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A first‐time survey across 15 cancer centers in Ontario, Canada, on the current practice of patient‐specific quality assurance (PSQA) for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) delivery was conducted. The objectives were to assess the current state of PSQA practice, identify areas for potential improvement, and facilitate the continued improvement in standardization, consistency, efficacy, and efficiency of PSQA regionally. The survey asked 40 questions related to PSQA practice for IMRT/VMAT delivery. The questions addressed PSQA policy and procedure, delivery log evaluation, instrumentation, measurement setup and methodology, data analysis and interpretation, documentation, process, failure modes, and feedback. The focus of this survey was on PSQA activities related to routine IMRT/VMAT treatments on conventional linacs, including stereotactic body radiation therapy but excluding stereotactic radiosurgery. The participating centers were instructed to submit answers that reflected the collective view or opinion of their department and represented the most typical process practiced. The results of the survey provided a snapshot of the current state of PSQA practice in Ontario and demonstrated considerable variations in the practice. A large majority (80%) of centers performed PSQA measurements on all VMAT plans. Most employed pseudo‐3D array detectors with a true composite (TC) geometry. No standard approach was found for stopping or reducing frequency of measurements. The sole use of delivery log evaluation was not widely implemented, though most centers expressed interest in adopting this technology. All used the Gamma evaluation method for analyzing PSQA measurements; however, no universal approach was reported on how Gamma evaluation and pass determination criteria were determined. All or some PSQA results were reviewed regularly in two‐thirds of the centers. Planning related issues were considered the most frequent source for PSQA failures (40%), whereas the most frequent course of action for a failed PSQA was to review the result and decide whether to proceed to treatment.

Background Clinical target volume (CTV) contouring guidelines are frequently developed through studies in which experts contour the CTV for a representative set of cases for a given treatment site and the consensus CTVs are analyzed to generate margin recommendations. Measures of interobserver variability are used to quantify agreement between experts. In cases where an isotropic margin is not appropriate, however, there is no standard method to compute margins in specified directions that represent possible routes of tumor spread. Moreover, interobserver variability metrics are often measures of volume overlap that do not account for the dependence of disagreement on direction. To aid in the development of consensus contouring guidelines, this study demonstrates a novel method of quantifying CTV margins and interobserver variability in clinician-specified directions. Methods The proposed algorithm was applied to 11 cases of non-spine bone metastases to compute the consensus CTV margin in each direction of intraosseous and extraosseous disease. The median over all cases for each route of spread yielded the recommended margins. The disagreement between experts on the CTV margin was quantified by computing the median of the coefficients of variation for intraosseous and extraosseous margins. Results The recommended intraosseous and extraosseous margins were 7.0 mm and 8.0 mm, respectively. The median coefficient of variation quantifying the margin disagreement between experts was 0.59 and 0.48 for intraosseous and extraosseous disease. Conclusions The proposed algorithm permits the generation of margin recommendations in relation to adjacent anatomy and quantifies interobserver variability in specified directions. This method can be applied to future consensus CTV contouring studies.

In an effort to understand dynamic optical changes during laser interstitial thermal therapy (LITT), we utilize the perturbative solution of the diffusion equation in heterogeneous media to formulate scattering weight functions for cylindrical line sources. The analysis explicitly shows how changes in detected interstitial light intensity are associated with the extent and location of the volume of thermal coagulation during treatment. Explanations for previously reported increases in optical intensity observed early during laser heating are clarified using the model and demonstrated with experimental measurements in ex vivo bovine liver tissue. This work provides an improved understanding of interstitial optical signal changes during LITT and indicates the sensitivity and potential of interstitial optical monitoring of thermal damage.

Laser thermal therapy uses near-infrared optical energy to heat and thereby treat diseased tissues such as solid tumors. A method to monitor the progress of laser thermal therapy by detecting temperature-induced changes in optical propagation has been developed. The advantage of a point optical monitoring strategy over a conventional point temperature monitoring approach is that optical intensity measurements are indicative of a larger ‘sampling volume’ of optothermal events. In porcine kidney in vivo, the optical intensity at 5 mm from a laser-coupled heating fiber decreased by 49\% after 2.5 min of heating at 3 W. In bovine tissue ex vivo, the optical intensity at 8 mm from the heating fiber decreased by 62--83 % during laser irradiation at 5 W. This substantial decrease in optical penetration is consistent with increased optical scattering by thermally damaged tissue (i.e., kidney and liver) around the heating fiber. This damage was not detected by a temperature sensor placed at the same distance from the \vadjust{\pagebreak}heating\break fiber in kidney or liver. Furthermore, in the porcine kidney experiment, smoke production occurred, which is normally concomitant with high-temperature tissue charring around the heating fiber. This was observed as a complete loss in optical intensity but was not detectable in the temperature data. The measurements in this work indicate that point optical intensity may have a greater sensitivity to important optothermal events than do point temperature measurements for monitoring laser heating in tissues

We have developed a multi-region spherical Monte Carlo (MC) model to simulate the dynamic changes in light intensity measured during laser interstitial thermal therapy (LITT). Model predictions were validated experimentally in tissue-simulating albumen phantoms with well-characterized optical properties that vary dynamically with LITT in a way similar to tissue. For long treatments (2.5 W, approximately 1800 s), the transient light intensity changes demonstrated better qualitative agreement with a three-region MC model (with an inner layer of fully coagulated optical properties, a middle layer of partially coagulated properties and an outer region of native properties); for short treatments (4 W, approximately 240 s), better qualitative agreement was seen with a two-region MC model (with an inner layer of fully coagulated properties and outer region of native properties). These differences were attributed to differences in coagulation formation during low- and high-powered heating regimes, respectively. At the end of heating, a three-region coagulation zone was observed for both heating schemes. Quantitatively, final light intensity changes at the end of heating were compared with changes predicted by both two- and three-region MC for the same experimentally measured coagulation size and found to agree within approximately 30% for both models. The developed MC model helps lend insight into the nature of thermal coagulation events occurring for low and high power LITT irradiation schemes.

Normal tissue radiation toxicities are evaluated subjectively and cannot predict the development of severe side-effects. Using a hand-held diffuse reflectance optical spectroscopy probe, we measured optical parameters in mouse skin 1-4 days after irradiation. Using a radiation toxicity model and a therapeutic mitigator described previously [BMC Cancer14, 614 (2014)]25159192, we found that hemoglobin (Hb) levels increased sharply 24 h after irradiation only in the irradiated group without the mitigator. This group also had the largest peak wound areas after 14 days. We conclude that increased Hb one day after skin irradiation predicts the severity of the subsequent irradiation-induced wound.

Optical fiber technology offers a convenient, affordable, safe and effective approach for the delivery and collection of light to and from the tissue region of interest, and has been employed clinically since the 1960s [1]. This chapter discusses and reviews the recent developments in optical fiber sensor technology in the field of biomedicine.

Motivated by a recent report by Dickey et al. [Phys. Med. Biol. 46, 2359 (2001)], who demonstrated optical property retrieval by using relative radiance measurements at a single position, we investigate the uniqueness of relative radiance measurements for quantifying the optical properties of turbid media by studying the solutions of the diffusion and P3 approximations of the Boltzmann transfer equation for a point source. Using the P3 approximation, we investigate the potential of radiance measurements for optical property recovery by examining the optical property response surface for point radiance information. We further derive first-order similarity relations for relative point radiance measurements and use these expressions to examine analytically the effects of noise on optical property retrieval over a wide range of optical properties typical of biological tissue. Finally, optimal experimental configurations are studied and explicit conditions for uniqueness derived that suggest potential strategies for improving optical property recovery. It is expected that point radiance measurements will prove valuable for both on-line treatment planning of minimally invasive laser therapies and optical characterization of tissues.

Multipoint optical fluence measurements can potentially be used to detect coagulation-induced changes in optical propagation during interstitial laser thermal therapy. Estimating the dimensions of coagulation using on-line optical monitoring, which is applicable to treatments where the tip of the source fibre is not precharred, may be limited by the accuracy of the placement of optical sensors with respect to source fibres. A strategy has been developed to determine accurately the position of a four-sensor linear array, prior to treatment, using optical fluence data obtained from the sensors for low-power (or = 0.5 W) irradiation. A minimum of four sensors in an array was required in order to develop a mathematical formulation for position determination that did not require tissue optical properties or laser power as input. Optical propagation was based on diffusion theory for homogeneous tissues in spherical geometry. Low input laser power is needed to ensure that there are no thermally induced changes in tissue optical properties not accounted for in the mathematical description. Experimental evaluation was performed in a tissue-equivalent liquid phantom using 0.5 W of 805 nm optical energy and a translatable isotropic optical sensor. For sensor locations with 2 mm spacing, placement accuracy of 0.67 mm was achieved. The accuracy improved to 0.13 mm as the sensor spacing increased to 5 mm.

We present an optical technique, point radiance spectroscopy, to directly recover chromophore concentrations and the reduced optical scattering coefficient spectrum from continuous wave interstitial point radiance measurements at a single-source-detector separation in turbid, tissuelike media. The method employs a spectral algorithm to fit the relative radiance data, using the P3 approximation, at only two detection angles (0° and 90°). The spectral fitting algorithm is applied to simulated data of relative point fluence and relative point radiance data with added 1% noise and shows that even under realistic experimental conditions, only point radiance information is able to provide quantitative information regarding chromophore concentrations and scattering power at distances greater than two to three mean free paths from the source. Furthermore, experimental measurements in tissue-simulating phantoms demonstrate that dye concentrations and scattering parameters can be recovered to within ∼10%. The devel...

Interstitial quantification of the optical properties of tissue is important in biomedicine for both treatment planning of minimally invasive laser therapies and optical spectroscopic characterization of tissues, for example, prostate cancer. In a previous study, we analyzed a method first demonstrated by Dickey et al., Phys. Med. Biol. 46, 2359 2001 to utilize relative interstitial steady-state radiance mea- surements for recovering the optical properties of turbid media. The uniqueness of point radiance measurements were demonstrated in a forward sense, and strategies were suggested for improving perfor- mance under noisy experimental conditions. In this work, we test our previous conclusions by fitting the P3 approximation for radiance to Monte Carlo predictions and experimental data in tissue-simulating phantoms. Fits are performed at: 1. a single sensor position 0.5 or 1c m, 2. two sensor positions 0.5 and 1c m, and 3. a single sensor position 0.5 or 1c m with input knowledge of the sample's effective attenuation coefficient. The results demonstrate that single sensor ra- diance measurements can be used to retrieve optical properties to within 20%, provided the transport albedo is greater than 0.9. Furthermore, compared to the single sensor fits, employing radiance data at two sensor positions did not significantly improve the accuracy of recovered optical properties. However, with knowledge of the ef- fective attenuation coefficient of the medium, optical properties can be retrieved experimentally to within 10% for an albedo greater or equal to 0.5. © 2007 Society of Photo-Optical Instrumentation Engineers. DOI: 10.1117/1.2821406

Optical monitoring relates the dynamic changes in measured light intensity to the extent of treatment-induced coagulation that occurs during laser interstitial thermal therapy. We utilized a two-region Monte Carlo simulation to elucidate the nature of the changes in interstitial radiance and fluence that result from the formation of a volume of thermal coagulation surrounding a cylindrical emitter. Using simulation results, we demonstrate that radiance sensors are more sensitive than traditional fluence sensors to coagulation-induced scattering changes. Radiance measurements take advantage of directional detection angles that are more receptive to the onset and passing of the coagulation boundary. We performed experiments with albumen phantoms to demonstrate the practicality of the radiance method for monitoring interstitial laser thermal therapy.