AFOMP policy number 6: code of ethics for medical physicists in AFOMP Countries

This policy statement, which is the sixth of a series of documents prepared by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP) Professional Development Committee, gives guidance on how medical physicists in AFOMP countries should conduct themselves in an ethical manner in their professional practice (Ng et al. in Australas Phys Eng Sci Med 32:175-179, 2009; Round et al. in Australas Phys Eng Sci Med 33:7-10, 2010; Round et al. in Australas Phys Eng Sci Med 34:303-307, 2011; Round et al. in Australas Phys Eng Sci Med 35:393-398, 2012; Round et al. in Australas Phys Eng Sci Med 38:217-221, 2015). It was developed after the ethics policies and codes of conducts of several medical physics societies and other professional organisations were studied. The policy was adopted at the Annual General Meeting of AFOMP held in Jaipur, India, in November 2017.

Radiation exposure to caregivers from patients undergoing common radionuclide therapies: a review

The contribution of radionuclide therapies (RNTs) to effective patient treatment is widely appreciated. The administration of high doses has necessitated investigating the potential radiation hazard to caregivers from patients undergoing RNTs. This work aimed to review the literature regarding measured effective doses to caregivers from such patients. The main selection criterion was the presence of real radiation exposure measurements. The results were categorised according to the treatment protocol and dose parameters. Analysis of the collected data demonstrated that the measured effective dose values were within the dose constraints defined by the International Commission on Radiological Protection, provided that the radiation protection instructions were followed by both patients and caregivers. In conclusion, the radiation risk for caregivers was almost negligible. In this context, treatments could be administered more often on an outpatient basis, once cost-effectiveness criteria were established and radiation protection training and procedures were appropriately applied.

Patient-specific dosimetry in peptide receptor radionuclide therapy: a clinical review

Neuroendocrine tumours (NETs) belong to a relatively rare class of neoplasms. Nonetheless, their prevalence has increased significantly during the last decades. Peptide receptor radionuclide therapy (PRRT) is a relatively new treatment approach for inoperable or metastasised NETs. The therapeutic effect is based on the binding of radiolabelled somatostatin analogue peptides with NETs' somatostatin receptors, resulting in internal irradiation of tumours. Pre-therapeutic patient-specific dosimetry is essential to ensure that a treatment course has high levels of safety and efficacy. This paper reviews the methods applied for PRRT dosimetry, as well as the dosimetric results presented in the literature. Focus is given on data concerning the therapeutic somatostatin analogue radiopeptides (111)In-[DTPA(0),D-Phe(1)]-octreotide ((111)In-DTPA-octreotide), (90)Y-[DOTA(0),Tyr(3)]-octreotide ((90)Y-DOTATOC) and (177)Lu-[DOTA(0),Tyr(3),Thr(8)]-octreotide ((177)Lu-DOTATATE). Following the Medical Internal Radiation Dose (MIRD) Committee formalism, dosimetric analysis demonstrates large interpatient variability in tumour and organ uptake, with kidneys and bone marrow being the critical organs. The results are dependent on the image acquisition and processing protocol, as well as the dosimetric imaging radiopharmaceutical.

AFOMP Policy Statement No. 3: recommendations for the education and training of medical physicists in AFOMP countries

AFOMP recognizes that clinical medical physicists should demonstrate that they are competent to practice their profession by obtaining appropriate education, training and supervised experience in the specialties of medical physics in which they practice, as well as having a basic knowledge of other specialties. To help its member countries to achieve this, AFOMP has developed this policy to provide guidance when developing medical physicist education and training programs. The policy is compatible with the standards being promoted by the International Organization for Medical Physics and the International Medical Physics Certification Board.

A Monte Carlo evaluation of three Compton camera absorbers

We present a quantitative study on the performance of cadmium zinc telluride (CZT), thallium-doped sodium iodide (NaI(Tl)) and germanium (Ge) detectors as potential Compton camera absorbers. The GEANT4 toolkit was used to model the performance of these materials over the nuclear medicine energy range. CZT and Ge demonstrate the highest and lowest efficiencies respectively. Although the best spatial resolution was attained for Ge, its lowest ratio of single photoelectric to multiple interactions suggests that it is most prone to inter-pixel cross-talk. In contrast, CZT, which demonstrates the least positioning error due to multiple interactions, has a comparable spatial resolution with Ge. Therefore, we modelled a Compton camera system based on silicon (Si) and CZT as the scatterer and absorber respectively. The effects of the detector parameters of our proposed system on image resolution were evaluated and our results show good agreement with previous studies. Interestingly, spatial resolution which accounted for the least image degradation at 140.5 keV became the dominant degrading factor at 511 keV, indicating that the absorber parameters play some key roles at higher energies. The results of this study have validated the predictions by An et al. which state that the use of a higher energy gamma source together with reduction of the absorber segmentation to sub-millimetre could achieve the image resolution of 5 mm required in medical imaging.

GEANT4 simulation of the effects of Doppler energy broadening in Compton imaging

A Monte Carlo approach was used to study the effects of Doppler energy broadening on Compton camera performance. The GEANT4 simulation toolkit was used to model the radiation transport and interactions with matter in a simulated Compton camera. The low energy electromagnetic physics model of GEANT4 incorporating Doppler broadening developed by Longo et al. was used in the simulations. The camera had a 9 × 9 cm scatterer and a 10 × 10 cm absorber with a scatterer to-absorber separation of 5 cm. Modelling was done such that only the effects of Doppler broadening were taken into consideration and effects of scatterer and absorber thickness and pixelation were not taken into account, thus a 'perfect' Compton camera was assumed. Scatterer materials were either silicon or germanium and the absorber material was cadmium zinc telluride. Simulations were done for point sources 10 cm in front of the scatterer. The results of the simulations validated the use of the low energy model of GEANT4. As expected, Doppler broadening was found to degrade the Compton camera imaging resolution. For a 140.5 keV source the resulting full-width-at-half-maximum (FWHM) of the point source image without accounting for Doppler broadening and using a silicon scatterer was 0.58 mm. This degraded to 7.1 mm when Doppler broadening was introduced and degraded further to 12.3 mm when a germanium scatterer was used instead of silicon. But for a 511 keV source, the FWHM was better than for a 140 keV source. The FWHM improved to 2.4 mm for a silicon scatterer and 4.6 mm for a germanium scatterer. Our result for silicon at 140.5 keV is in very good agreement with that published by An et al.

A survey of the Australasian clinical medical physics and biomedical engineering workforce

A survey of the medical physics and biomedical engineering workforce was carried out in 2006. 495 positions (equivalent to 478 equivalent full time (EFT) positions) were captured by the survey. Of these 268 EFT were in radiation oncology physics, 36 EFT were in radiology physics, 44 were in nuclear medicine physics, 101 EFT were in biomedical engineering and 29 EFT were attributed to other activities. The survey reviewed the experience profile, the salary levels and the number of vacant positions in the workforce for the different disciplines in each Australian state and in New Zealand. Analysis of the data identifies staffing shortfalls in the various disciplines and demonstrates the difficulties that will occur in trying to train sufficient physicists to raise staffing to an acceptable level.

Photon beam convolution using polyenergetic energy deposition kernels

In photon beam convolution calculations where polyenergetic energy deposition kernels (EDKS) are used, the primary photon energy spectrum should be correctly accounted for in Monte Carlo generation of EDKS. This requires the probability of interaction, determined by the linear attenuation coefficient, mu, to be taken into account when primary photon interactions are forced to occur at the EDK origin. The use of primary and scattered EDKS generated with a fixed photon spectrum can give rise to an error in the dose calculation due to neglecting the effects of beam hardening with depth. The proportion of primary photon energy that is transferred to secondary electrons increases with depth of interaction, due to the increase in the ratio mu ab/mu as the beam hardens. Convolution depth-dose curves calculated using polyenergetic EDKS generated for the primary photon spectra which exist at depths of 0, 20 and 40 cm in water, show a fall-off which is too steep when compared with EGS4 Monte Carlo results. A beam hardening correction factor applied to primary and scattered 0 cm EDKS, based on the ratio of kerma to terma at each depth, gives primary, scattered and total dose in good agreement with Monte Carlo results.

A study of objective functions for organs with parallel and serial architecture

An objective function analysis when target volumes are deliberately enlarged to account for tumour mobility and consecutive uncertainty in the tumour position in external beam radiotherapy has been carried out. The dose distribution inside the tumour is assumed to have logarithmic dependence on the tumour cell density which assures an iso-local tumour control probability. The normal tissue immediately surrounding the tumour is irradiated homogeneously at a dose level equal to the dose D(R) delivered at the edge of the tumour. The normal tissue in the high dose field is modelled as being organized in identical functional subunits (FSUs) composed of a relatively large number of cells. Two types of organs--having serial and parallel architecture are considered. Implicit averaging over intrapatient normal tissue radiosensitivity variations is done. A function describing the normal tissue survival probability S0 is constructed. The objective function is given as a product of the total tumour control probability (TCP) and the normal tissue survival probability S0. The values of the dose D(R) which result in a maximum of the objective function are obtained for different combinations of tumour and normal tissue parameters, such as tumour and normal tissue radiosensitivities, number of cells constituting a normal tissue functional unit, total number of normal cells under high dose (D(R)) exposure and functional reserve for organs having parallel architecture. The corresponding TCP and S0 values are computed and discussed.

A new method for optimum dose distribution determination taking tumour mobility into account

A method for determining the optimum dose distribution in the planning target volume is proposed when target volumes are deliberately enlarged to account for tumour mobility in external beam radiotherapy. The optimum dose distribution is a dose distribution that will result in an acceptable level of tumour control probability (TCP) in most of the arising cases of tumour dislocation. An assumption is made that the possible shifts of the tumour are subject to a Gaussian distribution with mean zero and known variance. The idea of a reduced (mean in ensemble) tumour cell density is introduced. On this basis, the target volume and dose distribution in it are determined. The tumour control probability as a function of the shift of the tumour has been calculated. The Monte Carlo method has been used to simulate TCP distributions corresponding to tumour mobility characterized by different variances. The obtained TCP distributions are independent of the variance of the mobility because the dose distribution in the planning target volume is prescribed so that the mobility variance is taken into account. For simplicity a one-dimensional model is used but three-dimensional generalization can be done.

A variational approach to the problem of optimizing the radiation dose distribution in tumours

This paper presents a precise mathematical formulation of a biological criterion by which the radiation dose distribution in tumours homogeneous or heterogeneous in cell density and radiosensitivity can be optimized. The criterion is formulated as search for a dose distribution that would minimize the mean dose delivered to the tumour under the constraint that the tumour control probability reaches a given desired value. Using a method from the calculus of variations it has been proven that a homogeneous dose distribution is the solution in case of tumours homogeneous in radiosensitivity independent of their cell spatial density status. Thus the usual requirement for homogeneous dose distribution in case of homogeneous tumours is proven if the leading clinical criterion is the described one. The formula for the dose distribution in case of tumours heterogeneous in cell radiosensitivity is given too.

A mathematical approach to optimizing the radiation dose distribution in heterogeneous tumours

This paper offers a general mathematical approach to dose distribution optimization which allows tumours with different degrees of complexity to be considered. Two different biological criteria - A) keeping the control probability of the different parts of the tumour (local tumour control probability) uniform throughout the tumour and B) minimizing the mean dose delivered to the tumour are studied. For both criteria we impose the requirement that the whole tumour control probability be kept on a certain desired level. It is proved that the adoption of the first criterion requires a dose distribution logarithmic with the cell density and proportional to the inverse of the cell radiosensitivity while the adoption of the second criterion necessitates a homogeneous dose distribution when the cell radiosensitivity is constant. The corresponding formula for the dose distribution in case of heterogeneous cell radiosensitivity is also given. The two criteria are compared in terms of local tumour control probability and mean dose delivered to the tumour. It is concluded that maintaining constant local tumour control probability (criterion A) may be of greater clinical importance then minimizing the mean dose (criterion B).

The effect of density on the 10MV photon beam penumbra

An investigation into the density dependence of the penumbra of the Varian Clinac 18/10 10MV photon beam has been carried out. A water/lung phantom was constructed of polystyrene (r = 1.04 g cm-3) and cork (r = 0.23 g cm-3), in which interfaces exist both parallel and perpendicular to the beam axis. The irradiation of the phantom was also simulated using the EGS4 Monte Carlo system with a cartesian voxel geometry. Experimental (TLD) and Monte Carlo dose profiles are in close agreement, and show a large degree of penumbral broadening in the lung region. This broadening is due primarily to lateral electronic disequilibrium occurring at a larger distance from the geometric beam edge in lung than in water. This disequilibrium can also cause the dose in lung to drop below the dose in water at the same depth and off axis distance, even though the radiological depth is less in lung. Monte Carlo simulations were also performed where the dose is separated into primary and scattered components, for homogeneous media of densities 0.25, 0.50, 0.75 and 1.00 g cm-3. The penumbral width of the primary dose profile was found to be almost constant with depth for a point source of photons (after the initial build-up region), where the lateral distances from the 95-50% and 50-5% dose levels on the dose profile (normalised to the dose at the central axis) are equal in all cases. Also, primary penumbra width was found to be almost inversely proportional to density. The primary penumbra for a unit density material can be fitted accurately by an exponential forming function with empirical determined coefficients. The penumbral shape for the lower densities can then be closely fitted by scaling the coefficients in proportion to density. This scaling method has application in treatment planning, where the predicted primary penumbra shape should take account of inhomogeneities, and is particularly important in matching adjacent fields. When the scattered dose component is added to give the total dose, penumbral width increases because the scattered dose penumbra is wider than that of the primary dose. Also, the inverse proportionality of the penumbra width with density does not hold for the scattered dose. The relative contribution of the scattered dose increases with density. Therefore, the inverse proportionality of penumbra width with density does not hold for the total dose.

Ultrasonic beam-plotting with very small spheres

A method of pulse-echo ultrasonic beam plotting is described. It differs from traditional pulse-echo beam plotting in that the ultrasonic pulses are scattered off a totally isolated sphere rather than a sphere suspended on a wire. The method also allows extremely small spheres to be used thus providing greater resolution. It is demonstrated that pulse-echo beam plotting using spheres of different size produces different iso-echo amplitude curves.

Fourier coefficient description of left ventricular shape

A method of quantifying the shape of the left ventricle of the heart as seen in 2D echocardiograms was developed. It is based on describing the shape in terms of the coefficients a fifth-order trigonometric Fourier series. Such a series has eleven Fourier coefficients which is too large a number for clinical application so pairs of coefficients are combined to give six coefficients (alpha 0, alpha 1, ... , alpha 5). A trial was conducted to test the ability of the coefficient description to classify subjects as having normal right ventricles or ventricles with an apical abnormality. The tests showed that one of the coefficients (alpha 2) was higher for the subjects with an apical abnormality and that this difference increased with exercise. This is as was expected. However, it was found to be difficult to get a reliable estimate of alpha 2 from a single scan of a patient and that it is therefore probably necessary to average data from several scans to obtain a reliable alpha 2 value for a single patient.

Electron contamination in 4 MV and 10 MV radiotherapy x-ray beams

A thin window parallel-plate ionization chamber was constructed for dose measurement in the build-up region of high energy radiotherapy photon beams. The chamber is an integral part of a perspex block. The entrance window is 12 microns Melinex foil with a thin aluminium surface. Cavity thickness is 1.45 mm. Surface doses for varying field sizes were found to increase almost linearly with the side length of a square field. The surface dose for a 10x10 cm 4 MV photon beam is 12.1% for an open field and this increases to 14.1% with a polycarbonate block tray in the beam. Similarly for a 10 MV photon beam the surface dose is 10.6% for an open field and this increases to 12.4% with a polycarbonate block tray. The difference between the dose for an open field and a field with a polycarbonate block tray inserted becomes more significant for larger field sizes. Electron contamination depth dose curves are determined for a 4 MV and 10 MV photon beam. This is achieved by subtracting a pure photon beam build-up curve generated by an EGS4 Monte Carlo simulation from the experimental build-up curve. The EGS4 curve is a theoretical, electron contamination free curve. The electron contamination curve (of the 10 MV photon beam) has depth dose characteristics similar to that of a broad low energy electron beam.

Superposition on a multicomputer system

Superposition (convolution using a noninvariant kernel) has been shown to be a highly promising technique for use in calculating dose distributions in radiotherapy treatment planning. However, one major difficulty that currently prevents use in routine planning is the computational effort required to perform the calculation in three dimensions. To help solve this problem the superposition technique has been implemented on a parallel processor multicomputer in order to examine the performance characteristics of such a system. Up to eight elements have been connected in a pipeline (linear array), and tree networks of three and seven processors have also been constructed (using INMOS T800 transputers). The significant results obtained with these networks are: (1) Both topologies provide near-linear speedup with increasing processor number (8 processors provide 7.81 times the computing power of a single processor when using an optimal communication packet size); (2) increasing communication packet size from 1 voxel to an optimum of approximately 40 voxels significantly reduces communication overhead per processor. Overhead per processor for a 7-element linear array is 6.9% when using 1-voxel packets, but only 1.8% when using 40-voxel packets; (3) the topology of the network has some effect on communication overhead: Arranging 7 processors in a 1-2-4 binary tree reduces overhead to 80.1% of that encountered using a 7-element linear array (with packet size of 1 voxel).

Beam hardening of 10 MV radiotherapy x-rays: analysis using a convolution/superposition method

Total and primary polyenergetic dose spread arrays (PDSA) have been generated for a high energy 10 MV radiotherapy photon beam using the electron gamma shower (EGS) Monte Carlo code. By considering the attenuation of fluence per energy interval, PDSA have been produced at radiological depths of 0 cm (the surface PDSA) and 40 cm (the beam hardened PDSA). By comparing primary PDSA produced at these different depths, the effect of beam hardening on the PDSA has been quantified. Calculations show that the mean electron range due to the surface primary PDSA is 6.67 mm and the mean electron range of the beam hardened primary PDSA is 8.24 mm. In comparison, a 3 MeV primary monoenergetic dose spread array (MDSA) has a much smaller mean electron range of 4.81 mm. A radiotherapy x-ray beam computation method is introduced which involves a single superposition of the surface generated PDSA or beam hardened PDSA with a polyenergetic TERMA. The mean percentage difference between depth-dose curves obtained using super-position of surface and beam hardened PDSA is only 0.1%. The mean percentage difference from experimental data for these superposition curves is 2.8% down to 40 cm in a homogeneous phantom. The superposition process is shown to be forgiving to spectral differences when calculating the PDSA, but sensitive to the incident photon energy spectrum used to calculate the TERMA.

The production of body analogs for use in radiation physics

Bone, muscle and lung analog materials have been produced in-house, and dosimetry phantoms have been produced. A method using computed tomography (CT) has been developed to check that the analogs produced match the radiation properties of body tissues. The relative electron densities and ratio of electron cross sections are calculated from elemental compositions of the analogs. Using these data the theoretical CT numbers are calculated and these numbers are compared with experimental CT numbers for the analogs produced. The experimental CT numbers are found by scanning the samples on a Siemens DRH CT scanner. Results show the maximum difference between theoretical and experimental CT numbers for the analogs is 18 Hounsfield units, which relates to a delta NCT of less than 1%. Comparison of analog CT numbers with CT numbers for the related patient tissues also shows a close match.

Superposition dose calculation in lung for 10MV photons

Currently available radiotherapy treatment planning systems employ scatter function models such as ETAR and Batho dSAR for dose calculation. Errors using these models for high energy photon irradiation occur in and beyond lung tissue for small fields. For larger fields, central axis dose is correctly predicted but penumbral broadening in lung is underestimated. The major source of error is the assumption that lateral electronic equilibrium is always established. A superposition algorithm has been developed for 10MV photons which calculates the dose by convolving the TERMA (Total Energy Released per unit MAss by primary photons) with a dose spread array formed using the EGS4 Monte Carlo code. TERMA and dose spread arrays are both generated using a 10 component photon energy spectrum. Dose in inhomogeneous media is calculated using dose spread arrays generated for different density media and by scaling dose spread arrays according to density variations. This method ensures that electronic disequilibrium is modelled in situations where it exists. Superposition results in a lung phantom for a 5 x 5 cm field agree with EGS4 Monte Carlo results to within 2% for p = 0.20 gcm-3 and p = 0.30 gcm-3 lung. Profiles generated by superposition for a 10 x 10 cm field at mid-lung and compared with film measurements show that penumbral broadening in low density material is also correctly predicted.

Modelling polychromatic high energy photon beams by superposition

A unified three dimensional superposition approach to dose calculations used in treatment planning of polychromatic high energy photon beams in radiotherapy is developed. The approach we have used involves computing the dose at all points in a medium by superposing the dose spread array (DSA) from the interaction of a photon at a point in the medium with an array of data representing the TERMA (photon fluence times the photon energy) at points in the beam. The polychromatic nature of the beam is accounted for by modelling the beam as having ten spectral components. A "polychromatic dose spread array" (PDSA) for an interaction from a beam with this spectrum was derived. The TERMA array is calculated from a weighted average of the TERMA arrays for the ten photon energies to give a "polychromatic TERMA array". Thus the method accounts for the effect of beam hardening of the TERMA. But it does not account for the effect of beam hardening on the PDSA since a single PDSA (usually for the spectrum at the surface of the medium) is used at all depths. However, by considering measured and calculated beam central axis data, this model is shown to be adequate for computing depth doses for beams in a homogeneous medium penetrating to extreme radiological depths. A computation time advantage is gained because only one superposition per beam is required.

3-D superposition for radiotherapy treatment planning using fast Fourier transforms

Currently used radiotherapy treatment planning algorithms based on effective path length or scatter function methods do not model electron ranging from photon interaction sites. The superposition (or convolution) technique does model this effect, which is especially important at higher (linear accelerator) energies since the electron range is significant. Another advantage of this method is that it is conceptually simple and models the physical processes directly, rather than using empirically derived methods. A major disadvantage of superposition lies in the large amount of computer time required to generate a plan, especially in three dimensions. To help solve this problem, superposition using an invariant dose spread array (kernel) can be achieved by performing a convolution in Fourier space using fast Fourier transforms (FFTs). A method for 3 dimensional calculation of dose using FFTs is presented. Dose spread arrays are calculated using the EGS Monte Carlo code, and convolved with the TERMA (total energy released per unit mass). In both cases a 10 MV nominal beam energy is modelled by a 10 component spectrum, which is compared to the result obtained using monochromatic energy only (3.0 MeV at the surface). The FFT technique is shown to be significantly faster than standard convolution for medium to large TERMA and dose spread array sizes. The method is shown to be highly accurate for small fields in homogeneous media. For larger fields the central axis depth dose is accurate but the profile shape in the penumbral region becomes slightly distorted. This is because photons incident near the beam edges are not parallel to the cartesian coordinate system used as the convolution framework. However, this effect is sufficiently small to indicate that the convolution method is suitable for use in routine treatment planning.

Investigation of ultrasound axially traversing the human eye

A ray tracing model for ultrasonic propagation through the human eye, including the lens, has been developed on the assumptions of lossless media and non-reflecting interfaces. Measurement of the distribution of an ultrasonic beam before and after traversing specimens of human eyes in vitro, and of the velocity of ultrasound in the various dissected media, has permitted some comparison of the predictions of the model with experiment. The agreement is good although there are significant limitations involved and these are discussed. For imaging systems the effect of the eye arises largely from the lens which acts as a defocussing lens of focal length approx. 13.5 cm. Although the experiments were performed at approx. 4 MHz, the validity of the ray tracing model is largely frequency independent and will be appropriate at the higher frequencies commonly used in ophthalmology.