CT Image Electron Density Quantification in Regions with Metal Implants: Implications for Radiotherapy Treatment Planning

In radiotherapy planning, computed tomography (CT) images are used to quantify the electron density of tissues and provide spatial anatomical information. Treatment planning systems use these data to calculate the expected spatial distribution of absorbed dose in a patient. CT imaging is complicated by the presence of metal implants which cause increased image noise, produce artifacts throughout the image and can exceed the available range of CT number values within the implant, perturbing electron density estimates in the image. Furthermore, current dose calculation algorithms do not accurately model radiation transport at metal-tissue interfaces. Combined, these issues adversely affect the accuracy of dose calculations in the vicinity of metal implants. As the number of patients with orthopedic and dental implants grows, so does the need to deliver safe and effective radiotherapy treatments in the presence of implants. The Medical Physics group at the Cancer Centre of Southeastern Ontario and Queen's University has developed a Cobalt-60 CT system that is relatively insensitive to metal artifacts due to the high energy, nearly monoenergetic Cobalt-60 photon beam. Kilovoltage CT (kVCT) images, including images corrected using a commercial metal artifact reduction tool, were compared to Cobalt-60 CT images throughout the treatment planning process, from initial imaging through to dose calculation. An effective metal artifact reduction algorithm was also implemented for the Cobalt-60 CT system. Electron density maps derived from the same kVCT and Cobalt-60 CT images indicated the impact of image artifacts on estimates of photon attenuation for treatment planning applications. Measurements showed that truncation of CT number data in kVCT images produced significant mischaracterization of the electron density of metals. Dose measurements downstream of metal inserts in a water phantom were compared to dose data calculated using CT images from kVCT and Cobalt-60 systems with and without artifact correction. The superior accuracy of electron density data derived from Cobalt-60 images compared to kVCT images produced calculated dose with far better agreement with measured results. These results indicated that dose calculation errors from metal image artifacts are primarily due to misrepresentation of electron density within metals rather than artifacts surrounding the implants.

Prudent Budget Planning and Budgetary Process Effectiveness: The Canadian Federal Government’s Experience (Working Paper 47)

In 1994, the Liberal government introduced a structured approach to prudent budgeting to provide the fiscal discipline needed to meet its debt reduction targets in which explicit prudence factors were introduced into the fiscal framework to reduce the amount of fiscal flexibility available for allocation in each annual budget. Although that framework was successful in contributing to the elimination of persistent budgetary deficits, this paper advances three linked arguments: • that additional but undisclosed prudence factors were also introduced into the fiscal framework to attenuate the political risk of missing budget targets; • that these undisclosed prudence factors are one cause of a number of unintended budgetary outcomes that put the effectiveness of the budgetary process at risk; and • that there is nothing inherently politically partisan about the Liberal’s approach to prudent budget planning and, changes to terminology and display notwithstanding, the present Conservative government has continued to apply most elements of that framework in its budgets. Moving from a single-year budget target to one that is expressed as a cumulative total over the election cycle is discussed as one option that would help preserve the merits of prudent budgeting.

Energizing the Oak Ridges Moraine? Analyzing the Policy Implications of Three Wind Energy Developments on the Oak Ridges Moraine and their Potential Impact on the Coordinated Land Use Planning Review through the Involvement of First Nations and Environmental Non-governmental Organizations

This research explores the policy implications of the approval of three wind energy projects on the Oak Ridges Moraine, and their impact on the Coordinated Land Use Planning Review process. Specifically, it focuses on the involvement of First Nations and environmental non-governmental organizations (ENGOs). This research was conducted through analyzing submissions to the Coordinated Land Use Planning Review, related legislation and policy, Environmental Review Tribunal hearing documents, and interviews with key informants. This research culminates in a number of recommendations to the Coordinated Review informed by the analysis.

The Canadian Federal Government’s Experience with Prudent Budget Planning (Working Paper 42)

The Liberal government made three significant changes to the budget process during the twelve years that it held office (from 1993 to the election call in the winter of 2005). The first of these changes was the formal introduction of prudent budget planning. The second was a focus on reallocation, beginning with its 1994 Program Review initiative, followed by a series of other measures. The third was the introduction for fiscal 2003-04 of a full accrual basis for the budget (though not, it should be noted, full accrual budgeting) and for the Public Accounts. This paper focuses predominantly on the first of these changes and examines its impact on the government’s budget and expenditure management decision-making processes.