bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative evaluation of patient setup uncertainty of stereotactic radiotherapy with the frameless 6D ExacTrac system using statistical modeling
Authors: Keeling Vance , Hossain Sabbir , Jin Hosang , Algan Ozer , Ahmad Salahuddin , Ali Imad 
Published: February 2017

The purpose of this study is to evaluate patient setup accuracy and quantify individual and cumulative positioning uncertainties associated with different hardware and software components of the stereotactic radiotherapy (SRS/SRT) with the frameless 6D ExacTrac system. A statistical model is used to evaluate positioning uncertainties of the different components of SRS/SRT treatment with the Brainlab 6D ExacTrac system using the positioning shifts of 35 patients having cranial lesions. All these patients are immobilized with rigid head‐and‐neck masks, simulated with Brainlab localizer and planned with iPlan treatment planning system. Stereoscopic X‐ray images (XC) are acquired and registered to corresponding digitally reconstructed radiographs using bony‐anatomy matching to calculate 6D translational and rotational shifts. When the shifts are within tolerance (0.7 mm and 1°), treatment is initiated. Otherwise corrections are applied and additional X‐rays (XV) are acquired to verify that patient position is within tolerance. The uncertainties from the mask, localizer, IR ‐frame, X‐ray imaging, MV, and kV isocentricity are quantified individually. Mask uncertainty (translational: lateral, longitudinal, vertical; rotational: pitch, roll, yaw) is the largest and varies with patients in the range obtained from mean of XC shifts for each patient. Setup uncertainty in IR positioning (0.88, 2.12, 1.40 mm, and 0.64°, 0.83°, 0.96°) is extracted from standard deviation of XC. Systematic uncertainties of the frame (0.18, 0.25, , , 0.18°, and 0.47°) and localizer (, , 0.03 mm, and , 0.00°, ) are extracted from means of all XV setups and mean of all XC distributions, respectively. Uncertainties in isocentricity of the MV radiotherapy machine are (0.27, 0.24, 0.34 mm) and kV imager (0.15, , 0.21 mm). A statistical model is developed to evaluate the individual and cumulative systematic and random positioning uncertainties induced by the different hardware and software components of the 6D ExacTrac system. The uncertainties from the mask, localizer, IR frame, X‐ray imaging, couch, MV linac, and kV imager isocentricity are quantified using statistical modeling.PACS number(s): 87.56.B‐, 87.59.B‐
Small field detector correction factors: effects of the flattening filter for Elekta and Varian linear accelerators
Authors: Tyler Madelaine K. , Liu Paul Z.Y. , Lee Christopher , McKenzie David R. , Suchowerska Natalka 
Published: February 2017

Flattening filter‐free (FFF) beams are becoming the preferred beam type for stereotactic radiosurgery (SRS) and stereotactic ablative radiation therapy (SABR), as they enable an increase in dose rate and a decrease in treatment time. This work assesses the effects of the flattening filter on small field output factors for 6 MV beams generated by both Elekta and Varian linear accelerators, and determines differences between detector response in flattened (FF) and FFF beams. Relative output factors were measured with a range of detectors (diodes, ionization chambers, radiochromic film, and microDiamond) and referenced to the relative output factors measured with an air core fiber optic dosimeter (FOD), a scintillation dosimeter developed at Chris O'Brien Lifehouse, Sydney. Small field correction factors were generated for both FF and FFF beams. Diode measured detector response was compared with a recently published mathematical relation to predict diode response corrections in small fields. The effect of flattening filter removal on detector response was quantified using a ratio of relative detector responses in FFF and FF fields for the same field size. The removal of the flattening filter was found to have a small but measurable effect on ionization chamber response with maximum deviations of less than across all field sizes measured. Solid‐state detectors showed an increased dependence on the flattening filter of up to . Measured diode response was within of the published mathematical relation for all fields up to 30 mm, independent of linac type and presence or absence of a flattening filter. For 6 MV beams, detector correction factors between FFF and FF beams are interchangeable for a linac between FF and FFF modes, providing that an additional uncertainty of up to is accepted.PACS number(s): 87.55.km, 87.56.bd, 87.56.Da
The feasibility of atlas‐based automatic segmentation of MRI for H&N radiotherapy planning
Authors: Wardman Kieran , Prestwich Robin J.D. , Gooding Mark J. , Speight Richard J. 
Published: February 2017

Atlas‐based autosegmentation is an established tool for segmenting structures for CT‐planned head and neck radiotherapy. MRI is being increasingly integrated into the planning process. The aim of this study is to assess the feasibility of MRI‐based, atlas‐based autosegmentation for organs at risk (OAR) and lymph node levels, and to compare the segmentation accuracy with CT‐based autosegmentation. Fourteen patients with locally advanced head and neck cancer in a prospective imaging study underwent a T1‐weighted MRI and a PET‐CT (with dedicated contrast‐enhanced CT) in an immobilization mask. Organs at risk (orbits, parotids, brainstem, and spinal cord) and the left level II lymph node region were manually delineated on the CT and MRI separately. A ‘leave one out’ approach was used to automatically segment structures onto the remaining images separately for CT and MRI. Contour comparison was performed using multiple positional metrics: Dice index, mean distance to conformity (MDC), sensitivity index (Se Idx), and inclusion index (Incl Idx). Automatic segmentation using MRI of orbits, parotids, brainstem, and lymph node level was acceptable with a DICE coefficient of , MDC , Se Idx , Incl Idx Segmentation of the spinal cord was poor (Dice coefficient 0.37). The process of automatic segmentation was significantly better on MRI compared to CT for orbits, parotid glands, brainstem, and left lymph node level II by multiple positional metrics; spinal cord segmentation based on MRI was inferior compared with CT. Accurate atlas‐based automatic segmentation of OAR and lymph node levels is feasible using T1‐MRI; segmentation of the spinal cord was found to be poor. Comparison with CT‐based automatic segmentation suggests that the process is equally as, or more accurate, using MRI. These results support further translation of MRI‐based segmentation methodology into clinical practice.PACS number(s): 87.55.de
Treatment accuracy without rotational setup corrections in intracranial SRT
Authors: Boman Eeva , Kapanen Mika , Laaksomaa Marko , Mäenpää Hanna , Hyödynmaa Simo , Kellokumpu‐Lehtinen Pirkko‐Liisa 
Published: February 2017

The aim of this study was to evaluate the impact of actual rotational setup errors on dose distributions in intracranial stereotactic radiotherapy (SRT) with different alternatives for treatment position selection. A total of 38 SRT fractions from 18 patients were retrospectively evaluated with rotational setup errors obtained from actual treatments. The planning computed tomography (CT) images were rotated according to online cone‐beam CT (CBCT) images and the dose distribution was recalculated to the rotated CT images using three different patient positionings derived from: 1) an automatic 6D match neglecting rotation correction ; 2) an automatic 3D match ; and 3) a manual 3D match from actual treatment . The mean conformity index (CI) was 0.92 for the original plans and 0.91 for the plans. The mean CI decreased significantly to 0.78 and 0.80 for the and the plans, respectively. The mean minimum dose of the planning target volume (PTVmin) was 91.9% of the prescribed dose for the original plans and 92.1% for the plans, while for the and the plans PTVmin decreased significantly to 78.9% and 80.2%, respectively. No significant differences were seen between the and the original treatment plans in terms of the dose parameters. However, the and the plans were statistically significantly inferior to the and the original plans. In addition, a significant negative correlation was found in the and the cases between the rotation error and CI, PTVmin or minimum dose of gross tumour volume. In SRT, a treatment plan of comparable quality to 6D rotation correction can be achieved by using 6D registration without a rotational correction in the selection of patient positioning. This was demonstrated for typical rotation errors seen in clinical practice.PACS number(s): 87.55, 87.57
Measurement of image rotation angle in CT for radiotherapy treatment planning
Authors: Skrzynski Witold , Ślusarczyk‐Kacprzyk Wioletta 
Published: February 2017

The geometric accuracy of CT images is essential when they are used for planning radiation therapy. In this study, a method of quantitative testing of image rotation in CT is presented, based on the automated analysis of an image of a phantom half‐filled with water. A plug‐in was written for ImageJ software for automated detection of a water surface in an image and measurement of its angle relative to a horizontal line. A water phantom can be used for the evaluation of image rotation for axial mode. In helical mode the movement of the table would cause movement of the water. The difference between image rotation for axial and helical scans can be evaluated by measuring and comparing the angles of the tabletop surface for both modes. Preliminary results of measurements for three CT scanners show that image rotation does not exceed 0.5°, and is less than 0.1° for the dedicated CT simulator. It was observed that, for one CT scanner image, the rotation angle depended on tube rotation time.PACS number(s): 87.57.Q‐, 87.55.Qr, 06.30.Bp
Predicting deliverability of volumetric‐modulated arc therapy (VMAT) plans using aperture complexity analysis
Authors: Younge Kelly C. , Roberts Don , Janes Lindsay A. , Anderson Carlos , Moran Jean M. , Matuszak Martha M. 
Published: February 2017

The purpose of this study was to evaluate the ability of an aperture complexity metric for volumetric‐modulated arc therapy (VMAT) plans to predict plan delivery accuracy. We developed a complexity analysis tool as a plug‐in script to Varian's Eclipse treatment planning system. This script reports the modulation of plans, arcs, and individual control points for VMAT plans using a previously developed complexity metric. The calculated complexities are compared to that of 649 VMAT plans previously treated at our institution from 2013 to mid‐2015. We used the VMAT quality assurance (QA) results from the 649 treated plans, plus 62 plans that failed pretreatment QA, to validate the ability of the complexity metric to predict plan deliverability. We used a receiver operating characteristic (ROC) analysis to determine an appropriate complexity threshold value above which a plan should be considered for reoptimization before it moves further through our planning workflow. The average complexity metric for the 649 treated plans analyzed with the script was with a standard deviation of . We found that when using a threshold complexity value of , the true positive rate for correctly identifying plans that failed QA was 44%, and the false‐positive rate was 7%. Used clinically with this threshold, the script can identify overly modulated plans and thus prevent a significant portion of QA failures. Reducing VMAT plan complexity has a number of important clinical benefits, including improving plan deliverability and reducing treatment time. Use of the complexity metric during both the planning and QA processes can reduce the number of QA failures and improve the quality of VMAT plans used for treatment.PACS number(s): 87.55.de, 87.55.Qr, 87.56.jk
Radiation leakage dose from Elekta electron collimation system
Authors: Pitcher Garrett M. , Hogstrom Kenneth R. , Carver Robert L. 
Published: February 2017

This study provided baseline data required for a greater project, whose objective was to design a new Elekta electron collimation system having significantly lighter electron applicators with equally low out‐of field leakage dose. Specifically, off‐axis dose profiles for the electron collimation system of our uniquely configured Elekta Infinity accelerator with the MLCi2 treatment head were measured and calculated for two primary purposes: 1) to evaluate and document the out‐of‐field leakage dose in the patient plane and 2) to validate the dose distributions calculated using a BEAMnrc Monte Carlo (MC) model for out‐of‐field dose profiles. Off‐axis dose profiles were measured in a water phantom at 100 cm SSD for 1 and 2 cm depths along the in‐plane, cross‐plane, and both diagonal axes using a cylindrical ionization chamber with the and applicators and 7, 13, and 20 MeV beams. Dose distributions were calculated using a previously developed BEAMnrc MC model of the Elekta Infinity accelerator for the same beam energies and applicator sizes and compared with measurements. Measured results showed that the in‐field beam flatness met our acceptance criteria ( on major and on diagonal axes) and that out‐of‐field mean and maximum percent leakage doses in the patient plane met acceptance criteria as specified by the International Electrotechnical Commission (IEC). Cross‐plane out‐of‐field dose profiles showed greater leakage dose than in‐plane profiles, attributed to the curved edges of the upper X‐ray jaws and multileaf collimator. Mean leakage doses increased with beam energy, being 0.93% and 0.85% of maximum central axis dose for the and applicators, respectively, at 20 MeV. MC calculations predicted the measured dose to within 0.1% in most profiles outside the radiation field; however, excluding modeling of nontrimmer applicator components led to calculations exceeding measured data by as much as 0.2% for some regions along the in‐plane axis. Using EGSnrc LATCH bit filtering to separately calculate out‐of‐field leakage dose components (photon dose, primary electron dose, and electron dose arising from interactions in various collimating components), MC calculations revealed that the primary electron dose in the out‐of‐field leakage region was small and decreased as beam energy increased. Also, both the photon dose component and electron dose component resulting from collimator scatter dominated the leakage dose, increasing with increasing beam energy. We concluded that our custom Elekta Infinity with the MLCi2 treatment head met IEC leakage dose criteria in the patient plane. Also, accuracy of our MC model should be sufficient for our use in the design of a new, improved electron collimation system.PACS number(s): 87.56.nk, 87.10.Rt, 87.56.J
On the use of a convolution–superposition algorithm for plan checking in lung stereotactic body radiation therapy
Authors: Hardcastle Nicholas , Oborn Bradley M. , Haworth Annette 
Published: February 2017

Stereotactic body radiation therapy (SBRT) aims to deliver a highly conformal ablative dose to a small target. Dosimetric verification of SBRT for lung tumors presents a challenge due to heterogeneities, moving targets, and small fields. Recent software (M3D) designed for dosimetric verification of lung SBRT treatment plans using an advanced convolution–superposition algorithm was evaluated. Ten lung SBRT patients covering a range of tumor volumes were selected. 3D CRT plans were created using the XiO treatment planning system (TPS) with the superposition algorithm. Dose was recalculated in the Eclipse TPS using the AAA algorithm, M3D verification software using the collapsed‐cone‐convolution algorithm, and in‐house Monte Carlo (MC). Target point doses were calculated with RadCalc software. Near‐maximum, median, and near‐minimum target doses, conformity indices, and lung doses were compared with MC as the reference calculation. M3D 3D gamma passing rates were compared with the XiO and Eclipse. Wilcoxon signed‐rank test was used to compare each calculation method with XiO with a threshold of significance of . M3D and RadCalc point dose calculations were greater than MC by up to 7.7% and 13.1%, respectively, with M3D being statistically significant (s.s.). AAA and XiO calculated point doses were less than MC by 11.3% and 5.2%, respectively (AAA s.s.). Median and near‐minimum and near‐maximum target doses were less than MC when calculated with AAA and XiO (all s.s.). Near‐maximum and median target doses were higher with M3D compared with MC (s.s.), but there was no difference in near‐minimum M3D doses compared with MC. M3D‐calculated ipsilateral lung V20 Gy and V5 Gy were greater than that calculated with MC (s.s.); AAA‐ and XiO‐calculated V20 Gy was lower than that calculated with MC, but not statistically different to MC for V5 Gy. Nine of the 10 plans achieved M3D gamma passing rates greater than 95% and 80%for and criteria, respectively. M3D typically calculated a higher target and lung dose than MC for lung SBRT plans. The results show a range of calculated doses with different algorithms and suggest that M3D is in closer agreement with Monte Carlo, thus discrepancies between the TPS and M3D software will be observed for lung SBRT plans. M3D provides a useful supplement to verification of lung SBRT plans by direct measurement, which typically excludes patient specific heterogeneities.PACS number(s): 87.55.D‐, 87.55.Qr, 87.55.K‐
Investigation on using high‐energy proton beam for total body irradiation (TBI)
Authors: Zhang Miao , Qin Nan , Jia Xun , Zou Wei J. , Khan Atif , Yue Ning J. 
Published: February 2017

This work investigated the possibility of using proton beam for total body irradiation (TBI). We hypothesized the broad‐slow‐rising entrance dose from a monoenergetic proton beam can deliver a uniform dose to patient with varied thickness. Comparing to photon‐based TBI, it would not require any patient‐specific compensator or beam spoiler. The hypothesis was first tested by simulating 250 MeV, 275 MeV, and 300 MeV protons irradiating a wedge‐shaped water phantom in a paired opposing arrangement using Monte Carlo (MC) method. To allow dose variation, the maximum water equivalent thickness (WET) of a treatable patient separation was 29 cm for 250 MeV proton, and for 275 MeV and 300 MeV proton. The compared 6 MV photon can only treat patients with up to 15.5 cm water‐equivalent separation. In the second step, we simulated the dose deposition from the same beams on a patient's whole‐body CT scan. The maximum patient separation in WET was 23 cm. The calculated whole‐body dose variations were , , and for 250 MeV proton, 275 MeV proton, 300 MeV proton, and 6 MV photon. At last, we tested the current machine capability to deliver a monoenergetic proton beam with a large uniform field. Experiments were performed on a compact double scattering single‐gantry proton system. With its C‐shaped gantry design, the source‐to‐surface distance (SSD) reached 7 m. The measured dose deposition curve had 22 cm relatively flat entrance region. The full width half maximum field size was measured 105 cm. The current scatter filter had to be redesigned to produce a uniform intensity at such treatment distance. In conclusion, this work demonstrated the possibility of using proton beam for TBI. The current commercially available proton machines would soon be ready for such task.PACS number(s): 87.53.Bn, 87.55.K‐, 87.55.‐x, 87.56.‐v
Implementation of a double Gaussian source model for the BEAMnrc Monte Carlo code and its influence on small fields dose distributions
Authors: Doerner Edgardo , Caprile Paola 
Published: February 2017

The shape of the radiation source of a linac has a direct impact on the delivered dose distributions, especially in the case of small radiation fields. Traditionally, a single Gaussian source model is used to describe the electron beam hitting the target, although different studies have shown that the shape of the electron source can be better described by a mixed distribution consisting of two Gaussian components. Therefore, this study presents the implementation of a double Gaussian source model into the BEAMnrc Monte Carlo code. The impact of the double Gaussian source model for a 6 MV beam is assessed through the comparison of different dosimetric parameters calculated using a single Gaussian source, previously commissioned, the new double Gaussian source model and measurements, performed with a diode detector in a water phantom. It was found that the new source can be easily implemented into the BEAMnrc code and that it improves the agreement between measurements and simulations for small radiation fields. The impact of the change in source shape becomes less important as the field size increases and for increasing distance of the collimators to the source, as expected. In particular, for radiation fields delivered using stereotactic collimators located at a distance of 59 cm from the source, it was found that the effect of the double Gaussian source on the calculated dose distributions is negligible, even for radiation fields smaller than 5 mm in diameter. Accurate determination of the shape of the radiation source allows us to improve the Monte Carlo modeling of the linac, especially for treatment modalities such as IMRT, were the radiation beams used could be very narrow, becoming more sensitive to the shape of the source.PACS number(s): 87.53.Bn, 87.55.K, 87.56.B‐, 87.56.jf
Improving treatment plan evaluation with automation
Authors: Covington Elizabeth L. , Chen Xiaoping , Younge Kelly C. , Lee Choonik , Matuszak Martha M. , Kessler Marc L. , Keranen Wayne , Acosta Eduardo , Dougherty Ashley M. , Filpansick Stephanie E. , Moran Jean M. 
Published: February 2017

The goal of this work is to evaluate the effectiveness of Plan‐Checker Tool (PCT) which was created to improve first‐time plan quality, reduce patient delays, increase the efficiency of our electronic workflow, and standardize and automate the physics plan review in the treatment planning system (TPS). PCT uses an application programming interface to check and compare data from the TPS and treatment management system (TMS). PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user as part of a plan readiness check for treatment. Prior to and during PCT development, errors identified during the physics review and causes of patient treatment start delays were tracked to prioritize which checks should be automated. Nineteen of 33 checklist items were automated, with data extracted with PCT. There was a 60% reduction in the number of patient delays in the six months after PCT release. PCT was successfully implemented for use on all external beam treatment plans in our clinic. While the number of errors found during the physics check did not decrease, automation of checks increased visibility of errors during the physics check, which led to decreased patient delays. The methods used here can be applied to any TMS and TPS that allows queries of the database.PACS number(s): 87.55.‐x, 87.55.N‐, 87.55.Qr, 87.55.tm, 89.20.Bb