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Dental amalgams are a common source of artifacts in head and neck (HN) images. Commercial artifact reduction techniques have been offered, but are substantially ineffectual at reducing artifacts from dental amalgams, can produce additional artifacts, provide inaccurate HU information, or require extensive computation time, and thus offer limited clinically utility. The goal of this work was to define and validate a novel algorithm and provide a phantom‐based testing as proof of principle. An initial clinical comparison to a vendor's current solution was also performed. The algorithm uses two‐angled CT scans in order to generate a single image set with minimal artifacts posterior to the metal implants. The algorithm was evaluated using a phantom simulating a HN patient with dental fillings. Baseline (no artifacts) geometrical measurements of the phantom were taken in the anterior–posterior, left–right, and superior–inferior directions and compared to the metal‐corrected images using our algorithm to evaluate possible distortion from application of the algorithm. Mean HU numbers were also compared between the baseline scan and corrected image sets. A similar analysis was performed on the vendor's algorithm for comparison. The algorithm developed in this work successfully preserved the image geometry and HU and corrected the CT metal artifacts in the region posterior to the metal. The average total distortion for all gantry angles in the AP, LR, and SI directions was 0.17, 0.12, and 0.14 mm, respectively. The HU measurements showed significant consistency throughout the different reconstructed images when compared to the baseline image sets. The vendor's algorithm also showed no geometrical distortion but performed inferiorly in the HU number analysis compared to our technique. Our novel metal artifact management algorithm, using CT gantry angle tilts, provides a promising technique for clinical management of metal artifacts from dental amalgam.

Purpose The goal of total scalp irradiation (TSI) is to deliver a uniform dose to the scalp, which requires the use of a bolus cap. Most current methods for fabricating bolus caps are laborious, yet still result in nonconformity and low reproducibility, which can lead to nonuniform irradiation of the scalp. We developed and validated patient‐specific bolus caps for TSI using three‐dimensional (3D) printing. Methods and materials 3D‐printing materials were radiologically analyzed to identify a material with properties suitable for use as a bolus cap. A Python script was developed within a commercial treatment planning system to automate the creation of a ready‐to‐print, patient‐specific 3D bolus cap model. A bolus cap was printed for an anthropomorphic head phantom using a commercial vendor and a computed tomography simulation of the anthropomorphic head phantom and bolus cap was used to create a volumetric‐modulated arc therapy TSI treatment plan. The planned treatment was delivered to the head phantom and dosimetric validation was performed using thermoluminescent dosimeters (TLD). The developed procedure was used to create a bolus cap for a clinical TSI patient, and in vivo TLD measurements were acquired for several fractions. Results Agilus‐60 was validated as a new 3D‐printing material suitable for use as bolus. A 3D‐printed Agilus‐60 bolus cap had excellent conformality to the phantom scalp, with a maximum air gap of 4 mm. TLD measurements showed that the bolus cap generated a uniform dose to the scalp within a 2.7% standard deviation, and the delivered doses agreed with calculated doses to within 2.4% on average. The patient bolus was conformal and the average difference between TLD measured and planned doses was 5.3%. Conclusions We have developed a workflow to 3D‐print highly conformal bolus caps for TSI and demonstrated these caps can reproducibly generate a uniform dose to the scalp.

The purpose of this work was to determine the dosimetric benefit to normal tissues by tracking the multi‐leaf collimator (MLC) apertures with the photon jaws in step‐and‐shoot intensity‐modulated radiation therapy (IMRT) on the Varian 2100 platform. Radiation treatment plans for ten thoracic, three pediatric, and three head and neck cancer patients were converted to plans with the jaws tracking each segment's MLC apertures, and compared to the original plans in a commercial radiation treatment planning system (TPS). The change in normal tissue dose was evaluated in the new plan by using the parameters V5, V10, and V20 (volumes receiving 5, 10 and 20 Gy, respectively) in the cumulative dose‐volume histogram for the following structures: total lung minus gross target volume, heart, esophagus, spinal cord, liver, parotids, and brainstem. To validate the accuracy of our beam model, MLC transmission was measured and compared to that predicted by the TPS. The greatest changes between the original and new plans occurred at lower dose levels. In all patients, the reduction in V20 was never more than 6.3% and was typically less than 1%; the maximum reduction in V5 was 16.7% and was typically less than 3%. The variation in normal tissue dose reduction was not predictable, and we found no clear parameters that indicated which patients would benefit most from jaw tracking. Our TPS model of MLC transmission agreed with measurements with absolute transmission differences of less than 0.1% and, thus, uncertainties in the model did not contribute significantly to the uncertainty in the dose determination. We conclude that the amount of dose reduction achieved by collimating the jaws around each MLC aperture in step‐and‐shoot IMRT is probably not clinically significant. PACS numbers: 87.55.D‐ 87.55.de 87.55.dk

It may be possible to use a single device to measure the in vivo dose delivered during radiotherapy, as well as to localize the target volume. This potential, as well as the detectors' ability to relate dosimetry and localization, were evaluated using two implantable MOSFET dosimeters placed inside an acrylic pelvic phantom. A wedged‐field photon plan and an eight‐field prostate treatment plan were developed. For each plan, conditions were simulated so that detectors were in their correct positions or slightly displaced to represent patient setup error and/or organ motion. Doses measured by the two detectors after irradiation were compared to those calculated by the treatment planning software. Additionally, using localization software and kilovoltage images of each setup, the displacement of the detectors from their correct locations was calculated and compared to the induced physical displacement. For all alignments and detector positions, measured and calculated doses showed an average disagreement of 2.7%. The detectors were easily visualized radiographically and the induced detector displacements were typically recognized by the localization software to within 0.1 cm. The implantable detector functioned well as both an internal dosimeter and as an internal fiducial marker, and thus may be useful as a clinical tool to localize the target volume and verify dose delivery in vivo. PACS numbers: 87.53.‐j 87.55.‐x