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Oliveira AM, Akkerman HB, Braccini S, van Breemen AJJM, Gelinck GH, Heracleous N, Leidner J, Murtas F, Peeters B, Silari M. A high-resolution large-area detector for quality assurance in radiotherapy. Sci Rep 2024; 14:10637. [PMID: 38724569 PMCID: PMC11082155 DOI: 10.1038/s41598-024-61095-2] [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: 02/07/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
Hadron therapy is an advanced radiation modality for treating cancer, which currently uses protons and carbon ions. Hadrons allow for a highly conformal dose distribution to the tumour, minimising the detrimental side-effects due to radiation received by healthy tissues. Treatment with hadrons requires sub-millimetre spatial resolution and high dosimetric accuracy. This paper discusses the design, fabrication and performance tests of a detector based on Gas Electron Multipliers (GEM) coupled to a matrix of thin-film transistors (TFT), with an active area of 60 × 80 mm2 and 200 ppi resolution. The experimental results show that this novel detector is able to detect low-energy (40 kVp X-rays), high-energy (6 MeV) photons used in conventional radiation therapy and protons and carbon ions of clinical energies used in hadron therapy. The GEM-TFT is a compact, fully scalable, radiation-hard detector that measures secondary electrons produced by the GEMs with sub-millimetre spatial resolution and a linear response for proton currents from 18 pA to 0.7 nA. Correcting known detector defects may aid in future studies on dose uniformity, LET dependence, and different gas mixture evaluation, improving the accuracy of QA in radiotherapy.
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Affiliation(s)
- Andreia Maia Oliveira
- CERN - Occupational Health & Safety and Environmental Protection Unit, Radiation Protection Group, 1211, Geneva 23, Switzerland.
- Laboratory for High Energy Physics (LHEP), Albert Einstein Center for Fundamental Physics (AEC), University of Bern, Sidlerstrasse 5, 3012, Bern, Switzerland.
- EBG MedAustron GmbH, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria.
| | - Hylke B Akkerman
- Holst Centre/TNO, High Tech, Campus 31, 5656 AE, Eindhoven, The Netherlands
| | - Saverio Braccini
- Laboratory for High Energy Physics (LHEP), Albert Einstein Center for Fundamental Physics (AEC), University of Bern, Sidlerstrasse 5, 3012, Bern, Switzerland
| | | | - Gerwin H Gelinck
- Holst Centre/TNO, High Tech, Campus 31, 5656 AE, Eindhoven, The Netherlands
| | - Natalie Heracleous
- CERN - Occupational Health & Safety and Environmental Protection Unit, Radiation Protection Group, 1211, Geneva 23, Switzerland
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Johannes Leidner
- CERN - Occupational Health & Safety and Environmental Protection Unit, Radiation Protection Group, 1211, Geneva 23, Switzerland
- Medidee Services SA, Chemin de Rovéréaz 5, 1012, Lausanne, Switzerland
| | - Fabrizio Murtas
- CERN - Occupational Health & Safety and Environmental Protection Unit, Radiation Protection Group, 1211, Geneva 23, Switzerland
- INFN-LNF, 00044, Frascati, Italy
| | - Bart Peeters
- Holst Centre/TNO, High Tech, Campus 31, 5656 AE, Eindhoven, The Netherlands
| | - Marco Silari
- CERN - Occupational Health & Safety and Environmental Protection Unit, Radiation Protection Group, 1211, Geneva 23, Switzerland
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Zhang J, Chen Z, Lei Y, Wen J. A Novel Approach for Position Verification and Dose Calculation through Local MVCT Reconstruction. Diagnostics (Basel) 2024; 14:482. [PMID: 38472954 DOI: 10.3390/diagnostics14050482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Traditional positioning verification using cone-beam computed tomography (CBCT) may incur errors due to potential misalignments between the isocenter of CBCT and the treatment beams in radiotherapy. This study introduces an innovative method for verifying patient positioning in radiotherapy. Initially, the transmission images from an electronic portal imaging device (EPID) are acquired from 10 distinct angles. Utilizing the ART-TV algorithm, a sparse reconstruction of local megavoltage computed tomography (MVCT) is performed. Subsequently, this MVCT is aligned with the planning CT via a three-dimensional mutual information registration technique, pinpointing any patient-positioning discrepancies and facilitating corrective adjustments to the treatment setup. Notably, this approach employs the same radiation source as used in treatment to obtain three-dimensional images, thereby circumventing errors stemming from misalignment between the isocenter of CBCT and the accelerator. The registration process requires only 10 EPID images, and the dose absorbed during this process is included in the total dose calculation. The results show that our method's reconstructed MVCT images fulfill the requirements for registration, and the registration algorithm accurately detects positioning errors, thus allowing for adjustments in the patient's treatment position and precise calculation of the absorbed dose.
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Affiliation(s)
- Jun Zhang
- College of Computer Science and Technology, Taiyuan University of Technology, Taiyuan 030024, China
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Zerui Chen
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Yuxin Lei
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Junhai Wen
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
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3
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Cao Z, Gao X, Liu G, Pei Y. Effect of metal implants and metal artifacts on back-projected two-dimensional entrance fluence determined by EPID dosimetry. J Appl Clin Med Phys 2023; 24:e14115. [PMID: 37573570 PMCID: PMC10647983 DOI: 10.1002/acm2.14115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
PURPOSE To evaluate the errors caused by metal implants and metal artifacts in the two-dimensional entrance fluences reconstructed using the back-projection algorithm based on electronic portal imaging device (EPID) images. METHODS The EPID in the Varian VitalBeam accelerator was used to acquire portal dose images (PDIs), and then commercial EPID dosimetry software was employed to reconstruct the two-dimensional entrance fluences based on computed tomography (CT) images of the head phantoms containing interchangeable metal-free/titanium/aluminum round bars. The metal-induced errors in the two-dimensional entrance fluences were evaluated by comparing the γ results and the pixel value errors in the metal-affected regions. We obtained metal-artifact-free CT images by replacing the voxel values of non-metal inserts with those of metal inserts in metal-free CT images to evaluate the metal-artifact-induced errors. RESULTS The γ passing rates (versus PDIs obtained without a phantom in the beam field (PDIair ), 2%/2 mm) for the back-projected two-dimensional entrance fluences of phantoms containing titanium or aluminum (BPTi /BPAl ) were reduced from 92.4% to 90.5% and 90.6%, respectively, relative to the metal-free phantom (BPmetal-free ). Titanium causes more severe metal artifacts in CT images than aluminum, and its removal resulted in a 0.0022 CU (median) reduction in the pixel value of BPTi artifact-free relative to BPTi in the metal-affected region. Moreover, the mean absolute error (MAE) and root mean square error (RMSE) decreased from 0.0050 CU and 0.0063 CU to 0.0034 CU and 0.0040 CU, respectively (vs. BPmetal-free ). CONCLUSION Metal implants increase the errors in back-projected two-dimensional entrance fluences, and metals with higher electron densities cause more errors. For high-electron-density metal implants that produce severe metal artifacts (e.g., titanium), removing metal artifacts from the CT images can improve the accuracy of the two-dimensional entrance fluences reconstructed by back-projection algorithms.
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Affiliation(s)
- Zheng Cao
- National Synchrotron Radiation LaboratoryUniversity of Science and Technology of ChinaHefeiChina
- Hematology & Oncology DepartmentHefei First People's HospitalHefeiChina
| | - Xiang Gao
- Hematology & Oncology DepartmentHefei First People's HospitalHefeiChina
| | - Gongfa Liu
- National Synchrotron Radiation LaboratoryUniversity of Science and Technology of ChinaHefeiChina
| | - Yuanji Pei
- National Synchrotron Radiation LaboratoryUniversity of Science and Technology of ChinaHefeiChina
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Stevens S, Moloney S, Blackmore A, Hart C, Rixham P, Bangiri A, Pooler A, Doolan P. IPEM topical report: guidance for the clinical implementation of online treatment monitoring solutions for IMRT/VMAT. Phys Med Biol 2023; 68:18TR02. [PMID: 37531959 DOI: 10.1088/1361-6560/acecd0] [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: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
This report provides guidance for the implementation of online treatment monitoring (OTM) solutions in radiotherapy (RT), with a focus on modulated treatments. Support is provided covering the implementation process, from identification of an OTM solution to local implementation strategy. Guidance has been developed by a RT special interest group (RTSIG) working party (WP) on behalf of the Institute of Physics and Engineering in Medicine (IPEM). Recommendations within the report are derived from the experience of the WP members (in consultation with manufacturers, vendors and user groups), existing guidance or legislation and a UK survey conducted in 2020 (Stevenset al2021). OTM is an inclusive term representing any system capable of providing a direct or inferred measurement of the delivered dose to a RT patient. Information on each type of OTM is provided but, commensurate with UK demand, guidance is largely influenced byin vivodosimetry methods utilising the electronic portal imager device (EPID). Sections are included on the choice of OTM solutions, acceptance and commissioning methods with recommendations on routine quality control, analytical methods and tolerance setting, clinical introduction and staffing/resource requirements. The guidance aims to give a practical solution to sensitivity and specificity testing. Functionality is provided for the user to introduce known errors into treatment plans for local testing. Receiver operating characteristic analysis is discussed as a tool to performance assess OTM systems. OTM solutions can help verify the correct delivery of radiotherapy treatment. Furthermore, modern systems are increasingly capable of providing clinical decision-making information which can impact the course of a patient's treatment. However, technical limitations persist. It is not within the scope of this guidance to critique each available solution, but the user is encouraged to carefully consider workflow and engage with manufacturers in resolving compatibility issues.
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Affiliation(s)
| | - Stephen Moloney
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | | | - Clare Hart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Philip Rixham
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Anna Bangiri
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alistair Pooler
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Clinical pilot study for EPID-based in vivo dosimetry using EPIgray™ for head and neck VMAT. Phys Eng Sci Med 2022; 45:1335-1340. [PMID: 36227496 DOI: 10.1007/s13246-022-01184-6] [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: 05/02/2022] [Accepted: 10/01/2022] [Indexed: 12/14/2022]
Abstract
This work details the clinical pilot study methodology used at Wellington Blood and Cancer Centre (WBCC) before the clinical release of in vivo dosimetry (IVD) system EPIgray™ for head and neck (H&N) volumetric modulated arc therapy (VMAT) treatments. Clinical pilot studies make it possible to select appropriate, department-specific tolerance ranges for the treatment type and site under investigation. An IVD clinical pilot study of H&N VMAT treatments was conducted over 3 months at WBCC using EPIgray™ dose reconstruction software and included 12 patients and 32 individual treatment fractions. Statistical analysis of the dose deviations between the treatment planning system (TPS) dose and EPIgray™ reconstructed dose confirmed that a deviation tolerance range of ± 7.0% was an appropriate choice for H&N VMAT at WBCC.
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Latorre-Musoll A, Delgado-Tapia P, Gisbert ML, Sala NJ, Sempau J. Transit-guided radiation therapy: proof of concept of an on-line technique for correcting position errors using transit portal images. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7d32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. Transit in vivo dosimetry methods monitor that the dose distribution is delivered as planned. However, they have a limited ability to identify and to quantify the cause of a given disagreement, especially those caused by position errors. This paper describes a proof of concept of a simple in vivo technique to infer a position error from a transit portal image (TPI). Approach. For a given treatment field, the impact of a position error is modeled as a perturbation of the corresponding reference (unperturbed) TPI. The perturbation model determines the patient translation, described by a shift vector, by comparing a given in vivo TPI to the corresponding reference TPI. Patient rotations can also be determined by applying this formalism to independent regions of interest over the patient. Eight treatment plans have been delivered to an anthropomorphic phantom under a large set of couch shifts (<15 mm) and rotations (<10°) to experimentally validate this technique, which we have named Transit-Guided Radiation Therapy (TGRT). Main results. The root mean squared error (RMSE) between the determined and the true shift magnitudes was 1.0/2.4/4.9 mm for true shifts ranging between 0–5/5–10/10–15 mm, respectively. The angular accuracy of the determined shift directions was 12° ± 14°. The RMSE between the determined and the true rotations was 0.5°. The TGRT technique decoupled translations and rotations satisfactorily. In 96% of the cases, the TGRT technique decreased the existing position error. The detection threshold of the TGRT technique was around 1 mm and it was nearly independent of the tumor site, delivery technique, beam energy or patient thickness. Significance. TGRT is a promising technique that not only provides reliable determinations of the position errors without increasing the required equipment, acquisition time or patient dose, but it also adds on-line correction capabilities to existing methods currently using TPIs.
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Olaciregui-Ruiz I, Osinga-Blaettermann JM, Ortega-Marin K, Mijnheer B, Mans A. Extending in aqua portal dosimetry with dose inhomogeneity conversion maps for accurate patient dose reconstruction in external beam radiotherapy. Phys Imaging Radiat Oncol 2022; 22:20-27. [PMID: 35493851 PMCID: PMC9038561 DOI: 10.1016/j.phro.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
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Dosimetric verification of IMRT and 3D conformal treatment delivery using EPID. Appl Radiat Isot 2022; 182:110116. [DOI: 10.1016/j.apradiso.2022.110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
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Renaud J, Muir B. Assessing the accuracy of electronic portal imaging device (EPID)-based dosimetry: II. Evaluation of a dosimetric uncertainty budget and development of a new film-in-EPID absorbed dose calibration methodology. Med Phys 2021; 49:1238-1247. [PMID: 34954834 DOI: 10.1002/mp.15425] [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: 11/22/2021] [Accepted: 12/12/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study is to reduce the uncertainty associated with determining dose-to-water using an amorphous silicon electronic portal imaging detector (EPID) under reference conditions by developing a direct calibration formalism based on radiochromic film measurements made within the EPID panel and detailed Monte Carlo simulations. To our knowledge, this is the first EPID-based dosimetry study reporting an uncertainty budget . METHODS Pixel sensitivity and relative off-axis response was mapped by simultaneously irradiating film contained within the imager panel and acquiring an EPID image set. The detector panel was disassembled for the purpose of modeling the EPID in detail using the EGSnrc DOSXYZnrc usercode, which was in turn used to calculate dose-to-film in EPID to dose-to-water in water conversion factors . RESULTS A direct comparison of the two correction methodologies investigated in this work, the previously established empirical method and the proposed simultaneous measurement approach involving in-EPID film dosimetry, produced an agreement with an RMS deviation of 1.4 % overall. A combined standard relative uncertainty of 3.3 % (k = 1) was estimated for the determination of absorbed dose to water at the position of the EPID using the proposed calibration methodology . CONCLUSIONS This work describes a direct method of calibrating EPID response in terms of absorbed dose to water requiring fewer measurements than other empirical approaches, and without 2D spatial interpolation of correction factors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- James Renaud
- Metrology Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
| | - Bryan Muir
- Metrology Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
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Li Y, Xiao F, Liu B, Qi M, Lu X, Cai J, Zhou L, Song T. Deep learning-based 3D in vivodose reconstruction with an electronic portal imaging device for magnetic resonance-linear accelerators: a proof of concept study. Phys Med Biol 2021; 66. [PMID: 34798623 DOI: 10.1088/1361-6560/ac3b66] [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: 09/13/2021] [Accepted: 11/19/2021] [Indexed: 11/11/2022]
Abstract
Objective.To develop a novel deep learning-based 3Din vivodose reconstruction framework with an electronic portal imaging device (EPID) for magnetic resonance-linear accelerators (MR-LINACs).Approach.The proposed method directly back-projected 2D portal dose into 3D patient coarse dose, which bypassed the complicated patient-to-EPID scatter estimation step used in conventional methods. A pre-trained convolutional neural network (CNN) was then employed to map the coarse dose to the final accurate dose. The electron return effect caused by the magnetic field was captured with the CNN model. Patient dose and portal dose datasets were synchronously generated with Monte Carlo simulation for 96 patients (78 cases for training and validation and 18 cases for testing) treated with fixed-beam intensity-modulated radiotherapy in four different tumor sites, including the brain, nasopharynx, lung, and rectum. Beam angles from the training dataset were further rotated 2-3 times, and doses were recalculated to augment the datasets.Results.The comparison between reconstructed doses and MC ground truth doses showed mean absolute errors <0.88% for all tumor sites. The averaged 3Dγ-passing rates (3%, 2 mm) were 97.42%±2.66% (brain), 98.53%±0.95% (nasopharynx), 99.41%±0.46% (lung), and 98.63%±1.01% (rectum). The dose volume histograms and indices also showed good consistency. The average dose reconstruction time, including back projection and CNN dose mapping, was less than 3 s for each individual beam.Significance.The proposed method can be potentially used for accurate and fast 3D dosimetric verification for online adaptive radiotherapy using MR-LINACs.
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Affiliation(s)
- Yongbao Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Fan Xiao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People's Republic of China
| | - Biaoshui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Mengke Qi
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People's Republic of China
| | - Xingyu Lu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiajun Cai
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People's Republic of China
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People's Republic of China
| | - Ting Song
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People's Republic of China
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Jia M, Yang Y, Wu Y, Li X, Xing L, Wang L. Deep learning-augmented radioluminescence imaging for radiotherapy dose verification. Med Phys 2021; 48:6820-6831. [PMID: 34523131 DOI: 10.1002/mp.15229] [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: 07/31/2020] [Revised: 07/15/2021] [Accepted: 09/05/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We developed a novel dose verification method using a camera-based radioluminescence imaging system (CRIS) combined with a deep learning-based signal processing technique. METHODS The CRIS consists of a cylindrical chamber coated with scintillator material on the inner surface of the cylinder, coupled with a hemispherical mirror and a digital camera at the two ends. After training, the deep learning model is used for image-to-dose conversion to provide absolute dose prediction at multiple depths of a specific water phantom from a single CRIS image under the assumption of a good consistency between the TPS setting and actual beam energy. The model was trained using a set of captured radioluminescence images and the corresponding dose maps from the clinical treatment planning system (TPS) for the sake of acceptable data collection. To overcome the latent error and inconsistency that exists between the TPS calculation and the corresponding measurement, the model was trained in an unsupervised manner. Validation experiments were performed on five square fields (ranging from 2 × 2 to 10 × 10 cm2 ) and three clinical intensity-modulated radiation therapy (IMRT) cases. The results were compared to the TPS calculations in terms of gamma index at 1.5, 5, and 10 cm depths. RESULTS The mean 2%/2 mm gamma pass rates were 100% for square fields and 97.2% (range from 95.5% to 99.5%) for the IMRT fields. Further validations were performed by comparing the CRIS results with measurements on various regular fields. The results show a mean gamma pass rate of 91% (1%/1 mm) for cross-profiles and a mean percentage deviation of 1.15% for percentage depth doses (PDDs). CONCLUSIONS The system is capable of converting the irradiated radioluminescence image to corresponding water-based dose maps at multiple depths with a spatial resolution comparable to the TPS calculations.
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Affiliation(s)
- Mengyu Jia
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Yan Wu
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Xiaomeng Li
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Lei Wang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Jia M, Wu Y, Yang Y, Wang L, Chuang C, Han B, Xing L. Deep learning-enabled EPID-based 3D dosimetry for dose verification of step-and-shoot radiotherapy. Med Phys 2021; 48:6810-6819. [PMID: 34519365 DOI: 10.1002/mp.15218] [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: 03/09/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The study aims at a novel dosimetry methodology to reconstruct a 3D dose distribution as imparted to a virtual cylindrical phantom using an electronic portal imaging device (EPID). METHODS A deep learning-based signal processing strategy, referred to as 3DosiNet, is utilized to learn a mapping from an EPID image to planar dose distributions at given depths. The network was trained with the volumetric dose exported from the clinical treatment planning system (TPS). Given the latent inconsistency between measurements and corresponding TPS calculations, unsupervised learning is formulated in 3DosiNet to capture abstractive image features that are less sensitive to the potential variations. RESULTS Validation experiments were performed using five regular fields and three clinical intensity-modulated radiation therapy (IMRT) cases. The measured dose profiles and percentage depth dose (PDD) curves were compared with those measured using standard tools in terms of the 1D gamma index. The mean gamma pass rates (2%/2 mm) over the regular fields are 100% and 97.3% for the dose profile and PDD measurements, respectively. The measured volumetric dose was compared to the corresponding TPS calculation in terms of the 3D gamma index. The mean 2%/2 mm gamma pass rates are 97.9% for square fields and 94.9% for the IMRT fields. CONCLUSIONS The system promises to be a practical 3D dosimetric tool for pre-treatment patient-specific quality assurance and further developed for in-treatment patient dose monitoring.
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Affiliation(s)
- Mengyu Jia
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Yan Wu
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Lei Wang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Cynthia Chuang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Bin Han
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Torres Valderrama A, Olaciregui-Ruiz I, González P, Perik T, Mijnheer B, Mans A. Portal dosimetry of small unflattened beams. Phys Med Biol 2021; 66. [PMID: 32217828 DOI: 10.1088/1361-6560/ab843d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/27/2020] [Indexed: 11/12/2022]
Abstract
We developed and validated a dedicated small field back-projection portal dosimetry model for pretreatment andin vivoverification of stereotactic plans entailing small unflattened photon beams. For this purpose an aSi-EPID was commissioned as a small field dosimeter. Small field output factors for 6 MV FFF beams were measured using the PTW microDiamond detector and the Agility 160-leaf MLC from Elekta. The back-projection algorithm developed in our department was modified to better model the small field physics. The feasibility of small field portal dosimetry was validated via absolute point dose differences w.r.t. small static beams, and 5 hypofractionated stereotactic VMAT clinical plans measured with the OCTAVIUS 1000 SRS array dosimeter and computed with the treatment planning system Pinnacle v16.2. Dose reconstructions using the currently clinically applied back-projection model were also computed for comparison. We found that the latter yields underdosage of about -8% for square beams with cross section near 10 mm x 10 mm and about -6% for VMAT treatments with PTV volumes smaller than about 2cm3. With the methods described in this work such errors can be reduced to less than the ±3.0% recommendations for clinical use. Our results indicate that aSi-EPIDs can be used as accurate small field radiation dosimeters, offering advantages over point dose detectors, the correct positioning and orientation of which is challenging for routine clinical QA.
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Affiliation(s)
- Aldemar Torres Valderrama
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan, 121 1066 CX Amsterdam, The Netherlands
| | - Igor Olaciregui-Ruiz
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan, 121 1066 CX Amsterdam, The Netherlands
| | - Patrick González
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan, 121 1066 CX Amsterdam, The Netherlands
| | - Thijs Perik
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan, 121 1066 CX Amsterdam, The Netherlands
| | - Ben Mijnheer
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan, 121 1066 CX Amsterdam, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan, 121 1066 CX Amsterdam, The Netherlands
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14
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Muñoz D, Olaciregui-Ruiz I, Norberg G, van der Heide UA, Mans A. Characterization of Gas Electron Multiplier-based detector for external beam radiation therapy dosimetry. Med Phys 2021; 48:1931-1940. [PMID: 33440024 DOI: 10.1002/mp.14718] [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: 08/19/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Electronic portal imaging devices (EPIDs) are commonly installed on modern linear accelerators (LINACs) and are convenient for imaging and, potentially, dosimetry. However, owing to their construction with metal and scintillating layers of high atomic number, they exhibit nonwater-equivalent response and oversensitivity to low-energy photons. Therefore, EPIDs are not ideal for dosimetry purposes. Additionally, nonlinearities due to the combined use of scintillators and photodiodes have been reported. Here, an EPID which employs a variable gain Gas Electron Multiplier (GEM) and direct detection of electrons is introduced. To investigate its dosimetric performance, measurements characterizing the novel EPID are performed and compared with measurements from ionization chambers and conventional EPIDs. METHODS Linearity, dose rate dependence, field size dependence, off-axis response, and transmission response were measured for all available energy settings (6, 10, 6 MV Flattening Filter Free (FFF) and 10 MVFFF) using three different detector gain settings. Additionally, an evaluation of the ghosting and image lag of the panel was completed. Reference ionization chamber measurements were performed for the off-axis and transmission response and existing data for conventional EPIDs and ionization chambers from equivalent measurements were used for comparison of the field size dependence. Elsewhere, values from the linac monitoring chambers were used. RESULTS In the range from 10 to 1000 Monitor Units (MU), the detector was linear within 1% for all combinations of gain settings and energies. The dose rate dependence was also within 1% for all energies and for two out of three gain settings. Regarding field size dependency, the ratio of ionization chamber and panel values was 0.94 and 0.98 for the conventional EPID and GEMini respectively, at 20 × 20 cm2 and 10 MV. For 6 MV, 6 MVFFF, and 10MVFFF these ratios were 0.97, 0.98, and 0.99 for the GEMini, and 0.95, 0.97, and 0.97 for the conventional EPID. Similar performance between the GEMini and conventional EPID is observed for field sizes smaller than 10 × 10 cm2 . The transmission response was within 5% for all energies for thicknesses up to 30 cm, compared to 10-20% for a conventional EPID. The off-axis response for shifts up to 16 cm was within 1% and 3% for 6 MV and 10 MV, with and without phantom. The rise and fall of the signal from the detector correspond well to monitor chamber measurements indicating little ghosting and image lag, regardless of gain setting. CONCLUSION The GEM EPID exhibits dose rate dependence and linearity within 1%, and negligible ghosting and image lag. In this regard, it performs particularly well using 50 and 250 V of gain, and either could be chosen. For higher sensitivity, 250 V is the recommended base gain setting, although other applications may warrant different gains. For most tests performed in this study, the GEM EPID demonstrates a more water-equivalent response than conventional EPIDs making GEMs a viable technology for dosimetry in radiation therapy.
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Affiliation(s)
- Daniel Muñoz
- C-RAD Imaging AB, Uppsala, Sweden.,Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Igor Olaciregui-Ruiz
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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M M, V J, O P G. Clinical Experience of Intensity Modulated Radiotherapy Pre-Treatment Quality Assurance for Carcinoma Head and Neck Patients with EPID and IMatriXX in Rural Center. J Biomed Phys Eng 2020; 10:691-698. [PMID: 33364206 PMCID: PMC7753253 DOI: 10.31661/jbpe.v0i0.2004-1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/21/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Radiation therapy techniques as Intensity Modulated Radiotherapy (IMRT), rapid arc have been used for treatment of cancer with high accuracy. OBJECTIVE Verification of planned and delivered dose distribution is important, therefore current study aims to analyse quality assurance (QA) results of IMRT by Electronic Portal Imaging Device (EPID) and IMatriXX in head and neck Carcinoma (Ca H&N) patients. MATERIAL AND METHODS In this experimental study, performance of an EPID and IMatriXX was assessed with dose measurements using ionization chamber. Calibrated IMatriXX and EPID are used for pre-treatment patient specific quality assurance (PSQA), for 122 patients' plans of Ca H&N with IMRT treatment technique on linear accelerator. Dose images were acquired and compared with gamma evaluation (3% / 3 mm) and three scalar parameters, named average γ (γavg), maximum γ (γmax) and area gamma <1, were analyzed in the region of interest. RESULTS The γ correlation comparisons yielded average correlation of 0.990 and 0.982 for IMatriXX and EPID respectively. Maximum value of gamma is 0.998, while minimum gamma is 0.872 for IMatriXX and 0.953 for EPID. For students, unpaired 't' test analysis is applied for comparison to two data sets. P-value was set at 0.005 which, for this study, was computed 0.001, showing good correlation between measured data with IMatriXX and EPID. CONCLUSION The EPID and IMatriXX have significantly improved dosimetric properties, resulting in more sensitive, accurate measurements before actual treatment. The result shows EPID can be replaced with other dosimetry method and ionization chamber measurements. Portal imager is an efficient, accurate and sensitive dosimetry tool and is also the basis of pre-treatment quality assurance protocol.
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Affiliation(s)
- More M
- PhD Candidate, Department of Radiotherapy and Oncology, Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni, India
| | - Jain V
- MD, Department of Radiotherapy and Oncology, Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni, India
| | - Gurjar O P
- PhD, Government Cancer Hospital, Mahatma Gandhi Memorial Medical College, Indore, India
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Abbasian P, McCowan PM, Rickey DW, Van Uytven E, McCurdy BMC. Modeling the temporal–spatial nature of the readout of an electronic portal imaging device (EPID). Med Phys 2020; 47:5301-5311. [DOI: 10.1002/mp.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Parandoush Abbasian
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
| | - Peter M. McCowan
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
| | - Daniel W. Rickey
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
- Department of Radiology University of Manitoba 820 Sherbrook Street Winnipeg ManitobaR3A 1R9 Canada
| | - Eric Van Uytven
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
- Department of Radiology University of Manitoba 820 Sherbrook Street Winnipeg ManitobaR3A 1R9 Canada
| | - Boyd M. C. McCurdy
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
- Department of Radiology University of Manitoba 820 Sherbrook Street Winnipeg ManitobaR3A 1R9 Canada
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Olaciregui-Ruiz I, Beddar S, Greer P, Jornet N, McCurdy B, Paiva-Fonseca G, Mijnheer B, Verhaegen F. In vivo dosimetry in external beam photon radiotherapy: Requirements and future directions for research, development, and clinical practice. Phys Imaging Radiat Oncol 2020; 15:108-116. [PMID: 33458335 PMCID: PMC7807612 DOI: 10.1016/j.phro.2020.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
External beam radiotherapy with photon beams is a highly accurate treatment modality, but requires extensive quality assurance programs to confirm that radiation therapy will be or was administered appropriately. In vivo dosimetry (IVD) is an essential element of modern radiation therapy because it provides the ability to catch treatment delivery errors, assist in treatment adaptation, and record the actual dose delivered to the patient. However, for various reasons, its clinical implementation has been slow and limited. The purpose of this report is to stimulate the wider use of IVD for external beam radiotherapy, and in particular of systems using electronic portal imaging devices (EPIDs). After documenting the current IVD methods, this report provides detailed software, hardware and system requirements for in vivo EPID dosimetry systems in order to help in bridging the current vendor-user gap. The report also outlines directions for further development and research. In vivo EPID dosimetry vendors, in collaboration with users across multiple institutions, are requested to improve the understanding and reduce the uncertainties of the system and to help in the determination of optimal action limits for error detection. Finally, the report recommends that automation of all aspects of IVD is needed to help facilitate clinical adoption, including automation of image acquisition, analysis, result interpretation, and reporting/documentation. With the guidance of this report, it is hoped that widespread clinical use of IVD will be significantly accelerated.
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Affiliation(s)
- Igor Olaciregui-Ruiz
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sam Beddar
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Greer
- Calvary Mater Newcastle Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - Nuria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Boyd McCurdy
- Medical Physics Department, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Gabriel Paiva-Fonseca
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Ben Mijnheer
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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18
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Detailed evaluation of Mobius3D dose calculation accuracy for volumetric-modulated arc therapy. Phys Med 2020; 74:125-132. [DOI: 10.1016/j.ejmp.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 11/17/2022] Open
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Torres-Xirau I, Olaciregui-Ruiz I, Kaas J, Nowee ME, van der Heide UA, Mans A. 3D dosimetric verification of unity MR-linac treatments by portal dosimetry. Radiother Oncol 2020; 146:161-166. [PMID: 32182503 DOI: 10.1016/j.radonc.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE AND BACKGROUND 3D dosimetric verification of online adaptive workflows is essential as their complexity is unprecedented in radiation oncology. The aim of this work is to demonstrate the feasibility of back-projection portal dosimetry for 3D dosimetric verification of Unity MR-linac treatments. MATERIAL AND METHODS An earlier presented 2D back-projection algorithm for the Unity MR-linac geometry was extended for 3D dose reconstruction and comparison against planned dose distributions. 'In-air' as well as in-vivo portal EPID images can be used as input. The method was validated using data from treatments of 5 patients (2 rectal, 2 prostate cancer and one oligo metastasis). 3D pre-treatment verification of the reference plan using 'in-air' EPID images was performed and compared against measured (with the Octavius 4D system) and planned (in the planning CT) dose distributions. In-vivo EPID dose distributions were compared to the TPS for the first three adaptations of all treatments. For all comparisons, dose difference values at the reference point and γ-parameters were reported. RESULTS The comparison against the OCTAVIUS 4D system (3%, 2 mm, local) showed y-mean = 0.52 ± 0.10 and y-passrate = 91.9%, 95% CI [85.4, 98.4], and ΔDRP = -0.1 ± 1.1%. Pre-treatment verification against TPS data (3%, 2 mm, global) showed y-mean = 0.52 ± 0.04, y-passrate = 93.5%, 95% CI [92.4, 94.6] and ΔDRP = -0.9 ± 1.5%. The averaged y-results for the in-vivo 3D verification were y-mean = 0.52 ± 0.05, y-passrate = 92.5%, 95% CI [90.2, 94.8] and ΔDRP = 0.8 ± 2.1%. CONCLUSION 3D dosimetric verification of Unity MR-linac treatments using portal dosimetry is feasible, pre-treatment as well as in-vivo.
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Affiliation(s)
- Iban Torres-Xirau
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Igor Olaciregui-Ruiz
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Jochem Kaas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marlies E Nowee
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Beck L, Velthuis JJ, Fletcher S, Haynes JA, Page RF. Using a TRAPS upstream transmission detector to verify multileaf collimator positions during dynamic radiotherapy delivery. Appl Radiat Isot 2020; 156:108951. [PMID: 31790976 DOI: 10.1016/j.apradiso.2019.108951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Abstract
With the advancement of high-precision radiotherapy and the increasing use of higher intensity beams, the risk to the patient increases should the radiotherapy machine malfunction. Hence more accurate treatment verification is required. In this paper we provide a solution for real-time monitoring of X-ray beams from radiotherapy linear accelerators using monolithic active pixel sensors. We show that leaf errors can be detected with high precision in static fields and IMRT step and shoot, and accurate leaf tracking is possible in Volumetric Modulated Arc Therapy. The prototype MAPS detector meets the criteria of 1% attenuation acceptable for clinical use.
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Affiliation(s)
- L Beck
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom.
| | - J J Velthuis
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom; Swansea University Medical School, Singleton Park, Swansea, United Kingdom; University of South China, School of Nuclear Science and Technology, West Changsheng Rd, Hengyang, 421001, China
| | - S Fletcher
- United Hospitals Bristol NHS Foundation Trust (UHB), at the Department of Medical Physics & Bioengineering at Bristol Haematology and Oncology Centre, Horfield Road, Bristol, United Kingdom
| | - J A Haynes
- United Hospitals Bristol NHS Foundation Trust (UHB), at the Department of Medical Physics & Bioengineering at Bristol Haematology and Oncology Centre, Horfield Road, Bristol, United Kingdom
| | - R F Page
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom
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Manikandan A, Sekaran SC, Sarkar B, Manikandan S. Simple Electronic Portal Imager-Based Pretreatment Quality Assurance using Acuros XB: A Feasibility Study. J Med Phys 2020; 44:231-238. [PMID: 31908381 PMCID: PMC6936198 DOI: 10.4103/jmp.jmp_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/04/2022] Open
Abstract
Objective This study demonstrates a novel electronic portal imaging device (EPID)-based forward dosimetry approach for pretreatment quality assurance aided by a treatment planning system (TPS). Materials and Methods Dynamic multileaf collimator intensity-modulated radiation therapy (IMRT) plans were delivered in EPID and fluence was captured on a beam-by-beam basis (FEPID). An open field having dimensions equal to those of the largest IMRT field was used in the TPS to obtain the transmitted fluence. This represented the patient-specific heterogeneity correction (Fhet). To obtain the resultant heterogeneity-corrected fluence, EPID measured fluence was corrected for the TPS generated heterogeneity (FResultant = FEPID × Fhet). Next, the calculated fluence per beam basis was collected from TPS (FTPS). Finally, FResultant and FTPS were compared using a 3% percentage dose difference (% DD)-3 mm distance to agreement [DTA] gamma analysis in an isocentric plane (two-dimensional [2D]) and multiple planes (quasi three-dimensional [3D]) orthogonal to the beam axis. Results The 2D heterogeneity-corrected dose reconstruction revealed a mean γ passing of the pelvis, thorax, and head-and-neck cases of 96.3% ±2.0%, 96.3% ±1.8%, and 96.1% ±2.2%, respectively. Quasi-3D γ passing for the pelvis, thorax, and head-and-neck cases were 97.5% ±1.4%, 96.3% ±2.4%, and 97.5% ±1.0%, respectively. Conclusion EPID dosimetry produced an inferior result due to no heterogeneity corrections for sites such as the lung and esophagus. Incorporating TPS-based heterogeneity correction improved the EPID dosimetry result for those sites with large heterogeneity.
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Affiliation(s)
- Arjunan Manikandan
- Department of Medical Physics, Bharathiar University, Coimbatore, Tamil Nadu, India
| | | | - Biplab Sarkar
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, India
| | - Sujatha Manikandan
- Department of Radiotherapy, Government General Hospital, Guntur, Andhra Pradesh, India
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Abstract
Abstract
Biomedical accelerators used in radiotherapy are equipped with detector arrays which are commonly used to obtain the image of patient position during the treatment session. These devices use both kilovolt and megavolt x-ray beams. The advantage of EPID (Electronic Portal Imaging Device) megavolt panels is the correlation of the measured signal with the calibrated dose. The EPID gives a possibility to verify delivered dose. The aim of the study is to answer the question whether EPID can be useful as a tool for interfraction QC (quality control) of dose and geometry repeatability.
The EPID system has been calibrated according to the manufacturer’s recommendations to obtain a signal and dose values correlation. Initially, the uncertainty of the EPID matrix measurement was estimated. According to that, the detecting sensitivity of two parameters was checked: discrepancies between the planned and measured dose and field geometry variance. Moreover, the linearity of measured signal-dose function was evaluated.
In the second part of the work, an analysis of several dose distributions was performed. In this study, the analysis of clinical cases was limited to stereotactic dynamic radiotherapy. Fluence maps were obtained as a result of the dose distribution measurements with the EPID during treatment sessions. The compatibility of fluence maps was analyzed using the gamma index. The fluence map acquired during the first fraction was the reference one. The obtained results show that EPID system can be used for interfraction control of dose and geometry repeatability.
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Olaciregui-Ruiz I, Rozendaal R, van Kranen S, Mijnheer B, Mans A. The effect of the choice of patient model on the performance of in vivo 3D EPID dosimetry to detect variations in patient position and anatomy. Med Phys 2019; 47:171-180. [PMID: 31674038 DOI: 10.1002/mp.13893] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/09/2019] [Accepted: 10/21/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE In vivo EPID dosimetry is meant to trigger on relevant differences between delivered and planned dose distributions and should therefore be sensitive to changes in patient position and patient anatomy. Three-dimensional (3D) EPID back-projection algorithms can use either the planning computed tomography (CT) or the daily patient anatomy as patient model for dose reconstruction. The purpose of this study is to quantify the effect of the choice of patient model on the performance of in vivo 3D EPID dosimetry to detect patient-related variations. METHODS Variations in patient position and patient anatomy were simulated by transforming the reference planning CT images (pCT) into synthetic daily CT images (dCT) representing a variation of a given magnitude in patient position or in patient anatomy. For each variation, synthetic in vivo EPID data were also generated to simulate the reconstruction of in vivo EPID dose distributions. Both the planning CT images and the synthetic daily CT images could be used as patient model in the reconstructions yielding e D pCT and e D dCT EPID reconstructed dose distributions respectively. The accuracy of e D pCT and e D dCT reconstructions was evaluated against absolute dose measurements made in different phantom setups, and against dose distributions calculated by the treatment planning system (TPS). The comparison was performed by γ-analysis (3% local dose/2 mm). The difference in sensitivity between e D pCT and e D dCT reconstructions to detect variations in patient position and in patient anatomy was investigated using receiver operating characteristic analysis and the number of triggered alerts for 100 volumetric modulated arc therapy plans and 12 variations. RESULTS e D dCT showed good agreement with both absolute point dose measurements (<0.5%) and TPS data (γ-mean = 0.52 ± 0.11). The agreement degraded with e D pCT , with the magnitude of the deviation varying with each specific case. e D dCT readily detected combined 3 mm translation setup errors in all directions (AUC = 1.0) and combined 3° rotation setup errors around all axes (AUC = 0.86) whereas e D pCT showed good detectability only for 12 mm translations (AUC = 0.85) and 9° rotations (AUC = 0.80). Conversely, e D pCT manifested a higher sensitivity to patient anatomical changes resulting in AUC values of 0.92/0.95 for a 6 mm patient contour expansion/contraction compared to 0.70/0.64 with e D dCT . Using |ΔPTVD50 | > 3% as clinical tolerance level, the percentage of alerts for 6 mm changes in patient contour were 85%/27% with e D pCT / e D dCT . CONCLUSIONS With planning CT images as patient model, EPID dose reconstructions underestimate the dosimetric effects caused by errors in patient positioning and overestimate the dosimetric effects caused by changes in patient anatomy. The use of the daily patient position and anatomy as patient model for in vivo 3D EPID transit dosimetry improves the ability of the system to detect uncorrected errors in patient position and it reduces the likelihood of false positives due to patient anatomical changes.
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Affiliation(s)
- Igor Olaciregui-Ruiz
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Roel Rozendaal
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Simon van Kranen
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ben Mijnheer
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Ray X, Bojechko C, Moore KL. Evaluating the sensitivity of Halcyon's automatic transit image acquisition for treatment error detection: A phantom study using static IMRT. J Appl Clin Med Phys 2019; 20:131-143. [PMID: 31587477 PMCID: PMC6839375 DOI: 10.1002/acm2.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 07/12/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The Varian Halcyon™ electronic portal imaging detector is always in-line with the beam and automatically acquires transit images for every patient with full-field coverage. These images could be used for "every patient, every monitor unit" quality assurance (QA) and eventually adaptive radiotherapy. This study evaluated the imager's sensitivity to potential clinical errors and day-to-day variations from clinical exit images. METHODS Open and modulated fields were delivered for each potential error. To evaluate output changes, monitor units were scaled by 2%-10% and delivered to solid water slabs and a homogeneous CIRS phantom. To mimic weight changes, 0.5-5.0 cm of buildup was added to the solid water. To evaluate positioning changes, a homogeneous and heterogeneous CIRS phantom were shifted 2-10 cm and 0.2-1.5 cm, respectively. For each test, mean relative differences (MRDs) and standard deviations in the pixel-difference histograms (σRD ) between test and baseline images were calculated. Lateral shift magnitudes were calculated using cross-correlation and edge-detection filtration. To assess patient variations, MRD and σRD were calculated from six prostate patients' daily exit images and compared between fractions with and without gas present. RESULTS MRDs responded linearly to output and buildup changes with a standard deviation of 0.3%, implying a 1% output change and 0.2 cm changes in buildup could be detected with 2.5σ confidence. Shifting the homogenous phantom laterally resulted in detectable MRD and σRD changes, and the cross-correlation function calculated the shift to within 0.5 mm for the heterogeneous phantom. MRD and σRD values were significantly associated with the presence of gas for five of the six patients. CONCLUSIONS Rapid analyses of automatically acquired Halcyon™ exit images could detect mid-treatment changes with high sensitivity, though appropriate thresholds will need to be set. This study presents the first steps toward developing effortless image evaluation for all aspects of every patient's treatment.
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Affiliation(s)
- Xenia Ray
- Department of Radiation Medicine and Applied SciencesUCSD Moores Cancer CenterLa JollaCAUSA
| | - Casey Bojechko
- Department of Radiation Medicine and Applied SciencesUCSD Moores Cancer CenterLa JollaCAUSA
| | - Kevin L. Moore
- Department of Radiation Medicine and Applied SciencesUCSD Moores Cancer CenterLa JollaCAUSA
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Arjunan M, Sekaran SC, Sarkar B, Manavalan SK. Electronic Portal Imaging Device-Based Three-Dimensional Volumetric Dosimetry for Intensity-modulated Radiotherapy Pretreatment Quality Assurance. J Med Phys 2019; 44:176-184. [PMID: 31576065 PMCID: PMC6764179 DOI: 10.4103/jmp.jmp_42_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: This study aimed at evaluating the efficacy of treatment planning system (TPS)-based heterogeneity correction for two- and three-dimensional (2D and 3D) electronic portal imaging device (EPID)-based pretreatment dose verification. An experiment was conducted on the EPID back-projection technique and intensity-modulated radiotherapy (IMRT). Materials and Methods: Treatment plans were delivered in EPID without a patient to obtain the fluence pattern (FEPID). A heterogeneity correction plane (Fhet) for an open beam of 30 cm × 30 cm was extracted from the TPS. The heterogeneity-corrected measured fluence is developed by matrix element multiplication (FResultant = FEPID × Fhet). Further planes were summed to develop a 3D dose distribution and exported to the TPS. Dose verifications for 2D and 3D were carried out with the corresponding TPS values using 2D gamma analysis (ɣ) and dose volume histogram (DVH) comparison, respectively. Totally, 33 patients (17 head–neck and 16 thorax cases) were evaluated in this study. Results: The head–neck and thorax plans show a 3-mm-distance to agreement (DTA) 3% DD gamma passing of 96.3% ± 2.0% and 95.4% ± 1.8% points, respectively, between FTPS and FResultant. The comparison of the uncorrected measured fluence (FEPID) with FTPS reveals a gamma passing of 82.2% ± 7.3% and 80.4% ± 8.6% for head–neck and thorax cases, respectively. A total of 87 out of the 102 head–neck and thorax beams exhibit a planner gamma passing of 97.6% ± 2.1%. In the 3D-DVH comparison of thorax and head–neck cases, D5% for planning target volume were −0.5% ± 2.2% and −2.1% ± 3.5%, respectively; D95% varies as 1.0% ± 2.7% and 1.4% ± 1.1% between TPS calculated and heterogeneity-corrected-EPID-based dose reconstruction. Conclusion: The novel TPS-based heterogeneity correction can improve the 2D and 3D EPID-based back projection technique. Structures with large heterogeneities can also be handled using the proposed technique.
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Affiliation(s)
- Manikandan Arjunan
- Department of Medical Physics, Bharathiar University, Coimbatore, Tamil Nadu, India
| | | | - Biplab Sarkar
- Department of Radiation Oncology, Manipal Hospital, Delhi, India
| | - Saran Kumar Manavalan
- Department of Radiation Oncology, Nagarjuna Hospital, Vijayawada, Andhra Pradesh, India
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Biltekin F, Yedekci Y, Ozyigit G. Feasibility of novel in vivo EPID dosimetry system for linear accelerator quality control tests. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:995-1009. [PMID: 31515686 DOI: 10.1007/s13246-019-00798-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
The main aim was to validate the capability of a novel EPID-based in vivo dosimetry system for machine-specific quality control (QC) tests. In current study, two sets of measurements were performed in Elekta Versa HD linear accelerator using novel iViewDose™ in vivo dosimetry software. In the first part, measurements were carried out to evaluate the feasibility of novel in vivo system for daily dosimetric QC tests including output constancy, percentage depth dose (PDD) and beam profile measurements. In addition to daily QC tests, measured output factor as a function of field size, leaf transmission and tongue and groove effect were compared with calculated TPS data. In the second part of the measurements, detection capability of iViewDose software for basic mechanical QC tests were investigated for different setup conditions. In dosimetric QC tests, measured output factor with changing field size, PDD, beam profile and leaf transmission factors were found to be compatible with calculated TPS data. Additionally, the EPID-based system was capable to detect given dose calibration errors of 1% with ± 0.02% deviation. In mechanical QC tests, it was found that iViewDose software was sensitive for catching errors in collimator rotation (≥ 1°), changes in phantom thickness (≥ 1 cm) and major differences in irradiated field size down to 1 mm. In conclusion, iViewDose was proved to be as useful EPID-based software for daily monitoring of linear accelerator beam parameters and it provides extra safety net to prevent machine based radiation incidents.
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Affiliation(s)
- Fatih Biltekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Yagiz Yedekci
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Oderinde OM, du Plessis F. Sensitivity of the IQM and MatriXX detectors in megavolt photon beams. Rep Pract Oncol Radiother 2019; 24:462-471. [DOI: 10.1016/j.rpor.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/12/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022] Open
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Torres-Xirau I, Olaciregui-Ruiz I, van der Heide UA, Mans A. Two-dimensional EPID dosimetry for an MR-linac: Proof of concept. Med Phys 2019; 46:4193-4203. [PMID: 31199521 DOI: 10.1002/mp.13664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE At our institute, in vivo patient dose distributions are reconstructed for all treatments delivered using conventional linacs from electronic portal imaging device (EPID) transit images acquired during treatment using a simple back-projection model. Currently, the clinical implementation of MRI-guided radiotherapy systems, which aims for online and real-time adaptation of the treatment plan, is progressing. In our department, the MR-linac (Unity, Elekta AB, Stockholm, Sweden) is now in clinical use. The aim of this work is to demonstrate the feasibility of two-dimensional (2D) EPID dosimetric verification for the magnetic resonance (MR)-linac by comparing back-projected EPID doses to ionization chamber (IC) array dose distributions. MATERIALS AND METHODS Our conventional back-projection algorithm was adapted for the MR-linac. The most important changes involve modeling of the attenuation by and scatter from the cryostat. The commissioning process involved the acquisition of square field EPID measurements using various phantom setups (varying SSD, phantom thickness, and field size). Commissioning models were created for gantry 0°, 90°, and 180° and verified by comparing EPID-reconstructed 2D dose distributions to measurements made with the OCTAVIUS 1500 IC array (PTW, Freiburg, Germany) for two prostate and one rectum IMRT plans (25 beams total). The average of the γ parameters (y-mean and y-pass rate) and the dose difference at a reference point were reported. Due to their construction, the attenuation of couch, bridge, and cryostat shows a much stronger dependence on gantry angle in the MR-linac compared to conventional linacs. We present a method to correct for these effects. This method is validated by dose reconstruction of the 25 intensity-modulated radiation therapy beams recorded at a certain gantry angle using the model of another gantry angle, combined with the correction method. RESULTS For dose verification performed at a gantry angle identical to the commissioned model, the average y-mean and y-pass rate values (3% global dose, 2 mm, 10% isodose) were 0.37 ± 0.07 and 98.1, 95% CI [98.1 ± 2.4], respectively. The average dose difference at the reference point was -0.5% ± 1.8%. Verification at gantry angles different from the commissioned model (i.e., using the gantry angle dependent correction) reported 0.39 ± 0.08 and 97.6, 95% CI [96.9, 98.3] average y-mean and y-pass rate values. The average dose difference at the reference point was -0.1% ± 1.8%. CONCLUSION The EPID dosimetry back-projection model was successfully adapted for the MR-linac at gantry 0°, 90°, and 180°, accounting for the presence of the MRI housing between phantom (or patient) and the EPID. A method to account for the gantry angle dependence was also tested reporting similar results.
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Affiliation(s)
- Iban Torres-Xirau
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Igor Olaciregui-Ruiz
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Kohler G, Hanauer N. Technical Note: Alternating clinical usage of the integral quality monitor transmission detector. Med Phys 2019; 46:4356-4360. [PMID: 31233615 DOI: 10.1002/mp.13680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of the study was the implementation of a method to use the integral quality monitor (IQM) transmission detector for occasional, alternating usage during patient treatment with intensity modulated radiotherapy. Due to attenuation, the transmission detector must be taken into account during the planning process. The proposed workflow is based on determining a dynamic transmission factor (dTF) required to scale the total number of MU of the original radiotherapy (RT) plan. Thus a very similar radiation therapy plan is obtained that can be used with the IQM detector. METHODS Ten clinically applied volumetric modulated arc therapy plans were delivered at two beam qualities. A dTF is calculated from each RT plan for which a collapsed RT plan was created for verification using a two-dimensional array with and without the IQM detector. The total number of MU of the original RT plan was scaled by the inverse of the dTF to obtain the modified RT plan for clinical use with the IQM detector. Validation was performed with an electronic three-dimensional phantom and via gamma analysis using strict criteria of 1%/1 mm. RESULTS Except for one outlier, the gamma pass rate between the original RT plan without IQM and the modified RT plan with IQM was always above 99.5%. The variations of the dTF were smaller than 1% for all tested RT plans. CONCLUSIONS The results show that the proposed workflow can be used clinically. Thus the IQM transmission detector can also be used occasionally for online verification of RT plans.
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Affiliation(s)
- Götz Kohler
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, 4031, Basel, Switzerland
| | - Nicolas Hanauer
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, 4031, Basel, Switzerland
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Olaciregui‐Ruiz I, Vivas‐Maiques B, Kaas J, Perik T, Wittkamper F, Mijnheer B, Mans A. Transit and non-transit 3D EPID dosimetry versus detector arrays for patient specific QA. J Appl Clin Med Phys 2019; 20:79-90. [PMID: 31083776 PMCID: PMC6560233 DOI: 10.1002/acm2.12610] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Despite their availability and simplicity of use, Electronic Portal Imaging Devices (EPIDs) have not yet replaced detector arrays for patient specific QA in 3D. The purpose of this study is to perform a large scale dosimetric evaluation of transit and non-transit EPID dosimetry against absolute dose measurements in 3D. METHODS After evaluating basic dosimetric characteristics of the EPID and two detector arrays (Octavius 1500 and Octavius 1000SRS ), 3D dose distributions for 68 VMAT arcs, and 10 IMRT plans were reconstructed within the same phantom geometry using transit EPID dosimetry, non-transit EPID dosimetry, and the Octavius 4D system. The reconstructed 3D dose distributions were directly compared by γ-analysis (2L2 = 2% local/2 mm and 3G2 = 3% global/2 mm, 50% isodose) and by the percentage difference in median dose to the high dose volume (%∆HDVD 50 ). RESULTS Regarding dose rate dependency, dose linearity, and field size dependence, the agreement between EPID dosimetry and the two detector arrays was found to be within 1.0%. In the 2L2 γ-comparison with Octavius 4D dose distributions, the average γ-pass rate value was 92.2 ± 5.2%(1SD) and 94.1 ± 4.3%(1SD) for transit and non-transit EPID dosimetry, respectively. 3G2 γ-pass rate values were higher than 95% in 150/156 cases. %∆HDVD 50 values were within 2% in 134/156 cases and within 3% in 155/156 cases. With regard to the clinical classification of alerts, 97.5% of the treatments were equally classified by EPID dosimetry and Octavius 4D. CONCLUSION Transit and non-transit EPID dosimetry are equivalent in dosimetric terms to conventional detector arrays for patient specific QA. Non-transit 3D EPID dosimetry can be readily used for pre-treatment patient specific QA of IMRT and VMAT, eliminating the need of phantom positioning.
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Affiliation(s)
- Igor Olaciregui‐Ruiz
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Begoña Vivas‐Maiques
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Jochem Kaas
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Thijs Perik
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Frits Wittkamper
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Ben Mijnheer
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Anton Mans
- Department of Radiation OncologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
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Oderinde OM, Du Plessis F. Sensitivity evaluation of two commercial quality assurance systems to organ-dose variations of patient-specific VMAT plans. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1080/16878507.2019.1618080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Oluwaseyi M. Oderinde
- Department of Medical Physics, University of the Free State, Bloemfontein Republic of South Africa
| | - Freek Du Plessis
- Department of Medical Physics, University of the Free State, Bloemfontein Republic of South Africa
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32
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Nyflot MJ, Thammasorn P, Wootton LS, Ford EC, Chaovalitwongse WA. Deep learning for patient-specific quality assurance: Identifying errors in radiotherapy delivery by radiomic analysis of gamma images with convolutional neural networks. Med Phys 2018; 46:456-464. [PMID: 30548601 DOI: 10.1002/mp.13338] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Patient-specific quality assurance (QA) for intensity-modulated radiation therapy (IMRT) is a ubiquitous clinical procedure, but conventional methods have often been criticized as being insensitive to errors or less effective than other common physics checks. Recently, there has been interest in the application of radiomics, quantitative extraction of image features, to radiotherapy QA. In this work, we investigate a deep learning approach to classify the presence or absence of introduced radiotherapy treatment delivery errors from patient-specific QA. METHODS Planar dose maps from 186 IMRT beams from 23 IMRT plans were evaluated. Each plan was transferred to a cylindrical phantom CT geometry. Three sets of planar doses were exported from each plan corresponding to (a) the error-free case, (b) a random multileaf collimator (MLC) error case, and (c) a systematic MLC error case. Each plan was delivered to the electronic portal imaging device (EPID), and planned and measured doses were used to calculate gamma images in an EPID dosimetry software package (for a total of 558 gamma images). Two radiomic approaches were used. In the first, a convolutional neural network with triplet learning was used to extract image features from the gamma images. In the second, a handcrafted approach using texture features was used. The resulting metrics from both approaches were input into four machine learning classifiers (support vector machines, multilayer perceptrons, decision trees, and k-nearest-neighbors) in order to determine whether images contained the introduced errors. Two experiments were considered: the two-class experiment classified images as error-free or containing any MLC error, and the three-class experiment classified images as error-free, containing a random MLC error, or containing a systematic MLC error. Additionally, threshold-based passing criteria were calculated for comparison. RESULTS In total, 303 gamma images were used for model training and 255 images were used for model testing. The highest classification accuracy was achieved with the deep learning approach, with a maximum accuracy of 77.3% in the two-class experiment and 64.3% in the three-class experiment. The performance of the handcrafted approach with texture features was lower, with a maximum accuracy of 66.3% in the two-class experiment and 53.7% in the three-class experiment. Variability between the results of the four machine learning classifiers was lower for the deep learning approach vs the texture feature approach. Both radiomic approaches were superior to threshold-based passing criteria. CONCLUSIONS Deep learning with convolutional neural networks can be used to classify the presence or absence of introduced radiotherapy treatment delivery errors from patient-specific gamma images. The performance of the deep learning network was superior to a handcrafted approach with texture features, and both radiomic approaches were better than threshold-based passing criteria. The results suggest that radiomic QA is a promising direction for clinical radiotherapy.
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Affiliation(s)
- Matthew J Nyflot
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - Phawis Thammasorn
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Landon S Wootton
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Eric C Ford
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - W Art Chaovalitwongse
- Department of Radiology, University of Washington, Seattle, WA, USA.,Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
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Olaciregui-Ruiz I, Rozendaal R, Mijnheer B, Mans A. Site-specific alert criteria to detect patient-related errors with 3D EPID transit dosimetry. Med Phys 2018; 46:45-55. [DOI: 10.1002/mp.13265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 10/19/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Igor Olaciregui-Ruiz
- Department of Radiation Oncology; Netherlands Cancer Institute; Plesmanlaan 121 1066 CX Amsterdam The Netherlands
| | - Roel Rozendaal
- Department of Radiation Oncology; Netherlands Cancer Institute; Plesmanlaan 121 1066 CX Amsterdam The Netherlands
| | - Ben Mijnheer
- Department of Radiation Oncology; Netherlands Cancer Institute; Plesmanlaan 121 1066 CX Amsterdam The Netherlands
| | - Anton Mans
- Department of Radiation Oncology; Netherlands Cancer Institute; Plesmanlaan 121 1066 CX Amsterdam The Netherlands
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Anvari A, Poirier Y, Sawant A. Kilovoltage transit and exit dosimetry for a small animal image-guided radiotherapy system using built-in EPID. Med Phys 2018; 45:4642-4651. [DOI: 10.1002/mp.13134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akbar Anvari
- Department of Radiation Oncology; University of Maryland School of Medicine; Baltimore MD 21201 USA
| | - Yannick Poirier
- Department of Radiation Oncology; University of Maryland School of Medicine; Baltimore MD 21201 USA
| | - Amit Sawant
- Department of Radiation Oncology; University of Maryland School of Medicine; Baltimore MD 21201 USA
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Najem MA, Tedder M, King D, Bernstein D, Trouncer R, Meehan C, Bidmead AM. In-vivo EPID dosimetry for IMRT and VMAT based on through-air predicted portal dose algorithm. Phys Med 2018; 52:143-153. [PMID: 30139603 DOI: 10.1016/j.ejmp.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/02/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022] Open
Abstract
We have adapted the methodology of Berry et al. (2012) for Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) treatments at a fixed source to imager distance (SID) based on the manufacturer's through-air portal dose image prediction algorithm. In order to fix the SID a correction factor was introduced to account for the change in air gap between patient and imager. Commissioning data, collected with multiple field sizes, solid water thicknesses and air gaps, were acquired at 150 cm SID on the Varian aS1200 EPID. The method was verified using six IMRT and seven VMAT plans on up to three different phantoms. The method's sensitivity and accuracy were investigated by introducing errors. A global 3%/3 mm gamma was used to assess the differences between the predicted and measured portal dose images. The effect of a varying air gap on EPID signal was found to be significant - varying by up to 30% with field size, phantom thickness, and air gap. All IMRT plans passed the 3%/3 mm gamma criteria by more than 95% on the three phantoms. 23 of 24 arcs from the VMAT plans passed the 3%/3 mm gamma criteria by more than 95%. This method was found to be sensitive to a range of potential errors. The presented approach provides fast and accurate in-vivo EPID dosimetry for IMRT and VMAT treatments and can potentially replace many pre-treatment verifications.
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Affiliation(s)
- M A Najem
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK.
| | - M Tedder
- Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - D King
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - D Bernstein
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - R Trouncer
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - C Meehan
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - A M Bidmead
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
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Piron O, Varfalvy N, Archambault L. Establishing action threshold for change in patient anatomy using EPID gamma analysis and PTV coverage for head and neck radiotherapy treatment. Med Phys 2018; 45:3534-3545. [PMID: 29896916 DOI: 10.1002/mp.13045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 02/28/2024] Open
Abstract
PURPOSE To present a new adaptive radiotherapy (ART) method based on relative gamma analysis and patient classification for the identification of anatomical changes that induce a sufficient dosimetric impact to affect the treatment delivery and require complete replanning. METHODS This retrospective study includes 55 patients treated for a head and neck cancer with IMRT, VMAT, or 3D conformal RT. Electronic Portal Imaging Device images for all treatment fields were acquired daily at every fraction. CBCTs were collected at least once a week. Gamma analysis was performed using the first fraction of the treatment as a reference once validated that it was delivered without error. Gamma analysis parameters (<γ>, standard deviation and the Top 1% γ) were used to define categories using statistic from a k-means clustering analysis. From these categories an action threshold was defined and correlated with dosimetric changes. For 23 of 55 patients, the V100% for PTV was computed for both, the planning CT and original contours deformed onto CBCT acquired at the last fraction. These values were then compared with 2D image relative γ-analysis of EPID images. Sensitivity and specificity of the method for the detection of dosimetric changes were computed. RESULTS Three categories indicating an increasing level of change with the planned treatment were identified. A threshold was established for which patients were at risk of deviation at <γ> = 0.42. From 23 recomputing plans, it has been confirmed that patients with a strong dosimetric impact were above this threshold, with a specificity of 0.80 and a sensitivity of 0.84. CONCLUSIONS The specificity and the sensitivity value confirmed the performance of the method to detect anatomical changes. The γ-analysis threshold correlated well with morphological changes that have a relevant dosimetric impact. Analysis of daily EPID images provides a method to identify patients at risk of deviation from their planned treatment and can support an early replanning decision.
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Affiliation(s)
- Ophélie Piron
- Department de Radio-oncologie, CHU de Quebec, 11 Côte du Palais, Quebec, QC, Canada
- Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
| | - Nicolas Varfalvy
- Department de Radio-oncologie, CHU de Quebec, 11 Côte du Palais, Quebec, QC, Canada
- Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
| | - Louis Archambault
- Department de Radio-oncologie, CHU de Quebec, 11 Côte du Palais, Quebec, QC, Canada
- Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
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Wootton LS, Nyflot MJ, Chaovalitwongse WA, Ford E. Error Detection in Intensity-Modulated Radiation Therapy Quality Assurance Using Radiomic Analysis of Gamma Distributions. Int J Radiat Oncol Biol Phys 2018; 102:219-228. [PMID: 30102197 DOI: 10.1016/j.ijrobp.2018.05.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/10/2018] [Accepted: 05/13/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To improve the detection of errors in intensity-modulated radiation therapy (IMRT) with a novel method that uses quantitative image features from radiomics to analyze gamma distributions generated during patient specific quality assurance (QA). METHODS AND MATERIALS One hundred eighty-six IMRT beams from 23 patient treatments were delivered to a phantom and measured with electronic portal imaging device dosimetry. The treatments spanned a range of anatomic sites; half were head and neck treatments, and the other half were drawn from treatments for lung and rectal cancers, sarcoma, and glioblastoma. Planar gamma distributions, or gamma images, were calculated for each beam using the measured dose and calculated doses from the 3-dimensional treatment planning system under various scenarios: a plan without errors and plans with either simulated random or systematic multileaf collimator mispositioning errors. The gamma images were randomly divided into 2 sets: a training set for model development and testing set for validation. Radiomic features were calculated for each gamma image. Error detection models were developed by training logistic regression models on these radiomic features. The models were applied to the testing set to quantify their predictive utility, determined by calculating the area under the curve (AUC) of the receiver operator characteristic curve, and were compared with traditional threshold-based gamma analysis. RESULTS The AUC of the random multileaf collimator mispositioning model on the testing set was 0.761 compared with 0.512 for threshold-based gamma analysis. The AUC for the systematic mispositioning model was 0.717 versus 0.660 for threshold-based gamma analysis. Furthermore, the models could discriminate between the 2 types of errors simulated here, exhibiting AUCs of approximately 0.5 (equivalent to random guessing) when applied to the error they were not designed to detect. CONCLUSIONS The feasibility of error detection in patient-specific IMRT QA using radiomic analysis of QA images has been demonstrated. This methodology represents a substantial step forward for IMRT QA with improved sensitivity and specificity over current QA methods and the potential to distinguish between different types of errors.
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Affiliation(s)
- Landon S Wootton
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
| | - Matthew J Nyflot
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - W Art Chaovalitwongse
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Industrial Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Eric Ford
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
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Miften M, Olch A, Mihailidis D, Moran J, Pawlicki T, Molineu A, Li H, Wijesooriya K, Shi J, Xia P, Papanikolaou N, Low DA. Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218. Med Phys 2018; 45:e53-e83. [DOI: 10.1002/mp.12810] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/10/2017] [Accepted: 01/11/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Moyed Miften
- Department of Radiation Oncology; University of Colorado School of Medicine; Aurora CO USA
| | - Arthur Olch
- Department of Radiation Oncology; University of Southern California and Radiation Oncology Program; Childrens Hospital of Los Angeles; Los Angeles CA USA
| | - Dimitris Mihailidis
- Department of Radiation Oncology; University of Pennsylvania; Perelman Center for Advanced Medicine; Philadelphia PA USA
| | - Jean Moran
- Department of Radiation Oncology; University of Michigan; Ann Arbor MI USA
| | - Todd Pawlicki
- Department of Radiation Oncology; University of California San Diego; La Jolla CA USA
| | - Andrea Molineu
- Radiological Physics Center; UT MD Anderson Cancer Center; Houston TX USA
| | - Harold Li
- Department of Radiation Oncology; Washington University; St. Louis MO USA
| | - Krishni Wijesooriya
- Department of Radiation Oncology; University of Virginia; Charlottesville VA USA
| | - Jie Shi
- Sun Nuclear Corporation; Melbourne FL USA
| | - Ping Xia
- Department of Radiation Oncology; The Cleveland Clinic; Cleveland OH USA
| | - Nikos Papanikolaou
- Department of Medical Physics; University of Texas Health Sciences Center; San Antonio TX USA
| | - Daniel A. Low
- Department of Radiation Oncology; University of California Los Angeles; Los Angeles CA USA
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Olaciregui-Ruiz I, Rozendaal R, Mijnheer B, Mans A. A 2D couch attenuation model for
in vivo
EPID transit dosimetry. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aaa370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bedford JL, Hanson IM, Hansen VN. Comparison of forward- and back-projection in vivo EPID dosimetry for VMAT treatment of the prostate. Phys Med Biol 2018; 63:025008. [PMID: 29165319 DOI: 10.1088/1361-6560/aa9c60] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the forward-projection method of portal dosimetry for volumetric modulated arc therapy (VMAT), the integrated signal at the electronic portal imaging device (EPID) is predicted at the time of treatment planning, against which the measured integrated image is compared. In the back-projection method, the measured signal at each gantry angle is back-projected through the patient CT scan to give a measure of total dose to the patient. This study aims to investigate the practical agreement between the two types of EPID dosimetry for prostate radiotherapy. The AutoBeam treatment planning system produced VMAT plans together with corresponding predicted portal images, and a total of 46 sets of gantry-resolved portal images were acquired in 13 patients using an iViewGT portal imager. For the forward-projection method, each acquisition of gantry-resolved images was combined into a single integrated image and compared with the predicted image. For the back-projection method, iViewDose was used to calculate the dose distribution in the patient for comparison with the planned dose. A gamma index for 3% and 3 mm was used for both methods. The results were investigated by delivering the same plans to a phantom and repeating some of the deliveries with deliberately introduced errors. The strongest agreement between forward- and back-projection methods is seen in the isocentric intensity/dose difference, with moderate agreement in the mean gamma. The strongest correlation is observed within a given patient, with less correlation between patients, the latter representing the accuracy of prediction of the two methods. The error study shows that each of the two methods has its own distinct sensitivity to errors, but that overall the response is similar. The forward- and back-projection EPID dosimetry methods show moderate agreement in this series of prostate VMAT patients, indicating that both methods can contribute to the verification of dose delivered to the patient.
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Affiliation(s)
- James L Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SM2 5PT, United Kingdom
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Usefulness of a new online patient-specific quality assurance system for respiratory-gated radiotherapy. Phys Med 2017; 43:63-72. [PMID: 29195565 DOI: 10.1016/j.ejmp.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/27/2017] [Accepted: 10/14/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The accuracy of gated irradiation may decrease when treatment is performed with short "beam-on" times. Also, the dose is subject to variation between treatment sessions if the respiratory rate is irregular. We therefore evaluated the impact of the differences between gated and non-gated treatment on doses using a new online quality assurance (QA) system for respiratory-gated radiotherapy. METHODS We generated dose estimation models to associate dose and pulse information using a 0.6 cc Farmer chamber and our QA system. During gated irradiation with each of seven regular and irregular respiratory patterns, with the Farmer chamber readings as references, we evaluated our QA system's accuracy. We then used the QA system to assess the impact of respiratory patterns on dose distribution for three lung and three liver radiotherapy plans. Gated and non-gated plans were generated and compared. RESULTS There was agreement within 1.7% between the ionization chamber and our system for several regular and irregular motion patterns. For dose distributions with measured errors, there were larger differences between gated and non-gated treatment for high-dose regions within the planned treatment volume (PTV). Compared with a non-gated plan, PTV D95% for a gated plan decreased by -1.5% to -2.6%. Doses to organs at risk were similar with both plans. CONCLUSIONS Our simple system estimated the radiation dose to the patient using only pulse information from the linac, even during irregular respiration. The quality of gated irradiation for each patient can be verified fraction by fraction.
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McCurdy BM, McCowan PM. In vivo dosimetry for lung radiotherapy including SBRT. Phys Med 2017; 44:123-130. [DOI: 10.1016/j.ejmp.2017.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022] Open
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Comparison of gamma- and DVH-based in vivo dosimetric plan evaluation for pelvic VMAT treatments. Radiother Oncol 2017; 125:405-410. [PMID: 29017719 DOI: 10.1016/j.radonc.2017.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/25/2017] [Accepted: 09/15/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To compare DVH-based quality assurance to a multi-parametric γ-based methodology for in vivo EPID dosimetry for VMAT to the pelvis. MATERIALS AND METHODS For 47 rectum, 37 prostate, and 44 bladder VMAT treatments we reconstructed the 3D dose distributions of 387 fractions from in vivo EPID dosimetry. The difference between planned and measured dose was evaluated using γ analysis (3%/3mm) in the 50% isodose volume (IDV) and DVH differences (ΔD2, ΔD50 and ΔD98) of targets and organs at risk. The γ-indicators mean γ, γ pass rate and γ1% were compared to DVH-differences and their correlations were studied. DVH-based alerts on PTV and IDV were compared to γ-based alerts. RESULTS Average PTV D50 and D98 dose differences were 0.0±2.2% (1SD) and -1.4±2.9% (1SD). Alert criteria of |ΔD50|<3.5-4.5% corresponded to an alert rate of about 10%. Strong correlations between mean γ and γ pass rate and difference in PTV ΔD50 were observed for all sites. DVH- and γ-based alerts agreed on >80% of the fractions for the majority of compared alert thresholds and methods. This agreement is >90% for the larger deviations. CONCLUSIONS Strong correlations between some γ- and DVH indicators were found. Our comparison of multi-parametric alert strategies showed clinical equivalence for γ- and DVH-based methods.
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Bruza P, Andreozzi JM, Gladstone DJ, Jarvis LA, Rottmann J, Pogue BW. Online Combination of EPID & Cherenkov Imaging for 3-D Dosimetry in a Liquid Phantom. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:2099-2103. [PMID: 28644800 PMCID: PMC5659346 DOI: 10.1109/tmi.2017.2717800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Online acquisition of Cherenkov and portal imaging data was combined with a reconstruction scheme called EC3-D, providing a full 3-D dosimetry of megavoltage X-ray beams in a water tank. The methodology was demonstrated and quantified in a single static beam. Furthermore, the dynamics and visualization of the 3-D dose reconstruction were demonstrated with a volumetric modulated arc therapy plan for TG-119 C-Shape geometry. The developed algorithm combines depth dose information, provided by Cherenkov images, with the lateral dose distribution, provided by the electronic portal imaging device. The strength of our approach lies in the acquisition of both imaging data streams with sub-millimeter theoretical resolution at 5-Hz frame-rate, which can be concurrently processed by the fast Fourier transform-based analysis, thus providing means for an efficient real-time 3-D dosimetry.
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Torres-Xirau I, Olaciregui-Ruiz I, Rozendaal RA, González P, Mijnheer BJ, Sonke JJ, van der Heide UA, Mans A. A back-projection algorithm in the presence of an extra attenuating medium: towards EPID dosimetry for the MR-Linac. ACTA ACUST UNITED AC 2017; 62:6322-6340. [DOI: 10.1088/1361-6560/aa779e] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huang M, Huang D, Zhang J, Chen Y, Xu B, Chen L. Preliminary study of clinical application on IMRT three-dimensional dose verification-based EPID system. J Appl Clin Med Phys 2017; 18:97-105. [PMID: 28594085 PMCID: PMC5875845 DOI: 10.1002/acm2.12098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/16/2017] [Accepted: 04/02/2017] [Indexed: 12/19/2022] Open
Abstract
The three-dimensional dose (3D) distribution of intensity-modulated radiation therapy (IMRT) was verified based on electronic portal imaging devices (EPIDs), and the results were analyzed. Thirty IMRT plans of different lesions were selected for 3D EPID-based dose verification. The gamma passing rates of the 3D dose verification-based EPID system (Edose, Version 3.01, Raydose, Guangdong, China) and Delta4 measurements were then compared with treatment planning system (TPS) calculations using global gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm. Furthermore, the dose-volume histograms (DVHs) for planning target volumes (PTVs) as well as organs at risk (OARs) were analyzed using Edose. For dose verification of the 30 treatment plans, the average gamma passing rates of Edose reconstructions under the gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm were (98.58 ± 0.93)%, (95.67 ± 1.97)%, and (83.13 ± 4.53)%, respectively, whereas the Delta4 measurement results were (99.14% ± 1.16)%, (95.81% ± 2.88)%, and (84.74% ± 7.00)%, respectively. The dose differences between Edose reconstructions and TPS calculations were within 3% for D95% , D98% , and Dmean in each PTV, with the exception that the D98% of the PTV-clinical target volume (CTV) in esophageal carcinoma cases was (3.21 ± 2.33)%. However, the larger dose deviations in OARs (such as lens, parotid gland, optic nerve, and spinal cord) can be determined based on DVHs. The difference was particularly obvious for OARs with small volumes; for example, the maximum dose deviation for the lens reached (-6.12 ± 5.28)%. A comparison of the results obtained with Edose and Delta4 indicated that the Edose system could be applied for 3D pretreatment dose verification of IMRT. This system could also be utilized to evaluate the gamma passing rate of each treatment plan. Furthermore, the detailed dose distributions of PTVs and OARs could be indicated based on DVHs, providing additional reliable data for quality assurance in a clinic setting.
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Affiliation(s)
- Miaoyun Huang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - David Huang
- Medical Physics Graduate ProgramDuke Kunshan UniversityKunshanChina
| | - Jianping Zhang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Yuangui Chen
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Benhua Xu
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Lixin Chen
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
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Abstract
PURPOSE To improve patient safety and treatment quality, verification of dose delivery in radiotherapy is desirable. We present a simple, easy-to-implement, open-source method for in vivo planar dosimetry of conformal radiotherapy by electronic portal imaging device (EPID). METHODS Correlation ratios, which relate dose in the mid-depth of slab phantoms to transit EPID signal, were determined for multiple phantom thicknesses and field sizes. Off-axis dose is corrected for by means of model-based convolution. We tested efficacy of dose reconstruction through measurements with off-reference values of attenuator thickness, field size, and monitor units. We quantified the dose calculation error in the presence of thickness changes to simulate anatomical or setup variations. An example of dose calculation on patient data is provided. RESULTS With varying phantom thickness, field size, and monitor units, dose reconstruction was almost always within 3% of planned dose. In the presence of thickness changes from planning CT, the dose discrepancy is exaggerated by up to approximately 1.5% for 1 cm changes upstream of the isocenter plane and 4% for 1 cm changes downstream. CONCLUSION Our novel electronic portal imaging device in vivo dosimetry allows clinically accurate 2-dimensional reconstruction of dose inside a phantom/patient at isocenter depth. Due to its simplicity, commissioning can be performed in a few hours per energy and may be modified to the user's needs. It may provide useful dose delivery information to detect harmful errors, guide adaptive radiotherapy, and assure quality of treatment.
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Affiliation(s)
- Stefano Peca
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Derek Wilson Brown
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Wendy Lani Smith
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Radiation Oncology, University of Calgary, Calgary, AB, Canada
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Abstract
Although many error pathways are common to both stereotactic body radiation therapy (SBRT) and conventional radiation therapy, SBRT presents a special set of challenges including short treatment courses and high-doses, an enhanced reliance on imaging, technical challenges associated with commissioning, special resource requirements for staff and training, and workflow differences. Emerging data also suggest that errors occur at a higher rate in SBRT treatments. Furthermore, when errors do occur they often have a greater effect on SBRT treatments. Given these challenges, it is important to understand and employ systematic approaches to ensure the quality and safety of SBRT treatment. Here, we outline the pathways by which error can occur in SBRT, illustrated through a series of case studies, and highlight 9 specific well-established tools to either reduce error or minimize its effect to the patient or both.
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Affiliation(s)
- Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, WA.
| | - Sonja Dieterich
- Department of Radiation Oncology, University of California, Davis, CA
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Virtual patient 3D dose reconstruction using in air EPID measurements and a back-projection algorithm for IMRT and VMAT treatments. Phys Med 2017; 37:49-57. [DOI: 10.1016/j.ejmp.2017.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/24/2017] [Accepted: 04/14/2017] [Indexed: 11/24/2022] Open
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Spreeuw H, Rozendaal R, Olaciregui-Ruiz I, González P, Mans A, Mijnheer B, van Herk M. Online 3D EPID-based dose verification: Proof of concept. Med Phys 2017; 43:3969. [PMID: 27370115 DOI: 10.1118/1.4952729] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Delivery errors during radiotherapy may lead to medical harm and reduced life expectancy for patients. Such serious incidents can be avoided by performing dose verification online, i.e., while the patient is being irradiated, creating the possibility of halting the linac in case of a large overdosage or underdosage. The offline EPID-based 3D in vivo dosimetry system clinically employed at our institute is in principle suited for online treatment verification, provided the system is able to complete 3D dose reconstruction and verification within 420 ms, the present acquisition time of a single EPID frame. It is the aim of this study to show that our EPID-based dosimetry system can be made fast enough to achieve online 3D in vivo dose verification. METHODS The current dose verification system was sped up in two ways. First, a new software package was developed to perform all computations that are not dependent on portal image acquisition separately, thus removing the need for doing these calculations in real time. Second, the 3D dose reconstruction algorithm was sped up via a new, multithreaded implementation. Dose verification was implemented by comparing planned with reconstructed 3D dose distributions delivered to two regions in a patient: the target volume and the nontarget volume receiving at least 10 cGy. In both volumes, the mean dose is compared, while in the nontarget volume, the near-maximum dose (D2) is compared as well. The real-time dosimetry system was tested by irradiating an anthropomorphic phantom with three VMAT plans: a 6 MV head-and-neck treatment plan, a 10 MV rectum treatment plan, and a 10 MV prostate treatment plan. In all plans, two types of serious delivery errors were introduced. The functionality of automatically halting the linac was also implemented and tested. RESULTS The precomputation time per treatment was ∼180 s/treatment arc, depending on gantry angle resolution. The complete processing of a single portal frame, including dose verification, took 266 ± 11 ms on a dual octocore Intel Xeon E5-2630 CPU running at 2.40 GHz. The introduced delivery errors were detected after 5-10 s irradiation time. CONCLUSIONS A prototype online 3D dose verification tool using portal imaging has been developed and successfully tested for two different kinds of gross delivery errors. Thus, online 3D dose verification has been technologically achieved.
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Affiliation(s)
- Hanno Spreeuw
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | - Roel Rozendaal
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | - Igor Olaciregui-Ruiz
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | - Patrick González
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | - Ben Mijnheer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | - Marcel van Herk
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
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