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A filtered backprojection dose calculation method for inverse treatment planning.

An efficient method of calculating dose distributions in homogeneous media for megavoltage photons is described. The method is similar to filtered backprojection image reconstruction and is based on the analogy between external beam radiotherapy and SPECT image reconstruction. The filtered backprojection dose calculation significantly reduces the computation time for a large number of x-ray beams compared to a conventional convolution dosimetry method. A factor of 20 reduction in computation time is demonstrated for a 2D implementation of the model. The method has proved useful for speeding up an inverse treatment planning algorithm for conformal radiotherapy, and has the potential to be implemented in the reconstruction hardware of a radiotherapy CT simulator. Results of computer simulations based on the model are presented.

Humans↗

A maximum-entropy method for the planning of conformal radiotherapy.

The maximum entropy method (MEM) is a powerful inverse analysis technique that is used in many fields of science and engineering to perform tasks such as image reconstruction and processing of nuclear magnetic resonance signals. Unlike other methods, MEM naturally incorporates a priori knowledge of the problem into the optimized cost function. This feature is especially important in radiotherapy planning, because some knowledge is usually available about the stage of tumor development and about the prescription doses, including some dose constraints to the surrounding normal organs. Inverse planning is inherently consistent with the ability of MEM to estimate parameters inversely. In this investigation, an entropy function determines the homogeneity of dose distribution in the planning target volume; a least-squares function is added to the maximum entropy function as a constraint to measure the quality of reconstructed doses in organs at risk; and an iterative Newton-Ralphson algorithm searches for the optimization solution. Here we provide two examples that validate this application of MEM and the results were compared with manual plans. Although the examples involve conformal radiotherapy, we think MEM can be adopted to optimize intensity-modulated radiation therapy.

Algorithms↗

Integration of intraoperative radiotherapy (IORT) dose distribution into the postoperative CT-based external beam radiotherapy (EBRT) treatment planing.

In the treatment of malignant disease external beam radiation therapy (EBRT) is often combined with surgery. Intraoperative radiotherapy (IORT) improves the local control by dose escalation. For reasons of recording, improvement and security of the intervention, it would be necessary to merge the IORT-dose distribution with the postoperative CT-based EBRT-planing. The aim of this work was to develop a method to reconstruct the IORT field and register it with the postoperative planing CT. This enables the reconstruction of the IORT dose distribution and merge it with the CT-based EBRT planing data. We use a surface scanner to receive a large amount of surface points which enables us reconstruct the IORT-field and to register it with the CT-based EBRT planning data. Scanning and calculation time is not over 2 seconds, depending mainly on the CPU power. The error of a single point is below 1 mm. The density of the point cloud is approx. 4 per mm2. In this paper we give an overview of our experimental setup and the accuracy of the method.

Brachytherapy↗

Dose-survival curves, alpha/beta ratios, RBE values, and equal effect per fraction for neutron irradiation of jejunal crypt cells.

Jejunal crypt cell survival after regimens of one, two, three and five fractions was used to reconstruct composite single-dose survival curves for neutrons of five different energies. There is no obvious shoulder, but there is a gradual divergence from linearity that is most evident at low levels of cell survival (high doses). The effect of dose fractionation is relatively small, especially at the low doses characteristic of each treatment session in neutron radiotherapy. The alpha/beta values for the linear-quadratic survival curves range from 27 to 40 Gy. The curves for neutrons are different from the curves for gamma rays mainly in their alpha coefficients, as predicted by Kellerer and Rossi's theory of dual radiation action, but both alpha and beta values are higher the lower the mean neutron energy, which is not consistent with the theory. The ratio of alpha coefficients reported here for various neutron beams to those for gamma rays reported elsewhere ranges between 3.2 and 4.6. This range of values represents the maximum limits for RBEn/gamma values (at very low doses), and is sometimes referred to as RBEm. These values increase with decreasing neutron energy. The ratios of beta coefficients for neutron and gamma-ray survival curves were lower than the alpha ratios, ranging between 0.9 and 1.9, although not reliably distinguished from 1.0. Each of a series of equal dose fractions given at 3-h intervals produced a constant (logarithmic) decrease in cell survival as evidenced by the consistency of the estimate of cell survival from a certain single dose fraction, regardless of the level of cell survival (number of dose fractions) from which the estimate was made. Even more significant than the overlap of individual data points is the excellent fit of all the data to survival curves reconstructed on the assumption of an equal effect per fraction. An implication of these results is that, with neutrons, too little unrepaired injury persists at 3 h to influence the response to a subsequent exposure measurably.

Animals↗

On-line implant reconstruction in HDR brachytherapy.

BACKGROUND AND PURPOSE: To evaluate the accuracy of on-line planning in an Integrated Brachytherapy Unit (IBU) using dedicated image distortion correction algorithms, correcting the geometric distortion and magnetic distortion separately, and to determine the effect of the reconstruction accuracy on clinical treatment plans in terms of deviations in treatment time and dose. PATIENTS AND METHODS: The reconstruction accuracy has been measured using 20 markers, positioned at well known locations in a QA phantom. Treatment plans of two phantoms representing clinical implant geometries, have been compared with reference plans to determine the effect of the reconstruction accuracy on the treatment plan. Before clinical introduction, treatment plans of three representative patients, based on on-line reconstruction, have been compared with reference plans. RESULTS: The average reconstruction error for 10 in. images reduces from -0.6 mm (range -2.6 to +1.0 mm) to -0.2 mm (range -1.2 to +0.6 mm) after image distortion correction and for 15 in. images from 0.8 mm (range -0.5 to +3.0 mm) to 0.0 mm (range -0.8 to +0.8 mm). The error in case of eccentric positioning of the phantom, i.e. 0.8 mm (range -1.0 to +3.3 mm), reduces to 0.1 mm (range -0.5 to +0.9 mm). Correction of the image distortions reduces the deviation in the calculated treatment time of maximally 2.7% to less than 0.8% in case of eccentrically positioned clinical phantoms. The deviation in the treatment time or reference dose in the plans based on on-line reconstruction with image distortion correction of the three patient examples is smaller than 0.3%. CONCLUSIONS: Accurate on-line implant reconstruction using the IBU localiser and dedicated correction algorithms separating the geometric distortion and the magnetic distortion is possible. The results fulfill the minimum requirements as imposed by the Netherlands Commission on Radiation Dosimetry (NCS) without limitations regarding the usable range of the field of view of the image intensifier. However, the C-arm angle is limited to those angles for which magnetic distortion corrections have been obtained.

Algorithms↗

Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck.

BACKGROUND: Twenty-four hours of perioperative antibiotics provides effective prophylaxis for most head and neck cancer resections. Many reconstructive surgeons have been hesitant to apply this standard to free-flap reconstruction of the head and neck. This prospective clinical trial compared short-course and long-course clindamycin prophylaxis for wound infection in patients with head and neck cancer undergoing free-flap reconstruction. METHODS: Seventy-four patients were randomized to receive short-course (3 doses) or long-course (15 doses) clindamycin perioperatively. Wound infections, fistulas, and other postoperative complications were documented by faculty surgeons who were blinded as to treatment group. RESULTS: The differences in wound infections and other complications were statistically insignificant. No other independent predictors of wound complications emerged in this series of patients. CONCLUSIONS: Short-course clindamycin is as effective as long-course clindamycin in preventing wound infections after free-flap surgery for head and neck ablative defects.

Adult↗

Additional thyroid dose factor from transportation sources in Russia after the Chernobyl disaster.

Beginning approximately 4 years after the Chernobyl nuclear accident a steady increase in the incidence of thyroid cancer was observed in children and adolescents of the Bryansk Oblast, which received the highest level of radionuclide contaminants in Russia. We examined the spatial relationship between the residence location of patients with identified thyroid cancer (0-18 years old at the time of the accident) and a number of geographic parameters to better account for the etiology of thyroid cancer spatial distribution. Geographic parameters analyzed included spatial distribution of 137Cs and 131I in soil, population demographics, measurements and reconstructions. of absorbed thyroid 131I doses in the population, and maps of major transportation arteries. An interesting finding is the lack of a consistent correlation between the spatial distribution of radionuclides in the soil and thyroid cancer incidence. Instead, most of the thyroid cancer cases were diagnosed in settlements situated on major railways and roads. Correlating population with thyroid cancer cases and transportation arteries reveals a much higher cancer rate on or near major roads and railways than at a distance from them, again independent of radionuclide soil concentration. There are other important factors, of course, that must be considered in future evaluations of this phenomenon. These include the influence of iodine endemic zones, genetic predisposition to thyroid cancer, and duration of residence time in contaminated areas. The feasibility of radionuclide transport on railways and roads is discussed, together with the vectors for transfer of the contaminants to the human population. Developing a model to reconstruct the radiation dose to the thyroid over time in this geographic region is proposed in light of the impact of transportation arteries. Specific studies are outlined to provide the data necessary to develop this model as well as to better characterize the feasibility and scientific validity of the contribution to human health effects of this transport factor. Transport factor refers to the transport of radionuclides on transportation arteries and the transfer of these agents to the human population residing in the vicinity of these arteries. If the impact on thyroid cancer of the transport of radionuclides on major railways and roads is indeed significant, a major reappraisal of the risk of large-scale radioactive release into the environment is necessary.

Adolescent↗

A new method for assessing the temporomandibular joint quantitatively by dental scan.

The objective of this study was to assess the applicability of a multiplanar reformatting program (dental scan) for delineation and quantitative evaluation of the temporomandibular joint (TMJ) in the sagittal and coronal planes using the data of axial computed tomography. The resulting images were compared with standardized linear tomograms and direct sagittal and frontal computed tomography. Standardized linear tomograms and computed tomography of the TMJ in axial, frontal and sagittal planes were obtained in 11 patients. The axial computed tomography slices were then reconstructed in oblique frontal and sagittal planes according to the horizontal condylar angle of the TMJ by dental scan software. For each patient and each of the three imaging methods, 14 measurements were undertaken and 24 qualitative characterizations were assessed. Axial computed tomograms in combination with their corresponding coronal and sagittal reconstructions were more accurate than conventional tomograms. Direct coronal and sagittal scans gave the most detailed images, but required additional radiation dose, time and cost. Reconstructions of axial computed tomography slices of the TMJ using the dental scan software show several advantages over linear tomograms. They allow qualitative as well as quantitative evaluation of the TMJ.

Adolescent↗

A linear programming approach to limited angle 3D reconstruction from DSA projections.

OBJECTIVES: We investigate the feasibility of binary-valued 3D tomographic reconstruction using only a small number of projections acquired over a limited range of angles. METHODS: Regularization of this strongly ill-posed problem is achieved by (i) confining the reconstruction to binary vessel/non-vessel decisions, and (ii) by minimizing a global functional involving a smoothness prior. RESULTS: Our approach successfully reconstructs volumetric vessel structures from three projections taken within 90 degrees. The percentage of reconstructed voxels differing from ground truth is below 1%. CONCLUSION: We demonstrate that for particular applications--like Digital Subtraction Angiography--3D reconstructions are possible where conventional methods must fail, due to a severely limited imaging geometry. This could play an important role for dose reduction and 3D reconstruction using non-conventional technical setups.

Angiography, Digital Subtraction↗

The assessment of organ doses from plutonium for an epidemiological study of the Sellafield workforce.

An epidemiological study of mortality and cancer rates in plutonium workers at the Sellafield nuclear installation has been carried out by researchers at the London School of Hygiene and Tropical Medicine. The study required the assessment of organ-specific doses from plutonium for more than 5000 workers over a period of 40 years. This was a major undertaking as it involved the reconstruction of annual received doses from the results of some 223,000 urine samples that had been provided by the workers in the study. This paper outlines the techniques and strategies adopted in order to generate best estimates of dose from the available data, and presents summaries of these doses.

Body Burden↗

Reconstruction of high-energy bremsstrahlung spectra by numerical analysis of depth-dose data.

The determination of the spectral distribution of a photon beam is important for exact dosimetry and for the calculation of dose distributions. Direct measurements are not possible because of physical reasons. The approximation described uses a numerical reconstruction method based upon depth-dose data measured in water. The basic idea of the method is that a measured depth-dose curve can be thought of as a weighted superposition of monoenergetic depth-dose curves. The monoenergetic data are obtained by convolution of Monte Carlo generated energy deposition kernels. They were fitted to the measured data by means of a least squares method. Several constraints were applied to the superposition coefficients. The optimization algorithm uses the Wolfe reduced gradient method. The results were compared to Monte Carlo generated thick target spectra.

Algorithms↗

Spectral reconstruction by scatter analysis for a linear accelerator photon beam.

Pre-existing methods for photon beam spectral reconstruction are briefly reviewed. An alternative reconstruction method by scatter analysis for linear accelerators is introduced. The method consists in irradiating a small plastic phantom at standard 100 cm SSD and inferring primary beam energy spectral information based on the measurement with a standard Farmer chamber of scatter around the phantom at several specific scatter angles: a scatter curve is measured which is indicative of the primary spectrum at hand. A Monte Carlo code is used to simulate the scatter measurement set-up and predict the relative magnitude of scatter measurements for mono-energetic primary beams. Based on mono-energetic primary scatter data, measured scatter curves are analysed and the spectrum unfolded as the sum of mono-energetic individual energy bins using the Schiff bremsstrahlung model. The method is applied to an Elekta/SL18 6 MV photon beam. The reconstructed spectrum matches the Monte Carlo calculated spectrum for the same beam within 6.2% (average error when spectra are compared bin by bin). Depth dose values calculated for the reconstructed spectrum agree with physically measured depth dose data to within 1%. Scatter analysis is preliminarily shown to have potential as a practical spectral reconstruction method requiring few measurements under standard 100 cm SSD and feasible in any radiotherapy department using a phantom and a Farmer chamber.

Computer Simulation↗

An accidental exposure by a medical linear accelerator under construction.

A radiation accident occurred at a medical linear accelerator facility under construction in Japan. The radiation source was a 3- and 6-MV potential drop accelerator designed to produce X-rays for radiation therapy. This accelerator was also capable of producing a 5 to14-MV swept electron beam. During setting up, an operator turned on the accelerator to test the beam not knowing that a man was working on the ceiling above the accelerator. Thus, an X-ray beam was emitted against the ceiling and the man was exposed to 10-MV of X-ray irradiation. However, no obvious physical symptoms were noted. Dose estimation was made from reconstruction of the accident and clinical examinations including chromosome analysis. Mean dose of the whole body ranged from 70 to 180 mSv. Estimated dose from his right foot to hand was between180 to 900 mSv.

Humans↗

Potentiation of the bioavailability of daidzin by an extract of Radix puerariae.

The dose effect of pure daidzin on the suppression of ethanol intake in Syrian golden hamsters was compared with that of crude daidzin contained in a methanol extract of Radix puerariae (RP). EC50 values estimated from the graded dose-response curves for pure daidzin and RP extract daidzin are 23 and 2.3 mg per hamster per day, respectively. Apparently the antidipsotropic activity of the RP extract cannot be accounted for solely by its daidzin content (22 mg/g). In addition to daidzin, six other isoflavones were identified in the RP extract and quantified--namely, puerarin (160 mg per g of extract), genistin (3.7 mg/g), daidzein (2.6 mg/g), daidzein-4',7-diglucoside (1.2 mg/g), genistein (0.2 mg/g), and formononetin (0.16 mg/g). None of these, administered either alone or combined, contributes in any significant way to the antidipsotropic activity of the extract. Plasma daidzin concentration-time curves determined in hamsters administered various doses of pure daidzin or RP extract by i.p.injection indicate that the crude extract daidzin has approximately 10 times greater bioavailability than the pure compound. Reconstruction of the dose-response effects for pure and crude daidzin using bioavailable daidzin rather than administered dose gives a single curve. Synthetic daidzin added to the RP extract acquires the bioavailability of the endogenous daidzin that exists naturally in the extract. These results show that (i) daidzin is the major active principle in methanol extracts of RP, and (ii) additional constituents in the methanol extract of RP assist uptake of daidzin in golden hamsters.

Alcohol Deterrents↗

Real-time 3D dose calculation and display: a tool for plan optimization.

PURPOSE: Both human and computer optimization of treatment plans have advantages; humans are much better at global pattern recognition, and computers are much better at detailed calculations. A major impediment to human optimization of treatment plans by manipulation of beam parameters is the long time required for feedback to the operator on the effectiveness of a change in beam parameters. Our goal was to create a real-time dose calculation and display system that provides the planner with immediate (fraction of a second) feedback with displays of three-dimensional (3D) isodose surfaces, digitally reconstructed radiographs (DRRs), dose-volume histograms, and/or a figure of merit (FOM) (i.e., a single value plan score function). This will allow the experienced treatment planner to optimize a plan by adjusting beam parameters based on a direct indication of plan effectiveness, the FOM value, and to use 3D display of target, critical organs, DRRs, and isodose contours to guide changes aimed at improving the FOM value. METHODS AND MATERIALS: We use computer platforms that contain easily utilized parallel processors and very tight coupling between calculation and display. We ported code running on a network of two workstations and an array of transputers to a single multiprocessor workstation. Our current high-performance graphics workstation contains four 150-MHz processors that can be readily used in a shared-memory multithreaded calculation. RESULTS: When a 10 x 10-cm beam is moved, using an 8-mm dose grid, the full 3D dose matrix is recalculated using a Bentley-Milan-type dose calculation algorithm, and the 3D dose surface display is then updated, all in < 0.1s. A 64 x 64-pixel DRR calculation can be performed in < 0.1 s. Other features, such as automated aperture calculation, are still required to make real-time feedback practical for clinical use. CONCLUSION: We demonstrate that real-time plan optimization using general purpose multiprocessor workstations is a practical goal. Parallel processing technology provides this capability for 3D planning systems, and when combined with objective plan ranking algorithms should prove effective for optimizing 3D conformal radiation therapy. Compared to our earlier transputer work, multiprocessor workstations are more easily programmed, making software development costs more reasonable compared with uniprocessor development costs. How the dose calculation is partitioned into parallel tasks on a multiprocessor work station can make a significant difference in performance. Shared-memory multiprocessor workstations are our first choice for future work, because they require minimum programming effort and continue to be driven to higher performance by competition in the workstation arena.

Computer Graphics↗

Performance of a commercial optical CT scanner and polymer gel dosimeters for 3-D dose verification.

Performance analysis of a commercial three-dimensional (3-D) dose mapping system based on optical CT scanning of polymer gels is presented. The system consists of BANG 3 polymer gels (MGS Research, Inc., Madison, CT), OCTOPUS laser CT scanner (MGS Research, Inc., Madison, CT), and an in-house developed software for optical CT image reconstruction and 3-D dose distribution comparison between the gel, film measurements and the radiation therapy treatment plans. Various sources of image noise (digitization, electronic, optical, and mechanical) generated by the scanner as well as optical uniformity of the polymer gel are analyzed. The performance of the scanner is further evaluated in terms of the reproducibility of the data acquisition process, the uncertainties at different levels of reconstructed optical density per unit length and the effects of scanning parameters. It is demonstrated that for BANG 3 gel phantoms held in cylindrical plastic containers, the relative dose distribution can be reproduced by the scanner with an overall uncertainty of about 3% within approximately 75% of the radius of the container. In regions located closer to the container wall, however, the scanner generates erroneous optical density values that arise from the reflection and refraction of the laser rays at the interface between the gel and the container. The analysis of the accuracy of the polymer gel dosimeter is exemplified by the comparison of the gel/OCT-derived dose distributions with those from film measurements and a commercial treatment planning system (Cadplan, Varian Corporation, Palo Alto, CA) for a 6 cm x 6 cm single field of 6 MV x rays and a 3-D conformal radiotherapy (3DCRT) plan. The gel measurements agree with the treatment plans and the film measurements within the "3%-or-2 mm" criterion throughout the usable, artifact-free central region of the gel volume. Discrepancies among the three data sets are analyzed.

Equipment Design↗

Dose correlation for thoracic motion in radiation therapy of breast cancer.

This work investigates the dose correlation for deformed objects due to thoracic motion for radiotherapy treatment of breast cancer. An analytical model has been developed to reconstruct patient anatomy based on the assumption that the body will expand or compress proportionally during respiration. The patient geometry at any phase during a breathing pattern is reconstructed using the CT data taken at the inspiration and expiration phases and the breathing level which can be related to the measured chest wall motion. A correlation between the voxels in the inspiration (or expiration) geometry and the voxels in the reconstructed geometry at any phase of the breathing pattern is established so that the dose can be accumulated during a treatment. The method has been implemented for treatment planning dose calculation by interfacing with a Monte Carlo code. The patient geometry files for different phases of the breathing pattern are generated and the three-dimensional dose data are obtained from the Monte Carlo simulations. The final dose distribution is reconstructed from the dose data at different breathing phases based on patient's breathing pattern associated with chest wall movements.

Artifacts↗

Performance evaluation of a multi-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart.

BACKGROUND: 4-slice CT scanners have shown limitations in clinical application for noninvasive coronary CT angiography (CTA). We evaluate advances in ECG-gated scanning of the heart and the coronary arteries with recently introduced 16-slice CT equipment (SOMATOM Sensation 16, Siemens, Forchheim, Germany). MATERIALS AND METHODS: The technical principles of ECG-gated cardiac scanning, scan parameters, and detector design of the new scanner are presented. ECG-gated scan and image reconstruction techniques and ECG-controlled dose modulation ("ECG pulsing") for a reduction of the patient dose are described, key parameters for image quality and simulation results presented, and phantom studies and initial patient experience discussed. The impact of reduced gantry rotation time (0.42 s) on temporal resolution and initial estimations of the patient dose are presented. RESULTS: Extensions of ECG-gated reconstruction algorithms used for 4-slice CT provide adequate image quality for up to 16 slices. For each detector collimation different slice widths are available for retrospective reconstruction with well-defined slice sensitivity profiles (SSPs). For coronary CTA the heart can be covered with 0.75 mm collimation within a 20-s breathhold. The best possible spatial resolution is 0.5 x 0.5 x 0.6 mm. For 0.42 s gantry rotation time, temporal resolution reaches its optimum (105 ms) at a heart rate of 81 bpm. Effective patient dose for coronary CTA is 4-5 mSv using ECG-pulsed acquisition. CONCLUSION: The clinical performance of coronary CTA by means of spatial resolution, temporal resolution and scan time is substantially improved with the evaluated 16-slice CT scanner. Also, display of smaller coronary segments and instent visualization are substantially improved.

Algorithms↗