Journal of Medical Physics
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   2016| April-June  | Volume 41 | Issue 2  
    Online since May 3, 2016

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Surface dose measurements and comparison of unflattened and flattened photon beams
Ashokkumar Sigamani, Arunai Nambiraj, Girigesh Yadav, Ananda Giribabu, Karthikeyan Srinivasan, Venkadamanickam Gurusamy, Kothanda Raman, Kaviarasu Karunakaran, Rajesh Thiyagarajan
April-June 2016, 41(2):85-91
DOI:10.4103/0971-6203.181648  PMID:27217619
The purpose of this study was to evaluate the central axis dose in the build-up region and the surface dose of a 6 MV and 10 MV flattened photon beam (FB) and flattening filter free (FFF) therapeutic photon beam for different square field sizes (FSs) for a Varian Truebeam linear accelerator using parallel-plate ionization chamber and Gafchromic film. Knowledge of dosimetric characteristics in the build-up region and surface dose of the FFF is essential for clinical care. The dose measurements were also obtained empirically using two different commonly used dosimeters: a p-type photon semiconductor dosimeter and a cylindrical ionization chamber. Surface dose increased linearly with FS for both FB and FFF photon beams. The surface dose values of FFF were higher than the FB FSs. The measured surface dose clearly increases with increasing FS. The FFF beams have a modestly higher surface dose in the build-up region than the FB. The dependence of source to skin distance (SSD) is less significant in FFF beams when compared to the flattened beams at extended SSDs.
  3,776 293 -
Dosimetric differences in flattened and flattening filter-free beam treatment plans
Yue Yan, Poonam Yadav, Michael Bassetti, Kaifang Du, Daniel Saenz, Paul Harari, Bhudatt R Paliwal
April-June 2016, 41(2):92-99
DOI:10.4103/0971-6203.181636  PMID:27217620
This study investigated the dosimetric differences in treatment plans from flattened and flattening filter-free (FFF) beams from the TrueBeam System. A total of 104 treatment plans with static (sliding window) intensity-modulated radiotherapy beams and volumetric-modulated arc therapy (VMAT) beams were generated for 15 patients involving three cancer sites. In general, the FFF beam provides similar target coverage as the flattened beam with improved dose sparing to organ-at-risk (OAR). Among all three cancer sites, the head and neck showed more important differences between the flattened beam and FFF beam. The maximum reduction of the FFF beam in the mean dose reached up to 2.82 Gy for larynx in head and neck case. Compared to the 6 MV flattened beam, the 10 MV FFF beam provided improved dose sparing to certain OARs, especially for VMAT cases. Thus, 10 MV FFF beam could be used to improve the treatment plan.
  2,541 259 -
An investigation of the dose distribution effect related with collimator angle in volumetric arc therapy of prostate cancer
Bora Tas, Hatice Bilge, Sibel Tokdemir Ozturk
April-June 2016, 41(2):100-105
DOI:10.4103/0971-6203.181635  PMID:27217621
To investigate the dose-volume variations of planning target volume (PTV) and organ at risks (OARs) in eleven prostate cancer patients planned with single and double arc volumetric modulated arc therapy (VMAT) when varying collimator angle. Single and double arc VMAT treatment plans were created using Monaco5.0® with collimator angle set to 0°. All plans were normalized 7600 cGy dose to the 95% of clinical target volume (CTV) volume. The single arc VMAT plans were reoptimized with different collimator angles (0°, 15°, 30°, 45°, 60°, 75°, and 90°), and for double arc VMAT plans (0–0°, 15°–345, 30–330°, 45–315°, 60–300°, 75–285°, 90–270°) using the same optimization parameters. For the comparison the parameters of heterogeneity index (HI), dose-volume histogram and minimum dose to the 95% of PTV volume (D95 PTV) calculated and analyzed. The best plans were verified using 2 dimensional ion chamber array IBA Matrixx® and three-dimensional IBA Compass® program. The comparison between calculation and measurement were made by the γ-index (3%/3 mm) analysis. A higher D95 (PTV) were found for single arc VMAT with 15° collimator angle. For double arc, VMAT with 60–300° and 75–285° collimator angles. However, lower rectum doses obtained for 75–285° collimator angles. There was no significant dose difference, based on other OARs which are bladder and femur head. When we compared single and double arc VMAT's D95 (PTV), we determined 2.44% high coverage and lower HI with double arc VMAT. All plans passed the γ-index (3%/3 mm) analysis with more than 97% of the points and we had an average γ-index for CTV 0.36, for PTV 0.32 with double arc VMAT. These results were significant by Wilcoxon signed rank test statistically. The results show that dose coverage of target and OAR's doses also depend significantly on the collimator angles due to the geometry of target and OARs. Based on the results we have decided to plan prostate cancer patients in our clinic with double arc VMAT and 75°–285° collimator angles.
  2,125 164 -
Development of a deformable dosimetric phantom to verify dose accumulation algorithms for adaptive radiotherapy
Hualiang Zhong, Jeffrey Adams, Carri Glide-Hurst, Hualin Zhang, Haisen Li, Indrin J Chetty
April-June 2016, 41(2):106-114
DOI:10.4103/0971-6203.181641  PMID:27217622
Adaptive radiotherapy may improve treatment outcomes for lung cancer patients. Because of the lack of an effective tool for quality assurance, this therapeutic modality is not yet accepted in clinic. The purpose of this study is to develop a deformable physical phantom for validation of dose accumulation algorithms in regions with heterogeneous mass. A three-dimensional (3D) deformable phantom was developed containing a tissue-equivalent tumor and heterogeneous sponge inserts. Thermoluminescent dosimeters (TLDs) were placed at multiple locations in the phantom each time before dose measurement. Doses were measured with the phantom in both the static and deformed cases. The deformation of the phantom was actuated by a motor driven piston. 4D computed tomography images were acquired to calculate 3D doses at each phase using Pinnacle and EGSnrc/DOSXYZnrc. These images were registered using two registration software packages: VelocityAI and Elastix. With the resultant displacement vector fields (DVFs), the calculated 3D doses were accumulated using a mass-and energy congruent mapping method and compared to those measured by the TLDs at four typical locations. In the static case, TLD measurements agreed with all the algorithms by 1.8% at the center of the tumor volume and by 4.0% in the penumbra. In the deformable case, the phantom's deformation was reproduced within 1.1 mm. For the 3D dose calculated by Pinnacle, the total dose accumulated with the Elastix DVF agreed well to the TLD measurements with their differences <2.5% at four measured locations. When the VelocityAI DVF was used, their difference increased up to 11.8%. For the 3D dose calculated by EGSnrc/DOSXYZnrc, the total doses accumulated with the two DVFs were within 5.7% of the TLD measurements which are slightly over the rate of 5% for clinical acceptance. The detector-embedded deformable phantom allows radiation dose to be measured in a dynamic environment, similar to deforming lung tissues, supporting the validation of dose mapping and accumulation operations in regions with heterogeneous mass, and dose distributions.
  1,975 119 -
Dosimetric and radiobiological comparison of CyberKnife M6TM InCise multileaf collimator over IRISTM variable collimator in prostate stereotactic body radiation therapy
Vindu Kathriarachchi, Charles Shang, Grant Evans, Theodora Leventouri, Georgios Kalantzis
April-June 2016, 41(2):135-143
DOI:10.4103/0971-6203.181638  PMID:27217626
The impetus behind our study was to establish a quantitative comparison between the IRIS collimator and the InCise multileaf collimator (MLC) (Accuray Inc. Synnyvale, CA) for prostate stereotactic body radiation therapy (SBRT). Treatment plans for ten prostate cancer patients were performed on MultiPlan™ 5.1.2 treatment planning system utilizing MLC and IRIS for 36.25 Gy in five fractions. To reduce the magnitude of variations between cases, the planning tumor volume (PTV) was defined and outlined for treating prostate gland only, assuming no seminal vesicle or ex-capsule involvement. Evaluation indices of each plan include PTV coverage, conformity index (CI), Paddick's new CI, homogeneity index, and gradient index. Organ at risk (OAR) dose sparing was analyzed by the bladder wall Dmaxand V37Gy, rectum Dmaxand V36Gy. The radiobiological response was evaluated by tumor control probability and normal tissue complication probability based on equivalent uniform dose. The dose delivery efficiency was evaluated on the basis of planned monitor units (MUs) and the reported treatment time per fraction. Statistical significance was tested using the Wilcoxon signed rank test. The studies indicated that CyberKnife M6™ IRIS and InCise™ MLC produce equivalent SBRT prostate treatment plans in terms of dosimetry, radiobiology, and OAR sparing, except that the MLC plans offer improvement of the dose fall-off gradient by 29% over IRIS. The main advantage of replacing the IRIS collimator with MLC is the improved efficiency, determined from the reduction of MUs by 42%, and a 36% faster delivery time.
  1,928 114 -
On the scenario of passive dosimeters in personnel monitoring: Relevance to diagnostic radiology and fluoroscopy-based interventional cardiology
AS Pradhan, JI Lee, JL Kim
April-June 2016, 41(2):81-84
DOI:10.4103/0971-6203.181634  PMID:27217618
  1,775 187 -
Dosimetry of indigenously developed 192Ir high-dose rate brachytherapy source: An EGSnrc Monte Carlo study
Sridhar Sahoo, T Palani Selvam, SD Sharma, Trupti Das, AC Dey, BN Patil, K.V.S. Sastri
April-June 2016, 41(2):115-122
DOI:10.4103/0971-6203.181639  PMID:27217623
Clinical application using high-dose rate (HDR) 192Ir sources in remote afterloading technique is a well-established treatment method. In this direction, Board of Radiation and Isotope Technology (BRIT) and Bhabha Atomic Research Centre, India, jointly indigenously developed a remote afterloading machine and 192Ir HDR source. The two-dimensional (2D) dose distribution and dosimetric parameters of the BRIT 192Ir HDR source are generated using EGSnrc Monte Carlo code system in a 40 cm dia × 40 cm height cylindrical water phantom. The values of air-kerma strength and dose rate constant for BRIT 192Ir HDR source are 9.894 × 10−8 ± 0.06% UBq−1 and 1.112 ± 0.11% cGyh−1U−1, respectively. The values of radial dose function (gL(r)) of this source compare well with the corresponding values of BEBIG, Flexisource, and GammaMed 12i source models. This is because of identical active lengths of the sources (3.5 mm) and the comparable phantom dimensions. A comparison of gL(r) values of BRIT source with microSelectron-v1 show differences about 2% at r = 6 cm and up to 13% at r = 12 cm, which is due to differences in phantom dimensions involved in the calculations. The anisotropy function of BRIT 192Ir HDR source is comparable with the corresponding values of microSelectron-v1 (classic) HDR source.
  1,745 142 -
Dosimetric impact of setup errors in head and neck cancer patients treated by image-guided radiotherapy
Inderjit Kaur, Sheh Rawat, Parveen Ahlawat, Anjali Kakria, Gourav Gupta, Upasna Saxena, Manindra Bhushan Mishra
April-June 2016, 41(2):144-148
DOI:10.4103/0971-6203.181640  PMID:27217627
To assess and analyze the impact of setup uncertainties on target volume coverage and doses to organs at risk (OAR) in head and neck cancer (HNC) patients treated by image-guided radiotherapy (IGRT). Translational setup errors in 25 HNC patients were observed by kilovoltage cone beam computed tomography (kV CBCT). Two plans were generated. Plan one – the original plan which was the initially optimized and approved plan of the patient. All patients were treated according to their respective approved plans at a defined isocenter. Plan two – the plan sum which was the sum of all plans recalculated at a different isocenter according to setup errors in x, y, and z-direction. Plan sum was created to evaluate doses that would have been received by planning target volume (PTV) and OARs if setup errors were not corrected. These 2 plans were analyzed and compared in terms of target volume coverage and doses to OARs. A total 503 kV CBCT images were acquired for evaluation of setup errors in 25 HNC patients. The systematic (mean) and random errors (standard deviation) combined for 25 patients in x, y, and z directions were 0.15 cm, 0.21 cm, and 0.19 cm and 0.09 cm, 0.12 cm, and 0.09 cm, respectively. The study showed that there was a significant difference in PTV coverage between 2 plans. The doses to various OARs showed a nonsignificant increase in the plan sum. The correction of translational setup errors is essential for IGRT treatment in terms of delivery of planned optimal doses to target volume.
  1,509 146 -
Estimation of the effects of normal tissue sparing using equivalent uniform dose-based optimization
K Senthilkumar, KJ Maria Das, K Balasubramanian, AC Deka, BR Patil
April-June 2016, 41(2):123-128
DOI:10.4103/0971-6203.181631  PMID:27217624
In this study, we intend to estimate the effects of normal tissue sparing between intensity modulated radiotherapy (IMRT) treatment plans generated with and without a dose volume (DV)-based physical cost function using equivalent uniform dose (EUD). Twenty prostate cancer patients were retrospectively selected for this study. For each patient, two IMRT plans were generated (i) EUD-based optimization with a DV-based physical cost function to control inhomogeneity (EUDWith DV) and (ii) EUD-based optimization without a DV-based physical cost function to allow inhomogeneity (EUDWithout DV). The generated plans were prescribed a dose of 72 Gy in 36 fractions to planning target volume (PTV). Mean dose, D30%, and D5%were evaluated for all organ at risk (OAR). Normal tissue complication probability was also calculated for all OARs using BioSuite software. The average volume of PTV for all patients was 103.02 ± 27 cm3. The PTV mean dose for EUDWith DVplans was 73.67 ± 1.7 Gy, whereas for EUDWithout DVplans was 80.42 ± 2.7 Gy. It was found that PTV volume receiving dose more than 115% of prescription dose was negligible in EUDWith DV plans, whereas it was 28% in EUDWithout DV plans. In almost all dosimetric parameters evaluated, dose to OARs in EUDWith DVplans was higher than in EUDWithout DVplans. Allowing inhomogeneous dose (EUDWithout DV) inside the target would achieve better normal tissue sparing compared to homogenous dose distribution (EUDWith DV). Hence, this inhomogeneous dose could be intentionally dumped on the high-risk volume to achieve high local control. Therefore, it was concluded that EUD optimized plans offer added advantage of less OAR dose as well as selectively boosting dose to gross tumor volume.
  1,474 153 -
Build-up material requirements in clinical dosimetry during total body irradiation treatments
Martin Butson, Dane Pope, Mamoon Haque, Tom Chen, Guangli Song, May Whitaker
April-June 2016, 41(2):149-152
DOI:10.4103/0971-6203.181632  PMID:27217628
Total body irradiation (TBI) treatments are mainly used in a preparative regimen for hematopoietic stem cell (or bone marrow) transplantation. Our standard clinical regimen is a 12 Gy/6 fraction bi-daily technique using 6MV X-rays at a large extended source to surface distance (SSD). This work investigates and quantifies the dose build-up characteristics and thus the requirements for bolus used for in vivo dosimetry for TBI applications. Percentage dose build-up characteristics of photon beams have been investigated at large extended SSDs using ionization chambers and Gafchromic film. Open field measurements at different field sizes and with differing scatter conditions such as the introduction of standard Perspex scattering plates at different distances to the measurement point were made in an effort to determine the required bolus/build-up material required for accurate determination of applied dose. Percentage surface dose values measured for open fields at 300 cm SSD were found to range from 20% up to 65.5% for fields 5 cm × 5 cm to 40 cm × 40 cm, respectively. With the introduction of 1 cm Perspex scattering plates used in TBI treatments, the surface dose values increased up to 83–90% (93–97% at 1 mm depth), depending on the position of the Perspex scattering plate compared to the measurement point. Our work showed that at least 5 mm water equivalent bolus/scatter material should be placed over the EBT3 film for accurate dose assessment for TBI treatments. Results also show that a small but measurable decrease in measured dose occurred with 5 mm water equivalent thick bolus material of areas '3 cm2. As such, we recommend that 3 cm × 3 cm × 5 mm bolus build-up is the smallest size that should be placed over EBT3 Gafchromic film when used for accurate in vivo dosimetry for TBI applications.
  1,359 131 -
Determination of optimal number of beams in direct machine parameter optimization-based intensity modulated radiotherapy for head and neck cases
Vaitheeswaran Ranganathan, KJ Maria Das
April-June 2016, 41(2):129-134
DOI:10.4103/0971-6203.181633  PMID:27217625
This paper aims to introduce an algorithm called &##8220;sensitivity-based beam number selection (SBBNS)” for fully automated and case-specific determination of an optimal number of equispaced beams in intensity-modulated radiotherapy (IMRT). We tested the algorithm in five head and neck cases of varying complexity. We used direct machine parameter optimization method coupled with Auto Plan feature available in Pinnacle TPS (Version 9.10.0) for optimization. The Pearson correlation test shows a correlation of 0.88 between predicted and actual optimal number of beams, which indicates that SBBNS method is capable of predicting optimal number of beams for head and neck cases with reasonable accuracy. The major advantage of the algorithm is that it intrinsically takes into account various case- and machine-specific factors for the determination of optimal number. The study demonstrates that the algorithm can be effectively applied to IMRT scenarios to determine case specific and optimal number of beams for head and neck cases.
  1,120 111 -
Assessment of some image quality tests on a 128 slice computed tomography scanner using a Catphan700 phantom
Eric Naab Manson, John Justice Fletcher, Vivian Della Atuwo-Ampoh, Eric K.T. Addison, Cyril Schandorf, Luc Bambara
April-June 2016, 41(2):153-156
DOI:10.4103/0971-6203.181637  PMID:27217629
  1,037 90 -
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