Search

Simple Summary: Nasopharynx cancer treatment often involves radiation therapy, but choosing the best method can be challenging. This study compares two advanced radiation techniques: one using X-rays and another using protons. Both aim to target the tumor while sparing healthy tissues, but their effectiveness can vary based on the cancer's location and stage. Researchers want to determine which technique works best for different patients, particularly those with cancer close to sensitive brain structures. By analyzing treatment plans for 28 patients, we developed guidelines to help doctors choose the most suitable technique. This research could lead to more personalized and effective treatments, potentially improving outcomes and quality of life for patients with nasopharynx cancer. The findings may also help healthcare providers use resources more efficiently, benefiting both patients and the broader medical community. Background: Proton therapy requires caution when treating patients with targets near neural structures. Intuitive and quantitative guidelines are needed to support decision-making concerning the treatment modality. This study compared dosimetric profiles of intensity-modulated proton therapy (IMPT) and intensity-modulated radiation therapy (IMRT) using helical tomotherapy (HT) for adaptive re-planning in cT3-4 nasopharyngeal cancer (NPCa) patients, aiming to establish criteria for selecting appropriate treatment modalities. Methods: HT and IMPT plans were generated for 28 cT3-4 NPCa patients undergoing definitive radiotherapy. Dosimetric comparisons were performed for target coverage and high-priority organs at risk (OARs). The correlation between dosimetric parameters and RT modality selection was analyzed with the target OAR distances. Results: Target coverages were similar, while IMPT achieved better dose spillage. HT was more favorable for brainstem D1, optic chiasm Dmax, optic nerves Dmax, and p-cord D1. IMPT showed advantages for oral cavity Dmean. Actually, 14 IMPT and 14 HT plans were selected as adaptive plans, with IMPT allocated to most cT3 patients (92.9% vs. 42.9%, p = 0.013). The shortest distances from the target to neural structures were negatively correlated with OAR doses. Receiver operating characteristic curve analyses were carried out to discover the optimal cut-off values of the shortest distances between the target and the OARs (temporal lobes and brainstem), which were 0.75 cm (AUC = 0.908, specificity = 1.00) and 0.85 cm (AUC = 0.857, specificity = 0.929), respectively. Conclusions: NPCa patients with cT4 tumor or with the shortest distance between the target and critical neural structures < 0.8 cm were suboptimal candidates for IMPT adaptive re-planning. These criteria may improve resource utilization and clinical outcomes. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the homogeneity of the dose at the junction for fields used in breast radiotherapy using a different technique. Methods: A total of 4 fields, including 2 tangential fields and AP-PA fields, were planned on the phantom on the RayStation treatment planning system. Gamma analysis was used to compare the results of the measurement and treatment planning system. Results: When the graphs are analyzed, it is seen that the dose obtained in the junction region on the 2D measurement system as a result of the 1st tangential field and AP field irradiation is 8.3% less than the dose obtained in the treatment planning system. For the 2nd tangential field and PA field, this difference was obtained as 11.8%. When the horizontal profile in the junction region was analyzed as a result of irradiation of all areas, dose differences were measured between 12.5-8.2%. Due to the examination of a region with a high dose gradient, parameters such as the tongue-and-groove effect of MLCs, jaw calibration, parameters included in the treatment planning system's calculations, and measurement setup can directly impact the obtained data. Conclusions: The results of our study indicate that doses in the connection area should be planned by treatment centers with different techniques, examined with different dosimetric devices, and the acceptability of the obtained doses should be verified. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the clinical suitability of the current facility-based treatment plan protocol in establishing acceptability criteria. Material and methods: Automated Volumetric Arc Therapy (VMAT) treatment plans were retrospectively evaluated for intact breast and chest-wall cancer patients from January 2021 to January 2023. Results: A total of 94 patients were planned and treated using automated contouring and VMAT planning technique. The number of patients planned and treated for intact breast and chest-wall were 41 (43.6%) and 53 (56.4%), respectively. The mean intact breast volumes for optimization (Brst_opt) receiving 95% and 105% of the prescribed doses were 92.80% ± 1.11 and 1.54% ± 1.02, respectively. Their corresponding mean chest-wall volumes for optimization (Chst_opt) were 90.65% ± 3.19 and 2.28% ± 2.99, respectively. For left-sided cases, the mean heart dose received was 4.61 Gy ± 1.76 and 5.18 Gy ± 1.55 for intact breast plans and that for chest-wall plans, respectively. The mean ipsilateral lung volume receiving 20 Gy of the prescribed dose was 12.22% ± 3.86 and 13.19% ± 3.74 for intact breast plans and chest-wall plans, respectively. For the Brst_opt and Chst_opt dose metrics were calculated; the mean homogeneity index (HI) was 0.14 ± 0.03 and 0.15 ± 0.04, mean uniformity index (UI) was 1.09 ± 0.03 and 1.11 ± 0.03, and mean conformity index (CI) were 0.92 ± 0.04 and 0.91 ± 0.04, respectively. Conclusions: The dosimetric evaluation shows a good dose distribution in the target volumes with minimal doses to the organs at risk (OAR). Assessment of the current data affirms the clinical usefulness of the facility-adopted protocol in achieving quality treatment plans for intact breast and chest-wall irradiations. The establishment of plan acceptability criteria will help achieve improved overall treatment outcomes. [ABSTRACT FROM AUTHOR]

Stereotactic radiotherapy (SRT) methods have become common for the treatment of small tumors in various parts of the body. Small field dosimetry has a unique set of challenges when it comes to the pre‐treatment validation of a radiotherapy plan that involves film dosimetry or high‐resolution detectors. Comparison of commercial quality assurance (QA) devices to the film dosimetry method for pre‐treatment evaluation of stereotactic radiosurgery (SRS), fractionated SRT, and stereotactic body radiation therapy treatment plans have been evaluated in this study. Forty stereotactic QA plans were measured using EBT‐XD film, IBA Matrixx Resolution, SNC ArcCHECK, Varian aS1200 EPID, SNC SRS MapCHECK, and IBA myQA SRS. The results of the commercial devices are compared to the EBT‐XD film dosimetry results for each gamma criteria. Treatment plan characteristics such as modulation factor and target volume were investigated for correlation with the passing rates. It was found that all detectors have greater than 95% passing rates at 3%/3 mm. Passing rates decrease rapidly for ArcCHECK and the Matrixx as criteria became more strict. In contrast, EBT‐XD film, SNC SRS MapCHECK, and IBA myQA SRS passing rates do not decline as rapidly when compared to Matrix Resolution, ArcCHECK, and the EPID. EBT‐XD film, SNC SRS MapCHECK, and IBA myQA SRS maintain greater than 90% passing rate at 2%/1 mm and greater than 80% at 1%/1 mm. Additionally, the ability of these devices to detect changes in dose distribution due to MLC positioning errors was investigated. Ten VMAT SBRT/SRS treatment plans were created with 6 MV FFF or 10 MV FFF beam energies using Eclipse 15.6. A MATLAB script was used to create two MLC positioning error scenarios from the original treatment plan. It was found that errors in MLC positioning were most reliably detected at 2%/1 mm for high‐resolution detectors and that lower‐resolution detectors did not consistently detect MLC positioning errors. [ABSTRACT FROM AUTHOR]

• So far, UHDR electron TP studies focussed on dosimetric aspects of treatment delivery • Importance of FLASH RT TP will augment when shifting to more complex treatments • FLASH predictors for TP comprise: delivery parameter-based metrics, DMF, and TCP/NTCP • FLASH predictors used by current TP studies often not based on solid exp. evidence • This is due to lack of an established mechanism and a limited exp. characterization The FLASH effect designates normal tissue sparing at ultra-high dose rate (UHDR, >40 Gy/s) compared to conventional dose rate (∼0.1 Gy/s) irradiation while maintaining tumour control and has the potential to improve the therapeutic ratio of radiotherapy (RT). UHDR high-energy electron (HEE, 4–20 MeV) beams are currently a mainstay for investigating the clinical potential of FLASH RT for superficial tumours. In the future very-high energy electron (VHEE, 50–250 MeV) UHDR beams may be used to treat deep-seated tumours. UHDR HEE treatment planning focused at its initial stage on accurate dosimetric modelling of converted and dedicated UHDR electron RT devices for the clinical transfer of FLASH RT. VHEE treatment planning demonstrated promising dosimetric performance compared to clinical photon RT techniques in silico and was used to evaluate and optimise the design of novel VHEE RT devices. Multiple metrics and models have been proposed for a quantitative description of the FLASH effect in treatment planning, but an improved experimental characterization and understanding of the FLASH effect is needed to allow for an accurate and validated modelling of the effect in treatment planning. The importance of treatment planning for electron FLASH RT will augment as the field moves forward to treat more complex clinical indications and target sites. In this review, TPS developments in HEE and VHEE are presented considering beam models, characteristics, and future FLASH applications. [ABSTRACT FROM AUTHOR]

Background: Intensity-modulated radiation therapy (IMRT) may have too many peaks and valleys, making the treatment plan undeliverable. When there are too many fluency differences between adjacent pixels in the X or Y directions, the X and Y smoothing factors are utilized as weighting factors to penalize this behavior. Generally, a high degree of complexity is accompanied by many monitor units (MUs), large number of segments, small sized segments, and complex segment shapes. The degree of plan delivery uncertainty can all increase with a higher detailed fluence map. Aim: This study aims to evaluate the dosimetric effects of various smoothing levels on the planning target volume (PTV) and organs at risk (OARs) for cervix cancer. Materials and Methods: IMRT treatment plans were re‑optimized by combining several values of the X and Y penalty between 0 and 100. The dose–volume histogram assessed various dosimetric indicators for PTV and OARs. Additionally, gamma passing rates were evaluated and noted as an indicator of the complex treatment plan. Results: At X = 60, Y = 60 fluence map penalty, the conformity index (CI) value reached its highest value of 0.996 ± 0.004. At X = 0, Y = 0, the homogeneity index (HI) was determined to have a maximum value of 0.0628 ± 0.0235. The highest and lowest MU values were 2424.30 ± 471.12 and 1087.80 ± 91.57, respectively, with X = 0, Y = 0 and X = 100, Y = 100. At X = 100, Y = 100, the gamma passing rate reaches its highest value of 99.28% ± 0.44% and minimum value of 85.93% ± 3.87% at X = 0, Y = 0. Conclusion: The CI and HI values showed no discernible fluctuation, and the OAR doses were barely affected as smoothing was increased. When the smoothing factor was raised, the number of MUs sharply dropped, and a decrease in the number of segments and higher gamma passing rates were also seen. [ABSTRACT FROM AUTHOR]

It is important to have accurate information regarding the dose distribution for treatment planning and to accurately deposit that dose in the tissue surrounding the brachytherapy source. However, the practical measurement of dose distribution for various reasons is associated with several problems. In this study, 6711 I-125, Micro Selectron mHDR-v2r Ir-192, and Flexisource Co-60 sources were simulated using the MCNP5 Monte Carlo method. To simulate the sources, the exact geometric characteristics of each source, the material used in them, and the energy spectrum of each source were entered as input to the program, and finally, the dosimetric parameters including dose rate constant, radial dose function, and anisotropy function were calculated for considered seeds according to AAPM, TG-43 protocol recommendation. Results obtained for dosimetric parameters of dose rate constant, radial dose function, and anisotropy function for I-125, Ir-192, and Co-60 sources agreed with other studies. According to the good agreement obtained between the parameters of TG43 and other studies, now these datasets can be used as input in the treatment planning systems and to validate their calculations. [ABSTRACT FROM AUTHOR]

Purpose: The influence of radiotherapy on patient immune cell subsets has been established by several groups. Following a previously published analysis of immune changes during and after curative radiotherapy for prostate cancer, this analysis focused on describing correlations of changes of immune cell subsets with radiation treatment parameters. Patients and methods: For 13 patients treated in a prospective trial with radiotherapy to the prostate region (primary analysis) and five patients treated with radiotherapy to prostate and pelvic nodal regions (exploratory analysis), already published immune monitoring data were correlated with clinical data as well as radiation planning parameters such as clinical target volume (CTV) and volumes receiving 20 Gy (V20) for newly contoured volumes of pelvic blood vessels and bone marrow. Results: Most significant changes among immune cell subsets were observed at the end of radiotherapy. In contrast, correlations of age and CD8+ subsets (effector and memory cells) were observed early during and 3 months after radiotherapy. Ratios of T cells and T cell proliferation compared to baseline correlated with CTV. Early changes in regulatory T cells (Treg cells) and CD8+ effector T cells correlated with V20 of blood vessels and bone volumes. Conclusions: Patient age as well as radiotherapy planning parameters correlated with immune changes during radiotherapy. Larger irradiated volumes seem to correlate with early suppression of anti-cancer immunity. For immune cell analysis during normofractionated radiotherapy and correlations with treatment planning parameters, different time points should be looked at in future projects. Trial registration number: NCT01376674, 20.06.2011 [ABSTRACT FROM AUTHOR]

Background/Aim. In the past two decades, we have witnessed the emergence of new radiation therapy techniques, radiotherapy treatment planning system (TPS) with calculating algorithms for the dosage calculation in a patient, units for multislice computed tomography (CT) and image-guided treatment delivery. The aim of the study was investigating the significant difference in dosimetric calculation of radiotherapy TPS in relation to the values obtained by measuring on the linear accelerator (LINAC), and the accuracy of dosimetric calculation between calculating algorithms Analytical Anisotropic Algorithm (AAA) and Acuros XB in various tissues and photon beam energies. Methods. For End-to-End test we used the heterogeneous phantom CIRS Thorax002LFC, which anatomically represents human torso with a set of inserts known as relative electron densities (RED) for obtaining a CT calibration curve, comparable to the "reference" CIRS 062M phantom. For the AAA and Acuros XB algorithms and for 6 MV and 16 MV photon beams in the TPS Varian Eclipse 13.6, four 3D conformal (3DCRT), and one intensity modulated (IMRT) and volumetric modulated arc (VMAT) radiotherapy plans were made. Measurements of the absolute dose in Thorax phantom, by PTW-Semiflex ionization chamber, were carried out on three Varian-DHX LINACs. Results. The difference between "reference" and measured CT conversion curves in the bone area was 3%. For 476 phantom measurements, the difference between measured and TPS calculated dose of 3-6%, was found in 30 (6.3%) c ases. According to regression analysis, the standardized Beta coefficient for relative errors, 6 MV vs. 16 MV, was 0.337 (33.7%, p < 0.001). Mean relative errors for AAA and Acuros XB, using Mann-Whitney test, for bones were 1.56% and 2.64%, respectively (p = 0.004). Conclusion. End-to-End test on Thorax002LFC phantom proved the accuracy of TPS dose calculation in relation to the one delivered to a patient by LINAC. There was a significant difference for photon energies relative errors (higher values are obtained for 16 MV vs. 6 MV). A statistically significant minor relative error in AAA vs. Acuros XB was found for the bone. [ABSTRACT FROM AUTHOR]

Intensity modulated radiation therapy and brachytherapy are standard techniques of irradiation for the treatment of oral cavity cancers. These techniques are detailed in terms of indication, planning, delineation and selection of the volumes of interest, dosimetry and patients positioning control. This is an update of the guidelines of the French Society of Radiotherapy Correspondence. [ABSTRACT FROM AUTHOR]

Background: The evaluation of automatic segmentation algorithms is commonly performed using geometric metrics. An analysis based on dosimetric parameters might be more relevant in clinical practice but is often lacking in the literature. The aim of this study was to investigate the impact of state-of-the-art 3D U-Net-generated organ delineations on dose optimization in radiation therapy (RT) for prostate cancer patients.Methods: A database of 69 computed tomography images with prostate, bladder, and rectum delineations was used for single-label 3D U-Net training with dice similarity coefficient (DSC)-based loss. Volumetric modulated arc therapy (VMAT) plans have been generated for both manual and automatic segmentations with the same optimization settings. These were chosen to give consistent plans when applying perturbations to the manual segmentations. Contours were evaluated in terms of DSC, average and 95% Hausdorff distance (HD). Dose distributions were evaluated with the manual segmentation as reference using dose volume histogram (DVH) parameters and a 3%/3 mm gamma-criterion with 10% dose cut-off. A Pearson correlation coefficient between DSC and dosimetric metrics, i.e. gamma index and DVH parameters, has been calculated.Results: 3D U-Net-based segmentation achieved a DSC of 0.87 (0.03) for prostate, 0.97 (0.01) for bladder and 0.89 (0.04) for rectum. The mean and 95% HD were below 1.6 (0.4) and below 5 (4) mm, respectively. The DVH parameters, V[Formula: see text] for the bladder and V[Formula: see text] for the rectum, showed agreement between dose distributions within [Formula: see text] and [Formula: see text], respectively. The D[Formula: see text] and V[Formula: see text], for prostate and its 3 mm expansion (surrogate clinical target volume) showed agreement with the reference dose distribution within 2% and 3 Gy with the exception of one case. The average gamma pass-rate was 85%. The comparison between geometric and dosimetric metrics showed no strong statistically significant correlation.Conclusions: The 3D U-Net developed for this work achieved state-of-the-art geometrical performance. Analysis based on clinically relevant DVH parameters of VMAT plans demonstrated neither excessive dose increase to OARs nor substantial under/over-dosage of the target in all but one case. Yet the gamma analysis indicated several cases with low pass rates. The study highlighted the importance of adding dosimetric analysis to the standard geometric evaluation. [ABSTRACT FROM AUTHOR]

La radiothérapie guidée par l'image est devenue une technique standard d'irradiation permettant d'améliorer le devenir clinique des patients en termes de toxicité et de contrôle local du fait d'un meilleur ciblage du rayonnement lors de la séance d'irradiation. Les systèmes d'imagerie de positionnement, embarqués ou non, tels que les kV pour les acquisitions bidimensionnelles et surtout les tomographies coniques de basse énergie pour les acquisitions tridimensionnelles sont cependant irradiants dans un large volume comprenant le volume cible mais aussi du tissu sain, avec un risque théorique de majoration de toxicité et de second cancer. Il apparaît donc très important à la fois d'optimiser la dose délivrée par l'imagerie de contrôle de type tomographies coniques de basse énergie mais aussi de rapporter cette dose. Le rapport de l'AAPM (Association of Physicists in Medicine) publié en 2018 (« Image guidance doses delivered during radiotherapy : Quantification, management, and reduction ») propose une démarche d'optimisation et de gestion de ces doses. Ce rapport constitue la base de cette mise au point dont les objectifs sont de donner les ordres de grandeur des doses délivrées par l'imagerie de positionnement et de proposer une méthodologie de gestion de ces doses dans la pratique clinique. Une tomographie conique de basse énergie délivre approximativement 0,5 à 2 cGy à l'isocentre selon la localisation anatomique. Tant que les algorithmes de calcul ne sont pas disponibles dans les systèmes de planimétrie pour les faisceaux de positionnement, il semble adapté d'utiliser au moins les ordres de grandeur publiés. Cette estimation doit permettre au clinicien de décider de la stratégie thérapeutique en cas d'accumulation de sessions d'imagerie de positionnement. Image-guided radiotherapy (IGRT) has become a standard irradiation technique to improve the clinical outcome of patients in terms of toxicity and local control due to better targeting of radiation during the irradiation fraction. Positioning imaging systems, whether embedded or not, such as kV for 2 × 2D acquisitions and especially kVCBCT for 3D acquisitions are however irradiating in a large volume including the target volume but also healthy tissue, with a theoretical risk of increased toxicity and second cancer. It therefore appears very important both to optimize the absorbed dose due to IGRT practice but also to report it, especially in case of kVCBCT. The AAPM report published in 2018 (« Image guidance doses delivered during radiotherapy: Quantification, management, and reduction ») proposes a management of image guidance doses delivered during radiotherapy. This report is the basis of this focus article that aims at giving orders of magnitude and proposing a management of image guidance doses delivered during radiotherapy in clinical practice. The dose delivered per kVCBCT is about 0.5 to 2 cGy at isocenter according to treatment site. As long as the calculation algorithms are not available in the treatment planning systems, it seems appropriate to use at least the published dose orders of magnitude. This estimate should ultimately allow the clinician to decide on the therapeutic strategy in the event of accumulation of positioning imaging sessions. [ABSTRACT FROM AUTHOR]

Purpose: To propose guidelines for lung stereotactic body radiation therapy (SBRT) when using Acuros XB (AXB) equivalent to the existing ones developed for convolution algorithms such as analytic anisotropic algorithm (AAA), considering the difference between the algorithms. Methods: A retrospective analysis was performed on 30 lung patients previously treated with SBRT. The original AAA plans, which were developed using dynamic conformal arcs,were recalculated and then renormalized for planning target volume (PTV) coverage using AXB. The recalculated and renormalized plans were compared to the original plans based on V100% and V90% PTV coverage, as well as V105%, conformality index, D2cm, Rx/Dmax, R50, and Dmin. These metrics were analyzed nominally and on variations according to RTOG and NRGguidelines.Based on the relative difference between eachmetric in the AAA and AXB plans,new guidelines were developed.The relative differences in our cohort were compared to previously documented AAA to AXB comparisons found in the literature. Results: AAA plans recalculated in AXB had a significant reduction in most dosimetric metrics. The most notable changes were in V100% (4%) and the conformality index (7.5%). To achieve equal PTV coverage, AXB required an average of 1.8% more monitor units (MU).This fits well with previously published data. Applying the new guidelines to the AXB plans significantly increased the number of minor violations with no change in major violations, making them comparable to those of the original AAA plans. Conclusion: The relative difference found between AAA and AXB for SBRT lung plans has been shown to be consistent with previous works. Based on these findings,new guidelines for lung SBRT are recommended when planning with AXB. [ABSTRACT FROM AUTHOR]

Purpose: Minimum segment width (MSW) plays a fundamental role in the shaping of optimized apertures and creation of segments of varying sizes and shapes in complex radiotherapy treatment plans. The purpose of this work was to study the effect of MSW on dose distribution in patients planned with VMAT for various treatment sites using dose volume histogram (DVH) analysis. Materials and methods: For the validation of optimum MSW, 125 clinical treatment plans were evaluated. Five groups were identified (brain, head and neck, thorax, pelvis, and extremity), and five cases were chosen from each group. For each case, five plans were created with different MSW (0.5, 0.8, 1.0, 1.25, and 1.5 cm). The quality of treatment plans created using different MSW were compared using dosimetric indicators such as target coverage (D98—dose to 98% of the planning target volume (PTV), maximum dose (D2—maximum dose to 2% of the PTV), monitor units (MU), and DVH parameters related to organs at risk (OAR). The effect of the MSW on delivery accuracy was quantitatively analyzed using the measured fluence utilizing ionization chamber‐based transmission detector and model‐based dose verification system. Traditional global gamma analysis (2%, 2 mm) and dose volume information was gathered for the PTV and organs at risk and compared for different MSWs. Results: A total of 125 plans were created and compared across five groups. In terms of treatment plan quality, the plans using MSW of 0.5 cm was found to be superior in all groups. PTV coverage (D98) decreased significantly (p < 0.05) as the MSW increased. Similarly, the maximum dose (D2) was found to be increased significantly (p < 0.05) as the MSW increased from 0.5 cm, with MSW of 1.5 cm being the least in terms of plan quality for both PTVs and OARs. In terms of plan deliverability using DVH analysis, treatment planning system (TPS) compared to measured fluence, VMAT plans produced with MSW of 0.5 cm showed a better dosimetric index and a smaller deviation for both PTVs and OARs. The deliverability of the plans deteriorated as the MSW increased. Conclusion: Dose volume histogram (DVH) analysis demonstrated that treatment plans with minimal MSW showed better plan quality and deliverability and provided clinical relevance as compared to gamma index analysis. [ABSTRACT FROM AUTHOR]

Small‐field dosimetry used in advance treatment technologies poses challenges due to loss of lateral charged particle equilibrium (LCPE), occlusion of the primary photon source, and the limited choice of suitable radiation detectors. These challenges greatly influence dosimetric accuracy. Many high‐profile radiation incidents have demonstrated a poor understanding of appropriate methodology for small‐field dosimetry. These incidents are a cause for concern because the use of small fields in various specialized radiation treatment techniques continues to grow rapidly. Reference and relative dosimetry in small and composite fields are the subject of the International Atomic Energy Agency (IAEA) dosimetry code of practice that has been published as TRS‐483 and an AAPM summary publication (IAEA TRS 483; Dosimetry of small static fields used in external beam radiotherapy: An IAEA/AAPM International Code of Practice for reference and relative dose determination, Technical Report Series No. 483; Palmans et al., Med Phys 45(11):e1123, 2018). The charge of AAPM task group 155 (TG‐155) is to summarize current knowledge on small‐field dosimetry and to provide recommendations of best practices for relative dose determination in small megavoltage photon beams. An overview of the issue of LCPE and the changes in photon beam perturbations with decreasing field size is provided. Recommendations are included on appropriate detector systems and measurement methodologies. Existing published data on dosimetric parameters in small photon fields (e.g., percentage depth dose, tissue phantom ratio/tissue maximum ratio, off‐axis ratios, and field output factors) together with the necessary perturbation corrections for various detectors are reviewed. A discussion on errors and an uncertainty analysis in measurements is provided. The design of beam models in treatment planning systems to simulate small fields necessitates special attention on the influence of the primary beam source and collimating devices in the computation of energy fluence and dose. The general requirements for fluence and dose calculation engines suitable for modeling dose in small fields are reviewed. Implementations in commercial treatment planning systems vary widely, and the aims of this report are to provide insight for the medical physicist and guidance to developers of beams models for radiotherapy treatment planning systems. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate whether RapidPlan (RP) could generate clinically acceptable prostate volumetric modulated arc therapy (VMAT) plans. Methods: The in-house RP model was used to generate VMAT plans for 50 previously treated prostate cancer patients, with no additional optimisation being performed. The VMAT plans that were generated using the RP model were compared with the patients' previous, manually optimised clinical plans (MP), none of which had been used for the development of the in-house RP prostate model. Differences between RP and MP in planning target volume (PTV) doses, organs at risk (OAR) sparing, monitor units (MU) and planning time required to produce treatment plans were analysed. Assessment of PTV doses was based on the conformation number (CN), homogeneity index (HI), D2%, D99% and the mean dose of the PTV. The OAR doses evaluated were the rectal V50 Gy, V65 Gy, V70 Gy and the mean dose, the bladder V65 Gy, V70 Gy and the mean dose, and the mean dose to both femurs. Results: D99% and mean dose of the PTV were lower for RP than for MP (p = 0·006 and p = 0·040, respectively).V50 Gy, V65 Gy and the mean dose to rectum were lower in RP than in MP (p < 0·001). V65 Gy, V70 Gy and the mean dose to bladder were lower in RP than in MP (p < 0·001). RP had enhanced the sparing of both femurs (p < 0·001) and significantly reduced the planning time to less than 5% of the time taken with MP. MU in RP was significantly higher than MP by an average of 52·5 MU (p < 0·001) and 46 out of the 50 RP plans were approved by the radiation oncologist. Conclusion: This study has demonstrated that VMAT plans generated using an in-house RP prostate model in a single optimisation for prostate patients were clinically acceptable with comparable or better plan quality compared to MP. RP can add value and improve treatment planning efficiency in a high-throughput radiotherapy department through reduced plan optimisation time while maintaining consistency in the plan quality. [ABSTRACT FROM AUTHOR]

Accurate treatment planning in radiotherapy essentially decreases damage to healthy tissue surrounding the tumor. Due to plans to use a direct, highly collimated, narrow beam with high intensity to treat small area tumors, researchers have studied microbeam radiation therapy extensively. Using a synchrotron beam as the radiation source may help to limit damage, but treatment planning using computerized simulations and dosimetry is still necessary to achieve optimal results. For this purpose, PDA-gel dosimeters were developed and their sensitivity around a 150 keV induced synchrotron X-ray radiation beam was examined via Monte Carlo simulations using the EGS5 code system. The microbeam development is now at the animal study stage. In this study, we simulate the irradiation of a rat's brain. The simulation results obtained spectra for two types of PDA-gel dosimeters that were compared with the spectrum obtained in a modelized brain tumor of a rat. Additionally, percentage depth dose curves were calculated for the brain tissue and the two gels. Correction equations for the dosimeters were obtained from the dose-difference plots. For further references, these equations can be used to calculate the actual dose in a brain tumor in a rat. The Monte Carlo simulations demonstrate that PDA-gel dosimeters can be used for treatment planning using synchrotron irradiations. [ABSTRACT FROM AUTHOR]

Nanoparticle-enhanced radiotherapy offers the potential to selectively increase the radiation dose imparted to the tumor while at the same time sparing the healthy structures around it. Among the recommendations of an interdisciplinary group for the clinical translation of this treatment modality, is the developing of methods to quantify the effects that the nanoparticle concentration has on the radiation dosimetry and incorporate these effects into the treatment planning process. In this work, using Monte Carlo simulations and dynamic contrast-enhanced MRI images, treatment plans for nanoparticle-enhanced radiotherapy are calculated in order to evaluate the effects that realistic distributions of the nanoparticles have on the resultant plans and to devise treatment strategies to account for these effects, including the selection of the proper x-ray source configuration in terms of energy and collimation. Dynamic contrast-enhanced MRI studies were obtained for two treatment sites, namely brain and breast. A model to convert the MRI signal to contrast agent concentration was applied to each set of images. Two treatment modalities, 3D conformal radiotherapy and Stereotactic Body Radiation Therapy, were evaluated at three different x-ray spectra, namely 6 MV from a linear accelerator, 110 kVp and 220 kVp from a tungsten target. For the breast patient, as the nanoparticle distribution varies markedly with time, the treatment plans were obtained at two different times after administration. It was determined that maximum doses to the healthy structures around the tumor are mostly determined by the minimum nanoparticle concentration in the tumor. The presence of highly hypoxic or necrotic tissue, which fails to accumulate the nanoparticles, or leakage of the contrast agent into the surrounding healthy tissue, make irradiation with conventional conformal radiotherapy unfeasible for kilovoltage beam energies, as the uniform beam apertures lack the ability to compensate for the non-uniform distribution of the nanoparticles. Therefore, proper quantification of the nanoparticle distribution not only in the target volume but also in the surrounding tissues and structures is crucial for the proper planning of nanoparticle-enhanced radiotherapy and a treatment delivery with a high-degree of freedom, such as small-field stereotactic body radiotherapy, should be the method of choice for this treatment modality. • Nanoparticle-enhanced radiotherapy yields dose distributions highly dependent on the distribution of the nanoparticles. • Using dynamic contrast-enhanced MRI, the distribution of Gd nanoparticles is determined for two sites, breast and brain. • Radiation source is optimized to take into account the presence of regions with nonuniform concentrations of nanoparticles. • Open, conformally collimated x-ray sources are not suitable to deliver nanoparticle-enhanced radiation treatments. • Small-diameter x-ray sources yield acceptable dose distributions even in regions with low concentration of nanoparticles. [ABSTRACT FROM AUTHOR]

To evaluate attenuation of the totally implantable vascular access device (TIVAD) and assess its clinical and dosimetric impact on radiotherapy (RT) of lymphoma patients. The first part of the study consisted of an in vitro approach by irradiating the TIVAD with different electron and photon energies. The attenuation data measured were compared with data calculated by our treatment planning system. All patients treated by radiotherapy for Hodgkin's lymphoma with their TIVAD in the target volume were then reviewed to assess the clinical outcome and dosimetric comparison using different plan metrics. All patients were treated by 3D conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy delivered by Helical Tomotherapy (HT). Nineteen patients treated for stage I-III HL were studied. Seven patients were treated exclusively on the side of TIVAD and 12 were treated bilaterally. Median prescription dose was 30 Gy. No significant clinical or dosimetric differences were observed between the side of the TIVAD and the contralateral side in patients treated bilaterally. HT resulted in a significantly higher conformity index (P < 0.0022) and a significantly lower healthy tissue coverage (P = 0.0008) than 3DCRT. The observed attenuation was 79% for 6 MeV, 59% for 9 MeV, and 46% for 12 MeV for electrons and 9% for 4 MV, 8% for 6 MV, 5% for 10 MV and 15 MV and 3% for 20 MV for X photons. TIVADs induce significant beam attenuation when using electrons, which can be overcome by using high-energy photons or by creating an exclusion zone in when HT is used. [ABSTRACT FROM AUTHOR]

Well-controlled ionizing radiation injury animal models for testing medical countermeasure efficacy require robust radiation physics and dosimetry to ensure accuracy of dose-delivery and reproducibility of the radiation dose-response relationship. The objective of this study was to establish a simple, convenient, robust and accurate technique for validating total body irradiation (TBI) exposure of the New Zealand White rabbit. We use radiotherapy techniques such as computed tomography simulation and a 3 D-conformal radiation therapy treatment planning system (TPS) on three animals to comprehensively design and preplan a TBI technique for rabbits. We evaluate the requirement for bolus, treatment geometry, bilateral vs anterior-posterior treatment delivery, the agreement between monitor units calculated using the TPS vs a traditional hand calculation to the mid-plane, and resulting individual organ doses. The optimal technique irradiates animals on the left-decubitus position using two isocentric bilateral parallel-opposed 6 MV x-ray beams. Placement of a 5 mm bolus and 8.5 mm beam spoiler was shown to increase the dose to within ≤5 mm of the surface, improving dose homogeneity throughout the body of the rabbit. A simple hand calculation formalism, dependent only on mid-abdominal separation, could be used to calculate the number of monitor units (MUs) required to accurately deliver the prescribed dose to the animal. For the representative animal, the total body volume receiving > 95% of the dose, V95% > 99%, V100% > 95%, and V107% < 20%. The area of the body receiving >107% of the prescribed dose was mainly within the limbs, head, and around the lungs of the animal, where the smaller animal width reduces the x-ray attenuation. Individual organs were contoured by an experienced dosimetrist, and each received doses within 95–107% of the intended dose, with mean values ∼104%. Only the bronchus showed a maximal dose >107% (113%) due to the decreased attenuation of the lungs. To validate the technique, twenty animals were irradiated with four optically-stimulated luminescence dosimeters (OSLDs) placed on the surface of each animal (two on each side in the center of the radiation beam). The average dose over all animals was within <0.1% from intended values, with no animal receiving an average dose more than ±3.1% from prescription. The TBI technique developed in this pilot study was successfully used to establish the dose-response relationship for 45-day lethality across the dose-range to induce the hematopoietic-subsyndrome of the acute radiation syndrome (ARS). [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the potential for improvement of routine breast and organs at risk contouring in patients treated in the lateral decubitus position using Workflow Box™ (Mirada Medical™, UK) automatic contouring software. Automatic contouring of the breast by this software is currently based on an atlas created from isodoses representing 95% of the prescribed dose in a population of patients previously treated at institut Curie. Forty cases of breast cancer (20 right breasts and 20 left breasts) were contoured by three radiation oncologists specialized in breast cancer, allowing the creation of a new atlas in the automatic contouring software. This study assessed the quality of contouring in 20 patients (ten right breasts and ten left breasts) by comparing manual contouring performed by the expert radiation oncologists (reference) with those generated by the old and new atlases developed at Institut Curie. The accuracy of contouring was assessed by overlap volume and the associated standard deviations. Breast contouring based on the new atlas and by radiation oncologists presented a mean overlap of 0.80 ± 0.09 for the right breast and 0.81 ± 0.06 for the left breast. By comparing volumes of interest contoured by radiation oncologists and those obtained from the old atlas, mean overlap volumes were 0.75 ± 0.08 and 0.74 ± 0.13 for the right and left breasts, respectively. Twenty cases (ten right breasts and ten left breasts) used to create the new atlas were also reprocessed by this same atlas in order to assess the quality of automatic contouring of the breast when the case was already known to the software. The mean overlap volume in this case was 0.84 ± 0.08 for the right breast and 0.83 ± 0.06 for the left breast. Finally, after automatic contouring of organs at risk by means of the new atlas, the mean overlap volume was 0.87 ± 0.04 for the heart and 0.93 for each lung (±0.05 for the right lung and ± 0.04 for the left lung). Workflow Box™ automatic contouring software, based on our new atlas provides reliable and clinically relevant organs at risk and breast contouring. The contours proposed by the software from the new atlas were better than those obtained with the previous atlas based on 95% isodoses obtained from old treatment plans. This software has therefore become more efficient, justifying its use in routine clinical practice for breast cancer contouring in patients treated in the lateral decubitus position. Investigations are currently underway to develop a fully automated process to ensure reliable, robust and operator-independent contouring and breast cancer treatment dosimetry in the lateral decubitus position. Promising preliminary results have already been obtained. [ABSTRACT FROM AUTHOR]

This work aims to evaluate the dosimetric consequences of replacing the Anisotropic Analytical Algorithm (AAA) by Acuros XB (AXB), dose-to-water (Dw) or dose-to-medium (Dm), for RapidArc plans of nasopharyngeal carcinomas (NPC). Seventeen NPC plans created with AAA (v15.6) were recalculated with AXB (v15.6) Dw and Dm. The dose–volume parameters to the planning target volumes (PTV) and relevant organs at risk (OAR) were compared. The high dose PTV was divided into bone, air and tissue components and the comparison was performed for each of them. AXB Dw revealed no significant differences in the PTVs compared to AAA. Lower values were observed to spinal cord, brainstem, oral cavity and parotids (0.5% to 2.3%), and higher values to cochleas (up to 5.4%) and mandible (up to 6.7%). AXB Dm predicted lower values than AAA for all PTVs and OARs (2.0% to 6.1%). For the bone PTV subvolume, AXB Dw and Dm predicted respectively higher (2.4%) and lower (2.2% to 3.4%) values. No significant differences were noted in air. AXB predicted lower values than AAA in soft tissues (0.4% to 1.6%). The largest difference was found to the mandible V 60Gy parameter, with median differences of 6.7% for AXB Dw and −6.0% for AXB Dm. Significant dose differences are expected when switching from AAA to AXB in NPC cases. The dose prescriptions and the tolerance limits for some OARs, especially those of high density, may need to be adjusted depending on the selected dose calculation algorithm and reporting mode. [ABSTRACT FROM AUTHOR]

Purpose: A dosimetry evaluation model for treatment planning of esophageal radiation therapy is developed using a deep learning model. The model predicts dose volume histogram (DVH) from distance to target histogram (DTH) based on stacked de‐noise auto‐encoder (SDAE) and one‐dimensional convolutional network (1D‐CN). Method: First, SDAE is used to extract the features from the curves of DTH and DVH. Then 1D‐CN model is employed to learn the relationship between the features of DTH and DVH, and later used to predict the features of DVH from the features of DTH. Finally, the curve of DVH is restored from the features of DVH based on SDAE. Two hundred and seventy treatment plans are used for training 1D‐CN and another sixty‐three treatment plans are used for evaluating this model. This method is also compared with another two popular prediction methods based on support vector machine (SVM) and U‐net. Results: Based on the experimental result, the proposed model achieves the lowest dose endpoint error comparing to the other models. The average prediction error on planned target volume, left lung, right lung, heart, and spinal cord is 2.94% for the proposed model, while the average prediction errors are 6.79% and 3.41% for SVM and U‐net, respectively. Conclusions: A dosimetry evaluation method based on SDAE and 1D‐CN is developed in characterizing the correlation relationship between DTH and DVH of treatment plans. The results show that the model could be trained more efficiently in this framework and the DVH could be predicted with higher accuracy comparing to those existing methods. It provides a useful tool in supporting automated treatment planning of esophageal intensity‐modulated radiotherapy. [ABSTRACT FROM AUTHOR]

Deep learning algorithms have recently been developed that utilize patient anatomy and raw imaging information to predict radiation dose, as a means to increase treatment planning efficiency and improve radiotherapy plan quality. Current state-of-the-art techniques rely on convolutional neural networks (CNNs) that use pixel-to-pixel loss to update network parameters. However, stereotactic body radiotherapy (SBRT) dose is often heterogeneous, making it difficult to model using pixel-level loss. Generative adversarial networks (GANs) utilize adversarial learning that incorporates image-level loss and is better suited to learn from heterogeneous labels. However, GANs are difficult to train and rely on compromised architectures to facilitate convergence. This study suggests an attention-gated generative adversarial network (DoseGAN) to improve learning, increase model complexity, and reduce network redundancy by focusing on relevant anatomy. DoseGAN was compared to alternative state-of-the-art dose prediction algorithms using heterogeneity index, conformity index, and various dosimetric parameters. All algorithms were trained, validated, and tested using 141 prostate SBRT patients. DoseGAN was able to predict more realistic volumetric dosimetry compared to all other algorithms and achieved statistically significant improvement compared to all alternative algorithms for the V100 and V120 of the PTV, V60 of the rectum, and heterogeneity index. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the dosimetric impact of magnetic (B) field on varying air cavities in rectum patients treated on the hybrid 1.5 T MR‐linac. Methods: Artificial air cavities of varying diameters (0.0, 1.0, 1.5, 2.0, 2.5, 3.0, and 5.0 cm) were created for four rectum patients (two prone and two supine). A total of 56 plans using a 7 MV flattening filter‐free beam were generated with and without B‐field. Reference intensity‐modulated radiation therapy treatment plans without air cavity in the presence and absence of B‐field were generated to a total dose of 45/50 Gy. The reference plans were copied and recalculated for the varying air cavities. D95(PTV45–PTV50), D95(PTV50–aircavity), V50(PTV50–aircavity), Dmax(PTV50–aircavity), and V110%(PTV50–aircavity) were extracted for each patient. Annulus rings of 1‐mm‐diameter step size were generated for one of the air cavity plans (3.0 cm) for all four patients to determine Dmax (%) and V110% (cc) within each annulus. Results: In the presence of B‐field, hot spots at the cavity interface start to become visible at ~1 cm air cavity in both supine and prone positioning due to electron return effect (ERE). In the presence of B‐field Dmax and V110% varied from 5523 ± 49 cGy and 0.09 ± 0.16 cc for 0 cm air cavity size to 6050 ± 109 cGy and 11.6 ± 6.7 cc for 5 cm air cavity size. The hot spots were located within 3 mm inside the rectal‐air interface, where Dmax increased from 110.4 ± 0.5% without B‐field to 119.2 ± 0.8 % with B‐field. Conclusions: Air cavities inside rectum affects rectum plan dosimetry due ERE. Location and magnitude of hot spots are dependent on the size of the air cavity. [ABSTRACT FROM AUTHOR]

Background: An accurate and fast radiation dose calculations method is the main part of treatment planning for successful radiation therapy. Objective: This work aimed to create a novel GPU-based fast Monte Carlo Photon Dose Code (MCPDC) as a fast and accurate tool in dose calculation for radiotherapy treatment planning. Materials and Methods: In this analytical study, MCDPC was written to implement photon MC simulation for energies 0.01 to 20 MeV and run on an NVIDIA GTX970. The code was validated using DOSXYZnrc results and experimental measurements, performed by a Mapcheck dosimeter. Using the innovative definition of photon and electron interactions, mean calculation time for the MCPDC was 5.4 sec for 5e7 source particle history, significantly less than that of DOSXYZnrc which was 400 min. Results: Considering the simulations in the anthropomorphic phantom with bone and lung inhomogeneity, more than 96.1% of all significant voxels passed the gamma criteria of 3%-3 mm. Compared to the experimental dosimetry results, 97.6% or more of all significant voxels passed the acceptable clinical gamma index of 3%-3 mm. Conclusion: Very fast calculation speed and high accuracy in dose calculation may allow the MCPDC to be used in radiotherapy as a central component of a treatment plan verification system and also as the dose calculation engine for MC-based planning. MCPDC is currently being developed for electron dose calculation module and graphic user interface. In addition, future work on the applicability of the improved version of the MCPDC in transit dosimetry of megavoltage CT is in process. [ABSTRACT FROM AUTHOR]

Circular discs of diameter 5 mm were made from three indigenously developed optically stimulated luminescent (OSL) phosphors for medical dosimetry. Dosimetric characteristics of these discs were evaluated for their use in machine and patient-specific dosimetry in radiotherapy. Uncertainty in dosimetric measurements using these discs was also estimated, and combined standard uncertainty in measurement of absorbed dose was found to be 3.34%. Characterisation studies indicate that OSL discs are suitable for dosimetric application in radiotherapy. These discs were also used for patient-specific dosimetry in conventional and conformal radiotherapy treatments (five different cases) vis-à-vis ionisation chamber and Gafchromic EBT3 film. Doses measured by OSL discs were found comparable to ionisation chamber and Gafchromic EBT3 film measured values and radiotherapy treatment planning system (TPS) calculated dose values in all the cases. The variation between TPS calculated dose values and OSL discs measured dose values was found within the measurement uncertainty. [ABSTRACT FROM AUTHOR]

To evaluate the performance of 2 methods predicting liver dosimetric indices for hepatocellular cancer patients treated with intensity modulated radiation therapy (IMRT). Two predicting methods were implemented to build correlation between geometric and dosimetric information of hepatocellular cancer IMRT plans. One method used Principle Component Analysis method to simplify information and Support Vector Machine (SVM) regression method to build correlation. The other method used a simple linear function to map volumes of certain regions to dosimetic indices. Thirty eight hepatocellular cancer IMRT plans were randomly selected to train the 2 methods. The effectiveness of the 2 methods was validated using another 8 plans. Liver dosimetric indices V 10 , V 20 , V 30 , and mean dose of the 8 plans in validation cohort were calculated using the predicting methods. The predicted indices were compared with the indices derived from the clinically accepted treatment plans. The absolute differences of V 10 calculated with the SVM method and the actual values of treatment plans had a mean value of 7.87%. And the values for V 20 , V 30 , and mean dose were 4.37%, 4.41%, and 4.20%, respectively. The absolute differences of V 10 calculated with the linear formulation method and the actual values of treatment plans had a mean value of 6.09%. And the values for V 20 , V 30 , and mean dose were 5.28%, 5.05%, and 5.92%, respectively. These 2 methods have similar accuracy in predicting dosimetric indices V 10 , V 20 , V 30 of livers. The predicting of V 30 and V 20 is more accurate than the predicting of V 10. The SVM method is more accurate in predicting mean liver dose. [ABSTRACT FROM AUTHOR]

Dosimetry comparison studies of radiotherapy treatment planning are common, but often their limitations are not fully acknowledged. Useful data for the community may be produced, which is reproducible and reliable for implementation by others. However, this will only be achieved by clear and detailed reporting, and by consideration of delivered doses and clinical significance. [ABSTRACT FROM AUTHOR]

In radiotherapy, dosimetry tools are needed to record and verify complex 3-D dose distributions. A novel composition of polymer gel dosimeter based on radiation-induced polymerization of N-(3-methoxypropyl) acrylamide (NMPA) is presented and studied as a 3-D dose verification quality assurance tool (QA) in radiotherapy treatment planning. A 160 mm diameter crystal glass round bottom flask (CrystalBall) containing NMPA gel was used as a phantom. The gel was irradiated by a CyberKnife robotic radiotherapy system and scanned optically with a red light source using an optical computed tomography OCT scanner with sub-millimeter spatial resolution. Additionally, a commercial polymer gel dosimeter of BANG-GEL-QA™ was irradiated and scanned to compare its performance with that of the novel gel dosimeter. The dose distributions of a CyberKnife robotic SRS/SBRT treatment planning system (TPS) for a patient with brain metastasis were compared to the measurements of both polymers using 2-D and 3-D gamma analysis with a criteria of 5% dose difference and 2 mm distance-to-agreement. A gamma pass rate of 95% was calculated within a diameter of at least 32 mm for the 2-D and 3-D gamma analysis of both polymer gels. This suggests that the novel NMPA polymer dosimeter can provide an accurate 3-D verification of complex dose distribution in SRS/SBRT radiotherapy treatments. This study demonstrates that the newly developed CrystalBall NMPA phantom can provide a promising 3-D quality assurance tool for radiation therapy. • Novel 3-D N-(3-methoxypropyl)acrylamide polymer gel dosimeter was introduced. • CrystalBall NMPA gel phantom has been studied using optical CT scanner. • Excellent 3-D QA dose distribution verification was implemented. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this work was to compare the dosimetry and delivery times of 3D‐conformal (3DCRT)‐, volumetric modulated arc therapy (VMAT)‐, and tomotherapy‐based approaches for spatially fractionated radiation therapy for deep tumor targets. Methods: Two virtual GRID phantoms were created consisting of 7 "target" cylinders (1‐cm diameter) aligned longitudinally along the tumor in a honey‐comb pattern, mimicking a conventional GRID block, with 2‐cm center‐to‐center spacing (GRID2 cm) and 3‐cm center‐to‐center spacing (GRID3 cm), all contained within a larger cylinder (8 and 10 cm in diameter for the GRID2 cm and GRID3 cm, respectively). In a single patient, a GRID3 cm structure was created within the gross tumor volume (GTV). Tomotherapy, VMAT (6 MV + 6 MV‐flattening‐filter‐free) and multi‐leaf collimator segment 3DCRT (6 MV) plans were created using commercially available software. Two tomotherapy plans were created with field widths (TOMO2.5 cm) 2.5 cm and (TOMO5 cm) 5 cm. Prescriptions for all plans were set to deliver a mean dose of 15 Gy to the GRID targets in one fraction. The mean dose to the GRID target and the heterogeneity of the dose distribution (peak‐to‐valley and peak‐to‐edge dose ratios) inside the GRID target were obtained. The volume of normal tissue receiving 7.5 Gy was determined. Results: The peak‐to‐valley ratios for GRID2 cm/GRID3 cm/Patient were 2.1/2.3/2.8, 1.7/1.5/2.8, 1.7/1.9/2.4, and 1.8/2.0/2.8 for the 3DCRT, VMAT, TOMO5 cm, and TOMO2.5 cm plans, respectively. The peak‐to‐edge ratios for GRID2 cm/GRID3 cm/Patient were 2.8/3.2/5.4, 2.1/1.8/5.4, 2.0/2.2/3.9, 2.1/2.7/5.2 and for the 3DCRT, VMAT, TOMO5 cm, and TOMO2.5 cm plans, respectively. The volume of normal tissue receiving 7.5 Gy was lowest in the TOMO2.5 cm plan (GRID2 cm/GRID3 cm/Patient = 54 cm3/19 cm3/10 cm3). The VMAT plans had the lowest delivery times (GRID2 cm/GRID3 cm/Patient = 17 min/8 min/9 min). Conclusion: Our results present, for the first time, preliminary evidence comparing IMRT‐GRID approaches which result in high‐dose "islands" within a target, mimicking what is achieved with a conventional GRID block but without high‐dose "tail" regions outside of the target. These approaches differ modestly in their ability to achieve high peak‐to‐edge ratios and also differ in delivery times. [ABSTRACT FROM AUTHOR]

Objective: To compare 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) techniques on the target tissue and critical organ doses in terms of dosimetry, during treatment planning of patient's post-mastectomy radiotherapy (PMRT) to the left chest wall. Materials and Methods: Twenty breast cancer patients with left-sided post-mastectomy have selected for PMRT both 3D-CRT and IMRT techniques. Dosimetric calculation of dose simulation in Eclipse treatment planning system have been performed. Organs at risk with the maximum dose, minimum dose, mean dose, D95, conformity and homogeneity indexes and total monitor unit for the Planning Target Volume were compared in terms of the critical organ doses. Results: There was no significant difference between the two treatment planning techniques in terms of maximum, minimum, mean dose and heterogeneity index (p>0.05). At low doses, the dose received at the heart was significantly lower with the 3D-CRT technique, but there was no statistically significant difference between the two techniques at the maximum and average doses in the high dose regions. Conclusion: For PMRT to the left chest wall, IMRT significantly improves the conformity of plan and reduce the high-dose volumes of ipsilateral lung and heart compared to 3D-CRT, but 3D-CRT is superior in terms of low-dose volume. [ABSTRACT FROM AUTHOR]

In radiotherapy, dose distributions are obtained by using dose calculation algorithms that are implanted in treatment planning systems (TPS). This study aims to compare the surface doses of separate field sizes calculated by different version of The Analytical Anisotropic Algorithm (AAA) and measured by the parallel-plate ion chamber that is admitted as the most reliable dosimetry system for the surface region dose measurements. In order to measure the near surface dose, water equivalent solid phantom was used and measurements were made for 6MV photon beam at 100 cm source-detector distance for 5×5, 10×10, and 20×20 cm2 field sizes. AAA 8.9 and AAA 15.1 versions of the Varian Eclipse TPS were used for surface dose calculations by generating beams with separate field sizes. The doses were read by considering the effective buildup thickness of Markus parallel-plate ion chamber. The surface doses using 6 MV photon beams for 10×10 cm2 field size at 0.07 mm were found to be 11.04%, 26.25%, and 19.69% for AAA v8.9, AAA v15.1 and Markus chamber, respectively. It was seen that for both of the AAA versions and Markus parallel-plate ion chamber, increasing field sizes also increase surface dose. For all field sizes, surface dose was lowest by using AAA v8.9 at 0.07 mm. The different versions of the same TPS algorithms may calculate the surface doses distinctively. After upgrading of TPS algorithms, surface doses should be calculated and compared by measurements with different dosimetry systems to better understand their calculation behaviors in the near surface region. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study is to evaluate the performance of dose calculation algorithms used in radiotherapy treatment planning systems (TPSs) in comparison with Monte Carlo (MC) simulations in nonelectronic equilibrium conditions. MC simulations with PENELOPE package were performed for comparison of doses calculated by pencil beam convolution (PBC), analytical anisotropy algorithm (AAA), and Acuros XB TPS algorithms. Relative depth dose curves were calculated in heterogeneous water phantoms with layers of bone (1.8 g/cm3) and lung (0.3 g/cm3) equivalent materials for radiation fields between 1 × 1 cm2 and 10 × 10 cm2. Analysis of relative depth dose curves at the water-bone interface shows that PBC and AAA algorithms present the largest differences to MC calculations (u MC = 0.5%), with maximum differences of up to 4.3% of maximum dose. For the lung-equivalent material and 1 × 1 cm2 field, differences can be up to 24.3% for PBC, 11.5% for AAA, and 7.5% for Acuros. Results show that Acurus presents the best agreement with MC simulation data with equivalent accuracy for modeling radiotherapy dose deposition especially in regions where electronic equilibrium does not hold. For typical (nonsmall) fields used in radiotherapy, AAA and PBC can exhibit reasonable agreement with MC results even in regions of heterogeneities. [ABSTRACT FROM AUTHOR]

Abstract Acute skin toxicity in adjuvant breast radiation can be reduced with modern radiotherapy (RT) techniques. However, having reviewed the literature, we found no dosimetric constraint for acute skin toxicity that would be applicable to modern RT planning. This study aimed to identify dosimetric factors that are associated with higher rates of acute skin toxicity. A retrospective review was carried out including women who received adjuvant forward-planned intensity-modulated radiotherapy (IMRT) after breast-conserving surgery. Acute skin toxicity grade was prospectively recorded. A total of 131 patients were analyzed. On multivariate analysis, the V105% > 30 cc (p = 0.013) and the use of conventional fractionation (CF) (p = 0.001) were statistically significant for acute skin toxicity. On literature review, current quantitative dosimetric parameters that have shown statistical significance include a V107% > 3 cc in hypofractionation (HF), V107% > 9 cc in CF, treated volume 110% > 5.13%, and V107% > 28.6%. There is little evidence on the predictive value of clinically applicable dosimetric factors in acute skin toxicity. Given the recent improvements in RT planning, we would consider a V107% or a V110% too high a dosimetric value to be useful for the majority of patients. We have shown that a V105% of greater than 30 cc is significantly associated with acute skin toxicity, controlling for other variables. We suggest that this is currently the most useful modifiable parameter available to reduce skin toxicity and is applicable to modern RT planning. We also suggest that consideration be given to hypofractionated schedules to further reduce acute skin toxicity. [ABSTRACT FROM AUTHOR]

Abstract The objective of this study was to evaluate the procedures for patient-specific quality assurance measurements using modulated scanned and energy stacked beams for proton and carbon ion teletherapy. Delivery records from 1734 portal measurements were analyzed using a 3-point pass criteria: more than 22 of 24 chambers in a water phantom (WP) had to have a measured dose difference from the planned portal doses less than or equal to 3%, or the distance from the measurement point location to a point location in the plan having the same dose had to be less than or equal to 3 mm (distance to agreement [DTA]), and the mean dose deviation of all chambers had to be less than 3%. Stratification of results showed some associations between measurement parameters and pass rates. For proton portals, pass rates were high at all measurement depths, but for carbon ion portals, pass rates decreased as a function of increasing measurement depth. Pass rates of both proton and carbon ion portals with 1 WP were slightly lower than those with a second WP. The total pass rates were 97.7% and 91.9% for proton and carbon ion patient portals, respectively. In general, the measured doses exhibited good agreement with the treatment planning system (TPS) calculated doses. When the chamber position was deeper than 150 mm in carbon ion beams, a lower pass rate was observed, which may have been caused by ion chamber array setup uncertainty (lateral and depth) in highly modulated portals or incorrect modeling of scatter by the TPS. These deviations need further investigation. [ABSTRACT FROM AUTHOR]

Abstract Our study aimed to correlate the overall 3-dimensional (3-D) shape of the breast to the compensation depth to produce a homogeneous dose distribution using the electronic tissue compensation (ECOMP) treatment technique. The study involved creating a number of semioval water phantoms with the diameter of the larger axis representing the breast separation and the shorter axis representing the distance from the chest wall to the apex of the breast. Multiple plans with 2 tangential fields were created for each phantom using different transmission penetration depths (TPDs) to determine the optimum TPD value based on the evaluation of dose uniformity and maximum hot spot. Optimum TPD values from the semioval water phantom plans were plotted on a graph as a function of separation and radius and were used as guidelines to choose the optimum TPD for the breast patient's cases. A total of 10 patients who had been treated with radiation therapy using ECOMP tangential fields were randomly selected. The separation and the radius of the breast were measured for 3 regions (superior, middle, and inferior) to retrospectively determine the optimum TPD from the graph for each region. These TPD values were then used to plan the breast cases. For all the patients studied, the optimized TPD technique produced a lower average homogeneity index (HI) value of 0.658 than the standard ECOMP technique of 0.856. These results showed that optimized TPD technique produced a more homogeneous dose distribution than the standard ECOMP technique. By measuring the breast size based on breast separation and the chest wall-to-apex distance at different locations along the superior-inferior axis of the breast, the optimum TPD can be determined at each location to provide a homogeneous dose distribution. A module can be created within the planning system to automatically assign the optimum TPD for both tangential fields so uniform fluence maps can be achieved throughout the whole breast volume. This method can serve as a guideline in ECOMP during the treatment planning to obtain a homogeneous dose distribution. [ABSTRACT FROM AUTHOR]

Purpose: Few features characterizing the dosimetric properties of the patients are included in currently available dose‐volume histogram (DVH) prediction models, making it intractable to build a correlative relationship between the input and output parameters. Here, we use planning target volume (PTV)‐only treatment plans of the patients (i.e., the achievable dose distribution in the absence of organs‐at‐risk (OAR) constraints) to estimate the potentially achievable quality of treatment plans and establish a machine learning‐based DVH prediction framework with the use of the dosimetric metric as model input parameters. Methods: A support vector regression (SVR) approach was used as the backbone of our machine learning model. A database containing volumetric modulated arc therapy (VMAT) plans of 63 prostate cancer patients were used. For each patient, the PTV‐only plan was generated first. A correlative relationship between the OAR DVH of the PTV‐only plan (model input) and the corresponding DVH of the clinical treatment plan (CTP) (model output) was then established with the 53 training cases. The prediction model was tested by the validation cohort of ten cases. Results: For the training cohort, the checks of dosimetric endpoints (DEs) indicated that 52 of 53 plans (98%) were within the 10% error bound for bladder, and 45 of 53 plans (85%) were within the 10% error bound for rectum. In the validation tests, 92% and 96% of the DEs were within the 10% error bounds for bladder and rectum, respectively, and eight of ten validation plans (80%) were within the 10% error bound for both the bladder and rectum. The sum of absolute residuals (SAR) achieved a mean of 0.034 ± 0.028 and 0.046 ± 0.021 for the bladder and rectum, respectively. Conclusions: A novel dosimetric features‐driven machine learning model with the use of PTV‐only plan has been established for DVH prediction. The framework is capable of efficiently generating best achievable DVHs for VMAT planning. [ABSTRACT FROM AUTHOR]

TomoDirect has been reported to have some advantages over TomoHelical in delivering total body irradiation (TBI). This study aimed to investigate the relationships between the number of ports and the dose evaluation indices in low‐dose TBI in TomoDirect mode using 2–12 ports and to compare these data with those for the TomoHelical mode in a simulation study. Thirteen patients underwent low‐dose TBI in TomoHelical mode from June 2015 to June 2016. We used the same computed tomography data sets for these patients to create new treatment plans for upper‐body parts using TomoDirect mode with 2–12 beam angles as well as TomoHelical mode. The prescription was 4 Gy in two equal fractions. For the TomoDirect data, we generated plans with 2–12 ports with approximately equally spaced angles; the modulation factor, field width, and pitch were 2.0, 5.0 cm, and 0.500, respectively. For the TomoHelical plans, the modulation factor, field width, and pitch were 2.0, 5.0 cm, and 0.397, respectively. D2, D98, D50, and the homogeneity index (HI) were evaluated to compare TomoDirect plans having 2–12 ports with the TomoHelical plan. Using TomoDirect plans, D2 with four ports or fewer, D98 with 10 ports or fewer, D50 with four ports or fewer and HI with five ports or fewer showed statistically significantly worse results than the TomoHelical plan. With the TomoDirect plans, D2 with seven ports or more, D50 with eight ports or more, and HI with eight ports or more showed statistically significant improvement compared with the TomoHelical plan. All of the dose evaluation indices of the TomoDirect plans showed a tendency to improve as the number of ports increased. TomoDirect plans showed statistically significant improvement of D2, D50, and HI compared with the TomoHelical plan. Therefore, we conclude that TomoDirect can provide better dose distribution in low‐dose TBI with TomoTherapy. [ABSTRACT FROM AUTHOR]

Despite the improvements in the dose calculation models of the commercial treatment planning systems (TPS), their ability to accurately predict patient dose is still limited. One of the limitations is caused by the simplified model of the multileaf collimator (MLC). The aim of this study was to develop a Monte Carlo (MC) method‐based independent patient dose validation system with an elaborate MLC model for more accurate dose evaluation. Varian Clinac 2300 IX was simulated using Geant4 toolkits, after which MC commissioning with measurements was performed to validate the simulation model. A DICOM‐RT interface was developed to obtain the beam delivery conditions including the hundreds of MLC motions. Finally, the TPS dose distributions were compared with the MC dose distributions for water phantom cases and a patient case. Our results show that the TPS overestimated the absolute abutting leakage dose in the closed MLC field, with about 20% more of the maximum dose than that of the MC calculation. For water phantom cases, the dose distributions inside the target region were almost identical with the dose difference of less than 2%, while the dose near the edge of the target shows difference about 10% between Geant4 and TPS due to geometrical differences in MLC model. For the patient analysis, the Geant4 and TPS doses of all organs were matched well within 1.4% of the prescribed dose. However, for organs located in areas with high ratio of leaf pairs with distances less than 10 mm leaf pair (LP(<10mm)), the maximum dose of TPS was overestimated by about 3% of the prescribed dose. These dose comparison results demonstrate that our system for calculating the patient dose is quite accurate. Furthermore, if the MLC sequences in treatment plan have a large ratio of LP(short), more than 3% dose difference in normal tissue could be seen. [ABSTRACT FROM AUTHOR]

Purpose: MRI‐based treatment planning is a promising technique for liver stereotactic‐body radiation therapy (SBRT) treatment planning to improve target volume delineation and reduce radiation dose to normal tissues. MR geometric distortion, however, is a source of potential error in MRI‐based treatment planning. The aim of this study is to investigate dosimetric uncertainties caused by MRI geometric distortion in MRI‐based treatment planning for liver SBRT. Materials and Methods: The study was conducted using computer simulations. 3D MR geometric distortion was simulated using measured data in the literature. Planning MR images with distortions were generated by integrating the simulated 3D MR geometric distortion onto planning CT images. MRI‐based treatment plans were then generated on the planning MR images with two dose calculation methods: (1) using original CT numbers; and (2) using organ‐specific assigned CT numbers. Dosimetric uncertainties of various dose‐volume‐histogram parameters were determined as their differences between the simulated MRI‐based plans and the original clinical CT‐based plans for five liver SBRT cases. Results: The average simulated distortion for the five liver SBRT cases was 2.77 mm. In the case of using original CT numbers for dose calculation, the average dose uncertainties for target volumes and critical structures were <0.5 Gy, and the average target volume percentage at prescription dose uncertainties was 0.97%. In the case of using assigned CT numbers, the average dose uncertainties for target volumes and critical structures were <1.0 Gy, and the average target volume percentage at prescription dose uncertainties was 2.02%. Conclusions: Dosimetric uncertainties caused by MR geometric distortion in MRI‐based liver SBRT treatment planning was generally small (<1 Gy) when the distortion is 3 mm. [ABSTRACT FROM AUTHOR]

Purpose: A fast‐rotating O‐ring dedicated intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) delivery system, the Halcyon, is delivered by default with a fully preconfigured photon beam model in the treatment planning system (TPS). This work reports on the validation and achieved IMRT/VMAT delivery quality on the system. Methods: Acceptance testing followed the vendor's installation product acceptance and was supplemented with mechanical QA. The dosimetric calibration was performed according to the IAEA TRS‐398 code‐of‐practice, delivering 600 cGy/min at 10 cm depth, a 90 cm source‐surface distance, and a 10 × 10 cm² field size. The output factors, multileaf collimator (MLC) transmission and dosimetric leaf gap (DLG) were validated by comparing measurements with the modeled values in the TPS. Validation of IMRT/VMAT was conducted following AAPM reports (MPPG 5.a, TG‐119). Next, dose measurements were performed for end‐to‐end (E2E) checks in heterogeneous anthropomorphic phantoms using radiochromic film in multiple planes and using ionization chambers (IC) point measurements. E2E checks were performed for VMAT (cranial, rectum, spine, and head and neck) and IMRT (lung). Additionally, IROC Houston mailed dosimetry audits were performed for the beam calibration and E2E measurements using a thorax phantom (IMRT) and a head and neck phantom (VMAT). Lastly, extensive patient‐specific QA was performed for the first patients of each new indication, 26 in total (nrectum = 2, nspine = 5, nlung = 5, nesophagus = 2, nhead and neck = 7, ncranial = 5), treated on the fast‐rotating O‐ring linac. The patient‐specific QA followed the AAPM TG‐218 guidelines and comprised of portal dosimetry, ArcCHECK diode array, radiochromic film dosimetry in a MultiCube phantom, and IC point measurements. Results: The measured output factors showed an agreement <1% for fields ≥3 × 3 cm². Field sizes ≤2 × 2 cm² had a difference of <2%. The measured single‐layer MLC transmission was 0.42 ± 0.01% and the measured DLG was 0.27 ± 0.22 mm. The AAPM MPPG 5.a measurements were fully compliant with the guideline criteria. Dose differences larger than 2% were found for the PDD at large depths (>25 cm). TG‐119's confidence limits were achieved for the VMAT point dose measurements and for both the IMRT and VMAT radiochromic film measurements. The TG‐119 confidence limits were not achieved for IMRT point dose measurements in both the target (5.9%) and the avoidance structure (6.4%). All E2E tests had point differences below 2.3% and gamma agreement scores above 90.6%. The IROC beam calibration audit showed agreement of <1%. The IROC lung IMRT audit and head and neck VMAT audit had results compliant with the IROC Houston's credentialing criteria. All IMRT and VMAT plans selected for patient‐specific QA were within the action limits suggested by TG‐218. Conclusions: The fast‐rotating O‐ring linac and its preconfigured TPS are compliant with the international commissioning criteria of AAPM MPPG 5.a and AAPM TG‐119. E2E measurements on heterogeneous anthropomorphic phantoms were within clinically acceptable tolerances. IROC Houston's audits satisfied the credentialing criteria. This work comprises the first extensive dataset reporting on the preconfigured fast‐rotating O‐ring linac. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the dose calculation accuracy in the Prowess Panther treatment planning system (TPS) using the collapsed cone convolution (CCC) algorithm. METHODS: The BEAMnrc Monte Carlo (MC) package was used to predict the dose distribution of photon beams produced by the Oncor® linear accelerator (linac). The MC model of an 18 MV photon beam was verified by measurement using a p-type diode dosimeter. Percent depth dose (PDD) and dose profiles were used for comparison based on three field sizes: 5×5, 10×10, and 20×20cm2. The accuracy of the CCC dosimetry was also evaluated using a plan composed of a simple parallel-opposed field (11×16cm2) in a lung phantom comprised of four tissue simulating media namely, lung, soft tissue, bone and spinal cord. The CCC dose calculation accuracy was evaluated by MC simulation and measurements according to the dose difference and 3D gamma analysis. Gamma analysis was carried out through comparison of the Monte Carlo simulation and the TPS calculated dose. RESULTS: Compared to the dosimetric results measured by the Farmer chamber, the CCC algorithm underestimated dose in the planning target volume (PTV), right lung and lung-tissue interface regions by about –0.11%, –1.6 %, and –2.9%, respectively. Moreover, the CCC algorithm underestimated the dose at the PTV, right lung and lung-tissue interface regions in the order of –0.34%, –0.4% and –3.5%, respectively, when compared to the MC simulation. Gamma analysis results showed that the passing rates within the PTV and heterogeneous region were above 59% and 76%. For the right lung and spinal cord, the passing rates were above 80% for all gamma criteria. CONCLUSIONS: This study demonstrates that the CCC algorithm has potential to calculate dose with sufficient accuracy for 3D conformal radiotherapy within the thorax where a significant amount of tissue heterogeneity exists. [ABSTRACT FROM AUTHOR]

Accurate beam modeling is essential to help ensure overall accuracy in the radiotherapy process. This study describes our experience with beam model validation of a Monaco treatment planning system on a Versa HD linear accelerator. Data were collected such that Monaco beam models could be generated using three algorithms: collapsed cone (CC) and photon Monte Carlo (MC) for photon beams, and electron Monte Carlo (eMC) for electron beams. Validations are performed on measured percent depth doses (PDDs) and profiles, for open‐field point‐doses in homogenous and heterogeneous media, and for obliquely incident electron beams. Gamma analysis is used to assess the agreement between calculation and measurement for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans, including volumetric modulated arc therapy for stereotactic body radiation therapy (VMAT SBRT). For all relevant conditions, gamma index values below 1 are obtained when comparing Monaco calculated PDDs and profiles with measured data. Point‐doses in a water medium are found to be within 2% agreement of commissioning data in 99.5% and 98.6% of the points computed by MC and CC, respectively. All point‐dose calculations for the eMC algorithm in water are within 4% agreement of measurement, and 92% of measurements are within 3%. In heterogeneous media of air and cortical bone, both CC and MC yielded better than 3% agreement with ion chamber measurements. eMC yielded 3% agreement to measurement downstream of air with oblique beams of up to 27°, 5% agreement distal to bone, and within 4% agreement at extended source to surface distance (SSD) for all electron energies except 6 MeV. The 6‐MeV point of measurement is on a steep dose gradient which may impact the magnitude of discrepancy measured. The average gamma passing rate for IMRT/VMAT plans is 96.9% (±2.1%) and 98.0% (±1.9%) for VMAT SBRT when evaluated using 3%/2 mm criteria. Monaco beam models for the Versa HD linac were successfully commissioned for clinical use. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this work was to evaluate the use of an angularly independent silicon detector (edgeless diodes) developed for dosimetry in megavoltage radiotherapy for Cyberknife in a phantom and for patient quality assurance (QA). Method: The characterization of the edgeless diodes has been performed on Cyberknife with fixed and IRIS collimators. The edgeless diode probes were tested in terms of basic QA parameters such as measurements of tissue‐phantom ratio (TPR), output factor and off‐axis ratio. The measurements were performed in both water and water‐equivalent phantoms. In addition, three patient‐specific plans have been delivered to a lung phantom with and without motion and dose measurements have been performed to verify the ability of the diodes to work as patient‐specific QA devices. The data obtained by the edgeless diodes have been compared to PTW 60016, SN edge, PinPoint ionization chamber, Gafchromic EBT3 film, and treatment planning system (TPS). Results: The TPR measurement performed by the edgeless diodes show agreement within 2.2% with data obtained with PTW 60016 diode for all the field sizes. Output factor agrees within 2.6% with that measured by SN EDGE diodes corrected for their field size dependence. The beam profiles' measurements of edgeless diodes match SN EDGE diodes with a measured full width half maximum (FWHM) within 2.3% and penumbra widths within 0.148 mm. Patient‐specific QA measurements demonstrate an agreement within 4.72% in comparison with TPS. Conclusion: The edgeless diodes have been proved to be an excellent candidate for machine and patient QA for Cyberknife reproducing commercial dosimetry device measurements without need of angular dependence corrections. However, further investigation is required to evaluate the effect of their dose rate dependence on complex brain cancer dose verification. [ABSTRACT FROM AUTHOR]

For safety and radioprotection reasons in radiotherapy treatment, the exit dose is evaluated with irradiation field size and photon beam energy. The objective of this study is to introduce an empirical law for predicting the delivered dose at the other side of patient while radiotherapy treatment of cancer. In this study, the exit dose is the delivered dose out of the phantom on beam central axis. The measurements of percentage depth dose were done as a function of irradiation field size with an uncertainty of 2 % as recommended by IAEA protocols for two photon beam energies 6 and 18 MV. For high radioprotection quality inside radiotherapy department, an empirical law is elaborated with a reliability of 97 %. Thereafter, it consists a basic law that should be used theoretically to know the delivered dose variation with field size at the exit dose point for knowing the behavior of dose outside of radiotherapy treatment region. The medical physicists and physicians should take this law in radiotherapy treatment of the cancer. [ABSTRACT FROM AUTHOR]

Purpose: Peptide receptor radionuclide therapy (PRRT) with 90Y-labelled and 177Lu-labelled peptides is an effective strategy for the treatment of metastatic/nonresectable neuroendocrine tumours (NETs). Dosimetry provides important information useful for optimizing PRRT with individualized regimens to reduce toxicity and increase tumour responses. However, this strategy is not applied in routine clinical practice, despite the fact that several dosimetric studies have demonstrated significant dose-effect correlations for normal organ toxicity and tumour response that can better guide therapy planning. The present study reviews the key relationships and the radiobiological models available in the literature with the aim of providing evidence that optimization of PRRT is feasible through the implementation of dosimetry.Methods: The MEDLINE database was searched combining specific keywords. Original studies published in the English language reporting dose-effect outcomes in patients treated with PRRT were chosen.Results: Nine of 126 studies were selected from PubMed, and a further five were added manually, reporting on 590 patients. The studies were analysed and are discussed in terms of weak and strong elements of correlations.Conclusion: Several studies provided evidence of clinical benefit from the implementation of dosimetry in PRRT, indicating the potential contribution of this approach to reducing severe toxicity and/or reducing undertreatment that commonly occurs. Prospective trials, possibly multicentre, with larger numbers of patients undergoing quantitative dosimetry and with standardized methodologies should be carried out to definitively provide robust predictive paradigms to establish effective tailored PRRT. [ABSTRACT FROM AUTHOR]