PubMed · 4059924
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F von Hippel. 1985-11-29. Lethal radiation dose.. https://doi.org/10.1126/science.230.4729.992-b
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PURPOSE: To develop a method of analyzing rectal surface area irradiated and rectal complications in prostate conformal radiotherapy. METHODS AND MATERIALS: Dose-surface histograms of the rectum, which state the rectal surface area irradiated to any given dose, were calculated for a group of 27 patients treated with a four-field box technique to a total (tumor minimum) dose ranging from 68 to 70 Gy. Occurrences of rectal toxicities as defined by the Radiation Therapy Oncology Group (RTOG) were recorded and examined in terms of dose and rectal surface area irradiated. For a specified end point of rectal complication, the complication probability was analyzed as a function of dose irradiated to a fixed rectal area, and as a function of area receiving a fixed dose. Lyman's model of normal tissue complication probability (NTCP) was used to fit the data. RESULTS: The observed occurrences of rectal complications appear to depend on the rectal surface area irradiated to a given dose level. The patient distribution of each toxicity grade exhibits a maximum as a function of percentage surface area irradiated, and the maximum moves to higher values of percentage surface area as the toxicity grade increases. The dependence of the NTCP for the specified end point on dose and percentage surface area irradiated was fitted to Lyman's NTCP model with a set of parameters. The curvature of the NTCP as a function of the surface area suggests that the rectum is a parallel structured organ. CONCLUSIONS: The described method of analyzing rectal surface area irradiated yields interesting insight into understanding rectal complications in prostate conformal radiotherapy. Application of the method to a larger patient data set has the potential to facilitate the construction of a full dose-surface-complication relationship, which would be most useful in guiding clinical practice.
PURPOSE: To study a procedure that uses megavoltage digitally reconstructed radiographs (DRRs) calculated from patient's three-dimensional (3D) computed tomography (CT) data as a reference image for correlation with on-line electronic portal images (EPIs) to detect patient setup errors. METHODS AND MATERIALS: Megavoltage DRRs were generated by ray tracing through a modified volumetric CT data set in which CT numbers were converted into linear attenuation coefficients for the therapeutic beam energy. The DRR transmission image was transformed to the grayscale window of the EPI by a histogram-matching technique. An alternative approach was to calibrate the transmission DRR using a measured response curve of the electronic portal imaging device (EPID). This forces the calculated transmission fluence values to be distributed in the same range as that of the EPID image. A cross-correlation technique was used to determine the degree of alignment of the patient anatomy found in the EPID image relative to the reference DRR. RESULTS: Phantom studies demonstrated that the correlation procedure had a standard deviation of 0.5 mm and 0.5 degrees in aligning translational shifts and in-plane rotations. Systematic errors were found between a reference DRR and a reference EPID image. The automated grayscale image-correlation process was completed within 3 s on a workstation computer or 12 s on a PC. CONCLUSION: The alignment procedure allows the direct comparison of a patient's treatment portal designed with a 3D planning computer with a patient's on-line portal image acquired at the treatment unit. The image registration process is automated to the extent that it requires minimal user intervention, and it is fast and accurate enough for on-line clinical applications.
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