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A composite comprising Ti and NaCl powders was sintered similar to a three-dimensional (3D)-printed patient-customized artificial bone scaffold. Additionally, a proper microstructure of the mimetic scaffold and the optimum processing parameters for its development were analyzed. The mechanical properties of the metal-based porous-structured framework used as an artificial bone scaffold were an optimum replacement for the human bone. Thus, it was confirmed that patient-customized scaffolds could be manufactured via 3D printing. The 3D-printed mimetic specimens were fabricated by a powder-sintering method using Ti for the metal parts, NaCl as the pore former, and polylactic acid as the biodegradable binder. Scanning electron microscopy (SEM) images showed that pores were formed homogeneously, while X-ray computed tomography confirmed that open pores were generated. The porosity and pore size distribution were measured using a mercury porosimeter, while the flexural strength and flexural elastic modulus were calculated using the three-point bending test. Based on these measurements, a pore-former content of 15 vol % optimized the density and flexural strength to 2.52 g cm

The aim of this study is to provide an effective method to construct a three-dimensionally (3D) printed scaffold to reconstruct a damaged bone. The tibia of a rabbit with a comminuted fracture was scanned by computed tomography. A bio-scaffold was designed using a 3D modeling program for its reconstruction and fabricated by a 3D printer. As the tibia could tolerate a large stress, pure biodegradable materials used alone as scaffold were not effective as they could not sufficiently support the weight of rabbit. Therefore, an external metal scaffold was required as a support. To fabricate the metal scaffold, its mechanical properties were calculated using simulations by the ANSYS static structural program. The simulation showed that the metal scaffold could endure five times the rabbit’s weight with a volume of 2362.93 mm3, area of 3671.23 mm2, and weight of 10.73 g. The proposed design of metal scaffold for a fractured bone exhibited a high supporting ability for the weight of the rabbit. The necessity of an external metal scaffold to support the biodegradable scaffold in bone reconstruction is demonstrated.

Background An O-ring gantry-type linear accelerator (LINAC) with a 6-MV flattening filter-free (FFF) photon beam, Halcyon, includes a reference beam that contains representative information such as the percent depth dose, profile and output factor for commissioning and quality assurance. However, because it does not provide information about the field size, we proposed a method to determine all field sizes according to all depths for radiation therapy using simplified sigmoidal curve fitting (SCF). Methods After mathematical definition of the SCF using four coefficients, the defined curves were fitted to both the reference data (RD) and the measured data (MD). For good agreement between the fitting curve and the profiles in each data set, the field sizes were determined by identifying the maximum point along the third derivative of the fitting curve. The curve fitting included the field sizes for beam profiles of 2 × 2, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20 and 28 × 28 cm2 as a function of depth (at 1.3, 5, 10 and 20 cm). The field size results from the RD were compared with the results from the MD using the same condition. Results All fitting curves show goodness of fit, R2, values that are greater than 0.99. The differences in field size between the RD and the MD were within the range of 0 to 0.2 cm. The smallest difference in the field sizes at a depth of 10 cm, which is a surface-to-axis distance, was reported. Conclusion Application of the SCF method has been proven to accurately capture the field size of the preconfigured RD and the measured FFF photon beam data for the Halcyon system. The current work can be useful for beam commissioning as a countercheck methodology to determine the field size from RD in the treatment planning system of a newly installed Halcyon system and for routine quality assurance to ascertain the correctness of field sizes for clinical use of the Halcyon system.

The aim of this study is to evaluate the feasibility of a deep learning tumor segmentation network trained by merged tumor dataset. PET-CT datasets for head-and-neck (H&N) and limb tumors were used to train three different networks: H&N, Limb, and merged (H&N + Limb). Dice similarity coefficient (DSC) of the merged network (0.89) in limb tumors was the same as that of the Limb network. In H&N tumor, DSC of the merged network (0.72) was higher than that of the H&N network (0.69). We found that the merged network could be applied simultaneously in H&N and limb tumor segmentation.

Purpose The purpose of this study was to investigate the matching error that occurs when the Mobius3D fingerprinting system is applied in conjunction with an Elekta linear accelerator (LINAC) and to offer an acceptable and alternative method for circumventing this problem. Material and methods To avoid the multileaf collimator (MLC) conflicting error in the Mobius3D fingerprinting system, we developed an in-house program to move the MLC in the Digital Imaging and Communications in Medicine (DICOM) radiotherapy (RT)-Plan to pertinent positions, considering the relationship between log data and planned data. The re-delivered log files were calculated in the Mobius3D system, and the results were compared with those of corrected data (i.e., we analyzed a pair of re-collected log data and the previous DICOM RT-Plan data). The results were then evaluated by comparing several items, such as point dose errors, gamma index (GI) passing rates, and MLC root-mean-square (RMS) values. Results For the point dose error, the maximum difference found was below 2.0%. In the case of GI analysis of all plans, the maximum difference in the passing rates was below 1.4%. The statistical results obtained using a paired Student's t-test showed that there were no significant differences within the uncertainty. In the case of the RMS test, the maximum difference found was approximately 0.08 mm. Conclusions Our results showed that all the mismatched log files were sufficiently acceptable within the uncertainty. We conclude that the matching error obtained when applying Mobius3D to an Elekta LINAC may be addressed using a simple modification of the fingerprinting system, and we expect that our study findings will help vendors resolve this issue in the near future.

The purpose of the present study was to develop a hybrid magnetic resonance/computed tomography (MR/CT)-compatible phantom and tissue-equivalent materials for each MR and CT image. Therefore, the essential requirements necessary for the development of a hybrid MR/CT-compatible phantom were determined and the development process is described. A total of 12 different tissue-equivalent materials for each MR and CT image were developed from chemical components. The uniformity of each sample was calculated. The developed phantom was designed to use 14 plugs that contained various tissue-equivalent materials. Measurement using the developed phantom was performed using a 3.0-T scanner with 32 channels and a Somatom Sensation 64. The maximum percentage difference of the signal intensity (SI) value on MR images after adding K2CO3 was 3.31%. Additionally, the uniformity of each tissue was evaluated by calculating the percent image uniformity (%PIU) of the MR image, which was 82.18 ±1.87% with 83% acceptance, and the average circular-shaped regions of interest (ROIs) on CT images for all samples were within ±5 Hounsfield units (HU). Also, dosimetric evaluation was performed. The percentage differences of each tissue-equivalent sample for average dose ranged from −0.76 to 0.21%. A hybrid MR/CT-compatible phantom for MR and CT was investigated as the first trial in this field of radiation oncology and medical physics.

To investigate the optimal detector material for prompt gamma imaging during boron neutron capture therapy, in this study, we evaluated the characteristic regarding radiation reaction of available detector materials using a Monte Carlo simulation. Sixteen detector materials used for radiation detection were investigated to assess their advantages and drawbacks. The estimations used previous experimental data to build the simulation codes. The energy resolution and detection efficiency of each material was investigated, and prompt gamma images during BNCT simulation were acquired using only the detectors that showed good performance in our preliminary data. From the simulation, we could evaluate the majority of detector materials in BNCT and also could acquire a prompt gamma image using the six high ranked-detector materials and lutetium yttrium oxyorthosilicate. We provide a strategy to select an optimal detector material for the prompt gamma imaging during BNCT with three conclusions. Keywords: Boron neutron capture therapy (BNCT), Prompt gamma, Detector materials, Monte Carlo simulation

In high energy electron beam therapy, a bolus can be used for the conformal dose to target and achieve the appropriate treatment quality. To evaluate the use of a customized silicone bolus, we analyzed the dosimetric properties of the electron beam according to the silicone bolus thickness. Eight silicone slits were fabricated using an acrylic mold. The size of each slit was 150 × 150 × 5 m3 (width × length × height). Degassing was performed to eliminate bubbles in the slits during the silicone casting process. Depth dose measurements were performed for a 6 MeV and 9 MeV electron beams with 10 × 10 cm2, 6 × 6 cm2 and 5 cm diameter circular fields with various silicone thickness and with the conventional bolus. For the depth dose measurement, the film was placed between two 6 cm solid water phantoms, and the electron beam was delivered parallel to the film. The Rando phantom dose with customized bolus were evaluated with the 10 × 10 cm2 6 MeV electron beam. As the slab thickness increased, the depth dose in the solid water phantom decreased after reaching the maximum dose depth (dmax). Depending on the silicone thickness, the surface dose of the phantom was increased until reaching the electron beam dmax and was decreased after dmax. The coefficient to convert the thickness of the silicone to water were 1.06 in 6 MeV and 1.07 in 9 MeV, respectively. We measured the electron beam dose properties for making patient-specific silicone boluses with optimal thickness. The results of this study can be used to predict the silicone bolus thickness required in order to deliver the appropriate dose to the target.

Purpose We compared and analyzed the detectability performance pertaining to an abdominal phantom including a region of interest (ROI) according to a computed tomography (CT) reconstruction algorithm. Methods Three types of reconstruction algorithms (FBP, SAFIRE, and ADMIRE) were used to evaluate the detectability performance using the abdominal phantom (phantom size: 25 × 18 × 28 cm3 ). The vendor default settings for routine multi-detector computed tomography abdominal scans were used. As the quantitative evaluation method, the contrast-to-noise ratio (CNR), difference in coefficient of variation (COV) with the normalization based on the FBP data, and the noise power spectrum (NPS) were measured. Results The characteristic of the ADMIRE-3 reconstructed image was higher than those of the FBP and SAFIRE-3 reconstructed images. The CNR values of the SAFIRE and ADMIRE images were much higher than the corresponding values of the FBP images. The difference in COV values for the ADMIRE images was ~1.2 times lower than the corresponding values of the SAFIRE images. Conclusion The comparative analysis of the abdominal phantom low-contrast resolution differences for each CT exposure parameters showed that ADMIRE demonstrated better results than SAFIRE and FBP in terms of contrast, CNR, COV difference, and 1D NPS. This indicates that ADMIRE can provide a clearer observation even with the same number of contrast objects as compared to SAFIRE and FBP owing to its better contrast resolution in the central part of the contrast hole at low kV.

The purpose of this study is to investigate the possibility of interchanging patients on beam-matched linear accelerators (linacs), by evaluating the dosimetric variation and the dose delivery accuracy of volumetric modulated arc therapy (VMAT). Two VitalBeam linacs installed recently in our center were included in this study. For dosimetric data comparison, beam data, such as percentage depth doses (PDDs), beam profiles, output factors, multi-leaf collimator (MLC) leaf transmission factors, and the dosimetric leaf gap (DLG), for 6-MV and 10-MV beams were measured on both linacs. Sixty patients (20 head and neck, 20 lung, and 20 prostate cancers) were selected to evaluate the dosimetric parameters and the delivery accuracy of the VMAT plans created for various treatment sites. All the VMAT plans were generated using the Eclipse treatment planning system (TPS) with the same optimizer algorithm. The dose differences between two beam-matched linacs for planning target volumes (PTVs) and organs at risk (OARs) were recorded and analyzed. Patient-specific dosimetric quality assurance (DQA) using the Electronic Portal Image Device (EPID) were performed, and the measured planar doses were compared with those calculated by using the TPS though absolute dose gamma evaluation using 2%/2 mm and 2%/3 mm criteria. The differences in all dosimetric beam data between the two beam-matched linacs were all within 1% for the 6-MV and the 10-MV beams. For all 60 cases of three treatment sites, no notable differences were observed in the dosimetric comparison and the DVH variation between the beam-matched linacs. The average differences in dosimetric parameters of PTV and OARs were all within 1%. Furthermore, all passing rates of measured doses on the beam-matched linacs were higher than 93% and 97% for the 2%/2 mm and the 2%/3 mm criteria, respectively. Our overall dosimetric variation in beam data and VMAT plans remains within the tolerance of clinical acceptability. Pretreatment verification results were also clinically acceptable, showing good agreement with the calculated doses. Therefore, this study demonstrated the possibility of swapping patients in a VMAT plan without any modification and re-planning between two beam-matched linacs.

This study aimed to determine the optimal initial electron beam parameters of a Linac for radiotherapy with a multivariate approach using statistical and machine-learning tools.For MC beam commissioning, a 6 MV Varian Clinac was simulated using the Geant4 toolkit. The authors investigated the relations between simulated dose distribution and initial electron beam parameters, namely, mean energy (E), energy spread (ES), and radial beam size (RS). The goodness of simulation was evaluated by the slope of differences between the simulated and the golden beam data. The best-fit combination of the electron beam parameters that minimized the slope of dose difference was searched through multivariate methods using conventional statistical methods and machine-learning tools of the scikit-learn library.Simulation results with 87 combinations of the electron beam parameters were analyzed. Regardless of being univariate or multivariate, traditional statistical models did not recommend a single parameter set simultaneously minimizing slope of dose differences for percent depth dose (PDD) and lateral dose profile (LDP). Two machine learning classification modules, RandomForestClassifier and BaggingClassifier, agreed in recommending (E = 6.3 MeV, ES = ±5.0%, RS = 1.0 mm) for predicting simultaneous acceptance of PDD and LDP.The machine learning with random-forest and bagging classifier modules recommended a consistent result. It was possible to draw an optimal electron beam parameter set using multivariate methods for MC simulation of a radiotherapy 6 MV Linac.

This study introduces and evaluates respiratory-correlated four-dimensional (4D) inverse geometry computed tomography (IGCT). The projection data of the IGCT were acquired in a single gantry rotation over 120 s. Three virtual phantoms—static Defrise, 4D Shepp–Logan, and 4D extended cardiac-torso (XCAT)—were used to obtain projection data for the IGCT and cone-beam computed tomography (CBCT). The projection acquisition parameters were determined to eliminate vacancies in the Radon space for an accurate rebinning process. Phase-based sorting was conducted within 10 phase bins, and the sorted projection data were binned into a cone beam geometry. Finally, Feldkamp–Davis–Kress reconstruction was conducted independently at each phase. The reconstructed images were compared using the structural similarity index measure (SSIM) and root mean square error (RMSE). The vertical profile of the Defrise reconstruction image was uniform, and the cone beam artefact was reduced in the IGCT image. Under an ideal projection acquisition condition, the mean coronal plane SSIMs of the Shepp–Logan and 4D XCAT phantoms were 0.899 and 0.706, respectively, which were higher than those of the CBCT (0.784 and 0.623, respectively). Similarly, the mean RMSEs of the coronal plane IGCT (0.036 and 0.158) exhibited an improvement over those of the CBCT (0.165 and 0.261, respectively). The mean standard deviations of the SSIM and RMSE were lower for IGCT than for CBCT. In particular, the SSIM and RMSE of the sagittal and coronal planes of the Shepp–Logan IGCT images were stable in all phase bins; however, those of the CBCT changed depending on the phase bins. Poor image quality was observed for IGCT under inappropriate conditions. This was caused by a vacancy in the Radon space, owing to an inappropriate scan setting. Overall, the proposed 4D IGCT exhibited better image quality than conventional CBCT.

Background : An O-ring gantry-type linear accelerator (Linac) with a 6 MV flattening filter-free (FFF) photon beam, Halcyon, includes a reference beam containing the representative information regarding the percent depth dose, profile, output factor, etc. for commissioning and quality assurance. However, because it does not provide the information of the field size, we proposed a method to determine all field sizes according to all depths for radiation therapy using simplified sigmoidal curve fitting (SCF). Methods : After a mathematical definition of the SCF using four coefficients, the defined curves were fitted to both the reference and measured data. For a high agreement between the fitting curve and the profiles in each data set, the field sizes were determined by identifying the maximum point along the third derivative of the fitting curve. The curve fitting included the field sizes for beam profiles of 2 × 2, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20 and 28 × 28 cm 2 as a function of depth (at 1.3, 5, 10, 20 cm). The results of the field size from the reference data were compared with the results in the measured data using the same condition. Results : All fitting curves show values of goodness of fit, R 2 , better than 0.99. The differences in the field size between the reference data and the measured data were within the range of 0 to 0.2 cm. The lowest difference in the field sizes at a depth of 10 cm, which is a surface-to-axis distance, was reported. Conclusion : The application of the SCF has been proven to accurately obtain the field size of the preconfigured reference and of the measured FFF photon beam data for the Halcyon system. The current work can be useful for beam commissioning as a counte-rcheck methodology to determine the field size from the reference data in the treatment planning system of a newly installed Halcyon system and for the routine quality assurance to ascertain the correctness of field sizes clinically used with the Halcyon system.

Background: An O-ring gantry-type linear accelerator (Linac) with a 6 MV flattening filter-free (FFF) photon beam, Halcyon, includes a reference beam containing the representative information regarding the percent depth dose, profile, output factor, etc. for commissioning and quality assurance. However, because it does not provide the information of the field size, we proposed a method to determine all field sizes according to all depths for radiation therapy using simplified sigmoidal curve fitting (SCF).Methods: After a mathematical definition of the SCF using four coefficients, the defined curves were fitted to both the reference and measured data. For a high agreement between the fitting curve and the profiles in each data set, the field sizes were determined by identifying the maximum point along the third derivative of the fitting curve. The curve fitting included the field sizes for beam profiles of 2 × 2, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20 and 28 × 28 cm2 as a function of depth (at 1.3, 5, 10, 20 cm). The results of the field size from the reference data were compared with the results in the measured data using the same condition.Results: All fitting curves show values of goodness of fit, R2, better than 0.99. The differences in the field size between the reference data and the measured data were within the range of 0 to 0.2 cm. The lowest difference in the field sizes at a depth of 10 cm, which is a surface-to-axis distance, was reported. Conclusion: The application of the SCF has been proven to accurately obtain the field size of the preconfigured reference and of the measured FFF photon beam data for the Halcyon system. The current work can be useful for beam commissioning as a countercheck methodology to determine the field size from the reference data in the treatment planning system of a newly installed Halcyon system and for the routine quality assurance to ascertain the correctness of field sizes clinically used with the Halcyon system.

The purpose of this study is to evaluate the performance of a “stealth chamber” as a novel reference detector for measuring the commissioning beam data for a wedge field. The stealth chamber is a transmission ionization chamber intended to be used as a reference chamber for relative dosimetry. The percentage depth doses (PDDs) and the dose profiles of 6-, 8-, and 10-MV photon beams of four wedge filters were measured using the stealth and the CC13 chambers as reference detectors. The PDD and the profile measurements were performed under various field sizes ranging from 4 × 4 cm2 to 20 × 20 cm2. For the evaluate of the performance of the stealth chamber in fields with a physical wedge, all measurement data obtained using the stealth chamber as a reference detector were compared with those measured using two CC13 chambers as both field and reference detectors. For the PDDs, the differences in dosimetric parameters such as the depth of maximum dose (dmax) and the PDD at 10 cm (D10) and 5 cm (D5) were analyzed for both reference detectors. In addition, the root-mean-square error (RMSE) was calculated to measure the agreement of the profiles at dmax and a 10 cm depth. The percentage differences in D10 and D5 between both detectors were less than 1% for all energies and fields with four wedges. Furthermore, the RMSEs of the profiles at dmax and 10-cm depth in both chambers were within 1% for all energies and fields except for the 60° wedge angle. This study found that the use of a stealth chamber to measure the commissioning beam data for a wedge field is feasible, although a relatively large difference in the PDD was observed in the build-up region. However, we recommend careful verification of the PDDs and dose profiles for large field size and wedge angle before clinical use.

Background Delivery of a single energy 6 MV flattening filter free (FFF) photon beam is a main characteristic of an O-ring gantry type linear accelerator (linac) Halcyon. The purpose of this study is to determine the field size of the beam through an application of the simplified sigmoidal curve fitting (SCF) to the beam profiles obtained from the preconfigured reference data of Halcyon, and then to compare its parametrization with the measured beam data from Halcyon. Methods After a mathematical definition of the SCF using four coefficients, the defined curves were fitted to both the reference and measured data. When a high agreement between the fitting curve and the profiles in each data, the field sizes were determined by identifying the maximum point along the third derivative of the fitting curve. The curve fitting included the field sizes for beam profiles as 2 × 2, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20 and 28 × 28 cm 2 as a function of depths (at 1.3, 5, 10, 20 cm). The results of the field size from the reference data were compared with the results in the measured data using same condition. Results All fitting curves show an average agreement ratio higher than 97% and the values of goodness of fit, R 2 , as better than 0.99. The differences of the field size between the reference data and the measured data were within the range of 0 to 0.2 cm. The least difference of the field sizes at depth 10 cm which is a surface to axis distance was reported. Conclusion The application of the SCF has been proved to accurately obtain the field size of the preconfigured reference and of measured FFF photon beam data for Halcyon. The current work can be useful to the beam commissioning as a countercheck methodology to the field size from the reference data in the treatment planning system of a newly installed Halcyon and to the routine quality assurance to ascertain the correctness of field sizes clinically used with the Halcyon.

Purpose Scanning proton therapy has dosimetric advantage over passive treatment, but has a large penumbra in low-energy region. This study investigates the penumbra reduction when multi-leaf collimators (MLCs) are used for line scanning proton beams and secondary neutron production from MLCs. Methods Scanning beam plans with and without MLC shaping were devised. Line scanning proton plan of 36 energy layers between 71.2 and 155.2 MeV was generated. The MLCs were shaped according to the cross-sectional target shape for each energy layer. The two-dimensional doses were measured through an ion-chamber array, depending on the presence of MLC field, and Monte Carlo (MC) simulations were performed. The plan, measurement, and MC data, with and without MLC, were compared at each depth. The secondary neutron dose was simulated with MC. Ambient neutron dose equivalents were computed for the line scanning with 10 × 10 × 5 cm3 volume and maximum proton energy of 150 MeV, with and without MLCs, at lateral distances of 25–200 cm from the isocenter. The neutron dose for a wobbling plan with 10 × 10 × 5 cm3 volume was also evaluated. Results The lateral penumbra width using MLC was reduced by 23.2% on average, up to a maximum of 32.2%, over the four depths evaluated. The ambient neutron dose equivalent was 18.52% of that of the wobbling beam but was 353.1% larger than the scanning open field. Conclusions MLC field shaping with line scanning reduced the lateral penumbra and should be effective in sparing normal tissue. However, it is important to investigate the increase in neutron dose.

The purpose of this study is to evaluate the performance of a "stealth chamber" as a novel reference chamber for measuring percentage depth dose (PDD) and profile of 6, 8 and 10 MV photon energies. The PDD curves and dose profiles with fields ranging from $3{\times}3$ to $25{\times}25cm...

This study analyzed the effectiveness attained through generation of three alpha particles in proton-boron fusion therapy (PBFT) based on a Monte Carlo simulation. PBFT is based on a fusion reaction between protons and boron. Three alpha particles are emitted from this reaction. The three alpha particles cause greater damage to tumor cells than the single alpha particle produced in the boron neutron capture reaction or conventional therapy. In addition, the intrinsic proton dose pattern follows Bragg-peak curve. We confirmed an energy deposition by the alpha particle and verified the therapeutic effect of the PBFT.

In this study, we investigated the clinical performance of an online dosimetry system (Mobius FX system, MFX) by 1) dosimetric plan verification using gamma passing rates and dose volume metrics and 2) error-detection capability evaluation by deliberately introduced machine error. Eighteen volumetric modulated arc therapy (VMAT) plans were studied. To evaluate the clinical performance of the MFX, we used gamma analysis and dose volume histogram (DVH) analysis. In addition, to evaluate the error-detection capability, we used gamma analysis and DVH analysis utilizing three types of deliberately introduced errors (Type 1: gantry angle-independent multi-leaf collimator (MLC) error, Type 2: gantry angle-dependent MLC error, and Type 3: gantry angle error). A dosimetric verification comparison of physical dosimetry system (Delt4PT) and online dosimetry system (MFX), gamma passing rates of the two dosimetry systems showed very good agreement with treatment planning system (TPS) calculation. For the average dose difference between the TPS calculation and the MFX measurement, most of the dose metrics showed good agreement within a tolerance of 3%. For the error-detection comparison of Delta4PT and MFX, the gamma passing rates of the two dosimetry systems did not meet the 90% acceptance criterion with the magnitude of error exceeding 2 mm and 1.5 ◦, respectively, for error plans of Types 1, 2, and 3. For delivery with all error types, the average dose difference of PTV due to error magnitude showed good agreement between calculated TPS and measured MFX within 1%. Overall, the results of the online dosimetry system showed very good agreement with those of the physical dosimetry system. Our results suggest that a log file-based online dosimetry system is a very suitable verification tool for accurate and efficient clinical routines for patient-specific quality assurance (QA).

The purpose of this study is to evaluate the prompt gamma ray imaging technique according to the clinical boron concentration range during proton boron fusion therapy (PBFT). To acquire a prompt gamma ray image from 32 projections, we simulated four head single photon emission computed tomography and a proton beam nozzle using a Monte Carlo simulation. We used modified ordered subset expectation maximization reconstruction algorithm with a graphic processing unit for fast image acquisition. Boron concentration was set as 20 to 100 μg at intervals of 20 μg. For quantitative analysis of the prompt gamma ray image, we acquired an image profile drawn through two boron uptake regions (BURs) and calculated the contrast value, signal-to-noise ratio (SNR), and difference between the physical target volume and volume of the prompt gamma ray image. The relative counts of prompt gamma rays were noticeably increased with increasing boron concentration. Although the intensities on the image profiles showed a similar tendency according to the boron concentration, the SNR and contrast value were improved with increasing boron concentration. This study suggests that a tumor monitoring technique using prompt gamma ray detection can be clinically applicable even if the boron concentration is relatively low.

The purpose of this research is to demonstrate, based on a Monte Carlo simulation code, the procedure of radiation treatment planning for proton-boron fusion therapy (PBFT). A discrete proton beam (60 - 120 MeV) relevant to the Bragg peak was simulated using a Monte Carlo n-particle extended (MCNPX, Ver. 2.6.0, National Laboratory, Los Alamos NM, USA) simulation code. After computed tomography (CT) scanning of a virtual water phantom including air cavities, the acquired CT images were converted using the simulation source code. We set the boron uptake regions (BURs) in the simulated water phantom to achieve the proton-boron fusion reaction. Proton sources irradiated the BUR, in the phantom. The acquired dose maps were overlapped with the original CT image of the phantom to analyze the dose volume histogram (DVH). We successfully confirmed amplifications of the proton doses (average: 130%) at the target regions. From the DVH result for each simulation, we acquired a relatively accurate dose map for the treatment. A simulation was conducted to characterize the dose distribution and verify the feasibility of proton-boron fusion therapy (PBFT). We observed a variation in proton range and developed a tumor-targeting technique for treatment that was more accurate and powerful than both conventional proton therapy and boron-neutron capture therapy.

Respiratory gated radiation therapy (RGRT) gives accurate results when a patient’s breathing is stable and regular. Thus, the patient should be acutely aware during respiratory pattern training before undergoing the RGRT treatment. To bypass the process of respiratory pattern training, we propose a tumor location prediction system for RGRT that uses only the natural respiratory volume, and we confirm its application. In order to verify the proposed tumor location prediction system, we used an in-house phantom set. The set involved a chest phantom with target, external markers and a motion generator. Natural respiratory volume signals were generated using the random function in the MATLAB code. In the chest phantom, the target undergoes linear motion based on the respiratory signal. After a four-dimensional computed tomography (4DCT) scan of the in-house phantom, the motion trajectory was derived as a linear equation. The accuracy of the linear equation was compared with that of the motion algorithm used by the operating motion generator. In addition, we attempted to predict the tumor’s location by using the random respiratory volume values. The correspondence rate of the linear equation derived from the 4DCT images with the motion algorithm of the motion generator was 99.41% (p > 0.05). Also, the average error rate of the tumor-location prediction was 1.23% for 26 cases. We confirmed the applicability of our proposed tumor location prediction system using the natural respiratory volume for RGRT. If additional clinical studies can be conducted, a more accurate prediction that would not require respiratory pattern training can be realized.

Purpose Deformable lung phantoms have been proposed to investigate four-dimensional (4D) imaging and radiotherapy delivery techniques. However, most phantoms mimic only the lung and tumor without pulmonary airways. The purpose of this study was to develop a reproducible, deformable lung phantom with three-dimensional (3D)-printed airways. Methods The phantom consists of: (a) 3D-printed flexible airways, (b) flexible polyurethane foam infused with iodinated contrast agents, and (c) a motion platform. The airways were simulated using publicly available breath-hold computed tomography (CT) image datasets of a human lung through airway segmentation, computer-aided design modeling, and 3D printing with a rubber-like material. The lung was simulated by pouring liquid expanding foam into a mold with the 3D-printed airways attached. Iodinated contrast agents were infused into the lung phantom to emulate the density of the human lung. The lung/airways phantom was integrated into our previously developed motion platform, which allows for compression and decompression of the phantom in the superior-inferior direction. We quantified the reproducibility of the density (lung), motion/deformation (lung and airways), and position (airways) using breath-hold CT scans (with the phantom compressed and decompressed) repeated every two weeks over a 2-month period as well as 4D CT scans (with the phantom continuously compressed and decompressed) repeated twice over four weeks. The density reproducibility was quantified with a difference image (created by subtracting the rigidly registered baseline and the repeated images) in each of the compressed and decompressed states. Reproducibility of the motion/deformation was evaluated by comparing the baseline displacement vector fields (DVFs) derived from deformable image registration (DIR) between the compressed and decompressed phantom CT images with those of repeated scans and calculating the difference in the displacement vectors. Reproducibility of the airway position was quantified based on DIR between the baseline and repeated images. Results For the breath-hold CT scans, the mean difference in lung density between baseline and week 8 was -1.3 (standard deviation 33.5) Hounsfield unit (HU) in the compressed state and 0.4 (36.8) HU in the decompressed state, while large local differences were observed around the high-contrast structures (caused by small misalignments). By visual inspection, the DVFs (between the compressed and decompressed states) at baseline and last time point (week 8 for the breath-hold CT scans) demonstrated a similar pattern. The mean lengths of displacement vector differences between baseline and week 8 were 0.5 (0.4) mm for the lung and 0.3 (0.2) mm for the airways. The mean airway displacements between baseline and week 8 were 0.6 (0.5) mm in the compressed state and 0.6 (0.4) mm in the decompressed state. We also observed similar results for the 4D CT scans (week 0 vs week 4) as well as for the breath-hold CT scans at other time points (week 0 vs weeks 2, 4, and 6). Conclusions We have developed a deformable lung phantom with 3D-printed airways based on a human lung CT image. Our findings indicate reproducible density, motion/deformation, and position. This phantom is based on widely available materials and technology, which represents advantages over other deformable phantoms.

The purpose of this study was to evaluate the impact of dosimetric and radiobiological parameters on treatment plans by using different dose-calculation algorithms and delivery-beam modes for prostate stereotactic body radiation therapy using an endorectal balloon. For 20 patients with prostate cancer, stereotactic body radiation therapy (SBRT) plans were generated by using a 10-MV photon beam with flattening filter (FF) and flattening-filter-free (FFF) modes. The total treatment dose prescribed was 42.7 Gy in 7 fractions to cover at least 95% of the planning target volume (PTV) with 95% of the prescribed dose. The dose computation was initially performed using an anisotropic analytical algorithm (AAA) in the Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA) and was then re-calculated using Acuros XB (AXB V. 11.0.34) with the same monitor units and multileaf collimator files. The dosimetric and the radiobiological parameters for the PTV and organs at risk (OARs) were analyzed from the dose-volume histogram. An obvious difference in dosimetric parameters between the AAA and the AXB plans was observed in the PTV and rectum. Doses to the PTV, excluding the maximum dose, were always higher in the AAA plans than in the AXB plans. However, doses to the other OARs were similar in both algorithm plans. In addition, no difference was observed in the dosimetric parameters for different delivery-beam modes when using the same algorithm to generate plans. As a result of the dosimetric parameters, the radiobiological parameters for the two algorithm plans presented an apparent difference in the PTV and the rectum. The average tumor control probability of the AAA plans was higher than that of the AXB plans. The average normal tissue complication probability (NTCP) to rectum was lower in the AXB plans than in the AAA plans. The AAA and the AXB plans yielded very similar NTCPs for the other OARs. In plans using the same algorithms, the NTCPs for delivery-beam modes showed no differences. This study demonstrated that the dosimetric and the radiobiological parameters for the PTV and the rectum affected the dose-calculation algorithms for prostate SBRT using an endorectal balloon. However, the dosimetric and the radiobiological parameters in the AAA and the AXB plans for other OARs were similar. Furthermore, difference between the dosimetric and the radiobiological parameters for different delivery-beam modes were not found when the same algorithm was used to generate the treatment plan.

The purpose of this study was to analyze the glottis rotational error (GRE) by using a thermoplastic mask for patients with the glottic cancer undergoing intensity-modulated radiation therapy (IMRT). We selected 20 patients with glottic cancer who had received IMRT by using the tomotherapy. The image modalities with both kilovoltage computed tomography (planning kVCT) and megavoltage CT (daily MVCT) images were used for evaluating the error. Six anatomical landmarks in the image were defined to evaluate a correlation between the absolute GRE (°) and the length of contact with the underlying skin of the patient by the mask (mask, mm). We also statistically analyzed the results by using the Pearson’s correlation coefficient and a linear regression analysis (P

Background The aim of this study was to determine the optimal strategy among various arc arrangements in prostate plans of stereotactic body radiotherapy with volumetric modulated arc therapy (SBRT-VMAT). Patients and methods To investigate how arc arrangements affect dosimetric and biological metrics, SBRT-VMAT plans for eighteen patients were generated with arrangements of single-full arc (1FA), single-partial arc (1PA), double-full arc (2FA), and double-partial arc (2PA). All plans were calculated by the Acuros XB calculation algorithm. Dosimetric and radiobiological metrics for target volumes and organs at risk (OARs) were evaluated from dosevolume histograms. Results All plans were highly conformal (CI2% and mean dose in both femoral heads were always lower in plans using 1FA and 2FA. The average tumor control probability and normal tissue complication probability were comparable in plans using all arc arrangements. Conclusions The use of 1PA had a more effective delivery time and produced equivalent target coverage with better rectal sparing, although all plans using four arc arrangements showed generally similar for dosimetric and biological metrics. However, the D2% and mean dose in femoral heads increased slightly and remained within the tolerance. Therefore, this study suggests that the use of 1PA is an attractive choice for delivering prostate SBRT-VMAT.

Purpose The purpose of total body irradiation (TBI) techniques is to deliver a uniform radiation dose to the entire volume of a patient's body. Due to variations in the thickness of the patient, it is difficult to produce such a uniform dose distribution throughout the body. In many techniques, a compensator is used to adjust the dose delivered to various sections of the patient. The current study aims to develop and validate an innovative method of using depth-sensing cameras and 3D printing techniques for TBI treatment planning and compensator fabrication. Methods A tablet with an integrated depth-sensing camera and motion tracking sensors was used to scan a RANDO™ phantom positioned in a TBI treatment booth to detect and store the 3D surface in a point cloud format. The accuracy of the detected surface was evaluated by comparing extracted body thickness measurements with corresponding measurements from computed tomography (CT) scan images. The thickness, source to surface distance, and off-axis distance of the phantom at different body section were measured for TBI treatment planning. A detailed compensator design was calculated to achieve a uniform dose distribution throughout the phantom. The compensator was fabricated using a 3D printer, silicone molding, and a mixture of wax and tungsten powder. In vivo dosimetry measurements were performed using optically stimulated luminescent detectors. Results The scan of the phantom took approximately 30 s. The mean error for thickness measurements at each section of phantom relative to CT was 0.48 ± 0.27 cm. The average fabrication error for the 3D-printed compensator was 0.16 ± 0.15 mm. In vivo measurements for an end-to-end test showed that overall dose differences were within 5%. Conclusions A technique for planning and fabricating a compensator for TBI treatment using a depth camera equipped tablet and a 3D printer was demonstrated to be sufficiently accurate to be considered for further investigation.