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Cancer radiothérapie : journal de la Société française de radiothérapie oncologique
An inverse planning algorithm for determining the intensity of modulated beams that generates con... more An inverse planning algorithm for determining the intensity of modulated beams that generates conformal radiotherapy dose distributions is presented. This algorithm is based on the mathematical analysis of the singular values decomposition. It is integrated in the DOSIGRAY 3D treatment planning software. The dose is calculated by the separation of the primary and scattered radiation. We presented, for a prostate cancer, the modulated intensity profiles and the optimal dose distribution obtained by the inverse optimization software developed and integrated in the treatment planning system. We obtained a region with high doses which geometrically conforms the target volume and spares the neighboring critical structures. This preliminary study showed the feasibility and the managing of the singular value decomposition to generate conformal dose distribution in a clinical environment.
Journal De Radiologie, 2010
Reducing radiation dose while maintaining adequate image quality on conventional and digital radi... more Reducing radiation dose while maintaining adequate image quality on conventional and digital radiographs requires optimal use of the unit. Additional filtration avoids unnecessary tissue exposure and improves photon transmission. Automatic exposure control may reduce exposure and dose. The volume of tissue imaged must be limited by the use of diaphragms and shutters or compression. Sensitive detectors with increased photon detection also contribute to reduce dose. Radiographic films combined to rare-earth screens also afford a good photon-conversion efficiency. Large area flat panel amorphous silicon x-ray sensors may also reduce dose up to 50% compared to films. Finally, calculation of the Kerma-area product independent of the source distance constitutes an important indicator of radiation dose.
Bulletin du cancer. Radiothérapie: journal de la Société française du cancer: organe de la société française de radiothérapie oncologique
Cancer/Radiothérapie, 2006
Cancer/Radiothérapie, 2007
Neuro-Chirurgie, 2001
The purpose was to present the successive steps of dosimetric planning and the different means us... more The purpose was to present the successive steps of dosimetric planning and the different means used to allow the choice of the best solution among several planning projects considering the anatomical and clinical features of arteriovenous malformation. Method. Four successive steps were: A study of these factors for 5 different plannings of a clinical case using different isocenters is presented and the results are discussed. For complex arteriovenous malformations several hours are often necessary to permit physicians/radiotherapists to elaborate planning which is often a compromise among several solutions.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2001
To evaluate dosimetric consequences generated by the automatic definition based on lesion coverag... more To evaluate dosimetric consequences generated by the automatic definition based on lesion coverage of prescription isodose. A clinical series of 124 arteriovenous malformations was analysed. Plan quality was quantified by the standard deviation of the differential dose volume histogram calculated in the lesion. We define two quantitative protocols based on lesion coverage for the automatic definition of prescription isodose using a volumetric definition of coverage (90% of lesion volume), and an isodose-based definition proposed by RTOG (prescription isodose equals minimum isodose in the lesion divided by 0.9). We have evaluated the plans obtained for these two protocols, calculating several dose-volume indices. These indices are presented as a function of dose-volume histogram standard deviation in order to quantify the consequences of their variations for this representative series of plans. The margin our team tolerates is such that the sum of underdosed lesion and overdosed heal...
Bulletin du cancer. Radiothérapie : journal de la Société française du cancer : organe de la société française de radiothérapie oncologique, 1996
Bulletin du Cancer/Radiothérapie, 1996
Cancer/Radiothérapie, 2009
International Journal of Radiation Oncology*Biology*Physics, 1992
International Journal of Radiation Oncology*Biology*Physics, 2005
To report a retrospective study concerning the impact of fused 18F-fluoro-deoxy-D-glucose (FDG)-h... more To report a retrospective study concerning the impact of fused 18F-fluoro-deoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and CT images on three-dimensional conformal radiotherapy planning for patients with non-small-cell lung cancer. A total of 101 patients consecutively treated for Stage I-III non-small-cell lung cancer were studied. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same treatment position. Images were coregistered using five fiducial markers. Target volume delineation was initially performed on the CT images, and the corresponding FDG-PET data were subsequently used as an overlay to the CT data to define the target volume. 18F-fluoro-deoxy-D-glucose-PET identified previously undetected distant metastatic disease in 8 patients, making them ineligible for curative conformal radiotherapy (1 patient presented with some positive uptake corresponding to concomitant pulmonary tuberculosis). Another patient was ineligible for curative treatment because the fused PET-CT images demonstrated excessively extensive intrathoracic disease. The gross tumor volume (GTV) was decreased by CT-PET image fusion in 21 patients (23%) and was increased in 24 patients (26%). The GTV reduction was > or = 25% in 7 patients because CT-PET image fusion reduced the pulmonary GTV in 6 patients (3 patients with atelectasis) and the mediastinal nodal GTV in 1 patient. The GTV increase was > or = 25% in 14 patients owing to an increase in the pulmonary GTV in 11 patients (4 patients with atelectasis) and detection of occult mediastinal lymph node involvement in 3 patients. Of 81 patients receiving a total dose of > or = 60 Gy at the International Commission on Radiation Units and Measurements point, after CT-PET image fusion, the percentage of total lung volume receiving >20 Gy increased in 15 cases and decreased in 22. The percentage of total heart volume receiving >36 Gy increased in 8 patients and decreased in 14. The spinal cord volume receiving at least 45 Gy (2 patients) decreased. Multivariate analysis showed that tumor with atelectasis was the single independent factor that resulted in a significant effect on the modification of the size of the GTV by FDG-PET: tumor with atelectasis (with vs. without atelectasis, p = 0.0001). The results of our study have confirmed that integrated hybrid PET/CT in the treatment position and coregistered images have an impact on treatment planning and management of non-small-cell lung cancer. However, FDG images using dedicated PET scanners and respiration-gated acquisition protocols could improve the PET-CT image coregistration. Furthermore, the impact on treatment outcome remains to be demonstrated.
2017 Fourth International Conference on Advances in Biomedical Engineering (ICABME), 2017
The following article presents the results of a risk analysis exploring potential exposure of med... more The following article presents the results of a risk analysis exploring potential exposure of medical operators working in a radiotherapy and brachytherapy department. The presented work takes its particularity since the brachytherapy treatment takes place in a common bunker for radiotherapy and brachytherapy. A detailed study of different scenarios involving source blockage is presented. A detailed dosimetric study for operators in case of source blockage is developed.
Journal of Medical Physics, 2021
IntroductIon Lung stereotactic body radiation therapy (SBRT) is used for the treatment of early-s... more IntroductIon Lung stereotactic body radiation therapy (SBRT) is used for the treatment of early-stage nonsmall cell lung cancer and metastatic lung tumors. [1,2] SBRT treatments are delivered in a hypofractionation mode, with high doses in a few fractions (from 3 to 8 fractions), depending on tumor localization (central or peripheral tumors). [3] The treatment of lung cancer with high doses can be impacted by tumor motion and proximity to the organ at risk. [4-7] Various techniques were developed to take into consideration tumor motion during treatment delivery to accurately target the moving tumor and to spare healthy tissues. [8-10] The abdominal compression technique is used to reduce the breathing amplitude, reducing the amplitude of the tumor motion throughout the respiratory cycle. [8] Radiation during a certain phase of the respiratory cycle can be performed using respiratory gating radiation therapy (RGRT). [9] Real-time tumor tracking allows for tumor irradiation throughout the respiratory cycle. [10] RGRT does not require controlled breathing or breath hold during simulation and dose delivery. There are three types of gating: phase gating, amplitude gating, and breath-hold gating techniques. With phase gating, the treatment is delivered during a certain phase of the respiratory cycle. With amplitude gating, the treatment is delivered when a chosen threshold of the breathing amplitude is reached, which is generally during the Introduction: This study compared phase-gated and amplitude-gated dose deliveries to the moving gross tumor volume (GTV) in lung stereotactic body radiation therapy (SBRT) using Gafchromic External Beam Therapy (EBT3) dosimetry film. Materials and Methods: Eighty treatment plans using two techniques (40 phase gated and 40 amplitude gated) were delivered using dynamic conformal arc therapy (DCAT). The GTV motion, breathing amplitude, and period were taken from 40 lung SBRT patients who performed regular breathing. These parameters were re-simulated using a modified Varian breathing mini phantom. The dosimetric accuracy of the phase-and amplitude-gated treatment plans was analyzed using Gafchromic EBT3 dosimetry film. The treatment delivery efficacy was analyzed for gantry rotation, number of monitor unit (MU), and target position per triggering window. The time required to deliver the phase-and amplitude-gated treatment techniques was also evaluated. Results: The mean dose (range) per fraction was 16.11 ± 0.91 Gy (13.04-17.50 Gy) versus 16.26 ± 0.83 Gy (13.82-17.99 Gy) (P < 0.0001) for phase-and amplitude-gated delivery. The greater difference in the gamma passing rate was 1.2% ±0.4% in the amplitude-gated compared to the phase gated. The gantry rotation per triggering time (tt) was 2° ±1° (1.2°-3°) versus 5° ±1° (3°-6°) (P < 0.0001) and MU per tt was 10 ± 3 MU (6-13 MU) versus 24 ± 7 MU (12-32 MU) (P < 0.0001), for phase-versus amplitude-gated techniques. A 90 beam interruption in the phase-gated technique impacted the treatment delivery efficacy, increasing the treatment delivery time in the phase gated for 1664 ± 202 s 1353-1942 s) compared to 36 interruptions in the amplitude gated 823 ± 79 s (712-926 s) (P < 0.0001). Conclusion: Amplitude-gated DCAT allows for better dosimetric accuracy over phase-gated treatment patients with regular breathing patterns.
Journal of Radiation Oncology, 2020
Purpose To evaluate the amplitude of lung tumor motion and impact of tumor motion on dose deliver... more Purpose To evaluate the amplitude of lung tumor motion and impact of tumor motion on dose delivered to the organs at risk (OARs) during lung stereotactic body radiation therapy (SBRT). Materials and methods This study included 55 patients (30 males and 25 females) with lung cancer who had a small gross tumor volume (GTV). SBRT lung cancer patients were treated with a prescribed dose of 60 Gy in 4 to 8 fractions. Radiotherapy plans were planned in Pinnacle 9.10 with two partial dynamic conformal arcs (DCAs) for the peripheral region (PR) and three to four partial DCAs for the central region (CR). The amplitude of tumor motion and their impact on the maximum dose delivered (D max) to the OARs were evaluated in the upper lobe (UL) and lower lobe (LL) in cases of CR and PR tumor's localizations. Results The median tumor motions between CR and PR were 4.5 vs 2.2 mm in the UL and 12.5 vs 7.0 mm in the LL. Max dose delivered to the OARs between CR and PR in the UL and LL were as follows: 6.7 vs 8.9 Gy and 9.1 vs 11.7 Gy for the spinal cord; 15.2 vs 0.6 Gy and 22.4 vs 7.6 Gy for the heart; and 11.7 vs 10.8 Gy and 14.8 vs 9.8 Gy for the esophagus, respectively. Conclusion The dose received by the OARs depends on the amplitude of tumor motion and is relative to the OAR's location and motion, due to patient respiration and heart contribution.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique
An inverse planning algorithm for determining the intensity of modulated beams that generates con... more An inverse planning algorithm for determining the intensity of modulated beams that generates conformal radiotherapy dose distributions is presented. This algorithm is based on the mathematical analysis of the singular values decomposition. It is integrated in the DOSIGRAY 3D treatment planning software. The dose is calculated by the separation of the primary and scattered radiation. We presented, for a prostate cancer, the modulated intensity profiles and the optimal dose distribution obtained by the inverse optimization software developed and integrated in the treatment planning system. We obtained a region with high doses which geometrically conforms the target volume and spares the neighboring critical structures. This preliminary study showed the feasibility and the managing of the singular value decomposition to generate conformal dose distribution in a clinical environment.
Journal De Radiologie, 2010
Reducing radiation dose while maintaining adequate image quality on conventional and digital radi... more Reducing radiation dose while maintaining adequate image quality on conventional and digital radiographs requires optimal use of the unit. Additional filtration avoids unnecessary tissue exposure and improves photon transmission. Automatic exposure control may reduce exposure and dose. The volume of tissue imaged must be limited by the use of diaphragms and shutters or compression. Sensitive detectors with increased photon detection also contribute to reduce dose. Radiographic films combined to rare-earth screens also afford a good photon-conversion efficiency. Large area flat panel amorphous silicon x-ray sensors may also reduce dose up to 50% compared to films. Finally, calculation of the Kerma-area product independent of the source distance constitutes an important indicator of radiation dose.
Bulletin du cancer. Radiothérapie: journal de la Société française du cancer: organe de la société française de radiothérapie oncologique
Cancer/Radiothérapie, 2006
Cancer/Radiothérapie, 2007
Neuro-Chirurgie, 2001
The purpose was to present the successive steps of dosimetric planning and the different means us... more The purpose was to present the successive steps of dosimetric planning and the different means used to allow the choice of the best solution among several planning projects considering the anatomical and clinical features of arteriovenous malformation. Method. Four successive steps were: A study of these factors for 5 different plannings of a clinical case using different isocenters is presented and the results are discussed. For complex arteriovenous malformations several hours are often necessary to permit physicians/radiotherapists to elaborate planning which is often a compromise among several solutions.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2001
To evaluate dosimetric consequences generated by the automatic definition based on lesion coverag... more To evaluate dosimetric consequences generated by the automatic definition based on lesion coverage of prescription isodose. A clinical series of 124 arteriovenous malformations was analysed. Plan quality was quantified by the standard deviation of the differential dose volume histogram calculated in the lesion. We define two quantitative protocols based on lesion coverage for the automatic definition of prescription isodose using a volumetric definition of coverage (90% of lesion volume), and an isodose-based definition proposed by RTOG (prescription isodose equals minimum isodose in the lesion divided by 0.9). We have evaluated the plans obtained for these two protocols, calculating several dose-volume indices. These indices are presented as a function of dose-volume histogram standard deviation in order to quantify the consequences of their variations for this representative series of plans. The margin our team tolerates is such that the sum of underdosed lesion and overdosed heal...
Bulletin du cancer. Radiothérapie : journal de la Société française du cancer : organe de la société française de radiothérapie oncologique, 1996
Bulletin du Cancer/Radiothérapie, 1996
Cancer/Radiothérapie, 2009
International Journal of Radiation Oncology*Biology*Physics, 1992
International Journal of Radiation Oncology*Biology*Physics, 2005
To report a retrospective study concerning the impact of fused 18F-fluoro-deoxy-D-glucose (FDG)-h... more To report a retrospective study concerning the impact of fused 18F-fluoro-deoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and CT images on three-dimensional conformal radiotherapy planning for patients with non-small-cell lung cancer. A total of 101 patients consecutively treated for Stage I-III non-small-cell lung cancer were studied. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same treatment position. Images were coregistered using five fiducial markers. Target volume delineation was initially performed on the CT images, and the corresponding FDG-PET data were subsequently used as an overlay to the CT data to define the target volume. 18F-fluoro-deoxy-D-glucose-PET identified previously undetected distant metastatic disease in 8 patients, making them ineligible for curative conformal radiotherapy (1 patient presented with some positive uptake corresponding to concomitant pulmonary tuberculosis). Another patient was ineligible for curative treatment because the fused PET-CT images demonstrated excessively extensive intrathoracic disease. The gross tumor volume (GTV) was decreased by CT-PET image fusion in 21 patients (23%) and was increased in 24 patients (26%). The GTV reduction was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 25% in 7 patients because CT-PET image fusion reduced the pulmonary GTV in 6 patients (3 patients with atelectasis) and the mediastinal nodal GTV in 1 patient. The GTV increase was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 25% in 14 patients owing to an increase in the pulmonary GTV in 11 patients (4 patients with atelectasis) and detection of occult mediastinal lymph node involvement in 3 patients. Of 81 patients receiving a total dose of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 60 Gy at the International Commission on Radiation Units and Measurements point, after CT-PET image fusion, the percentage of total lung volume receiving &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 Gy increased in 15 cases and decreased in 22. The percentage of total heart volume receiving &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;36 Gy increased in 8 patients and decreased in 14. The spinal cord volume receiving at least 45 Gy (2 patients) decreased. Multivariate analysis showed that tumor with atelectasis was the single independent factor that resulted in a significant effect on the modification of the size of the GTV by FDG-PET: tumor with atelectasis (with vs. without atelectasis, p = 0.0001). The results of our study have confirmed that integrated hybrid PET/CT in the treatment position and coregistered images have an impact on treatment planning and management of non-small-cell lung cancer. However, FDG images using dedicated PET scanners and respiration-gated acquisition protocols could improve the PET-CT image coregistration. Furthermore, the impact on treatment outcome remains to be demonstrated.
2017 Fourth International Conference on Advances in Biomedical Engineering (ICABME), 2017
The following article presents the results of a risk analysis exploring potential exposure of med... more The following article presents the results of a risk analysis exploring potential exposure of medical operators working in a radiotherapy and brachytherapy department. The presented work takes its particularity since the brachytherapy treatment takes place in a common bunker for radiotherapy and brachytherapy. A detailed study of different scenarios involving source blockage is presented. A detailed dosimetric study for operators in case of source blockage is developed.
Journal of Medical Physics, 2021
IntroductIon Lung stereotactic body radiation therapy (SBRT) is used for the treatment of early-s... more IntroductIon Lung stereotactic body radiation therapy (SBRT) is used for the treatment of early-stage nonsmall cell lung cancer and metastatic lung tumors. [1,2] SBRT treatments are delivered in a hypofractionation mode, with high doses in a few fractions (from 3 to 8 fractions), depending on tumor localization (central or peripheral tumors). [3] The treatment of lung cancer with high doses can be impacted by tumor motion and proximity to the organ at risk. [4-7] Various techniques were developed to take into consideration tumor motion during treatment delivery to accurately target the moving tumor and to spare healthy tissues. [8-10] The abdominal compression technique is used to reduce the breathing amplitude, reducing the amplitude of the tumor motion throughout the respiratory cycle. [8] Radiation during a certain phase of the respiratory cycle can be performed using respiratory gating radiation therapy (RGRT). [9] Real-time tumor tracking allows for tumor irradiation throughout the respiratory cycle. [10] RGRT does not require controlled breathing or breath hold during simulation and dose delivery. There are three types of gating: phase gating, amplitude gating, and breath-hold gating techniques. With phase gating, the treatment is delivered during a certain phase of the respiratory cycle. With amplitude gating, the treatment is delivered when a chosen threshold of the breathing amplitude is reached, which is generally during the Introduction: This study compared phase-gated and amplitude-gated dose deliveries to the moving gross tumor volume (GTV) in lung stereotactic body radiation therapy (SBRT) using Gafchromic External Beam Therapy (EBT3) dosimetry film. Materials and Methods: Eighty treatment plans using two techniques (40 phase gated and 40 amplitude gated) were delivered using dynamic conformal arc therapy (DCAT). The GTV motion, breathing amplitude, and period were taken from 40 lung SBRT patients who performed regular breathing. These parameters were re-simulated using a modified Varian breathing mini phantom. The dosimetric accuracy of the phase-and amplitude-gated treatment plans was analyzed using Gafchromic EBT3 dosimetry film. The treatment delivery efficacy was analyzed for gantry rotation, number of monitor unit (MU), and target position per triggering window. The time required to deliver the phase-and amplitude-gated treatment techniques was also evaluated. Results: The mean dose (range) per fraction was 16.11 ± 0.91 Gy (13.04-17.50 Gy) versus 16.26 ± 0.83 Gy (13.82-17.99 Gy) (P < 0.0001) for phase-and amplitude-gated delivery. The greater difference in the gamma passing rate was 1.2% ±0.4% in the amplitude-gated compared to the phase gated. The gantry rotation per triggering time (tt) was 2° ±1° (1.2°-3°) versus 5° ±1° (3°-6°) (P < 0.0001) and MU per tt was 10 ± 3 MU (6-13 MU) versus 24 ± 7 MU (12-32 MU) (P < 0.0001), for phase-versus amplitude-gated techniques. A 90 beam interruption in the phase-gated technique impacted the treatment delivery efficacy, increasing the treatment delivery time in the phase gated for 1664 ± 202 s 1353-1942 s) compared to 36 interruptions in the amplitude gated 823 ± 79 s (712-926 s) (P < 0.0001). Conclusion: Amplitude-gated DCAT allows for better dosimetric accuracy over phase-gated treatment patients with regular breathing patterns.
Journal of Radiation Oncology, 2020
Purpose To evaluate the amplitude of lung tumor motion and impact of tumor motion on dose deliver... more Purpose To evaluate the amplitude of lung tumor motion and impact of tumor motion on dose delivered to the organs at risk (OARs) during lung stereotactic body radiation therapy (SBRT). Materials and methods This study included 55 patients (30 males and 25 females) with lung cancer who had a small gross tumor volume (GTV). SBRT lung cancer patients were treated with a prescribed dose of 60 Gy in 4 to 8 fractions. Radiotherapy plans were planned in Pinnacle 9.10 with two partial dynamic conformal arcs (DCAs) for the peripheral region (PR) and three to four partial DCAs for the central region (CR). The amplitude of tumor motion and their impact on the maximum dose delivered (D max) to the OARs were evaluated in the upper lobe (UL) and lower lobe (LL) in cases of CR and PR tumor's localizations. Results The median tumor motions between CR and PR were 4.5 vs 2.2 mm in the UL and 12.5 vs 7.0 mm in the LL. Max dose delivered to the OARs between CR and PR in the UL and LL were as follows: 6.7 vs 8.9 Gy and 9.1 vs 11.7 Gy for the spinal cord; 15.2 vs 0.6 Gy and 22.4 vs 7.6 Gy for the heart; and 11.7 vs 10.8 Gy and 14.8 vs 9.8 Gy for the esophagus, respectively. Conclusion The dose received by the OARs depends on the amplitude of tumor motion and is relative to the OAR's location and motion, due to patient respiration and heart contribution.