Biomedical subjects

B J M Heijmen

Publications and source records attributed to B J M Heijmen.

6 recordsLinked to original sources

PubMed2006

Improvement of radiotherapy treatment delivery accuracy using an electronic portal imaging device.

Reliable application of advanced external beam techniques for the treatment of patients with cancer, such as intensity modulated radiotherapy, requires an adequate quality assurance programme for the verification of the dose delivery. Accurate patient positioning is mandatory because of the steep dose gradients outside the tumour volume. Owing to the increased complexity of the treatment planning and delivery techniques, verification of the dose delivery before and during the actual patient treatment is equally important. For this purpose, a quality assurance programme has been established in our clinic that is primarily based on measurements with electronic portal imaging devices. To minimise systematic set-up errors, the patient positioning is measured in the first few treatment fractions and a set-up correction is applied in the subsequent ones. Before the first treatment fraction, portal dose measurements are performed for each treatment field with the electronic portal imaging device to verify that the planned fluence distribution is correctly delivered at the treatment unit. Dosimetric measurements are also performed during patient treatment to derive the actually delivered fluence maps. By combining this information with knowledge on the patient set-up, the delivered 3-D dose distribution to both the tumour and sensitive organs may be assessed. However, for the highest accuracy, exact knowledge on the (internal) patient geometry during treatment, e.g. using a cone-beam CT, is required.

Humans↗

PubMed2006

A novel approach to accurate portal dosimetry using CCD-camera based EPIDs.

A new method for portal dosimetry using CCD camera-based electronic portal imaging devices (CEPIDs) is demonstrated. Unlike previous approaches, it is not based on a priori assumptions concerning CEPID cross-talk characteristics. In this method, the nonsymmetrical and position-dependent cross-talk is determined by directly imaging a set of cross-talk kernels generated by small fields ("pencil beams") exploiting the high signal-to-noise ratio of a cooled CCD camera. Signal calibration is achieved by imaging two reference fields. Next, portal dose images (PDIs) can be derived from electronic portal dose images (EPIs), in a fast forward-calculating iterative deconvolution. To test the accuracy of these EPI-based PDIs, a comparison is made to PDIs obtained by scanning diode measurements. The method proved accurate to within 0.2+/-0.7% (1 SD), for on-axis symmetrical and asymmetrical fields with different field widths and homogeneous phantom thicknesses, off-axis Alderson thorax fields and a strongly modulated IMRT field. Hence, the proposed method allows for fast, accurate portal dosimetry. In addition, it is demonstrated that the CEPID cross-talk signal is not only induced by optical photon reflection and scatter within the CEPID structure, but also by high-energy back-scattered radiation from CEPID elements (mirror and housing) towards the fluorescent screen.

Algorithms↗

PubMed2004

Characteristics relevant to portal dosimetry of a cooled CCD camera-based EPID.

Our EPIDs have recently been equipped with Peltier-cooled CCD cameras. The CCD cooling dramatically reduced deteriorating effects of radiation damage on image quality. Over more than 600 days of clinical operation, the radiation induced noise contribution has remained stable at a very low level (1 SD < or = 0.15% of the camera dynamic range), in marked contrast with the previously used noncooled cameras. The camera response (output signal versus incident EPID radiation exposure) can be accurately described with a quadratic function. This response reproduced well, both in short and long term (variation < 0.2% respectively < 0.4% (1 SD)), rendering the cooled camera well-suited for EPID dosimetry applications.

Cold Temperature↗

PubMed2004

Stereotactic arc therapy for small elongated tumors using cones and collimator jaws; dosimetric and planning aspects.

Stereotactic arc treatment of small intracranial tumors is usually performed with arcs collimated by circular cones, resulting in treatment volumes which are basically spherical. For nonspherical lesions this results in a suboptimal dose distribution. Multiple isocenters may improve the dose conformity for these lesions, at the cost of large overdosages in the target volume. To achieve improved dose conformity as well as dose homogeneity, the linac jaws (with a minimum distance of 1.0 cm to the central beam axis) can routinely be used to block part of the circular beams. The purpose of this study was to investigate the feasibility of blocking cones with diameters as small as 1.0 cm and a minimum distance between the jaw and the central beam axis of 0.3 cm. First, the reproducibility in jaw positioning and resulting dose delivery on the treatment unit were assessed. Second, the accuracy of the TPS dose calculation for these small fields was established. Finally, clinically applied treatment plans using nonblocked cones were compared with plans using the partially blocked cones for several treatment sites. The reproducibility in dose delivery on our Varian Clinac 2300 C/D machines on the central beam axis is 0.8% (1 SD). The accuracy of the treatment planning system dose calculation algorithm is critically dependent on the used fits for the penumbra and the phantom scatter. The average deviation of calculated from measured dose on the central beam axis is -1.0%+/-1.4% (1 SD), which is clinically acceptable. Partial cone blocking results in improved dose distributions for elongated tumors, such as vestibular schwannoma and uveal melanoma. Multiple isocenters may be avoided. The technique is easy to implement and requires no additional workload.

Algorithms↗

PubMed2003

Dosimetric verification of x-ray fields with steep dose gradients using an electronic portal imaging device.

Regions with steep dose gradients are often encountered in clinical x-ray beams, especially with the growing use of intensity modulated radiotherapy (IMRT). Such regions are present both at field edges and, for IMRT, in the vicinity of the projection of sensitive anatomical structures in the treatment field. Dose measurements in these regions are often difficult and labour intensive, while dose prediction may be inaccurate. A dedicated algorithm developed in our institution for conversion of pixel values, measured with a charged coupled device camera based fluoroscopic electronic portal imaging device (EPID), into absolute absorbed doses at the EPID plane has an accuracy of 1-2% for flat and smoothly modulated fields. However, in the current algorithm there is no mechanism to correct for the (short-range) differences in lateral electron transport between water and the metal plate with the fluorescent layer in the EPID. Moreover, lateral optical photon transport in the fluorescent layer is not taken into account. This results in large deviations (>10%) in the penumbra region of these fields. We have investigated the differences between dose profiles measured in water and with the EPID for small heavily peaked fields. A convolution kernel has been developed to empirically describe these differences. After applying the derived kernel to raw EPID images, a general agreement within 2% was obtained with the water measurements in the central region of the fields, and within 0.03 cm in the penumbra region. These results indicate that the EPID is well suited for accurate dosimetric verification of steep gradient x-ray fields.

Equipment Design↗

PubMed2002

A new approach to off-line setup corrections: combining safety with minimum workload.

Off-line patient setup correction protocols based on electronic portal images are an effective tool to reduce systematic patient setup errors. Recently, we have introduced the no action level (NAL) protocol which establishes a significant error reduction at a very small workload. However, this protocol did not include an explicit verification of the applied setup corrections. Systematic mistakes in the execution of setup corrections (e.g., a setup correction is always executed in the +X direction whereas a correction in the -X direction was prescribed) may introduce large systematic setup errors (irrespective of the setup protocol) and may seriously impair treatment outcome. We have therefore extended the NAL protocol with a correction verification (COVER) stage, solely aimed at detecting such mistakes. In short, COVER tests the magnitude of the postcorrection setup error in each relevant direction. If these residue errors are below the acceptance threshold T, no more electronic portal images are required and the protocol has finished. If not, the origin of this result should be investigated; if no obvious mistakes are present, the procedure is repeated for one more treatment fraction. If the residue setup errors are confirmed to be larger than T, the entire protocol is restarted. Using both Monte Carlo simulations and analytical calculations, we performed a risk analysis and evaluated the workload for various choices of T. A threshold T = 3 x sigma(r), where sigma(r) is the mean standard deviation of the random setup errors, ensured that (1) COVER introduces only a small additional workload (1.05 measurement per patient, while the absolute minimum is 1.0) and (2) serious correction mistakes are detected with high probability. Even if setup corrections are wrongly applied in each patient (worst case scenario), COVER ensures that the final distribution of systematic errors is not wider than the precorrection distribution of systematic errors; for realistic frequencies of correction mistakes (<< 1 per patient) this distribution becomes much more narrow. The combination of NAL and COVER thus provides a highly efficient as well as safe method to reduce systematic setup errors.

Algorithms↗