Journal of Medical Physics
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   2009| July-September  | Volume 34 | Issue 3  
    Online since August 3, 2009

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Advances in multimodality molecular imaging
Habib Zaidi, Rameshwar Prasad
July-September 2009, 34(3):122-128
DOI:10.4103/0971-6203.54844  PMID:20098557
Multimodality molecular imaging using high resolution positron emission tomography (PET) combined with other modalities is now playing a pivotal role in basic and clinical research. The introduction of combined PET/CT systems in clinical setting has revolutionized the practice of diagnostic imaging. The complementarity between the intrinsically aligned anatomic (CT) and functional or metabolic (PET) information provided in a "one-stop shop" and the possibility to use CT images for attenuation correction of the PET data has been the driving force behind the success of this technology. On the other hand, combining PET with Magnetic Resonance Imaging (MRI) in a single gantry is technically more challenging owing to the strong magnetic fields. Nevertheless, significant progress has been made resulting in the design of few preclinical PET systems and one human prototype dedicated for simultaneous PET/MR brain imaging. This paper discusses recent advances in PET instrumentation and the advantages and challenges of multimodality imaging systems. Future opportunities and the challenges facing the adoption of multimodality imaging instrumentation will also be addressed.
  21 4,893 336
Technique alternatives for breast radiation oncology: Conventional radiation therapy to tomotherapy
N Fournier-Bidoz, Y Kirova, F Campana, J El Barouky, S Zefkili, R Dendale, MA Bollet, A Mazal, A Fourquet
July-September 2009, 34(3):149-152
DOI:10.4103/0971-6203.54849  PMID:20098562
Breast conserving radiotherapy uses tangential fields and compensating wedges. This conventional approach can be improved by a field-in-field technique using the linac multi-leaf collimator (MLC). A simplified field-in-field technique that planners can easily achieve and which improves dose uniformity in the breast volume is presented here. Field junction problems are more easily solved by the use of a virtual simulation. A unique isocenter can be set at the junction between the supra-clavicular field and the breast tangential fields. However, careful quality assurance of the treatment planning system must be performed. Tomotherapy has promising clinical advantages: the ability of a tomographic image to correct for random set-up errors, a continuous cranio-caudal delivery which suppresses junction problems, the conformality of the dose distribution throughout the complex volumes formed by the lymph nodes and the breasts. Tomotherapy is a valuable recourse for complex irradiations like bilateral breast or mammary plus axillary irradiation while a field-in-field associated with a unique isocenter technique can be used for majority of the patients.
  16 6,086 384
Optimization of beam angles for intensity modulated radiation therapy treatment planning using genetic algorithm on a distributed computing platform
Daryl P Nazareth, Stephen Brunner, Matthew D Jones, Harish K Malhotra, Mohammad Bakhtiari
July-September 2009, 34(3):129-132
DOI:10.4103/0971-6203.54845  PMID:20098558
Planning intensity modulated radiation therapy (IMRT) treatment involves selection of several angle parameters as well as specification of structures and constraints employed in the optimization process. Including these parameters in the combinatorial search space vastly increases the computational burden, and therefore the parameter selection is normally performed manually by a clinician, based on clinical experience. We have investigated the use of a genetic algorithm (GA) and distributed-computing platform to optimize the gantry angle parameters and provide insight into additional structures, which may be necessary, in the dose optimization process to produce optimal IMRT treatment plans. For an IMRT prostate patient, we produced the first generation of 40 samples, each of five gantry angles, by selecting from a uniform random distribution, subject to certain adjacency and opposition constraints. Dose optimization was performed by distributing the 40-plan workload over several machines running a commercial treatment planning system. A score was assigned to each resulting plan, based on how well it satisfied clinically-relevant constraints. The second generation of 40 samples was produced by combining the highest-scoring samples using techniques of crossover and mutation. The process was repeated until the sixth generation, and the results compared with a clinical (equally-spaced) gantry angle configuration. In the sixth generation, 34 of the 40 GA samples achieved better scores than the clinical plan, with the best plan showing an improvement of 84%. Moreover, the resulting configuration of beam angles tended to cluster toward the patient's sides, indicating where the inclusion of additional structures in the dose optimization process may avoid dose hot spots. Additional parameter selection in IMRT leads to a large-scale computational problem. We have demonstrated that the GA combined with a distributed-computing platform can be applied to optimize gantry angle selection within a reasonable amount of time.
  15 3,789 305
Coherent and incoherent scatterings for measurement of mandibular bone density and stable iodine content of tissue
Amandeep Sharma, Mohinderpal Singh, Bhajan Singh, Balvir S Sandhu
July-September 2009, 34(3):182-187
DOI:10.4103/0971-6203.54855  PMID:20098568
The aim of present study is to investigate the feasibility of gamma ray scattering for measurements of mandibular bone density and stable iodine content of tissue. Scattered spectra from solutions of K 2 HPO 4 in distilled water (a phantom simulating the mandibular bone) and KI in distilled water filled in a thin plastic vial (a phantom simulating the kinetics of thyroid iodine) are recorded for 59.54 and 145 keV incident gamma rays, respectively. A high-purity germanium detector is placed at various angular positions to record the scattered spectra originating from interactions of incident gamma rays with the phantom. The measured intensity ratio of coherent to incoherent scattered gamma rays, corrected for photo-peak efficiency of HPGe detector, absorption of gamma rays in air column present between phantom and detector, and self-absorption in the phantom, is found to be increasing linearly with increase in concentration of K 2 HPO 4 and KI in distilled water within experimental estimated error of <6%. The regression lines, obtained from experimental data for intensity ratio, provide the bone density and stable iodine contents of thyroid. The present non-destructive technique has the potential for a measure of mandibular bone density and stable iodine contents of thyroid.
  9 2,985 198
The role of Cobalt-60 in modern radiation therapy: Dose delivery and image guidance
L John Schreiner, Chandra P Joshi, Johnson Darko, Andrew Kerr, Greg Salomons, Sandeep Dhanesar
July-September 2009, 34(3):133-136
DOI:10.4103/0971-6203.54846  PMID:20098559
The advances in modern radiation therapy with techniques such as intensity-modulated radiation therapy and image-guid­ed radiation therapy (IMRT and IGRT) have been limited almost exclusively to linear accel­erators. Investigations of modern Cobalt-60 (Co-60) radiation delivery in the context of IMRT and IGRT have been very sparse, and have been limited mainly to computer-modeling and treatment-planning exercises. In this paper, we report on the results of experiments using a tomotherapy benchtop apparatus attached to a conventional Co-60 unit. We show that conformal dose delivery is possible and also that Co-60 can be used as the radiation source in megavoltage computed tomography imaging. These results complement our modeling studies of Co-60 tomotherapy and provide a strong motivation for continuing development of modern Cobalt-60 treatment devices.
  7 10,233 422
Practical and clinical considerations in Cobalt-60 tomotherapy
Chandra P Joshi, Sandeep Dhanesar, Johnson Darko, Andrew Kerr, PB Vidyasagar, L John Schreiner
July-September 2009, 34(3):137-140
DOI:10.4103/0971-6203.54847  PMID:20098560
Cobalt-60 (Co-60) based radiation therapy continues to play a significant role in not only developing countries, where access to radiation therapy is extremely limited, but also in industrialized countries. Howver, technology has to be developed to accommodate modern techniques, in­clud­ing image guided and adaptive radiation therapy (IGART). In this paper we describe some of the practical and clinical considerations for Co-60 based tomotherapy by comparing Co-60 and 6 MV linac-based tomotherapy plans for a head and neck (HandN) cancer and a prostate cancer case. The tomotherapy IMRT plans were obtained by modeling a MIMiC binary multi-leaf collimator attached to a Theratron-780c Co-60 unit and a 6 MV linear accelerator (CL2100EX). The EGSnrc/BEAMnrc Monte Carlo (MC) code was used for the modeling of the treatment units with the MIMiC collimator and EGSnrc/DOSXYZnrc code was used for beamlet dose data. An in-house inverse treatment planning program was then used to generate optimized tomotherapy dose distributions for the H and N and prostate cases. The dose distributions, cumulative dose area histograms (DAHs) and dose difference maps were used to evaluate and compare Co-60 and 6 MV based tomotherapy plans. A quantitative analysis of the dose distributions and dose-volume histograms shows that both Co-60 and 6 MV plans achieve the plan objectives for the targets (CTV and nodes) and OARs (spinal cord in HandN case, and rectum in prostate case).
  7 4,055 312
First year experience with newly developed Leksell Gamma Knife® Perfexion™
Jagdish P Bhatnagar, Josef Novotny, Ajay Niranjan, Douglas Kondziolka, John Flickinger, Dade Lunsford, M Saiful Huq
July-September 2009, 34(3):141-148
DOI:10.4103/0971-6203.54848  PMID:20098561
A new model of Leksell Gamma Knife® (LGK), known as Perfexion™ (LGK PFX), was introduced by Elekta Instrument, AB, Sweden, in 2006. This model has a radically different design from the earlier models U, B, C and 4C. Dosimetric characteristics of LGK PFX, technical differences between LGK PFX and LGK 4C, experience gained with acceptance testing and commissioning of the LGK PFX, and comparison between LGK PFX and LGK 4C are presented in this study. Excellent agreement is found between the manufacturers recommended values of absorbed dose rate, relative output factors for 4 and 8 mm collimators, coincidence of mechanical and dosimetric isocenter, FWHM for beam profiles for various collimators and those reported in the present study. Excellent agreement is also found between the dosimetric characteristics of LGK PFX and LGK 4C for the 4 and 8 mm collimators. Examples of clinical cases treated with LGK PFX and impact of LGK PFX on workflow and dosimetric conformity of treatment planning is also given. The set up and treatment of patients on the LGK PFX is much more efficient since it is a fully automated system. The system also provides more options to generate plan with high dosimetric conformity.
  5 3,764 298
Teletherapy sources with imported and indigenous 60 Co activity
Jain Reji George, Raksha Kushwah, K.V.S Sastry
July-September 2009, 34(3):180-181
DOI:10.4103/0971-6203.54854  PMID:20098567
Board of Radiation and Isotope Technology, a unit of the Department of Atomic Energy, fabricates and supplies radioactive sources for medical, industrial, agriculture and research applications. High specific activity cobalt-60, required for teletherapy is normally imported. There was a proposal for manufacturing high specific activity sources indigenously. A study was carried out to observe the feasibility of mixing imported and indigenous cobalt-60 pellets to fabricate teletherapy source capsules. The specific activity of imported pellets is more than 300 Ci/g, whereas that of indigenous pellets obtained from Indian power reactors is 140 Ci/g. The radiation output from a capsule for different combinations of specific activity was evaluated. Losses due to self-absorption were accounted in the evaluations. In another study, the optimized lengths of the capsule for an output of 200 RMM and the additional activity to be added to compensate losses due to self-absorption were also estimated for different specific activity pellets. Sources fabricated on the basis of this study showed a good agreement with the estimations. Source capsules with a combination of different specific activities are yet to be fabricated.
  5 3,442 227
Pocket-size solid-state iPOD and flash drives for gigabyte storage, display and transfer of digital medical images: Review and work initiated
A Sankaran
July-September 2009, 34(3):167-175
DOI:10.4103/0971-6203.54852  PMID:20098565
A locally assembled image viewer system with pocket-size iPOD (80 GB) and flash (2 GB) drives for gigabyte storage, display and transfer of digital medical images, oriented towards training purposes, is described. Both the iPOD and flash drive enable storage of thousands of images from diverse medical-imaging equipments. The iPOD, in addition, can display with sufficient resolution any of these images and serves as a transportable preview device. Through the use of a computer, these devices can access/ store/ display the images/ photos from a CD, digital camera or the internet. A TV image viewing unit is also provided. The operational features and the advantages of these devices are discussed in detail. The quality assurance (QA) of the displays has been successfully carried out with standard test patterns. The image quality has been tested with dynamic and static medical images. The system will be highly useful for storage and remote display of multitude of images from several modalities in the hospital, as well as other images, from the point of view of education and training. It has good potential for use in clinical diagnosis as well. Other recent advancements using iPHONE and improved but expensive computers, integrated with picture archiving and communication system (PACS) as well as radiology and hospital information system (RHIS) for versatile applications in modern radiology, are also highlighted.This system, assembled with indigenous equipments, is much less expensive and specially suited for teaching radiologists, physicists and technologists, particularly in developing countries.
  4 4,229 301
Verification of tomotherapy dose delivery
SM Pelagade, BR Paliwal
July-September 2009, 34(3):188-190
DOI:10.4103/0971-6203.54856  PMID:20098569
Seventy-one patient-specific delivery quality assurance (DQA) plans for the Tomotherapy HI-ART II helical tomotherapy system (TomoTherapy, Inc., Madison, WI, USA) were measured using film and ion chamber. The agreement in absolute point dose was 1.19 ± 0.79%, 1.91 ± 1.39%, 2.14 ± 1.3%, 1.3 ± 0.73% and 1.67 ± 1.5% for head and neck, prostate, pelvis-abdomen sites, and for all other sites. The spatial agreement between the calculated and the measured film dose distributions was evaluated using the gamma metric distribution. The average frequency versus gamma interval was plotted as a bar graph to quantify the gamma index variation inside the region of interest for each body site.
  4 2,595 296
Improvement of I'mRT MatriXX in terms of spatial resolution and large area acquisition for patient-specific intensity-modulated radiotherapy verification
Arun S Oinam, Lakhwant Singh, SC Sharma, Pradeep Goswami
July-September 2009, 34(3):153-160
DOI:10.4103/0971-6203.54850  PMID:20098563
2D array of ionization chambers can be used for both absolute and relative dose verification of patient-specific intensity-modulated radiotherapy (IMRT) quality assurance. After an analysis of the dose linearity and spatial resolution of this 2D array (I'mRT MatriXX), the signal sampling time of 200 ms was selected for data acquisition. Multiple-sequence acquisitions at the nearest 4 positions with the shift of half of the distance between the centers of two adjacent ion chambers increase the spatial resolution up to four times when used with this I'mRT MatriXX. IMRT verification of head-and-neck case, which requires a large area for dosimetric verification, can be done with limited size of 24×24 cm 2 , depending on the user requirements. It is found that the convolution method can also be used to improve the IMRT dose verification with the same parameters of the passing criteria significantly, viz., up to 99.87% agreement, by smoothening the treatment planning system profile.
  3 3,246 332
Advances in radiation therapy dosimetry
Bhudatt Paliwal, Dinesh Tewatia
July-September 2009, 34(3):108-116
DOI:10.4103/0971-6203.54842  PMID:20098555
During the last decade, there has been an explosion of new radiation therapy planning and delivery tools. We went through a rapid transition from conventional three-dimensional (3D) conformal radiation therapy to intensity-modulated radiation therapy (IMRT) treatments, and additional new techniques for motion-adaptive radiation therapy are being introduced. These advances push the frontiers in our effort to provide better patient care; and with the addition of IMRT, temporal dimensions are major challenges for the radiotherapy patient dosimetry and delivery verification. Advanced techniques are less tolerant to poor implementation than are standard techniques. Mis-administrations are more difficult to detect and can possibly lead to poor outcomes for some patients. Instead of presenting a manual on quality assurance for radiation therapy, this manuscript provides an overview of dosimetry verification tools and a focused discussion on breath holding, respiratory gating and the applications of four-dimensional computed tomography in motion management. Some of the major challenges in the above areas are discussed.
  2 4,244 675
Radiation-based quantitative bioimaging at the national institute of standards and technology
Lisa R Karam
July-September 2009, 34(3):117-121
DOI:10.4103/0971-6203.54843  PMID:20098556
Building on a long history of providing physical measurements and standards for medical x rays and nuclear medicine radionuclides, the laboratory has expanded its focus to better support the extensive use of medical physics in the United States today, providing confidence in key results needed for drug and device development and marketing, therapy planning and efficacy and disease screening. In particular, to support more quantitative medical imaging, this laboratory has implemented a program to provide key measurement infrastructure to support radiation-based imaging through developing standard, benchmark phantoms, which contain radioactive sources calibrated to national measurement standards, to allow more quantitative imaging through traceable instrument calibration for clinical trials or patient management. Working closely with colleagues at the National Institutes of Health, Rensselaer Polytechnic Institute, the Food and Drug Administration and Cornell University, this laboratory has taken the initial steps in developing phantoms, and the protocols to use them, for more accurate calibration of positron emission tomography (PET) or single-photon emission computed tomography (SPECT) cameras, including recently standardizing 68 Ge. X-ray measurements of the laboratory's recently developed small, resilient and inexpensive length standard phantom have shown the potential usefulness of such a "pocket" phantom for patient-based calibration of computed tomography (alone or with PET) systems. The ability to calibrate diagnostic imaging tools in a way that is traceable to national standards will lead to a more quantitative approach; both physician and patient benefit from increased accuracy in treatment planning, as well as increased safety for the patient.
  2 2,739 239
Effective atomic numbers and electron density of dosimetric material
SB Kaginelli, T Rajeshwari, Sharanabasappa , BR Kerur, Anil S Kumar
July-September 2009, 34(3):176-179
DOI:10.4103/0971-6203.54853  PMID:20098566
A novel method for determination of mass attenuation coefficient of x-rays employing NaI (Tl) detector system and radioactive sources is this paper. A rigid geometry arrangement and gating of the spectrometer at FWHM position and selection of absorber foils are all done following detailed investigation, to minimize the effect of small angle scattering and multiple scattering on the mass attenuation coefficient, m/r, value. Firstly, for standardization purposes the mass attenuation coefficients of elemental foils such as Aluminum, Copper, Molybdenum, Tantalum and Lead are measured and then, this method is utilized for dosimetric interested material (sulfates). The experimental mass attenuation coefficient values are compared with the theoretical values to find good agreement between the theory and experiment within one to two per cent. The effective atomic numbers of the biological substitute material are calculated by sum rule and from the graph. The electron density of dosimetric material is calculated using the effective atomic number. The study has discussed in detail the attenuation coefficient, effective atomic number and electron density of dosimetric material/biological substitutes.
  1 4,684 411
Preface to the Special Issue
AS Pradhan
July-September 2009, 34(3):107-107
DOI:10.4103/0971-6203.54841  PMID:20098554
  - 1,953 268
Target foil rupture scenario and provision for handling different models of medical cyclotrons used in India
VS Shaiju, SD Sharma, Rajesh Kumar, B Sarin
July-September 2009, 34(3):161-166
DOI:10.4103/0971-6203.54851  PMID:20098564
Medical cyclotron is a particle accelerator used in producing short lived radiotracers such as 18 F, 11 C, 15 O, 13 N etc. These radiotracers are labeled with suitable pharmaceuticals for use to gather information related to metabolic activity of the cell using Positron Emission Tomography (PET) scan. Target foil rupture is considered one of the major emergency situations during medical cyclotron operations because there is a potential of over exposure to the working personnel. Radiation protection survey of a self-shielded medical cyclotron installation was carried out during normal and emergency conditions. It is found that the induced activity in the target foil increases with its successive usages. As a case study, we have evaluated the emergency handling procedures of GE PETtrace-6 medical cyclotron. Recommendations have also been made to reduce personal exposure while handling the target foil rupture condition such as the use of L-Bench near the target area and participation of experienced personnel.
  - 4,119 300
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