Rectangular edge synchronization for intensity modulated radiation therapy with dynamic multileaf collimation

The implementation of intensity modulated radiotherapy by dynamic multileaf collimator control involves the use of interpreter software which creates leaf trajectory plans for each leaf pair. Interpreter software for use with an Elekta SL15 linear accelerator and dedicated multileaf collimator has been written and tested. In practice the ideal trajectory plans often predict contact between leaves from opposing leaf banks, but this is prohibited by control software on the Elekta system as it could lead to mechanical damage. If the modulation within the geometric limits of a shaped field is not to be compromised then strategies to avoid leaf contact result in additional unwanted doses outside the geometric edge. The magnitude of any such additional dose can be reduced to acceptable levels by a technique which we have called rectangular edge synchronization. The performance of interpreter software which incorporates rectangular edge synchronization has been compared with that of potentially more efficient software which does not. The option containing the rectangular edge synchronization algorithm was shown to work consistently well at high monitor unit rates, and without incurring leaf contacts, under a wide range of test conditions. It therefore provides a sound basis for using intensity modulation to replace mechanical wedges, to simulate customized patient shape compensators, or to implement the results of inverse treatment planning processes that require superimposed intensity modulated beams.     

A method for implementing dynamic photon beam intensity modulation using independent jaws and a multileaf collimator

A mathematical model is derived for digitally controlled linear accelerators to deliver a desired photon intensity distribution by combining collimator motion and machine dose rate variations. It shows that, at any instant, the quotient of the machine dose rate and the speed of collimator motion is proportional to the gradient of the desired in-air photon fluence distribution. The model is applicable for both independently controlled collimator jaws and multileaf collimators and can be implemented by controlling different parameters to accommodate linear accelerators from different manufactures. For independent jaws, each pair of jaws creates photon fluence variations along the direction of the jaw movement. For multileaf collimators, where each leaf is independently controlled, any two-dimensional (2D) photon fluence distribution can be delivered. The model has been implemented for wedged isodose distributions using independent jaws, and 2D intensity modulation using a multileaf collimator. One-dimensional (1D) wedged isodose distributions are created by moving an independent jaw at constant speed while varying machine dose rate. 2D intensity modulation has been implemented using a 'dynamic stepping' scheme, which controls the leaf progression during irradiation at constant machine dose rate. With this automated delivery scheme, the beam delivery time for dynamic intensity modulation, which depends on the complexity of the desired intensity distribution, approaches that of conventional beam modifiers. This paper shows the derivation of the model, its application, and our delivery scheme. Examples of 1D dynamic wedges and 2D intensity modulations will be given to illustrate the versatility of the model, the simplicity of its application, and the efficiency of beam delivery. These features make this approach practical for delivering conformal therapy treatments.     

Accurate portal dose measurement with a fluoroscopic electronic portal imaging device (EPID) for open and wedged beams and dynamic multileaf collimation

Measuring portal dose with an electronic portal imaging device (EPID) in external beam radiotherapy can be used to perform routine dosimetric quality control checks on linear accelerators and to verify treatments (in vivo dosimetry). An accurate method to measure portal dose images (PDIs) with a commercially available fluoroscopic EPID has been developed. The method accounts for (i) the optical 'cross talk' within the EPID structure, (ii) the spatially nonuniform EPID response and (iii) the nonlinearity of the EPID response. The method is based on a deconvolution algorithm. Measurement of the required input data is straightforward. The observed nonlinearity of the EPID response was largely due to the somewhat outdated EPID electronics. Nonlinearity corrections for more modern systems are expected to be smaller. The accuracy of the method was assessed by comparing PDIs measured with the EPID with PDIs measured with a scanning ionization chamber in a miniphantom, located at the same position as the fluorescent screen. For irradiations in open, wedged and intensity modulated 25 MV photon beams (produced with dynamic multileaf collimation) EPID and ionization chamber measurements agreed to within 1% (1 SD).     

Beam characteristics and clinical possibilities of a new compact treatment unit design combining narrow pencil beam scanning and segmental multileaf collimation

Not until the last decade has flexible intensity modulated three-dimensional dose delivery techniques with photon beams become a clinical reality, first in the form of heavy metal transmission blocks and other beam compensators, then in dynamic and segmented multileaf collimation, and most recently by scanning high-energy narrow electron and photon beams. The merits of various treatment unit and bremsstrahlung target designs for high-energy photon therapy are investigated theoretically for two clinically relevant target sites, a cervix and a larynx cancer both in late stages. With an optimized bremsstrahlung target it is possible to generate photon beams with a half-width of about 3 cm at a source to axis distance (SAD) of 100 cm and an initial electron energy of 50 MeV. By making a more compact treatment head and shortening the SAD, it is possible to reduce the half-width even further to about 2 cm at a SAD of 70 cm and still have sufficient clearance between the collimator head and the patient. One advantage of a reduced SAD is that the divergence of the beam for a given field size on the patient is increased, and thus the exit dose is lowered by as much as 1%/cm of the patient cross section. A second advantage of a reduced SAD is that the electron beam on the patient surface will be only about 8 mm wide and very suitable for precision spot beam scanning. It may also be possible to reduce the beamwidth further by increasing the electron energy up to about 60 MeV to get a photon beam of around 15 mm half-width and an electron beam as narrow as 5 mm. The compact machine will be more efficient and easy to work with, due to the small gantry and the reduced isocentric height. For a given target volume and optimally selected static multileaf collimator, it is no surprise that the narrowest possible scanned elementary bremsstrahlung beam generates the best possible treatment outcome. In fact, by delivering a few static field segments with individually optimized scan patterns, it is possible to combine the advantage of being able to fine tune the fluence distribution by the scanning system with the steeper dose gradients that can be delivered by a few static multileaf collimator segments. It is demonstrated that in most cases a few collimator segments are sufficient and often a single segment per beam portal may suffice when narrow scanned photon beams are employed, and they can be delivered sequentially with a negligible time delay. A further advantage is the increase of therapeutically useful photons and improved patient protection, since the pencil beam is only scanned where the leaf collimator is open. Consequently, some of the problems associated with dynamic multileaf collimation such as the tongue and groove and edge leakage effects are significantly reduced. Fast scanning beam techniques combined with good treatment verification systems allow interesting future possibilities to counteract patient and internal organ motions in real time.     

An adaptive control algorithm for optimization of intensity modulated radiotherapy considering uncertainties in beam profiles, patient set-up and internal organ motion

A new general beam optimization algorithm for inverse treatment planning is presented. It utilizes a new formulation of the probability to achieve complication-free tumour control. The new formulation explicitly describes the dependence of the treatment outcome on the incident fluence distribution, the patient geometry, the radiobiological properties of the patient and the fractionation schedule. In order to account for both measured and non-measured positioning uncertainties, the algorithm is based on a combination of dynamic and stochastic optimization techniques. Because of the difficulty in measuring all aspects of the intra- and interfractional variations in the patient geometry, such as internal organ displacements and deformations, these uncertainties are primarily accounted for in the treatment planning process by intensity modulation using stochastic optimization. The information about the deviations from the nominal fluence profiles and the nominal position of the patient relative to the beam that is obtained by portal imaging during treatment delivery, is used in a feedback loop to automatically adjust the profiles and the location of the patient for all subsequent treatments. Based on the treatment delivered in previous fractions, the algorithm furnishes optimal corrections for the remaining dose delivery both with regard to the fluence profile and its position relative to the patient. By dynamically refining the beam configuration from fraction to fraction, the algorithm generates an optimal sequence of treatments that very effectively reduces the influence of systematic and random set-up uncertainties to minimize and almost eliminate their overall effect on the treatment. Computer simulations have shown that the present algorithm leads to a significant increase in the probability of uncomplicated tumour control compared with the simple classical approach of adding fixed set-up margins to the internal target volume.     

Use of a multileaf collimator for the production of intensity-modulated beams

The continuous release of nitric oxide (NO) from the constitutive, endothelial isoform of nitric oxide synthase (e-NOS) serves mainly to keep the vasculature in a continuous state of active vasodilation. Although it has been suggested that NO production from e-NOS might also be affected by hemorrhagic shock (HS), this relationship is still controversial. Therefore, the roles of NO in the pathophysiology in hemorrhagic shock were reviewed. According to the previous reports, NO might play an important role in the pathophysioliogy of HS. In the early phase of HS, it may be possible that NO delivered from e-NOS serves a cytoprotective function in preventing shock-induced organ injury. This opinion suggests that endothelial NO production has a significant modulatory effect on vascular tone during hemorrhage, and that inhibition of NO production permits greater vasconstrictor influences leading to organ injury. NO production in the late phases of HS has an adverse effect on survival rate in the HS model. Moreover, the findings from an animal study of prolonged periods of HS suggest that excessive NO formation, including those produced from i-NOS, induces vascular hypoactivity and they have suggested that NOS inhibitors may improve the therapeutic outcome for patients suffering from HS. Therefore, it may be suggested that NO might play a biphasic role, cytoprotective during the early phase and cytotoxic late in HS.     

Dosimetric evaluation of a widely used kilovoltage x-ray unit for endocavitary radiotherapy

In this paper we present the dosimetric data of a Therapax DTX300 kilovoltage x-ray unit for endocavitary rectal irradiation. The unit if operated at tube voltage of 40-60 kVp (30 mA) with an added filtration of 0.2-0.4 mm Al generates acceptable beam qualities comparable to those of the original Papillon technique. Relative dosimetric measurements were performed at the cone end (37.2 cm SSD) of a 3 cm diameter rectal cone using various detectors to ensure the accuracy. A Monte Carlo method was used to calculate correction factors for the diode used in the percentage depth-dose (PDD) measurement, and to study the effect of the detector size on the beam profile. The PDD data were determined using the diode measurement corrected for its energy and angular response. It was found that the PTW N23342 and Markus parallel-plate chamber can be used directly to measure the PDD for this beam quality with 2% uncertainty. Measurement and Monte Carlo results have shown that the detector size has a significant effect on the penumbral profile. Film and diode detectors have a better spatial resolution compared to ionization chambers, but they may give an incorrect profile tail due to either nonlinear response at low energy or angular dependence. This can be corrected using the ionization-chamber measurement, based on the Monte Carlo analysis. The isodose distributions for this x-ray unit are presented.     

Comparison of projection algorithms used for the construction of maximum intensity projection images

OBJECTIVE: Four methods of producing maximum intensity projection (MIP) images were studied and compared. MATERIALS AND METHODS: Three of the projection methods differ in the interpolation kernel used for ray tracing. The interpolation kernels include nearest neighbor interpolation, linear interpolation, and cubic convolution interpolation. The fourth projection method is a voxel projection method that is not explicitly a ray-tracing technique. The four algorithms' performance was evaluated using a computer-generated model of a vessel and using real MR angiography data. The evaluation centered around how well an algorithm transferred an object's width to the projection plane. RESULTS: The voxel projection algorithm does not suffer from artifacts associated with the nearest neighbor algorithm. Also, a speed-up in the calculation of the projection is seen with the voxel projection method. Linear interpolation dramatically improves the transfer of width information from the 3D MRA data set over both nearest neighbor and voxel projection methods. Even though the cubic convolution interpolation kernel is theoretically superior to the linear kernel, it did not project widths more accurately than linear interpolation. A possible advantage to the nearest neighbor interpolation is that the size of small vessels tends to be exaggerated in the projection plane, thereby increasing their visibility. CONCLUSION: The results confirm that the way in which an MIP image is constructed has a dramatic effect on information contained in the projection. The construction method must be chosen with the knowledge that the clinical information in the 2D projections in general will be different from that contained in the original 3D data volume.     

Design and dosimetric characteristics of a high dose rate remotely afterloaded endocavitary applicator system

PURPOSE: An applicator is described for endocavitary treatment of rectal cancers using a high dose rate (HDR) remote afterloading system with a single high-intensity 192Ir source as an alternative to the 50 kVp x-ray therapy contact unit most frequently used in this application. METHODS AND MATERIALS: The applicator consists of a tungsten-alloy collimator with a 45 degree beveled end, placed in a protoscope with an elliptical cross-section. The resultant 3 cm diameter circular treatment aperture, located in the beveled face of the proctoscope, is irradiated by circular array of dwell positions located about 6.5 mm from the applicator surface. This beveled end allows patients with posterior wall tumors to be treated in the dorsal lithotomy position. The dose-rate distributions about the applicator were determined using a combination of thermoluminescent dosimetry (TLD-100 detectors) and radiochromic film dose measurement techniques along with Monte Carlo dosimetry calculations. TLD-100 (3 x 3 x 0.9 mm3 chips) measurements were used to measure the distribution of dose over the proctoscope surface as well as the central axis dose-rate distribution. Relative radiochromic film measurements were used to measure off-axis ratios (flatness and penumbra width) within the treatment aperture. These data were combined with Monte Carlo simulation results to obtain the final dose distribution. RESULTS: The tungsten collimator successfully limits the dose to the tissue in contact with the proctoscope walls to less than 12% of the prescribed dose. These results indicate that the HDR applicator system has slightly more penetrating depth-dose characteristics than the most widely used contact therapy x-ray machine. Flatness characteristics of the two treatment delivery systems are comparable, although the HDR endocavitary applicator has a significantly wider penumbra. Finally, the HDR applicator has a lower surface dose rate (1.5-4 Gy/min of dwell time) compared to 9-10 Gy/min for the x-ray unit. CONCLUSIONS: An applicator system has been developed for endocavitary treatment of early stage rectal carcinoma that uses a single-stepping source HDR remote afterloading system as a radiation source. The advantages of the HDR-based system over x-ray therapy contact units currently used in this clinical application are (a) enhanced flexibility in applicator design and (b) widespread availability of single-stepping source HDR remote afterloading systems.     

CSP生产线MES中的动态生产调度系统建模

动态生产调度系统是CSP生产线制造执行系统(MES)的重要组成之一，它处理MES与过程控制系统之间的信息交互，并对生产执行过程中的各种变化做出实时响应。本文采用面向对象技术，分析CSP生产环境的特点，建立基于统一建模语言的CSP动态生产调度系统模型。     

热装模式下板坯库动态调度系统研究与应用

针对钢铁企业热装模式下板坯库作业动态调度的需求,采用Petri网对热装模式下辊道输送作业、板坯入库作业和出库作业进行详细、系统的分析,提出了辊道输送控制策略和天车动态调度策略,在此基础上研发了板坯库动态调度系统。2011年系统在某钢铁集团热轧薄板厂板坯库实际运行后,实现了板坯库辊道输送的自动控制以及天车的动态调度,验证了本文提出的动态调度方法的可行性及有效性。     

网络动态调度系统的服务质量性能分析

提出了考虑具有不同输入速率和输出速率的任务队列的网络动态调度系统状态空间模型,描述了网络动态调度系统的清空型调度策略,并在此基础上给出了系统服务质量性能指标包括队列长度、总任务数量、系统吞吐量、响应时间等的分析算法.数值计算表明,适当的调度策略可以使网络动态调度系统的响应时间处于受控的范围内,系统吞吐量处于稳定的状态.     

An experimental investigation of the tongue and groove effect for the Philips multileaf collimator

The tongue and groove effect is an underdosing effect which can occur in certain applications of multileaf collimators. It results from the need to overlap adjacent leaves of a multileaf collimator in order to limit leakage between leaves. The applications in which the effect can occur are the abutment of fields where the beam edges are defined by the leaf edge and the production of intensity-modulated fields by dynamic collimation. The effect has been measured for the 'worst case' when just two MLC fields are matched along leaf edges which have overlapping steps. Measurements of the dose have been made at d(max) and also at a more clinically relevant depth of 87 mm in Perspex for beam energies of 6 MV, 8 MV and 20 MV on two Philips SL series accelerators. Dose distributions were recorded on radiographic film which was subsequently digitized for analysis. The dose reduction of the tongue and groove effect was found to be 15-28% and spread over a width of 3.8 to 4.2 mm. This is somewhat shallower and wider than would be expected from a simple, idealized model of the effect which would predict a dose reduction of 80% over a width of 1 mm.