Monte Carlo evaluation of glandular dose in cone-beam X-ray computed tomography dedicated to the breast: Homogeneous and heterogeneous breast models

PurposeIn cone-beam computed tomography dedicated to the breast (BCT), the mean glandular dose (MGD) is the dose metric of reference, evaluated from the measured air kerma by means of normalized glandular dose coefficients (DgN_CT). This work aimed at computing, for a simple breast model, a set of DgN_CT values for monoenergetic and polyenergetic X-ray beams, and at validating the results vs. those for patient specific digital phantoms from BCT scans.MethodsWe developed a Monte Carlo code for calculation of monoenergetic DgN_CT coefficients (energy range 4.25–82.25 keV). The pendant breast was modelled as a cylinder of a homogeneous mixture of adipose and glandular tissue with glandular fractions by mass of 0.1%, 14.3%, 25%, 50% or 100%, enveloped by a 1.45 mm-thick skin layer. The breast diameter ranged between 8 cm and 18 cm. Then, polyenergetic DgN_CT coefficients were analytically derived for 49-kVp W-anode spectra (half value layer 1.25–1.50 mm Al), as in a commercial BCT scanner. We compared the homogeneous models to 20 digital phantoms produced from classified 3D breast images.ResultsPolyenergetic DgN_CT resulted 13% lower than most recent published data. The comparison vs. patient specific breast phantoms showed that the homogeneous cylindrical model leads to a DgN_CT percentage difference between −15% and +27%, with an average overestimation of 8%.ConclusionsA dataset of monoenergetic and polyenergetic DgN_CT coefficients for BCT was provided. Patient specific breast models showed a different volume distribution of glandular dose and determined a DgN_CT 8% lower, on average, than homogeneous breast model.     

Breast glandularity and mean glandular dose assessment using a deep learning framework: Virtual patients study

PurposeBreast dosimetry in mammography is an important aspect of radioprotection since women are exposed periodically to ionizing radiation due to breast cancer screening programs. Mean glandular dose (MGD) is the standard quantity employed for the establishment of dose reference levels in retrospective population studies. However, MGD calculations requires breast glandularity estimation. This work proposes a deep learning framework for volume glandular fraction (VGF) estimations based on mammography images, which in turn are converted to glandularity values for MGD calculations.Methods208 virtual breast phantoms were generated and compressed computationally. The mammography images were obtained with Monte Carlo simulations (MC-GPU code) and a ray-tracing algorithm was employed for labeling the training data. The architectures of the neural networks are based on the XNet and multilayer perceptron, adapted for each task. The network predictions were compared with the ground truth using the coefficient of determination (r²).ResultsThe results have shown a good agreement for inner breast segmentation (r² = 0.999), breast volume prediction (r² = 0.982) and VGF prediction (r² = 0.935). Moreover, the DgN coefficients using the predicted VGF for the virtual population differ on average 1.3% from the ground truth values. Afterwards with the obtained DgN coefficients, the MGD values were estimated from exposure factors extracted from the DICOM header of a clinical cohort, with median(75 percentile) values of 1.91(2.45) mGy.ConclusionWe successfully implemented a deep learning framework for VGF and MGD calculations for virtual breast phantoms.     

Homogeneous vs. patient specific breast models for Monte Carlo evaluation of mean glandular dose in mammography

PurposeTo compare, via Monte Carlo simulations, homogeneous and non-homogenous breast models adopted for mean glandular dose (MGD) estimates in mammography vs. patient specific digital breast phantoms.MethodsWe developed a GEANT4 Monte Carlo code simulating four homogenous cylindrical breast models featured as follows: (1) semi-cylindrical section enveloped in a 5-mm adipose layer; (2) semi-elliptical section with a 4-mm thick skin; (3) semi-cylindrical section with a 1.45-mm skin layer; (4) semi-cylindrical section in a 1.45-mm skin layer and 2-mm subcutaneous adipose layer. Twenty patient specific digital breast phantoms produced from a dedicated CT scanner were assumed as reference in the comparison. We simulated two spectra produced from two anode/filter combinations. An additional digital breast phantom was produced via BreastSimulator software.ResultsWith reference to the results for patient-specific breast phantoms and for W/Al spectra, models #1 and #3 showed higher MGD values by about 1% (ranges [–33%; +28%] and [−31%; +30%], respectively), while for model #4 it was 2% lower (range [−34%; +26%]) and for model #2 –11% (range [−39%; +14%]), on average. On the other hand, for W/Rh spectra, models #1 and #4 showed lower MGD values by 2% and 1%, while for model #2 and #3 it was 14% and 8% lower, respectively (ranges [−43%; +13%] and [−41%; +21%]). The simulation with the digital breast phantom produced with BreastSimulator showed a MGD overestimation of +33%.ConclusionsThe homogeneous breast models led to maximum MGD underestimation and overestimation of 43% and 28%, respectively, when compared to patient specific breast phantoms derived from clinical CT scans.     

Evaluation of the effect of silicone breast inserts on X-ray mammography and breast tomosynthesis images: A Monte Carlo simulation study

PurposeBreast augmentation is one of the most popular cosmetic surgeries worldwide. The aim of this study is to investigate the effect of breast implant insertion on the detectability and visibility of lesions on mammography and breast tomosynthesis (BT) images.Materials and methodsThree software phantoms, composed of a homogeneous background with embedded silicone gel structures, and two types of breast abnormalities, microcalcifications (µCs) and masses, were generated. Two X-ray breast imaging modalities were simulated: mammography and BT with six incident monochromatic X-ray beams with energies in the interval between 20 and 30 keV. Projection images were generated using an in-house developed Monte Carlo simulator. The detectability of mammographic findings adjacent to the implant material and the influence of the incident beam energy and implant thickness on the feature detection were studied.ResultsIt was found that implants thicker than 26 mm for the case of mammography and 14 mm for the case of BT obscured the visibility of underlying structures. Although BT demonstrated a lack of contrast, this modality was able to visualize µCs under considerable depths of implant. Increasing the incident beam energy led to better visualization of small µCs, while in the case of breast masses, their detectability was limited.ConclusionsSilicone gel implants introduce a limitation in the image quality of mammograms resulting in low detectability of features. In addition, silicone gel implants obscure partially or totally parts of the image, depending on the size and the thickness of the implant as well the energy of the X-rays used.     

Clinical application of a gantry-attachable plastic scintillating plate dosimetry system in pencil beam scanning proton therapy beam monitoring

PurposeThe entrance beam fluence of therapeutic proton scanning beams can be monitored using a gantry-attachable plastic scintillating plate (GAPSP). This study evaluated the clinical application of the GAPSP using a method that measures intensity modulated proton therapy (IMPT) beams for patient treatment.MethodsIMPT beams for the treatment of nine patients, at sites that included the spine, head and neck, pelvis, and lung, were measured using the GAPSP, composed of an EJ-212 plastic scintillator and a CMOS camera. All energy layers distinguished by the GAPSP were accumulated to determine the dose distribution of the treatment field. The evaluated fields were compared with reference dose maps verified by quality assurance.ResultsComparison of dose distributions of evaluation treatment fields with reference dose distributions showed that the 3%/1 mm average gamma passing rate was 96.4%, independent of the treatment site, energy range and field size. When dose distributions were evaluated using the same criteria for each energy layer, the average gamma passing rate was 91.7%.ConclusionsThe GAPSP is a suitable, low-cost method for monitoring pencil beam scanning proton therapy, especially for non-spot scanning or additional collimation. The GAPSP can also estimate the treatment beam by the energy layer, a feature not common to other proton dosimetry tools.     

In vivo dosimetry with MOSFETs and GAFCHROMIC films during electron IORT for Accelerated Partial Breast Irradiation

PurposeThe purpose of this study was to compare the delivered dose to the expected intraoperative radiation therapy (IORT) dose with in vivo dosimetry. For IORT using electrons in accelerated partial breast irradiation, this is especially relevant since a high dose is delivered in a single fraction.MethodsFor 47 of breast cancer patients, in vivo dosimetry was performed with MOSFETs and/or GAFCHROMIC EBT2 films. A total dose of 23.33 Gy at d_max was given directly after completing the lumpectomy procedure with electron beams generated with an IORT dedicated mobile accelerator. A protection disk was used to shield the thoracic wall.ResultsThe results of in vivo MOSFET dosimetry for 27 patients and GAFROMIC film dosimetry for 20 patients were analysed. The entry dose for the breast tissue, measured with MOSFETs, (mean value 22.3 Gy, SD 3.4%) agreed within 1.7% with the expected dose (mean value 21.9 Gy). The dose in breast tissue, measured with GAFCHROMIC films (mean value 23.50 Gy) was on average within 0.7% (SD = 3.7%, range −5.5% to 5.6%) of the prescribed dose of 23.33 Gy.ConclusionsThe dose measured with MOSFETs and GAFROMIC EBT2 films agreed well with the expected dose. For both methods, the dose to the thoracic wall, lungs and heart for left sided patents was lower than 2.5 Gy even when 12 MeV was applied. The positioning time of GAFCHROMIC films is negligible and based on our results we recommend its use as a standard tool for patient quality assurance during breast cancer IORT.     

A patient immobilization device for prone breast radiotherapy: Dosimetric effects and inclusion in the treatment planning system

PurposeTo assess the dosimetric impact of a patient positioning device for prone breast radiotherapy and assess the accuracy of a treatment planning system (TPS) in predicting this impact.MethodsBeam attenuation and build-up dose perturbations, quantified by ionization chamber and radiochromic film dosimetry, were evaluated for 3 components of the patient positioning device: the carbon fiber baseplate, the support cushions and the support wedge for the contralateral breast. Dose calculations were performed using the XVMC dose engine implemented in the Monaco TPS. All components were included during planning CT acquisition.ResultsBeam attenuation amounted to 7.57% (6 MV) and 5.33% (15 MV) for beams obliquely intersecting the couchtop–baseplate combination. Beams traversing large sections of the support wedge were attenuated by 12.28% (6 MV) and 9.37% (15 MV). For the support cushion foam, beam attenuation remained limited to 0.11% (6 MV) and 0.08% (15 MV) per centimeter thickness. A substantial loss of dose build-up was detected when irradiating through any of the investigated components. TPS dose calculations accurately predicted beam attenuation by the baseplate and support wedge. A manual density overwrite was needed to model attenuation by the support cushion foam. TPS dose calculations in build-up regions differed considerably from measurements for both open beams and beams traversing the device components.ConclusionsIrradiating through the components of the positioning device resulted in a considerable degradation of skin sparing. Inclusion of the device components in the treatment planning CT allowed to accurately model the most important attenuation effect, but failed to accurately predict build-up doses.     

Real-time estimation of surface dose based on incident air kerma in diagnostic radiology

PurposeTo estimate the surface dose in diagnostic radiology in real time based on the relationship between the incident air kerma and the surface dose.MethodsThe air kerma for 20 X-ray beams with tube voltages of 50–140 kV and a half-value layer (HVL) of 2.27–9.65 mm Al was measured using an ionization chamber. The beam quality was classified based on the quality indexes (QIs) of 0.4, 0.5, and 0.6, which are defined as the ratio of the effective energy to the maximum energy corresponding to the tube potential. The surface dose for 20 X-ray beams was evaluated based on the measured air kerma, backscatter factor, and ratio of the mass–energy absorption coefficients of water to air, which were calculated using the Monte Carlo method. Finally, the relationship between the air kerma and the surface dose was investigated for X-ray beams with the specific QI values.ResultsThe surface dose at a water phantom was represented by a linear approximation of R² > 0.98, with the air kerma, regardless of the X-ray beam quality. The surface dose estimated based on a linear approximation with the air kerma indicated an agreement within 8% with that evaluated by the chamber measurements at HVL > 3.4 mm Al.ConclusionIt is possible to estimate the surface dose in real time using the linear relationship between the incident air kerma and the surface dose regardless of the X-ray beam quality by accepting ±10% uncertainty in the surface dose estimation.     

Monte Carlo determination of a nanoDot OSLD response using quality index for diagnostic kilovoltage X-ray beams

PurposeThis study aims to investigate the energy response of an optically stimulated luminescent dosimeter known as nanoDot for diagnostic kilovoltage X-ray beams via Monte Carlo calculations.MethodsThe nanoDot response is calculated as a function of X-ray beam quality in free air and on a water phantom surface using Monte Carlo simulations. The X-ray fluence spectra are classified using the quality index (QI), which is defined as the ratio of the effective energy to the maximum energy of the photons. The response is calculated for X-ray fluence spectra with QIs of 0.4, 0.5, and 0.6 with tube voltages of 50–137.6 kVp and monoenergetic photon beams. The surface dose estimated using the calculated response is verified by comparing it with that measured using an ionization chamber.ResultsThe nanoDot response in free air for monoenergetic photon beams (QI = 1.0) varies significantly at photon energies below 100 keV and reaches a factor of 3.6 at 25–30 keV. The response differs by up to approximately 6% between QIs of 0.4 and 0.6 for the same half-value layer (HVL). The response at the phantom surface decreases slightly owing to the backscatter effect, and it is almost independent of the field size. The agreement between the surface dose estimated using the nanoDot and that measured using the ionization chamber for assessing X-ray beam qualities is less than 2%.ConclusionsThe nanoDot response is indicated as a function of HVL for the specified QIs, and it enables the direct surface dose measurement.     

Simplified method for determining dose to a non-water phantom through the use of ND,w and IAEA TRS 483 for the GammaPod

PurposeGammaPod, a breast stereotactic radiosurgery device, utilizes 25 rotating Co-60 sources to deliver highly conformal dose distributions. The GammaPod system requires that reference dosimetry be performed in a specific vendor-supplied poly-methylmethacrylate (PMMA) phantom. The nonstandard nature of GammaPod dosimetry, in both the phantom material and machine-specific reference (msr), prohibits use of the American Association of Physicists in Medicine Task Group 51 (TG-51) protocol. This study proposes a practical method using TRS 483 to make the reference dosimetry procedure simpler and to reduce overall uncertainties.MethodsThe dose to PMMA (D_PMMA) is determined under msr conditions using TRS 483 with an Exradin A1SL chamber placed in a PMMA phantom. The conversion factor, which converts from the dose-to-water (D_w) in broad-beam Co-60 reference geometry to D_PMMA in the msr small field Co-60 (Q_msr) geometry, is derived using the Monte Carlo simulations and procedure described in TRS 483.ResultsThe new conversion factor value for an Exradin A1SL chamber is 0.974. When combined with N_D,w, D_PMMA differs by 0.5% from the TG-21/N_x method and 0.2% from the IROC values. Uncertainty decreased from 2.2% to 1.6%.ConclusionWe successfully implemented TRS 483 reference dosimetry protocols utilizing N_D,w for the GammaPod in the PMMA phantom. These results show not only agreement between measurements performed with the previously published method and independent thermoluminescent dosimetry measurements but also reductions in uncertainty. This also provides readers with a pathway to develop their own IAEA TRS 483 factor for any new small field machine that may be developed.     

Dose to the skin in helical tomotherapy: Results of in vivo measurements with radiochromic films

PurposeThe aim of this study is to report results of measurements of dose to the skin in vivo with radiochromic EBT films in treatments with helical tomotherapy.Methods and materialsIn vivo measurements were performed by applying pieces of radiochromic films to the skin or to the inner side of thermoplastic mask before the treatment. The sites of treatment included scalp, brain, head and neck, cranio-spinal axis and lower limbs. Skin dosimetry was performed in a patient who experienced grade 3–4 acute side effects to the skin shortly after the first treatment sessions. For each patient we measured the setup errors using the daily MVCT acquired for image guidance of the treatment. EBT films were read with a flatbed Epson Expression scanner and images were processed with an in-house written routine.ResultsA total of 96 measurements of dose to the skin performed on 14 patients. The mean difference and standard error of the mean difference between measured and TPS-calculated dose was ?9.2% ± 2.6% for all treatments, ?6.6% ± 2.6% for head and neck treatments. These differences were statistically significant at the 0.05 significance level (t-Student test). Planned dose and dose range in the region of measurements were not correlated with dose discrepancy.ConclusionsRadiochromic EBT films are suitable detectors for surface dose measurements in tomotherapy treatments. Results show that TPS overestimates dose to the skin measured with EBT radiochromic films. In vivo skin measurements with EBT films are a useful tool for quality assurance of tomotherapy treatments, as the treatment planning system may not give accurate dose values at the surface.     

A novel high-resolution 2D silicon array detector for small field dosimetry with FFF photon beams

PurposeFlattening filter free (FFF) beams are increasingly being considered for stereotactic radiotherapy (SRT). For the first time, the performance of a monolithic silicon array detector under 6 and 10 MV FFF beams was evaluated. The dosimeter, named “Octa” and designed by the Centre for Medical Radiation Physics (CMRP), was tested also under flattened beams for comparison.MethodsOutput factors (OFs), percentage depth-dose (PDD), dose profiles (DPs) and dose per pulse (DPP) dependence were investigated. Results were benchmarked against commercially available detectors for small field dosimetry.ResultsThe dosimeter was shown to be a ‘correction-free’ silicon array detector for OFs and PDD measurements for all the beam qualities investigated. Measured OFs were accurate within 3% and PDD values within 2% compared against the benchmarks. Cross-plane, in-plane and diagonal DPs were measured simultaneously with high spatial resolution (0.3 mm) and real time read-out. A DPP dependence (24% at 0.021 mGy/pulse relative to 0.278 mGy/pulse) was found and could be easily corrected for in the case of machine specific quality assurance applications.ConclusionsResults were consistent with those for monolithic silicon array detectors designed by the CMRP and previously characterized under flattened beams only, supporting the robustness of this technology for relative dosimetry for a wide range of beam qualities and dose per pulses. In contrast to its predecessors, the design of the Octa offers an exhaustive high-resolution 2D dose map characterization, making it a unique real-time radiation detector for small field dosimetry for field sizes up to 3 cm side.     

CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk

BackgroundThe purpose of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation with special focus on dose to organs at risk (OARs).Materials and methodsTreatment plans of thirty-one patients treated with MIBT were selected and additional CK plans were created on the same CT images. The OARs included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left sided cases. The fractionation was identical (4 × 6.25 Gy). Dose-volume parameters were calculated for both techniques and compared.ResultsThe D90 of the PTV for MIBT and CK were similar (102.4% vs. 103.6%, p = 0.0654), but in COIN the MIBT achieved lower value (0.75 vs. 0.91, p < 0.001). Regarding the V100 parameter of non-target breast CK performed slightly better than MIBT (V100: 1.1% vs. 1.6%), but for V90, V50 and V25 MIBT resulted in less dose. Every examined parameter of ipsilateral lung, skin, ribs and contralateral lung was significantly smaller for MIBT than for CK. Protection of the heart was slightly better with MIBT, but only the difference of D2cm³ was statistically significant (17.3% vs. 20.4%, p = 0.0311). There were no significant differences among the dose-volume parameters of the contralateral breast.ConclusionThe target volume can be properly irradiated by both techniques with high conformity and similar dose to the OARs. MIBT provides more advantageous plans than CK, except for dose conformity and the dosimetry of the heart and contralateral breast. More studies are needed to analyze whether these dosimetrical findings have clinical significance.     

Ultrasonography in the diagnosis of diffuse fibrocystic mastopathy

The breast of 160 females clinically diagnosed as having diffuse fibrocystic mastopathy and 61 females without clinical manifestations of breast diseases were echographically studied. The ultrasonographic design included measurement of the layer thickness of glandular tissue and its echodensity. In all diffuse mastopathies, including cystic one, there was over 14-mm glandular tissue thickness in all the portions of the breast or in its any quadrant, as well as glandular tissue echodensity changes which do not correspondent to the patients' age. In the control group, the thickness of a glandular layer varied with age, but it was no greater than 14 mm. Thus, the studies have demonstrated that over 14-mm glandular layer thickness and age-unspecific glandular tissue changes are the symptoms of diffuse fibrocystic mastopathy. The authors propose to include the measurement of these parameters into breast ultrasonographic methods since this allows one not only to make a more accurate diagnosis, but to clearly identify an echographic type of mastopathy.     

Tumor characteristics and family history in relation to mammographic density and breast cancer: The French E3N cohort

BackgroundMammographic density is a known heritable risk factor for breast cancer, but reports how tumor characteristics and family history may modify this association are inconsistent.MethodsDense and total breast areas were assessed using Cumulus™ from pre-diagnostic mammograms for 820 invasive breast cancer cases and 820 matched controls nested within the French E3N cohort study. To allow comparisons across models, percent mammographic density (PMD) was standardized to the distribution of the controls. Odds ratios (OR) and 95% confidence intervals (CI) of breast cancer risk for mammographic density were estimated by conditional logistic regression while adjusting for age and body mass index. Heterogeneity according to tumor characteristic and family history was assessed using stratified analyses.ResultsOverall, the OR per 1 SD for PMD was 1.50 (95% CI, 1.33–1.69). No evidence for significant heterogeneity by tumor size, lymph node status, grade, and hormone receptor status (estrogen, progesterone, and HER2) was detected. However, the association of PMD was stronger for women reporting a family history of breast cancer (OR_1SD = 2.25; 95% CI, 1.67–3.04) than in women reporting none (OR_1SD = 1.41; 95% CI, 1.24–1.60; p_{heterogeneity} = 0.002). Similarly, effect modification by FHBC was observed using categories of PMD (p_{heterogeneity} = 0.02) with respective ORs of 15.16 (95% CI, 4.23–54.28) vs. 3.14 (95% CI, 1.89–5.22) for ≥50% vs. <10% PMD.ConclusionsThe stronger association between mammographic density and breast cancer risk with a family history supports the hypothesis of shared genetic factors responsible for familial aggregation of breast cancer and the heritable component of mammographic density.     

Dosimetric and radiobiological comparison of TG-43 and Monte Carlo calculations in 192Ir breast brachytherapy applications

PurposeTo investigate the clinical significance of introducing model based dose calculation algorithms (MBDCAs) as an alternative to TG-43 in ¹⁹²Ir interstitial breast brachytherapy.Materials and methodsA 57 patient cohort was used in a retrospective comparison between TG-43 based dosimetry data exported from a treatment planning system and Monte Carlo (MC) dosimetry performed using MCNP v. 6.1 with plan and anatomy information in DICOM-RT format. Comparison was performed for the target, ipsilateral lung, heart, skin, breast and ribs, using dose distributions, dose-volume histograms (DVH) and plan quality indices clinically used for plan evaluation, as well as radiobiological parameters.ResultsTG-43 overestimation of target DVH parameters is statistically significant but small (less than 2% for the target coverage indices and 4% for homogeneity indices, on average). Significant dose differences (>5%) were observed close to the skin and at relatively large distances from the implant leading to a TG-43 dose overestimation for the organs at risk. These differences correspond to low dose regions (<50% of the prescribed dose), being less than 2% of the prescribed dose. Detected dosimetric differences did not induce clinically significant differences in calculated tumor control probabilities (mean absolute difference <0.2%) and normal tissue complication probabilities.ConclusionWhile TG-43 shows a statistically significant overestimation of most indices used for plan evaluation, differences are small and therefore not clinically significant. Improved MBDCA dosimetry could be important for re-irradiation, technique inter-comparison and/or the assessment of secondary cancer induction risk, where accurate dosimetry in the whole patient anatomy is of the essence.     

Determination of the surface dose of a water phantom using a semiconductor detector for diagnostic kilovoltage x-ray beams

PurposeTo determine the surface dose of a water phantom using a semiconductor detector for diagnostic kilovoltage x-ray beams.MethodsAn AGMS-DM+ semiconductor detector was calibrated in terms of air kerma measured with an ionization chamber. Air kerma was measured for 20 x-ray beams with tube voltages of 50–140 kVp and a half-value layer (HVL) of 2.2–9.7 mm Al for given quality index (QI) values of 0.4, 0.5, and 0.6, and converted to the surface dose. Finally, the air kerma and HVL measured by the AGMS-DM+ detector were expressed as a ratio of the surface dose for 10 × 10 and 20 × 20 cm² fields. The ratio of both was represented as a function of HVL for the given QI values and verified by comparing it with that calculated using the Monte Carlo method.ResultsThe air kerma calibration factor, CF, for the AGMS-DM+ detector ranged from 0.986 to 1.016 (0.9% in k = 1). The CF values were almost independent of the x-ray fluence spectra for the given QI values. The ratio of the surface dose to the air kerma determined by the PTW 30,013 chamber and the AGMS-DM+ detector was less than 1.8% for the values calculated using the Monte Carlo method, and showed a good correlation with the HVL for the given QI values.ConclusionIt is possible to determine the surface dose of a water phantom from the air kerma and HVL measured by a semiconductor detector for given QI values.     

Towards MR-guided electron therapy: Measurement and simulation of clinical electron beams in magnetic fields

PurposeIn the current era of MRI-linac radiotherapy, dose optimization with arbitrary dose distributions is a reality. For the first time, we present new and targeted experiments and modeling to aid in evaluating the potential dose improvements offered with an electron beam mode during MRI-linac radiotherapy.MethodsSmall collimated (1 cm diameter and 1.5 × 1.5 cm² square) electron beams (6, 12 and 20 MeV) from a clinical linear accelerator (Varian Clinac 2100C) are incident perpendicular and parallel to the strong and localized magnetic fields (0–0.7 T) generated by a permanent magnet device. Gafchromic EBT3 film is placed inside a slab phantom to measure two-dimensional dose distributions. A benchmarked and comprehensive Monte Carlo model (Geant4) is established to directly compare with experiments.ResultsWith perpendicular fields a 5% narrowing of the beam FWHM and a 10 mm reduction in the 15% isodose penetration is seen for the 20 MeV beam. In the inline setup the penumbral width is reduced by up to 20%, and a local central dose enhancement of 100% is observed. Monte Carlo simulations are in agreement with the measured dose distributions (2% or 2 mm).ConclusionA new range of experiments have been performed to offer insight into how an electron beam mode could offer additional choices in MRI-linac radiotherapy. The work extends on historic studies to bring a successful unified experimental and Monte Carlo modeling approach for studying small field electron beam dosimetry inside magnetic fields. The results suggest further work, particularly on the inline magnetic field scenario.     

Loose versus stranded seeds in permanent prostate brachytherapy: Dosimetric comparison of intraoperative plans

PurposeTo compare target volume coverage and critical organ dosimetry of intraoperative treatment plans for loose seed (LS) and stranded seed (SS) ¹²⁵I permanent implants for low and intermediate risk prostate cancer.MethodsTwo hundred and five patients who underwent permanent seed brachytherapy were included in the study. For prostate dosimetry V90, V100, V150, V200, D90 and COIN were used. The dose to urethra and rectum was determined by the maximal dose and relative doses that cover specified volumes. Means and standard deviations were calculated and statistically compared.ResultsOn average, 54 (range, 30–78) and 48 (range, 31–67) seeds were implanted in the prostate with individual median activities of 0.62 U (range, 0.52–0.70 U) and 0.71 U (range, 0.65–0.71 U) for LS and SS technique, respectively. The target coverage was slightly better with SS (V100: 98% vs. 96%, p < 0.05; D90: 172 Gy vs. 166 Gy, p < 0.05), but more conformal dose distributions were observed with LS (COIN: 0.70 vs. 0.63, p < 0.05). The dose homogeneity did not differ significantly between the two groups. Regarding the dose to urethra and rectum all dose parameters were significantly lower with LS.ConclusionsLS resulted in less dose to the urethra and rectum compared to SS in intraoperative dosimetry. A slightly better target volume coverage with decreased conformity of dose distribution is reported with SS. More studies are necessary to determine how these results will affect postoperative dosimetry, and ultimately, clinical outcome.