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Kakade NR, Kumar R, Sharma SD, Sapra BK. Dosimetry audit in advanced radiotherapy using in-house developed anthropomorphic head & neck phantom. Biomed Phys Eng Express 2024; 10:025022. [PMID: 38269653 DOI: 10.1088/2057-1976/ad222a] [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: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 01/26/2024]
Abstract
The treatment of head and neck (H&N) cancer presents formidable challenges due to the involvement of normal tissue and organs at risk (OARs) in the close vicinity. Ensuring the precise administration of the prescribed dose demands prior dose verification. Considering contour irregularity and heterogeneity in the H&N region, an anthropomorphic and heterogeneous H&N phantom was developed and fabricated locally for conducting the dosimetry audit in advanced radiotherapy treatments. This specialized phantom emulates human anatomy and incorporates a removable cylindrical insert housing a C-shaped planning target volume (PTV) alongside key OARs including the spinal cord, oral cavity, and bilateral parotid glands. Acrylonitrile Butadiene Styrene (ABS) was chosen for PTV and parotid fabrication, while Delrin was adopted for spinal cord fabrication. A pivotal feature of this phantom is the incorporation of thermoluminescent dosimeters (TLDs) within the PTV and OARs, enabling the measurement of delivered dose. To execute the dosimetry audit, the phantom, accompanied by dosimeters and comprehensive guidelines, was disseminated to multiple radiotherapy centers. Subsequently, hospital physicists acquired computed tomography (CT) scans to generate treatment plans for phantom irradiation. The treatment planning system (TPS) computed the anticipated dose distribution within the phantom, and post-irradiation TLD readings yielded actual dose measurements. The TPS calculated and TLD measured dose values at most of the locations inside the PTV were found comparable within ± 4%. The outcomes affirm the suitability of the developed anthropomorphic H&N phantom for precise dosimetry audits of advanced radiotherapy treatments.
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Affiliation(s)
- Nitin R Kakade
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
| | - Rajesh Kumar
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
| | - S D Sharma
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
- Homi Bhabha National Institute, Mumbai-400094, India
| | - B K Sapra
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
- Homi Bhabha National Institute, Mumbai-400094, India
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Mohammed Ali A, Al-Murshedi S. Low-cost chest paediatric phantom for dose optimisation: construction and validation. RADIOLOGIA 2023; 65:327-337. [PMID: 37516486 DOI: 10.1016/j.rxeng.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/05/2022] [Indexed: 07/31/2023]
Abstract
INTRODUCTION AND OBJECTIVES In order to perform chest dose optimisation studies, the imaging phantom should be adequate for image quality evaluation. Since high-end phantoms are cost prohibitive, there is a need for a low-cost construction method with fairly available tissue substitutes. MATERIALS AND METHODS Theoretical calculations of radiological characteristics were performed for each of lung, cortical bone and soft tissues in order to choose appropriate substitute, then, cork, P.V.C. (Polyvinyl chloride) and water were chosen, respectively. Validation included, firstly, measuring CT Hounsfield Units (HU) of a real patient's tissues then compared against their corresponding anatomies in the constructed phantom. Secondly, Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were acquired in this study to evaluate the quality of images generated from the constructed phantom, then, compare their trends with a valid phantom under different exposure parameters (kVp and mAs). RESULTS From theoretical calculations, the percentage differences showed high accuracy of tissue substitutes when simulating real patient tissues; P.V.C. was ≥5.78%, cork was ≥4.46% and water ≥5%. The percentage difference (CT HU) between lung and cortical bone and their equivalent tissue substitutes were 10.44% and 0.53%-3.17%, respectively. Strong positive correlations were found for SNR when changing both kVp (0.79) and mAs (0.65). While the correlation strength of CNR values were found to be moderate when changing both kVp (0.58) and mAs (0.53). CONCLUSIONS Our low-cost phantom approved through CT HU that their materials replicate the radiological characteristics of real one-year-old child while SNR and SNR correlations confirmed its applicability in imaging and optimisation studies.
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Affiliation(s)
- A Mohammed Ali
- Department of Radiological Techniques, College of Health and Medical Technology, Al-Zahraa University for Women, Karbala, Iraq; Department of medical physics, College of Applied Medical Sciences, University of Kerbala, 56001 Karbala, Iraq.
| | - S Al-Murshedi
- Department of Radiological Techniques, College of Health and Medical Technology, Al-Zahraa University for Women, Karbala, Iraq
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Construcción y validación de un fantoma torácico pediátrico asequible para optimizar la dosis. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Development and dosimetric evaluation of the IMRT prostate at outside-the-irradiated field in a heterogeneity male pelvis phantom. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s146039692200019x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Intensity-modulated radiation therapy (IMRT) treatment delivery requires pre-treatment patient-specific quality assurance (QA) for the dosimetry verification due to its complex multileaf-collimator movement. The prostate target close position between the bladder and rectum requires a tight margin during planning, and mistreatment would have a huge impact on the patient. A commercially available QA tool consists of a homogeneous medium and does not represent an exact photon interaction on the tumour and also on the nearby healthy organ.
Objective:
A heterogeneous male pelvis phantom was developed and investigated the efficiency of the treatment planning system (TPS) calculation on the off-axis region.
Methods:
Polymethyl methacrylate was used for the phantom housing, and the material closed to the bladder, rectum and prostate density was chosen to construct the organ models. The phantom was scanned and validated by the computed tomography number and density. An IMRT treatment was planned in the Monaco TPS, and a thermoluminescent dosimeter (TLD-100) was used to validate the point dosimetry. In addition, an EGSnrc Monte Carlo simulation was carried out to validate the phantom dosimetry.
Results & Discussion:
The dose measurement between TLD-100, TPS, and EGSnrc was compared and validated in the pelvis phantom. In the prostate region, the dose difference was within ± 5%, and the maximum dose difference outside-the-irradiated field was up to 20·07 % and 47·31 % in TPS and TLD-100, respectively. Meanwhile, the measured dose was lower than the calculated dose, and it was apparent for the dose outside-the-irradiated field.
Conclusion:
The developed heterogeneity male pelvis phantom was validated and verified to be an important QA device for validating radiation dosimetry in the pelvis region. The dose outside-the-irradiated field was underestimated by both TPS and TLD, respectively.
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Giacometti V, King RB, McCreery C, Buchanan F, Jeevanandam P, Jain S, Hounsell AR, McGarry CK. 3D-printed patient-specific pelvis phantom for dosimetry measurements for prostate stereotactic radiotherapy with dominant intraprostatic lesion boost. Phys Med 2021; 92:8-14. [PMID: 34823110 DOI: 10.1016/j.ejmp.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/29/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022] Open
Abstract
AIM Developing and assessing the feasibility of using a three-dimensional (3D) printed patient-specific anthropomorphic pelvis phantom for dose calculation and verification for stereotactic ablative radiation therapy (SABR) with dose escalation to the dominant intraprostatic lesions. MATERIAL AND METHODS A 3D-printed pelvis phantom, including bone-mimicking material, was fabricated based on the computed tomography (CT) images of a prostate cancer patient. To compare the extent to which patient and phantom body and bones overlapped, the similarity Dice coefficient was calculated. Modular cylindrical inserts were created to encapsulate radiochromic films and ionization chamber for absolute dosimetry measurements at the location of prostate and at the boost region. Gamma analysis evaluation with 2%/2mm criteria was performed to compare treatment planning system calculations and measured dose when delivering a 10 flattening filter free (FFF) SABR plan and a 10FFF boost SABR plan. RESULTS Dice coefficients of 0.98 and 0.91 were measured for body and bones, respectively, demonstrating agreement between patient and phantom outlines. For the boost plans the gamma analysis yielded 97.0% of pixels passing 2%/2mm criteria and these results were supported by the chamber average dose difference of 0.47 ± 0.03%. These results were further improved when overriding the bone relative electron density: 97.3% for the 2%/2mm gamma analysis, and 0.05 ± 0.03% for the ionization chamber average dose difference. CONCLUSIONS The modular patient-specific 3D-printed pelvis phantom has proven to be a highly attractive and versatile tool to validate prostate SABR boost plans using multiple detectors.
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Affiliation(s)
- Valentina Giacometti
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, United Kingdom.
| | - Raymond B King
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Craig McCreery
- School of Mechanical & Aerospace Engineering, Queen's University, Belfast, United Kingdom
| | - Fraser Buchanan
- School of Mechanical & Aerospace Engineering, Queen's University, Belfast, United Kingdom
| | - Prakash Jeevanandam
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Suneil Jain
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Alan R Hounsell
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Conor K McGarry
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Gaubert V, Gidik H, Koncar V. Proposal of a Lab Bench for the Unobtrusive Monitoring of the Bladder Fullness with Bioimpedance Measurements. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3980. [PMID: 32709078 PMCID: PMC7412207 DOI: 10.3390/s20143980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: millions of people, from children to the elderly, suffer from bladder dysfunctions all over the world. Monitoring bladder fullness with appropriate miniaturized textile devices can improve, significantly, their daily life quality, or even cure them. Amongst the existing bladder sensing technologies, bioimpedance spectroscopy seems to be the most appropriate one to be integrated into textiles. (2) Methods: to assess the feasibility of monitoring the bladder fullness with textile-based bioimpedance spectroscopy; an innovative lab-bench has been designed and fabricated. As a step towards obtaining a more realistic pelvic phantom, ex vivo pig's bladder and skin were used. The electrical properties of the fabricated pelvic phantom have been compared to those of two individuals with tetrapolar impedance measurements. The measurements' reproducibility on the lab bench has been evaluated and discussed. Moreover, its suitability for the continuous monitoring of the bladder filling has been investigated. (3) Results: although the pelvic phantom failed in reproducing the frequency-dependent electrical properties of human tissues, it was found to be suitable at 5 kHz to record bladder volume change. The resistance variations recorded are proportional to the conductivity of the liquid filling the bladder. A 350 mL filling with artificial urine corresponds to a decrease in resistance of 7.2%, which was found to be in the same range as in humans. (4) Conclusions: based on that resistance variation; the instantaneous bladder fullness can be extrapolated. The presented lab-bench will be used to evaluate the ability of textiles electrodes to unobtrusively monitor the bladder volume.
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Affiliation(s)
- Valentin Gaubert
- GEnie et Matériaux TEXtiles (GEMTEX) Laboratory, École Nationale Supérieure des Arts et Industries Textiles (ENSAIT), F-59100 Roubaix, France; (H.G.); (V.K.)
- Hautes Etudes Ingénieur (HEI)—YNCREA, University of Lille, F-59650 Villeneuve d’Ascq, France
| | - Hayriye Gidik
- GEnie et Matériaux TEXtiles (GEMTEX) Laboratory, École Nationale Supérieure des Arts et Industries Textiles (ENSAIT), F-59100 Roubaix, France; (H.G.); (V.K.)
- Hautes Etudes Ingénieur (HEI)—YNCREA, University of Lille, F-59650 Villeneuve d’Ascq, France
| | - Vladan Koncar
- GEnie et Matériaux TEXtiles (GEMTEX) Laboratory, École Nationale Supérieure des Arts et Industries Textiles (ENSAIT), F-59100 Roubaix, France; (H.G.); (V.K.)
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Hoffmans D, Niebuhr N, Bohoudi O, Pfaffenberger A, Palacios M. An end-to-end test for MR-guided online adaptive radiotherapy. ACTA ACUST UNITED AC 2020; 65:125012. [DOI: 10.1088/1361-6560/ab8955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Joseph D, Denham JW, Steigler A, Lamb DS, Spry NA, Stanley J, Shannon T, Duchesne G, Atkinson C, Matthews JH, Turner S, Kenny L, Christie D, Tai KH, Gogna NK, Kearvell R, Murray J, Ebert MA, Haworth A, Delahunt B, Oldmeadow C, Attia J. Radiation Dose Escalation or Longer Androgen Suppression to Prevent Distant Progression in Men With Locally Advanced Prostate Cancer: 10-Year Data From the TROG 03.04 RADAR Trial. Int J Radiat Oncol Biol Phys 2020; 106:693-702. [DOI: 10.1016/j.ijrobp.2019.11.415] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Mohammed Ali A, Hogg P, Johansen S, England A. Construction and validation of a low cost paediatric pelvis phantom. Eur J Radiol 2018; 108:84-91. [PMID: 30396676 DOI: 10.1016/j.ejrad.2018.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Imaging phantoms can be cost prohibitive, therefore a need exists to produce low cost alternatives which are fit for purpose. This paper describes the development and validation of a low cost paediatric pelvis phantom based on the anatomy of a 5-year-old child. METHODS Tissue equivalent materials representing paediatric bone (Plaster of Paris; PoP) and soft tissue (Poly methyl methacrylate; PMMA) were used. PMMA was machined to match the bony anatomy identified from a CT scan of a 5-year-old child and cavities were created for infusing the PoP. Phantom validation comprised physical and visual measures. Physical included CT density comparison between a CT scan of a 5-year old child and the phantom and Signal to Noise Ratio (SNR) comparative analysis of anteroposterior phantom X-ray images against a commercial anthropomorphic phantom. Visual analysis using a psychometric image quality scale (face validity). RESULTS CT density, the percentage difference between cortical bone, soft tissue and their equivalent tissue substitutes were -4.7 to -4.1% and -23.4%, respectively. For SNR, (mAs response) there was a strong positive correlation between the two phantoms (r > 0.95 for all kVps). For kVp response, there was a strong positive correlation between 1 and 8 mAs (r = 0.85), this then decreased as mAs increased (r = -0.21 at 20 mAs). Psychometric scale results produced a Cronbach's Alpha of almost 0.8. CONCLUSIONS Physical and visual measures suggest our low-cost phantom has suitable anatomical characteristics for X-ray imaging. Our phantom could have utility in dose and image quality optimisation studies.
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Affiliation(s)
- Ali Mohammed Ali
- School of Health Sciences, University of Salford, Salford, M6 6PU, United Kingdom.
| | - Peter Hogg
- School of Health Sciences, University of Salford, Salford, M6 6PU, United Kingdom.
| | - Safora Johansen
- Oslo Metropolitan University, Faculty of Health Sciences, Norway; Department of Oncology, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
| | - Andrew England
- School of Health Sciences, University of Salford, Salford, M6 6PU, United Kingdom.
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Lee CL, Dietrich MC, Desai UG, Das A, Yu S, Xiang HF, Jaffe CC, Hirsch AE, Bloch BN. A 3D-Printed Patient-Specific Phantom for External Beam Radiation Therapy of Prostate Cancer. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2018; 1. [PMID: 30775692 DOI: 10.1115/1.4040817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents the design evolution, fabrication, and testing of a novel patient and organ-specific, 3D printed phantom for external beam radiation therapy of prostate cancer. In contrast to those found in current practice, this phantom can be used to plan and validate treatment tailored to an individual patient. It contains a model of the prostate gland with a dominant intraprostatic lesion, seminal vesicles, urethra, ejaculatory duct, neurovascular bundles, rectal wall, and penile bulb generated from a series of combined T2-weighted/dynamic contrast-enhanced magnetic resonance images. The iterative process for designing the phantom based on user interaction and evaluation is described. Using the CyberKnife System at Boston Medical Center a treatment plan was successfully created and delivered. Dosage delivery results were validated through gamma index calculations based on radiochromic film measurements which yielded a 99.8% passing rate. This phantom is a demonstration of a methodology for incorporating high-contrast magnetic resonance imaging into computed-tomography-based radiotherapy treatment planning; moreover, it can be used to perform quality assurance.
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Affiliation(s)
- Christopher L Lee
- Franklin W. Olin College of Engineering, 1000 Olin Way, Needham MA 02492
| | - Max C Dietrich
- Franklin W. Olin College of Engineering, 1000 Olin Way, Needham MA 02492
| | - Uma G Desai
- Franklin W. Olin College of Engineering, 1000 Olin Way, Needham MA 02492
| | - Ankur Das
- Franklin W. Olin College of Engineering, 1000 Olin Way, Needham MA 02492
| | - Suhong Yu
- Department of Radiology Oncology, Boston Medical Center & Boston University School of Medicine, 820 Harrison Ave., Boston, MA 02118
| | - Hong F Xiang
- Department of Radiology Oncology, Boston Medical Center & Boston University School of Medicine, 820 Harrison Ave., Boston, MA 02118.,Current Affiliation: Department of Radiation Oncology, Penn Medicine/Lancaster General Health and University of Pennsylvania School of Medicine, 2100 Harrisburg Pike, Lancaster, PA 17601
| | - C Carl Jaffe
- Department of Radiology, Boston Medical Center & Boston University School of Medicine, 820 Harrison Ave., Boston, MA 02118
| | - Ariel E Hirsch
- Department of Radiology Oncology, Boston Medical Center & Boston University School of Medicine, 820 Harrison Ave., Boston, MA 02118
| | - B Nicolas Bloch
- Department of Radiology, Boston Medical Center & Boston University School of Medicine, 820 Harrison Ave., Boston, MA 02118
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Marcello M, Ebert MA, Haworth A, Steigler A, Kennedy A, Bulsara M, Kearvell R, Joseph DJ, Denham JW. Association between measures of treatment quality and disease progression in prostate cancer radiotherapy: An exploratory analysis from the TROG 03.04 RADAR trial. J Med Imaging Radiat Oncol 2017; 62:248-255. [PMID: 29222833 DOI: 10.1111/1754-9485.12695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Quality assurance methods are incorporated into multicentre radiotherapy clinical trials for ensuring consistent application of trial protocol and quantifying treatment uncertainties. The study's purpose was to determine whether post-treatment disease progression is associated with measures of the quality of radiotherapy treatment. METHODS The TROG 03.04 RADAR trial tested the impact of androgen deprivation on prostate cancer patients receiving dose-escalated external beam radiation therapy. The trial incorporated a plan-review process and Level III dosimetric intercomparison at each centre, from which variables suggestive of treatment quality were collected. Kaplan-Meier statistics and Fine and Gray competing risk modelling were employed to test for associations between quality-related variables and the participant outcome local composite progression. RESULTS Increased 'dose-difference' at the prostatic apex and at the anterior rectal wall, between planned and measured dose, was associated with reduced progression. Participants whose treatment plans included clinical target volume (CTV) to planning target volume (PTV) margins exceeding protocol requirements also experienced reduced progression. Other quality-related variables, including total accrual from participating centres, measures of target coverage and other variations from protocol, were not significantly associated with progression. CONCLUSIONS This analysis has revealed the association of several treatment quality factors with disease progression. Increased dose and dose margin coverage in the prostate region can reduce disease progression. Extensive and rigorous monitoring has helped to maximise treatment quality, reducing the incidence of quality-indicator outliers, and thus reduce the chance of observing significant associations with progression rates.
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Affiliation(s)
- Marco Marcello
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Crawley, Western Australia, Australia
| | - Martin A Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Crawley, Western Australia, Australia
| | - Annette Haworth
- School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Allison Steigler
- Prostate Cancer Trials Group, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Rachel Kearvell
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Gear JI, Cummings C, Craig AJ, Divoli A, Long CDC, Tapner M, Flux GD. Abdo-Man: a 3D-printed anthropomorphic phantom for validating quantitative SIRT. EJNMMI Phys 2016; 3:17. [PMID: 27495914 PMCID: PMC4975728 DOI: 10.1186/s40658-016-0151-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/26/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of selective internal radiation therapy (SIRT) is rapidly increasing, and the need for quantification and dosimetry is becoming more widespread to facilitate treatment planning and verification. The aim of this project was to develop an anthropomorphic phantom that can be used as a validation tool for post-SIRT imaging and its application to dosimetry. METHOD The phantom design was based on anatomical data obtained from a T1-weighted volume-interpolated breath-hold examination (VIBE) on a Siemens Aera 1.5 T MRI scanner. The liver, lungs and abdominal trunk were segmented using the Hermes image processing workstation. Organ volumes were then uploaded to the Delft Visualization and Image processing Development Environment for smoothing and surface rendering. Triangular meshes defining the iso-surfaces were saved as stereo lithography (STL) files and imported into the Autodesk® Meshmixer software. Organ volumes were subtracted from the abdomen and a removable base designed to allow access to the liver cavity. Connection points for placing lesion inserts and filling holes were also included. The phantom was manufactured using a Stratasys Connex3 PolyJet 3D printer. The printer uses stereolithography technology combined with ink jet printing. Print material is a solid acrylic plastic, with similar properties to polymethylmethacrylate (PMMA). RESULTS Measured Hounsfield units and calculated attenuation coefficients of the material were shown to also be similar to PMMA. Total print time for the phantom was approximately 5 days. Initial scans of the phantom have been performed with Y-90 bremsstrahlung SPECT/CT, Y-90 PET/CT and Tc-99m SPECT/CT. The CT component of these images compared well with the original anatomical reference, and measurements of volume agreed to within 9 %. Quantitative analysis of the phantom was performed using all three imaging techniques. Lesion and normal liver absorbed doses were calculated from the quantitative images in three dimensions using the local deposition method. CONCLUSIONS 3D printing is a flexible and cost-efficient technology for manufacture of anthropomorphic phantom. Application of such phantoms will enable quantitative imaging and dosimetry methodologies to be evaluated, which with optimisation could help improve outcome for patients.
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Affiliation(s)
- Jonathan I Gear
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK.
| | - Craig Cummings
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK
| | - Allison J Craig
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK
| | - Antigoni Divoli
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK
| | - Clive D C Long
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK
| | - Michael Tapner
- Research and Development, Sirtex, North Sydney, Australia
| | - Glenn D Flux
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK
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Niebuhr NI, Johnen W, Güldaglar T, Runz A, Echner G, Mann P, Möhler C, Pfaffenberger A, Jäkel O, Greilich S. Technical Note: Radiological properties of tissue surrogates used in a multimodality deformable pelvic phantom for MR-guided radiotherapy. Med Phys 2016; 43:908-16. [DOI: 10.1118/1.4939874] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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15
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Denham JW, Steigler A, Joseph D, Lamb DS, Spry NA, Duchesne G, Atkinson C, Matthews J, Turner S, Kenny L, Tai KH, Gogna NK, Gill S, Tan H, Kearvell R, Murray J, Ebert M, Haworth A, Kennedy A, Delahunt B, Oldmeadow C, Holliday EG, Attia J. Radiation dose escalation or longer androgen suppression for locally advanced prostate cancer? Data from the TROG 03.04 RADAR trial. Radiother Oncol 2015; 115:301-7. [DOI: 10.1016/j.radonc.2015.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
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16
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Ross C, Donlon E, Kessler A, Lee C, Xiang H, Carl Jaffe C, Nicolas Bloch B. Patient and Organ Specific Quality Assurance Phantom Insert for Stereotactic Body Radiation Therapy of Prostate Cancer1. J Med Device 2015. [DOI: 10.1115/1.4030146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Cullen Ross
- Franklin W. Olin College of Engineering, Needham, MA 02492
| | - Elliott Donlon
- Franklin W. Olin College of Engineering, Needham, MA 02492
| | | | | | - Hong Xiang
- CyberKnife SRS/SBRT Program at BMC, Department Radiation Oncology, MGH/Harvard Medical School and Boston Medical Center, Boston, MA 02118
| | - C. Carl Jaffe
- Department of Radiology, Boston University School of Medicine, Boston, MA 02118
| | - B. Nicolas Bloch
- Department of Radiology, Boston University School of Medicine, Boston, MA 02118
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Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): an open-label, randomised, phase 3 factorial trial. Lancet Oncol 2014; 15:1076-89. [PMID: 25130995 DOI: 10.1016/s1470-2045(14)70328-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND We investigated whether 18 months of androgen suppression plus radiotherapy, with or without 18 months of zoledronic acid, is more effective than 6 months of neoadjuvant androgen suppression plus radiotherapy with or without zoledronic acid. METHODS We did an open-label, randomised, 2 × 2 factorial trial in men with locally advanced prostate cancer (either T2a N0 M0 prostatic adenocarcinomas with prostate-specific antigen [PSA] ≥10 μg/L and a Gleason score of ≥7, or T2b-4 N0 M0 tumours regardless of PSA and Gleason score). We randomly allocated patients by computer-generated minimisation--stratified by centre, baseline PSA, tumour stage, Gleason score, and use of a brachytherapy boost--to one of four groups in a 1:1:1:1 ratio. Patients in the control group were treated with neoadjuvant androgen suppression with leuprorelin (22·5 mg every 3 months, intramuscularly) for 6 months (short-term) and radiotherapy alone (designated STAS); this procedure was either followed by another 12 months of androgen suppression with leuprorelin (intermediate-term; ITAS) or accompanied by 18 months of zoledronic acid (4 mg every 3 months for 18 months, intravenously; STAS plus zoledronic acid) or by both (ITAS plus zoledronic acid). The primary endpoint was prostate cancer-specific mortality. This analysis represents the first, preplanned assessment of oncological endpoints, 5 years after treatment. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00193856. FINDINGS Between Oct 20, 2003, and Aug 15, 2007, 1071 men were randomly assigned to STAS (n=268), STAS plus zoledronic acid (n=268), ITAS (n=268), and ITAS plus zoledronic acid (n=267). Median follow-up was 7·4 years (IQR 6·5-8·4). Cumulative incidences of prostate cancer-specific mortality were 4·1% (95% CI 2·2-7·0) in the STAS group, 7·8% (4·9-11·5) in the STAS plus zoledronic acid group, 7·4% (4·6-11·0) in the ITAS group, and 4·3% (2·3-7·3) in the ITAS plus zoledronic acid group. Cumulative incidence of all-cause mortality was 17·0% (13·0-22·1), 18·9% (14·6-24·2), 19·4% (15·0-24·7), and 13·9% (10·3-18·8), respectively. Neither prostate cancer-specific mortality nor all-cause mortality differed between control and experimental groups. Cumulative incidence of PSA progression was 34·2% (28·6-39·9) in the STAS group, 39·6% (33·6-45·5) in the STAS plus zoledronic acid group, 29·2% (23·8-34·8) in the ITAS group, and 26·0% (20·8-31·4) in the ITAS plus zoledronic acid group. Compared with STAS, no difference was noted in PSA progression with ITAS or STAS plus zoledronic acid; however, ITAS plus zoledronic acid reduced PSA progression (sub-hazard ratio [SHR] 0·71, 95% CI 0·53-0·95; p=0·021). Cumulative incidence of local progression was 4·1% (2·2-7·0) in the STAS group, 6·1% (3·7-9·5) in the STAS plus zoledronic acid group, 1·5% (0·5-3·7) in the ITAS group, and 3·4% (1·7-6·1) in the ITAS plus zoledronic acid group; no differences were noted between groups. Cumulative incidences of bone progression were 7·5% (4·8-11·1), 14·6% (10·6-19·2), 8·4% (5·5-12·2), and 7·6% (4·8-11·2), respectively. Compared with STAS, STAS plus zoledronic acid increased the risk of bone progression (SHR 1·90, 95% CI 1·14-3·17; p=0·012), but no differences were noted with the other two groups. Cumulative incidence of distant progression was 14·7% (10·7-19·2) in the STAS group, 17·3% (13·0-22·1) in the STAS plus zoledronic acid group, 14·2% (10·3-18·7) in the ITAS group, and 11·1% (7·6-15·2) in the ITAS plus zoledronic acid group; no differences were recorded between groups. Cumulative incidence of secondary therapeutic intervention was 25·6% (20·5-30·9), 28·9% (23·5-34·5), 20·7% (16·1-25·9), and 15·3% (11·3-20·0), respectively. Compared with STAS, ITAS plus zoledronic acid reduced the need for secondary therapeutic intervention (SHR 0·67, 95% CI 0·48-0·95; p=0·024); no differences were noted with the other two groups. An interaction between trial factors was recorded for Gleason score; therefore, we did pairwise comparisons between all groups. Post-hoc analyses suggested that the reductions in PSA progression and decreased need for secondary therapeutic intervention with ITAS plus zoledronic acid were restricted to tumours with a Gleason score of 8-10, and that ITAS was better than STAS in tumours with a Gleason score of 7 or lower. Long-term morbidity and quality-of-life scores were not affected adversely by 18 months of androgen suppression or zoledronic acid. INTERPRETATION Compared with STAS, ITAS plus zoledronic acid was more effective for treatment of prostate cancers with a Gleason score of 8-10, and ITAS alone was effective for tumours with a Gleason score of 7 or lower. Nevertheless, these findings are based on secondary endpoint data and post-hoc analyses and must be regarded cautiously. Long- term follow-up is necessary, as is external validation of the interaction between zoledronic acid and Gleason score. STAS plus zoledronic acid can be ruled out as a potential therapeutic option. FUNDING National Health and Medical Research Council of Australia, Novartis Pharmaceuticals Australia, Abbott Pharmaceuticals Australia, New Zealand Health Research Council, New Zealand Cancer Society, University of Newcastle (Australia), Calvary Health Care (Calvary Mater Newcastle Radiation Oncology Fund), Hunter Medical Research Institute, Maitland Cancer Appeal, Cancer Standards Institute New Zealand.
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Ebert MA, Bulsara M, Haworth A, Kearvell R, Richardson S, Kennedy A, Spry NA, Bydder SA, Joseph DJ, Denham JW. Technical quality assurance during the TROG 03.04 RADAR prostate radiotherapy trial: Are the results reflected in observed toxicity rates? J Med Imaging Radiat Oncol 2014; 59:99-108. [DOI: 10.1111/1754-9485.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Martin A Ebert
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
- School of Physics; University of Western Australia; Perth Australia
| | - Max Bulsara
- School of Health Sciences; University of Notre Dame; Fremantle Western Australia Australia
| | - Annette Haworth
- Department of Physical Sciences; Peter MacCallum Cancer Centre, University of Melbourne; Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
| | - Rachel Kearvell
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
| | - Sharon Richardson
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
| | - Angel Kennedy
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
| | - Nigel A Spry
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
- School of Medicine and Pharmacology; University of Western Australia; Perth Australia
| | - Sean A Bydder
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
- School of Surgery; University of Western Australia; Perth Australia
| | - David J Joseph
- Department of Radiation Oncology; Sir Charles Gairdner Hospital, University of Western Australia; Perth Australia
- School of Surgery; University of Western Australia; Perth Australia
| | - James W Denham
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
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Healy B, Frantzis J, Murry R, Martin J, Plank A, Middleton M, Catton C, Kron T. Results from a multicenter prostate IMRT dosimetry intercomparison for an OCOG-TROG clinical trial. Med Phys 2014; 40:071706. [PMID: 23822410 DOI: 10.1118/1.4808151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A multi-institution dosimetry intercomparison has been undertaken of prostate intensity modulated radiation therapy (IMRT) delivery. The dosimetry intercomparison was incorporated into the quality assurance for site credentialing for the Trans-Tasman Radiation Oncology Group Prostate Fractionated Irradiation Trial 08.01 clinical trial. METHODS An anthropomorphic pelvic phantom with realistic anatomy was used along with multiplanar dosimetry tools for the assessment. Nineteen centers across Australia and New Zealand participated in the study. RESULTS In comparing planned versus measured dose to the target at the isocenter within the phantom, all centers were able to achieve a total delivered dose within 3% of planned dose. In multiplanar analysis with radiochromic film using the gamma analysis method to compare delivered and planned dose, pass rates for a 5%/3 mm criterion were better than 90% for a coronal slice through the isocenter. Pass rates for an off-axis coronal slice were also better than 90% except for one instance with 84% pass rate. CONCLUSIONS Strengths of the dosimetry assessment procedure included the true anthropomorphic nature of the phantom used, the involvement of an expert from the reference center in carrying out the assessment at every site, and the ability of the assessment to detect and resolve dosimetry discrepancies.
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Affiliation(s)
- B Healy
- Radiation Oncology Queensland, Toowoomba, Queensland 4350, Australia.
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Qiu J, Wang G, Min J, Wang X, Wang P. Testing the quality of images for permanent magnet desktop MRI systems using specially designed phantoms. Phys Med Biol 2013; 58:8677-87. [PMID: 24263463 DOI: 10.1088/0031-9155/58/24/8677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Our aim was to measure the performance of desktop magnetic resonance imaging (MRI) systems using specially designed phantoms, by testing imaging parameters and analysing the imaging quality. We designed multifunction phantoms with diameters of 18 and 60 mm for desktop MRI scanners in accordance with the American Association of Physicists in Medicine (AAPM) report no. 28. We scanned the phantoms with three permanent magnet 0.5 T desktop MRI systems, measured the MRI image parameters, and analysed imaging quality by comparing the data with the AAPM criteria and Chinese national standards. Image parameters included: resonance frequency, high contrast spatial resolution, low contrast object detectability, slice thickness, geometrical distortion, signal-to-noise ratio (SNR), and image uniformity. The image parameters of three desktop MRI machines could be measured using our specially designed phantoms, and most parameters were in line with MRI quality control criterion, including: resonance frequency, high contrast spatial resolution, low contrast object detectability, slice thickness, geometrical distortion, image uniformity and slice position accuracy. However, SNR was significantly lower than in some references. The imaging test and quality control are necessary for desktop MRI systems, and should be performed with the applicable phantom and corresponding standards.
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Kron T, Haworth A, Williams I. Dosimetry for audit and clinical trials: challenges and requirements. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/444/1/012014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Haworth A, Wilfert L, Butler D, Ebert MA, Todd S, Bucci J, Duchesne GM, Joseph D, Kron T. Australasian brachytherapy audit: Results of the ‘end-to-end’ dosimetry pilot study. J Med Imaging Radiat Oncol 2013; 57:490-8. [DOI: 10.1111/1754-9485.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Annette Haworth
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Kearvell R, Haworth A, Ebert MA, Murray J, Hooton B, Richardson S, Joseph DJ, Lamb D, Spry NA, Duchesne G, Denham JW. Quality improvements in prostate radiotherapy: Outcomes and impact of comprehensive quality assurance during the TROG 03.04 ‘RADAR’ trial. J Med Imaging Radiat Oncol 2013; 57:247-57. [DOI: 10.1111/1754-9485.12025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel Kearvell
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | | | | | - Judy Murray
- Department of Pathology and Molecular Medicine; University of Otago; Wellington; New Zealand
| | - Ben Hooton
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | - Sharon Richardson
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | | | - David Lamb
- Department of Pathology and Molecular Medicine; University of Otago; Wellington; New Zealand
| | | | | | - James W Denham
- School of Medicine and Public Health; University of Newcastle; Callaghan; New South Wales; Australia
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Denham JW, Wilcox C, Lamb DS, Spry NA, Duchesne G, Atkinson C, Matthews J, Turner S, Kenny L, Tai KH, Gogna NK, Ebert M, Delahunt B, McElduff P, Joseph D. Rectal and urinary dysfunction in the TROG 03.04 RADAR trial for locally advanced prostate cancer. Radiother Oncol 2012; 105:184-92. [DOI: 10.1016/j.radonc.2012.09.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/20/2012] [Accepted: 09/29/2012] [Indexed: 01/03/2023]
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