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PubMed1991

[Computerized tomography in the planning of radiotherapy of prostatic cancer].

The paper is devoted to the description of methods of topometric preparation of 73 prostatic cancer patients for gamma-and proton-beam irradiation using an x-ray simulator and a CT tomograph. Basing on the measurement of the prostate in 3 directions in patients with different stages of disease (T1-2-24, T3-29 and T4-20), a conclusion was made that a prostate size was not enough to determine a stage of disease though a tendency to an increase in prostate size corresponded to the growing T index. However, stages T1-2 and T4 could be determined for sure within a certain range of prostate size values.

Evaluation Studies as Topic↗
PubMed1991

The dose to lung in TBI.

Many physical problems are associated with TBI prior to BMT. Determination of the dose to lung, the organ at risk in TBI, is the most demanding task the DGMP working group on "Physical Aspects of TBI" has to solve. At an international workshop held at Essen in May 1990 the 50 participants discussed the problems and possibilities to measure, calculate, plan, modify, confirm, verify, and report the dose to lung. Some highlights are discussed here. The review lectures are summarized as abstracts in this issue. Details are published separately in the proceedings.

Algorithms↗
PubMed1991

[Evaluation of the accuracy of the study on diverse techniques of planning radiotherapy of breast tumors].

The authors report the results of the analysis of several factors contributing to the accuracy of treatment planning in the radiation therapy of breast cancer. Different techniques (non-radiological vs CT-based) were used for the acquisition of patients' data; different methods (manual vs computerized) were employed for dose calculation. As for geometric parameters describing the external outline and target volume, mean differences were lower than 4%. Switching from a completely manual method to a CT-based one with computerized calculation, a 3.56% mean decrease in the value of reference isodose (p less than 0.01) was observed, together with a 3.87% mean increase in the estimated inhomogeneity (p less than 0.001). The non-CT-based outline of target volume exhibited geographic missing of inner portions of the target in 8/16 patients. Our results demonstrate that treatment planning procedures can be a significant source of clinically relevant inaccuracy, which may affect treatment outcome and tumor control.

Breast Neoplasms↗
PubMed1991

[Assessment of radiotherapy plans: dose-volume histograms, integral effects and tumor control].

Suitable criteria are necessary for judgement and for comparison of treatment plans. These criteria must take into account radiobiological effects, i.e. tumor control and treatment complications. Quantitative evaluation of dose volume histograms gives helpful criteria for radiation treatment planning and for the choice between different treatment plans. For normal tissue and organs at risk it is shown, how to assign integral dose effect to inhomogeneous dose distribution. The evaluation algorithm is based on the assumption of a power law for volume dependence of dose effect. The algorithm is discussed for arbitrary form of dose effect function. Explicit evaluation is given in terms of the linear quadratic model. Hot spots influence integral dose effect much stronger than low dose level irradiation. For judgement of treatment plans, the significance of mean organ dose is only poor. Higher moments of dose distribution are more suitable. An effective tumor control probability is derived for judgement of tumor dose distribution. It is shown that tumor control is determined by mean dose and dose inhomogeneity in tumor volume. Control probability falls with increasing dose inhomogeneity in tumor region-in first order approximation characterized by variance of dose distribution. Using a clinical example, the evaluation rules for normal and tumor tissue are demonstrated. Two different treatment techniques are analyzed and discussed. Only numerical evaluation of dose volume histograms for lung region shows the better technique.

Algorithms↗
PubMed1992

Random search algorithm (RONSC) for optimization of radiation therapy with both physical and biological end points and constraints.

A new algorithm for the optimization of 3-dimensional radiotherapy plans is presented. The RONSC algorithm (Random Optimization with Non-linear Score functions and Constraints) is based on the idea of random search in the space of feasible solutions. RONSC takes advantage of some specific properties of the dose distribution and derivable information such as dose-volume histograms and calculated estimates of tumor control and normal tissue complication probabilities. The performance of the algorithm for clinical and test cases is discussed and compared with the performance of the simulated annealing algorithm, which is also based on the idea of random search.

Algorithms↗
PubMed1992

High-performance computing in radiation cancer treatment.

In 1989 a consortium of the Radiation Oncology and Computer Science Departments at the University of North Carolina, BellSouth Corporation, GTE, and the MCNC was formed in response to the high-speed network initiative proposed by the National Science Foundation and the Defense Advanced Research Projects Agency. One of the purposes of this effort has been to demonstrate that applications exist that require gigabit per second networks. Our consortium, known as VISTAnet, proposed to use real-time radiation therapy treatment planning as the application that would require the use of a gigabit network. The plan was to develop a system that could rapidly calculate and display a three-dimensional radiation dose distribution for any configuration of radiation beams. The gigabit network would be used to tie the dose calculations done with the Cray Y-MP at the Research Triangle to the graphics engine at the Department of Computer Science (Pixel-Planes 5) and the medical workstation at Radiation Oncology. The system would then provide the radiation physician with the capability of considering hundreds of potential treatment plans, instead of the usual two or three, with the goal of arriving at a highly optimized plan within a few minutes.

Computer Communication Networks↗
PubMed1977

Computer-aided medical decision making in radiotherapy.

Radiotherapy departments are becoming sophisticated in working with computers for isodose computations, treatment machine verifications and administrative and medical records. The next step lies in computer-assisted medical decision making. The logic for a patient's diagnostic work-up and treatment protocol can be stored in a computer. It can then be used as an aid in making the diagnosis, in prescribing the treatment and for quality control. For patients who fit established protocols the computer can select and list treatment using the logic of that protocol. Such a system has been implemented for the postoperative radiotherapy of breast cancer on a trial basis. Its potential usefulness is illustrated by results in 25 consecutive patients. Physician acceptance and costs of the program are under investigation.

Breast Neoplasms↗
PubMedDate not supplied

Bayesian statistics: a guided tour.

An overview of Bayesian statistical decision theory is presented in the tutorial spirit. A section on fundamental principles is followed by selected applications of the Bayesian approach to parameter estimation, pattern recognition, image processing, computer-aided medical diagnosis, optimal diagnostic test selection, and radiotherapy treatment planning.

Decision Making↗
PubMedDate not supplied

Investigating the potential of three-dimensional treatment planning.

3-D treatment planning has received a great deal of attention in the radiation therapy community over the last several years. This new technology makes use of the continuous improvements in computer hardware and graphics capabilities, along with major improvements in treatment planning software, to provide a fully three dimensional simulation of the patient, radiation beams, and dose distributions which are used for radiation therapy of various cancers. With these capabilities, the physician and treatment planner may now optimize the radiation beams used to treat the patient much more effectively than in the past, when only a limited description of the patient, beams, and doses was available. This paper describes several of the new capabilities of these 3-D planning systems, some research studies which are currently being performed to evaluate the usefulness of the new technology, and finally some of the costs associated with its implementation.

Computer Simulation↗
PubMed1978

[Ultrasound in tumor diagnostics and treatment planning (author's transl)].

The fundamental requirements of irradiation planning are discussed delimitating the minimum and maximum demands of planning. Different possibilities to represent the topographic relations within the irradiation plane of the patient's cross-section are described. The computer-assisted system for irradiation planning, installed at our hospital by means of MAT construction, is discussed. A pathway is shown which leads to individual treatment planning and considers dosimetrically the actual conditions of the patient who will undergo radiation therapy. The possibilities and limits of ultrasonic cross-sectional imaging are demonstrated.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

An interactive beam-weight optimization tool for three-dimensional radiotherapy treatment planning.

A computer software tool has been developed to aid the treatment planner in selecting beam weights for three-dimensional radiotherapy treatment planning. The program consists of a feasibility search algorithm embedded in an interactive, user-friendly driving program. The feasibility search algorithm is based on the iterative relaxation algorithm of Cimmino [La Ricerca Scientifica, Vol. I, pp. 326-333 (1938)] as applied to the radiotherapy inverse problem by Altschuler et al. [Med. Phys. 13, 590 (1986)]. Relative importances of structures based upon clinical considerations can be incorporated into the algorithm. In order to speed convergence, the relaxation parameter is made to vary, with its value based upon a measure of deviation from feasibility. The interactive driving program is designed so that the treatment planner can make reasonable judgments regarding the acceptability of a plan in the event that the dose constraints yield no feasible solution. An example of the use of this program applied to a problem in three-dimensional radiotherapy treatment planning is illustrated.

Algorithms↗
PubMed1991

[Technical aspects of proton irradiation of intraocular tumors].

The paper is concerned with the description of some technical aspects of irradiation of intraocular melanomas of the preequatorial and retroequatorial localizations with a proton beam on a synchrotron at the Institute of Theoretical and Experimental Physics. Potentialities of a program of design of irradiation of intraocular tumors were considered. The parameters of an optimized plan of irradiation were determined by analysis of computer-simulated dose topographic and anatomic situations at different variants of irradiation. Reproducibility of an optimized plan of irradiation was no worse than 1 mm.

Eye Neoplasms↗
PubMed1992

Computer-assisted 3D-reconstruction and statistics of the limbic system. 1. Computer-assisted 3D-reconstruction of the hippocampal formation, the fornix, and the mamillary bodies.

The hippocampal formation of eight perfusion-fixed human brains was examined using new methods according to stereotactic and morphometric principles (macrovibratome and computer-aided 3D reconstruction). The reconstructions form part of a neuroanatomical reference system (NeuRef). This reference system allows for 3D visualisation of the brain and its components on a computer graphic workstation, as well as for the presentation of the union set based on a neuroanatomical structure taken from this sample of brains. This retrievable knowledge of neurofunctional systems is important for the preoperative planning of neurosurgeons and the adjustment of radiotherapy.

Adult↗
PubMed1991

[Three-dimensional reconstructions in neuroanatomy].

Computer-aided 3D reconstructions of neurofunctional systems and structures are generated as a reference for neuroimaging (CT, MRI, PET). The clinical application of these 3D reconstructions requires a coordinate system and conditions resembling the intravital neuroanatomy as far as possible. In this paper the neuroanatomical Reference System (NeuRef) of the Department of Neuroanatomy of Hannover Medical School is presented. This consists of methods to record brain structures from serial sections with minimal error (less than 1 mm) and to display 3D brain models derived from such a data base. In addition, NeuRef is able to generate sections through, for instance, the visual and pyramidal system and to transfer these data onto a corresponding CT image. Therefore, this method can serve as a diagnostic aid in neuroradiology, in operation planning, and radiotherapy. It can also be used in PACS.

Brain↗
PubMed1976

New methods of imaging in diagnostic radiology Sylvanus Thompson Memorial Lecture.

A brief history of the recent developments in computer-assisted tomography (CAT) is presented. The development of whole-body scanners from the basic brain scanner, the trend towards higher-speed scanners using multiple detectors in a fan-type geometry, and some of the unsolved problems related to CAT scanners are discussed, as well as the potential use of whole-body scanning in radiotherapy treatment planning and in radiobiology. A review of recent developments in electrostatic imaging is presented and a new method of imaging called ionography is described in detail. It is shown how a single exposure can be used to produce a number of copies, each with a different amount of edge contrast, under the control of the radiologist. Further, it is shown how this can be done using a closed system so that the ionography chamber never needs to be opened. Some of the recent commercial developments in this field are described. It is suggested that in the future radiology departments may be replaced by departments of imaging, which will include all ways of obtaining diagnostic information and where such a department would be problem oriented rather than technique oriented. The need for basic scientific support by a medical physics and engineering group in such a department is emphasized.

Electrons↗
PubMed1992

True three-dimensional dose computations for megavoltage x-ray therapy: a role for the superposition principle.

The objective of radiation therapy is to concentrate a prescribed radiation dose accurately within a target volume in the patient. Major advances in imaging technology have greatly improved our ability to plan radiation treatments in three dimensions (3D) and to verify the treatment geometrically, but there is a concomitant need to improve dosimetric accuracy. It has been recommended that radiation doses should be computed with an accuracy of 3% within the target volume and in radiosensitive normal tissues. We review the rationale behind this recommendation, and describe a new generation of 3D dose algorithms which are capable of achieving this goal. A true 3D dose calculation tracks primary and scattered radiations in 3D space while accounting for tissue inhomogeneities. In the past, dose distributions have been computed in a 2D transverse slice with the assumption that the anatomy of the patient dose not change abruptly in nearby slices. We demonstrate the importance of computing 3D scatter contributions to dose from photons and electrons correctly, and show the magnitude of dose errors caused by using traditional 2D methods. The Monte Carlo technique is the most general and rigorous approach since individual primary and secondary particle tracks are simulated. However, this approach is too time-consuming for clinical treatment planning. We review an approach that is based on the superposition principle and achieves a reasonable compromise between the speed of computation and accuracy in dose. In this approach, dose deposition is separated into two steps. Firstly, the attenuation of incident photons interacting in the absorber is computed to determine the total energy released in the material (TERMA). This quantity is treated as an impulse at each irradiated point. Secondly, the transport of energy by scattered photons and electrons is described by a point dose spread kernel. The dose distribution is the superposition of the kernels, weighted by the magnitude of the TERMA impulse for all interaction sites. In this review, we demonstrate the capabilities of the superposition method, particularly for situations of charged particle disequilibrium, and we report on the progress made by several research groups in adapting this method to clinical treatment planning. In the future, the superposition method will have a significant role in dose optimization for conformal irradiation techniques because of its close correspondence to image reconstruction by filtered back-projection.

Image Processing, Computer-Assisted↗