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  • 1.
    Adolfsson, Emelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Grindborg, Jan-Erik
    Swedish Radiation Safety Authority, Stockholm, Sweden .
    Gustafsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Lund, Eva
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics. Swedish Radiation Safety Authority, Stockholm, Sweden .
    Response of lithium formate EPR dosimeters at photon energies relevant to the dosimetry of brachytherapy2010In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 37, no 9, p. 4946-4959Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To investigate experimentally the energy dependence of the detector response of lithium formate EPR dosimeters for photon energies below 1 MeV relative to that at 60Co energies. High energy photon beams are used in calibrating dosimeters for use in brachytherapy since the absorbed dose to water can be determined with high accuracy in such beams using calibrated ion chambers and standard dosimetry protocols. In addition to any differences in mass-energy absorption properties between water and detector, variations in radiation yield (detector response) with radiation quality, caused by differences in the density of ionization in the energy imparted (LET), may exist. Knowledge of an eventual deviation in detector response with photon energy is important for attaining high accuracy in measured brachytherapy dose distributions.

    METHODS:

    Lithium formate EPR dosimeters were irradiated to known levels of air kerma in 25-250 kV x-ray beams and in 137Cs and 60Co beams at the Swedish Secondary Standards Dosimetry Laboratory. Conversions from air kerma free in air into values of mean absorbed dose to the detectors were made using EGSnrc MC simulations and x-ray energy spectra measured or calculated for the actual beams. The signals from the detectors were measured using EPR spectrometry. Detector response (the EPR signal per mean absorbed dose to the detector) relative to that for 60Co was determined for each beam quality.

    RESULTS:

    Significant decreases in the relative response ranging from 5% to 6% were seen for x-ray beams at tube voltages < or = 180 kV. No significant reduction in the relative response was seen for 137Cs and 250 kV x rays.

    CONCLUSIONS:

    When calibrated in 60Co or MV photon beams, corrections for the photon energy dependence of detector response are needed to achieve the highest accuracy when using lithium formate EPR dosimeters for measuring absorbed doses around brachytherapy sources emitting photons in the energy range of 20-150 keV such as 169Yb and electronic sources.

  • 2.
    Ballester, Facundo
    et al.
    University of Valencia, Spain.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Karolinska University Hospital, Sweden.
    Granero, Domingo
    Hospital Gen University, Spain.
    Haworth, Annette
    Peter MacCallum Cancer Centre, Australia; RMIT University, Australia.
    Mourtada, Firas
    Helen F Graham Cancer Centre, DE 19713 USA.
    Paiva Fonseca, Gabriel
    CNEN SP, Brazil; Maastricht University, Netherlands.
    Zourari, Kyveli
    University of Athens, Greece.
    Papagiannis, Panagiotis
    University of Athens, Greece.
    Rivard, Mark J.
    Tufts University, MA 02111 USA.
    Siebert, Frank-Andre
    University Hospital Schleswig Holstein, Germany.
    Sloboda, Ron S.
    Cross Cancer Institute, Canada; University of Alberta, Canada.
    Smith, Ryan L.
    Alfred Hospital, Australia.
    Thomson, Rowan M.
    Carleton University, Canada.
    Verhaegen, Frank
    Maastricht University, Netherlands; McGill University, Canada.
    Vijande, Javier
    University of Valencia, Spain; IFIC CSIC UV, Spain.
    Ma, Yunzhi
    CHU Quebec, Canada; University of Laval, Canada; University of Laval, Canada.
    Beaulieu, Luc
    CHU Quebec, Canada; University of Laval, Canada; University of Laval, Canada.
    A generic high-dose rate Ir-192 brachytherapy source for evaluation of model-based dose calculations beyond the TG-43 formalism2015In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 42, no 6, p. 3048-3062Article in journal (Refereed)
    Abstract [en]

    Purpose: In order to facilitate a smooth transition for brachytherapy dose calculations from the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) formalism to model-based dose calculation algorithms (MBDCAs), treatment planning systems (TPSs) using a MBDCA require a set of well-defined test case plans characterized by Monte Carlo (MC) methods. This also permits direct dose comparison to TG-43 reference data. Such test case plans should be made available for use in the software commissioning process performed by clinical end users. To this end, a hypothetical, generic high-dose rate (HDR) Ir-192 source and a virtual water phantom were designed, which can be imported into a TPS. Methods: A hypothetical, generic HDR Ir-192 source was designed based on commercially available sources as well as a virtual, cubic water phantom that can be imported into any TPS in DICOM format. The dose distribution of the generic Ir-192 source when placed at the center of the cubic phantom, and away from the center under altered scatter conditions, was evaluated using two commercial MBDCAs [Oncentra (R) Brachy with advanced collapsed-cone engine (ACE) and BrachyVision AcuRos (TM)]. Dose comparisons were performed using state-of-the-art MC codes for radiation transport, including ALGEBRA, BrachyDose, GEANT4, MCNP5, MCNP6, and pENELopE2008. The methodologies adhered to recommendations in the AAPM TG-229 report on high-energy brachytherapy source dosimetry. TG-43 dosimetry parameters, an along-away dose-rate table, and primary and scatter separated (PSS) data were obtained. The virtual water phantom of (201)(3) voxels (1 mm sides) was used to evaluate the calculated dose distributions. Two test case plans involving a single position of the generic HDR Ir-192 source in this phantom were prepared: (i) source centered in the phantom and (ii) source displaced 7 cm laterally from the center. Datasets were independently produced by different investigators. MC results were then compared against dose calculated using TG-43 and MBDCA methods. Results: TG-43 and PSS datasets were generated for the generic source, the PSS data for use with the ACE algorithm. The dose-rate constant values obtained from seven MC simulations, performed independently using different codes, were in excellent agreement, yielding an average of 1.1109 +/- 0.0004 cGy/(h U) (k = 1, Type A uncertainty). MC calculated dose-rate distributions for the two plans were also found to be in excellent agreement, with differences within type A uncertainties. Differences between commercial MBDCA and MC results were test, position, and calculation parameter dependent. On average, however, these differences were within 1% for ACUROS and 2% for ACE at clinically relevant distances. Conclusions: A hypothetical, generic HDR Ir-192 source was designed and implemented in two commercially available TPSs employing different MBDCAs. Reference dose distributions for this source were benchmarked and used for the evaluation of MBDCA calculations employing a virtual, cubic water phantom in the form of a CT DICOM image series. The implementation of a generic source of identical design in all TPSs using MBDCAs is an important step toward supporting univocal commissioning procedures and direct comparisons between TPSs. (C) 2015 American Association of Physicists in Medicine.

  • 3.
    Beaulieu, Luc
    et al.
    Centre hospitalier universitaire de Québec, Canada and Université Laval, Québec, Canada .
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Carrier, Jean-François
    Centre hospitalier de l’Université de Montréal, Québec, Canada and Département de physique, Université de Montréal, Québec Canada .
    Davis, Stephen D.
    University of Wisconsin-Madison, USA and McGill University Health Centre, Montréal, Québec, Canada .
    Mourtada, Firas
    Helen F. Graham Cancer Center, Christiana Care Health System, Newark, Delaware, USA.
    Rivard, Mark J.
    Tufts University School of Medicine, Boston, Massachusetts, USA.
    Thomson, Rowan M.
    Carleton University, Ottawa, Ontario, Canada.
    Verhaegen, Frank
    Maastricht University Medical Center, the Netherlands and McGill University Health Centre, Montréal, Québec, Canada .
    Wareing, Todd A.
    Transpire Inc., Gig Harbor, Washington, USA.
    Williamson, Jeffrey F.
    Virginia Commonwealth University, Richmond, USA.
    Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: Current status and recommendations for clinical implementation2012In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 39, no 10, p. 6208-6236Article in journal (Refereed)
    Abstract [en]

    The charge of Task Group 186 (TG-186) is to provide guidance for early adopters of model-based dose calculation algorithms (MBDCAs) for brachytherapy (BT) dose calculations to ensure practice uniformity. Contrary to external beam radiotherapy, heterogeneity correction algorithms have only recently been made available to the BT community. Yet, BT dose calculation accuracy is highly dependent on scatter conditions and photoelectric effect cross-sections relative to water. In specific situations, differences between the current water-based BT dose calculation formalism (TG-43) and MBDCAs can lead to differences in calculated doses exceeding a factor of 10. MBDCAs raise three major issues that are not addressed by current guidance documents: (1) MBDCA calculated doses are sensitive to the dose specification medium, resulting in energy-dependent differences between dose calculated to water in a homogeneous water geometry (TG-43), dose calculated to the local medium in the heterogeneous medium, and the intermediate scenario of dose calculated to a small volume of water in the heterogeneous medium. (2) MBDCA doses are sensitive to voxel-by-voxel interaction cross sections. Neither conventional single-energy CT nor ICRU∕ICRP tissue composition compilations provide useful guidance for the task of assigning interaction cross sections to each voxel. (3) Since each patient-source-applicator combination is unique, having reference data for each possible combination to benchmark MBDCAs is an impractical strategy. Hence, a new commissioning process is required. TG-186 addresses in detail the above issues through the literature review and provides explicit recommendations based on the current state of knowledge. TG-43-based dose prescription and dose calculation remain in effect, with MBDCA dose reporting performed in parallel when available. In using MBDCAs, it is recommended that the radiation transport should be performed in the heterogeneous medium and, at minimum, the dose to the local medium be reported along with the TG-43 calculated doses. Assignments of voxel-by-voxel cross sections represent a particular challenge. Electron density information is readily extracted from CT imaging, but cannot be used to distinguish between different materials having the same density. Therefore, a recommendation is made to use a number of standardized materials to maintain uniformity across institutions. Sensitivity analysis shows that this recommendation offers increased accuracy over TG-43. MBDCA commissioning will share commonalities with current TG-43-based systems, but in addition there will be algorithm-specific tasks. Two levels of commissioning are recommended: reproducing TG-43 dose parameters and testing the advanced capabilities of MBDCAs. For validation of heterogeneity and scatter conditions, MBDCAs should mimic the 3D dose distributions from reference virtual geometries. Potential changes in BT dose prescriptions and MBDCA limitations are discussed. When data required for full MBDCA implementation are insufficient, interim recommendations are made and potential areas of research are identified. Application of TG-186 guidance should retain practice uniformity in transitioning from the TG-43 to the MBDCA approach.

  • 4.
    Candela-Juan, C.
    et al.
    La Fe University of and Polytech Hospital, Spain; University of Valencia, Spain.
    Karlsson, Mattias
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Lundell, M.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Ballester, F.
    University of Valencia, Spain.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Swedish Radiat Safety Author, Sweden.
    Dosimetric characterization of two radium sources for retrospective dosimetry studies2015In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 42, no 5, p. 2132-2142Article in journal (Refereed)
    Abstract [en]

    Purpose: During the first part of the 20th century, Ra-226 was the most used radionuclide for brachytherapy. Retrospective accurate dosimetry, coupled with patient follow up, is important for advancing knowledge on long-term radiation effects. The purpose of this work was to dosimetrically characterize two Ra-226 sources, commonly used in Sweden during the first half of the 20th century, for retrospective dose-effect studies. Methods: An 8 mg Ra-226 tube and a 10 mg Ra-226 needle, used at Radiumhemmet (Karolinska University Hospital, Stockholm, Sweden), from 1925 to the 1960s, were modeled in two independent Monte Carlo (MC) radiation transport codes: GEANT4 and MCNP5. Absorbed dose and collision kerma around the two sources were obtained, from which the TG-43 parameters were derived for the secular equilibrium state. Furthermore, results from this dosimetric formalism were compared with results from a MC simulation with a superficial mould constituted by five needles inside a glass casing, placed over a water phantom, trying to mimic a typical clinical setup. Calculated absorbed doses using the TG-43 formalism were also compared with previously reported measurements and calculations based on the Sievert integral. Finally, the dose rate at large distances from a Ra-226 point-like-source placed in the center of 1 m radius water sphere was calculated with GEANT4. Results: TG-43 parameters [including gL(r), F(r,theta), Lambda, and s(K)] have been uploaded in spreadsheets as additional material, and the fitting parameters of a mathematical curve that provides the dose rate between 10 and 60 cm from the source have been provided. Results from TG-43 formalism are consistent within the treatment volume with those of a MC simulation of a typical clinical scenario. Comparisons with reported measurements made with thermoluminescent dosimeters show differences up to 13% along the transverse axis of the radium needle. It has been estimated that the uncertainty associated to the absorbed dose within the treatment volume is 10%-15%, whereas uncertainty of absorbed dose to distant organs is roughly 20%-25%. Conclusions: The results provided here facilitate retrospective dosimetry studies of Ra-226 using modern treatment planning systems, which may be used to improve knowledge on long term radiation effects. It is surely important for the epidemiologic studies to be aware of the estimated uncertainty provided here before extracting their conclusions.

  • 5.
    Carlsson Tedgren, Asa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Ahnesjö, Anders
    Uppsala University.
    Optimization of the computational efficiency of a 3D, collapsed cone dose calculation algorithm for brachytherapy.2008In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 35, no 4, p. 1611-1618Article in journal (Refereed)
    Abstract [en]

    Brachytherapy dose calculations based on point kernel superposition using the collapsed cone method have been shown to accurately model the influence from finite dimensions of the patient and effects from heterogeneities including those of high atomic numbers. The collapsed cone method is for brachytherapy applications most effectively implemented through a successive-scattering approach, in which the dose from once and higher order of scattered photons is calculated separately and in successive scatter order. The calculation speed achievable is directly proportional to the number of directions used for point kernel discretization and to the number of voxels in the volume. In this work we investigate how to best divide the total number of directions between the two steps of successive-scattering dose calculations. Results show that the largest fraction of the total number of directions should be utilized in calculating the first-scatter dose. Also shown is how the number of directions required for keeping discretization artifacts at acceptably low levels decreases significantly in multiple-source configurations, as a result of the dose gradients being less steep than those around single sources. Investigating the number of kernel directions required to keep artifacts low enough within the high dose region of an implant (i.e., for dose levels above approximately 5%-10% of the mean central target dose) reveals similar figures for brachytherapy as for external beam applications, where collapsed cone superposition is clinically used. Also shown is that approximating point kernels with their isotropic average leads to small dose differences at low and intermediate energies, implying that the collapsed cone calculations can be done in a single operation common to all sources of the implant at these energies. The current findings show that collapsed cone calculations can be achieved for brachytherapy with the same efficiency as for external beams. This, combined with recent results on gains in efficiency through implementing the algorithm on graphical card parallel hardware indicates that dose can be calculated with account for heterogeneities and finite dimensions within a few seconds for large voxel arrays and is therefore of interest for practical application to treatment planning.

  • 6.
    Carlsson Tedgren, Åsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    de Luelmo, Sandro
    Swedish Radiation Safety Authority.
    Grindborg, Jan-Erik
    Swedish Radiation Safety Authority.
    Characterization of a Co-60 unit at a secondary standard dosimetry laboratory: Monte Carlo simulations compared to measurements and results from the literature2010In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 37, no 6, p. 2777-2786Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare a Monte Carlo (MC) characterization of a Co-60 unit at the Swedish Secondary Standard Dosimetry Laboratory (SSDL) with the results of both measurements and literature with the aims of (1) resolving a change in the ratio of air-kerma free in air K-air and absorbed dose to water D-w in a water phantom noted experimentally after a source exchange in the laboratory and (2) reviewing results from the literature on similar MC simulations. Although their use in radiotherapy is decreasing, the characteristics of Co-60 beams are of interest since Co-60 beams are utilized in calibrating ionization chambers for the absolute dosimetry of radiotherapy beams and as reference radiation quality in evaluating the energy dependence of radiation detectors and in studies on radiobiological effectiveness. Methods: The BEAMnrc MC code was used with a detailed geometrical model of the treatment head and two models of the Co-60 source representing the sources used before and after source exchange, respectively. The active diameters of the Co-60 sources were 1.5 cm in pellet form and 2.0 cm in sintered form. Measurements were performed on the actual unit at the Swedish SSDL. Results: Agreement was obtained between the MC and the measured results within the estimated uncertainties for beam profiles, water depth-dose curve, relative air-kerma output factors, and for the ratios of K-air/D-w before and after source exchange. The on-axis energy distribution of the photon fluence free in air for the unit loaded with its present (1.5 cm in diameter) source agreed closely with the results from the literature in which a source of the same make and active diameter, inside a different treatment head, was simulated. The spectrum for the larger (2.0 cm in diameter) source was in close agreement with another published spectrum, also modeling a Co-60 source with an active diameter of 2.0 cm inside a different treatment head. Conclusions: The reduction in the value of K-air/D-w following source exchange was explained by the spectral differences between the two sources that were larger in the free in-air geometry used for K-air calibrations than at 5 g/cm(2) depth in the water phantom used for D-w calibrations. Literature review revealed differences between published in-air Co-60 spectra derived for sources of different active diameters, and investigators in need of an accurately determined Co-60 in-air spectrum should be aware of differences due to source active diameter.

  • 7.
    Carlsson Tedgren, Åsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Elia, Rouba
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Hedtjärn, Håkan
    Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Olsson, Sara
    Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Determination of absorbed dose to water around a clinical HDR 192-Ir source using LiF:Mg,Ti TLDs demonstrates an LET dependence of detector response2012In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 39, no 2, p. 1133-1140Article in journal (Refereed)
    Abstract [en]

    Purpose: Experimental radiation dosimetry with thermoluminescent dosimeters (TLDs), calibrated in a (60)Co or megavoltage (MV) photon beam, is recommended by AAPM TG-43U1for verification of Monte Carlo calculated absorbed doses around brachytherapy sources. However, it has been shown by Carlsson Tedgren et al. [Med. Phys. 38, 5539-5550 (2011)] that for TLDs of LiF:Mg,Ti, detector response was 4% higher in a (137)Cs beam than in a (60)Co one. The aim of this work was to investigate if similar over-response exists when measuring absorbed dose to water around (192)Ir sources, using LiF:Mg,Ti dosimeters calibrated in a 6 MV photon beam.Methods: LiF dosimeters were calibrated to measure absorbed dose to water in a 6 MV photon beam and used to measure absorbed dose to water at distances of 3, 5, and 7 cm from a clinical high dose rate (HDR) (192)Ir source in a polymethylmethacrylate (PMMA) phantom. Measured values were compared to values of absorbed dose to water calculated using a treatment planning system (TPS) including corrections for the difference in energy absorption properties between calibration quality and the quality in the users' (192)Ir beam and for the use of a PMMA phantom instead of the water phantom underlying dose calculations in the TPS.Results: Measured absorbed doses to water around the (192)Ir source were overestimated by 5% compared to those calculated by the TPS. Corresponding absorbed doses to water measured in a previous work with lithium formate electron paramagnetic resonance (EPR) dosimeters by Antonovic et al. [Med. Phys. 36, 2236-2247 (2009)], using the same irradiation setup and calibration procedure as in this work, were 2% lower than those calculated by the TPS. The results obtained in the measurements in this work and those obtained using the EPR lithium formate dosimeters were, within the expanded (k = 2) uncertainty, in agreement with the values derived by the TPS. The discrepancy between the results using LiF:Mg,Ti TLDs and the EPR lithium formate dosimeters was, however, statistically significant and in agreement with the difference in relative detector responses found for the two detector systems by Carlsson Tedgren et al. [Med. Phys. 38, 5539-5550 (2011)] and by Adolfsson et al. [Med. Phys. 37, 4946-4959 (2010)].Conclusions: When calibrated in (60)Co or MV photon beams, correction for the linear energy transfer (LET) dependence of LiF:Mg,Ti detector response will be needed as to measure absorbed doses to water in a (192)Ir beam with highest accuracy. Such corrections will depend on the manufacturing process (MTS-N Poland or Harshaw TLD-100) and details of the annealing and read-out schemes used.

  • 8.
    Carlsson Tedgren, Åsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Hedman, Angelica
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Grindborg, Jan-Erik
    Swedish Radiation Safety Authority.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Response of LiF:Mg,Ti thermoluminescent dosimeters at photon energies relevant to the dosimetry of brachytherapy (andlt; 1 MeV)2011In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 38, no 10, p. 5539-5550Article in journal (Refereed)
    Abstract [en]

    Purpose: High energy photon beams are used in calibrating dosimeters for use in brachytherapy since absorbed dose to water can be determined accurately and with traceability to primary standards in such beams, using calibrated ion chambers and standard dosimetry protocols. For use in brachytherapy, beam quality correction factors are needed, which include corrections for differences in mass energy absorption properties between water and detector as well as variations in detector response (intrinsic efficiency) with radiation quality, caused by variations in the density of ionization (linear energy transfer (LET) -distributions) along the secondary electron tracks. The aim of this work was to investigate experimentally the detector response of LiF:Mg, Ti thermoluminescent dosimeters (TLD) for photon energies below 1 MeV relative to (60)Co and to address discrepancies between the results found in recent publications of detector response. less thanbrgreater than less thanbrgreater thanMethods: LiF:Mg,Ti dosimeters of formulation MTS-N Poland were irradiated to known values of air kerma free-in-air in x-ray beams at tube voltages 25-250 kV, in (137)Cs- and (60)Co-beams at the Swedish Secondary Standards Dosimetry Laboratory. Conversions from air kerma free-in-air into values of mean absorbed dose in the dosimeters in the actual irradiation geometries were made using EGSnrc Monte Carlo simulations. X-ray energy spectra were measured or calculated for the actual beams. Detector response relative to that for (60)Co was determined at each beam quality. less thanbrgreater than less thanbrgreater thanResults: An increase in relative response was seen for all beam qualities ranging from 8% at tube voltage 25 kV (effective energy 13 keV) to 3%-4% at 250 kV (122 keV effective energy) and (137)Cs with a minimum at 80 keV effective energy (tube voltage 180 kV). The variation with effective energy was similar to that reported by Davis [Radiat. Prot. Dosim. 106, 33-43 (2003)] with our values being systematically lower by 2%-4%. Compared to the results by Nunn [Med. Phys. 35, 1861-1869 (2008)], the relative detector response as a function of effective energy differed in both shape and magnitude. This could be explained by the higher maximum read-out temperature (350 degrees C) used by Nunn [Med. Phys. 35, 1861-1869 (2008)], allowing light emitted from high-temperature peaks with a strong LET dependence to be registered. Use of TLD-100 by Davis [Radiat. Prot. Dosim. 106, 33-43 (2003)] with a stronger super-linear dose response compared to MTS-N was identified as causing the lower relative detector response in this work. less thanbrgreater than less thanbrgreater thanConclusions: Both careful dosimetry and strict protocols for handling the TLDs are required to reach solid experimental data on relative detector response. This work confirms older findings that an over-response relative to (60)Co exists for photon energies below 200-300 keV. Comparison with the results from the literature indicates that using similar protocols for annealing and read-out, dosimeters of different makes (TLD-100, MTS-N) differ in relative detector response. Though universality of the results has not been proven and further investigation is needed, it is anticipated that with the use of strict protocols for annealing and read-out, it will be possible to determine correction factors that can be used to reduce uncertainties in dose measurements around brachytherapy sources at photon energies where primary standards for absorbed dose to water are not available.

  • 9. Dance, D
    et al.
    Hunt, R
    Bakic, P
    Maidment, A
    Sandborg, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Carlsson, GA
    Computer simulation of X-ray mammography using high resolution voxel phantoms2003In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 30, no 6, p. 1456-1456Conference paper (Other academic)
  • 10.
    Dasu, Alexandru
    et al.
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences.
    Toma-Dasu, Iuliana
    Stockholm University and Karolinska Institutet.
    Impact of variable RBE on proton fractionation2013In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 40, no 1, p. Article ID 011705-Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore the impact of variable proton RBE on dose fractionation for clinically-relevant situations. A generic RBE=1.1 is generally used for isoeffect calculations, while experimental studies showed that proton RBE varies with tissue type, dose and LET.

    Material and methods: An analytical expression for the LET and α/β dependence of the LQ model has been used for proton simulations in parallel with the assumption of a generic RBE=1.1. Calculations have been performed for ranges of LET values and fractionation sensitivities to describe clinically-relevant cases, like the treatment of H&N and prostate tumors. Isoeffect calculations were compared with predictions from a generic RBE value and reported clinical results.

    Results: The generic RBE=1.1 appears to be a reasonable estimate for the proton RBE of rapidly growing tissues irradiated with low LET radiation. However, the use of a variable RBE predicts larger differences for tissues with low α/β (both tumor and normal) and at low doses per fraction. In some situations these differences may appear in contrast to the findings from photon studies highlighting the importance of accurate accounting for the radiobiological effectiveness of protons. Furthermore, the use of variable RBE leads to closer predictions to clinical results.

    Conclusions: The LET dependence of the RBE has a strong impact on the predicted effectiveness of fractionated proton radiotherapy. The magnitude of the effect is modulated by the fractionation sensitivity and the fractional dose indicating the need for accurate analyses both in the target and around it. Care should therefore be employed for changing clinical fractionation patterns or when analyzing results from clinical studies for this type of radiation.

  • 11.
    Daşu, Alexandru
    et al.
    Norrland University Hospital.
    Toma-Daşu, Iuliana
    Stockholm University and Karolinska Institutet.
    Vascular oxygen content and the tissue oxygenation--a theoretical analysis2008In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 35, no 2, p. 539-545Article in journal (Refereed)
    Abstract [en]

    Several methods exist for evaluating tumor oxygenation as hypoxia is an important prognostic factor for cancer patients. They use different measuring principles that highlight various aspects of oxygenation. The results could be empirically correlated, but it has been suspected that there could be discordances in some cases. This study describes an analysis of the relationship between vascular and tissue oxygenations. Theoretical simulation has been employed to characterize tissue oxygenations for a broad range of distributions of intervessel distances and vascular oxygenations. The results were evaluated with respect to the implications for practical measurements of tissue oxygenations. The findings showed that although the tissue oxygenation is deterministically related to vascular oxygenation, the relationship between them is not unequivocal. Variability also exists between the fractions of values below the sensitivity thresholds of various measurement methods which in turn could be reflected in the power of correlations between results from different methods or in the selection of patients for prognostic studies. The study has also identified potential difficulties that may be encountered at the quantitative evaluation of the results from oxygenation measurements. These could improve the understanding of oxygenation measurements and the interpretation of comparisons between results from various measurement methods.

  • 12.
    Hedtjärn, Håkan
    et al.
    Linköping University, Department of Medicine and Care, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medicine and Care, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Williamson, Jeffrey
    Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, USA.
    Monte Carlo-aided dosimetry of the symmetra model I25.S06 125I, interstitial brachytherapy seed2000In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 27, no 5, p. 1076-1085Article in journal (Refereed)
    Abstract [en]

    A dosimetric study of a new 125I seed for permanent prostate implant, the Symmetra 125I Seed model I25.S06, has been undertaken utilizing Monte Carlo photon transport calculations. All dosimetric quantities recommended by the AAPM Task Group 43 (TG-43) report have been calculated. Quantities determined are dose rate constant, radial dose function, anisotropy function, anisotropy factor, and anisotropy constant. The recently (January 1999) revised NIST (National Institute of Standards and Technology) 125I standard for air kerma strength calibration was taken into account as well as updated interaction cross-section data. Calculations were done for the competing model 6702 source for the purpose of comparison. The calculated dose-rate constants for the two seeds are 1.010 and 1.016 cGyh−1U−1 for the Symmetra and model 6702 seeds, respectively. The latter value deviates from the value, 1.039 cGyh−1U−1, recommended in the TG-43 report. The calculated radial dose function for the Symmetra new seed is more penetrating than that of the model 6711 seed (by 20% at 5 cm distance) but agrees closely (within statistical errors) with that of the model 6702 seed up to distances of 10 cm. The anisotropy function for the seed is also close to that for the 6702 seed with a tendency of somewhat more pronounced anisotropy (lower values at small angles from the longitudinal axis). Compared to the model 6711 seed, the Symmetra new seed is more isotropic. The anisotropy constants (the anisotropy function averaged with respect to angle and distance) for the three seed models are within 2%.

  • 13.
    Holm, Åsa
    et al.
    Linköping University, Department of Mathematics, Optimization . Linköping University, The Institute of Technology.
    Larsson, Torbjörn
    Linköping University, Department of Mathematics, Optimization . Linköping University, The Institute of Technology.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    A linear programming model for optimizing HDR brachytherapy dose distributions with respect to mean dose in the DVH-tail2013In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 40, no 8Article in journal (Refereed)
    Abstract [en]

    Purpose: Recent research has shown that the optimization model hitherto used in high-dose-rate (HDR) brachytherapy corresponds weakly to the dosimetric indices used to evaluate the quality of a dose distribution. Although alternative models that explicitly include such dosimetric indices have been presented, the inclusion of the dosimetric indices explicitly yields intractable models. The purpose of this paper is to develop a model for optimizing dosimetric indices that is easier to solve than those proposed earlier. less thanbrgreater than less thanbrgreater thanMethods: In this paper, the authors present an alternative approach for optimizing dose distributions for HDR brachytherapy where dosimetric indices are taken into account through surrogates based on the conditional value-at-risk concept. This yields a linear optimization model that is easy to solve, and has the advantage that the constraints are easy to interpret and modify to obtain satisfactory dose distributions. less thanbrgreater than less thanbrgreater thanResults: The authors show by experimental comparisons, carried out retrospectively for a set of prostate cancer patients, that their proposed model corresponds well with constraining dosimetric indices. All modifications of the parameters in the authors model yield the expected result. The dose distributions generated are also comparable to those generated by the standard model with respect to the dosimetric indices that are used for evaluating quality. less thanbrgreater than less thanbrgreater thanConclusions: The authors new model is a viable surrogate to optimizing dosimetric indices and quickly and easily yields high quality dose distributions.

  • 14.
    Holm, Åsa
    et al.
    Linköping University, Department of Mathematics. Linköping University, The Institute of Technology.
    Larsson, Torbjörn
    Linköping University, Department of Mathematics, Optimization . Linköping University, The Institute of Technology.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Impact of Using Linear Optimization Models in Dose Planning for HDR Brachytherapy2012In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 39, no 2, p. 1021-1028Article in journal (Refereed)
    Abstract [en]

    Purpose: Dose plans generated with optimization models hitherto used in HDR brachytherapy have shown a tendency to yield longer dwell times than manually optimized plans. Concern has been raised for the corresponding undesired hot spots and various methods to mitigate these have been developed. The hypotheses of this work are a) that one cause for the long dwell times is the use of objective functions comprising simple linear penalties and b) that alternative penalties, being piecewise linear, would lead to reduced length of individual dwell times.

    Methods: The characteristics of the linear penalties and the piecewise linear penalties are analysed mathematically. Experimental comparisons between the two types of penalties are carried out retrospectively for a set of prostate cancer patients.

    Results: While most dose-volume parameters do not differ significantly between the two types of penalties significant changes can be seen in the dwell times. On the average, total dwell times were reduced by 4.2%, with a reduction of maximum dwell times by 30%, using the alternative penalties.

    Conclusion: The use of linear penalties in optimization models for HDR brachytherapy is one cause for undesired longer dwell times appearing in mathematically optimized plans. By introducing alternative penalties significant reduction in dwell times can be achieved for HDR brachytherapy dose plans. Although various constraints as to reduce the long dwell times have been developed our finding is of fundamental interest in showing the shape of the objective function to be one reason for their appearance.

  • 15.
    Kaveckyte, Vaiva
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Malusek, Alexandr
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Benmakhlouf, Hamza
    Karolinska Univ Hosp, Sweden.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Suitability of microDiamond detectors for the determination of absorbed dose to water around high-dose-rate Ir-192 brachytherapy sources2018In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 45, no 1, p. 429-437Article in journal (Refereed)
    Abstract [en]

    Purpose: Experimental dosimetry of high-dose-rate (HDR) Ir-192 brachytherapy (BT) sources is complicated due to high dose and dose-rate gradients, and softening of photon energy spectrum with depth. A single crystal synthetic diamond detector microDiamond (PTW 60019, Freiburg, Germany) has a small active volume, high sensitivity, direct readout, and nearly water-equivalent active volume. The purpose of this study was to evaluate the suitability of microDiamond detectors for the determination of absorbed dose to water around HDR Ir-192 BT sources. Three microDiamond detectors were used, allowing for the comparison of their properties. Methods: In-phantom measurements were performed using microSelectron and VariSource iX HDR Ir-192 BT treatment units. Their treatment planning systems (TPSs), Oncentra (v. 4.3) and BrachyVision (v. 13.6), respectively, were used to create irradiation plans for a cubic PMMA phantom with the microDiamond positioned at one of three source-to-detector distances (SDDs) (1.5, 2.5, and 5.5 cm) at a time. The source was stepped in increments of 0.5 cm over a total length of 6 cm to yield absorbed dose of 2 Gy at the nominal reference-point of the detector. Detectors were calibrated in Co-60 beam in terms of absorbed dose to water, and Monte Carlo (MC) calculated beam quality correction factors were applied to account for absorbed-dose energy dependence. Phantom correction factors were applied to account for differences in dimensions between the measurement phantom and a water phantom used for absorbed dose calculations made with a TPS. The same measurements were made with all three of the detectors. Additionally, dose-rate dependence and stability of the detectors were evaluated in Co-60 beam. Results: The percentage differences between experimentally determined and TPS-calculated absorbed doses to water were from -1.3% to +2.9%. The values agreed to within experimental uncertainties, which were from 1.9% to 4.3% (k = 2) depending on the detector, SDD and treatment delivery unit. No dose-rate or intrinsic energy dependence corrections were applied. All microDiamonds were comparable in terms of preirradiation dose, stability of the readings and energy response, and showed a good agreement. Conclusions: The results indicate that the microDiamond is potentially suitable for the determination of absorbed dose to water around HDR Ir-192 BT sources and may be used for independent verification of TPSs calculations, as well as for QA measurements of HDR Ir-192 BT treatment delivery units at clinical sites. (C) 2017 American Association of Physicists in Medicine

  • 16.
    Ma, Yunzhi
    et al.
    CHU Quebec, Canada; University of Laval, Canada; University of Laval, Canada.
    Vijande, Javier
    University of Valencia, Spain; IFIC, Spain.
    Ballester, Facundo
    University of Valencia, Spain.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Karolinska University Hospital, Sweden.
    Granero, Domingo
    Hospital Gen University, Spain.
    Haworth, Annette
    University of Sydney, Australia.
    Mourtada, Firas
    Christiana Care Health Syst, DE 19713 USA; Christiana Care Health Syst, DE 19713 USA.
    Paiva Fonseca, Gabriel
    Maastricht University, Netherlands.
    Zourari, Kyveli
    University of Athens, Greece.
    Papagiannis, Panagiotis
    University of Athens, Greece.
    Rivard, Mark J.
    Tufts University, MA 02111 USA.
    Siebert, Frank-Andre
    University Hospital Schleswig Holstein, Germany.
    Sloboda, Ron S.
    Cross Cancer Institute, Canada; University of Alberta, Canada.
    Smith, Ryan
    Alfred Hospital, Australia.
    Chamberland, Marc J. P.
    Carleton University, Canada.
    Thomson, Rowan M.
    Carleton University, Canada.
    Verhaegen, Frank
    Maastricht University, Netherlands.
    Beaulieu, Luc
    CHU Quebec, Canada; University of Laval, Canada; University of Laval, Canada.
    A generic TG-186 shielded applicator for commissioning model-based dose calculation algorithms for high-dose-rate Ir-192 brachytherapy2017In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 44, no 11, p. 5961-5976Article in journal (Refereed)
    Abstract [en]

    PurposeA joint working group was created by the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy and Oncology (ESTRO), and the Australasian Brachytherapy Group (ABG) with the charge, among others, to develop a set of well-defined test case plans and perform calculations and comparisons with model-based dose calculation algorithms (MBDCAs). Its main goal is to facilitate a smooth transition from the AAPM Task Group No. 43 (TG-43) dose calculation formalism, widely being used in clinical practice for brachytherapy, to the one proposed by Task Group No. 186 (TG-186) for MBDCAs. To do so, in this work a hypothetical, generic high-dose rate (HDR) Ir-192 shielded applicator has been designed and benchmarked. MethodsA generic HDR Ir-192 shielded applicator was designed based on three commercially available gynecological applicators as well as a virtual cubic water phantom that can be imported into any DICOM-RT compatible treatment planning system (TPS). The absorbed dose distribution around the applicator with the TG-186 Ir-192 source located at one dwell position at its center was computed using two commercial TPSs incorporating MBDCAs (Oncentra((R)) Brachy with Advanced Collapsed-cone Engine, ACE, and BrachyVision ACUROS) and state-of-the-art Monte Carlo (MC) codes, including ALGEBRA, BrachyDose, egs_brachy, Geant4, MCNP6, and Penelope2008. TPS-based volumetric dose distributions for the previously reported source centered in water and source displaced test cases, and the new source centered in applicator test case, were analyzed here using the MCNP6 dose distribution as a reference. Volumetric dose comparisons of TPS results against results for the other MC codes were also performed. Distributions of local and global dose difference ratios are reported. ResultsThe local dose differences among MC codes are comparable to the statistical uncertainties of the reference datasets for the source centered in water and source displaced test cases and for the clinically relevant part of the unshielded volume in the source centered in applicator case. Larger local differences appear in the shielded volume or at large distances. Considering clinically relevant regions, global dose differences are smaller than the local ones. The most disadvantageous case for the MBDCAs is the one including the shielded applicator. In this case, ACUROS agrees with MC within [-4.2%, +4.2%] for the majority of voxels (95%) while presenting dose differences within [-0.12%, +0.12%] of the dose at a clinically relevant reference point. For ACE, 95% of the total volume presents differences with respect to MC in the range [-1.7%, +0.4%] of the dose at the reference point. ConclusionsThe combination of the generic source and generic shielded applicator, together with the previously developed test cases and reference datasets (available in the Brachytherapy Source Registry), lay a solid foundation in supporting uniform commissioning procedures and direct comparisons among treatment planning systems for HDR Ir-192 brachytherapy.

  • 17.
    Maier, Andreas
    et al.
    Stanford University.
    Wigström, Lars
    Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Hofmann, Hannes G.
    Friedrich-Alexander University of Erlangen-Nuremberg.
    Hornegger, Joachim
    Friedrich-Alexander University of Erlangen-Nuremberg.
    Zhu, Lei
    Georgia Institute Technology.
    Strobel, Norbert
    Siemens AG Healthcare.
    Fahrig, Rebecca
    Stanford University.
    Three-dimensional anisotropic adaptive filtering of projection data for noise reduction in cone beam CT2011In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 38, no 11, p. 5896-5909Article in journal (Refereed)
    Abstract [en]

    Purpose: The combination of quickly rotating C-arm gantry with digital flat panel has enabled the acquisition of three-dimensional data (3D) in the interventional suite. However, image quality is still somewhat limited since the hardware has not been optimized for CT imaging. Adaptive anisotropic filtering has the ability to improve image quality by reducing the noise level and therewith the radiation dose without introducing noticeable blurring. By applying the filtering prior to 3D reconstruction, noise-induced streak artifacts are reduced as compared to processing in the image domain. Methods: 3D anisotropic adaptive filtering was used to process an ensemble of 2D x-ray views acquired along a circular trajectory around an object. After arranging the input data into a 3D space (2D projections + angle), the orientation of structures was estimated using a set of differently oriented filters. The resulting tensor representation of local orientation was utilized to control the anisotropic filtering. Low-pass filtering is applied only along structures to maintain high spatial frequency components perpendicular to these. The evaluation of the proposed algorithm includes numerical simulations, phantom experiments, and in-vivo data which were acquired using an AXIOM Artis dTA C-arm system (Siemens AG, Healthcare Sector, Forchheim, Germany). Spatial resolution and noise levels were compared with and without adaptive filtering. A human observer study was carried out to evaluate low-contrast detectability. Results: The adaptive anisotropic filtering algorithm was found to significantly improve low-contrast detectability by reducing the noise level by half (reduction of the standard deviation in certain areas from 74 to 30 HU). Virtually no degradation of high contrast spatial resolution was observed in the modulation transfer function (MTF) analysis. Although the algorithm is computationally intensive, hardware acceleration using Nvidias CUDA Interface provided an 8.9-fold speed-up of the processing (from 1336 to 150 s). Conclusions: Adaptive anisotropic filtering has the potential to substantially improve image quality and/or reduce the radiation dose required for obtaining 3D image data using cone beam CT.

  • 18.
    Malusek, Alexandr
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Magnusson, Maria
    Linköping University, Department of Electrical Engineering, Computer Vision. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Sandborg, Michael
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    A model-based iterative reconstruction algorithm DIRA using patient-specific tissue classification via DECT for improved quantitative CT in dose planning2017In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 44, no 6, p. 2345-2357Article in journal (Refereed)
    Abstract [en]

    Purpose: To develop and evaluate-in a proof-of-concept configuration-a novel iterative reconstruction algorithm (DIRA) for quantitative determination of elemental composition of patient tissues for application to brachytherapy with low energy (amp;lt; 50 keV) photons and proton therapy. Methods: DIRA was designed as a model-based iterative reconstruction algorithm, which uses filtered backprojection, automatic segmentation and multimaterial tissue decomposition. The evaluation was done for a phantom derived from the voxelized ICRP 110 male phantom. Soft tissues were decomposed to the lipid, protein and water triplet, bones were decomposed to the compact bone and bone marrow doublet. Projections were derived using the Drasim simulation code for an axial scanning configuration resembling a typical DECT (dual-energy CT) scanner with 80 kV and Sn140 kV x-ray spectra. The iterative loop produced mono-energetic images at 50 and 88 keV without beam hardening artifacts. Different noise levels were considered: no noise, a typical noise level in diagnostic imaging and reduced noise level corresponding to tenfold higher doses. An uncertainty analysis of the results was performed using type A and B evaluations. The two approaches were compared. Results: Linear attenuation coefficients averaged over a region were obtained with relative errors less than 0.5% for all evaluated regions. Errors in average mass fractions of the three-material decomposition were less than 0.04 for no noise and reduced noise levels and less than 0.11 for the typical noise level. Mass fractions of individual pixels were strongly affected by noise, which slightly increased after the first iteration but subsequently stabilized. Estimates of uncertainties in mass fractions provided by the type B evaluation differed from the type A estimates by less than 1.5% for most cases. The algorithm was fast, the results converged after 5 iterations. The algorithmic complexity of forward polyenergetic projection calculation was much reduced by using material doublets and triplets. Conclusions: The simulations indicated that DIRA is capable of determining elemental composition of tissues, which are needed in brachytherapy with low energy (amp;lt; 50 keV) photons and proton therapy. The algorithm provided quantitative monoenergetic images with beam hardening artifacts removed. Its convergence was fast, image sharpness expressed via the modulation transfer function was maintained, and image noise did not increase with the number of iterations. c 2017 American Association of Physicists in Medicine

  • 19.
    Moreno, Rodrigo
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
    Borga, Magnus
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Smedby, Örjan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Generalizing the mean intercept length tensor for gray-level images2012In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 39, no 7, p. 4599-4612Article in journal (Refereed)
    Abstract [en]

    Purpose: The mean intercept length tensor is the most used technique to estimate microstructure orientation and anisotropy of trabecular bone. This paper proposes an efficient extension of this technique to gray-scale images based on a closed formulation of the mean intercept length tensor and a generalization using different angular convolution kernels.

    Methods: First, the extended Gaussian image is computed for the binary or gray-scale image. Second, the intercepts are computed for all possible orientations through an angular convolution with the half-cosine function. Finally, the tensor is computed by means of the covariance matrix. The complexity of the method is O(n + m) in contrast with O(nm) of traditional implementations, where n is the number of voxels in the image and m is the number of orientations used in the computations. The method is generalized by applying other angular convolution kernels instead of the half-cosine function. As a result, the anisotropy of the tensor can be controlled while keeping the eigenvectors intact.

    Results: The proposed extension to gray-scale yields accurate results for reliable computations of the extended Gaussian image and, unlike the traditional methodology, is not affected by artifacts generated by discretizations during the sampling of different orientations.

    Conclusions: Experiments show that the computations on both binary and gray-scale images are correlated, and that computations in gray-scale are more robust, enabling the use of the mean intercept length tensor to clinical examinations of trabecular bone. The use of kernels based on the von Mises-Fisher distribution is promising as the anisotropy can be adjusted with a parameter in order to improve its power to predict mechanical properties of trabecular bone.

  • 20.
    Sandborg, Michael
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radio Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Mc Vey, Graham
    Dance, David
    Alm Carlsson, Gudrun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radio Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Schemes for the optimization of chest radiography using a computer model of the patient and x-ray imaging system2001In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 28, no 10, p. 2007-2019Article in journal (Refereed)
    Abstract [en]

    A computer program has been developed to model chest radiography. It incorporates a voxel phantom of an adult and includes antiscatter grid, radiographic screen, and film. Image quality is quantified by calculating the contrast (?OD) and the ideal observer signal-to-noise ratio (SNRI) for a number of relevant anatomical details at various positions in the anatomy. Detector noise and system unsharpness are modeled and their influence on image quality is considered. A measure of useful dynamic range is computed and defined as the fraction of the image that is reproduced at an optical density such that the film gradient exceeds a preset value. The effective dose is used as a measure of the radiation risk for the patient. A novel approach to patient dose and image quality optimization has been developed and implemented. It is based on a reference system acknowledged to yield acceptable image quality in a clinical trial. Two optimizations schemes have been studied, the first including the contrast of vessels as measure of image quality and the second scheme using also the signal-to-noise ratio of calcifications. Both schemes make use of our measure of useful dynamic range as a key quantity. A large variety of imaging conditions was simulated by varying the tube voltage, antiscatter device, screen-film system, and maximum optical density in the computed image. It was found that the optical density is crucial in screen-film chest radiography. Significant dose savings (30%-50%) can be accomplished without sacrificing image quality by using low-atomic-number grids with a low grid ratio or an air gap and more sensitive screen-film system. Dose-efficient configurations proposed by the model agree well with the example of good radiographic technique suggested by the European Commission. ⌐ 2001 American Association of Physicists in Medicine.

  • 21.
    Sandborg, Michael
    et al.
    Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Faculty of Health Sciences.
    Tingberg, Anders
    Department of Radiation Physics, Malmö University Hospital, Malmö, Sweden.
    Ullman, Gustaf
    Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Faculty of Health Sciences.
    Dance, David R.
    Joint Department of Physics, The Royal Marsden NHS Trust and Institute of Cancer Research, London.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Faculty of Health Sciences.
    Comparison of clinical and physical measures of image quality in chest and pelvis computed radiography at different tube voltages2006In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 33, no 11, p. 4169-4175Article in journal (Refereed)
    Abstract [en]

    The aim of this work was to study the dependence of image quality in digital chest and pelvis radiography on tube voltage, and to explore correlations between clinical and physical measures of image quality. The effect on image quality of tube voltage in these two examinations was assessed using two methods. The first method relies on radiologists' observations of images of an anthropomorphic phantom, and the second method was based on computer modeling of the imaging system using an anthropomorphic voxel phantom. The tube voltage was varied within a broad range (50–150  kV), including those values typically used with screen-film radiography. The tube charge was altered so that the same effective dose was achieved for each projection. Two x-ray units were employed using a computed radiography (CR) image detector with standard tube filtration and antiscatter device. Clinical image quality was assessed by a group of radiologists using a visual grading analysis (VGA) technique based on the revised CEC image criteria. Physical image quality was derived from a Monte Carlo computer model in terms of the signal-to-noise ratio, SNR, of anatomical structures corresponding to the image criteria. Both the VGAS (visual grading analysis score) and SNR decrease with increasing tube voltage in both chest PA and pelvis AP examinations, indicating superior performance if lower tube voltages are employed. Hence, a positive correlation between clinical and physical measures of image quality was found. The pros and cons of using lower tube voltages with CR digital radiography than typically used in analog screen-film radiography are discussed, as well as the relevance of using VGAS and quantum-noise SNR as measures of image quality in pelvis and chest radiography.

  • 22.
    Slatkin, Daniel
    et al.
    Brookhaven National Laboratory.
    Spanne, Per
    Brookhaven National Laboratory.
    Dilmanian, Avraham
    Brookhaven National Laboratory.
    Sandborg, Michael
    Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Center for Medical Image Science and Visualization, CMIV. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Microbeam Radiation Therapy1992In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 19, p. 1395-1400Article in journal (Refereed)
    Abstract [en]

    It is proposed to carry out radiotherapy and radiosurgery for brain lesions by crossfiring an array of parallel, closely spaced microbeams of synchrotron-generated x rays several times through an isocentric target, each microbeam in the array having an 25-µm-wide adjustable-height rectangular cross section. The following inferences from the known tissue sparing of 22-MeV deuteron microbeams in the mouse brain and the following exemplary Monte Carlo computations indicate that endothelial cells in the brain that are lethally irradiated by any microbeam in an array of adequately spaced microbeams outside an isocentric target will be replaced by endothelial cells regenerated from microscopically contiguous, minimally irradiated endothelium in intermicrobeam segments of brain vasculature. Endothelial regeneration will prevent necrosis of the nontargeted parenchymal tissue. However, neoplastic and/or nonneoplastic targeted tissues at the isocenter will be so severely depleted of potentially mitotic endothelial and parenchymal cells by multiple overlapping microbeams that necrosis will ensue. The Monte Carlo computations simulate microbeam irradiations of a 16-cm diameter, 16-cm-long cylindrical human head phantom using 50-, 100-, and 150-keV monochromatic x rays.

  • 23.
    Sunnegårdh, Johan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Electrical Engineering.
    Danielsson, Per-Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Electrical Engineering.
    Regularized iterative weighted filtered backprojection for helical cone-beam CT2008In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 35, no 9, p. 4173-4185Article in journal (Refereed)
    Abstract [en]

    Contemporary reconstruction methods employed for clinical helical cone-beam computed tomography (CT) are analytical (noniterative) but mathematically nonexact, i.e., the reconstructed image contains so called cone-beam artifacts, especially for higher cone angles. Besides cone artifacts, these methods also suffer from windmill artifacts: alternating dark and bright regions creating spiral-like patterns occurring in the vicinity of high z-direction derivatives. In this article, the authors examine the possibility to suppress cone and windmill artifacts by means of iterative application of nonexact three-dimensional filtered backprojection, where the analytical part of the reconstruction brings about accelerated convergence. Specifically, they base their investigations on the weighted filtered backprojection method [Stierstorfer et al., Phys. Med. Biol. 49, 2209-2218 (2004)]. Enhancement of high frequencies and amplification of noise is a common but unwanted side effect in many acceleration attempts. They have employed linear regularization to avoid these effects and to improve the convergence properties of the iterative scheme. Artifacts and noise, as well as spatial resolution in terms of modulation transfer functions and slice sensitivity profiles have been measured. The results show that for cone angles up to ±2.78°, cone artifacts are suppressed and windmill artifacts are alleviated within three iterations. Furthermore, regularization parameters controlling spatial resolution can be tuned so that image quality in terms of spatial resolution and noise is preserved. Simulations with higher number of iterations and long objects (exceeding the measured region) verify that the size of the reconstructible region is not reduced, and that the regularization greatly improves the convergence properties of the iterative scheme. Taking these results into account, and the possibilities to extend the proposed method with more accurate modeling of the acquisition process, the authors believe that iterative improvement with non-exact methods is a promising technique for medical CT applications.

  • 24. Tapiovaara, M
    et al.
    Sandborg, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    How should low-contrast detail detectability be measured in fluoroscopy?2004In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 31, no 9, p. 2564-2576Article in journal (Refereed)
    Abstract [en]

    The relationship and precision of four methods for measuring the low-contrast detail detectability in fluoroscopic imaging were studied. These included the physical measurement of the accumulation rate of the square of the signal-to-noise ratio (SNRrate2), two-alternative forced-choice (2-AFC) experiments, sixteen-alternative forced-choice (16-AFC) experiments and subjective determination of the threshold contrast. The precision and sensitivity of the threshold contrast measurement were seen to be modest in the constancy testing of fluoroscopic equipment: only large changes in system performance could be reliably detected by that method. The measurement of the SNRrate2 is suggested instead. The relationship between the results of the various methods were studied, and it was found that human performance can be related to SNRrate2 by introducing the concept of the effective image information integration time (teff). When measured for an unlimited observation time, it depicts the saturation of human performance in detecting a static low-contrast detail in dynamic image noise. Here, teff was found to be about 0.6 s in 2-AFC tests and 0.3 s in 16-AFC tests. © 2004 American Association of Physicists in Medicine.

  • 25.
    Wang, Chunliang
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Frimmel, Hans
    Uppsala University, Sweden .
    Smedby, Örjan
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Fast level-set based image segmentation using coherent propagation2014In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 41, no 7, article id 073501Article in journal (Refereed)
    Abstract [en]

    Purpose: The level-set method is known to require long computation time for 3D image segmentation, which limits its usage in clinical workflow. The goal of this study was to develop a fast level-set algorithm based on the coherent propagation method and explore its character using clinical datasets.

    Methods: The coherent propagation algorithm allows level set functions to converge faster by forcing the contour to move monotonically according to a predicted developing trend. Repeated temporary backwards propagation, caused by noise or numerical errors, is then avoided. It also makes it possible to detect local convergence, so that the parts of the boundary that have reached their final position can be excluded in subsequent iterations, thus reducing computation time. To compensate for the overshoot error, forward and backward coherent propagation is repeated periodically. This can result in fluctuations of great magnitude in parts of the contour. In this paper, a new gradual convergence scheme using a damping factor is proposed to address this problem. The new algorithm is also generalized to non-narrow band cases. Finally, the coherent propagation approach is combined with a new distance-regularized level set, which eliminates the needs of reinitialization of the distance.

    Results: Compared with the sparse field method implemented in the widely available ITKSnap software, the proposed algorithm is about 10 times faster when used for brain segmentation and about 100 times faster for aorta segmentation. Using a multiresolution approach, the new method achieved 50 times speed-up in liver segmentation. The Dice coefficient between the proposed method and the sparse field method is above 99% in most cases.

    Conclusions: A generalized coherent propagation algorithm for level set evolution yielded substantial improvement in processing time with both synthetic datasets and medical images. (C) 2014 American Association of Physicists in Medicine.

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