Commissioning of a linear accelerator (Linac) and treatment planning systems (RTPs) for clinical use is complex and time-consuming, typically 3–4 months in total. However, based on clinical needs and economics, hospitals desire early clinical starts for patients, and various studies have been conducted for shortening the preparation period. One of the methods to shorten the period is using golden beam data (GBD). The purpose of this study was to shorten the commissioning period without reducing accuracy and to simplify commissioning works while improving safety. We conducted commissioning of the RTPs before installing the Linac using GBD, and carried out verification immediately after the acceptance test. We used TrueBeam STx (Varian Medical Systems) and Eclipse (ver. 13.7, Varian Medical Systems) for RTPs and anisotropic analysis algorithm (AAA) and AcurosXB (AXB) for calculation algorithms. The difference between GBD and the measured beam data was 0.0 ± 0.2% [percentage depth dose (PDDs) ] and −0.1 ± 0.2% (Profiles) with X-ray, and −1.2 ± 1.3% (PDDs) with electrons. The difference between the calculated dose and the measured dose was 0.1 ± 0.3% (AAA) and 0.0 ± 0.3% (AXB) under homogeneous conditions, and 0.7 ± 1.4% (AAA) and 0.6 ± 1.1% (AXB) under heterogeneous conditions. We took 43 days from the end of the acceptance test to the start of clinical use. We found that the preparation period for clinical use can be shortened without reducing the accuracy, by thinning out the number of measurement items using GBD.

Purpose: The aim of this study was to investigate the resolution property in XY-plane for half-reconstruction computed tomography (CT) image by measuring 360° multi-directional modulation transfer functions (MTFs). Materials and Methods: The 360° multi-directional MTFs were measured by use of a wire method to obtain line spread function with 15° interval in XY-plane. The MTFs of half-reconstruction CT image were measured with 100 mm off-center positions on the X- and Y-axis (X_{+100 mm}, X_{−100 mm}, Y_{+100 mm}, and Y_{−100 mm}) and compared with those of full-reconstruction CT image. We measured the MTFs of the half-reconstruction CT image at X_{+100 mm} position with various X-ray tube positions of projection dataset. Results: There were obvious differences for the MTFs of the half-reconstruction CT image between the tangential and radial directions at each measurement position. The dependences of the resolution property for the half-reconstruction CT image on positions and directions in XYplane were similar to those for the full-reconstruction CT image. The higher and the lower MTFs of the half-reconstruction CT image at X_{+100 mm} position were measured with X-ray tube position of projection dataset at +X side and at −X side compared with those of the full-reconstruction CT image, respectively. Conclusion: We conclude that the half-reconstruction CT image had similar resolution property in XY-plane to the full-reconstruction CT image and showed dependency on the X-ray tube position of projection dataset for MTF in the tangential direction.

In recent years, various types of stents are deployed for the treatment of intracranial artery stenosis and aneurysms. Digital subtraction angiography has been considered to be the gold standard for the follow-up study. However, magnetic resonance angiography (MRA) is less invasive and the recent advances may contribute to the imaging of patients with intracranial stents. Then, a phantom study was carried out to evaluate the MR lumen visibility with these stents. Four stents [low-profile visualized intraluminal support (LVIS), Neuroform Atlas, Neuroform EZ, and Enterprise 2] were placed into plastic tubes with 3 mm inner diameter, and fixed in a container filled with agar. Time-of-flight MRA (TOF-MRA) was performed for these stents, and the signal intensities inside and outside the stents were measured on ImageJ software. Furthermore, 25%, 50%, and 75% stenosis models were created and passed through these stents to evaluate the diagnostic accuracy of in-stent stenosis. The signal intensity inside the LVIS stent was the highest among the four stents (P<0.001), and no significant difference was found between the signal intensities inside and outside the LVIS stent. The diagnostic accuracy with LVIS was also higher than that of Enterprise 2 (P<0.001). In conclusion, the visibility with LVIS indicates that TOF-MRA could be reliably utilized as a diagnostic tool for the detection of in-stent stenosis.

The purpose of this study was to evaluate the discrepancy between the monitor unit (MU) calculated by different dose normalization methods in the electron Monte Carlo (eMC) algorithm and the conventional manual MU. In the water phantom condition, the manual MU obtained from the measured output factor was compared with the calculated MU by the eMC algorithm, using 24 different irradiation field shapes and several different energies of electron beam. In the breast boost condition, calculated MUs by both calculation methods were evaluated for 45 cases. As a result, the MUs computed by the eMC algorithm in the water phantom varied according to the dose normalization methods, and the mean±standard deviation of the difference between the manual and calculated MU were 1.1±1.4%, 0.0±1.0% and 0.4±1.2% in peak depth normalization (PN), no plan normalization (NPN) and 100% at body maximum (100%BM), respectively. In breast-boost cases, the MU difference between the manual and the calculated MU were 6.1±3.7%, 3.4±2.8% and 1.1±2.9% in PN, NPN and 100%BM, respectively. We revealed that the resultant MU calculated by eMC algorithm was dependent on the dose normalization method and the averaged differences exceeded 6% in PN, especially in breast boost condition. When using the eMC in the breast boost condition, it is desirable to select an appropriate dose normalization method according to dose prescription policies at each facility.

Purpose: A three-dimensional (3D) image from computed tomography (CT) angiography is a useful method for evaluation of complex anatomy such as congenital heart disease. However, 3D imaging requires high contrast enhancement for distinguishing between blood vessels and soft tissue. To improve the contrast enhancement, many are increasing the injection rate. However, one method is the use of fenestrated catheters, it allows use of a smaller gauge catheter for high-flow protocols. The purpose of this study was to compare the pressure of injection rate and CT number of a 24-gauge fenestrated catheter with an 22-gauge non-fenestrated catheter for i.v. contrast infusion during CT. Methods: Between December 2014 and March 2015, 50 newborn patients were randomly divided into two protocols; 22-gauge conventional non-fenestrated catheter (24 newborn; age range 0.25–8 months, body weight 3.6±1.2 kg) and 24-gauge new fenestrated catheter (22 newborn; age range 0.25–12 months, body weight 3.3±0.9 kg). Helical scan of the heart was performed using a 64-detector CT (LightSpeed VCT, GE Healthcare) (tube voltage 80 kV; detector configuration 64×0.625 mm, rotation time 0.4 s/rot, helical pitch 1.375, preset noise index for automatic tube current modulation 40 at 0.625 mm slice thickness). Results: We compared the maximum pressure of injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement between both protocols. The median injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement were 0.9 (0.5–3.4) ml/s, 455.5 (398–659) HU, and 500.0 (437–701) HU in 22-gauge conventional non-fenestrated catheter and 0.9 (0.5–2.0) ml/s, 436.5 (406–632) HU, and 479.5 (445–695) HU in the 24-gauge fenestrated catheter, respectively. There are no significantly different between a 24-gauge fenestrated catheter and 22-gauge non-fenestrated catheters at injection rate and CT number. Maximum pressure of injection rate was lower with 24-gauge non-fenestrated catheters (0.33 kg/cm²) than 22-gauge non-fenestrated catheters (0.55 kg/cm²) (p<0.01Conclusion: A 24-gauge fenestrated catheter performs similarly to an 22-gauge non-fenestrated catheter with respect to i.v. contrast infusion and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 22-gauge catheter.

Purpose: There are few reports focusing on the radioactivity concentration in the normal brain region for the phantom experiment. We investigated the radioactivity concentration of normal brain regions for the phantom experiment of brain tumor PET imaging. Methods: A total of 30 patients (age: 53±19 years old, body weight: 58±11 kg) underwent the brain tumor PET examinations using ¹⁸F-fluorothymidine (¹⁸F-FLT), ¹⁸F-fluoromisonidazole (¹⁸F-FMISO) and ¹¹C-methionine (¹¹C-MET) during April 1, 2017–October 1, 2017. A region of interest was set in the brain parenchyma excluding the tumor lesion area and the ventricle in PET image, and radioactivity concentrations of the normal brain region were obtained. Results: The radioactivity concentrations of the normal brain region were 0.79±0.25 kBq/ml for ¹⁸F-FLT, 2.34±0.42 kBq/ml for ¹⁸F-FMISO and 4.05±0.80 kBq/ml for ¹¹C-MET. Conclusion: We proposed the radioactivity concentrations of background region in the phantom for brain tumor PET imaging using ¹⁸F-FLT, ¹⁸F-FMISO and ¹¹C-MET.

Purpose: The respiratory gated irradiation using the real-time position management system (RPM) was used to clarify the generation of the gated signal when the respiration waveform changed, and also the evaluation method of the respiration waveform was also examined. Methods: The respiratory waveform was changed using a moving phantom. Respiratory waveform was analyzed from the data recorded in RPM, and the out-of-phase gated rate was examined. Analysis was made by focusing on the coefficient of variation of the respiratory wavelength in the evaluation of respiratory waveform. Results: Immediately after the change of respiratory wavelength from the short cycle to the long cycle, a gated signal was generated at a phase before the set gated phase, and a maximum advance of 1.259 ± 0.212 s occurred. Immediately after the change of respiratory wavelength from the long cycle to the short cycle, the gated signal was generated at the phase exceeding the set gated phase, and a delay of 0.997 ± 0.180 s occurred at the maximum. As the value of the coefficient of variation increased, the gated rate which was out of setting also increased. Conclusion: In respiratory gated irradiation using RPM, it became clear that the gated signal is generated out of the phase set by the respiratory waveform change. Coefficient of variation of the respiratory wavelength is considered to be an indicator for evaluating the respiratory waveform to be used in the respiratory gated irradiation.