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Top 20 Most Read Articles
May 2013
The 20 articles with the most full-text downloads during the month, in descending order.
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The future of IMRT/SBRT lies in the use of unflattened x-ray beams Med. Phys. 40, 060601 (2013); http://dx.doi.org/10.1118/1.4793410 (3 pages) Online Publication Date: 3 May 2013
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Submillimeter accuracy in radiosurgery is not possible Med. Phys. 40, 050601 (2013); http://dx.doi.org/10.1118/1.4790690 (4 pages) Online Publication Date: 4 April 2013
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Progressive cone beam CT dose control in image-guided radiation therapy Med. Phys. 40, 060701 (2013); http://dx.doi.org/10.1118/1.4804215 (7 pages) Online Publication Date: 13 May 2013
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Purpose: Cone beam CT (CBCT) in image-guided radiotherapy (IGRT) offers a tremendous advantage for treatment guidance. The associated imaging dose is a clinical concern. One unique feature of CBCT-based IGRT is that the same patient is repeatedly scanned during a treatment course, and the contents of CBCT images at different fractions are similar. The authors propose a progressive dose control (PDC) scheme to utilize this temporal correlation for imaging dose reduction.
Methods: A dynamic CBCT scan protocol, as opposed to the static one in the current clinical practice, is proposed to gradually reduce the imaging dose in each treatment fraction. The CBCT image from each fraction is processed by a prior-image based nonlocal means (PINLM) module to enhance its quality. The increasing amount of prior information from previous CBCT images prevents degradation of image quality due to the reduced imaging dose. Two proof-of-principle experiments have been conducted using measured phantom data and Monte Carlo simulated patient data with deformation.
Results: In the measured phantom case, utilizing a prior image acquired at 0.4 mAs, PINLM is able to improve the image quality of a CBCT acquired at 0.2 mAs by reducing the noise level from 34.95 to 12.45 HU. In the synthetic patient case, acceptable image quality is maintained at four consecutive fractions with gradually decreasing exposure levels of 0.4, 0.1, 0.07, and 0.05 mAs. When compared with the standard low-dose protocol of 0.4 mAs for each fraction, an overall imaging dose reduction of more than 60% is achieved.
Conclusions: PINLM-PDC is able to reduce CBCT imaging dose in IGRT utilizing the temporal correlations among the sequence of CBCT images while maintaining the quality. |
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Med. Phys. 40, 051705 (2013); http://dx.doi.org/10.1118/1.4798944 (10 pages) Online Publication Date: 17 April 2013
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Purpose: Although modern technology has allowed for target dose escalation by minimizing normal tissue dose, the dose delivered to a tumor and surrounding tissues still depends largely on the inherent characteristics of the radiation delivery platform. This work aims to determine the optimal prescription isodose line that minimizes normal tissue irradiation for stereotactic body radiation therapy (SBRT) for a conventional linear accelerator and a robotic delivery platform.
Methods: Spherical targets with diameters of 10, 20, and 30 mm were constructed in the lungs and liver of a computer based digital torso phantom which simulates respiratory and cardiac motion. Normal tissue contours included normal lung, normal liver, and a concentric 10 mm shell of normal tissue extending from the spherical target surface. For linac planning, noncoplanar, nonopposing three dimensional (3D) conformal beams were designed, and variable prescription isodose lines were achieved by varying the MLC block margin. For CyberKnife planning, variable prescription isodose lines were achieved by inverse planning. True 4D dose calculations were used for the moving target and surrounding tissue based on each of ten phases of a 4D CT dataset. Doses of 60 Gy in three fractions were prescribed to cover 95% of the target tumor. Commonly used conformality, dosimetric, and radiobiological indices for lung and liver SBRT were used to compare different plans and determine the optimally prescribed isodose line for each treatment platform.
Results: For linac plans, the average optimal prescription isodose line based on all indices evaluated occurred between 59% and 69% for lung tumors and between 67% and 77% for liver tumors depending on the tumor size. CyberKnife plans had average optimal prescription isodose lines occurring between 40% and 48% for lung tumors and between 41% and 42% depending on the tumor size. However, prescription isodose lines under 50% are not advised to prevent large heterogeneous dose distributions within the target.
Conclusions: The choice of prescription isodose line was shown to have a significant impact on parameters commonly used as constraints for lung and liver SBRT treatment planning for both linac-based and CyberKnife delivery platforms. By methodically choosing the prescription isodose line, normal tissue toxicities from SBRT may be reduced. |
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Nuclear imaging of the breast: Translating achievements in instrumentation into clinical use Med. Phys. 40, 050901 (2013); http://dx.doi.org/10.1118/1.4802733 (23 pages) Online Publication Date: 1 May 2013
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Approaches to imaging the breast with nuclear medicine and/or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed. |
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Med. Phys. 40, 050701 (2013); http://dx.doi.org/10.1118/1.4802748 (9 pages) Online Publication Date: 1 May 2013
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Purpose: Conventional volumetric modulated arc therapy (VMAT) discretizes the angular space into equally spaced control points during planning and then optimizes the apertures and weights of the control points. The aperture at an angle in between two control points is obtained through interpolation. This approach tacitly ignores the differential need for intensity modulation of different angles. As such, multiple arcs are often required, which may oversample some angle(s) and undersample others. The purpose of this work is to develop a segmentally boosted VMAT scheme to eliminate the need for multiple arcs in VMAT treatment with improved dose distribution and/or delivery efficiency.
Methods: The essence of the new treatment scheme is how to identify the need of individual angles for intensity modulation and to provide the necessary beam intensity modulation for those beam angles that need it. We introduce a “demand metric” at each control point to decide which station or control points need intensity modulation. To boost the modulation at selected stations, additional segments are added in the vicinity of the selected stations. The added segments are then optimized together with the original set of station or control points as a whole. The authors apply the segmentally boosted planning technique to four previously treated clinical cases: two head and neck (HN) cases, one prostate case, and one liver case. The proposed planning technique is compared with conventional one-arc and two-arc VMAT.
Results: The proposed segmentally boosted VMAT technique achieves better critical structure sparing than one-arc VMAT with similar or better target coverage in all four clinical cases. The segmentally boosted VMAT also outperforms two-arc VMAT for the two complicated HN cases, yet with ∼30% reduction in the machine monitor units (MUs) relative to two-arc VMAT, which leads to less leakage/scatter dose to the patient and can potentially translate into faster dose delivery. For the less challenging prostate and liver cases, similar critical structure sparing as the two-arc VMAT plans was obtained using the segmentally boosted VMAT. The benefit for the two simpler cases is the reduction of MUs and improvement of treatment delivery efficiency.
Conclusions: Segmentally boosted VMAT achieves better dose conformality and/or reduced MUs through effective consideration of the need of individual beam angles for intensity modulation. Elimination of the need for multiple arcs in rotational arc therapy while improving the dose distribution should lead to improved workflow and treatment efficacy, thus may have significant implication to radiation oncology practice. |
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The feasibility of a regional CTDIvol to estimate organ dose from tube current modulated CT exams Med. Phys. 40, 051903 (2013); http://dx.doi.org/10.1118/1.4798561 (11 pages) Online Publication Date: 5 April 2013
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Purpose: In AAPM Task Group 204, the size-specific dose estimate (SSDE) was developed by providing size adjustment factors which are applied to the Computed Tomography (CT) standardized dose metric, CTDIvol. However, that work focused on fixed tube current scans and did not specifically address tube current modulation (TCM) scans, which are currently the majority of clinical scans performed. The purpose of this study was to extend the SSDE concept to account for TCM by investigating the feasibility of using anatomic and organ specific regions of scanner output to improve accuracy of dose estimates.
Methods: Thirty-nine adult abdomen/pelvis and 32 chest scans from clinically indicated CT exams acquired on a multidetector CT using TCM were obtained with Institutional Review Board approval for generating voxelized models. Along with image data, raw projection data were obtained to extract TCM functions for use in Monte Carlo simulations. Patient size was calculated using the effective diameter described in TG 204. In addition, the scanner-reported CTDIvol (CTDIvol,global) was obtained for each patient, which is based on the average tube current across the entire scan. For the abdomen/pelvis scans, liver, spleen, and kidneys were manually segmented from the patient datasets; for the chest scans, lungs and for female models only, glandular breast tissue were segmented. For each patient organ doses were estimated using Monte Carlo Methods. To investigate the utility of regional measures of scanner output, regional and organ anatomic boundaries were identified from image data and used to calculate regional and organ-specific average tube current values. From these regional and organ-specific averages, CTDIvol values, referred to as regional and organ-specific CTDIvol, were calculated for each patient. Using an approach similar to TG 204, all CTDIvol values were used to normalize simulated organ doses; and the ability of each normalized dose to correlate with patient size was investigated.
Results: For all five organs, the correlations with patient size increased when organ doses were normalized by regional and organ-specific CTDIvol values. For example, when estimating dose to the liver, CTDIvol,global yielded a R2 value of 0.26, which improved to 0.77 and 0.86, when using the regional and organ-specific CTDIvol for abdomen and liver, respectively. For breast dose, the global CTDIvol yielded a R2 value of 0.08, which improved to 0.58 and 0.83, when using the regional and organ-specific CTDIvol for chest and breasts, respectively. The R2 values also increased once the thoracic models were separated for the analysis into females and males, indicating differences between genders in this region not explained by a simple measure of effective diameter.
Conclusions: This work demonstrated the utility of regional and organ-specific CTDIvol as normalization factors when using TCM. It was demonstrated that CTDIvol,global is not an effective normalization factor in TCM exams where attenuation (and therefore tube current) varies considerably throughout the scan, such as abdomen/pelvis and even thorax. These exams can be more accurately assessed for dose using regional CTDIvol descriptors that account for local variations in scanner output present when TCM is employed.
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Resolution modeling in PET imaging: Theory, practice, benefits, and pitfalls Med. Phys. 40, 064301 (2013); http://dx.doi.org/10.1118/1.4800806 (15 pages) Online Publication Date: 6 May 2013
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In this paper, the authors review the field of resolution modeling in positron emission tomography (PET) image reconstruction, also referred to as point-spread-function modeling. The review includes theoretical analysis of the resolution modeling framework as well as an overview of various approaches in the literature. It also discusses potential advantages gained via this approach, as discussed with reference to various metrics and tasks, including lesion detection observer studies. Furthermore, attention is paid to issues arising from this approach including the pervasive problem of edge artifacts, as well as explanation and potential remedies for this phenomenon. Furthermore, the authors emphasize limitations encountered in the context of quantitative PET imaging, wherein increased intervoxel correlations due to resolution modeling can lead to significant loss of precision (reproducibility) for small regions of interest, which can be a considerable pitfall depending on the task of interest. |
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Consensus recommendations for incident learning database structures in radiation oncology Med. Phys. 39, 7272 (2012); http://dx.doi.org/10.1118/1.4764914 (19 pages) Online Publication Date: 26 November 2012
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Purpose: Incident learning plays a key role in improving quality and safety in a wide range of industries and medical disciplines. However, implementing an effective incident learning system is complex, especially in radiation oncology. One current barrier is the lack of technical standards to guide users or developers. This report, the product of an initiative by the Work Group on Prevention of Errors in Radiation Oncology of the American Association of Physicists in Medicine, provides technical recommendations for the content and structure of incident learning databases in radiation oncology.
Methods: A panel of experts was assembled and tasked with developing consensus recommendations in five key areas: definitions, process maps, severity scales, causality taxonomy, and data elements. Experts included representatives from all major North American radiation oncology organizations as well as users and developers of public and in-house reporting systems with over two decades of collective experience. Recommendations were developed that take into account existing incident learning systems as well as the requirements of outside agencies.
Results: Consensus recommendations are provided for the five major topic areas. In the process mapping task, 91 common steps were identified for external beam radiation therapy and 88 in brachytherapy. A novel feature of the process maps is the identification of “safety barriers,” also known as critical control points, which are any process steps whose primary function is to prevent errors or mistakes from occurring or propagating through the radiotherapy workflow. Other recommendations include a ten-level medical severity scale designed to reflect the observed or estimated harm to a patient, a radiation oncology-specific root causes table to facilitate and regularize root-cause analyses, and recommendations for data elements and structures to aid in development of electronic databases. Also presented is a list of key functional requirements of any reporting system.
Conclusions: Incident learning is recognized as an invaluable tool for improving the quality and safety of treatments. The consensus recommendations in this report are intended to facilitate the implementation of such systems within individual clinics as well as on broader national and international scales. |
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Proton and Carbon Ion Therapy. Med. Phys. 40, 057301 (2013); http://dx.doi.org/10.1118/1.4802213 (2 pages) Online Publication Date: 22 April 2013
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Med. Phys. 40, 031001 (2013); http://dx.doi.org/10.1118/1.4794317 (1 page) Online Publication Date: 28 February 2013
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Med. Phys. 40, 061701 (2013); http://dx.doi.org/10.1118/1.4803499 (9 pages) Online Publication Date: 6 May 2013
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Purpose: The aim of the study was to evaluate the impact of multileaf collimator (MLC) leaf width on treatment adaptation and delivery accuracy for concurrent treatment of the prostate and pelvic lymph nodes with intensity modulated radiation therapy (IMRT).
Methods: Seventy-five kilovoltage cone beam CTs (KV-CBCT) from six patients were included for this retrospective study. For each patient, three different IMRT plans were created based on a planning CT using three different MLC leaf widths of 2.5, 5, and 10 mm, respectively. For each CBCT, the prostate displacement was determined by a dual image registration. Adaptive plans were created by shifting selected MLC leaf pairs to compensate for daily prostate movements. To evaluate the impact of MLC leaf width on the adaptive plan for each daily CBCT, three MLC shifted plans were created using three different leaf widths of MLCs (a total of 225 adaptive treatment plans). Selective dosimetric endpoints for the tumor volumes and organs at risk (OARs) were evaluated for these adaptive plans. Using the planning CT from a selected patient, MLC shifted plans for three hypothetical longitudinal shifts of 2, 4, and 8 mm were delivered on the three linear accelerators to test the deliverability of the shifted plans and to compare the dose accuracy of the shifted plans with the original IMRT plans.
Results: Adaptive plans from 2.5 and 5 mm MLCs had inadequate dose coverage to the prostate (D99 < 97%, or Dmean < 99% of the planned dose) in 6%–8% of the fractions, while adaptive plans from 10 mm MLC led to inadequate dose coverage to the prostate in 25.3% of the fractions. The average V56Gy of the prostate over the six patients was improved by 6.4% (1.6%–32.7%) and 5.8% (1.5%–35.7%) with adaptive plans from 2.5 and 5 mm MLCs, respectively, when compared with adaptive plans from 10 mm MLC. Pelvic lymph nodes were well covered for all MLC adaptive plans, as small differences were observed for D99, Dmean, and V50.4Gy. Similar OAR sparing could be achieved for the bladder and rectum with all three MLCs for treatment adaptation. The MLC shifted plans can be accurately delivered on all three linear accelerators with accuracy similar to their original IMRT plans, where gamma (3%/3 mm) passing rates were 99.6%, 93.0%, and 92.1% for 2.5, 5, and 10 mm MLCs, respectively. The percentages of pixels with dose differences between the measurement and calculation being less than 3% of the maximum dose were 85.9%, 82.5%, and 70.5% for the original IMRT plans from the three MLCs, respectively.
Conclusions: Dosimetric advantages associated with smaller MLC leaves were observed in terms of the coverage to the prostate, when the treatment was adapted to account for daily prostate movement for concurrent irradiation of the prostate and pelvic lymph nodes. The benefit of switching the MLC from 10 to 5 mm was significant (p ≪ 0.01); however, switching the MLC from 5 to 2.5 mm would not gain significant (p = 0.15) improvement. IMRT plans with smaller MLC leaf widths achieved more accurate dose delivery.
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Relative properties of tomography, K‐edge imaging, and K‐edge tomography Med. Phys. 4, 244 (1977); http://dx.doi.org/10.1118/1.594374 (6 pages)
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The properties of tomography, K‐edge imaging, and K‐edge tomography are discussed in relation to the imaging of small concentrations of elements such as iodine and xenon and are compared by means of phantom images. It is demonstrated that the complementary selectivities provided by depth and energy subtraction are combined in K‐edge tomography. Using a three‐spectrum subtraction technique, the iodine difference signal predicted by computer calculations is on the order of 8000 times that of an equal concentration of bone. The corresponding ratio in tomography without energy subtraction is 20:1. It is argued that K‐edge tomography can successfully eliminate artifacts due to tissue inhomogeneities which presently enable 0.6% variations in tissue attenuation to mimic minimum detectable iodine signals in conventional computed tomography. Various instrumentation possibilities and energy subtraction techniques are discussed. |
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Emerging technologies for image guidance and device navigation in interventional radiology Med. Phys. 39, 5768 (2012); http://dx.doi.org/10.1118/1.4747343 (14 pages) Online Publication Date: 4 September 2012
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Recent developments in image-guidance and device navigation, along with emerging robotic technologies, are rapidly transforming the landscape of interventional radiology (IR). Future state-of-the-art IR procedures may include real-time three-dimensional imaging that is capable of visualizing the target organ, interventional tools, and surrounding anatomy with high spatial and temporal resolution. Remote device actuation is becoming a reality with the introduction of novel magnetic-field enabled instruments and remote robotic steering systems. Robots offer several degrees of freedom and unprecedented accuracy, stability, and dexterity during device navigation, propulsion, and actuation. Optimization of tracking and navigation of interventional tools inside the human body will be critical in converting IR suites into the minimally invasive operating theaters of the future with increased safety and unsurpassed therapeutic efficacy. In the not too distant future, individual image guidance modalities and device tracking methods could merge into autonomous, multimodality, multiparametric platforms that offer real-time data of anatomy, morphology, function, and metabolism along with on-the-fly computational modeling and remote robotic actuation. The authors provide a concise overview of the latest developments in image guidance and device navigation, while critically envisioning what the future might hold for 2020 IR procedures. |
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Comparison of x‐ray cross sections for diagnostic and therapeutic medical physics Med. Phys. 23, 1997 (1996); http://dx.doi.org/10.1118/1.597899 (9 pages)
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The purpose of this technical report is to make available an up‐to‐date source of attenuation coefficient data to the medical physics community, and to compare these data with other more familiar sources. Data files from Lawrence Livermore National Laboratory (in Livermore, CA) were truncated to match the needs of the medical physics community, and an interpolation routine was written to calculate a continuous set of cross sections spanning energies from 1 keV to 50 MeV. Coefficient data are available for elements Z=1 through Z=100. Values for mass attenuation coefficients, mass‐energy‐transfer coefficients, and mass‐energy absorption coefficients are produced by a single computer subroutine. In addition to total interaction cross sections, the cross sections for the photoelectric, Rayleigh, Compton, pair, and some triplet interactions are also produced by this single program. The coefficients were compared to the 1970 data of Storm and Israel over the energy interval from 1 to 1000 keV; for elements 10, 20, 30, 40, 50, 60, 70, and 80, the average positive difference between the Storm and Israel coefficients and the coefficients reported here are 1.4%, 2.7%, and 2.6%, for the mass attenuation, mass energy‐transfer, and mass‐energy absorption coefficients, respectively. The 1969 data compilation of mass attenuation coefficients from McMaster et al. were also compared with the newer LLNL data. Over the energy region from 10 keV to 1000 keV, and from elements Z=1 to Z=82 (inclusive), the overall average difference was 1.53% (σ=0.85%). While the overall average difference was small, there was larger variation (>5%) between cross sections for some elements. In addition to coefficient data, other useful data such as the density, atomic weight, K, L1, L2, L3, M, and N edges, and numerous characteristic emission energies are output by the program, depending on a single input variable. The computer source code, written in C, can be accessed and downloaded from the World Wide Web at: http://www.aip.org/epaps/epaps.html [E‐MPHSA‐23‐1997]. © 1996 American Association of Physicists in Medicine. |
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Med. Phys. 40, 051710 (2013); http://dx.doi.org/10.1118/1.4802216 (11 pages) Online Publication Date: 22 April 2013
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Purpose: The novel deterministic radiation transport algorithm, Acuros XB (AXB), has shown great potential for accurate heterogeneous dose calculation. However, the clinical impact between AXB and other currently used algorithms still needs to be elucidated for translation between these algorithms. The purpose of this study was to investigate the impact of AXB for heterogeneous dose calculation in lung cancer for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).
Methods: The thorax phantom from the Radiological Physics Center (RPC) was used for this study. IMRT and VMAT plans were created for the phantom in the Eclipse 11.0 treatment planning system. Each plan was delivered to the phantom three times using a Varian Clinac iX linear accelerator to ensure reproducibility. Thermoluminescent dosimeters (TLDs) and Gafchromic EBT2 film were placed inside the phantom to measure delivered doses. The measurements were compared with dose calculations from AXB 11.0.21 and the anisotropic analytical algorithm (AAA) 11.0.21. Two dose reporting modes of AXB, dose-to-medium in medium (Dm,m) and dose-to-water in medium (Dw,m), were studied. Point doses, dose profiles, and gamma analysis were used to quantify the agreement between measurements and calculations from both AXB and AAA. The computation times for AAA and AXB were also evaluated.
Results: For the RPC lung phantom, AAA and AXB dose predictions were found in good agreement to TLD and film measurements for both IMRT and VMAT plans. TLD dose predictions were within 0.4%–4.4% to AXB doses (both Dm,m and Dw,m); and within 2.5%–6.4% to AAA doses, respectively. For the film comparisons, the gamma indexes (±3%/3 mm criteria) were 94%, 97%, and 98% for AAA, AXB_Dm,m, and AXB_Dw,m, respectively. The differences between AXB and AAA in dose–volume histogram mean doses were within 2% in the planning target volume, lung, heart, and within 5% in the spinal cord. However, differences up to 8% between AXB and AAA were found at lung/soft tissue interface regions for individual IMRT fields. AAA was found to be 5–6 times faster than AXB for IMRT, while AXB was 4–5 times faster than AAA for VMAT plan.
Conclusions: AXB is satisfactorily accurate for the dose calculation in lung cancer for both IMRT and VMAT plans. The differences between AXB and AAA are generally small except in heterogeneous interface regions. AXB Dw,m and Dm,m calculations are similar inside the soft tissue and lung regions. AXB can benefit lung VMAT plans by both improving accuracy and reducing computation time. |
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A study of IMRT planning parameters on planning efficiency, delivery efficiency, and plan quality Med. Phys. 40, 061704 (2013); http://dx.doi.org/10.1118/1.4803460 (13 pages) Online Publication Date: 13 May 2013
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Purpose: To improve planning and delivery efficiency of head and neck IMRT without compromising planning quality through the evaluation of inverse planning parameters.
Methods: Eleven head and neck patients with pre-existing IMRT treatment plans were selected for this retrospective study. The Pinnacle treatment planning system (TPS) was used to compute new treatment plans for each patient by varying the individual or the combined parameters of dose/fluence grid resolution, minimum MU per segment, and minimum segment area. Forty-five plans per patient were generated with the following variations: 4 dose/fluence grid resolution plans, 12 minimum segment area plans, 9 minimum MU plans, and 20 combined minimum segment area/minimum MU plans. Each plan was evaluated and compared to others based on dose volume histograms (DVHs) (i.e., plan quality), planning time, and delivery time. To evaluate delivery efficiency, a model was developed that estimated the delivery time of a treatment plan, and validated through measurements on an Elekta Synergy linear accelerator.
Results: The uncertainty (i.e., variation) of the dose-volume index due to dose calculation grid variation was as high as 8.2% (5.5 Gy in absolute dose) for planning target volumes (PTVs) and 13.3% (2.1 Gy in absolute dose) for planning at risk volumes (PRVs). Comparison results of dose distributions indicated that smaller volumes were more susceptible to uncertainties. The grid resolution of a 4 mm dose grid with a 2 mm fluence grid was recommended, since it can reduce the final dose calculation time by 63% compared to the accepted standard (2 mm dose grid with a 2 mm fluence grid resolution) while maintaining a similar level of dose-volume index variation. Threshold values that maintained adequate plan quality (DVH results of the PTVs and PRVs remained satisfied for their dose objectives) were 5 cm2 for minimum segment area and 5 MU for minimum MU. As the minimum MU parameter was increased, the number of segments and delivery time were decreased. Increasing the minimum segment area parameter decreased the plan MU, but had less of an effect on the number of segments and delivery time. Our delivery time model predicted delivery time to within 1.8%.
Conclusions: Increasing the dose grid while maintaining a small fluence grid allows for improved planning efficiency without compromising plan quality. Delivery efficiency can be improved by increasing the minimum MU, but not the minimum segment area. However, increasing the respective minimum MU and/or the minimum segment area to any value greater than 5 MU and 5 cm2 is not recommended because it degrades plan quality. |
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Med. Phys. 40, 040401 (2013); http://dx.doi.org/10.1118/1.4794923 (2 pages) Online Publication Date: 11 March 2013
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Respiration-based sorting of dynamic MRI to derive representative 4D-MRI for radiotherapy planning Med. Phys. 40, 051909 (2013); http://dx.doi.org/10.1118/1.4800808 (12 pages) Online Publication Date: 19 April 2013
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Purpose: Current pretreatment, 4D imaging techniques are suboptimal in that they sample breathing motion over a very limited “snap-shot” in time. To potentially address this, the authors have developed a longer-duration MRI and postprocessing technique to derive the average or most-probable state of mobile anatomy and meanwhile capture and convey the observed motion variability.
Methods: Sagittal and coronal multislice, 2D dynamic MRI was acquired in a sequential fashion over extended durations in two abdominal and four lung studies involving healthy volunteers. Two sequences, readily available on a commercial system, were employed. Respiratory interval-correlated, or 4D-MRI, volumes were retrospectively derived using a two-pass approach. In a first pass, a respiratory trace acquired simultaneous with imaging was processed and slice stacking was used to derive a set of MRI volumes, each representing an equal time or proportion of respiration. Herein, all raw 2D frames mapping to the given respiratory interval, per slice location, were averaged. In a second-pass, this prior reconstruction provided a set of template images and a similarity metric was employed to discern the subset of best-matching raw 2D frames for secondary averaging (per slice location and respiratory interval). Breathing variability (per respiratory interval and slice location) was depicted by computing both a maximum intensity projection as well as a pixelwise standard deviation image.
Results: These methods were successfully demonstrated in both the lung and abdomen for both applicable sequences, performing reconstructions with ten respiratory intervals. The first-pass (average) resulted in motion-induced blurring, especially for irregular breathing. The authors have demonstrated qualitatively that the second-pass result can mitigate this blurring.
Conclusions: They have presented a novel methodology employing dMRI to derive representative 4D-MRI. This set of techniques are practical in that (1) they employ MRI sequences that are standard across commercial vendors; (2) the 2D imaging planes can be oriented onto an arbitrary axis (e.g., sagittal, coronal, axial…); (3) the image processing techniques are relatively simple. Systematically applying this and similar dMRI-based techniques in patients is a crucial next step to demonstrate efficacy beyond CT-only based practice. |
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Automatic quantitative analysis of in-stent restenosis using FD-OCT in vivo intra-arterial imaging Med. Phys. 40, 063101 (2013); http://dx.doi.org/10.1118/1.4803461 (9 pages) Online Publication Date: 6 May 2013
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Purpose: A new segmentation technique is implemented for automatic lumen area extraction and stent strut detection in intravascular optical coherence tomography (OCT) images for the purpose of quantitative analysis of in-stent restenosis (ISR). In addition, a user-friendly graphical user interface (GUI) is developed based on the employed algorithm toward clinical use.
Methods: Four clinical datasets of frequency-domain OCT scans of the human femoral artery were analyzed. First, a segmentation method based on fuzzy C means (FCM) clustering and wavelet transform (WT) was applied toward inner luminal contour extraction. Subsequently, stent strut positions were detected by utilizing metrics derived from the local maxima of the wavelet transform into the FCM membership function.
Results: The inner lumen contour and the position of stent strut were extracted with high precision. Compared to manual segmentation by an expert physician, the automatic lumen contour delineation had an average overlap value of 0.917 ± 0.065 for all OCT images included in the study. The strut detection procedure achieved an overall accuracy of 93.80% and successfully identified 9.57 ± 0.5 struts for every OCT image. Processing time was confined to approximately 2.5 s per OCT frame.
Conclusions: A new fast and robust automatic segmentation technique combining FCM and WT for lumen border extraction and strut detection in intravascular OCT images was designed and implemented. The proposed algorithm integrated in a GUI represents a step forward toward the employment of automated quantitative analysis of ISR in clinical practice.
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