A prototype system which has integrated a linear accelerator (linac) with a magnetic resonance imager (MRI) has been constructed at the Cross Cancer Institute. The real time operation of a linac-MRI system will require proper radio frequency (RF) shielding such that the MRI images can be acquired without extraneous RF noise from the linac. This thesis reports on the steps taken to successfully RF-shield the linac from the MRI such that the two devices can operate independently of one another. The RF noise from functioning multileaf collimators (MLC) is measured using near field probes and MRI images are acquired with the MLC near the MRI. This included measuring the RF noise as a function of applied magnetic field strength. Several measurement and simulation scenarios are discussed to determine the major sources of RF noise generation from the modulator of a linac. Finally RF power density levels are reported internally and externally to the RF cage which houses the linac and the MRI. The shielding effectiveness of the RF cage has been measured in the frequency range 1 50 MHz and is presented. MRI images of two phantoms are presented during linac operation. The MLC studies illustrate that the small RF noise produced by functioning MLC motors can be effectively shielded to avoid signal-to-noise degradation in the MRI image. A functioning MLC can be incorporated into a linac-MRI unit. The RF noise source investigations of the modulator of a linac illustrate that the major source of RF noise involves the operation of a magnetron. These studies also eliminate the pulse forming network (PFN) coil and the grid voltage spikes on the thyratron as possible major sources of RF noise. The main result is that for linac-MRI systems the modulator of a linac should be housed in a separate RF cage from the MRI. Finally imaging work with the linac operating illustrates that the accelerating structure of a linac and an MRI can be housed within the same RF cage. The 6 MV linac can be operated to produce radiation with no experientially measurable degradation in image quality due to RF effects. / Medical Physics

Intrafraction motion has long been suspected of causing inaccuracies in the resultant dose delivered to the patient. This study attempts to determine how breathing motion affects intact-breast cancer patients for three different treatment techniques commonly used in the clinic: physical wedge compensators (PWs), enhanced dynamic wedges (EDWs), and step-and-shoot intensity modulated radiation therapy (ssIMRT). Some of the effects of intrafraction motion can be eliminated with Gating Therapy. In this study, we have also investigated the efficiency of a Real-Time Position Management Gating System. In order to mimic patient breathing, equipment has been designed to simulate respiratory motion to a first order approximation. A breast phantom has also been designed to represent patient tissue and shape. Film was used as a dosimeter and static dosimetry data were used as a control for comparison. Three velocities of the breast phantom were studied, and Gating Therapy was introduced for each data set. Dose area histograms were calculated for a breast and lung planning target area (PTA), and Normalized Agreement Test (NAT) Indexes were calculated in reference to the static case. Our study shows that the results are dependent on the respiratory rate and the wedge angle and that deviation from the static case is highest if the collimator speed is of the same magnitude as the speed of the target. Generally, there is a large overdosage to the lung PTA and a large underdosage to the breast PTA. However, with the implementation of Gating Therapy, these dose discrepancies are dramatically reduced. The areas of high and low dose within the treatment field observed in this study can be related to other treatment sites affected by respiratory motion. Based on these results, we highly recommend using Gating Therapy for all treatments that may be affected by intrafraction organ motion.

Intrafraction motion has long been suspected of causing inaccuracies in the resultant dose delivered to the patient. This study attempts to determine how breathing motion affects intact-breast cancer patients for three different treatment techniques commonly used in the clinic: physical wedge compensators (PWs), enhanced dynamic wedges (EDWs), and step-and-shoot intensity modulated radiation therapy (ssIMRT). Some of the effects of intrafraction motion can be eliminated with Gating Therapy. In this study, we have also investigated the efficiency of a Real-Time Position Management Gating System. In order to mimic patient breathing, equipment has been designed to simulate respiratory motion to a first order approximation. A breast phantom has also been designed to represent patient tissue and shape. Film was used as a dosimeter and static dosimetry data were used as a control for comparison. Three velocities of the breast phantom were studied, and Gating Therapy was introduced for each data set. Dose area histograms were calculated for a breast and lung planning target area (PTA), and Normalized Agreement Test (NAT) Indexes were calculated in reference to the static case. Our study shows that the results are dependent on the respiratory rate and the wedge angle and that deviation from the static case is highest if the collimator speed is of the same magnitude as the speed of the target. Generally, there is a large overdosage to the lung PTA and a large underdosage to the breast PTA. However, with the implementation of Gating Therapy, these dose discrepancies are dramatically reduced. The areas of high and low dose within the treatment field observed in this study can be related to other treatment sites affected by respiratory motion. Based on these results, we highly recommend using Gating Therapy for all treatments that may be affected by intrafraction organ motion.

External beam radiotherapy is delivered from outside the body aimed at cancer cells to damage their DNA making them unable to divide and reproduce. The beams travel through the body and may damage nearby healthy tissues unless carefully planned. Therefore, the goal of treatment plan optimization is to find the best system configuration to deliver sufficient dose to target structures while avoiding damage to healthy tissues. This thesis investigates optimization approaches for two external beam radiation therapy techniques: Intensity-Modulated Radiation Therapy (IMRT) and Volumetric-Modulated Arc Therapy (VMAT). We develop an automated treatment planning technology for IMRT which generates several high-quality treatment plans satisfying the provided requirements in a single invocation and without human guidance. Our approach is based on an existing linear programming-based fluence map optimization model that approximates dose-volume requirements using conditional value-at-risk (C-VaR) constraints. We show how the parameters of the C-VaR constraints can be used to control various metrics of treatment plan quality. A novel bi-criteria scoring based beam selection algorithm is developed which finds the best beam configuration at least ten times faster for real-life brain, prostate, and head and neck cases as compared to an exact mixed integer programming model. Patient anatomy changes due to breathing during the treatment of lung cancer need to be considered in treatment planning. To date, a single phase of the breathing cycle is typically selected for treatment and radiation is shut-off in other phases. We investigate optimization technology that finds optimal fluence maps for each phase of the breathing cycle by considering the overall dose delivered to a patient using image registration algorithms to track target structures and organs at risk. Because the optimization exploits the opportunities provided in each phase, better treatment plans are obtained. The improvements are shown on a real-life lung case. VMAT is a recent radiation treatment technology which has the potential to provide treatments in less time compared to other delivery techniques. This enhances patient comfort and allows for the treatment of more patients. We build a large-scale mixed-integer programming model for VMAT treatment plan optimization. The solution of this model is computationally prohibitive. Therefore, we develop an iterative MIP-based heuristic algorithm which solves the model multiple times on a reduced set of decision variables. We introduce valid inequalities that decrease solution times, and, more importantly, that identify higher quality integer solutions within specified time limits. Computational studies on a spinal tumor and a prostate tumor case produce clinically acceptable results.

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high- precision radiation therapy that utilizes computer-controlled x-ray accelerators to deliver precise radiation doses to malignant tumors. The radiation dose is designed to conform to the three-dimensional (3-D) shape of a tumor by modulating the intensity of the radiation beam to focus a higher radiation dose to the tumor while minimizing radiation exposure to surrounding normal tissue. One form of IMRT is known as tomotherapy. Tomotherapy achieves dose conformity to a tumor by modulating the intensity of a fan beam of radiation as the source revolves about a patient. Current available tomotherapy machines use x-ray linear accelerators (linacs) as a source of radiation. However, since linacs are technologically complex, the world- wide use of linac-based tomotherapy is limited. This thesis involves an investigation of Cobalt 60 (Co-60) based tomotherapy. The inherent simplicity of Co-60 has the potential to extend the availability of this technique to clinics throughout the world. The goal of this thesis is to generate two-dimensional (2-D) Co-60 tomotherapy con- formal dose distributions with a computer program and experimentally validate them on ¯lm using a ¯rst generation bench-top tomotherapy apparatus. The bench-top apparatus consists of a rotation-translation stage that can mimic a 2-D tomotherapy delivery by translating the phantom across a thin, "pencil- like" photon beam from various beam orientations. In this thesis, several random and clinical patterns are planned using an in-house inverse treatment planning system and are delivered on ¯lm using the tomotherapy technique. The delivered dose plans are compared with the simulated plans using the gamma dose comparison method. The results show a reasonably good agreement between the plans and the measurements, suggesting that Co-60 tomotherapy is indeed capable of providing state-of-the-art conformal dose delivery. / Thesis (Master, Physics, Engineering Physics and Astronomy) -- Queen's University, 2008-04-25 02:20:56.102 / Canadian Institutes of Health Research (CIHR) and the ORDCF’s Ontario Consortium for Image-guided Therapy and Surgery.

No description available.

We explore both robust biologically guided intensity-modulated radiation therapy (BG-IMRT) and pattern recognition to identify responders to cancer treatment for lung cancer. Heterogeneous dose prescriptions that are derived from biological images are subject to uncertainty, due to potential noise in the image. We develop a robust optimization model to design BG-IMRT plans that are de-sensitized to uncertainty. Computational results show improvements in tumor control probability and deviation from prescription dose compared to a non-robust model, while maintaining tissue dose below toxicity levels. We applied machine learning algorithms to 4D gated positron emission tomography/computed tomography (PET/CT) scans. We identified classifiers which could outperform a naive classifier. Our work shows the potential of using machine learning algorithms to predict patient response. This could hopefully lead to more adaptive treatment plans, where the clinician would adapt the treatment based on the prediction provided at certain time intervals in the treatment.

We explore both robust biologically guided intensity-modulated radiation therapy (BG-IMRT) and pattern recognition to identify responders to cancer treatment for lung cancer. Heterogeneous dose prescriptions that are derived from biological images are subject to uncertainty, due to potential noise in the image. We develop a robust optimization model to design BG-IMRT plans that are de-sensitized to uncertainty. Computational results show improvements in tumor control probability and deviation from prescription dose compared to a non-robust model, while maintaining tissue dose below toxicity levels. We applied machine learning algorithms to 4D gated positron emission tomography/computed tomography (PET/CT) scans. We identified classifiers which could outperform a naive classifier. Our work shows the potential of using machine learning algorithms to predict patient response. This could hopefully lead to more adaptive treatment plans, where the clinician would adapt the treatment based on the prediction provided at certain time intervals in the treatment.

Patients with skin lesions of the temple region that have spread to the parotid gland are commonly treated with three-dimensional conformal radiation therapy (3DCRT). 3DCRT has associated limitations when treating this disease. 3DCRT requires this disease site to be treated with two junction regions, resulting in poor dose conformity to the tumour target. Proximity of critical structures to the target volume can make dosimetry difficult, "especially for concave-shaped targets in close proximity to sensitive normal structures" (Saw.C et al., 2002, p76). Intensity modulated radiation therapy (IMRT) is a relatively new treatment technology that has potential to overcome limitations associated with 3DCRT (Garden.A et al., 2004). IMRT has been reported to have significant advantages over conventional 3DCRT treatment, by improving dose to the tumour and lowering doses to critical structures (Adams.E et al., 2001). Research has been conducted into the optimal IMRT treatment for specific head and neck carcinomas. They are identified as class solutions. "A class solution can be defined as the historical experience in designing RT plans for a particular site" (Intensity Modulated Radiation Therapy Collaborative Working, 2001, p913). This study was performed to establish an optimal IMRT class solution for patients with skin lesions of the temple region that have spread to the parotid gland, and to determine if it is the superior treatment option over 3DCRT treatment. Dosimetry planning was performed on computerised tomography data sets of nine patients with this disease site. One optimised 3DCRT dosimetry plan and eight optimised IMRT plans with specific beam arrangements were calculated. Clinical and statistical analysis was performed on; critical structures, conformity indices (CI) and dose volume histogram (DVH) range analysis of the planning target volume (PTV). Analysis of IMRT plans revealed that the 7-beam arrangement and 4-beam ipsilateral arrangement produced significantly lower doses to the majority of critical structures (P < 0.05). The 7-beam IMRT arrangement produced the best and second best CI and DVH PTV results, but these were not significantly different to the majority of other beam arrangements. This indicates that the 7-beam arrangement with defined beam angles of; 40°,120°,160°,200°,240°,300°,0°, is the superior IMRT treatment plan, and thus class solution for this disease site. Clinical analysis confirmed results. Analysis was performed on IMRT class solution results compared with 3DCRT results. CI was significance higher and DVH PTV range was significantly lower for the IMRT class solution (P < 0.05). The class solution delivered significantly higher doses to the majority of critical structures in comparison to the 3DCRT plan (P < 0.05). This indicates that the IMRT class solution is superior to 3DCRT in terms of PTV conformity and homogeneity, but not in terms of doses to critical structures. Skin lesions of the temple region with tumour extension to the parotid gland, is a complicated disease site. Investigations into current and potential radiation therapy treatments will guide treatment options and facilitate outcomes for patients with this disease.

Atualmente a radioterapia de intensidade modulada (IMRT) está sendo implementada em um número crescente de centros no Brasil. Como conseqüência disto, muitas instituições estão enfrentando o problema de executar um programa de controle de qualidade antes e durante a execução do IMRT na prática da rotina clínica. O objetivo deste trabalho é avaliar e propor uma metodologia para o controle de qualidade de tratamentos com IMRT. Uma câmara de ionização e um detector bidimensional foram utilizados para avaliar a dose absoluta total de todos os campos em um determinado ponto. A distribuição de dose relativa total de todos os campos foi medida com filmes radiocrômicos e um detector bidimensional em uma profundidade no objeto simulador. Uma comparação entre as distribuições de dose medidas e calculadas foi realizada usando o método do índice gama, avaliando o percentual de pontos que satisfazem os critérios de diferença dose de ±3% e distância de concordância de ±3 mm. Como resultado da dosimetria absoluta de 113 feixes de IMRT medidos com uma câmara de ionização e 81 feixes usando o detector bidimensional, foi proposto um nível de ação de cerca de ± 5% em relação ao sistema de planejamento e de tratamento para a verificação da dose em um único ponto na região de baixo gradiente de dose. A análise das medições com o detector bidimensional mostrou que o valor da função gama foi <1 para 97,7% dos dados e, para o filme, o valor da função gama foi <1 para 96,6% dos dados. Neste trabalho pode-se concluir que para uma entrega exata de dose em IMRT sliding-window com um colimador micro multilâminas, os parâmetros de dose total absoluta e distribuição de dose total relativa devem ser verificados por dosimetria absoluta e relativa respectivamente. / Intensity modulated radiation therapy (IMRT) is currently been implemented in a rapidly growing number of centers in Brazil. As consequence many institutions are now facing the problem of performing a comprehensive quality control program before and during the implementation of IMRT in the clinical routine practice. The aim of this work is to evaluate and propose a methodology for quality assurance in IMRT treatments. An ionization chamber and a two-dimensional array detector were performed to assess the absolute value of the total dose of all fields in one specific point. The relative total dose distribution of all fields was measured with a radiochromic film and a two-dimensional array at one depth in a phantom. A comparison between measured and calculated dose distributions was performed using the gamma-index method, assessing the percentage of points that meet the criteria of ±3% dose difference and ±3 mm distance to agreement. As a result of 113 tested IMRT beams using ionization chamber and 81 using two-dimensional array, the proposal was to take an action level of about ± 5% compared to the treatment planning systems and measurements, for the verification of the dose in a single point at the low gradient dose region. Analysis of the two-dimensional array measurements showed that the gamma value was <1 for 97.7% of the data and for the film the gamma value was <1 for 96.6% of the data. This can be concluded that for an accurate delivery of dose in sliding-window IMRT with micro multileaf collimator, the absolute value of the total dose and the relative total dose distribution should be checked by absolute and relative dosimetry respectively.