Search

Background: Volumetric modulated arc therapy (VMAT) planning optimization involves iterative adjustment of numerous parameters, and hence requires repeatedly dose recalculation. In this study, we used the deep learning method to develop a fast and accurate dose calculation method for VMAT. Methods: The classical 3D UNet was adopted and trained to learn the physics principle of dose calculation. The inputs included the projected fluence map (FM), computed tomography (CT) images, the radiological depth and the source-to-voxel distance (SVD). The projected FM was generated by projecting the accumulated FM between two consecutive control points (CPs) onto the patient's anatomy. The accumulated FM was calculated by simulating the movement of the multi-leaf collimator (MLC) from one CP to the next. The dose, calculated by the treatment planning system (TPS), was used as ground truth. 51 head and neck VMAT plans were used, with 43, 1 and 7 cases as training, validation, and testing datasets, respectively. Correspondingly, 7182, 180 and 1260 CP samples were included in the training, validation, and testing datasets. Results: This presented method was evaluated by comparing the derived dose distribution to the TPS calculated dose distribution. The dose profiles coincided for both the single CP and the entire plan (summation of all CPs). But the network derived dose was smoother than the TPS calculated dose. Gamma analysis was performed between the network derived dose and the TPS calculated dose. The average gamma pass rate was 96.56%, 98.75%, 98.03% and 99.30% under the criteria of 2% (tolerance) -2 mm (distance to agreement, DTA). 2%-3 mm, 3%-2 mm and 3%-3 mm. No significant difference was observed on the critical indices including the max, mean dose, and the relative volume covered by the 2000 cGy, 4000 cGy and the prescription dose. For one CP, the average computational time of the network and TPS was 0.09s and 0.53s. And for one patient, the average time was 16.51s and 95.60s. Conclusion: The dose distribution derived by the network showed good agreement with the TPS calculated dose distribution. The computational time was reduced to approximate one-sixth of its original duration. Therefore the presented deep learning-based dose calculation method has the potential to be used for planning optimization. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Monte Carlo (MC) modeling of MR‐guided radiotherapy (MRgRT) treatment machines enables the characterization of photon/electron interactions in the presence of a magnetic field. The EGSnrc MC code system is a well‐established system for radiation dose calculations. The multi‐leaf collimator (MLC) component modules presently available within the EGSnrc MC code system do not include a model of the double‐focused MLC available on a low‐field (0.35T) MRI linear accelerator (MR linac).Here we developed and validated a new component module (CM) for the low‐field MRgRT MLC using the EGSnrc/BEAMnrc/DOSXYZnrc code system. We performed detailed modeling of the treatment head and validated the model using measurements and calculations from the vendor‐specific treatment planning system (TPS).The detailed geometry of the low‐field MR linac MLC and other treatment head structures were modeled using BEAMnrc. Comparisons of DOSXYZnrc simulated dose against measurements and the low‐field MR linac TPS for a variety of AAPM TG‐53 task group report suggested square and shaped fields, as well as a step‐and‐shoot intensity‐modulated radiotherapy (IMRT) plan, are presented.Our model agrees with both measured and TPS calculated data on average within 2%/2 mm (dose/DTA) criterion for square field profiles. Output factors agreed within 1% for field sizes down to 2.49 × 2.49 cm2 and within 2% of TPS data for the smallest field size of 0.83 × 0.83 cm2. Shaped field and IMRT MC calculations agreed with measured and TPS data such that the gamma pass rates (3%/2 mm) were 99.5% and (3%/3 mm) 96.2%, respectively.We developed and validated an MLC CM (SYNCVRMLC) for the low‐field MR linac using the EGSnrc MC code systems. This new CM will facilitate MC computation of fluence and dose distributions using BEAMnrc/DOSXYZnrc for patients treated on the low‐field MR linac. [ABSTRACT FROM AUTHOR]

This article discusses the use of CZT SPECT systems in brain imaging applications. CZT-based detectors offer advantages such as higher contrast, energy resolution, and spatial resolution compared to traditional scintillation crystals. Preliminary studies have shown that CZT SPECT systems can reduce acquisition time without compromising image quality. CZT SPECT is particularly useful in brain perfusion imaging and dopaminergic imaging. It also has potential applications in theranostics for brain tumors. Efforts are being made to standardize protocols and collect data to further improve diagnostic accuracy and patient management. [Extracted from the article]

Background: Treatment delivery safety and accuracy are essential to control the disease and protect healthy tissues in radiation therapy. For usual treatment, a phantom‐based patient specific quality assurance (PSQA) is performed to verify the delivery prior to the treatment. The emergence of adaptive radiation therapy (ART) adds new complexities to PSQA. In fact, organ at risks and target volume re‐contouring as well as plan re‐optimization and treatment delivery are performed with the patient immobilized on the treatment couch, making phantom‐based pretreatment PSQA impractical. In this case, phantomless PSQA tools based on multileaf collimator (MLC) leaf open times (LOTs) verifications provide alternative approaches for the Radixact® treatment units. However, their validity is compromised by the lack of independent and reliable methods for calculating the LOT performed by the MLC during deliveries. Purpose: To provide independent and reliable methods of LOT calculation for the Radixact® treatment units. Methods: Two methods for calculating the LOTs performed by the MLC during deliveries have been implemented. The first method uses the signal recorded by the build‐in detector and the second method uses the signal recorded by optical sensors mounted on the MLC. To calibrate the methods to the ground truth, in‐phantom ionization chamber LOT measurements have been conducted on a Radixact® treatment unit. The methods were validated by comparing LOT calculations with in‐phantom ionization chamber LOT measurements performed on two Radixact® treatment units. Results: The study shows a good agreement between the two LOT calculation methods and the in‐phantom ionization chamber measurements. There are no notable differences between the two methods and the same results were observed on the different treatment units. Conclusions: The two implemented methods have the potential to be part of a PSQA solution for ART in tomotherapy. [ABSTRACT FROM AUTHOR]

This study investigated the feasibility of a simplified method of alpha spectroscopy for radionuclidic purity tests at 225Ac production sites that eliminates the need for a vacuum chamber. The impact of enhancing the energy resolution using a collimator was evaluated through radiation transport simulations. The results showed that a full width at tenth maximum (FWTM) of <300 keV was achieved for alpha particles from 241Am, for which the main energy peak was 5.5 MeV. Experimental validation using an electrodeposition source containing 237Np, 241Am, and 244Cm confirmed an FWTM of 272 keV for both 241Am and 244Cm. These two peaks, with a difference of ~300 keV, were effectively separated. In response to the growing demand for targeted radioisotope therapy, this simplified alpha spectroscopy method offers the potential to detect 226Ra mixed with 225Ac generated by accelerators, given the alpha energy difference of ~700 keV. [ABSTRACT FROM AUTHOR]

Background: Element-equivalent matched theranostic pairs facilitate quantitative in vivo imaging to establish pharmacokinetics and dosimetry estimates in the development of preclinical radiopharmaceuticals. Terbium radionuclides have significant potential as matched theranostic pairs for multipurpose applications in nuclear medicine. In particular, 155Tb (t1/2 = 5.32 d) and 161Tb (t1/2 = 6.89 d) have been proposed as a theranostic pair for their respective applications in single photon emission computed tomography (SPECT) imaging and targeted beta therapy. Our study assessed the performance of preclinical quantitative SPECT imaging with 155Tb and 161Tb. A hot rod resolution phantom with rod diameters ranging between 0.85 and 1.70 mm was filled with either 155Tb (21.8 ± 1.7 MBq/mL) or 161Tb (23.6 ± 1.9 MBq/mL) and scanned with the VECTor preclinical SPECT/CT scanner. Image performance was evaluated with two collimators: a high energy ultra high resolution (HEUHR) collimator and an extra ultra high sensitivity (UHS) collimator. SPECT images were reconstructed from photopeaks at 43.0 keV, 86.6 keV, and 105.3 keV for 155Tb and 48.9 keV and 74.6 keV for 161Tb. Quantitative SPECT images of the resolution phantoms were analyzed to report inter-rod contrast, recovery coefficients, and contrast-to-noise metrics. Results: Quantitative SPECT images of the resolution phantom established that the HEUHR collimator resolved all rods for 155Tb and 161Tb, and the UHS collimator resolved rods ≥ 1.10 mm for 161Tb and ≥ 1.30 mm for 155Tb. The HEUHR collimator maintained better quantitative accuracy than the UHS collimator with recovery coefficients up to 92%. Contrast-to-noise metrics were also superior with the HEUHR collimator. Conclusions: Both 155Tb and 161Tb demonstrated potential for applications in preclinical quantitative SPECT imaging. The high-resolution collimator achieves < 0.85 mm resolution and maintains quantitative accuracy in small volumes which is advantageous for assessing sub organ activity distributions in small animals. This imaging method can provide critical quantitative information for assessing and optimizing preclinical Tb-radiopharmaceuticals. [ABSTRACT FROM AUTHOR]

In this study, we proposed 2 new multileaf collimator leaf designs to eliminate leaf gaps for closed leaf pairs so that radiation leakage can be avoided. In the new designs, multi tongues and grooves were added to the conventional multileaf collimators leaf ends. Thus, when a pair of leaves closed, tongues of a leaf can enter grooves of its opposing leaf. Consequently, there would be no radiation leakage through closed leaves. One design was named finger-shaped MLC, and another design with doubled leaf end thickness was named hand-shaped MLC. Monte Carlo simulations were performed to simulate dosimetric characteristics of the new MLC designs and comparison to conventional MLCs was performed. The simulations show that for the closed field, the new designs reduce leakage dramatically. And for the open field, the finger-shaped MLC has a larger penumbra width than conventional MLC, while the penumbra for the hand-shaped MLC is comparable to that of conventional MLC. With the application of new MLC designs, it is expected to eliminate leaf gaps for MLC usage and protect normal tissues better. [ABSTRACT FROM AUTHOR]

The Compact thermal neutron imaging systems have become an important development trend. Compact thermal neutron imaging systems can use neutron tubes as neutron sources because of their low cost, small size, and portability. In order to achieve optimal imaging quality, the moderator and collimator in a neutron imaging system based on neutron tubes source are designed and simulated using SuperMC. The entrance position of the collimator is determined by analyzing the performance of different materials with their parameter's optimization. It is suggested that a cylinder-shaped structure made of carbon, hydrogenous materials, and heavy metals can significantly increase the thermal neutron flux at the sample location. Further dimension optimization is carried out to improve the neutron beam collimation performance. A vertically divergent collimator with a divergence angle of 5° and an air gap is selected, along with the addition of a B4C lining material. According to the modelling results, the sample position can be as far away from the neutron source as 77 cm with a neutron source yield of 1.14 × 109 n/s. The collimation ratio is 29, the thermal neutron flux is 1.08 × 103 n/cm2·s, and n/γ is 1.44 × 1012 n/cm2·Sv, which is suitable for thermal neutron radiography. [ABSTRACT FROM AUTHOR]

When planning a simultaneous integrated boost in breast treatment with sliding window intensity-modulated radiotherapy, the use of an oblique anterior field can be advantageous. To limit the irradiation to the tumor bed on the oblique anterior field, we use the "fixed jaw" option during optimization in Eclipse (v15.6, Varian Medical System). However, this option is not available for Halcyon (Varian Medical System) linear accelerators because the beam-defining collimator is only composed of a dual-layer multileaf collimator (MLC) without any jaw collimator. Hence, the optimizer opens the leaves on all target volumes, and leaves facing the heart or medullary canal may be opened on the oblique anterior field. To avoid this unacceptable behavior, we created an avoidance structure using the Eclipse Scripting Application Programming Interface (ESAPI) to force the optimizer to close the leaves when facing critical organs at risk. The avoidance structure was the whole body of the patient subtracted from every beam path used: the tangential fields collimated to the breast planning target volume (PTV) and the oblique anterior field collimated to the tumor bed PTV. The ESAPI has a built-in method that returns a table of points, drawing the outline of a structure at the isocenter plane of a beam. We used this method to build the avoidance structure. We planned 6 breast cancer patients using this structure, and we were able to meet all dosimetric constraints. All MLC leaves were fully closed outside the tumor bed PTV for the oblique anterior field. [ABSTRACT FROM AUTHOR]

Background: The recent emergence of targeted radionuclide therapy has increased the demand for imagers capable of visualizing pharmacokinetics in developing radiopharmaceuticals in the preclinical phase. Some radionuclides emit hard x‐rays and gamma‐rays below 100 keV, in which energy range the performance of conventional NaI scintillators is poor. Multipinhole collimators are also used for small animal imaging with a good spatial resolution but have a limited field of view (FOV). Purpose: In this study, a new imager with high sensitivity over a wide FOV in the low‐energy band (<$<$100 keV) was developed for the pharmacokinetic study. Methods: We developed an x‐ray and gamma‐ray camera for high‐resolution spectroscopy, named "CdTe XG‐Cam," equipped with a cadmium telluride semiconductor detector and a parallel‐hole collimator using a metal 3D printer. To evaluate the camera‐system performance, phantom measurements with single and dual nuclides (99mTc$^{\rm 99m}{\rm Tc}$, 111In$^{111}{\rm In}$, and 125I)$^{125}{\rm I)}$ were performed. The performance for in vivo imaging was evaluated using tumor‐bearing mice to which a nuclide (99mTc$^{\rm 99m}{\rm Tc}$ or 125I)$^{125}{\rm I)}$ administered. Results: We simultaneously obtained information on 111In$^{111}{\rm In}$ and 125I$^{125}{\rm I}$, which emit emission lines in the low‐energy band with peak energies close to each other (23–26 keV for 111In$^{111}{\rm In}$ and 27–31 keV for 125I)$^{125}{\rm I)}$, and applied an analytical method based on spectral model fitting to determine the individual radioactivities accurately. In the small animal imaging, the distributions of the nuclide in tumors were accurately quantified and time‐activity curves in tumors are obtained. Conclusions: The demonstrated capability of our system to perform in vivo imaging suggests that the camera can be used for applications of pharmacokinetics research. [ABSTRACT FROM AUTHOR]

With off-axis reflection systems with specific distortion values serving as objectives or collimators, it is possible to compensate and correct for spectral line bending in spectroscopic instruments. However, there is limited research on the precise control of distortion, which poses particular challenges in large field-of-view optical systems. This paper presents a method for controlling distortion in off-axis reflection systems. Based on Seidel aberration theory and the relationship between distortion wavefront error and primary ray error, we construct objective functions with structural constraints and aberration constraints. The initial structure with specific distortion values is then solved using a differential evolution algorithm. The effectiveness and reliability of this method are verified through the design of an off-axis three-reflection system. The method provided in this study facilitates the design of remote sensing instruments. [ABSTRACT FROM AUTHOR]

The purpose of this study is to develop an electronic portal imaging device‐based multi‐leaf collimator calibration procedure using log files. Picket fence fields with 2–14 mm nominal strip widths were performed and normalized by open field. Normalized pixel intensity profiles along the direction of leaf motion for each leaf pair were taken. Three independent algorithms and an integration method derived from them were developed according to the valley value, valley area, full‐width half‐maximum (FWHM) of the profile, and the abutment width of the leaf pairs obtained from the log files. Three data processing schemes (Scheme A, Scheme B, and Scheme C) were performed based on different data processing methods. To test the usefulness and robustness of the algorithm, the known leaf position errors along the direction of perpendicular leaf motion via the treatment planning system were introduced in the picket fence field with nominal 5, 8, and 11 mm. Algorithm tests were performed every 2 weeks over 4 months. According to the log files, about 17.628% and 1.060% of the leaves had position errors beyond ± 0.1 and ± 0.2 mm, respectively. The absolute position errors of the algorithm tests for different data schemes were 0.062 ± 0.067 (Scheme A), 0.041 ± 0.045 (Scheme B), and 0.037 ± 0.043 (Scheme C). The absolute position errors of the algorithms developed by Scheme C were 0.054 ± 0.063 (valley depth method), 0.040 ± 0.038 (valley area method), 0.031 ± 0.031 (FWHM method), and 0.021 ± 0.024 (integrated method). For the efficiency and robustness test of the algorithm, the absolute position errors of the integration method of Scheme C were 0.020 ± 0.024 (5 mm), 0.024 ± 0.026 (8 mm), and 0.018 ± 0.024 (11 mm). Different data processing schemes could affect the accuracy of the developed algorithms. The integration method could integrate the benefits of each algorithm, which improved the level of robustness and accuracy of the algorithm. The integration method can perform multi‐leaf collimator (MLC) quality assurance with an accuracy of 0.1 mm. This method is simple, effective, robust, quantitative, and can detect a wide range of MLC leaf position errors. [ABSTRACT FROM AUTHOR]

Background and purpose: This study aimed to compare the dosimetric attributes of two multi‐leaf collimator based techniques, HyperArc and Incise CyberKnife, in the treatment of brain metastases. Material and methods: 17 cases of brain metastases were selected including 6 patients of single lesion and 11 patients of multiple lesions. Treatment plans of HyperArc and CyberKnife were designed in Eclipse 15.5 and Precision 1.0, respectively, and transferred to Velocity 3.2 for comparison. Results: HyperArc plans provided superior Conformity Index (0.91 ± 0.06 vs. 0.77 ± 0.07, p < 0.01) with reduced dose distribution in organs at risk (Dmax, p < 0.05) and lower normal tissue exposure (V4Gy–V20Gy, p < 0.05) in contrast to CyberKnife plans, although the Gradient Indexes were similar. CyberKnife plans showed higher Homogeneity Index (1.54 ± 0.17 vs. 1.39 ± 0.09, p < 0.05) and increased D2% and D50% in the target (p < 0.05). Additionally, HyperArc plans had significantly fewer Monitor Units (MUs) and beam‐on time (p < 0.01). Conclusion: HyperArc plans demonstrated superior performance compared with MLC‐based CyberKnife plans in terms of conformity and the sparing of critical organs and normal tissues, although no significant difference in GI outcomes was noted. Conversely, CyberKnife plans achieved a higher target dose and HI. The study suggests that HyperArc is more efficient and particularly suitable for treating larger lesions in brain metastases. [ABSTRACT FROM AUTHOR]

Background: The application of semi-conductor detectors such as cadmium–zinc–telluride (CZT) in nuclear medicine improves extrinsic energy resolution and count sensitivity due to the direct conversion of gamma photons into electric signals. A 3D-ring pixelated CZT system named StarGuide was recently developed and implemented by GE HealthCare for SPECT acquisition. The system consists of 12 detector columns with seven modules of 16 × 16 CZT pixelated crystals, each with an integrated parallel-hole tungsten collimator. The axial coverage is 27.5 cm. The detector thickness is 7.25 mm, which allows acquisitions in the energy range [40–279] keV. Since there is currently no performance characterization specific to 3D-ring CZT SPECT systems, the National Electrical Manufacturers Association (NEMA) NU 1-2018 clinical standard can be tailored to these cameras. The aim of this study was to evaluate the performance of the SPECT/CT StarGuide system according to the NEMA NU 1-2018 clinical standard specifically adapted to characterize the new 3D-ring CZT. Results: Due to the integrated collimator, the system geometry and the pixelated nature of the detector, some NEMA tests have been adapted to the features of the system. The extrinsic measured energy resolution was about 5–6% for the tested isotopes (99mTc, 123I and 57Co); the maximum count rate was 760 kcps and the observed count rate at 20% loss was 917 kcps. The system spatial resolution in air extrapolated at 10 cm with 99mTc was 7.2 mm, while the SPECT spatial resolutions with scatter were 4.2, 3.7 and 3.6 mm in a central, radial and tangential direction respectively. Single head sensitivity value for 99mTc was 97 cps/MBq; with 12 detector columns, the system volumetric sensitivity reached 520 kcps MBq−1 cc−1. Conclusions: The performance tests of the StarGuide can be performed according to the NEMA NU 1-2018 standard with some adaptations. The system has shown promising results, particularly in terms of energy resolution, spatial resolution and volumetric sensitivity, potentially leading to higher quality clinical images. [ABSTRACT FROM AUTHOR]

Background: The aim was to investigate the noise and bias properties of quantitative 177Lu-SPECT with respect to the number of projection angles, and the number of subsets and iterations in the OS-EM reconstruction, for different total acquisition times. Methods: Experimental SPECT acquisition of six spheres in a NEMA body phantom filled with 177Lu was performed, using medium-energy collimators and 120 projections with 180 s per projection. Bootstrapping was applied to generate data sets representing acquisitions with 20 to 120 projections for 10 min, 20 min, and 40 min, with 32 noise realizations per setting. Monte Carlo simulations were performed of 177Lu-DOTA-TATE in an anthropomorphic computer phantom with three tumours (2.8 mL to 40.0 mL). Projections representing 24 h and 168 h post administration were simulated, each with 32 noise realizations. Images were reconstructed using OS-EM with compensation for attenuation, scatter, and distance-dependent resolution. The number of subsets and iterations were varied within a constrained range of the product number of iterations × number of projections ≤ 2400 . Volumes-of-interest were defined following the physical size of the spheres and tumours, the mean activity-concentrations estimated, and the absolute mean relative error and coefficient of variation (CV) over noise realizations calculated. Pareto fronts were established by analysis of CV versus mean relative error. Results: Points at the Pareto fronts with low CV and high mean error resulted from using a low number of subsets, whilst points at the Pareto fronts associated with high CV but low mean error resulted from reconstructions with a high number of subsets. The number of projection angles had limited impact. Conclusions: For accurate estimation of the 177Lu activity-concentration from SPECT images, the number of projection angles has limited importance, whilst the total acquisition time and the number of subsets and iterations are parameters of importance. [ABSTRACT FROM AUTHOR]

Objective: Parkinson's disease (PD) is an age-related neurodegenerative condition characterized mostly by motor symptoms. Although a wide range of non-motor symptoms (NMS) are frequently experienced by PD patients. One of the important and common NMS is cognitive impairment, which is measured using different cognitive scales. Monitoring cognitive impairment and its decline in PD is essential for patient care and management. In this study, our goal is to identify the most effective cognitive scale in predicting cognitive decline over a 5-year timeframe initializing clinical biomarkers and DAT SPECT. Methods: Machine Learning has previously shown superior performance in image and clinical data classification and detection. In this study, we propose to use machine learning with different types of data, such as DAT SPECT and clinical biomarkers, to predict PD-CD based on various cognitive scales. We collected 330 DAT SPECT images and their clinical data in baseline, years 2,3,4, and 5 from Parkinson's Progression Markers Initiative (PPMI). We then designed a 3D Autoencoder to extract deep radiomic features (DF) from DAT SPECT images, and we then concatenated it with 17 clinical features (CF) to predict cognitive decline based on Montreal Cognitive Assessment (MoCA) and The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-I). Results: The utilization of MoCA as a cognitive decline scale yielded better performance in various years compared to MDS-UPDRS-I. In year 4, the application of the deep radiomic feature resulted in the highest achievement, with a cross-validation AUC of 89.28, utilizing the gradient boosting classifier. For the MDS-UPDRS-I scale, the highest achievement was obtained by utilizing the deep radiomic feature, resulting in a cross-validation AUC of 81.34 with the random forest classifier. Conclusions: The study findings indicate that the MoCA scale may be a more effective predictor of cognitive decline within 5 years compared to MDS-UPDRS-I. Furthermore, deep radiomic features had better performance compared to sole clinical biomarkers or clinical and deep radiomic combined. These results suggest that using the MoCA score and deep radiomic features extracted from DAT SPECT could be a promising approach for identifying individuals at risk for cognitive decline in four years. Future research is needed to validate these findings and explore their utility in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: 123I-Ioflupane SPECT is an effective tool for the diagnosis and progression assessment of Parkinson's disease (PD). Radiomics and deep learning (DL) can be used to track and analyze the underlying image texture and features to predict the Hoehn-Yahr stages (HYS) of PD. In this study, we aim to predict HYS at year 0 and year 4 after the first diagnosis with combined imaging, radiomics and DL-based features using 123I-Ioflupane SPECT images at year 0. Methods: In this study, 161 subjects from the Parkinson's Progressive Marker Initiative database underwent baseline 3T MRI and 123I-Ioflupane SPECT, with HYS assessment at years 0 and 4 after first diagnosis. Conventional imaging features (IF) and radiomic features (RaF) for striatum uptakes were extracted from SPECT images using MRI- and SPECT-based (SPECT-V and SPECT-T) segmentations respectively. A 2D DenseNet was used to predict HYS of PD, and simultaneously generate deep features (DF). The random forest algorithm was applied to develop models based on DF, RaF, IF and combined features to predict HYS (stage 0, 1 and 2) at year 0 and (stage 0, 1 and ≥ 2) at year 4, respectively. Model predictive accuracy and receiver operating characteristic (ROC) analysis were assessed for various prediction models. Results: For the diagnostic accuracy at year 0, DL (0.696) outperformed most models, except DF + IF in SPECT-V (0.704), significantly superior based on paired t-test. For year 4, accuracy of DF + RaF model in MRI-based method is the highest (0.835), significantly better than DF + IF, IF + RaF, RaF and IF models. And DL (0.820) surpassed models in both SPECT-based methods. The area under the ROC curve (AUC) highlighted DF + RaF model (0.854) in MRI-based method at year 0 and DF + RaF model (0.869) in SPECT-T method at year 4, outperforming DL models, respectively. And then, there was no significant differences between SPECT-based and MRI-based segmentation methods except for the imaging feature models. Conclusion: The combination of radiomic and deep features enhances the prediction accuracy of PD HYS compared to only radiomics or DL. This suggests the potential for further advancements in predictive model performance for PD HYS at year 0 and year 4 after first diagnosis using 123I-Ioflupane SPECT images at year 0, thereby facilitating early diagnosis and treatment for PD patients. No significant difference was observed in radiomics results obtained between MRI- and SPECT-based striatum segmentations for radiomic and deep features. [ABSTRACT FROM AUTHOR]

Background: Portable gamma cameras are being developed for nuclear medicine procedures such as thyroid scintigraphy. This article introduces Seracam® – a new technology that combines small field of view gamma imaging with optical imaging – and reports its performance and suitability for small organ imaging. Methods: The count rate capability, uniformity, spatial resolution, and sensitivity for 99mTc are reported for four integrated pinhole collimators of nominal sizes of 1 mm, 2 mm, 3 mm and 5 mm. Characterisation methodology is based on NEMA guidelines, with some adjustments necessitated by camera design. Two diagnostic scenarios – thyroid scintigraphy and gastric emptying – are simulated using clinically relevant activities and geometries to investigate application-specific performance. A qualitative assessment of the potential benefits and disadvantages of Seracam is also provided. Results: Seracam's performance across the measured characteristics is appropriate for small field of view applications in nuclear medicine. At an imaging distance of 50 mm, corresponding to a field of view of 77.6 mm × 77.6 mm, spatial resolution ranged from 4.6 mm to 26 mm and sensitivity from 3.6 cps/MBq to 52.2 cps/MBq, depending on the collimator chosen. Results from the clinical simulations were particularly promising despite the challenging scenarios investigated. The optimal collimator choice was strongly application dependent, with gastric emptying relying on the higher sensitivity of the 5 mm pinhole whereas thyroid imaging benefitted from the enhanced spatial resolution of the 1 mm pinhole. Signal to noise ratio in images was improved by pixel binning. Seracam has lower measured sensitivity when compared to a traditional large field of view gamma camera, for the simulated applications this is balanced by advantages such as high spatial resolution, portability, ease of use and real time gamma-optical image fusion and display. Conclusion: The results show that Seracam has appropriate performance for small organ 99mTc imaging. The results also show that the performance of small field of view systems must be considered holistically and in clinically appropriate scenarios. [ABSTRACT FROM AUTHOR]

Objective. Spatially fractionated radiotherapy is showing promise as a treatment modality. Initial focus was on beams of photons at low energy produced from a synchrotron but more recently research has expanded to include applications in proton therapy. Interest in photon beams remains and this is the focus of this paper Approach. This study presents a 3D printed tungsten minibeam collimator intended to produce peak-to-valley dose ratios (PVDR) of between seven and ten with a 1 MV, bremsstrahlung generated, photon beam. The design of the collimator is motivated by a Monte Carlo study estimating the PVDR for different collimator designs at different energies. This collimator was characterised on a clinical linear accelerator (Elekta VersaHD) as well as an orthovoltage unit. Main results. The performance of the fabricated collimator was measured on Elekta VersaHD running in unflattened mode with a 6 MV beam. On the Elekta VersaHD units the PVDR was measured to be between approximately 1.5 and 2.0 at 3 cm deep. For measurements with the orthovoltage unit PVDRs of greater than 10 were observed at a depth of 4 cm. Significance. The results confirmed that the predictions from simulation could be reproduced on linear accelerators currently in clinical usage, producing PVDRs between 2–2.5. Using the model to predict PVDRs using 1 MV photon beams, the threshold considered to produce enhanced normal tissue dose tolerance ( > 7) was surpassed. This suggests the possibility of using such techniques with versions of existing Linac technology which have been modified to operate at low energy and high beam currents. [ABSTRACT FROM AUTHOR]

Purpose: To apply an independent GPU-accelerated Monte Carlo (MC) dose verification for CyberKnife M6 with Iris collimator and evaluate the dose calculation accuracy of RayTracing (TPS-RT) algorithm and Monte Carlo (TPS-MC) algorithm in the Precision treatment planning system (TPS). Methods: GPU-accelerated MC algorithm (ArcherQA-CK) was integrated into a commercial dose verification system, ArcherQA, to implement the patient-specific quality assurance in the CyberKnife M6 system. 30 clinical cases (10 cases in head, and 10 cases in chest, and 10 cases in abdomen) were collected in this study. For each case, three different dose calculation methods (TPS-MC, TPS-RT and ArcherQA-CK) were implemented based on the same treatment plan and compared with each other. For evaluation, the 3D global gamma analysis and dose parameters of the target volume and organs at risk (OARs) were analyzed comparatively. Results: For gamma pass rates at the criterion of 2%/2 mm, the results were over 98.0% for TPS-MC vs.TPS-RT, TPS-MC vs. ArcherQA-CK and TPS-RT vs. ArcherQA-CK in head cases, 84.9% for TPS-MC vs.TPS-RT, 98.0% for TPS-MC vs. ArcherQA-CK and 83.3% for TPS-RT vs. ArcherQA-CK in chest cases, 98.2% for TPS-MC vs.TPS-RT, 99.4% for TPS-MC vs. ArcherQA-CK and 94.5% for TPS-RT vs. ArcherQA-CK in abdomen cases. For dose parameters of planning target volume (PTV) in chest cases, the deviations of TPS-RT vs. TPS-MC and ArcherQA-CK vs. TPS-MC had significant difference (P < 0.01), and the deviations of TPS-RT vs. TPS-MC and TPS-RT vs. ArcherQA-CK were similar (P > 0.05). ArcherQA-CK had less calculation time compared with TPS-MC (1.66 min vs. 65.11 min). Conclusions: Our proposed MC dose engine (ArcherQA-CK) has a high degree of consistency with the Precision TPS-MC algorithm, which can quickly identify the calculation errors of TPS-RT algorithm for some chest cases. ArcherQA-CK can provide accurate patient-specific quality assurance in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This study proposes a practical method for evaluating 2D spatial resolution with scatter on a CZT planar detector gamma camera, which is simpler and faster than the NEMA method. It is used to characterize the influence of distance on spatial resolution FWHM on a CZT camera equipped with a WEHR collimator. Methods: The practical method uses linear sources tilted with respect to the detector axes. The spatial resolution full width at half maximum (FWHM) with four tilt angles was compared to the FWHM evaluated using the NEMA NU1-2018 method. Spatial resolution FWHM was also assessed with tilted sources acquired at distances of 0 to 20 cm using a single angle, with and without the post-processing image enhancement proposed by the manufacturer. Results: Estimated spatial resolution FWHM with tilted sources was close to the spatial resolution FWHM estimated at 7.63 mm by the NEMA method, with deviations ranging from − 5.62 to 4.59% at 10 cm depending on the angle considered. The study of spatial resolution FWHM dependence on distance indicates that, for distances less than 3 cm, the FWHM no longer decreases with distance. The manufacturer's post-processing reduces the FWHM by an average of 15%. Conclusion: The practical method is quicker to implement and gives comparable results to the NEMA reference method for spatial resolution FWHM. Evaluation of spatial resolution with linear sources at short distances from the collimator is limited by the collimator effect and signal digitization. The tilted source method can be used to measure spatial resolution quickly and easily under clinical conditions for CZT planar cameras. [ABSTRACT FROM AUTHOR]

Purpose: Although 221Fr and 213Bi have sufficient gamma emission probabilities, quantitative SPECT after [225Ac]Ac-PSMA-I&T therapy remains challenging due to low therapeutic activities. Furthermore, 221Fr and 213Bi may underlie a different pharmacokinetics due to alpha recoil. We conducted a quantitative SPECT study and a urine analysis to investigate the pharmacokinetics of 221Fr and 213Bi and the impact on image-based lesion and kidney dosimetry. Methods: Five patients (7.7 ± 0.2 MBq [225Ac]Ac-PSMA-I&T) underwent an abdominal SPECT/CT (1 h) at 24 and 48 h (Siemens Symbia T2, high-energy collimator, 440 keV/218 keV (width 20%), 78 keV (width 50%)). Quantitative SPECT was reconstructed using MAP-EM with attenuation and transmission-dependent scatter corrections and resolution modelling. Time-activity curves for kidneys (CT-based) and lesions (80% isocontour 24 h) were fitted mono-exponentially. Urine samples collected along with each SPECT/CT were measured in a gamma counter until secular equilibrium was reached. Results: Mean kidney and lesion effective half-lives were as follows: 213Bi, 27 ± 6/38 ± 10 h; 221Fr, 24 ± 6/38 ± 11 h; 78 keV, 23 ± 7/39 ± 13 h. The 213Bi-to-221Fr kidney SUV ratio increased by an average of 9% from 24 to 48 h. Urine analysis revealed an increasing 213Bi-to-225Ac ratio (24 h, 0.98 ± 0.15; 48 h, 1.08 ± 0.09). Mean kidney and lesion absorbed doses were 0.17 ± 0.06 and 0.36 ± 0.1 Sv RBE = 5 /MBq using 221Fr and 213Bi SPECT images, compared to 0.16 ± 0.05/0.18 ± 0.06 and 0.36 ± 0.1/0.38 ± 0.1 Sv RBE = 5 /MBq considering either the 221Fr or 213Bi SPECT. Conclusion: SPECT/CT imaging and urine analysis showed minor differences of up to 10% in the daughter-specific pharmacokinetics. These variances had a minimal impact on the lesion and kidney dosimetry which remained within 8%. [ABSTRACT FROM AUTHOR]

The Gamma Knife Icon unit is the latest radiosurgery equipment used for noninvasively treating intra-cranial diseases through Stereotactic radiosurgery treatment procedures. Performing radio-physical testing on the new Gamma Knife Icon unit before starting clinical procedures is essential to ensure its functionality. In line with the manufacturer's recommendations and the American Association of Physicists in Medicine (AAPM) formed Task Group 178 (TG-178), we conducted the vital radio physical tests for the newly installed Gamma Knife unit, including precision of beam alignment, measurement of Gamma Knife accuracy, Center Position measurements, off center position measurements, measurement of absorbed dose rate, and Relative Output factor measurement. We used high special resolution External Beam Therapy 3 (EBT3) GafChromic film and small volume ion chambers (Exradin A16, chamber volume 0.007 cc and PTW 0.125 cc) for the above mentioned tests. We also performed the source confirmation test with a 16 mm collimator. Our results are consistent with previous literature values and within international guidelines' acceptable measurement uncertainty tolerance. [ABSTRACT FROM AUTHOR]

Windows for vacuum ultraviolet (VUV) sources are valuable for many applications but difficult to fabricate due to most materials being too absorptive at VUV wavelengths. We have designed, fabricated, and characterized a carbon nanotube (CNT) collimator as a window with high (VUV) transmission and significant differential pumping. The CNT collimators are arrays of square channels of various dimensions and height with sidewalls composed of vertically aligned CNT forests. The CNT collimators in this work exhibited peak intensity transmissions for VUV light (58.4 nm) of 18%–37% of that reported for the same system without a collimator present [S. Olsen, D. Allred, and R. Vanfleet, J. Vac. Sci. Technol. A (2024)]. Further analysis found that the peak intensity transmissions were lowered due to carbon deposition on the phosphor viewing screen from contaminants. The CNT collimator also had significant sidewall reflection in the VUV range (R = 0.21 ± 0.08 in the VUV range for angles 15.6 degrees and below). Pressure ratios (low pressure over high pressure) in the VUV transmission experiment were dominated by leaks in the alignment mechanism. Additional experiments demonstrated the CNT collimator's reflection and superior differential pumping with pressure ratios less than 0.001. [ABSTRACT FROM AUTHOR]

Purpose: The picket fence (PF) test is highly recommended for multi‐leaf collimator (MLC) quality assurance. However, since the electronic portal imaging device (EPID) on the Elekta Unity only covers a small area, it is not feasible to perform the PF test for the entire MLC. Here, we propose a technique for the PF test by stitching two double‐exposed films. Methods: Two EBT3 films were used to encompass the entire MLC, with each one covering one half of the area. Two fields were employed to apply double exposure: a PF pattern consisting of 11 2 mm wide pickets and a 2.84 cm x 22 cm open field. The edges of the open field defined by the diaphragms were used to correct film rotation as well as align them horizontally. The PF pattern was also measured with the EPID where the pickets were used to align the films vertically. Individual leaf positions were detected on the merged film for quantitative analysis. Various MLC positioning errors were introduced to evaluate the technique's sensitivity. Results: The merged films covered 72 leaf pairs properly (four leaf pairs on both sides were outside the treatment couch). With the EPID, the leaf positioning accuracy was ‐0.02 ± 0.07 mm (maximum: 0.29 mm) and the picket width variation was 0.00 ± 0.03 mm (maximum: 0.11 mm); with the films, the position accuracy and width variation were ‐0.03 ± 0.13 mm (maximum: 0.80 mm) and 0.00 ± 0.13 mm (maximum: 0.74 mm), respectively. The EPID was able to detect errors of 0.5 mm or above with submillimeter accuracy; the films were only able to detect errors > 1.0 mm. Conclusion: We developed a quantitative technique for the PF test on the Elekta Unity. The merged films covered nearly the entire MLC leaf banks. The technique exhibited clinically acceptable accuracy and sensitivity to MLC positioning errors. [ABSTRACT FROM AUTHOR]

Background: Although the importance of quantitative SPECT has increased tremendously due to newly developed therapeutic radiopharmaceuticals, there are still no accreditation programs to harmonize SPECT imaging. Work is currently underway to develop an accreditation for quantitative 177Lu SPECT/CT. The aim of this study is to verify whether the positioning of the spheres within the phantom has an influence on the recovery and thus needs to be considered in SPECT harmonization. In addition, the effects of these recovery coefficients on a potential partial volume correction as well as absorbed-dose estimates are investigated. Methods: Using a low-dose CT of a SPECT/CT acquisition, a computerized version of the NEMA body phantom was created using a semi-automatic threshold-based method. Based on the mass-density map, the detector orbit, and the sphere centers, realistic SPECT acquisitions of all possible 720 sphere configurations of both the PET and the SPECT versions of the NEMA Body Phantom were generated using Monte Carlo simulations. SPECT reconstructions with different numbers of updates were performed without (CASToR) and with resolution modeling (STIR). Recovery coefficients were calculated for all permutations, reconstruction methods, and phantoms, and their dependence on the sphere positioning was investigated. Finally, the simulation-based findings were validated using SPECT/CT acquisitions of six different sphere configurations. Results: Our analysis shows that sphere positioning has a significant impact on the recovery for both of the reconstruction methods and the phantom type. Although resolution modeling resulted in significantly higher recovery, the relative variation in recovery within the 720 permutations was even larger. When examining the extreme values of the recovery, reconstructions without resolution modeling were influenced primarily by the sphere position, while with resolution modeling the volume of the two adjacent spheres had a larger influence. The SPECT measurements confirmed these observations, and the recovery curves showed good overall agreement with the simulated data. Conclusion: Our study shows that sphere positioning has a significant impact on the recovery obtained in NEMA sphere phantom measurements and should therefore be considered in a future SPECT accreditation. Furthermore, the single-measurement method normally performed for PVC should be reconsidered to account for the position dependency. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the accuracy of patient-specific absorbed dose calculations for tumours and organs at risk in radiopharmaceutical therapy planning, utilizing hybrid planar-SPECT/CT imaging. Methods: Three Monte Carlo (MC) simulated digital patient phantoms were created, with time-activity data for mIBG labelled to I-123 (LEHR and ME collimators) and I-131 (HE collimator). The study assessed the accuracy of the mean absorbed doses for I-131-mIBG therapy treatment planning. Multiple planar whole-body (WB) images were simulated (between 1 to 72 h post-injection (p.i)). The geometric-mean image of the anterior and posterior WB images was calculated, with scatter and attenuation corrections applied. Time-activity curves were created for regions of interest over the liver and two tumours (diameters: 3.0 cm and 5.0 cm) in the WB images. A corresponding SPECT study was simulated at 24 h p.i and reconstructed using the OS-EM algorithm, incorporating scatter, attenuation, collimator-detector response, septal scatter and penetration corrections. MC voxel-based absorbed dose rate calculations used two image sets, (i) the activity distribution represented by the SPECT images and (ii) the activity distribution from the SPECT images distributed uniformly within the volume of interest. Mean absorbed doses were calculated considering photon and charged particle emissions, and beta emissions only. True absorbed doses were calculated by MC voxel-based dosimetry of the known activity distributions for reference. Results: Considering photon and charged particle emissions, mean absorbed dose accuracies across all three radionuclide-collimator combinations of 3.8 ± 5.5% and 0.1 ± 0.9% (liver), 5.2 ± 10.0% and 4.3 ± 1.7% (3.0 cm tumour) and 15.0 ± 5.8% and 2.6 ± 0.6% (5.0 cm tumour) were obtained for image set (i) and (ii) respectively. Considering charged particle emissions, accuracies of 2.7 ± 4.1% and 5.7 ± 0.7% (liver), 3.2 ± 10.2% and 9.1 ± 1.7% (3.0 cm tumour) and 13.6 ± 5.7% and 7.0 ± 0.6% (5.0 cm tumour) were obtained for image set (i) and (ii) respectively. Conclusion: The hybrid WB planar-SPECT/CT method proved accurate for I-131-mIBG dosimetry, suggesting its potential for personalized treatment planning. [ABSTRACT FROM AUTHOR]

Objectives The purpose of a parallel-hole collimator in a scintillation camera system is to transmit only those photons that have an emission angle close to the direction of the hole. This makes it possible to receive spatial information about the origin of the emission, that is, radioactivity decay. The dimension, shape, and intrahole thickness determine the spatial resolution and, by a tradeoff, sensitivity. The composition of the collimator material also plays an important role in determining a proper collimator. In this study, we compared tungsten alloys as a potential collimator material replacement for the conventional lead antimony material used in most of the current camera systems. Materials and Methods Monte Carlo simulations of a commercial scintillation camera system with low energy high resolution (LEHR), medium-energy (ME), and high-energy (HE) collimators of lead, tungsten, and tungsten-based alloy were simulated for different I-131, Lu-177, I-123, and Tc-99m sources, and a Deluxe rod phantom using the SIMIND Monte Carlo code. Planar images were analyzed regarding spatial resolution, image contrast in a cold source case, and system sensitivity for each collimator configuration. The hole dimensions for the three collimators were those specified in the vendor's datasheet. Results Using Pb, W, and tungsten alloy (Wolfmet) as collimator materials, the full width at half maximum (FWHM) measures for total counts (T) for LEHR with Tc-99m source (6.9, 6.8, and 6.8 mm), for ME with Lu-177 source (11.7, 11.5, and 11.6 mm), and for HE with I-131 (6.2, 13.1, and 13.1 mm) were obtained, and the system sensitivities were calculated as 89.9, 86.1, and 89.8 cps T /MBq with Tc-99m source; 42.7, 17.4, and 20.9 cps T /MBq with Lu-177 source; and 40.1, 69.7, and 77.4 cps T /MBq with I-131 source. The collimators of tungsten and tungsten alloy (97.0% W, 1.5% Fe, 1.5% Ni) provided better spatial resolution and improved image contrast when compared with conventional lead-based collimators. This was due to lower septal penetration. Conclusion The results suggest that development of a new set of ME and HE tungsten and tungsten alloy collimators could improve imaging of I-131, Lu-177, and I-123. [ABSTRACT FROM AUTHOR]

This paper describes a procedure for the estimation of 241Am and 239Pu activity present in the human tissue by measuring the depth of contaminant using a portable Planar High Purity Germanium detector (HPGe). The ratios of photopeak counts of X-rays or gammas obtained with the detector coupled to collimator are calculated for the estimation of depth of the contaminant and the optimum one is determined. Since Minimum Detectable Activities (MDA) for the detector coupled to a collimator are higher than that of bare detector, activity must be estimated using bare detector, after locating the contaminant. Two methods are described for the estimation of plutonium coexisting with 241Am: (i) Abundance and isotopic correction for 239Pu (ii) and 239Pu:241Am ratio. The procedure to estimate 239Pu when plutonium isotopes alone are present is also established. An optimum monitoring period to detect the minimum value of intake for both radionuclides corresponding to chelation therapy and excision is also derived. [ABSTRACT FROM AUTHOR]

Purpose: To propose an efficient collimator angle optimization method by combining island blocking (IB) and parked gap (PG) problem to reduce the radiotherapy dose for normal tissue. The reduction will be done with single‐isocenter multi‐lesion volumetric modulated arc therapy (VMAT) for the stereotactic body radiation therapy (SBRT) of liver cancer. Methods: A novel collimator angle optimization algorithm was developed based on the two‐dimensional projection of targets on a beam's eye view (BEV) plane as a function of gantry and collimator angle. This optimization algorithm minimized the sum of the combined IB and PG (IB & PG) areas from all gantry angles for each arc. For comparison, two SBRT plans were respectively generated for each of the 20 retrospective liver cancer cases with multiple lesions. One plan was optimized using the IB & PG algorithm, and the other plan was optimized with a previously reported optimization algorithm that only considered the IB area. Plans were then evaluated and compared using typical dosimetric metrics. Results: With the comparable target coverage, IB & PG plans had significantly lower D500cc, D700cc, mean dose (Dmean), and V15 of normal liver tissues when compared to IB plans. The median percent reductions were 3.32% to 5.36%. The D1cc, D5cc, and Dmean for duodenum and small intestine in IB & PG plans were significantly reduced in a range from 7.60% up to 16.03%. Similarly, the median integral dose was reduced by 3.73%. Furthermore, the percentage of normal liver Dmean sparing when IB & PG plans compared to IB plans, was found to be positively correlated (ρ = 0.669, P = 0.001) with the inter‐target distance. Conclusion: The proposed IB & PG algorithm has been demonstrated to outperform the IB algorithm in almost all normal tissue sparing, and the magnitude of liver sparing was positively correlated with inter‐target distance. [ABSTRACT FROM AUTHOR]

Background: Electron out‐of‐field scatter is generally not given importance mainly in electron fields. However, this is important when applicator down and boost treatments are given usually at an angle from the central axis. The electron scatter dose is found to be far away from the central axis which could be easily ignored. Purpose: This study aims to investigate the out‐of‐field radiation doses from electron applicators and their effects on clinical treatment. By identifying the parameters that contribute to out‐of‐field doses and to explore potential strategies for reducing these doses in order to improve patient outcomes from modern machines. Methods: Measurements were performed in water phantom using electron diode for modern Elekta and Varian machines. Dose profiles were acquired at surface and dmax with 0° and 90° collimation angle. Various gantry angles were also studied for some data with IC Profiler. The profiles were normalized with respect to the central axis dose. Results: The scatter dose peaks were found at a distance between 11 and 28 cm from the central axis on all machines. However, the peak shifts to 15 cm at 90° collimator when beam is tilted. The position and intensity of the dose varies with depth, collimator, and gantry angles for both Elekta and Varian machines. Due to clearance issues more gantry angles were studied for Elekta applicator compared to Varian. In general, Varian TrueBeam has a lower scatter that Elekta Infinity. The 90° collimator angle has a higher scatter compared to zero degree for both machines. Conclusions: There are clinically significant peripheral doses around 3% of the central axis dose from the electron applicator. Elekta has a slightly higher scatter (3%) than Varian (2%) that peaks at 25 cm which is clinically important but often overlooked. [ABSTRACT FROM AUTHOR]

Accurate in-vivo verification of beam range and dose distribution is crucial for the safety and effectiveness of particle therapy. Prompt gamma (PG) imaging, as a method for real-time verification, has gained prominence in this area. Currently, several PG imaging systems are under development, including gamma electron vertex imaging (GEVI), the Compton camera, the slit camera, and the multi-array type collimator camera. However, challenges persist in dose prediction accuracy, largely due to patient positioning uncertainty and anatomical changes. Although each system demonstrates potential in verifying PG range, further improvements in detection efficiency, spatial resolution, background reduction, and integration into clinical workflows are essential. [ABSTRACT FROM AUTHOR]

Objective. A novel x-ray field produced by an ultrathin conical target is described in the literature. However, the optimal design for an associated collimator remains ambiguous. Current optimization methods using Monte Carlo calculations restrict the efficiency and robustness of the design process. A more generic optimization method that reduces parameter constraints while minimizing computational load is necessary. A numerical method for optimizing the longitudinal collimator hole geometry for a cylindrically-symmetrical x-ray tube is demonstrated and compared to Monte Carlo calculations. Approach. The x-ray phase space was modelled as a four-dimensional histogram differential in photon initial position, final position, and photon energy. The collimator was modeled as a stack of thin washers with varying inner radii. Simulated annealing was employed to optimize this set of inner radii according to various objective functions calculated on the photon flux at a specified plane. Main results. The analytical transport model used for optimization was validated against Monte Carlo calculations using Geant4 via its wrapper, TOPAS. Optimized collimators and the resulting photon flux profiles are presented for three focal spot sizes and five positions of the source. Optimizations were performed with multiple objective functions based on various weightings of precision, intensity, and field flatness metrics. Finally, a select set of these optimized collimators, plus a parallel-hole collimator for comparison, were modeled in TOPAS. The evolution of the radiation field profiles are presented for various positions of the source for each collimator. Significance. This novel optimization strategy proved consistent and robust across the range of x-ray tube settings regardless of the optimization starting point. Common collimator geometries were re-derived using this algorithm while simultaneously optimizing geometry-specific parameters. The advantages of this strategy over iterative Monte Carlo-based techniques, including computational efficiency, radiation source-specificity, and solution flexibility, make it a desirable optimization method for complex irradiation geometries. [ABSTRACT FROM AUTHOR]

Purpose: Accurate dosimetry is critical for ensuring the safety and efficacy of radiopharmaceutical therapies. In current clinical dosimetry practice, MIRD formalisms are widely employed. However, with the rapid advancement of deep learning (DL) algorithms, there has been an increasing interest in leveraging the calculation speed and automation capabilities for different tasks. We aimed to develop a hybrid transformer-based deep learning (DL) model that incorporates a multiple voxel S-value (MSV) approach for voxel-level dosimetry in [177Lu]Lu-DOTATATE therapy. The goal was to enhance the performance of the model to achieve accuracy levels closely aligned with Monte Carlo (MC) simulations, considered as the standard of reference. We extended our analysis to include MIRD formalisms (SSV and MSV), thereby conducting a comprehensive dosimetry study. Methods: We used a dataset consisting of 22 patients undergoing up to 4 cycles of [177Lu]Lu-DOTATATE therapy. MC simulations were used to generate reference absorbed dose maps. In addition, MIRD formalism approaches, namely, single S-value (SSV) and MSV techniques, were performed. A UNEt TRansformer (UNETR) DL architecture was trained using five-fold cross-validation to generate MC-based dose maps. Co-registered CT images were fed into the network as input, whereas the difference between MC and MSV (MC-MSV) was set as output. DL results are then integrated to MSV to revive the MC dose maps. Finally, the dose maps generated by MSV, SSV, and DL were quantitatively compared to the MC reference at both voxel level and organ level (organs at risk and lesions). Results: The DL approach showed slightly better performance (voxel relative absolute error (RAE) = 5.28 ± 1.32) compared to MSV (voxel RAE = 5.54 ± 1.4) and outperformed SSV (voxel RAE = 7.8 ± 3.02). Gamma analysis pass rates were 99.0 ± 1.2%, 98.8 ± 1.3%, and 98.7 ± 1.52% for DL, MSV, and SSV approaches, respectively. The computational time for MC was the highest (~2 days for a single-bed SPECT study) compared to MSV, SSV, and DL, whereas the DL-based approach outperformed the other approaches in terms of time efficiency (3 s for a single-bed SPECT). Organ-wise analysis showed absolute percent errors of 1.44 ± 3.05%, 1.18 ± 2.65%, and 1.15 ± 2.5% for SSV, MSV, and DL approaches, respectively, in lesion-absorbed doses. Conclusion: A hybrid transformer-based deep learning model was developed for fast and accurate dose map generation, outperforming the MIRD approaches, specifically in heterogenous regions. The model achieved accuracy close to MC gold standard and has potential for clinical implementation for use on large-scale datasets. [ABSTRACT FROM AUTHOR]

Background: A new, alternative option for patients with recurrent glioblastoma is targeted alpha therapy (TAT), in the form of a local administration of substance P (neurokinin type 1 receptor ligand, NK-1) labelled with 225Ac. The purpose of the study was to confirm the feasibility of quantitative SPECT imaging of 225Ac, in a model reproducing specific conditions of TAT. In particular, to present the SPECT calibration methodology used, as well as the results of validation measurements and their accuracy. Additionally, to discuss the specific problems related to high noise in the presented case. Materials and methods: All SPECT/CT scans were conducted using the Symbia T6 equipped with HE collimators, and acquired with multiple energy windows (three main windows: 440 keV, 218 keV, and 78 keV, with three lower scatter energy windows). A Jaszczak phantom with fillable cylindrical sources of various sizes was used to investigate quantitative SPECT/CT imaging characteristics. The planar sensitivity of the camera, an imaging calibration factor, and recovery coefficients were determined. Additionally, the 3D printed model of the glioblastoma tumour was developed and imaged to evaluate the accuracy of the proposed protocol. Results: Using the imaging calibration factor and recovery coefficients obtained with the Jaszczak phantom, we were able to quantify the activity in a 3D-printed model of a glioblastoma tumour with uncertainty of no more than 10% and satisfying accuracy. Conclusions: It is feasible to perform quantitative 225Ac SPECT/CT imaging. However, there are still many more challenges that should be considered for further research on this topic (among others: accurate determination of ICF in the case of high background noise, better method of background estimation for recovery coefficient calculations, other methods for scatter correction than the dual-energy window scatter-compensation method used in this study). [ABSTRACT FROM AUTHOR]

Background: Dynamic treatment in Gamma Knife (GK) radiosurgery systems delivers radiation continuously with couch movement, as opposed to stationary step‐and‐shoot treatment where radiation is paused when moving between isocenters. Previous studies have shown the potential for dynamic GK treatment to give faster treatment times and improved dose conformity and homogeneity. However, these studies focused only on computational simulations and lack physical validation. Purpose: This study aims conduct dynamic treatment dosimetric validation with physical experimental measurements. The experiments aim to (1) address assumptions made with computational studies, such as the validity of treating a continuous path as discretised points, (2) investigate uncertainties in translating computed plans to actual treatment, and (3) determine ideal treatment planning parameters, such as interval distance for the path discretization, collimator change limitations, and minimum isocenter treatment times. Methods: This study uses a GK ICON treatment delivery machine, and a motion phantom custom‐made to attach to the machine's mask adapter and move in 1D superior‐inferior motion. Phantom positioning is first verified through comparisons against couch motion and computed doses. For dynamic treatment experiments, the phantom is moved through a program that first reads the desired treatment plan isocenters' position, time, and collimator sizes, then carries out the motion continuously while the treatment machine delivers radiation. Measurements are done with increasing levels of complexity: varying speed, varying collimator sizes, varying both speed and collimator sizes, then extends the same measurements to simulated 2D motion by combining phantom and couch motion. Dose comparisons between phantom motion radiation measurements and either couch motion measurements or dose calculations are analyzed with 2 mm/2% and 1 mm/2% gamma indices, using both local and global gamma index calculations. Results: Phantom positional experiments show a high accuracy, with global gamma indices for all dose comparisons ≥$\ge $99%. Discretization level to approximate continuous path as discrete points show the good dose matches with dose calculations when using 1 and 2‐mm gaps. Complex 1D motion, including varying speed, collimator sizes, or both, as well as 2D motion with the same complexities, all show good dose matches with dose calculations: the scores are ≥$\ge $92.0% for the strictest 1 mm/2% local gamma index calculation, ≥$\ge $ 99.8% for 2 mm/2% local gamma index, and ≥$\ge $97.0% for all global gamma indices. Five simulated 2D treatments with optimized plans scored highly as well, with all gamma index scores ≥$\ge $95.3% when compared to stationary treatment, and scores ≥$\ge $97.9% when compared to plan calculated dose. Conclusions: Dynamic treatment computational studies are validated, with dynamic treatment shown to be physically feasible and deliverable with high accuracy. A 2‐mm discretization level in treatment planning is proposed as the best option for shorter dose calculation times while maintaining dose accuracy. Our experimental method enables dynamic treatment measurements using the existing clinical workflow, which may be replicated in other centers, and future studies may include 2D or 3D motion experiments, or planning studies to further quantify potential indication‐specific benefits. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare the efficiency and accumulation of 99mTc attached to iron oxide nanoparticles (IONPs) for use in the SPECT imaging. A comprehensive literature search identified 13 relevant studies, and the maximum absorbed dose per gram (ID/g) of [99mTc] Tc-IONPs in various organs at different time intervals was analyzed. The findings showed the distribution patterns of the compounds in each organ, emphasizing the significance of coating and nanoparticle size for optimal imaging results. By selecting the appropriate coating and nanoparticle size, imaging quality and accuracy can be improved. [ABSTRACT FROM AUTHOR]

Purpose: Skin collimation is a useful tool in electron beam therapy (EBT) to decrease the penumbra at the field edge and minimize dose to nearby superficial organs at risk (OARs), but manually fabricating these collimation devices in the clinic to conform to the patient's anatomy can be a difficult and time intensive process. This work compares two types of patient‐specific skin collimation (in‐house 3D printed and vendor‐provided machined brass) using clinically relevant metrics. Methods: Attenuation measurements were performed to determine the thickness of each material needed to adequately shield both 6 and 9 MeV electron beams. Relative and absolute dose planes at various depths were measured using radiochromic film to compare the surface dose, flatness, and penumbra of the different skin collimation materials. Results: Clinically acceptable thicknesses of each material were determined for both 6 and 9 MeV electron beams. Field width, flatness, and penumbra results between the two systems were very similar and significantly improved compared to measurements performed with no surface collimation. Conclusion: Both skin collimation methods investigated in this work generate sharp penumbras at the field edge and can minimize dose to superficial OARs compared to treatment fields with no surface collimation. The benefits of skin collimation are greatest for lower energy electron beams, and the benefits decrease as the measurement depth increases. Using bolus with skin collimation is recommended to avoid surface dose enhancement seen with collimators placed on the skin surface. Ultimately, the appropriate choice of material will depend on the desire to create these devices in‐house or outsource the fabrication to a vendor. [ABSTRACT FROM AUTHOR]

Purpose: To investigate and characterize the performance of a novel orthogonal dual‐layer alpha multileaf collimator (αMLC) mounted on the LinaTech VenusX linac. Methods: We evaluated leaf positioning accuracy and reproducibility using an electronic portal imaging device through the picket fence test. The average, interleaf, intraleaf, and leaf tip transmissions of the single and dual layers were measured using an ionization chamber. Square and rhombus fields were used to evaluate the leaf penumbra of αMLC. To investigate the advantages of the orthogonal dual‐layer multileaf collimator (MLC) in field shaping, right triangular and circular pattern fields were formed using both the dual layers and single layers of the αMLC. Results: The average maximum positioning deviations of the upper and lower αMLC over 1 year were 0.76 ± 0.09 mm and 0.62 ± 0.07 mm, respectively. The average transmissions were 1.87%, 1.83%, and 0.03% for the upper‐, lower‐ and dual‐layer αMLC, respectively. The maximum interleaf transmissions of the lower‐ and dual‐layer were 2.43% and 0.17%, respectively. The leaf tip transmissions were 9.34% and 0.25%, respectively. The penumbra of the square field was 6.2 mm in the X direction and 8.0 mm in the Y direction. The average penumbras of the rhombus fields with side lengths of 5 and 10 cm were 3.6 and 4.9 mm, respectively. For the right triangular and circular fields, the fields shaped by the dual‐layer leaves were much closer to the set field than those shaped by single‐layer leaves. The dose undulation amplitude of the 50% isodose lines and leaf stepping angle change of the dual‐layer leaves were smaller than those of the single‐layer leaves. Conclusions: The αMLC benefits from its orthogonal dual‐layer design. Leaf transmission, dose undulations at the field edge, and MLC field dependence of the leaf stepping angle of the dual‐layer αMLC were remarkably reduced. [ABSTRACT FROM AUTHOR]

Purpose: Single‐isocenter multi‐target intracranial stereotactic radiotherapy (SIMT) is an effective treatment for brain metastases with complex treatment plans and delivery optimization necessitating rigorous quality assurance. This work aims to assess five methods for quality assurance of SIMT treatment plans in terms of their suitability and sensitivity to delivery errors. Methods: Sun Nuclear ArcCHECK and SRS MapCHECK, GafChromic EBT Radiochromic Film, machine log files, and Varian Portal Dosimetry were all used to measure 15 variations of a single SIMT plan. Variations of the original plan were created with Python. They comprised various degrees of systematic MLC offsets per leaf up to 2 mm, random per‐leaf variations with differing minimum and maximum magnitudes, simulated collimator, and dose miscalibrations (MU scaling). The erroneous plans were re‐imported into Eclipse and plan‐quality degradation was assessed by comparing each plan variation to the original clinical plan in terms of the percentage of clinical goals passing relative to the original plan. Each erroneous plan could be then ranked by the plan‐quality degradation percentage following recalculation in the TPS so that the effects of each variation could be correlated with γ pass rates and detector suitability. Results & conclusions: It was found that 2%/1 mm is a good starting point for the ArcCHECK, Portal Dosimetry, and the SRS MapCHECK methods, respectively, and provides clinically relevant error detection sensitivity. Looser dose criteria of 5%/1 mm or 5%/1.5 mm are suitable for film dosimetry and log‐file‐based methods. The statistical methods explored can be expanded to other areas of patient‐specific QA and detector assessment. [ABSTRACT FROM AUTHOR]

Spatially Fractionated Radiotherapy (SFRT) has demonstrated promising potential in cancer treatment, combining the advantages of reduced post-radiation effects and enhanced local control rates. Within this paradigm, proton minibeam radiotherapy (pMBRT) was suggested as a new treatment modality, possibly producing superior normal tissue sparing to conventional proton therapy, leading to improvements in patient outcomes. However, an effective and convenient beam generation method for pMBRT, capable of implementing various optimum dose profiles, is essential for its real-world application. Our study investigates the potential of utilizing the moiré effect in a dual collimator system (DCS) to generate pMBRT dose profiles with the flexibility to modify the center-to-center distance (CTC) of the dose distribution in a technically simple way. We employ the Geant4 Monte Carlo simulations tool to demonstrate that the angle between the two collimators of a DCS can significantly impact the dose profile. Varying the DCS angle from 10 ∘ to 50 ∘ we could cover CTC ranging from 11.8 mm to 2.4 mm, respectively. Further investigations reveal the substantial influence of the multi-slit collimator's (MSC) physical parameters on the spatially fractionated dose profile, such as period (CTC), throughput, and spacing between MSCs. These findings highlight opportunities for precision dose profile adjustments tailored to specific clinical scenarios. The DCS capacity for rapid angle adjustments during the energy transition stages of a spot scanning system can facilitate dynamic alterations in the irradiation profile, enhancing dose contrast in normal tissues. Furthermore, its unique attribute of spatially fractionated doses in both lateral directions could potentially improve normal tissue sparing by minimizing irradiated volume. Beyond the realm of pMBRT, the dual MSC system exhibits remarkable versatility, showing compatibility with different types of beams (X-rays and electrons) and applicability across various SFRT modalities. Our study illuminates the dual MSC system's potential as an efficient and adaptable tool in the refinement of pMBRT techniques. By enabling meticulous control over irradiation profiles, this system may expedite advancements in clinical and experimental applications, thereby contributing to the evolution of SFRT strategies. [ABSTRACT FROM AUTHOR]

Objective. The Elekta unity MR-linac delivers step-and-shoot intensity modulated radiotherapy plans using a multileaf collimator (MLC) based on the Agility MLC used on conventional Elekta linacs. Currently, details of the physical Unity MLC and the computational model within its treatment planning system (TPS) Monaco are lacking in published literature. Recently, a novel approach to characterize the physical properties of MLCs was introduced using dynamic synchronous and asynchronous sweeping gap (aSG) tests. Our objective was to develop a step-and-shoot version of the dynamic aSG test to characterize the Unity MLC and the computational MLC models in the Monaco and RayStation TPSs. Approach. Dynamic aSG were discretized into a step-and-shoot aSG by investigating the number of segments/sweep and the minimal number of monitor units (MU) per segment. The step-and-shoot aSG tests were compared to the dynamic aSG tests on a conventional linac at a source-to-detector distance of 143.5 cm, mimicking the Unity configuration. the step-and-shoot aSG tests were used to characterize the Unity MLC through measurements and dose calculations in both TPSs. Main results. The step-and-shoot aSGs tests with 100 segments and 5 MU/segment gave results very similar to the dynamic aSG experiments. The effective tongue-and-groove width of the Unity gradually increased up to 1.4 cm from the leaf tip end. The MLC models in RayStation and Monaco agreed with experimental data within 2.0% and 10%, respectively. The largest discrepancies in Monaco were found for aSG tests with >10 mm leaf interdigitation, which are non-typical for clinical plans. Significance. The step-and-shoot aSG tests accurately characterize the MLC in step-and-shoot delivery mode. The MLC model in RayStation 2023B accurately describes the tongue-and-groove and leaf tip effects whereas Monaco overestimates the tongue-and-groove shadowing further away from the leaf tip end. [ABSTRACT FROM AUTHOR]

Background: The administration of a 166Ho scout dose is available as an alternative to 99mTc particles for pre-treatment imaging in Selective Internal Radiation Therapy (SIRT). It has been reported that the 166Ho scout dose may be more accurate for the prediction of microsphere distribution and the associated therapy planning. The aim of the current study is to compare the scintigraphic imaging characteristics of both isotopes, considering the objectives of the pre-treatment imaging using clinically geared phantoms. Methods: Planar and SPECT/CT images were obtained using a NEMA image quality phantom in different phantom setups and another body-shaped phantom with several inserts. The influence of collimator type, count statistics, dead time effects, isotope properties and patient obesity on spatial resolution, contrast recovery and the detectability of small activity accumulations was investigated. Furthermore, the effects of the imaging characteristics on personalized dosimetry are discussed. Results: The images with 99mTc showed up to 3 mm better spatial resolution, up to two times higher contrast recovery and significantly lower image noise than those with 166Ho. The contrast-to-noise ratio was up to five times higher for 99mTc than for 166Ho. Only when using 99mTc all activity-filled spheres could be distinguished from the activity-filled background. The measurements mimicking an obese patient resulted in a degraded image quality for both isotopes. Conclusions: Our measurements demonstrate better scintigraphic imaging properties for 99mTc compared to 166Ho in terms of spatial resolution, contrast recovery, image noise, and lesion detectability. While the 166Ho scout dose promises better prediction of the microsphere distribution, it is important to consider the inferior imaging characteristics of 166Ho, which may affect individualized treatment planning in SIRT. [ABSTRACT FROM AUTHOR]

Purpose: Dopamine transporter (DAT) imaging is used to support the diagnosis of neurodegenerative parkinsonian disorders. Specific medications have been reported to confound the interpretation of [123I]I-FP-CIT SPECT scans, but there is limited data. The aim of the current study is to identify potential medication effects on the interpretation of [123I]I-FP-CIT SPECT scans in routine practice. Materials and methods: Consecutive patients undergoing a [123I]I-FP-CIT SPECT/CT scan on a 360° CZT camera between September 2019 and December 2022 were included. An exhaustive review of patient medications (antidepressants, antipsychotics, anti-epileptics, anti-parkinsonians, benzodiazepines, lithium, opioids, and stimulants) was performed. Two experienced nuclear physicians, blinded to the medication reports, interpreted the [123I]I-FP-CIT SPECT scans visually and a semi-quantitative analysis was performed using a local normal database. Results: The study included 305 patients (71.0 ± 10.4, 135 women) and 145 (47.5%) visually interpreted normal scans. In normal scans, the striatum/occiput radioligand uptake ratio was decreased by noradrenergic and specific serotonergic antidepressants (NASSAs) (n = 15, z-score of − 0.93) and opioid medication (tramadol, n = 6, z-score of − 0.85) and was associated with a younger age in the multivariate analysis. In the overall population, the striatum/occiput ratio was influenced by NASSAs and associated with consensual visual analysis, age, sex, and anti-parkinsonian medications related to the status of the disease. Conclusion: Our study confirms the potential impact of antidepressant (NASSA) and opioid (tramadol) medications on the semi-quantitative analysis of [123I]I-FP-CIT SPECT scans. However, when performing a visual analysis, only NASSAs significantly impacted the interpretation of [123I]I-FP-CIT SPECT scans. [ABSTRACT FROM AUTHOR]

Purpose: Deep convolutional neural networks (CNN) are promising for automatic classification of dopamine transporter (DAT)-SPECT images. Reporting the certainty of CNN-based decisions is highly desired to flag cases that might be misclassified and, therefore, require particularly careful inspection by the user. The aim of the current study was to design and validate a CNN-based system for the identification of uncertain cases. Methods: A network ensemble (NE) combining five CNNs was trained for binary classification of [123I]FP-CIT DAT-SPECT images as "normal" or "neurodegeneration-typical reduction" with high accuracy (NE for classification, NEfC). An uncertainty detection module (UDM) was obtained by combining two additional NE, one trained for detection of "reduced" DAT-SPECT with high sensitivity, the other with high specificity. A case was considered "uncertain" if the "high sensitivity" NE and the "high specificity" NE disagreed. An internal "development" dataset of 1740 clinical DAT-SPECT images was used for training (n = 1250) and testing (n = 490). Two independent datasets with different image characteristics were used for testing only (n = 640, 645). Three established approaches for uncertainty detection were used for comparison (sigmoid, dropout, model averaging). Results: In the test data from the development dataset, the NEfC achieved 98.0% accuracy. 4.3% of all test cases were flagged as "uncertain" by the UDM: 2.5% of the correctly classified cases and 90% of the misclassified cases. NEfC accuracy among "certain" cases was 99.8%. The three comparison methods were less effective in labelling misclassified cases as "uncertain" (40–80%). These findings were confirmed in both additional test datasets. Conclusion: The UDM allows reliable identification of uncertain [123I]FP-CIT SPECT with high risk of misclassification. We recommend that automatic classification of [123I]FP-CIT SPECT images is combined with an UDM to improve clinical utility and acceptance. The proposed UDM method ("high sensitivity versus high specificity") might be useful also for DAT imaging with other ligands and for other binary classification tasks. [ABSTRACT FROM AUTHOR]

La radiochirurgie pour le traitement de la névralgie du trijumeau délivre une très forte dose en une seule séance, sur quelques millimètres, au niveau d'un isocentre unique placé le long du nerf. Nous présentons ici les différentes étapes qui ont été réalisées pour valider des petits faisceaux par collimateurs coniques, et rapportons les résultats cliniques des premiers patients pris en charge sur Novalis Tx® sans cadre invasif. Nous avons d'abord été évalué l'exactitude géométrique des collimateurs coniques de 4 et 6 mm à l'aide de tests de Winston-Lutz ; puis l'acquisition des données dosimétriques a été réalisée grâce à des détecteurs de haute résolution spatiale (microdiamant PTW 60019 et une diode E PTW 60017). Les facteurs correctifs du rapport TRS no 483 ont été appliqués pour le calcul des facteurs d'ouverture du collimateur. Ces données dosimétriques ont ensuite été comparées avec les données implémentées dans le système de planification de traitement iPlan®. Puis des tests end-to-end ont permis de contrôler l'ensemble du processus de traitement à l'aide d'un fantôme anthropomorphique stereotactic end-to-end verification. Entre 2020 et 2022, 18 patients ont été traités pour névralgie trigéminale réfractaire sur Novalis Tx® sans cadre invasif avec repositionnement par Exactrac®. Dix-sept patients ont été évalués (un a été perdu de vue) à l'aide du score du Barrow Neurological Institute pour l'évaluation de la douleur, et par IRM avec un suivi médian de 12 mois. Les critères de qualité d'exactitude géométrique et dosimétriques ont été atteints pour le cône de 6 mm mais pas pour le cône de 4 mm. Tous les patients ont été traités avec un cône de 6 mm avec une dose de 90 Gy prescrite à l'isocentre ciblée au niveau de la root entry zone. Le contrôle initial de la douleur a été obtenu chez 70,5 % de nos patients, et 53 % ont conservé ce contrôle avec un suivi médian de 12 mois. Toutes les récidives sont survenues dans un délai de 3 à 6 mois après la radiochirurgie. Aucune toxicité n'a été observée sur le tronc cérébral. Trois patients ont eu une hypoesthésie faciale non invalidante. Le traitement des névralgies trigéminales sur accélérateur linéaire dédié est un traitement de haute technicité dont l'exactitude et la sécurité est primordiale. Les mesures physiques ont permis la mise en service de la technique avec un cône de 6 mm. Nos premiers résultats cliniques sont conformes aux données de la littérature. Radiosurgery for the treatment of trigeminal neuralgia delivers a very high dose in a single fraction, over a few millimeters, at a single isocenter placed along the nerve. We present here the different steps that have been performed to validate small beams by conical collimators, and report the clinical results of the first patients treated on Novalis Tx®, frameless. First, the geometric accuracy of 4 and 6 mm conical collimators was evaluated using Winston-Lutz tests; then dosimetric data acquisition was performed using high spatial resolution detectors (PTW 60019 microdiamond and a PTW 60017 E-diode). The corrective factors of the TRS 483 report were applied to calculate the collimator aperture factors. These dosimetric data were then compared with the data implemented in the iPlan® treatment planning system. Then end-to-end tests were performed to control the entire treatment process using an anthropomorphic phantom "STEEV". Between 2020 and 2022, 18 patients were treated for refractory trigeminal neuralgia on Novalis Tx®, frameless, with Exactrac® repositioning. A total of 17 patients were evaluated (one was lost to follow-up) using the BNI score for pain assessment and MRI with a median follow-up of 12 months. The quality criteria of geometric and dosimetric accuracy were met for the 6-mm cone but not for the 4-mm cone. All patients were treated with a 6-mm cone with a dose of 90 Gy prescribed at the isocenter at the root entry zone. Initial pain control was obtained in 70.5% of our patients, and 53% maintained pain control with a median follow-up of 12 months. All recurrences occurred within 3 to 6 months after radiosurgery. No brainstem toxicity was observed. Six patients had non-disabling facial hypoesthesia, half of whom already had pretreatment hypoesthesia. The treatment of trigeminal neuralgia on a dedicated linear accelerator is a highly technical treatment whose accuracy and safety are paramount. The physical measurements allowed the commissioning of the technique with a 6 mm cone. Our first clinical results are in accordance with the literature. [ABSTRACT FROM AUTHOR]

Purpose: To show the workflow for the commissioning of a MRlinac, and some proposed tests; off-axis targets, output factors for small fields, dose in inhomogeneities, and multileaf collimator quality assurance (MLC QA). Methods: The tests were performed based on TG-142, TG-119, ICRU 97, TRS-398, and TRS-483 recommendations as well as national regulations for radiation protection and safety. Results: The imaging tests are in agreement with the protocols. The radiation isocenter was 0.34 mm, and for off-axis targets location was up to 0.88 mm. The dose profiles measured and calculated in treatment planning system (TPS) passed in all cases the gamma analysis of 2%/2 mm (global dose differences). The output factors of fields larger than 2 cm × 2 cm are in agreement with the model of the MRlinac in the TPS. However, for smaller fields, their differences are higher than 10%. Picket fence test for different gantry angles showed a maximum leaf deviation up to 0.2 mm. Displacements observed in treatment couch adding weight (50 kg) are lower than 1 mm. Cryostat, bridge, and couch attenuation was up to 1.2%, 10%, and 24%, respectively. Conclusion: The implemented tests confirm that the studied MRlinac agrees with the standards reported in the literature and that the strict tolerances established as a baseline should allow a smoother implementation of stereotactic treatments in this machine. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the viability of utilizing the Structural Similarity Index (SSI*) as an innovative imaging metric for quality assurance (QA) of the multi‐leaf collimator (MLC). Additionally, we compared the results obtained through SSI* with those derived from a conventional Gamma index test for three types of Varian machines (Trilogy, Truebeam, and Edge) over a 12‐week period of MLC QA in our clinic. Method: To assess sensitivity to MLC positioning errors, we designed a 1 cm slit on the reference MLC, subsequently shifted by 0.5–5 mm on the target MLC. For evaluating sensitivity to output error, we irradiated five 25 cm × 25 cm open fields on the portal image with varying Monitor Units (MUs) of 96–100. We compared SSI* and Gamma index tests using three linear accelerator (LINAC) machines: Varian Trilogy, Truebeam, and Edge, with MLC leaf widths of 1, 0.5, and 0.25 mm. Weekly QA included VMAT and static field modes, with Picket fence test images acquired. Mechanical uncertainties related to the LINAC head, electronic portal imaging device (EPID), and MLC during gantry rotation and leaf motion were monitored. Results: The Gamma index test started detecting the MLC shift at a threshold of 4 mm, whereas the SSI* metric showed sensitivity to shifts as small as 2 mm. Moreover, the Gamma index test identified dose changes at 95MUs, indicating a 5% dose difference based on the distance to agreement (DTA)/dose difference (DD) criteria of 1 mm/3%. In contrast, the SSI* metric alerted to dose differences starting from 97MUs, corresponding to a 3% dose difference. The Gamma index test passed all measurements conducted on each machine. However, the SSI* metric rejected all measurements from the Edge and Trilogy machines and two from the Truebeam. Conclusions: Our findings demonstrate that the SSI* exhibits greater sensitivity than the Gamma index test in detecting MLC positioning errors and dose changes between static and VMAT modes. The SSI* metric outperformed the Gamma index test regarding sensitivity across these parameters. [ABSTRACT FROM AUTHOR]