Background and purpose: A comprehensive dosimetry intercomparison has been carried out involving ... more Background and purpose: A comprehensive dosimetry intercomparison has been carried out involving all the radiotherapy centres, all external beam modalities and every radiotherapy treatment unit in the Republic of Ireland. Materials and methods: Reference point measurements were made for all megavoltage photon beams. Doses were also investigated in planned three-field distributions. One of these was in a homogeneous epoxy resin solid water phantom, whilst the second included a lung equivalent insert. The intercomparison was also carried out for three electron energies in each centre. The position of the depth of maximum dose for a standard field size was independently determined, as was the beam energy and a subsequent beam calibration was made. In addition, a kilovoltage X-ray intercomparison was carried out on every kilovoltage quality. Results: For 13 megavoltage photon beams a mean ratio of intercomparison measured dose to locally measured dose of 1.002 was obtained (standard deviation 1.2%). For 12 electron beam measurements a mean ratio of intercomparison measured dose to locally measured dose of 1.018 was obtained (standard deviation 0.8%). For four kilovoltage beams a mean ratio of intercomparison measured dose to locally measured dose of 0.997 was obtained (standard deviation 1.9%). Conclusions: The intercomparison has given confidence in the basis of clinical delivery of radiation dose in radiotherapy treatment and in the consistency (precision) of dosimetry between different centres within the Republic of Ireland. In addition, it has established a methodology for subsequent ongoing routine radiotherapy dosimetry audit and a baseline set of results to act as an initial reference point.
Background and purpose: This work reports a detailed study carried out in two UK radiotherapy cen... more Background and purpose: This work reports a detailed study carried out in two UK radiotherapy centres of the dosimetric accuracy of the collapsed cone algorithm of a commercial treatment planning system (Helax-TMS) in simulated clinical situations. Materials and methods: Initially the accuracy of the collapsed cone algorithm in homogeneous media is evaluated for an extensive set of simple and complex fields. Water, lung and bone substitute epoxy resin material were then used to assess the algorithm in inhomogeneous media and compare its accuracy with the pencil beam algorithm currently in clinical use. Finally a semi-anatomic phantom and an anthropomorphic phantom were employed to assess the dosimetric accuracy using simulated clinical set ups. Thermoluminescence dosimeter (TLD) measurements were made with the anthropomorphic phantom and ionisation chambers otherwise. Nominal 4, 6 and 15 MV photon beams were studied. Results: For most homogeneous cases agreement between measured and calculated dose is within G2% or G2 mm. In cases with heterogeneities and simulated clinical situations it is observed that the accuracy is also generally within G2% or G2 mm. Specific instances where the difference between measured and calculated values exceed this are highlighted. Conclusions: It can be concluded that in clinical treatment planning situations where lung is present the collapsed cone algorithm should be considered in preference to pencil beam algorithms normally used but that there may still be some discrepancy between calculations and measurement.
The goal of this work was to implement a recently proposed small field dosimetry formalism [Alfon... more The goal of this work was to implement a recently proposed small field dosimetry formalism [Alfonso et al., Med. Phys. 35(12), 5179-5186 (2008)] for a comprehensive set of diode detectors and provide the required Monte Carlo generated factors to correct measurement. Jaw collimated square small field sizes of side 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, and 3.0 cm normalized to a reference field of 5.0 cm × 5.0 cm were used throughout this study. Initial linac modeling was performed with electron source parameters at 6.0, 6.1, and 6.2 MeV with the Gaussian FWHM decreased in steps of 0.010 cm from 0.150 to 0.100 cm. DOSRZnrc was used to develop models of the IBA stereotactic field diode (SFD) as well as the PTW T60008, T60012, T60016, and T60017 field diodes. Simulations were run and isocentric, detector specific, output ratios (OR(det)) calculated at depths of 1.5, 5.0, and 10.0 cm. This was performed using the following source parameter subset: 6.1 and 6.2 MeV with a FWHM = 0.100, 0.110, and 0.120 cm. The source parameters were finalized by comparing experimental detector specific output ratios with simulation. Simulations were then run with the active volume and surrounding materials set to water and the replacement correction factors calculated according to the newly proposed formalism. In all cases, the experimental field size widths (at the 50% level) were found to be smaller than the nominal, and therefore, the simulated field sizes were adjusted accordingly. At a FWHM = 0.150 cm simulation produced penumbral widths that were too broad. The fit improved as the FWHM was decreased, yet for all but the smallest field size worsened again at a FWHM = 0.100 cm. The simulated OR(det) were found to be greater than, equivalent to and less than experiment for spot size FWHM = 0.100, 0.110, and 0.120 cm, respectively. This is due to the change in source occlusion as a function of FWHM and field size. The corrections required for the 0.5 cm field size were 0.95 (± 1.0%) for the SFD, T60012 and T60017 diodes and 0.90 (± 1.0%) for the T60008 and T60016 diodes-indicating measured output ratios to be 5% and 10% high, respectively. Our results also revealed the correction factors to be the same within statistical variation at all depths considered. A number of general conclusions are evident: (1) small field OR(det) are very sensitive to the simulated source parameters, and therefore, rigorous Monte Carlo linac model commissioning, with respect to measurement, must be pursued prior to use, (2) backscattered dose to the monitor chamber should be included in simulated OR(det) calculations, (3) the corrections required for diode detectors are design dependent and therefore detailed detector modeling is required, and (4) the reported detector specific correction factors may be applied to experimental small field OR(det) consistent with those presented here.
As from the 1 January 1997, the recent IPEMB code of practice for electron dosimetry is the recom... more As from the 1 January 1997, the recent IPEMB code of practice for electron dosimetry is the recommended protocol for electron beam dosimetry in the UK, replacing the previous HPA code of practice and its IPSM addendum. New recommendations for electron beam dosimetry have also been formulated recently by the AAPM and the IAEA on the use of parallel-plate ionization chambers in high-energy electron beams. Against this background, the procedures recommended in each of these codes of practice have been followed from intercomparison of the field instrument ionization chamber with a secondary standard through to the determination of absorbed dose at the reference position in the electron beam. Absorbed doses have been determined for a number of electron beam energies ranging from nominal 5 MeV through to 17 MeV, and for four different types of field instrument ionization chamber: an NE2571 graphite walled cylindrical chamber; an NACP parallel-plate chamber; a Markus parallel-plate chamber; and a Roos parallel-plate chamber. The differences in the determination of absorbed dose between the IPEMB protocol and the HPA/IPSM protocol vary from +0.5% to +1.6% at the depth of maximum dose. In addition the IPEMB measured doses are 0.2% larger than those measured following the IAEA code of practice. It may also be stated that the IPEMB measured doses at the depth of maximum dose are up to 1.5%, but generally less than 1.0%, lower than those measured by the AAPM protocol.
The most important geometric characteristic of stereotactic treatment is the accuracy of position... more The most important geometric characteristic of stereotactic treatment is the accuracy of positioning the target at the treatment isocenter and the accuracy of directing the radiation beam at the treatment isocenter. Commonly, the radiation isocenter is used as the reference for the treatment isocenter, but its method of localization is not strictly defined, and it depends on the linac‐specific beam steering parameters. A novel method is presented for determining the linac mechanical isocenter position and size based on the localization of the collimator axis of rotation at arbitrary gantry angle. The collimator axis of rotation position is determined from the radiation beam center position corrected for the focal spot offset. The focal spot offset is determined using the image center shift method with a custom‐design rigid phantom with two sets of ball‐bearings. Three specific quality assurance (QA) applications and assessment methods are also presented to demonstrate the functional...
Radiotherapy treatment planning based only on magnetic resonance imaging (MRI) has become clinica... more Radiotherapy treatment planning based only on magnetic resonance imaging (MRI) has become clinically achievable. Though computed tomography (CT) is the gold standard for radiotherapy imaging, directly providing the electron density values needed for planning calculations, MRI has superior soft tissue visualisation to guide treatment planning decisions and optimisation. MRI-only planning removes the need for the CT scan, but requires generation of a substitute/synthetic/pseudo CT (sCT) for electron density information. Shortening the MRI imaging time would improve patient comfort and reduce the likelihood of motion artefacts. A volunteer study was previously carried out to investigate and optimise faster MRI sequences for a hybrid atlas-voxel conversion to sCT for prostate treatment planning. The aim of this follow-on study was to clinically validate the performance of the new optimised sequence for sCT generation in a treated MRI-only prostate patient cohort. 10 patients undergoing ...
Radiotherapy for thoracic and breast tumours is associated with a range of cardiotoxicities. Emer... more Radiotherapy for thoracic and breast tumours is associated with a range of cardiotoxicities. Emerging evidence suggests cardiac substructure doses may be more predictive of specific outcomes, however, quantitative data necessary to develop clinical planning constraints is lacking. Retrospective analysis of patient data is required, which relies on accurate segmentation of cardiac substructures. In this study, a novel model was designed to deliver reliable, accurate, and anatomically consistent segmentation of 18 cardiac substructures on computed tomography (CT) scans. Thirty manually contoured CT scans were included. The proposed multi-stage method leverages deep learning (DL), multi-atlas mapping, and geometric modelling to automatically segment the whole heart, cardiac chambers, great vessels, heart valves, coronary arteries, and conduction nodes. Segmentation performance was evaluated using the Dice similarity coefficient (DSC), mean distance to agreement (MDA), Hausdorff distanc...
Introduction: Within an International Atomic Energy Agency (IAEA) coordinated research project (C... more Introduction: Within an International Atomic Energy Agency (IAEA) coordinated research project (CRP), a remote end-to-end dosimetric quality audit for intensity modulated radiation therapy (IMRT)/ volumetric arc therapy (VMAT) was developed to verify the radiotherapy chain including imaging, treatment planning and dose delivery. The methodology as well as the results obtained in a multicentre pilot study and national trial runs conducted in close cooperation with dosimetry audit networks (DANs) of IAEA Member States are presented. Material and methods: A solid polystyrene phantom containing a dosimetry insert with an irregular solid water planning target volume (PTV) and organ at risk (OAR) was designed for this audit. The insert can be preloaded with radiochromic film and four thermoluminescent dosimeters (TLDs). For the audit, radiotherapy centres were asked to scan the phantom, contour the structures, create an IMRT/VMAT treatment plan and irradiate the phantom. The dose prescription was to deliver 4 Gy to the PTV in two fractions and to limit the OAR dose to a maximum of 2.8 Gy. The TLD measured doses and film measured dose distributions were compared with the TPS calculations. Results: Sixteen hospitals from 13 countries and 64 hospitals from 6 countries participated in the multicenter pilot study and in the national runs, respectively. The TLD results for the PTV were all within ±5% acceptance limit for the multicentre pilot study, whereas for national runs, 17 participants failed to meet this criterion. All measured doses in the OAR were below the treatment planning constraint. The film analysis identified seven plans in national runs below the 90% passing rate gamma criteria. Conclusion: The results proved that the methodology of the IMRT/VMAT dosimetric end-to-end audit was feasible for its intended purpose, i.e., the phantom design and materials were suitable; the phantom was easy to use and it was robust enough for shipment. Most importantly the audit methodology was capable of identifying suboptimal IMRT/VMAT delivery.
Conclusion: The MDC-OVER-UNDER analysis as an assessment tool, has the potential to reduce labour... more Conclusion: The MDC-OVER-UNDER analysis as an assessment tool, has the potential to reduce labour, reduce inter/intra observer variability and provide rapid quantified feedback. Consistently failing volumes would trigger protocol review in the first instance. Wider application in an RTTQA or educational setting requires a consensus min/max extent volume for several operator defined volumes by the TMG from the outset, supported by the STAPLE algorithm. (Excluding spaces <2500 characters on word.) PO-0950 QA and dummy-run results of the TRENDY randomized trial on SBRT vs. chemoembolization for HCC
Results: Whereas for machines younger than 10 years agreement between measured and stated dose wa... more Results: Whereas for machines younger than 10 years agreement between measured and stated dose was 90% overall, for those over 30 years old agreement dropped to 70%. However, this picture varied with region. Linac dosimetry was always better than 60 Co and multi-machine centres generally performed better than single machine institutions. We interpret this latter observation as a reflection of a more substantial physics infrastructure in larger centres. The data suggest virtually no dependence on the time elapsed since the last dosimetry system calibration at least out to 10 years. Second or subsequent participation in audits reflected higher quality dosimetry (85% of results within the XX's acceptance criterion) than the first audit (77%). The use of N D,w based dosimetry protocols resulted in more accurate dosimetry than the use of the older N k or N x protocols (95%, 92% and 79% agreement respectively). Conclusions: Clearly, over the 45 years that the XX has accumulated these TLD data, practice has changed both in institutions and at the XX's Dosimetry Laboratory. However, it is possible to draw some general conclusions from the analysis. Higher quality dosimetry is generally associated with younger machines, linacs as opposed to 60 Co, centres with more than one machine, prior experience with the XX's audit programme and the use of an N D,w based protocol.
A dosimetry intercomparison has been carried out for all 52 radiotherapy centres in the UK which ... more A dosimetry intercomparison has been carried out for all 52 radiotherapy centres in the UK which possess electron treatment facilities. The intercomparison was carried out on one treatment unit in each centre and for three energies across the range of available energies. The position of the depth of maximum dose for a standard field size was independently determined and a subsequent beam calibration made. The factor to convert the reading on a calibrated ionization chamber to absorbed dose in an electron beam is energy dependent, and hence to carry out an independent calibration measurement also requires the beam energy to be determined. In addition a quantitative measure of the difference in the calibration chains between the intercomparison equipment and the host department&#39;s field instrument was carried out. In order to provide a follow-up to the initial IPSM national photon intercomparison, a photon beam calibration was measured in one photon beam in each centre. For 156 electron beam measurements, a mean ratio of intercomparison measured dose to locally measured dose of 0.994 was obtained with a standard deviation of 1.8%. For the 52 photon beam measurements, a mean ratio of intercomparison measured dose to locally measured dose of 1.003 was obtained with a standard deviation of 1.0%.
Background Anal cancer is a rare cancer with rising incidence. Despite the relatively good outcom... more Background Anal cancer is a rare cancer with rising incidence. Despite the relatively good outcomes conferred by state-of-the-art chemoradiotherapy, further improving disease control and reducing toxicity has proven challenging. Developing and validating prognostic models using routinely collected data may provide new insights for treatment development and selection. However, due to the rarity of the cancer, it can be difficult to obtain sufficient data, especially from single centres, to develop and validate robust models. Moreover, multi-centre model development is hampered by ethical barriers and data protection regulations that often limit accessibility to patient data. Distributed (or federated) learning allows models to be developed using data from multiple centres without any individual-level patient data leaving the originating centre, therefore preserving patient data privacy. This work builds on the proof-of-concept three-centre atomCAT1 study and describes the protocol fo...
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Australasian Physical & Engineering Sciences in Medicine, 2018
Computed tomography (CT) is the gold standard for radiotherapy simulation and treatment planning,... more Computed tomography (CT) is the gold standard for radiotherapy simulation and treatment planning, providing spatial accuracy, bony anatomy definition and electron density information for dose calculations. Magnetic resonance imaging (MRI) has been introduced in radiotherapy to improve visualisation of anatomy for accurate target definition and contouring, however lacks electron density information required for dose calculations, with various methods used to overcome this. The aim of this work is to assess the impact on dose calculation accuracy and optimisation results of different approaches to determine electron density, as could be used in MRI only treatment planning for nasopharyngeal datasets with VMAT treatment plans. Volumetric modulated arc therapy (VMAT) plans were created for 10 retrospective head and neck (H&N) nasopharyngeal patients. The VMAT plans were generated on the gold standard dataset, the original CT scan. Data sets with no density correction (water equivalent) and two different sets of bulk density correction for bone/air/tissue applied separately were generated for these patients and the VMAT plans were recalculated for each case. Plans were also reoptimised on these data sets, and recalculated. Optimisation error was assessed through equivalent uniform dose (EUD) differences. Additionally, point dose comparison, dose volume histogram (DVH) analysis and gamma analysis of dose were used to assess dose calculation error. The dose calculation error on average was an increase in EUD whereas the optimisation error on average was a reduction in EUD compared to the original plan for all datasets aside from the bone only override dataset where bone was set to 1.61 g/cm 3. For the optimisation error, the largest mean absolute error (MAE) was 1.88 Gy EUD for the PTV, and 2.21 Gy EUD for the brainstem, for the reoptimisation completed on the air only overridden dataset, and recalculated on the original. Bulk density corrections for bone and air provide dose calculations within 3% of the original treatment plans. Optimisation errors have the potential to be greater than dose calculation errors if incorrect density corrections are utilized. Electron density correction using a bulk density approach achieves dose calculation uncertainties within 3%, however more advanced approaches, such as a voxel based approach, may improve accuracy and should be considered.
This work introduces the concept of very small field size. Output factor (OPF) measurements at th... more This work introduces the concept of very small field size. Output factor (OPF) measurements at these field sizes require extremely careful experimental methodology including the measurement of dosimetric field size at the same time as each OPF measurement. Two quantifiable scientific definitions of the threshold of very small field size are presented. Methods: A practical definition was established by quantifying the effect that a 1 mm error in field size or detector position had on OPFs and setting acceptable uncertainties on OPF at 1%. Alternatively, for a theoretical definition of very small field size, the OPFs were separated into additional factors to investigate the specific effects of lateral electronic disequilibrium, photon scatter in the phantom, and source occlusion. The dominant effect was established and formed the basis of a theoretical definition of very small fields. Each factor was obtained using Monte Carlo simulations of a Varian iX linear accelerator for various square field sizes of side length from 4 to 100 mm, using a nominal photon energy of 6 MV. Results: According to the practical definition established in this project, field sizes ≤15 mm were considered to be very small for 6 MV beams for maximal field size uncertainties of 1 mm. If the acceptable uncertainty in the OPF was increased from 1.0% to 2.0%, or field size uncertainties are 0.5 mm, field sizes ≤12 mm were considered to be very small. Lateral electronic disequilibrium in the phantom was the dominant cause of change in OPF at very small field sizes. Thus the theoretical definition of very small field size coincided to the field size at which lateral electronic disequilibrium clearly caused a greater change in OPF than any other effects. This was found to occur at field sizes ≤12 mm. Source occlusion also caused a large change in OPF for field sizes ≤8 mm. Based on the results of this study, field sizes ≤12 mm were considered to be theoretically very small for 6 MV beams. Conclusions: Extremely careful experimental methodology including the measurement of dosimetric field size at the same time as output factor measurement for each field size setting and also very precise detector alignment is required at field sizes at least ≤12 mm and more conservatively 041707-1 Med. Phys. 41 (4), April 2014
Background and purpose: A comprehensive dosimetry intercomparison has been carried out involving ... more Background and purpose: A comprehensive dosimetry intercomparison has been carried out involving all the radiotherapy centres, all external beam modalities and every radiotherapy treatment unit in the Republic of Ireland. Materials and methods: Reference point measurements were made for all megavoltage photon beams. Doses were also investigated in planned three-field distributions. One of these was in a homogeneous epoxy resin solid water phantom, whilst the second included a lung equivalent insert. The intercomparison was also carried out for three electron energies in each centre. The position of the depth of maximum dose for a standard field size was independently determined, as was the beam energy and a subsequent beam calibration was made. In addition, a kilovoltage X-ray intercomparison was carried out on every kilovoltage quality. Results: For 13 megavoltage photon beams a mean ratio of intercomparison measured dose to locally measured dose of 1.002 was obtained (standard deviation 1.2%). For 12 electron beam measurements a mean ratio of intercomparison measured dose to locally measured dose of 1.018 was obtained (standard deviation 0.8%). For four kilovoltage beams a mean ratio of intercomparison measured dose to locally measured dose of 0.997 was obtained (standard deviation 1.9%). Conclusions: The intercomparison has given confidence in the basis of clinical delivery of radiation dose in radiotherapy treatment and in the consistency (precision) of dosimetry between different centres within the Republic of Ireland. In addition, it has established a methodology for subsequent ongoing routine radiotherapy dosimetry audit and a baseline set of results to act as an initial reference point.
Background and purpose: This work reports a detailed study carried out in two UK radiotherapy cen... more Background and purpose: This work reports a detailed study carried out in two UK radiotherapy centres of the dosimetric accuracy of the collapsed cone algorithm of a commercial treatment planning system (Helax-TMS) in simulated clinical situations. Materials and methods: Initially the accuracy of the collapsed cone algorithm in homogeneous media is evaluated for an extensive set of simple and complex fields. Water, lung and bone substitute epoxy resin material were then used to assess the algorithm in inhomogeneous media and compare its accuracy with the pencil beam algorithm currently in clinical use. Finally a semi-anatomic phantom and an anthropomorphic phantom were employed to assess the dosimetric accuracy using simulated clinical set ups. Thermoluminescence dosimeter (TLD) measurements were made with the anthropomorphic phantom and ionisation chambers otherwise. Nominal 4, 6 and 15 MV photon beams were studied. Results: For most homogeneous cases agreement between measured and calculated dose is within G2% or G2 mm. In cases with heterogeneities and simulated clinical situations it is observed that the accuracy is also generally within G2% or G2 mm. Specific instances where the difference between measured and calculated values exceed this are highlighted. Conclusions: It can be concluded that in clinical treatment planning situations where lung is present the collapsed cone algorithm should be considered in preference to pencil beam algorithms normally used but that there may still be some discrepancy between calculations and measurement.
The goal of this work was to implement a recently proposed small field dosimetry formalism [Alfon... more The goal of this work was to implement a recently proposed small field dosimetry formalism [Alfonso et al., Med. Phys. 35(12), 5179-5186 (2008)] for a comprehensive set of diode detectors and provide the required Monte Carlo generated factors to correct measurement. Jaw collimated square small field sizes of side 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, and 3.0 cm normalized to a reference field of 5.0 cm × 5.0 cm were used throughout this study. Initial linac modeling was performed with electron source parameters at 6.0, 6.1, and 6.2 MeV with the Gaussian FWHM decreased in steps of 0.010 cm from 0.150 to 0.100 cm. DOSRZnrc was used to develop models of the IBA stereotactic field diode (SFD) as well as the PTW T60008, T60012, T60016, and T60017 field diodes. Simulations were run and isocentric, detector specific, output ratios (OR(det)) calculated at depths of 1.5, 5.0, and 10.0 cm. This was performed using the following source parameter subset: 6.1 and 6.2 MeV with a FWHM = 0.100, 0.110, and 0.120 cm. The source parameters were finalized by comparing experimental detector specific output ratios with simulation. Simulations were then run with the active volume and surrounding materials set to water and the replacement correction factors calculated according to the newly proposed formalism. In all cases, the experimental field size widths (at the 50% level) were found to be smaller than the nominal, and therefore, the simulated field sizes were adjusted accordingly. At a FWHM = 0.150 cm simulation produced penumbral widths that were too broad. The fit improved as the FWHM was decreased, yet for all but the smallest field size worsened again at a FWHM = 0.100 cm. The simulated OR(det) were found to be greater than, equivalent to and less than experiment for spot size FWHM = 0.100, 0.110, and 0.120 cm, respectively. This is due to the change in source occlusion as a function of FWHM and field size. The corrections required for the 0.5 cm field size were 0.95 (± 1.0%) for the SFD, T60012 and T60017 diodes and 0.90 (± 1.0%) for the T60008 and T60016 diodes-indicating measured output ratios to be 5% and 10% high, respectively. Our results also revealed the correction factors to be the same within statistical variation at all depths considered. A number of general conclusions are evident: (1) small field OR(det) are very sensitive to the simulated source parameters, and therefore, rigorous Monte Carlo linac model commissioning, with respect to measurement, must be pursued prior to use, (2) backscattered dose to the monitor chamber should be included in simulated OR(det) calculations, (3) the corrections required for diode detectors are design dependent and therefore detailed detector modeling is required, and (4) the reported detector specific correction factors may be applied to experimental small field OR(det) consistent with those presented here.
As from the 1 January 1997, the recent IPEMB code of practice for electron dosimetry is the recom... more As from the 1 January 1997, the recent IPEMB code of practice for electron dosimetry is the recommended protocol for electron beam dosimetry in the UK, replacing the previous HPA code of practice and its IPSM addendum. New recommendations for electron beam dosimetry have also been formulated recently by the AAPM and the IAEA on the use of parallel-plate ionization chambers in high-energy electron beams. Against this background, the procedures recommended in each of these codes of practice have been followed from intercomparison of the field instrument ionization chamber with a secondary standard through to the determination of absorbed dose at the reference position in the electron beam. Absorbed doses have been determined for a number of electron beam energies ranging from nominal 5 MeV through to 17 MeV, and for four different types of field instrument ionization chamber: an NE2571 graphite walled cylindrical chamber; an NACP parallel-plate chamber; a Markus parallel-plate chamber; and a Roos parallel-plate chamber. The differences in the determination of absorbed dose between the IPEMB protocol and the HPA/IPSM protocol vary from +0.5% to +1.6% at the depth of maximum dose. In addition the IPEMB measured doses are 0.2% larger than those measured following the IAEA code of practice. It may also be stated that the IPEMB measured doses at the depth of maximum dose are up to 1.5%, but generally less than 1.0%, lower than those measured by the AAPM protocol.
The most important geometric characteristic of stereotactic treatment is the accuracy of position... more The most important geometric characteristic of stereotactic treatment is the accuracy of positioning the target at the treatment isocenter and the accuracy of directing the radiation beam at the treatment isocenter. Commonly, the radiation isocenter is used as the reference for the treatment isocenter, but its method of localization is not strictly defined, and it depends on the linac‐specific beam steering parameters. A novel method is presented for determining the linac mechanical isocenter position and size based on the localization of the collimator axis of rotation at arbitrary gantry angle. The collimator axis of rotation position is determined from the radiation beam center position corrected for the focal spot offset. The focal spot offset is determined using the image center shift method with a custom‐design rigid phantom with two sets of ball‐bearings. Three specific quality assurance (QA) applications and assessment methods are also presented to demonstrate the functional...
Radiotherapy treatment planning based only on magnetic resonance imaging (MRI) has become clinica... more Radiotherapy treatment planning based only on magnetic resonance imaging (MRI) has become clinically achievable. Though computed tomography (CT) is the gold standard for radiotherapy imaging, directly providing the electron density values needed for planning calculations, MRI has superior soft tissue visualisation to guide treatment planning decisions and optimisation. MRI-only planning removes the need for the CT scan, but requires generation of a substitute/synthetic/pseudo CT (sCT) for electron density information. Shortening the MRI imaging time would improve patient comfort and reduce the likelihood of motion artefacts. A volunteer study was previously carried out to investigate and optimise faster MRI sequences for a hybrid atlas-voxel conversion to sCT for prostate treatment planning. The aim of this follow-on study was to clinically validate the performance of the new optimised sequence for sCT generation in a treated MRI-only prostate patient cohort. 10 patients undergoing ...
Radiotherapy for thoracic and breast tumours is associated with a range of cardiotoxicities. Emer... more Radiotherapy for thoracic and breast tumours is associated with a range of cardiotoxicities. Emerging evidence suggests cardiac substructure doses may be more predictive of specific outcomes, however, quantitative data necessary to develop clinical planning constraints is lacking. Retrospective analysis of patient data is required, which relies on accurate segmentation of cardiac substructures. In this study, a novel model was designed to deliver reliable, accurate, and anatomically consistent segmentation of 18 cardiac substructures on computed tomography (CT) scans. Thirty manually contoured CT scans were included. The proposed multi-stage method leverages deep learning (DL), multi-atlas mapping, and geometric modelling to automatically segment the whole heart, cardiac chambers, great vessels, heart valves, coronary arteries, and conduction nodes. Segmentation performance was evaluated using the Dice similarity coefficient (DSC), mean distance to agreement (MDA), Hausdorff distanc...
Introduction: Within an International Atomic Energy Agency (IAEA) coordinated research project (C... more Introduction: Within an International Atomic Energy Agency (IAEA) coordinated research project (CRP), a remote end-to-end dosimetric quality audit for intensity modulated radiation therapy (IMRT)/ volumetric arc therapy (VMAT) was developed to verify the radiotherapy chain including imaging, treatment planning and dose delivery. The methodology as well as the results obtained in a multicentre pilot study and national trial runs conducted in close cooperation with dosimetry audit networks (DANs) of IAEA Member States are presented. Material and methods: A solid polystyrene phantom containing a dosimetry insert with an irregular solid water planning target volume (PTV) and organ at risk (OAR) was designed for this audit. The insert can be preloaded with radiochromic film and four thermoluminescent dosimeters (TLDs). For the audit, radiotherapy centres were asked to scan the phantom, contour the structures, create an IMRT/VMAT treatment plan and irradiate the phantom. The dose prescription was to deliver 4 Gy to the PTV in two fractions and to limit the OAR dose to a maximum of 2.8 Gy. The TLD measured doses and film measured dose distributions were compared with the TPS calculations. Results: Sixteen hospitals from 13 countries and 64 hospitals from 6 countries participated in the multicenter pilot study and in the national runs, respectively. The TLD results for the PTV were all within ±5% acceptance limit for the multicentre pilot study, whereas for national runs, 17 participants failed to meet this criterion. All measured doses in the OAR were below the treatment planning constraint. The film analysis identified seven plans in national runs below the 90% passing rate gamma criteria. Conclusion: The results proved that the methodology of the IMRT/VMAT dosimetric end-to-end audit was feasible for its intended purpose, i.e., the phantom design and materials were suitable; the phantom was easy to use and it was robust enough for shipment. Most importantly the audit methodology was capable of identifying suboptimal IMRT/VMAT delivery.
Conclusion: The MDC-OVER-UNDER analysis as an assessment tool, has the potential to reduce labour... more Conclusion: The MDC-OVER-UNDER analysis as an assessment tool, has the potential to reduce labour, reduce inter/intra observer variability and provide rapid quantified feedback. Consistently failing volumes would trigger protocol review in the first instance. Wider application in an RTTQA or educational setting requires a consensus min/max extent volume for several operator defined volumes by the TMG from the outset, supported by the STAPLE algorithm. (Excluding spaces <2500 characters on word.) PO-0950 QA and dummy-run results of the TRENDY randomized trial on SBRT vs. chemoembolization for HCC
Results: Whereas for machines younger than 10 years agreement between measured and stated dose wa... more Results: Whereas for machines younger than 10 years agreement between measured and stated dose was 90% overall, for those over 30 years old agreement dropped to 70%. However, this picture varied with region. Linac dosimetry was always better than 60 Co and multi-machine centres generally performed better than single machine institutions. We interpret this latter observation as a reflection of a more substantial physics infrastructure in larger centres. The data suggest virtually no dependence on the time elapsed since the last dosimetry system calibration at least out to 10 years. Second or subsequent participation in audits reflected higher quality dosimetry (85% of results within the XX's acceptance criterion) than the first audit (77%). The use of N D,w based dosimetry protocols resulted in more accurate dosimetry than the use of the older N k or N x protocols (95%, 92% and 79% agreement respectively). Conclusions: Clearly, over the 45 years that the XX has accumulated these TLD data, practice has changed both in institutions and at the XX's Dosimetry Laboratory. However, it is possible to draw some general conclusions from the analysis. Higher quality dosimetry is generally associated with younger machines, linacs as opposed to 60 Co, centres with more than one machine, prior experience with the XX's audit programme and the use of an N D,w based protocol.
A dosimetry intercomparison has been carried out for all 52 radiotherapy centres in the UK which ... more A dosimetry intercomparison has been carried out for all 52 radiotherapy centres in the UK which possess electron treatment facilities. The intercomparison was carried out on one treatment unit in each centre and for three energies across the range of available energies. The position of the depth of maximum dose for a standard field size was independently determined and a subsequent beam calibration made. The factor to convert the reading on a calibrated ionization chamber to absorbed dose in an electron beam is energy dependent, and hence to carry out an independent calibration measurement also requires the beam energy to be determined. In addition a quantitative measure of the difference in the calibration chains between the intercomparison equipment and the host department&#39;s field instrument was carried out. In order to provide a follow-up to the initial IPSM national photon intercomparison, a photon beam calibration was measured in one photon beam in each centre. For 156 electron beam measurements, a mean ratio of intercomparison measured dose to locally measured dose of 0.994 was obtained with a standard deviation of 1.8%. For the 52 photon beam measurements, a mean ratio of intercomparison measured dose to locally measured dose of 1.003 was obtained with a standard deviation of 1.0%.
Background Anal cancer is a rare cancer with rising incidence. Despite the relatively good outcom... more Background Anal cancer is a rare cancer with rising incidence. Despite the relatively good outcomes conferred by state-of-the-art chemoradiotherapy, further improving disease control and reducing toxicity has proven challenging. Developing and validating prognostic models using routinely collected data may provide new insights for treatment development and selection. However, due to the rarity of the cancer, it can be difficult to obtain sufficient data, especially from single centres, to develop and validate robust models. Moreover, multi-centre model development is hampered by ethical barriers and data protection regulations that often limit accessibility to patient data. Distributed (or federated) learning allows models to be developed using data from multiple centres without any individual-level patient data leaving the originating centre, therefore preserving patient data privacy. This work builds on the proof-of-concept three-centre atomCAT1 study and describes the protocol fo...
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Australasian Physical & Engineering Sciences in Medicine, 2018
Computed tomography (CT) is the gold standard for radiotherapy simulation and treatment planning,... more Computed tomography (CT) is the gold standard for radiotherapy simulation and treatment planning, providing spatial accuracy, bony anatomy definition and electron density information for dose calculations. Magnetic resonance imaging (MRI) has been introduced in radiotherapy to improve visualisation of anatomy for accurate target definition and contouring, however lacks electron density information required for dose calculations, with various methods used to overcome this. The aim of this work is to assess the impact on dose calculation accuracy and optimisation results of different approaches to determine electron density, as could be used in MRI only treatment planning for nasopharyngeal datasets with VMAT treatment plans. Volumetric modulated arc therapy (VMAT) plans were created for 10 retrospective head and neck (H&N) nasopharyngeal patients. The VMAT plans were generated on the gold standard dataset, the original CT scan. Data sets with no density correction (water equivalent) and two different sets of bulk density correction for bone/air/tissue applied separately were generated for these patients and the VMAT plans were recalculated for each case. Plans were also reoptimised on these data sets, and recalculated. Optimisation error was assessed through equivalent uniform dose (EUD) differences. Additionally, point dose comparison, dose volume histogram (DVH) analysis and gamma analysis of dose were used to assess dose calculation error. The dose calculation error on average was an increase in EUD whereas the optimisation error on average was a reduction in EUD compared to the original plan for all datasets aside from the bone only override dataset where bone was set to 1.61 g/cm 3. For the optimisation error, the largest mean absolute error (MAE) was 1.88 Gy EUD for the PTV, and 2.21 Gy EUD for the brainstem, for the reoptimisation completed on the air only overridden dataset, and recalculated on the original. Bulk density corrections for bone and air provide dose calculations within 3% of the original treatment plans. Optimisation errors have the potential to be greater than dose calculation errors if incorrect density corrections are utilized. Electron density correction using a bulk density approach achieves dose calculation uncertainties within 3%, however more advanced approaches, such as a voxel based approach, may improve accuracy and should be considered.
This work introduces the concept of very small field size. Output factor (OPF) measurements at th... more This work introduces the concept of very small field size. Output factor (OPF) measurements at these field sizes require extremely careful experimental methodology including the measurement of dosimetric field size at the same time as each OPF measurement. Two quantifiable scientific definitions of the threshold of very small field size are presented. Methods: A practical definition was established by quantifying the effect that a 1 mm error in field size or detector position had on OPFs and setting acceptable uncertainties on OPF at 1%. Alternatively, for a theoretical definition of very small field size, the OPFs were separated into additional factors to investigate the specific effects of lateral electronic disequilibrium, photon scatter in the phantom, and source occlusion. The dominant effect was established and formed the basis of a theoretical definition of very small fields. Each factor was obtained using Monte Carlo simulations of a Varian iX linear accelerator for various square field sizes of side length from 4 to 100 mm, using a nominal photon energy of 6 MV. Results: According to the practical definition established in this project, field sizes ≤15 mm were considered to be very small for 6 MV beams for maximal field size uncertainties of 1 mm. If the acceptable uncertainty in the OPF was increased from 1.0% to 2.0%, or field size uncertainties are 0.5 mm, field sizes ≤12 mm were considered to be very small. Lateral electronic disequilibrium in the phantom was the dominant cause of change in OPF at very small field sizes. Thus the theoretical definition of very small field size coincided to the field size at which lateral electronic disequilibrium clearly caused a greater change in OPF than any other effects. This was found to occur at field sizes ≤12 mm. Source occlusion also caused a large change in OPF for field sizes ≤8 mm. Based on the results of this study, field sizes ≤12 mm were considered to be theoretically very small for 6 MV beams. Conclusions: Extremely careful experimental methodology including the measurement of dosimetric field size at the same time as output factor measurement for each field size setting and also very precise detector alignment is required at field sizes at least ≤12 mm and more conservatively 041707-1 Med. Phys. 41 (4), April 2014
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