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

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

O desenvolvimento da tecnologia de tomografia computadorizada (TC) trouxe maiores possibilidades em medicina diagnóstica. É um método não invasivo de se explorar o corpo humano detalhadamente. Com o aumento das aplicações em TC, aumenta a preocupação com as altas taxas de dose administradas quando comparada com outras modalidades de diagnóstico por imagem. A comunidade científica e os fabricantes uniram esforços para alcançar níveis menores de dose possíveis, sem comprometer a qualidade da imagem diagnóstica. O maior e relativamente novo avanço nessa busca para diminuir os níveis de dose é o controle automático de exposição (CAE) em TC. Esses sistemas foram projetados para ponderar a distribuição de dose ao longo do comprimento de varredura e entre pacientes, levando em consideração o tamanho e as diferentes densidades de tecidos irradiados. Baseando-se na geometria de aquisição em TC, os sistemas CAE são altamente complexos. Sendo assim, sua forma de funcionamento ainda não é inteiramente conhecida. O presente trabalho tem como objetivo avaliar o desempenho clínico dos sistemas CAE, suas susceptibilidades ao usuário e, com isso, ajudar na otimização de dose em pacientes. A abordagem utilizada para avaliar os sistemas CAE de três dos maiores fabricantes de TC no Brasil, General Electric, Philips e Toshiba, foi pela extração dos valores de corrente anódica do cabeçalho da sequência de imagens no padrão DICOM, medição e análise do ruído das imagens dessas sequências e a medição da distribuição da dose ao longo do comprimento de varredura nas superfícies e dentro de dois simuladores de paciente de formatos diferentes. A variação da corrente anódica de cada equipamento de TC associada à qualidade da imagem resultante fornece o desempenho do sistema CAE. As medições de distribuição de dose fornecem o perfil de dose resultante da modulação de corrente. Medições com e sem o sistema CAE acionado foram feitas para quantificar a importância em termos de dose desses sistemas. Os resultados obtidos permitem otimizações no uso dos sistemas CAE e, consequentemente, a redução da dose no paciente sem comprometer a qualidade diagnóstica da imagem. / The development of the computed tomography (CT) technology has brought wider possibilities on diagnostic medicine. It is a non-invasive method to see the human body in details. As the CT application increases, it raises the concern about patient dose, because the higher dose levels imparted compared to other diagnostic imaging modalities. The radiology community (radiologists, medical physicists and manufacturer) are working together to find the lowest dose level possible, without compromising the diagnostic image quality. The greatest and relatively new advance to lower the patient dose is the automatic exposure control (AEC) systems in CT. These systems are designed to ponder the dose distribution along the patient scanning and between patients taking into account their sizes and irradiated tissue densities. Based on the CT scanning geometry, the AEC-systems are very complex and their functioning is yet not fully understood. This work aims to evaluate the clinical performance of AEC-systems and their susceptibilities to assist on possible patient dose optimizations. The approach to evaluate the AEC-systems of three of the leading CT manufacturers in Brazil, General Electric, Philips and Toshiba, was the extraction of tube current modulation data from the DICOM standard image sequences, measurement and analysis of the image noise of those image sequences and measurement of the dose distribution along the scan length on the surface and inside of two different phantoms configurations. The tube current modulation of each CT scanner associated to the resulted image quality provides the performance of the AEC-system. The dose distribution measurements provide the dose profile due to the tube current modulation. Dose measurements with the AEC-system ON and OFF were made to quantify the impact of these systems regarding patient dose. The results attained give rise to optimizations on the AEC-systems applications and, by consequence, decreases the patient dose without compromising the diagnostic image quality.

Desde o seu desenvolvimento na década de 1970 a tomografia computadorizada (TC) passou por grandes mudanças tecnológicas, tornando-se uma importante ferramenta diagnóstica para a medicina. Consequentemente o papel da TC em diagnóstico por imagem expandiu-se rapidamente, principalmente devido a melhorias na qualidade da imagem e tempo de aquisição. A dose de radiação recebida por pacientes devido a tais procedimentos vem ganhando atenção, levando a comunidade científica e os fabricantes a trabalharem juntos em direção a determinação e otimização de doses. Nas últimas décadas muitas metodologias para dosimetria em pacientes têm sido propostas, baseadas especialmente em cálculos utilizando a técnica Monte Carlo ou medições experimentais com objetos simuladores e dosímetros. A possibilidade de medições in vivo também está sendo investigada. Atualmente as principais técnicas para a otimização da dose incluem redução e/ou modulação da corrente anódica. O presente trabalho propõe uma metodologia experimental para estimativa de doses absorvidas pelos pulmões devido a protocolos clínicos de TC, usando um objeto simulador antropomórfico adulto e dosímetros termoluminescentes de Fluoreto de Lítio (LiF). Sete protocolos clínicos diferentes foram selecionados, com base em sua relevância com respeito à otimização de dose e frequência na rotina clínica de dois hospitais de grande porte: Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad) e Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira (ICESP). Quatro protocolos de otimização de dose foram analisados: Auto mA, Auto + Smart mA, Baixa Dose (BD) e Ultra Baixa Dose (UBD). Os dois primeiros protocolos supracitados buscam redução de dose por meio de modulação da corrente anódica, enquanto os protocolos BD e UBD propõem a redução do valor da corrente anódica, mantendo-a constante. Os protocolos BD e UBD proporcionaram redução de dose de 72,7(8) % e 91(1) %, respectivamente; 16,8(1,3) % e 35,0(1,2) % de redução de dose foram obtidas com os protocolos Auto mA e Auto + Smart mA, respectivamente. As estimativas de dose para os protocolos analisados neste estudo são compatíveis com estudos similares publicados na literatura, demonstrando a eficiência da metodologia para o cálculo de doses absorvidas no pulmão. Sua aplicabilidade pode ser estendida a diferentes órgãos, diferentes protocolos de CT e diferentes tipos de objetos simuladores antropomórficos (pediátricos, por exemplo). Por fim, a comparação entre os valores de doses estimadas para os pulmões e valores de estimativas de doses dependentes do tamanho (Size Specific Dose Estimates SSDE) demonstrou dependência linear entre as duas grandezas. Resultados de estudos similares exibiram comportamentos similares para doses no reto, sugerindo que doses absorvidas pelos uma órgãos podem ser linearmente dependente dos valores de SSDE, com coeficientes lineares específicos para cada órgão. Uma investigação mais aprofundada sobre doses em órgãos é necessária para avaliar essa hipótese. / Since its development in 1970s the computer tomography (CT) technique have gone through major technological advances, becoming an important diagnostic tool in medicine. Consequently the role of CT in diagnostic imaging expanded rapidly, mainly due to improvements in image quality and speed of acquisition. The radiation dose imparted in patients undergoing CT scans has gained attention, leading the radiology community (radiologists, medical physicists and manufacturers) to work together towards dose estimation and optimization. New methodologies for patients dosimetry have been proposed in the past decades, based specially on Monte Carlo calculations or experimental measurements with phantoms and dosimeters. In vivo methodologies are also under investigation. Current dose optimization strategies include mainly tube current reduction and/or tube current modulation. The present work proposes a methodology to experimentally estimate lung absorbed doses due to clinical CT protocols using an adult anthropomorphic phantom and Lithium Fluorite (LiF) thermoluminescent dosimeters (TLD). Seven clinical protocols were selected for phantom irradiation, based on their relevance regarding dose optimization and frequency in two major hospitals routine: the Institute of Radiology from the Medical Faculty from the University of São Paulo (Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo InRad) and the Cancer Institute of the State of São Paulo Octávio Frias de Oliveira (Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira ICESP). Fours thorax protocols for dose optimization were analyzed: Auto mA, Auto + Smart mA, Low Dose (LD) and Ultra Low Dose (ULD) thorax. The first two aforementioned protocols seek dose reduction by tube current modulation, while the last two propose a decrease on the constant tube current value. Values of 72.9(8) % and 91(1) % of lung dose reduction were achieved with LD and ULD protocols, respectively. Auto mA and Auto + Smart mA provided 16.8(1.3) % and 35.0(1.2) % of lung dose reduction, respectively. The results from all analyzed protocols are compatible with similar studies published in literature, demonstrating the efficiency of the methodology to lung absorbed dose estimation. Its applicability could be extended to different organs, different clinical CT protocols and pediatric phantoms. Moreover, comparison of lung absorbed doses and Size Specific Dose Estimates (SSDE) for the studied protocols exhibited a tendency of linear dependency. Results from similar studies demonstrate a similar behavior between rectal doses and SSDE, suggesting that organ absorbed doses and SSDE values may be linearly dependent, with organ-specific linear coefficients. Further investigation in organ doses is necessary to evaluate this assumption.

<p>A novel system has been simulated with accompanying experimental data that is designed to provide spatial information of elemental concentrations at biologically relevant levels. Using a deuterium-deuterium (DD) neutron generator, two large high-purity germanium (HPGe) detectors operating in tandem, and the associated particle imaging (API) technique, elemental iron concentrations as low as 100 ppm have been resolved <i>in vivo</i> in the liver of a simulated reference man with an equivalent dose to the region of interest of < 5 mSv and an estimated whole body dose of 0.82 mSv. Using the Monte Carlo Neutral Particle (MCNP) transport code, achievable spatial resolutions in the projective and depth dimensions of < 1 cm and < 3 cm are achievable, respectively, for iron-containing voxels on the order of 1,000 ppm Fe – with an overall 225 ps system timing resolution, 6.25 mm² imaging plate pixels, and a Gaussian-distributed DD neutron source spot with a diameter of 2 mm. Additionally, as a departure from Monte Carlo simulations, the underlying concepts of fast neutron inelastic scatter analysis as an initial surrogate to true associated particle neutron elemental imaging (APNEI) were demonstrated using a DD neutron generator, iron-made interrogation targets, a sodium iodide detector, and physical neutron/gamma shielding, which yielded an approximate detection limit for iron of 3.45 kg which was simulated to improve to 0.44 kg upon incorporation of the associated particle collimation methodology.</p> The API technique allows concentrations of elements such as iron to be quantified due to time-tagged electronic collimation and corresponding background signal reduction. Inherent to the API process is the collection of spatial and temporal information, which allows the perceived origin of a photon signal to be identified in 3D space. This process was modeled algorithmically in MCNP and employed using relevant equipment and shielding geometries. By leveraging the capabilities of modern-day neutron generator and coincident timing technologies with high throughput signal processing discrimination, the applicability of APNEI to disease diagnostics and etiological research is promising.

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

Intracavitary high dose rate (HDR) brachytherapy is a form of radiation therapy generally in which a post-surgical tissue margin is treated. The dose gradient of HDR brachytherapy is very steep, and thus small displacements of the applicator, even as small as 1 mm, could potentially cause significant variations of dose which could result in undesired side effects such as overdose of a critical organ. In this retrospective dosimetric study, the variation of dose due to various small range motions of gynecological applicators is investigated. The results show that the implementation of additional immobilization and localization devices along with other safety measures needs to be further investigated. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015 / FAU Electronic Theses and Dissertations Collection

Neste trabalho foi desenvolvido um sistema on-line para a avaliação de doses fetais em radiologia diagnóstica, chamado Dose Fetal Web. A metodologia empregada no sistema estima a dose fetal a partir de dados referentes a exames radiológicos realizados pela paciente gestante, ou a partir da monitoração pessoal de uma IOE gestante. Os dados de entrada deste programa são associados às tabelas de coeficientes de conversão de dose uterina para dose fetal, NUD, geradas por meio de simulações pelo método de Monte Carlo. Este sistema incorpora informações de operação de equipamentos de hospitais e clínicas radiológicas acompanhados por um programa de garantia de qualidade, bem como dados reais de parâmetros fetais e maternos coletados durante exames de ultra-sonografia obstétrica. A dose fetal médica, a dose fetal ocupacional e os riscos radiológicos associados a estas exposições foram avaliados por meio de estudos de casos simulados usando o sistema on-line. No caso hipotético de uma gestante ocupacionalmente exposta (IOE), foi avaliada uma base de dados reais de serviços de hemodinâmica. Além disso, a distribuição de cargas de trabalho de salas de cateterismo cardíaco foi incorporada ao modelo matemático. Estas duas metodologias foram implementadas na avaliação da dose fetal ocupacional, a fim de avaliar estes casos particulares de exposição, que oferecem níveis mais altos de doses ocupacionais aos profissionais expostos. / In this work, an online system called Dose Fetal Web was developed for the evaluation of fetal doses in diagnostic radiology. The methodology used in this system estimates the fetal dose from data related to radiologic diagnostic examinations of a pregnant patient, or from the routine individual monitoring dosimetry of a pregnant worker. The input data of this program are associated to the conversion-coefficients tables of uterine to fetal dose, NUD, generated by means of Monte Carlo simulations. This system incorporates operational information of equipment in hospitals and radiological facilities which are attended by a quality assurance program, as well as real maternal and fetal parameter data collected during obstetric ultrasound.The fetal dose from both medical and occupational exposures of the pregnant woman, as well as the risks associated with these exposures, were evaluated by means of simulated case studies using the on-line system. In the hypothetical case of an occupationally-exposed pregnant worker, a real database regarding routine individual monitoring dosimetry in Cath Lab facilities was evaluated. Moreover, the workload spectrum of a cardiac angiographic room was incorporated into the mathematical model. These two methodologies were used in the evaluation of the occupational fetal dose, in order to evaluate these particular cases of exposure, which offer higher occupational dose levels to the exposed staff.

Orientador: Daniela Renata Cantane / Resumo: A escolha do conjunto de feixes e a intensidade de dose a ser depositada nos tecidos são problemas de suma importância para se obter um eficiente planejamento da radioterapia, uma vez que o melhor conjunto de feixes é escolhido de maneira que haja uma melhor distribuição de dose no tumor e proteção das células sadias. Para um melhor planejamento, diversos modelos de otimização estão sendo propostos utilizando metaheurísticas e/ou métodos exatos para a resolução dos mesmos. Este trabalho consiste em propor um modelo de programação não linear inteiro misto para escolha de feixes e intensidade de dose de irradiação baseado em um modelo de programação linear da literatura. Para a escolha do conjunto de feixes, foram propostas duas metaheurísticas (Busca Tabu e Busca em Vizinhança Variável), já para o problema de intensidade de dose, foram utilizados métodos exatos (Método de Pontos Interiores Barreira Logarítmica, Primal Simplex e Dual Simplex). Os métodos exatos foram integrados a ambas metaheurísticas e foram aplicados em $4$ casos reais de tumor de próstata utilizando imagens de tomografia computadorizada. Os resultados obtidos através dessas mateheurísticas foram analisados e comparados quanto ao tempo computacional, quantidade de iterações e função objetivo. Conclui-se que o modelo proposto foi eficiente para o planejamento da radioterapia. / Abstract: The beam set choice and dose intensity to be deposited in all tissues are essential problems to obtain an efficient radiotherapy planning, since the best beam set is chosen in a way to achieve the best dose distribution in tumor, protecting the surrounding cells to absorb high dose amount. To a better treatment plan, some optimization models have been proposed using metaheuristic algorithms and/or exact methods to solve them. This thesis consists on proposing a mixed integer non linear programming model to beam choice and dose intensity based on a linear programming model from the literature. To beam set choice problem, two metaheuristic algorithms were proposed (Tabu Search and Variable Neighbourhood Search), and to intensity dose absorption problem, were used three exact methods (Log Barrier Interior Point Method, Primal Simplex and Dual Simplex). The exact methods were integrated with both metaheuristic algorithm and applied in $4$ real prostate cases using computerized tomography image. The results from the applied matheuristic were analysed and compared in terms of computational time, number of interactions and objective function. Concluding that the proposed model was efficient to radiotherapy planning. / Mestre