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Title: Breast in vivo dosimetry by a portal ionization chamber

Abstract

This work reports a practical method for the determination of the in vivo breast middle dose value, D{sub m}, on the beam central axis, using a signal S{sub t}, obtained by a small thimble ion chamber positioned at the center of the electronic portal imaging device, and irradiated by the x-ray beam transmitted through the patient. The use of a stable ion chamber reduces many of the disadvantages associated with the use of diodes as their periodic recalibration and positioning is time consuming. The method makes use of a set of correlation functions obtained by the ratios S{sub t}/D{sub m}, determined by irradiating cylindrical water phantoms with different diameters. The method proposed here is based on the determination of the water-equivalent thickness of the patient, along the beam central axis, by the treatment planning system that makes use of the electron densities obtained by a computed tomography scanner. The method has been applied for the breast in vivo dosimetry of ten patients treated with a manual intensity modulation with four asymmetric beams. In particular, two tangential rectangular fields were first delivered, thereafter a fraction of the dose (typically less than 10%) was delivered with two multi leaf-shaped beams which includedmore » only the mammarian tissue. Only the two rectangular fields were tested and for every checked field five measurements were carried out. Applying a continuous quality assurance program based on the tests of patient setup, machine settings and dose planning, the proposed method is able to verify agreements between the computed dose D{sub m,TPS} and the in vivo dose value D{sub m}, within 4%.« less

Authors:
; ; ; ; ; ; ; ; ;  [1]
  1. U.O. di Fisica Sanitaria - Centro di Ricerca ad Alta Tecnologia nelle Scienze Biomediche dell'Universita Cattolica S. Cuore, Campobasso and Istituto di Fisica - Universita Cattolica del S. Cuore, Rome (Italy) and U.O. di Radioterapia - Centro di Ricerca ad Alta Tecnologia nelle Scienze Biomediche dell'Universita Cattolica S. Cuore, Campobasso and U.O. di Fisica Sanitaria- Centro di Ricerca ad Alta Tecnologia nelle Scienze Biomediche dell'Universita Cattolica S. Cuore, Campobasso and Istituto di Fisica - Universita Cattolica del S. Cuore, Rome (Italy)
Publication Date:
OSTI Identifier:
20951097
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 34; Journal Issue: 3; Other Information: DOI: 10.1118/1.2426401; (c) 2007 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; BEAMS; COMPUTERIZED TOMOGRAPHY; DOSIMETRY; ELECTRON DENSITY; IN VIVO; IONIZATION CHAMBERS; IRRADIATION; MAMMARY GLANDS; PATIENTS; PHANTOMS; PLANNING; QUALITY ASSURANCE; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Grimaldi, Luca, D'Onofrio, Guido, Cilla, Savino, Fidanzio, Andrea, Stimato, Gerardina, Azario, Luigi, Deodato, Francesco, Macchia, Gabriella, Morganti, Alessio, and Piermattei, Angelo. Breast in vivo dosimetry by a portal ionization chamber. United States: N. p., 2007. Web. doi:10.1118/1.2426401.
Grimaldi, Luca, D'Onofrio, Guido, Cilla, Savino, Fidanzio, Andrea, Stimato, Gerardina, Azario, Luigi, Deodato, Francesco, Macchia, Gabriella, Morganti, Alessio, & Piermattei, Angelo. Breast in vivo dosimetry by a portal ionization chamber. United States. doi:10.1118/1.2426401.
Grimaldi, Luca, D'Onofrio, Guido, Cilla, Savino, Fidanzio, Andrea, Stimato, Gerardina, Azario, Luigi, Deodato, Francesco, Macchia, Gabriella, Morganti, Alessio, and Piermattei, Angelo. Thu . "Breast in vivo dosimetry by a portal ionization chamber". United States. doi:10.1118/1.2426401.
@article{osti_20951097,
title = {Breast in vivo dosimetry by a portal ionization chamber},
author = {Grimaldi, Luca and D'Onofrio, Guido and Cilla, Savino and Fidanzio, Andrea and Stimato, Gerardina and Azario, Luigi and Deodato, Francesco and Macchia, Gabriella and Morganti, Alessio and Piermattei, Angelo},
abstractNote = {This work reports a practical method for the determination of the in vivo breast middle dose value, D{sub m}, on the beam central axis, using a signal S{sub t}, obtained by a small thimble ion chamber positioned at the center of the electronic portal imaging device, and irradiated by the x-ray beam transmitted through the patient. The use of a stable ion chamber reduces many of the disadvantages associated with the use of diodes as their periodic recalibration and positioning is time consuming. The method makes use of a set of correlation functions obtained by the ratios S{sub t}/D{sub m}, determined by irradiating cylindrical water phantoms with different diameters. The method proposed here is based on the determination of the water-equivalent thickness of the patient, along the beam central axis, by the treatment planning system that makes use of the electron densities obtained by a computed tomography scanner. The method has been applied for the breast in vivo dosimetry of ten patients treated with a manual intensity modulation with four asymmetric beams. In particular, two tangential rectangular fields were first delivered, thereafter a fraction of the dose (typically less than 10%) was delivered with two multi leaf-shaped beams which included only the mammarian tissue. Only the two rectangular fields were tested and for every checked field five measurements were carried out. Applying a continuous quality assurance program based on the tests of patient setup, machine settings and dose planning, the proposed method is able to verify agreements between the computed dose D{sub m,TPS} and the in vivo dose value D{sub m}, within 4%.},
doi = {10.1118/1.2426401},
journal = {Medical Physics},
number = 3,
volume = 34,
place = {United States},
year = {Thu Mar 15 00:00:00 EDT 2007},
month = {Thu Mar 15 00:00:00 EDT 2007}
}
  • Purpose: Pre-treatment QA of individual treatment plans requires costly linac time and physics effort. Starting with IMRT breast treatments, we aim to replace pre-treatment QA with in-vivo portal dosimetry. Methods: Our IMRT breast cancer plans are routinely measured using the ArcCheck device (SunNuclear). 2D-Gamma analysis is performed with 3%/3mm criteria and the percentage of points with gamma<1 (nG1) is calculated within the 50% isodose surface. Following AAPM recommendations, plans with nG1<90% are approved; others need further inspection and might be rejected. For this study, we used invivo portal dosimetry (IPD) to measure the 3D back-projected dose of the first threemore » fractions for IMRT breast plans. Patient setup was online corrected before for all measured fractions. To reduce patient related uncertainties, the three IPD results were averaged and 3D-gamma analysis was applied with abovementioned criteria . For a subset of patients, phantom portal dosimetry (PPD) was also performed on a slab phantom. Results: Forty consecutive breast patients with plans that fitted the EPID were analysed. The average difference between planned and IPD dose in the reference point was −0.7+/−1.6% (1SD). Variation in nG1 between the 3 invivo fractions was about 6% (1SD). The average nG1 for IPD was 89+/−6%, worse than ArcCheck (95+/−3%). This can be explained by patient related factors such as changes in anatomy and/or model deficiencies due to e.g. inhomogeneities. For the 20 cases with PPD, mean nG1 was equal to ArcCheck values, which indicates that the two systems are equally accurate. These data therefore suggest that proper criteria for 3D invivo verification of breast treatments should be nG1>80% instead of nG1>90%, which, for our breast cases, would result in 5% (2/40) further inspections. Conclusion: First-fraction in-vivo portal dosimetry using new gamma-evaluation criteria will replace phantom measurements in our institution, saving resources and yielding 3D dosimetry of the actual patient treatment.« less
  • Irradiation of the heart is one of the major concerns during radiotherapy of breast cancer. Three-dimensional (3D) treatment planning would therefore be useful but cannot always be performed for left-sided breast treatments, because CT data may not be available. However, even if 3D dose calculations are available and an estimate of the normal tissue damage can be made, uncertainties in patient positioning may significantly influence the heart dose during treatment. Therefore, 3D reconstruction of the actual heart dose during breast cancer treatment using electronic imaging portal device (EPID) dosimetry has been investigated. A previously described method to reconstruct the dosemore » in the patient from treatment portal images at the radiological midsurface was used in combination with a simple geometrical model of the irradiated heart volume to enable calculation of dose-volume histograms (DVHs), to independently verify this aspect of the treatment without using 3D data from a planning CT scan. To investigate the accuracy of our method, the DVHs obtained with full 3D treatment planning system (TPS) calculations and those obtained after resampling the TPS dose in the radiological midsurface were compared for fifteen breast cancer patients for whom CT data were available. In addition, EPID dosimetry as well as 3D dose calculations using our TPS, film dosimetry, and ionization chamber measurements were performed in an anthropomorphic phantom. It was found that the dose reconstructed using EPID dosimetry and the dose calculated with the TPS agreed within 1.5% in the lung/heart region. The dose-volume histograms obtained with EPID dosimetry were used to estimate the normal tissue complication probability (NTCP) for late excess cardiac mortality. Although the accuracy of these NTCP calculations might be limited due to the uncertainty in the NTCP model, in combination with our portal dosimetry approach it allows incorporation of the actual heart dose. For the anthropomorphic phantom, and for fifteen patients for whom CT data were available to test our method, the average difference between the NTCP values obtained with our method and those resulting from the dose distributions calculated with the TPS was 0.1% {+-}0.3% (1 SD). Most NTCP values were 1%-2% lower than those obtained using the method described by Hurkmans et al. [Radiother. Oncol. 62, 163-171 (2002)], using the maximum heart distance determined from a simulator image as a single pre-treatment parameter. A similar difference between the two methods was found for twelve patients using in vivo EPID dosimetry; the average NTCP value obtained with EPID dosimetry was 0.9%, whereas an average NTCP value of 2.2% was derived using the method of Hurkmans et al. The results obtained in this study show that EPID dosimetry is well suited for in vivo verification of the heart dose during breast cancer treatment, and can be used to estimate the NTCP for late excess cardiac mortality. To the best of our knowledge, this is the first study using portal dosimetry to calculate a DVH and NTCP of an organ at risk.« less
  • Electronic portal imaging devices (EPIDs) are increasingly used for portal dosimetry applications. In our department, EPIDs are clinically used for two-dimensional (2D) transit dosimetry. Predicted and measured portal dose images are compared to detect dose delivery errors caused for instance by setup errors or organ motion. The aim of this work is to develop a model to predict dose-volume histogram (DVH) changes due to setup errors during breast cancer treatment using 2D transit dosimetry. First, correlations between DVH parameter changes and 2D gamma parameters are investigated for different simulated setup errors, which are described by a binomial logistic regression model.more » The model calculates the probability that a DVH parameter changes more than a specific tolerance level and uses several gamma evaluation parameters for the planning target volume (PTV) projection in the EPID plane as input. Second, the predictive model is applied to clinically measured portal images. Predicted DVH parameter changes are compared to calculated DVH parameter changes using the measured setup error resulting from a dosimetric registration procedure. Statistical accuracy is investigated by using receiver operating characteristic (ROC) curves and values for the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values. Changes in the mean PTV dose larger than 5%, and changes in V{sub 90} and V{sub 95} larger than 10% are accurately predicted based on a set of 2D gamma parameters. Most pronounced changes in the three DVH parameters are found for setup errors in the lateral-medial direction. AUC, sensitivity, specificity, and negative predictive values were between 85% and 100% while the positive predictive values were lower but still higher than 54%. Clinical predictive value is decreased due to the occurrence of patient rotations or breast deformations during treatment, but the overall reliability of the predictive model remains high. Based on our predictive model, 2D transit dosimetry measurements can now directly be translated in clinically more relevant DVH parameter changes for the PTV during conventional breast treatment. In this way, the possibility to design decision protocols based on extracted DVH changes is created instead of undertaking elaborate actions such as repeated treatment planning or 3D dose reconstruction for a large group of patients.« less
  • Purpose: To quantify the ability of electronic portal imaging device (EPID) dosimetry used during treatment (in vivo) in detecting variations that can occur in the course of patient treatment. Methods: Images of transmitted radiation from in vivo EPID measurements were converted to a 2D planar dose at isocenter and compared to the treatment planning dose using a prototype software system. Using the treatment planning system (TPS), four different types of variability were modeled: overall dose scaling, shifting the positions of the multileaf collimator (MLC) leaves, shifting of the patient position, and changes in the patient body contour. The gamma passmore » rate was calculated for the modified and unmodified plans and used to construct a receiver operator characteristic (ROC) curve to assess the detectability of the different parameter variations. The detectability is given by the area under the ROC curve (AUC). The TPS was also used to calculate the impact of the variations on the target dose–volume histogram. Results: Nine intensity modulation radiation therapy plans were measured for four different anatomical sites consisting of 70 separate fields. Results show that in vivo EPID dosimetry was most sensitive to variations in the machine output, AUC = 0.70 − 0.94, changes in patient body habitus, AUC = 0.67 − 0.88, and systematic shifts in the MLC bank positions, AUC = 0.59 − 0.82. These deviations are expected to have a relatively small clinical impact [planning target volume (PTV) D{sub 99} change <7%]. Larger variations have even higher detectability. Displacements in the patient’s position and random variations in MLC leaf positions were not readily detectable, AUC < 0.64. The D{sub 99} of the PTV changed by up to 57% for the patient position shifts considered here. Conclusions: In vivo EPID dosimetry is able to detect relatively small variations in overall dose, systematic shifts of the MLC’s, and changes in the patient habitus. Shifts in the patient’s position which can introduce large changes in the target dose coverage were not readily detected.« less
  • The quantum efficiency (QE) of an imaging detector can be increased by utilizing a thick, high-density detection medium to increase the number of quantum interactions. However, image quality is more accurately described by the detection quantum efficiency (DQE). If a significant fraction of the increase in the number of detected quanta from a thick, dense detector were to result in useful imaging signal, this represents a favorable case where enhanced QE leads to increased DQE. However, for ionization-type detectors, one factor that limits DQE is the recombination between ion pairs that acts as a secondary quantum sink due to whichmore » enhancement in QE may not result in higher DQE depending on the extent of the signal loss from recombination. Therefore, an analysis of signal loss mechanisms or quantum sinks in an imaging system is essential for validating the overall benefit of high QE detectors. In this paper, a study of ion recombination as a secondary quantum sink is presented for a high QE prototype ion-chamber-based electronic portal imaging device (EPID): the kinestatic charge detector (KCD). The KCD utilizes a high pressure noble gas (krypton or xenon at 100 atm) and an arbitrarily large detector thickness (of the order of centimeters), resulting in a high QE imager. Compared with commercial amorphous silicon flat panel imagers that provide DQE(0){approx_equal}0.01, the KCD has much higher DQE. Studies indicated that DQE(0)=0.20 for 6.1 cm thick, 100 atm ({rho}=3.4 g/cm{sup 3}) xenon chamber, and DQE(0)=0.34 for a 9.1 cm thick chamber. A series of experiments was devised and conducted to determine the signal loss due to recombination for a KCD chamber. The measurements indicated a fractional recombination loss of about 14% for a krypton chamber and about 18% for a xenon chamber under standard operating conditions (100 atm chamber pressure and 1275 V/cm electric field intensity). A theoretical treatment of the effect of recombination on imaging signal-to-noise ratio was applied to quantify the loss in DQE. These calculations indicated that recombination had a limited effect (<2%) on DQE under standard operating conditions. This was validated by good agreement between experimentally measured DQE and that obtained using Monte Carlo simulations that did not account for recombination.« less