bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing radiation risks to staff for patients with permanently implanted radioactive sources requiring unrelated surgery
Authors: Basran Parminder S. , Baxter Patricia , Beckham Wayne A. 
Published: February 2017

Permanent implant of sealed radioactive sources is an effective technique for treating cancer. Typically, the radioactive sources are implanted in and near the disease, depositing radiation absorbed dose locally over several months. There may be instances where these patients must undergo unrelated surgical procedures when the radioactive material remains active enough to pose risks. This work explores these risks, discusses strategies to mitigate those risks, and describes a case study for a permanent iodine‐125 (I‐125) prostate brachytherapy implant patient who developed colorectal cancer and required surgery six months after brachytherapy. The first consideration is identifying the radiological risk to the patient and staff before, during, and after the surgical procedure. The second is identifying the risk the surgical procedure may have on the efficacy of the brachytherapy implant. Finally, there are considerations for controlling the radioactive substances from a regulatory perspective. After these risks are defined, strategies to mitigate those risks are considered. We summarize this experience with some guidelines: If the surgical procedure is near (e.g., within 5–10 cm of) the implant; and, the surgical intervention may dislodge sources enough to compromise treatment or introduces radiation safety risks; and, the radioactivity has not sufficiently decayed to background levels; and, the surgery cannot be postponed, then a detailed analysis of risk is advised.PACS numbers: 87.53Bn, 87.53Jw, 87.55.N, 87.56.bg
Enhanced dynamic wedge output factors for Varian 2300CD and the case for a reference database
Authors: Njeh Christopher F. 
Published: February 2017

Dose inhomogeneity in treatment planning can be compensated using physical wedges. Enhanced dynamic wedges (EDW) were introduced by Varian to overcome some of the shortcomings of physical wedges. The objectives of this study were to measure EDW output factors for 6 MV and 20 MV photon energies for a Varian 2300CD. Secondly, to review the literature in terms of published enhanced dynamic wedge output factors (EDWOF) for different Varian models and thereby add credence to the case of the validity of reference databases. The enhanced dynamic wedge output factors were measured for the Varian 2300CD for both 6 MV and 20 MV photon energies. Twelve papers with published EDWOF for different Varian linac models were found in the literature. Comparing our results with the published mean, we found an excellent agreement for 6 MV EDWOF, with the percentage differences ranging from 0.01% to 0.57%, with a mean of 0.03%. The coefficient of variation of published EDWOF ranged from 0.17% to 0.85% and 0.1% to 0.9% for the for 6 MV and 18 MV photon energies, respectively. This paper provides the first published EDWOF for 20 MV photon energy. In addition, we have provided the first compendium of EDWOFs for different Varian linac models. The consistency of value across models and institution provide further support that a standard dataset of basic photon and electron dosimetry could be established as a guide for future commissioning, beam modeling, and quality assurance purposes.PACS numbers: 87.50, 87.55
Accuracy of dual‐energy computed tomography for the quantification of iodine in a soft tissue‐mimicking phantom
Authors: Li Jung‐Hui , Du Yeh‐Ming , Huang Hsuan‐Ming 
Published: February 2017

The objective of this study was to evaluate the accuracy of dual‐energy CT (DECT) for quantifying iodine using a soft tissue‐mimicking phantom across various DECT acquisition parameters and dual‐source CT (DSCT) scanners. A phantom was constructed with plastic tubes containing soft tissue‐mimicking materials with known iodine concentrations (0–20 mg/mL). Experiments were performed on two DSCT scanners, one equipped with an integrated detector and the other with a conventional detector. DECT data were acquired using two DE modes (80 kV/Sn140 kV and 100 kV/Sn140 kV) with four pitch values (0.6, 0.8, 1.0, and 1.2). Images were reconstructed using a soft tissue kernel with and without beam hardening correction (BHC) for iodine. Using the dedicated DE software, iodine concentrations were measured and compared to true concentrations. We also investigated the effect of reducing gantry rotation time on the DECT‐based iodine measurement. At iodine concentrations higher than 10 mg/mL, the relative error in measured iodine concentration increased slightly. This error can be decreased by using the kernel with BHC, compared with the kernel without BHC. Both 80 kV/Sn140 kV and 100 kV/Sn140 kV modes could provide accurate quantification of iodine content. Increasing pitch value or reducing gantry rotation time had only a minor impact on the DECT‐based iodine measurement. The DSCT scanner, equipped with the new integrated detector, showed more accurate iodine quantification for all iodine concentrations higher than 10 mg/mL. An accurate quantification of iodine can be obtained using the second‐generation DSCT scanner in various DE modes with pitch values up to 1.2 and gantry rotation time down to 0.28 s. For iodine concentrations , using the new integrated detector and the kernel with BHC can improve the accuracy of DECT‐based iodine measurements.PACS number: 87.57.Q‐
Development and clinical evaluation of a simple optical method to detect and measure patient external motion
Authors: Barbés Benigno , Azcona Juan Diego , Prieto Elena , de Foronda José Manuel , García Marina , Burguete Javier 
Published: February 2017

A simple and independent system to detect and measure the position of a number of points in space was devised and implemented. Its application aimed to detect patient motion during radiotherapy treatments, alert of out‐of‐tolerances motion, and record the trajectories for subsequent studies. The system obtains the 3D position of points in space, through its projections in 2D images recorded by two cameras. It tracks black dots on a white sticker placed on the surface of the moving object. The system was tested with linear displacements of a phantom, circular trajectories of a rotating disk, oscillations of an in‐house phantom, and oscillations of a 4D phantom. It was also used to track 461 trajectories of points on the surface of patients during their radiotherapy treatments. Trajectories of several points were reproduced with accuracy better than 0.3 mm in the three spatial directions. The system was able to follow periodic motion with amplitudes lower than 0.5 mm, to follow trajectories of rotating points at speeds up to 11.5 cm/s, and to track accurately the motion of a respiratory phantom. The technique has been used to track the motion of patients during radiotherapy and to analyze that motion. The method is flexible. Its installation and calibration are simple and quick. It is easy to use and can be implemented at a very affordable price. Data collection does not involve any discomfort to the patient and does not delay the treatment, so the system can be used routinely in all treatments. It has an accuracy similar to that of other, more sophisticated, commercially available systems. It is suitable to implement a gating system or any other application requiring motion detection, such as 4D CT, MRI or PET.PACS numbers: 87.55.N, 87.56.Da
Dose perturbation effect of metallic spinal implants in proton beam therapy
Authors: Jia Yingcui , Zhao Li , Cheng Chee‐Wai , McDonald Mark W. , Das Indra J. 
Published: February 2017

The purpose of this study was to investigate the effect of dose perturbations for two metallic spinal screw implants in proton beam therapy in the perpendicular and parallel beam geometry. A 5.5 mm (diameter) by 45 mm (length) stainless steel (SS) screw and a 5.5 mm by 35 mm titanium (Ti) screw commonly used for spinal fixation were CT‐scanned in a hybrid phantom of water and solid water. The CT data were processed with an orthopedic metal artifact reduction (O‐MAR) algorithm. Treatment plans were generated for each metal screw with a proton beam oriented, first parallel and then perpendicular, to the longitudinal axis of the screw. The calculated dose profiles were compared with measured results from a plane‐parallel ion chamber and Gafchromic EBT2 films. For the perpendicular setup, the measured dose immediately downstream from the screw exhibited dose enhancement up to 12% for SS and 8% for Ti, respectively, but such dose perturbation was not observed outside the lateral edges of the screws. The TPS showed 5% and 2% dose reductions immediately at the interface for the SS and Ti screws, respectively, and up to 9% dose enhancements within 1 cm outside of the lateral edges of the screws. The measured dose enhancement was only observed within 5 mm from the interface along the beam path. At deeper depths, the lateral dose profiles appeared to be similar between the measurement and TPS, with dose reduction in the screw shadow region and dose enhancement within 1–2 cm outside of the lateral edges of the metals. For the parallel setup, no significant dose perturbation was detected at lateral distance beyond 3 mm away from both screws. Significant dose discrepancies exist between TPS calculations and ion chamber and film measurements in close proximity of high‐Z inhomogeneities. The observed dose enhancement effect with proton therapy is not correctly modeled by TPS. An extra measure of caution should be taken when evaluating dosimetry with spinal metallic implants.PACS number: 87.50.sj
Gold nanoparticle‐based brachytherapy enhancement in choroidal melanoma using a full Monte Carlo model of the human eye
Authors: Asadi Somayeh , Vaez‐zadeh Mehdi , Masoudi S. Farhad , Rahmani Faezeh , Knaup Courtney , Meigooni Ali S. 
Published: February 2017

The effects of gold nanoparticles (GNPs) in 125I brachytherapy dose enhancement on choroidal melanoma are examined using the Monte Carlo simulation technique. Usually, Monte Carlo ophthalmic brachytherapy dosimetry is performed in a water phantom. However, here, the compositions of human eye have been considered instead of water. Both human eye and water phantoms have been simulated with MCNP5 code. These simulations were performed for a fully loaded 16 mm COMS eye plaque containing 13 125I seeds. The dose delivered to the tumor and normal tissues have been calculated in both phantoms with and without GNPs. Normally, the radiation therapy of cancer patients is designed to deliver a required dose to the tumor while sparing the surrounding normal tissues. However, as the normal and cancerous cells absorbed dose in an almost identical fashion, the normal tissue absorbed radiation dose during the treatment time. The use of GNPs in combination with radiotherapy in the treatment of tumor decreases the absorbed dose by normal tissues. The results indicate that the dose to the tumor in an eyeball implanted with COMS plaque increases with increasing GNPs concentration inside the target. Therefore, the required irradiation time for the tumors in the eye is decreased by adding the GNPs prior to treatment. As a result, the dose to normal tissues decreases when the irradiation time is reduced. Furthermore, a comparison between the simulated data in an eye phantom made of water and eye phantom made of human eye composition, in the presence of GNPs, shows the significance of utilizing the composition of eye in ophthalmic brachytherapy dosimetry Also, defining the eye composition instead of water leads to more accurate calculations of GNPs radiation effects in ophthalmic brachytherapy dosimetry.PACS number: 87.53.Jw, 87.85.Rs, 87.10.Rt
Ultraviolet exposure of Gafchromic XR‐RV3 and XR‐SP2 films
Authors: Katsuda Toshizo , Gotanda Rumi , Gotanda Tatsuhiro , Akagawa Takuya , Tanki Nobuyoshi , Kuwano Tadao , Yabunaka Kouichi 
Published: February 2017

Gafchromic film has been used for X‐ray dose measurement in diagnostic examinations. Their use has been initiated for three‐dimensional X‐ray dose measurement by using the high‐resolution characteristics of Gafchromic films in computed tomography. However, it is necessary to solve the problem of nonuniform thickness in the active layers of Gafchromic films. A double exposure technique using X‐rays is performed in therapeutic radiology; it is difficult to use in a diagnostic examination because of the heel effect. Therefore, it is suggested that ultraviolet (UV) rays be substituted for X‐rays. However, the appropriate UV wavelength is unknown. In this study, we aimed to determine which UV wavelengths are effective to expose Gafchromic XR‐RV3 and XR‐SP2. UV lamps with peak wavelengths of 245 nm, 310 nm, and 365 nm were used. The three UV wavelengths were used to irradiate Gafchromic XR‐RV3 and XR‐SP2 films for 60 min, and irradiation was repeated every 60 min for 600 min thereafter. Films were scanned after each irradiation period on a flatbed scanner. The images were split into their red‐green‐blue components, and red images were stored using ImageJ version 1.44o image analysis software. Regions of interest (ROI), 0.5 inches in diameter, were placed at the centers of the subtracted Gafchromic film images, and graphs of UV irradiation duration and mean pixel values were plotted. There were reactions to UV‐A on both Gafchromic XR‐RV3 and XR‐SP2; those to UV‐B were moderate. However, UV‐C demonstrated few reactions with Gafchromic XR‐RV3 and XR‐SP2. From these results, irradiation with UV‐A may be able to correct nonuniformity errors. Uniform UV‐A irradiation of Gafchromic films with large areas is possible, and UV rays can be used as a substitute for X‐rays in the double exposure technique.PACS number: 87.53 Bn
Long‐term stability assessment of a 4D tumor tracking system integrated into a gimbaled linear accelerator
Authors: Akimoto Mami , Nakamura Mitsuhiro , Miyabe Yuki , Mukumoto Nobutaka , Yokota Kenji , Mizowaki Takashi , Hiraoka Masahiro 
Published: February 2017

We assessed long‐term stability of tracking accuracy using the Vero4DRT system. This metric was observed between September 2012 and March 2015. A programmable respiratory motion phantom, designed to move phantoms synchronously with respiratory surrogates, was used. The infrared (IR) markers moved in the anterior–posterior (AP) direction as respiratory surrogates, while a cube phantom with a steel ball at the center, representing the tumor, and with radiopaque markers around it moved in the superior–inferior (SI) direction with one‐dimensional (1D) sinusoidal patterns. A correlation model between the tumor and IR marker motion (4D model) was created from the training data obtained for 20 s just before beam delivery. The irradiation field was set to and 300 monitor units (MUs) of desired MV X‐ray beam were delivered. The gantry and ring angles were set to 0° and 45°, respectively. During beam delivery, the system recorded approximately 60 electronic portal imaging device (EPID) images. We analyzed: 1) the predictive accuracy of the 4D model (), defined as the difference between the detected and predicted target positions during 4D model creation, and 2) the tracking accuracy (), defined as the difference between the center of the steel ball and the MV X‐ray field on the EPID image. The median values of mean plus two standard deviations (SDs) for were 0.06, 0.35, and 0.06 mm in the left–right (LR), SI, and AP directions, respectively. The mean values of maximum deviation for were 0.38, 0.49, and 0.53 mm and the coefficients of variance (CV) were 0.16, 0.10, and 0.05 in lateral, longitudinal, and 2D directions, respectively. Consequently, the IR Tracking accuracy was consistent over a period of two years. Our proposed method assessed the overall tracking accuracy readily using real‐time EPID images, and proved to be a useful QA tool for dynamic tumor tracking with the Vero4DRT system.PACS number: 87.59.‐e, 88.10.gc, 87.55.Qr
Comparing proton treatment plans of pediatric brain tumors in two pencil beam scanning nozzles with different spot sizes
Authors: Kralik John C. , Xi Liwen , Solberg Timothy D. , Simone Charles B. , Lin Liyong 
Published: February 2017

Target coverage and organ‐at‐risk sparing were compared for 22 pediatric patients with primary brain tumors treated using two distinct nozzles in pencil beam scanning (PBS) proton therapy. Consecutive patients treated at our institution using a PBS‐dedicated nozzle (DN) were replanned using a universal nozzle (UN) beam model and the original DN plan objectives. Various cranial sites were treated among the patients to prescription doses ranging from 45 to 54 Gy. Organs at risk (OARs) evaluated were patient‐dependent; 15 unique OARs were analyzed, all of which were assessed in at least 10 patients. Clinical target volume (CTV) coverage and organ sparing were compared for the two nozzles using dose‐volume histogram data. Statistical analysis using a confidence‐interval approach demonstrates that CTV coverage is equivalent for UN and DN plans within equivalence bounds. In contrast, average mean and maximum doses are significantly higher for nearly all 15 OARs in the UN plans. The average median increase over all OARs and patients is approximately 1.7 Gy, with an increase in the 25%–75% of 1.0–2.3 Gy; the median increase to the pituitary gland, temporal lobes, eyes and cochleas are 1.8, 1.7, 0.7, and 2.7 Gy, respectively. The CTV dose distributions fall off slower for UN than for the DN plans; hence, normal tissue structures in close proximity to CTVs receive higher doses in UN plans than in DN plans. The higher OAR doses in the UN plans are likely due to the larger spot profile in plans created with UN beams. In light of the high rates of toxicities in pediatric patients receiving cranial irradiation and in light of selected brain tumor types having high cure rates, this study suggests the smaller DN beam profile is preferable for the advantage of reducing dose to OARs.PACS number: 87.55.D‐
Image‐domain shading correction for cone‐beam CT without prior patient information
Authors: Fan Qiyong , Lu Bo , Park Justin C. , Niu Tianye , Li Jonathan G. , Liu Chihray , Zhu Lei 
Published: February 2017

In the era of high‐precision radiotherapy, cone‐beam CT (CBCT) is frequently utilized for on‐board treatment guidance. However, CBCT images usually contain severe shading artifacts due to strong photon scatter from illumination of a large volume and non‐optimized patient‐specific data measurements, limiting the full clinical applications of CBCT. Many algorithms have been proposed to alleviate this problem by data correction on projections. Sophisticated methods have also been designed when prior patient information is available. Nevertheless, a standard, efficient, and effective approach with large applicability remains elusive for current clinical practice. In this work, we develop a novel algorithm for shading correction directly on CBCT images. Distinct from other image‐domain correction methods, our approach does not rely on prior patient information or prior assumption of patient data. In CBCT, projection errors (mostly from scatter and non‐ideal usage of bowtie filter) result in dominant low‐frequency shading artifacts in image domain. In circular scan geometry, these artifacts often show global or local radial patterns. Hence, the raw CBCT images are first preprocessed into the polar coordinate system. Median filtering and polynomial fitting are applied on the transformed image to estimate the low‐frequency shading artifacts (referred to as the bias field) angle‐by‐angle and slice‐by‐slice. The low‐pass filtering process is done firstly along the angular direction and then the radial direction to preserve image contrast. The estimated bias field is then converted back to the Cartesian coordinate system, followed by 3D low‐pass filtering to eliminate possible high‐frequency components. The shading‐corrected image is finally obtained as the uncorrected volume divided by the bias field. The proposed algorithm was evaluated on CBCT images of a pelvis patient and a head patient. Mean CT number values and spatial non‐uniformity on the reconstructed images were used as image quality metrics. Within selected regions of interest, the average CT number error was reduced from around 300 HU to 42 and 38 HU, and the spatial nonuniformity error was reduced from above 17.5% to 2.1% and 1.7% for the pelvis and the head patients, respectively. As our method suppresses only low‐frequency shading artifacts, patient anatomy and contrast were retained in the corrected images for both cases. Our shading correction algorithm on CBCT images offers several advantages. It has a high efficiency, since it is deterministic and directly operates on the reconstructed images. It requires no prior information or assumptions, which not only achieves the merits of CBCT‐based treatment monitoring by retaining the patient anatomy, but also facilitates its clinical use as an efficient image‐correction solution.PACS number(s): 87.57.C‐, 87.57.cp, 87.57.Q‐
Clinical implementation of MR‐guided vaginal cylinder brachytherapy
Authors: Owrangi Amir M. , Jolly Shruti , Balter James M. , Cao Yue , Maturen Katherine E. , Young Lisa , Zhu Tong , Prisciandaro Joann I. 
Published: February 2017

We present an institutional experience on the clinical implementation of magnetic resonance (MR)‐guided vaginal brachytherapy using commercially available solid applicator models. To test the fidelity of solid applicator models to digitize vaginal cylinder applicators, three datasets were evaluated. The first included 15 patients who were simulated with CT alone. Next, a water phantom was used to evaluate vaginal cylinders ranging from 20 to 35 mm in diameter with CT and MR. Finally, three patients undergoing HDR brachytherapy with vaginal cylinders that were simulated with both CT and MR were evaluated. In these assessments, the solid applicator models were aligned based on the outline of the applicators on the corresponding volumetric image, and deviations between the central source positions defined based on X‐ray markers (on CT) and solid applicator models (on CT and MR), and the percent dose difference between select reference points were calculated. The mean central source deviation defined based on X‐ray markers (on CT) and solid applicator models (on CT and MR) for the 15‐patient cohort, the phantom, and the 3‐patient cohort is 0.6 mm, 0.6 mm, and 1.2 mm, respectively. The average absolute percent dose difference for the bladder, rectum, prescription, and inferior reference points were 2.2%, 2.3%, 2.2%, and 2.4%, respectively, for the 15 patient cohort. For the phantom study, the average, absolute percent dose difference for the prescription and inferior reference points are 2.0% and 2.1% for the CT, 2.3% and 2.2% for the T1W, and 2.8% and 3.0% for the T2W images. For the three patient cohort, the average absolute percent dose difference for the bladder, rectum, prescription, and inferior reference points are 2.9%, 2.6%, 3.0%, and 4.2% for the CT, 6.5%, 1.6%, 2.5%, and 4.7% for the T1W, and 6.0%, 7.4%, 2.6, and 2.0% for the T2W images. Based on the current study, aligning the applicator model to MR images provides a practical, efficient approach to perform MR‐based brachytherapy planning.PACS numbers: 87.53.Jw, 87.61.Tg