Journal of Medical Physics
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   2006| October-December  | Volume 31 | Issue 4  
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Magnetic resonance imaging for adaptive cobalt tomotherapy: A proposal
Tomas Kron, David Eyles, Schreiner L John, Jerry Battista
October-December 2006, 31(4):242-254
DOI:10.4103/0971-6203.29194  PMID:21206640
Magnetic resonance imaging (MRI) provides excellent soft tissue contrast for oncology applications. We propose to combine a MRI scanner with a helical tomotherapy (HT) system to enable daily target imaging for improved conformal radiation dose delivery to a patient. HT uses an intensity-modulated fan-beam that revolves around a patient, while the patient slowly advances through the plane of rotation, yielding a helical beam trajectory. Since the use of a linear accelerator to produce radiation may be incompatible with the pulsed radiofrequency and the high and pulsed magnetic fields required for MRI, it is proposed that a radioactive Cobalt-60 (60Co) source be used instead to provide the radiation. An open low field (0.25 T) MRI system is proposed where the tomotherapy ring gantry is located between two sets of Helmholtz coils that can generate a sufficiently homogenous main magnetic field. It is shown that the two major challenges with the design, namely acceptable radiation dose rate (and therefore treatment duration) and moving parts in strong magnetic field, can be addressed. The high dose rate desired for helical tomotherapy delivery can be achieved using two radiation sources of 220TBq (6000Ci) each on a ring gantry with a source to axis-of-rotation distance of 75 cm. In addition to this, a dual row multi-leaf collimator (MLC) system with 15 mm leaf width at isocentre and relatively large fan beam widths between 15 and 30 mm per row shall be employed. In this configuration, the unit would be well-suited for most pelvic radiotherapy applications where the soft tissue contrast of MRI will be particularly beneficial. Non-magnetic MRI compatible materials must be used for the rotating gantry. Tungsten, which is non-magnetic, can be used for primary collimation of the fan-beam as well as for the MLC, which allows intensity modulated radiation delivery. We propose to employ a low magnetic Cobalt compound, sycoporite (CoS) for the Cobalt source material itself. Rotational delivery is less susceptible to problems related to the use of a low energy megavoltage photon source while the helical delivery reduces the negative impact of the relatively large penumbra inherent in the use of Cobalt sources for radiotherapy. On the other hand, the use of a 60Co source ensures constant dose rate with gantry rotation and makes dose calculation in a magnetic field as easy as the range of secondary electrons is limited. The MR-integrated Cobalt tomotherapy unit, dubbed 'MiCoTo,' uses two independent physical principles for image acquisition and treatment delivery. It would offer excellent target definition and will allow following target motion during treatment using fast imaging techniques thus providing the best possible input for adaptive radiotherapy. As an additional bonus, quality assurance of the radiation delivery can be performed in situ using radiation sensitive gels imaged by MRI.
  12,651 862 20
An ideal blood mimicking fluid for doppler ultrasound phantoms
H Samavat, JA Evans
October-December 2006, 31(4):275-278
DOI:10.4103/0971-6203.29198  PMID:21206644
In order to investigate the problems of detecting tumours by ultrasound it is very important to have a portable Doppler flow test object to use as a standardising tool. The flow Doppler test objects are intended to mimic the flow in human arteries. To make the test meaningful, the acoustic properties of the main test object components (tissue and blood mimic) should match closely the properties of the corresponding human tissues, while the tube should ideally have little influence. The blood mimic should also represent the haemodynamic properties of blood. An acceptable flow test object has been designed to closely mimic blood flow in arteries. We have evaluated the properties of three blood mimicking fluid: two have been described recently in the literature, the third is a local design. One of these has emerged as being particularly well matched to the necessary characteristics for in-vitro work.
  9,641 698 15
Prostate brachytherapy: HDR or seed implant
KR Das
October-December 2006, 31(4):239-241
DOI:10.4103/0971-6203.29193  PMID:21206639
  8,847 519 -
Development of patient support devices for execution of clinical radiotherapy for cancer patients: A preliminary report
NK Babu, Bakshish Singh, S Namrata, BK Mohanti, R Ravichandran, KE Ghamrawy
October-December 2006, 31(4):255-261
DOI:10.4103/0971-6203.29195  PMID:21206641
The present paper illustrates our attempt to design and test the reproducibility of low-cost patient positioning devices prepared in-house in our radiotherapy department. Rigid thermocole boards with angulations, scales and support were designed as breast, pelvis and head positioning devices. Reproducibility and accuracy were tested by serial electronic portal imaging detector imaging. The positioning devices (with or without superimposed moulds) showed variations within 2-3 mm on serial treatment days which were within acceptable limits. It is therefore concluded that low-cost patient positioning devices for head, breast and pelvis (the common sites of treatments in radiotherapy) can be fabricated from available materials in-house. These have been shown to be resulting in accurate immobilization, can be customized for particular techniques and are considerably cheaper than commercially available solutions.
  8,502 520 2
Performance characterization of siemens primus linear accelerator under small monitor unit and small segments for the implementation of step-and-shoot intensitymodulated radiotherapy
P Reena, S Dayananda, Rajeshri Pai, SV Jamema, Tejpal Gupta, D Deepak, S Rajeev
October-December 2006, 31(4):269-274
DOI:10.4103/0971-6203.29197  PMID:21206643
Implementation of step-and-shoot intensity-modulated radiotherapy (IMRT) needs careful understanding of the accelerator start-up characteristic to ensure accurate and precise delivery of radiation dose to patient. The dosimetric characteristic of a Siemens Primus linear accelerator (LA) which delivers 6 and 18 MV x-rays at the dose rate of 300 and 500 monitor unit (MU) per minutes (min) respectively was studied under the condition of small MU ranging from 1 to 100. Dose monitor linearity was studied at different dose calibration parameter (D1_C0) by measuring ionization at 10 cm depth in a solid water phantom using a 0.6 cc ionization chamber. Monitor unit stability was studied from different intensity modulated (IM) groups comprising various combinations of MU per field and number of fields. Stability of beam flatness and symmetry was investigated under normal and IMRT mode for 2020 cm2 field under small MU using a 2D Profiler kept isocentrically at 5 cm depth. Inter segment response was investigated form 1 to 10 MU by measuring the dose per MU from various IM groups, each consisting of four segments with inter-segment separation of 2 cm. In the range 1-4 MU, the dose linearity error was more than 5% (max -32% at 1 MU) for 6 MV x-rays at factory calibrated D1_C0 value of 6000. The dose linearity error was reduced to -10.95% at 1 MU, within -3% for 2 and 3 MU and 1% for MU ≥4 when the D1_C0 was subsequently tuned at 4500. For 18 MV x-rays, the dose linearity error at factory calibrated D1_C0 value of 4400 was within 1% for MU ≥ 3 with maximum of -13.5 observed at 1 MU. For both the beam energies and MU/field ≥ 4, the stability of monitor unit tested for different IM groups was within 1% of the dose from the normal treatment field. This variation increases to -2.6% for 6 MV and -2.7% for 18 MV x-rays for 2 MU/field. No significant variation was observed in the stability of beam profile measured from normal and IMRT mode. The beam flatness was within 3% for 6 MV x-rays and more than 3% (Max 3.5%) for 18 MV x-rays at lesser irradiation time ≤ 3 MU. The beam stability improves with the increase in irradiation time. Both the beam energies show very good symmetry (≤ 2%) at all irradiation time. For all the three segment sizes studied, the nonlinearity was observed at smaller MU/segment in both the energies. When the MU/segment is ≥ 4, all segment size shows fairly linear relation with dose/MU. The smaller segment size shows larger nonlinearity at smaller MU/segment and become more linear at larger MU/segment. Based on our study, we conclude that the Primus LA from Siemens installed at our hospital is ideally suited for step-and-shoot IMRT preferably for radiation ON time 4MU per segment.
  7,971 583 11
Empirical formula for the prediction of off axis ratios and isodose curves for a treatment planning system
Surajit Pal, R Ravishankar, RP Sharma, G Muthukrishnan, Dilip Kr Ray, SN Roy, DK Srivastava
October-December 2006, 31(4):262-268
DOI:10.4103/0971-6203.29196  PMID:21206642
A mathematical model has been developed for prediction of off axis ratio (OAR), using Wood - Saxon term used to represent nuclear potential. This method has been satisfactorily applied for predicting OAR in case of 60Co γ -rays and high energy X-rays. Investigations are considered upto a depth of 25 cm in the case of 4MV LINAC for which measurements were carried out in our laboratory using indigenously developed Radiation Field Analyzer. For 60Co γ-rays as well as 6 and 18MV LINAC beams we could get off-axis profiles only upto 20 cm. The shift δ between measured and predicted OAR is within 2 mm except for 20 cm depth near the falling edge of the penumbra, where it is 2.80 mm. Software has been developed in Visual Basic 6 on Windows platform to plot Isodose curves, which is based on the mathematical modeling of OAR and central axis percentage depth dose.
  6,888 476 -
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