Commissioning and clinical implementation of Mobius3D and MobiusFX: Experience on multiple linear accelerators

PurposeTo provide practical guidelines for Mobius3D commissioning based on experiences of commissioning/clinical implementation of Mobius3D and MobiusFX as patient-specific quality assurance tools on multiple linear accelerators.MethodsThe vendor-suggested Mobius3D commissioning procedures, including beam model adjustment and dosimetric leaf gap (DLG) optimization, were performed for 6 MV X-ray beams of six Elekta linear accelerators. For the beam model adjustment, beam data, such as the percentage depth dose, off-axis ratio (OAR), and output factor (OF), were measured using a water phantom and compared to the vendor-provided reference values. DLG optimization was performed to determine an optimal DLG correction factor to minimize the mean difference between Mobius3D-calculated and measured doses for multiple volumetric modulated arc therapy (VMAT) plans. Small-field VMAT plans, in which Mobius3D has dose calculate uncertainties, were initially included in the DLG optimization, but excluded later.ResultsThe measured beam data were consistent across the six linear accelerators. Relatively large differences between the reference and measured values were observed for the OAR at large off-axis distances (>5 cm) and for the OF for small fields (<3 × 3 cm²). The optimal DLG correction factor was 0.6 ± 0.3 (range: 0.3–1.0) with small-field plans and 0.2 ± 0.2 (0.0–0.5) without them.ConclusionsA reasonable agreement was found between the vendor-provided reference and measured beam models. DLG optimization results were dependent on the selection of the VMAT plans, requiring careful attention to the known dose calculation uncertainties of Mobius3D when determining a DLG correction factor.     

TomoEQA: Dose verification for patient-specific quality assurance in helical tomotherapy using an exit detector

PurposeExisting phantom-less quality assurance (QA) platforms does not provide patient-specific QA for helical tomotherapy (HT). A new system, called TomoEQA, is presented to facilitate this using the leaf open time (LOT) of a binary multi-leaf collimator, as measured by an exit detector.MethodsTomoEQA was designed to provide measurement-based LOTs based on detector data and to generate a new digital imaging and communication in medicine (DICOM) dataset that includes the measured LOTs for use by secondary check platforms. To evaluate the system, 20 patient-specific QAs were performed using the program in Mobius3D software, and the results were compared to conventional phantom-based QA results.ResultsFrom our assessment, most of the differences between the planned and measured (or calculated) data, excluding one case, were within the acceptance criteria comparing with those of conventional QA. Regarding the gamma analysis, all results considered in this study were within the acceptance criteria. In addition, the developed system was performed for a failed case and showed approximately the same trends as the conventional approach.ConclusionsTomoEQA could perform patient-specific QAs of HT using Mobius3D and provide reliable patient-specific QAs results by evaluating point dose errors and 3D gamma passing rates. TomoEQA could also distinguish whether an intensity-modulated radiation therapy plan failed or not.     

Clinical impact of dosimetric changes for volumetric modulated arc therapy in log file-based patient dose calculations

PurposeA log file-based method cannot detect dosimetric changes due to linac component miscalibration because log files are insensitive to miscalibration. Herein, clinical impacts of dosimetric changes on a log file-based method were determined.Methods and materialsFive head-and-neck and five prostate plans were applied. Miscalibration-simulated log files were generated by inducing a linac component miscalibration into the log file. Miscalibration magnitudes for leaf, gantry, and collimator at the general tolerance level were ±0.5 mm, ±1°, and ±1°, respectively, and at a tighter tolerance level achievable on current linac were ±0.3 mm, ±0.5°, and ±0.5°, respectively. Re-calculations were performed on patient anatomy using log file data.ResultsChanges in tumor control probability/normal tissue complication probability from treatment planning system dose to re-calculated dose at the general tolerance level was 1.8% on planning target volume (PTV) and 2.4% on organs at risk (OARs) in both plans. These changes at the tighter tolerance level were improved to 1.0% on PTV and to 1.5% on OARs, with a statistically significant difference.ConclusionsWe determined the clinical impacts of dosimetric changes on a log file-based method using a general tolerance level and a tighter tolerance level for linac miscalibration and found that a tighter tolerance level significantly improved the accuracy of the log file-based method.     

Evaluation of a no-reference image quality metric for projection X-ray imaging using a 3D printed patient-specific phantom

PurposeFeasability of a no-reference image quality metric was assessed on patient-like images using a patient-specific phantom simulating a frame of a coronary angiogram.MethodsOne background and one contrast-filled frame of a coronary angiogram, acquired using a clinical imaging protocol, were selected from a Philips Integris Allura FD (Philips Healthcare, Best, The Netherlands). The background frame’s pixels were extruded to a thickness proportional to their grey value. One phantom was 3D printed using composite 80% bronze filament (max. thickness of 5.1 mm), the other was a custom PMMA cast (max thickness of 8.5 cm). A vessel mold was created from the contrast-filled frame and injected with a solution of 320 mg I/ml contrast fluid (75%), water and gelatin. Still X-ray frames of the vessel mold + background phantom + 16 cm PMMA were acquired at manually selected different exposure settings using a Philips Azurion (Philips Healthcare, Best, The Netherlands) in User Quality Control Mode and were exported as RAW images. The signal-difference-to-noise-ratio-squared (SDNR²) and a spatial-domain-equivalent of the noise equivalent quanta (NEQ_SDE) were calculated. The Spearman’s correlation of the latter parameters with a no-reference perceptual image quality metric (NIQE) was investigated.ResultsThe bronze phantom showed better resemblance to the original patient frame selected from a coronary angiogram of an actual patient, with better contrast and less blur than the PMMA phantom. Both phantoms were imaged using a comparable imaging protocol to the one used to acquire the original frame. The bronze phantom was hence used together with the vessel mold for image quality measurements on the 165 still phantom frames. A strong correlation was noted between NEQ_SDE and NIQE (SROCC = –0.99, p < 0.0005) and between SDNR² and NIQE (SROCC = –0.97, p < 0.0005).ConclusionUsing a cost-effective and easy to realize patient-specific phantom we were able to generate patient-like X-ray frames. NIQE as a no-reference image quality model has the potential to predict physical image quality from patient images.     

On the evaluation of edgeless diode detectors for patient-specific QA in high-dose stereotactic radiosurgery

PurposeIn this work, the potential of an innovative “edgeless” silicon diode was evaluated as a response to the still unmet need of a reliable tool for plan dosimetry verification of very high dose, non-coplanar, patient-specific radiosurgery treatments. In order to prove the effectiveness of the proposed technology, we focused on radiosurgical treatments for functional disease like tremor or pain.MethodsThe edgeless diodes response has been validated with respect to clinical practice standard detectors by reproducing the reference dosimetry data adopted for the Treatment Planning System. In order to evaluate the potential for radiosurgery patient-specific treatment plan verification, the anthropomorphic phantom Alderson RANDO has been adopted along with three edgeless sensors, one placed in the centre of the Planning Target Volume, one superiorly and one inferiorly.ResultsThe reference dosimetry data obtained from the edgeless detectors are within 2.6% for output factor, off-axis ratio and well within 2% for tissue phantom ratio when compared to PTW 60,018 diode. The edgeless detectors measure a dose discrepancy of approximately 3.6% from the mean value calculated by the TPS. Larger discrepancies are obtained in very steep gradient dose regions when the sensors are placed outside the PTV.ConclusionsThe angular independent edgeless diode is proposed as an innovative dosimeter for patient quality assurance of brain functional disorders and other radiosurgery treatments. The comparison of the diode measurements with TPS calculations confirms that edgeless diodes are suitable candidates for patient-specific dosimetric verification in very high dose ranges delivered by non-isocentric stereotactic radiosurgery modalities.     

Simplification of head and neck volumetric modulated arc therapy patient-specific quality assurance,using a Delta4 PT

Background/AimIn many facilities, intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) use intensity-modulated beams, formed by a multi-leaf collimator (MLC). In IMRT and VMAT, MLC and linear accelerator errors (both geometric and dose), can significantly affect the doses administered to patients. Therefore, IMRT and VMAT treatment plans must include the use of patient-specific quality assurance (QA) before treatment to confirm dose accuracy.Materials and methodsIn this study, we compared and analyzed the results of dose verification using a multi-dimensional dose verification system Delta4 PT, an ionization chamber dosimeter, and gafchromic film, using data from 52 patients undergoing head and neck VMAT as the test material.ResultBased on the results of the absolute dose verification for the ionization chamber dosimeter and Delta4 PT, taking an axial view, the upper limit of the 95% confidence interval was 3.13%, and the lower limit was −3.67%, indicating good agreement. These results mean that as long as absolute dose verification for the axial view does not deviate from this range, Delta4 PT can be used as an alternative to an ionization chamber dosimeter for absolute dose verification. When we then reviewed dose distribution verification, the pass rate for Delta4 PT was acceptable, and was less varied than that of gafchromic film.ConclusionThis results in that provided the pass rate result for Delta4 PT does not fall below 96%, it can be used as a substitute for gafchromic film in dose distribution verification. These results indicate that patient-specific QA could be simplified.     

Development of a 3D optical scanner for evaluating patient-specific dose distributions

PurposeThis paper describes the hardware and software characteristics of a 3D optical scanner (P3DS) developed in-house. The P3DS consists of an LED light source, diffuse screen, step motor, CCD camera, and scanner management software with 3D reconstructed software.Materials and methodWe performed optical simulation, 2D and 3D reconstruction image testing, and pre-clinical testing for the P3DS. We developed the optical scanner with three key characteristics in mind. First, we developed a continuous scanning method to expand possible clinical applications. Second, we manufactured a collimator to improve image quality by reducing scattering from the light source. Third, we developed an optical scanner with changeable camera positioning to enable acquisition of optimal images according to the size of the gel dosimeter.ResultsWe confirmed ray-tracing in P3DS with optic simulation and found that 2D projection and 3D reconstructed images were qualitatively similar to the phantom images. For pre-clinical tests, the dose distribution and profile showed good agreement among RTP, optical CT, and external beam radiotherapy film data for the axial and coronal views. The P3DS has shown that it can scan and reconstruct for evaluation of the gel dosimeter within 1 min. We confirmed that the P3DS system is a useful tool for the measurement of 3D dose distributions for 3D radiation therapy QA. Further experiments are needed to investigate quantitative analysis for 3D dose distribution.     

Clinically relevant quality assurance (QA) for prostate RapidArc plans: Gamma maps and DVH-based evaluation

The aim of this paper is to evaluate clinically relevant quality assurance (QA) tests for RapidArc prostate patients. 26 plans were verified by the COMPASS system that provides an independent angle response and a reconstruction of dose distribution in patient CT model. Plan data were imported from treatment planning system via DICOM. The fluencies, measured by a 2D detector, were used by COMPASS to forward calculate dose in CT patients and reconstruct dose-volume-histogram (DVH). The gamma analysis was performed, using both the criteria 3%-3-mm and 2%-2 mm, for the whole grid patient and the per-structure volume. A DVH-based analysis was accomplished for target and organs-at-risk (OAR). The correlation between gamma passing rates and DVH discrepancies was performed using Pearson's test. Sensitivity, specificity and accuracy of whole and per-structure gamma method were calculated.No significant DVH deviation was observed for target and OAR. Weak correlation between gamma passing rates and dosimetric deviations was observed, all significant r-values were negative. The whole gamma method shows lack of sensitivity to detect dosimetric deviations >5%. Instead, a better balance between sensitivity and specificity was obtained employing per structure gamma both with 3%-3 mm and 2%-2 mm criteria.Because of the poor correlation between DVH goals and gamma passing rates, we encourage the DVH-based gamma passing rates, when it is possible. At least, a gamma method specific for structure was strongly suggested.     

Development of patient-specific 3D models from histopathological samples for applications in radiation therapy

The biological effects of ionizing radiation depend on the tissue, tumor type, radiation quality, and patient-specific factors. Inter-patient variation in cell/nucleus size may influence patient-specific dose response. However, this variability in dose response is not well investigated due to lack of available cell/nucleus size data. The aim of this study was to develop methods to derive cell/nucleus size distributions from digital images of 2D histopathological samples and use them to build digital 3D models for use in cellular dosimetry.Nineteen of sixty hematoxylin and eosin stained lung adenocarcinoma samples investigated passed exclusion criterion to be analyzed in the study. A difference of gaussians blob detection algorithm was used to identify nucleus centers and quantify cell spacing. Hematoxylin content was measured to determine nucleus radius. Pouring simulations were conducted to generate one-hundred 3D models containing volumes of equivalent cell spacing and nuclei radius to those in histopathological samples.The nuclei radius distributions of non-tumoral and cancerous regions appearing in the same slide were significantly different (p < 0.01) in all samples analyzed. The median nuclear-cytoplasmic ratio was 0.36 for non-tumoral cells and 0.50 for cancerous cells. The average cellular and nucleus packing densities in the 3D models generated were 65.9% (SD: 1.5%) and 13.3% (SD: 0.3%) respectively.Software to determine cell spacing and nuclei radius from histopathological samples was developed. 3D digital tissue models containing volumes with equivalent cell spacing, nucleus radius, and packing density to cancerous tissues were generated.     

Multi-institutional evaluation using the end-to-end test for implementation of dynamic techniques of radiation therapy in Thailand

AimIn this study, an accuracy survey of intensity-modulated radiation therapy (IMRT) and volumetric arc radiation therapy (VMAT) implementation in radiotherapy centers in Thailand was conducted.BackgroundIt is well recognized that there is a need for radiotherapy centers to evaluate the accuracy levels of their current practices, and use the related information to identify opportunities for future development.Materials and methodsAn end-to-end test using a CIRS thorax phantom was carried out at 8 participating centers. Based on each center's protocol for simulation and planning, linac-based IMRT or VMAT plans were generated following the IAEA (CRP E24017) guidelines. Point doses in the region of PTVs and OARs were obtained from 5 ionization chamber readings and the dose distribution from the radiochromic films. The global gamma indices of the measurement doses and the treatment planning system calculation doses were compared.ResultsThe large majority of the RT centers (6/8) fulfilled the dosimetric goals, with the measured and calculated doses at the specification points agreeing within ±3% for PTV and ±5% for OARS. At 2 centers, TPS underestimated the lung doses by about 6% and spinal cord doses by 8%. The mean percentage gamma pass rates for the 8 centers were 98.29 ± 0.67% (for the 3%/3 mm criterion) and 96.72 ± 0.84% (for the 2%/2 mm criterion).ConclusionsThe 8 participating RT centers achieved a satisfactory quality level of IMRT/VMAT clinical implementation.     

In-air versus underwater comparison of 3D reconstruction accuracy using action sport cameras

Action sport cameras (ASC) have achieved a large consensus for recreational purposes due to ongoing cost decrease, image resolution and frame rate increase, along with plug-and-play usability. Consequently, they have been recently considered for sport gesture studies and quantitative athletic performance evaluation. In this paper, we evaluated the potential of two ASCs (GoPro Hero3+) for in-air (laboratory) and underwater (swimming pool) three-dimensional (3D) motion analysis as a function of different camera setups involving the acquisition frequency, image resolution and field of view. This is motivated by the fact that in swimming, movement cycles are characterized by underwater and in-air phases what imposes the technical challenge of having a split volume configuration: an underwater measurement volume observed by underwater cameras and an in-air measurement volume observed by in-air cameras. The reconstruction of whole swimming cycles requires thus merging of simultaneous measurements acquired in both volumes. Characterizing and optimizing the instrumental errors of such a configuration makes mandatory the assessment of the instrumental errors of both volumes.In order to calibrate the camera stereo pair, black spherical markers placed on two calibration tools, used both in-air and underwater, and a two-step nonlinear optimization were exploited. The 3D reconstruction accuracy of testing markers and the repeatability of the estimated camera parameters accounted for system performance. For both environments, statistical tests were focused on the comparison of the different camera configurations. Then, each camera configuration was compared across the two environments. In all assessed resolutions, and in both environments, the reconstruction error (true distance between the two testing markers) was less than 3mm and the error related to the working volume diagonal was in the range of 1:2000 (3×1.3×1.5 m³) to 1:7000 (4.5×2.2×1.5 m³) in agreement with the literature. Statistically, the 3D accuracy obtained in the in-air environment was poorer (p<10⁻⁵) than the one in the underwater environment, across all the tested camera configurations. Related to the repeatability of the camera parameters, we found a very low variability in both environments (1.7% and 2.9%, in-air and underwater). This result encourage the use of ASC technology to perform quantitative reconstruction both in-air and underwater environments.     

RNA2D3D: A program for Generating,Viewing, and Comparing 3-Dimensional Models of RNA

Abstract

Using primary and secondary structure information of an RNA molecule, the program RNA2D3D automatically and rapidly produces a first-order approximation of a 3-dimensional conformation consistent with this information. Applicable to structures of arbitrary branching complexity and pseudoknot content, it features efficient interactive graphical editing for the removal of any overlaps introduced by the initial generating procedure and for making conformational changes favorable to targeted features and subsequent refinement. With emphasis on fast exploration of alternative 3D conformations, one may interactively add or delete base-pairs, adjacent stems can be coaxially stacked or unstacked, single strands can be shaped to accommodate special constraints, and arbitrary subsets can be defined and manipulated as rigid bodies. Compaction, whereby base stacking within stems is optimally extended into connecting single strands, is also available as a means of strategically making the structures more compact and revealing folding motifs. Subsequent refinement of the first-order approximation, of modifications, and for the imposing of tertiary constraints is assisted with standard energy refinement techniques. Previously determined coordinates for any part of the molecule are readily incorporated, and any part of the modeled structure can be output as a PDB or XYZ file. Illustrative applications in the areas of ribozymes, viral kissing loops, viral internal ribosome entry sites, and nanobiology are presented.     

In phantom evaluation of targeting accuracy in MRI-based brain radiosurgery

PurposeTo determine the targeting accuracy of brain radiosurgery when planning procedures employing different MRI and MRI + CT combinations are adopted.Materials and methodA new phantom, the BrainTool, has been designed and realized to test image co-registration and targeting accuracy in a realistic anatomical situation. The phantom was created with a 3D printer and materials that mimic realistic brain MRI and CT contrast using a model extracted from a synthetic MRI study of a human brain. Eight markers distributed within the BrainTool provide for assessment of the accuracy of image registrations while two cavities that host an ionization chamber are used to perform targeting accuracy measurements with an iterative cross-scan method. Two procedures employing 1.5 T MRI-only or a combination of MRI (taken with 1.5 T or 3 T scanners) and CT to carry out Gamma Knife treatments were investigated. As distortions can impact targeting accuracy, MR images were preliminary evaluated to assess image deformation extent using GammaTool phantom.ResultsMR images taken with both scanners showed average and maximum distortion of 0.3 mm and 1 mm respectively. The marker distances in co-registered images resulted below 0.5 mm for both MRI scans. The targeting mismatches obtained were 0.8 mm, 1.0 mm and 1.2 mm for MRI-only and MRI + CT (1,5T and 3 T), respectively.ConclusionsProcedures using a combination of MR and CT images provide targeting accuracies comparable to those of MRI-only procedures. The BrainTool proved to be a suitable tool for carrying out co-registration and targeting accuracy of Gamma Knife brain radiosurgery treatments.     

Novel phantom for performance evaluation of contrast-enhanced 3D rotational angiography

PurposeThis technical note presents an in-house phantom with a specially designed contrast-object module constructed to address the need for three-dimensional rotational angiography (3DRA) testing.MethodsThe initial part of the study was a brief evaluation on the commercially available phantom used for 3DRA and computed tomography angiography (CTA) to confirm the need for a special phantom for 3D angiography. Once confirmed, an in-house phantom was constructed. The novel phantom was tested to evaluate the basic image performance metrics, i.e., unsharpness (MTF) and noise characterization (NPS), as well as to show its capability for vessel contrast visibility study.ResultsThe low contrast objects in the commercially available tools dedicated for CT is found to yield significantly lower signal difference to noise ratio (SDNR) when used for 3DRA, therefore deemed inadequate for 3DRA contrast evaluation. The constructed in-house phantom demonstrates a capability to serve for basic imaging performance check (MTF, NPS, and low contrast evaluation) for 3DRA and CTA. With higher and potentially adjustable visibility of contrast objects as artificial vessels, the in-house phantom also makes more clinically relevant tests, e.g., human- or model observer study and task-based optimization, possible.ConclusionThe novel phantom with special contrast object module shows higher visibility in 3DRA compared to the currently available commercial phantom and, therefore, is recommended for use in 3D angiography.     

3D Modelling of Biological Systems for Biomimetics

1　IntroductionBasedonthereviewofthepreviousworkof 3Dgeometricalmodellingtechniquesandsystemsdevelopedforindustrial,medicalandanimationapplications,thispaperdiscussestheproblemsassociatedwiththeexist ingtechniquesandsystems ,especiallywhenappliedto3Dmodellingof plants ,insectsandanimalsforbiomimeticsresearchanddevelopment .Then ,paperproposessomeareasofresearchinterestsin 3Dmod ellingofplants ,insectsandanimalsforBiomimetics .Toavoidtherepeating ,inthispaper ,biologicalobjectswillbeusedtorep…     

Fabrication of 3D calcium-alginate scaffolds for human glioblastoma modeling and anticancer drug response evaluation

The three-dimensional (3D) cell culture model has been increasingly used to study cancer biology and screen for anticancer agents due to its close mimicry to in vivo tumor biopsies. In this study, 3D calcium(Ca)-alginate scaffolds were developed for human glioblastoma cell culture and an investigation of the responses to two anticancer agents, doxorubicin and cordycepin. Compared to the 2D monolayer culture, glioblastoma cells cultured on these 3D Ca-alginate scaffolds showed reduced cell proliferation, increased tumor spheroid formation, enhanced expression of cancer stem cell genes (CD133, SOX2, Nestin, and Musashi-1), and improved expression of differentiation potential-associated genes (GFAP and β-tubulin III). Additionally, the vascularization potential of the 3D glioblastoma cells was increased, as indicated by a higher expression of tumor angiogenesis biomarker (VEGF) than in the cells in 2D culture. To highlight the application of Ca-alginate scaffolds, the 3D glioblastomas were treated with anticancer agents, including doxorubicin and cordycepin. The results demonstrated that the 3D glioblastomas presented a greater resistance to the tested anticancer agents than that of the cells in 2D culture. In summary, the 3D Ca-alginate scaffolds for glioblastoma cells that were developed in this study offer a promising platform for anticancer agent screening and the discovery of drug-resistant mechanisms of cancer.     

数字化骨科理念辅助椎弓根置钉在寰枢椎不稳中的临床应用

目的:探讨3D打印辅助置钉技术用于寰枢椎不稳椎弓根置钉的安全性及准确性。方法:收集2013年1月到2015年1月西安交通大学第一附属医院收治的寰枢椎不稳病例,术前采用3D打印技术构建个体化3D打印模型,在模型上模拟置钉,获取最佳置钉点、置钉角度等个体化置钉数据,并于术中辅助椎弓根螺钉置入。通过CT扫描评价置钉准确性,测量术前、术后患者寰齿间隙判断寰枢椎复位情况,测量颈延角评价脊髓压迫改善情况,并采用日本骨科学会(JOA)评分判断患者脊髓功能改善情况。术后定期随访观察固定效果、稳定性、神经损伤等手术并发症的发生情况。结果:13例患者均采用3D打印辅助置钉技术进行内固定治疗,手术顺利,术中及术后无血管、神经损伤等并发症,复位及内固定效果满意。共置入椎弓根螺钉31枚,其中29枚完全在椎弓根内,置钉准确率为93.5%。寰枢椎较术前明显复位,术后寰齿间隙、颈延角和JOA评分较术前明显改善,差异具有统计学意义(P0.05)。结论:3D打印技术辅助上颈椎椎弓根置钉的准确性及安全性均较高。     

Design,synthesis and evaluation of bitopic arylpiperazinephenyl-1,2,4-oxadiazoles as preferential dopamine D3 receptor ligands

The dopamine D3 receptor (D3R) was proposed as a therapeutic target for drug development to treat drug abuse and addiction and neuropsychiatric disorders. Several D3R-selective modulators over the dopamine D2 receptor (D2R) can avoid extrapyramidal symptoms (EPS) and hyperprolactinemia. However, few biased D3R ligands were identified or showed a narrow range of selectivity at the D3R over D2R because of their high sequence homology. Herein, we designed, synthesized and evaluated the binding affinity of a series of bitopic ligands: arypiperazine-phenyl-1,2,4-oxadiazoles. Compound 9e·HCl was the most potent and selective D3R modulator among these bitopic ligands. Molecular modeling revealed that D3R selectivity depends on the divergence of secondary binding pocket (SBP) in D3R and D2R. Specifically, non-conserved Tyr36, EL1 especially non-conserved Thr92 and Gly94, and EL2 Val180, Cys181 and Ser182 of D3R may contribute to D3R specificity over D2R.     

Dosimetric accuracy of three dose calculation algorithms for radiation therapy of in situ non-small cell lung carcinoma

BackgroundStudy determines differences in calculated dose distributions for non-small cell lung carcinoma (NSC LC) patients. NSC LC cases were investigated, being the most common lung cancer treated by radiotherapy in our clinical practice.Materials and methodsA retrospective study of 15 NSCLC patient dose distributions originally calculated using standard superposition (SS) and recalculated using collapsed cone (CC ) and Monte Carlo (MC) based algorithm expressed as dose to medium in medium (MCD_m) and dose to water in medium (MCD_w,) was performed so that prescribed dose covers at least 99% of the gross target volume (GTV). Statistical analysis was performed for differences of conformity index (CI), heterogeneity index (HI), gradient index (GI), dose delivered to 2% of the volume (D_2%), mean dose (D_mean) and percentage of volumes covered by prescribed dose (V_70Gy). For organs at risk (OARs), D_mean and percentage of volume receiving 20 Gy and 5Gy (V_20Gy, V_5Gy) were analysed.ResultsStatistically significant difference for GTVs was observed between MCD_w and SS algorithm in mean dose only. For planning target volumes (PTVs), statistically significant differences were observed in prescribed dose coverage for CC, MCD_m and MCD_w. The differences in mean CI value for the CC algorithm and mean HI value for MCD_m and MCD_w were statistically significant. There is a statistically significant difference in the number of MUs for MCD_m and MCD_w compared to SS.ConclusionAll investigated algorithms succeed in managing the restrictive conditions of the clinical goals. This study shows the drawbacks of the CC algorithm compared to other algorithms used.