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Papers by gustavo olivera

Revista Panamericana De Salud Publica-pan American Journal of Public Health, 2005

International Journal of Radiation Oncology Biology Physics, 2007

Physics in Medicine and Biology, 2003

Under various clinical situations, it is desirable to modify the original treatment plan to bette... more Under various clinical situations, it is desirable to modify the original treatment plan to better suit the clinical goals. In this work, a method to help physicians modify treatment plans based on their clinical preferences is proposed. The method uses a weighted quadratic dose objective function. The commonly used organ-/ROI-based weighting factors are expanded to a set of voxel-based weighting factors in order to obtain greater flexibility in treatment plan modification. Two different but equivalent modification schemes based on Rustem's quadratic programming algorithms--modification of a weighting matrix and modification of prescribed doses--are presented. Case studies demonstrated the effectiveness of the two methods with regard to their capability to fine-tune treatment plans.

International Journal of Radiation Oncology Biology Physics, 2008

Physics in Medicine and Biology, 2002

In routine clinical practice, radiotherapy treatment planning is performed based on the patient C... more In routine clinical practice, radiotherapy treatment planning is performed based on the patient CT images obtained during the patient setup procedure. However, the actual delivered dose to the patient might be different from the planned dose because of various reasons such as patient motion. Under such situations, it is desirable to modify the original treatment plan in order to partially remedy the dose delivery errors in the subsequent dose delivery process. Such modification can be implemented by modifying the original treatment plan using re-optimization. In this work, issues such as the re-optimization dose prescription, optimization constraints in re-optimization, re-optimization in multiple fractionation schemes and re-optimization procedure with generalized dose-based objective functions were investigated and corresponding mathematical schemes proposed. The derived results were applied to a clinical case study in which it was shown that the proposed re-optimization method is able to remedy the cold spots in tumour while delivering low dose to normal structures. Thus the potential effectiveness of the method was demonstrated.

Medical Physics, 2005

Current dosimetric protocols based on the absorbed dose (AAPM TG-51 and IAEA TRS-398 protocols) r... more Current dosimetric protocols based on the absorbed dose (AAPM TG-51 and IAEA TRS-398 protocols) require calibration measurements under reference conditions. For some radiotherapy systems, this requirement cannot be met, and calibration has to be performed under nonreference experimental conditions. In order to solve this problem, both protocols can be extended by inclusion of the measured-to-reference conversion factor, k(mr). In order to determine this factor, basic dosimetric quantities, like stopping power ratios, mass attenuation coefficients and chamber correction factors have to be calculated. If measurements are not feasible, accurate Monte Carlo modeling is required. The extension of the protocols is illustrated using the case of the helical tomotherapy radiation unit, where the typical calibration measurement conditions are the 10 x 5 cm2 field size and the 85 cm surface source distance, limited by the system design. It was calculated that the k(mr) factor for this conditions is close to unity (0.997+/-0.001). In addition, the deviation of the measurement conditions from the reference conditions results in the change of the quality conversion factor (approximately 0.995-0.998, depending on the ionization chamber used). This change is the same regardless of the used calibration protocol. For smaller field sizes the corrections become more significant, resulting in the total correction factor compared to the reference conditions of up to 1.5% for the smallest considered field size of 2 x 2 cm2.

Medical Physics, 2005

Total body radiation (TBI) has been used for many years as a preconditioning agent before bone ma... more Total body radiation (TBI) has been used for many years as a preconditioning agent before bone marrow transplantation. Many side effects still plague its use. We investigated the planning and delivery of total body irradiation (TBI) and selective total marrow irradiation (TMI) and a reduced radiation dose to sensitive structures using image-guided helical tomotherapy. To assess the feasibility of using helical tomotherapy, (A) we studied variations in pitch, field width, and modulation factor on total body and total marrow helical tomotherapy treatments. We varied these parameters to provide a uniform dose along with a treatment times similar to conventional TBI (15-30 min). (B) We also investigated limited (head, chest, and pelvis) megavoltage CT (MVCT) scanning for the dimensional pretreatment setup verification rather than total body MVCT scanning to shorten the overall treatment time per treatment fraction. (C) We placed thermoluminescent detectors (TLDs) inside a Rando phantom to measure the dose at seven anatomical sites, including the lungs. A simulated TBI treatment showed homogeneous dose coverage (+/-10%) to the whole body. Doses to the sensitive organs were reduced by 35%-70% of the target dose. TLD measurements on Rando showed an accurate dose delivery (+/-7%) to the target and critical organs. In the TMI study, the dose was delivered conformally to the bone marrow only. The TBI and TMI treatment delivery time was reduced (by 50%) by increasing the field width from 2.5 to 5.0 cm in the inferior-superior direction. A limited MVCT reduced the target localization time 60% compared to whole body MVCT. MVCT image-guided helical tomotherapy offers a novel method to deliver a precise, homogeneous radiation dose to the whole body target while reducing the dose significantly to all critical organs. A judicious selection of pitch, modulation factor, and field size is required to produce a homogeneous dose distribution along with an acceptable treatment time. In addition, conformal radiation to the bone marrow appears feasible in an external radiation treatment using image-guided helical tomotherapy.

Physics in Medicine and Biology, 2004

Current Oncology Reports, 2000

Over the last 2 years, several advances have been made in the field of radiotherapy for brain tum... more Over the last 2 years, several advances have been made in the field of radiotherapy for brain tumors. Key advances are summarized in this review. Crucial technologic advances, such as radiosurgery, fractionated stereotactic radiotherapy, and intensity-modulated radiotherapy, are discussed. Better understanding of the interaction between the processes of angiogenesis, apoptosis, cell-cycle regulation, and signal transduction and the effects of ionizing radiation has made it clear that many of these ‘new agents’ are, in fact, valuable modulators of the radiation response. Another exciting molecular discovery is the recognition of radiation-induced promoters that can be exploited to cause spatially and temporally configured expression of selected genes; this approach may represent the ideal application of conformal radiation techniques in the future, yielding welldefined genetic changes in specifically targeted tissues. The final ‘frontier’ covered in this review is the newer categories of radiosensitizers, ranging from topoisomerase-I inhibitors, to expanded metalloporphyrins, to oxygendissociating agents.

Physics in Medicine and Biology, 2006

Medical Physics, 2003

Helical tomotherapy presented many unique dosimetric challenges and solutions during the initial ... more Helical tomotherapy presented many unique dosimetric challenges and solutions during the initial commissioning process, and some of them are presented. The dose calculation algorithm is convolution/superposition based. This requires that the energy fluence spectrum and magnitude be quantified. The methodology for doing so is described. Aspects of the energy fluence characterization that are unique to tomotherapy are highlighted. Many beam characteristics can be measured automatically by an included megavoltage computed tomography imaging system. This greatly improves data collection efficiency.

International Journal of Radiation Oncology Biology Physics, 2008

Medical Physics, 2004

Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-bo... more Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-board imaging capability (MVCT) and therefore differs from conventional treatment units. Different design goals resulted in some distinctive radiation field characteristics. The most significant differences in the design are the lack of flattening filter, increased shielding of the collimators, treatment and imaging operation modes and narrow fan beam delivery. Radiation characteristics of the helical tomotherapy system, sensitivity studies of various incident electron beam parameters and radiation safety analyses are presented here. It was determined that the photon beam energy spectrum of helical tomotherapy is similar to that of more conventional radiation treatment units. The two operational modes of the system result in different nominal energies of the incident electron beam with approximately 6 MeV and 3.5 MeV in the treatment and imaging modes, respectively. The off-axis mean energy dependence is much lower than in conventional radiotherapy units with less than 5% variation across the field, which is the consequence of the absent flattening filter. For the same reason the transverse profile exhibits the characteristic conical shape resulting in a 2-fold increase of the beam intensity in the center. The radiation leakage outside the field was found to be negligible at less than 0.05% because of the increased shielding of the collimators. At this level the in-field scattering is a dominant source of the radiation outside the field and thus a narrow field treatment does not result in the increased leakage. The sensitivity studies showed increased sensitivity on the incident electron position because of the narrow fan beam delivery and high sensitivity on the incident electron energy, as common to other treatment systems. All in all, it was determined that helical tomotherapy is a system with some unique radiation characteristics, which have been to a large extent optimized for intensity modulated delivery.

Radiotherapy and Oncology, 2008

Physics in Medicine and Biology, 2009

The gamma index is a tool for dose distribution comparison. It combines both dose difference (DD)... more The gamma index is a tool for dose distribution comparison. It combines both dose difference (DD) and distance to agreement (DTA) into a single quantity. Though it is an effective measure, making up for the inadequacy of DD or DTA alone, its calculation can be very time-consuming. For a k-D space with N quantization levels in each dimension, the complexity of the exhaustive search is O(N2k). In this work, we proposed an efficient method that reduces the complexity from O(N2k) to O(NkM), where M is the number of discretized dose values and is comparable to N. More precisely, by embedding the reference dose distribution in a (k+1)-D spatial-dose space, we can use fast Euclidean distance transform with linear complexity to obtain a table of gamma indices evaluated over a range of the (k+1)-D spatial-dose space. Then, to obtain gamma indices for the test dose distribution, it requires only table lookup with complexity O(Nk). Such a table can also be used for other test dose distributions as long as the reference dose distribution is the same. Simulations demonstrated the efficiency of our proposed method. The speedup for 3D gamma index calculation is expected to be on the order of tens of thousands (from O(N6) to O(N3M)) if N is a few hundreds, which makes clinical usage of the 3D gamma index feasible. A byproduct of the gamma index table is that the gradient of the gamma index with respect to either the spatial or dose dimension can be easily derived. The gradient can be used to identify the main causes of the discrepancy from the reference distribution at any dose point in the test distribution or incorporated in treatment planning and machine parameter optimization.

Revista Panamericana De Salud Publica-pan American Journal of Public Health, 2005

International Journal of Radiation Oncology Biology Physics, 2007

Physics in Medicine and Biology, 2003

Under various clinical situations, it is desirable to modify the original treatment plan to bette... more Under various clinical situations, it is desirable to modify the original treatment plan to better suit the clinical goals. In this work, a method to help physicians modify treatment plans based on their clinical preferences is proposed. The method uses a weighted quadratic dose objective function. The commonly used organ-/ROI-based weighting factors are expanded to a set of voxel-based weighting factors in order to obtain greater flexibility in treatment plan modification. Two different but equivalent modification schemes based on Rustem's quadratic programming algorithms--modification of a weighting matrix and modification of prescribed doses--are presented. Case studies demonstrated the effectiveness of the two methods with regard to their capability to fine-tune treatment plans.

International Journal of Radiation Oncology Biology Physics, 2008

Physics in Medicine and Biology, 2002

In routine clinical practice, radiotherapy treatment planning is performed based on the patient C... more In routine clinical practice, radiotherapy treatment planning is performed based on the patient CT images obtained during the patient setup procedure. However, the actual delivered dose to the patient might be different from the planned dose because of various reasons such as patient motion. Under such situations, it is desirable to modify the original treatment plan in order to partially remedy the dose delivery errors in the subsequent dose delivery process. Such modification can be implemented by modifying the original treatment plan using re-optimization. In this work, issues such as the re-optimization dose prescription, optimization constraints in re-optimization, re-optimization in multiple fractionation schemes and re-optimization procedure with generalized dose-based objective functions were investigated and corresponding mathematical schemes proposed. The derived results were applied to a clinical case study in which it was shown that the proposed re-optimization method is able to remedy the cold spots in tumour while delivering low dose to normal structures. Thus the potential effectiveness of the method was demonstrated.

Medical Physics, 2005

Current dosimetric protocols based on the absorbed dose (AAPM TG-51 and IAEA TRS-398 protocols) r... more Current dosimetric protocols based on the absorbed dose (AAPM TG-51 and IAEA TRS-398 protocols) require calibration measurements under reference conditions. For some radiotherapy systems, this requirement cannot be met, and calibration has to be performed under nonreference experimental conditions. In order to solve this problem, both protocols can be extended by inclusion of the measured-to-reference conversion factor, k(mr). In order to determine this factor, basic dosimetric quantities, like stopping power ratios, mass attenuation coefficients and chamber correction factors have to be calculated. If measurements are not feasible, accurate Monte Carlo modeling is required. The extension of the protocols is illustrated using the case of the helical tomotherapy radiation unit, where the typical calibration measurement conditions are the 10 x 5 cm2 field size and the 85 cm surface source distance, limited by the system design. It was calculated that the k(mr) factor for this conditions is close to unity (0.997+/-0.001). In addition, the deviation of the measurement conditions from the reference conditions results in the change of the quality conversion factor (approximately 0.995-0.998, depending on the ionization chamber used). This change is the same regardless of the used calibration protocol. For smaller field sizes the corrections become more significant, resulting in the total correction factor compared to the reference conditions of up to 1.5% for the smallest considered field size of 2 x 2 cm2.

Medical Physics, 2005

Total body radiation (TBI) has been used for many years as a preconditioning agent before bone ma... more Total body radiation (TBI) has been used for many years as a preconditioning agent before bone marrow transplantation. Many side effects still plague its use. We investigated the planning and delivery of total body irradiation (TBI) and selective total marrow irradiation (TMI) and a reduced radiation dose to sensitive structures using image-guided helical tomotherapy. To assess the feasibility of using helical tomotherapy, (A) we studied variations in pitch, field width, and modulation factor on total body and total marrow helical tomotherapy treatments. We varied these parameters to provide a uniform dose along with a treatment times similar to conventional TBI (15-30 min). (B) We also investigated limited (head, chest, and pelvis) megavoltage CT (MVCT) scanning for the dimensional pretreatment setup verification rather than total body MVCT scanning to shorten the overall treatment time per treatment fraction. (C) We placed thermoluminescent detectors (TLDs) inside a Rando phantom to measure the dose at seven anatomical sites, including the lungs. A simulated TBI treatment showed homogeneous dose coverage (+/-10%) to the whole body. Doses to the sensitive organs were reduced by 35%-70% of the target dose. TLD measurements on Rando showed an accurate dose delivery (+/-7%) to the target and critical organs. In the TMI study, the dose was delivered conformally to the bone marrow only. The TBI and TMI treatment delivery time was reduced (by 50%) by increasing the field width from 2.5 to 5.0 cm in the inferior-superior direction. A limited MVCT reduced the target localization time 60% compared to whole body MVCT. MVCT image-guided helical tomotherapy offers a novel method to deliver a precise, homogeneous radiation dose to the whole body target while reducing the dose significantly to all critical organs. A judicious selection of pitch, modulation factor, and field size is required to produce a homogeneous dose distribution along with an acceptable treatment time. In addition, conformal radiation to the bone marrow appears feasible in an external radiation treatment using image-guided helical tomotherapy.

Physics in Medicine and Biology, 2004

Current Oncology Reports, 2000

Over the last 2 years, several advances have been made in the field of radiotherapy for brain tum... more Over the last 2 years, several advances have been made in the field of radiotherapy for brain tumors. Key advances are summarized in this review. Crucial technologic advances, such as radiosurgery, fractionated stereotactic radiotherapy, and intensity-modulated radiotherapy, are discussed. Better understanding of the interaction between the processes of angiogenesis, apoptosis, cell-cycle regulation, and signal transduction and the effects of ionizing radiation has made it clear that many of these ‘new agents’ are, in fact, valuable modulators of the radiation response. Another exciting molecular discovery is the recognition of radiation-induced promoters that can be exploited to cause spatially and temporally configured expression of selected genes; this approach may represent the ideal application of conformal radiation techniques in the future, yielding welldefined genetic changes in specifically targeted tissues. The final ‘frontier’ covered in this review is the newer categories of radiosensitizers, ranging from topoisomerase-I inhibitors, to expanded metalloporphyrins, to oxygendissociating agents.

Physics in Medicine and Biology, 2006

Medical Physics, 2003

Helical tomotherapy presented many unique dosimetric challenges and solutions during the initial ... more Helical tomotherapy presented many unique dosimetric challenges and solutions during the initial commissioning process, and some of them are presented. The dose calculation algorithm is convolution/superposition based. This requires that the energy fluence spectrum and magnitude be quantified. The methodology for doing so is described. Aspects of the energy fluence characterization that are unique to tomotherapy are highlighted. Many beam characteristics can be measured automatically by an included megavoltage computed tomography imaging system. This greatly improves data collection efficiency.

International Journal of Radiation Oncology Biology Physics, 2008

Medical Physics, 2004

Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-bo... more Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-board imaging capability (MVCT) and therefore differs from conventional treatment units. Different design goals resulted in some distinctive radiation field characteristics. The most significant differences in the design are the lack of flattening filter, increased shielding of the collimators, treatment and imaging operation modes and narrow fan beam delivery. Radiation characteristics of the helical tomotherapy system, sensitivity studies of various incident electron beam parameters and radiation safety analyses are presented here. It was determined that the photon beam energy spectrum of helical tomotherapy is similar to that of more conventional radiation treatment units. The two operational modes of the system result in different nominal energies of the incident electron beam with approximately 6 MeV and 3.5 MeV in the treatment and imaging modes, respectively. The off-axis mean energy dependence is much lower than in conventional radiotherapy units with less than 5% variation across the field, which is the consequence of the absent flattening filter. For the same reason the transverse profile exhibits the characteristic conical shape resulting in a 2-fold increase of the beam intensity in the center. The radiation leakage outside the field was found to be negligible at less than 0.05% because of the increased shielding of the collimators. At this level the in-field scattering is a dominant source of the radiation outside the field and thus a narrow field treatment does not result in the increased leakage. The sensitivity studies showed increased sensitivity on the incident electron position because of the narrow fan beam delivery and high sensitivity on the incident electron energy, as common to other treatment systems. All in all, it was determined that helical tomotherapy is a system with some unique radiation characteristics, which have been to a large extent optimized for intensity modulated delivery.

Radiotherapy and Oncology, 2008

Physics in Medicine and Biology, 2009

The gamma index is a tool for dose distribution comparison. It combines both dose difference (DD)... more The gamma index is a tool for dose distribution comparison. It combines both dose difference (DD) and distance to agreement (DTA) into a single quantity. Though it is an effective measure, making up for the inadequacy of DD or DTA alone, its calculation can be very time-consuming. For a k-D space with N quantization levels in each dimension, the complexity of the exhaustive search is O(N2k). In this work, we proposed an efficient method that reduces the complexity from O(N2k) to O(NkM), where M is the number of discretized dose values and is comparable to N. More precisely, by embedding the reference dose distribution in a (k+1)-D spatial-dose space, we can use fast Euclidean distance transform with linear complexity to obtain a table of gamma indices evaluated over a range of the (k+1)-D spatial-dose space. Then, to obtain gamma indices for the test dose distribution, it requires only table lookup with complexity O(Nk). Such a table can also be used for other test dose distributions as long as the reference dose distribution is the same. Simulations demonstrated the efficiency of our proposed method. The speedup for 3D gamma index calculation is expected to be on the order of tens of thousands (from O(N6) to O(N3M)) if N is a few hundreds, which makes clinical usage of the 3D gamma index feasible. A byproduct of the gamma index table is that the gradient of the gamma index with respect to either the spatial or dose dimension can be easily derived. The gradient can be used to identify the main causes of the discrepancy from the reference distribution at any dose point in the test distribution or incorporated in treatment planning and machine parameter optimization.