Anders Ahnesjö - Academia.edu (original) (raw)
Papers by Anders Ahnesjö
Frontiers in Oncology
PurposeDose painting (DP) is a radiation therapy (RT) strategy for patients with heterogeneous tu... more PurposeDose painting (DP) is a radiation therapy (RT) strategy for patients with heterogeneous tumors delivering higher dose to radiation resistant regions and less to sensitive ones, thus aiming to maximize tumor control with limited side effects. The success of DP treatments is influenced by the spatial accuracy in dose delivery. Adaptive RT (ART) workflows can reduce the overall geometric dose delivery uncertainty. The purpose of this study is to dosimetrically compare ART and non-adaptive conventional RT workflows for delivery of DP prescriptions in the treatment of prostate cancer (PCa).Materials and methodsWe performed a planning and treatment simulation study of four study arms. Adaptive and conventional workflows were tested in combination with DP and Homogeneous dose. We used image data from 5 PCa patients that had been treated on the Elekta Unity MR linac; the patients had been imaged in treatment position before each treatment fraction (7 in total). The local radiation se...
The concept of in-air output ratio (Sc) was introduced to characterize how the incident photon fl... more The concept of in-air output ratio (Sc) was introduced to characterize how the incident photon fluence per monitor unit (or unit time for a Co-60 unit) varies with collimator settings.1, 2 This quantity is also called in-air output factor,3 collimator-scatter factor,4 and headscatter factor.5, 6 The latter two names were somewhat misleading since they emphasized a single component of the output ratio. We retained the symbol Sc
Towards automated and personalized organ dose determination in CT examinations – influence of tis... more Towards automated and personalized organ dose determination in CT examinations – influence of tissue data representations for Monte Carlo dose calculation with a Therapy Planning System
Probabilistic (or robust) optimization is an alternative to margins for handling geometrical unce... more Probabilistic (or robust) optimization is an alternative to margins for handling geometrical uncertainties in treatment planning of radiotherapy where the uncertainties are explicitly incorporated ...
Medical Physics, 2021
Conflict of interest The Chair of the [TG-155, Indra J Das] has reviewed the required Conflict of... more Conflict of interest The Chair of the [TG-155, Indra J Das] has reviewed the required Conflict of Interest statement on file for each member of [TG-155] and determined that disclosure of potential Conflicts of Interest is an adequate management plan. Disclosures of potential Conflicts of Interest for each member of [TG-155] are found at the close of this document but there is no COI.
Journal of Applied Clinical Medical Physics, 2021
Abstract Patient breathing during lung cancer radiotherapy reduces the ability to keep a sharp do... more Abstract Patient breathing during lung cancer radiotherapy reduces the ability to keep a sharp dose gradient between tumor and normal tissues. To mitigate detrimental effects, accurate information about the tumor position is required. In this work, we evaluate the errors in modeled tumor positions over several fractions of a simple tumor motion model driven by a surface surrogate measure and its time derivative. The model is tested with respect to four different surface surrogates and a varying number of surrogate and image acquisitions used for model training. Fourteen patients were imaged 100 times with cine CT, at three sessions mimicking a planning session followed by two treatment fractions. Patient body contours were concurrently detected by a body surface laser scanning system BSLS from which four surface surrogates were extracted; thoracic point TP, abdominal point AP, the radial distance mean RDM, and a surface derived volume SDV. The motion model was trained on session 1 and evaluated on sessions 2 and 3 by comparing modeled tumor positions with measured positions from the cine images. The number of concurrent surrogate and image acquisitions used in the training set was varied, and its impact on the final result was evaluated. The use of AP as a surface surrogate yielded the smallest error in modeled tumor positions. The mean deviation between modeled and measured tumor positions was 1.9 mm. The corresponding deviations for using the other surrogates were 2.0 mm (RDM), 2.8 mm (SDV), and 3.0 mm (TP). To produce a motion model that accurately models the tumor position over several fractions requires at least 10 simultaneous surrogate and image acquisitions over 1–2 minutes.
Medical Physics, 2021
Irregular breathing may compromise the treated volume for free-breathing lung cancer patients dur... more Irregular breathing may compromise the treated volume for free-breathing lung cancer patients during radiotherapy. We try to find a measure based on a breathing amplitude surrogate that can be used to select the patients who need further investigation of tumor motion to ensure that the internal target volume (ITV) provides reliant coverage of the tumor. Material and methods: Fourteen patients were scanned with four-dimensional computed tomography (4DCT) during free-breathing. The breathing motion was detected by a pneumatic bellows device used as a breathing amplitude surrogate. In addition to the 4DCT, a breath-hold (BH) scan and three cine CT imaging sessions were acquired. The cine images were taken at randomized intervals at a rate of 12 per minute for 8 minutes to allow tumor motion determination during a typical hypo-fractionated treatment scenario. A clinical target volume (CTV) was segmented in the BH CT and propagated over all cine images and 4DCT bins. The center-of-volume of the translated CTV (CTV COV) in the ten 4DCT bins were interconnected to define the 4DCT determined tumor trajectory (4DCT-TT). The volume of CTV inside ITV for all cine CTs was calculated and reported at the 10th percentile (V CTV10%). The deviations between CTV COV in the cine CTs and the 4DCT-TT were calculated and reported at its 90th percentile (d 90%). The standard deviation of the bellows amplitude peaks (SDP) and the ratio between large and normal inspirations, κ rel , were tested as surrogates for V CTV10% and d 90%. Results: The values of d 90% ranged from 0.6 to 5.2 mm with a mean of 2.2 mm. The values of V CTV10% ranged from 59-93% with a mean of 78 %. The SDP had a moderate correlation (r = 0.87) to d 90%. Less correlation was seen between SDP and V CTV10% (r = 0.77), κ rel and d 90% (r = 0.75) and finally κ rel and V CTV10% (r = 0.75). Conclusions: The ITV coverage had a large variation for some patients. SDP seems to be a feasible surrogate measure to select patients that needs further tumor motion determination.
Acta Oncologica, 2020
Ahnesjö (2020): Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gl... more Ahnesjö (2020): Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gleason score mappings-what is the potential to increase the tumor control probability?, Acta Oncologica,
Acta Oncologica, 2017
Background: Gleason scores for prostate cancer correlates with an increased recurrence risk after... more Background: Gleason scores for prostate cancer correlates with an increased recurrence risk after radiotherapy (RT). Furthermore, higher Gleason scores correlates with decreasing apparent diffusion coefficient (ADC) data from diffusion weighted MRI (DWI-MRI). Based on these observations, we present a formalism for dose painting prescriptions of prostate volumes based on ADC images mapped to Gleason score driven dose-responses. Methods: The Gleason score driven dose-responses were derived from a learning data set consisting of pre-RT biopsy data and post-RT outcomes for 122 patients treated with a homogeneous dose to the prostate. For a test data set of 18 prostate cancer patients with pre-RT ADC images, we mapped the ADC data to the Gleason driven dose-responses by using probability distributions constructed from published Gleason score correlations with ADC data. We used the Gleason driven dose-responses to optimize dose painting prescriptions that maximize the tumor control probability (TCP) with equal average dose as for the learning sets homogeneous treatment dose. Results: The dose painting prescriptions increased the estimated TCP compared to the homogeneous dose by 0-51% for the learning set and by 4-30% for the test set. The potential for individual TCP gains with dose painting correlated with increasing Gleason score spread and larger prostate volumes. The TCP gains were also found to be larger for patients with a low expected TCP for the homogeneous dose prescription. Conclusions: We have from retrospective treatment data demonstrated a formalism that yield ADC driven dose painting prescriptions for prostate volumes that potentially can yield significant TCP increases without increasing dose burdens as compared to a homogeneous treatment dose. This motivates further development of the approach to consider more accurate ADC to Gleason mappings, issues with delivery robustness of heterogeneous dose distributions, and patient selection criteria for design of clinical trials.
Radiation Research, 2018
BioOne Complete (complete.BioOne.org) is a full-text database of 200 subscribed and open-access t... more BioOne Complete (complete.BioOne.org) is a full-text database of 200 subscribed and open-access titles in the biological, ecological, and environmental sciences published by nonprofit societies, associations, museums, institutions, and presses.
Medical Physics, 2018
To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatme... more To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatment planning in the head and neck (H&N) area. Methods: An anthropomorphic head phantom with removable metallic implants (dental fillings or neck implant) was CT-scanned to evaluate the O-MAR (Philips) and the iMAR (Siemens) algorithms. Reference images were acquired without any metallic implants in place. Water equivalent thickness (WET) was calculated for different path directions and compared between image sets. Images were also evaluated for use in proton treatment planning for parotid, tonsil, tongue base, and neck node targets. The beams were arranged so as to not traverse any metal prior to the target, enabling evaluation of the impact on dose calculation accuracy from artifacts surrounding the metal volume. Plans were compared based on c analysis (1 mm distanceto-agreement/1% difference in local dose) and dose volume histogram metrics for targets and organs at risk (OARs). Visual grading evaluation of 30 dental implant patient MAR images was performed by three radiation oncologists. Results: In the dental fillings images, DWET along a low-density streak was reduced from À17.0 to À4.3 mm with O-MAR and from À16.1 mm to À2.3 mm with iMAR, while for other directions the deviations were increased or approximately unchanged when the MAR algorithms were used. For the neck implant images, DWET was generally reduced with MAR but residual deviations remained (of up to À2.3 mm with O-MAR and of up to À1.5 mm with iMAR). The c analysis comparing proton dose distributions for uncorrected/MAR plans and corresponding reference plans showed passing rates >98% of the voxels for all phantom plans. However, substantial dose differences were seen in areas of most severe artifacts (c passing rates of down to 89% for some cases). MAR reduced the deviations in some cases, but not for all plans. For a single patient case dosimetrically evaluated, minor dose differences were seen between the uncorrected and MAR plans (c passing rate approximately 97%). The visual grading of patient images showed that MAR significantly improved image quality (P < 0.001). Conclusions: O-MAR and iMAR significantly improved image quality in terms of anatomical visualization for target and OAR delineation in dental implant patient images. WET calculations along several directions, all outside the metallic regions, showed that both uncorrected and MAR images contained metal artifacts which could potentially lead to unacceptable errors in proton treatment planning. DWET was reduced by MAR in some areas, while increased or unchanged deviations were seen for other path directions. The proton treatment plans created for the phantom images showed overall acceptable dose distributions differences when compared to the reference cases, both for the uncorrected and MAR images. However, substantial dose distribution differences in the areas of most severe artifacts were seen for some plans, which were reduced by MAR in some cases but not all. In conclusion, MAR could be beneficial to use for proton treatment planning; however, case-by-case evaluations of the metal artifact-degraded images are always recommended.
Physics in Medicine & Biology, 2016
A discrepancy between the Monte Carlo derived relative standard deviation σ z rel (microdosimetri... more A discrepancy between the Monte Carlo derived relative standard deviation σ z rel (microdosimetric spread) and experimental data was reported by Villegas et al (2013 Phys. Med. Biol. 58 6149-62) suggesting wall effects as a plausible explanation. The comment by Lindborg et al (2015 Phys. Med. Biol. 60 8621-4) concludes that this is not a likely explanation. A thorough investigation of the Monte Carlo (MC) transport code used for track simulation revealed a critical bug. The corrected MC version yielded σ z rel values that are now within experimental uncertainty. Other microdosimetric findings are hereby communicated.
Medical Physics, 2018
PURPOSE Computed tomography (CT) is a versatile tool in diagnostic radiology with rapidly increas... more PURPOSE Computed tomography (CT) is a versatile tool in diagnostic radiology with rapidly increasing number of examinations per year globally. Routine adaption of the exposure level for patient anatomy and examination protocol cause the patients' exposures to become diversified and harder to predict by simple methods. To facilitate individualized organ dose estimates, we explore the possibility to automate organ dose calculations using a radiotherapy treatment planning system (TPS). In particular, the mapping of CT number to elemental composition for Monte Carlo (MC) dose calculations is investigated. METHODS Organ dose calculations were done for a female thorax examination test case with a TPS (Raystation™, Raysearch Laboratories AB, Stockholm, Sweden) utilizing a MC dose engine with a CT source model presented in a previous study. The TPS's inherent tissue characterization model for mapping of CT number to elemental composition of the tissues was calibrated using a phantom with known elemental compositions and validated through comparison of MC calculated dose with dose measured with Thermo Luminescence Dosimeters (TLD) in an anthropomorphic phantom. Given the segmentation tools of the TPS, organ segmentation strategies suitable for automation were analyzed for high contrast organs, utilizing CT number thresholding and model-based segmentation, and for low contrast organs utilizing water replacements in larger tissue volumes. Organ doses calculated with a selection of organ segmentation methods in combination with mapping of CT numbers to elemental composition (RT model), normally used in radiotherapy, were compared to a tissue characterization model with organ segmentation and elemental compositions defined by replacement materials [International Commission on Radiological Protection (ICRP) model], frequently favored in imaging dosimetry. RESULTS The results of the validation with the anthropomorphic phantom yielded mean deviations from the dose to water calculated with the RT and ICRP model as measured with TLD of 1.1% and 1.5% with maximum deviations of 6.1% and 8.7% respectively over all locations in the phantom. A strategy for automated organ segmentation was evaluated for two different risk organ groups, that is, low contrast soft organs and high contrast organs. The relative deviation between organ doses calculated with the RT model and with the ICRP model varied between 0% and 20% for the thorax/upper abdomen risk organs. CONCLUSIONS After calibration, the RT model in the TPS provides accurate MC dose results as compared to measurements with TLD and the ICRP model. Dosimetric feasible segmentation of the risk organs for a female thorax demonstrates a possibility for automation using the segmentation tool available in a TPS for high contrast organs. Low contrast soft organs can be represented by water volumes, but organ dose to the esophagus and thyroid must be determined using standardized organ shapes. The uncertainties of the organ doses are small compared to the overall uncertainty, at least an order of magnitude larger, in the estimates of lifetime attributable risk (LAR) based on organ doses. Large-scale and automated individual organ dose calculations could provide an improvement in cancer incidence estimates from epidemiological studies.
![Research paper thumbnail of Corrigendum to “Dose painting by numbers based on retrospectively determined recurrence probabilities” [Radiother Oncol 122 (2017) 236–241]](https://attachments.academia-assets.com/95111109/thumbnails/1.jpg)
](Radiotherapy and Oncology, 2018
Radiotherapy and Oncology, 2017
Background and purpose: The aim of this study is to derive ''dose painting by numbers" prescripti... more Background and purpose: The aim of this study is to derive ''dose painting by numbers" prescriptions from retrospectively observed recurrence volumes in a patient group treated with conventional radiotherapy for head and neck squamous cell carcinoma. Materials and methods: The spatial relation between retrospectively observed recurrence volumes and pre-treatment standardized uptake values (SUV) from fluorodeoxyglucose positron emission tomography (FDG-PET) imaging was determined. Based on this information we derived SUV driven dose-response functions and used these to optimize ideal dose redistributions under the constraint of equal average dose to the tumor volumes as for a conventional treatment. The response functions were also implemented into a treatment planning system for realistic dose optimization. Results: The calculated tumor control probabilities (TCP) increased between 0.1-14.6% by the ideal dose redistributions for all included patients, where patients with larger and more heterogeneous tumors got greater increases than smaller and more homogeneous tumors. Conclusions: Dose painting prescriptions can be derived from retrospectively observed recurrence volumes spatial relation to pre-treatment FDG-PET image data. The ideal dose redistributions could significantly increase the TCP for patients with large tumor volumes and large spread in SUV from FDG-PET. The results yield a basis for prospective studies to determine the clinical value for dose painting of head and neck squamous cell carcinomas.
Medical Physics, 2016
Purpose: Radiation dose to patients undergoing examinations with Multislice Computed Tomography (... more Purpose: Radiation dose to patients undergoing examinations with Multislice Computed Tomography (MSCT) as well as Cone Beam Computed Tomography (CBCT) is a matter of concern. Risk management could benefit from efficient replace rational dose calculation tools. The paper aims to verify MSCT dose calculations using a Treatment Planning System (TPS) for radiotherapy and to evaluate four different variations of bow-tie filter characterizations for the beam model used in the dose calculations. Methods: A TPS (RayStation™, RaySearch Laboratories, Stockholm, Sweden) was configured to calculate dose from a MSCT (GE Healthcare, Wauwatosa, WI, USA). The x-ray beam was characterized in a stationary position the by measurements of the Half-Value Layer (HVL) in aluminum and kerma along the principal axes of the isocenter plane perpendicular to the beam. A Monte Carlo source model for the dose calculation was applied with four different variations on the beam-shaping bow-tie filter, taking into account the different degrees of HVL information but reconstructing the measured kerma distribution after the bow-tie filter by adjusting the photon sampling function. The resulting dose calculations were verified by comparison with measurements in solid water as well as in an anthropomorphic phantom. Results: The calculated depth dose in solid water as well as the relative dose profiles was in agreement with the corresponding measured values. Doses calculated in the anthropomorphic phantom in the range 26-55 mGy agreed with the corresponding thermo luminescence dosimeter (TLD) measurements. Deviations between measurements and calculations were of the order of the measurement uncertainties. There was no significant difference between the different variations on the bow-tie filter modeling. Conclusions: Under the assumption that the calculated kerma after the bow-tie filter replicates the measured kerma, the central specification of the HVL of the x-ray beam together with the kerma distribution can be used to characterize the beam. Thus, within the limits of the study, a flat bow-tie filter with an HVL specified by the vendor suffices to calculate the dose distribution. The TPS could be successfully configured to replicate the beam movement and intensity modulation of a spiral scan with dose modulation, on the basis of the specifications available in the metadata of the digital images and the log file of the CT.
Medical Physics, 2016
To present and characterize a Monte Carlo (MC) tool for the simulation of the relative biological... more To present and characterize a Monte Carlo (MC) tool for the simulation of the relative biological effectiveness for the induction of direct DNA double strand breaks (RBE direct DSB) for protons and light ions. Methods: The MC tool uses a pregenerated event-by-event tracks library of protons and light ions that are overlaid on a cell nucleus model. The cell nucleus model is a cylindrical arrangement of nucleosome structures consisting of 198 DNA base pairs. An algorithm relying on k-dimensional trees and cylindrical symmetries is used to search coincidences of energy deposition sites with volumes corresponding to the sugar-phosphate backbone of the DNA molecule. Strand breaks (SBs) are scored when energy higher than a threshold is reached in these volumes. Based on the number of affected strands, they are categorized into either single strand break (SSB) or double strand break (DSB) lesions. The number of SBs composing each lesion (i.e., its size) is also recorded. RBE direct DSB is obtained by taking the ratio of DSB yields of a given radiation field to a 60 Co field. The MC tool was used to obtain SSB yields, DSB yields, and RBE direct DSB as a function of linear energy transfer (LET) for protons (1 H +), 4 He 2+ , 7 Li 3+ , and 12 C 6+ ions. Results: For protons, the SSB yields decreased and the DSB yields increased with LET. At ≈24.5 keV µm −1 , protons generated 15% more DSBs than 12 C 6+ ions. The RBE direct DSB varied between 1.24 and 1.77 for proton fields between 8.5 and 30.2 keV µm −1 , and it was higher for iso-LET ions with lowest atomic number. The SSB and DSB lesion sizes showed significant differences for all radiation fields. Generally, the yields of SSB lesions of sizes ≥2 and the yields of DSB lesions of sizes ≥3 increased with LET and increased for iso-LET ions of lower atomic number. On the other hand, the ratios of SSB to DSB lesions of sizes 2-4 did not show variability with LET nor projectile atomic number, suggesting that these metrics are independent of the radiation quality. Finally, a variance of up to 8% in the DSB yields was observed as a function of the particle incidence angle on the cell nucleus. This simulation effect is due to the preferential alignment of ion tracks with the DNA nucleosomes at specific angles. Conclusions: The MC tool can predict SSB and DSB yields for light ions of various LET and estimate RBE direct DSB. In addition, it can calculate the frequencies of different DNA lesion sizes, which is of interest in the context of biologically relevant absolute dosimetry of particle beams.
Basic dosimetric properties of fast-neutron beams with energies ≤80 MeV were explored using Monte... more Basic dosimetric properties of fast-neutron beams with energies ≤80 MeV were explored using Monte Carlo techniques. Elementary pencil-beam dose distributions taking into account transport of all relevant types of released charged particles (protons, deuterons, tritons, 3He and a particles) were calculated and used to derive several absorbed dose distributions. Broad-beam depth doses in phantoms of different materials were compared and scaling factors calculated to convert absorbed dose in one material to absorbed dose in another. The scaling factors were in good agreement with available published data and show that water is a good substitute for soft tissue even at neutron energies as high as 80 Me V. The inherent penumbra and fraction of absorbed dose due to photons were also studied, and found to be consistent with published values.Treatment planning in fast-neutron therapy is commonly performed using dose calculation algorithms designed for photon beam therapy. These algorithms have limitations in the physical models when applied to neutron beams. Monte Carlo derived neutron pencil-beam kernels were parameterized and implemented into the photon dose calculation algorithms of the TMS (MDS Nordion) treatment planning system. It was shown that these algorithms yield good results in homogeneous water media. However, the heterogeneity correction method of the photon dose calculation algorithm failed to calculate correct results in heterogeneous media for neutron beams.Fundamental cross-section data are needed when calculating absorbed doses. To achieve results with adequate accuracy, neutron cross-sections are still not sufficiently well known. At the The Svedberg Laboratory in Uppsala, Sweden, an experimental facility has been designed to measure neutron-induced charged-particle production cross-sections for (n,xp), (n,xd), (n,xt), (n,x3He) and (n,xα) reactions at neutron energies up to 100 MeV. In order to derive the energy distributions of charged particles generated inside the production target, the measured data have to be corrected for the energy lost by the particles in the target. In this work a code (CRAWL) was developed for the reconstruction of the true spectrum. It uses a stripping method. With the limitation of reduced energy resolution, results using CRAWL compare well with those of other methods.
Radiotherapy and Oncology, 2015
Frontiers in Oncology
PurposeDose painting (DP) is a radiation therapy (RT) strategy for patients with heterogeneous tu... more PurposeDose painting (DP) is a radiation therapy (RT) strategy for patients with heterogeneous tumors delivering higher dose to radiation resistant regions and less to sensitive ones, thus aiming to maximize tumor control with limited side effects. The success of DP treatments is influenced by the spatial accuracy in dose delivery. Adaptive RT (ART) workflows can reduce the overall geometric dose delivery uncertainty. The purpose of this study is to dosimetrically compare ART and non-adaptive conventional RT workflows for delivery of DP prescriptions in the treatment of prostate cancer (PCa).Materials and methodsWe performed a planning and treatment simulation study of four study arms. Adaptive and conventional workflows were tested in combination with DP and Homogeneous dose. We used image data from 5 PCa patients that had been treated on the Elekta Unity MR linac; the patients had been imaged in treatment position before each treatment fraction (7 in total). The local radiation se...
The concept of in-air output ratio (Sc) was introduced to characterize how the incident photon fl... more The concept of in-air output ratio (Sc) was introduced to characterize how the incident photon fluence per monitor unit (or unit time for a Co-60 unit) varies with collimator settings.1, 2 This quantity is also called in-air output factor,3 collimator-scatter factor,4 and headscatter factor.5, 6 The latter two names were somewhat misleading since they emphasized a single component of the output ratio. We retained the symbol Sc
Towards automated and personalized organ dose determination in CT examinations – influence of tis... more Towards automated and personalized organ dose determination in CT examinations – influence of tissue data representations for Monte Carlo dose calculation with a Therapy Planning System
Probabilistic (or robust) optimization is an alternative to margins for handling geometrical unce... more Probabilistic (or robust) optimization is an alternative to margins for handling geometrical uncertainties in treatment planning of radiotherapy where the uncertainties are explicitly incorporated ...
Medical Physics, 2021
Conflict of interest The Chair of the [TG-155, Indra J Das] has reviewed the required Conflict of... more Conflict of interest The Chair of the [TG-155, Indra J Das] has reviewed the required Conflict of Interest statement on file for each member of [TG-155] and determined that disclosure of potential Conflicts of Interest is an adequate management plan. Disclosures of potential Conflicts of Interest for each member of [TG-155] are found at the close of this document but there is no COI.
Journal of Applied Clinical Medical Physics, 2021
Abstract Patient breathing during lung cancer radiotherapy reduces the ability to keep a sharp do... more Abstract Patient breathing during lung cancer radiotherapy reduces the ability to keep a sharp dose gradient between tumor and normal tissues. To mitigate detrimental effects, accurate information about the tumor position is required. In this work, we evaluate the errors in modeled tumor positions over several fractions of a simple tumor motion model driven by a surface surrogate measure and its time derivative. The model is tested with respect to four different surface surrogates and a varying number of surrogate and image acquisitions used for model training. Fourteen patients were imaged 100 times with cine CT, at three sessions mimicking a planning session followed by two treatment fractions. Patient body contours were concurrently detected by a body surface laser scanning system BSLS from which four surface surrogates were extracted; thoracic point TP, abdominal point AP, the radial distance mean RDM, and a surface derived volume SDV. The motion model was trained on session 1 and evaluated on sessions 2 and 3 by comparing modeled tumor positions with measured positions from the cine images. The number of concurrent surrogate and image acquisitions used in the training set was varied, and its impact on the final result was evaluated. The use of AP as a surface surrogate yielded the smallest error in modeled tumor positions. The mean deviation between modeled and measured tumor positions was 1.9 mm. The corresponding deviations for using the other surrogates were 2.0 mm (RDM), 2.8 mm (SDV), and 3.0 mm (TP). To produce a motion model that accurately models the tumor position over several fractions requires at least 10 simultaneous surrogate and image acquisitions over 1–2 minutes.
Medical Physics, 2021
Irregular breathing may compromise the treated volume for free-breathing lung cancer patients dur... more Irregular breathing may compromise the treated volume for free-breathing lung cancer patients during radiotherapy. We try to find a measure based on a breathing amplitude surrogate that can be used to select the patients who need further investigation of tumor motion to ensure that the internal target volume (ITV) provides reliant coverage of the tumor. Material and methods: Fourteen patients were scanned with four-dimensional computed tomography (4DCT) during free-breathing. The breathing motion was detected by a pneumatic bellows device used as a breathing amplitude surrogate. In addition to the 4DCT, a breath-hold (BH) scan and three cine CT imaging sessions were acquired. The cine images were taken at randomized intervals at a rate of 12 per minute for 8 minutes to allow tumor motion determination during a typical hypo-fractionated treatment scenario. A clinical target volume (CTV) was segmented in the BH CT and propagated over all cine images and 4DCT bins. The center-of-volume of the translated CTV (CTV COV) in the ten 4DCT bins were interconnected to define the 4DCT determined tumor trajectory (4DCT-TT). The volume of CTV inside ITV for all cine CTs was calculated and reported at the 10th percentile (V CTV10%). The deviations between CTV COV in the cine CTs and the 4DCT-TT were calculated and reported at its 90th percentile (d 90%). The standard deviation of the bellows amplitude peaks (SDP) and the ratio between large and normal inspirations, κ rel , were tested as surrogates for V CTV10% and d 90%. Results: The values of d 90% ranged from 0.6 to 5.2 mm with a mean of 2.2 mm. The values of V CTV10% ranged from 59-93% with a mean of 78 %. The SDP had a moderate correlation (r = 0.87) to d 90%. Less correlation was seen between SDP and V CTV10% (r = 0.77), κ rel and d 90% (r = 0.75) and finally κ rel and V CTV10% (r = 0.75). Conclusions: The ITV coverage had a large variation for some patients. SDP seems to be a feasible surrogate measure to select patients that needs further tumor motion determination.
Acta Oncologica, 2020
Ahnesjö (2020): Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gl... more Ahnesjö (2020): Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gleason score mappings-what is the potential to increase the tumor control probability?, Acta Oncologica,
Acta Oncologica, 2017
Background: Gleason scores for prostate cancer correlates with an increased recurrence risk after... more Background: Gleason scores for prostate cancer correlates with an increased recurrence risk after radiotherapy (RT). Furthermore, higher Gleason scores correlates with decreasing apparent diffusion coefficient (ADC) data from diffusion weighted MRI (DWI-MRI). Based on these observations, we present a formalism for dose painting prescriptions of prostate volumes based on ADC images mapped to Gleason score driven dose-responses. Methods: The Gleason score driven dose-responses were derived from a learning data set consisting of pre-RT biopsy data and post-RT outcomes for 122 patients treated with a homogeneous dose to the prostate. For a test data set of 18 prostate cancer patients with pre-RT ADC images, we mapped the ADC data to the Gleason driven dose-responses by using probability distributions constructed from published Gleason score correlations with ADC data. We used the Gleason driven dose-responses to optimize dose painting prescriptions that maximize the tumor control probability (TCP) with equal average dose as for the learning sets homogeneous treatment dose. Results: The dose painting prescriptions increased the estimated TCP compared to the homogeneous dose by 0-51% for the learning set and by 4-30% for the test set. The potential for individual TCP gains with dose painting correlated with increasing Gleason score spread and larger prostate volumes. The TCP gains were also found to be larger for patients with a low expected TCP for the homogeneous dose prescription. Conclusions: We have from retrospective treatment data demonstrated a formalism that yield ADC driven dose painting prescriptions for prostate volumes that potentially can yield significant TCP increases without increasing dose burdens as compared to a homogeneous treatment dose. This motivates further development of the approach to consider more accurate ADC to Gleason mappings, issues with delivery robustness of heterogeneous dose distributions, and patient selection criteria for design of clinical trials.
Radiation Research, 2018
BioOne Complete (complete.BioOne.org) is a full-text database of 200 subscribed and open-access t... more BioOne Complete (complete.BioOne.org) is a full-text database of 200 subscribed and open-access titles in the biological, ecological, and environmental sciences published by nonprofit societies, associations, museums, institutions, and presses.
Medical Physics, 2018
To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatme... more To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatment planning in the head and neck (H&N) area. Methods: An anthropomorphic head phantom with removable metallic implants (dental fillings or neck implant) was CT-scanned to evaluate the O-MAR (Philips) and the iMAR (Siemens) algorithms. Reference images were acquired without any metallic implants in place. Water equivalent thickness (WET) was calculated for different path directions and compared between image sets. Images were also evaluated for use in proton treatment planning for parotid, tonsil, tongue base, and neck node targets. The beams were arranged so as to not traverse any metal prior to the target, enabling evaluation of the impact on dose calculation accuracy from artifacts surrounding the metal volume. Plans were compared based on c analysis (1 mm distanceto-agreement/1% difference in local dose) and dose volume histogram metrics for targets and organs at risk (OARs). Visual grading evaluation of 30 dental implant patient MAR images was performed by three radiation oncologists. Results: In the dental fillings images, DWET along a low-density streak was reduced from À17.0 to À4.3 mm with O-MAR and from À16.1 mm to À2.3 mm with iMAR, while for other directions the deviations were increased or approximately unchanged when the MAR algorithms were used. For the neck implant images, DWET was generally reduced with MAR but residual deviations remained (of up to À2.3 mm with O-MAR and of up to À1.5 mm with iMAR). The c analysis comparing proton dose distributions for uncorrected/MAR plans and corresponding reference plans showed passing rates >98% of the voxels for all phantom plans. However, substantial dose differences were seen in areas of most severe artifacts (c passing rates of down to 89% for some cases). MAR reduced the deviations in some cases, but not for all plans. For a single patient case dosimetrically evaluated, minor dose differences were seen between the uncorrected and MAR plans (c passing rate approximately 97%). The visual grading of patient images showed that MAR significantly improved image quality (P < 0.001). Conclusions: O-MAR and iMAR significantly improved image quality in terms of anatomical visualization for target and OAR delineation in dental implant patient images. WET calculations along several directions, all outside the metallic regions, showed that both uncorrected and MAR images contained metal artifacts which could potentially lead to unacceptable errors in proton treatment planning. DWET was reduced by MAR in some areas, while increased or unchanged deviations were seen for other path directions. The proton treatment plans created for the phantom images showed overall acceptable dose distributions differences when compared to the reference cases, both for the uncorrected and MAR images. However, substantial dose distribution differences in the areas of most severe artifacts were seen for some plans, which were reduced by MAR in some cases but not all. In conclusion, MAR could be beneficial to use for proton treatment planning; however, case-by-case evaluations of the metal artifact-degraded images are always recommended.
Physics in Medicine & Biology, 2016
A discrepancy between the Monte Carlo derived relative standard deviation σ z rel (microdosimetri... more A discrepancy between the Monte Carlo derived relative standard deviation σ z rel (microdosimetric spread) and experimental data was reported by Villegas et al (2013 Phys. Med. Biol. 58 6149-62) suggesting wall effects as a plausible explanation. The comment by Lindborg et al (2015 Phys. Med. Biol. 60 8621-4) concludes that this is not a likely explanation. A thorough investigation of the Monte Carlo (MC) transport code used for track simulation revealed a critical bug. The corrected MC version yielded σ z rel values that are now within experimental uncertainty. Other microdosimetric findings are hereby communicated.
Medical Physics, 2018
PURPOSE Computed tomography (CT) is a versatile tool in diagnostic radiology with rapidly increas... more PURPOSE Computed tomography (CT) is a versatile tool in diagnostic radiology with rapidly increasing number of examinations per year globally. Routine adaption of the exposure level for patient anatomy and examination protocol cause the patients' exposures to become diversified and harder to predict by simple methods. To facilitate individualized organ dose estimates, we explore the possibility to automate organ dose calculations using a radiotherapy treatment planning system (TPS). In particular, the mapping of CT number to elemental composition for Monte Carlo (MC) dose calculations is investigated. METHODS Organ dose calculations were done for a female thorax examination test case with a TPS (Raystation™, Raysearch Laboratories AB, Stockholm, Sweden) utilizing a MC dose engine with a CT source model presented in a previous study. The TPS's inherent tissue characterization model for mapping of CT number to elemental composition of the tissues was calibrated using a phantom with known elemental compositions and validated through comparison of MC calculated dose with dose measured with Thermo Luminescence Dosimeters (TLD) in an anthropomorphic phantom. Given the segmentation tools of the TPS, organ segmentation strategies suitable for automation were analyzed for high contrast organs, utilizing CT number thresholding and model-based segmentation, and for low contrast organs utilizing water replacements in larger tissue volumes. Organ doses calculated with a selection of organ segmentation methods in combination with mapping of CT numbers to elemental composition (RT model), normally used in radiotherapy, were compared to a tissue characterization model with organ segmentation and elemental compositions defined by replacement materials [International Commission on Radiological Protection (ICRP) model], frequently favored in imaging dosimetry. RESULTS The results of the validation with the anthropomorphic phantom yielded mean deviations from the dose to water calculated with the RT and ICRP model as measured with TLD of 1.1% and 1.5% with maximum deviations of 6.1% and 8.7% respectively over all locations in the phantom. A strategy for automated organ segmentation was evaluated for two different risk organ groups, that is, low contrast soft organs and high contrast organs. The relative deviation between organ doses calculated with the RT model and with the ICRP model varied between 0% and 20% for the thorax/upper abdomen risk organs. CONCLUSIONS After calibration, the RT model in the TPS provides accurate MC dose results as compared to measurements with TLD and the ICRP model. Dosimetric feasible segmentation of the risk organs for a female thorax demonstrates a possibility for automation using the segmentation tool available in a TPS for high contrast organs. Low contrast soft organs can be represented by water volumes, but organ dose to the esophagus and thyroid must be determined using standardized organ shapes. The uncertainties of the organ doses are small compared to the overall uncertainty, at least an order of magnitude larger, in the estimates of lifetime attributable risk (LAR) based on organ doses. Large-scale and automated individual organ dose calculations could provide an improvement in cancer incidence estimates from epidemiological studies.
Radiotherapy and Oncology, 2018
Radiotherapy and Oncology, 2017
Background and purpose: The aim of this study is to derive ''dose painting by numbers" prescripti... more Background and purpose: The aim of this study is to derive ''dose painting by numbers" prescriptions from retrospectively observed recurrence volumes in a patient group treated with conventional radiotherapy for head and neck squamous cell carcinoma. Materials and methods: The spatial relation between retrospectively observed recurrence volumes and pre-treatment standardized uptake values (SUV) from fluorodeoxyglucose positron emission tomography (FDG-PET) imaging was determined. Based on this information we derived SUV driven dose-response functions and used these to optimize ideal dose redistributions under the constraint of equal average dose to the tumor volumes as for a conventional treatment. The response functions were also implemented into a treatment planning system for realistic dose optimization. Results: The calculated tumor control probabilities (TCP) increased between 0.1-14.6% by the ideal dose redistributions for all included patients, where patients with larger and more heterogeneous tumors got greater increases than smaller and more homogeneous tumors. Conclusions: Dose painting prescriptions can be derived from retrospectively observed recurrence volumes spatial relation to pre-treatment FDG-PET image data. The ideal dose redistributions could significantly increase the TCP for patients with large tumor volumes and large spread in SUV from FDG-PET. The results yield a basis for prospective studies to determine the clinical value for dose painting of head and neck squamous cell carcinomas.
Medical Physics, 2016
Purpose: Radiation dose to patients undergoing examinations with Multislice Computed Tomography (... more Purpose: Radiation dose to patients undergoing examinations with Multislice Computed Tomography (MSCT) as well as Cone Beam Computed Tomography (CBCT) is a matter of concern. Risk management could benefit from efficient replace rational dose calculation tools. The paper aims to verify MSCT dose calculations using a Treatment Planning System (TPS) for radiotherapy and to evaluate four different variations of bow-tie filter characterizations for the beam model used in the dose calculations. Methods: A TPS (RayStation™, RaySearch Laboratories, Stockholm, Sweden) was configured to calculate dose from a MSCT (GE Healthcare, Wauwatosa, WI, USA). The x-ray beam was characterized in a stationary position the by measurements of the Half-Value Layer (HVL) in aluminum and kerma along the principal axes of the isocenter plane perpendicular to the beam. A Monte Carlo source model for the dose calculation was applied with four different variations on the beam-shaping bow-tie filter, taking into account the different degrees of HVL information but reconstructing the measured kerma distribution after the bow-tie filter by adjusting the photon sampling function. The resulting dose calculations were verified by comparison with measurements in solid water as well as in an anthropomorphic phantom. Results: The calculated depth dose in solid water as well as the relative dose profiles was in agreement with the corresponding measured values. Doses calculated in the anthropomorphic phantom in the range 26-55 mGy agreed with the corresponding thermo luminescence dosimeter (TLD) measurements. Deviations between measurements and calculations were of the order of the measurement uncertainties. There was no significant difference between the different variations on the bow-tie filter modeling. Conclusions: Under the assumption that the calculated kerma after the bow-tie filter replicates the measured kerma, the central specification of the HVL of the x-ray beam together with the kerma distribution can be used to characterize the beam. Thus, within the limits of the study, a flat bow-tie filter with an HVL specified by the vendor suffices to calculate the dose distribution. The TPS could be successfully configured to replicate the beam movement and intensity modulation of a spiral scan with dose modulation, on the basis of the specifications available in the metadata of the digital images and the log file of the CT.
Medical Physics, 2016
To present and characterize a Monte Carlo (MC) tool for the simulation of the relative biological... more To present and characterize a Monte Carlo (MC) tool for the simulation of the relative biological effectiveness for the induction of direct DNA double strand breaks (RBE direct DSB) for protons and light ions. Methods: The MC tool uses a pregenerated event-by-event tracks library of protons and light ions that are overlaid on a cell nucleus model. The cell nucleus model is a cylindrical arrangement of nucleosome structures consisting of 198 DNA base pairs. An algorithm relying on k-dimensional trees and cylindrical symmetries is used to search coincidences of energy deposition sites with volumes corresponding to the sugar-phosphate backbone of the DNA molecule. Strand breaks (SBs) are scored when energy higher than a threshold is reached in these volumes. Based on the number of affected strands, they are categorized into either single strand break (SSB) or double strand break (DSB) lesions. The number of SBs composing each lesion (i.e., its size) is also recorded. RBE direct DSB is obtained by taking the ratio of DSB yields of a given radiation field to a 60 Co field. The MC tool was used to obtain SSB yields, DSB yields, and RBE direct DSB as a function of linear energy transfer (LET) for protons (1 H +), 4 He 2+ , 7 Li 3+ , and 12 C 6+ ions. Results: For protons, the SSB yields decreased and the DSB yields increased with LET. At ≈24.5 keV µm −1 , protons generated 15% more DSBs than 12 C 6+ ions. The RBE direct DSB varied between 1.24 and 1.77 for proton fields between 8.5 and 30.2 keV µm −1 , and it was higher for iso-LET ions with lowest atomic number. The SSB and DSB lesion sizes showed significant differences for all radiation fields. Generally, the yields of SSB lesions of sizes ≥2 and the yields of DSB lesions of sizes ≥3 increased with LET and increased for iso-LET ions of lower atomic number. On the other hand, the ratios of SSB to DSB lesions of sizes 2-4 did not show variability with LET nor projectile atomic number, suggesting that these metrics are independent of the radiation quality. Finally, a variance of up to 8% in the DSB yields was observed as a function of the particle incidence angle on the cell nucleus. This simulation effect is due to the preferential alignment of ion tracks with the DNA nucleosomes at specific angles. Conclusions: The MC tool can predict SSB and DSB yields for light ions of various LET and estimate RBE direct DSB. In addition, it can calculate the frequencies of different DNA lesion sizes, which is of interest in the context of biologically relevant absolute dosimetry of particle beams.
Basic dosimetric properties of fast-neutron beams with energies ≤80 MeV were explored using Monte... more Basic dosimetric properties of fast-neutron beams with energies ≤80 MeV were explored using Monte Carlo techniques. Elementary pencil-beam dose distributions taking into account transport of all relevant types of released charged particles (protons, deuterons, tritons, 3He and a particles) were calculated and used to derive several absorbed dose distributions. Broad-beam depth doses in phantoms of different materials were compared and scaling factors calculated to convert absorbed dose in one material to absorbed dose in another. The scaling factors were in good agreement with available published data and show that water is a good substitute for soft tissue even at neutron energies as high as 80 Me V. The inherent penumbra and fraction of absorbed dose due to photons were also studied, and found to be consistent with published values.Treatment planning in fast-neutron therapy is commonly performed using dose calculation algorithms designed for photon beam therapy. These algorithms have limitations in the physical models when applied to neutron beams. Monte Carlo derived neutron pencil-beam kernels were parameterized and implemented into the photon dose calculation algorithms of the TMS (MDS Nordion) treatment planning system. It was shown that these algorithms yield good results in homogeneous water media. However, the heterogeneity correction method of the photon dose calculation algorithm failed to calculate correct results in heterogeneous media for neutron beams.Fundamental cross-section data are needed when calculating absorbed doses. To achieve results with adequate accuracy, neutron cross-sections are still not sufficiently well known. At the The Svedberg Laboratory in Uppsala, Sweden, an experimental facility has been designed to measure neutron-induced charged-particle production cross-sections for (n,xp), (n,xd), (n,xt), (n,x3He) and (n,xα) reactions at neutron energies up to 100 MeV. In order to derive the energy distributions of charged particles generated inside the production target, the measured data have to be corrected for the energy lost by the particles in the target. In this work a code (CRAWL) was developed for the reconstruction of the true spectrum. It uses a stripping method. With the limitation of reduced energy resolution, results using CRAWL compare well with those of other methods.
Radiotherapy and Oncology, 2015