Table of contents

Substantial changes in ion chamber perturbation correction factors in ⁶⁰Co γ-rays, suggested by recent Monte Carlo (MC) calculations, would cause a decrease of about 1.5% in the reference dosimetry of all types of charged particles (electrons, protons and heavier ions) based on calculated k_Q values. It has gone largely unnoticed that the ratio of calibration coefficients N_{D, w, Co60} and N_{K, air, Co60} yields an experimental value of F_{ch, Co60} = (s_w-air p_ch)_Co60 through N_{D, air, Co60}. Coefficients provided by the IAEA and traceable to the BIPM for 91 NE-2571 chambers result in an average F_{ch, Co60} which is compared with published (and new) MC simulations and with the value in IAEA TRS-398. It is shown that TRS-398 agrees within 0.12% with the experimental F_{ch, Co60}. The 1.5% difference resulting from MC calculations (1.1% for the new simulations) cannot be justified using current fundamental data and BIPM standards if consistency in the entire dosimetry chain is sought. For photons, MC k_Q factors are compared with TRS-398. Using the same uncertainty for W_air, the two sets of data overlap considerably. Experimental k_Q values from standards laboratories lie between the two sets of calculated values, showing no preference for one set over the other. Observed chamber-to-chamber differences, that include the effect of waterproof sleeves (also seen for ⁶⁰Co), justify the recommendation in TRS-398 for k_Q values specifically measured for the user chamber. Current developments on I-values for the stopping powers of water and graphite are presented. A weighted average I_water = 78 ± 2 eV is obtained from published experimental and DRF-based values; this would decrease s_w-air for all types of radiotherapy beams between 0.3% and 0.6%, and would consequently decrease the MC derived F_{ch, Co60}. The implications of a recent proposal for I_graphite = 81 eV are analysed, resulting in a potential decrease of 0.7% in N_{K, air, Co60} which would raise the experimental F_{ch, Co60}; this would result in an increase of about 0.8% in the current TRS-398 value when referred to the BIPM standards. MC derived F_{ch, Co60} using new stopping powers would then agree at a level of 0.1% with the experimental value, confirming the need for consistency in the dosimetry chain data. Should world average standards be used as reference, the figures would become +0.4% for TRS-398 and −0.3% for the MC calculation. F_{ch, Q} calculated for megavoltage photons using new stopping powers would decrease by between 0.2% and 0.5%. When they enter as a ratios in k_Q, differences with MC values based on current key data would be within 0.2% but their discrepancy with k_Q experimental photon values remains unresolved. For protons the new data would require an increase in W_{air, Q} of about 0.6%, as this is inferred from a combination of calorimetry and ionometry. This consistent scenario would leave unchanged the current TRS-398 k_Q (NE-2571) data for protons, as well as for ions heavier than protons unless new independent W_{air, Q} values become available. Also in these advanced radiotherapy modalities, the need for maintaining data consistency in an analysis that unavoidably must include the complete dosimetry chain is demonstrated.

A novel phantom is presented for 'full system' dosimetric audit comparing planned and delivered dose distributions in HDR gynaecological brachytherapy, using clinical treatment applicators. The brachytherapy applicator dosimetry test object consists of a near full-scatter water tank with applicator and film supports constructed of Solid Water, accommodating any typical cervix applicator. Film dosimeters are precisely held in four orthogonal planes bisecting the intrauterine tube, sampling dose distributions in the high risk clinical target volume, points A and B, bladder, rectum and sigmoid. The applicator position is fixed prior to CT scanning and through treatment planning and irradiation. The CT data is acquired with the applicator in a near clinical orientation to include applicator reconstruction in the system test. Gamma analysis is used to compare treatment planning system exported RTDose grid with measured multi-channel film dose maps. Results from two pilot audits are presented, using Ir-192 and Co-60 HDR sources, with a mean gamma passing rate of 98.6% using criteria of 3% local normalization and 3 mm distance to agreement (DTA). The mean DTA between prescribed dose and measured film dose at point A was 1.2 mm. The phantom was funded by IPEM and will be used for a UK national brachytherapy dosimetry audit.

Stereotactic body radiation therapy (SBRT) has quickly become a preferred treatment option for early-stage lung cancer patients who are ineligible for surgery. This technique uses tightly conformed megavoltage (MV) x-ray beams to irradiate a tumour with ablative doses in only a few treatment fractions. Small high energy x-ray fields can cause lateral electron disequilibrium (LED) to occur within low density media, which can reduce tumour dose. These dose effects may be challenging to predict using analytic dose calculation algorithms, especially at higher beam energies. As a result, previous authors have suggested using low energy photons (<10 MV) and larger fields (>5 × 5 cm²) for lung cancer patients to avoid the negative dosimetric effects of LED. In this work, we propose a new form of SBRT, described as LED-optimized SBRT (LED-SBRT), which utilizes radiotherapy (RT) parameters designed to cause LED to advantage. It will be shown that LED-SBRT creates enhanced dose gradients at the tumour/lung interface, which can be used to manipulate tumour dose, and/or normal lung dose. To demonstrate the potential benefits of LED-SBRT, the DOSXYZnrc (National Research Council of Canada, Ottawa, ON) Monte Carlo (MC) software was used to calculate dose within a cylindrical phantom and a typical lung patient. 6 MV or 18 MV x-ray fields were focused onto a small tumour volume (diameter ∼1 cm). For the phantom, square fields of 1 × 1 cm², 3 × 3 cm², or 5 × 5 cm² were applied. However, in the patient, 3 × 1 cm², 3 × 2 cm², 3 × 2.5 cm², or 3 × 3 cm² field sizes were used in simulations to assure target coverage in the superior–inferior direction. To mimic a 180° SBRT arc in the (symmetric) phantom, a single beam profile was calculated, rotated, and beams were summed at 1° segments to accumulate an arc dose distribution. For the patient, a 360° arc was modelled with 36 equally weighted (and spaced) fields focused on the tumour centre. A planning target volume (PTV) was generated by considering the extent of tumour motion over the patient's breathing cycle and set-up uncertainties. All patient dose results were normalized such that at least 95% of the PTV received at least 54 Gy (i.e. D95 = 54 Gy). Further, we introduce 'LED maps' as a novel clinical tool to compare the magnitude of LED resulting from the various SBRT arc plans. Results from the phantom simulation suggest that the best lung sparing occurred for RT parameters that cause severe LED. For equal tumour dose coverage, normal lung dose (2 cm outside the target region) was reduced from 92% to 23%, comparing results between the 18 MV (5 × 5 cm²) and 18 MV (1 × 1 cm²) arc simulations. In addition to reduced lung dose for the 18 MV (1 × 1 cm²) arc, maximal tumour dose increased beyond 125%. Thus, LED can create steep dose gradients to spare normal lung, while increasing tumour dose levels (if desired). In the patient simulation, a LED-optimized arc plan was designed using either 18 MV (3 × 1 cm²) or 6 MV (3 × 3cm²) beams. Both plans met the D95 dose coverage requirement for the target. However, the LED-optimized plan increased the maximum, mean, and minimum dose within the PTV by as much as 80 Gy, 11 Gy, and 3 Gy, respectively. Despite increased tumour dose levels, the 18 MV (3 × 1 cm²) arc plan improved or maintained the V20, V5, and mean lung dose metrics compared to the 6 MV (3 × 3 cm²) simulation. We conclude that LED-SBRT has the potential to increase dose gradients, and dose levels within a small lung tumour. The magnitude of tumour dose increase or lung sparing can be optimized through manipulation of RT parameters (e.g. beam energy and field size).

This paper presents a numerical study for ultrasound transcranial imaging. To correct for the phase aberration from the skull, two critical steps are needed prior to brain imaging. In the first step, the skull shape and speed of sound are acquired by either CT scans or ultrasound scans. In the ultrasound scan approach, phased array and double focusing technique are utilized, which are able to estimate the thickness of the skull with a maximum error of around 10% and the average speed of sound in the skull is underestimated by less than 2%. In the second step, the fast marching method is used to compute the phase delay based on the known skull shape and sound speed from the first step, and the computation can be completed in seconds for 2D problems. The computed phase delays are then used in combination with the conventional delay-and-sum algorithm for generating B-mode images. Images of wire phantoms with CT or ultrasound scan-based phase correction are shown to have much less artifact than the ones without correction. Errors of deducing speed of sound from CT scans are also discussed regarding its effect on the transcranial ultrasound images. Assuming the speed of sound grows linearly with the density, this study shows that, the CT-based phase correction approach can provide clear images of wire phantoms even if the speed of sound is overestimated by 400 m s⁻¹, or the linear coefficient is overestimated by 40%. While in this study, ultrasound scan-based phase correction performs almost equally well with the CT-based approach, potential problems are identified and discussed.

Volumetric modulated arc therapy (VMAT) is a relatively new treatment modality for dynamic photon radiation therapy. Pre-treatment quality assurance (QA) is necessary and many efforts have been made to apply electronic portal imaging device (EPID)-based IMRT QA methods to VMAT. It is important to verify the gantry rotation speed during delivery as this is a new variable that is also modulated in VMAT. In this paper, we present a new technique to perform VMAT QA using an EPID. The method utilizes EPID cine mode and was tested on Varian TrueBeam in research mode. The cine images were acquired during delivery and converted to dose matrices after profile correction and dose calibration. A sub-arc corresponding to each cine image was extracted from the original plan and its portal image prediction was calculated. Several analyses were performed including 3D γ analysis (2D images + gantry angle axis), 2D γ analysis, and other statistical analyses. The method was applied to 21 VMAT photon plans of 3 photon energies. The accuracy of the cine image information was investigated. Furthermore, this method's sensitivity to machine delivery errors was studied. The pass rate (92.8 ± 1.4%) for 3D γ analysis was comparable to those from Delta⁴ system (99.9 ± 0.1%) under similar criteria (3%, 3 mm, 5% threshold and 2° angle to agreement) at 6 MV. The recorded gantry angle and start/stop MUs were found to have sufficient accuracy for clinical QA. Machine delivery errors can be detected through combined analyses of 3D γ, gantry angle, and percentage dose difference. In summary, we have developed and validated a QA technique that can simultaneously verify the gantry angle and delivered MLC fluence for VMAT treatment.This technique is efficient and its accuracy is comparable to other QA methods.

Gallium nitride (GaN), a direct-gap semiconductor that is radioluminescent, can be used as a transducer yielding a high signal from a small detecting volume and thus potentially suitable for use in small fields and for high dose gradients. A common drawback of semiconductor dosimeters with effective atomic numbers higher than soft tissues is that their responses depend on the presence of low energy photons for which the photoelectric cross section varies strongly with atomic number, which may affect the accuracy of dosimetric measurements. To tackle this 'over-response' issue, we propose a model for GaN-based dosimetry with readout correction. The local photon spectrum is calculated by convolving fluence pencil kernel spectra with the beam aperture fluence distribution. The response of a GaN detector is modelled by combining large cavity theory and small cavity theory for the low and high energy components of the local spectrum. Monte Carlo simulations are employed for determination of specific correction factors for different GaN transducer sizes and irradiation conditions. Some model parameters such as the cut-off energy and partitioning energy are discussed. The accuracy of the GaN dosimetric response model has been evaluated for tissue phantom ratio experiments along the central axis. These experiments have shown that calculated and measured GaN responses stay within ±3% at all depths beyond the build-up depth. The calculated GaN response factor is also in good agreement with measured data (±2.5%). The validated model with response compensation improves significantly the accuracy of dosimetric measurements: below 2.5% deviation as compared to 13% without compensation, for a 10 × 10 cm² field, at depth from 1.5 to 22 cm.

In fully three-dimensional PET imaging, iterative image reconstruction techniques usually outperform analytical algorithms in terms of image quality provided that an appropriate system model is used. In this study we concentrate on the calculation of an accurate system model for the YAP-(S)PET II small animal scanner, with the aim to obtain fully resolution- and contrast-recovered images at low levels of image roughness. For this purpose we calculate the system model by decomposing it into a product of five matrices: (1) a detector response component obtained via Monte Carlo simulations, (2) a geometric component which describes the scanner geometry and which is calculated via a multi-ray method, (3) a detector normalization component derived from the acquisition of a planar source, (4) a photon attenuation component calculated from x-ray computed tomography data, and finally, (5) a positron range component is formally included. This system model factorization allows the optimization of each component in terms of computation time, storage requirements and accuracy. The main contribution of this work is a new, efficient way to calculate the detector response component for rotating, planar detectors, that consists of a GEANT4 based simulation of a subset of lines of flight (LOFs) for a single detector head whereas the missing LOFs are obtained by using intrinsic detector symmetries. Additionally, we introduce and analyze a probability threshold for matrix elements of the detector component to optimize the trade-off between the matrix size in terms of non-zero elements and the resulting quality of the reconstructed images. In order to evaluate our proposed system model we reconstructed various images of objects, acquired according to the NEMA NU 4-2008 standard, and we compared them to the images reconstructed with two other system models: a model that does not include any detector response component and a model that approximates analytically the depth of interaction as detector response component. The comparisons confirm previous research results, showing that the usage of an accurate system model with a realistic detector response leads to reconstructed images with better resolution and contrast recovery at low levels of image roughness.

Monte Carlo (MC) modeling of a 6 MV photon beam was used to study the dose perturbation from a titanium rod 5 mm in diameter in various small fields range from 2 × 2 to 5 × 5 cm². The results showed that the rod increased the dose to water by ∼6% at the water–rod interface because of electron backscattering and decreased the dose by ∼7% in the shadow of the rod because of photon attenuation. The Pinnacle³ treatment planning system calculations matched the MC results at the depths more than 1 cm past the rod when the correct titanium density of 4.5 g cm⁻³ was used, but significantly underestimated the backscattering dose at the water–rod interface. A CT–density table with a top density of 1.82 g cm⁻³ (cortical bone) is a practical way to reduce the dosimetric error from the artifacts by preventing high density assignment to them, but can underestimates the attenuation by the titanium rod by 6%. However, when multi-beam with intensity modulation is used in actual patient spinal stereotactic radiosurgery treatment, the dosimetric effect of assigning 4.5 instead of 1.82 g cm⁻³ to titanium implants is complicated. It ranged from minimal effect to 2% dose difference affecting 15% target volume in the study. When hardware is in the beam path, density override to the titanium hardware is recommended.

Monte Carlo-based simulation of positron emission tomography (PET) data plays a key role in the design and optimization of data correction and processing methods. Our first aim was to adapt and configure the PET-SORTEO Monte Carlo simulation program for the geometry of the widely distributed Inveon PET preclinical scanner manufactured by Siemens Preclinical Solutions. The validation was carried out against actual measurements performed on the Inveon PET scanner at the Australian Nuclear Science and Technology Organisation in Australia and at the Brain & Mind Research Institute and by strictly following the NEMA NU 4-2008 standard. The comparison of simulated and experimental performance measurements included spatial resolution, sensitivity, scatter fraction and count rates, image quality and Derenzo phantom studies. Results showed that PET-SORTEO reliably reproduces the performances of this Inveon preclinical system. In addition, imaging studies showed that the PET-SORTEO simulation program provides raw data for the Inveon scanner that can be fully corrected and reconstructed using the same programs as for the actual data. All correction techniques (attenuation, scatter, randoms, dead-time, and normalization) can be applied on the simulated data leading to fully quantitative reconstructed images. In the second part of the study, we demonstrated its ability to generate fast and realistic biological studies. PET-SORTEO is a workable and reliable tool that can be used, in a classical way, to validate and/or optimize a single PET data processing step such as a reconstruction method. However, we demonstrated that by combining a realistic simulated biological study ([¹¹C]Raclopride here) involving different condition groups, simulation allows one also to assess and optimize the data correction, reconstruction and data processing line flow as a whole, specifically for each biological study, which is our ultimate intent.

Shear wave imaging (SWI) maps soft tissue elasticity by measuring shear wave propagation with ultrafast ultrasound acquisitions (10 000 frames s⁻¹). This spatiotemporal data can be used as an input for an inverse problem that determines a shear modulus map. Common inversion methods are local: the shear modulus at each point is calculated based on the values of its neighbour (e.g. time-of-flight, wave equation inversion). However, these approaches are sensitive to the information loss such as noise or the lack of the backscattered signal. In this paper, we evaluate the benefits of a global approach for elasticity inversion using a least-squares formulation, which is derived from full waveform inversion in geophysics known as the adjoint method. We simulate an acoustic waveform in a medium with a soft and a hard lesion. For this initial application, full elastic propagation and viscosity are ignored. We demonstrate that the reconstruction of the shear modulus map is robust with a non-uniform background or in the presence of noise with regularization. Compared to regular local inversions, the global approach leads to an increase of contrast (∼+3 dB) and a decrease of the quantification error (∼+2%). We demonstrate that the inversion is reliable in the case when there is no signal measured within the inclusions like hypoechoic lesions which could have an impact on medical diagnosis.

Pulsed high-intensity focused ultrasound (HIFU) is proposed as a new alternative treatment for contracture of dense fibrous tissue. It is hypothesized that the pulsed-HIFU can release the contracted tissues by attenuating tensile stiffness along the fiber axis, and that the stiffness reduction can be quantitatively monitored by change of B-mode images. Fresh porcine tendons and ligaments were adapted to an ex vivo model and insonated with pulsed-HIFU for durations ranging from 5 to 30 min. The pulse length was 91 µs with a repetition frequency of 500 Hz, and the peak rarefactional pressure was 6.36 MPa. The corresponding average intensities were kept around 1606 W cm⁻² for I_SPPA and 72.3 W cm⁻² for I_SPTA. B-mode images of the tissues were acquired before and after pulsed-HIFU exposure, and the changes in speckle intensity and organization were analyzed. The tensile stiffness of the HIFU-exposed tissues along the longitudinal axis was examined using a stretching machine. Histology examinations were performed by optical and transmission electron microscopy. Pulsed-HIFU exposure significantly decreased the tensile stiffness of the ligaments and tendons. The intensity and organization of tissue speckles in the exposed region were also decreased. The speckle changes correlated well with the degree of stiffness alteration. Histology examinations revealed that pulsed-HIFU exposure probably damages tissues via a cavitation-mediated mechanism. Our results suggest that pulsed-HIFU with a low duty factor is a promising tool for developing new treatment strategies for orthopedic disorders.

This work presents the derivation of a Rayleigh–Plesset-like equation that describes the radial oscillation of a contrast agent microbubble between two elastic walls, assuming that the bubble is attached to one of them. The obtained equation is then used in numerical simulations in order to establish how the presence of the second wall affects the resonance properties and the scattered echo of the contrast microbubble. The effect of encapsulation on the dynamics of the microbubble is simulated by the Marmottant shell model which is commonly used for the modeling of the dynamics of lipid-shelled contrast agents. Two cases are examined. In the first, the mechanical properties of the walls are set to correspond to OptiCell chambers which are widely used in experiments on microbubble contrast agents. In the second, the properties of the walls correspond to walls of blood vessels. It is shown that the presence of the second wall increases the resonance frequency of the contrast microbubble and decreases the amplitudes of the radial oscillation and the scattered echo of the microbubble as compared to the case that the second wall is absent. It is also shown that the presence of the second wall can change noticeably the intensity of the second harmonic in the spectrum of the scattered pressure. It is demonstrated that, depending on the value of the driving frequency, the presence of the second wall can either increase or decrease the intensity of the second harmonic as compared to its intensity in the case that the second wall is absent.

X-ray grating interferometry is a promising tool for medical imaging because of its capability of providing additional and complementary information to conventional absorption-based methods. This technology can simultaneously measure absorption, differential phase and small-angle scattering signals from the sample, significantly improving the diagnostic content. In this work, we present a method which uses the image (dubbed the R image) obtained by taking the ratio of the absorption and small-angle scattering signals to gain quantitative insight from a radiographic x-ray projection. We demonstrate that with the help of the R image we can successfully distinguish among different (light-Z) plastic materials, which are usually used to mimic soft tissues. Two potential applications in medical imaging, such as quantitative x-ray radiography and volumetric breast density estimation, are demonstrated.

The relative biological effectiveness (RBE) is a central quantity in particle radiobiology and depends on many physical and biological factors. The local effect model (LEM) allows one to predict the RBE for radiobiologic experiments and particle therapy. In this work the sensitivity of the RBE on its determining factors is elucidated based on monitoring the RBE dependence on the input parameters of the LEM. The relevance and meaning of all parameters are discussed within the formalism of the LEM. While most of the parameters are fixed by experimental constraints, one parameter, the threshold dose D_t, may remain free and is then regarded as a fit parameter to the high LET dose response curve. The influence of each parameter on the RBE is understood in terms of theoretic considerations. The sensitivity analysis has been systematically carried out for fictitious in vitro cell lines or tissues with α/β = 2 Gy and 10 Gy, either irradiated under track segment conditions with a monoenergetic beam or within a spread out Bragg peak. For both irradiation conditions, a change of each of the parameters typically causes an approximately equal or smaller relative change of the predicted RBE values. These results may be used for the assessment of treatment plans and for general uncertainty estimations of the RBE.

Dual energy computed tomography (DECT) can provide simultaneous estimation of relative electron density ρ_e and effective atomic number Z_eff. The ability to obtain these quantities (ρ_e, Z_eff) has been shown to benefit selected radiotherapy applications where tissue characterization is required. The conventional analysis method (spectral method) relies on knowledge of the CT scanner photon spectra which may be difficult to obtain accurately. Furthermore an approximate empirical attenuation correction of the photon spectrum through the patient is necessary. We present an alternative approach based on a parameterization of the measured ratio of low and high kVp linear attenuation coefficients for deriving Z_eff which does not require the estimation of the CT scanner spectra. In a first approach, the tissue substitute method (TSM), the Rutherford parameterization of the linear attenuation coefficients was employed to derive a relation between Z_eff and the ratio of the linear attenuation coefficients measured at the low and high kVp of the CT scanner. A phantom containing 16 tissue mimicking inserts was scanned with a dual source DECT scanner at 80 and 140 kVp. The data from the 16 inserts phantom was used to obtain model parameters for the relation between Z_eff and $\mu \big|_{{\rm 140kVp}}^{{\rm 80kVp}}$. The accuracy of the method was evaluated with a second phantom containing 4 tissue mimicking inserts. The TSM was compared to a more complex approach, the reference tissue method (RTM), which requires the derivation of stoichiometric fit parameters. These were derived from the 16 inserts phantom scans and used to calculate CT numbers at 80 and 140 kVp for a set of tabulated reference human tissues. Model parameters for the parameterization of $\mu \big|_{{\rm 140}\;{\rm kVp}}^{{\rm 80}\;{\rm kVp}}$ were estimated for this reference tissue dataset and compared to the results of the TSM. Residuals on Z_eff for the reference tissue dataset for both TSM and RTM were compared to those obtained from the spectral method. The tissue substitutes were well fitted by the TSM with R² = 0.9930. Residuals on Z_eff for the phantoms were similar between the TSM and spectral methods for Z_eff < 8 while they were improved by the TSM for higher Z_eff. The RTM fitted the reference tissue dataset well with R² = 0.9999. Comparing the Z_eff extracted from TSM and the more complex RTM to the known values from the reference tissue dataset yielded errors of up to 0.3 and 0.15 units of Z_eff respectively. The parameterization approach yielded standard deviations which were up to 0.3 units of Z_eff higher than those observed with the spectral method for Z_eff around 7.5. Procedures for the DECT estimation of Z_eff removing the need for estimates of the CT scanner spectra have been presented. Both the TSM and the more complex RTM performed better than the spectral method. The RTM yielded the best results for the reference human tissue dataset reducing errors from up to 0.3 to 0.15 units of Z_eff compared to the simpler TSM. Both TSM and RTM are simpler to implement than the spectral method which requires estimates of the CT scanner spectra.

PET is a promising technique for in vivo treatment verification in hadrontherapy. Three main PET geometries dedicated to in-beam treatment monitoring have been proposed in the literature: the dual-head PET geometry, the OpenPET geometry and the slanted-closed ring geometry. The aim of this work is to characterize the performance of two of these dedicated PET detectors in realistic clinical conditions. Several configurations of the dual-head PET and OpenPET systems were simulated using GATE v6.2. For the dual-head configuration, two aperture angles (15° and 45°) were studied. For the OpenPET system, two gaps between rings were investigated (110 and 160 mm). A full-ring PET system was also simulated as a reference. After preliminary evaluation of the sensitivity and spatial resolution using a Derenzo phantom, a real small-field head and neck treatment plan was simulated, with and without introducing patient displacements. No wash-out was taken into account. 3D maps of the annihilation photon locations were deduced from the PET data acquired right after the treatment session (5 min acquisition) using a dedicated OS-EM reconstruction algorithm. Detection sensitivity at the center of the field-of-view (FOV) varied from 5.2% (45° dual-head system) to 7.0% (full-ring PET). The dual-head systems had a more uniform efficiency within the FOV than the OpenPET systems. The spatial resolution strongly depended on the location within the FOV for the ϕ = 45° dual-head system and for the two OpenPET systems. All investigated architectures identified the magnitude of mispositioning introduced in the simulations within a 1.5 mm accuracy. The variability on the estimated mispositionings was less than 2 mm for all PET systems.

Age-related macular degeneration is a leading cause of vision loss for the elderly population of industrialized nations. The IRay® Radiotherapy System, developed by Oraya® Therapeutics, Inc., is a stereotactic low-voltage irradiation system designed to treat the wet form of the disease. The IRay System uses three robotically positioned 100 kVp collimated photon beams to deliver an absorbed dose of up to 24 Gy to the macula. The present study uses the Monte Carlo radiation transport code MCNPX to assess absorbed dose to six non-targeted tissues within the eye—total lens, radiosensitive tissues of the lens, optic nerve, distal tip of the central retinal artery, non-targeted portion of the retina, and the ciliary body-–all as a function of eye size and beam entry angle. The ocular axial length was ranged from 20 to 28 mm in 2 mm increments, with the polar entry angle of the delivery system varied from 18° to 34° in 2° increments. The resulting data showed insignificant variations in dose for all eye sizes. Slight variations in the dose to the optic nerve and the distal tip of the central retinal artery were noted as the polar beam angle changed. An increase in non-targeted retinal dose was noted as the entry angle increased, while the dose to the lens, sensitive volume of the lens, and ciliary body decreased as the treatment polar angle increased. Polar angles of 26° or greater resulted in no portion of the sensitive volume of the lens receiving an absorbed dose of 0.5 Gy or greater. All doses to non-targeted structures reported in this study were less than accepted thresholds for post-procedure complications.

The simple Linear–Quadratic (LQ)-based Withers iso-effect formula (WIF) is widely used in external-beam radiotherapy to derive a new tumour dose prescription such that there is normal-tissue (NT) iso-effect when changing the fraction size and/or number. However, as conventionally applied, the WIF is invalid unless the normal-tissue response is solely determined by the tumour dose. We propose a generalized WIF (gWIF) which retains the tumour prescription dose, but replaces the intrinsic fractionation sensitivity measure (α/β) by a new concept, the normal-tissue effective fractionation sensitivity, $(\alpha /\beta )_{{\rm eff}}^{{\rm NT}}$, which takes into account both the dose heterogeneity in, and the volume effect of, the late-responding normal-tissue in question. Closed-form analytical expressions for $(\alpha /\beta )_{{\rm eff}}^{{\rm NT}}$ ensuring exact normal-tissue iso-effect are derived for: (i) uniform dose, and (ii) arbitrary dose distributions with volume-effect parameter n = 1 from the normal-tissue dose–volume histogram. For arbitrary dose distributions and arbitrary n, a numerical solution for $(\alpha /\beta )_{{\rm eff}}^{{\rm NT}}$ exhibits a weak dependence on the number of fractions. As n is increased, $(\alpha /\beta )_{{\rm eff}}^{{\rm NT}}$ increases from its intrinsic value at n = 0 (100% serial normal-tissue) to values close to or even exceeding the tumour (α/β) at n = 1 (100% parallel normal-tissue), with the highest values of $(\alpha /\beta )_{{\rm eff}}^{{\rm NT}}$ corresponding to the most conformal dose distributions. Applications of this new concept to inverse planning and to highly conformal modalities are discussed, as is the effect of possible deviations from LQ behaviour at large fraction sizes.

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 assessing the quality of delivery of complex radiotherapy in the head and neck, and is a useful tool to assist development and audit of these techniques.

Segmentation is often required for the analysis of dynamic positron emission tomography (PET) images. However, noise and low spatial resolution make it a difficult task and several supervised and unsupervised methods have been proposed in the literature to perform the segmentation based on semi-automatic clustering of the time activity curves of voxels. In this paper we propose a new method based on spectral clustering that does not require any prior information on the shape of clusters in the space in which they are identified. In our approach, the p-dimensional data, where p is the number of time frames, is first mapped into a high dimensional space and then clustering is performed in a low-dimensional space of the Laplacian matrix. An estimation of the bounds for the scale parameter involved in the spectral clustering is derived. The method is assessed using dynamic brain PET images simulated with GATE and results on real images are presented. We demonstrate the usefulness of the method and its superior performance over three other clustering methods from the literature. The proposed approach appears as a promising pre-processing tool before parametric map calculation or ROI-based quantification tasks.

Positron emission tomography imaging is affected by a number of resolution degrading phenomena, including positron range, photon non-collinearity and inter-crystal blurring. An approach to this issue is to model some or all of these effects within the image reconstruction task, referred to as resolution modeling (RM). This approach is commonly observed to yield images of higher resolution and subsequently contrast, and can be thought of as improving the modulation transfer function. Nonetheless, RM can substantially alter the noise distribution. In this work, we utilize noise propagation models in order to accurately characterize the noise texture of reconstructed images in the presence of RM. Furthermore we consider the task of lesion or defect detection, which is highly determined by the noise distribution as quantified using the noise power spectrum. Ultimately, we use this framework to demonstrate why conventional trade-off analyses (e.g. contrast versus noise, using simplistic noise metrics) do not provide a complete picture of the impact of RM and that improved performance of RM according to such analyses does not necessarily translate to the superiority of RM in detection task performance.

This study investigates whether 'pencil beam resampling', i.e. iterative selection and weight optimization of randomly placed pencil beams (PBs), reduces optimization time and improves plan quality for multi-criteria optimization in intensity-modulated proton therapy, compared with traditional modes in which PBs are distributed over a regular grid. Resampling consisted of repeatedly performing: (1) random selection of candidate PBs from a very fine grid, (2) inverse multi-criteria optimization, and (3) exclusion of low-weight PBs. The newly selected candidate PBs were added to the PBs in the existing solution, causing the solution to improve with each iteration. Resampling and traditional regular grid planning were implemented into our in-house developed multi-criteria treatment planning system 'Erasmus iCycle'. The system optimizes objectives successively according to their priorities as defined in the so-called 'wish-list'. For five head-and-neck cancer patients and two PB widths (3 and 6 mm sigma at 230 MeV), treatment plans were generated using: (1) resampling, (2) anisotropic regular grids and (3) isotropic regular grids, while using varying sample sizes (resampling) or grid spacings (regular grid). We assessed differences in optimization time (for comparable plan quality) and in plan quality parameters (for comparable optimization time). Resampling reduced optimization time by a factor of 2.8 and 5.6 on average (7.8 and 17.0 at maximum) compared with the use of anisotropic and isotropic grids, respectively. Doses to organs-at-risk were generally reduced when using resampling, with median dose reductions ranging from 0.0 to 3.0 Gy (maximum: 14.3 Gy, relative: 0%–42%) compared with anisotropic grids and from −0.3 to 2.6 Gy (maximum: 11.4 Gy, relative: −4%–19%) compared with isotropic grids. Resampling was especially effective when using thin PBs (3 mm sigma). Resampling plans contained on average fewer PBs, energy layers and protons than anisotropic grid plans and more energy layers and protons than isotropic grid plans. In conclusion, resampling resulted in improved plan quality and in considerable optimization time reduction compared with traditional regular grid planning.

The International Commission on Radiological Protection (ICRP) reference phantoms, developed based on computed tomography images of human bodies, provide much more realism of human anatomy than the previously used MIRD5 (Medical Internal Radiation Dose) mathematical phantoms. It has been, however, realized that the ICRP reference phantoms have some critical limitations showing a considerable amount of holes for the skin and wall organs mainly due to the nature of voxels of which the phantoms are made, especially due to their low voxel resolutions. To address this problem, we are planning to develop the polygon-surface version of ICRP reference phantoms by directly converting the ICRP reference phantoms (voxel phantoms) to polygon-surface phantoms. The objective of this preliminary study is to see if it is indeed possible to construct the high-quality polygon-surface phantoms based on the ICRP reference phantoms maintaining identical organ morphology and also to identify any potential issues, and technologies to address these issues, in advance. For this purpose, in the present study, the ICRP reference male phantom was roughly converted to a polygon-surface phantom. Then, the constructed phantom was implemented in Geant4, Monte Carlo particle transport code, for dose calculations, and the calculated dose values were compared with those of the original ICRP reference phantom to see how much the calculated dose values are sensitive to the accuracy of the conversion process. The results of the present study show that it is certainly possible to convert the ICRP reference phantoms to surface phantoms with enough accuracy. In spite of using relatively less resources (<2 man-months), we were able to construct the polygon-surface phantom with the organ masses perfectly matching the ICRP reference values. The analysis of the calculated dose values also implies that the dose values are indeed not very sensitive to the detailed morphology of the organ models in the phantom for highly penetrating radiations such as photons and neutrons. The results of the electron beams, on the other hand, show that the dose values of the polygon-surface phantom are higher by a factor of 2–5 times than those of the ICRP reference phantom for the skin and wall organs which have large holes due to low voxel resolution. The results demonstrate that the ICRP reference phantom could provide significantly unreasonable dose values to thin or wall organs especially for weakly penetrating radiations. Therefore, when compared to the original ICRP reference phantoms, it is believed that the polygon-surface version of ICRP reference phantoms properly developed will not only provide the same or similar dose values (say, difference <5 or 10%) for highly penetrating radiations, but also provide correct dose values for the weakly penetrating radiations such as electrons and other charged particles.

Inspired by compressive sensing theory and spectral detection technology, here we propose a novel design of a CT detector array that uses current-integrating/photon-counting modules in an interlacing fashion so that strengths of each detector type can be synergistically combined. For geometrical symmetry, an evenly alternating pattern is initially assumed for these detector modules to form a hybrid detector array. While grayscale detector modules acquire regular raw data in a large dynamic range cost-effectively, spectral detector modules simultaneously sense energy-discriminative data in multiple energy bins. A split Bregman iterative algorithm is developed for spectral CT reconstruction from projection data of an object collected with the hybrid detector array. With mathematical phantoms, an optimal ratio of the number of the spectral elements over the number of grayscale elements is determined based on classic image quality evaluation. This hybrid detector array is capable of delivering a performance comparable with that of a full spectral detector array.

The result from any assurance measurement needs to be checked against some limits for acceptability. There are two types of limits; those that define clinical acceptability (action limits) and those that are meant to serve as a warning that the measurement is close to the action limits (tolerance limits). Currently, there is no standard procedure to set these limits. In this work, we propose an operational procedure to set tolerance limits and action limits. The approach to establish the limits is based on techniques of quality engineering using control charts and a process capability index. The method is different for tolerance limits and action limits with action limits being categorized into those that are specified and unspecified. The procedure is to first ensure process control using the I-MR control charts. Then, the tolerance limits are set equal to the control chart limits on the I chart. Action limits are determined using the C_pm process capability index with the requirements that the process must be in-control. The limits from the proposed procedure are compared to an existing or conventional method. Four examples are investigated: two of volumetric modulated arc therapy (VMAT) point dose quality assurance (QA) and two of routine linear accelerator output QA. The tolerance limits range from about 6% larger to 9% smaller than conventional action limits for VMAT QA cases. For the linac output QA, tolerance limits are about 60% smaller than conventional action limits. The operational procedure describe in this work is based on established quality management tools and will provide a systematic guide to set up tolerance and action limits for different equipment and processes.