Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy

This work analysed the feasibility of using a fast, customized Monte Carlo (MC) method to perform accurate computation of dose distributions during pre- and intraplanning of intraoperative electron radiation therapy (IOERT) procedures. The MC method that was implemented, which has been integrated into a specific innovative simulation and planning tool, is able to simulate the fate of thousands of particles per second, and it was the aim of this work to determine the level of interactivity that could be achieved. The planning workflow enabled calibration of the imaging and treatment equipment, as well as manipulation of the surgical frame and insertion of the protection shields around the organs at risk and other beam modifiers. In this way, the multidisciplinary team involved in IOERT has all the tools necessary to perform complex MC dosage simulations adapted to their equipment in an efficient and transparent way. To assess the accuracy and reliability of this MC technique, dose distributions for a monoenergetic source were compared with those obtained using a general-purpose software package used widely in medical physics applications. Once accuracy of the underlying simulator was confirmed, a clinical accelerator was modelled and experimental measurements in water were conducted. A comparison was made with the output from the simulator to identify the conditions under which accurate dose estimations could be obtained in less than 3 min, which is the threshold imposed to allow for interactive use of the tool in treatment planning. Finally, a clinically relevant scenario, namely early-stage breast cancer treatment, was simulated with pre- and intraoperative volumes to verify that it was feasible to use the MC tool intraoperatively and to adjust dose delivery based on the simulation output, without compromising accuracy. The workflow provided a satisfactory model of the treatment head and the imaging system, enabling proper configuration of the treatment planning system and providing good accuracy in the dosage simulation.

Incorporating equity into transport planning: utility, priority and sufficiency approaches

The analysis addresses the issue of transport equity and explores three different approaches to equity in transport: utilitarianism, sufficientarianism and prioritarianism. Each approach calls for a different treatment of the benefits reaped by different population groups in the assessment of transport investments or policies. In utilitarianism, which underlies much of the current practice of transport project appraisal, all benefits receive the same weight, irrespective of the recipient of the benefits. In both sufficientarianism and prioritarianism, benefits are weighed in distinct ways, depending on the characteristics of the recipients. The three approaches are illustrated using a fictive case study, in which three different transport investment are assessed and compared to each other. Finally, the assessment of transport investments will be explored using the cost-effectiveness analysis (CEA). The CEA assesses the distributional effects of transport investments for utilitarism, sufficientarism and prioritarism approaches and addresses distinct needs associated with different population groups in respect to their transport