International Journal of Medical Physics, Clinical Engineering and Radiation Oncology

Journal Information
ISSN / EISSN : 21685436 / 21685444
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 261
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Mukesh Zope, Deepali Patil, Angel Kuriakose, P. A. Aslam, Basil George, Abhijeet Mandal
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 62-72; doi:10.4236/ijmpcero.2020.92007

This study aims to compare the dosimetric coverage of the Planning Target Volume (PTV) and the dose to main organs at risk (OARs) between two different algorithms fast superposition (FSUP), superposition (SUP) using intensity-modulated radiotherapy (IMRT) techniques for prostate cancer. Ten patients with prostate cancer were selected for this study. For each patient, IMRT plans were created with 6 MV photon beam quality using CMS XiO treatment planning system. The delivery of IMRT was carried out using the step and shoot techniques. The dose coverage for each patient was designated to an ICRU report 62 reference point in the PTV, medium coverage of the planned target volume to be 95% of the prescribed dose while the maximum dose in the target volume to be not greater than 107% of the prescribed dose. A hypofractionated prescription dose of 70 Gy/28# at 2.5 Gy per fraction was used. Besides we compared the number of MUs and OARs dose to D15%, D25%, D35%, D50% on both algorithm planning sets. For target, this evaluation was made with comparing the conformity index (CI) and homogeneity index (HI). In our study, the results show the OARs got less dose from the SUP algorithm compared to FSUP algorithms. Statistically not significant difference was observed in V107% of PTV, MU/CC, conformity Index (p = 0.057, p = 0.215, p = 0.370) and 95% PTV Volume received prescription dose from both Plans. But Homogeneity Index for both algorithms was statistically significant (p = 0.000, p = 0.001). For prostate cancer, the superposition algorithm showed better results in the IMRT plan compared to the fast superposition algorithm.
Jialu Yu, Huazhi Geng, Yutao Gong, Mitchell Machtay, Himanshu R. Lukka, Zhongxing Liao, Ying Xiao, Wei Zou
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 43-51; doi:10.4236/ijmpcero.2020.92005

Purpose: Standardization of tumor dosimetric coverage is essential for the evaluation of radiotherapy treatment plan quality. National clinical trials network RTOG protocols include tumor target dosimetric criteria that specify the prescription dose and minimum and maximum dose (Dmin and Dmax) coverages. This study investigated the impact of various minimum and maximum dose definitions using tumor control probability (TCP) models. Methods and Materials: Three disease sites (head and neck, lung, and prostate) were studied using target volume dosimetric criteria from the RTOG 0920, 1308, and 0938 protocols. Simulated target dose-volume histograms (DVHs) of Dmin and Dmax were modeled using the protocol specifications. Published TCP models for the three disease sites were applied to the DVH curves. The effects of various dose definitions on TCP were studied. Results: While the prescription dose coverage was maintained, a -3.7% TCP difference was observed for head and neck cancer when the target doses varied by 3.5% of the tumor volume from the point dose. For prostate and lung cancers, -3.3% and -2.2% TCP differences were observed, respectively. The TCPs for head and neck and prostate cancers were more negatively affected by deviations in the Dmin than the TCP for lung cancer. The lung TCP increased to a greater extent with a change in the Dmax compared with the head and neck and prostate TCPs. Conclusions: These results can be used to evaluate plan quality when the target dose only slightly deviates from the dosimetric criteria. When the overall target prescription dose coverage is maintained, the Dmax is recommended to be within 3% of the target volume: 98% (for head and neck and prostate) and 97% (for lung) of the target volume, satisfying the Dmin needed to maintain TCP variations at less than 2.1%. Using 0.03 cc instead of a point dose for Dmin and Dmax criteria minimally impacts TCPs.
Ghada Mohammed Abd El Razeq, Mohammad A. M. Ahmed
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 24-33; doi:10.4236/ijmpcero.2020.91003

Introduction: Ovarian cancer is the commonest reason for death in females due to gynecologic malignancy around the world. In contrast to other gynecologic tumours, the definitive diagnosis is accomplished days after of the index surgery by the histopathology. Preoperative assessment based on conventional MRI is not accurate. Information is expanding increasing about the ability of new MRI modalities to assess ovarian mass. Aim of the study: To assess the ability of dynamic contrast-enhanced MRI (DCE–MRI), and Diffusion-weighted image (DWI) to describe uncertain ovarian masses. Patients and Methods: This is a retrospective study. Patients were referred from radio-diagnosis department and gynecology department of Qena faculty of medicine hospitals, South Valley University. Patients had uncertain adnexal masses at ultrasound. Magnetic resonance examination was doneutilizing 1.5 Tesla machine. The protocol included T1WI, T2WI, T1WI following contrast, and DWI. Results: We included 44 patients with different forms of complex cystic and solid ovarian masses. The final pathology of the ovarian masses was 18 benign, 4 borderline, and 22 malignant. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for DWI were 100%, 94.4%, 96.3%, 100%, and 97.7% respectively. The performance of DWI was higher than the conventional MRI and DCE-MRI. Conclusion: DCE-MRI and DWI have accepted ability to recognize malignant ovarian mass.
Soai Dang Quoc, Quang Bui Vinh, Cuong Bui Xuan, Toan Hoang Van, Truong Vu, Dang Quoc Soai, Bui Vinh Quang, Bui Xuan Cuong, Vu Truong
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 1-13; doi:10.4236/ijmpcero.2020.91001

Aims: This study compares data between the Field in Field planning and Wedge planning techniques to figure out which technique has better dose coverage and distribution for PTV, and, if using FiF technique for whole brain treatment, how many beams will have better plan. Methods: 56 patients, who need to radiate whole brain with 30 Gy/10 fractions, have been selected for this study. Four plans have been made for each patient (FiF1—one subfield per field plan, FiF2—two subfields per field plan, FiF3—three subfields per field plan, and a Wedge plan). Results: The results of Field in Field plans including Compare dose distribution on the transverse CT slice, plan evaluation using DVH, number MU of plan, Dmax, HI, HTCI, DmaxPTV, DmeanPTV. Volume of PTV with the dose over 105% prescribed dose, dose of organ at risk, and Quality Assurance (QA) plan, are better than those of Wedge plan. Conclusions: Plans using Field in Field technique has better coverage, is more homogeneous in dose distribution than plan using Wedge technique. When using Field in Field technique for whole brain radiotherapy, using three subfields per field has better result than two subfields per field and one subfield per field.
Shlomi Caduri, Itzhak Orion
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 14-23; doi:10.4236/ijmpcero.2020.91002

EGS5 Monte Carlo code is a general-purpose code for calculating photons and electrons transport for complex geometries in a wide range of energies. EGSnrc Monte Carlo code (BEAMnrc enclosed) was specially developed for medical physics usage, in particular for Linac modeling and dose calculations. Both EGS5 an EGSnrc were developed based on the former EGS4 code. For each of the codes, changes were made in the electron transport methods and in the geometrical utilities. Conformity between EGS5 calculation results and EGSnrc code results for Linac modelling was shown in recent work in our group. However, a large simulation run-time difference was found for the same conditions and statistical precision between these two codes. The EGS5 code took a longer period to obtain the same results compared to the EGSnrc code for Linac modelling. The electron transport in EGSnrc is based on the ESTEPE parameter, which is the maximum fractional energy loss per electron step. We investigated the ESTEPE parameter influence on the run-time and on the results accuracy. A set of variety simulations were performed using both codes in order to inspect the codes performance. We found that the EGSnrc run-time is strongly influenced by choosing different ESTEPE parameter values. While setting larger fractional energy losses per step, reduced simulation run-time was achieved. Hence, for optimal dose, one should define the optimal ESTEPE step-size parameter to achieve the desired dose results resolution. The use of the EGS5 code, based on the electron transport method improvements, is automatically adapted to the desired dose results quality without any user interference. Choosing the proper ESTEPE parameter for the use of EGSnrc for a given simulation resulted in similar run-time duration as with the use of EGS5. In conclusion, some cases that were tested in this study on the EGS5 and on the EGSnrc showed that the EGS5 is faster and more fluent to use between these two codes.
Benjamin Foe Ngono, Alexandre Ngwa Ebongue, Daniel Bongu, Albert Mouelle Sone, Moise G. Kwato Njock
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 34-41; doi:10.4236/ijmpcero.2020.91004

In this work, a method to reduce increase in optical density (OD) caused by multiple scanning in radiochromic film dosimetry in combination with a flatbed scanner is presented. Gafchromic EBT3 films are scanned with Epson Pro 1680 Expression scanner and time intervals of 15 minutes and 30 minutes are observed between consecutive scans to reduce the increase in temperature of the scanner. The maximum variations in OD after consecutive scans are calculated and compared to the values obtained for scans without interruption. For film irradiated to 3 Gy, a time interval of 15 minutes between two successive scans leads to a reduction of the OD increase of 56.2% compared to when films are scanned without interruption. Reductions of OD increase of 86.72% and 78.72% respectively for film irradiated to 1 Gy and 2 Gy are obtained when a time interval of 30 minutes is left between two successive scans. These results show that when time intervals are observed between consecutive scans, the increase in OD has significantly reduced. However, the method has the drawback of increasing the time needed to perform radiochromic film dosimetry.
Turan Sahmaran, Ayse Kaskas
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 110-124; doi:10.4236/ijmpcero.2020.93011

The study is aimed to investigate the effect of the trace element concentrations in healthy and cancerous prostate tissues on dose distributions in radiotherapy. In this work, the trace element compounds completely soluble in the water were used and their concentrations given in the literature were mixed homogeneously with pure water. This is the first time study in literature as far as we know. The percent depth dose (PDD) measurements were performed using Elekta Synergy Platform Linac device for 6 and 18 MV photon energies. We also obtained the PDDs results by choosing higher trace element concentrations than given in literature in cancerous prostate tissue to see the effect on radiotherapy. The experimental measurements were compared with the results obtained from the GATE simulation code. The TPR20/10 was calculated for 10 × 10 cm2 field size at 6/18 MV energies photons and compared with simulation results. The differences between simulation and measurement for 6 MV and 18 MV photons are 1.75% and 1.82% respectively. The experimental results and simulations were presented an uncertainty lower than 3%. Simulated dose values are in good agreement with less than 2% differences with the experimental results. We see that the trace element concentrations of healthy and cancerous tissues did not affect the dose distribution at high-energy photons. This is expected and well known result. We believe that this in vitro study is important for proving the reliability of the dose given in radiotherapy treatment once again.
Sameer Taneja, Jose R. Teruel, Lei Hu, Jinyu Xue, David Barbee
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 87-95; doi:10.4236/ijmpcero.2020.93009

The purpose of this work is to evaluate the use of a two-dimensional (2D) planar ion chamber array to characterize leakage radiation from the head of the linear accelerator. Ion chamber arrays provide a benefit over a singular ion chamber measurement as they allow for the measurement of a larger area in order to isolate the point of maximum leakage dose and the small size of each individual ion chamber minimizes volume-averaging effects. A Varian Truebeam® undergoing acceptance testing was used for all measurements. The gantry was wrapped in Portal Pack for Localization (PPL) radiographic film in order to isolate the location of maximum leakage. A calibration curve was developed and used to determine dose-to-film. An Ion Chamber Profiler (IC Profiler™) manufactured by Sun Nuclear Corporation was used to confirm measurements by the PPL film. All measurements were normalized to leakage at 100 cm from the target relative to the central axis. Three points were investigated with the IC Profiler, including the top of the gantry, the Varian logo, and the side of the gantry. For the three locations, respectively, the PPL film and the IC profiler were measured 0.142% and 0.131%, 0.036% and 0.030%, and 0.014% and 0.019%. The good agreement between the PPL film and the IC Profiler provides confidence in the use of a more efficient and accurate ion chamber array for head leakage measurements.
Aaron Innocent Bogmis, Adrian Raducu Popa, Daniela Adam, Violeta Ciocâltei, Nicoleta Alina Guraliuc, Florin Ciubotaru, Ion-Christian Chiricuță
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 125-140; doi:10.4236/ijmpcero.2020.93012

Introduction: Radiotherapy alone or combined with surgery and/or chemotherapy is being investigated in the treatment of malignant pleural mesothelioma (MPM). This study aimed to simulate a Volumetric Modulated Arc Therapy (VMAT) treatment of a patient with MPM. Materials and Methods: CT images from a patient with intact lungs were imported via DICOM into the Pinnacle3 treatment planning (TP) system (TPS) and used as a model for MPM to delineate organs at risk (OAR) and both clinical and planning target volumes (CTV and PTV) with a margin of 5 mm. Elekta Synergy with 6 MV photons and 80 leafs MLCi2 was employed. VMAT plans were generated using two coplanar arcs with gantry rotation angles of 178° - 182°, the collimator angles of each arc were set to 90°, Octavius® 4D 729 was employed for quality assurance while the calculated and measured doses were compared using VeriSoft. Results: A TP was achieved. The Gamma volume analysis with criteria of 3 mm distance to agreement and 3% dose difference yielded the gamma passing rate = 99.9%. The reference isodose was 42.75 Gy with the coverage constraints for the PTV D95 and V95 = 95.0% of 45 Gy. The remaining dosimetric parameters met the recommendations from the clinically acceptable guidelines for the radiotherapy of MPM. Conclusion: Using well-defined TV and VMAT, a consistent TP compared to similar ones from publications was achieved. We obtained a high agreement between the 3D dose reconstructed and the dose calculated.
Rafiqul Islam, Hiroshi Watabe, Andreoli Stefano
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Volume 9, pp 52-61; doi:10.4236/ijmpcero.2020.92006

The aim of this work was to evaluate and compare the performance of comparatively new synthetic PTW 60019 microDiamond with PTW 60017 Diode E detector in measuring the output factors (OF) of IntraOperative Radiation Therapy (IORT) electron beams. For a given electron beam, OFs are defined as the ratio of the dose for any applicator size at the depth of maximum to that for a reference applicator. IORT is an innovative treatment technique that delivers a large single fraction of radiation dose to the tumor bed during surgery. The electron beams considered in this study were generated by the mobile NOVAC7 system. This device produces high-dose-per-pulse electron beams with four different energies in the range from 3 MeV to 9 MeV. We performed measurements for two higher energies, namely 7MeV and 9 MeV. The beam collimation was performed through Perspex (PMMA) cylindrical applicators with different diameters. The accurate dose delivery of IORT tightly depends on the precision of measured dose by reference applicator and the output factors of clinical applicators. The output factors were measured using microDiamond and Diode E detectors. The microDiamond detector performance was compared with a Diode E detector. Determined output factors of two detectors were in good agreement. The maximum deviations of output factors for microDiamond were found 2.74%, and 2.17% for 7 MeV and 9 MeV, respectively with respect to the PTW Diode E. The microDiamond detector was shown to exhibit excellent properties for output factor measurements and could be considered as a suitable tool for electron beam dosimetry.
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