Biomedical subjects

M A Mosleh-Shirazi

Publications and source records attributed to M A Mosleh-Shirazi.

9 recordsLinked to original sources

PubMed2005

Radiotherapy of localised intracranial germinoma: time to sever historical ties?

The optimum management of localised intracranial germinoma remains controversial. Cure rates for this rare CNS tumour, which arises mainly in adolescents, exceed 90% at 10 years, and limitation of treatment-related late morbidity is therefore essential. Craniospinal radiotherapy plus boost is perceived to be the gold-standard treatment, but there have been suggestions that reduced-volume radiotherapy could be adequate for cure. We reviewed publications since 1988 to compare patterns of disease relapse and cure rates after craniospinal radiotherapy, reduced-volume irradiation alone (i.e., whole-brain or whole-ventricular irradiation followed by a boost), and focal or localised irradiation alone. The recurrence rate after whole-brain or whole-ventricular radiotherapy plus boost was 7.6% compared with 3.8% after craniospinal radiotherapy, with no predilection for isolated spinal relapses (2.9% vs 1.2%). We challenge the consensus that craniospinal radiotherapy is the best treatment for localised germinomas and conclude that reduced-volume radiotherapy plus boost should replace craniospinal radiotherapy when a radiotherapy-only approach is used.

Adolescent↗

PubMed2005

Quantification and reduction of cardiac dose in radical radiotherapy for oesophageal cancer.

Chemoradiation is increasingly used in the management of localized oesophageal cancer and has been shown in randomized controlled trials to improve overall survival. Although early toxicity of radiotherapy is well documented, this is not the case for late toxicity. As patients with oesophageal cancer have a high incidence of co-morbidities including cardiac problems, the aim of this paper was to quantify the extent of cardiac radiation and discuss the influence of beam arrangement to reduce this. Eight patients with localized oesophageal cancer treated with radical chemoradiation were selected. The mean cardiac dose and the volumes of heart receiving 30 Gy, 40 Gy and 45 Gy from the conventional two-phase technique were compared with those of single-phase 3-field and 4-field conformal beam arrangements. The 4-field arrangement reduced the mean cardiac dose by at least 3.3 Gy compared with the other two beam arrangements (p=0.01). The mean volume of heart receiving high doses between the three techniques widened as the dose increased in the range 30-45 Gy. There is no statistically significant difference in volumes receiving more than 30 Gy and 40 Gy. 65% of the cardiac volume received more than 45 Gy using a two-phase technique, compared with 57% using three fields and 26% using four fields (p<0.01). With a 4-field beam arrangement, therefore, there is a significant reduction in cardiac dose compared with the other two techniques. Cardiac toxicity and a 4-field beam arrangement should be considered when planning radical radiotherapy for localized oesophageal cancer.

Aged↗

PubMed2003

Commissioning and quality assurance of the Pinnacle(3) radiotherapy treatment planning system for external beam photons.

The commissioning of a Pinnacle(3) treatment planning system is described. Four Elekta linear accelerators were commissioned for external beam photons. Measured data were used to derive parameter values for the Pinnacle(3) beam model by (1). fitting a Monte Carlo model of the accelerator head to measured data and then extracting the parameters for the Pinnacle(3) beam model, and by (2). using the auto-modelling facility within Pinnacle(3). Both of these methods yielded dose distributions in accord with published recommendations. A separate small-field beam model, customized for an in-house compact blocking system, was also created, which satisfied appropriate acceptance criteria for stereotactically guided conformal brain treatments. Inhomogeneous, oblique, asymmetrical and irregular fields were also assessed, with calculated and measured doses agreeing to within +/-3%. Dose-volume histogram calculation was found to be accurate to within +/-5% dose or volume for a grid size of 4 mm x 4 mm x 4 mm, with better accuracy being achieved for finer grids. Isocentric doses were compared between Pinnacle(3)'s collapsed cone convolution algorithm and the Bentley-Milan algorithm within the Target-2 treatment planning system. Dose differences were generally less than 3% in the dose prescribed, with larger values for breast plans, where the Pinnacle(3) algorithm calculated scatter more accurately. Pelvic and thoracic plans were also verified using an anthropomorphic phantom, with local dose differences between calculated and delivered dose of up to 8%, but mainly less than 3%, and with no systematic difference. Ionization chamber verifications using START and RT-01 trial procedures demonstrated differences between calculated and measured doses of less than 2%. Following satisfactory performance in the commissioning process, Pinnacle(3) has now been introduced into routine clinical use.

Algorithms↗

PubMed2000

Directionality of extruded lithium fluoride thermoluminescent dosemeters in a cobalt-60 beam.

An experimental investigation of the directionality of commercially available extruded lithium fluoride (LiF:Mg,Ti) thermoluminescent dosemeters was carried out in a cobalt-60 beam at a water depth of 5 cm. One-half of a batch of 60 chips (3.1 x 3.1 x 0.9 mm3) was exposed face-on (faces perpendicular to the beam central axis), and the other half was exposed in an edge-on orientation (two edges perpendicular and faces parallel to the beam axis). Measurements show that an edge-on exposure results in a thermoluminescence reading approximately 0.9% lower than a face-on exposure. Although this is of minor importance in every day patient dosimetry, it is relevant in evaluating errors in in-phantom dosimetric measurements where greater accuracy is required.

Calibration↗

PubMed1998

A cone-beam megavoltage CT scanner for treatment verification in conformal radiotherapy.

PURPOSE: A prototype scanner for large-volume megavoltage computed tomography (MVCT) in a clinical set-up is described. The ultimate aim is to improve treatment accuracy in conformal radiotherapy through patient set-up error reduction and transit dosimetry. MATERIALS AND METHODS: The scanner consists of a custom-built 2D CsI(Tl) crystal array viewed by a lens and a CCD camera. Image acquisition is synchronized with radiation pulses. The 2D projections resulting from a single continuous 360 degrees gantry rotation are reconstructed using a cone-beam tomography algorithm. Prior to reconstruction, the raw projections are calibrated and corrected for centre of rotation movement and accelerator output fluctuation. The performance of the system has been evaluated by reconstructing projections of open fields, test objects and a humanoid phantom. RESULTS: Hundreds of 2D projections can be acquired with a clinically-acceptable data collection time (about 2 min) and dose (approximately 40 cGy, with a possible four-fold reduction). A maximum density resolution of about 2% is achieved offering some soft tissue discrimination without using image enhancement tools. A spatial resolution of 2.5 mm is obtained. The reconstructed image intensity is linear with electron density over the range of interest. Coronal or sagittal slices through the 3D reconstruction of the humanoid phantom show a better delineation of structures than the corresponding portal images taken at the same orientation. CONCLUSIONS: A similar image quality to our current single-slice MVCT scanner is achieved with the advantage of providing tens of tomographic slices for a single gantry rotation. This work demonstrates the feasibility of clinical cone-beam MVCT and indicates how this prototype can be improved.

Image Processing, Computer-Assisted↗

PubMed1998

Linear accelerator output variations and their consequences for megavoltage imaging.

An experimental study of radiation output intensity fluctuations of a Philips SL25 linear accelerator is presented. Measurements are obtained using an electronic portal imaging device, and the consequences of the measured fluctuations for various different applications of megavoltage imaging including portal imaging, transit dosimetry and megavoltage computed tomography (MVCT) are discussed with examples. Fluctuations in output of +/- 0.7% (1 SD) are seen on every radiation pulse after photon noise and uncertainties caused by the detection system have been accounted for. Large fluctuations are also seen during the initial beam stabilization period (15%), during normal accelerator operation after the beam has been on for more than 1 min (4.5%) and during are therapy as a repeatable function of gantry angle (9%). Such output intensity fluctuations are shown to produce image artifacts in portal imaging devices with scanned detector readout and can also produce systematic errors in detector calibration that would lead to uncertainty in transit dose calculations. The propagation of these intensity fluctuations through MVCT image reconstruction is shown to produce ring artifacts in the reconstructed image. Sample portal and MVCT images are presented. All observed fluctuations in accelerator output are well within the manufacturer's specifications and do not affect the total dose delivered during normal treatment. Finally, megavoltage imaging is shown to be a powerful tool for accelerator quality assurance and treatment verification.

Calibration↗

PubMed1998

Optimization of the scintillation detector in a combined 3D megavoltage CT scanner and portal imager.

A parametric study is described leading to the optimization of a custom-made scintillation detector with a relatively high quantum efficiency (QE) for megavoltage photons and light output toward a remote lens. This detector allows low-dose portal imaging and continuous cone-beam megavoltage CT acquisition. The EGS4 Monte Carlo code was used to simulate the x-ray and electron transport in the detector. A Monte Carlo model of optical photon transport in a detector element was devised and used as well as various irradiation experiments on scintillators. Different detector materials and configurations were compared in terms of the optical photon irradiance on the lens from on- and off-axis detector elements and the practical constraints regarding detector construction and weight. Effects of scintillator material, detector element size, crystal coating type, and reflectivity, combinations of different coatings on detector faces, scintillator doping level, and crystal transparency were studied. With scintillator thickness adjusted to give an 18% x-ray QE at 6 MV, the light output of CsI(Tl) was at least eight times higher than ZnWO4, BGO and NE118 plastic. Further, CsI(Tl) showed the smallest decrease in QE going from 6 to 24 MV. The off-axis reduction in emittance from the periphery of the detector was relatively small with a slight dependence on the type and reflectivity of the coating and the crystal thickness for a fixed detector element cross section. Light output was more strongly dependent on the reflectivity of lambertian coatings than specular ones. For a fixed detector element cross section, optimum coating type depended on crystal thickness. Typical CsI(Tl) crystals showed a relatively small variation in light output with changes in optical attenuation length. The optimum detector element was found to be CsI(Tl) coated on five faces with TiO2-loaded epoxy resin offering about a ten-fold improvement in light output per incident photon compared to typical metal/phosphor screens.

Biophysical Phenomena↗

PubMed1998

Rapid portal imaging with a high-efficiency, large field-of-view detector.

The design, construction, and performance evaluation of an electronic portal imaging device (EPID) are described. The EPID has the same imaging geometry as the current mirror-based systems except for the x-ray detection stage, where a two-dimensional (2D) array of 1 cm thick CsI(Tl) detector elements are utilized. The approximately 18% x-ray quantum efficiency of the scintillation detector and its 30 x 40 cm2 field-of-view at the isocenter are greater than other area-imaging EPIDs. The imaging issues addressed are theoretical and measured signal-to-noise ratio, linearity of the imaging chain, influence of frame-summing on image quality and image calibration. Portal images of test objects and a humanoid phantom are used to measure the performance of the system. An image quality similar to the current devices is achieved but with a lower dose. With approximately 1 cGy dose delivered by a 6 MV beam, a 2 mm diam structure of 1.3% contrast and an 18 mm diam object of 0.125% contrast can be resolved without using image-enhancement methods. A spatial resolution of about 2 mm at the isocenter is demonstrated. The capability of the system to perform fast sequential imaging, synchronized with the radiation pulses, makes it suitable for patient motion studies and verification of intensity-modulated beams as well as its application in cone-beam megavoltage computed tomography.

Equipment Design↗

PubMed1995

Noise reduction by frame averaging: a numerical simulation for portal imaging systems.

We have studied the usefulness of both pre- and post-ADC frame summing for the purpose of reducing the effect of quantum noise and digitization noise in portal imaging systems. The study is based on the fluorescent-screen video-camera type of system. The study predicts the not-surprising result that provided the noise level at the ADC input is sufficiently large, the overall SNR can be increased by a factor of square root of M1M2, where M1 and M2 are the number of frames summed before and after the ADC. The study also predicts, somewhat unexpectedly, that there is an operating region in which increasing M1 actually decreases the SNR in the final image. To avoid this region M1 must be less than approximately 6 x 2(2B) (1 + -delta-1)1/2/(iaccf), where B is the number of ADC bits, -delta is the mean number of optical photons detected by the video camera per detected x-ray photon, iacc is the open-field number of detected x-ray photons per accelerator pulse per pixel, and f is the patient transmission factor. An equivalent statement is that the rms noise at the input to the ADC, sigma in, must exceed approximately 0.4q where q is the quantization interval of the ADC. It is possible that some systems operate in or close to this region. A second feature of this anomalous behavior is that the final image is not necessarily improved by increasing the number M2 of post-ADC-summed frames. For example, when sigma in/q = 0.2, there is no improvement in the overall rms error for M2 > 32.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗