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Analysis and convergence of the iterative convolution/superposition dose reconstruction technique for multiple treatment beams and tomotherapy.

An iterative convolution/superposition (C/S) algorithm has been created to reconstruct dose distributions in patients from exit dose measurements during a radiotherapy treatment. The method is based on an extended phantom which includes the patient CT representation and an electronic portal imaging device (EPID). The patient CT is assumed to be a true and rigid representation of the patient at the time of treatment. The C/S method computes the dose throughout the extended phantom which allows the exit dose to be predicted in the EPID. The process is then reversed to take the exit dose measurement and infer what the dose distribution must have been to produce the measured exit dose. The dose distribution is modeled without knowledge of the incident intensity distribution, and includes the effects of scatter in the computation. The iterative method begins by assuming that the exit primary energy fluence (PEF) is equal to the exit dose, the PEF is then backprojected through the extended phantom and superposed with the dose deposition kernel to determine a new prediction of the exit dose. The ratio of the computed PEF to exit dose is then multiplied by the measured exit dose image to produce a better representation of the exit PEF. Successive iterations then converge to the exit PEF image that would produce the measured exit dose image. Once convergence is established, the dose distribution is determined by backprojecting the exit PEF followed by superposition with the dose deposition kernel. The method is used to reconstruct the dose from a stimulated dynamic wedge and verified with film. Convergence and termination of the algorithm is then investigated with no noise and in the presence of noise. The method is then expanded to handle multiple treatment beams by separating the representation of the EPID from the patient or phantom representation in the computation process. Investigation of the effects of noise during the process of iterative dose reconstruction is necessary to understand the capabilities of the algorithm using exit dose images that may contain significant amounts of noise. The capability of the algorithm is evaluated for multiple field treatments to a cube phantom and a prostate patient CT representation in the presence of noise. The method is then used to simulate the dose reconstruction process for tomotherapy using 72 intensity-modulated fan beams. Dose reconstruction is shown to be capable of verifying the dose distributions in patients including multiple beams and dynamic collimation, provided the patient CT is known at the time of treatment.

Algorithms↗

Why should we do environmental dose reconstructions?

Environmental dose reconstructions are being conducted at many nuclear weapons production and testing sites in the United States. These projects involve reconstructing potential radiation exposures and doses from past releases of radionuclides to people who lived near nuclear facilities where these releases occurred. The results of dose reconstructions can be used as the basis for deciding if epidemiologic studies or other public health activities should be undertaken. In addition, the results of dose reconstruction can be used in other risk assessment activities, such as those associated with environmental restoration and radioactive waste management. For example, the historical inventory of hazardous materials used and potentially released at the site can be used to begin to assess the risk for exposures from current and future activities. The site-specific environmental dosimetry methods developed for dose-reconstruction purposes are applicable to other environmental risk assessments performed for that site. These and other benefits of environmental dose reconstructions are discussed.

Environmental Exposure↗

On the accuracy and effectiveness of dose reconstruction for tomotherapy.

Dose reconstruction is a process that re-creates the treatment-time dose deposited in a patient provided there is knowledge of the delivered energy fluence and the patient's anatomy at the time of treatment. A method for reconstructing dose is presented. The process starts with delivery verification, in which the incident energy fluence from a treatment is computed using the exit detector signal and a transfer matrix to convert the detector signal to energy fluence. With the verified energy fluence and a CT image of the patient in the treatment position, the treatment-time dose distribution is computed using any model-based algorithm such as convolution/superposition or Monte Carlo. The accuracy of dose reconstruction and the ability of the process to reveal delivery errors are presented. Regarding accuracy, a reconstructed dose distribution was compared with a measured film distribution for a simulated breast treatment carried out on a thorax phantom. It was found that the reconstructed dose distribution agreed well with the dose distribution measured using film: the majority of the voxels were within the low and high dose-gradient tolerances of 3% and 3 mm respectively. Concerning delivery errors, it was found that errors associated with the accelerator, the multileaf collimator and patient positioning might be detected in the verified energy fluence and are readily apparent in the reconstructed dose. For the cases in which errors appear in the reconstructed dose, the possibility for adaptive radiotherapy is discussed.

Algorithms↗

Mayak worker study: an improved biokinetic model for reconstructing doses from internally deposited plutonium.

The plutonium production facility known as the Mayak Production Association was put into operation in June 1948. A high incidence of cancer in the Mayak workers has been related to the level of exposure to plutonium, but uncertainties in tissue doses have hampered development of dose-risk relationships. As part of an effort to improve dose estimates for these workers, the systemic biokinetic model for plutonium currently recommended by the International Commission on Radiological Protection (ICRP) has been modified to reflect recently developed data and facilitate interpretation of case-specific information. This paper describes the proposed model and discusses its implications for dose reconstruction for the Mayak workers.

Bone and Bones↗

Technical note: reconstructing dose distributions from manually planned electron boosts in breast radiotherapy.

PURPOSE: In breast radiotherapy, delivery of manually-calculated electron boosts limits retrospective dose-response analyses as dose distribution is unavailable. This work evaluates the feasibility of reconstructing dose distributions from manually planned electron boosts in breast-conserving radiotherapy. METHODS: Only 72 out of 198 breast cancer patients had complete stored dose distributions from sequential electron boosts in the REQUITE study. Arbitrary data from 70/72 patients were used to develop and validate dose reconstruction method. Twenty patients were used to determine optimal parameters for Monte-Carlo-based (MC) electron dose reconstruction on RayStation (v.11B-R), considering CT-calibration curve, MC-history number, andcalculation grid resolution. Remaining 50 patients were used to quantify dose reconstruction accuracy. The similarity between reconstructed and stored dose was evaluated using 3D-gamma index and dosimetric parameters extracted from breast and tumour bed contours. Dose difference location was evaluated using dose-location histogram. RESULTS: Calculation grid resolution significantly impacted electron dose distribution (p&#xa0;<&#xa0;0.01), where the finest grid (0.15&#xa0;cm) showed highest similarity to stored doses. CT-calibration curve and MC-history number had a negligible influence on dose reconstruction. Dosimetric difference between reconstructed and stored doses was&#xa0;<&#xa0;1&#xa0;Gy for breast and tumour bed. Reconstructed dose was achieved&#xa0;>&#xa0;90% gamma passing rate in the validation set. However, around 2.5&#xa0;Gy dose differences were observed at the skin and tissue interface regions. CONCLUSIONS: Retrospective electron boost dose reconstruction is feasible with acceptable accuracy, and could increase data completeness in large cohort studies. Caution is advised when assessing dose near tissue interface and further validation is needed outside the REQUITE dataset.

Electrons↗

A method for deconvolution of integrated electronic portal images to obtain incident fluence for dose reconstruction.

A method to convert integrated electronic portal imaging device (EPID) images to fluence for the purpose of reconstructing the dose to a phantom is investigated here for simple open fields. Ultimately, the goal is to develop a method to reconstruct the dose to patients. The EPID images are transformed into incident intensity fluence by spatial filtering with a deconvolution kernel. The kernel uses a general mathematical form derived from a Monte Carlo calculation of the point spread function of an EPID. The deconvolution kernel is fitted using a downhill search algorithm that minimizes the difference between the reconstructed dose and the dose measured in water. The beam profile "horns" that are removed by the EPID calibration procedure are restored to the resulting images by direct multiplication using the measured in-air off-axis ratio. Applying the fitted kernel to an EPID image provides the incident fluence for that beam. This beam fluence is then entered into an independent dose calculation algorithm for phantom or patient dose reconstruction. The phantom dose was computed to an accuracy of 2.0% of the dmax dose at one standard deviation. The method is general and can possibly be applied to any EPID equipped with an integration mode. We demonstrate the application of the fitted kernel in two clinical IMRT cases.

Algorithms↗

A Monte Carlo based three-dimensional dose reconstruction method derived from portal dose images.

The verification of intensity-modulated radiation therapy (IMRT) is necessary for adequate quality control of the treatment. Pretreatment verification may trace the possible differences between the planned dose and the actual dose delivered to the patient. To estimate the impact of differences between planned and delivered photon beams, a three-dimensional (3-D) dose verification method has been developed that reconstructs the dose inside a phantom. The pretreatment procedure is based on portal dose images measured with an electronic portal imaging device (EPID) of the separate beams, without the phantom in the beam and a 3-D dose calculation engine based on the Monte Carlo calculation. Measured gray scale portal images are converted into portal dose images. From these images the lateral scattered dose in the EPID is subtracted and the image is converted into energy fluence. Subsequently, a phase-space distribution is sampled from the energy fluence and a 3-D dose calculation in a phantom is started based on a Monte Carlo dose engine. The reconstruction model is compared to film and ionization chamber measurements for various field sizes. The reconstruction algorithm is also tested for an IMRT plan using 10 MV photons delivered to a phantom and measured using films at several depths in the phantom. Depth dose curves for both 6 and 10 MV photons are reconstructed with a maximum error generally smaller than 1% at depths larger than the buildup region, and smaller than 2% for the off-axis profiles, excluding the penumbra region. The absolute dose values are reconstructed to within 1.5% for square field sizes ranging from 5 to 20 cm width. For the IMRT plan, the dose was reconstructed and compared to the dose distribution with film using the gamma evaluation, with a 3% and 3 mm criterion. 99% of the pixels inside the irradiated field had a gamma value smaller than one. The absolute dose at the isocenter agreed to within 1% with the dose measured with an ionization chamber. It can be concluded that our new dose reconstruction algorithm is able to reconstruct the 3-D dose distribution in phantoms with a high accuracy. This result is obtained by combining portal dose images measured prior to treatment with an accurate dose calculation engine.

Algorithms↗

Three-dimensional portal image-based dose reconstruction in a virtual phantom for rapid evaluation of IMRT plans.

A new method for rapid evaluation of intensity modulated radiation therapy (IMRT) plans has been developed, using portal images for reconstruction of the dose delivered to a virtual three-dimensional (3D) phantom. This technique can replace an array of less complete but more time-consuming measurements. A reference dose calculation is first created by transferring an IMRT plan to a cylindrical phantom, retaining the treatment gantry angles. The isocenter of the fields is placed on or near the phantom axis. This geometry preserves the relative locations of high and low dose regions and has the required symmetry for the dose reconstruction. An electronic portal image (EPI) is acquired for each field, representing the dose in the midplane of a virtual phantom. The image is convolved with a kernel to correct for the lack of scatter, replicating the effect of the cylindrical phantom surrounding the dose plane. This avoids the need to calculate fluence. Images are calibrated to a reference field that delivers a known dose to the isocenter of this phantom. The 3D dose matrix is reconstructed by attenuation and divergence corrections and summed to create a dose matrix (PI-dose) on the same grid spacing as the reference calculation. Comparison of the two distributions is performed with a gradient-weighted 3D dose difference based on dose and position tolerances. Because of its inherent simplicity, the technique is optimally suited for detecting clinically significant variances from a planned dose distribution, rather than for use in the validation of IMRT algorithms. An analysis of differences between PI-dose and calculation, delta PI, compared to differences between conventional quality assurance (QA) and calculation, delta CQ, was performed retrospectively for 20 clinical IMRT cases. PI-dose differences at the isocenter were in good agreement with ionization chamber differences (mean delta PI = -0.8%, standard deviation sigma = 1.5%, against delta CQ = 0.3%, sigma = 1.0%, respectively). PI-dose plane differences had significantly less variance than film plane differences (sigma = 1.1 and 2.1%, respectively). Twenty-two further cases were evaluated using 3D EPI-dosimetry alone. The mean difference delta over volumes with doses above 80% of the isocenter value was delta = -0.3%, sigma(delta) = 0.7%, and standard deviations of the distributions ranged from 1.0 to 2.0%. Verification time per plan, from initial calculation, delivery, dose reconstruction to evaluation, takes less than 1.5 h and is more than four times faster than conventional QA.

Algorithms↗

IMRT verification by three-dimensional dose reconstruction from portal beam measurements.

A method of reconstructing three-dimensional, in vivo dose distributions delivered by intensity-modulated radiotherapy (IMRT) is presented. A proof-of-principle experiment is described where an inverse-planned IMRT treatment is delivered to an anthropomorphic phantom. The exact position of the phantom at the time of treatment is measured by acquiring megavoltage CT data with the treatment beam and a research prototype, flat-panel, electronic portal imaging device. Immediately following CT imaging, the planned IMRT beams are delivered using the multiple-static field technique. The delivered fluence is sampled using the same detector as for the CT data. The signal measured by the portal imaging device is converted to primary fluence using an iterative phantom-scatter estimation technique. This primary fluence is back-projected through the previously acquired megavoltage CT model of the phantom, with inverse attenuation correction, to yield an input fluence map. The input fluence maps are used to calculate a "reconstructed" dose distribution using the same convolution/superposition algorithm as for the original planning dose calculation. Both relative and absolute dose reconstructions are shown. For the relative measurements, individual beam weights are taken from measurements but the total dose is normalized at the reference point. The absolute dose reconstructions do not use any dosimetric information from the original plan. Planned and reconstructed dose distributions are compared, with the reconstructed relative dose distribution also being compared to film measurements.

Feasibility Studies↗

A feasible method for clinical delivery verification and dose reconstruction in tomotherapy.

Delivery verification is the process in which the energy fluence delivered during a treatment is verified. This verified energy fluence can be used in conjunction with an image in the treatment position to reconstruct the full three-dimensional dose deposited. A method for delivery verification that utilizes a measured database of detector signal is described in this work. This database is a function of two parameters, radiological path-length and detector-to-phantom distance, both of which are computed from a CT image taken at the time of delivery. Such a database was generated and used to perform delivery verification and dose reconstruction. Two experiments were conducted: a simulated prostate delivery on an inhomogeneous abdominal phantom, and a nasopharyngeal delivery on a dog cadaver. For both cases, it was found that the verified fluence and dose results using the database approach agreed very well with those using previously developed and proven techniques. Delivery verification with a measured database and CT image at the time of treatment is an accurate procedure for tomotherapy. The database eliminates the need for any patient-specific, pre- or post-treatment measurements. Moreover, such an approach creates an opportunity for accurate, real-time delivery verification and dose reconstruction given fast image reconstruction and dose computation tools.

Animals↗

Hanford Environmental Dose Reconstruction Project--an overview.

The Hanford Environmental Dose Reconstruction Project was initiated because of public interest in the historical releases of radioactive materials from the Hanford Site, located in southcentral Washington State. By 1986, over 38,000 pages of environmental monitoring documentation from the early years of Hanford operations had been released. Special committees reviewing the documents recommended initiation of the Hanford Environmental Dose Reconstruction Project, which began in October 1987, and is conducted by Battelle, Pacific Northwest Laboratories. The technical approach taken was to reconstruct releases of radioactive materials based on facility operating information; develop and/or adapt transport, pathway, and dose models and computer codes; reconstruct environmental, meteorological, and hydrological monitoring information; reconstruct demographic, agricultural, and lifestyle characteristics; apply statistical methods to all forms of uncertainty in the information, parameters, and models; and perform scientific investigations that were technically defensible. The geographic area for the study includes approximately 2 x 10(5) km2 (75,000 mi2) in eastern Washington, western Idaho, and northeastern Oregon (essentially the Mid-Columbia Basin of the Pacific Northwest). Three exposure pathways were considered: the atmosphere, the Columbia River, and ground water. the radionuclide of interest for atmospheric pathway doses was 131I. The median dose for the maximally exposed individual was approximately 2.3 Gy (230 rad) to the thyroid over the period from 1944 to 1972 with a 90% subjective confidence interval of 0.54 to 8.4 Gy (54 to 840 rad). The Columbia River was studied from Priest Rapids Dam, upstream of the Hanford Site, to the mouth of the river and nearby bays. Radionuclides of interest for river pathway doses were 24Na, 32P, 65Zn, 76As, and 239Np. The median dose from the river pathway for the maximally exposed individual was approximately 0.0015 Sv (0.15 rem) effective dose equivalent in the period of maximum exposure (1950-1970). Doses from the groundwater pathway were determined to be below levels of interest for the project.

Air Pollutants, Radioactive↗

Three-dimensional dose reconstruction of breast cancer treatment using portal imaging.

In this study, we present an algorithm for three-dimensional (3-D) dose reconstruction using portal images obtained with an electronic portal imaging device (EPID). For this purpose an algorithm for 2-D dose reconstruction, which was previously developed in our institution, was adapted. The external contour of the patient was used to correct for absorption of primary photons, but the presence of inhomogeneities was not taken into account. The accuracy of the algorithm was determined by irradiating two anthropomorphic breast phantoms with 6 MV photons. The dose values derived from portal images were compared with results from 3-D dose calculations, which, in turn, were verified with data obtained with an ionization chamber and film dosimetry. It was found that the application of contour information significantly improves the accuracy of 2-D dose reconstruction. If the total dose at the isocenter plane resulting from all treatment beams is reconstructed, the average deviation from the planned dose is 0.1%+/-1.7% (1 SD). If contour information is not available, the differences increase up to +/-20% for the individual beams. In that case, the dose can only be reconstructed with reasonable accuracy when (nearly) opposing beams are used. The average deviation of the 3-D reconstructed dose from the planned dose in the irradiated volume is 1.4%+/-5.4% (1 SD). If the irradiated volume is enclosed by planes less than 5 cm distant from the isocenter plane, then the average deviation is only 0.5%+/-3.4% (1 SD). It can be concluded that the proposed algorithm for a 3-D dose reconstruction allows a determination of the dose at the isocenter plane and the dose-volume histogram with an accuracy acceptable for an independent verification of the treatment.

Algorithms↗

EPR dose reconstruction for bone-seeking 90Sr.

The results of the EPR dose reconstruction in calcified tissues of dog injected with 90Sr are presented. It has been established that there is no essential difference in the values of doses absorbed in tooth tissues of teeth in symmetric positions in the mouth, whereas a significant difference occurs in the values of absorbed doses in teeth in non-symmetric positions. In the case of 90Sr internal exposure the dose reconstruction in crown dentine plays an important role. It has been found that its quantity is close to the dose in diaphyseal cortical bone of the femur, dose at the endosteal bone surface and in femural fatty marrow. The fact that these values exceed doses absorbed in tooth enamel points out the predominant contribution of internal exposure. The highest absorbed doses have been observed in metaphyseal trabecular femur bones, tooth alveolar bone walls, and cortical and trabecular vertebra that can be considered as suitable candidates for biomarkers of internal 90Sr exposure for post-mortal autopsy. The satisfactory correlation has been found between the doses reconstructed in calcified dog tissues and the doses measured by EPR in alanine dosimeters fixed in (or nearby) the sites of autopsy of bones/teeth. The experiments provide support for the view that EPR retrospective dosimetry with calcified tissues for internal exposure is unique in providing useful information on the doses obtained.

Absorption↗

General approach to dose reconstruction in the population exposed as a result of the release of radioactive wastes into the Techa River.

Massive releases of fission products from the plutonium production facility 'Mayak' resulted in the years 1949-1956 in the contamination of the river Techa and its flood lands. This led to the exposure of the population in many riverside villages due to external gamma-rays and due to the incorporation of radionuclides, primarily Sr-90. The exposure situation is described and the reconstruction of doses due to external and due to internal radioactivity is explained. The internal dosimetry is based on large scale measurements of Sr-90 beta-rays on the surface of teeth that were begun in 1960, and on whole-body measurements of Sr-90 that were begun in 1974. The details of the analyses are presented in Part 2 of the present report. Average doses due to the external and the internal exposure are given for the residents of the different villages along the river Techa. In the total population of about 28,000 persons that were assessed, the medium dose to the red bone marrow was about 0.25 Gy and the mean dose about 0.4 Gy. In about 5% of the individuals the dose to the red bone marrow was estimated to be in excess of 1 Gy.

Adolescent↗

Dose reconstruction in deforming lung anatomy: dose grid size effects and clinical implications.

In this study we investigated the accumulation of dose to a deforming anatomy (such as lung) based on voxel tracking and by using time weighting factors derived from a breathing probability distribution function (p.d.f.). A mutual information registration scheme (using thin-plate spline warping) provided a transformation that allows the tracking of points between exhale and inhale treatment planning datasets (and/or intermediate state scans). The dose distributions were computed at the same resolution on each dataset using the Dose Planning Method (DPM) Monte Carlo code. Two accumulation/interpolation approaches were assessed. The first maps exhale dose grid points onto the inhale scan, estimates the doses at the "tracked" locations by trilinear interpolation and scores the accumulated doses (via the p.d.f.) on the original exhale data set. In the second approach, the "volume" associated with each exhale dose grid point (exhale dose voxel) is first subdivided into octants, the center of each octant is mapped to locations on the inhale dose grid and doses are estimated by trilinear interpolation. The octant doses are then averaged to form the inhale voxel dose and scored at the original exhale dose grid point location. Differences between the interpolation schemes are voxel size and tissue density dependent, but in general appear primarily only in regions with steep dose gradients (e.g., penumbra). Their magnitude (small regions of few percent differences) is less than the alterations in dose due to positional and shape changes from breathing in the first place. Thus, for sufficiently small dose grid point spacing, and relative to organ motion and deformation, differences due solely to the interpolation are unlikely to result in clinically significant differences to volume-based evaluation metrics such as mean lung dose (MLD) and tumor equivalent uniform dose (gEUD). The overall effects of deformation vary among patients. They depend on the tumor location, field size, volume expansion, tissue heterogeneity, and direction of tumor displacement with respect to the beam, and are more likely to have an impact on serial organs (such as esophagus), rather than on large parallel organs (such as lung).

Body Burden↗

Dose reconstruction for residents living in buildings with moderate and minor 60Co contamination in rebar.

Previously, we have reconstructed cohort dependent individual doses for residents living in rebar buildings of high 60Co contamination. These reconstructions were carried out using intensively collected TLD data on exposure rates at locations of 1 m height and 1 m x 1 m intersections. The present work deals with dose reconstructions for residents living in rebar buildings of moderate and minor 60Co contamination. Since only limited data on exposure rates from survey meters were available, dose reconstructions were based on these data using interpolations. To utilize such data, we examined them with respect to all factors that influenced the dose uncertainties. The interpolated results were given in terms of contour plots (isodose curves) and compared with corresponding results derived from TLD data and Monte Carlo simulations. The comparison revealed that survey meter data could be used to provide reasonable and conservative estimates of residential doses. By applying the cohort-dependent room occupancy factor and the site-dependent area occupancy factor, we reconstructed cohort dependent individual doses and associated uncertainties. Results of dose reconstructions for all residents living in contaminated rebar buildings were provided to the Atomic Energy Council and health authorities for epidemiologic and medical uses.

Air Pollution, Indoor↗

Depth-dose distribution in bricks determined by thermoluminescence and by Monte-Carlo calculation for external gamma-dose reconstruction.

The analysis of depth-dose distributions in bricks sampled from walls in areas with nuclear waste or accident contamination has the potential of providing information on the energy and source configuration of the gamma-radiation that had been incident on the brick. In this study, a brick from a mill facing a shallow water reservoir of the contaminated Techa river in the South Ural region is investigated. Thermoluminescence (TL) methods were used to measure the accumulated dose at several depths in the brick. The accidental external gamma-dose is obtained by subtracting the natural radiation background dose from the total accumulated dose. In the first segment of the brick, at a depth of about 1.5 cm, the accident dose was found to be roughly 3.5 Gy. Monte-Carlo simulations of the photon transport from the reservoir bed contaminated with 137Cs were calculated for different depths in the brick. The calculations were made assuming different attenuating water levels. It is found that the depth-dose distribution determined by measurements corresponds to a water level between 20 and 50 cm. The results indicate that TL measurements combined with Monte-Carlo modelling calculations are highly promising for external gamma-dose reconstruction applications.

Beta Particles↗

Dose reconstruction for individuals exposed to ionizing radiation using chromosome painting.

To be most useful, a biomarker for dose reconstruction should employ an end point that is highly quantitative, stable with time and easily measured. Reciprocal translocations have been shown to be a promising biomarker that is linked to both prior exposure and risk, and they can be measured easily and quantitatively using fluorescence in situ hybridization. In contrast to other biomarkers that are available, the frequency of reciprocal translocations in individuals exposed to whole-body radiation is stable with time after exposure, has rather small interindividual variability and can be measured accurately at low levels of exposure. Results from recent studies demonstrate that measurements of reciprocal translocation frequencies, facilitated by chromosome painting, can be used to reconstruct radiation dose for individuals exposed in the distant past.

Animals↗