Dose Voxel Kernel Research Articles

Efficacy and Toxicity Related to Treatment of Hepatocellular Carcinoma with 90Y-SIR Spheres: Radiobiologic Considerations

Radioactive (90)Y-selective internal radiation (SIR) sphere therapy is increasingly used for the treatment of nonresectable hepatocellular carcinoma (HCC). However, the maximum delivered dose is limited by severe injury to the nontarget tissue, including liver parenchyma. Our study aimed to implement radiobiologic models for both tumor control probability (TCP) and normal-tissue complication probability (NTCP) to describe more effectively local response and the liver toxicity rate, respectively. Patients with documented HCC, adequate bone marrow parameters, and regular hepatic and pulmonary function were eligible for the study. Patients who had pulmonary shunt greater than 20% of (99m)Tc-labeled macroaggregated albumin or any uncorrectable delivery to the gastrointestinal tract, reverse blood flow out of the liver, or complete portal vein thrombosis were excluded. Patients received a planned activity of the (90)Y-SIR spheres, determined using the empiric body surface area method. The dose distribution was determined using posttreatment (3-dimensional) activity distribution and Monte Carlo dose voxel kernel calculations, and the mean doses to healthy liver and tumor were calculated for each patient. Response was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) and recommendations of the European Association for the Study of the Liver (EASL). Criteria were used to assess possible liver toxicities. The parameters of TCP and NTCP models were established by direct maximization of the likelihood. Seventy-three patients were treated. With an average dose of 110 Gy to the tumor, complete or partial response was observed in 74% and 55% of patients according to the EASL guideline and RECIST, respectively, and the predicted TCPs were 73% and 55%, respectively. With a median liver dose of 36 Gy (range, 6-78 Gy), the >or=grade 2 (G2), >or=grade 3 (G3), and >or=grade 4 (G4) liver toxicities were observed in 32% (23/73), 21% (15/73), and 11% (8/73) of patients, respectively. The parameters describing the >or=G2 liver toxicity data using the NTCP model were a tolerance dose of the whole organ leading to a 50% complication probability of 52 Gy (95% confidence interval, 44-61 Gy) and a slope of NTCP versus dose of 0.28 (95% confidence interval, 0.18-0.60), assuming n = 1. The radiobiologic approach, based on patient-specific dosimetry, could improve the (90)Y-microsphere therapeutic approach of HCC, maintaining an acceptable liver toxicity.

Monte Carlo dose voxel kernel calculations of beta-emitting and Auger-emitting radionuclides for internal dosimetry: A comparison between EGSnrcMP and EGS4

Dose-point kernels (DPKs) can be widely applied to therapeutic nuclear medicine to obtain more accurate absorbed dose assessments in internal dosimetry assuming a spherical geometry. Recently, EGSnrc-the latest in the family of EGS Monte Carlo codes--has been tested for isotropic monoenergetic electrons and Y-90 beta spectrum in spherical geometry. The availability of SPECT images allows one to take into account heterogeneities in activity distribution within tumors, and to perform dose calculations using voxel dosimetry based on Monte Carlo simulations in a Cartesian geometry. The purpose of this study is to evaluate the differences of dose distributions scored in Cartesian voxels also known as Dose Voxel Kernels (DVKs) for five beta-emitting (131I, 89Sr, 153Sm, 186Re, and 90Y) and Auger-emitting (111In) radionuclides, when their computation is made using these two Monte Carlo codes from the same family to check if the new physics in EGSnrc simulation system produces DVK very different from those calculated with EGS4. We have calculated the DVKs for point and voxel sources in Cartesian scoring grids of different spatial resolutions. Our results for the point source, scored in the finer spatial resolution, show a poor agreement between EGSnrc and EGS4 (up to about 20%) for voxels closer to the origin, and a better agreement (below 5%) for longer distances for all radionuclides. For the voxel source, where doses were scored in the coarser spatial resolution, dose deposition in the central voxel is in good agreement for all the radionuclides; while surrounding voxels exhibit a slightly worse agreement.

Radiation absorbed dose distribution in a patient treated with yttrium-90 microspheres for hepatocellular carcinoma.

We have implemented a three-dimensional dose calculation technique accounting for dose inhomogeneity within the liver and tumor of a patient treated with 90Y microspheres. Single-photon emission computed tomography (SPECT) images were used to derive the activity distribution within liver. A Monte Carlo calculation was performed to create a voxel dose kernel for the 90Y source. The activity distribution was convolved with the voxel dose kernel to obtain the three-dimensional (3D) radiation absorbed dose distribution. An automated technique was developed to accurately register the computed tomography (CT) and SPECT scans in order to display the 3D dose distribution on the CT scans. In addition, dose-volume histograms were generated to fully analyze the tumor and liver doses. The calculated dose-volume histogram indicated that although the patient was treated to the nominal whole liver dose of 110 Gy, only 16% of the liver and 83% of the tumor received a dose higher than 110 Gy. The mean tumor and liver doses were 163 and 58 Gy, respectively.

A software tool for specifying voxel models for dosimetry estimation.

Many dose estimation problems can be conveniently formulated in terms of finding the energy emitted and absorbed by a set of homogeneous volume elements (voxels) arranged in a rectilinear grid. The solution of these problems requires an accurate model of the source and target geometry to be established, whereupon conventional Monte Carlo simulation of radiation transport can be employed to determine energy deposition. A software application ("MrVoxel") has been developed to assist in the specification of the source and target models. This application includes tools for image segmentation and image registration (2D and 3D, intra- and inter-modality, interactive, and automatic). It employs a plug-in architecture to facilitate customization and future expansion: plug-ins can be written to perform image import and export as well as to implement specialized image processing routines. Using plug-ins, the package can, for example, import DICOM 3.10 files and export input files for a voxel-based Monte Carlo package. Standard dosimetric tools such as the geometric mean method, transmission based attenuation correction, and MIRD-style voxel dose kernel convolution are also implemented as plug-ins. MrVoxel was implemented on a Macintosh computer using a commercial software framework to produce a conventional document-centric application. Hence it includes useful features such as the ability to undo an operation or to save a processed image set at any point. This latter feature enables the production of a processing trail, to allow post-hoc auditing of the analysis process. This paper describes the MrVoxel application and its role in the analysis of a particular dosimetry problem.