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Background: MRI‐only radiotherapy planning (MROP) is beneficial to patients by avoiding MRI/CT registration errors, simplifying the radiation treatment simulation workflow and reducing exposure to ionizing radiation. MRI is the primary imaging modality for soft tissue delineation. Treatment planning CTs (i.e., CT simulation scan) are redundant if a synthetic CT (sCT) can be generated from the MRI to provide the patient positioning and electron density information. Unsupervised deep learning (DL) models like CycleGAN are widely used in MR‐to‐sCT conversion, when paired patient CT and MR image datasets are not available for model training. However, compared to supervised DL models, they cannot guarantee anatomic consistency, especially around bone. Purpose: The purpose of this work was to improve the sCT accuracy generated from MRI around bone for MROP. Methods: To generate more reliable bony structures on sCT images, we proposed to add bony structure constraints in the unsupervised CycleGAN model's loss function and leverage Dixon constructed fat and in‐phase (IP) MR images. Dixon images provide better bone contrast than T2‐weighted images as inputs to a modified multi‐channel CycleGAN. A private dataset with a total of 31 prostate cancer patients were used for training (20) and testing (11). Results: We compared model performance with and without bony structure constraints using single‐ and multi‐channel inputs. Among all the models, multi‐channel CycleGAN with bony structure constraints had the lowest mean absolute error, both inside the bone and whole body (50.7 and 145.2 HU). This approach also resulted in the highest Dice similarity coefficient (0.88) of all bony structures compared with the planning CT. Conclusion: Modified multi‐channel CycleGAN with bony structure constraints, taking Dixon‐constructed fat and IP images as inputs, can generate clinically suitable sCT images in both bone and soft tissue. The generated sCT images have the potential to be used for accurate dose calculation and patient positioning in MROP radiation therapy. [ABSTRACT FROM AUTHOR]

Background: The BEBIG Portio multi-channel applicator provides better target dose coverage and sparing organs-at-risk compared to a single-channel cylinder. However, artifacts and distortions of Portio in magnetic resonance images (MRI) have not yet been reported. Objective: We aimed to quantify the artifacts and distortions in its 1.5-Tesla MR images before clinical use. Material and Methods: In this experimental study, we employed a gelatinfilled phantom to conduct our measurements. T2-weighted (T2W) images were examined for artifacts and distortions. Computed tomography (CT) images were used as a reference to assess image distortions. Artifact severity was measured by recording the full-width-at-half-maximum (FWHM) image pixel values at various positions along the length of the applicator/channels. CT and MRI-based applicator reconstruction accuracy were then compared, and signal-to-noise ratio (SNR) and contrast were also determined for the applicator images. Results: The applicator distortion level for the Portio applicator was less than the image spatial resolution (0.5±0.5 pixels). The average FWHM for the tandem applicator images was 5.23±0.39 mm, while it was 3.21±0.37 mm for all channels (compared to their actual diameters of 5.0 mm and 3.0 mm, respectively). The average applicator reconstruction difference between CT and MR images was 0.75±0.30 mm overall source dwell positions. The image SNR and contrast were both acceptable. Conclusion: These findings indicate that the Portio applicator has a satisfactory low level of artifacts and image distortions in 1.5-Tesla, T2W images. It may, therefore, be a promising option for MRI-guided multi-channel vaginal brachytherapy. [ABSTRACT FROM AUTHOR]

Purpose: Suitable commissioning and quality control (QC) tests for high-dose-rate brachytherapy (HDR-BT) is necessary to ensure dosimetric and geometric accuracy of the treatment. This study aimed to present the methodology of developing a novel multi-purpose QC phantom (AQuA-BT) and examples of its' application in 3D image-based (particularly magnetic resonance imaging [MRI]-based) planning for cervix BT. Material and methods: Design criteria led to a phantom with sufficient size waterproof box for dosimetry and capability for inserting other components inside the phantom for: (A) Validating dose calculation algorithms in treatment planning systems (TPSs) using a small-volume ionization chamber; (B) Testing volume calculation accuracy in TPSs for bladder, rectum, and sigmoid organs at risk (OARs) constructed by 3D printing; (C) Quantification of MRI distortions using 17 semi-elliptical plates with 4,317 control points to mimic a realistic female's pelvis size; and (D) Quantification of image distortions and artifacts induced by MRI-compatible applicators using a specific radial fiducial marker. The utility of the phantom was tested in various QC procedures. Results: The phantom was successfully implemented for examples of intended QC procedures. The maximum deviation between the absorbed doses to water assessed with our phantom and those calculated by SagiPlan TPS was 1.7%. The mean discrepancy in volumes of TPS-calculated OARs was 1.1%. The differences between known distances within the phantom on MR imaging were within 0.7 mm compared with computed tomography. Conclusions: This phantom is a promising useful tool for dosimetric and geometric quality assurance (QA) in MRIbased cervix BT. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to address the dosimetric accuracy of synthetic computed tomography (sCT) images of patients with brain tumor generated using a modified generative adversarial network (GAN) method, for their use in magnetic resonance imaging (MRI)‐only treatment planning for proton therapy. Methods: Dose volume histogram (DVH) analysis was performed on CT and sCT images of patients with brain tumor for plans generated for intensity‐modulated proton therapy (IMPT). All plans were robustly optimized using a commercially available treatment planning system (RayStation, from RaySearch Laboratories) and standard robust parameters reported in the literature. The IMPT plan was then used to compute the dose on CT and sCT images for dosimetric comparison, using RayStation analytical (pencil beam) dose algorithm. We used a second, independent Monte Carlo dose calculation engine to recompute the dose on both CT and sCT images to ensure a proper analysis of the dosimetric accuracy of the sCT images. Results: The results extracted from RayStation showed excellent agreement for most DVH metrics computed on the CT and sCT for the nominal case, with a mean absolute difference below 0.5% (0.3 Gy) of the prescription dose for the clinical target volume (CTV) and below 2% (1.2 Gy) for the organs at risk (OARs) considered. This demonstrates a high dosimetric accuracy for the generated sCT images, especially in the target volume. The metrics obtained from the Monte Carlo doses mostly agreed with the values extracted from RayStation for the nominal and worst‐case scenarios (mean difference below 3%). Conclusions: This work demonstrated the feasibility of using sCT generated with a GAN‐based deep learning method for MRI‐only treatment planning of patients with brain tumor in intensity‐modulated proton therapy. [ABSTRACT FROM AUTHOR]

Purpose To evaluate plan quality of a novel MRI-compatible direction modulated brachytherapy (DMBT) tandem applicator using 192Ir, 60Co, and 169Yb HDR brachytherapy sources, for various cervical cancer high-risk clinical target volumes (CTVHR). Materials and Methods The novel DMBT tandem applicator has six peripheral grooves of 1.3-mm diameter along a 5.4-mm thick nonmagnetic tungsten alloy rod. Monte Carlo (MC) simulations were used to benchmark the dosimetric parameters of the 192Ir, 60Co, and 169Yb HDR sources in a water phantom against the literature data. 45 clinical cases that were treated using conventional tandem-and-ring applicators with 192Ir source (192Ir-T&R) were selected consecutively from int Ernational MRI-guided BRAchytherapy in CErvical cancer (EMBRACE) trial. Then, for each clinical case, 3D dose distribution of each source inside the DMBT and conventional applicators were calculated and imported onto an in-house developed inverse planning optimization code to generate optimal plans. All plans generated by the DMBT tandem-and-ring (DMBT T&R) from all three sources were compared to the respective 192Ir-T&R plans. For consistency, all plans were normalized to the same CTVHR D90 achieved in clinical plans. The D2 cm3 for organs at risk (OAR) such as bladder, rectum, and sigmoid, and D90, D98, D10, V100, and V200 for CTVHR were calculated. Results In general, plan quality significantly improved when a conventional tandem (Con.T) is replaced with the DMBT tandem. The target coverage metrics were similar across 192Ir-T&R and DMBT T&R plans with all three sources ( P > 0.093). 60Co-DMBT T&R generated greater hot spots and less dose homogeneity in the target volumes compared with the 192Ir- and 169Yb-DMBT T&R plans. Mean OAR doses in the DMBT T&R plans were significantly smaller ( P < 0.0084) than the 192Ir-T&R plans. Mean bladder D2 cm3 was reduced by 4.07%, 4.15%, and 5.13%, for the 192Ir-, 60Co-, and 169Yb-DMBT T&R plans respectively. Mean rectum (sigmoid) D2 cm3 was reduced by 3.17% (3.63%), 2.57% (3.96%), and 4.65% (4.34%) for the 192Ir-, 60Co-, and 169Yb-DMBT T&R plans respectively. The DMBT T&R plans with the 169Yb source generally resulted in the greatest OAR sparing when the CTVHR were larger and irregular in shape, while for smaller and regularly shaped CTVHR (<30 cm3), OAR sparing between the sources were comparable. Conclusions The DMBT tandem provides a promising alternative to the Con.T design with significant improvement in the plan quality for various target volumes. The DMBT T&R plans generated with the three sources of varying energies generated superior plans compared to the conventional T&R applicators. Plans generated with the 169Yb-DMBT T&R produced best results for larger and irregularly shaped CTVHR in terms of OAR sparing. Thus, this study suggests that the combination of the DMBT tandem applicator with varying energy sources can work synergistically to generate improved plans for cervical cancer brachytherapy. [ABSTRACT FROM AUTHOR]

The importance of assessing the metal-induced artefacts in magnetic resonance imaging (MRI)-guided brachytherapy is growing along with the increasing interest of integrating MRI into the treatment procedure of cervical cancer. Examples of metal objects in use include intracavitary cervical applicators and interstitial needles. The induced artefacts increase the uncertainties in the clinical workflow and can be a potential obstacle for the accurate delivery of the treatment. Overcoming this problem necessitates a good understanding of its originating sources. Several efforts are recorded in the literature to quantify the extent of such artefacts, in phantoms and in clinical practice. Here, we elaborate on the origin of metal-induced artefacts in the light of brachytherapy applications, while summarizing recent efforts that have been made to assess and overcome the induced distortions. [ABSTRACT FROM AUTHOR]

Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer. To implement a high quality image guided brachytherapy program, a multidisciplinary team is required with appropriate expertise as well as an adequate patient load to ensure a sustainable program. It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized. A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times. [ABSTRACT FROM AUTHOR]

Noble gas pulmonary magnetic resonance imaging ( MRI) is transitioning away from 3He to 129Xe gas, but the physiological/clinical relevance of 129Xe apparent diffusion coefficient ( ADC) parenchyma measurements is not well understood. Therefore, our objective was to generate 129Xe MRI ADC for comparison with 3He ADC and with well-established measurements of alveolar structure and function in older never-smokers and ex-smokers with chronic obstructive pulmonary disease ( COPD). In four never-smokers and 10 COPD ex-smokers, 3He ( b = 1.6 sec/cm2) and 129Xe ( b = 12, 20, and 30 sec/cm2) ADC, computed tomography ( CT) density-threshold measurements, and the diffusing capacity for carbon monoxide (DLCO) were measured. To understand regional differences, the anterior-posterior ( APG) and superior-inferior (∆ SI) ADC differences were evaluated. Compared to never-smokers, COPD ex-smokers showed greater 3He ADC ( P = 0.006), 129Xe ADCb12 ( P = 0.006), and ADCb20 ( P = 0.006), but not for ADCb30 ( P > 0.05). Never-smokers and COPD ex-smokers had significantly different APG for 3He ADC ( P = 0.02), 129Xe ADCb12 ( P = 0.006), and ADCb20 ( P = 0.01), but not for ADCb30 ( P > 0.05). ∆ SI for never- and ex-smokers was significantly different for 3He ADC ( P = 0.046), but not for 129Xe ADC ( P > 0.05). There were strong correlations for DLCO with 3He ADC and 129Xe ADCb12 (both r = −0.95, P < 0.05); in a multivariate model 129Xe ADCb12 was the only significant predictor of DLCO ( P = 0.049). For COPD ex-smokers, CT relative area <−950 HU ( RA950) correlated with 3He ADC ( r = 0.90, P = 0.008) and 129Xe ADCb12 ( r = 0.85, P = 0.03). In conclusion, while 129Xe ADCb30 may be appropriate for evaluating subclinical or mild emphysema, in this small group of never-smokers and ex-smokers with moderate-to-severe emphysema, 129Xe ADCb12 provided a physiologically appropriate estimate of gas exchange abnormalities and alveolar microstructure. [ABSTRACT FROM AUTHOR]

Background: The functional effects of abnormal diffusing capacity for carbon monoxide (DLCO) in ex-smokers without chronic obstructive pulmonary disease (COPD) are not well understood. Objective: We aimed to evaluate and compare well established clinical, physiological and emerging imaging measurements in ex-smokers with normal spirometry and abnormal DLCO with a group of ex-smokers with normal spirometry and DLCO and ex-smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I COPD. Methods We enrolled 38 ex-smokers and 15 subjects with stage I COPD who underwent spirometry, plethysmography, St George's Respiratory Questionnaire (SGRQ), 6 min Walk Test (6MWT), x-ray CT and hyperpolarised helium-3 (³He) MRI. The 6MWT distance (6MWD), SGRQ scores, ³He MRI apparent diffusion coefficients (ADC) and CT attenuation values below -950 HU (RA950) were evaluated. Results: Of 38 ex-smokers without COPD, 19 subjects had abnormal DLCO with significantly worse ADC ( p=0.01), 6MWD ( p=0.008) and SGRQ (p=0.01) but not RA950 ( p=0.53) compared with 19 ex-smokers with normal DLCO. Stage I COPD subjects showed significantly worse ADC (p=0.02), RA950 (p=0.0008) and 6MWD (p=0.005), but not SGRQ (p=0.59) compared with subjects with abnormal DLCO. There was a significant correlation for ³He ADC with SGRQ (r=0.34, p=0.02) and 6MWD (r=-0.51, p=0.0002). Conclusions: In ex-smokers with normal spirometry and CT but abnormal DLCO, there were significantly worse symptoms, 6MWD and ³He ADC compared with exsmokers with normal DLCO, providing evidence of the impact of mild or early stage emphysema and a better understanding of abnormal DLCO and hyperpolarised ³He MRI in ex-smokers without COPD. [ABSTRACT FROM AUTHOR]

In subjects with chronic obstructive pulmonary disease (COPD), hyperpolarized xenon-129 (129Xe) magnetic resonance imaging (MRI) reveals significantly greater ventilation defects than hyperpolarized helium-3 (³He) MRI. The physiological and/or morphological determinants of ventilation defects and the differences observed between hyperpolarized ³He and 129Xe MRI are not yet understood. Here we aimed to determine the structural basis for the differences in ventilation observed between ³He and 129Xe MRI in subjects with COPD using apparent diffusion coefficients (ADC) and computed tomography (CT). Ten COPD ex-smokers provided written, informed consent and underwent MRI, CT, spirometry, and plethysmography. ³He and 129Xe MRI ventilation volume was generated using semiautomated segmentation, and ADC maps were registered to generate ADC values for lung regions of interest ventilated by both gases (ADCHX) and by ³He gas only (ADCHO). CT wall area percentage and the lowest 15th percentile point of the CT lung density histogram (HU15%) were also evaluated. For lung regions accessed by ³He gas only, mean ³He ADCHO was significantly greater than for regions accessed by both gases (ADCHO = 0.503 ± 0.119 cm²/s, ADCHX = 0.470 ± 0.125 cm²/s, P < 0.0001). The difference between ³He and 129Xe ventilation volume was significantly correlated with CT HU15% (r = -65, P = 0.04) and ³He ADCHO (r = 0.70, P = 0.02), but not CT wall area percentage (r = -0.34, P = 0.33). In conclusion, in this small study in COPD subjects, we observed significantly decreased 129Xe MRI ventilation compared with ³He MRI, and these regions of decreased 129Xe ventilation were spatially and significantly correlated with regions of increased pulmonary emphysema, but not airway wall thickness. [ABSTRACT FROM AUTHOR]

Purpose: Manual segmentation of lung tumors is observer dependent and time-consuming but an important component of radiology and radiation oncology workflow. The objective of this study was to generate an automated lung tumor measurement tool for segmentation of pulmonary metastatic tumors from x-ray computed tomography (CT) images to improve reproducibility and decrease the time required to segment tumor boundaries. Methods: The authors developed an automated lung tumor segmentation algorithm for volumetric image analysis of chest CT images using shape constrained Otsu multithresholding (SCOMT) and sparse field active surface (SFAS) algorithms. The observer was required to select the tumor center and the SCOMT algorithm subsequently created an initial surface that was deformed using level set SFAS to minimize the total energy consisting of mean separation, edge, partial volume, rolling, distribution, background, shape, volume, smoothness, and curvature energies. Results: The proposed segmentation algorithm was compared to manual segmentation whereby 21 tumors were evaluated using one-dimensional (1D) response evaluation criteria in solid tumors (RECIST), two-dimensional (2D) World Health Organization (WHO), and 3D volume measurements. Linear regression goodness-of-fit measures (r2 = 0.63, p < 0.0001; r2 = 0.87, p < 0.0001; and r2 = 0.96, p < 0.0001), and Pearson correlation coefficients (r = 0.79, p < 0.0001; r = 0.93, p < 0.0001; and r = 0.98, p < 0.0001) for 1D, 2D, and 3D measurements, respectively, showed significant correlations between manual and algorithm results. Intra-observer intraclass correlation coefficients (ICC) demonstrated high reproducibility for algorithm (0.989-0.995, 0.996-0.997, and 0.999-0.999) and manual measurements (0.975-0.993, 0.985-0.993, and 0.980-0.992) for 1D, 2D, and 3D measurements, respectively. The intra-observer coefficient of variation (CV%) was low for algorithm (3.09%-4.67%, 4.85%-5.84%, and 5.65%-5.88%) and manual observers (4.20%-6.61%, 8.14%-9.57%, and 14.57%-21.61%) for 1D, 2D, and 3D measurements, respectively. Conclusions: The authors developed an automated segmentation algorithm requiring only that the operator select the tumor to measure pulmonary metastatic tumors in 1D, 2D, and 3D. Algorithm and manual measurements were significantly correlated. Since the algorithm segmentation involves selection of a single seed point, it resulted in reduced intra-observer variability and decreased time, for making the measurements. [ABSTRACT FROM AUTHOR]

We study how mucosal dose in the oral or nasal cavity depends on the irradiated small segmental photon fields varying with beam energy, beam angle and mucosa thickness. Dose ratio (mucosal dose with bone underneath to dose at the same point without bone) reflecting the dose enhancement due to the bone backscatter was determined by Monte Carlo simulation (EGSnrc-based code), validated by measurements. Phase space files based on the 6 and 18 MV photon beams with small field size of 1 × 1 cm2, produced by a Varian 21 EX linear accelerator, were generated using the BEAMnrc Monte Carlo code. Mucosa phantoms (mucosa thickness = 1, 2 and 3 mm) with and without a bone under the mucosa were irradiated by photon beams with gantry angles varying from 0 to 30°. Doses along the central beam axis in the mucosa and the dose ratio were calculated with different mucosa thicknesses. For the 6 MV photon beams, the dose at the mucosa-bone interface increased by 44.9DS41.7%, when the mucosa thickness increased from 1 to 3 mm for the beam angle ranging from 0 to 30°. These values were lower than those (58.8DS53.6%) for the 18 MV photon beams with the same beam angle range. For both the 6 and 18 MV photon beams, depth doses in the mucosa were found to increase with an increase of the beam angle. Moreover, the dose gradient in the mucosa was greater for the 18 MV photon beams compared to the 6 MV. For the dose ratio, it was found that the dose enhancement due to the bone backscatter increased with a decrease of mucosa thickness, and was more significant at both the air-mucosa and mucosa-bone interface. Mucosal dose with bone was investigated by Monte Carlo simulations with different experimental configurations, and was found vary with the beam energy, beam angle and mucosa thickness for a small segmental photon field. The dosimetric information in this study should be considered when searching for an optimized treatment strategy to minimize the mucosal complications in the head-and-neck intensity-modulated radiation therapy. [ABSTRACT FROM AUTHOR]

Purpose: The beam model in a three dimensional treatment planning system (TPS) defines virtually the mechanical and dosimetric characteristics of a treatment unit. The manual optimization of a beam model during commissioning can be a time consuming task due to its iterative nature. Furthermore, the quality of the beam model commissioning depends on the user’s ability to manage multiple parameters and assess their impact on the agreement between measured and calculated dose. The objective of this work is to develop and validate the performance of an automated beam model optimization system (ABMOS) based on intensity modulated radiotherapy (IMRT) beam measurements to improve beam model accuracy while streamlining the commissioning process. Methods: The ABMOS was developed to adjust selected TPS beam model parameters iteratively to maximize the agreement between measured and calculated 2D dose maps obtained for an IMRT beam pattern. A 2D diode array with high spatial resolution detectors was used to sample the entire IMRT beam pattern in a single dose measurement. The use of an IMRT beam pattern with large number of monitor units was selected to highlight the difference between planned and delivered dose and improve the signal to noise ratio in the low dose regions. ABMOS was applied to the optimization of a beam model for an Elekta Synergy S treatment unit. The optimized beam model was validated for two anatomical sites (25 paraspinal and 25 prostate cases) using two independent patient-specific IMRT quality control (QC) methods based on ion chamber and 2D diode array measurements, respectively. The conventional approach of comparing calculated and measured beam profiles and percent-depth dose curves was also used to assess improvement in beam model after ABMOS optimization. Elements of statistical process control were applied to the process of patient-specific QC performed with the ion chamber and the 2D array to complement the model comparison. Results: After beam model optimization with ABMOS, improvement in planned to delivered dose agreement was demonstrated with both patient-specific IMRT QC methods and the calculated to measured profile comparison. In terms of ion chamber measurements, the largest improvement was observed for the paraspinal cases with the mean measured to calculated dose difference at the low dose points decreasing from -13.8% to 2.0% with the optimized beam model. The 2D diode array patient-specific QC also demonstrated clearly the improvement in beam model for both paraspinal and prostate cases with, on average, more than 96% of the diodes satisfying tolerances of 3% of dose difference or 2 mm of distance to agreement after ABMOS optimization. The capability index (Cpk) for both patient-specific QC methods also increased with the optimized beam model. Conclusions: In this work, ABMOS was developed to use 2D diode array measurements of an IMRT beam pattern for the automated multivariable optimization of a TPS beam model. Based on the observed improvements in patient-specific QC results for 25 paraspinal and 25 prostate plans, optimization of the remaining clinical beam models using ABMOS is now ongoing in the institution. [ABSTRACT FROM AUTHOR]

This study evaluated the dosimetry of electron backscatter when Solid Water is used to substitute water as phantom in electron radiotherapy. Monte Carlo simulation (EGSnrc-based code) was employed to predict electron energy spectra and depth doses for the 0.5 and 1 cm of Solid Water and water slabs above 3 mm of lead (Pb) layers using electron beams with energies of 4 and 6 MeV. For comparison, Monte Carlo simulations were repeated with Pb layers taken out from the phantoms using the same experimental configuration. Analyses on electron energy spectra for the 4 and 6 MeV electron beams showed that deviations of electron energy distributions between the Solid Water and water phantom were more significant in the high-energy range (i.e., close to the maximal electron energy) than the lower range corresponding to the electron backscatter. These deviations of electron energy spectra varied with depth and were mainly due to the electron fluence or beam attenuation. Dosimetry results from Monte Carlo simulations showed that the Solid Water phantom had lower depth dose compared to water with the same experimental setup. For the 4 MeV electron beams with 0.5 cm of Solid Water, depth doses were 1.8%–3.9% and 2.3%–4.4% lower than those in water, with and without the Pb layer underneath, respectively. Thicker Solid Water of 1 cm resulted in different decreases in depth doses of 1.8%–4.6% (with Pb) and 2.3%–4.4% (without Pb) compared to water. For higher nominal electron beam energy of 6 MeV with 0.5 cm of Solid Water, depth doses decreased 1.7%–2.9% (with Pb) and 1.6%–2.1% (without Pb) compared to water. These decreases in depth doses changed to 1.7%–3.7% (with Pb) and 1.7%–3% (without Pb) when the thickness of Solid Water was increased to 1 cm. The dosimetry data in this study are useful in determining the correction factor when using Solid Water to substitute water for the electron backscatter measurement in electron radiotherapy. [ABSTRACT FROM AUTHOR]

This study investigated the depth dependence of electron backscatter from a layer of lead (Pb) for clinical electron beams. The change in the electron backscatter with variation in the water depth above the Pb was determined. Electron energy spectra and relative depth doses as a function of depth in water over the Pb layer were calculated using a Monte Carlo simulation and studied. Phase-space files for 4 and 9 MeV electron beams (10×10 cm2 applicator and cutout) based on the Varian 21 EX linear accelerator were generated using the EGSnrc-based BEAMNRC code. 3 mm of Pb, at depths of 0.5 and 1 cm in water, was irradiated with electrons. The source-to-surface distance is equal to 100 cm. Electron energy spectra and relative depth doses with and without the presence of the Pb layer at different depths in water were determined using the BEAMNRC code. For the 4 MeV electron energy spectra at a depth of 0.5 cm in water, electron backscatter was found to originate at the Pb-water interface and extend to 0.5 cm above the Pb insert. However, at a depth of 1 cm in water, electron backscatter almost disappeared at 0.5 and 1 cm above th ePb insert. This is due to the increased attenuation of the incident 4 MeV electron beam in a thicker layer of water as well as increased attenuation of the electron backscatter above the Pb. This resulted in a 23% decrease in relative dose at a measurement point of 0.5 cm depth, when the depth of the Pb insert was changed from 1 to 0.5 cm. For the electron energy spectra of the 9 MeV beams with a 0.5 cm depth of water, only a small amount of electron backscatter was observed. However, more electron backscatter was found when the water depth was increased to 1 cm. This is because the electron beam energy was decreased more due to the increase in attenuation from the increased depth of water compared to 0.5 cm. Since the electron energy spectrum and relative depth dose above the Pb layer vary with depth of water on top of the Pb, the electron backscatter depends significantly on the thickness of water, or water equivalent bolus, or critical tissue over the Pb shield in electron radiotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We developed a semi-automated tool to quantify emphysema from thoracic X-ray multi-detector (64-slice) computed tomography (CT) for training purposes and multi-reader studies. Materials and Methods: Thoracic X-ray CT was acquired in 93 ex-smokers, who were evaluated by six trainees with little or no expertise (trainees) and a single experienced thoracic radiologist (expert). A graphic user interface (GUI) was developed for emphysema quantification based on the percentile of lung where a score of 0=no abnormalities, 1=1–25%, 2=26–50%, 3=51–75% and 4=76–100% for each lung side/slice. Trainees blinded to subject characteristics scored randomized images twice; accuracy was determined by comparison to expert scores, density histogram 15th percentile (HU15), relative area at −950HU (RA950), low attenuation clusters at −950HU (LAC950), −856HU (LAC856) and the diffusing capacity for carbon monoxide (DLCO%pred). Intra- and inter-observer reproducibility was evaluated using coefficients-of-variation (COV), intra-class (ICC) and Pearson correlations. Results: Trainee–expert correlations were significant (r =0.85–0.97, p <0.0001) and a significant trainee bias (0.15±0.22) was observed. Emphysema score was correlated with RA950 (r =0.88, p <0.0001), HU15 (r =−0.77, p <0.0001), LAC950 (r =0.76, p <0.0001), LAC856 (r =0.74, p =0.0001) and DLCO%pred (r =−0.71, p <0.0001). Intra-observer reproducibility (COV=4–27%; ICC=0.75–0.94) was moderate to high for trainees; intra- and inter-observer COV were negatively and non-linearly correlated with emphysema score. Conclusion: We developed a GUI for rapid and interactive emphysema scoring that allows for comparison of multiple readers with clinical and radiological standards. [Copyright &y& Elsevier]

Purpose: To perform a comprehensive comparative planning study evaluating the utility of the proposed direction modulated brachytherapy (DMBT) tandem applicator against standard applicators, in the setting of image guided adaptive brachytherapy of cervical cancer.Methods and Materials: A detailed conceptual article was published in 2014. The proposed DMBT tandem applicator has 6 peripheral grooves of 1.3-mm width, along a 5.4-mm-thick nonmagnetic tungsten alloy rod of density 18.0 g/cm(3), capable of generating directional dose profiles. We performed a comparative planning study with 45 cervical cancer patients enrolled consecutively in the prospective observational EMBRACE study. In all patients, MRI-based planning was performed while utilizing various tandem-ring (27 patients) and tandem-ring-needles (18 patients) applicators, in accordance with the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology recommendations. For unbiased comparisons, all cases were replanned with an in-house-developed inverse optimization code while enforcing a uniform set of constraints that are reflective of the clinical practice. All plans were normalized to the same high-risk clinical target volume D90 values achieved in the original clinical plans.Results: In general, if the standard tandem was replaced with the DMBT tandem while maintaining all other planning conditions the same, there was consistent improvement in the plan quality. For example, among the 18 tandem-ring-needles cases, the average D2cm(3) reductions achieved were -2.48% ± 11.03%, -4.45% ± 5.24%, and -5.66% ± 6.43% for the bladder, rectum, and sigmoid, respectively. An opportunity may also exist in avoiding use of needles altogether for when the total number of needles required is small (approximately 2 to 3 needles or less), if DMBT tandem is used.Conclusions: Integrating the novel DMBT tandem onto both intracavitary and intracavitary-interstitial applicator assembly enabled consistent improvement in the sparing of the OARs, over a standard "single-channel" tandem, though individual variations in benefit were considerable. Although at an early stage of development, the DMBT concept design is demonstrated to be useful and pragmatic for potential clinical translation. [ABSTRACT FROM AUTHOR]

Accurate segmentation of prostate and surrounding organs at risk is important for prostate cancer radiotherapy treatment planning. We present a fully automated workflow for male pelvic CT image segmentation using deep learning. The architecture consists of a 2D organ volume localization network followed by a 3D segmentation network for volumetric segmentation of prostate, bladder, rectum, and femoral heads. We used a multi-channel 2D U-Net followed by a 3D U-Net with encoding arm modified with aggregated residual networks, known as ResNeXt. The models were trained and tested on a pelvic CT image dataset comprising 136 patients. Test results show that 3D U-Net based segmentation achieves mean (±SD) Dice coefficient values of 90 (±2.0)%, 96 (±3.0)%, 95 (±1.3)%, 95 (±1.5)%, and 84 (±3.7)% for prostate, left femoral head, right femoral head, bladder, and rectum, respectively, using the proposed fully automated segmentation method.

Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in the accuracy of target delineation in MRI-guided radiation therapy may improve clinical outcomes in a variety of cancer types. However, some considerations should be recognized including patient motion during image acquisition and geometric accuracy of images. Moreover, MR-compatible immobilization devices need to be used when acquiring images in the treatment position while minimizing patient motion during the scan time. Finally, synthetic CT images (i.e. electron density maps) and digitally reconstructed radiograph images should be generated from MRI images for dose calculation and image guidance prior to treatment. A short review of the concepts and techniques that have been developed for implementation of MRI-only workflows in radiation therapy is provided in this document.

To create a comprehensive dataset of peripheral dose (PD) measurements from a new generation of linear accelerators with and without the presence of a newly designed fetal shield, PD measurements were performed to evaluate the effects of depth, field size, distance from the field edge, collimator angle, and beam modi-fiers for common treatment protocols and modalities. A custom fetal lead shield was designed and made for our department that allows external beam treatments from multiple angles while minimizing the need to adjust the shield during patient treatments. PD measurements were acquired for a comprehensive series of static fields on a stack of Solid Water. Additionally, PDs from various clinically relevant treatment scenarios for pregnant patients were measured using an anthropomorphic phantom that was abutted to a stack of Solid Water. As expected, the PD decreased as the distance from the field edge increased and the field size decreased. On aver-age, a PD reduction was observed when a 90° collimator rotation was applied and/or when the tertiary MLCs and jaws defined the field aperture. However, the effect of the collimator rotation (90° versus 0°) in PD reduction was not found to be clini-cally significant when the tertiary MLCs were used to define the field aperture. In the presence of both the MLCs and the fetal shield, the PD was reduced by 58% at a distance of 10 cm from the field edge. The newly designed fetal shield may effectively reduce fetal dose and is relatively easy to setup. Due to its design, we are able to use a broad range of treatment techniques and beam angles. We believe the acquired comprehensive PD dataset collected with and without the fetal shield will be useful for treatment teams to estimate fetal dose and help guide decisions on treat-ment techniques without the need to perform pretreatment phantom measurements., (© 2016 The Authors.)