Intra-individual diagnostic image quality and organ-specific-radiation dose comparison between spiral cCT with iterative image reconstruction and z-axis automated tube current modulation and sequential cCT

International Nuclear Information System (INIS)

Wenz, Holger; Maros, Máté E.; Meyer, Mathias; Gawlitza, Joshua; Förster, Alex; Haubenreisser, Holger; Kurth, Stefan; Schoenberg, Stefan O.; Groden, Christoph; Henzler, Thomas

2016-01-01

•Superiority of spiral versus sequential cCT in image quality and organ-specific-radiation dose.•Spiral cCT: lower organ-specific-radiation-dose in eye lense compared to tilted sequential cCT.•State-of-the-art IR spiral cCT techniques has significant advantages over sequential cCT techniques. Superiority of spiral versus sequential cCT in image quality and organ-specific-radiation dose. Spiral cCT: lower organ-specific-radiation-dose in eye lense compared to tilted sequential cCT. State-of-the-art IR spiral cCT techniques has significant advantages over sequential cCT techniques. To prospectively evaluate image quality and organ-specific-radiation dose of spiral cranial CT (cCT) combined with automated tube current modulation (ATCM) and iterative image reconstruction (IR) in comparison to sequential tilted cCT reconstructed with filtered back projection (FBP) without ATCM. 31 patients with a previous performed tilted non-contrast enhanced sequential cCT aquisition on a 4-slice CT system with only FBP reconstruction and no ATCM were prospectively enrolled in this study for a clinical indicated cCT scan. All spiral cCT examinations were performed on a 3rd generation dual-source CT system using ATCM in z-axis direction. Images were reconstructed using both, FBP and IR (level 1–5). A Monte-Carlo-simulation-based analysis was used to compare organ-specific-radiation dose. Subjective image quality for various anatomic structures was evaluated using a 4-point Likert-scale and objective image quality was evaluated by comparing signal-to-noise ratios (SNR). Spiral cCT led to a significantly lower (p < 0.05) organ-specific-radiation dose in all targets including eye lense. Subjective image quality of spiral cCT datasets with an IR reconstruction level 5 was rated significantly higher compared to the sequential cCT acquisitions (p < 0.0001). Consecutive mean SNR was significantly higher in all spiral datasets (FBP, IR 1–5) when compared to sequential cCT with a mean

Dose distribution in head and neck during dental x-ray procedures

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Mason, E.W.; Goepp, R.A.

1978-01-01

Previous studies, notably by Franklin (Angle Ortho., 43:53-64, 1973), have shown significant exposures during cephalometric dental procedures and ways in which these exposures can be reduced. Skin dose over thyroid tissue has been measured by Alcox (J. Am. Dent. Assoc., 88:568-579, 1974), and others. This study is an expansion of thyroid dose measurements by Block, Goepp, and Mason (Angle Ortho., 47:17-24, 1977). The internal dose distribution in the head and neck area due to cephalometric and panoramic dental x-ray procedures is shown along with the dependence of orbit and thyroid dose on patient positioning. Higher doses can be delivered to deep tissue by panoramic machines since tissue at the axis of rotation is exposed during the entire procedure. (author)

Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-Modulated Radiotherapy?

International Nuclear Information System (INIS)

Yao Min; Hoffman, Henry T.; Chang, Kristi; Funk, Gerry F.; Smith, Russell B.; Tan Huaming; Clamon, Gerald H.; Dornfeld, Ken; Buatti, John M.

2007-01-01

Purpose: The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. Methods and Materials: A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [ 18 F] fluorodeoxyglucose positron emission tomography in recent years. Results: Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. Conclusions: Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [ 18 F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection

Head-and-neck IMRT treatments assessed with a Monte Carlo dose calculation engine

International Nuclear Information System (INIS)

Seco, J; Adams, E; Bidmead, M; Partridge, M; Verhaegen, F

2005-01-01

IMRT is frequently used in the head-and-neck region, which contains materials of widely differing densities (soft tissue, bone, air-cavities). Conventional methods of dose computation for these complex, inhomogeneous IMRT cases involve significant approximations. In the present work, a methodology for the development, commissioning and implementation of a Monte Carlo (MC) dose calculation engine for intensity modulated radiotherapy (MC-IMRT) is proposed which can be used by radiotherapy centres interested in developing MC-IMRT capabilities for research or clinical evaluations. The method proposes three levels for developing, commissioning and maintaining a MC-IMRT dose calculation engine: (a) development of a MC model of the linear accelerator, (b) validation of MC model for IMRT and (c) periodic quality assurance (QA) of the MC-IMRT system. The first step, level (a), in developing an MC-IMRT system is to build a model of the linac that correctly predicts standard open field measurements for percentage depth-dose and off-axis ratios. Validation of MC-IMRT, level (b), can be performed in a rando phantom and in a homogeneous water equivalent phantom. Ultimately, periodic quality assurance of the MC-IMRT system is needed to verify the MC-IMRT dose calculation system, level (c). Once the MC-IMRT dose calculation system is commissioned it can be applied to more complex clinical IMRT treatments. The MC-IMRT system implemented at the Royal Marsden Hospital was used for IMRT calculations for a patient undergoing treatment for primary disease with nodal involvement in the head-and-neck region (primary treated to 65 Gy and nodes to 54 Gy), while sparing the spinal cord, brain stem and parotid glands. Preliminary MC results predict a decrease of approximately 1-2 Gy in the median dose of both the primary tumour and nodal volumes (compared with both pencil beam and collapsed cone). This is possibly due to the large air-cavity (the larynx of the patient) situated in the centre

A two-dimensional matrix correction for off-axis portal dose prediction errors

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Bailey, Daniel W.; Kumaraswamy, Lalith; Bakhtiari, Mohammad; Podgorsak, Matthew B.

2013-01-01

Purpose: This study presents a follow-up to a modified calibration procedure for portal dosimetry published by Bailey et al. [“An effective correction algorithm for off-axis portal dosimetry errors,” Med. Phys. 36, 4089–4094 (2009)]. A commercial portal dose prediction system exhibits disagreement of up to 15% (calibrated units) between measured and predicted images as off-axis distance increases. The previous modified calibration procedure accounts for these off-axis effects in most regions of the detecting surface, but is limited by the simplistic assumption of radial symmetry. Methods: We find that a two-dimensional (2D) matrix correction, applied to each calibrated image, accounts for off-axis prediction errors in all regions of the detecting surface, including those still problematic after the radial correction is performed. The correction matrix is calculated by quantitative comparison of predicted and measured images that span the entire detecting surface. The correction matrix was verified for dose-linearity, and its effectiveness was verified on a number of test fields. The 2D correction was employed to retrospectively examine 22 off-axis, asymmetric electronic-compensation breast fields, five intensity-modulated brain fields (moderate-high modulation) manipulated for far off-axis delivery, and 29 intensity-modulated clinical fields of varying complexity in the central portion of the detecting surface. Results: Employing the matrix correction to the off-axis test fields and clinical fields, predicted vs measured portal dose agreement improves by up to 15%, producing up to 10% better agreement than the radial correction in some areas of the detecting surface. Gamma evaluation analyses (3 mm, 3% global, 10% dose threshold) of predicted vs measured portal dose images demonstrate pass rate improvement of up to 75% with the matrix correction, producing pass rates that are up to 30% higher than those resulting from the radial correction technique alone. As

Position modification and actual radiation dose in parotids for head and neck cancers treated with TomoTherapy

International Nuclear Information System (INIS)

Jiang Huayong; Zhang Yongqian; Wang Yadi; Xu Weidong; Gao Junmao; Zhang Fuli; Yao Bo

2014-01-01

Objective: To analyze the impact of parotid's position and volume changing on radiation dose for head and neck cancer treated with TomoTherapy. Methods: Totally 12 patients with head and neck cancer were treated with TomoTherapy. Before the treatment, the dose distribution was recalculated with MVCT images, which would obtain the parameters of position, volume and actual radiation dose for parotids. Results: The volume of parotids in Plan2 was significantly lower than in Plan1, and the percentage reduction was 29.06% and 31.78% for left and right parotid, respectively (Z = 6.77, 3.06, P < 0.05). Distance between the COM(center of mass) of parotids and the midline of body was significantly smaller in Plan2 than in Plan1, and the percentage reduction was 6.72% and 6.19% (t = 5.14, 5.80, P < 0.05) at left and right side, respectively. Average dose and V_2_6 for both parotids were higher than those in Plan1, increasing by an average of 37.74%, 25.08% (Z = -6.03, -5.31, P < 0.05) for left parotid and 30.45%, 19.33% (Z = -5.43, -3.26, P < 0.05) for right parotid, respectively. Conclusions: The actual radiation dose to parotids was significantly increased during the radiation therapy for patients with head and neck cancer. There was a linear correlation between the decrease of distance between the COM of parotids and the midline of body and the percentage increase of parotids' radiation dose. No correlation between the reduction of parotids' volume and dose to parotids. In order to reduce the parotids' radiation dose, modification of treatment plan at the appropriate time is essential. (authors)

Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer: Is What You Plan What You Get?

International Nuclear Information System (INIS)

O'Daniel, Jennifer C.; Garden, Adam S.; Schwartz, David L.; Wang He; Ang, Kian K.; Ahamad, Anesa; Rosenthal, David I.; Morrison, William H.; Asper, Joshua A.; Zhang Lifei; Tung Shihming; Mohan, Radhe; Dong Lei

2007-01-01

Purpose: To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head and neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Eleven head and neck cancer patients received two CT scans per week with an in-room CT scanner over the course of their radiotherapy. The clinical IMRT plans, designed with 3-mm to 4-mm planning margins, were recalculated on the repeat CT images. The plans were aligned using the actual treatment isocenter marked with radiopaque markers (BB) and bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative delivered dose distribution for each patient. Results: Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5 to 7 Gy in 45% of the patients (median, 3.0 Gy ipsilateral, p = 0.026; median, 1.0 Gy contralateral, p = 0.016). Use of bone alignment led to reductions relative to BB alignment in 91% of patients (median, 2 Gy; range, 0.3-8.3 Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median, 1.0 Gy, p = 0.007). Neither approach affected tumor dose coverage. Conclusions: With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared with BB alignment in almost all patients. A 3- to 4-mm planning margin was adequate for tumor dose coverage

Evaluation of surface and build-up region dose for intensity-modulated radiation therapy in head and neck cancer

International Nuclear Information System (INIS)

Chung, Heeteak; Jin, Hosang; Dempsey, James F.; Liu, Chihray; Palta, Jatinder; Suh, Tae-Suk; Kim, Siyong

2005-01-01

Despite much development, there remains dosimetric uncertainty in the surface and build-up regions in intensity-modulated radiation therapy treatment plans for head and neck cancers. Experiments were performed to determine the dosimetric discrepancies in the surface and build-up region between the treatment planning system (TPS) prediction and experimental measurement using radiochromic film. A head and neck compression film phantom was constructed from two semicylindrical solid water slabs. Treatment plans were generated using two commercial TPSs (PINNACLE3 and CORVUS) for two cases, one with a shallow (∼0.5 cm depth) target and another with a deep (∼6 cm depth) target. The plans were evaluated for a 54 Gy prescribed dose. For each case, two pieces of radiochromic film were used for dose measurement. A small piece of film strip was placed on the surface and another was inserted within the phantom. Overall, both TPSs showed good agreement with the measurement. For the shallow target case, the dose differences were within ±300 cGy (5.6% with respect to the prescribed dose) for PINNACLE3 and ±240 cGy (4.4%) for CORVUS in 90% of the region of interest. For the deep target case, the dose differences were ±350 (6.5%) for PINNACLE3 and ±260 cGy (4.8%) for CORVUS in 90% of the region of interest. However, it was found that there were significant discrepancies from the surface to about 0.2 cm in depth for both the shallow and deep target cases. It was concluded that both TPSs overestimated the surface dose for both shallow and deep target cases. The amount of overestimation ranges from 400 to 1000 cGy (∼7.4% to 18.5% with respect to the prescribed dose, 5400 cGy)

Matching Intensity-Modulated Radiation Therapy to an Anterior Low Neck Field

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Amdur, Robert J.; Liu, Chihray; Li, Jonathan; Mendenhall, William; Hinerman, Russell

2007-01-01

When using intensity-modulated radiation therapy (IMRT) to treat head and neck cancer with the primary site above the level of the larynx, there are two basic options for the low neck lymphatics: to treat the entire neck with IMRT, or to match the IMRT plan to a conventional anterior 'low neck' field. In view of the potential advantages of using a conventional low neck field, it is important to look for ways to minimize or manage the problems of matching IMRT to a conventional radiotherapy field. Treating the low neck with a single anterior field and the standard larynx block decreases the dose to the larynx and often results in a superior IMRT plan at the primary site. The purpose of this article is to review the most applicable studies and to discuss our experience with implementing a technique that involves moving the position of the superior border of the low neck field several times during a single treatment fraction

Dynamic intensity-modulated non-coplanar arc radiotherapy (INCA) for head and neck cancer

International Nuclear Information System (INIS)

Krayenbuehl, Jerome; Davis, J. Bernard; Ciernik, I. Frank

2006-01-01

Background and purpose: To define the potential advantages of intensity-modulated radiotherapy (IMRT) applied using a non-coplanar dynamic arc technique for the treatment of head and neck cancer. Materials and methods: External beam radiotherapy (EBRT) was planned in ten patients with head and neck cancer using coplanar IMRT and non-coplanar arc techniques, termed intensity modulated non-coplanar arc EBRT (INCA). Planning target volumes (PTV1) of first order covered the gross tumor volume and surrounding clinical target volume treated with 68-70 Gy, whereas PTV2 covered the elective lymph nodes with 54-55 Gy using a simultaneous internal boost. Treatment plan comparison between IMRT and INCA was carried out using dose-volume histogram and 'equivalent uniform dose' (EUD). Results: INCA resulted in better dose coverage and homogeneity of the PTV1, PTV2, and reduced dose delivered to most of the organs at risk (OAR). For the parotid glands, a reduction of the mean dose of 2.9 (±2.0) Gy was observed (p 0.002), the mean dose to the larynx was reduced by 6.9 (±2.9) Gy (p 0.003), the oral mucosa by 2.4 (±1.1) Gy (p < 0.001), and the maximal dose to the spinal cord by 3.2 (±1.7) Gy (p = 0.004). The mean dose to the brain was increased by 3.0 (±1.4) Gy (p = 0.002) and the mean lung dose increased by 0.2 (±0.4) Gy (p = 0.87). The EUD suggested better avoidance of the OAR, except for the lung, and better coverage and dose uniformity were achieved with INCA compared to IMRT. Conclusion: Dose delivery accuracy with IMRT using a non-coplanar dynamic arc beam geometry potentially improves treatment of head and neck cancer

A study of the positioning errors of head and neck in the process of intensity modulation radiated therapy of nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Lin Chengguang; Lin Liuwen; Liu Bingti; Liu Xiaomao; Li Guowen

2011-01-01

Objective: To investigate the positioning errors of head and neck during intensity-modulated radiation therapy of nasopharyngeal carcinoma. Methods: Nineteen patients with middle-advanced nasopharyngeal carcinoma (T 2-4 N 1-3 M 0 ), treated by intensity-modulated radiation therapy, underwent repeated CT during their 6-week treatment course. All the patients were immobilized by head-neck-shoulder thermoplastic mask. We evaluated their anatomic landmark coordinated in a total of 66 repeated CT data sets and respective x, y, z shifts relative to their position in the planning CT. Results: The positioning error of the neck was 2.44 mm ± 2.24 mm, 2.05 mm ± 1.42 mm, 1.83 mm ± 1.53 mm in x, y, z respectively. And that of the head was 1.05 mm ± 0.87 mm, 1.23 mm ± 1.05 mm, 1.17 mm ± 1.55 mm respectively. The positioning error between neck and head have respectively statistical difference (t=-6.58, -5.28, -3.42, P=0.000, 0.000, 0.001). The system error of the neck was 2.33, 1.67 and 1.56 higher than that of the head, respectively in left-right, vertical and head-foot directions; and the random error of neck was 2.57, 1.34 and 0.99 higher than that of head respectively. Conclusions: In the process of the intensity-modulated radiation therapy of nasopharyngeal carcinoma, with the immobilization by head-neck-shoulder thermoplastic mask, the positioning error of neck is higher than that of head. (authors)

Dose-response relationship for elective neck irradiation of head and neck cancer - facts and controversies

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Suwinski, R.; Maciejewski, B.; Withers, H.R.

1998-01-01

The aim of this study is to assign dose-response relationship for subclinical neck metastases of squamous cell head and neck cancer based on extensive survey of 24 data sets collected from the literature. Neck relapse rates (NRR) without and after elective (ENI) or preoperative irradiation were estimated for each site and stage of primary tumor and the reduction in neck relapse rate was calculated. An average NRR without ENI was 22% (12-35% ) and only 2.5% (0-1 0%) after the ENI with total dose of 46- 50 Gy which gives high reduction rate in the risk of neck recurrences being on the average 89% and 42% (0-46%) after preoperative irradiation using 22-30 Gy. Dose response curve for elective and preoperative irradiation have shown that 50 Gy in 2 Gy fraction reduces the incidence of neck relapses in the NO patients by more than 90% and only by less than 50% after total doses lower than 30 Gy. No correlation between the risk of neck metastases without ENI and the reduction in neck relapses after ENI was found. (authors)

Utilization of intensity modulated beam radiotherapy (IMBXRT) to diminish dose to the parotid gland in head and neck cancer

International Nuclear Information System (INIS)

Shiao, W. Woo; Grant, Walter H.; Butler, E. Brian

1996-01-01

Purpose/Objective: To determine if intensity conformal modulated radiotherapy could diminish the radiation dose to the parotid gland in the treatment of primary head and neck cancer. Materials and Methods: The NOMOS Peacock treatment system was utilized in the planning and delivery of conformal radiotherapy for the following diseases: 1) an oropharyngeal cancer that extends from the soft palate to the tonsillar fossa without nodal disease, 2) laryngeal hypopharyngeal cancer without nodal disease, 3) and adenocystic carcinoma, that originated in the hard palate. Patients were treated to areas suspicious for microscopic disease (nodal disease in 1 and 2, perineural spread in 3) at 2 Gy per fraction for a tc of 50 Gy in five weeks. The primary disease was treated at 2.4 Gy per fraction for a total of 60 Gy over five weeks. The percent of the volume of each parotid gland receiving < 20 Gy, <25 Gy and <30 Gy retrospectively was determined for each of the above mentioned optimized plans. The patients were observed for the clinical development of xerostomia. Results: No patient developed clinically apparent xerostomia within one month of completion of radiotherapy. Conclusion: IMBXRT could reduce the volume to parotid glands receiving high radiation doses. Sparing of the parotid glands appear to be most easily accomplished when irradiating head and neck tumors that do not require regional nodal treatment. For head and neck cancer that requires nodal treatment it is possible to spare a significant portion of the parotid glands if the disease originates below the hyoid bone where the primary site is not in close proximity to the parotid glands. Objective salivary flow data are being obtained pre ar post treatment, to confirm the subjective impression of lack of clinical xerostomia. IMBXRT is potentially beneficial in decreasing the morbidity of xerostomia related to head and neck irradiation

Doses to head and neck normal tissues for early stage Hodgkin lymphoma after involved node radiotherapy

International Nuclear Information System (INIS)

Maraldo, M.V.; Brodin, N.P.; Aznar, M.C.; Vogelius, I.R.; Munck af Rosenschöld, P.; Petersen, P.M.; Specht, L.

2014-01-01

Purpose: To evaluate dose plans for head and neck organs at risk (OARs) for classical Hodgkin lymphoma (HL) patients using involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), and intensity modulated proton therapy (PT), in comparison to the past mantle field (MF). Materials and methods: Data from 37 patients with cervical lymph node involvement were used. All patients originally received chemotherapy followed by 3DCRT–INRT (30.6 Gy). A VMAT–INRT, PT–INRT (both 30.6 Gy), and a MF plan (36 Gy) were simulated. Doses to head and neck OARs were compared with cumulative DVHs and repeated measures ANOVA. Results: The estimated median mean doses were 15.3, 19.3, 15.4, and 37.3 Gy (thyroid), 10.9, 12.0, 7.9, and 34.5 Gy (neck muscles), 2.3, 11.1, 1.8, and 37.1 Gy (larynx), 1.7, 5.1, 1.3, and 23.8 Gy (pharynx), 0.5, 0.8, 0.01, and 32.3 Gy (ipsilateral parotid), and 2.4, 3.8, 0.7, and 34.7 Gy (ipsilateral submandibular) with 3DCRT, VMAT, PT, and MF (all p < 0.0001), respectively. Conclusion: The use of INRT significantly lowered the estimated radiation dose to the head and neck OARs. VMAT appeared suboptimal compared to 3DCRT and PT, and for some patients, PT offered an additional gain

Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck

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Sher, David J.; Balboni, Tracy A.; Haddad, Robert I.; Norris, Charles M.; Posner, Marshall R.; Wirth, Lori J.; Goguen, Laura A.; Annino, Donald; Tishler, Roy B.

2011-01-01

Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. Patients and Materials: A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. Results: A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. Conclusion: In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.

A comparison of radiation treatment techniques for carcinomas of the larynx and hypopharynx using 3-D dose distributions and intensity modulation

International Nuclear Information System (INIS)

Morris, David; Miller, Elizabeth P.; Rosenman, Julian; Sailer, Scott; Tepper, Joel

1997-01-01

Purpose/Objective: Patients with carcinomas of the larynx and hypopharynx often cannot be treated effectively with a lateral/low anterior neck combination because the midline block will cover the tumor bed. Common alternatives to this approach often produce serious dose inhomogeneities. Our study was to determine whether modern 3D treatment planning techniques with intensity modulation could overcome these dose inhomogeneities and also allow us to omit the problematic posterior neck electron boost which often gives poor nodal coverage. Materials and Methods: Dose distribution studies were performed on patients who had received post-operative radiation following laryngectomy for advanced staged cancer. The clinical tumor volume or CTV (surgical bed and at-risk nodal stations) was defined on planning CT images. Four commonly used alternative plans, the MGH 'minimantle', 'kicked-out' laterals, the University of Florida 3-field, and a standard 3 field with a lateral cord block were evaluated using the Plan UNC (PLUNC) treatment planning software. New plans that might also preclude the use of posterior neck electrons were also evaluated. The plans were then intensity modulated to reduce the well known cold spots as described previously in IJROBP August 1991, Vol. 21, No. 3. All dose distributions were evaluated for dose homogeneity, minimum and maximum CTV dose, and dose to normal critical structures. The inhomogeneities were determined using standard dose-volume histogram (DVH) techniques but positional information was gathered by dividing the CTV into sensible anatomic regions and studying the DVH for each separately. Results: For the mini-mantle approach, intensity modulation substantially improved the dose inhomogeneities but did not affect the minimum CTV dose and had no effect on the cord dose. Intensity modulation decreased the maximum CTV dose (110% vs. 130%) but had the undesirable effect of lessening the dose difference between cord and CTV. For the kicked

Early-onset dropped head syndrome after radiotherapy for head and neck cancer: dose constraints for neck extensor muscles

International Nuclear Information System (INIS)

Inaba, Koji; Nakamura, Satoshi; Okamoto, Hiroyuki; Kashihara, Tairo; Kobayashi, Kazuma; Harada, Ken; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Murakami, Naoya; Ito, Yoshinori; Igaki, Hiroshi; Uno, Takashi; Itami, Jun

2016-01-01

Dropped head syndrome (DHS) is a famous but unusual late complication of multimodality treatment for head and neck carcinoma. We reported this early-onset complication and analyzed the dose to the neck extensor muscles. We examined the records of three patients with DHS after radiotherapy. The doses to the neck extensor muscles were compared between three patients with DHS and nine patients without DHS. The mean dose to the neck extensor muscles of the three patients with DHS were 58.5 Gy, 42.3 Gy and 60.9 Gy, while the dose was <50 Gy in all nine patients in the control group. The onset of this syndrome was 5 months, 6 months and 15 months. The early-onset DHS may have something to do with dose to the neck extensor muscles. The proposed dose to the neck extensor muscles might be <46 Gy (or at least <50 Gy)

A phase I study of dose-escalated chemoradiation with accelerated intensity modulated radiotherapy in locally advanced head and neck cancer

International Nuclear Information System (INIS)

Guerrero Urbano, Teresa; Clark, Catharine H.; Hansen, Vibeke N.; Adams, Elizabeth J.; A'Hern, Roger; Miles, Elizabeth A.; McNair, Helen; Bidmead, Margaret; Warrington, Alan P.; Dearnaley, David P.; Harrington, Kevin J.; Nutting, Christopher M.

2007-01-01

Background and purpose: Intensity modulated radiotherapy (IMRT) allows the delivery of higher and more homogeneous radiation dose to head and neck tumours. This study aims to determine the safety of dose-escalated chemo-IMRT for larynx preservation in locally advanced head and neck cancer. Methods: Patients with T2-4, N1-3, M0 squamous cell carcinoma of the larynx or hypopharynx were treated with a simultaneous-boost IMRT. Two radiation dose levels (DL) were tested: In DL 1, 63 Gy/28F was delivered to primary tumour and involved nodes and 51.8 Gy/28F to elective nodes. In DL 2, the doses were 67.2 Gy/28F and 56 Gy/28F, respectively, representing a 9% dose escalation for the primary. All patients received 2 cycles of neoadjuvant cisplatin and 5-fluorouracil, and concomitant cisplatin. Acute (NCICTCv.2.0) and late toxicity (RTOG and modified LENTSOM) were collected. Results: Thirty patients were entered, 15 in each dose level. All patients completed the treatment schedule. In DL 1, the incidences of acute G3 toxicities were 27% (pain), 20% (radiation dermatitis), 0% (xerostomia) and 67% required gastrostomy tubes. For DL 2 the corresponding incidences were 40%, 20%, 7%, and 87%. G3 dysphagia and pain persisted longer in DL 2. With regard to mucositis, a prolonged healing time for DL 2 was found, with prevalence of G2 of 58% in week 10. No acute grade 4 toxicity was observed. At 6 months, 1 patient in DL 2 had G3 late toxicity (dysphagia). No dose limiting toxicity was found. Complete response rates were 80% in DL 1, and 87% in DL 2. Conclusion: Moderately accelerated chemo-IMRT is safe and feasible with good compliance and acceptable acute toxicity. Dose escalation was possible without a significant difference in acute toxicity. Longer follow-up is required to determine the incidence of late radiation toxicities, and tumour control rates

The effect of a multi-axis suspension on whole body vibration exposures and physical stress in the neck and low back in agricultural tractor applications.

Science.gov (United States)

Kim, Jeong Ho; Dennerlein, Jack T; Johnson, Peter W

2018-04-01

Whole body vibration (WBV) exposures are often predominant in the fore-aft (x) or lateral (y) axis among off-road agricultural vehicles. However, as the current industry standard seats are designed to reduce mainly vertical (z) axis WBV exposures, they may be less effective in reducing drivers' exposure to multi-axial WBV. Therefore, this laboratory-based study aimed to determine the differences between a single-axial (vertical) and multi-axial (vertical + lateral) suspension seat in reducing WBV exposures, head acceleration, self-reported discomfort, and muscle activity (electromyography) of the major muscle of the low back, neck and shoulders. The results showed that the multi-axial suspension seat had significantly lower WBV exposures compared to the single-axial suspension seats (p' suspension seat had lower head acceleration and muscle activity of the neck, shoulder, and low back compared to the single-axial suspension seat; some but not all of the differences were statistically significant. These results indicate that the multi-axial suspension seat may reduce the lateral WBV exposures and associated muscular loading in the neck and low back in agricultural vehicle operators. Copyright © 2017 Elsevier Ltd. All rights reserved.

Brachial plexus dose tolerance in head and neck cancer patients treated with sequential intensity modulated radiation therapy

International Nuclear Information System (INIS)

Thomas, Tarita O; Refaat, Tamer; Choi, Mehee; Bacchus, Ian; Sachdev, Sean; Rademaker, Alfred W; Sathiaseelan, Vythialingam; Karagianis, Achilles; Mittal, Bharat B

2015-01-01

We aimed to study the radiation induced brachial plexopathy in patients with head and neck squamous cell carcinoma (HNSCC) treated with Sequential Intensity Modulated Radiation Therapy (S-IMRT). This IRB approved study included 68 patients with HNSCC treated consecutively. Detailed dose volume histogram data was generated for ipsilateral and contralateral brachial plexus (BP) volumes receiving a specified dose (Vds) i.e. V50-V75 and dose in Gray covering specified percent of BP volume (Dvs) i.e. D5-D30 and maximum point doses (Dmax). To assess BP injury all patients’ charts were reviewed in detail for sign and symptoms of BP damage. Post-hoc comparisons were done using Tukey-Kramer method to account for multiple significance testing. The mean and maximum doses to BP were significantly different (p < .05) based on tumor site, nodal status and tumor stage. The mean volume to the ipsilateral BP for V50, V60, V70, and V75 were 7.01 cc, 4.37 cc, 1.47 cc and 0.24 cc, respectively. The mean dose delivered to ≤5% of ipsilateral BP was 68.70 Gy (median 69.5Gy). None of the patients had acute or late brachial plexopathy or any other significant neurological complications, with a minimum follow up of two years (mean 54 months). In this study cohort, at a minimum of two-years follow up, the mean dose of 68.7Gy, a median dose to 69.5Gy to ≤5% of ipsilateral BP, and a median Dmax of 72.96Gy did not result in BP injury when patients were treated with S-IMRT technique. However, longer follow up is needed

Collapse of Z-pinch necks for inertial fusion

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Yan'kov, V.V.

1989-01-01

The ignition is possible under the condition of collapring z-pinch neck up to the diameter 10 -4 cm. The current pulse with duration 10 -7 s and 10 7 A must be applied to a cylinder of condensed D-T mixture in order to obtain the parameter ρr≥0.4 g/cm 2 . 22 refs

A Phase 1 Study of Everolimus + Weekly Cisplatin + Intensity Modulated Radiation Therapy in Head-and-Neck Cancer

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Fury, Matthew G. [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Medicine, Weill Cornell Medical College, New York, New York (United States); Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Sherman, Eric; Ho, Alan L. [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Medicine, Weill Cornell Medical College, New York, New York (United States); Rao, Shyam [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Heguy, Adriana [Department of Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Shen, Ronglai [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Korte, Susan; Lisa, Donna [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ganly, Ian; Patel, Snehal; Wong, Richard J.; Shaha, Ashok; Shah, Jatin [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Haque, Sofia [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Katabi, Nora [Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Pfister, David G. [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Medicine, Weill Cornell Medical College, New York, New York (United States)

2013-11-01

Purpose: Elevated expression of eukaryotic protein synthesis initiation factor 4E (eIF4E) in histologically cancer-free margins of resected head and neck squamous cell carcinomas (HNSCCs) is mediated by mammalian target of rapamycin complex 1 (mTORC1) and has been associated with increased risk of disease recurrence. Preclinically, inhibition of mTORC1 with everolimus sensitizes cancer cells to cisplatin and radiation. Methods and Materials: This was single-institution phase 1 study to establish the maximum tolerated dose of daily everolimus given with fixed dose cisplatin (30 mg/m{sup 2} weekly × 6) and concurrent intensity modulated radiation therapy for patients with locally and/or regionally advanced head-and-neck cancer. The study had a standard 3 + 3 dose-escalation design. Results: Tumor primary sites were oral cavity (4), salivary gland (4), oropharynx (2), nasopharynx (1), scalp (1), and neck node with occult primary (1). In 4 of 4 cases in which resected HNSCC surgical pathology specimens were available for immunohistochemistry, elevated expression of eIF4E was observed in the cancer-free margins. The most common grade ≥3 treatment-related adverse event was lymphopenia (92%), and dose-limiting toxicities (DLTs) were mucositis (n=2) and failure to thrive (n=1). With a median follow up of 19.4 months, 2 patients have experienced recurrent disease. The maximum tolerated dose was everolimus 5 mg/day. Conclusions: Head-and-neck cancer patients tolerated everolimus at therapeutic doses (5 mg/day) given with weekly cisplatin and intensity modulated radiation therapy. The regimen merits further evaluation, especially among patients who are status post resection of HNSCCs that harbor mTORC1-mediated activation of eIF4E in histologically negative surgical margins.

A Phase 1 Study of Everolimus + Weekly Cisplatin + Intensity Modulated Radiation Therapy in Head-and-Neck Cancer

International Nuclear Information System (INIS)

Fury, Matthew G.; Lee, Nancy Y.; Sherman, Eric; Ho, Alan L.; Rao, Shyam; Heguy, Adriana; Shen, Ronglai; Korte, Susan; Lisa, Donna; Ganly, Ian; Patel, Snehal; Wong, Richard J.; Shaha, Ashok; Shah, Jatin; Haque, Sofia; Katabi, Nora; Pfister, David G.

2013-01-01

Purpose: Elevated expression of eukaryotic protein synthesis initiation factor 4E (eIF4E) in histologically cancer-free margins of resected head and neck squamous cell carcinomas (HNSCCs) is mediated by mammalian target of rapamycin complex 1 (mTORC1) and has been associated with increased risk of disease recurrence. Preclinically, inhibition of mTORC1 with everolimus sensitizes cancer cells to cisplatin and radiation. Methods and Materials: This was single-institution phase 1 study to establish the maximum tolerated dose of daily everolimus given with fixed dose cisplatin (30 mg/m 2 weekly × 6) and concurrent intensity modulated radiation therapy for patients with locally and/or regionally advanced head-and-neck cancer. The study had a standard 3 + 3 dose-escalation design. Results: Tumor primary sites were oral cavity (4), salivary gland (4), oropharynx (2), nasopharynx (1), scalp (1), and neck node with occult primary (1). In 4 of 4 cases in which resected HNSCC surgical pathology specimens were available for immunohistochemistry, elevated expression of eIF4E was observed in the cancer-free margins. The most common grade ≥3 treatment-related adverse event was lymphopenia (92%), and dose-limiting toxicities (DLTs) were mucositis (n=2) and failure to thrive (n=1). With a median follow up of 19.4 months, 2 patients have experienced recurrent disease. The maximum tolerated dose was everolimus 5 mg/day. Conclusions: Head-and-neck cancer patients tolerated everolimus at therapeutic doses (5 mg/day) given with weekly cisplatin and intensity modulated radiation therapy. The regimen merits further evaluation, especially among patients who are status post resection of HNSCCs that harbor mTORC1-mediated activation of eIF4E in histologically negative surgical margins

Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

International Nuclear Information System (INIS)

Chen, Allen M.; Hall, William H.; Li, Judy; Beckett, Laurel; Farwell, D. Gregory; Lau, Derick H.; Purdy, James A.

2012-01-01

Purpose: To identify clinical and treatment-related predictors of brachial plexus–associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6–135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus–associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose–response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

Effect of interfractional shoulder motion on low neck nodal targets for patients treated using volume modulated arc therapy (VMAT

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Kevin Casey

2014-03-01

Full Text Available Purpose: To quantify the dosimetric impact of interfractional shoulder motion on targets in the low neck for head and neck patients treated with volume modulated arc therapy (VMAT.Methods: Three patients with head and neck cancer were selected. All three required treatment to nodal regions in the low neck in addition to the primary tumor site. The patients were immobilized during simulation and treatment with a custom thermoplastic mask covering the head and shoulders. One VMAT plan was created for each patient utilizing two full 360° arcs and a second plan was created consisting of two superior VMAT arcs matched to an inferior static AP supraclavicular field. A CT-on-rails alignment verification was performed weekly during each patient’s treatment course. The weekly CT images were registered to the simulation CT and the target contours were deformed and applied to the weekly CT. The two VMAT plans were copied to the weekly CT datasets and recalculated to obtain the dose to the deformed low neck contours.Results: The average observed shoulder position shift in any single dimension relative to simulation was 2.5 mm. The maximum shoulder shift observed in a single dimension was 25.7 mm. Low neck target mean doses, normalized to simulation and averaged across all weekly recalculations were 0.996, 0.991, and 1.033 (Full VMAT plan and 0.986, 0.995, and 0.990 (Half-Beam VMAT plan for the three patients, respectively. The maximum observed deviation in target mean dose for any individual weekly recalculation was 6.5%, occurring with the Full VMAT plan for Patient 3.Conclusion: Interfractional variation in dose to low neck nodal regions was quantified for three head and neck patients treated with VMAT. Mean dose was 3.3% higher than planned for one patient using a Full VMAT plan. A Half-Beam technique is likely a safer choice when treating the supraclavicular region with VMAT.-------------------------------------------Cite this article as: Casey K

Local Control After Intensity-Modulated Radiotherapy for Head-and-Neck Rhabdomyosarcoma

International Nuclear Information System (INIS)

Curtis, Amarinthia E.; Okcu, M. Fatih; Chintagumpala, Murali; Teh, Bin S.; Paulino, Arnold C.

2009-01-01

Purpose: To examine the patterns of failure in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck rhabdomyosarcoma (RMS). Methods and Materials: Between 1998 and 2005, 19 patients with a diagnosis of head-and-neck RMS received IMRT at The Methodist Hospital. There were 11 male and 8 female patients, with a median age of 6 years at time of irradiation. Tumor location was parameningeal in 7, orbital in 6, and other head-and-neck RMS in 6. Chemotherapy was given to all patients, with vincristine, actinomycin D, and cyclophosphamide being the most common regimen (n = 18). The median prescribed dose was 5040 cGy. The clinical target volume included the gross tumor volume with a 1.5-cm margin. The median duration of follow-up for surviving patients was 56 months. Results: The 4-year overall survival and local control rates were 76% and 92.9%, respectively. One patient developed a local failure in the high-dose region of the radiation field; there were no marginal failures. Distant metastasis was seen in 4 patients. Overall survival was 42.9% for parameningeal sites and 100% for other sites (p < 0.01). Late toxicities were seen in 7 patients. Two secondary malignancies occurred in 1 child with embryonal RMS of the face and a p53 mutation. Conclusions: Local control was excellent in patients receiving IMRT for head-and-neck RMS. Patterns of local failure reveal no marginal failures in this group of patients

A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation

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Pursley, Jennifer, E-mail: jpursley@mgh.harvard.edu [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Damato, Antonio L.; Czerminska, Maria A.; Margalit, Danielle N. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, MA (United States); Sher, David J. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, MA (United States); Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX (United States); Tishler, Roy B. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, MA (United States)

2017-04-01

The purpose of this study was to investigate class solutions using RapidArc volumetric-modulated arc therapy (VMAT) planning for ipsilateral and bilateral head and neck (H&N) irradiation, and to compare dosimetric results with intensity-modulated radiotherapy (IMRT) plans. A total of 14 patients who received ipsilateral and 10 patients who received bilateral head and neck irradiation were retrospectively replanned with several volumetric-modulated arc therapy techniques. For ipsilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360° arcs, two 360° arcs with avoidance sectors around the contralateral parotid, two 260° or 270° arcs, and two 210° arcs. For bilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360° arcs, two 360° arcs with avoidance sectors around the shoulders, and 3 arcs. All patients had a sliding-window-delivery intensity-modulated radiotherapy plan that was used as the benchmark for dosimetric comparison. For ipsilateral neck irradiation, a volumetric-modulated arc therapy technique using two 360° arcs with avoidance sectors around the contralateral parotid was dosimetrically comparable to intensity-modulated radiotherapy, with improved conformity (conformity index = 1.22 vs 1.36, p < 0.04) and lower contralateral parotid mean dose (5.6 vs 6.8 Gy, p < 0.03). For bilateral neck irradiation, 3-arc volumetric-modulated arc therapy techniques were dosimetrically comparable to intensity-modulated radiotherapy while also avoiding irradiation through the shoulders. All volumetric-modulated arc therapy techniques required fewer monitor units than sliding-window intensity-modulated radiotherapy to deliver treatment, with an average reduction of 35% for ipsilateral plans and 67% for bilateral plans. Thus, for ipsilateral head and neck irradiation a volumetric-modulated arc therapy technique using two 360° arcs with avoidance sectors around the contralateral parotid is

Changes in lateral dimensions of irradiated volume and their impact on the accuracy of dose delivery during radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Senkus-Konefka, Elzbieta; Naczk, Edmund; Borowska, Ilona; Badzio, Andrzej; Jassem, Jacek

2006-01-01

Background and purpose: To assess changes in lateral dimensions of irradiated volume during head and neck cancer radiotherapy and to determine their impact on the accuracy of dose delivery. Patients and methods: Lateral dimensions of irradiated volumes were measured in five predefined points prior to treatment and then bi-weekly. For each measurement, midline dose was calculated and verified using in vivo dosimetry. Early radiation reactions, patient weight changes and the need to modify radiotherapy accessories were also recorded. The study included 33 head and neck cancer patients irradiated using parallel opposed megavoltage fields. Results: Body mass changes during radiotherapy ranged from -18 to +4 kg (median -5). Lateral dimension changes >5 mm (range -37 to +16) occurred in 32 patients (97%). For axis measurements, the degree of lateral dimension changes were correlated with treatment field size (P=0.022) and degree of mucositis (P=0.017). Axis doses calculated for changed dimensions varied from those prescribed by -2.5 to +6% (median +2%). Differences larger than 5% were present in 4.8% of calculations. In 17 patients (52%), radiotherapy accessories had to be modified during treatment. The need to modify radiotherapy accessories correlated with larger treatment portals (P=0.004), more weight loss during treatment (P=0.01) and higher initial N stage (P=0.04). Conclusions: Changes of irradiated volume lateral dimensions during head and neck cancer radiotherapy may lead to considerable dose delivery inaccuracies. Watchful monitoring, corrections to calculated dose when changes observed are significant and radiotherapy accessories modification during the course of treatment are strongly recommended

Estimation of eye absorbed doses in head & neck radiotherapy practices using thermoluminescent detectors

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Gh Bagheri

2011-09-01

Full Text Available  Determination of eye absorbed dose during head & neck radiotherapy is essential to estimate the risk of cataract. Dose measurements were made in 20 head & neck cancer patients undergoing 60Co radiotherapy using LiF(MCP thermoluminescent dosimeters. Head & neck cancer radiotherapy was delivered by fields using SAD & SSD techniques. For each patient, 3 TLD chips were placed on each eye. Head & neck dose was about 700-6000 cGy in 8-28 equal fractions. The range of eye dose is estimated to be (3.49-639.1 mGy with a mean of maximum dose (98.114 mGy, which is about 3 % of head & neck dose. Maximum eye dose was observed for distsnces of about 3 cm from edge of the field to eye.

Prospective Trial of High-Dose Reirradiation Using Daily Image Guidance With Intensity-Modulated Radiotherapy for Recurrent and Second Primary Head-and-Neck Cancer

International Nuclear Information System (INIS)

Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Cheng, Suzan; Donald, Paul J.; Purdy, James A.

2011-01-01

Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.

Intensity-modulated radiation therapy for head and neck cancers with bilateral irradiation of the neck: preliminary results

International Nuclear Information System (INIS)

Lapeyre, M.; Mege, A.; Mege, P.; Racadot, S.; Marchal, C.; Marchesi, V.; Aletti, P.; Noel, A.; Marchesi, V.; Aletti, P.; Noel, A.; Marchal, C.

2004-01-01

Purpose. - To report preliminary results of a prospective study of intensity-modulated radiotherapy (IMRT) for head and neck squamous cell carcinoma (HNC) with bilateral irradiation of the neck. Patients and methods. - At the Alexis Vautrin Cancer Center, 23 patients have been treated with IMRT for HNC since January 2002-August 2003. The first 10 patients with a minimum follow-up of 3 months were analyzed. All tumors were oropharyngeal. There were four females and six males, with a mean age of 50 years (range 39-66). Stages were I-II in eight and III-IV in two. CTV1 was microscopic disease and N0 neck (prescribed dose: 50 Gy) and CTV2 was macroscopic disease and the volume at risk (prescribed dose: 66-70 Gy). PTV were CTV + 5 mm. Patient's immobilization consisted of a five-point head neck shoulder thermoplastic mask. Set-up verifications were done by semi-automatically matching portal images and digitized reconstructed radiographs. IMRT used dynamic multi-leaf collimation. Five patients (group A) received 50 Gy IMRT (two post-operative and three with a brachytherapy boost with a mean dose: 27.5 Gy), and five patients (group B) received 66-70 Gy IMRT (four post-operative). Acute and late normal tissue effects were graded according to the RTOG-EORTC radiation morbidity scoring criteria. Results. - With a median follow-up of 7.4 months (range 3-18.5), no patient died or had loco-regional relapse. The displacements were <4 mm in 98% cases. CTV1 and 2 received 95% of the prescribed dose in 100% of the volume. On average the mean dose to the contralateral parotid was 25.5 Gy for group A vs. 31 Gy for group B (P = 0.09). Mean doses <26 Gy were obtained in three of five patients in group A vs. zero of five patients in group B (P = 0.04). Acute skin toxicities were grade 1 in five patients, grade 2 in four and grade 3 in one. Acute mucositis cases were grade 1 in three patients, grade 2 in five and localized grade 3 in two. At 3 months, 50% of the patients had a grade 0

COMPARISON OF THE PERIPHERAL DOSES FROM DIFFERENT IMRT TECHNIQUES FOR PEDIATRIC HEAD AND NECK RADIATION THERAPY.

Science.gov (United States)

Toyota, Masahiko; Saigo, Yasumasa; Higuchi, Kenta; Fujimura, Takuya; Koriyama, Chihaya; Yoshiura, Takashi; Akiba, Suminori

2017-11-01

Intensity-modulated radiation therapy (IMRT) can deliver high and homogeneous doses to the target area while limiting doses to organs at risk. We used a pediatric phantom to simulate the treatment of a head and neck tumor in a child. The peripheral doses were examined for three different IMRT techniques [dynamic multileaf collimator (DMLC), segmental multileaf collimator (SMLC) and volumetric modulated arc therapy (VMAT)]. Peripheral doses were evaluated taking thyroid, breast, ovary and testis as the points of interest. Doses were determined using a radio-photoluminescence glass dosemeter, and the COMPASS system was used for three-dimensional dose evaluation. VMAT achieved the lowest peripheral doses because it had the highest monitor unit efficiency. However, doses in the vicinity of the irradiated field, i.e. the thyroid, could be relatively high, depending on the VMAT collimator angle. DMLC and SMLC had a large area of relatively high peripheral doses in the breast region. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Measurement of International Roughness Index by Using Z-Axis Accelerometers and GPS

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Yuchuan Du

2014-01-01

Full Text Available The International Roughness Index (IRI is a well-recognized standard in the field of pavement management. Many different types of devices can be used to measure the IRI, but these devices are mainly mounted on a full-size automobile and are complicated to operate. In addition, these devices are expensive. The development of methods for IRI measurement is a prerequisite for pavement management systems and other parts of the road management industry. Based on the quarter-car model and the vehicle vibration caused by road roughness, there is a strong correlation between the in-car Z-axis acceleration and the IRI. The variation of speed of the car during the measurement process has a large influence on IRI estimation. A measurement system equipped with Z-axis accelerometers and a GPS device was developed. Using the self-designing measurement system based on the methodology proposed in this study, we performed a small-scale field test. We used a one-wheel linear model and two-wheel model to fit the variation of the Z-axis acceleration. The test results demonstrated that the low-cost measurement system has good accuracy and could enhance the efficiency of IRI measurement.

Measurement of off-axis and peripheral skin dose using radiochromic film

International Nuclear Information System (INIS)

Butson, Martin J.; Yu, P.K.N.; Metcalfe, P.E.

1998-01-01

A radiotherapy skin dose profile can be obtained with radiochromic film. The central axis skin dose relative to D max for a 10x10cm 2 field size was found to be 22%, 17% and 15.5% for 6 MV, 10 MV and 18 MV photon beams. Peripheral dose increased with increasing field size. At 10 MV the skin dose 2 cm outside the geometric field edge was measured as 6%, 10% and 17% for 10x10cm 2 , 20x20cm 2 and 30x30cm 2 field sizes respectively. Off-axis skin dose decreased as distance increased from central axis for fields with Perspex block trays. For a 20x20cm 2 field, an approximately 5-8% drop in percentage skin dose was observed from central axis to the beam edge. (author)

Dose-volume modeling of salivary function in patients with head-and-neck cancer receiving radiotherapy

International Nuclear Information System (INIS)

Blanco, Angel I.; Chao, K.S. Clifford; El Naqa, Issam; Franklin, Gregg E.; Zakarian, Konstantin; Vicic, Milos; Deasy, Joseph O.

2005-01-01

Purpose: We investigated the factors that affect salivary function after head-and-neck radiotherapy (RT), including parotid gland dose-volume effects, potential compensation by less-irradiated gland tissue, and functional recovery over time. Methods and Materials: Sixty-five patients with head-and-neck tumors were enrolled in a prospective salivary function study. RT was delivered using intensity-modulated RT (n = 45), forward-planning three-dimensional conformal RT (n = 14), or three-dimensional conformal RT with an intensity-modulated RT boost (n = 6). Whole salivary flow was measured before therapy and at 6 months (n = 61) and 12 months (n = 31) after RT. A wide variety of dose-volume models to predict post-RT salivary function were tested. Xerostomia was defined according to the subjective, objective, management, analytic (SOMA) criteria as occurring when posttreatment salivary function was s ] = 0.46, p s = 0.73), stimulated saliva flow at 12 months (R s = 0.54), and quality-of-life score at 6 months (R s = 0.35) after RT. Conclusion: Stimulated parotid salivary gland dose-volume models strongly correlated with both stimulated salivary function and quality-of-life scores at 6 months after RT. The mean stimulated saliva flow rates improved from 6 to 12 months after RT. Salivary function, in each gland, appeared to be lost exponentially at a rate of approximately 5%/1 Gy of mean dose. Additional research is necessary to distinguish among the models for use in treatment planning. The incidence of xerostomia was significantly decreased when the mean dose of at least one parotid gland was kept to <25.8 Gy with conventional fractionation. However, even lower mean doses imply increased late salivary function

MRI gel dosimetry for verification of mono-isocentric junction doses in head and neck radiotherapy

International Nuclear Information System (INIS)

Back, S.A.J.; Jayasekera, P.M.; Lepage, M.; Baldock, C.; Menzies, N.; Back, P.

2000-01-01

Full text: The use of independent collimators in the abutment of two adjacent treatment volumes, as in head and neck radiation treatments, consists typically of positioning the collimator rotation axis (CRA) at the junction of the volumes, and offsetting each field by its half-field width. This has the effect of positioning one of the collimator jaws at the CRA for each field. However, misalignment of the jaws can lead to variations in dose uniformity in the junction region. We have used gel dosimetry to measure junction doses in three dimensions. PAG gel MRI was used to investigate junction dosimetry for a mono-isocentriic treatment of two orthogonal pairs of opposed (ant/post and lateral) 6 MV x-ray beams. PAG gels in an 11cm diameter cylindrical gel phantom were imaged using a Siemens Vision 1.5 T MRI. The exposures were made using a Philips SL 20 linear accelerator with independent jaws that were known to overlap at the isocentre for sequential abutting offset (within manufacturer's specifications for symmetric fields). X-Omat V films were exposed in mono-directional beams, and optically scanned for comparison. Measurements of off-axis ratios and of relative depth profiles using gel MRI and perpendicular film were in excellent agreement with each other. Measurements through the multi-directional junction at the isocentre are illustrated in the graph, for orthogonal planes centred at the isocentre of the neck phantom. They demonstrate a minimum dose of 75 % of that of the adjacent 'treatment' regions, which agrees closely with the results measured (72%) in the mono-directional case with film. We conclude that this measurement confirms that junction dosimetry at the isocentre measured with perpendicular film for a single direction is a good approximation to the situation in multiple directions. Copyright (2000) Australasian College of Physical Scientists and Engineers in Medicine

The dosimetric impact of dental implants on head-and-neck volumetric modulated arc therapy

International Nuclear Information System (INIS)

Lin, Mu-Han; Li Jinsheng; Price, Robert A Jr; Wang Lu; Ma, C-M; Lee, Chung-Chi

2013-01-01

This work aims to investigate the dosimetric impact of dental implants on volumetric modulated arc therapy (VMAT) for head-and-neck patients and to evaluate the effectiveness of using the material's electron-density ratio for the correction. An in-house Monte Carlo (MC) code was utilized for the dose calculation to account for the scattering and attenuation caused by the high-Z implant material. Three different dental implant materials were studied in this work: titanium, Degubond®4 and gold. The dose perturbations caused by the dental implant materials were first investigated in a water phantom with a 1 cm 3 insert. The per cent depth dose distributions of a 3 × 3 cm 2 photon field were compared with the insert material as water and the three selected dental implant materials. To evaluate the impact of the dental implant on VMAT patient dose calculation, four head-and-neck cases were selected. For each case, the VMAT plan was designed based on the artifact-corrected patient geometry using a treatment planning system (TPS) that was typically utilized for routine patient treatment. The plans were re-calculated using the MC code for five situations: uncorrected geometry, artifact-corrected geometry and artifact-corrected geometry with one of the three different implant materials. The isodose distributions and the dose–volume histograms were cross-compared with each other. To evaluate the effectiveness of using the material's electron-density ratio for dental implant correction, the implant region was set as water with the material's electron-density ratio and the calculated dose was compared with the MC simulation with the real material. The main effect of the dental implant was the severe attenuation in the downstream. The 1 cm 3 dental implant can lower the downstream dose by 10% (Ti) to 51% (Au) for a 3 × 3 cm 2 field. The TPS failed to account for the dose perturbation if the dental implant material was not precisely defined. For the VMAT patient dose

Influence of jaw tracking in intensity-modulated and volumetric-modulated arc radiotherapy for head and neck cancers: a dosimetric study

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Mani, Karthick Raj [Research and Development Centre, Bharathiar University, Tamilnadu (India); Upadhayay, Sagar [Radiation Oncology, Kathmandu Cancer Center, Bhaktapur (Nepal); Das, K. J. Maria [Dept. of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh (India)

2017-03-15

To Study the dosimetric advantage of the Jaw tracking technique in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for Head and Neck Cancers. We retrospectively selected 10 previously treated head and neck cancer patients stage (T1/T2, N1, M0) in this study. All the patients were planned for IMRT and VMAT with simultaneous integrated boost technique. IMRT and VMAT plans were performed with jaw tracking (JT) and with static jaw (SJ) technique by keeping the same constraints and priorities for a particular patient. Target conformity, dose to the critical structures and low dose volumes were recorded and analyzed for IMRT and VMAT plans with and without JT for all the patients. The conformity index average of all patients followed by standard deviation (x¯x¯ ± σx¯σx¯) of the JT-IMRT, SJ-IMRT, JT-VMAT, and SJ-VMAT were 1.72 ± 0.56, 1.67 ± 0.57, 1.83 ± 0.65, and 1.85 ± 0.64, and homogeneity index were 0.059 ± 0.05, 0.064 ± 0.05, 0.064 ± 0.04, and 0.064 ± 0.05. JT-IMRT shows significant mean reduction in right parotid and left parotid shows of 7.64% (p < 0.001) and 7.45% (p < 0.001) compare to SJ-IMRT. JT-IMRT plans also shows considerable dose reduction to thyroid, inferior constrictors, spinal cord and brainstem compared to the SJ-IMRT plans. Significant dose reductions were observed for critical structure in the JT-IMRT compared to SJ-IMRT technique. In JT-VMAT plans dose reduction to the critical structure were not significant compared to the SJ-IMRT due to relatively lesser monitor units.

Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients?

Science.gov (United States)

Didona, Annamaria; Lancellotta, Valentina; Zucchetti, Claudio; Panizza, Bianca Moira; Frattegiani, Alessandro; Iacco, Martina; Di Pilato, Anna Concetta; Saldi, Simonetta; Aristei, Cynthia

2018-01-01

Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle 3 TPS (v 9.8) using 6 MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66 Gy, 60 Gy and 54 Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs ( D mean , D 2% , D 50% , D 95% , D 98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times. Compared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D 98% and D 95% . It significantly spared parotid and submandibular glands and was associated with a lower D mean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better D mean , to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the D mean to the larynx was also worse

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.

Development of a Method to Assess the Precision Of the z-axis X-ray Beam Collimation in a CT Scanner

Science.gov (United States)

Kim, Yon-Min

2018-05-01

Generally X-ray equipment specifies the beam collimator for the accuracy measurement as a quality control item, but the computed tomography (CT) scanner with high dose has no collimator accuracy measurement item. If the radiation dose is to be reduced, an important step is to check if the beam precisely collimates at the body part for CT scan. However, few ways are available to assess how precisely the X-ray beam is collimated. In this regard, this paper provides a way to assess the precision of z-axis X-ray beam collimation in a CT scanner. After the image plate cassette had been exposed to the X-ray beam, the exposed width was automatically detected by using a computer program developed by the research team to calculate the difference between the exposed width and the imaged width (at isocenter). The result for the precision of z-axis X-ray beam collimation showed that the exposed width was 3.8 mm and the overexposure was high at 304% when a narrow beam of a 1.25 mm imaged width was used. In this study, the precision of the beam collimation of the CT scanner, which is frequently used for medical services, was measured in a convenient way by using the image plate (IP) cassette.

SU-F-T-473: Evaluation of Off-Axis And Peripheral Dose Using Different Detectors

Energy Technology Data Exchange (ETDEWEB)

Ganesan, B; Prakasarao, A; Singaravelu, G [Anna University, Chennai, TamilNadu (India); Palraj, T; Rai, R [Dr. Rai Memorial Cancer Institute, Chennai, TamilNadu (India)

2016-06-15

Purpose: In radiation therapy, measurement of off-axis and peripheral dose is a tedious task. The dose distribution along the beam central axis give only part of the information required for an accurate dose description inside the patient. Dose distributions in 2-D and 3-D are determined with central axis data in conjunction with off-axis dose profiles. Combining a central axis dose distribution with off-axis data results in volume dose matrix that provides 2-D and 3-D information on dose distribution. By considering the importance of these two parameters this study investigates and compares the off axis and peripheral dose measurement using Ionization chamber, MOSFET, Radiochromic film and EDR2 film. Methods: In the measurement of off-axis and peripheral doses 0.6cc farmer type chamber, EDR-2 film, MD-55 radiochromic film and MOSFET detectors were used for both 6MV and 15MV beams. The off-axis and peripheral dose was measured at every 1 cm interval by changing the position of the couch without disturbing the other experimental setup in particular, the phantom with detector position. Results: Readings were obtained for both 6MV and 15MV photon beams at SSD technique for various field size using MOSFET, Ionization chamber and Radiochromic film. The results shows the percentage difference between various detectors for various field sizes. For Peripheral dose measurement were taken from the edge of the field size and for off axis it is measured form central axis dose. Conclusion: In conclusion, our study shows that no detector is ideal and only a comparison between different detectors highlights the weaknesses of each detector. MOSFET provides adequate dose assessment in off-axis and peripheral regions in 6MV and 15MV photon beams. Film dosimetry in general a convenient method to generate one- and two-dimensional dose distributions. The result of this indicates that MOSFET is flexible tool for relative dosimetry as films.

Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions

International Nuclear Information System (INIS)

Ben-David, Merav A.; Diamante, Maximiliano; Radawski, Jeffrey D.; Vineberg, Karen A.; Stroup, Cynthia; Murdoch-Kinch, Carol-Anne; Zwetchkenbaum, Samuel R.; Eisbruch, Avraham

2007-01-01

Purpose: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. Results: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received ≥65 Gy and ≥70 Gy to ≥1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). Conclusion: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk

Improvements in dose calculation accuracy for small off-axis targets in high dose per fraction tomotherapy

Energy Technology Data Exchange (ETDEWEB)

Hardcastle, Nicholas; Bayliss, Adam; Wong, Jeannie Hsiu Ding; Rosenfeld, Anatoly B.; Tome, Wolfgang A. [Department of Human Oncology, University of Wisconsin-Madison, WI, 53792 (United States); Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC 3002 (Australia) and Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Department of Human Oncology, University of Wisconsin-Madison, WI 53792 (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia) and Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur (Malaysia); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Einstein Institute of Oncophysics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York 10461 (United States) and Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia)

2012-08-15

Purpose: A recent field safety notice from TomoTherapy detailed the underdosing of small, off-axis targets when receiving high doses per fraction. This is due to angular undersampling in the dose calculation gantry angles. This study evaluates a correction method to reduce the underdosing, to be implemented in the current version (v4.1) of the TomoTherapy treatment planning software. Methods: The correction method, termed 'Super Sampling' involved the tripling of the number of gantry angles from which the dose is calculated during optimization and dose calculation. Radiochromic film was used to measure the dose to small targets at various off-axis distances receiving a minimum of 21 Gy in one fraction. Measurements were also performed for single small targets at the center of the Lucy phantom, using radiochromic film and the dose magnifying glass (DMG). Results: Without super sampling, the peak dose deficit increased from 0% to 18% for a 10 mm target and 0% to 30% for a 5 mm target as off-axis target distances increased from 0 to 16.5 cm. When super sampling was turned on, the dose deficit trend was removed and all peak doses were within 5% of the planned dose. For measurements in the Lucy phantom at 9.7 cm off-axis, the positional and dose magnitude accuracy using super sampling was verified using radiochromic film and the DMG. Conclusions: A correction method implemented in the TomoTherapy treatment planning system which triples the angular sampling of the gantry angles used during optimization and dose calculation removes the underdosing for targets as small as 5 mm diameter, up to 16.5 cm off-axis receiving up to 21 Gy.

Improvements in dose calculation accuracy for small off-axis targets in high dose per fraction tomotherapy

International Nuclear Information System (INIS)

Hardcastle, Nicholas; Bayliss, Adam; Wong, Jeannie Hsiu Ding; Rosenfeld, Anatoly B.; Tomé, Wolfgang A.

2012-01-01

Purpose: A recent field safety notice from TomoTherapy detailed the underdosing of small, off-axis targets when receiving high doses per fraction. This is due to angular undersampling in the dose calculation gantry angles. This study evaluates a correction method to reduce the underdosing, to be implemented in the current version (v4.1) of the TomoTherapy treatment planning software. Methods: The correction method, termed “Super Sampling” involved the tripling of the number of gantry angles from which the dose is calculated during optimization and dose calculation. Radiochromic film was used to measure the dose to small targets at various off-axis distances receiving a minimum of 21 Gy in one fraction. Measurements were also performed for single small targets at the center of the Lucy phantom, using radiochromic film and the dose magnifying glass (DMG). Results: Without super sampling, the peak dose deficit increased from 0% to 18% for a 10 mm target and 0% to 30% for a 5 mm target as off-axis target distances increased from 0 to 16.5 cm. When super sampling was turned on, the dose deficit trend was removed and all peak doses were within 5% of the planned dose. For measurements in the Lucy phantom at 9.7 cm off-axis, the positional and dose magnitude accuracy using super sampling was verified using radiochromic film and the DMG. Conclusions: A correction method implemented in the TomoTherapy treatment planning system which triples the angular sampling of the gantry angles used during optimization and dose calculation removes the underdosing for targets as small as 5 mm diameter, up to 16.5 cm off-axis receiving up to 21 Gy.

Static/dynamic Analysis and Optimization of Z-axis Stand of PCB CNC Drilling Machine*

Directory of Open Access Journals (Sweden)

Zhou Yanjun

2016-01-01

Full Text Available The finite element analysis is used for the static and dynamic analysis of the Z axis brace of PCB CNC drilling machine. With its results of maximum displacement deformation and von Mises stress and modal frequency, the defect of original design was found out. On such bases, a variety of optimization scheme is put forward and the best size of the Z axis brace is obtained by the performance comparison of the schemes. This method offers bases for the design and renovation of other machine tool components.

Modeling of tube current modulation methods in computed tomography dose calculations for adult and pregnant patients

International Nuclear Information System (INIS)

Caracappa, Peter F.; Xu, X. George; Gu, Jianwei

2011-01-01

The comparatively high dose and increasing frequency of computed tomography (CT) examinations have spurred the development of techniques for reducing radiation dose to imaging patients. Among these is the application of tube current modulation (TCM), which can be applied either longitudinally along the body or rotationally along the body, or both. Existing computational models for calculating dose from CT examinations do not include TCM techniques. Dose calculations using Monte Carlo methods have been previously prepared for constant-current rotational exposures at various positions along the body and for the principle exposure projections for several sets of computational phantoms, including adult male and female and pregnant patients. Dose calculations from CT scans with TCM are prepared by appropriately weighting the existing dose data. Longitudinal TCM doses can be obtained by weighting the dose at the z-axis scan position by the relative tube current at that position. Rotational TCM doses are weighted using the relative organ doses from the principle projections as a function of the current at the rotational angle. Significant dose reductions of 15% to 25% to fetal tissues are found from simulations of longitudinal TCM schemes to pregnant patients of different gestational ages. Weighting factors for each organ in rotational TCM schemes applied to adult male and female patients have also been found. As the application of TCM techniques becomes more prevalent, the need for including TCM in CT dose estimates will necessarily increase. (author)

High-accuracy self-calibration method for dual-axis rotation-modulating RLG-INS

Science.gov (United States)

Wei, Guo; Gao, Chunfeng; Wang, Qi; Wang, Qun; Long, Xingwu

2017-05-01

Inertial navigation system has been the core component of both military and civil navigation systems. Dual-axis rotation modulation can completely eliminate the inertial elements constant errors of the three axes to improve the system accuracy. But the error caused by the misalignment angles and the scale factor error cannot be eliminated through dual-axis rotation modulation. And discrete calibration method cannot fulfill requirements of high-accurate calibration of the mechanically dithered ring laser gyroscope navigation system with shock absorbers. This paper has analyzed the effect of calibration error during one modulated period and presented a new systematic self-calibration method for dual-axis rotation-modulating RLG-INS. Procedure for self-calibration of dual-axis rotation-modulating RLG-INS has been designed. The results of self-calibration simulation experiment proved that: this scheme can estimate all the errors in the calibration error model, the calibration precision of the inertial sensors scale factor error is less than 1ppm and the misalignment is less than 5″. These results have validated the systematic self-calibration method and proved its importance for accuracy improvement of dual -axis rotation inertial navigation system with mechanically dithered ring laser gyroscope.

Volumetric tumor burden and its effect on brachial plexus dosimetry in head and neck intensity-modulated radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Romesser, Paul B.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Truong, Minh Tam, E-mail: mitruong@bu.edu

2014-07-01

To determine the effect of gross tumor volume of the primary (GTV-P) and nodal (GTV-N) disease on planned radiation dose to the brachial plexus (BP) in head and neck intensity-modulated radiotherapy (IMRT). Overall, 75 patients underwent definitive IMRT to a median total dose of 69.96 Gy in 33 fractions. The right BP and left BP were prospectively contoured as separate organs at risk. The GTV was related to BP dose using the unpaired t-test. Receiver operating characteristics curves were constructed to determine optimized volumetric thresholds of GTV-P and GTV-N corresponding to a maximum BP dose cutoff of > 66 Gy. Multivariate analyses were performed to account for factors associated with a higher maximal BP dose. A higher maximum BP dose (> 66 vs ≤ 66 Gy) correlated with a greater mean GTV-P (79.5 vs 30.8 cc; p = 0.001) and ipsilateral GTV-N (60.6 vs 19.8 cc; p = 0.014). When dichotomized by the optimized nodal volume, patients with an ipsilateral GTV-N ≥ 4.9 vs < 4.9 cc had a significant difference in maximum BP dose (64.2 vs 59.4 Gy; p = 0.001). Multivariate analysis confirmed that an ipsilateral GTV-N ≥ 4.9 cc was an independent predictor for the BP to receive a maximal dose of > 66 Gy when adjusted individually for BP volume, GTV-P, the use of a low anterior neck field technique, total planned radiation dose, and tumor category. Although both the primary and the nodal tumor volumes affected the BP maximal dose, the ipsilateral nodal tumor volume (GTV-N ≥ 4.9 cc) was an independent predictor for high maximal BP dose constraints in head and neck IMRT.

Scintigraphic assessment of salivary function after intensity-modulated radiotherapy for head and neck cancer: correlations with parotid dose and quality of life.

Science.gov (United States)

Chen, Wen-Cheng; Lai, Chia-Hsuan; Lee, Tsair-Fwu; Hung, Chao-Hsiung; Liu, Kuo-Chi; Tsai, Ming-Fong; Wang, Wen-Hung; Chen, Hungcheng; Fang, Fu-Ming; Chen, Miao-Fen

2013-01-01

We investigated salivary function using quantitative scintigraphy and sought to identify functional correlations between parotid dose and quality of life (QoL) for head and neck cancer (HNC) patients receiving intensity-modulated radiotherapy (IMRT). Between August, 2007 and June, 2008, 31 patients treated IMRT for HNC were enrolled in this prospective study. Salivary excretion function (SEF) was previously measured by salivary scintigraphy at annual intervals for 2 years after IMRT. A dose-volume histogram of each parotid gland was calculated, and the normal tissue complication probability (NTCP) was used to determine the tolerance dose. QoL was longitudinally assessed by the EORTC QLQ-C30 and H&N35 questionnaires prior to RT, and at one, three, 12 and 24 months after RT. A significant correlation was found between the reduction of SEF and the mean parotid dose measured at 1 year (correlation coefficient, R(2)=0.651) and 2 years (R(2)=0.310) after IMRT (pwestern countries. We further found that contralateral parotid and submandibular gland function preservation was correlated with reduced sticky saliva and a better QoL compared to the functional preservation of both parotid glands, as determined by the EORTC QLQ-H&N35 questionnaire. A significant correlation was found between the reduction of SEF and the mean parotid dose. Preservation of contralateral parotid and submandibular gland function predicts a better QoL compared to preservation of the function of both parotid glands. Copyright © 2012 Elsevier Ltd. All rights reserved.

Dose to Larynx Predicts for Swallowing Complications After Intensity-Modulated Radiotherapy

International Nuclear Information System (INIS)

Caglar, Hale B.; Tishler, Roy B.; Othus, Megan; Burke, Elaine; Li Yi; Goguen, Laura; Wirth, Lori J.; Haddad, Robert I.; Norris, Carl M.; Court, Laurence E.; Aninno, Donald J. D.; Posner, Marshall R.; Allen, Aaron M.

2008-01-01

Purpose: To evaluate early swallowing after intensity-modulated radiotherapy for head and neck squamous cell carcinoma and determine factors correlating with aspiration and/or stricture. Methods and Materials: Consecutive patients treated with intensity-modulated radiotherapy with or without chemotherapy between September 2004 and August 2006 at the Dana Farber Cancer Institute/Brigham and Women's Hospital were evaluated with institutional review board approval. Patients underwent swallowing evaluation after completion of therapy; including video swallow studies. The clinical- and treatment-related variables were examined for correlation with aspiration or strictures, as well as doses to the larynx, pharyngeal constrictor muscles, and cervical esophagus. The correlation was assessed with logistic regression analysis. Results: A total of 96 patients were evaluated. Their median age was 55 years, and 79 (82%) were men. The primary site of cancer was the oropharynx in 43, hypopharynx/larynx in 17, oral cavity in 13, nasopharynx in 11, maxillary sinus in 2, and unknown primary in 10. Of the 96 patients, 85% underwent definitive RT and 15% postoperative RT. Also, 28 patients underwent induction chemotherapy followed by concurrent chemotherapy, 59 received concurrent chemotherapy, and 9 patients underwent RT alone. The median follow-up was 10 months. Of the 96 patients, 31 (32%) had clinically significant aspiration and 36 (37%) developed a stricture. The radiation dose-volume metrics, including the volume of the larynx receiving ≥50 Gy (p = 0.04 and p = 0.03, respectively) and volume of the inferior constrictor receiving ≥50 Gy (p = 0.05 and p = 0.02, respectively) were significantly associated with both aspiration and stricture. The mean larynx dose correlated with aspiration (p = 0.003). Smoking history was the only clinical factor to correlate with stricture (p = 0.05) but not aspiration. Conclusion: Aspiration and stricture are common side effects after

Maximum tolerated dose in a phase I trial on adaptive dose painting by numbers for head and neck cancer

International Nuclear Information System (INIS)

Madani, Indira; Duprez, Fréderic; Boterberg, Tom; Van de Wiele, Christophe; Bonte, Katrien; Deron, Philippe; De Gersem, Werner; Coghe, Marc; De Neve, Wilfried

2011-01-01

Purpose: To determine the maximum tolerated dose (MTD) in a phase I trial on adaptive dose-painting-by-numbers (DPBN) for non-metastatic head and neck cancer. Materials and methods: Adaptive intensity-modulated radiotherapy was based on voxel intensity of pre-treatment and per-treatment [ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography ( 18 F-FDG-PET) scans. Dose was escalated to a median total dose of 80.9 Gy in the high-dose clinical target volume (dose level I) and 85.9 Gy in the gross tumor volume (dose level II). The MTD would be reached, if ⩾33% of patients developed any grade ⩾4 toxicity (DLT) up to 3 months follow-up. Results: Between February 2007 and August 2009, seven patients at dose level I and 14 at dose level II were treated. All patients completed treatment without interruption. At a median follow-up for surviving patients of 38 (dose level I) and 22 months (dose level II) there was no grade ⩾4 toxicity during treatment and follow-up but six cases of mucosal ulcers at latency of 4–10 months, of which five (36%) were observed at dose level II. Mucosal ulcers healed spontaneously in four patients. Conclusions: Considering late mucosal ulcers as DLT, the MTD of a median dose of 80.9 Gy has been reached in our trial.

Comparison between the chest dose and the neck dose of workers with protective aprons at PNC plutonium fuel fabrication facilities

Energy Technology Data Exchange (ETDEWEB)

Tsujimura, Norio; Momose, Takumaro; Shinohara, Kunihiko [Power Reactor and Nuclear Fuel Development Corp., Tokai, Ibaraki (Japan). Tokai Works

1996-06-01

The dose equivalents recorded by a chest dosemeter under the protective apron and a neck dosemeter above the apron, worn by workers in the fabrication process of MOX fuels at PNC Tokai works, are compared. The ratio of the chest and neck dose equivalent is from 3 to 4. The effective dose equivalent calculated from a weighted combination of the dosemeter readings is about 2 times of the dose under protective aprons. (author)

Comparison between the chest dose and the neck dose of workers with protective aprons at PNC plutonium fuel fabrication facilities

International Nuclear Information System (INIS)

Tsujimura, Norio; Momose, Takumaro; Shinohara, Kunihiko

1996-01-01

The dose equivalents recorded by a chest dosemeter under the protective apron and a neck dosemeter above the apron, worn by workers in the fabrication process of MOX fuels at PNC Tokai works, are compared. The ratio of the chest and neck dose equivalent is from 3 to 4. The effective dose equivalent calculated from a weighted combination of the dosemeter readings is about 2 times of the dose under protective aprons. (author)

Tank Z-361 dose rate calculations

International Nuclear Information System (INIS)

Richard, R.F.

1998-01-01

Neutron and gamma ray dose rates were calculated above and around the 6-inch riser of tank Z-361 located at the Plutonium Finishing Plant. Dose rates were also determined off of one side of the tank. The largest dose rate 0.029 mrem/h was a gamma ray dose and occurred 76.2 cm (30 in.) directly above the open riser. All other dose rates were negligible. The ANSI/ANS 1991 flux to dose conversion factor for neutrons and photons were used in this analysis. Dose rates are reported in units of mrem/h with the calculated uncertainty shown within the parentheses

Unilateral and bilateral neck SIB for head and neck cancer patients. Intensity-modulated proton therapy, tomotherapy, and RapidArc

Energy Technology Data Exchange (ETDEWEB)

Stromberger, Carmen; Budach, Volker; Ghadjar, Pirus; Wlodarczyk, Waldemar; Marnitz, Simone [Charite - Universitaetsmedizin Berlin, Department of Radiation Oncology and Radiotherapy, Berlin (Germany); Cozzi, Luca; Fogliata, Antonella [Humanitas Cancer Center Milan, Radiotherapy and Radiosurgery Department, Milan (Italy); Jamil, Basil [Klinikum Frankfurt Oder, Praxis fuer Strahlentherapie, Frankfurt Oder (Germany); Raguse, Jan D. [Clinic for Oral and Maxillofacial Surgery, Berlin (Germany); Boettcher, Arne [Charite - Universitaetsmedizin Berlin, Department of Otorhinolaryngology, Berlin (Germany)

2016-04-15

To compare simultaneous integrated boost plans for intensity-modulated proton therapy (IMPT), helical tomotherapy (HT), and RapidArc therapy (RA) for patients with head and neck cancer. A total of 20 patients with squamous cell carcinoma of the head and neck received definitive chemoradiation with bilateral (n = 14) or unilateral (n = 6) neck irradiation and were planned using IMPT, HT, and RA with 54.4, 60.8, and 70.4 GyE/Gy in 32 fractions. Dose distributions, coverage, conformity, homogeneity to planning target volumes (PTV)s and sparing of organs at risk and normal tissue were compared. All unilateral and bilateral plans showed excellent PTV coverage and acceptable dose conformity. For unilateral treatment, IMPT delivered substantially lower mean doses to contralateral salivary glands (< 0.001-1.1 Gy) than both rotational techniques did (parotid gland: 6-10 Gy; submandibular gland: 15-20 Gy). Regarding the sparing of classical organs at risk for bilateral treatment, IMPT and HT were similarly excellent and RA was satisfactory. For unilateral neck irradiation, IMPT may minimize the dry mouth risk in this subgroup but showed no advantage over HT for bilateral neck treatment regarding classical organ-at-risk sparing. All methods satisfied modern standards regarding toxicity and excellent target coverage for unilateral and bilateral treatment of head and neck cancer at the planning level. (orig.) [German] Planvergleich von intensitaetsmodulierter Protonentherapie (IMPT), Tomotherapie (HT) und RapidArc-Therapie (RA) fuer Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region unter Anwendung des simultan integrierten Boost-Konzepts (SIB). Fuer 20 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region und bilateraler (n = 14) oder unilateraler (n = 6) zervikaler primaerer Radiochemotherapie erfolgte eine IMPT-, HT- und RA-Planung mit 54,4, 60,8 und 70,4 GyE/Gy in 32 Fraktionen. Die Dosisverteilung, Abdeckung, Konformitaet und Homogenitaet der PTVs sowie die

Physical dose of therapeutic exercises in institutional neck rehabilitation.

Science.gov (United States)

Wasenius, Niko; Karapalo, Teppo; Sjögren, Tuulikki; Pekkonen, Mika; Mälkiä, Esko

2013-03-01

To determine the intensity and volume of therapeutic exercises during a standard 13-day inpatient neck rehabilitation course in relation to overall physical activity in rehabilitation and everyday life. Cross-sectional study. Subjects (n = 19; 16 women and 3 men; mean age 48.6 years, standard deviation (SD) 6.6) with chronic non-specific neck pain were recruited from two inpatient neck rehabilitation courses. Intensity and volume of therapeutic exercises and physical activity were measured in metabolic equivalents (METs) with an objective measurement device and all-time recall questionnaire. Maximum oxygen uptake was determined in METs (METc) by direct maximal cycle ergometer. Subjects' mean METc was 7.2 METs (SD 1.4) or 25.3 ml/kg/min (SD 4.8). Intensity of all therapeutic exercises was 1.9 METs or 27 %METc (SD 5.1) and volume 7.7 MET-hours/week. Intensity of specific neck and shoulder exercises was 2.0 METs or 28 %METc (SD 5.4) and volume 2.5 MET-hours/week. In addition, subjects were more active in everyday life than in inpatient rehabilitation. The therapeutic exercise dose failed to reach previously reported target values for pain relief. The dose of therapeutic exercises and confounding physical activity should be carefully controlled in pain rehabilitation programmes.

BENEFITS OF INTENSITY-MODULATED RADIOTHERAPY (IMRT IN PATIENTS WITH HEAD AND NECK MALIGNANCIES- A SINGLE INSTITUTION EXPERIENCE

Directory of Open Access Journals (Sweden)

Sherry Seasor Abraham

2017-09-01

Full Text Available BACKGROUND Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional twodimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. IntensityModulated Radiotherapy (IMRT can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This study reveals the role of IMRT in head and neck cancer in view of normal tissue sparing with good tumour control. MATERIALS AND METHODS Radical radiotherapy was given using linear accelerator up to a dose of 66 to 70 gray in 30 to 33 fractions (intensity-modulated radiotherapy with simultaneous integrated boost over 6 to 7 weeks to 56 eligible patients. Concurrent cisplatin was given to patients with locally-advanced disease up to a dose of 40 mg/m2 weekly once along with radiation. The patients were monitored weekly once during the treatment for acute skin and mucosal toxicities using the RTOG scoring criteria. After the treatment, locoregional response was assessed and recorded at 6 weeks, 3 months and 6 months intervals. RESULTS Severe skin toxicity (grade III or more was seen in approximately 7% patients. Severe mucosal toxicity (grade III or more was seen in approximately 80% of patients. IMRT technique showed better skin sparing compared to 3D conformal radiotherapy. Severe mucosal toxicity was slightly higher in this study due to the simultaneous integrated boost technique used for dose intensification to the mucosa, which results in better primary tumour control. At the end of 6 months, 75% patients achieved locoregional control and residual/recurrent disease was seen in 25% of patients. IMRT offered good locoregional control with less skin toxicity and acceptable mucosal toxicity. The results were similar to the previous study reports using IMRT. CONCLUSION IMRT is a better treatment option in locally-advanced head and neck malignancies providing good

An immediate effect of axial neck rotation training with real time visual feedback using a smartphone inclinometer on improvement in axial neck rotation function.

Science.gov (United States)

Park, Kyue-Nam; Kwon, Oh-Yun; Kim, Si-Hyun; Jeon, In-Cheol

2017-03-01

The purpose of this study was to compare the immediate effects of axial neck rotation training (Axi-NRT) with and without real-time visual feedback (VF) using a smartphone inclinometer on the range of motion (ROM) for axial neck rotation and the onset of compensatory neck lateral bending and extension during active neck rotation. Twenty participants with restricted ROM for neck rotation but no neck pain (21.1 ± 1.6 years and 8 males, 12 females) were recruited for Axi-NRT with VF, and twenty age- and gender-matched participants with restricted ROM for neck rotation were recruited for Axi-NRT without VF. Changes in ROM for neck rotation and the onset time of compensatory neck movement during active neck rotation were measured using an electromagnetic tracking system. Axi-NRT with VF was more effective in increasing ROM for neck rotation and decreasing and delaying the onset of compensatory neck movements during active neck rotation compared with Axi-NRT without VF. Repeated Axi-NRT using VF is useful to educate participants in maintaining the axis of the cervical spine and to increase ROM for axial neck rotation with less compensatory neck motion in participants with a restricted range of neck rotations.

Abdominal-pelvic scanning parameters revisited: a case for Z-axis reduction in patients with clinical suspicion for acute appendicitis.

Science.gov (United States)

Patel, Darshan C; Huang, Yu-Hui; Meyer, Jonathan; Sepahdari, Amir

2017-12-01

The purpose of this study was to determine if CT for appendicitis can be abbreviated to begin at the top of the L2 vertebral body level and still maintain the detection rate of appendicitis and other symptomatic pathology without omitting significant incidental findings. Retrospective review of CT abdomen-pelvis exams for suspected appendicitis over a 5-month period was performed. The Z-axis scan length of the original full scans and theoretical limited scans from the top of L2 were recorded and calculated. Images were reviewed for incidental findings above the L2 vertebral body level and categorized by severity per American College of Radiology (ACR) white paper guidelines. Final diagnoses based on imaging findings were also recorded. One hundred nineteen patients (46 males, 73 females, mean age 29 ± 14) were included. Appendicitis was present in 26 cases (22%). Using a theoretical scan beginning at the top of the L2 vertebral body, none of the findings leading to diagnosis of appendicitis would have been missed. A total of 30 incidental findings were found above the L2 vertebral body. Per ACR white paper guidelines, 26 of these findings did not require additional imaging follow-up. Additional follow-up imaging was recommended for 3 of the findings above L2, and 1 right adrenal metastasis was found above L2 in a patient with previously undiagnosed NSCLC. This patient coincidentally also had appendicitis. No symptomatic pathology would have been missed had the scans begun at the top of the L2 vertebral body. Such an abbreviated scan would have resulted in a mean Z-axis reduction of 12.9 cm (30.3%). CT using abbreviated Z-axis scan length can reduce radiation dose and provide necessary imaging needed to diagnose appendicitis or other symptomatic pathology without omitting significant incidental findings.

Fielding of the on-axis diagnostic package at Z

International Nuclear Information System (INIS)

Hurst, M.J.; Nash, T.J.; Derzon, M.; Kellogg, J.W.; Torres, J.; McGurn, J.; Seaman, J.; Jobe, D.; Lazier, S.E.

1998-06-01

The authors have developed a comprehensive diagnostic package for observing z-pinch radiation along the pinch axis on the Z accelerator. The instrumentation, which was fielded on the axial package, are x-ray diagnostics requiring direct lines of sight to the target. The diagnostics require vacuum access to the center of the accelerator. The environment is a hostile one, where one must deal with an intense, energetic photon flux (>100 keV), EMP, debris (e.g. bullets or shrapnel), and mechanical shock in order for the diagnostics to survive. In addition, practical constraints require the package be refurbished and utilized on a once a day shot schedule. In spite of this harsh environment, the authors have successfully fielded the diagnostic package with a high survivability of the data and the instruments. In this paper, they describe the environment and issues related to the re-entrant diagnostic package's implementation and maintenance

Design of a Three-Axis Machine Tool Module

National Research Council Canada - National Science Library

Childers, Marshal

2003-01-01

This report documents the design improvement process of the components in a tool module for a three-axis machine tool, which occurred during the period of March-April 2002 in support of a critical U.S...

Development of a unique phantom to assess dose error of metal artifact in head and neck cancer

Energy Technology Data Exchange (ETDEWEB)

Lee, Min Young; Kang, Sang Won; Suh, Tae Suk [Dept. of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Lee, Jeong Woo [Dept. of Radiation Oncology, Konkuk University Medical Center, Seoul (Korea, Republic of); Park, Ji Yeon [Dept. of Pediatrics and Molecular Imaging Program at Stanford, Stanford University, Stanford (United States)

2016-04-15

The artifacts not only blur the CT images and lead to inaccuracies in diagnosis, but also make the delineation of anatomical structures intractable, which is important in image-guided intervention procedures. These artifacts obscure the underlying anatomy, leading to uncertainty in the delineation of the target volumes and compromising the integrity of the density representation that is crucial for accurate dose calculation. Because head and neck cancer patients tend to be over the age of 50 years, they constitute a group likely to have dental prostheses. This kind of side effects considerably disturbs the therapeutic procedure. Radiation scatter from high atomic number (Z) materials is established to cause both soft tissue and bony complications in the oral cavity, making scattered radiation an important factor in head and neck region radiotherapy planning. In this study, we carried out theoretical analysis of the metal artifact, that is, streak artifact and dark artifact, and also critical analysis of dosimetric effect which cause by dental implants in CT images of head and neck cancer patients with the genuine teeth and implants inserted humanoid phantom. The phantom provides a unique and useful tool in head and neck dosimetry research. It can be used in the development of new imaging instrumentation, image acquisition strategies, and image processing and reconstruction methods.

The effect of angular and longitudinal tube current modulations on the estimation of organ and effective doses in x-ray computed tomography

International Nuclear Information System (INIS)

Straten, Marcel van; Deak, Paul; Shrimpton, Paul C.; Kalender, Willi A.

2009-01-01

Purpose: Tube current modulation (TCM) is one of the recent developments in multislice CT that has proven to reduce the patient radiation dose without affecting the image quality. Presently established methods and published coefficients for estimating organ doses from the dose measured free in air on the axis of rotation or in the CT dose index (CTDI) dosimetry phantoms do not take into account this relatively new development in CT scanner design and technology. Based on these organ dose coefficients effective dose estimates can be made. The estimates are not strictly valid for CT scanning protocols utilizing TCM. In this study, the authors investigated the need to take TCM into account when estimating organ and effective dose values. Methods: A whole-body adult anthropomorphic phantom (Alderson Rando) was scanned with a multislice CT scanner (Somatom Definition, Siemens, Forchheim, Germany) utilizing TCM (CareDose4D). Tube voltage was 120 kV, beam collimation 19.2 mm, and pitch 1. A voxelized patient model was used to define the tissues and organs in the phantom. Tube current values as a function of tube angle were obtained from the raw data for each individual tube rotation of the scan. These values were used together with the Monte Carlo dosimetry tool IMPACTMC (VAMP GmbH, Erlangen, Germany) to calculate organ dose values both with and without account of TCM. Angular and longitudinal modulations were investigated separately. Finally, corresponding effective dose conversion coefficients were determined for both cases according to the updated 2007 recommendations of the ICRP. Results: TCM amplitude was greatest in the shoulder and pelvic regions. Consequently, dose distributions and organ dose values for particular cross sections changed considerably when taking angular modulation into account. The effective dose conversion coefficients were up to 11% lower for a single rotation in the shoulder region and 17% lower in the pelvis when taking angular TCM into

Lhermitte's Sign Developing after IMRT for Head and Neck Cancer

Directory of Open Access Journals (Sweden)

Dong C. Lim

2010-01-01

Full Text Available Background. Lhermitte's sign (LS is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

Validation of a Monte Carlo model used for simulating tube current modulation in computed tomography over a wide range of phantom conditions/challenges

Energy Technology Data Exchange (ETDEWEB)

Bostani, Maryam, E-mail: mbostani@mednet.ucla.edu; McMillan, Kyle; Cagnon, Chris H.; McNitt-Gray, Michael F. [Departments of Biomedical Physics and Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90024 (United States); DeMarco, John J. [Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California 90095 (United States)

2014-11-01

Purpose: Monte Carlo (MC) simulation methods have been widely used in patient dosimetry in computed tomography (CT), including estimating patient organ doses. However, most simulation methods have undergone a limited set of validations, often using homogeneous phantoms with simple geometries. As clinical scanning has become more complex and the use of tube current modulation (TCM) has become pervasive in the clinic, MC simulations should include these techniques in their methodologies and therefore should also be validated using a variety of phantoms with different shapes and material compositions to result in a variety of differently modulated tube current profiles. The purpose of this work is to perform the measurements and simulations to validate a Monte Carlo model under a variety of test conditions where fixed tube current (FTC) and TCM were used. Methods: A previously developed MC model for estimating dose from CT scans that models TCM, built using the platform of MCNPX, was used for CT dose quantification. In order to validate the suitability of this model to accurately simulate patient dose from FTC and TCM CT scan, measurements and simulations were compared over a wide range of conditions. Phantoms used for testing range from simple geometries with homogeneous composition (16 and 32 cm computed tomography dose index phantoms) to more complex phantoms including a rectangular homogeneous water equivalent phantom, an elliptical shaped phantom with three sections (where each section was a homogeneous, but different material), and a heterogeneous, complex geometry anthropomorphic phantom. Each phantom requires varying levels of x-, y- and z-modulation. Each phantom was scanned on a multidetector row CT (Sensation 64) scanner under the conditions of both FTC and TCM. Dose measurements were made at various surface and depth positions within each phantom. Simulations using each phantom were performed for FTC, detailed x–y–z TCM, and z-axis-only TCM to obtain

SU-E-I-31: Differences Observed in Radiation Doses Across 2 Similar CT Scanners From Adult Brain-Neck CT Angiography

Energy Technology Data Exchange (ETDEWEB)

Fujii, K [Graduate School of Medicine, Nagoya University, Nagoya, JP (Japan); UCLA School of Medicine, Los Angeles, CA (United States); McMillan, K; Bostani, M; Cagnon, C; McNitt-Gray, M [UCLA School of Medicine, Los Angeles, CA (United States)

2015-06-15

Purpose: The aim of this study is to evaluate the difference in radiation doses from adult Brain-Neck CT angiography (CTA) between two CT scanners. Methods: We collected CT dose index data (CTDIvol, DLP) from adult Brain-Neck CTA performed with two CT scanners (Sensation 64 (S64) and Definition AS (AS), Siemens Healthcare) performed at two of our facilities from Jan 1st to Dec 31th, 2014. X-ray dose management software (Radmetrics, Bayer Healthcare) was used to mine these data. All exams were performed with Tube Current Modulation (Care Dose 4D), tube voltage of 120 kVp, quality reference mAs of 300, beam collimation of 64*0.6 mm. The rotation time was set to 0.5 sec for S64 and 1.0 sec for AS. We also scanned an anthropomorphic skull and chest phantom under routine Brain-Neck CTA protocol with the two scanners and extracted the tube current values from the raw projection data. Results: The mean CTDIvol and DLP in Brain-Neck CTA was 72 mGy and 2554 mGy*cm for AS, which was substantially larger than the mean values of 46 mGy and 1699 mGy*cm for S64. The maximum tube current was 583 mA for most cases on the S64 while the maximum was 666 mA for AS even though the rotation time set for AS was 1.0 sec. Measurements obtained with the anthropomorphic phantom showed that the tube current reached 583 mA at the shoulder region for S64 while it reached to 666 mA for AS. Conclusion: The results of this study showed that substantially different CT doses can Result from Brain-Neck CTA protocols even when similar scanners and similar settings are used. Though both scanners have a similar maximum mA rating, differences in mA were observed through the shoulders, resulting in substantially different CTDIvol values.

Decreasing the effective radiation dose in pediatric craniofacial CT by changing head position

International Nuclear Information System (INIS)

Didier, Ryne A.; Kuang, Anna A.; Schwartz, Daniel L.; Selden, Nathan R.; Stevens, Donna M.; Bardo, Dianna M.E.

2010-01-01

Children are exposed to ionizing radiation during pre- and post-operative evaluation for craniofacial surgery. The primary purpose of the study was to decrease effective radiation dose while preserving the diagnostic quality of the study. In this prospective study 49 children were positioned during craniofacial CT (CFCT) imaging with their neck fully extended into an exaggerated sniff position, parallel to the CT gantry, to eliminate the majority of the cervical spine and the thyroid gland from radiation exposure. Image-quality and effective radiation dose comparisons were made retrospectively in age-matched controls (n = 49). When compared to CT scans reviewed retrospectively, the prospective examinations showed a statistically significant decrease in z-axis length by 16% (P < 0.0001) and delivered a reduced effective radiation dose by 18% (P < 0.0001). The subjective diagnostic quality of the exams performed in the prospective arm was maintained despite a slight decrease in the quality of the brain windows. There was statistically significant improvement in the quality of the bone windows and three-dimensional reconstructed images. Altering the position of the head by extending the neck during pediatric craniofacial CT imaging statistically reduces the effective radiation dose while maintaining the diagnostic quality of the images. (orig.)

3D-conformal-intensity modulated radiotherapy with compensators for head and neck cancer: clinical results of normal tissue sparing

Directory of Open Access Journals (Sweden)

Koscielny Sven

2006-06-01

Full Text Available Abstract Background To investigate the potential of parotic gland sparing of intensity modulated radiotherapy (3D-c-IMRT performed with metallic compensators for head and neck cancer in a clinical series by analysis of dose distributions and clinical measures. Materials and methods 39 patients with squamous cell cancer of the head and neck irradiated using 3D-c-IMRT were evaluable for dose distribution within PTVs and at one parotid gland and 38 patients for toxicity analysis. 10 patients were treated primarily, 29 postoperatively, 19 received concomittant cis-platin based chemotherapy, 20 3D-c-IMRT alone. Initially the dose distribution was calculated with Helax ® and photon fluence was modulated using metallic compensators made of tin-granulate (n = 22. Later the dose distribution was calculated with KonRad ® and fluence was modified by MCP 96 alloy compensators (n = 17. Gross tumor/tumor bed (PTV 1 was irradiated up to 60–70 Gy, [5 fractions/week, single fraction dose: 2.0–2.2 (simultaneously integrated boost], adjuvantly irradiated bilateral cervical lymph nodes (PTV 2 with 48–54 Gy [single dose: 1.5–1.8]. Toxicity was scored according the RTOG scale and patient-reported xerostomia questionnaire (XQ. Results Mean of the median doses at the parotid glands to be spared was 25.9 (16.3–46.8 Gy, for tin graulate 26 Gy, for MCP alloy 24.2 Gy. Tin-granulate compensators resulted in a median parotid dose above 26 Gy in 10/22, MCP 96 alloy in 0/17 patients. Following acute toxicities were seen (°0–2/3: xerostomia: 87%/13%, dysphagia: 84%/16%, mucositis: 89%/11%, dermatitis: 100%/0%. No grade 4 reaction was encountered. During therapy the XQ forms showed °0–2/3: 88%/12%. 6 months postRT chronic xerostomia °0–2/3 was observed in 85%/15% of patients, none with °4 xerostomia. Conclusion 3D-c-IMRT using metallic compensators along with inverse calculation algorithm achieves sufficient parotid gland sparing in virtually all advanced

Off-axis dose equivalent due to secondary neutrons from uniform scanning proton beams during proton radiotherapy

Science.gov (United States)

Islam, M. R.; Collums, T. L.; Zheng, Y.; Monson, J.; Benton, E. R.

2013-11-01

The production of secondary neutrons is an undesirable byproduct of proton therapy and it is important to quantify the contribution from secondary neutrons to patient dose received outside the treatment volume. The purpose of this study is to investigate the off-axis dose equivalent from secondary neutrons experimentally using CR-39 plastic nuclear track detectors (PNTD) at ProCure Proton Therapy Center, Oklahoma City, OK. In this experiment, we placed several layers of CR-39 PNTD laterally outside the treatment volume inside a phantom and in air at various depths and angles with respect to the primary beam axis. Three different proton beams with max energies of 78, 162 and 226 MeV and 4 cm modulation width, a 5 cm diameter brass aperture, and a small snout located 38 cm from isocenter were used for the entire experiment. Monte Carlo simulations were also performed based on the experimental setup using a simplified snout configuration and the FLUKA Monte Carlo radiation transport code. The measured ratio of secondary neutron dose equivalent to therapeutic primary proton dose (H/D) ranged from 0.3 ± 0.08 mSv Gy-1 for 78 MeV proton beam to 37.4 ± 2.42 mSv Gy-1 for 226 MeV proton beam. Both experiment and simulation showed a similar decreasing trend in dose equivalent with distance to the central axis and the magnitude varied by a factor of about 2 in most locations. H/D was found to increase as the energy of the primary proton beam increased and higher H/D was observed at 135° compared to 45° and 90°. The overall higher H/D in air indicates the predominance of external neutrons produced in the nozzle rather than inside the body.

Off-axis dose equivalent due to secondary neutrons from uniform scanning proton beams during proton radiotherapy

International Nuclear Information System (INIS)

Islam, M R; Collums, T L; Monson, J; Benton, E R; Zheng, Y

2013-01-01

The production of secondary neutrons is an undesirable byproduct of proton therapy and it is important to quantify the contribution from secondary neutrons to patient dose received outside the treatment volume. The purpose of this study is to investigate the off-axis dose equivalent from secondary neutrons experimentally using CR-39 plastic nuclear track detectors (PNTD) at ProCure Proton Therapy Center, Oklahoma City, OK. In this experiment, we placed several layers of CR-39 PNTD laterally outside the treatment volume inside a phantom and in air at various depths and angles with respect to the primary beam axis. Three different proton beams with max energies of 78, 162 and 226 MeV and 4 cm modulation width, a 5 cm diameter brass aperture, and a small snout located 38 cm from isocenter were used for the entire experiment. Monte Carlo simulations were also performed based on the experimental setup using a simplified snout configuration and the FLUKA Monte Carlo radiation transport code. The measured ratio of secondary neutron dose equivalent to therapeutic primary proton dose (H/D) ranged from 0.3 ± 0.08 mSv Gy −1  for 78 MeV proton beam to 37.4 ± 2.42 mSv Gy −1  for 226 MeV proton beam. Both experiment and simulation showed a similar decreasing trend in dose equivalent with distance to the central axis and the magnitude varied by a factor of about 2 in most locations. H/D was found to increase as the energy of the primary proton beam increased and higher H/D was observed at 135° compared to 45° and 90°. The overall higher H/D in air indicates the predominance of external neutrons produced in the nozzle rather than inside the body. (paper)

Simulation of a low frequency Z-axis SU-8 accelerometer in coventorware and MEMS+

KAUST Repository

Carreno, Armando Arpys Arevalo

2013-04-01

This paper presents the simulation of a z-axis SU-8 capacitive accelerometer. The study consists of a modal analysis of the modeled accelerometer, a study relating capacitance to acceleration, capacitance to deflection, an effective spring constant calculation, and a comparison of results achieved using CoventorWare® ANALYZER™ and MEMS+®. A fabricated energy harvester design from [1] was used for modeling and simulation in this study, with a four spring attachment of a 650μm×650μm; ×110μm proof mass of 4.542×10-8 kg. At rest, the spacing between electrodes is 4μm along the z-axis, and at 1.5g acceleration, there is 1.9μm spacing between electrodes, at which point pull in occurs for a 1V voltage. © 2013 IEEE.

Modulation Schemes of Multi-phase Three-Level Z-Source Inverters

DEFF Research Database (Denmark)

Gao, F.; Loh, P.C.; Blaabjerg, Frede

2007-01-01

different modulation requirement and output performance. For clearly illustrating the detailed modulation process, time domain analysis instead of the traditional multi-dimensional space vector demonstration is assumed which reveals the right way to insert shoot-through durations in the switching sequence...... with minimal commutation count. Lastly, the theoretical findings are verified in Matlab/PLECS simulation and experimentally using constructed laboratory prototypes.......This paper investigates the modulation schemes of three-level multiphase Z-source inverters with either two Z-source networks or single Z-source network connected between the dc sources and inverter circuitry. With the proper offset added for achieving both desired four-leg operation and optimized...

Importance of contouring the cervical spine levels in initial intensity-modulated radiation therapy radiation for head and neck cancers: Implications for re-irradiation

Directory of Open Access Journals (Sweden)

Parashar Bhupesh

2009-01-01

Full Text Available Aim: To evaluate the maximum differential cervical spinal (C-spine cord dose in intensity-modulated radiation therapy (IMRT plans of patients undergoing radiotherapy for treatment of head and neck cancer. Materials and Methods: The C-spine of ten head and neck cancer patients that were planned using IMRT and each cervical vertebral body and the right and left sides was contoured by splitting the cord in the center. Dose-volume histograms (DVH and maximum point doses were obtained for each contour and compared. Results: The dose to the cord varied with the location of the primary tumor but such variation was not consistently seen. This report provides information that is critical for planning reirradiation treatments. We recommend that contouring of the C-spine cord with IMRT should include outlining of each cervical cord level and identification of the right and the left sides of the cord on each plan.

Radiation absorbed dose and expected risk in head and neck tissues after thyroid radioiodine therapy

Energy Technology Data Exchange (ETDEWEB)

Hamed, A [National Center for Nuclear and Radiation Control, AEA., Cairo (Egypt); Farag, H I [National Cancer instiute, Cairo University, Cairo (Egypt); Saleh, A [Al-hussien Hospital, Al-Azhar University, Cairo (Egypt)

1997-12-31

Measurement of absorbed dose in head and neck phantom after applying I-131 therapeutic dose for the treatment of thyroid malignancies was conducted. The measurement were carried out at several sites of phantom using TL dosimeters. The absorbed doses were also measured on the skin of four patients during their administration of I-131 therapeutic doses 1.332 GBq (36 mci) I-131. The measurements were taken over 69 hours exposure at different sites of phantom. The same measurements were carried out on the four patients. At five sites of the patients head and neck, the absorbed dose were measured and compared with that measured on the phantom. The values measured are discussed in the light of the published individual absorbed doses in the organs by ICRP tables. High absorbed doses were absorbed in the different sites of the head and neck during the I-131 therapy (0.14-9.68 mGy/mCi). 3 figs., 2 tabs.

SU-C-BRC-05: Monte Carlo Calculations to Establish a Simple Relation of Backscatter Dose Enhancement Around High-Z Dental Alloy to Its Atomic Number

Energy Technology Data Exchange (ETDEWEB)

Utsunomiya, S; Kushima, N; Katsura, K; Tanabe, S; Hayakawa, T; Sakai, H; Yamada, T; Takahashi, H; Abe, E; Wada, S; Aoyama, H [Niigata University, Niigata (Japan)

2016-06-15

Purpose: To establish a simple relation of backscatter dose enhancement around a high-Z dental alloy in head and neck radiation therapy to its average atomic number based on Monte Carlo calculations. Methods: The PHITS Monte Carlo code was used to calculate dose enhancement, which is quantified by the backscatter dose factor (BSDF). The accuracy of the beam modeling with PHITS was verified by comparing with basic measured data namely PDDs and dose profiles. In the simulation, a high-Z alloy of 1 cm cube was embedded into a tough water phantom irradiated by a 6-MV (nominal) X-ray beam of 10 cm × 10 cm field size of Novalis TX (Brainlab). The ten different materials of high-Z alloys (Al, Ti, Cu, Ag, Au-Pd-Ag, I, Ba, W, Au, Pb) were considered. The accuracy of calculated BSDF was verified by comparing with measured data by Gafchromic EBT3 films placed at from 0 to 10 mm away from a high-Z alloy (Au-Pd-Ag). We derived an approximate equation to determine the relation of BSDF and range of backscatter to average atomic number of high-Z alloy. Results: The calculated BSDF showed excellent agreement with measured one by Gafchromic EBT3 films at from 0 to 10 mm away from the high-Z alloy. We found the simple linear relation of BSDF and range of backscatter to average atomic number of dental alloys. The latter relation was proven by the fact that energy spectrum of backscatter electrons strongly depend on average atomic number. Conclusion: We found a simple relation of backscatter dose enhancement around high-Z alloys to its average atomic number based on Monte Carlo calculations. This work provides a simple and useful method to estimate backscatter dose enhancement from dental alloys and corresponding optimal thickness of dental spacer to prevent mucositis effectively.

Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

Energy Technology Data Exchange (ETDEWEB)

Bosch, Sven van den, E-mail: sven.vandenbosch@radboudumc.nl; Dijkema, Tim; Verhoef, Lia C.G.; Zwijnenburg, Ellen M.; Janssens, Geert O.; Kaanders, Johannes H.A.M.

2016-03-15

Purpose: To provide a comprehensive risk assessment on the patterns of recurrence in electively irradiated lymph node regions after definitive radiation therapy for head and neck cancer. Methods and Materials: Two hundred sixty-four patients with stage cT2-4N0-2M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx treated with accelerated intensity modulated radiation therapy between 2008 and 2012 were included. On the radiation therapy planning computed tomography (CT) scans from all patients, 1166 lymph nodes (short-axis diameter ≥5 mm) localized in the elective volume were identified and delineated. The exact sites of regional recurrences were reconstructed and projected on the initial radiation therapy planning CT scan by performing coregistration with diagnostic imaging of the recurrence. Results: The actuarial rate of recurrence in electively irradiated lymph node regions at 2 years was 5.1% (95% confidence interval 2.4%-7.8%). Volumetric analysis showed an increased risk of recurrence with increasing nodal volume. Receiver operating characteristic analysis demonstrated that the summed long- and short-axis diameter is a good alternative for laborious volume calculations, using ≥17 mm as cut-off (hazard ratio 17.8; 95% confidence interval 5.7-55.1; P<.001). Conclusions: An important risk factor was identified that can help clinicians in the pretreatment risk assessment of borderline-sized lymph nodes. Not overtly pathologic nodes with a summed diameter ≥17 mm may require a higher than elective radiation therapy dose. For low-risk elective regions (all nodes <17 mm), the safety of dose de-escalation below the traditional 45 to 50 Gy should be investigated.

Surface doses under head and neck immobilisation devices

International Nuclear Information System (INIS)

Baveas, E.

2004-01-01

Full text: Methods using ion chambers, TLDs and film were developed to measure the skin-sparing properties of three head and neck immobilisation devices used in radiation therapy, viz. Sinmed multi-perforated and micro-perforated posicast thermoplastic masks (used with a supporting carbon fibre back support), and a Kablite vacuum-formed shell plastic mask (used with a Perspex back support). All measurements were performed with 6 MV beams from Elekta Precise linear accelerators. Two situations have been considered in this study. In the first situation, phantom surface doses under the flat unmoulded mask and back-support materials lying on the surface of a 'solid water' phantom were measured with parallel plate ion chambers and correlated with the physical properties of the materials. In the second situation a particular head and neck treatment technique was adopted and the treatment planned on an anthropomorphic tissue-equivalent phantom. The clinical setup consisted of a wedged pair to the right parotid, planned to deliver a reference dose of 63 Gy to the isocentre, plus an anterior supraclavicular field planned to deliver a reference dose of 50 Gy at a depth of 2 cm. The 3 immobilisation masks were each moulded to the anthropomorphic tissue-equivalent phantom. TLD chips were used to measure the phantom skin dose at a set of 18 locations under each of the 3 immobilisation masks and also without an immobilisation device. The results clearly demonstrate the extent to which the various immobilisation devices increase the surface dose. Results for the first situation are summarised. The averages of the doses recorded by the TLDs in three separate regions for the second situation are shown in Table 2. The combined results show that the areal density of the unmoulded mask materials correlates with the surface dose these materials produce before moulding, but this correlation is lost after moulding for the clinical situation considered. This change upon moulding is

Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain

Science.gov (United States)

Sherman, Karen J.; Cook, Andrea J.; Wellman, Robert D.; Hawkes, Rene J.; Kahn, Janet R.; Deyo, Richard A.; Cherkin, Daniel C.

2014-01-01

PURPOSE This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain. METHODS We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list). We assessed neck-related dysfunction with the Neck Disability Index (range, 0–50 points) and pain intensity with a numerical rating scale (range, 0–10 points) at baseline and 5 weeks. We used log-linear regression to assess the likelihood of clinically meaningful improvement in neck-related dysfunction (≥5 points on Neck Disability Index) or pain intensity (≥30% improvement) by treatment group. RESULTS After adjustment for baseline age, outcome measures, and imbalanced covariates, 30-minute treatments were not significantly better than the wait list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction (relative risk = 3.41 and 4.98, P = .04 and .005, respectively) and pain intensity (relative risk = 2.30 and 2.73; P = .007 and .001, respectively). CONCLUSIONS After 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment. PMID:24615306

Spot-scanning beam proton therapy vs intensity-modulated radiation therapy for ipsilateral head and neck malignancies: A treatment planning comparison

International Nuclear Information System (INIS)

Kandula, Shravan; Zhu, Xiaorong; Garden, Adam S.; Gillin, Michael; Rosenthal, David I.; Ang, Kie-Kian; Mohan, Radhe; Amin, Mayankkumar V.; Garcia, John A.; Wu, Richard; Sahoo, Narayan; Frank, Steven J.

2013-01-01

Radiation therapy for head and neck malignancies can have side effects that impede quality of life. Theoretically, proton therapy can reduce treatment-related morbidity by minimizing the dose to critical normal tissues. We evaluated the feasibility of spot-scanning proton therapy for head and neck malignancies and compared dosimetry between those plans and intensity-modulated radiation therapy (IMRT) plans. Plans from 5 patients who had undergone IMRT for primary tumors of the head and neck were used for planning proton therapy. Both sets of plans were prepared using computed tomography (CT) scans with the goals of achieving 100% of the prescribed dose to the clinical target volume (CTV) and 95% to the planning TV (PTV) while maximizing conformity to the PTV. Dose-volume histograms were generated and compared, as were conformity indexes (CIs) to the PTVs and mean doses to the organs at risk (OARs). Both modalities in all cases achieved 100% of the dose to the CTV and 95% to the PTV. Mean PTV CIs were comparable (0.371 IMRT, 0.374 protons, p = 0.953). Mean doses were significantly lower in the proton plans to the contralateral submandibular (638.7 cGy IMRT, 4.3 cGy protons, p = 0.002) and parotid (533.3 cGy IMRT, 48.5 cGy protons, p = 0.003) glands; oral cavity (1760.4 cGy IMRT, 458.9 cGy protons, p = 0.003); spinal cord (2112.4 cGy IMRT, 249.2 cGy protons, p = 0.002); and brainstem (1553.52 cGy IMRT, 166.2 cGy protons, p = 0.005). Proton plans also produced lower maximum doses to the spinal cord (3692.1 cGy IMRT, 2014.8 cGy protons, p = 0.034) and brainstem (3412.1 cGy IMRT, 1387.6 cGy protons, p = 0.005). Normal tissue V 10 , V 30 , and V 50 values were also significantly lower in the proton plans. We conclude that spot-scanning proton therapy can significantly reduce the integral dose to head and neck critical structures. Prospective studies are underway to determine if this reduced dose translates to improved quality of life

Relative plan robustness of step-and-shoot vs rotational intensity–modulated radiotherapy on repeat computed tomographic simulation for weight loss in head and neck cancer

Energy Technology Data Exchange (ETDEWEB)

Thomson, David J. [Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester (United Kingdom); The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester (United Kingdom); Beasley, William J. [The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester (United Kingdom); Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester (United Kingdom); Garcez, Kate; Lee, Lip W.; Sykes, Andrew J. [Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester (United Kingdom); Rowbottom, Carl G. [The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester (United Kingdom); Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester (United Kingdom); Slevin, Nicholas J., E-mail: nick.slevin@christie.nhs.uk [Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester (United Kingdom); The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester (United Kingdom)

2016-07-01

Introduction: Interfractional anatomical alterations may have a differential effect on the dose delivered by step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). The increased degrees of freedom afforded by rotational delivery may increase plan robustness (measured by change in target volume coverage and doses to organs at risk [OARs]). However, this has not been evaluated for head and neck cancer. Materials and methods: A total of 10 patients who required repeat computed tomography (CT) simulation and replanning during head and neck IMRT were included. Step-and-shoot IMRT and VMAT plans were generated from the original planning scan. The initial and second CT simulation scans were fused and targets/OAR contours transferred, reviewed, and modified. The plans were applied to the second CT scan and doses recalculated without repeat optimization. Differences between step-and-shoot IMRT and VMAT for change in target volume coverage and doses to OARs between first and second CT scans were compared by Wilcoxon signed rank test. Results: There were clinically relevant dosimetric changes between the first and the second CT scans for both the techniques (reduction in mean D{sub 95%} for PTV2 and PTV3, D{sub min} for CTV2 and CTV3, and increased mean doses to the parotid glands). However, there were no significant differences between step-and-shoot IMRT and VMAT for change in any target coverage parameter (including D{sub 95%} for PTV2 and PTV3 and D{sub min} for CTV2 and CTV3) or dose to any OARs (including parotid glands) between the first and the second CT scans. Conclusions: For patients with head and neck cancer who required replanning mainly due to weight loss, there were no significant differences in plan robustness between step-and-shoot IMRT and VMAT. This information is useful with increased clinical adoption of VMAT.

Head and neck cancers: clinical benefits of three-dimensional conformal radiotherapy and of intensity-modulated radiotherapy

International Nuclear Information System (INIS)

Giraud, P.; Jaulerry, C.; Brunin, F.; Zefkili, S.; Helfre, S.; Chauvet, I.; Rosenwald, J.C.; Cosset, J.M.

2002-01-01

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3-D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of normal tissues. These techniques would then allow further tumor dose escalation. Head-and-neck tumors are some of the most attractive localizations to test conformal radiotherapy. They combine ballistic difficulties due to particularly complex shapes (nasopharynx, ethmoid) and problems due to the number and low tolerance of neighbouring organs like parotids, eyes, brainstem and spinal cord. The therapeutic irradiation of head-and-neck tumors thus remains a challenge for the radiation oncologist. Conformal radiotherapy does have a significant potential for improving local control and reducing toxicity when compared to standard radiotherapy. However, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from 3DCRT and IMRT. The published clinical reports on the use of conformal radiotherapy are essentially dealing with dosimetric comparisons on relatively small numbers of patients. Recently, a few publications have emphasized the clinical experience several precursor teams with a suitable follow-up. This paper describes the current state-of-the-art of 3DCRT and IMRT in order to evaluate the impact of these techniques on head-and-neck cancers irradiation. (authors)

Clinically practical intensity modulation for complex head and neck lesions using multiple, static MLC fields

International Nuclear Information System (INIS)

Verhey, L.J.; Xia, P.; Akazawa, P.

1997-01-01

Purpose: A number of different beam delivery methods have been proposed for implementing intensity modulated radiotherapy (IMRT), including fixed gantry with multiple static MLC fields (MSMLC - often referred to as 'stop and shoot'), fixed gantry with dynamic MLC (DMLC), intensity modulated arc therapy (IMAT), Tomotherapy and Peacock MIMiC. Using two complex head and neck cases as examples, we have compared dose distributions achievable with 3-D conformal radiotherapy (3DCRT) to those which can be achieved using IMRT delivered with MSMLC, DMLC and Peacock MIMiC. The goal is to demonstrate the potential value of IMRT in the treatment of complex lesions in the head and neck and to determine whether MSMLC, the simplest of the proposed IMRT methods, can produce dose distributions which are competitive with dynamic IMRT methods and which can be implemented in clinically acceptable times. Materials and Methods: Two patients with nasopharyngeal carcinoma were selected from the archives of the Department of Radiation Oncology at the University of California, San Francisco (UCSF). These patients were previously planned and treated with CT-based 3-D treatment planning methods which are routinely used at UCSF, including non-axial beam directions and partial transmission blocks when indicated. The CT data tapes were then read into a test version of CORVUS, an inverse treatment planning program being developed by NOMOS Corporation, target volumes and critical normal structures were outlined on axial CT slices and dose goals and limits were defined for the targets and normal tissues of interest. Optimized dose plans were then obtained for each delivery method including MSMLC (4 or 5 hand-selected beams with 3 levels of intensity), DMLC (9 evenly spaced axial beams with 10 levels of intensity) and Peacock MIMiC (55 axial beams spanning 270 degrees with 10 levels of intensity). Dose-volume histograms (DVH's) for all IMRT plans were then compared with the 3DCRT plans. Treatment

Mobility potential of a robotic six-wheeled omnidirectional drive vehicle (ODV) with z-axis and tire inflation control

Science.gov (United States)

Witus, Gary

2000-07-01

Robot vehicle mobility is the product of the physical configuration, mechatronics (sensors, actuators, and control) and the motion programs for different obstacles, terrain conditions, and maneuver objectives. This paper examines the mobility potential of a robotic 6-by-6 wheeled omni-directional drive vehicle (ODV) with z-axis and tire inflation control. Ad ODV can steer and drive all wheels independently. The direction of motion is independent of the orientation of the body. Z- axis control refers to independent control of the suspension elevation at each wheel. Pneumatic tire inflation control provides the ability to inflate and deflate individual tires. The paper describes motion programs for various discrete obstacles and challenging terrain conditions. The paper illustrates how ODV control, z-axis control and tire inflation control interact to provide high mobility with respect to cornering, maneuvering on slopes, negotiating vertical step and horizontal gap obstacles, and braking/acceleration on soft soil and slick surfaces. The paper derives guidelines for the physical dimensions of the vehicle needed to achieve these capabilities.

Usefulness of Non-coplanar Helical Tomotherapy Using Variable Axis Baseplate

International Nuclear Information System (INIS)

Ha, Jin Sook; Chung, Yoon Sun; Lee, Ik Jae; Shin, Dong Bong; Kim, Jong Dae; Kim, Sei Joon; Jeon, Mi Jin; Chok, Yoon Jin; Kim, Ki Kwang; Lee, Seul Bee

2011-01-01

who did not use, but the mean of Y-axis movement was lower by at least 64%, and the mean of Z-axis was lower by at least 67%, and the mean of Z-axis was lower by at least 67%, and the vector was lower by at least 59% with the use of a mouthpiece. Among these 8 patients, one patient whose tumor was located on left frontal lobe and left basal ganglia received reduced radiation dose of 38% in right eye, 23% in left eye, 30% in optic chiasm, 27% in brain stem, and 8% in normal brain with non-coplanar method. Tomotherapy only allows coplanar delivery of IMRT treatment. To complement this shortcoming, Tomotherapy can be used with non-coplanar method by artificially tilting the patient's head and using an oral immobilization instrument to minimize the movement of patient, when intracranial tumor locates near critical organs or has to be treated with high dose radiation.

Intensity-modulated radiation therapy for head and neck cancers with bilateral irradiation of the neck: preliminary results; Radiotherapie conformationnelle avec modulation d'intensite des cancers des voies aerodigestives superieures avec irradiation bilaterale du cou: resultats preliminaires

Energy Technology Data Exchange (ETDEWEB)

Lapeyre, M.; Mege, A.; Mege, P.; Racadot, S.; Marchal, C. [Centre Alexis-Vautrin, Dept. de radiotherapie, avenue de Bourgogne, Unite de radiotherapie externe, 54 - Vandoeuvre-les-Nancy (France); Marchesi, V.; Aletti, P.; Noel, A. [Centre Alexis-Vautrin, Dept. de radiotherapie, avenue de Bourgogne, Unite de radiophysique, 54 - Vandoeuvre-les-Nancy (France); Noel, A.; Marchal, C. [Institut National Polytechnique de Lorraine, Universite Henri-Poincare, Centre de Recherche en Automatique de Nancy, UMR CNRS 7039 Nancy-I, 54 - Vandoeuvre-les-Nancy (France)

2004-06-01

Purpose. - To report preliminary results of a prospective study of intensity-modulated radiotherapy (IMRT) for head and neck squamous cell carcinoma (HNC) with bilateral irradiation of the neck. Patients and methods. - At the Alexis Vautrin Cancer Center, 23 patients have been treated with IMRT for HNC since January 2002-August 2003. The first 10 patients with a minimum follow-up of 3 months were analyzed. All tumors were oropharyngeal. There were four females and six males, with a mean age of 50 years (range 39-66). Stages were I-II in eight and III-IV in two. CTV1 was microscopic disease and N0 neck (prescribed dose: 50 Gy) and CTV2 was macroscopic disease and the volume at risk (prescribed dose: 66-70 Gy). PTV were CTV + 5 mm. Patient's immobilization consisted of a five-point head neck shoulder thermoplastic mask. Set-up verifications were done by semi-automatically matching portal images and digitized reconstructed radiographs. IMRT used dynamic multi-leaf collimation. Five patients (group A) received 50 Gy IMRT (two post-operative and three with a brachytherapy boost with a mean dose: 27.5 Gy), and five patients (group B) received 66-70 Gy IMRT (four post-operative). Acute and late normal tissue effects were graded according to the RTOG-EORTC radiation morbidity scoring criteria. Results. - With a median follow-up of 7.4 months (range 3-18.5), no patient died or had loco-regional relapse. The displacements were <4 mm in 98% cases. CTV1 and 2 received 95% of the prescribed dose in 100% of the volume. On average the mean dose to the contralateral parotid was 25.5 Gy for group A vs. 31 Gy for group B (P = 0.09). Mean doses <26 Gy were obtained in three of five patients in group A vs. zero of five patients in group B (P = 0.04). Acute skin toxicities were grade 1 in five patients, grade 2 in four and grade 3 in one. Acute mucositis cases were grade 1 in three patients, grade 2 in five and localized grade 3 in two. At 3 months, 50% of the patients had a grade

Assessment of Parotid Gland Dose Changes During Head and Neck Cancer Radiotherapy Using Daily Megavoltage Computed Tomography and Deformable Image Registration

International Nuclear Information System (INIS)

Lee, Choonik; Langen, Katja M.; Lu Weiguo; Haimerl, Jason; Schnarr, Eric; Ruchala, Kenneth J.; Olivera, Gustavo H.; Meeks, Sanford L.; Kupelian, Patrick A.; Shellenberger, Thomas D.; Manon, Rafael R.

2008-01-01

Purpose: To analyze changes in parotid gland dose resulting from anatomic changes throughout a course of radiotherapy in a cohort of head-and-neck cancer patients. Methods and Materials: The study population consisted of 10 head-and-neck cancer patients treated definitively with intensity-modulated radiotherapy on a helical tomotherapy unit. A total of 330 daily megavoltage computed tomography images were retrospectively processed through a deformable image registration algorithm to be registered to the planning kilovoltage computed tomography images. The process resulted in deformed parotid contours and voxel mappings for both daily and accumulated dose-volume histogram calculations. The daily and cumulative dose deviations from the original treatment plan were analyzed. Correlations between dosimetric variations and anatomic changes were investigated. Results: The daily parotid mean dose of the 10 patients differed from the plan dose by an average of 15%. At the end of the treatment, 3 of the 10 patients were estimated to have received a greater than 10% higher mean parotid dose than in the original plan (range, 13-42%), whereas the remaining 7 patients received doses that differed by less than 10% (range, -6-8%). The dose difference was correlated with a migration of the parotids toward the high-dose region. Conclusions: The use of deformable image registration techniques and daily megavoltage computed tomography imaging makes it possible to calculate daily and accumulated dose-volume histograms. Significant dose variations were observed as result of interfractional anatomic changes. These techniques enable the implementation of dose-adaptive radiotherapy

Intensity modulated radiation therapy for head and neck cancer: The standard; Radiotherapie avec modulation d'intensite pour les cancers de la tete et du cou: le standard

Energy Technology Data Exchange (ETDEWEB)

Maingon, P.; Crehange, G.; Chamois, J.; Khoury, C.; Truc, G. [Departement de radiotherapie, centre Georges-Francois-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex (France)

2011-10-15

Combined radical radiation therapy for head and neck carcinoma should be planned with intensity modulated beams to provide a rapid answer to patients' requirements in terms of quality of treatment. The most frequent late toxicity of radiation therapy is xerostomia, which may be prevented by using this technique able to significantly spare salivary glands irradiation. Selection of indications is a very important step. The objective of sparing salivary functions, strongly associated with optimization criteria of quality of life should be considered as a main objective in irradiation of head and neck tumours. The various possibilities offered by this technique allowing to boost a target volume included in prophylactically irradiated regions could offer the possibility to escalate the dose in selected patients. The feasibility of this process is currently validated in prospective studies. Finally, routine implementation of intensity modulated radiation therapy should be performed with strong and robust quality assurance procedures, ensuring that the expected benefit could be increased with the current developments by using rotational techniques. (authors)

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

NARCIS (Netherlands)

van der Molen, Lisette; Heemsbergen, Wilma D.; de Jong, Rianne; van Rossum, Maya A.; Smeele, Ludi E.; Rasch, Coen R. N.; Hilgers, Frans J. M.

2013-01-01

Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters

SU-E-T-368: Evaluating Dosimetric Outcome of Modulated Photon Radiotherapy (XMRT) Optimization for Head and Neck Patients

Energy Technology Data Exchange (ETDEWEB)

McGeachy, P; Villarreal-Barajas, JE; Khan, R [University of Calgary, Calgary, AB (Canada); Tom Baker Cancer Centre, Calgary, AB (Canada); Zinchenko, Y [University of Calgary, Calgary, AB (Canada)

2015-06-15

Purpose: The dosimetric outcome of optimized treatment plans obtained by modulating the photon beamlet energy and fluence on a small cohort of four Head and Neck (H and N) patients was investigated. This novel optimization technique is denoted XMRT for modulated photon radiotherapy. The dosimetric plans from XMRT for H and N treatment were compared to conventional, 6 MV intensity modulated radiotherapy (IMRT) optimization plans. Methods: An arrangement of two non-coplanar and five coplanar beams was used for all four H and N patients. Both XMRT and IMRT were subject to the same optimization algorithm, with XMRT optimization allowing both 6 and 18 MV beamlets while IMRT was restricted to 6 MV only. The optimization algorithm was based on a linear programming approach with partial-volume constraints implemented via the conditional value-at-risk method. H and N constraints were based off of those mentioned in the Radiation Therapy Oncology Group 1016 protocol. XMRT and IMRT solutions were assessed using metrics suggested by International Commission on Radiation Units and Measurements report 83. The Gurobi solver was used in conjunction with the CVX package to solve each optimization problem. Dose calculations and analysis were done in CERR using Monte Carlo dose calculation with VMC{sub ++}. Results: Both XMRT and IMRT solutions met all clinical criteria. Trade-offs were observed between improved dose uniformity to the primary target volume (PTV1) and increased dose to some of the surrounding healthy organs for XMRT compared to IMRT. On average, IMRT improved dose to the contralateral parotid gland and spinal cord while XMRT improved dose to the brainstem and mandible. Conclusion: Bi-energy XMRT optimization for H and N patients provides benefits in terms of improved dose uniformity to the primary target and reduced dose to some healthy structures, at the expense of increased dose to other healthy structures when compared with IMRT.

Intensity-Modulated Radiotherapy for Craniospinal Irradiation: Target Volume Considerations, Dose Constraints, and Competing Risks

International Nuclear Information System (INIS)

Parker, William; Filion, Edith; Roberge, David; Freeman, Carolyn R.

2007-01-01

Purpose: To report the results of an analysis of dose received to tissues and organs outside the target volume, in the setting of spinal axis irradiation for the treatment of medulloblastoma, using three treatment techniques. Methods and Materials: Treatment plans (total dose, 23.4 Gy) for a standard two-dimensional (2D) technique, a three-dimensional (3D) technique using a 3D imaging-based target volume, and an intensity-modulated radiotherapy (IMRT) technique, were compared for 3 patients in terms of dose-volume statistics for target coverage, as well as organ at risk (OAR) and overall tissue sparing. Results: Planning target volume coverage and dose homogeneity was superior for the IMRT plans for V 95% (IMRT, 100%; 3D, 96%; 2D, 98%) and V 107% (IMRT, 3%; 3D, 38%; 2D, 37%). In terms of OAR sparing, the IMRT plan was better for all organs and whole-body contour when comparing V 10Gy , V 15Gy , and V 20Gy . The 3D plan was superior for V 5Gy and below. For the heart and liver in particular, the IMRT plans provided considerable sparing in terms of V 10Gy and above. In terms of the integral dose, the IMRT plans were superior for liver (IMRT, 21.9 J; 3D, 28.6 J; 2D, 38.6 J) and heart (IMRT, 9 J; 3D, 14.1J; 2D, 19.4 J), the 3D plan for the body contour (IMRT, 349 J; 3D, 337 J; 2D, 555 J). Conclusions: Intensity-modulated radiotherapy is a valid treatment option for spinal axis irradiation. We have shown that IMRT results in sparing of organs at risk without a significant increase in integral dose

Does IGRT ensure target dose coverage of head and neck IMRT patients?

International Nuclear Information System (INIS)

Graff, Pierre; Hu Weigang; Yom, Sue S.; Pouliot, Jean

2012-01-01

Purpose: To determine if image-guided radiotherapy (IGRT) ensures dose coverage to the target, and to assess the dosimetric impact of anatomic changes using megavoltage cone-beam CT (MVCBCT) for patient positioning during head and neck IMRT. Methods and materials: Forty-eight MVCBCT from 10 head and neck IMRT/IGRT patients were analyzed off-line. Target volumes and organs at risk (OARs) contours delineated on CT were transferred and adjusted on MVCBCT images. Each MVCBCT was processed to allow dose recalculation, resulting in 469 dose–volume histograms (DVHs). The concept of dosimetric latitude was introduced to provide a clinical perspective. Results: MVCBCT target DVHs showed a moderate level of difference in D95 (dose to ⩾95% of volume), generally less than a 5% difference from the planned dose. Delivered-dose increases to the spinal cord and brainstem showed no apparent time trend. The 4 mm margin around OARs was a useful precaution to prevent exceeding critical dose thresholds. The parotid glands showed progressive increases in mean dose related to shrinkage of the external contours. Conclusion: IGRT repositioning ensured target volume coverage, but significant dose variations were observed for OARs. The dosimetric impact of anatomic changes during radiotherapy was of lesser importance than the effects of IGRT repositioning.

Assessing doses of radiotherapy with the risk of developing cancer in the head and neck

International Nuclear Information System (INIS)

Yu, Cheng-Ching; Hsu, Fang-Yuh; Yu, Wan-Hsuan; Liu, Mu-Tai; Huang, Sheng-Shien

2011-01-01

Radiation is known to be a major cause of cancer in normal tissue. After treatment with radiotherapy, for young patients or the patients can survive for a long time, the radiation-induced cancer risk is noteworthy. This research investigated the dose delivered by the treatment of intensity modulated radiation therapy (IMRT) for head and neck cancer, such as NPC and oral cancer, and assessed the risk of developing radiation-induced secondary cancer in non-targeted normal tissues. A Rando phantom was used to simulate a patient with NPC or oral cancer, and thermoluminescent dosimeter (TLD) chips were placed inside the phantom to estimate the doses delivered by IMRT. In summary, the risks to patients with NPC was somewhat higher than for those with oral cancer, because the region of the PTV was lower, requiring larger field sizes be used for cases of NPC. The smaller the field size used, the less the risk was of developing secondary cancer. In addition, the higher the value of MU used, the higher the dose delivered to normal tissues was. The risk of radiation-induced secondary cancer was proportional to the delivered dose.

Effect of patient setup errors on simultaneously integrated boost head and neck IMRT treatment plans

International Nuclear Information System (INIS)

Siebers, Jeffrey V.; Keall, Paul J.; Wu Qiuwen; Williamson, Jeffrey F.; Schmidt-Ullrich, Rupert K.

2005-01-01

Purpose: The purpose of this study is to determine dose delivery errors that could result from random and systematic setup errors for head-and-neck patients treated using the simultaneous integrated boost (SIB)-intensity-modulated radiation therapy (IMRT) technique. Methods and Materials: Twenty-four patients who participated in an intramural Phase I/II parotid-sparing IMRT dose-escalation protocol using the SIB treatment technique had their dose distributions reevaluated to assess the impact of random and systematic setup errors. The dosimetric effect of random setup error was simulated by convolving the two-dimensional fluence distribution of each beam with the random setup error probability density distribution. Random setup errors of σ = 1, 3, and 5 mm were simulated. Systematic setup errors were simulated by randomly shifting the patient isocenter along each of the three Cartesian axes, with each shift selected from a normal distribution. Systematic setup error distributions with Σ = 1.5 and 3.0 mm along each axis were simulated. Combined systematic and random setup errors were simulated for σ = Σ = 1.5 and 3.0 mm along each axis. For each dose calculation, the gross tumor volume (GTV) received by 98% of the volume (D 98 ), clinical target volume (CTV) D 90 , nodes D 90 , cord D 2 , and parotid D 50 and parotid mean dose were evaluated with respect to the plan used for treatment for the structure dose and for an effective planning target volume (PTV) with a 3-mm margin. Results: Simultaneous integrated boost-IMRT head-and-neck treatment plans were found to be less sensitive to random setup errors than to systematic setup errors. For random-only errors, errors exceeded 3% only when the random setup error σ exceeded 3 mm. Simulated systematic setup errors with Σ = 1.5 mm resulted in approximately 10% of plan having more than a 3% dose error, whereas a Σ = 3.0 mm resulted in half of the plans having more than a 3% dose error and 28% with a 5% dose error

Intensity-Modulated Radiotherapy With Use of Cone-Down Boost for Pediatric Head-and-Neck Rhabdomyosarcoma

International Nuclear Information System (INIS)

McDonald, Mark W.; Esiashvili, Natia; George, Bradley A.; Katzenstein, Howard M.; Olson, Thomas A.; Rapkin, Louis B.; Marcus, Robert B.

2008-01-01

Purpose: To report our initial experience using intensity-modulated radiotherapy (IMRT) with a cone-down boost for pediatric head-and-neck rhabdomyosarcoma (RMS). Methods and Materials: A review of institutional treatment records identified children treated with IMRT for head-and-neck RMS between January 2000 and February 2007. All patients had undergone chemotherapy according to cooperative group RMS protocols. The initial planning target volume (PTV) covered the prechemotherapy tumor extent with variable margins, generally 1-2 cm. The boost PTV covered the postchemotherapy tumor volume, usually with a margin of 0.5-1 cm. Results: A total of 20 patients were treated with IMRT for head-and-neck RMS. Of these 20 patients, 4 had Group II, 15 Group III, and 1 Group IV disease. The site was parameningeal in 12, nonparameningeal in 6, and orbit primary in 2. Of the 20 patients, 14 were treated with a cone-down boost after a median dose of 36 Gy (range, 30-45.6). The mean initial PTV was 213.5 cm 3 , and the mean boost PTV was 76.9 cm 3 . Patients received a median total dose of 50.4 Gy. The median follow-up time was 29 months. The 3-year Kaplan-Meier local control rate was 100%, although 1 patient developed an in-field recurrence 50 months after IMRT. The 3-year event-free survival rate, overall survival rate, and risk of central nervous system failure was 74%, 76%, and 7%, respectively. Conclusions: Our preliminary follow-up of pediatric head-and-neck RMS patients treated with IMRT revealed excellent local control. The initial targeting of the prechemotherapy tumor volume with 1-2-cm margin to 30.6 or 36 Gy followed by a cone-down boost to the postchemotherapy tumor volume with a 0.5-1-cm margin allowed for significant sparing of normal tissues and provided good local control

Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Dawson, Laura A.; Anzai, Yoshimi; Marsh, Lon; Martel, Mary K.; Paulino, Augusto; Ship, Jonathan A.; Eisbruch, Avraham

2000-01-01

Purpose: To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT). Methods and Materials: Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) 'in-field', in which 95% or more of the recurrence volume (V recur ) was within the 95% isodose; 2) 'marginal', in which 20% to 95% of V recur was within the 95% isodose; or 3) 'outside', in which less than 20% of V recur was within the 95% isodose. Results: With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences

Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer.

Science.gov (United States)

Dawson, L A; Anzai, Y; Marsh, L; Martel, M K; Paulino, A; Ship, J A; Eisbruch, A

2000-03-15

To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT). Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) "in-field," in which 95% or more of the recurrence volume (V(recur)) was within the 95% isodose; 2) "marginal," in which 20% to 95% of V(recur) was within the 95% isodose; or 3) "outside," in which less than 20% of V(recur) was within the 95% isodose. With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences (including one noninvasive recurrence) and 1

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)

Relative plan robustness of step-and-shoot vs rotational intensity–modulated radiotherapy on repeat computed tomographic simulation for weight loss in head and neck cancer

International Nuclear Information System (INIS)

Thomson, David J.; Beasley, William J.; Garcez, Kate; Lee, Lip W.; Sykes, Andrew J.; Rowbottom, Carl G.; Slevin, Nicholas J.

2016-01-01

Introduction: Interfractional anatomical alterations may have a differential effect on the dose delivered by step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). The increased degrees of freedom afforded by rotational delivery may increase plan robustness (measured by change in target volume coverage and doses to organs at risk [OARs]). However, this has not been evaluated for head and neck cancer. Materials and methods: A total of 10 patients who required repeat computed tomography (CT) simulation and replanning during head and neck IMRT were included. Step-and-shoot IMRT and VMAT plans were generated from the original planning scan. The initial and second CT simulation scans were fused and targets/OAR contours transferred, reviewed, and modified. The plans were applied to the second CT scan and doses recalculated without repeat optimization. Differences between step-and-shoot IMRT and VMAT for change in target volume coverage and doses to OARs between first and second CT scans were compared by Wilcoxon signed rank test. Results: There were clinically relevant dosimetric changes between the first and the second CT scans for both the techniques (reduction in mean D_9_5_% for PTV2 and PTV3, D_m_i_n for CTV2 and CTV3, and increased mean doses to the parotid glands). However, there were no significant differences between step-and-shoot IMRT and VMAT for change in any target coverage parameter (including D_9_5_% for PTV2 and PTV3 and D_m_i_n for CTV2 and CTV3) or dose to any OARs (including parotid glands) between the first and the second CT scans. Conclusions: For patients with head and neck cancer who required replanning mainly due to weight loss, there were no significant differences in plan robustness between step-and-shoot IMRT and VMAT. This information is useful with increased clinical adoption of VMAT.

Highly preserved consensus gene modules in human papilloma virus 16 positive cervical cancer and head and neck cancers.

Science.gov (United States)

Zhang, Xianglan; Cha, In-Ho; Kim, Ki-Yeol

2017-12-26

In this study, we investigated the consensus gene modules in head and neck cancer (HNC) and cervical cancer (CC). We used a publicly available gene expression dataset, GSE6791, which included 42 HNC, 14 normal head and neck, 20 CC and 8 normal cervical tissue samples. To exclude bias because of different human papilloma virus (HPV) types, we analyzed HPV16-positive samples only. We identified 3824 genes common to HNC and CC samples. Among these, 977 genes showed high connectivity and were used to construct consensus modules. We demonstrated eight consensus gene modules for HNC and CC using the dissimilarity measure and average linkage hierarchical clustering methods. These consensus modules included genes with significant biological functions, including ATP binding and extracellular exosome. Eigengen network analysis revealed the consensus modules were highly preserved with high connectivity. These findings demonstrate that HPV16-positive head and neck and cervical cancers share highly preserved consensus gene modules with common potentially therapeutic targets.

Seeded perturbations in wire array Z-Pinches

International Nuclear Information System (INIS)

Robinson, Allen Conrad; Fedin, Dmitry; Kantsyrev, Victor Leonidovich; Wunsch, Scott Edward; Oliver, Bryan Velten; Lebedev, Sergey V.; Coverdale, Christine Anne; Ouart, Nicholas D.; LePell, Paul David; Safronova, Alla S.; Shrestha, I.; McKenney, John Lee; Ampleford, David J.; Rapley, J.; Bott, S.C.; Palmer, J.B.A.; Sotnikov, Vladimir Isaakovich; Bland, Simon Nicholas; Ivanov, Vladimir V.; Chittenden, Jeremy Paul; Jones, B.; Garasi, Christopher Joseph; Hall, Gareth Neville; Yilmaz, M. Faith; Mehlhorn, Thomas Alan; Deeney, Christopher; Pokala, S.; Nalajala, V.

2005-01-01

Controlled seeding of perturbations is employed to study the evolution of wire array z-pinch implosion instabilities which strongly impact x-ray production when the 3D plasma stagnates on axis. Wires modulated in radius exhibit locally enhanced magnetic field and imploding bubble formation at discontinuities in wire radius due to the perturbed current path. Wires coated with localized spectroscopic dopants are used to track turbulent material flow. Experiments and MHD modeling offer insight into the behavior of z-pinch instabilities.

Low Z target switching to increase tumor endothelial cell dose enhancement during gold nanoparticle-aided radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Berbeco, Ross I., E-mail: rberbeco@partners.org; Detappe, Alexandre [Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts 02115 (United States); Tsiamas, Panogiotis [Department of Radiation Oncology, St. Jude Children’s Hospital, Memphis, Tennessee 38105 (United States); Parsons, David; Yewondwossen, Mammo; Robar, James [Department of Radiation Oncology and Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia B3H 1V7 (Canada)

2016-01-15

Purpose: Previous studies have introduced gold nanoparticles as vascular-disrupting agents during radiation therapy. Crucial to this concept is the low energy photon content of the therapy radiation beam. The authors introduce a new mode of delivery including a linear accelerator target that can toggle between low Z and high Z targets during beam delivery. In this study, the authors examine the potential increase in tumor blood vessel endothelial cell radiation dose enhancement with the low Z target. Methods: The authors use Monte Carlo methods to simulate delivery of three different clinical photon beams: (1) a 6 MV standard (Cu/W) beam, (2) a 6 MV flattening filter free (Cu/W), and (3) a 6 MV (carbon) beam. The photon energy spectra for each scenario are generated for depths in tissue-equivalent material: 2, 10, and 20 cm. The endothelial dose enhancement for each target and depth is calculated using a previously published analytic method. Results: It is found that the carbon target increases the proportion of low energy (<150 keV) photons at 10 cm depth to 28% from 8% for the 6 MV standard (Cu/W) beam. This nearly quadrupling of the low energy photon content incident on a gold nanoparticle results in 7.7 times the endothelial dose enhancement as a 6 MV standard (Cu/W) beam at this depth. Increased surface dose from the low Z target can be mitigated by well-spaced beam arrangements. Conclusions: By using the fast-switching target, one can modulate the photon beam during delivery, producing a customized photon energy spectrum for each specific situation.

Evaluation of dose prediction errors and optimization convergence errors of deliverable-based head-and-neck IMRT plans computed with a superposition/convolution dose algorithm

International Nuclear Information System (INIS)

Mihaylov, I. B.; Siebers, J. V.

2008-01-01

The purpose of this study is to evaluate dose prediction errors (DPEs) and optimization convergence errors (OCEs) resulting from use of a superposition/convolution dose calculation algorithm in deliverable intensity-modulated radiation therapy (IMRT) optimization for head-and-neck (HN) patients. Thirteen HN IMRT patient plans were retrospectively reoptimized. The IMRT optimization was performed in three sequential steps: (1) fast optimization in which an initial nondeliverable IMRT solution was achieved and then converted to multileaf collimator (MLC) leaf sequences; (2) mixed deliverable optimization that used a Monte Carlo (MC) algorithm to account for the incident photon fluence modulation by the MLC, whereas a superposition/convolution (SC) dose calculation algorithm was utilized for the patient dose calculations; and (3) MC deliverable-based optimization in which both fluence and patient dose calculations were performed with a MC algorithm. DPEs of the mixed method were quantified by evaluating the differences between the mixed optimization SC dose result and a MC dose recalculation of the mixed optimization solution. OCEs of the mixed method were quantified by evaluating the differences between the MC recalculation of the mixed optimization solution and the final MC optimization solution. The results were analyzed through dose volume indices derived from the cumulative dose-volume histograms for selected anatomic structures. Statistical equivalence tests were used to determine the significance of the DPEs and the OCEs. Furthermore, a correlation analysis between DPEs and OCEs was performed. The evaluated DPEs were within ±2.8% while the OCEs were within 5.5%, indicating that OCEs can be clinically significant even when DPEs are clinically insignificant. The full MC-dose-based optimization reduced normal tissue dose by as much as 8.5% compared with the mixed-method optimization results. The DPEs and the OCEs in the targets had correlation coefficients greater

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients.

Science.gov (United States)

Fregnani, Eduardo Rodrigues; Parahyba, Cláudia Joffily; Morais-Faria, Karina; Fonseca, Felipe Paiva; Ramos, Pedro Augusto Mendes; de Moraes, Fábio Yone; da Conceição Vasconcelos, Karina Gondim Moutinho; Menegussi, Gisela; Santos-Silva, Alan Roger; Brandão, Thais B

2016-09-07

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient's morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients' treatment plans. Clinicopathological data were retrieved from patients' medical files. The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p radiation doses to teeth than 3DRT, but only for some groups of patients and teeth, suggesting that this decrease was more likely due to the protection of

TU-EF-204-07: Add Tube Current Modulation to a Low Dose Simulation Tool for CT Systems

International Nuclear Information System (INIS)

Ding, Y.; Wen, G.; Brown, K.; Klahr, P.; Dhanantwari, A.

2015-01-01

Purpose: We extended the capabilities of a low dose simulation tool to model Tube-Current Modulation (TCM). TCM is widely used in clinical practice to reduce radiation dose in CT scans. We expect the tool to be valuable for various clinical applications (e.g., optimize protocols, compare reconstruction techniques and evaluate TCM methods). Methods: The tube current is input as a function of z location, instead of a fixed value. Starting from the line integrals of a scan, a new Poisson noise realization at a lower dose is generated for each view. To validate the new functionality, we compared simulated scans with real scans in image space. Results: First we assessed noise in the difference between the low-dose simulations and the original high-dose scan. When the simulated tube current is a step function of z location, the noise at each segment matches the noise of 3 separate constant-tube-current-simulations. Secondly, with a phantom that forces TCM, we compared a low-dose simulation with an equivalent real low-dose scan. The mean CT number of the simulated scan and the real low-dose scan were 137.7±0.6 and 137.8±0.5 respectively. Furthermore, with 240 ROIs, the noise of the simulated scan and the real low-dose scan were 24.03±0.45 and 23.99±0.43 respectively, and they were not statistically different (2-sample t-test, p-value=0.28). The facts that the noise reflected the trend of the TCM curve, and that the absolute noise measurements were not statistically different validated the TCM function. Conclusion: We successfully added tube-current modulation functionality in an existing low dose simulation tool. We demonstrated that the noise reflected an input tube-current modulation curve. In addition, we verified that the noise and mean CT number of our simulation agreed with a real low dose scan. The authors are all employees of Philips. Yijun Ding is also supported by NIBIB P41EB002035 and NIBIB R01EB000803

The evaluation of composite dose using deformable image registration in adaptive radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Hwang, Chul Hwan; Ko, Seong Jin; Kim, Chang Soo; Kim, Jung Hoon; Kim, Dong Hyun; Choi, Seok Yoon; Ye, Soo Young; Kang, Se Sik

2013-01-01

In adaptive radiotherapy(ART), generated composite dose of surrounding normal tissue on overall treatment course which is using deformable image registration from multistage images. Also, compared with doses summed by each treatment plan and clinical significance is considered. From the first of May, 2011 to the last of July, 2012. Patients who were given treatment and had the head and neck cancer with 3-dimension conformal radiotherapy or intensity modulated radiotherapy, those who were carried out adaptive radiotherapy cause of tumor shrinkage and weight loss. Generated composite dose of surrounding normal tissue using deformable image registration was been possible, statistically significant difference was showed to mandible(48.95±3.89 vs 49.10±3.55 Gy), oral cavity(36.93±4.03 vs 38.97±5.08 Gy), parotid gland(35.71±6.22 vs 36.12±6.70 Gy) and temporomandibular joint(18.41±9.60 vs 20.13±10.42 Gy) compared with doses summed by each treatment plan. The results of this study show significant difference between composite dose by deformable image registration and doses summed by each treatment plan, composite dose by deformable image registration may generate more exact evaluation to surrounding normal tissue in adaptive radiotherapy

The evaluation of composite dose using deformable image registration in adaptive radiotherapy for head and neck cancer

Energy Technology Data Exchange (ETDEWEB)

Hwang, Chul Hwan; Ko, Seong Jin; Kim, Chang Soo; Kim, Jung Hoon; Kim, Dong Hyun; Choi, Seok Yoon; Ye, Soo Young; Kang, Se Sik [Dept. of Radiological Science, College of Health Sciences, Catholic University of Pusan, Pusan (Korea, Republic of)

2013-09-15

In adaptive radiotherapy(ART), generated composite dose of surrounding normal tissue on overall treatment course which is using deformable image registration from multistage images. Also, compared with doses summed by each treatment plan and clinical significance is considered. From the first of May, 2011 to the last of July, 2012. Patients who were given treatment and had the head and neck cancer with 3-dimension conformal radiotherapy or intensity modulated radiotherapy, those who were carried out adaptive radiotherapy cause of tumor shrinkage and weight loss. Generated composite dose of surrounding normal tissue using deformable image registration was been possible, statistically significant difference was showed to mandible(48.95±3.89 vs 49.10±3.55 Gy), oral cavity(36.93±4.03 vs 38.97±5.08 Gy), parotid gland(35.71±6.22 vs 36.12±6.70 Gy) and temporomandibular joint(18.41±9.60 vs 20.13±10.42 Gy) compared with doses summed by each treatment plan. The results of this study show significant difference between composite dose by deformable image registration and doses summed by each treatment plan, composite dose by deformable image registration may generate more exact evaluation to surrounding normal tissue in adaptive radiotherapy.

Dose variations with varying calculation grid size in head and neck IMRT

Energy Technology Data Exchange (ETDEWEB)

Chung, Heeteak [Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Fl 32611-8300 (United States); Jin, Hosang [Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Fl 32611-8300 (United States); Palta, Jatinder [Department of Radiation Oncology, University of Florida, Gainesville, Fl 32610-0385 (United States); Suh, Tae-Suk [Department of Biomedical Engineering, Catholic University of Korea (Korea, Republic of); Kim, Siyong [Department of Radiation Oncology, University of Florida, Gainesville, Fl 32610-0385 (United States)

2006-10-07

Ever since the advent and development of treatment planning systems, the uncertainty associated with calculation grid size has been an issue. Even to this day, with highly sophisticated 3D conformal and intensity-modulated radiation therapy (IMRT) treatment planning systems (TPS), dose uncertainty due to grid size is still a concern. A phantom simulating head and neck treatment was prepared from two semi-cylindrical solid water slabs and a radiochromic film was inserted between the two slabs for measurement. Plans were generated for a 5400 cGy prescribed dose using Philips Pinnacle{sup 3} TPS for two targets, one shallow ({approx}0.5 cm depth) and one deep ({approx}6 cm depth). Calculation grid sizes of 1.5, 2, 3 and 4 mm were considered. Three clinical cases were also evaluated. The dose differences for the varying grid sizes (2 mm, 3 mm and 4 mm from 1.5 mm) in the phantom study were 126 cGy (2.3% of the 5400 cGy dose prescription), 248.2 cGy (4.6% of the 5400 cGy dose prescription) and 301.8 cGy (5.6% of the 5400 cGy dose prescription), respectively for the shallow target case. It was found that the dose could be varied to about 100 cGy (1.9% of the 5400 cGy dose prescription), 148.9 cGy (2.8% of the 5400 cGy dose prescription) and 202.9 cGy (3.8% of the 5400 cGy dose prescription) for 2 mm, 3 mm and 4 mm grid sizes, respectively, simply by shifting the calculation grid origin. Dose difference with a different range of the relative dose gradient was evaluated and we found that the relative dose difference increased with an increase in the range of the relative dose gradient. When comparing varying calculation grid sizes and measurements, the variation of the dose difference histogram was insignificant, but a local effect was observed in the dose difference map. Similar results were observed in the case of the deep target and the three clinical cases also showed results comparable to those from the phantom study.

Dose variations with varying calculation grid size in head and neck IMRT

International Nuclear Information System (INIS)

Chung, Heeteak; Jin, Hosang; Palta, Jatinder; Suh, Tae-Suk; Kim, Siyong

2006-01-01

Ever since the advent and development of treatment planning systems, the uncertainty associated with calculation grid size has been an issue. Even to this day, with highly sophisticated 3D conformal and intensity-modulated radiation therapy (IMRT) treatment planning systems (TPS), dose uncertainty due to grid size is still a concern. A phantom simulating head and neck treatment was prepared from two semi-cylindrical solid water slabs and a radiochromic film was inserted between the two slabs for measurement. Plans were generated for a 5400 cGy prescribed dose using Philips Pinnacle 3 TPS for two targets, one shallow (∼0.5 cm depth) and one deep (∼6 cm depth). Calculation grid sizes of 1.5, 2, 3 and 4 mm were considered. Three clinical cases were also evaluated. The dose differences for the varying grid sizes (2 mm, 3 mm and 4 mm from 1.5 mm) in the phantom study were 126 cGy (2.3% of the 5400 cGy dose prescription), 248.2 cGy (4.6% of the 5400 cGy dose prescription) and 301.8 cGy (5.6% of the 5400 cGy dose prescription), respectively for the shallow target case. It was found that the dose could be varied to about 100 cGy (1.9% of the 5400 cGy dose prescription), 148.9 cGy (2.8% of the 5400 cGy dose prescription) and 202.9 cGy (3.8% of the 5400 cGy dose prescription) for 2 mm, 3 mm and 4 mm grid sizes, respectively, simply by shifting the calculation grid origin. Dose difference with a different range of the relative dose gradient was evaluated and we found that the relative dose difference increased with an increase in the range of the relative dose gradient. When comparing varying calculation grid sizes and measurements, the variation of the dose difference histogram was insignificant, but a local effect was observed in the dose difference map. Similar results were observed in the case of the deep target and the three clinical cases also showed results comparable to those from the phantom study

In vivo verification of superficial dose for head and neck treatments using intensity-modulated techniques

International Nuclear Information System (INIS)

Qi Zhenyu; Deng Xiaowu; Huang Shaomin; Zhang Li; He Zhichun; Allen Li, X.; Kwan, Ian; Lerch, Michael; Cutajar, Dean; Metcalfe, Peter; Rosenfeld, Anatoly

2009-01-01

Skin dose is one of the key issues for clinical dosimetry in radiation therapy. Currently planning computer systems are unable to accurately predict dose in the buildup region, leaving ambiguity as to the dose levels actually received by the patient's skin during radiotherapy. This is one of the prime reasons why in vivo measurements are necessary to estimate the dose in the buildup region. A newly developed metal-oxide-semiconductor-field-effect-transistor (MOSFET) detector designed specifically for dose measurements in rapidly changing dose gradients was introduced for accurate in vivo skin dosimetry. The feasibility of this detector for skin dose measurements was verified in comparison with plane parallel ionization chamber and radiochromic films. The accuracy of a commercial treatment planning system (TPS) in skin dose calculations for intensity-modulated radiation therapy treatment of nasopharyngeal carcinoma was evaluated using MOSFET detectors in an anthropomorphic phantom as well as on the patients. Results show that this newly developed MOSFET detector can provide a minimal but highly reproducible intrinsic buildup of 7 mg cm -2 corresponding to the requirements of personal surface dose equivalent Hp (0.07). The reproducibility of the MOSFET response, in high sensitivity mode, is found to be better than 2% at the phantom surface for the doses normally delivered to the patients. The MOSFET detector agrees well with the Attix chamber and the EBT Gafchromic registered film in terms of surface and buildup region dose measurements, even for oblique incident beams. While the dose difference between MOSFET measurements and TPS calculations is within measurement uncertainty for the depths equal to or greater than 0.5 cm, an overestimation of up to 8.5% was found for the surface dose calculations in the anthropomorphic phantom study. In vivo skin dose measurements reveal that the dose difference between the MOSFET results and the TPS calculations was on average -7

Phase II Trial of Hyperfractionated Intensity-Modulated Radiation Therapy and Concurrent Weekly Cisplatin for Stage III and IVa Head-and-Neck Cancer

International Nuclear Information System (INIS)

Maguire, Patrick D.; Papagikos, Michael; Hamann, Sue; Neal, Charles; Meyerson, Martin; Hayes, Neil; Ungaro, Peter; Kotz, Kenneth; Couch, Marion; Pollock, Hoke; Tepper, Joel

2011-01-01

Purpose: To investigate a novel chemoradiation regimen designed to maximize locoregional control (LRC) and minimize toxicity for patients with advanced head-and-neck squamous cell carcinoma (HNSCC). Methods and Materials: Patients received hyperfractionated intensity modulated radiation therapy (HIMRT) in 1.25-Gy fractions b.i.d. to 70 Gy to high-risk planning target volume (PTV). Intermediate and low-risk PTVs received 60 Gy and 50 Gy, at 1.07, and 0.89 Gy per fraction, respectively. Concurrent cisplatin 33 mg/m 2 /week was started Week 1. Patients completed the Quality of Life Radiation Therapy Instrument pretreatment (PRE), at end of treatment (EOT), and at 1, 3, 6, 9, and 12 months. Overall survival (OS), progression-free (PFS), LRC, and toxicities were assessed. Results: Of 39 patients, 30 (77%) were alive without disease at median follow-up of 37.5 months. Actuarial 3-year OS, PFS, and LRC were 80%, 82%, and 87%, respectively. No failures occurred in the electively irradiated neck and there were no isolated neck failures. Head and neck QOL was significantly worse in 18 of 35 patients (51%): mean 7.8 PRE vs. 3.9 EOT. By month 1, H and N QOL returned near baseline (mean 6.2, SD = 1.7). The most common acute Grade 3+ toxicities were mucositis (38%), fatigue (28%), dysphagia (28%), and leukopenia (26%). Conclusions: Hyperfractionated IMRT with low-dose weekly cisplatin resulted in good LRC with acceptable toxicity and QOL. Lack of elective nodal failures despite very low dose per fraction has led to an attempt to further minimize toxicity by reducing elective nodal doses in our subsequent protocol.

Assessment of skin dose modification caused by application of immobilizing cast in head and neck radiotherapy

International Nuclear Information System (INIS)

Soleymanifard, Shokouhozaman; Toossi, Mohammad T.B.; Khosroabadi, Mohsen; Noghreiyan, Atefeh Vejdani; Shahidsales, Soodabeh; Tabrizi, Fatemeh Varshoee

2014-01-01

Skin dose assessment for radiotherapy patients is important to ensure that the dose received by skin is not excessive and does not cause skin reactions. Immobilizing casts may have a buildup effect, and can enhance the skin dose. This study has quantified changes to the surface dose as a result of head and neck immobilizing casts. Medtech and Renfu casts were stretched on the head of an Alderson Rando-Phantom. Irradiation was performed using 6 and 15 MV X-rays, and surface dose was measured by thermoluminescence dosimeters. In the case of 15MV photons, immobilizing casts had no effect on the surface dose. However, the mean surface dose increase reached up to 20 % when 6MV X-rays were applied. Radiation incidence angle, thickness, and meshed pattern of the casts affected the quantity of dose enhancement. For vertical beams, the surface dose increase was more than tangential beams, and when doses of the points under different areas of the casts were analysed separately, results showed that only doses of the points under the thick area had been changed. Doses of the points under the thin area and those within the holes were identical to the same points without immobilizing casts. Higher dose which was incurred due to application of immobilizing casts (20 %) would not affect the quality of life and treatment of patients whose head and neck are treated. Therefore, the benefits of head and neck thermoplastic casts are more than their detriments. However, producing thinner casts with larger holes may reduce the dose enhancement effect.

Planning comparison between intensity modulated radiation therapy and intensity modulated proton therapy in a case of head and neck cancer

Science.gov (United States)

Nguyen, T. T. C.; Nguyen, B. T.; Mai, N. V.

2018-03-01

In this work, we made the comparison between IMRT plan and IMPT plan for a head and neck case. We used Prowess Panther to perform IMRT plan and LAP- CERR for IMPT plan. The result showed that IMPT plan had better coverage than IMRT plan. In the IMRT plan, normal structures received higher dose with higher volume. Especially, the maximum dose of spinal cord is 31.5 Gy (RBE) using IMRT technique compared to 13.5 Gy (RBE) using IMPT technique. These results showed that IMPT is beneficial for head and neck cancer compared to IMRT technique.

Angle calculations for a z-axis/(2S+2D) hybrid diffractometer

DEFF Research Database (Denmark)

Bunk, Oliver; Nielsen, Martin Meedom

2004-01-01

calculations are presented for a new 'hybrid' diffractometer consisting of a base instrument that can be combined with two different detector arms. With one of the detector arms, the instrument is a standard z-axis diffractometer as commonly used in surface studies. The other detector arm is designed...... for a heavy two-dimensional detector. The calculations are formulated in a general framework making it easy to incorporate, e. g. a second sample rotation stage, whereby it is possible to perform reflectivity and standard surface-crystallography measurements in the same geometry....

Evaluation of absorbed dose in organs far from the target volume for different therapies of head and neck cancer

International Nuclear Information System (INIS)

Pletsch, Cristiana

2013-01-01

Many advances in radiotherapy are the result of innovations in technology and engineering as well as the information technology revolution applied to the treatment planning of patients. The intensity modulated radiation therapy (lMRT) is a sophisticated treatment technique that allows the concentration of the dose prescribed by radiotherapist in tumor volume, while sparing healthy tissues that surround it. However, the disadvantage of the technique is a potential induction of secondary cancers in distant organs related to the target volume due to leakage and scattered radiation, which generate these higher doses to the distant organs when compared to those measured in conventional treatments. These higher doses are is due to the greater use of monitor units and a larger amount of treatment fields. In this study the absorbed dose values in distant organs from the head and neck region were assessed, comparing conventional treatments and treatments using the IMRT techniques. The evaluation was made considering the assessment of dose in radiological significant organs distant from the treatment area. All measurements were performed using the RANDO Alderson anthropomorphic phantom that has internal components equivalent to muscle, bones and lungs and is sliced for placing thermoluminescent detectors in appropriate holes existing in the slices. This phantom, tilled with TLD-100 dosimeters, was submitted to a head and neck treatment with a cobalt-60 irradiator and a Trilogy linear accelerator. Three treatments were carried out with the accelerator, namely a conventional one and two treatments of IMRT with different complexities, all treatments using the 6MV beam. The results show that IMRT techniques generate large doses in distant organs when compared to those generated due to the conventional 6 MV beam treatment. However, these doses are not very different from those measured in the case of 60 Co treatment. (author)

A method to acquire CT organ dose map using OSL dosimeters and ATOM anthropomorphic phantoms

Energy Technology Data Exchange (ETDEWEB)

Zhang, Da; Li, Xinhua; Liu, Bob [Division of Diagnostic Imaging Physics and Webster Center for Advanced Research and Education in Radiation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114 (United States); Gao, Yiming; Xu, X. George [Nuclear Engineering Program, Rensselaer Polytechnic Institute, Troy, New York 12180 (United States)

2013-08-15

Purpose: To present the design and procedure of an experimental method for acquiring densely sampled organ dose map for CT applications, based on optically stimulated luminescence (OSL) dosimeters “nanoDots” and standard ATOM anthropomorphic phantoms; and to provide the results of applying the method—a dose data set with good statistics for the comparison with Monte Carlo simulation result in the future.Methods: A standard ATOM phantom has densely located holes (in 3 × 3 cm or 1.5 × 1.5 cm grids), which are too small (5 mm in diameter) to host many types of dosimeters, including the nanoDots. The authors modified the conventional way in which nanoDots are used, by removing the OSL disks from the holders before inserting them inside a standard ATOM phantom for dose measurements. The authors solved three technical difficulties introduced by this modification: (1) energy dependent dose calibration for raw OSL readings; (2) influence of the brief background exposure of OSL disks to dimmed room light; (3) correct pairing between the dose readings and measurement locations. The authors acquired 100 dose measurements at various positions in the phantom, which was scanned using a clinical chest protocol with both angular and z-axis tube current modulations.Results: Dose calibration was performed according to the beam qualities inside the phantom as determined from an established Monte Carlo model of the scanner. The influence of the brief exposure to dimmed room light was evaluated and deemed negligible. Pairing between the OSL readings and measurement locations was ensured by the experimental design. The organ doses measured for a routine adult chest scan protocol ranged from 9.4 to 18.8 mGy, depending on the composition, location, and surrounding anatomy of the organs. The dose distribution across different slices of the phantom strongly depended on the z-axis mA modulation. In the same slice, doses to the soft tissues other than the spinal cord demonstrated

A method to acquire CT organ dose map using OSL dosimeters and ATOM anthropomorphic phantoms

International Nuclear Information System (INIS)

Zhang, Da; Li, Xinhua; Liu, Bob; Gao, Yiming; Xu, X. George

2013-01-01

Purpose: To present the design and procedure of an experimental method for acquiring densely sampled organ dose map for CT applications, based on optically stimulated luminescence (OSL) dosimeters “nanoDots” and standard ATOM anthropomorphic phantoms; and to provide the results of applying the method—a dose data set with good statistics for the comparison with Monte Carlo simulation result in the future.Methods: A standard ATOM phantom has densely located holes (in 3 × 3 cm or 1.5 × 1.5 cm grids), which are too small (5 mm in diameter) to host many types of dosimeters, including the nanoDots. The authors modified the conventional way in which nanoDots are used, by removing the OSL disks from the holders before inserting them inside a standard ATOM phantom for dose measurements. The authors solved three technical difficulties introduced by this modification: (1) energy dependent dose calibration for raw OSL readings; (2) influence of the brief background exposure of OSL disks to dimmed room light; (3) correct pairing between the dose readings and measurement locations. The authors acquired 100 dose measurements at various positions in the phantom, which was scanned using a clinical chest protocol with both angular and z-axis tube current modulations.Results: Dose calibration was performed according to the beam qualities inside the phantom as determined from an established Monte Carlo model of the scanner. The influence of the brief exposure to dimmed room light was evaluated and deemed negligible. Pairing between the OSL readings and measurement locations was ensured by the experimental design. The organ doses measured for a routine adult chest scan protocol ranged from 9.4 to 18.8 mGy, depending on the composition, location, and surrounding anatomy of the organs. The dose distribution across different slices of the phantom strongly depended on the z-axis mA modulation. In the same slice, doses to the soft tissues other than the spinal cord demonstrated

Reirradiation of Head and Neck Cancers With Intensity Modulated Radiation Therapy: Outcomes and Analyses

Energy Technology Data Exchange (ETDEWEB)

Takiar, Vinita [Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio (United States); Garden, Adam S.; Ma, Dominic; Morrison, William H.; Edson, Mark [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zafereo, Mark E. [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gunn, Gary B.; Fuller, Clifton D.; Beadle, Beth; Frank, Steven J. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); William, William N.; Kies, Merrill [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); El-Naggar, Adel K. [Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Weber, Randal [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rosenthal, David I. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Phan, Jack, E-mail: jphan@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2016-07-15

Purpose: To review our 15-year institutional experience using intensity modulated radiation therapy (IMRT) to reirradiate patients with head and neck squamous cell carcinomas (HNSCC) and identify predictors of outcomes and toxicity. Methods and Materials: We retrospectively reviewed the records of 227 patients who received head and neck reirradiation using IMRT from 1999 to 2014. Patients treated with noncurative intent were excluded. Radiation-related acute and late toxicities were recorded. Prognostic variables included performance status, disease site, disease-free interval, chemotherapy, and RT dose and volume. Correlative analyses were performed separately for surgery and nonsurgery patients. Results: Two hundred six patients (91%) were retreated with curative intent, and 173 had HNSCC histology; 104 (50%) underwent salvage resection, and 135 (66%) received chemotherapy. Median follow-up after reirradiation was 24.7 months. Clinical outcomes were worse for HNSCC patients, with 5-year locoregional control, progression-free survival, and overall survival rates of 53%, 22%, and 32%, respectively, compared with 74%, 59%, and 79%, respectively, for non-HNSCC patients. On multivariate analysis, concurrent chemotherapy and retreatment site were associated with tumor control, whereas performance status was associated with survival. Favorable prognostic factors specific to surgery patients were neck retreatment and lack of extracapsular extension, whereas for nonsurgery patients, these were a nasopharynx subsite and complete response to induction chemotherapy. Actuarial rates of grade ≥3 toxicity were 32% at 2 years and 48% at 5 years, with dysphagia or odynophagia being most common. Increased grade ≥3 toxicity was associated with retreatment volume >50 cm{sup 3} and concurrent chemotherapy. Conclusions: Reirradiation with IMRT either definitively or after salvage surgery can produce promising local control and survival in selected patients with head and neck

Dose-volume analysis of hypothyroidism in patients irradiated to the neck

International Nuclear Information System (INIS)

Te, Vuong; Liu, Mitchell C.C.; Parker, William; Curtin-Savard, Arthur J.; Clark, Brenda

1997-01-01

Purpose: To determine if the incidence of hypothyroidism in patients who have received radiation therapy to the neck region has any relationship with the total dose to the thyroid and volume of thyroid irradiation. Methods and Materials: From 1988 to 1996, TSH levels were measured at regular intervals of every 3 to 6 months in 528 patients with head and neck cancers or lymphomas (Hodgkin and non-Hodgkin) who had received radiation therapy to the neck region. Hypothyroidism was defined by TSH of ≥ 5 (normal range: 0.5 - 4mU/L). Medical charts, radiotherapy charts, treatment planning films, dosimetry and CT scans/MRI were reviewed. Thyroid volume was determined utilizing treatment planning films and CT scans/MRI. Four hundred and six patients had normal TSH prior to radiation and sufficient information to be eligible for analysis. There were 264 (65%) male and 142 (35%) female, median age was 59 yr (range: 12 - 85). Median follow-up was 39.5 months (range: 1 - 289 months). Results: Out of the 406 eligible patients, 152 (37%) had developed hypothyroidism. The actuarial incidence of hypothyroidism at 1 yr, 3 yr and 5 yr are 9.1%, 29% and 38.5%, respectively. Analysis of volume effect and dose effect are as follows: When the radiation dose to the thyroid and the volume of thyroid irradiated are analyzed together, the group of patients who received ≥ 60Gy to half of thyroid or received ≥ 30Gy to the whole thyroid has increased risk of developing hypothyroidism as compared to those receiving <60Gy to half the thyroid or <30Gy to the whole thyroid (p=.0001). Conclusions: The actuarial incidence of hypothyroidism at 5 year in patients who had received radiation to the neck is 38.5%. Patients who received ≥ 60Gy to half the thyroid or received ≥ 30Gy to the whole thyroid are at higher risk of developing hyperthyroidism

Absorbed dose calculation from beta and gamma rays of 131I in ellipsoidal thyroid and other organs of neck with MCNPX code

Directory of Open Access Journals (Sweden)

Mohammad Mirzaie

2012-09-01

Full Text Available Background: The 131I radioisotope is used for diagnosis and treatment of hyperthyroidism and thyroid cancer. In optimized Iodine therapy, a specific dose must be reached to the thyroid gland with minimum radiation to the cervical spine, cervical vertebrae, neck tissue, subcutaneous fat and skin. Dose measurement inside the alive organ is difficult therefore the aim of this research was dose calculation in the organs by MCNPX code. Materials and Methods: First of all, the input file for MCNPX code has been prepared to calculate F6 and F8 tallies for ellipsoidal thyroid lobes with long axes is tow times of short axes which the 131I is distributed uniformly inside the lobes. Then the code has been run for F6 and F8 tallies for variation of lobe volume from 1 to 25 milliliters. From the output file of tally F6, the gamma absorbed dose in ellipsoidal thyroid, spinal neck, neck bone, neck tissue, subcutaneous fat layer and skin for the volume lobe variation from 1 ml to 25 ml have been derived and the graphs are drew. As well as, form the output of F8 tally the absorbed energy of beta in thyroid and soft tissue of neck is obtained and listed in the table and then absorbed dose of bate has been calculated. Results: The results of this research show that for constant activity in thyroid, the absorbed dose of gamma decreases about 88.3% in thyroid, 6.9% at soft tissue, 19.3% in adipose layer and 17.4% in skin, but it increases 32.1% in spinal of neck and 32.3% in neck bone when the lobe volume varied from 1 to 25 milliliters. For the same situation, the beta absorbed dose decreases 95.9% in thyroid and 64.2% in soft tissue. Conclusion: For the constant activity in thyroid by increasing the thyroid volume, absorbed dose of gamma in thyroid and soft tissue of neck, adipose layer under the skin and skin of neck decreased, but it increased at spinal of neck and neck bone. Also, by increasing of the lobe volume in constant activity, the beta absorbed dose

Improved Dosimetric and Clinical Outcomes With Intensity-Modulated Radiotherapy for Head-and-Neck Cancer of Unknown Primary Origin

International Nuclear Information System (INIS)

Chen, Allen M.; Li Baoqing; Farwell, D. Gregory; Marsano, Joseph; Vijayakumar, Srinivasan; Purdy, James A.

2011-01-01

Purpose: To compare differences in dosimetric, clinical, and quality-of-life endpoints among a cohort of patients treated by intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 51 patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Twenty-four patients (47%) were treated using CRT, and 27 (53%) were treated using IMRT. The proportions of patients receiving concurrent chemotherapy were 54% and 63%, respectively. Results: The 2-year estimates of overall survival, local-regional control, and disease-specific survival for the entire patient population were 86%, 89%, and84%, respectively. There were no significant differences in any of these endpoints with respect to radiation therapy technique (p > 0.05 for all). Dosimetric analysis revealed that the use of IMRT resulted in significant improvements with respect to mean dose and V30 to the contralateral (spared) parotid gland. In addition, mean doses to the ipsilateral inner and middle ear structures were significantly reduced with IMRT (p < 0.05 for all). The incidence of severe xerostomia in the late setting was 58% and 11% among patients treated by CRT and IMRT, respectively (p < 0.001). The percentages of patients who were G-tube dependent at 6 months after treatment were 42% and 11%, respectively (p < 0.001). Conclusions: IMRT results in significant improvements in the therapeutic ratio among patients treated by radiation therapy for head-and-neck cancer of unknown primary origin.

Microfabrication and Characterization of an Integrated 3-Axis CMOS-MEMS Accelerometer

Directory of Open Access Journals (Sweden)

Hongwei QU

2007-10-01

Full Text Available This paper reports the fabrication and characterization of a monolithically integrated 3-axis CMOS-MEMS accelerometer with a single proof mass. An improved microfabrication process has been developed to solve the structure overheating and particle contamination problems in the plasma etching processes of device fabrication. The whole device is made of bulk silicon except for some short thin films for electrical isolation, allowing large sensing capacitance and flat device structure. A low-noise, low-power amplifier is designed for each axis, which provides 40 dB on-chip amplification and consumes only 1 mW power. Quasi-static and dynamic characterization of the fabricated device has been performed. The measured sensitivities of the lateral- and z-axis accelerometers are 560 mV/g and 320 mV/g, respectively, which can be tuned by simply varying the amplitude of the modulation signal. The over-all noise floors of the lateral- and z-axis are 12 μg/ÖHz and 110 μg/ÖHz, respectively when tested at 200 Hz.

Activated HGF-c-Met Axis in Head and Neck Cancer

Directory of Open Access Journals (Sweden)

Levi Arnold

2017-12-01

Full Text Available Head and neck squamous cell carcinoma (HNSCC is a highly morbid disease. Recent developments including Food and Drug Administration (FDA approved molecular targeted agent’s pembrolizumab and cetuximab show promise but did not improve the five-year survival which is currently less than 40%. The hepatocyte growth factor receptor; also known as mesenchymal–epithelial transition factor (c-Met and its ligand hepatocyte growth factor (HGF are overexpressed in head and neck squamous cell carcinoma (HNSCC; and regulates tumor progression and response to therapy. The c-Met pathway has been shown to regulate many cellular processes such as cell proliferation, invasion, and angiogenesis. The c-Met pathway is involved in cross-talk, activation, and perpetuation of other signaling pathways, curbing the cogency of a blockade molecule on a single pathway. The receptor and its ligand act on several downstream effectors including phospholipase C gamma (PLCγ, cellular Src kinase (c-Src, phosphotidylinsitol-3-OH kinase (PI3K alpha serine/threonine-protein kinase (Akt, mitogen activate protein kinase (MAPK, and wingless-related integration site (Wnt pathways. They are also known to cross-talk with other receptors; namely epidermal growth factor receptor (EGFR and vascular endothelial growth factor receptor (VEGFR and specifically contribute to treatment resistance. Clinical trials targeting the c-Met axis in HNSCC have been undertaken because of significant preclinical work demonstrating a relationship between HGF/c-Met signaling and cancer cell survival. Here we focus on HGF/c-Met impact on cellular signaling in HNSCC to potentiate tumor growth and disrupt therapeutic efficacy. Herein we summarize the current understanding of HGF/c-Met signaling and its effects on HNSCC. The intertwining of c-Met signaling with other signaling pathways provides opportunities for more robust and specific therapies, leading to better clinical outcomes.

A transparent flexible z-axis sensitive multi-touch panel based on colloidal ITO nanocrystals.

Science.gov (United States)

Sangeetha, N M; Gauvin, M; Decorde, N; Delpech, F; Fazzini, P F; Viallet, B; Viau, G; Grisolia, J; Ressier, L

2015-08-07

Bottom-up fabrication of a flexible multi-touch panel prototype based on transparent colloidal indium tin oxide (ITO) nanocrystal (NC) films is presented. A series of 7% Sn(4+) doped ITO NCs protected by oleate, octanoate and butanoate ligands are synthesized and characterized by a battery of techniques including, high resolution transmission electron microscopy, X-ray diffraction, (1)H, (13)C and (119)Sn nuclear magnetic resonance spectroscopy, and the related diffusion ordered spectroscopy. Electrical resistivities of transparent films of these NCs assembled on flexible polyethylene terephthalate substrates by convective self-assembly from their suspension in toluene decrease with the ligand length, from 220 × 10(3) for oleate ITO to 13 × 10(3)Ω cm for butanoate ITO NC films. A highly transparent, flexible touch panel based on a matrix of strain gauges derived from the least resistive film of 17 nm butanoate ITO NCs sensitively detects the lateral position (x, y) of the touch as well as its intensity over the z-axis. Being compatible with a stylus or bare/gloved finger, a larger version of this module may be readily implemented in upcoming flexible screens, enabling navigation capabilities over all three axes, a feature highly desired by the display industry.

Correlation of osteoradionecrosis and dental events with dosimetric parameters in intensity-modulated radiation therapy for head-and-neck cancer.

Science.gov (United States)

Gomez, Daniel R; Estilo, Cherry L; Wolden, Suzanne L; Zelefsky, Michael J; Kraus, Dennis H; Wong, Richard J; Shaha, Ashok R; Shah, Jatin P; Mechalakos, James G; Lee, Nancy Y

2011-11-15

Osteoradionecrosis (ORN) is a known complication of radiation therapy to the head and neck. However, the incidence of this complication with intensity-modulated radiation therapy (IMRT) and dental sequelae with this technique have not been fully elucidated. From December 2000 to July 2007, 168 patients from our institution have been previously reported for IMRT of the oral cavity, nasopharynx, larynx/hypopharynx, sinus, and oropharynx. All patients underwent pretreatment dental evaluation, including panoramic radiographs, an aggressive fluoride regimen, and a mouthguard when indicated. The median maximum mandibular dose was 6,798 cGy, and the median mean mandibular dose was 3,845 cGy. Patient visits were retrospectively reviewed for the incidence of ORN, and dental records were reviewed for the development of dental events. Univariate analysis was then used to assess the effect of mandibular and parotid gland dosimetric parameters on dental endpoints. With a median clinic follow-up of 37.4 months (range, 0.8-89.6 months), 2 patients, both with oral cavity primaries, experienced ORN. Neither patient had preradiation dental extractions. The maximum mandibular dose and mean mandibular dose of the 2 patients were 7,183 and 6,828 cGy and 5812 and 5335 cGy, respectively. In all, 17% of the patients (n = 29) experienced a dental event. A mean parotid dose of >26 Gy was predictive of a subsequent dental caries, whereas a maximum mandibular dose >70 Gy and a mean mandibular dose >40 Gy were correlated with dental extractions after IMRT. ORN is rare after head-and-neck IMRT, but is more common with oral cavity primaries. Our results suggest different mechanisms for radiation-induced caries versus extractions. Copyright © 2011 Elsevier Inc. All rights reserved.

Correlation of Osteoradionecrosis and Dental Events With Dosimetric Parameters in Intensity-Modulated Radiation Therapy for Head-and-Neck Cancer

International Nuclear Information System (INIS)

Gomez, Daniel R.; Estilo, Cherry L.; Wolden, Suzanne L.; Zelefsky, Michael J.; Kraus, Dennis H.; Wong, Richard J.; Shaha, Ashok R.; Shah, Jatin P.; Mechalakos, James G.; Lee, Nancy Y.

2011-01-01

Purpose: Osteoradionecrosis (ORN) is a known complication of radiation therapy to the head and neck. However, the incidence of this complication with intensity-modulated radiation therapy (IMRT) and dental sequelae with this technique have not been fully elucidated. Methods and Materials: From December 2000 to July 2007, 168 patients from our institution have been previously reported for IMRT of the oral cavity, nasopharynx, larynx/hypopharynx, sinus, and oropharynx. All patients underwent pretreatment dental evaluation, including panoramic radiographs, an aggressive fluoride regimen, and a mouthguard when indicated. The median maximum mandibular dose was 6,798 cGy, and the median mean mandibular dose was 3,845 cGy. Patient visits were retrospectively reviewed for the incidence of ORN, and dental records were reviewed for the development of dental events. Univariate analysis was then used to assess the effect of mandibular and parotid gland dosimetric parameters on dental endpoints. Results: With a median clinic follow-up of 37.4 months (range, 0.8–89.6 months), 2 patients, both with oral cavity primaries, experienced ORN. Neither patient had preradiation dental extractions. The maximum mandibular dose and mean mandibular dose of the 2 patients were 7,183 and 6,828 cGy and 5812 and 5335 cGy, respectively. In all, 17% of the patients (n = 29) experienced a dental event. A mean parotid dose of >26 Gy was predictive of a subsequent dental caries, whereas a maximum mandibular dose >70 Gy and a mean mandibular dose >40 Gy were correlated with dental extractions after IMRT. Conclusions: ORN is rare after head-and-neck IMRT, but is more common with oral cavity primaries. Our results suggest different mechanisms for radiation-induced caries versus extractions.

Correlation of Osteoradionecrosis and Dental Events With Dosimetric Parameters in Intensity-Modulated Radiation Therapy for Head-and-Neck Cancer

Energy Technology Data Exchange (ETDEWEB)

Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Estilo, Cherry L. [Dental Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne L.; Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kraus, Dennis H.; Wong, Richard J.; Shaha, Ashok R.; Shah, Jatin P. [Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Mechalakos, James G.; Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2011-11-15

Purpose: Osteoradionecrosis (ORN) is a known complication of radiation therapy to the head and neck. However, the incidence of this complication with intensity-modulated radiation therapy (IMRT) and dental sequelae with this technique have not been fully elucidated. Methods and Materials: From December 2000 to July 2007, 168 patients from our institution have been previously reported for IMRT of the oral cavity, nasopharynx, larynx/hypopharynx, sinus, and oropharynx. All patients underwent pretreatment dental evaluation, including panoramic radiographs, an aggressive fluoride regimen, and a mouthguard when indicated. The median maximum mandibular dose was 6,798 cGy, and the median mean mandibular dose was 3,845 cGy. Patient visits were retrospectively reviewed for the incidence of ORN, and dental records were reviewed for the development of dental events. Univariate analysis was then used to assess the effect of mandibular and parotid gland dosimetric parameters on dental endpoints. Results: With a median clinic follow-up of 37.4 months (range, 0.8-89.6 months), 2 patients, both with oral cavity primaries, experienced ORN. Neither patient had preradiation dental extractions. The maximum mandibular dose and mean mandibular dose of the 2 patients were 7,183 and 6,828 cGy and 5812 and 5335 cGy, respectively. In all, 17% of the patients (n = 29) experienced a dental event. A mean parotid dose of >26 Gy was predictive of a subsequent dental caries, whereas a maximum mandibular dose >70 Gy and a mean mandibular dose >40 Gy were correlated with dental extractions after IMRT. Conclusions: ORN is rare after head-and-neck IMRT, but is more common with oral cavity primaries. Our results suggest different mechanisms for radiation-induced caries versus extractions.

Intensity Modulated Radiotherapy Improves Target Coverage and Parotid Gland Sparing When Delivering Total Mucosal Irradiation in Patients With Squamous Cell Carcinoma of Head and Neck of Unknown Primary Site

International Nuclear Information System (INIS)

Bhide, Shreerang; Clark, Catherine; Harrington, Kevin; Nutting, Christopher M.

2007-01-01

Head and neck squamous cell carcinoma with occult primary site represents a controversial clinical problem. Conventional total mucosal irradiation (TMI) maximizes local control, but at the expense of xerostomia. IMRT has been shown to spare salivary tissue in head and cancer patients. This study has been performed to investigate the potential of IMRT to perform nodal and TMI and also allow parotid gland sparing in this patient group. Conventional radiotherapy (CRT) and IMRT plans were produced for six patients to treat the ipsilateral (involved) post-operative neck (PTV1) and the un-operated contralateral neck and mucosal axis (PTV2). Plans were produced with and without the inclusion of nasopharynx in the PTV2. The potential to improve target coverage and spare the parotid glands was investigated for the IMRT plans. There was no significant difference in the mean doses to the PTV1 using CRT and IMRT (59.7 and 60.0 respectively, p = 0.5). The maximum doses to PTV1 and PTV2 were lower for the IMRT technique as compared to CRT (P = 0.008 and P < 0.0001), respectively, and the minimum doses to PTV1 and PTV2 were significantly higher for IMRT as compared to CRT (P = 0.001 and P = 0.001), respectively, illustrating better dose homogeneity with IMRT. The mean dose to the parotid gland contralateral to PTV1 was significantly lower for IMRT (23.21 ± 0.7) as compared to CRT (50.5 ± 5.8) (P < 0.0001). There was a significant difference in parotid dose between plans with and without the inclusion of the nasopharynx. IMRT offers improved dose homogeneity in PTV1 and PTV2 and allows for parotid sparing

MO-PIS-Exhibit Hall-01: Imaging: CT Dose Optimization Technologies I

Energy Technology Data Exchange (ETDEWEB)

Denison, K; Smith, S [GE Healthcare, Waukesha, WI (United States)

2014-06-15

Partners in Solutions is an exciting new program in which AAPM partners with our vendors to present practical “hands-on” information about the equipment and software systems that we use in our clinics. The imaging topic this year is CT scanner dose optimization capabilities. Note that the sessions are being held in a special purpose room built on the Exhibit Hall Floor, to encourage further interaction with the vendors. Dose Optimization Capabilities of GE Computed Tomography Scanners Presentation Time: 11:15 – 11:45 AM GE Healthcare is dedicated to the delivery of high quality clinical images through the development of technologies, which optimize the application of ionizing radiation. In computed tomography, dose management solutions fall into four categories: employs projection data and statistical modeling to decrease noise in the reconstructed image - creating an opportunity for mA reduction in the acquisition of diagnostic images. Veo represents true Model Based Iterative Reconstruction (MBiR). Using high-level algorithms in tandem with advanced computing power, Veo enables lower pixel noise standard deviation and improved spatial resolution within a single image. Advanced Adaptive Image Filters allow for maintenance of spatial resolution while reducing image noise. Examples of adaptive image space filters include Neuro 3-D filters and Cardiac Noise Reduction Filters. AutomA adjusts mA along the z-axis and is the CT equivalent of auto exposure control in conventional x-ray systems. Dynamic Z-axis Tracking offers an additional opportunity for dose reduction in helical acquisitions while SmartTrack Z-axis Tracking serves to ensure beam, collimator and detector alignment during tube rotation. SmartmA provides angular mA modulation. ECG Helical Modulation reduces mA during the systolic phase of the heart cycle. SmartBeam optimization uses bowtie beam-shaping hardware and software to filter off-axis x-rays - minimizing dose and reducing x-ray scatter. The

MO-PIS-Exhibit Hall-01: Imaging: CT Dose Optimization Technologies I

International Nuclear Information System (INIS)

Denison, K; Smith, S

2014-01-01

Partners in Solutions is an exciting new program in which AAPM partners with our vendors to present practical “hands-on” information about the equipment and software systems that we use in our clinics. The imaging topic this year is CT scanner dose optimization capabilities. Note that the sessions are being held in a special purpose room built on the Exhibit Hall Floor, to encourage further interaction with the vendors. Dose Optimization Capabilities of GE Computed Tomography Scanners Presentation Time: 11:15 – 11:45 AM GE Healthcare is dedicated to the delivery of high quality clinical images through the development of technologies, which optimize the application of ionizing radiation. In computed tomography, dose management solutions fall into four categories: employs projection data and statistical modeling to decrease noise in the reconstructed image - creating an opportunity for mA reduction in the acquisition of diagnostic images. Veo represents true Model Based Iterative Reconstruction (MBiR). Using high-level algorithms in tandem with advanced computing power, Veo enables lower pixel noise standard deviation and improved spatial resolution within a single image. Advanced Adaptive Image Filters allow for maintenance of spatial resolution while reducing image noise. Examples of adaptive image space filters include Neuro 3-D filters and Cardiac Noise Reduction Filters. AutomA adjusts mA along the z-axis and is the CT equivalent of auto exposure control in conventional x-ray systems. Dynamic Z-axis Tracking offers an additional opportunity for dose reduction in helical acquisitions while SmartTrack Z-axis Tracking serves to ensure beam, collimator and detector alignment during tube rotation. SmartmA provides angular mA modulation. ECG Helical Modulation reduces mA during the systolic phase of the heart cycle. SmartBeam optimization uses bowtie beam-shaping hardware and software to filter off-axis x-rays - minimizing dose and reducing x-ray scatter. The

Do we need 3D tube current modulation information for accurate organ dosimetry in chest CT? Protocols dose comparisons.

Science.gov (United States)

Lopez-Rendon, Xochitl; Zhang, Guozhi; Coudyzer, Walter; Develter, Wim; Bosmans, Hilde; Zanca, Federica

2017-11-01

To compare the lung and breast dose associated with three chest protocols: standard, organ-based tube current modulation (OBTCM) and fast-speed scanning; and to estimate the error associated with organ dose when modelling the longitudinal (z-) TCM versus the 3D-TCM in Monte Carlo simulations (MC) for these three protocols. Five adult and three paediatric cadavers with different BMI were scanned. The CTDI vol of the OBTCM and the fast-speed protocols were matched to the patient-specific CTDI vol of the standard protocol. Lung and breast doses were estimated using MC with both z- and 3D-TCM simulated and compared between protocols. The fast-speed scanning protocol delivered the highest doses. A slight reduction for breast dose (up to 5.1%) was observed for two of the three female cadavers with the OBTCM in comparison to the standard. For both adult and paediatric, the implementation of the z-TCM data only for organ dose estimation resulted in 10.0% accuracy for the standard and fast-speed protocols, while relative dose differences were up to 15.3% for the OBTCM protocol. At identical CTDI vol values, the standard protocol delivered the lowest overall doses. Only for the OBTCM protocol is the 3D-TCM needed if an accurate (<10.0%) organ dosimetry is desired. • The z-TCM information is sufficient for accurate dosimetry for standard protocols. • The z-TCM information is sufficient for accurate dosimetry for fast-speed scanning protocols. • For organ-based TCM schemes, the 3D-TCM information is necessary for accurate dosimetry. • At identical CTDI vol , the fast-speed scanning protocol delivered the highest doses. • Lung dose was higher in XCare than standard protocol at identical CTDI vol .

Increase in tumor control and normal tissue complication probabilities in advanced head-and-neck cancer for dose-escalated intensity-modulated photon and proton therapy

Directory of Open Access Journals (Sweden)

Annika eJakobi

2015-11-01

Full Text Available Introduction:Presently used radio-chemotherapy regimens result in moderate local control rates for patients with advanced head and neck squamous cell carcinoma (HNSCC. Dose escalation (DE may be an option to improve patient outcome, but may also increase the risk of toxicities in healthy tissue. The presented treatment planning study evaluated the feasibility of two DE levels for advanced HNSCC patients, planned with either intensity-modulated photon therapy (IMXT or proton therapy (IMPT.Materials and Methods:For 45 HNSCC patients, IMXT and IMPT treatment plans were created including DE via a simultaneous integrated boost (SIB in the high-risk volume, while maintaining standard fractionation with 2 Gy per fraction in the remaining target volume. Two DE levels for the SIB were compared: 2.3 Gy and 2.6 Gy. Treatment plan evaluation included assessment of tumor control probabilities (TCP and normal tissue complication probabilities (NTCP.Results:An increase of approximately 10% in TCP was estimated between the DE levels. A pronounced high-dose rim surrounding the SIB volume was identified in IMXT treatment. Compared to IMPT, this extra dose slightly increased the TCP values and to a larger extent the NTCP values. For both modalities, the higher DE level led only to a small increase in NTCP values (mean differences < 2% in all models, except for the risk of aspiration, which increased on average by 8% and 6% with IMXT and IMPT, respectively, but showed a considerable patient dependence. Conclusions:Both DE levels appear applicable to patients with IMXT and IMPT since all calculated NTCP values, except for one, increased only little for the higher DE level. The estimated TCP increase is of relevant magnitude. The higher DE schedule needs to be investigated carefully in the setting of a prospective clinical trial, especially regarding toxicities caused by high local doses that lack a sound dose response description, e.g., ulcers.

Measuring quality of life in patients with head and neck cancer: Update of the EORTC QLQ-H&N Module, Phase III

DEFF Research Database (Denmark)

Singer, Susanne; Araújo, Cláudia; Arraras, Juan Ignacio

2015-01-01

BACKGROUND: The objective of this study was to pilot test an updated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N60). METHODS: Patients with head and neck cancer were asked to complete a list of 60 head...... and neck cancer-specific items comprising the updated EORTC head and neck module and the core questionnaire EORTC QLQ-C30. Debriefing interviews were conducted to identify any irrelevant items and confusing or upsetting wording. RESULTS: Interviews were performed with 330 patients from 17 countries......, representing different head and neck cancer sites and treatments. Forty-one of the 60 items were retained according to the predefined EORTC criteria for module development, for another 2 items the wording was refined, and 17 items were removed. CONCLUSION: The preliminary EORTC QLQ-H&N43 can now be used...

Impact of total radiotherapy dose on survival for head and neck Merkel cell carcinoma after resection.

Science.gov (United States)

Patel, Sagar A; Qureshi, Muhammad M; Mak, Kimberley S; Sahni, Debjani; Giacalone, Nicholas J; Ezzat, Waleed; Jalisi, Scharukh; Truong, Minh Tam

2017-07-01

Head and neck Merkel cell carcinoma (MCC) is commonly treated with surgery and adjuvant radiotherapy (RT) for high-risk features. The optimal radiation dose is unknown. One thousand six hundred twenty-five eligible patients with head and neck MCC were identified in the National Cancer Data Base (NCDB). Radiation dose was divided into 3 groups: 30 to 55-70 Gy. Cox regression was used to compare overall survival (OS) between groups, accounting for age, sex, stage, surgery type, margin status, comorbidities, and use of chemotherapy. With a median follow-up of 33.5 months, 3-year OS was 48.9%, 70.3%, and 58.7% for 30 to 55-70 Gy, respectively (P 55-70 Gy (adjusted HR 1.21; 95% CI 1.0-1.46; P = .06) were associated with worse survival. Adjuvant radiation doses within 50-55 Gy may be optimal for head and neck MCC. © 2017 Wiley Periodicals, Inc.

Head and Neck Cancer Treatment

Science.gov (United States)

... Professions Site Index A-Z Head and Neck Cancer Treatment Head and neck cancer overview What are my ... and neck cancer. For updated information on new cancer treatments that are available, you should discuss these issues ...

Analytical probabilistic proton dose calculation and range uncertainties

Science.gov (United States)

Bangert, M.; Hennig, P.; Oelfke, U.

2014-03-01

We introduce the concept of analytical probabilistic modeling (APM) to calculate the mean and the standard deviation of intensity-modulated proton dose distributions under the influence of range uncertainties in closed form. For APM, range uncertainties are modeled with a multivariate Normal distribution p(z) over the radiological depths z. A pencil beam algorithm that parameterizes the proton depth dose d(z) with a weighted superposition of ten Gaussians is used. Hence, the integrals ∫ dz p(z) d(z) and ∫ dz p(z) d(z)2 required for the calculation of the expected value and standard deviation of the dose remain analytically tractable and can be efficiently evaluated. The means μk, widths δk, and weights ωk of the Gaussian components parameterizing the depth dose curves are found with least squares fits for all available proton ranges. We observe less than 0.3% average deviation of the Gaussian parameterizations from the original proton depth dose curves. Consequently, APM yields high accuracy estimates for the expected value and standard deviation of intensity-modulated proton dose distributions for two dimensional test cases. APM can accommodate arbitrary correlation models and account for the different nature of random and systematic errors in fractionated radiation therapy. Beneficial applications of APM in robust planning are feasible.

Equivalent dose, effective dose and risk assessment from panoramic radiography to the critical organs of head and neck region

International Nuclear Information System (INIS)

Cho, Bong Hae; Nah, Kyung Soo; Lee, Ae Ryeon

1995-01-01

The purpose of this study was to evaluate the equivalent and effective dose, and estimate radiation risk to the critical organs of head and neck region from the use of adult and child mode in panoramic radiography. The results were as follows. 1. The salivary glands showed the highest equivalent and effective dose in adult and child mode. The equivalent and effective dose in adult mode were 837 μSv and 20.93 μSv, those in child mode were 462 μSv and 11.54 μSv, respectively. 2. Total effective doses to the critical head and neck organs were estimated 34.2l μSv in adult mode, 20.14 μSv in child mode. From these data, the probabilities of stochastic effect from adult and child mode were 2.50xl0 -6 and 1.47x10 -6 3. The other remainder showed the greatest risk of fatal cancer. The risk estimate were 4.5 and 2.7 fatal malignancies in adult and child mode from million examinations. The bone marrow and thyroid gland showed about 0.1 fatal cancer in adult. and child mode from these examinations.

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients

International Nuclear Information System (INIS)

Fregnani, Eduardo Rodrigues; Parahyba, Cláudia Joffily; Morais-Faria, Karina; Fonseca, Felipe Paiva; Ramos, Pedro Augusto Mendes; Moraes, Fábio Yone de; Conceição Vasconcelos, Karina Gondim Moutinho da; Menegussi, Gisela; Santos-Silva, Alan Roger; Brandão, Thais B.

2016-01-01

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient’s morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients’ treatment plans. Clinicopathological data were retrieved from patients’ medical files. The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p < 0.001), whereas no significant difference was found for the other dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p < 0.001). IMRT delivered lower radiation doses to teeth than 3DRT, but only for some groups of patients and

Do we need 3D tube current modulation information for accurate organ dosimetry in chest CT? Protocols dose comparisons

Energy Technology Data Exchange (ETDEWEB)

Lopez-Rendon, Xochitl; Develter, Wim [KU Leuven, Department of Imaging and Pathology, Division of Medical Physics and Quality Assessment, Leuven (Belgium); Zhang, Guozhi; Coudyzer, Walter; Zanca, Federica [University Hospitals of the KU Leuven, Department of Radiology, Leuven (Belgium); Bosmans, Hilde [KU Leuven, Department of Imaging and Pathology, Division of Medical Physics and Quality Assessment, Leuven (Belgium); University Hospitals of the KU Leuven, Department of Radiology, Leuven (Belgium)

2017-11-15

To compare the lung and breast dose associated with three chest protocols: standard, organ-based tube current modulation (OBTCM) and fast-speed scanning; and to estimate the error associated with organ dose when modelling the longitudinal (z-) TCM versus the 3D-TCM in Monte Carlo simulations (MC) for these three protocols. Five adult and three paediatric cadavers with different BMI were scanned. The CTDI{sub vol} of the OBTCM and the fast-speed protocols were matched to the patient-specific CTDI{sub vol} of the standard protocol. Lung and breast doses were estimated using MC with both z- and 3D-TCM simulated and compared between protocols. The fast-speed scanning protocol delivered the highest doses. A slight reduction for breast dose (up to 5.1%) was observed for two of the three female cadavers with the OBTCM in comparison to the standard. For both adult and paediatric, the implementation of the z-TCM data only for organ dose estimation resulted in 10.0% accuracy for the standard and fast-speed protocols, while relative dose differences were up to 15.3% for the OBTCM protocol. At identical CTDI{sub vol} values, the standard protocol delivered the lowest overall doses. Only for the OBTCM protocol is the 3D-TCM needed if an accurate (<10.0%) organ dosimetry is desired. (orig.)

Dose-volumetric parameters for predicting hypothyroidism after radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Kim, Mi Young; Yu, Tosol; Wu, Hong-Gyun

2014-01-01

To investigate predictors affecting the development of hypothyroidism after radiotherapy for head and neck cancer, focusing on radiation dose-volumetric parameters, and to determine the appropriate radiation dose-volumetric threshold of radiation-induced hypothyroidism. A total of 114 patients with head and neck cancer whose radiotherapy fields included the thyroid gland were analysed. The purpose of the radiotherapy was either definitive (n=81) or post-operative (n=33). Thyroid function was monitored before starting radiotherapy and after completion of radiotherapy at 1 month, 6 months, 1 year and 2 years. A diagnosis of hypothyroidism was based on a thyroid stimulating hormone value greater than the maximum value of laboratory range, regardless of symptoms. In all patients, dose volumetric parameters were analysed. Median follow-up duration was 25 months (range; 6-38). Forty-six percent of the patients were diagnosed as hypothyroidism after a median time of 8 months (range; 1-24). There were no significant differences in the distribution of age, gender, surgery, radiotherapy technique and chemotherapy between the euthyroid group and the hypothyroid group. In univariate analysis, the mean dose and V35-V50 results were significantly associated with hypothyroidism. The V45 is the only variable that independently contributes to the prediction of hypothyroidism in multivariate analysis and V45 of 50% was a threshold value. If V45 was <50%, the cumulative incidence of hypothyroidism at 1 year was 22.8%, whereas the incidence was 56.1% if V45 was ≥50%. (P=0.034). The V45 may predict risk of developing hypothyroidism after radiotherapy for head and neck cancer, and a V45 of 50% can be a useful dose-volumetric threshold of radiation-induced hypothyroidism. (author)

Intensity-modulated radiation therapy: overlapping co-axial modulated fields

International Nuclear Information System (INIS)

Metcalfe, P; Tangboonduangjit, P; White, P

2004-01-01

The Varian multi-leaf collimator has a 14.5 cm leaf extension limit from each carriage. This means the target volumes in the head and neck region are sometimes too wide for standard width-modulated fields to provide adequate dose coverage. A solution is to set up asymmetric co-axial overlapping fields. This protects the MLC carriage while in return the MLC provides modulated dose blending in the field overlap region. Planar dose maps for coincident fields from the Pinnacle radiotherapy treatment planning system are compared with planar dose maps reconstructed from radiographic film and electronic portal images. The film and portal images show small leaf-jaw matchlines at each field overlap border. Linear profiles taken across each image show that the observed leaf-jaw matchlines from the accelerator images are not accounted for by the treatment planning system. Dose difference between film reconstructed electronic portal images and planning system are about 2.5 cGy in a modulated field at d max . While the magnitude of the dose differences are small improved round end leaf modelling combined with a finer dose calculation grid may minimize the discrepancy between calculated and delivered dose

ICRU reference dose in an era of intensity-modulated radiation therapy clinical trials: Correlation with planning target volume mean dose and suitability for intensity-modulated radiation therapy dose prescription

International Nuclear Information System (INIS)

Yaparpalvi, Ravindra; Hong, Linda; Mah, Dennis; Shen Jin; Mutyala, Subhakar; Spierer, Marnee; Garg, Madhur; Guha, Chandan; Kalnicki, Shalom

2008-01-01

Background and Purpose: IMRT clinical trials lack dose prescription and specification standards similar to ICRU standards for two- and three-dimensional external beam planning. In this study, we analyzed dose distributions for patients whose treatment plans incorporated IMRT, and compared the dose determined at the ICRU reference point to the PTV doses determined from dose-volume histograms. Additionally, we evaluated if ICRU reference type single-point dose prescriptions are suitable for IMRT dose prescriptions. Materials and methods: For this study, IMRT plans of 117 patients treated at our institution were randomly selected and analyzed. The treatment plans were clinically applied to the following disease sites: abdominal (11), anal (10), brain (11), gynecological (15), head and neck (25), lung (15), male pelvis (10) and prostate (20). The ICRU reference point was located in each treatment plan following ICRU Report 50 guidelines. The reference point was placed in the central part of the PTV and at or near the isocenter. In each case, the dose was calculated and recorded to this point. For each patient - volume and dose (PTV, PTV mean, median and modal) information was extracted from the planned dose-volume histogram. Results: The ICRU reference dose vs PTV mean dose relationship in IMRT exhibited a weak positive association (Pearson correlation coefficient 0.63). In approximately 65% of the cases studied, dose at the ICRU reference point was greater than the corresponding PTV mean dose. The dose difference between ICRU reference and PTV mean doses was ≤2% in approximately 79% of the cases studied (average 1.21% (±1.55), range -4% to +4%). Paired t-test analyses showed that the ICRU reference doses and PTV median doses were statistically similar (p = 0.42). The magnitude of PTV did not influence the difference between ICRU reference and PTV mean doses. Conclusions: The general relationship between ICRU reference and PTV mean doses in IMRT is similar to that

Automatic tube-current modulation in CT - A comparison between different solutions

International Nuclear Information System (INIS)

Althen, J. N.

2005-01-01

In this study, tube-current modulation systems on two different CT equipments have been evaluated: Care Dose from Siemens and Auto mA from GE Medical Systems. Care Dose modulates the tube current in the xy-plane during rotation whereas Auto mA modulates the tube current in the z-direction. xy-Plane modulation was investigated by using an elliptic Poly-methylmethacrylate phantom and a CTDI-ion chamber. To investigate modulation in the z-direction, an anthropomorphic dosimetry phantom (Atom) was used. Tests performed with and without tube-current modulation were compared with respect to absorbed dose and image quality. In the anthropomorphic phantom measurements, the dose savings were 15% using Care Dose and the photon starvation artefacts were negligible. Using Auto mA the absorbed dose depends on the chosen noise level. Image noise becomes more constant throughout the patient but photon starvation artefacts remain. We conclude that the two tube-current modulation techniques show different dose advantages and image quality artefacts. (authors)

Development of a head and neck companion module for the quality of life-radiation therapy instrument (QOL-RTI)

International Nuclear Information System (INIS)

Trotti, Andy; Johnson, Darlene J.; Gwede, Clement; Casey, Linda; Sauder, Bonnie; Cantor, Alan; Pearlman, James

1998-01-01

Purpose/Objective: A review of available head and neck quality of life (QOL) instruments reveals them to inadequately address important radiation related side effects, or to be too cumbersome for routine use. The purpose of this study was to develop a head and neck disease specific module as a companion to the previously developed quality of life - radiation therapy instrument (QOL-RTI). The goal was to create a more complete, yet concise, head and neck site-specific module geared toward patients receiving radiation therapy for head and neck cancer. Methods and Materials: This exploratory study included 34 consecutive patients undergoing definitive radiotherapy over a 6-7 week course (60-79.8 Gy). We developed and administered a 14-item questionnaire to all eligible patients treated with radiotherapy for head and neck cancer who were not already registered in another research study assessing quality of life (e.g., RTOG). During the treatment period, the QOL-RTI general tool and the head and neck (H and N) module were administered as follows: at baseline, at week four (for test-retest), and at the end of the treatment period. For validation purposes the QOL-RTI/H and N was compared to the functional assessment cancer tool head and neck (FACT-H and N) questionnaire. The FACT-H and N was administered one time at week 4, on the same day as the QOL-RTI/H and N. This report includes the treatment phase of the study (during the course of radiation). Results: Mean age was 62 years (range 40-75). Internal consistency of the module was satisfactory (Chronbach's α = 0.85). Test-retest yielded a correlation coefficient of 0.90 (p < 0.001). Concurrent validity, established by comparing the module to the FACT/H and N , yielded a correlation coefficient of 0.85. Significant changes in quality of life scores during a course of radiation was noted for both general quality of life tool and the site specific module. For the head and neck module, the difference in the mean baseline

Differences among doses for neuro-axis radiotherapy planning in the gonadal region

International Nuclear Information System (INIS)

Lima, F.F de; Vilela, E.C.; Oliveira, F.L.; Filho, J.A.

2015-01-01

Radiotherapy can disrupt the functioning of the hypothalamic-pituitary axis, directly causing ovarian deficiencies, such as the decrease in fertility or damage that renders the uterus incapable of accommodating the growth of a fetus. However, these issues have become increasingly important to a growing number of pediatric and adolescent cancer survivors. The whole-body, cranial-spinal axis, as well as abdomen and pelvic region irradiations may expose the ovaries to radiation and may cause premature ovarian failure, whereas doses above 35 Gy cranial can affect the hypothalamic-pituitary functions. This study performed a comparison of four doses of radiotherapy planning techniques for the neural axis. For this analysis, technical simulations were performed for the treatment of medulloblastoma in four different planning, applied in a RANDO anthropomorphic phantom and dosimeters (TLD-100). The radiation fields in the 1”st and 2”nd planning were 40 x 5 cm”2 and 17 x 5 cm”2 with 4.0 cm depth, in which doses were 0.03 and 0.05 Gy / day and 0.11 and 0.09 Gy / days, on the right and left sides, respectively. The 3”rd and 4”th measured planning 32 x 7 cm”2 and 18 x 7 cm”2, with a 2 cm gap and a 4.0 and 5.0 cm depth, in which doses were 1.08 and 0.2 Gy/day and 1.14 and 0.14 Gy/day, on the left and right sides, respectively. It could be observed that the doses in the ovaries in the 3”rd and 4”th schedules proved to be larger than the doses in the 1 s t and 2 n d planning. This is caused by the spinal field width and the depth of the second spinal field, which is 1.0 cm more than the field of the 1”st and 2”nd planning. These differences should be observed in image planning, as incorrect measures can cause damage in the treatment finish. (authors)

Dose reduction in CT examination of children by an attenuation-based on-line modulation of tube current (CARE Dose)

International Nuclear Information System (INIS)

Greess, Holger; Noemayr, Anton; Baum, Ulrich; Lell, Michael; Boewing, Bernhard; Bautz, Werner A.; Wolf, Heiko; Kalender, Willi

2002-01-01

In a controlled patient study we investigated the potential of attenuation-based on-line modulation of the tube current to reduce milliampere values (mAs) in CT examinations of children without loss of image quality. mAs can be reduced for non-circular patient cross sections without an increase in noise if tube current is reduced at those angular positions where the patient diameter and, consequently, attenuation are small. We investigated a technical approach with an attenuation-based on-line control for the tube current realised as a work-in-progress implementation. The CT projection data are analysed in real time to determine optimal mAs values for each projection angle. We evaluated mAs reduction for 100 spiral CT examinations with attenuation-based on-line modulation of the tube current in a group of children. Two radiologists evaluated image quality by visual interpretation in consensus. We compared the mAs values read from the CT scanner with preset mAs of a standard protocol. Four different scan regions were examined in spiral technique (neck, thorax, abdomen, thorax and abdomen). We found the mAs product to be reduced typically by 10-60% depending on patient geometry and anatomical regions. The mean reduction was 22.3% (neck 20%, thorax 23%, abdomen 23%, thorax and abdomen 22%). In general, no deterioration of image quality was observed. There was no correlation between the age and the mean mAs reduction in the different anatomical regions. By classifying the children respectively to their weight, there is a positive trend between increasing weight and mAs reduction. We conclude that mAs in spiral CT examinations of children can be reduced substantially by attenuation-based on-line modulation of the tube current without deterioration of image quality. Attenuation-based on-line modulation of tube current is efficient and practical for reducing dose exposure to children. (orig.)

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

NARCIS (Netherlands)

van der Molen, L.; Heemsbergen, W.D.; de Jong, R.; van Rossum, M.A.; Smeele, L.E.; Rasch, C.R.N.; Hilgers, F.J.M.

2013-01-01

Background and purpose: Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Material and methods: Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment

Dosimetric verification of brain and head and neck intensity-modulated radiation therapy treatment using EDR2 films and 2D ion chamber array matrix

Directory of Open Access Journals (Sweden)

Varatharaj C

2010-01-01

Full Text Available Background: The evaluation of the agreement between measured and calculated dose plays an essential role in the quality assurance (QA procedures of intensity-modulated radiation therapy (IMRT. Aim: The purpose of this study is to compare performances of the two dosimetric systems (EDR2 and I′matriXX in the verification of the dose distributions calculated by the TPS for brain and head and neck dynamic IMRT cases. Materials and Methods: The comparison of cumulative fluence by using Kodak extended dose rate (EDR2 and I′matriXX detectors has been done for the evaluation of 10 brain, 10 head and neck IMRT cases treated with 6 MV beams. The parameter used to assess the quality of dose calculation is the gamma-index (g -index method. The acceptance limits for g calculation we have used are 3% and 3 mm respectively for dose agreement and distance to agreement parameters. Statistical analyses were performed by using the paired, two-tailed Student t-test, and P< 0.01 is kept as a threshold for the significance level. Results: The qualitative dose distribution comparison was performed using composite dose distribution in the measurement plane and profiles along various axes for TPS vs. EDR2 film and TPS Vs I′matriXX. The quantitative analysis between the calculated and measured dose distribution was evaluated using DTA and g-index. The percentage of pixels matching with the set DTA and g values are comparable for both with EDR2 film and I′matriXX array detectors. Statistically there was no significant variation observed between EDR2 film and I′matriXX in terms of the mean percentage of pixel passing g for brain cases (98.77 ± 1.03 vs 97.62 ± 1.66, P = 0.0218 and for head and neck cases (97.39 ± 2.13 vs 97.17 ± 1.52%, P = 0.7404. Conclusion: Due to simplicity and fast evaluation process of array detectors, it can be routinely used in busy departments without compromising the measurement accuracy.

Cancer of the head and neck

International Nuclear Information System (INIS)

Leignel, D.; Toledano, A.; Calais, G.; Gardner, M.; Valinta, D.; Halimi, P.; Alberini, J.L.; Plantet, M.M.; Banal, A.; Hans, S.; Floiras, J.L.; Labib, A.; Djemaa, A.; Naoun, L.; Bali, M.; Melais, K.; George, L.; Cazalet, M.; Gross, E.; Padovani, L.; Cowen, D.; Pignon, T.; Bannour, N.; Guedouar, R.; Bouaouina, N.; Mege, A.; Lapeyre, M.; Graff, P.; Marchesi, V.; Aletti, P.; Marchal, C.; Peiffert, D.; Serre, A.; Ailleres, N.; Lemanski, C.; Hay, M.H.; Llacer Moscardo, C.; Allaw, A.; Azria, D.; Dubois, J.B.; Fenoglietto, P.; Maalej, M.; Nasr, C.; Chaari, N.; Hentati, D.; Kochbati, L.; Besbes, M.; Benjelloun, H.; Benchakroun, N.; Houjami, M.; Jouhadi, H.; Tawfiq, N.; Acharki, A.; Sahraoui, S.; Benider, A.; Racadot, S.; Mercier, M.; Dessard-Diana, B.; Bensadoun, R.J.; Martin, M.; Malaurie, E.; Favrel, V.; Housset, M.; Journel, C.; Calais, G.; Huet, J.; Pillet, G.; Hennequin, C.; Haddad, E.; Diana, C.; Blaska-Jaulerry, B.; Henry-Amar, M.; Gehanno, P.; Baillet, F.; Mazeron, J.J.; Chaouache, C.K.; Tebra Mrad, T.M.S.; Bannour, B.N.S.; Bouaouina, B.N.; Favrel, V.; Khodri, M.; Chapet, O.; Nguyen, D.; Ardiet, J.; Romestaing, P.; Thillays, F.; Bardet, E.; Rolland, F.; Maingan, P.; Campion, L.; Mahe, M.A.

2005-01-01

Thirteen articles are presented in relation with head and neck cancer. Chemoradiotherapy, medical examinations using nuclear techniques such PET scanning, fractionated radiotherapy after a chemotherapy, analysis of dose volume for patients treated by irradiation with a combined chemotherapy, dosimetry, conformal radiotherapy with intensity modulation, dosimetry in brachytherapy, association of radiotherapy and chemotherapy in the treatment of nose pharynx carcinomas, recurrence, are the different subjects treated in this part. (N.C.)

The effect of source-axis distance on integral dose: implications for IMRT

International Nuclear Information System (INIS)

Keall, P.

2001-01-01

The source-axis distance (SAD) is a treatment machine design parameter that affects integral dose, dose rate and patient clearance. The aim of this work was to investigate the effect of source-axis distance on integral dose for conformal arc therapy. This work is part of a larger project to determine the ideal characteristics of a dedicated IMRT machine. The sensitivity of SAD to beam energy, PTV size, body size and PTV position were determined for conformal arc therapy. For the calculations performed here it was assumed that dose equals terma. The integral dose ratio (IDR) was used to quantify the calculation results. It was found that the IDR increases as both SAD and photon energy increase, though the dependence of IDR on SAD decreases as energy increases. The PTV size was found to have a negligible effect on the relationship between the SAD and IDR, however the body size does affect the relationship between the SAD and IDR. The position of the PTV within the body also affects the IDR. From dosimetric considerations alone, the larger the SAD, the better the possible dose distribution. The IDR for a very large SAD is increased by approximately 5% when compared with the IDR for 100 cm SAD. Similarly, the IDR for 100 cm SAD is approximately 5% higher than the IDR at 50 cm SAD. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

Computation of thyroid doses and carcinogenic radiation risks to patients undergoing neck CT examinations

International Nuclear Information System (INIS)

Huda, W.; Spampinato, M. V.; Tipnis, S. V.; Magill, D.

2013-01-01

The aim of the study was to investigate how differences in patient anatomy and CT technical factors in neck CT impact on thyroid doses and the corresponding carcinogenic risks. The CTDI vol and dose-length product used in 11 consecutive neck CT studies, as well as data on automatic exposure control (AEC) tube current variation(s) from the image DICOM header, were recorded. For each CT image that included the thyroid, the mass equivalent water cylinder was estimated based on the patient cross-sectional area and average relative attenuation coefficient (Hounsfield unit, HU). Patient thyroid doses were estimated by accounting for radiation intensity at the location of the patient's thyroid, patient size and the scan length. Thyroid doses were used to estimate thyroid cancer risks as a function of patient demographics using risk factors in BEIR VII. The length of the thyroid glands ranged from 21 to 54 mm with an average length of 42±12 mm. Water cylinder diameters corresponding to the central slice through the patient thyroid ranged from 18 to 32 cm with a mean of 25±5 cm. The average CTDI vol (32-cm phantom) used to perform these scans was 26±6 mGy, but the use of an AEC increased the tube current by an average of 44 % at the thyroid mid-point. Thyroid doses ranged from 29 to 80 mGy, with an average of 55±19 mGy. A 20-y-old female receiving the highest thyroid dose of 80 mGy would have a thyroid cancer risk of nearly 0.1 %, but radiation risks decreased very rapidly with increasing patient age. The key factors that affect thyroid doses in neck CT examinations are the radiation intensity at the thyroid location and the size of the patient. The corresponding patient thyroid cancer risk is markedly influenced by patient sex and age. (authors)

Patterns of Failure and Toxicity after Intensity-Modulated Radiotherapy for Head and Neck Cancer

International Nuclear Information System (INIS)

Schoenfeld, Gordon O.; Amdur, Robert J.; Morris, Christopher G.; Li, Jonathan G.; Hinerman, Russell W.; Mendenhall, William M.

2008-01-01

Purpose: To determine the outcome of patients treated with intensity-modulated radiotherapy (IMRT) for head and neck cancer. Methods and Materials: We reviewed the charts of 100 consecutive patients treated with IMRT for squamous cell carcinoma of the oropharynx (64%), nasopharynx (16%), hypopharynx (14%), and larynx (6%). Most patients were treated with a concomitant boost schedule to 72 Gy. Of the 100 patients, 54 (54%) received adjuvant chemotherapy, mostly concurrent cisplatin. The dosimetry plans for patients with either locoregional failure or Grade 4-5 complications were reviewed and fused over the computed tomography images corresponding with the location of the event. Marginal failures were defined as those that occurred at a region of high-dose falloff, where conventional fields would have provided better coverage. Results: The median follow-up of living patients was 3.1 years (range, 1-5.2 years). The 3-year rate of local control, locoregional control, freedom from relapse, cause-specific survival, and overall survival for all patients was 89%, 87%, 72%, 78%, and 71%, respectively. The 3-year rate of freedom from relapse, cause-specific survival, and overall survival for the 64 oropharynx patients was 86%, 92%, and 84%, respectively. Of the 10 local failures, 2 occurred at the margin of the high-dose planning target volume. Both regional failures occurred within the planning target volume. No locoregional failures occurred outside the planning target volume. Of the 100 patients, 8 and 5 had Grade 4 and 5 complications from treatment, respectively. All patients with Grade 5 complications had received adjuvant chemotherapy. No attempt was made to discriminate between the complications from IMRT and other aspects of the patients' treatment. Conclusion: Intensity-modulated radiotherapy did not compromise the outcome compared with what we have achieved with conventional techniques. The 2 cases of recurrence in the high-dose gradient region highlight the

Comparison of linear and nonlinear programming approaches for "worst case dose" and "minmax" robust optimization of intensity-modulated proton therapy dose distributions.

Science.gov (United States)

Zaghian, Maryam; Cao, Wenhua; Liu, Wei; Kardar, Laleh; Randeniya, Sharmalee; Mohan, Radhe; Lim, Gino

2017-03-01

Robust optimization of intensity-modulated proton therapy (IMPT) takes uncertainties into account during spot weight optimization and leads to dose distributions that are resilient to uncertainties. Previous studies demonstrated benefits of linear programming (LP) for IMPT in terms of delivery efficiency by considerably reducing the number of spots required for the same quality of plans. However, a reduction in the number of spots may lead to loss of robustness. The purpose of this study was to evaluate and compare the performance in terms of plan quality and robustness of two robust optimization approaches using LP and nonlinear programming (NLP) models. The so-called "worst case dose" and "minmax" robust optimization approaches and conventional planning target volume (PTV)-based optimization approach were applied to designing IMPT plans for five patients: two with prostate cancer, one with skull-based cancer, and two with head and neck cancer. For each approach, both LP and NLP models were used. Thus, for each case, six sets of IMPT plans were generated and assessed: LP-PTV-based, NLP-PTV-based, LP-worst case dose, NLP-worst case dose, LP-minmax, and NLP-minmax. The four robust optimization methods behaved differently from patient to patient, and no method emerged as superior to the others in terms of nominal plan quality and robustness against uncertainties. The plans generated using LP-based robust optimization were more robust regarding patient setup and range uncertainties than were those generated using NLP-based robust optimization for the prostate cancer patients. However, the robustness of plans generated using NLP-based methods was superior for the skull-based and head and neck cancer patients. Overall, LP-based methods were suitable for the less challenging cancer cases in which all uncertainty scenarios were able to satisfy tight dose constraints, while NLP performed better in more difficult cases in which most uncertainty scenarios were hard to meet

Comparative Evaluation of Pulsewidth Modulation Strategies for Z-Source Neutral-Point-Clamped Inverter

DEFF Research Database (Denmark)

Loh, P.C.; Blaabjerg, Frede; Wong, C.P.

2007-01-01

modulation (PWM) strategies for controlling the Z-source NPC inverter. While developing the PWM techniques, attention has been devoted to carefully derive them from a common generic basis for improved portability, easier implementation, and most importantly, assisting readers in understanding all concepts......Z-source neutral-point-clamped (NPC) inverter has recently been proposed as an alternative three-level buck-boost power conversion solution with an improved output waveform quality. In principle, the designed Z-source inverter functions by selectively "shooting through" its power sources, coupled...... to the inverter using two unique Z-source impedance networks, to boost the inverter three-level output waveform. Proper modulation of the new inverter would therefore require careful integration of the selective shoot-through process to the basic switching concepts to achieve maximal voltage-boost, minimal...

Risk Factors for Hearing Loss in Patients Treated With Intensity-Modulated Radiotherapy for Head-and-Neck Tumors

International Nuclear Information System (INIS)

Zuur, Charlotte L.; Simis, Yvonne J.; Lamers, Emmy A.; Hart, Augustinus A.; Dreschler, Wouter A.; Balm, Alfons J.; Rasch, Coen R.

2009-01-01

Purpose: Radiotherapy (RT) is a common treatment of head-and-neck carcinoma. The objective of this study was to perform a prospective multivariate assessment of the dose-effect relationship between intensity-modulated RT and hearing loss. Methods and Materials: Pure tone audiometry at 0.250-16 kHz was obtained before and after treatment in 101 patients (202 ears). All patients received full-course intensity-modulated RT (range, 56-70 Gy), with a median cochlear dose of 11.4 Gy (range, 0.2-69.7). Results: Audiometry was performed 1 week before and a median of 9 weeks (range, 1-112) after treatment. The mean hearing deterioration at pure tone average air-conduction 1-2-4 kHz was small (from 28.6 dB HL to 30.1 dB HL). However, individual patients showed clinically significant hearing loss, with 10-dB threshold shift incidences of 13% and 18% at pure tone averages air-conduction 1-2-4 kHz and 8-10-12.5 kHz, respectively. Post-treatment hearing capability was unfavorable in the case of greater inner ear radiation doses (p <0.0001), unfavorable baseline hearing capability (p <0.0001), green-eyed patients (p <0.0001), and older age (p <0.0001). Using multivariate analysis, a prediction of individual hearing capabiltity after treatment was made. Conclusion: RT-induced hearing loss in the mean population is modest. However, clinically significant hearing loss was observed in older patients with green eyes and unfavorable pretreatment hearing. In these patients, the intended radiation dose may be adjusted according to the proposed predictive model, aiming to decrease the risk of ototoxicity.

Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT)

International Nuclear Information System (INIS)

Peponi, Evangelia; Glanzmann, Christoph; Willi, Bettina; Huber, Gerhard; Studer, Gabriela

2011-01-01

To evaluate the objective and subjective long term swallowing function, and to relate dysphagia to the radiation dose delivered to the critical anatomical structures in head and neck cancer patients treated with intensity modulated radiation therapy (IMRT, +/- chemotherapy), using a midline protection contour (below hyoid, ~level of vertebra 2/3). 82 patients with stage III/IV squamous cell carcinoma of the larynx, oropharynx, or hypopharynx, who underwent successful definitive (n = 63, mean dose 68.9Gy) or postoperative (n = 19, mean dose 64.2Gy) simultaneous integrated boost (SIB) -IMRT either alone or in combination with chemotherapy (85%) with curative intent between January 2002 and November 2005, were evaluated retrospectively. 13/63 definitively irradiated patients (21%) presented with a total gross tumor volume (tGTV) >70cc (82-173cc; mean 106cc). In all patients, a laryngo-pharyngeal midline sparing contour outside of the PTV was drawn. Dysphagia was graded according subjective patient-reported and objective observer-assessed instruments. All patients were re-assessed 12 months later. Dose distribution to the swallowing structures was calculated. At the re-assessment, 32-month mean post treatment follow-up (range 16-60), grade 3/4 objective toxicity was assessed in 10%. At the 32-month evaluation as well as at the last follow up assessment mean 50 months (16-85) post-treatment, persisting swallowing dysfunction grade 3 was subjectively and objectively observed in 1 patient (1%). The 5-year local control rate of the cohort was 75%; no medial marginal failures were observed. Our results show that sparing the swallowing structures by IMRT seems effective and relatively safe in terms of avoidance of persistent grade 3/4 late dysphagia and local disease control

Influence of Parotid from Various Dose Rate in Intensity Modulated Radiation Therapy Planning for Head and Neck Cancer

International Nuclear Information System (INIS)

Hong, Joo Wan; Jeong, Yun Ju; Won, Hui Su; Chang, Nam Jun; Choi, Ji Hun; Seok, Jin Yong

2010-01-01

There are various beam parameter in intensity modulated radiation therapy (IMRT). The aim of this study is to investigate how various dose rate affect the parotid in treatment plan of IMRT. Materials and Methods: The study was performed on 10 nasopharyngeal carcinoma patients who have undergone IMRT. CT images were scanned 3 mm of thickness in the same condition and the treatment plan was performed by Eclipse (Ver.7.1, Varian, Palo Alto, USA). The parameters for planning used 6 MV energy and 8 beams under the same dose volume constraint. The variation of dose rates were used 300, 400, 500 MU/min. The mean dose of both parotid was accessed from the calculated planning among the 10 patients. The mean dose of parotid was verificated by 2D diode array (Mapcheck from Sun Nuclear Corporation, Melbourne, Florida). Also, Total monitor unit (MU) and beam-on time was analysed. Results: According to the dose rate, the mean dose of parotid was increased by 0.8%, 2.0% each, when dose rate was changed from 300 MU/min to 400, 500 MU/min, moreover Total MU was increased by 5.4% and 10.6% each. There was also a dose upward trend in the dose measurement of parotid by 2D diode array. However, beam - on time difference of 1-2 minutes was no significant in the dose rate increases. From this study, when the dose rates increase, there was a significant increase of Total MU and the parotid dose accordingly, however the shortened treatment time was not significant. Hence, it is considered that there is a significant decrease of late side effect in parotid radiation therapy, if the precise dose rate in IMRT is used.

Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy

International Nuclear Information System (INIS)

Alevronta, Eleftheria; Ahlberg, Alexander; Mavroidis, Panayiotis; Al-Abany, Massoud; Friesland, Signe; Tilikidis, Aris; Laurell, Goeran; Lind, Bengt K.

2010-01-01

Background and purpose: Determination of the dose-response relations for oesophageal stricture after radiotherapy of the head and neck. Material and methods: In this study 33 patients who developed oesophageal stricture and 39 patients as controls are included. The patients received radiation therapy for head and neck cancer at Karolinska University Hospital, Stockholm, Sweden. For each patient the 3D dose distribution delivered to the upper 5 cm of the oesophagus was analysed. The analysis was conducted for two periods, 1992-2000 and 2001-2005, due to the different irradiation techniques used. The fitting has been done using the relative seriality model. Results: For the treatment period 1992-2005, the mean doses were 49.8 and 33.4 Gy, respectively, for the cases and the controls. For the period 1992-2000, the mean doses for the cases and the controls were 49.9 and 45.9 Gy and for the period 2001-2005 were 49.8 and 21.4 Gy. For the period 2001-2005 the best estimates of the dose-response parameters are D 50 = 61.5 Gy (52.9-84.9 Gy), γ = 1.4 (0.8-2.6) and s = 0.1 (0.01-0.3). Conclusions: Radiation-induced strictures were found to have a dose response relation and volume dependence (low relative seriality) for the treatment period 2001-2005. However, no dose response relation was found for the complete material.

Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer

Directory of Open Access Journals (Sweden)

Neubauer Emily

2012-02-01

Full Text Available Abstract Background For radiotherapy of the head and neck, 5-point mask immobilization is used to stabilize the shoulders. Still, the daily position of the shoulders during treatment may be different from the position in the treatment plan despite correct isocenter setup. The purpose of this study was to determine the interfractional displacement of the shoulders relative to isocenter over the course of treatment and the associated dosimetric effect of this displacement. Methods The extent of shoulder displacements relative to isocenter was assessed for 10 patients in 5-point thermoplastic masks using image registration and daily CT-on-rails scans. Dosimetric effects on IMRT and VMAT plans were evaluated in Pinnacle based on simulation CTs modified to represent shoulder shifts between 3 and 15 mm in the superior-inferior, anterior-posterior, and right-left directions. The impact of clinically observed shoulder shifts on the low-neck dose distributions was examined. Results Shoulder motion was 2-5 mm in each direction on average but reached 20 mm. Superior shifts resulted in coverage loss, whereas inferior shifts increased the dose to the brachial plexus. These findings were generally consistent for both IMRT and VMAT plans. Over a course of observed shifts, the dose to 99% of the CTV decreased by up to 101 cGy, and the brachial plexus dose increased by up to 72 cGy. Conclusions he position of the shoulder affects target coverage and critical structure dose, and may therefore be a concern during the setup of head and neck patients, particularly those with low neck primary disease.

Tolerance doses of cutaneous and mucosal tissues in ring-necked parakeets (Psittacula krameri) for external beam megavoltage radiation.

Science.gov (United States)

Barron, Heather W; Roberts, Royce E; Latimer, Kenneth S; Hernandez-Divers, Stephen; Northrup, Nicole C

2009-03-01

Currently used dosages for external-beam megavoltage radiation therapy in birds have been extrapolated from mammalian patients and often appear to provide inadequate doses of radiation for effective tumor control. To determine the tolerance doses of cutaneous and mucosal tissues of normal birds in order to provide more effective radiation treatment for tumors that have been shown to be radiation responsive in other species, ingluvial mucosa and the skin over the ingluvies of 9 ring-necked parakeets (Psittacula krameri) were irradiated in 4-Gy fractions to a total dose of either 48, 60, or 72 Gy using an isocentric cobalt-60 teletherapy unit. Minimal radiation-induced epidermal changes were present in the high-dose group histologically. Neither dose-related acute nor chronic radiation effects could be detected in any group grossly in cutaneous or mucosal tissue over a 9-month period. Radiation doses of 72 Gy in 4-Gy fractions were well tolerated in the small number of ring-necked parakeets in this initial tolerance dose study.

Is uniform target dose possible in IMRT plans in the head and neck?

International Nuclear Information System (INIS)

Vineberg, K.A.; Eisbruch, A.; Coselmon, M.M.; McShan, D.L.; Kessler, M.L.; Fraass, B.A.

2002-01-01

Purpose: Various published reports involving intensity-modulated radiotherapy (IMRT) plans developed using automated optimization (inverse planning) have demonstrated highly conformal plans. These reported conformal IMRT plans involve significant target dose inhomogeneity, including both overdosage and underdosage within the target volume. In this study, we demonstrate the development of optimized beamlet IMRT plans that satisfy rigorous dose homogeneity requirements for all target volumes (e.g., ±5%), while also sparing the parotids and other normal structures. Methods and Materials: The treatment plans of 15 patients with oropharyngeal cancer who were previously treated with forward-planned multisegmental IMRT were planned again using an automated optimization system developed in-house. The optimization system allows for variable sized beamlets computed using a three-dimensional convolution/superposition dose calculation and flexible cost functions derived from combinations of clinically relevant factors (costlets) that can include dose, dose-volume, and biologic model-based costlets. The current study compared optimized IMRT plans designed to treat the various planning target volumes to doses of 66, 60, and 54 Gy with varying target dose homogeneity while using a flexible optimization cost function to minimize the dose to the parotids, spinal cord, oral cavity, brainstem, submandibular nodes, and other structures. Results: In all cases, target dose uniformity was achieved through steeply varying dose-based costs. Differences in clinical plan evaluation metrics were evaluated for individual cases (eight different target homogeneity costlets), and for the entire cohort of plans. Highly conformal plans were achieved, with significant sparing of both the contralateral and ipsilateral parotid glands. As the homogeneity of the target dose distributions was allowed to decrease, increased sparing of the parotids (and other normal tissues) may be achieved. However, it

Intensity Modulated Radiation Therapy. Development of the technique

International Nuclear Information System (INIS)

Rafailovici, L.; Alva, R.; Chiozza, J.; Donato, H.; Falomo, S.; Cardiello, C.; Furia, O.; Martinez, A.; Filomia, M.L.; Sansogne, R.; Arbiser, S.; Dosoretz, B.

2008-01-01

Full text: Introduction: Intensity Modulated Radiation Therapy (IMRT) is a result of advances in computer sciences that allowed the development of new technology related to planning and radiation therapy. IMRT was developed to homogenize the dose in the target volumes and decrease the dose in the surrounding healthy tissue. Using a software with high calculation capacity a simultaneous irradiation with different doses in a given volume is achieved. IMRT is based on internal planning. Material and methods: 628 patients were treated with IMRT in prostate lesions, head and neck, breast, thorax, abdomen and brain since August 2008. The software for IMRT is the XIO CMS and the accelerator used is a Varian Clinac 6 / 100. IMRT requires a first simulation, where immobilization systems are selected (mats, thermoplastic masks, among others) and the demarcation of the target structures, healthy tissue and dose prescription by a tattoo. Images of CT / MRI are merged when necessary. Once the system made the treatment optimization, this one is regulated by modulators. These are produced by numerical control machines from digital files produced by software. In a second modulation the planned irradiation is checked and tattoo is carried out according with this. We have a strict process of quality assurance to assess the viability of the plan before its implementation. We use the Map Check it possible to compare the dose on the central axis and the distribution in the whole plane regarding to that generated by the planning system. From 03/2008 the virtual simulation process was implemented integrating the described stages. Results and Conclusions: IMRT is a complex technique. The meticulous planning, implementation of process and quality control allows the use of this technique in a reliable and secure way. With IMRT we achieved a high level of dose conformation, less irradiation of healthy tissue, lower rates of complications and the dose escalation for some tumors. (authors) [es

Cumulative cisplatin dose in concurrent chemoradiotherapy for head and neck cancer : A systematic review

NARCIS (Netherlands)

Strojan, Primoz; Vermorken, Jan B.; Beitler, Jonathan J.; Saba, Nabil F.; Haigentz, Missak; Bossi, Paolo; Worden, Francis P.; Langendijk, Johannes A.; Eisbruch, Avraham; Mendenhall, William M.; Lee, Anne W. M.; Harrison, Louis B.; Bradford, Carol R.; Smee, Robert; Silver, Carl E.; Rinaldo, Alessandra; Ferlito, Alfio

Background. The optimal cumulative dose and timing of cisplatin administration in various concurrent chemoradiotherapy protocols for nonmetastatic head and neck squamous cell carcinoma (HNSCC) has not been determined. Methods. The absolute survival benefit at 5 years of concurrent chemoradiotherapy

Radiotherapy through intensity modulation (IMRT). A new modality in the treatment of head and neck cancer

International Nuclear Information System (INIS)

Besa de C, Pelayo; Venencia M, Daniel

2006-01-01

Objective: To describe the treatment and evaluate the advantages of IMRT in the treatment of head and neck cancer. Material and methods: Four years ago, at the Cancer Center of the Pontificia Universidad Catolica, the IMRT technique for the treatment of head and neck tumors was implemented. The IMRT technique is based on modifying the intensity of the radiation beam through a multisheet collimator in order to produce a more exact distribution in the radiation doses. The results are evaluated with dose/ volume histograms. The distributions of doses and toxicity for tridimensional con formed therapy (CRT-3D) and IMRT are compared. Results: The distribution of the dose in the dose/volume histograms showed a better coverage of the white volume (PTV), with IMRT. The doses received by the organs under risk: salivary glands, eyes, ears and brain diminish with IMRT. The spinal marrow is protected with IMRT without dividing the treatment area, preventing points with lower dosage that could reduce control of the tumor. Conclusions: IMRT achieves a better conformation of the dose obtaining a better coverage of the tumor and higher protection of the organs under risk

Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers

Energy Technology Data Exchange (ETDEWEB)

Henriques de Figueiredo, B. [Institut Bergonie, Department of Radiotherapy, Bordeaux (France); INCIA UMR-CNRS 5287, Bordeaux (France); Zacharatou, C. [Institut Bergonie, Department of Radiotherapy, Bordeaux (France); Galland-Girodet, S.; Benech, J. [Hospital Haut-Leveque, Department of Radiotherapy, CHRU Bordeaux (France); Clermont-Gallerande, H. de [Hospital Pellegrin, Department of Nuclear Medicine, CHRU Bordeaux (France); Lamare, F. [INCIA UMR-CNRS 5287, Bordeaux (France); Hospital Haut-Leveque, Department of Radiotherapy, CHRU Bordeaux (France); Hatt, M. [LaTIM INSERM U1101, Brest (France); Digue, L. [Hospital Saint-Andre, Department of Clinical Oncology, CHRU Bordeaux (France); Mones del Pujol, E. de [Department of Oto-rhino-laryngology, CHRU Bordeaux (France); Fernandez, P. [INCIA UMR-CNRS 5287, Bordeaux (France); Hospital Pellegrin, Department of Nuclear Medicine, CHRU Bordeaux (France); University Bordeaux 2, Bordeaux (France)

2014-09-23

Positron emission tomography (PET) with [{sup 18}F]-fluoromisonidazole ([{sup 18}F]-FMISO) provides a non-invasive assessment of hypoxia. The aim of this study is to assess the feasibility of a dose escalation with volumetric modulated arc therapy (VMAT) guided by [{sup 18}F]-FMISO-PET for head-and-neck cancers (HNC). Ten patients with inoperable stages III-IV HNC underwent [{sup 18}F]-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were segmented automatically by using the fuzzy locally adaptive Bayesian method. Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the HTV. A dosimetric comparison was performed, based on calculations of tumour control probability (TCP), normal tissue complication probability (NTCP) for the parotid glands and uncomplicated tumour control probability (UTCP). The mean hypoxic fraction, defined as the ratio between the HTV and the GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy without and with dose escalation respectively. FMISO-guided dose escalation led to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8 % respectively. A dose escalation up to 79.8 Gy guided by [{sup 18}F]-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids. (orig.) [German] Die Positronenemissionstomographie (PET) mit [{sup 18}F]-Fluoromisonidazol ([{sup 18}F]-FMISO) ermoeglicht eine nichtinvasive Beurteilung der Hypoxie. Ziel dieser Studie ist es, die Durchfuehrbarkeit einer [{sup 18}F]-FMISO-PET-gefuehrten Dosissteigerung bei volumetrisch modulierter Arc-Therapie (VMAT) von Kopf-Hals-Tumoren (KHT) zu bewerten. Zehn Patienten mit inoperablen KHT der Stadien III-IV erhielten vor der Strahlentherapie eine [{sup 18}F]-FMISO-PET. Hypoxische Zielvolumina (HV) wurden automatisch mit Hilfe des FLAB(Fuzzy Locally Adaptive Bayesian

SU-F-19A-10: Recalculation and Reporting Clinical HDR 192-Ir Head and Neck Dose Distributions Using Model Based Dose Calculation

Energy Technology Data Exchange (ETDEWEB)

Carlsson Tedgren, A [Linkoping University, Linkoping, Linkoping (Sweden); Persson, M; Nilsson, J [Karolinska hospital, Stockholm, Stockholm (Sweden)

2014-06-15

Purpose: To retrospectively re-calculate dose distributions for selected head and neck cancer patients, earlier treated with HDR 192Ir brachytherapy, using Monte Carlo (MC) simulations and compare results to distributions from the planning system derived using TG43 formalism. To study differences between dose to medium (as obtained with the MC code) and dose to water in medium as obtained through (1) ratios of stopping powers and (2) ratios of mass energy absorption coefficients between water and medium. Methods: The MC code Algebra was used to calculate dose distributions according to earlier actual treatment plans using anonymized plan data and CT images in DICOM format. Ratios of stopping power and mass energy absorption coefficients for water with various media obtained from 192-Ir spectra were used in toggling between dose to water and dose to media. Results: Differences between initial planned TG43 dose distributions and the doses to media calculated by MC are insignificant in the target volume. Differences are moderate (within 4–5 % at distances of 3–4 cm) but increase with distance and are most notable in bone and at the patient surface. Differences between dose to water and dose to medium are within 1-2% when using mass energy absorption coefficients to toggle between the two quantities but increase to above 10% for bone using stopping power ratios. Conclusion: MC predicts target doses for head and neck cancer patients in close agreement with TG43. MC yields improved dose estimations outside the target where a larger fraction of dose is from scattered photons. It is important with awareness and a clear reporting of absorbed dose values in using model based algorithms. Differences in bone media can exceed 10% depending on how dose to water in medium is defined.

SU-F-19A-10: Recalculation and Reporting Clinical HDR 192-Ir Head and Neck Dose Distributions Using Model Based Dose Calculation

International Nuclear Information System (INIS)

Carlsson Tedgren, A; Persson, M; Nilsson, J

2014-01-01

Purpose: To retrospectively re-calculate dose distributions for selected head and neck cancer patients, earlier treated with HDR 192Ir brachytherapy, using Monte Carlo (MC) simulations and compare results to distributions from the planning system derived using TG43 formalism. To study differences between dose to medium (as obtained with the MC code) and dose to water in medium as obtained through (1) ratios of stopping powers and (2) ratios of mass energy absorption coefficients between water and medium. Methods: The MC code Algebra was used to calculate dose distributions according to earlier actual treatment plans using anonymized plan data and CT images in DICOM format. Ratios of stopping power and mass energy absorption coefficients for water with various media obtained from 192-Ir spectra were used in toggling between dose to water and dose to media. Results: Differences between initial planned TG43 dose distributions and the doses to media calculated by MC are insignificant in the target volume. Differences are moderate (within 4–5 % at distances of 3–4 cm) but increase with distance and are most notable in bone and at the patient surface. Differences between dose to water and dose to medium are within 1-2% when using mass energy absorption coefficients to toggle between the two quantities but increase to above 10% for bone using stopping power ratios. Conclusion: MC predicts target doses for head and neck cancer patients in close agreement with TG43. MC yields improved dose estimations outside the target where a larger fraction of dose is from scattered photons. It is important with awareness and a clear reporting of absorbed dose values in using model based algorithms. Differences in bone media can exceed 10% depending on how dose to water in medium is defined

Isometries of semi-orthogonal forms on a Z-module of rank 3

International Nuclear Information System (INIS)

Kuleshov, Sergej A

2013-01-01

We study the isometry groups of semi-orthogonal forms (that is, forms whose Gram matrix in some basis is upper triangular with ones on the diagonal) on a Z-module of rank 3. Such forms have a discrete parameter: the height (the trace of the dualizing operator + 3). We prove that the isometry group is either Z or Z 2 ×Z, list all the cases when it is a direct product and describe the generator of order 2 in that case. We also describe a generator of infinite order for many particular values of the height.

SU-E-T-71: A Radiochromic Film Based Quantitative Assessment of Thermoplastic Mask Bolus Effect in Head and Neck IMRT/VMAT

Energy Technology Data Exchange (ETDEWEB)

Kalavagunta, C; Lin, M; Snider, J; Xu, H; Schrum, A; Vadnais, P; Marter, K; Suntharalingam, M; Prado, K [University of Maryland School of Medicine, Baltimore, MD (United States)

2015-06-15

Purpose: To quantify the factors leading to thermoplastic mask bolus-associated-increased skin dose in head and neck IMRT/VMAT using EBT2 film. Methods: EBT2 film placed beneath a dual layer 3-point ORFIT head, neck and shoulder mask was used to test the effect of mask thickness, beam modulation, air gap, and beam obliquity on bolus effect. Mask thickness was varied based on the distribution of 1.6mm Orfilight layer on top of 2 mm Efficast layer. Beam modulation was varied by irradiating the film with an open field (no beam modulation) and a step and shoot field (beam modulation). Air gap between mask and film was varied from 0 to 5mm. Beam obliquity was varied by irradiating the film at gantry angles of 0°, 35°, and 70°.Finally, film strips placed on a Rando phantom under an Orfit mask, in regions of expected high dose, were irradiated using 5 IMRT and 5 VMAT plans with various modulation levels (modulation factor 2 to 5) and the results were compared with those obtained placing OSLDs at the same locations. Results: An 18–34% increase in mask bolus effect was observed for three factors where the effect of beam obliquity ≥ beam modulation > mask thickness. No increase in mask bolus effect was observed for change in air gap. A 6–13% increase in dose due to mask bolus effect was observed on film strips. Conclusion: This work underlines the role of beam obliquity and beam modulation combined with thermoplastic mask thickness in increasing mask bolus-associated skin dose in head and neck IMRT/VMAT. One possible method of dose reduction, based on knowledge gained from this work, is inclusion of skin as an avoidance structure in treatment planning. Another approach is to design a mask with the least amount of thermoplastic material necessary for immobilization.

SU-E-T-71: A Radiochromic Film Based Quantitative Assessment of Thermoplastic Mask Bolus Effect in Head and Neck IMRT/VMAT

International Nuclear Information System (INIS)

Kalavagunta, C; Lin, M; Snider, J; Xu, H; Schrum, A; Vadnais, P; Marter, K; Suntharalingam, M; Prado, K

2015-01-01

Purpose: To quantify the factors leading to thermoplastic mask bolus-associated-increased skin dose in head and neck IMRT/VMAT using EBT2 film. Methods: EBT2 film placed beneath a dual layer 3-point ORFIT head, neck and shoulder mask was used to test the effect of mask thickness, beam modulation, air gap, and beam obliquity on bolus effect. Mask thickness was varied based on the distribution of 1.6mm Orfilight layer on top of 2 mm Efficast layer. Beam modulation was varied by irradiating the film with an open field (no beam modulation) and a step and shoot field (beam modulation). Air gap between mask and film was varied from 0 to 5mm. Beam obliquity was varied by irradiating the film at gantry angles of 0°, 35°, and 70°.Finally, film strips placed on a Rando phantom under an Orfit mask, in regions of expected high dose, were irradiated using 5 IMRT and 5 VMAT plans with various modulation levels (modulation factor 2 to 5) and the results were compared with those obtained placing OSLDs at the same locations. Results: An 18–34% increase in mask bolus effect was observed for three factors where the effect of beam obliquity ≥ beam modulation > mask thickness. No increase in mask bolus effect was observed for change in air gap. A 6–13% increase in dose due to mask bolus effect was observed on film strips. Conclusion: This work underlines the role of beam obliquity and beam modulation combined with thermoplastic mask thickness in increasing mask bolus-associated skin dose in head and neck IMRT/VMAT. One possible method of dose reduction, based on knowledge gained from this work, is inclusion of skin as an avoidance structure in treatment planning. Another approach is to design a mask with the least amount of thermoplastic material necessary for immobilization

Neuroactive steroids modulate HPA axis activity and cerebral brain-derived neurotrophic factor (BDNF) protein levels in adult male rats.

Science.gov (United States)

Naert, Gaëlle; Maurice, Tangui; Tapia-Arancibia, Lucia; Givalois, Laurent

2007-01-01

Depression is characterized by hypothalamo-pituitary-adrenocortical (HPA) axis hyperactivity. In this major mood disorder, neurosteroids and neurotrophins, particularly brain-derived neurotrophic factor (BDNF), seem to be implicated and have some antidepressant effects. BDNF is highly involved in regulation of the HPA axis, whereas neurosteroids effects have never been clearly established. In this systematic in vivo study, we showed that the principal neuroactive steroids, namely dehydroepiandrosterone (DHEA), pregnenolone (PREG) and their sulfate esters (DHEA-S and PREG-S), along with allopregnanolone (ALLO), stimulated HPA axis activity, while also modulating central BDNF contents. In detail, DHEA, DHEA-S, PREG, PREG-S and ALLO induced corticotropin-releasing hormone (CRH) and/or arginine vasopressin (AVP) synthesis and release at the hypothalamic level, thus enhancing plasma adrenocorticotropin hormone (ACTH) and corticosterone (CORT) concentrations. This stimulation of the HPA axis occurred concomitantly with BDNF modifications at the hippocampus, amygdala and hypothalamus levels. We showed that these neurosteroids induced rapid effects, probably via neurotransmitter receptors and delayed effects perhaps after metabolization in other neuroactive steroids. We highlighted that they had peripheral effects directly at the adrenal level by inducing CORT release, certainly after estrogenic metabolization. In addition, we showed that, at the dose used, only DHEA, DHEA-S and PREG-S had antidepressant effects. In conclusion, these results highly suggest that part of the HPA axis and antidepressant effects of neuroactive steroids could be mediated by BDNF, particularly at the amygdala level. They also suggest that neurosteroids effects on central BDNF could partially explain the trophic properties of these molecules.

A comparison of mean parotid gland dose with measures of parotid gland function after radiotherapy for head-and-neck cancer: Implications for future trials

International Nuclear Information System (INIS)

Roesink, Judith M.; Schipper, Maria; Busschers, Wim; Raaijmakers, Cornelis P.J.; Terhaard, Chris H.J.

2005-01-01

Purpose: To determine the most adequate parameter to measure the consequences of reducing the parotid gland dose. Methods and Materials: One hundred eight patients treated with radiotherapy for various malignancies of the head and neck were prospectively evaluated using three methods. Parotid gland function was objectively determined by measuring stimulated parotid flow using Lashley cups and scintigraphy. To assess xerostomia-related quality of life, the head-and-neck cancer module European Organization for Research and Treatment of Cancer QLQ (Quality of Life Questionnaire) H and N35 was used. Measurements took place before radiotherapy and 6 weeks and 12 months after the completion of radiotherapy. Complication was defined for each method using cutoff values. The correlation between these complications and the mean parotid gland dose was investigated to find the best measure for parotid gland function. Results: For both flow and scintigraphy data, the best definition for objective parotid gland toxicity seemed to be reduction of stimulated parotid flow to ≤25% of the preradiotherapy flow. Of all the subjective variables, only the single item dry mouth 6 weeks after radiotherapy was found to be significant. The best correlation with the mean parotid gland dose was found for the stimulated flow measurements. The predictive ability was the highest for the time point 1 year after radiotherapy. Subjective findings did not correlate with the mean parotid dose. Conclusions: Stimulated flow measurements using Lashley cups, with a complication defined as flow ≤25% of the preradiotherapy output, correlated best with the mean parotid gland dose. When reduction of the mean dose to the parotid gland is intended, the stimulated flow measurement is the best method for evaluating parotid gland function

Radiation dose reduction in soft tissue neck CT using adaptive statistical iterative reconstruction (ASIR)

Energy Technology Data Exchange (ETDEWEB)

Vachha, Behroze, E-mail: bvachha@partners.org [Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 (United States); Brodoefel, Harald; Wilcox, Carol; Hackney, David B.; Moonis, Gul [Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 (United States)

2013-12-01

Purpose: To compare objective and subjective image quality in neck CT images acquired at different tube current–time products (275 mA s and 340 mA s) and reconstructed with filtered-back-projection (FBP) and adaptive statistical iterative reconstruction (ASIR). Materials and methods: HIPAA-compliant study with IRB approval and waiver of informed consent. 66 consecutive patients were randomly assigned to undergo contrast-enhanced neck CT at a standard tube-current–time-product (340 mA s; n = 33) or reduced tube-current–time-product (275 mA s, n = 33). Data sets were reconstructed with FBP and 2 levels (30%, 40%) of ASIR-FBP blending at 340 mA s and 275 mA s. Two neuroradiologists assessed subjective image quality in a blinded and randomized manner. Volume CT dose index (CTDIvol), dose-length-product (DLP), effective dose, and objective image noise were recorded. Signal-to-noise ratio (SNR) was computed as mean attenuation in a region of interest in the sternocleidomastoid muscle divided by image noise. Results: Compared with FBP, ASIR resulted in a reduction of image noise at both 340 mA s and 275 mA s. Reduction of tube current from 340 mA s to 275 mA s resulted in an increase in mean objective image noise (p = 0.02) and a decrease in SNR (p = 0.03) when images were reconstructed with FBP. However, when the 275 mA s images were reconstructed using ASIR, the mean objective image noise and SNR were similar to those of the standard 340 mA s CT images reconstructed with FBP (p > 0.05). Subjective image noise was ranked by both raters as either average or less-than-average irrespective of the tube current and iterative reconstruction technique. Conclusion: Adapting ASIR into neck CT protocols reduced effective dose by 17% without compromising image quality.

Radiation dose reduction in soft tissue neck CT using adaptive statistical iterative reconstruction (ASIR)

International Nuclear Information System (INIS)

Vachha, Behroze; Brodoefel, Harald; Wilcox, Carol; Hackney, David B.; Moonis, Gul

2013-01-01

Purpose: To compare objective and subjective image quality in neck CT images acquired at different tube current–time products (275 mA s and 340 mA s) and reconstructed with filtered-back-projection (FBP) and adaptive statistical iterative reconstruction (ASIR). Materials and methods: HIPAA-compliant study with IRB approval and waiver of informed consent. 66 consecutive patients were randomly assigned to undergo contrast-enhanced neck CT at a standard tube-current–time-product (340 mA s; n = 33) or reduced tube-current–time-product (275 mA s, n = 33). Data sets were reconstructed with FBP and 2 levels (30%, 40%) of ASIR-FBP blending at 340 mA s and 275 mA s. Two neuroradiologists assessed subjective image quality in a blinded and randomized manner. Volume CT dose index (CTDIvol), dose-length-product (DLP), effective dose, and objective image noise were recorded. Signal-to-noise ratio (SNR) was computed as mean attenuation in a region of interest in the sternocleidomastoid muscle divided by image noise. Results: Compared with FBP, ASIR resulted in a reduction of image noise at both 340 mA s and 275 mA s. Reduction of tube current from 340 mA s to 275 mA s resulted in an increase in mean objective image noise (p = 0.02) and a decrease in SNR (p = 0.03) when images were reconstructed with FBP. However, when the 275 mA s images were reconstructed using ASIR, the mean objective image noise and SNR were similar to those of the standard 340 mA s CT images reconstructed with FBP (p > 0.05). Subjective image noise was ranked by both raters as either average or less-than-average irrespective of the tube current and iterative reconstruction technique. Conclusion: Adapting ASIR into neck CT protocols reduced effective dose by 17% without compromising image quality

Radiation dose reduction in soft tissue neck CT using adaptive statistical iterative reconstruction (ASIR).

Science.gov (United States)

Vachha, Behroze; Brodoefel, Harald; Wilcox, Carol; Hackney, David B; Moonis, Gul

2013-12-01

To compare objective and subjective image quality in neck CT images acquired at different tube current-time products (275 mAs and 340 mAs) and reconstructed with filtered-back-projection (FBP) and adaptive statistical iterative reconstruction (ASIR). HIPAA-compliant study with IRB approval and waiver of informed consent. 66 consecutive patients were randomly assigned to undergo contrast-enhanced neck CT at a standard tube-current-time-product (340 mAs; n = 33) or reduced tube-current-time-product (275 mAs, n = 33). Data sets were reconstructed with FBP and 2 levels (30%, 40%) of ASIR-FBP blending at 340 mAs and 275 mAs. Two neuroradiologists assessed subjective image quality in a blinded and randomized manner. Volume CT dose index (CTDIvol), dose-length-product (DLP), effective dose, and objective image noise were recorded. Signal-to-noise ratio (SNR) was computed as mean attenuation in a region of interest in the sternocleidomastoid muscle divided by image noise. Compared with FBP, ASIR resulted in a reduction of image noise at both 340 mAs and 275 mAs. Reduction of tube current from 340 mAs to 275 mAs resulted in an increase in mean objective image noise (p=0.02) and a decrease in SNR (p = 0.03) when images were reconstructed with FBP. However, when the 275 mAs images were reconstructed using ASIR, the mean objective image noise and SNR were similar to those of the standard 340 mAs CT images reconstructed with FBP (p>0.05). Subjective image noise was ranked by both raters as either average or less-than-average irrespective of the tube current and iterative reconstruction technique. Adapting ASIR into neck CT protocols reduced effective dose by 17% without compromising image quality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Evaluation of xerostomia following intensity modulated radiotherapy (IMRT) for head and neck cancer patients

International Nuclear Information System (INIS)

Lee, Seok Ho; Kim, Tae Hyun; Chie, Eui Kyu

2004-01-01

This study was done to evaluate xerostomia following intensity modulated radiotherapy for patients with head and neck cancer, and to analyze the correlation between the dosimetric parameters and xerostomia parameters. From February till October 2003, 13 patients with 3 months of follow-up were evaluated for xerostomia after being treated for head and neck cancer with IMRT. Their median age was 57 years (range:43 ∼ 77). Xerostomia were assessed with a 4-question xerostomia questionnaire score (XQS) and a test for salivary flow rates (unstimulated and stimulated). The patients were also given a validated LENT SOMA scale (LSC) questionnaire. The evaluations were completed before radiation therapy (pre-RT) and at 1 and. 3 months after radiation therapy (RT). We evaluated xerostomia at pre-RT, 1 and, 3 months after RT. The association between the xerostomia parameters (XQS and LSC) and salivary flow rates (unstimulated and stimulated: USFR and SSFR) was assessed at 1 and 3 months after RT. All 13 patients showed no significant changes in XQS, LSC and Salivary Flow rates. As a result, we couldn't find out about xerostomia development. Based on the total mean parotid dose, 3,500 cGy, we divided these patients into two groups. The 8 patients (< 3,500 cGy) showed no significant changes in XQS, LSC and Salivary Flow rates. However, in 5 patients (≥ 3,500 cGy), there was a significant increase in USFR and, SSFR at 3 months after RT, and for the XQS and, LSC at 1 and 3 months after RT. The correlation between XQS and, LSC, and USFR and, SSFR in all patients (13) was significant at 3 months after RT. The correlation had a tendency to the decrease for USFR and, SSFR in proportion to the increase of XQS and, LSC. Base on the results of this study, IMRT seem to be an effective treatment to significantly decrease the xerostomia. XQS and, LSC seem to be a effective tool for predicting the xerostomia. A total parotid gland mean dose of < 3,500 cGy should be a planning goal if

Reduction of xerostomia in head and neck cancer patients. A critical review of the literature

International Nuclear Information System (INIS)

Hanley, O.; Leech, M.

2016-01-01

Background: Radical radiotherapy given with or without concurrent chemotherapy is the main treatment modality in non-surgical patients for the management of squamous cell carcinoma in the head and neck. Xerostomia, which results from reduced salivary production is a debilitating side-effect of radiation therapy to these patients. Xerostomia may greatly impact on quality of life for head and neck cancer patients for up to 24 months post-radiation therapy. Such effects include difficulties in fundamental daily activities such as speech, mastication and swallowing. It is believed that modulated techniques provide better sparing to surrounding salivary glands. The aim of this critical review of the literature is to investigate what advantage intensity modulated radiotherapy (IMRT) can provide over 3 dimensional conformal radiation therapy (3DCRT) in reducing xerostomia in this subset of patients. Search methodology: An extensive literature search was undertaken to compare the incidence of grade 2 or worse xerostomia in HNSCC patients treated with IMRT or 3DCRT (±chemotherapy). Results: Studies reported a lower incidence of grade 2 or worse xerostomia with IMRT over patients treated with 3DCRT. The highest incidence of xerostomia was reported at 6 months following the completion of radiotherapy treatment. The incidence of xerostomia in patients declined with time, in both patients treated with IMRT and those of the 3DCRT cohort. The incidence of xerostomia was greater in the acute setting than in the late. Conclusion: An IMRT technique can consistently reduce grade 2 or worse xerostomia in head and neck cancer patients over conformal techniques. This will not compromise dose homogeneity or dose coverage. IMRT should remain the standard of care for head and neck patients. - Highlights: • IMRT technique can consistently reduce grade 2 or worse xerostomia in head and neck cancer patients over 3DCRT. • IMRT does not compromise the treatment's dose homogeneity or

Neither high-dose nor low-dose brachytherapy increases flap morbidity in salvage treatment of recurrent head and neck cancer

Directory of Open Access Journals (Sweden)

Peter W. Henderson

2016-08-01

Full Text Available Purpose: While brachytherapy is often used concurrently with flap reconstruction following surgical ablation for head and neck cancer, it remains unclear whether it increases morbidity in the particularly high risk subset of patients undergoing salvage treatment for recurrent head and neck cancer (RH&NC. Material and methods : A retrospective chart review was undertaken that evaluated patients with RH&NC who underwent flap coverage after surgical re-resection and concomitant brachytherapy. The primary endpoint was flap viability, and the secondary endpoints were flap and recipient site complications. Results : In the 23 subjects included in series, flap viability and skin graft take was 100%. Overall recipient site complication rate was 34.8%, high-dose radiation (HDR group 50%, and low-dose radiation (LDR group 29.4%. There was no statistically significant difference between these groups. Conclusions : In patients who undergo flap reconstruction and immediate postoperative radiotherapy following salvage procedures for RH&NC, flap coverage of defects in combination with brachytherapy remains a safe and effective means of providing stable soft tissue coverage.

Automated tube voltage adaptation in head and neck computed tomography between 120 and 100 kV: effects on image quality and radiation dose

Energy Technology Data Exchange (ETDEWEB)

May, Matthias S.; Uder, Michael; Lell, Michael M. [University Hospital Erlangen, Department of Radiology, Erlangen (Germany); University Erlangen, Imaging Science Institute, Erlangen (Germany); Kramer, Manuel R.; Eller, Achim; Wuest, Wolfgang; Scharf, Michael; Brand, Michael; Saake, Marc [University Hospital Erlangen, Department of Radiology, Erlangen (Germany); Schmidt, Bernhard [Siemens Healthcare, Erlangen (Germany)

2014-09-15

Low tube voltage allows for computed tomography (CT) imaging with increased iodine contrast at reduced radiation dose. We sought to evaluate the image quality and potential dose reduction using a combination of attenuation based tube current modulation (TCM) and automated tube voltage adaptation (TVA) between 100 and 120 kV in CT of the head and neck. One hundred thirty consecutive patients with indication for head and neck CT were examined with a 128-slice system capable of TCM and TVA. Reference protocol was set at 120 kV. Tube voltage was reduced to 100 kV whenever proposed by automated analysis of the localizer. An additional small scan aligned to the jaw was performed at a fixed 120 kV setting. Image quality was assessed by two radiologists on a standardized Likert-scale and measurements of signal- (SNR) and contrast-to-noise ratio (CNR). Radiation dose was assessed as CTDI{sub vol}. Diagnostic image quality was excellent in both groups and did not differ significantly (p = 0.34). Image noise in the 100 kV data was increased and SNR decreased (17.8/9.6) in the jugular veins and the sternocleidomastoid muscle when compared to 120 kV (SNR 24.4/10.3), but not in fatty tissue and air. However, CNR did not differ statistically significant between 100 (23.5/14.4/9.4) and 120 kV data (24.2/15.3/8.6) while radiation dose was decreased by 7-8 %. TVA between 100 and 120 kV in combination with TCM led to a radiation dose reduction compared to TCM alone, while keeping CNR constant though maintaining diagnostic image quality. (orig.)

Imidazoline2 (I2) receptor- and alpha2-adrenoceptor-mediated modulation of hypothalamic-pituitary-adrenal axis activity in control and acute restraint stressed rats.

Science.gov (United States)

Finn, David P; Hudson, Alan L; Kinoshita, Hiroshi; Coventry, Toni L; Jessop, David S; Nutt, David J; Harbuz, Michael S

2004-03-01

Central noradrenaline regulates the activity of the hypothalamic-pituitary-adrenal (HPA) axis and the neuroendocrine response to stress. alpha2-adrenoceptors and imidazoline2 (I2) receptors modulate the activity of the central noradrenergic system. The present set of experiments investigated the role of alpha2-adrenoceptors and I2 receptors in the regulation of HPA axis activity under basal conditions and during exposure to the acute psychological stress of restraint. Three separate experiments were carried out in which rats were given an i.p. injection of either saline vehicle, the combined alpha2-adrenoceptor antagonist and I2 receptor ligand idazoxan (10 mg/kg), the selective I2 receptor ligand BU224 (2.5 or 10 mg/kg) or the selective alpha2-adrenoceptor antagonist RX821002 (2.5 mg/kg) with or without restraint stress. Drugs were administered immediately prior to restraint of 60 min duration. Blood was sampled pre-injection, 30, 60 and 240 min post-injection and plasma corticosterone was measured by radioimmunoassay. In experiment 1, idazoxan increased plasma corticosterone levels in naive animals and potentiated the corticosterone response to acute restraint stress. In experiment 2, BU224 administration increased plasma corticosterone levels in a dose-related manner in naive rats. The results of experiment 3 indicated that RX821002 also elevated plasma corticosterone levels in naive rats, however, only BU224 potentiated the corticosterone response to restraint stress. These studies suggest that both alpha2-adrenoceptors and I2 receptors play a role in modulating basal HPA axis activity and that I2 receptors may play a more important role than alpha2-adrenoceptors in modulating the HPA axis response to the acute psychological stress of restraint.

Dual energy CT intracranial angiography: image quality, radiation dose and initial application results

International Nuclear Information System (INIS)

Chai Xue; Zhang Longjiang; Lu Guangming; Zhou Changsheng

2009-01-01

Objective: To assess the clinical value of dual-energy intracranial CT angiography (CTA). Methods: Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group. Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametric test and independent-samples t test, respectively. Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results: The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA. There was no significant difference between the two groups (Z= -0.455, P=0.650). Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P=0.000). Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy·cm respectively. Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA. Out of the 41 patients, 19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results. Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques. Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) mm, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1

Actuator assembly including a single axis of rotation locking member

Science.gov (United States)

Quitmeyer, James N.; Benson, Dwayne M.; Geck, Kellan P.

2009-12-08

An actuator assembly including an actuator housing assembly and a single axis of rotation locking member fixedly attached to a portion of the actuator housing assembly and an external mounting structure. The single axis of rotation locking member restricting rotational movement of the actuator housing assembly about at least one axis. The single axis of rotation locking member is coupled at a first end to the actuator housing assembly about a Y axis and at a 90.degree. angle to an X and Z axis providing rotation of the actuator housing assembly about the Y axis. The single axis of rotation locking member is coupled at a second end to a mounting structure, and more particularly a mounting pin, about an X axis and at a 90.degree. angle to a Y and Z axis providing rotation of the actuator housing assembly about the X axis. The actuator assembly is thereby restricted from rotation about the Z axis.

Radiolabeled cetuximab: dose optimization for epidermal growth factor receptor imaging in a head-and-neck squamous cell carcinoma model

NARCIS (Netherlands)

Hoeben, B.A.W.; Molkenboer-Kuenen, J.D.M.; Oyen, W.J.G.; Peeters, W.J.M.; Kaanders, J.H.A.M.; Bussink, J.; Boerman, O.C.

2011-01-01

Noninvasive imaging of the epidermal growth factor receptor (EGFR) in head-and-neck squamous cell carcinoma could be of value to select patients for EGFR-targeted therapy. We assessed dose optimization of (111) Indium-DTPA-cetuximab ((111) In-cetuximab) for EGFR imaging in a head-and-neck squamous

Normal tissue complication probability modeling for cochlea constraints to avoid causing tinnitus after head-and-neck intensity-modulated radiation therapy

International Nuclear Information System (INIS)

Lee, Tsair-Fwu; Yeh, Shyh-An; Chao, Pei-Ju; Chang, Liyun; Chiu, Chien-Liang; Ting, Hui-Min; Wang, Hung-Yu; Huang, Yu-Jie

2015-01-01

Radiation-induced tinnitus is a side effect of radiotherapy in the inner ear for cancers of the head and neck. Effective dose constraints for protecting the cochlea are under-reported. The aim of this study is to determine the cochlea dose limitation to avoid causing tinnitus after head-and-neck cancer (HNC) intensity-modulated radiation therapy (IMRT). In total 211 patients with HNC were included; the side effects of radiotherapy were investigated for 422 inner ears in the cohort. Forty-nine of the four hundred and twenty-two samples (11.6 %) developed grade 2+ tinnitus symptoms after IMRT, as diagnosed by a clinician. The Late Effects of Normal Tissues–Subjective, Objective, Management, Analytic (LENT-SOMA) criteria were used for tinnitus evaluation. The logistic and Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) models were used for the analyses. The NTCP-fitted parameters were TD 50 = 46.31 Gy (95 % CI, 41.46–52.50), γ 50 = 1.27 (95 % CI, 1.02–1.55), and TD 50 = 46.52 Gy (95 % CI, 41.91–53.43), m = 0.35 (95 % CI, 0.30–0.42) for the logistic and LKB models, respectively. The suggested guideline TD 20 for the tolerance dose to produce a 20 % complication rate within a specific period of time was TD 20 = 33.62 Gy (95 % CI, 30.15–38.27) (logistic) and TD 20 = 32.82 Gy (95 % CI, 29.58–37.69) (LKB). To maintain the incidence of grade 2+ tinnitus toxicity <20 % in IMRT, we suggest that the mean dose to the cochlea should be <32 Gy. However, models should not be extrapolated to other patient populations without further verification and should first be confirmed before clinical implementation

Arsenic-induced dose-dependent modulation of the NF-κB/IL-6 axis in thymocytes triggers differential immune responses

International Nuclear Information System (INIS)

Choudhury, Sreetama; Gupta, Payal; Ghosh, Sayan; Mukherjee, Sudeshna; Chakraborty, Priyanka; Chatterji, Urmi; Chattopadhyay, Sreya

2016-01-01

Highlights: • We for the first time explicitly show that arsenic exposure causes morphological damage to the thymus and results in heightened death of thymocytes. • Our data suggests that arsenic-induced apoptosis occurs due to increase in cellular oxidative and nitrosative stress. • We have for the first time established a non-classical role of NF-κB, correlating it with increase in FoxP3 expression. • The % of CD4+ CD25+ T cells were high and expression of FoxP3 has also increased at higher doses of arsenic indicating an nTreg bias. - Abstract: Arsenic contamination of drinking water is a matter of global concern. Arsenic intake impairs immune responses and leads to a variety of pathological conditions including cancer. In order to understand the intricate tuning of immune responses elicited by chronic exposure to arsenic, a mouse model was established by subjecting mice to different environmentally relevant concentrations of arsenic in drinking water for 30 days. Detailed study of the thymus, a primary immune organ, revealed arsenic-mediated tissue damage in both histological specimens and scanning electron micrographs. Analysis of molecular markers of apoptosis by Western blot revealed a dose-dependent activation of the apoptotic cascade. Enzymatic assays supported oxidative stress as an instigator of cell death. Interestingly, assessment of inflammatory responses revealed disparity in the NF-κB/IL-6/STAT3 axis, where it was found that in animals consuming higher amounts of arsenic NF-κB activation did not lead to the classical IL-6 upregulation response. This deviation from the canonical pathway was accompanied with a significant rise in numbers of CD4+ CD25+ FoxP3 expressing cells in the thymus. The cytokine profile of the animals exposed to higher doses of arsenic also indicated an immune-suppressed milieu, thus validating that arsenic shapes the immune environment in context to its dose of exposure and that at higher doses it leads to immune

Subcutaneous fibrosis after whole neck irradiation

International Nuclear Information System (INIS)

Hirota, Saeko; Tsujino, Kayoko; Oshitani, Takashi; Hishikawa, Yoshio; Takada, Yoshiki; Kono, Michio; Abe, Mitsuyuki

2002-01-01

Purpose: To identify the risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. Methods and Materials: We analyzed 233 cases of patients who had undergone whole neck irradiation with 4-MV X-ray or 8-10-MeV electrons, or both, and had been followed with regard to their skin condition for at least 1 year. The prescribed dose to the whole neck ranged from 19.2 to 72.4 Gy (median 50). The skin-absorbed dose was specified as that at a depth of 4.1 mm (d4.1-mm depth ), and a biologically equivalent dose (BED) of d4.1-mm depth was also estimated (BED 1.8 4.1-mm depth ). Results: Univariate analysis revealed that previous neck dissection, concurrent chemotherapy, corticosteroid administration as a part of chemotherapy, fractionation, and BED 1.8 4.1-mm depth were significant prognostic variables. Multivariate analysis showed that BED 1.8 4.1-mm depth and previous neck dissection were the only prognostic variables for moderate to severe subcutaneous fibrosis. Conclusion: A high dose to a 4.1-mm depth of the skin and a history of neck dissection were identified as the predominant risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. A subcutaneous dose should be considered in radiotherapy treatment planning involving the whole neck, especially in cases in which patients have undergone previous neck dissection

Intensity-Modulated Radiotherapy is Associated With Improved Global Quality of Life Among Long-term Survivors of Head-and-Neck Cancer

International Nuclear Information System (INIS)

Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Vazquez, Esther G.; Lau, Derick H.; Purdy, James A.

2012-01-01

Purpose: To compare the long-term quality of life among patients treated with and without intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Methods and Materials: University of Washington Quality of Life instrument scores were reviewed for 155 patients previously treated with radiation therapy for locally advanced head-and-neck cancer. All patients were disease free and had at least 2 years of follow-up. Eighty-four patients (54%) were treated with IMRT. The remaining 71 patients (46%) were treated with three-dimensional conformal radiotherapy (3D CRT) by use of initial opposed lateral fields matched to a low anterior neck field. Results: The mean global quality of life scores were 67.5 and 80.1 for the IMRT patients at 1 and 2 years, respectively, compared with 55.4 and 57.0 for the 3D CRT patients, respectively (p < 0.001). At 1 year after the completion of radiation therapy, the proportion of patients who rated their global quality of life as “very good” or “outstanding” was 51% and 41% among patients treated by IMRT and 3DCRT, respectively (p = 0.11). At 2 years, the corresponding percentages increased to 73% and 49%, respectively (p < 0.001). On multivariate analysis accounting for sex, age, radiation intent (definitive vs. postoperative), radiation dose, T stage, primary site, use of concurrent chemotherapy, and neck dissection, the use of IMRT was the only variable independently associated with improved quality of life (p = 0.01). Conclusion: The early quality of life improvements associated with IMRT not only are maintained but apparently become more magnified over time. These data provide powerful evidence attesting to the long-term benefits of IMRT for head-and-neck cancer.

Automated tube voltage adaptation in head and neck computed tomography between 120 and 100 kV: effects on image quality and radiation dose.

Science.gov (United States)

May, Matthias S; Kramer, Manuel R; Eller, Achim; Wuest, Wolfgang; Scharf, Michael; Brand, Michael; Saake, Marc; Schmidt, Bernhard; Uder, Michael; Lell, Michael M

2014-09-01

Low tube voltage allows for computed tomography (CT) imaging with increased iodine contrast at reduced radiation dose. We sought to evaluate the image quality and potential dose reduction using a combination of attenuation based tube current modulation (TCM) and automated tube voltage adaptation (TVA) between 100 and 120 kV in CT of the head and neck. One hundred thirty consecutive patients with indication for head and neck CT were examined with a 128-slice system capable of TCM and TVA. Reference protocol was set at 120 kV. Tube voltage was reduced to 100 kV whenever proposed by automated analysis of the localizer. An additional small scan aligned to the jaw was performed at a fixed 120 kV setting. Image quality was assessed by two radiologists on a standardized Likert-scale and measurements of signal- (SNR) and contrast-to-noise ratio (CNR). Radiation dose was assessed as CTDIvol. Diagnostic image quality was excellent in both groups and did not differ significantly (p = 0.34). Image noise in the 100 kV data was increased and SNR decreased (17.8/9.6) in the jugular veins and the sternocleidomastoid muscle when compared to 120 kV (SNR 24.4/10.3), but not in fatty tissue and air. However, CNR did not differ statistically significant between 100 (23.5/14.4/9.4) and 120 kV data (24.2/15.3/8.6) while radiation dose was decreased by 7-8%. TVA between 100 and 120 kV in combination with TCM led to a radiation dose reduction compared to TCM alone, while keeping CNR constant though maintaining diagnostic image quality.

WE-E-BRE-09: Investigation of the Association Between Radiation-Induced Pain and Radiation Dose in Head and Neck Cancer Patients

Energy Technology Data Exchange (ETDEWEB)

Gay, H; Dyk, P; Mullen, D; Eschen, L; Fergus, S; Chin, R; Thorstad, W [Washington University School of Medicine, St. Louis, MO (United States); Oh, J; Apte, A; Deasy, J [Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2014-06-15

Purpose: Patients with head and neck cancer who undergo radiotherapy often experience several undesirable side-effects, including xerostomia, trismus, and pain in the head and neck area, but little is know about the dose-volume predictors of such pain. We investigated the association between radiation dose and both throat and esophagus pain during radiotherapy. Methods: We analyzed 124 head and neck patients who received radiotherapy at the Washington University School of Medicine in Saint Louis. For these patients, weekly PROs were recorded, including 16 pain and anatomical location questions. In addition, 17 observational symptoms were recorded. Patients were asked to describe their pain at each site according to a four-level scale: none (0), mild (1), moderate (2), and severe (3). We explored the association between throat pain and the mean dose received in oral cavity and between esophageal pain and the mean dose received in the esophagus. The severity of pain was determined by the difference between the baseline (week 1) pain score and the maximum pain score during treatment. The baseline pain score was defined as the first available pain score before receiving 10 Gy because radiotherapy pain originates later during treatment. Dose-volume metrics were extracted from treatment plans using CERR. To evaluate the correlation between pain and radiation dose, Spearman's correlation coefficient (Rs) was used. Results: The associations between throat pain and the mean dose to the oral cavity, and between esophagus pain and the mean dose to the esophagus, were both statistically significant, with Rs=0.320 (p=0.003) and Rs=0.424 (p<0.0001), respectively. Mean dose, for each structure, was a better predictor of pain than total integral dose. Conclusion: We demonstrated that pain during radiotherapy in head and neck patients highly correlates with the dose delivered. We will further investigate the association between other pain locations and relevant normal tissue

WE-E-BRE-09: Investigation of the Association Between Radiation-Induced Pain and Radiation Dose in Head and Neck Cancer Patients

International Nuclear Information System (INIS)

Gay, H; Dyk, P; Mullen, D; Eschen, L; Fergus, S; Chin, R; Thorstad, W; Oh, J; Apte, A; Deasy, J

2014-01-01

Purpose: Patients with head and neck cancer who undergo radiotherapy often experience several undesirable side-effects, including xerostomia, trismus, and pain in the head and neck area, but little is know about the dose-volume predictors of such pain. We investigated the association between radiation dose and both throat and esophagus pain during radiotherapy. Methods: We analyzed 124 head and neck patients who received radiotherapy at the Washington University School of Medicine in Saint Louis. For these patients, weekly PROs were recorded, including 16 pain and anatomical location questions. In addition, 17 observational symptoms were recorded. Patients were asked to describe their pain at each site according to a four-level scale: none (0), mild (1), moderate (2), and severe (3). We explored the association between throat pain and the mean dose received in oral cavity and between esophageal pain and the mean dose received in the esophagus. The severity of pain was determined by the difference between the baseline (week 1) pain score and the maximum pain score during treatment. The baseline pain score was defined as the first available pain score before receiving 10 Gy because radiotherapy pain originates later during treatment. Dose-volume metrics were extracted from treatment plans using CERR. To evaluate the correlation between pain and radiation dose, Spearman's correlation coefficient (Rs) was used. Results: The associations between throat pain and the mean dose to the oral cavity, and between esophagus pain and the mean dose to the esophagus, were both statistically significant, with Rs=0.320 (p=0.003) and Rs=0.424 (p<0.0001), respectively. Mean dose, for each structure, was a better predictor of pain than total integral dose. Conclusion: We demonstrated that pain during radiotherapy in head and neck patients highly correlates with the dose delivered. We will further investigate the association between other pain locations and relevant normal tissue

Assessment of volumetric-modulated arc therapy for constant and variable dose rates

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Mariluz De Ornelas-Couto

2017-01-01

Full Text Available Purpose: The aim of this study is to compare the effects of dose rate on volumetric-modulated arc therapy plans to determine optimal dose rates for prostate and head and neck (HN cases. Materials and Methods: Ten prostate and ten HN cases were retrospectively studied. For each case, seven plans were generated: one variable dose rate (VDR and six constant dose rate (CDR (100–600 monitor units [MUs]/min plans. Prescription doses were: 80 Gy to planning target volume (PTV for the prostate cases, and 70, 60, and 54 Gy to PTV1, PTV2, and PTV3, respectively, for HN cases. Plans were normalized to 95% of the PTV and PTV1, respectively, with the prescription dose. Plans were assessed using Dose-Volume-Histogram metrics, homogeneity index, conformity index, MUs, and delivery time. Results: For the prostate cases, significant differences were found for rectum D35 between VDR and all CDR plans, except CDR500. Furthermore, VDR was significantly different than CDR100 and 200 for bladder D50. Delivery time for all CDR plans and MUs for CDR400–600 were significantly higher when compared to VDR. HN cases showed significant differences between VDR and CDR100, 500 and 600 for D2 to the cord and brainstem. Significant differences were found for delivery time and MUs for all CDR plans, except CDR100 for number of MUs. Conclusion: The most significant differences were observed in delivery time and number of MUs. All-in-all, the best CDR for prostate cases was found to be 300 MUs/min and 200 or 300 MUs/min for HN cases. However, VDR plans are still the choice in terms of MU efficiency and plan quality.

Head and neck intensity modulated radiation therapy leads to an increase of opportunistic oral pathogens

NARCIS (Netherlands)

Schuurhuis, Jennifer M.; Stokman, Monique A.; Witjes, Max J. H.; Langendijk, Johannes A.; van Winkelhoff, Arie J.; Vissink, Arjan; Spijkervet, Frederik K. L.

Objectives: The introduction of intensity modulated radiation therapy (IMRT) has led to new possibilities in the treatment of head and neck cancer (HNC). Limited information is available on how this more advanced radiation technique affects the oral microflora. In a prospective study we assessed the

Acceleration of intensity-modulated radiotherapy dose calculation by importance sampling of the calculation matrices

International Nuclear Information System (INIS)

Thieke, Christian; Nill, Simeon; Oelfke, Uwe; Bortfeld, Thomas

2002-01-01

In inverse planning for intensity-modulated radiotherapy, the dose calculation is a crucial element limiting both the maximum achievable plan quality and the speed of the optimization process. One way to integrate accurate dose calculation algorithms into inverse planning is to precalculate the dose contribution of each beam element to each voxel for unit fluence. These precalculated values are stored in a big dose calculation matrix. Then the dose calculation during the iterative optimization process consists merely of matrix look-up and multiplication with the actual fluence values. However, because the dose calculation matrix can become very large, this ansatz requires a lot of computer memory and is still very time consuming, making it not practical for clinical routine without further modifications. In this work we present a new method to significantly reduce the number of entries in the dose calculation matrix. The method utilizes the fact that a photon pencil beam has a rapid radial dose falloff, and has very small dose values for the most part. In this low-dose part of the pencil beam, the dose contribution to a voxel is only integrated into the dose calculation matrix with a certain probability. Normalization with the reciprocal of this probability preserves the total energy, even though many matrix elements are omitted. Three probability distributions were tested to find the most accurate one for a given memory size. The sampling method is compared with the use of a fully filled matrix and with the well-known method of just cutting off the pencil beam at a certain lateral distance. A clinical example of a head and neck case is presented. It turns out that a sampled dose calculation matrix with only 1/3 of the entries of the fully filled matrix does not sacrifice the quality of the resulting plans, whereby the cutoff method results in a suboptimal treatment plan

Repeated Neck Restraint Stress Bidirectionally Modulates Excitatory Transmission in the Dentate Gyrus and Performance in a Hippocampus-dependent Memory Task.

Science.gov (United States)

Spyrka, Jadwiga; Hess, Grzegorz

2018-05-21

The consequences of stress depend on characteristics of the stressor, including the duration of exposure, severity, and predictability. Exposure of mice to repeated neck restraint has been shown to bidirectionally modulate the potential for long-term potentiation (LTP) in the dentate gyrus (DG) in a manner dependent on the number of restraint repetitions, but the influence of repeated brief neck restraint on electrophysiology of single DG neurons has not yet been investigated. Here, we aimed at finding the effects of 1, 3, 7, 14, or 21 daily neck restraint sessions lasting 10 min on electrophysiological characteristics of DG granule cells as well as excitatory and inhibitory synaptic inputs to these neurons. While the excitability of DG granule cells and inhibitory synaptic transmission were unchanged, neck restraint decreased the frequency of spontaneous excitatory currents after three repetitions but enhanced it after 14 and 21 repetitions. The consequences of repeated neck restraint on hippocampus-dependent memory were investigated using the object location test (OLT). Neck restraint stress impaired cognitive performance in the OLT after three repetitions but improved it after 14 and 21 repetitions. Mice subjected to three neck restraint sessions displayed an increase in the measures of depressive and anxiety-like behaviors, however, prolongation of the exposure to neck restraint resulted in a gradual decline in the intensity of these measures. These data indicate that stress imposed by an increasing number of repeated neck restraint episodes bidirectionally modulates both excitatory synaptic transmission in the DG and cognitive performance in the object location memory task. Copyright © 2018 IBRO. Published by Elsevier Ltd. All rights reserved.

Integrated beam orientation and scanning-spot optimization in intensity-modulated proton therapy for brain and unilateral head and neck tumors.

Science.gov (United States)

Gu, Wenbo; O'Connor, Daniel; Nguyen, Dan; Yu, Victoria Y; Ruan, Dan; Dong, Lei; Sheng, Ke

2018-04-01

Intensity-Modulated Proton Therapy (IMPT) is the state-of-the-art method of delivering proton radiotherapy. Previous research has been mainly focused on optimization of scanning spots with manually selected beam angles. Due to the computational complexity, the potential benefit of simultaneously optimizing beam orientations and spot pattern could not be realized. In this study, we developed a novel integrated beam orientation optimization (BOO) and scanning-spot optimization algorithm for intensity-modulated proton therapy (IMPT). A brain chordoma and three unilateral head-and-neck patients with a maximal target size of 112.49 cm 3 were included in this study. A total number of 1162 noncoplanar candidate beams evenly distributed across 4π steradians were included in the optimization. For each candidate beam, the pencil-beam doses of all scanning spots covering the PTV and a margin were calculated. The beam angle selection and spot intensity optimization problem was formulated to include three terms: a dose fidelity term to penalize the deviation of PTV and OAR doses from ideal dose distribution; an L1-norm sparsity term to reduce the number of active spots and improve delivery efficiency; a group sparsity term to control the number of active beams between 2 and 4. For the group sparsity term, convex L2,1-norm and nonconvex L2,1/2-norm were tested. For the dose fidelity term, both quadratic function and linearized equivalent uniform dose (LEUD) cost function were implemented. The optimization problem was solved using the Fast Iterative Shrinkage-Thresholding Algorithm (FISTA). The IMPT BOO method was tested on three head-and-neck patients and one skull base chordoma patient. The results were compared with IMPT plans created using column generation selected beams or manually selected beams. The L2,1-norm plan selected spatially aggregated beams, indicating potential degeneracy using this norm. L2,1/2-norm was able to select spatially separated beams and achieve

MzrA: a novel modulator of the EnvZ/OmpR two-component regulon

Science.gov (United States)

Gerken, Henri; Charlson, Emily S; Cicirelli, Elisha M; Kenney, Linda J; Misra, Rajeev

2009-01-01

Analysis of suppressors that alleviate the acute envelope stress phenotype of a ΔbamBΔdegP strain of Escherichia coli identified a novel protein MzrA and pleiotropic envZ mutations. Genetic evidence shows that overexpression of MzrA – formerly known as YqjB and EcfM – modulates the activity of EnvZ/OmpR similarly to pleiotropic EnvZ mutants and alter porin expression. However, porin expression in strains devoid of MzrA or overexpressing it is still sensitive to medium osmolarity, pH and procaine, all of which modulate EnvZ/OmpR activities. Thus, MzrA appears to alter the output of the EnvZ/OmpR system but not its ability to receive and respond to various environmental signals. Localization and topology experiments indicate that MzrA is a type II membrane protein, with its N-terminus exposed in the cytoplasm and C-terminus in the periplasm. Bacterial two-hybrid experiments determined that MzrA specifically interacts with EnvZ but not with OmpR or the related membrane sensor kinase, CpxA. This and additional genetic and biochemical evidence suggest that the interaction of MzrA with EnvZ would either enhance EnvZ's kinase activity or reduce its phosphatase activity, thus elevating the steady state levels of OmpR∼P. Furthermore, our data show that MzrA links the two-component envelope stress response regulators, CpxA/CpxR and EnvZ/OmpR. PMID:19432797

Patient-Reported Voice and Speech Outcomes After Whole-Neck Intensity Modulated Radiation Therapy and Chemotherapy for Oropharyngeal Cancer: Prospective Longitudinal Study

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Vainshtein, Jeffrey M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan (United States); Feng, Felix Y.; Vineberg, Karen A. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Chepeha, Douglas B. [Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan (United States); Eisbruch, Avraham, E-mail: eisbruch@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

2014-08-01

Purpose: To describe voice and speech quality changes and their predictors in patients with locally advanced oropharyngeal cancer treated on prospective clinical studies of organ-preserving chemotherapy–intensity modulated radiation therapy (chemo-IMRT). Methods and Materials: Ninety-one patients with stage III/IV oropharyngeal cancer were treated on 2 consecutive prospective studies of definitive chemoradiation using whole-field IMRT from 2003 to 2011. Patient-reported voice and speech quality were longitudinally assessed from before treatment through 24 months using the Communication Domain of the Head and Neck Quality of Life (HNQOL-C) instrument and the Speech question of the University of Washington Quality of Life (UWQOL-S) instrument, respectively. Factors associated with patient-reported voice quality worsening from baseline and speech impairment were assessed. Results: Voice quality decreased maximally at 1 month, with 68% and 41% of patients reporting worse HNQOL-C and UWQOL-S scores compared with before treatment, and improved thereafter, recovering to baseline by 12-18 months on average. In contrast, observer-rated larynx toxicity was rare (7% at 3 months; 5% at 6 months). Among patients with mean glottic larynx (GL) dose ≤20 Gy, >20-30 Gy, >30-40 Gy, >40-50 Gy, and >50 Gy, 10%, 32%, 25%, 30%, and 63%, respectively, reported worse voice quality at 12 months compared with before treatment (P=.011). Results for speech impairment were similar. Glottic larynx dose, N stage, neck dissection, oral cavity dose, and time since chemo-IMRT were univariately associated with either voice worsening or speech impairment. On multivariate analysis, mean GL dose remained independently predictive for both voice quality worsening (8.1%/Gy) and speech impairment (4.3%/Gy). Conclusions: Voice quality worsening and speech impairment after chemo-IMRT for locally advanced oropharyngeal cancer were frequently reported by patients, underrecognized by clinicians, and

Patient-reported voice and speech outcomes after whole-neck intensity modulated radiation therapy and chemotherapy for oropharyngeal cancer: prospective longitudinal study.

Science.gov (United States)

Vainshtein, Jeffrey M; Griffith, Kent A; Feng, Felix Y; Vineberg, Karen A; Chepeha, Douglas B; Eisbruch, Avraham

2014-08-01

To describe voice and speech quality changes and their predictors in patients with locally advanced oropharyngeal cancer treated on prospective clinical studies of organ-preserving chemotherapy-intensity modulated radiation therapy (chemo-IMRT). Ninety-one patients with stage III/IV oropharyngeal cancer were treated on 2 consecutive prospective studies of definitive chemoradiation using whole-field IMRT from 2003 to 2011. Patient-reported voice and speech quality were longitudinally assessed from before treatment through 24 months using the Communication Domain of the Head and Neck Quality of Life (HNQOL-C) instrument and the Speech question of the University of Washington Quality of Life (UWQOL-S) instrument, respectively. Factors associated with patient-reported voice quality worsening from baseline and speech impairment were assessed. Voice quality decreased maximally at 1 month, with 68% and 41% of patients reporting worse HNQOL-C and UWQOL-S scores compared with before treatment, and improved thereafter, recovering to baseline by 12-18 months on average. In contrast, observer-rated larynx toxicity was rare (7% at 3 months; 5% at 6 months). Among patients with mean glottic larynx (GL) dose ≤20 Gy, >20-30 Gy, >30-40 Gy, >40-50 Gy, and >50 Gy, 10%, 32%, 25%, 30%, and 63%, respectively, reported worse voice quality at 12 months compared with before treatment (P=.011). Results for speech impairment were similar. Glottic larynx dose, N stage, neck dissection, oral cavity dose, and time since chemo-IMRT were univariately associated with either voice worsening or speech impairment. On multivariate analysis, mean GL dose remained independently predictive for both voice quality worsening (8.1%/Gy) and speech impairment (4.3%/Gy). Voice quality worsening and speech impairment after chemo-IMRT for locally advanced oropharyngeal cancer were frequently reported by patients, underrecognized by clinicians, and independently associated with GL dose. These findings support

Patient-Reported Voice and Speech Outcomes After Whole-Neck Intensity Modulated Radiation Therapy and Chemotherapy for Oropharyngeal Cancer: Prospective Longitudinal Study

International Nuclear Information System (INIS)

Vainshtein, Jeffrey M.; Griffith, Kent A.; Feng, Felix Y.; Vineberg, Karen A.; Chepeha, Douglas B.; Eisbruch, Avraham

2014-01-01

Purpose: To describe voice and speech quality changes and their predictors in patients with locally advanced oropharyngeal cancer treated on prospective clinical studies of organ-preserving chemotherapy–intensity modulated radiation therapy (chemo-IMRT). Methods and Materials: Ninety-one patients with stage III/IV oropharyngeal cancer were treated on 2 consecutive prospective studies of definitive chemoradiation using whole-field IMRT from 2003 to 2011. Patient-reported voice and speech quality were longitudinally assessed from before treatment through 24 months using the Communication Domain of the Head and Neck Quality of Life (HNQOL-C) instrument and the Speech question of the University of Washington Quality of Life (UWQOL-S) instrument, respectively. Factors associated with patient-reported voice quality worsening from baseline and speech impairment were assessed. Results: Voice quality decreased maximally at 1 month, with 68% and 41% of patients reporting worse HNQOL-C and UWQOL-S scores compared with before treatment, and improved thereafter, recovering to baseline by 12-18 months on average. In contrast, observer-rated larynx toxicity was rare (7% at 3 months; 5% at 6 months). Among patients with mean glottic larynx (GL) dose ≤20 Gy, >20-30 Gy, >30-40 Gy, >40-50 Gy, and >50 Gy, 10%, 32%, 25%, 30%, and 63%, respectively, reported worse voice quality at 12 months compared with before treatment (P=.011). Results for speech impairment were similar. Glottic larynx dose, N stage, neck dissection, oral cavity dose, and time since chemo-IMRT were univariately associated with either voice worsening or speech impairment. On multivariate analysis, mean GL dose remained independently predictive for both voice quality worsening (8.1%/Gy) and speech impairment (4.3%/Gy). Conclusions: Voice quality worsening and speech impairment after chemo-IMRT for locally advanced oropharyngeal cancer were frequently reported by patients, underrecognized by clinicians, and

Improvement of off-axis SABR plan verification results by using adapted dose reconstruction algorithms for the Octavius 4D system.

Science.gov (United States)

Jeevanandam, Prakash; Agnew, Christina E; Irvine, Denise M; McGarry, Conor K

2018-04-01

Stereotactic ablative body radiotherapy (SABR) for lung patients can be performed with volumetric-modulated arc therapy (VMAT) plans using off-axis target geometry to allow treatment in their CBCT verified position. For patient-specific quality assurance measurements using the PTW Octavius 4D phantom (PTW, Freiburg, Germany) (OCT4D) in conjunction with an Octavius 1000SRS array (OCT1000) (PTW, Freiburg, Germany), repositioning the phantom off-axis is required to ensure the measurement area coincides with the tumor. The aim of this work is to quantify delivery errors using an array repositioned off-axis and evaluate new software which incorporates corrections for off-axis phantom measurements. Dynamic conformal arcs and 25 lung SABR plans were created with the isocenter at the patient midline and the target volume off-axis. Measurements were acquired with an OCT4D phantom in conjunction with a 729 array (PTW, Freiburg, Germany) (OCT729) placed at isocenter. These plans were recalculated and delivered to both the OCT729 and OCT1000 arrays repositioned so that the high-dose region was at the center of the phantom. Comparisons were made using VeriSoft v7.0 (PTW, Freiburg, Germany) and the newly implemented version 7.1 with 2%/2 mm gamma criterion (10% threshold) and results correlated with off-axis distance to the tumor. Average pass rates for VeriSoft v7.0 significantly reduced from 92.7 ± 2.4% to 84.9 ± 4.1% when the phantom was repositioned compared to the isocenter setup for the OCT729. The gamma pass rates significantly decreased the further the phantom was moved off-axis. Significantly higher pass rates were observed for the OCT1000 of 95.7 ± 3.6% and a significant decrease in gamma pass rate with off-axis phantom distance was again observed. In contrast, even with phantom repositioning, the pass rates for analysis with VeriSoft v7.1 were 93.7 ± 2.1% and 99.4 ± 1.1% for OCT729 and OCT1000, respectively. No significant difference in gamma pass rate

CT-automatic exposure control devices: What are their performances?

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Gutierrez, Daniel [University Institute for Radiation Physics (IRA-DUMSC), Grand-Pre 1, CH-1007 Lausanne (Switzerland); Schmidt, Sabine; Denys, Alban; Schnyder, Pierre [Radiology Department, University Hospital of Lausanne, CHUV, CH-1011 Lausanne (Switzerland); Bochud, Francois O. [University Institute for Radiation Physics (IRA-DUMSC), Grand-Pre 1, CH-1007 Lausanne (Switzerland); Verdun, Francis R. [University Institute for Radiation Physics (IRA-DUMSC), Grand-Pre 1, CH-1007 Lausanne (Switzerland)], E-mail: francis.verdun@chuv.ch

2007-10-01

Purpose: To avoid unnecessary exposure to the patients, constructors have developed tube current modulation algorithms. The purpose of this work is to assess the performance of computed tomography (CT) tube current modulation concerning patient dose and image noise in MSCT scanners. Material and methods: A conical PMMA phantom with elliptical cross-section, to vary the thickness of the irradiated object in a monotonous way, and an anthropomorphic chest phantom were scanned under similar conditions on a general electrics (GE) LightSpeed VCT (64 slices) scanner. Noise measurements were made by calculating the standard deviation of the CT-number on a homogeneous ROI in both phantoms. The dose was estimated with the parameters read in the DICOM header of each studied image. Results: The study has shown that most of the time, constant noise levels (noise index) can be obtained by a variation of the mA. Nevertheless, this adaptation can be not fast enough when the variation of the attenuation changes is rapid. Thus, an adaptation length up to 5 cm was obtained. A 18% dose reduction can be achieved (mean of 9.9%) by switching from z-axis modulation algorithm to xyz-axis modulation option. However, exposure in the chest area can be higher with current modulation than without, when trying to keep an image noise level constant in thoraco-abdominal investigations. Conclusion: Current modulation algorithms can produce inadequate quality images due to problems with tube current stabilization when a sudden attenuation variation takes place as at the start of a scanning sequence. As expected, rotational (xyz-axis) modulation performs better than only z-axis modulation algorithm. The use of automatic exposure control (AEC) can lead to an increase of the dose if the maximum allowed current is not properly set in thoraco-abdominal acquisitions.

Radiation-Induced Cancers From Modern Radiotherapy Techniques: Intensity-Modulated Radiotherapy Versus Proton Therapy

International Nuclear Information System (INIS)

Yoon, Myonggeun; Ahn, Sung Hwan; Kim, Jinsung; Shin, Dong Ho; Park, Sung Yong; Lee, Se Byeong; Shin, Kyung Hwan; Cho, Kwan Ho

2010-01-01

Purpose: To assess and compare secondary cancer risk resulting from intensity-modulated radiotherapy (IMRT) and proton therapy in patients with prostate and head-and-neck cancer. Methods and Materials: Intensity-modulated radiotherapy and proton therapy in the scattering mode were planned for 5 prostate caner patients and 5 head-and-neck cancer patients. The secondary doses during irradiation were measured using ion chamber and CR-39 detectors for IMRT and proton therapy, respectively. Organ-specific radiation-induced cancer risk was estimated by applying organ equivalent dose to dose distributions. Results: The average secondary doses of proton therapy for prostate cancer patients, measured 20-60cm from the isocenter, ranged from 0.4 mSv/Gy to 0.1 mSv/Gy. The average secondary doses of IMRT for prostate patients, however, ranged between 3 mSv/Gy and 1 mSv/Gy, approximately one order of magnitude higher than for proton therapy. Although the average secondary doses of IMRT were higher than those of proton therapy for head-and-neck cancers, these differences were not significant. Organ equivalent dose calculations showed that, for prostate cancer patients, the risk of secondary cancers in out-of-field organs, such as the stomach, lungs, and thyroid, was at least 5 times higher for IMRT than for proton therapy, whereas the difference was lower for head-and-neck cancer patients. Conclusions: Comparisons of organ-specific organ equivalent dose showed that the estimated secondary cancer risk using scattering mode in proton therapy is either significantly lower than the cases in IMRT treatment or, at least, does not exceed the risk induced by conventional IMRT treatment.

Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques

International Nuclear Information System (INIS)

Dabaja, Bouthaina; Salehpour, Mohammad R.; Rosen, Isaac; Tung, Sam; Morrison, William H.; Ang, K. Kian; Garden, Adam S.

2005-01-01

Background: Oropharynx cancers treated with intensity-modulated radiation (IMRT) are often treated with a monoisocentric or half-beam technique (HB). IMRT is delivered to the primary tumor and upper neck alone, while the lower neck is treated with a matching anterior beam. Because IMRT can treat the entire volume or whole field (WF), the primary aim of the study was to test the ability to plan cases using WF-IMRT while obtaining an optimal plan and acceptable dose distribution and also respecting normal critical structures. Methods and Materials: Thirteen patients with early-stage oropharynx cancers had treatment plans created with HB-IMRT and WF-IMRT techniques. Plans were deemed acceptable if they met the planning guidelines (as defined or with minor violations) of the Radiation Therapy Oncology Group protocol H0022. Comparisons included coverage to the planning target volume (PTV) of the primary (PTV66) and subclinical disease (PTV54). We also compared the ability of both techniques to respect the tolerance of critical structures. Results: The volume of PTV66 treated to >110% was less in 9 of the 13 patients in the WF-IMRT plan as compared to the HB-IMRT plan. The calculated mean volume receiving >110% for all patients planned with WF-IMRT was 9.3% (0.8%-25%) compared to 13.7% (2.7%-23.7%) with HB-IMRT (p = 0.09). The PTV54 volume receiving >110% of dose was less in 10 of the 13 patients planned with WF-IMRT compared to HB-IMRT. The mean doses to all critical structures except the larynx were comparable with each plan. The mean dose to the larynx was significantly less (p = 0.001), 18.7 Gy, with HB-IMRT compared to 47 Gy with WF-IMRT. Conclusions: Regarding target volumes, acceptable plans can be generated with either WF-IMRT or HB-IMRT. WF-IMRT has an advantage if uncertainty at the match line is a concern, whereas HB-IMRT, particularly in cases not involving the base of tongue, can achieve much lower doses to the larynx

Dosimetric analysis of testicular doses in prostate intensity-modulated and volumetric-modulated arc radiation therapy at different energy levels

Energy Technology Data Exchange (ETDEWEB)

Onal, Cem, E-mail: hcemonal@hotmail.com; Arslan, Gungor; Dolek, Yemliha; Efe, Esma

2016-01-01

The aim of this study is to evaluate the incidental testicular doses during prostate radiation therapy with intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy (VMAT) at different energies. Dosimetric data of 15 patients with intermediate-risk prostate cancer who were treated with radiotherapy were analyzed. The prescribed dose was 78 Gy in 39 fractions. Dosimetric analysis compared testicular doses generated by 7-field intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy with a single arc at 6, 10, and 15 MV energy levels. Testicular doses calculated from the treatment planning system and doses measured from the detectors were analyzed. Mean testicular doses from the intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy per fraction calculated in the treatment planning system were 16.3 ± 10.3 cGy vs 21.5 ± 11.2 cGy (p = 0.03) at 6 MV, 13.4 ± 10.4 cGy vs 17.8 ± 10.7 cGy (p = 0.04) at 10 MV, and 10.6 ± 8.5 cGy vs 14.5 ± 8.6 cGy (p = 0.03) at 15 MV, respectively. Mean scattered testicular doses in the phantom measurements were 99.5 ± 17.2 cGy, 118.7 ± 16.4 cGy, and 193.9 ± 14.5 cGy at 6, 10, and 15 MV, respectively, in the intensity-modulated radiotherapy plans. In the volumetric-modulated arc radiotherapy plans, corresponding testicular doses per course were 90.4 ± 16.3 cGy, 103.6 ± 16.4 cGy, and 139.3 ± 14.6 cGy at 6, 10, and 15 MV, respectively. In conclusions, this study was the first to measure the incidental testicular doses by intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy plans at different energy levels during prostate-only irradiation. Higher photon energy and volumetric-modulated arc radiotherapy plans resulted in higher incidental testicular doses compared with lower photon energy and intensity-modulated radiotherapy plans.

Intensity Modulated Radiation Therapy in Head and Neck Squamous Cell Carcinoma: state of the art and future challenges

International Nuclear Information System (INIS)

Gregoire, V.; Maingon, P.

2005-01-01

Intensity-modulated radiation therapy (IMRT) for head and neck (HN) tumors refers to a new approach to the whole treatment procedure from patient immobilization to beam delivery. Implementation of IMRT thus requires knowledge of setup uncertainties, adequate selection and delineation of target volumes based on clinical examination and optimal imaging modalities, appropriate specification and dose prescription regarding dose-volume constraints, and ad hoc quality control of both the clinical and physical aspects of the whole procedure. A large number of issues still need to be resolved and/or further refined, such as the optimal selection and delineation of the target volume in particular, with the introduction of functional imaging, and a better integration of improved dose distribution into the fractionation strategy. IMRT is associated with a potentially increased incidence of carcinogenesis, although in the HN area this risk is relative to the intrinsic risk of co-morbidity and secondary cancer associated with the patient's lifestyle. Currently, the implementation of IMRT into routine clinical practice for HN cancers may not be a straightforward matter, and should probably be restricted to selected patients and selected institutions with adequate resources and experience. This review emphasizes the above aspects and provides some recommendations for the future use of IMRT in patients with HN tumors. (author)

An investigation into the effect of protective devices on the dose to radiosensitive organs in the head and neck

International Nuclear Information System (INIS)

Marshall, N.W.; Faulkner, K.; Clarke, P.

1992-01-01

A series of experiments were performed to determine the dose reduction afforded to radiosensitive organs in the head and neck by various protective devices. These included spectacles with plastic, standard glass, photochromic and lead-glass lenses, a thyroid collar and a lead-acrylic face mask. The measurements were performed using an anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters, in conditions realistic of clinical practice. Irradiations were performed using scattered radiation produced by a pelvic phantom, for X-ray beams generated at 80 kVp and 110 KVp. Also presented is the ratio of organ dose to dose to the bridge of the nose for thyroid, oesophagus, brain and sinuses, as measured for the case of no head or neck protection. (author)

Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: Radiotherapy target volume transformation and dose de-escalation.

Science.gov (United States)

van den Bosch, Sven; Vogel, Wouter V; Raaijmakers, Cornelis P; Dijkema, Tim; Terhaard, Chris H J; Al-Mamgani, Abrahim; Kaanders, Johannes H A M

2018-05-03

Diagnostic imaging continues to evolve, and now has unprecedented accuracy for detecting small nodal metastasis. This influences the tumor load in elective target volumes and subsequently has consequences for the radiotherapy dose required to control disease in these volumes. Small metastases that used to remain subclinical and were included in elective volumes, will nowadays be detected and included in high-dose volumes. Consequentially, high-dose volumes will more often contain low-volume disease. These target volume transformations lead to changes in the tumor burden in elective and "gross" tumor volumes with implications for the radiotherapy dose prescribed to these volumes. For head and neck tumors, nodal staging has evolved from mere palpation to combinations of high-resolution imaging modalities. A traditional nodal gross tumor volume in the neck typically had a minimum diameter of 10-15 mm, while nowadays much smaller tumor deposits are detected in lymph nodes. However, the current dose levels for elective nodal irradiation were empirically determined in the 1950s, and have not changed since. In this report the radiobiological consequences of target volume transformation caused by modern imaging of the neck are evaluated, and theoretically derived reductions of dose in radiotherapy for head and neck cancer are proposed. The concept of target volume transformation and subsequent strategies for dose adaptation applies to many other tumor types as well. Awareness of this concept may result in new strategies for target definition and selection of dose levels with the aim to provide optimal tumor control with less toxicity. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Predicting the effects of organ motion on the dose delivered by dynamic intensity modulation

International Nuclear Information System (INIS)

Yu, C.X.; Jaffray, David; Martinez, A.A.; Wong, J.W.

1997-01-01

Purpose: Computer-optimized treatment plans, aimed to enhance tumor control and reduce normal tissue complication, generally require non-uniform beam intensities. One of the techniques for delivering intensity-modulated beams is the use of dynamic multileaf collimation, where the beam aperture and field shape change during irradiation. When intensity-modulated beams are delivered with dynamic collimation, intra-treatment organ motion may not only cause geometric misses at the field boundaries but also create hot and cold spots in the target. The mechanism for producing such effects has not been well understood. This study analyzes the dosimetric effects of intra-treatment organ motion on dynamic intensity modulation. A numerical method is developed for predicting the intensity distributions in a moving target before dose is delivered with dynamic intensity modulation. Material and Methods: In the numerical algorithm, the change in position and shape of the beam aperture with time were modeled as a three-dimensional 'tunnel', with the shape of the field aperture described in the x-y plane and its temporal position shown in the z-dimension. A point in the target had to be in the tunnel in order to receive irradiation and the dose to the point was proportional to the amount of time that this point stayed in the tunnel. Since each point in the target were analyzed separately, non-rigid body variations could easily be handled. The dependency of the dose variations on all parameters involved, including the speed of collimator motion, the frequency and amplitude of the target motion, and the size of the field segments, was analyzed. The algorithm was verified by irradiating moving phantoms with beams of dynamically modulated intensities. Predictions were also made for a treatment of a thoracic tumor using a dynamic wedge. The changes of target position with time were based on the MRI images of the chest region acquired using fast MRI scans in a cine fashion for a duration

FBX dosimetry for point dose measurements in head and neck cancer patients

International Nuclear Information System (INIS)

Balraj, A.; Thakur, P.K.; Bhatnagar, S.; Vidyasagar, P.B.; Nirhali, Amit; Semwal, M.K.

2007-01-01

FBX dosimeter is mainly based on the determination of the radiation dose from the chemical changes produced in an irradiated medium, which can be measured by Spectrophotometry or Colorimetry, for which adequate FBX solution of 2 ml required for measuring the optical density (OD). To measure the point dose using 2 ml solution may lead to error in the measured dose since the solution may occupy 2 cc volume of the point measured. In head and neck carcinoma patients, the treatment area involves curvatures. Fixing 2 ml vial at the body surface is difficult and leads to give wrong readings. In this study we have measured the entrance and exit dose by filling 0.5 ml solution in a flexible catheter and placed at a point in the patient body surface during the radiation treatment. The solution was diluted adding 1.5 ml distilled water to measure the OD in the colorimeter

A self-calibration method in single-axis rotational inertial navigation system with rotating mechanism

Science.gov (United States)

Chen, Yuanpei; Wang, Lingcao; Li, Kui

2017-10-01

Rotary inertial navigation modulation mechanism can greatly improve the inertial navigation system (INS) accuracy through the rotation. Based on the single-axis rotational inertial navigation system (RINS), a self-calibration method is put forward. The whole system is applied with the rotation modulation technique so that whole inertial measurement unit (IMU) of system can rotate around the motor shaft without any external input. In the process of modulation, some important errors can be decoupled. Coupled with the initial position information and attitude information of the system as the reference, the velocity errors and attitude errors in the rotation are used as measurement to perform Kalman filtering to estimate part of important errors of the system after which the errors can be compensated into the system. The simulation results show that the method can complete the self-calibration of the single-axis RINS in 15 minutes and estimate gyro drifts of three-axis, the installation error angle of the IMU and the scale factor error of the gyro on z-axis. The calibration accuracy of optic gyro drifts could be about 0.003°/h (1σ) as well as the scale factor error could be about 1 parts per million (1σ). The errors estimate reaches the system requirements which can effectively improve the longtime navigation accuracy of the vehicle or the boat.

TU-D-209-06: Head and Neck Tissue Dose From X-Ray Scatter to Physicians Performing Cardiovascular Procedures

Energy Technology Data Exchange (ETDEWEB)

Fetterly, K; Schueler, B; Grams, M [Mayo Clinic, Rochester, MN (United States); Sturchio, G [Mayo Clinic, Jacksonville, FL (United States)

2016-06-15

Purpose: The purpose of this work was to characterize the spatial distribution of scatter radiation to the head and neck of a physician performing an x-ray interventional procedure and assess brain, eye lens, and carotid artery dose. Methods: Radiographic x-ray beams were tuned to match the peak energy (56 to 106 keV) and HVL (3.5 to 6.5 mm Al) of x-ray scatter originating from a patient during a fluoroscopic procedure. The radiographic beam was directed upon a Rando phantom from an inferior-left location to mimic a typical patient-operator geometric relationship. A lead-equivalent protective garment was secured to the phantom. Direct exposure Gafchromic film (XRQA2) was placed between the transverse plane layers of the head and neck region of the phantom and exposed with 4 scatter-equivalent radiographic beams. A 3×3 cm{sup 2} film placed at the left collar of the phantom was used to monitor incident dose in the position of a radiation monitoring badge. The films were converted to 2D dose distribution maps using FilmQA Pro software and an Epson 11000-XL scanner. The 2D dose distributions maps were normalized by the left collar dose and the percent of left collar dose (%LCD) was calculated for select tissues. Results: The dose maps had high dynamic range (10{sub 4}) and spatial detail. Considering all transverse planes and 4 scatter beam qualities, the median %LCD values were: whole brain 8.5%, left brain 13%, right brain 5.4%, left eye lens 67%, right eye lens 25%, left carotid artery 72%, and right carotid artery 28%. Conclusion: Scatter radiation dose to an operator can be simulated using a tuned radiographic beam and used to expose a phantom and Gafchromic film, thereby creating detailed 2D dose distribution maps. This work facilitates individualized estimation of dose to select head and neck tissues based on an operator’s radiation monitoring badge value.

Estimation of dose enhancement to soft tissue due to backscatter radiation near metal interfaces during head and neck radiothearpy - A phantom dosimetric study with radiochromic film

Directory of Open Access Journals (Sweden)

Rajesh Ashok Kinhikar

2014-01-01

Full Text Available The objective of this study was to investigate the dose enhancement to soft tissue due to backscatter radiation near metal interfaces during head and neck radiotherapy. The influence of titanium-mandibular plate with the screws on radiation dose was tested on four real bones from mandible with the metal and screws fixed. Radiochromic films were used for dosimetry. The bone and metal were inserted through the film at the center symmetrically. This was then placed in a small jig (7 cm × 7 cm × 10 cm to hold the film vertically straight. The polymer granules (tissue-equivalent were placed around the film for homogeneous scatter medium. The film was irradiated with 6 MV X-rays for 200 monitor units in Trilogy linear accelerator for 10 cm × 10 cm field size with source to axis distance of 100 cm at 5 cm. A single film was also irradiated without any bone and metal interface for reference data. The absolute dose and the vertical dose profile were measured from the film. There was 10% dose enhancement due to the backscatter radiation just adjacent to the metal-bone interface for all the materials. The extent of the backscatter effect was up to 4 mm. There is significant higher dose enhancement in the soft tissue/skin due to the backscatter radiation from the metallic components in the treatment region.

Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy

International Nuclear Information System (INIS)

McDonald, Mark W.; Liu, Yuan; Moore, Michael G.; Johnstone, Peter A. S.

2016-01-01

To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation. In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus. Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life

Comparison of IMRT Treatment Plans Between Linac and Helical Tomotherapy Based on Integral Dose and Inhomogeneity Index

International Nuclear Information System (INIS)

Shi Chengyu; Penagaricano, Jose; Papanikolaou, Niko

2008-01-01

Intensity modulated radiotherapy (IMRT) is an advanced treatment technology for radiation therapy. There are several treatment planning systems (TPS) that can generate IMRT plans. These plans may show different inhomogeneity indices to the planning target volume (PTV) and integral dose to organs at risk (OAR). In this study, we compared clinical cases covering different anatomical treatment sites, including head and neck, brain, lung, prostate, pelvis, and cranio-spinal axis. Two treatment plans were developed for each case using Pinnacle 3 and helical tomotherapy (HT) TPS. The inhomogeneity index of the PTV and the non-tumor integral dose (NTID) were calculated and compared for each case. Despite the difference in the number of effective beams, in several cases, NTID did not increase from HT as compared to the step-and-shoot delivery method. Six helical tomotherapy treatment plans for different treatment sites have been analyzed and compared against corresponding step-and-shoot plans generated with the Pinnacle 3 planning system. Results show that HT may produce plans with smaller integral doses to healthy organs, and fairly homogeneous doses to the target as compared to linac-based step-and-shoot IMRT planning in special treatment site such as cranio-spinal

Sparing of the submandibular glands by intensity modulated radiotherapy in the treatment of head and neck cancer

International Nuclear Information System (INIS)

Saarilahti, Kauko; Kouri, Mauri; Collan, Juhani; Kangasmaeki, Aki; Atula, Timo; Joensuu, Heikki; Tenhunen, Mikko

2006-01-01

Background and purpose: The submandibular glands produce most of the unstimulated saliva output and are the key in prevention of radiation-related xerostomia. We investigated whether sparing of the submandibular function is feasible with intensity modulated radiotherapy (IMRT). Patients and methods: Thirty-six patients diagnosed with head and neck cancer were treated with IMRT and had at least one parotid gland excluded from the planning target volume. In a subset, of these patients (n=18) where the risk of cancer recurrence in the contralateral submandibular region was judged low, the contralateral submandibular gland was spared from full-dose irradiation. The total unstimulated and stimulated salivary flow rates and adverse effects were monitored. Results: Twelve months following IMRT mean unstimulated saliva flow was 60% of the baseline value among patients who had one submandibular gland spared and 25% among those who did not (P=0.006). Patients whose contralateral submandibular was spared reported less grade two or three xerostomia (4 vs. 11; P=0.018), and used less saliva substitutes. No cancer recurrences were detected at the vicinity of the spared glands during a median follow-up time of 31 months. Conclusions: Submandibular gland sparing with IMRT is safe in selected patients treated for head and neck cancer. It is effective in prevention of radiation-associated xerostomia

Measurement of modulation transfer function in z-axis for multi-slice spiral CT using the micro-disk method. Comparison with the bead method and examination of geometric influence

International Nuclear Information System (INIS)

Hara, Takanori

2003-01-01

Many methods of measuring the section-sensitive profile (SSP) of computed tomography (CT) by the input of a delta function have been reported. In Japan, the bead method is used as a common measurement because of the high flexibility of the multi-purpose method. However, the intensity of the response of the bead method tends to decline, creating a relatively large error in the base of SSPs. A problem is considered to be the accuracy of measurement in evaluating spatial resolution along the z-axis in multi-slice spiral/helical CT (MSCT). We therefore evaluated the modulation transfer function (MTF) by conducting research with the micro-disk method (100 μm thickness and 1.0 mmφ diameter) and the bead method (1.0 mmφ diameter) for the same input width. Moreover, in the micro-disk method, we also examined alignment, circular region of interest (ROI), and the energy characteristic. Our comparison of MTFs obtained by the micro-disk method and the bead method showed that the former resulted in a higher value and lower standard deviation. The difference was significant at p<0.01. Measurement using the micro-disk method did not show significant differences in terms of alignment and ROIs. Moreover, the energy characteristic was not indicated. This research demonstrated that the accuracy of MTF measurement with the micro-disk method was greater than that with the bead method, and it was found that there was no influence on the actual measurement level of the geometric structure with the micro-disk method. (author)

Output energy of a photovoltaic module mounted on a single-axis tracking system

International Nuclear Information System (INIS)

Chang, Tian Pau

2009-01-01

In this study, the electric energy from a photovoltaic module was calculated theoretically at different azimuths and tilt angles in Taiwan. The gain of the module mounted on a single-axis tracking panel relative to a traditional fixed panel was analyzed. To simulate different operation environments, both types of radiation will be considered in addition to observed radiation, i.e. the extraterrestrial radiation and the global radiation predicted by an empirical model. The results show that the optimal tilt angle obtained from the observed data is flatter than those from other two radiation types and becomes flatter while the panel deviates from due south. The yearly gains obtained from the extraterrestrial, predicted and observed radiations are 51.4%, 28.5% and 18.7%, respectively, if a single-axis tracked panel is installed with the yearly optimal tilt angle; the similar gains are 45.3%, 25.9% and 17.5%, respectively, while the panel is adjusted to its monthly optimal angle each month. The amount of yearly energy in due west (or east) is less than its maximum in due south by about 11%, 10% and 5% for the extraterrestrial, predicted and observed radiation respectively. The yearly conversion efficiency of a fixed module is 10.2%, 9.2% and 8.3% for the extraterrestrial, predicted and observed radiation, respectively.

Internal and external generalizability of temporal dose-response relationships for xerostomia following IMRT for head and neck cancer.

Science.gov (United States)

Thor, Maria; Owosho, Adepitan A; Clark, Haley D; Oh, Jung Hun; Riaz, Nadeem; Hovan, Allan; Tsai, Jillian; Thomas, Steven D; Yom, Sae Hee K; Wu, Jonn S; Huryn, Joseph M; Moiseenko, Vitali; Lee, Nancy Y; Estilo, Cherry L; Deasy, Joseph O

2017-02-01

To study internal and external generalizability of temporal dose-response relationships for xerostomia after intensity-modulated radiotherapy (IMRT) for head and neck cancer, and to investigate potential amendments of the QUANTEC guidelines. Objective xerostomia was assessed in 121 patients (n Cohort1 =55; n Cohort2 =66) treated to 70Gy@2Gy in 2006-2015. Univariate and multivariate analyses (UVA, MVA with 1000 bootstrap populations) were conducted in Cohort1, and generalizability of the best-performing MVA model was investigated in Cohort2 (performance: AUC, p-values, and Hosmer-Lemeshow p-values (p HL )). Ultimately and for clinical guidance, minimum mean dose thresholds to the contralateral and the ipsilateral parotid glands (Dmean contra , Dmean ipsi ) were estimated from the generated dose-response curves. The observed xerostomia rate was 38%/47% (3months) and 19%/23% (11-12months) in Cohort1/Cohort2. Risk of xerostomia at 3months increased for higher Dmean contra and Dmean ipsi (Cohort1: 0.17·Dmean contra +0.11·Dmean ipsi -8.13; AUC=0.90±0.05; p=0.0002±0.002; p HL =0.22±0.23; Cohort2: AUC=0.81; pxerostomia following IMRT. Our results also suggest decreasing Dmean contra to below 20Gy, while keeping Dmean ipsi to around 25Gy. Long-term xerostomia was less frequent, and no dose-response relationship was established for this follow-up time. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

SU-F-T-449: Dosimetric Comparison of Acuros XB, Adaptive Convolve in Intensity Modulated Radiotherapy for Head and Neck Cancer

Energy Technology Data Exchange (ETDEWEB)

Uehara, R [National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Tachibana, H [National Cancer Center, Kashiwa, Chiba (Japan)

2016-06-15

Purpose: There have been several publications focusing on dose calculation in lung for a new dose calculation algorithm of Acuros XB (AXB). AXB could contribute to dose calculation for high-density media for bone and dental prosthesis rather than in lung. We compared the dosimetric performance of AXB, Adaptive Convolve (AC) in head and neck IMRT plans. Methods: In a phantom study, the difference in depth profile between AXB and AC was evaluated using Kodak EDR2 film sandwiched with tough water phantoms. 6 MV x-ray using the TrueBeam was irradiated. In a patient study, 20 head and neck IMRT plans had been clinically approved in Pinnacle3 and were transferred to Eclipse. Dose distribution was recalculated using AXB in Eclipse while maintaining AC-calculated monitor units and MLC sequence planned in Pinnacle. Subsequently, both the dose-volumetric data obtained using the two different calculation algorithms were compared. Results: The results in the phantom evaluation for the shallow area ahead of the build-up region shows over-dose for AXB and under-dose for AC, respectively. In the patient plans, AXB shows more hot spots especially around the high-density media than AC in terms of PTV (Max difference: 4.0%) and OAR (Max. difference: 1.9%). Compared to AC, there were larger dose deviations in steep dose gradient region and higher skin-dose. Conclusion: In head and neck IMRT plans, AXB and AC show different dosimetric performance for the regions inside the target volume around high-density media, steep dose gradient regions and skin-surface. There are limitations in skin-dose and complex anatomic condition using even inhomogeneous anthropomorphic phantom Thus, there is the potential for an increase of hot-spot in AXB, and an underestimation of dose in substance boundaries and skin regions in AC.

SU-F-T-449: Dosimetric Comparison of Acuros XB, Adaptive Convolve in Intensity Modulated Radiotherapy for Head and Neck Cancer

International Nuclear Information System (INIS)

Uehara, R; Tachibana, H

2016-01-01

Purpose: There have been several publications focusing on dose calculation in lung for a new dose calculation algorithm of Acuros XB (AXB). AXB could contribute to dose calculation for high-density media for bone and dental prosthesis rather than in lung. We compared the dosimetric performance of AXB, Adaptive Convolve (AC) in head and neck IMRT plans. Methods: In a phantom study, the difference in depth profile between AXB and AC was evaluated using Kodak EDR2 film sandwiched with tough water phantoms. 6 MV x-ray using the TrueBeam was irradiated. In a patient study, 20 head and neck IMRT plans had been clinically approved in Pinnacle3 and were transferred to Eclipse. Dose distribution was recalculated using AXB in Eclipse while maintaining AC-calculated monitor units and MLC sequence planned in Pinnacle. Subsequently, both the dose-volumetric data obtained using the two different calculation algorithms were compared. Results: The results in the phantom evaluation for the shallow area ahead of the build-up region shows over-dose for AXB and under-dose for AC, respectively. In the patient plans, AXB shows more hot spots especially around the high-density media than AC in terms of PTV (Max difference: 4.0%) and OAR (Max. difference: 1.9%). Compared to AC, there were larger dose deviations in steep dose gradient region and higher skin-dose. Conclusion: In head and neck IMRT plans, AXB and AC show different dosimetric performance for the regions inside the target volume around high-density media, steep dose gradient regions and skin-surface. There are limitations in skin-dose and complex anatomic condition using even inhomogeneous anthropomorphic phantom Thus, there is the potential for an increase of hot-spot in AXB, and an underestimation of dose in substance boundaries and skin regions in AC.

Mind-altering with the gut: Modulation of the gut-brain axis with probiotics.

Science.gov (United States)

Kim, Namhee; Yun, Misun; Oh, Young Joon; Choi, Hak-Jong

2018-03-01

It is increasingly evident that bidirectional interactions exist among the gastrointestinal tract, the enteric nervous system, and the central nervous system. Recent preclinical and clinical trials have shown that gut microbiota plays an important role in these gut-brain interactions. Furthermore, alterations in gut microbiota composition may be associated with pathogenesis of various neurological disorders, including stress, autism, depression, Parkinson's disease, and Alzheimer's disease. Therefore, the concepts of the microbiota-gut-brain axis is emerging. Here, we review the role of gut microbiota in bidirectional interactions between the gut and the brain, including neural, immune-mediated, and metabolic mechanisms. We highlight recent advances in the understanding of probiotic modulation of neurological and neuropsychiatric disorders via the gut-brain axis.

[Evaluation of Dose Reduction of the Active Collimator in Multi Detector Row CT].

Science.gov (United States)

Ueno, Hiroyuki; Matsubara, Kosuke

The purpose of this study was to evaluate the performance of active collimator by changing acquisition parameters and obtaining dose profiles in z-axis direction. Dose profiles along z-axis were obtained using XRQA2 Gafchromic film. As a result, the active collimator reduced overranging about 55% compared to that without the active collimator. In addition, by changing the combination of X-ray beam width (32 mm, 40 mm), pitch factor (1.4, 0.6), and the X-ray tube rotation time (0.5 s/rot, 1.0 s/rot), the overranging changed from 19.4 to 34.9 mm. Although the active collimator is effective for reducing overranging, it is necessary to adjust acquisition parameters by taking the properties of the active collimator for acquisition parameters, especially setting beam width, into consideration.

Radiation dose, driving performance, and cognitive function in patients with head and neck cancer

International Nuclear Information System (INIS)

Yuen, Hon K.; Sharma, Anand K.; Logan, William C.; Gillespie, M. Boyd; Day, Terry A.; Brooks, Johnell O.

2008-01-01

Seven head and neck cancer patients participated in a driving evaluation in a driving simulator. Radiation dose on the temporal lobes was moderately associated with time to complete a cognitive test and with driving performance. Results indicated that incidental irradiation may contribute to a decrease in cognition and in unsafe driving performance, which seems to be time-dependent

Experimental study of the neck formation in an X pinch

International Nuclear Information System (INIS)

Artyomov, A P; Chaikovsky, S A; Fedunin, A V; Labetskaya, N A; Rousskikh, A G; Zhigalin, A S; Oreshkin, V I

2014-01-01

X-pinch experiments have been performed on a compact 250 kA, 180 ns pulsed power generator specially designed for this purpose at the Institute of High Current Electronics (Tomsk, Russia). The X pinches were composed of two molybdenum wires of diameter 25 μm making an angle of 36° with the z-axis. The X-pinch dynamics was recorded with a 3 ns exposure time using an HSFC Pro four-frame camera. Axial plasma jets propagating toward both the anode and the cathode were observed. The jets became noticeable within 10 ns after the onset of current flow, which approximately corresponded to the time at which the electrical explosion of the X-pinch wires occurred. The velocity of the anode-directed jet reached 10 7 cm/s, which was about 1.5 times the velocity of the cathode-directed jet. These high jet velocities are inconsistent with the plasma temperature resulting from the wire explosion. Hence, these jets seem to develop due to implosion of the light plasma layer stripped by magnetic forces from the wire surface, and the increase in their velocities is perhaps due to cumulative effects taking place at the X-pinch axis. The X-pinch neck formed as a rule above the initial wire cross point (closer to the anode). In this region, the plasma diameter gradually increased with time and then drastically decreased 10-15 ns prior to the x-ray pulse. Immediately before the x-ray pulse, in the (250-300 μm long) plasma neck, a lower scale constriction developed, forming a h ot spot . It has been confirmed that the anode-directed plasma jet could take some part of the X-pinch wire current because of the evident jet pinching in the anode region. This process seems to determine the neck length

Fully Automated Simultaneous Integrated Boosted-Intensity Modulated Radiation Therapy Treatment Planning Is Feasible for Head-and-Neck Cancer: A Prospective Clinical Study

Energy Technology Data Exchange (ETDEWEB)

Wu Binbin, E-mail: binbin.wu@gunet.georgetown.edu [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States); Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); McNutt, Todd [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States); Zahurak, Marianna [Department of Oncology Biostatistics, Johns Hopkins University, Baltimore, Maryland (United States); Simari, Patricio [Autodesk Research, Toronto, ON (Canada); Pang, Dalong [Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); Taylor, Russell [Department of Computer Science, Johns Hopkins University, Baltimore, Maryland (United States); Sanguineti, Giuseppe [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States)

2012-12-01

Purpose: To prospectively determine whether overlap volume histogram (OVH)-driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics. Methods and Materials: A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison. Results: Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases. Conclusions: The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.

Fully Automated Simultaneous Integrated Boosted–Intensity Modulated Radiation Therapy Treatment Planning Is Feasible for Head-and-Neck Cancer: A Prospective Clinical Study

International Nuclear Information System (INIS)

Wu Binbin; McNutt, Todd; Zahurak, Marianna; Simari, Patricio; Pang, Dalong; Taylor, Russell; Sanguineti, Giuseppe

2012-01-01

Purpose: To prospectively determine whether overlap volume histogram (OVH)–driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics. Methods and Materials: A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison. Results: Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases. Conclusions: The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.

Irradiation of a 2.5 m long SciFi module with 24 GeV/c protons to the dose profile expected in LHCb

CERN Document Server

Rodrigues Cavalcante, Ana Barbara; Glaser, Maurice; Joram, Christian; Karacson, Matthias; Kristic, Robert; Ravotti, Federico; Riggaz, Nicolas

2015-01-01

A 2.5 m long and 13 cm wide SciFi module, made of a 6-layer single fibre mat, was irradiated with 24 GeV/c protons in the new CERN PS IRRAD facility. The module is equipped with an aluminised mylar mirror and was previously carefully characterised in a test beam experiment in the CERN H8 zone. For the irradiation the module was tilted by $7 ^o$ w.r.t. the beam axis. A translation table allowed to move the module during the irradiation transverse to the beam in order to generate the dose distribution expected in LHCb after an integrated luminosity of 50 fb$^{-1}$, including the very sharp rise at the mirror end to 35 kGy. The dose distribution was derived from the generation of sodium isotopes in the aluminium strips placed in front of and behind the module. The dosimetry relies mainly on the activity of the long-lived Na-22 isotope, as the short-lived Na-24 gave in our specific case less precise results. The irradiated zone corresponds to an approximately 25 mm wide band running along the fibre mat, at 32 mm ...

Derivation of electron and photon energy spectra from electron beam central axis depth dose curves

Energy Technology Data Exchange (ETDEWEB)

Deng Jun [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305 (United States)]. E-mail: jun@reyes.stanford.edu; Jiang, Steve B.; Pawlicki, Todd; Li Jinsheng; Ma, C.M. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305 (United States)

2001-05-01

A method for deriving the electron and photon energy spectra from electron beam central axis percentage depth dose (PDD) curves has been investigated. The PDD curves of 6, 12 and 20 MeV electron beams obtained from the Monte Carlo full phase space simulations of the Varian linear accelerator treatment head have been used to test the method. We have employed a 'random creep' algorithm to determine the energy spectra of electrons and photons in a clinical electron beam. The fitted electron and photon energy spectra have been compared with the corresponding spectra obtained from the Monte Carlo full phase space simulations. Our fitted energy spectra are in good agreement with the Monte Carlo simulated spectra in terms of peak location, peak width, amplitude and smoothness of the spectrum. In addition, the derived depth dose curves of head-generated photons agree well in both shape and amplitude with those calculated using the full phase space data. The central axis depth dose curves and dose profiles at various depths have been compared using an automated electron beam commissioning procedure. The comparison has demonstrated that our method is capable of deriving the energy spectra for the Varian accelerator electron beams investigated. We have implemented this method in the electron beam commissioning procedure for Monte Carlo electron beam dose calculations. (author)

Dose to the Bladder Neck Is the Most Important Predictor for Acute and Late Toxicity After Low-Dose-Rate Prostate Brachytherapy: Implications for Establishing New Dose Constraints for Treatment Planning

Energy Technology Data Exchange (ETDEWEB)

Hathout, Lara; Folkert, Michael R.; Kollmeier, Marisa A.; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Cohen, Gil' ad N. [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

2014-10-01

Purpose: To identify an anatomic structure predictive for acute (AUT) and late (LUT) urinary toxicity in patients with prostate cancer treated with low-dose-rate brachytherapy (LDR) with or without external beam radiation therapy (EBRT). Methods and Materials: From July 2002 to January 2013, 927 patients with prostate cancer (median age, 66 years) underwent LDR brachytherapy with Iodine 125 (n=753) or Palladium 103 (n=174) as definitive treatment (n=478) and as a boost (n=449) followed by supplemental EBRT (median dose, 50.4 Gy). Structures contoured on the computed tomographic (CT) scan on day 0 after implantation included prostate, urethra, bladder, and the bladder neck, defined as 5 mm around the urethra between the catheter balloon and the prostatic urethra. AUT and LUT were assessed with the Common Terminology Criteria for Adverse Events, version4. Clinical and dosimetric factors associated with AUT and LUT were analyzed with Cox regression and receiver operating characteristic analysis to calculate area under the receiver operator curve (ROC) (AUC). Results: Grade ≥2 AUT and grade ≥2 LUT occurred in 520 patients (56%) and 154 patients (20%), respectively. No grade 4 toxicities were observed. Bladder neck D2cc retained a significant association with AUT (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.03-1.04; P<.0001) and LUT (HR, 1.01; 95% CI, 1.00-1.03; P=.014) on multivariable analysis. In a comparison of bladder neck with the standard dosimetric variables by use of ROC analysis (prostate V100 >90%, D90 >100%, V150 >60%, urethra D20 >130%), bladder neck D2cc >50% was shown to have the strongest prognostic power for AUT (AUC, 0.697; P<.0001) and LUT (AUC, 0.620; P<.001). Conclusions: Bladder neck D2cc >50% was the strongest predictor for grade ≥2 AUT and LUT in patients treated with LDR brachytherapy. These data support inclusion of bladder neck constraints into brachytherapy planning to decrease urinary toxicity.

Matching IMRT fields with static photon field in the treatment of head-and-neck cancer

International Nuclear Information System (INIS)

Li, Jonathan G.; Liu, Chihray; Kim, Siyong; Amdur, Robert J.; Palta, Jatinder R.

2005-01-01

Radiation treatment with intensity-modulated radiation therapy (IMRT) for head-and-neck cancer usually involves treating the superior aspects of the target volume with intensity-modulated (IM) fields, and the inferior portion of the target volume (the low neck nodes) with a static anterior-posterior field (commonly known as the low anterior neck, or LAN field). A match line between the IM and the LAN fields is created with possibly large dose inhomogeneities, which are clinically undesirable. We propose a practical method to properly match these fields with minimal dependence on patient setup errors. The method requires mono-isocentric setup of the IM and LAN fields with half-beam blocks as defined by the asymmetric jaws. The inferior jaws of the IM fields, which extend ∼1 cm inferiorly past the isocenter, are changed manually before patient treatment, so that they match the superior jaw of the LAN field at the isocenter. The matching of these fields therefore does not depend on the particular treatment plan of IMRT and depends only on the matching of the asymmetric jaws. Measurements in solid water phantom were performed to verify the field-matching technique. Dose inhomogeneities of less than 5% were obtained in the match-line region. Feathering of the match line is done twice during the course of a treatment by changing the matching jaw positions superiorly at 3-mm increments each time, which further reduces the dose inhomogeneity. Compared to the method of including the lower neck nodes in the IMRT fields, the field-matching technique increases the delivery efficiency and significantly reduces the total treatment time

SU-F-T-315: Comparative Studies of Planar Dose with Different Spatial Resolution for Head and Neck IMRT QA

Energy Technology Data Exchange (ETDEWEB)

Hwang, T; Koo, T [Hallym University Medical Center, Chuncheon, Gangwon (Korea, Republic of)

2016-06-15

Purpose: To quantitatively investigate the planar dose difference and the γ value between the reference fluence map with the 1 mm detector-to-detector distance and the other fluence maps with less spatial resolution for head and neck intensity modulated radiation (IMRT) therapy. Methods: For ten head and neck cancer patients, the IMRT quality assurance (QA) beams were generated using by the commercial radiation treatment planning system, Pinnacle3 (ver. 8.0.d Philips Medical System, Madison, WI). For each beam, ten fluence maps (detector-to-detector distance: 1 mm to 10 mm by 1 mm) were generated. The fluence maps with larger than 1 mm detector-todetector distance were interpolated using MATLAB (R2014a, the Math Works,Natick, MA) by four different interpolation Methods: for the bilinear, the cubic spline, the bicubic, and the nearest neighbor interpolation, respectively. These interpolated fluence maps were compared with the reference one using the γ value (criteria: 3%, 3 mm) and the relative dose difference. Results: As the detector-to-detector distance increases, the dose difference between the two maps increases. For the fluence map with the same resolution, the cubic spline interpolation and the bicubic interpolation are almost equally best interpolation methods while the nearest neighbor interpolation is the worst.For example, for 5 mm distance fluence maps, γ≤1 are 98.12±2.28%, 99.48±0.66%, 99.45±0.65% and 82.23±0.48% for the bilinear, the cubic spline, the bicubic, and the nearest neighbor interpolation, respectively. For 7 mm distance fluence maps, γ≤1 are 90.87±5.91%, 90.22±6.95%, 91.79±5.97% and 71.93±4.92 for the bilinear, the cubic spline, the bicubic, and the nearest neighbor interpolation, respectively. Conclusion: We recommend that the 2-dimensional detector array with high spatial resolution should be used as an IMRT QA tool and that the measured fluence maps should be interpolated using by the cubic spline interpolation or the

SU-F-J-214: Dose Reduction by Spatially Optimized Image Quality Via Fluence Modulated Proton CT (FMpCT)

International Nuclear Information System (INIS)

De Angelis, L; Landry, G; Dedes, G; Parodi, K; Hansen, D; Rit, S; Belka, C

2016-01-01

Purpose: Proton CT (pCT) is a promising imaging modality for reducing range uncertainty in image-guided proton therapy. Range uncertainties partially originate from X-ray CT number conversion to stopping power ratio (SPR) and are limiting the exploitation of the full potential of proton therapy. In this study we explore the concept of spatially dependent fluence modulated proton CT (FMpCT), for achieving optimal image quality in a clinical region of interest (ROI), while reducing significantly the imaging dose to the patient. Methods: The study was based on simulated ideal pCT using pencil beam (PB) scanning. A set of 250 MeV protons PBs was used to create 360 projections of a cylindrical water phantom and a head and neck cancer patient. The tomographic images were reconstructed using a filtered backprojection (FBP) as well as an iterative algorithm (ITR). Different fluence modulation levels were investigated and their impact on the image was quantified in terms of SPR accuracy as well as noise within and outside selected ROIs, as a function of imaging dose. The unmodulated image served as reference. Results: Both FBP reconstruction and ITR without total variation (TV) yielded image quality in the ROIs similar to the reference images, for modulation down to 0.1 of the full proton fluence. The average dose was reduced by 75% for the water phantom and by 40% for the patient. FMpCT does not improve the noise for ITR with TV and modulation 0.1. Conclusion: This is the first work proposing and investigating FMpCT for producing optimal image quality for treatment planning and image guidance, while simultaneously reducing imaging dose. Future work will address spatial resolution effects and the impact of FMpCT on the quality of proton treatment plans for a prototype pCT scanner capable of list mode data acquisition. Acknowledgement: DFG-MAP DFG - Munich-Centre for Advanced Photonics (MAP)

SU-F-J-214: Dose Reduction by Spatially Optimized Image Quality Via Fluence Modulated Proton CT (FMpCT)

Energy Technology Data Exchange (ETDEWEB)

De Angelis, L; Landry, G; Dedes, G; Parodi, K [Ludwig-Maximilians-Universitaet Muenchen (LMU Munich), Garching b. Muenchen (Germany); Hansen, D [Aarhus University Hospital, Aarhus, Jutland (Denmark); Rit, S [University Lyon, Lyon, Auvergne-Rhone-Alpes (France); Belka, C [LMU Munich, Munich (Germany)

2016-06-15

Purpose: Proton CT (pCT) is a promising imaging modality for reducing range uncertainty in image-guided proton therapy. Range uncertainties partially originate from X-ray CT number conversion to stopping power ratio (SPR) and are limiting the exploitation of the full potential of proton therapy. In this study we explore the concept of spatially dependent fluence modulated proton CT (FMpCT), for achieving optimal image quality in a clinical region of interest (ROI), while reducing significantly the imaging dose to the patient. Methods: The study was based on simulated ideal pCT using pencil beam (PB) scanning. A set of 250 MeV protons PBs was used to create 360 projections of a cylindrical water phantom and a head and neck cancer patient. The tomographic images were reconstructed using a filtered backprojection (FBP) as well as an iterative algorithm (ITR). Different fluence modulation levels were investigated and their impact on the image was quantified in terms of SPR accuracy as well as noise within and outside selected ROIs, as a function of imaging dose. The unmodulated image served as reference. Results: Both FBP reconstruction and ITR without total variation (TV) yielded image quality in the ROIs similar to the reference images, for modulation down to 0.1 of the full proton fluence. The average dose was reduced by 75% for the water phantom and by 40% for the patient. FMpCT does not improve the noise for ITR with TV and modulation 0.1. Conclusion: This is the first work proposing and investigating FMpCT for producing optimal image quality for treatment planning and image guidance, while simultaneously reducing imaging dose. Future work will address spatial resolution effects and the impact of FMpCT on the quality of proton treatment plans for a prototype pCT scanner capable of list mode data acquisition. Acknowledgement: DFG-MAP DFG - Munich-Centre for Advanced Photonics (MAP)

Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice

Energy Technology Data Exchange (ETDEWEB)

Frank, Steven J., E-mail: sjfrank@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael; Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Garden, Adam S.; Rosenthal, David I.; Gunn, G. Brandon [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Weber, Randal S. [Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kies, Merrill S. [Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lewin, Jan S. [Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Palmer, Matthew B. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sahoo, Narayan; Zhang, Xiaodong; Liu, Wei; Zhu, X. Ronald [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2014-07-15

Background: We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials: Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results: Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions: To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.

Intensity-Modulated Radiotherapy of Head and Neck Cancer Aiming to Reduce Dysphagia: Early Dose-Effect Relationships for the Swallowing Structures

International Nuclear Information System (INIS)

Feng, Felix Y.; Kim, Hyungjin M.; Lyden, Teresa H.; Haxer, Marc J.; Feng, Mary; Worden, Frank P.; Chepeha, Douglas B.; Eisbruch, Avraham

2007-01-01

Purpose: To present initial results of a clinical trial of intensity-modulated radiotherapy (IMRT) aiming to spare the swallowing structures whose dysfunction after chemoradiation is a likely cause of dysphagia and aspiration, without compromising target doses. Methods and Materials: This was a prospective, longitudinal study of 36 patients with Stage III-IV oropharyngeal (31) or nasopharyngeal (5) cancer. Definitive chemo-IMRT spared salivary glands and swallowing structures: pharyngeal constrictors (PC), glottic and supraglottic larynx (GSL), and esophagus. Lateral but not medial retropharyngeal nodes were considered at risk. Dysphagia endpoints included objective swallowing dysfunction (videofluoroscopy), and both patient-reported and observer-rated scores. Correlations between doses and changes in these endpoints from pre-therapy to 3 months after therapy were assessed. Results: Significant correlations were observed between videofluoroscopy-based aspirations and the mean doses to the PC and GSL, as well as the partial volumes of these structures receiving 50-65 Gy; the highest correlations were associated with doses to the superior PC (p = 0.005). All patients with aspirations received mean PC doses >60 Gy or PC V 65 >50%, and GSL V 50 >50%. Reduced laryngeal elevation and epiglottic inversion were correlated with mean PC and GSL doses (p 70 >50%. Worsening patient-reported liquid swallowing was correlated with mean PC (p = 0.05) and esophageal (p 0.02) doses. Only mean PC doses were correlated with worsening patient-reported solid swallowing (p = 0.04) and observer-rated swallowing scores (p = 0.04). Conclusions: These dose-volume-effect relationships provide initial IMRT optimization goals and motivate further efforts to reduce swallowing structures doses to reduce dysphagia and aspiration

Three-dimensional cluster formation and structure in heterogeneous dose distribution of intensity modulated radiation therapy.

Science.gov (United States)

Chao, Ming; Wei, Jie; Narayanasamy, Ganesh; Yuan, Yading; Lo, Yeh-Chi; Peñagarícano, José A

2018-05-01

To investigate three-dimensional cluster structure and its correlation to clinical endpoint in heterogeneous dose distributions from intensity modulated radiation therapy. Twenty-five clinical plans from twenty-one head and neck (HN) patients were used for a phenomenological study of the cluster structure formed from the dose distributions of organs at risks (OARs) close to the planning target volumes (PTVs). Initially, OAR clusters were searched to examine the pattern consistence among ten HN patients and five clinically similar plans from another HN patient. Second, clusters of the esophagus from another ten HN patients were scrutinized to correlate their sizes to radiobiological parameters. Finally, an extensive Monte Carlo (MC) procedure was implemented to gain deeper insights into the behavioral properties of the cluster formation. Clinical studies showed that OAR clusters had drastic differences despite similar PTV coverage among different patients, and the radiobiological parameters failed to positively correlate with the cluster sizes. MC study demonstrated the inverse relationship between the cluster size and the cluster connectivity, and the nonlinear changes in cluster size with dose thresholds. In addition, the clusters were insensitive to the shape of OARs. The results demonstrated that the cluster size could serve as an insightful index of normal tissue damage. The clinical outcome of the same dose-volume might be potentially different. Copyright © 2018 Elsevier B.V. All rights reserved.

Split-field vs extended-field intensity-modulated radiation therapy plans for oropharyngeal cancer: Which spares the larynx? Which spares the thyroid?

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Yu, Yao; Chen, Josephine [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Leary, Celeste I. [Department of Radiation Medicine, Oregon Health Sciences University, Portland, OR (United States); Shugard, Erin [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Yom, Sue S., E-mail: yoms@radonc.ucsf.edu [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA (United States)

2016-07-01

Radiation of the low neck can be accomplished using split-field intensity-modulated radiation therapy (sf-IMRT) or extended-field intensity-modulated radiation therapy (ef-IMRT). We evaluated the effect of these treatment choices on target coverage and thyroid and larynx doses. Using data from 14 patients with cancers of the oropharynx, we compared the following 3 strategies for radiating the low neck: (1) extended-field IMRT, (2) traditional split-field IMRT with an initial cord-junction block to 40 Gy, followed by a full-cord block to 50 Gy, and (3) split-field IMRT with a full-cord block to 50 Gy. Patients were planned using each of these 3 techniques. To facilitate comparison, extended-field plans were normalized to deliver 50 Gy to 95% of the neck volume. Target coverage was assessed using the dose to 95% of the neck volume (D{sub 95}). Mean thyroid and larynx doses were computed. Extended-field IMRT was used as the reference arm; the mean larynx dose was 25.7 ± 7.4 Gy, and the mean thyroid dose was 28.6 ± 2.4 Gy. Split-field IMRT with 2-step blocking reduced laryngeal dose (mean larynx dose 15.2 ± 5.1 Gy) at the cost of a moderate reduction in target coverage (D{sub 95} 41.4 ± 14 Gy) and much higher thyroid dose (mean thyroid dose 44.7 ± 3.7 Gy). Split-field IMRT with initial full-cord block resulted in greater laryngeal sparing (mean larynx dose 14.2 ± 5.1 Gy) and only a moderately higher thyroid dose (mean thyroid dose 31 ± 8 Gy) but resulted in a significant reduction in target coverage (D{sub 95} 34.4 ± 15 Gy). Extended-field IMRT comprehensively covers the low neck and achieves acceptable thyroid and laryngeal sparing. Split-field IMRT with a full-cord block reduces laryngeal doses to less than 20 Gy and spares the thyroid, at the cost of substantially reduced coverage of the low neck. Traditional 2-step split-field IMRT similarly reduces the laryngeal dose but also reduces low-neck coverage and delivers very high doses to the thyroid.

Dosimetric evaluation of abutted fields using asymmetric collimators for treatment of head and neck

International Nuclear Information System (INIS)

Saw, Cheng B.; Krishna, Komanduri V.; Enke, Charles A.; Hussey, David H.

2000-01-01

Purpose: The objective of this study was to reevaluate the dose nonuniformity of abutted fields defined using asymmetric collimators and one isocenter for treatment of the head and neck region. Methods and Materials: Bilateral parallel-opposed fields abutted to the anterior field at one isocenter were implemented in the treatment of head and neck. The effect of digital display tolerance can produce dose nonuniformity at the junction of the abutted fields. The amount of dose nonuniformity was quantified using both mathematical summation of dose profiles and by direct measurement of doses at the junction of the two abutted fields. The dose nonuniformity was obtained by irradiating the superior part of a film using bilateral parallel-opposed fields and the inferior part by an anterior field with a gap or an overlap. Dose profiles were taken at the depth of maximum dose for the anterior field across the abutted fields. The dose nonuniformity was determined for the case where the asymmetric jaw was set at -2 mm, -1 mm, 0, +1 mm, and +2 mm from the beam central axis. Results: The dose at the junction increases systematically as the abutment of the fields changes from a gap to an overlap. The dose nonuniformity with 1-mm gap and 1-mm overlap is about 15% underdose and overdose, respectively. Conclusion: Imperfect abutment of split fields due to digital display tolerance (no. +-no. 1 mm) of asymmetric collimator can cause an underdose or overdose of 15% of the delivered dose

Planning and delivering high doses to targets surrounding the spinal cord at the lower neck and upper mediastinal levels: static beam-segmentation technique executed with a multileaf collimator

International Nuclear Information System (INIS)

Neve, W. de; Wagter, C. de; Jaeger, K. de; Thienpont, M.; Colle, C.; Derycke, S.; Schelfhout, J.

1996-01-01

Background and purpose. It remains a technical challenge to limit the dose to the spinal cord below tolerance if, in head and neck or thyroid cancer, the planning target volume reaches to a level below the shoulders. In order to avoid these dose limitations, we developed a standard plan involving Beam Intensity Modulation (BIM) executed by a static technique of beam segmentation. In this standard plan, many machine parameters (gantry angles, couch position, relative beam and segment weights) as well as the beam segmentation rules were identical for all patients. Materials and methods. The standard plan involved: the use of static beams with a single isocenter; BIM by field segmentation executable with a standard Philips multileaf collimator; virtual simulation and dose computation on a general 3D-planning system (Sherouse's GRATIS[reg]); heuristic computation of segment intensities and optimization (improving the dose distribution and reducing the execution time) by human intelligence. The standard plan used 20 segments spread over 8 gantry angles plus 2 non-segmented wedged beams (2 gantry angles). Results. The dose that could be achieved at the lowest target voxel, without exceeding tolerance of the spinal cord (50 Gy at highest voxel) was 70-80 Gy. The in-target 3D dose-inhomogeneity was ∼25%. The shortest time of execution of a treatment (22 segments) on a patient (unpublished) was 25 min. Conclusions. A heuristic model has been developed and investigated to obtain a 3D concave dose distribution applicable to irradiate targets in the lower neck and upper mediastinal regions. The technique spares efficiently the spinal cord and allows the delivery of higher target doses than with conventional techniques. It can be planned as a standard plan using conventional 3D-planning technology. The routine clinical implementation is performed with commercially available equipment, however, at the expense of extended execution times

Automatic planning of head and neck treatment plans

DEFF Research Database (Denmark)

Hazell, Irene; Bzdusek, Karl; Kumar, Prashant

2016-01-01

radiation dose planning (dosimetrist) and potentially improve the overall plan quality. This study evaluates the performance of the Auto-Planning module that has recently become clinically available in the Pinnacle3 radiation therapy treatment planning system. Twenty-six clinically delivered head and neck...... as the previously delivered clinical plans. For all patients, the Auto-Planning tool produced clinically acceptable head and neck treatment plans without any manual intervention, except for the initial target and OAR delineations. The main benefit of the method is the likely improvement in the overall treatment......Treatment planning is time-consuming and the outcome depends on the person performing the optimization. A system that automates treatment planning could potentially reduce the manual time required for optimization and could also pro-vide a method to reduce the variation between persons performing...

Potential clinical efficacy of intensity-modulated conformal therapy

International Nuclear Information System (INIS)

Meeks, Sanford L.; Buatti, John M.; Bova, Francis J.; Friedman, William A.; Mendenhall, William M.; Zlotecki, Robert A.

1998-01-01

Purpose: The purpose of this study was to examine the potential benefit of using intensity-modulated conformal therapy for a variety of lesions currently treated with stereotactic radiosurgery or conventional radiotherapy. Methods and Materials: Intensity-modulated conformal treatment plans were generated for small intracranial lesions, as well as head and neck, lung, breast, and prostate cases, using the Peacock Plan[reg] treatment-planning system (Nomos Corporation). For small intracranial lesions, intensity-modulated conformal treatment plans were compared with stereotactic radiosurgery treatment plans generated for patient treatment at the University of Florida Shands Cancer Center. For other sites (head and neck, lung, breast, and prostate), plans generated using the Peacock Plan[reg] were compared with conventional treatment plans, as well as beam's-eye-view conformal treatment plans. Plan comparisons were accomplished through conventional qualitative review of two-dimensional (2D) dose distributions in conjunction with quantitative techniques, such as dose-volume histograms, dosimetric statistics, normal tissue complication probabilities, tumor control probabilities, and objective numerical scoring. Results: For small intracranial lesions, there is little difference between intensity-modulated conformal treatment planning and radiosurgery treatment planning in the conformation of high isodose lines with the target volume. However, stereotactic treatment planning provides a steeper dose gradient outside the target volume and, hence, a lower normal tissue toxicity index. For extracranial sites, objective numerical scores for beam's-eye-view and intensity-modulated conformal planning techniques are superior to scores for conventional treatment plans. The beam's-eye-view planning technique prevents geographic target misses and better excludes healthy tissues from the treatment portal. Compared with scores for the beam's-eye-view planning technique, scores for

Aperture modulated arc therapy

International Nuclear Information System (INIS)

Crooks, S M; Wu, Xiaodong; Takita, C; Watzich, M; Xing Lei

2003-01-01

We show that it is possible to translate an intensity modulated radiation therapy (IMRT) treatment plan and deliver it as a single arc. This technique is referred to in this paper as aperture modulation arc therapy (AMAT). During this arc, the MLC leaves do not conform to the projection of the target PTV and the machine output of the accelerator has a constant value. Dose was calculated using the CORVUS 4.0 IMRT system, which uses a pencil beam dose algorithm, and treatments were delivered using a Varian 2100C/D Clinac. Results are presented for a head and neck and a prostate case, showing the equivalence of the IMRT and the translated AMAT delivery. For a prostate AMAT delivery, coronal plane film dose for the IMRT and AMAT deliveries agreed within 7.19 ± 6.62%. For a meningioma the coronal plane dose distributions were similar to a value of 4.6 ± 6.62%. Dose to the isocentre was measured as being within 2% of the planned value in both cases

Evaluation of the dose received in the tissues of the neck during quantification of iodine in the thyroid by X-ray fluorescence spectrometry

Science.gov (United States)

Portararo, Antonio; Licour, Caroline; Gerardy, Isabelle; Pozuelo Navarro, Fausto

2018-04-01

The determination of the iodine content in the thyroid is of great interest for many investigations of this gland. The conventional scintigraphic method, using radionuclides, is efficient but delivers a significant dose to the patient. The X-ray fluorescence spectrometry could give information about the iodine content in the thyroid. The measured signal is obtained after stimulation of the stable iodine contained in the gland by X-rays. The advantage of this technique is the complete absence of radioactive isotope injected into the patient body. By applying this, a decrease in effective dose to the patient should be obtained. In this work, the study of the dose received by a thyroid phantom (surrounded by the different tissues of the neck) was performed. The phantom is made of PLA. The dose is measured in optimised conditions defined for the analytical technique. A total head-neck phantom was also used in order to consider the absorbed dose in each different tissues and organs as spinal cord or eyes. Thermo-luminescence dosimeters were chosen for their small size, their sensitivity and the easy positioning on the surface of the phantom but also inside of it to evaluate dose to internal organs. Those LiF 100 dosimeters have been calibrated within the X-ray beam also used for the analysis of iodine. The repeatability and reproducibility of the method has been evaluated. The influence of parameters as concentration of iodine in the thyroid, distance between the X-ray generator and the neck, thickness of the tissues surrounding the thyroid, has been investigated in terms of modifying parameters of the dose received by different tissues situated in the neck and the head.

Improvement of Dose Homogeneity in a 3-Dimensional Conformal Radiotherapy for Head and Neck Cancer

International Nuclear Information System (INIS)

Kim, Yong Nam; Lee, Chang Geol; Chung, Kyeong Keun; Kim, Joo Young; Seong, Jin Sil

2007-01-01

When an electron field is abutted at the surface with a photon field for head-and-neck cancer (HNC) treatment, the traditional method using bilateral field gives rise to an extreme inhomogeneity of dose distribution with both very hot and very cold regions. When we consider clinically only tumor doses of primary concern regardless of dose to normal tissues, the hot spots can be accepted, depending on their magnitude, extent, and location. However, an extreme inhomogeneity inside the radiation field is generally undesirable. An overdose to normal tissues around a target region or an underdosage in the tumor may be problematic. This study intends to develop a novel approach to improve the dose distribution inside the photon-electron abutting fields for HNC treatment

The Microbiome-Gut-Behavior Axis: Crosstalk Between the Gut Microbiome and Oligodendrocytes Modulates Behavioral Responses.

Science.gov (United States)

Ntranos, Achilles; Casaccia, Patrizia

2018-01-01

Environmental and dietary stimuli have always been implicated in brain development and behavioral responses. The gut, being the major portal of communication with the external environment, has recently been brought to the forefront of this interaction with the establishment of a gut-brain axis in health and disease. Moreover, recent breakthroughs in germ-free and antibiotic-treated mice have demonstrated the significant impact of the microbiome in modulating behavioral responses in mice and have established a more specific microbiome-gut-behavior axis. One of the mechanisms by which this axis affects social behavior is by regulating myelination at the prefrontal cortex, an important site for complex cognitive behavior planning and decision-making. The prefrontal cortex exhibits late myelination of its axonal projections that could extend into the third decade of life in humans, which make it susceptible to external influences, such as microbial metabolites. Changes in the gut microbiome were shown to alter the composition of the microbial metabolome affecting highly permeable bioactive compounds, such as p-cresol, which could impair oligodendrocyte differentiation. Dysregulated myelination in the prefrontal cortex is then able to affect behavioral responses in mice, shifting them towards social isolation. The reduced social interactions could then limit microbial exchange, which could otherwise pose a threat to the survival of the existing microbial community in the host and, thus, provide an evolutionary advantage to the specific microbial community. In this review, we will analyze the microbiome-gut-behavior axis, describe the interactions between the gut microbiome and oligodendrocytes and highlight their role in the modulation of social behavior.

Dosimetry audit for a multi-centre IMRT head and neck trial

International Nuclear Information System (INIS)

Clark, Catharine H.; Hansen, Vibeke Nordmark; Chantler, Hannah; Edwards, Craig; James, Hayley V.; Webster, Gareth; Miles, Elizabeth A.; Guerrero Urbano, M. Teresa; Bhide, Shree A.; Bidmead, A. Margaret; Nutting, Christoper M.

2009-01-01

Background and purpose: PARSPORT was a multi-centre randomised trial in the UK which compared Intensity-Modulated Radiotherapy (IMRT) and conventional radiotherapy (CRT) for patients with head and neck cancer. The dosimetry audit goals were to verify the plan delivery in participating centres, ascertain what tolerances were suitable for head and neck IMRT trials and develop an IMRT credentialing program. Materials and methods: Centres enrolling patients underwent rigorous quality assurance before joining the trial. Following this each centre was visited for a dosimetry audit, which consisted of treatment planning system tests, fluence verification films, combined field films and dose point measurements. Results: Mean dose point measurements were made at six centres. For the primary planning target volume (PTV) the differences with the planned values for the IMRT and CRT arms were -0.6% (1.8% to -2.4%) and 0.7% (2.0% to -0.9%), respectively. Ninety-four percent of the IMRT fluence films for individual fields passed gamma criterion of 3%/3 mm and 75% of the films for combined fields passed gamma criterion 4%/3 mm (no significant difference between dynamic delivery and step and shoot delivery). Conclusions: This audit suggests that a 3% tolerance could be applied for PTV point doses. For dose distributions tolerances of 3%/3 mm on individual fields and 4%/3 mm for combined fields are proposed for multi-centre head and neck IMRT trials.

Patient Dose From Megavoltage Computed Tomography Imaging

International Nuclear Information System (INIS)

Shah, Amish P.; Langen, Katja M.; Ruchala, Kenneth J.; Cox, Andrea; Kupelian, Patrick A.; Meeks, Sanford L.

2008-01-01

Purpose: Megavoltage computed tomography (MVCT) can be used daily for imaging with a helical tomotherapy unit for patient alignment before treatment delivery. The purpose of this investigation was to show that the MVCT dose can be computed in phantoms, and further, that the dose can be reported for actual patients from MVCT on a helical tomotherapy unit. Methods and Materials: An MVCT beam model was commissioned and verified through a series of absorbed dose measurements in phantoms. This model was then used to retrospectively calculate the imaging doses to the patients. The MVCT dose was computed for five clinical cases: prostate, breast, head/neck, lung, and craniospinal axis. Results: Validation measurements in phantoms verified that the computed dose can be reported to within 5% of the measured dose delivered at the helical tomotherapy unit. The imaging dose scaled inversely with changes to the CT pitch. Relative to a normal pitch of 2.0, the organ dose can be scaled by 0.67 and 2.0 for scans done with a pitch of 3.0 and 1.0, respectively. Typical doses were in the range of 1.0-2.0 cGy, if imaged with a normal pitch. The maximal organ dose calculated was 3.6 cGy in the neck region of the craniospinal patient, if imaged with a pitch of 1.0. Conclusion: Calculation of the MVCT dose has shown that the typical imaging dose is approximately 1.5 cGy per image. The uniform MVCT dose delivered using helical tomotherapy is greatest when the anatomic thickness is the smallest and the pitch is set to the lowest value

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures.

Science.gov (United States)

van der Molen, Lisette; Heemsbergen, Wilma D; de Jong, Rianne; van Rossum, Maya A; Smeele, Ludi E; Rasch, Coen R N; Hilgers, Frans J M

2013-03-01

Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters for swallowing (inferior (IC), middle (MC), and superior constrictors (SC)), and mastication structures (e.g. masseter). Investigation of relationships between dose-parameters and endpoints for swallowing problems (videofluoroscopy-based laryngeal Penetration-Aspiration Scale (PAS), and study-specific structured questionnaire) and limited mouth-opening (measurements and questionnaire), taking into account baseline scores. At 10-weeks, volume of IC receiving ≥60 Gy (V60) and mean dose IC were significant predictors for PAS. One-year post-treatment, reported problems with swallowing solids were significantly related to masseter dose-parameters (mean, V20, V40 and V60) and an inverse relationship (lower dose related to a higher probability) was observed for V60 of the IC. Dose-parameters of masseter and pterygoid muscles were significant predictors of trismus at 10-weeks (mean, V20, and V40). At 1-year, dose-parameters of all mastication structures were strong predictors for subjective mouth-opening problems (mean, max, V20, V40, and V60). Dose-effect relationships exist for dysphagia and trismus. Therefore treatment plans should be optimized to avoid these side effects. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Clinically Applicable Monte Carlo–based Biological Dose Optimization for the Treatment of Head and Neck Cancers With Spot-Scanning Proton Therapy

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Wan Chan Tseung, Hok Seum, E-mail: wanchantseung.hok@mayo.edu; Ma, Jiasen; Kreofsky, Cole R.; Ma, Daniel J.; Beltran, Chris

2016-08-01

Purpose: Our aim is to demonstrate the feasibility of fast Monte Carlo (MC)–based inverse biological planning for the treatment of head and neck tumors in spot-scanning proton therapy. Methods and Materials: Recently, a fast and accurate graphics processor unit (GPU)–based MC simulation of proton transport was developed and used as the dose-calculation engine in a GPU-accelerated intensity modulated proton therapy (IMPT) optimizer. Besides dose, the MC can simultaneously score the dose-averaged linear energy transfer (LET{sub d}), which makes biological dose (BD) optimization possible. To convert from LET{sub d} to BD, a simple linear relation was assumed. By use of this novel optimizer, inverse biological planning was applied to 4 patients, including 2 small and 1 large thyroid tumor targets, as well as 1 glioma case. To create these plans, constraints were placed to maintain the physical dose (PD) within 1.25 times the prescription while maximizing target BD. For comparison, conventional intensity modulated radiation therapy (IMRT) and IMPT plans were also created using Eclipse (Varian Medical Systems) in each case. The same critical-structure PD constraints were used for the IMRT, IMPT, and biologically optimized plans. The BD distributions for the IMPT plans were obtained through MC recalculations. Results: Compared with standard IMPT, the biologically optimal plans for patients with small tumor targets displayed a BD escalation that was around twice the PD increase. Dose sparing to critical structures was improved compared with both IMRT and IMPT. No significant BD increase could be achieved for the large thyroid tumor case and when the presence of critical structures mitigated the contribution of additional fields. The calculation of the biologically optimized plans can be completed in a clinically viable time (<30 minutes) on a small 24-GPU system. Conclusions: By exploiting GPU acceleration, MC-based, biologically optimized plans were created for

Evaluation of the impact of dental artefacts on intensity-modulated radiotherapy planning for the head and neck

International Nuclear Information System (INIS)

Webster, Gareth J.; Rowbottom, Carl G.; Mackay, Ranald I.

2009-01-01

Background and purpose: High density materials create severe artefacts in the computed tomography (CT) scans used for radiotherapy dose calculations. Increased use of intensity-modulated radiotherapy (IMRT) to treat oropharyngeal cancers raises concerns over the accuracy of the resulting dose calculation. This work quantifies their impact and evaluates a simple corrective technique. Materials and methods: Fifteen oropharyngeal patients with severe artefacts were retrospectively planned with IMRT using two different CT/density look-up tables. Each plan was recalculated using a corrected CT dataset to evaluate the dose distribution delivered to the patient. Plan quality in the absence of dental artefacts was similarly assessed. A range of dosimetric and radiobiological parameters were compared pre- and post-correction. Results: Plans using a standard CT/density look-up table (density ≤1.8 g/cm 3 ) revealed inconsistent inter-patient errors, mostly within clinical acceptance, although potentially significantly reducing target coverage for individual patients. Using an extended CT/density look-up table (density ≤10.0 g/cm 3 ) greatly reduced the errors for 13/15 patients. In 2/15 patients with residual errors the CTV extended into the severely affected region and could be corrected by applying a simple manual correction. Conclusions: Use of an extended CT/density look-up table together with a simple manual bulk density correction reduces the impact of dental artefacts on head and neck IMRT planning to acceptable levels.

Weekly Volume and Dosimetric Changes During Chemoradiotherapy With Intensity-Modulated Radiation Therapy for Head and Neck Cancer: A Prospective Observational Study

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Bhide, Shreerang A [Institute of Cancer Research, 237 Fulham Road, London SW6 6JB (United Kingdom); Head and Neck Unit, Royal Marsden NHS Foundation Trust Hospital, London SW3 6JJ (United Kingdom); Davies, Mark; Burke, Kevin; McNair, Helen A; Hansen, Vibeke [Department of Radiation Oncology, Royal Marsden NHS Foundation Trust Hospital, London and Sutton (United Kingdom); Barbachano, Y [Department of Statistics, Royal Marsden NHS Foundation Trust Hospital, London and Sutton (United Kingdom); El-Hariry, I A [Head and Neck Unit, Royal Marsden NHS Foundation Trust Hospital, London SW3 6JJ (United Kingdom); Newbold, Kate [Department of Radiation Oncology, Royal Marsden NHS Foundation Trust Hospital, London and Sutton (United Kingdom); Harrington, Kevin J [Institute of Cancer Research, 237 Fulham Road, London SW6 6JB (United Kingdom); Head and Neck Unit, Royal Marsden NHS Foundation Trust Hospital, London SW3 6JJ (United Kingdom); Nutting, Christopher M., E-mail: chris.nutting@rmh.nhs.u [Head and Neck Unit, Royal Marsden NHS Foundation Trust Hospital, London SW3 6JJ (United Kingdom)

2010-04-15

Purpose: The aim of this study was to investigate prospectively the weekly volume changes in the target volumes and organs at risk and the resulting dosimetric changes during induction chemotherapy followed by chemoradiotherapy with intensity-modulated radiation therapy (C-IMRT) for head-and-neck cancer patients. Methods and Materials: Patients receiving C-IMRT for head-and-neck cancer had repeat CT scans at weeks 2, 3, 4, and 5 during radiotherapy. The volume changes of clinical target volume 1 (CTV1) and CTV2 and the resulting dosimetric changes to planning target volume 1 (PTV1) and PTV2 and the organs at risk were measured. Results: The most significant volume differences were seen at week 2 for CTV1 and CTV2. The reductions in the volumes of CTV1 and CTV2 at week 2 were 3.2% and 10%, respectively (p = 0.003 and p < 0.001). The volume changes resulted in a significant reduction in the minimum dose to PTV1 and PTV2 (2 Gy, p = 0.002, and 3.9 Gy, p = 0.03, respectively) and an increased dose range across PTV1 and PTV2 (2.5 Gy, p < 0.001, and 5.1 Gy, p = 0.008, respectively). There was a 15% reduction in the parotid volumes by week 2 (p < 0.001) and 31% by week 4 (p < 0.001). There was a statistically significant increase in the mean dose to the ipsilateral parotid only at week 4 (2.7 Gy, p = 0.006). The parotid glands shifted medially by an average of 2.3 mm (p < 0.001) by week 4. Conclusion: The most significant volumetric changes and dosimetric alterations in the tumor volumes and organs at risk during a course of C-IMRT occur by week 2 of radiotherapy. Further adaptive radiotherapy with replanning, if appropriate, is recommended.

Does the fluence map editing in electronic tissue compensator improve dose homogeneity in bilateral field plan of head and neck patients?

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Kinhikar Rajesh

2008-01-01

Full Text Available The purpose of this study was to evaluate the effect of fluence map editing in electronic tissue compensator (ETC on the dose homogeneity for head and neck cancer patients. Treatment planning using 6-MV X-rays and bilateral field arrangement employing ETC was carried out on the computed tomography (CT datasets of 20 patients with head and neck cancer. All the patients were planned in Varian Eclipse three-dimensional treatment planning system (3DTPS with dynamic multileaf collimator (DMLC. The treatment plans, with and without fluence editing, was compared and the effect of pre-editing and post-editing the fluence maps in the treatment field was evaluated. The skin dose was measured with thermoluminescent dosimeters (TLDs and was compared with the skin dose estimated by TPS. The mean percentage volume of the tissue receiving at least 107% of the prescription dose was 5.4 (range 1.5-10; SD 2.4. Post-editing fluence map showed that the mean percentage volume of the tissue receiving at least 107% of the prescription dose was 0.47 (range 0.1-0.9; SD 0.3. The mean skin dose measured with TLD was found to be 74% (range 71-80% of the prescribed dose while the TPS showed the mean skin dose as 85% (range 80-90%. The TPS overestimated the skin dose by 11%. Fluence map editing thus proved to be a potential tool for improving dose homogeneity in head and neck cancer patients planned with ETC, thus reducing the hot spots in the treatment region as well. The treatment with ETC is feasible with DMLC and does not take any additional time for setup or delivery. The method used to edit the fluence maps is simple and time efficient. Manual control over a plan is essential to create the best treatment plan possible.

Monte Carlo-based QA for IMRT of head and neck cancers

Science.gov (United States)

Tang, F.; Sham, J.; Ma, C.-M.; Li, J.-S.

2007-06-01

It is well-known that the presence of large air cavity in a dense medium (or patient) introduces significant electronic disequilibrium when irradiated with megavoltage X-ray field. This condition may worsen by the possible use of tiny beamlets in intensity-modulated radiation therapy (IMRT). Commercial treatment planning systems (TPSs), in particular those based on the pencil-beam method, do not provide accurate dose computation for the lungs and other cavity-laden body sites such as the head and neck. In this paper we present the use of Monte Carlo (MC) technique for dose re-calculation of IMRT of head and neck cancers. In our clinic, a turn-key software system is set up for MC calculation and comparison with TPS-calculated treatment plans as part of the quality assurance (QA) programme for IMRT delivery. A set of 10 off-the-self PCs is employed as the MC calculation engine with treatment plan parameters imported from the TPS via a graphical user interface (GUI) which also provides a platform for launching remote MC simulation and subsequent dose comparison with the TPS. The TPS-segmented intensity maps are used as input for the simulation hence skipping the time-consuming simulation of the multi-leaf collimator (MLC). The primary objective of this approach is to assess the accuracy of the TPS calculations in the presence of air cavities in the head and neck whereas the accuracy of leaf segmentation is verified by fluence measurement using a fluoroscopic camera-based imaging device. This measurement can also validate the correct transfer of intensity maps to the record and verify system. Comparisons between TPS and MC calculations of 6 MV IMRT for typical head and neck treatments review regional consistency in dose distribution except at and around the sinuses where our pencil-beam-based TPS sometimes over-predicts the dose by up to 10%, depending on the size of the cavities. In addition, dose re-buildup of up to 4% is observed at the posterior nasopharyngeal

Modulation of mitochondrial activity in HaCaT keratinocytes by the cell penetrating peptide Z-Gly-RGD(DPhe)-mitoparan.

Science.gov (United States)

Richardson, Adam; Muir, Lewis; Mousdell, Sasha; Sexton, Darren; Jones, Sarah; Howl, John; Ross, Kehinde

2018-01-30

Biologically active cell penetrating peptides (CPPs) are an emerging class of therapeutic agent. The wasp venom peptide mastoparan is an established CPP that modulates mitochondrial activity and triggers caspase-dependent apoptosis in cancer cells, as does the mastoparan analogue mitoparan (mitP). Mitochondrial depolarisation and activation of the caspase cascade also underpins the action of dithranol, a topical agent for treatment of psoriasis. The effects of a potent mitP analogue on mitochondrial activity were therefore examined to assess its potential as a novel approach for targeting mitochondria for the treatment of psoriasis. In HaCaT keratinocytes treated with the mitP analogue Z-Gly-RGD(DPhe)-mitP for 24 h, a dose-dependent loss of mitochondrial activity was observed using the methyl-thiazolyl-tetrazolium (MTT) assay. At 10 μmol L -1 , MTT activity was less than 30% that observed in untreated cells. Staining with the cationic dye JC-1 suggested that Z-Gly-RGD(DPhe)-mitP also dissipated the mitochondrial membrane potential, with a threefold increase in mitochondrial depolarisation levels. However, caspase activity appeared to be reduced by 24 h exposure to Z-Gly-RGD(DPhe)-mitP treatment. Furthermore, Z-Gly-RGD(DPhe)-mitP treatment had little effect on overall cell viability. Our findings suggest Z-Gly-RGD(DPhe)-mitP promotes the loss of mitochondrial activity but does not appear to evoke apoptosis in HaCaT keratinocytes.

Ocular allergy modulation to hi-dose antigen sensitization is a Treg-dependent process.

Science.gov (United States)

Lee, Hyun Soo; Schlereth, Simona; Khandelwal, Payal; Saban, Daniel R

2013-01-01

A reproducible method to inhibit allergic immune responses is accomplished with hi-dose Ag sensitization, via intraperitoneal (IP) injection. However, the role of CD4+ CD25+ FoxP3+ T regulatory cells (Treg) in this process is unknown, as is whether such modulation extends to ocular allergy. We therefore determined herein whether hi-dose sensitization modulates ocular allergy, and whether CD4+ CD25+ FoxP3+ Treg are involved. C57BL/6 mice were IP sensitized via low-dose (100 µg) versus hi-dose (1000 µg) ovalbumin (OVA), in aluminum hydroxide (1 mg) and pertussis-toxin (300 ng). Other mice received anti-CD25 Ab (PC61) to ablate Treg during sensitization. In another experiment, Treg from hi-dose sensitized mice were adoptively transferred into low-dose sensitized mice. Once daily OVA challenges were administered. Clinical signs, IgE, T cell cytokines, and eosinophils were assessed. Data revealed that hi-dose, but not low-dose, sensitization led to allergy modulation, indicated by decreased clinical signs, serum IgE levels, Th2 recall responses, and eosinophil recruitment. T cells from hi-dose sensitized mice showed a robust increase in TGF-b production, and Treg from these mice were able to efficiently suppress effector T cell proliferation in vitro. In addition, in vivo Treg ablation in hi-dose sensitized mice revoked allergy modulation. Lastly, Treg from hi-dose sensitized mice were able to adoptively transfer allergy modulation to their low-dose sensitized counterparts. Collectively, these findings indicate that modulation to hi-dose sensitization, which is extended to ocular allergy, occurs in a Treg-dependent manner. In addition, our data suggest that hi-dose sensitization may henceforth facilitate the further examination of CD4+ CD25+ FoxP3+ Treg in allergic disease.

Fetus absorbed dose evaluation in head and neck radiotherapy procedures of pregnant patients

International Nuclear Information System (INIS)

Camargo da C, E.; Ribeiro da R, L. A.; Santos B, D. V.

2014-08-01

Each year a considerable amount of pregnant women needs to be submitted to radiotherapeutic procedures to combat malignant tumors. Radiation therapy is often a treatment of choice for these patients. It is possible to use shielding and beam positioning such that the potential dose to the fetus can be minimized. In this work the head and neck cancer treatment of a pregnant patient was experimentally simulated. The patient was simulated by an anthropomorphic Alderson phantom and the absorbed dose to the fetus was evaluated using micro-rod TLD-100 detectors in two conditions, namely protecting the patients abdomen with a 7 cm lead layer and using no abdomen shielding. The aim of this experiment was to evaluate the efficiency of the abdomen protection in reducing the fetus absorbed dose. Irradiations were performed with a Trilogy linear accelerator using x-rays of 6 MV. A total dose of 50 Gy to the target volume was delivered. The fetus doses evaluated with and without the lead shielding were, respectively, 0.52±0.039 and (0.88±0.052) c Gy, corresponding to a dose reduction of 59%. The dose (0.52±0.039) c Gy is within the zone of biological tolerance for the fetus. (Author)

Fetus absorbed dose evaluation in head and neck radiotherapy procedures of pregnant patients

Energy Technology Data Exchange (ETDEWEB)

Camargo da C, E.; Ribeiro da R, L. A.; Santos B, D. V., E-mail: etieli@ird.gov.br [Instituto de Radioprotecao e Dosimetria / CNEN, Av. Salvador Allende s/n, Barra de Tijuca, 22783-127 Rio de Janeiro (Brazil)

2014-08-15

Each year a considerable amount of pregnant women needs to be submitted to radiotherapeutic procedures to combat malignant tumors. Radiation therapy is often a treatment of choice for these patients. It is possible to use shielding and beam positioning such that the potential dose to the fetus can be minimized. In this work the head and neck cancer treatment of a pregnant patient was experimentally simulated. The patient was simulated by an anthropomorphic Alderson phantom and the absorbed dose to the fetus was evaluated using micro-rod TLD-100 detectors in two conditions, namely protecting the patients abdomen with a 7 cm lead layer and using no abdomen shielding. The aim of this experiment was to evaluate the efficiency of the abdomen protection in reducing the fetus absorbed dose. Irradiations were performed with a Trilogy linear accelerator using x-rays of 6 MV. A total dose of 50 Gy to the target volume was delivered. The fetus doses evaluated with and without the lead shielding were, respectively, 0.52±0.039 and (0.88±0.052) c Gy, corresponding to a dose reduction of 59%. The dose (0.52±0.039) c Gy is within the zone of biological tolerance for the fetus. (Author)

Fetal dose reduction in head and neck radiotherapy of a pregnant woman

International Nuclear Information System (INIS)

Moeckli, R.; Pache, G.; Valley, J.F.; Ozsahin, M.; Mirimanoff, R.O.; Azria, D.

2004-01-01

Background and purpose: a pregnant woman was referred for post-operative radiotherapy of a malignant schwannoma in the head and neck region. A best-treatment plan was devised in order to minimize the fetal dose. Material and methods: the fetal dose resulting from radiological examinations was determined according to international protocols, that resulting from radiotherapy was calculated according to recommendation 36 of the American Association of Physicists in Medicine (AAPM) Task Group. Pre-treatment dosimetry was performed with an anthropomorphic phantom. Several alternative treatment plans were evaluated. The use of a multileaf collimator (MLC) and a virtual wedge (VW) was compared to cerrobend blocks (CB) and physical wedge (PW). In-vivo dosimetry was performed using a vaginal probe containing thermoluminescent dosimeters (TLD). Results: the total fetal dose resulting from diagnostic and radiotherapy procedures was estimated to be 36 mGy. The technique based on MLC and VW was elected for patient treatment. Measurements for this configuration resulted in a fetal dose reduction of 82%. The shielding of the patient's abdomen further reduced the fetal dose by 42%. Conclusion: the use of VW and MLC for the treatment of a pregnant woman is highly recommended. Each case should be individually studied with pre-treatment and in-vivo dosimetry. (orig.)

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

International Nuclear Information System (INIS)

Murdoch-Kinch, Carol-Anne; Kim, Hyugnjin M.; Vineberg, Karen A.; Ship, Jonathan; Eisbruch, Avraham

2008-01-01

Purpose: Submandibular salivary glands (SMGs) dysfunction contributes to xerostomia after radiotherapy (RT) of head-and-neck (HN) cancer. We assessed SMG dose-response relationships and their implications for sparing these glands by intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 148 HN cancer patients underwent unstimulated and stimulated SMG salivary flow rate measurements selectively from Wharton's duct orifices, before RT and periodically through 24 months after RT. Correlations of flow rates and mean SMG doses were modeled throughout all time points. IMRT replanning in 8 patients whose contralateral level I was not a target incorporated the results in a new cost function aiming to spare contralateral SMGs. Results: Stimulated SMG flow rates decreased exponentially by (1.2%) Gy as mean doses increased up to 39 Gy threshold, and then plateaued near zero. At mean doses ≤39 Gy, but not higher, flow rates recovered over time at 2.2%/month. Similarly, the unstimulated salivary flow rates decreased exponentially by (3%) Gy as mean dose increased and recovered over time if mean dose was <39 Gy. IMRT replanning reduced mean contralateral SMG dose by average 12 Gy, achieving ≤39 Gy in 5 of 8 patients, without target underdosing, increasing the mean doses to the parotid glands and swallowing structures by average 2-3 Gy. Conclusions: SMG salivary flow rates depended on mean dose with recovery over time up to a threshold of 39 Gy. Substantial SMG dose reduction to below this threshold and without target underdosing is feasible in some patients, at the expense of modestly higher doses to some other organs

Thyroid V50 Highly Predictive of Hypothyroidism in Head-and-Neck Cancer Patients Treated With Intensity-modulated Radiotherapy (IMRT).

Science.gov (United States)

Sachdev, Sean; Refaat, Tamer; Bacchus, Ian D; Sathiaseelan, Vythialinga; Mittal, Bharat B

2017-08-01

Radiation-induced hypothyroidism affects a significant number of patients with head-and-neck squamous cell cancer (HNSCC). We examined detailed dosimetric and clinical parameters to better determine the risk of hypothyroidism in euthyroid HNSCC patients treated with intensity-modulated radiation therapy (IMRT). From 2006 to 2010, 75 clinically euthyroid patients with HNSCC were treated with sequential IMRT. The cohort included 59 men and 16 females with a median age of 55 years (range, 30 to 89 y) who were treated to a median dose of 70 Gy (range, 60 to 75 Gy) with concurrent chemotherapy in nearly all (95%) cases. Detailed thyroid dosimetric parameters including maximum dose, mean dose, and other parameters (eg, V50-percent volume receiving at least 50 Gy) were obtained. Freedom from hypothyroidism was evaluated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted using Cox regression. After a median follow-up period of 50 months, 25 patients (33%) became hypothyroid. On univariate analysis, thyroid V50 was highly correlated with developing hypothyroidism (P=0.035). Other dosimetric paramaters including mean thyroid dose (P=0.11) and maximum thyroid dose (P=0.39) did not reach statistical significance. On multivariate analysis incorporating patient, tumor, and treatment variables, V50 remained highly statistically significant (P=0.037). Regardless of other factors, for V50>60%, the odds ratio of developing hypothyroidism was 6.76 (P=0.002). In HNSCC patients treated with IMRT, thyroid V50 highly predicts the risk of developing hypothyroidism. V50>60% puts patients at a significantly higher risk of becoming hypothyroid. This can be a useful dose constraint to consider during treatment planning.

SU-E-T-110: Development of An Independent, Monte Carlo, Dose Calculation, Quality Assurance Tool for Clinical Trials

Energy Technology Data Exchange (ETDEWEB)

Faught, A [UT MD Anderson Cancer Center, Houston, TX (United States); University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX (United States); Davidson, S [University of Texas Medical Branch of Galveston, Galveston, TX (United States); Kry, S; Ibbott, G; Followill, D [UT MD Anderson Cancer Center, Houston, TX (United States); Fontenot, J [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States); Etzel, C [Consortium of Rheumatology Researchers of North America (CORRONA), Inc., Southborough, MA (United States)

2014-06-01

Purpose: To develop a comprehensive end-to-end test for Varian's TrueBeam linear accelerator for head and neck IMRT using a custom phantom designed to utilize multiple dosimetry devices. Purpose: To commission a multiple-source Monte Carlo model of Elekta linear accelerator beams of nominal energies 6MV and 10MV. Methods: A three source, Monte Carlo model of Elekta 6 and 10MV therapeutic x-ray beams was developed. Energy spectra of two photon sources corresponding to primary photons created in the target and scattered photons originating in the linear accelerator head were determined by an optimization process that fit the relative fluence of 0.25 MeV energy bins to the product of Fatigue-Life and Fermi functions to match calculated percent depth dose (PDD) data with that measured in a water tank for a 10x10cm2 field. Off-axis effects were modeled by a 3rd degree polynomial used to describe the off-axis half-value layer as a function of off-axis angle and fitting the off-axis fluence to a piecewise linear function to match calculated dose profiles with measured dose profiles for a 40×40cm2 field. The model was validated by comparing calculated PDDs and dose profiles for field sizes ranging from 3×3cm2 to 30×30cm2 to those obtained from measurements. A benchmarking study compared calculated data to measurements for IMRT plans delivered to anthropomorphic phantoms. Results: Along the central axis of the beam 99.6% and 99.7% of all data passed the 2%/2mm gamma criterion for 6 and 10MV models, respectively. Dose profiles at depths of dmax, through 25cm agreed with measured data for 99.4% and 99.6% of data tested for 6 and 10MV models, respectively. A comparison of calculated dose to film measurement in a head and neck phantom showed an average of 85.3% and 90.5% of pixels passing a 3%/2mm gamma criterion for 6 and 10MV models respectively. Conclusion: A Monte Carlo multiple-source model for Elekta 6 and 10MV therapeutic x-ray beams has been developed as a

Fully automated treatment planning for head and neck radiotherapy using a voxel-based dose prediction and dose mimicking method

Science.gov (United States)

McIntosh, Chris; Welch, Mattea; McNiven, Andrea; Jaffray, David A.; Purdie, Thomas G.

2017-08-01

Recent works in automated radiotherapy treatment planning have used machine learning based on historical treatment plans to infer the spatial dose distribution for a novel patient directly from the planning image. We present a probabilistic, atlas-based approach which predicts the dose for novel patients using a set of automatically selected most similar patients (atlases). The output is a spatial dose objective, which specifies the desired dose-per-voxel, and therefore replaces the need to specify and tune dose-volume objectives. Voxel-based dose mimicking optimization then converts the predicted dose distribution to a complete treatment plan with dose calculation using a collapsed cone convolution dose engine. In this study, we investigated automated planning for right-sided oropharaynx head and neck patients treated with IMRT and VMAT. We compare four versions of our dose prediction pipeline using a database of 54 training and 12 independent testing patients by evaluating 14 clinical dose evaluation criteria. Our preliminary results are promising and demonstrate that automated methods can generate comparable dose distributions to clinical. Overall, automated plans achieved an average of 0.6% higher dose for target coverage evaluation criteria, and 2.4% lower dose at the organs at risk criteria levels evaluated compared with clinical. There was no statistically significant difference detected in high-dose conformity between automated and clinical plans as measured by the conformation number. Automated plans achieved nine more unique criteria than clinical across the 12 patients tested and automated plans scored a significantly higher dose at the evaluation limit for two high-risk target coverage criteria and a significantly lower dose in one critical organ maximum dose. The novel dose prediction method with dose mimicking can generate complete treatment plans in 12-13 min without user interaction. It is a promising approach for fully automated treatment

Skin dose measurements using MOSFET and TLD for head and neck patients treated with tomotherapy

International Nuclear Information System (INIS)

Kinhikar, Rajesh A.; Murthy, Vedang; Goel, Vineeta; Tambe, Chandrashekar M.; Dhote, Dipak S.; Deshpande, Deepak D.

2009-01-01

The purpose of this work was to estimate skin dose for the patients treated with tomotherapy using metal oxide semiconductor field-effect transistors (MOSFETs) and thermoluminescent dosimeters (TLDs). In vivo measurements were performed for two head and neck patients treated with tomotherapy and compared to TLD measurements. The measurements were subsequently carried out for five days to estimate the inter-fraction deviations in MOSFET measurements. The variation between skin dose measured with MOSFET and TLD for first patient was 2.2%. Similarly, the variation of 2.3% was observed between skin dose measured with MOSFET and TLD for second patient. The tomotherapy treatment planning system overestimated the skin dose as much as by 10-12% when compared to both MOSFET and TLD. However, the MOSFET measured patient skin doses also had good reproducibility, with inter-fraction deviations ranging from 1% to 1.4%. MOSFETs may be used as a viable dosimeter for measuring skin dose in areas where the treatment planning system may not be accurate.

Skin dose measurements using MOSFET and TLD for head and neck patients treated with tomotherapy.

Science.gov (United States)

Kinhikar, Rajesh A; Murthy, Vedang; Goel, Vineeta; Tambe, Chandrashekar M; Dhote, Dipak S; Deshpande, Deepak D

2009-09-01

The purpose of this work was to estimate skin dose for the patients treated with tomotherapy using metal oxide semiconductor field-effect transistors (MOSFETs) and thermoluminescent dosimeters (TLDs). In vivo measurements were performed for two head and neck patients treated with tomotherapy and compared to TLD measurements. The measurements were subsequently carried out for five days to estimate the inter-fraction deviations in MOSFET measurements. The variation between skin dose measured with MOSFET and TLD for first patient was 2.2%. Similarly, the variation of 2.3% was observed between skin dose measured with MOSFET and TLD for second patient. The tomotherapy treatment planning system overestimated the skin dose as much as by 10-12% when compared to both MOSFET and TLD. However, the MOSFET measured patient skin doses also had good reproducibility, with inter-fraction deviations ranging from 1% to 1.4%. MOSFETs may be used as a viable dosimeter for measuring skin dose in areas where the treatment planning system may not be accurate.

Validating the RTOG-Endorsed Brachial Plexus Contouring Atlas: An Evaluation of Reproducibility Among Patients Treated by Intensity-Modulated Radiotherapy for Head-and-Neck Cancer

International Nuclear Information System (INIS)

Yi, Sun K.; Hall, William H.; Mathai, Mathew; Dublin, Arthur B.; Gupta, Vishal; Purdy, James A.; Chen, Allen M.

2012-01-01

Purpose: To evaluate interobserver variability for contouring the brachial plexus as an organ-at-risk (OAR) and to analyze its potential dosimetric consequences in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Methods and Materials: Using the Radiation Therapy Oncology Group (RTOG)-endorsed brachial plexus contouring atlas, three radiation oncologists independently delineated the OAR on treatment planning computed-tomography (CT) axial scans from 5 representative patients undergoing IMRT to a prescribed dose of 70 Gy for head-and-neck cancer. Dose-volume histograms for the brachial plexus were calculated, and interobserver differences were quantified by comparing various dosimetric statistics. Qualitative analysis was performed by visually assessing the overlapping contours on a single beam’s eye view. Results: Brachial plexus volumes for the 5 patients across observers were 26 cc (18–35 cc), 25 cc (21–30 cc), 29 cc (28–32 cc), 29 cc (23–38 cc), and 29 cc (23–34 cc). On qualitative analysis, minimal variability existed except at the inferolateral portion of the OAR, where slight discrepancies were noted among the physicians. Maximum doses to the brachial plexus ranged from 71.6 to 72.6 Gy, 75.2 to 75.8 Gy, 69.1 to 71.0 Gy, 76.4 to 76.9 Gy, and 70.6 to 71.4 Gy. Respective volumes receiving doses greater than 60 Gy (V60) were 8.6 to 10.9 cc, 6.2 to 8.1 cc, 8.2 to 11.6 cc, 8.3 to 10.5 cc, and 5.6 to 9.8 cc. Conclusion: The RTOG-endorsed brachial plexus atlas provides a consistent set of guidelines for contouring this OAR with essentially no learning curve. Adoption of these contouring guidelines in the clinical setting is encouraged.

Predictive factors of local-regional recurrences following parotid sparing intensity modulated or 3D conformal radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Feng, Mary; Jabbari, Siavash; Lin, Alexander; Bradford, Carol R.; Chepeha, Douglas B.; Teknos, Theodoros N.; Worden, Francis P.; Tsien, Christina; Schipper, Matthew J.; Wolf, Gregory T.; Dawson, Laura A.; Eisbruch, Avraham

2005-01-01

Background and purpose: Predictive factors for local-regional (LR) failures after parotid-sparing, Intensity modulated (IMRT) or 3D conformal radiotherapy for head and neck (HN) cancers were assessed. Patients and methods: One hundred and fifty-eight patients with mostly stages III-IV HN squamous cell carcinoma underwent curative bilateral neck irradiation aimed at sparing the parotid glands. Patient, tumor, and treatment factors were analyzed as predictive factors for LR failure. Results: Twenty-three patients had LR recurrence (19 in-field and four marginal). No differences were found in the doses delivered to the PTVs of patients with or without in-field recurrences. In univariate analysis, tumor site was highly predictive for LR failure in both postoperative and definitive RT patients. In postoperative RT patients, pathologic tumor size, margin status, extracapsular extension (ECE) and number of lymph node metastases, were also significantly predictive. Multivariate analysis showed tumor site (oropharynx vs. other sites) to be a significant predictor in all patients, and involved margins and number of involved lymph nodes in postoperative patients. Conclusions: Clinical rather than dosimetric factors predicted for LR failures in this series, and were similar to those reported following standard RT. These factors may aid in the selection of patients for studies of treatment intensification using IMRT

Evaluation of an automated knowledge based treatment planning system for head and neck

International Nuclear Information System (INIS)

Krayenbuehl, Jerome; Norton, Ian; Studer, Gabriela; Guckenberger, Matthias

2015-01-01

This study evaluated an automated inverse treatment planning algorithm, Pinnacle Auto-Planning (AP), and compared automatically generated plans with historical plans in a large cohort of head and neck cancer patients. Fifty consecutive patients treated with volumetric modulated arc therapy (Eclipse, Varian Medical System, Palo Alto, CA) for head and neck were re-planned with AP version 9.10. Only one single cycle of plan optimization using one single template was allowed for AP. The dose to the planning target volumes (PTV’s; 3–4 dose levels), the organs at risk (OAR’s) and the effective working time for planning was evaluated. Additionally, two experienced radiation oncologists blind-reviewed and ranked 10 plans. Dose coverage and dose homogeneity of the PTV were significantly improved with AP, however manually optimized plans showed significantly improved dose conformity. The mean dose to the parotid glands, oral mucosa, swallowing muscles, dorsal neck tissue and maximal dose to the spinal cord were significantly reduced with AP. In 64 % of the plans, the mean dose to any OAR (spinal cord excluded) was reduced by >20 % with AP in comparison to the manually optimized plans. In 12 % of the plans, the manually optimized plans showed reduced doses by >20 % in at least one OAR. The experienced radiation oncologists preferred the AP plan and the clinical plan in 80 and 20 % of the cases, respectively. The average effective working time was 3.8 min ± 1.1 min in comparison to 48.5 min ± 6.0 min using AP compared to the manually optimized plans, respectively. The evaluated automated planning algorithm achieved highly consistent and significantly improved treatment plans with potentially clinically relevant OAR sparing by >20 % in 64 % of the cases. The effective working time was substantially reduced with Auto-Planning

Statistical variability and confidence intervals for planar dose QA pass rates

Energy Technology Data Exchange (ETDEWEB)

Bailey, Daniel W.; Nelms, Benjamin E.; Attwood, Kristopher; Kumaraswamy, Lalith; Podgorsak, Matthew B. [Department of Physics, State University of New York at Buffalo, Buffalo, New York 14260 (United States) and Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263 (United States); Canis Lupus LLC, Merrimac, Wisconsin 53561 (United States); Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York 14263 (United States); Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263 (United States); Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263 (United States); Department of Molecular and Cellular Biophysics and Biochemistry, Roswell Park Cancer Institute, Buffalo, New York 14263 (United States) and Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York 14214 (United States)

2011-11-15

Purpose: The most common metric for comparing measured to calculated dose, such as for pretreatment quality assurance of intensity-modulated photon fields, is a pass rate (%) generated using percent difference (%Diff), distance-to-agreement (DTA), or some combination of the two (e.g., gamma evaluation). For many dosimeters, the grid of analyzed points corresponds to an array with a low areal density of point detectors. In these cases, the pass rates for any given comparison criteria are not absolute but exhibit statistical variability that is a function, in part, on the detector sampling geometry. In this work, the authors analyze the statistics of various methods commonly used to calculate pass rates and propose methods for establishing confidence intervals for pass rates obtained with low-density arrays. Methods: Dose planes were acquired for 25 prostate and 79 head and neck intensity-modulated fields via diode array and electronic portal imaging device (EPID), and matching calculated dose planes were created via a commercial treatment planning system. Pass rates for each dose plane pair (both centered to the beam central axis) were calculated with several common comparison methods: %Diff/DTA composite analysis and gamma evaluation, using absolute dose comparison with both local and global normalization. Specialized software was designed to selectively sample the measured EPID response (very high data density) down to discrete points to simulate low-density measurements. The software was used to realign the simulated detector grid at many simulated positions with respect to the beam central axis, thereby altering the low-density sampled grid. Simulations were repeated with 100 positional iterations using a 1 detector/cm{sup 2} uniform grid, a 2 detector/cm{sup 2} uniform grid, and similar random detector grids. For each simulation, %/DTA composite pass rates were calculated with various %Diff/DTA criteria and for both local and global %Diff normalization

Marvin: an anatomical phantom for dosimetric evaluation of complex radiotherapy of the head and neck

Science.gov (United States)

Aitkenhead, A. H.; Rowbottom, C. G.; Mackay, R. I.

2013-10-01

We report on the design of Marvin, a Model Anatomy for Radiotherapy Verification and audit In the head and Neck and present results demonstrating its use in the development of the Elekta volumetric modulated arc therapy (VMAT) technique at the Christie, and in the audit of TomoTherapy and Varian RapidArc at other institutions. The geometry of Marvin was generated from CT datasets of eight male and female patients lying in the treatment position, with removable inhomogeneities modelling the sinuses and mandible. A modular system allows the phantom to be used with a range of detectors, with the locations of the modules being based on an analysis of a range of typical treatment plans (27 in total) which were mapped onto the phantom geometry. Results demonstrate the use of Gafchromic EBT2/EBT3 film for measurement of relative dose in a plane through the target and organs-at-risk, and the use of a small-volume ionization chamber for measurement of absolute dose in the target and spinal cord. Measurements made during the development of the head and neck VMAT protocol at the Christie quantified the improvement in plan delivery resulting from the installation of the Elekta Integrity upgrade (which permits an effectively continuously variable dose rate), with plans delivered before and after the upgrade having 88.5 ± 9.4% and 98.0 ± 2.2% respectively of points passing a gamma analysis (at 4%, 4 mm, global). Audits of TomoTherapy and Varian RapidArc neck techniques at other institutions showed a similar quality of plan delivery as for post-Integrity Elekta VMAT: film measurements for both techniques had >99% of points passing a gamma analysis at the clinical criteria of 4%, 4 mm, global, and >95% of points passing at tighter criteria of 3%, 3 mm, global; and absolute dose measurements in the PTV and spinal cord were within 1.5% and 3.5% of the planned doses respectively for both techniques. The results demonstrate that Marvin is an efficient and effective means of

Marvin: an anatomical phantom for dosimetric evaluation of complex radiotherapy of the head and neck

International Nuclear Information System (INIS)

Aitkenhead, A H; Rowbottom, C G; Mackay, R I

2013-01-01

We report on the design of Marvin, a Model Anatomy for Radiotherapy Verification and audit In the head and Neck and present results demonstrating its use in the development of the Elekta volumetric modulated arc therapy (VMAT) technique at the Christie, and in the audit of TomoTherapy and Varian RapidArc at other institutions. The geometry of Marvin was generated from CT datasets of eight male and female patients lying in the treatment position, with removable inhomogeneities modelling the sinuses and mandible. A modular system allows the phantom to be used with a range of detectors, with the locations of the modules being based on an analysis of a range of typical treatment plans (27 in total) which were mapped onto the phantom geometry. Results demonstrate the use of Gafchromic EBT2/EBT3 film for measurement of relative dose in a plane through the target and organs-at-risk, and the use of a small-volume ionization chamber for measurement of absolute dose in the target and spinal cord. Measurements made during the development of the head and neck VMAT protocol at the Christie quantified the improvement in plan delivery resulting from the installation of the Elekta Integrity upgrade (which permits an effectively continuously variable dose rate), with plans delivered before and after the upgrade having 88.5 ± 9.4% and 98.0 ± 2.2% respectively of points passing a gamma analysis (at 4%, 4 mm, global). Audits of TomoTherapy and Varian RapidArc neck techniques at other institutions showed a similar quality of plan delivery as for post-Integrity Elekta VMAT: film measurements for both techniques had >99% of points passing a gamma analysis at the clinical criteria of 4%, 4 mm, global, and >95% of points passing at tighter criteria of 3%, 3 mm, global; and absolute dose measurements in the PTV and spinal cord were within 1.5% and 3.5% of the planned doses respectively for both techniques. The results demonstrate that Marvin is an efficient and effective means of

The impact of pediatric-specific dose modulation curves on radiation dose and image quality in head computed tomography

International Nuclear Information System (INIS)

Santos, Joana; Paulo, Graciano; Foley, Shane; Rainford, Louise; McEntee, Mark F.

2015-01-01

The volume of CT examinations has increased with resultant increases in collective dose values over the last decade. To analyze the impact of the tube current and voltage modulation for dose values and image quality of pediatric head CT examinations. Head CT examinations were performed on anthropomorphic phantoms and four pediatric age categories before and after the introduction of dedicated pediatric curves for tube voltage and current modulation. Local diagnostic reference levels were calculated. Visual grading characteristic image quality evaluation was performed by four pediatric neuroradiologists and image noise comparisons were performed. Pediatric-specific modulation curves demonstrated a 49% decrease in mean radiation dose for phantom examinations. The local diagnostic reference levels (CTDIvol) for clinical examinations decreased by 52%, 41%, 46% and 40% for newborn, 5-, 10- and 15-year-old patients, respectively. Visual grading characteristic image quality was maintained for the majority of age categorizations (area under the curve = 0.5) and image noise measurements did not change (P = 0.693). Pediatric-specific dose modulation curves resulted in an overall mean dose reduction of 45% with no significant differences in subjective or objective image quality findings. (orig.)

The impact of pediatric-specific dose modulation curves on radiation dose and image quality in head computed tomography

Energy Technology Data Exchange (ETDEWEB)

Santos, Joana; Paulo, Graciano [Instituto Politecnico de Coimbra, ESTESC, DMIR, Coimbra (Portugal); Foley, Shane; Rainford, Louise [University College Dublin, School of Medicine and Medical Science, Health Science Centre, Dublin 4 (Ireland); McEntee, Mark F. [The University of Sydney, Faculty of Health Sciences, Cumberland Campus, Sydney (Australia)

2015-11-15

The volume of CT examinations has increased with resultant increases in collective dose values over the last decade. To analyze the impact of the tube current and voltage modulation for dose values and image quality of pediatric head CT examinations. Head CT examinations were performed on anthropomorphic phantoms and four pediatric age categories before and after the introduction of dedicated pediatric curves for tube voltage and current modulation. Local diagnostic reference levels were calculated. Visual grading characteristic image quality evaluation was performed by four pediatric neuroradiologists and image noise comparisons were performed. Pediatric-specific modulation curves demonstrated a 49% decrease in mean radiation dose for phantom examinations. The local diagnostic reference levels (CTDIvol) for clinical examinations decreased by 52%, 41%, 46% and 40% for newborn, 5-, 10- and 15-year-old patients, respectively. Visual grading characteristic image quality was maintained for the majority of age categorizations (area under the curve = 0.5) and image noise measurements did not change (P = 0.693). Pediatric-specific dose modulation curves resulted in an overall mean dose reduction of 45% with no significant differences in subjective or objective image quality findings. (orig.)

Comprehensive Study of Z-Cut Highly Integrated LiNbO3 Optical Modulator with Adjustable Chirp Parameters

Science.gov (United States)

Palodiya, Vikram; Raghuwanshi, Sanjeev Kumar

2017-12-01

In this paper, the domain inversion is used in a simple fashion to improve the performance of a Z-cut highly integrated LiNbO3 optical modulator (LNOM). The Z-cut modulator having ≤ 3 V switching voltage and bandwidth of 15 GHz for an external modulator in which traveling-wave electrode length L_{m} imposed the modulating voltage, the product of V_π and L_{m} is fixed for a given electro-optic material (EOM). An investigation to achieve a low V_π by both magnitude of the electro-optic coefficient (EOC) for a wide variety of EOMs has been reported. The Sellmeier equation (SE) for the extraordinary index of congruent LiNbO3 is derived. The predictions related to phase matching are accurate between room temperature and 250 °C and wavelength ranging from 0.4 to 5 μm. The SE predicts more accurate refractive indices (RI) at long wavelengths. The different overlaps between the waveguides for the Z-cut structure are shown to yield a chirp parameter that can able to adjust 0-0.7. Theoretical results are perfectly verified by simulated results.

Development of a head and neck companion module for the quality of life - radiation therapy instrument (QOL-RTI)

International Nuclear Information System (INIS)

Trotti, Andy; Johnson, Darlene J.; Gwede, Clement; Casey, Linda; Cantor, Alan

1997-01-01

Purpose/Objective: The purpose of this study is to develop a Likert version, disease specific module for the Quality of Life - Radiation Therapy Instrument (QOL-RTI) for head and neck patients. This module combined with the QOL-RTI may help us to determine what changes, if any, occur in the quality of life of patients receiving primary radiation therapy for head and neck cancer. A compelling reason to study head and neck patients is because of the extensive difficulties these patients experience while undergoing radiotherapy. Their psychological and emotional well-being may also have an adverse affect on their quality of life as they strive to cope with both a life-threatening disease and with the prospect of disfigurement or dysfunction that cannot be hidden from view. Many tools have been developed to measure quality of life, however, previously published literature has focused on quantifying functional status and toxicity assessment rather than the alteration of quality of life as perceived by the patient. This study, limited to patients receiving primary radiation, is expected to yield a tool that is applicable to the patient receiving multi-modality treatment for head and neck cancer and will be useful to the physician/nurse in determining interventions for these patients. Materials and Methods: This study is an uncontrolled, non-randomized exploratory study, including fifty (50) consecutive eligible patients undergoing definitive primary radiotherapy. The questionnaires were given to all eligible patients being treated with radiotherapy for head and neck cancer who are not already registered on another research study assessing Quality of Life (i.e. RTOG). During the 5-8 week treatment period, the QOL-RTI/H and N instrument is administered as follows: at baseline evaluation (immediately prior to the beginning of radiotherapy), at week four (4) two days in a row (for test-retest) and at the end of the treatment period. For validation purposes the QOL-RTI/H and

Dosimetric assessment of the field abutment region in head and neck treatments using a multileaf collimator

Energy Technology Data Exchange (ETDEWEB)

Abdel-Hakim, K.; Nishimura, T.; Sakahara, H. [Dept. of Radiology, Hamamatsu Univ. School of Medicine, Hamamatsu (Japan); Takaih, M.; Suzuki, S. [Dept. of Informatics, Hamamatsu Univ. School of Medicine, Hamamatsu (Japan)

2003-05-01

Background and Purpose: The use of conventional asymmetric collimators for junctioning of abutted fields can lead to significant dose inhomogeneity, due to jaw misalignment. However, recent technologic advances enable us to fabricate much finer leaf-positioning accuracy. Consequently, it is anticipated that the use of multileaf collimator (MLC) will potentially improve dose homogeneity at the junction of abutted fields. In this work, we evaluated the dose inhomogeneities at the match-plane in monoisocentric three-field head and neck setups, using MLC for field abutment. Material and Methods: To define either the anterior or the lateral fields, the MLC was used with either the longitudinal (0 angle) or the transverse (90 angle) settings. For 0 setting, each leaf moves in a direction perpendicular to the gantry rotation axis, hence the ''tongue and groove'' (T and G) design can effect matching-area dose at the side of the leaf (Figure 1a). For 90 setting, the rounded shape of the leaf produces its effect at the leaf end. Four combinations of abutted anterior field and abutted lateral field defined by MLC, i.e., abutted using MLC side-by-side, side-by-end, end-by-side and end-by-end, were compared. Dose inhomogeneity was measured at the junction of the two abutted fields with films in a solid water phantom. The effect of jaw settings as a backup diaphragm on the dose distribution was also studied. Reproducibility of the results was confirmed by repeated measurements over a 1-year period. Results: Abutted fields using MLC side-by-side caused underdose of approximately 15%. Abutted fields using MLC side-by-end produced > 10% overdose that could be improved to {+-} 1% for 0.5 mm overlap of the leaf end from the lateral portals. When using end-by-side, an overdose of approximately 15% was observed. However, the dose improved to a homogeneous dose for 0.8 mm overlap of leaf end from the anterior portal. End-by-end showed an overdose of > 20%. This

Dosimetric assessment of the field abutment region in head and neck treatments using a multileaf collimator

International Nuclear Information System (INIS)

Abdel-Hakim, K.; Nishimura, T.; Sakahara, H.; Takaih, M.; Suzuki, S.

2003-01-01

Background and Purpose: The use of conventional asymmetric collimators for junctioning of abutted fields can lead to significant dose inhomogeneity, due to jaw misalignment. However, recent technologic advances enable us to fabricate much finer leaf-positioning accuracy. Consequently, it is anticipated that the use of multileaf collimator (MLC) will potentially improve dose homogeneity at the junction of abutted fields. In this work, we evaluated the dose inhomogeneities at the match-plane in monoisocentric three-field head and neck setups, using MLC for field abutment. Material and Methods: To define either the anterior or the lateral fields, the MLC was used with either the longitudinal (0 angle) or the transverse (90 angle) settings. For 0 setting, each leaf moves in a direction perpendicular to the gantry rotation axis, hence the ''tongue and groove'' (T and G) design can effect matching-area dose at the side of the leaf (Figure 1a). For 90 setting, the rounded shape of the leaf produces its effect at the leaf end. Four combinations of abutted anterior field and abutted lateral field defined by MLC, i.e., abutted using MLC side-by-side, side-by-end, end-by-side and end-by-end, were compared. Dose inhomogeneity was measured at the junction of the two abutted fields with films in a solid water phantom. The effect of jaw settings as a backup diaphragm on the dose distribution was also studied. Reproducibility of the results was confirmed by repeated measurements over a 1-year period. Results: Abutted fields using MLC side-by-side caused underdose of approximately 15%. Abutted fields using MLC side-by-end produced > 10% overdose that could be improved to ± 1% for 0.5 mm overlap of the leaf end from the lateral portals. When using end-by-side, an overdose of approximately 15% was observed. However, the dose improved to a homogeneous dose for 0.8 mm overlap of leaf end from the anterior portal. End-by-end showed an overdose of > 20%. This overdose could be smoothed

Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers

International Nuclear Information System (INIS)

Jang, Na Young; Lee, Keun-Wook; Ahn, Soon-Hyun; Kim, Jae-Sung; Ah Kim, In

2012-01-01

The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer. We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy. Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC. The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy

Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma-the University of Iowa experience

International Nuclear Information System (INIS)

Yao Min; Dornfeld, Kenneth J.; Buatti, John M.; Skwarchuk, Mark; Tan Huaming; Nguyen, Thanh; Wacha, Judith C.; Bayouth, John E.; Funk, Gerry F.; Smith, Russell B.; Graham, Scott M.; Chang, Kristi; Hoffman, Henry T.

2005-01-01

Purpose: To review the University of Iowa experience with intensity-modulated radiotherapy (IMRT) in the treatment of head-and-neck squamous cell carcinoma. Methods and Materials: From October 1999 to April 2004, 151 patients with head-and-neck squamous cell carcinoma were treated with IMRT for curative intent. One patient was lost to follow-up 2 months after treatment and therefore excluded from analysis. Of the remaining 150 patients, 99 were treated with definitive IMRT, and 51 received postoperative IMRT. Sites included were nasopharynx, 5; oropharynx, 56; larynx, 33; oral cavity, 29; hypopharynx, 8; nasal cavity/paranasal sinus, 8; and unknown primary, 11. None of the patients treated with postoperative IMRT received chemotherapy. Of 99 patients who had definitive IMRT, 68 patients received concurrent cisplatin-based chemotherapy. One patient received induction cisplatin-based chemotherapy, but no concurrent chemotherapy was given. Three clinical target volumes (CTV1, CTV2, and CTV3) were defined. The prescribed doses to CTV1, CTV2, and CTV3 in the definitive cohort were 70-74 Gy, 60 Gy, and 54 Gy, respectively. For high-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 64-66 Gy, 60 Gy, and 54 Gy, respectively. For intermediate-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 60 Gy, 60 Gy, and 54 Gy. Results: The median follow-up was 18 months (range, 2-60 months). All living patients were followed for at least 6 months. There were 11 local-regional failures: 7 local failures, 3 regional failures, and 1 failure both in the primary tumor and regional lymph node. There were 16 patients who failed distantly, either with distant metastasis or new lung primaries. The 2-year overall survival, local progression-free survival, locoregional progression-free survival, and distant disease-free survival rates were 85%, 94%, 92%, and 87%, respectively. The median time from treatment completion to local-regional recurrence

Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy

International Nuclear Information System (INIS)

Li, Baoqing; Chen, Allen M; Li, Dan; Lau, Derick H; Farwell, D Gregory; Luu, Quang; Rocke, David M; Newman, Kathleen; Courquin, Jean; Purdy, James A

2009-01-01

To investigate the association between dose to various anatomical structures and dysphagia among patients with head and neck cancer treated by definitive intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy. Thirty-nine patients with squamous cancer of the head and neck were treated by definitive concurrent chemotherapy and IMRT to a median dose of 70 Gy (range, 68 to 72). In each patient, a gastrostomy tube (GT) was prophylacticly placed prior to starting treatment. Prolonged GT dependence was defined as exceeding the median GT duration of 192 days. Dysphagia was scored using standardized quality-of-life instruments. Dose-volume histogram (DVH) data incorporating the superior/middle pharyngeal constrictors (SMPC), inferior pharyngeal constrictor (IPC), cricoid pharyngeal inlet (CPI), and cervical esophagus (CE) were analyzed in relation to prolonged GT dependence, dysphagia, and weight loss. At 3 months and 6 months after treatment, 87% and 44% of patients, respectively, were GT dependent. Spearman's ρ analysis identified statistical correlations (p < 0.05) between prolonged GT dependence or high grade dysphagia with IPC V65, IPC V60, IPC Dmean, and CPI Dmax. Logistic regression model showed that IPC V65 > 30%, IPC V60 > 60%, IPC Dmean > 60 Gy, and CPI Dmax > 62 Gy predicted for greater than 50% probability of prolonged GT dependence. Our analysis suggests that adhering to the following parameters may decrease the risk of prolonged GT dependence and dysphagia: IPC V65 < 15%, IPC V60 < 40%, IPC Dmean < 55 Gy, and CPI Dmax < 60 Gy

Cancer of the head and neck; Cancers de la tete et du cou

Energy Technology Data Exchange (ETDEWEB)

Leignel, D.; Toledano, A.; Calais, G.; Gardner, M.; Valinta, D.; Halimi, P.; Alberini, J.L.; Plantet, M.M.; Banal, A.; Hans, S.; Floiras, J.L.; Labib, A.; Djemaa, A.; Naoun, L.; Bali, M.; Melais, K.; George, L.; Cazalet, M.; Gross, E.; Padovani, L.; Cowen, D.; Pignon, T.; Bannour, N.; Guedouar, R.; Bouaouina, N.; Mege, A.; Lapeyre, M.; Graff, P.; Marchesi, V.; Aletti, P.; Marchal, C.; Peiffert, D.; Serre, A.; Ailleres, N.; Lemanski, C.; Hay, M.H.; Llacer Moscardo, C.; Allaw, A.; Azria, D.; Dubois, J.B.; Fenoglietto, P.; Maalej, M.; Nasr, C.; Chaari, N.; Hentati, D.; Kochbati, L.; Besbes, M.; Benjelloun, H.; Benchakroun, N.; Houjami, M.; Jouhadi, H.; Tawfiq, N.; Acharki, A.; Sahraoui, S.; Benider, A.; Racadot, S.; Mercier, M.; Dessard-Diana, B.; Bensadoun, R.J.; Martin, M.; Malaurie, E.; Favrel, V.; Housset, M.; Journel, C.; Calais, G.; Huet, J.; Pillet, G.; Hennequin, C.; Haddad, E.; Diana, C.; Blaska-Jaulerry, B.; Henry-Amar, M.; Gehanno, P.; Baillet, F.; Mazeron, J.J.; Chaouache, C.K.; Tebra Mrad, T.M.S.; Bannour, B.N.S.; Bouaouina, B.N.; Favrel, V.; Khodri, M.; Chapet, O.; Nguyen, D.; Ardiet, J.; Romestaing, P.; Thillays, F.; Bardet, E.; Rolland, F.; Maingan, P.; Campion, L.; Mahe, M.A

2005-11-15

Thirteen articles are presented in relation with head and neck cancer. Chemoradiotherapy, medical examinations using nuclear techniques such PET scanning, fractionated radiotherapy after a chemotherapy, analysis of dose volume for patients treated by irradiation with a combined chemotherapy, dosimetry, conformal radiotherapy with intensity modulation, dosimetry in brachytherapy, association of radiotherapy and chemotherapy in the treatment of nose pharynx carcinomas, recurrence, are the different subjects treated in this part. (N.C.)

Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study

Energy Technology Data Exchange (ETDEWEB)

Cvek, J.; Skacelikova, E.; Otahal, B.; Halamka, M.; Feltl, D. [University Hospital Ostrava (Czech Republic). Dept. of Oncology; Kubes, J. [University Hospital Bulovka, Prague (Czech Republic). Dept. of Radiation Oncology; Kominek, P. [University Hospital Ostrava (Czech Republic). Dept. of Otolaryngology

2012-08-15

Background and purpose: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. Methods and materials: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV{sub tumor}) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV{sub uninvolved}) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. Results: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was {<=} 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. Conclusion: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

Evaluation of a leaf position optimization tool for intensity modulated radiation therapy of head and neck cancer

International Nuclear Information System (INIS)

Claus, Filip; Gersem, Werner de; Vanhoutte, Ilse; Duthoy, Wim; Remouchamps, Vincent; Wagter, Carlos de; Neve, Wilfried de

2001-01-01

Background and purpose: Since 1996, patients are treated at Ghent University Hospital with a multi-segment technique using MultiLeaf Collimators. The segments were obtained by using the Beam's eye view projections of the planning target volume (PTV) and the organs at risk (OARs), after which the segments weights were optimized. To investigate if optimization of the leaf positions would further improve the intensity modulated radiation therapy (IMRT) plans, a tool optimizing leaf positions and segment weights simultaneously, was developed. This tool is called SOWAT, which is the acronym for segment outline and weight adapting tool. Material and methods: The tool evaluates the effects of changing the position of each collimating leaf of all segments on the value of the objective function. Only changes that improve the value of the objective function are retained. Between December 1999 and January 2001, 30 head and neck patients were treated with IMRT. Two patient groups were distinguished: pharyngeal and laryngeal tumors (n=17) and sinonasal tumors (n=13). A specific set of physical endpoints was evaluated for each group. Dose statistics of the treatment plans without and with SOWAT were analyzed. Results: When using SOWAT for the pharyngeal and laryngeal cases, the PTV dose homogeneity increased with a median of 11% (range 2-27%), while the maximum dose to the spinal cord was decreased for 14 of the 17 patients. In four plans where parotid function preservation was a goal, the parotid mean dose was lower than 26 Gy in one plan without SOWAT, and in four plans with SOWAT. For the sinonasal tumors, the PTV dose homogeneity increased with a median of 7% (range 1-14%). SOWAT lowered the mean dose to 53 of the 63 optic pathway structures (retina, optic nerve and optic chiasm). SOWAT leaves the number of segments unchanged and has little or no effect on the delivery time. Conclusions: SOWAT is a powerful tool to perform the final optimization of IMRT plans, without

Primary and Central Hypothyroidism After Radiotherapy for Head-and-Neck Tumors

International Nuclear Information System (INIS)

Bhandare, Niranjan; Kennedy, Laurence; Malyapa, Robert S.; Morris, Christopher G.; Mendenhall, William M.

2007-01-01

Purpose: To investigate the incidence of radiotherapy (RT)-induced central and primary hypothyroidism regarding total dose, fractionation, and adjuvant chemotherapy. Methods and Materials: We retrospectively reviewed the data from 312 patients treated with RT for extracranial head-and-neck tumors between 1964 and 2000. The cervical lymph nodes were irradiated in 197 patients. The radiation doses to the thyroid gland and hypothalamic-pituitary axis were estimated by reconstructing the treatment plans. Results: Clinical central hypothyroidism (CH) was observed in 17 patients (5.4%); the median clinical latency was 4.8 years. Clinical primary hypothyroidism (PH) was observed in 40 patients (20.3%); the median clinical latency was 3.1 years. Multivariate analysis of clinical CH revealed that fractionation, adjuvant chemotherapy, and total dose to the pituitary were not significant. Multivariate analysis of clinical PH revealed that the total dose to the thyroid (p = 0.043) was significant, but adjuvant chemotherapy, age, and gender were not. Of the patients tested for hypopituitarism, 14 (20.3%) of 69 demonstrated subclinical CH and 17 (27.4%) of 62 demonstrated subclinical PH. The 5-year and 10-year rates of freedom from clinical CH and PH were 97% and 87% and 68% and 67%, respectively. Of the patients tested, the 5-year and 10-year rates of freedom from subclinical CH and PH were 91% and 78% and 71% and 71%, respectively. Conclusion: Clinical and subclinical manifestations of late radiation toxicity were observed in the thyroid and hypothalamic-pituitary axis. Although CH did not indicate a dependence on fractionation, adjuvant chemotherapy, or total dose to the pituitary, PH showed a dependence on the total dose to the thyroid gland

Implementation of an algorithm for absorbed dose calculation in high energy photon beams at off axis points

International Nuclear Information System (INIS)

Matos, M.F.; Alvarez, G.D.; Sanz, D.E.

2008-01-01

Full text: A semiempirical algorithm for absorbed dose calculation at off-axis points in irregular beams was implemented. It is well known that semiempirical methods are very useful because of their easy implementation and its helpfulness in dose calculation in the clinic. These methods can be used as independent tools for dosimetric calculation in many applications of quality assurance. However, the applicability of such methods has some limitations, even in homogeneous media, specially at off axis points, near beam fringes or outside the beam. Only methods derived from tissue-air-ratio (TAR) or scatter-maximum-ratio (SMR) have been devised for those situations, many years ago. Despite there have been improvements for these manual methods, like the Sc-Sp ones, no attempt has been made to extend their usage at off axis points. In this work, a semiempirical formalism was introduced, based on the works of Venselaar et al. (1999) and Sanz et al. (2004), aimed to the Sc-Sp separation. This new formalism relies on the separation of primary and secondary components of the beam although in a relative way. The data required by the algorithm are reduced to a minimal, allowing for experimental easy. According to modern recommendations, reference measurements in water phantom are performed at 10 cm depth, keeping away electron contamination. Air measurements are done using a mini phantom instead of the old equilibrium caps. Finally, the calculation at off-axis points are done using data measured on the central beam axis; but correcting the results with the introduction of a measured function which depends on the location of the off axis point. The measurements for testing the algorithm were performed in our Siemens MXE linear accelerator. The algorithm was used to determine specific dose profiles for a great number of different beam configurations, and the results were compared with direct measurements to validate the accuracy of the algorithm. Additionally, the results were

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.

An automated dose tracking system for adaptive radiation therapy.

Science.gov (United States)

Liu, Chang; Kim, Jinkoo; Kumarasiri, Akila; Mayyas, Essa; Brown, Stephen L; Wen, Ning; Siddiqui, Farzan; Chetty, Indrin J

2018-02-01

The implementation of adaptive radiation therapy (ART) into routine clinical practice is technically challenging and requires significant resources to perform and validate each process step. The objective of this report is to identify the key components of ART, to illustrate how a specific automated procedure improves efficiency, and to facilitate the routine clinical application of ART. Data was used from patient images, exported from a clinical database and converted to an intermediate format for point-wise dose tracking and accumulation. The process was automated using in-house developed software containing three modularized components: an ART engine, user interactive tools, and integration tools. The ART engine conducts computing tasks using the following modules: data importing, image pre-processing, dose mapping, dose accumulation, and reporting. In addition, custom graphical user interfaces (GUIs) were developed to allow user interaction with select processes such as deformable image registration (DIR). A commercial scripting application programming interface was used to incorporate automated dose calculation for application in routine treatment planning. Each module was considered an independent program, written in C++or C#, running in a distributed Windows environment, scheduled and monitored by integration tools. The automated tracking system was retrospectively evaluated for 20 patients with prostate cancer and 96 patients with head and neck cancer, under institutional review board (IRB) approval. In addition, the system was evaluated prospectively using 4 patients with head and neck cancer. Altogether 780 prostate dose fractions and 2586 head and neck cancer dose fractions went processed, including DIR and dose mapping. On average, daily cumulative dose was computed in 3 h and the manual work was limited to 13 min per case with approximately 10% of cases requiring an additional 10 min for image registration refinement. An efficient and convenient

Automatic exposure control to reduce the dose in subsecond multislice spiral CT: phantom measurements and clinical results

International Nuclear Information System (INIS)

Greess, H.; Bautz, W.; Baum, U.; Wolf, H.; Suess, C.; Kalender, W.A.

2004-01-01

Purpose: To investigate the potential of dose reduction in multislice spiral CT (MSCT) with automatic exposure control. Materials and Methods: The study was performed on a Sensation 4 multislice scanner. This prototype implementation analyzed the distribution of the attenuation along the z-axis in the lateral and sagittal directions of the digital radiogram. Depending on this distribution of the attenuation, the tube current (mA) is defined for every tube rotation. In addition, the tube current was modulated during each tube rotation. First, a three step oval water phantom was measured to evaluate the potential of this method with respect to dose reduction and image quality. In a patient study (n=26), four different scan regions (shoulder, thorax, abdomen, pelvis) were examined and dose (mAs) and image quality evaluated in comparison to examinations with a standard protocol for these regions in adults and a weight-adjusted standard protocol in children. The image quality was classified in consensus as good, sufficient and poor image quality. Results: By adapting and modulating the tube current, we substantially reduced the variation of noise in one spiral scan and in one scan region of our patient collective. The dose (average mAs) was reduced by 31% to 66% in children (mean 44%) and between 35% and 64% in adults (mean 53%), depending on the scan region. The image quality was substantially improved in regions with high attenuation and did not suffer in low attenuation regions. Conclusion: The dose can be reduced substantially by an automatic exposure control including angular tube current modulation with the same or improved image quality. (orig.) [de

Experimental validation of deterministic Acuros XB algorithm for IMRT and VMAT dose calculations with the Radiological Physics Center's head and neck phantom

International Nuclear Information System (INIS)

Han Tao; Mourtada, Firas; Kisling, Kelly; Mikell, Justin; Followill, David; Howell, Rebecca

2012-01-01

Purpose: The purpose of this study was to verify the dosimetric performance of Acuros XB (AXB), a grid-based Boltzmann solver, in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Methods: The Radiological Physics Center (RPC) head and neck (H and N) phantom was used for all calculations and measurements in this study. Clinically equivalent IMRT and VMAT plans were created on the RPC H and N phantom in the Eclipse treatment planning system (version 10.0) by using RPC dose prescription specifications. The dose distributions were calculated with two different algorithms, AXB 11.0.03 and anisotropic analytical algorithm (AAA) 10.0.24. Two dose report modes of AXB were recorded: dose-to-medium in medium (D m,m ) and dose-to-water in medium (D w,m ). Each treatment plan was delivered to the RPC phantom three times for reproducibility by using a Varian Clinac iX linear accelerator. Absolute point dose and planar dose were measured with thermoluminescent dosimeters (TLDs) and GafChromic registered EBT2 film, respectively. Profile comparison and 2D gamma analysis were used to quantify the agreement between the film measurements and the calculated dose distributions from both AXB and AAA. The computation times for AAA and AXB were also evaluated. Results: Good agreement was observed between measured doses and those calculated with AAA or AXB. Both AAA and AXB calculated doses within 5% of TLD measurements in both the IMRT and VMAT plans. Results of AXB Dm,m (0.1% to 3.6%) were slightly better than AAA (0.2% to 4.6%) or AXB Dw,m (0.3% to 5.1%). The gamma analysis for both AAA and AXB met the RPC 7%/4 mm criteria (over 90% passed), whereas AXB Dm,m met 5%/3 mm criteria in most cases. AAA was 2 to 3 times faster than AXB for IMRT, whereas AXB was 4-6 times faster than AAA for VMAT. Conclusions: AXB was found to be satisfactorily accurate when compared to measurements in the RPC H and N phantom. Compared with AAA, AXB results were equal

Dose determination in radiotherapy for photon beams modified by static intensity modulators

International Nuclear Information System (INIS)

Castellanos Lopez, M.E.

1998-01-01

The static intensity modulators, used in radiotherapy, modify the spectral composition of the beam and lead to specific problems of the dose calculation. The aim of this work was to establish a three dimensional calculation, global and accurate, adapted to the primary-diffused separation algorithm and valid for any static modulator type. A theoretical study, experimentally verified, allowed the evaluation of the primary fluence, resulting from metallic sheets placed between photons beams of 6 to 23 MV nominal energy. It has been showed that the diffused, coming from the modulators, could be neglected for weak thickness and for the relative dose variation. In return it leads to significant variations of many % on the absolute dose and must be take into account for the bigger thicknesses. Corrective methods for the primary fluence have been proposed. From the energy spectra of the beam, the metallic modulator influence has been studied on the primary and diffused components of the dose and improvements of the calculation method have been proposed. These improvements are based on the modulator representation as a transmission matrix and on semi-empirical corrective factors. (A.L.B.)

Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy

International Nuclear Information System (INIS)

Narayan, Samir; Lehmann, Joerg; Coleman, Matthew A.; Vaughan, Andrew; Yang, Claus Chunli; Enepekides, Danny; Farwell, Gregory; Purdy, James A.; Laredo, Grace; Nolan, Kerry A.S.; Pearson, Francesca S.; Vijayakumar, Srinivasan

2008-01-01

Purpose: We conducted a clinical study to correlate oral cavity dose with clinical mucositis, perform in vivo dosimetry, and determine the feasibility of obtaining buccal mucosal cell samples in patients undergoing head-and-neck radiation therapy. The main objective is to establish a quantitative dose response for clinical oral mucositis. Methods and Materials: Twelve patients undergoing radiation therapy for head-and-neck cancer were prospectively studied. Four points were chosen in separate quadrants of the oral cavity. Calculated dose distributions were generated by using AcQPlan and Eclipse treatment planning systems. MOSFET dosimeters were used to measure dose at each sampled point. Each patient underwent buccal sampling for future RNA analysis before and after the first radiation treatment at the four selected points. Clinical and functional mucositis were assessed weekly according to National Cancer Institute Common Toxicity Criteria, Version 3. Results: Maximum and average doses for sampled sites ranged from 7.4-62.3 and 3.0-54.3 Gy, respectively. A cumulative point dose of 39.1 Gy resulted in mucositis for 3 weeks or longer. Mild severity (Grade ≤ 1) and short duration (≤1 week) of mucositis were found at cumulative point doses less than 32 Gy. Polymerase chain reaction consistently was able to detect basal levels of two known radiation responsive genes. Conclusions: In our sample, cumulative doses to the oral cavity of less than 32 Gy were associated with minimal acute mucositis. A dose greater than 39 Gy was associated with longer duration of mucositis. Our technique for sampling buccal mucosa yielded sufficient cells for RNA analysis using polymerase chain reaction

Clinical experience transitioning from IMRT to VMAT for head and neck cancer

Energy Technology Data Exchange (ETDEWEB)

Studenski, Matthew T., E-mail: matthew.studenski@jeffersonhospital.org [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Bar-Ad, Voichita; Siglin, Joshua [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Cognetti, David; Curry, Joseph [Department of Otolaryngology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Tuluc, Madalina [Department of Pathology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Harrison, Amy S. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States)

2013-07-01

To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion.

Revisiting the dose-effect correlations in irradiated head and neck cancer using automatic segmentation tools of the dental structures, mandible and maxilla

International Nuclear Information System (INIS)

Thariat, J.; Ramus, L.; Odin, G.; Vincent, S.; Orlanducci, M.H.; Dassonville, O.; Darcourt, V.; Lacout, A.; Marcy, P.Y.; Cagnol, G.; Malandain, G.

2011-01-01

Purpose. - Manual delineation of dental structures is too time-consuming to be feasible in routine practice. Information on dose risk levels is crucial for dentists following irradiation of the head and neck to avoid post-extraction osteoradionecrosis based on empirical dose-effects data established on bidimensional radiation therapy plans. Material and methods. - We present an automatic atlas-based segmentation framework of the dental structures, called Dentalmaps, constructed from a patient image-segmentation database. Results. - This framework is accurate (within 2 Gy accuracy) and relevant for the routine use. It has the potential to guide dental care in the context of new irradiation techniques. Conclusion. - This tool provides a user-friendly interface for dentists and radiation oncologists in the context of irradiated head and neck cancer patients. It will likely improve the knowledge of dose-effect correlations for dental complications and osteoradionecrosis. (authors)

Evaluation of Deformable Image Coregistration in Adaptive Dose Painting by Numbers for Head-and-Neck Cancer

Energy Technology Data Exchange (ETDEWEB)

Olteanu, Luiza A.M., E-mail: AnaMariaLuiza.Olteanu@uzgent.be [Department of Radiotherapy, Ghent University Hospital, De Pintelaan, Ghent (Belgium); Madani, Indira; De Neve, Wilfried; Vercauteren, Tom; De Gersem, Werner [Department of Radiotherapy, Ghent University Hospital, De Pintelaan, Ghent (Belgium)

2012-06-01

Purpose: To assess the accuracy of contour deformation and feasibility of dose summation applying deformable image coregistration in adaptive dose painting by numbers (DPBN) for head and neck cancer. Methods and Materials: Data of 12 head-and-neck-cancer patients treated within a Phase I trial on adaptive {sup 18}F-FDG positron emission tomography (PET)-guided DPBN were used. Each patient had two DPBN treatment plans: the initial plan was based on a pretreatment PET/CT scan; the second adapted plan was based on a PET/CT scan acquired after 8 fractions. The median prescription dose to the dose-painted volume was 30 Gy for both DPBN plans. To obtain deformed contours and dose distributions, pretreatment CT was deformed to per-treatment CT using deformable image coregistration. Deformed contours of regions of interest (ROI{sub def}) were visually inspected and, if necessary, adjusted (ROI{sub def{sub ad}}) and both compared with manually redrawn ROIs (ROI{sub m}) using Jaccard (JI) and overlap indices (OI). Dose summation was done on the ROI{sub m}, ROI{sub def{sub ad}}, or their unions with the ROI{sub def}. Results: Almost all deformed ROIs were adjusted. The largest adjustment was made in patients with substantially regressing tumors: ROI{sub def} = 11.8 {+-} 10.9 cm{sup 3} vs. ROI{sub def{sub ad}} = 5.9 {+-} 7.8 cm{sup 3} vs. ROI{sub m} = 7.7 {+-} 7.2 cm{sup 3} (p = 0.57). The swallowing structures were the most frequently adjusted ROIs with the lowest indices for the upper esophageal sphincter: JI = 0.3 (ROI{sub def}) and 0.4 (ROI{sub def{sub ad}}); OI = 0.5 (both ROIs). The mandible needed the least adjustment with the highest indices: JI = 0.8 (both ROIs), OI = 0.9 (ROI{sub def}), and 1.0 (ROI{sub def{sub ad}}). Summed doses differed non-significantly. There was a trend of higher doses in the targets and lower doses in the spinal cord when doses were summed on unions. Conclusion: Visual inspection and adjustment were necessary for most ROIs. Fast automatic ROI

Impact of Intensity-Modulated Radiotherapy on Health-Related Quality of Life for Head and Neck Cancer Patients: Matched-Pair Comparison with Conventional Radiotherapy

International Nuclear Information System (INIS)

Graff, Pierre; Lapeyre, Michel; Desandes, Emmanuel; Ortholan, Cecile; Bensadoun, Rene-Jean; Alfonsi, Marc; Maingon, Philippe; Giraud, Philippe; Bourhis, Jean; Marchesi, Vincent; Mege, Alice; Peiffert, Didier

2007-01-01

Purpose: To assess the benefit of intensity-modulated radiotherapy (IMRT) compared with conventional RT for the quality of life (QOL) of head and neck cancer survivors. Methods and Materials: Cross-sectional QOL measures (European Organization for Research and Treatment of Cancer QOL questionnaire C30 and head and neck cancer module) were used with a French multicenter cohort of patients cured of head and neck cancer (follow-up ≥ 1 year) who had received bilateral neck RT (≥ 45 Gy) as a part of their initial treatment. We compared the QOL mean scores regarding RT modality (conventional RT vs. IMRT). The patients of the two groups were matched (one to one) according to the delay between the end of RT and the timing of the QOL evaluation and the T stage. Each QOL item was divided into two relevant levels of severity: 'not severe' (responses, 'not at all' and 'a little') vs. 'severe' (responses 'quite a bit' and 'very much'). The association between the type of RT and the prevalence of severe symptoms was approximated, through multivariate analysis using the prevalence odds ratio. Results: Two comparable groups (67 pairs) were available. Better scores were observed on the head and neck cancer module QOL questionnaire for the IMRT group, especially for dry mouth and sticky saliva (p < 0.0001). Severe symptoms were more frequent with conventional RT concerning saliva modifications and oral discomfort. The adjusted prevalence odds ratios were 3.17 (p = 0.04) for dry mouth, 3.16 (p = 0.02) for sticky saliva, 3.58 (p = 0.02) for pain in the mouth, 3.35 (p = 0.04) for pain in the jaw, 2.60 (p = 0.02) for difficulties opening the mouth, 2.76 (p = 0.02) for difficulties with swallowing, and 2.68 (p = 0.03) for trouble with eating. Conclusion: The QOL assessment of head and neck cancer survivors demonstrated the benefit of IMRT, particularly in the areas of salivary dysfunction and oral discomfort

Injection of a Phase Modulated Source into the Z-Beamlet Laser for Increased Energy Extraction.

Energy Technology Data Exchange (ETDEWEB)

Rambo, Patrick K.; Armstrong, Darrell J.; Schwarz, Jens; Smith, Ian C; Shores, Jonathon; Speas, Christopher; Porter, John L.

2014-11-01

The Z-Beamlet laser has been operating at Sandia National Laboratories since 2001 to provide a source of laser-generated x-rays for radiography of events on the Z-Accelerator. Changes in desired operational scope have necessitated the increase in pulse duration and energy available from the laser system. This is enabled via the addition of a phase modulated seed laser as an alternative front-end. The practical aspects of deployment are discussed here.

The M. D. Anderson Symptom Inventory-Head and Neck Module, a Patient-Reported Outcome Instrument, Accurately Predicts the Severity of Radiation-Induced Mucositis

International Nuclear Information System (INIS)

Rosenthal, David I.; Mendoza, Tito R.; Chambers, Mark; Burkett, V. Shannon; Garden, Adam S.; Hessell, Amy C.; Lewin, Jan S.; Ang, K. Kian; Kies, Merrill S.; Gning, Ibrahima; Wang, Xin S.; Cleeland, Charles S.

2008-01-01

Purpose: To compare the M. D. Anderson Symptom Inventory-Head and Neck (MDASI-HN) module, a symptom burden instrument, with the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) module, a quality-of-life instrument, for the assessment of mucositis in patients with head-and-neck cancer treated with radiotherapy and to identify the most distressing symptoms from the patient's perspective. Methods and Materials: Consecutive patients with head-and-neck cancer (n = 134) completed the MDASI-HN and FACT-HN before radiotherapy (time 1) and after 6 weeks of radiotherapy or chemoradiotherapy (time 2). The mean global and subscale scores for each instrument were compared with the objective mucositis scores determined from the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0. Results: The global and subscale scores for each instrument showed highly significant changes from time 1 to time 2 and a significant correlation with the objective mucositis scores at time 2. Only the MDASI scores, however, were significant predictors of objective Common Terminology Criteria for Adverse Events mucositis scores on multivariate regression analysis (standardized regression coefficient, 0.355 for the global score and 0.310 for the head-and-neck cancer-specific score). Most of the moderate and severe symptoms associated with mucositis as identified on the MDASI-HN are not present on the FACT-HN. Conclusion: Both the MDASI-HN and FACT-HN modules can predict the mucositis scores. However, the MDASI-HN, a symptom burden instrument, was more closely associated with the severity of radiation-induced mucositis than the FACT-HN on multivariate regression analysis. This greater association was most likely related to the inclusion of a greater number of face-valid mucositis-related items in the MDASI-HN compared with the FACT-HN

In vivo dose verification for photon treatments of head and neck carcinomas using MOSFET dosimeters

International Nuclear Information System (INIS)

Tung, C.J.; Wang, L.C.; Wang, H.C.; Lee, C.C.; Chao, T.C.

2008-01-01

In vivo dosimetry was performed for the head and neck carcinoma patients during the treatment of a large photon field using MOSFETs. This study followed the protocols recommended by the European Society for Therapeutic Radiology and Oncology. A total of 32 portals belonging to 12 patients were under investigation. Results showed that the deviation between in vivo midline doses and planned target doses was partly due to the manual dose calculations in the treatment planning which used the patient geometric thickness rather than the radiological thickness. Other factors responsible for this deviation included the difficult positioning of MOSFETs on the face mask, the asymmetric positioning of MOSFETs on the left and right sides of the mask, and the asymmetric tissue inhomogeneities with respect to the body midline. To reduce the deviation contributed from these factors, in vivo midline doses were calculated by averaging the results for each bilaterally opposed portals and compared with corresponding planned target doses. This comparison showed that MOSFET dosimeters are suitable for in vivo dosimetry of the present study

Analysis of the major factors of influence on the conditions of the intensity modulated radiation therapy planning optimization in head and neck

International Nuclear Information System (INIS)

Kim, Dae Sup; Yoon, In Ha; Lee, Woo Seok; Back, Geum Mun

2014-01-01

To derive the most appropriate factors by considering the effects of the major factors when applied to the optimization algorithm, thereby aiding the effective designing of a ideal treatment plan. The eclipse treatment planning system(Eclipse 10.0, Varian, USA) was used in this study. The PBC (Pencil Beam Convolution) algorithm was used for dose calculation, and the DVO (Dose Volume Optimizer 10.0.28) Optimization algorithm was used for intensity modulated radiation therapy. The experimental group consists of patients receiving intensity modulated radiation therapy for the head and neck cancer and dose prescription to two planned target volume was 2.2 Gy and 2.0 Gy simultaneously. Treatment plan was done with inverse dose calculation methods utilizing 6 MV beam and 7 fields. The optimal algorithm parameter of the established plan was selected based on volume dose-priority(Constrain), dose fluence smooth value and the impact of the treatment plan was analyzed according to the variation of each factors. Volume dose-priority determines the reference conditions and the optimization process was carried out under the condition using same ratio, but different absolute values. We evaluated the surrounding normal organs of treatment volume according to the changing conditions of the absolute values of the volume dose-priority. Dose fluence smooth value was applied by simply changing the reference conditions (absolute value) and by changing the related volume dose-priority. The treatment plan was evaluated using Conformal Index, Paddick's Conformal Index, Homogeneity Index and the average dose of each organs. When the volume dose-priority values were directly proportioned by changing the absolute values, the CI values were found to be different. However PCI was 1.299±0.006 and HI was 1.095±0.004 while D5%/D95% was 1.090±1.011. The impact on the prescribed dose were similar. The average dose of parotid gland decreased to 67.4, 50.3, 51.2, 47.1 Gy when the absolute

On the impact of improved dosimetric accuracy on head and neck high dose rate brachytherapy.

Science.gov (United States)

Peppa, Vasiliki; Pappas, Eleftherios; Major, Tibor; Takácsi-Nagy, Zoltán; Pantelis, Evaggelos; Papagiannis, Panagiotis

2016-07-01

To study the effect of finite patient dimensions and tissue heterogeneities in head and neck high dose rate brachytherapy. The current practice of TG-43 dosimetry was compared to patient specific dosimetry obtained using Monte Carlo simulation for a sample of 22 patient plans. The dose distributions were compared in terms of percentage dose differences as well as differences in dose volume histogram and radiobiological indices for the target and organs at risk (mandible, parotids, skin, and spinal cord). Noticeable percentage differences exist between TG-43 and patient specific dosimetry, mainly at low dose points. Expressed as fractions of the planning aim dose, percentage differences are within 2% with a general TG-43 overestimation except for the spine. These differences are consistent resulting in statistically significant differences of dose volume histogram and radiobiology indices. Absolute differences of these indices are however small to warrant clinical importance in terms of tumor control or complication probabilities. The introduction of dosimetry methods characterized by improved accuracy is a valuable advancement. It does not appear however to influence dose prescription or call for amendment of clinical recommendations for the mobile tongue, base of tongue, and floor of mouth patient cohort of this study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Hypoxia imaging with [F-18] FMISO-PET in head and neck cancer: Potential for guiding intensity modulated radiation therapy in overcoming hypoxia-induced treatment resistance

International Nuclear Information System (INIS)

Hendrickson, Kristi; Phillips, Mark; Smith, Wade; Peterson, Lanell; Krohn, Kenneth; Rajendran, Joseph

2011-01-01

Background and purpose: Positron emission tomography (PET) imaging with [F-18] fluoromisonidazole (FMISO) has been validated as a hypoxic tracer . Head and neck cancer exhibits hypoxia, inducing aggressive biologic traits that impart resistance to treatment. Delivery of modestly higher radiation doses to tumors with stable areas of chronic hypoxia can improve tumor control . Advanced radiation treatment planning (RTP) and delivery techniques such as intensity modulated radiation therapy (IMRT) can deliver higher doses to a small volume without increasing morbidity. We investigated the utility of co-registered FMISO-PET and CT images to develop clinically feasible RTPs with higher tumor control probabilities (TCP). Materials and methods: FMISO-PET images were used to determine hypoxic sub-volumes for boost planning. Example plans were generated for 10 of the patients in the study who exhibited significant hypoxia. We created an IMRT plan for each patient with a simultaneous integrated boost (SIB) to the hypoxic sub-volumes. We also varied the boost for two patients. Result: A significant (mean 17%, median 15%) improvement in TCP is predicted when the modest additional boost dose to the hypoxic sub-volume is included. Conclusion: Combined FMISO-PET imaging and IMRT planning permit delivery of higher doses to hypoxic regions, increasing the predicted TCP (mean 17%) without increasing expected complications.

Recurrence in Region of Spared Parotid Gland After Definitive Intensity-Modulated Radiotherapy for Head and Neck Cancer

International Nuclear Information System (INIS)

Cannon, Donald M.; Lee, Nancy Y.

2008-01-01

Purpose: To discuss the implications of three examples of periparotid recurrence after definitive intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC). Methods and Materials: We present 3 patients with HNC who underwent definitive IMRT with concurrent chemotherapy and later had treatment failure in or near a spared parotid gland. Two patients had bilateral multilevel nodal disease, and all had Level II nodal disease ipsilateral to the site of recurrence. The patients were treated using dose-painting IMRT with a dose of 70 Gy to the gross tumor volume and 59.4 Gy or 54 Gy to the high-risk or low-risk clinical tumor volume, respectively. The parotid glands were spared bilaterally. The patients had not undergone any surgical treatment for HNC before radiotherapy. Results: All patients had treatment failure in the region of a spared parotid gland. Failure in the 2 patients with bilateral multilevel nodal involvement occurred in the periparotid lymph nodes. The third patient developed a dermal metastasis near the tail of a spared parotid gland. On pretreatment imaging, the 2 patients with nodal failure had small nonspecific periparotid nodules that showed no hypermetabolic activity on positron emission tomography. Conclusion: For HNC patients receiving definitive IMRT, nonspecific positron emission tomography-negative periparotid nodules on pretreatment imaging should raise the index of suspicion for subclinical disease in the presence of multilevel or Level II nodal metastases. Additional evaluation of such nodules might be indicated before sparing the ipsilateral parotid gland

Feasibility of a unified approach to intensity-modulated radiation therapy and volume-modulated arc therapy optimization and delivery

International Nuclear Information System (INIS)

Hoover, Douglas A.; Chen, Jeff Z.; MacFarlane, Michael; Wong, Eugene; Battista, Jerry J.

2015-01-01

Purpose: To study the feasibility of unified intensity-modulated arc therapy (UIMAT) which combines intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) optimization and delivery to produce superior radiation treatment plans, both in terms of dose distribution and efficiency of beam delivery when compared with either VMAT or IMRT alone. Methods: An inverse planning algorithm for UIMAT was prototyped within the PINNACLE treatment planning system (Philips Healthcare). The IMRT and VMAT deliveries are unified within the same arc, with IMRT being delivered at specific gantry angles within the arc. Optimized gantry angles for the IMRT and VMAT phases are assigned automatically by the inverse optimization algorithm. Optimization of the IMRT and VMAT phases is done simultaneously using a direct aperture optimization algorithm. Five treatment plans each for prostate, head and neck, and lung were generated using a unified optimization technique and compared with clinical IMRT or VMAT plans. Delivery verification was performed with an ArcCheck phantom (Sun Nuclear) on a Varian TrueBeam linear accelerator (Varian Medical Systems). Results: In this prototype implementation, the UIMAT plans offered the same target dose coverage while reducing mean doses to organs at risk by 8.4% for head-and-neck cases, 5.7% for lung cases, and 3.5% for prostate cases, compared with the VMAT or IMRT plans. In addition, UIMAT can be delivered with similar efficiency as VMAT. Conclusions: In this proof-of-concept work, a novel radiation therapy optimization and delivery technique that interlaces VMAT or IMRT delivery within the same arc has been demonstrated. Initial results show that unified VMAT/IMRT has the potential to be superior to either standard IMRT or VMAT

Improved VMAT planning for head and neck tumors with an advanced optimization algorithm

International Nuclear Information System (INIS)

Klippel, Norbert; Schmuecking, Michael; Terribilini, Dario; Geretschlaeger, Andreas; Aebersold, Daniel M.; Manser, Peter

2015-01-01

In this study, the ''Progressive Resolution Optimizer PRO3'' (Varian Medical Systems) is compared to the previous version PRO2'' with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. Materials and Methods For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. Results For the phase 1 plans (PD = 54 Gy) the near maximum dose D 2% of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V 95% = 97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. Conclusion A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better

Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: Patient selection, practical aspects, and current evidence

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Kim, Yeon Sil [Dept. of Radiation Oncology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul(Korea, Republic of)

2017-03-15

Locoregional failure is the most frequent pattern of failure in locally advanced head and neck cancer patients and it leads to death in most of the patients. Second primary tumors occurring in the other head and neck region reach up to almost 40% of long-term survivors. Recommended and preferred retreatment option in operable patients is salvage surgical resection, reporting a 5-year overall survival of up to 40%. However, because of tumor location, extent, and underlying comorbidities, salvage surgery is often limited and compromised by incomplete resection. Reirradiation with or without combined chemotherapy is an appropriate option for unresectable recurrence. Reirradiation is carefully considered with a case-by-case basis. Reirradiation protocol enrollment is highly encouraged prior to committing patient to an aggressive therapy. Radiation doses greater than 60 Gy are usually recommended for successful salvage. Despite recent technical improvement in intensity-modulated radiotherapy (IMRT), the use of concurrent chemotherapy, and the emergence of molecularly targeted agents, careful patient selection remain as the most paramount factor in reirradiation. Tumors that recur or persist despite aggressive prior chemoradiation therapy imply the presence of chemoradio-resistant clonogens. Treatment protocols that combine novel targeted radiosensitizing agents with conformal high precision radiation are required to overcome the resistance while minimizing toxicity. Recent large number of data showed that IMRT may provide better locoregional control with acceptable acute or chronic morbidities. However, additional prospective studies are required before a definitive conclusion can be drawn on safety and effectiveness of IMRT.

Radiation dose distributions close to the shower axis calculated for high energy electron initiated electromagnetic showers in air

International Nuclear Information System (INIS)

Geer, S.; Gsponer, A.

1983-01-01

Absorbed radiation doses produced by 500, 1,000 and 10,000 MeV electron initiated electromagnetic showers in air have been calculated using a Monte Carlo program. The radial distributions of the absorbed dose near to the shower axis are found to be significantly narrower than predicted by simple analytical shower theory. For a 500 MeV, 10 kA, 100 ns electron beam pulse, the region in which the total dose is in excess of 1 krad and the dose rate in excess of 10 10 rad/s is a cigar-shaped envelope of radius 1 m and length 200 m. (orig.) [de

EPR imaging of dose distributions aiming at applications in radiation therapy

International Nuclear Information System (INIS)

Lund, E.; Kolbun, N.; Adolfsson, E.; Gustafsson, H.

2014-01-01

A one-dimensional electron paramagnetic resonance (EPR) imaging method for visualisation of dose distributions in photon fields has been developed. Pressed pellets of potassium dithionate were homogeneously irradiated in a 60 Co radiation field to 600 Gy. The EPR analysis was performed with an X-Band (9.6 GHz) Bruker E540 EPR and EPR imaging spectrometer equipped with an E540 GC2X two-axis X-band gradient coil set with gradients along the y axis (along the sample tube) and z axis (along B 0 ) and an ER 4108TMHS resonator. Image reconstruction, including deconvolution, baseline corrections and corrections for the resonator sensitivity, was performed using an in-house-developed Matlab code for the purpose to have a transparent and complete algorithm for image reconstruction. With this method, it is possible to visualise a dose distribution with an accuracy of ∼5 % within ±5 mm from the centre of the resonator. (authors)

Impact of residual setup error on parotid gland dose in intensity-modulated radiation therapy with or without planning organ-at-risk margin

International Nuclear Information System (INIS)

Delana, Anna; Menegotti, Loris; Valentini, Aldo; Bolner, Andrea; Tomio, Luigi; Vanoni, Valentina; Lohr, Frank

2009-01-01

Purpose: To estimate the dosimetric impact of residual setup errors on parotid sparing in head-and-neck (H and N) intensity-modulated treatments and to evaluate the effect of employing an PRV (planning organ-at-risk volume) margin for the parotid gland. Patients and methods: Ten patients treated for H and N cancer were considered. A nine-beam intensity-modulated radiotherapy (IMRT) was planned for each patient. A second optimization was performed prescribing dose constraint to the PRV of the parotid gland. Systematic setup errors of 2 mm, 3 mm, and 5 mm were simulated. The dose-volume histograms of the shifted and reference plans were compared with regard to mean parotid gland dose (MPD), normal-tissue complication probability (NTCP), and coverage of the clinical target volume (V 95% and equivalent uniform dose [EUD]); the sensitivity of parotid sparing on setup error was evaluated with a probability-based approach. Results: MPD increased by 3.4%/mm and 3.0%/mm for displacements in the craniocaudal and lateral direction and by 0.7%/mm for displacements in the anterior-posterior direction. The probability to irradiate the parotid with a mean dose > 30 Gy was > 50%, for setup errors in cranial and lateral direction and 95% and EUD variations < 1% and < 1 Gy). Conclusion: The parotid gland is more sensitive to craniocaudal and lateral displacements. A setup error of 2 mm guarantees an MPD ≤ 30 Gy in most cases, without adding a PRV margin. If greater displacements are expected/accepted, an adequate PRV margin could be used to meet the clinical parotid gland constraint of 30 Gy, without affecting target volume coverage. (orig.)

Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing

International Nuclear Information System (INIS)

Eisbruch, Avraham; Marsh, Lon H.; Martel, Mary K.; Ship, Jonathan A.; Haken, Randall ten; Pu, Anthony T.; Fraass, Benedick A.; Lichter, Allen S.

1998-01-01

Purpose: Conformal treatment using static multisegmental intensity modulation was developed for patients requiring comprehensive irradiation for head and neck cancer. The major aim is sparing major salivary gland function while adequately treating the targets. To assess the adequacy of the conformal plans regarding target coverage and dose homogeneity, they were compared with standard irradiation plans. Methods and Materials: Fifteen patients with stage III/IV head and neck cancer requiring comprehensive, bilateral neck irradiation participated in this study. CT-based treatment plans included five to six nonopposed fields, each having two to four in-field segments. Fields and segments were devised using beam's eye views of the planning target volumes (PTVs), noninvolved organs, and isodose surfaces, to achieve homogeneous dose distribution that encompassed the targets and spared major salivary gland tissue. For comparison, standard three-field radiation plans were devised retrospectively for each patient, with the same CT-derived targets used for the clinical (conformal) plans. Saliva flow rates from each major salivary gland were measured before and periodically after treatment. Results: On average, the minimal dose to the primary PTVs in the conformal plans [95.2% of the prescribed dose, standard deviation (SD) 4%] was higher than in the standard plans (91%, SD 7%; p = 0.02), and target volumes receiving <95% or <90% of the prescribed dose were smaller in the conformal plans (p = 0.004 and 0.02, respectively). Similar advantages of the conformal plans compared to standard plans were found in ipsilateral jugular nodes PTV coverage. The reason for underdosing in the standard treatment plans was primarily failure of electron beams to fully encompass targets. No significant differences were found in contralateral jugular or posterior neck nodes coverage. The minimal dose to the retropharyngeal nodes was higher in the standard plans. However, all conformal plans

Measurement of computed tomography dose profile with pitch variation using Gafchromic XR-QA2 and thermoluminescence dosimeter (TLD)

Science.gov (United States)

Purwaningsih, S.; Lubis, L. E.; Pawiro, S. A.; Soejoko, D. S.

2016-03-01

This research was aimed to check the patterns of dose profile on adult and pediatric head scan. We compared measurement result on dose profile along the z- axis rotation at peripheries and center phantom with a variety of pitch, i.e. 0.75, 1, 1.5 for adult and pediatric head protocol, keeping the rest of the scan parameters constant. Measurements were performed on homogeneous, cylindrical PMMA phantom with diameters of 16 and 10 cm using XR-QA2 Gafchromic film and TLD as dosimeters. The measurement result indicated a decrease in the dose about 50% and 47% for adult and pediatric head scan with the increase of pitch. For 0.75 value of pitch adult head scan, dose range for each position were (2.4 - 5.0) cGy, (3.1 - 5.3) cGy, (2.2 - 4.5) cGy, (2.8 - 5.3) cGy, and (3.3 - 5.6) cGy for position of center, 3, 6, 9 and 12 o'clock peripheral phantom position respectively. Dose profile for adult and pediatric head scan protocols has pattern curve with the maximum dose in the middle and tendency of symmetry near the edges, with different the plateau length along z- axis direction in accordance to the measurement position in the phantom.

Brachytherapy in the treatment of head and neck cancer

International Nuclear Information System (INIS)

Yoo, Seong Yul

1999-01-01

Brachytherapy has been proved to be an effective method for the purpose of increasing radiation dose to the tumor and reducing the dose to the surrounding normal tissue. In head and neck cancer, the rationale of brachytherapy is as follows; Firstly, early small lesion is radiocurative and the major cause of failure is local recurrence. Secondly, it can diminish evidently the dose to the normal tissue especially masseteric muscle and salivary gland. Thirdly, the anatomy of head and neck is suitable to various technique of brachytherapy. On background of accumulated experience of LDR iridium brachytherapy of head and neck cancer for the last 15 years, the author reviewed the history of radioisotope therapy, the characteristics of radionuclides, and some important things in the method, clinical technique and treatment planning. The author analyzed the clinical result of 185 cases of head and neck cancer treated in the Korea Cancer Center Hospital. Finally the future prospect of brachytherapy of head and neck cancer is discussed

SU-E-J-229: Quantitative Assessment for Timely Adaptive Re-Planning Using Weekly Dose Monitoring for Head and Neck Cancer

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Shang, Q; Liu, H; Greskovich, J; Koyfman, S; Xia, P [Cleveland Clinic, Cleveland, OH (United States); Li, Z [Cleveland Clinic, Cleveland, OH (United States); the 6th people' s hospital of Shanghai Jiaotong University, Shanghai, Shanghai (China)

2014-06-01

Purpose: For patients with head and neck (HN) cancer, mid-course adaptive radiation therapy (ART) is a common practice in our institution to accommodate anatomic changes. The aim of the study is to evaluate whether dose re-calculation on weekly verification images can provide quantitative assessment for timely adaptive re-planning with daily image-guided intensity modulated radiotherapy (IMRT). Methods: We retrospectively selected sixty daily verification images acquired on CT-on-rail/CBCT from ten HN patients. These image sets were typically a week apart. Among these patients, six patients received a mid-course ART. Contours of the tumors and organ-at-risks (OARs) were manually delineated by a physician on each verification CT. After placing the treatment iso-center on the verification CTs according to the recorded clinical shifts, daily dose was re-calculated with the same beam configuration as the original plan. For the purpose of this study, electron densities for both verification CTs and planning CTs were set to 1.0 g/cm3. Results: Two patients had D99 of the CTV < 97% of the planned dose for more than three fractions due to remarkable tumor volume shrinkages. D-max of the spinal cord exceeded a tolerance of 45 Gy for four fractions in additional two patients. D-mean of the parotid increased within 25% of the planned value. D-max of the brainstem and D-mean of the oral cavity did not show significant variation. If the re-planning criteria included D99 of the CTV < 97% of the planned dose and D-max of the spinal cord > 45 Gy, two out ten patients required ART at week 2 and two patients required ART at week 3, respectively. Conclusion: Weekly dose monitoring with re-calculation on verification images can provide quantitative dose guidance for timely adaptive re-planning. Future work will include accumulative dose analysis for the decision of adaptive re-planning. The study is supported in part by Siemens Medical Solutions.

Neck muscle atrophy and soft-tissue fibrosis after neck dissection and postoperative radiotherapy for oral cancer

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Kim, Jinu; Shin, Eun Seow; Kim, Jeong Eon; Yoon, Sang Pil [Jeju National University School of Medicine, Jeju (Korea, Republic of); Kim, Young Suk [Dept. of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of)

2015-12-15

Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.

Prospective estimation of organ dose in CT under tube current modulation

International Nuclear Information System (INIS)

Tian, Xiaoyu; Li, Xiang; Segars, W. Paul; Frush, Donald P.; Samei, Ehsan

2015-01-01

Purpose: Computed tomography (CT) has been widely used worldwide as a tool for medical diagnosis and imaging. However, despite its significant clinical benefits, CT radiation dose at the population level has become a subject of public attention and concern. In this light, optimizing radiation dose has become a core responsibility for the CT community. As a fundamental step to manage and optimize dose, it may be beneficial to have accurate and prospective knowledge about the radiation dose for an individual patient. In this study, the authors developed a framework to prospectively estimate organ dose for chest and abdominopelvic CT exams under tube current modulation (TCM). Methods: The organ dose is mainly dependent on two key factors: patient anatomy and irradiation field. A prediction process was developed to accurately model both factors. To model the anatomical diversity and complexity in the patient population, the authors used a previously developed library of computational phantoms with broad distributions of sizes, ages, and genders. A selected clinical patient, represented by a computational phantom in the study, was optimally matched with another computational phantom in the library to obtain a representation of the patient’s anatomy. To model the irradiation field, a previously validated Monte Carlo program was used to model CT scanner systems. The tube current profiles were modeled using a ray-tracing program as previously reported that theoretically emulated the variability of modulation profiles from major CT machine manufacturers Li et al., [Phys. Med. Biol. 59, 4525–4548 (2014)]. The prediction of organ dose was achieved using the following process: (1) CTDI vol -normalized-organ dose coefficients (h organ ) for fixed tube current were first estimated as the prediction basis for the computational phantoms; (2) each computation phantom, regarded as a clinical patient, was optimally matched with one computational phantom in the library; (3) to

Evaluation of DVH-based treatment plan verification in addition to gamma passing rates for head and neck IMRT

International Nuclear Information System (INIS)

Visser, Ruurd; Wauben, David J.L.; Groot, Martijn de; Steenbakkers, Roel J.H.M.; Bijl, Henk P.; Godart, Jeremy; Veld, Aart A. van’t; Langendijk, Johannes A.; Korevaar, Erik W.

2014-01-01

Background and purpose: Treatment plan verification of intensity modulated radiotherapy (IMRT) is generally performed with the gamma index (GI) evaluation method, which is difficult to extrapolate to clinical implications. Incorporating Dose Volume Histogram (DVH) information can compensate for this. The aim of this study was to evaluate DVH-based treatment plan verification in addition to the GI evaluation method for head and neck IMRT. Materials and methods: Dose verifications of 700 subsequent head and neck cancer IMRT treatment plans were categorised according to gamma and DVH-based action levels. Fractionation dependent absolute dose limits were chosen. The results of the gamma- and DVH-based evaluations were compared to the decision of the medical physicist and/or radiation oncologist for plan acceptance. Results: Nearly all treatment plans (99.7%) were accepted for treatment according to the GI evaluation combined with DVH-based verification. Two treatment plans were re-planned according to DVH-based verification, which would have been accepted using the evaluation alone. DVH-based verification increased insight into dose delivery to patient specific structures increasing confidence that the treatment plans were clinically acceptable. Moreover, DVH-based action levels clearly distinguished the role of the medical physicist and radiation oncologist within the Quality Assurance (QA) procedure. Conclusions: DVH-based treatment plan verification complements the GI evaluation method improving head and neck IMRT-QA

Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

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Ana Lecia Carneiro Leão de Araújo Lima

Full Text Available ABSTRACT OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur with femoral neck fractures or transtrochanteric fractures. METHODS: Cervicodiaphyseal angle (CDA, femoral neck width (FNW, hip axis length (HAL, and acetabular tear drop distance (ATD were analyzed in 30 pelvis anteroposterior view X-rays of patients with femoral neck fractures (n = 15 and transtrochanteric fractures (n = 15. The analysis was performed by comparing the results of the X-rays with femoral neck fractures and with transtrochanteric fractures. RESULTS: No statistically significant differences between samples were observed. CONCLUSION: There was no correlation between radiographic parameters evaluated and specific occurrence of femoral neck fractures or transtrochanteric fractures.

Comparative study between IMRT planning and RapidArc® sliding window for head and neck tumors

International Nuclear Information System (INIS)

Pirani, Luiz F.; Silva, Leonardo P.; Lima, Marilia B.; Bittencourt, Guilherme R.; Ferreira, Anne Caroline M.; Batista, Delano V.S.

2012-01-01

This study aims to evaluate the RapidArc (RA) technique in the treatment of head and neck tumors and compare the results of treatments with intensity modulated radiation therapy (IMRT) in the National Cancer Institute (INCA). Head and neck carcinomas have a natural history with relative expansion to others regions, especially in advanced levels. Faster treatments, with better coverage of the Planning Target Volume (PTV) and sparing more risks organs (ROs) are necessary and bring a better clinical impact. Ten patients with head and neck cancer, planned with IMRT technique were replanned using the RA technique. Some dosimetric indexes were calculated for both techniques, with the intention of verifying which of them, at the same time, would promote greater coverage of the PTV and preserve more healthy tissue. In terms of coverage, both indexes were similar. The RA technique was more efficient for delivered doses to ROs. The number of monitor units (MU), number of fields and treatments time estimated were lower than IMRT technique. Finally, the results have showed that the RA technique clearly reduces the treatment time, reducing the average and maximum dose to ROs and conforming the target as IMRT technique. (author)

Is neck tilt and shoulder imbalance the same phenomenon? A prospective analysis of 89 adolescent idiopathic scoliosis patients (Lenke type 1 and 2).

Science.gov (United States)

Kwan, Mun Keong; Wong, Kai Ann; Lee, Chee Kean; Chan, Chris Yin Wei

2016-02-01

To introduce a new clinical neck tilt grading and to investigate clinically and radiologically whether neck tilt and shoulder imbalance is the same phenomenon in AIS patients. 89 AIS Lenke 1 and 2 cases were assessed prospectively using the new clinical neck tilt grading. Shoulder imbalance and neck tilt were correlated with coracoid height difference (CHD), clavicle\\rib intersection distance (CRID), clavicle angle (CA), radiographic shoulder height (RSH), T1 tilt and cervical axis. Mean age was 17.2 ± 3.8 years old. 66.3 % were Lenke type 1 and 33.7 % were type 2 curves. Strong intraobserver (0.79) and interobserver (0.75) agreement of the clinical neck tilt grading was noted. No significant correlation was observed between clinical neck tilt and shoulder imbalance (0.936). 56.3 % of grade 3 neck tilt, 50.0 % grade 2 neck tilt patients had grade 0 shoulder imbalance. In patients with grade 2 shoulder imbalance, 42.9 % had grade 0, 35.7 % grade 1, 14.3 % grade 2 and only 7.1 % had grade 3 neck tilt. CHD, CRID, CA and RSH correlated with shoulder imbalance. T1 tilt and cervical axis measurements correlated with neck tilt. In conclusion, neck tilt is distinct from shoulder imbalance. Clinical neck tilt has poor correlation with clinical shoulder imbalance. Clinical neck tilt grading correlated with cervical axis and T1 tilt whereas clinical shoulder grading correlated with CHD, RSH CRID and CA.

Preliminary analysis of the sequential simultaneous integrated boost technique for intensity-modulated radiotherapy for head and neck cancers.

Science.gov (United States)

Miyazaki, Masayoshi; Nishiyama, Kinji; Ueda, Yoshihiro; Ohira, Shingo; Tsujii, Katsutomo; Isono, Masaru; Masaoka, Akira; Teshima, Teruki

2016-07-01

The aim of this study was to compare three strategies for intensity-modulated radiotherapy (IMRT) for 20 head-and-neck cancer patients. For simultaneous integrated boost (SIB), doses were 66 and 54 Gy in 30 fractions for PTVboost and PTVelective, respectively. Two-phase IMRT delivered 50 Gy in 25 fractions to PTVelective in the First Plan, and 20 Gy in 10 fractions to PTVboost in the Second Plan. Sequential SIB (SEQ-SIB) delivered 55 Gy and 50 Gy in 25 fractions, respectively, to PTVboost and PTVelective using SIB in the First Plan and 11 Gy in 5 fractions to PTVboost in the Second Plan. Conformity indexes (CIs) (mean ± SD) for PTVboost and PTVelective were 1.09 ± 0.05 and 1.34 ± 0.12 for SIB, 1.39 ± 0.14 and 1.80 ± 0.28 for two-phase IMRT, and 1.14 ± 0.07 and 1.60 ± 0.18 for SEQ-SIB, respectively. CI was significantly highest for two-phase IMRT. Maximum doses (Dmax) to the spinal cord were 42.1 ± 1.5 Gy for SIB, 43.9 ± 1.0 Gy for two-phase IMRT and 40.3 ± 1.8 Gy for SEQ-SIB. Brainstem Dmax were 50.1 ± 2.2 Gy for SIB, 50.5 ± 4.6 Gy for two-phase IMRT and 47.4 ± 3.6 Gy for SEQ-SIB. Spinal cord Dmax for the three techniques was significantly different, and brainstem Dmax was significantly lower for SEQ-SIB. The compromised conformity of two-phase IMRT can result in higher doses to organs at risk (OARs). Lower OAR doses in SEQ-SIB made SEQ-SIB an alternative to SIB, which applies unconventional doses per fraction. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

A user's guide to the inhalation and external radiation collective dose module NECTAR-POPDOS

International Nuclear Information System (INIS)

Merlin, J.H.

1982-02-01

NECTAR-POPDOS is a module of the computer program NECTAR, which has been written in modular form to evaluate radioactive releases from nuclear fuel, their dispersion in the environment and the consequent individual and collective doses to man. The NECTAR-POPDOS module may be used to evaluate external and inhalation collective doses to any specified area of Great Britain, either to the total population or to any one of six age groups, using population data from the 1971 UK census. If a dose-risk function is defined, the module may be used to assess population health effects or for optimisation studies. The module is based on the stand-alone program POPDOS2, and is written in Fortran IV. The input data to the module is described and the module's limitations and sources of inaccuracy are discussed. Appendices to the report contain the necessary Job Control Language for running NECTAR, a list of NECTAR-POPDOS subroutines, and the input and output of two sample NECTAR-POPDOS cases. (author)

Radiation therapy technology innovations applied to the treatment of head and neck patients: - Clinical results of Intensity Modulated Radiotherapy (IMRT), - Contribution of Image Guided Radiotherapy (IGRT) in the management of head and neck patients treated with IMRT

International Nuclear Information System (INIS)

Graff-Cailleaud, Pierre

2011-01-01

Numerous and exciting technological innovations were recently developed in radiotherapy. We aimed to assess benefits in two specific fields. 1) Clinical results of Intensity Modulated Radiotherapy (IMRT) applied to the treatment of Head and Neck (H and N) patients. The first study was a long-term mono-centric prospective registration of all H and N patients treated with IMRT in our institution. Locoregional control was excellent and toxicities limited. Recurrences were in-field. Dosimetric recommendations (parotids mean dose) were established. The second study assessed the impact of IMRT on health-related quality of life for H and N patients through a multicentric matched-pair comparison with conventional radiotherapy. Outstanding benefits were observed particularly in the fields of salivary dysfunction and oral discomfort. 2) Contribution of Image Guided Radiotherapy (IGRT) in the management of H and N patients treated with IMRT. The first study was a monitoring of delivered dose, using 3D dose recalculation from Megavoltage Cone-Beam CT (CBCT), as a quality assurance measure of a panel of H and N IMRT patients aligned with IGRT. Dosimetric consequences of anatomical changes were assessed. Contribution of color-coded MVCBCT dose-difference maps was studied. The aim of the second study was to quantify the inherent relative mobility between anatomic regions of the H and N area and to assess the dosimetric impact of several different matching procedures. Recommendations for the use of CBCT images in a daily practice were established. (author) [fr

Superstability for Generalized Module Left Derivations and Generalized Module Derivations on a Banach Module (I

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Huai-Xin Cao

2009-01-01

Full Text Available We discuss the superstability of generalized module left derivations and generalized module derivations on a Banach module. Let 𝒜 be a Banach algebra and X a Banach 𝒜-module, f:X→X and g:𝒜→𝒜. The mappings Δf,g1, Δf,g2, Δf,g3, and Δf,g4 are defined and it is proved that if ∥Δf,g1(x,y,z,w∥ (resp., ∥Δf,g3(x,y,z,w,α,β∥ is dominated by φ(x,y,z,w, then f is a generalized (resp., linear module-𝒜 left derivation and g is a (resp., linear module-X left derivation. It is also shown that if ∥Δf,g2(x,y,z,w∥ (resp., ∥Δf,g4(x,y,z,w,α,β∥ is dominated by φ(x,y,z,w, then f is a generalized (resp., linear module-𝒜 derivation and g is a (resp., linear module-X derivation.

Parotid Gland Sparing With Helical Tomotherapy in Head-and-Neck Cancer

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Voordeckers, Mia; Farrag, Ashraf; Everaert, Hendrik; Tournel, Koen; Storme, Guy; Verellen, Dirk; De Ridder, Mark

2012-01-01

Purpose: This study evaluated the ability of helical tomotherapy to spare the function of the parotid glands in patients with head-and-neck cancer by analyzing dose–volume histograms, salivary gland scintigraphy, and quality of life assessment. Methods and Materials: Data from 76 consecutive patients treated with helical tomotherapy (Hi-Art Tomotherapy) at University Hospital Brussel were analyzed. During planning, priority was given to planning target volume (PTV) coverage: ≥95% of the dose must be delivered to ≥95% of the PTV. Elective nodal regions received 54 Gy (1.8 Gy/fraction). A dose of 70.5 Gy (2.35 Gy/fraction) was prescribed to the primary tumor and pathologic lymph nodes (simultaneous integrated boost scheme). Objective scoring of salivary excretion was performed by salivary gland scintigraphy. Subjective scoring of salivary gland function was evaluated by the European Organization for Research and Treatment of Cancer quality of life questionnaires Quality of Life Questionnaire—C30 (QLQ-C30) and Quality of Life Questionnaire—Head and Neck 35 (H and N35). Results: Analysis of dose–volume histograms (DVHs) showed excellent coverage of the PTV. The volume of PTV receiving 95% of the prescribed dose (V95%) was 99.4 (range, 96.3–99.9). DVH analysis of parotid gland showed a median value of the mean parotid dose of 32.1 Gy (range, 17.5–70.3 Gy). The median parotid volume receiving a dose <26 Gy was 51.2%. Quality of life evaluation demonstrated an initial deterioration of almost all scales and items in QLQ-C30 and QLQ-H and N35. Most items improved in time, and some reached baseline values 18 months after treatment. Conclusion: DVH analysis, scintigraphic evaluation of parotid function, and quality of life assessment of our patient group showed that helical tomotherapy makes it possible to preserve parotid gland function without compromising disease control. We recommend mean parotid doses of <34 Gy and doses <26 Gy to a maximum 47% of the

Z2×Z2 generalizations of 𝒩 =2 super Schrödinger algebras and their representations

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Aizawa, N.; Segar, J.

2017-11-01

We generalize the real and chiral N =2 super Schrödinger algebras to Z2×Z2-graded Lie superalgebras. This is done by D-module presentation, and as a consequence, the D-module presentations of Z2×Z2-graded superalgebras are identical to the ones of super Schrödinger algebras. We then generalize the calculus over the Grassmann number to Z2×Z2 setting. Using it and the standard technique of Lie theory, we obtain a vector field realization of Z2×Z2-graded superalgebras. A vector field realization of the Z2×Z2 generalization of N =1 super Schrödinger algebra is also presented.

Intensity modulated operating mode of the rotating gamma system.

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Sengupta, Bishwambhar; Gulyas, Laszlo; Medlin, Donald; Koroknai, Tibor; Takacs, David; Filep, Gyorgy; Panko, Peter; Godo, Bence; Hollo, Tamas; Zheng, Xiao Ran; Fedorcsak, Imre; Dobai, Jozsef; Bognar, Laszlo; Takacs, Endre

2018-05-01

The purpose of this work was to explore two novel operation modalities of the rotating gamma systems (RGS) that could expand its clinical application to lesions in close proximity to critical organs at risk (OAR). The approach taken in this study consists of two components. First, a Geant4-based Monte Carlo (MC) simulation toolkit is used to model the dosimetric properties of the RGS Vertex 360™ for the normal, intensity modulated radiosurgery (IMRS), and speed modulated radiosurgery (SMRS) operation modalities. Second, the RGS Vertex 360™ at the Rotating Gamma Institute in Debrecen, Hungary is used to collect experimental data for the normal and IMRS operation modes. An ion chamber is used to record measurements of the absolute dose. The dose profiles are measured using Gafchromic EBT3 films positioned within a spherical water equivalent phantom. A strong dosimetric agreement between the measured and simulated dose profiles and penumbra was found for both the normal and IMRS operation modes for all collimator sizes (4, 8, 14, and 18 mm diameter). The simulated falloff and maximum dose regions agree better with the experimental results for the 4 and 8 mm diameter collimators. Although the falloff regions align well in the 14 and 18 mm collimators, the maximum dose regions have a larger difference. For the IMRS operation mode, the simulated and experimental dose distributions are ellipsoidal, where the short axis aligns with the blocked angles. Similarly, the simulated dose distributions for the SMRS operation mode also adopt an ellipsoidal shape, where the short axis aligns with the angles where the orbital speed is highest. For both modalities, the dose distribution is highly constrained with a sharper penumbra along the short axes. Dose modulation of the RGS can be achieved with the IMRS and SMRS modes. By providing a highly constrained dose distribution with a sharp penumbra, both modes could be clinically applicable for the treatment of lesions in close

Whole-heart 320-row computed tomography. Reduction of radiation dose via prior coronary calcium scanning

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Zimmermann, E.; Dewey, M. [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

2011-01-15

Purpose: The whole heart can be scanned in one rotation using 320-row coronary computed tomography angiography (CCTA), which covers up to 16 cm. Since most hearts are smaller, the total radiation dose may be reduced by adjusting the CCTA range to the individual heart size defined on a low-dose calcium scan (CACS). Materials and Methods: Forty-five patients with suspected coronary artery disease (13 women, 32 men; mean 61 {+-} 10 years) underwent CCTA preceded by low-dose CACS on a 320-row scanner (Aquilion ONE, Toshiba; 0.35 s gantry rotation, 120 kV, 350 - 450 mA) with 16-cm z-axis coverage (120 kV, 150 mA). The subsequent CCTA was performed over an adjusted scan range calculated as the individual heart size on CACS ({+-} 1 cm above and below). The total radiation dose of 16-cm CACS and the individually adjusted CCTA was compared with that of a calculated single CCTA using full 16-cm z-axis coverage. Results: CCTA could be performed with a reduced scan length in the z-axis in all patients. None of the scans had to be performed over the whole range of 16 cm. The adjusted scan length was 14 cm in 2 patients, 12.8 cm in 3 patients, and 12 cm in 40 patients. The effective CCTA scan range was 12.1 {+-} 0.5 cm based on mean individual heart sizes of 9.6 {+-} 1.1 cm. The mean total effective radiation dose of the entire cardiac CT examination (individually adapted CCTA and CACS) was significantly smaller than the exposure calculated for 16-cm CCTA without CACS (8.5 {+-} 4.7 vs. 9.1 {+-} 6.0 mSv, p = 0.006). The dose reduction was most relevant in patients with heart rates above 65 beats/min (n = 10) in whom 2 or 3 heartbeats were necessary for CCTA (17.7 {+-} 6.5 vs. 21.1 {+-} 8.4 mSv, p = 0.001). Conclusion: 320-row CCTA with an individually adjusted scan range based on prior CACS significantly reduces the radiation exposure compared with full 16-cm CCTA. (orig.)

Incorporating single-side sparing in models for predicting parotid dose sparing in head and neck IMRT

International Nuclear Information System (INIS)

Yuan, Lulin; Wu, Q. Jackie; Yin, Fang-Fang; Yoo, David; Jiang, Yuliang; Ge, Yaorong

2014-01-01

Purpose: Sparing of single-side parotid gland is a common practice in head-and-neck (HN) intensity modulated radiation therapy (IMRT) planning. It is a special case of dose sparing tradeoff between different organs-at-risk. The authors describe an improved mathematical model for predicting achievable dose sparing in parotid glands in HN IMRT planning that incorporates single-side sparing considerations based on patient anatomy and learning from prior plan data. Methods: Among 68 HN cases analyzed retrospectively, 35 cases had physician prescribed single-side parotid sparing preferences. The single-side sparing model was trained with cases which had single-side sparing preferences, while the standard model was trained with the remainder of cases. A receiver operating characteristics (ROC) analysis was performed to determine the best criterion that separates the two case groups using the physician's single-side sparing prescription as ground truth. The final predictive model (combined model) takes into account the single-side sparing by switching between the standard and single-side sparing models according to the single-side sparing criterion. The models were tested with 20 additional cases. The significance of the improvement of prediction accuracy by the combined model over the standard model was evaluated using the Wilcoxon rank-sum test. Results: Using the ROC analysis, the best single-side sparing criterion is (1) the predicted median dose of one parotid is higher than 24 Gy; and (2) that of the other is higher than 7 Gy. This criterion gives a true positive rate of 0.82 and a false positive rate of 0.19, respectively. For the bilateral sparing cases, the combined and the standard models performed equally well, with the median of the prediction errors for parotid median dose being 0.34 Gy by both models (p = 0.81). For the single-side sparing cases, the standard model overestimates the median dose by 7.8 Gy on average, while the predictions by the combined

Accurate Bessel functions Jsub(n)(z), Ysub(n)(z), Hsub(n)sup((1))(z) and Hsub(n)sup((2))(z) of integer order and complex argument

International Nuclear Information System (INIS)

Ardill, R.W.B.; Moriarty, K.J.M.

1979-01-01

The Bessel function appears in a wide range of physical applications, and in particular where there is axial symmetry. The package contains complex function routines to calculate Jsub(n)(z), Ysub(n)(z), Hsub(n)sup((1))(z) and Hsub(n)sup((2))(z) for integer n and complex z. The method of solution is based on the ascending series representations and asymptotic forms of the Bessel functions Jsub(n)(z) and Ysub(n)(z) and asymptotic forms of the modified Bessel functions Isub(n)(z) and Ksub(n)(z). The program will return results for all values of mod(z) up to machine overflows in the Bessel functions. The size of the order should not be too large (say, mod(n) -11 . For the asymptotic region, the accuracy EPS may not always be achieved (since the asymptotic series may have to be truncated at their lower terms), in which case the output parameter ISET will indicate this and an estimation of the relative error is also produced. The functions Ysub(n)(z), Hsub(n)sup((1))(z) and Hsub(n)sup((2))(z) have a branch point at the origin, together with a cut along the negative real axis. (Auth.)

Comparison of measurement methods with a mixed effects procedure accounting for replicated evaluations (COM3PARE): method comparison algorithm implementation for head and neck IGRT positional verification.

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Roy, Anuradha; Fuller, Clifton D; Rosenthal, David I; Thomas, Charles R

2015-08-28

Comparison of imaging measurement devices in the absence of a gold-standard comparator remains a vexing problem; especially in scenarios where multiple, non-paired, replicated measurements occur, as in image-guided radiotherapy (IGRT). As the number of commercially available IGRT presents a challenge to determine whether different IGRT methods may be used interchangeably, an unmet need conceptually parsimonious and statistically robust method to evaluate the agreement between two methods with replicated observations. Consequently, we sought to determine, using an previously reported head and neck positional verification dataset, the feasibility and utility of a Comparison of Measurement Methods with the Mixed Effects Procedure Accounting for Replicated Evaluations (COM3PARE), a unified conceptual schema and analytic algorithm based upon Roy's linear mixed effects (LME) model with Kronecker product covariance structure in a doubly multivariate set-up, for IGRT method comparison. An anonymized dataset consisting of 100 paired coordinate (X/ measurements from a sequential series of head and neck cancer patients imaged near-simultaneously with cone beam CT (CBCT) and kilovoltage X-ray (KVX) imaging was used for model implementation. Software-suggested CBCT and KVX shifts for the lateral (X), vertical (Y) and longitudinal (Z) dimensions were evaluated for bias, inter-method (between-subject variation), intra-method (within-subject variation), and overall agreement using with a script implementing COM3PARE with the MIXED procedure of the statistical software package SAS (SAS Institute, Cary, NC, USA). COM3PARE showed statistically significant bias agreement and difference in inter-method between CBCT and KVX was observed in the Z-axis (both p - value<0.01). Intra-method and overall agreement differences were noted as statistically significant for both the X- and Z-axes (all p - value<0.01). Using pre-specified criteria, based on intra-method agreement, CBCT was deemed

Dosimetric Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Squamous Cell Carcinoma of the Head and Neck

International Nuclear Information System (INIS)

Caudell, Jimmy J.; Schaner, Philip E.; Desmond, Renee A.; Meredith, Ruby F.; Spencer, Sharon A.; Bonner, James A.

2010-01-01

Purpose: Intensification of radiotherapy and chemotherapy for head-and-neck cancer may lead to increased rates of dysphagia. Dosimetric predictors of objective findings of long-term dysphagia were sought. Methods and Materials: From an institutional database, 83 patients were identified who underwent definitive intensity-modulated radiotherapy for squamous cell carcinoma of the head and neck, after exclusion of those who were treated for a second or recurrent head-and-neck primary lesion, had locoregional recurrence at any time, had less than 12 months of follow-up, or had postoperative radiotherapy. Dosimetric parameters were analyzed relative to three objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy (PEG) tube dependence at 12 months, aspiration on modified barium swallow, or pharyngoesophageal stricture requiring dilation. Results: Mean dose greater than 41 Gy and volume receiving 60 Gy (V 60 ) greater than 24% to the larynx were significantly associated with PEG tube dependence and aspiration. V 60 greater than 12% to the inferior pharyngeal constrictor was also significantly associated with increased PEG tube dependence and aspiration. V 65 greater than 33% to the superior pharyngeal constrictor or greater than 75% to the middle pharyngeal constrictor was associated with pharyngoesophageal stricture requiring dilation. Conclusions: Doses to the larynx and pharyngeal constrictors predicted long-term swallowing complications, even when controlled for other clinical factors. The addition of these structures to intensity-modulated radiotherapy optimization may reduce the incidence of dysphagia, although cautious clinical validation is necessary.

Acetylcholine Modulates the Hormones of the Growth Hormone/Insulinlike Growth Factor-1 Axis During Development in Mice.

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Lecomte, Marie-José; Bertolus, Chloé; Ramanantsoa, Nélina; Saurini, Françoise; Callebert, Jacques; Sénamaud-Beaufort, Catherine; Ringot, Maud; Bourgeois, Thomas; Matrot, Boris; Collet, Corinne; Nardelli, Jeannette; Mallet, Jacques; Vodjdani, Guilan; Gallego, Jorge; Launay, Jean-Marie; Berrard, Sylvie

2018-04-01

Pituitary growth hormone (GH) and insulinlike growth factor (IGF)-1 are anabolic hormones whose physiological roles are particularly important during development. The activity of the GH/IGF-1 axis is controlled by complex neuroendocrine systems including two hypothalamic neuropeptides, GH-releasing hormone (GHRH) and somatostatin (SRIF), and a gastrointestinal hormone, ghrelin. The neurotransmitter acetylcholine (ACh) is involved in tuning GH secretion, and its GH-stimulatory action has mainly been shown in adults but is not clearly documented during development. ACh, together with these hormones and their receptors, is expressed before birth, and somatotroph cells are already responsive to GHRH, SRIF, and ghrelin. We thus hypothesized that ACh could contribute to the modulation of the main components of the somatotropic axis during development. In this study, we generated a choline acetyltransferase knockout mouse line and showed that heterozygous mice display a transient deficit in ACh from embryonic day 18.5 to postnatal day 10, and they recover normal ACh levels from the second postnatal week. This developmental ACh deficiency had no major impact on weight gain and cardiorespiratory status of newborn mice. Using this mouse model, we found that endogenous ACh levels determined the concentrations of circulating GH and IGF-1 at embryonic and postnatal stages. In particular, serum GH level was correlated with brain ACh content. ACh also modulated the levels of GHRH and SRIF in the hypothalamus and ghrelin in the stomach, and it affected the levels of these hormones in the circulation. This study identifies ACh as a potential regulator of the somatotropic axis during the developmental period.

Thermal adaptation of mesophilic and thermophilic FtsZ assembly by modulation of the critical concentration.

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Luis Concha-Marambio

Full Text Available Cytokinesis is the last stage in the cell cycle. In prokaryotes, the protein FtsZ guides cell constriction by assembling into a contractile ring-shaped structure termed the Z-ring. Constriction of the Z-ring is driven by the GTPase activity of FtsZ that overcomes the energetic barrier between two protein conformations having different propensities to assemble into polymers. FtsZ is found in psychrophilic, mesophilic and thermophilic organisms thereby functioning at temperatures ranging from subzero to >100°C. To gain insight into the functional adaptations enabling assembly of FtsZ in distinct environmental conditions, we analyzed the energetics of FtsZ function from mesophilic Escherichia coli in comparison with FtsZ from thermophilic Methanocaldococcus jannaschii. Presumably, the assembly may be similarly modulated by temperature for both FtsZ orthologs. The temperature dependence of the first-order rates of nucleotide hydrolysis and of polymer disassembly, indicated an entropy-driven destabilization of the FtsZ-GTP intermediate. This destabilization was true for both mesophilic and thermophilic FtsZ, reflecting a conserved mechanism of disassembly. From the temperature dependence of the critical concentrations for polymerization, we detected a change of opposite sign in the heat capacity, that was partially explained by the specific changes in the solvent-accessible surface area between the free and polymerized states of FtsZ. At the physiological temperature, the assembly of both FtsZ orthologs was found to be driven by a small positive entropy. In contrast, the assembly occurred with a negative enthalpy for mesophilic FtsZ and with a positive enthalpy for thermophilic FtsZ. Notably, the assembly of both FtsZ orthologs is characterized by a critical concentration of similar value (1-2 μM at the environmental temperatures of their host organisms. These findings suggest a simple but robust mechanism of adaptation of FtsZ, previously shown

Radiation dose response simulation for biomechanical-based deformable image registration of head and neck cancer treatment

International Nuclear Information System (INIS)

Al-Mayah, Adil; Moseley, Joanne; Hunter, Shannon; Brock, Kristy

2015-01-01

Biomechanical-based deformable image registration is conducted on the head and neck region. Patient specific 3D finite element models consisting of parotid glands (PG), submandibular glands (SG), tumor, vertebrae (VB), mandible, and external body are used to register pre-treatment MRI to post-treatment MR images to model the dose response using image data of five patients. The images are registered using combinations of vertebrae and mandible alignments, and surface projection of the external body as boundary conditions. In addition, the dose response is simulated by applying a new loading technique in the form of a dose-induced shrinkage using the dose-volume relationship. The dose-induced load is applied as dose-induced shrinkage of the tumor and four salivary glands. The Dice Similarity Coefficient (DSC) is calculated for the four salivary glands, and tumor to calculate the volume overlap of the structures after deformable registration. A substantial improvement in the registration is found by including the dose-induced shrinkage. The greatest registration improvement is found in the four glands where the average DSC increases from 0.53, 0.55, 0.32, and 0.37 to 0.68, 0.68, 0.51, and 0.49 in the left PG, right PG, left SG, and right SG, respectively by using bony alignment of vertebrae and mandible (M), body (B) surface projection and dose (D) (VB+M+B+D). (paper)

Evaluation of radiotherapy methods for adaptative head and neck treatment with RapidArc®

International Nuclear Information System (INIS)

Mazaro, Sarah J.; Vasconcellos, Herminiane L.; Silva, Laura E. da; Bastos, Fernanda M.; Silva, Leonardo P. da; Alvaro S; Migoviski, Igor

2015-01-01

Head and neck cancer is considered a public health problem worldwide. The intensity-modulated techniques have shown benefit in the treatment of these sites, particularly with respect to reduction of deterministic effects of risk, such as parotid. Anatomical variations in cases of head and neck are very frequent and may lead, for example, to an overdose in the parotid. This can be mitigated if making use of adaptive radiation therapy. The work aims to analyze a methodology to redo the planning of treatments, through 02 acquisitions of TC. The results showed that, due to a reduction in the volumes of the parotid, the doses delivered to these organs are underestimated, which is relevant to readapt the treatment, with the addition of only a second scan without the need of the third. (author)

Analytical equations for CT dose profiles derived using a scatter kernel of Monte Carlo parentage with broad applicability to CT dosimetry problems

International Nuclear Information System (INIS)

Dixon, Robert L.; Boone, John M.

2011-01-01

Purpose: Knowledge of the complete axial dose profile f(z), including its long scatter tails, provides the most complete (and flexible) description of the accumulated dose in CT scanning. The CTDI paradigm (including CTDI vol ) requires shift-invariance along z (identical dose profiles spaced at equal intervals), and is therefore inapplicable to many of the new and complex shift-variant scan protocols, e.g., high dose perfusion studies using variable (or zero) pitch. In this work, a convolution-based beam model developed by Dixon et al.[Med. Phys. 32, 3712-3728, (2005)] updated with a scatter LSF kernel (or DSF) derived from a Monte Carlo simulation by Boone [Med. Phys. 36, 4547-4554 (2009)] is used to create an analytical equation for the axial dose profile f(z) in a cylindrical phantom. Using f(z), equations are derived which provide the analytical description of conventional (axial and helical) dose, demonstrating its physical underpinnings; and likewise for the peak axial dose f(0) appropriate to stationary phantom cone beam CT, (SCBCT). The methodology can also be applied to dose calculations in shift-variant scan protocols. This paper is an extension of our recent work Dixon and Boone [Med. Phys. 37, 2703-2718 (2010)], which dealt only with the properties of the peak dose f(0), its relationship to CTDI, and its appropriateness to SCBCT. Methods: The experimental beam profile data f(z) of Mori et al.[Med. Phys. 32, 1061-1069 (2005)] from a 256 channel prototype cone beam scanner for beam widths (apertures) ranging from a = 28 to 138 mm are used to corroborate the theoretical axial profiles in a 32 cm PMMA body phantom. Results: The theoretical functions f(z) closely-matched the central axis experimental profile data 11 for all apertures (a = 28 -138 mm). Integration of f(z) likewise yields analytical equations for all the (CTDI-based) dosimetric quantities of conventional CT (including CTDI L itself) in addition to the peak dose f(0) relevant to SCBCT