The potential impact of CT-MRI matching on tumor volume delineation in advanced head and neck cancer

To study the potential impact of the combined use of CT and MRI scans on the Gross Tumor Volume (GTV) estimation and interobserver variation. Four observers outlined the GTV in six patients with advanced head and neck cancer on CT, axial MRI, and coronal or sagittal MRI. The MRI scans were subsequently matched to the CT scan. The interobserver and interscan set variation were assessed in three dimensions. The mean CT derived volume was a factor of 1.3 larger than the mean axial MRI volume. The range in volumes was larger for the CT than for the axial MRI volumes in five of the six cases. The ratio of the scan set common (i.e., the volume common to all GTVs) and the scan set encompassing volume (i.e., the smallest volume encompassing all GTVs) was closer to one in MRI (0.3-0.6) than in CT (0.1-0.5). The rest volumes (i.e., the volume defined by one observer as GTV in one data set but not in the other data set) were never zero for CT vs. MRI nor for MRI vs. CT. In two cases the craniocaudal border was poorly recognized on the axial MRI but could be delineated with a good agreement between the observers in the coronal/sagittal MRI. MRI-derived GTVs are smaller and have less interobserver variation than CT-derived GTVs. CT and MRI are complementary in delineating the GTV. A coronal or sagittal MRI adds to a better GTV definition in the craniocaudal directio

The effect of magnetic dipolar interactions on the interchain spin wave dispersion in CsNiF_3

Inelastic neutron scattering measurements were performed on the ferromagnetic chain system CsNiF_3 in the collinear antiferromagnetic ordered state below T_N = 2.67K. The measured spin wave dispersion was found to be in good agreement with linear spin wave theory including dipolar interactions. The additional dipole tensor in the Hamiltonian was essential to explain some striking phenomena in the measured spin wave spectrum: a peculiar feature of the dispersion relation is a jump at the zone center, caused by strong dipolar interactions in this system. The interchain exchange coupling constant and the planar anisotropy energy were determined within the present model to be J'/k_B = -0.0247(12)K and A/k_B = 3.3(1)K. This gives a ratio J/J' \approx 500, using the previously determined intrachain coupling constant J/k_B = 11.8$. The small exchange energy J' is of the same order as the dipolar energy, which implies a strong competition between the both interactions.Comment: 18 pages, TeX type, 7 Postscript figures included. To be published in Phys. Rev.

Target margins for random geometrical treatment uncertainties in conformal radiotherapy

In this study we investigate a method for positioning the margin required around the clinical target volume (CTV) to account for the random geometrical treatment uncertainties during conformal radiotherapy. These uncertainties are introduced by patient setup errors and CTV motion within the patient. Three-dimensional dose distributions are calculated for two four-field box techniques and a three-field technique, using rectangular fields. In addition, dose calculations are performed for four prostate cases, treated with a three-field conformal technique. The effects of random rotational and translational deviations on the delivered dose are described as a convolution of the "static" dose with the distribution of the deviations. For the rectangular field techniques, these convolutions are performed with a range of standard deviations (SDs) of the distribution of random translations (0-7 mm in the three directions) and rotations (0 degree-5 degrees around the main axes). Two centers of rotation are considered: the isocenter and a position that is 3.5 cm shifted with respect to the isocenter. For the prostate cases, the random deviations are estimated by combining the results from organ motion and setup accuracy studies. The required margin is defined as the change in the position of the static 95% isodose surface by the convolution and it is approximated by a morphological erosion operator, applied to the static 95% isodose surface. When the center of rotation coincides with the isocenter the change in the position of the static 95% isodose surface can accurately be described by an erosion operator. For the rectangular field techniques, the margin is equal to about 0.7 SD of the distribution of translations, independent of the distribution of rotations. When the center of rotation does not coincide with the isocenter and rotations are considerable, the margin is strongly place dependent, and the accuracy of the approximation by an erosion operator is much lower. In conclusion, margins for random uncertainties can be approximated by a dilation operator (inverse of an erosion operator) when the center of rotational deviations coincides with the isocenter. The size of the margin is about 0.7 SD of the distribution of translations. When rotational deviations are present and the center of rotation does not coincide with the isocenter, the margin can become strongly place dependent and the convolution computation should be incorporated in the planning syste

Beam intensity modulation to reduce the field sizes for conformal irradiation of lung tumors: a dosimetric study

In conformal radiotherapy of lung tumors, penumbra broadening in lung tissue necessitates the use of larger field sizes to achieve the same target coverage as in a homogeneous environment. In an idealized model configuration, some fundamental aspects of field size reduction were investigated, both for the static situation and for a moving tumor, while maintaining the dose homogeneity in the target volume by employing a simple beam-intensity modulation technique. An inhomogeneous phantom, consisting of polystyrene, cork, and polystyrene layers, with a 6 x 6 x 6 cm3 polystyrene cube inside the cork representing the tumor, was used to simulate a lung cancer treatment. Film dosimetry experiments were performed for an AP-PA irradiation technique with 8-MV or 18-MV beams. Dose distributions were compared for large square fields, small square fields, and intensity-modulated fields in which additional segments increase the dose at the edge of the field. The effect of target motion was studied by measuring the dose distribution for the solid cube, displaced with respect to the beams. For the 18-MV beam, the field sizes required to establish a sufficient target coverage are larger than for the 8-MV beam. For each beam energy, the mean dose in cork can significantly be reduced (at least a factor of 1.6) by decreasing the field size with 2 cm, while keeping the mean target dose constant. Target dose inhomogeneity for these smaller fields is limited if the additional edge segments are applied for 8% of the number of monitor units given with the open fields. The target dose distribution averaged over a motion cycle is hardly affected if the target edge does not approach the field edge to within 3 mm. For lung cancer treatment, a beam energy of 8 MV is more suitable than 18 MV. The mean lung dose can be significantly reduced by decreasing the field sizes of conformal fields. The smaller fields result in the same biological effect to the tumor if the mean target dose is kept constant. Intensity modulation can be employed to maintain the same target dose homogeneity for these smaller fields. As long as the target (with a 3 mm margin) stays within the field portal, application of a margin for target motion is not necessar

Setup deviations in wedged pair irradiation of parotid gland and tonsillar tumors, measured with an electronic portal imaging device

The first aim of this study was to quantify estimated translational setup deviations of patients treated with a wedged pair of oblique beams for parotid gland and tonsillar tumors, using portal imaging. The second aim was to design an off-line setup verification procedure, to improve the setup accuracy, if necessary. Thirty-one patients were treated with two conformal fields (anterior-oblique and posterior-oblique). The patients were immobilized with a head cast. For the last 10 patients, the rigidity of the cast was improved while, in addition, wax molds with metal markers were placed into the outer ear for image correlation. Portal images were acquired about weekly. Setup deviations were analyzed, using anatomical structures and, when available, metal markers for image matching. The consistency of the deviations was determined by the correlation between deviations in the cranio-caudal direction, as measured from both beams. When the deviations were consistent, the translational setup deviation during a treatment session could be described by a three-dimensional (3D) vector. A setup verification procedure was designed using a computer simulation. The statistics of the 3D setup deviations were used as input. The output consisted of the resulting setup accuracy and workload (i.e., the number of setup corrections and portal images). Using the anatomical structures for image correlation, the deviations in the cranio-caudal direction were not correlated, either for the old or the improved cast. However, by using the metal markers, the deviations were correlated and a 3D analysis could be performed. The standard deviations, averaged over the three directions, were equal to 1.8 and 1.4 mm for the distribution of systematic and random deviations, respectively. Application of a setup verification procedure, with 0.7 corrections on the average per patient, could potentially reduce the percentage of 3D systematic deviations larger than 4 mm from 30 to 2%. It can be concluded that it was not possible to obtain consistent translational setup deviations, due to rotations. To quantify 3D translational setup deviations, it was necessary to use additional metal markers, which were visible in the portal images of both beams. A further improvement of the setup accuracy is possible by using an off-line setup verification procedur

Dosimetric verification of the 95% isodose surface for a conformal irradiation technique

In the treatment planning of conformal radiotherapy, field shapes are often designed in such a way that a high-value isodose surface fully encompasses the target volume. Therefore, knowledge about the accuracy with which the treatment planning system calculates the position of that isodose surface is essential to prevent field shapes which are either too large or too small. To determine this accuracy for a conformal multi-field technique, the dose in the high-dose region must be measured with a high spatial resolution. A method is presented to reconstruct and evaluate the experimental high-dose region from a set of water phantom scans. This method, which assesses combined dose profiles for multi-field irradiation techniques, can be used for the commissioning and/or quality assurance of a 3-D treatment planning system. For a specific conformal technique, the measured and calculated 95% isodose positions along lines in several directions have been compared. It is shown that different dose values of single beam profiles determine the resulting 95% isodose position, which is important to recognize for quality assurance of treatment planning calculations. It is further found that the uncertainty in the calculated 95% isodose surface can be described by a standard deviation in dose value, which relates to a positional uncertainty through the local dose gradient. Thus the confidence region of the calculated 95% isodose can be indicated in the treatment plan by plotting isodoses at the 95% level plus and minus its standard deviation. Such a procedure is recommended instead of plotting the 95% isodose with a constant width. In addition, restrictions for the cumulative dose-volume histogram of acceptable treatment plans can be formulated, based on the sensitivity of the actual target coverage on the uncertainty with which the prescribed isodose surface is calculate