On-line portal imaging: contributions and limitations in clinical practice.
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Humans↗
Biomedical subjects
S Shalev
Publications and source records attributed to S Shalev.
Progress in the evaluation of electronic portal imaging--taking one step at a time.
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Humans↗
Thick phosphor screens for on-line portal imaging.
Gd2O2S phosphor screens between 250 and 1000 mg/cm2 thick were evaluated for use in megavoltage imaging systems. The phosphor layers were placed on brass plates ranging from 1 to 5 mm thick, each with and without an optical back reflector (white paint). Light output and spatial resolution were measured at 6- and 23-MV x-ray energies. Light output was found to increase linearly with phosphor thickness up to 500 mg/cm2, reaching a plateau at 1000 mg/cm2. Spatial resolution [modulation transfer function (MTF)] decreased exponentially with phosphor thickness up to 750 mg/cm2, where a minimum was reached. The variation of MTF with phosphor thickness was found to obey a simple empirical relation.
Gadolinium↗
Optimization of metal/phosphor screens for on-line portal imaging.
Studies were conducted to determine the optimal metal/phosphor screen for on-line video verification of radiation treatment portals. Screens were evaluated for luminance and spatial resolution as a function of composition and thickness at 6- and 23-MV x-ray energies. A new video technique was used to determine modulation transfer functions. Gd2O2S was found to be the most efficient (brightest) phosphor for this application. Luminance was found to vary linearly with phosphor thickness up to a thickness of 500 mg/cm2. Metal plates made of iron, brass, copper, lead, and sintered tungsten of various thicknesses were also tested for luminance and resolution with Gd2O2S phosphor. Brightness peaked at about 2-mm thickness for most metals. Significant contributions to the brightness were found to come from x rays interacting with the phosphor itself.
Evaluation Studies as Topic↗
Pseudocorrelation: a fast, robust, absolute, grey-level image alignment algorithm.
A new image alignment algorithm--pseudocorrelation--has been developed based on the application of Monte Carlo techniques to the calculation of a cross-correlation integral for grey-scale images. It has many advantages over cross-correlation: it is at least a factor of 10 faster than fast-Fourier-transform-based cross-correlation, and requires 8 times less memory. Its high speed allows for the search space of geometric transformations between images to include magnification and rotation as well as translations without the search time becoming too long. It allows noise to be taken into account, making calculation of a robust, absolute probability of good alignment possible. It is relatively insensitive to differences in quality between images. This article describes the pseudocorrelation algorithm in detail and presents the results of tests of the effects of contrast enhancement, resolution differences, and noise on the algorithm's performance. These tests show that the algorithm is well suited to the task of automated alignment of very low contrast images from video electronic portal imaging devices.
Algorithms↗
Noise analysis in real-time portal imaging. I. Quantization noise.
The limit at which quantization noise becomes dominant in video-based real-time portal imaging has been studied. Quantization noise due to truncation in integer frame averaging is shown to be dominant over the input analog-to-digital converter (A/D) quantization noise, unless image addition is used in video-based real-time portal imaging systems. Portal images acquired with the Newvicon camera by averaging more than 64 frames are found to be dominated by the quantization noise due to truncation. It has shown that the signal-to-noise ratio (SNR) is limited to 886.8 when using an 8-bit A/D with digital frame averaging, but higher values can be achieved with digital frame addition. It is also shown that digital frame addition together with 16-bit processing can achieve higher contrast resolution than digital frame averaging and 8-bit processing.
Gadolinium↗
The objective evaluation of alternative treatment plans. III: The quantitative analysis of dose volume histograms.
The computer program OSCAR evaluates dose-volume histograms in a consistent way for use in 3-dimensional treatment planning. Based on a dose prescription specified by a radiation oncologist, the technique provides a quantitative and easily understood visual analysis of a proposed dose distribution. Rapid, reliable, and consistent choices can be made between alternative treatment plans, and if necessary the results of OSCAR calculations can be used to guide the design of a plan that will be closer to the required prescription. The method is well suited to use in the definition of treatment protocols. The use of OSCAR is demonstrated by applying it to the evaluation of alternative volumetric treatment plans for ca lung. The results demonstrate the importance of using corrections for inhomogeneous tissue density in the calculation of 3-dimensional dose distributions.
Computer Graphics↗
The objective evaluation of alternative treatment plans: II. Score functions.
A series of six patients with adenocarcinoma of the prostate, Stages A2, B1, or B2, were planned for treatment using a four-field box technique at 25 MV. Plans were prepared by three techniques: composite, mid-plane, and conformal. The dose distributions at the central plane and at two planes offset by +/- 2 cm were evaluated by means of score functions which quantify the magnitude of regret for target dose gradient, target over- and under-dose, non-target tissue overdose, and for overdose to the rectum, bladder, and femoral heads. The score functions are normalized to give values in the range from 10 (ideal) to zero (limit of acceptability), with negative values indicating unacceptable deviations from the prescribed dose limits. The scores for off-axis conformal plans were found to be essentially the same as for mid-plane plans on the central plane. However, mid-plane planning was shown to be totally inadequate for off-axis planes, where the average target gradient and underdose scores were reduced by 10 units. Composite planning resulted in adequate target coverage on all planes, but at the expense of unacceptable overdose to non-target tissue. The effect of reducing the posterior beam weight to half that of the other three beams was to reduce the target gradient score by 1.6 +/- 0.5 units and to increase the rectal score by 0.9 +/- 0.3 units.
Adenocarcinoma↗
Treatment planning for protocol-based radiation therapy.
Many protocol studies are conducted in which patients are assigned to alternative treatment regimens. Typically the dosimetric specifications will define the maximal and minimal target doses and maximal doses to specified critical normal structures, and the success of the study will depend upon the consistency and reliability with which these dose specifications are applied. We have investigated the use of dose-area histograms to ensure complete adherence to protocol dose specifications. A dose prescription is prepared that defines upper and lower target doses as well as normal tissue dose tolerance levels for all organs of interest. In addition, dose-volume histograms are derived which provide quantitative measures of the extent to which each dose limit has been met. This technique can be used during treatment planning to prevent protocol violations of pre-defined severity, or for retroactive correlation of local tumor recurrence and treatment-related morbidity with dose levels in the target and normal tissues. An example is presented for a protocol study of ca prostate, stages A and B, in which seven treatments were evaluated at the mid-plane for protocol violations.
Clinical Trials as Topic↗
An adaptive technique for digital noise suppression in on-line portal imaging.
Two complementary approaches to the noise suppression problem in on-line portal imaging have been analysed. Temporal filtering by image summation can substantially reduce the amount of noise in an image. In many cases, however, movements of the patient or the radiation source limit the time period over which the averaging can be done. Any remaining noise has to be dealt with by applying spatial filtering. The adaptive Lee filter is particularly suitable for portal imaging applications. It preserves a crisp definition of edges while removing noise in flat regions of the image. It can be used to obtain images of satisfactory quality with short radiation exposure of the patient. We have proposed a modification to the basic Lee technique which permits the calculation of the noise variance locally by utilising the information contained in intermediate images acquired during frame averaging. Unlike the original Lee formulation, no a priori knowledge of the noise variance is required, and in contrast to Mastin's approach (Mastin 1985), the variance may vary with position in the image. The tests of performance of the modified Lee filter, carried out using on-line images, have shown its superiority in comparison with the original Lee technique as well as with conventional averaging and median filters.
Filtration↗
Digital contrast enhancement for online portal imaging.
Seven digital contrast enhancement algorithms were implemented and evaluated for application to images obtained with an online video portal imaging system. An objective quantitative comparison shows that superior contrast enhancement is obtained using histogram modification techniques. Additional tests made on an image of a humanoid phantom indicate that local (adaptive) histogram modification methods can produce a better contrast in detail than their global counterparts, if the original image is nonuniform in intensity.
Algorithms↗
The objective evaluation of alternative treatment plans: I. Images of regret.
An innovative approach to treatment planning is described in which a planned dose distribution is evaluated in terms of prescribed limits of acceptability, and any discrepancies (referred to as "regions of regret") are displayed in the form of a contour diagram in which colors are used to represent different types and degrees of regret. A commercial treatment planning system has been modified to display images of regret in addition to conventional isodose plots, and is used for the comparison of alternative plans in terms of adequate target coverage and minimal irradiation of sensitive organs. Required tumor dose levels and organ-specific tolerance doses are prepared in advance by the clinician for each site and stored in a prescription file for use in the planning process. The method is found to expedite the optimization procedure, is objective and reproducible, and provides clear documentation of the selection process.
Computer Graphics↗
Treatment planning using images of regret.
The lack of well-defined criteria for evaluating alternative treatment plans introduces a degree of subjectivity into the planning process. The complexity of conventional isodose charts causes further difficulty in making rapid and reliable evaluations of a plan. An objective method is described, using a prescription file to define the clinician's requirements in terms of the area of each organ which may be treated to predefined tolerance doses. The computer program OSCAR then compares the predicted dose distribution with the prescribed limits, and displays regions of noncompliance as colored "areas of regret." In addition, score functions are used to provide a quantitative measure of the acceptability of dose distributions within the target and each organ at risk. An example is described in which a plan for the treatment of ca esophagus is evaluated using both images of regret and score functions.
Esophageal Neoplasms↗
Three dimensional craniofacial imaging.
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Face↗
Colour visualization as an aid to the comparison of treatment plans for prostatic carcinoma.
The conventional treatment plan is usually presented as a longitudinal set of axial cross-sections showing the patient contour and selected anatomical features, together with a set of isodose lines. It is difficult to interpret the correlation between dose, target and organs at risk, and the comparison of several plans is time-consuming and highly subjective. This procedure has been improved by modifying a treatment planning system to provide 'images of regret', in which regions are shown in appropriate colour if the planned dose distribution is at variance with prescribed conditions defining limits of acceptability. The method has been used for planning treatment for localized prostatic cancer, and found to be useful for the rapid selection of the optimal treatment plan from a set of alternatives.
Adenocarcinoma↗