Radiation, Volume 5, Issue 1 (March 2025) – 9 articles

Background: Quality assurance (QA) programs are designed to improve the quality and safety of radiation treatments, including patient-specific QA (PSQA). The objective of this study was to investigate the conditions in which pretreatment PSQA is performed, to evaluate the root cause of the implementation of more complex techniques, and to identify areas for potential improvement. Materials/Methods: The Octavius 4D (O4D) system accuracy was evaluated using an O4D homogeneous phantom for different field sizes. Tests of the system response to dose linearity, field sizes, and PDD differences were performed against calculated doses for a 6 MV photon beam. The pretreatment verification of 40 VMAT plans was performed using the PTW VeriSoft software (version 8.0.1) for local and global 3D gamma analysis. The reconstructed 3D dose was compared to the calculated dose using 2%/2 mm and 3%/3 mm, 20% of the low-dose threshold, and 95% of the gamma passing rate (%GP) tolerance level. The sensitivity of the O4D system in detecting VMAT delivery and setup errors has been investigated by measuring the variation in %GP values before and after the simulated errors. Results: The O4D system reported good agreement for linearity, field size, and PDD differences with TPS dose, being within ±2% tolerance. The output factors were consistent between the ionization chamber and the O4D detector down to a 4 × 4 cm² field size with a maximum deviation less than 1%. The introduction of deliberate errors caused a decrease in %GP values. In most scenarios, the %GP value of the simulated errors was detected with 2%/2 mm. Conclusion: The results indicate that the O4D system is sensitive enough to detect delivery and setup errors with the restrictive global criterion of 2%/2 mm for routine pretreatment verification. Full article

Salivary glands are common organs at risk in both head and neck external beam radiotherapy (EBRT) and radiopharmaceutical therapy (RPT), but incidences of xerostomia in RPT are inconsistent with the EBRT Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) limits. In EBRT, salivary glands are usually assumed to be parallel organs, with QUANTEC guidelines based on $D_{mean}$, but this is known to be a gross over-simplification of the full complexity of the underlying functional organization. The goal of this work is to combine machine learning of EBRT dose–outcome data with stylized small-scale RPT dosimetry to discover more reliable normal tissue complication probability (NTCP) models of xerostomia across both modalities. A retrospective cohort of 211 EBRT patients was analyzed using a custom-designed in-house machine learning workflow. From this, a hierarchy of three models of increasing complexity was trained, evaluated for performance and generalization, and coupled with stylized small-scale salivary gland dosimetry to assess the influence of model complexity on the predicted NTCP for plausible patterns of RPT dose nonuniformity. The three models in the hierarchy (A, B, C), in increasing order of complexity, associate xerostomia with the following: the mean dose to the whole contralateral parotid (model A), the mean dose to a ductally localized region (model B) and a serial interaction dose term between two ductal sub-compartments (model C). While the difference between the three models for EBRT p-values and AUCs is rather marginal, for physiologically driven ductal dose distributions in RPT, the predicted reduction in TD50 can be as large as a factor of 10. These results provide hints towards a plausible reconciliation of the observed inconsistency of xerostomia in RPT with EBRT dose limits. Full article

Radiomics and deep learning computer vision algorithms can extract clinically relevant information from medical images, providing valuable insights for accurate diagnosis of cancerous lesions, tumor differentiation and molecular subtyping, prediction of treatment response, and prognostication of long-term outcomes. In head and neck squamous cell carcinoma (HNSCC), growing evidence supports the potential role of radiomics and deep learning models in predicting treatment response, long-term outcomes, and treatment complications following radiation therapy. This is especially important given the pivotal role of radiotherapy in early-stage and locally advanced HNSCC, as well as in post-operative and concomitant chemoradiotherapy. In this article, we summarize recent studies highlighting the role of radiomics in predicting early post-radiotherapy response, locoregional recurrence, survival outcomes, and treatment-related complications. Radiomics-guided tools have the potential to personalize HNSCC radiation treatment by identifying low-risk patients who may benefit from de-intensified therapy and high-risk individuals who require more aggressive treatment strategies. Full article

Effective dose calculation is essential for optimizing Gamma Knife (GK) stereotactic radiosurgery (SRS) treatment plans. Modern GK systems allow independent sector activation, enabling complex dose distributions per shot. This study presents a dose approximation method designed to account for shot flexibility and generate 3D doses external to GammaPlan. A treatment plan was created with the TMR10 calculation for individual sector activations using a Radiosurgery Head Phantom. The resulting dose arrays established a basis set of sector-specific distributions, which were then referenced by shot parameters from the plan, allowing dose accumulation through superposition. This superposition approximation (SA) was compared to the original TMR10 using the Dice Similarity Coefficient (DSC), 95% Hausdorff Distance (HD95), and GK deliverability metrics: coverage, selectivity, and gradient index, across an isodose normalization range from 10% to 90%. In a cohort of 30 patients with 71 targets, strong agreement was observed between TMR10 and SA in the clinically used 50–60% isodose range, with DSC above 85% and HD95 under 2.18 mm. The average differences for the coverage, selectivity, and gradient index were 0.014, 0.008, and 0.118, respectively. This method accurately approximates TMR10 calculations within clinically relevant ranges, offering an external tool to assess 3D dose distributions for GK treatment plans. Full article

The image quality index for whole-body bone scintigraphy has traditionally relied on the total count (Total-C) with a threshold of ≥1.5 million counts (MC). However, Total-C measurements are susceptible to variability owing to urine retention. This study aimed to develop a skeletal count (Skel-C)-based index, focusing exclusively on bone regions, to improve the accuracy of image analysis in bone scintigraphy. To determine the optimal Skel-C-based threshold, Skel-C thresholds were set at 0.9, 1.0, 1.1, and 1.2 MC, and Total-C thresholds were set at 1.75, 2.0, and 2.25 MC. Patients were then categorized based on whether their values were above or below these thresholds. The group including all cases was defined as the Total-C 1.5 high group. Sensitivity and specificity were calculated for each group, and receiver operating characteristic analyses and statistical evaluations were conducted. The specificity of the bone scintigraphy image analysis program in the Skel-C < 0.9 MC group was significantly lower than that in the Skel-C ≥ 0.9 MC and Total-C 1.5 high groups. The decrease in specificity was evident only with Skel-C and was not identified based on Total-C levels. These findings highlight the importance of achieving Skel-C ≥ 0.9 MC and suggest that Total-C alone is insufficient for reliable image assessment. Full article

Background: We aimed to measure the pacemaker- and defibrillator-induced distortion at 0.35T and 3.0T magnetic fields. Methods: The pacemaker/defibrillator was placed at the top center of a water-filled/MagPhan phantom, followed by a T1 scan at 3T and a TrueFISP scan at 0.35T. The extent of distortion (i.e., the distance from the device to the furthest signal loss/void/rings) in the water-filled phantom was measured in MIM. For geometrical distortion (i.e., dislocation of geometrical structures), the spheres in the MagPhan phantom were contoured and their distortion was calculated based on their manufacturing coordinate positions. Results: The maximum extent of distortion caused by the defibrillator was 18.8 cm at 0.35T and 5.8 cm at 3.0T. Similarly, the maximum extent of distortion caused by the pacemaker was 9.28 cm at 0.35T and 2.8 cm at 3.0T. Geometrical distortion measurements using the MagPhan phantom showed that the maximum distortion caused by the defibrillator was 12.8 mm at 0.35T and 13.2 mm at 3.0T. Likewise, the maximum distortion caused by the pacemaker was 8.7 mm at 0.35T and 6.0 mm at 3.0T. Conclusions: Defibrillators cause larger distortions/signal voids than pacemakers, and require careful consideration when performing MRI-based treatment planning. To minimize distortion, sequences with lower sensitivity to magnetic field inhomogeneity should be used. Full article

Spatially fractionated radiation therapy (SFRT) has a long history of treating bulky and hypoxic tumors. Recent evidence suggests that, compared to conventional uniform dose radiation therapy, SFRT may utilize different mechanisms of tumor cell killing, potentially including bystander and immune-activating effects. The abscopal effect in radiation therapy refers to the control or even elimination of distant untreated tumors following the treatment of a primary tumor with radiation, a process believed to be immune-mediated. Such effects have been shown to be enhanced by immunotherapy, particularly immune checkpoint inhibition. In this manuscript, we explore the potential synergy of spatially fractionated radiation therapy, in the form of kV x-ray minibeam, combined with PD-L1 checkpoint inhibition in a murine mammary carcinoma model at conventional dose-rate. We found that minibeam of peak/valley doses of 50 Gy/3.7 Gy performed statistically equivalent but trending better than that of 100 Gy/7.4 Gy in its abscopal effect and so 50 Gy/3.7 Gy was selected for further studies. Our findings indicate that the abscopal effect is significantly greater in the minibeam plus anti-PD-L1 treated animals compared to those receiving uniform dose radiation therapy plus anti-PD-L1 (p = 0.04948). Immune cell profiling in the minibeam plus anti-PD-L1 group compared to uniform dose reveals a consistent trend towards greater immune cell infiltration in the primary tumor, as well as a higher percentage of CD8+ T cells, both systemically and at the abscopal tumor site. Full article

Ion radiotherapy requires accurate relative biological effectiveness (RBE) calculations to account for the markedly different biological effects of ions compared to photons. Microdosimetric RBE models rely on descriptions of the energy deposition at the microscopic scale, either through radial dose distributions (RDDs) or microdosimetric probability density distributions. While RDD approaches focus on the theoretical description of the energy deposition around the ion track, microdosimetric distributions offer the advantage of being experimentally measurable, which is crucial for quality assurance programs. As the results of microdosimetric RBE models depend on whether RDD or microdosimetric distributions are used, the model parameters are not interchangeable between these approaches. This study presents and validates a method to reproduce the published reference biological and clinical dose calculations at NIRS-QST for only carbon ion radiotherapy by using the modified microdosimetric kinetic model (MKM) alongside microdosimetric distributions instead of the reference RDD approach. To achieve this, Monte Carlo simulations were performed to estimate the variation of the radiation quality within and outside the field of pristine and spread-out Bragg peaks. By appropriately optimizing the modified MKM parameters for microdosimetric distributions assessed within water spheres, we successfully reproduced the results of calculations using the reference NIRS-QST RDD, generally within 2%. Full article

The pursuit of exploring the outer space environment for biological research has been a topic of interest for nearly 60 years. The success of the next phase of space exploration depends on the ability to increase crew safety by identifying ways to mitigate these threats. Using a universal scientific citation indexing tool, we extracted data on literature production in terms of the most prolific key terms, authors, countries, institutions, and journals for two distinct topic sets related to space radiation research published from 1 January 1990 to 31 December 2023. The focus of space radiation research in relation to its effects on human health has fluctuated over time, as reflected in the term maps that were generated for each decade. Our bibliometric analysis provides insight into the trends in the top producers in the space radiation research field over the years, as well as into how the focus of such studies has evolved throughout the decades. Full article