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Benzazon N, Carré A, de Kermenguy F, Niyoteka S, Maury P, Colnot J, M'hamdi M, Aichi ME, Veres C, Allodji R, de Vathaire F, Sarrut D, Journy N, Alapetite C, Grégoire V, Deutsch E, Diallo I, Robert C. Deep-Learning for Rapid Estimation of the Out-of-Field Dose in External Beam Photon Radiation Therapy - A Proof of Concept. Int J Radiat Oncol Biol Phys 2024; 120:253-264. [PMID: 38554830 DOI: 10.1016/j.ijrobp.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The dose deposited outside of the treatment field during external photon beam radiation therapy treatment, also known as out-of-field dose, is the subject of extensive study as it may be associated with a higher risk of developing a second cancer and could have deleterious effects on the immune system that compromise the efficiency of combined radio-immunotherapy treatments. Out-of-field dose estimation tools developed today in research, including Monte Carlo simulations and analytical methods, are not suited to the requirements of clinical implementation because of their lack of versatility and their cumbersome application. We propose a proof of concept based on deep learning for out-of-field dose map estimation that addresses these limitations. METHODS AND MATERIALS For this purpose, a 3D U-Net, considering as inputs the in-field dose, as computed by the treatment planning system, and the patient's anatomy, was trained to predict out-of-field dose maps. The cohort used for learning and performance evaluation included 3151 pediatric patients from the FCCSS database, treated in 5 clinical centers, whose whole-body dose maps were previously estimated with an empirical analytical method. The test set, composed of 433 patients, was split into 5 subdata sets, each containing patients treated with devices unseen during the training phase. Root mean square deviation evaluated only on nonzero voxels located in the out-of-field areas was computed as performance metric. RESULTS Root mean square deviations of 0.28 and 0.41 cGy/Gy were obtained for the training and validation data sets, respectively. Values of 0.27, 0.26, 0.28, 0.30, and 0.45 cGy/Gy were achieved for the 6 MV linear accelerator, 16 MV linear accelerator, Alcyon cobalt irradiator, Mobiletron cobalt irradiator, and betatron device test sets, respectively. CONCLUSIONS This proof-of-concept approach using a convolutional neural network has demonstrated unprecedented generalizability for this task, although it remains limited, and brings us closer to an implementation compatible with clinical routine.
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Affiliation(s)
- Nathan Benzazon
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
| | - Alexandre Carré
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - François de Kermenguy
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Stéphane Niyoteka
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Pauline Maury
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Julie Colnot
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; THERYQ, PMB-Alcen, Peynier, France
| | - Meissane M'hamdi
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Mohammed El Aichi
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Rodrigue Allodji
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | - David Sarrut
- Université de Lyon; CREATIS; CNRS UMR5220; Inserm U1294; INSA-Lyon; Léon Bérard cancer center, Lyon, France
| | - Neige Journy
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | | | - Vincent Grégoire
- Department of Radiation Oncology, centre Léon-Bérard, Lyon, France
| | - Eric Deutsch
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Ibrahima Diallo
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Charlotte Robert
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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Ahmad H, Ali J, Ahmad K, Biradar G, Zaman A, Uddin Y, Sohail M, Ali S. Assessment of peripheral dose as a function of distance and depth from cobalt-60 beam in water phantom using TLD-100. J Egypt Natl Canc Inst 2024; 36:22. [PMID: 38910202 DOI: 10.1186/s43046-024-00227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/08/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Innovations in cancer treatment have contributed to the improved survival rate of cancer patients. The cancer survival rates have been growing and nearly two third of those survivors have been exposed to clinical radiation during their treatment. The study of long-term radiation effects, especially secondary cancer induction, has become increasingly important. An accurate assessment of out-of-field/peripheral dose (PDs) is necessary to estimate the risk of second cancer after radiotherapy and the damage to the organs at risk surrounding the planning target volume. This study was designed to measure the PDs as a function of dose, distances, and depths from Telecobalt-60 (Co-60) beam in water phantom using thermoluminescent dosimeter-100 (TLD-100). METHODS The PDs were measured for Co-60 beam at specified depths of 0 cm (surface), 5 cm, 10 cm, and 15 cm outside the radiation beam at distances of 5, 10, and 13 cm away from the radiation field edge using TLD-100 (G1 cards) as detectors. These calibrated cards were placed on the acrylic disc in circular tracks. The radiation dose of 2000 mGy of Co-60 beam was applied inside 10 × 10 cm2 field size at constant source to surface distance (SSD) of 80 cm. RESULTS The results showed maximum and minimum PDs at surface and 5 cm depth respectively at all distances from the radiation field edge. Dose distributions out of the field edge with respect to distance were isotropic. The decrease in PDs at 5 cm depth was due to dominant forward scattering of Co-60 gamma rays. The increase in PDs beyond 5 cm depth was due to increase in the irradiated volume, increase in penumbra, increase in source to axis distance (SAD), and increase in field size due to inverse square factor. CONCLUSION It is concluded that the PDs depends upon depth and distance from the radiation field edge. All the measurements show PDs in the homogenous medium (water); therefore, it estimates absorbed dose to the organ at risk (OAR) adjacent to cancer tissues/planning target volume (PTV). It is suggested that PDs can be minimized by using the SAD technique, as this technique controls sources of scattered radiation like inverse square factor and effect of penumbra up-to some extent.
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Affiliation(s)
- Habib Ahmad
- Swat Institute of Nuclear Medicine, Oncology & Radiotherapy (SINOR) Cancer Hospital, Saidu Sharif Swat, KPK, Pakistan
| | - Javaid Ali
- Larkana Institute of Nuclear Medicine and Radiotherapy (LINAR) Cancer Hospital, Larkana, Sindh, Pakistan.
| | - Khalil Ahmad
- Pakistan Institute of Nuclear Science and Technology (PINSTECH), Islamabad, Pakistan
| | - Ghufran Biradar
- Swat Institute of Nuclear Medicine, Oncology & Radiotherapy (SINOR) Cancer Hospital, Saidu Sharif Swat, KPK, Pakistan
| | - Ashfaq Zaman
- Swat Institute of Nuclear Medicine, Oncology & Radiotherapy (SINOR) Cancer Hospital, Saidu Sharif Swat, KPK, Pakistan
| | - Yasir Uddin
- Royal College of Nursing, Saidu Sharif, Swat, KPK, Pakistan
| | - Muhammad Sohail
- International Collaborative Laboratory of 2D Materials for Optoelectronics Science and Technology of Ministry of Education, Institute of Microscale Optoelectronics, College of Electronics and Information Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Shahid Ali
- Department of Physics, University of Peshawar (UOP), Peshawar, KPK, Pakistan
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Benzazon N, Colnot J, de Kermenguy F, Achkar S, de Vathaire F, Deutsch E, Robert C, Diallo I. Analytical models for external photon beam radiotherapy out-of-field dose calculation: a scoping review. Front Oncol 2023; 13:1197079. [PMID: 37228501 PMCID: PMC10203488 DOI: 10.3389/fonc.2023.1197079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
A growing body of scientific evidence indicates that exposure to low dose ionizing radiation (< 2 Gy) is associated with a higher risk of developing radio-induced cancer. Additionally, it has been shown to have significant impacts on both innate and adaptive immune responses. As a result, the evaluation of the low doses inevitably delivered outside the treatment fields (out-of-field dose) in photon radiotherapy is a topic that is regaining interest at a pivotal moment in radiotherapy. In this work, we proposed a scoping review in order to identify evidence of strengths and limitations of available analytical models for out-of-field dose calculation in external photon beam radiotherapy for the purpose of implementation in clinical routine. Papers published between 1988 and 2022 proposing a novel analytical model that estimated at least one component of the out-of-field dose for photon external radiotherapy were included. Models focusing on electrons, protons and Monte-Carlo methods were excluded. The methodological quality and potential limitations of each model were analyzed to assess their generalizability. Twenty-one published papers were selected for analysis, of which 14 proposed multi-compartment models, demonstrating that research efforts are directed towards an increasingly detailed description of the underlying physical phenomena. Our synthesis revealed great inhomogeneities in practices, in particular in the acquisition of experimental data and the standardization of measurements, in the choice of metrics used for the evaluation of model performance and even in the definition of regions considered out-of-the-field, which makes quantitative comparisons impossible. We therefore propose to clarify some key concepts. The analytical methods do not seem to be easily suitable for massive use in clinical routine, due to the inevitable cumbersome nature of their implementation. Currently, there is no consensus on a mathematical formalism that comprehensively describes the out-of-field dose in external photon radiotherapy, partly due to the complex interactions between a large number of influencing factors. Out-of-field dose calculation models based on neural networks could be promising tools to overcome these limitations and thus favor a transfer to the clinic, but the lack of sufficiently large and heterogeneous data sets is the main obstacle.
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Affiliation(s)
- Nathan Benzazon
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Julie Colnot
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
- THERYQ, PMB-Alcen, Peynier, France
| | - François de Kermenguy
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Samir Achkar
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
| | - Eric Deutsch
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Charlotte Robert
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Ibrahima Diallo
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
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Sánchez-Nieto B, Stolarczyk L, Dasu A, Newhauser WD, Sánchez-Doblado F. Editorial: Out-of-field second primary cancer induction: Dosimetry and modelling. Front Oncol 2022; 12:1076792. [PMID: 36544702 PMCID: PMC9761579 DOI: 10.3389/fonc.2022.1076792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- Beatriz Sánchez-Nieto
- Institute of Physics, Faculty of Physics, Pontifical Catholic University of Chile, Santiago, Chile,*Correspondence: Beatriz Sánchez-Nieto,
| | - Liliana Stolarczyk
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark,The Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Alexandru Dasu
- Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden,The Skandion Clinic, Uppsala, Sweden
| | - Wayne D. Newhauser
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, United States
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Sánchez-Nieto B, López-Martínez IN, Rodríguez-Mongua JL, Espinoza I. A simple analytical model for a fast 3D assessment of peripheral photon dose during coplanar isocentric photon radiotherapy. Front Oncol 2022; 12:872752. [PMID: 36276161 PMCID: PMC9583866 DOI: 10.3389/fonc.2022.872752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Considering that cancer survival rates have been growing and that nearly two-thirds of those survivors were exposed to clinical radiation during its treatment, the study of long-term radiation effects, especially secondary cancer induction, has become increasingly important. To correctly assess this risk, knowing the dose to out-of-field organs is essential. As it has been reported, commercial treatment planning systems do not accurately calculate the dose far away from the border of the field; analytical dose estimation models may help this purpose. In this work, the development and validation of a new three-dimensional (3D) analytical model to assess the photon peripheral dose during radiotherapy is presented. It needs only two treatment-specific input parameter values, plus information about the linac-specific leakage, when available. It is easy to use and generates 3D whole-body dose distributions and, particularly, the dose to out-of-field organs (as dose–volume histograms) outside the 5% isodose for any isocentric treatment using coplanar beams [including intensity modulated radiotherapy and volumetric modulated arc therapy (VMAT)]. The model was configured with the corresponding Monte Carlo simulation of the peripheral absorbed dose for a 6 MV abdomen treatment on the International Comission on Radiological Protection (ICRP) 110 computational phantom. It was then validated with experimental measurements using thermoluminescent dosimeters in the male ATOM anthropomorphic phantom irradiated with a VMAT treatment for prostate cancer. Additionally, its performance was challenged by applying it to a lung radiotherapy treatment very different from the one used for training. The model agreed well with measurements and simulated dose values. A graphical user interface was developed as a first step to making this work more approachable to a daily clinical application.
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Affiliation(s)
- Beatriz Sánchez-Nieto
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Beatriz Sánchez-Nieto,
| | | | | | - Ignacio Espinoza
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
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Elmtalab S, Abedi I, Alirezaei Z, Choopan Dastjerdi MH, Geraily G, Karimi AH. Semi-experimental assessment of neutron equivalent dose and secondary cancer risk for off-field organs in glioma patients undergoing 18-MV radiotherapy. PLoS One 2022; 17:e0271028. [PMID: 35905102 PMCID: PMC9337694 DOI: 10.1371/journal.pone.0271028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
Neutron contamination as a source of out-of-field dose in radiotherapy is still of concern. High-energy treatment photons have the potential to overcome the binding energy of neutrons inside the nuclei. Fast neutrons emitting from the accelerator head can directly reach the patient’s bed. Considering that modern radiotherapy techniques can increase patient survival, concerns about unwanted doses and the lifetime risk of fatal cancer remain strong or even more prominent, especially in young adult patients. The current study addressed these concerns by quantifying the dose and risk of fatal cancer due to photo-neutrons for glioma patients undergoing 18-MV radiotherapy. In this study, an NRD model rem-meter detector was used to measure neutron ambient dose equivalent, H*(10), at the patient table. Then, the neutron equivalent dose received by each organ was estimated concerning the depth of each organ and by applying depth dose corrections to the measured H*(10). Finally, the effective dose and risk of secondary cancer were determined using NCRP 116 coefficients. Evidence revealed that among all organs, the breast (0.62 mSv/Gy) and gonads (0.58 mSv/Gy) are at risk of photoneutrons more than the other organs in such treatments. The neutron effective dose in the 18-MV conventional radiotherapy of the brain was 13.36 mSv. Among all organs, gonads (6.96 mSv), thyroid (1.86 mSv), and breasts (1.86 mSv) had more contribution to the effective dose, respectively. The total secondary cancer risk was estimated as 281.4 cases (per 1 million persons). The highest risk was related to the breast and gonads with 74.4 and, 34.8 cases per 1 million persons, respectively. Therefore, it is recommended that to prevent late complications (secondary cancer and genetic effects), these organs should be shielded from photoneutrons. This procedure not only improves the quality of the patient’s personal life but also the healthy childbearing in the community.
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Affiliation(s)
- Soheil Elmtalab
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iraj Abedi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Alirezaei
- School of Paramedicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohammad Hossein Choopan Dastjerdi
- Reactor and Nuclear Safety Research School, Nuclear Science and Technology Research Institute, Isfahan, Iran
- * E-mail: (MHCD); (GG); (AHK)
| | - Ghazale Geraily
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: (MHCD); (GG); (AHK)
| | - Amir Hossein Karimi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: (MHCD); (GG); (AHK)
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A publicly available dataset of out-of-field dose profiles of a 6 MV linear accelerator. Phys Eng Sci Med 2022; 45:613-621. [PMID: 35553016 DOI: 10.1007/s13246-022-01131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
An increase in radiotherapy-induced secondary malignancies has led to recent developments in analytical modelling of out-of-field dose. These models must be validated against measurements, but currently available datasets are outdated or limited in scope. This study aimed to address these shortcomings by producing a large dataset of out-of-field dose profiles measured with modern equipment. A novel method was developed with the intention of allowing physicists in all clinics to perform these measurements themselves using commonly available dosimetry equipment. A standard 3D scanning water tank was used to collect 36 extended profiles. Each profile was measured in two sections, with the inner section measured with the beam directly incident on the tank, and the outer section with the beam incident on a water-equivalent phantom abutted next to the tank. The two sections were then stitched using a novel feature-matching approach. The profiles were compared against linac commissioning data and manually inspected for discontinuities in the overlap region. The dataset is presented as a publicly accessible comma separated variable file containing off-axis ratios at a range of off-axis distances. This dataset may be applied to the development and validation of analytical models of out-of-field dose. Additionally, it may be used to inform dose estimates to radiosensitive implants and anatomy. Physicists are encouraged to perform these out-of-field measurements in their own clinics and share their results with the community.
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Tillery H, Moore M, Gallagher KJ, Taddei PJ, Leuro E, Argento DC, Moffitt GB, Kranz M, Carey M, Heymsfield S, Newhauser WD. Personalized 3D-printed anthropomorphic whole-body phantom irradiated by protons, photons, and neutrons. Biomed Phys Eng Express 2022; 8. [PMID: 35045408 DOI: 10.1088/2057-1976/ac4d04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022]
Abstract
The objective of this study was to confirm the feasibility of three-dimensionally-printed (3D-printed), personalized whole-body anthropomorphic phantoms for radiation dose measurements in a variety of charged and uncharged particle radiation fields. We 3D-printed a personalized whole-body phantom of an adult female with a height of 154.8 cm, mass of 90.7 kg, and body mass index of 37.8 kg/m2. The phantom comprised of a hollow plastic shell filled with water and included a watertight access conduit for positioning dosimeters. It is compatible with a wide variety of radiation dosimeters, including ionization chambers that are suitable for uncharged and charged particles. Its mass was 6.8 kg empty and 98 kg when filled with water. Watertightness and mechanical robustness were confirmed after multiple experiments and transportations between institutions. The phantom was irradiated to the cranium with therapeutic beams of 170-MeV protons, 6-MV photons, and fast neutrons. Radiation absorbed dose was measured from the cranium to the pelvis along the longitudinal central axis of the phantom. The dose measurements were made using established dosimetry protocols and well-characterized instruments. For the therapeutic environments considered in this study, stray radiation from intracranial treatment beams was the lowest for proton therapy, intermediate for photon therapy, and highest for neutron therapy. An illustrative example set of measurements at the location of the thyroid for a square field of 5.3 cm per side resulted in 0.09, 0.59, and 1.93 cGy/Gy from proton, photon, and neutron beams, respectively. In this study, we found that 3D-printed personalized phantoms are feasible, inherently reproducible, and well-suited for therapeutic radiation measurements. The measurement methodologies we developed enabled the direct comparison of radiation exposures from neutron, proton, and photon beam irradiations.
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Affiliation(s)
- Hunter Tillery
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Meagan Moore
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Kyle Joseph Gallagher
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Phillip J Taddei
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, UNITED STATES
| | - Eric Leuro
- Seattle Cancer Care Alliance, 1570 N 115th St, Seattle, Washington, 98133, UNITED STATES
| | - David C Argento
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Gregory B Moffitt
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Marissa Kranz
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Margaret Carey
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Steven Heymsfield
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Wayne David Newhauser
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
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Kollitz E, Han H, Kim CH, Pinto M, Schwarz M, Riboldi M, Kamp F, Belka C, Newhauser WD, Dedes G, Parodi K. A patient-specific hybrid phantom for calculating radiation dose and equivalent dose to the whole body. Phys Med Biol 2021; 67. [PMID: 34969024 DOI: 10.1088/1361-6560/ac4738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE As cancer survivorship increases, there is growing interest in minimizing the late effects of radiation therapy such as radiogenic second cancer, which may occur anywhere in the body. Assessing the risk of late effects requires knowledge of the dose distribution throughout the whole body, including regions far from the treatment field, beyond the typical anatomical extent of clinical CT scans. APPROACH A hybrid phantom was developed which consists of in-field patient CT images extracted from ground truth whole-body CT (WBCT) scans, out-of-field mesh phantoms scaled to basic patient measurements, and a blended transition region. Four of these hybrid phantoms were created, representing male and female patients receiving proton therapy treatment in pelvic and cranial sites. To assess the performance of the hybrid approach, we simulated treatments using the hybrid phantoms, the scaled and unscaled mesh phantoms, and the ground truth whole-body CTs. We calculated absorbed dose and equivalent dose in and outside of the treatment field, with a focus on neutrons induced in the patient by proton therapy. Proton and neutron dose was calculated using a general purpose Monte Carlo code. MAIN RESULTS The hybrid phantom provided equal or superior accuracy in calculated organ dose and equivalent dose values relative to those obtained using the mesh phantoms in 78% in all selected organs and calculated dose quantities. Comparatively the default mesh and scaled mesh were equal or superior to the other phantoms in 21% and 28% of cases respectively. SIGNIFICANCE The proposed methodology for hybrid synthesis provides a tool for whole-body organ dose estimation for individual patients without requiring CT scans of their entire body. Such a capability would be useful for personalized assessment of late effects and risk-optimization of treatment plans.
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Affiliation(s)
- Erika Kollitz
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Garching, Bayern, 85748, GERMANY
| | - Haegin Han
- Department of Nuclear Engineering, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seongdong-gu, Seoul, 04763, Korea (the Republic of)
| | - Chan Hyeong Kim
- Department of Nuclear Engineering, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seongdong-gu, Seoul, 04763, Korea (the Republic of)
| | - Marco Pinto
- Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Garching, Bayern, 85748, GERMANY
| | - Marco Schwarz
- Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, Trento, Trentino-Alto Adige, 38123, ITALY
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
| | - Florian Kamp
- Radiotherapy, Klinikum der Universitat Munchen, Marchioninistraße 15, Munich, 81377, GERMANY
| | - Claus Belka
- Department of Radiation Oncology, Klinikum der Universitat Munchen, Marchioninistraße 15, Munchen, Bayern, 81377, GERMANY
| | - Wayne David Newhauser
- Department of Physics & Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana, 70803, UNITED STATES
| | - Georgios Dedes
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
| | - Katia Parodi
- Experimental Physics Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
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Kang DJ, Shin YJ, Jeong S, Jung JY, Lee H, Lee B. Development of clinical application program for radiotherapy induced cancer risk calculation using Monte Carlo engine in volumetric-modulated arc therapy. Radiat Oncol 2021; 16:108. [PMID: 34118968 PMCID: PMC8199704 DOI: 10.1186/s13014-020-01722-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study is to develop a clinical application program that automatically calculates the effect for secondary cancer risk (SCR) of individual patient. The program was designed based on accurate dose calculations using patient computed tomography (CT) data and Monte Carlo engine. Automated patient-specific evaluation program was configured to calculate SCR. Methods The application program is designed to re-calculate the beam sequence of treatment plan using the Monte Carlo engine and patient CT data, so it is possible to accurately calculate and evaluate scatter and leakage radiation, difficult to calculate in TPS. The Monte Carlo dose calculation system was performed through stoichiometric calibration using patient CT data. The automatic SCR evaluation program in application program created with a MATLAB was set to analyze the results to calculate SCR. The SCR for organ of patient was calculated based on Biological Effects of Ionizing Radiation (BEIR) VII models. The program is designed to sequentially calculate organ equivalent dose (OED), excess absolute risk (EAR), excess relative risk (ERR), and the lifetime attributable risk (LAR) in consideration of 3D dose distribution analysis. In order to confirm the usefulness of the developed clinical application program, the result values from clinical application program were compared with the manual calculation method used in the previous study. Results The OED values calculated in program were calculated to be at most approximately 13.3% higher than results in TPS. The SCR result calculated by the developed clinical application program showed a maximum difference of 1.24% compared to the result of the conventional manual calculation method. And it was confirmed that EAR, ERR and LAR values can be easily calculated by changing the biological parameters. Conclusions We have developed a patient-specific SCR evaluation program that can be used conveniently in the clinic. The program consists of a Monte Carlo dose calculation system for accurate calculation of scatter and leakage radiation and a patient-specific automatic SCR evaluation program using 3D dose distribution. The clinical application program that improved the disadvantages of the existing process can be used as an index for evaluating a patient treatment plan.
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Affiliation(s)
- Dong-Jin Kang
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Korea
| | - Young-Joo Shin
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Korea.
| | - Seonghoon Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Jae-Yong Jung
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Korea
| | | | - Boram Lee
- Department of Radiation Oncology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Wilson LJ, Newhauser WD. Generalized approach for radiotherapy treatment planning by optimizing projected health outcome: preliminary results for prostate radiotherapy patients. Phys Med Biol 2021; 66:065007. [PMID: 33545710 DOI: 10.1088/1361-6560/abe3cf] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Research in cancer care increasingly focuses on survivorship issues, e.g. managing disease- and treatment-related morbidity and mortality occurring during and after treatment. This necessitates innovative approaches that consider treatment side effects in addition to tumor cure. Current treatment-planning methods rely on constrained iterative optimization of dose distributions as a surrogate for health outcomes. The goal of this study was to develop a generally applicable method to directly optimize projected health outcomes. We developed an outcome-based objective function to guide selection of the number, angle, and relative fluence weight of photon and proton radiotherapy beams in a sample of ten prostate-cancer patients by optimizing the projected health outcome. We tested whether outcome-optimized radiotherapy (OORT) improved the projected longitudinal outcome compared to dose-optimized radiotherapy (DORT) first for a statistically significant majority of patients, then for each individual patient. We assessed whether the results were influenced by the selection of treatment modality, late-risk model, or host factors. The results of this study revealed that OORT was superior to DORT. Namely, OORT maintained or improved the projected health outcome of photon- and proton-therapy treatment plans for all ten patients compared to DORT. Furthermore, the results were qualitatively similar across three treatment modalities, six late-risk models, and 10 patients. The major finding of this work was that it is feasible to directly optimize the longitudinal (i.e. long- and short-term) health outcomes associated with the total (i.e. therapeutic and stray) absorbed dose in all of the tissues (i.e. healthy and diseased) in individual patients. This approach enables consideration of arbitrary treatment factors, host factors, health endpoints, and times of relevance to cancer survivorship. It also provides a simpler, more direct approach to realizing the full beneficial potential of cancer radiotherapy.
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Affiliation(s)
- Lydia J Wilson
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA 70803-4001, United States of America
| | - Wayne D Newhauser
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA 70803-4001, United States of America.,Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, United States of America
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Method to quickly and accurately calculate absorbed dose from therapeutic and stray photon exposures throughout the entire body in individual patients. Med Phys 2020; 47:2254-2266. [DOI: 10.1002/mp.14018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/11/2019] [Accepted: 12/24/2019] [Indexed: 01/26/2023] Open
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