Ionization chambers (ICs) are the most commonly used detectors for radiation therapy dose measurements. Typical IC measurements use cylindrical ICs in a water phantom and therefore require initial IC alignment to the water surface. This alignment has long been ignored and only recently has a qualitative governing recommendation been made. This thesis describes a reproducible methodology for quantitative ionization chamber water surface alignment. Depth-ionization measurements are taken with twenty-eight IC designs under varying conditions including, but not limited to, changes in scan direction, speed, and resolution, radiation beam type, field size, energy, and electron contamination. Measurements are acquired using standard radiotherapy accelerators in the Virginia Commonwealth University Department of Radiation Oncology and at the National Research Council of Canada, where a customized scanning system capable of better than 0.15 mm IC positioning precision is used. Measurements are also performed with standard commercial scanning equipment on the Accuray CyberKnife, a specialized radiosurgery-class accelerator. An analytical model is developed from basic principles to test the theoretical foundations of IC response near a water surface. The theoretical foundation is further validated via Monte Carlo simulation models that fully account for all details of the ICs used to take measurements. It is determined that the dose gradient as a function of depth is maximized when a given IC reaches the water surface when moving from depth in water. This effect is unchanged under all of the measurement scenarios tested. Measurements taken at 0.1 mm resolution for several seconds per point over several millimeters near the surface will yield a gradient peak that can be used for quantitative alignment. Using developed software, multiple scans at variant resolutions can be stitched into typical clinical scans so as not to significantly affect clinical measurement workflow. The recommended measurement method is developed in a format suitable for inclusion into a clinical protocol for depth-ionization measurement acquisition.

Doctor of Philosophy / Department of Physics / Dean A. Zollman / In this study we explored students' transfer of learning in the X-ray medical imaging context, including the X-ray-based computer-assisted tomography (or CAT). For this purpose we have conducted a series of clinical and teaching interviews. The investigation was a part of a bigger research effort to design teaching-learning materials for pre-medical students who are completing their algebra-based physics course. Our students brought to the discussion pieces of knowledge transferred from very different sources such as their own X-ray experiences, previous learning and the mass media. This transfer seems to result in more or less firm mental models, although often not internally consistent or coherent. Based on our research on pre-med students' models of X-rays we designed a hands-on lab using semi-transparent Lego bricks to model CAT scans. Without "surgery" (i.e. without intrusion into the Lego "body") students determined the shape of an object, which was built out of opaque and translucent Lego bricks and hidden from view. A source of light and a detector were provided upon request. Using a learning cycle format, we introduced CAT scans after students successfully have completed this task. By comparing students' ideas before and after teaching interview with the groups of 2 or 3 participants, we have investigated transfer of learning from basic physics and everyday experience to a complex medical technology and how their peer interactions trigger and facilitate this process. During the last phase of our research we also introduced a CAT-scan simulation problem into our teaching interview routine and compared students' perception of this simulation and their perception of the hands-on activity.

In recent years, small fields have come to play a key role in advanced radiotherapy, yet protocols to perform dosimetry under small field conditions are still in their infancy. In 2008, the IAEA and AAPM published a formalism [Med. Phys. 35, 5179-5186] recommending the use of point-dose correction factors. This thesis uses Monte Carlo simulations to demonstrate that the values of these correction factors depend strongly on both detector design and field size, as well as other variables such as detector off-axis position and detector azimuthal angle. Mass density is found to be the principal determinant of detector water non-equivalence. Furthermore, it is shown that it is possible to compensate for the mass-density of a detector cavity by incorporating additional components of contrasting mass-density into that detector’s design. For small cavities, such design modifications enable the detector’s small- to large- field response ratio to be matched to that of a “point-like” water-structure: ideal detector performance can be achieved across a variety of irradiation conditions. For existing commercial detectors, a Dose Area Product (DAP) formalism is also developed and shown to be much more robust than the point-dose correction factor approach. In conclusion, correction factor values for existing detector designs depend on a host of variables and their calculation typically relies on the use of time-intensive Monte Carlo methods. This thesis indicates that future moves towards density-compensated detector designs or DAP-based protocols can simplify the methodology of small field dosimetry.

A hybrid stochastic-deterministic method, COMET-PE, is developed for dose calculation in radiotherapy. Fast, accurate dose calculation is a key component of successful radiotherapy treatment. To calculate dose, COMET-PE solves the coupled Boltzmann Transport Equations for photons and electrons. The method uses a deterministic iteration to compose response functions that are pre-computed using Monte Carlo. Thus, COMET-PE takes advantage of Monte Carlo physics without incurring the computational costs typically required for statistical convergence. This work extends the method to 3-D problems with realistic source distributions. Additionally, the performance of the deterministic solver is improved, taking advantage of both shared-memory and distributed-memory parallelism to enhance efficiency. To verify the method’s accuracy, it is compared with the DOSXYZnrc (Monte Carlo) method using three different benchmark problems: a heterogeneous slab phantom, a water phantom, and a CT-based lung phantom. For the slab phantom, all errors are less than 1.5% of the maximum dose or less than 3% of local dose. For both the water phantom and the lung phantom, over 97% of voxels receiving greater than 10% of the maximum dose pass a 2% (relative error) / 2 mm (distance-to-agreement) test. Timing comparisons show that COMET-PE is roughly 10-30 times faster than DOSXYZnrc. Thus, the new method provides a fast, accurate alternative to Monte Carlo for dose calculation in radiotherapy treatment planning.

Δεδομένης και της χρήσης της τεχνικής SPECT, ο σκοπός της παρούσας διπλωματικής εργασίας είναι η διερεύνηση του κατά πόσο μπορούν, συνδυαστικά, οι 5 αυτές τεχνικές να δείξουν μία πιο σαφή εικόνα στη διαφορική διάγνωση όγκων του ΚΝΣ. Συνδυάζοντας τα δεδομένα που θα ληφθούν από τις μετρήσεις θα δημιουργηθεί μια μικρή βάση δεδομένων η οποία ως απώτερο στόχο θα έχει τη διεύρυνσή της στο μέλλον και συνεπώς την εξαγωγή ασφαλέστερων συμπερασμάτων. / Combination and evaluation of advanced MR techniques (MRS, DWI, DTI, PWI) and Scintigraphy in the differential diagnosis of Central Nervous System tumors.

Electron beam therapy planning and custom electron bolus design were identified as areas in which improvements in equipment and techniques could lead to significant improvements in treatment delivery and patient outcomes. The electron pencil beam algorithms used in conventional Treatment Planning Systems do not accurately model the dose distribution in irregularly shaped objects, near oblique surfaces or in inhomogeneous media. For this reason, at Christchurch Oncology Centre the TPS is not relied on for planning electron beam treatments. This project is an initial study of ways to improve the design of custom electron bolus, the planning of electron beam therapy, and other radiation therapy simulation tasks, by developing a system for the accurate assessment of dose distributions under irregular contours in clinically relevant situations. A shaped water phantom system and a diode array have been developed and tested. The design and construction of this water phantom dosimetry system are described, and its capabilities and limitations discussed. An EGS/BEAM Monte Carlo simulation system has been installed, and models of the Christchurch Oncology Centre linacs in 6MeV and 9MeV electron beam modes have been built and commissioned. A test was run comparing the EGS/BEAM Monte Carlo system and the CMS Xio conventional treatment planning system with the experimental measurement technique using the water phantom and the diode array. This test was successful as a proof of the concept of the experimental technique. At the conclusion of this project, the main limitation of the diode array system was the lack of data processing software. The array produces a large volume of raw data, but not enough processed data was produced during this project to match the spatial resolution of the computer models. An automated data processing system will be needed for clinical use of the array. It has been confirmed that Monte Carlo and pencil-beam algorithms predict significantly different dose distributions for an irregularly shaped object irradiated with megavoltage electron beams. The results from the diode array were consistent with the theoretical models. This project was an initial investigation. At the time of writing, the diode array and the water phantom systems were still at an early stage of development. The work reported here was performed to build, test and commission the equipment. Additional work will be needed to produce an instrument for clinical use. Research into electron beam therapy could be continued, or the equipment used to expand research into new areas.

3T MRI provides higher signal-to-noise ratio images compared to lower field machines. However, a major drawback of 3T MRI is a higher B1 transmission-field inhomogeneity across the field-of-view compared to imaging at lower fields. B1-field mapping was performed on volunteers using a Philips 3.0T MR scanner and a typical head-first prone patient positioning technique. The B1-field transmitted in the breasts was found to be reduced towards the right side of the body. In some volunteers, the B1-field was reduced to about one-half of the nominal field in the right breast. To minimize the B1 inhomogeneity artefacts, a saturation recovery snapshot FLASH (SRSF) imaging sequence was proposed. Different saturation techniques were assessed. The best saturation efficiency was produced by Hoffmann’s saturation method. By using Hoffmann’s SRSF sequence, the error in the enhancement ratio (ER) can be reduced to about one half compared to imaging obtained using typical FLASH sequence in the presence of a 50% B1-field reduction. Other techniques i.e. bilateral power optimization and a dedicated patient support system were also tested. Both of these approaches produced substantial reductions of the B1 inhomogeneity seen with the standard technique. To address the effects of the native T1 (T10) of different tissues on DCE-MRI, novel enhancement factor indices calculated using SRSF sequence images were introduced and assessed. Computer simulations and gel phantom experiments showed that less error was observed in the indices calculated compared to the ER calculated using the conventional and widely used FLASH sequence. Furthermore, the effect of B1-field inhomogeneity on the novel indices is also reduced. One of the indices proposed is directly related to the contrast agent concentration. The theory and results presented show that the SRSF pulse sequence and the quantification techniques proposed have the potential to improve the accuracy of breast DCE-MRI at 3T.

No description available.

Interstitial and intracavitary brachytherapy plays an essential role in management of several malignancies. However, the achievable accuracy of brachytherapy treatment for prostate and cervical cancer is limited due to the lack of intraoperative planning and adaptive replanning. A major problem in implementing TRUS-based intraoperative planning is an inability of TRUS to accurately localize individual seed poses (positions and orientations) relative to the prostate volume during or after the implantation. For the locally advanced cervical cancer patient, manual drawing of the source positions on orthogonal films can not localize the full 3D intracavitary brachytherapy (ICB) applicator geometry. A new iterative forward projection matching (IFPM) algorithm can explicitly localize each individual seed/applicator by iteratively matching computed projections of the post-implant patient with the measured projections. This thesis describes adaptation and implementation of a novel IFPM algorithm that addresses hitherto unsolved problems in localization of brachytherapy seeds and applicators. The prototype implementation of 3-parameter point-seed IFPM algorithm was experimentally validated using a set of a few cone-beam CT (CBCT) projections of both the phantom and post-implant patient’s datasets. Geometric uncertainty due to gantry angle inaccuracy was incorporated. After this, IFPM algorithm was extended to 5-parameter elongated line-seed model which automatically reconstructs individual seed orientation as well as position. The accuracy of this algorithm was tested using both the synthetic-measured projections of clinically-realistic Model-6711 125I seed arrangements and measured projections of an in-house precision-machined prostate implant phantom that allows the orientations and locations of up to 100 seeds to be set to known values. The seed reconstruction error for simulation was less than 0.6 mm/3o. For the physical phantom experiments, IFPM absolute accuracy for position, polar angle, and azimuthal angel were (0.78 ± 0.57) mm, (5.8 ± 4.8)o, and (6.8 ± 4.0)o, respectively. It avoids the need to match corresponding seeds in each projection and accommodates incomplete data, overlapping seed clusters, and highly-migrated seeds. IFPM was further generalized from 5-parameter to 6-parameter model which was needed to reconstruct 3D pose of arbitrary-shape applicators. The voxelized 3D model of the applicator was obtained from external complex combinatorial geometric modeling. It is then integrated into the forward projection matching method for computing the 2D projections of the 3D ICB applicators, iteratively. The applicator reconstruction error for simulation was about 0.5 mm/2o. The residual 2D registration error (positional difference) between computed and actual measured applicator images was less than 1 mm for the intrauterine tandem and about 1.5 mm for the bilateral colpostats in each detector plane. By localizing the applicator’s internal structure and the sources, the effect of intra and inter-applicator attenuation can be included in the resultant dose distribution and CBCT metal streaking artifact mitigation. The localization accuracy of better than 1 mm and 6o has the potential to support more accurate Monte Carlo-based or 2D TG-43 dose calculations in clinical practice. It is hoped the clinical implementation of IFPM approach to localize elongated line-seed/applicator for intraoperative brachytherapy planning may have a positive impact on the treatment of prostate and cervical cancers.

Blast wave induced traumatic brain injury (bTBI) is a modality of injury that has come into prominence at the current time due to the large number of military and civilian personnel who have experienced the localized shock wave produced by explosive devices. The shock wave will travel concentrically outward from the explosive center, being absorbed and transmitted thru soft objects, such as tissue, and reflecting off stationary obstructions. Transmission and absorption in tissues can result in a number of physiological measureable injuries, the most common of which being what is frequently called “blast lung”. Blast lung involves the spalling effect at air-tissue interfaces. Another documented effect involves the asynchronous motion of tissue, particularly in the cranium, as the shock wave passes by. This predominately manifests itself in what is believed to be diffuse axonal injury and initiation of secondary injury mechanism. This study is designed to explore the relationship between shock waves and bTBI. A blast device was constructed for generating a free field shock wave through the high pressure rupture of a polycarbonate membrane. Air pressure in a small chamber is increased to a value several orders of magnitude greater than ambient air pressure and is held in place with the polycarbonate member. At the rupture of this membrane a shock wave is created. Measurements of this blast event, carried out with a piezoelectric pressure transducer, have shown that this shock wave is reproducible for the different membrane materials tested and is symmetrical with respect to the central axis of the high pressure chamber and exit nozzle. Having characterized the shock wave properties in the blast field, a location was chosen at which maximum shock wave pressure could be applied to the cranium for inducing bTBI. Experiments involving blast wave exposure were performed on two separate groups of animals in an attempt at establishing injury. One group was placed at a fixed distance directly below the blast nozzle, thereby experiencing both the shock wave and the associated air blast from the residual air in the chamber, and one placed at a defined distance off-axis to avoid the air blast, yet receiving two sequential blast exposures. All animal studies were approved by the VCU Institutional Animal Care and Use Committee. The degree of injury was then assessed with the use of magnetic resonance imaging (MRI) and spectroscopy (MRS). Image Data was acquired on a 2.4 Tesla magnet for assessing changes in either the total percent water concentration or the apparent diffusion coefficients (ADC) of selected regions of interest in the brain of rats. Localized proton spectroscopic data was acquired from a voxel placed centrally in the brain. The baseline values of these parameters were established before the induction of bTBI. After the blast exposure, the animals were followed up with MRI and MRS at defined intervals over a period of one week. The first group of animals received blast exposure directly underneath the blast device nozzle and the MR data does suggest changes in some of the measureable parameters from baseline following blast exposure. This blast wave data though is confounded with additional and undesirable characteristics of the blast wave. The second group of animals that received a pure shock wave blast exposure revealed no remarkable changes in the MR data pre- to post- blast exposure. The percent water concentration, ADC and spectroscopic parameters were for statistical purposes identical before and after the blast. The resolution of this negative result will require reconsideration of the free field blast exposure concept.