Challenges in calculation of the gamma index in radiotherapy – Towards good practice

The gamma index (γ) is one of the most commonly used metrics for the verification of complex modulated radiotherapy. The mathematical definition of the γ is computationally expensive and various techniques have been reported to speed up the calculation either by mathematically refining the γ or employing various computational techniques. These techniques can cause variation in output with different software implementations. The γ has traditionally been used to compare a 2D measured plane against a 2D or 3D dose distribution. Recently, software algorithm and hardware improvements have led to the possibility of using measured 2D data from commercial detector arrays to reconstruct a 3D-dose distribution and perform a volumetric comparison against the treatment planning system (TPS). A limitation in this approach is that commercial detector arrays have so far been limited by their spatial resolution which may affect the accuracy of the reconstructed 3D volume and subsequently the γ calculation. Additionally, 3D versus 3D γ comparison adds a layer of complication in the calculation of the γ given the increase in the number of calculation points and the result cannot be as easily interpreted in the same way as 2D comparison. This review summarises and highlights the computational challenges of the γ calculation and sheds light on some of these issues by means of a bespoke MATLAB software to demonstrate the impact of interpolation, γ search distance, resolution and 2D and 3D calculations. Finally, a recommendation is made on the minimum information that should be reported when publishing γ results.     

Comparison of dose distribution in IMRT and RapidArc technique in prostate radiotherapy

AimThe aim was to provide a dosimetric comparison between IMRT and RapidArc treatment plans with RPI index with simultaneous comparison of the treatment delivery time.BackgroundIMRT and RapidArc provide highly conformal dose distribution with good sparing of normal tissues. However, a complex spatial dosimetry of IMRT and RapidArc plans hampers the evaluation and comparison between plans calculated for the two modalities. RPI was used in this paper for treatment plan comparisons. The duration of the therapeutic session in RapidArc is reported to be shorter in comparison to therapeutic time of the other dynamic techniques. For this reasons, total treatment delivery time in both techniques was compared and discussed.Materials and methods15 patients with prostate carcinoma were randomly selected for the analysis. Two competitive treatment plans using respectively the IMRT and RapidArc techniques were computed for each patient in Eclipse planning system v. 8.6.15. RPIwin^® application was used for RPI calculations for each treatment plan.Additionally, total treatment time was compared between IMRT and RapidArc plans. Total treatment time was a sum of monitor units (MU) for each treated field.ResultsThe mean values of the RPI indices were insignificantly higher for IMRT plans in comparison to rotational therapy. Comparison of the mean numbers of monitor units confirmed that the use of rotational technique instead of conventional static field IMRT can significantly reduce the treatment time.ConclusionAnalysis presented in this paper, demonstrated that RapidArc can compete with the IMRT technique in the field of treatment plan dosimetry reducing the time required for dose delivery.     

Evaluation of nutrients and related environmental factors for wolfberry (Lycium barbarum) fruits grown in the different areas of China

The wolfberry (Lycium barbarumL.) fruit has been used in traditional Chinese medicine and food, but fruits grown in various geographic areas are significantly different in quality and content of functional components. In this study, we tested the internal nutritional ingredients and related environmental factors using forty-two wolfberry fruits collected from seven wolfberry producing regions in China (Yinchuan and Zhongning in Ningxia, Jingyuan in Gansu, Nuomuhong Farm in Qinghai,Hangjinhouqi and Wulateqianqi in Inner Mongolia, and Jinghe in Xinjiang). The nutritional ingredients of the forty-two wolfberry fruits are dependent on the environment. Correlation analysis revealed that the amount of nutrients was highly related to each other. Based on the analysis ofratio of total sugar to betaine (sugar-alkali ratio), we have successfully established quality standards for the wolfberry based on the levels of betaine and sugar. The standards were as follows: high betaine low sugar (sugar-alkali ratio≤15.1), high betaine medium sugar (15<sugar-alkali ratio≤60), medium betaine medium sugar (60<sugar-alkali ratio≤121), medium betaine high sugar (121<sugar-alkali ratio≤165), and low betaine high sugar (sugar-alkali ratio>165). Zhongning of Ningxia is the geo-authentic producing region of the wolfberry, whereby the wolfberries are rich in main pharmacological ingredients Lycium barbarum polysaccharide (LBP) and three trace elements (iron, manganese and selenium) and medium sugar-alkali ratio. In addition, the correlation analysis showed that both the altitude and average temperature difference between day and night had positive effects on the wolfberry flavonoids content but the annual sunshine duration negatively affected the betaine contents of the wolfberry fruit.     

Combination of dual-energy computed tomography and iterative metal artefact reduction to increase general quality of imaging for radiotherapy patients with high dense materials. Phantom study

PurposeTo evaluate the use of pseudo-monoenergetic reconstructions (PMR) from dual-energy computed tomography, combined with the iterative metal artefact reduction (iMAR) method.MethodsPseudo-monoenergetic CT images were obtained using the dual-energy mode on the Siemens Somatom Definition AS scanner. A range of PMR combinations (70–130 keV) were used with and without iMAR. A Virtual Water™ phantom was used for quantitative assessment of error in the presence of high density materials: titanium, alloys 330 and 600. The absolute values of CT number differences (AD) and normalised standard deviations (NSD) were calculated for different phantom positions. Image quality was assessed using an anthropomorphic pelvic phantom with an embedded hip prosthesis. Image quality was scored blindly by five observers.ResultsAD and NSD values revealed differences in CT number errors between tested sets. AD and NSD were reduced in the vicinity of metal for images with iMAR (p < 0.001 for AD/NSD). For ROIs away from metal, with and without iMAR, 70 keV PMR and pCT AD values were lower than for the other reconstructions (p = 0.039). Similarly, iMAR NSD values measured away from metal were lower for 130 keV and 70 keV PMR (p = 0.002). Image quality scores were higher for 70 keV and 130 keV PMR with iMAR (p = 0.034).ConclusionThe use of 70 keV PMR with iMAR allows for significant metal artefact reduction and low CT number errors observed in the vicinity of dense materials. It is therefore an attractive alternative to high keV imaging when imaging patients with metallic implants, especially in the context of radiotherapy planning.     

Evaluation of the effects of implementing a diode transmission device into the clinical workflow

PurposeThis work investigated effects of implementing the Delta⁴ Discover diode transmission detector into the clinical workflow.MethodsPDD and profile scans were completed with and without the Discover for a number of photon beam energies. Transmission factors were determined for all beam energies and included in Eclipse TPS to account for the attenuation of the Discover. A variety of IMRT plans were delivered to a Delta⁴ Phantom+ with and without the Discover to evaluate the Discover’s effects on IMRT QA. An imaging QA phantom was used to assess the detector’s effects on MV image quality. OSLDs placed on the Phantom+ were used to determine the detector’s effects on superficial dose.ResultsThe largest effect on PDDs after d_max was 0.5%. The largest change in beam profile symmetry and flatness was 0.2% and 0.1%, respectively. An average difference in gamma passing rates (2%/2 mm) of 0.2% was observed between plans that did not include the Discover in the measurement and calculation to plans that did include the Discover in the measurement and calculation. The Discover did not significantly change the MV image quality, and the largest observed increase in the relative superficial dose when the Discover was present was 1%.ConclusionsThe effects the Discover has on the linac beam were found to be minimal. The device can be implemented into the clinic without the need to alter the TPS beam modeling, other than accounting for the device’s attenuation. However, a careful workflow review to implement the Discover should be completed.     

Measurement and Selection of Parasitoid Quality for Mass-Reared Trichogramma minutum Riley Used in Inundative Release

Parasitoid quality, subject to both genetic and environmental influences, is critical to the success of any biological control program, however, its measurement and improvement is poorly understood. In this study, a classic genetic approach is taken to develop two indices, namely a character index and a fitness index, for the measurement and selection of high quality parasitoids used in inundative release. Six life-history traits and corresponding fitness components in 33 inbred strains of Trichogramma minutum were used to generate both genotypic and phenotypic variance-covariance matrices that then allowed for the construction of the indices. Most traits and their fitness components were positively correlated, both phenotypically and genotypically, with lifetime fecundity and the number of female offspring appearing to have an important influence. Selection of the top three strains showed that parasitoid quality could be improved by 36% using the character index and possibly up to 150% using the fitness index. The two indices were linearly correlated suggesting that either could be used to measure quality. The character index is recommended because it requires information on only three life-history traits (fecundity, number of female offspring, and number of male offspring) and has highly correlated responses of fitness components. Our work demonstrates that the best quality T. minutum will be obtained by using the character index to select for inbred strains which have high fecundity and number of female offspring.     

Effect of preharvest spraying Cryptococcus laurentii on postharvest decay and quality of strawberry

Application of a suspension (log 8.0/ml) of Cryptococcus laurentii prior to harvest led to a reduction in Botrytis cinerea decay of strawberries stored at 4 or 20 °C, for 12 or 4 days, respectively. The frequency of spraying antagonist significantly influenced disease incidence in strawberry fruit. The best inhibition of disease was achieved when fruit sprayed C. laurentii with three applications that began 6 days prior to harvest, and the incidence of gray mold and natural decay treated with this method was 21% and 11%, compared with 88% and 62% in the control after storage at 20 °C for 4 days. A similar result occurred in the treated fruit after storage at 4 °C for 12 days. Dilation plate counts on Rose Bengal agar and scanning electron microscopy results showed that three applications with C. laurentii at 6, 3 and 0 days before harvest improved its ability to colonize the epidermis of strawberry fruit in the greenhouse and during storage compared to single application. In addition, antagonistic yeast spraying before harvest could reduce the weight loss, delay the decrease of the firmness and ascorbic acid, but had no significant effect on the contents of soluble solids, titratable acidity and fruit surface color. These results suggested that preharvest spraying with C. laurentii might be a promising alternative to fungicide application for decay control of strawberry.     

Performance evaluation of contrast-detail in full field digital mammography systems using ideal (Hotelling) observer vs. conventional automated analysis of CDMAM images for quality control of contrast-detail characteristics

PurposeThe purpose of this work was to evaluate the contrast-detail performance of full field digital mammography (FFDM) systems using ideal (Hotelling) observer Signal-to-Noise Ratio (SNR) methodology and ascertain whether it can be considered an alternative to the conventional, automated analysis of CDMAM phantom images.MethodsFive FFDM units currently used in the national breast screening programme were evaluated, which differed with respect to age, detector, Automatic Exposure Control (AEC) and target/filter combination. Contrast-detail performance was analysed using CDMAM and ideal observer SNR methodology. The ideal observer SNR was calculated for input signal originating from gold discs of varying thicknesses and diameters, and then used to estimate the threshold gold thickness for each diameter as per CDMAM analysis. The variability of both methods and the dependence of CDMAM analysis on phantom manufacturing discrepancies also investigated.ResultsResults from both CDMAM and ideal observer methodologies were informative differentiators of FFDM systems' contrast-detail performance, displaying comparable patterns with respect to the FFDM systems' type and age. CDMAM results suggested higher threshold gold thickness values compared with the ideal observer methodology, especially for small-diameter details, which can be attributed to the behaviour of the CDMAM phantom used in this study. In addition, ideal observer methodology results showed lower variability than CDMAM results.ConclusionThe Ideal observer SNR methodology can provide a useful metric of the FFDM systems' contrast detail characteristics and could be considered a surrogate for conventional, automated analysis of CDMAM images.     

Dosimetric evaluation of Gafchromic EBT2 film for breast intraoperative electron radiotherapy verification

PurposeQuality assurance (QA) is one of the most important issues that should be addressed for intraoperative electron radiotherapy (IOERT), which is not benefiting from image-based treatment planning system. The aim of this study is to evaluate the dosimetric characteristics of Gafchromic EBT2 film for breast IOERT QA procedure.MethodsDue to the fact that some dedicated accelerators are being used for IOERT, dependence of the film response to energy, field size, dose rate and incidence angle of electron beam from the LIAC IOERT accelerator was studied. Then, film response curve to breast IOERT doses was obtained and its accuracy was evaluated and justified through comparison to the results of ionometric dosimetry.ResultsThe results of this study indicated that there are no significant differences between the film responses at different energies of 6, 8, 10 and 12 MeV (P-value = 0.99). Similarly, no field size dependency was found when evaluating the response of the film to different field sizes ranging from 4 to 10 cm (P-value = 0.94). Film response was found to be independent of the dose rate of intraoperative electron beam (P-value = 0.12). Film response variations with changing the beam incidence angle were not significant (P-value > 0.8). Calibration curve at the dose range of 8–24 Gy had an acceptable accuracy. The difference between the results of film dosimetry and ionometric dosimetry was around 5% which was in agreement with the results of dose uncertainty estimation.ConclusionThe EBT2 film was found to be a potentially appropriate tool for breast IOERT verification.