High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging

Purpose: To investigate in three institutions, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis [AvL]), Dr. Daniel den Hoed Cancer Center (DDHC), and Dr. Bernard Verbeeten Institute (BVI), how much the patient setup accuracy for irradiation of prostate cancer can be improved by an offline setup verification and correction procedure, using portal imaging. Methods and Materials: The verification procedure consisted of two stages. During the first stage, setup deviations were measured during a number (N(max)) of consecutive initial treatment sessions. The length of the average three dimensional (3D) setup deviation vector was compared with an action level for corrections, which shrunk with the number of setup measurements. After a correction was applied, N(max) measurements had to be performed again. Each institution chose different values for the initial action level (6, 9, and 10 mm) and N(max) (2 and 4). The choice of these parameters was based on a simulation of the procedure, using as input preestimated values of random and systematic deviations in each institution. During the second stage of the procedure, with weekly setup measurements, the AvL used a different criterion ('outlier detection') for corrective actions than the DDHC and the BVI ('sliding average'). After each correction the first stage of the procedure was restarted. The procedure was tested for 151 patients (62 in AvL, 47 in DDHC, and 42 in BVI) treated for prostate carcinoma. Treatment techniques and portal image acquisition and analysis were different in each institution. Results: The actual distributions of random and systematic deviations without corrections were estimated by eliminating the effect of the corrections. The percentage of mean (systematic) 3D deviations larger than 5 mm was 26% for the AvL and the DDHC, and 36% for the BVI. The setup accuracy after application of the procedure was considerably improved (percentage of mean 3D deviations larger than 5 mm was 1.6% in the AvL and 0% in the DDHC and BVI), in agreement with the results of the simulation. The number of corrections (about 0.7 on the average per patient) was not larger than predicted. Conclusion: The verification procedure appeared to be feasible in the three institutions and enabled a significant reduction of mean 3D setup deviations. The computer simulation of the procedure proved to be a useful tool, because it enabled an accurate prediction of the setup accuracy and the required number of corrections

Nonlinear excitations in CsNiF3 in magnetic fields perpendicular to the easy plane

Experimental and numerical studies of the magnetic field dependence of the specific heat and magnetization of single crystals of CsNiF3 have been performed at 2.4 K, 2.9 K, and 4.2 K in magnetic fields up to 9 T oriented perpendicular to the easy plane. The experimental results confirm the presence of the theoretically predicted double peak structure in the specific heat arising from the formation of nonlinear spin modes. The demagnetizing effects are found to be negligible, and the overall agreement between the data and numerical predictions is better than reported for the case when the magnetic field was oriented in the easy plane. Demagnetizing effects might play a role in generating the difference observed between theory and experiment in previous work analyzing the excess specific heat using the sine-Gordon model.Comment: 6 pages, 5 figures, submitted to Phys. Rev.