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By collimating the photons scattered when a megavoltage therapy beam interacts with the patient, a Compton-scatter image may be formed without the delivery of an extra dose. To characterize and assess the potential of the technique, an analytical model for simulating scatter images was developed and validated against Monte Carlo (MC). For three phantoms, the scatter images collected during irradiation with a 6 MV flattening-filter-free therapy beam were simulated. Images, profiles, and spectra were compared for different phantoms and different irradiation angles. The proposed analytical method simulates accurate scatter images up to 1000 times faster than MC. Minor differences between MC and analytical simulated images are attributed to limitations in the isotropic superposition/convolution algorithm used to analytically model multiple-order scattering. For a detector placed at 90° relative to the treatment beam, the simulated scattered photon energy spectrum peaks at 140-220 keV, and 40-50% of the photons are the result of multiple scattering. The high energy photons originate at the beam entrance. Increasing the angle between source and detector increases the average energy of the collected photons and decreases the relative contribution of multiple scattered photons. Multiple scattered photons cause blurring in the image. For an ideal 5 mm diameter pinhole collimator placed 18.5 cm from the isocenter, 10 cGy of deposited dose (2 Hz imaging rate for 1200 MU min -1 treatment delivery) is expected to generate an average 1000 photons per mm 2 at the detector. For the considered lung tumor CT phantom, the contrast is high enough to clearly identify the lung tumor in the scatter image. Increasing the treatment beam size perpendicular to the detector plane decreases the contrast, although the scatter subject contrast is expected to be greater than the megavoltage transmission image contrast. With the analytical method, real-time tumor tracking may be possible through comparison of simulated and acquired patient images.

Purpose: Total body irradiation (TBI) with megavoltage photon beams has been accepted as an important component of management for a number of hematologic malignancies, generally as part of bone marrow conditioning regimens. The purpose of this paper is to present and discuss the authors' TBI technique, which both simplifies the treatment process and improves the treatment quality., Methods: An AP/PA TBI treatment technique to produce uniform dose distributions using sequential collimator reductions during each fraction was implemented, and a sample calculation worksheet is presented. Using this methodology, the dosimetric characteristics of both 6 and 18 MV photon beams, including lung dose under cerrobend blocks was investigated. A method of estimating midplane lung doses based on measured entrance and exit doses was proposed, and the estimated results were compared with measurements., Results: Whole body midplane dose uniformity of ±10% was achieved with no more than two collimator-based beam modulations. The proposed model predicted midplane lung doses 5% to 10% higher than the measured doses for 6 and 18 MV beams. The estimated total midplane doses were within ±5% of the prescribed midplane dose on average except for the lungs where the doses were 6% to 10% lower than the prescribed dose on average., Conclusions: The proposed TBI technique can achieve dose uniformity within ±10%. This technique is easy to implement and does not require complicated dosimetry and/or compensators.

We evaluated 4 volume-based automatic image registration algorithms from 2 commercially available treatment planning systems (Philips Syntegra and BrainScan). The algorithms based on cross correlation (CC), local correlation (LC), normalized mutual information (NMI), and BrainScan mutual information (BSMI) were evaluated with: (1) the synthetic computed tomography (CT) images, (2) the CT and magnetic resonance (MR) phantom images, and (3) the CT and MR head image pairs from 12 patients with brain tumors. For the synthetic images, the registration results were compared with known transformation parameters, and all algorithms achieved accuracy of submillimeter in translation and subdegree in rotation. For the phantom images, the registration results were compared with those provided by frame and marker-based manual registration. For the patient images, the results were compared with anatomical landmark-based manual registration to qualitatively determine how the results were close to a clinically acceptable registration. NMI and LC outperformed CC and BSMI, with the sense of being closer to a clinically acceptable result. As for the robustness, NMI and BSMI outperformed CC and LC. A guideline of image registration in our institution was given, and final visual assessment is necessary to guarantee reasonable results.

The Varian 120 multileaf collimator (MLC) has a leaf thickness of 5 mm projected at the isocenter plane and can deliver a radiation beam of large field size (up to 30 cm) to be used in intensity-modulated radiotherapy (IMRT). Often the dose must be delivered to depths greater than 20 cm. Therefore, during the commissioning of the BrainSCAN v5.21 or any radiation treatment-planning (RTP) systems, extensive testing of dose and monitor unit calculations must encompass the field sizes (1 cm to 30 cm) and the prescription depths (1 cm to 20 cm). Accordingly, the central-axis percent depth doses (PDDs) and off-axis percentage profiles must be measured at several depths for various field sizes. The data for this study were acquired with a 6-MV X-ray beam from a Varian 2100EX LINAC with a water phantom at a source-to-surface distance (SSD) of 100 cm. These measurements were also used to generate a photon beam module, based on a photon pencil beam dose-calculation algorithm with a fast-Fourier transform method. To commission the photon beam module used in our BrainSCAN RTP system, we performed a quantitative comparison of measured and calculated central-axis depth doses and off-axis profiles. Utilizing the principles of dose difference and distance-to-agreement introduced by Van Dyk et al. [Commissioning and quality assurance of treatment planning computers. Int J Radiat Oncol Biol Phys. 1993; 26:261-273], agreements between calculated and measured doses are <2% and <2 mm for the regions of low- and high-dose gradients, respectively. However, large errors (up to approximately 5% and approximately 7% for 20-cm and 30-cm fields, respectively, at the depth 20 cm) were observed for monitor unit calculations. For a given field size, the disagreement increased with the depth. Similarly, for a given depth the disagreement also increase with the field size. These large systematic errors were caused by using the tissue maximum ratio (TMR) in BrainSCAN v5.21 without considering increased field size as depth increased. These errors have been reported to BrainLAB.