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Combining external beam radiation therapy (EBRT) and prostate seed implant (PSI) is efficacious in treating intermediate- and high-risk prostate cancer at the cost of increased genitourinary toxicity. Accurate combined dosimetry remains elusive due to lack of registration between treatment plans and different biological effect. The current work proposes a method to convert physical dose to biological effective dose (BED) and spatially register the dose distributions for more accurate combined dosimetry. A PSI phantom was CT scanned with and without seeds under rigid and deformed transformations. The resulting CTs were registered using image-based rigid registration (RI), fiducial-based rigid registration (RF), or b-spline deformable image registration (DIR) to determine which was most accurate. Physical EBRT and PSI dose distributions from a sample of 91 previously-treated combined-modality prostate cancer patients were converted to BED and registered using RI, RF, and DIR. Forty-eight (48) previously-treated patients whose PSI occurred before EBRT were included as a "control" group due to inherent registration. Dose-volume histogram (DVH) parameters were compared for RI, RF, DIR, DICOM, and scalar addition of DVH parameters using ANOVA or independent Student's t tests (α = 0.05). In the phantom study, DIR was the most accurate registration algorithm, especially in the case of deformation. In the patient study, dosimetry from RI was significantly different than the other registration algorithms, including the control group. Dosimetry from RF and DIR were not significantly different from the control group or each other. Combined dosimetry with BED and image registration is feasible. Future work will utilize this method to correlate dosimetry with clinical outcomes. [ABSTRACT FROM AUTHOR]

The SARS‐CoV‐2 coronavirus pandemic has spread around the world including the United States. New York State has been hardest hit by the virus with over 380 000 citizens with confirmed COVID‐19, the illness associated with the SARS‐CoV‐2 virus. At our institution, the medical physics and dosimetry group developed a pandemic preparedness plan to ensure continued operation of our service. Actions taken included launching remote access to clinical systems for all dosimetrists and physicists, establishing lines of communication among staff members, and altering coverage schedules to limit on‐site presence and decrease risk of infection. The preparedness plan was activated March 23, 2020, and data were collected on treatment planning and chart checking efficiency for 6 weeks. External beam patient load decreased by 25% during the COVID‐19 crisis, and special procedures were almost entirely eliminated excepting urgent stereotactic radiosurgery or brachytherapy. Efficiency of treatment planning and chart checking was slightly better than a comparable 6‐week interval in 2019. This is most likely due to decreased patient load: Fewer plans to generate and more physicists available for checking without special procedure coverage. Physicists and dosimetrists completed a survey about their experience during the crisis and responded positively about the preparedness plan and their altered work arrangements, though technical problems and connectivity issues made the transition to remote work difficult. Overall, the medical physics and dosimetry group successfully maintained high‐quality, efficient care while minimizing risk to the staff by minimizing on‐site presence. Currently, the number of COVID‐19 cases in our area is decreasing, but the preparedness plan has demonstrated efficacy, and we will be ready to activate the plan should COVID‐19 return or an unknown virus manifest in the future. [ABSTRACT FROM AUTHOR]

This study examined the relationship of achievable mean dose and percent volumetric overlap of salivary gland with the planning target volume (PTV) in volumetric-modulated arc therapy (VMAT) plan in radiotherapy for a patient with head-and-neck cancer. The aim was to develop a model to predict the viability of planning objectives for both PTV coverage and organs-at-risk (OAR) sparing based on overlap volumes between PTVs and OARs, before the planning process. Forty patients with head-and-neck cancer were selected for this retrospective plan analysis. The patients were treated using 6 MV photons with 2-arc VMAT plan in prescriptions with simultaneous integrated boost in dose of 70 Gy, 63 Gy, and 58.1 Gy to primary tumor sites, high-risk nodal regions, and low-risk nodal regions, respectively, over 35 fractions. A VMAT plan was generated using Varian Eclipse (V13.6), in optimization with biological-based generalized equivalent uniform dose (gEUD) objective for OARs and targets. Target dose coverage (D95, Dmax, conformity index) and salivary gland dose (Dmean and Dmax) were evaluated in those plans. With a range of volume overlaps between salivary glands and PTVs and dose constraints applied, results showed that dose D95 for each PTV was adequate to satisfy D95 >95% of the prescription. Mean dose to parotid <26 Gy could be achieved with <20% volumetric overlap with PTV58 (parotid-PTV58). On an average, the Dmean was seen at 15.6 Gy, 21.1 Gy, and 24.2 Gy for the parotid-PTV58 volume at <5%, <10%, and <20%, respectively. For submandibular glands (SMGs), an average Dmean of 27.6 Gy was achieved in patients having <10% overlap with PTV58, and 36.1 Gy when <20% overlap. Mean doses on parotid and SMG were linearly correlated with overlap volume (regression R2 = 0.95 and 0.98, respectively), which were statistically significant (P < 0.0001). This linear relationship suggests that the assessment of the structural overlap might provide prospective for achievable planning objectives in the head-and-neck plan. [ABSTRACT FROM AUTHOR]

Optically stimulated luminescent dosimeters (OSLDs) are used in clinical radiation dosimetry, but their sensitivity changes with the accumulated dose, limiting their reusability. Different studies have reported inconsistent results regarding the changes in sensitivity at different accumulated doses, and the reasons for this inconsistency remain unclear. In addition, the extent to which the OSLD linearity and element sensitivity correction factor (k s , i ) change with the accumulated dose has not been well established. We sought to characterize how the individual k s , i and dose non-linearity correction factor (k L) change with accumulated dose and how such changes affect the measurement of the dose to water (D w). Determining the extent to which these parameters change with the accumulated dose can help clinics, institutions, and the Imaging and Radiation Oncology Core (IROC) at MD Anderson extend the OSLD accumulated dose limit above 10 Gy and thus increase the efficiency of use of these detectors, including for the remote audit output audits run by IROC for the National Clinical Trials Network. 95 nanoDot OSLDs were individually irradiated in 4-Gy cycles with 90 cGy used to determine sensitivity, irradiated between 0.25- to 3-Gy to determine linearity, and then irradiated to return all dosimeters to the same total dose history. Repeated measurements between 10 and 23 Gy were performed with the same batch (N = 129) and with a different batch (batch 2, N = 130). Dosimeters were read with a microSTARii system 5–8 h following each irradiation, and each OSLD was bleached for 24 h in the IROC bleaching box prior to every irradiation. A combination of single-factor ANOVA, Levene tests, and linear regressions was used to quantify changes in OSLD characteristics as a function of accumulated dose. The D w was calculated using Equation (1)in the American Association of Physicists in Medicine Task Group 191 report. The signal response of the OSLDs showed stability within 1% up to an accumulated dose of 23 Gy before decreasing with dose. The k s , i remained the same, while linearity changed with accumulated dose but did so in a linear and predictable manner. Our findings improve our understanding of accumulated dose and could help improve overall process efficiency by extending the reusability of OSLDs. • Systematically evaluated how TG-191 factors change with accumulated dose. • Dose-nonlinearity correction factor changes linearly with accumulated dose. • No change in element sensitivity correction factor with accumulated dose. • OSLDs can be used up to 23 Gy with the irradiation and bleaching scheme at IROC. • OSLDs can be reused to higher dose limits with well characterized factors. [ABSTRACT FROM AUTHOR]