Anatomical changes can occur during course of head-and-neck (H and N) radiotherapy like tumor shrinkage, decreased edema and/or weight loss. This can lead to discrepancies in planned and delivered dose increasing the dose to organs at risk. A study was conducted to determine the volumetric and dosimetric changes with the help of repeat computed tomography (CT) and replanning for selected H and N cancer patients treated with IMRT plans to see for these effects. In 15 patients with primary H and N cancer, a repeat CT scan after 3 ^rd week of radiotherapy was done when it was clinically indicated and then two plans were generated on repeat CT scan, actual plan (AP) planned on repeat CT scan, and hybrid plan (HP), which was generated by applying the first intensity-modulated radiation therapy (IMRT) plan (including monitoring units) to the images of second CT scan. Both plans (AP and HP) on repeat CT scan were compared for volumetric and dosimetric parameter. The mean variation in volumes between CT and repeat CT were 44.32 cc, 82.2 cc, and 149.83 cc for gross tumor volume (GTV), clinical target volumes (CTV), and planning target volume (PTV), respectively. Mean conformity index and homogeneity index was 0.68 and 1.07, respectively for AP and 0.5 and 1.16, respectively for HP. Mean D ₉₅ and D ₉₉ of PTV was 97.92% (standard deviation, SD 2.32) and 93.4% (SD 3.75), respectively for AP and 92.8% (SD 3.83) and 82.8% (SD 8.0), respectively for HP. Increase in mean doses to right parotid, left parotid, spine, and brainstem were 5.56 Gy (D _mean ), 3.28 Gy (D _mean ), 1.25 Gy (D _max ), and 3.88 Gy (D _max ), respectively in HP compared to AP. Repeat CT and replanning reduces the chance of discrepancies in delivered dose due to volume changes and also improves coverage to target volume and further reduces dose to organ at risk.

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The characteristics of a mobile metal oxide semiconductor field effect transistor (mobile MOSFET) detector for standard bias were investigated for megavoltage photon beams. This study was performed with a brass alloy build-up cap for three energies namely Co-60, 6 and 15 MV photon beams. The MOSFETs were calibrated and the performance characteristics were analyzed with respect to dose rate dependence, energy dependence, field size dependence, linearity, build-up factor, and angular dependence for all the three energies. A linear dose-response curve was noted for Co-60, 6 MV, and 15 MV photons. The calibration factors were found to be 1.03, 1, and 0.79 cGy/mV for Co-60, 6 MV, and 15 MV photon energies, respectively. The calibration graph has been obtained to the dose up to 600 cGy, and the dose-response curve was found to be linear. The MOSFETs were found to be energy independent both for measurements performed at depth as well as on the surface with build-up. However, field size dependence was also analyzed for variable field sizes and found to be field size independent. Angular dependence was analyzed by keeping the MOSFET dosimeter in parallel and perpendicular orientation to the angle of incidence of the radiation with and without build-up on the surface of the phantom. The maximum variation for the three energies was found to be within ± 2% for the gantry angles 90° and 270°, the deviations without the build-up for the same gantry angles were found to be 6%, 25%, and 60%, respectively. The MOSFET response was found to be independent of dose rate for all three energies. The dosimetric characteristics of the MOSFET detector make it a suitable in vivo dosimeter for megavoltage photon beams.

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An important requirement for proton therapy is a software for dose calculation. Monte Carlo is the most accurate method for dose calculation, but it is very slow. In this work, a method is developed to improve the speed of dose calculation. The method is based on pre-generated tracks for particle transport. The MCNPX code has been used for generation of tracks. A set of data including the track of the particle was produced in each particular material (water, air, lung tissue, bone, and soft tissue). This code can transport protons in wide range of energies (up to 200 MeV for proton). The validity of the fast Monte Carlo (MC) code is evaluated with data MCNPX as a reference code. While analytical pencil beam algorithm transport shows great errors (up to 10%) near small high density heterogeneities, there was less than 2% deviation of MCNPX results in our dose calculation and isodose distribution. In terms of speed, the code runs 200 times faster than MCNPX. In the Fast MC code which is developed in this work, it takes the system less than 2 minutes to calculate dose for 10 ⁶ particles in an Intel Core 2 Duo 2.66 GHZ desktop computer.

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The dosimetric accuracies of CATPhan 504 and CIRS 062 have been evaluated using the kV-CBCT of Varian TrueBeam linac and Eclipse TPS. The assessment was done using the kV-CBCT as a standalone tool for dosimetric calculations towards Adaptive replanning. Dosimetric calculations were made without altering the HU-ED curves of the planning computed tomography (CT) scanner that is used by the Eclipse TPS. All computations were done using the images and dataset from kV-CBCT while maintaining the HU-ED calibration curve of the planning CT (pCT), assuming pCT was used for the initial treatment plan. Results showed that the CIRS phantom produces doses within ±5% of the CT-based plan while CATPhan 504 produces a variation of ±14% of the CT-based plan.

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In this paper, a combined approach for enhancement and segmentation of mammograms is proposed. In preprocessing stage, a contrast limited adaptive histogram equalization (CLAHE) method is applied to obtain the better contrast mammograms. After this, the proposed combined methods are applied. In the first step of the proposed approach, a two dimensional (2D) discrete wavelet transform (DWT) is applied to all the input images. In the second step, a proposed nonlinear complex diffusion based unsharp masking and crispening method is applied on the approximation coefficients of the wavelet transformed images to further highlight the abnormalities such as micro-calcifications, tumours, etc., to reduce the false positives (FPs). Thirdly, a modified fuzzy c-means (FCM) segmentation method is applied on the output of the second step. In the modified FCM method, the mutual information is proposed as a similarity measure in place of conventional Euclidian distance based dissimilarity measure for FCM segmentation. Finally, the inverse 2D-DWT is applied. The efficacy of the proposed unsharp masking and crispening method for image enhancement is evaluated in terms of signal-to-noise ratio (SNR) and that of the proposed segmentation method is evaluated in terms of random index (RI), global consistency error (GCE), and variation of information (VoI). The performance of the proposed segmentation approach is compared with the other commonly used segmentation approaches such as Otsu's thresholding, texture based, k-means, and FCM clustering as well as thresholding. From the obtained results, it is observed that the proposed segmentation approach performs better and takes lesser processing time in comparison to the standard FCM and other segmentation methods in consideration.

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The aim of this study was to evaluate the dose optimization in 3D image based gynecological interstitial brachytherapy using Martinez Universal Perineal Interstitial Template (MUPIT). Axial CT image data set of 20 patients of gynecological cancer who underwent external radiotherapy and high dose rate (HDR) interstitial brachytherapy using MUPIT was employed to delineate clinical target volume (CTV) and organs at risk (OARs). Geometrical and graphical optimization were done for optimum CTV coverage and sparing of OARs. Coverage Index (CI), dose homogeneity index (DHI), overdose index (OI), dose non-uniformity ratio (DNR), external volume index (EI), conformity index (COIN) and dose volume parameters recommended by GEC-ESTRO were evaluated. The mean CTV, bladder and rectum volume were 137 ± 47cc, 106 ± 41cc and 50 ± 25cc, respectively. Mean CI, DHI and DNR were 0.86 ± 0.03, 0.69 ± 0.11 and 0.31 ± 0.09, while the mean OI, EI, and COIN were 0.08 ± 0.03, 0.07 ± 0.05 and 0.79 ± 0.05, respectively. The estimated mean CTV D90 was 76 ± 11Gy and D100 was 63 ± 9Gy. The different dosimetric parameters of bladder D2cc, D1cc and D0.1cc were 76 ± 11Gy, 81 ± 14Gy, and 98 ± 21Gy and of rectum/recto-sigmoid were 80 ± 17Gy, 85 ± 13Gy, and 124 ± 37Gy, respectively. Dose optimization yields superior coverage with optimal values of indices. Emerging data on 3D image based brachytherapy with reporting and clinical correlation of DVH parameters outcome is enterprizing and provides definite assistance in improving the quality of brachytherapy implants. DVH parameter for urethra in gynecological implants needs to be defined further.

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Purpose: To explore the dosimetric effects of flattening filter-free (FFF) beams in volumetric modulated arc therapy (VMAT) of nasopharyngeal carcinoma via a retrospective planning study. Materials and Methods: A linear accelerator (LINAC) was prepared to operate in FFF mode and the beam data were collected and used to build a model in TPS. For 10 nasopharyngeal carcinoma (NPC) cases, VMAT plans of FFF beams and normal flattened (FF) beams were designed. Differences of plan quality and delivery efficiency between FFF-VMAT plans and filter filtered VMAT (FF-VMAT) plans were analyzed using two-tailed paired t-tests. Results: Removal of the flattening filter increased the dose rate. Averaged beam on time (BOT) of FFF-VMAT plans was decreased by 24.2%. Differences of target dose coverage between plans with flattened and unflattened beams were statistically insignificant. For dose to normal organs, up to 4.9% decrease in V35 of parotid grand and 4.5% decrease in averaged normal tissue (NT) dose was observed. Conclusions: The TPS used in our study was able to handle FFF beams. The FFF beam prone to improve the normal tissue sparing while achieving similar target dose distribution. Decreasing of BOT in NPC cases was valuable in terms of patient's comfort.

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To measure and compare the head scatter factor for flattened (FB) and unflattened (FFF) of 6MV and 10MV photon beam using indigenously designed mini phantom. A columnar mini phantom was designed as recommended by AAPM Task Group 74 with low and high atomic number materials at 10 cm (mini phantom) and at approximately twice the depth of maximum dose water equivalent thickness (brass build-up cap). Scatter in the accelerator (Sc) values of 6MV-FFF photon beams are lesser than that of the 6MV-FB photon beams (0.66-2.8%; Clinac iX, 2300CD) and (0.47-1.74%; True beam) for field sizes ranging from 10 × 10 cm ² to 40 × 40 cm ² . Sc values of 10MV-FFF photon beams are lesser (0.61-2.19%; True beam) than that of the 10MV-FB photons beams for field sizes ranging from 10 × 10 cm ² to 40 × 40 cm ² . The SSD had no influence on head scatter for both flattened and unflattened beams and irrespective of head design of the different linear accelerators. The presence of field shaping device influences the Sc values. The collimator exchange effect reveals that the opening of the upper jaw increases Sc irrespective of FB or FFF photon beams and different linear accelerators, and it is less significant in FFF beams. Sc values of 6MV-FB square field were in good agreement with that of AAPM, TG-74 published data for Varian (Clinac iX, 2300CD) accelerator. Our results confirm that the removal of flattening filter decreases in the head scatter factor compared to flattened beam. This could reduce the out-of-field dose in advanced treatment delivery techniques.

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Radiation damages initiated by radiation-induced bystander effect (RIBE) are not limited to the first or immediate neighbors of the irradiated cells, but the effects have been observed in the cells far from the irradiation site. It has been postulated that bystander cells, by producing bystander factors, are actively involved in the propagation of bystander effect in the regions beyond the initial irradiated site. Current study was planned to test the hypothesis. MRC5 and QU-DB cell lines were irradiated, and successive medium transfer technique was performed to induce bystander effects in two bystander cell groups. Conditioned medium extracted from the target cells was transferred to the bystander cells (first bystander cells). After one hour, conditioned medium was substituted by fresh medium. Two hours later, the fresh medium was transferred to a second group of non-irradiated cells (second bystander cells). Micronucleated cells (MC) were counted to quantify damages induced in the first and second bystander cell groups. Radiation effect was observed in the second bystander cells as well as in the first ones. Statistical analyses revealed that the number of MC in second bystander subgroups was significantly more than the corresponding value observed in control groups, but in most cases it was equal to the number of MC observed in the first bystander cells. MRC5 and QU-DB bystander cells can produce and release bystander signals in the culture medium and affect non-irradiated cells. Therefore, they may contribute to the RIBE propagation.

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