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Biomedical subjects

T Ackerly

Publications and source records attributed to T Ackerly.

5 recordsLinked to original sources

Stereotactic radiosurgery planning with ictal SPECT images.

This paper is motivated by a clinical requirement to utilise ictal SPECT images for target localisation in stereotactic radiosurgery treatment planning using the xknife system which only supports CT and MRI images. To achieve this, the SPECT images were converted from raw (pixel data only) format into a part 10 compliant DICOM CT fileset. The minimum requirements for the recasting of a raw format image as DICOM CT or MRI data set are described in detail. The method can be applied to the importation of raw format images into any radiotherapy treatment planning system that supports CT or MRI import. It is demonstrated that the combination of the low spatial resolution SPECT images, depicting functional information, with high spatial resolution MRI images, which show the structural information, is suitable for stereotactic radiosurgery treatment planning.

Algorithms↗

Discrepancies in volume calculations between different radiotherapy treatment planning systems.

It has been determined that, contrary to expectation, there is a clinically significant variation in the volume calculations of different RTPS (Radiotherapy Treatment Planning System) for identical contours. The situation was investigated prior to a multi-centre trial to determine whether tumour volume is an independent prognostic factor in NSCLC (non-small cell lung cancer) and included four of the commercially available RTPS. The four RTPS tested were, Theraplan Plus V3.0, Cadplan V6.2, Focus V2.6 and ADAC V3.0. Five randomly chosen clinical target related volumes (3 GTVs, one PTV and one CTV) from the trial database originally marked on the Cadplan system were transferred to the other four systems and the resulting volumes were calculated. It was found that Cadplan consistently underestimated the volume relative to the other three systems by 6-12%. This systematic underestimation was found to be caused by different assumptions made by the Cadplan system about the axial outer slice extension of the volume. Cadplan truncates the volume, while the other three systems extrapolate it by half the slice thickness at each end. A short program was written to apply the same method of volume extension to the Cadplan volume that is utilised by the other systems. This produced calculated volumes that were within +/- 1.0% of the average of the volumes calculated by the other three planning systems, and the maximum deviation from the average for any planning system was then reduced to 1.5%. This program was implemented at all participating trial centres utilising Cadplan, thus reducing the intersystem variability to a negligible factor in comparison to the estimates of inter-physician variation. This unexpected finding has significant implications for the validity of multi-centre trials using dose volume histograms, and indeed the adoption of any clinical protocol employing dose volume histogram constraints derived from experience at another centre employing a different RTPS.

Carcinoma, Non-Small-Cell Lung↗

Display of positron emission tomography with Cadplan.

Recent clinical experience at Peter MacCallum Cancer Institute (PMCI) with the use of unregistered Positron Emission Tomography (PET) images for radiotherapy target marking in the lung suggests that co-registered PET images would be invaluable. PMCI has three radiotherapy treatment planning systems but none of them currently is able to display or co-register PET images with Computed Tomography (CT) images. This paper details the approach taken to display co-registered PET images with the CADPLAN treatment planning system. CT Image files are normally transferred to Cadplan by DICOM transfer, but the Cadplan DICOM server will not receive (has no presentation context for) PET images. The fundamental design of the CADPLAN system envisages display of only a single image dataset, which must be a CT scan for planning reasons. The problem of data transfer is crudely solved by File Transfer Protocol (FTP) over the network. Fortunately the multislice format of the PET image files makes individual transfer manageable. A menu based C program running at the same time as Cadplan is invoked to sample the DICOM PET Image and create multiple Cadplan CART image format files that are co-registered with each existing transverse CT slice. With the Cadplan in contour mode, the program allows the co-registered PET images to be swapped in and out of the image section of the CART files promptly, while keeping the contour information. This allows radiotherapy target volumes to be marked using transverse PET emission images, and effectively circumvents the design constraints prohibiting the display of more than one image set. Contours can be over-laid for review on reconstructed sagittal or coronal views of CT or PET images constructed using the standard Cadplan tools. Co-registration is facilitated by identical positioning with the aid of lasers and FDG loaded fiducial markers on the PET scanner and CT couch. A polyurethane cast fixed with EFFILOCK is used to ensure identical patient orientation on the CT and PET couches. Since both imaging modalities are without significant geometric distortion the co-registration is then simply a translation. PET transmission images can be used for co-registration verification. The practical implementation of display of PET images with CADPLAN has enabled us to begin a trial of 10 patients, the results of which will be reported separately.

Data Display↗

Comparative evaluation of Wellhöfer ion chamber array and Scanditronix diode array for dynamic wedge dosimetry.

Normalised profiles have been measured using the Scanditronix diode array and the Wellhöfer ion chamber array for the Varian dynamic wedge. Agreement was of the order of 0.1% of central axis peak dose for an open beam at depth, 0.3% for a dynamic wedge field at depth, and up to 0.6% at the peak depth. The use of the arrays for data acquisition is discussed, including user interface limitations. Data reproducibility is determined to be of the order of 0.1% for both systems. The issue of beam hardening within dynamic wedges is discussed and resolved in terms of the dose-gradient effect. A method for interpolation between dynamic wedge profiles using open beam data is presented that allows construction of isodoses to an estimated accuracy of 0.7%. Finally a benchmark for comparison of different measuring systems based on quality assurance requirements for the enhanced dynamic wedge is suggested.

Particle Accelerators↗