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Article ; Online: High-dose-rate interstitial brachytherapy vs external beam radiation for the treatment of complex keloids.

Liao, Yixiang / Dorafshar, Amir H / Bernard, Damian / Kim, Thomas / Camden, Nathaniel B / Wang, Dian

Medical dosimetry : official journal of the American Association of Medical Dosimetrists

2022 Volume 47, Issue 2, Page(s) 158–160

Abstract: Postoperative external beam radiation therapy (EBRT) with superficial X-rays or electrons and high-dose-rate brachytherapy (HDR BT) are both viable options for managing keloid scars. However, complex keloid scars are especially challenging to manage. We ... ...

Abstract	Postoperative external beam radiation therapy (EBRT) with superficial X-rays or electrons and high-dose-rate brachytherapy (HDR BT) are both viable options for managing keloid scars. However, complex keloid scars are especially challenging to manage. We aim to compare the benefit and challenges between interstitial HDR BT and electron EBRT in treating the complex keloids. Three patients with 7 complex keloids: 3 jaw lines, 1 postauricular, 1 posterior neck, and 2 chest walls are included in this study. All patients are treated to 6 Gy x 3 fractions with HDR BT using the flexible interstitial catheters, and electron EBRT plans were created retrospectively for dosimetric comparison. The average D
MeSH term(s)	Brachytherapy/methods ; Humans ; Keloid/etiology ; Keloid/radiotherapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Retrospective Studies
Language	English
Publishing date	2022-03-07
Publishing country	United States
Document type	Case Reports
ZDB-ID	645065-9
ISSN	1873-4022 ; 0958-3947 ; 0739-0211
ISSN (online)	1873-4022
ISSN	0958-3947 ; 0739-0211
DOI	10.1016/j.meddos.2022.01.003
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Article ; Online: Quantitative Medical Physics National Job Data Distribution Analysis.

Paul, Jijo / Grelewicz, Zachary / Chowdhary, Mudit / Liao, Yixiang / Bernard, Damian / Patel, Kirtesh / Turian, Julius

Practical radiation oncology

2021 Volume 11, Issue 4, Page(s) e438–e445

Abstract: Purpose: The purpose of this study was to investigate the contemporary distribution of medical physics (MP) employment opportunities across the United States.: Methods and materials: An annual record (2018-2019) of advertised full-time MP jobs was ... ...

Abstract	Purpose: The purpose of this study was to investigate the contemporary distribution of medical physics (MP) employment opportunities across the United States. Methods and materials: An annual record (2018-2019) of advertised full-time MP jobs was created using publicly available information from the American Association of Physicists in Medicine and Indeed websites. Listed jobs were categorized based on position name, work experience, job function, and geographic region. To account for regional population differences, a preponderance of employment opportunities per 10 million people was computed. Using Commission on Accreditation of Medical Physics Education Programs residency accreditation data, the nationwide locations of the MP training centers and the number of residency positions per annum were identified. A chi-square goodness-of-fit test was used for statistical analysis. Results: A total of 441 unique MP jobs were identified nationwide per annum (2018-2019). The highest percentage of MP jobs was reported from the South region (33.6%), and the lowest (17.2%) was from the West. Analysis revealed that 148 jobs (33.6%) were academic and 293 (66.4%) were nonacademic. The South had the most academic jobs overall (31.8%), whereas the West had the fewest (13.5%). Regionally, the highest percentage of academic jobs (46.9%) was reported from the Northeast, whereas the West had the lowest percentage (26.3%). The analysis of academic versus nonacademic job comparison by regions showed statistically significant differences (P = .0133). The Midwest and the West regions, respectively, showed the highest (18.2) and lowest (10.24) number of jobs per unit population, measured in 10 million. Conclusions: To our knowledge, this is one of the first national quantitative job data analyses of MP job distributions. This study revealed the level of demand for qualified candidates in 2018 to 2019, showing an imbalance between academic and nonacademic positions across the regions of the United States. Moreover, the geographic distribution of job listings deviated significantly from expectation given the relative population of each region.
MeSH term(s)	Advertising ; Employment ; Humans ; Internship and Residency ; Physics ; United States ; Workforce
Language	English
Publishing date	2021-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2655748-4
ISSN	1879-8519 ; 1879-8500
ISSN (online)	1879-8519
ISSN	1879-8500
DOI	10.1016/j.prro.2021.02.009
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Article ; Online: Scatter imaging during lung stereotactic body radiation therapy characterized with phantom studies.

Jones, Kevin C / Turian, Julius / Redler, Gage / Cifter, Gizem / Strologas, John / Templeton, Alistair / Bernard, Damian / Chu, James C H

Physics in medicine and biology

2020 Volume 65, Issue 15, Page(s) 155013

Abstract: By collecting photons scattered out of the therapy beam, scatter imaging creates images of the treated volume. Two phantoms were used to assess the possible application of scatter imaging for markerless tracking of lung tumors during stereotactic body ... ...

Abstract	By collecting photons scattered out of the therapy beam, scatter imaging creates images of the treated volume. Two phantoms were used to assess the possible application of scatter imaging for markerless tracking of lung tumors during stereotactic body radiation therapy (SBRT) treatment. A scatter-imaging camera was assembled with a CsI flat-panel detector and a 5 mm diameter pinhole collimator. Scatter images were collected during the irradiation of phantoms with megavoltage photons. To assess scatter image quality, spherical phantom lung tumors of 2.1-2.8 cm diameters were placed inside a static, anthropomorphic phantom. To show the efficacy of the technique with a moving target (3 cm diameter), the position of a simulated tumor was tracked in scatter images during sinusoidal motion (15 mm amplitude, 0.25 Hz frequency) in a dynamic lung phantom in open-field, dynamic conformal arc (DCA), and volumetric modulated arc therapy (VMAT) deliveries. Anatomical features are identifiable on static phantom scatter images collected with 10 MU of delivered dose (2.1 cm diameter lung tumor contrast-to-noise ratio of 4.4). The contrast-to-noise ratio increases with tumor size and delivered dose. During dynamic motion, the position of the 3.0 cm diameter lung tumor was identified with a root-mean-square error of 0.8, 1.2, and 2.9 mm for open field (0.3 s frame integration), DCA (0.5 s), and VMAT (0.5 s), respectively. Based on phantom studies, scatter imaging is a potential technique for markerless lung tumor tracking during SBRT without additional imaging dose. Quality scatter images may be collected at low, clinically relevant doses (10 MU). Scatter images are capable of sub-millimeter tracking precision, but modulation decreases accuracy.
MeSH term(s)	Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Molecular Imaging/instrumentation ; Phantoms, Imaging ; Radiosurgery/instrumentation ; Radiotherapy, Intensity-Modulated ; Scattering, Radiation
Keywords	covid19
Language	English
Publishing date	2020-08-10
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	208857-5
ISSN	1361-6560 ; 0031-9155
ISSN (online)	1361-6560
ISSN	0031-9155
DOI	10.1088/1361-6560/ab9355
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Article ; Online: Characterization of Compton-scatter imaging with an analytical simulation method.

Jones, Kevin C / Redler, Gage / Templeton, Alistair / Bernard, Damian / Turian, Julius V / Chu, James C H

Physics in medicine and biology

2018 Volume 63, Issue 2, Page(s) 25016

Abstract: By collimating the photons scattered when a megavoltage therapy beam interacts with the patient, a Compton-scatter image may be formed without the delivery of an extra dose. To characterize and assess the potential of the technique, an analytical model ... ...

Abstract	By collimating the photons scattered when a megavoltage therapy beam interacts with the patient, a Compton-scatter image may be formed without the delivery of an extra dose. To characterize and assess the potential of the technique, an analytical model for simulating scatter images was developed and validated against Monte Carlo (MC). For three phantoms, the scatter images collected during irradiation with a 6 MV flattening-filter-free therapy beam were simulated. Images, profiles, and spectra were compared for different phantoms and different irradiation angles. The proposed analytical method simulates accurate scatter images up to 1000 times faster than MC. Minor differences between MC and analytical simulated images are attributed to limitations in the isotropic superposition/convolution algorithm used to analytically model multiple-order scattering. For a detector placed at 90° relative to the treatment beam, the simulated scattered photon energy spectrum peaks at 140-220 keV, and 40-50% of the photons are the result of multiple scattering. The high energy photons originate at the beam entrance. Increasing the angle between source and detector increases the average energy of the collected photons and decreases the relative contribution of multiple scattered photons. Multiple scattered photons cause blurring in the image. For an ideal 5 mm diameter pinhole collimator placed 18.5 cm from the isocenter, 10 cGy of deposited dose (2 Hz imaging rate for 1200 MU min
MeSH term(s)	Algorithms ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Monte Carlo Method ; Phantoms, Imaging ; Photons ; Radiographic Image Interpretation, Computer-Assisted ; Radiotherapy Planning, Computer-Assisted/methods ; Scattering, Radiation ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2018-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	208857-5
ISSN	1361-6560 ; 0031-9155
ISSN (online)	1361-6560
ISSN	0031-9155
DOI	10.1088/1361-6560/aaa200
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Article ; Online: Compton scatter imaging: A promising modality for image guidance in lung stereotactic body radiation therapy.

Redler, Gage / Jones, Kevin C / Templeton, Alistair / Bernard, Damian / Turian, Julius / Chu, James C H

Medical physics

2018 Volume 45, Issue 3, Page(s) 1233–1240

Abstract: Purpose: Lung stereotactic body radiation therapy (SBRT) requires delivering large radiation doses with millimeter accuracy, making image guidance essential. An approach to forming images of patient anatomy from Compton-scattered photons during lung ... ...

Abstract	Purpose: Lung stereotactic body radiation therapy (SBRT) requires delivering large radiation doses with millimeter accuracy, making image guidance essential. An approach to forming images of patient anatomy from Compton-scattered photons during lung SBRT is presented. Methods: To investigate the potential of scatter imaging, a pinhole collimator and flat-panel detector are used for spatial localization and detection of photons scattered during external beam therapy using lung SBRT treatment conditions (6 MV FFF beam). MCNP Monte Carlo software is used to develop a model to simulate scatter images. This model is validated by comparing experimental and simulated phantom images. Patient scatter images are then simulated from 4DCT data. Results: Experimental lung tumor phantom images have sufficient contrast-to-noise to visualize the tumor with as few as 10 MU (0.5 s temporal resolution). The relative signal intensity from objects of different composition as well as lung tumor contrast for simulated phantom images agree quantitatively with experimental images, thus validating the Monte Carlo model. Scatter images are shown to display high contrast between different materials (lung, water, bone). Simulated patient images show superior (~double) tumor contrast compared to MV transmission images. Conclusions: Compton scatter imaging is a promising modality for directly imaging patient anatomy during treatment without additional radiation, and it has the potential to complement existing technologies and aid tumor tracking and lung SBRT image guidance.
MeSH term(s)	Four-Dimensional Computed Tomography ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Monte Carlo Method ; Phantoms, Imaging ; Radiosurgery/methods ; Radiotherapy, Image-Guided/methods ; Scattering, Radiation
Language	English
Publishing date	2018-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.12755
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Article ; Online: Reporting small bowel dose in cervix cancer high-dose-rate brachytherapy.

Liao, Yixiang / Dandekar, Virag / Chu, James C H / Turian, Julius / Bernard, Damian / Kiel, Krystyna

Medical dosimetry : official journal of the American Association of Medical Dosimetrists

2016 Volume 41, Issue 1, Page(s) 28–33

Abstract: Small bowel (SB) is an organ at risk (OAR) that may potentially develop toxicity after radiotherapy for cervix cancer. However, its dose from brachytherapy (BT) is not systematically reported as in other OARs, even with image-guided brachytherapy (IGBT). ...

Abstract	Small bowel (SB) is an organ at risk (OAR) that may potentially develop toxicity after radiotherapy for cervix cancer. However, its dose from brachytherapy (BT) is not systematically reported as in other OARs, even with image-guided brachytherapy (IGBT). This study aims to introduce consideration of quantified objectives for SB in BT plan optimization and to evaluate the feasibility of sparing SB while maintaining adequate target coverage. In all, 13 patients were included in this retrospective study. All patients were treated with external beam radiotherapy (EBRT) 45Gy in 25 fractions followed by high dose rate (HDR)-BT boost of 28Gy in 4 fractions using tandem/ring applicator. Magnetic resonance imaging (MRI) and computed tomographic (CT) images were obtained to define the gross tumor volume (GTV), high-risk clinical target volume (HR-CTV) and OARs (rectum, bladder, sigmoid colon, and SB). Treatment plans were generated for each patient using GEC-ESTRO recommendations based on the first CT/MRI. Treatment plans were revised to reduce SB dose when the [Formula: see text] dose to SB was > 5Gy, while maintaining other OAR constraints. For the 7 patients with 2 sets of CT and MRI studies, the interfraction variation of the most exposed SB was analyzed. Plan revisions were done in 6 of 13 cases owing to high [Formula: see text] of SB. An average reduction of 19% in [Formula: see text] was achieved. Meeting SB and other OAR constraints resulted in less than optimal target coverage in 2 patients (D90 of HR-CTV < 77Gyαβ10). The highest interfraction variation was observed for SB at 16 ± 59%, as opposed to 28 ± 27% for rectum and 21 ± 16% for bladder. Prospective reporting of SB dose could provide data required to establish a potential correlation with radiation-induced late complication for SB.
MeSH term(s)	Brachytherapy ; Female ; Humans ; Intestine, Small ; Radiation Dosage ; Radiotherapy, Image-Guided ; Uterine Cervical Neoplasms/radiotherapy
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article
ZDB-ID	645065-9
ISSN	1873-4022 ; 0958-3947 ; 0739-0211
ISSN (online)	1873-4022
ISSN	0958-3947 ; 0739-0211
DOI	10.1016/j.meddos.2015.06.005
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Article: Scatter imaging during lung stereotactic body radiation therapy characterized with phantom studies

Jones, Kevin C / Turian, Julius V / Redler, Gage / Cifter, Gizem / Strologas, John / Templeton, Alistair / Bernard, Damian / Chu, James C H

Phys. med. biol

Abstract	By collecting photons scattered out of the therapy beam, scatter imaging creates images of the treated volume. Two phantoms were used to assess the possible application of scatter imaging for markerless tracking of lung tumors during stereotactic body radiation therapy (SBRT) treatment. A scatter-imaging camera was assembled with a CsI flat-panel detector and a 5 mm diameter pinhole collimator. Scatter images were collected during the irradiation of phantoms with megavoltage photons. To assess scatter image quality, spherical phantom lung tumors of 2.1 - 2.8 cm diameters were placed inside a static, anthropomorphic phantom. To show the efficacy of the technique with a moving target (3 cm diameter), the position of a simulated tumor was tracked in scatter images during sinusoidal motion (15 mm amplitude, 0.25 Hz frequency) in a dynamic lung phantom in open-field, dynamic conformal arc (DCA), and volumetric modulated arc therapy (VMAT) deliveries. Anatomical features are identifiable on static phantom scatter images collected with 10 MU of delivered dose (2.1 cm diameter lung tumor contrast-to-noise ratio of 4.4). The contrast-to-noise ratio increases with tumor size and delivered dose. During dynamic motion, the position of the 3.0 cm diameter lung tumor was identified with a root-mean-square error of 0.8, 1.2, and 2.9 mm for open field (0.3 s frame integration), DCA (0.5 s), and VMAT (0.5 s), respectively. Based on phantom studies, scatter imaging is a potential technique for markerless lung tumor tracking during SBRT without additional imaging dose. Quality scatter images may be collected at low, clinically relevant doses (10 MU). Scatter images are capable of sub-millimeter tracking precision, but modulation decreases accuracy.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32408276
Database	COVID19

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Article ; Online: Dosimetric effects of saline- versus water-filled balloon applicators for IORT using the model S700 electronic brachytherapy source.

Redler, Gage / Templeton, Alistair / Zhen, Heming / Turian, Julius / Bernard, Damian / Chu, James C H / Griem, Katherine L / Liao, Yixiang

Brachytherapy

2017 Volume 17, Issue 2, Page(s) 500–505

Abstract: Purpose: The Xoft Axxent Electronic Brachytherapy System (Xoft, Inc., San Jose, CA) is a viable option for intraoperative radiation therapy (IORT) treatment of early-stage breast cancer. The low-energy (50-kVp) X-ray source simplifies shielding and ... ...

Abstract	Purpose: The Xoft Axxent Electronic Brachytherapy System (Xoft, Inc., San Jose, CA) is a viable option for intraoperative radiation therapy (IORT) treatment of early-stage breast cancer. The low-energy (50-kVp) X-ray source simplifies shielding and increases relative biological effectiveness but increases dose distribution sensitivity to medium composition. Treatment planning systems typically assume homogenous water for brachytherapy dose calculations, including precalculated atlas plans for Xoft IORT. However, Xoft recommends saline for balloon applicator filling. This study investigates dosimetric differences due to increased effective atomic number (Z Methods: Balloon applicator diameters range from 3 to 6 cm. Monte Carlo N-Particle software is used to calculate dose at the surface (D Results: Single-dwell plans show a 4.4-6.1% decrease in D Conclusions: The dosimetric effect introduced by saline versus water filling for Xoft balloon applicator-based IORT treatments is ∼5%. Users should be aware of this in the context of both treatment planning and patient outcome studies.
MeSH term(s)	Brachytherapy/instrumentation ; Brachytherapy/methods ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/surgery ; Humans ; Intraoperative Care/instrumentation ; Intraoperative Care/methods ; Monte Carlo Method ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/instrumentation ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Adjuvant ; Saline Solution ; Water
Chemical Substances	Saline Solution ; Water (059QF0KO0R)
Language	English
Publishing date	2017-12-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2017.11.003
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Article ; Online: Automated survey of 8000 plan checks at eight facilities.

Halabi, Tarek / Lu, Hsiao-Ming / Bernard, Damian A / Chu, James C H / Kirk, Michael C / Hamilton, Russell J / Lei, Yu / Driewer, Joseph

Medical physics

2016 Volume 43, Issue 9, Page(s) 4966

Abstract: Purpose: To identify policy and system related weaknesses in treatment planning and plan check work-flows.: Methods: The authors' web deployed plan check automation solution, PlanCheck, which works with all major planning and record and verify ... ...

Abstract	Purpose: To identify policy and system related weaknesses in treatment planning and plan check work-flows. Methods: The authors' web deployed plan check automation solution, PlanCheck, which works with all major planning and record and verify systems (demonstrated here for mosaiq only), allows them to compute violation rates for a large number of plan checks across many facilities without requiring the manual data entry involved with incident filings. Workflows and failure modes are heavily influenced by the type of record and verify system used. Rather than tackle multiple record and verify systems at once, the authors restricted the present survey to mosaiq facilities. Violations were investigated by sending inquiries to physicists running the program. Results: Frequent violations included inadequate tracking in the record and verify system of total and prescription doses. Infrequent violations included incorrect setting of patient orientation in the record and verify system. Peaks in the distribution, over facilities, of violation frequencies pointed to suboptimal policies at some of these facilities. Correspondence with physicists often revealed incomplete knowledge of settings at their facility necessary to perform thorough plan checks. Conclusions: The survey leads to the identification of specific and important policy and system deficiencies that include: suboptimal timing of initial plan checks, lack of communication or agreement on conventions surrounding prescription definitions, and lack of automation in the transfer of some parameters.
MeSH term(s)	Automation ; Internet ; Quality Assurance, Health Care ; Radiotherapy Planning, Computer-Assisted/standards ; Surveys and Questionnaires
Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1118/1.4959999
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Article ; Online: Detection of electron beam energy variations using a computed radiography system.

Cai, Yang C / Ge, Yuanyuan / Bernard, Damian / Turian, Julius / Chu, James C H

Journal of applied clinical medical physics

2009 Volume 10, Issue 4, Page(s) 142–150

Abstract: A method to evaluate the electron beam energy constancy by employing the computed radiography (CR) system has been developed. In this method, a right triangular plastic wedge is used to produce a curve of the CR storage phosphor plate signal versus the ... ...

Abstract	A method to evaluate the electron beam energy constancy by employing the computed radiography (CR) system has been developed. In this method, a right triangular plastic wedge is used to produce a curve of the CR storage phosphor plate signal versus the wedge thickness. The curve, which resembles the percentage depth ionization curve of the clinical electron beams, can be used to derive the energy constancy metric EC(50). The sensitivity of the method was tested using polystyrene sheets of variable thicknesses. For electron energies up to 12 MeV, energy changes induced by 1.5 mm thick polystyrene can be detected, while a 2.3 mm thick polystyrene sheet is required for higher energies. The measurements were carried out over a two-year period. The results showed a good reproducibility with the use of the same CR plate and cassette, and without the requirement of calibration procedures. The two-year range of the EC(50) was within the 99% confidence intervals, and the standard deviation of the EC(50) was measured to be from 0.3 to 0.4 mm for different beam energies. This technique provides an efficient and accurate method to perform the electron beam energy check and could be used by centers equipped with the CR system without requiring additional detection devices.
MeSH term(s)	Calibration ; Computer-Aided Design ; Electrons ; Humans ; Particle Accelerators/standards ; Radiographic Image Enhancement ; Radiometry/instrumentation ; Tomography, X-Ray Computed
Language	English
Publishing date	2009-10-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1120/jacmp.v10i4.2911
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