Monte Carlo verification of intensity modulated radiotherapy treatments using EPIDS

Purpose: Electronic Portal Imaging Devices (EPIDs) are available with most linear accelerators (Amonuk, 2002), the current technology being amorphous silicon flat panel imagers. EPIDs are currently used routinely in patient positioning before radiotherapy treatments. There has been an increasing interest in using EPID technology tor dosimetric verification of radiotherapy treatments (van Elmpt, 2008). A straightforward technique involves the EPID panel being used to measure the fluence exiting the patient during a treatment which is then compared to a prediction of the fluence based on the treatment plan. However, there are a number of significant limitations which exist in this Method: Resulting in a limited proliferation ot this technique in a clinical environment. In this paper, we aim to present a technique of simulating IMRT fields using Monte Carlo to predict the dose in an EPID which can then be compared to the measured dose in the EPID. Materials: Measurements were made using an iView GT flat panel a-SI EPfD mounted on an Elekta Synergy linear accelerator. The images from the EPID were acquired using the XIS software (Heimann Imaging Systems). Monte Carlo simulations were performed using the BEAMnrc and DOSXVZnrc user codes. The IMRT fieids to be delivered were taken from the treatment planning system in DICOMRT format and converted into BEAMnrc and DOSXYZnrc input files using an in-house application (Crowe, 2009). Additionally. all image processing and analysis was performed using another in-house application written using the Interactive Data Language (IDL) (In Visual Information Systems). Comparison between the measured and Monte Carlo EPID images was performed using a gamma analysis (Low, 1998) incorporating dose and distance to agreement criteria. Results: The fluence maps recorded by the EPID were found to provide good agreement between measured and simulated data. Figure 1 shows an example of measured and simulated IMRT dose images and profiles in the x and y directions. "A technique for the quantitative evaluation of dose distributions", Med Phys, 25(5) May 1998 S. Crowe, 1. Kairn, A. Fielding, "The Development of a Monte Carlo system to verify Radiotherapy treatment dose calculations", Radiotherapy & Oncology, Volume 92, Supplement 1, August 2009, Pages S71-S71.

Phantom Scatter and the A-SI EPID

Introduction: The use of amorphous-silicon electronic portal imaging devices (a-Si EPIDs) for dosimetry is complicated by the effects of scattered radiation. In photon radiotherapy, primary signal at the detector can be accompanied by photons scattered from linear accelerator components, detector materials, intervening air, treatment room surfaces (floor, walls, etc) and from the patient/phantom being irradiated. Consequently, EPID measurements which presume to take scatter into account are highly sensitive to the identification of these contributions. One example of this susceptibility is the process of calibrating an EPID for use as a gauge of (radiological) thickness, where specific allowance must be made for the effect of phantom-scatter on the intensity of radiation measured through different thicknesses of phantom. This is usually done via a theoretical calculation which assumes that phantom scatter is linearly related to thickness and field-size. We have, however, undertaken a more detailed study of the scattering effects of fields of different dimensions when applied to phantoms of various thicknesses in order to derive scattered-primary ratios (SPRs) directly from simulation results. This allows us to make a more-accurate calibration of the EPID, and to qualify the appositeness of the theoretical SPR calculations. Methods: This study uses a full MC model of the entire linac-phantom-detector system simulated using EGSnrc/BEAMnrc codes. The Elekta linac and EPID are modelled according to specifications from the manufacturer and the intervening phantoms are modelled as rectilinear blocks of water or plastic, with their densities set to a range of physically realistic and unrealistic values. Transmissions through these various phantoms are calculated using the dose detected in the model EPID and used in an evaluation of the field-size-dependence of SPR, in different media, applying a method suggested for experimental systems by Swindell and Evans [1]. These results are compared firstly with SPRs calculated using the theoretical, linear relationship between SPR and irradiated volume, and secondly with SPRs evaluated from our own experimental data. An alternate evaluation of the SPR in each simulated system is also made by modifying the BEAMnrc user code READPHSP, to identify and count those particles in a given plane of the system that have undergone a scattering event. In addition to these simulations, which are designed to closely replicate the experimental setup, we also used MC models to examine the effects of varying the setup in experimentally challenging ways (changing the size of the air gap between the phantom and the EPID, changing the longitudinal position of the EPID itself). Experimental measurements used in this study were made using an Elekta Precise linear accelerator, operating at 6MV, with an Elekta iView GT a-Si EPID. Results and Discussion: 1. Comparison with theory: With the Elekta iView EPID fixed at 160 cm from the photon source, the phantoms, when positioned isocentrically, are located 41 to 55 cm from the surface of the panel. At this geometry, a close but imperfect agreement (differing by up to 5%) can be identified between the results of the simulations and the theoretical calculations. However, this agreement can be totally disrupted by shifting the phantom out of the isocentric position. Evidently, the allowance made for source-phantom-detector geometry by the theoretical expression for SPR is inadequate to describe the effect that phantom proximity can have on measurements made using an (infamously low-energy sensitive) a-Si EPID. 2. Comparison with experiment: For various square field sizes and across the range of phantom thicknesses, there is good agreement between simulation data and experimental measurements of the transmissions and the derived values of the primary intensities. However, the values of SPR obtained through these simulations and measurements seem to be much more sensitive to slight differences between the simulated and real systems, leading to difficulties in producing a simulated system which adequately replicates the experimental data. (For instance, small changes to simulated phantom density make large differences to resulting SPR.) 3. Comparison with direct calculation: By developing a method for directly counting the number scattered particles reaching the detector after passing through the various isocentric phantom thicknesses, we show that the experimental method discussed above is providing a good measure of the actual degree of scattering produced by the phantom. This calculation also permits the analysis of the scattering sources/sinks within the linac and EPID, as well as the phantom and intervening air. Conclusions: This work challenges the assumption that scatter to and within an EPID can be accounted for using a simple, linear model. Simulations discussed here are intended to contribute to a fuller understanding of the contribution of scattered radiation to the EPID images that are used in dosimetry calculations. Acknowledgements: This work is funded by the NHMRC, through a project grant, and supported by the Queensland University of Technology (QUT) and the Royal Brisbane and Women's Hospital, Brisbane, Australia. The authors are also grateful to Elekta for the provision of manufacturing specifications which permitted the detailed simulation of their linear accelerators and amorphous-silicon electronic portal imaging devices. Computational resources and services used in this work were provided by the HPC and Research Support Group, QUT, Brisbane, Australia.

Pixel value to electron density conversion for a Megavoltage Cone Beam CT System

Introduction: The motivation for developing megavoltage (and kilovoltage) cone beam CT (MV CBCT) capabilities in the radiotherapy treatment room was primarily based on the need to improve patient set-up accuracy. There has recently been an interest in using the cone beam CT data for treatment planning. Accurate treatment planning, however, requires knowledge of the electron density of the tissues receiving radiation in order to calculate dose distributions. This is obtained from CT, utilising a conversion between CT number and electron density of various tissues. The use of MV CBCT has particular advantages compared to treatment planning with kilovoltage CT in the presence of high atomic number materials and requires the conversion of pixel values from the image sets to electron density. Therefore, a study was undertaken to characterise the pixel value to electron density relationship for the Siemens MV CBCT system, MVision, and determine the effect, if any, of differing the number of monitor units used for acquisition. If a significant difference with number of monitor units was seen then pixel value to ED conversions may be required for each of the clinical settings. The calibration of the MV CT images for electron density offers the possibility for a daily recalculation of the dose distribution and the introduction of new adaptive radiotherapy treatment strategies. Methods: A Gammex Electron Density CT Phantom was imaged with the MVCB CT system. The pixel value for each of the sixteen inserts, which ranged from 0.292 to 1.707 relative electron density to the background solid water, was determined by taking the mean value from within a region of interest centred on the insert, over 5 slices within the centre of the phantom. These results were averaged and plotted against the relative electron densities of each insert with a linear least squares fit was preformed. This procedure was performed for images acquired with 5, 8, 15 and 60 monitor units. Results: The linear relationship between MVCT pixel value and ED was demonstrated for all monitor unit settings and over a range of electron densities. The number of monitor units utilised was found to have no significant impact on this relationship. Discussion: It was found that the number of MU utilised does not significantly alter the pixel value obtained for different ED materials. However, to ensure the most accurate and reproducible MV to ED calibration, one MU setting should be chosen and used routinely. To ensure accuracy for the clinical situation this MU setting should correspond to that which is used clinically. If more than one MU setting is used clinically then an average of the CT values acquired with different numbers of MU could be utilized without loss in accuracy. Conclusions: No significant differences have been shown between the pixel value to ED conversion for the Siemens MV CT cone beam unit with change in monitor units. Thus as single conversion curve could be utilised for MV CT treatment planning. To fully utilise MV CT imaging for radiotherapy treatment planning further work will be undertaken to ensure all corrections have been made and dose calculations verified. These dose calculations may be either for treatment planning purposes or for reconstructing the delivered dose distribution from transit dosimetry measurements made using electronic portal imaging devices. This will potentially allow the cumulative dose distribution to be determined through the patient’s multi-fraction treatment and adaptive treatment strategies developed to optimize the tumour response.

Beat-mixing Rock music: Rock and electronic dance music merge to create the Manarays

This research introduces the proposition that Electronic Dance Music’s beat-mixing function could be implemented to create immediacy in other musical genres. The inclusion of rhythmic sections at the beginning and end of each musical work created a ‘DJ friendly’ environment. The term used in this thesis to refer to the application of beat-mixing in Rock music is ‘ClubRock’. Collaboration between a number of DJs and Rock music professionals applied the process of beat-mixing to blend Rock tracks to produce a continuous ClubRock set. The DJ technique of beat-mixing Rock music transformed static renditions into a fluid creative work. The hybridisation of the two genres, EDM and Rock, resulted in a contribution to Rock music compositional approaches and the production of a unique Rock album; Manarays—Get Lucky.

The role of perceived usefulness and attitude on electronic health record acceptance : an empirical investigation using response surface analysis

Information and communications technologies are a significant component of the healthcare domain and electronic health records play a major role within it. As a result, it is important that they are accepted en masse by healthcare professionals. How healthcare professionals perceive the usefulness of electronic health records and their attitudes towards them have been shown to have significant effects on their overall acceptance. This paper investigates the role of perceived usefulness and attitude on the intention to use electronic health records by future healthcare professionals using polynomial regression with response surface analysis. Results show that the relationship is more complex than predicted in prior research. The paper concludes that the predicting properties of the above determinants must be further investigated to clearly understand their role in predicting the intention to use electronic health records and in designing systems that are better adopted by healthcare professionals of the future.

Investigation of megavoltage beams and detectors for electronic portal imaging

Accuracy of dose delivery in external beam radiotherapy is usually verified with electronic portal imaging (EPI) in which the treatment beam is used to check the positioning of the patient. However the resulting megavoltage x-ray images suffer from poor quality. The image quality can be improved by developing a special operating mode in the linear accelerator. The existing treatment beam is modified such that it produces enough low-energy photons for imaging. In this work the problem of optimizing the beam/detector combination to achieve optimal electronic portal image quality is addressed. The linac used for this study was modified to produce two experimental photon beams. These beams, named Al6 and Al10, were non-flat and were produced by 4MeV electrons hitting aluminum targets, 6 and 10mm thick respectively. The images produced by a conventional EPI system (6MV treatment beam and camera-based EPID with a Cu plate & Gd2O2S screen ) were compared with the images produced by the experimental beams and various screens with the same camera). The contrast of 0.8cm bone equivalent material in 5 cm water increased from 1.5% for the conventional system to 11% for the combination of Al6 beam with a 200mg/cm2 Gd2O2S screen. The signal-to-noise ratio calculated for 1cGy flood field images increased by about a factor of two for the same EPI systems. The spatial resolution of the two imaging systems was comparable. This work demonstrates that significant improvements in portal image contrast can be obtained by simultaneous optimization of the linac spectrum and EPI detector.

Verification of patient position and delivery of IMRT by electronic Portal Imaging

We have taken a new method of calibrating portal images of IMRT beams and used this to measure patient set-up accuracy and delivery errors, such as leaf errors and segment intensity errors during treatment. A calibration technique was used to remove the intensity modulations from the images leaving equivalent open field images that show patient anatomy that can be used for verification of the patient position. The images of the treatment beam can also be used to verify the delivery of the beam in terms of multileaf collimator leaf position and dosimetric errors. A series of controlled experiments delivering an IMRT anterior beam to the head and neck of a humanoid phantom were undertaken. A 2mm translation in the position of the phantom could be detected. With intentional introduction of delivery errors into the beam this method allowed us to detect leaf positioning errors of 2mm and variation in monitor units of 1%. The method was then applied to the case of a patient who received IMRT treatment to the larynx and cervical nodes. The anterior IMRT beam was imaged during four fractions and the images calibrated and investigated for the characteristic signs of patient position error and delivery error that were shown in the control experiments. No significant errors were seen. The method of imaging the IMRT beam and calibrating the images to remove the intensity modulations can be a useful tool in verifying both the patient position and the delivery of the beam.

Electrical property and characterization of nano-SnO2/wollastonite composite materials

Nano-tin oxide was deposited on the surface of wollastonite using the mixed solution including stannic chloride pentahydrate precursor and wollastonite by a hydrolysis precipitation process. The antistatic properties of the wollastonite materials under different calcined conditions and composite materials (nano-SnO2/wollastonite, SW) were measured by rubber sheeter and four-point probe (FPP) sheet resistance measurement. Effects of hydrolysis temperature and time, calcination temperature and time, pH value and nano-SnO2 coating amount on the resistivity of SW powders were studied, and the optimum experimental conditions were obtained. The microstructure and surface properties of wollastonite, precipitate and SW were characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray spectrometry (EDS), specific surface area analyzer (BET), thermogravimetry (TG), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), and Fourier translation infrared spectroscopy (FTIR) respectively. The results showed that the nano-SnO2/wollastonite composite materials under optimum preparation conditions showed better antistatic properties, the resistivity of which was reduced from 1.068 × 104 Ω cm to 2.533 × 103 Ω cm. From TG and XRD analysis, the possible mechanism for coating of SnO2 nanoparticles on the surface of wollastonite was proposed. The infrared spectrum indicated that there were a large number of the hydroxyl groups on the surface of wollastonite. This is beneficial to the heterogeneous nucleation reaction. Through morphology, EDS and XPS analysis, the surface of wollastonite fiber was coated with a layer of 10–15 nm thickness of tin oxide grains the distribution of which was uniform.

Thermal transport in graphene-polymer nanocomposites

Graphene-polymer nanocomposites have attracted considerable attention due to their unique properties, such as high thermal conductivity (~3000 W mK-1), mechanical stiffness (~ 1 TPa) and electronic transport properties. Relatively, the thermal performance of graphene-polymer composites has not been well investigated. The major technical challenge is to understand the interfacial thermal transport between graphene nanofiller and polymer matrix at small material length scale. To this end, we conducted molecular dynamics simulations to investigate the thermal transport in graphene-polyethylene nanocomposite. The influence of functionalization with hydrocarbon chains on the interfacial thermal conductivity was studied, taking into account of the effects of model size and thermal conductivity of graphene. The results are considered to contribute to development of new graphene-polymer nanocomposites with tailored thermal properties.

Trends in nurse-administered procedural sedation and analgesia across cardiac catheterisation laboratories in Australia and New Zealand : results of an electronic survey

Background Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. Objective To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs. Design A quantitative, cross-sectional, descriptive survey design was used. Methods Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data. Results A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n = 58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n = 58). One respondent indicated that propofol was also used. 20% (n = 12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n = 18) indicated that comprehensive education about PSA is provided. 45% (n = 26) indicated that nurses who administer PSA should undergo competency assessment. Conclusion By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand.

Developing media production skills for literacy in a primary school classroom : digital materials, embodied knowledge and material contexts

This chapter investigates the relationship between technical and operational skills and the development of conceptual knowledge and literacy in Media Arts learning. It argues that there is a relationship between the stories, expressions and ideas that students aim to produce with communications media, and their ability to realise these in material form through technical processes in specific material contexts. Our claim is that there is a relationship between the technical and the operational, along with material relations and the development of conceptual knowledge and literacy in media arts learning. We place more emphasis on the material aspects of literacy than is usually the case in socio-cultural accounts of media literacy. We provide examples from a current project to demonstrate that it is just as important to address the material as it is the discursive and conceptual when considering how students develop media literacy in classroom spaces.