Integrating a MRI scanner with a 6 MV radiotherapy accelerator:dose deposition in a transverse magnetic field

\u3cp\u3eIntegrating magnetic resonance imaging (MRI) functionality with a radiotherapy accelerator can facilitate on-line, soft-tissue based, position verification. A technical feasibility study, in collaboration with Elekta Oncology Systems and Philips Medical Systems, led to the preliminary design specifications of a MRI accelerator. Basically the design is a 6 MV accelerator rotating around a 1.5 T MRI system. Several technical issues and the clinical rational are currently under investigation. The aim of this paper is to determine the impact of the transverse 1.5 T magnetic field on the dose deposition. Monte Carlo simulations were used to calculate the dose deposition kernel in the presence of 1.5 T. This kernel in turn was used to determine the dose deposition for larger fields. Also simulations and measurements were done in the presence of 1.1 T. The pencil beam dose deposition is asymmetric. For larger fields the asymmetry persists but decreases. For the latter the distance to dose maximum is reduced by approximately 5 mm, the penumbra is increased by approximately 1 mm, and the 50% isodose line is shifted approximately 1 mm. The dose deposition in the presence of 1.5 T is affected, but the effect can be taken into account in a conventional treatment planning procedure. The impact of the altered dose deposition for clinical IMRT treatments is the topic of further research.\u3c/p\u3

Label fusion in multi-atlas based segmentation with user-defined local weights

Multi-atlas based segmentation is a popular method to automatically segment a target image, in which the correspondence to already segmented atlas images is used to construct multiple segmentations for a single structure in the target image. These multiple segmentations are then combined into a single segmentation for the target image in a process called label fusion. In the past, the result of multi-atlas based segmentation has mostly been evaluated using a volume overlap measure. However, such a measure can only be used to assess the global quality of a segmentation and does not take into account local differences in for example the clinical relevance of a certain region of the segmentation. We propose to use voxel-based weights in the evaluation of segmentations and show that by using these weights already during the label fusion process, one is able to obtain multi-atlas based segmentation results with an improved clinical relevance compared to unweighted atlas based segmentation. A method is proposed to implement this for multi-atlas based segmentation of the prostate. © 2011 IEEE

Registration of structurally dissimilar images in MRI-based brachytherapy

A serious challenge in image registration is the accurate alignment of two images in which a certain structure is present in only one of the two. Such topological changes are problematic for conventional non-rigid registration algorithms. We propose to incorporate in a conventional free-form registration framework a geometrical penalty term that minimizes the volume of the missing structure in one image. We demonstrate our method on cervical MR images for brachytherapy. The intrapatient registration problem involves one image in which a therapy applicator is present and one in which it is not. By including the penalty term, a substantial improvement in the surface distance to the gold standard anatomical position and the residual volume of the applicator void are obtained. Registration of neighboring structures, i.e. the rectum and the bladder is generally improved as well, albeit to a lesser degree. © 2014 Institute of Physics and Engineering in Medicine

Calculation of change in brain temperatures due to exposure to a mobile phone

In this study we evaluated for a realistic head model the 3D temperature rise induced by a mobile phone. This was done numerically with the consecutive use of an FDTD model to predict the absorbed electromagnetic power distribution, and a thermal model describing bioheat transfer both by conduction and by blood flow. We calculated a maximum rise in brain temperature of 0.11 °C for an antenna with an average emitted power of 0.25 W, the maximum value in common mobile phones, and indefinite exposure. Maximum temperature rise is at the skin. The power distributions were characterized by a maximum averaged SAR over an arbitrarily shaped 10 g volume of approximately 1.6 W kg-1. Although these power distributions are not in compliance with all proposed safety standards, temperature rises are far too small to have lasting effects. We verified our simulations by measuring the skin temperature rise experimentally. Our simulation method can be instrumental in further development of safety standards

Probabilistic treatment planning for pancreatic cancer treatment : prospective incorporation of respiratory motion shows only limited dosimetric benefit

BACKGROUND: We introduced a probabilistic treatment planning approach that prospectively incorporates respiratory-induced motion in the treatment plan optimization. The aim of this study was to determine the potential dosimetric benefit by comparing this approach to the use of an internal target volume (ITV). MATERIAL AND METHOD: We retrospectively compared the probabilistic respiratory motion-incorporated (RMI) approach to the ITV approach for 18 pancreatic cancer patients, for seven simulated respiratory amplitudes from 5 to 50 mm in the superior-inferior (SI) direction. For each plan, we assessed the target coverage (required: D98%≥95% of 50 Gy prescribed dose). For the RMI plans, we investigated whether target coverage was robust against daily variations in respiratory amplitude. We determined the distance between the clinical target volume and the 30 Gy isodose line (i.e. dose gradient steepness) in the SI direction. To investigate the clinical benefit of the RMI approach, we created for each patient an ITV and RMI treatment plan for the three-dimensional (3D) respiratory amplitudes observed on their pretreatment 4D computed tomography (4DCT). We determined Dmean, V30Gy, V40Gy and V50Gy for the duodenum. RESULTS: All treatment plans yielded good target coverage. The RMI plans were robust against respiratory amplitude variations up to 10 mm, as D98% remained ≥95%. We observed steeper dose gradients compared to the ITV approach, with a mean decrease from 25.9 to 19.2 mm for a motion amplitude of 50 mm. For the 4DCT motion amplitudes, the RMI approach resulted in a mean decrease of 0.43 Gy, 1.1 cm(3), 1.4 cm(3) and 0.9 cm(3) for the Dmean, V30Gy, V40Gy and V50Gy of the duodenum, respectively. CONCLUSION: The probabilistic treatment planning approach yielded significantly steeper dose gradients and therefore significantly lower dose to surrounding healthy tissues than the ITV approach. However, the observed dosimetric gain for clinically observed respiratory motion amplitudes for this patient group was limited

Non-rigid CT/CBCT to CBCT registration for online external beam radiotherapy guidance

Image-guided external beam radiotherapy (EBRT) allows radiation dose deposition with a high degree of accuracy and precision. Guidance is usually achieved by estimating the displacements, via image registration, between cone beam computed tomography (CBCT) and computed tomography (CT) images acquired at different stages of the therapy. The resulting displacements are then used to reposition the patient such that the location of the tumor at the time of treatment matches its position during planning. Moreover, ongoing research aims to use CBCT-CT image registration for online plan adaptation.
 However, CBCT images are usually acquired using a small number of X-Ray projections and/or low beam intensities. This often leads to the images being subject to low contrast, low signal-to-noise ratio and artifacts, which ends-up hampering the image registration process. Previous studies addressed this by integrating additional image processing steps into the registration procedure. However, these steps are usually designed for particular image acquisition schemes, therefore limiting their use on a case-by-case basis.
 In the current study we address CT to CBCT and CBCT to CBCT registration by the means of the recently proposed EVolution registration algorithm. Contrary to previous approaches, EVolution does not require the integration of additional image processing steps in the registration scheme. Moreover, the algorithm requires a low number of input parameters, is easily parallelizable and provides an elastic deformation on a point-by-point basis. Results have shown that relative to a pure CT-based registration, the intrinsic artifacts present in typical CBCT images only have a sub-millimeter impact on the accuracy and precision of the estimated deformation. In addition, the algorithm has low computational requirements, which are compatible with online image-based guidance of EBRT treatments.&#13

Numerical Modeling of Temperature Distributions within the Neonatal Head

Introduction of hypothermia therapy as a neuroprotection therapy after hypoxia-ischemia in newborn infants requires appraisal of cooling methods. In this numerical study thermal simulations were performed to test the hypothesis that cooling of the surface of the cranium by the application of a cooling bonnet significantly reduces deep brain temperature and produces a temperature differential between the deep brain and the body core. A realistic three-dimensional (3-D) computer model of infant head anatomy was used, derived from magnetic resonance data from a newborn infant. Temperature distributions were calculated using the Pennes heatsink model. The cooling bonnet was at a constant temperature of 10[degrees]C. When modeling head cooling only, a constant body core temperature of 37[degrees]C was imposed. The computed result showed no significant cooling of the deep brain regions, only the very superficial regions of the brain are cooled to temperatures of 33-34[degrees]C. Poor efficacy of head cooling was still found after a considerable increase in the modeled thermal conductivities of the skin and skull, or after a decrease in perfusion. The results for the heatsink thermal model of the infant head were confirmed by comparison of results computed for a scaled down adult head, using both the heatsink description and a discrete vessel thermal model with both anatomy and vasculature obtained from MR data. The results indicate that significant reduction in brain temperature will only be achieved if the infant's core temperature is lowered

Post-lumpectomy CT-guided tumor bed delineation for breast boost and partial breast irradiation : Can additional pre- and postoperative imaging reduce interobserver variability?

For breast boost radiotherapy or accelerated partial breast irradiation, the tumor bed (TB) is delineated by the radiation oncologist on a planning computed tomography (CT) scan. The aim of the present study was to investigate whether the interobserver variability (IOV) of the TB delineation is reduced by providing the radiation oncologist with additional magnetic resonance imaging (MRI) or CT scans. A total of 14 T1-T2 breast cancer patients underwent a standard planning CT in the supine treatment position following lumpectomy, as well as additional pre- and postoperative imaging in the same position. Post-lumpectomy TBs were independently delineated by four breast radiation oncologists on standard postoperative CT and on CT registered to an additional imaging modality. The additional imaging modalities used were postoperative MRI, preoperative contrast-enhanced (CE)-CT and preoperative CE-MRI. A cavity visualization score (CVS) was assigned to each standard postoperative CT by each observer. In addition, the conformity index (CI), volume and distance between centers of mass (dCOM) of the TB delineations were calculated. On CT, the median CI was 0.57, with a median volume of 22 cm(3) and dCOM of 5.1 mm. The addition of postoperative MRI increased the median TB volume significantly to 28 cm(3) (

Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise.

Background and purpose Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance.Materials and methods Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTV pre/post ), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TV ref ) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSC ref/part ) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTV ref was regarded as an unacceptable variation.Results A total of 57/60 delineation sets were completed. The median DSC ref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTV pre , GTV post , CTV-T and CTV-N, respectively. An unacceptable variation from the CTV ref was found for 7/9 participants for case 5 and 6/9 participants for case 6.Conclusion This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale