The aim of this study was assess the patient setup errors for various tumor sites based on clinical data from a sufficient number of treatments with volumetric‐modulated arc therapy (VMAT) using daily pretreatment CBCT imaging guidance. In addition, we calculated and compared the planning target volume (PTV) margins for all disease sites based on an analysis of specific systematic and random errors in our institution. All patients underwent pretreatment kV‐CBCT imaging. The various tumor sites were divided into four categories; 21 brain (438 fractions), 35 head‐and‐neck tumors (H&N, 933 fractions), 19 thorax and abdomen tumors (T&A, 313 fractions), and 17 prostate cancer tumors (546 fractions). Overall distributions of setup corrections in all directions, frequencies of 3D vector lengths, institution‐specific setup error, and PTV margins were analyzed. The longitudinal distribution for the T&A site represented an asymmetric offset in the negative direction. Rotational distributions were comparable for all treatment sites, and the prostate site had the narrowest distribution of ≤±2∘. The cumulative frequencies of 3D vector length of ≥ 7 mm were rare for brain lesions and H&N, but more common for T&A and prostate lesions at 25.6% and 12.1%, respectively. The overall mean error for all treatment sites were within ±1 mm and ±0.1∘, with the exception of the T&A site, which had overall mean error of 2 mm in the negative longitudinal direction. The largest magnitude of systematic error and random error for the brain lesions and H&N was 1.4 mm in the translational directions, and 3.3 mm for T&A and prostate lesions. The PTV margins required in this analysis are ≤ 4 mm for the brain lesions and H&N in all translational directions, but ranged from 4 to 10 mm for T&A and prostate lesions. Analysis of each institution's specific setup errors using daily CBCT is essential for determining PTV margins and reducing setup uncertainties, because setup errors vary according to each immobilization system and patient.PACS number: 87.55.km

BackgroundAdipose-derived stem cells (ASCs) are important to homeostasis and the regeneration of subcutaneous fat. Hence, we examined the proliferation and differentiation capacity of irradiated ASCs over time.MethodsTwo female pigs received a single 18 Gy dose of ionizing radiation to an 18 × 8 cm area on the dorsal body skin via a 6 MeV electron beam. After irradiation, the ASCs were cultured from adipose tissue harvested from a non-irradiated area and an irradiated area at 2, 4, and 6 weeks. The proliferation capacity of ASCs was evaluated by a colony-forming units–fibroblasts (CFUs-Fs) assay, a cholecystokinin (CCK) test with 10 % fetal bovine serum (FBS), and a 1 % FBS culture test. The senescence of ASCs was evaluated through morphological examination, immunophenotyping, and β-galactosidase activity, and the multipotent differentiation potential of ASCs was evaluated in adipogenic, osteogenic, and chondrogenic differentiation media.ResultsIrradiated ASCs demonstrated significantly decreased proliferative capacity 6 weeks after irradiation. As well, the cells underwent senescence, which was confirmed by blunted morphology, weak mesenchymal cell surface marker expression, and elevated β-galactosidase activity. Irradiated ASCs also exhibited significant losses in the capacity for adipocyte and chondrocyte differentiation. In contrast, osteogenic differentiation was preserved in irradiated ASCs.ConclusionsWe observed decreased proliferation and senescence of irradiated ASCs compared to non-irradiated ASCs 6 weeks after irradiation. Furthermore, irradiated ASCs demonstrated impaired adipocyte and chondrocyte differentiation but retained their osteogenic differentiation capacity. Our results could shed light on additional pathogenic effects of late irradiation, including subcutaneous fibrosis and calcinosis.

The experimental beam with a low-Z target, which was simply installed on the wedge tray mount of the radiotherapy linear accelerator, generated significantly more low-energy photons than the 6 MV radiotherapy photon beam, and provided better quality portal images. Advances in knowledge: This study shows that, unlike the existing low-Z beam studies, a low-Z target can be installed outside the head of a linear accelerator to improve portal image quality.

Background In this study, an external 8 mm thick aluminum target was installed on the upper accessory tray mount of a medical linear accelerator head. The purpose of this study was to determine the effects of the external aluminum target beam (Al-target beam) on the portal image quality by analyzing the spatial and contrast resolutions. In addition, the image resolutions with the Al-target beams were compared with those of conventional 6 megavoltage (MV) images. Methods The optimized Al-target beam was calculated using Monte Carlo simulations. To validate the simulations, the percentage depth dose and lateral profiles were measured and compared with the modeled dose distributions. A PTW resolution phantom was used for imaging to assess the image resolution. The spatial resolution was quantified by determining the modulation transfer function. The contrast resolution was determined by a fine contrast difference between the 27 measurement areas. The spatial and contrast resolutions were compared with the those of conventional portal images. Results The measured and calculated percentage depth dose of the Al-target beam were consistent within 1.6%. The correspondence of measured and modelled profiles was evaluated by gamma analysis (3%, 3 mm) and all gamma values inside the field were less than one. The critical spatial frequencies ( f 50 ) of the images obtained with the Al-target beam and conventional imaging beam were 0.745 lp/mm and 0.451 lp/mm, respectively. The limiting spatial frequencies ( f 10 ) for the Al-target beam image and the conventional portal image were 2.39 lp/mm and 1.82 lp/mm, respectively. The Al-target beam resolved the smaller and lower contrast objects better than that of the MV photon beam. Conclusion The Al-target beams generated by the simple target installation method provided better spatial and contrast resolutions than those of the conventional 6 MV imaging beam.

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