Journal of Medical Physics
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   2014| October-December  | Volume 39 | Issue 4  
    Online since November 12, 2014

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Incident reporting and learning in radiation oncology: Need of the hour
T Ganesh
October-December 2014, 39(4):203-205
  8,528 441 -
Acceptance criteria for flattening filter-free photon beam from standard medical electron linear accelerator: AERB task group recommendations
G Sahani, SD Sharma, PK Dash Sharma, DD Deshpande, PS Negi, VK Sathianarayanan, GK Rath
October-December 2014, 39(4):206-211
Medical electron linear accelerators with the capability of generating unflat photon (flattening filter-free, FFF) beams are also available commercially for clinical applications in radiotherapy. However, the beam characteristics evaluation criteria and parameters are not yet available for such photon beams. Atomic Energy Regulatory Board (AERB) of India constituted a Task Group comprising experts from regulatory agency, advisory body/research and technical institutions, and clinical radiotherapy centers in the country to evolve and recommend the acceptance criteria for the flattening filter-free (FFF) photon beams. The Task Group thoroughly reviewed the literature and inputs of the manufactures/suppliers of the FFF linac and recommended a set of dosimetry parameters for evaluating the characteristics of the unflat photon beam. The recommendations included the evaluation of quality index, degree of unflatness, difference in percentage surface dose between flat and unflat photon beams, percentage depth dose at 10 cm depth, off-axis-ratios and radiation beam penumbra. The recommended parameters were evaluated for FFF photon beams generated by three different models of the linac, and it was observed that recommended evaluation methods are simple and easy to be implemented with the existing dosimetry and quality assurance infrastructure of the linac facilities of the radiotherapy departments. Recommendations were also made for periodic quality control check of the unflat photon beams and constancy evaluation in the beam characteristics.
  7,426 917 -
A simple planning technique of craniospinal irradiation in the eclipse treatment planning system
Hemalatha Athiyaman, Athiyaman Mayilvaganan, Daleep Singh
October-December 2014, 39(4):251-258
A new planning method for Craniospinal Irradiation by Eclipse treatment planning system using Field alignment, Field-in-Field technique was developed. Advantage of this planning method was also studied retrospectively for previously treated five patients of medulloblastoma with variable spine length. Plan consists of half beam blocked parallel opposed cranium, and a single posterior cervicospine field was created by sharing the same isocenter, which obviates divergence matching. Further, a single symmetrical field was created to treat remaining Lumbosacral spine. Matching between a inferior diverging edge of cervicospine field and superior diverging edge of a Lumbosacral field was done using the field alignment option. 'Field alignment' is specific option in the Eclipse Treatment Planning System, which automatically matches the field edge divergence as per field alignment rule. Multiple segments were applied in both the spine field to manage with hot and cold spots created by varying depth of spinal cord. Plan becomes fully computerized using this field alignment option and multiple segments. Plan evaluation and calculated mean modified Homogeneity Index (1.04 and 0.1) ensured that dose to target volume is homogeneous and critical organ doses were within tolerance. Dose variation at the spinal field junction was verified using ionization chamber array (I'MatriXX) for matched, overlapped and gap junction spine fields; the delivered dose distribution confirmed the ideal clinical match, over exposure and under exposure at the junction, respectively. This method is simple to plan, executable in Record and Verify mode and can be adopted for various length of spinal cord with only two isocenter in shorter treatment time.
  3,757 257 -
Effects of shielding the radiosensitive superficial organs of ORNL pediatric phantoms on dose reduction in computed tomography
Parisa Akhlaghi, Hashem Miri-Hakimabad, Laleh Rafat-Motavalli
October-December 2014, 39(4):238-246
In computed tomography (CT), some superficial organs which have increased sensitivity to radiation, receive doses that are significant enough to be matter of concern. Therefore, in this study, the effects of using shields on the amount of dose reduction and image quality was investigated for pediatric imaging. Absorbed doses of breasts, eyes, thyroid and testes of a series of pediatric phantoms without and with different thickness of bismuth and lead were calculated by Monte Carlo simulation. Appropriate thicknesses of shields were chosen based on their weights, X-ray spectrum, and the amount of dose reduction. In addition, the effect of lead shield on image quality of a simple phantom was assessed quantitatively using region of interest (ROI) measurements. Considering the maximum reduction in absorbed doses and X-ray spectrum, using a lead shield with a maximum thickness of 0.4 mm would be appropriate for testes and thyroid and two other organs (which are exposed directly) should be protected with thinner shields. Moreover, the image quality assessment showed that lead was associated with significant increases in both noise and CT attenuation values, especially in the anterior of the phantom. Overall, the results suggested that shielding is a useful optimization tool in CT.
  2,517 89 -
Dosimetric impact of number of treatment fields in uniform scanning proton therapy planning of lung cancer
Suresh Rana, Hilarie Simpson, Gary Larson, Yuanshui Zheng
October-December 2014, 39(4):212-218
The main purpose of this study was to perform a treatment planning study for lung cancer comparing 2-field (2F) versus 3-field (3F) techniques in uniform scanning proton therapy (USPT). Ten clinically approved lung cancer treatment plans delivered using USPT at our proton center were included in this retrospective study. All 10 lung cases included 4D computed tomography (CT) simulation. The delineation of target volumes was done based on the maximum intensity projection (MIP) images. Both the 3F and 2F treatment plans were generated for the total dose of 74 cobalt-gray-equivalent (CGE) with a daily dose of 2 CGE. 3F plan was generated by adding an extra beam in the 2F plan. Various dosimetric parameters between 2F and 3F plans were evaluated. 3F plans produced better target coverage and conformality as well as lower mean dose to the lung, with absolute difference between 3F and 2F plans within 2%. In contrast, the addition of third beam led to increase of low-dose regions (V20 and V5) in the lung in 3F plans compared to the ones in 2F plans with absolute difference within 2%. Maximum dose to the spinal cord was lower in 2F plans. Mean dose to the heart and esophagus were comparable in both 3F and 2F plans. In conclusion, the 3F technique in USPT produced better target coverage and conformality, but increased the low-dose regions in the lung when compared to 2F technique.
  1,986 109 -
Influence of increment of gantry angle and number of arcs on esophageal volumetric modulated arc therapy planning in Monaco planning system: A planning study
L Nithya, N Arunai Nambi Raj, Sasikumar Rathinamuthu, Kanika Sharma, Manish Bhushan Pandey
October-December 2014, 39(4):231-237
The objective of this study was to analyze the influence of the increment of gantry angle and the number of arcs on esophageal volumetric modulated arc therapy plan. All plans were done in Monaco planning system for Elekta Synergy linear accelerator with 80 multileaf collimator (MLC). Volumetric modulated arc therapy (VMAT) plans were done with different increment of gantry angle like 15 o , 20 o , 30 o and 40 o . The remaining parameters were similar for all the plans. The results were compared. To compare the plan quality with number of arcs, VMAT plans were done with single and dual arc with increment of gantry angle of 20 o . The dose to gross tumor volume (GTV) for 60 Gy and planning target volume (PTV) for 48 Gy was compared. The dosimetric parameters D 98% , D 95% , D 50% and D max of GTV were analyzed. The homogeneity index (HI) and conformity index (CI) of GTV were studied and the dose to 98% and 95% of PTV was analyzed. Maximum dose to spinal cord and planning risk volume of cord (PRV cord) was compared. The Volume of lung receiving 10 Gy, 20 Gy and mean dose was analyzed. The volume of heart receiving 30 Gy and 45 Gy was compared. The volume of normal tissue receiving greater than 2 Gy and 5 Gy was compared. The number of monitor units (MU) required to deliver the plans were compared. The plan with larger increment of gantry angle proved to be superior to smaller increment of gantry angle plans in terms of dose coverage, HI, CI and normal tissue sparing. The number of arcs did not make any difference in the quality of the plan.
  1,919 153 -
Neutron dose estimation via LET spectrometry using CR-39 detector for the reaction 9 Be (p, n)
GS Sahoo, SP Tripathy, S Paul, SD Sharma, SC Sharma, DS Joshi, T Bandyopadhyay
October-December 2014, 39(4):225-230
CR-39 detectors, widely used for neutron dosimetry in accelerator radiation environment, have also been applied in tissue microdosimetry by generating the linear energy transfer (LET) spectrum. In this work, the neutron dose has been estimated via LET spectrometry for 9 Be (p, n) reaction which is useful for personnel monitoring around particle accelerators and accelerator based therapy facilities. Neutrons were generated by the interaction of protons of 6 different energies from 4-24 MeV with a thick Be target. The LET spectra were obtained from the major and minor radii of each track and the thickness of removed surface. From the LET spectra, the absorbed dose (DLET ) and the dose equivalent (HLET ) were estimated using Q-L relationship as given by International Commission on Radiological Protection (ICRP) 60. The track density in CR-39 detector and hence the neutron yield was found to be increasing with the increase in projectile (proton) energy. Similar observations were also obtained for absorbed dose (DLET ) and dose equivalents (HLET ).
  1,619 107 -
Dose verification in carcinoma of uterine cervix patients undergoing 3D conformal radiotherapy with Farmer type ion chamber
Challapalli Srinivas, Suman P Kumar, Ramamoorthy Ravichandran, S Banerjee, PU Saxena, ES Arun Kumar, Dinesh K Pai
October-December 2014, 39(4):247-250
External beam radiotherapy (EBRT) for carcinoma of uterine cervix is a basic line of treatment with three dimensional conformal radiotherapy (3DCRT) in large number of patients. There is need for an established method for verification dosimetry. We tried to document absorbed doses in a group of carcinoma cervix patients by inserting a 0.6 cc Farmer type ion chamber in the vaginal cavity. A special long perspex sleeve cap is designed to cover the chamber for using in the patient's body. Response of ionization chamber is checked earlier in water phantom with and without cap. Treatment planning was carried out with X-ray computed tomography (CT) scan and with the chamber along with cap in inserted position, and with the images Xio treatment planning system. Three measurements on 3 days at 5-6 fraction intervals were recorded in 12 patients. Electrometer measured charges are converted to absorbed dose at the chamber center, in vivo. Our results show good agreement with planned dose within 3% against prescribed dose. This study, is a refinement over our previous studies with transmission dosimetry and chemicals in ampules. This preliminary work shows promise that this can be followed as a routine dose check with special relevance to new protocols in the treatment of carcinoma cervix with EBRT.
  1,509 191 -
Results of 1 year of clinical experience with independent dose calculation software for VMAT fields
Juan Fernando Mata Colodro, Alfredo Serna Berna, Vicente Puchades Puchades, David Ramos Amores, Miguel Alcaraz Banos
October-December 2014, 39(4):219-224
It is widely accepted that a redundant independent dose calculation (RIDC) must be included in any treatment planning verification procedure. Specifically, volumetric modulated arc therapy (VMAT) technique implies a comprehensive quality assurance (QA) program in which RIDC should be included. In this paper, the results obtained in 1 year of clinical experience are presented. Eclipse from Varian is the treatment planning system (TPS), here in use. RIDC were performed with the commercial software; Diamond ® (PTW) which is capable of calculating VMAT fields. Once the plan is clinically accepted, it is exported via Digital Imaging and Communications in Medicine (DICOM) to RIDC, together with the body contour, and then a point dose calculation is performed, usually at the isocenter. A total of 459 plans were evaluated. The total average deviation was -0.3 ± 1.8% (one standard deviation (1SD)). For higher clearance the plans were grouped by location in: Prostate, pelvis, abdomen, chest, head and neck, brain, stereotactic radiosurgery, lung stereotactic body radiation therapy, and miscellaneous. The highest absolute deviation was -0.8 ± 1.5% corresponding to the prostate. A linear fit between doses calculated by RIDC and by TPS produced a correlation coefficient of 0.9991 and a slope of 1.0023. These results are very close to those obtained in the validation process. This agreement led us to consider this RIDC software as a valuable tool for QA in VMAT plans.
  1,340 102 -
Letter to the Editor concerning Bhandari et al. "Impact of repeat computerized tomography replans in the radiation therapy of head and neck cancers"
Maria Grazia Ruo Redda, Alessia Reali, Simona Allis, Silvia Maria Anglesio, Roberta Verna, Lavinia Bianco
October-December 2014, 39(4):259-260
  929 74 -
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