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[Development of a moving target aiming system using an ultrasound imaging unit].

We developed an ultrasound imaging unit for gating the irradiation of proton beams or acquiring CT scan data for treatment planning according to the motion of tumors in the abdomen. In proton therapy, it is essential that the maximum region of dose rate distribution in a body always coincide with the volume of the tumor in motion during irradiation. Gated proton bean irradiation based on tumor motion could solve this problem and minimize undesirable dose distribution to normal tissues in the vicinity of the tumor. This device can generate the TTL level signal of time width corresponding to the period that the tumor would be sited in a region determined in advance, to control the various kinds of machines. Results of our preliminary experiment using X-ray irradiation showed that this aiming device was able to make the width of the gated irradiation area coincide with that of the planned area within a difference of about 0.5 mm.

Humans↗

[The CT-stereotaxic neutron brachytherapy of brain tumors with californium sources on the ANET-B apparatus].

A method for stereotaxic intratissue radiotherapy of brain tumors based on the findings of computed tomography is described. Radiosurgical implantation of sources with increased 252Cf content emitting mixed neutron + gamma-radiation was accomplished by means of an ANET-B apparatus by the afterloading method. Neutron irradiation is particularly effective in patients with malignant tumors possessing a large fraction of cells in a state of deep anoxia. Dosimetric planning was conducted by means of an original computer system. Devices and radiation-technical equipment for adaptation of the ANET-B apparatus for irradiation of neurosurgical patients are described. The indications for the use of this method and its place among the complex of measures for the treatment of patients with new growths of the brain are discussed. The first experience in using CT-stereotaxic neutron brachytherapy with californium sources on the ANET-B apparatus for the treatment of 6 patients with malignant glial tumors of the brain is dwelt on.

Adult↗

[Conformal technics by the movement of bars in pendular fields. 1. Prototype realization and the possible applications].

The growing interest for conformal radiotherapy originates from the need of giving the prescribed dose to the target volume, by sparing, at the same time, surrounding healthy tissues and organs. More dose to the target volume with respect to the healthy tissues always increases the curative possibilities of the treatment. However, the development of conformal techniques implies an increased complexity of the treatment and the solution of many technical and dosimetric problems. In our Institute we are developing new conformal techniques, based on the use of moving bars driven by a computer-controlled system in arc therapy. This paper refers to the conclusion of the preliminary part of our work: a movement (translating or rotating) of bars in arc therapy seems to have good chances to tailor dose distribution in a relatively simple way. We realized two mechanical systems driven by computer for translating and rotating movements of a bar. The two techniques have been tested by TLD and film dosimetry on acrylic phantoms. We present the results of these tests, and describe technical problems and the clinical possibilities of this method.

Equipment Design↗

[Conformal technics by the movement of bars in pendular fields. 2. The dosimetric aspects].

The development of conformal techniques by movement of bars in pendular fields requires a careful examination of many physical and dosimetric problems: bar-critical organ synchronization problems, dose calculation problems, and problems relative to the "shadow effect". The use of a bar in an arc field, causes to a slow gradient of dose between shielded zone and target volume with a loss of homogeneity in dose distribution. This effect is well known ("shadow effect") and depends on the fact that different points spend different times beyond the bar's shadow. In this work the problem is investigated in the case of moving bar technique, mainly for dose calculation possibilities; then the possibility is analyzed of optimizing dose distribution by means of filters whose profile can be calculated for simple geometric conditions (fixed bar on the isocenter without considering the profile of the patient). These filters will be made in our Institute and they will be tested in various conditions, for both fixed bars and moving bars in arc fields.

Equipment Design↗

Assessment of exposure to radon decay products in realistic living conditions.

The development of an automated system for activity-weighted size distribution measurements now permits more complete exposure and dose assessment for indoor radon decay products. Exposures characterized by the semi-continuous measurement of activity-weighted size distributions of radon decay products were obtained over four test periods in three normally occupied houses, two of which were occupied by cigarette smokers. These measured activity size distributions were used to calculate exposure-dose conversion coefficients and the annual effective doses. These doses were found to be approximately two-fold higher than the values derived conventionally from the measured radon concentration, on the assumption that indoor exposure to 20 Bq m-3 radon gas concentration corresponds to an annual effective dose 1 mSv y-1. The degree to which aerosol-measurement-based dose estimates were higher than radon-gas-based estimates was found to be influenced if the study house occupant was a cigarette smoker. Reassessment of the measured PAEC-weighted radon progeny particle size distribution in terms of the classical "unattached" and "attached" modes yielded lower estimates of the exposure-effective dose conversion coefficient that were similar to the reference values derived from a recent study by the National Research Council. Thus, by not resolving the measured radon progeny PAEC that is associated with particles intermediate in size between the two classical radon progeny modes, the estimated annual effective doses were also found to be similar to the values derived conventionally from the measured radon gas concentration. It is concluded that the observed presence of 4 to 13% of the radon progeny PAEC in the size-range 1.5 to 15 nm diameter is a dosimetrically significant factor that appears to be commonplace in various home environments.

Air Pollution, Indoor↗

[Practical use of the TDF factor in radiotherapy of basalioma and squamous cell carcinoma].

For X-ray therapy, the relation between single doses, number of fractions and duration of therapy have been combined in the TDF (time, dose, fraction) factor by Orton and Ellis. This factor seems to be well suited to evaluation of the X-ray therapy of basal cell carcinomas and squamous cell carcinomas of the skin. A simplified TDF formula is presented, together with some methods of calculation. Furthermore, tables are presented containing TDF values for frequently applied single doses and for two to five fractions per week. In addition, some hints are given on the use of the decay factor of Orton and Ellis to compensate for the loss of X-ray effectiveness if therapy has been interrupted.

Basal Cell Carcinoma↗

Technique to improve lateral cervico-thoracic radiographs.

Lateral radiographs taken during radiotherapy simulation of the upper thoracic and lower cervical region are often of poor quality because of the difference in separation seen by the incident beam. A simple method of compensating for this is the application of a thin foil of lead on the simulator that obscures the light field in the superior portion of the field. This technique has the advantage of being simple, fast and easily reproducible.

Humans↗

Advantage of three-dimensional treatment planning for localized radiotherapy of early stage prostatic cancer.

Conventional two-dimensional (2-d) treatment planning was compared to three-dimensional (3-d) treatment planning for patients with prostatic carcinoma. Both types of treatment planning were performed for all ten patients with five fixed fields. In 3-d planning we used irregular shaped fields. For further evaluation we performed conventional planning in rotation technique in two patients. The target volume included prostate, seminal vesicles and a surrounding security margin of 2 cm. Using the MPR-version of the MEVAPLAN planning system, the three-dimensional dose calculations were performed. For the volumes of interest (VOI's) we discussed quality of the dose distribution concerning homogeneity in the target volume and isodose distribution in the organs at risk, which are the rectum and the urinary bladder. We defined the tumor encompassing reference isodose (ca. 95%) for the calculation of the involved rectum- and bladder volume. Using the five-field technique our results show a reduction of the radiation related rectum- and bladder volume concerning the tumor encompassing reference isodose (ca. 95%) for the rectum in between 9.5 and 36.6% (median: 19%, n = 10) and for the urinary bladder in between 15.7 and 47.8% (median: 28%, n = 10). Calculated for 80% of the reference isodose the difference for the rectum was 15.7 to 31.3% (median: 23%) and for the urinary bladder 24.5 to 56.7% (median: 42%). A significant reduction of radiation related side-effects concerning rectum and urinary bladder can be expected by a reduction of volume involvement and a consecutive dosage limitation.

Humans↗

Visualization of 3-D treatment plans with fast neutrons.

The treatment planning for radiotherapy with fast neutrons requires modifications of the planning systems used for photons. The neutron- and photon-component of the treatment fields must be determined and can then be used for separate calculations. The corrections for inhomogeneities are performed by use of attenuation coefficients and the corresponding corrections for changes in the kerma. The treatment planning system MEVAPLAN (Siemens) was modified to follow these requirements. Thus treatment planning for 14 MeV DT-neutrons could be performed. The multiplanar option is used to calculate 3D-dose distributions based on up to 40 serial CT slices. The generated three-dimensional dose matrix and the CT data are transferred via magnetic tape to the visualization system VOXEL-MAN developed at the University Hospital of Hamburg. This system uses a ray casting algorithm based on the generalized Voxel-model to display detailed 3D-images of human anatomy together with the calculated dose distribution. Different treatment plans for neutrons and photons are calculated and visualized. Various manipulations of the data-sets are displayed to improve the critical examination of the simulated dose distribution and to discern the quality of treatment techniques.

Fast Neutrons↗

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↗

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↗

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↗

[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↗

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↗

High dose rate treatment of a maxillary sarcomatoid carcinoma: a case report.

A 37-year old Native American woman presented with a rare sarcomatoid carcinoma of the left maxilla. She underwent extensive resection, but developed an orbital cavity recurrence. This was treated with external beam radiation therapy. The boost posed dosimetric difficulties due to the anatomic peculiarities of the treatment area. Extensive treatment planning for a high dose rate Iridium 192 source helped overcome these problems. Control of the tumor was achieved in the site of recurrence.

Adult↗

A computer-assisted three-dimensional treatment planning system.

The three-dimensional treatment planning system developed at the Rhode Island Hospital visualizes the spatial interrelationships of the radiation beam, the tumor, and the adjacent organs within the patient. It is possible to rotate and vary the scale of the display to better comprehend the extent of these structures. By viewing the display as if from along the radiation beam, one can design shaped treatment fields which best suit the three-dimensional nature of the disease. With this system, it is possible to reduce the volume of normal tissue which would typically be irradiated if two-dimensional treatment planning techniques and assumptions were employed.

Computers↗