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<p>The typical High Dose Rate (HDR) lung brachytherapy procedure involves inserting treatment catheters into the bronchi next to the tumour location using a bronchoscope. The anterior-posterior and lateral fluoroscopy images are acquired in order to localize the catheters prior to treatment. Although, these images enable accurate reconstruction of the catheter location, they do not allow for the visualization of the tumour or organs-at-risk due to poor soft tissue contrast. Although CT images offer an improved soft tissue contrast, moving the patient with catheters in place prior to each treatment is impractical.</p> <p>An alternative option is to use prior diagnostic or external beam radiation treatment planning CT images. These images cannot be used for treatment planning directly because of the variation in patient positioning between the CT and orthogonal images acquisition. In order to account for positioning differences, a 2D/3D registration algorithm that registers the orthogonal images with a previously acquired CT data was developed. The algorithm utilizes a rigid registration model based on a pixel/voxel intensity matching approach. A similarity measure combining normalized mutual information (NMI), image gradient, and intensity difference was developed. Evaluation of the algorithm was performed using tissue equivalent phantoms, and, in the clinical setting using data from six patients. The mean registration error was 2.1 mm and 3.2 mm for phantoms and patients respectively.</p> <p>External objects such as the treatment table and ECG leads are often in CT images, affecting the above mentioned 2D/3D registration. To address this, an algorithm for automatic removal of external objects from CT images was developed. This was applied to automatic contouring and removal of the fiducial markers in CT images used for external beam radiation therapy treatment planning for breast cancer. The algorithm was further modified to compute the girth of patients as part of a diagnostic radiology clinical trial.</p> / Doctor of Philosophy (PhD)

A dosimetria em braquiterapia é importante para garantir a igualdade entre a dose entregue ao paciente e a dose planejada, porém a determinação experimental da dose é difícil devido ao alto gradiente de dose em regiões próximas à fonte. Nesse sentido, a dosimetria gel polimérica têm sido estudada como forma de se obter a distribuição tridimensional das doses dessas fontes. O protocolo da Associação Americana de Físicos em Medicina, intitulado TG-43, propõe um formalismo para o cálculo de dose de fontes de braquiterapia através de parâmetros da atividade, anisotropia e geometria da fonte, além de atenuação e espalhamento da radiação produzida pela fonte. Porém, a determinação das funções dosimétricas necessárias para o cálculo da dose não é feita diretamente através de experimentos. Nessa linha, o Método Monte Carlo vêm sendo utilizado no cálculo dessas funções dosimétricas em braquiterapia. Neste trabalho, foram determinados os parâmetros dosimétricos de duas fontes de braquiterapia, 60Co e 192Ir, utilizando simulação Monte Carlo com o código PENELOPE, assim como as distribuições de dose utilizando dosimetria gel polimérica com o MAGIC-f. Os dados obtidos computacionalmente foram comparados com a literatura, obtendo-se concordância melhor que 98% em todos os parâmetros para a fonte de 60Co. Para a fonte de 192Ir, encontraram-se diferenças de até 22%, embora quando os resultados deste trabalho foram comparados com o sistema de planejamento, o ajuste utilizado para o conjunto de pontos possui R2 de 0,9996. A comparação das distribuições de dose da fonte de 192Ir simuladas e determinadas com o gel polimérico MAGIC-f, apresentou concordância de 97% nos pontos englobados pela isodose de 50%, quando o critério de 3% e 3 mm foi utilizado. Esses resultados evidenciam o potencial do uso da dosimetria gel polimérica e da simulação Monte Carlo com o código PENELOPE em dosimetria de fontes de braquiterapia de alta taxa de dose. / Dosimetry in brachytherapy is important to assure the conformity between the planned and the delivered dose to the patient. However, the experimental determination of dose is difficult in this technique due the high dose gradient in regions near the source. Hence, polymer gel dosimetry has been studied as a tool to obtain three-dimensional distribution dose for these sources. A report of American Association of Medical Physics, entitled TG-43, proposes a formalism for dose calculation for brachytherapy sources through parameters such as activity, anisotropy and geometry of the source, and the attenuation and radiation scattering produced in the surrounding medium. However, the dosimetric functions needed for dose calculations are not directly determined through experiments. In this concern, the Monte Carlo method has been used in the calculation of these dosimetric funcions in brachytherapy. In the present work, the dosimetric parameters for two brachytherapy sources, 60Co e 192Ir, were determined using Monte Carlo simulation with PENELOPE code, and the dose distributions for the 192Ir source were determined using polymer gel dosimetry with MAGIC-f. Data obtained computationally were compared to literature, showing more than 98% agreement in all parameters for the 60Co source. For 192Ir, differences up to 22% were found to the literature, although when the results of this work were compared to the treatment planning system, a R2 equal to 0,9996 was found to the data fitting adjusting both data. The comparison of simulated dose distributions for 192Ir and those determined with MAGIC-f polymer gel showed that 97% of the points covered by 50% isodose are in agreement when gamma index criteria of 3% and 3 mm was used. These results indicate the potential use of polymer gel dosimetry with MAGIC-f and Monte Carlo simulation with PENELOPE code in dosimetry of high dose rate brachytherapy sources.

Recently, the Oak Ridge National Laboratory (ORNL) successfully encapsulated a new generation of medical grade Cf-252 sources having intensities and size comparable to that of the widely used high-dose-rate (HDR) Ir-192 brachytherapy sources. Advent of the new sources, therefore, marked a new era for Cf-252-based neutron brachytherapy (NBT). As part of source calibration and characterization process, a study has been conducted at Georgia Tech lately on determining the neutron and gamma dose rates in water surrounding the new Cf-252 source. A Lucite-walled water phantom was built for this study. The neutron and gamma dose rates were determined both by ion chamber measurements and by Monte Carlo code MCNP. The results show that the measured neutron absorbed dose rates were approximately 25% lower than that predicted by MCNP for all dose positions in water, suggesting that the Cf-252 content of the new source is actually 25% lower than the ORNL's estimate. The measured gamma absorbed dose rates in water, on the contrary, are higher than that predicted by MCNP. The differences between the measured and MCNP-predicted gamma doses are not uniform for all dose positions; they are most pronounced (~a factor of two) at the distance of 1 cm, and fall to approximately 30% at distances 2 cm and beyond. These results suggest that the spectrum of gamma rays emitted from the new Cf-252 source may contain significantly more low-energy gamma rays than the previously published spectrum used in MCNP.

A dosimetria em braquiterapia é importante para garantir a igualdade entre a dose entregue ao paciente e a dose planejada, porém a determinação experimental da dose é difícil devido ao alto gradiente de dose em regiões próximas à fonte. Nesse sentido, a dosimetria gel polimérica têm sido estudada como forma de se obter a distribuição tridimensional das doses dessas fontes. O protocolo da Associação Americana de Físicos em Medicina, intitulado TG-43, propõe um formalismo para o cálculo de dose de fontes de braquiterapia através de parâmetros da atividade, anisotropia e geometria da fonte, além de atenuação e espalhamento da radiação produzida pela fonte. Porém, a determinação das funções dosimétricas necessárias para o cálculo da dose não é feita diretamente através de experimentos. Nessa linha, o Método Monte Carlo vêm sendo utilizado no cálculo dessas funções dosimétricas em braquiterapia. Neste trabalho, foram determinados os parâmetros dosimétricos de duas fontes de braquiterapia, 60Co e 192Ir, utilizando simulação Monte Carlo com o código PENELOPE, assim como as distribuições de dose utilizando dosimetria gel polimérica com o MAGIC-f. Os dados obtidos computacionalmente foram comparados com a literatura, obtendo-se concordância melhor que 98% em todos os parâmetros para a fonte de 60Co. Para a fonte de 192Ir, encontraram-se diferenças de até 22%, embora quando os resultados deste trabalho foram comparados com o sistema de planejamento, o ajuste utilizado para o conjunto de pontos possui R2 de 0,9996. A comparação das distribuições de dose da fonte de 192Ir simuladas e determinadas com o gel polimérico MAGIC-f, apresentou concordância de 97% nos pontos englobados pela isodose de 50%, quando o critério de 3% e 3 mm foi utilizado. Esses resultados evidenciam o potencial do uso da dosimetria gel polimérica e da simulação Monte Carlo com o código PENELOPE em dosimetria de fontes de braquiterapia de alta taxa de dose. / Dosimetry in brachytherapy is important to assure the conformity between the planned and the delivered dose to the patient. However, the experimental determination of dose is difficult in this technique due the high dose gradient in regions near the source. Hence, polymer gel dosimetry has been studied as a tool to obtain three-dimensional distribution dose for these sources. A report of American Association of Medical Physics, entitled TG-43, proposes a formalism for dose calculation for brachytherapy sources through parameters such as activity, anisotropy and geometry of the source, and the attenuation and radiation scattering produced in the surrounding medium. However, the dosimetric functions needed for dose calculations are not directly determined through experiments. In this concern, the Monte Carlo method has been used in the calculation of these dosimetric funcions in brachytherapy. In the present work, the dosimetric parameters for two brachytherapy sources, 60Co e 192Ir, were determined using Monte Carlo simulation with PENELOPE code, and the dose distributions for the 192Ir source were determined using polymer gel dosimetry with MAGIC-f. Data obtained computationally were compared to literature, showing more than 98% agreement in all parameters for the 60Co source. For 192Ir, differences up to 22% were found to the literature, although when the results of this work were compared to the treatment planning system, a R2 equal to 0,9996 was found to the data fitting adjusting both data. The comparison of simulated dose distributions for 192Ir and those determined with MAGIC-f polymer gel showed that 97% of the points covered by 50% isodose are in agreement when gamma index criteria of 3% and 3 mm was used. These results indicate the potential use of polymer gel dosimetry with MAGIC-f and Monte Carlo simulation with PENELOPE code in dosimetry of high dose rate brachytherapy sources.

Submitted in fulfillment of the requirements of the degree of the Master of Technology : Radiography, Durban University of Technology, 2014. / Research Aims The purpose of this study is to compare 2D HDR Brachytherapy planning and 3D HDR Brachytherapy planning in terms of dose distribution in order to accurately determine bladder and rectal doses. Further research questions were explored to determine whether relationships existed between Computer Tomography volumes and bladder and rectum dose. Methodology The 30 female patients that volunteered for the study were conveniently selected. Their age and ethnic group did not contribute to their selection. All participants were prepared for cervical HDR Brachytherapy. The Brachytherapy templates were computer generated and treatments were given based on the templates. They then had a Computer Tomography (CT) scan (3D data set) of the pelvis. The computer generated templates for 2D Brachytherapy planning were applied to the CT data set i.e. 2DBP. The plans were optimised to take into consideration the dose to the bladder and the rectum i.e. 3DBP. The 2DBP and the 3DBP were then evaluated in order to determine which method of planning yielded more acceptable dose distributions to the bladder and rectum. Results Significant differences in dose distribution were noted on comparison of 2DBP and 3DBP. A significant relationship was noted in respect of bladder mean dose and rectum mean dose. 3DBP proved to be more efficient in yielding lower mean dose to the bladder and the rectum. Whilst a significant relationship was noted in respect of bladder maximum dose, an insignificant relationship was noted for rectum maximum dose. Therefore, the efficiency of 3DBP to yield lower bladder maximum dose was established but its efficiency to yield lower rectum maximum dose is questionable. This has implications for the management of patients’ with cervical cancer who require cervical Brachytherapy. Recommendations It is imperative that imaging modalities be used for the accurate planning of cervical Brachytherapy. This study recommends that CT be used for HDR Brachytherapy planning by proving its greater efficiency compared to template planning.

Este trabalho visa implementar o planejamento tridimensional (3D) para tratamentos de braquiterapia ginecológica. Para isto, foram realizados testes de aceite e comissionamento do equipamento de braquiterapia para verificação de suas funções e para estabelecer um programa de garantia da qualidade periódico, assegurando assim a segurança dos pacientes e dos colaboradores. Uma etapa importante de ser realizada foi procurar um material que pudesse ser utilizado como dummy, já que os aplicadores utilizados não possuem dummy específica. Entretanto, somente com o emprego de uma biblioteca de aplicadores foi possível a reconstrução em imagens de ressonância magnética (RM) com a mesma acurácia da obtida em imagens de tomografia computadorizada (TC). Tal ferramenta torna-se assim imprescindível para a utilização clinica da braquiterapia 3D baseada em imagens de RM. Para validar o planejamento 3D realizou-se comparação das doses recebidas em pontos de avaliação de dose (ICRUBexiga, ICRUReto, Ponto Sig) utilizados em planejamento bidimensional (2D) com doses volumétricas (D0,1cc e D2cc) recebidas por órgãos adjacentes ao tumor. A relação média entre D2cc e dose em ICRUBexiga foi 1,74, que é 22% maior que a relação encontrada na literatura. Esta diferença pode ser explicada devido à diferença de volume inserido na bexiga para o planejamento, 50 cc neste estudo contra 200 cc no estudo realizado na literatura. A relação média entre a D2cc e a dose no ponto de reto, 0,85, está de acordo com o valor encontrado na literatura. A dose D2cc foi 69% maior que a dose do ponto de sigmoide utilizado, porém, não foi possível confrontar este valor, pois o ponto de sigmoide utilizado nos procedimentos com planejamento 2D no serviço não é utilizado em outros serviços. O percentual de dose em 2 cc do sigmóide encontrado foi de 57% da dose de prescrição, mesmo valor encontrado na literatura. Este trabalho possibilitou a implementação de um protocolo de braquiterapia de planejamento 3D viável, utilizando-se imagens de RM para primeira fração e imagens de TC para as frações subsequentes. / This work aims to implement the Tridimensional (3D) planning for gynecological brachytherapy treatments. For this purpose, tests of acceptance and commissioning of brachytherapy equipment were performed to establish a quality and periodic assurance program. For this purpose, an important step was searching for a material to be used as a dummy source, since the applicators dont have any specific dummy. In addition, the validation of the use of applicators library was made for reconstruction in computed tomography (CT) and magnetic resonance imaging (MRI). In order to validate 3D planning, comparison of doses in dose assessment points used in bidimensional (2D) plans have been performed with volumetric doses to adjacent organs to the tumor. Finally, a protocol was established for 3D brachytherapy planning alternately using magnetic resonance image (MRI) and CT images, making evaluation of the dose in the tumor through the recording of MR and CT images. It was not possible to find a suitable material that could be used as dummy in MRI. However, the acquisition of the licenses library for the applicators made possible the 3D planning based on MRI. No correlation was found between volumetric and specific doses analyzed, showing the importance of the implementation of 3D planning. The average ratio between D2cc and ICRUBladder dose was 1,74, 22% higher than the ratio found by others authors. For the rectum, D2cc was less than dose point for 60% of fractions; the average difference was 12,5%. The average ratio between D2cc and point dose rectum, 0,85, is equivalent to the value showed by Kim et al, 0,91. The D2cc for sigmoid was 69% higher than point dose used, unless it was not possible compare this value, since the sigmoid point used in the 2D procedures is not used in others institutes. Relative dose in 2 cc of sigmoid was 57% of the prescription dose, the same value was found by in literature. This work enabled the implementation of a viable brachytherapy 3D protocol planning, using MRI for the first fraction of the treatment and CT images for the subsequent fractions.

Este trabalho visa implementar o planejamento tridimensional (3D) para tratamentos de braquiterapia ginecológica. Para isto, foram realizados testes de aceite e comissionamento do equipamento de braquiterapia para verificação de suas funções e para estabelecer um programa de garantia da qualidade periódico, assegurando assim a segurança dos pacientes e dos colaboradores. Uma etapa importante de ser realizada foi procurar um material que pudesse ser utilizado como dummy, já que os aplicadores utilizados não possuem dummy específica. Entretanto, somente com o emprego de uma biblioteca de aplicadores foi possível a reconstrução em imagens de ressonância magnética (RM) com a mesma acurácia da obtida em imagens de tomografia computadorizada (TC). Tal ferramenta torna-se assim imprescindível para a utilização clinica da braquiterapia 3D baseada em imagens de RM. Para validar o planejamento 3D realizou-se comparação das doses recebidas em pontos de avaliação de dose (ICRUBexiga, ICRUReto, Ponto Sig) utilizados em planejamento bidimensional (2D) com doses volumétricas (D0,1cc e D2cc) recebidas por órgãos adjacentes ao tumor. A relação média entre D2cc e dose em ICRUBexiga foi 1,74, que é 22% maior que a relação encontrada na literatura. Esta diferença pode ser explicada devido à diferença de volume inserido na bexiga para o planejamento, 50 cc neste estudo contra 200 cc no estudo realizado na literatura. A relação média entre a D2cc e a dose no ponto de reto, 0,85, está de acordo com o valor encontrado na literatura. A dose D2cc foi 69% maior que a dose do ponto de sigmoide utilizado, porém, não foi possível confrontar este valor, pois o ponto de sigmoide utilizado nos procedimentos com planejamento 2D no serviço não é utilizado em outros serviços. O percentual de dose em 2 cc do sigmóide encontrado foi de 57% da dose de prescrição, mesmo valor encontrado na literatura. Este trabalho possibilitou a implementação de um protocolo de braquiterapia de planejamento 3D viável, utilizando-se imagens de RM para primeira fração e imagens de TC para as frações subsequentes. / This work aims to implement the Tridimensional (3D) planning for gynecological brachytherapy treatments. For this purpose, tests of acceptance and commissioning of brachytherapy equipment were performed to establish a quality and periodic assurance program. For this purpose, an important step was searching for a material to be used as a dummy source, since the applicators dont have any specific dummy. In addition, the validation of the use of applicators library was made for reconstruction in computed tomography (CT) and magnetic resonance imaging (MRI). In order to validate 3D planning, comparison of doses in dose assessment points used in bidimensional (2D) plans have been performed with volumetric doses to adjacent organs to the tumor. Finally, a protocol was established for 3D brachytherapy planning alternately using magnetic resonance image (MRI) and CT images, making evaluation of the dose in the tumor through the recording of MR and CT images. It was not possible to find a suitable material that could be used as dummy in MRI. However, the acquisition of the licenses library for the applicators made possible the 3D planning based on MRI. No correlation was found between volumetric and specific doses analyzed, showing the importance of the implementation of 3D planning. The average ratio between D2cc and ICRUBladder dose was 1,74, 22% higher than the ratio found by others authors. For the rectum, D2cc was less than dose point for 60% of fractions; the average difference was 12,5%. The average ratio between D2cc and point dose rectum, 0,85, is equivalent to the value showed by Kim et al, 0,91. The D2cc for sigmoid was 69% higher than point dose used, unless it was not possible compare this value, since the sigmoid point used in the 2D procedures is not used in others institutes. Relative dose in 2 cc of sigmoid was 57% of the prescription dose, the same value was found by in literature. This work enabled the implementation of a viable brachytherapy 3D protocol planning, using MRI for the first fraction of the treatment and CT images for the subsequent fractions.