Three-dimensional imaging.
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Biomedical subjects
Publications and source records attributed to E L Chaney.
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Radiation treatment planning is currently in a state of rapid change. Dissatisfaction with past planning technology stems from the growing realization that: (1) Increases in the local regional tumor control rate will increase the cure rate in many malignancies. (2) Even at the best treatment centers geometric tumor misses are commonplace. (3) Traditional constraints on treatment techniques, originally imposed for simplicity and reproducibility, are no longer necessary, and can result in suboptimal treatment. (4) Treatment plans judged "optimal" in two dimensions may be far from optimal when viewed over the entire treatment volume. (5) Lack of treatment reproducibility is also commonplace, and can be demonstrated to adversely affect treatment outcome. On the positive side, recent developments in computer graphics, image processing, radiation physics, and radiation biology are now making it possible to define, design, and deliver sophisticated 3D radiation treatments. However, because many of these technologies are being developed for other disciplines, their applicability to radiation therapy treatment planning is not widely appreciated. We outline the current status and new developments in radiation therapy treatment planning.
Virtual simulation departs from normal practice by replacing conventional treatment simulation with 3-dimensional image data and computer software. Implementation of virtual simulation requires the ability to transfer the planned treatment geometry from the computer to the treatment room in a way which is accurate, reproducible, and efficient enough for routine use. We have separated this process into: (a) immobilization of the patient; (b) establishment and alignment of a practical coordinate system for the patient/couch system; and (c) setup of the patient/couch been addressed by the use of hemi- or full-body foam casts, the second by use of an alignment jig on the treatment couch, and the third with the aid of a patient coordinate system referenced to easily located landmarks. Phantom studies and clinical practice have shown these techniques to be practical and effective within reasonable clinical bounds.
The increasing use of 3-dimensional radiotherapy treatment design has created greater reliance on methods for computing images from CT data which correspond to the conventional simulation film. These images, known as computed or digitally reconstructed radiographs, serve as reference images for verification of computer-designed treatments. Used with software that registers graphic overlays of target and anatomic structures, digitally reconstructed radiographs are also valuable tools for designing portal shape. We have developed radiograph reconstruction software that takes full advantage of the contrast and spatial detail inherent in the original CT data. This goal has been achieved by using a ray casting algorithm which explicitly takes into account every intersected voxel, and a heuristic approach for approximating the images that would result from purely photoelectric or Compton interactions. The software also offers utilities to superimpose outlines of anatomic structures, field edges, beam crosshairs, and linear scales on digitally reconstructed radiographs. The pixel size of the computed image can be controlled, and several methods of interslice interpolation are offered. The software is written in modular format in the C language, and can stand alone or interface with other treatment planning software.
An efficient system for preparing, afterloading, and removing interstitial 192Ir strands has been developed. Use of the system reduces the risk of personnel exposure and eliminates some patient discomfort. The system is "integrated" in that all aspects of the implantation process are considered, from source preparation to source removal. Strand preparation is facilitated by an "assembly line" process using shielded equipment. Components include a handling block for measuring and cutting active strands, a mirror, and a transport container. Afterloading and removal techniques use quick release devices and several forms of afterloading tubing and catheters, each terminated by a Luer lock adapter. Both blind-end and through-and-through implants are possible. Each 192Ir strand, threaded through an injection cap that mates with the Luer lock adapter, is quickly inserted into its tubing or catheter and locked into place. No crimping is required and no additional positioning of the sources is needed. Strand removal is easily accomplished by unlocking and removing the injection cap. The strands receive no mechanical damage and can be reused after appropriate cleaning. More than 100 cases have been performed without incident. Applications include head/neck, breast, and template and non-template vaginal wall treatments.
The practice of radiotherapy involves the precise geometric localization of both anatomic and non-anatomic structures using radiographs which are typically of very low contrast. Portal and verification films suffer from poor contrast as a result of the dominance of Compton interactions at therapeutic energies, and implant localization films often are degraded by extreme patient thickness (lateral pelvis) or projection of bony structures (head and neck). Automatic contrast enhancement techniques developed and proven for optimization of the display of digitally produced images such as CT have been applied to radiotherapy films to improve contrast and augment readability. This approach has become viable only recently with the advent of high speed, high resolution film digitizers and laser cameras and the evolution of sufficiently powerful computer hardware.
We studied the effects of ionizing radiation on the morphology of the pulmonary circulation using an in vivo rat model and an in vitro pulmonary artery endothelial cell model. Gamma radiation was given as either an acute (30 Gy) or fractionated (5 X 6 Gy) dose to one hemithorax of rats. An acute 30-Gy dose delivered resulted in a 70% decrease in pulmonary arterial perfusion, using technetium-99m microaggregated albumin (99mTc-MAA), in the irradiated lung by 2-3 weeks after irradiation. Pulmonary microradiographs, using a barium sulfate perfusion method, obtained 2-3 weeks after irradiation demonstrated widespread loss of capillary filling and segmentation of the vessels. Histologic examination demonstrated intact capillaries, suggesting that the alterations in pulmonary perfusion were at the precapillary level. Similar abnormalities in lung perfusion and morphology were found after delivery of fractionated doses of radiation, but the onset of the changes was delayed, occurring 4-6 weeks postirradiation. Using cultured pulmonary endothelial cell monolayers, cell sloughing and retraction from the surface substrate were observed within 24 h after in vitro delivery of 30 Gy. Similar findings occurred in monolayers given fractionated doses (5 X 6 Gy) of radiation 2-3 days after the final dose. The in vivo animal and in vitro endothelial cell models offer a useful means of examining the morphologic alterations involved in radiation lung vascular damage.
The effects of ionizing irradiation (0, 600, 1,500, or 3,000 rads) on the permeability of pulmonary endothelial monolayers to albumin were studied. Pulmonary endothelial cells were grown to confluence on gelatin-coated polycarbonate filters, placed in serum-free medium, and exposed to a 60Co source. The monolayers were placed in modified flux chambers 24 hours after irradiation; 125I-albumin was added to the upper well, and both the upper and lower wells were serially sampled over 4 hours. The amount of albumin transferred from the upper well/hour over the period of steady-state clearance (90-240 min after addition of 125I-albumin) was 2.8 +/- 0.2% in control monolayers and was increased in monolayers exposed to 1,500 or 3,000 rads (increase of 63 +/- 10% and 61 +/- 10%, respectively, P less than 0.01). No increase was found in monolayers exposed to 600 rads. The increases in endothelial albumin transfer rates were associated with morphologic evidence of monolayer disruption and endothelial injury which paralleled the changes in albumin permeability. Dose-dependent alterations in endothelial actin filament organization were also found. Incubation of the monolayers exposed to 3,000 rads with medium supplemented with 10% fetal calf serum for 24 hours resulted in normalization of albumin permeability, improvement in morphologic appearance of the monolayers, and reorganization of the actin filament structure. These studies demonstrate that ionizing radiation is an active principle in the reversible disorganization of cultured pulmonary endothelial cell monolayers without the need of other cell types or serum components.
The effects of gamma irradiation (150-3000 rad) on prostacyclin synthesis (PGI2) and Na+-dependent amino acid uptake (alpha-aminoisobutyric acid, AIB) were assessed in vitro in bovine pulmonary artery endothelial cells grown in plastic culture dishes. A dose-dependent increase in both PGI2 synthesis and AIB was found 24 h after irradiation at exposure levels greater than 600 rad. The increase in PGI2 synthesis [297% of sham-irradiated values at 3000 rad, P less than 0.01] was due to an increase in release of arachidonic acid from plasma membrane stores as well as stimulation of cyclooxygenase and/or prostacyclin synthetase enzymes. The increase in AIB uptake (75% increase at 3000 rad compared to sham-exposure values) correlated with the increased synthesis of PGI2 (r = 0.94). There was also a dose-dependent increase in the number of cells that became detached from the culture dishes during the 24-h period after irradiation. The changes in PGI2 synthesis and AIB uptake induced by gamma irradiation differed if the endothelial cells were grown on cover slips, indicating that the endothelial response to irradiation may be dependent on the interaction between the endothelial cell and its extracellular basement membrane matrix.
Phototimers detect x rays impinging on or emerging from an x-ray film cassette and terminate the exposure after a predetermined amount of radiation has been received by the film. A phototimer must provide reproducible film exposures over a wide range of target-to-film distances, patient thicknesses, and technique variables. A method is needed which verifies that the phototimer is functioning properly and identifies exposure techniques and practices which are compatible with its use. Several techniques are presented for evaluating phototimer performance, and data accumulated during application of these techniques to the use of three spot-film phototimers are presented.
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A method for absolute calibration of diagnostic x-ray generators is presented and discussed. The method employs a Ge(Li) detector and relies on the direct observation of the onset of fluorescence radiation from scattering foils placed in the primary beam.
An electronic instrument with digital readout has been designed and constructed for indirect determination of the kVp applied to diagnostic x-ray tubes. The signals from two detectors exposed simultaneously to a differentially filtered x-ray beam are processed by analog computing circuitry to yield an output signal directly proportional to the applied peak kilovoltage. Theory and preliminary results are presented and discussed.
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