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Reconstruction of electron spectra from depth doses with adaptive regularization.

Electron spectral reconstruction of medical accelerators from measured depth doses is a practical method for providing the input initial phase space distribution at the patient surface that is required by Monte Carlo treatment planning systems. The posed inverse problem of spectral reconstruction is ill conditioned and this may lead to nonphysical oscillations in the reconstructed spectra. Use of a variational method of solution with a regularization technique removes the oscillations but tends to smooth the sharp (deltalike) energy peak that is a common feature in electron spectra generated by medical accelerators. Because the sharp peak contains a large percentage of the electrons in the spectrum, an accurate estimate of the peak width, height and position is critical to the success of the technique for spectrum reconstruction with regularization. We propose use of an adaptive regularization term as a special form of the general Tichonov regularization function. The variational method with the adaptive regularization term is applied to reconstruct electron spectra for the 6, 9, and 18 MeV electron beams of a Varian Clinac 2100C accelerator and proves to be a very simple, effective and accurate approach. Results using this variational method with adaptive regularization almost perfectly reconstruct electron spectra from depth dose distributions.

Electrons↗

Effect of metal reconstruction plates on cobalt-60 dose distribution: a predictive formula and clinical implications.

PURPOSE: We sought to create a predictive formula for the dose perturbations caused by head and neck reconstruction plates in the delivery of postoperative radiotherapy with 60Co beams. MATERIALS AND METHODS: The dose perturbation effects of Vitallium and Titanium reconstruction plates and flat metal plates of aluminum (13Al), stainless steel (26Fe), tin (50Sn) and lead (82Pb) irradiated with a 60Co beam were measured in polystyrene phantoms using a film dosimetry system. We then used these results to create formulas to predict the effect of a metal reconstruction plate dependent upon its effective atomic number. RESULTS: Percentage dose increases secondary to back scattering were 10% at 1 mm in front of the Vitallium plate and 40% at the plate while the percentage dose decrease was 29% at the plate and 10% 1 mm behind the plate. For the Titanium plate, the percentage dose increase was 5% at 1 mm in front the plate and 25% at the plate while the percentage dose decrease was 20% at the plate and 5% 1 mm behind the plate. For flat plates the percentage dose increases and decreases, respectively, at the plate surfaces were: 13Al (8%, 6%), 26Fe (35%, 16%), 50Sn (60%, 24%), and 82Pb (85%, 13%). A second order polynomial predicting the back scatter and shadowing effects was created, Y = a + bZ + cZ2, where Z is the effective atomic number of the plate while a, b, and c are the following constants: for back scatter a = 0.854 +/- 0.082, b = 0.0212 +/- 0.0044, c = -0.00011 +/- 0.00004 and for shadowing a = 1.108 +/- 0.021, b = -0.0141 +/- 0.0011, c = 0.00014 +/- 0.00001. CONCLUSIONS: It is possible to predict the effect of a metal reconstruction plate upon the delivered postoperative radiotherapy dose. The dose perturbations around the plate only exist for a few millimeters, but this is substantially greater than the thickness of a normal tissue or tumor cell. Perhaps a coating of a low effective atomic number, biologically inert, substance might allow for greater dose homogeneity and decrease the risks of plate failure or tumor recurrence.

Bone Plates↗

Concurrent treatment planning for outpatient high dose rate prostate template implants.

PURPOSE: Since November of 1991, we have treated locally advanced (B2-C) prostate cancer using external beam radiotherapy integrated with outpatient high dose rate interstitial implant boost as part of a Phase II clinical trial. This required (a) rapid, automated planning; (b) incorporation of image data and (c) dose optimization. METHODS AND MATERIALS: A treatment planning system was designed which integrates imaging and needle guidance with source reconstruction and dose display. All components of treatment planning (reconstruction, optimization, dose prescription, dose display) are largely automated. A rectal reference point was defined which was reproducible and easily verified. No pretreatment planning was required. RESULTS: As of November 1992, 83 treatments were delivered using this system. Intra-operative treatment decisions were made possible due to the speed and ease of interpretation of the system. The system has proven satisfactory in the operating room. Rectal doses were calculated for all patients, and ranged from 35-79% of the prescribed dose, with a mean of 58%. The first echelon of a Phase II escalating dose trial has been completed, with 22 patients treated over a period of 1 year. CONCLUSION: Outpatient high dose rate brachytherapy appears to be a practical means of boosting locally advanced prostate cancer patients. Rapid treatment planning is possible incorporating on-line ultrasound images to allow immediate dose optimization to be performed during and after implant placement.

Brachytherapy↗

Reconstruction of individual absorbed doses by tooth enamel on the base of non-linear simulation of their EPR-spectra.

Model of separate spectral lines composing EPR-spectra of tooth enamel can be described with fine accuracy by integral of convolution of three distribution functions: Lorenzian, Gaussian and anisotropy. Simulation of spectra was done by the method of optimisation of non-linear parameters combined with the Gauss method of exclusion for linear parameters to obtain the minimum of the sum of the squares of the differences between the experimental EPR-spectrum and its model. The final result was the deconvolution of complex EPR-spectrum into its components (the background and radiation-induced signals) with the following reconstruction of the individual absorbed dose.

Anisotropy↗

Retrospective reconstruction of individual and collective external gamma doses of population evacuated after the Chernobyl accident.

About 90,000 citizens of Ukraine, who were residents of the near zone of the Chernobyl nuclear power plant were evacuated during the first weeks after the accident due to the heavy contamination of the environment. Doses of this cohort were unknown. Retrospective reconstruction of external gamma exposure doses, based on the results of direct dose rate measurements performed during the accident and individual behavior/migration histories of the evacuees, was performed. Individual doses were reconstructed for 30,586 evacuees from the city of Prip'at and the settlements of the 30-km zone. The average effective dose H(E) due to external irradiation for this cohort was estimated to be 15 mSv, although individual values vary in an extremely wide range from 0.1 to 383 mSv. The collective dose of the whole evacuated population was found to be 1,300 person-Sv.

Accidents↗

Evaluation of high energy photon external beam treatment planning: project summary. Photon Treatment Planning Collaborative Working Group.

A three-year project for the "Evaluation of High Energy Photon External Beam Treatment Planning," sponsored by the National Cancer Institute, is summarized. The participants in this project were determined on a competitive basis and included staff from four institutions: Massachusetts General Hospital; Memorial Sloan-Kettering Cancer Center; the University of Pennsylvania; and Mallinckrodt Institute of Radiation. This project built on the developments in three-dimensional anatomical and dose distribution reconstruction at these institutions and on the clinical guidance at these centers for quantitative evaluation of treatment plans. Protocols for acceptance of patients with lesions at eight different sites were developed and utilized. The technical methodology for interchange of treatment planning tapes, specifications for computerized tomography sections and their reconstruction, and the employment of dose-volume histograms of target regions and specified normal tissues and organs were all developed. Data were accumulated for tumor control probabilities (TCP) and for normal tissue complication probabilities (NTCP) for use in treatment plan design and evaluation. Several treatment parameters were studied as influenced by the availability of three-dimensional treatment planning and specific conclusions were reached.

Humans↗

The next decade in external dosimetry.

In recent years, a number of external dosimetry problems have been solved. However, changes in standards and legal concepts relating to the application of dosimetry results will require further enhancements in measurement techniques and philosophy in the next 10 y. The introduction of effective dose equivalent and the legal use of probability of causation will require that much greater attention be given to determination of weighted organ dose from external exposure. An imminent change--an increase in the fast neutron quality factor--will require a new round of technology development in a field that has just received a decade of close scrutiny. For the future, we must take advantage of developments in microelectronics. The use of random access memory (RAM) and metal-on-silicon (MOS) devices as detector elements, particularly for neutron dosimetry, has exciting possibilities that are just beginning to be explored. Advances in microcircuitry are leading, and will continue to lead, in the development of a new generation of small, rugged and "smart" radiation survey instruments that will make the most of detector data. It has become possible with very compact instruments to obtain energy spectra, linear-energy-transfer (LET) spectra, and quality factors in addition to the usual integrated dosimetric quantities: exposure, absorbed dose, and dose equivalent. These instruments will be reliable and easy to use. The user will be able to select the level of sophistication that is required for any specific application. Moreover, since the processing algorithms can be changed, changes in conversion factors can be accommodated with relative ease. During the next decade, the use of computers will continue to grow in value to the health physicist. Personal computers and codes designed for dosimetry applications will become prominent, providing the health physicist with the ability to perform sophisticated data reduction, spectra unfolding and even radiation modeling and transport calculations on the desk top. In the far term, the use of computers could extend to the development of sophisticated tracking systems that would follow and record the workers' movements throughout a radiation area. These data, together with information from area monitors, air samplers and personnel dosimeters, could be used to develop truly integrated dose estimates, including reconstruction of organ doses.

Beta Particles↗

Beamlet dose distribution compression and reconstruction using wavelets for intensity modulated treatment planning.

Intensity modulated radiation therapy (IMRT) treatment planning is often formulated as the optimization of weights of fixed-geometry subfields (beamlets). Efficient optimization techniques can be based on direct storage of the influence matrix relating beamlet weights to dose values. However, direct storage of beamlet dose distributions for IMRT treatment planning can easily exceed several gigabytes, and is therefore often not feasible. We present a method for rapidly calculating full three-dimensional IMRT dose distributions, based on a vector of beamlet weights. The method is based on compressed beamlet dose distributions using fast digital wavelet transforms and so-called hard thresholding. We studied the method with a rectangular beamlet of 0.5 cm x 0.5 cm cross section from a monoenergetic 6 MeV photon point source simulated in homogeneous (water) and heterogeneous (CT-data) phantoms. Dose was calculated using the accurate VMC+ + Monte Carlo engine. The beamlet dose distributions were wavelet transformed and compressed by dropping wavelet coefficients below a given threshold value. Dose is then computed using the remaining wavelets. Selection of the wavelet basis function, decomposition level, and threshold values, for different slice orientations (transverse or parallel to the beam) and varying angles of beamlet incidence are studied. A typical in-slice compression ratio for a plane containing a beamlet was 32:1 using the sym2 wavelet and a threshold of 0.01, with a typical root-mean-square error, for voxels above 50% of the maximum dose, of about 0.04%. The overall compression performance, which includes many planes with little information content, is on the order of 100:1 or greater compared to full matrix storage. Although other methods are available to make the use of stored influence matrix values more feasible in IMRT treatment planning (such as using coarse grids or restricting values to defined volumes of interest) we conclude that wavelet compression facilitates the storage and use of full pencil dose deposition (influence matrix) data in IMRT treatment planning.

Algorithms↗

Reconstructing population exposures from dose biomarkers: inhalation of trichloroethylene (TCE) as a case study.

Physiologically based pharmacokinetic (PBPK) modeling is a well-established toxicological tool designed to relate exposure to a target tissue dose. The emergence of federal and state programs for environmental health tracking and the availability of exposure monitoring through biomarkers creates the opportunity to apply PBPK models to estimate exposures to environmental contaminants from urine, blood, and tissue samples. However, reconstructing exposures for large populations is complicated by often having too few biomarker samples, large uncertainties about exposures, and large interindividual variability. In this paper, we use an illustrative case study to identify some of these difficulties, and for a process for confronting them by reconstructing population-scale exposures using Bayesian inference. The application consists of interpreting biomarker data from eight adult males with controlled exposures to trichloroethylene (TCE) as if the biomarkers were random samples from a large population with unknown exposure conditions. The TCE concentrations in blood from the individuals fell into two distinctly different groups even though the individuals were simultaneously in a single exposure chamber. We successfully reconstructed the exposure scenarios for both subgroups - although the reconstruction of one subgroup is different than what is believed to be the true experimental conditions. We were however unable to predict with high certainty the concentration of TCE in air.

Adult↗

3-D reconstruction of anterior mantle-field techniques in Hodgkin's disease survivors: doses to cardiac structures.

BACKGROUND: The long-term dose-effect relationship for specific cardiac structures in mediastinal radiotherapy has rarely been investigated. As part of an interdisciplinary project, the 3-D dose distribution within the heart was reconstructed in all long-term Hodgkin's disease survivors (n = 55) treated with mediastinal radiotherapy between 1978 and 1985. For dose reconstruction, original techniques were transferred to the CT data sets of appropriate test patients, in whom left (LV) and right ventricle (RV), left (LA) and right atrium (RA) as well as right (RCA), left anterior descending (LAD) and left circumflex (LCX) coronary arteries were contoured. Dose-volume histograms (DVHs) were generated for these heart structures and results compared between techniques. RESULTS: Predominant technique was an anterior mantle field (cobalt-60). 26 patients (47%) were treated with anterior mantle field alone (MF), 18 (33%) with anterior mantle field and monoaxial, bisegmental rotation boost (MF+ROT), 7 (13%) with anterior mantle field and dorsal boost (MF+DORS) and 4 (7%) with other techniques. Mean +/- SD total mediastinal doses for MF+ROT (41.7 +/- 3.5 Gy) and for MF+DORS (42.7 +/- 7.4) were significantly higher than for MF (36.7 +/- 5.2 Gy). DVH analysis documented relative overdosage to right heart structures with MF (median maximal dose to RV 129%, to RCA 127%) which was significantly reduced to 117% and 112%, respectively, in MF+ROT. Absolute doses in right heart structures, however, did not differ between techniques. Absolute LA doses were significantly higher in MF+ROT patients than in MF patients where large parts of LA were blocked. Median maximal doses for all techniques ranged between 48 and 52 Gy (RV), 44 and 46 Gy (LV), 47 and 49 Gy (RA), 38 and 45 Gy (LA), 46 and 50 Gy (RCA), 39 and 44 Gy (LAD) and 34 and 42 Gy (LCX). CONCLUSION: In patients irradiated with anterior mantle-field techniques, high doses to anterior heart portions were partly compensated by boost treatment from non-anterior angles. As the threshold doses for coronary artery disease, cardiomyopathy, pericarditis and valvular changes are assumed to be 30 to 40 Gy, cardiac toxicity must be anticipated in these patients. Thus, dose distributions in individual subjects should be correlated to the corresponding cardiovascular findings in these long-term survivors, e. g. by cardiovascular magnetic resonance imaging.

Adolescent↗

External radiation exposure of residents living close to the Mayak facility: main sources, dose estimates, and comparison with earlier assessments.

In 1951 and 1952 specialists from the Mayak production association investigated the radiological situation in the area of the Metlinski reservoir that was located 5-7 km from the site of liquid radioactive waste (LRW) discharge. Based on their measurements of both the specific radioactivity in the water and the dose-rate above the water surface, the gamma-field above the water surface in 1951 was demonstrated to be mainly due to (95)Zr+(95)Nb. The dose-rate at the shore of the reservoir was calculated for the period 1949-1951. In November and December 1951, the gamma-field at the shore was mainly due to (140)Ba+(140)La. For the period 1949-1951, the external exposure of the Metlino population due to the decay of these radionuclides was about 200 R (2 Sv), most of the dose having been produced in 1951. The contribution of (137)Cs to external doses did at that time probably not exceed a fraction of several percent. This finding is in contradiction to the assumptions made in the most recent TRDS-2000 system that was developed to reconstruct the doses to the residents of the Techa river. The results presented here demonstrate that the reconstruction of external doses received by the Metlino population as well as by the Techa river residents can be improved for the most critical period between 1949 and 1954.

Body Fluids↗

ORERP (Off-Site Radiation Exposure Review Project) internal dose estimates for individuals.

A method was developed to reconstruct the internal radiation dose to off-site individuals who were exposed to fallout from nuclear weapons tests at the Nevada Test Site (NTS). By this method, committed absorbed doses can be estimated for 22 target organs of persons in four age groups and for selected organs of the fetus. Ingestion doses are calculated by combining age-group dose factors and intakes specific for age group, test event, and location as calculated by the PATHWAY food-chain model. Inhalation doses are calculated by combining age-group dose factors and breathing rates, and time-integrated air concentrations that are derived from the ORERP Air-Quality Data Base. Dose estimates are calculated for the radionuclides that contribute significantly to the total dose; these number 20 via the ingestion pathway and 46 via the inhalation pathway. Internal doses to nonspecified individuals and nonspecified fetuses are being reconstructed for each location in the ORERP Town Data Base for which exposure rates and cloud-arrival times are listed. Examples of reconstructing internal dose are presented. This method will also be adapted to reconstruct internal doses from NTS fallout to specific individuals in accordance with the person's age, past residence, life-style, and living pattern.

Aerosols↗

Reconstruction of the inhalation dose in the 30-km zone after the Chernobyl accident.

Due to lack of measurements of activity concentrations in air, the assessment of the inhalation dose of the population evacuated from the 30-km zone after the Chernobyl accident is not possible from continuous filter measurements. Since the evaluation of the inhalation dose in each settlement of the zone is of great interest for epidemiological purposes, an approach was chosen that utilizes the available data on ground deposition of 137Cs, a recently performed best estimate of the radionuclide vector and its spatial distribution as well as the radionuclide dependent deposition velocity. The derived inhalation dose values in the 30-km zone range between 3 mSv to 150 mSv effective dose for adults depending on the distance to the reactor site and the day of evacuation. For 1-y-old infants the values range between 10 to 700 mSv. In Chernobyl town, an effective inhalation dose of 25 mSv until evacuation day was assessed. Thyroid doses due to inhalation ranged from 0.02 to 1 Sv for adults, for 1-y-old infants from 0.02 to 6 Sv. The inhalation dose in each settlement of the 30-km zone is approximately 8-13 times higher than the external exposure in each settlement if evacuation of the settlement occurred at an early stage. For settlements with evacuation at a later stage (day 10 or later) the inhalation dose was about 50-70% higher than the external dose. The dominant contribution to the effective inhalation dose comes from 131I (about 40%) and tellurium and rubidium isotopes (about 20-30%). Despite high zirconium and cerium ground depositions, zirconium and cerium isotopes contribute rather little to the inhalation dose which is mainly due to the great particle sizes to which they are attached. The relative contribution of short-lived radionuclides is, despite higher activities than at greater distances, less than 5%.

Air Pollutants, Radioactive↗

Reconstruction of the ingestion doses received by the population evacuated from the settlements in the 30-km zone around the Chernobyl reactor.

As a consequence of the Chernobyl accident, about 50,000 people were evacuated from the settlements in the 30-km zone around the reactor in the period 3-11 d after the accident. As no countermeasures were implemented in the early phase, people continued to consume milk and some leafy vegetables. In this paper, average effective ingestion doses are modeled for evacuees. Input data for the assessment are the 137Cs activity per unit area, the ratios of the radionuclides relative to 137Cs, the mean day of evacuation, and intake rates for milk and green vegetables. The transfer of radionuclides from deposition to humans is estimated by modeling radionuclide interception by vegetation, weathering, and the time-dependent transfer of radionuclides to milk taking into account site-specific agricultural practices. Depending on the evacuation day and site, the estimated ingestion doses for the settlements are in the range of 20 to 1,300 mSv and 3 to 180 mSv for infants and adults, respectively. 131I is by far the most important isotope, the ingestion dose due to 133I is more than one order of magnitude lower. The most exposed organ is the thyroid, inducing more than 80% and 50% of the ingestion dose for infants and adults. The ingestion doses are compared to the doses due to inhalation and external exposure. The internal dose exceeds the external by a factor of about 2-10 for adults and 2-40 for 1-y-old infants depending on site and evacuation day. The thyroid doses assessed for the evacuees are consistent with results achieved in studies performed in areas outside the 30-km zone.

Adult↗

Reconstruction of biologically equivalent dose distribution on CT-image from measured physical dose distribution of therapeutic beam in water phantom.

From the standpoint of quality assurance in radiotherapy, it is very important to compare the dose distributions realized by an irradiation system with the distribution planned by a treatment planning system. To compare the two dose distributions, it is necessary to convert the dose distributions on CT images to distributions in a water phantom or convert the measured dose distributions to distributions on CT images. Especially in heavy-ion radiotherapy, it is reasonable to show the biologically equivalent dose distribution on the CT images. We developed tools for the visualization and comparison of these distributions in order to check the therapeutic beam for each patient at the National Institute of Radiological Sciences (NIRS). To estimate the distribution in a patient, the dose is derived from the measurement by mapping it on a CT-image. Fitting the depth-dose curve to the calculated SOBP curve also gives biologically equivalent dose distributions in the case of a carbon beam. Once calculated, dose distribution information can be easily handled to make a comparison with the planned distribution and display it on a grey-scale CT-image. Quantitative comparisons of dose distributions can be made with anatomical information, which also gives a verification of the irradiation system in a very straightforward way.

Humans↗

[The experience of FISH technique application for reconstruction of individual radiation doses in Chernobyl liquidators in the framework of Ukrainian-American project "Leukemia"].

The results of proper investigations received under the cytogenetic examination of 225 persons (control groups, Chernobyl liquidators exposed to different radiation doses, oncogematology patients) had been summarized and analyzed. The conclusion concerning possibilities and limitations of FISH technique usage for retrospective biodosimetry of human radiation exposure has been presented.

Adult↗