Computer visualization techniques (CVTs) foster evidence-based target delineation

Computer visualization techniques (CVTs) are an emerging technology that can organize all cancer specialists. This article describes CVTs' ability to maximize the currently untapped advantages of intensity modulated radiotherapy (IMRT). The visual speed and dynamic strategies inherent in CVTs improves IMRT by distilling vast amounts of anatomic, multimodal imaging, textual/meaning, and surgical/outcome data into a large, rigorous, standardized evidence base of storable target delineation plans. This ability to standardize strategies will allow the collection of meaningful evidence based outcome data.

Applying the equivalent uniform dose formulation based on the linear-quadratic model to inhomogeneous tumor dose distributions: Caution for analyzing and reporting

We apply the concept of equivalent uniform dose (EUD) to our data set of model distributions and intensity modulated radiotherapy (IMRT) treatment plans as a method for analyzing large dose inhomogeneities within the tumor volume. For large dose nonuniformities, we find that the linerar-quadratic based EUD model is sensitive to the linear-quadratic model parameters, alpha and beta, making it necessary to consider EUD as a function of these parameters. This complicates the analysis for inhomogeneous dose distributions. EUD provides a biological estimate that requires interpretation and cannot be used as a single parameter for judging an inhomogeneous plan. We present heuristic examples to demonstrate the dose volume effect associated with EUD and the correlation to statistical parameters used for describing dose distributions. From these examples and patient plans, we discuss the risk of incorrectly applying EUD to IMRT patient plans.

A clinical evaluation of setup errors for a prostate immobilization system

A prostate treatment immobilization system was evaluated with respect to setup errors and efficiency for a specific treatment setup. Prostate patients were treated in the prone position with a rectal catheter using the NOMOS intensity modulated radiotherapy system. Immobilization and setup consisted of a Vac-Loktrade mark bag (MED-TEC, Orange City, IO) fitted within a registration carrier box where patients were aligned to the bag using skin marks along the lower leg. Daily setup errors were analyzed using lateral portal films, registration plates mounted to the carrier box, and the pubic symphasis as a bony reference. Two studies were conducted to evaluate setup technique. In the first study, patient setup required 3-5 minutes for patient positioning and the corresponding superior/inferior errors were found to have a standard deviation of 3.5 mm. In the second study, the technique standards were reduced to allow for faster setup times and, consequently, larger errors; setup times were 1-2 minutes and the mean and standard deviation errors were approximately 2 and 5 mm, respectively.

A comparison of Monte Carlo and analytic first scatter dose spread arrays

We compare first scattered point dose spread arrays generated by Monte Carlo and an analytic method. The analytic method models energy deposition using Klein-Nishina cross sections for Compton scatter and approximations for electron transport. Assumptions in the analytic method are shown to be valid within a region of the point dose spread kernel in which meaningful comparisons can be made. Differences between the models are less than 10% for the forward scatter directions for radii greater than the electron range associated with the first scattered Compton photon. Differences in the backscatter region are discussed and indicate that the analytic model is useful for identifying large errors that might be present in numerically generated first scatter point dose spread arrays. The analytic method is simple and useful for validating first scatter kernels.