The effect on intensity correlation time T by input signal is studied for gain-noise model of a single-mode laser driven by colored pump noise and colored quantum noise with colored cross-correlation with a bias signa...The effect on intensity correlation time T by input signal is studied for gain-noise model of a single-mode laser driven by colored pump noise and colored quantum noise with colored cross-correlation with a bias signal modulation in this paper. By using the linear approximation method, we detect that there exists maximum (i.e., resonance) in the curve of the intensity correlation time T upon bias current io when the noise correlation coefficient λ is positive; and there exists minimum (i.e., suppression) in the T-io curve when λ is negative. And whenλ is zero, T increases monotonously with increasing io. Furthermore, the curve of T upon the signal frequency Ω is also studied. Our study shows that no matter what the value of λ is, there exists minimum (i.e., suppression) in the T-Ω curve.展开更多
This paper demonstrates the intensity modulation characters of orthogonally polarized HeNe lasers with different optical feedback level generated by the variable reflectivity of external reflector. The modulation dept...This paper demonstrates the intensity modulation characters of orthogonally polarized HeNe lasers with different optical feedback level generated by the variable reflectivity of external reflector. The modulation depths of the orthogonally polarized frequencies are increased when the optical feedback level becomes strong. It also observes that the modulation amplitudes are different for different external cavity length. Based on the vectorial extension of Lamb's semi-classical theory, it finds that the calculations are consistent with the experimental results.展开更多
Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survi...Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survival duration, there is the potential for latent RT morbidity, not previously seen in historical patients. This study evaluates the potential dosimetric advantages of utilising IMRT over 3D-conformal RT in such patients. Methods: 10 consecutive patients with GBM formally screened for a clinical study over a two-month period were planned and treated with IMRT utilising daily on-board imaging (OBI). The EORTC protocol dosimetric criteria and constraints were used in target delineation and planning. For each patient, a 3DCRT plan was also produced. Endpoints for dosimetric evaluation analysed related to tumour dose: mean PTV60 dose (mPTV60Dose), Conformity Index (CI);and normal tissue dose: mean normal brain dose (mBrainDose) and V40 Brain (Brainv40). IGRT endpoints were the median isocentre shifts required in 3 axes measured in one direction. The variation between the IMRT and 3DCRT dosimetric endpoints was examined using Wilcoxon analysis. Results: The 10 patients had tumours located in temporal (3), parietal (3), occipital (2) and callosal (2) regions. The median PTV and normal brain volumes were 308.1 cm3 and 1077.5 cm3 respectively. The IMRT dosimetry was significantly improved in all endpoints specifically CI (p = 0.002), mPTV60Dose (p = 0.004), mBrainDose (p = 0.002) and Brainv40 (p = 0.019). OBI directed isocentre measurements in the patient group were available for 230 treatments. The median shifts (and 95% C.I.s) were 0.1 cm vertical (0.1 - 0.2), 0.1 cm longitudinal (0.1 - 0.2) and 0.2 cm lateral (0.2 - 0.2). At a minimum follow-up of 2 years’ post diagnosis, the median survival of the group is 18.0 months (95% CI: 13.4 - 22.6 months). Conclusion: IMRT for GBM produces significant dosimetric advantages in relation to planning target volume and normal tissue dose compared with 3D conformal plans. The data also confirm the accuracy of IMRT technique for CNS with IGRT delivery utilising OBI demonstrating minimal deviation from planned to treated isocentre.展开更多
AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent fou...AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.展开更多
The characteristics of a conventional LiNbO3 intensity modulator made up of a Mach-Zehnder(MZ) type annealed proton exchange(APE) waveguide and coplanar waveguide(CPW) modulation electrode are presented. The APE waveg...The characteristics of a conventional LiNbO3 intensity modulator made up of a Mach-Zehnder(MZ) type annealed proton exchange(APE) waveguide and coplanar waveguide(CPW) modulation electrode are presented. The APE waveguide characteristics and their relations with process parameters are analyzed. At the same time, the electrical characteristics of modulation electrode, such as modulation voltage, microwave effective index associated with modulation bandwidth, characteristics impedance, are also investigated in detail.展开更多
The objective of this study is to investigate the dose perturbations introduced by the implanted gold fiducial markers in the prostate cancer intensity modulated proton therapy (IMPT) and the impacts of different plan...The objective of this study is to investigate the dose perturbations introduced by the implanted gold fiducial markers in the prostate cancer intensity modulated proton therapy (IMPT) and the impacts of different plan designs on the pertur-bations. Five proton plans: a single lateral field 3D-modulation (3D-mod) plan, 2 fields laterally opposing 3D-mod plan, 6-, 9-, and 18-field distal edge tracking (DET) plans were designed on the CT images of a prostate patient. The dose distributions were first generated for the plans free of fiducial markers with 78 Gy prescribed to 95% of the PTV. To derive the dose perturbations of the gold fiducial markers, three cylindrical shaped gold fiducial markers (3 mm long and 1 mm in diameter) were artificially inserted into the prostate, and the dose distributions were re-computed. Monte Carlo method was used for dose computation. It was found that the gold fiducial markers perturbed the dose distribu-tions, especially along the beam paths. The markers caused a shadowing effect reducing the doses in the areas beyond the markers. Overall, due to the presence of the fiducial markers, D99% of prostate were reduced by 2.96 Gy, 4.21 Gy, 0.16 Gy, 0.34 Gy, 0.15 Gy for the plans of single field 3D-mod, 2-field parallel opposed 3D-mod, 6-, 9-, and 18-field DET respectively. Our study showed these dose perturbation effects decreased with the increase of number of beam angles. Up to 6 beam angles may be required to reduce the dose perturbations from the gold fiducial markers to a clini- cally acceptable level in IMPT.展开更多
Background:To protect neurological tissues,underdosing occurs in most cases of T4 nasopharyngeal carcinoma(NPC) with intracranial extension.In this study,we aimed to evaluate the effect of dosimetric inadequacy on loc...Background:To protect neurological tissues,underdosing occurs in most cases of T4 nasopharyngeal carcinoma(NPC) with intracranial extension.In this study,we aimed to evaluate the effect of dosimetric inadequacy on local control and late neurological toxicities for patients treated with intensity-modulated radiotherapy(IMRT) plus chemotherapy.Methods:We prospectively enrolled patients who had non-metastaticT4 NPC with intracranial extension treated between January 2009 and November 2013.The prescribed dose was 66.0-70.4 Gy to the primary planning target volume(primary gross tumor volume [GTVp;i.e.,the nasopharyngeal tumor] +5.0 mm).Dose-volume histogram parameters were calculated,including minimum point dose(D_(min)) and dose to 95% of the target volume(D95).All patients received chemotherapy with the cisplatin,5-fluorouracil,and docetaxel regimen.Survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.Results:In total,41 patients were enrolled.The local partial response rate was 87.8% after induction chemotherapy.With a median follow-up of 51 months,7 patients experienced failure in the nasopharynx;the 3-year local failure-free survival and overall survival rates of the 41 patients were 87.4% and 90.2%,respectively.The actual mean D_(min) to the GTVp was 55.2 Gy(range 48.3-67.3 Gy),and D95 was 61.6 Gy(range 52.6-69.0 Gy).All doses received by neurological organs remained well within their dose constraints.No patients developed temporal lobe necrosis or other neurological dysfunctions.Conclusions:With relative underdosed IMRT plus effective chemotherapy,the patients achieved satisfactory local control with few late toxicities of the central nervous system.Determining the acceptable extent of dosimetric inadequacy requires further exploration.展开更多
Using a pump with a multi-line spectrum to broaden the Brillouin gain bandwidth is an effective way to achieve lowdistortion amplification with high gain. Here, we theoretically and experimentally investigate the gene...Using a pump with a multi-line spectrum to broaden the Brillouin gain bandwidth is an effective way to achieve lowdistortion amplification with high gain. Here, we theoretically and experimentally investigate the generation of a broadband Brillouin gain spectrum based on multi-frequency intensity modulation in an optical fiber. The arbitrary bandwidth of the Brillouin gain spectrum of stimulated Brillouin scattering(SBS) can be obtained as expected. In our experiment, a broadband Brillouin gain spectrum with a bandwidth of about 200 MHz is demonstrated. We also achieve a low-distortion amplification of a weak signal, whose maximum magnification is 65 d B for a-68-dBm input power signal.展开更多
Intensity-modulated proton therapy(IMPT)is becoming essential for proton therapy and is under rapid development.However,for IMPT,the lateral penumbra of the spot-scanning proton beam is still an urgent issue to be sol...Intensity-modulated proton therapy(IMPT)is becoming essential for proton therapy and is under rapid development.However,for IMPT,the lateral penumbra of the spot-scanning proton beam is still an urgent issue to be solved.Patient-specific block collimators(PSBCs),which can block unnecessary doses,play a crucial role in passive scattering delivery technology but are rarely used in spot scanning.One objective of this study is to investigate the lateral penumbra variations of intensity-modulated spot scanning with and without a PSBC.For fields with varying degrees of sharpness and at varying depths in a water phantom,the lateral penumbral widths were calculated using a Monte Carlo-based dose engine from RayStation 6.The results suggest that the lateral penumbral widths can be reduced by more than 30%for uniform target volumes,regardless of whether a range-shifter is used,and that the maximum dose beyond the field edges can be reduced significantly.The results of patient cases show that the doses in organs-at-risk near the edge of the target volume decrease if a PSBC is implemented.This study demonstrates that intensity-modulated spot scanning with a PSBC can effectively reduce the lateral penumbra and block unnecessary doses and is therefore promising for clinical applications in spot-scanning proton therapy.展开更多
A bunch arrival-time monitor(BAM) based on an electro-optical intensity modulation scheme is currently under development at Shanghai Soft X-ray Free-Electron Laser to meet the high-resolution requirements for bunch st...A bunch arrival-time monitor(BAM) based on an electro-optical intensity modulation scheme is currently under development at Shanghai Soft X-ray Free-Electron Laser to meet the high-resolution requirements for bunch stability. The BAM uses a radio frequency signal generated by a pickup cavity to modulate the reference laser pulses in an electro-optical intensity modulator(EOM), and the bunch arrival-time information is derived from the amplitude change of the laser pulse after laser pulse modulation.EOM is a key optical component in the BAM system.Through the basic principle analysis of BAM, many parameters of the EOM are observed to affect the measurement resolution of the BAM system. Therefore, a systematic analysis of the EOM is crucial. In this paper, we present two schemes to compare and analyze an EOM and provide a reference for selecting a new version of the EOM.展开更多
Recently, the phase compensation technique has allowed the ultrasound to propagate through the skull and focus into the brain. However, the temperature evolution during treatment is hard to control to achieve effectiv...Recently, the phase compensation technique has allowed the ultrasound to propagate through the skull and focus into the brain. However, the temperature evolution during treatment is hard to control to achieve effective treatment and avoid over-high temperature. Proposed in this paper is a method to modulate the temperature distribution in the focal region. It superimposes two signals which focus on two preset different targets with a certain distance. Then the temperature distribution is modulated by changing triggering time delay and amplitudes of the two signals. The simulation model is established based on an 82-element transducer and computed tomography (CT) data of a volunteer's head. A finite- difference time-domain (FDTD) method is used to calculate the temperature distributions. The results show that when the distances between the two targets respectively are 7.5-12.5 mm on the acoustic axis and 2.0-3.0 mm in the direction perpendicular to the acoustic axis, a focal region with a uniform temperature distribution (64-65 ℃) can be created. Moreover, the volume of the focal region formed by one irradiation can be adjusted (26.8-266.7 mm3) along with the uniform temperature distribution. This method may ensure the safety and efficacy of HIFU brain tumor therapy.展开更多
During radiotherapy to kill femoral hydatid tapeworms, the sciatic nerve surrounding the focus can be easily damaged by the treatment. Thus, it is very important to evaluate the effects of ra- diotherapy on the surrou...During radiotherapy to kill femoral hydatid tapeworms, the sciatic nerve surrounding the focus can be easily damaged by the treatment. Thus, it is very important to evaluate the effects of ra- diotherapy on the surrounding nervous tissue. In the present study, we used three-dimensional, conformal, intensity-modulated radiation therapy to treat bilateral femoral hydatid disease in Meriones meridiani. The focus of the hydatid disease on the left femur was subiected to radio- therapy (40 Gy) for 14 days, and the right femur received sham irradiation. Hematoxylin-eosin staining, electron microscopy, and terminal deoxynucleotidyl transferase-dUTP nick end labeling assays on the left femurs showed that the left sciatic nerve cell structure was normal, with no ob- vious apoptosis after radiation. Trypan blue staining demonstrated that the overall protoscolex structure in bone parasitized with Echinococcus granulosus disappeared in the left femur of the animals after treatment. The mortality of the protoscolex was higher in the left side than in the right side. The succinate dehydrogenase activity in the protoscolex in bone parasitized with Echi- nococcus granulosus was lower in the left femur than in the right femur. These results suggest that three-dimensional conformal intensity-modulated radiation therapy achieves good therapeutic effects on the secondary bone in hydatid disease in Meriones meridiani without damaging the morphology or function of the sciatic nerve.展开更多
Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated...Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.展开更多
In intensity modulated radiation treatment (IMRT) planning, the use of asymmetrically collimated fields that are placed on central axis or its off-set is mostly required. Output is the main topic discussed today for e...In intensity modulated radiation treatment (IMRT) planning, the use of asymmetrically collimated fields that are placed on central axis or its off-set is mostly required. Output is the main topic discussed today for extremely small and/or severe irregularly shaped fields. The air scatter data are involved directly or indirectly in obtaining the output. Despite the fact that extensive data have been published in many studies to provide a guide on the magnitude of output factor for clinical accelerators, there are very few data reviewed about output factor in-air or phantom for off-set fields. This study was aimed to investigate the impact of these conditions for small fields. This study was conducted in Elekta Synergy linear accelerator which produces 6 MV X-ray energy. The in-air output factor (Sc) has been measured by CC04 ion chamber with brass-alloy “build-up” cap and Dose-1 electrometer, and the total output (Scp) measurements were carried on at dose maximum depth in phantom by the same chamber and Thermoluminescence dosimeter (TLD) for 1 - 10 cm2 fields. The all measurements at center of isocenter and off-set fields at three directions (X2, Y1, Diagonal) were done. By decreasing field size from 10 to 2 cm2 at isocenter, the Sc value using CC04 was decreased to 5.4% and Scp using CC04 and TLD to 14.5% and 11% respectively. By increasing off-set value, the Sc and Scp values were increased in all directions comparing to central fields. The maximum increase was obtained in Y1 direction for Sc and Scp. TLD results for Scp is slightly higher than CC04. The dosimetric properties of small fields and their off-set should be evaluated and modelled appropriately in the treatment planning system to ensure accurate dose calculation in Intensity Modulated Radiation Treatment.展开更多
By using the linear approximation method, the intensity correlation function is calculated for a single-mode laser modulated by a bias signal and driven by colored pump and quantum noises with colored cross-correlatio...By using the linear approximation method, the intensity correlation function is calculated for a single-mode laser modulated by a bias signal and driven by colored pump and quantum noises with colored cross-correlation. We found that, when the correlation time between the two noises is very short, the behavior of the intensity correlation function versus the time, in addition to decreasing monotonously, also exhibits several cases, such as one maximum, one minimum, and two extrema. When the correlation time between the two noises is very long, the behavior of the intensity correlation function exhibits oscillation and the envelope is similar to the case of short cross-correlation time.展开更多
Purpose: We performed both, dosimetric and positional accuracy verification of dynamic tumor tracking (DTT) intensity modulated radiation therapy (IMRT), with the Vero4DRT system using a moving phantom (QUASAR respira...Purpose: We performed both, dosimetric and positional accuracy verification of dynamic tumor tracking (DTT) intensity modulated radiation therapy (IMRT), with the Vero4DRT system using a moving phantom (QUASAR respiratory motion platform;QUASAR phantom) and system log files. Methods: The QUASAR phantom was placed on a treatment couch. Measurement of the point dose and dose distribution was performed for conventional IMRT, with the QUASAR phantom static and moving;for DTT IMRT, this was performed with the phantom moving for pyramid shaped, prostate, paranasal sinus, and pancreas targets. The QUASAR phantom was driven by a sinusoidal signal in the superior-inferior direction. Furthermore, predicted positional errors induced by the Vero4DRT system and mechanical positional errors of the gimbal head, were calculated using the system log files. Results and Conclusion: For DTT IMRT, the dose at the evaluation point was within 3% compared with the verification plan, and the dose distribution in the passing rates of γ was 97.9%, with the criteria of 3% dose and 3 mm distance to agreement. The position error calculated from the log files was within 2 mm, suggesting the feasibility of employing DTT IMRT with high accuracy using the Vero4DRT system.展开更多
The modulation depth, defined according to practical modulation results, which changes with the microwave power and its frequency, is significant for systems utilizing the frequency-shift characteristic of the LiNbO3 ...The modulation depth, defined according to practical modulation results, which changes with the microwave power and its frequency, is significant for systems utilizing the frequency-shift characteristic of the LiNbO3 waveguide Electro-Optic Intensity Modulator (EOIM). By analyzing the impedance mismatch between the microwave source and the EOIM, the effective voltage applied to the RF port of the EOIM is deprived from the microwave power and its frequency. Associating with analyses of the phase velocity mismatch between the microwave and the optical wave, the theoretical modulation depth has been obtained, which is verified by experimental results. We provide a method to choose the appropriate modulation depth to optimize the desired sideband through proper transmission bias for the system based on the frequency-shift characteristic of the EOIM.展开更多
Objective:This study was to compare 5 field conformal technique to the intensity modulated radiotherapy (IMRT) 8 fields technique in boosting locally advanced cancer cervix cases after external beam radiotherapy with ...Objective:This study was to compare 5 field conformal technique to the intensity modulated radiotherapy (IMRT) 8 fields technique in boosting locally advanced cancer cervix cases after external beam radiotherapy with respect to target volume coverage and dose to normal tissues. Methods:We conducted a single institutional comparative dosimetric analysis of 10 patients with cancer cervix who was presented to radiotherapy department in National Cancer Institute, Cairo in period between June 2012 to September 2012 and received a CRT boost in the place of planned brachytherapy after large field pelvic radiotherapy (PRT) with concurrent chemotherapy were retrospectively identified. All tumors were situated in the low central pelvis. Two plans were done for every patient; one using the 8 fields IMRT and the second one using 5 fields' 3DCRT the two techniques were then compared using dose volume histogram (DVH) analysis for the PTV, bladder, rectum and both femoral heads. Results:Comparing different DVHs, it was found that the planning target volume (PTV) was adequately covered in both plans while it was demonstrates that the 8 fields IMRT technique carried less doses reaching OARs (rectum, bladder, both femoral heads). Conclusion:From the present study, it is concluded that IMRT technique spared more efficiently OARs than CRT technique but both techniques covered the PTV adequately so whenever possible IMRT technique should be used.展开更多
Objective: To evaluate the clinical effects of concurrent and sequential therapy for middle and advanced stage non-small cell lung cancer (NSCLC) useing IMRT combined with NP regimen chemotherapy. Methods: Eighty pati...Objective: To evaluate the clinical effects of concurrent and sequential therapy for middle and advanced stage non-small cell lung cancer (NSCLC) useing IMRT combined with NP regimen chemotherapy. Methods: Eighty patients with middle and advanced stage NSCLC were randomized into two groups. Forty patients were underwent sequential therapy and other 40 patients were underwent concurrent therapy. IMRT was used in radiotherapy and NP regimen of vinorelbine+cispatin (NP) was used in chemotherapy. Results: (1) The overall response (CR+PR) rate was 75% in concurrent group and 45% in sequential group (P<0.05); (2) The treatment courses were 84 days and 140 days for concurrent group and sequential group respectively (P<0.05); (3) One-year survival rate in concurrent group was 72.4% and 52.3% in sequential group respectively; (4) The toxic effects can be tolerable by all of patients. Conclusion: The concurrent chemo-radiotherapy has better overall re- sponse, one-year survival rate and shorter treatment course than the sequential chemo-radiotherapy, so it is a better method for the treatment of middle and advanced stage NSCLC, but the long term survival rate will be studied.展开更多
Objective: The purpose of this study was to investigate the impact of intensity modulated radiotherapy (IMRT) on surface doses for brain, abdomen and pelvis deep located tumors treated with 6 MV photon and to evaluate...Objective: The purpose of this study was to investigate the impact of intensity modulated radiotherapy (IMRT) on surface doses for brain, abdomen and pelvis deep located tumors treated with 6 MV photon and to evaluate the skin dose calculation accuracy of the XIO 4.04 treatment planning system. Methods: More investigations for the influences of IMRT on skin doses would increase its applications for many treatment sites. Measuring skin doses in real treatment situations would reduce the uncertainty of skin dose prediction. In this work a pediatric human phantom was covered by a layer of 1 mm bolus at three treatment sites and thermoluminescent dosimeter (TLD) chips were inserted into the bolus at each treatment site before CT scan. Two different treatment plans [three-dimensional conformal radiation therapy (3DCRT) and IMRT] for each treatment sites were performed on XIO 4.04 treatment planning system using superposition algorism. Results: The results showed that the surface doses for 3DCRT were higher than the surface doses in IMRT by 1.6%, 2.5% and 3.2% for brain, abdomen and pelvis sites respectively. There was good agreement between measured and calculated surface doses, where the calculated surface dose was 15.5% for brain tumor calculated with 3DCRT whereas the measured surface dose was 12.1%. For abdomen site the calculated surface dose for IMRT treatment plan was 16.5% whereas the measured surface dose was 12.6%. Conclusion: The skin dose in IMRT for deep seated tumors is lower than that in 3DCRT which is another advantage for the IMRT. The TLD readings showed that the difference between the calculated and measured point dose is negligible. The superposition calculation algorism of the XIO 4.04 treatment planning system modeled the superficial dose well.展开更多
文摘The effect on intensity correlation time T by input signal is studied for gain-noise model of a single-mode laser driven by colored pump noise and colored quantum noise with colored cross-correlation with a bias signal modulation in this paper. By using the linear approximation method, we detect that there exists maximum (i.e., resonance) in the curve of the intensity correlation time T upon bias current io when the noise correlation coefficient λ is positive; and there exists minimum (i.e., suppression) in the T-io curve when λ is negative. And whenλ is zero, T increases monotonously with increasing io. Furthermore, the curve of T upon the signal frequency Ω is also studied. Our study shows that no matter what the value of λ is, there exists minimum (i.e., suppression) in the T-Ω curve.
基金Project supported by the State Key Program of National Natural Science of China (Grant No 60438010)
文摘This paper demonstrates the intensity modulation characters of orthogonally polarized HeNe lasers with different optical feedback level generated by the variable reflectivity of external reflector. The modulation depths of the orthogonally polarized frequencies are increased when the optical feedback level becomes strong. It also observes that the modulation amplitudes are different for different external cavity length. Based on the vectorial extension of Lamb's semi-classical theory, it finds that the calculations are consistent with the experimental results.
文摘Aims: The EORTC-NCI study investigating the addition of temozolomide trial to standard radiation therapy has demonstrated improved duration of survival in patients with Glioblastoma multiforme (GBM). With longer survival duration, there is the potential for latent RT morbidity, not previously seen in historical patients. This study evaluates the potential dosimetric advantages of utilising IMRT over 3D-conformal RT in such patients. Methods: 10 consecutive patients with GBM formally screened for a clinical study over a two-month period were planned and treated with IMRT utilising daily on-board imaging (OBI). The EORTC protocol dosimetric criteria and constraints were used in target delineation and planning. For each patient, a 3DCRT plan was also produced. Endpoints for dosimetric evaluation analysed related to tumour dose: mean PTV60 dose (mPTV60Dose), Conformity Index (CI);and normal tissue dose: mean normal brain dose (mBrainDose) and V40 Brain (Brainv40). IGRT endpoints were the median isocentre shifts required in 3 axes measured in one direction. The variation between the IMRT and 3DCRT dosimetric endpoints was examined using Wilcoxon analysis. Results: The 10 patients had tumours located in temporal (3), parietal (3), occipital (2) and callosal (2) regions. The median PTV and normal brain volumes were 308.1 cm3 and 1077.5 cm3 respectively. The IMRT dosimetry was significantly improved in all endpoints specifically CI (p = 0.002), mPTV60Dose (p = 0.004), mBrainDose (p = 0.002) and Brainv40 (p = 0.019). OBI directed isocentre measurements in the patient group were available for 230 treatments. The median shifts (and 95% C.I.s) were 0.1 cm vertical (0.1 - 0.2), 0.1 cm longitudinal (0.1 - 0.2) and 0.2 cm lateral (0.2 - 0.2). At a minimum follow-up of 2 years’ post diagnosis, the median survival of the group is 18.0 months (95% CI: 13.4 - 22.6 months). Conclusion: IMRT for GBM produces significant dosimetric advantages in relation to planning target volume and normal tissue dose compared with 3D conformal plans. The data also confirm the accuracy of IMRT technique for CNS with IGRT delivery utilising OBI demonstrating minimal deviation from planned to treated isocentre.
文摘AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.
文摘The characteristics of a conventional LiNbO3 intensity modulator made up of a Mach-Zehnder(MZ) type annealed proton exchange(APE) waveguide and coplanar waveguide(CPW) modulation electrode are presented. The APE waveguide characteristics and their relations with process parameters are analyzed. At the same time, the electrical characteristics of modulation electrode, such as modulation voltage, microwave effective index associated with modulation bandwidth, characteristics impedance, are also investigated in detail.
文摘The objective of this study is to investigate the dose perturbations introduced by the implanted gold fiducial markers in the prostate cancer intensity modulated proton therapy (IMPT) and the impacts of different plan designs on the pertur-bations. Five proton plans: a single lateral field 3D-modulation (3D-mod) plan, 2 fields laterally opposing 3D-mod plan, 6-, 9-, and 18-field distal edge tracking (DET) plans were designed on the CT images of a prostate patient. The dose distributions were first generated for the plans free of fiducial markers with 78 Gy prescribed to 95% of the PTV. To derive the dose perturbations of the gold fiducial markers, three cylindrical shaped gold fiducial markers (3 mm long and 1 mm in diameter) were artificially inserted into the prostate, and the dose distributions were re-computed. Monte Carlo method was used for dose computation. It was found that the gold fiducial markers perturbed the dose distribu-tions, especially along the beam paths. The markers caused a shadowing effect reducing the doses in the areas beyond the markers. Overall, due to the presence of the fiducial markers, D99% of prostate were reduced by 2.96 Gy, 4.21 Gy, 0.16 Gy, 0.34 Gy, 0.15 Gy for the plans of single field 3D-mod, 2-field parallel opposed 3D-mod, 6-, 9-, and 18-field DET respectively. Our study showed these dose perturbation effects decreased with the increase of number of beam angles. Up to 6 beam angles may be required to reduce the dose perturbations from the gold fiducial markers to a clini- cally acceptable level in IMPT.
基金support of the Department of Radiation Oncology,Fudan University Shanghai Cancer Centersupported by Science and Technology Commission of Shanghai Municipality(14411962400)
文摘Background:To protect neurological tissues,underdosing occurs in most cases of T4 nasopharyngeal carcinoma(NPC) with intracranial extension.In this study,we aimed to evaluate the effect of dosimetric inadequacy on local control and late neurological toxicities for patients treated with intensity-modulated radiotherapy(IMRT) plus chemotherapy.Methods:We prospectively enrolled patients who had non-metastaticT4 NPC with intracranial extension treated between January 2009 and November 2013.The prescribed dose was 66.0-70.4 Gy to the primary planning target volume(primary gross tumor volume [GTVp;i.e.,the nasopharyngeal tumor] +5.0 mm).Dose-volume histogram parameters were calculated,including minimum point dose(D_(min)) and dose to 95% of the target volume(D95).All patients received chemotherapy with the cisplatin,5-fluorouracil,and docetaxel regimen.Survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.Results:In total,41 patients were enrolled.The local partial response rate was 87.8% after induction chemotherapy.With a median follow-up of 51 months,7 patients experienced failure in the nasopharynx;the 3-year local failure-free survival and overall survival rates of the 41 patients were 87.4% and 90.2%,respectively.The actual mean D_(min) to the GTVp was 55.2 Gy(range 48.3-67.3 Gy),and D95 was 61.6 Gy(range 52.6-69.0 Gy).All doses received by neurological organs remained well within their dose constraints.No patients developed temporal lobe necrosis or other neurological dysfunctions.Conclusions:With relative underdosed IMRT plus effective chemotherapy,the patients achieved satisfactory local control with few late toxicities of the central nervous system.Determining the acceptable extent of dosimetric inadequacy requires further exploration.
基金Project supported by the National Natural Science Foundation of China(Grant No.61605034)
文摘Using a pump with a multi-line spectrum to broaden the Brillouin gain bandwidth is an effective way to achieve lowdistortion amplification with high gain. Here, we theoretically and experimentally investigate the generation of a broadband Brillouin gain spectrum based on multi-frequency intensity modulation in an optical fiber. The arbitrary bandwidth of the Brillouin gain spectrum of stimulated Brillouin scattering(SBS) can be obtained as expected. In our experiment, a broadband Brillouin gain spectrum with a bandwidth of about 200 MHz is demonstrated. We also achieve a low-distortion amplification of a weak signal, whose maximum magnification is 65 d B for a-68-dBm input power signal.
基金supported by the Key Program of the 13th Five-Year Plan,the Hefei Institutes of Physical Science of the Chinese Academy of Sciences(No.KP-2017-24)
文摘Intensity-modulated proton therapy(IMPT)is becoming essential for proton therapy and is under rapid development.However,for IMPT,the lateral penumbra of the spot-scanning proton beam is still an urgent issue to be solved.Patient-specific block collimators(PSBCs),which can block unnecessary doses,play a crucial role in passive scattering delivery technology but are rarely used in spot scanning.One objective of this study is to investigate the lateral penumbra variations of intensity-modulated spot scanning with and without a PSBC.For fields with varying degrees of sharpness and at varying depths in a water phantom,the lateral penumbral widths were calculated using a Monte Carlo-based dose engine from RayStation 6.The results suggest that the lateral penumbral widths can be reduced by more than 30%for uniform target volumes,regardless of whether a range-shifter is used,and that the maximum dose beyond the field edges can be reduced significantly.The results of patient cases show that the doses in organs-at-risk near the edge of the target volume decrease if a PSBC is implemented.This study demonstrates that intensity-modulated spot scanning with a PSBC can effectively reduce the lateral penumbra and block unnecessary doses and is therefore promising for clinical applications in spot-scanning proton therapy.
基金supported by the National Key R&D Plan(No.2016YFA0401900)
文摘A bunch arrival-time monitor(BAM) based on an electro-optical intensity modulation scheme is currently under development at Shanghai Soft X-ray Free-Electron Laser to meet the high-resolution requirements for bunch stability. The BAM uses a radio frequency signal generated by a pickup cavity to modulate the reference laser pulses in an electro-optical intensity modulator(EOM), and the bunch arrival-time information is derived from the amplitude change of the laser pulse after laser pulse modulation.EOM is a key optical component in the BAM system.Through the basic principle analysis of BAM, many parameters of the EOM are observed to affect the measurement resolution of the BAM system. Therefore, a systematic analysis of the EOM is crucial. In this paper, we present two schemes to compare and analyze an EOM and provide a reference for selecting a new version of the EOM.
基金Project supported by the National Natural Science Foundation of China(Grant No.81272495)the Natural Science Foundation of Tianjin,China(Grant No.16JC2DJC32200)
文摘Recently, the phase compensation technique has allowed the ultrasound to propagate through the skull and focus into the brain. However, the temperature evolution during treatment is hard to control to achieve effective treatment and avoid over-high temperature. Proposed in this paper is a method to modulate the temperature distribution in the focal region. It superimposes two signals which focus on two preset different targets with a certain distance. Then the temperature distribution is modulated by changing triggering time delay and amplitudes of the two signals. The simulation model is established based on an 82-element transducer and computed tomography (CT) data of a volunteer's head. A finite- difference time-domain (FDTD) method is used to calculate the temperature distributions. The results show that when the distances between the two targets respectively are 7.5-12.5 mm on the acoustic axis and 2.0-3.0 mm in the direction perpendicular to the acoustic axis, a focal region with a uniform temperature distribution (64-65 ℃) can be created. Moreover, the volume of the focal region formed by one irradiation can be adjusted (26.8-266.7 mm3) along with the uniform temperature distribution. This method may ensure the safety and efficacy of HIFU brain tumor therapy.
基金supported by the National Natural Science Foundation of China,No.81360276a grant from the Science and Technology Project of Xinjiang Uygur Autonomous Region in China,No.2013911129+2 种基金a grant from the Youth Science and Technology Innovation Talents Project of Xinjiang Uygur Autonomous Region-Young Doctor Talents Training Project,No.2013731013the Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2012211B34the China Postdoctoral Science Foundation,No.2014M552566XB
文摘During radiotherapy to kill femoral hydatid tapeworms, the sciatic nerve surrounding the focus can be easily damaged by the treatment. Thus, it is very important to evaluate the effects of ra- diotherapy on the surrounding nervous tissue. In the present study, we used three-dimensional, conformal, intensity-modulated radiation therapy to treat bilateral femoral hydatid disease in Meriones meridiani. The focus of the hydatid disease on the left femur was subiected to radio- therapy (40 Gy) for 14 days, and the right femur received sham irradiation. Hematoxylin-eosin staining, electron microscopy, and terminal deoxynucleotidyl transferase-dUTP nick end labeling assays on the left femurs showed that the left sciatic nerve cell structure was normal, with no ob- vious apoptosis after radiation. Trypan blue staining demonstrated that the overall protoscolex structure in bone parasitized with Echinococcus granulosus disappeared in the left femur of the animals after treatment. The mortality of the protoscolex was higher in the left side than in the right side. The succinate dehydrogenase activity in the protoscolex in bone parasitized with Echi- nococcus granulosus was lower in the left femur than in the right femur. These results suggest that three-dimensional conformal intensity-modulated radiation therapy achieves good therapeutic effects on the secondary bone in hydatid disease in Meriones meridiani without damaging the morphology or function of the sciatic nerve.
文摘Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.
文摘In intensity modulated radiation treatment (IMRT) planning, the use of asymmetrically collimated fields that are placed on central axis or its off-set is mostly required. Output is the main topic discussed today for extremely small and/or severe irregularly shaped fields. The air scatter data are involved directly or indirectly in obtaining the output. Despite the fact that extensive data have been published in many studies to provide a guide on the magnitude of output factor for clinical accelerators, there are very few data reviewed about output factor in-air or phantom for off-set fields. This study was aimed to investigate the impact of these conditions for small fields. This study was conducted in Elekta Synergy linear accelerator which produces 6 MV X-ray energy. The in-air output factor (Sc) has been measured by CC04 ion chamber with brass-alloy “build-up” cap and Dose-1 electrometer, and the total output (Scp) measurements were carried on at dose maximum depth in phantom by the same chamber and Thermoluminescence dosimeter (TLD) for 1 - 10 cm2 fields. The all measurements at center of isocenter and off-set fields at three directions (X2, Y1, Diagonal) were done. By decreasing field size from 10 to 2 cm2 at isocenter, the Sc value using CC04 was decreased to 5.4% and Scp using CC04 and TLD to 14.5% and 11% respectively. By increasing off-set value, the Sc and Scp values were increased in all directions comparing to central fields. The maximum increase was obtained in Y1 direction for Sc and Scp. TLD results for Scp is slightly higher than CC04. The dosimetric properties of small fields and their off-set should be evaluated and modelled appropriately in the treatment planning system to ensure accurate dose calculation in Intensity Modulated Radiation Treatment.
文摘By using the linear approximation method, the intensity correlation function is calculated for a single-mode laser modulated by a bias signal and driven by colored pump and quantum noises with colored cross-correlation. We found that, when the correlation time between the two noises is very short, the behavior of the intensity correlation function versus the time, in addition to decreasing monotonously, also exhibits several cases, such as one maximum, one minimum, and two extrema. When the correlation time between the two noises is very long, the behavior of the intensity correlation function exhibits oscillation and the envelope is similar to the case of short cross-correlation time.
文摘Purpose: We performed both, dosimetric and positional accuracy verification of dynamic tumor tracking (DTT) intensity modulated radiation therapy (IMRT), with the Vero4DRT system using a moving phantom (QUASAR respiratory motion platform;QUASAR phantom) and system log files. Methods: The QUASAR phantom was placed on a treatment couch. Measurement of the point dose and dose distribution was performed for conventional IMRT, with the QUASAR phantom static and moving;for DTT IMRT, this was performed with the phantom moving for pyramid shaped, prostate, paranasal sinus, and pancreas targets. The QUASAR phantom was driven by a sinusoidal signal in the superior-inferior direction. Furthermore, predicted positional errors induced by the Vero4DRT system and mechanical positional errors of the gimbal head, were calculated using the system log files. Results and Conclusion: For DTT IMRT, the dose at the evaluation point was within 3% compared with the verification plan, and the dose distribution in the passing rates of γ was 97.9%, with the criteria of 3% dose and 3 mm distance to agreement. The position error calculated from the log files was within 2 mm, suggesting the feasibility of employing DTT IMRT with high accuracy using the Vero4DRT system.
基金supported by Program for New Century Excellent Talents in University(No.NCET-06-0925)
文摘The modulation depth, defined according to practical modulation results, which changes with the microwave power and its frequency, is significant for systems utilizing the frequency-shift characteristic of the LiNbO3 waveguide Electro-Optic Intensity Modulator (EOIM). By analyzing the impedance mismatch between the microwave source and the EOIM, the effective voltage applied to the RF port of the EOIM is deprived from the microwave power and its frequency. Associating with analyses of the phase velocity mismatch between the microwave and the optical wave, the theoretical modulation depth has been obtained, which is verified by experimental results. We provide a method to choose the appropriate modulation depth to optimize the desired sideband through proper transmission bias for the system based on the frequency-shift characteristic of the EOIM.
文摘Objective:This study was to compare 5 field conformal technique to the intensity modulated radiotherapy (IMRT) 8 fields technique in boosting locally advanced cancer cervix cases after external beam radiotherapy with respect to target volume coverage and dose to normal tissues. Methods:We conducted a single institutional comparative dosimetric analysis of 10 patients with cancer cervix who was presented to radiotherapy department in National Cancer Institute, Cairo in period between June 2012 to September 2012 and received a CRT boost in the place of planned brachytherapy after large field pelvic radiotherapy (PRT) with concurrent chemotherapy were retrospectively identified. All tumors were situated in the low central pelvis. Two plans were done for every patient; one using the 8 fields IMRT and the second one using 5 fields' 3DCRT the two techniques were then compared using dose volume histogram (DVH) analysis for the PTV, bladder, rectum and both femoral heads. Results:Comparing different DVHs, it was found that the planning target volume (PTV) was adequately covered in both plans while it was demonstrates that the 8 fields IMRT technique carried less doses reaching OARs (rectum, bladder, both femoral heads). Conclusion:From the present study, it is concluded that IMRT technique spared more efficiently OARs than CRT technique but both techniques covered the PTV adequately so whenever possible IMRT technique should be used.
基金Supported by a grant from Health Bureau of Lianyungang City’s Fund Program (No. 05051).
文摘Objective: To evaluate the clinical effects of concurrent and sequential therapy for middle and advanced stage non-small cell lung cancer (NSCLC) useing IMRT combined with NP regimen chemotherapy. Methods: Eighty patients with middle and advanced stage NSCLC were randomized into two groups. Forty patients were underwent sequential therapy and other 40 patients were underwent concurrent therapy. IMRT was used in radiotherapy and NP regimen of vinorelbine+cispatin (NP) was used in chemotherapy. Results: (1) The overall response (CR+PR) rate was 75% in concurrent group and 45% in sequential group (P<0.05); (2) The treatment courses were 84 days and 140 days for concurrent group and sequential group respectively (P<0.05); (3) One-year survival rate in concurrent group was 72.4% and 52.3% in sequential group respectively; (4) The toxic effects can be tolerable by all of patients. Conclusion: The concurrent chemo-radiotherapy has better overall re- sponse, one-year survival rate and shorter treatment course than the sequential chemo-radiotherapy, so it is a better method for the treatment of middle and advanced stage NSCLC, but the long term survival rate will be studied.
文摘Objective: The purpose of this study was to investigate the impact of intensity modulated radiotherapy (IMRT) on surface doses for brain, abdomen and pelvis deep located tumors treated with 6 MV photon and to evaluate the skin dose calculation accuracy of the XIO 4.04 treatment planning system. Methods: More investigations for the influences of IMRT on skin doses would increase its applications for many treatment sites. Measuring skin doses in real treatment situations would reduce the uncertainty of skin dose prediction. In this work a pediatric human phantom was covered by a layer of 1 mm bolus at three treatment sites and thermoluminescent dosimeter (TLD) chips were inserted into the bolus at each treatment site before CT scan. Two different treatment plans [three-dimensional conformal radiation therapy (3DCRT) and IMRT] for each treatment sites were performed on XIO 4.04 treatment planning system using superposition algorism. Results: The results showed that the surface doses for 3DCRT were higher than the surface doses in IMRT by 1.6%, 2.5% and 3.2% for brain, abdomen and pelvis sites respectively. There was good agreement between measured and calculated surface doses, where the calculated surface dose was 15.5% for brain tumor calculated with 3DCRT whereas the measured surface dose was 12.1%. For abdomen site the calculated surface dose for IMRT treatment plan was 16.5% whereas the measured surface dose was 12.6%. Conclusion: The skin dose in IMRT for deep seated tumors is lower than that in 3DCRT which is another advantage for the IMRT. The TLD readings showed that the difference between the calculated and measured point dose is negligible. The superposition calculation algorism of the XIO 4.04 treatment planning system modeled the superficial dose well.