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Iso-dose maps creation and kerma-area products calculation are important procedures in radiotherapy and medical imaging. In this work, a method is presented to obtain iso-dose maps through digital processing of the images obtained from radiochromic films, which are employed to estimate the dose absorbed by the patient. The kerma-area product in selected regions of interest (ROIs) in the iso-dose map was then evaluated. The images were obtained by scanning the irradiated films using a commercial flatbed scanner. The iso-dose areas were extracted by means of an image segmentation algorithm, while calibration for a particular film to obtain a sensitometric curve relating dose to film darkening, was also made. A software interface allowed introducing the scanned image for the estimation of kerma-area products by defining the ROI interactively. The methods developed in this work allowed to implement a software application to obtain the iso-dose maps and kerma-area product in selected ROIs. [ABSTRACT FROM AUTHOR]

Background: Herein, the authors evaluated how the time to testosterone rebound (TTR) after radiotherapy (RT) and 6 months of androgen deprivation therapy (ADT) impacted the risk of prostate cancer-specific mortality (PCSM) and cardiovascular-specific mortality (CVM) among men with varying comorbidity extent.Methods: Between 1995 and 2001, a total of 206 men who were randomized to receive RT either alone or with 6 months of ADT for unfavorable-risk PC and who had a comorbidity score assigned using the Adult Comorbidity Evaluation 27 metric comprised the study cohort. Multivariable competing risk regression was used to evaluate the impact of and possible interaction between comorbidity and TTR on PCSM and CVM.Results: After a median follow-up of 18.19 years, 30 men (18.6%), 39 men (24.2%), and 92 men (57.1%), respectively, had died of PC, CV disease, or other causes. As TTR increased, PCSM significantly decreased in men with no or minimal (adjusted hazard ratio [AHR], 0.53, 95% confidence interval [95% CI], 0.34-0.84 [P =.007]) and moderate to severe (AHR, 0.37; 95% CI, 0.14-0.99 [P = .048]) comorbidity. However, increasing TTR significantly increased the risk of CVM among men with moderate to severe comorbidity (AHR, 1.87; 95% CI, 1.40-2.49 [P <.001]), but not those with no or minimal comorbidity (AHR, 0.86; 95% CI, 0.57-1.29 [P =.46]), leading to a significant interaction between TTR and comorbidity (P = .001).Conclusions: The results of the current study indicate that considering an intermittent course of ADT such that the TTR approaches 18 months, instead of continuous long-term administration of ADT, in men with moderate to severe comorbidity and high-risk PC may reduce the increased risk of CVM without increasing the risk of PCSM. Cancer 2018;124:1391-9. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Osteoradionecrosis is defined as bone death secondary to radiotherapy. There is a relationship between the radiation dose received and the occurrence of osteoradionecrosis of the jaws, with the risk increasing above a dose of 60 Gy. In cases of class III mandibular osteoradionecrosis, a segmental resection can be indicated. Current practice is to completely remove the affected bone up to the point where the bone looks healthy and is bleeding. Exact resection planning and the use of guided surgery based on imaging of the bone changes have not been reported so far. This article describes a method whereby the radiotherapy dose information is incorporated into the imaging of the affected bone in order to plan a three-dimensional (3D) virtual guided resection and reconstruction of the mandible in osteoradionecrosis. The method enables 3D visualization of each desired dose field in relation to the 3D model of the affected bone. Two types of application – for resection and reconstruction – are described. [ABSTRACT FROM AUTHOR]

Background: To identify optimization of dose distributions of target volumes and decrease of radiation doses to normal tissues during stereotactic body radiation therapy (SBRT) for pancreatic cancer with dose-limiting auto-shells.Methods: With the same prescription dose, dose constraints of normal organs and calculation algorithm, treatment plans of each eligible patient were re-generated with 3 shells, 5 shells and 7 shells, respectively. The prescription isodose line and beam number of each patient in 3-shell, 5-shell and 7-shell plan remained the same. Hence, a triplet data set of dosimetric parameters was generated and analyzed.Results: As the increase of shell number, the conformal index, volumes encompassed by 100% prescription isodose line and 30% prescription isodose line significantly decreased. The new conformal index was higher in 3-shell group than that in 5-shell and 7-shell group. A sharper dose fall-off was found in 5-shell and 7-shell group compared to 3-shell group. And the tumor coverage in 7-shell was better than that of 3-shell and 5-shell. Lower D5cc of the intestine, D10cc of the stomach, Dmax of the spinal cord and smaller V10 of the spleen was confirmed in 7-shell group compared to 3-shell group.Conclusions: More conformal dose distributions of target volumes and lower radiation doses to normal organs could be performed with the increase of dose-limiting auto-shells, which may be more beneficial to potential critical organs without established dose constraints. [ABSTRACT FROM AUTHOR]

Background: Spontaneous cervical artery dissection (sCAD) is an important etiology of juvenile stroke. The gold standard for the diagnosis of sCAD is convential angiography. However, magnetic resonance imaging (MRI)/MR angiography (MRA) and computed tomography (CT)/CT angiography (CTA) are frequently used alternatives. New developments such as multislice CT/CTA have enabled routine acquisition of thinner sections with rapid imaging times. The goal of this study was to compare the capability of recent developed 128-slice CT/CTA to MRI/MRA to detect radiologic features of sCAD.Methods: Retrospective review of patients with suspected sCAD (n = 188) in a database of our Stroke center (2008-2014), who underwent CT/CTA and MRI/MRA on initial clinical work-up. A control group of 26 patients was added. All Images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two modalities.Results: Forty patients with 43 dissected arteries received both modalities (29 internal carotid arteries [ICAs] and 14 vertebral arteries [VAs]). All CADs were identified in CT/CTA and MRI/MRA. The features intimal flap, stenosis, and lumen irregularity appeared in both modalities. One high-grade stenosis was identified by CT/CTA that was expected occluded on MRI/MRA. Two MRI/MRA-confirmed pseudoaneurysms were missed by CT/CTA. None of the controls evidenced specific imaging signs for dissection.Conclusions: CT/CTA is a reliable and better available alternative to MRI/MRA for diagnosis of sCAD. CT/CTA should be used to complement MRI/MRA in cases where MRI/MRA suggests occlusion. [ABSTRACT FROM AUTHOR]

Background: By the use of PSMA positron emission tomography (PET) detection of prostate cancer lesions with a high sensitivity and specificity combined with a favorable lesion to background contrast is feasible. Therefore, PSMA-PET is increasingly used for planning of radiotherapy treatment; however, any data on intermediate-term outcome is missing so far.Methods: Patients with high-risk or very high risk prostate cancer, referred for salvage radiotherapy (SRT, n = 22) between 2013 and 2015, underwent PSMA-PET prior to therapy. Irradiation was planned on PET data with boost to macroscopic tumors/metastases. Treatment related toxicity was measured using Common Terminology Criteria for Adverse Events (CTCAE, v4.0).Result: Findings in PSMA-PET led to treatment modifications in 77% of SRT patients compared to available CT information. One patient did not receive irradiation due to disseminated disease, the other patients received increased boost doses to macroscopic disease and/or inclusion of additional target volumes. Toxicity was low as only 2 patients reported toxicities > grade 1. With a Median follow-up time of 29 in patients that were not lost to follow-up, prolonged PSA responses below baseline were observed in the majority of patients (14 of 20). In hormone-naïve SRT patients (n = 11), radiotherapy led to prolonged PSA decrease in 8/11 patients, however with 3 of these 8 patients receiving repeated PSMA based irradiation of novel lesions during follow-up.Conclusion: PSMA-PET guided planning of radiotherapy led to change of treatment in the majority of patients. Treatment related toxicity was well tolerated and promising results regarding intermediate-term PSA decrease were observed.Trial Registration: No trial registration was performed due to retrospective evaluation. [ABSTRACT FROM AUTHOR]

Background: Emerging techniques such as brain hypo-fractionated radiotherapy (HF-RT) involve complex cases with limited guidelines for plan quality and normal tissue tolerances. The purpose of the present study was to statistically parameterize irradiated volume independently of dose prescription, or margin to determine what spread in achievable irradiated volume one may expect for a given case.Methods: We defined EXT as the total tissue within the external contour of the patient (including the target) and we defined BMP as the contour of the brain minus PTV. Irradiated volumes of EXT and BMP at specific doses (i.e. 50, 60%, etc., of the prescribed dose) were extracted from 135 single-target HF-RT clinical cases, each planned with a single-arc, homogeneous (SAHO) approach in which target maximum dose (Dmax) was constrained to <130% of the prescribed dose. Irradiated volumes were subsequently measured for cases involving 2 targets (N = 29), 3 targets (N = 7) and >3 targets (N = 10) to investigate the effect of target number. We also examined the effect of shape complexity. A series of best fit curves with confidence and prediction intervals were generated for irradiated volume versus total target volume and the resulting model was subsequently validated on a subsequent set of 23 consecutive prospective cases not originally used in curve-fitting. A subset of 30 HF-RT cases were re-planned with a well-published four-arc, heterogeneous (FAHE) radiosurgery planning approach (Dmax could exceed 130%) to demonstrate how technique affects irradiated volume.Results: For SAHO, strong correlation (R2 > 0.98) was found for predicting irradiated volumes. For a given total target volume, irradiated-volume increased by a range of 1.4-2.9× for >3 versus single-targets depending on isodose level. Shape complexity had minor impact on irradiated volume. There was no statistical difference in irradiated volumes between validation and input data (p > 0.2). The FAHE-generated irradiated volumes yielded curves and prediction and confidence bands that agreed well with published data indicating that the proposed approach is feasible for cross-institutional comparisons.Conclusions: A description of irradiated volume for linac-based HF-RT is proposed based on population data. We have demonstrated that the proposed approach is feasible for inter and intra-institutional comparisons. [ABSTRACT FROM AUTHOR]

Objectives. Based on single-arm trial data (BOLT), sonidegib was approved in the US and EU to treat locally advanced basal cell carcinomas (BCCs) ineligible for curative surgery or radiotherapy. Vismodegib, the other approved targeted therapy, also was assessed in a single-arm trial (ERIVANCE). We examined the comparative effectiveness of the two drugs using a matching-adjusted indirect comparison (MAIC) versus an unadjusted indirect comparison. Methods. After comparing trials and identifying potential prognostic factors, an MAIC was conducted to adjust for differences in key patient baseline characteristics. Due to BOLT’s small sample size, the number of matching variables was restricted to two. Efficacy results for sonidegib were generated so that selected baseline characteristics matched those from ERIVANCE and were compared with published ERIVANCE results. Results. Matching variables were baseline percentages of patients receiving prior radiotherapy and surgery. After weighting, sonidegib objective response rate (ORR) and median progression-free survival (PFS) were effectively unchanged (prematched versus postmatched ORR and PFS, 56.1% versus 56.7% and 22.1 versus 22.1 months, resp.). Vismodegib’s ORR and PFS were 47.6% and 9.5 months. Conclusions. Comparative effectiveness of sonidegib versus vismodegib remains unchanged after adjusting BOLT patient-level data to match published ERIVANCE baseline percentages of patients receiving prior surgery and radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: To report findings from an in vivo dosimetry program implemented for all stereotactic body radiation therapy patients over a 31-month period and discuss the value and challenges of utilizing in vivo electronic portal imaging device (EPID) dosimetry clinically.Methods and Materials: From December 2013 to July 2016, 117 stereotactic body radiation therapy-volumetric modulated arc therapy patients (100 lung, 15 spine, and 2 liver) underwent 602 EPID-based in vivo dose verification events. A developed model-based dose reconstruction algorithm calculates the 3-dimensional dose distribution to the patient by back-projecting the primary fluence measured by the EPID during treatment. The EPID frame-averaging was optimized in June 2015. For each treatment, a 3%/3-mm γ comparison between our EPID-derived dose and the Eclipse AcurosXB-predicted dose to the planning target volume (PTV) and the ≥20% isodose volume were performed. Alert levels were defined as γ pass rates <85% (lung and liver) and <80% (spine). Investigations were carried out for all fractions exceeding the alert level and were classified as follows: EPID-related, algorithmic, patient setup, anatomic change, or unknown/unidentified errors.Results: The percentages of fractions exceeding the alert levels were 22.6% for lung before frame-average optimization and 8.0% for lung, 20.0% for spine, and 10.0% for liver after frame-average optimization. Overall, mean (± standard deviation) planning target volume γ pass rates were 90.7% ± 9.2%, 87.0% ± 9.3%, and 91.2% ± 3.4% for the lung, spine, and liver patients, respectively.Conclusions: Results from the clinical implementation of our model-based in vivo dose verification method using on-treatment EPID images is reported. The method is demonstrated to be valuable for routine clinical use for verifying delivered dose as well as for detecting errors. [ABSTRACT FROM AUTHOR]

Purpose: To test the hypothesis that intensity modulated radiation therapy (IMRT) reduces acute hematologic and gastrointestinal (GI) toxicity for patients with locoregionally advanced cervical cancer.Methods and Materials: We enrolled patients with stage IB-IVA cervical carcinoma in a single-arm phase II trial involving 8 centers internationally. All patients received weekly cisplatin concurrently with once-daily IMRT, followed by intracavitary brachytherapy, as indicated. The primary endpoint was the occurrence of either acute grade ≥3 neutropenia or clinically significant GI toxicity within 30 days of completing chemoradiation therapy. A preplanned subgroup analysis tested the hypothesis that positron emission tomography-based image-guided IMRT (IG-IMRT) would lower the risk of acute neutropenia. We also longitudinally assessed patients' changes in quality of life.Results: From October 2011 to April 2015, 83 patients met the eligibility criteria and initiated protocol therapy. The median follow-up was 26.0 months. The incidence of any primary event was 26.5% (95% confidence interval [CI] 18.2%-36.9%), significantly lower than the 40% incidence hypothesized a priori from historical data (P=.012). The incidence of grade ≥3 neutropenia and clinically significant GI toxicity was 19.3% (95% CI 12.2%-29.0%) and 12.0% (95% CI 6.7%-20.8%), respectively. Compared with patients treated without IG-IMRT (n=48), those treated with IG-IMRT (n=35) had a significantly lower incidence of grade ≥3 neutropenia (8.6% vs 27.1%; 2-sided χ2P=.035) and nonsignificantly lower incidence of grade ≥3 leukopenia (25.7% vs 41.7%; P=.13) and any grade ≥3 hematologic toxicity (31.4% vs 43.8%; P=.25).Conclusions: IMRT reduces acute hematologic and GI toxicity compared with standard treatment, with promising therapeutic outcomes. Positron emission tomography IG-IMRT reduces the incidence of acute neutropenia. [ABSTRACT FROM AUTHOR]

Carbon ions are an up-and-coming ion species, currently being used in charged particle radiotherapy. As it is well established that there are considerable interindividual differences in radiosensitivity in the general population that can significantly influence clinical outcomes of radiotherapy, we evaluate the degree of these differences in the context of carbon ion therapy compared with conventional radiotherapy. In this study, we evaluate individual radiosensitivity following exposure to carbon-13 ions or γ-rays in peripheral blood lymphocytes of healthy individuals based on the frequency of ionizing radiation (IR)-induced DNA double strand breaks (DSBs) that was either misrepaired or left unrepaired to form chromosomal aberrations (CAs) (simply referred to here as DSBs for brevity). Levels of DSBs were estimated from the scoring of CAs visualized with telomere/centromere-fluorescence in situ hybridization (TC-FISH). We examine radiosensitivity at the dose of 2 Gy, a routinely administered dose during fractionated radiotherapy, and we determined that a wide range of DSBs were induced by the given dose among healthy individuals, with highly radiosensitive individuals harboring more IR-induced breaks in the genome than radioresistant individuals following exposure to the same dose. Furthermore, we determined the relative effectiveness of carbon irradiation in comparison to γ-irradiation in the induction of DSBs at each studied dose (isodose effect), a quality we term "relative dose effect" (RDE). This ratio is advantageous, as it allows for simple comparison of dose-response curves. At 2 Gy, carbon irradiation was three times more effective in inducing DSBs compared with γ-irradiation (RDE of 3); these results were confirmed using a second cytogenetic technique, multicolor-FISH. We also analyze radiosensitivity at other doses (0.2-15 Gy), to represent hypo- and hyperfractionation doses and determined that RDE is dose dependent: high ratios at low doses, and approaching 1 at high doses. These results could have clinical implications as IR-induced DNA damage and the ensuing CAs and genomic instability can have significant cellular consequences that could potentially have profound implications for long-term human health after IR exposure, such as the emergence of secondary cancers and other pathobiological conditions after radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy is based on the premise of accurate dose delivery to target volumes within a patient, while minimizing dose to surrounding tissues. Recent developments in the treatment of breast cancer have focused on “gating” the delivery of the treatment beams to minimize the effect of patient motion during treatment, and increasing separation between the target volume and organs at risk (OAR), such as lung, heart and left anterior descending coronary artery. The basic principle involves rapidly switching the treatment beam on or off depending on the patient breathing cycle. It is therefore important to know the characteristics of gated treatments such as latency. Methods: In this work an electrical PIN diode circuit (EPDC) was designed for quality assurance (QA) purposes to examine beam latency timing properties. Evaluation of the EPDC was performed on a TrueBeam™ (Varian, Palo Alto) linear accelerator and its internal gating system. The EPDC was coupled to a moving stage to simulate a binary pattern with fast beam triggering within predefined limits, the so called “gating window”. Pulses of radiation were measured with the PIN diode and the results were compared to measurements of current produced across the linac target. Processing of the beam pulses and calculation of the latency timings was performed by an Atmega328P microcontroller. Results: For beam-on latencies, 2.11 ms (6 MV) and 2.12 ms (10 MV) were measured using the PIN diode, compared to 2.13 ms (6 MV) and 2.15 ms (10 MV) using the target current signal. For beam-off latencies, 57.69 ms (6 MV) and 57.73 ms (10 MV) were measured using the PIN diode, compared to 57.33 ms (6 MV) and 56.01 ms (10 MV) using the target current. Conclusions: PIN diodes can be used for accurate determination of the beam-on and beam-off latency characteristics, which could potentially lead to improvements in gated radiotherapy treatments, for example optimizing the gating windows and in estimating dosimetric errors associated with treatment beam latencies. [ABSTRACT FROM AUTHOR]

Purpose: To provide a comprehensive characterization of a novel respiratory surrogate that uses optical surface imaging (OSI) for accurate tidal volume (TV) measurement, dynamic airflow (TV') calculation, and quantitative breathing pattern (BP) estimation during free breathing (FB), belly breathing (BB), chest breathing (CB), and breath hold (BH). Methods: Optical surface imaging, which captures all respiration-induced torso surface motion, was applied to measure respiratory TV, TV', and BP in three common breathing patterns. Eleven healthy volunteers participated in breathing experiments with concurrent OSI-based and conventional spirometric measurements under an institutional review board approved protocol. This OSI-based technique measures dynamic TV from torso volume change (▵ Vtorso = TV) in reference to full exhalation and airflow (TV'= dTV/dt). Volume conservation, excluding exchanging air, was applied for OSI-based measurements under negligible pleural pressure variation in FB, BB, and CB. To demonstrate volume conservation, a constant TV was measured during BH while the chest and belly are moving ("pretended" respiration). To assess the accuracy of OSI-based spirometry, a conventional spirometer was used as the standard for both TV and TV'. Using OSI, BP was measured as BPOSI = ▵ Vchest /▵ Vtorso and BP can be visualized using BPSHI = SHIchest/(SHIchest+SHIbelly), where surface height index (SHI) is defined as the mean vertical distance within a region of interest on the torso surface. A software tool was developed for OSI image processing, volume calculation, and BP visualization, and another tool was implemented for data acquisition using a Bernoulli-type spirometer. Results: The accuracy of the OSI-based spirometry is -21±33 cm3 or -3.5%±6.3%averaged from 11 volunteers with 76±28 breathing cycles on average in FB. Breathing variations between two separate acquisitions with approximate 30-min intervals are substantial: -1%±34% (ranging from -64% to 40%) in TV, 4%±20% (ranging from -50% to 26%) in breathing period (T), and -1%±34% (ranging from-49%to44%)inBP. The airflowaccuracy and variation (between two exercises) are-1±54cm3/s and -5%±30%, respectively. The slope of linear regression between OSI-TV and spirometric TV is 0.93 (R2 = 0.95) for FB, 0.96 (R2 = 0.98) for BB, and 0.95 (R2 = 0.95) for CB. The correlation between the two spirometric measurements is 0.98±0.01. BP increases from BB, FB to CB, while TV increases from FB, BB, to CB. Under BH, 4% volume variation (range) on average was observed. Conclusions: The OSI-based technique provides an accurate measurement of tidal volume, airflow rate, and breathing pattern; all affect internal organ motion. This technique can be applied to various breathing patterns, including FB, BB, and CB. Substantial breathing irregularities and irreproducibility were observed and quantified with the OSI-based technique. These breathing parameters are useful to quantify breathing conditions, which could be used for effective tumor motion predictions. [ABSTRACT FROM AUTHOR]

Objectives To identify patterns of long-term, radiation-induced swallowing dysfunction after definitive radiotherapy with or without chemotherapy (RT or CHRT) and to determine which factors may explain these patterns over time. Material and methods The study population consisted of 238 consecutive head and neck cancer patients treated with RT or CHRT. The primary endpoint was ⩾grade 2 swallowing dysfunction at 6, 12, 18 and 24 months after treatment. Cluster analysis was used to identify different patterns over time. The differences between the mean dose to the swallowing organs at risk for each pattern were determined by using dose maps. Results The cluster analysis revealed five patterns of swallowing dysfunction: low persistent, intermediate persistent, severe persistent, transient and progressive. Patients with high dose to the upper pharyngeal, laryngeal and lower pharyngeal region had the highest risk of severe persistent swallowing dysfunction. Transient problems mainly occurred after high dose to the laryngeal and lower pharyngeal regions, combined with moderate dose to the upper pharyngeal region. The progressive pattern was mainly seen after moderate dose to the upper pharyngeal region. Conclusions Various patterns of swallowing dysfunction after definitive RT or CHRT can be identified over time. This could reflect different underlying biological processes. [ABSTRACT FROM AUTHOR]

Background: Myxoid liposarcoma is the most common soft-tissue sarcoma that metastasizes to the peritoneal cavity. Recently, an advanced intensity-modulated radiotherapy, known as helical tomotherapy, has been introduced to improve target coverage, while reducing normal tissue radiation. Here, we report a case of myxoid liposarcoma with multiple peritoneal seeding that was chemotherapy-refractory, but was successfully salvaged by helical tomotherapy-based intraperitoneal radiotherapy. Case presentation: A 71-year-old East-Asian male was initially diagnosed with myxoid liposarcoma in his left thigh by excision. Six years later, the patient underwent a left pneumonectomy for metastatic myxoid liposarcoma in the left lung. Since then, the patient was treated with two segmental resections, and multiple lines of chemotherapy, for repeated recurrences in the peritoneal cavity. The patient underwent intraperitoneal radiotherapy followed by tumor boost radiotherapy, as salvage treatment for chemotherapy-resistant metastatic peritoneal myxoid liposarcoma. The prescribed dose was 24 Gy delivered in 15 fractions of 1.6 Gy over 3 weeks, followed by a 16 Gy boost dose administered in eight fractions of 2 Gy, to multifocal peritoneal lesions. A positron emission tomography scan obtained 8 weeks after completion of radiotherapy, showed a complete metabolic response of metastatic peritoneal lesions. Radiotherapy was well tolerated, without any side effects. In a computed tomography scan obtained 20 weeks after completion of radiotherapy, most of the peritoneal metastatic lesions had disappeared, except for two small residual nodules. Conclusion: This case suggests that low fraction-sized intraperitoneal radiotherapy (1.6 Gy administered once daily), followed by a focal boost using helical tomotherapy, is a feasible treatment without side effects. It produced an excellent tumor response, and durable intraperitoneal control for metastatic peritoneal myxoid liposarcoma. [ABSTRACT FROM AUTHOR]

An important requirement for proton therapy is a software for dose calculation. Monte Carlo is the most accurate method for dose calculation, but it is very slow. In this work, a method is developed to improve the speed of dose calculation. The method is based on pre-generated tracks for particle transport. The MCNPX code has been used for generation of tracks. A set of data including the track of the particle was produced in each particular material (water, air, lung tissue, bone, and soft tissue). This code can transport protons in wide range of energies (up to 200 MeV for proton). The validity of the fast Monte Carlo (MC) code is evaluated with data MCNPX as a reference code. While analytical pencil beam algorithm transport shows great errors (up to 10%) near small high density heterogeneities, there was less than 2% deviation of MCNPX results in our dose calculation and isodose distribution. In terms of speed, the code runs 200 times faster than MCNPX. In the Fast MC code which is developed in this work, it takes the system less than 2 minutes to calculate dose for 106 particles in an Intel Core 2 Duo 2.66 GHZ desktop computer. [ABSTRACT FROM AUTHOR]

Purpose: The prescribed percentage-isodose-line (PIDL) in linac-based SRS varies among institutions. For plans with similar tumor coverage and conformity index, the one with sharper dose falloff outside the tumor volume would be preferred because the probability of brain necrosis is related to the irradiated volume (for example V12Gy) outside the tumor. The aim of this study is to investigate the optimal isodose line that yields the steepest dose falloff for linac-based SRS using dynamic conformal arc technique (DCA). Methods: 30 patients with brain tumors were retrospectively studied. The MLC-based DCA was used for planning. For each patient, 5-7 plans with different PIDLs but similar conformity indices were generated. All plans were normalized such that 95% of target volume receives the prescription dose (PD). Gradient index was calculated. The plan with minimum GI was considered optimal. Results: Optimal GI decreases (3.9 to 2.2) as target volumes increases (0.15 to 50.1cm³), and the optimal PIDL shifts to higher percentile. Median optimal PIDL is 40.0±7.2% (range 33.2-53.1%) for targets <1cm³ and 62.3±8.3% (range 44.6-72.9%) for those >1cm³. The average planned PIDL used for treatment was 83.6±3.3%. The lower optimal PIDL results in smaller V0.5PD and higher mean dose to the tumor. Conclusion: The optimal PIDL appears to be between 50% and 75% which is lower than the commonly used PIDLs in published studies. Larger targets tend to have higher optimal PIDLs. By choosing an optimal PIDL, we could reduce the volume of irradiated normal brain while delivering higher mean dose to the tumor. [ABSTRACT FROM AUTHOR]

One of the main goals of radiotherapy is to achieve tumor control and minimize probability of normal-tissue complications. For this reason radiation oncology requires high accuracy, which implies no more than 2-3% uncertainty levels in the treatment planning calculations. That is challenging, when heterogeneous tissues such as lungs and bones are involved. To verify the accuracy of the dose calculation algorithms numerous approaches might be performed. The most common are point dose, one-dimensional profile and two-dimensional isodose line comparison with experimental measurements. In presented study, results of transport modeling and the deposited spatial distribution of the dose, obtained by anisotropic analytical algorithm and pencil beam convolution algorithm, were compared to measurements recorded during the experiment. To achieve meaningful conclusions, three parameters: dose difference, distance to agreement and gamma parameter (γ) were taken into consideration and examined. The irradiation was performed using CIRS anthropomorphic phantom. For dose detection gafchromic EBT films were used and scanned after exposure using Epson Scanner. Measured and planned dose distributions were analyzed via FilmQA software. Preliminary results showed that the anisotropic analytical algorithm, with its complex accounting of heterogeneities, provides more accurate dose calculation within an area of a high density gradient, than pencil beam convolution does. The level of the data accuracy derived from the experiment was: dose difference (5%) - 83.4% and 68% pixels passing, distance to agreement (3 mm) - 99.0% and 96.7%, gamma parameter (for dose difference (3%), distance to agreement (3 mm)) - 90% and 75.5%, respectively, for anisotropic analytical algorithm and pencil beam convolution algorithms. The comparison between studied parameters dose difference, distance to agreement and γ for both algorithms implicated anisotropic analytical algorithm as an appropriate approach in radiotherapy treatment planning. [ABSTRACT FROM AUTHOR]

Brachytherapy is an advanced cancer treatment that is minimally invasive, minimising radiation exposure to the surrounding healthy tissues. Microselectron© Nucletron devices with 192Ir source can be used for gynaecological brachytherapy, in patients with vaginal or uterine cancer. Measurements of isodose curves have been performed in a PMMA phantom and compared with Monte Carlo calculations and TPS (Plato software of Nucletron BPS 14.2) evaluation. The isodose measurements have been performed with radiochromic films (Gafchromic EBT©). The dose matrix has been obtained after digitalisation and use of a dose calibration curve obtained with a 6 MV photon beam provided by a medical linear accelerator. A comparison between the calculated and the measured matrix has been performed. The calculated dose matrix is obtained with a simulation using the MCNP5 Monte Carlo code (F4MESH tally). [ABSTRACT FROM AUTHOR]

Previous works indicate that intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans that are highly complex may produce more errors in dose calculation and treatment delivery. Multiple complexity metrics have been proposed and associated with IMRT QA results, but their relationships with plan performance using in situ dose measurements have not been thoroughly investigated. This study aimed to evaluate the relationships between IMRT treatment plan complexity and anthropomorphic phantom performance in order to assess the extent to which plan complexity is related to dosimetric performance in the IROC phantom credentialing program. Sixteen complexity metrics, including the modulation complexity score (MCS), several modulation indices, and total monitor units (MU) delivered, were evaluated for 343 head and neck phantom irradiations, comprising both IMRT (step-and-shoot and sliding window techniques) and VMAT. Spearman's correlations were used to explore the relationship between complexity and plan performance, as measured by the dosimetric differences between the treatment planning system (TPS) and thermoluminescent dosimeter (TLD) measurement, as well as film gamma analysis. Relationships were likewise determined for several combinations of subpopulations, based on the linear accelerator model, TPS used, and delivery modality. Evaluation of the complexity metrics presented here yielded no significant relationships (p  >  0.01, Bonferroni-corrected) and all correlations were weak (less than  ±0.30). These results indicate that complexity metrics have limited predictive utility in assessing plan performance in multi-institutional comparisons of IMRT plans. Other factors affecting plan accuracy, such as dosimetric modeling or multileaf collimator (MLC) performance, should be investigated to determine a more probable cause for dose delivery errors. [ABSTRACT FROM AUTHOR]

In 2016, UNSCEAR published an attachment to its Fukushima 2015 White Paper, entitled ‘Development of isodose maps representing annual external exposure in Japan as a function of time’, in which the committee presented an annual additional 1 mSv effective dose ab extra isodose lines for 1, 3, 5, 10, 30, 50 years after the accident, based on the soil deposition data of radionuclides within 100 km of the Fukushima Dai-ichi Nuclear Power Plant. Meanwhile, the median of the ratio, c, between the external effective dose rates and the ambient dose equivalent rates 1 m above the ground obtained by airborne monitoring has been established to be . Here, we compare the UNSCEAR predictions with estimates based on the airborne monitoring. Although both the methods and the data used in the two approaches are different, the resultant contours show relatively good agreement. However, to improve the accuracy of long-term annual effective isodose lines, feedback from continuous measurements such as airborne monitoring is important. [ABSTRACT FROM AUTHOR]

Use of proton beam therapy has expanded, with the number of proton centres rapidly increasing not only in the USA but also worldwide. The physical characteristics of the proton beam offer important advantages versus widely used photon techniques in terms of radiation precision. In head and neck cancer in particular, proton beam therapy is uniquely suited for the complex anatomy of tumours and sensitive surrounding organs. De-intensification and personalisation of treatment to limit toxicity are of renewed importance in the context of human papilloma virus-associated disease, in which young patients will be cured but bear the consequences of adverse effects for decades. Comparisons of radiation dose distributions between photon and proton techniques suggest considerable benefit in terms of toxicity sparing, but this has only recently been confirmed by substantial clinical data. In this Review, we attempt to define the role of this method in the contemporary multidisciplinary management of various types of head and neck cancer. [ABSTRACT FROM AUTHOR]