Patients receiving Intensity Modulated Radiation Therapy (IMRT) for late stage head and neck (HN) cancer often experience anatomical changes due to weight loss, tumor regression, and positional changes of normal anatomy (1). As a result, the actual dose delivered may vary from the original treatment plan. The purpose of this study was (a) to evaluate the dosimetric consequences of the parotid glands during the course of treatment, and (b) to determine if there would be an optimal timeframe for replanning. Nineteen locally advanced HN cancer patients underwent definitive IMRT. Each patient received an initial computerized tomography simulation (CT-SIM) scan and weekly cone beam computerized tomography (CBCT) scans. A Deformable Image Registration (DIR) was performed between the CT-SIM and CBCT of the parotid glands and Planning Target Volumes (PTVs) using the Eclipse treatment planning system (TPS) and the Velocity deformation software. A recalculation of the dose was performed on the weekly CBCTs using the original monitor units. The parameters for evaluation of our method were: the changes in volume of the PTVs and parotid glands, the dose coverage of the PTVs, the lateral displacement in the Center of Mass (COM), the mean dose, and Normal Tissue Complication Probability (NTCP) of the parotid glands. The studies showed a reduction of the volume in the PTVs and parotids, a medial displacement in COM, and alterations of the mean dose to the parotid glands as compared to the initial plans. Differences were observed for the dose volume coverage of the PTVs and NTCP of the parotid gland values between the initial plan and our proposed method utilizing deformable registration-based dose calculations. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

The purpose of this study is to investigate the changes of the pericardial dose at different respiratory phases and statuses in accelerated partial breast irradiation (APBI) using Cyberknife M6™ multileaf collimators (CK-MLC). Anonymous 6 female patient files with respiration gated four-dimensional computed tomography (4DCT) sets, and 6 left breast cancer cases with CT images in free-breathing (FB) and deep inhalation breath-hold (BH) were selected. One CT image set from each patient was planned for APBI in Accuray Multiplan™ 5.2, and respectively compared its pericardial dose with those from CT sets of other respiratory phases. All the comparable CT images were fused in the planning system according to the left chest wall, among which the lung gap anterior to the pericardium varies by the lung expansion. For the purpose of this study, the tumor volume was outlined in the media-lower quadrant of the left breast where this lung gap is relatively small. All the plans in this study met the requirements set by the National Surgical Adjuvant Breast and Bowel Project/Radiation Therapy Oncology Group (NSABP/RTOG), specifically protocol B-39/RTOG 0413. From the comparisons in this investigation, the mean relative pericardial dose of the BH CT group showed significant or 45% (p < 0.01) lower value than that of FB CT group. However, in FB 4DCT group, 3 of 6 cases indicated a meaningful reduction (p < 0.05) in 100% inhalation phase when compared with the mean dose over other phases. The inconsistent pericardial doses were displayed in FB 4DCT group due to minimal changes in the anterior lung gap of the pericardium, when the diaphragmatic breathing was dominant in those patients. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

As técnicas radioterápicas evoluíram muito nas últimas décadas, destacando-se a utilização de feixes segmentados por colimadores de multifolhas, os quais permitem entregar maior quantidade de dose com maior precisão espacial. Os sistemas de planejamento em radioterapia (TPS), entretanto, são em grande parte fechados, com acesso restrito aos parâmetros de cálculo de dose. Desta forma, o presente trabalho teve como principal objetivo comparar valores de dose envolvidas em tratamentos radioterápicos, medidos com a técnica de dosimetria termoluminescente (TL), usando um objeto simulador antropomórfico (Alderson Rando Phantom - ARP) como paciente, com valores de referência extraídos dos TPS em simulações realistas de tratamento. O objeto simulador continha dosímetros TL de LiF (TLD100) posicionados na pelve, no tórax, na cabeça e no pescoço, a fim de que fossem monitoradas regiões com dose homogênea (como no volume alvo planejado - PTV), regiões com gradiente de dose e regiões afastadas do PTV. As irradiações foram feitas usando técnicas de radioterapia conformacional 3D e radioterapia por modulação da intensidade do feixe (IMRT). Quatro TPS foram utilizados: CadPlan, ECLIPSE, Helax-TMS e KonRad. Em algumas situações utilizaram-se algoritmos de cálculo implementados pelos fabricantes nos TPS; dois deles baseados em correção de heterogeneidades (Batho e pencil beam) e um deles baseado em convolução e superposição de feixes simulados (collapsed cone). Nos casos de irradiações com IMRT os algoritmos foram sempre usados. Paralelamente ao uso do ARP, utilizou-se um objeto simulador com água com objetivo de verificar o comportamento dos dosímetros TL expostos a feixes de fótons de alta energia, em comparação com câmaras de ionização cilíndricas do tipo Farmer (volume interno de 0,6 cm3). Além disso, esse objeto simulador possibilitou garantir a qualidade de suportes desenvolvidos para a câmara e para os dosímetros, nos casos de medidas em água. A irradiação da pelve do objeto simulador ARP, região com poucas heterogeneidades, revelou que o comportamento do material que o constitui é equivalente ao da água e, por isso, pode ser usado na simulação de tecido humano em feixes de radioterapia. Simulações de tratamentos revelaram compatibilidade entre valores medidos e planejados no interior do PTV, com discrepâncias menores que 2%; valores que estão dentro dos limites estabelecidos pelo ICRU62 (+7%/-5%, 2?). Nas regiões afastadas do PTV, todos os códigos de planejamento apresentaram discrepâncias relativamente grandes, evidenciando limitações no cálculo de componentes secondárias. Apesar dos algoritmos de cálculo aumentarem a concordância entre doses medidas e planejadas, não foi possível identificar diferenças entre os algoritmos pencil beam e collapsed cone. Em regiões onde havia alto gradiente de dose, as discrepâncias se tornam maiores devido à dificuldade em posicionar os dosímetros no mesmo ponto em que o cálculo é feito. Sistematicamente, observou-se que a técnica para radioterapia 3D apresenta valores de dose dentro dos limites preestabelecidos, enquanto IMRT mostra valores com maior exatidão. / The last decades noticed a massive improvement in radiotherapy techniques and the use of segmented beams produced by multileaf collimators. However, the dose radiation therapy planning systems (TPS) in use are characterized by the restriction of access to the calculation algorithms. The aim of this work was to compare dose values measured in an anthropomorphic phantom (Alderson Rando Phantom - ARP) to the reference dose values obtained from the TPS in real case simulations of radiotherapy treatments. Thermoluminescent dosimetry (TLD) technique was used to evaluate the doses. LiF dosimeters (TLD100) were positioned on the phantom pelvis, thorax, head and neck at homogeneous dose regions, as the Planned Target Volume (PTV), gradient dose regions, and areas far from PTV. The doses were delivered using two techniques, 3D conformal radiotherapy and Intensity Modulated Radiation Therapy (IMRT). Four TPS were used: CadPlan, ECLIPSE, Helax-TMS and KonRad. In several situations, calculation algorithms implemented in these planning systems were employed to take heterogeneities into account: two of them were correction-based algorithms (Batho and Pencil Beam) and one of them based in beam convolution-superposition (Collapsed Cone). Furthermore, a liquid water phantom was used to compare the TLD behavior to the Farmer thimble chamber (0,6 cc internal volume) results when exposed to high-energy photon beams. It was also possible to verify the quality of the PMMA supports that wer used in the calibration of the dosimeters on clinical beam, obtaining reliable results. Both the ARP pelvis and a water phantom showed similar behavior under irradiation, indicating that, in highly homogenous regions, the ARP material can be used to simulate human soft tissues under radiotherapy treatment. Inside the PTV, the dosimetry performed in the ARP, showed compatibility between measured and planned dose values, with discrepancies smaller than 2%, which are within the ICRU62 fixed limits (+7%/-5%, 2?). When the algorithms were used, a better agreement between the experimental and planned doses was achieved, but it was not possible to discriminate the Pencil Beam and Collapsed Cone algorithms. In regions with large dose gradients, the discrepancies between experimental and planned dose values are higher as the difficulties the position of the dosimeters are more critical. The measured doses, when the 3D radiotherapy technique was used, were within the ICRU62 pre-established limits whereas the IMRT technique provider more accurate values.

Thesis (Ph. D.)--M.I.T., Harvard-MIT Division of Health Sciences and Technology Program in Medical Engineering and Medical Physics, 1985. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIECNE. / Vita. / Includes bibliographical references. / by David William Carley. / Ph.D.

Thesis (Ph.D.)--Harvard--Massachusetts Institute of Technology Division of Health Sciences and Technology Program in Medical Engineering and Medical Physics, 1984. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE. / Bibliography: leaves 193-202. / by David Albert Sebok. / Ph.D.

Thesis (Ph.D.)--Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology Program in Medical Engineering and Medical Physics, 1983. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE. / Bibliography: leaves 120-122. / by Jose Gabriel Venegas T. / Ph.D.

Thesis (Ph.D.)--Harvard--Massachusetts Institute of Technology Division of Health Sciences and Technology Program in Medical Engineering and Medical Physics, 1983. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE. / Bibliography: leaves 200-214. / by Tamar Yashin-Flash. / Ph.D.

Thesis (Ph.D.)--Harvard-Massachusetts Institute of Technology, Division of Health Sciences and Technology, Program in Medical Engineering and Medical Physics, 1984. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE. / Includes bibliographical references. / by Edward Patrick Ingenito. / Ph.D.

This thesis explores learning in clinical practice in the cases of CT, MRI and PACS in UK hospitals. It asks the questions of how and why certain evolutionary features of technology condition learning and change in medical contexts. Using an evolutionary perspective of cognitive and social aspects of technological change, this thesis explores the relationships between technology and organisational learning processes of intuition, interpretation, integration and institutionalisation. Technological regimes are manifested in routines, skills and artefacts, and dynamically evolve with knowledge accumulation processes at the individual, group and organisational levels. Technological change increases the uncertainty and complexity of organisational learning, making organisational outcomes partially unpredictable. Systemic and emergent properties of medical devices such as CT and MRI make learning context-specific and experimental. Negotiation processes between different social groups shape the role and function of an artefact in an organisational context. Technological systems connect artefacts to other parts of society, mediating values, velocity and directionality of change. Practice communities affect how organisations deal with this complexity and learn. These views are used to explore the accumulation of knowledge in clinical practices in CT, MRI and PACS. This thesis develops contextualised theory using a case-study approach to gather novel empirical data from over 40 interviews with clinical, technical, managerial and administrative staff in five NHS hospitals. It uses clinical practice (such as processes, procedures, tasks, rules, interpretations and routines) as a unit of analysis and CT, MRI and PACS technology areas as cases. Results are generalised to evolutionary aspects of technological learning and change provided by the framework, using processes for qualitative analysis such as ordering and coding. When analysed using an evolutionary perspective of technology, the findings in this thesis suggest that learning in clinical practice is diverse, cumulative and incremental, and shaped by complex processes of mediation, by issues such as disease complexity, values, external rules and choice restrictions from different regimes, and by interdisciplinary problem-solving in operational routines.

Thesis (Ph.D.)--Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology Program in Medical Engineering and Medical Physics, 1983. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE. / Includes bibliographical references. / by Dennis P. Orgill. / Ph.D.