A commercial linear accelerator with a factory-fitted multileaf collimator (MLC) was commissioned for clinical use. Measurements made of dosimetric parameters included central axis depth-dose, field-size factors, wedge factors, penumbra, and leaf leakage for the 6-MV and 15-MV photon beams available on this accelerator. The depth-dose characteristics, output factors, and transmission factors were similar to those reported in the literature for a machine by the same manufacturer with a standard treatment head. Because of scalloping, the effective penumbra for the MLC was 3 to 4 mm wider than that for the conventional collimator jaws. The output for the fields shaped by the MLC was generally lower than that for similar fields shaped with Lipowitz's metal (Cerrobend). The magnitude of the difference was field-size dependent and ranged from 0.5% to 4.5% for open shaped fields, increasing to 1% to 5% in the presence of wedges. Further analysis of this observation has shown it to be primarily due to differences in the scattered radiation from the collimator head.
Purpose: To implement a web‐based DICOM‐RT PACS for peer review, quality assurance and clinical outcome studies in proton therapy. Method and Materials: We have designed and deployed a web‐based clinical data submission and retrieval system to implement a successful peer review and clinical QA paradigm for proton therapy treatment plans. Our proprietary local DICOM server automates the communication between the TPS and our web‐based secure client application. The TPS outputs the clinical treatment plan as DICOM‐RT objects, which are then uploaded to the central server via a secure web‐based link. The data sets are automatically anonymized based on one‐to‐one mapping that is known only to the submitter of a patient plan. It is often necessary to supplement this data set with additional information in order to appraise the plan reviewers of clinical rationale used in the plan evaluation and selection. The information that is not part of the DICOM ion‐plan includes; proximal and distal margins used to account for range uncertainty, smearing and smoothing margins for compensator design, distal blocking to spare OAR, etc. The submitter may generate screen captured views of a plan and add comments, instructions, and provide planning criteria by adding multi‐media data. This information is converted to DICOM objects and is submitted to the server as a part of a plan. The reviewers can use our web‐based client application to retrieve part or all of the submitted data set and use their own TPS for more comprehensive plan evaluation. Results and Conclusion: The treatment plans for several prostate patients have been successfully submitted to and retrieved from the prototype system at UFPTI. In all cases, the restored plans maintained the integrity of all clinical information as submitted. We found that the supplemental information uploaded with each plan was extremely important and useful for the plan reviewers.
Purpose: To present standalone software that allows for transfer of treatment planning data from a treatment planning system (TPS) in DICOM‐RT format to any user‐defined image analysis platform. With this, several treatment planning tools have been developed outside of TPS for 4DCT analysis. Materials and method: Treatment planning systems have been primarily viewed as dose calculation engines, and only recently have begun introducing rudimentary tools dealing with 4DCT and deformable image registration. Concurrently, there has been a proliferation of imaging software, either in public domain or user‐written, for the new imaging paradigm offered by 4DCT to study organ deformation. There is a disconnect between available treatment planning tools and the state‐of‐art in image processing. While DICOM‐RT standard allows, in theory, for a straightforward transfer of treatment planning data, the clinical experience is generally anything but this. Thus most radiotherapy clinics, without benefit of dedicated programming and imaging science teams and yet treating the majority of patients, are unable to realize the full potential offered by 4DCT or contribute valuable clinical experience. Using a simplified DICOM‐RT export from TPS, we developed several treatment planning tools for enhanced visualization and image analysis of 4DCT data. Results: Various tools for processing 4DCT data were developed: 1) autosegmentation of normal structures onto phased CTs using a reference 3D CT containing initial manual segmentations; 2) automatic generation of internal target volume (ITV); 3) target motion characterization using center‐of‐mass trajectories; 4) dose volume histograms based either on maximal target motion, or probability density function; and 5) visualization for studying goodness of registration. Conclusion: Image analysis tools, which supplement available image visualization using software from CERR (Washington University, St. Louis) and RCET (University of Florida), for 4DCT were presented. This approach allows for rapid development and clinical implementation of state‐of‐art image analysis tools in treatment planning.
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