bluuebunny/crossref_metadata_2025_split huggingface dataset:
Output trends, characteristics, and measurements of three megavoltage radiotherapy linear accelerators
Authors: Hossain Murshed 
Published: February 2017

The purpose of this study is to characterize and understand the long‐term behavior of the output from megavoltage radiotherapy linear accelerators. Output trends of nine beams from three linear accelerators over a period of more than three years are reported and analyzed. Output, taken during daily warm‐up, forms the basis of this study. The output is measured using devices having ion chambers. These are not calibrated by accredited dosimetry laboratory, but are baseline‐compared against monthly output which is measured using calibrated ion chambers. We consider the output from the daily check devices as it is, and sometimes normalized it by the actual output measured during the monthly calibration of the linacs. The data show noisy quasi‐periodic behavior. The output variation, if normalized by monthly measured “real’ output, is bounded between ± 3%. Beams of different energies from the same linac are correlated with a correlation coefficient as high as 0.97, for one particular linac, and as low as 0.44 for another. These maximum and minimum correlations drop to 0.78 and 0.25 when daily output is normalized by the monthly measurements. These results suggest that the origin of these correlations is both the linacs and the daily output check devices. Beams from different linacs, independent of their energies, have lower correlation coefficient, with a maximum of about 0.50 and a minimum of almost zero. The maximum correlation drops to almost zero if the output is normalized by the monthly measured output. Some scatter plots of pairs of beam output from the same linac show band‐like structures. These structures are blurred when the output is normalized by the monthly calibrated output. Fourier decomposition of the quasi‐periodic output is consistent with a 1/f power law. The output variation appears to come from a distorted normal distribution with a mean of slightly greater than unity. The quasi‐periodic behavior is manifested in the seasonally averaged output, showing annual variability with negative variations in the winter and positive in the summer. This trend is weakened when the daily output is normalized by the monthly calibrated output, indicating that the variation of the periodic component may be intrinsic to both the linacs and the daily measurement devices. Actual linac output was measured monthly. It needs to be adjusted once every three to six months for our tolerance and action levels. If these adjustments are artificially removed, then there is an increase in output of about 2%–4% per year.PACS numbers: 87.56bd, 87.56Fc, 87.55Qr
A simple method to prolong the service life of radioactive sources for external radiotherapy
Authors: Xu Yingjie , Tian Yuan , Dai Jianrong 
Published: February 2017

A radioactive source is usually replaced and disposed after being used for a certain amount of time (usually a half‐life). In this study, a simple method is proposed to prolong its service life. Instead of replacing the used source with a new source of full activity, a new source of less activity is added in the source holder in front of the used one, so that the total activity of two sources is equal to the initial activity of the used source or even higher. Similarly, more sources can be added to the previous ones. Attenuation of front source(s) to the back source(s) was evaluated with exponential attenuation equation, and variation of source‐focus distance (SFD) with inverse square law for Leksell 4C Gamma Knife, which served as an example of external radiotherapy units. When the number of front sources increased from 1 to 3, the relative air kerma decreased from 36.5% to 5.0%. Both the attenuation effect and SFD variation contributed to the decrease in air kerma, with the former being the major factor. If the height of the source can be decreased in some way, such as increasing the specific activity of sources, the sources can be used more efficiently. The method prolongs the service life of sources by several factors, and reduces the expense of source exchange and reclamation.PACS number: 87.56.bg
The clinical impact of detector choice for beam scanning
Authors: Gersh Jacob A. , Best Ryan C. M. , Watts Ronald J. 
Published: February 2017

Recently, the developers of Eclipse have recommended the use of ionization chambers for all profile scanning, including for the modeling of VMAT and stereotactic applications. The purpose of this study is to show the clinical impact caused by the choice of detector with respect to its ability to accurately measure dose in the penumbra and tail regions of a scanned profile. Using scan data acquired with several detectors, including an IBA CC13, a PTW 60012, and a Sun Nuclear EDGE Detector, three complete beam models are created, one for each respective detector. Next, using each beam model, dose volumes are retrospectively recalculated from actual anonymous patient plans. These plans include three full‐arc VMAT prostate plans, three left chest wall plans delivered using irregular compensators, two half‐arc VMAT lung plans, three MLC‐collimated static‐field pairs, and two SBRT liver plans. Finally, plans are reweighted to deliver the same number of monitor units, and mean dose‐to‐target volumes and organs at risk are calculated and compared. Penumbra width did not play a role. Dose in the tail region of the profile made the largest difference. By overresponding in the tail region of the profile, the 60012 diode detector scan data affected the beam model in such a way that target doses were reduced by as much as 0.4% (in comparison to CC13 and EDGE data). This overresponse also resulted in an overestimation of dose to peripheral critical structure, whose dose consisted mainly of scatter. This study shows that, for modeling the 6 MV beam of Acuros XB in Eclipse Version 11, the choice to use a CC13 scanning ion chamber or an EDGE Detector was an unimportant choice, providing nearly identical models in the treatment planning system.PACS number: 87.55.kh
Commissioning and comprehensive evaluation of the ArcCHECK cylindrical diode array for VMAT pretreatment delivery QA
Authors: Chaswal Vibha , Weldon Michael , Gupta Nilendu , Chakravarti Arnab , Rong Yi 
Published: February 2017

We present commissioning and comprehensive evaluation for ArcCHECK as a QA equipment for volumetric‐modulated arc therapy (VMAT), using the 6 MV photon beam with and without the flattening filter, and the SNC patient software (version 6.2). In addition to commissioning involving absolute dose calibration, array calibration, and PMMA density verification, ArcCHECK was evaluated for its response dependency on linac dose rate, instantaneous dose rate, radiation field size, beam angle, and couch insertion. Scatter dose characterization, consistency and symmetry of response, and dosimetry accuracy evaluation for fixed aperture arcs and clinical VMAT patient plans were also investigated. All the evaluation tests were performed with the central plug inserted and the homogeneous PMMA density value. Results of gamma analysis demonstrated an overall agreement between ArcCHECK‐measured and TPS‐calculated reference doses. The diode based field size dependency was found to be within 0.5% of the reference. The dose rate‐based dependency was well within 1% of the TPS reference, and the angular dependency was found to be ± 3% of the reference, as tested for BEV angles, for both beams. Dosimetry of fixed arcs, using both narrow and wide field widths, resulted in clinically acceptable global gamma passing rates on the 3%/3 mm level and 10% threshold. Dosimetry of narrow arcs showed an improvement over published literature. The clinical VMAT cases demonstrated high level of dosimetry accuracy in gamma passing rates.PACS numbers: 87.56.Fc, 87.55.kh, 87.55.Qr
The photon dose calculation algorithm used in breast radiotherapy has significant impact on the parameters of radiobiological models
Authors: Petillion Saskia , Swinnen Ans , Defraene Gilles , Verhoeven Karolien , Weltens Caroline , den Heuvel Frank Van 
Published: February 2017

The comparison of the pencil beam dose calculation algorithm with modified Batho heterogeneity correction (PBC‐MB) and the analytical anisotropic algorithm (AAA) and the mutual comparison of advanced dose calculation algorithms used in breast radiotherapy have focused on the differences between the physical dose distributions. Studies on the radiobiological impact of the algorithm (both on the tumor control and the moderate breast fibrosis prediction) are lacking. We, therefore, investigated the radiobiological impact of the dose calculation algorithm in whole breast radiotherapy. The clinical dose distributions of 30 breast cancer patients, calculated with PBC‐MB, were recalculated with fixed monitor units using more advanced algorithms: AAA and Acuros XB. For the latter, both dose reporting modes were used (i.e., dose‐to‐medium and dose‐to‐water). Next, the tumor control probability (TCP) and the normal tissue complication probability (NTCP) of each dose distribution were calculated with the Poisson model and with the relative seriality model, respectively. The endpoint for the NTCP calculation was moderate breast fibrosis five years post treatment. The differences were checked for significance with the paired t‐test. The more advanced algorithms predicted a significantly lower TCP and NTCP of moderate breast fibrosis then found during the corresponding clinical follow‐up study based on PBC calculations. The differences varied between 1% and 2.1% for the TCP and between 2.9% and 5.5% for the NTCP of moderate breast fibrosis. The significant differences were eliminated by determination of algorithm‐specific model parameters using least square fitting. Application of the new parameters on a second group of 30 breast cancer patients proved their appropriateness. In this study, we assessed the impact of the dose calculation algorithms used in whole breast radiotherapy on the parameters of the radiobiological models. The radiobiological impact was eliminated by determination of algorithm specific model parameters.PACS numbers: 87.55.dh, 87.55.dk
Assessing the deviation from the inverse square law for orthovoltage beams with closed‐ended applicators
Authors: Gräfe James , Poirier Yannick , Jacso Ferenc , Khan Rao , Liu Hong‐Wei , Eduardo Villarreal‐Barajas J. 
Published: February 2017

In this report, we quantify the divergence from the inverse square law (ISL) of the beam output as a function of distance (standoff) from closed‐ended applicators for a modern clinical orthovoltage unit. The divergence is clinically significant exceeding 3% at a 1.2 cm distance for 4 × 4 and closed‐ended applicators. For all investigated cases, the measured dose falloff is more rapid than that predicted by the ISL and, therefore, causes a systematic underdose when using the ISL for dose calculations at extended SSD. The observed divergence from the ISL in closed‐ended applicators can be explained by the end‐plate scattering contribution not accounted for in the ISL calculation. The standoff measurements were also compared to the predictions from a home‐built kV dose computation algorithm, kVDoseCalc. The kVDoseCalc computation predicted a more rapid falloff with distance than observed experimentally. The computation and measurements agree to within 1.1% for standoff distances of 3 cm or less for and field sizes. The overall agreement is within 2.3% for all field sizes and standoff distances measured. No significant deviation from the ISL was observed for open‐ended applicators for standoff distances up to 10 cm.PACS numbers: 87.55.‐x, 87.55.kh
High‐resolution micro‐CT scanning as an innovative tool for evaluating dental hard tissue development
Authors: Dong Guangyan , Dong Qianqian , Liu Yi , Lou Beiyan , Feng Jin , Wang Kejing , Zhou Xuedong , Wu Hongkun 
Published: February 2017

Microcomputerized tomography (micro‐CT) allows discriminating very small changes in dental hard tissue volumes. The aim of the present study was to create a new method for obtaining high‐resolution, three‐dimensional images of dental hard tissue development using micro‐CT, and to observe the changes in dental hard tissue development and composition in growing rat pups. Tooth germs from rats at the end of the 20‐day embryonic period (E20) and during the neonatal period (D1‐14) were subjected to micro‐CT. Three‐dimensional reconstructions were analyzed to compare dental hard tissue formation and mineralization during the different development periods. Scanning electron microscopy and energy dispersive spectroscopy were used to confirm mineral density (MD). Dental hard tissue began to form during the E20, but the process was slow and resulted in minimal deposition. Hard tissue volume increased by approximately 0.040 mm3/day from E20 to D3, and by 0.12‐0.42 mm3/day after D3, peaking at 0.42 mm3/day at D12. This increase in hard tissue volume resulted in continuous increases in hard tissue thickness, from 90.0 ± 20.7 μm at E20 to 545.2 ± 14.1 μm by D14. MD was 298 ± 3.1 mg HA/cm at E20 and increased to 678.2 ± 6.1 mg HA/cm by D14. The degree of calcification also progressively increased during the first 14 days of development. Dental MD was strongly associated with calcification. This study indicates that micro‐CT is a nondestructive, high‐resolution, reliable, and innovative tool for the evaluation of volume and MD of dental hard tissues during development. Micro‐CT minimizes artifacts caused by sample preparation.PACS number: 87
Improving linear accelerator service response with a real‐time electronic event reporting system
Authors: Hoisak Jeremy D. P. , Pawlicki Todd , Kim Gwe‐Ya , Fletcher Richard , Moore Kevin L. 
Published: February 2017

To track linear accelerator performance issues, an online event recording system was developed in‐house for use by therapists and physicists to log the details of technical problems arising on our institution's four linear accelerators. In use since October 2010, the system was designed so that all clinical physicists would receive email notification when an event was logged. Starting in October 2012, we initiated a pilot project in collaboration with our linear accelerator vendor to explore a new model of service and support, in which event notifications were also sent electronically directly to dedicated engineers at the vendor's technical help desk, who then initiated a response to technical issues. Previously, technical issues were reported by telephone to the vendor's call center, which then disseminated information and coordinated a response with the Technical Support help desk and local service engineers. The purpose of this work was to investigate the improvements to clinical operations resulting from this new service model. The new and old service models were quantitatively compared by reviewing event logs and the oncology information system database in the nine months prior to and after initiation of the project. Here, we focus on events that resulted in an inoperative linear accelerator (“down” machine). Machine downtime, vendor response time, treatment cancellations, and event resolution were evaluated and compared over two equivalent time periods. In 389 clinical days, there were 119 machine‐down events: 59 events before and 60 after introduction of the new model. In the new model, median time to service response decreased from 45 to 8 min, service engineer dispatch time decreased 44%, downtime per event decreased from 45 to 20 min, and treatment cancellations decreased 68%. The decreased vendor response time and reduced number of on‐site visits by a service engineer resulted in decreased downtime and decreased patient treatment cancellations.PACS numbers: 87.56.bd, 87.55.Qr
VMAT for the treatment of gynecologic malignancies for patients unable to receive HDR brachytherapy
Authors: Merrow Caitlin , deBoer Steven , Podgorsak Matthew B. 
Published: February 2017

This investigation studies the use of volumetric‐modulated arc therapy (VMAT) to deliver the following conceptual gynecological brachytherapy (BT) dose distributions: Type 1, traditional pear‐shaped dose distribution with substantial dose gradients; Type 2, homogeneous dose distribution throughout PTV (BT prescription volume); and Type 3, increased dose to PTV without organ‐at‐risk (OAR) overdose. A tandem and ovoid BT treatment plan, with the prescription dose of 6 Gy to point A, was exported into the VMAT treatment planning system (TPS) and became the baseline for comparative analysis. The 200%, 150%, 130%, 100%, 75%, and 50% dose volumes were converted into structures for optimization and evaluation purposes. The 100% dose volume was chosen to be the PTV. Five VMAT plans (Type 1) were created to duplicate the Ir‐192 tandem and ovoid inhomogeneous dose distribution. Another five VMAT plans (Type 2) were generated to deliver a homogeneous dose of 6 Gy to the PTV. An additional five VMAT plans (Type 3) were created to increase the dose to the PTV with a homogeneous dose distribution. In the first set of plans, the dose given to 99% of the 200%–100% dose volumes agreed within 2% of the BT plan on average. Additionally, it was found that the 75% dose volumes agreed within 5% of the BT plan and the 50% dose volumes agreed within 6.4% of the BT plan. In the second set of comparative analyses, the 100% dose volume was found to be within 1% of the original plan. Furthermore, the maximum increase of dose to the PTV in the last set of comparative analyses was 8 Gy with similar doses to OARs as the other VMAT plans. The maximum increase of dose was 2.50 Gy to the rectum and the maximum decrease of dose was 0.70 Gy to the bladder. Henceforth, VMAT was successful at reproducing brachytherapy dose distributions demonstrating that alternative dose distributions have the potential to be used in lieu of brachytherapy. It should also be noted that differences in radiobiology need to be further investigated.PACS numbers: 87.50.‐a, 87.53.‐j, 87.55.‐x, 87.55.D‐, 87.55.dk, 87.55.de
Dose differences between the three dose calculation algorithms in Leksell GammaPlan
Authors: Xu Andy (Yuanguang) , Bhatnagar Jagdish , Bednarz Greg , Niranjan Ajay , Flickinger John , Lunsford L. Dade , Huq M. Saiful 
Published: February 2017

The purpose of this study was to evaluate the dose differences introduced by the TMR 10 and the convolution dose calculation algorithms in GammaPlan version 10, as compared to the TMR classic algorithm in the previous versions of GammaPlan. Computed axial tomographic images of a polystyrene phantom and a human head were acquired using a GE LightSpeed VCT scanner. A treatment target with a prescription dose of 20 Gy to 50% isodose line was defined in the phantom or the head CT set. The treatment times for single collimator, single shot placements were calculated using the three dose calculation algorithms in GammaPlan version 10. Four comparative studies were conducted: i) the dose matrix position was varied every 10 mm along the x‐, y‐, z‐axes of the stereotactic coordinate system inside the phantom and the treatment times were compared on each matrix for the three collimators of the Gamma Knife Perfexion and the four collimators of the 4C; ii) the study was repeated for the human head CT dataset; iii) the matrix position was varied every 20 mm in the X and the Y directions on the central slice of the head CT and the shot times were compared on each matrix for the 8 mm collimator of both units; a total of 51 matrix positions were identified for each unit; iv) the above comparison was repeated for the head CT transverse slices with and 160 mm. A total of 271 matrix positions were studied. Based on the comparison of the treatment times needed to deliver 20 Gy at 50% isodose line, the equivalent TMR classic dose of the TMR 10 algorithm is roughly a constant for each collimator of the 4C unit and is 97.5%, 98.5%, 98%, and 100% of the TMR 10 dose for the 18 mm, 14 mm, 8 mm, and the 4 mm collimators, respectively. The numbers for the three collimators of the Perfexion change with the shot positions in the range from 99% to 102% for both the phantom and the head CT. The minimum, maximum, and the mean values of the equivalent TMR classic doses of the convolution algorithm on the 271 voxels of the head CT are 99.5%, 111.5%, 106.5% of the convolution dose for the Perfexion, and 99%, 109%, 104.5% for the 4C unit. We identified a maximum decrease in delivered dose of 11.5% for treatment in the superior frontal/parietal vertex region of the head CT for older calculations lacking inhomogeneity correction to account for the greater percentage of the average beam path occupied by bone. The differences in the inferior temporal lobe and the cerebellum/neck regions are significantly less, owing to the counter‐balancing effects of both bone and the air cavity inhomogeneities. The dose differences between the TMR 10 and the TMR classic are within for a single shot placement on both Perfexion and 4C. Dose prescriptions based on the experiences with the TMR classic may need to be adjusted to accommodate the up to 11.5% difference between the convolution and the TMR classic.PACS numbers: 87.55.D, 87.55.kd
Three‐dimensional dose prediction based on two‐dimensional verification measurements for IMRT
Authors: Sumida Iori , Yamaguchi Hajime , Kizaki Hisao , Aboshi Keiko , Yamada Yuji , Yoshioka Yasuo , Ogawa Kazuhiko 
Published: February 2017

Dose verifications for intensity‐modulated radiation therapy (IMRT) are generally performed once before treatment. A 39‐fraction treatment course for prostate cancer delivers a dose prescription of 78 Gy in eight weeks. Any changes in multileaf collimator leaf position over the treatment course may affect the dosimetry. To evaluate the magnitude of deviations from the predicted dose over an entire treatment course with MLC leaf calibrations performed every two weeks, we tracked weekly changes in relative dose error distributions measured with two‐dimensional (2D) beam‐by‐beam analysis. We compared the dosimetric results from 20 consecutive patient‐specific IMRT quality assurance (QA) tests using beam‐by‐beam analysis and a 2D diode detector array to the dose plans calculated by the treatment planning system (TPS). We added back the resulting relative dose error measured weekly into the original dose grid for each beam. To validate the prediction method, the predicted doses and dose distributions were compared to the measurements using an ionization chamber and film. The predicted doses were in good agreement, within 2% of the measured doses, and the predicted dose distributions also presented good agreement with the measured distributions. Dose verification results measured once as a pretreatment QA test were not completely stable, as results of weekly beam‐by‐beam analysis showed some variation. Because dosimetric errors throughout the treatment course were averaged, the overall dosimetric impact to patients was small.PACS numbers: 87.55.D‐, 87.55.dk, 87.55.km, 87.55.Qr