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Introduction: Exquisite soft tissue contrast of magnetic resonance images (MRI) and the new combined radiotherapy system of MR-Linac have been the main impetus for applying MR imaging in radiotherapy. One limitation of MR-based radiotherapy is the geometric distortion of MR images that can generate errors in the contouring and dosimetry stages. This study aimed to evaluate and correct geometric distortion for radiotherapy applications. Material and Methods: A large field of view (FOV) phantom develop using Perspex sheets and 325 plastic pipes. The quantification and correction of MR images' system-related geometric distortion are conducted for HASTE protocol by MATLAB and 3D slicer software in phantom and patient images. The effect of MRI images geometrical distortion was evaluated for ten patients undergoing body radiotherapy treatment. CT images were used as a primary dataset to estimate the distortion map. Results: The phantom investigation results indicate that in radial distances of < 13 cm (or FOVs < 25 cm), the amount of distortion is under 2 mm. Still, at more considerable radial distances, distortion may increase up to about 3.5 cm. MR images of Patients with lateral (LAT) and anterior-posterior (AP) diameters of more than 38 cm and 25 cm respectively, need to be corrected for geometric distortion. Conclusion: MR images' geometric precision in large FOVs is not sufficient for MRI only treatment planning of radiotherapy and further corrections are required. The B-spline deformable registration method can correct the MR geometric distortion until an acceptable range of 2 mm for radiotherapy applications.

Introduction: Interfractional set-up variations may cause deviation of the delivered dose from the planned dose distribution. This study aimed at calculating random and systematic set-up errors using an electronic portal imaging device (EPID) to set the optimum planning target volume (PTV) margins in patients with head and neck cancer who were under treatment with three-dimensional conformal (3DCRT) and intensity-modulated radiotherapy (IMRT). Material and Methods: In this study, 50 patients underwent 3DCRT along with weekly electronic portal image (EPI), and daily IMRT imaging was performed on 50 others. The EPIs were compared with Digitally Reconstructed Radiographs (DRRs) to quantify the systematic, random, and 3D vector length of set-up errors in three translational directions (X, Y, Z). The PTV margins were measured utilizing International Commission on Radiation Units and Measurements report 62, Stroom’s and van Herk’s models. Results: For 3DCRT and IMRT techniques, the overall mean 3D vector length of displacement was obtained at 3.9 and 2.7 mm, respectively. The maximum systematic and random errors were 1.3 and 1.9 mm for the IMRT technique and 2 and 2.9 mm for 3DCRT, respectively. PTV margins in the three acquisition directions were 2-7.2 mm. Conclusion: It was found that a 7 mm extension of the clinical target volume (CTV) to PTV margin ensures that 90% of head and neck cancer patients have received 95% of the planned dose.

One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future.This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.

Introduction: Radiation therapy involves a multistep procedure; therefore, the error in patient set up is an inherent part of the treatment. Main purpose of this study was to determine the clinical target volume (CTV) to planning target volume (PTV) in head and neck cancer patients. Material and Methods: A total of 15 patients who had daily portal images during the treatment courses were randomly selected in the present study. Systematic (Σ) and random (σ) errors were evaluated in three directions. The Isogray treatment planning system and Elekta linear accelerator were used in this study. Moreover, we had used MOSIAQ software as arecord and Verify system. Setup margins were calculated using three published margin recipes, including the International Commission on Radiation Units and Measurements (ICRU) report 62, as well as Stroom’s and van Herk’s formulae. Results: Average magnitude of the translational errors was reported between 0.7 and 10 mm. The systematic and random errors for head and neck cancer patients were 3.55 (2.58-4.52) and 1.83 (1.56-2.10) mm, respectively. According to the ICRU report 62, as well as Stoorm’s and van Herk’s formulas, the required margins to cover the target were obtained within the ranges of 3.1-4.9, 6.4-10.5, and 7.7-12.7 mm, respectively. Conclusion: According to the results of the present study, 6.5-10.5 mm extension in CTV to PTV margin can ensure that 90% of the head and neck cancer patients will receive a minimum cumulative CTV dose higher than or equal to 95% of the prescribed dose.

Introduction The purpose of this study was to evaluate personal shields in radiation departments of hospitals affiliated to Mashhad University of Medical Sciences. Materials and Methods First, the information related to 109 personal shields was recorded and evaluated by imaging equipment. Afterwards, the equivalent lead thickness (ELT) of 62 personal shields was assessed, using dosimeter and standard lead layers at 100 kVp. Results In this study, 109 personal shields were assessed in terms of tears, holes and cracks. The results showed that 18 shields were damaged. Moreover, ELT was evaluated in 62 shields. As the results indicated, ELT was unacceptable in 8 personal shields and lower than expected in 9 shields. Conclusion According to the results, 16.5% of personal shields had defects (tears, holes and cracks) and 13% of them were unacceptable in terms of ELT and needed to be replaced. Therefore, regular quality control of personal shields and evaluation of new shields are necessary at any radiation department.

Introduction In computed tomography (CT) technology, an optimal radiation dose can be achieved via changing radiation parameters such as mA, pitch factor, rotation time and tube voltage (kVp) for diagnostic images. Materials and Methods In this study, the brain, abdomen, and thorax scaning was performed using Toshiba 16-slice scannerand standard AAPM and CTDI phantoms. AAPM phantom was used for the measurement of image-related parameters and CTDI phantom was utilized for the calculation of absorbed dose to patients. Imaging parameters including mA (50-400 mA), pitch factor (1 and 1.5) and rotation time (range of 0.5, 0.75, 1, 1.5 and 2 seconds) were considered as independent variables. The brain, abdomen and chest imaging was performed multi-slice and spiral modes. Changes in image quality parameters including contrast resolution (CR) and spatial resolution (SR) in each condition were measured and determined by MATLAB software. Results After normalizing data by plotting the full width at half maximum (FWHM) of point spread function (PSF) in each condition, it was observed that image quality was not noticeably affected by each cases. Therefore, in brain scan, the lowest patient dose was in 150 mA and rotation time of 1.5 seconds. Based on results of scanning of the abdomen and chest, the lowest patient dose was obtained by 100 mA and pitch factors of 1 and 1.5. Conclusion It was found that images with acceptable quality and reliable detection ability could be obtained using smaller doses of radiation, compared to protocols commonly used by operators.

Introduction Quality control is an important phenomenon in nuclear medicine imaging. A Jaszczak SPECT Phantom provides consistent performance information for any SPECT or PET system. This article describes the simulation of a Jaszczak phantom and creating an executable phantom file for comparing assessment of SPECT cameras using SIMIND Monte Carlo simulation program which is well-established for SPECT. Materials and Methods The simulation was based on a Deluxe model of Jaszczak Phantom with defined geometry. Quality control tests were provided together with initial imaging example and suggested use for the assessment of parameters such as spatial resolution, limits of lesion detection, and contrast comparing with a Siemens E.Cam SPECT system. Results The phantom simulation was verified by matching tomographic spatial resolution, image contrast, and also uniformity compared with the experiment SPECT of the phantom from filtered backprojection reconstructed images of the spheres and rods. The calculated contrasts of the rods were 0.774, 0.627, 0.575, 0.372, 0.191, and 0.132 for an experiment with the rods diameters of 31.8, 25.4, 19.1, 15.9, 12.7, and 9.5 mm, respectively. The calculated contrasts of simulated rods were 0.661, 0.527, 0.487, 0.400, 0.23, and 0.2 for cold rods and also 0.92, 0.91, 0.88, 0.81, 0.76, and 0.56 for hot rods. Reconstructed spatial tomographic resolution of both experiment and simulated SPECTs of the phantom obtained about 9.5 mm. An executable phantom file and an input phantom file were created for the SIMIND Monte Carlo program. Conclusion This phantom may be used for simulated SPECT systems and would be ideal for verification of the simulated systems with real ones by comparing the results of quality control and image evaluation. It is also envisaged that this phantom could be used with a range of radionuclide doses in simulation situations such as cold, hot, and background uptakes for the assessment of detection characteristics when a new similar clinical SPECT procedure is being simulated.