Dr Claire Dempsey

Purpose The purpose of this study was to determine the effect of deformable image registration (DIR) on cumulative organ at risk dose¿volume histogram (DVH) parameter summation for more than three brachytherapy fractions. The reproducibility of different methods of DIR was tested. DIR was then used to assess the stability of the anatomic position of the DVH parameters within the bladder and rectum. Methods and Materials DIR was completed for 39 consecutive cervical cancer brachytherapy patients' planning CTs. Accumulated DVH parameters (D2cc and D0.1cc) for bladder and rectum were compared with dose summation without DIR. Reproducibility of DIR results was assessed for different methods of implementation based on adding contour biases added to the DIR algorithm. VolD2cc and VolD0.1cc structures were created from the overlap of the D2cc and D0.1cc isodose and the bladder or rectum, respectively. The overlap of VolD2cc and VolD0.1cc structures was calculated using the Dice similarity coefficient. Results DIR accumulated D2cc and D0.1cc decreased by an average of 2.9% and 4.2% for bladder and 5.08% and 2.8% for rectum compared with no DIR. DIR was most reproducible when the bladder or rectum contour was masked. The average Dice similarity coefficient was 0.78 and 0.61 for the bladder D2cc and D0.1cc as well as 0.83 and 0.62 for rectal D2cc and D0.1cc, respectively. Conclusions Dose decreases were observed for accumulated DVH parameters using DIR. Adding contour-based biases to the algorithm increases the reproducibility of D2cc and D0.1cc accumulation. The anatomic position of VolD2cc was more stable than VolD0.1cc.

Monthly QA is recommended to verify the constancy of high-energy electron beams generated for clinical use by linear accelerators. The tolerances are defined as 2%/2 mm in beam penetration according to AAPM task group report 142. The practical implementation is typically achieved by measuring the ratio of readings at two different depths, preferably near the depth of maximum dose and at the depth corresponding to half the dose maximum. Based on beam commissioning data, we show that the relationship between the ranges of energy ratios for different electron energies is highly nonlinear. We provide a formalism that translates measurement deviations in the reference ratios into change in beam penetration for electron energies for six Elekta (6-18 MeV) and eight Varian (6-22 MeV) electron beams. Experimental checks were conducted for each Elekta energy to compare calculated values with measurements, and it was shown that they are in agreement. For example, for a 6 MeV beam a deviation in the measured ionization ratio of ± 15% might still be acceptable (i.e., be within ± 2 mm), whereas for an 18 MeV beam the corresponding tolerance might be ± 6%. These values strongly depend on the initial ratio chosen. In summary, the relationship between differences of the ionization ratio and the corresponding beam energy are derived. The findings can be translated into acceptable tolerance values for monthly QA of electron beam energies.

Purpose: The superior image quality of 3 tesla (3T) magnetic resonance (MR) imaging in cervical cancer offers the potential to use a single image set for brachytherapy. This study aimed to determine a suitable single sequence for contouring tumour and organs at risk, applicator reconstruction, and treatment planning. Material and methods: A 3T (Skyra, Siemens Healthcare AG, Germany) MR imaging system with an 18 channel body matrix coil generated HDR cervical cancer brachytherapy planning images on 20 cases using plastic-based treatment applicators. Seven different T2-weighted Turbo Spin Echo (TSE) sequences including both 3D and contiguous 2D scans based on sagittal, axial (transverse), and oblique planes were analysed. Each image set was assessed for total scanning time and usefulness in tumour localization via inter- and intra-observer analysis of high-risk clinical target volume (HR CTV) contouring. Applicator reconstruction in the treatment planning system was also considered. Results: The intra-observer difference in HR CTV volumes between 2D and 3D axial-based image sets was low with an average difference of 3.1% for each observer. 2D and 3D sagittal image sets had the highest intra- and inter observer differences (over 15%). A 2D axial 'double oblique' sequence was found to produce the best intra- (average difference of 0.6%) and inter-observer (mean SD of 9.2%) consistency and greatest conformity (average 0.80). Conclusions: There was little difference between 2D and 3D-based scanning sequences; however the increased scanning time of 3D sequences have potential to introduce greater patient motion artifacts. A contiguous 2D sequence based on an axial T2-weighted turbo-spin-echo (TSE) sequence orientated in all planes of the treatment applicator provided consistent tumour delineation whilst allowing applicator reconstruction and treatment planning.

Purpose: Consistency of radiotherapy contours is required to ensure consistency of treatment and for this reason many studies have been undertaken and are expected in the future comparing contours of multiple observers or systems. This study was undertaken to determine the minimum uncertainty achievable when undertaking this type of investigation including multiple centres and treatment planning systems. Methods: A Computed Tomography (CT) scan was taken of a commercially available uniformity Phantom. This dataset was then imported into various contouring software programs including Pinnacle, Xio and Focal at the same institution and variations at different institutions. Contours of the perimeter of the phantom and a detailed cylinder inside the phantom were contoured using the same observer at provided window levels. The perimeter of the phantom was auto-contoured using auto-threshold. The inside circle was contoured manually. Contours were then exported from the treatment planning systems and into CERR for analysis. Results: A comparison of the phantom perimeter from Focal and Pinnacle at a single institution demonstrated a Concordance Index (CI) of 0.98, while the manually contoured cylinder has a CI of 0.77. When comparing between institutions the CI ranged from 0.75¿0.85 for the cylinder. Variation in the phantom perimeter contours was mainly in the Z direction with 2 slices (0.4cm) not being contoured in Focal compared to Pinnacle. Maximum variation in the X and Y direction for the phantom perimeter was 0.098cm. The centre of mass of all phantom perimeter contours were within 0.10cm, with the largest variance between institutions occurring in the anterior-posterior direction. Conclusion: The variation between auto-contouring and manually contouring a high contrast object for different treatment planning systems has been established. As expected manually contouring produces greater variation than auto-threshold contours between different treatment planning system. Funding from Cancer Australia and The National Breast Cancer Foundation, Project grant 1033237. © 2013, American Association of Physicists in Medicine. All rights reserved.