is proven to significantly improve the efficiency of the department. It is a key to facilitate the information sharing and department management. More functions can be added or modified for further enhancement its potentials in research and clinical practice.

  19. SU-E-J-153: MRI Based, Daily Adaptive Radiotherapy for Rectal Cancer: Contour Adaptation

    International Nuclear Information System (INIS)

    Kleijnen, J; Burbach, M; Verbraeken, T; Weggers, R; Zoetelief, A; Reerink, O; Lagendijk, J; Raaymakers, B; Asselen, B

    2014-01-01

    Purpose: A major hurdle in adaptive radiotherapy is the adaptation of the planning MRI's delineations to the daily anatomy. We therefore investigate the accuracy and time needed for online clinical target volume (CTV) adaptation by radiation therapists (RTT), to be used in MRI-guided adaptive treatments on a MRI-Linac (MRL). Methods: Sixteen patients, diagnosed with early stage rectal cancer, underwent a T2-weighted MRI prior to each fraction of short-course radiotherapy, resulting in 4–5 scans per patient. On these scans, the CTV was delineated according to guidelines by an experienced radiation oncologist (RO) and considered to be the gold standard. For each patient, the first MRI was considered as the planning MRI and matched on bony anatomy to the 3–4 daily MRIs. The planning MRI's CTV delineation was rigidly propagated to the daily MRI scans as a proposal for adaptation. Three RTTs in training started the adaptation of the CTV conform guidelines, after a two hour training lecture and a two patient (n=7) training set. To assess the inter-therapist variation, all three RTTs altered delineations of 3 patients (n=12). One RTT altered the CTV delineations (n=53) of the remaining 11 patients. Time needed for adaptation of the CTV to guidelines was registered.As a measure of agreement, the conformity index (CI) was determined between the RTTs' delineations as a group. Dice similarity coefficients were determined between delineations of the RTT and the RO. Results: We found good agreement between RTTs' and RO's delineations (average Dice=0.91, SD=0.03). Furthermore, the inter-observer agreement between the RTTs was high (average CI=0.94, SD=0.02). Adaptation time reduced from 10:33 min (SD= 3:46) to 2:56 min (SD=1:06) between the first and last ten delineations, respectively. Conclusion: Daily CTV adaptation by RTTs, seems a feasible and safe way to introduce daily, online MRI-based plan adaptation for a MRL

  20. The international protocol for the dosimetry of external radiotherapy beams based on standards of absorbed dose to water

    International Nuclear Information System (INIS)

    Andreo, P.

    2001-01-01

    An International Code of Practice (CoP, or dosimetry protocol) for external beam radiotherapy dosimetry based on standards of absorbed dose to water has been published by the IAEA on behalf of IAEA, WHO, PAHO and ESTRO. The CoP provides a systematic and internationally unified approach for the determination of the absorbed dose to water in reference conditions with radiotherapy beams. The development of absorbed-dose-to-water standards for high-energy photons and electrons offers the possibility of reducing the uncertainty in the dosimetry of radiotherapy beams. Many laboratories already provide calibrations at the radiation quality of 60Co gamma-rays and some have extended calibrations to high-energy photon and electron beams. The dosimetry of kilovoltage x-rays, as well as that of proton and ion beams can also be based on these standards. Thus, a coherent dosimetry system based on the same formalism is achieved for practically all radiotherapy beams. The practical use of the CoP as simple. The document is formed by a set of different CoPs for each radiation type, which include detailed procedures and worksheets. All CoPs are based on ND,w chamber calibrations at a reference beam quality Qo, together with radiation beam quality correction factors kQ preferably measured directly for the user's chamber in a standards laboratory. Calculated values of kQ are provided together with their uncertainty estimates. Beam quality specifiers are 60Co, TPR20,10 (high-energy photons), R50 (electrons), HVL and kV (x-rays) and Rres (protons and ions) [es

  1. Two cases with giant lung abscess originating in the irradiated lung field following the concurrent chemo-radiotherapy of lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Takeshi; Inui, Hiroyuki; Yukawa, Susumu; Nomoto, Hiroshi (Wakayama Medical Coll. (Japan)); Minakata, Yoshiaki; Yamagata, Toshiyuki

    1992-05-01

    Two patients with giant lung abscess originating in the irradiated lung field are reported. Lung abscesses occurred during the term of leukopenia following the concurrent chemo-radiotherapy of lung cancer. Both patients were diagnosed as small cell lung cancer, and were treated concurrently with chemotherapy (Cisplatin + Etoposide) and radiotherapy (total 40-50 Gy). Case 1 was a 59 years old male. Seven weeks after the first irradiation, a giant lung abscess was caused by methicillin resistant staphylococcus aureus (MRSA) originated in the lung field with radiation pneumonitis, and giant bronchial fistula was formed, that showed the specific bronchofiberscopic findings. Case 2 was a 67 years old male. Twelve weeks after the first irradiation, a giant lung abscess was caused by pseudomonas aeruginosa originated in the irradiated lung field following the formation of a pneumatocele. MRSA and pseudomonas aeruginosa are important as cause of hospital infection, and both can cause lung abscess. However, in our cases, lung abscess were formed just in the irradiated lung field and rapidly enlarged. These clinical findings suggested that myelosuppression and radiation injury of lung tissue might cause such giant lung abscess. (author).

  2. Two cases with giant lung abscess originating in the irradiated lung field following the concurrent chemo-radiotherapy of lung cancer

    International Nuclear Information System (INIS)

    Ikeda, Takeshi; Inui, Hiroyuki; Yukawa, Susumu; Nomoto, Hiroshi; Minakata, Yoshiaki; Yamagata, Toshiyuki.

    1992-01-01

    Two patients with giant lung abscess originating in the irradiated lung field are reported. Lung abscesses occurred during the term of leukopenia following the concurrent chemo-radiotherapy of lung cancer. Both patients were diagnosed as small cell lung cancer, and were treated concurrently with chemotherapy (Cisplatin + Etoposide) and radiotherapy (total 40-50 Gy). Case 1 was a 59 years old male. Seven weeks after the first irradiation, a giant lung abscess was caused by methicillin resistant staphylococcus aureus (MRSA) originated in the lung field with radiation pneumonitis, and giant bronchial fistula was formed, that showed the specific bronchofiberscopic findings. Case 2 was a 67 years old male. Twelve weeks after the first irradiation, a giant lung abscess was caused by pseudomonas aeruginosa originated in the irradiated lung field following the formation of a pneumatocele. MRSA and pseudomonas aeruginosa are important as cause of hospital infection, and both can cause lung abscess. However, in our cases, lung abscess were formed just in the irradiated lung field and rapidly enlarged. These clinical findings suggested that myelosuppression and radiation injury of lung tissue might cause such giant lung abscess. (author)

  3. Consolidation Radiotherapy in Primary Central Nervous System Lymphomas: Impact on Outcome of Different Fields and Doses in Patients in Complete Remission After Upfront Chemotherapy

    International Nuclear Information System (INIS)

    Ferreri, Andres Jose Maria; Verona, Chiara; Politi, Letterio Salvatore; Chiara, Anna; Perna, Lucia; Villa, Eugenio; Reni, Michele

    2011-01-01

    Purpose: Avoidance radiotherapy or reduction of irradiation doses in patients with primary central nervous system lymphoma (PCNSL) in complete remission (CR) after high-dose methotrexate (HD-MTX)-based chemotherapy has been proposed to minimize the neurotoxicity risk. Nevertheless, no study has focused on the survival impact of radiation parameters, as far as we know, and the optimal radiation schedule remains to be defined. Methods and Materials: The impact on outcome and neurologic performance of different radiation fields and doses was assessed in 33 patients with PCNSL who achieved CR after MTX-containing chemotherapy and were referred to consolidation whole-brain irradiation (WBRT). Patterns of relapse were analyzed on computed tomography-guided treatment planning, and neurologic impairment was assessed by the Mini Mental Status Examination. Results: At a median follow-up of 50 months, 21 patients are relapse-free (5-year failure-free survival [FFS], 51%). WBRT doses ≥40 Gy were not associated with improved disease control in comparison with a WBRT dose of 30 to 36 Gy (relapse rate, 46% vs. 30%; 5-year FFS, 51% vs. 50%; p = 0.26). Disease control was not significantly different between patients irradiated to the tumor bed with 45 to 54 Gy or with 36 to 44 Gy, with a 5-year FFS of 35% and 44% (p = 0.43), respectively. Twenty patients are alive (5-year overall survival, 54%); WB and tumor bed doses did not have an impact on survival. Impairment as assessed by the Mini Mental Status Examination was significantly more common in patients treated with a WBRT dose ≥40 Gy. Conclusion: Consolidation with WBRT 36 Gy is advisable in patients with PCNSL in CR after HD-MTX-based chemotherapy. Higher doses do not change the outcome and could increase the risk of neurotoxicity.

  4. The evidence base for the use of internal dosimetry in the clinical practice of molecular radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Strigari, Lidia [Regina Elena National Cancer Institute, Laboratory of Medical Physics and Expert Systems, Rome (Italy); Konijnenberg, Mark [Erasmus MC, Department of Nuclear Medicine, Rotterdam (Netherlands); Chiesa, Carlo [Instituto Nazionale Tumori, Department of Nuclear Medicine, Milan (Italy); Bardies, Manuel [UMR 1037 INSERM / Universite Paul Sabatier, Centre de Recherche en Cancerologie de Toulouse, Toulouse (France); Du, Yong [Royal Marsden NHS Foundation Trust, Department of Nuclear Medicine and PET/CT, Sutton, London (United Kingdom); Gleisner, Katarina Sjoegreen [Medical Radiation Physics, Clinical Sciences, Lund (Sweden); Lassmann, Michael [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Flux, Glenn [Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Joint Department of Physics, Sutton (United Kingdom)

    2014-10-15

    Molecular radiotherapy (MRT) has demonstrated unique therapeutic advantages in the treatment of an increasing number of cancers. As with other treatment modalities, there is related toxicity to a number of organs at risk. Despite the large number of clinical trials over the past several decades, considerable uncertainties still remain regarding the optimization of this therapeutic approach and one of the vital issues to be answered is whether an absorbed radiation dose-response exists that could be used to guide personalized treatment. There are only limited and sporadic data investigating MRT dosimetry. The determination of dose-effect relationships for MRT has yet to be the explicit aim of a clinical trial. The aim of this article was to collate and discuss the available evidence for an absorbed radiation dose-effect relationships in MRT through a review of published data. Based on a PubMed search, 92 papers were found. Out of 79 studies investigating dosimetry, an absorbed dose-effect correlation was found in 48. The application of radiobiological modelling to clinical data is of increasing importance and the limited published data on absorbed dose-effect relationships based on these models are also reviewed. Based on National Cancer Institute guideline definition, the studies had a moderate or low rate of clinical relevance due to the limited number of studies investigating overall survival and absorbed dose. Nevertheless, the evidence strongly implies a correlation between the absorbed doses delivered and the response and toxicity, indicating that dosimetry-based personalized treatments would improve outcome and increase survival. (orig.)

  5. Lateral Penumbra Modelling Based Leaf End Shape Optimization for Multileaf Collimator in Radiotherapy

    Directory of Open Access Journals (Sweden)

    Dong Zhou

    2016-01-01

    Full Text Available Lateral penumbra of multileaf collimator plays an important role in radiotherapy treatment planning. Growing evidence has revealed that, for a single-focused multileaf collimator, lateral penumbra width is leaf position dependent and largely attributed to the leaf end shape. In our study, an analytical method for leaf end induced lateral penumbra modelling is formulated using Tangent Secant Theory. Compared with Monte Carlo simulation and ray tracing algorithm, our model serves well the purpose of cost-efficient penumbra evaluation. Leaf ends represented in parametric forms of circular arc, elliptical arc, Bézier curve, and B-spline are implemented. With biobjective function of penumbra mean and variance introduced, genetic algorithm is carried out for approximating the Pareto frontier. Results show that for circular arc leaf end objective function is convex and convergence to optimal solution is guaranteed using gradient based iterative method. It is found that optimal leaf end in the shape of Bézier curve achieves minimal standard deviation, while using B-spline minimum of penumbra mean is obtained. For treatment modalities in clinical application, optimized leaf ends are in close agreement with actual shapes. Taken together, the method that we propose can provide insight into leaf end shape design of multileaf collimator.

  6. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors

    International Nuclear Information System (INIS)

    Herschtal, A; Te Marvelde, L; Mengersen, K; Foroudi, F; Ball, D; Devereux, T; Pham, D; Greer, P B; Pichler, P; Eade, T; Kneebone, A; Bell, L; Caine, H; Hindson, B; Kron, T; Hosseinifard, Z

    2015-01-01

    Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement (‘random error’) than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts −19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements. (paper)

  7. Selection and determination of beam weights based on genetic algorithms for conformal radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Xingen Wu; Zunliang Wang

    2000-01-01

    A genetic algorithm has been used to optimize the selection of beam weights for external beam three-dimensional conformal radiotherapy treatment planning. A fitness function is defined, which includes a difference function to achieve a least-square fit to doses at preselected points in a planning target volume, and a penalty item to constrain the maximum allowable doses delivered to critical organs. Adjustment between the dose uniformity within the target volume and the dose constraint to the critical structures can be achieved by varying the beam weight variables in the fitness function. A floating-point encoding schema and several operators, like uniform crossover, arithmetical crossover, geometrical crossover, Gaussian mutation and uniform mutation, have been used to evolve the population. Three different cases were used to verify the correctness of the algorithm and quality assessment based on dose-volume histograms and three-dimensional dose distributions were given. The results indicate that the genetic algorithm presented here has considerable potential. (author)

  8. Patient-specific dosimetric endpoints based treatment plan quality control in radiotherapy

    International Nuclear Information System (INIS)

    Song, Ting; Zhou, Linghong; Staub, David; Chen, Mingli; Lu, Weiguo; Tian, Zhen; Jia, Xun; Li, Yongbao; Jiang, Steve B; Gu, Xuejun

    2015-01-01

    In intensity modulated radiotherapy (IMRT), the optimal plan for each patient is specific due to unique patient anatomy. To achieve such a plan, patient-specific dosimetric goals reflecting each patient’s unique anatomy should be defined and adopted in the treatment planning procedure for plan quality control. This study is to develop such a personalized treatment plan quality control tool by predicting patient-specific dosimetric endpoints (DEs). The incorporation of patient specific DEs is realized by a multi-OAR geometry-dosimetry model, capable of predicting optimal DEs based on the individual patient’s geometry. The overall quality of a treatment plan is then judged with a numerical treatment plan quality indicator and characterized as optimal or suboptimal. Taking advantage of clinically available prostate volumetric modulated arc therapy (VMAT) treatment plans, we built and evaluated our proposed plan quality control tool. Using our developed tool, six of twenty evaluated plans were identified as sub-optimal plans. After plan re-optimization, these suboptimal plans achieved better OAR dose sparing without sacrificing the PTV coverage, and the dosimetric endpoints of the re-optimized plans agreed well with the model predicted values, which validate the predictability of the proposed tool. In conclusion, the developed tool is able to accurately predict optimally achievable DEs of multiple OARs, identify suboptimal plans, and guide plan optimization. It is a useful tool for achieving patient-specific treatment plan quality control. (paper)

  9. Langerhans Cell Histiocytosis of the Cranial Base: Is Low-Dose Radiotherapy Effective?

    Directory of Open Access Journals (Sweden)

    Andreas Meyer

    2012-01-01

    Full Text Available Introduction. Langerhans cell histiocytosis (LCH is a rare disease of unknown etiology with different clinical features. A standardised treatment has not been established so far. Case Report. We report a case of a 28-year-old patient who initially presented with hypesthesia of the fifth cranial nerve and pain of the left ear. Diagnosis showed a tumour localised in the cranial base with a maximum diameter of 4.1 cm. The diagnosis of LCH was confirmed histologically by biopsy. Diagnostic workup verified the cranial lesion as the sole manifestation of LCH. A total dose of 9 Gy (single dose 1.8 Gy was delivered. The symptoms dissolved completely within 6 months after radiation; repeated CT and MRI scans revealed a reduction in size of the lesion and a remineralisation of the bone. After a followup of 13 years the patient remains free of symptoms without relapse or any side effects from therapy. Discussion. Due to the indolent course of the disease with a high rate of spontaneous remissions the choice of treatment strongly depends on the individual clinical situation. In the presented case low-dose radiotherapy was sufficient to obtain long-term local control in a region with critical structures and tissues.

  10. Lateral Penumbra Modelling Based Leaf End Shape Optimization for Multileaf Collimator in Radiotherapy.

    Science.gov (United States)

    Zhou, Dong; Zhang, Hui; Ye, Peiqing

    2016-01-01

    Lateral penumbra of multileaf collimator plays an important role in radiotherapy treatment planning. Growing evidence has revealed that, for a single-focused multileaf collimator, lateral penumbra width is leaf position dependent and largely attributed to the leaf end shape. In our study, an analytical method for leaf end induced lateral penumbra modelling is formulated using Tangent Secant Theory. Compared with Monte Carlo simulation and ray tracing algorithm, our model serves well the purpose of cost-efficient penumbra evaluation. Leaf ends represented in parametric forms of circular arc, elliptical arc, Bézier curve, and B-spline are implemented. With biobjective function of penumbra mean and variance introduced, genetic algorithm is carried out for approximating the Pareto frontier. Results show that for circular arc leaf end objective function is convex and convergence to optimal solution is guaranteed using gradient based iterative method. It is found that optimal leaf end in the shape of Bézier curve achieves minimal standard deviation, while using B-spline minimum of penumbra mean is obtained. For treatment modalities in clinical application, optimized leaf ends are in close agreement with actual shapes. Taken together, the method that we propose can provide insight into leaf end shape design of multileaf collimator.

  11. Lateral Penumbra Modelling Based Leaf End Shape Optimization for Multileaf Collimator in Radiotherapy

    Science.gov (United States)

    Zhou, Dong; Zhang, Hui; Ye, Peiqing

    2016-01-01

    Lateral penumbra of multileaf collimator plays an important role in radiotherapy treatment planning. Growing evidence has revealed that, for a single-focused multileaf collimator, lateral penumbra width is leaf position dependent and largely attributed to the leaf end shape. In our study, an analytical method for leaf end induced lateral penumbra modelling is formulated using Tangent Secant Theory. Compared with Monte Carlo simulation and ray tracing algorithm, our model serves well the purpose of cost-efficient penumbra evaluation. Leaf ends represented in parametric forms of circular arc, elliptical arc, Bézier curve, and B-spline are implemented. With biobjective function of penumbra mean and variance introduced, genetic algorithm is carried out for approximating the Pareto frontier. Results show that for circular arc leaf end objective function is convex and convergence to optimal solution is guaranteed using gradient based iterative method. It is found that optimal leaf end in the shape of Bézier curve achieves minimal standard deviation, while using B-spline minimum of penumbra mean is obtained. For treatment modalities in clinical application, optimized leaf ends are in close agreement with actual shapes. Taken together, the method that we propose can provide insight into leaf end shape design of multileaf collimator. PMID:27110274

  12. Dosimetric comparison of intensity-modulated, conformal, and four-field pelvic radiotherapy boost plans for gynecologic cancer: a retrospective planning study

    International Nuclear Information System (INIS)

    Chan, Philip; Yeo, Inhwan; Perkins, Gregory; Fyles, Anthony; Milosevic, Michael

    2006-01-01

    To evaluate intensity-modulated radiation therapy (IMRT) as an alternative to conformal radiotherapy (CRT) or 4-field box boost (4FB) in women with gynecologic malignancies who are unsuitable for brachytherapy for technical or medical reasons. Dosimetric and toxicity information was analyzed for 12 patients with cervical (8), endometrial (2) or vaginal (2) cancer previously treated with external beam pelvic radiotherapy and a CRT boost. Optimized IMRT boost treatment plans were then developed for each of the 12 patients and compared to CRT and 4FB plans. The plans were compared in terms of dose conformality and critical normal tissue avoidance. The median planning target volume (PTV) was 151 cm 3 (range 58–512 cm 3 ). The median overlap of the contoured rectum with the PTV was 15 (1–56) %, and 11 (4–35) % for the bladder. Two of the 12 patients, both with large PTVs and large overlap of the contoured rectum and PTV, developed grade 3 rectal bleeding. The dose conformity was significantly improved with IMRT over CRT and 4FB (p ≤ 0.001 for both). IMRT also yielded an overall improvement in the rectal and bladder dose-volume distributions relative to CRT and 4FB. The volume of rectum that received the highest doses (>66% of the prescription) was reduced by 22% (p < 0.001) with IMRT relative to 4FB, and the bladder volume was reduced by 19% (p < 0.001). This was at the expense of an increase in the volume of these organs receiving doses in the lowest range (<33%). These results indicate that IMRT can improve target coverage and reduce dose to critical structures in gynecologic patients receiving an external beam radiotherapy boost. This dosimetric advantage will be integrated with other patient and treatment-specific factors, particularly internal tumor movement during fractionated radiotherapy, in the context of a future image-guided radiation therapy study

  13. Analysis of in-field control and late toxicity for adults with early-stage Hodgkin's disease treated with chemotherapy followed by radiotherapy

    International Nuclear Information System (INIS)

    Chronowski, Gregory M.; Wilder, Richard B.; Tucker, Susan L.; Ha, Chul S.; Younes, Anas; Fayad, Luis; Rodriguez, Maria A.; Hagemeister, Fredrick B.; Barista, Ibrahim; Cabanillas, Fernando; Cox, James D.

    2003-01-01

    Purpose: We analyzed in-field (IF) control in adults with early-stage Hodgkin's disease who received chemotherapy followed by radiotherapy (RT) in terms of the (1) chemotherapeutic regimen used and number of cycles delivered, (2) response to chemotherapy, and (3) initial tumor size. Cardiac toxicity and second malignancies, particularly the incidence of solid tumors in terms of the RT field size treated, were also examined. Methods and Materials: From 1980 to 1995, 286 patients ranging in age from 16 to 88 years (median: 28 years) with Ann Arbor clinical Stage I or II Hodgkin's disease underwent chemotherapy followed 3 to 4 weeks later by RT. There were 516 nodal sites measuring 0.5 to 19.0 cm at the start of chemotherapy, including 134 cases of bulky mediastinal disease. NOVP, MOPP, ABVD, CVPP/ABDIC, and other chemotherapeutic regimens were given to 161, 67, 19, 18, and 21 patients, respectively. Patients received 1-8 (median: 3) cycles of induction chemotherapy. All 533 gross nodal and extranodal sites of disease were included in the RT fields. The median prescribed RT dose for gross disease was 40.0 Gy given in 20 daily 2.0-Gy fractions. There was little variation in the RT dose. Eighty-five patients were treated with involved-field or regional RT (to one side of the diaphragm), and 201 patients were treated with extended-field RT (to both sides of the diaphragm), based on the protocol on which they were enrolled. Results: Follow-up of surviving patients ranged from 1.3 to 19.9 years (median: 7.4 years). Based on a review of simulation films, there were 16 IF, 8 marginal, and 15 out-of-field recurrences. The chemotherapeutic regimen used and the number of cycles of chemotherapy delivered did not significantly affect IF control. IF control also did not significantly depend on the response to induction chemotherapy. In cases where there was a confirmed or unconfirmed complete response as opposed to a partial response or stable disease in response to induction

  14. Analysis of in-field control and late toxicity for adults with early-stage Hodgkin's disease treated with chemotherapy followed by radiotherapy.

    Science.gov (United States)

    Chronowski, Gregory M; Wilder, Richard B; Tucker, Susan L; Ha, Chul S; Younes, Anas; Fayad, Luis; Rodriguez, Maria A; Hagemeister, Fredrick B; Barista, Ibrahim; Cabanillas, Fernando; Cox, James D

    2003-01-01

    We analyzed in-field (IF) control in adults with early-stage Hodgkin's disease who received chemotherapy followed by radiotherapy (RT) in terms of the (1) chemotherapeutic regimen used and number of cycles delivered, (2) response to chemotherapy, and (3) initial tumor size. Cardiac toxicity and second malignancies, particularly the incidence of solid tumors in terms of the RT field size treated, were also examined. From 1980 to 1995, 286 patients ranging in age from 16 to 88 years (median: 28 years) with Ann Arbor clinical Stage I or II Hodgkin's disease underwent chemotherapy followed 3 to 4 weeks later by RT. There were 516 nodal sites measuring 0.5 to 19.0 cm at the start of chemotherapy, including 134 cases of bulky mediastinal disease. NOVP, MOPP, ABVD, CVPP/ABDIC, and other chemotherapeutic regimens were given to 161, 67, 19, 18, and 21 patients, respectively. Patients received 1-8 (median: 3) cycles of induction chemotherapy. All 533 gross nodal and extranodal sites of disease were included in the RT fields. The median prescribed RT dose for gross disease was 40.0 Gy given in 20 daily 2.0-Gy fractions. There was little variation in the RT dose. Eighty-five patients were treated with involved-field or regional RT (to one side of the diaphragm), and 201 patients were treated with extended-field RT (to both sides of the diaphragm), based on the protocol on which they were enrolled. Follow-up of surviving patients ranged from 1.3 to 19.9 years (median: 7.4 years). Based on a review of simulation films, there were 16 IF, 8 marginal, and 15 out-of-field recurrences. The chemotherapeutic regimen used and the number of cycles of chemotherapy delivered did not significantly affect IF control. IF control also did not significantly depend on the response to induction chemotherapy. In cases where there was a confirmed or unconfirmed complete response as opposed to a partial response or stable disease in response to induction chemotherapy for bulky nodal disease, the 5

  15. Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline

    International Nuclear Information System (INIS)

    Lutz, Stephen; Berk, Lawrence; Chang, Eric; Chow, Edward; Hahn, Carol; Hoskin, Peter; Howell, David; Konski, Andre; Kachnic, Lisa; Lo, Simon; Sahgal, Arjun; Silverman, Larry; Gunten, Charles von; Mendel, Ehud; Vassil, Andrew; Bruner, Deborah Watkins; Hartsell, William

    2011-01-01

    Purpose: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. Conclusions: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use

  16. Estimating the Magnitude and Field-Size Dependence of Radiotherapy-Induced Mortality and Tumor Control After Postoperative Radiotherapy For Non-Small-Cell Lung Cancer: Calculations From Clinical Trials

    International Nuclear Information System (INIS)

    Miles, Edward F.; Kelsey, Chris R.; Kirkpatrick, John P.; Marks, Lawrence B.

    2007-01-01

    Purpose: To create, on the basis of available data, a mathematical model to describe the tumor stage- and field size-dependent risks/benefits of postoperative radiotherapy (PORT) for non-small-cell lung cancer (NSCLC), and to assess whether this simple model can accurately describe the reported changes in overall survival. Methods and Materials: The increase in overall survival afforded by PORT is assumed equal to the increase in cancer-specific survival minus the rate of RT-induced mortality. The increase in cancer-specific survival is the product of the probabilities of (residual local disease) x (sterilization of residual disease with PORT) x (absence of metastatic disease). Data were extracted from the literature to estimate these probabilities. Different models were considered to relate the RT-induced mortality to field size. Results: The rate of RT-induced mortality seems to be proportional to the cube of the field size. When these mortality rates are included in the model, the predicted changes in overall survival approximate the literature values. Conclusion: Clinical data can be explained by a simple model that suggests that RT-induced mortality is strongly dependent on field size and at least partly offsets the benefit afforded by PORT. Smaller RT fields, tailored to treat the areas most at risk for recurrence, provide the highest therapeutic ratio. The data used do not reflect the impact of chemotherapy, which will reduce the rate of distant metastases and enhance the efficacy of RT

  17. Historical review of radiotherapy

    International Nuclear Information System (INIS)

    Onai, Yoshio

    1993-01-01

    The techniques of radiotherapy have been improved by development of particle accelerators, radionuclides and computers. This paper presents a historical review of the physical and technical aspects of radiotherapy in Japan. Changes in the kinds of radiation, such as X-rays, gamma rays, electrons, neutrons and protons used for external radiotherapy, and the equipment involved are described chronologically, and historical changes in the quality of radiotherapy apparatus are outlined. Patient data acquisition equipment, such as X-ray simulator and X-ray CT, beam modifying devices, patient setup devices, and devices to verify treatment fields and patient doses are reviewed historically. Radiation sources for brachytherapy and internal radiotherapy, and remotely controlled afterloading systems are reviewed chronologically. Historical changes in methods to evaluate absorbed doses, dose monitor systems and beam data acquisition systems are outlined. Changes in methods of calculating dose distributions for external X-ray and electron therapy, brachytherapy and internal radiotherapy by unsealded radionuclides are described and calculation techniques for treatment planning system are reviewed. Annual figures in the numbers of radiotherapy equipment, such as telecobalt and telecesium units, linear accelerators, betatrons, microtrons, stereotactic gamma units, conformation radiotherapy units, remotely controlled afterloading systems, and associated equipment such as X-ray simulators and treatment planning systems are provided, as are changes in the number of accelerators by maximum X-ray energy and maximum electron energy, and in the number of licensed hospitals and clinics using small sealed sources. Changes in techniques of external radiotherapy and brachytherapy are described briefly from the point of view of dose distributions. (author)

  18. Gel dosimetry for conformal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Gambarini, G [Department of Physics of the University and INFN, Milan (Italy)

    2005-07-01

    With the continuum development of conformal radio therapies, aimed at delivering high dose to tumor tissue and low dose to the healthy tissue around, the necessities has appeared of suitable improvement of dosimetry techniques giving the possibility of obtaining dose images to be compared with diagnostic images. Also if wide software has been developed for calculating dose distributions in the fields of various radiotherapy units, experimental verifications are necessary, in particular in the case of complex geometries in conformal radiotherapy. Gel dosimetry is a promising method for imaging the absorbed dose in tissue-equivalent phantoms, with the possibility of 3D reconstruction of the spatial dose distribution, with milli metric resolution. Optical imaging of gel dosimeters, based on visible light absorbance analysis, has shown to be a reliable technique for achieving dose distributions. (Author)

  19. A new strategy for online adaptive prostate radiotherapy based on cone-beam CT

    International Nuclear Information System (INIS)

    Boggula, Ramesh; Lorenz, Friedlieb; Lohr, Frank; Wolff, Dirk; Boda-Heggemann, Judit; Hesser, Juergen; Wenz, Frederik; Wertz, Hansjoerg

    2009-01-01

    Interfractional organ motion and patient positioning errors during prostate radiotherapy can have deleterious clinical consequences. It has become clinical practice to re-position the patient with image-guided translational position correction before each treatment to compensate for those errors. However, tilt errors can only be corrected with table corrections in six degrees of freedom or ''full'' adaptive treatment planning strategies. Organ shape deformations can only be corrected by ''full'' plan adaptation. This study evaluates the potential of instant treatment plan adaptation (fast isodose line adaptation with real-time dose manipulating tools) based on cone-beam CT (CBCT) to further improve treatment quality. Using in-house software, CBCTs were modified to approximate a correct density calibration. To evaluate the dosimetric accuracy, dose distributions based on CBCTs were compared with dose distributions calculated on conventional planning CTs (PCT) for four datasets (one inhomogeneous phantom, three patient datasets). To determine the potential dosimetric benefit of a ''full'' plan adaptation over translational position correction, dose distributions were re-optimized using graphical ''online'' dose modification tools for three additional patients' CT-datasets with a substantially distended rectum while the original plans have been created with an empty rectum (single treatment fraction estimates). Absolute dose deviations of up to 51% in comparison to the PCT were observed when uncorrected CBCTs were used for replanning. After density calibration of the CBCTs, 97% of the dose deviations were ≤3% (gamma index: 3%/3 mm). Translational position correction restored the PTV dose (D 95 ) to 73% of the corresponding dose of the reference plan. After plan adaptation, larger improvements of dose restoration to 95% were observed. Additionally, the rectal dose (D 30 ) was further decreased by 42 percentage points (mean of three patient datasets). An accurate dose

  20. Radiotherapy indications - rectum cancer

    International Nuclear Information System (INIS)

    2009-05-01

    This document is addressed to oncologists radiotherapists and to any health professional concerned by rectum cancer treatment. Rectum cancer therapy is based on various technical procedures including surgery, radiotherapy and systemic treatments defined for each patient according to his clinical situation. This document precises the specific situations where radiotherapy can be employed. However, the radiotherapy decision must be taken with respect to other therapeutic alternatives. Such a decision must be validated and must be the object of a discussion in the framework of a pluri-disciplinary consultation. (J.S.)

  1. Primary radiotherapy or postoperative radiotherapy in patients with head and neck cancer. Comparative analysis of inflammation-based prognostic scoring systems

    Energy Technology Data Exchange (ETDEWEB)

    Selzer, Edgar; Grah, Anja [Medical University of Vienna, Department of Radiotherapy, Vienna (Austria); Heiduschka, Gregor; Thurnher, Dietmar [Medical University of Vienna, Otorhinolaryngology - Head and Neck Surgery, Vienna (Austria); Kornek, Gabriela [Medical University of Vienna, Medicine I - Division of Clinical Oncology, Vienna (Austria)

    2015-01-13

    Inflammation-based scoring systems have potential value in evaluating the prognosis of cancer patients; however, detailed comparative analyses in well-characterized head and neck cancer patient collectives are missing. We analyzed overall survival (OS) in locally advanced head and neck cancer patients who were treated with curative intent by primary radiotherapy (RT) alone, by RT in combination with cetuximab (RIT) or with cisplatin (RCHT), and by primary surgery followed by postoperative radiotherapy (PORT). The primary RT collective (N = 170) was analyzed separately from the surgery plus RT group (N = 148). OS was estimated using the Kaplan-Meyer method. Cox proportional-hazard regression models were applied to compare the risk of death among patients stratified according to risk factors and the inflammation-based Glasgow Prognostic Score (GPS), the modified GPS (mGPS), the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the prognostic index (PI). A prognostic relevance of the scoring systems for OS was observed in the primarily irradiated, but not in the PORT collective. OS was 35.5, 18.8, and 15.4 months, respectively, according to GPS 0, 1, and 2. OS according to mGPS 0-2 was identical. The PLR scoring system was not of prognostic relevance, while OS was 27.3 months in the NLR 0 group and 17.3 months in the NLR 1 group. OS was 35.5 months in PI 0, 16.1 months in PI 1, and 22.6 months in PI 2. GPS/mGPS scoring systems are able to discriminate between three risk groups in primarily, but not postoperatively irradiated locally advanced head and neck cancer patients. (orig.) [German] Entzuendungsbasierte Bewertungssysteme haben eine potenzielle Bedeutung fuer die Beurteilung der Prognose von Krebspatienten. Derzeit fehlen jedoch ausreichend detailliert durchgefuehrte Analysen in Kollektiven von Patienten mit Kopf-Hals-Tumoren. Untersucht wurde das Gesamtueberleben (''overall survival'', OS) von Patienten mit lokal

  2. Wavelet-Based Quantum Field Theory

    Directory of Open Access Journals (Sweden)

    Mikhail V. Altaisky

    2007-11-01

    Full Text Available The Euclidean quantum field theory for the fields $phi_{Delta x}(x$, which depend on both the position $x$ and the resolution $Delta x$, constructed in SIGMA 2 (2006, 046, on the base of the continuous wavelet transform, is considered. The Feynman diagrams in such a theory become finite under the assumption there should be no scales in internal lines smaller than the minimal of scales of external lines. This regularisation agrees with the existing calculations of radiative corrections to the electron magnetic moment. The transition from the newly constructed theory to a standard Euclidean field theory is achieved by integration over the scale arguments.

  3. Neuropsychological outcome after fractionated stereotactic radiotherapy (FSRT) for base of skull meningiomas: a prospective 1-year follow-up

    International Nuclear Information System (INIS)

    Steinvorth, Sarah; Welzel, Grit; Fuss, Martin; Debus, Juergen; Wildermuth, Susanne; Wannenmacher, Michael; Wenz, Frederik

    2003-01-01

    Purpose: The purpose of this study was to evaluate the cognitive outcome after fractionated stereotactic radiotherapy (FSRT) in patients with base of skull meningiomas. Methods and material: A total of 40 patients with base of skull meningiomas were neuro psychologically evaluated before, after the first fraction (1.8 Gy), at the end of FSRT (n=37), 6 weeks (n=24), 6 (n=18) and 12 months (n=14) after FSRT. A comprehensive test battery including assessment of general intelligence, attention and memory functions was used. Alternate forms were used and current mood state was controlled. Results: After the first fraction a transient decline in memory function and simultaneous improvements in attention functions were observed. No cognitive deteriorations were seen during further follow-up, but increases in attention and memory functions were observed. Mood state improved after the first fraction, at the end of radiotherapy and 6 weeks after radiotherapy. Conclusion: The present data support the conclusion that the probability for the development of permanent cognitive dysfunctions appears to be very low after FSRT. The transient memory impairments on day 1 are interpreted as most likely related to an increase of a preexisting peritumoral edema, whereas the significant acute improvements in attention functions are interpreted as practice effects. An analysis of localization specific effects of radiation failed to show clear hemisphere specific cognitive changes

  4. A patch-based pseudo-CT approach for MRI-only radiotherapy in the pelvis

    Energy Technology Data Exchange (ETDEWEB)

    Andreasen, Daniel, E-mail: dana@dtu.dk [Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark and Radiotherapy Research Unit, Department of Oncology, Gentofte and Herlev Hospital, University of Copenhagen, 2730 Herlev (Denmark); Van Leemput, Koen [Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark and A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129 (United States); Edmund, Jens M. [Radiotherapy Research Unit, Department of Oncology, Gentofte and Herlev Hospital, University of Copenhagen, 2730 Herlev (Denmark)

    2016-08-15

    Purpose: In radiotherapy based only on magnetic resonance imaging (MRI), knowledge about tissue electron densities must be derived from the MRI. This can be achieved by converting the MRI scan to the so-called pseudo-computed tomography (pCT). An obstacle is that the voxel intensities in conventional MRI scans are not uniquely related to electron density. The authors previously demonstrated that a patch-based method could produce accurate pCTs of the brain using conventional T{sub 1}-weighted MRI scans. The method was driven mainly by local patch similarities and relied on simple affine registrations between an atlas database of the co-registered MRI/CT scan pairs and the MRI scan to be converted. In this study, the authors investigate the applicability of the patch-based approach in the pelvis. This region is challenging for a method based on local similarities due to the greater inter-patient variation. The authors benchmark the method against a baseline pCT strategy where all voxels inside the body contour are assigned a water-equivalent bulk density. Furthermore, the authors implement a parallelized approximate patch search strategy to speed up the pCT generation time to a more clinically relevant level. Methods: The data consisted of CT and T{sub 1}-weighted MRI scans of 10 prostate patients. pCTs were generated using an approximate patch search algorithm in a leave-one-out fashion and compared with the CT using frequently described metrics such as the voxel-wise mean absolute error (MAE{sub vox}) and the deviation in water-equivalent path lengths. Furthermore, the dosimetric accuracy was tested for a volumetric modulated arc therapy plan using dose–volume histogram (DVH) point deviations and γ-index analysis. Results: The patch-based approach had an average MAE{sub vox} of 54 HU; median deviations of less than 0.4% in relevant DVH points and a γ-index pass rate of 0.97 using a 1%/1 mm criterion. The patch-based approach showed a significantly better

  5. Involved-Field Radiotherapy versus Elective Nodal Irradiation in Combination with Concurrent Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer: A Prospective Randomized Study

    Science.gov (United States)

    Chen, Ming; Bao, Yong; Ma, Hong-Lian; Wang, Jin; Wang, Yan; Peng, Fang; Zhou, Qi-Chao; Xie, Cong-Hua

    2013-01-01

    This prospective randomized study is to evaluate the locoregional failure and its impact on survival by comparing involved field radiotherapy (IFRT) with elective nodal irradiation (ENI) in combination with concurrent chemotherapy for locally advanced non-small cell lung cancer. It appears that higher dose could be delivered in IFRT arm than that in ENI arm, and IFRT did not increase the risk of initially uninvolved or isolated nodal failures. Both a tendency of improved locoregional progression-free survival and a significant increased overall survival rate are in favor of IFRT arm in this study. PMID:23762840

  6. Optic neuropathy following combined proton and photon radiotherapy for base of skull tumors

    International Nuclear Information System (INIS)

    Kim, June; Munzenrider, John; Maas, Alicea; Finkelstein, Dianne; Liebsch, Norbert; Hug, Eugen; Suit, Herman; Smith, Al; Goitein, Michael

    1997-01-01

    Purpose/Objective: To evaluate the risk of radiation injury to the optic pathway following high dose radiation therapy (RT) for base of skull tumors with regard to the following variables: diabetes, hypertension, number of surgical procedures, use of patch, patch distance, radiation dose, and volume of optic structures receiving 50, 55, or 60 Cobalt Gray Equivalent (CGE). Materials and Methods: A total of 359 patients with base of skull chordoma or low grade chondrosarcoma received high dose radiation therapy. Patients were treated with external beam radiotherapy utilizing protons alone or combined protons and photons. Protons of 160 MeV were delivered at the Harvard Cyclotron Laboratory using a modulated Bragg peak. The tumor dose ranged from 61 to 76 CGE. CGE was used because modulated protons have an RBE of 1.1 compared to 60 Co. Among 359 patients, 85 patients were excluded from evaluation based on age, tumor location, and pre-RT treatment criteria. All 274 evaluable patients had a minimum follow up of 12 months. Medical records were reviewed to determine the actual cause of vision changes. A total of 12 patients with grade II, III, and IV radiation-induced optic neuropathy were identified. Twenty-four patients without complications who closely matched the aforementioned 12 cases with optic neuropathy were selected from the 274 patients as a control group. Dose volume histograms of 12 cases and 24 controls were reviewed to determine minimum, median, and maximum dose to the optic apparatus as well as dose volume at 50, 55, and 60 CGE. Other information regarding remaining potential risk factors, such as diabetes, hypertension, number of surgical procedures, use of patch, and patch distance, was also obtained. Results: A total of 12 patients (4.4%) developed radiation-induced optic neuropathy: 1 grade II, 9 grade III, and 2 grade IV. Specific sites of involvement were left optic nerve in 9, right optic nerve in 5, and chiasm in 4 cases. The duration to the onset

  7. Toward efficient biomechanical-based deformable image registration of lungs for image-guided radiotherapy

    Science.gov (United States)

    Al-Mayah, Adil; Moseley, Joanne; Velec, Mike; Brock, Kristy

    2011-08-01

    Both accuracy and efficiency are critical for the implementation of biomechanical model-based deformable registration in clinical practice. The focus of this investigation is to evaluate the potential of improving the efficiency of the deformable image registration of the human lungs without loss of accuracy. Three-dimensional finite element models have been developed using image data of 14 lung cancer patients. Each model consists of two lungs, tumor and external body. Sliding of the lungs inside the chest cavity is modeled using a frictionless surface-based contact model. The effect of the type of element, finite deformation and elasticity on the accuracy and computing time is investigated. Linear and quadrilateral tetrahedral elements are used with linear and nonlinear geometric analysis. Two types of material properties are applied namely: elastic and hyperelastic. The accuracy of each of the four models is examined using a number of anatomical landmarks representing the vessels bifurcation points distributed across the lungs. The registration error is not significantly affected by the element type or linearity of analysis, with an average vector error of around 2.8 mm. The displacement differences between linear and nonlinear analysis methods are calculated for all lungs nodes and a maximum value of 3.6 mm is found in one of the nodes near the entrance of the bronchial tree into the lungs. The 95 percentile of displacement difference ranges between 0.4 and 0.8 mm. However, the time required for the analysis is reduced from 95 min in the quadratic elements nonlinear geometry model to 3.4 min in the linear element linear geometry model. Therefore using linear tetrahedral elements with linear elastic materials and linear geometry is preferable for modeling the breathing motion of lungs for image-guided radiotherapy applications.

  8. Classification of fibroglandular tissue distribution in the breast based on radiotherapy planning CT

    International Nuclear Information System (INIS)

    Juneja, Prabhjot; Evans, Philip; Windridge, David; Harris, Emma

    2016-01-01

    Accurate segmentation of breast tissues is required for a number of applications such as model based deformable registration in breast radiotherapy. The accuracy of breast tissue segmentation is affected by the spatial distribution (or pattern) of fibroglandular tissue (FT). The goal of this study was to develop and evaluate texture features, determined from planning computed tomography (CT) data, to classify the spatial distribution of FT in the breast. Planning CT data of 23 patients were evaluated in this study. Texture features were derived from the radial glandular fraction (RGF), which described the distribution of FT within three breast regions (posterior, middle, and anterior). Using visual assessment, experts grouped patients according to FT spatial distribution: sparse or non-sparse. Differences in the features between the two groups were investigated using the Wilcoxon rank test. Classification performance of the features was evaluated for a range of support vector machine (SVM) classifiers. Experts found eight patients and 15 patients had sparse and non-sparse spatial distribution of FT, respectively. A large proportion of features (>9 of 13) from the individual breast regions had significant differences (p <0.05) between the sparse and non-sparse group. The features from middle region had most significant differences and gave the highest classification accuracy for all the SVM kernels investigated. Overall, the features from middle breast region achieved highest accuracy (91 %) with the linear SVM kernel. This study found that features based on radial glandular fraction provide a means for discriminating between fibroglandular tissue distributions and could achieve a classification accuracy of 91 %

  9. Whither radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ross, W M

    1987-03-01

    The 1986 Glyn Evans Memorial Lecture, given at the Joint Provincial Meeting of the Royal College of Radiologists, Sheffield, September 1986, sketches an outline of the history of radiotherapy and discusses the future development of the art. Topics included are siting of centres, training needs, the relationship of radiotherapy to other medical specialities, and the advantages and disadvantages of radiotherapy practitioners forming a separate medical College. (U.K.)

  10. Concurrent radiotherapy with temozolomide vs. concurrent radiotherapy with a cisplatinum-based polychemotherapy regimen : Acute toxicity in pediatric high-grade glioma patients.

    Science.gov (United States)

    Seidel, Clemens; von Bueren, André O; Bojko, Sabrina; Hoffmann, Marion; Pietsch, Torsten; Gielen, Gerrit H; Warmuth-Metz, Monika; Bison, Brigitte; Kortmann, Rolf-D; Kramm, Christof M

    2018-03-01

    As the efficacy of all pediatric high-grade glioma (HGG) treatments is similar and still disappointing, it is essential to also investigate the toxicity of available treatments. Prospectively recorded hematologic and nonhematologic toxicities of children treated with radiochemotherapy in the HIT GBM-C/D and HIT-HGG-2007 trials were compared. Children aged 3-18 years with histologically proven HGG (WHO grade III and IV tumors) or unequivocal radiologic diagnosis of diffuse intrinsic pontine glioma (DIPG) were included in these trials. The HIT-HGG-2007 protocol comprised concomitant radiochemotherapy with temozolomide, while cisplatinum/etoposide (PE) and PE plus ifosfamide (PEI) in combination with weekly vincristine injections were applied during radiochemotherapy in the HIT GBM-C/D protocol. Regular blood counts and information about cellular nadirs were available from 304 patients (leukocytes) and 306 patients (thrombocytes), respectively. Grade 3-4 leukopenia was much more frequent in the HIT GBM-C/D cohort (n = 88, 52%) vs. HIT-HGG-2007 (n = 13, 10%; P <0.001). Grade 3-4 thrombopenia was also more likely in the HIT GBM-C/D cohort (n = 21, 12% vs. n = 3,2%; P <0.001). Grade 3-4 leukopenia appeared more often in children aged 3-7 years (n = 38/85, 45%) than in children aged 8-12 years (n = 39/120, 33%) and 13-18 years (24/100, 24%; P =0.034). In addition, sickness was more frequent in the HIT GBM-C/D cohort (grade 1-2: 44%, grade 3-4: 6% vs. grade 1-2: 28%, grade 3-4: 1%; P <0.001). Radiochemotherapy involving cisplatinum-based polychemotherapy is more toxic than radiotherapy in combination with temozolomide. Without evidence of differences in therapeutic efficacy, the treatment with lower toxicity, i. e., radiotherapy with temozolomide should be used.

  11. Magnetic Resonance-Based Treatment Planning for Prostate Intensity-Modulated Radiotherapy: Creation of Digitally Reconstructed Radiographs

    International Nuclear Information System (INIS)

    Chen, Lili; Nguyen, Thai-Binh; Jones, Elan; Chen Zuoqun; Luo Wei; Wang Lu; Price, Robert A.; Pollack, Alan; Ma, C.-M. Charlie

    2007-01-01

    Purpose: To develop a technique to create magnetic resonance (MR)-based digitally reconstructed radiographs (DRR) for initial patient setup for routine clinical applications of MR-based treatment planning for prostate intensity-modulated radiotherapy. Methods and Materials: Twenty prostate cancer patients' computed tomography (CT) and MR images were used for the study. Computed tomography and MR images were fused. The pelvic bony structures, including femoral heads, pubic rami, ischium, and ischial tuberosity, that are relevant for routine clinical patient setup were manually contoured on axial MR images. The contoured bony structures were then assigned a bulk density of 2.0 g/cm 3 . The MR-based DRRs were generated. The accuracy of the MR-based DDRs was quantitatively evaluated by comparing MR-based DRRs with CT-based DRRs for these patients. For each patient, eight measuring points on both coronal and sagittal DRRs were used for quantitative evaluation. Results: The maximum difference in the mean values of these measurement points was 1.3 ± 1.6 mm, and the maximum difference in absolute positions was within 3 mm for the 20 patients investigated. Conclusions: Magnetic resonance-based DRRs are comparable to CT-based DRRs for prostate intensity-modulated radiotherapy and can be used for patient treatment setup when MR-based treatment planning is applied clinically

  12. A comparison of mantle versus involved-field radiotherapy for Hodgkin's lymphoma: reduction in normal tissue dose and second cancer risk

    International Nuclear Information System (INIS)

    Koh, Eng-Siew; Paul, Narinder; Hodgson, David C; Tran, Tu Huan; Heydarian, Mostafa; Sachs, Rainer K; Tsang, Richard W; Brenner, David J; Pintilie, Melania; Xu, Tony; Chung, June

    2007-01-01

    Hodgkin's lymphoma (HL) survivors who undergo radiotherapy experience increased risks of second cancers (SC) and cardiac sequelae. To reduce such risks, extended-field radiotherapy (RT) for HL has largely been replaced by involved field radiotherapy (IFRT). While it has generally been assumed that IFRT will reduce SC risks, there are few data that quantify the reduction in dose to normal tissues associated with modern RT practice for patients with mediastinal HL, and no estimates of the expected reduction in SC risk. Organ-specific dose-volume histograms (DVH) were generated for 41 patients receiving 35 Gy mantle RT, 35 Gy IFRT, or 20 Gy IFRT, and integrated organ mean doses were compared for the three protocols. Organ-specific SC risk estimates were estimated using a dosimetric risk-modeling approach, analyzing DVH data with quantitative, mechanistic models of radiation-induced cancer. Dose reductions resulted in corresponding reductions in predicted excess relative risks (ERR) for SC induction. Moving from 35 Gy mantle RT to 35 Gy IFRT reduces predicted ERR for female breast and lung cancer by approximately 65%, and for male lung cancer by approximately 35%; moving from 35 Gy IFRT to 20 Gy IFRT reduces predicted ERRs approximately 40% more. The median reduction in integral dose to the whole heart with the transition to 35 Gy IFRT was 35%, with a smaller (2%) reduction in dose to proximal coronary arteries. There was no significant reduction in thyroid dose. The significant decreases estimated for radiation-induced SC risks associated with modern IFRT provide strong support for the use of IFRT to reduce the late effects of treatment. The approach employed here can provide new insight into the risks associated with contemporary IFRT for HL, and may facilitate the counseling of patients regarding the risks associated with this treatment

  13. WE-FG-201-04: Cloud-Based Collaboration for Radiotherapy Clinical Trials, Research and Training

    International Nuclear Information System (INIS)

    Palta, J.

    2016-01-01

    Many low- and middle-income countries lack the resources and services to manage cancer, from screening and diagnosis to radiation therapy planning, treatment and quality assurance. The challenges in upgrading or introducing the needed services are enormous, and include severe shortages in equipment and trained staff. In this symposium, we will describe examples of technology and scientific research that have the potential to impact all these areas. These include: (1) the development of high-quality/low-cost colposcopes for cervical cancer screening, (2) the application of automated radiotherapy treatment planning to reduce staffing shortages, (3) the development of a novel radiotherapy treatment unit, and (4) utilizing a cloud-based infrastructure to facilitate collaboration and QA. Learning Objectives: Understand some of the issues in cancer care in low- resource environments, including shortages in staff and equipment, and inadequate physical infrastructure for advanced radiotherapy. Understand the challenges in developing and deploying diagnostic and treatment devices and services for low-resource environments. Understand some of the emerging technological solutions for cancer management in LMICs. NCI; L. Court, NIH, Varian, Elekta; I. Feain, Ilana Feain is founder and CTO of Nano-X Pty Ltd

  14. WE-FG-201-04: Cloud-Based Collaboration for Radiotherapy Clinical Trials, Research and Training

    Energy Technology Data Exchange (ETDEWEB)

    Palta, J. [Virginia Commonwealth University (United States)

    2016-06-15

    Many low- and middle-income countries lack the resources and services to manage cancer, from screening and diagnosis to radiation therapy planning, treatment and quality assurance. The challenges in upgrading or introducing the needed services are enormous, and include severe shortages in equipment and trained staff. In this symposium, we will describe examples of technology and scientific research that have the potential to impact all these areas. These include: (1) the development of high-quality/low-cost colposcopes for cervical cancer screening, (2) the application of automated radiotherapy treatment planning to reduce staffing shortages, (3) the development of a novel radiotherapy treatment unit, and (4) utilizing a cloud-based infrastructure to facilitate collaboration and QA. Learning Objectives: Understand some of the issues in cancer care in low- resource environments, including shortages in staff and equipment, and inadequate physical infrastructure for advanced radiotherapy. Understand the challenges in developing and deploying diagnostic and treatment devices and services for low-resource environments. Understand some of the emerging technological solutions for cancer management in LMICs. NCI; L. Court, NIH, Varian, Elekta; I. Feain, Ilana Feain is founder and CTO of Nano-X Pty Ltd.

  15. Evaluation of the MEMS based portable respiratory training system with a tactile sensor for respiratory-gated radiotherapy

    Science.gov (United States)

    Moon, Sun Young; Yoon, Myonggeun; Chung, Mijoo; Chung, Weon Kuu; Kim, Dong Wook

    2017-10-01

    In respiratory-gated radiotherapy, it is important to maintain the regular respiratory cycles of patients. If patients undergo respiration training, their regular breathing pattern is affected. Therefore, we developed a respiratory training system based on a micro electromechanical system (MEMS) and evaluated the feasibility of the MEMS in radiotherapy. By comparing the measured signal before and after radiation exposure, we confirmed the effects of radiation. By evaluating the period of the electric signal emitted by a tactile sensor and its constancy, the performance of the tactile sensor was confirmed. Moreover, by comparing the delay between the motion of the MEMS and the electric signal from the tactile sensor, we confirmed the reaction time of the tactile sensor. The results showed that a baseline shift occurred for an accumulated dose of 400 Gy in the sensor, and both the amplitude and period changed. The period of the signal released by the tactile sensor was 5.39 and its standard deviation was 0.06. Considering the errors from the motion phantom, a standard deviation of 0.06 was desirable. The delay time was within 0.5 s and not distinguishable by a patient. We confirmed the performance of the MEMS and concluded that MEMS could be applied to patients for respiratory-gated radiotherapy.

  16. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Lorraine [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Cox, Jennifer [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Sydney, New South Wales (Australia); Morgia, Marita [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Atyeo, John [Faculty of Health Sciences, University of Sydney, Sydney, New South Wales (Australia); Lamoury, Gillian [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia)

    2015-09-15

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm{sup 3} (4–118) and CT2ch: median 16 cm{sup 3}, (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.

  17. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    International Nuclear Information System (INIS)

    Lewis, Lorraine; Cox, Jennifer; Morgia, Marita; Atyeo, John; Lamoury, Gillian

    2015-01-01

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm 3 (4–118) and CT2ch: median 16 cm 3 , (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence

  18. Technical note: real-time web-based wireless visual guidance system for radiotherapy.

    Science.gov (United States)

    Lee, Danny; Kim, Siyong; Palta, Jatinder R; Kim, Taeho

    2017-06-01

    Describe a Web-based wireless visual guidance system that mitigates issues associated with hard-wired audio-visual aided patient interactive motion management systems that are cumbersome to use in routine clinical practice. Web-based wireless visual display duplicates an existing visual display of a respiratory-motion management system for visual guidance. The visual display of the existing system is sent to legacy Web clients over a private wireless network, thereby allowing a wireless setting for real-time visual guidance. In this study, active breathing coordinator (ABC) trace was used as an input for visual display, which captured and transmitted to Web clients. Virtual reality goggles require two (left and right eye view) images for visual display. We investigated the performance of Web-based wireless visual guidance by quantifying (1) the network latency of visual displays between an ABC computer display and Web clients of a laptop, an iPad mini 2 and an iPhone 6, and (2) the frame rate of visual display on the Web clients in frames per second (fps). The network latency of visual display between the ABC computer and Web clients was about 100 ms and the frame rate was 14.0 fps (laptop), 9.2 fps (iPad mini 2) and 11.2 fps (iPhone 6). In addition, visual display for virtual reality goggles was successfully shown on the iPhone 6 with 100 ms and 11.2 fps. A high network security was maintained by utilizing the private network configuration. This study demonstrated that a Web-based wireless visual guidance can be a promising technique for clinical motion management systems, which require real-time visual display of their outputs. Based on the results of this study, our approach has the potential to reduce clutter associated with wired-systems, reduce space requirements, and extend the use of medical devices from static usage to interactive and dynamic usage in a radiotherapy treatment vault.

  19. Residual motion of lung tumors in end-of-inhale respiratory gated radiotherapy based on external surrogates

    International Nuclear Information System (INIS)

    Berbeco, Ross I.; Nishioka, Seiko; Shirato, Hiroki; Jiang, Steve B.

    2006-01-01

    It has been noted that some lung tumors exhibit large periodic motion due to respiration. To limit the amount of dose to healthy lung tissues, many clinics have begun gating radiotherapy treatment using externally placed surrogates. It has been observed by several institutions that the end-of-exhale (EOE) tumor position is more reproducible than other phases of the breathing cycle, so the gating window is often set there. From a treatment planning perspective, end-of-inhale (EOI) phase might be preferred for gating because the expanded lungs will further decrease the healthy tissue within the treatment field. We simulate gated treatment at the EOI phase, using a set of recently measured internal/external anatomy patient data. This paper attempts to answer three questions: (1) How much is the tumor residual motion when we use an external surrogate gating window at EOI? (2) How could we reduce the residual motion in the EOI gating window? (3) Is there a preference for amplitude- versus phase-based gating at EOI? We found that under free breathing conditions the residual motion of the tumors is much larger for EOI phase than for EOE phase. The mean values of residual motion at EOI were found to be 2.2 and 2.7 mm for amplitude- and phase-based gating, respectively, and, at EOE, 1.0 and 1.2 mm for amplitude- and phase-based gating, respectively. However, we note that the residual motion in the EOI gating window is correlated well with the reproducibility of the external surface position in the EOI phase. Using the results of a published breath-coaching study, we deduce that the residual motion of a lung tumor at EOI would approach that at EOE, with the same duty cycle (30%), under breath-coaching conditions. Additionally, we found that under these same conditions, phase-based gating approaches the same residual motion as amplitude-based gating, going from a 28% difference to 11%, for the patient with the largest difference between the two gating modalities. We conclude

  20. Systematisation of spatial uncertainties for comparison between a MR and a CT-based radiotherapy workflow for prostate treatments

    International Nuclear Information System (INIS)

    Nyholm, Tufve; Nyberg, Morgan; Karlsson, Magnus G; Karlsson, Mikael

    2009-01-01

    In the present work we compared the spatial uncertainties associated with a MR-based workflow for external radiotherapy of prostate cancer to a standard CT-based workflow. The MR-based workflow relies on target definition and patient positioning based on MR imaging. A solution for patient transport between the MR scanner and the treatment units has been developed. For the CT-based workflow, the target is defined on a MR series but then transferred to a CT study through image registration before treatment planning, and a patient positioning using portal imaging and fiducial markers. An 'open bore' 1.5T MRI scanner, Siemens Espree, has been installed in the radiotherapy department in near proximity to a treatment unit to enable patient transport between the two installations, and hence use the MRI for patient positioning. The spatial uncertainty caused by the transport was added to the uncertainty originating from the target definition process, estimated through a review of the scientific literature. The uncertainty in the CT-based workflow was estimated through a literature review. The systematic uncertainties, affecting all treatment fractions, are reduced from 3-4 mm (1Sd) with a CT based workflow to 2-3 mm with a MR based workflow. The main contributing factor to this improvement is the exclusion of registration between MR and CT in the planning phase of the treatment. Treatment planning directly on MR images reduce the spatial uncertainty for prostate treatments

  1. Patient feature based dosimetric Pareto front prediction in esophageal cancer radiotherapy.

    Science.gov (United States)

    Wang, Jiazhou; Jin, Xiance; Zhao, Kuaike; Peng, Jiayuan; Xie, Jiang; Chen, Junchao; Zhang, Zhen; Studenski, Matthew; Hu, Weigang

    2015-02-01

    To investigate the feasibility of the dosimetric Pareto front (PF) prediction based on patient's anatomic and dosimetric parameters for esophageal cancer patients. Eighty esophagus patients in the authors' institution were enrolled in this study. A total of 2928 intensity-modulated radiotherapy plans were obtained and used to generate PF for each patient. On average, each patient had 36.6 plans. The anatomic and dosimetric features were extracted from these plans. The mean lung dose (MLD), mean heart dose (MHD), spinal cord max dose, and PTV homogeneity index were recorded for each plan. Principal component analysis was used to extract overlap volume histogram (OVH) features between PTV and other organs at risk. The full dataset was separated into two parts; a training dataset and a validation dataset. The prediction outcomes were the MHD and MLD. The spearman's rank correlation coefficient was used to evaluate the correlation between the anatomical features and dosimetric features. The stepwise multiple regression method was used to fit the PF. The cross validation method was used to evaluate the model. With 1000 repetitions, the mean prediction error of the MHD was 469 cGy. The most correlated factor was the first principal components of the OVH between heart and PTV and the overlap between heart and PTV in Z-axis. The mean prediction error of the MLD was 284 cGy. The most correlated factors were the first principal components of the OVH between heart and PTV and the overlap between lung and PTV in Z-axis. It is feasible to use patients' anatomic and dosimetric features to generate a predicted Pareto front. Additional samples and further studies are required improve the prediction model.

  2. Important prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after radiotherapy

    International Nuclear Information System (INIS)

    Lu, T.-X.; Mai, W.-Y.; Teh, Bin S.; Hu, Y.-H.; Lu, Hsin H.; Chiu, J. Kam; Carpenter, L. Steven; Woo, Shiao Y.; Butler, E. Brian

    2001-01-01

    Purpose: To evaluate the long-term outcome and prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after initial radiotherapy (RT). Methods and Materials: From January 1985 to December 1986, 100 patients (71 males, 29 females) with a diagnosis of nasopharyngeal carcinoma were found on computed tomography (CT) to have skull base erosion. The mean age was 41 years (range 16-66). Ninety-six patients had World Health Organization type III undifferentiated carcinoma, and 4 had type I. The metastatic workup, including chest radiography, liver ultrasound scanning, and liver function test was negative. All patients underwent external beam RT (EBRT) alone to 66-80 Gy during 6-8 weeks. A daily fraction size of 2 Gy was delivered using 60 Co or a linear accelerator. No patient received chemotherapy. All patients were followed at regular intervals after irradiation. The median follow-up was 22.3 months (range 2-174). Survival of the cohort was computed by the Kaplan-Meier method. The potential prognostic factors of survival were examined. Multivariate analyses were performed using the Cox regression model. Results: The 1, 2, 5, and 10-year overall survival rate for the cohort was 79%, 41%, 27%, and 13%, respectively. However, the subgroup of patients with both anterior cranial nerve (I-VIII) and posterior cranial nerve (IX-XII) involvement had a 5-year survival of only 7.7%. A difference in the time course of local recurrence and distant metastasis was observed. Both local recurrence and distant metastasis often occurred within the first 2 years after RT. However, local relapse continued to occur after 5 years. In contrast, no additional distant metastases were found after 5 years. The causes of death included local recurrence (n=59), distant metastasis (n=21), both local recurrence and distant metastasis (n = 1), and unrelated causes (n=5). After multivariate analysis, complete recovery of cranial nerve involvement, cranial nerve palsy, and

  3. New 2-D dosimetric technique for radiotherapy based on planar thermoluminescent detectors

    International Nuclear Information System (INIS)

    Olko, P.; Marczewska, B.; Czopyk, L.; Czermak, M. A.; Klosowski, M.; Waligorski, M. P. R.

    2006-01-01

    At the Inst. of Nuclear Physics of the Polish Academy of Sciences (IFJ) in Krakow, a two-dimensional (2-D) thermoluminescence (TL) dosimetry system was developed within the MAESTRO (Methods and Advanced Equipment for Simulation and Treatment in Radio-Oncology) 6 Framework Programme and tested by evaluating 2-D dose distributions around radioactive sources. A thermoluminescent detector (TLD) foil was developed, of thickness 0.3 mm and diameter 60 mm, containing a mixture of highly sensitive LiF:Mg,Cu,P powder and Ethylene Tetrafluoroethylene (ETFE) polymer. Foil detectors were irradiated with 226 Ra brachytherapy sources and a 90 Sr/ 90 Y source. 2-D dose distributions were evaluated using a prototype planar (diameter 60 mm) reader, equipped with a 12 bit Charge Coupled Devices (CCD) PCO AG camera, with a resolution of 640 x 480 pixels. The new detectors, showing a spatial resolution better than 0.5 mm and a measurable dose range typical for radiotherapy, can find many applications in clinical dosimetry. Another technology applicable to clinical dosimetry, also developed at IFJ, is the Si microstrip detector of size 95 x 95 mm 2 , which may be used to evaluate the dose distribution with a spatial resolution of 120 μm along one direction, in real-time mode. The microstrip and TLD technology will be further improved, especially to develop detectors of larger area, and to make them applicable to some advanced radiotherapy modalities, such as intensity modulated radiotherapy (IMRT) or proton radiotherapy. (authors)

  4. Paediatric Photon and Proton Radiotherapy Treatment Planning Based on Advanced Imaging

    DEFF Research Database (Denmark)

    Kornerup, Josefine S.

    The overall cure-rates for young cancer patients are continuously increasing and about 80% of the children diagnosed with cancer today will survive for more than five years. However, the cancer treatment, usually a combination of surgery, radiotherapy and chemotherapy, is aggressive. Apart from a...

  5. SU-F-T-243: Major Risks in Radiotherapy. A Review Based On Risk Analysis Literature

    Energy Technology Data Exchange (ETDEWEB)

    López-Tarjuelo, J; Guasp-Tortajada, M; Iglesias-Montenegro, N; Monasor-Denia, P [Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, España/Spain (Spain); Bouché-Babiloni, A; Morillo-Macías, V; Ferrer-Albiach, C [Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, España/Spain (Spain)

    2016-06-15

    Purpose: We present a literature review of risk analyses in radiotherapy to highlight the most reported risks and facilitate the spread of this valuable information so that professionals can be aware of these major threats before performing their own studies. Methods: We considered studies with at least an estimation of the probability of occurrence of an adverse event (O) and its associated severity (S). They cover external beam radiotherapy, brachytherapy, intraoperative radiotherapy, and stereotactic techniques. We selected only the works containing a detailed ranked series of elements or failure modes and focused on the first fully reported quartile as much. Afterward, we sorted the risk elements according to a regular radiotherapy procedure so that the resulting groups were cited in several works and be ranked in this way. Results: 29 references published between 2007 and February 2016 were studied. Publication trend has been generally rising. The most employed analysis has been the Failure mode and effect analysis (FMEA). Among references, we selected 20 works listing 258 ranked risk elements. They were sorted into 31 groups appearing at least in two different works. 11 groups appeared in at least 5 references and 5 groups did it in 7 or more papers. These last sets of risks where choosing another set of images or plan for planning or treating, errors related with contours, errors in patient positioning for treatment, human mistakes when programming treatments, and planning errors. Conclusion: There is a sufficient amount and variety of references for identifying which failure modes or elements should be addressed in a radiotherapy department before attempting a specific analysis. FMEA prevailed, but other studies such as “risk matrix” or “occurrence × severity” analyses can also lead professionals’ efforts. Risk associated with human actions ranks very high; therefore, they should be automated or at least peer-reviewed.

  6. SU-F-T-243: Major Risks in Radiotherapy. A Review Based On Risk Analysis Literature

    International Nuclear Information System (INIS)

    López-Tarjuelo, J; Guasp-Tortajada, M; Iglesias-Montenegro, N; Monasor-Denia, P; Bouché-Babiloni, A; Morillo-Macías, V; Ferrer-Albiach, C

    2016-01-01

    Purpose: We present a literature review of risk analyses in radiotherapy to highlight the most reported risks and facilitate the spread of this valuable information so that professionals can be aware of these major threats before performing their own studies. Methods: We considered studies with at least an estimation of the probability of occurrence of an adverse event (O) and its associated severity (S). They cover external beam radiotherapy, brachytherapy, intraoperative radiotherapy, and stereotactic techniques. We selected only the works containing a detailed ranked series of elements or failure modes and focused on the first fully reported quartile as much. Afterward, we sorted the risk elements according to a regular radiotherapy procedure so that the resulting groups were cited in several works and be ranked in this way. Results: 29 references published between 2007 and February 2016 were studied. Publication trend has been generally rising. The most employed analysis has been the Failure mode and effect analysis (FMEA). Among references, we selected 20 works listing 258 ranked risk elements. They were sorted into 31 groups appearing at least in two different works. 11 groups appeared in at least 5 references and 5 groups did it in 7 or more papers. These last sets of risks where choosing another set of images or plan for planning or treating, errors related with contours, errors in patient positioning for treatment, human mistakes when programming treatments, and planning errors. Conclusion: There is a sufficient amount and variety of references for identifying which failure modes or elements should be addressed in a radiotherapy department before attempting a specific analysis. FMEA prevailed, but other studies such as “risk matrix” or “occurrence × severity” analyses can also lead professionals’ efforts. Risk associated with human actions ranks very high; therefore, they should be automated or at least peer-reviewed.

  7. MRI-based measurements of respiratory motion variability and assessment of imaging strategies for radiotherapy planning

    International Nuclear Information System (INIS)

    Blackall, J M; Ahmad, S; Miquel, M E; McClelland, J R; Landau, D B; Hawkes, D J

    2006-01-01

    Respiratory organ motion has a significant impact on the planning and delivery of radiotherapy (RT) treatment for lung cancer. Currently widespread techniques, such as 4D-computed tomography (4DCT), cannot be used to measure variability of this motion from one cycle to the next. In this paper, we describe the use of fast magnetic resonance imaging (MRI) techniques to investigate the intra- and inter-cycle reproducibility of respiratory motion and also to estimate the level of errors that may be introduced into treatment delivery by using various breath-hold imaging strategies during lung RT planning. A reference model of respiratory motion is formed to enable comparison of different breathing cycles at any arbitrary position in the respiratory cycle. This is constructed by using free-breathing images from the inhale phase of a single breathing cycle, then co-registering the images, and thereby tracking landmarks. This reference model is then compared to alternative models constructed from images acquired during the exhale phase of the same cycle and the inhale phase of a subsequent cycle, to assess intra- and inter-cycle variability ('hysteresis' and 'reproducibility') of organ motion. The reference model is also compared to a series of models formed from breath-hold data at exhale and inhale. Evaluation of these models is carried out on data from ten healthy volunteers and five lung cancer patients. Free-breathing models show good levels of intra- and inter-cycle reproducibility across the tidal breathing range. Mean intra-cycle errors in the position of organ surface landmarks of 1.5(1.4)-3.5(3.3) mm for volunteers and 2.8(1.8)-5.2(5.2) mm for patients. Equivalent measures of inter-cycle variability across this range are 1.7(1.0)-3.9(3.3) mm for volunteers and 2.8(1.8)-3.3(2.2) mm for patients. As expected, models based on breath-hold sequences do not represent normal tidal motion as well as those based on free-breathing data, with mean errors of 4

  8. A population-based study of the use and outcome of radical radiotherapy for invasive bladder cancer

    International Nuclear Information System (INIS)

    Hayter, Charles R.R.; Paszat, Lawrence F.; Groome, Patti A.; Schulze, Karleen; Mackillop, William J.

    1999-01-01

    nonpapillary transitional cell carcinoma [TCC]) and advanced age. Conclusion: This population-based study confirms previous institutional studies and clinical trials and shows that radical RT has a curative role in the management of invasive bladder cancer and allows about one-quarter of patients receiving radiotherapy to survive 5 years while retaining the bladder. Salvage cystectomy following RT provides a chance of cure at the time of bladder relapse

  9. An evidence-based estimate of the appropriate rate of utilization of radiotherapy for cancer of the cervix

    International Nuclear Information System (INIS)

    Usmani, Nawaid; Foroudi, Farshad; Du, Jenny; Zakos, Celine; Campbell, Holly; Bryson, Peter; Mackillop, William J.

    2005-01-01

    Purpose: Current estimates of the proportion of cancer patients who will require radiotherapy (RT) are based almost entirely on expert opinion. The objective of this study was to calculate the proportion of incident cases of cervical cancer that should receive RT by application of an evidence-based approach. Methods and Materials: A systematic review of the literature was done to identify indications for RT for cervical cancer and to ascertain the level of evidence that supported each indication. A survey of Canadian gynecologic oncologists and radiation oncologists who treat cervical cancer was done to determine the level of acceptance of each indication among doctors who practice in the field. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of patients with cervical cancer. Results: The systematic review of the literature identified 29 different indications for RT for cervical cancer. The majority of the 75 experts who responded to the mail survey stated that they 'usually' or 'always' recommended RT in all but one of the clinical situations that were identified as indications for RT on the basis of the systematic review. The analysis of epidemiologic data revealed that, in a typical North American population, 65.4% ± 2.5% of cervical cancer cases will develop one or more indications for RT at some point in the course of the illness, 63.4% ± 2.3% will develop indications for RT as part of their initial management, and 2.0% ± 0.9% will develop indications for RT for progressive or recurrent disease. The effects of variations in case mix on the need for RT was examined by sensitivity analysis, which suggested that the maximum plausible range for the appropriate rate of utilization of RT was 54.3% to 67.9%. The proportion of cases that required RT was stage dependent: 10.6% ± 1.2% in Stage IA, 74.9% ± 1.3% in Stage IB, 100% in Stages II and III, and 97.2% ± 1.1% in Stage IV

  10. Contact radiotherapy. Report of technological assessment

    International Nuclear Information System (INIS)

    Ortholan, Cecile; Melin, Nicole; Lee-Robin, Sun Hae; David, Denis Jean; Pages, Frederique; Devaud, Christine; Noel, Georges; Biga, Julie; Moty-Monnereau, Celine; Canet, Philippe; Lascols, Sylvie; Lamas, Muriel; Ramdine, Jessica; Tuil, Louise

    2008-10-01

    This report aims at assessing safety, indications, the role in therapeutic strategy, and efficiency of contact radiotherapy. It also aims at answering questions like: is the contact radiotherapy technique validated? What are the indications for contact radiotherapy? What about the efficiency and safety of contact radiotherapy? After a presentation of preliminary notions on radiotherapy (radiation types, dose, and irradiation techniques), the report presents this specific technique of contact radiotherapy: definition, devices, use recommendations, issues of radiation protection, modalities of performance of a contact radiotherapy session, and concerned pathologies. Then, based on a literature survey, this report addresses the various concerned tumours (skin, rectum, brain, breast), indicates some general information about these tumours (epidemiological data, anatomy and classification, therapeutic options, radiotherapy), and proposes an assessment of the efficiency and safety of contact radiotherapy

  11. Automated beam placement for breast radiotherapy using a support vector machine based algorithm

    International Nuclear Information System (INIS)

    Zhao Xuan; Kong, Dewen; Jozsef, Gabor; Chang, Jenghwa; Wong, Edward K.; Formenti, Silvia C.; Wang Yao

    2012-01-01

    Purpose: To develop an automated beam placement technique for whole breast radiotherapy using tangential beams. We seek to find optimal parameters for tangential beams to cover the whole ipsilateral breast (WB) and minimize the dose to the organs at risk (OARs). Methods: A support vector machine (SVM) based method is proposed to determine the optimal posterior plane of the tangential beams. Relative significances of including/avoiding the volumes of interests are incorporated into the cost function of the SVM. After finding the optimal 3-D plane that separates the whole breast (WB) and the included clinical target volumes (CTVs) from the OARs, the gantry angle, collimator angle, and posterior jaw size of the tangential beams are derived from the separating plane equation. Dosimetric measures of the treatment plans determined by the automated method are compared with those obtained by applying manual beam placement by the physicians. The method can be further extended to use multileaf collimator (MLC) blocking by optimizing posterior MLC positions. Results: The plans for 36 patients (23 prone- and 13 supine-treated) with left breast cancer were analyzed. Our algorithm reduced the volume of the heart that receives >500 cGy dose (V5) from 2.7 to 1.7 cm 3 (p = 0.058) on average and the volume of the ipsilateral lung that receives >1000 cGy dose (V10) from 55.2 to 40.7 cm 3 (p = 0.0013). The dose coverage as measured by volume receiving >95% of the prescription dose (V95%) of the WB without a 5 mm superficial layer decreases by only 0.74% (p = 0.0002) and the V95% for the tumor bed with 1.5 cm margin remains unchanged. Conclusions: This study has demonstrated the feasibility of using a SVM-based algorithm to determine optimal beam placement without a physician's intervention. The proposed method reduced the dose to OARs, especially for supine treated patients, without any relevant degradation of dose homogeneity and coverage in general.

  12. SU-F-J-113: Multi-Atlas Based Automatic Organ Segmentation for Lung Radiotherapy Planning

    International Nuclear Information System (INIS)

    Kim, J; Han, J; Ailawadi, S; Baker, J; Hsia, A; Xu, Z; Ryu, S

    2016-01-01

    Purpose: Normal organ segmentation is one time-consuming and labor-intensive step for lung radiotherapy treatment planning. The aim of this study is to evaluate the performance of a multi-atlas based segmentation approach for automatic organs at risk (OAR) delineation. Methods: Fifteen Lung stereotactic body radiation therapy patients were randomly selected. Planning CT images and OAR contours of the heart - HT, aorta - AO, vena cava - VC, pulmonary trunk - PT, and esophagus – ES were exported and used as reference and atlas sets. For automatic organ delineation for a given target CT, 1) all atlas sets were deformably warped to the target CT, 2) the deformed sets were accumulated and normalized to produce organ probability density (OPD) maps, and 3) the OPD maps were converted to contours via image thresholding. Optimal threshold for each organ was empirically determined by comparing the auto-segmented contours against their respective reference contours. The delineated results were evaluated by measuring contour similarity metrics: DICE, mean distance (MD), and true detection rate (TD), where DICE=(intersection volume/sum of two volumes) and TD = {1.0 - (false positive + false negative)/2.0}. Diffeomorphic Demons algorithm was employed for CT-CT deformable image registrations. Results: Optimal thresholds were determined to be 0.53 for HT, 0.38 for AO, 0.28 for PT, 0.43 for VC, and 0.31 for ES. The mean similarity metrics (DICE[%], MD[mm], TD[%]) were (88, 3.2, 89) for HT, (79, 3.2, 82) for AO, (75, 2.7, 77) for PT, (68, 3.4, 73) for VC, and (51,2.7, 60) for ES. Conclusion: The investigated multi-atlas based approach produced reliable segmentations for the organs with large and relatively clear boundaries (HT and AO). However, the detection of small and narrow organs with diffused boundaries (ES) were challenging. Sophisticated atlas selection and multi-atlas fusion algorithms may further improve the quality of segmentations.

  13. Evidence-based estimate of appropriate radiotherapy utilization rate for prostate cancer

    International Nuclear Information System (INIS)

    Foroudi, Farshad; Tyldesley, Scott; Barbera, Lisa; Huang, Jenny; Mackillop, William J.

    2003-01-01

    Purpose: Current estimates of the proportion of cancer patients who will require radiotherapy (RT) are based almost entirely on expert opinion. The objective of this study was to use an evidence-based approach to estimate the proportion of incident cases of prostate cancer that should receive RT at any point in the evolution of the illness. Methods and Materials: A systematic review of the literature was undertaken to identify indications for RT for prostate cancer and to ascertain the level of evidence that supported each indication. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of prostate cancer patients. The effect of sampling error on the estimated appropriate rate of RT was calculated mathematically, and the effect of systematic error using alternative sources of information was estimated by sensitivity analysis. Results: It was estimated that 61.2% ±5.6% of prostate cancer cases develop one or more indications for RT at some point in the course of the illness. The plausible range for this rate was 57.3%-69.8% on sensitivity analysis. Of all prostate cancer patients, 32.2%±3.8% should receive RT in their initial treatment and 29.0% ± 4.1% later for recurrence or progression. The proportion of cases that ever require RT is risk grouping dependent; 43.9%±2.2% in low-risk disease, 68.7%± .5% in intermediate-risk disease; and 79.0% ± 3.8% in high-risk locoregional disease. For metastatic disease, the predicted rate was 66.4%±0.3%. Conclusion: This method provides a rational starting point for the long-term planning of radiation services and for the audit of access to RT at the population level. By completing such evaluations in major cancer sites, it will be possible to estimate the appropriate RT rate for the cancer population as a whole

  14. LINAC based stereotactic radiotherapy of uveal melanoma: 4 years clinical experience

    International Nuclear Information System (INIS)

    Dieckmann, Karin; Georg, Dietmar; Zehetmayer, Martin; Bogner, Joachim; Georgopoulos, Michael; Poetter, Richard

    2003-01-01

    Purpose: To study local tumor control and radiogenic side effects after fractionated LINAC based stereotactic radiotherapy for selected uveal melanoma. Patients and methods: Between June 1997 and March 2001, 90 patients suffering from uveal melanoma were treated at a LINAC with 6 MV. The head was immobilized with a modified stereotactic frame system (BrainLAB). For stabilization of the eye position a light source was integrated into the mask system in front of the healthy or the diseased eye. A mini-video camera was used for on-line eye movement control. Tumors included in the study were either located unfavorably with respect to macula and optical disc ( 7 mm. Median tumor volume was 305±234 mm 3 (range 70-1430 mm 3 ), and mean tumor height was 5.4±2.3 mm (range 2.7-15.9 mm). Total doses of 70 (single dose 14 Gy at 80% isodose) or 60 Gy (single dose 12 Gy at 80% isodose) were applied in five fractions within 10 days. The first fractionation results in total dose (TD) (2 Gy) of 175 Gy for tumor and 238 Gy for normal tissue, corresponding values for the second fractionation schedule are 135 and 180 Gy, respectively. Results: After a median follow-up of 20 months (range 1-48 months) local control was achieved in 98% (n=88). The mean relative tumor reductions were 24, 27, and 37% after 12, 24 and 36 months. Three patients (3.3%) developed metastases. Secondary enucleation was performed in seven patients (7.7%). Long term side effects were retinopathy (25.5%), cataract (18.9%), optic neuropathy (20%), and secondary neovascular glaucoma (8.8%). Conclusion: Fractionated LINAC based stereotactic photon beam therapy in conjunction with a dedicated eye movement control system is a highly effective method to treat unfavorably located uveal melanoma. Total doses of 60 Gy (single dose 12 Gy) are considered to be sufficient to achieve good local tumor control

  15. SU-F-J-113: Multi-Atlas Based Automatic Organ Segmentation for Lung Radiotherapy Planning

    Energy Technology Data Exchange (ETDEWEB)

    Kim, J; Han, J; Ailawadi, S; Baker, J; Hsia, A; Xu, Z; Ryu, S [Stony Brook University Hospital, Stony Brook, NY (United States)

    2016-06-15

    Purpose: Normal organ segmentation is one time-consuming and labor-intensive step for lung radiotherapy treatment planning. The aim of this study is to evaluate the performance of a multi-atlas based segmentation approach for automatic organs at risk (OAR) delineation. Methods: Fifteen Lung stereotactic body radiation therapy patients were randomly selected. Planning CT images and OAR contours of the heart - HT, aorta - AO, vena cava - VC, pulmonary trunk - PT, and esophagus – ES were exported and used as reference and atlas sets. For automatic organ delineation for a given target CT, 1) all atlas sets were deformably warped to the target CT, 2) the deformed sets were accumulated and normalized to produce organ probability density (OPD) maps, and 3) the OPD maps were converted to contours via image thresholding. Optimal threshold for each organ was empirically determined by comparing the auto-segmented contours against their respective reference contours. The delineated results were evaluated by measuring contour similarity metrics: DICE, mean distance (MD), and true detection rate (TD), where DICE=(intersection volume/sum of two volumes) and TD = {1.0 - (false positive + false negative)/2.0}. Diffeomorphic Demons algorithm was employed for CT-CT deformable image registrations. Results: Optimal thresholds were determined to be 0.53 for HT, 0.38 for AO, 0.28 for PT, 0.43 for VC, and 0.31 for ES. The mean similarity metrics (DICE[%], MD[mm], TD[%]) were (88, 3.2, 89) for HT, (79, 3.2, 82) for AO, (75, 2.7, 77) for PT, (68, 3.4, 73) for VC, and (51,2.7, 60) for ES. Conclusion: The investigated multi-atlas based approach produced reliable segmentations for the organs with large and relatively clear boundaries (HT and AO). However, the detection of small and narrow organs with diffused boundaries (ES) were challenging. Sophisticated atlas selection and multi-atlas fusion algorithms may further improve the quality of segmentations.

  16. The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy

    International Nuclear Information System (INIS)

    Park, Won; Huh, Seung-Jae; Yang, Jung-Hyun

    2008-01-01

    The objective of this study was to analyze the implication of abnormal hot spots in the irradiated field of patients treated with mastectomy followed by radiotherapy for breast cancer. We reviewed 1842 consecutive bone scans performed on 292 patients treated with a modified radical mastectomy and followed by radiotherapy. If abnormal hot spots at the irradiated sites were detected in the bone scans, we evaluated further studies to determine whether bone metastases were present. Radiation was given using 4 or 6 MV X-rays at a dosage of 50.4 Gy during 5.5 weeks with a dosage per fraction of 1.8 Gy. The follow-up period was 25-136 months (median 57 months). Sixty patients (20.6%) developed bone metastasis. Solitary rib metastases were identified in four patients; all were detected outside of the irradiated field. Of 232 patients who did not develop bone metastases, hot spots in the irradiated field were detected in 30 patients (12.9%). A simple rib facture at the site of a hot spot was demonstrated in four patients. The cumulative incidence of hot spots at 5 years was 12.9%. The cumulative incidence of hot spots was more common in postmenopausal women, patients who were less than 60 kg, patients who received adjuvant hormonal therapy and patients who had radiation that included the supraclavicular area. We confirmed that the hot spots within the irradiated fields might be benign, especially in patients who were postmenopause, had a low body weight, received adjuvant hormonal therapy and who had radiation that included the supraclavicular area. (author)

  17. Second primary cancers after adjuvant radiotherapy in early breast cancer patients: A national population based study under the Danish Breast Cancer Cooperative Group (DBCG)

    International Nuclear Information System (INIS)

    Grantzau, Trine; Mellemkjær, Lene; Overgaard, Jens

    2013-01-01

    Background and purpose: To analyze the long-term risk of second primary solid non-breast cancer in a national population-based cohort of 46,176 patients treated for early breast cancer between 1982 and 2007. Patients and methods: All patients studied were treated according to the national guidelines of the Danish Breast Cancer Cooperative Group. The risk of second primary cancers was estimated by Standardised incidence ratios (SIRs) and multivariate Cox regression models were used to estimate adjusted hazard ratios (HR) among irradiated women compared to non-irradiated. All irradiated patients were treated on linear accelerators. Second cancers were a priori categorized into two groups; radiotherapy-associated- (oesophagus, lung, heart/mediastinum, pleura, bones, and connective tissue) and non-radiotherapy-associated sites (all other cancers). Results: 2358 second cancers had occurred during the follow-up. For the radiotherapy-associated sites the HR among irradiated women was 1.34 (95% CI 1.11–1.61) with significantly increased HRs for the time periods of 10–14 years (HR 1.55; 95% CI 1.08–2.24) and ⩾15 years after treatment (HR 1.79; 95% CI 1.14–2.81). There was no increased risk for the non-radiotherapy-associated sites (HR 1.04; 95% CI 0.94–1.1). The estimated attributable risk related to radiotherapy for the radiotherapy-associated sites translates into one radiation-induced second cancer in every 200 women treated with radiotherapy. Conclusions: Radiotherapy treated breast cancer patients have a small but significantly excess risk of second cancers

  18. Influence of boost technique (external beam radiotherapy or brachytherapy) on the outcome of patients with carcinoma of the base of the tongue

    International Nuclear Information System (INIS)

    Regueiro, C.A.; Millan, I.; Torre, A. de la; Valcarcel, F.J.; Magallon, R.; Fernandez, E.; Aragon, G.

    1995-01-01

    We reviewed 90 patients with squamous cell carcinoma of the base of the tongue. Fifty-three patients were treated with external beam radiotherapy alone (3 T1, 11 T2, 21 T3, and 18 T4 tumors) and thirty-seven patients were treated with external beam radiotherapy plus brachytherapy boost (4 T1, 15 T2, 11 T3, and 7 T4 tumors). For patients with T1, T2 and T3 primaries, the actuarial 3-year local relapse-free survival was 42% following external beam radiotherapy alone and 67% following external beam radiotherapy plus brachytherapy (p<0.05). The actuarial 3-year cause specific survival for these T-stages was 37% for patients treated with external beam radiotherapy alone and 53% for patients treated with external beam radiotherapy plus brachytherapy (p=0.1). In the Cox multivariate analyses restricted patients with T1, T2 and T3 staged tumors, treatment modality was the only predictor for local control but no influence on specific survival was found. The trend towards significant differences in specific survival found in the univariate comparison of both treatment modalities was probably due to the significantly higher number of N-positive patients treated with external beam radiotherapy alone. When all stages were included in the Cox analysis, low hemoglobin level, invasion of deep muscle, number of palpable nodes, and history of weight loss significantly influenced the outcome. Soft tissue necrosis occurred more frequently in patients treated with external beam radiotherapy plus brachytherapy (33% vs. 10%, p=0.52). (orig.)

  19. External audit in radiotherapy dosimetry

    International Nuclear Information System (INIS)

    Thwaites, D.I.; Western General Hospital, Edinburgh

    1996-01-01

    Quality audit forms an essential part of any comprehensive quality assurance programme. This is true in radiotherapy generally and in specific areas such as radiotherapy dosimetry. Quality audit can independently test the effectiveness of the quality system and in so doing can identify problem areas and minimize their possible consequences. Some general points concerning quality audit applied to radiotherapy are followed by specific discussion of its practical role in radiotherapy dosimetry, following its evolution from dosimetric intercomparison exercises to routine measurement-based on-going audit in the various developing audit networks both in the UK and internationally. Specific examples of methods and results are given from some of these, including the Scottish+ audit group. Quality audit in radiotherapy dosimetry is now well proven and participation by individual centres is strongly recommended. Similar audit approaches are to be encouraged in other areas of the radiotherapy process. (author)

  20. Radiotherapy induced xerostomia: mechanisms, diagnostics, prevention and treatment--evidence based up to 2013.

    Science.gov (United States)

    Kałużny, Jarosław; Wierzbicka, Małgorzata; Nogala, Hanna; Milecki, Piotr; Kopeć, Tomasz

    2014-01-01

    Definition and prevalence of xerostomia were shortly presented. Radiosensitivity of the salivary glands, mechanism, diagnostics, and possible prediction methods of the intensity of xerostomia in the pre-radiotherapy period are widely discussed. Prevention of xerostomia: salivary gland sparing radiotherapy, cytoprotective agents, preservation by stimulation with cholinergic muscarinic agonists, surgical transfer of submandibular glands according to ASCO Management Guidelines and Quality of Life Recommendations were cited. Oral Care Study Group (2010) therapeutic approaches for relieving xerostomia are referred. Current therapies, restricted to symptom relief such as oral hygiene with fluoride agents, antimicrobials to prevent dental caries, saliva substitutes to relieve symptoms, and sialogenic agents to stimulate saliva were also discussed. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

  1. Distress associated with radiotherapy for malignant disease: a quantitative analysis based on patients perceptions

    International Nuclear Information System (INIS)

    Munro, A.J.; Biruls, R.; Griffin, A.V.; Thomas, H.; Vallis, K.A.

    1989-01-01

    Distress associated with attendance at a radiotherapy department was assessed in 80 consecutive patients. All patients were interviewed within 24 h of their first fraction of radiotherapy; 31 patients were also interviewed at the end of treatment. The problem identified at first interview as causing the most distress was worry about the effects of disease and its treatment upon the patient's family. At second interview the dominant complaint was of not being allowed to wash. Psychological problems, including anxiety and sleep disturbances, caused more overall distress than did physical symptoms. The method used in this study for eliciting information on the side-effects of therapy is straightforward and has yielded data that are provocative and suggest interesting avenues for further investigation. (author)

  2. Radiotherapy planning for glioblastoma based on a tumor growth model: improving target volume delineation

    Science.gov (United States)

    Unkelbach, Jan; Menze, Bjoern H.; Konukoglu, Ender; Dittmann, Florian; Le, Matthieu; Ayache, Nicholas; Shih, Helen A.

    2014-02-01

    Glioblastoma differ from many other tumors in the sense that they grow infiltratively into the brain tissue instead of forming a solid tumor mass with a defined boundary. Only the part of the tumor with high tumor cell density can be localized through imaging directly. In contrast, brain tissue infiltrated by tumor cells at low density appears normal on current imaging modalities. In current clinical practice, a uniform margin, typically two centimeters, is applied to account for microscopic spread of disease that is not directly assessable through imaging. The current treatment planning procedure can potentially be improved by accounting for the anisotropy of tumor growth, which arises from different factors: anatomical barriers such as the falx cerebri represent boundaries for migrating tumor cells. In addition, tumor cells primarily spread in white matter and infiltrate gray matter at lower rate. We investigate the use of a phenomenological tumor growth model for treatment planning. The model is based on the Fisher-Kolmogorov equation, which formalizes these growth characteristics and estimates the spatial distribution of tumor cells in normal appearing regions of the brain. The target volume for radiotherapy planning can be defined as an isoline of the simulated tumor cell density. This paper analyzes the model with respect to implications for target volume definition and identifies its most critical components. A retrospective study involving ten glioblastoma patients treated at our institution has been performed. To illustrate the main findings of the study, a detailed case study is presented for a glioblastoma located close to the falx. In this situation, the falx represents a boundary for migrating tumor cells, whereas the corpus callosum provides a route for the tumor to spread to the contralateral hemisphere. We further discuss the sensitivity of the model with respect to the input parameters. Correct segmentation of the brain appears to be the most

  3. Radiotherapy planning for glioblastoma based on a tumor growth model: improving target volume delineation

    International Nuclear Information System (INIS)

    Unkelbach, Jan; Dittmann, Florian; Le, Matthieu; Shih, Helen A; Menze, Bjoern H; Ayache, Nicholas; Konukoglu, Ender

    2014-01-01

    Glioblastoma differ from many other tumors in the sense that they grow infiltratively into the brain tissue instead of forming a solid tumor mass with a defined boundary. Only the part of the tumor with high tumor cell density can be localized through imaging directly. In contrast, brain tissue infiltrated by tumor cells at low density appears normal on current imaging modalities. In current clinical practice, a uniform margin, typically two centimeters, is applied to account for microscopic spread of disease that is not directly assessable through imaging. The current treatment planning procedure can potentially be improved by accounting for the anisotropy of tumor growth, which arises from different factors: anatomical barriers such as the falx cerebri represent boundaries for migrating tumor cells. In addition, tumor cells primarily spread in white matter and infiltrate gray matter at lower rate. We investigate the use of a phenomenological tumor growth model for treatment planning. The model is based on the Fisher–Kolmogorov equation, which formalizes these growth characteristics and estimates the spatial distribution of tumor cells in normal appearing regions of the brain. The target volume for radiotherapy planning can be defined as an isoline of the simulated tumor cell density. This paper analyzes the model with respect to implications for target volume definition and identifies its most critical components. A retrospective study involving ten glioblastoma patients treated at our institution has been performed. To illustrate the main findings of the study, a detailed case study is presented for a glioblastoma located close to the falx. In this situation, the falx represents a boundary for migrating tumor cells, whereas the corpus callosum provides a route for the tumor to spread to the contralateral hemisphere. We further discuss the sensitivity of the model with respect to the input parameters. Correct segmentation of the brain appears to be the most

  4. Linear accelerator based stereotactic radiosurgery with micro multi-leaf collimator : technological advancement in precision radiotherapy

    International Nuclear Information System (INIS)

    Dayananda, S.; Kinhikar, R.A.; Saju, Sherley; Deshpande, D.D.; Jalali, R.; Sarin, R.; Shrivastava, S.K.; Dinshaw, K.A.

    2003-01-01

    Stereotactic Radiosurgery (SRS) is an advancement on precision radiotherapy, in which stereo tactically guided localized high dose is delivered to the lesion (target) in a single fraction, while sparing the surrounding normal tissue. Radiosurgery has been used to treat variety of benign and malignant lesions as well as functional disorders in brain such as arteriovenous malformation (AVM), acoustic neuroma, solitary primary brain tumor, single metastasis, pituitary adenoma etc

  5. Evidence-based recommendations for the use of antiemetics in radiotherapy

    International Nuclear Information System (INIS)

    Maranzano, Ernesto; Feyer, Petra Ch.; Molassiotis, Alexander; Rossi, Romina; Clark-Snow, Rebecca A.; Olver, Ian; Warr, David; Schiavone, Concetta; Roila, Fausto

    2005-01-01

    Background and purpose: To report recommendations given in the Multinational Association of Supportive Care in Cancer (MASCC) International Consensus Conference regarding the use of antiemetics in radiotherapy. Patients and methods: A steering committee under MASCC auspice chose panel participants for the guidelines development process on prevention of chemotherapy- and radiotherapy-induced emesis (RIE). Pertinent information from published literature as of March 2004 was reviewed for the guideline process. Both the MASCC level of scientific confidence and level of consensus, and the American Society of Clinical Oncology (ASCO) type of evidence and grade for recommendation were adopted. Results: Total body irradiation is classified at high risk, upper abdomen at moderate, lower thorax, pelvis, cranium (radiosurgery) and craniospinal at low, head and neck, extremities, cranium and breast at minimal risk. The recommendations for the use of antiemetics in radiotherapy are as follows: prophylaxis with a 5-HT3 antagonist in patients at high and moderate risk levels of RIE (±dexamethasone in the former group), prophylaxis or rescue with a 5-HT3 antagonist in the low risk group, and rescue with dopamine or a 5-HT3 receptor antagonist in minimal risk level. Conclusions: These recommendations represent a valid tool for prophylaxis and treatment of RIE in clinical practice

  6. Field-based systems and advanced diagnostics

    International Nuclear Information System (INIS)

    Eryurek, E.

    1998-01-01

    Detection and characterization of anomalies in an industrial plant provide improved plant availability and plant efficiency thus yielding increased economic efficiency. Traditionally, detection of process anomalies is done at a high-level control system through various signal validation methods. These signal validation techniques rely on data from transmitters, which measure related process variables. Correlating these signals and deducing anomalies often is a very time consuming and a difficult task. Delays in detecting these anomalies can be costly during plant operation. Conventional centralized approaches also suffer from their dependence on detailed mathematical models of the processes. Smart field devices have the advantage of providing the necessary information directly to the control system as anomalies develop during operation of the processes enabling operators to take necessary steps to either prevent an unnecessary shut down before the problem becomes serious or schedule maintenance on the problematic loop. Fisher-Rosemount's PlantWeb TM architecture addresses 'Enhanced Measurement, Advanced Diagnostics and Control in the Field'. PlantWeb TM builds open process management systems by networking intelligent field devices, scalable control and systems platforms, and integrated modular software. A description of PlantWeb TM and how it improves various process conditions and reduces operating cost of a plant as well as a high level description of 'Enhanced Measurement, Advanced Diagnostics and Control in the Field', will be provided in this paper. PlantWeb TM is the trademark for Fisher-Rosemount's new field-based architecture that uses emerging technologies to utilize the power of intelligent field devices and deliver critical process and equipment information to improve plant performance. (author)

  7. Movement of the cervix in after-loading brachytherapy: implications for designing external-beam radiotherapy boost fields.

    Science.gov (United States)

    Hombaiah, U; Blake, P; Bidmead, M

    2006-05-01

    Women with invasive carcinoma of the cervix treated by chemo-radiotherapy and brachytherapy may also receive a pelvic sidewall boost using a midline shield (MLS). The purpose of this study was to assess the usefulness of implanted gold grains in detecting the movement of the cervix caused by the insertion of low-dose-rate brachytherapy applicators, and its implications in designing the MLS. The medical records of 42 women with various stages of cervical carcinoma, who were treated by radical chemo-radiotherapy, were reviewed. All of these women underwent examination under anaesthesia (EUA) and a gold-grain insertion to demarcate the vaginal tumour extent, in the antero-posterior and lateral planes, before starting external-beam radiotherapy. The isocentric orthogonal films (simulator films) of external radiotherapy and brachytherapy were compared to assess the change in position of the gold grains and the consequences for the design of the MLS for parametrial and pelvic sidewall boosts. A significant shift in the position of the gold grains was noted in both the x (lateral) and the y (cranial/caudal) axes. The median shift of the midline, right and left lateral gold grains was 4.5, 5 and 7 mm in the x axis, whereas it was 10, 8 and 9.5 mm in the y axis, respectively. The median shift in the x and y axes was 5.5 and 9 mm, ranging from 1 to 40 mm and 1 to 45 mm, respectively. The gold grains were shifted cranially in 34 (80%) and laterally in 29 (69%) women. Thirty-two women (76.2%) received parametrial boost radiotherapy, of which 25 (59.5%) women had a customised, pear-shaped shield, and the remaining seven (16.7%) had a straight-sided, rectangular MLS. Four women (9.5%) relapsed locally, and three of them had been treated using a customised shield. In two of these four women, there was an absolute under-dosage of the central pelvis at the tip of the intra-uterine tube by 50% of the parametrial boost dose (5.4 Gy/3 fractions/3 days). Insertion of the gold grains

  8. Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

    International Nuclear Information System (INIS)

    Guckenberger, Matthias; Alexandrow, Nikolaus; Flentje, Michael

    2012-01-01

    To analyze long-term results of radiotherapy alone for stage I-III low grade follicular lymphoma and to compare outcome after extended field irradiation (EFI) and total nodal irradiation (TNI). Between 1982 and 2007, 107 patients were treated with radiotherapy alone for low grade follicular lymphoma at Ann Arbor stage I (n = 50), II (n = 36) and III (n = 21); 48 and 59 patients were treated with EFI and TNI, respectively. The median total dose in the first treatment series of the diaphragmatic side with larger lymphoma burden was 38 Gy (25 Gy – 50 Gy) and after an interval of median 30 days, a total dose of 28 Gy (12.6 Gy – 45 Gy) was given in the second treatment series completing TNI. After a median follow-up of 14 years for living patients, 10-years and 15-years overall survival (OS) were 64% and 50%, respectively. Survival was not significantly different between stages I, II and III. TNI and EFI resulted in 15-years OS of 65% and 34% but patients treated with TNI were younger, had better performance status and higher stage of disease compared to patients treated with EFI. In multivariate analysis, only age at diagnosis (p < 0.001, relative risk [RR] 1.06) and Karnofsky performance status (p = 0.04, RR = 0.96) were significantly correlated with OS. Freedom from progression (FFP) was 58% and 56% after 10-years and 15-years, respectively. Recurrences outside the irradiated volume were significantly reduced after TNI compared to EFI; however, increased rates of in-field recurrences and extra-nodal out-of-field recurrence counterbalanced this effect resulting in no significant difference in FFP between TNI and EFI. In univariate analysis, FFP was significantly improved in stage I compared to stage II but no differences were observed between stages I/II and stage III. In multivariate analysis no patient or treatment parameter was correlated with FFP. Acute toxicity was significantly increased after TNI compared to EFI with a trend to increased late toxicity as

  9. IMRT and 3D conformal radiotherapy with or without elective nodal irradiation in locally advanced NSCLC. A direct comparison of PET-based treatment planning

    International Nuclear Information System (INIS)

    Fleckenstein, Jochen; Kremp, Katharina; Kremp, Stephanie; Palm, Jan; Ruebe, Christian

    2016-01-01

    The potential of intensity-modulated radiation therapy (IMRT) as opposed to three-dimensional conformal radiotherapy (3D-CRT) is analyzed for two different concepts of fluorodeoxyglucose positron emission tomography (FDG PET)-based target volume delineation in locally advanced non-small cell lung cancer (LA-NSCLC): involved-field radiotherapy (IF-RT) vs. elective nodal irradiation (ENI). Treatment planning was performed for 41 patients with LA-NSCLC, using four different planning approaches (3D-CRT-IF, 3D-CRT-ENI, IMRT-IF, IMRT-ENI). ENI included a boost irradiation after 50 Gy. For each plan, maximum dose escalation was calculated based on prespecified normal tissue constraints. The maximum prescription dose (PD), tumor control probability (TCP), conformal indices (CI), and normal tissue complication probabilities (NTCP) were analyzed. IMRT resulted in statistically significant higher prescription doses for both target volume concepts as compared with 3D-CRT (ENI: 68.4 vs. 60.9 Gy, p < 0.001; IF: 74.3 vs. 70.1 Gy, p < 0.03). With IMRT-IF, a PD of at least 66 Gy was achieved for 95 % of all plans. For IF as compared with ENI, there was a considerable theoretical increase in TCP (IMRT: 27.3 vs. 17.7 %, p < 0.00001; 3D-CRT: 20.2 vs. 9.9 %, p < 0.00001). The esophageal NTCP showed a particularly good sparing with IMRT vs. 3D-CRT (ENI: 12.3 vs. 30.9 % p < 0.0001; IF: 15.9 vs. 24.1 %; p < 0.001). The IMRT technique and IF target volume delineation allow a significant dose escalation and an increase in TCP. IMRT results in an improved sparing of OARs as compared with 3D-CRT at equivalent dose levels. (orig.) [de

  10. Discrete phase space based on finite fields

    International Nuclear Information System (INIS)

    Gibbons, Kathleen S.; Hoffman, Matthew J.; Wootters, William K.

    2004-01-01

    The original Wigner function provides a way of representing in phase space the quantum states of systems with continuous degrees of freedom. Wigner functions have also been developed for discrete quantum systems, one popular version being defined on a 2Nx2N discrete phase space for a system with N orthogonal states. Here we investigate an alternative class of discrete Wigner functions, in which the field of real numbers that labels the axes of continuous phase space is replaced by a finite field having N elements. There exists such a field if and only if N is a power of a prime; so our formulation can be applied directly only to systems for which the state-space dimension takes such a value. Though this condition may seem limiting, we note that any quantum computer based on qubits meets the condition and can thus be accommodated within our scheme. The geometry of our NxN phase space also leads naturally to a method of constructing a complete set of N+1 mutually unbiased bases for the state space

  11. SU-E-T-469: Implementation of VAs Web-Based Radiotherapy Incident Reporting and Analysis System (RIRAS)

    International Nuclear Information System (INIS)

    Kapoor, R; Palta, J; Hagan, M; Malik, G

    2015-01-01

    Purpose: This Web-based Radiotherapy Incident Reporting and Analysis System (RIRAS) is a tool to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: VA’s National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and good-catch data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. This VA-Intranet based software design has made use of dataset taxonomies and data dictionaries defined in AAPM/ASTRO reports on error reporting. We used proven industrial and medical event reporting techniques to avoid several common problems faced in effective data collection such as incomplete data due to data entry fatigue by the reporters, missing data due to data difficult to obtain or not familiar to most reporters, missing reports due to fear of reprisal etc. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The analysis reports with corrective, learning actions are shared with the reporter/facility and made public to the community (after deidentification) as part of the learning process. Results: Till date 50 incident/good catches have been reported in RIRAS and we have completed analysis on 100% of these reports. This is done due to the fact that each reported incidents is investigated and a complete analysis/patient-safety-work-product report is generated by radiation oncology domain-experts. Conclusions Because of the completeness of the data, the system has enabled us to analyze process steps and track trends of major errors which in the future will lead to implementing system wide process improvement steps and safe standard operating procedures for each radiotherapy treatment modality/technique and fulfills our goal of

  12. SU-E-T-469: Implementation of VAs Web-Based Radiotherapy Incident Reporting and Analysis System (RIRAS)

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, R; Palta, J; Hagan, M [Veteran Health Administration, Richmond, Virginia (United States); Virginia Commonwealth University, Richmond, VA (United States); Malik, G [TSG Innovations Inc. (United States)

    2015-06-15

    Purpose: This Web-based Radiotherapy Incident Reporting and Analysis System (RIRAS) is a tool to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: VA’s National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and good-catch data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. This VA-Intranet based software design has made use of dataset taxonomies and data dictionaries defined in AAPM/ASTRO reports on error reporting. We used proven industrial and medical event reporting techniques to avoid several common problems faced in effective data collection such as incomplete data due to data entry fatigue by the reporters, missing data due to data difficult to obtain or not familiar to most reporters, missing reports due to fear of reprisal etc. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The analysis reports with corrective, learning actions are shared with the reporter/facility and made public to the community (after deidentification) as part of the learning process. Results: Till date 50 incident/good catches have been reported in RIRAS and we have completed analysis on 100% of these reports. This is done due to the fact that each reported incidents is investigated and a complete analysis/patient-safety-work-product report is generated by radiation oncology domain-experts. Conclusions Because of the completeness of the data, the system has enabled us to analyze process steps and track trends of major errors which in the future will lead to implementing system wide process improvement steps and safe standard operating procedures for each radiotherapy treatment modality/technique and fulfills our goal of

  13. New light field camera based on physical based rendering tracing

    Science.gov (United States)

    Chung, Ming-Han; Chang, Shan-Ching; Lee, Chih-Kung

    2014-03-01

    Even though light field technology was first invented more than 50 years ago, it did not gain popularity due to the limitation imposed by the computation technology. With the rapid advancement of computer technology over the last decade, the limitation has been uplifted and the light field technology quickly returns to the spotlight of the research stage. In this paper, PBRT (Physical Based Rendering Tracing) was introduced to overcome the limitation of using traditional optical simulation approach to study the light field camera technology. More specifically, traditional optical simulation approach can only present light energy distribution but typically lack the capability to present the pictures in realistic scenes. By using PBRT, which was developed to create virtual scenes, 4D light field information was obtained to conduct initial data analysis and calculation. This PBRT approach was also used to explore the light field data calculation potential in creating realistic photos. Furthermore, we integrated the optical experimental measurement results with PBRT in order to place the real measurement results into the virtually created scenes. In other words, our approach provided us with a way to establish a link of virtual scene with the real measurement results. Several images developed based on the above-mentioned approaches were analyzed and discussed to verify the pros and cons of the newly developed PBRT based light field camera technology. It will be shown that this newly developed light field camera approach can circumvent the loss of spatial resolution associated with adopting a micro-lens array in front of the image sensors. Detailed operational constraint, performance metrics, computation resources needed, etc. associated with this newly developed light field camera technique were presented in detail.

  14. Feasibility study of a photoconductor based dosimeter for quality assurance in radiotherapy

    Science.gov (United States)

    Lee, Y. K.; Kim, S. W.; Kim, J. N.; Kang, Y. N.; Kim, J. Y.; Lee, D. S.; Kim, K. T.; Han, M. J.; Ahn, K. J.; Park, S. K.

    2017-09-01

    , falling time, and response delay, were then measured, in addition to the consistency, reproducibility and linearity of each unit-cell. According to the measurement results, HgI2/TiO2 composite outperformed the other candidate materials. A radiation dosimeter with a chamber-type structure was fabricated in this study using a LINAC under accelerating voltages of 6, and 15 MV and compared with a commercial ion chamber. Percent depth dose (PDD) and beam profile were measured on a water phantom at a fixed area of 10 × 10 cm2 by using the fabricated chamber-type dosimeter, and the values were compared with those measured by a commercial ion chamber. Additionally, a homogeneous phantom was fabricated, and the exposure doses of the center points were measured according to a real treatment plan, followed by a comparison of the measured values as relative values. In this paper, we report that the manufactured dosimeter shows similar characteristics in terms of PDD and beam profile and results for the conventional ion chamber. Based on these results, it is demonstrated that the HgI2/TiO2-based dosimeter complies with radiotherapy QA requirements, namely Superior detection characteristics, consistency, dose linearity, reproducibility. Thus, we expect the HgI2/TiO2-based dosimeter to be used commercially in the future.

  15. Laboratory and field based evaluation of chromatography ...

    Science.gov (United States)

    The Monitor for AeRosols and GAses in ambient air (MARGA) is an on-line ion-chromatography-based instrument designed for speciation of the inorganic gas and aerosol ammonium-nitrate-sulfate system. Previous work to characterize the performance of the MARGA has been primarily based on field comparison to other measurement methods to evaluate accuracy. While such studies are useful, the underlying reasons for disagreement among methods are not always clear. This study examines aspects of MARGA accuracy and precision specifically related to automated chromatography analysis. Using laboratory standards, analytical accuracy, precision, and method detection limits derived from the MARGA chromatography software are compared to an alternative software package (Chromeleon, Thermo Scientific Dionex). Field measurements are used to further evaluate instrument performance, including the MARGA’s use of an internal LiBr standard to control accuracy. Using gas/aerosol ratios and aerosol neutralization state as a case study, the impact of chromatography on measurement error is assessed. The new generation of on-line chromatography-based gas and particle measurement systems have many advantages, including simultaneous analysis of multiple pollutants. The Monitor for Aerosols and Gases in Ambient Air (MARGA) is such an instrument that is used in North America, Europe, and Asia for atmospheric process studies as well as routine monitoring. While the instrument has been evaluat

  16. The pioneer of radiotherapy

    International Nuclear Information System (INIS)

    Camilleri, J.P.; Coursaget, J.

    2005-09-01

    This work narrates the history of the birth of a new field, the radiology and its application to radiotherapy for these multiform pathologies that are the cancers. Two leading figures will favour this field: Marie Curie, physicist and twice awarded by nobel price, and Claudius Regaud, histologist and become a specialist of the action of ionizing radiations on tissues. They will create the Curie Institute, in relation with the Radium Institute and the support of the Pasteur Institute in 1920. (N.C.)

  17. Markerless gating for lung cancer radiotherapy based on machine learning techniques

    International Nuclear Information System (INIS)

    Lin Tong; Li Ruijiang; Tang Xiaoli; Jiang, Steve B; Dy, Jennifer G

    2009-01-01

    In lung cancer radiotherapy, radiation to a mobile target can be delivered by respiratory gating, for which we need to know whether the target is inside or outside a predefined gating window at any time point during the treatment. This can be achieved by tracking one or more fiducial markers implanted inside or near the target, either fluoroscopically or electromagnetically. However, the clinical implementation of marker tracking is limited for lung cancer radiotherapy mainly due to the risk of pneumothorax. Therefore, gating without implanted fiducial markers is a promising clinical direction. We have developed several template-matching methods for fluoroscopic marker-less gating. Recently, we have modeled the gating problem as a binary pattern classification problem, in which principal component analysis (PCA) and support vector machine (SVM) are combined to perform the classification task. Following the same framework, we investigated different combinations of dimensionality reduction techniques (PCA and four nonlinear manifold learning methods) and two machine learning classification methods (artificial neural networks-ANN and SVM). Performance was evaluated on ten fluoroscopic image sequences of nine lung cancer patients. We found that among all combinations of dimensionality reduction techniques and classification methods, PCA combined with either ANN or SVM achieved a better performance than the other nonlinear manifold learning methods. ANN when combined with PCA achieves a better performance than SVM in terms of classification accuracy and recall rate, although the target coverage is similar for the two classification methods. Furthermore, the running time for both ANN and SVM with PCA is within tolerance for real-time applications. Overall, ANN combined with PCA is a better candidate than other combinations we investigated in this work for real-time gated radiotherapy.

  18. Patterns of Failure and Treatment-Related Toxicity in Advanced Cervical Cancer Patients Treated Using Extended Field Radiotherapy With Curative Intent

    International Nuclear Information System (INIS)

    Rajasooriyar, Chrishanthi; Van Dyk, Sylvia; Bernshaw, David; Kondalsamy-Chennakesavan, Srinivas; Barkati, Maroie; Narayan, Kailash

    2011-01-01

    Purpose: The purpose of this study was to evaluate the patterns of failure and overall survival (OS) and disease-free survival (DFS) rates in cervical cancer patients who had metastatic disease in common iliac or para-aortic lymph nodes and were treated with curative intent, using extended field radiotherapy (EFRT). Methods and Materials: This was a retrospective study involving 39 patients treated from January 1996 to June 2007, using EFRT with concurrent chemotherapy and intracavitary brachytherapy. EFRT consisted of 45 Gy in 1.8-Gy fractions. Radiation to involved nodes was boosted to a total dose of 50.4 to 54 Gy. Primary tumor radiation was boosted to a dose of 80 Gy using brachytherapy. Results: Overall, 30 patients (77%) have relapsed. The 5-year OS rate was 26% (95% confidence interval [CI], 11-44). The 5-year DFS rate was 19.4% (95% CI, 8-35). Only 3 patients (7.5%) experienced treatment failure exclusively within the treatment field, and 2 patients underwent salvage treatment. Grade 3 to 4 acute bone marrow and gastrointestinal toxicities were observed in 10 (26%) and 7 (18%) patients, respectively. Conclusions: Concurrent chemotherapy and EFRT treatment was well tolerated. Most patients showed failure at multiple sites and outside the treatment field. Only 3/39 patients had failures exclusively within the treatment field, and 2 underwent salvage treatment.

  19. Design of security scheme of the radiotherapy planning administration system based on the hospital information system

    International Nuclear Information System (INIS)

    Zhuang Yongzhi; Zhao Jinzao

    2010-01-01

    Objective: To design a security scheme of radiotherapy planning administration system. Methods: Power Builder 9i language was used to program the system through the model of client-server machine. Oracle 9i was used as the database server. Results In this system, user registration management, user login management, application-level functions of control, database access control, and audit trail were designed to provide system security. Conclusions: As a prototype for the security analysis and protection of this scheme provides security of the system, application system, important data and message, which ensures the system work normally. (authors)

  20. Markov chain Monte Carlo methods in radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Hugtenburg, R.P.

    2001-01-01

    The Markov chain method can be used to incorporate measured data in Monte Carlo based radiotherapy treatment planning. This paper shows that convergence to the measured data, within the target precision, is achievable. Relative output factors for blocked fields and oblique beams are shown to compare well with independent measurements according to the same criterion. (orig.)

  1. Decision logics in radiotherapy

    International Nuclear Information System (INIS)

    Gauwerky, F.

    1979-01-01

    Decisions in planning procedures can generally, at least for beam therapy to deep seated tumors, be based on a self-consistent system of criteria of optimization, namely: 1. The absorbed dose to the target volume must be applied as uniformly as possible. 2. Absorbed doses to organs (volumes) at risk must be as low as possible, at least below an accepted limit. 3. Radiation effects to outside volumes must be kept as low as possible. Whereas these criteria, as being reduced to the simplest possible requirements, have to be regarded as the stable elements, the radiotherapy parameters, such as geometric arrangements, special techniques, absorbed dose contributions to reference points or systems, have to be taken as the variables within decision processes. The properties of the criteria which have widely proved to be valuable in routine clinical practice, have been investigated in relation to the theoretical system of axioms as it is e.g. offered by Karl Popper's general logics of scientific research. An axiomatic system, as it is demanded (after Popper) must be a) free of discrepancies, i.e. self-consistent (not any sentence can be derived), b) independent, that is, one axiom cannot be derived from another one within the system, c) sufficient for deduction of statements needed, d) necessary, that is complete. All these requirements are fitting also to the offered system of radiotherapy optimization criteria. It has been demonstrated, that Popper's axiomatic system can be regarded as to be the general case for all scientific fields of application, the set of optimization criteria being a special system for radiation therapy, which would have been derivable from Popper's theory. Also practical use could be demonstrated. (orig./ORU) [de

  2. Demand for radiotherapy in Spain.

    Science.gov (United States)

    Rodríguez, A; Borrás, J M; López-Torrecilla, J; Algara, M; Palacios-Eito, A; Gómez-Caamaño, A; Olay, L; Lara, P C

    2017-02-01

    Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.

  3. Multivariate analysis for the estimation of target localization errors in fiducial marker-based radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Takamiya, Masanori [Department of Nuclear Engineering, Graduate School of Engineering, Kyoto University, Kyoto 606-8501, Japan and Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507 (Japan); Nakamura, Mitsuhiro, E-mail: m-nkmr@kuhp.kyoto-u.ac.jp; Akimoto, Mami; Ueki, Nami; Yamada, Masahiro; Matsuo, Yukinori; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507 (Japan); Tanabe, Hiroaki [Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe 650-0047 (Japan); Kokubo, Masaki [Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe 650-0047, Japan and Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe 650-0047 (Japan); Itoh, Akio [Department of Nuclear Engineering, Graduate School of Engineering, Kyoto University, Kyoto 606-8501 (Japan)

    2016-04-15

    calculated from the MRA ({sup MRA}TLE) increased as |TMD| and |aRM| increased and adversely decreased with each increment of n. The median 3D {sup MRA}TLE was 2.0 mm (range, 0.6–4.3 mm) for n = 1, 1.8 mm (range, 0.4–4.0 mm) for n = 2, and 1.6 mm (range, 0.3–3.7 mm) for n = 3. Although statistical significance between n = 1 and n = 3 was observed in all directions, the absolute average difference and the standard deviation of the {sup MRA}TLE between n = 1 and n = 3 were 0.5 and 0.2 mm, respectively. Conclusions: A large |TMD| and |aRM| increased the differences in TLE between each n; however, the difference in 3D {sup MRA}TLEs was, at most, 0.6 mm. Thus, the authors conclude that it is acceptable to continue fiducial marker-based radiotherapy as long as |TMD| is maintained at ≤58.7 mm for a 3D |aRM|  ≥  10 mm.

  4. Assessment of pulmonary toxicities in breast cancer patients undergoing treatment with anthracycline and taxane based chemotherapy and radiotherapy- a prospective study

    Directory of Open Access Journals (Sweden)

    Aramita Saha

    2013-12-01

    Full Text Available Background: Anthracycline based regiments and/or taxanes and adjuvant radiotherapy; the main modalities of treatment for breast cancers are associated with deterioration of pulmonary functions and progressive pulmonary toxicities. Aim: Assessment of pulmonary toxicities and impact on pulmonary functions mainly in terms of decline of forced vital capacity (FVC and the ratio of forced expiratory volume (FEV in 1 Second and FEV1/FVC ratio with different treatment times and follow ups in carcinoma breast patients receiving anthracycline and/or taxane based chemotherapy and radiotherapy. Materials and methods: A prospective single institutional cohort study was performed with 58 breast cancer patients between January 2011 to July 2012 who received either anthracycline based (37 patients received 6 cycles FAC= 5 FU, Adriamycin, Cyclophosphamide regime and radiotherapy or anthracycline and taxane based chemotherapy (21 patients received 4cycles AC= Adriamycin, Cyclophosphamide; followed by 4 cycles of T=Taxane and radiotherapy. Assessment of pulmonary symptoms and signs, chest x-ray and pulmonary function tests were performed at baseline, midcycle, at end of chemotherapy, at end radiotherapy, at 1 and 6 months follow ups and compared. By means of a two-way analysis of variance (ANOVA model, the course of lung parameters across the time points was compared. Results and Conclusion: Analysis of mean forced vital capacities at different points of study times showed definitive declining pattern, which is at statistically significant level at the end of 6th month of follow up (p=0.032 .The FEV1/FVC ratio (in percentage also revealed a definite decreasing pattern over different treatment times and at statistically significant level at 6th month follow up with p value 0.003. Separate analysis of mean FEV1/FVC ratios over time in anthracycline based chemotherapy and radiotherapy group as well as anthracycline and taxane based chemotherapy and radiotherapy group

  5. Cloud field classification based on textural features

    Science.gov (United States)

    Sengupta, Sailes Kumar

    1989-01-01

    An essential component in global climate research is accurate cloud cover and type determination. Of the two approaches to texture-based classification (statistical and textural), only the former is effective in the classification of natural scenes such as land, ocean, and atmosphere. In the statistical approach that was adopted, parameters characterizing the stochastic properties of the spatial distribution of grey levels in an image are estimated and then used as features for cloud classification. Two types of textural measures were used. One is based on the distribution of the grey level difference vector (GLDV), and the other on a set of textural features derived from the MaxMin cooccurrence matrix (MMCM). The GLDV method looks at the difference D of grey levels at pixels separated by a horizontal distance d and computes several statistics based on this distribution. These are then used as features in subsequent classification. The MaxMin tectural features on the other hand are based on the MMCM, a matrix whose (I,J)th entry give the relative frequency of occurrences of the grey level pair (I,J) that are consecutive and thresholded local extremes separated by a given pixel distance d. Textural measures are then computed based on this matrix in much the same manner as is done in texture computation using the grey level cooccurrence matrix. The database consists of 37 cloud field scenes from LANDSAT imagery using a near IR visible channel. The classification algorithm used is the well known Stepwise Discriminant Analysis. The overall accuracy was estimated by the percentage or correct classifications in each case. It turns out that both types of classifiers, at their best combination of features, and at any given spatial resolution give approximately the same classification accuracy. A neural network based classifier with a feed forward architecture and a back propagation training algorithm is used to increase the classification accuracy, using these two classes

  6. Frequency filtering based analysis on the cardiac induced lung tumor motion and its impact on the radiotherapy management

    International Nuclear Information System (INIS)

    Chen, Ting; Qin, Songbing; Xu, Xiaoting; Jabbour, Salma K.; Haffty, Bruce G.; Yue, Ning J.

    2014-01-01

    Purpose/objectives: Lung tumor motion may be impacted by heartbeat in addition to respiration. This study seeks to quantitatively analyze heart-motion-induced tumor motion and to evaluate its impact on lung cancer radiotherapy. Methods/materials: Fluoroscopy images were acquired for 30 lung cancer patients. Tumor, diaphragm, and heart were delineated on selected fluoroscopy frames, and their motion was tracked and converted into temporal signals based on deformable registration propagation. The clinical relevance of heart impact was evaluated using the dose volumetric histogram of the redefined target volumes. Results: Correlation was found between tumor and cardiac motion for 23 patients. The heart-induced motion amplitude ranged from 0.2 to 2.6 mm. The ratio between heart-induced tumor motion and the tumor motion was inversely proportional to the amplitude of overall tumor motion. When the heart motion impact was integrated, there was an average 9% increase in internal target volumes for 17 patients. Dose coverage decrease was observed on redefined planning target volume in simulated SBRT plans. Conclusions: The tumor motion of thoracic cancer patients is influenced by both heart and respiratory motion. The cardiac impact is relatively more significant for tumor with less motion, which may lead to clinically significant uncertainty in radiotherapy for some patients

  7. The impact of radiotherapy dose and other treatment-related and clinical factors on in-field control in stage I and II non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Kamath, Sachin S.; Marcus, Robert B.; Lynch, James W.; Mendenhall, Nancy Price

    1999-01-01

    Purpose/Objective: To assess local (in-field) disease control, identify potential prognostic factors, and elucidate the optimal radiotherapy dose in various clinical settings of Stage I and II nonHodgkin's lymphoma (non-CNS). Materials and Methods: A total of 285 consecutive patients with Stage I and II non-Hodgkin's lymphoma were treated with curative intent, including 159 with radiotherapy (RT) alone and 126 with combined-modality therapy (CMT). Of these, 72 patients had low-grade lymphomas (LGL), 92 had intermediate or high-grade lymphomas (I/HGL), and 21 had unclassified lymphomas. Clinical and treatment variables with potential prognostic significance for in-field disease control, freedom from relapse (FFR), and absolute survival (AS) were evaluated by univariate and multivariate analyses. Results: The 5-, 10-, and 20-year actuarial AS rates were 73%, 46%, and 33% for patients with LGL and 64%, 44%, and 18% for patients with I/HGL, respectively. The 5-, 10-, and 20-year actuarial FFR rates were 62%, 59%, and 49% for patients with LGL and 66%, 57%, and 57% for patients with I/HGL, respectively. Significant prognostic factors identified by the multivariate analysis were age, tumor size, and histology for AS; tumor size and treatment for FFR; and only tumor size for in-field disease control. There were 95 total failures, with only 12 occurring infield. Most failures (65%) were in contiguous unirradiated sites. All 4 in-field failures in patients with LGL occurred after RT doses 6 cm, and 4 with less than a complete response (CR) to chemotherapy. Conclusion: Our analysis suggests that the overwhelming problem in the treatment of non-Hodgkin's lymphoma is not in-field failure but, rather, failure in contiguous unirradiated sites. A dose of 20-25 Gy may be sufficient for small-volume LGL of the orbit. A dose of 30 Gy is sufficient for LGL in general, as well as for patients with nonbulky (≤ 6 cm) I/HGL treated with CMT who have a CR. However, patients with I

  8. An international review of patient safety measures in radiotherapy practice

    International Nuclear Information System (INIS)

    Shafiq, Jesmin; Barton, Michael; Noble, Douglas; Lemer, Claire; Donaldson, Liam J.

    2009-01-01

    Errors from radiotherapy machine or software malfunction usually are well documented as they affect hundreds of patients, whereas random errors affecting individual patients are more difficult to be discovered and prevented. Although major clinical radiotherapy incidents have been reported, many more have remained unrecognised or have not been reported. The literature in this field is limited as it is mostly published as a result of investigation of major errors. We present a review of radiotherapy incidents internationally with the aim of identifying the domains where most errors occur through extensive review and synthesis of published reports, unpublished 'Grey literature' and departmental incident data. Our review of radiotherapy-related events in the last three decades (1976-2007) identified more than seven thousand (N = 7741) incidents and near misses. Three thousand one hundred and twenty-five incidents reported patient harm of variable intensity ranging from underdose increasing the risk of recurrence, to overdose causing toxicity, and even death for 1% (N = 38); 4616 events were near misses with no recognisable patient harm. Based on our review, a radiotherapy risk profile has been published by the WHO World Alliance for Patient Safety that highlights the role of communication, training and strict adherence to guidelines/protocols in improving the safety of radiotherapy process.

  9. Craniospinal radiotherapy in children: Electron- or photon-based technique of spinal irradiation

    International Nuclear Information System (INIS)

    Chojnacka, M.; Skowronska-Gardas, A.; Pedziwiatr, K.; Morawska-Kaczynska, M.; Zygmuntowicz-Pietka, A.; Semaniak, A.

    2010-01-01

    Background: The prone position and electron-based technique for craniospinal irradiation (CSI) have been standard in our department for many years. But this immobilization is difficult for the anaesthesiologist to gain airway access. The increasing number of children treated under anaesthesia led us to reconsider our technique. Aim: The purpose of this study is to report our new photon-based technique for CSI which could be applied in both the supine and the prone position and to compare this technique with our electron-based technique. Materials and methods: Between November 2007 and May 2008, 11 children with brain tumours were treated in the prone position with CSI. For 9 patients two treatment plans were created: the first one using photons and the second one using electron beams for spinal irradiation. We prepared seven 3D-conformal photon plans and four forward planned segmented field plans. We compared 20 treatment plans in terms of target dose homogeneity and sparing of organs at risk. Results: In segmented field plans better dose homogeneity in the thecal sac volume was achieved than in electron-based plans. Regarding doses in organs at risk, in photon-based plans we obtained a lower dose in the thyroid but a higher one in the heart and liver. Conclusions: Our technique can be applied in both the supine and prone position and it seems to be more feasible and precise than the electron technique. However, more homogeneous target coverage and higher precision of dose delivery for photons are obtained at the cost of slightly higher doses to the heart and liver. (authors)

  10. Practical recommendations for breathing-adapted radiotherapy

    International Nuclear Information System (INIS)

    Simon, L.; Giraud, P.; Rosenwald, J.C.; Dumas, J.L.; Lorchel, F.; Marre, D.; Dupont, S.; Varmenot, N.; Ginestet, C.; Caron, J.; Marchesi, V.; Ferreira, I.; Garcia, R.

    2007-01-01

    Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience. (authors)

  11. Concurrent radiotherapy with temozolomide vs. concurrent radiotherapy with a cisplatinum-based polychemotherapy regimen. Acute toxicity in pediatric high-grade glioma patients

    Energy Technology Data Exchange (ETDEWEB)

    Seidel, Clemens; Kortmann, Rolf D. [University of Leipzig Medical Center, Department of Radiotherapy and Radiation Oncology, Leipzig (Germany); Bueren, Andre O. von [University Medical Center Goettingen, Division of Pediatric Hematology and Oncology, Goettingen (Germany); University Hospital of Geneva, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Geneva (Switzerland); University of Geneva, Department of Pediatrics, CANSEARCH Research Laboratory, Faculty of Medicine, Geneva (Switzerland); Bojko, Sabrina; Hoffmann, Marion; Kramm, Christof M. [University Medical Center Goettingen, Division of Pediatric Hematology and Oncology, Goettingen (Germany); Pietsch, Torsten; Gielen, Gerrit H. [University of Bonn Medical Center, Department of Neuropathology, Brain Tumor Reference Center of the DGNN, Bonn (Germany); Warmuth-Metz, Monika; Bison, Brigitte [University Hospital Wuerzburg, Department of Neuroradiology, Wuerzburg (Germany)

    2018-03-15

    As the efficacy of all pediatric high-grade glioma (HGG) treatments is similar and still disappointing, it is essential to also investigate the toxicity of available treatments. Prospectively recorded hematologic and nonhematologic toxicities of children treated with radiochemotherapy in the HIT GBM-C/D and HIT-HGG-2007 trials were compared. Children aged 3-18 years with histologically proven HGG (WHO grade III and IV tumors) or unequivocal radiologic diagnosis of diffuse intrinsic pontine glioma (DIPG) were included in these trials. The HIT-HGG-2007 protocol comprised concomitant radiochemotherapy with temozolomide, while cisplatinum/etoposide (PE) and PE plus ifosfamide (PEI) in combination with weekly vincristine injections were applied during radiochemotherapy in the HIT GBM-C/D protocol. Regular blood counts and information about cellular nadirs were available from 304 patients (leukocytes) and 306 patients (thrombocytes), respectively. Grade 3-4 leukopenia was much more frequent in the HIT GBM-C/D cohort (n = 88, 52%) vs. HIT-HGG-2007 (n = 13, 10%; P <0.001). Grade 3-4 thrombopenia was also more likely in the HIT GBM-C/D cohort (n = 21, 12% vs. n = 3,2%; P <0.001). Grade 3-4 leukopenia appeared more often in children aged 3-7 years (n = 38/85, 45%) than in children aged 8-12 years (n = 39/120, 33%) and 13-18 years (24/100, 24%; P =0.034). In addition, sickness was more frequent in the HIT GBM-C/D cohort (grade 1-2: 44%, grade 3-4: 6% vs. grade 1-2: 28%, grade 3-4: 1%; P <0.001). Radiochemotherapy involving cisplatinum-based polychemotherapy is more toxic than radiotherapy in combination with temozolomide. Without evidence of differences in therapeutic efficacy, the treatment with lower toxicity, i. e., radiotherapy with temozolomide should be used. (orig.) [German] Die Wirksamkeit verschiedener Protokolle zur Radiochemotherapie bei Kindern mit hochmalignen Gliomen (''high-grade glioma'', HGG) ist aehnlich und leider noch enttaeuschend. Es

  12. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Watson, Linda C., E-mail: Linda.watson@albertahealthservices.ca [Department of Interdisciplinary Practice, Community Oncology, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Gies, Donna [Department of Radiation Oncology Nursing, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Thompson, Emmanuel [Department of Mathematics and Statistics, University of Calgary Faculty of Science, Calgary, AB (Canada); Thomas, Bejoy [Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Department of Psychosocial Oncology, University of Calgary Faculty of Medicine, Calgary, AB (Canada)

    2012-05-01

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from

  13. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    International Nuclear Information System (INIS)

    Watson, Linda C.; Gies, Donna; Thompson, Emmanuel; Thomas, Bejoy

    2012-01-01

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy’s questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using

  14. Field displacement during external radiotherapy in prostatic adenocarcinoma treated with radioactive 198Au implants and external irradiation

    International Nuclear Information System (INIS)

    Lennernaes, B.; Letocha, H.; Rikner, G.; Magnusson, A.; Nilsson, S.

    1995-01-01

    The purpose of this work was to study displacement error and internal movements of the prostate during external beam radiotherapy. Verification films in the frontal (n=194) and lateral (n=64) portals were investigated in 14 patients treated with radioactive 198 Au implants. Displacement errors of two implants were investigated. In seven patients, filling of the rectum and the bladder with contrast medium or isotonic saline was performed during CT investigation for planning purposes to detect movements of the prostate. Most (95%) of the displacement errors were less than 10 mm in the frontal portal and less than 15 mm in the lateral portals. No correlation to the patient's weight was found. The displacement errors were randomly distributed. The spatial relations between the implants were not altered during the treatments. Small movements of the prostate were observed. To conclude, the positioning system employed at present (laser) can be sufficient for the margins used (2 cm). In lateral portals, however, the system did not have the ability to detect a possible systematic displacement error from simulator to accelerator. The intention is to decrease the margins to 1 cm, which will necessitate a better positioning system. (orig.)

  15. MO-E-18C-01: Open Access Web-Based Peer-To-Peer Training and Education in Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Pawlicki, T [UC San Diego Medical Center, La Jolla, CA (United States); Brown, D; Dunscombe, P [Tom Baker Cancer Centre, Calgary, AB (Canada); Mutic, S [Washington University School of Medicine, Saint Louis, MO (United States)

    2014-06-15

    Purpose: Current training and education delivery models have limitations which result in gaps in clinical proficiency with equipment, procedures, and techniques. Educational and training opportunities offered by vendors and professional societies are by their nature not available at point of need or for the life of clinical systems. The objective of this work is to leverage modern communications technology to provide peer-to-peer training and education for radiotherapy professionals, in the clinic and on demand, as they undertake their clinical duties. Methods: We have developed a free of charge web site ( https://i.treatsafely.org ) using the Google App Engine and datastore (NDB, GQL), Python with AJAX-RPC, and Javascript. The site is a radiotherapy-specific hosting service to which user-created videos illustrating clinical or physics processes and other relevant educational material can be uploaded. Efficient navigation to the material of interest is provided through several RT specific search tools and videos can be scored by users, thus providing comprehensive peer review of the site content. The site also supports multilingual narration\\translation of videos, a quiz function for competence assessment and a library function allowing groups or institutions to define their standard operating procedures based on the video content. Results: The website went live in August 2013 and currently has over 680 registered users from 55 countries; 27.2% from the United States, 9.8% from India, 8.3% from the United Kingdom, 7.3% from Brazil, and 47.5% from other countries. The users include physicists (57.4%), Oncologists (12.5%), therapists (8.2%) and dosimetrists (4.8%). There are 75 videos to date including English, Portuguese, Mandarin, and Thai. Conclusion: Based on the initial acceptance of the site, we conclude that this open access web-based peer-to-peer tool is fulfilling an important need in radiotherapy training and education. Site functionality should expand in

  16. MO-E-18C-01: Open Access Web-Based Peer-To-Peer Training and Education in Radiotherapy

    International Nuclear Information System (INIS)

    Pawlicki, T; Brown, D; Dunscombe, P; Mutic, S

    2014-01-01

    Purpose: Current training and education delivery models have limitations which result in gaps in clinical proficiency with equipment, procedures, and techniques. Educational and training opportunities offered by vendors and professional societies are by their nature not available at point of need or for the life of clinical systems. The objective of this work is to leverage modern communications technology to provide peer-to-peer training and education for radiotherapy professionals, in the clinic and on demand, as they undertake their clinical duties. Methods: We have developed a free of charge web site ( https://i.treatsafely.org ) using the Google App Engine and datastore (NDB, GQL), Python with AJAX-RPC, and Javascript. The site is a radiotherapy-specific hosting service to which user-created videos illustrating clinical or physics processes and other relevant educational material can be uploaded. Efficient navigation to the material of interest is provided through several RT specific search tools and videos can be scored by users, thus providing comprehensive peer review of the site content. The site also supports multilingual narration\\translation of videos, a quiz function for competence assessment and a library function allowing groups or institutions to define their standard operating procedures based on the video content. Results: The website went live in August 2013 and currently has over 680 registered users from 55 countries; 27.2% from the United States, 9.8% from India, 8.3% from the United Kingdom, 7.3% from Brazil, and 47.5% from other countries. The users include physicists (57.4%), Oncologists (12.5%), therapists (8.2%) and dosimetrists (4.8%). There are 75 videos to date including English, Portuguese, Mandarin, and Thai. Conclusion: Based on the initial acceptance of the site, we conclude that this open access web-based peer-to-peer tool is fulfilling an important need in radiotherapy training and education. Site functionality should expand in

  17. Physics aspects of recent and future concepts in radiotherapy

    International Nuclear Information System (INIS)

    Georg, D.

    2001-01-01

    Full text: The development of 3-D conformal radiotherapy (3D-CRT), in which the high dose volume matches as closely as possible the target volume and avoids therefore normal tissue irradiation as far as possible, has been a major theme in radiotherapy for improving the therapeutic window. Conformal radiotherapy is not a new concept but only the technological improvements of the last decade allow its clinical implementation. More recent and advanced forms of 3D-CRT are intensity modulated radiotherapy (IMRT) and stereotactic radiotherapy (SRT). IMRT uses an additional degree of freedom to achieve a new class of conformation: the variation of the primary beam intensity. SRT is based on a three dimensional stereotactic coordinate system which is correlated with the patient and the treatment facility through modern imaging technology. IMRT and SRT are related by common features, e.g. high dose gradients and small fields which require a high geometric precision. A high dosimetric and geometric precision can only be based on a detailed knowledge of the patient specific anatomy. Therefore, IMRT and SRT need to underlie multi-modality imaging studies. Both IMRT and SRT utilize photon beams and multiple field arrangements which increase the volumes of healthy tissue receiving low doses. Photons have a low selectivity along the beam direction implying that the sharp dose gradients are to be compromised. The increased low dose volume as well as the low selectivity of photon beams can be over-come by using proton or ions. Brachytherapy, a form of radiotherapy where encapsuled radioactive sources are placed directly in or in the vicinity of the tumor, is by definition conformal. Endovascular brachytherapy has become a promising new field in radiotherapy for the prevention of (re)stenosis after angioplasty. Although many clinical trials have been performed during the last years specific aspects related to endovascular brachytherapy have not been addressed clearly, such as the

  18. Field microcomputerized multichannel γ ray spectrometer based on notebook computer

    International Nuclear Information System (INIS)

    Jia Wenyi; Wei Biao; Zhou Rongsheng; Li Guodong; Tang Hong

    1996-01-01

    Currently, field γ ray spectrometry can not rapidly measure γ ray full spectrum, so a field microcomputerized multichannel γ ray spectrometer based on notebook computer is described, and the γ ray full spectrum can be rapidly measured in the field

  19. KSC ADVANCED GROUND BASED FIELD MILL V1

    Data.gov (United States)

    National Aeronautics and Space Administration — The Advanced Ground Based Field Mill (AGBFM) network consists of 34 (31 operational) field mills located at Kennedy Space Center (KSC), Florida. The field mills...

  20. Evaluating radiotherapy patients' need for information: a study using a patient information booklet; Evaluation des besoins en information des patients suivis en radiotherapi: etude effectuee sur la base du livret de la radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Bonnet, V.; Romestaing, P.; Gerard, J.P.; Mornex, F. [Centre Hospitalier Universitaire Lyon-Sud, Dept. d' Oncologie-Radiotherapie, 69 - Pierre-Benite (France); Couvreur, C. [Institut Gustave Roussy, Dept. d' Oncologie-Radiotherapie, 94 - Villejuif (France); Demachy, P. [Centre Hospitalier V. Dupouy, Centre de Radiologie et de Traitement des Tumeurs, 95 - Argenteuil (France); Kimmel, F. [Centre de Radiologie et de Traitement des Tumeurs, 92 - Meudon-la-Foret (France); Milan, H. [Centre Georges-Francois-Leclerc, 21 - Dijon (France); Noel, D. [Hopital Pitie-Salpetriere, Dept. d' Oncologie-Radiotherapie, 75 - Paris (France); Pace, M. [Hopital d' Annecy, Dept. d' Oncologie-Radiotherapie, 74 - Annecy (France); Raison, C. [Centre Catherine-de-Sienne, 44 - Nantes (France); Compagnon, C. [Ligue Nationale Contre le Cancer, 75 -Paris (France); Pigeon, P. [Isis Research, 69 - Lyon (France)

    2000-08-01

    The French Radiotherapy-Oncology Society (SFRO) and the National Trade of Radiotherapists-Oncologists (SNRO) elaborated and published a patient information booklet on radiotherapy, in 1999. This present study appraises the pertinence of the form and substance of this booklet one year after its release. Eight radiotherapy centers participated in this research which evaluated 162 patients at treatment initiation. The conclusions of this study demonstrated the importance of clearly informing patients of their disease, treatment, and the secondary effects of treatment. It is essential to emphasize that 97% of the patients declared that an information booklet is a real necessity, and that the one provided by the SFRO responds to the majority of their concerns. Obtaining technical and practical knowledge resulted in a reassurance about their treatment. The most revealing result is that 87% requested direct communication about their illness, and that cancer be named by this word and not other, evasive terms. Seventy-two percent of the patients requested more information about their cancer, different treatment options, and quality of life issues in an attempt to psychologically prepare themselves to face an illness for which they have little control. Patients refuse to be passive, and claim the right to become 'partners' of the medical teams, concerning their treatment and recovery. (authors)

  1. Radiotherapy; Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Wannenmacher, M. [Heidelberg Univ., Mannheim (Germany). Abt. fuer Klinische Radiologie; Debus, J. [Univ. Heidelberg (Germany). Abt. Radioonkologie und Strahlentherapie; Wenz, F. (eds.) [Universitaetsklinikum Mannheim (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2006-07-01

    The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy.

  2. Independent Monte-Carlo dose calculation for MLC based CyberKnife radiotherapy

    Science.gov (United States)

    Mackeprang, P.-H.; Vuong, D.; Volken, W.; Henzen, D.; Schmidhalter, D.; Malthaner, M.; Mueller, S.; Frei, D.; Stampanoni, M. F. M.; Dal Pra, A.; Aebersold, D. M.; Fix, M. K.; Manser, P.

    2018-01-01

    This work aims to develop, implement and validate a Monte Carlo (MC)-based independent dose calculation (IDC) framework to perform patient-specific quality assurance (QA) for multi-leaf collimator (MLC)-based CyberKnife® (Accuray Inc., Sunnyvale, CA) treatment plans. The IDC framework uses an XML-format treatment plan as exported from the treatment planning system (TPS) and DICOM format patient CT data, an MC beam model using phase spaces, CyberKnife MLC beam modifier transport using the EGS++ class library, a beam sampling and coordinate transformation engine and dose scoring using DOSXYZnrc. The framework is validated against dose profiles and depth dose curves of single beams with varying field sizes in a water tank in units of cGy/Monitor Unit and against a 2D dose distribution of a full prostate treatment plan measured with Gafchromic EBT3 (Ashland Advanced Materials, Bridgewater, NJ) film in a homogeneous water-equivalent slab phantom. The film measurement is compared to IDC results by gamma analysis using 2% (global)/2 mm criteria. Further, the dose distribution of the clinical treatment plan in the patient CT is compared to TPS calculation by gamma analysis using the same criteria. Dose profiles from IDC calculation in a homogeneous water phantom agree within 2.3% of the global max dose or 1 mm distance to agreement to measurements for all except the smallest field size. Comparing the film measurement to calculated dose, 99.9% of all voxels pass gamma analysis, comparing dose calculated by the IDC framework to TPS calculated dose for the clinical prostate plan shows 99.0% passing rate. IDC calculated dose is found to be up to 5.6% lower than dose calculated by the TPS in this case near metal fiducial markers. An MC-based modular IDC framework was successfully developed, implemented and validated against measurements and is now available to perform patient-specific QA by IDC.

  3. Nomogram based overall survival prediction in stereotactic body radiotherapy for oligo-metastatic lung disease

    DEFF Research Database (Denmark)

    Tanadini-Lang, S; Rieber, J; Filippi, A R

    2017-01-01

    BACKGROUND: Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT......) for pulmonary metastases. PATIENTS AND METHODS: A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model...... to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases...

  4. SU-E-J-171: Surface Imaging Based Intrafraction Motion Assessments for Whole Brain Radiotherapy

    International Nuclear Information System (INIS)

    Wiant, D; Vanderstraeten, C; Maurer, J; Pursley, J; Terrell, J; Sintay, B

    2014-01-01

    Purpose: To quantify and characterize intrafraction motion for whole brain radiotherapy treatments in open face masks using 3D surface imaging. Methods: Fifteen whole brain patients were monitored with 3D surface imaging over a total of 202 monitoring sessions. Mean translations and rotations were calculated over each minute, each session, and over all sessions combined. The percentage of each session that the root mean square (RMS) of the linear translations were outside of 2 mm, 3 mm, 4 mm, and 5 mm were determined for each patient. Correlations between mean translations per minute and time and between standard deviation per minute and time were evaluated using Pearson's r value. Results: The mean RMS translation averaged over all patients was 1.45 mm +/− 1.52 mm. The patients spent an average of 18%, 10%, 6%, and 3% of the monitoring time outside of 2 mm, 3 mm, 4 mm, and 5 mm RMS tolerances, respectively. The RMS values averaged over all patients were 1.31 mm +/− 0.98 mm, 1.52 +/- 1.04, and 1.30 mm +/− 0.71 mm over the 1th, 5th, and 10th minutes of monitoring, respectively. Neither, the RMS values (p = 0.15) or the standard deviations of the RMS values (p = 0.16) showed significant correlations with time. Conclusion: The patients were positioned within 2 mm of isocenter, which was the initial set-up tolerance, for the majority of their treatments. The average position changed by < 0.3 mm over 10 minutes of monitoring. Short term movements, reflected by the standard deviations, where on the order of 1 mm. This immobilization system provides adequate immobilization over a course of treatment for whole brain radiotherapy. This system may also be suitable for head and neck or stereotactic radiosurgery treatments as well

  5. Patient positioning in radiotherapy based on surface imaging using time of flight cameras

    Energy Technology Data Exchange (ETDEWEB)

    Gilles, M., E-mail: marlene.gilles@univ-brest.fr; Fayad, H.; Clement, J. F.; Bert, J.; Visvikis, D. [INSERM, UMR 1101, LaTIM, Brest 29609 (France); Miglierini, P. [Academic Radiotherapy Department, CHRU Morvan, Brest 29200 (France); Scheib, S. [Varian Medical Systems Imaging Laboratory GmbH, Baden-Daettwil 5405 (Switzerland); Cozzi, L. [Radiotherapy and Radiosurgery Department, Instituto Clinico Humanitas, Rozzano 20089 (Italy); Boussion, N.; Schick, U.; Pradier, O. [INSERM, UMR 1101, LaTIM, Brest 29609, France and Academic Radiotherapy Department, CHRU Morvan, Brest 29200 (France)

    2016-08-15

    Purpose: To evaluate the patient positioning accuracy in radiotherapy using a stereo-time of flight (ToF)-camera system. Methods: A system using two ToF cameras was used to scan the surface of the patients in order to position them daily on the treatment couch. The obtained point clouds were registered to (a) detect translations applied to the table (intrafraction motion) and (b) predict the displacement to be applied in order to place the patient in its reference position (interfraction motion). The measures provided by this system were compared to the effectively applied translations. The authors analyzed 150 fractions including lung, pelvis/prostate, and head and neck cancer patients. Results: The authors obtained small absolute errors for displacement detection: 0.8 ± 0.7, 0.8 ± 0.7, and 0.7 ± 0.6 mm along the vertical, longitudinal, and lateral axes, respectively, and 0.8 ± 0.7 mm for the total norm displacement. Lung cancer patients presented the largest errors with a respective mean of 1.1 ± 0.9, 0.9 ± 0.9, and 0.8 ± 0.7 mm. Conclusions: The proposed stereo-ToF system allows for sufficient accuracy and faster patient repositioning in radiotherapy. Its capability to track the complete patient surface in real time could allow, in the future, not only for an accurate positioning but also a real time tracking of any patient intrafraction motion (translation, involuntary, and breathing).

  6. Production of a datolite-based heavy concrete for shielding nuclear reactors and megavoltage radiotherapy rooms

    International Nuclear Information System (INIS)

    Mortazavi, S. M. J.; Mosleh-Shirazi, M.A.; Baradaran-Ghahfarokhi, M.; Siavashpour, Z.; Farshadi, A.; Ghafoori, M.; Shahvar, A.

    2010-01-01

    Biological shielding of nuclear reactors has always been a great concern and decreasing the complexity and expense of these installations is of great interest. In this study, we used datolite and galena minerals for production of a high performance heavy concrete. Materials and Methods: Datolite and galena minerals which can be found in many parts of Iran were used in the concrete mix design. To measure the gamma radiation attenuation of the Datolite and galena concrete samples, they were exposed to both narrow and wide beams of gamma rays emitted from a cobalt-60 radiotherapy unit. An Am-Be neutron source was used for assessing the shielding properties of the samples against neutrons. To test the compression strengths, both types of concrete mixes (Datolite and galena and ordinary concrete) were investigated. Results: The concrete samples had a density of 4420-4650 kg/m 3 compared to that of ordinary concrete (2300-2500 kg/m 3 ) or barite high density concrete (up to 3500 kg/m 3 ). The measured half value layer thickness of the Datolite and galena concrete samples for cobalt-60 gamma rays was much less than that of ordinary concrete (2.56 cm compared to 6.0 cm). Furthermore, the galena concrete samples had a significantly higher compressive strength as well as 20% more neutron absorption. Conclusion: The Datolite and galena concrete samples showed good shielding/engineering properties in comparison with other reported samples made, using high-density materials other than depleted uranium. It is also more economic than the high-density concretes. Datolite and galena concrete may be a suitable option for shielding nuclear reactors and megavoltage radiotherapy rooms.

  7. Sensitivity-based virtual fields for the non-linear virtual fields method

    Science.gov (United States)

    Marek, Aleksander; Davis, Frances M.; Pierron, Fabrice

    2017-09-01

    The virtual fields method is an approach to inversely identify material parameters using full-field deformation data. In this manuscript, a new set of automatically-defined virtual fields for non-linear constitutive models has been proposed. These new sensitivity-based virtual fields reduce the influence of noise on the parameter identification. The sensitivity-based virtual fields were applied to a numerical example involving small strain plasticity; however, the general formulation derived for these virtual fields is applicable to any non-linear constitutive model. To quantify the improvement offered by these new virtual fields, they were compared with stiffness-based and manually defined virtual fields. The proposed sensitivity-based virtual fields were consistently able to identify plastic model parameters and outperform the stiffness-based and manually defined virtual fields when the data was corrupted by noise.

  8. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    International Nuclear Information System (INIS)

    Wu, Jackson Sai-Yiu; Wong, Rebecca KS; Lloyd, Nancy S; Johnston, Mary; Bezjak, Andrea; Whelan, Timothy

    2004-01-01

    This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently

  9. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    Directory of Open Access Journals (Sweden)

    Bezjak Andrea

    2004-10-01

    Full Text Available Abstract Background This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. Methods A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Results Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%. Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. Conclusion For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and

  10. Optimal usage of cone beam computed tomography system with different field of views in image guided radiotherapy (IGRT

    Directory of Open Access Journals (Sweden)

    Narayana Venkata Naga Madhusudhana Sresty

    2015-09-01

    Full Text Available Purpose: To find methods for optimal usage of XVI (X-ray volume imaging system in Elekta synergy linear accelerator with different field of views for same lesion in order to minimize patient dose due to imaging.Methods: 20 scans of 2 individual patients with ca sigmoid colon and ca lung were used in this study. Kilo voltage collimators with medium field of view were used as per the preset information. Images were reconstructed for another collimator with small field of view. The set up errors were evaluated with XVI software. Shift results of both methods were compared. Results: Variation in treatment set up errors with M20 and S20 collimators were ≤ 0.2 mm in translational and 0.30 in rotational shifts. Results showed almost equal translational and rotational shifts in both medium and small field of views with different collimators in all the scans. Visualization of target and surrounding structures were good enough and sufficient for XVI auto matching.Conclusion: Imaging with small field of view results less patient dose compared with medium or large field of views. It is Suggestible to use collimators with small field of view wherever possible. In this study, collimators with small field of view were sufficient for both patients though the preset information indicated medium field of view. But, it always depends on the area required for matching purpose. So, individual selection is important than preset information in the XVI system.

  11. Relations of image quality in on-line portal images and individual patient parameters for pelvic field radiotherapy

    International Nuclear Information System (INIS)

    Heuvel, F. van den; Neve, W. de; Coghe, M.; Verellen, D.; Storme, G.

    1992-01-01

    The aims of the present study involving 566 pelvic fields on 13 patients were: 1. To study the machine- and patient-related factors influencing image quality. 2. To study the factors related to machine, patient and patient set-up, influencing the errors of field set-up. 3. To develop a method for predicting the camera settings. The OPI device consisted of a fluorescent screen scanned by a video camera. An image quality score on a scale 0-5 was given for 546/566 fields. In a univariate analysis, open field subtraction adversely affected the score. The image score of anterior fields was significantly better than that of posterior fields. Multivariate stepwise logistic regression showed that, in addition to anterior or posterior field and subtraction, gender was also a significant predictor of image score. Errors requiring field adjustments were detected on 289/530 (54.5%) evaluable fields or 229/278 (82.4%) evaluable patient set-ups. Multivariate logistic regression showed that the probability of performing an adjustment was significantly related to gender, image quality and AP-PA diameter. The magnitude of adjustments made in the lateral direction correlated significantly with patient bulk. The camera kV level with gain held constant showed an exponential dependency on dose rate at the image detector plate and can thus be predicted by treatment planning. (orig.)

  12. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

    NARCIS (Netherlands)

    van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J. A.; Siesling, Sabine

    BACKGROUND: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving

  13. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study

    NARCIS (Netherlands)

    Maaren, M.C. van; Munck, L.; Bock, G.H. de; Jobsen, J.J.; Dalen, T. van; Linn, S.C.; Poortmans, P.; Strobbe, L.J.A.; Siesling, S.

    2016-01-01

    BACKGROUND: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving

  14. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

    NARCIS (Netherlands)

    van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J A; Siesling, Sabine

    Background Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery

  15. Radiotherapy apparatus

    International Nuclear Information System (INIS)

    Leung, P.M.; Webb, H.P.J.

    1985-01-01

    This invention relates to apparatus for applying intracavitary radiotherapy. In previously-known systems radioactive material is conveyed to a desired location within a patient by transporting a chain of balls pneumatically to and from an appropriately inserted applicator. According to this invention a ball chain for such a purpose comprises several radioactive balls separated by non-radioactive tracer balls of radiographically transparent material of lower density and surface hardness than the radioactive balls. The invention also extends to radiotherapy treatment apparatus comprising a storage, sorting and assembly system

  16. Radiogenomics and radiotherapy response modeling

    Science.gov (United States)

    El Naqa, Issam; Kerns, Sarah L.; Coates, James; Luo, Yi; Speers, Corey; West, Catharine M. L.; Rosenstein, Barry S.; Ten Haken, Randall K.

    2017-08-01

    Advances in patient-specific information and biotechnology have contributed to a new era of computational medicine. Radiogenomics has emerged as a new field that investigates the role of genetics in treatment response to radiation therapy. Radiation oncology is currently attempting to embrace these recent advances and add to its rich history by maintaining its prominent role as a quantitative leader in oncologic response modeling. Here, we provide an overview of radiogenomics starting with genotyping, data aggregation, and application of different modeling approaches based on modifying traditional radiobiological methods or application of advanced machine learning techniques. We highlight the current status and potential for this new field to reshape the landscape of outcome modeling in radiotherapy and drive future advances in computational oncology.

  17. Tissue interfaces dosimetry in small field radiotherapy with alanine/EPR mini dosimeters and Monte Carlo-Penelope simulation

    Energy Technology Data Exchange (ETDEWEB)

    Vega R, J. L.; Nicolucci, P.; Baffa, O. [Universidade de Sao Paulo, FFCLRP, Departamento de Fisica, Av. Bandeirantes 3900, Bairro Monte Alegre, 14040-901 Ribeirao Preto, Sao Paulo (Brazil); Chen, F. [Universidade Federale do ABC, CCNH, Rua Santa Adelia 166, Bangu, 09210-170 Santo Andre, Sao Paulo (Brazil); Apaza V, D. G., E-mail: josevegaramirez@yahoo.es [Universidad Nacional de San Agustin de Arequipa, Departamento de Fisica, Arequipa (Peru)

    2014-08-15

    The dosimetry system based on alanine mini dosimeters plus K-Band EPR spectrometer was tested in the tissue-interface dosimetry through the percentage depth-dose (Pdd) determination for 3 x 3 cm{sup 2} and 1 x 1 cm{sup 2} radiation fields sizes. The alanine mini dosimeters were produced by mechanical pressure from a mixture of 95% L-alanine and 5% polyvinyl alcohol (Pva) acting as binder. Nominal dimensions of these mini dosimeters were 1 mm diameter and 3 mm length as well as 3 - 4 mg mass. The EPR spectra of the mini dosimeters were registered using a K-Band (24 GHz) EPR spectrometer. The mini dosimeters were placed in a nonhomogeneous phantom and irradiated with 20 Gy in a 6 MV PRIMUS Siemens linear accelerator, with a source-to-surface distance of 100 cm using the small fields previously mentioned. The cylindrical non-homogeneous phantom was comprised of several disk-shaped plates of different materials in the sequence acrylic-bone cork-bone-acrylic, with dimensions 15 cm diameter and 1 cm thick. The plates were placed in descending order, starting from top with four acrylic plates followed by two bone plates plus eight cork plates plus two bone plates and finally, four acrylic plates (4-2-8-2-4). Pdd curves from the treatment planning system and from Monte Carlo simulation with Penelope code were determined. Mini dosimeters Pdd results show good agreement with Penelope, better than 95% for the cork homogeneous region and 97.7% in the bone heterogeneous region. In the first interface region, between acrylic and bone, it can see a dose increment of 0.6% for mini dosimeters compared to Penelope. At the second interface, between bone and cork, there is 9.1% of dose increment for mini dosimeter relative to Penelope. For the third (cork-bone) and fourth (bone-acrylic) interfaces, the dose increment for mini dosimeters compared to Penelope was 4.1% both. (Author)

  18. Tissue interfaces dosimetry in small field radiotherapy with alanine/EPR mini dosimeters and Monte Carlo-Penelope simulation

    International Nuclear Information System (INIS)

    Vega R, J. L.; Nicolucci, P.; Baffa, O.; Chen, F.; Apaza V, D. G.

    2014-08-01

    The dosimetry system based on alanine mini dosimeters plus K-Band EPR spectrometer was tested in the tissue-interface dosimetry through the percentage depth-dose (Pdd) determination for 3 x 3 cm 2 and 1 x 1 cm 2 radiation fields sizes. The alanine mini dosimeters were produced by mechanical pressure from a mixture of 95% L-alanine and 5% polyvinyl alcohol (Pva) acting as binder. Nominal dimensions of these mini dosimeters were 1 mm diameter and 3 mm length as well as 3 - 4 mg mass. The EPR spectra of the mini dosimeters were registered using a K-Band (24 GHz) EPR spectrometer. The mini dosimeters were placed in a nonhomogeneous phantom and irradiated with 20 Gy in a 6 MV PRIMUS Siemens linear accelerator, with a source-to-surface distance of 100 cm using the small fields previously mentioned. The cylindrical non-homogeneous phantom was comprised of several disk-shaped plates of different materials in the sequence acrylic-bone cork-bone-acrylic, with dimensions 15 cm diameter and 1 cm thick. The plates were placed in descending order, starting from top with four acrylic plates followed by two bone plates plus eight cork plates plus two bone plates and finally, four acrylic plates (4-2-8-2-4). Pdd curves from the treatment planning system and from Monte Carlo simulation with Penelope code were determined. Mini dosimeters Pdd results show good agreement with Penelope, better than 95% for the cork homogeneous region and 97.7% in the bone heterogeneous region. In the first interface region, between acrylic and bone, it can see a dose increment of 0.6% for mini dosimeters compared to Penelope. At the second interface, between bone and cork, there is 9.1% of dose increment for mini dosimeter relative to Penelope. For the third (cork-bone) and fourth (bone-acrylic) interfaces, the dose increment for mini dosimeters compared to Penelope was 4.1% both. (Author)

  19. A fiber-dosimetry method based on OSL from Al2O3:C for radiotherapy applications

    International Nuclear Information System (INIS)

    Gaza, R.; McKeever, S.W.S.; Akselrod, M.S.; Akselrod, A.; Underwood, T.; Yoder, C.; Andersen, C.E.; Aznar, M.C.; Marckmann, C.J.; Boetter-Jensen, L.

    2004-01-01

    We describe a high-sensitivity, fiber-optic dosimetry system based on optically stimulated luminescence (OSL) and radioluminescence from Al 2 O 3 :C single-crystal fibers (detectors). The detectors are coupled to a fiber optic delivery system and OSL from the detector is stimulated via the optical fiber cable using light from a Nd:YAG laser. The OSL is guided back along the same fiber and is detected by a photomultiplier tube. The Al 2 O 3 :C detectors are small and demonstrate high sensitivity with a large signal-to-noise ratio. We describe two modes of operation of the system and discuss algorithms that provide accurate estimation of dose rate and integrated dose in near real time. The system is free from magnetic and electrical interference, and is designed for use in several forms of radiotherapy, including in vitro brachytherapy source calibration, and in vivo dosimetry during patient treatment

  20. Sites of local recurrence after surgery, with or without chemotherapy, for rectal cancer: implications for radiotherapy field design

    International Nuclear Information System (INIS)

    Hruby, George; Barton, Michael; Miles, Sharon; Carroll, Susan; Nasser, Elias; Stevens, Graham

    2003-01-01

    Purpose: To examine the sites of pelvic recurrence in patients with rectal cancer previously untreated with radiotherapy to determine the relative frequency and location of recurrence within the pelvis. Methods and Materials: The records of patients with locally recurrent rectal cancer referred to three radiation oncology departments between 1984 and 1997 were reviewed. The data collected included the date and type of the initial resection and the pathologic findings. The site of recurrence within the pelvis, presence of metastasis, and date of recurrence were documented. Results: A total of 269 patients were included. Tumor had invaded through the muscularis in 74% and involved other organs in 9%. Fifty-two percent of patients were node positive at initial surgery. The median time to local recurrence from surgery was 18 months (range 15-20) and from local recurrence to death was 14 months (range 12-17). Both the initial tumor stage and the resection type influenced the recurrence location within the pelvis (p<0.01). T4 tumors comprised only 9% of initial T stage tumors but accounted for 38% of anterior central pelvic recurrences (p<0.01). All perineal recurrences occurred after abdominoperineal resection. The sites of recurrence within the pelvis were the posterior central pelvis (47%) and anastomotic (21%). Conclusion: If those patients with T4 tumors at presentation were excluded, 89% had local recurrence at, or posterior to, the anastomosis. Furthermore, if we exclude both patients who underwent abdominoperineal resection and those with T4 tumors at presentation, the rate increases to 93%. The rate of recurrence anteriorly (7%) does not justify routine radiation of the anterior pelvis beyond that required to adequately cover the anastomotic site

  1. SU-D-BRD-02: A Web-Based Image Processing and Plan Evaluation Platform (WIPPEP) for Future Cloud-Based Radiotherapy

    International Nuclear Information System (INIS)

    Chai, X; Liu, L; Xing, L

    2014-01-01

    Purpose: Visualization and processing of medical images and radiation treatment plan evaluation have traditionally been constrained to local workstations with limited computation power and ability of data sharing and software update. We present a web-based image processing and planning evaluation platform (WIPPEP) for radiotherapy applications with high efficiency, ubiquitous web access, and real-time data sharing. Methods: This software platform consists of three parts: web server, image server and computation server. Each independent server communicates with each other through HTTP requests. The web server is the key component that provides visualizations and user interface through front-end web browsers and relay information to the backend to process user requests. The image server serves as a PACS system. The computation server performs the actual image processing and dose calculation. The web server backend is developed using Java Servlets and the frontend is developed using HTML5, Javascript, and jQuery. The image server is based on open source DCME4CHEE PACS system. The computation server can be written in any programming language as long as it can send/receive HTTP requests. Our computation server was implemented in Delphi, Python and PHP, which can process data directly or via a C++ program DLL. Results: This software platform is running on a 32-core CPU server virtually hosting the web server, image server, and computation servers separately. Users can visit our internal website with Chrome browser, select a specific patient, visualize image and RT structures belonging to this patient and perform image segmentation running Delphi computation server and Monte Carlo dose calculation on Python or PHP computation server. Conclusion: We have developed a webbased image processing and plan evaluation platform prototype for radiotherapy. This system has clearly demonstrated the feasibility of performing image processing and plan evaluation platform through a web

  2. SU-D-BRD-02: A Web-Based Image Processing and Plan Evaluation Platform (WIPPEP) for Future Cloud-Based Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Chai, X; Liu, L; Xing, L [Stanford UniversitySchool of Medicine, Stanford, CA (United States)

    2014-06-01

    Purpose: Visualization and processing of medical images and radiation treatment plan evaluation have traditionally been constrained to local workstations with limited computation power and ability of data sharing and software update. We present a web-based image processing and planning evaluation platform (WIPPEP) for radiotherapy applications with high efficiency, ubiquitous web access, and real-time data sharing. Methods: This software platform consists of three parts: web server, image server and computation server. Each independent server communicates with each other through HTTP requests. The web server is the key component that provides visualizations and user interface through front-end web browsers and relay information to the backend to process user requests. The image server serves as a PACS system. The computation server performs the actual image processing and dose calculation. The web server backend is developed using Java Servlets and the frontend is developed using HTML5, Javascript, and jQuery. The image server is based on open source DCME4CHEE PACS system. The computation server can be written in any programming language as long as it can send/receive HTTP requests. Our computation server was implemented in Delphi, Python and PHP, which can process data directly or via a C++ program DLL. Results: This software platform is running on a 32-core CPU server virtually hosting the web server, image server, and computation servers separately. Users can visit our internal website with Chrome browser, select a specific patient, visualize image and RT structures belonging to this patient and perform image segmentation running Delphi computation server and Monte Carlo dose calculation on Python or PHP computation server. Conclusion: We have developed a webbased image processing and plan evaluation platform prototype for radiotherapy. This system has clearly demonstrated the feasibility of performing image processing and plan evaluation platform through a web

  3. Accelerated gradient-based free form deformable registration for online adaptive radiotherapy

    International Nuclear Information System (INIS)

    Yu, Gang; Yang, Guanyu; Shu, Huazhong; Li, Baosheng; Liang, Yueqiang; Yin, Yong; Li, Dengwang

    2015-01-01

    The registration of planning fan-beam computed tomography (FBCT) and daily cone-beam CT (CBCT) is a crucial step in adaptive radiation therapy. The current intensity-based registration algorithms, such as Demons, may fail when they are used to register FBCT and CBCT, because the CT numbers in CBCT cannot exactly correspond to the electron densities. In this paper, we investigated the effects of CBCT intensity inaccuracy on the registration accuracy and developed an accurate gradient-based free form deformation algorithm (GFFD). GFFD distinguishes itself from other free form deformable registration algorithms by (a) measuring the similarity using the 3D gradient vector fields to avoid the effect of inconsistent intensities between the two modalities; (b) accommodating image sampling anisotropy using the local polynomial approximation-intersection of confidence intervals (LPA-ICI) algorithm to ensure a smooth and continuous displacement field; and (c) introducing a ‘bi-directional’ force along with an adaptive force strength adjustment to accelerate the convergence process. It is expected that such a strategy can decrease the effect of the inconsistent intensities between the two modalities, thus improving the registration accuracy and robustness. Moreover, for clinical application, the algorithm was implemented by graphics processing units (GPU) through OpenCL framework. The registration time of the GFFD algorithm for each set of CT data ranges from 8 to 13 s. The applications of on-line adaptive image-guided radiation therapy, including auto-propagation of contours, aperture-optimization and dose volume histogram (DVH) in the course of radiation therapy were also studied by in-house-developed software. (paper)

  4. Planning Target Margin Calculations for Prostate Radiotherapy Based on Intrafraction and Interfraction Motion Using Four Localization Methods

    International Nuclear Information System (INIS)

    Beltran, Chris; Herman, Michael G.; Davis, Brian J.

    2008-01-01

    Purpose: To determine planning target volume (PTV) margins for prostate radiotherapy based on the internal margin (IM) (intrafractional motion) and the setup margin (SM) (interfractional motion) for four daily localization methods: skin marks (tattoo), pelvic bony anatomy (bone), intraprostatic gold seeds using a 5-mm action threshold, and using no threshold. Methods and Materials: Forty prostate cancer patients were treated with external radiotherapy according to an online localization protocol using four intraprostatic gold seeds and electronic portal images (EPIs). Daily localization and treatment EPIs were obtained. These data allowed inter- and intrafractional analysis of prostate motion. The SM for the four daily localization methods and the IM were determined. Results: A total of 1532 fractions were analyzed. Tattoo localization requires a SM of 6.8 mm left-right (LR), 7.2 mm inferior-superior (IS), and 9.8 mm anterior-posterior (AP). Bone localization requires 3.1, 8.9, and 10.7 mm, respectively. The 5-mm threshold localization requires 4.0, 3.9, and 3.7 mm. No threshold localization requires 3.4, 3.2, and 3.2 mm. The intrafractional prostate motion requires an IM of 2.4 mm LR, 3.4 mm IS and AP. The PTV margin using the 5-mm threshold, including interobserver uncertainty, IM, and SM, is 4.8 mm LR, 5.4 mm IS, and 5.2 mm AP. Conclusions: Localization based on EPI with implanted gold seeds allows a large PTV margin reduction when compared with tattoo localization. Except for the LR direction, bony anatomy localization does not decrease the margins compared with tattoo localization. Intrafractional prostate motion is a limiting factor on margin reduction

  5. Patch-based generation of a pseudo CT from conventional MRI sequences for MRI-only radiotherapy of the brain

    DEFF Research Database (Denmark)

    Andreasen, Daniel; Van Leemput, Koen; Hansen, Rasmus H.

    2015-01-01

    scans. In this study, we investigate the potential of a patch-based method for creating a pCT based on conventional T1-weighted MRI scans without using deformable registrations. We compare this method against two state-of-the-art methods within the voxel-based and atlas-based categories. Methods...... based on water equivalent path lengths was carried out, comparing the upper hemisphere of the head in the pCT and the real CT. Finally, the dosimetric accuracy was tested and compared for a photon treatment plan. Results:The pCTs produced with the patch-based method had the best voxel-wise, geometric......Purpose: In radiotherapy (RT) based on magnetic resonance imaging (MRI) as the only modality, the information on electron density must be derived from the MRI scan by creating a so-called pseudo computed tomography (pCT). This is a nontrivial task, since the voxel-intensities in an MRI scan...

  6. SU-F-P-52: A Meta-Analysis of Controlled Clinical Trials Comparing Elective Nodal Irradiation with Involved-Field Irradiation for Conformal Or Intensity-Modulated Radiotherapy in Patients with Esophageal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bai, W; Zhang, R; Zhou, Z; Qiao, X [The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei (China)

    2016-06-15

    Purpose: To compare elective nodal irradiation with involved-field irradiation for three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in patients with esophageal cancer by a metaanalysis. Methods: Wanfang, CNKI, VIP, CBM databases, PubMed, Embase and Cochrane Library were searched to identify the controlled clinical trials of elective nodal irradiation with involved-field irradiation for three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in patients with esophageal cancer. The obtained data were analyzed using Stata 11.0. The difference between two groups was estimated by calculating the odds ratio (OR) with 95% confidence interval (95% CI). Results: A total of 12 controlled clinical trials involving 1095 esophageal cancer patients, which were selected according to inclusion and exclusion criteria, were included in this meta-analysis. The meta-analysis showed that the elective nodal irradiation group reduced the rates of out-field failure comparing with involved-field irradiation group (OR=3.727, P=0.007). However, the rates of ≥grades 3 acute radiation pneumonitis and esophagitis were significantly higher in the elective nodal irradiation group than in the involved-field irradiation group (OR=0.348, P=0.001, OR=0.385, P=0.000). 1-, 2-, 3-year local control rates (OR=0.966, P=0.837, OR=0.946, P=0.781; OR=0.732P=0.098) and 1-, 3-, 5-year survival rates were similar in the two groups ( OR=0.966, P=0.837; OR=0.946, P=0.781; OR=0.732, P=0.098; OR=0.952, P=0.756; OR=1.149, P=0.422; OR=0.768, P=0.120). It is the same with the rates of distant metastasis (OR=0.986, P=0.937). Conclusion: Compared with involved-field irradiation, the elective nodal irradiation can reduce the rates of out-field failure for three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in patients with esophageal cancer. However, its advantage of local control and survival rates is not obvious and it increases the incidence

  7. The European Society of Therapeutic Radiology and Oncology-European Institute of Radiotherapy (ESTRO-EIR) report on 3D CT-based in-room image guidance systems: a practical and technical review and guide

    DEFF Research Database (Denmark)

    Korreman, Stine; Rasch, Coen; McNair, Helen

    2010-01-01

    The past decade has provided many technological advances in radiotherapy. The European Institute of Radiotherapy (EIR) was established by the European Society of Therapeutic Radiology and Oncology (ESTRO) to provide current consensus statement with evidence-based and pragmatic guidelines on topics...

  8. Automatic commissioning of a GPU-based Monte Carlo radiation dose calculation code for photon radiotherapy

    International Nuclear Information System (INIS)

    Tian, Zhen; Jia, Xun; Jiang, Steve B; Graves, Yan Jiang

    2014-01-01

    Monte Carlo (MC) simulation is commonly considered as the most accurate method for radiation dose calculations. Commissioning of a beam model in the MC code against a clinical linear accelerator beam is of crucial importance for its clinical implementation. In this paper, we propose an automatic commissioning method for our GPU-based MC dose engine, gDPM. gDPM utilizes a beam model based on a concept of phase-space-let (PSL). A PSL contains a group of particles that are of the same type and close in space and energy. A set of generic PSLs was generated by splitting a reference phase-space file. Each PSL was associated with a weighting factor, and in dose calculations the particle carried a weight corresponding to the PSL where it was from. Dose for each PSL in water was pre-computed, and hence the dose in water for a whole beam under a given set of PSL weighting factors was the weighted sum of the PSL doses. At the commissioning stage, an optimization problem was solved to adjust the PSL weights in order to minimize the difference between the calculated dose and measured one. Symmetry and smoothness regularizations were utilized to uniquely determine the solution. An augmented Lagrangian method was employed to solve the optimization problem. To validate our method, a phase-space file of a Varian TrueBeam 6 MV beam was used to generate the PSLs for 6 MV beams. In a simulation study, we commissioned a Siemens 6 MV beam on which a set of field-dependent phase-space files was available. The dose data of this desired beam for different open fields and a small off-axis open field were obtained by calculating doses using these phase-space files. The 3D γ-index test passing rate within the regions with dose above 10% of d max dose for those open fields tested was improved averagely from 70.56 to 99.36% for 2%/2 mm criteria and from 32.22 to 89.65% for 1%/1 mm criteria. We also tested our commissioning method on a six-field head-and-neck cancer IMRT plan. The

  9. Quality indicators in radiotherapy

    International Nuclear Information System (INIS)

    Cionini, Luca; Gardani, Gianstefano; Gabriele, Pietro; Magri, Secondo; Morosini, Pier Luigi; Rosi, Antonella; Viti, Vincenza

    2007-01-01

    Background and purpose: There is a widespread and increasing tendency to develop hospital performance indicators in the field of accreditation/certification systems and quality benchmarking. A study has been undertaken to develop a set of performance indicators for a typical radiotherapy Centre and to evaluate their ability to provide a continuous quality improvement. Materials and methods: A working group consisting of radiation oncologists, medical physicists and radiation technologists under the coordination of experts in health technology assessment has elaborated a set of general indicators able to monitor performances and the quality level of a typical radiotherapy Centre. The work has been carried out through four steps: a preliminary set of indicators was selected; data on these indicators were collected in a number of Italian radiotherapy Centres and medical physics Services; problems in collection and analysis of data were discussed; a final set of indicators was developed. Results: A final set of 13 indicators is here presented. They concern general structural and/or operational features, health physics activities and accuracy and technical complexity of the treatment. Conclusions: The indicators tested in a few Italian Centres of radiotherapy and medical physics Services are now ready to be utilized by a larger community

  10. Evaluation of an automatic MR-based gold fiducial marker localisation method for MR-only prostate radiotherapy

    Science.gov (United States)

    Maspero, Matteo; van den Berg, Cornelis A. T.; Zijlstra, Frank; Sikkes, Gonda G.; de Boer, Hans C. J.; Meijer, Gert J.; Kerkmeijer, Linda G. W.; Viergever, Max A.; Lagendijk, Jan J. W.; Seevinck, Peter R.

    2017-10-01

    An MR-only radiotherapy planning (RTP) workflow would reduce the cost, radiation exposure and uncertainties introduced by CT-MRI registrations. In the case of prostate treatment, one of the remaining challenges currently holding back the implementation of an RTP workflow is the MR-based localisation of intraprostatic gold fiducial markers (FMs), which is crucial for accurate patient positioning. Currently, MR-based FM localisation is clinically performed manually. This is sub-optimal, as manual interaction increases the workload. Attempts to perform automatic FM detection often rely on being able to detect signal voids induced by the FMs in magnitude images. However, signal voids may not always be sufficiently specific, hampering accurate and robust automatic FM localisation. Here, we present an approach that aims at automatic MR-based FM localisation. This method is based on template matching using a library of simulated complex-valued templates, and exploiting the behaviour of the complex MR signal in the vicinity of the FM. Clinical evaluation was performed on seventeen prostate cancer patients undergoing external beam radiotherapy treatment. Automatic MR-based FM localisation was compared to manual MR-based and semi-automatic CT-based localisation (the current gold standard) in terms of detection rate and the spatial accuracy and precision of localisation. The proposed method correctly detected all three FMs in 15/17 patients. The spatial accuracy (mean) and precision (STD) were 0.9 mm and 0.5 mm respectively, which is below the voxel size of 1.1 × 1.1 × 1.2 mm3 and comparable to MR-based manual localisation. FM localisation failed (3/51 FMs) in the presence of bleeding or calcifications in the direct vicinity of the FM. The method was found to be spatially accurate and precise, which is essential for clinical use. To overcome any missed detection, we envision the use of the proposed method along with verification by an observer. This will result in a

  11. Evaluation of an automatic MR-based gold fiducial marker localisation method for MR-only prostate radiotherapy.

    Science.gov (United States)

    Maspero, Matteo; van den Berg, Cornelis A T; Zijlstra, Frank; Sikkes, Gonda G; de Boer, Hans C J; Meijer, Gert J; Kerkmeijer, Linda G W; Viergever, Max A; Lagendijk, Jan J W; Seevinck, Peter R

    2017-10-03

    An MR-only radiotherapy planning (RTP) workflow would reduce the cost, radiation exposure and uncertainties introduced by CT-MRI registrations. In the case of prostate treatment, one of the remaining challenges currently holding back the implementation of an RTP workflow is the MR-based localisation of intraprostatic gold fiducial markers (FMs), which is crucial for accurate patient positioning. Currently, MR-based FM localisation is clinically performed manually. This is sub-optimal, as manual interaction increases the workload. Attempts to perform automatic FM detection often rely on being able to detect signal voids induced by the FMs in magnitude images. However, signal voids may not always be sufficiently specific, hampering accurate and robust automatic FM localisation. Here, we present an approach that aims at automatic MR-based FM localisation. This method is based on template matching using a library of simulated complex-valued templates, and exploiting the behaviour of the complex MR signal in the vicinity of the FM. Clinical evaluation was performed on seventeen prostate cancer patients undergoing external beam radiotherapy treatment. Automatic MR-based FM localisation was compared to manual MR-based and semi-automatic CT-based localisation (the current gold standard) in terms of detection rate and the spatial accuracy and precision of localisation. The proposed method correctly detected all three FMs in 15/17 patients. The spatial accuracy (mean) and precision (STD) were 0.9 mm and 0.5 mm respectively, which is below the voxel size of [Formula: see text] mm 3 and comparable to MR-based manual localisation. FM localisation failed (3/51 FMs) in the presence of bleeding or calcifications in the direct vicinity of the FM. The method was found to be spatially accurate and precise, which is essential for clinical use. To overcome any missed detection, we envision the use of the proposed method along with verification by an observer. This will result in a

  12. Shielding the spinal cord is necessary when junctioning abutting fields with independent collimation in head and neck radiotherapy

    International Nuclear Information System (INIS)

    Rosenthal, David I.; McDonough, James; Kassaee, Alireza

    1997-01-01

    Purpose: Asymmetric collimation is a relatively new method of junctioning abutting fields with non-diverging beam edges. When this technique is used at the junction of lateral and low anterior fields in three field head and neck set ups, there should, in theory, be a perfect match. There should be no overdose or underdose at the match line. We have performed dosimetric measurements to evaluate the actual dosimetry at the central axis. Materials and Methods: X-ray verification film was placed in a water-equivalent phantom at a depth of 4 cm, corresponding to an isocentric distance of 100 cm. A double exposure technique was used to mimic two half-beam blocked fields abutting at the central axis. Each half of the film was irradiated with 50 monitor units using a 6 MV photon beam. One of the collimators was set to an off-axis position to force a gap or overlap of the radiation fields at the isocenter in increments of 1 mm. The films were scanned with a laser densitometer with a resolution of 300 μm. The beam profiles were evaluated at the region of overdose or underdose around the match line. Results: The dose on the central axis varied linearly from - 50% (field gap of 3 mm) to + 50% (field overlap of 3 mm). Surprisingly, the width (defined as a full-width, half-maximum, FWHM) of the region of overdose or underdose around the match line is 3 mm for field gaps or overlaps of 1 and 2 mm. The width of the region is 4.5 mm for field gaps or overlaps of 3 mm. The larger than expected width of this region is due to the addition of the two abutting penumbras. Conclusion: Asymmetric collimation with half-beam blocks may overdose the spinal cord. Calibration specifications generally allow for a 1 mm tolerance in the position of each independent jaw. In a calibrated machine, this could lead to a 2 mm field overlap. A field overlap of just 1 mm results in a FWHM region of overdose measuring 3 mm with a maximum dose of 140%. To our knowledge, there are no current recommendations

  13. A high-precision system for conformal intracranial radiotherapy

    International Nuclear Information System (INIS)

    Tome, Wolfgang A.; Meeks, Sanford L.; Buatti, John M.; Bova, Francis J.; Friedman, William A.; Li Zuofeng

    2000-01-01

    Purpose: Currently, optimally precise delivery of intracranial radiotherapy is possible with stereotactic radiosurgery and fractionated stereotactic radiotherapy. We report on an optimally precise optically guided system for three-dimensional (3D) conformal radiotherapy using multiple noncoplanar fixed fields. Methods and Materials: The optically guided system detects infrared light emitting diodes (IRLEDs) attached to a custom bite plate linked to the patient's maxillary dentition. The IRLEDs are monitored by a commercially available stereo camera system, which is interfaced to a personal computer. An IRLED reference is established with the patient at the selected stereotactic isocenter, and the computer reports the patient's current position based on the location of the IRLEDs relative to this reference position. Using this readout from the computer, the patient may be dialed directly to the desired position in stereotactic space. The patient is localized on the first day and a reference file is established for 5 different couch positions. The patient's image data are then imported into a commercial convolution-based 3D radiotherapy planning system. The previously established isocenter and couch positions are then used as a template upon which to design a conformal 3D plan with maximum beam separation. Results: The use of the optically guided system in conjunction with noncoplanar radiotherapy treatment planning using fixed fields allows the generation of highly conformal treatment plans that exhibit a high degree of dose homogeneity and a steep dose gradient. To date, this approach has been used to treat 28 patients. Conclusion: Because IRLED technology improves the accuracy of patient localization relative to the linac isocenter and allows real-time monitoring of patient position, one can choose treatment-field margins that only account for beam penumbra and image resolution without adding margin to account for larger and poorly defined setup uncertainty. This

  14. Investigation of the 4D composite MR image distortion field associated with tumor motion for MR-guided radiotherapy.

    Science.gov (United States)

    Stanescu, T; Jaffray, D

    2016-03-01

    Magnetic resonance (MR) images are affected by geometric distortions due to the specifics of the MR scanner and patient anatomy. Quantifying the distortions associated with mobile tumors is particularly challenging due to real anatomical changes in the tumor's volume, shape, and relative location within the MR imaging volume. In this study, the authors investigate the 4D composite distortion field, which combines the effects of the susceptibility-induced and system-related distortion fields, experienced by mobile lung tumors. The susceptibility (χ) effects were numerically simulated for two specific scenarios: (a) a full motion cycle of a lung tumor due to breathing as depicted on ten phases of a 4D CBCT data set and (b) varying the tumor size and location in lung tissue via a synthetically generated sphere with variable diameter (4-80 mm). The χ simulation procedure relied on the segmentation and generation of 3D susceptibility (χ) masks and computation of the magnetic field by means of finite difference methods. A system-related distortion field, determined with a phantom and image processing algorithm, was used as a reference. The 4D composite distortion field was generated as the vector summation of the χ-induced and system-related fields. The analysis was performed for two orientations of the main magnetic field (B0), which correspond to several MRIgRT system configurations. Specifically, B0 was set along the z-axis as in the case of a cylindrical-bore scanner and in the (x,y)-plane as for a biplanar MR. Computations were also performed for a full revolution at 15° increments in the case of a rotating biplanar magnet. Histograms and metrics such as maximum, mean, and range were used to evaluate the characteristics of the 4D distortion field. The χ-induced field depends on the change in volume and shape of the moving tumor as well as the local surrounding anatomy. In the case of system-related distortions, the tumor experiences increased field

  15. A criterion-based audit of the technical quality of external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Brundage, Michael; Danielson, Brita; Pearcey, Robert; Bass, Brenda; Pickles, Tom; Bahary, Jean-Paul; Peng, Yingwei; Wallace, David; Mackillop, William

    2013-01-01

    Purpose: To evaluate the technical quality of external beam