Biomedical subjects

G H Hartmann

Publications and source records attributed to G H Hartmann.

At least 19 recordsLinked to original sources

PubMed2004

A calibration procedure for beam monitors in a scanned beam of heavy charged particles.

An international code of practice (CoP) for dosimetry based on standards of absorbed dose to water has recently been published by the IAEA [Technical Report Series No. 398, 2000] (TRS-398). This new CoP includes procedures for proton and heavy ion beams as well as all other beam qualities. In particular it defines reference conditions to which dose measurements should refer to. For proton and ion beams these conditions include dose measurements in the center of all possible modulated Bragg peaks. The recommended reference conditions in general are used also for the calibration of beam monitors. For a dynamic beam delivery system using beam scanning in combination with energy variation, like, e.g., at the German carbon ion radiotherapy facility, this calibration procedure is not appropriate. We have independently developed a different calibration procedure. Similar to the IAEA CoP this procedure is based on the measurement of absorbed dose to water. This is translated in terms of fluence which finally results in an energy-dependent calibration of the beam monitor in units of particle number per monitor unit, which is unique for all treatment fields. In contrast to the IAEA CoP, the reference depth is chosen to be very small. The procedure enables an accurate and reliable determination of calibration factors. In a second step, the calibration is verified by measurements of absorbed dose in various modulated Bragg peaks by comparing measured against calculated doses. The agreement between measured and calculated doses is usually better than 1% for homogeneous fields and the mean deviation for more inhomogeneous treatment fields, as they are used for patient treatments, is within 3%. It is proposed that the CoP in general, and in particular the IAEA TRS-398 should include explicit recommendations for the beam monitor calibration. These recommendations should then distinguish between systems using static and dynamic beams.

Algorithms↗

PubMed2002

Dosimetric characterization of a new miniature multileaf collimator.

The dosimetrical characteristics of a new miniature multileaf collimator (ModuLeaf MLC, MRC Systems GmbH, Heidelberg, Germany) attached to the accessory holder of a Siemens accelerator with 6 MV x-rays (PRIMUS, Siemens OCS, Concord, California, USA) have been investigated. In particular, those parameters which are important for the accuracy of the treatment such as output factors, penumbra, field edge precision and transmission/leakage were determined. These data can now be used to implement specific dose calculation procedures for this miniature multileaf collimator in treatment planning systems.

Humans↗

PubMed2001

Three-dimensional accuracy and interfractional reproducibility of patient fixation and positioning using a stereotactic head mask system.

PURPOSE: Conformal radiotherapy in the head and neck region requires precise and reproducible patient setup. The definition of safety margins around the clinical target volume has to take into account uncertainties of fixation and positioning. Data are presented to quantify the involved uncertainties for the system used. METHODS AND MATERIALS: Interfractional reproducibility of fixation and positioning of a target point in the brain was evaluated by biplanar films. 118 film pairs obtained at 52 fractions in 4 patients were analyzed. The setup was verified at the actual treatment table position by diagnostic X-ray units aligned to the isocenter and by a stereotactic X-ray localization technique. The stereotactic coordinates of the treated isocenter, of fiducials on the mask, and of implanted internal markers within the patient were measured to determine systematic and random errors. The data are corrected for uncertainty of the localization method. RESULTS: Displacements in target point positioning were 0.35 +/- 0.41 mm, 1.22 +/- 0.25 mm, and -0.74 +/- 0.32 mm in the x, y, and z direction, respectively. The reproducibility of the fixation of the patient's head within the mask was 0.48 mm (x), 0.67 mm (y), and 0.72 mm (z). Rotational uncertainties around an axis parallel to the x, y, and z axis were 0.72 degrees, 0.43 degrees, and 0.70 degrees, respectively. A simulation, based on the acquired data, yields a typical radial overall uncertainty for positioning and fixation of 1.80 +/- 0.60 mm. CONCLUSIONS: The applied setup technique showed to be highly reproducible. The data suggest that for the applied technique, a safety margin between clinical and planning target volume of 1-2 mm along one axis is sufficient for a target at the base of skull.

Algorithms↗

PubMed2001

Determination of tolerance dose uncertainties and optimal design of dose response experiments with small animal numbers.

BACKGROUND: Dose response experiments aim to determine the complication probability as a function of dose. Adjusting the parameters of the frequently used dose response model P(D) = 1/[1 + (D50/D)k] to the experimental data, 2 intuitive quantities are obtained: the tolerance dose D50 and the slope parameter k. For mathematical reasons, however, standard statistic software uses a different set of parameters. Therefore, the resulting fit parameters of the statistic software as well as their standard errors have to be transformed to obtain D50 and k as well as their standard errors. MATERIAL AND METHODS: The influence of the number of dose levels on the uncertainty of the fit parameters is studied by a simulation for a fixed number of animals. For experiments with small animal numbers, statistical artifacts may prevent the determination of the standard errors of the fit parameters. Consequences on the design of dose response experiments are investigated. RESULTS: Explicit formulas are presented, which allow to calculate the parameters D50 and k as well as their standard errors from the output of standard statistic software. The simulation shows, that the standard errors of the resulting parameters are independent of the number of dose levels, as long as the total number of animals involved in the experiment, remains constant. CONCLUSION: Statistical artifacts in experiments containing small animal numbers may be prevented by an adequate design of the experiment. For this, it is suggested to select a higher number of dose levels, rather than using a higher number of animals per dose level.

Animals↗

PubMed2001

A method for determining the alignment accuracy of the treatment table axis at an isocentric irradiation facility.

At an isocentric irradiation facility, the rotation axis of the treatment table has to be accurately aligned in vertical orientation to the isocentre, which is usually marked by three perpendicular laser planes. In particular, high precision radiotherapy techniques, such as radiosurgery or intensity modulated radiotherapy, require a higher alignment accuracy of the table axis than routinely specified by the manufacturers. A simple and efficient method is presented to measure the direction and the size of the displacement of the table axis from the isocentre as marked by the lasers. In addition, the inclination of the table axis against the vertical direction can be determined. The measured displacement and inclination provide the required data to correct for possible misalignments of the treatment table axis and to maintain its alignment. Measurements were performed over a period of two years for a treatment table located at the German heavy ion therapy facility. The mean radial distance between the table axis and the isocentre was found to be 0.25 +/- 0.25 mm. The mean inclination of the table axis in the XZ- and YZ-planes was measured to be -0.03 +/- 0.02 degrees and -0.04 +/- 0.01 degrees, respectively. The measurements demonstrate the good alignment of the treatment table over the analysed time period. The described method can be applied to any isocentric irradiation facility, especially including isocentric linear accelerators used for radiosurgery or other high precision irradiation techniques.

Algorithms↗

PubMed2001

Relation between carbon ion ranges and x-ray CT numbers.

Measurements of carbon ion ranges in various phantom materials and real bones are presented. Together with measured Hounsfield values, an empirical relation between ranges and Hounsfield units is derived, which is an important prerequisite for treatment planning in carbon ion therapy.

Animals↗

PubMed2000

Effective point of measurement of cylindrical ionization chambers for heavy charged particles.

Cylindrical ionization chambers are used for the determination of absorbed dose in beams of heavy charged particles, where the effective point of measurement, Peff (the point in depth to which the measured dose refers), is a priori not known. A measurement of Peff for a Farmer-type chamber in a carbon ion beam is presented. It is based on a comparison of relative depth dose curves measured with a cylindrical chamber and a plane-parallel Markus chamber. Both measurements were compared against another high-precision relative depth dose measurement using large-area plane-parallel chambers. For Peff, a value of 72 +/- 7% of the inner radius of the chamber is obtained. The relative depth dose curve for the cylindrical chamber is calculated using an averaging of the depth dose values over the curved inner surface of the active volume while taking account of the different depths of points on the inner surface. Within the measurement uncertainty of 0.2 mm the measurements agree well with the calculated Bragg curve for the Farmer chamber. The result for Peff is in correspondence with the value suggested in a new code of practice by the IAEA for protons and ions, and somewhat less than that suggested by Palmans for protons. The measurements show that cylindrical chambers are in general well suited for depth dose measurements in fields of heavy charged particles if the correct Peff is used.

Heavy Ions↗

PubMed2000

Quality management of medical physics issues at the German heavy ion therapy project.

For the commissioning and operation of the German Heavy Ion Therapy Project a quality assurance program was developed and successfully applied. The complete radiotherapy process using heavy ions was carefully analyzed and divided into three areas related to beam delivery and control, safety-interlock system and medical physics issues. In this paper, the medical physics issues are addressed. Since the irradiation with heavy ions is a nonstandard modality, new concepts and ion specific tests were developed. As far as possible, national and international standard specifications for radiotherapy were adopted. For each aspect, a performance characteristic and a corresponding acceptance test were introduced. In addition, test characteristics for the constancy tests were established. For all tests, intervention thresholds and test frequencies were specified. Using the described protocol of acceptance tests, the commissioning was passed successfully. The heavy ion irradiation facility was approved by the governmental authorities on the basis of these test results. During clinical operation, constancy tests are performed at the beginning of each treatment period, in order to maintain the quality found during the acceptance tests. Up to now, 48 patients have been treated within 6 treatment periods of 4 weeks each. The concepts used and the tests developed for the quality assurance program may serve as an example of how to introduce systematically a quality assurance program for a new treatment modality.

Brain Neoplasms↗

PubMed2000

Quality assurance for a treatment planning system in scanned ion beam therapy.

Conformal radiation therapy using dynamic beam delivery systems like scanned ion beams requires concise quality assurance procedures for the complete treatment planning process. For the heavy ion therapy facility at GSI, Darmstadt, a quality assurance program for the treatment planning system (TPS) has been developed. It covers the development and updating of software, data protection and safety, and the application of soft- and hardware. The tests also apply to the geometrical precision of imaging devices and the geometrical and dosimetrical verification of dose distributions in different phantoms. The quality assurance program addresses acceptance and constancy tests of the treatment planning program. Results of the acceptance tests served as a basis for its governmental approval. Two main results of the acceptance tests are representative for the overall performance of the system. (1) The geometrical uncertainty that could be achieved for the target point definition, setup accuracy, field contouring, and field alignment is typically 1.5 mm. The uncertainty for the setup verification using digitally reconstructed radiographs (DRR's) is limited to 2 mm. (2) The mean deviations between measured and planned dose values is 3% for standardized cases in a water phantom and up to 6% for more complicated treatment configurations.

Dose-Response Relationship, Radiation↗

PubMed1999

Treatment planning for the heavy-ion facility at GSI.

A new treatment planning program was developed for the heavy-ion therapy facility at GSI. In addition, a concise quality standard for treatment planning has been set up. It covers acceptance and constancy checks of all critical aspects in treatment planning. Dose verification measurements done during the commissioning phase show an overall good agreement with the treatment planning calculations.

Algorithms↗

PubMed1999

Determination of water absorbed dose in a carbon ion beam using thimble ionization chambers.

The method to measure absorbed dose to water in a field of carbon ions as applied for the heavy ion therapy project at the Heavy Ion Research Laboratory in Darmstadt (GSI), Germany, is described in detail. Thimble ionization chambers with a water absorbed calibration factor are applied. The dose obtained with this method was compared with that obtained at the heavy ion therapy facility HIMAC at the National Institute of Radiological Sciences in Chiba, Japan, using the Japanese code of practice. The agreement found was better than 1%. The combined uncertainty of the determination of absorbed dose to water was estimated to amount to 5%.

Air↗

PubMed1999

A system for three-dimensional dosimetric verification of treatment plans in intensity-modulated radiotherapy with heavy ions.

The introduction of dynamic intensity modulation into radiotherapy using conventional photon beams or scanning particle beams requires additional and efficient methods of dose verification. Dose measurements in dynamically generated dose distributions with a single ionization chamber require a complete application of the treatment field for each single measurement. Therefore measurements are performed by simultaneous use of multiple ionization chambers. The measurement is performed by a computer controlled system and is comprised of the following steps: (a) automated positioning of the ionization chambers, (b) measurement at these points, (c) a comparison with the calculated dose from the treatment planning system, and (d) documentation of the measurement. The ionization chambers are read out by a multichannel electrometer and are densely packed into a mounting of polymethylmetacrylate, which is attached to the arm of a three-dimensional motor-driven water phantom. The measured and planned dose values are displayed numerically as well as graphically. The mean deviation between measured and planned doses as well as their standard deviation are calculated and displayed. Through printouts complete documentation of the measurement is obtained and a quick decision can be made whether the dose distribution is acceptable for the patient. The system is now routinely used for dose verification at the heavy ion therapy project at the Gesellschaft für Schwerionenforschung in Darmstadt. Up to now 242 measurements have been performed for heavy ion treatment of 30 patients. The system allows efficient verification and documentation of carbon ion fields and is in principle also applicable to intensity-modulated photon beams.

Bone Neoplasms↗

PubMed1998

Carbon beam dosimetry intercomparison at HIMAC.

To verify international uniformity in carbon beam dosimetry, an intercomparison programme was carried out at the heavy ion medical accelerator (HIMAC). Dose measurements with ionization chambers were performed for both unmodulated and 6 cm modulated 290 MeV/nucleon carbon beams. Although two different dosimetry procedures were employed, the evaluated values of absorbed dose were in good agreement. This comparison established a common framework for ionization chamber dosimetry between two different carbon beam therapy facilities.

Carbon↗

PubMed1997

Dose-response relationship for late functional changes in the rat brain after radiosurgery evaluated by magnetic resonance imaging.

PURPOSE: Only few quantitative data are available on late effects in the healthy brain after radiosurgery. An animal model can contribute to systematically investigate such late effects. Therefore, a model applying radiosurgery at the rat brain was established. A long-term (19 months) follow up study with 66 animals after radiosurgery was carried out. METHODS AND MATERIALS: In 60 animals, an area in the frontal lobe of the brain was irradiated stereotactically with a 15 MV linac. Different doses of 20, 30, 40, 50, and 100 Gy with two field sizes (3.9 and 5.9 mm collimator) were selected, using the integrated logistic formula with input parameters from human brain. The induced alteration of the blood-brain barrier permeability was investigated by means of contrast enhanced magnetic resonance imaging. RESULTS: A first intracranial signal enhancement was observed in one animal 160 days after irradiation with 100 Gy. Beginning at 5 months all animals in the two 100 Gy groups homogeneously showed contrast enhancement, but none of the other groups. This remained until 13 months after irradiation. The volume of contrast enhancement as well as the increase of signal intensity were different between the two 100 Gy groups. After 19 months, the animals irradiated with lower doses also showed contrast enhancements, although not uniformly throughout one group. A maximum likelihood fit of the logistic formula P(D) = 1/[1 + (D50/D)k] to the incidence of late effects for the 5.9 mm collimator at 19 months after irradiation results in the parameters D50 = 37.4(-5.2,+6.1) Gy and k = 4.7 +/- 2.4. CONCLUSIONS: An animal model was established to study late normal brain tissue response. The observed late effects appeared very similar to the estimation of the integrated logistic formula for human brain. Based on these radiosurgery techniques, future experiments will focus on modifications in the irradiation modalities, i.e., irregular volumes, radiation quality or fractionation.

Animals↗

PubMed1996

Stereotactic radiosurgery of the rat dunning R3327-AT1 prostate tumor.

PURPOSE: Stereotactic radiosurgery (RS) is being used increasingly for the treatment of small benign and malignant lesions, particularly in the brain. However, to fully realize the potential of this technique, more experimental data are needed. In this report we describe an RS technique suitable for small animals, and present the results obtained with different irradiation doses and volumes given to a rat prostate tumor. METHODS AND MATERIALS: Single doses of RS were administered to the Dunning prostate R3327-AT1 carcinoma transplanted subcutaneously into the thigh of male Copenhagen rats. The tumors (approximately 5 mm in diameter) were localized within a stereotactic frame and irradiated at a linac facility (15 MV) with single doses of 15.3, 30.6, 46.0, 61.3, or 76.6 Gy at the 80% isodose level using narrow beams from 3- and 5-mm collimators (80% isodose field size of 5 or 8.5 mm, respectively) and a six-arc irradiation technique. Tumor size was measured three times a week (Mondays, Wednesdays, and Fridays). Conventional stains were used to examine the histologic status of the tumors. To evaluate the proliferative response of the tumors to RS and assess the prevalence and spatial distribution of proliferating cells, tissue slices were stained with the proliferation markers 5-bromo-2'- deoxyuridine and proliferating cell nuclear antigen 4 and 8 h, and 4, 8, 12, and 210 days after stereotactic irradiation with a dose of 61.3 Gy. RESULTS: The extent of growth delay and local tumor control depended on the radiation dose, the field size, and the accuracy of irradiation. Local control at day 100 ranged from two of eight rats at 30.6 Gy, five of seven rats at 61.3 Gy, and six of seven at 76.6 Gy. No overt side effects in the surrounding tissues was observed. After 61.3 Gy, the immunohistochemical staining revealed a rapid decrease of proliferative active tumor cells after irradiation. The irradiated tumor tissue was gradually replaced by connective tissue. However, in one persistent nodule, a few proliferative cells were detected even after 200 days. CONCLUSION: A radiosurgical technique was successfully developed for a small animal system. The technique was concluded to be reproducible and suitable for future use in single and fractionated treatment regimens.

Adenocarcinoma↗

PubMed1995

A system for stereotactic irradiation and magnetic resonance evaluations in the rat brain.

PURPOSE: A stereotactic fixation and localization device developed for small animal stereotactic radiosurgery is described. METHODS AND MATERIALS: Irradiated volumes of spherical shape down to 1.7 mm in diameter at the 80% isodose level are attainable. The fixation device can also be used for magnetic resonance imaging (MRI) and allows target localization during magnetic resonance (MR) image content measurement. The capabilities of the entire system were investigated using a phantom that permitted measurement and localization of the three-dimensional dose distribution. Localization of target isocenter coordinates in MR images was also checked with the phantom. RESULTS: An overall spatial error of about 1 mm for subsequent stereotactic irradiation was obtained. CONCLUSIONS: The accuracy of the fixation and localization techniques is adequate to investigate radiation-induced changes in the rat brain.

Animals↗

PubMed1994

Precision and accuracy of stereotactic convergent beam irradiations from a linear accelerator.

PURPOSE: The accuracy and the precision for radiosurgery procedures at linear accelerator facilities were investigated. METHODS AND MATERIALS: The technique of convergent beam irradiation, that is a series of successive isocentric arc irradiations, is specifically considered in this paper. Accuracy and precision depend on a sequence of methods and equipment among which localization of the target, patient alignment, and the dose delivery are the most critical steps. The purpose of the investigation was to quantitatively assess their contribution to the overall accuracy. The definitions and methods used to quantify and control accuracy are described. Measurements were carried out at a phantom to analyze the localization and positioning errors. Errors which may occur with the dose delivery technique were studied by a computer simulation. RESULTS: The calculations showed that these errors are not the main contributors to the overall accuracy as long as the linac inaccuracies are in the order or less than 1 mm. The accuracy found in the localization and positioning methods was less than 1 mm. CONCLUSION: It was concluded that an overall accuracy in the order of 1 mm can be obtained also under routine conditions. The great importance of adequate quality control is emphasized.

Humans↗

PubMed1994

Quality assurance programme on stereotactic radiosurgery.

In order to achieve a high level of quality in radiosurgical procedures, a quality assurance programme (QAP) has to be worked out. An informal "Quality Assurance Task Group" is currently preparing a QAP for that purpose. The concepts that have been worked out and critically discussed by the members of the task group are presented. The final version of the QAP is expected to be completed at the end of 1993.

Humans↗