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At least 487 records · Page 27
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

SU-D-BRB-07: Lipiodol Impact On Dose Distribution in Liver SBRT After TACE

Purpose: Stereotactic body radiotherapy (SBRT) combining transarterial chemoembolization (TACE) with Lipiodol is expected to improve local control. This study aims to evaluate the impact of Lipiodol on dose distribution by comparing the dosimetric performance of the Acuros XB (AXB) algorithm, anisotropic analytical algorithm (AAA), and Monte Carlo (MC) method using a virtual heterogeneous phantom and a treatment plan for liver SBRT after TACE. Methods: The dose distributions calculated using AAA and AXB algorithm, both in Eclipse (ver. 11; Varian Medical Systems, Palo Alto, CA), and EGSnrc-MC were compared. First, the inhomogeneity correction accuracy of the AXB algorithm and AAA was evaluated by comparing the percent depth dose (PDD) obtained from the algorithms with that from the MC calculations using a virtual inhomogeneity phantom, which included water and Lipiodol. Second, the dose distribution of a liver SBRT patient treatment plan was compared between the calculation algorithms. Results In the virtual phantom, compared with the MC calculations, AAA underestimated the doses just before and in the Lipiodol region by 5.1% and 9.5%, respectively, and overestimated the doses behind the region by 6.0%. Furthermore, compared with the MC calculations, the AXB algorithm underestimated the doses just before and in the Lipiodol region by 4.5% and 10.5%, respectively, and overestimated the doses behind the region by 4.2%. In the SBRT plan, the AAA and AXB algorithm underestimated the maximum doses in the Lipiodol region by 9.0% in comparison with the MC calculations. In clinical cases, the dose enhancement in the Lipiodol region can approximately 10% increases in tumor dose without increase of dose to normal tissue. Conclusion: The MC method demonstrated a larger increase in the dose in the Lipiodol region than the AAA and AXB algorithm. Notably, dose enhancement were observed in the tumor area; this may lead to a clinical benefit.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-89: Accuracy of Absolute Three-Dimensional Dose Distribution Measurement Using the Delta4

Purpose: In this study, we investigated the accuracy of the absolute dose distribution measurement using the Delta4 phantom compared to the measurements using a ionization chamber and EDR2 film Methods: Several conventional and intensity-modulated radiation therapy plans were used to compare the dose distribution measured using the Delta4 phantom to the absolute point dose using the chamber and the relative two-dimensional dose distribution using the EDR2 film. For the absolute dose distribution evaluation, the measurements using the Delta4, the chamber and the film were performed in similar measurement geometry. For point dose measurement using the chamber, an acrylic slab phantom with the PTW Semiflex chamber was inserted into the Delta4 phantom, alternative to the Delta4 main unit. Similarly, for dose distribution measurement using the film, the EDR2 film sandwiched with two acrylic slab phantoms were inserted to the phantom. Dose difference and gamma analysis were done for point dose and relative dose distribution comparisons, respectively. Results: The point dose measurements show slight negative systematic dose difference of −0.5 ± 0.1% and −1.0 ± 0.4% in the conventional and the IMRT plans, respectively. The additional measurement for direction dependency for Delta4 shows similar negative systematic dose difference even the phantom analysis software consider the directional dependency. The pass rate of the gamma evaluation was 77.7 ± 5.8% and 88.8±3.3% in the conventional and the IMRT plans, respectively. Conclusions: The Delta4 phantom shows a 1%-systematic dose difference derived from directional dependency and lower resolution compared to the film. Thus it is necessary to comprehensively evaluate the phantom to verify the IMRT/VMAT plans. Especially, the dosimetry tool is needed to have high resolution and high measurement accuracy in IMRT/VMAT-SBRT plan with small fields using intensity modulation in which the analysis area is limited and the higher correspondence between calculation and measurement is needed.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Technical Note: A Monte Carlo study of magnetic-field-induced radiation dose effects in mice

Purpose: Magnetic fields are known to alter radiation dose deposition. Before patients receive treatment using an MRI-linear accelerator (MRI-Linac), preclinical studies are needed to understand the biological consequences of magnetic-field-induced dose effects. In the present study, the authors sought to identify a beam energy and magnetic field strength combination suitable for preclinical murine experiments. Methods: Magnetic field dose effects were simulated in a mouse lung phantom using various beam energies (225 kVp, 350 kVp, 662 keV [Cs-137], 2 MV, and 1.25 MeV [Co-60]) and magnetic field strengths (0.75, 1.5, and 3 T). The resulting dose distributions were compared with those in a simulated human lung phantom irradiated with a 6 or 8 MV beam and orthogonal 1.5 T magnetic field. Results: In the human lung phantom, the authors observed a dose increase of 45% and 54% at the soft-tissue-to-lung interface and a dose decrease of 41% and 48% at the lung-to-soft-tissue interface for the 6 and 8 MV beams, respectively. In the mouse simulations, the magnetic fields had no measurable effect on the 225 or 350 kVp dose distribution. The dose increases with the Cs-137 beam for the 0.75, 1.5, and 3 T magnetic fields were 9%, 29%, and 42%, respectively. The dose decreases were 9%, 21%, and 37%. For the 2 MV beam, the dose increases were 16%, 33%, and 31% and the dose decreases were 9%, 19%, and 30%. For the Co-60 beam, the dose increases were 19%, 54%, and 44%, and the dose decreases were 19%, 42%, and 40%. Conclusions: The magnetic field dose effects in the mouse phantom using a Cs-137, 3 T combination or a Co-60, 1.5 or 3 T combination most closely resemble those in simulated human treatments with a 6 MV, 1.5 T MRI-Linac. The effects with a Co-60, 1.5 T combination most closely resemble those in simulated human treatments with an 8 MV, 1.5 T MRI-Linac.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Evaluation of a commercial MRI Linac based Monte Carlo dose calculation algorithm with GEANT 4

Purpose: This paper provides a comparison between a fast, commercial, in-patient Monte Carlo dose calculation algorithm (GPUMCD) and GEANT4. It also evaluates the dosimetric impact of the application of an external 1.5 T magnetic field. Methods: A stand-alone version of the Elekta™ GPUMCD algorithm, to be used within the Monaco treatment planning system to model dose for the Elekta™ magnetic resonance imaging (MRI) Linac, was compared against GEANT4 (v10.1). This was done in the presence or absence of a 1.5 T static magnetic field directed orthogonally to the radiation beam axis. Phantoms with material compositions of water, ICRU lung, ICRU compact-bone, and titanium were used for this purpose. Beams with 2 MeV monoenergetic photons as well as a 7 MV histogrammed spectrum representing the MRI Linac spectrum were emitted from a point source using a nominal source-to-surface distance of 142.5 cm. Field sizes ranged from 1.5 × 1.5 to 10 × 10 cm{sup 2}. Dose scoring was performed using a 3D grid comprising 1 mm{sup 3} voxels. The production thresholds were equivalent for both codes. Results were analyzed based upon a voxel by voxel dose difference between the two codes and also using a volumetric gamma analysis. Results: Comparisons were drawn from central axis depth doses, cross beam profiles, and isodose contours. Both in the presence and absence of a 1.5 T static magnetic field the relative differences in doses scored along the beam central axis were less than 1% for the homogeneous water phantom and all results matched within a maximum of ±2% for heterogeneous phantoms. Volumetric gamma analysis indicated that more than 99% of the examined volume passed gamma criteria of 2%—2 mm (dose difference and distance to agreement, respectively). These criteria were chosen because the minimum primary statistical uncertainty in dose scoring voxels was 0.5%. The presence of the magnetic field affects the dose at the interface depending upon the density of the material on either sides of the interface. This effect varies with the field size. For example, at the water-lung interface a 33.94% increase in dose was observed (relative to the D{sub max}), by both GPUMCD and GEANT4 for the field size of 2 × 2 cm{sup 2} (compared to no B-field case), which increased to 47.83% for the field size of 5 × 5 cm{sup 2} in the presence of the magnetic field. Similarly, at the lung-water interface, the dose decreased by 19.21% (relative to D{sub max}) for a field size of 2 × 2 cm{sup 2} and by 30.01% for 5 × 5 cm{sup 2} field size. For more complex combinations of materials the dose deposition also becomes more complex. Conclusions: The GPUMCD algorithm showed good agreement against GEANT4 both in the presence and absence of a 1.5 T external magnetic field. The application of 1.5 T magnetic field significantly alters the dose at the interfaces by either increasing or decreasing the dose depending upon the density of the material on either side of the interfaces.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

SU-F-J-86: Method to Include Tissue Dose Response Effect in Deformable Image Registration

Purpose: Organ changes shape and size during radiation treatment due to both mechanical stress and radiation dose response. However, the dose response induced deformation has not been considered in conventional deformable image registration (DIR). A novel DIR approach is proposed to include both tissue elasticity and radiation dose induced organ deformation. Methods: Assuming that organ sub-volume shrinkage was proportional to the radiation dose induced cell killing/absorption, the dose induced organ volume change was simulated applying virtual temperature on each sub-volume. Hence, both stress and heterogeneity temperature induced organ deformation. Thermal stress finite element method with organ surface boundary condition was used to solve deformation. Initial boundary correspondence on organ surface was created from conventional DIR. Boundary condition was updated by an iterative optimization scheme to minimize elastic deformation energy. The registration was validated on a numerical phantom. Treatment dose was constructed applying both the conventional DIR and the proposed method using daily CBCT image obtained from HN treatment. Results: Phantom study showed 2.7% maximal discrepancy with respect to the actual displacement. Compared with conventional DIR, subvolume displacement difference in a right parotid had the mean±SD (Min, Max) to be 1.1±0.9(−0.4∼4.8), −0.1±0.9(−2.9∼2.4) and −0.1±0.9(−3.4∼1.9)mm in RL/PA/SI directions respectively. Mean parotid dose and V30 constructed including the dose response induced shrinkage were 6.3% and 12.0% higher than those from the conventional DIR. Conclusion: Heterogeneous dose distribution in normal organ causes non-uniform sub-volume shrinkage. Sub-volume in high dose region has a larger shrinkage than the one in low dose region, therefore causing more sub-volumes to move into the high dose area during the treatment course. This leads to an unfavorable dose-volume relationship for the normal organ. Without including this effect in DIR, treatment dose in normal organ could be underestimated affecting treatment evaluation and planning modification. Acknowledgement: Partially Supported by Elekta Research Grant.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2012

Dose-Effect Relationships for Individual Pelvic Floor Muscles and Anorectal Complaints After Prostate Radiotherapy

Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). Methods and Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. Results: The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: {<=}30 Gy to the IAS; {<=}10 Gy to the EAS; {<=}50 Gy to the PRM; and {<=}40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Conclusions: Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are excluded.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

Purpose: The dosimetric impact of dose probability based planning target volume (PTV) margins for liver cancer patients receiving stereotactic body radiation therapy (SBRT) was compared with standard PTV based on the internal target volume (ITV). Plan robustness was evaluated by accumulating the treatment dose to ensure delivery of the intended plan. Methods and Materials: Twenty patients planned on exhale CT for 27 to 50 Gy in 6 fractions using an ITV-based PTV and treated free-breathing were retrospectively evaluated. Isotoxic, dose escalated plans were created on midposition computed tomography (CT), representing the mean breathing position, using a dose probability PTV. The delivered doses were accumulated using biomechanical deformable registration of the daily cone beam CT based on liver targeting at the exhale or mean breathing position, for the exhale and midposition CT plans, respectively. Results: The dose probability PTVs were on average 38% smaller than the ITV-based PTV, enabling an average ± standard deviation increase in the planned dose to 95% of the PTV of 4.0 ± 2.8 Gy (9 ± 5%) on the midposition CT (P<.01). For both plans, the delivered minimum gross tumor volume (GTV) doses were greater than the planned nominal prescribed dose in all 20 patients and greater than the planned dose to 95% of the PTV in 18 (90%) patients. Nine patients (45%) had 1 or more GTVs with a delivered minimum dose more than 5 Gy higher with the midposition CT plan using dose probability PTV, compared with the delivered dose with the exhale CT plan using ITV-based PTV. Conclusions: For isotoxic liver SBRT planned and delivered at the mean respiratory, reduced dose probability PTV enables a mean escalation of 4 Gy (9%) in 6 fractions over ITV-based PTV. This may potentially improve local control without increasing the risk of tumor underdosing.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Cytogenetic Low-Dose Hyperradiosensitivity Is Observed in Human Peripheral Blood Lymphocytes

Purpose: The shape of the ionizing radiation response curve at very low doses has been the subject of considerable debate. Linear-no-threshold (LNT) models are widely used to estimate risks associated with low-dose exposures. However, the low-dose hyperradiosensitivity (HRS) phenomenon, in which cells are especially sensitive at low doses but then show increased radioresistance at higher doses, provides evidence of nonlinearity in the low-dose region. HRS is more prominent in the G2 phase of the cell cycle than in the G0/G1 or S phases. Here we provide the first cytogenetic mechanistic evidence of low-dose HRS in human peripheral blood lymphocytes using structural chromosomal aberrations. Methods and Materials: Human peripheral blood lymphocytes from 2 normal healthy female donors were acutely exposed to cobalt 60 γ rays in either G0 or G2 using closely spaced doses ranging from 0 to 1.5 Gy. Structural chromosomal aberrations were enumerated, and the slopes of the regression lines at low doses (0-0.4 Gy) were compared with doses of 0.5 Gy and above. Results: HRS was clearly evident in both donors for cells irradiated in G2. No HRS was observed in cells irradiated in G0. The radiation effect per unit dose was 2.5- to 3.5-fold higher for doses ≤0.4 Gy than for doses >0.5 Gy. Conclusions: These data provide the first cytogenetic evidence for the existence of HRS in human cells irradiated in G2 and suggest that LNT models may not always be optimal for making radiation risk assessments at low doses.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Volumetric-modulated arc therapy (RapidArc) vs. conventional fixed-field intensity-modulated radiotherapy for {sup 18}F-FDG-PET-guided dose escalation in oropharyngeal cancer: A planning study

Fluorine-18-fluorodeoxyglucose-positron emission tomography ({sup 18}F-FDG-PET)–guided focal dose escalation in oropharyngeal cancer may potentially improve local control. We evaluated the feasibility of this approach using volumetric-modulated arc therapy (RapidArc) and compared these plans with fixed-field intensity-modulated radiotherapy (IMRT) focal dose escalation plans. Materials and methods: An initial study of 20 patients compared RapidArc with fixed-field IMRT using standard dose prescriptions. From this cohort, 10 were included in a dose escalation planning study. Dose escalation was applied to {sup 18}F-FDG-PET–positive regions in the primary tumor at dose levels of 5% (DL1), 10% (DL2), and 15% (DL3) above standard radical dose (65 Gy in 30 fractions). Fixed-field IMRT and double-arc RapidArc plans were generated for each dataset. Dose-volume histograms were used for plan evaluation and comparison. The Paddick conformity index (CI{sub Paddick}) and monitor units (MU) for each plan were recorded and compared. Both IMRT and RapidArc produced clinically acceptable plans and achieved planning objectives for target volumes. Dose conformity was significantly better in the RapidArc plans, with lower CI{sub Paddick} scores in both primary (PTV1) and elective (PTV2) planning target volumes (largest difference in PTV1 at DL3; 0.81 ± 0.03 [RapidArc] vs. 0.77 ± 0.07 [IMRT], p = 0.04). Maximum dose constraints for spinal cord and brainstem were not exceeded in both RapidArc and IMRT plans, but mean doses were higher with RapidArc (by 2.7 ± 1 Gy for spinal cord and 1.9 ± 1 Gy for brainstem). Contralateral parotid mean dose was lower with RapidArc, which was statistically significant at DL1 (29.0 vs. 29.9 Gy, p = 0.01) and DL2 (29.3 vs. 30.3 Gy, p = 0.03). MU were reduced by 39.8–49.2% with RapidArc (largest difference at DL3, 641 ± 94 vs. 1261 ± 118, p < 0.01). {sup 18}F-FDG-PET–guided focal dose escalation in oropharyngeal cancer is feasible with RapidArc. Compared with conventional fixed-field IMRT, RapidArc can achieve better dose conformity, improve contralateral parotid sparing, and uses fewer MU.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Heterogeneity-corrected vs -uncorrected critical structure maximum point doses in breast balloon brachytherapy

Recent studies have reported potentially clinically meaningful dose differences when heterogeneity correction is used in breast balloon brachytherapy. In this study, we report on the relationship between heterogeneity-corrected and -uncorrected doses for 2 commonly used plan evaluation metrics: maximum point dose to skin surface and maximum point dose to ribs. Maximum point doses to skin surface and ribs were calculated using TG-43 and Varian Acuros for 20 patients treated with breast balloon brachytherapy. The results were plotted against each other and fit with a zero-intercept line. Max skin dose (Acuros) = max skin dose (TG-43) ⁎ 0.930 (R{sup 2} = 0.995). The average magnitude of difference from this relationship was 1.1% (max 2.8%). Max rib dose (Acuros) = max rib dose (TG-43) ⁎ 0.955 (R{sup 2} = 0.9995). The average magnitude of difference from this relationship was 0.7% (max 1.6%). Heterogeneity-corrected maximum point doses to the skin surface and ribs were proportional to TG-43-calculated doses. The average deviation from proportionality was 1%. The proportional relationship suggests that a different metric other than maximum point dose may be needed to obtain a clinical advantage from heterogeneity correction. Alternatively, if maximum point dose continues to be used in recommended limits while incorporating heterogeneity correction, institutions without this capability may be able to accurately estimate these doses by use of a scaling factor.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2017

Importance of deformable image registration and biological dose summation in planning of radiotherapy retreatments

The purpose of this study is to evaluate the effect of nonrigid and fractionation-corrected dose summation on total doses in radiotherapy and to demonstrate the benefits of such dose summation on clinical decision-making for planning of retreatments. Dose summation of organs at risk (OARs) was investigated for 3 clinical cases with need of retreatment to the same site: head and neck, brain, and mediastinum. Three different summation methods over old and new radiotherapy treatment plans are presented and compared: (1) rigid raw sum with rigid registration of the planning images and direct dose summing; (2) deformable raw sum with deformable image registration and direct dose summing; and (3) deformable biological sum with deformable registration and takes into account the dose per fraction in biological manner in certain critical organs. In 2 cases, a user-defined dose downscaling is applied to take into account the time between the treatments and the healing from the radiation-induced effects. Of the 3 summation methods presented, the deformable biological sum was considered to offer the most biologically plausible account of the treatment. There were remarkable differences between near-maximum doses (D0.1cc) and dose-volume histogram (DVH) curves for OARs between different summation methods. The differences between deformable raw sum and rigid raw sum D0.1cc doses are in the range from −8 Gy to 2 Gy. Similarly, the deviation was from −14 Gy to 5 Gy for the deformable biological sum compared with the rigid raw sum. These differences come from incorrect summation of doses in the rigid raw sum case, and from the dose per fraction effect in biological summation. We conclude that computing the 3-dimensional deformable biological summation could be a valuable tool for treating patients with complex retreatments. It has the potential to assist the oncologist in refining plans for maximally curative doses while respecting appropriate tissue tolerances.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Moving from gamma passing rates to patient DVH-based QA metrics in pretreatment dose QA

Purpose: The purpose of this work is to explore the usefulness of the gamma passing rate metric for per-patient, pretreatment dose QA and to validate a novel patient-dose/DVH-based method and its accuracy and correlation. Specifically, correlations between: (1) gamma passing rates for three 3D dosimeter detector geometries vs clinically relevant patient DVH-based metrics; (2) Gamma passing rates of whole patient dose grids vs DVH-based metrics, (3) gamma passing rates filtered by region of interest (ROI) vs DVH-based metrics, and (4) the capability of a novel software algorithm that estimates corrected patient Dose-DVH based on conventional phan-tom QA data are analyzed. Methods: Ninety six unique ''imperfect'' step-and-shoot IMRT plans were generated by applying four different types of errors on 24 clinical Head/Neck patients. The 3D patient doses as well as the dose to a cylindrical QA phantom were then recalculated using an error-free beam model to serve as a simulated measurement for comparison. Resulting deviations to the planned vs simulated measured DVH-based metrics were generated, as were gamma passing rates for a variety of difference/distance criteria covering: dose-in-phantom comparisons and dose-in-patient comparisons, with the in-patient results calculated both over the whole grid and per-ROI volume. Finally, patient dose and DVH were predicted using the conventional per-beam planar data as input into a commercial ''planned dose perturbation'' (PDP) algorithm, and the results of these predicted DVH-based metrics were compared to the known values. Results: A range of weak to moderate correlations were found between clinically relevant patient DVH metrics (CTV-D95, parotid D{sub mean}, spinal cord D1cc, and larynx D{sub mean}) and both 3D detector and 3D patient gamma passing rate (3%/3 mm, 2%/2 mm) for dose-in-phantom along with dose-in-patient for both whole patient volume and filtered per-ROI. There was considerable scatter in the gamma passing rate vs DVH-based metric curves. However, for the same input data, the PDP estimates were in agreement with actual patient DVH results. Conclusions: Gamma passing rate, even if calculated based on patient dose grids, has generally weak correlation to critical patient DVH errors. However, the PDP algorithm was shown to accurately predict the DVH impact using conventional planar QA results. Using patient-DVH-based metrics IMRT QA allows per-patient dose QA to be based on metrics that are both sensitive and specific. Further studies are now required to analyze new processes and action levels associated with DVH-based metrics to ensure effectiveness and practicality in the clinical setting.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2012

On the dosimetric effect and reduction of inverse consistency and transitivity errors in deformable image registration for dose accumulation

Purpose: Deformable image registration (DIR) is necessary for accurate dose accumulation between multiple radiotherapy image sets. DIR algorithms can suffer from inverse and transitivity inconsistencies. When using deformation vector fields (DVFs) that exhibit inverse-inconsistency and are nontransitive, dose accumulation on a given image set via different image pathways will lead to different accumulated doses. The purpose of this study was to investigate the dosimetric effect of and propose a postprocessing solution to reduce inverse consistency and transitivity errors. Methods: Four MVCT images and four phases of a lung 4DCT, each with an associated calculated dose, were selected for analysis. DVFs between all four images in each data set were created using the Fast Symmetric Demons algorithm. Dose was accumulated on the fourth image in each set using DIR via two different image pathways. The two accumulated doses on the fourth image were compared. The inverse consistency and transitivity errors in the DVFs were then reduced. The dose accumulation was repeated using the processed DVFs, the results of which were compared with the accumulated dose from the original DVFs. To evaluate the influence of the postprocessing technique on DVF accuracy, the original and processed DVF accuracy was evaluated on the lung 4DCT data on which anatomical landmarks had been identified by an expert. Results: Dose accumulation to the same image via different image pathways resulted in two different accumulated dose results. After the inverse consistency errors were reduced, the difference between the accumulated doses diminished. The difference was further reduced after reducing the transitivity errors. The postprocessing technique had minimal effect on the accuracy of the DVF for the lung 4DCT images. Conclusions: This study shows that inverse consistency and transitivity errors in DIR have a significant dosimetric effect in dose accumulation; Depending on the image pathway taken to accumulate the dose, different results may be obtained. A postprocessing technique that reduces inverse consistency and transitivity error is presented, which allows for consistent dose accumulation regardless of the image pathway followed.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Failure-probability driven dose painting

Purpose: To demonstrate a data-driven dose-painting strategy based on the spatial distribution of recurrences in previously treated patients. The result is a quantitative way to define a dose prescription function, optimizing the predicted local control at constant treatment intensity. A dose planning study using the optimized dose prescription in 20 patients is performed.Methods: Patients treated at our center have five tumor subvolumes from the center of the tumor (PET positive volume) and out delineated. The spatial distribution of 48 failures in patients with complete clinical response after (chemo)radiation is used to derive a model for tumor control probability (TCP). The total TCP is fixed to the clinically observed 70% actuarial TCP at five years. Additionally, the authors match the distribution of failures between the five subvolumes to the observed distribution. The steepness of the dose–response is extracted from the literature and the authors assume 30% and 20% risk of subclinical involvement in the elective volumes. The result is a five-compartment dose response model matching the observed distribution of failures. The model is used to optimize the distribution of dose in individual patients, while keeping the treatment intensity constant and the maximum prescribed dose below 85 Gy.Results: The vast majority of failures occur centrally despite the small volumes of the central regions. Thus, optimizing the dose prescription yields higher doses to the central target volumes and lower doses to the elective volumes. The dose planning study shows that the modified prescription is clinically feasible. The optimized TCP is 89% (range: 82%–91%) as compared to the observed TCP of 70%.Conclusions: The observed distribution of locoregional failures was used to derive an objective, data-driven dose prescription function. The optimized dose is predicted to result in a substantial increase in local control without increasing the predicted risk of toxicity.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

SU-E-T-94: Daily Fraction Dose Recalculation Based On Rigid Registration Using Cone Beam CT

Purpose: To calculate the daily fraction dose for a CBCT recalculation based on rigid registration and compare it to the planned CT dose. Methods: For this study, 30 patients that were previously treated (10 SBRT lung, 10 prostate and 10 abdomen) were considered. The daily CBCT images were imported into the Pinnacle treatment planning system from Mosaic. The prescribing physician contoured the regions of interest (ROI) on each CBCT and then dose was computed on each CBCT. Each CBCT dose distribution was then compared against the plan. The evaluation was based on isodose line comparison and Dose Volume Histogram comparison. Results: In the case of lung patients the dose differences between daily dose and plan dose were considered small. The PTV coverage was not compromised and the dose to the organs at risk had negligible differences. Larger differences were observed for prostate and abdomen patients. In these cases, although the PTV doses did not change on a daily basis, the doses to the organs at risk had significant differences. For a prostate patient, the bladder dose at 35% volume was 2714.444 cGy for the CT plan and 2844.747, 2801.556, 3552.37, and 2970.968 cGy for subsequent CBCTs. For the PTV on a SBRT patient, however, the CT plan had a dose at 35% volume of 6917.71 cGy and 6815.385, 6892.5, 6896.25, and 6922.9 cGy for the CBCTs. Conclusion: Daily dose validation is feasible using CBCT and treatment planning system. It provides means to evaluate the course of treatment for the patient undergoing radiation therapy and can assist in the decision of the need of adaptation of the treatment plan.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-641: Development and Verification of Automatic Reading Dose of Interest From Eclipse's DVH

Purpose: According to clinical and research requirement, we develop a function of automatic reading dose of interest from dose volume histogram(DVH), to replace the traditional method with a mouse one by one point, and it's also verified. Methods: The DVH automatic reading function will be developed in an in-house developed radiotherapy information management system(RTIMS), which is based on Apache+PHP+MySQL. A DVH ASCII file is exported from Varian Eclipse V8.6, which includes the following contents: 1. basic information of patient; 2. dose information of plan; 3. dose information of structures, including basic information and dose volume data of target volume and organ at risk. And the default exported dose volume data also includes relative doses by 1% step and corresponding absolute doses and cumulative relative volumes, and the volumes are 4 decimal fraction. Clinically, we often need read the doses of some integer percent volumes, such as D50 and D30. So it couldn't be directly obtained from the above data, but we can use linear interpolation bye the near volumes and doses: Dx=D2−(V2−Vx)*(D2−D1)/(V2−V1), and program a function to search, read and calculate the corresponding data. And the doses of all preseted volume of interest of all structures can be automatically read one by one patient, and saved as a CSV file. To verify it, we select 24 IMRT plans for prostate cancer, and doses of interest are PTV D98/D95/D5/D2, bladder D30/D50, and rectum D25/D50. Two groups of data, using the automatic reading method(ARM) and pointed dose method(PDM), are analyzed with SPSS 16. The absolute difference=D-ARM-D-PDM, relative difference=absolute difference*100%/prescription dose(7600cGy). Results: The differences are as following: PTV D98/D95/D5/D2: −0.04%/− 0.04%/0.13%/0.19%, bladder D30/D50: −0.02%/0.01%, and rectum D25/D50: 0.03%/0.01%. Conclusion: Using this function, the error is very small, and can be neglected. It could greatly improve the efficiency of clinical work. Project supported by the National Natural Science Foundation of China (Grant No.81101694)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

DMLC tracking and gating can improve dose coverage for prostate VMAT

Purpose: To assess and compare the dosimetric impact of dynamic multileaf collimator (DMLC) tracking and gating as motion correction strategies to account for intrafraction motion during conventionally fractionated prostate radiotherapy. Methods: A dose reconstruction method was used to retrospectively assess the dose distributions delivered without motion correction during volumetric modulated arc therapy fractions for 20 fractions of five prostate cancer patients who received conventionally fractionated radiotherapy. These delivered dose distributions were compared with the dose distributions which would have been delivered had DMLC tracking or gating motion correction strategies been implemented. The delivered dose distributions were constructed by incorporating the observed prostate motion with the patient's original treatment plan to simulate the treatment delivery. The DMLC tracking dose distributions were constructed using the same dose reconstruction method with the addition of MLC positions from Linac log files obtained during DMLC tracking simulations with the observed prostate motions input to the DMLC tracking software. The gating dose distributions were constructed by altering the prostate motion to simulate the application of a gating threshold of 3 mm for 5 s. Results: The delivered dose distributions showed that dosimetric effects of intrafraction prostate motion could be substantial for some fractions, with an estimated dose decrease of more than 19% and 34% from the planned CTVD{sub 99%} and PTV D{sub 95%} values, respectively, for one fraction. Evaluation of dose distributions for DMLC tracking and gating deliveries showed that both interventions were effective in improving the CTV D{sub 99%} for all of the selected fractions to within 4% of planned value for all fractions. For the delivered dose distributions the difference in rectum V{sub 65%} for the individual fractions from planned ranged from −44% to 101% and for the bladder V{sub 65%} the range was −61% to 26% from planned. The application of tracking decreased the maximum rectum and bladder V{sub 65%} difference to 6% and 4%, respectively. Conclusions: For the first time, the dosimetric impact of DMLC tracking and gating to account for intrafraction motion during prostate radiotherapy has been assessed and compared with no motion correction. Without motion correction intrafraction prostate motion can result in a significant decrease in target dose coverage for a small number of individual fractions. This is unlikely to effect the overall treatment for most patients undergoing conventionally fractionated treatments. Both DMLC tracking and gating demonstrate dose distributions for all assessed fractions that are robust to intrafraction motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

Purpose: To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Methods: Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. Results: The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8% − 25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2 ± 3.3 and 16.5 ± 2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the fix-mA doses with local mA values; (2) the general power law relationship between dose and kVp varied from location to location, with the power index ranged between 2.7 and 3.5. The averaged dose measurements at both nipples, which were about 0.6 cm outside the prescribed scan region, ranged from 23 to 27 mGy at the left nipple, and varied from 3 to 20 mGy at the right nipple over the three scan protocols. Large fluctuations over repeated scans were also observed, as a combined result of helical scans of large pitch (1.375) and small active areas of the skin dosimeters. In addition, the averaged skin dose fell off drastically with the distance to the nearest boundary of the scanned region. Conclusions: This study revealed the complexity of CT dose fluctuation and variation with a human cadaver.

60 APPLIED LIFE SCIENCES↗