Geometrical and dosimetrical characterization of the photon source using a micro-multileaf collimator for stereotactic radiosurgery

Detection of the focal spot motion relative to the collimator axis of a linear accelerator under gantry rotation

The potential for delivering high precision radiotherapy using linear accelerators (linacs) has been improved with the development of digital x-ray electronic portal imaging devices (EPID) for acquiring kilovoltage (kV) cone-beam CT and megavoltage (MV) images for patient positioning. EPIDs have also opened the possibilities of developing novel quality assurance and insight into radiotherapy equipment performance. The aim of this work was to measure the offset of the focal spot position (FSP) of a linac under gantry rotation relative to the collimator axis using an EPID. The focal spot was assumed to be a point source of MV x-ray generation. A special phantom was designed for measurement of FSP as a function of gantry angle on clinical linacs. The phantom was designed for attachment to the gantry head and supporting two tungsten-carbide ball-bearings at two different distances from the focal spot. The methodology was demonstrated on a series of images acquired of the phantom on three Elekta linacs in clinical use with 6 MV flattening-filter-free (FFF) beams. The gantry and collimator were rotated 360° in steps of 30°. For each position an image of the phantom was acquired using the EPID. Each series consisted of 169 EPID images. The images were analysed using in-house developed software. Analyses of the EPID images acquired with 6 MV FFF beams showed that the focal spot motion amplitudes relative to the collimator axis during gantry rotation in the longitudinal and lateral directions were less than 0.10 mm and 0.50 mm, respectively, for an optimized 6 MV FFF FSP calibrated linac. In a treatment planning system (TPS) the focal spot is assumed to be located on the rotation axis of the collimator at all gantry angles. This work introduces a method for quantifying the actual variation from this assumption in practice.

Direct reconstruction of the source intensity distribution of a clinical linear accelerator using a maximum likelihood expectation maximization algorithm

Direct determination of the source intensity distribution of clinical linear accelerators is still a challenging problem for small field beam modeling. Current techniques most often involve special equipment and are difficult to implement in the clinic. In this work we present a maximum-likelihood expectation-maximization (MLEM) approach to the source reconstruction problem utilizing small fields and a simple experimental set-up. The MLEM algorithm iteratively ray-traces photons from the source plane to the exit plane and extracts corrections based on photon fluence profile measurements. The photon fluence profiles were determined by dose profile film measurements in air using a high density thin foil as build-up material and an appropriate point spread function (PSF). The effect of other beam parameters and scatter sources was minimized by using the smallest field size ([Formula: see text] cm(2)). The source occlusion effect was reproduced by estimating the position of the collimating jaws during this process. The method was first benchmarked against simulations for a range of typical accelerator source sizes. The sources were reconstructed with an accuracy better than 0.12 mm in the full width at half maximum (FWHM) to the respective electron sources incident on the target. The estimated jaw positions agreed within 0.2 mm with the expected values. The reconstruction technique was also tested against measurements on a Varian Novalis Tx linear accelerator and compared to a previously commissioned Monte Carlo model. The reconstructed FWHM of the source agreed within 0.03 mm and 0.11 mm to the commissioned electron source in the crossplane and inplane orientations respectively. The impact of the jaw positioning, experimental and PSF uncertainties on the reconstructed source distribution was evaluated with the former presenting the dominant effect.

How to implement grid technology in tissue-based diagnosis: diagnostic surgical pathology

BACKGROUND

Tissue-based diagnosis or diagnostic surgical pathology is a highly accurate, sensitive and specific medical diagnostic technique that has expanded rapidly in using both molecular biology and computer technology.

OBJECTIVE

The objective is to analyze the present stage and potential influence of distributed data acquisition, analysis and presentation in tissue-based diagnosis by using recently developed standardized network systems such as grids.

METHODS

Interpretation of medical data is often based upon specialized examination, visual information acquisition and transfer as well as upon data collected from various sources. Efficient and accurate diagnostics require standardized data and transfer modes, which can be provided by a grid environment. The medical requirements, construction of an adequate grid environment, practical experiences in various medical disciplines and potential use in tissue-based diagnosis are described.

CONCLUSIONS

Grid technology is probably a useful tool to meet the conditions of tissue-based diagnosis in the near future, and will probably play a significant role in its further development.

Estimation of the focal spot size and shape for a medical linear accelerator by Monte Carlo simulation

The focal spot size and shape of a medical linac are important parameters that determine the dose profiles, especially in the penumbral region. A relationship between the focal spot size and the dose profile penumbra has been studied and established from simulation results of the EGSnrc Monte Carlo code. A simple method is proposed to estimate the size and the shape of a linac's focal spot from the measured dose profile data.

Impact of target point deviations on control and complication probabilities in stereotactic radiosurgery of AVMs and metastases

OBJECTIVE

Determination of the impact of inaccuracies in the determination and setup of the target point in stereotactic radiosurgery (SRS) on the expectable complication and control probabilities.

METHODS

Two randomized samples of patients with arteriovenous malformation (AVM) (n=20) and with brain metastases (n=20) treated with SRS were formed, and the probability for complete obliteration (COP) or complete remission (CRP), the size of the 10 Gy-volume in the brain tissue (VOI10), and the probability for radiation necrosis (NTCP) were calculated. The dose-effect relations for COP and CRP were fitted to clinical data. Target point deviations were simulated through random vectors and the resulting probabilities and volumes were calculated and compared with the values of the treatment plan.

RESULTS

The decrease of the relative value of the control probabilities at 1mm target point deviation was up to 4% for AVMs and up to 10% for metastases. At 2 mm the median decrease was 5% for AVMs and 9% for metastases. The value for the target point deviation, at which COP and CRP decreased about 0.05 in 90% of the cases, was 1.3 mm. The increase of NTCP was maximally 0.0025 per mm target point deviation for AVMs and 0.0035/mm for metastases. The maximal increase of VOI10 was 0.7 cm(3)/mm target point deviation in both patient groups.

CONCLUSIONS

The upper limit for tolerable target point deviations is at 1.3mm. If this value cannot be achieved during the system test, a supplementary safety margin should be applied for the definition of the target volume. A better accuracy level is desirable, in order to ensure optimal chances for the success of the treatment. The target point precision is less important for the minimization of the probability of radiation necroses.

High resolution MR based polymer dosimetry versus film densitometry: a systematic study based on the modulation transfer function approach

Precise methods of modem radiation therapy such as intensity modulated radiotherapy (IMRT), brachytherapy (BT) and high LET irradiation allow for high dose localization in volumes of a few mm3. However, most dosimetry methods-ionization chambers, TLD arrangements or silicon detectors, for example-are not capable of detecting sub-mm dose variations or do not allow for simple dose imaging. Magnetic resonance based polymer dosimetry (MRPD) appears to be well suited to three-dimensional high resolution relative dosimetry but the spatial resolution based on a systematic modulation transfer function (MTF) approach has not yet been investigated. We offer a theoretical construct for addressing the spatial resolution in different dose imaging systems, i.e. the dose modulation transfer function (DMTF) approach, an experimental realization of this concept with a phantom and quantitative comparisons between two dosimetric systems: polymer gel and film dosimetry. Polymer gel samples were irradiated by Co-60 photons through an absorber grid which is characterized by periodic structures of different spatial period (a), the smallest one at width of a/2 = 280 microm. The modulation in dose under the grid is visualized via calibrated, high resolution, parameter-selective (T2) and dose images based on multi-echo MR imaging. The DMTF is obtained from the modulation depth of the spin-spin relaxation time (T2) after calibration. Voxel sizes below 0.04 mm3 could be achieved, which are significantly smaller than those reported in MR based dose imaging on polymer gels elsewhere, using a powerful gradient system and a highly sensitive small birdcage resonator on a whole-body 3T MR scanner. Dose modulations at 22% of maximum dose amplitude could be observed at about 2 line pairs per mm. The polymer DMTF results are compared to those of a typical clinical film-scanner system. This study demonstrates that MR based gel dosimetry at 200 microm pixel resolution might even be superior, with reference to relative spatial resolution, to the results of a standard film-scanner system offering a nominal scan resolution of 200 microm.

MLC leaf width impact on the clinical dose distribution: a Monte Carlo approach

PURPOSE

The influence of the multileaf collimator (MLC) leaf width on the dose distribution in patients treated with conformal radiotherapy and intensity-modulated radiotherapy has been analyzed. This study was based on the Monte Carlo simulation with the beams generated by a linac with the double-focused MLC.

MATERIALS AND METHODS

The transmission through the leaves and the exact shape of the penumbra regions are difficult to model by treatment planning system algorithms. An accurate assessment of the dose variations due to the leaf width change can be achieved by means of Monte Carlo simulation. The BEAM/EGS4 code was used at the Hospital of the Virgen Macarena to model a Siemens PRIMUS linac, featuring an MLC with a leaf width projecting 1 cm at the isocenter. Based on this real model, a virtual head was designed while allowing for a variation of the leaf width projection. Both the real linac and the virtual linac, with leaves projecting 0.5 cm, were used to obtain the dose distributions for several treatments. A few disease sites, including the prostate, head and neck, and endometrium, were selected for the design of the conformal and intensity-modulated radiotherapy treatments with a forward planning algorithm sensitive to the different shapes of the volumes of interest. Isodose curves, differential matrix, gamma function, and the dose-volume histograms (DVHs) corresponding to both MLC models were obtained for all cases. The tumor control probability and the normal tissue complication probability were derived for those cases studied featuring the greatest differences between results for both MLCs.

RESULTS

The impact on the DVHs of changing leaf width projections at the isocenter from 1.0 cm to 0.5 cm was low. Radiobiologic models showed slightly better tumor control probability/normal tissue complication probability values using the virtual MLC with a leaf width projecting 0.5 cm at isocenter in those cases presenting greater differences in the DVHs.

CONCLUSIONS

The impact on the clinical dose distribution due to the MLC leaf width change is low based on the design and conditions used in this study.