Publications by authors named "Florian Cremers"

16 Publications

  • Page 1 of 1

Tumor-dose-rate variations during robotic radiosurgery of oligo and multiple brain metastases.

Strahlenther Onkol 2021 Jul 25;197(7):581-591. Epub 2020 Jun 25.

Saphir Radiosurgery Center Frankfurt and Northern Germany, Guestrow, Germany.

Purpose: For step-and-shoot robotic stereotactic radiosurgery (SRS) the dose delivered over time, called local tumor-dose-rate (TDR), may strongly vary during treatment of multiple lesions. The authors sought to evaluate technical parameters influencing TDR and correlate TDR to clinical outcome.

Material And Methods: A total of 23 patients with 162 oligo (1-3) and multiple (>3) brain metastases (OBM/MBM) treated in 33 SRS sessions were retrospectively analyzed. Median PTV were 0.11 cc (0.01-6.36 cc) and 0.50 cc (0.12-3.68 cc) for OBM and MBM, respectively. Prescription dose ranged from 16 to 20 Gy prescribed to the median 70% isodose line. The maximum dose-rate for planning target volume (PTV) percentage p in time span s during treatment (TDR) was calculated for various p and s based on treatment log files and in-house software.

Results: TDR was 0.30 Gy/min (0.23-0.87 Gy/min) for OBM and 0.22 Gy/min (0.12-0.63 Gy/min) for MBM, respectively, and increased by 0.03 Gy/min per prescribed Gy. TDR strongly correlated with treatment time (ρ = -0.717, p < 0.001), monitor units (MU) (ρ = -0.767, p < 0.001), number of beams (ρ = -0.755, p < 0.001) and beam directions (ρ = -0.685, p < 0.001) as well as lesions treated per collimator (ρ = -0.708, P < 0.001). Median overall survival (OS) was 20 months and 1‑ and 2‑year local control (LC) was 98.8% and 90.3%, respectively. LC did not correlate with any TDR, but tumor response (partial response [PR] or complete response [CR]) correlated with all TDR in univariate analysis (e.g., TDR: hazard ration [HR] = 0.974, confidence interval [CI] = 0.952-0.996, p = 0.019). In multivariate analysis only concomitant targeted therapy or immunotherapy and breast cancer tumor histology remained a significant factor for tumor response. Local grade ≥2 radiation-induced tissue reactions were noted in 26.3% (OBM) and 5.2% (MBM), respectively, mainly influenced by tumor volume (p < 0.001).

Conclusions: Large TDR variations are noted during MBM-SRS which mainly arise from prolonged treatment times. Clinically, low TDR corresponded with decreased local tumor responses, although the main influencing factor was concomitant medication.
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http://dx.doi.org/10.1007/s00066-020-01652-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219559PMC
July 2021

A New Phantom for Individual Verification of the Dose Distribution in Precision Radiotherapy for Head-and-Neck Cancer.

Anticancer Res 2019 Dec;39(12):6931-6938

Institute of Medical Engineering, University of Lübeck, Lübeck, Germany.

Background/aim: Many patients with head-and-neck cancers receive radiotherapy. Treatment planning can be very complex in case of dental fillings or implants that cause metal artefacts. Verification of dose distributions may be performed using specific phantoms. This study aimed to develop a 3D-printed phantom that can be produced easily and cost-effectively.

Patients And Methods: The phantom was designed to allow fast adaption to a patient's individual situation with a particular focus on metal artefacts due to dental fillings. Bone and soft-tissue shells were 3D-printed and filled with tissue-equivalent materials.

Results: Attenuation properties of the tissue-equivalent structures in the phantom corresponded well to the structures of real human anatomy. In magnetic resonance (MR)-imaging, useful signals of the materials in the phantom were obtained.

Conclusion: The phantom met the requirements including equivalence with human tissues and can be useful for highly individual treatment planning in precision-radiotherapy of head-and-neck cancers. It can be also used for scientific issues related to MR-imaging.
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http://dx.doi.org/10.21873/anticanres.13914DOI Listing
December 2019

A visual probe positioning tool for 4D ultrasound-guided radiotherapy.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:883-886

Ultrasound (US) guidance is a rapidly growing area in image-guided radiotherapy. For motion compensation, the therapy target needs to be visualized with the US probe to continuously determine its position and adapt for shifts. While US has obvious benefits such as real-time capability and proven safety, one of the main drawbacks to date is its user dependency - high quality results require long years of clinical experience. To provide positioning assistance for the setup of US equipment by non-experts, we developed a visual guidance tool combining real-time US volume and CT visualization in a geometrically calibrated setup. By using a 4D US station with real-time data access and an optical tracking system, we achieved a calibration accuracy of 1.2 mm and a mean 2D contour distance of 1.7 mm between organ boundaries identified in US and CT. With this low calibration error as well as the good visual alignment of the structures, the developed probe positioning tool could be a valuable aid for ultrasound-guided radiotherapy and other interventions by guiding the user to a suitable acoustic window while potentially improving setup reproducibility.
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http://dx.doi.org/10.1109/EMBC.2018.8512390DOI Listing
July 2018

Improvement of dose calculation in radiation therapy due to metal artifact correction using the augmented likelihood image reconstruction.

J Appl Clin Med Phys 2018 May 17;19(3):227-233. Epub 2018 Apr 17.

Department of Radiotherapy, University Medical Center Schleswig Holstein/Campus Luebeck, Luebeck, Germany.

Background: Metal artifacts caused by high-density implants lead to incorrectly reconstructed Hounsfield units in computed tomography images. This can result in a loss of accuracy in dose calculation in radiation therapy. This study investigates the potential of the metal artifact reduction algorithms, Augmented Likelihood Image Reconstruction and linear interpolation, in improving dose calculation in the presence of metal artifacts.

Materials And Methods: In order to simulate a pelvis with a double-sided total endoprosthesis, a polymethylmethacrylate phantom was equipped with two steel bars. Artifacts were reduced by applying the Augmented Likelihood Image Reconstruction, a linear interpolation, and a manual correction approach. Using the treatment planning system Eclipse™, identical planning target volumes for an idealized prostate as well as structures for bladder and rectum were defined in corrected and noncorrected images. Volumetric modulated arc therapy plans have been created with double arc rotations with and without avoidance sectors that mask out the prosthesis. The irradiation plans were analyzed for variations in the dose distribution and their homogeneity. Dosimetric measurements were performed using isocentric positioned ionization chambers.

Results: Irradiation plans based on images containing artifacts lead to a dose error in the isocenter of up to 8.4%. Corrections with the Augmented Likelihood Image Reconstruction reduce this dose error to 2.7%, corrections with linear interpolation to 3.2%, and manual artifact correction to 4.1%. When applying artifact correction, the dose homogeneity was slightly improved for all investigated methods. Furthermore, the calculated mean doses are higher for rectum and bladder if avoidance sectors are applied.

Conclusion: Streaking artifacts cause an imprecise dose calculation within irradiation plans. Using a metal artifact correction algorithm, the planning accuracy can be significantly improved. Best results were accomplished using the Augmented Likelihood Image Reconstruction algorithm.
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http://dx.doi.org/10.1002/acm2.12325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978555PMC
May 2018

The effects of metal artifact reduction on the retrieval of attenuation values.

J Appl Clin Med Phys 2017 Jan 5;18(1):243-250. Epub 2016 Dec 5.

University of Luebeck, Institute of Medical Engineering, Ratzeburger Allee 160, D-23562, Luebeck, Germany.

Background: The quality of CT slices can be drastically reduced in the presence of high-density objects such as metal implants within the patients' body due to the occurrence of streaking artifacts. Consequently, a delineation of anatomical structures might not be possible, which strongly influences clinical examination.

Purpose: The aim of the study is to clinically evaluate the retrieval of attenuation values and structures by the recently proposed Augmented Likelihood Image Reconstruction (ALIR) and linear interpolation in the presence of metal artifacts.

Material And Methods: A commercially available phantom was equipped with two steel inserts. At a position between the metal rods, which shows severe streaking artifacts, different human tissue-equivalent inserts are alternately mounted. Using a single-source computer tomograph, raw data with and without metal rods are acquired for each insert. Images are reconstructed using the ALIR algorithm and a filtered back projection with and without linear interpolation. Mean and standard deviation are compared for a region of interest in the ALIR reconstructions, linear interpolation results, uncorrected images with metal rods, and the images without metal rods, which are used as a reference. Furthermore, the reconstructed shape of the inserts is analyzed by comparing different profiles of the image.

Results: The measured mean and standard deviation values show that for all tissue classes, the metal artifacts could be reduced using the ALIR algorithm and the linear interpolation. Furthermore, the HU values for the different classes could be retrieved with errors below the standard deviation in the reference image. An evaluation of the shape of the inserts shows that the reconstructed object fits the shape of the insert accurately after metal artifact correction. Moreover, the evaluation shows a drop in the standard deviation for the ALIR reconstructed images compared to the reference images while reducing artifacts and keeping the shape of the inserts, which indicates a noise reduction ability of the ALIR algorithm.

Conclusion: HU values, which are distorted by metal artifacts, can be retrieved accurately with the ALIR algorithm and the linear interpolation approach. After metal artifact correction, structures, which are not perceptible in the original images due to streaking artifacts, are reconstructed correctly within the image using the ALIR algorithm. Furthermore, the ALIR produced images with a reduced noise level compared to reference images and artifact images. Linear interpolation results in a distortion of the investigated shapes and features remaining streaking artifacts.
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http://dx.doi.org/10.1002/acm2.12002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689900PMC
January 2017

Dosimetric Implications of Residual Tracking Errors During Robotic SBRT of Liver Metastases.

Int J Radiat Oncol Biol Phys 2017 03 27;97(4):839-848. Epub 2016 Nov 27.

Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany; Saphir Radiosurgery Center Northern Germany, Güstrow, Germany. Electronic address:

Purpose: Although the metric precision of robotic stereotactic body radiation therapy in the presence of breathing motion is widely known, we investigated the dosimetric implications of breathing phase-related residual tracking errors.

Methods And Materials: In 24 patients (28 liver metastases) treated with the CyberKnife, we recorded the residual correlation, prediction, and rotational tracking errors from 90 fractions and binned them into 10 breathing phases. The average breathing phase errors were used to shift and rotate the clinical tumor volume (CTV) and planning target volume (PTV) for each phase to calculate a pseudo 4-dimensional error dose distribution for comparison with the original planned dose distribution.

Results: The median systematic directional correlation, prediction, and absolute aggregate rotation errors were 0.3 mm (range, 0.1-1.3 mm), 0.01 mm (range, 0.00-0.05 mm), and 1.5° (range, 0.4°-2.7°), respectively. Dosimetrically, 44%, 81%, and 92% of all voxels differed by less than 1%, 3%, and 5% of the planned local dose, respectively. The median coverage reduction for the PTV was 1.1% (range in coverage difference, -7.8% to +0.8%), significantly depending on correlation (P=.026) and rotational (P=.005) error. With a 3-mm PTV margin, the median coverage change for the CTV was 0.0% (range, -1.0% to +5.4%), not significantly depending on any investigated parameter. In 42% of patients, the 3-mm margin did not fully compensate for the residual tracking errors, resulting in a CTV coverage reduction of 0.1% to 1.0%.

Conclusions: For liver tumors treated with robotic stereotactic body radiation therapy, a safety margin of 3 mm is not always sufficient to cover all residual tracking errors. Dosimetrically, this translates into only small CTV coverage reductions.
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http://dx.doi.org/10.1016/j.ijrobp.2016.11.041DOI Listing
March 2017

Assessment of image quality and dose calculation accuracy on kV CBCT, MV CBCT, and MV CT images for urgent palliative radiotherapy treatments.

J Appl Clin Med Phys 2016 03 8;17(2):279-290. Epub 2016 Mar 8.

University of California San Francisco.

A clinical workflow was developed for urgent palliative radiotherapy treatments that integrates patient simulation, planning, quality assurance, and treatment in one 30-minute session. This has been successfully tested and implemented clinically on a linac with MV CBCT capabilities. To make this approach available to all clin-ics equipped with common imaging systems, dose calculation accuracy based on treatment sites was assessed for other imaging units. We evaluated the feasibility of palliative treatment planning using on-board imaging with respect to image quality and technical challenges. The purpose was to test multiple systems using their commercial setup, disregarding any additional in-house development. kV CT, kV CBCT, MV CBCT, and MV CT images of water and anthropomorphic phantoms were acquired on five different imaging units (Philips MX8000 CT Scanner, and Varian TrueBeam, Elekta VersaHD, Siemens Artiste, and Accuray Tomotherapy linacs). Image quality (noise, contrast, uniformity, spatial resolution) was evaluated and compared across all machines. Using individual image value to density calibrations, dose calculation accuracies for simple treatment plans were assessed for the same phantom images. Finally, image artifacts on clinical patient images were evaluated and compared among the machines. Image contrast to visualize bony anatomy was sufficient on all machines. Despite a high noise level and low contrast, MV CT images provided the most accurate treatment plans relative to kV CT-based planning. Spatial resolution was poorest for MV CBCT, but did not limit the visualization of small anatomical structures. A comparison of treatment plans showed that monitor units calculated based on a prescription point were within 5% difference relative to kV CT-based plans for all machines and all studied treatment sites (brain, neck, and pelvis). Local dose differences > 5% were found near the phantom edges. The gamma index for 3%/3 mm criteria was ≥ 95% in most cases. Best dose calculation results were obtained when the treatment isocenter was near the image isocenter for all machines. A large field of view and immediate image export to the treatment planning system were essential for a smooth workflow and were not provided on all devices. Based on this phantom study, image quality of the studied kV CBCT, MV CBCT, and MV CT on-board imaging devices was sufficient for treatment planning in all tested cases. Treatment plans provided dose calculation accuracies within an acceptable range for simple, urgently planned palliative treatments. However, dose calculation accuracy was compromised towards the edges of an image. Feasibility for clinical implementation should be assessed separately and may be complicated by machine specific features. Image artifacts in patient images and the effect on dose calculation accuracy should be assessed in a separate, machine-specific study.
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http://dx.doi.org/10.1120/jacmp.v17i2.6040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874969PMC
March 2016

The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists.

Phys Med 2016 Jan 2;32(1):7-11. Epub 2016 Feb 2.

Medical Physics Dep., Niguarda Ca' Granda Hospital, Milano, Italy.

Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) and the International Basic Safety Standards (BSS). It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time. This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD.
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http://dx.doi.org/10.1016/j.ejmp.2016.01.480DOI Listing
January 2016

The European Federation of Organisations for Medical Physics Policy Statement No. 6.1: Recommended Guidelines on National Registration Schemes for Medical Physicists.

Phys Med 2016 Jan 2;32(1):1-6. Epub 2016 Feb 2.

Institute for Radio-Oncology, Donauspital Vienna, Langobardenstrasse 122, Vienna A-1220, Austria.

This EFOMP Policy Statement is an update of Policy Statement No. 6 first published in 1994. The present version takes into account the European Union Parliament and Council Directive 2013/55/EU that amends Directive 2005/36/EU on the recognition of professional qualifications and the European Union Council Directive 2013/59/EURATOM laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation. The European Commission Radiation Protection Report No. 174, Guidelines on Medical Physics Expert and the EFOMP Policy Statement No. 12.1, Recommendations on Medical Physics Education and Training in Europe 2014, are also taken into consideration. The EFOMP National Member Organisations are encouraged to update their Medical Physics registration schemes where these exist or to develop registration schemes taking into account the present version of this EFOMP Policy Statement (Policy Statement No. 6.1"Recommended Guidelines on National Registration Schemes for Medical Physicists").
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http://dx.doi.org/10.1016/j.ejmp.2016.01.479DOI Listing
January 2016

Design, performance characteristics and application examples of a new 4D motion platform.

Z Med Phys 2015 Jun 27;25(2):156-67. Epub 2014 Sep 27.

Department of Radiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

In this publication, a three-dimensionally movable motion phantom is described and its performance characteristics are evaluated. The intended primary fields of application for the phantom are the quality assurance (QA) of respiratory motion management devices in radiation therapy (RT) like gating or tumour tracking systems, training for clinical use of these techniques, and related 4DRT research. Considering especially the QA aspect, the phantom was designed as a motion platform that can be equipped with an appropriate add-on like standard QA phantoms for dosimetric measurements. The platform is driven by three computer-controlled independent linear motors (motion range: 40 × 50 × 50 mm in anterior-posterior/superior-inferior/lateral direction; max. velocity: 3.9 m/s; max. acceleration: 10 m/s(2)), which allow the simulation of normal breathing patterns as well as arbitrary trajectories and anomalous events like coughing or baseline drift. For normal breathing patterns (here: sinusoidal curves with an amplitude of 20mm and a period of 3 s/6 s), the accuracy of the simulated motion paths was measured to be within 0,521 mm even for the ArcCHECK (weight: 20 kg) as a platform load - values that we consider to be sufficient for the intended fields of application. The respective use of the motion phantom is illustrated.
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http://dx.doi.org/10.1016/j.zemedi.2014.09.003DOI Listing
June 2015

Suitability of markerless EPID tracking for tumor position verification in gated radiotherapy.

Med Phys 2014 Mar;41(3):031702

Department of Radiation Oncology, University of Washington, Seattle, Washington 98195, USA.

Purpose: To maximize the benefits of respiratory gated radiotherapy (RGRT) of lung tumors real-time verification of the tumor position is required. This work investigates the feasibility of markerless tracking of lung tumors during beam-on time in electronic portal imaging device (EPID) images of the MV therapeutic beam.

Methods: EPID movies were acquired at ∼2 fps for seven lung cancer patients with tumor peak-to-peak motion ranges between 7.8 and 17.9 mm (mean: 13.7 mm) undergoing stereotactic body radiotherapy. The external breathing motion of the abdomen was synchronously measured. Both datasets were retrospectively analyzed in PortalTrack, an in-house developed tracking software. The authors define a three-step procedure to run the simulations: (1) gating window definition, (2) gated-beam delivery simulation, and (3) tumor tracking. First, an amplitude threshold level was set on the external signal, defining the onset of beam-on/-off signals. This information was then mapped onto a sequence of EPID images to generate stamps of beam-on/-hold periods throughout the EPID movies in PortalTrack, by obscuring the frames corresponding to beam-off times. Last, tumor motion in the superior-inferior direction was determined on portal images by the tracking algorithm during beam-on time. The residual motion inside the gating window as well as target coverage (TC) and the marginal target displacement (MTD) were used as measures to quantify tumor position variability.

Results: Tumor position monitoring and estimation from beam's-eye-view images during RGRT was possible in 67% of the analyzed beams. For a reference gating window of 5 mm, deviations ranging from 2% to 86% (35% on average) were recorded between the reference and measured residual motion. TC (range: 62%-93%; mean: 77%) losses were correlated with false positives incidence rates resulting mostly from intra-/inter-beam baseline drifts, as well as sudden cycle-to-cycle fluctuations in exhale positions. Both phenomena can lead to considerable deviations (with MTD values up to a maximum of 7.8 mm) from the intended tumor position, and in turn may result in a marginal miss. The difference between tumor traces determined within the gating window against ground truth trajectory maps was 1.1 ± 0.7 mm on average (range: 0.4-2.3 mm).

Conclusions: In this retrospective analysis of motion data, it is demonstrated that the system is capable of determining tumor positions in the plane perpendicular to the beam direction without the aid of fiducial markers, and may hence be suitable as an online verification tool in RGRT. It may be possible to use the tracking information to enable on-the-fly corrections to intra-/inter-beam variations by adapting the gating window by means of a robotic couch.
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http://dx.doi.org/10.1118/1.4863597DOI Listing
March 2014

Towards accurate dose accumulation for Step-&-Shoot IMRT: Impact of weighting schemes and temporal image resolution on the estimation of dosimetric motion effects.

Z Med Phys 2012 Jun 15;22(2):109-22. Epub 2011 Sep 15.

University of Lübeck, Institute of Medical Informatics, Ratzeburger Allee 160, 23538 Lübeck, Germany.

Purpose: Breathing-induced motion effects on dose distributions in radiotherapy can be analyzed using 4D CT image sequences and registration-based dose accumulation techniques. Often simplifying assumptions are made during accumulation. In this paper, we study the dosimetric impact of two aspects which may be especially critical for IMRT treatment: the weighting scheme for the dose contributions of IMRT segments at different breathing phases and the temporal resolution of 4D CT images applied for dose accumulation.

Methods: Based on a continuous problem formulation a patient- and plan-specific scheme for weighting segment dose contributions at different breathing phases is derived for use in step-&-shoot IMRT dose accumulation. Using 4D CT data sets and treatment plans for 5 lung tumor patients, dosimetric motion effects as estimated by the derived scheme are compared to effects resulting from a common equal weighting approach. Effects of reducing the temporal image resolution are evaluated for the same patients and both weighting schemes.

Results: The equal weighting approach underestimates dosimetric motion effects when considering single treatment fractions. Especially interplay effects (relative misplacement of segments due to respiratory tumor motion) for IMRT segments with only a few monitor units are insufficiently represented (local point differences >25% of the prescribed dose for larger tumor motion). The effects, however, tend to be averaged out over the entire treatment course. Regarding temporal image resolution, estimated motion effects in terms of measures of the CTV dose coverage are barely affected (in comparison to the full resolution) when using only half of the original resolution and equal weighting. In contrast, occurence and impact of interplay effects are poorly captured for some cases (large tumor motion, undersized PTV margin) for a resolution of 10/14 phases and the more accurate patient- and plan-specific dose accumulation scheme.

Conclusions: Radiobiological consequences of reported single fraction local point differences >25% of the prescribed dose are widely unclear and should be subject to future investigation. Meanwhile, if aiming at accurate and reliable estimation of dosimetric motion effects, precise weighting schemes such as the presented patient- and plan-specific scheme for step-&-shoot IMRT and full available temporal 4D CT image resolution should be applied for IMRT dose accumulation.
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http://dx.doi.org/10.1016/j.zemedi.2011.08.001DOI Listing
June 2012

Commissioning of a double-focused micro multileaf collimator (muMLC).

J Appl Clin Med Phys 2010 Apr 16;11(2):3131. Epub 2010 Apr 16.

Department of Radiotherapy and Radio-Oncology, Center for Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Double-focused muMLCs are able to create fields with steeper dose gradients at the field edges and are, therefore, an advancement in delivering stereotactic treatments. A double-focused muMLC has been installed at a Siemens Primus linear accelerator (linac) as a first research installation in Europe. The basic dosimetric parameters, such as leakage, output factors, depth-dose curves and penumbra, have been measured in 6 and 15 MV-mode by use of radiochromic films (GafChromic EBT), ionization chambers and our solid water QA-phantom (Easy Cube). The leakage between the leaves is minimal and lower than that of most commercially available MLCs. Therefore, the field size of the linac can be kept constant while the leaves of the muMLC are creating different aperture shapes. Percentage depth doses (PDDs) generated by the double-focused muMLC are equal to depth-dose curves of the original linac. That means the muMLC affects only the off-axis ratio (OAR). Based on the fact that the muMLC is double-focused and the source-to-collimator distance is larger, the penumbra is sharper than that for fields defined by the original linac MLC. The mechanical and dosimetric investigations show the benefit of the double-focused muMLC attached to a Siemens Primus linear accelerator.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719954PMC
http://dx.doi.org/10.1120/jacmp.v11i2.3131DOI Listing
April 2010

[Model for the response of radiographic films and implications for quality assurance].

Z Med Phys 2007 ;17(3):197-204

Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf.

The present paper describes the development of a model linking the optical density of a radiographic film to the applied dose. This model takes into account the kind of bremsstrahlung used in radiotherapy, and uses fewer parameters compared with the models developed so far. The measurements showed an influence of the field size on the model parameters. Monte Carlo simulations showed that different field sizes and depths in solid water can change the spectral distributions. The spectrum hardens with decreasing field size and increasing depth in phantom material. This has an influence on the model parameters. Nevertheless, the model can still be used to describe the relation between optical density and applied dose for films that are irradiated with fields of different size. A dose-rate dependence was not observed. The size and form of the fields used in calibration and application can therefore cause a systematic error in verification with film.
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http://dx.doi.org/10.1016/j.zemedi.2007.04.005DOI Listing
October 2007

High accuracy of virtual simulation with the laser system Dorado CT4.

Strahlenther Onkol 2007 Feb;183(2):89-93

Department of Radiation Oncology, University Medical Center, Hamburg-Eppendorf, Germany.

Purpose: To evaluate the accuracy of virtual simulation, which is less time-consuming than physical simulation, with the new laser system Dorado CT4 in 96 prostate cancer patients.

Patients And Methods: Virtual simulation was based on a spiral scan with 8 mm reconstruction index and 8 mm slice thickness in 64 patients (group A), and 3 mm reconstruction index and 3 mm slice thickness in 32 patients (group B). Both groups were evaluated for impact on maximum difference (Deltamax) regarding the isocenters obtained from virtual simulation versus those obtained from physical simulation.

Results: In the entire cohort, mean differences were as follows: Deltamax 5.7 +/- 3.5 mm, Deltax (left/right) 2.8 +/- 2.9 mm, Deltay (anterior/posterior) 4.5 +/- 3.8 mm, and Deltaz (cranial/caudal) 2.1 +/- 2.2 mm. In group A, mean values were Deltamax 6.2 +/- 3.8 mm, Deltax 2.9 +/- 3.1 mm, Deltay 4.9 +/- 4.2 mm, and Deltaz 2.3 +/- 2.3 mm. In group B, mean values were Deltamax 4.8 +/- 2.8 mm, Deltax 2.7 +/- 2.7 mm, Deltay 3.7 +/- 2.7 mm, and Deltaz 1.7 +/- 2.0 mm. Time of radiotherapy (primary vs. salvage RT) and radiation regimen (external-beam radiotherapy [EBRT] vs. high-dose-rate brachytherapy [HDR-BT] plus EBRT) had no significant impact on Deltamax.

Conclusion: Virtual simulation with the new laser system Dorado CT4 was very precise for both primary and salvage RT in the treatment of prostate cancer patients. High precision was achieved for both EBRT and HDR-BT plus EBRT. Virtual simulation should be performed with a planning CT with 3 mm reconstruction index and 3 mm slice thickness for high accuracy.
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http://dx.doi.org/10.1007/s00066-007-1610-8DOI Listing
February 2007

[Investigations of beta-dosimetry at two different sources for the cardiovascular brachytherapy].

Z Med Phys 2005 ;15(1):23-30

Radiologisches Zentrum, Klinik für Strahlentherapie und Radioonkologie, Sektion Medizinische Strahlenphysik, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg.

The intracoronary brachytherapy is used at the Hamburg University Hospital as a method to treat in-stent restenosis. Two different radiochromic film types were applied to obtain dosimetric information of the beta-sources used (32P and 90Sr/90Y). First, these films were analyzed for their suitability for dosimetry. Within the investigated dose range (MD-55-2: 0 to 33 Gy, HD-810: 0 to 105 Gy), both films showed a linear behavior between the dose and the optical density (OD). Because radiochromic films are subject to time-based changes in OD, a method for colour stabilization was investigated (RCS-method). This method allowed to greatly shorten the time between irradiation and evaluation from 24 hours (time necessary for the film to reach a quasi-stable status) to 2.5 hours. Colour-stabilized films can also be stored for a long time and reanalyzed with almost the same results. Within the limits of the measurements error, both film types showed an energy independent response. Within the dose profiles, analyses of the two source types resulted in differences of 13.5% (32P) and 21% (90Sr/90Y). These inhomogenities are consistent with the fabrication tolerances given by the manufactures.
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http://dx.doi.org/10.1078/0939-3889-00239DOI Listing
May 2005
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