TPS Values Research Articles

A-327 Statistical Technique-based Image Analysis for Digital Reading of Immunochemistry Cassette

Abstract Background Covid-19 transformed healthcare and how we think about clinical diagnostics. People prefer at home testing options that enable them to focus on staying healthy at their own comfort and privacy. Fast and accurate lateral flow assays or rapid diagnostic test (RDT) meets that need, however ensuring high test specificity and accuracy are of utmost importance. Visual readout of RDTs is subjective and time consuming. With the current technological advancement, medical devices are smarter and can be used for automated readout. The core of such devices are the algorithms that process the information despite several limitations and unknown variations affecting input signals. Many such algorithms are developed and are used for similar applications. Here, a statistical model for any optical device that is designed to automatically read an RDT with one or more test lines is described. Methods The described LFA algorithm is a innovative way to analyze images acquired with Complementary Metal-Oxide-Semiconductor (CMOS) based optical system with low Signal-to-noise ratio (SNR), giving a semi quantitative result. This also takes care of variations in illumination sources with relatively reduced computation, by converting the images to a 1 Dimensional (1D) signal. Algorithm workflow: Image pre-processing: Affine transformations such as rotation, translation, etc. (depends on the inherent setup) are applied on the acquired images as a pre-processing step. Pattern matching techniques using Gaussian templates are applied to determine the window region of the LFA and precisely identify the test and control line regions. Image formatting: The sample region of the cassette is converted from RGB color space to the weighted gray (Gw) for digital interpretation of the primary biomarker present. Characterization of the Gw channel enables test peak detection with enhanced resolution. This helps in early call out of results and improved accuracy, thereby reducing chances of erroneous results. A second order Butterworth low pass filter is applied to reduce system noise and enhance SNR. The images are converted to 1D signal by averaging for mathematical read out. Mathematical interpretation: Maximum peak height (max) and minimum peak depth (min) of Gw channel values in the test line region (t-peak) are extracted from the 1D signal. The mathematical representation of the test line is calculated as: Test Peak Signal = {max(t-peak) - min(t-peak)} / Alpha; Normalization Factor, Alpha = (sum of all Gw channel values for any clear non-reactive part of the test device) / (number of Gw channel values) Results TPS values for various biomarkers from statistically significant replicates were computed at Low, Medium, and High levels. Two sample T-tests were performed, and respective p values are distinctly different as p-value<0.05. For a concentration level of Low to medium, p-value is 0.044 and for Medium - High p-value is 0.004. Conclusions This algorithm can run on any off-the-shelf available RDT coupled with a CMOS based optical system. The proposed algorithm can differentiate between low, medium, and high concentrations with high confidence. High throughput semiquantitative digital readouts are robust, accurate and are preferred for diagnostic test result interpretation.

MR compatible detectors assessment for a 0.35 T MR-linac commissioning

PurposeTo assess a large panel of MR compatible detectors on the full range of measurements required for a 0.35 T MR-linac commissioning by using a specific statistical method represented as a continuum of comparison with the Monte Carlo (MC) TPS calculations. This study also describes the commissioning tests and the secondary MC dose calculation validation.Material and methodsPlans were created on the Viewray TPS to generate MC reference data. Absolute dose points, PDD, profiles and output factors were extracted and compared to measurements performed with ten different detectors: PTW 31010, 31021, 31022, Markus 34045 and Exradin A28 MR ionization chambers, SN Edge shielded diode, PTW 60019 microdiamond, PTW 60023 unshielded diode, EBT3 radiochromic films and LiF µcubes. Three commissioning steps consisted in comparison between calculated and measured dose: the beam model validation, the output calibration verification in four different phantoms and the commissioning tests recommended by the IAEA-TECDOC-1583.Main resultsThe symmetry for the high resolution detectors was higher than the TPS data of about 1%. The angular responses of the PTW 60023 and the SN Edge were − 6.6 and − 11.9% compared to the PTW 31010 at 60°. The X/Y-left and the Y-right penumbras measured by the high resolution detectors were in good agreement with the TPS values except for the PTW 60023 for large field sizes. For the 0.84 × 0.83 cm2 field size, the mean deviation to the TPS of the uncorrected OF was − 1.7 ± 1.6% against − 4.0 ± 0.6% for the corrected OF whereas we found − 4.8 ± 0.8% for passive dosimeters. The mean absolute dose deviations to the TPS in different phantoms were 0 ± 0.4%, − 1.2 ± 0.6% and 0.5 ± 1.1% for the PTW 31010, PTW 31021 and Exradin A28 MR respectively.ConclusionsThe magnetic field effects on the measurements are considerably reduced at low magnetic field. The PTW 31010 ionization chamber can be used with confidence in different phantoms for commissioning and QA tests requiring absolute dose verifications. For relative measurements, the PTW 60019 presented the best agreement for the full range of field size. For the profile assessment, shielded diodes had a behaviour similar to the PTW 60019 and 60023 while the ionization chambers were the most suitable detectors for the symmetry. The output correction factors published by the IAEA TRS 483 seem to be applicable at low magnetic field pending the publication of new MR specific values.

Validation of a 3D Pretreatment Quality Assurance Tool for Volumetric Modulated Arc Therapy (VMAT)

Implementation of a pretreatment quality assurance (QA) system needs a strong validation process and a good comprehension of the tool. The aim of this study is to validate COMPASS (IBA Dosimetry, Germany) as our 3D pre- treatment QA tool for system of Pinnacle as treatment planning system and an ELEKTA synergy linear accelerator. Validation of the systems was performed with static and dynamic plans on AAPM TG-119 phantom and 10 real VMAT plans for prostate and head and neck. Comparison between point dose from TPS and COMPASS was performed to evaluate the confidence limit in high dose region (98.5% and 98.6%) and low dose region (94.1% and 95.2%) for COMPASS computed and reconstructed dose respectively. For planar dose the confidence limit was respectively 95.37% and 96.35% for COMPASS computed and reconstructed dose. Clinical validation was evaluated by comparing dose-volume parameters for real VMAT plans with TPS values (mean differences were below of 1% for the target). The comparison between 2D dose distribution from TPS and dose extracted from COMPASS computed and reconstructed for real VMAT plans were also performed (mean global gamma passing rate better than 94% and 98% for the 2%/2mm and 3%/3mm criteria). The 3D dose distribution comparison between TPS and COMPASS was also performed with good gamma score for global and local analysis. COMPASS was successfully evaluated as our 3D pretreatment system.

Capabilities of electret ion chambers to measure absorbed dose outside the treated volume, during external-photon radiation therapy

The capabilities of electret ion chambers to measure non-target absorbed dose during radio- therapy treatment was investigated for the first time. During radiotherapy, non-target doses can be classified as one of three approximate dose levels: high doses, intermediate doses and low doses. Low doses (<5 % of the prescription dose) are not generally considered during treatment planning, due to the fact that is difficult to measure, characterize, or model them in the planning system. In this work were performed measurements with electret ion chambers of absorbed dose outside the treated volume (<5 % of the prescription dose), during external photon radiation therapy in an Elekta Infinity Linear Accelerator of Theagenio Cancer Hospital of Thessaloniki, Greece. The absorbed dose values for distances 8-100 cm from the borders of the irradiated volume varied from 0.3 to 17 mGy which corresponds to 0.01 % up to % of the prescription dose (2660 mGy). Near the irradiation volume the absorbed dose values were greater than the upper detection limit of the electret ion chambers (threshold 40 mGy). The results are compared with the calculated ones by the Monaco treatment planning system ? TPS (Elekta Monaco at November 5, 2003) in three positions distanced at 8 cm and about 30 cm from the border of the irradiation zone. In the position at 8 cm from the irradiation zone, where Monaco TPS calculates (within uncertainty of about 15 %) the absorbed dose, measured and calculated doses are the same within experimental uncertainties. On the contrary for the other two positions, where leakage radiation becomes the dominant source of out-of-field dose the absorbed dose values calculated by the TPS are seriously underestimated ( by a factor of 4) due to the fact that TPS does not take into account the leakage radiation. However, adding to the TPS values an estimated dose due to leakage radiation, the difference between measured and calculated doses are about 30 %.

Investigation of a source model for a new electronic brachytherapy tandem by film measurement.

PurposeTo investigate the accuracy of a vendor‐supplied source model for a new Xoft Axxent 0‐degree titanium tandem by film measurement.MethodsWe measured the anisotropy factors at varying distances and angles from the tandem in water using radiochromic film (Gafchromic EBT3) and an Epson Perfection v750 desktop flatbed scanner (US Epson, Long Beach, CA). A 0‐degree tandem was placed vertically in a water phantom. Four pieces of film, each at varying depths, were positioned orthogonal to the longitudinal axis of the tandem for azimuthal anisotropy measurements. Polar anisotropy measurements were taken with the film aligned parallel to the tandem. An absolute dose calibration for the film was verified with a PTW 34013 Soft X‐Ray Chamber. The film measurements were analyzed using different color channels. The measured polar anisotropy for varying source positions was compared to the vendor's data. Azimuthal anisotropy was measured as a function of the radius and angle, and normalized to the mean value over all angles at the specified radius.ResultsThe azimuthal anisotropy of the tandem and source was found to be consistent for different positions along the tandem's longitudinal axis and at varying distances from the tandem. Absolute dose using a calibrated parallel plate chamber showed agreement to within 2% of expected TPS values. The custom tandem, which has a thicker tip than the wall, was attenuating the 50 kV photons more than expected, at the angles where the photons had more wall material to traverse. This discrepancy was verified at different distances from the tandem and with different measurement techniques. As distance increased, anisotropy values had better agreement.ConclusionsWe quantified the agreement between the measured and provided anisotropy factors for a new Xoft Axxent 0‐degree titanium tandem. Radiochromic film response at low kV energy was also investigated. Our results showed that vendor‐supplied TG‐43 values were appropriate for clinical use at majority of the angles. A rigorous quality assurance method for new electronic brachytherapy sources and applicators, along with complete knowledge of all dosimetric measuring tools, should be implemented for all parts of the verification and commissioning process.

Evaluation and comparison of second-check monitor unit calculation software with Pinnacle3 treatment planning system

The purpose of this study was to evaluate and compare the accuracy of dose calculations in second check softwares (Diamond, IMSure, MuCheck, and RadCalc) against the Phillips Pinnacle3 treatment planning system. Eighteen previously treated patients’ treatment planning files consisting of a total of 204 beams were exported from the Pinnacle3 TPS to each of the four second check software. Of these beams, 145 of the beams used were IMRT plans while 59 were VMAT arcs. The values were represented as a percent difference between primary and secondary calculations and used for statistical analysis. Box plots, Pearson Correlation, and Bland-Altman analysis were performed in MedCalc. The mean percent difference in calculated dose for Diamond, IMSure, MuCheck, and RadCalc from Pinnacle3 were −0.67%, 0.31%, 1.51% and −0.36%, respectively. The corresponding variances were calculated to be 0.07%, 0.13%, 0.08%, and 0.03%; and the largest percent differences were −7.9%, 9.70%, 9.39%, and 5.45%. The dose differences of each of the second check software in this study can vary considerably and VMAT plans have larger differences than IMRT. Among the four second check softwares, RadCalc values has shown a high agreement on average with low variation, and had the smallest percent range from Pinnacle3 values. The closest in average percent difference from the Pinnacle3data was the IMSure software, but suffered from significantly larger variance and percent range. The values reported by Diamond and MuCheck had significantly high percent differences with TPS values.

Performance of a multi leaf collimator system for MR-guided radiation therapy.

The purpose of this study was to investigate and characterize the performance of a Multi Leaf Collimator (MLC) designed for Cobalt-60 based MR-guided radiation therapy system in a 0.35 T magnetic field. The MLC design and unique assembly features in the ViewRay MRIdian system were first reviewed. The RF cage shielding of MLC motor and cables were evaluated using ACR phantoms with real-time imaging and quantified by signal-to-noise ratio. The dosimetric characterizations, including the leaf transmission, leaf penumbra, tongue-and-groove effect, were investigated using radiosensitive films. The output factor of MLC-defined fields was measured with ionization chambers for both symmetric fields from 2.1 × 2.1 cm2 to 27.3 × 27.3 cm2 and asymmetric fields from 10.5 × 10.5 cm2 to 10.5 × 2.0 cm2 . Multi leaf collimator (MLC) positional accuracy was assessed by delivering either a picket fence (PF) style pattern on radiochromic films with wire-jig phantom or double and triple-rectangular patterns on ArcCheck-MR (Sun Nuclear, Melbourne, FL, USA) with gamma analysis as the pass/fail indicator. Leaf speed tests were performed to assess the capability of full range leaf travel within manufacture's specifications. Multi leaf collimator plan delivery reproducibility was tested by repeatedly delivering both open fields and fields with irregular shaped segments over 1-month period. Comparable SNRs within 4% were observed for MLC moving and stationary plans on vendor-reconstructed images, and the direct k-space reconstructed images showed that the three SNRs are within 1%. The maximum leaf transmission for all three MLCs was less than 0.35% and the average leakage was 0.153 ± 0.006%, 0.151 ± 0.008%, and 0.159 ± 0.015% for head 1, 2, and 3, respectively. Both the leaf edge and leaf end penumbra showed comparable values within 0.05 cm, and the measured values are within 0.1 cm with TPS values. The leaf edge TG effect indicated 10% underdose and the leaf end TG showed a shifted dose distribution with 0.3 cm offset. The leaf positioning test showed a 0.2 cm accuracy in the PF style test, and a gamma passing rate above 96% was observed with a 3%/2 mm criteria when comparing the measured double/triple-rectangular pattern fluence with TPS calculated fluence. The average leaf speed when executing the test plan fell in a range from 1.86 to 1.95 cm/s. The measured and TPS calculated output factors were within 2% for squared fields and within 3% for rectangular fields. The reproducibility test showed the deviation of output factors were well within 2% for square fields and the gamma passing rate within 1.5% for fields with irregular segments. The Monte Carlo predicted output factors were within 2% compared to TPS values. 15 out of the 16 IMRT plans have gamma passing rate more than 98% compared to the TPS fluence with an average passing rate of 99.1 ± 0.6%. The MRIdian MLC has a good RF noise shielding design, low radiation leakage, good positioning accuracy, comparable TG effect, and can be modeled by an independent Monte Carlo calculation platform.

WE‐DE‐201‐07: Measurement of Real‐Time Dose for Tandem and Ovoid Brachytherapy Procedures Using a High Precision Optical Fiber Radiation Detector

Purpose:Development of a novel on‐line dosimetry tool is needed to move toward patient‐specific quality assurance measurements for Ir‐192 HDR brachytherapy to verify accurate dose delivery to the intended location. This work describes the development and use of a nano‐crystalline yttrium oxide inorganic scintillator based optical‐fiber detector capable of acquiring real‐time high‐precision dose measurements during tandem and ovoid (T&O) gynecological (GYN) applicator Ir‐192 HDR brachytherapy procedures.Methods:An optical‐fiber detector was calibrated by acquiring light output measurements in liquid water at 3, 5, 7, and 9cm radial source‐detector‐distances from an Ir‐192 HDR source. A regression model was fit to the data to describe the relative light output per unit dose (TG‐43 derived) as a function of source‐detector‐distance. Next, the optical‐fiber detector was attached to a vaginal balloon fixed to a Varian Fletcher‐Suit‐Delclos‐style applicator (to mimic clinical setup), and localized by acquiring high‐resolution computed tomography (CT) images. To compare the physical point dose to the TPS calculated values (TG‐43 and Acuros‐BV), a phantom measurement was performed, by submerging the T&O applicator in a liquid water bath and delivering a treatment template representative of a clinical T&O procedure. The fiber detector collected scintillation signal as a function of time, and the calibration data was applied to calculate both real‐time dose rate, and cumulative dose.Results:Fiber cumulative dose values were 100.0cGy, 94.3cGy, and 348.9cGy from the tandem, left ovoid, and right ovoid dwells, respectively (total of 443.2cGy). A plot of real time dose rate during the treatment was also acquired. The TPS values at the fiber location were 458.4cGy using TG‐43, and 437.6cGy using Acuros‐BV calculated as Dm,m (per TG‐186).Conclusion:The fiber measured dose value agreement was 3% vs TG‐43 and −1% vs Acuros‐BV. This fiber detector opens up new possibilities for performing patient‐specific quality assurance for Ir‐192 HDR GYN procedures.Funding from Coulter Foundation, Duke Bio‐medical Engineering. Company is being created around the detector technology. Duke holds patents on the technology.

Dosimetric validation and clinical implementation of two 3D dose verification systems for quality assurance in volumetric-modulated arc therapy techniques.

A pretreatment quality assurance program for volumetric techniques should include redundant calculations and measurement‐based verifications. The patient‐specific quality assurance process must be based in clinically relevant metrics. The aim of this study was to show the commission, clinical implementation, and comparison of two systems that allow performing a 3D redundant dose calculation. In addition, one of them is capable of reconstructing the dose on patient anatomy from measurements taken with a 2D ion chamber array. Both systems were compared in terms of reference calibration data (absolute dose, output factors, percentage depth‐dose curves, and profiles). Results were in good agreement for absolute dose values (discrepancies were below 0.5%) and output factors (mean differences were below 1%). Maximum mean discrepancies were located between 10 and 20 cm of depth for PDDs (‐2.7%) and in the penumbra region for profiles (mean DTA of 1.5 mm). Validation of the systems was performed by comparing point‐dose measurements with values obtained by the two systems for static, dynamic fields from AAPM TG‐119 report, and 12 real VMAT plans for different anatomical sites (differences better than 1.2%). Comparisons between measurements taken with a 2D ion chamber array and results obtained by both systems for real VMAT plans were also performed (mean global gamma passing rates better than 87.0% and 97.9% for the 2%/2 mm and 3%/3 mm criteria). Clinical implementation of the systems was evaluated by comparing dose‐volume parameters for all TG‐119 tests and real VMAT plans with TPS values (mean differences were below 1%). In addition, comparisons between dose distributions calculated by TPS and those extracted by the two systems for real VMAT plans were also performed (mean global gamma passing rates better than 86.0% and 93.0% for the 2%/2 mm and 3%/3 mm criteria). The clinical use of both systems was successfully evaluated.PACS numbers: 87.56.Fc, 87.56.‐v, 87.55.dk, 87.55.Qr, 87.55.‐x, 07.57.Kp, 85.25.Pb

SU-E-T-77: Comparison of 2D and 3D Gamma Analysis in Patient-Specific QA for Prostate VMAT Plans

Purpose: Patient-specific QA procedures for IMRT and VMAT are traditionally performed by comparing TPS calculations with measured single point values and plane dose distributions by means of gamma analysis. New QA devices permit us to calculate 3D dose distributions on patient anatomy as redundant secondary check and reconstruct it from measurements taken with 2D and 3D detector arrays. 3D dose calculations allow us to perform DVH-based comparisons with clinical relevance, as well as 3D gamma analysis. One of these systems (Compass, IBA Dosimetry) combines traditional 2D with new anatomical-based 3D gamma analysis. This work shows the ability of this system by comparing 2D and 3D gamma analysis in pre-treatment QA for several VMAT prostate plans. Methods: Compass is capable of calculating dose as secondary check from DICOM TPS data and reconstructing it from measurements taken by a 2D ion chamber array (MatriXX Evolution, IBA Dosimetry). Both 2D and 3D gamma tests are available to compare calculated and reconstructed dose in Compass with TPS RT Dose. Results: 15 VMAT prostate plans have been measured with Compass. Dose is reconstructed with Compass for these plans. 2D gamma comparisons can be done for any plane from dose matrix. Mean gamma passing rates for isocenter planes (axial, coronal, sagittal) are (99.7±0.2)%, (99.9±0.1)%, (99.9±0.1)% for reconstructed dose planes. 3D mean gamma passing rates are (98.5±1.7)% for PTVs, (99.1±1.5)% for rectum, (100.0±0.0)% for bladder, (99.6±0.7)% for femoral heads and (98.1±4.1)% for penile bulb. Conclusion: Compass is a powerful tool to perform a complete pre-treatment QA analysis, from 2D techniques to 3D DVH-based techniques with clinical relevance. All reported values for VMAT prostate plans are in good agreement with TPS values. This system permits us to ensure the accuracy in the delivery of VMAT treatments completing a full patient-specific QA program.

Dosimetry in brain tumor phantom at 15 MV 3D conformal radiation therapy

Glioblastoma multiforme (GBM) is the most common, aggressive, highly malignant and infiltrative of all brain tumors with low rate of control. The main goal of this work was to evaluate the spatial dose distribution into a GBM simulator inside a head phantom exposed to a 15 MV 3D conformal radiation therapy in order to validate internal doses. A head and neck phantom developed by the Ionizing Radiation Research Group (NRI) was used on the experiments. Such phantom holds the following synthetic structures: brain and spinal cord, skull, cervical and thoracic vertebrae, jaw, hyoid bone, laryngeal cartilages, head and neck muscles and skin. Computer tomography (CT) of the simulator was taken, capturing a set of contrasted references. Therapy Radiation planning (TPS) was performed based on those CT images, satisfying a 200 cGy prescribed dose split in three irradiation fields. The TPS assumed 97% of prescribed dose cover the prescribed treatment volume (PTV). Radiochromic films in a solid water phantom provided dose response as a function of optical density. Spatial dosimetric distribution was generated by radiochromic film samples at coronal, sagittal-anterior and sagittal-posterior positions, inserted into tumor simulator and brain. The spatial dose profiles held 70 to 120% of the prescribed dose. In spite of the stratified profile, as opposed to the smooth dose profile from TPS, the tumor internal doses were within a 5% deviation from 214.4 cGy evaluated by TPS. 83.2% of the points with a gamma value of less than 1 (3%/3mm) for TPS and experimental values, respectively. At the tumor, measured at coronal section, a few dark spots in the film caused the appearance of outlier points in 13-15% of dose deviation percentage. And, as final conclusion, such dosimeter choice and the physical anthropomorphic and anthropometric phantom provided an efficient method for validating radiotherapy protocols.

SU-E-T-102: Measurement of Absorbed Dose-To-Water for An HDR Ir-192 Source with a Farmer Ionization Chamber in a Sandwich Setup

Purpose: This study developed a dedicated device for ion chamber measurements of absorbed dose-to-water for an HDR Ir-192 brachytherapy source. The device uses two Farmer chambers in a so-called sandwich assembly. The accuracy of the sundwich method was examined by comparing chamber measurements with absorbed dose-to-water determination based on the AAPM TG-43 protocol. Methods: A microSelectron-v2 HDR Ir-192 source was modeled with the EGSnrc/egs_chamber code. The accuracy of modeling was confirmed by comparing calculated results for gL(r) and F(r, θ) with those of TG-43. The PTW30013 Framer chamber was also modeled with the egs_chamber code and its beam quality conversion factors, kQ, of Ir-192 to Co-60 were calculated as a function of distance from the Ir-192 source. From calculation results, we developed a dedicated device for the sandwich setup with 1 mm PMMA waterproof sleeves located at both side of 8 cm from the Ir-192 source. The chamber readings measured with the Farmer chambers inserted into the 1 mm PMMA sleeves were converted to the absorbed dose to water using kQ. The average dose of two Farmer chamber measurements with the sandwich setup were compared with the TPS values based on TG-43 for eight Ir-192 sources at four institutes. Results: Calculated gL(r) and F(r, θ) values agreed well with those of TG-43. The calculated kQ values for the PTW30013 Framer chamber ranged from 1.103 to 0.986 at distance of 2∼10 cm from the source and it was 0.992 at distance of 8 cm. The doses to water measured with the sandwich setup were −0.73 +/− 0.28% (n=10) compared to TG-43 values. Conclusion: The dose to water measurement by the Farmer chamber with the sandwich setup is useful for daily dose management for Ir-192 sources.

Perceptually enhanced blind single-channel music source separation by Non-negative Matrix Factorization

We propose a new approach that improves perceptual quality of the separated sources in blind single-channel musical source separation. It uses the advantages of subspace learning based on Non-negative Matrix Factorization (NMF) in which the bases represent the notes. The cost function is formulated in the form of weighted @b-divergence by adopting the PEAQ auditory model defined in ITU-R BS.1387 into the source separation. The proposed perceptually weighted factorization scheme is integrated into the Non-negative Matrix Factor 2-D Deconvolution (NMF2D) and Clustered Non-negative Matrix Factorization (CNMF) to overcome the source clustering problem encountered in under-determined source separation. It is shown that the introduced perceptually weighted NMF schemes, named as PW-NMF2D and PW-CNMF, efficiently learn the bases that enable us to apply a simple resynthesis of the musical sources based on the temporal model stored in the encoding matrix. Source separation performance has been reported on musical mixtures where 1-2 dB improvement is achieved in terms of SDR, SIR and SAR compared to the state-of-the-art methods. Performance has also been evaluated by perceptual measures resulting an improvement of 2-5 in OPS, TPS, IPS and APS values.

SU-E-T-116: Measuring Dose Distribution Accuracy in Stereotactic Radiosurgery and Gamma Knife Treatment Using MR Or CT Imaging

Purpose: This study aimed to establish a standard dosimetry protocol for HDR Ir‐192 sources using an ion chamber calibrated with a Co‐60 beam. We developed a dedicated device for ion chambermeasurements with a sandwich method and examined its measurement accuracy. Methods: A microSelectron‐v2 HDR Ir‐192 source was modeled with the EGSnrc/egs_chamber code. The accuracy of modeling was confirmed by comparing calculated results for gL (r) and F(r, angle) with those of TG‐43. First, an optimal source‐to‐chamber (SCD) separation for Ir‐192 dosimetry was determined from measurements with a PTW 31010 chamber at distances of 1.5–5 cm from the source center in water. The measuredionization chamber reading was corrected with the Monte Carlo‐calculated energy response for Co‐60 and Ir‐192, and was converted to the absorbed dose to water. The measured doses were compared with TPS values based on TG‐43. We developed a dedicated device for ion chambermeasurements with a sandwich method at the optimal SCD separation. The average dose measured with two EXRADIN A1SL chambers was compared with the TPS value. Results: Calculated gL (r) and F(r, angle) values agreed well with those of TG‐43. The absorbed dose to water measured with the PTW31010 chamber was 3% lower than that of TPS at a distance of 5 cm and was 3%‐7% lower at distances less than 5 cm. This was addressed to the uncertainty of the chamber positioning. We made a sandwich measurement device with the separation of 5 cm, considering the uncertainty of positioning and measurement time. The dose to water with the sandwich method was in agreement with that of TG‐43 within −1.2%. Conclusions: The optimal distance for ion chambermeasurements was at 5 cm from the Ir‐192 source. The dose to water measurement with the sandwich method is useful for daily dose management for Ir‐192 sources.

SU-E-T-117: Absorbed Dose to Water Measurement with a Sandwich Method for High Dose-Rate Ir-192 Brachytherapy Sources

Purpose: This study aimed to establish a standard dosimetry protocol for HDR Ir‐192 sources using an ion chamber calibrated with a Co‐60 beam. We developed a dedicated device for ion chambermeasurements with a sandwich method and examined its measurement accuracy. Methods: A microSelectron‐v2 HDR Ir‐192 source was modeled with the EGSnrc/egs_chamber code. The accuracy of modeling was confirmed by comparing calculated results for gL (r) and F(r, angle) with those of TG‐43. First, an optimal source‐to‐chamber (SCD) separation for Ir‐192 dosimetry was determined from measurements with a PTW 31010 chamber at distances of 1.5–5 cm from the source center in water. The measuredionization chamber reading was corrected with the Monte Carlo‐calculated energy response for Co‐60 and Ir‐192, and was converted to the absorbed dose to water. The measureddoses were compared with TPS values based on TG‐43. We developed a dedicated device for ion chambermeasurements with a sandwich method at the optimal SCD separation. The average dosemeasured with two EXRADIN A1SL chambers was compared with the TPS value. Results: Calculated gL (r) and F(r, angle) values agreed well withthose of TG‐43. The absorbed dose to watermeasured with the PTW31010 chamber was 3% lower than that of TPS at a distance of 5 cm and was 3%– 7% lower at distances less than 5 cm. This was addressed to the uncertainty of the chamber positioning. We made a sandwich measurement device with the separation of 5 cm, considering the uncertainty of positioning and measurement time. The dose to water with the sandwich method was in agreement with that of TG‐43 within −1.2%. Conclusions: The optimal distance for ion chambermeasurements was at 5 cm from the Ir‐192 source. The dose to watermeasurement with the sandwich method is useful for daily dose management for Ir‐192 sources.

Estimation of inhomogenity correction factors for a Co-60 beam using Monte Carlo simulation

The aim was to obtain inhomogenity correction factors (ICFs) for lung tissue inhomogenity for a Co-60 teletherapy beam using Monte Carlo simulation and to compare them with factors obtained from a commercially available treatment planning system. The Monte Carlo simulation code of EGSnrc is used for the depth dose calculations. Two clinical like situations were simulated-dose calculation point beyond the lung tissue volume and dose calculation point within the lung tissue volume. The variation of ICF with lung thicknesses and positions was studied. ICF values were obtained for the similar situations from a commercially available treatment planning system, Theraplan Plus. Percentage depth dose data obtained from Monte Carlo simulation is well matching with the published measurement data. ICFs for lung tissue inhomogenity calculated using the Monte Carlo code are in good agreement with Theraplan Plus TPS values for small inhomogenity thicknesses. These results can be used for the verification of TPS calculation or manual treatment time calculation.

Serum concentrations of the tissue polypeptide specific antigen in patients suffering from non‐alcoholic steatohepatitis

Liver histology is the gold standard for diagnosis of non-alcoholic fatty liver disease. Ethical considerations and patient choice often preclude performing a liver biopsy, especially considering the rare but potential risk. Searching for a good serological marker substitute for the invasive procedure was the aim of our study. Keratins, mainly 8 and 18, play not only a mere structural role providing mechanical stability to hepatocytes, but also represent a target via toxic stress ultimately inducing apoptosis/necrosis. Tissue polypeptide-specific antigen (TPS), a serological mirror of keratin 18, is widely used as a marker for various cancers. This antigen was assessed in three different groups who were overweight or obese. In this cross-sectional case-control study, 48 cancer-free patients with non-alcoholic steatohepatitis (NASH, Group 1), 48 patients with pure fatty liver (FL, Group 2), and 47 volunteers (Group 3) were studied. All of them were referred to our metabolic unit for routine evaluation. The median (range) TPS levels were 123 (56-286) ng mL(-1) in NASH patients. FL patients and volunteers had significantly lower TPS levels, 76 (38-98) ng mL(-1) and 64 (28-87) ng mL(-1), respectively (P = 0.0001). A value of 88 ng mL(-1) in patients with underlying bright liver was associated with a high probability of NASH (sensitivity and specificity = 92% and 96%, respectively). One patient (2.1%) with FL had a TPS value > 88 ng mL(-1), but in the same group, 29 FL patients (60.4%) had an alanine aminotransferase value > 40 U L(-1). Based on a recent classification of liver fibrosis, the median (range) TPS values were significantly different among the stages: F1 (n = 23) = 100 (76-264) ng mL(-1); F2 (n = 21) = 134 (56-276) ng mL(-1); and F3 (n = 4) = 199.5 (123-286) ng mL(-1), respectively (P = 0.014). Our study shows that TPS is a better marker than alanine aminotransferase activity, ultrasonography or the combination of both parameters in differentiating NASH from FL.

Thermosensitive polyalcohols: Synthesis via living cationic polymerization of vinyl ethers with a silyloxy group

AbstractThermosensitive homopolymers and copolymers with hydroxy groups were synthesized via the living cationic polymerization of Si‐containing vinyl ethers. The cationic homopolymerization and copolymerization of five vinyl ethers with silyloxy groups, each with a different spacer length, were examined with a cationogen/Et1.5AlCl1.5 initiating system in the presence of an added base. When an appropriate base was added, the living cationic polymerization of Si‐containing monomers became feasible, giving polymers with narrow molecular weight distributions and various block copolymers. Subsequent desilylation gave well‐defined polyalcohols, in both water‐soluble and water‐insoluble forms. One of these polyalcohols, poly(4‐hydroxybutyl vinyl ether), underwent lower‐critical‐solution‐temperature‐type thermally induced phase separation in water at a critical temperature (TPS) of 42 °C. This phase separation was quite sensitive and reversible on heating and cooling. The phase separation also occurred sensitively with random copolymers of thermosensitive and hydrophilic or hydrophobic units, the TPS values of which in water could be controlled by the monomer feed ratio. The thermal responsiveness of this polyalcohol unit made it possible to prepare novel thermosensitive block and random copolymers consisting solely of alcohol units. One example prepared in this study was a 20 wt % aqueous solution of a diblock copolymer consisting of thermosensitive poly(4‐hydroxybutyl vinyl ether) and water‐soluble poly(2‐hydroxyethyl vinyl ether) segments, which transformed into a physical gel above 42 °C. © 2003 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 41: 3300–3312, 2003

Mutagenic activity of airborne particulate matter as an indicative measure of atmospheric pollution

Mutagenic activity of organic extracts of airborne particulate matter at four different sites within the urban area of the city of Porto Alegre, Brazil, was investigated using the Salmonella/microsome assay, with the Kado microsuspension method. The extracts were obtained by sonication, sequentially extracted according to polarity, with cyclohexane (CX) and dichloromethane (DCM) solvents. The different fractions were tested for mutagenicity with the Salmonella typhimurium strains TA98, TA98NR and TA98/1,8-DNP 6, without S9 mix metabolic activation. A positive frameshift mutagenic response was observed for non-polar (CX) and/or moderately polar (DCM) compounds at the different sites. The responses varied at different seasons of the year, and the highest revertants per m 3 (rev/m 3) values were observed at the site subject to the strongest influence of automotive vehicles (site 3) in spring (17.13 rev/m 3) in DCM fractions, and in summer (13.01 rev/m 3) in CX fractions. The responses observed for the TA98NR and TA98/1,8-DNP 6 strains suggest the contribution of nitrocompounds to the mutagenic activity observed. Although there appears to be an indicative association between the increased mass per unit volume of air (TSP) and the mutagenicity of organic extracts of airborne particulate matter in the present study, the Salmonella/microsome assay was a sensitive method to define areas contaminated by genotoxic compounds, even in samples that present TPS values acceptable by the environmental quality standards established by law.

Tissue polypeptide-specific antigen (TPS) determinations before and during intermittent maximal androgen blockade in patients with metastatic prostatic carcinoma.

To evaluate the prognostic significance of serially measured tissue polypeptide-specific antigen (TPS) levels in patients with metastatic prostatic carcinoma treated with intermittent maximal androgen blockade (MAB). To determine its value with respect to predicting response to treatment and time to clinical progression. Finally to compare TPS with prostate-specific antigen (PSA) measurements in terms of prognostic impact in patients with metastatic prostatic carcinoma. TPS and PSA measurements were performed before start of and monthly during intermittent MAB in 68 patients participating in EORTC protocol 30954. Both TPS and PSA were measured in serum. Fifty-six patients from eight centers were included in the final analysis because at least three TPS values were available. TPS and PSA values were correlated with clinical course of the disease. Median follow-up was 21.3 months. Three patient groups were defined on clinical grounds: (a) clinically progressive disease (n=18); (b) clinically stable disease (n=33); and (c) patients who did not reach a predefined nadir PSA value following 9 months of treatment (n=5). Pretreatment TPS was significantly higher in the clinically progressive patients than in the other patient groups (p=0.0041). When grouping patients according to their pretreatment TPS values (cut-off value of 100 U/l) the pretreatment TPS value (>100 U/l) proved to be a statistically significant prognostic factor with respect to time to progression: elevated TPS was associated with a 3.8 increased risk for progressive disease (p=0.0055). Pretreatment PSA (>100 ng/ml) was of no prognostic value for time to progression. In five patients increase of TPS coincided with or preceded clinical progression during treatment, whereas PSA remained normal. Additional value of pretreatment TPS measurements in metastatic prostate cancer patients is found in defining the patients with rapid clinical progression. Following MAB an increase in TPS signifies clinical progression even if PSA is found to remain normal.