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1.	Al-Hallaq, Hania A., et al. (författare) AAPM task group report 302 : Surface-guided radiotherapy 2022 Ingår i: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 49:4, s. 82-112 Tidskriftsartikel (refereegranskat)abstract The clinical use of surface imaging has increased dramatically, with demonstrated utility for initial patient positioning, real-time motion monitoring, and beam gating in a variety of anatomical sites. The Therapy Physics Subcommittee and the Imaging for Treatment Verification Working Group of the American Association of Physicists in Medicine commissioned Task Group 302 to review the current clinical uses of surface imaging and emerging clinical applications. The specific charge of this task group was to provide technical guidelines for clinical indications of use for general positioning, breast deep-inspiration breath hold treatment, and frameless stereotactic radiosurgery. Additionally, the task group was charged with providing commissioning and on-going quality assurance (QA) requirements for surface-guided radiation therapy (SGRT) as part of a comprehensive QA program including risk assessment. Workflow considerations for other anatomic sites and for computed tomography simulation, including motion management, are also discussed. Finally, developing clinical applications, such as stereotactic body radiotherapy (SBRT) or proton radiotherapy, are presented. The recommendations made in this report, which are summarized at the end of the report, are applicable to all video-based SGRT systems available at the time of writing.
2.	Ali, MA, et al. (författare) Detection of potential microcalcification clusters using multivendor for-presentation digital mammograms for short-term breast cancer risk estimation 2019 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 46:4, s. 1938-1946 Tidskriftsartikel (refereegranskat)
3.	Andersén, Christoffer, 1991-, et al. (författare) Deep learning based digitisation of prostate brachytherapy needles in ultrasound images 2020 Ingår i: Medical physics. - : Wiley-Blackwell Publishing Inc.. - 2473-4209 .- 0094-2405. ; 47:12, s. 6414-6420 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To develop, and evaluate the performance of, a deep learning based 3D convolutional neural network (CNN) artificial intelligence (AI) algorithm aimed at finding needles in ultrasound images used in prostate brachytherapy.METHODS: Transrectal ultrasound (TRUS) image volumes from 1102 treatments were used to create a clinical ground truth (CGT) including 24422 individual needles that had been manually digitised by medical physicists during brachytherapy procedures. A 3D CNN U-net with 128x128x128 TRUS image volumes as input was trained using 17215 needle examples. Predictions of voxels constituting a needle were combined to yield a 3D linear function describing the localisation of each needle in a TRUS volume. Manual and AI digitisations were compared in terms of the root-mean-square distance (RMSD) along each needle, expressed as median and interquartile range (IQR). The method was evaluated on a dataset including 7207 needle examples. A subgroup of the evaluation data set (n=188) was created, where the needles were digitised once more by a medical physicist (G1) trained in brachytherapy. The digitisation procedure was timed.RESULTS: The RMSD between the AI and CGT was 0.55 (IQR: 0.35-0.86) mm. In the smaller subset, the RMSD between AI and CGT was similar (0.52 [IQR: 0.33-0.79] mm) but significantly smaller (p<0.001) than the difference of 0.75 (IQR: 0.49-1.20) mm between AI and G1. The difference between CGT and G1 was 0.80 (IQR: 0.48-1.18) mm, implying that the AI performed as well as the CGT in relation to G1. The mean time needed for human digitisation was 10 min 11 sec, while the time needed for the AI was negligible.CONCLUSIONS: A 3D CNN can be trained to identify needles in TRUS images. The performance of the network was similar to that of a medical physicist trained in brachytherapy. Incorporating a CNN for needle identification can shorten brachytherapy treatment procedures substantially.
4.	Anderson, D, et al. (författare) Sci-Sat AM: Brachy - 01: Evaluation of dose-volume metrics for microbeam radiation therapy 2012 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 39:77Part4, s. 4645-4645 Tidskriftsartikel (refereegranskat)
5.	Andersson, Jonas, 1975-, et al. (författare) Estimation of patient skin dose in fluoroscopy : summary of a joint report by AAPM TG357 and EFOMP 2021 Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 48:7, s. e671-e696 Tidskriftsartikel (refereegranskat)abstract Background: Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin.Materials and Methods: The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation.Results: The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed.Conclusions: The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
6.	Andersson, Karin M., 1989-, et al. (författare) Evaluation of two commercial CT metal artifact reduction algorithms for use in proton radiotherapy treatment planning in the head and neck area 2018 Ingår i: Medical physics (Lancaster). - : Wiley-Blackwell Publishing Inc.. - 0094-2405 .- 2473-4209. ; 45:10, s. 4329-4344 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatment planning in the head and neck (H&N) area.METHODS: An anthropomorphic head phantom with removable metallic implants (dental fillings or neck implant) was CT-scanned to evaluate the O-MAR (Philips) and the iMAR (Siemens) algorithms. Reference images were acquired without any metallic implants in place. Water equivalent thickness (WET) was calculated for different path directions and compared between image sets. Images were also evaluated for use in proton treatment planning for parotid, tonsil, tongue base, and neck node targets. The beams were arranged so as to not traverse any metal prior to the target, enabling evaluation of the impact on dose calculation accuracy from artifacts surrounding the metal volume. Plans were compared based on γ analysis (1 mm distance-to-agreement/1% difference in local dose) and dose volume histogram metrics for targets and organs at risk (OARs). Visual grading evaluation of 30 dental implant patient MAR images was performed by three radiation oncologists.RESULTS: In the dental fillings images, ΔWET along a low-density streak was reduced from -17.0 to -4.3 mm with O-MAR and from -16.1 mm to -2.3 mm with iMAR, while for other directions the deviations were increased or approximately unchanged when the MAR algorithms were used. For the neck implant images, ΔWET was generally reduced with MAR but residual deviations remained (of up to -2.3 mm with O-MAR and of up to -1.5 mm with iMAR). The γ analysis comparing proton dose distributions for uncorrected/MAR plans and corresponding reference plans showed passing rates >98% of the voxels for all phantom plans. However, substantial dose differences were seen in areas of most severe artifacts (γ passing rates of down to 89% for some cases). MAR reduced the deviations in some cases, but not for all plans. For a single patient case dosimetrically evaluated, minor dose differences were seen between the uncorrected and MAR plans (γ passing rate approximately 97%). The visual grading of patient images showed that MAR significantly improved image quality (P < 0.001).CONCLUSIONS: O-MAR and iMAR significantly improved image quality in terms of anatomical visualization for target and OAR delineation in dental implant patient images. WET calculations along several directions, all outside the metallic regions, showed that both uncorrected and MAR images contained metal artifacts which could potentially lead to unacceptable errors in proton treatment planning. ΔWET was reduced by MAR in some areas, while increased or unchanged deviations were seen for other path directions. The proton treatment plans created for the phantom images showed overall acceptable dose distributions differences when compared to the reference cases, both for the uncorrected and MAR images. However, substantial dose distribution differences in the areas of most severe artifacts were seen for some plans, which were reduced by MAR in some cases but not all. In conclusion, MAR could be beneficial to use for proton treatment planning; however, case-by-case evaluations of the metal artifact-degraded images are always recommended.
7.	Andreo, P, et al. (författare) Comment on "Experimental determination of the PTW 60019 microDiamond dosimeter active area and volume" [Med. Phys. 43, 5205-5212 (2016)] 2016 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 43:12, s. 6667-6667 Tidskriftsartikel (refereegranskat)
8.	Arce, P., et al. (författare) Report on G4-Med, a Geant4 benchmarking system for medical physics applications developed by the Geant4 Medical Simulation Benchmarking Group 2021 Ingår i: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 48:1, s. 19-56 Tidskriftsartikel (refereegranskat)abstract Background: Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing. Aims: To respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics. Materials and Methods: G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes. Results: This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data. Discussion: Our results indicate that the Geant4 electromagnetic physics constructor G4EmStandardPhysics_option4 gives a good agreement with the reference data for all the tests. The QGSP_BIC_HP physics list provided an overall adequate description of the physics involved in hadron therapy, including proton and carbon ion therapy. New tests should be included in the next stage of the project to extend the benchmarking to other physical quantities and application scenarios of interest for medical physics. Conclusion: The results presented and discussed in this paper will aid users in tailoring physics lists to their particular application.
9.	Atefi, Seyed Reza, et al. (författare) Intracranial haemorrhage alters scalp potential distributions in bioimpedance cerebral monitoring applications : preliminary results from FEM simulation on a realistic head model and human subjects 2016 Ingår i: Medical Physics. - : American Association of Physicists in Medicine. - 2473-4209 .- 0094-2405. ; 43:2, s. 675-686 Tidskriftsartikel (refereegranskat)abstract Purpose: Current diagnostic neuroimaging for detection of intracranial hemorrhage (ICH) is limited to fixed scanners requiring patient transport and extensive infrastructure support. ICH diagnosis would therefore benefit from a portable diagnostic technology, such as electrical bioimpedance (EBI). Through simulations and patient observation, the authors assessed the influence of unilateral ICH hematomas on quasisymmetric scalp potential distributions in order to establish the feasibility of EBI technology as a potential tool for early diagnosis. Methods: Finite element method (FEM) simulations and experimental leftright hemispheric scalp potential differences of healthy and damaged brains were compared with respect to the asymmetry caused by ICH lesions on quasisymmetric scalp potential distributions. In numerical simulations, this asymmetry was measured at 25 kHz and visualized on the scalp as the normalized potential difference between the healthy and ICH damaged models. Proof-of-concept simulations were extended in a pilot study of experimental scalp potential measurements recorded between 0 and 50 kHz with the authors custom-made bioimpedance spectrometer. Mean leftright scalp potential differences recorded from the frontal, central, and parietal brain regions of ten healthy control and six patients suffering from acute/subacute ICH were compared. The observed differences were measured at the 5% level of significance using the two-sample Welch ttest. Results: The 3D-anatomically accurate FEM simulations showed that the normalized scalp potential difference between the damaged and healthy brain models is zero everywhere on the head surface, except in the vicinity of the lesion, where it can vary up to 5%. The authors preliminary experimental results also confirmed that the leftright scalp potential difference in patients with ICH (e.g., 64 mV) is significantly larger than in healthy subjects (e.g., 20.8 mV; P < 0.05). Conclusions: Realistic, proof-of-concept simulations confirmed that ICH affects quasisymmetric scalp potential distributions. Pilot clinical observations with the authors custom-made bioimpedance spectrometer also showed higher leftright potential differences in the presence of ICH, similar to those of their simulations, that may help to distinguish healthy subjects from ICH patients. Although these pilot clinical observations are in agreement with the computer simulations, the small sample size of this study lacks statistical power to exclude the influence of other possible confounders such as age, ex, and electrode positioning. The agreement with previously published simulation-based and clinical results, however, suggests that EBI technology may be potentially useful for ICH detection.
10.	Ba, Alexandre, et al. (författare) Inter-laboratory comparison of channelized hotelling observer computation 2018 Ingår i: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 45:7, s. 3019-3030 Tidskriftsartikel (refereegranskat)abstract Purpose: The task-based assessment of image quality using model observers is increasingly used for the assessment of different imaging modalities. However, the performance computation of model observers needs standardization as well as a well-established trust in its implementation methodology and uncertainty estimation. The purpose of this work was to determine the degree of equivalence of the channelized Hotelling observer performance and uncertainty estimation using an intercomparison exercise. Materials and Methods: Image samples to estimate model observer performance for detection tasks were generated from two-dimensional CT image slices of a uniform water phantom. A common set of images was sent to participating laboratories to perform and document the following tasks: (a) estimate the detectability index of a well-defined CHO and its uncertainty in three conditions involving different sized targets all at the same dose, and (b) apply this CHO to an image set where ground truth was unknown to participants (lower image dose). In addition, and on an optional basis, we asked the participating laboratories to (c) estimate the performance of real human observers from a psychophysical experiment of their choice. Each of the 13 participating laboratories was confidentially assigned a participant number and image sets could be downloaded through a secure server. Results were distributed with each participant recognizable by its number and then each laboratory was able to modify their results with justification as model observer calculation are not yet a routine and potentially error prone. Results: Detectability index increased with signal size for all participants and was very consistent for 6 mm sized target while showing higher variability for 8 and 10 mm sized target. There was one order of magnitude between the lowest and the largest uncertainty estimation. Conclusions: This intercomparison helped define the state of the art of model observer performance computation and with thirteen participants, reflects openness and trust within the medical imaging community. The performance of a CHO with explicitly defined channels and a relatively large number of test images was consistently estimated by all participants. In contrast, the paper demonstrates that there is no agreement on estimating the variance of detectability in the training and testing setting.
11.	Barufaldi, Bruno, et al. (författare) Computer simulations of case difficulty in digital breast tomosynthesis using virtual clinical trials 2022 Ingår i: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 49:4, s. 2220-2232 Tidskriftsartikel (refereegranskat)abstract Purpose: Virtual clinical trials (VCTs) require computer simulations of representative patients and images to evaluate and compare changes in performance of imaging technologies. The simulated images are usually interpreted by model observers whose performance depends upon the selection of imaging cases used in training evaluation models. This work proposes an efficient method to simulate and calibrate soft tissue lesions, which matches the detectability threshold of virtual and human readings. Methods: Anthropomorphic breast phantoms were used to evaluate the simulation of four mass models (I–IV) that vary in shape and composition of soft tissue. Ellipsoidal (I) and spiculated (II–IV) masses were simulated using composite voxels with partial volumes. Digital breast tomosynthesis projections and reconstructions of a clinical system were simulated. Channelized Hotelling observers (CHOs) were evaluated using reconstructed slices of masses that varied in shape, composition, and density of surrounded tissue. The detectability threshold of each mass model was evaluated using receiver operating characteristic (ROC) curves calculated with the CHO's scores. Results: The area under the curve (AUC) of each calibrated mass model were within the 95% confidence interval (mean AUC [95% CI]) reported in a previous reader study (0.93 [0.89, 0.97]). The mean AUC [95% CI] obtained were 0.94 [0.93, 0.96], 0.92 [0.90, 0.93], 0.92 [0.90, 0.94], 0.93 [0.92, 0.95] for models I to IV, respectively. The mean AUC results varied substantially as a function of shape, composition, and density of surrounded tissue. Conclusions: For successful VCTs, lesions composed of soft tissue should be calibrated to simulate imaging cases that match the case difficulty predicted by human readers. Lesion composition, shape, and size are parameters that should be carefully selected to calibrate VCTs.
12.	Bayisa, Fekadu, et al. (författare) Statistical learning in computed tomography image estimation 2018 Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 45:12, s. 5450-5460 Tidskriftsartikel (refereegranskat)abstract Purpose: There is increasing interest in computed tomography (CT) image estimations from magneticresonance (MR) images. The estimated CT images can be utilized for attenuation correction, patientpositioning, and dose planning in diagnostic and radiotherapy workflows. This study aims to introducea novel statistical learning approach for improving CT estimation from MR images and to compare theperformance of our method with the existing model-based CT image estimation methods.Methods: The statistical learning approach proposed here consists of two stages. At the trainingstage, prior knowledge about tissue types from CT images was used together with a Gaussian mixturemodel (GMM) to explore CT image estimations from MR images. Since the prior knowledge is notavailable at the prediction stage, a classifier based on RUSBoost algorithm was trained to estimatethe tissue types from MR images. For a new patient, the trained classifier and GMMs were used topredict CT image from MR images. The classifier and GMMs were validated by using voxel-leveltenfold cross-validation and patient-level leave-one-out cross-validation, respectively.Results: The proposed approach has outperformance in CT estimation quality in comparison withthe existing model-based methods, especially on bone tissues. Our method improved CT image estimationby 5% and 23% on the whole brain and bone tissues, respectively.Conclusions: Evaluation of our method shows that it is a promising method to generate CTimage substitutes for the implementation of fully MR-based radiotherapy and PET/MRI applications
13.	Beaulieu, Luc, et al. (författare) AAPM WGDCAB Report 372: A joint AAPM, ESTRO, ABG, and ABS report on commissioning of model-based dose calculation algorithms in brachytherapy 2023 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405. ; 50:8, s. E946-E960 Tidskriftsartikel (refereegranskat)abstract The introduction of model-based dose calculation algorithms (MBDCAs) in brachytherapy provides an opportunity for a more accurate dose calculation and opens the possibility for novel, innovative treatment modalities. The joint AAPM, ESTRO, and ABG Task Group 186 (TG-186) report provided guidance to early adopters. However, the commissioning aspect of these algorithms was described only in general terms with no quantitative goals. This report, from the Working Group on Model-Based Dose Calculation Algorithms in Brachytherapy, introduced a field-tested approach to MBDCA commissioning. It is based on a set of well-characterized test cases for which reference Monte Carlo (MC) and vendor-specific MBDCA dose distributions are available in a Digital Imaging and Communications in Medicine-Radiotherapy (DICOM-RT) format to the clinical users. The key elements of the TG-186 commissioning workflow are now described in detail, and quantitative goals are provided. This approach leverages the well-known Brachytherapy Source Registry jointly managed by the AAPM and the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center (with associated links at ESTRO) to provide open access to test cases as well as step-by-step user guides. While the current report is limited to the two most widely commercially available MBDCAs and only for Ir-192-based afterloading brachytherapy at this time, this report establishes a general framework that can easily be extended to other brachytherapy MBDCAs and brachytherapy sources. The AAPM, ESTRO, ABG, and ABS recommend that clinical medical physicists implement the workflow presented in this report to validate both the basic and the advanced dose calculation features of their commercial MBDCAs. Recommendations are also given to vendors to integrate advanced analysis tools into their brachytherapy treatment planning system to facilitate extensive dose comparisons. The use of the test cases for research and educational purposes is further encouraged.
14.	Benmakhlouf, Hamza, et al. (författare) Output correction factors for nine small field detectors in 6 MV radiation therapy photon beams : A PENELOPE Monte Carlo study 2014 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 41:4, s. 041711- Tidskriftsartikel (refereegranskat)abstract Purpose: To determine detector-specific output correction factors, k(Qclin,Qmsr)(fclin,fmsr) in 6 MV small photon beams for air and liquid ionization chambers, silicon diodes, and diamond detectors from two manufacturers. Methods: Field output factors, defined according to the international formalism published by Alfonso et al. [Med. Phys. 35, 5179-5186 (2008)], relate the dosimetry of small photon beams to that of the machine-specific reference field; they include a correction to measured ratios of detector readings, conventionally used as output factors in broad beams. Output correction factors were calculated with the PENELOPE Monte Carlo (MC) system with a statistical uncertainty (type-A) of 0.15% or lower. The geometries of the detectors were coded using blueprints provided by the manufacturers, and phase-space files for field sizes between 0.5 x 0.5 cm(2) and 10 x 10 cm(2) from a Varian Clinac iX 6 MV linac used as sources. The output correction factors were determined scoring the absorbed dose within a detector and to a small water volume in the absence of the detector, both at a depth of 10 cm, for each small field and for the reference beam of 10 x 10 cm(2). Results: The Monte Carlo calculated output correction factors for the liquid ionization chamber and the diamond detector were within about +/- 1% of unity even for the smallest field sizes. Corrections were found to be significant for small air ionization chambers due to their cavity dimensions, as expected. The correction factors for silicon diodes varied with the detector type (shielded or un-shielded), confirming the findings by other authors; different corrections for the detectors from the two manufacturers were obtained. The differences in the calculated factors for the various detectors were analyzed thoroughly and whenever possible the results were compared to published data, often calculated for different accelerators and using the EGSnrc MC system. The differences were used to estimate a type-B uncertainty for the correction factors. Together with the type-A uncertainty from the Monte Carlo calculations, an estimation of the combined standard uncertainty was made, assigned to the mean correction factors from various estimates. Conclusions: The present work provides a consistent and specific set of data for the output correction factors of a broad set of detectors in a Varian Clinac iX 6 MV accelerator and contributes to improving the understanding of the physics of small photon beams. The correction factors cannot in general be neglected for any detector and, as expected, their magnitude increases with decreasing field size. Due to the reduced number of clinical accelerator types currently available, it is suggested that detector output correction factors be given specifically for linac models and field sizes, rather than for a beam quality specifier that necessarily varies with the accelerator type and field size due to the different electron spot dimensions and photon collimation systems used by each accelerator model. (C) 2014 American Association of Physicists in Medicine.
15.	Benmakhlouf, H, et al. (författare) Spectral distribution of particle fluence in small field detectors and its implication on small field dosimetry 2017 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 44:2, s. 713-724 Tidskriftsartikel (refereegranskat)
16.	Berggren, Karl, 1989-, et al. (författare) Characterization of photon-counting multislit breast tomosynthesis 2018 Ingår i: Medical Physics. - : John Wiley & Sons. - 2473-4209 .- 0094-2405. Tidskriftsartikel (refereegranskat)abstract Purpose: It has been shown that breast tomosynthesis may improve sensitivity and specificity compared to two-dimensional mammography, resulting in increased detection-rate of cancers or lowered call-back rates. The purpose of this study is to characterize a spectral photon-counting multislit breast tomosynthesis system that is able to do single-scan spectral imaging with multiple collimated x-ray beams. The system differs in many aspects compared to conventional tomosynthesis using energyintegrating flat-panel detectors. Methods: The investigated system was a prototype consisting of a dual-threshold photon-counting detector with 21 collimated line detectors scanning across the compressed breast. A review of the system is done in terms of detector, acquisition geometry, and reconstruction methods. Three reconstruction methods were used, simple back-projection, filtered back-projection and an iterative algebraic reconstruction technique. The image quality was evaluated by measuring the modulation transfer-function (MTF), normalized noise-power spectrum, detective quantum-efficiency (DQE), and artifact spread-function (ASF) on reconstructed spectral tomosynthesis images for a total-energy bin (defined by a low-energy threshold calibrated to remove electronic noise) and for a high-energy bin (with a threshold calibrated to split the spectrum in roughly equal parts). Acquisition was performed using a 29 kVp W/Al x-ray spectrum at a 0.24 mGy exposure. Results: The difference in MTF between the two energy bins was negligible, that is, there was no energy dependence on resolution. The MTF dropped to 50% at 1.5 lp/mm to 2.3 lp/mm in the scan direction and 2.4 lp/mm to 3.3 lp/mm in the slit direction, depending on the reconstruction method. The full width at half maximum of the ASF was found to range from 13.8 mm to 18.0 mm for the different reconstruction methods. The zero-frequency DQE of the system was found to be 0.72. The fraction of counts in the high-energy bin was measured to be 59% of the total detected spectrum. Scantimes ranged from 4 s to 16.5 s depending on voltage and current settings. Conclusions: The characterized system generates spectral tomosynthesis images with a dual-energy photon-counting detector. Measurements show a high DQE, enabling high image quality at a low dose, which is beneficial for low-dose applications such as screening. The single-scan spectral images open up for applications such as quantitative material decomposition and contrast-enhanced tomosynthesis.
17.	Böck, Michelle (författare) On adaptation cost and tractability in robust adaptive radiation therapy optimization 2020 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 47:7, s. 2791-2804 Tidskriftsartikel (refereegranskat)abstract Purpose In this paper, a framework for online robust adaptive radiation therapy (ART) is discussed and evaluated. The purpose of the presented approach to ART is to: (a) handle interfractional geometric variations following a probability distribution different from the a priori hypothesis, (b) address adaptation cost, and Methods A novel framework for online robust ART using the concept of Bayesian inference and scenario reduction is introduced and evaluated in a series of simulated cases on a one-dimensional phantom geometry. The initial robust plan is generated from a robust optimization problem based on either expected-value or worst-case optimization approach using the a priori hypothesis of the probability distribution governing the interfractional geometric variations. Throughout the course of treatment, the simulated interfractional variations are evaluated in terms of their likelihood with respect to the a priori hypothesis of their distribution and violation of user-specified tolerance limits by the accumulated dose. If an adaptation is considered, the a posteriori distribution is computed from the actual variations using Bayesian inference. Then, the adapted plan is optimized to better suit the actual interfractional variations of the individual case. This adapted plan is used until the next adaptation is triggered. To address adaptation cost, the proposed framework provides an option for increased adaptation frequency. Computational tractability in robust planning and ART is addressed by an approximation algorithm to reduce the size of the optimization problem. Results According to the simulations, the proposed framework may improve target coverage compared to the corresponding nonadaptive robust approach. In particular, Bayesian inference may be useful to individualize plans to the actual interfractional variations. Concerning adaptation cost, the results indicate that mathematical methods like Bayesian inference may have a greater impact on improving individual treatment quality than increased adaptation frequency. In addition, the simulations suggest that the concept of scenario reduction may be useful to address computational tractability in ART and robust planning in general. Conclusions The simulations indicate that the adapted plans may improve target coverage and OAR protection at manageable adaptation and computational cost within the novel framework. In particular, adaptive strategies using Bayesian inference appear to perform best among all strategies. This proof-of-concept study provides insights into the mathematical aspects of robustness, tractability, and ART, which are a useful guide for further development of frameworks for online robust ART.
18.	Candela-Juan, C., et al. (författare) Dosimetric characterization of two radium sources for retrospective dosimetry studies 2015 Ingår i: Medical physics (Lancaster). - : American Association of Physicists in Medicine: Medical Physics. - 0094-2405 .- 2473-4209. ; 42:5, s. 2132-2142 Tidskriftsartikel (refereegranskat)abstract Purpose: During the first part of the 20th century, Ra-226 was the most used radionuclide for brachytherapy. Retrospective accurate dosimetry, coupled with patient follow up, is important for advancing knowledge on long-term radiation effects. The purpose of this work was to dosimetrically characterize two Ra-226 sources, commonly used in Sweden during the first half of the 20th century, for retrospective dose-effect studies. Methods: An 8 mg Ra-226 tube and a 10 mg Ra-226 needle, used at Radiumhemmet (Karolinska University Hospital, Stockholm, Sweden), from 1925 to the 1960s, were modeled in two independent Monte Carlo (MC) radiation transport codes: GEANT4 and MCNP5. Absorbed dose and collision kerma around the two sources were obtained, from which the TG-43 parameters were derived for the secular equilibrium state. Furthermore, results from this dosimetric formalism were compared with results from a MC simulation with a superficial mould constituted by five needles inside a glass casing, placed over a water phantom, trying to mimic a typical clinical setup. Calculated absorbed doses using the TG-43 formalism were also compared with previously reported measurements and calculations based on the Sievert integral. Finally, the dose rate at large distances from a Ra-226 point-like-source placed in the center of 1 m radius water sphere was calculated with GEANT4. Results: TG-43 parameters [including gL(r), F(r,theta), Lambda, and s(K)] have been uploaded in spreadsheets as additional material, and the fitting parameters of a mathematical curve that provides the dose rate between 10 and 60 cm from the source have been provided. Results from TG-43 formalism are consistent within the treatment volume with those of a MC simulation of a typical clinical scenario. Comparisons with reported measurements made with thermoluminescent dosimeters show differences up to 13% along the transverse axis of the radium needle. It has been estimated that the uncertainty associated to the absorbed dose within the treatment volume is 10%-15%, whereas uncertainty of absorbed dose to distant organs is roughly 20%-25%. Conclusions: The results provided here facilitate retrospective dosimetry studies of Ra-226 using modern treatment planning systems, which may be used to improve knowledge on long term radiation effects. It is surely important for the epidemiologic studies to be aware of the estimated uncertainty provided here before extracting their conclusions.
19.	Das, Indra J., et al. (författare) Report of AAPM Task Group 155 : Megavoltage photon beam dosimetry in small fields and non-equilibrium conditions 2021 Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 48:10, s. E886-E921 Tidskriftsartikel (refereegranskat)abstract Small-field dosimetry used in advance treatment technologies poses challenges due to loss of lateral charged particle equilibrium (LCPE), occlusion of the primary photon source, and the limited choice of suitable radiation detectors. These challenges greatly influence dosimetric accuracy. Many high-profile radiation incidents have demonstrated a poor understanding of appropriate methodology for small-field dosimetry. These incidents are a cause for concern because the use of small fields in various specialized radiation treatment techniques continues to grow rapidly. Reference and relative dosimetry in small and composite fields are the subject of the International Atomic Energy Agency (IAEA) dosimetry code of practice that has been published as TRS-483 and an AAPM summary publication (IAEA TRS 483; Dosimetry of small static fields used in external beam radiotherapy: An IAEA/AAPM International Code of Practice for reference and relative dose determination, Technical Report Series No. 483; Pal-mans et al., Med Phys 45(11):e1123, 2018). The charge of AAPM task group 155 (TG-155) is to summarize current knowledge on small-field dosimetry and to provide recommendations of best practices for relative dose determination in small megavoltage photon beams. An overview of the issue of LCPE and the changes in photon beam perturbations with decreasing field size is provided. Recommendations are included on appropriate detector systems and measurement methodologies. Existing published data on dosimetric parameters in small photon fields (e.g., percentage depth dose, tissue phantom ratio/tissue maximum ratio, off-axis ratios, and field output factors) together with the necessary perturbation corrections for various detectors are reviewed. A discussion on errors and an uncertainty analysis in measurements is provided. The design of beam models in treatment planning systems to simulate small fields necessitates special attention on the influence of the primary beam source and collimating devices in the computation of energy fluence and dose. The general requirements for fluence and dose calculation engines suitable for modeling dose in small fields are reviewed. Implementations in commercial treatment planning systems vary widely, and the aims of this report are to provide insight for the medical physicist and guidance to developers of beams models for radiotherapy treatment planning systems.
20.	Dasu, Alexandru, et al. (författare) Impact of variable RBE on proton fractionation 2013 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 40:1 Tidskriftsartikel (refereegranskat)abstract Purpose: To explore the impact of variable proton RBE on dose fractionation for clinically-relevant situations. A generic RBE=1.1 is generally used for isoeffect calculations, while experimental studies showed that proton RBE varies with tissue type, dose and LET.Material and methods: An analytical expression for the LET and α/β dependence of the LQ model has been used for proton simulations in parallel with the assumption of a generic RBE=1.1. Calculations have been performed for ranges of LET values and fractionation sensitivities to describe clinically-relevant cases, like the treatment of H&N and prostate tumors. Isoeffect calculations were compared with predictions from a generic RBE value and reported clinical results.Results: The generic RBE=1.1 appears to be a reasonable estimate for the proton RBE of rapidly growing tissues irradiated with low LET radiation. However, the use of a variable RBE predicts larger differences for tissues with low α/β (both tumor and normal) and at low doses per fraction. In some situations these differences may appear in contrast to the findings from photon studies highlighting the importance of accurate accounting for the radiobiological effectiveness of protons. Furthermore, the use of variable RBE leads to closer predictions to clinical results. Conclusions: The LET dependence of the RBE has a strong impact on the predicted effectiveness of fractionated proton radiotherapy. The magnitude of the effect is modulated by the fractionation sensitivity and the fractional dose indicating the need for accurate analyses both in the target and around it. Care should therefore be employed for changing clinical fractionation patterns or when analyzing results from clinical studies for this type of radiation.
21.	Eriksson, O., et al. (författare) Robust automated radiation therapy treatment planning using scenario-specific dose prediction and robust dose mimicking 2022 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 49:6, s. 3564-3573 Tidskriftsartikel (refereegranskat)abstract Purpose: We present a framework for robust automated treatment planning using machine learning, comprising scenario-specific dose prediction and robust dose mimicking. Methods: The scenario dose prediction pipeline is divided into the prediction of nominal dose from input image and the prediction of scenario dose from nominal dose, each using a deep learning model with U-net architecture. By using a specially developed dose–volume histogram–based loss function, the predicted scenario doses are ensured sufficient target coverage despite the possibility of the training data being non-robust. Deliverable plans may then be created by solving a robust dose mimicking problem with the predictions as scenario-specific reference doses. Results: Numerical experiments are performed using a data set of 52 intensity-modulated proton therapy plans for prostate patients. We show that the predicted scenario doses resemble their respective ground truth well, in particular while having target coverage comparable to that of the nominal scenario. The deliverable plans produced by the subsequent robust dose mimicking were showed to be robust against the same scenario set considered for prediction. Conclusions: We demonstrate the feasibility and merits of the proposed methodology for incorporating robustness into automated treatment planning algorithms.
22.	Fan, Peng, et al. (författare) Scatter and crosstalk corrections for (99m)Tc/(123)I dual-radionuclide imaging using a CZT SPECT system with pinhole collimators. 2015 Ingår i: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 42:12, s. 6895-6911 Tidskriftsartikel (refereegranskat)abstract The energy spectrum for a cadmium zinc telluride (CZT) detector has a low energy tail due to incomplete charge collection and intercrystal scattering. Due to these solid-state detector effects, scatter would be overestimated if the conventional triple-energy window (TEW) method is used for scatter and crosstalk corrections in CZT-based imaging systems. The objective of this work is to develop a scatter and crosstalk correction method for (99m)Tc/(123)I dual-radionuclide imaging for a CZT-based dedicated cardiac SPECT system with pinhole collimators (GE Discovery NM 530c/570c).
23.	Georgi, Peter, et al. (författare) Determination of intrinsic energy dependence of point-like inorganic scintillation detector in brachytherapy 2024 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405. Tidskriftsartikel (refereegranskat)abstract Background: Inorganic scintillation detectors (ISDs) are promising for in vivo dosimetry in brachytherapy (BT). ISDs have fast response, providing time resolved dose rate information, and high sensitivity, attributed to high atomic numbers. However, the conversion of the detector signal to absorbed dose-to-water is highly dependent on the energy spectrum of the incident radiation. This dependence is comprised of absorbed dose energy dependence, obtainable with Monte Carlo (MC) simulation, and the absorbed dose-to-signal conversion efficiency or intrinsic energy dependence requiring measurements. Studies have indicated negligible intrinsic energy dependence of ZnSe:O-based ISDs in Ir-192 BT. A full characterization has not been performed earlier.Purpose: This study characterizes the intrinsic energy dependence of ZnSe:O-based ISDs for kV X-ray radiation qualities, with energies relevant for BT.Methods: Three point-like ISDs made from fiber-coupled cuboid ZnSe:O-based scintillators were calibrated at the Swedish National Metrology Laboratory for ionizing radiation. The calibration was done in terms of air kerma free-in-air, K-air, in 13 X-ray radiation qualities, Q, from 25 to 300 kVp (CCRI 25-250 kV and ISO 4037 N-series), and in terms of absorbed dose to water, D-w, in a Co-60 beam, Q(0).The mean absorbed dose to the ISDs, relative to K-air and D-w, were obtained with the MC code TOPAS (Geant4) using X-ray spectra obtained with SpekPy software and laboratory filtration data and a generic Co-60 source.The intrinsic energy dependence was determined as a function of effective photon energy, E-eff, (relative to Co-60).The angular dependence of the ISD signal was measured in a 25 kVp (0.20 mm Al HVL) and 135 kVp beam (0.48 mm Cu HVL), by rotating the ISDs 180 degrees around the fiber's longitudinal axis (perpendicular to the beam). A full 360 degrees was not performed due to setup limitations. The impact of detector design was quantified with MC simulation.ResultsAbove 30 keV E-eff the intrinsic energy dependence varied with less than 5 +/- 4% from unity for all detectors (with the uncertainty expressed as the mean of all expanded measurement uncertainties for individual E-eff above 30 keV, k = 2). Below 30 keV, it decreased with up to 17% and inter-detector variations of 13% were observed, likely due to differences in detector geometry not captured by the simulations using nominal geometry. In the 25 kVp radiation quality, the ISD signal varied with 24% over a similar to 45 degrees rotation. For 135 kVp, the corresponding variation was below 3%. Assuming a 0.05 mm thicker layer of reflective paint around the sensitive volume changed the absorbed dose with 6.3% at the lowest E-eff, and with less than 2% at higher energies.ConclusionThe study suggests that the ISDs have an intrinsic energy dependence relative to Co-60 lower than 5 +/- 4% in radiation qualities with E-eff > 30 keV. Therefore, they could in principle be calibrated in a Co-60 beam quality and transferred to such radiation qualities with correction factors determined only by the absorbed dose energy dependence obtained from MC simulations. This encourages exploration of the ISDs' applications in intensity modulated BT with Yb-169 or other novel intermediate energy isotopes.
24.	Ghazal, Mohammed, et al. (författare) 6-MV small field output factors: intra-/intermachine comparison and implementation of TRS-483 using various detectors and several linear accelerators 2019 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405 .- 2473-4209. ; 46:11, s. 5350-5359 Tidskriftsartikel (refereegranskat)abstract Purpose To investigate the applicability of output correction factors reported in TRS-483 on 6-MV small-field detector-reading ratios using four solid-state detectors. Also, to investigate variations in 6-MV small-field output factors (OF) among nominally matched linear accelerators (linacs). Methods The TRS-483 Code of Practice (CoP) introduced and provided output correction factors to be applied to measured detector-reading ratios to obtain OFs for several small-field detectors. Detector readings for 0.5 cm x 0.5 cm to 8 cm x 8 cm fields were measured and normalized to that of 10 cm x 10 cm field giving the detector-reading ratios. Three silicon diodes, IBA PFD, IBA EFD (IBA, Schwarzenbruck, Germany), PTW T60017, and one microdiamond, PTW T60019 (PTW, Freiburg, Germany), were used. Output correction factors from the CoP were applied to measured detector-reading ratios. Measurements were performed on six Clinac and six TrueBeam linacs (Varian Medical Systems, Palo Alto, USA). An investigation of the relationship between the size of small fields and corresponding detector-reading ratio among the linacs was performed by measuring lateral dose profiles for 0.5 cm x 0.5 cm fields to determine the full width half maximum (FWHM). The relationship between the linacs focal spot size and the small-field detector-reading ratio was investigated by measuring 10 cm x 10 cm lateral dose profiles and determining the penumbra width reflecting the focal spot size. Measurement geometry was as follows: gantry angle = 0 degrees, collimator angle = 0 degrees, source-to surface distance (SSD) = 90 cm, and depth in water = 10 cm. Results For a given linac and 0.5 cm x 0.5 cm field, the deviations in detector-reading ratios among the detectors were 9%-15% for the Clinacs and 4%-5% for the TrueBeams. Use of output correction factors reduced these deviations to 6%-12% and 3%-4%, respectively. For field sizes equal to or larger than 0.8 cm x 0.8 cm, the deviations were corrected to 1% using output correction factors for both Clinacs and TrueBeams. For a given detector and 0.5 cm x 0.5 cm field, the deviations in detector-reading ratios among the linacs were 11%-17% for the Clinacs and 5-6% for the TrueBeams. For 1 cm x 1 cm the deviations were 1%-2% for Clinacs and 1% for TrueBeams. For field sizes larger than 1 cm x 1 cm the deviations were within 1% for both Clinacs and TrueBeams. No relationship between FWHMs and detector-reading ratios for 0.5 cm x 0.5 cm was observed. For Clinacs, larger 10 cm x 10 cm penumbra width yielded lower 0.5 cm x 0.5 cm detector-reading ratio indicating an effect of the focal spot size. For TrueBeams, the spread of penumbra widths was lower compared to Clinacs and no similar relationship was observed. Conclusions Output correction factors from the TRS-483 CoP are not sufficient for accurate determination of OF for 0.5 cm x 0.5 cm fields but are applicable for 0.8 cm x 0.8 cm to 8 cm x 8 cm fields. Nominally matched Clinacs and TrueBeams show large differences in detector-reading ratios for fields smaller than 1 cm x 1 cm.
25.	Giantsoudi, D., et al. (författare) A gEUD-based inverse planning technique for HDR prostate brachytherapy : Feasibility study 2013 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 40:4, s. 041704- Tidskriftsartikel (refereegranskat)abstract Purpose: The purpose of this work was to study the feasibility of a new inverse planning technique based on the generalized equivalent uniform dose for image-guided high dose rate (HDR) prostate cancer brachytherapy in comparison to conventional dose-volume based optimization. Methods: The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO (Hybrid Inverse Planning Optimization) is compared with alternative plans, which were produced through inverse planning using the generalized equivalent uniform dose (gEUD). All the common dose-volume indices for the prostate and the organs at risk were considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by comparing dose volume histogram and gEUD evaluators. Results: Our results demonstrate the feasibility of gEUD-based inverse planning in HDR brachytherapy implants for prostate. A statistically significant decrease in D-10 or/and final gEUD values for the organs at risk (urethra, bladder, and rectum) was found while improving dose homogeneity or dose conformity of the target volume. Conclusions: Following the promising results of gEUD-based optimization in intensity modulated radiation therapy treatment optimization, as reported in the literature, the implementation of a similar model in HDR brachytherapy treatment plan optimization is suggested by this study. The potential of improved sparing of organs at risk was shown for various gEUD-based optimization parameter protocols, which indicates the ability of this method to adapt to the user's preferences.
26.	Gotz, Malte, et al. (författare) Correction for volume recombination in liquid ionization chambers at high dose-per-pulse 2019 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405 .- 2473-4209. ; 46:8, s. 3692-3699 Tidskriftsartikel (refereegranskat)abstract Purpose To determine the volume recombination at high dose-per-pulse in liquid ionization chambers (LIC) and to ascertain whether existing calculation methods verified in air-filled chambers may be used to calculate a correction factor. Methods Two LICs, one filled with 2,2,4-trimethylpentane (isooctane) the other with tetramethylsilane (TMS), were irradiated in a pulsed, 20 MeV electron beam. Via reference measurements with a Faraday cup, the saturation correction for volume recombination was determined for dose-per-pulse values ranging from about 5 mGy to 1 Gy for both chambers at a pulse duration of 693 ns. In addition, the isooctane chamber was irradiated with pulses of varying duration, ranging from 5 ps to 10 ms, at a dose-per-pulse of about 76.5 mGy. The dose-per-pulse-dependent measurements were compared to calculations based on Boag's models (with and without a free electron fraction), the two-dose-rate method, and a numerical calculation. The pulse duration dependent measurements were compared only to a numerical calculation that iteratively calculates the charge transport and loss in a 1D model of an ionization chamber. Results In TMS only Boag's model with a free electron fraction and the numerical calculation are in good agreement with the experimental data. However, in isooctane, good agreement is observed between the experimental data, the numerical calculation as well as the two-dose-rate method, and Boag's model including a free electron fraction. Only Boag's model without a free electron fraction shows a good agreement with lesser extend. Furthermore, the pulse duration-dependent data for isooctane are well described by the numerical model. Conclusion With isooctane as an active medium, a LIC could be directly used in a field with high dose-per-pulse utilizing the well-established two-dose-rate method to correct the volume recombination. In addition, pulsed fields with variable pulse duration are easily modeled for this medium using a numerical calculation. Other media, as exemplified by the TMS-filled chamber, might require additional considerations, such as including a fraction of free electrons in the consideration of volume recombination.
27.	Götstedt, Julia, et al. (författare) Development and evaluation of aperture-based complexity metrics using film and EPID measurements of static MLC openings. 2015 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 42:7, s. 3911-21 Tidskriftsartikel (refereegranskat)abstract Complexity metrics have been suggested as a complement to measurement-based quality assurance for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). However, these metrics have not yet been sufficiently validated. This study develops and evaluates new aperture-based complexity metrics in the context of static multileaf collimator (MLC) openings and compares them to previously published metrics.This study develops the converted aperture metric and the edge area metric. The converted aperture metric is based on small and irregular parts within the MLC opening that are quantified as measured distances between MLC leaves. The edge area metric is based on the relative size of the region around the edges defined by the MLC. Another metric suggested in this study is the circumference/area ratio. Earlier defined aperture-based complexity metrics-the modulation complexity score, the edge metric, the ratio monitor units (MU)/Gy, the aperture area, and the aperture irregularity-are compared to the newly proposed metrics. A set of small and irregular static MLC openings are created which simulate individual IMRT/VMAT control points of various complexities. These are measured with both an amorphous silicon electronic portal imaging device and EBT3 film. The differences between calculated and measured dose distributions are evaluated using a pixel-by-pixel comparison with two global dose difference criteria of 3% and 5%. The extent of the dose differences, expressed in terms of pass rate, is used as a measure of the complexity of the MLC openings and used for the evaluation of the metrics compared in this study. The different complexity scores are calculated for each created static MLC opening. The correlation between the calculated complexity scores and the extent of the dose differences (pass rate) are analyzed in scatter plots and using Pearson's r-values.The complexity scores calculated by the edge area metric, converted aperture metric, circumference/area ratio, edge metric, and MU/Gy ratio show good linear correlation to the complexity of the MLC openings, expressed as the 5% dose difference pass rate, with Pearson's r-values of -0.94, -0.88, -0.84, -0.89, and -0.82, respectively. The overall trends for the 3% and 5% dose difference evaluations are similar.New complexity metrics are developed. The calculated scores correlate to the complexity of the created static MLC openings. The complexity of the MLC opening is dependent on the penumbra region relative to the area of the opening. The aperture-based complexity metrics that combined either the distances between the MLC leaves or the MLC opening circumference with the aperture area show the best correlation with the complexity of the static MLC openings.
28.	Hartmann, GH, et al. (författare) Cema-based formalism for the determination of absorbed dose for high-energy photon beams 2021 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 48:11, s. 7461-7475 Tidskriftsartikel (refereegranskat)
29.	Hinton, B, et al. (författare) Derived mammographic masking measures based on simulated lesions predict the risk of interval cancer after controlling for known risk factors: a case-case analysis 2019 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 46:3, s. 1309-1316 Tidskriftsartikel (refereegranskat)
30.	Holmes, Robin B., et al. (författare) Creation of an anthropomorphic CT head phantom for verification of image segmentation 2020 Ingår i: Medical physics (Lancaster). - : Wiley-Blackwell. - 0094-2405 .- 2473-4209. ; 47:6, s. 2380-2391 Tidskriftsartikel (refereegranskat)abstract Purpose: Many methods are available to segment structural magnetic resonance (MR) images of the brain into different tissue types. These have generally been developed for research purposes but there is some clinical use in the diagnosis of neurodegenerative diseases such as dementia. The potential exists for computed tomography (CT) segmentation to be used in place of MRI segmentation, but this will require a method to verify the accuracy of CT processing, particularly if algorithms developed for MR are used, as MR has notably greater tissue contrast.Methods: To investigate these issues we have created a three-dimensional (3D) printed brain with realistic Hounsfield unit (HU) values based on tissue maps segmented directly from an individual T1 MRI scan of a normal subject. Several T1 MRI scans of normal subjects from the ADNI database were segmented using SPM12 and used to create stereolithography files of different tissues for 3D printing. The attenuation properties of several material blends were investigated, and three suitable formulations were used to print an object expected to have realistic geometry and attenuation properties. A skull was simulated by coating the object with plaster of Paris impregnated bandages. Using two CT scanners, the realism of the phantom was assessed by the measurement of HU values, SPM12 segmentation and comparison with the source data used to create the phantom.Results: Realistic relative HU values were measured although a subtraction of 60 was required to obtain equivalence with the expected values (gray matter 32.9-35.8 phantom, 29.9-34.2 literature). Segmentation of images acquired at different kVps/mAs showed excellent agreement with the source data (Dice Similarity Coefficient 0.79 for gray matter). The performance of two scanners with two segmentation methods was compared, with the scanners found to have similar performance and with one segmentation method clearly superior to the other.Conclusion: The ability to use 3D printing to create a realistic (in terms of geometry and attenuation properties) head phantom has been demonstrated and used in an initial assessment of CT segmentation accuracy using freely available software developed for MRI.
31.	Hufnagl, A, et al. (författare) Modeling secondary cancer risk ratios for proton versus carbon ion beam therapy: A comparative study based on the local effect model 2022 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 49:8, s. 5589-5603 Tidskriftsartikel (refereegranskat)
32.	Häger, Wille, et al. (författare) Experimental investigation of TRS-483 reference dosimetry correction factors for Leksell Gamma Knife (R) Icon (TM) beams 2021 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 48:1, s. 434-444 Tidskriftsartikel (refereegranskat)abstract Purpose: Radiosurgery using the Leksell Gamma Knife (R) (LGK) Icon (TM) is an established technique used for treating intracranial lesions. The largest beam field size the LGK Icon can produce is a 16 mm diameter sphere. Despite this, reference dosimetry on the LGK Icon is typically performed using ionization chambers calibrated in 10 x 10 cm(2) fields. Furthermore, plastic phantoms are widely used instead of liquid water phantoms. In an effort to resolve these issues, the International Atomic Energy Agency (IAEA) in collaboration with American Association of Physicists in medicine (AAPM) recently published Technical Report Series No. 483 (TRS-483) as a Code of Practice for small-field dosimetry. TRS-483 includes small-field correction factors, k(Qmsr,Q0)(fmsr,fref), intended to account for the differences between setups when using small-field modalities such as the LGK Icon, and conventional setups. Since the publication of TRS-483, at least three new sets of values of k(Qmsr,Q0)(fmsr,fref) for the LGK Icon have been published. The purpose of this study was to experimentally investigate the published values of k(Qmsr,Q0)(fmsr,fref) for commonly used phantom and ionization chamber (IC) models for the LGK Icon.Methods: Dose-rates from two LGK units were determined using acrylonitrile butadiene styrene (ABS) and Certified Medical Grade Solid Water (R) (SW) phantoms, and PTW 31010 and PTW 31016 ICs. Correction factors were applied, and the resulting dose-rates compared. Relative validity of the correction factors was investigated by taking the ratios of dose-rate correction factor products. Additionally, dose-rates from the individual sectors were determined in order to calculate the beam attenuation caused by the ABS phantom adapter.Results and Conclusions: It was seen that the dose-rate is underestimated by at least 1% when using the ABS phantom, which was attributed to fluence perturbation caused by the IC and phantom adapter. Published correction factors k(Qmsr,Q0)(fmsr,fref) account for these effects to varying degree and should be used. The SW phantom is unlikely to underestimate the dose-rate by more than 1%, and applying k(Qmsr,Q0)(fmsr,fref) could not be shown to be necessary. Out of the two phantom models, the ABS phantom is not recommended for use in LGK reference dosimetry. The use of newly published values of k(Qmsr,Q0)(fmsr,fref) should be considered.
33.	Johansson, Adam, et al. (författare) Gastrointestinal 4D MRI with respiratory motion correction 2021 Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 48:5, s. 2521-2527 Tidskriftsartikel (refereegranskat)abstract Purpose Gastrointestinal motion patterns such as peristalsis and segmental contractions can alter the shape and position of the stomach and intestines with respect to other irradiated organs during radiation therapy. Unfortunately, these deformations are concealed by conventional four-dimensional (4D)-MRI techniques, which were developed to visualize respiratory motion by binning acquired data into respiratory motion states without considering the phases of GI motion. We present a method to reconstruct breathing-compensated images showing the phases of periodic gastric motion and study the effect of this motion on regional anatomical structures. Methods Sixty-seven DCE-MRI examinations were performed on patients undergoing MRI simulation for hepatocellular carcinoma using a golden-angle stack-of-stars sequence that collected 2000 radial spokes over 5 min. The collected data were reconstructed using a method with integrated respiratory motion correction into a time series of 3D image volumes without visible breathing motion. From this series, a gastric motion signal was extracted by temporal filtering of time-intensity curves in the stomach. Using this motion signal, breathing-corrected back-projection images were sorted according to the gastric phase and reconstructed into 21 gastric motion state images showing the phases of gastric motion. Results Reconstructed image volumes showed gastric motion states clearly with no visible breathing motion or related artifacts. The mean frequency of the gastric motion signal was 3 cycles/min with a standard deviation of 0.27 cycles/min. Conclusions Periodic gastrointestinal motion can be visualized without confounding respiratory motion using the presented GI 4D MRI technique. GI 4D MRIs may help define internal target volumes for treatment planning, aid in planning organ at risk volume definition, or support motion model development for gastrointestinal motion tracking algorithms for real-time MR-guided radiation therapy.
34.	Kalholm, Fredrik, et al. (författare) Modeling RBE with other quantities than LET significantly improves prediction of in vitro cell survival for proton therapy 2023 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 50:1, s. 651-659 Tidskriftsartikel (refereegranskat)abstract Background: For proton therapy, a relative biological effectiveness (RBE) of 1.1 has broadly been applied clinically. However, as unexpected toxicities have been observed by the end of the proton tracks, variable RBE models have been proposed. Typically, the dose-averaged linear energy transfer (LETd) has been used as an input variable for these models but the way the LETd was defined, calculated, or determined was not always consistent, potentially impacting the corresponding RBE value.Purpose: This study compares consistently calculated LETd with other quantities as input variables for a phenomenological RBE model and attempts to determine which quantity that can best predicts proton RBE. The comparison was performed within the frame of introducing a new model for the proton RBE.Methods: High-throughput experimental setups of in vitro cell survival studies for proton RBE determination are simulated using the SHIELD-HIT12A Monte Carlo particle transport code. Together with LET, z∗2∕?2, here called effective Q (Qeff), and Q are scored. Each quantity is calculated using the dose and track averaging methods, because the scoring includes all hadronic particles, all protons or only primaries. A phenomenological linear-quadratic-based RBE model is subsequently applied to the in vitro data with the various beam quality descriptors used as input variables and the goodness of fit is determined and compared using a bootstrapping approach. Both linear and nonlinear fit functions were tested.Results: Versions of Qeff and Q outperform LET with a statistically significant margin, with the best nonlinear and linear fit having a relative root mean square error (RMSE) for RBE2Gy ± one standard error of 1.55 ± 0.04 (Qeff, t, primary) and 2.84 ± 0.07 (Qeff, d, primary), respectively. For comparison, the corresponding best nonlinear and linear fits for LETd, all protons had a relative RMSE of 2.07 ± 0.06 and 3.39 ± 0.08, respectively. Applying Welch's t-test for comparing the calculated RMSE of RBE2Gy resulted in two-tailed p-values of <0.002 for all Q and Qeff quantities compared to LETd, all protons.Conclusions: The study shows that Q or Qeff could be better RBE descriptors that dose averaged LET.
35.	Kaushik, Suryakant, 1993-, et al. (författare) Generation and evaluation of anatomy-preserving virtual CT for online adaptive proton therapy 2024 Ingår i: Medical physics (Lancaster). - 0094-2405. ; 51:3, s. 1536-1546 Tidskriftsartikel (refereegranskat)abstract Background: Daily CTs generated by CBCT correction are required for daily replanning in online-adaptive proton therapy (APT) to effectively deal with inter-fractional changes. Out of the currently available methods, the suitability of a daily CT generation method for proton dose calculation also depends on the anatomical site.Purpose: We propose an anatomy-preserving virtual CT (APvCT) method as a hybrid method of CBCT correction, which is especially suitable for large anatomy deformations. The accuracy of the hybrid method was assessed by comparison with the corrected CBCT (cCBCT) and virtual CT (vCT) methods in the context of online APT.Methods: Seventy-one daily CBCTs of four prostate cancer patients treated with intensity modulated proton therapy (IMPT) were converted to daily CTs using cCBCT, vCT, and the newly proposed APvCT method. In APvCT, planning CT (pCT) were mapped to CBCT geometry using deformable image registration with boundary conditions on controlling regions of interest (ROIs) created with deep learning segmentation on cCBCT. The relative frequency distribution (RFD) of HU, mass density and stopping power ratio (SPR) values were assessed and compared with the pCT. The ROIs in the APvCT and vCT were compared with cCBCT in terms of Dice similarity coefficient (DSC) and mean distance-to-agreement (mDTA). For each patient, a robustly optimized IMPT plan was created on the pCT and subsequent daily adaptive plans on daily CTs. For dose distribution comparison on the same anatomy, the daily adaptive plans on cCBCT and vCT were recalculated on the corresponding APvCT. The dose distributions were compared in terms of isodose volumes and 3D global gamma-index passing rate (GPR) at γ(2%, 2 mm) criterion.Results: For all patients, no noticeable difference in RFDs was observed amongst APvCT, vCT, and pCT except in cCBCT, which showed a noticeable difference. The minimum DSC value was 0.96 and 0.39 for contours in APvCT and vCT respectively. The average value of mDTA for APvCT was 0.01 cm for clinical target volume and ≤0.01 cm for organs at risk, which increased to 0.18 cm and ≤0.52 cm for vCT. The mean GPR value was 90.9%, 64.5%, and 67.0% for APvCT versus cCBCT, vCT versus cCBCT, and APvCT versus vCT, respectively. When recalculated on APvCT, the adaptive cCBCT and vCT plans resulted in mean GPRs of 89.5 ± 5.1% and 65.9 ± 19.1%, respectively. The mean DSC values for 80.0%, 90.0%, 95.0%, 98.0%, and 100.0% isodose volumes were 0.97, 0.97, 0.97, 0.95, and 0.91 for recalculated cCBCT plans, and 0.89, 0.88, 0.87, 0.85, and 0.81 for recalculated vCT plans. Hausdorff distance for the 100.0% isodose volume in some cases of recalculated cCBCT plans on APvCT exceeded 1.00 cm.Conclusions: APvCT contours showed good agreement with reference contours of cCBCT which indicates anatomy preservation in APvCT. A vCT with erroneous anatomy can result in an incorrect adaptive plan. Further, slightly lower values of GPR between the APvCT and cCBCT-based adaptive plans can be explained by the difference in the cCBCT's SPR RFD from the pCT.
36.	Kaveckyte, Vaiva, et al. (författare) Investigation of a synthetic diamond detector response in kilovoltage photon beams 2020 Ingår i: Medical physics (Lancaster). - : Wiley-Blackwell Publishing Inc.. - 0094-2405 .- 2473-4209. ; 47:3, s. 1268-1279 Tidskriftsartikel (refereegranskat)abstract Purpose An important characteristic of radiation dosimetry detectors is their energy response which consists of absorbed-dose and intrinsic energy responses. The former can be characterized using Monte Carlo (MC) simulations, whereas the latter (i.e., detector signal per absorbed dose to detector) is extracted from experimental data. Such a characterization is especially relevant when detectors are used in nonrelative measurements at a beam quality that differs from the calibration beam quality. Having in mind the possible application of synthetic diamond detectors (microDiamond PTW 60019, Freiburg, Germany) for nonrelative dosimetry of low-energy brachytherapy (BT) beams, we determined their intrinsic and absorbed-dose energy responses in 25-250 kV beams relative to a Co-60 beam, which is usually the reference beam quality for detector calibration in radiotherapy. Material and Methods Three microDiamond detectors and, for comparison, two silicon diodes (PTW 60017) were calibrated in terms of air-kerma free in air in six x-ray beam qualities (from 25 to 250 kV) and in terms of absorbed dose to water in a Co-60 beam at the national metrology laboratory in Sweden. The PENELOPE/penEasy MC radiation transport code was used to calculate the absorbed-dose energy response of the detectors (modeled based on blueprints) relative to air and water depending on calibration conditions. The MC results were used to extract the relative intrinsic energy response of the detectors from the overall energy response. Measurements using an independent setup with a single ophthalmic BEBIG I25.S16 I-125 BT seed (effective photon energy of 28 keV) were used as a qualitative check of the extracted intrinsic energy response correction factors. Additionally, the impact of the thickness of the active volume as well as the presence of extra-cameral components on the absorbed-dose energy response of a microDiamond detector was studied using MC simulations. Results The relative intrinsic energy response of the microDiamond detectors was higher by a factor of 2 in 25 and 50 kV beams compared to the Co-60 beam. The variation in the relative intrinsic energy response of silicon diodes was within 10% over the investigated photon energy range. The use of relative intrinsic energy response correction factors improved the agreement among the absorbed dose to water values determined using microDiamond detectors and silicon diodes, as well as with the TG-43 formalism-based calculations for the I-125 seed. MC study of microDiamond detector design features provided a possible explanation for inter-detector response variation at low-energy photon beams by differences in the effective thickness of the active volume. Conclusions MicroDiamond detectors had a non-negligible variation in the relative intrinsic energy response (factor of 2) which was comparable to that in the absorbed-dose energy response relative to water at low-energy photon beams. Silicon diodes, in contrast, had an absorbed-dose energy dependence on photon energy that varied by a factor of 6, whereas the intrinsic energy dependence on beam quality was within 10%. It is important to decouple these two responses for a full characterization of detector energy response especially when the user and reference beam qualities differ significantly, and MC alone is not enough.
37.	Kaveckyte, Vaiva, et al. (författare) Monte Carlo characterization of high atomic number inorganic scintillators for in vivo dosimetry in Ir-192 brachytherapy 2022 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405 .- 2473-4209. ; 49:7, s. 4715-4730 Tidskriftsartikel (refereegranskat)abstract BackgroundThere is increased interest in in vivo dosimetry for 192Ir brachytherapy (BT) treatments using high atomic number (Z) inorganic scintillators. Their high light output enables construction of small detectors with negligible stem effect and simple readout electronics. Experimental determination of absorbed-dose energy dependence of detectors relative to water is prevalent, but it can be prone to high detector positioning uncertainties and does not allow for decoupling of absorbed-dose energy dependence from other factors affecting detector response .PurposeTo investigate which measurement conditions and detector properties could affect their absorbed-dose energy dependence in BT in vivo dosimetry.MethodsWe used a general-purpose Monte Carlo (MC) code PENELOPE for the characterization of high-Z inorganic scintillators with the focus on ZnSe () Z. Two other promising media CsI () and Al2O3 () were included for comparison in selected scenarios. We determined absorbed-dose energy dependence of crystals relative to water under different scatter conditions (calibration phantom 12 × 12 × 30 cm3, characterization phantoms 20 × 20 × 20 cm3, 30 × 30 × 30 cm3, 40 × 40 × 40 cm3, and patient-like elliptic phantom 40 × 30 × 25 cm3). To mimic irradiation conditions during prostate treatments, we evaluated whether the presence of pelvic bones and calcifications affect ZnSe response. ZnSe detector design influence was also investigated.ResultsIn contrast to low-Z organic and medium-Z inorganic scintillators, ZnSe and CsI media have substantially greater absorbed-dose energy dependence relative to water. The response was phantom-size dependent and changed by 11% between limited- and full-scatter conditions for ZnSe, but not for Al2O3. For a given phantom size, a part of the absorbed-dose energy dependence of ZnSe is caused not due to in-phantom scatter but due to source anisotropy. Thus, the absorbed-dose energy dependence of high-Z scintillators is a function of not only the radial distance but also the polar angle. Pelvic bones did not affect ZnSe response, whereas large and intermediate size calcifications reduced it by 9% and 5%, respectively, when placed midway between the source and the detector.ConclusionsUnlike currently prevalent low- and medium-Z scintillators, high-Z crystals are sensitive to characterization and in vivo measurement conditions. However, good agreement between MC data for ZnSe in the present study and experimental data for ZnSe:O by Jørgensen et al. (2021) suggests that detector signal is proportional to the average absorbed dose to the detector cavity. This enables an easy correction for non-TG43-like scenarios (e.g., patient sizes and calcifications) through MC simulations. Such information should be provided to the clinic by the detector vendors.
38.	Kaveckyte, Vaiva, et al. (författare) Suitability of microDiamond detectors for the determination of absorbed dose to water around high-dose-rate Ir-192 brachytherapy sources 2018 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405 .- 2473-4209. ; 45:1, s. 429-437 Tidskriftsartikel (refereegranskat)abstract Purpose: Experimental dosimetry of high-dose-rate (HDR) Ir-192 brachytherapy (BT) sources is complicated due to high dose and dose-rate gradients, and softening of photon energy spectrum with depth. A single crystal synthetic diamond detector microDiamond (PTW 60019, Freiburg, Germany) has a small active volume, high sensitivity, direct readout, and nearly water-equivalent active volume. The purpose of this study was to evaluate the suitability of microDiamond detectors for the determination of absorbed dose to water around HDR Ir-192 BT sources. Three microDiamond detectors were used, allowing for the comparison of their properties. Methods: In-phantom measurements were performed using microSelectron and VariSource iX HDR Ir-192 BT treatment units. Their treatment planning systems (TPSs), Oncentra (v. 4.3) and BrachyVision (v. 13.6), respectively, were used to create irradiation plans for a cubic PMMA phantom with the microDiamond positioned at one of three source-to-detector distances (SDDs) (1.5, 2.5, and 5.5 cm) at a time. The source was stepped in increments of 0.5 cm over a total length of 6 cm to yield absorbed dose of 2 Gy at the nominal reference-point of the detector. Detectors were calibrated in Co-60 beam in terms of absorbed dose to water, and Monte Carlo (MC) calculated beam quality correction factors were applied to account for absorbed-dose energy dependence. Phantom correction factors were applied to account for differences in dimensions between the measurement phantom and a water phantom used for absorbed dose calculations made with a TPS. The same measurements were made with all three of the detectors. Additionally, dose-rate dependence and stability of the detectors were evaluated in Co-60 beam. Results: The percentage differences between experimentally determined and TPS-calculated absorbed doses to water were from -1.3% to +2.9%. The values agreed to within experimental uncertainties, which were from 1.9% to 4.3% (k = 2) depending on the detector, SDD and treatment delivery unit. No dose-rate or intrinsic energy dependence corrections were applied. All microDiamonds were comparable in terms of preirradiation dose, stability of the readings and energy response, and showed a good agreement. Conclusions: The results indicate that the microDiamond is potentially suitable for the determination of absorbed dose to water around HDR Ir-192 BT sources and may be used for independent verification of TPSs calculations, as well as for QA measurements of HDR Ir-192 BT treatment delivery units at clinical sites. (C) 2017 American Association of Physicists in Medicine
39.	Kjellsson Lindblom, Emely, et al. (författare) Impact of SBRT fractionation in hypoxia dose painting - accounting for heterogeneous and dynamic tumour oxygenation 2019 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 46:5, s. 2512-2521 Tidskriftsartikel (refereegranskat)abstract PurposeTumor hypoxia, often found in nonsmall cell lung cancer (NSCLC), implies an increased resistance to radiotherapy. Pretreatment assessment of tumor oxygenation is, therefore, warranted in these patients, as functional imaging of hypoxia could be used as a basis for dose painting. This study aimed at investigating the feasibility of using a method for calculating the dose required in hypoxic subvolumes segmented on 18F‐HX4 positron emission tomography (PET) imaging of NSCLC.MethodsPositron emission tomography imaging data based on the hypoxia tracer 18F‐HX4 of 19 NSCLC patients were included in the study. Normalized tracer uptake was converted to oxygen partial pressure (pO2) and hypoxic target volumes (HTVs) were segmented using a threshold of 10 mmHg. Uniform doses required to overcome the hypoxic resistance in the target volumes were calculated based on a previously proposed method taking into account the effect of interfraction reoxygenation, for fractionation schedules ranging from extremely hypofractionated stereotactic body radiotherapy (SBRT) to conventionally fractionated radiotherapy.ResultsGross target volumes ranged between 6.2 and 859.6 cm3, and the hypoxic fraction < 10 mmHg between 1.2% and 72.4%. The calculated doses for overcoming the resistance of cells in the HTVs were comparable to those currently prescribed in clinical practice as well as those previously tested in feasibility studies on dose escalation in NSCLC. Depending on the size of the HTV and the distribution of pO2, HTV doses were calculated as 43.6–48.4 Gy for a three‐fraction schedule, 51.7–57.6 Gy for five fractions, and 59.5–66.4 Gy for eight fractions. For patients in whom the HTV pO2 distribution was more favorable, a lower dose was required despite a bigger volume. Tumor control probability was lower for single‐fraction schedules, while higher levels of tumor control probability were found for schedules employing several fractions.ConclusionsThe method to account for heterogeneous and dynamic hypoxia in target volume segmentation and dose prescription based on 18F‐HX4‐PET imaging appears feasible in NSCLC patients. The distribution of oxygen partial pressure within HTV could impact the required prescribed dose more than the size of the volume.
40.	Knaup, C, et al. (författare) SU-E-T-458: Radiobiological Comparison of Single and Dual-Isotope Prostate Seed Implants 2012 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 39:66Part17, s. 3810-3810 Tidskriftsartikel (refereegranskat)
41.	Knaup, C, et al. (författare) SU-E-T-465: Exploring the Dosimetric and Tumor Control Consequences of Prostate Seed Loss and Migration 2012 Ingår i: Medical physics. - : Wiley. - 2473-4209 .- 0094-2405. ; 39:66Part17, s. 3812-3812 Tidskriftsartikel (refereegranskat)
42.	Kry, Stephen F., et al. (författare) APM Task Group 329 : Reference dose specification for dose calculations: Dose-to-water or dose-to-muscle? 2020 Ingår i: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 47:3, s. 52-64 Tidskriftsartikel (refereegranskat)abstract Linac calibration is done in water, but patients are comprised primarily of soft tissue. Conceptually, and specified in NRG/RTOG trials, dose should be reported as dose-to-muscle to describe the dose to the patient. Historically, the dose-to-water of the linac calibration was often converted to dose-to-muscle for patient calculations through manual application of a 0.99 dose-to-water to dose-to-muscle correction factor, applied during the linac clinical reference calibration. However, many current treatment planning system (TPS) dose calculation algorithms approximately provide dose-to-muscle (tissue), making application of a manual scaling unnecessary. There is little guidance on when application of a scaling factor is appropriate, resulting in highly inconsistent application of this scaling by the community. In this report we provide guidance on the steps necessary to go from the linac absorbed dose-to-water calibration to dose-to-muscle in patient, for various commercial TPS algorithms. If the TPS does not account for the difference between dose-to-water and dose-to-muscle, then TPS reference dose scaling is warranted. We have tabulated the major vendors' TPS in terms of whether they approximate dose-to-muscle or calculate dose-to-water and recommend the correction factor required to report dose-to-muscle directly from the TPS algorithm. Physicists should use this report to determine the applicable correction required for specifying the reference dose in their TPS to achieve this goal and should remain attentive to possible changes to their dose calculation algorithm in the future.
43.	Källman, Hans-Erik, PhD, 1960-, et al. (författare) Toward automated and personalized organ dose determination in CT examinations : A comparison of two tissue characterization models for Monte Carlo organ dose calculation with a Therapy Planning System 2019 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405 .- 2473-4209. ; 46:2, s. 1012-1023 Tidskriftsartikel (refereegranskat)abstract Purpose: Computed tomography (CT) is a versatile tool in diagnostic radiology with rapidly increasing number of examinations per year globally. Routine adaption of the exposure level for patient anatomy and examination protocol cause the patients' exposures to become diversified and harder to predict by simple methods. To facilitate individualized organ dose estimates, we explore the possibility to automate organ dose calculations using a radiotherapy treatment planning system (TPS). In particular, the mapping of CT number to elemental composition for Monte Carlo (MC) dose calculations is investigated.Methods: Organ dose calculations were done for a female thorax examination test case with a TPS (Raystation, Raysearch Laboratories AB, Stockholm, Sweden) utilizing a MC dose engine with a CT source model presented in a previous study. The TPS's inherent tissue characterization model for mapping of CT number to elemental composition of the tissues was calibrated using a phantom with known elemental compositions and validated through comparison of MC calculated dose with dose measured with Thermo Luminescence Dosimeters (TLD) in an anthropomorphic phantom. Given the segmentation tools of the TPS, organ segmentation strategies suitable for automation were analyzed for high contrast organs, utilizing CT number thresholding and model-based segmentation, and for low contrast organs utilizing water replacements in larger tissue volumes. Organ doses calculated with a selection of organ segmentation methods in combination with mapping of CT numbers to elemental composition (RT model), normally used in radiotherapy, were compared to a tissue characterization model with organ segmentation and elemental compositions defined by replacement materials [International Commission on Radiological Protection (ICRP) model], frequently favored in imaging dosimetry.Results: The results of the validation with the anthropomorphic phantom yielded mean deviations from the dose to water calculated with the RT and ICRP model as measured with TLD of 1.1% and 1.5% with maximum deviations of 6.1% and 8.7% respectively over all locations in the phantom. A strategy for automated organ segmentation was evaluated for two different risk organ groups, that is, low contrast soft organs and high contrast organs. The relative deviation between organ doses calculated with the RT model and with the ICRP model varied between 0% and 20% for the thorax/upper abdomen risk organs.Conclusions: After calibration, the RT model in the TPS provides accurate MC dose results as compared to measurements with TLD and the ICRP model. Dosimetric feasible segmentation of the risk organs for a female thorax demonstrates a possibility for automation using the segmentation tool available in a TPS for high contrast organs. Low contrast soft organs can be represented by water volumes, but organ dose to the esophagus and thyroid must be determined using standardized organ shapes. The uncertainties of the organ doses are small compared to the overall uncertainty, at least an order of magnitude larger, in the estimates of lifetime attributable risk (LAR) based on organ doses. Large-scale and automated individual organ dose calculations could provide an improvement in cancer incidence estimates from epidemiological studies.
44.	Lagerlöf, Jakob Heydorn, 1978, et al. (författare) Image-based 3D modeling study of the influence of vessel density and blood hemoglobin concentration on tumor oxygenation and response to irradiation. 2013 Ingår i: Medical physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 40:2 Tidskriftsartikel (refereegranskat)abstract Hypoxia is one of the most important factors influencing clinical outcome after radiotherapy. Improved knowledge of factors affecting the levels and distribution of oxygen within a tumor is needed. The authors constructed a theoretical 3D model based on histological images to analyze the influence of vessel density and hemoglobin (Hb) concentration on the response to irradiation.
45.	Lagerlöf, Jakob Heydorn, 1978, et al. (författare) The impact of including spatially longitudinal heterogeneities of vessel oxygen content and vascular fraction in 3D tumor oxygenation models on predicted radiation sensitivity. 2014 Ingår i: Medical physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 41:4 Tidskriftsartikel (refereegranskat)abstract Oxygen distribution models have been used to analyze the influences of oxygen tensions on tissue response after radiotherapy. These distributions are often generated assuming constant oxygen tension in the blood vessels. However, as red blood cells progress through the vessels, oxygen is continuously released into the plasma and the surrounding tissue, resulting in longitudinally varying oxygen levels in the blood vessels. In the present study, the authors investigated whether a tumor oxygenation model that incorporated longitudinally varying oxygen levels would provide different predictions of necrotic fractions and radiosensitivity compared to commonly used models with a constant oxygen pressure.
46.	Larsson, Daniel H., et al. (författare) First application of liquid-metal-jet sources for small-animal imaging : High-resolution CT and phase-contrast tumor demarcation 2013 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 40:2, s. 021909- Tidskriftsartikel (refereegranskat)abstract Purpose: Small-animal studies require images with high spatial resolution and high contrast due to the small scale of the structures. X-ray imaging systems for small animals are often limited by the microfocus source. Here, the authors investigate the applicability of liquid-metal-jet x-ray sources for such high-resolution small-animal imaging, both in tomography based on absorption and in soft-tissue tumor imaging based on in-line phase contrast. Methods: The experimental arrangement consists of a liquid-metal-jet x-ray source, the small-animal object on a rotating stage, and an imaging detector. The source-to-object and object-to-detector distances are adjusted for the preferred contrast mechanism. Two different liquid-metal-jet sources are used, one circulating a Ga/In/Sn alloy and the other an In/Ga alloy for higher penetration through thick tissue. Both sources are operated at 40-50 W electron-beam power with similar to 7 mu m x-ray spots, providing high spatial resolution in absorption imaging and high spatial coherence for the phase-contrast imaging. Results: High-resolution absorption imaging is demonstrated on mice with CT, showing 50 mu m bone details in the reconstructed slices. High-resolution phase-contrast soft-tissue imaging shows clear demarcation of mm-sized tumors at much lower dose than is required in absorption. Conclusions: This is the first application of liquid-metal-jet x-ray sources for whole-body small-animal x-ray imaging. In absorption, the method allows high-resolution tomographic skeletal imaging with potential for significantly shorter exposure times due to the power scalability of liquid-metal-jet sources. In phase contrast, the authors use a simple in-line arrangement to show distinct tumor demarcation of few-mm-sized tumors. This is, to their knowledge, the first small-animal tumor visualization with a laboratory phase-contrast system.
47.	Liamsuwan, Thiansin, et al. (författare) Microdosimetry of proton and carbon ions 2014 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 41:8, s. 239-250 Tidskriftsartikel (refereegranskat)abstract Purpose: To investigate microdosimetry properties of 160 MeV/u protons and 290 MeV/u C-12 ion beams in small volumes of diameters 10-100 nm. Methods: Energy distributions of primary particles and nuclear fragments in the beams were calculated from simulations with the general purpose code SHIELD-HIT, while energy depositions by monoenergetic ions in nanometer volumes were obtained from the event-by-event Monte Carlo track structure ion code PITS99 coupled with the electron track structure code KURBUC. Results: The results are presented for frequencies of energy depositions in cylindrical targets of diameters 10-100 nm, dose distributions (y) over bar (D) in lineal energy y, and dose-mean lineal energies YD For monoenergetic ions, the hp was found to increase with an increasing target size for high-linear energy transfer (LET) ions, but decrease with an increasing target size for low-LET ions. Compared to the depth dose profile of the ion beams, the maximum of the hp depth profile for the 160 MeV proton beam was located at similar to 0.5 cm behind the Bragg peak maximum, while the PD peak of the 290 MeV/u C-12 beam coincided well with the peak of the absorbed dose profile. Differences between the (y) over bar (D) and dose-averaged linear energy transfer (LETD) were large in the proton beam for both target volumes studied, and in the C-12 beam for the 10 nm diameter cylindrical volumes. The (y) over bar (D) determined for 100 run diameter cylindrical volumes in the C-12 beam was approximately equal to the LETD. The contributions from secondary particles to the (y) over bar (D) of the beams are presented, including the contributions from secondary protons in the proton beam and from fragments with atomic number Z = 1-6 in the C-12 beam. Conclusions: The present investigation provides an insight into differences in energy depositions in subcellular-size volumes when irradiated by proton and carbon ion beams. The results are useful for characterizing ion beams of practical importance for biophysical modeling of radiation-induced DNA damage response and repair in the depth profiles of protons and carbon ions used in radiotherapy.
48.	Liu, Lianli, et al. (författare) Real time volumetric MRI for 3D motion tracking via geometry-informed deep learning 2022 Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 49:9, s. 6110-6119 Tidskriftsartikel (refereegranskat)abstract Purpose To develop a geometry-informed deep learning framework for volumetric MRI with sub-second acquisition time in support of 3D motion tracking, which is highly desirable for improved radiotherapy precision but hindered by the long image acquisition time. Methods A 2D-3D deep learning network with an explicitly defined geometry module that embeds geometric priors of the k-space encoding pattern was investigated, where a 2D generation network first augmented the sparsely sampled image dataset by generating new 2D representations of the underlying 3D subject. A geometry module then unfolded the 2D representations to the volumetric space. Finally, a 3D refinement network took the unfolded 3D data and outputted high-resolution volumetric images. Patient-specific models were trained for seven abdominal patients to reconstruct volumetric MRI from both orthogonal cine slices and sparse radial samples. To evaluate the robustness of the proposed method to longitudinal patient anatomy and position changes, we tested the trained model on separate datasets acquired more than one month later and evaluated 3D target motion tracking accuracy using the model-reconstructed images by deforming a reference MRI with gross tumor volume (GTV) contours to a 5-min time series of both ground truth and model-reconstructed volumetric images with a temporal resolution of 340 ms. Results Across the seven patients evaluated, the median distances between model-predicted and ground truth GTV centroids in the superior-inferior direction were 0.4 +/- 0.3 mm and 0.5 +/- 0.4 mm for cine and radial acquisitions, respectively. The 95-percentile Hausdorff distances between model-predicted and ground truth GTV contours were 4.7 +/- 1.1 mm and 3.2 +/- 1.5 mm for cine and radial acquisitions, which are of the same scale as cross-plane image resolution. Conclusion Incorporating geometric priors into deep learning model enables volumetric imaging with high spatial and temporal resolution, which is particularly valuable for 3D motion tracking and has the potential of greatly improving MRI-guided radiotherapy precision.
49.	Ma, Yunzhi, et al. (författare) A generic TG-186 shielded applicator for commissioning model-based dose calculation algorithms for high-dose-rate Ir-192 brachytherapy 2017 Ingår i: Medical physics (Lancaster). - : WILEY. - 0094-2405 .- 2473-4209. ; 44:11, s. 5961-5976 Tidskriftsartikel (refereegranskat)abstract PurposeA joint working group was created by the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy and Oncology (ESTRO), and the Australasian Brachytherapy Group (ABG) with the charge, among others, to develop a set of well-defined test case plans and perform calculations and comparisons with model-based dose calculation algorithms (MBDCAs). Its main goal is to facilitate a smooth transition from the AAPM Task Group No. 43 (TG-43) dose calculation formalism, widely being used in clinical practice for brachytherapy, to the one proposed by Task Group No. 186 (TG-186) for MBDCAs. To do so, in this work a hypothetical, generic high-dose rate (HDR) Ir-192 shielded applicator has been designed and benchmarked. MethodsA generic HDR Ir-192 shielded applicator was designed based on three commercially available gynecological applicators as well as a virtual cubic water phantom that can be imported into any DICOM-RT compatible treatment planning system (TPS). The absorbed dose distribution around the applicator with the TG-186 Ir-192 source located at one dwell position at its center was computed using two commercial TPSs incorporating MBDCAs (Oncentra((R)) Brachy with Advanced Collapsed-cone Engine, ACE, and BrachyVision ACUROS) and state-of-the-art Monte Carlo (MC) codes, including ALGEBRA, BrachyDose, egs_brachy, Geant4, MCNP6, and Penelope2008. TPS-based volumetric dose distributions for the previously reported source centered in water and source displaced test cases, and the new source centered in applicator test case, were analyzed here using the MCNP6 dose distribution as a reference. Volumetric dose comparisons of TPS results against results for the other MC codes were also performed. Distributions of local and global dose difference ratios are reported. ResultsThe local dose differences among MC codes are comparable to the statistical uncertainties of the reference datasets for the source centered in water and source displaced test cases and for the clinically relevant part of the unshielded volume in the source centered in applicator case. Larger local differences appear in the shielded volume or at large distances. Considering clinically relevant regions, global dose differences are smaller than the local ones. The most disadvantageous case for the MBDCAs is the one including the shielded applicator. In this case, ACUROS agrees with MC within [-4.2%, +4.2%] for the majority of voxels (95%) while presenting dose differences within [-0.12%, +0.12%] of the dose at a clinically relevant reference point. For ACE, 95% of the total volume presents differences with respect to MC in the range [-1.7%, +0.4%] of the dose at the reference point. ConclusionsThe combination of the generic source and generic shielded applicator, together with the previously developed test cases and reference datasets (available in the Brachytherapy Source Registry), lay a solid foundation in supporting uniform commissioning procedures and direct comparisons among treatment planning systems for HDR Ir-192 brachytherapy.
50.	Mavroidis, Panayiotis, et al. (författare) Analysis of fractionation correction methodologies for multiple phase treatment plans in radiation therapy 2013 Ingår i: Medical physics (Lancaster). - : Wiley. - 0094-2405 .- 2473-4209. ; 40:3, s. 031715- Tidskriftsartikel (refereegranskat)abstract Purpose: Radiation therapy is often delivered by multiple sequential treatment plans. For an accurate radiobiological evaluation of the overall treatment, fractionation corrections to each dose distribution must be applied before summing the three-dimensional dose matrix of each plan since the simpler approach of performing the fractionation correction to the total dose-volume histograms, obtained by the arithmetical sum of the different plans, becomes inaccurate for more heterogeneous dose patterns. In this study, the differences between these two fractionation correction methods, named here as exact (corrected before) and approximate (after summation), respectively, are assessed for different cancer types. Methods: Prostate, breast, and head and neck (HN) tumor patients were selected to quantify the differences between two fractionation correction methods (the exact vs the approximate). For each cancer type, two different treatment plans were developed using uniform (CRT) and intensity modulated beams (IMRT), respectively. The responses of the target and normal tissue were calculated using the Poisson linear-quadratic-time model and the relative seriality model, respectively. All treatments were radiobiologically evaluated and compared using the complication-free tumor control probability (P+), the biologically effective uniform dose ((D) double under bar) together with common dosimetric criteria. Results: For the prostate cancer patient, an underestimation of around 14%-15% in P+ was obtained when the fractionation correction was applied after summation compared to the exact approach due to significant biological and dosimetric variations obtained between the two fractionation correction methods in the involved lymph nodes. For the breast cancer patient, an underestimation of around 3%-4% in the maximum dose in the heart was obtained. Despite the dosimetric differences in this organ, no significant variations were obtained in treatment outcome. For the HN tumor patient, an underestimation of about 5% in treatment outcome was obtained for the CRT plan as a result of an underestimation of the planning target volume control probability by about 10%. An underestimation of about 6% in the complication probability of the right parotid was also obtained. For all the other organs at risk, dosimetric differences of up to 4% were obtained but with no significant impact in the expected clinical outcome. However, for the IMRT plan, an overestimation in P+ of 4.3% was obtained mainly due to an underestimation of the complication probability of the left and right parotids (2.9% and 5.8%, respectively). Conclusions: The use of the exact fractionation correction method, which is applying fractionation correction on the separate dose distributions of a multiple phase treatment before their summation was found to have a significant expected clinical impact. For regions of interest that are irradiated with very heterogeneous dose distributions and significantly different doses per fraction in the different treatment phases, the exact fractionation correction method needs to be applied since a significant underestimation of the true patient outcome can be introduced otherwise.

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