The goal of this study was to improve dosimetry for pelvic, lung, head and neck, and other cancers sites with aspherical planning target volumes (PTV) using a new algorithm for collimator optimization for intensity modulated radiation therapy (IMRT) that minimizes the x-jaw gap (CAX) and the area of the jaws (CAA) for each treatment field. A retroactive study on the effects of collimator optimization of 20 patients was performed by comparing metric results for new collimator optimization techniques in Eclipse version 11.0. Keeping all other parameters equal, multiple plans are created using four collimator techniques: CA0, all fields have collimators set to 0°, CAE, using the Eclipse collimator optimization, CAA, minimizing the area of the jaws around the PTV, and CAX, minimizing the x-jaw gap. The minimum area and the minimum x-jaw angles are found by evaluating each field beam’s eye view of the PTV with ImageJ and finding the desired parameters with a custom script. The evaluation of the plans included the monitor units (MU), the maximum dose of the plan, the maximum dose to organs at risk (OAR), the conformity index (CI) and the number of fields that are calculated to split. Compared to the CA0 plans, the monitor units decreased on average by 6% for the CAX method with a p-value of 0.01 from an ANOVA test. The average maximum dose remained within 1.1% difference between all four methods with the lowest given by CAX. The maximum dose to the most at risk organ was best spared by the CAA method, which decreased by 0.62% compared to the CA0. Minimizing the x-jaws significantly reduced the number of split fields from 61 to 37. In every metric tested the CAX optimization produced comparable or superior results compared to the other three techniques. For aspherical PTVs, CAX on average reduced the number of split fields, lowered the maximum dose, minimized the dose to the surrounding OAR, and decreased the monitor units. This is achieved while maintaining the same control of the PTV. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Evaluation of dose optimization using the Pencil Beam (PB) and Monte Carlo (MC) algorithms may allow physicists to apply dosimetric offsets to account for inaccuracies of the PB algorithm for lung cancer treatment with Stereotactic Body Radiotherapy (SBRT). 20 cases of Non-Small Cell Lung Cancer (NSCLC) were selected. Treatment plans were created with Brainlab iPlanDose® 4.1.2. The D97 of the Planning Target Volume (PTV) was normalized to 50 Gy on the Average Intensity Projection (AIP) using the fast PB and compared with MC. This exact plan with the same beam Monitor Units (MUs) was recalculated over each respiratory phase. The results show that the PB algorithm has a 2.3-2.4% less overestimation at the maximum exhalation phase than the maximum inhalation phase when compared to MC. Significantly smaller dose difference between PB and MC is also shown in plans for peripheral lesions (7.7 ± 0.7%) versus central lesions (12.7±0.8%)(p< 0.01). / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

The purpose of this research is to accurately match the calculation environment, i.e. the treatment planning system (TPS) with the measurement environment (using a 2-D diode array) for lung Stereotactic Body Radiation Therapy (SBRT) patient-specific quality assurance (QA). Furthermore, a new phantom was studied in which the 2-D array and heterogeneities were incorporated into the patient-specific QA process for lung SBRT. Dual source dual energy computerized tomography (DSCT) and single energy computerized tomography (SECT) were used to model phantoms incorporating a 2-D diode array into the TPS. A water-equivalent and a heterogeneous phantom (simulating the thoracic region of a patient) were studied. Monte Carlo and pencil beam dose distributions were compared to the measured distributions. Composite and individual fields were analyzed for normally incident and planned gantry angle deliveries. The distributions were compared using γ-analysis for criteria 3% 3mm, 2% 2mm, and 1% 1mm. The Monte Carlo calculations for the DSCT modeled phantoms (incorporating the array) showed an increase in the passing percentage magnitude for 46.4 % of the fields at 3% 3mm, 85.7% at 2% 2mm, and 92.9% at 1% 1mm. The Monte Carlo calculations gave no agreement for the same γ-analysis criteria using the SECT. Pencil beam calculations resulted in lower passing percentages when the diode array was incorporated in the TPS. The DSCT modeled phantoms (incorporating the array) exhibited decrease in the passing percentage magnitude for 85.7% of the fields at 3% 3mm, 82.1% at 2% 2mm, and 71.4% at 1% 1mm. In SECT modeled phantoms (incorporating the array), a decrease in passing percentage magnitude were found for 92.9% of the fields at 3% 3mm, 89.3% at 2% 2mm, and 82.1% at 1% 1mm. In conclusion, this study demonstrates that including the diode array in the TPS results in increased passing percentages when using a DSCT system with a Monte Carlo algorithm for patient-specific lung SBRT QA. Furthermore, as recommended by task groups (e.g. TG 65, TG 101, TG 244) of the American Association of Physicists in Medicine (AAPM), pencil beam algorithms should be avoided in the presence of heterogeneous materials, including a diode array. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Empirical methods of beam angle optimization (BAO) are tested against the BAO that is currently employed in Eclipse treatment planning software. Creating an improved BAO can decrease the amount of time a dosimetrist spends on making a treatment plan, improve the treatment quality and enhance the tools an inexperienced dosimetrist can use to develop planning techniques. Using empirical data created by experienced dosimetrists from 69 patients treated for lung cancer, the most frequently used gantry angles were applied to four different regions in each lung to gather an optimal set of fields that could be used to treat future lung cancer patients. This method, given the moniker FAU BAO, is compared in 7 plans created with the Eclipse BAO choosing 5 fields and 9 fields. The results show that the conformality index improved by 30% or 3% when using the 5 and 9 fields. The conformation number was better by 12% from the 5 fields and 9% from the 9 fields. The organs at risk (OAR) were overall more protected to produce fewer nonstochastic effects from the radiation treatment with the FAU BAO. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Intensity modulated radiation therapy (IMRT) is a cancer treatment method in which the intensities of the radiation beams are modulated; therefore these beams have non-uniform radiation intensities. The overall result is the delivery of the prescribed dose in the target volume. The dose distribution is conformal to the shape of the target and minimizes the dose to the nearby critical organs. An inverse planning algorithm is used to obtain those non-uniform beam intensities. In inverse treatment planning, the treatment plan is achieved by using an optimization process. The optimized plan results to a high-quality dose distribution in the planning target volume (PTV), which receives the prescribed dose while the dose that is received by the organs at risk (OARs) is reduced. Accordingly, an objective function has to be defined for the PTV, while some constraints have to be considered to handle the dose limitations for the OARs. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

The purpose of this research is to determine the feasibility of introducing the Monte Carlo (MC) dose calculation algorithm into the clinical practice. Unlike the Ray Tracing (RT) algorithm, the MC algorithm is not affected by the tissue inhomogeneities, which are significant inside the chest cavity. A retrospective study was completed for 102 plans calculated using both the RT and MC algorithms. The D95 of the PTV was 26% lower for the MC calculation. The first parameter of conformality, as defined as the ratio of the Prescription Isodose Volume to the PTV Volume was on average 1.27 for RT and 0.67 for MC. The results confirm that the RT algorithm significantly overestimates the dosages delivered confirming previous analyses. Correlations indicate that these overestimates are largest for small PTV and/or when the ratio of the volume of lung tissue to the PTV approaches 1. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

<p>Digital tomosynthesis (DTS) is a quasi-three-dimensional (3D) imaging technique which reconstructs images from a limited angle of cone-beam projections with shorter acquisition time, lower imaging dose, and less mechanical constraint than full cone-beam CT (CBCT). However, DTS images reconstructed by the conventional filtered back projection method have low plane-to-plane resolution, and they do not provide full volumetric information for target localization due to the limited angle of the DTS acquisition. </p><p>This dissertation presents the optimization and clinical implementation of image guided radiation therapy using limited-angle projections.</p><p>A hybrid multiresolution rigid-body registration technique was developed to automatically register reference DTS images with on-board DTS images to guide patient positioning in radiation therapy. This hybrid registration technique uses a faster but less accurate static method to achieve an initial registration, followed by a slower but more accurate adaptive method to fine tune the registration. A multiresolution scheme is employed in the registration to further improve the registration accuracy, robustness and efficiency. Normalized mutual information is selected as the criterion for the similarity measure, and the downhill simplex method is used as the search engine. This technique was tested using image data both from an anthropomorphic chest phantom and from head-and-neck cancer patients. The effects of the scan angle and the region-of-interest size on the registration accuracy and robustness were investigated. The average capture ranges in single-axis simulations with a 44° scan angle and a large ROI covering the entire DTS volume were between -31 and +34 deg for rotations and between -89 and +78 mm for translations in the phantom study, and between -38 and +38 deg for rotations and between -58 and +65 mm for translations in the patient study.</p><p>Additionally, a novel limited-angle CBCT estimation method using a deformation field map was developed to optimally estimate volumetric information of organ deformation for soft tissue alignment in image guided radiation therapy. The deformation field map is solved by using prior information, a deformation model, and new projection data. Patients' previous CBCT data are used as the prior information, and the new patient volume to be estimated is considered as a deformation of the prior patient volume. The deformation field is solved by minimizing bending energy and maintaining new projection data fidelity using a nonlinear conjugate gradient method. The new patient CBCT volume is then obtained by deforming the prior patient CBCT volume according to the solution to the deformation field. The method was tested for different scan angles in 2D and 3D cases using simulated and real projections of a Shepp-Logan phantom, liver, prostate and head-and-neck patient data. Hardware acceleration and multiresolution scheme are used to accelerate the 3D estimation process. The accuracy of the estimation was evaluated by comparing organ volume, similarity and pixel value differences between limited-angle CBCT and full-rotation CBCT images. Results showed that the respiratory motion in the liver patient, rectum volume change in the prostate patient, and the weight loss and airway volume change in the head-and-neck patient were accurately estimated in the 60° CBCT images. This new estimation method is able to optimally estimate the volumetric information using 60-degree projection images. It is both technically and clinically feasible for image-guidance in radiation therapy.</p> / Dissertation

<p>A bench-top dual cone-beam computed tomography (CBCT) system was developed consisting of two orthogonally placed 40x30 cm<super>2</super> flat-panel detectors and two conventional X-ray tubes with two individual high-voltage generators sharing the same rotational axis. The X-ray source to detector distance is 150 cm and X-ray source to rotational axis distance is 100 cm for both subsystems. The objects are scanned through 200° of rotation. The dual CBCT (DCBCT) system utilized 110° of projection data from one detector and 90° from the other while the two individual single CBCTs utilized 200° data from each detector. The system performance was characterized in terms of uniformity, contrast, spatial resolution, noise power spectrum and CT number linearity. The uniformity, within the axial slice and along the longitudinal direction, and noise power spectrum were assessed by scanning a water bucket; the contrast and CT number linearity were measured using the Catphan phantom; and the spatial resolution was evaluated using a tungsten wire phantom. A skull phantom and a ham were also scanned to provide qualitative evaluation of high- and low-contrast resolution. Each measurement was compared between dual and single CBCT systems.</p><p>Compared with single CBCT, the DCBCT presented: 1) a decrease in uniformity by 1.9% in axial view and 1.1% in the longitudinal view, as averaged for four energies (80, 100, 125 and 150 kVp); 2) comparable or slightly better contrast to noise ratio (CNR) for low-contrast objects and comparable contrast for high-contrast objects; 3) comparable spatial resolution; 4) comparable CT number linearity with R<super>2</super> &#8805; 0.99 for all four tested energies; 5) lower noise power spectrum in magnitude. DCBCT images of the skull phantom and the ham demonstrated both high-contrast resolution and good soft-tissue contrast.</p><p>One of the major challenges for clinical implementation of four-dimensional (4D) CBCT is the long scan time. To investigate the 4D imaging capabilities of the DCBCT system, motion phantom studies were conducted to validate the efficiency by comparing 4D images generated from 4D-DCBCT and 4D-CBCT. First, a simple sinusoidal profile was used to confirm the scan time reduction. Next, both irregular sinusoidal and patient-derived profiles were used to investigate the advantage of temporally correlated orthogonal projections due to a reduced scan time. Normalized mutual information (NMI) between 4D-DCBCT and 4D-CBCT was used for quantitative evaluation.</p><p>For the simple sinusoidal profile, the average NMI for ten phases between two single 4D-CBCTs was 0.336, indicating the maximum NMI that can be achieved for this study. The average NMIs between 4D-DCBCT and each single 4D-CBCT were 0.331 and 0.320. For both irregular sinusoidal and patient-derived profiles, 4D-DCBCT generated phase images with less motion blurring when compared with single 4D-CBCT.</p><p>For dual kV energy imaging, we acquired 80kVp projections and 150 kVp projections, with an additional 0.8 mm tin filtration. The virtual monochromatic (VM) technique was implemented, by first decomposing these projections into acrylic and aluminum basis material projections to synthesize VM projections, which were then used to reconstruct VM CBCTs. The effect of the VM CBCT on metal artifact reduction was evaluated with an in-house titanium-BB phantom. The optimal VM energy to maximize CNR for iodine contrast and minimize beam hardening in VM CBCT was determined using a water phantom containing two iodine concentrations. The linearly-mixed (LM) technique was implemented by linearly combining the low- (80kVp) and high-energy (150kVp) CBCTs. The dose partitioning between low- and high-energy CBCTs was varied (20%, 40%, 60% and 80% for low-energy) while keeping total dose approximately equal to single-energy CBCTs, measured using an ion chamber. Noise levels and CNRs for four tissue types were investigated for dual-energy LM CBCTs in comparison with single-energy CBCTs at 80, 100, 125 and 150kVp.</p><p>The VM technique showed a substantial reduction of metal artifacts at 100 keV with a 40% reduction in the background standard deviation compared with a 125 kVp single-energy scan of equal dose. The VM energy to maximize CNR for both iodine concentrations and minimize beam hardening in the metal-free object was 50 keV and 60 keV, respectively. The difference in average noise levels measured in the phantom background was 1.2% for dual-energy LM CBCTs and equivalent-dose single-energy CBCTs. CNR values in the LM CBCTs of any dose partitioning were better than those of 150 kVp single-energy CBCTs. The average CNRs for four tissue types with 80% dose fraction at low-energy showed 9.0% and 4.1% improvement relative to 100 kVp and 125 kVp single-energy CBCTs, respectively. CNRs for low contrast objects improved as dose partitioning was more heavily weighted towards low-energy (80kVp) for LM CBCTs.</p><p>For application of the dual-energy technique in the kilovoltage (kV) and megavoltage (MV) range, we acquired both MV projections (from gantry angle of 0° to 100°) and kV projections (90° to 200°) with the current orthogonal kV/MV imaging hardware equipped in modern linear accelerators, as gantry rotated a total of 110°. A selected range of overlap projections between 90° to 100° were then decomposed into two material projections using experimentally determined parameters from orthogonally stacked aluminum and acrylic step-wedges. Given attenuation coefficients of aluminum and acrylic at a predetermined energy, one set of VM projections could be synthesized from two corresponding sets of decomposed projections. Two linear functions were generated using projection information at overlap angles to convert kV and MV projections at non-overlap angles to approximate VM projections for CBCT reconstruction. The CNRs were calculated for different inserts in VM CBCTs of a CatPhan phantom with various selected energies and compared with those in kV and MV CBCTs. The effect of overlap projection number on CNR was evaluated. Additionally, the effect of beam orientation was studied by scanning the CatPhan sandwiched with two 5 cm solid-water phantoms on both lateral sides and an electronic density phantom with two metal bolt inserts.</p><p>Proper selection of VM energy (30keV and 40keV for low-density polyethylene (LDPE), polymethylpentene (PMP), 2MeV for Delrin) provided comparable or even better CNR results as compared with kV or MV CBCT. An increased number of overlap between kV and MV projections demonstrated only marginal improvements of CNR for different inserts (with the exception of LDPE) and therefore one projection overlap was found to be sufficient for the CatPhan study. It was also evident that the optimal CBCT image quality was achieved when MV beams penetrated through the heavy attenuation direction of the object. </p><p>In conclusion, the performance of a bench-top DCBCT imaging system has been characterized and is comparable to that of a single CBCT. The 4D-DCBCT provides an efficient 4D imaging technique for motion management. The scan time is reduced by approximately a factor of two. The temporally correlated orthogonal projections improved the image blur across 4D phase images. Dual-energy CBCT imaging techniques were implemented to synthesize VM CBCT and LM CBCTs. VM CBCT was effective at achieving metal artifact reduction. Depending on the dose-partitioning scheme, LM CBCT demonstrated the potential to improve CNR for low contrast objects compared with single-energy CBCT acquired with equivalent dose. A novel technique was developed to generate VM CBCTs from kV/MV projections. This technique has the potential to improve CNR at selected VM energies and to suppress artifacts at appropriate beam orientations.</p> / Dissertation

Modern image guided radiation therapy involves the use of an isocentrically mounted imaging system to take radiographs of a patient's position before the start of each treatment. Image guidance helps to minimize errors associated with a patients setup, but the radiation dose received by patients from imaging must be managed to ensure no additional risks. The Varian On-Board Imager (OBI) (Varian Medical Systems, Inc., Palo Alto, CA) does not have an automatic exposure control system and therefore requires exposure factors to be manually selected. Without patient specific exposure factors, images may become saturated and require multiple unnecessary exposures. A software based automatic exposure control system has been developed to predict optimal, patient specific exposure factors. The OBI system was modelled in terms of the x-ray tube output and detector response in order to calculate the level of detector saturation for any exposure situation. Digitally reconstructed radiographs are produced via ray-tracing through the patients' volumetric datasets that are acquired for treatment planning. The ray-trace determines the attenuation of the patient and subsequent x-ray spectra incident on the imaging detector. The resulting spectra are used in the detector response model to determine the exposure levels required to minimize detector saturation. Images calculated for various phantoms showed good agreement with the images that were acquired on the OBI. Overall, regions of detector saturation were accurately predicted and the detector response for non-saturated regions in images of an anthropomorphic phantom were calculated to generally be within 5 to 10 % of the measured values. Calculations were performed on patient data and found similar results as the phantom images, with the calculated images being able to determine detector saturation with close agreement to images that were acquired during treatment. Overall, it was shown that the system model and calculation method could potentially be used to predict patients' exposure factors before their treatment begins, thus preventing the need for multiple exposures. / Graduate / 0760 / 0574 / 0756

Monte Carlo (MC) and Pencil Beam (PB) calculations are compared to their measured planar dose distributions using a 2-D diode array for lung Stereotactic Body Radiation Therapy (SBRT). The planar dose distributions were studied for two different phantom types: an in-house heterogeneous phantom and a homogeneous phantom. The motivation is to mimic the human anatomy during a lung SBRT treatment and incorporate heterogeneities into the pre-treatment Quality Assurance process, where measured and calculated planar dose distributions are compared before the radiation treatment. Individual and combined field dosimetry has been performed for both fixed gantry angle (anterior to posterior) and planned gantry angle delivery. A gamma analysis has been performed for all beam arrangements. The measurements were obtained using the 2-D diode array MapCHECK 2™. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection