Publications by authors named "Ron S Sloboda"

32 Publications

Delivered dose changes in COMS plaque-based ocular brachytherapy arising from vitrectomy with silicone oil replacement.

Brachytherapy 2019 Sep - Oct;18(5):668-674. Epub 2019 Jul 2.

Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.

Purpose: The purpose of the study was to determine dosimetric effects of performing concurrent I-125 Collaborative Ocular Melanoma Study plaque brachytherapy and vitrectomy with replacement using silicone oil, previously shown to be a means of shielding uninvolved parts of the eye.

Methods And Materials: Monte Carlo simulations using MCNP6 were performed to compare the dosimetry with all eye materials assigned as water, and for the vitreous (excluding the tumor), composed of polydimethylsiloxane oil for three generic, one large tumor, and two patient geometry scenarios. Dose was scored at the tumor apex, along the sclera, and within a 3D grid encompassing the eye. The assessed patient cases included vitrectomies to treat intraocular pathologies; not to enhance attenuation/shielding.

Results: The doses along the sclera and for the entire eye were decreased when the silicone oil replaced the vitreal fluid, with a maximum decrease at the opposite sclera of 63%. Yet, absolute changes in dose to critical structures were often small and likely not clinically significant. The dose at the tumor apex was decreased by 3.1-9.4%. Dose was also decreased at the edges of the tumor because of decreased backscatter at the tumor-oil interface.

Conclusions: Concurrent silicone vitrectomy was found to reduce total radiation dose to the eye. Based on current radiation retinopathy predictive models, the evaluation of the absolute doses revealed only a subset of patients in which a clinically significant difference in outcomes is expected. Furthermore, the presence of the silicone oil decreased dose to the tumor edges, indicating that the tumor could be underdosed if the oil is unaccounted for.
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http://dx.doi.org/10.1016/j.brachy.2019.05.013DOI Listing
March 2020

Robotic-Assisted Needle Steering Around Anatomical Obstacles Using Notched Steerable Needles.

IEEE J Biomed Health Inform 2018 11 6;22(6):1917-1928. Epub 2017 Dec 6.

Robotic-assisted needle steering can enhance the accuracy of needle-based interventions. Application of current needle steering techniques are restricted by the limited deflection curvature of needles. Here, a novel steerable needle with improved curvature is developed and used with an online motion planner to steer the needle along curved paths inside tissue. The needle is developed by carving series of small notches on the shaft of a standard needle. The notches decrease the needle flexural stiffness, allowing the needle to follow tightly curved paths with small radius of curvature. In this paper, first, a finite element model of the notched needle deflection in tissue is presented. Next, the model is used to estimate the optimal location for the notches on needle's shaft for achieving a desired curvature. Finally, an ultrasound-guided motion planner for needle steering inside tissue is developed and used to demonstrate the capability of the notched needle in achieving high curvature and maneuvering around obstacles in tissue. We simulated a clinical scenario in brachytherapy, where the target is obstructed by the pubic bone and cannot be reached using regular needles. Experimental results show that the target can be reached using the notched needle with a mean accuracy of 1.2 mm. Thus, the proposed needle enables future research on needle steering toward deeper or more difficult-to-reach targets.
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http://dx.doi.org/10.1109/JBHI.2017.2780192DOI Listing
November 2018

Advanced Collapsed cone Engine dose calculations in tissue media for COMS eye plaques loaded with I-125 seeds.

Med Phys 2018 Jul 23;45(7):3349-3360. Epub 2018 May 23.

Department of Medical Physics, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

Purpose: To investigate the dose calculation accuracy of the Advanced Collapsed cone Engine (ACE) algorithm for ocular brachytherapy using a COMS plaque loaded with I-125 seeds for two heterogeneous patient tissue scenarios.

Methods: The Oncura model 6711 I-125 seed and 16 mm COMS plaque were added to a research version (v4.6) of the Oncentra Brachy (OcB) treatment planning system (TPS) for dose calculations using ACE. Treatment plans were created for two heterogeneous cases: (a) a voxelized eye phantom comprising realistic eye materials and densities and (b) a patient CT dataset with variable densities throughout the dataset. ACE dose calculations were performed using a high accuracy mode, high-resolution calculation grid matching the imported CT datasets (0.5 × 0.5 × 0.5 mm ), and a user-defined CT calibration curve. The accuracy of ACE was evaluated by replicating the plan geometries and comparing to Monte Carlo (MC) calculated doses obtained using MCNP6. The effects of the heterogeneous patient tissues on the dose distributions were also evaluated by performing the ACE and MCNP6 calculations for the same scenarios but setting all tissues and air to water.

Results: Average local percent dose differences between ACE and MC within contoured structures and at points of interest for both scenarios ranged from 1.2% to 20.9%, and along the plaque central axis (CAX) from 0.7% to 7.8%. The largest differences occurred in the plaque penumbra (up to 17%), and at contoured structure interfaces (up to 20%). Other regions in the eye agreed more closely, within the uncertainties of ACE dose calculations (~5%). Compared to that, dose differences between water-based and fully heterogeneous tissue simulations were up to 27%.

Conclusions: Overall, ACE dosimetry agreed well with MC in the tumor volume and along the plaque CAX for the two heterogeneous tissue scenarios, indicating that ACE could potentially be used for clinical ocular brachytherapy dosimetry. In general, ACE data matched the fully heterogeneous MC data more closely than water-based data, even in regions where the ACE accuracy was relatively low. However, depending on the plaque position, doses to critical structures near the plaque penumbra or at tissue interfaces were less accurate, indicating that improvements may be necessary. More extensive knowledge of eye tissue compositions is still required.
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http://dx.doi.org/10.1002/mp.12946DOI Listing
July 2018

Initial evaluation of Advanced Collapsed cone Engine dose calculations in water medium for I-125 seeds and COMS eye plaques.

Med Phys 2018 Mar 19;45(3):1276-1286. Epub 2018 Feb 19.

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.

Purpose: To investigate the dose calculation accuracy in water medium of the Advanced Collapsed cone Engine (ACE) for three sizes of COMS eye plaques loaded with low-energy I-125 seeds.

Methods: A model of the Oncura 6711 I-125 seed was created for use with ACE in Oncentra Brachy (OcB) using primary-scatter separated (PSS) point dose kernel and Task Group (TG) 43 datasets. COMS eye plaque models of diameters 12, 16, and 20 mm were introduced into the OcB applicator library based on 3D CAD drawings of the plaques and Silastic inserts. To perform TG-186 level 1 commissioning, treatment plans were created in OcB for a single source in water and for each COMS plaque in water for two scenarios: with only one centrally loaded seed, or with all seed positions loaded. ACE dose calculations were performed in high accuracy mode with a 0.5 × 0.5 × 0.5 mm calculation grid. The resulting dose data were evaluated against Monte Carlo (MC) calculated doses obtained with MCNP6, using both local and global percent differences.

Results: ACE doses around the source for the single seed in water agreed with MC doses on average within < 5% inside a 6 × 6 × 6 cm region, and within < 1.5% inside a 2 × 2 × 2 cm region. The PSS data were generated at a higher resolution within 2 cm from the source, resulting in this improved agreement closer to the source due to fewer approximations in the ACE dose calculation. Average differences in both investigated plaque loading patterns in front of the plaques and on the plaque central axes were ≤ 2.5%, though larger differences (up to 12%) were found near the plaque lip.

Conclusions: Overall, good agreement was found between ACE and MC dose calculations for a single I-125 seed and in front of the COMS plaques in water. More complex scenarios need to be investigated to determine how well ACE handles heterogeneous patient materials.
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http://dx.doi.org/10.1002/mp.12776DOI Listing
March 2018

Experimental assessment of the Advanced Collapsed-cone Engine for scalp brachytherapy treatments.

Brachytherapy 2018 Mar - Apr;17(2):489-499. Epub 2017 Nov 24.

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.

Purpose: To experimentally assess the performance of the Advanced Collapsed-cone Engine (ACE) for Ir high-dose-rate brachytherapy treatment planning of nonmelanoma skin cancers of the scalp.

Methods And Materials: A layered slab phantom was designed to model the head (skin, skull, and brain) and surface treatment mold using tissue equivalent materials. Six variations of the phantom were created by varying skin thickness, skull thickness, and size of air gap between the mold and skin. Treatment planning was initially performed using the Task Group 43 (TG-43) formalism with CT images of each phantom variation. Doses were recalculated using standard and high accuracy modes of ACE. The plans were delivered to Gafchromic EBT3 film placed between different layers of the phantom.

Results: Doses calculated by TG-43 and ACE and those measured by film agreed with each other at most locations within the phantoms. For a given phantom variation, average TG-43- and ACE-calculated doses were similar, with a maximum difference of (3 ± 12)% (k = 2). Compared to the film measurements, TG-43 and ACE overestimated the film-measured dose by (13 ± 12)% (k = 2) for one phantom variation below the skull layer.

Conclusions: TG-43- and ACE-calculated and film-measured doses were found to agree above the skull layer of the phantom, which is where the tumor would be located in a clinical case. ACE appears to underestimate the attenuation through bone relative to that measured by film; however, the dose to bone is below tolerance levels for this treatment.
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http://dx.doi.org/10.1016/j.brachy.2017.10.010DOI Listing
January 2019

Initial clinical assessment of "center-specific" automated treatment plans for low-dose-rate prostate brachytherapy.

Brachytherapy 2018 Mar - Apr;17(2):476-488. Epub 2017 Dec 1.

Department of Oncology, University of Alberta, Edmonton, AB, Canada, T6G 1Z2. Electronic address:

Purpose: To report results of an initial pilot study assessing iodine-125 prostate implant treatment plans created automatically by a new seed-placement method.

Methods And Materials: A novel mixed-integer linear programming method incorporating spatial constraints on seed locations in addition to standard dose-volume constraints was used to place seeds. The approach, described in detail elsewhere, was used to create treatment plans fully automatically on a retrospective basis for 20 patients having a wide range of prostate sizes and shapes. Corresponding manual plans used for patient treatment at a single institution were combined with the automated plans, and all 40 plans were anonymized, randomized, and independently evaluated by five clinicians using a common scoring tool. Numerical and clinical features of the plans were extracted for comparison purposes.

Results: A full 51% of the automated plans were deemed clinically acceptable without any modification by the five practitioners collectively versus 90% of the manual plans. Automated plan seed distributions were for the most part not substantially different from those for the manual plans. Two observed shortcomings of the automated plans were seed strands not intersecting the prostate and strands extending into the bladder. Both are amenable to remediation by adjusting existing spatial constraints.

Conclusions: After spatial and dose-volume constraints are set, the mixed-integer linear programming method is capable of creating prostate implant treatment plans fully automatically, with clinical acceptability sufficient to warrant further investigation. These plans, intended to be reviewed and refined as necessary by an expert planner, have the potential to both save planner time and enhance treatment plan consistency.
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http://dx.doi.org/10.1016/j.brachy.2017.10.012DOI Listing
January 2019

A generic TG-186 shielded applicator for commissioning model-based dose calculation algorithms for high-dose-rate Ir brachytherapy.

Med Phys 2017 Nov 19;44(11):5961-5976. Epub 2017 Oct 19.

Département de Radio-Oncologie et Axe oncologie du Centre de recherche du CHU de Québec, CHU de Québec, Québec, Québec, G1R 2J6, Canada.

Purpose: A 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 shielded applicator has been designed and benchmarked.

Methods: A generic HDR Ir 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 source located at one dwell position at its center was computed using two commercial TPSs incorporating MBDCAs (Oncentra 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.

Results: The 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.

Conclusions: The 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 brachytherapy.
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http://dx.doi.org/10.1002/mp.12459DOI Listing
November 2017

A brief look at model-based dose calculation principles, practicalities, and promise.

J Contemp Brachytherapy 2017 Feb 8;9(1):79-88. Epub 2017 Feb 8.

Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Department of Medical Physics, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada.

Model-based dose calculation algorithms (MBDCAs) have recently emerged as potential successors to the highly practical, but sometimes inaccurate TG-43 formalism for brachytherapy treatment planning. So named for their capacity to more accurately calculate dose deposition in a patient using information from medical images, these approaches to solve the linear Boltzmann radiation transport equation include point kernel superposition, the discrete ordinates method, and Monte Carlo simulation. In this overview, we describe three MBDCAs that are commercially available at the present time, and identify guidance from professional societies and the broader peer-reviewed literature intended to facilitate their safe and appropriate use. We also highlight several important considerations to keep in mind when introducing an MBDCA into clinical practice, and look briefly at early applications reported in the literature and selected from our own ongoing work. The enhanced dose calculation accuracy offered by a MBDCA comes at the additional cost of modelling the geometry and material composition of the patient in treatment position (as determined from imaging), and the treatment applicator (as characterized by the vendor). The adequacy of these inputs and of the radiation source model, which needs to be assessed for each treatment site, treatment technique, and radiation source type, determines the accuracy of the resultant dose calculations. Although new challenges associated with their familiarization, commissioning, clinical implementation, and quality assurance exist, MBDCAs clearly afford an opportunity to improve brachytherapy practice, particularly for low-energy sources.
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http://dx.doi.org/10.5114/jcb.2017.65849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346608PMC
February 2017

Experimental verification of Advanced Collapsed-cone Engine for use with a multichannel vaginal cylinder applicator.

J Appl Clin Med Phys 2017 May 20;18(3):16-27. Epub 2017 Mar 20.

Department of Medical Physics, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

Model-based dose calculation algorithms have recently been incorporated into brachytherapy treatment planning systems, and their introduction requires critical evaluation before clinical implementation. Here, we present an experimental evaluation of Oncentra Brachy Advanced Collapsed-cone Engine (ACE) for a multichannel vaginal cylinder (MCVC) applicator using radiochromic film. A uniform dose of 500 cGy was specified to the surface of the MCVC using the TG-43 dose formalism under two conditions: (a) with only the central channel loaded or (b) only the peripheral channels loaded. Film measurements were made at the applicator surface and compared to the doses calculated using TG-43, standard accuracy ACE (sACE), and high accuracy ACE (hACE). When the central channel of the applicator was used, the film measurements showed a dose increase of (11 ± 8)% (k = 2) above the two outer grooves on the applicator surface. This increase in dose was confirmed with the hACE calculations, but was not confirmed with the sACE calculations at the applicator surface. When the peripheral channels were used, a periodic azimuthal variation in measured dose was observed around the applicator. The sACE and hACE calculations confirmed this variation and agreed within 1% of each other at the applicator surface. Additionally for the film measurements with the central channel used, a baseline dose variation of (10 ± 4)% (k = 2) of the mean dose was observed azimuthally around the applicator surface, which can be explained by offset source positioning in the central channel.
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http://dx.doi.org/10.1002/acm2.12061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689852PMC
May 2017

Semi-Automated Needle Steering in Biological Tissue Using an Ultrasound-Based Deflection Predictor.

Ann Biomed Eng 2017 04 19;45(4):924-938. Epub 2016 Sep 19.

Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada.

The performance of needle-based interventions depends on the accuracy of needle tip positioning. Here, a novel needle steering strategy is proposed that enhances accuracy of needle steering. In our approach the surgeon is in charge of needle insertion to ensure the safety of operation, while the needle tip bevel location is robotically controlled to minimize the targeting error. The system has two main components: (1) a real-time predictor for estimating future needle deflection as it is steered inside soft tissue, and (2) an online motion planner that calculates control decisions and steers the needle toward the target by iterative optimization of the needle deflection predictions. The predictor uses the ultrasound-based curvature information to estimate the needle deflection. Given the specification of anatomical obstacles and a target from preoperative images, the motion planner uses the deflection predictions to estimate control actions, i.e., the depth(s) at which the needle should be rotated to reach the target. Ex-vivo needle insertions are performed with and without obstacle to validate our approach. The results demonstrate the needle steering strategy guides the needle to the targets with a maximum error of 1.22 mm.
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http://dx.doi.org/10.1007/s10439-016-1736-xDOI Listing
April 2017

Delivered dose uncertainty analysis at the tumor apex for ocular brachytherapy.

Med Phys 2016 Aug;43(8):4891

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada and Department of Oncology, University of Alberta, Edmonton, Alberta T6G 2R3, Canada.

Purpose: To estimate the total dosimetric uncertainty at the tumor apex for ocular brachytherapy treatments delivered using 16 mm Collaborative Ocular Melanoma Study (COMS) and Super9 plaques loaded with (125)I seeds in order to determine the size of the apex margin that would be required to ensure adequate dosimetric coverage of the tumor.

Methods: The total dosimetric uncertainty was assessed for three reference tumor heights: 3, 5, and 10 mm, using the Guide to the expression of Uncertainty in Measurement/National Institute of Standards and Technology approach. Uncertainties pertaining to seed construction, source strength, plaque assembly, treatment planning calculations, tumor height measurement, plaque placement, and plaque tilt for a simple dome-shaped tumor were investigated and quantified to estimate the total dosimetric uncertainty at the tumor apex. Uncertainties in seed construction were determined using EBT3 Gafchromic film measurements around single seeds, plaque assembly uncertainties were determined using high resolution microCT scanning of loaded plaques to measure seed positions in the plaques, and all other uncertainties were determined from the previously published studies and recommended values. All dose calculations were performed using plaque simulator v5.7.6 ophthalmic treatment planning system with the inclusion of plaque heterogeneity corrections.

Results: The total dosimetric uncertainties at 3, 5, and 10 mm tumor heights for the 16 mm COMS plaque were 17.3%, 16.1%, and 14.2%, respectively, and for the Super9 plaque were 18.2%, 14.4%, and 13.1%, respectively (all values with coverage factor k = 2). The apex margins at 3, 5, and 10 mm tumor heights required to adequately account for these uncertainties were 1.3, 1.3, and 1.4 mm, respectively, for the 16 mm COMS plaque, and 1.8, 1.4, and 1.2 mm, respectively, for the Super9 plaque. These uncertainties and associated margins are dependent on the dose gradient at the given prescription depth, thus resulting in the changing uncertainties and margins with depth.

Conclusions: The margins determined in this work can be used as a guide for determining an appropriate apex margin for a given treatment, which can be chosen based on the tumor height. The required margin may need to be increased for more complex scenarios (mushroom shaped tumors, tumors close to the optic nerve, oblique muscle related tilt, etc.) than the simple dome-shaped tumor examined and should be chosen on a case-by-case basis. The sources of uncertainty contributing most significantly to the total dosimetric uncertainty are seed placement within the plaques, treatment planning calculations, tumor height measurement, and plaque tilt. This work presents an uncertainty-based, rational approach to estimating an appropriate apex margin.
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http://dx.doi.org/10.1118/1.4959540DOI Listing
August 2016

A generic high-dose rate (192)Ir brachytherapy source for evaluation of model-based dose calculations beyond the TG-43 formalism.

Med Phys 2015 Jun;42(6):3048-61

Département de Radio-Oncologie et Axe oncologie du Centre de Recherche du CHU de Québec, CHU de Québec, Québec, Québec G1R 2J6, Canada and Département de Physique, de Génie Physique et d'Optique et Centre de recherche sur le cancer, Université Laval, Québec, Québec G1R 2J6, Canada.

Purpose: In order to facilitate a smooth transition for brachytherapy dose calculations from the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) formalism to model-based dose calculation algorithms (MBDCAs), treatment planning systems (TPSs) using a MBDCA require a set of well-defined test case plans characterized by Monte Carlo (MC) methods. This also permits direct dose comparison to TG-43 reference data. Such test case plans should be made available for use in the software commissioning process performed by clinical end users. To this end, a hypothetical, generic high-dose rate (HDR) (192)Ir source and a virtual water phantom were designed, which can be imported into a TPS.

Methods: A hypothetical, generic HDR (192)Ir source was designed based on commercially available sources as well as a virtual, cubic water phantom that can be imported into any TPS in DICOM format. The dose distribution of the generic (192)Ir source when placed at the center of the cubic phantom, and away from the center under altered scatter conditions, was evaluated using two commercial MBDCAs [Oncentra(®) Brachy with advanced collapsed-cone engine (ACE) and BrachyVision ACUROS™ ]. Dose comparisons were performed using state-of-the-art MC codes for radiation transport, including ALGEBRA, BrachyDose, GEANT4, MCNP5, MCNP6, and PENELOPE2008. The methodologies adhered to recommendations in the AAPM TG-229 report on high-energy brachytherapy source dosimetry. TG-43 dosimetry parameters, an along-away dose-rate table, and primary and scatter separated (PSS) data were obtained. The virtual water phantom of (201)(3) voxels (1 mm sides) was used to evaluate the calculated dose distributions. Two test case plans involving a single position of the generic HDR (192)Ir source in this phantom were prepared: (i) source centered in the phantom and (ii) source displaced 7 cm laterally from the center. Datasets were independently produced by different investigators. MC results were then compared against dose calculated using TG-43 and MBDCA methods.

Results: TG-43 and PSS datasets were generated for the generic source, the PSS data for use with the ace algorithm. The dose-rate constant values obtained from seven MC simulations, performed independently using different codes, were in excellent agreement, yielding an average of 1.1109 ± 0.0004 cGy/(h U) (k = 1, Type A uncertainty). MC calculated dose-rate distributions for the two plans were also found to be in excellent agreement, with differences within type A uncertainties. Differences between commercial MBDCA and MC results were test, position, and calculation parameter dependent. On average, however, these differences were within 1% for ACUROS and 2% for ace at clinically relevant distances.

Conclusions: A hypothetical, generic HDR (192)Ir source was designed and implemented in two commercially available TPSs employing different MBDCAs. Reference dose distributions for this source were benchmarked and used for the evaluation of MBDCA calculations employing a virtual, cubic water phantom in the form of a CT DICOM image series. The implementation of a generic source of identical design in all TPSs using MBDCAs is an important step toward supporting univocal commissioning procedures and direct comparisons between TPSs.
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http://dx.doi.org/10.1118/1.4921020DOI Listing
June 2015

Radiochromic film calibration for low-energy seed brachytherapy dose measurement.

Med Phys 2014 Jul;41(7):072101

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada and Department of Oncology, University of Alberta, Edmonton, Alberta T6G 2R3, Canada.

Purpose: Radiochromic film dosimetry is typically performed for high energy photons and moderate doses characterizing external beam radiotherapy (XRT). The purpose of this study was to investigate the accuracy of previously established film calibration procedures used in XRT when applied to low-energy, seed-based brachytherapy at higher doses, and to determine necessary modifications to achieve similar accuracy in absolute dose measurements.

Methods: Gafchromic EBT3 film was used to measure radiation doses upwards of 35 Gy from 75 kVp, 200 kVp, 6 MV, and (∼28 keV) I-125 photon sources. For the latter irradiations a custom phantom was built to hold a single I-125 seed. Film pieces were scanned with an Epson 10000XL flatbed scanner and the resulting 48-bit RGB TIFF images were analyzed using both FilmQA Pro software andMATLAB. Calibration curves relating dose and optical density via a rational functional form for all three color channels at each irradiation energy were determined with and without the inclusion of uncertainties in the measured optical densities and dose values. The accuracy of calibration curve variations obtained using piecewise fitting, a reduced film measurement area for I-125 irradiation, and a reduced number of dose levels was also investigated. The energy dependence of the film lot used was also analyzed by calculating normalized optical density values.

Results: Slight differences were found in the resulting calibration curves for the various fitting methods used. The accuracy of the calibration curves was found to improve at low doses and worsen at high doses when including uncertainties in optical densities and doses, which may better represent the variability that could be seen in film optical density measurements. When exposing the films to doses > 8 Gy, two-segment piecewise fitting was found to be necessary to achieve similar accuracies in absolute dose measurements as when using smaller dose ranges. When reducing the film measurement area for the I-125 irradiations, the accuracy of the calibration curve was degraded due to the presence of localized film heterogeneities. No degradation in the calibration curves was found when reducing the number of calibration points down to only 4, but with piecewise fitting, 6 calibration points as well as a blank film are required. Variations due to photon energy in film optical density of up to 3% were found above doses of 2 Gy.

Conclusions: A modified procedure for performing EBT3 film calibration was established for use with low-energy brachytherapy seeds and high dose exposures. The energy dependence between 6 MV and I-125 photons is significant such that film calibrations should be done with an appropriately low-energy source when performing low-energy brachytherapy dose measurements. Two-segment piecewise fitting with the inclusion of errors in measured optical density as well as dose was found to result in the most accurate calibration curves. Above doses of 1 Gy, absolute dose measurements can be made with an accuracy of 1.6% for 6 MV beams and 5.7% for I-125 seed exposures if using the I-125 source for calibration, or 2.3% if using the 75 kVp photon beam for calibration.
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http://dx.doi.org/10.1118/1.4881146DOI Listing
July 2014

Fast dose kernel interpolation using Fourier transform with application to permanent prostate brachytherapy dosimetry.

Med Phys 2014 May;41(5):051701

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada and Department of Oncology, University of Alberta, Edmonton, Alberta T6G 2R3, Canada.

Purpose: Boyer and Mok proposed a fast calculation method employing the Fourier transform (FT), for which calculation time is independent of the number of seeds but seed placement is restricted to calculation grid points. Here an interpolation method is described enabling unrestricted seed placement while preserving the computational efficiency of the original method.

Methods: The Iodine-125 seed dose kernel was sampled and selected values were modified to optimize interpolation accuracy for clinically relevant doses. For each seed, the kernel was shifted to the nearest grid point via convolution with a unit impulse, implemented in the Fourier domain. The remaining fractional shift was performed using a piecewise third-order Lagrange filter.

Results: Implementation of the interpolation method greatly improved FT-based dose calculation accuracy. The dose distribution was accurate to within 2% beyond 3 mm from each seed. Isodose contours were indistinguishable from explicit TG-43 calculation. Dose-volume metric errors were negligible. Computation time for the FT interpolation method was essentially the same as Boyer's method.

Conclusions: A FT interpolation method for permanent prostate brachytherapy TG-43 dose calculation was developed which expands upon Boyer's original method and enables unrestricted seed placement. The proposed method substantially improves the clinically relevant dose accuracy with negligible additional computation cost, preserving the efficiency of the original method.
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http://dx.doi.org/10.1118/1.4870440DOI Listing
May 2014

Reply on 'Comparative evaluation of two dose optimization methods for image-guided, highly-conformal, tandem and ovoids cervix brachytherapy planning'.

Phys Med Biol 2014 Jan 16;59(1):247-9. Epub 2013 Dec 16.

Department of Physics, University of Alberta, Edmonton, Alberta, T6G 2J1, Canada.

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http://dx.doi.org/10.1088/0031-9155/59/1/247DOI Listing
January 2014

Transrectal ultrasound based prostate volume determination: is the frustum algorithm more accurate than planimetry?

Med Phys 2013 Mar;40(3):031705

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.

Purpose: To compare reconstructed volumes calculated via planimetry and frustum algorithms in the context of stepped transrectal ultrasound (US) imaging, and to estimate the reconstruction error for prostate volumes.

Methods: Prostate contours for 40 permanent implant patients were delineated on magnetic resonance (MR) and transrectal US images by a radiation oncologist. Simulated images of ellipsoid and truncated cone geometrical objects were constructed to determine volume calculation accuracy. Simulation results were used to deduce the algorithm-associated error made when calculating transrectal US prostate volumes.

Results: For imaging without deliberate slice positioning, planimetry reconstruction was mostly accurate while the frustum algorithm underestimated the volume. The discrepancy was mostly due to the end slice reconstruction. For slice positioning that reflected US image acquisition, planimetry overestimated by half the superior slice volume on average while frustum underestimated by half the inferior slice volume. The estimated algorithm errors for prostate contours were 4% and -3%, respectively.

Conclusions: The planimetry and frustum algorithms offer different interpretations for reconstruction and yield systematic differences in calculated volumes. Both algorithms introduce bias into transrectal US prostate volume determinations that may have clinical implications, planimetry overestimating and frustum underestimating the volume.
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http://dx.doi.org/10.1118/1.4789920DOI Listing
March 2013

Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: report of the AAPM and ESTRO.

Med Phys 2012 May;39(5):2904-29

Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain.

Purpose: Recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO) on dose calculations for high-energy (average energy higher than 50 keV) photon-emitting brachytherapy sources are presented, including the physical characteristics of specific (192)Ir, (137)Cs, and (60)Co source models.

Methods: This report has been prepared by the High Energy Brachytherapy Source Dosimetry (HEBD) Working Group. This report includes considerations in the application of the TG-43U1 formalism to high-energy photon-emitting sources with particular attention to phantom size effects, interpolation accuracy dependence on dose calculation grid size, and dosimetry parameter dependence on source active length.

Results: Consensus datasets for commercially available high-energy photon sources are provided, along with recommended methods for evaluating these datasets. Recommendations on dosimetry characterization methods, mainly using experimental procedures and Monte Carlo, are established and discussed. Also included are methodological recommendations on detector choice, detector energy response characterization and phantom materials, and measurement specification methodology. Uncertainty analyses are discussed and recommendations for high-energy sources without consensus datasets are given.

Conclusions: Recommended consensus datasets for high-energy sources have been derived for sources that were commercially available as of January 2010. Data are presented according to the AAPM TG-43U1 formalism, with modified interpolation and extrapolation techniques of the AAPM TG-43U1S1 report for the 2D anisotropy function and radial dose function.
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http://dx.doi.org/10.1118/1.3703892DOI Listing
May 2012

Impact of edema and seed movement on the dosimetry of prostate seed implants.

J Med Phys 2012 Apr;37(2):81-9

Department of Medical Physics, Cross Cancer Institute, Alberta Health Services - Cancer Care and Department of Oncology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.

This article summarizes current knowledge concerning the characterization of prostatic edema and intra-prostatic seed movement as these relate to dosimetry of permanent prostate implants, and reports the initial application to clinical data of a new edema model used in calculating pre- and post-implant dose distributions. Published edema magnitude and half-life parameters span a broad range depending on implant technique and measurement uncertainty, hence clinically applicable values should be determined locally. Observed intra-prostatic seed movements appear to be associated with particular aspects of implant technique and could be minimized by technique modification. Using an extended AAPM TG-43 formalism incorporating the new edema model, relative dose error RE associated with neglecting edema was calculated for three I-125 seed implants (18.9 cc, 37.6 cc, 60.2 cc) performed at our center. Pre- and post-plan RE average values and ranges in a 50 × 50 × 50 mm(3) calculation volume were similar at ~2% and ~0-3.5%, respectively, for all three implants; however, the spatial distribution of RE varied for different seed configurations. Post-plan values of D90 and V100 for prostate were reduced by ~2% and ~1%, respectively. In cases where RE is not clinically negligible as a consequence of large edema magnitude and / or use of Pd-103 seeds, the dose calculation method demonstrated here can be applied to account for edema explicitly and there by improve the accuracy of clinical dose estimates.
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http://dx.doi.org/10.4103/0971-6203.94742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339147PMC
April 2012

Comparison of prostate volume, shape, and contouring variability determined from preimplant magnetic resonance and transrectal ultrasound images.

Brachytherapy 2012 Jul-Aug;11(4):284-91. Epub 2011 Dec 23.

Division of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.

Purpose: To compare preimplant prostate contours and contouring variability between magnetic resonance (MR) and transrectal ultrasound images.

Methods And Materials: Twenty-three patients were imaged using ultrasound (US) and MR before permanent brachytherapy treatment. Images were anonymized, randomized, and duplicated, and the prostate was independently delineated by five radiation oncologists. Contours were compared in terms of volume, dimensions, posterior rectal indentation, and observer variability. The Jaccard index quantified spatial overlap between contours from duplicated images.

Results: The mean US/MR volume ratio was 0.99±0.08 (p=0.5). The width, height, and length ratios for the prostate were 0.98±0.06 (p=0.09), 0.99±0.08 (p=0.4), and 1.05±0.14 (p=0.1). Rectal indentation was larger on US by 0.18mL (p=0.01) and correlated with prostate volume (p<0.01). MR and US interobserver variability in volume were similar at 3.5±1.7 and 3.3±1.9mL (p=0.6). Intraobserver variability was smaller on US at 1.4±1.1mL compared with MR at 2.4±2.2mL (p=0.01). Local intraobserver variability was lower on US at the midgland slice (p<0.01) but lower on MR at the base (p<0.01) and apex (p<0.01) slices.

Conclusions: US is comparable to MR for preimplant prostate delineation, with no significant difference in volume and dimensions. Rectal indentation because of the transrectal ultrasound probe was measurable, although the effects were small. Intraobserver variability was lower on US for the prostate volume but was lower on MR locally at the base and apex. However, the difference was not observed for the interobserver variability, which was similar between MR and US.
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http://dx.doi.org/10.1016/j.brachy.2011.11.004DOI Listing
November 2012

Dose calculation for permanent prostate implants incorporating spatially anisotropic linearly time-resolving edema.

Med Phys 2011 Apr;38(4):2289-98

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada.

Purpose: The objectives of this study were (i) to develop a dose calculation method for permanent prostate implants that incorporates a clinically motivated model for edema and (ii) to illustrate the use of the method by calculating the preimplant dosimetry error for a reference configuration of 125I, 103Pd, and 137Cs seeds subject to edema-induced motions corresponding to a variety of model parameters.

Methods: A model for spatially anisotropic edema that resolves linearly with time was developed based on serial magnetic resonance imaging measurements made previously at our center to characterize the edema for a group of n = 40 prostate implant patients [R. S. Sloboda et al., "Time course of prostatic edema post permanent seed implant determined by magnetic resonance imaging," Brachytherapy 9, 354-361 (2010)]. Model parameters consisted of edema magnitude, delta, and period, T. The TG-43 dose calculation formalism for a point source was extended to incorporate the edema model, thus enabling calculation via numerical integration of the cumulative dose around an individual seed in the presence of edema. Using an even power piecewise-continuous polynomial representation for the radial dose function, the cumulative dose was also expressed in closed analytical form. Application of the method was illustrated by calculating the preimplant dosimetry error, RE(preplan), in a 5 x 5 x 5 cm3 volume for 125I (Oncura 6711), 103Pd (Theragenics 200), and 131Cs (IsoRay CS-1) seeds arranged in the Radiological Physics Center test case 2 configuration for a range of edema relative magnitudes (delta = [0.1, 0.2, 0.4, 0.6, 1.0]) and periods (T = [28, 56, 84] d). Results were compared to preimplant dosimetry errors calculated using a variation of the isotropic edema model developed by Chen et al. ["Dosimetric effects of edema in permanent prostate seed implants: A rigorous solution," Int. J. Radiat. Oncol., Biol., Phys. 47, 1405-1419 (2000)].

Results: As expected, RE(preplan) for our edema model indicated underdosage in the calculation volume with a clear dependence on seed and calculation point positions, and increased with increasing values of delta and T. Values of RE(preplan) were generally larger near the ends of the virtual prostate in the RPC phantom compared with more central locations. For edema characteristics similar to the population average values previously measured at our center, i.e., delta = 0.2 and T = 28 d, mean values of RE(preplan) in an axial plane located 1.5 cm from the center of the seed distribution were 8.3% for 131Cs seeds, 7.5% for 103Pd seeds, and 2.2% for 125I seeds. Maximum values of RE(preplan) in the same plane were about 1.5 times greater. Note that detailed results strictly apply only for loose seed implants where the seeds are fixed in tissue and move in synchrony with that tissue.

Conclusions: A dose calculation method for permanent prostate implants incorporating spatially anisotropic linearly time-resolving edema was developed for which cumulative dose can be written in closed form. The method yields values for RE(preplan) that differ from those for spatially isotropic edema. The method is suitable for calculating pre- and postimplant dosimetry correction factors for clinical seed configurations when edema characteristics can be measured or estimated.
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http://dx.doi.org/10.1118/1.3568926DOI Listing
April 2011

Time course of prostatic edema post permanent seed implant determined by magnetic resonance imaging.

Brachytherapy 2010 Oct-Dec;9(4):354-61. Epub 2010 Jan 29.

Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.

Purpose: To quantify the time course of postimplant prostatic edema magnitude and spatial isotropy using serial magnetic resonance imaging (MRI).

Methods And Materials: Forty patients with histologic diagnosis of prostate cancer received an iodine-125 seed implant (Day 0) and consented to 1.5-T MRI on Days -1, 0, 14, and 28. Seeds of strength 0.39mCi were placed in a modified peripheral loading pattern to deliver 145Gy to the target volume. MR images consisted of 3-4mm thick axial slices with no gap. The image sets were anonymized and randomized to minimize contouring bias, then contoured by a single radiation oncologist. Contours were reoriented about their center of mass to align the prostate long axis with the superior-inferior (S-I) direction; prostate volumes and dimensions in the left-right (L-R), anterior-posterior (A-P), and S-I directions through the center of mass were calculated.

Results: The average relative edema volume was 1.18±0.14 (1standard deviation) on Day 0 and 1.01±0.15 on Day 30. Between Days 0 and 30, the edema resolved linearly with time on average. Average relative edema dimensions on Day 0 in the L-R, A-P, and S-I directions were 1.01±0.07, 1.11±0.09, and 1.08±0.13, respectively.

Conclusions: As measured using MRI, the average edema magnitude for our study population was ∼20% on Day 0 and resolved linearly with time to ∼0% on Day 30. The edema exhibited spatial anisotropy, the prostate expanding on Day 0 by ∼10% in each of the A-P and S-I directions and by ∼0% in the L-R direction.
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http://dx.doi.org/10.1016/j.brachy.2009.09.008DOI Listing
February 2011

Transit dose contributions to intracavitary and interstitial PDR brachytherapy treatments.

Phys Med Biol 2008 Jul 11;53(13):3447-62. Epub 2008 Jun 11.

Department of Medical Physics, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada.

The objective of this study was to determine the magnitude of transit dose contributions to the planned dose in common intracavitary and interstitial brachytherapy treatments delivered using a pulsed dose rate (PDR) remote afterloader. The total transit dose arises from the travel of the radiation source into (entry) and out of (exit) the applicator, and between the dwell positions (inter-dwell). In this paper, we used a well-type ionization chamber to measure the transit dose component for a PDR afterloader and compared the results against measurements for a high dose rate (HDR) afterloader. Our results show that for typical intracavitary and interstitial treatments, the major contribution to transit dose is from the entry+exit source travel, as the inter-dwell component is effectively compensated for (<0.5%) by the afterloader. The transit dose was generally found to be larger for PDR treatments than for HDR treatments, as it is influenced by the source activity, dwell times and number of radiation pulses. The overall increase in the planned dose contributed by the transit dose in a typical intracavitary PDR treatment was estimated to be <2%, but much higher for interstitial treatments. This study shows that the effect of the transit dose on common clinical intracavitary PDR brachytherapy treatments is practically negligible, but requires attention in highly fractionated large volume interstitial treatments.
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http://dx.doi.org/10.1088/0031-9155/53/13/003DOI Listing
July 2008

Brachytherapy scatter dose calculation in heterogeneous media: II. Empirical formulation for the multiple-scatter contribution.

Phys Med Biol 2007 Sep 3;52(18):5637-54. Epub 2007 Sep 3.

Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada.

The presence of heterogeneous media can produce significant perturbations of dose distribution in brachytherapy. In a companion paper, we proposed a dose decomposition approach for dose calculation in a heterogeneous medium, which separately treats dose contributions from primary, once-scattered and multiple-scattered photons. The companion paper also describes and verifies a micro-beam ray-tracing method for evaluating the once-scatter dose. This paper deals with the calculation of the multiple-scatter dose. We present two empirical formulations for evaluating the heterogeneity correction factor for a 27 keV point source in a water sphere containing a disc-shaped heterogeneity. The empirical formulations are based on nonlinear curve fitting of the Monte Carlo multiple-scatter dose estimates calculated for the heterogeneous system. Extensive benchmark comparisons show that these formulations provide results for the multiple-scatter dose that agree within 10% (and mostly within 5%) with corresponding Monte Carlo dose estimates. Combining them with the algorithms for primary and once-scatter dose calculation described in the companion paper yields results for the total dose of equivalent accuracy. The empirical formulations are expressed in simple mathematical forms which involve a separation of the geometry and position variables of the heterogeneous system. Such representation provides a good tool to investigate the heterogeneity-induced perturbation of a multiple-scatter dose at low photon energy.
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http://dx.doi.org/10.1088/0031-9155/52/18/011DOI Listing
September 2007

Brachytherapy scatter dose calculation in heterogeneous media: I. A microbeam ray-tracing method for the single-scatter contribution.

Phys Med Biol 2007 Sep 3;52(18):5619-36. Epub 2007 Sep 3.

Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada.

In this work, we propose a framework for calculating brachytherapy dose distributions in heterogeneous media. The approach taken includes analytical calculation of the primary dose, and separately treats contributions of the once-scatter photons and multiple-scatter photons to the total scatter dose. This paper focuses on the evaluation of the once-scatter dose, which is based on a micro-beam ray-tracing model developed by the authors that incorporates an accurate description of the physical scattering of photons (Compton and Rayleigh scattering) with considerable flexibility in accommodating diverse geometries in a heterogeneous medium. The accuracy of the ray-tracing model has been verified by comparing model-calculated once-scatter doses with corresponding Monte Carlo results. For a 22 keV, 27 keV and 300 keV point source in water containing a disc-shaped heterogeneity of whitlockite, stainless steel or lead, our calculated results for once-scatter doses are in excellent agreement with corresponding Monte Carlo results over a wide range of heterogeneity dimensions and positions. Our investigation also explores the differences between physical scattering and isotropic scattering in evaluating the once-scatter dose, and thus enables the domain of applicability of the latter to be assessed. An appropriate method for evaluating the multiple-scatter dose, which together with the micro-beam method described here provides a means to calculate the total dose, is the subject of a companion paper.
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http://dx.doi.org/10.1088/0031-9155/52/18/010DOI Listing
September 2007

Post-implant computed tomography-magnetic resonance prostate image registration using feature line parallelization and normalized mutual information.

J Appl Clin Med Phys 2006 Jul 5;8(1):21-32. Epub 2006 Jul 5.

Cross Cancer Institute, Department of Medical Physics, Edmonton, Alberta, Canada.

Post-implant dosimetry for permanent prostate brachytherapy is typically performed using computed tomography (CT) images, for which the clear visualization of soft tissue structures is problematic. Registration of CT and magnetic resonance (MR) image volumes can improve the definition of all structures of interest (soft tissues, bones, and seeds) in the joint image set. In the present paper, we describe a novel two-stage rigid-body registration algorithm that consists of (1) parallelization of straight lines fit to image features running primarily in the superior-inferior (Z) direction, followed by (2) normalized mutual information registration. The first stage serves to fix rotation angles about the anterior-posterior (Y) and left-right (X) directions, and the second stage determines the remaining Z-axis rotation angle and the X, Y, Z translation values. The new algorithm was applied to CT and 1.5T MR (T2-weighted and balanced fast-field echo sequences) axial image sets for three patients acquired four weeks after prostate brachytherapy using 125I seeds. Image features used for the stage 1 parallelization were seed trains in CT and needle tracks and seed voids in MR. Simulated datasets were also created to further investigate algorithm performance. Clinical image volumes were successfully registered using the two-stage approach to within a root-mean-squares (RMS) distance of <1.5 mm, provided that some pubic bone and anterior rectum were included in the registration volume of interest and that no motion artifact was apparent. This level of accuracy is comparable to that obtained for the same clinical datasets using the Procrustes algorithm. Unlike Procrustes, the new algorithm can be almost fully automated, and hence we conclude that its further development for application in post-implant dosimetry is warranted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722399PMC
http://dx.doi.org/10.1120/jacmp.v8i1.2351DOI Listing
July 2006

The importance of urethra visualization for preplanned permanent prostate implants.

Brachytherapy 2005 ;4(3):195-201

Department of Medical Physics, Cross Cancer Institute, Edmonton, Canada.

Purpose: To assess the potential consequences of using a surrogate urethra on urethral dose estimates in preplanned 125I prostate implants.

Methods And Materials: For n=220 patients, the A-P and L-R extents of prostate and urethra contours were measured in transrectal ultrasound images. Treatment plans were then developed for 6 patients, of which 5 had atypical urethral positions. For each patient, three plan variations were made using the visualized and two different surrogate urethra contours.

Results: The urethra typically remains fixed in the L-R direction and extends slightly below midgland, but may veer off-center and can come within 0.5 cm of the posterior surface of the prostate. Use of a surrogate urethra can potentially result in up to 30% of the urethra receiving doses exceeding a planned limit of 1.5 x 145 Gy over a contiguous length of 2.0 cm.

Conclusions: The urethra should be visualized for preplanning purposes, because unintended urethral doses arising from the use of a surrogate urethra can approach levels associated with late urinary morbidity. Visualization is also essential in the postimplant setting for accurate collection of dose-toxicity data.
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http://dx.doi.org/10.1016/j.brachy.2005.03.004DOI Listing
February 2006

Compensator thickness verification using an a-Si EPID.

Med Phys 2004 Aug;31(8):2300-12

Department of Physics, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.

Electronic portal imaging devices (EPIDs) are being increasingly employed to make therapy verification and dose measurements in the clinic. In this work, we investigate the use of an amorphous silicon (a-Si) EPID to verify the accuracy of compensator fabrication and mounting. Compensator thickness estimates on a two-dimensional grid were calculated from the primary component of transmission obtained by subtracting a modeled scatter component from the total transmission measured with the EPID. The primary component was related to the thickness via an exponential relation that includes beam hardening. Implementation of the method involved determination of: (i) a calibration curve relating EPID pixel values to energy fluence for open and attenuated fields, which was found to be linear for open fields but to have a small quadratic component for attenuated beams; (ii) EPID scatter factors to account for field size effects, which exhibited a small dependence on compensator thickness and field size; (iii) the attenuation coefficient of the steel shot compensator material, which varied slightly with off-axis distance and field size, and (iv) an analytical model to predict scatter from the compensator, which was calculated to be <4% at the standard EPID imaging distance of 140 cm. Thickness distributions were then measured for several types of attenuators including flat, test, and clinical compensators. Although uncertainties associated with compensator manufacturing were non-negligible and made assessment of thickness measurement uncertainty difficult, we estimate the latter to be approximately 0.5 mm for steel shot compensators of thickness <4 cm.
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http://dx.doi.org/10.1118/1.1767694DOI Listing
August 2004

Quality assurance measurements of a-Si EPID performance.

Med Dosim 2004 ;29(1):11-7

Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, Canada.

The performance stability of a Varian aS500 amorphous silicon (a-Si) electronic portal imaging device (EPID) was monitored over an 18-month period using a variety of standard quality assurance (QA) tests. The tests were selected to provide ongoing information about image quality and dose response from the time of EPID acceptance into clinical service. To evaluate imaging performance, we made spatial resolution and contrast measurements using both PortalVision and QC-3V phantoms for 6- and 15-MV photon beams at repetition rates of 100, 300, and 400 MU/min in standard scanning mode. To assess operational stability for dosimetry applications, we measured central axis radiation response and beam pulse variability for the same image acquisition modes. Using the QC-3V phantom, values for the critical frequency of 0.435 +/- 0.005 lp/mm for 6 MV and 0.382 +/- 0.003 lp/mm for 15 MV were obtained. The contrast-to-noise ratio was found to be approximately 20% higher for the lower photon energy. Beam pulse variability remained within the tolerance of 3% set by the manufacturer. The central axis pixel response of the EPID remained constant within +/-1% over a 5-month period for the 6-MV beam, but fell approximately 4% over the same period for the 15-MV beam. The Varian aS500 EPID studied exhibited consistent image quality and a stable radiation response. These characteristics render it suitable for quantitative applications such as clinical dose measurement.
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http://dx.doi.org/10.1016/j.meddos.2003.09.002DOI Listing
July 2004

Dosimetric consequences of increased seed strength for I-125 prostate implants.

Radiother Oncol 2003 Sep;68(3):295-7

Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada.

Based on the findings of an earlier planning study, we compared post-implant dose distributions for two groups of 20 consecutive patients treated to 145 Gy with 0.414 and 0.526 U I-125 seeds. Dosimetric coverage as measured by the key clinical index D(90) was significantly better for the higher-strength seeds, with no apparent deleterious effects.
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http://dx.doi.org/10.1016/s0167-8140(03)00243-3DOI Listing
September 2003

Compensator quality control with an amorphous silicon EPID.

Med Phys 2003 Jul;30(7):1816-24

Department of Physics, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada.

The calibration and quality control of compensators is conventionally performed with an ion chamber in a water-equivalent phantom. In our center, the compensator factor and four off-axis fluence ratios are measured to verify the central axis beam modulation and orientation of the compensator. Here we report the investigation of an alternative technique for compensator quality control using an amorphous silicon electronic portal imaging device (a-Si EPID). Preliminary experiments were performed to identify appropriate EPID operating parameters for this relative dosimetric study and also to quantify EPID operation. The pixel value versus energy fluence response of the EPID for both open and compensated fields was then determined, and expressed via calibration curves. For open fields the response was seen to be linear, whereas for compensated fields it exhibited a small quadratic component. To account for field size effects, we measured EPID scatter factors. These exhibited small but non-negligible dependencies on compensator thickness and source-detector distance. Finally, a number of test and clinical compensators were evaluated to assess the suitability of the EPID for compensator quality control. Our results indicate that the a-Si EPID can measure clinical compensator factors and off-axis energy fluence ratios to within 2% of values measured by a Farmer chamber on average, and so is a suitable ion chamber replacement.
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http://dx.doi.org/10.1118/1.1584040DOI Listing
July 2003